The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study.

OBJECTIVES: the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. METHODS: this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals. RESULTS: The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). CONCLUSIONS: We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.

Caffeine protects against hippocampal alterations in type 2 diabetic rats via modulation of gliosis, inflammation and apoptosis.

Type 2 diabetes (T2D) is implicated in the injury of several organs, including the brain resulting in neuronal damage, which may lead to cognitive impairment and dementia. Additionally, it is linked to inflammation, cytokine release, apoptosis and various degenerative conditions. Astrocytes and microglia might have a role in mediating these processes. Caffeine, a psychoactive beverage, has been shown to reduce the risk of cognitive and memory impairment. This study proposes anti-inflammatory and anti-apoptotic role of caffeine, which can be mediated via microglia/astrocyte activation and overexpression of pro-inflammatory molecules. T2D was induced in rats by feeding with high fat high sugar diet and injecting a single low dose streptozotocin (STZ) intraperitoneally. Other diabetic rats were given caffeine orally (in two doses) for 5 weeks, starting 1 week before STZ injection. Measurement of plasma cytokines, TNFα and IL6, was performed using enzyme-linked immunosorbent assay (ELISA) technique. After sacrificing animals, brains were obtained and processed for histological evaluation. Immunohistochemistry was also performed using the following primary antibodies, anti-astrocyte marker GFAP, anti-microglia marker CD11b and apoptotic marker (anti-cleaved caspase-3). There was upregulation of IL6 and TNF-α in diabetic rats. Additionally, histological evaluation of the hippocampus of diabetic rats revealed cellular degeneration. There was increased immunostaining of GFAP, CD11b and cleaved caspase-3 in diabetic rats. Pretreatment with caffeine to diabetic rats, resulted in improvement of structural changes and decrease in cytokine levels and immuno-markers, expression, and this was in a dose-dependent manner. In conclusion, caffeine had an ameliorative role in enhancing hippocampal degenerative changes in T2D.

Perception of online and face to face microbiology laboratory sessions among medical students and faculty at Arabian Gulf University: a mixed method study.

BACKGROUND: The COVID-19 pandemic has impacted all spheres of society including medical education and healthcare systems. In response to the pandemic, there has been a transition in medical education practice from traditional forms of teaching to online instruction delivery and virtual learning. Effective clinical microbiology education involves a combination of 'hands-on' practical learning and instructional delivery of scientific knowledge. Microbiology practical laboratories are critical learning environments offering 'hands-on' learning experiences that cannot be replicated through online learning. We conducted a mixed-methods study to understand the perception of online and face-to-face microbiology laboratory sessions among the medical students and microbiology faculty at Arabian Gulf University (AGU). METHODS: The study participants were third and fourth-year undergraduate medical students and faculty involved in delivering microbiology labs at AGU. The questionnaire consisted of questions ranging from perceived learning style to attitude towards online delivery of microbiology curriculum. After the questionnaire administration (google form), focus group discussion (FGD) was conducted for students and microbiology faculty separately. RESULTS: Among 168 students, 50.6% preferred face-to-face lab sessions as compared to 30.4% who preferred online labs, and 51.8% considered online labs to be an essential addition to face-to-face labs. Among the faculty, 85.7% preferred the face-to-face mode of teaching. All the faculty (100%) disagreed that all the microbiology labs teaching should be online. 57.2% considered online labs to be an essential addition to traditional face-to-face labs. Both faculty and students hold that a blended mode of instructional delivery is vital and indispensable for the transfer of skills and knowledge for microbiology students. CONCLUSION: The blended mode of delivering microbiology laboratory sessions in medical school is successful and well-received by both students and faculty. Students take the responsibility for furthering their own learning and understanding of concepts. Instructors have also noticed that blending learning strategies also successfully enhances the development of cognitive skills and problem-solving abilities in students. A review of the microbiology lab curriculum is necessary to identify content areas that can be delivered effectively through online, face-to-face lab sessions, or both, supported with appropriate tools and infrastructure.

