Role and challenges of simulation in undergraduate curriculum.

RATIONALE: Medical simulation is relatively a novel technology widely utilized for teaching and assessing students clinical skills. Students and faculty face many challenges when simulation sessions are introduced into undergraduate curriculum. OBJECTIVES: The aim of this study is to obtain the opinion of undergraduate medical students and our faculty regarding the role of simulation in undergraduate curriculum, the simulation modalities used, and the perceived barriers in implementing simulation sessions. METHODS: A self-administered pilot tested questionnaire with 18 items using a 5-point Likert scale was distributed to undergraduate male (n = 125) and female students (n = 70) as well as to the faculty members (n = 14) at King Fahad Medical City, King Saud Bin Abdul Aziz University of Health Sciences, Saudi Arabia, to respond. Survey elements addressed the role of simulation, simulation modalities used, and perceived challenges to implementation of simulation sessions. RESULT: Various learning outcomes are achieved and improved through the technology enhanced simulation sessions such as communication skills, diagnostic skills, procedural skills, self-confidence, and integration of basic and clinical sciences. The use of high fidelity simulators, simulated patients and task trainers was more desirable by our students and faculty for teaching and learning as well as an evaluation tool. According to most of the students', institutional support in terms of resources, staff and duration of sessions was adequate. However, motivation to participate in the sessions and provision of adequate feedback by the staff was a constraint. CONCLUSION: The use of simulation laboratory is of great benefit to the students and a great teaching tool for the staff to ensure students learn various skills.

Gender differences in learning styles and academic performance of medical students in Saudi Arabia.

RATIONALE: Teachers at medical school are often faced with challenges of improving student satisfaction with the learning environment. On the other hand, education in the medical field is very competitive and medical students are exposed to diverse methods of teaching. Students adapt specific learning styles to keep pace with the information delivered to them in their institutions. OBJECTIVE: The aim of this study is to know the differences in learning styles between male and female students, and the effect it has on academic performance. METHOD: The VARK Questionnaire version 7.0 (Visual, Aural, Read/Write and Kinesthetic) was administered to the fourth year and fifth year medical students at King Saud Bin Abdul Aziz University for Health Sciences, Faculty of Medicine at King Fahad Medical City, Saudi Arabia for determining the preferred learning methods of students participating in this study. The learning styles were then compared to cumulative grade point average (GPA) obtained by the students. RESULT: The dominant learning style preference of students was multimodal. Among students who preferred unimodal preference, aural and kinesthetic preference was predominant for males and females. Moreover, Females had more diverse preferences than male students. Multimodal learners have higher cumulative GPAs when compared with the unimodal learners. CONCLUSION: This study revealed variation in learning style preferences among genders, and its implications on academic performance of medical students.

Laboratory Characteristics on SARS-CoV-2 Infection among Patients with Diabetes Mellitus: A Single-Center Retrospective Study.

Background: Diabetic patients have been severely affected by COVID-19 infection. It has been reported that the disease is more progressive leading to venous and arterial thromboembolism, due to multiple factors. This study was conducted to determine the hematologic parameters including D-dimer in diabetic patients with COVID-19 infection in association with disease severity and treatment. Method: This retrospective cohort study was conducted at King Fahad Medical City, Saudi Arabia, after obtaining IRB approval, by collecting data regarding all laboratory parameters, disease severity, and anticoagulant treatment of COVID-19 diabetic patients (n = 159) from medical records from March to December 2020. Result: Mean value of white blood cells, neutrophils, monocytes, eosinophils, lymphocyte monocyte ratio, C-reactive protein, serum ferritin, and LDH levels was elevated in severe cases than in mild cases with statistical significant increase in HbA1c (0.047), serum fibrinogen (0.007), C-reactive protein (0.005), serum ferritin (0.034), and serum LDH (0.015). Mortality was observed in 14 (8.8%) patients mostly with severe COVID-19 with diabetes. In our study, treatment with low molecular weight heparin was not significantly related to severity. A logistic regression analysis indicated an association of some laboratory parameters with severity and mortality of the disease. Conclusion: The routine blood parameters if detected early will enable physicians to identify severe cases of COVID-19 patients with Diabetes for prompt treatment and save considerable time and resources.

Risk of Infertility Index in Women with Polycystic Ovarian Syndrome.

