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Relapse rates at 1year following elective withdrawal of anti-TNF are 36%, with high retreatment response rate. Predictors of relapse include ileocolonic involvement, previous anti-TNF therapy and raised FC. Endoscopic/radiologic assessment prior to cessation of therapy does not appear to predict those at lower risk of relapse.

Objectives: Case-based teaching is a relatively new approach to teaching basic sciences. Although this technique has been used in medical teaching for many years, few attempts have been made to examine its efficacy for nursing students. The aim of this study was to compare the effectiveness of didactic and case-based teaching of physiology among second-year nursing students at our college.Methods: A descriptive cross-over study was conducted, in which the students served as their own controls, as they were examined after each of two sessions. In the first session, the students were taught digestive physiology by traditional lectures. In the second session, the same students were taught renal physiology by the same instructor using a case-based technique. Multiple-choice questions were used to assess each student's comprehension after each session and compared. At the end of the two sessions, students evaluated the teaching method on a questionnaire. Paired t tests were used to analyse differences.Results: The performance in tests was statistically significantly better after didactic lectures (mean, 17.53) than after case-based teaching (mean, 16.47) (two-tailed p ¼ 0.003). However, 65e72% of students found that case-based teaching improved their knowledge about the topic better than lectures.Conclusions: Significantly better examination performance was observed after didactic teaching, but the students' feedback indicated that case-based teaching could be used as an alternative to lectures and may facilitate skills acquisition, which is considered to be important in professional problem-solving during nursing care.

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BACKGROUND AND OBJECTIVESConsumption of energy drinks has adverse effects on the heart that might be potentiated in obese individuals. Since the incidence of obesity and use of energy drinks is high among Saudi youth, we used non-invasive tests to study hemodynamic changes produced by altered autonomic cardiac activity following consumption of energy drinks in obese male students.DESIGN AND SETTINGThis cross-sectional study was carried out at Department of Physiology, College of Medicine, University of Dammam, Saudi Arabia, over a one-year period from December 2013 to December 2014.SUBJECTS AND METHODSIn Saudi male university students we measured continuous ECG recordings and a one-minute deep breathing maneuver to measure the expiratory-to-inspiratory ratio, the mean heart rate range (MHRR), the mean percentage variability. (M%VHR) and the corrected QT interval (QTc) at 0, 30 and 60 minutes after consumption of energy drink.RESULTSWe enrolled 31 students (18 overweight/obese and 13 normal weights. QTc was significantly increased at 60 min as compared with the resting state in overweight/obese subjects (P=.006). Heart rate variability was significantly less in obese as compared with normal weight subjects at 60 minutes as indicated by E:I ratio, (P=.037), MHRR (P=.012), M%VHR (P=.040) after energy drink consumption. Significant increases in diastolic (P= .020) and mean arterial blood pressure (P=.024) were observed at 30 minutes in the obese group.CONCLUSIONHemodynamic changes after intake of energy drinks in obese subjects indicate that obesity and energy drinks could synergistically induce harmful effects. This finding warrants efforts to caution the obese on intake of energy drinks and timely intervention to motivate changes in life style.

Objectives:To determine the effect of energy drink consumption before exercise on indices of physical performance in untrained females.Methods:This single blind placebo controlled experimental study was carried out at the Physiology Department, University of Dammam, Dammam, Kingdom of Saudi Arabia from September 2011 to May 2012, on 32 healthy female students, in a crossover design. They were given either a standardized energy drink or the placebo 45 minutes before the exercise. Time to exhaustion and the stages of Bruce protocol achieved were noted. Heart rate, blood pressure, peripheral capillary oxygen saturation, and blood lactate were recorded before and after the exercise. Maximum oxygen consumption (VO2max) was calculated by formula. Paired sample t-test was used for statistics.Results:The mean age was 19.93±0.8 years, mean height 156.40±3.83 cm, and the mean weight 51.73±3.65 kg. Time to exhaustion in the placebo group was 11.67±1.51 minutes and 11.41±1.56 in the energy drink group (p<0.157). The VO2max in the placebo group was 34.06±6.62, while it was 32.89±6.83 in the energy drink group (p<0.154). There were no significant differences between the placebo and the energy drinks groups in regards to heart rate, blood pressure, and blood lactate levels, before or after the exercise. However, there were significant differences before, immediately, and 30 minutes post exercise for all parameters between each group.Conclusion:The effects of energy drinks intake on physical performance during the exercise in our small sample does not significantly differ from placebo.

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BACKGROUNDObesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders.OBJECTIVESTo determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks.DESIGNCross-sectional, analytical.SETTINGPhysiology department at a university in Saudi Arabia.SUBJECTS AND METHODSUniversity students, 18–22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption.MAIN OUTCOME MEASURE(S)Autonomic disturbance, hemodynamic changes.RESULTSIn 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes.CONCLUSIONObesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects.LIMITATIONSDue to time and resource restraints, only the acute effects of energy drinks were examined.