Switching from face-to-face to an online teaching strategy: how anatomy and physiology teaching transformed post-COVID-19 for a university preprofessional program.

The College of Science and Health Professions offers a university preprofessional program. Like most medical schools in Saudi Arabia, the teaching delivery strategy in the university preprofessional program is on campus and face-to-face. During the month of March 2020, teaching activities of the spring semester were proceeding as normal; however, the sudden emergence of COVID-19 disturbed routine activities and compelled authorities to switch all teaching activities from face-to-face to online. Training sessions and workshops for all stakeholders on online delivery methods were arranged. Blackboard and other online facilities were utilized. All teaching materials, including newly made video clips for anatomy and physiology practicals, were uploaded on Blackboard and discussed online with students. Students' anxiety related to the exam was reassured by giving them the option of open book quizzes during summative continuous assessment. All scheduled teaching sessions, lectures, and practicals were conducted proficiently. Revision sessions and assessment quizzes were conducted with students' satisfaction. At the end of the semester, a final exam was conducted online as an open book exam. Students with technical issues while attempting the exam were given an opportunity to make up for it. After a successful final exam, the cumulative block grades showed students secured higher grades in the open book exam. Following that, the King Saud bin Abdulaziz University for Health Sciences has managed to conduct on-campus close book exams that abide by self-distancing and standard operating procedure policies.

Approaches used for teaching anatomy and physiology in the university pre-professional program at King Saud bin Abdulaziz University for Health Sciences.

Many medical schools offer pre-professional programs to undergraduate students. The main purpose of the university pre-professional program (UPPP) is to equip students with the necessary knowledge and skills required to successfully cope with the academic demands of further education provided by professional colleges. The aim of this commentary article is to describe the role of UPPP at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in preparing students to continue studies at the College of Medicine (COM) and other health-related colleges. The anatomy and physiology course is presented as a representative model. An outline of the UPPP in the context of the curriculum, teaching strategies, learning facilities, and assessment is presented. The pre-professional program at KSAU-HS prepares school graduates to become self-learners and enable them to learn effectively in the clinical context in a problem-based learning curriculum at COM.

Analgesic, anti-inflammatory and toxic effects of ethanol extracts of Cucumis melo and Citrullus lanatus seeds.

Plants are vital in drug discovery, since many safe and bioactive molecules have been discovered from plants in past, hence this study was designed to evaluate analgesic, anti-inflammatory and toxic effects of Cucumis melo and Citrullus lanatus. Seeds of these plants were selected due to their traditional value for medicinal use. Analgesic activity was determined in mice by Eddy's Hot plate and tail flick method, while anti-inflammatory activity was evaluated by hind paw edema method. Both seed extracts produced highly significant analgesic effects comparable to standard drugs at all three doses by both methods. The extract of C. lanatus showed significant anti-inflammatory activity at 100 mg while showed highly significant activity at 200 mg between 3 to 24 hours as compared to standard drugs. Both extracts did not reveal any mortality up to 1000mg/kg, while there was also no change in normal the gross behavior pattern of the animals at the dose of 50 and 100mg/kg, however there was increase in passivity, sedation and startle response at 200mg/kg. Analgesic and anti-inflammatory effects of extracts may be due to presence of cucurbitacin A, B or E in both seeds which are thought to inhibit COX 2. Results indicate that seeds of C. melo and C. lanatus may be effectively used as adjuvant analgesic and anti-inflammatory agents in situation of chronic pain and inflammation.

Anti-inflammatory effects of Citrus sinensis L., Citrus paradisi L. and their combinations.

