Search

This study evaluates the prevalence of epilepsy within the Saudi population. A comprehensive computerized search of pertinent databases was carried out to find research that satisfied the requirements for inclusion. The search encompassed PubMed, SCOPUS, Science Direct, Cochrane Library, and Web of Science to find pertinent research. Our analysis included six studies with a total of 7408 Saudi participants. Females comprised the majority of the participants, totaling 6663 (89.9%). The prevalence of epilepsy among Saudi adults is underreported. Structural causes, such as cerebrovascular events and malignancies, were the most frequent etiologies, followed by genetic factors. A notable proportion of cases had an unknown cause. Gender-specific patterns were observed to show increased seizure severity in males whilst females showed age-specific vulnerability. This review emphasizes the complexity of epileptic conditions within the Saudi population, with diverse causes ranging from structural and genetic factors to strokes and head trauma. While males were more likely to experience severe seizures, females faced age-related vulnerability, pointing to the need for gender-sensitive treatment strategies. The lack of clear causes in nearly half of the cases further emphasizes the need for improved diagnostic approaches. However, the significant gap in prevalence studies within Saudi Arabia limits our understanding of the true burden of epilepsy in the region. Moving forward, comprehensive epidemiological studies focusing on prevalence and risk factors are crucial to inform public health strategies and improve outcomes for individuals living with epilepsy in Saudi Arabia., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alenazi et al.)

Toxoplasmosis is the most common space-occupying lesion in HIV-infected patients that typically presents as a space-occupying lesion in the supratentorial region, often manifesting as focal neurological deficits. Infratentorial toxoplasmosis is extremely rare, with a few reported cases in the literature. Here, we are reporting a 53-year-old healthy female presented with isolated single cerebellar toxoplasmosis as a first manifestation of HIV infection. The patient underwent suboccipital craniotomy and tumor excision, and the subsequent histopathological exam revealed toxoplasma protozoan. While cerebral toxoplasmosis is common in HIV-infected patients, cerebellar involvement is rare and requires prompt diagnosis for effective treatment. A high index of suspicion is emphasized to prompt early diagnosis and initiation of therapy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Turkistani et al.)

Non-gestational choriocarcinoma of the ovary is extremely rare and presents diagnostic and therapeutic challenges. Early recognition, appropriate surgical intervention, and adjuvant chemotherapy are essential for successful management. This case underscores the importance of considering choriocarcinoma in the differential diagnosis of ovarian tumors, especially in perimenopausal women with vascular mass. We present the case of a 47-year-old sexually active woman with a history of pelvic pain, diagnosed with non-gestational choriocarcinoma of the ovary. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with successful management using the bleomycin, etoposide, and platinum (BEP) regimen. This case highlights the importance of early detection and appropriate management of this rare entity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sait et al.)

Introduction:  Smokeless tobacco (SLT) stands out for its higher nicotine absorption and its role in preventable fatalities. The Global Adult Tobacco survey in Saudi Arabia revealed SLT usage, while past legislation restricted its use. Linking SLT consumption to oral cancer and oral mucosal ulcers, the study addresses its prevalence in head and neck malignancies., Methodology: This study is cross-sectional and includes adult users of SLT. Raosoft (Raosoft Inc., Seattle, WA) was used to calculate the sample size. The data was analyzed using SPSS software (IBM Corp., Armonk, NY)., Results: The research study investigated various sociodemographic characteristics and prevalence of SLT use among participants. All participants reported using SLT, with toombak (33.2%) and shamma (36.0%) being the most prevalent. Notably, reasons for initiating SLT included influence from peer pressure (33.6%), alternatives to smoking (32.0%), and influence from relatives (19.0%). While 75.1% intended to quit within a year, awareness of SLT's harmfulness varied: 40.3% believed it was less harmful than smoking, and 57.7% recognized its link to oral cancer. Additionally, 62.2% believed SLT could lead to dependence. Sociodemographic factors generally did not significantly affect awareness of SLT causing oral cancer., Conclusion: The findings indicate a significant prevalence of SLT use, with toombak and shamma being the most common types consumed. Awareness of the potential harm of SLT use in relation to oral cancer varied among participants, with a notable proportion misunderstanding its harmfulness compared to smoking tobacco., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharbi et al.)