Ambulatory Pharmacotherapy of Five Psychiatric Disorders in Bahrain: a Descriptive Study.

We examined the outpatient prescription pattern of psychotropic drugs used for the treatment of five major psychiatric diseases in Bahrain. Setting outpatient department of the main psychiatric hospital in Bahrain. Methods This was a retrospective, cross-sectional study in which we targeted randomly selected prescriptions (n = 992, 56.1% males, 43.9% females) from 1st of January until 31st of December, 2017. Main outcome measure the types of outpatient psychotropic drugs prescribed by the physicians. Results The pharmacotherapy of schizophrenia consisted of atypical anti-psychotics (92.8%), or typical anti-psychotics (17.8%). The anti-depressants used were: Selective-serotonin reuptake inhibiters (SSRIs) (41.6%), Serotonin-norepinephrine reuptake inhibiters (SNRIs) (34.5%), tricyclic anti-depressants (TCAs) (12.8%), and atypical anti-depressants (10.6%). Combination anti-depressants was employed in (12.4%) of cases. The pharmacotherapy for anxiety disorders was composed of benzodiazepines (59.5%), atypical anti-psychotics (45.2%), SSRIs (40.5%), SNRIs (28.6%), TCAs (14.3%), and anti-convulsants (16.7%) and atypical anti-psychotics (7.1). The medications prescribed for bipolar disorder were atypical anti-psychotics (78.6%), anti-convulsants (66.5%), benzodiazepines (27.7%), typical anti-psychotics (8.9%) and lithium (6.7%). Schizoaffective disorder patients received atypical anti-psychotics (97.3%), anti-convulsants (47.8%), benzodiazepines (27.4%), SNRIs (25.7%), SSRIs (15%), typical anti-psychotics (10.6%), atypical anti-depressants (10.6%) and TCAs (6.2%). A combination of antipsychotics and anti-depressants was employed in 33.6% and 4.7% of all subjects regardless of the diagnosis, respectively. Conclusions With a few exceptions, the pharmacotherapy of psychiatric diseases in Bahrain was in line with the latest recommendations. However, psychotropic polypharmacy was observed and calls for immediate attention.

Pharmacology and therapeutics resource session attendance and academic performance of pre-clerkship medical students in problem-based learning curricula.

BACKGROUND: The relationship between large-group classroom attendance by students and test achievement in problem-based learning (PBL) curricula is unclear. This study examined the correlation between attendance at resource sessions (hybrid lectures in the PBL curriculum) and test scores achieved in pharmacology and determined whether the score achieved was related to student gender. METHODS: A cross-sectional observational study over one academic year of 1404 pre-clerkship medical students was performed. Class attendance during pharmacology resource sessions and MCQ test scores achieved in pharmacology were analysed. RESULTS: The percentage of students' attendance in resource sessions declined over three years of the programme, from 78.7 ± 27.5 in unit I to 22.1 ± 35.6 (mean ± SD) in unit IX. A significant but weakly positive correlation was evident between attendance and achievement in pharmacology (r = 0.280; p < 0.0001). The mean score of the students who attended > 50% of the resource sessions was significantly higher (p < 0.0001). Students who attended ≤50% were more likely to achieve lower tertile scores. The mean score achieved and the number of higher tertile scorers were higher among students who attended > 50% of the resource sessions. Although female students' attendance was significantly higher, no significant gender-related differences in either mean scores or top grades achieved were found. CONCLUSIONS: In a PBL curriculum, the classroom attendance of students in pharmacology declined during the pre-clerkship phase. A weak positive correlation was found between attendance and academic achievement, as measured by MCQ test scores. Factors other than motivation and attendance may confound gender-based academic performance and merit further research.

Therapeutic regimens for vitamin D deficiency in postmenopausal women: a systematic review.

