Perception of competence achievement and students' satisfaction using virtual laboratories in Medical Biochemistry course: Lessons from the COVID-19 pandemic.

After the COVID-19 pandemic, there was an increasing demand for remote learning and an expansion in the substitution of traditional practical sessions with lab-based virtual tools. This study aimed to assess the effectiveness of virtual labs in practicing biochemical experiments and to examine the student's feedback regarding this tool. Virtual and traditional labs training were compared in teaching qualitative analysis of proteins and carbohydrates experiments for first-year medical students. Students' achievements were assessed, and their satisfaction regarding virtual labs was estimated using a questionnaire. A total of 633 students were enrolled in the study. There was a significant increase in the average scores of students performing the virtual lab of protein analysis compared with those trained in a real lab and those who watched videos explaining the experiment (p < 0.001). The opposite was noticed in the qualitative analysis of carbohydrates with significantly high grades of students trained conventionally compared with those who practiced with virtual labs (p < 0.001). Students' feedback rates on the virtual labs were high (>70% satisfaction rate). Most students believed virtual labs were supported with a clear explanation, yet they thought it did not give a realistic experience. Students accepted virtual labs, but they still prefer using them as preparatory to classic labs. In conclusion, virtual labs can offer good laboratory practice in the Medical Biochemistry course. Their impact on students' learning might be increased if selected cautiously and implemented properly in the curriculum.

Exon Skipping Through Chimeric Antisense U1 snRNAs to Correct Retinitis Pigmentosa GTPase-Regulator (RPGR) Splice Defect.

Inherited retinal dystrophies are caused by mutations in more than 250 genes, each of them carrying several types of mutations that can lead to different clinical phenotypes. Mutations in Retinitis Pigmentosa GTPase-Regulator (RPGR) cause X-linked Retinitis pigmentosa (RP). A nucleotide substitution in intron 9 of RPGR causes the increase of an alternatively spliced isoform of the mature mRNA, bearing exon 9a (E9a). This introduces a stop codon, leading to truncation of the protein. Aiming at restoring impaired gene expression, we developed an antisense RNA-based therapeutic approach for the skipping of RPGR E9a. We designed a set of specific U1 antisense snRNAs (U1_asRNAs) and tested their efficacy in vitro, upon transient cotransfection with RPGR minigene reporter systems in HEK-293T, 661W, and PC-12 cell lines. We thus identified three chimeric U1_asRNAs that efficiently mediate E9a skipping, correcting the genetic defect. Unexpectedly, the U1-5'antisense construct, which exhibited the highest exon-skipping efficiency in PC-12 cells, induced E9a inclusion in HEK-293T and 661W cells, indicating caution in the choice of preclinical model systems when testing RNA splicing-correcting therapies. Our data provide a proof of principle for the application of U1_snRNA exon skipping-based approach to correct splicing defects in RPGR.

Simulation-Based Learning Versus Didactic Lecture in Teaching Bronchial Asthma for Undergraduate Medical Students: a Step Toward Improvement of Clinical Competencies.

BACKGROUND: Simulation-based learning (SBL), an effective teaching strategy, is still questionable on whether it can be an alternative to didactic lectures in medical education. Our study aimed to evaluate the effectiveness of SBL versus traditional lectures in retention of knowledge. METHODS: A randomized controlled trial was conducted among medical students who were divided in two groups (36 students each). Each group received the same information about diagnosis and management of bronchial asthma, but with a different teaching method: didactic lecture or simulation. Knowledge level was tested before, immediately after the teaching sessions and 3 months later using multiple-choice questions. Student's satisfaction was evaluated using feedback questionnaire. RESULTS: The simulation group scored higher than the lecture group in the post-test and the late test. However, these differences were not significant. Additionally, students' satisfaction scores were significantly higher in the simulation group than in the lecture group (p < 0.01). Students ranked simulation significantly better regarding motivation (71.9%), comfort (59.4%), understanding (59.4%), and effective communication (59.4%) (p < 0.01). CONCLUSION: Simulation is as effective as lecture in retention of medical knowledge. Nonetheless, students agree that it is more satisfactory and interesting. SBL integration in medical programs is recommended to overcome obstacles in clinical training.

Grand multiparity and the possible risk of adverse maternal and neonatal outcomes: a dilemma to be deciphered.

