10 years of experience in adopting, implementing and evaluating progress testing for Saudi medical students.

Objectives: The progress test (PT) is a comprehensive examination that is designed to match the knowledge acquisition necessary at graduation and monitors progress during the entire period of an undergraduate program. Qassim College of Medicine (QCM) began using the multi-institutional PT in the Kingdom of Saudi Arabia (KSA). This study aimed to determine if the PT can be utilized to assess the progress of medical students at different Saudi medical colleges with different educational approaches, as well as whether this testing modality could be accepted by other colleges. Methods: Beside the establishment of a PT committee, comprehensive blueprinting was crafted to sample 200 A-type multiple choice questions (MCQs) from different disciplines. The PT is a paper-and-pencil model and is answered in a 4-h period. All PT items followed a uniform design. Results: In total, 13 rounds of the progress test have been conducted. The number of participating colleges increased from three (with 285 students) in the first test (May 2012) to more than 20 (with >6000 students) in the ninth round (February 2017). The average % scores for first-year students ranged from 3.0% to 7.9% while the average scores for fifth-year students ranged from 34.0% to 43.0%. Conclusion: The conduction of this meticulously crafted test to evaluate knowledge achievement at medical graduation is a fruitful tool and helps to provide constructive feedback for test-takers and other stakeholders relating to their relative positions among other fellows at the national level.

Cucurbitacins - a promising target for cancer therapy.

During the last decades a large number of cucurbitacins have been isolated from various plant species belonging to other plant families than Cucurbitaceae. Although the roots and the fruits of plant belong to these Cucurbitaceae species are very bitter, they have been used as folk medicines in some countries because of their wide spectrum of pharmacological activities such as anti-inflammation and anticancer effects. In the last ten years, cucurbitacins had been shown to inhibit proliferation and induced apoptosis utilizing a long array of in vitro and in vivo cancer cell models. Several molecular targets for cucurbitacins have been discovered, such as fibrous-actin, signal transducer and activator of transcription (STAT), cyclooxygenase-2, etc. This review aimed at elucidating the natural sources of some cucurbitacin compounds, their chemical structure and derivatives, physical properties, biological activities and mechanism by which they reduce the proliferation human cancer cells. This widens our armaments against a devastating disease that we are failing to face.

Effect of students' learning styles on classroom performance in problem-based learning.

INTRODUCTION: Since problem-based learning (PBL) sessions require a combination of active discussion, group interaction, and inductive and reflective thinking, students with different learning styles can be expected to perform differently in the PBL sessions. METHODOLOGY: Using "Learning Style Inventory Questionnaire," students were divided into separate active and reflective learner groups. Tutors were asked to observe and assess the students' behavioral performance during the PBL sessions for a period of 5 weeks. A questionnaire of 24 items was developed to assess students' behavioral performance in PBL sessions. RESULTS: Active students tended to use multiple activities to obtain the needed information were more adjusted to the group norms and regulation and more skillful in using reasoning and problem-solving skills and in participation in discussion. On the other hand, reflective students used independent study more, listened actively and carefully to others and used previously acquired information in the discussion more frequently. Formative assessment quizzes did not indicate better performance of either group. There were no significant gender differences in PBL behavioral performance or quizzes' scores. CONCLUSION: Active and reflective learners differ in PBL class behavioral performance but not in the formative assessment. We recommend that students should be informed about their learning style and that they should learn strategies to compensate for any lacks in PBL sessions through self-study. Also, educational planners should ensure an adequate mix of students with different learning styles in the PBL groups to achieve PBL desired objectives.

Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy.