Introduction Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal tumor of the gastrointestinal tract. The clinical presentation of GIST varies widely and ranges from being asymptomatic to being a life-threatening emergency in the form of gastrointestinal bleeding or bowel obstruction. Multiple prognostic factors have been identified for GIST, including, most importantly, larger tumor size (>5 cm), higher mitotic activity (>5 per 50 high-power fields), rupture of the mass, site of the mass, and personal history of GIST. Objective In this paper, we aim to study bleeding in gastrointestinal tumors as a predictor for morbidity and mortality and investigate possible factors influencing bleeding in GIST. Method A retrospective study design was used. Electronic medical records of 39 patients diagnosed with GIST in Prince Sultan Military Medical City in Riyadh between January 2015 and December 2020 were retrieved. Normal variables were presented as mean and standard deviation, while non-normal variables were presented as median and interquartile range. Student t-test or Mann-Whitney test was used to compare quantitative data when appropriate. The distribution of recurrence and survival was plotted with the Kaplan-Meier curve and compared between the two groups (bleeding and non-bleeding groups) with the log-rank test. Factors affecting recurrence and mortality were assessed using univariable Cox regression. Result A total of 39 cases of GIST tumors were included in this study. Patients were categorized according to the presentation into two groups: patients with no bleeding (n= 28) and those presented with bleeding (n= 11). The gender distribution was equal. The mean age was 58.14± 12.46 in patients with non-bleeding GIST and 58.18± 16.01 in patients with bleeding GIST. The most common location of GIST was the stomach (22 cases, 56%). Neither group had any significant differences regarding age (P-value = 0.993), gender (P-value = 0.648), tumor location (P-value = 0.057), size (P-value = 0.250), cluster of differentiation (CD) markers, histological types (P-value = 0.692), and shape (P-value = 0.079). There was no significant difference in recurrence between both groups (log-rank P = 0.972). There was no significant difference in survival between both groups (Log-rank P = 0.506). Conclusion We concluded that bleeding GIST was not a significant predictor for recurrence rate or higher mortality. This can help in the debate of whether bleeding GIST should be added as an independent factor in risk stratification. Despite that, further studies are needed to identify more variables that can add more accuracy to the pre-existing risk stratification systems., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alrashed et al.)

Introduction:  Spinal muscular atrophy (SMA) is an inherited, neuromuscular disease characterized by the deterioration of spinal motor neurons, causing progressive muscular atrophy and weakening. It is an autosomal recessive disease with the mutation of the survival motor neuron 1 (SMN1) gene as a hallmark. Evidence suggests that the SMN2 gene modulates the severity of the disease. SMA is classified based on the maximum motor function achieved. This study aims to describe the genetic makeup and characteristics of an SMA cohort in the Kingdom of Saudi Arabia (KSA)., Methods:  Data from families presenting with SMA children was collected between January 2018 and December 2020. Blood samples were collected from patients and family members. Genetic testing for SMA and mutations was performed at a European central lab., Results and Discussion:  Seventeen families were enrolled in the study, including 52 children. Among 34 parents, 28 were carriers with heterozygous deletion (82.3%), one (2.9%) had no deletion detected by multiplex ligation-dependent probe amplification (MLPA) but had point mutation by sequencing, one (2.9%) had homozygous deletion and was symptomatic, three (8.8%) had no deletion or point mutation and were presumed to have 2+0, and one (2.9%) was not tested., Conclusion:  This study provides insight into the carrier mutational analysis of families with SMA disease manifestations in KSA. Further studies are needed to understand the burden and impact of SMA among the Saudi population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alghamdi et al.)

