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This clinical report describes the prosthetic restoration of a failing dentition subsequent to methamphetamine abuse. The treatment involved the use of endosteal dental implants and milled cobalt-chromium, screw-retained, implant-supported fixed dental prostheses. At the 1-year follow-up, the prosthetic rehabilitation had markedly improved the patients’ health, esthetics, and function.

This clinical report describes the successful prosthetic rehabilitation of a deficient lower lip in an edentulous patient who had undergone surgery for removal of a squamous cell carcinoma of the anterior floor of the mouth and vestibule. The rehabilitation used a combined approach of an extraoral lip prosthesis joined by 3 magnets to an intraoral implant-retained mandibular resection prosthesis. The outcome demonstrated rehabilitation of the lower third of the face by eliminating loss of fluids and by improving the facial profile, lip contour and competence, esthetics, the patient's eating ability, speech intelligibility, and reported quality of life.

BackgroundThe rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU).MethodsThe SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations.ResultsThe SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. ConclusionThe SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

The Dental amalgam used in the dental fillings is basically an alloy of mercury (Hg). The amalgam is one of the most commonly used and versatile restorative material. Since more than 150 years this alloy of mercury, that is amalgam is used for it been economical, easy to use, durable, high strength and bacterio-static characteristics. Due to environmental pollution, detrimental health its use is decreasing in recent times. Also its not so appealing like the other materials used that resemble the tooth color. The tooth coloured restorative materials are recommended by both the doctor and the patient. Many researchers suggested that over the period of time the mercury from the filling might leach into the mouth. Thus in this study a detailed review of all the literature available online is done to understand the hazardous effects of dental amalgam fillings in the human body. The systematic literature search using Scopus, PubMed, EMBASE and Web of Science electronic databases was done using PRISMA. The experiments conducted in Sheep and monkey suggested the penetration of amalgam into the jaw bone of the patient with dental restorations. Constant exposure of mercury at lower levels can also lead to multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus. Most commonly reported renal dysfunction due to the dental amalgams are Tubular and Glomerular damage of the kidneys.

Favism is most common in those who have G6PD deficiency from the Mediterranean region. As hemolytic anaemia is the most common complication of G6PD deficiency, and it can be life-threatening in certain people. Infection, hyperglycemia, certain meals, and certain drugs can all cause hemolysis therefore, the most prevalent enzymopathy is glucose-6-phosphate dehydrogenase (G6PD) deficiency, which affects an estimated 400 million individuals, globally. Exposure to some medicines might cause hemolytic anaemia. The most important management technique is to avoid oxidative stresses by avoiding a hemolytic crisis. Also, avoidance of exposure to food and medicines that causes hemolytic anaemia episodes This review looks at etiology, epidemiology, pathopysiology, evaluation and management of the disease.

Objectives This study aimed to describe the incidence and spectrum of postoperative complications in infants who underwent their first cardiac surgery for the repair of congenital heart diseases. Methods This is a single-center retrospective study. Data of infants admitted to King Faisal Specialist Hospital & Research Center; Jeddah; Saudi Arabia, from January 2015 to December 2019 who underwent the first cardiac procedure for congenital heart disease at an age of less than 3 months, were analyzed. The primary outcome is the prevalence and spectrum of postoperative complications during hospitalization. Data were analyzed by using descriptive and analytical statistics using SAS software version 9.4. Results Data of 130 procedures were analyzed. The most frequent procedure performed was the Norwood procedure (31.5%), aortic coarctation repair (13.8%), arterial switch operation (13%), and Blalock-Taussig and central shunts (10%). The overall postprocedural complications were reported in 96 (73.8%) of the procedures. The most frequent complications were prolonged postoperative mechanical ventilation (27%), pleural effusion (21%), excessive bleeding (19%), cardiac arrest (18%), and systemic infections (18%). Conclusion Cardiac surgery for congenital heart disease in young infants has a substantial risk for postoperative complications. The high incidence of these complications in these cases makes necessary attention to prove the outcomes in the cardiac centers.

Background: Understanding the effect of accreditation on healthcare outputs and outcomes and the cost savings associated with accreditation is valuable for policymakers as well as hospitals facing the decision to commit potentially limited resources to the accreditation process. Literature reviews on the effects of accreditation on the quality of care do not deliver strong evidence due to limitations of the studies. Aim of the study: The aim of the current study is to determine the impact of the CBAHI accreditation on efficiency rate and patient's safety measures on three different hospitals in Makkah city. Subjects and Methods: A retrospective cohort research design was utilized to achieve the aim of the study. Data required for this study was obtained from available electronic medical records and quality management departments data base from three different hospitals in Makkah city that has different functions and sectors. Data which has been collected concerning bed occupancy rate, bed turnover rate, average length of stay and cancellation rate as variables to measure the efficiency rate in addition to rate of medication errors/ 1000 dispensed doses, rate of patient falls, mortality rate, hospital acquired pressure ulcer and surgical site infection as variables to measure the patients safety profile in the involved hospitals after getting the approval from the quality department seniors that those factors are reflecting both efficiency and patients safety status. Data was collected the data from January 2016 to March 2020 which has the data of 15 months before the accreditation, and we will compare it with the data of 36 months after the accreditation for the same variables and monitor the progression of those variables after accreditation. Results: No statistically significant differences were found related to efficiency rate and patient safety before and after CBAHI accreditation 2017. Also, no statistically significant differences found related to efficiency rate and patient safety before and after CBAHI reaccreditation 2020 except bed turnover rate. Conclusion: Research measuring the impact of CBAHI accreditation on efficiency rate and patient's safety measures using methodologically strong designs is lacking So, more rigorous designs are needed to establish causal links between the accreditation and outcomes.