OBJECTIVE: To compare efficacy between double-dose methotrexate and single-dose methotrexate for treatment of tubal ectopic pregnancy (EP). METHODS: Between March 2008 and February 2011,157 patients who had tubal EP diagnosed by a non-laparoscopic approach and were hemodynamically stable were enrolled in a prospective study in Qassim, Saudi Arabia. The participants were randomized to receive either double-dose (50mg/m(2) intramuscularly on days 0 and 4; group 1) or single-dose (50mg/m(2) intramuscularly on day 0; group 2) methotrexate. Serum human chorionic gonadotropin (ß-hCG) levels were followed until negative. RESULTS: The overall success rate was comparable between groups 1 and 2 (88.6% versus 82.0%, P=0.1). The duration of follow up until negative ß-hCG was shorter in group 1 (P=0.001). Receiver operative characteristics showed that higher cut-off levels of ß-hCG and gestational mass diameter were associated with successful outcome in group 1. Among participants with initial ß-hCG of 3600-5500 mIU/mL, the success rate was higher in group 1 (P=0.03). There was no significant difference between groups in adverse effects. CONCLUSION: For treatment of EP, double-dose methotrexate had efficacy and safety comparable to that of single-dose methotrexate; it had better success among patients with moderately high ß-hCG and led to a shorter follow up.

Association of Blood Lead level with Elevated Blood Pressure in Hypertensive Patients.

BACKGROUND: Lead is a metal with many important industrial uses. The relationship between lead exposure and the rise of blood pressure has received a great deal of attention as it was implicated that the mortality from cardiovascular diseases might be reduced by lowering lead levels in the environment. OBJECTIVES: The study was to investigate the correlation between the blood lead (B-Pb) levels and the values of blood pressure in hypertensive patients. Moreover, the plasma activities of angiotensin converting enzyme (ACE), plasma levels of nitric oxide (NO), total antioxidants (TAOX) and malondialdehyde (MDA) were estimated to investigate the correlations between the measured parameters and B-Pb levels in hypertensive patients. METHODS: Fifty-five hypertensive patients were compared with fifty-three age and sex matched control group. The B-Pb levels were detected by flame atomic absorption spectrometry. The plasma levels of ACE activities, NO, TAOX and MDA were measured by colorimetric methods. RESULTS: In the hypertensive patients, B-Pb levels were significantly higher than controls. Concomitantly, the plasma levels of ACE activities and MDA were significantly increased while the plasma levels of NO and TAOX were significantly reduced in the hypertensive patients in comparison with controls. There were significant positive correlations between B-Pb and each of MDA, and systolic as well as diastolic blood pressure. Conversely, a significant negative correlation was found between B-Pb and NO. CONCLUSIONS: Our study indicated that a positive relationship exists between blood pressure and B-Pb levels. The increased B-Pb levels were associated with oxidative stress. Moreover, The B-Pb level was negatively correlated with NO and this may clarify the implication of Pb as leading risk factor for the cardiovascular diseases and hypertension. These findings provide support for continued efforts to reduce lead concentration in the population at Qassim region.

Generic drug prescribing in central Saudi Arabia: perceptions and attitudes of physicians.

BACKGROUND AND OBJECTIVES: Physicians play a key role in generic drug prescribing, but their behavior is affected by many determinants. We examined physician practices and attitudes and other factors influencing the prescription of generic drugs. METHODS: A self-administered questionnaire was used to collect information from a random sample of physicians from different settings in central Saudi Arabia. Data were analyzed to describe all variables and test any significant difference between groups of physicians. RESULTS: The study included 772 physicians from different affiliations. The majority of physicians (n=741, 96%) reported that they knew enough about the therapeutic value of generic drugs. The majority (75%) reported that they knew the price differences, and this knowledge helped 72% of them to switch to generic prescription medication. Most physicians (79%) support generic substitution, but they indicated that there are certain clinical situations where they prefer to use brand name drugs. Physicians reported receiving visits and samples more frequently from representatives of brand name companies. Physicians did not report a significant difference in pressure from patients to prescribe either generic or brand drugs. Most physicians had a positive attitude towards the government role in assuring the quality of local drug products (80%) and in enforcing physicians to prescribe generic drugs (85%). CONCLUSION: Physicians face competing forces to prescribe either brand name or generic drugs. The majority support generic drug substitution. There are multiple factors that support prescription of generic drugs.

