Social Determinants of Health Impacting Access to Renal Dialysis for Racial/Ethnic Minorities.

Although widespread, the burden of disease presented by chronic kidney disease (CKD) is not equally distributed among all demographics. Examining the social determinants of health (SDOH) that relate to barriers to renal dialysis care in CKD can help to prevent future disparities. There has not been a study addressing the social factors that create barriers to care for ethnic minority patients with CKD. The aim of this scoping review is to address the SDOH that affects access to renal dialysis for ethnic minority patients in the United States. This study was based on the protocol published by the Joanna Briggs Institute. A total of 349 studies were identified from PubMed, EBSCOhost, and Embase. Each article was screened against population, concept, and context criteria in order to be considered for inclusion. The population was determined to be adults of all genders from underrepresented minority populations. The selected concept was SDOH. The context of this study was the United States population. From the articles selected by the search criteria, neighborhood of residence, mental health care access, glomerular filtration rate (GFR) methodology, socioeconomic status (SES), language barriers, immigration status, and military rank were identified as SDOH affecting access to renal dialysis care. While this study identified four social determinants, more research is needed for the investigation of other possible SDOH contributing to disparities related to CKD and access to renal dialysis care.

Combined Aplasia of Frontal and Sphenoid Sinuses: A case report.

INTRODUCTION AND IMPORTANCE: The paranasal sinuses are a group of four paired air-filled spaces located within the bony skull; maxillary, frontal, sphenoid, and ethmoid sinuses. Paranasal sinuses aplasia is a rare condition that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses along with hypoplasia of other sinuses is extremely rare. This rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries. CASE PRESENTATION: A 13-year-old male patient presented to our ENT clinic complaining of a prolonged history of persistent headache, nasal obstruction, and nasal discharge. He also complained of bilateral ears fullness and facial pain. On physical examination, bilateral purulent nasal discharge with congested inflamed nasal mucosa and both inferior turbinate. The patient was diagnosed to have sinusitis and was started on treatment. The patient returns to our clinic after several weeks with minimal improvement. Computed tomography (CT was obtained and showed completely absent pneumatization of bilateral frontal and sphenoid sinuses. CLINICAL DISCUSSION: The development of the paranasal sinuses appears prenatally which can lead to a variety of PNS anomalies. However, the aplasia or hypoplasia of the PNS is found to be rare. Aplasia is mainly found in frontal and maxillary sinuses with a prevalence of 12 % and 6 %, respectively. While the prevalence of sphenoid sinus aplasia is extremely rare and found to be less than 0.7 %. Moreover, aplasia of multiple sinuses "combined aplasia" is an incredibly unusual finding. CONCLUSION: this patient is one of the extremely rare cases of the combined aplasia of frontal and sphenoid sinuses who was diagnosed and confirmed at an early age without any skeletal, systemic, or hematological abnormalities. Despite that, this rare case should be considered in mind before scheduling any endoscopic sinus surgery to prevent complications during these surgeries.

GPs' and pharmacists' views of integrating pharmacists into general practices: a qualitative study.

BACKGROUND: Practice-based pharmacists (PBPs) have been introduced into general practice across the UK to relieve some of the pressures within primary care. However, there is little existing UK literature that has explored healthcare professionals' (HCPs') views about PBP integration and how this role has evolved. AIM: To explore the views and experiences of GPs, PBPs, and community pharmacists (CPs) about PBPs' integration into general practice and their impact on primary healthcare delivery. DESIGN AND SETTING: A qualitative interview study in primary care in Northern Ireland. METHOD: Purposive and snowball sampling were used to recruit triads (a GP, a PBP, and a CP) from across five administrative healthcare areas in Northern Ireland. Sampling of practices to recruit GPs and PBPs commenced in August 2020. These HCPs identified the CPs who had most contact with the general practices in which the recruited GPs and PBPs were working. Semi-structured interviews were recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS: Eleven triads were recruited from across the five administrative areas. Four main themes in relation to PBPs' integration into general practices were revealed: evolution of the role; PBP attributes; collaboration and communication; and impact on care. Areas for development were identified such as patient awareness of the PBP role. Many saw PBPs as a 'central hub-middleman' between general practice and community pharmacies. CONCLUSION: Participants reported that PBPs had integrated well and perceived a positive impact on primary healthcare delivery. Further work is needed to increase patient awareness of the PBP role.