Citrus bioflavonoids embrace a wide group of phenolic compounds effecting the production and scavenging of reactive oxygen species and the processes relating free radical-mediated injury. Keeping in view of the antioxidant and anti-inflammatory properties of Citrus sinensis and Citrus paradisi, present study was undertaken to explore the effects of C. sinensis (orange juice) and C. paradisi (grapefruit juice) at three different doses alone and their two combinations with the objective to examine the effects of these compounds in an experimental model of rat colitis induced by trinitrobenzenesulphonic acid (TNBS). Hence biochemical parameters e.g. myeloperoxidase, alkaline phosphatase, C-reactive protein (CRP) and glutathione were assessed. Data entry and analysis was accomplished by Statistical Package for the Social Sciences version 17 and was presented as mean ± S.E.M with 95% confidence interval. Present result shows that these juices, mainly C. paradisi, may be efficacious for the management of inflammatory bowel disease. In acute colitis model, C. paradise encouraged a decrease in the extension of the lesion escorted by a decrease in the occurrence of diarrhea and reinstatement of the glutathione content. Related effects were produced by the administration of C. sinensis, which also prevented the myeloperoxidase and alkaline phosphatase actions in acute intestinal inflammatory process. The effect of the citrus juices on the inflammatory process may be associated to their antioxidant and anti-inflammatory properties, as revealed in present investigation. The favorable effects exerted were demonstrated both by histological and biochemical changes and were related with a progress in the colonic oxidative status.

Assessment of sub-chronic, hematological and histopathological toxicities of a herbal combination.

The herbal combination under study consists of Withania somnifera, Tribulus terrestris, Mucuna pruriens and Argyria speciosa. Present study is mainly designed to investigate the gross physical, sub-chronic, hematological and histopathological effects of the combination widely used for its stimulating, revitalizing and fertility boosting effects in Pakistan. Sub-chronic, hematological and histopathological outcomes of herbal combination were assessed on 27 albino rabbits weighing from 1000 gm-1500 gm after giving herbal combination for 60 days in two doses 27 and 81 mg/kg against control. No significant toxicity was revealed during the entire period of study, however some biochemical changes were observed in kidney and liver but these changes did not coincide with histopathological findings. There was no mortality and evidence of systemic toxicity including hematological toxicity following 60 days administration of herbal combination. Results of present study suggest that further studies are required on large number of animals before reaching to a definite conclusion, more over clinical studies should also be conducted to confirm the possible toxic effects of the herbal combination.

Effect of Carthamus tinctorius (Safflower) on fasting blood glucose and insulin levels in alloxan induced diabetic rabbits.

Diabetes mellitus is a major threat to present and future generations. The role of herbal medication has emerged as a safe alternative to currently available medication due to its decreased potential to produce side effects, hence effect of Carthamus tinctorius was observed on fasting blood glucose and insulin levels in alloxan induced diabetic rabbits. Thirty five healthy male rabbits were divided into 5 groups with 7 rabbits in each (Normal control, diabetic control, diabetic treated with glibenclamide, diabetic treated with Carthamus tinctorius extract at doses of 200 and 300mg/kg of body weight). Drug and extract were given orally for 30 days and the values for blood glucose levels were observed after 15(th) and 30(th) day of treatment by using standard reagent kits provided by Human Germany. While insulin levels were checked at the end of the study by using Architect i1000 by Abbott Diagnostics USA. Animals were also observed for any gross toxicity during the study. Results revealed that Carthamus tinctorius has significant hypoglycemic effect at 200mg/kg and 300mg/kg doses as compared to diabetic control group. Insulin levels were significantly increased in Glibenclamide treated as well as Carthamus tinctorius treated groups as compared to diabetic control.

Retinopathy risk factors in patients with type 2 diabetes on liraglutide.