INTRODUCTION: We reviewed the most effective vitamin D3 regimen for vitamin D deficiency in postmenopausal women. MATERIAL AND METHODS: We searched for studies and clinical trials conducted on healthy postmenopausal women published on PubMed from 2000 to 2018 using the term "Vitamin D deficiency" combined with the following terms: "dose", "supplement", "supplementation", "cholecalciferol" or "cholecalciferol dose". We identified 1376 articles which matched the search criteria. Based on reviewing the title and abstract, 17 articles were eligible for a full-text review. Of those, 12 manuscripts were ultimately included. RESULTS: A majority of the studies (75%) reported using daily maintenance doses which were predominantly administered orally (83.3%). Two studies reported favorable results following therapy with a single oral dose of 300,000 IU. After one month, however, 25-hydroxy vitamin D [25(OH)D] was satisfactory; both studies failed to maintain adequate responses after 60 and 90 days. One study found that loading oral doses of 50,000 IU/day for 2 weeks followed by the same doses every 2 weeks for one year were effective. Five studies employed oral doses of 800 IU/day but none of them reported that this dose was adequate. Three studies used doses of 1000 IU/day but only two of them reported positive results. Three trials examined oral doses of 2000 IU/day and another 3 studies tested oral doses of 4000-4800 IU/day. All of them reported acceptable responses that lasted with continued treatment. CONCLUSIONS: Oral maintenance doses of 2000-4800 IU/day satisfactorily corrected vitamin D deficiency and maintained 25(OH)D levels in postmenopausal women with continuous therapy.

Therapeutic and maintenance regimens of vitamin D3 supplementation in healthy adults: A systematic review.

Studies carried out assessing the effect of different doses of cholecalciferol (vitamin D3) on correcting serum 25-hydroxyvitamin D deficiency in healthy adults are limited and review studies are lacking. Moreover, the maintenance dose and its duration offered by these few studies are inconsistent. We performed a systematic review of randomized clinical controlled trials (RCTs) that assessed the effect of different doses of vitamin D3 on serum 25(OH)D in healthy adults. PubMed database was searched from 2010 to 2018 using the following search terms: "vitamin D deficiency", "Cholecalciferol", "vitamin D3 dose", "vitamin D supplement", "vitamin D therapy". RCTs and original articles that evaluated different doses of vitamin D3 were identified. A total of sixteen (out of 3016) acceptable studies fulfilling our inclusion criteria were included in the current systematic review. Our results revealed that supplementation with vitamin D3 had a significant positive effect in raising serum 25(OH) D concentrations. Our findings indicated that the best regimen of vitamin D3 supplement consisted of an initial large bolus dose either IM injection of 600.000 IU monthly or oral dose of 200.000 IU monthly or 50.000 IU weekly for 8 weeks, followed by a maintenance dose of 50.000 IU monthly or bimonthly. A large bolus therapeutic dose of vitamin D3, frequently or infrequently for 8 weeks, followed by long-term oral maintenance dose of 50.000 IU monthly or bimonthly optimiz and manitain vitamin D serum levels year round.

Barriers to colorectal cancer screening in Palestine: a national study in a medically underserved population.

BACKGROUND & AIMS: Cultural, religious, and financial barriers can hinder uptake of colorectal cancer (CRC) screening in Arab communities. We aim to understand attitudes and barriers that contribute to the low rate of CRC screening among Palestinians in the West Bank. METHODS: We performed a national, cross-sectional study of Palestinian adults older than 50 years. A self-administered questionnaire was developed and validated. Data were randomly collected in all major districts of the West Bank. The primary outcome was the willingness to undergo CRC screening. Multivariable logistic regression models were used to assess the strength of association between the primary outcome and its predictors while controlling for possible confounders. RESULTS: Of 1601 people approached for an interview, 1352 agreed to participate (response rate, 84%). Only 193 had undergone CRC screening (14%); 1069 (79%) agreed to take a fecal occult blood test, 906 (67%) agreed to a colonoscopy examination, and 1098 (81%) were willing to undergo CRC screening if recommended by a physician. Only 194 (14%) said they had been informed about CRC screening by a physician. Urban residents were more likely to be screened for CRC than nonurban residents (odds ratio, 0.73; 95% confidence interval, 0.56-0.93; P = .011). Multivariable analysis showed that lack of education beyond elementary school or familiarity with CRC screening, distrust of Western medicine, religious objection, and finding the test to be embarrassing were all associated with decreased odds of accepting CRC screening. CONCLUSIONS: Based on a national, cross-sectional study of Palestinian adults, there are many cultural and religious barriers to CRC screening. Improving our understanding of these could increase screening among Arab populations in the Middle East and in Western countries.