A 20-Year-Old Gossypiboma Causing Small Bowel Obstruction.

Retained foreign bodies including gossypiboma could be silent for years. However, in some cases, it can lead to major complications. Gossypiboma is not frequently reported for multiple reasons, including nonspecific presentation clinically and radiologically, and ethical issues. We present a case of a gossypiboma that was retained for more than 20 years causing a severe intestinal obstruction for an elderly female. The intestinal obstruction was initially thought to be adhesive in nature and was managed initially conservatively, but with failure to improve, the patient was taken for exploratory laparotomy, and the foreign body was found attached to the root of the mesentery posterior to the transverse colon. This case sheds light on the fact that although surgical tools are of great utility, they must be managed with utmost care to prevent complications and secure patients' safety.

Development of a core set of clinical skills for pharmacist prescribers working in general practice: A Delphi study.

BACKGROUND: With increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed. OBJECTIVE: To develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine. METHODS: Based on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1 = limited importance to 9 = critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. RESULTS: Following Round 1, seven CSs met the criteria for inclusion: 'Measuring heart rate (radial pulse)', 'Assessing respiratory rate', 'Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)', 'Measuring blood pressure (automated, i.e. electronic blood pressure monitor)', 'Measuring peripheral oxygen saturation (using pulse oximeter)', 'Measuring temperature', 'Measuring Peak Expiratory Flow Rate'. After two further rounds, a further four CSs were included consisting of 'Undertaking a urinalysis', 'Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)', 'Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)', and 'Patient assessment via National Early Warning Score (NEWS)'. No consensus was reached on nine CSs. CONCLUSION: This study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine.

General practitioners' experiences with, views of, and attitudes towards, general practice-based pharmacists: a cross-sectional survey.

BACKGROUND: There is limited United Kingdom (UK) literature on general practice-based pharmacists' (PBPs') role evolution and few studies have explored general practitioners' (GPs') experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs' experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI). METHODS: A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically. RESULTS: The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts. CONCLUSION: Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs', community pharmacists' and patients' views of this role in general practice is required to corroborate study findings.

Future healthcare providers and professionalism on social media: a cross-sectional study.

BACKGROUND: Nowadays, social media have become central in the daily lives of people, including healthcare professionals. Fears arise that the accelerated growth of these social platforms was not accompanied by the appropriate training of the healthcare students and workers on the professional use of social media. This study primarily aimed to assess the awareness of the healthcare students at Beirut Arab University, Lebanon on the professional standards of social media. It also aimed to assess the presence of differences in the practices and attitudes of healthcare students according to gender and major. METHODS: A cross-sectional study was designed, and a paper-based questionnaire was distributed to healthcare students. Chi-Square test was used to analyse certain findings. RESULTS: Out of 1800 students approached, 496 participated in the questionnaire. All participants used social media. Only 19.5% (96/496) of them had received a structured education on the professional use of social media during their university study. The majority of students (349/488, 71.5%) thought that the professional standards on social media are distinct from those established in face-to-face interactions. Female students were more likely to get adequate answers in accordance with international guidelines. There were statistically significant differences in the practices and attitudes of students belonging to different majors (p value < 0.05). CONCLUSION: The line between what is professional on social media, and what is not, remains blurred for healthcare students. This study uncovered the need for clear and updated evidence-based guidelines assisting students in making the most appropriate decisions in the various online scenarios faced in healthcare practice.

Early and Mid-Term Results After Repair of Ischaemic Mitral Regurgitation with Complete Annuloplasty Ring and Incomplete Ring.

