Students' Perceptions towards the Experience, Quality, Challenges and Effectiveness of Online Teaching-Learning during Covid-19 Pandemic in Riyadh Elm University, Saudi Arabia.

Due to the massive transition from traditional face-to-face classes to distance online learning during the Covid-19 pandemic, a cross-sectional study was designed to investigate the perception of university students towards online education. The study was conducted among undergraduate students of Riyadh Elm University, KSA, in June 2021. Data were collected through a self-administered online questionnaire created via the Google Form platform. The link was distributed to the students by email through the administration office. The survey questionnaire contains 11 questions assessing students' perceptions related to students' experiences with online learning, the quality of online learning, the challenges faced by the students and the effectiveness of online learning during Covid-19 pandemic. Data was analyzed using SPSS Version 25.0. Kruskal-Wallis test was used to compare the differences between groups while Spearman Rho test was used to evaluate correlation strength between the variables. A total of 309 students participated in this study, 66.0% were 18 to 24 years, and 71.5% were from the Faculty of Dentistry. The major constituents of online education were lectures (77.3%) and quiz (77.0%). There was a significant association between age groups and online learning participation. Age groups significantly correlated with 'independent learner' and 'accomplish assignments effectively'. IT and technical skills had a strong correlation with online learning technology, effective communication and convenience learning. This study demonstrated students' positive attitudes towards online learning and the effectiveness of blended learning in maintaining the quality of education during the Covid-19 pandemic.

Citicoline improved cardiovascular function in animal model of dysautonomia.

The autonomic nervous system controls cardiovascular function. Autonomic dysfunction or dysautonomia is commonly encountered in several diseases like Parkinson's disease. 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is a chemical that changes into the neurotoxin MPP+, which causes catecholamine depletion. We aimed to study the effects of citicoline on cardiovascular function in MPTP-treated albino rats. Twenty-four male albino rats were divided into four groups (6 rats/group): negative control received intraperitoneal (i.p.) saline injection for five consecutive days, a positive control (Citicoline group) received citicoline (250 mg/kg) by oral gavage for consecutive 20 days, MPTP treated with MPTP-HCL (30 mg/kg, i.p.) for five consecutive days, MPTP + citicoline treated with MPTP-HCL (30 mg/kg, i.p.) for five consecutive days followed by treatment with oral doses of citicoline (250 mg/kg) for 20 days. Cardiovascular functions evaluated through recording electrocardiogram (ECG), echocardiography, measuring arterial blood pressure and assessment of aortic rings vascular reactivity. Biochemical measurements on cardiac tissue for tyrosine hydroxylase, norepinephrine, glucose transporter 1 (GLUT1), insulin receptor substrate 1 (IRS1), peroxisome proliferator-activated receptor γ co-activator-1 (PPAR-γ co-activator-1) (PGC-1), phosphatase and tensin homolog-induced kinase 1 (PINK1), carnitine palmitoyltransferase I (CPT1), uncoupling protein 2 (UCP2) and adenosine monophosphate-activated protein kinase alpha 2 (AMPKα2). Citicoline increased cardiac norepinephrine and tyrosine hydroxylase and improved markers related to ROS scavenger, mitochondrial permeability, calcium homeostasis on the cellular level, metabolic homeostasis, and mitochondrial biogenesis. We conclude that citicoline improved cardiovascular dysautonomia and that was reflected on cardiac contractility, electrical activity, blood pressure, and vascular reactivity.

Subchronic toxicity of Nile tilapia with different exposure routes to Microcystis aeruginosa: Histopathology, liver functions, and oxidative stress biomarkers.