Disseminated intravascular coagulation (DIC) is life threatening disease it’s often associated with sepsis, which require ICU management. In individuals with sepsis, the risk of DIC is especially high, DIC affects 30 to 50 percent of these individuals. Also it affects only about ten percent of patients with solid tumors, trauma, or obstetric emergencies. Hematological malignancies, aneurysms, and liver diseases can also cause the disease, the treatment for DIC focuses on resolving the underlying problem that led to this condition in the first place. As a result, antibiotics for severe sepsis, delivery in the case of placental abruption, and exploratory surgical intervention in the case of trauma are the pillars of DIC treatment, Patients with active bleeding or a high risk of bleeding, as well as those who require an invasive surgery, should consider platelet and plasma transfusions. Other anti-coagulant drugs can also be used. Prothrombin complex concentrates should only be administered in an emergency, due to their possible dangers. Recombinant human soluble thrombomodulin rhTM it was developed and licensed for clinical usage in Japan in 2008, and it’s one of the novel treatments for DIC. Anti-Xa agents, Synthetic protease inhibitors, and antithrombin are another options for treatment. In this article we will be making overview of the disease, it’s etiology an what’s the current management options.

Implant placement necessitates an interdisciplinary approach in which a team of dental implant specialists, including an oral surgeon, prosthodontist, periodontist, and oral radiologist, collaborate on the design, execution, and maintenance of the implants to provide the best possible result. According to the data, the vast majority of the participating dentists provide implant-supported restorations to their patients on a regular basis. Surprisingly, the percentage of dentists who plan implant placement and employ backward planning methods was significantly lower. This finding implies that dentists do not always follow the current scientific consensus that the placement of an implant should be based on prosthetic principles.

The severe acute respiratory syndrome coronavirus (SARS‐Cov‐2) resulting in the coronavirus disease 2019 (COVID‐19) is documented to have a negative psychosocial impact on patients. Home dialysis patients may be at risk of additional isolating factors affecting their mental health. The aim of this study is to describe levels of anxiety and quality of life during the COVID‐19 pandemic among home dialysis patients. This is a single‐centre survey of home dialysis patients in Toronto, Ontario. Surveys were sent to 98 home haemodialysis and 43 peritoneal dialysis patients. Validated instruments (Haemodialysis and Peritoneal Dialysis Treatment Satisfaction Questionnaire, Generalized Anxiety Disorder 7 Item [GAD7] Scale, Patient Health Questionnaire [PHQ‐9], Illness Intrusiveness Ratings Scale, Family APGAR Questionnaire and The Self Perceived Burden Scale) assessing well‐being were used. Forty of the 141 patients surveyed, participated in September 2020. The mean age was 53.1 ± 12.1 years, with 60% male, and 85% home haemodialysis, 80% of patients rated their satisfaction with dialysis at 8/10 or greater, 82% of respondents reported either “not at all” or “for several days” indicating frequency of anxiety and depressive symptoms, 79% said their illness minimally or moderately impacted their life, 76% of respondents were almost always satisfied with interactions with family members, 91% were never or sometimes worried about caregiver burden. Among our respondents, there was no indication of a negative psychosocial impact from the pandemic, despite the increased social isolation. Our data further supports the use of home dialysis as the optimal form of dialysis., SUMMARY AT A GLANCE This survey of home haemodialysis or peritoneal dialysis patients found no indication of a negative psychosocial impact from the COVID‐19 pandemic, despite the increased social isolation. Thus, patients who are able to practise dialysis at home and hence minimize infectious contacts do not experience high levels of psychosocial distress, adding to the paradigm of home dialysis as the optimal form of dialysis.

Background Many organizations have suggested a minimum standard regarding pharmaceutical counselling for patients, which includes information about the name of the drug, the description the drug, the indication for use, how to use it, the method of treatment, precautions, adverse reactions, and any contraindications. Correspondingly, the World Health Organization (WHO) has recommended that pharmacists spend at least 3 min with each patient to provide counselling. This study aimed to evaluate the counselling practices of community pharmacists for both over-the-counter (OTC) and prescription-only medicines in the Bisha Health Directorate, Saudi Arabia. Method This was a cross-sectional study designed to evaluate simulated patient visits to observe real counselling practices of community pharmacies in the Bisha area; 73 pharmacies were visited. Two scenarios were used in this study. The first scenario was for a prescription-only medicine, and the second scenario was for an OTC medicine. The duration of counselling was recorded for every visit. Results A total of 105 visits to the 73 pharmacies were conducted under the following scenarios: scenario 1 = 73 visits and scenario 2 = 32 visits. The average time for the simulation was 110 s for scenario 1 and 73.4 s for scenario 2. There was a statistically significant negative correlation between the duration of counselling and patient simulation visits that occurred in the morning (Spearman’s rho = − 0.396, p = 0.001). Conclusion It was shown that patient counselling needs to be given greater emphasis in community pharmacies. In this study, the time spent for patient counselling failed to meet the minimum WHO standard. Thus, pharmacists must be encouraged to spend at least 3 min on patient counselling.

Free-floating thrombus (FFT) of the cervicocranial arteries is a rare neurovascular condition. Up to now, there is no standardized definition for FFT. Therefore, FFT is occasionally mistaken for intraluminal thrombus (ILT) or smooth mural thrombus. The most precise and ideal definition of FFT would be a long-extended intraarterial thrombus that is attached to the arterial wall with its one end, while its other end is surrounded by blood flow and moves freely with the cardiac cycle. FFT usually manifests as an ischemic stroke, thus it is considered as an emergency case. Herein, we report a rare case of symptomatic FFT in the left vertebral artery extending from V0 to V2 segments in a middle-aged smoker, who presented with multiple embolic strokes in different territories of posterior circulation and was successfully treated medically. This case sheds light on the challenges of the clinical approach of FFT in the vertebral artery and it is an attempt to draw attention to the necessity of conducting a large-scale study to find out the ideal approach to manage such conditions.

