Creativity-related cognitive processes and personality traits are not often examined together in educational contexts, particularly when discussing high-achieving subgroups of medical students. This study investigated these predictors of academic performance among high-achieving and typical-achieving medical students within a problem-based learning (PBL) environment of a medical school. Data were collected from 274 Doctor of Medicine students at Arabian Gulf University during the 2024–2025 academic year. Participants completed assessments of convergent thinking (Raven’s Advanced Progressive Matrices and Watson–Glaser Critical Thinking Appraisal), divergent thinking (Alternative Uses Test and Figural Divergent Thinking Test), and openness to experience (NEO-FFI). Students’ grade point averages (GPAs) were obtained from institutional records. Hierarchical regression analyses and moderation tests were performed, controlling for age and sex. Convergent thinking (β = 0.20, p < .001) and divergent thinking (β = 0.25, p < .001) emerged as modest-to-moderate positive predictors of GPA, whereas openness to experience showed a small negative association (β = −0.13, p = .026). Achievement status, defined as high-achieving versus typical-achieving GPA, significantly moderated the effects of both convergent and divergent thinking, such that the academic benefits of higher thinking skills were meaningfully stronger among high-achieving students, while these associations were weaker among their typical-achieving peers. No moderating effect was observed for openness to experience. Convergent and divergent thinking independently enhance academic performance in medical students, with amplified effects for high-achieving students. In contrast, openness to experience was negatively linked with GPA, reflecting the complex interplay between personality traits and structured medical training. These findings underscore the need for medical curricula that balance convergent reasoning with creative problem-solving while considering diverse student cognitive and personality profiles.

Curriculum integration is one of the main objectives of problem-based learning (PBL). However, the perceptions between students and faculty about the degree of this integration may differ. This study examined faculty and students’ perceptions about curriculum integration in two PBL medical schools. A total of 648 participants (582 students, 66 faculty) completed a validated 24-item tool assessing curriculum integration across four domains. Faculty consistently rated integration higher than students, with the largest discrepancy observed in assessment alignment. These findings reveal a perception gap between students and faculty in the degree of curriculum integration.

BACKGROUND:This study investigated the association between response to hydroxyurea (HU) treatment and fetal hemoglobin (HbF), and the prevalence of mutations that regulate HbF synthesis, drug transport and biotransformation in sickle cell disease (SCD) patients. RESEARCH DESIGN AND METHODS:Study included n = 390 Bahrainis with a history of sickle cell crises. Responders (n = 127; 68%) were patients achieving HbF ≥ 15% along with other improvements. Non-responders (n = 60; 32%) failed to achieve this threshold despite maximum tolerated dose treatment. RESULTS:Hydroxyurea treated patients had decreased frequency of painful crises and hospitalizations, increased Hb and HbF and decreased sickle cell hemoglobin (HbS), and white blood cells (WBCs). The minor allele frequency of ARG2 (rs10483801), HBS1L-MYB (rs4895441), CYP2C19 (rs4986893) CYP2C19 (rs4244285), and OATP1B3 (rs3711358) gene was significantly higher in non-responders compared to responders. A negative correlation was found between the number of pain crises and hospitalizations per year and HbF%. No significant correlation was reported between the dosage and the number of hospitalizations per year. No significant correlation was found between the duration of treatment and HbF%. CONCLUSIONS:Findings highlight the importance of a personalized treatment approach to maximize the benefits and minimize the side effects of HU, thereby improving clinical outcomes.

Integrated curricula reinforce student learning and retention of relevant knowledge. At Qatar University and Arabian Gulf University medical colleges, Problem-Based Learning (PBL) is the principal teaching and learning strategy to implement integrated multidisciplinary system-based curriculum. In addition, other initiatives include integrated assessment, logical organization of teaching and learning methods, as well as combined faculty effort in curriculum planning and delivery. This multicenter study aims to develop and validate a questionnaire for measuring the extent of medical curriculum integration in PBL programs. Following an extensive literature review, the content validity of a questionnaire was tested through focus group discussion with subject matter experts (n = 20), followed by pilot testing with medical students (n = 20). The content-validated questionnaire (31 items) was distributed to students in the two colleges. To examine the construct validity and construct reliability of the questionnaire, exploratory factor analysis (EFA) was conducted with 330 students followed by confirmatory factor analysis (CFA) on 579 students. EFA supported a four-factor structure of the questionnaire which explained 62

