Background: An ongoing challenge for medical education in the twenty-first century is determining the best method to foster problem-solving and critical thinking in learners. These higher-order aptitudes help to prepare medical doctors for practice in a rapidly evolving health system. In medical education, Problem-Based Learning (PBL) is an instructional pedagogy in which pupils are challenged to seek answers to authentic patient scenarios in small groups. PBL techniques are proposed as one method to enhance pupils’ learning abilities including critical thinking and problem-solving. Aim: This systematic review was conducted to search for evidence from the past fifteen years of literature, demonstrating the capability of PBL to improve critical thinking and problem-solving skills for medical students. Review Question: Is there evidence to support the capability of PBL to improve problem solving and critical thinking skills in medical students? Methods: The search process was conducted through electronic databases on publications related to the impact of PBL, particularly, on two fundamental skills; critical thinking and problem-solving for medical students. The search process was restricted to publicationsbetween January 1, 2005 and December 31, 2019. Four electronic databases were searched, namely; Medline, PubMed, EMBASE and Scopus. The Best Evidence Medical Education (BEME) guidelines were utilised to guide the way this systematic review was conducted. Quality assessment was performed through rating the evaluation methods of the included studies. This rating was through employing a five-point Likert scale (1= strongly disagree to 5= strongly agree) for each study in relation to three items; the appropriateness of study design, the implementation of the study as well as the appropriateness of data analysis. The rating for each study was then mapped to a grade from grade 1 (low) to grade 5 (high), which aligns with the BEME strength of the study findings. Results: Searching the four aforementioned databases produced 657 publications, including 249 duplicates. Therefore, 408 publications were screened based on their titles against inclusion and exclusion criteria, leaving 86 articles to screen their abstracts. A further 9 articles were manually obtained such that a total of 95 articles were obtained for a review of their abstracts. Forty-one met the criteria for full text review. Following the full text review, twenty-nine articles were excluded. Therefore, twelve studies were included in this systematic review. The BEME strength of study findings were as follows; only two of the reviewed studies were graded as grade 5, four were graded as grade 4, and six were graded as grade 3. Of the twelve studies reviewed, only five studies provided evidence in support of the capability of PBL to improve critical thinking and problem-solving skills among medical students. Two of these five studies were graded as grade 5 and two were graded as grade 4, while one was graded as grade 3. Discussion: The available evidence in this systematic review provided limited support of the claim that PBL improves medical students’ critical thinking and problem-solving aptitudes. Only five studies provided evidence in support of this claim, while the remaining seven studies did not. Two of these seven studies assessed only the knowledge, comprehension, and application domains, as their evaluation of problem-solving and critical thinking abilities was based on student perspectives. A further two of these seven studies, where the description provided either for case-analysis tests or modified essay questions, did not give an actual indication for measuring critical thinking and problem-solving skills. Another two of these seven studies did not describe their written tests i.e. case-analysis tests and proxy questions that are purported to measure higher-order skills, including critical thinking and problem-solving. This prevented the use of the findings from these two studies as evidence to support the specified review question. The remaining study reported that PBL students’ scores in the final assessment did not improve significantly (p>0.05) compared to the initial assessment. Conclusion: There is very little published evidence over the last fifteen years supporting the claim that PBL improves critical thinking and problem-solving skills in medical students. Therefore, recent practice is not based on evidence. As such, investigations are required to legitimise the claims that PBL improves critical thinking and problem-solving skills for medical students. Key words: Problem-Based Learning, Critical Thinking and Problem-Solving Skills, Medical Students

Vaccination is the most promising approach for ending or containing the SARS-CoV-2 pandemic. However, serious post-COVID-19 vaccine reactions, including immunocytopenia (ITP) syndrome, have been increasingly reported. Several factors cause increased risks including multiple doses, age-dependent heterogeneity in immune-responses, platelet cross-reactions with microbial components, and Long-COVID syndrome. Thus, in the absence of widely available specific therapeutics, vigilance is important while more studies are needed. Using a structured questionnaire sent to different regions in Saudi Arabia, we conducted a comprehensive investigation on the frequency, rates, disease patterns, and patient demographics of post-COVID-19 vaccine side effects on febrile patients after administration three major vaccines. Results indicated that the majority of respondents administered Pfizer BioNtech vaccine (81%, n = 809); followed by AstraZeneca (16%, n = 155); and Moderna (3%, n = 34). Overall 998 participants, 74% (n = 737) showed no serious symptoms; however, 26.2% (n = 261) revealed typical syndromes. In a focused group of 722 participants, the following rates were identified: shortness of breath (20%), bruises or bleeding (18%), inattention (18%), GIT symptoms (17.6%), skin irritation (8.6%), and anosmia and ageusia (8%) were the most prominent among those who showed typical symptoms. The onset time was mostly between 1–3 days in 49% (n = 128), followed by 4–7 days in 21.8% (n = 57), 8–14 days in 16.5% (n = 43), and more than a month in 12.6% (n = 33). The onsets occurred mostly after the first, second, or both doses, 9%, 10%, and 7% of participants, respectively. The frequency of symptoms was significantly higher after Moderna^® vaccine (p-value = 0.00006) and it was significantly lower in participants who received Pfizer (p-value = 0.00231). We did not find significant difference in symptoms related to differences in regions. Similarly, the region, age, sex, education, and nationality had no influence on the dose and onset timings. The findings of this study have significant clinical implications in disease management strategies, preventive measures, and vaccine development. Future vertical studies would reveal more insights into the mechanisms of post-COVID-19 vaccine syndrome.