BACKGROUND: Toxic cyanobacterial blooms (Microcystis aeruginosa contains microcystins [MCs]) have been reported to induce clinicopathological alterations as well as different oxidative stress in aquatic biota. AIM: Three-week subchronic exposure experiment was carried out on Nile tilapia, to determine their effects on fish behavior, tissues, liver functions, antioxidant enzymes, and lipid peroxidation. MATERIALS AND METHODS: Fish were exposed to four main treatments; orally fed diet plus toxic cells of M. aeruginosa (containing 3500 µg/g MC-LR), immersion in 500 µg MC-LR/L, intraperitoneal injection of M. aeruginosa MC-LR with a dose of 0.1 ml of extracted toxin at a dose of 200 µg/kg bwt, and the fourth one served as a control group, then the fish were sacrificed at the end of 3rd week of exposure. RESULTS: The results revealed no recorded mortality with obvious behavioral changes and an enlarged liver with the congested gall bladder. Histopathology demonstrated fragmentation, hyalinization, and necrosis of the subcutaneous musculature marked fatty degeneration, and vacuolation of hepatopancreatic cells with adhesion of the secondary gill lamellae associated with severe leukocytic infiltration. Furthermore, liver functions enzymes (aspartate aminotransferase and alanine aminotransferase, and the activities of glutathione peroxidase, glutathione reductase, lipid peroxidase, and catalase enzymes) were significantly increased in all treatments starting from the 2nd week as compared to the control levels. CONCLUSION: In this context, the study addresses the possible toxicological impacts of toxic M. aeruginosa contain MC-LR to Nile tilapia, and the results investigated that MC-LR is toxic to Nile tilapia in different routes of exposure as well as different doses.

Clinical audit: can we improve further?

Clinical audit is an important tool for comparing one's practice against existing standards. The authors have analysed the Junior Doctor's understanding of audit by performing a survey and questionnaire from 146 trainees, SpRs and SHOs from nine hospitals. The study showed that 107 (72.8%) performed audit and among those who performed audit, 52 (48.6%) experienced difficulty in obtaining data. This study highlights the importance of support needed to encourage the junior doctors to participate in audit programmes.

Nirschl tennis elbow release with or without drilling.

Nirschl release appears to be a very successful technique for surgically suitable cases of tennis elbow. However, although the drilling or decortication aspect of the procedure was thought to be of benefit to the immediate outcome, this has not actually been confirmed. This randomised double blind comparative prospective trial shows that drilling confers no benefit and actually causes more pain, stiffness, and wound bleeding than not drilling.

Broken arm wrestler.

An unusual injury following an arm wrestle is presented, that of a fractured humerus.

Eponyms - are they relevant?

This study was performed to investigate the value of eponyms of fractures amongst orthopaedic/casualty trainees. Our results show eponyms are not favoured.

Axillary arch and its implications in axillary dissection--review.

Axillary arch is an anomalous muscular slip of latissimus dorsi muscle occasionally encountered in axillary dissection. A systematic review of medical literature published between 1966 to 1999 was performed regarding its incidence, clinical features and management. Its presence in axillary dissection should be recognised to avoid confusion in staging of lymph nodes and to prevent injury to axillary vessels and brachial plexus.

Use of biplane transesophageal echocardiography as the only imaging technique for percutaneous balloon mitral commissurotomy.

Percutaneous balloon mitral commissurotomy with the Inoue technique was attempted in 9 patients with rheumatic mitral stenosis under the sole guidance of biplane transesophageal echocardiography and was completed in 8 patients. This preliminary experience points to the feasibility and relative safety of performing percutaneous balloon mitral commissurotomy under the sole guidance of biplane transesophageal echocardiography.

Congenital cholesteatomas of the middle ear: a different experience.

A retrospective analysis is presented of 44 cases of congenital cholesteatoma of the middle ear. Twenty-one patients had cholesteatoma localized to the posterosuperior mesotympanum in complete contrast to the commonly reported anterosuperior location seen in only two cases. The remaining 21 patients had cholesteatoma involving either the entire mesotympanum or epitympanum or both. The posteriorly located congenital cholesteatomas might represent a completely different entity and originate from the trapped epithelial cell rests in the posterior mesotympanum during the development of temporal bone. All but one patient were treated by using a closed tympanoplasty. Eight patients underwent a single-stage surgery. A preplanned second-stage procedure was performed in 33 patients, and three are awaiting their second stage. Residual disease was seen in 19 (57%) patients undergoing second-stage surgery. No patient has had recurrent disease so far. Thirty-eight (85%) patients had a preoperative air-bone gap of > or = 30 dB. Of the 33 patients considered for hearing results, 16 (48%) had a postoperative gap within 10 db.