Background Severe acute respiratory syndrome coronavirus (SARS-CoV-2) due to novel coronavirus disease 2019 (COVID-19) has led to an unprecedented worldwide pandemic with diverse respiratory symptoms as well as systemic manifestations and complications. The neurological manifestations of COVID-19 include, but are not limited to, headache, cerebrovascular disease, and skeletal muscle injury. Case report Herein, we present a case of stroke with large vessel occlusion in a middle-aged man, who recently recovered from severe SARS-CoV-2 infection. This patient is not known to have any medical illness or surgical history and has no cerebrovascular risk factors. Moreover, the patient underwent extensive investigations, including neuroimaging, cardiac and laboratory work-up with no evidence of stroke etiology. Conclusion The mechanism of cerebrovascular events in the setting of COVID-19 is still uncertain and probably multi-factorial. The prevailing hypothesis is a strong thrombotic tendency, which may even be prolonged after complete recovery. In our patient's case, hypercoagulability in the context of viral infection is the most likely mechanism for the stroke. Further studies are needed to find out the exact pathogenesis of thromboembolic events in the setting of COVID-19 infection as well as the efficacy, safety, dosage, and duration of anticoagulants in such conditions.

Worldwide energy requirements demand the functioning and formulating of thermal mechanisms and heat exchangers for the use and resuscitation of thermal energy. As a result, new heat transport liqui...

OBJECTIVES To assess the sex hormone levels in young Saudi female migraineurs during a migraine attack and during pain-free periods and compare them with control subjects. METHODS A case-control study involving 14 Saudi female migraineurs and 21 control subjects was conducted between December 2019 and March 2020. Demographic and disease history data were collected through participant interviews. Blood samples were drawn during the migraine attack and pain-free periods. RESULTS Follicular (30.00±19.60; p

This study discusses the role of government in community economic empowerment through Baitul Mal in Aceh. This study aims to contribute to the government on social issues such as poverty and underdevelopment. The method used in this study is qualitative research with data collection techniques, namely the study of literature. While the theory used is structural functionalism theory. Research findings from the discussion and analysis above that the Government of Aceh through Baitul Mal has played a role in empowering the economic community in Aceh in the form of productive Zakat, Infaq and Shadaqah. The government through Baitul Mal has carried out programs (a) providing business capital to the people who have their businesses to develop their businesses, both in the agriculture, animal husbandry, industrial, and trade sectors, (b) providing assistance in working tools, in the form of motorized pedicabs, and the tools needed in the agriculture, animal husbandry, trading, and industrial sectors that support their businesses, and (c) human resource development through skills training and skills to the community. This community economic empowerment program clearly contributes to social problems such as poverty, under development and access to education.

Purpose: Our study aimed to evaluate the effect of COVID-19 on pediatric urology practice in the Kingdom of Saudi Arabia (KSA). Methods: Data of 10 tertiary hospitals in KSA were retrospectively analyzed. Data of outpatient department (OPD) visits and pediatric urology surgical procedures from January 1, 2019, to April 30, 2019, and from January 1, 2020, to April 30, 2020, were extracted. The primary outcome was to compare OPD visits and pediatric urology workload in the first third of 2020 versus 2019, where there was no curfew. The secondary outcome was to compare the same variables during the full curfew time, i.e., April 2020 versus April 2019. Results: The number of OPD visits was lower in the first third of 2020 (7390 vs. 10,379 in 2019 P < 0.001). OPD visits in April 2020 were 78.6% lower than in April 2019, and teleclinics represented 850 (94.3%). Elective procedures in the first third of 2020 were 688, with a reduction rate of 34.3% compared to the same period of 2019 (P < 0.001). In April 2020, there were 18 elective surgeries, with a 91.4% decrease than in April 2019. Ureteric reimplantation, hypospadias, cryptorchidism, and circumcision stopped, while pyeloplasty (n = 14) and urolithiasis (n = 4) procedures had declined by 50% and 76.5%, respectively. Most of the procedures (71.8%) were day surgery. Emergency procedures were similar in the first third of 2020 (65 vs. 64 in 2019, P = 0.994) and declined in April 2020 by 6.7% versus April 2019. During the full curfew, the most common emergency intervention were cases with obstructive uropathy (42.8%), followed by torsion testis (28.6%), posterior urethral valve (14.3%), and urological trauma (14.3%). Conclusions: In KSA, the number of elective pediatric surgical procedures were reduced by >90%, while the number of emergency pediatric surgical procdures were similar during COVID-19 pandemic compared with non-COVID-19 time. Ureteric reimplantation, hypospadias repair, cryptorchidism, and circumcision procedures were postponed. Pyeloplasty and urolithiasis-related procedures were performed to prevent irreversible disease progression or organ damage. There was an increase in rate of teleclinic and day surgery to reduce the risk of COVID-19 infection.

Objective The American Joint Committee on Cancer tumor node metastasis (TNM) staging system eighth edition (TNM-8) for differentiated thyroid cancer (DTC) has been introduced as a replacement for tumor node metastasis staging system seventh edition (TNM-7). We present the first study from a Middle Eastern population comparing these 2 versions of the TNM staging system. Methods We compared TNM-8 with TNM-7 in 701 patients with DTC seen during a 3-year period with a median age of 37 years (6-83) and a female-to-male ratio of 558 (79.6%) to 143 (20.4%). Results The number (%) of patients within each stage in TNM-7 and TNM-8, respectively, are as follows: stage I = 503 (71.6%) and 583 (83.2%), stage II = 52 (7.4%) and 81 (11.4%), stage III = 53 (7.6%) and 6 (0.9%), and stage IV = 93 (13.2%) and 31 (4.6%). Overall, 172 patients (24.5%) were downstaged in TNM-8 compared to that in TNM-7, as follows: 26, 30, and 24 patients from stages II, III, and IV in TNM-7 to stage I in TNM-8; 23 and 32 patients from TNM-7 stages III and IV to TNM-8 stage II; 6 patients from stage IVa in TNM-7 to stage III in TNM-8; and 31 patients from stage IVc in TNM-7 to stage IVb in TNM-8. TNM-7 and TNM-8 predicted the long-term outcome well (median follow-up, 7.9 years), but Kaplan-Meier analysis showed better separation of cancer-specific survival in TNM-8 compared to TNM-7. Conclusions Compared with TNM-7, TNM-8 approximately downstaged a quarter of DTC patients and was more robust in separating the outcome of different stages over time.