Objective: Pulp canal calcification is a dental condition that is characterized by the deposition of mineralized tissue within the dental pulp space. While it is primarily a local phenomenon, recent studies have suggested a potential link between pulp calcification and systemic diseases. This study aimed to determine the correlation between certain systemic diseases, medications, and the presence of pulp canal calcification. Second, it aimed to estimate the prevalence of pulp calcification in the smoker population., Methods: A pair-matched case-control observational study was conducted from June 2022 to June 2023 at the Faculty of Dentistry, King Abdulaziz University. Digital periapical and bitewing radiographs were used for case-based sampling. Patients were categorized into two study groups: the cases group (n=100), consisting of patients with pulp canal calcification including either pulp stone, pulp canal obliteration, or both. Whereas the control group (n=100), consisted of patients without pulp canal calcification. Detailed medical histories were obtained to identify the presence of systemic diseases. Additionally, systemic medications and smoking status were documented., Result: The participants were divided into two groups; cases (n=100), diagnosed with teeth calcifications and confirmed by radiographic examination, and controls (n=100), showing no evidence of teeth calcifications. Among the patients in the calcification group, 26% had a history of systemic disease compared to 17% in the control non-calcification group with no significant difference between both groups. No correlation between certain medications and pulp canal calcification. Smoking did not demonstrate a statistically significant association with teeth calcifications (p > 0.05)., Conclusion: Pulp calcification on routine radiographic examination could indicate an underlying unnoticed systemic disorder that demands accurate referral and subsequent therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alamoudi et al.)

Background: Asthma control among asthmatic children still remains suboptimal. Saudi literature are scarce in this context, and there is a paucity of reports that compare asthma control level pre- and post-education program directed to asthmatic patients and their parents., Objectives: The objective of this study was to assess the impact of asthma education and flu vaccination on asthma control in asthmatic children in Madinah region from 2020 to 2021, in terms of ED visits, hospitalization, pediatric intensive care unit (PICU) admission, and asthma control level., Methods: A cross-sectional study was conducted at primary health care (PHC) centers in Al-Madinah City, Saudi Arabia. The study analyzed data from 804 asthmatic children patients from randomly selected six PHC centers. The data were collected by a valid structured questionnaire. The questionnaire included socio-demographic and clinical data. Child asthma symptoms control was examined by the Childhood Asthma Control Test (C-ACT) for children aged 5-12 years, and the Test for Respiratory and Asthma Control in Kids (TRACK) for children less than five years of age. The collected data were analyzed using the appropriate statistical tests., Results: The mean age of the studied children was 6.1±3.0 (1-14 years), with 59.8% of them being males. There have been statistically significant reductions for asthmatic children in ED visits/month, hospitalization, and pediatric ICU admission/years in the post-education groups for all studied patients and patients

Human herpesvirus type 6 (HHV-6) is a DNA virus considered a member of the Herpesviridae family. HHV-6 is acquired early in life, when it may cause roseola infantum and nonspecific febrile illnesses which is usually a self-limiting disease before the age of two. Primary HHV-6 encephalitis and acute necrotizing encephalopathy (ANE) are rare diseases to occur in immunocompetent children. We describe an unusual case of HHV-6 encephalitis with mixed features of acute necrotizing encephalopathy and acute disseminated encephalomyelitis and contextualize it with a review of the literature on HHV-6 encephalitis in immunocompetent children. Although the incidence of primary HHV-6 encephalitis is rare in immunocompetent children, HHV-6 encephalitis associated with acute necrotizing encephalopathy is a devastating disease, highly fatal and neurologically damaging disease. Therefore, early testing and diagnosis are crucial as well as effective management of encephalitis with antiviral therapy is highly recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, AlQasim et al.)

