Peer evaluation as an alternative assessment method for case presentations: A cross-sectional study of dental students' perception.

INTRODUCTION: Peer assessment in dental and medical education is a key tool for evaluating attitudes and communication skills, serving as an effective formative learning method. It not only boosts academic performance and encourages lifelong learning and reflective practice but also fosters collaboration, effective communication, and constructive feedback among peers. OBJECTIVE: This study aimed to assess dental students' satisfaction and perceptions regarding implementing peer assessment in case presentations, including contribution to their learning. METHODS: This cross-sectional study involved third (n = 26), fourth (n = 54), and sixth (n = 71) dental students divided into five groups. Each student received peer assessments (n = 8) from the students of the other groups regarding their clinical presentation. At the end of the process, students were invited to complete an anonymous 9-item questionnaire to assess student perceptions of the peer-assessment process. Data were analyzed to evaluate students' perception and satisfaction with the peer assessment task. The bivariate analysis explored associations among questionnaire items. RESULTS: A total of 151 students participated in the current study. Results showed a high level of agreement for most of the students regarding their preparedness for peer and self-assessment. More than 75% of the students at all academic levels found it challenging to evaluate their peers. Student satisfaction scores increased with the level of education, (4.076, 4.214, and 4.246 out of five, respectively) with moderate correlations between peer evaluation characteristics. CONCLUSION: Peer assessment appears to enhance learning and professional development in dental students. Students' satisfaction with peer assessment grows with education level, reflecting its role in fostering critical evaluation skills and feedback.

Phased ERK-responsiveness and developmental robustness regulate teleost skin morphogenesis.

Elongation of the vertebrate embryonic axis necessitates rapid expansion of the epidermis to accommodate the growth of underlying tissues. Here, we generated a toolkit to visualize and quantify signaling in entire cell populations of periderm, the outermost layer of the epidermis, in live developing zebrafish. We find that oriented cell divisions facilitate growth of the early periderm during axial elongation rather than cell addition from the basal layer. Activity levels of ERK, a downstream effector of MAPK pathway, gauged by a live biosensor, predicts cell cycle entry, and optogenetic ERK activation controls proliferation dynamics. As development proceeds, rates of peridermal cell proliferation decrease, ERK activity becomes more pulsatile and functionally transitions to promote hypertrophic cell growth. Targeted genetic blockade of cell division generates animals with oversized periderm cells, yet, unexpectedly, development to adulthood is not impaired. Our findings reveal stage-dependent differential responsiveness to ERK signaling and marked developmental robustness in growing teleost skin.

Silicon nanoparticles: A promising approach for control of Pseudomonas aeruginosa biofilms.

Objectives: The current study aimed to investigate the control and treatment of biofilm-producing isolates of Pseudomonas aeruginosa using silicon nanoparticles (SiNPs). Materials and Methods: Biofilm-producing isolates of P. aeruginosa were recovered from various food samples and identified through fluorescent green colony formation on selective and differential media, as well as the amplification of oprI and oprL genes. Tube methods, Congo-red agar method, and scanning electron microscopy (SEM) were used to study biofilm phenotypes. The effect of SiNPs was evaluated by broth dilution assay. Results: The biofilm assay revealed that these isolates formed biofilms on glass surfaces within 72 hr of incubation. Scanning electron micrographs showed that the biofilm communities were composed of multicellular clusters of P. aeruginosa encased in matrix material. However, these isolates were unable to form biofilms on SiNPs-coated surfaces. The results showed that the planktonic isolates of P. aeruginosa were comparatively sensitive to the antibacterial properties of SiNPs, with minimum inhibitory concentration (MIC) ranging from 100 to 200 µg/ml. Contrarily, the biofilms were found to be 500 times more tolerant to the highest concentration of SiNPs (MIC of 500 µg/ml) and were more resistant. Under static conditions, the sedimentation of SiNPs resulted in their ineffectiveness. However, under shaking conditions, the biofilms were effectively dispersed and the cells were lysed. The results showed that SiNPs were effective against both the planktonic and the metabolically inactive forms of P. aeruginosa. Conclusion: This study suggests that SiNPs could be a useful tool for preventing the formation of biofilms and removing pre-existing biofilms.