الملخص: أهداف البحث: دراسة العلاقة بين مقدار معامل زاوية ''كوب'' ومختلف كثافات العظم لدى المرضى الإناث المصابات بجنف العمود الفقري لدى اليافعات في السعودية، وقياس مدى كثافة العظام في مختلف مناطق أجسامهن. طرق البحث: استخدم البحث نموذج دراسة مقطعية كمية بعدد مناسب من المشاركات. شملت العينة المدخلة ٥٤ مريضة بجنف العمود الفقري لدى اليافعات تراوحت أعمارهن بين ١٠-٢٠ عاما. تم تسجيل معامل زاوية كوب ودرجات ''زد'' في مقياس امتصاص الأشعة السينية ثنائي البواعث لكل من عظمة الفخذ وعظمة الفقرة القطنية، وتم جمعها بين الأعوام ٢٠٠٨-٢٠١٨. النتائج: من بين ٥٤ مريضة، ٤١ منهن كان معامل زاوية كوب لديهن يتراوح بين ٤٠°-٧٠°، و١٣ بمعامل زاوية كوب ٧٠° مقارنة بالمرضى اللاتي معامل زاوية كوب 70°. The mean lumbar bone, right femur, and left femur BMDs were markedly higher in those with Cobb angles ≤70° compared with BMDs in those with Cobb angles >70°. Of the group with Cobb angles ≤70°, six (14.6%) and nine (22.0%) exhibited low BMD according to their lumbar and femoral Z-scores, respectively. Of the group with Cobb angles >70°, eight (61.5%) and nine (69.2%) exhibited low BMD according to their lumbar and femoral Z-scores, respectively. Conclusions: Female AIS patients with greater higher Cobb angles exhibited a significantly higher frequency of low BMDs.

Background: HELLP is a potentially life-threatening conditions which has some similarity with preeclampsia therefore, it poses a challenging diagnostic and management issues for clinician. It is composed of H=hemolysis, EL=elevated liver enzymes and LP=low platelets. The aims of this study are to assess the prevalence of HELLP syndrome among Saudi Arabian, besides, assessing the risk factors related to it. Methodology: This is an analytical cross-sectional study conducted in kingdom of Saudi Arabia (female who previously get pregnant) from 07/08/2020 till 29/11/2020. The study was depending on using of online questionnaire assessing demographic factors including age and nationality besides disease-related information: Heart disease, Smoker patient, related risk factors of disease and DM patient. Results: We included 457 women who agreed to participate in the study and completed the questionnaire. 36.1% of participants were aged between 25-35 years. 13.3% of the sample had reported that they are smokers and 6.1% as X-smokers while 16.8% of the sample had diabetes mellitus. The prevalence of HELLP was 38.3%. It was found that age is not a significant factor in occurrence of HELLP symptoms except in having distribution of liver function (P=0.005). Cardiac diseases are another significant risk factor in developing symptoms of HELLP especially high blood pressure where 46% of patients with cardiac disease reported having high blood pressure during pregnancy with a risk of eight times over those with no cardiac disease (OR=8.03, 95% CI=4.2100 to 15.3, P=0.000) however, it has no significant effect on developing disturbance in liver function. Conclusion: we had found the 38.3% of females in Saudi Arabia had HELLP in their pregnancy, with increase the prevalence of some other conditions including smoking, diabetes mellitus, hypertension and autoimmune diseases which all found to increase the risk for developing HELLP in females. More investigation is needed to explore the same prevalence using hospital based study design.

Among health care professionals, dentists are more prone to infection due to their direct contact with blood and saliva. This study highlights the level of compliance with infection control measures among dental students; and linked this to their knowledge and attitudes regarding infection control measures and proper vaccinations. The study is a multi-centre analytical cross-sectional survey. The sample size was 969 clinical years' students from governmental and private dental colleges in Sudan and Saudi Arabia. A pre-coded, pre-tested, and anonymous questionnaire consisted of seven categories of knowledge, attitude, awareness, and practices, including 40 questions, was answered. The study has linked knowledge, attitude, and practice in dental clinics with possible COVID-19 transmission in dental clinics. The results showed that the use of some Personal Protective Equipment was low in Sudan and moderate in Saudi Arabia (statistically significant, p < 0.001). Moderate percentage of Hepatitis B vaccination status, with low percentage of Post HBV serology, was reported (p < 0.001). The percentages of major causes of percutaneous and/or eye exposure/injury, for examples, were as follows: anesthesia (33.3-62.7%, p 0.006) and suture needle (17.5-39.4%, p 0.037). In conclusion, dental students in the present study had good knowledge and positive attitudes regarding infection control in general, but showed moderate compliance with the recommended infection control guidelines.

Marine organisms are considered a cache of biologically active metabolites with pharmaceutical, functional, and nutraceutical properties. Among these, marine bioactive peptides (MBAs) present in diverse marine species (fish, sponges, cyanobacteria, fungi, ascidians, seaweeds, & mollusks) have acquired attention owing to their broad-spectrum health-promoting benefits. Nowadays, scientists are keener exploring marine bioactive peptides precisely due to their unique structural and biological properties. These MBAs have reported ameliorating potential against different diseases like hypertension, diabetes, obesity, HIV, cancer, oxidation, and inflammation. Furthermore, MBAs isolated from various marine organisms may also have a beneficial role in the cosmetic, nutraceutical, and food industries. Few marine peptides and their derivative are approved for commercial use, while many MBAs are in various pre-clinical and clinical trials. This review mainly focuses on the diversity of marine bioactive peptides in marine organisms and their production procedures, such as chemical and enzymatic hydrolysis. Moreover, MBAs' therapeutic and biological potential has also been critically discussed herein, along with their status in drug discovery, pre-clinical and clinical trials.