Serum visfatin and its relation to insulin resistance and inflammation in type 2 diabetic patients with and without macroangiopathy.

OBJECTIVE: To explore visfatin levels and its relationship to obesity, insulin resistance, lipid profile and inflammation in type 2 diabetes mellitus (T2DM) patients with and without macroangiopathy. METHODS: The study was designed in the College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia, and implemented between April 2006 and May 2007. It involved 84 subjects divided into 3 groups: 29 T2DM patients without macroangiopathy, 33 T2DM patients with macroangiopathy, and 22 non-diabetic controls. After overnight fast, weight, height, and blood pressure were measured and a single blood sample was obtained. Serum visfatin, insulin, interleukin-6 (IL-6), and high sensitive C-reactive protein (hsCRP) were measured by Enzyme-linked immunosorbent assay (ELISA), whereas glucose and lipid profile were measured using colorimetric enzymatic methods. Obesity was measured using body mass index (BMI) and insulin resistance was measured using Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). RESULTS: Compared to control, both non-macroangiopathic and macroangiopathic diabetic groups were associated significantly with an atherogenic lipid profile, and high levels of glucose, insulin, HOMA-IR, hsCRP and IL-6. Serum visfatin was significantly higher in non-complicated diabetics compared to controls and macroangiopathic diabetics, but difference in visfatin level between macroangiopathic diabetics and controls was insignificant. Visfatin levels were not correlated with BMI, insulin, glucose, or HOMA-IR, but they were negatively and significantly correlated with hsCRP, IL-6, and the atherogenicity of lipid profile. CONCLUSION: Visfatin levels were increased in T2DM regardless of BMI and type of diabetic treatment. These levels were correlated negatively with inflammatory markers and atherogenicity of lipid profile.

Potentiation of Valproate-induced Anticonvulsant Response by Nigella sativa Seed Constituents: The Role of GABA Receptors.

This study investigated antiepileptic effects of the main constituents of Nigella sativa (NS) seed (i.e. aqueous extract (AE), fixed oil (FO), volatile oil (VO)) and the main components of its VO (i.e. thymoquinone, α-pinene and p-cymene) using pentylenetetrazole (PTZ) and maximal electroshock (MES)-induced convulsions. The potential of these constituents to induce minimal neurological deficit (MND) was also evaluated by using chimney test.Except for the FO, all of the NS seed constituents protected mice effectively against PTZ-induced convulsions. The activity of the VO in this model maybe attributed mainly to its content of thymoquinone and p-cymene and to a lesser extent, α-pinene. VO and its component p-cymene effectively suppressed convulsions induced by MES. The contents of p-cymene present in the effective dose of the VO maybe partially responsible for its anti-seizure effects.All of the NS seed constituents induced varying degrees of MND in the chimney test. MND induced by VO may pertain to its contents of thymoquinone (63%), p-cymene (23%) and α-pinene (<14%). Protective indices of p-cymene and thymoquinone were closer to one, but only in PTZ model.Exploration on the role of receptors suggests that picrotoxin and bicuculline-sensitive GABA receptors, most probably GABAA receptors, mediate an increase in GABAergic response. In the part dealing with the interaction of valproate with thymoquinone, it can be mentioned that thymoquinone increased the potency of valproate in both PTZ and MES models.

Synthesis of a new series of substituted pyrimidines and its evaluation for antibacterial and antinociceptive effects.