Liraglutide, a glucagon-like peptide 1 receptor agonist, effectively treats type 2 diabetes(T2D) by lowering glucose levels, suppressing glucagon release, and promoting insulin secretion. Liraglutide has been shown to reduce body weight and glycated hemoglobin (HbA1c) levels and improve cardiovascular outcomes. However, evidence regarding the association between liraglutide and diabetic retinopathy in the Middle East is insufficient. Therefore, this study aimed to investigate the characteristics and risk factors of diabetic retinopathy in patients with T2D treated with liraglutide in Saudi Arabia. This retrospective cohort study was conducted on patients (≥14 years) with T2D treated with liraglutide between 2015 and 2021, who had a documented retinopathy assessment at baseline before liraglutide initiation and during follow-up, at King Abdulaziz Medical City (KAMC), Riyadh. Data collection included demographic information, retinopathy status, body mass index (BMI), and HbA1c level at baseline and follow-up after liraglutide use. The study included 181 patients with a mean age of 58.2 (9.8) years. Of these, 72.9% were females. At baseline, the median weight (interquartile range) was 88 (77-100) kg, diabetes duration was 19 (13-23.5) years, and HbA1c level was 9% (8-10%). Total of 69.6% were on insulin, 22.7% were on oral hypoglycemic agents, and 7.7% were on no other medications in addition to liraglutide. After a median of 2 years follow-up, both HbA1c level and weight decreased significantly (P < .001). Seventy-one of the 87 patients (81.6%) without retinopathy at baseline continued to show no retinopathy. Among patients with retinopathy at baseline, 25.5% showed improvement and 44.7% showed no change. In the multivariate binary mixed effect analysis, factors significantly associated with retinopathy were: use of insulin (odds ratio [OR]:2.68; 95% confidence interval [CI]: 1.18-6.09, P = .019), older age (OR:1.03; 95% CI: 1.00-1.06; P = .022), higher HbA1c level (OR:1.17; 95% CI: 1.02-1.34; P = .024), Hypertension (OR:2.56; 95% CI: 1.13-5.76; P=<.0001) and longer diabetes duration (OR:1.04; 95% CI: 1.00-1.08; P = .024). In conclusion, liraglutide use caused significant reductions in the HbA1c level and weight of patients with T2D. Most patients showed no change in retinopathy status after liraglutide use.

Impact of herbal drug combination on lipid profile, renal and cardiac parameters.

For the past two decades, there has been an increasing interest in the investigation of medicinal plants as potential sources of new therapeutic agents; hence it is crucial to recognize the apparent toxicity that might occur while using herbal medicines. This study was undertaken in rabbits to assess the safety profile of an herbal drug combination. It was tested in 3 different doses for a period of 45 days, each group comprising of seven rabbits of either sex. Biochemical test and histopathological assessment were performed at the completion of dosing using standards reagent kits. The result shows that high dose of herbal drug (10ml/kg) revealed significant increase in serum lactate dehydrogenase, total protein and creatinine (P<0.05); more over there was highly significant decrease in triglycerides (P>0.05) at the completion of dosing.

Hepatoprotective effect of herbal drug on CCl(4) induced liver damage.

Herbs have been a huge source of natural substances used to treat and prevent several illnesses; therefore it is vital to identify the probable toxicity that might take place as a consequence of using herbal combinations.This study was undertaken in rabbits to investigate the hepatoprotective effects of herbal drug in normal and CCl4-induced hepatic damage. Herbal drug was tested in 3 different doses, each group comprising of seven rabbits of either sex followed by the administration of CCl(4) with herbal drug and saline for 45 days. Liver function tests and histopathological evaluation were carried out at the end of dosing using standards kits.The result shows that normal dose of herbal drug (0.43 ml/kg) possess hepatoprotective effects against CCl(4) induced liver damage in rabbits which may be due to the various active ingredients present in herbal drug combination. Present study also suggests that there was a significant (p<0.05) increase in serum alkaline phosphatase and γ-GT in animals kept on high dose of herbal drug (10 ml/kg); however studies on huge number of animals and humans are requisite before reaching to definite conclusion.

Assessment of Barriers to Knowledge Sharing Among Medical Students in Riyadh, Saudi Arabia.

Background Knowledge sharing is a process by which information is exchanged between peers, colleagues, or, at a higher level, between institutions and organizations. This study aimed to assess the barriers to knowledge sharing among medical students at private and public-sector medical colleges in Riyadh, Saudi Arabia. Methodology An online questionnaire was used to collect data from four medical colleges. Students were selected by non-probability convenience sampling. The English-language questionnaire included 12 questions related to knowledge sharing based on a Likert scale of one to five, with one denoting strongly disagreeing and five strongly agreeing. Out of the 520 questionnaires, 497 (96%) were received and analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Results A total of 497 respondents completed our questionnaire. Most were males (67.8%). Our results revealed that statements such as "afraid to provide the wrong information," "people only share with those who share with them," and "too busy/lack of time" were the most perceived barriers to knowledge sharing (mean = 3.95, 3.61, and 3.60, respectively). Furthermore, female opinions on statements such as "lack of relationship," "afraid to provide the wrong information," "do not know what to share," and "shyness to provide own opinions" were more dominant than male opinions. This difference was found to be statistically significant (p-values = 0.007, 0.020, 0.002, and 0.009, respectively). Conclusions Our study indicated that barriers such as "afraid to provide the wrong information" and "people only share with those who share with them" are important barriers that hinder the process of knowledge sharing. Moreover, most students agreed that "too busy/lack of time" and "lack of relationship" are barriers to knowledge sharing. In addition, statements such as "lack of relationship," "afraid to provide the wrong information," "do not know what to share," and "shyness to provide own opinions" were acknowledged as barriers by female students more than male students. There is a need in the curriculum to structure various types of activities that inspire and promote knowledge exchange among students. Further research is needed to validate our findings.