Musculoskeletal disorders among dental students: a survey from Saudi Arabia.

BACKGROUND: Work-related musculoskeletal disorders (WMSD) are injuries affecting bones, joints, muscles, and tendons due to improper working conditions with serious consequences on health and career. Dentists were found to be at greater risk of developing WMSD compared to other healthcare providers. This study aimed to investigate the prevalence and risk factors of WMSD among dental students in Saudi Arabia. METHODS: This cross-sectional survey-based study recruited dental students across the kingdom using respondent-driven sampling technique. Data was collected using the Nordic Musculoskeletal scale and a validated, self- administered, close-ended questionnaire which assessed WMSDs predisposing factors, enabling factors and musculoskeletal disorders consequences and management. The questionnaire was administered in both Arabic and English languages and was distributed online using google forms. Data analysis was performed using SPSS, Chi-square test or Fisher Exact test was used where appropriate and Multivariate Logistic regression analysis was performed to identify predictors of developing WMSDs. RESULTS: The prevalence of WMSD was 87% (95% CL; 83.9% to 90.3%) among the 462 respondents. Gender, study year, type of practice, having clinics for left-handed, hours of clinical practice, sitting in the proper position while working, use of coping strategies were significantly associated with WMSD prevalence (P < 0.05). Males were OR = 10 times at higher risk of WMSD compared to females (P = 0.0001). Those with daily clinical practice were OR = 5 times at higher risk of WMSD than those who have weekly practice. Those practicing walking, workout, and yoga showed lower prevalence of WMSD (OR = 0.377 & 0.323, p = 0.015, 0.010 respectively). CONCLUSIONS: The prevalence of WMSD among dental students in KSA was high. Males and those with prolonged clinical sessions were at greater risk of WMSD. There is a need for awareness campaigns to educate dental students about risk factors of WMSD. Collegesy, dental colleges should adopt policies in reducing WMSD among their students.

Plasma levels of phosphorylated tau and neurofilament light chain as potential biomarkers for Alzheimer's disease: A biochemical analysis in Pakistani population.

The National Institute on Aging-Alzheimer's Association's research framework in 2018 proposed a molecular construct for the diagnosis of Alzheimer's disease (AD). Nonetheless, the clinical exclusionary strategy is still the mainstay of AD diagnosis in Pakistan. We looked at the plasma levels of amyloid beta-42 (Aß-42), phosphorylated tau (P-tau), and neurofilament light (NFL) in patients with Alzheimer's clinical syndrome (ACS) and healthy controls (HC) from the Pakistani population to keep pace with the global efforts towards establishing accessible and affordable biochemical diagnostic markers for AD in Pakistan. Consultant neurologists screened patients who presented with cognitive impairment to three large tertiary care hospitals in Karachi, and after receiving informed consent, recruited participants with ACS and HC from the same facilities. We collected 5cc of blood in EDTA tubes along with demographic and lifestyle information of the subjects. Plasma aliquots were stored at -80°C after centrifugation. For analysis it was thawed at 4℃ and levels of the three proteins were measured through ELISA. Data from 28 ACS patients and 28 age matched healthy controls were evaluated. Among demographic factors, education and depression were related with health status (p = 0.03 and 0.003, respectively). NFL and P-tau mean values demonstrated a significant difference between the ACS and control groups (p = 0.003 and 0.006), however Aß42 did not (p = 0.114). ROC analysis showed that plasma P-tau and NFL, with AUCs of 0.717 and 0.735, respectively, could substantially distinguish ACS from the HC group (p = 0.007 and 0.003, respectively). Both plasma P-tau (r = -0.389; p = 0.004) and NFL (r = -0.424; p = 0.001) levels were significantly and negatively correlated with individuals' MMSE scores. NFL and plasma P-tau show promise in differentiating AD patients from healthy individuals. However, similar larger studies are needed to validate our findings.