OBJECTIVE: To construct the risk of infertility index for women with polycystic ovarian syndrome, that can be used to assess the prognostic factors for conception; and categorise them in mild, moderate and high-risk groups. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: King Fahad Medical City, Riyadh, Saudi Arabia from March 2017 to  February 2018.   Methodology: Fifty women who were diagnosed as polycystic ovarian syndrome were selected by simple randomisation. After initial scrutiny, 39 women with all clinical, biochemical and sonographic features of Rotterdam criteria were included. Patients with congenital adrenal hyperplasia (CAH) and premature ovarian insufficiency (POI) were excluded. Risk of infertility (RII) scale was used to assess the score in women with polycystic ovarian syndrome (PCOS) and classify them into different risk categories like mild (score ≤7), moderate  (score 8-10) and severe  (score >10). RESULTS: There were 5.1% cases with a mild score, 61.5% with a moderate score, and 33.3% with a severe score. For cases in the high-risk group, 89.8% of women had no pregnancy. RII with the cut-off point of 12.5 had a sensitivity of 100%, and specificity of 88.2%, for the defined outcome. Area under the curve was 0.553 and 95% CI was 48.3% (lower bound) and 62.3% (upper bound). CONCLUSION: PCOS patients can be categorised in mild, moderate and high-risk depending on the score on RII scale. The patients with higher score of RII had fewer chances of pregnancy with assisted reproductive technologies (ART). Once the intensity of the risk of PCOS is identified, focused management can be implied thereby reducing the duration of infertility and cost of the treatment. Key Words: Risk, Female infertility, Index, Polycystic ovarian syndrome, Assisted reproductive technology.

Angiographic analysis of the variation of arterial collaterals in moyamoya and atherosclerosis at a tertiary care center in Saudi Arabia.

OBJECTIVES: To evaluate the anatomical variation of arterial collaterals and their prevalence in moyamoya and atherosclerosis. METHODS: Data was collected retrospectively from patients (n=46) database who underwent digital subtraction angiography between January 2010 and December 2018 at the Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia. Demographic details and clinical data of the patients such as age, gender, etiology, clinical presentation, angiographic staging using Suzuki grading for moyamoya cases, variation of arterial collaterals, and their prevalence, treatment and follow up were obtained. RESULTS:    Four types of collaterals network  were observed in atherosclerosis (n=21) and moyamoya (n=25); the leptomeningeal, durocortical, subependymal, inner-interstriatal and intrathalamic networks. More number of collaterals were observed in the moyamoya (n=534) than atherosclerosis (n=40). Leptomeningeal network (n=198, 37.1%) and subependymal network (n=170, 31.8%) were greater than durocortical and inner-interstriatal or intrathalamic in patients with moyamoya. Whereas leptomeningeal network (n=25, 62.5%) and inner-interstriatal or intrathalamic (n=7, 17.5%) were predominant in atherosclerosis. Out of 25 cases of moyamoya, Suzuki grading V was noted in 5 (20%) and grade IV in 13 (52%). CONCLUSION: Understanding the dynamics that have evolved in the development of the collaterals and  therefore can improve both management and prognosis.

Anatomy of Inferior Mesenteric Artery in Fetuses.

Aim. To analyze Inferior Mesenteric Artery in fetuses through its site of origin, length, diameter, and variation of its branches. Method. 100 fetuses were collected from various hospitals in Warangal at Kakatiya Medical College in Andhra Pradesh, India, and were divided into two groups, group I (second-trimester fetuses) and group II (third-trimester fetuses), followed by dissection. Result. (1) Site of Origin. In group I fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra in 33 out of 34 fetuses (97.2%). In one fetus it was at first lumbar vertebra, 2.8%. In all group II fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra. (2) Length. In group I fetuses it ranged between 18 and 30 mm, average being 24 mm except in one fetus where it was 48 mm. In group II fetuses the length ranged from 30 to 34 mm, average being 32 mm. (3) Diameter. In group I fetuses it ranged from 0.5 to 1 mm, and in group II fetuses it ranged from 1 to 2 mm, average being 1.5 mm. (4) Branches. Out of 34 fetuses of group I, 4 fetuses showed variation. In one fetus left colic artery was arising from abdominal aorta, 2.9%. In 3 fetuses, Inferior Mesenteric Artery was giving a branch to left kidney, 8.8%. Out of 66 fetuses in group II, 64 had normal branching. In one fetus left renal artery was arising from Inferior Mesenteric Artery, 1.5%, and in another fetus one accessory renal artery was arising from Inferior Mesenteric Artery and entering the lower pole of left kidney. Conclusion. Formation, course, and branching pattern of an artery depend on development and origin of organs to attain the actual adult position.