Search

Staging platform (SP) uses a modified Gates Glidden (GG) to help retrieve separated instruments deep in the root canal. However, GG drills may cause damage or severe dentin loss. A 46-year-old male patient was referred to the endodontic postgraduate clinics complaining of pain on biting related to the mandibular right second molar (#47). The preoperative periapical radiograph of #47 showed a previously initiated root canal treatment with an approximately 8-mm separated instrument in the apical third of a curved mesiolingual canal. A nickel–titanium (NiTi) rotary file size 25/0.04 was flattened with a carbide bur. The modified file was then used to create a centered SP. After SP was achieved, an ultrasonic tip was used at lower power for the trephination of dentin. The fragment became loose, and retrieval was achieved. The use of a modified NiTi rotary file presented a safe and alternative option to establish SP for instrument retrieval instead of using GG drills.

ABSTRACT: Objectives: The presence of red-complex bacteria (RCB) has been associated with the occurrence of not only periodontal disease but also other systemic diseases, thereby potentiating an oral–systemic relationship. This study aimed to explore the levels of periodontal RCB in pregnant preeclamptic women with periodontal disease, potentiating the pathophysiology of a bacterial association in both periodontitis and preeclampsia. Methods: Six hundred pregnant women (aged 20 to 35 years) in their third trimester were selected and divided into 3 groups comprising a control group (systemically and periodontally healthy pregnant women), group A (preeclamptic women with chronic periodontitis), and group B (preeclamptic women without chronic periodontitis). Demographic variables and periodontal parameters were recorded. Other variables such as systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the urine protein content were also estimated. RCB, namely Porphyromonas gingivalis (Pg), Treponema denticola (Td), and Tenerella forsythia (Tf), were assessed in both subgingival plaque samples and placental samples of all the pregnant participants in the study. Results: The mean weight, mean body mass index, mean SBP, mean DBP, and mean urine protein content were significantly elevated in group A and group B when compared to the control group. Preeclamptic women with chronic periodontitis (group A) had higher levels of plaque index, probing pocket depth, bleeding on probing, and clinical attachment level as compared with the other groups. The numbers of the RCB were found to be elevated in group A, out of which Pg was found to be more prevalent. Conclusions: Our findings indicate that the periodontal indices, blood pressure, and urine protein content were found to be higher in preeclamptic women with periodontitis. Hence, reducing the periodontal bacterial load in pregnant women via good oral hygiene maintenance would further reduce the putative risk of adverse pregnancy outcomes including preeclampsia in these women.

Abstract Background This study aimed to observe the impact of service learning on the attitude of senior dental students toward community service. Methods A cross-sectional survey-based was conducted and recruited a total of 120 senior students of Dentistry Taibah University that were enrolled in a clinical service-learning course using convenience sampling. The attitude of dental college students toward community service based on the model of helping behavior by Schwartz was evaluated through Community Service Attitude Scale (CSAS). The data was collected using the same questionnaires for the pre-test and post-test. Data were analyzed by using SPSS 25. A repeated-measures mixed-model ANOVA was used to test the changes across pre-and post-test. Results A total of 96 students completed the first survey, making a response rate of 80%, and 78 among them completed the second survey as well, making a response rate of 81%. Significant change (P

Background: History of rheumatoid arthritis (RA) increases risk of periodontal diseases. A pro-inflammatory condition noted in periodontitis is considered a trigger for RA. Thus, periodontal treatment aimed at attenuating the pro-inflammatory state could aid in potentially reducing the risk of RA. Aims: The objective of this research was to assess the effect of periodontal therapy on rheumatoid factor, Disease Activity Score-28, anti-citrullinated protein antibody, and C-reactive protein levels in patients with chronic periodontitis (CP) and RA. Materials and methods: The sample consisted of 28 patients with CP and RA. The study was designed to be a double-blind, randomised controlled clinical study. The samples were randomly categorised to either the treatment group (n = 13) or the control group (n = 15). CP status (plaque index, bleeding on probing, probing pocket depth, clinical attachment loss), clinical rheumatologic status (Disease Activity Score), and biochemical status (C-reactive protein, anti-citrullinated protein antibody, and rheumatoid factor) were assessed at baseline and at follow-up at 8 to 12 weeks. Results: The treatment group showed a highly statistically significant reduction in bleeding on probing (P < .005), probing pocket depth (P < .001), plaque index (P < .001), and C-reactive protein (P < .001); a gain in the clinical attachment loss (P < .001) and an improvement in Disease Activity Score-28 (P = .001) were observed at reassessment following nonsurgical periodontal treatment as compared to the control group. However, blood serum anti-citrullinated protein antibody (P = .002) and rheumatoid factor levels (P = .351) were found to increase from baseline to 8 to 12 weeks following subgingival scaling and root planing. Conclusions: Reduction of inflammation in the periodontium by nonsurgical periodontal therapy did not reduce anti-citrullinated protein antibody and rheumatoid factor levels. However, it has shown improvement in periodontal conditions, and remarkable changes were observed in the clinical Disease Activity Score and C-reactive protein levels of individuals with RA.

