Erectogenic Effects of Clerodendron capitatum

Clerodendron capitatum (Willd) (family: verbenaceae) is locally named as Gung and used traditionally to treat erectile dysfunction. Therefore, the current study was designed to investigate the erectogenic properties of C. capitatum. The relaxation effect of this plant was tested on phenylephrine precontracted rabbit corpus cavernosum smooth muscle (CCSM). The effects of C. capitatum were also examined on isolated Guinea pig atria alone, in the presence of calcium chloride (Ca2+ channel blocker), atropine (cholinergic blocker), and glibenclamide (ATP-sensitive K+ channel blocker). These effects were confirmed on isolated rabbit aortic strips. The extract, when tested colorimetrically for its inhibitory activities on phosphordiesterase-5 (PDE-5) in vitro towards p-nitrophenyl phenyl phosphate (PNPPP), was observed to induce significant dose-dependent inhibition of PDE-5, with an ID50 of 0.161 mg/ml (<.05). In conclusion, our results suggest that C. capitatum possesses a relaxant effect on CCSM, which is attributable to the inhibition of PDE-5, but not mediated by the release calcium, activation of adrenergic or cholinergic receptors, or the activation of potassium channels

Destructive practices in public service: Evidence from Sudan

Purpose - This article discusses the emergence of the public service in Sudan and the impact of corruption implicating the performance of civil service organizations during the last three decades. Design/methodology/approach - Comprehensive literature is reviewed by looking into the current practices done by other countries civil servant. Idea in combatting corruption and bribery were reviewed in detail. Findings - The study proposes several methods to reduce the emerging of corruption among civil servants in Sudan. This includes initiatives such as reducing the remuneration gap between the civil and private sectors, allowing civil servants to gain advantage through the process of monetization, appropriate and consistent process of transformation, providing necessary courses and trainings for civil servants that is related to public service guidelines and stern action being taken to civil servants who involves in corruption. Research limitations/implications - Further analysis is required in connecting data gathering methods relating to corruption. Policy makers needs to create a new business culture that perceived corruption as totally negative and bad for the nation. Practical implications - The findings are beneficial for researchers and policy makers to understand the real situation among civil servants in Sudan. There should be serious efforts at all levels of civil servants to combat against corruption. Originality/value - The study concludes that the performance of Sudan's civil service establishments is undermined by corruption. Serious measures need to be taken to uphold the trust of the public which were tarnished by the corruption allegation. Paper type: conceptual paper

Challenges of independence of internal audit police officers: Evidence from Sudan

Purpose - This study aims at understanding and explaining the issues related to the independence of internal audit Police Officers at the Ministry of Interior in Sudan. Design/methodology/approach - A qualitative research approach and study case design had been used by this study. Data were gathered through semi-structured interviews, document materials reviews, and observations. Findings - The study found that the application of the independence principle is limited. This is due to the constraint of the command system followed by the Police Force. In spite of that, substantial improvement has been achieved by the internal auditors at the Ministry of Interior in Sudan. The internal audit department is supported by a number of decrees that enhanced its organizational rank and the independence of individual internal audit Police Officers. Practical implications - In view of challenges of internal audit independence police officers, the current case study research contributes to enhancing the limited knowledge about the independence of internal audit practices at the Ministry of Interior in Sudan. This study also adds to the body literature of independence of internal audit by identifying roles, duties and responsibilities of internal audit independence. Originality/value - From the researcher's perspective, this is the first study that aims to understand and explain the issued related to the independence of internal audit police officers at the Ministry of Interior in Sudan

Breast cancer awareness and breast self-examination among future female university graduates: comparison between medical and non-medical students

Background: Breast cancer is a common health problem among females in Saudi Arabia. The disease account for 27% of all female malignancies representing 25.1% of all newly diagnosed female cancers. The objectives of the current study were to assess the level of carcinoma breast awareness of female university students, Majmaah University in Saudi Arabia and to compare the level of awareness, breast self-examination and breast cancer screening between medical and non-medical students.Methods: The current study was a cross-sectional, conducted among female students in Majmaah University in Saudi Arabia. The stratified and the systematic sampling were employed to select the colleges and the students respectively. The sample size was calculated as 325. Data was collected by a pre tested questionnaire and analyzed by SPSS.Results: The university students who acquired good knowledge were 111 (34.2%). Students who acquired average and poor knowledge were 42.2% and 23.6% respectively. Medical students who had good knowledge were 37.6% compared to 26.9% of non-medical students.  The results showed that 94 (28.9%) of the participants practice breast self-examination and 25 (7.6%) performed a screening test.Conclusions: The study concluded that Majmaah University students’ awareness of carcinoma breast is low. There is no significant difference in the level of awareness between students of medical colleges and those of non-medical colleges. The level of practicing breast self-examination and performing screening test for carcinoma breast among female university students is low. There is a significant difference in performing carcinoma breast screening test between medical and non-medical students.

Prevalence of Smoking among Male Medical Students at Majmaah University, Saudi Arabia

Smoking is defined as burning dry tobacco leaves and inhaling smoke from the burn. This process may be done using different forms of tobbaco products, including cigarettes (Cigars, Little Cigars, Cigarillos), electronic cigarettes, and hookah (shisha). Smoking can give rise to lung diseases such as chronic obstructive pulmonary disease (COPD) and has been proven to be the underlying cause in  84% of deaths in lung cancer and 83% mortalities in COPD. This study was conducted to determine the prevalence of tobacco smoking among male students of the Majmaah University, Saudi Arabia. This cross-sectional study was performed from January to February 2020 on among medical students of Majmaah University, Saudi Arabia. A pretested questionnaire was used to collect data while the SPSS was used for data analysis. From 256 male medical students, only 113 responded to the questionnaire. The prevalence of smoking was found to be 19.5% (n=22) with most smoked cigarettes (50%). Most smokers (50 %) were in the lowest age group, 19-21 years. There was an increase in smoking with an increase in income. Of the 22 respondents who smoked, 10 started smoking when they were 14 to 17 years old. In conclusion, the study shows a low prevalence of smoking among male medical students in the College of Medicine of Majmaah University. Most smokers consume cigarettes, and the majority are not considering quitting

Medical students' perceptions of complementary and alternative medicine therapies: A pre- and post-exposure survey in Majmaah University, Saudi Arabia

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health  and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and  innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia.Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 &amp; 39, respectively] were selected for this study. A reliable 16-item  self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or  alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities.Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies.Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation. Key words: Medical students; Complementary and Alternative Medicine; CAM course; CAM therapies; pre-post design study; Saudi Arabia

MEDICAL STUDENTS' PERCEPTIONS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES: A PRE- AND POST-EXPOSURE SURVEY IN MAJMAAH UNIVERSITY, SAUDI ARABIA

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia. Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities. Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies. Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p &lt; 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p &lt; 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care