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Background and Objective: Glucose-Potassium Ratio (GPR) has emerged as a biomarker in several pathophysiological conditions. However, the association between GPR and long-term outcomes in stroke patients has not been investigated. Our study evaluated the applicability of baseline GPR as a predictive prognostic tool for clinical outcomes in ischemic stroke patients., Methods: The multicenter retrospective cohort study included acute-subacute adult ischemic stroke patients who had their baseline serum GPR levels measured. Eligible patients were categorized into two sub-cohorts based on the baseline GPR levels (<1.67 vs. ≥ 1.67). The primary outcome was the incidence of 30-day hemorrhagic transformation, while stroke recurrence, and all-cause mortality within twelve months, were considered secondary., Results: Among 4083 patients screened, 1047 were included in the current study. In comparison with GPR < 1.67 group, patients with ≥ 1.67 GPR had a significantly higher ratio of all-cause mortality within twelve months (aHR 2.07 [95 % CI 1.21-3.75] p  = 0.01), and higher ratio of 30-day hemorrhagic transformation but failed to reach the statistical significance (aHR 1.60 [95 % CI 0.95-2.79], p  = 0.08)., Conclusion: Overall, baseline GPR serum is an independent predictor of all-cause mortality within twelve months in patients with acute and subacute ischemic stroke. Further clinical studies are necessary to validate these findings., (© 2024 The Author(s).)

Background The term "diverticula" refers to the existence of diverticula in the gastrointestinal tract but is mainly located in the sigmoid colon and is used to describe colonic diverticulosis. Diverticula, which are sac-like protrusions in the wall of the large bowel, are becoming more prevalent globally, in both developed and developing nations. This increase in occurrence is primarily attributed to changes in dietary and lifestyle patterns. Raising public awareness can potentially contribute to a decrease in the incidence of the disease and its associated complications. Aim This study aims to assess knowledge and awareness levels among the Saudi Arabian population regarding diverticulitis and its risk factors. Methods A descriptive cross-sectional study was conducted in Saudi Arabia between 1st January 2024 to 1st April 2024 using an online questionnaire for data collection. The target population consists of individuals who are between 18 years and 45, in Saudi Arabia without a history of diverticulitis. The study questionnaire covered participants' demographic (Western, Central, Southern, Eastern, Northern) regions, knowledge, awareness and practice of diverticulitis. Results A total of 548 eligible participants completed the study questionnaire, most of them (80.3%; 395) were from the Western region including Mecca, Medina and Jeddah. Participants' ages ranged from 18 to more than 40 years with a mean age of 30.5 ± 11.9 years old. A greater percentage (72.3%) of the participants were males compared to the percentage of females, which was 27.7%. The vast majority of the study participants had an inadequate knowledge level about diverticulitis (85.9%; 471) while only 31 (5.7%) had adequate knowledge and awareness about the disease. The most reported sources of information included study courses (6.4%), media (5.3%), and physicians (4.7%) while most respondents (83.6%) had no source. Conclusion In conclusion, aside from preventive strategies, the current study found that the public knew very little about diverticulitis, including its risk factors, clinical presentation, and diagnostic process. The two significant predictors of public awareness level were age and doctors as information sources., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Taha et al.)

This case report provides a detailed examination of a rare co-occurrence of Costello syndrome, euryblepharon, and Moyamoya syndrome in a 14-year-old female. Costello syndrome, a rare genetic disorder characterized by developmental delays, distinctive facial characteristics, and a predisposition to certain malignancies, presents an array of ocular manifestations, including downward-slanting palpebral fissures. A significant similarity is noted with euryblepharon, a rare periocular anomaly marked by the downward slanting of the eyelids. Despite these striking resemblances, the association between euryblepharon and Costello syndrome is yet to be documented in the literature. Furthermore, the coexistence of Costello syndrome and Moyamoya syndrome, a cerebrovascular disorder, is exceedingly rare. This report provides an in-depth analysis of the patient's ocular and periocular manifestations, establishing a potential association of euryblepharon within the phenotypic spectrum of Costello syndrome and documenting the unusual co-occurrence with Moyamoya syndrome. These findings aim to augment our understanding of Costello syndrome's phenotypic variability and potential associations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alhazmi et al.)