Measurement of Exam Anxiety Levels Among Medical Students and Their Association With the Influencing Factors.

Introduction Studying medical science is a demanding task, often leading to exam anxiety among medical students. This study aims to measure anxiety levels among medical students and their relationship with gender, age, grades, study time, year of study, and learning methods. Methods It is a cross-sectional study involving third- to sixth-year medical students, who filled in the questionnaire related to the personal data, studying methods, and the Westside Test Anxiety Scale, to estimate the exam anxiety levels before the final examinations of the academic year 2020-2021. Completed questionnaires were reviewed, entered in Microsoft Excel, and analyzed using SPSS.  Results We found a significant association between gender and high-test anxiety (p < 0.001), with a higher prevalence among females (47.9%) compared to males (22.5%). Although non-significant, its prevalence was higher among the 20 years old (34%) and those with a GPA 4.00-4.49 (37.9%). Anxiety decreased as the students progressed to higher years of studies (37.9% in the third year to only 9.1% in sixth year, p=0.073), with the lower incidence among those who studied five days or more per week (26.7%) and no significant difference was observed whether students studying in a group or individually. Though insignificant (p=0.754), learning through textbooks was found to be less stressful (29% vs 33%). Conclusion Our findings suggest that mediocre and female students are more vulnerable to exam high-test anxiety. Progression to senior years and use of textbooks were associated with lower anxiety levels. A cohort longitudinal study to establish an association between specific factors and anxiety levels is recommended.

University Pre-Professional Program: A Transitional Phase from Didactic to PBL Pedagogy.

Purpose: The College of Science and Health Professions offers the University Pre-Professional Program (UPPP) to newly enrolled students. This study aimed to evaluate the effectiveness of the program in preparing students to become self-directed learners and to seek students' perceptions about student-centered teaching. Methods: A quantitative quasi-experimental study that used a pre and post-test survey in two stages, before and after semester-4. A self-developed questionnaire was distributed online. Results: The t-test showed students (n=701) after semester-4 had a significant increase in the understanding of Problem-Based Learning (PBL) (t (699) = -8.27, p < 0.01), PBL dynamics (t (699) = -5.12, p < 0.01), learning and dynamics of Case-Based Learning (CBL) and Self-Directed Learning (SDL) (t (699) = -6.48, p < 0.01), and facilitators' role in such curriculum (t (699) = -3.41, p < 0.01). The ANOVA showed students attending various courses perceived the program variables differently (Learning in PBL p = 0.08, PBL dynamics p < 0.01, CBL and SDL dynamics p < 0.01, role of facilitator in PBL p < 0.01). Regarding the resources used by students during the basic medical sciences courses, no significant difference was observed between the study groups (p = 0.06). However, the only significant difference observed was in their satisfaction with the question related to assessment and course (p < 0.01). Conclusion: The UPPP improved students' understanding of student-centered teaching and learning approaches, especially the PBL. Thus, UPPP helps students shift their learning habits from didactic to student-centered modern learning approaches. Variation among different students' groups could be attributed to their previous academic background and change in learning medium to English. This study suggests that preparatory teaching programs like UPPP are helpful for students interested in joining the bachelor's programs in countries like Saudi Arabia where English is not a native language.

Cummulative toxicities on lipid profile and glucose following administration of anti-epileptic, anti-hypertensive, anti-diabetic and anti-arrhythmic drugs.