Subependymal giant cell astrocytoma (SEGA) is the most common intracranial tumor in tuberous sclerosis (TS) patients. The tumor generally localizes in the proximity of Monro's foramen; as it grows, it subsequently causes hydrocephalus and increases intracranial pressure (ICP). However, acute symptoms of increased ICP due to intratumoral bleeding rarely manifest in SEGA patients. We present a 27-year-old male with TS who presented due to hemorrhagic complications of SEGA with intratumoral bleeding and vitreous orbital hemorrhage. We then conducted a systematic review with four databases (PubMed, Web of Science, Google Scholar, and Cochrane) to identify similar cases using the following keywords: "Subependymal giant cell astrocytoma," "Hemorrhage," "Haemorrhage," and "Bleeding." Our review identified 12 articles reporting 14 cases of hemorrhagic complications of SEGA in addition to our case report. The median age of diagnosis was 21 (range 5-79) years with unequal gender distribution (M:F ratio, 11:4). Headache was the most presented symptom, followed by hemiparesis, seizure, altered mental status, visual deterioration, and headache accompanied by seizure. TS was seen in most of the cases (80%). Gross total resection (GTR) was achieved in 53.5% of the patients. Regarding the clinical outcome, 66.7% had a good outcome, 20% died, and 13.3% had no report of their outcomes. No tumor recurrence was seen in the cases with a reported duration of follow-up. Catastrophic presentation of SEGA apoplexy is a rare occurrence. We present a case report with a systematic review and discuss SEGA apoplexy's possible pathophysiology and outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Turkistani et al.)

Lichen planus pigmentosus (LPP) is a rare variant of lichen planus. Due to the scarce number of patients diagnosed with LPP, there are no treatment guidelines. Multiple topical and oral agents are utilized in LPP with varying degrees of response. Isotretinoin has only been investigated in a case report and a single prospective pilot study for managing LPP. Herein, we report the efficacy, safety, and moderate improvement of LPP patients on isotretinoin 20 mg (0.25 mg/kg), topical adapalene gel, 4% hydroquinone cream, and topical sunscreen., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alghamdi et al.)

Respiratory disease caused by a mutant coronavirus variant has spread rapidly worldwide. According to reports, the COVID-19 version propagated at the end of 2019 and originated in Wuhan, China. On January 30, 2022, the World Health Organization declared the outbreak a Public Health Emergency of International Concern, and on March 11, 2020, the outbreak has declared a pandemic. The COVID-19 infection might appear with no symptoms, very few symptoms, or extremely severe symptoms We are the first to identify sudden sensorineural hearing loss (SSNHL) as a side effect in COVID-19 patients who have fully recovered from the illness. Additionally, all reported cases of this presentation have an unexplained unilateral left ear involvement. This article reviews the literature and four cases of COVID-19 patients with SSNHL. We present four cases of COVID-19 positivity that were verified by PCR analysis of nasopharyngeal swabs. After fully recovering from the infection, all patients developed acute sensorineural hearing loss on the left side. A deterioration in the hearing ability among COVID-19 survivors makes it possible that the problem persists long after their recovery from infection. To support such a claim, additional in-depth research is required. The current study, in our opinion, will contribute to an increase in understanding about COVID-19, promote awareness, and alert healthcare professionals to take into account and discuss any symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Altwairqi et al.)

Background This retrospective study evaluated the prevalence of untreated canals in root-canal-treated maxillary and mandibular posterior teeth and their association with apical periodontitis (AP) in a Saudi Arabian population. This study is based on a radiographic examination of scans taken using cone-beam computed tomography (CBCT). Methodology The study comprised CBCT scans obtained from 300 individuals (150 women and 150 men) aged 18 to 80 years. Images were evaluated for the presence of AP related to untreated canals of endodontically treated maxillary and mandibular posterior teeth. Disruption in the lamina dura surrounding the breadth of periodontal ligaments at the apical third of the roots was described as a periapical lesion. The outcomes were presented in the form of frequencies and percentages. To assess proportional differences, the chi-square test was performed, with the significance level set at ≤0.05. Results The overall percentage of untreated canals among endodontically treated teeth was 12.46%. The prevalence of untreated canals was the highest in maxillary second molars (38.1%) (p = 0.045). The prevalence of AP among teeth with untreated canals was 85.4%, with 88.5% in the maxilla (p = 0.0347) and 81.8% in the mandible (p = 0.010). Conclusions The prevalence of AP in root-canal-treated teeth with missed canals was high (85.4%), with most identified untreated canals in maxillary and mandibular first molars., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alnowailaty et al.)