Primary systemic vasculitis can present with a wide spectrum of manifestations ranging from systemic non-specific features such as fever, malaise, arthralgia and myalgia to specific organ damage. We describe two cases of cholesterol embolisation syndrome and Kaposi sarcoma mimicking primary systemic vasculitis, both of which were characterised by features such as livedo reticularis , blue toe syndrome, a brown purpuric skin rash and positive perinuclear anti-neutrophil cytoplasmic antibodies associated with Kaposi sarcoma. Establishing the right diagnosis was challenging and thus this report aimed to highlight the possible ways to distinguish them from primary systemic vasculitis., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Introduction: Beta-blockers are proven to be safe and cost-effective agents in treating multiple dermatological conditions, which is why they are considered as an interesting and good alternative therapeutic agent by dermatologists. To our knowledge, there has been no comprehensive systematic review to date summarizing the role of both systemic and topical beta-blockers in dermatology., Methods: In this systematic review, we aim to review recent and relevant published literature in order to provide a comprehensive evidence-based summary to inform dermatologists., Results: An electronic-based literature search was carried out during October-December 2021 in the databases PubMed (MEDLINE), SCOPUS (EMBASE), and Cochrane Library. Furthermore, bibliographic sources were also reviewed for the selected articles. We followed The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We reviewed published literature about the role of beta-blockers in dermatology for the time period (January 2016 to December 2021)., Conclusions: A total of 126 publications were retrieved from different databases, of which 59 studies were finally included in our review after excluding non-eligible literature in accordance with our inclusion and exclusion criteria. The included articles consisted of meta-analyses, systematic reviews, clinical trials, retrospective and prospective cohort studies, case-control studies, case series, and case reports. In general, data in reviewed literature showed that both systemic and topical beta-blockers were reliable and safe therapeutic options in treating different dermatoses. Their effect has been studied as a mono-therapy, also as an adjuvant therapy combined with other current disease-specific therapeutic modalities such as lasers, radiation, chemotherapy, corticosteroids, or other beta-blockers options. Local and systemic adverse effects were mainly minor and non-significant., (© 2022. The Author(s).)

Headache is one of the most frequent complaints in the outpatient department. The types of headaches can be broadly classified into primary and secondary. The primary headaches have benign intrinsic causes and include tension, migraine, and cluster headaches. A detailed history and appropriate physical examination are essential in assessing patients with headaches.  We present the case of a 33-year-old woman who presented to our primary care clinic with three days history of worsening frontal headache. She had been experiencing this headache daily for the last three months; however, the current episode is more severe. The headache episode was not associated with fever, neck stiffness, or loss of consciousness. She often became nauseated with the headache. There was no history of weakness, numbness, or visual disturbances with the headache. There was no family history of migraine headaches. On examination, no focal neurological deficit was noted. The head CT scan showed the presence of two highly hyperdense foci in the frontotemporal region, one of them was related to the dura. Such foci were not causing midline shift or brain edema. The preliminary diagnosis was calcified meningioma. Surgical excision of the lesions was planned. The patient underwent right craniotomy under general anesthesia. The two osseous lesions were observed and successfully resected. Histopathological examination of the lesions was consistent with osteoma. Intracranial osteoma is a very rare benign neoplasm of the mature bone tissue. The typical clinical manifestation of intracranial osteoma is a chronic headache. Head CT shows a well-defined, hyperdense structure. However, this is often mistaken as calcified meningioma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Aldandan et al.)

With 14 million new infections each year, the human papillomavirus (HPV) is the most common sexually transmitted infection (STI) among both men and women in the United States (US). Infections with the human papillomavirus (HPV) are responsible for a considerable portion of the global cancer burden. HPV-related oral malignancies are on the rise around the world, according to epidemiological studies. To provide accurate advice to their patients, dental practitioners require thorough, up-to-date HPV-related knowledge. Methods. In this cross-sectional study, data were collected by the purposely constructed questionnaire. A questionnaire composed of the demographic items and items related to the awareness and knowledge about Human papillomavirus. The questionnaire was constructed after a series of discussions between the panel of experts. This panel was composed of a subject specialist, researcher, and language expert. The Cronbach alpha of the questionnaire was calculated. The study will be conducted in the Al Qunfudhah. Results. The Cronbach alpha of the questionnaire was 0.72. Out of a total of 550 respondents, with a mean (SD) age of 47.5 (11.5), the female respondents were 167 (30.4%) while male were 383 (69.6%). 20.5% of the respondents (out of 550) were having awareness of HPV. Implications. Knowledge of HPV-related oral cancer is critical, and it is advised to be taught as part of dental students' basic curriculum and clinical training. This problem can be solved by better educational training programs. Knowledge of HPV-related oral cancer is critical, and it is advised to be taught as part of dental students' basic curriculum and clinical training., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Ali Maeed Alshehri et al.)

