E-Learning in medicine: Current status and future developments Matthias Schneider, Thomas Binder Hamdan Medical Journal 2019 12(4):147-151 We are confronted with a rapid growth in medical knowledge. It has become more and more difficult for health care professionals to keep pace with the state of knowledge. At the same time teaching concepts have changed with a similar speed, propelled by the evolution of the internet, social media, and digital technology. Online education plays an increasing role in all stages of education and can help to overcome some of the difficulties that health care professionals encounter. E-Learning can be more effective, interactive, and adaptive to the needs of the learner. But most importantly, it is available anytime and anywhere. This article focuses on the different stages of learning in a physician's career and on new teaching concepts that are applying innovative technologies to improve education.

Smoking and its risks in Saudi Arabia: Literature review Muhammad Zubair Tahir Hamdan Medical Journal 2019 12(4):152-157 Smoking, as recreational activity, is being practiced by over 1 billion people globally. The main objective of the present study was to explore smoking prevalence, its effects and people attitude in the Kingdom of Saudi Arabia (KSA) by literature review. PubMed was used for systematic search. Search was made with key words ‘Smoking AND Saudi Arabia’ and a total of 790 articles were found. When limits were applied with English language and studies on human, 502 articles were left. All abstracts of these articles were reviewed with the application of inclusion criteria of studies in the KSA and Saudi Arabia population and 75 articles were left. Then, these articles were categorised according to content, attitudes, cross-sectional studies, factors or diseases, its effects and associations to risk factors, original articles, prospective and retrospective studies, studies about smoking, surveys, studies showed different prevalences of smoking among schoolchildren, medical colleges, university students, health professionals and other population. Tobacco smoking was a major and modifiable risk factor for cardiac diseases and other diseases in Saudi Arabian population. Majority of smokers were found motivated to quit smoking, needed guidance and treatment. Second-hand smoke (SHS) affects newborns and children's health. Waterpipe smoking and SHS were potential threats for population's health in SA. It was concluded that in the KSA, smoking is a forthcoming alarming threat for different tobacco-related diseases. Now, it can be controlled in minimal time with lesser efforts by strategic planning, designing tobacco control programmes according to sex, age groups and education levels.

An overview on interference in clinical immunoassays: A cause for concern Shiefa Sequeira Hamdan Medical Journal 2019 12(4):158-164 Immunoassays are rapid, simple, cost-effective, robust and sensitive laboratory techniques that are extensively used in many important areas of clinical medicine such as diagnosis, prevention, treatment and management of diseases. Universally, it is one of the most extensively used in vitro diagnostic testing methods, and its demand has been increasing exponentially over the past four decades. Routinely, these methods can quantify minute amounts of diverse analytes such as hormones, antibodies, proteins and drugs present in highly complex biological fluids, such as serum, urine, sweat, meconium and cerebrospinal fluid. Immunoassays are successful techniques that can detect up to picomolar concentrations using antigen–antibody reactions without the need of prior extraction. Although immunoassays are useful techniques that help physicians to take quick decisions, they too are subjected to interference from both exogenous and endogenous sources, resulting in false-positive and false-negative results. When the immunoassay results do not appear to fit the clinical picture, it becomes a great challenge to a clinical biochemist, alarms clinicians and confounds immunoassay manufacturers. Sometimes, these results can mislead or miss a diagnosis, resulting in unnecessary investigations and mental trauma to the patient and families. Hence, it is very important for one to be aware of the limitations of this immunoassay, to have knowledge about them and to take necessary actions or precautions to get the right result. There is no single procedure that can rule out all interferences. Furthermore, it is difficult for the laboratorians to identify antibody interference with immunoassay, and thus, physicians should be encouraged to communicate specifically with the laboratory about discordance between results and clinical findings. If there is any suspicion of discordance between the clinical and the laboratory data, an attempt should be made to reconcile the difference. Procedures should be put in place when interference is suspected. Constant communication is required between physician and laboratory about unexpected immunoassay results. Manufacturers can also be communicated to identify the presence of interfering antibody.