BACKGROUND: The choice of ring type for mitral valve (MV) repair is still debatable and usually is left to the surgeon's discretion. AIM: The aim of this study was to compare the early and mid-term results after repair of ischaemic mitral regurgitation (MR) with complete and incomplete annuloplasty rings. METHODS: Collected data included preoperative assessment (age, sex, comorbidities, clinical status, NYHA grade, and the EURO score); intraoperative details (echocardiography, degree of MR, and cross-clamp time); and results (the length of ICU and hospital stay, duration and need for inotropes, duration of mechanical ventilation, and postoperative adverse events). Follow up after discharge included assessment of dyspnea status, the degree and progression of MR, and left ventricular function and dimensions. RESULTS: The present study included 133 patients: 61 with incomplete rings and 72 with complete rings inserted. There was no significant difference in the rate of postoperative complications between the two groups, apart from a significantly higher percentage of patients with incomplete ring who required prolonged ventilation >24 hours (P = 0.002). There were no significant differences between the two groups, regarding the grade of residual MR (P = 0.464), postoperative dyspnea status (P = 0.723), 30-day mortality rate (P = 0.687), and mean duration of survival (P = 0.276). CONCLUSION: The choice of incomplete or complete annuloplasty ring was not associated with a marked difference in the early and midterm results of ischaemic MV repair.

Conversion disorder with aphonia in 12 years old male patient: A case report.

INTRODUCTION AND IMPORTANCE: Conversion aphonia is a rare disease characterized by total loss of voice. It is more commonly reported in females than males, and its diagnosis is based on a comprehensive patient's clinical history, and assessment of vocal cords and other laryngeal structures using Fiberoptic laryngoscopy. Early diagnosis and phonation have a significant role in the treatment. CASE PRESENTATION: A 12-year-old medically free male patient with unremarkable medical history and normal physical, social, cognitive and emotional developmental milestones presented to the otorhinolaryngology clinic with a sudden loss of voice for a duration of 3 days with absence of other associated symptoms. A comprehensive clinical history and general examination were within normal limits, and fiberoptic laryngoscopy revealed a normal-looking laryngeal structure with intact bilateral mobile vocal cords. A diagnosis of psychogenic aphonia was the most likely cause, so speech therapy concurrent with psychotherapy was the mainstay of treatment. Improvement of the patient condition noticed and he restored his speech 4 weeks after initiation of his treatment. CLINICAL DISCUSSION: Psychogenic Aphonia is rare disorder with female predominance and younger age onset when it is compared to males. It is also known as functional neurological symptom disorder (FND) as it is not explained by underlying medical or neurological factors. It is often preceded by psychological trauma or stressors. Diagnosis of Psychogenic Aphonia is challenging and it is often missed and delayed. Accordingly, the delay in diagnosis may significantly affect the ultimate outcome for affected patients. Speech therapy concurrent with psychotherapy represents the mainstay of treatment. CONCLUSION: Being rare disorder, early recognition and diagnosis of conversion disorder with aphonia is crucial. Applying diagnostic criteria which is introduced by American Psychiatric Association in The Diagnostic and Statistical Manual of Mental Disorders (DSM) facilitate the diagnosis. Multidisciplinary approach in management of affected patients ensures better outcome.

The effects of mode of delivery, maternal age, birth weight, gender and family history on screening hearing results: A cross sectional study.

INTRODUCTION: Congenital hearing impairment is one of the principal issues that make distress to families especially those with a family history of hearing problems. Early detection of hearing impairment can make a difference regarding cognitive, attention, learning, speech, and social and emotional development of babies. Otoacoustic test emission is a very common screening test that can be used to pick up early cases and relieve family stress. We tried to evaluate the factors that may disrupt our results regarding the OAE test. METHODS: A cross-sectional study included infants who were admitted to the nursery unit alone. Infants who were admitted to the NICU unit, infants with craniofacial anomalies, infants with vernix in the external auditory canal, and Infants with Stigmata associated with a syndrome known to include a sensorineural hearing loss were excluded from the study. Both transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) Screening tests were performed by the same professional audiologist experienced in neonatal screening. RESULTS: A total of 1413 newborns (733 males and 680 females) were included in the study. Among them, 1368 babies (96.8%) passed the first OAE in both ears, while 45 babies (3.2%) didn't pass the first OAE in one or both ears.Significant correlations between the female gender and family history of congenital hearing loss with failure of the first OAE test results. Moreover, vaginal delivery (VD) infants had a 1.5-fold higher failure rates of first OAE test screening results in comparison to caesarian delivery (CD) infants. CONCLUSION: Our study demonstrated higher failure rates of the first OAE in female infants, vaginal delivery infants, and infants with a family history of hearing impairment. It is recommended to postpone the first phase of hearing screening for those infants until the first scheduled vaccine appointment to achieve higher compliance attendance, and decrease family stress associated with false-negative results of the test.