This study compared three artificial intelligence (AI) platforms' potential to identify drug therapy communication competencies expected of a graduating medical doctor. We presented three AI platforms, namely, Poe Assistant©, ChatGPT© and Google Bard©, with structured queries to generate communication skill competencies and case scenarios appropriate for graduating medical doctors. These case scenarios comprised 15 prototypical medical conditions that required drug prescriptions. Two authors independently evaluated the AI-enhanced clinical encounters, which integrated a diverse range of information to create patient-centred care plans. Through a consensus-based approach using a checklist, the communication components generated for each scenario were assessed. The instructions and warnings provided for each case scenario were evaluated by referencing the British National Formulary. AI platforms demonstrated overlap in competency domains generated, albeit with variations in wording. The domains of knowledge (basic and clinical pharmacology, prescribing, communication and drug safety) were unanimously recognized by all platforms. A broad consensus among Poe Assistant© and ChatGPT© on drug therapy-related communication issues specific to each case scenario was evident. The consensus primarily encompassed salutation, generic drug prescribed, treatment goals and follow-up schedules. Differences were observed in patient instruction clarity, listed side effects, warnings and patient empowerment. Google Bard did not provide guidance on patient communication issues. AI platforms recognized competencies with variations in how these were stated. Poe Assistant© and ChatGPT© exhibited alignment of communication issues. However, significant discrepancies were observed in specific skill components, indicating the necessity of human intervention to critically evaluate AI-generated outputs.

BACKGROUND:Artificial intelligence (AI) tools are designed to create or generate content from their trained parameters using an online conversational interface. AI has opened new avenues in redefining the role boundaries of teachers and learners and has the potential to impact the teaching-learning process.METHODS:In this descriptive proof-of- concept cross-sectional study we have explored the application of three generative AI tools on drug treatment of hypertension theme to generate: (1) specific learning outcomes (SLOs); (2) test items (MCQs- A type and case cluster; SAQs; OSPE); (3) test standard-setting parameters for medical students.RESULTS:Analysis of AI-generated output showed profound homology but divergence in quality and responsiveness to refining search queries. The SLOs identified key domains of antihypertensive pharmacology and therapeutics relevant to stages of the medical program, stated with appropriate action verbs as per Bloom's taxonomy. Test items often had clinical vignettes aligned with the key domain stated in search queries. Some test items related to A-type MCQs had construction defects, multiple correct answers, and dubious appropriateness to the learner's stage. ChatGPT generated explanations for test items, this enhancing usefulness to support self-study by learners. Integrated case-cluster items had focused clinical case description vignettes, integration across disciplines, and targeted higher levels of competencies. The response of AI tools on standard-setting varied. Individual questions for each SAQ clinical scenario were mostly open-ended. The AI-generated OSPE test items were appropriate for the learner's stage and identified relevant pharmacotherapeutic issues. The model answers supplied for both SAQs and OSPEs can aid course instructors in planning classroom lessons, identifying suitable instructional methods, establishing rubrics for grading, and for learners as a study guide. Key lessons learnt for improving AI-generated test item quality are outlined.CONCLUSIONS:AI tools are useful adjuncts to plan instructional methods, identify themes for test blueprinting, generate test items, and guide test standard-setting appropriate to learners' stage in the medical program. However, experts need to review the content validity of AI-generated output. We expect AIs to influence the medical education landscape to empower learners, and to align competencies with curriculum implementation. AI literacy is an essential competency for health professionals.