Mature Cystic Ovarian Teratoma (MCOTs) are the most common benign ovarian neoplasms, representing around 20% of all ovarian neoplasms with middle age women representing the majority of patients. They usually include two germ cell layers being well differentiated and rarely they demonstrate malignant transformation with squamous cell carcinoma being the most common malignant transformation. In our case, we report an interesting case of a 45 years old lady who was unfortunate to have a MCOT with malignant degeneration and distant metastasis. We concluded that MCOT malignant degeneration is rare, however, if not caught early, mortality can be high. MCOT, Ovary, Small Bowel, Teratoma, Collision tumor., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Unhealthy lifestyles are a global concern. This study measured the prevalence and factors associated with an unhealthy lifestyle in Riyadh city, Saudi Arabia., Methods: An interview-based, cross-sectional study was conducted with 968 males and 2029 females, aged 30-75 years, covering 18 primary health care centers in Riyadh. Multivariate logistic regression analyses were conducted to identify the significant determinants associated with an unhealthy lifestyle., Results: Overall, men were 1.49 (1.28, 1.74) times at higher risk of an unhealthy lifestyle compared to women. Men reporting unhealthy lifestyle were 2.1 (1.3, 3.4) and 1.5 (1.0, 2.6) times more likely than men with healthy lifestyle to cite not enjoying physical activity, lack of social support, and not having enough information about a healthy diet [1.5 (1.0, 2.0)], whereas those ≥ 45 years age group were 30 times less likely to report unhealthy lifestyle [0.7 (0.5, 0.9)]. In contrast, in women aged ≥ 45 years [1.3 (1.1, 1.7)], lack of motivation [1.3 (1.1, 1.7)], feeling conscious while exercising [2.0 (1.4, 2.9)], not enjoying healthy food [1.6 (1.3, 2.1)], and no family support to prepare healthy food [1.4 (1.1, 1.8)] were significantly associated with an unhealthy lifestyle., Conclusions: In a Saudi sample, younger men and older women are at higher risk of an unhealthy lifestyle. In addition to self-motivation, combined strategies to promote physical activity and healthy eating are required to improve lifestyle.

Endometriosis is the ectopic presence of endometrial tissue outside of the uterus. Bladder involvement of these lesions is not uncommon and has been reported and studied extensively. Mullerianosis is a term that describes the ectopic presence of tissues from the endocervix and endosalpinx in extrauterine sites. Only a few cases of Mullerianosis involving the urinary tract system have been reported in literature. We report a case of a 32-year-old lady with bladder mass and periodic hematuria and dysuria. She underwent TURBT 1 and on histopathology was found to have bladder Mullerianosis. Patient was later treated with oral contraceptives with improvement., (© 2020 Published by Elsevier Inc.)

Background: Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful., Aim: The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures., Methods: We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability., Results: A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00)., Conclusion: Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Abdulmajeed Alajlan et al.)