Patient satisfaction is a critical indicator for assessing the quality of healthcare services, as it plays a crucial role in ensuring the effective, timely, and patient-centered delivery of high-quality healthcare. Additionally, patient satisfaction has a direct relationship with clinical outcomes. The objective of this study was to investigate the influence of clinic waiting time on patient satisfaction in an Ear Nose Throat (ENT) outpatient department. A total of 241 patients who visited hospitals and ENT outpatient departments in Jeddah were recruited for this cross-sectional study. Descriptive statistical analysis was performed using IBM SPSS version 25. The majority of patients expressed satisfaction with the waiting time at the clinic. Additionally, many patients reported being satisfied with the handling of appointments and the information they received from their friends or relatives. Significant statistical differences were observed between waiting time and demographic factors such as age, gender, employment status, and residence. Moreover, there was a statistically significant association between patient satisfaction with the appointment process and the information provided by the staff ( P -value

Dental caries is an infectious oral disease caused by the presence of different bacteria in biofilms. Multidrug resistance (MDR) is a major challenge of dental caries treatment. Swabs were taken from 65 patients with dental caries in Makkah, Saudi Arabia. Swabs were cultivated on mitis salivarius agar and de Man, Rogosa, and Sharpe (MRS) agar. VITEK 2 was used for the identification of isolated bacteria. Antibiotic susceptibility testing of the isolated bacteria was performed using commercial antibiotic disks. Ulva lactuca was used as a reducing agent and cellulose source to create nanocellulose and Ag/cellulose nanocomposites. Fourier-transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray diffraction spectroscopy (XRD) were used to characterize nanocellulose and Ag/cellulose nanocomposites. The results showed that most bacterial isolates were Streptococcus spp., followed by Staphylococcus spp. on mitis salivarius media. Lactobacillus spp. and Corynebacterium group f-1 were the bacterial isolates on de Man, Rogosa, and Sharpe (MRS) media. The antibiotic susceptibility test revealed resistance rates of 77%, 93%, 0, 83%, 79%, and 79% against penicillin G, Augmentin, metronidazole, ampicillin, ciprofloxacin, and cotrimoxazole, respectively. Ag/cellulose nanocomposites and Ag/cellulose nanocomposites with fluoride were the most effective antibacterial agents. The aim of this work was to assess the antibacterial activity of Ag/cellulose nanocomposites with and without fluoride against bacteria isolated from the oral cavities of patients with dental caries. This study demonstrated that Ag/cellulose nanocomposites have antibacterial properties against multidrug-resistant bacteria that cause dental caries.

Dental caries is a common chronic disease, and anyone can be at threat of it throughout their lifespan. In school-aged children, dental caries is the most frequent disease related with oral health. Contemporary dental caries management focuses on non-restorative, non-invasive, and micro-invasive therapeutic techniques that effectively eliminate the caries progression at the lesion level and decrease the loss of healthy tooth structure. One of these strategies is to use caries apprehending agents with antibacterial and remineralizing characteristics. Due to recent regulatory approval in the United States, the use of silver diamine fluoride (SDF) for the therapy of dental caries has received substantial interest. SDF has successfully prevented and reversed both primary tooth caries and permanent teeth root caries. Even though SDF is an effective anti-caries agent, but it is associated with certain drawbacks like gum irritation, metallic taste, and irreversible dark stains on applying on cavities. As an alternative agent Nano Silver Fluoride (NSF) is preferable because it performs like SDF without tooth staining. It has comparable preventive and antibacterial activities as SDF. Further, it is ergonomic, economic and safe in children and adults. The current article aims to highlight the superior properties of NSF as a better anti-caries agent outstripping the limitations of discoloration of SDF.

