Ahmed Hassan Alghamdi

Introduction: The journal club is widely used in most postgraduate programs of medical institutes; however, the use of journal clubs in undergraduate medical programs is nearly absent or very rare. Aim: The aim of this work is to document the insertion of the journal club as a method for learning in the undergraduate starting with the endocrinology/endocrine surgery module to be fully implemented in all modules of the MBBS of FMBU. In addition, the study aimed to outline the steps of designing a journal club by following specific procedures and Identification of students’ and faculty satisfaction through 5-years implementation of the journal club. Material and Methods: A total of 453 students representing the five consecutive batches of medical students from 2019 to 2023 who studied the endocrinology/endocrine surgery module were entered into the study. Following guidelines for implementation of the journal clubs that were adopted by the quality and accreditation committee, the faculty select the types of papers from the articles chosen by students. The papers discussed were case reports, original research, and review articles. The students were asked to formulate critical appraisal topics, PICO, for each paper. A 20-question test was applied to all participants. The students’ attendance, scores, and students/faculty satisfaction were estimated. Results: A total of 50 papers were discussed in the 5-year journal club 15 case reports (30%), 26 original research (52%), and 9 review articles (18%). The student’s attendance ranged from 72.53± 3.74 to 98.07± 3.15. The students and faculty’s satisfaction were 3.52 and 3.82 respectively. The mean Students’ score in A 20-question test in a 5-year journal club was 76.93 ± 9.78 and the lowest score was in the 2nd batch (online batch). Conclusion: The insertion of a well-structured journal club in the undergraduate medical program is necessary to improve the knowledge including knowledge among students. In addition, journal clubs inspire students to be lifelong learners.

Background: Diabetes mellitus (DM) has become a disease prevalent worldwide. Honey, which comprises predominantly bioactive constituents, has anti-inflammatory, antioxidant, and immunomodulating properties. Aim: Recent developments and benefits of natural products in treating various diseases have caught the attention of researchers. This study aims to investigate the antidiabetic effect of bee honey extract on induced diabetic Swiss mice. Materials and Methods: Fifty Swiss male mice were randomly assigned to five groups of 10 mice each. Group I served as the negative control; in group II, the mice received 2 mg/kg/b.wt of honey extract only; and groups III, IV, and V received cyclosporine (CsA) (20 mg/kg/day, s.c.) daily for 10 days prior to receiving streptozotocin (STZ) inoculated at multiple low doses (MLDSTZ) (30 mg/kg/day, i.p.) for five consecutive days. Group IV was administered with insulin initiated at a dose of 0.5 U/kg/b.wt as a standard treatment (positive control). Group V was administered 2 mg/kg/b.wt of honey extract, while group III received no treatment. Results: The results showed a significant hypoglycemic effect, increased body weight, increased liver glycogen levels, and the amelioration of antioxidant activities in groups IV and V compared with the diabetic group III. Moreover, serum matrix metalloproteinase (MMP-9) concentrations were significantly reduced in the mice treated with the insulin and honey extract in groups IV and V and the tissue inhibitor metalloproteinase-1 (TIMP-1) levels were significantly higher than the serum levels in group III. Furthermore, the histopathological examination of groups IV and V revealed regenerative changes with the restoration of normal islet cell architecture, as compared to the diabetic mice in group III. Compared to group I, group II showed no changes and exhibited non-significant data. Conclusion: Honey extract plays an effective role in improving all biomarkers in treated group V. Furthermore, MMP-9 and TIMP-1 are considered prognostic markers in the progression, severity, diagnosis, and treatment of type 1 DM. This may play an important role for the treatment of individuals in the future.

Introduction: Familial glucocorticoid deficiency (FGD) is a rare cause of adrenal insufficiency in children. The condition can present with features of low cortisol and high adrenocorticotropic hormone (ACTH). Late diagnosis can be associated with high morbidity and high mortality rates. Patient: The presented case was a three-year-old Saudi girl who presented with dehydration and seizures as a complication of hypoglycemia. The initial examination and investigations revealed hyperpigmentation and normal arterial blood pressure. The lab investigation and genetic study revealed hypoglycemia, metabolic acidosis, low serum cortisol: 53 nmol/L (N: 140–690 nmol/L), normal androgens: 0.65 nmol/L (N: 0.5–2.4 nmol/L) and aldosterone: 50 pgmL (N: 2–200 pg/mol), and normal serum electrolytes. The ACTH level was more than 2000 pg/mL. A genetic study indicated a homozygous likely variant in the nicotinamide nucleotide transhydrogenase (NNT) gene, consistent with a genetic diagnosis of autosomal recessive glucocorticoid deficiency type 4. No mutations were found regarding MC2R, MRAP, and TXNRD2. Intervention and outcome: The child was started on hydrocortisone, initially at 100 mg/m²/dose IV and then 100 mg/m²/day divided to q 6 hr. The dose was gradually decreased to 15 mg/m²/day PO BID, with clinical improvement and normalization of the serum ACTH level. Conclusions: The autosomal recessive glucocorticoid deficiency, a variant of FGD type 4, is a very rare condition that may lead to high rates of mortality when the diagnosis and treatment occur late. Therefore, early diagnosis and treatment is essential for good outcomes.

The progressive increase in the incidence of diabetes mellitus (DM), both worldwide and in Saudi Arabia, is associated with progressive complications rates development. Diabetic foot ulcerations and complications are major morbidities associated with progressions of DM neuropathies and vasculopathies. They contribute to marked health expenditure and efforts. Our study aimed at measuring the magnitude of the problem of diabetic foot in the special area of Albaha in Saudi Arabia. Material and method: We included 53 patients who presented to the diabetic foot center in Al Baha, Saudi Arabia over 1 year. The included patients were assessed by meticulous clinical examination including eye examination and foot assessment for ulcer, neuropathy, skin manifestations like abscesses, and foot deformities. Investigations included fasting blood glucose, hemoglobin A1C (HbA1C), lipid profile, and Doppler Ultrasonography of the lower limbs. Results: 52 (98.1%) had type II DM, duration of DM was 17.0 (10.0-25.0) years, fasting blood glucose 10.1 (7.6-14.8) mmol/L, and HbA1C 9.1±1.3%. Hypertension was found in 24 (45.3%), atherosclerotic cardiovascular disorders (ASCVD) in 27 (50.9%)and eye complications in 20 (37.7%) of cases. ASCVDs were found to be significantly higher (p 0.009) in patients aged >66 years (18 (69.2%)) in comparison to those <66 years (8 (30.8%)). Regarding foot complications; ulcers were found in 44 (83.0%), foot deformities in 4 (7.6%), skin complications in 28 (52.8%), infections in 20 (37.7%) and gangrene in 10 (18.9%) of cases. Interestingly, diabetic foot ulcers were found to be significantly higher (p 0.038) in patients aged 66 years (20 (76.9%)). Surgical management including debridement, abscess drainage, dressings, and a skin graft was required in 25 (47.2%) of cases and amputation in 7 (13.2%) of cases. In conclusion; diabetic foot ulcers and complications are a major health problem contributing to devastating morbidities up to amputations. Poor glycemic control is a major contributing factor for diabetic foot problems. Good glycemic control, diabetic foot meticulous care, and early interventions are recommended health practice strategies. Key words: Diabetes, Foot, ulcer, complications