The sharp increase in infections due to Staphylococcus aureus is associated with its ability to adapt to changes in its habitat. This study aimed to investigate the differences in the cytoplasmic amino acid profiles of a clinical strain of S. aureus under five combinations of stress-induced conditions representative of a wound site by varying temperature 35–37 °C, adding 0–5% NaCl and adjusting pH 6–8. The results indicated that aspartic acid, lysine, glutamic acid and histidine were the most abundant cytoplasmic amino acids in the control samples grown under optimal growth conditions. However, the magnitudes and levels of these amino acids were altered under the various wound site conditions, which led to differential cytoplasmic amino acid profiles as characterized by multivariate analyses (PLS-DA). The total cytoplasmic amino acid content was significantly reduced in the cells grown with 2.5% NaCl added at pH 7 and 37 °C relative to the control samples and other growth regimes. However, all combinations of enhanced stress conditions showed unique and characteristic changes in the concentration profiles of the cytoplasmic amino acids. These outcomes supported the hypothesis that bacterial cells of S. aureus maintain different metabolic homeostasis under various stress-induced conditions. The potent capability of S. aureus to constantly and rapidly acclimatize to variations within the environment may reflect the crucial feature supporting its virulence as an opportunistic pathogenic bacterium to invade the wound site. Understanding the control systems governing these marked changes in amino acids during the adaptation to the potential wound site conditions of this dangerous bacterium may offer new clinical controls to combat infection.

Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates (p-value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.

Background: Mental stress plagued type II diabetes (T2DM) patients. The psychological and emotional issues related to diabetes and its effects include depression, anxiety, poor diet, and hypoglycemia fear. Aim: Compare the impact of diabetes on depression and anxiety in Egyptian and Saudi diabetics. Methods: The diabetes, gastroenterology, and hepatology sections of University of Ha’il Clinic, KSA, and the Theodor Bilharz Research Institute, Egypt, conducted this retrospective study. Everyone gave informed consent before participating. Interviews with male and female outpatients and inpatients were conducted from June 2021 to December 2022. The self-administered validated Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) scale measured sociodemographic characteristics and symptoms of depression and anxiety. Results: In patients with diabetes, the prevalence of depression was higher in KSA [34.8%] than in Egypt [18%], while anxiety was higher in Egypt [40%] than in KSA [29.1%]. Most depressed patients were 31–55 years old (61.2%) from KSA and 97.8% (41–55 years old) from Egypt. Female anxiety was 70.7% in KSA and 51.0% in Egypt, with no significant difference. The duration of diabetes in depressed patients was 5–10 years ([46.9%, Saudis] vs. [57.8%, Egyptians]), while anxious patients (5–10 years [39.0%, Saudis] vs. >20 years [65.0%, Egyptians]) were mainly type-2. Most depressive patients had an HbA1c (59.2%) from 7–10% (Saudis) and 77.8% [>10% Egyptians] compared to anxiety patients (46.3%) and 48.0% [>10% Egyptians]. Depressed and anxious patients from both nations had higher glucose, triglycerides, and cholesterol levels. Saudis and Egyptians with obesity had higher rates of sadness (75.5% vs. 68.9%) and anxiety (82.9% vs. 69.0%). Treatment adherence and serum glucose monitoring were not significantly different from depression in diabetes individuals in both ethnicities. Conclusions: Anxiety was more common among Egyptian patients because of overcrowding, working whole days to fulfill life requirements, and the unavailability of health insurance to all citizens. Meanwhile, in KSA, obesity, unhealthy food, and less exercise reflect the high percentage of depression among patients with diabetes. The detection of depression and anxiety in the context of DM should be critical for the physical health and quality of life of Saudi and Egyptian diabetics. Further investigation is warranted to encompass anxiety and depression within the scope of future research.

Staphylococcus aureus strains are a great contributor to both hospital acquired infections as well as community acquired infections. The objective of the present investigation was to compare potential differences in cytoplasmic amino acid levels between clinical and ATCC 29213 strains of S. aureus. The two strains were grown under ideal conditions to mid-exponential and stationary growth phases, after which they were harvested to analyze their amino acid profiles. Initially, the amino acid patterns of both strains were compared at the mid-exponential phase when grown in controlled conditions. At the mid-exponential phase, both strains shared common features in cytoplasmic amino acid levels, with glutamic acid, aspartic acid, proline, and alanine identified as key amino acids. However, the concentration profiles of seven amino acids exhibited major variances between the strains, even though the total cytoplasmic levels of amino acids did not alter significantly. At the stationary phase, the magnitudes of the amino acids abundant in the mid-exponential phase were altered. Aspartic acid became the most abundant amino acid in both strains accounting for 44% and 59% of the total amino acids in the clinical and ATCC 29213 strains, respectively. Lysine was the second most abundant amino acid in both strains, accounting for 16% of the total cytoplasmic amino acids, followed by glutamic acid, the concentration of which was significantly higher in the clinical strain than in the ATCC 29213 strain. Interestingly, histidine was clearly present in the clinical strain but was virtually lacking in the ATCC 29213 strain. This study reveals the dynamic diversity of amino acid levels among strains, which is an essential step toward illustrating the variability in S. aureus cytoplasmic amino acid profiles and could be significant in explaining variances among strains of S. aureus.