Cryotherapy-induced lipolysis Saad Sami AlSogair Hamdan Medical Journal 2019 12(4):165-169 Cold-based therapies have been used in the skin in the past due to its minimal damage of skin tissues. Cryolipolysis is a type of non-invasive body contouring technology that makes use of the ability of cold applications to create an inflammatory reaction within adipose tissues which may later on lead to apoptotic adipocyte cell death. Human and animal studies have revealed that cryolipolysis can significantly decrease subcutaneous fat and change body contour without causing damage to the overlying skin and surrounding structures or deleterious changes in blood lipids. Cryolipolysis has been described as a safe and effective procedure by previous studies. A thorough medical history and physical examination is done before the performance of this method to ensure its optimal efficacy. This method can either be used alone or in combination with other treatments such as shock wave treatment. More studies should be done to investigate further how cryolipolysis leads to adipocyte apoptosis so that new methods may be discovered that may enhance subcutaneous fat reduction.

Transcriptional regulation of protein S gene Maha Dawood Jaffarali, Adrian Hall Hamdan Medical Journal 2019 12(4):170-181 Background: Protein S (PS) is a known Vitamin K dependent plasma glycoprotein that is produced in many human tissues including the liver. Furthermore, it has an important function in the coagulation cascade as an anticoagulant cofactor when it binds active protein C. The deficiency of PS may lead to the development of deep vein thrombosis. There are many transcription factors which play an important role in the regulation of the transcription of PS. One of these regulatory factors is the liver specific transcription factor hepatocyte nuclear factor 1 (HNF1), a binding site which is located in the 638 base pair promoter area at the 5' end of the PS gene. HNF1 and PS is not well understood and to confirm the importance of HNF1 in regulating expression of PS small interfering ribonucleic acid (siRNA) which will knockout the HNF1 gene expression can be used, and the effect on PS expression monitored. The levels of expression of HNF1 and PS can be determined by real time polymerase chain reaction. Materials and Methods: Preparation of total ribonucleic acid for complementary DNA synthesis, Evaluation the quality of HepG2 ribonucleic acid by agarose gel electrophores is, Real time polymerase chain reaction, Acrylamide gel electrophoresis. Results: HepG2 rRNA bands shows a good quality of RNA expression, Analysis of the total RNA quantity can be determined by spectrophotometric analysis, The best housekeeping genes were UBC and YWHAZ therefore, there has been used as a reference for the primers samples in efficiency test. HNF1 and PROS1 shows a good expression but with low efficiency which is not required to carry further gene knockdown experiment, SYBR green dye is less sensitive than TaqMan because it presents a non specific detection (primer dimers) were all dsDNA products are detected including primer dimers, contaminating DNA, and PCR product from mis annealed primer. Conclusion: The primer pairs are not efficient to carry further gene knockdown experiment and required to design another HNF1 and PROS1 primers. The efficiency of the PCR should be 90%-100% meaning doubling of the amplicon at each cycle. This corresponds to a slope of -3.1 to -3.6 in the Ct vs log template amount standard curve. To obtain accurate and reproducible results, reactions should have efficiency as close to 100% as possible.

Health sciences teaching staff's perception about quality of work life in Saudi Universities: Reliability and validity of the questionnaire instrument Ahmed Al Kuwaiti, Arun Vijay Subbarayalu Hamdan Medical Journal 2019 12(4):182-188 Purpose: This study aimed to develop a valid quality of work life (QoWL) questionnaire for measuring the QoWL of health sciences teaching staff working in Saudi universities. Materials and Methods: A total of 300 teaching staff belonging to health sciences colleges at four Saudi government universities were randomly selected and given with QoWL tool. This tool consists of 24 Likert scale items and five different subscales i.e., (i) working conditions, (ii) psychosocial factors in the workplace, (iii) opportunities for training and development, (iv) compensation and rewards and (v) job satisfaction and job security. Two-hundred and ninety completed questionnaires were received, demonstrating a 97% response rate. Responses were subjected to statistical analysis to measure the reliability and validity of the tool. P < 0.05 was considered as 'statistically significant'. Results: Factor analysis extracted five factors which conjointly explained 93.31% of the variance in health sciences teaching staff attitude toward the QoWL at selected Saudi universities. The overall Cronbach's alpha coefficient was measured at 0.928 for internal consistency reliability. This study demonstrates that the five critical factors consisting of working conditions, psychosocial factors in the workplace, opportunity for training and development, compensation and rewards and job satisfaction and job security are important determinants of QoWL among the health sciences teaching staff working at the higher education institutions in Saudi Arabia. Conclusion: This study provides a reliable and valid tool for capturing the QoWL perceptions of health sciences teaching staff at Saudi universities and may be considered for possible use at comparable institutions elsewhere.