BACKGROUND: The relation between grand multiparity (GMP) and the possible adverse pregnancy outcomes is not well identified. GMP (parity ≥5 births) frequently occurs in the Arab nations; therefore, this study aimed to identify the correlation between GMP and the different adverse maternal and neonatal outcomes in the Saudi population. METHOD: This cohort study was conducted on a total of 3327 women from the labour ward in King Khaled University Hospital, Riyadh, Saudi Arabia. Primiparous, multiparous and grand multiparous females were included. Socio-demographic data and pregnancy complications like gestational diabetes or hypertension, preeclampsia and intrauterine growth restriction were retrieved from the participants' files. In addition, the labour ward records were used to extract information about delivery events (e.g. spontaneous preterm delivery, caesarean section [CS]) and neonatal outcomes including anthropometric measurements, APGAR score and neonatal admission to the intensive care. RESULTS: Primiparas responses were more frequent in comparison to multiparas and GMP (56.8% and 33%, and 10.2% respectively). In general, history of miscarriage was elevated (27.2%), and was significantly higher in GMP (58.3%, p < 0.01). Caesarean delivery was also elevated (19.5%) and was significantly high in the GMP subgroup (p < 0.01). However, after adjustment for age, GMP were less likely to deliver by CS (odds ratio: 0.6, 95% CI: 0.4-0.8; p < 0.01). The two most frequent pregnancy-associated complications were gestational diabetes and spontaneous preterm delivery (12.6% and 9.1%, respectively). The former was significantly more frequent in the GMP (p < 0.01). The main neonatal complication was low birth weight (10.7%); nevertheless, neonatal admission to ICU was significantly higher in GMP (p = 0.04), and low birth weight was more common in primiparas (p < 0.01). Furthermore, logistic regression analysis revealed an insignificant increase in the maternal or neonatal risks in GMP compared to multiparas after adjustment for age. CONCLUSION: Grand multiparous Saudi females have similar risks of maternal and neonatal complications compared to the other parity groups. Advanced age might play a major role on pregnancy outcomes in GMP. Nevertheless, grand multiparty might not be discouraged as long as women are provided with good perinatal care.

Impact of vitamin D deficiency on maternal and birth outcomes in the Saudi population: a cross-sectional study.

BACKGROUND: Low serum vitamin D [25(OH)D] has been associated with different health problems worldwide. However, its causal role in several diseases remains unclear. We aimed to correlate vitamin D status with maternal and neonatal outcomes in pregnant females. METHOD: One thousand pregnant women were recruited during early labour from the labour ward of King Khaled University Hospital, Riyadh, Saudi Arabia. Detailed medical data of all participants were collected from their records. Delivery events and birth outcomes were also documented. Serum 25(OH)D levels were measured using an enzyme-linked immunosorbent assay. A receiver operating characteristic (ROC) curve was constructed to evaluate the ability of vitamin D levels to predict complicated pregnancies. Regression analysis was used to test the correlation between serum 25(OH)D levels and different variables. RESULTS: Most of the participants were Saudis (89.9 %) and housewives (85.1 %) and 86.4 % of them had vitamin D deficiency (mean: 30.46 ± 19.6 nmol/L). Gestational diabetes mellitus (GDM) was the commonest complication detected (11.1 %) while the history of miscarriage was elevated (24.5 %). There was no association between GDM and low 25(OH)D. Yet, there was a significant negative correlation between serum 25(OH)D levels and fasting blood glucose among females older than 35 years (r = -0.2, p = 0.03). Hypertensive disorders of pregnancy and pre-existing hypertension were less than 1.5 % of frequency. Nevertheless, they were only recorded in women with insufficient and deficient vitamin D. ROC curve revealed that 25(OH)D levels were not able to discriminate between normal and adverse pregnancy outcomes (AUROC curve: 0.51; 95 % confidence interval (CI): 0.44-0.58; p = 0.8). CONCLUSION: Hypovitaminosis D, a highly prevalent health problem among pregnant females in Riyadh, has no relation to adverse pregnancy outcomes except for a higher prevalence of miscarriage in women with low 25(OH)D.

Evaluation of circulating Transforming growth factor-beta1, Glypican-3 and Golgi protein-73 mRNAs expression as predictive markers for hepatocellular carcinoma in Egyptian patients.