BACKGROUND: Pyrimidines are a well known group of compounds reported to have different biological activities. Prompted from the diversity of its wider use and being an integral part of genetic material, an effort was made to synthesize a novel series of amino-pyrimidine derivatives of pharmaceutical interest by condensing the guanidinyl derivative of nalidixic acid with different chalcones. METHODS: The structures of all synthesized compounds were established on the basis of IR and 1HNMR spectral studies. All of the new compounds in this series were screened for antimicrobial activity. Gram +ve and Gram -ve strains were used to ascertain the spectrum of activity. ED50 values in the tail flick test were determined and recorded. Analgesic potential of compounds by using tail flick test in SWR male mice have also revealed promising results. RESULTS: All of the derivatives were effective in Gram -ve test against E. coli. None of the compounds show any inhibition of Gram +ve strain S. aureus. m-Bromo substitution derivative of amino-pyrimidines showed appreciable activity against E. coli, while 2,4 dichloro and p-chloro substitution derivatives also demonstrated improved activity. Compound 4 was most potent. The order of potency for these derivatives was 4>5≥6>1>2>7>3. Parallel to antimicrobial activity, m-bromo substitution derivative showed significant (P<0.01) antinociceptive response in comparison to control, and this effect was comparable to aspirin group. Trimethoxy substitution of benzene ring demonstrated moderate activity, whereas p-bromo substitution essentially had no antinociceptive effects in mice. CONCLUSION: Comparing meta- and para- bromo substitutions, there had been significant (P<0.01) difference in the antinociceptive response of both the bromo-substituted derivatives. It was observed that bromo-substitution at meta- position demonstrated comparatively higher potential for its antibacterial as well as antinociceptive properties.

Evaluation of ambrein and epicoprostanol for their antioxidant properties: protection against adriamycin-induced free radical toxicity.

Ambrein and epicoprostanol were evaluated for their antioxidant potential in vitro by chemiluminescence (CL), as well as in vivo using lipid peroxides and glutathione levels as indicators in liver tissue of rats treated with adriamycin (doxorubicin) a well known free radicals producing drug. In the in vitro test, the inhibition in CL by ambrein was dose dependent. Both the high concentrations of ambrein (20-40 microg/ml) inhibited CL response significantly (P<0.05 and P<0.01, respectively) when compared to control. Similarly two low concentrations (5-20 microg/ml) of epicoprostanol inhibited CL significantly (P<0.001 and P<0.01, respectively) in comparison of DMSO control. The high concentration (40 microg/ml) of epicoprostanol behaved exceptionally and caused an increase in CL response that was more than control and significantly (P<0.001) higher than both the low concentrations. In the in vivo studies adriamycin treatment significantly (P<0.05) increased malondialdehyde (MDA) and decreased non-protein sulfhydryl (NP-SH) contents in the liver tissue of mice after 5 days treatment. Ambrein (25 and 50 mg/kg) treatment as a solo therapy at both the dose levels significantly (P<0.001) decreased MDA contents in the liver tissue. On the other hand, in the combined treatment the high dose effectively prevented any rise in MDA contents and it remained around the levels of ambrein alone. In the same experiment, adriamycin declined NP-SH contents significantly (P<0.001). Ambrein alone at both the dose levels caused a decline (P<0.01) in NP-SH contents when compared to adriamycin group. But in the combined treatment this decline in NP-SH was significantly (P<0.05) different from adriamycin alone. In the experiments dealing with epicoprostanol, adriamycin treatment increased MDA contents significantly (P<0.05) that declined significantly (P<0.001) with epicoprostanol (10- or 20mg/kg) treatment. In the same experiment co-treatment with adriamycin prevented any rise in MDA contents significantly (P<0.001) as it was observed in adriamycin alone group. Although, this treatment failed to prevent any decline in NP-SH contents either alone or in combination with adriamycin. Epicoprostanol itself had the comparative declining effect on the contents of NP-SH as seen in adriamycin group. From the results of our experiments it seems that ambrein at all concentrations behaves like antioxidant in in vitro studies but the same time it decreased NP-SH contents in vivo accompanied by a decline in MDA contents. Whereas, epicoprostanol at two low concentrations had a decline in CL indicating a possible antioxidant potential but the high concentration increased CL showing a tendency towards oxidant prospective. However, in animal studies it has shown a clear protection against adriamycin induced free radical damage.