Surgical treatment of cholesteatoma in children.

Treating cholesteatoma in children is still controversial. This article reviews 93 cases of pediatric cholesteatoma operated on from 1983 to 1991 in the Gruppo Otologico, Placenza, Italy, and details the results in 83 children who underwent the intact canal wall technique. During second-stage surgery, residual cholesteatoma was detected in 38% of patients. Recurrent cholesteatoma was detected in 10% of patients treated with the intact canal wall technique. Residual cholesteatoma was seen in the middle ear cleft in 63%, in the epitympanum in 26%, and in the mastoid in 11% of cases. Social hearing level (< 25 dB) was achieved in 85% of cases with suprastructure, whereas only 53% of patients without suprastructure had these levels. In the treatment of cholesteatoma in children by use of the intact canal wall technique, a preplanned second-look operation is mandatory to eradicate the disease.

Benign osteoblastoma of the mastoid part of the temporal bone: case report.

Osteoblastoma is a benign bone lesion that mainly affects the long bones and rarely the temporal bones. Very few cases have been reported in the literature. This paper reviews the literature, discusses the differential diagnosis, clinical presentation, and CT scan findings of such a condition and details our experience with a young patient who had a temporal bone (mastoid process) osteoblastoma.

Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery.

Cerebrospinal fluid leakage is the most common complication of translabyrinthine acoustic neuroma surgery. This retrospective study reviews patients who had translabyrinthine acoustic neuroma surgery at the Gruppo Otologico, Piacenza, Italy, and ENT Department of Bergamo General Hospital, Bergamo, Italy, during the last 6 years. The incidence of postoperative cerebrospinal fluid leakage was 6.2%, and 75% of these patients underwent another surgery to control the cerebrospinal fluid leakage. A modification of translabyrinthine approach was used in patients with highly pneumatized temporal bones to prevent cerebrospinal fluid leakage in these high-risk patients.

HIV antibodies among intravenous drug users in Bahrain.

A 12-month study was conducted to identify risk factors for human immunodeficiency virus (HIV) infections among intravenous drug users (IDU) attending drug rehabilitation clinic of the Psychiatric Hospital, Manama, Bahrain. Patients provided demographic and behavioural information based on a questionnaire. Two hundred and forty male IDUs participated in the study on voluntary basis. The seroprevalence of HIV was 21.1 per cent. The presence of HIV antibody was associated with educational status, frequency of injecting drugs and needle sharing.

PIP: During January 1st to December 31st, 1991, a total of 242 male intravenous drug users (IDUs) attending the drug rehabilitation clinic of the Psychiatric Hospital, Manama, Bahrain, for treatment were interviewed by trained interviewers using a structured questionnaire to gather information on age, sex, marital status, nationality, religion, income, educational status, history of drug use, sexual practices, and blood and blood product transfusions. The sera were tested for antibodies to HIV-1 and HIV-2 using a second generation enzyme linked immunoassay (ELISA) and confirmed by Western Blot. 51 (21.1%) IDUs were positive for anti-HIV-1 by ELISA as confirmed by Western blot. 5 of 62 (8.1%) cases with college education were positive for HIV compared with 35 of 138 (25.4%) with secondary level of education and 11 of 42 (26.2%) with primary or lower level of education (p 0.01). Among the behavioral characteristics, only needle sharing showed an association of borderline statistical significance (p = 0.06). Frequency of intravenous drug use and sexual practice showed 95% confidence limits close to 1.0 (the null value) and higher limits of 4.61 and 2.71, respectively. Only educational status showed a significantly lower risk of HIV positivity in persons with college education with an odds ratio of 0.25. Stepdown logistic regression analysis was performed on 219 IDUs using the five potential predictor variables: age, education, intravenous drug use, needle sharing, and sexual practice. This showed that sexual practice was not an independent predictor variable of HIV positivity. Hence a second logistic regression analysis was carried out using age as a continuous variable and education, intravenous drug use, and needle sharing as dichotomous variables. Data on all 242 drug users were available for this analysis. Only education and needle sharing emerged as significant predictor variables. The odds ratios were: education 0.250 and needle sharing 2.46.