Aim: The aim of the study was to evaluate the oral secretagogue, anti-microbial and immunomodulatory properties of Centella asiatica in patients with type II diabetes mellitus. Materials and methods: In-vivo and In- vitro assessment was conducted for a period of 3 months. A before and after trial for a period of 3 months of intervention was performed involving 20 participants. Unstimulated Saliva and gingival crevicular fluid (GCF) samples was collected from all the participants before and after the intervention period. The effectiveness of Centella asiatica was estimated by evaluating the pre and post intervention values of salivary flow rate, salivary pH, S.mutans count, GCF flow rate, neutrophils count and alpha 1 defensin levels. Results: This clinico-interventional study inferred that after the usage of aqueous extract of Centella asiatica mouth wash, there was a high statistically significant improvement in the GCF flow rate, GCF neutrophil count and alpha 1 defensin levels from baseline to 90thday (after 3 months) (P = 0.001). The salivary flow rate, salivary pH and S.mutans colony count showed no statistically significant difference. Conclusion: The outcome of the current study enlightens the utility of ethnomedicinal plants and their usage, it is also helpful in enhancement of oral health status in hyperglycemic conditions. The current study concluded that rinsing twice with aqueous extract of Centella asiatica as mouth rinse for a period of 3 months has an immunomodulatory action. Clinical significance: Centella asiatica mouthwash can be used as an immunomodulatory agent.

This study analyzes the evidence of the marginal discrepancy and internal adaptation of copings fabricated using three types of resin patterns with subtractive (milling) and additive technology (3D printing), as it is not widely reported. Working casts (n = 15) were scanned and patterns were completed using computer-aided designing (CAD). Resin patterns were fabricated using the designed data and divided into three groups according to the method of fabrication of patterns: subtractive technology–CAD milled polymethyl methacrylate resin (Group-PMMA), additive technology [digital light processing (DLP) technique]–acrylonitrile–butadiene–styrene (ABS) patterns (Group-ABS), and polylactic acid (PLA) patterns (Group-PLA). Resin patterns were casted with Cobalt–Chromium (Co–Cr) alloy (lost wax technique). Internal and marginal gaps of the metal copings were analyzed with the replica technique under optical microscope. The Kruskal–Wallis test was used to compare values among the groups, and post hoc multiple tests confirmed the specific differences within the groups. The median marginal gap was least for CAD milled resin patterns, followed by PLA printed resin patterns and ABS printed resin patterns. There were significant differences between Group-PMMA and Group-PLA and Group-ABS (p = 0.0001). There was no significant difference between Group-PLA and Group-ABS (p = 0.899). The median internal gap was least for metal copings fabricated from Group-PLA, followed by Group-ABS and Group-PMMA. The differences were not statistically significant (p = 0.638) for the internal gap. Full metal Co–Cr copings fabricated from the milled PMMA group had a better marginal fit, followed by the PLA and ABS printed groups. Copings fabricated with the PLA printed group had the best internal fit, though the values were statistically insignificant between the groups.

During the current COVID-19 pandemic, timing and preparedness for healthcare facilities are fundamental. This descriptive article narrates the Department of Internal Medicine at the College of Medicine and King Saud University Medical City (KSUMC) response before and during the COVID-19 outbreak by focusing on the preparedness and mitigation plans the department implemented for its clinical services. A COVID-19 taskforce was created to implement the pathways for healthcare workers' workflow organization, plan the effective use of isolation facilities and personal protective equipment, and enhance liaisons between departments in the medical city. Telehealth was utilized for outpatient services, and medications were delivered to patients via courier. Aerosol-generating procedures were conducted after thoroughly reviewing the clinical indications and time-related risks. Medical day unit services followed a strict multistep screening protocol and rescheduled nonurgent investigations and therapeutics when possible. The Department of Internal Medicine prepandemic preparedness helped significantly mitigate the pandemic impact on KSUMC. Prioritizing in-hospital clinical care according to the patients' conditions, full adherence to infection control measures, clear and efficient communication between departments, and utilizing telehealth were the key elements in maintaining state-of-the-art clinical care during the pandemic.