Background: Breast cancer is having a major impact on women's health worldwide. Early detection is the best defense against the associated morbidity and mortality of the disease., Objectives: To assess the level of mammography uptake among working Saudi women and identify the obstacles and barriers that negatively affect it. In addition, to identify the most effective sources of breast-cancer-related information and early detection screening., Method: We conducted a cross-sectional study of women employees of King Saud University aged 40 years and above on March-May 2015 using a self-report questionnaire., Results: A total of 229 participants were recruited from the female staff of King Saud University. Of the participants, 34% were aged 41 years or above, approximately 66% were married, 53.3% had a bachelor's degree, and 61.1% worked as administrators; further, 64.6% had a history of breastfeeding. The rate of mammography uptake was 51.5%. Univariate logistic regression indicated that age, education, and being single predict the rate of mammography uptake. However, multivariate logistic regression indicated that earlier age significantly predicts a higher risk of a low rate of mammography uptake. The main obstacle negatively affecting mammography uptake was ineligible criteria (21.8%). The main sources of information regarding breast cancer were awareness campaigns and television and radio (45.4% and 43.7%, respectively)., Conclusion: The participants' rate of mammography uptake, awareness of mammograms, the risk factors, and signs of breast cancer were low. To improve breast-cancer mortality rates in Saudi Arabia, earlier detection of breast cancer through increasing awareness of mammograms is of paramount importance., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Background: Acute respiratory tract infections are the most common causes of both morbidity and mortality worldwid, and the management and prevention of acute respiratory infections is a global problem, especially in developing countries. This study sought to assess the community's compliance and practice of measures for the prevention of respiratory infections and discover their source of health information., Materials and Methods: A cross-sectional study was carried out in the five biggest shopping malls in Riyadh city in July 2014. The required sample size was 980 persons aged 15 or older, with 196 from each of the five biggest shopping malls from each of the five geographic areas of Riyadh. Data was collected by face-to-face interview using standardised questionnaire, and analyzed using SPSS., Results: Overall, 48.3% of the participants thought that they were susceptible to any of the respiratory infections of pandemic influenza; 59.7% always washed their hands with water and soap and 34.8% used antibacterial soap. About 29% reported avoiding touching their eyes, noses, and mouths directly with their hands; 63.5% covered their noses and mouths with tissue paper when sneezing or coughing. A substantial number said they "never" shared their personal stuff, including towels (70.5%) and utensils (49.0%) with others. Only 21.2% avoided crowded places or wore a mask (9.1%) in such a situation. A high proportion (62.8%) did not take the seasonal flu vaccine. The most common sources of health information included television/radio (47.9%), social media (29.4%), and friends/family (28.1%)., Conclusions: Health authorities should seize every opportunity to prevent respiratory infections by adopting all evidence-based infection control measures to improve public awareness, attitude, and practice., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Family and Community Medicine.)

Objectives: To develop a staging system that could better reflect symptoms by the spurs quantification in the fossa and joint space narrowing using computed tomography (CT) for elbow arthritis and to evaluate its reproducibility with multiple readers., Methods: This retrospective study evaluated 81 cases of primary elbow osteoarthritis using both plain radiography and CT. Qualitative and quantitative analyses were independently performed by four orthopedic surgeons using previous and newly proposed staging systems. The reproducibility of the new system was analyzed with intraclass correlation coefficients (ICC). Correlations between symptoms and radiologic classification were assessed using Pearson's correlation coefficient (PCC)., Results: The interobserver agreement (1) and intraobserver agreement (2) among the four evaluators was present by ICC. (1) The system of Hastings and Rettig [first observation, 0.544 (95% confidence interval (CI), 0.436-0.649); second observation, 0.582 (95% CI, 0.478-0.682)] and Broberg and Morrey's staging system [first observation, 0.620 (95% CI, 0.521-0.714); second observation, 0.656 (95% CI, 0.562-0.743)] showed substantial and moderate retrospective agreement, whereas the CT-based staging system showed almost perfect agreement [first observation, 0.867 (95% CI, 0.820-0.906); second observation, 0.909 (95% CI, 0.875-0.936)]. (2) The intraobserver agreement was almost perfect in the Brogerg and Morrey's and CT-based staging systems. CT-based staging showed high correlation with visual analogue scale (PCC 0.754, P < 0.001) and Mayo elbow performance score (PCC -0.614, P < 0.001) and moderate correlation with range of motion (PCC -0.458, P < 0.001)., Conclusions: CT-based staging system was highly reproducible and clinically feasible than previous plain radiograph-based staging systems., (Copyright © 2019 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Case: We report a patient with osteoarthritis of the shoulder joint who underwent reverse shoulder arthroplasty and showed anatomical variation in the subscapularis muscle (SM). A variation of the rotator cuff originating from the anteroinferior aspect of the glenoid was separated from the SM by a septum and was named infraglenoid muscle (IGM)., Conclusion: We suggest that the IGM may serve as an additional dynamic stabilizer for external rotation. Studying this particular muscular variation would lead to better understanding of the anatomical structures around the glenoid cavity.