Metal-Dielectric Nanopillar Antenna-Resonators for Efficient Collected Photon Rate from Silicon Carbide Color Centers.

A yet unresolved challenge in developing quantum technologies based on color centres in high refractive index semiconductors is the efficient fluorescence enhancement of point defects in bulk materials. Optical resonators and antennas have been designed to provide directional emission, spontaneous emission rate enhancement and collection efficiency enhancement at the same time. While collection efficiency enhancement can be achieved by individual nanopillars or nanowires, fluorescent emission enhancement is achieved using nanoresonators or nanoantennas. In this work, we optimise the design of a metal-dielectric nanopillar-based antenna/resonator fabricated in a silicon carbide (SiC) substrate with integrated quantum emitters. Here we consider various color centres known in SiC such as silicon mono-vacancy and the carbon antisite vacancy pair, that show single photon emission and quantum sensing functionalities with optical electron spin read-out, respectively. We model the dipole emission fluorescence rate of these color centres into the metal-dielectric nanopillar hybrid antenna resonator using multi-polar electromagnetic scattering resonances and near-field plasmonic field enhancement and confinement. We calculate the fluorescence collected photon rate enhancement for these solid state vacancy-centers in SiC in these metal-dielectric nanopillar resonators, showing a trade-off effect between the collection efficiency and radiative Purcell factor enhancement. We obtained a collected photon rate enhancement from a silicon monovacancy vacancy center embedded in an optimised hybrid antenna-resonator two orders of magnitude larger compared to the case of the color centres in bulk material.

Is It Mum or the Dad? Parental Factors That Influence the Use and Acceptance of Fluoride Varnish among Parents in Eastern Saudi Arabia.

Objective: To investigate parental factors that influence knowledge, use, and acceptance of fluoride varnish (FLV) application. Methods: This cross-sectional study was conducted during December 2021. A multistage sampling technique was used to recruit parents with children aged 3 to 6 years and residing in Eastern Saudi Arabia, excluding those working in the dental field. The questionnaire consisted of four parts: demographics, knowledge, previous experience, and acceptance of FLV and was pilot-tested and distributed online using social media. Results: A total of 623 parents responded to the survey. Only 36.9% of parents had good FLV knowledge with dentists being the main source of information. Gender, educational level, family income, being in the medical field, and source of knowledge were factors that significantly (P < 0.05) influenced parental knowledge. Only 24.6% of the parents applied fluoride varnish to their children before, of whom only 29% were satisfied with the experience. Parent's FLV knowledge, view of dental visits, satisfaction with previous experience, perception of children's oral health, and willingness to reapply FLV were factors that significantly (P < 0.05) influenced FLV use. Working in the medical field, perception of dental visits, and the source of knowledge were factors that significantly (P < 0.05) influenced the parent's acceptance to apply FLV. While lack of knowledge about fluoride benefits (15%) was the main reason for parental refusal to apply FLV. Conclusions: The current study highlights the lack of knowledge and application of FLV among parents. There were more factors influencing mothers' acceptance of FLV application compared to fathers. Age, educational level, working in the medical field, perception, and patterns of dental visits were some of the identified factors. Dentists played a major role in parental knowledge and FLV acceptance. In a country with high caries prevalence, preventive programs such as FLV education and application are crucial.

Is emotional intelligence linked with academic achievement? The first TEIQue-SF study in a sample of Saudi medical rehabilitation students.