Otitis media with effusion: The role of Helicobacter Pylori in its pathogenesis.

BACKGROUND: Otitis Media with Effusion (OME) is the most common disease of the middle ear. Different factors play a role in its pathogenesis, such as viral and bacterial infections, allergy, morphological and functional changes of nasal passage, Eustachian Tube (ET), and cleft palate. This study aims to investigate the Helicobacter Pylori presence in middle ear effusions from patients with OME through RT-PCR and compare our results with results from other published articles. METHODS: The study was carried out from October 2007 to February 2009, in the Department of Otorhinolaryngology of SS. Annunziata Hospital, Chieti, Italy. 132 consecutive patients with OME were included in the study. Fluid in the middle ear was assessed for the presence of Helicobacter Pylori through RT-PCR. RESULTS: 132 consecutive patients with OME were included in the study. The patients were between ages 8 and 78 (median 50); 62 were males (47%), 70 were females (53%), and 53 patients had bilateral OME (40%). 185 samples were collected from 132 patients. Of the 185 samples taken from the ear, 21 (11.35%) were not adequate for the correct execution of the DNA extraction procedure. The remaining 167 samples, subjected to RT-PCR, did not show in any case an increase in fluorescence linked to the FAM fluorophore, thus demonstrating the complete absence of Helicobacter Pylori. CONCLUSION: Based on the results obtained, we can affirm that although a third of the cases of OME is correlated to the presence of reflux, Helicobacter Pylori does not seem to play any role in the pathophysiology of OME as it cannot be found in endo-tympanic exudate.

A systematic review of general practice-based pharmacists' services to optimize medicines management in older people with multimorbidity and polypharmacy.

BACKGROUND: Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy. OBJECTIVE: To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with other primary health care professionals, that sought to optimize medicines management for older people with multimorbidity and polypharmacy. METHODS: Eight electronic databases and three trial registries were searched for studies published in English until April 2020. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of services delivered by PBPs in primary care/general practice, for patients aged ≥65 years with both multimorbidity and polypharmacy that focused on a number of outcomes. The Cochrane risk of bias tool for randomized trials (RoB 1) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool were used for quality assessment. A narrative synthesis was conducted due to study heterogeneity. RESULTS: Seven studies met inclusion criteria. All included studies employed PBP-led medication review accompanied by recommendations agreed and implemented by general practitioners. Other patient-level and practice-level interventions were described in one study. The limited available evidence suggested that PBPs, in collaboration with other practice team members, had mixed effects on outcomes focused on optimizing medicines management for older people. Most included studies were of poor quality and data to estimate the risk of bias were often missing. CONCLUSION: Future high-quality studies are needed to test the effects of PBP interventions on a well-defined range of medicines management-related outcomes.

Optimizing medicines use for older people (aged ≥ 65 years) with multimorbidity (the presence of two or more long-term conditions) and polypharmacy (the concomitant use of four or more medicines) is urgent due to an ageing population which commonly has complex medications regimens. It is anticipated that pharmacists who have been integrated into general practices [also called practice-based pharmacists (PBPs)] will positively impact on patient outcomes through various roles and activities. As the role of PBPs is relatively new, little is known about the exact nature of their role and how these pharmacists will optimize medicines management for older people in a patient-centred manner. The aim of this research was to provide a detailed understanding of how PBPs may enhance optimization of medication management in older people and to study the effects of PBPs' interventions on outcomes-focused on optimizing medicines management for older people with multimorbidity and polypharmacy such as quality of life. The seven included studies indicated that PBP-led interventions such as medication reviews improved a number of outcomes but had either a limited effect or no effect on other outcomes. Further high-quality research is needed in this area.

Electronic Smoking Behavior Among Adult Males in Jordan.