The skull and appendicular bones are derived from different embryological sources during their development. The impact of prenatal exposure of topiramate on ossification of these bones is not adequately studied. The goal of this study was to assess the ossification patterns of the craniofacial bones and bones of the forelimbs and hindlimbs in 20-day-old rat fetuses after maternal exposure to topiramate at doses equivalent to human therapeutic doses. Three groups of Sprague-Dawley pregnant rats were used: control, topiramate 50mg/kg/day (T50) and topiramate 100mg/kg/day (T100). Topiramate was given by oral gavage from day 6 to day19 of gestation. Ossification was evaluated in the bones of 20 days fetuses after staining with Alizarin red. Results showed a significant reduction in complete ossified centers of the metacarpal, metatarsal and craniofacial bones in topiramate-exposed fetuses at both doses when compared to the control group. Also, a significant decrease in the length of ossified part of the long bones of the forelimbs and hindlimbs in topiramate-exposed fetuses at both doses was noted when compared to the control group. Crown-rump length and fetal weight were significantly decreased in topiramate treated groups compared to the control group. In all examined groups, there was a positive correlation between the crown-rump length and the lengths of humerus and femur. No abnormalities in the ossified bones and no significant changes in their ossification pattern were observed between the treated groups. In conclusion, prenatal administration of topiramate in doses equivalent to human therapeutic doses delayed ossification and development of craniofacial and appendicular bones in rat fetuses and their effects are not dose dependent at doses investigated. The implications of these findings in women who require topiramate therapy in pregnancy merit further evaluation.

AimsThis study compared three artificial intelligence (AI) platforms' potential to identify drug therapy communication competencies expected of a graduating medical doctor.MethodsWe presented three AI platforms, namely, Poe Assistant (c), ChatGPT (c) and Google Bard (c), with structured queries to generate communication skill competencies and case scenarios appropriate for graduating medical doctors. These case scenarios comprised 15 prototypical medical conditions that required drug prescriptions. Two authors independently evaluated the AI-enhanced clinical encounters, which integrated a diverse range of information to create patient-centred care plans. Through a consensus-based approach using a checklist, the communication components generated for each scenario were assessed. The instructions and warnings provided for each case scenario were evaluated by referencing the British National Formulary.ResultsAI platforms demonstrated overlap in competency domains generated, albeit with variations in wording. The domains of knowledge (basic and clinical pharmacology, prescribing, communication and drug safety) were unanimously recognized by all platforms. A broad consensus among Poe Assistant (c) and ChatGPT (c) on drug therapy-related communication issues specific to each case scenario was evident. The consensus primarily encompassed salutation, generic drug prescribed, treatment goals and follow-up schedules. Differences were observed in patient instruction clarity, listed side effects, warnings and patient empowerment. Google Bard did not provide guidance on patient communication issues.ConclusionsAI platforms recognized competencies with variations in how these were stated. Poe Assistant (c) and ChatGPT (c) exhibited alignment of communication issues. However, significant discrepancies were observed in specific skill components, indicating the necessity of human intervention to critically evaluate AI-generated outputs.

Abstract Background Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022. Methods Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations). Results Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, – .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect. Conclusions Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Background Malaria caused by Plasmodium falciparum in pregnancy can result in adverse maternal and fetal sequelae. This review evaluated the adherence of the national guidelines drawn from World Health Organization (WHO) regions, Africa, Eastern Mediterranean, Southeast Asia, and Western Pacific, to the WHO recommendations on drug treatment and prevention of chloroquine-resistant falciparum malaria in pregnant women. Methods Thirty-five updated national guidelines and the President's Malaria Initiative (PMI), available in English language, were reviewed. The primary outcome measures were the first-line anti-malarial treatment protocols adopted by national guidelines for uncomplicated and complicated falciparum malaria infections in early (first) and late (second and third) trimesters of pregnancy. The strategy of intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) was also addressed. Results This review evaluated the treatment and prevention of falciparum malaria in pregnancy in 35 national guidelines/PMI-Malaria Operational Plans (MOP) reports out of 95 malaria-endemic countries. Of the 35 national guidelines, 10 (28.6%) recommend oral quinine plus clindamycin as first-line treatment for uncomplicated malaria in the first trimester. As the first-line option, artemether-lumefantrine, an artemisinin-based combination therapy, is adopted by 26 (74.3%) of the guidelines for treating uncomplicated or complicated malaria in the second and third trimesters. Intravenous artesunate is approved by 18 (51.4%) and 31 (88.6%) guidelines for treating complicated malaria during early and late pregnancy, respectively. Of the 23 national guidelines that recommend IPTp-SP strategy, 8 (34.8%) are not explicit about directly observed therapy requirements, and three-quarters, 17 (73.9%), do not specify contra-indication of SP in human immunodeficiency virus (HIV)-infected pregnant women receiving cotrimoxazole prophylaxis. Most of the guidelines (18/23; 78.3%) state the recommended folic acid dose. Conclusion Several national guidelines and PMI reports require update revisions to harmonize with international guidelines and emergent trends in managing falciparum malaria in pregnancy. National guidelines and those of donor agencies should comply with those of WHO guideline recommendations although local conditions and delayed guideline updates may call for deviations from WHO evidence-based guidelines.