Objective: The present study examined the relationship of the Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF) and academic achievement (GPA). Analyses were performed using a sample of Saudi-origin medical rehabilitation undergraduate students (N = 130). The present study examined the psychometric properties of the Chinese version of the Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF). Analyses were performed using a sample of undergraduates (N = 585) recruited from four universities across China. Methods: One hundred thirty medical rehabilitation students completed the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF). Descriptive and inferential statistical analyses were carried out to elucidate relationships (or the lack of the same) between various variables. Results: Whole sample alpha coefficient value for global trait EI was 0.84, while the same for trait EI factors ranged from 0.51 to 0.76. Global Trait EI was found higher in males than in females (Female students median score: 17 ± 2.56 VS Male students median score: 18 ± 3.67; U: 1667, p 0.04). A positive and statistically significant relationship was found between Well-being and the three other factors (with Self-control [r(128), 0.413, p 0.01]; with Emotionality [r(128), 0.518, p 0.01], with Sociability [r(128), 0.490, p 0.01]). Sociability was found to have a similar positive relationship with Self-control [r(128), 0.239, p 0.05] and Emotionality [r(128), 0.490, p 0.01] respectively. Furthermore, GPA was found to have a negative (not statistically significant) relation with Sociability. Overall, there was no association found between trait EI and GPA. Conclusions: The present study is one of two studies that has investigated the train EI-academic achievement link in healthcare-related students. Our findings resonate with existing literature on the subject.

Oral health-related interdisciplinary practices among healthcare professionals in Saudi Arabia: Does integrated care exist?

BACKGROUND: There is a bidirectional relation between oral and general health, therefore collaboration between healthcare providers is needed. This study investigated current interdisciplinary practices (IDP) and the associated factors among healthcare professionals in Saudi Arabia. METHODS: A cross-sectional study was conducted in the Eastern Saudi Arabia recruiting four groups of health professionals (nurses, physicians, pediatricians and Ear-Nose and Throat (ENT) specialists). A validated, self-administered questionnaire was distributed online and shared through social media platforms. The questionnaire explored predisposing factors (demographics) and facilitating factors (knowledge, attitudes, attendance of oral health training and source of knowledge) associated with IDP. RESULTS: A total of 1398 health professionals were recruited. Participants showed fair oral health knowledge (7.1 ± 2.1) and attitudes (22.2 ± 3). Three-fourths (74.6%) reported always providing oral health education (OHE) to their patients, more than half (59.6%) reported always conducting an oral health screening (OHS), two-thirds (66.7%) reported responding to patients' questions about oral health or conditions and 58.7% reported referring patients to dentists. Pediatricians and physicians had greater odds of IDP compared to other health professionals. Source of oral health knowledge (Ministry of Health (MOH) and formal education) was significantly associated with increased odds of IDP. Participants with good oral health knowledge had greater odds of responding to patients' oral health question as well as have more referral practices. CONCLUSION: The results reveal a discrepancy between participants' IDP, knowledge, and attitudes. Incorporating dental component to medical curricula, continuous education and training programs targeting health professionals through Ministry of Health should be considered.

Early Determinants of Mortality in Hospitalized COVID-19 Patients in the Eastern Province of Saudi Arabia.

PURPOSE: This study investigated the clinical determinants of mortality in hospitalized patients infected with COVID-19. PATIENTS AND METHODS: A retrospective multicenter large cohort of COVID-19 patients hospitalized between March 2020 and February 2021. We included patients admitted with a confirmed COVID-19 infection with positive COVID-19 through real-time polymerase chain reaction (RT-PCR). SPSS version 25.0 (Armonk, NY: IBM Corp.) was used to analyze the data. RESULTS: Among the study participants (n = 1444), the mean age of the population was 49.22±17.69 years, of which 63.9% were males (n = 924). Overall, the mean age for non-survivors was 55.65 ±16.41 years and the length of ICU stay was 13.95 ±12.4 years. The most common comorbidity among the study subjects was hypertension (HTN) (32.7%), followed by cardiovascular disease (CVD) (10.7%). Patients who were mechanically ventilated (MV) had higher mortality than those who did not require MV (p < 0.001). CONCLUSION: Our study concluded that old age, the presence of underlying cardiovascular conditions, an abnormal WBC count (leukopenia or leukocytosis), and abnormal blood urea nitrogen (BUN) levels are among the independent predictors of mortality in the Saudi population. These findings may guide health care providers to manage COVID-19 patients more effectively with better outcomes.