The use of Electronic cigarettes (E-cigarettes) has considerably expanded especially among adults. This paper highlights the behavior regarding E-cigarettes uses among adult males in Jordan. Moreover, we studied the electronic cigarette devices, the electronic cigarette liquids used in them, and the health-related complaints associated with e-smoking. Among smokers, we studied the association between E-cigarette use and their interest in smoking cessation. A questionnaire-based study regarding electronic cigarette prevalence and awareness among Jordanian individuals was conducted with a total sample size of 1536 participants. The questionnaire was distributed using Facebook and WhatsApp social groups. In this study, we included data of a total of 254 adult male participants after excluding non-E-cigarettes smokers, female smokers, and male smokers younger than 18 years old from the previously published study (Electronic Cigarettes Prevalence and Awareness among Jordanian Individuals) to describe electronic smoking behavior among adult males in Jordan. We described smoking behavior, electronic smoking technologies and materials, source of knowledge, and believe regarding electronic smoking among participants. A total of 254 E-cigarette smokers have participated in this study. 104 participants (40.9%) were found to smoke both traditional and electronic cigarettes, 111 (43.7%) quit traditional cigarette smoking and switched to E-cigarettes, and 39 (15.3%) individuals are exclusively e-smokers. More than half of the participants (n = 144; 56.7%) believe E-smoking is not addictive, and 213 (83.8%) suppose that the overall health effects attributable to E-smoking are less severe and not as serious as those related to traditional smoking. The use of E-cigarettes increased both nationally and globally in the past few years and is considered an emerging modality of smoking among non-smokers. Social media and other internet websites are the main sources of knowledge regarding E-cigarettes. Health-related issues and addiction are thought to be less than traditional smoking in considerable percentages of E-smokers. A more comprehensive conception of E-smoking patterns in Jordan is required to approach this phenomenon. Health authorities in collaboration with governmental policymakers are obligate to adopt strict recommendations to control the promotion of E-smoking through social media and other internet websites to limit its distribution among people especially youths.

Peritoneal Tuberculosis in a Young Healthy Male Resembling Intra-Abdominal Malignancy.

Intra-peritoneal tuberculosis is a rare disease, accounting for 1-2% of all tuberculosis cases. The absence of characteristic clinical picture of intra-peritoneal tuberculosis makes the diagnosis rarely easy for clinicians as it mimics malignancy. We present a case of a young male patient who presented with peritoneal tuberculosis, aiming to contribute to a better understanding of peritoneal tuberculosis in the literature.

Immobilization of glucose oxidase on bioinspired polyphenol coatings as a high-throughput glucose assay platform.

Glucose oxidase (GOx) is an enzyme with important industrial and biochemical applications, particularly in glucose detection. Here we leveraged the oxidative self-polymerization phenomenon of simple polyphenols (pyrogallol or catechol) in the presence of polyethylenimine (PEI) to form adhesive coatings that enabled GOx immobilization on conventional multi-well plates. Immobilization was verified and optimized by directly measuring GOx activity inside the coated wells. Our results showed that incorporating PEI in polyphenol coatings enhanced their enzyme immobilization efficiency, with pyrogallol (PG)-based coatings displaying the greatest enzyme activity. The immobilized enzyme maintained similar affinity to glucose compared to the free enzyme. GOx-immobilized PG/PEI-coated wells exhibited intermediate recycling ability but excellent resistance to urea as a denaturing agent compared to the free enzyme. GOx-immobilized 96-well plates allowed the construction of a linear glucose calibration curve upon adding glucose standards, with a detection limit of 0.4-112.6 mg dL-1, which was comparable to commercially available enzymatic glucose assay kits. The assay platform was also capable of effectively detecting glucose in rat plasma samples. Our findings present a simple enzyme immobilization technique that can be used to construct a glucose assay platform in a convenient multi-well format for high-throughput glucose quantification.

Electronic Cigarettes Prevalence and Awareness Among Jordanian Individuals.