The pernicious effect of far-fault and near-fault earthquake records on the seismic behavior of concrete structures has been studied widely. In addition, several research works have been carried out to investigate the influence of forward-directivity and fling‐step, as unique characteristics of the near-fault motions and not observed in the far-field, on the seismic response and damage of high-rise buildings. This paper focuses on seismic response demand and damage of building structures having different floor systems and subjected to two types of near-fault records with pulses. For this purpose, three-dimensional nonlinear finite element models were developed in ETABS. In addition, fourteen earthquake motions, with characteristics representing forward-directivity and fling-step, are selected to excite the developed models using nonlinear time-history analysis. Two damage models are employed in the study to capture the damage indices associated with each type of slab and earthquake. The compared results from the analysis revealed that floor system significantly influences the induced story responses as well as the level of damage of the buildings. Regardless the type of floor, findings from the study also revealed that response demand and damage index values were magnified for fling-step rather than forward-directivity motions leading to more severe damage to buildings.

This study aimed to investigate the knowledge, attitudes, and practices regarding brucellosis among parents in the Aseer region of southwestern Saudi Arabia in order to estimate the population sectors that are at high risk for accidental exposure to brucellosis. This was a cross-sectional survey conducted in 2018, including 311 participants representing various genders, ages, and levels of education. Bivariate analysis showed a significant association of good awareness of the disease with the male gender and higher education levels. Of the 311 participants, 90.0% had good knowledge, whereas 10.0% showed inadequate knowledge about brucellosis. Practices and attitudes regarding brucellosis were satisfactory as participants did not eat meat from their own animals (52.7%), did not practice slaughtering (71.4%), did not participate in the birth of animals (91.3%), were not exposed to abortion in animals (93.2%), and practiced burial of aborted animal fetuses (59.2%). The practice regarding brucellosis was unsatisfactory as 66.6% never wore gloves when dealing with animals. The study concluded that the majority of parents showed fair and positive knowledge, attitudes, and practices regarding brucellosis and found that gender and education were determinants of satisfactory awareness.

Severe deformity of the distal femur due to malunited fracture in a poliomyelitis patient is a rare entity. No reports are available in the literature about the results of total knee arthroplasty (TKA) in such cases. We report a 4-year follow-up of TKA in a 52-year-old woman who had postpoliomyelitis syndrome with malunited distal femur fracture associated with severe deformity and degenerative arthritis. TKA in poliomyelitis patients could reveal a good short-term functional improvement. We aim to demonstrate that even with the presence of deformity from previous trauma in polio cases, TKA would improve functional abilities. However, long-term follow-up is needed for similar cases.

Aims: The aim of the study was to estimate the prevalence and risk factors of diabetes mellitus among adult population of Albaha region, Saudi Arabia and to identify the diabetic risk clusters among Saudi population using various cluster analysis techniques. Study Design: Cross-sectional observation and Hierarchal cluster analyses. Place and Duration of Study: The study was conducted in three different cities of the Albaha region, Saudi Arabia including Albaha, AlAqiq and Baljurashi among Saudi adults 15 years of age or above. The study was carried out from April 2019 to May 2019. Methodology: The first part of the research was a random cross-sectional observational diabetic risk factors screening using a structured questionnaire among adult volunteers of the Albaha region. The second part constituted a multiple cluster analysis technique performed to identify the diabetic risk factors from 13 regions of Saudi Arabia, clustered into five main regions, using NCSS software. Results: In the first part, the risk factors identified among non-diabetic participants showed a significant association with the development of diabetes mellitus, particularly physical inactivity (49.12%), hypertension (41.15%), and high body mass index (19.03%). Likewise, in 11.54% of diabetic patients, elevated body mass index (30.51%), hypertension (27.12%) and physical inactivity (55.93%), which could be associated with diabetic complications. In the second part, the three forms of cluster analyses (the agglomerate hierarchical cluster, clustered heat map and K means clustering analysis) identified physical inactivity and high body mass index as key risk factors which are connected to all other risk factors among the total of 213591 volunteers. Conclusion: Increased prevalence of diabetes and risk of developing diabetes mellitus in the Kingdom require substantial education and training programs to counsel volunteers on all aspects of self-care. Our data provides a robust evidence to establish diabetic counseling through regular diabetes awareness program that can reduce the risk of developing diabetes mellitus.

Background Bile duct injury (BDI) after cholecystectomy remains a significant surgical challenge. No guideline exists to guide the timing of repair, while few studies compare early versus late repair BDI. This study aimed to analyze the outcomes in patients undergoing immediate, intermediate, and delayed repair of BDI. Methods We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020. The patients were divided into three groups based on the time of BDI reconstruction. Group 1 underwent an immediate reconstruction (within the first 72 hours post-cholecystectomy, n = 156); group 2 underwent an intermediate reconstruction (from 4 days to 6 weeks post-cholecystectomy, n = 75), and group 3 underwent delayed reconstruction (after 6 weeks post-cholecystectomy, n = 181). Results Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3. Favorable outcome was observed in 111 (71.2%) patients in group 1, 31 (41.3%) patients in group 2, and 157 (86.7%) patients in group 3 (P = 0.0001). Multivariate analysis identified that complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1, the use of external stent was an independent factor of favorable outcome in group 2, and level E4 BDI was an independent factor of unfavorable outcome in group 3. Transected BDI and level E4 BDI were independent factors of unfavorable outcome. Conclusions Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI. Complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of a favorable outcome.