OBJECTIVES:This study evaluated the prevalence of prescribing drugs with constipation-inducing potential and the prophylactic use of laxatives in community-dwelling older adults.METHOD:An audit of outpatient prescriptions ordered for older adults aged ≥65 years with one or more chronic morbidities in 24 governmental primary healthcare centres in Bahrain. The prescriptions were collected by pharmacist-in-charge of each health centre between December 2015 and June 2016. The proportion of prescriptions with constipation-inducing drugs and co-prescribed laxatives was determined.KEY FINDINGS:The overall prevalence of prescribing drugs with the potential to cause constipation was 30.5% (642/2106). Prescriptions with at least one anticholinergic/drug with anticholinergic potential (DAP) were 22.5% (473/2106): single medication in 16.6% (350/2106) and two or more combinations in 5.9% (124/2106). A combination of two or more anticholinergics/DAP accounted for 2.9% (61/2106) prescriptions. Constipation-inducing drugs other than anticholinergics such as multivalent cation preparations and non-dihydropyridine calcium channel blockers were prescribed in 8.0% (168/2106) of cases. Orphenadrine and first-generation antihistamines, both with high anticholinergic drug burden, were the frequently prescribed medications, either alone or combined. The rate of prescribed laxatives was 2.96% (19/642), mostly for those on constipation-inducing drug monotherapy.CONCLUSION:Approximately a third of prescriptions for older adults had constipation-inducing medications, typically a single DAP. Prescribing laxatives were uncommon and did not correlate with the prevalence of prescribing drugs with constipation potential. Physicians' awareness about anticholinergic drugs and their potential risks, and the prophylactic use of laxatives to mitigate iatrogenic constipation are to be included in continuing professional programmes.

Background The relationship between large-group classroom attendance by students and test achievement in problem-based learning (PBL) curricula is unclear. This study examined the correlation between attendance at resource sessions (hybrid lectures in the PBL curriculum) and test scores achieved in pharmacology and determined whether the score achieved was related to student gender. Methods A cross-sectional observational study over one academic year of 1404 pre-clerkship medical students was performed. Class attendance during pharmacology resource sessions and MCQ test scores achieved in pharmacology were analysed. Results The percentage of students’ attendance in resource sessions declined over three years of the programme, from 78.7 ± 27.5 in unit I to 22.1 ± 35.6 (mean ± SD) in unit IX. A significant but weakly positive correlation was evident between attendance and achievement in pharmacology ( r = 0.280; p < 0.0001). The mean score of the students who attended > 50% of the resource sessions was significantly higher ( p < 0.0001). Students who attended ≤50% were more likely to achieve lower tertile scores. The mean score achieved and the number of higher tertile scorers were higher among students who attended > 50% of the resource sessions. Although female students’ attendance was significantly higher, no significant gender-related differences in either mean scores or top grades achieved were found. Conclusions In a PBL curriculum, the classroom attendance of students in pharmacology declined during the pre-clerkship phase. A weak positive correlation was found between attendance and academic achievement, as measured by MCQ test scores. Factors other than motivation and attendance may confound gender-based academic performance and merit further research.