Objectives: This retrospective study aimed to assess the prevalence of the C-shaped canal system in mandibular first and second molars in a Saudi Arabian population using cone-beam computed tomography (CBCT)., Materials and Methods: The sample included 300 CBCT images from adults aged 18 to 80 years (38.7 ± 17.9) (150 females and 150 males). All images were analyzed to detect the C-shaped root canal according to Fan's criteria. We also categorized our findings according to the gender and direction of the longitudinal groove. Data were reported as frequencies and percentages. The Chi-squared test was used to analyze proportional differences, with the significance level set at ≤0.05., Results: The C-shaped canals were observed in 146 mandibular first molars (24.33%) and 182 second molars (30.33%). Male patients had a significantly higher prevalence of C-shaped canals in mandibular second molars than females (P=0.003). The longitudinal groove was most typically detected on the root's lingual surface (53.35%)., Conclusion: The incidence of the C-shaped canal in a Saudi Arabian population was 27.33% in the mandibular molars. The longitudinal groove was mostly on the lingual surface. Males showed a higher prevalence of the C-shaped canal than females., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alnowailaty et al.)

Objective This retrospective study aimed to investigate the prevalence and location of the second mesiobuccal (MB2) canal in the mesiobuccal root of the maxillary first molar (MFM) and the maxillary second molar (MSM) through cone-beam computed tomography (CBCT) imaging. Methods One thousand two hundred CBCT images of the MFM and MSM were divided equally and analyzed. To standardize the methodology of MB2 detection, the observation and measurements were located at the pulpal floor by 1 mm apically. The distances between canals were calculated from the center point of the MB2 canal (PMB2) to the center point of both the first mesiobuccal canal (PMB1) and the palatal canal (PP). The data were provided in the form of frequencies and percentages. The chi-square test was used to analyze the differences among maxillary molars, while the significance level was set at 0.05. Results The prevalence of the MB2 canal in the MFM and MSM was 46.7% (p=0.020) and 17.7% (p=0.457), respectively. Additionally, the prevalence of the MB2 canal was more frequent in females. The average distance between PMB1 and PMB2 for MFM and MSM was 1.87±0.42 mm and 1.24±0.76 mm, respectively. Furthermore, the average distances of PMB2 and PP were 0.74±0.21 mm and 0.43±0.18 mm for MFM and MSM, respectively. Conclusion The MB2 canal was found in 386 (32.2%) of the maxillary molars. The Saudi people have a high possibility of discovering the MB2 canal. The CBCT is a useful and high-precision diagnostic tool not only for detecting but also for locating in vivo MB2 canal in the mesiobuccal root of maxillary molars., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alnowailaty et al.)

Kimura disease (KD) is a rare benign chronic inflammatory condition of unknown cause, usually affecting young men of the Asian race. It is frequently associated with nephrotic syndrome. In this report, we present an uncommon case of KD in a 40-year-old Saudi man with sickle cell disease who presented with swelling on the right side of his face. CT scan of the head and neck showed the asymmetrical appearance of both parotid glands: the right side appeared heterogeneously enlarged, with adjacent moderate-to-significant fat stranding. Histologically, hyperplastic changes in lymphoid tissue were observed. The patient underwent superficial parotidectomy and was then followed up till the healing of the surgical site with no complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alanazi et al.)

