Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory.

Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.

Hybrid surgical approach excision of gastrointestinal stromal tumor (GIST): A case report of GIST at an unusual location and review of the literature.

Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes.

Spindle cell lipoma of the tongue: First case report from the Gulf region and review of the literature.

Spindle cell lipoma is a histological variant of oral lipomas. In this report, we present the first case from the Gulf region with the most comprehensive literature review. Clinicians should consider rare tumors in the differential diagnoses of oral masses.

Obesity and female infertility.

Infertility is a significant global health issue, with a negative impact on people's wellbeing and human rights. Despite the longstanding association between obesity and infertility, there remains uncertainty, about the precise mechanisms underpinning this association and best management strategies. In this article, we aimed to address these uncertainties by reviewing the recent literature, and focusing on studies which evaluated live birth rates. We found that just over half of the studies, investigating the relationship between preconception maternal weight and live birth rates found an inverse correlation. There was, however, insufficient evidence, that preconception maternal lifestyle or pharmacological interventions in obese women with infertility, resulted in improved live birth rates. The implications for clinical practice and future research are highlighted. For example, the need to consider some flexibility in applying strict preconception body mass index targets, limiting access to fertility treatment, and a need for large clinical trials of new pharmacological options and bariatric surgery.

Polycystic Ovarian Syndrome (PCOS): Does the Challenge End at Conception?

Polycystic ovary syndrome (PCOS) is a prevalent condition that not only has the potential to impede conception but also represents the most common endocrine dysfunction in fertile women. It is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome's risks. Undoubtedly, the impact of PCOS on infertility has attracted most of the attention of healthcare providers and investigators. However, there is growing evidence that even after conception is achieved, PCOS predisposes the parturient to several adverse pregnancy outcomes including a high risk of pregnancy-induced hypertension, spontaneous abortion, gestational diabetes, preeclampsia, and preterm birth, which increase the risks of stillbirth and neonatal death. Fetal growth abnormalities may also be more common, but the relationship is less well defined. This narrative review aims to summarize current knowledge regarding these conditions as they interplay with PCOS and concludes that although there appears to be an increase in these complications during the pregnancy of women with PCOS, there is a need for further research to clarify the possible confounding impact of obesity. Implications for clinical practice and future research are outlined.

COVID-19 vaccine hesitancy: A narrative review of four South Asian countries.

Objectives: Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there's an interplay of financial and non-financial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers. Methods: A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: "Afghanistan" OR "Pakistan" OR "India" OR "Bangladesh" in combination with "COVID-19 vaccine" and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper. Results: A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size (n = 223-5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy. Conclusion: Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it difficult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination.

A successful management of left-sided posterior congenital diaphragmatic hernia of the jejunum, ileum, colon and left kidney: a case report.

Congenital diaphragmatic hernia (CDH) is a rare developmental anomaly in which abdominal contents herniate into the thoracic cavity due to underdevelopment of the diaphragm, possibly leading to pulmonary hypoplasia. Whereas surgery is not the first priority in treatment, it must be performed within a window of 2 weeks and after hemodynamic stability has been achieved. The patient described in this case report had a CDH of the jejunum, ileum, colon and left kidney diagnosed in a boy of South Asian origin who presented with tachypnea in the third hour of life. Imaging studies conducted included chest X-ray, chest ultrasound including echocardiogram, and abdominal and pelvic ultrasound. Treatment and management were successful despite complications. Future research on CDH is warranted in the populations in the Middle East, and local guidelines must be generated in order to improve diagnosis, treatment and prognosis.

Implications of social media misinformation on COVID-19 vaccine confidence among pregnant women in Africa.

It has been over a year since the World Health Organization (WHO) declared the outbreak of COVID-19 as a Public Health Emergency of International Concern and subsequently a global pandemic. The world has experienced a lot of uncertainty since then as we all get used to this new 'normal' with social distancing measures, lockdowns, the emergence of new variants, and an array of hope with the development of vaccines. Having an abstract understanding of vaccine delivery, public perceptions of vaccines, and promoting acceptance of vaccines are critical to tackling the pandemic. The advent of the pandemic has led to the emergence of an 'infodemic' or rampant misinformation surrounding the virus, treatment, and vaccines. This poses a critical threat to global health as it has the potential to lead to a public health crisis by exacerbating disease spread and overwhelming healthcare systems. This 'infodemic' has led to rising vaccine hesitancy which is of paramount concern with the WHO even identifying it as one of the ten main threats to Global health almost 2 years before the approval of COVID-19 vaccines. Pregnant African women are one of the most vulnerable population groups in a region with an already burdened healthcare system. Currently, there isn't ample research in the literature that explores vaccine hesitancy in this subpopulation and the impact of social media misinformation surrounding it. The aim of this paper is to highlight the implications of this 'infodemic' on the pregnant African population and suggest key recommendations for improved healthcare strategies.

Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study.

BACKGROUND: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. OBJECTIVE: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. METHODS: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients' demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. RESULTS: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3% of children were younger than 1 year. Only 4 (3.6%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms, and none (0%) had severe illness requiring intensive care. Fever (23/111, 20.7%), cough (22/111, 19.8%), and rhinorrhea (17/111, 15.3%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7%), aspartate transaminase (18/111, 22.5%), alkaline phosphatase (29/111, 36.7%), and lactate dehydrogenase (31/111, 42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. CONCLUSIONS: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks.