Interns' Perceived Level of Proficiency After General Surgery Rotation: A Cross-Sectional Study From Saudi Arabia

BACKGROUND

The role of interns during general surgical rotation is crucial in shaping their future careers as surgeons. Surgical rotation offers a unique opportunity to gain valuable hands-on experience in fast-paced and challenging environments. However, interns often face significant challenges in obtaining the necessary practical training to develop proficiency in surgical techniques. This article aims to analyze some aspects of the accumulated competency of interns during their general surgery rotation, focusing on the range of skills and knowledge gained, in addition to the challenges faced.

SUBJECTS AND METHODS

We conducted a cross-sectional study using an anonymous web-based self-assessment questionnaire. The target population of the study included all Jazan University medical interns enrolled in the academic year 2022-2023.

RESULTS

Most participants showed low-to-average levels of proficiency in monitoring clinical evolution and treatment plans, ranging from fundamental awareness (n = 17, 17.5%) to working knowledge (n = 51, 52.6%), with only three participants (3.1%) reporting an expert level of proficiency. The same pattern was observed in the documentation of patient records (range: 7.2%, n = 7 for fundamental awareness to 42.3%, n = 41 for working knowledge). However, a significant proportion saw themselves as either proficient (n = 23, 23.7%) or experts (n = 15, 15.5%) in this aspect. Regarding bedside procedures, such as venipuncture, proctoscopy, nasogastric tube insertion, and urethral catheterization, the participants showed different proficiency levels, with the lowest in proctoscopy, where 66 (68.0%) of the participants reported only fundamental awareness. The results also revealed low perceived proficiency in performing surgical skin incisions, wound suturing, knot tying, application of surgical skin clips, and abscess drainage, with the lowest proficiency observed in the excision of superficial lumps as more than half of the participants reported only fundamental awareness (n = 51, 52.6%).

CONCLUSION

The results of this study indicate that documentation and monitoring of patient progress are the competencies mastered most by the majority of interns during their rotations in general surgery. However, the interns' overall level of proficiency in bedside procedures and basic surgical skills acquired during their rotation was low to average. Additionally, interns were dissatisfied with their training and the opportunities provided for them to actively engage in performing procedures in the operating room. This low proficiency is unrelated to pre-internship academic achievement, sex, or interest in future surgical careers. This suggests that efforts are needed to develop strategies to enhance interns' satisfaction and engagement, ultimately improving their overall experience during internships.

Common Genetic Variants in SIRT1 Gene Promoter and Type 2 Diabetes Mellitus in Saudi Arabia

BACKGROUND

Type 2 diabetes mellitus (T2DM) is common in Saudi Arabia and represents a major health concern. Silent information regulator of transcription-1 (SIRT1) positively influences insulin sensitivity and might contribute to the pathogenesis of T2DM. This study aimed to investigate the frequency of two common functional single nucleotide polymorphisms (SNPs) in the promoter region of SIRT1; rs12778366 (T>C) and rs3758391 (T>C) in Saudi Arabian population and examine any association with T2DM.

METHODS

A total of 445 volunteers were divided into 224 healthy controls and 221 patients previously diagnosed with T2DM. Genomic DNA was extracted from all samples and genotyped for SIRT1 rs12778366 and rs3758391 SNPs by TaqMan RT-PCR allelic discrimination assay. Logistic regression analysis was used to establish any relationship between these polymorphisms and T2DM.

RESULTS

In the total study population, rs12778366 genotype frequencies were TT (89.2%), TC (10.3%), and CC (0.45%) and for the rs3758391 they were TT (16.4%), TC (44.5%), and CC (39.1%). The distribution of these genotypes, in both polymorphisms, were similar among T2DM and controls. Logistic regression analysis confirmed the lack of association between the presence of CC or CT variants and T2DM for rs12778366 and rs3758391 SNP (OR = 0.98 [CI]: 0.55 - 1.75; p = 0.999 and OR= 0.75; [CI]: 0.45 - 1.24; p = 0.313), respectively.

CONCLUSIONS

This study revealed the frequency of SIRT1 rs12778366 and rs3758391 SNPs in our population and reported no association between these polymorphisms and the risk for T2DM. This finding might add to the growing body of literature exploring the genetics of T2DM.

Psychotropic Medication Adherence and Its Associated Factors Among Schizophrenia Patients: Exploring the Consistency of Adherence Scales

Background and objective Non-adherence to psychotropic medication can aggravate an individual's illness, diminish treatment efficacy, or make patients less responsive to future therapeutic interventions. There are several scales available to measure non-adherence to medications. In this study, we aimed to measure psychotropic medication adherence and its associated factors among schizophrenic outpatients in Saudi Arabia. Methodology A cross-sectional study was conducted with a view to measuring psychotropic medication adherence and its associated factors. The Medication Adherence Rating Scale (MARS) and the Drug Attitude Inventory-10 (DAI-10) were translated into Arabic, and their internal consistency was measured. The adjusted odds ratios (AOR) were calculated using logistic regression in the IBM SPSS Statistics software version 23 (IBM Corp., Armonk, NY). Results Spearman's rho correlation indicated a negative association between DAI-10 and MARS scores (r = -0.579; p<0.05). The Arabic version of MARS was more reliable than DAI-10, as evidenced by Cronbach's alpha value. Of note, 60.20% (n = 59) of the sample demonstrated high adherence levels. The adherence level based on MARS scoring remained unaffected (p>0.05) in terms of gender, age, employment, marital status, educational level, income level, and duration of sickness. These results were obtained by using the multivariate logistic regression model; 89% of respondents reported not using psychiatric drugs given by someone else, despite the adherence rate not affecting this number. Conclusion The rate of non-adherence to psychotropic treatment was found to be high in our cohort. Hence, it is imperative to develop comprehensive intervention methods targeting the causes of non-adherence to psychiatric medication.

Frequency of the rs2015 (T>G) and rs2241703 (G>A) polymorphisms in the miRNA-SIRT2 gene in type 2 diabetes mellitus in Saudi Arabia

OBJECTIVES

To investigate the prevalence of rs2015 (T>G) and rs2241703 (G>A) polymorphisms in the miRNA-SIRT2 gene in Saudi Arabia and their possible associations with type 2 diabetes mellitus (T2DM).

METHODS

Blood samples were collected from 428 participants from Jazan University Hospital, Jazan, Saudi Arabia between September 2021 and June 2022 and subjected to TaqMan single-nucleotide polymorphisms (SNP) genotyping assay for rs241703 (G>A) and rs2015 (G>T). Genotype frequencies were determined in control (n=217).

RESULTS

The A allele of rs2241703 was undetected in our population, and all samples carried the GG genotype. The rs2015 SNP frequency was 29.4% for GG, 45.6% for GT, and 24% for TT. However, logistic regression analysis of the dominant inheritance model showed no association between the T allele and T2DM calculated odds ratio [OR]=0.80, 95% confidence interval=0.53 to 1.20, p=0.301).

CONCLUSION

Although rs2241703 SNP of Sirtuins 2 is not present, rs2015 SNP is highly prevalent in Saudi Arabia, but no direct link was identified with T2DM.

The Health Belief Model Modifying Factors Associated with Missed Clinic Appointments among Individuals with Sickle Cell Disease in the Jazan Province, Saudi Arabia

In treating chronic illnesses, such as sickle cell disease (SCD), outpatient care is essential; poor adherence in attending clinic appointments can lead to serious outcomes. SCD is highly prevalent in Saudi Arabia, and patients with SCD are advised to follow up with their treating physician in order to control this disease manifestation and to better forecast its complications. Studies evaluating missed appointments among patients with SCD are rare. Therefore, the current study aimed to use the health belief model's modifying factors in order to evaluate the variables associated with poor adherence in attending appointments. A total of 381 participants with SCD from various regions in the Jazan Province, southwestern Saudi Arabia, were included. The survey instrument included socioeconomic determinants, factors associated with poor adherence in attending outpatient appointments, and solutions under the conceptual framework of the health belief model. A descriptive analysis was conducted and the factors that impacted adherence in attending the appointments were evaluated. In the current sample, respondents with SCD from 21 to 30 years represented 41%, which was followed by participants who were 11 to 20 years at 21.5%. In addition, about 60% of the participants were women. Further, approximately 62% of the patients admitted were missing one or more outpatient appointments in the previous year, which was significantly related to various factors, such as socioeconomic characteristics and patient residence. Forgetting the appointment was the main reason for skipping outpatient appointments for patients with SCD; as such, reminders appear to be a good solution for most participants. Our findings indicated that modifying components of the health belief model, including age, level of education, income, patients' residence, and lacking cues to action (such as reminders) are important in explaining the reason for poor adherence in attending appointments. Thus, efforts are needed to address these factors and to ensure that SCD patients uphold their appointments. Future studies should examine the clinical, psychological, and epidemiological aspects that are linked with missed consultations.

