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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 8 | Issue 4
Page Nos. 135-215

Online since Thursday, December 10, 2020

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EDITORIAL  

Introduction to the special issue: “COVID-19” under the lens p. 135
Somaya Hosny
DOI:10.4103/2213-879X.302975  
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REVIEW ARTICLES Top

Hydroxychloroquine toxicity management: A literature review in COVID-19 era p. 136
Hussain T Bakhsh
DOI:10.4103/JMAU.JMAU_54_20  
Background: Hydroxychloroquine (HCQ) has been widely investigated for the treatment of COVID-19. Although it is rare, several case reports of acute toxicity of HCQ due to overdose have been reported during the last two decades. The aim of this review is to summarize the management options of acute HCQ toxicity. Methods: A literature review that was conducted using an electronic search in the Google Scholar search engine. The inclusion criteria include any patient over 12 years old presenting with HCQ intoxication symptoms from January 1999 to January 2020. Results: Sixteen cases were found that have the inclusion criteria of this study. Most patients presented with altered mental status, electrocardiogram abnormalities, visual disturbance, and decrease cardiac output. Activated charcoal was the first line of management in nearly two-thirds of patients whereas 93.8% received fluid resuscitation and 81.3% of the patients need at least one type of vasopressor agent. Furthermore, potassium is given for 93.8% of the patient while 75% of the patients need sodium bicarbonate and intubation, lipid emulsion was used in three patients only and 13 patients survived. Conclusion: The acute HCQ toxicity may result during the treatment period of COVID-19. The most common options can use in this situation include included gastric lavage and decontamination, IV fluid resuscitation, potassium replacement, sodium bicarbonate, intravenous lipid emulsion, and extracorporeal circulation membrane oxygenation. The role of diazepam is not clear but can be used in the significant toxicity while hyperkalemia associated with severe ingestions.
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COVID-19 and phosphodiesterase enzyme type 5 inhibitors p. 141
Hayder M Al-Kuraishy, Ali I Al-Gareeb, Marwa S Al-Niemi, Ali K Al-Buhadily, Nasser A Al-Harchan, Claire Lugnier
DOI:10.4103/JMAU.JMAU_63_20  
COVID-19 pathology is mainly associated to a pulmonary disease which sometimes might result in an uncontrollable storm related to inflammatory diseases which could be fatal. It is well known that phosphodiesterase enzyme type 5 inhibitors (PDE5Is), such as sildenafil, have been successfully developed for the treatment of pulmonary arterial hypertension; interestingly, more recently, it was shown that PDE5Is might be also anti-inflammatory. Therefore, it would be of interest to question about the use of PDE5Is to overcome the COVID-19 storm, as much as PDE5 is mainly present in the lung tissues and vessels.
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Artificial intelligence in COVID-19 ultrastructure p. 146
Mohamed Y Elwazir, Somaya Hosny
DOI:10.4103/JMAU.JMAU_28_20  
Artificial intelligence has found its way into numerous fields of medicine in the past decade, spurred by the availability of big data and powerful processors. For the COVID-19 pandemic, aside from predicting its onset, artificial intelligence has been used to track disease spread, detect pulmonary involvement in computed tomography scans, risk-stratify patients, and model virtual protein structure and potential therapeutic agents. This mini-review briefly discusses the potential applications of artificial intelligence in COVID-19 microscopy.
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Renin–Angiotensin system implications to COVID-19 comorbidities p. 148
Hadeel A Alsufyani, Zienab Alrefaie
DOI:10.4103/jmau.jmau_105_20  
The role of the renin–angiotensin system (RAS) and its pharmacological modulators in the susceptibility and outcomes of SARS CoV-2 pandemic (COVID-19) has been much discussed recently. Angiotensin-converting enzyme type 2 (ACE2) has attracted much attention and debate in relevance to COVID-19. It not only acts as the receptor to which the SARS CoV-2 virus binds to be introduced into cells but also balances the effects of angiotensin II offering anti-inflammatory and antifibrotic protective actions to different organs. This mini-review aims to shed some light on the possible involvement of ACE2 and RAS alternate pathways in the comorbidities and clinical findings observed in COVID-19 patients.