Classification of brain tumours in MR images using deep spatiospatial models.

A brain tumour is a mass or cluster of abnormal cells in the brain, which has the possibility of becoming life-threatening because of its ability to invade neighbouring tissues and also form metastases. An accurate diagnosis is essential for successful treatment planning, and magnetic resonance imaging is the principal imaging modality for diagnosing brain tumours and their extent. Deep Learning methods in computer vision applications have shown significant improvement in recent years, most of which can be credited to the fact that a sizeable amount of data is available to train models, and the improvements in the model architectures yield better approximations in a supervised setting. Classifying tumours using such deep learning methods has made significant progress with the availability of open datasets with reliable annotations. Typically those methods are either 3D models, which use 3D volumetric MRIs or even 2D models considering each slice separately. However, by treating one spatial dimension separately or by considering the slices as a sequence of images over time, spatiotemporal models can be employed as "spatiospatial" models for this task. These models have the capabilities of learning specific spatial and temporal relationships while reducing computational costs. This paper uses two spatiotemporal models, ResNet (2+1)D and ResNet Mixed Convolution, to classify different types of brain tumours. It was observed that both these models performed superior to the pure 3D convolutional model, ResNet18. Furthermore, it was also observed that pre-training the models on a different, even unrelated dataset before training them for the task of tumour classification improves the performance. Finally, Pre-trained ResNet Mixed Convolution was observed to be the best model in these experiments, achieving a macro F1-score of 0.9345 and a test accuracy of 96.98%, while at the same time being the model with the least computational cost.

Inferring effects of mutations on SARS-CoV-2 transmission from genomic surveillance data

New and more transmissible variants of SARS-CoV-2 have arisen multiple times over the course of the pandemic. Rapidly identifying mutations that affect transmission could facilitate outbreak control efforts and highlight new variants that warrant further study. Here we develop an analytical epidemiological model that infers the transmission effects of mutations from genomic surveillance data. Applying our model to SARS-CoV-2 data across many regions, we find multiple mutations that strongly affect the transmission rate, both within and outside the Spike protein. We also quantify the effects of travel and competition between different lineages on the inferred transmission effects of mutations. Importantly, our model detects lineages with increased transmission as they arise. We infer significant transmission advantages for the Alpha and Delta variants within a week of their appearances in regional data, when their regional frequencies were only around 1%. Our model thus enables the rapid identification of variants and mutations that affect transmission from genomic surveillance data.

N-terminal pro-brain natriuretic peptide is an independent predictor of mortality in patients with sepsis.

This study aims to evaluate the role of cardiac enzymes N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin-I (CTnI) as predictors of outcomes in patients with sepsis.78 cases with a diagnosis of sepsis were enrolled over a 2-year period. Baseline demographic, Acute Physiology and Chronic Health Evaluation-II (APACHE-II), Simplified Acute Physiology Score-II (SAPS-II), hematologic and biochemical parameters were noted. Serum NT-proBNP and CTnI were evaluated at 24 and 72 hours of admission along with echocardiography. Patients were prospectively followed up until death or discharge.Mean APACHE-II score was 19.8±9.6 and SAPS-II was 44.8±17.2. Survival rate in the study was 47.5% (36 of 78 patients). NT-proBNP was significantly higher in non-survivors with values over 4300 pg/mL at 24 hours and 5229 pg/mL at 72 hours associated with poor outcomes (p<0.05). CTnI was higher among non-survivors than in survivors, but the difference was not significant. APACHE-II score combined with NT-proBNP predicted a poor outcome in 51.2% cases compared with 14.6% cases with APACHE-II alone (p<0.05), while SAPS-II combined with NT-proBNP predicted a poor outcome in 53.6% cases as compared with 9.6% cases with SAPS-II alone (p<0.05). SAPS-II greater than 45 and NT-proBNP values at 72 hours were independent predictors of mortality in patients with sepsis.NT-proBNP is an independent predictor of mortality in patients with sepsis and its combination with APACHE-II and SAPS-II improves the predictive values of the scoring systems.