Irritable bowel syndrome in middle-aged and elderly Palestinians: its prevalence and effect of location of residence.

OBJECTIVES: The prevalence of irritable bowel syndrome (IBS) around the world is variable, ranging from as little as 1.1 to 45%. Limited studies have been carried out in Arab populations. The aim of this study was to determine the prevalence of IBS and its subtypes in the West Bank, Palestine, and to assess variation by locality of residence. METHODS: We conducted a population-based, cross-sectional study. Participants were randomly selected from all districts of the West Bank, including cities, villages, and refugee camps, and they were at least 50 years of age. Participants completed the Rome III IBS questionnaire along with demographic data. The primary outcome was the effect of location of residence on the prevalence of IBS. A multivariable logistic regression model was used to assess the difference in IBS prevalence based on locality of residence. RESULTS: A total of 1,601 people were approached for interview, of which 1,352 agreed to participate (response rate 84%). Most participants (53%; n=637) lived in urban centers. The overall prevalence of IBS was 30% (28-33%). IBS was more common in refugee camps (34%) and in villages (34%) compared with urban centers (27%) (P<0.05). Mixed IBS (IBS-M) was the most common of IBS subtypes (55%, n=244). In a multivariable logistic regression analysis, living in refugee camps (odds ratio (OR) 1.68 (95% confidence interval (CI) 1.14-2.40), P=0.005) and in villages (OR 1.33 (1.02-1.72), P=0.033) was associated with increased odds of having IBS when compared with residents of urban centers. IBS, IBS with constipation, and IBS-M were more common in women than in men (P<0.05). CONCLUSIONS: The prevalence of IBS among middle-aged and elderly residents of Palestine is high. Residents in refugee camps and rural areas have a higher incidence of IBS than those in urban areas.

Isothiocyanate-cysteine conjugates protect renal tissue against cisplatin-induced apoptosis via induction of heme oxygenase-1.

Heme oxygenase-1 (HO-1) is a redox sensitive inducible enzyme endowed with important antioxidant and cytoprotective activities. Here we report that two water-soluble isothiocyanate-cysteine conjugates, S-[N-benzyl(thiocarbamoyl)]-l-cysteine (BTTC) and S-[N-(3-phenylpropyl)(thiocarbamoyl)]-l-cysteine (PTTC), potently increase HO-1 protein expression and heme oxygenase activity in renal tubular epithelial cells at 5 and 10µM, while higher concentrations are themselves cytotoxic and pro-apoptotic. Inhibitors of the pro-survival pathways ERK, MAPK and PI3K almost completely abolished the increase in HO-1 induction and heme oxygenase activity, while the JNK pathway appeared to be mainly involved in the apoptosis triggered by the isothiocyanates. We also found that renal cells exposed to 50µM cisplatin (CDDP), a chemotherapeutic agent known for its nephrotoxic actions, displayed a marked increase in caspase-3 activity and the number of apoptotic cells. These effects were abolished by pre-incubation of cells with concentrations of BTCC or PTCC that maximize HO-1 induction and were reversed by the inhibitor of heme oxygenase activity tin protoporphyrin IX (SnPPIX). Moreover, in a model of CDDP-induced nephrotoxicity in vivo, pre-treatment of rats with a daily dose of BTCC or PTCC (25mg/kg, i.p.) completely abolished the increase in serum creatinine and urea levels and markedly reduced the severity of renal tissue apoptosis caused by CDDP. The renoprotective effects of BTCC and PTCC in vivo were markedly attenuated by administration of rats with SnPPIX. These findings indicate that water-soluble isothiocyanates counteract renal dysfunction and apoptosis by up-regulating the HO-1 system and could be used as a supplementary treatment to mitigate CDDP-induced nephrotoxic effects.