Personal otolaryngology–head-and-neck wet lab Munzer Abdulhadi Manzlgi, Ammar Mohammed Haidar Shehadeh Hamdan Medical Journal 2019 12(4):189-194 Objectives: To have professional surgical instrumentational skills in a low-cost, readily available, personal wet lab, instead of having it on a real patient in the operation theatre or in the costly cadaveric workshops. This study was conducted to assess the feasibility of sheep's head as a valid ear, nose and throat (ENT) surgical training model and to establish a small yet comprehensive ENT wet laboratory. Methods: Sheep's heads, already checked by the veterinarian and safe to use, were collected from the abattoir. However, neck surgery specimens were specifically requested from butchery with more neck tissue and intact skin. Surgical instruments were collected from medical exhibitions, online and the industrial market. With the help of cheap functional industrial instruments, a personal surgical laboratory was established. Ovine specimens were evaluated for human simulation. Moreover, the applicability of most ENT procedures and operations was assessed by a team of six ENT surgeons including three junior surgeons and three senior ENT surgical consultants. Results: Utilising simple basic surgical instruments, a wide variety of surgeries performed with very similar conditions to human operations. Endoscopic procedures include middle ear surgeries, laryngeal fissure, tracheal resection and laryngotracheal reconstruction. Open surgeries, facial nerve decompression, dissection and repair were also performed. Moreover, fibre-optic intubation, fibre-optic bronchoscopy and foreign-body extraction training were tried. Some structures are very similar to human ones; some show mild-to-moderate differences, whereas few structures are totally absent in the sheep head. The consistency of, skin, subcutaneous tissues and bone are remarkably similar to that seen in humans. Lamb's heads are good and accepted substitute models for cadaveric specimens. This personal laboratory could be (at a certain level) a good substitute solution to repeated cadaveric workshops. Personal wet laboratories low-cost training improves surgical skills and if followed by few human cadaveric workshops, could enable the surgeon to start human operations with lower complication rate and shorter intervention time. Conclusion: Province otolaryngologist must build up his own experience before practicing on humans. Using sheep tissues do not carry any risks for disease transmission and are ethically defensible. Structural fresh, ovine heads provide a readily available, anatomically compatible, affordable, model for training. It could hone dexterity, surgical skills and teamwork behaviour well before venturing into real patient training. Anatomical variations in sheep's head such as mastoid, paranasal sinuses and skull base are minimal and do not affect the applicability of most of the procedures.

Quality of life in diabetics with different complications: A cross-sectional study with patients visiting a hospital on an outpatient basis Paul Simon, Datson Marian Pereiera, Rashmi Theresa Mathai, Thomas George, Soniya Abraham, Ovine Loyster D'Souza, Manjeshwar Shrinath Baliga Hamdan Medical Journal 2019 12(4):195-199 Objective: Recent data suggest that the incidence of Type II diabetes mellitus (DM2) is on a rise and is a major cause for health-care costs, morbidity and mortality. The major problem with DM II is the secondary complications such as retinopathy, nephropathy, diabetic foot disease, cardiovascular complications and neuropathy which severely hamper the afflicted individual's resources and quality of life (QOL). In the present study, we have attempted at understanding the QOL using the QOL instrument for Indian diabetic patients (QOLID). Aim: The principal objective of the study is to ascertain the QOL is DM II with and without complications in patients visiting a hospital on an outpatient basis. The QOLID is of advantage herewith as the eight domains address all relevant aspects afflicting the QOL of the patients. Materials and Methods: Depending on the complications and prevalence, we included six groups; diabetics without complications (Group I, n = 89), retinopathy (Group II, n = 72), nephropathy (Group III, n = 53), diabetic foot disease (Group IV, n = 86), cardiovascular complications (Group V, n = 25) and neuropathy (Group VI, n = 57). The demographic information, diabetes history, medication and QOLID were collected using a structured questionnaire. The collected data were analysed using the analysis of variance followed by Bonferroni post-multiple comparison test. A value of P < 0.05 was considered statistically significant. Results: In this study, 238 (62.3%) males and 144 (37.7%) females with a mean age of 58.5 years. The overall QOLID score was the highest (126.60 ± 18.54) in Group I and least (59.67 ± 13.4) in Group III. Role limitation due to physical health, physical endurance, financial worries, diet satisfaction and the overall score were lower among the groups with diabetic complications (Groups II–VI) compared to Group I and this was statistically significant. General health, treatment satisfaction, symptom botherness and emotional/mental health scored lower in the groups with diabetic complications (Groups II–VI) compared to Group I and this was statistically significant in all except with diabetic retinopathy. Conclusion: When compared to people without any complications, patients with complications had reduced QOL. Individuals with diabetic neuropathy and nephropathy had very reduced QOL compared to other diabetic complications. Prevention or delay of onset of complications through better management of diabetes may help improve the QOL.

