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.

ELISL: early-late integrated synthetic lethality prediction in cancer.

MOTIVATION: Anti-cancer therapies based on synthetic lethality (SL) exploit tumour vulnerabilities for treatment with reduced side effects, by targeting a gene that is jointly essential with another whose function is lost. Computational prediction is key to expedite SL screening, yet existing methods are vulnerable to prevalent selection bias in SL data and reliant on cancer or tissue type-specific omics, which can be scarce. Notably, sequence similarity remains underexplored as a proxy for related gene function and joint essentiality. RESULTS: We propose ELISL, Early-Late Integrated SL prediction with forest ensembles, using context-free protein sequence embeddings and context-specific omics from cell lines and tissue. Across eight cancer types, ELISL showed superior robustness to selection bias and recovery of known SL genes, as well as promising cross-cancer predictions. Co-occurring mutations in a BRCA gene and ELISL-predicted pairs from the HH, FGF, WNT, or NEIL gene families were associated with longer patient survival times, revealing therapeutic potential. AVAILABILITY AND IMPLEMENTATION: Data: 10.6084/m9.figshare.23607558 & Code: github.com/joanagoncalveslab/ELISL.

Preliminary screening of antioxidant and cytotoxic potential of green seaweed, Halimeda opuntia (Linnaeus) Lamouroux.

Marine natural products have displayed numerous advantageous effects on biological activities, including antioxidants and cytotoxicity. The total lipids, carotenoids, chlorophyll a and b content, total phenolic content (TPC), total flavonoid content (TFC), and antioxidant activity of methanolic crude extract of the green seaweed Halimeda opuntia were all measured in this study. The TPC of the extracts was determined according to the Folin-Ciocalteu method, yielding a result of 55.04 ± 0.98 mg GAE/g of extract. As determined by the aluminium chloride colorimetric method, the TFC of the extract was 40.02 ± 0.02 mg QE/g of extract. Antioxidant activity was determined by using a 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay with different concentrations that ranged between 200 and 1000 µg/mL, noted H. opuntia as the highest in DPPH reduction (63.61 %) at 1000 µg/mL concentration. Total antioxidant capacity (TAC) of the extract was 57.36 ± 0.004 mg AAE/g extract at concentration of 1.0 mg/mL. The cytotoxic activity of this seaweed was pre-screened against a panel of cell lines including estrogen receptor-positive human breast adenocarcinoma (MCF-7), estrogen negative human breast adenocarcinoma (MDA-MB-231), human colorectal adenocarcinoma (HT-29), human hepatocellular carcinoma (HepG2), and mouse embryonic fibroblast (3T3) using the MTT assay. The content of total lipids in H. opuntia was 1.60 ± 0.002 %. Total carotenoids were 115.57 ± 0.98 µg/g, while chlorophyll a and b were 148.73 ± 2.60 µg/g and 290.83 ± 9.46 µg/g, respectively. In terms of cytotoxicity activity, methanolic extract of H. opuntia was found to be highly cytotoxic to MCF-7 cells, with an IC50 of 25.14 ± 1.02 g/mL, and slightly less so to 3T3 cells (IC50 65.23 ± 0.25 µg/mL). This study's findings suggest that natural pigments (carotenoids and chlorophyll), phytochemicals like phenolic and flavonoid compounds found in this species may play an important role and could be used as a natural cancer treatment.

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.

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.

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.

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.

Development and Review of the Chest Tube High-Feedback Educational Simulation Trainer (CHEST).

INTRODUCTION: Emergency medicine physicians must receive training in chest tube placement. This life-saving skill must be completed quickly and competently to prevent morbidity and mortality. Training on live patients is no longer an appropriate or acceptable practice. Current training devices have been noted to be costly, may be difficult to store, or may require time-consuming cleanup or setup. METHODS: Fifteen Chest tube High-feedback Educational Simulation Trainers were created. Frames were made from wood and PVC, and soft tissue layers were designed using silicone and polyurethane foam. Nine training sites volunteered to test the model and provided feedback on the acceptability of the task trainer for skill training. RESULTS: Survey findings demonstrated that the model was realistic for teaching, portable, and was easy to use and maintain. In our model, the outer skin was noted to tear easily, thus limiting its use for suture training. Overall programs reported that they would use this model if it was available for the same or lower cost than current models. CONCLUSIONS: An inexpensive task trainer was created that was easy to store, quick to set up, durable, easy to clean, and rated as effective at training the skill of chest tube insertion.

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.

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.

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.