Objectives This study aimed to evaluate the biological and mechanical effect of different irrigation methods on the bond strength of Bioceramic (BC) sealer to root canal dentin walls. Material and Methods Forty-Five single-rooted teeth were decoronated and then prepared using rotary instrumentation. Teeth were randomly divided into three groups. Group 1: using the conventional syringe method; Group 2: using the ultrasonic (US) activation method; and Group 3: using the Nd:YAG laser activation method. The BC sealer (TotalFill ® BC Sealer™, FKG Dentaire, Switzerland) was used for obturation according to the manufacturer's recommendation. The bond strength was evaluated using the push-out test, and the adaptation of the sealer/dentin interface was assessed using Scanning Electron Microscope (SEM). Data were analyzed by Welch's ANOVA analysis of variance and Games-Howell for pairwise comparison. The level of statistical significance was set at 95% ( p -value ≤ 0.05). Results The push-out bond strength values of the Nd:YAG (6.46 ± 0.5) laser group were statistically significant than both conventional (3.33 ± 1.8) and US groups (4.21 ± 2.2). The mean gaps that were formed between the root walls and GP/BS sealer interface were statistically significant only between the Nd:YAG laser group (25.54 ± 13.8) compared to both conventional (62.00 ± 15.3) and US groups (58.82 ± 23.8) ( p ≤0.05). No significant difference was found between the conventional and US groups in both rested parameters ( p >0.05). Conclusion The method protocol of RC system irrigation affects the adhesion and bond strength of BS sealers to the root canal dentin walls., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Bogari et al.)

An alveolar cleft is the most common congenital bone defect. This systematic review aimed to investigate the use of stem cells for alveolar cleft repair and summarize the outcomes of clinical research studies. The electronic databases PubMed, Scopus, Web of Sciences, and Google Scholar were utilized to search the literature for relevant studies after administering specific inclusion and exclusion criteria. The search included articles that were published from 2011 to 2021 and specific keywords were used in the databases. The search was completed by two independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Only four studies satisfied both the inclusion and exclusion criteria and were included in this systematic review. These studies investigated different aspects of bone reconstruction in the maxillary alveolar bone by stem cells, including cell types, clinical applications, biomaterial scaffolds, and follow-up period. The accumulated evidence in this systematic review is limited and insufficient to support the role of stem cell use in bone regeneration of maxillary alveolar bone defects. The outcome of using stem cells was studied only in 57 subjects from the four included studies. Although the noninvasive methods of isolating stem cells make them attractive resources for bone regeneration, more research is required in order to standardize and investigate stem cell therapy. This should be done beforehand in adults in less invasive procedures such as bone defect repair in dentistry prior to considering this type of therapy in this vulnerable patient population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alfayez et al.)

Novel oral anti-androgens (NOAAs) represent a new class of drugs that are being approved for prostate cancer. However, fatigue and anemia are among the most common treatment-related symptoms. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the relative risks (RRs) of fatigue and anemia associated with NOAAs. PubMed, Cochrane, EMBASE, and abstracts presented at the annual meeting of the American Society of Clinical Oncology and European Society of Clinical Oncology were searched for phase III and V RCTs of NOAAs from January 2000 to March 2020. Safety profile from each selected study was evaluated for all-grade and high-grade fatigue and anemia adverse events. The RRs with 95% confidence intervals (95% CIs) were calculated using random-effects for all-grade and high-grade events. Our analysis involved 15 RCTs, including 16,795 patients. Overall, 9,177 patients were treated with NOAAs in the experimental arm, whereas 7,095 received a standard of care in the control arm. The RR of all-grade and high-grade fatigue was 1.26 (95% CI 1.15-1.38) and 1.24 (95% CI 0.83-1.84), and that of all-grade and high-grade anemia was 0.81 (95% CI 0.77-1.19) and 0.81 (95% CI 0.61-1.06), respectively. Our findings suggest that NOAAs are associated with an increased risk of fatigue but decreased risk of anemia. Patients should be frequently monitored to identify adverse events to improve oncological outcomes and optimize the overall treatment efficacy and safety. Not all the RCTs addressed fatigue and anemia simultaneously as side effects of NOAA treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Babkoor et al.)