Reporting of undesirable drug reactions is a problem in all countries, even those with sophisticated drug regulatory bodies. However we can expect a horrible picture in developing countries like Pakistan where drug regulatory control is very poor, hence present study has been exclusively designed to explore the outcome of individual administration of antiepileptic, antihypertensive, antidiabetic, antiarrhythmic drugs and their combinations on lipid profile and glucose. The study was conducted on healthy rabbits of either sex. Biochemical tests were performed at the completion of dosing i.e. on 61st day and again after drug-free interval of 15 days. Present study provides detailed evaluation of adverse effects on lipid profile and glucose, results of the study suggests that animals received amiodarone-glibenclamide-verapamil-oxcarbazepine combination did not revealed any significant changes but animals received amiodarone-glibenclamide-losartan potassium-oxcarbazepine and amiodarone-glibenclamide-captopril-oxcarbazepine combinations revealed significant changes. However more studies on large number of animals and human beings are required to justify the use of multiple drug administration, since trial in man is the only way of establishing drug interactions.

Assessing the Effects of Basic Medical Science Courses on the Knowledge and Attitude towards Antibiotic Usage among Pre-Professional Students in Saudi Arabia.

The curriculum of medical schools includes courses on antibiotics. Therefore, it is worth exploring information related to the knowledge and attitudes about antibiotics. In this cross-sectional study the questionnaire was administered to the undergraduates in two phases, before and after attending the basic medical science courses. The data were collected on demographic variables, source of antibiotics, level of knowledge, and changes in attitude statements. Data analysis was implemented using SPSS. The mean age of participants was 19.87 and 20.15 in phases I and II, respectively. Most of the participants' parents had education at the university level and a monthly income above 15,000 SAR. Generally, students had good knowledge and attitude about antibiotics. A significant improvement in students' knowledge in phase-II was noticed in "level of knowledge" (p-value = 0.044), "paracetamol is considered an antibiotic" (p-value < 0.001) and "overuse of antibiotics can cause antibiotics resistance" (p-value = 0.003). The overall knowledge and attitude of pre-professional students were good in both phases, but their attitude did not improve at a significant level in phase-II. There is a need to put more focus on antimicrobial therapy in their training.

Perceptions, knowledge, and attitudes toward complementary and alternative medicine among Saudi patients with vitiligo.

INTRODUCTION: The use of complementary and alternative medicine (CAM) in dermatology has been increasing in recent years. Patterns of CAM use by vitiligo patients have not previously been assessed in Saudi Arabia. Therefore, it is worth exploring the perceptions, knowledge, and attitudes of Saudi vitiligo patients toward CAM. METHODS: A cross-sectional study was conducted for 12 months among Saudi vitiligo patients at King Abdulaziz Medical City in Riyadh. A validated self-administered questionnaire, comprised of four sections, was used to collect the data. Descriptive analysis was used, and a chi-squared test was used to determine the association between dependent and independent variables. RESULTS: Two hundred patients with vitiligo were enrolled, 56% of whom were female. The average age was 31.6 ± 15.45 years. Approximately 52% of the patients were either current or previous users of CAM. Among the patients, 44.5% had been asked by their dermatologist about their CAM use, and 18.5% preferred not to disclose their CAM use. Social media was the most common source of information for CAM (28%). CONCLUSION: More than half of the vitiligo patients in our study used some form of CAM. The most popular remedies were honey (37%), Nigella sativa (29%), and olive oil (29%).

A new health care professional-based model for medication adherence.

This paper presents a practice-based conceptual (theoretical) model to address medication adherence. The study reviews literature for different rationales of medication adherence and its associated factors. It also reviews the interventions involved in improving medication adherence and its effect. It is known that many interventions applied have not received great success owing to the fact that they have not been employed in regular clinical practice. Furthermore, models or theories utilized for different interventions were based on patient perspective only. The model presented in the paper is based on health care professionals' perspective, with an aim to be employed in clinical practice. The model framework is based on five premises on the basis of which the two dynamics, patient and health care professional, work. The model is presented with a graphical representation and exemplary procedural framework. It is also compared to other related procedural models. It is suggested that using such a model will allow medication adherence as an integral part of health care outcomes.