Medical Students' Perceptions of Peer Assessment in a Problem-based Learning Curriculum.

OBJECTIVES: Peer assessment (PA) is believed to support learning and help students develop both professionally and personally. The aim of this study was to examine medical students' perceptions of intragroup PA in a problem-based learning (PBL) setting. METHODS: This study was carried out between September and November 2014 and involved six random groups of fourth-year undergraduate medical students (n = 60) enrolled at the Arabian Gulf University in Manama, Bahrain. While working on set tasks within a curriculum unit, each student evaluated a randomly selected peer using an English language adapted assessment tool to measure responsibility and respect, information processing, critical analysis, interaction and collaborative skills. At the end of the unit, students' perceptions of PA were identified using a specifically-designed voluntary and anonymous self-administered questionnaire in English. RESULTS: A total of 55 students participated in the study (response rate: 92%). The majority of students reported that their learning (60%), attendance (67%), respect towards group members (70%) and participation in group discussions (71%) improved as a result of PA. Regarding problem analysis skills, most participants believed that PA improved their ability to analyse problems (65%), identify learning needs (64%), fulfil tasks related to the analysis of learning needs (72%) and share knowledge within their group (74%). Lastly, a large proportion of students reported that this form of assessment helped them develop their communication (71%) and self-assessment skills (73%), as well as collaborative abilities (75%). CONCLUSION: PA was well accepted by the students in this cohort and led to self-reported improvements in learning, skills, attitudes, engagement and other indicators of personal and professional development. PA was also perceived to have a positive impact on intragroup attitudes.

Effect of experimentally induced hepatic and renal failure on the pharmacokinetics of topiramate in rats.

We aimed to investigate the effect of induced hepatic and renal failure on the pharmacokinetics of topiramate (TPM) in rats. Twenty-four Sprague-Dawley rats were used in this study. Renal or hepatic failure was induced by a single i.p. dose of 7.5 mg/kg cisplatin (n = 8) or 0.5 mL/kg carbon tetrachloride (CCl4) (n = 8), respectively. Three days after cisplatin dose or 24 h after CCl4 dose, the rats were administered a single oral dose of 20 mg/kg TPM. The plasma samples were quantified by LC-MS/MS method. Compared to control, plasma concentration-time profile in CCl4-treated and, to a lesser extent, in cisplatin-treated rats decreased more slowly particularly in the elimination phase. TPM oral clearance (CL/F) in CCl4-treated group was significantly lower than that in control (P < 0.001), whereas AUC0-∞, T1/2, and Vd/F were significantly higher in CCl4-treated rats compared to the control (P < 0.01). The CL/F was not significantly different between cisplatin-treated rats and control (P > 0.05). However, in cisplatin-treated rats, the T1/2 and Vd/F were significantly higher than that in the control group (P < 0.01). Both conditions failed to cause a significant effect on Cmax or Tmax. The present findings suggest that induced hepatic or renal failure could modify the pharmacokinetic profile of TPM in the rat.

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.

Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a central west bank hospital.

OBJECTIVES: We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. METHODS: This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. RESULTS: Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. CONCLUSION: These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents.

Learning from negative feedback in patients with major depressive disorder is attenuated by SSRI antidepressants.

One barrier to interpreting past studies of cognition and major depressive disorder (MDD) has been the failure in many studies to adequately dissociate the effects of MDD from the potential cognitive side effects of selective serotonin reuptake inhibitors (SSRIs) use. To better understand how remediation of depressive symptoms affects cognitive function in MDD, we evaluated three groups of subjects: medication-naïve patients with MDD, medicated patients with MDD receiving the SSRI paroxetine, and healthy control (HC) subjects. All were administered a category-learning task that allows for dissociation between learning from positive feedback (reward) vs. learning from negative feedback (punishment). Healthy subjects learned significantly better from positive feedback than medication-naïve and medicated MDD groups, whose learning accuracy did not differ significantly. In contrast, medicated patients with MDD learned significantly less from negative feedback than medication-naïve patients with MDD and healthy subjects, whose learning accuracy was comparable. A comparison of subject's relative sensitivity to positive vs. negative feedback showed that both the medicated MDD and HC groups conform to Kahneman and Tversky's (1979) Prospect Theory, which expects losses (negative feedback) to loom psychologically slightly larger than gains (positive feedback). However, medicated MDD and HC profiles are not similar, which indicates that the state of medicated MDD is not "normal" when compared to HC, but rather balanced with less learning from both positive and negative feedback. On the other hand, medication-naïve patients with MDD violate Prospect Theory by having significantly exaggerated learning from negative feedback. This suggests that SSRI antidepressants impair learning from negative feedback, while having negligible effect on learning from positive feedback. Overall, these findings shed light on the importance of dissociating the cognitive consequences of MDD from those of SSRI treatment, and from cognitive evaluation of MDD subjects in a medication-naïve state before the administration of antidepressants. Future research is needed to correlate the mood-elevating effects and the cognitive balance between reward- and punishment-based learning related to SSRIs.