The essential factor in determining the preservation of restoration is the marginal seal. Restoring cervical lesions with a resin composite has always been a challenge. Composite resins with various viscosities and different bonding systems are being researched to reduce the microleakage. Confocal laser scanning microscopy (CLSM) is the latest non-destructive technique for visualizing the microleakage. Objectives: To evaluate and compare the microleakage of Universal Flo composite resin (G-aenial) using etch and rinse adhesive system ER-2 steps (Adper Single Bond 2), self-etch adhesive system SE-1 step (G-Bond), and self-adhesive flowable composite resin (Constic) in Class V cavities using a confocal laser scanning microscope. Materials and Method: Class V cavities were prepared on 27 caries-free human extracted premolar teeth on the buccal and lingual surfaces with standardized dimensions of 2 mm height, width 4 mm, and a depth of 2 mm. After the cavity preparation, all teeth were randomly divided into three groups, namely Group-I: G-aenial Universal Flo with Single Bond 2 (n = 9 teeth); Group-II: G- aenial Universal Flo with G-Bond (n = 9 teeth), and Group-III: Constic (n = 9 teeth). The prepared and restored specimens were then subjected to thermocycling for 500 cycles in a water bath at 5 °C and 55 °C with a dwelling time of 30 s. The specimens were placed in 0.6% aqueous rhodamine dye for 48 h. Sectioning was carried out bucco-lingually and specimens were evaluated for microleakage under a confocal laser scanning microscope. Results: There was a significant difference (p = 0.009) in microleakage when comparing total etch and rinse, specifically between Adper Single Bond 2 ER-2 steps (fifth generation) and self-adhesive flowable composite resin, which is Constic. There was more microleakage in the self-etch bonding agent, particularly G-Bond, SE-1 step (seventh generation), when compared to ER-2 steps (fifth generation bonding agent); however, the results were not statistically significant (p = 0.468). The self-adhesive flowable composite resin showed more microleakage than SE-1 step and ER-2 steps. Conclusions: None of the adhesive systems tested were free from microleakage. However, less microleakage was observed in the total etch and rinse, especially Adper Single Bond 2 (ER-2 steps), than the self-etch adhesive system SE-1 step and self-adhesive flowable composite resin. Clinical significance: Constant research and technological advancements are taking place in dentin adhesives to improve the marginal seal. This has led to the evolution of total acid-etching dentin bonding agents termed as etch and rinse (ER)-2 steps (fifth generation dentin bonding agents) and self-etching (SE) 2 steps, and SE-1 step dentin bonding agents termed as the sixth and seventh generation bonding agents, respectively.

Erosive beverages cause dissolution of natural teeth and intra-oral restorations, resulting in surface characteristic changes, particularly roughness and degradation. The purpose of this study was to evaluate the surface roughness and topography of a dental ceramic following immersion in locally available erosive solutions. A total of 160 disc specimens of a nano-fluorapatite type ceramic (12 mm diameter and 2 mm thickness) were fabricated and equally distributed into two groups (n = 80) and then evenly distributed among the following five testing groups (n = 16): lemon juice, citrate buffer solution, 4% acetic acid, soft cola drink, and distilled water which served as a control. The surface roughness (Ra) and topography were evaluated using a profilometer and scanning electron microscope at baseline, 24 h, 96 h, and 168 h respectively. Data were analyzed using ANOVA and Tukey’s multiple comparisons (p ≤ 0.05). Surface changes were observed upon exposure to all acidic beverages except distilled water. Amongst all immersion media, 4% acetic acid produced the most severe surface roughness across all time periods (i.e., baseline, 24 h, 96 h, and 168 h). A statistically significant difference in the surface roughness values between all immersion media and across all four time intervals was observed. Erosive agents had a negative effect on the surface roughness and topography of the tested ceramic. The surface roughness increased with increased storage time intervals.

In the wake of the COVID-19 pandemic, fungal infections of the maxillofacial region have become prevalent, making their accurate diagnosis vital. Histopathological staining remains a simple, cost-effective technique for differentiation and diagnosis of the causative fungal organisms. The present study aims to evaluate the staining efficacy of Periodic Acid-Schiff (PAS), Alcian Blue, Safranin-O and Gomori’s Methenamine Silver (GMS) on fungal smears. This research work also attempts to study the morphometric characteristics of Candida albicans, Aspergillus flavus, Rhizopus oryzae. Candida albicans, Aspergillus flavus and Rhizopus oryzae, 10 smears each, were stained using PAS, Alcian Blue, Safranin-O and GMS. The morphological characteristics and staining efficacy were examined, and semi-quantitative scoring was performed. Candida albicans, Aspergillus flavus and Rhizopus oryzae were stained for the first time with Safranin-O. The morphometric traits were then analyzed using an image analysis software. Safranin-O provided the most reliable staining efficacy amongst the stains and optimum morphological definition for all three organisms. Safranin-O was found to be superior to PAS and GMS, ensuring detection of even the most minute mycotic colonies. The hyphae of Aspergillus flavus to be the largest, and the spores and fruiting body of Rhizopus oryzae were found to be the largest amongst the three organisms compared. Early and accurate diagnosis of fungal infections can significantly reduce morbidity in orofacial fungal infections.