Background: The older adults are at greater risk for developing adverse drug events due to both age-related comorbidities and polypharmacy practice. Objectives. To evaluate the drug-drug interaction (DDI) potential and drug therapy related problems (DRP) expected in community-dwelling older adults with chronic multiple morbidities in Bahrain. Design: Prescription-based retrospective audit. Setting: Primary care settings, Bahrain. Method: A nationwide audit of 2,090 primary care prescriptions, exploring potential DDI, in patients aged ≥65 years in Bahrain. Results: Approximately one-quarter of the older adults were on acid-suppressing drugs (ASD), mostly on long-term basis (mean 4 ±1 months). Twenty percent (211/1,073) of diabetic patients received concomitant metformin and ASD, both of which are known to cause vitamin B12 deficiency. Lipophilic statins (atorvastatin and simvastatin) and proton pump inhibitors (omeprazole/esomeprazole), which may interfere with clopidogrel efficacy, were prescribed in 63.8% (30/47) and 30.8% (4/13) of patients, respectively. Other potentially inappropriate prescriptions included: β-antagonists with insulin(s), glyburide or their combinations (3.2%; 34/1,073); paracetamol >4 gm/d (1.1%; 22/2,090); indapamide with QT prolonging drugs (0.9%; 19/2,090); cardioselective β,-antagonists in patients with airway diseases (0.8%; 16/2,090); supratherapeutic dose of Bipreterax® and metformin; and subtherapeutic dose of pregabalin, calcium supplements and vitamins. Conclusions: The spectrum of DDI and expected DRP suggests mild to hazardous ADR potential of many prescriptions issued to older adults with chronic morbidities. Interventions are needed to decrease the risk of potential adverse drug events that compromise older adult patient safety

Aim: We aimed to study the effects of prenatal administration of two doses of melamine on foetal ossification centers in rats. Methods: Positively-mated, virgin, adult female Sprague-Dawley rats (n=24) were treated from day 6 to day 20 of gestation with solvent (control), melamine 300 mg/kg/day (group 1) or melamine 450 mg/kg/day (group 2). On day 21, half of the fetuses were examined for bone ossification abnormalities. Results: A total of 109 foetal skeletons were examined. The percentage of incomplete or absent bones in the entire skeleton was significantly less in group 1 and group 2 compared to control. These findings were more prominent in group 2 compared to group 1. Likewise, ossified centers were fewer in the sternum and metacarpal bones in group 1 and group 2 compared to control. No abnormal ossification was observed in metatarsal, skull, pubic or rib bones. Regarding the vertebral centrae, a significant increase in the number of absent or delayed bones was noticed only in group 2 compared to control. Specifically, the abnormalities were observed in the thoracic and sacral centrae. Similarly, group 2 was associated with fewer ossified centers in vertebral arch compared to control. The abnormal ossifications were observed in sacral and coccygeal bones. The only observed abnormality in vertebral ossification in group 1 was in coccygeal arch, compared to control. Conclusions: Prenatal administration of melamine caused dose-dependent retardation in bone ossification, which mainly affected the sternum, metacarpal, vertebral centraee and arch.

Hypertension, if not appropriately treated, is associated with life-threatening complications. This study evaluated antihypertensive prescribing patterns in older adults (≥ 65 years) versus young adults based on the current guidelines with an emphasis on the use of dual single-pill combinations (SPCs). A nationwide audit of 8746 primary care prescriptions of hypertensive patients with comorbidities in Bahrain was performed. Antihypertensive combination therapy was prescribed more often to older (77.1%) than young adults (68.6%; P < 0.0001) whereas SPCs were under-used (57.6% vs. 69.4%; P < 0.0001). Recommended dual SPCs, without/with a combination of a free-dose complementary antihypertensive agent, were significantly less often prescribed for the older adult as compared to young adult adults (45.1% vs. 62.99% and 35.97% vs. 46.72%; P < 0.0001), respectively. Unacceptable two- and three-drug combinations (including those with limited clinical evidence and unacceptable ones) were prescribed more often to older adults rather than to young ones (20.06% vs. 12.6%; and 56.5% vs. 46.8%; P < 0.0001), respectively. In both age groups, the top-three antihypertensive classes prescribed as monotherapy were angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β blockers. The updated guidelines for hypertension treatment in older adults have had a limited impact on primary care practice in Bahrain. In both age groups, there was a high positive correlation between the number of antihypertensive drugs prescribed and prescribing unacceptable combinations. Unacceptable combinations comprising SPC-related antihypertensive therapy duplication were more common than those reported elsewhere. Introducing approved triple SPCs may discourage prescribing unacceptable antihypertensive drugs and their combinations that lack robust evidence.