Depression impairs learning, whereas the selective serotonin reuptake inhibitor, paroxetine, impairs generalization in patients with major depressive disorder.

To better understand how medication status and task demands affect cognition in major depressive disorder (MDD), we evaluated medication-naïve patients with MDD, medicated patients with MDD receiving the selective serotonin reuptake inhibitors (SSRI) paroxetine, and healthy controls. All three groups were administered a computer-based cognitive task with two phases, an initial phase in which a sequence is learned through reward-based feedback (which our prior studies suggest is striatal-dependent), followed by a generalization phase that involves a change in the context where learned rules are to be applied (which our prior studies suggest is hippocampal-region dependent). Medication-naïve MDD patients were slow to learn the initial sequence but were normal on subsequent generalization of that learning. In contrast, medicated patients learned the initial sequence normally, but were impaired at the generalization phase. We argue that these data suggest (i) an MDD-related impairment in striatal-dependent sequence learning which can be remediated by SSRIs and (ii) an SSRI-induced impairment in hippocampal-dependent generalization of past learning to novel contexts, not otherwise seen in the medication-naïve MDD group. Thus, SSRIs might have a beneficial effect on striatal function required for sequence learning, but a detrimental effect on the hippocampus and other medial temporal lobe structures is critical for generalization.

The Impact of Small Group Case-based Learning on Traditional Pharmacology Teaching.

OBJECTIVES: This study aimed to measure medical students' perceptions of incorporating small group case-based learning (CBL) in traditional pharmacology lectures. METHODS: Data were collected from third-year students (N = 68; 57% males, 43% females) at Al Quds University Medical School, Palestine. The students were offered a CBL-incorporated Pharmacology-2 course after they had been taught Pharmacology-1 in the traditional format during the preceding semester. Student attitudes towards the restructured course were examined by a self-administered structured questionnaire. RESULTS: The majority of students thought that CBL was an effective learning tool for them (82%) and that it improved their learning skills (83%), independent learning skills (74%), analytical skills (70%), and their level of preparation for exams (75%). Most students reported that team discussions addressed lecture objectives (84%). Regarding cases discussed, most responders said that the cases were appropriate to the lecture topics (96%) and that the time allocated for case discussion was sufficient (86%). A large proportion of students thought that CBL improved their communication and collaborative skills (68% and 80%, respectively) and ability to work within a team (79%). CONCLUSION: Pharmacology-2 course restructuring led to a significant improvement of self-reported student satisfaction, motivation, and engagement.

Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank.

OBJECTIVES: We aimed to determine the prevalence and correlates of obesity and hypertension (HTN) among students at a central university in the West Bank. MATERIALS AND METHODS: This cross-sectional study targeted a cohort of 553 students (59.5% males, 40.5% females) aged 17-26 years (median = 21) from Al-Quds University. Body mass index (BMI) and blood pressure (BP) were measured. Participants completed a questionnaire on physical activity, sedentary behavior, dietary factors, smoking and family history of obesity, HTN, and coronary artery disease. The magnitude of correlation was assessed by Spearman's rho (r(s)) and Chi-square tests. RESULTS: The prevalence of overweight was 25% (31.1% males, 15.6% females) and obesity 7.2% (9.4% males, 4% females). Obesity and overweight were associated with family history of obesity in both genders (p<0.001) and physical activity in males (r(s)= - 0.162, p<0.005). No correlation was demonstrated between participants' BMI and sedentary lifestyle or consumption of fast food. Pre-HTN was detected in 27.1% (38% males, 11.2% females) and HTN in 2.2% (3.3% males, 0.4% females). Pre-HTN and HTN were associated with obesity (r(s)=0.252, p<0.001) and smoking (p<0.05). No relationship was detected between students' BP and sedentary behavior, family history of HTN/CAD, or consumption of fast food. The prevalence of increased BMI and BP among males was significantly higher than females (p<0.001). CONCLUSIONS: We detected a high prevalence of elevated BP and excess weight gain among students at Al-Quds University. An interventional program is urgently needed to control these cardiovascular risk factors in this community.