Hepatocellular carcinoma (HCC) incidence is fast-growing especially in countries highly prevalent with viral hepatitis. Its poor prognosis has driven the research toward the discovery of sensitive markers for early detection. We investigated the usefulness of serum Transforming growth factor-beta1 (TGF-ß1), Glypican-3 (GPC3), and Golgi protein-73 (GP73) mRNAs as early biomarkers in HCC Egyptian patients chronically infected with hepatitis C virus (HCV) in comparison with serum alpha-fetoprotein (AFP). Using semi-quantitative RT-PCR and densitometry analysis, circulating TGF-ß1, GPC3, and GP73 mRNAs expressions were estimated in 15 healthy adults, 15 chronic HCV (CHC) patients and 25 HCC patients. Serum GP73 expression percentage in HCC group was significantly higher than controls (100 vs. 40 %, P ≤ 0.001) and when compared to elevated serum AFP levels (100 vs. 36 %, P ≤ 0.001). TGF-ß1 and GP73 expression means were also higher in HCC patients than controls and CHC patients (P < 0.05). GPC3 expression showed higher frequency in CHC patients compared to HCC group (80 vs. 28 %, P = 0.0016). According to the study cutoffs, serum TGF-ß1 and GP73 mRNAs showed 60 and 96 % sensitivities for HCC diagnosis with 100 and 95 % specificities, respectively. Furthermore, elevated GP73 mRNA expression levels in early HCC were significantly increased compared to those of TGF-ß1 mRNA and to high serum AFP (92.3 vs. 53.8 and 23.1 %; P = 0.03 and 0.0004, respectively). In conclusion, circulating TGF-ß1 and GP73 mRNAs could be useful biomarkers for HCV-induced HCC diagnosis. Moreover, serum GP73 mRNA is sensitive for early cancer detection than AFP and TGF-ß1 mRNA. However, these results need further validation studies.

Interleukin-18 gene polymorphisms in Egyptian patients with allergic diseases.

BACKGROUND: Allergic diseases, such as allergic rhinitis (AR) and atopic dermatitis (AD), affect a large proportion of people worldwide. Both have environmental and genetic predisposing factors. Single nucleotide polymorphisms (SNPs) in interleukin (IL)-18, may play a direct role in the disease pathogenesis. This study was designed to investigate the association of the IL-18 gene SNPs (-137 G/C [rs187238], and -140 C/G [rs360721]) with AR and AD, as well as their relations to the diseases' severity. METHODS: Seventy-five individuals were enrolled in the study including, 25 AD children, 25 AR patients, and 25 unrelated healthy adult volunteers who served as controls. Genotyping was performed by polymerase chain reaction and restriction fragment length polymorphism analysis. RESULTS: AR and AD patients showed no significant differences in the genotype distribution and allele frequencies of -137 G/C and -140 C/G SNPs when compared independently with the control group. However, the -140 GG genotype and the -140 G allele were more often associated with severe AD compared with mild and moderate phenotypes (p = 0.01 and 0.001, respectively; odds ratios [ORs], 14.25 [95% CI, 1.48-143.2] and 16 [95% CI, 2.8-90.46], respectively). Moreover, the -137 G allele was associated with moderate/severe AR (p = 0.019; OR, 6.1 [95% CI, 1.34-28.1]). CONCLUSION: This preliminary study indicates that the studied polymorphisms do not confer susceptibility to allergy in Egyptian patients but may be related to the disease phenotype. However, the role of IL-18 in allergy may be too complex to be reflected in a simple association study.

Evaluation of urinary proepithelin as a potential biomarker for bladder cancer detection and prognosis in Egyptian patients.

BACKGROUND/AIM: Proepithelin is a growth factor that may play a critical role in bladder cancer. Its over-expression in urine of bladder cancer patients gave us the impetus to evaluate its potential suitability as a biomarker for bladder cancer diagnosis and/or prognosis. METHODS: proepithelin was estimated in 86 voided urine samples, including 59 bladder cancer patients and 27 healthy volunteers using quantitative sandwich enzyme immunoassay technique. Urinary proepithelin level was expressed in ng/100 mg creatinine. RESULTS: Urinary proepithelin was significantly higher in bladder cancer patients compared to control subjects (means: 17.5 ± 10 and 8.9 ± 3.5 ng/100 mg creatinine, respectively; p < 0.001), and the test sensitivity and specificity to detect the presence of bladder cancer were 74.6 and 85.2%, respectively. Furthermore, patients with low-grade/non-muscle invasive stages bladder cancer showed significantly lower urinary proepithelin compared to high-grade/non-muscle invasive stages and high-grade/invasive stages ones (means: 11.6 ± 9, 20.2 ± 8.1 and 23.8 ± 11.9 ng/100 mg creatinine, respectively; p= 0.005 and 0.002, respectively). CONCLUSIONS: This preliminary study suggests that urinary proepithelin may be considered as a non-invasive, sensitive, and specific urine-based test for bladder cancer diagnosis and/or prognosis.