Perceptions of Medical Students on Distance Learning During the COVID-19 Pandemic: A Cross-Sectional Study from Bahrain.

Purpose: The COVID-19 pandemic resulted in a sudden shift from face-to-face to distance learning. We explored medical students' views of online learning during this pandemic at the Arabian Gulf University in Bahrain. Methods: This was a cross-sectional study of students in years two, three and four (n= 559) using an electronic questionnaire. Data were collected from April 10 to May 5, 2021. The survey included three domains: behavioral, affective, and cognitive. We also analyzed the association between students' perceptions and certain demographic and institutional factors. Results: The number of respondents was 311 (response rate: 55.6%; 27.7% males, 72.3% females). Participants were generally satisfied with distance learning (54.6%), although they had less motivation (46.3%) and required more effort (32.2%). Most students preferred distance learning for theoretical parts, and face-to-face approach for practical components (73.3%). Participants reported that distance learning, improved interaction with instructors and classmates (45.6% and 48.9%, respectively), small group learning (47.6%), independent learning (75.3%) and problem-solving skills (44.7%). The students were comfortable with online assessment (60.1%), and reported improved achievement in written (42.1%) and practical examinations (46%), but not in professional skills grades (21.6%). There was no association between students' perceptions and gender (p= 0.079), year of study (p= 0.28) or attendance of live or recorded sessions (p= 0.904), but there was a positive association with the availability of WiFi (p< 0.01) and attendance of college-organized activities (p< 0.0001). Conclusion: Distance learning was successfully implemented during the COVID-19 pandemic. Students were generally satisfied with distance learning and online assessment, but they had concerns about the clinical skills learning. After the pandemic is over, theoretical components of the curriculum can be delivered using distance learning, whereas hands on elements should be offered face-to-face. However, those curricular reforms will likely need investing in the information technology infrastructure.

Prescribing patterns of psychotropic medications in psychiatric disorders: a descriptive study from Palestine.

Background The practice patterns of psychiatrists have changed over the last two decades. Objectives This study describes the pattern of prescribing psychotropic drugs in treating common psychiatric disorders, and investigates the rate of polypharmacy and potential drug-drug interactions. Setting Psychiatry governmental outpatient clinic in the north of West Bank, Palestine. Methods Cross-sectional study that included all prescriptions which were issued over the period October 2018 to January 2019, for patients diagnosed with schizophrenia, depression, anxiety, bipolar disorder and schizoaffective disorders, and checked for the presence and the grade of potential drug-drug interactions using "Medscape drug interactions checker". Main outcome measure Prescribing patterns of psychotropic drugs. Results A total of 1045 prescriptions were examined. The mean age of the patients was 47.3 years (SD = 13.6), two-thirds of the patients (64.5%) were males. Fifty-two percent of the patients were diagnosed with schizophrenia while 15.2% were diagnosed with depression. The later third was diagnosed with bipolar disorder, schizoaffective and anxiety disorders (15.8%, 11.1% and 5.1% respectively). The most commonly prescribed drugs were typical antipsychotics for schizophrenia, bipolar and schizoaffective disorders, selective serotonin reuptake inhibitors for depression and tricyclic anti-depressants for anxiety. Polypharmacy was found in 877 prescriptions (84%), and drug-drug interactions (DDIs) were identified in 823 (94%) prescriptions. The DDIs were classified as minor (4, 0.5%), significant (418, 50.8%) and serious (401, 48.7%). Conclusions Our results suggest that the pharmacotherapy of psychiatric disorders in Palestine may not be in accordance to international guidelines and the incidence of polypharmacy and DDIs is high.

Language barriers to studying medicine in English: perceptions of final-year medical students at the Arabian Gulf University.

BACKGROUND: English is the language of instructions in many medical schools in the Arab world. Its use may create a language barrier and adversely affect an individual's learning and later professional life. AIMS: This study examined the views of final-year Arab medical students of a language barrier and its effect on their learning and academic performance, and their language preference for medial education. METHODS: All final-year medical students (n = 142, 62% females) at the Arabian Gulf University, Bahrain, were invited to respond to a self-completed questionnaire. Differences in responses according to English proficiency and sex were assessed. RESULTS: Of the 142 students, 99 (70%) responded. Most students did not feel a language barrier irrespective of their proficiency in English (P = 0.088). Most respondents did not think that language issues made studying more difficult, although there was a significant difference in responses between students considered proficient in English and those less proficient (P = 0.005). Most students (82%) were not aware or were not sure of medical terms in Arabic, but 66% were confident that they would be able to communicate with patients in Arabic. About half of the students (51%) supported medicine being taught only in English and 36% supported teaching in Arabic and English. CONCLUSIONS: Most students thought that learning in English did not affect their academic learning and performance. However, a good proportion supported being taught medicine in Arabic and English.

Prevalence of drugs with constipation-inducing potential and laxatives in community-dwelling older adults in Bahrain: therapeutic implications.

OBJECTIVES: This study evaluated the prevalence of prescribing drugs with constipation-inducing potential and the prophylactic use of laxatives in community-dwelling older adults. METHOD: An audit of outpatient prescriptions ordered for older adults aged ≥65 years with one or more chronic morbidities in 24 governmental primary healthcare centres in Bahrain. The prescriptions were collected by pharmacist-in-charge of each health centre between December 2015 and June 2016. The proportion of prescriptions with constipation-inducing drugs and co-prescribed laxatives was determined. KEY FINDINGS: The overall prevalence of prescribing drugs with the potential to cause constipation was 30.5% (642/2106). Prescriptions with at least one anticholinergic/drug with anticholinergic potential (DAP) were 22.5% (473/2106): single medication in 16.6% (350/2106) and two or more combinations in 5.9% (124/2106). A combination of two or more anticholinergics/DAP accounted for 2.9% (61/2106) prescriptions. Constipation-inducing drugs other than anticholinergics such as multivalent cation preparations and non-dihydropyridine calcium channel blockers were prescribed in 8.0% (168/2106) of cases. Orphenadrine and first-generation antihistamines, both with high anticholinergic drug burden, were the frequently prescribed medications, either alone or combined. The rate of prescribed laxatives was 2.96% (19/642), mostly for those on constipation-inducing drug monotherapy. CONCLUSION: Approximately a third of prescriptions for older adults had constipation-inducing medications, typically a single DAP. Prescribing laxatives were uncommon and did not correlate with the prevalence of prescribing drugs with constipation potential. Physicians' awareness about anticholinergic drugs and their potential risks, and the prophylactic use of laxatives to mitigate iatrogenic constipation are to be included in continuing professional programmes.

Evaluation of Curricular Adaptations Using Digital Transformation in a Medical School in Arabian Gulf during the COVID-19 Pandemic.

BACKGROUND: Several institutions adopted innovative approaches to ensure continued learning for their students during the COVID-19 pandemic. All curricular innovations should undergo curriculum evaluation; hence, the objective of this paper was to share the salient features of evaluation using faculty and student's feedback on curricular adaptations implemented through digital transformation in a Medical School in Arabian Gulf during the COVID-19 pandemic, using a structured questionnaire. METHODOLOGY: After getting informed consent, feedback about acceptability and limitations regarding various aspects of curricular adaptations was obtained from students and faculty, using a structured and validated questionnaire. The response rate from faculty and students was 90% and 60%, respectively. The qualitative responses were analyzed using thematic analysis. RESULTS: About 97% agreed that Modular Object-Oriented Dynamic Learning Environment, ZOOM, and Examsoft platforms were effective for curriculum delivery and assessment. 85% agreed that they were able to maintain online interactivity and 92% conveyed their willingness to continue to use these digital innovations even after the end of pandemic. "Lack of interactivity," "missed clinical training," "live sessions were more engaging than recorded ones" were the prominent themes emerged out of thematic analysis. All faculty and students expressed concern over the lack of clinical training involving real patients. All of them expressed appreciation to the university and faculty for their enormous efforts. CONCLUSION: Innovative ways should be considered to start clinical teaching with real patients, during pandemic. The learning outcomes of digital learning should be validated across all institutions. New indicators related to "digital learning" should be considered for accreditation of medical schools.