Psychological Impact of the COVID-19 Pandemic on Students, Assistants, and Faculty of a Dental Institute of Saudi Arabia.

This study aimed to assess the perceived stress levels in students, assistants, and faculty members of the College of Dentistry, Imam Abdulrahman Bin Faisal, University (IAU), Kingdom of Saudi Arabia (KSA) during the novel coronavirus disease 2019 (COVID-19) pandemic. Using the Cohen's perceived stress scale (PSS) questionnaire (consisting of 14 items, hence called PSS-14), an online observational survey was conducted. The PSS 14 was rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often). The scores ranging from 0-18 represented low stress, 19-37 represented moderate stress, and 38-56 represented high stress. The second-and third-year students were designated as junior year students, while fourth-year onwards were considered senior year students. Out of total 265 participants, 65% (173) were female, and the majority of the participants were dental students 70% (185) with a mean age of 26.71 ± 9.26 years. In the present study, the average PSS score for the participants was computed as 29.89 (range score: 0-56) which shows moderate stress levels among the respondents. The PSS score for the students was 31.03; for the faculty, it was 28, while for the assistants, it was 27.05. Among the three participant groups, the students were found more on the severe stress side (19%) (p-value = 0.002), and among them, the senior year students (6th year) showed significantly higher stress levels compared to the junior year students (p-value = 0.005). Age-wise, the participants below 20 years were most stressed (21%), followed by those 20-30 years old (18%). Female participants were more severely stressed than males (17% vs. 10%, respectively). It was concluded that the students experienced more stress, followed by the faculty members and dental assistants. In addition, younger participants, females, and senior year students were more stressed than their counterparts. Future studies directed at evaluating stress levels of these groups from different dental institutes could provide an opportunity for policymakers to offer various resources to improve their mental health.

SARS-CoV-2 T cell responses are expected to remain robust against Omicron

Omicron, the most recent SARS-CoV-2 variant of concern (VOC), harbours multiple mutations in the spike protein that were not observed in previous VOCs. Initial studies suggest Omicron to substantially reduce the neutralizing capability of antibodies induced from vaccines and previous infection. However, its effect on T cell responses remains to be determined. Here, we assess the effect of Omicron mutations on known T cell epitopes and report data suggesting T cell responses to remain broadly robust against this new variant.

Enamel Remineralization Competence of a Novel Fluoride-Incorporated Bioactive Glass Toothpaste-A Surface Micro-Hardness, Profilometric, and Micro-Computed Tomographic Analysis.

This study aimed to analyze the enamel remineralization efficacy of a novel fluoridated bioactive glass (F-BG) toothpaste compared to a standard fluoride toothpaste. Seventy-two enamel blocks (N = 72) were divided into groups of twenty-four blocks according to the toothpaste exposure-group 1: brushed with distilled water, group 2: brushed with fluoride toothpaste (ColgateTM), and group 3: brushed with F-BG toothpaste (BioMinFTM). Pre-brushing, enamel blocks were demineralized using 6 wt.% citric acid (pH = 2.4). Tooth brushing was performed using a mixture of respective toothpaste and artificial saliva (AS), and each enamel block received 5000 linear strokes. The samples were assessed for surface micro-hardness (to estimate Vickers hardness number, VHN), surface roughness (Ra), and volume loss/gain using micro-computed tomography (micro-CT). The highest increase in the VHN was noticed for group 3 (117.81) followed by group 2 (61.13), and all the intragroup comparisons were statistically significant (p < 0.05). Demineralization increased the Ra values, and a decrease was observed post-remineralization for all the groups. The maximum Ra decrease was observed for group 3 (-223.2 nm) followed by group 2 (-55.6 nm), and all the intragroup comparisons were again statistically significant (p < 0.05). Micro-CT investigation revealed that the enamel volume decreased after demineralization and increased after remineralization among all groups. The F-BG toothpaste showed greater enamel surface micro-hardness (increased VHN), smoother surface (low roughness), and better volume restoration (remineralization) in comparison to the fluoride toothpaste.