Dental pulp treatment is the least intrusive procedure currently available for preserving the vitality of the pulp. Several studies are underway to improve the bioactivity of pulp capping materials. Tideglusib isa potent anti-inflammatory, antioxidant, and a regenerative drug developed against Alzheimer’s disease and has been shown to be effective in the treatment of dental cavities. However, its bioactive properties encapsulated within the nanoparticles as a component of pulp capping material are largely unknown. In this study, tideglusib-loaded bioactive glass nanoparticles were synthesized (tideglusib-BgNPs) and mixed at various concentrations into the calcium silicate cement to testits physiomechanical and bioactivitiescompared with biodentine (control). The calcium silicate cement with 10wgt% tideglusib-BgNPs showed comparable physiomechanical properties to that of biodentine. Additionally, the assessment of cytotoxicity and bioactivity (cell proliferation, wound healing, and cell migration assays) showed increased bioactivity in terms of better wound healing, increased proliferation, and better migration of human dental pulp stem cells than biodentine. These findings suggest new opportunities to use tideglusib-BgNPs in pulp therapy.

A systematic review and meta-analysis is conducted for children with obstructive sleep apnea (OSA) treated with rapid maxillary expansion (RME). The study systematically and independently reviewed extracted articles from 2009 to 2019. The quality evaluation and selection of these studies was based on the high quality of NICE criteria. EMBASE, Scopus and other five databases were used to extract international publications. The findings indicated that the apnea-hypopnea index was enhanced after rapid maxillary expansion among children with OSA. It revealed that apnea hypopnea index enhances to 73% in children with obstructive sleep apnea after ≤ three years follow-up, while it was 77% in children with obstructive sleep apnea after > 3 years. The articles included in this meta-analysis reported differential outcomes based on different inclusion or exclusion criteria and diverse patient populations. Critical evaluation of previous literature suggests diagnosing the disorder at an early stage for reducing the adverse health outcomes and formulating an appropriate treatment plan.

Recovery and amplification of nucleic acids from archived formalin-fixed tissue samples is the most developing field in retrospective genetic studies. We compared different deparaffinization methods and DNA isolation techniques, and intergroup comparisons were performed to evaluate the effectiveness of different storing methods for archival OSCC samples based on obtained mean DNA quantity, quality, and PCR amplification of the P53 gene. The study comprised 75 archival histologically diagnosed OSCC samples which were divided into Group I: Formalin-fixed paraffin-embedded tissue blocks and Group II: Long-term formalin-fixed tissue. A comparison of different deparaffinization methods showed that xylene deparaffinization is an efficient method to obtain suitable DNA. Comparing different DNA isolation techniques illustrated that the conventional phenol–chloroform method gives better integrity to DNA in contrast with the kit method. Comparison between FFPET and long-term FFT samples demonstrated that samples fixed in formalin overnight and embedded in wax yield better quality and quantity DNA in comparison with long-term samples fixed in formalin. To obtain suitable integrity of DNA, tissue samples should be stored by fixing in formalin overnight followed by preparation of paraffin tissue blocks, deparaffinization by xylene, and subjecting them to the conventional phenol–chloroform DNA isolation protocol.

The success of endodontic treatment relies on both apical and coronal sealing. To achieve a good three-dimensional seal, the removal of the smear layer becomes mandatory. This study aims to assess the difference in debris accumulation and smear layer formation while using automated root canal irrigation and conventional syringe needle irrigation. Single-rooted human mandibular premolar teeth (n = 30) which were indicated for orthodontic extractions were selected. An endodontic access cavity was prepared, and a glide path was created. Based on the irrigation protocol decided upon for the study, the teeth were randomly allocated into three study groups, namely Group 1, where the manual syringe needle irrigation method was adopted; Group 2, in which automated root canal irrigation was undertaken; and Group 3, in which teeth remained un-instrumented as it was considered the Control group. The teeth were decoronated at the cement-enamel junction (CEJ) and were subjected for scanning electron microscopy (SEM) examination. Debris and smear layers were viewed in 1000× magnification and scored. A statistically significant (p < 0.05) lower mean debris and smear layer score (p < 0.05) was observed in both study groups when compared with the control group. However, no significant difference (p > 0.05) in the debris and smear layer was observed between the manual syringe needle irrigation and automated irrigation, although automated irrigation devices can be a potential alternative. The present study concluded that the efficacy of smear layer removal remained the same with both automated irrigation and manual syringe irrigation.