Chemical debridement is considered one of the most important steps during root canal treatment to target unreached areas and provide thorough disinfection of the canals. The efficiency of this step efficiency can be increased using different agitation and irrigation techniques/devices. This comprehensive review aimed to summarize the effect of various irrigant activation and agitation techniques/devices on endodontic treatment outcomes. Using mechanical active irrigation, which enables the activation or agitation of the irrigating solution, is beneficial in root canal treatment by increasing the efficiency of delivering the irrigant up to working length and ensuring isthmus cleanliness. However, considerable variation was noticed between the protocols used in each technique with a lack of well-designed randomized clinical trials to focus on the long-term outcome. Moreover, a low level of evidence was noticed regarding the effectiveness of certain activation techniques over others. Therefore, each study needs to be carefully weighed before using its results and embracing its conclusion. Future studies need to focus more on the antimicrobial effect of each technique and its effect on the healing of apical periodontitis. Also, recent advances, such as multisonic and laser activation, are promising tools that need more clinical investigations to show their efficiency., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Tashkandi et al.)

Studies suggest that breastfeeding can help resolve skeletal and dental malocclusions. But there is no clear evidence that breastfeeding duration affects skeletal or dental malocclusions in pediatric patients. Therefore, the objective of this narrative review was to review all the available updated articles on the impact of breastfeeding and non-nutritive sucking behaviors in deciduous and mixed teeth on different forms of malocclusions. The following electronic databases were used PubMed, Scopus, Web of Science, and Google Scholar to obtain relevant data that met the eligibility criteria. The studies in this narrative review were covered the last 10 years. Primary research identified 368 papers. In addition, three articles were selected from the gray literature for consideration. On the basis of duplication, title, abstract, methodology and/or irrelevant information, 177 articles were removed. This narrative review was focused on seventeen articles that met the eligibility criteria. When it comes to deciduous and mixed teeth, breastfeeding appears to decrease the occurrence of skeletal class II, posterior crossbite, and malocclusion. There appears to be a favorable correlation between prolong duration of breastfeeding and risk reduction. To avoid bias in the results, more longitudinal study is warranted, with data collected prospectively on the duration of exclusive breastfeeding and non-nutritive sucking behaviors, using specific survey questions, and subsequent clinical investigation of the occlusal status at the deciduous, mixed, and permanent teeth stages., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Almahrul et al.)

Background and Objective: The melanocortin-4 (MC4) receptor has been evaluated as a possible new therapeutic for neuropathic pain treatment. The purpose of this review article was to review and evaluate all recent in vivo studies on the effect of the MC4 receptor antagonist HS014 on rat hypersensitivity caused by neuropathic pain., Methods: An electronic search was carried out using Scopus, Web of Science, PubMed, and Google Scholar. The following inclusion criteria were used: rat models of neuropathic pain-induced hypersensitivity, with investigated effects of the selective antagonist HS014. The included duration of the search was within the last ten years. Data regarding HS014, neuropathic pain model, post-treatment administration time and dose (days post-injury), behavior assessment assays, treatment frequency, and route of delivery were collected and subjected descriptively as complementary data in this narrative review., Results: This narrative review included four papers that fulfilled the eligibility criteria. The findings demonstrate that as compared to vehicle-treated rats, administration of the MC4 receptor antagonist HS014 remarkably raised paw withdrawal threshold (PWT) in three studies and heat withdrawal latency in four studies among rat models subjected to neuropathic pain., Conclusions: In rat neuropathic pain models, the MC4 receptor antagonist HS014 is helpful in reducing hypersensitivity. However, further studies are needed to determine the ideal treatment dosage and timing. In addition, further investigations are required for the role of this selective receptor antagonist (HS014) and compared with other types of MC4 receptors in neuropathic pain in humans., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Shikdar et al.)

Endodontic treatment failure may occur due to different causes such as persistence of bacteria, root canals that are poorly cleaned and obturated, improper coronal seal (leakage), and untreated canals (missed canals). The main reason for endodontic failure is the presence of some species of bacteria inside the root canal system such as Enterococcus (E.) faecalis. Those bacteria are more resistant to disinfection agents, causing a persistent intra-radicular or extra-radicular infection. The current review aims to compile all the current studies concerning Enterococcus faecalis as a dental root canal pathogen that causes endodontic failure. In this systemic review, two databases, PubMed and Google Scholar, were searched using specific inclusion and exclusion criteria. Among 2943 studies, only 11 met the inclusion criteria and were included in the review for further analysis. The 11 studies give prominence to the high distribution of Enterococcus faecalis within the root canal system. These studies investigated different aspects of Enterococcus faecalis, including its prevalence, resistance mechanisms, characteristics, express survival genes, and treatment. The compiled data observed that most of the studies highlight Enterococcus faecalis as the primary pathogen associated with endodontic treatment. It has characteristic proprieties that make it capable of escaping disinfection means. Furthermore, clinical trials are required to examine E. faecalis and may provide valuable information about novel microbial detection methods to decrease the number of E. faecalis within the root canal system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Alghamdi et al.)