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ORIGINAL ARTICLES Top

Splitting teams at a hospital pharmaceutical care services during COVID-19 pandemic: A tertiary hospital experience in Saudi Arabia p. 152
Hussain T Bakhsh, Hala Makki
DOI:10.4103/JMAU.JMAU_57_20  
Background: The cautionary procedures of COVID-19 indicate the importance and urgency of preventing “community transmission” in the overall pandemic control. Pharmacy professionals are considered essential partners in response to the ongoing COVID-19 pandemic. Hospital pharmacies are expanding services and providing essential services, putting pharmacists and their co-workers at the frontlines for patient care and safety to improve the public health. Objective: The objective was to provide a guidance on minimizing pharmacy staff at risk of COVID-19 exposure and serve as emergency preparedness in case of mass staff infected with COVID-19 pandemic within the department. Setting: This study was conducted at Pharmaceutical Services Administration at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Methods: An instructional intervention using an electronic survey and summarization of the experience during the COVID 19 outbreak in a hospital pharmacy setting. We analyzed and discussed the methods and strategies that pharmacy settings and pharmacists should use to provide pharmaceutical care during the pandemic crisis. Main Outcome Measure: The outcome measures include staff perception and acceptance for splitting teams at pharmaceutical care services during the COVID-19 pandemic. Results: A total of 119 electronic surveys were distributed to the pharmacy staff and responded by 102 pharmacists and pharmacy technicians. All the study participants agreed on two group system which includes working-week-week-off. However, only three participants chose a full-team monthly roster. All participants agreed to be ready for work in their week-off as on demand. Furthermore, they all agreed to strictly follow the preventive measures of wearing masks and physical distancing. Furthermore, they gave permission to the administration to review the working schedule every 2 weeks to either continue the same way or to back to the full-team scheduled monthly roster. Conclusion: During the COVID-19 outbreak, the pharmaceutical services provided valuable pharmacy functions and care considering that we work into two teams and, yet, we are united in one mission and objective. Through these services, pharmacists have presented their professional competence, dedication, and responsibility to patients, other health-care providers, and society.
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Successful use of virtual microscopy in the assessment of practical histology during pandemic COVID-19: A descriptive study p. 156
Mona G Amer, Dalal M Nemenqani
DOI:10.4103/JMAU.JMAU_67_20  
Background: Practical knowledge and skills of microscopy has classically been delivered for medical students using conventional microscopes (CMs). Using virtual microscopy (VM) in teaching practical histology was established during distance learning for Taif medical students during COVID 19 pandemic period. However, the suitable assessment methods for student performance during distance learning are still debatable. We focused on how to ensure the learner's achievement of course practical outcomes and learning domain. Aims and Objectives: This study aimed to ascertain whether using VM to evaluate student learning in practical Histology during distance education programs and if moving to VM affecting students' scores. Materials and Methods: For the first time, we used VM during online objective structural practical examination (OSPE) of 3rd year medical students. Different sets of virtual slides were given for students at the time of assessment, then different tasks were described and each student was asked to finalize his/her task during the designed time. A specific rubric was designed for the evaluation of student work. Moreover, student perceptions of VM as teaching and assessment method were assessed using online survey. Post examination psychometric analysis of VM OSPE was done and compared with previous OSPE results of the same batch of students. Results: The average student score was 4.63 ± 0.51 with no significant difference from previous student's scores. The net students' feedback was positive. Their average satisfaction on all items ranged from 3.7 to 4.25 on Likert scale. Students recorded the easy image access at any time and place with VM as the most distinctive feature. Conclusion: Our results indicated that VM is not only an effective method in teaching histology but also it is an assessment method for measuring student performance during online assessment.
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The impact of COVID-19 outbreak on reassessing the need for drive thru community pharmacy: Cross-sectional study p. 162
Reem M Diri
DOI:10.4103/JMAU.JMAU_65_20  
Introduction: Community pharmacies spread all over Saudi Arabia. Customers face some of the logistic problems, such as parking availability and privacy. This study was aimed to evaluate the need, awareness, perception, and barriers of the drive-thru community pharmacy services. Methods: A cross-sectional study was conducted between January 1, 2020, and February 1, 2020, based on a questionnaire that was published on WhatsApp and Twitter. Results: From 1001 participants who completed the questionnaire, 54% of them are female and 70% between the age group of 18 and 30 years. The most common reason to visit the pharmacy among the participants is to purchase over-the-counter medications (36.4%). Although (86.5%) reported that there is no pharmacy provide drive-thru service in their city, 78% of participants think that this service will help all the community component. Participants believe that the drive-thru service will help in reducing car parking problems and traffic violations (83.8% and 86.3%, respectively) and will help in keeping patient privacy and (82.2%). Conclusion: Establishing community pharmacy with drive-thru service is very important to ensure a more convenient service to customers and to assist all ages, women, and special needs. Giving the recent declaration to live with coexisting COVID-19 pandemic, further procedures should be implemented to support this recommendation.