Evaluation of hypoglycemic and hypolipidemic activity of methanol extract of Brassica oleracea.

AIM: The hypoglycemic and hypolipidemic effects of the methanol extract of Brassica oleracea var. capitata (MEB) was evaluated in alloxan-induced diabetic rabbits. METHOD: The study was conducted on twenty-eight healthy white rabbits of either sex. All animals were equally divided into four groups. After confirmation of hyperglycemia, the animals of the treated and standard groups were administered MEB (500 mg·kg(-1)) and glibenclamide (10 mg·kg(-1)), respectively for 15 and 30 days. The animals of the normal and diabetic controls received normal saline 1 mL/day equivalent to the volume of doses given to the test and standard animals. Biochemical tests were performed at the end of dosing, i.e. the 16(th) and 31(st) days. RESULTS: The MEB revealed a decrease of 106.6 mg·dL(-1) in fasting blood glucose as compared to diabetic control, which was almost comparable to glibenclamide; both of these changes were highly significant. The decrease in total cholesterol and low density lipoprotein was 94.3 and 96.5 mg·dL(-1), respectively, whereas the high-density lipoprotein was increased by 26.7 mg·dL(-1), as compared to diabetic control. All of the changes in lipid profile were statistically significant. CONCLUSION: These results suggest the potential of MEB as a hypoglycemic and hypolipidemic agent.

Reduction in mortality and teratogenicity following simultaneous administration of folic acid and vitamin E with antiepileptic, antihypertensive and anti-allergic drugs.

AIM: The present study was designed to evaluate the teratogenic effects on breeding pattern in mice following administration of lamotrigine (LT) and levetiracetam (LV) and its combination with anti-hypertensive and anti-allergic drugs. Moreover, possibility of decrease in teratogenic effect was also evaluated upon simultaneous administration of these combinations with folic acid or vitamin E. MATERIALS AND METHODS: The study was carried out on mature female mice housed in polycarbonate breeding cages. Drugs were administered continuously till the birth of neonates and pups were examined for any teratogenic potential of drugs. RESULTS: The results of the study reveals that teratogenic effects of lamotrigine, methyldopa and loratadine (LTMLO) combination were seems to be reduced upon simultaneous administration with folic acid, while addition of vitamin E was found to be more effective in reducing the mortality rate of levetiracetam, methyldopa and loratadine combination. CONCLUSION: Teratogenic effects of LTMLO combination were better prevented by folic acid. However, further studies on large number of animals and humans are required before reaching to definite conclusion.

Patients' opinion of pharmacists and their roles in health care system in Pakistan.

BACKGROUND: Pharmacist-patient association is a decisive component in improving health care system. To offer patient centred services, the pharmacists need to fully understand patients' perspectives and views to meet their needs and expectations. PURPOSE: To evaluate patients' perception of pharmacist and pharmacy practice in Pakistan. METHODS: A cross sectional study was conducted between July and September 2012 on patients attended out-patient clinic in a teaching hospital of Pakistan. By using raosoft sample size calculator, questionnaires were distributed to a sample of 376 patients. Questionnaire included different section which evaluated the demographic information, frequency and reason of interaction, perception and choice of pharmacy. Statistical analysis was done by using SPSS (v.17). RESULTS: A total of 301, out of 376, surveys returned giving a response rate of 80%. 51.8% (n = 156) participants interacted with pharmacist on regular basis. The major reasons of interaction were drug alternative and drug availability queries (41.5%, n = 125 and 26.2%, n = 79). The finding also showed that 84.1% (n = 253) of participants agreed that pharmacists are important part of health care system. Interestingly, all the patients (n = 301) either agreed or strongly agreed that discount was the major influencing factor on their choice of pharmacy. CONCLUSION: The patients' perception of pharmacist in Pakistan was generally positive but their understanding is very primitive as majority of the patients are unaware of pharmaceutical care services. However, they are more devoted to witness such services being practiced in Pakistan. This transition in practice could be brought into certainty by proactive involvement of pharmacists in community setup.