Impact Of Prenatal Administration Of Melamine On Foetal Growth In Rats.

BACKGROUND: Data on the potential effects of maternal exposure to melamine is scarce. We aimed to evaluate the impact of melamine administration on pregnancy outcome and foetal growth in rats. METHODS: Positively-mated female Sprague-Dawley rats (n=24) were treated from day 6 to day 20 of gestation with vehicle (control), melamine 300 mg/kg/day (group-1) or melamine 450 mg/kg/day (group 2). On day 21, the numbers of foetal resorptions and dead foetuses were recorded. Thereafter, pups were examined for external anomalies, and various growth parameters were measured. RESULTS: A remarkable increase in the number of resorptions was observed in group-2 compared to the other two groups. A significant increase in foetal weight and placental weight was seen in group-2 compared to control. Head length and placental diameter were low in group-1 compared to control. The ratio between crown-rump length and head length was significantly greater in group 2 compared to control indicating asymmetrical intrauterine growth restriction. The only influence observed in group 1 compared to control was a decrease in placental diameter. No gross foetal malformations or changes in umbilical cord length, crownrump length or biparietal diameter were observed in both melamine-treated groups. CONCLUSIONS: Maternal exposure to melamine during pregnancy increased the incidence of resorption and resulted in asymmetrical intrauterine growth restriction.

Antihypertensive Prescribing Pattern in Older Adults: Implications of Age and the Use of Dual Single-Pill Combinations.

INTRODUCTION: Hypertension, if not appropriately treated, is associated with life-threatening complications. AIMS: This study evaluated antihypertensive prescribing patterns in older adults (≥ 65 years) versus young adults based on the current guidelines with an emphasis on the use of dual single-pill combinations (SPCs). METHODS: A nationwide audit of 8746 primary care prescriptions of hypertensive patients with comorbidities in Bahrain was performed. RESULTS: Antihypertensive combination therapy was prescribed more often to older (77.1%) than young adults (68.6%; P < 0.0001) whereas SPCs were under-used (57.6% vs. 69.4%; P < 0.0001). Recommended dual SPCs, without/with a combination of a free-dose complementary antihypertensive agent, were significantly less often prescribed for the older adult as compared to young adult adults (45.1% vs. 62.99% and 35.97% vs. 46.72%; P < 0.0001), respectively. Unacceptable two- and three-drug combinations (including those with limited clinical evidence and unacceptable ones) were prescribed more often to older adults rather than to young ones (20.06% vs. 12.6%; and 56.5% vs. 46.8%; P < 0.0001), respectively. In both age groups, the top-three antihypertensive classes prescribed as monotherapy were angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and ß blockers. CONCLUSION: The updated guidelines for hypertension treatment in older adults have had a limited impact on primary care practice in Bahrain. In both age groups, there was a high positive correlation between the number of antihypertensive drugs prescribed and prescribing unacceptable combinations. Unacceptable combinations comprising SPC-related antihypertensive therapy duplication were more common than those reported elsewhere. Introducing approved triple SPCs may discourage prescribing unacceptable antihypertensive drugs and their combinations that lack robust evidence.

Understanding Preclerkship Medical Students' Poor Performance in Prescription Writing.

