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Abdullah A Yousef,1,2 Bassam H Awary,1 Faisal O AlQurashi,1 Waleed H Albuali,1 Mohammad H Al-Qahtani,1 Syed I Husain,2 Omair Sharif2 1Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Vice Deanship for e-learning, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Faisal O AlQurashiDepartment of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box: 11286, Dammam, 31453, Saudi Arabia, Tel +966555078804, Fax +966138955088, Email Faisal.alqurashi@yahoo.comPurpose: The Objective Structured Clinical Examination (OSCE) is a standard academic assessment tool in the field of medical education. This study presents an innovative method for digitizing OSCE evaluation system for medical students and explores its efficacy compared to the traditional paper-based system, through the analysis of a User Satisfaction Survey.Methods: A cross-sectional, questionnaire-based study involving a User Satisfaction Survey to evaluate assessors’ attitudes toward and acceptance of the Computerized Web-based OSCE Evaluation System (COES) was used. Fifth-year medical students at a College of Medicine were assessed clinically through their 2019 end-of-year OSCE examination by 30 examiners in five different OSCE stations. The traditional paper-based stations were converted into an online electronic version using QuestionPro software. Answers were filled in using smart tablets (iPads). QR codes were used for students’ identification at each station to fully digitize the process and save time. After the completion of the exam, a User Satisfaction Survey was sent electronically to all examiners to evaluate their experiences with the new system.Results: The response rate for the survey was 100% with an internal consistency of 0.83. Almost all the examiners (29, 97%) were satisfied with the application of the COES. Further, 72% of the examiners indicated that the electronic system facilitated the evaluation of the students’ skills, and 84% found using a smart device (iPad) was easier than using a paper form. All examiners expressed their preference for using the electronic system in the future.Conclusion: Users were satisfied with the utilization of the customized COES. This concept of fully digitizing the OSCE assessment process shortened the time needed for both the analysis of results and providing students with feedback. Further observational studies are needed to assess examiners’ behaviors when using this methodology.Keywords: academic performance, clinical competency, clinical skills, medical education, undergraduate, Saudi Arabia

The end-to-end performance of multibranch dual-hop wireless communication systems with nonregenerative relays and equal gain combiner (EGC) at the destination over independent Nakagami-m fading channels is studied. We present new closed form expressions for probability distribution function (PDF) and cumulative distribution function (CDF) of end-to-end signal to noise ratio (SNR) per branch in terms of Meijer's G function. From these results, analytical formulae for the moments of the output SNR, the average overall SNR, the amount of fading, and the spectral efficiency are also obtained in closed form. Instead of using moments-based approach to analyze the asymptotic error performance of the system, we employ the characteristic function (CHF) method to calculate the average bit error probability (ABEP) and the outage probability for several coherent and noncoherent modulation schemes. The accuracy of the analytical formulae is verified by various numerical results and simulations.

This study aims to explore and analyze the forms of accounting practices applied by the Balinese migrant community in West Toili, Central Sulawesi, primarily to support the goals of the SDGs. The study results show that Balinese migrant farmers use only memory to apply accounting records from pre-planting, planting, maintenance, harvesting, and post-harvest activities. In implementing accounting, deep cultural and spiritual values exist at every step of the agricultural cycle. The local cultural values reflect the harmonious relationship between humans, God, and nature. Balinese migrant farmers believe that the local spiritual and cultural power can realize a sustainable net farm income, protecting and guiding them at every stage of the agricultural cycle. In addition, the gratitude expressed in a series of traditional ceremonies in the farming cycle is a long-term obligation to ensure the continuity of their agricultural business. The application of accounting practices based on the characteristics of local wisdom of Balinese migrant farmers is a strength possessed to obtain welfare, which ultimately contributes to the goal of the SDGs. The results of this study can also be used as a basis for the government and policymakers to formulate sustainable agricultural policies by considering the local wisdom of the community in poverty alleviation. In addition, the study in this study can provide of models that can be adopted by other countries that have the same local wisdom, as an effort to develop an environmentally friendly and sustainable agricultural accounting system.

Background: Cardiovascular magnetic resonance (CMR) is commonly used in patients with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) based on ECG, echocardiogram and Holter. However, various diseases may present with clinical characteristics resembling ARVC causing diagnostic dilemmas. The aim of this study was to explore the role of CMR in the differential diagnosis of patients with suspected ARVC., Methods: 657 CMR referrals suspicious for ARVC in a single tertiary referral centre were analysed. Standardized CMR imaging protocols for ARVC were performed. Potential ARVC mimics were grouped into: 1) displacement of the heart, 2) right ventricular overload, and 3) non ARVC-like cardiac scarring. For each, a judgment of clinical impact was made., Results: Twenty patients (3.0%) fulfilled imaging ARVC criteria. Thirty (4.6%) had a potential ARVC mimic, of which 25 (3.8%) were considered clinically important: cardiac displacement (n=17), RV overload (n=7) and non-ARVC like myocardial scarring (n=4). One patient had two mimics; one patient had dual pathology with important mimic and ARVC. RV overload and scarring conditions were always thought clinically important whilst the importance of cardiac displacement depended on the degree of displacement from severe (partial absence of pericardium) to epiphenomenon (minor kyphoscoliosis)., Conclusions: Some patients referred for CMR with suspected ARVC fulfil ARVC imaging criteria (3%) but more have otherwise unrecognised diseases (4.6%) mimicking potentially ARVC. Clinical assessment should reflect this, emphasising the assessment and/or exclusion of potential mimics in parallel with the detection of ARVC major and minor criteria.

We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure. However, in June 2006, the symptoms worsened to New York Heart Association functional class IV status. We implanted a continuous-flow left ventricular assist device as a bridge to cardiac transplantation; of note, a left ventricular core biopsy at that time showed no replacement fibrosis. The patient's clinical status improved thereafter, enabling left ventricular assist device ex-plantation after 17 months. To our knowledge, this is the first report of the use of left ventricular assist device support to reverse chronic anthracycline-induced heart failure.

This study was aimed to explore underlying mechanism(s) of cardiovascular effects of piperine. Intravenous administration of piperine caused a dose-dependent (1 to 10 mg/kg) decrease in mean arterial pressure (MAP) in normotensive anesthetized rats; the next higher dose (30 mg/kg) did not cause any further change in MAP. The fall in blood pressure (BP) was followed by small increase in MAP after each dose. In Langendorrf's rabbit heart preparation, piperine caused partial inhibition and verapamil caused complete inhibition of force and rate of ventricular contractions and coronary flow. In rabbit aortic rings, piperine inhibited high K+ (80 mM) precontractions and partially inhibited phenylephrine (PE), suggesting Ca2+ channel blockade (CCB), which was further confirmed when pretreatment of tissues with piperine caused rightward shift in Ca2+ concentration-response curves, similar to verapamil. In Ca2+-free medium, piperine (1 to 30 microM) exhibited vasoconstrictor effect. In rat aorta, piperine demonstrated endothelium-independent vasodilator effect and was more potent against high K+ precontractions than PE. In bovine coronary artery preparations, piperine inhibited high K+ precontractions completely. These data indicate that piperine possesses a blood pressure-lowering effect mediated possibly through CCB, while consistent decrease in BP was restricted by associated vasoconstrictor effect. Additionally, species selectivity exists in the CCB effect of piperine.