Comparative cross-sectional assessment of knowledge, attitude and practice among university students and employees towards the use of the microbiology laboratory equipment.

Background: Continuous evaluation of students and employee's knowledge and attitude in clinical laboratories is mandatory to ensure a high level of competency, proper practice and to assess the need for training, which shall be reflected on the quality of laboratory results. The aim of the present study was to evaluate the knowledge, attitude, and practice in microbiology laboratories among employees (at King Fahd Hospital of the University) and clinical laboratory students (at Imam Abdulrahman Bin Faisal University)    Methods: This was a cross-sectional survey of 30 2 nd year students, 26 3 rd year students, 24 4 th year students in the Clinical Laboratory Sciences department, and 30 employees. Participants completed a survey comprising 30 questions to assess their knowledge and attitude towards the use of equipment and practice in the microbiology laboratory. Results: The results indicated that there was no significant difference between the average scores of all levels of students regarding their knowledge (p = 0.85, 0.999, and 0.869), attitude (p = 0.883, 0.996, 0.853), and practice (p=0.633, 0.325, 0.858) in the microbiology laboratory. Employees scores (knowledge;5.03±2.646, attitude; 12.03±4.89, and practice; 7.7±6.11) were quite poor, as indicated by the lower average results than that of students (knowledge; 5.65±3.08, attitude; 13.25±5.33, and practice; 13.46±5.7). Conclusions: It is concluded that the knowledge, attitude, and practice of students and employees in the microbiology laboratory needs to be meticulously monitored and improved to ensure high achievement of learning outcomes and better overall performance in the laboratory. This may be achieved through using frequent quizzes and continuous education programs.

Chest pain and dyspnea in a young man.

A 27-year-old man presented with sudden onset chest pain associated with dyspnea for the preceding 1 week. He also reported typical angina for the past 3 months. Clinical examination revealed a continuous murmur in the upper left parasternal region. Echocardiography revealed a ruptured left sinus of Valsalva aneurysm communicating with the left atrium. CT angiogram confirmed a ruptured large aneurysm of the left sinus of Valsalva freely communicating with the left atrium via a long fistulous tract. Additionally, the tract resulted in partial compression of the left main coronary artery. A ruptured sinus of Valsalva aneurysm represents an important differential in young adults presenting with acute onset chest pain and heart failure. Fistulous tracts arising from the left sinus may result in compression of the left coronary system and sudden cardiac death making this a unique entity to recognize.

Under-reported COVID-19 cases in South Asian countries.

Background: The purpose of the study was to compare  trends in the progression of COVID-19 among South Asian countries with more developed Western countries. Methods: COVID-19 data from South Asian countries were used for this observational study. Data were taken up to April 21, 2020 from the outbreak of the COVID-19. Four of the seven countries met the inclusion criteria and were included in the analysis. Results: An exponential increase in the average number of weekly cases was reported after the fifth week following the first case. The correlation between reported cases and tests was found to be strong and significant (r=0.90, p=0.037). However, on average, 315.25 tests per million population were performed, which was at least 12 times lower than the number of tests performed in countries with a large number of COVID-19 cases. Conclusions: At present, the number of confirmed cases from South Asia was found to be significantly lower than in Western countries. Hence, an increase in the strength of performing diagnostic tests is highly recommended. Strict measures are required to make the people of these countries follow the instructions of social distancing and comply with preventive measures.