Background: Surgical root canal retreatment is required when peri-radicular pathosis associated with endodontically treated teeth cannot be treated by non-surgical root canal therapy (retreatment), or when retreatment was ineffective, not feasible or contraindicated. Endodontic failures maybe happen when irritants remain within the confines of the root canal, or when an extra-radicular infection cannot be eradicated by orthograde root canal treatment. Following enhanced microsurgical techniques in the last years, the success rates of surgical root canal retreatment have improved considerably., Objective: The aim of this systematic review is to gather updated data in regard to the surgical root canal (retrograde) retreatment to heal the periapical lesions., Materials and Methods: The electronic databases PubMed and Google Scholar were searched in this review using specific inclusion and exclusion criteria. The search was performed in June 2019 and updated in November 2019. Among 3900 studies, 10 studies satisfied the eligibility criteria and were included in the review to be analyzed., Results: The 10 studies showed the importance of surgical root canal retreatment as a treatment option in removing infections within the root canal system and its efficiency in periapical tissue healing. These studies investigated different aspects of healing of periapical lesion after surgical (retrograde) retreatment including success rates, follow-up duration, and updated studies in surgical (retrograde) retreatment., Conclusions: Surgical root canal (retrograde) retreatment demonstrates its efficiency in reducing the period needed for healing of the periapical lesions in short-term follow-up compared to conventional orthograde retreatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Alghamdi et al.)

Inverted papilloma is an uncommon benign epithelial tumor that typically affects the nasal cavity and originates from the lateral sinonasal wall. Inverted papilloma occurring in the middle ear is an even more rare and aggressive condition. We describe a case of a 76-year-old man who was treated for isolated sinonasal inverted papilloma and after 20 months he was found to have a recurrence in the nasal cavity with middle ear involvement and malignant changes consistent with nonkeratinizing squamous cell carcinoma arising from inverted papilloma. Several surgical procedures were required to remove the tumor along with radiation therapy postoperatively., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Alghamdi et al.)

Aim: To explore the specialty preferences and the factors influencing them among pre-clerkship (second-year and third-year) medical students at Alfaisal University-College of Medicine, Riyadh, Saudi Arabia., Methods: An online, anonymous, cross-sectional, self-rating survey was administered. The survey explored socio-demographical data, specialty preferences and the factors influencing such preferences. A gender-wise statistical analysis was performed., Results: Two hundred fifty-two students participated in the survey (n=252/308; response rate: 81.8%). The three main specialties chosen by males were general surgery (33.1%), pediatrics (7.9%), and neurology-ophthalmology (5.5%). Females also opted for general surgery (20.8%) followed by dermatology (11.2%) and pediatrics (8.8%). Gender-wise specialty preferences were noted: general surgery (p<0.028) and anesthesiology (p<0.045) by males, whereas obstetrics & gynecology (p<0.017) and dermatology (p<0.005) by females. Overall, the three major influences in choosing a specialty were "specialty interest" (86.5%), "specialty flexibility" (64.3%), and "anticipated income" (61.9%). Statistically significant differences were noticed between genders regarding the following factors: "specialty prestige" (p<0.005) by males and "culture-no opposite gender patients" by females (p<0.009)., Conclusion: The overall two preferred specialties were general surgery (27%) and pediatrics (8.3%). Career counseling should be offered to students about each specialty's challenges/opportunities with an ultimate goal to match the country-specific demand and supply of physicians., Competing Interests: The authors have declared that no competing interests exist.