Objectives: The aims of this study were to evaluate: (1) the prevalence and types of potentially inappropriate prescribing in older adults with hypertension or diabetes mellitus and hypertension, and (2) whether or not differences in the training of primary care physicians were associated with potentially inappropriate prescribing. Materials and Methods: Primary care prescriptions issued by family physicians and general practitioners were audited using Screening Tool of Older Persons’ Prescriptions criteria (version 1), with 18 out of 65 applicable criteria. Descriptive statistics were used to test the difference between proportions, and two-tailed t test was used for continuous variables. Results: A total of 2,090 outpatient prescriptions were written during the study period; of these, 712 (34.1%) were potentially inappropriate. The mean number of drugs per patient was 6.03 (±2.5). Of the 712 prescriptions, 543 (76.3%) were used for the treatment of acute medical illnesses. The most common examples of potentially inappropriate prescribing were: orphenadrine (n = 174; 8.33%), long-term nonsteroidal anti-inflammatory drugs for > 3 months (n = 150; 7.18%), proton pump inhibitors for > 8 weeks (n = 135; 6.46%), antihypertensive therapy duplication (n = 59; 2.82%), long-acting glyburide (n = 48; 2.29%), and chlordiazepoxide for > 1 month (n = 44; 2.11%). Family physicians showed a greater tendency toward potentially inappropriate prescribing compared to general practitioners, but the difference was nonsignificant (n = 514 [34.75%] vs. n = 162 [31.3%]; p = 0.16). Conclusions: The prevalence of potentially inappropriate prescribing (i.e., 34.1%) was within the spectrum reported worldwide and unrelated to the training backgrounds of physicians. Most of the identified potentially inappropriate prescribing (76.3%) in older adults was associated with medications for acute medical illnesses and hence inappropriate polypharmacy should be discouraged.

AimsPrevious trials on the effectiveness of genotype‐guided warfarin dosing vs. conventional dosing have been inconclusive. We conducted a systematic review and meta‐analysis of randomized trials comparing genotype‐guided to conventional dosing strategies.MethodsPubMed and the Cochrane Library were searched up to 23 October 2017.ResultsA total of 76 and 94 entries were retrieved were retrieved from PubMed and the Cochrane Library, respectively. A total of 2626 subjects in the genotype‐guided dosing (mean age 63.3 ± 5.8 years; 46% male) and 2604 subjects in the conventional dosing (mean age 64.7 ± 6.1 years; 46% male) groups (mean follow‐up duration 64 days) from 18 trials were included. Compared with conventional dosing, genotype‐guided dosing significantly shortened the time to first therapeutic international normalized ratio (INR) (mean difference 2.6 days, standard error 0.3 days; P < 0.0001; I2 0%) and time to first stable INR (mean difference 5.9 days, standard error 2.0 days; P < 0.01; I2 94%). Genotype‐guided dosing also increased the time in therapeutic range (mean difference 3.1%, standard error 1.2%; P < 0.01; I2 80%) and reduced the risks of both excessive anticoagulation, defined as INR ≥4 [risk ratio (RR) 0.87; 95% confidence interval (CI) 0.78, 0.98; P < 0.05; I2: 0%), and bleeding (RR 0.82; 95% CI 0.69, 0.98; P < 0.05; I2 31%). No difference in thromboembolism (RR 0.84; 95% CI 0.56, 1.26; P = 0.40; I2 0%) or mortality (RR 1.16; 95% CI 0.46, 2.91; P = 0.76; I2 0%) was observed between the two groups.ConclusionsGenotype‐guided warfarin dosing offers better safety with less bleeding compared with conventional dosing strategies. No significant benefit on thromboembolism or mortality was evident.