Objectives: To determine the prevalence, predictors, triggers and educational outcome of migraine among medical students and interns in King Abdulaziz University, Jeddah, Saudi Arabia., Methods: A cross-sectional study was completed among 566 participants selected through a multistage stratified random sample method. A validated, confidential, self-administered data collection sheet was utilized. It contained ID Migraine test™, Numeric Pain Rating Scale (NPRS). Questions about possible predictors, triggers and impact of migraine were asked. Descriptive, inferential statistics and multiple logistic regression analysis were conducted., Results: More than one-half (54.9%) of the participants had ≥ 2 headache attacks during the three months preceded the study. The prevalence of migraine was 26.3%, and 41.6% of the cases suffered from severe pain. The main migraine predictors were Functional Gastrointestinal Disorders (FGIDs), family history of migraine, female gender, and enrollment in the second academic year. Exam stress and sleep disturbances were the commonest triggers. The majority of the participants reported that their educational performance and ability to attend sessions were affected during migraine attacks., Conclusion: A relatively high prevalence of migraine was seen among our participants. FGIDs, gender and academic year were the predictors. Screening and management of migraine among medical students are required. Conduction of relaxation programs and stress management courses are also recommended., Competing Interests: Declaration of interest and funding: There is no conflict of interests and we had no fund.

Ionization of polymers in mass spectrometry is usually achieved by forming metal ion adducts. The metal ion has been shown by Wesdemiotis to often play a spectator role in the collision-induced dissociation (CID) chemistry of these species, wherein they fragment according to a free-radical mechanism similar to that found in their pyrolysis. The result is a predominance of low-mass ions in the CID mass spectrum. We have changed this behavior by generating protonated oligomers in the gas phase by first forming proton-bound complexes of the oligomers with amino acids or peptides by electrospray ionization. These complexes dissociate first by loss of the amino acid/peptide to form protonated oligomers, which then undergo a unique fragmentation chemistry. In this article we discuss the results for poly(methyl methacrylate) (PMMA) and poly(butyl acrylate) (PBA). Initially, protonated PMMA and PBA lose methanol and butanol, respectively, from the side chains of the respective monomers. The resulting PMMA-derived ion then undergoes a series of neutral losses corresponding to 32 and 28 Da, methanol and carbon monoxide. This continues as collision energy increases until a final, carbon-rich backbone ion is formed, which then undergoes a classic hydrocarbon fragmentation pattern. The PBA-derived ions are proposed to fragment by the loss of butylether molecules to form anhydride rings along the oligomer chain. The number of ether molecules lost corresponded to half the number of available side chains in the oligomer. The resulting poly-anhydride ion dissociates by small molecule loss. Mechanisms have been suggested for the fragmentation chemistry of these two classes of oligomers.

Electrospray ionization (ESI-MS) and matrix assisted laser desorption-ionization (MALDI-MS) were used to determine the composition (monomer ratios) and structure (end group analysis) relative to 1H NMR spectroscopy and theoretical predictions for three different copolymers: poly(butyl acrylate/vinyl acetate) (PBA/PVAc), poly(methyl methacrylate/vinyl acetate) (PMMA/PVAc) and poly(butyl acrylate/methyl methacrylate) (PBA/PMMA). We found that the ESI results were in excellent agreement with 1H NMR spectroscopy for PBA/PVAc and PBA/PMMA copolymers whereas there was more divergence in the case of PMMA/PVAc. In the case of PBA/PMMA copolymers similar distributions of products were observe by ESI-MS and MALDI-MS with the two major products classes differing by their end-groups. One class has hydrogen and dodecylthio end groups while in the other the dodecylthio has been replaced by alpha-cyanoisopropyl from the initiator. The relative abundance of these distributions as a function of copolymer conversion for a series of reaction conditions was investigated by both ESI and MALDI. MALDI results consistently underestimated (relative to ESI) the butylacrylate monomer ratio in PBA/PMMA and the abundance of co-polymer oligomers terminated by a dodecylthio group from the chain transfer agent.