The general awareness regarding E-smoking is varying from country to other depending on multivariable factors. We try to investigate the prevalence of E-Cigarette Awareness, Perceived Harmfulness, Prevalence, and Associations with Smoking-Cessation Outcomes among different age groups and different sex in Jordanian individuals. The study element shaped by data gathered from various questionnaire surveys. The questionnaire was of our own design the method of data collection was through online surveys Different applications were used to distributing the questionnaire including; Whatsapp, Facebook, Instagram, other social applications. The study included 1536 participants. The prevalence of E-smoking is 18% among Jordanian individuals where it is 24.9% in males and 3.5% in females. 47.3% of participants believe that E-smoking has less harmful effects than traditional cigarette smoking while 46.7% believe that E-smoking has the same risk of cigarette smoking. 56% of participants believe the E-smoking can lead to addiction. E-smoking is considered an emerging modality of smoking with limited data regarding its long term impact regarding its addictive behavior and toxic effect. Awareness program regarding E-smoking is mandatory especially for the nontraditional smoker and young people.

Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives.

BACKGROUND: As COVID-19 has been declared as a pandemic disease by the WHO on March 11th, 2020, the global incidence of COVID-19 disease increased dramatically. In response to the COVID-19 situation, Jordan announced the emergency state on the 19th of March, followed by the curfew on 21 March. All educational institutions have been closed as well as educational activities including clinical medical education have been suspended on the 15th of March. As a result, Distance E-learning emerged as a new method of teaching to maintain the continuity of medical education during the COVID-19 pandemic related closure of educational institutions. Distance E-Learning is defined as using computer technology to deliver training, including technology-supported learning either online, offline, or both. Before this period, distance learning was not considered in Jordanian universities as a modality for education. This study aims to explore the situation of distance E-learning among medical students during their clinical years and to identify possible challenges, limitations, satisfaction as well as perspectives for this approach to learning. METHODS: This cross-sectional study is based on a questionnaire that was designed and delivered to medical students in their clinical years. For this study, the estimated sample size (n = 588) is derived from the online Raosoft sample size calculator. RESULTS: A total of 652 students have completed the questionnaire, among them, 538 students (82.5%) have participated in distance learning in their medical schools amid COVID-19 pandemic. The overall satisfaction rate in medical distance learning was 26.8%, and it was significantly higher in students with previous experience in distance learning in their medical schools as well as when instructors were actively participating in learning sessions, using multimedia and devoting adequate time for their sessions. The delivery of educational material using synchronous live streaming sessions represented the major modality of teaching and Internet streaming quality and coverage was the main challenge that was reported by 69.1% of students. CONCLUSION: With advances in technologies and social media, distance learning is a new and rapidly growing approach for undergraduate, postgraduate, and health care providers. It may represent an optimal solution to maintain learning processes in exceptional and emergency situations such as COVID-19 pandemic. Technical and infrastructural resources reported as a major challenge for implementing distance learning, so understanding technological, financial, institutional, educators, and student barriers are essential for the successful implementation of distance learning in medical education.

Development of a Thymoquinone Polymeric Anticancer Nanomedicine through Optimization of Polymer Molecular Weight and Nanoparticle Architecture.

Thymoquinone (TQ) is a water-insoluble natural compound isolated from Nigella sativa that has demonstrated promising chemotherapeutic activity. The purpose of this study was to develop a polymeric nanoscale formulation for TQ to circumvent its delivery challenges. TQ-encapsulated nanoparticles (NPs) were fabricated using methoxy poly(ethylene glycol)-b-poly(ε-caprolactone) (mPEG-PCL) copolymers by the nanoprecipitation technique. Formulation variables included PCL chain length and NP architecture (matrix-type nanospheres or reservoir-type nanocapsules). The formulations were characterized in terms of their particle size, polydispersity index (PDI), drug loading efficiency, and drug release. An optimized TQ NP formulation in the form of oil-filled nanocapsules (F2-NC) was obtained with a mean hydrodynamic diameter of 117 nm, PDI of 0.16, about 60% loading efficiency, and sustained in vitro drug release. The formulation was then tested in cultured human cancer cell lines to verify its antiproliferative efficacy as a potential anticancer nanomedicine. A pilot pharmacokinetic study was also carried out in healthy mice to evaluate the oral bioavailability of the optimized formulation, which revealed a significant increase in the maximum plasma concentration (Cmax) and a 1.3-fold increase in bioavailability compared to free TQ. Our findings demonstrate that the versatility of polymeric NPs can be effectively applied to design a nanoscale delivery platform for TQ that can overcome its biopharmaceutical limitations.