OBJECTIVES: This study aimed to explore reasons for poor performance in prescription writing stations of the objective structured practical examination (OSPE) and absenteeism in prescription writing sessions among preclerkship medical students at the Arabian Gulf University (AGU) in Manama, Bahrain. METHODS: This descriptive study was carried out between September 2014 and June 2015 among 157 preclerkship medical students at AGU. Data were collected using focus group discussions and a questionnaire with closed- and open-ended items. RESULTS: All 157 students participated in the study (response rate: 100.0%). The most frequently cited reasons for poor performance in OSPE stations were an inability to select the correct drugs (79.6%), treatment duration (69.4%), drug quantity (69.4%) and drug formulation (68.2%). Additionally, students reported inadequate time for completing the stations (68.8%). During focus group discussions, students reported other reasons for poor performance, including examination stress and the difficulty of the stations. Absenteeism was attributed to the length of each session (55.4%), lack of interest (50.3%), reliance on peers for information (48.4%) and optional attendance policies (47.1%). Repetitive material, large group sessions, unmet student expectations and the proximity of the sessions to summative examinations were also indicated to contribute to absenteeism according to open-ended responses or focus group discussions. CONCLUSION: This study suggests that AGU medical students perform poorly in prescription writing OSPE stations because of inadequate clinical pharmacology knowledge. Participation in prescription writing sessions needs to be enhanced by addressing the concerns identified in this study. Strategies to improve attendance and performance should take into account the learner-teacher relationship.

Prescription Writing in Small Groups as a Clinical Pharmacology Educational Intervention: Perceptions of Preclerkship Medical Students.

Medical students do not perform well in writing prescriptions, and the 3 variables-learner, teacher, and instructional method-are held responsible to various degrees. The objective of this clinical pharmacology educational intervention was to improve medical students' perceptions, motivation, and participation in prescription-writing sessions. The study participants were second-year medical students of the College of Medicine and Medical Sciences of the Arabian Gulf University, Bahrain. Two prescription-writing sessions were conducted using clinical case scenarios based on problems the students had studied as part of the problem-based learning curriculum. At the end of the respiratory system subunit, the training was conducted in small groups, each facilitated by a tutor. At the end of the cardiovascular system subunit, the training was conducted in a traditional large-group classroom setting. Data were collected with the help of a questionnaire at the end of each session and a focus group discussion. A majority of the students (95.3% ± 2.4%) perceived the small-group method better for teaching and learning of all aspects of prescription writing: analyzing the clinical case scenario, applying clinical pharmacology knowledge for therapeutic reasoning, using a formulary for searching relevant prescribing information, and in writing a complete prescription. Students also endorsed the small-group method for better interaction among themselves and with the tutor and for the ease of asking questions and clarifying doubts. In view of the principles of adult learning, where motivation and interaction are important, teaching and learning prescription writing in small groups deserve a serious consideration in medical curricula.

Competence of medical students in communicating drug therapy: Value of role-play demonstrations.

OBJECTIVES: This study used role-play demonstrations to train medical students to communicate drug therapy and evaluated the perceptions on this instructional approach. MATERIALS AND METHODS: The second-year medical students who attended a prescription writing session (n = 133), participated in this study. Prescription communication was introduced by using role-play demonstrations. Participant's perceptions were explored by a self-administered questionnaire and focus group discussion. The academic achievement of attendees and nonattendees was compared with an objective structured performance evaluation (OSPE) station that tested students' competence in this skill. RESULTS: Most attendees responded to the questionnaire (81.2%). Almost all respondents expressed their desire to have similar demonstrations in other units. A large proportion of participants reported that role-play demonstrations helped them develop their communication skills, in general, confidence to communicate drug-related information in a prescription, and the ability to explain the aim of drug therapy to patients. Most trainees thought also that they developed skills to communicate instructions on drug use including drug dose, frequency of administration, duration of therapy, adverse drug reactions, and warnings. During the focus group interviews, students thought that role-play was useful but would be more beneficial if conducted frequently in small group as part of the curriculum implementation. The majority of students also reported improved competence in writing a complete prescription. Analysis of attendees and nonattendees grades in the OSPE showed that the former scored higher than the latter group (P = 0.016). CONCLUSIONS: Role-play demonstrations were well accepted by medical students and led to the development of their competence in communicating drug therapy to patients.