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Behavioral changes in gym attending due to COVID-19 pandemic: A descriptive survey p. 165
Diena Almasri, Ahmad Noor, Reem Diri
DOI:10.4103/JMAU.JMAU_64_20  
Introduction: On the declaration of the COVID-19 pandemic lockdown clearance in Saudi Arabia, the high-profile precautions were applied as a major step to resume the normal life activities and to coexist with the pandemic. One of those resumed activities is the reopening of the gym and fitness centers. The perception and the commitment with safe precautions in terms of personal hygiene and sterilization have dramatically changed due to the COVID-19 pandemic. The purpose of this study was to assess the behavior of gym attendees toward preventive precautions prior to the pandemic and the behavioral changes that will be accommodated after the new policy and procedure of attending a gym and fitness centers. Methods: A cross-sectional descriptive study was conducted in February 2020, a 1 month prior to the complete lockdown announcement in Saudi Arabia as a result of the COVID-19 pandemic outbreak. An electronic questionnaire was provided during a personal interview with gym and fitness centers' participants. Results: The majority of participants never use sterile wipes or any sterile product before or after using gym equipment (61.6%), and 35.4% of gym attendants do not use any sterilization materials distributed through fitness centers. In addition, most of the participants have had an episode of skin infections or respiratory infection at the fitness center for the past 12 months (22.2%), whereas 80.8% do not know about tinea microbial that causes athlete's foot, and 65.7% of them utilize the shower in the gym after their workout. Conclusion: The lack of awareness of previous and new gym members regarding safety precautions during indoor exercise should be overcome by more future educational intervention and emphasizing on following the Ministry of Sports in Saudi Arabia, even after the complete clearance of COVID-19 pandemic.
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E-learning readiness among dental students and faculty members Pre-COVID-19 pandemic p. 168
Amal I Linjawi, Shoroog Agou
DOI:10.4103/JMAU.JMAU_40_20  
Purpose: The purpose was to assess students' and faculty readiness toward online dental education in Saudi Arabia. Materials and Methods: This is a cross-sectional study using a 5-point Likert scale questionnaire distributed to students (undergraduates and postgraduates) and faculty at King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia, in 2018. It assessed individual characteristics, system competency needs, social influence, institutional support, overall readiness, and the needed technical support in using e-learning for personal as well as teaching and learning (T&L) purposes. The readiness response scale for each domain was categorized as follows: low (mean value = 1–<3), acceptable/moderate (mean value = 3–<4), and high readiness level (mean value = 4–5). Descriptive and group comparisons were conducted using Pearson's Chi-square test, paired sample t-test, independent sample t-test, one-way ANOVA, and Tukey's post hoc test. The statistical significance level was set at P < 0.05. Results: the total completed response rate was 400/550 (72.7%) comprising undergraduates (n = 312), postgraduates (n = 38), and faculty (n = 50). The results showed an acceptable level of online skills with no statistically significant difference between the groups (P > 0.05). A statistically significant difference between the two categories of uses, personal and T&L, was found (P < 0.05). The undergraduate students reported statistically significantly lower readiness level in online English literacy, perceived impact of online technology on education, technology accessibility, importance of institutional support, overall readiness, and the need for technical support (P < 0.05). Conclusion: Significant differences between students' and faculty readiness for e-learning adoption in dental education were reported. The current study captured the prepandemic e-readiness of students and faculty as a baseline for future assessment of pandemic effect on education.
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Advantages of Kahoot! Game-based formative assessments along with methods of its use and application during the COVID-19 Pandemic in various live learning sessions Highly accessed article p. 175
Nagwa Kostandy Kalleny
DOI:10.4103/JMAU.JMAU_61_20  
Background: Technology has played important roles in education, thus the application of online Kahoot! Game-based technology as a learning tool particularly in formative assessments might improve learning and achieve promising education. It can be applied live, either face to face or virtual in distance learning as during the current situation of COVID-19 pandemic that resulted in total shift toward online learning. Methodology: Kahoot! Game-based histology and cell biology lab formative assessments were prepared, equipped with light and electron microscopic photos, and applied for 2nd year undergraduate medical students. Students' engagement was evaluated by calculating number of engaged students in Kahoot! versus number of attended students in each lab. Students' satisfaction was evaluated according to students' feedback collected on Kahoot! platform and by an online questionnaire applied on Google Forms which included 5 items that were measured on a 5-point Likert scale, with 1 indicating strongly disagree and 5 indicating strongly agree, with overall satisfaction ranging between 5 (least satisfaction) and 25 (maximum satisfaction). YouTube videos were done to demonstrate and spread the idea of using Kahoot! platform in education particularly in the COVID-19 pandemic. Results: Kahoot! was successfully applied in Histology and Cell Biology lab sessions. Students' engagement for Kahoot! game-based formative assessments were 100% in most lab sessions. The mean overall students' fun assessment score for Kahoot! was 4.65 out of 5. Most students recommended the use of Kahoot! game-based formative assessments. The mean overall Kahoot! questionnaire satisfaction score was 24.25 (ranging between agree and strongly agree). YouTube videos were successfully published. Conclusion: Kahoot! produces marked students' engagement and satisfaction in formative assessments enabling it to be applied live for any learning session either face to face or virtual for distance learning.