Aim Several drugs have been used for treating non-alcoholic fatty liver disease (NAFLD). The present study is a network meta-analysis of such drugs. Design, setting and patients Randomised clinical trials comparing drug interventions in patients with NAFLD were analysed. OR and weighted mean difference (95 % CI) were the effect estimates for categorical and numerical outcomes, respectively. Random-effects model was used to generate pooled estimates. Surface under the cumulative ranking curve was used to rank the treatments. Main outcome measures Proportion of responders was the primary outcome measure and non-alcoholic steatohepatitis scores, liver enzymes, lipid profile, body mass index, homeostatic model assessment of insulin resistance, intrahepatic fat and adverse events were the key secondary outcomes. Results 116 studies were included in the systematic review and 106 in the meta-analysis. Elafibranor, gemfibrozil, metadoxine, obeticholic acid, pentoxifylline, pioglitazone, probiotics, telmisartan, vildagliptin and vitamin E significantly increased the response rate than standard of care. Various other drugs were observed to modify the secondary outcomes favourably. Probiotics was found with a better response in children; and elafibranor, obeticholic acid, pentoxifylline and pioglitazone in patients with type 2 diabetes mellitus. The quality of evidence observed was either low or very low. Conclusion In patients with NAFLD, several drugs have been shown to have variable therapeutic benefit. However, the estimates and the inferences should be considered with extreme caution as it might change with the advent of future head-to-head clinical trials.

Dissemination of misleading drug information through social media can be detrimental to the health of the public. This study, carried out in Bahrain, evaluated the truthfulness of 22 social media claims about drugs (72.7%), dietary supplements (22.7%), and toxic bisphenol-A (4.5%). They circulated on WhatsApp platform, as case studies. We categorized claims as objectively true, false, or potentially misleading. The content analysis revealed that “potentially misleading” claims were the most frequent messages (59.1%). They tend to exaggerate the efficacy or safety without sufficient evidence to substantiate claims. False claims (27.3%) were likely due to unfair competition or deception. Overall, 13.6% of the messages were objectively true claims that could withstand regulatory scrutiny. Majority of the drug-related messages on social media were potentially misleading or false claims that lacked credible evidence to support them. In the public interest, regulatory authorities should monitor such information disseminated via social media platforms.

AIMS Several antihypertensive drugs are used in the treatment of severe hypertension in pregnancy. The present study is a network meta-analysis comparing the efficacy and safety of these drugs. METHODS Electronic databases were searched for randomized clinical trials comparing drugs used in the treatment of severe hypertension in pregnancy. The number of women achieving the target blood pressure (BP) was the primary outcome. Doses required and time taken for achieving the target BP, failure rate, and incidences of maternal tachycardia, palpitation, hypotension, headache, and neonatal death and stillbirth were the secondary outcomes. Mixed treatment comparison pooled estimates were generated using a random-effects model. Odds ratios for the categorical and mean difference for the numerical outcomes were the effect estimates. RESULTS Fifty-one studies were included in the systematic review and 46 in the meta-analysis. No significant differences in the number of patients achieving target BP was observed between any of the drugs. Diazoxide [- 15 (- 20.6, - 9.4)], nicardipine [- 11.8 (- 22.3, - 1.2)], nifedipine/celastrol [- 19.3 (- 27.4, - 11.1)], nifedipine/vitamin D [- 17.1 (- 25.7, - 9.7)], nifedipine/resveratrol [- 13.9 (- 22.6, - 5.2)] and glyceryl trinitrate [- 33.8 (- 36.7, - 31)] were observed to achieve the target BP (in minutes) more rapidly than hydralazine. Nifedipine required fewer doses than hydralazine for achieving the target BP. Glyceryl trinitrate and labetalol were associated with fewer incidences of tachycardia and palpitation respectively than hydralazine. Trial sequential analysis concluded adequate evidence for hydralazine and nifedipine compared with labetalol. Moderate quality of evidence was observed for direct comparison estimate between labetalol and hydralazine but was either low or very low for other comparisons. CONCLUSION The present evidence suggests similar efficacy between nifedipine, hydralazine and labetalol in the treatment of severe hypertension in pregnancy. Subtle differences may exist in their safety profile. The evidence is inadequate for other drugs.