The prevalence of metabolic syndrome among hypertensive patients in Hadramout: A hospital-based study Rasheed Mohammed Bamekhlah, Mohammed Rasheed Bamekhlah, Hussain Saeed Alghazali, Abdulrahman Rasheed Bamekhlah Hamdan Medical Journal 2019 12(4):200-203 Background and Objectives: Hypertension (HTN) is one of the most common medical diseases worldwide, and it is one component of metabolic syndrome (MetS). The aim was to determine the prevalence of MetS among hypertensive patients. Subjects and Methods: A prospective hospital-based cross-sectional study conducted at Al-Rayan Specialized Hospital, Mukalla, Hadramout, Republic of Yemen, from February 2015 to April 2016. MetS was estimated according to the National Cholesterol Education Program-Adult Treatment Panel criteria. Results: From 345 patients, 207 were diagnosed as MetS (60%), whose age was 57.9 ± 9.2 years and significantly higher than that of patients without the syndrome (44.7 ± 6.6) years (P < 0.0001). Males with the syndrome were significantly less than females (32.4% and 67.6%, respectively) compared with patients without, (odds ratio 0.28 95% confidence interval [0.18–0.44], P < 0.0001). As HTN was present in all studied patients, diabetes was more common MetS component in patients with the syndrome (79.2%), followed by the high waist circumference (76.3%), then high triglycerides (66.2%) and the least was low high-density lipoprotein (59.9%). There was 58% of patients with MetS had four MetS components, 32.8% with five and only 7.2% had only three components. Conclusion: The prevalence of MetS among hypertensive patients was high. It was more common in females and older age. Diabetes and central obesity were the most frequent syndrome components. More than half of the patients had >3 components, but a considerable number of patients were with the all 5 components.

Radiographic assessment of cardiothoracic ratio in apparently healthy adults in Maiduguri Alhaji Modu Ali, Amina Sanda Gangrang, Ahmed Abubakar, Umar Abubakar Hamdan Medical Journal 2019 12(4):204-207 Background: Cardiothoracic ratio (CTR) is an easy and cheap diagnostic tool in the estimation of the cardiac sizes which is used for the screening and diagnosis of cardiac diseases. Objectives: The study objectives were to assess the normal cardiac size in apparently healthy adults and establish reference ranges in our population for comparison when investigating cardiac diseases. Materials and Methods: Radiographic evaluations of the cardiac size were performed from March 2017 to February 2018 in 172 apparently healthy individuals who were referred to the Radiology Department, Federal Neuro-Psychiatric Hospital, Maiduguri, in Nigeria, for medical examinations. The individuals were divided into the following five age groups: 18–27, 28–37, 38–47, 48–57 and 58 years and above, in order to determine the influence of age on cardiac size. Results: The mean CTR for males and females was 45.10% and 45.71%, respectively, and was statistically insignificant (0.362). The mean CTR of the general population was 45.6%, and the mean CTR value increased with age until the fourth decade when it reduces with age. Conclusion: The result of this study has established the CTR of the Nigerian population in Maiduguri. The CTR gradually increased with age until the fourth decade when it reduces with age. Therefore, establishing normal ranges of CTR is necessary for comparison in a condition where a possible cardiac disease is being examined.