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Evaluation of curricular adaptations using digital transformation in a medical school in arabian gulf during the COVID-19 pandemic p. 186
Archana Prabu Kumar, Ahmed Mohammed Al Ansari, Mohamed Hany Kamel Shehata, Yasin Ibrahimm Yousif Tayem, Mona Rushdi Khalil Arekat, Adel Abdulrahim Mohammed Kamal, Abdelhalim Deifalla, Khaled Saeed Tabbara
DOI:10.4103/jmau.jmau_87_20  
Background: Several institutions adopted innovative approaches to ensure continued learning for their students during the COVID-19 pandemic. All curricular innovations should undergo curriculum evaluation; hence, the objective of this paper was to share the salient features of evaluation using faculty and student's feedback on curricular adaptations implemented through digital transformation in a Medical School in Arabian Gulf during the COVID-19 pandemic, using a structured questionnaire. Methodology: After getting informed consent, feedback about acceptability and limitations regarding various aspects of curricular adaptations was obtained from students and faculty, using a structured and validated questionnaire. The response rate from faculty and students was 90% and 60%, respectively. The qualitative responses were analyzed using thematic analysis. Results: About 97% agreed that Modular Object-Oriented Dynamic Learning Environment, ZOOM, and Examsoft platforms were effective for curriculum delivery and assessment. 85% agreed that they were able to maintain online interactivity and 92% conveyed their willingness to continue to use these digital innovations even after the end of pandemic. “Lack of interactivity,” “missed clinical training,” “live sessions were more engaging than recorded ones” were the prominent themes emerged out of thematic analysis. All faculty and students expressed concern over the lack of clinical training involving real patients. All of them expressed appreciation to the university and faculty for their enormous efforts. Conclusion: Innovative ways should be considered to start clinical teaching with real patients, during pandemic. The learning outcomes of digital learning should be validated across all institutions. New indicators related to “digital learning” should be considered for accreditation of medical schools.
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Step-by-step guide to managing the educational crisis: Lessons learned from COVID-19 pandemic p. 193
Samar Abdelazim Ahmed, Mohamed Hany Kamel Shehata, Raymond L Wells, Hebat Allah Ahmed Amin, Hani Salem Mohamed Atwa
DOI:10.4103/jmau.jmau_79_20  
Background: Medical education is facing great challenges and uncertainties amidst the COVID-19 pandemic. Aims and Objectives: This article aims to provide tips that can provide a guide for medical education leaders to coordinate crisis management referring to the Egyptian context. Materials and Methods: This work was done using a reflection on the COVID-19 response by Egyptian universities and analysis of such responses. Results: Medical Education Institutions are required to build a taskforce team for crisis management. These should be committed to supporting sudden online education transition, academic support, and the psychological well-being of students, staff members, health care professionals, paramedics, and faculty administration. As the situation evolves, the taskforce has to monitor the challenges and provide appropriate plans, guidance, and solutions. Leaders in medical education have a crucial role in response to the pandemic crisis in securing a successful educational process while ensuring the mental and psychological well-being of the stakeholders. Conclusion: Crisis management is the skill of the future and more investment needs to be placed in designing crisis response and in enabling universities to accommodate this response.