Background: Diabetes mellitus type-2 (DM-T2) constitutes a major public health concern and is one of the fastest growing diseases worldwide, projected to affect 693 million adults by 2045. Devastating macrovascular complications (cardiovascular disease) and microvascular complications (diabetic kidney disease, diabetic retinopathy and neuropathy) lead to increased mortality, blindness, kidney failure and an overall decreased quality of life in individuals with diabetes. An optimum glycemic control is a key to reduce the associated complications of DM-T2 and can be achieved by assessing the knowledge and attitude of patients in the management of the diseases followed by proper counseling. Methodology: This is a descriptive cross-sectional study and was carried out on 400 diabetic patients (DM-T2) who attended diabetic center in King Abdullah Hospital, Bisha. A questionnaire was used for data collection from patients in the outpatient department after taking their prior permission. SPSS v.20 was used to analyses the data. Chi-square test was used to test the relationship between the categorical variables in the attitude and practice of diet control in patients with DM-T2 Results: Our results indicated a better understanding of the role of diet (73%) while as only about 42.5% of patients had a good knowledge about the role of exercise in the control of DM-T22. Majority of patients (61.5%) regularly visited their treating physicians and 47.5 % of patients reported doing regular exercise, 54.75% patients conrmed the regular consumption of vegetables and fruits. Amajority of patients (68.25 %) reported that they enquire from their treating physicians about the role of diet and exercise in the prevention of complication associated with DM-T2. Conclusions: Our study revealed a good level of knowledge, attitude and practices of diet control and exercise among the diabetes patients attending one diabetic center in Bisha city of Aseer region of KSA. There is a need for more such studies involving a bigger sample size of the diabetic patients from the region.

Background Paediatric rhinosinusitis is mostly different than that in adults. More frequently, children presented with cough, bad breath, crankiness, low energy, and swelling around the eyes, besides a thick yellow-green nasal or post-nasal discharge. About 5- 13% of childhood viral upper respiratory tract infections may advance to acute rhinosinusitis, with some of them developing a chronic condition. Aim To assess prevalence and clinical presentation of sinusitis in the paediatric age group in Aseer, Saudi Arabia. Methodology A retrospective record-based study was conducted in Abha Maternity and Children Hospital in Abha city, Saudi Arabia between January 2015 and January 2018. All medical records during the study period for children whose from to 15 years old attended the hospital and diagnosed as having sinusitis were included. Results The study included 100 children with complete files whose ages ranged from less than 1 year to up to 13 years old with a mean age of 5.3 4.2 years. Nearly 51% of the children aged 4 years or less and male were 53 (53%). Past history for chronic rhinosinusitis (CRS) was positive among 30 children. Regarding clinical presentations of rhinosinusitis (RS) as reported by the children caregivers, fever was the most reported complaint (50%) followed by red eye (44%), ringing nose (42%), cough (41%) and headache (36%). Mucous culture was positive among 58 cases. The most isolated pathogens were streptococcus pneumoniae (45.6%), Haemophilis influenza (24.6%). Conclusions In conclusion, the study revealed that CRS is a common disease in children at different ages, especially, maxillary and frontal sinuses. In most of the cases, medical treatment is highly appreciated; though, surgical intervention may be needed in a small percentage.

MOTIVATION: Studies have shown poor clinical effectiveness of the Epworth Sleepiness Scale (ESS) due to its ambiguity of items and cultural applicability. This study aimed to investigate the efficacy of a Visual Analog Scale (VAS) to assess sleepiness, compared to ESS. METHODS: Thirty-two obstructive sleep apnea (OSA) patients and 32 healthy participants completed two visits, 1 month apart, during which they completed both ESS and VAS. Patients diagnosed with OSA were treated with Continuous positive airway pressure (CPAP) between visits. The agreement between the ESS and VAS scores in both patients with OSA and healthy participants was investigated using Pearson correlation and Area Under the receiver operating characteristics. RESULTS: The (mean ± standard deviation) Oxygen Desaturation Index for patients with OSA was 18.5 ± 5.7 events/hour and 1.7 ± 1.0 events/hour in the healthy participants. A reduction in sleepiness, following CPAP treatment occurred in patients with OSA, using the ESS (11.2 ± 5.5–4.7 ± 5.0 points, P < 0.001) and the VAS (50.2 ± 3.0–21.9 ± 26.5 mm, P < 0.001). There was no significant change in sleepiness, in healthy participants using the ESS (3.91 ± 3.14–3.34 ± 3.27 points (P < 0.48) or the VAS (15.58 ± 21.21–12.05 ± 14.75 mm, (P < 0.44). A Likert scale showed that the VAS was easier to use compared to ESS in visit 1 (VAS: 8.7 ± 1.9 points, ESS: 7.7 ± 2.6 points, (P < 0.001), and visit 2 (VAS: 9.5 ± 1.4 points, ESS: 8.6 ± 1.5 points, P < 0.001). CONCLUSION: These preliminary results suggest that the VAS can detect a change in sleepiness after CPAP treatment in patients with OSA and that the VAS was also easier to use compared to ESS.

Objectives: To evaluate the prevalence and the factors associated with recurrence of myasthenia gravis following thymectomy. Methods: Six electronic databases which reported on recurrence of myasthenia gravis following thymectomy and/or its risk factors from 1985 to 2018 were searched. Summary prevalence and risk values obtained based on the random effect models were reported. Results: Seventy (70) papers containing 7,287 individuals with myasthenia gravis who received thymectomy as part of their management were retrieved. The patients had a mean follow-up of 4.65 years post-thymectomy. The prevalence of myasthenia gravis recurrence post-thymectomy was 18.0% (95% CI 14.7–22.0%; 1865/7287). Evident heterogeneity was observed (I2=93.6%; p