p-Trifluoromethyl- and p-pentafluorothio-substituted curcuminoids of the 2,6-di[(E)-benzylidene)]cycloalkanone type: Syntheses and activities against Leishmania major and Toxoplasma gondii parasites

A series of the title curcuminoids with structural variance in the heteroatom of the cycloalkanone and the p-substituents of the phenyl rings were tested for their activities against Leishmania major and Toxoplasma gondii parasites. The majority of them showed high activities against both parasite forms with EC₅₀ values in the sub-micromolar concentration range. Bis(p-pentafluorothio)-substituted 3,5-di[(E)-benzylidene]piperidin-4-one 1b was not just noticeable antiparasitic, but also exhibited a considerable selectivity for L. major promastigotes over normal Vero cells. While derivatives differing only in the p-phenyl substituents being CF₃ or SF₅ showed similar antiparasitic activities, the cyclic ketone hub was more decisive both for the anti-parasitic activities and the selectivities for the parasites vs. normal cells. QSAR calculations confirmed the observed structure-activity relations and suggested structural variations for a further improvement of the antiparasitic activity. Docking studies based on DFT calculations revealed L. major pteridine reductase 1 as a likely molecular target protein of the title compounds.

Antidepressant effect of methanol extract of smokeless tobacco and identification of its bioactive components

Purpose: To investigate the antidepressant effect of methanol extract of smokeless tobacco and identify its bioactive compounds. Methods: Adult Wistar rats were randomly assigned to five groups of five rats each: normal control group, standard (reference) control group as well as 100, 200 and 500 mg/kg extract group. The extract, standard drug (imipramine) and normal saline were administered via the intraperitoneal (i.p.) route. The rats were subjected to forced swim test (FST) and tail suspension test (TST) to assess the antidepressant effect of methanol extract of smokeless tobacco. Gas chromatography–mass spectrometry (GC-MS) was used to identify the bioactive compounds of the extract. Results: The oral LD50 of the extract was > 2000 mg/kg. Significant decrease in immobility time was observed after single administration of imipramine (p < 0.05). The extract significantly and dosedependently decreased the immobility time, but increased climbing and swimming times, when compared with normal control group (p < 0.05). The immobility time of stressed rats regardless of sex was significantly and dose-dependently lowered, relative to normal control group (p < 0.05). Four major compounds were identified in the extract: nicotine (45.88 %); 1,5-dimethyl-2-pyrrolidinone (23.00 %), nhexadecanoic acid (11.31 %) and vitamin A aldehyde (9.38 %). Conclusion: These results demonstrate that the methanol extract of smokeless tobacco possesses antidepressant and mood-elevating effects in rats. However, its use should be discouraged since it contains a number of hazardous and carcinogenic components such as N-nitroso compounds and benzo(a)pyrene which are categorized as Class-I carcinogens.

Risk-based exposure assessment for multiple toxic elements encountered by children in school playgrounds and parks in the southwest region of Saudi Arabia