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Students' awareness as an underlying factor for satisfaction and compliance p. 198
Omar Gamal Goda, Donia Tarek Mahdy, Mostafa M El Shahed, Hebat Allah Ahmed Amin, Samar A Ahmed
DOI:10.4103/JMAU.JMAU_77_20  
Introduction: As soon as the WHO declared COVID-19 a pandemic, many higher education facilities had to change their educational and teaching strategies to cope with the lockdown. Some medical schools decided to rely on online teaching while others depended on students' self-learning abilities. Methods of assessment also changed as some medical schools implemented pass/fail exams, online examinations, and research projects while others postponed their final exams. In Egypt, medical schools started delivering their lectures online and changed the assessment criteria of the preclinical academic years to depend mainly on research and online exams while postponed the clinical rotations and final exams of the clinical years. Aim: This study assesses medical students' awareness of the current situation regarding the safety guidelines and their satisfaction with the solutions provided by their schools for the plans to continue their learning and the new assessment methods and criteria. Methodology: The method used for data collection is an online survey filled by medical students from around Egypt. Moreover, data were statistically analyzed using IBM statistical package SPSS for doing a Chi-squared test on two variables. Results: After collecting the data and analyzing responses, we found that 66.2% of students who answered the survey do not think that the safety measures taken by their universities after the return back will be enough. Conclusion: This shows that the basic knowledge of COVID-19 among medical students is average and there is a need to start programs for infection control practices against COVID-19 for all medical students and professionals.
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CASE REPORTS Top

Transformation to virtual training during COVID-19 pandemic: Case report from a low resources' country p. 205
Gehan S Sadek, Mahmoud A Kora
DOI:10.4103/JMAU.JMAU_48_20  
Many challenges had faced medical schools worldwide after the beginning of the COVID-19 pandemic. From these challenges, training of the next generation of physicians and academic staff. Adoption of online education and training with getting the benefit of technology had introduced. Egypt has another special challenge, which is the adoption of a new undergraduate competency-based program since September 2018. Hence, there is a necessity to complete the ongoing capacity building of the academic staff regarding the development of all domains of medical education. Here is a case report of interactive training assessment online courses, which proved promising. Although there is fear about the rapid, unexpected transformation, in fact, it may lead to the emergence of a new model for teaching and learning, which is a mixture between the regular and electronic methods.
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E-workshop on writing multiple-choice questions: Online experience during the period of COVID-19 crisis p. 207
Hosam Hefny, Said Abbadi
DOI:10.4103/JMAU.JMAU_30_20  
Based on the recommendations of the Written Examination Review Committee, Faculty of Medicine Suez University (FOMSU), the Dean of the Faculty issued instructions that are necessary to establish a workshop for the faculty members at FOMSU on how to write technically correct multiple-choice questions (MCQs) as soon as possible. In addition, we should cope with the current situation (COVID-19 pandemic) that necessitates the shift from face-to-face to online/distance learning. All staff members should be trained about how to write MCQs.
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Use of short videos for faculty development in adaptation of interactive teaching strategies for virtual classroom p. 211
Samar Abdelazim Ahmed, Mohamed Hany Shehata, Hany W Abdel Malak, Sherif A El Saadany, Mohammed Ahmed Hassanien
DOI:10.4103/JMAU.JMAU_23_20  
The threat associated with physical interaction in teaching and learning timed with the COVID-19 pandemic has rendered faculty in a situation that they were not entirely prepared for. This paper describes a case study where educational videos were used in short format to help faculty progress in their adaptation to virtual teaching. The initiative describes the adaptations done to the videos and making them ore accessible to faculty. The channel experienced a 300% increase in viewership. There is an inherent need for training on using virtual classroom tools and adapting teaching strategies to these virtual tools. Using 5-7 minute videos proved useful in this area.
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Adapting blackboard-collaborate ultra as an interactive online learning tool during the COVID-19 pandemic p. 213
Ayman Zaky Elsamanoudy, Fayza Al Fayz, Mohammed Hassanien
DOI:10.4103/JMAU.JMAU_26_20  
Background: The 2019–2020 coronavirus pandemic has affected educational systems worldwide, leading to widespread closures of schools and universities and social distancing. Hence, the shift to an online tool was required. Aims and Objectives: The main problem postulated is the lack of student–teacher interaction that occurs with online learning. Methods: The Blackboard Collaborate Ultra platform was used to deliver lectures on clinical biochemistry and the reproductive module to our students. Our main goal was to achieve students' engagement and interaction. Results: There were 189 male students enrolled in the reproductive module. The attendance rate was 93%–95%. The download of the recording was 100%. The active participation rate was up to 87%. Hence, Blackboard Collaborate Ultra's virtual classrooms are very useful tools for online interactive lecturing. Conclusion: Based on this experience gained, we could conclude that interactive virtual classroom lecturing can be used in addition to or instead of traditional lectures during ordinary situations as a successful online learning community tool.
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