The Covid-19 epidemic poses a serious public health threat to the world, where people with little or no pre-existing human immunity can be more vulnerable to its effects Thus, developing surveillance systems for predicting the Covid-19 pandemic at an early stage could save millions of lives In this study, a deep learning algorithm and a Holt-trend model are proposed to predict the coronavirus The Long-Short Term Memory (LSTM) and Holt-trend algorithms were applied to predict confirmed numbers and death cases The real time data used has been collected from the World Health Organization (WHO) In the proposed research, we have considered three countries to test the proposed model, namely Saudi Arabia, Spain and Italy The results suggest that the LSTM models show better performance in predicting the cases of coronavirus patients Standard measure performance Mean squared Error (MSE), Root Mean Squared Error (RMSE), Mean error and correlation are employed to estimate the results of the proposed models The empirical results of the LSTM, using the correlation metrics, are 99 94%, 99 94% and 99 91% in predicting the number of confirmed cases in the three countries As far as the results of the LSTM model in predicting the number of death of Covid-19, they are 99 86%, 98 876% and 99 16% with respect to Saudi Arabia, Italy and Spain respectively Similarly, the experiment's results of the Holt-Trend model in predicting the number of confirmed cases of Covid-19, using the correlation metrics, are 99 06%, 99 96% and 99 94%, whereas the results of the Holt-Trend model in predicting the number of death cases are 99 80%, 99 96% and 99 94% with respect to the Saudi Arabia, Italy and Spain respectively The empirical results indicate the efficient performance of the presented model in predicting the number of confirmed and death cases of Covid-19 in these countries Such findings provide better insights regarding the future of Covid-19 this pandemic in general The results were obtained by applying time series models, which need to be considered for the sake of saving the lives of many people

Introduction Myocardial infarction is one of the major causes of death and disability. Various diagnostic modalities used to investigate cardiac ischaemia. Advances in Magnetic Resonance Imaging technology has opened up new horizons for investigating the cardiac function and quantifying any pathology that may be present. Aims The present study was designed to quantify the cardiac area at risk and infarction reperfusion areas using the mismatch of iron oxide contrast and gadolinium (Gd) contrast imaging (MRIs) and to test if a combination of T1, T2, and iron oxide T2* contrasts will distinguish the infarction and AAR zones. Methods A well-established mouse model was used to induced cardiac ischaemia and reperfusion. Six mice models’ hearts were harvested and processed according to various protocols. MI was induced through ligation technique for five mice, and one was kept as normal control. MR imaging and Reperfusion were performed using a Three-dimensional gradient-echo fast low angle shot (3DFLASH) and three-dimensional multi-slice multi-echo sequence (3DMSME). Generation of T1 and T2 maps, image post-processing including segmentation and mismatch measurement and drawing of the area of interest. Results The edematous myocardium had significant high signal intensity in 3DMSME with variable echo time (14, 28, 42 ms). The combination of 3DFLASH and 3DMSME at an echo time of 42 ms was statistically significant, detecting the AAR more accurately. Both T1 and T2 sequences had the potential to determine the AAR zone. The infarct area has significantly high signal intensity compared to normal areas (p = 0.04 for the T1 map and p = 0.01 for the T2 map). Conclusions The study demonstrated that Cardiac MRI was a valuable technology to investigate infarct areas and zones that are at risk.

Background: The rate of obesity in children is rising and it has become a growing epidemic worldwide; Childhood obesity is related to the high risk of obesity later in adult life. In the last 30 years the prevalence childhood obesity more than tripled. Overweight in paediatric population is suggested to be related to many cardio-metabolic risk factors such as metabolic syndrome, type 2 diabetes, hypertension, insulin resistance. Metabolic syndrome and dyslipidaemia and 70% obese children had first cardiovascular disease risk factor and 30% had second or more. Aim: To estimate the prevalence and correlates of obesity among children in Aseer region. Methodology: A descriptive cross-sectional survey was conducted in the schools of Abha and Khamis Mushayet Cities; Aseer region during the period from January to December 2019. The respondents were any of the parents of the child. After having permission from the school authority, self-administered questionnaires were distributed to a total of 300 children, with explanations about the questionnaire by the principal investigator and class teacher. Results: The study included 300 students with ages that ranged from 1 year up to 17 years and mean age was 8.6 years old. Exact of 55.3% of the students were males and 32% were at preschool age while 43.7% were at the primary level of education. Students' body mass index (BMI) distribution demonstrated that more than half of the children had overweight or obesity and 16.7% were with underweight. There was a significant relation between obesity among the children and some of their dietary habits including sweets, chocolate and fast food. Conclusions and Recommendations: In conclusion, the study revealed that nearly one-third of the children in the study group were overweight or obese with obesity more prevalent. Obesity was more recorded among old-aged children who frequently had unhealthy food. Improving the children lifestyle and dietary habits is mandatory to work against weight gain.

To transfer a satellite or a spacecraft from a low parking orbit to another orbit requires one of the many orbital transfers. These orbital transfers need to determine some orbital elements of the initial and final orbits as perigee and apogee distances. The transfers compete to achieve the transition with minimal consumption of energy, transfer time, as well as the highest accuracy of transition. In the present research, certain mathematical procedures implementable with the help of computers will be employed to investigate the two important non-coplanar tangential transfers between circular orbits called the Hohmann and bi-elliptic transfers. Also, a comparative study between Hohmann and bi-elliptic transfers will be established. At the end of present study, we will be able to determine the lowest value of the velocity change and the best transfer between the Hohmann and bi-elliptic transfers with minimal fuel consumption.

Background: Medical students even though being aware of the importance of well-balanced nutrition do tend to have laxity in practicing it themselves leading to poor nutrition. The aim of this study was to compare the awareness and knowledge of dietary habits among medical and non-medical students. Methods: This cross-sectional study was carried out in two universities in the Jeddah province, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and King Abdulaziz University (KAU), Jeddah over 6 months. A self-administered online questionnaire was employed to assess the knowledge and attitude of the dietary habits among the students. Results: The number of students who responded positively to the survey was 386, the mean age was 21.5 ± 2.10. 310 (80.3%) of which were males while 76 (19.7%) were females by a ratio of 4.07:1. Most of the participants were single (95.9%); 238 (87.6%) participants lived with their family and 272 (70.5%) participants were in the college of medicine. Among the medical students, 41.9% did exercise “sometimes,” 57.4% identified breakfast as an important meal of the day, and 14.7% were smokers. Conclusion: In our study, we found that the medical students were having a higher level of awareness about the dietary and lifestyle habits but it was not reflected in their practice which needed to be taken care of.