Children are in direct contact with surface soil and may inadvertently ingest and inhale toxic contaminants while playing; hence, special attention should be given to playgrounds regarding toxic contaminants. The concentrations of ten toxic metals were determined in soil samples collected from school playgrounds and children's parks from the southwest region of Saudi Arabia. The soils were moderately alkaline (pH 7.6-8.8), the texture was dominated by sand particles (54-88%), and the organic matter was in the range of 2.06 to 4.82%. Analytical solutions were prepared by microwave-digestion using a HNO₃/H₂O₂ mixture, and the concentrations of toxic elements were measured by inductively coupled plasma mass spectrometry (ICP-MS). Metal concentrations were recorded in the range of 0.014-0.087, 1.14-3.54, 0.85-23.29, 0.77-36.32, 312.6-2065.7, 285.3-822.6, 75.4-240.8, 0.00-53.12, 0.52-6.80, and 1.25-92.12 mg/kg dry soil for Cd, Co, Cr, Cu, Fe, Mg, Mn, Ni, Pb, and Zn, respectively. The levels of heavy metals in the studied playgrounds were below the permissible limits, indicating insignificant influence of anthropogenic activities and can be considered as unpolluted soil. Values of the enrichment coefficient (EC) and contamination factor (CF) were found to be less than one, suggesting that the source of these elements is mainly the local soil, with the exception of Ni and Zn in certain playgrounds (CF > 1), which indicates a possible contamination from external sources. The non-carcinogenic hazard index calculated for all of the metals was below one, indicating that the exposure to heavy metal through playground soil is unlikely to produce any adverse health effect in children playing in the playgrounds.

Thymoquinone induces apoptosis and increase ROS in ovarian cancer cell line

Nigella sativa is also known for its properties as a traditional herbal healing for many ailments. In this study, the anticancer properties of thyomquinone (TQ), the active ingredient of N. sativa, were studied using ovarian cancer cell line (Caov-3 cells). The anti-proliferative activity of TQ was determined using MTT and the apoptosis was investigated using Flowcytometry and Annexin-V Assays. Multiparameteric cytotoxicity bioassays were used to quantify the changes in cell permeability and mitochondrial membrane potential. Reactive oxygen species (ROS) and apoptosis-involved cell markers were examined to verify cell death mechanism. The MTT-assay showed that TQ induces anti-proliferative activity on Caov-3 with an IC50 of 6.0±0.03 μg/mL, without any cytotoxic activity towards WRL-68 normal hepatocytes. A significant induction of early phase of apoptosis was shown by annexin-V analysis. Treatment of Caov-3 cells with TQ induces decreases in plasma membrane permeability and mitochondrial membrane potential. Visible decrease in the nuclear area was also observed. A significant decrease is observed in Bcl-2 while Bax is down-regulated. TQ-triggered ROS-mediated has found to be associated with Hsp70 dysregulation, an indicator of oxidative injury. We found that TQ induced anti-cancer effect involves intrinsic pathway of apoptosis and cellular oxidative stress. Our results considered collectively indicated that thyomquinone may be a potential agent for ovarian cancer drug development.

In vitro anti-inflammatory, cytotoxic and antioxidant activities of boesenbergin A, a chalcone isolated from Boesenbergia rotunda (L.) (fingerroot)

The current in vitro study was designed to investigate the anti-inflammatory, cytotoxic and antioxidant activities of boesenbergin A (BA), a chalcone derivative of known structure isolated from Boesenbergia rotunda. Human hepatocellular carcinoma (HepG2), colon adenocarcinoma (HT-29), non-small cell lung cancer (A549), prostate adenocarcinoma (PC3), and normal hepatic cells (WRL-68) were used to evaluate the cytotoxicity of BA using the MTT assay. The antioxidant activity of BA was assessed by the ORAC assay and compared to quercetin as a standard reference antioxidant. ORAC results are reported as the equivalent concentration of Trolox that produces the same level of antioxidant activity as the sample tested at 20 µg/mL. The toxic effect of BA on different cell types, reported as IC₅₀, yielded 20.22 ± 3.15, 10.69 ± 2.64, 20.31 ± 1.34, 94.10 ± 1.19, and 9.324 ± 0.24 µg/mL for A549, PC3, HepG2, HT-29, and WRL-68, respectively. BA displayed considerable antioxidant activity, when the results of ORAC assay were reported as Trolox equivalents. BA (20 µg/mL) and quercetin (5 µg/mL) were equivalent to a Trolox concentration of 11.91 ± 0.23 and 160.32 ± 2.75 µM, respectively. Moreover, the anti-inflammatory activity of BA was significant at 12.5 to 50 µg/mL and without any significant cytotoxicity for the murine macrophage cell line RAW 264.7 at 50 µg/mL. The significant biological activities observed in this study indicated that BA may be one of the agents responsible for the reported biological activities of B. rotunda crude extract.