Three anteromedial fasciocutaneous leg island flaps for covering defects of the lower two-thirds of the leg.

Three different fasciocutaneous island flaps based on the medial septocutaneous vessels of the leg have been successfully transferred in eight patients. The flaps are based on three segments of the anteromedial aspect of the leg where their feeding vessels were most frequently identified. These anteromedial fasciocutaneous leg island flaps are thin, reliable and safe. They are relatively easy to elevate and are useful for covering defects of the lower two-thirds of the leg.

Breast feeding and infant growth, a follow-up study in Menoufia, Egypt.

PIP: Staff from a maternal and child health (MCH) center in urban Shebeen El Kom and from an MCH center in rural Om-khnan in Menoufia Governate, Egypt followed 200 newborn infants for 6 months. The mean birth weight stood at 3.3 kg, mean birth length 50.2 cm, mean head circumference at birth 34.5 cm, and the mean mid arm circumference at birth 10.2 cm. Infants which were exclusively breast fed lost 14 percentiles of weight for age from birth-6 months while those which were exclusively formula fed lost 18 percentiles. On the other hand, those which received solid food in addition to breast milk gained 24 percentiles. Similarly, exclusively breast fed infants lost 6 percentiles of length for age and exclusively formula fed infants lost 8 percentiles. Infants which breast fed and had solid food supplements gained 14 percentiles. In addition, breast fed infants regardless of solid food supplementation maintained their percentiles for age for head circumference while formula fed infants lost 8 percentiles. The reduced growth velocity in formula fed infants may be due to dilutions of formula and an increased incidence of infections, especially gastroenteritis. After 3-4 months of lactation, the breast milk yield fell in the mothers who exclusively breast fed their infants which may have caused a reduction in growth velocity. No group of infants experienced an increase in protein energy malnutrition. Even though there was a reduced growth velocity in these infants, research shows that breast fed infants maintain a better health status and have fewer infections than nonexclusively breast fed infants. In fact, no evidence exists that shows more rapid growth of normal neonates to be desirable.^ieng

Correlation between circulating schistosomal antigen, schistosomal complement C3 and intensity of infection.

53.7% of the already parasitologically proved schistosomiasis cases showed circulating schistosomal antigen (C.S.A.) in their sera with significantly higher levels than the controls, with no correlation between the level of C.S.A. and the foecal egg count. Significant higher levels of schistosomal complement C3 were found in schistosomiasis patients as compared to the control group, with no significant difference in the mean level of C3 between patients with positive and negative C.S.A.

Study of congenital toxoplasmosis in Egyptian newborns.

Five hundred cord blood samples of normal, full term, apparently healthy newborns of both sexes and of different social classes were studied for Toxoplasma antibodies. Eighty nine cases (17.8%) showed a seropositivity for IgG antibodies while specific IgM antibodies were found in 3 cases. A significant higher percentage of seropositivity was found among newborns whose mothers had a previous history of abortion (p less than 0.01), still birth, prematurity or delivery of infants with congenital anomalies (p less than 0.001). The relation between seropositivity and maternal lymphadenopathy and/or fever during pregnancy was highly significant (p less than 0.001). Also, a highly significant (p 0.001) relationship was observed between mothers' contact with cats and seropositivity for toxoplasmosis. No statistical differences were found in the seropositivity between the 2 social classes studied, nor between the sexes. The study ensured that the problem of congenital toxoplasmosis in Egypt should be seriously considered and emphasized the importance of serological screening before and during pregnancy for those women who are at greater risk and of newborns.