Background: Early and accurate detection of respiratory viruses (RV) is important for patient management. We have previously shown that self-collected nasal swabs (NS) are feasible and as sensitive as clinician-collected nasal washes for detection of RV, but the additive benefit of self-collected throat swabs is unknown.Objectives: To test the rise in auto sufficient nasal yields to the throat swabs in patients with upper respiratory (URTI) symptoms for PCR identification of RV.Study Design: Patients with URTI symptoms self-collected paired polyurethane foam NS and nylon flocked throat swabs and completed a symptom survey. Swabs were tested for 12 RV by real-time reverse transcription (RT)-PCR. Descriptive, McNemar's, and Wilcoxon signed rank statistical tests were used.Results: The sample was made up of 115 paired swab nasals and throat, with at least 1 specimen being positive for RV (71/115 (62 percent), including 51 positive for both specimens, 17 positive for NS only and 3 favorable for RV only with throat swab. NS was 96 percent sensitive (95 percent CI: 88-99) compared with 76 per cent in throat swabs, p < 0.001 (95 percent CI: 65-85). The median PCR period threshold (Ct) of 51 concordant samples was lower in NS (25.1) than in swabs of the throat (32.0).Conclusion: Self-collection of NS was significantly more sensitive than self-collection of throat swabs for detection of RV by RT-PCR. The addition of throat sampling does not appear to increase the diagnostic load in the self-testing setting.

BACKGROUND: Although frequently diagnosed in our region, transfusion-dependent thalassemia (TDT) often remains a poorly managed disease. This is due to a lack of awareness of the long-term effect of iron overload among thalassemic patients. This study aimed to examine the unmet needs of TDT patients and provide insight into achieving better care. METHODS: We conducted a cross-sectional study of 50 caregivers of heavily transfused thalassemia and sickle cell anemia (SCA) patients. The participants were recruited during their visit to the pediatric hematology clinic or daycare unit between September 2018 and May 2019. The researchers administered a questionnaire to assess the awareness of iron overload and compliance with its management in TDT and SCA. RESULTS: Most participant caregivers of children with TDT and SCA had a low level of awareness about the most critical complication of TDT and SCA, which is iron overload. Furthermore, two-thirds of the participants did not appreciate the seriousness of iron overload nor its potential complications. Moreover, the participants reported that their health-care providers rarely or occasionally discuss iron overload or its management. Furthermore, they reported that compliance with health-care appointments and iron chelation therapy was suboptimal. CONCLUSION: Caregivers of TDT and SCA patients reported a low level of knowledge of the magnitude of iron overload, its management, and expected complications if not treated appropriately. Health education on iron overload is critical to ensure appropriate compliance and consequently, control of such disease. The focus must be shifted from giving blood to eliminating excess iron among TDT patients.

Background and Objective: Regular exercise has a positive effect on the well-being of individuals; however, improper utilization of exercise facilities may result in sports/exercise-related injuries leading to increased burden on the health system. The objective of this study was to measure the prevalence of sports injury and explore its association with warm-up in males visiting the fitness center in Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted on 521 males, while they were visiting the fitness/sports center in Riyadh city. The interviews comprised of questions on sociodemographic information, sports/exercise-related injury, warm-up, and its type and duration, medical history, smoking status, height, and weight of the participants. Multivariate logistic regression analysis was conducted to measure the association between sports injury and warm-up. Results: The mean age and body mass index (BMI) of the participants was 24.0 (±6.7) years and 25.8 (±5.8) kg/m2, respectively. Regular exercise was reported by 63% (n = 330) of the participants, whereas 43.4% (n = 228) mentioned some kind of sports/exercise-related injury during the last 1 year. Regualr warm-up was reported by 45% (n = 236) of the participants. The multivariate logistic regression analysis found no significant association between sports injury and warm up [0.73 (0.41, 1.31)]; and the age category 31–50 years had 2.06 (95% confidence interval [CI]: 1.15–3.69) times higher odds for the injury in comparison to younger ages (16–25 years). Low income group (10,000 SAR. The participants following the diet plan for weight loss also showed higher odds (1.61 [95% CI: 1.06–2.43]) for reporting sports injury in comparison to those without diet plan. The association was adjusted for BMI. Conclusions: Prevalence of exercise/sports-related injury among fitness club visitors is significantly high. Awareness about sports injury and proper gym training should focus on young adults visiting the fitness center with the purpose of weight loss.

This paper discusses the impact caused by a virus outbreak called coronavirus disease (COVID-19). The virus initially appeared in Wuhan, China, in late 2019, then spread throughout the world, including the Asia-Pacific Region (APR). COVID-19 is believed to have damaged health and the global economy. Unlike the crisis that was caused by many previous disruptions, the impact caused by COVID-19 is wider and bigger. Many economic sectors have been paralyzed and suffered losses, such as production and trade. Export-import cooperation has become a dependency between countries, and this has also been hampered due to the rapid spread of this pandemic. Then, the closure of transportation access and the suggestion to stay at home has made the tourism sector sluggish. Meanwhile, another effect of this pandemic is the emergence of new poor groups due to the rise in layoffs. This study uses qualitative research methods to search for theoretical references relevant to cases or problems found in various works of literature, mainly scientific journals, books, reports, and actual and trusted news on the internet. This study aims to explore the potential of COVID-19 that not only threatens health, but also social, political, and economic spheres. From the analysis, it was concluded that COVID-19 could inhibit all global socio- economic activities that threaten the success of realizing Sustainable Development Goals (SDGs), but on the other hand, this pandemic can also be momentum for a more sustainable life order.