This study aimed to test the biocompatibility and antibacterial properties of Salvadora persica (S. persica) extract, a natural product, as an intracanal medication in comparison with calcium hydroxide (Metapaste, META BIOMED, Cheongju, Korea). The pH values of both materials were tested. The biocompatibility of S. persica extract and Metapaste was determined using light microscopy and MTT assays. The antibacterial action was tested using the zone of bacterial inhibition on four common bacterial species. In addition, intracanal medication was administered using 68 extracted single-rooted teeth contaminated with Enterococcus faecalis (E. faecalis), and the percentage reduction in colony count (% RCC) at 1, 3, and 7 days was measured. The extension of activity for both materials was assessed using histological sections and scanning electron microscopy. S. persica was found to be acidic in nature. Both materials showed significantly lower cell viability than the positive control cells on days 1 and 3 but not on day 7. S. persica showed better antibacterial effects against E. faecalis and S. mutans. S. persica extract showed 97.6%, 98.9%, and 99.3% RCC values at 1, 3, and 7 days, respectively, which are comparable to those of Metapaste. S. persica herbal extract is a promising material that can be utilized as an intracanal medication, but its use requires further research.

This study aimed at assessing the clinical outcomes of the Single Flap Approach (SFA) with the additional use of Low-level laser therapy (LLLT). The defects were treated as per the principles of SFA, whereby 20 defects received only SFA (control group) and 20 defects received additional LLLT for bio stimulation/bio modulation (test group). Stable primary closure of the flaps was obtained with vertical internal mattress sutures. Plaque indices (FMPS), clinical attachment levels (CAL), probing pocket depth (PPD), and gingival bleeding scores (FMBS) were calculated at baseline, and at the 3rd and 6th months in both groups. An EHI score of 1 was observed at all sites except for two, where a score of 2 in the control group at week 2 was observed. In the test group, the PPD reduction at 6 months was 3.60 ± 0.95 and in the control group it was 3.75 ± 0.91 mm. CAL gain at 6 months was 2.70 ± 1.36 mm and 3.45 ± 1.2 mm in the test group and showed no statistical significance. These data suggested the positive effect of LLLT over CAL gain; thus, LLLT may be combined with SFA to potentially enhance the early wound healing and higher clinical outcomes in terms of increase in CAL and decrease in PPD.

BackgroundLevels of cortisol, melatonin, ghrelin, and leptin are highly correlated with circadian rhythmicity. The levels of these hormones are affected by sleep, feeding, and general behaviors, and fluctuate with light and dark cycles. During the fasting month of Ramadan, a shift to nighttime eating is expected to affect circadian rhythm hormones and, subsequently, the levels of melatonin, cortisol, ghrelin, and leptin. The present study aimed to examine the effect of diurnal intermittent fasting (DIF) during Ramadan on daytime levels of ghrelin, leptin, melatonin, and cortisol hormones in a group of overweight and obese subjects, and to determine how anthropometric, dietary, and lifestyle changes during the month of Ramadan correlate with these hormonal changes.MethodsFifty-seven overweight and obese male (40) and female (17) subjects were enrolled in this study. Anthropometric measurements, dietary intake, sleep duration, and hormonal levels of serum ghrelin, leptin, melatonin, and salivary cortisol were assessed one week before the start of Ramadan fasting and after 28 days of fasting at fixed times of the day (11:00 am-1:00 pm).ResultsAt the end of Ramadan, serum levels of ghrelin, melatonin, and leptin significantly (PConclusionsDIF during Ramadan significantly altered serum levels of ghrelin, melatonin, and serum leptin. Further, male sex and anthropometric variables were the most impacting factors on the tested four hormones. Further studies are needed to assess DIF's impact on the circadian rhythmicity of overweight and obese fasting people.

Despite the risks associated with hypnotics and their recent increased use in Saudi Arabia, there are no specific national guidelines for using these medicines to treat insomnia nor are there any data on how these medicines are currently prescribed. There is the potential, however, that some physicians might be adhering to the United States guidelines. The current audit study was aimed to assess the current practice in treating insomnia with hypnotics in Saudi Arabia, and to evaluate its agreement with the US guidelines. The audit was conducted using data collected between April 2012 and March 2017 at King Fahad Central Hospital (KFCH; Jazan), of patients who were either prescribed benzodiazepines (BZDs) or Z-drugs or diagnosed with insomnia. The audit criteria followed two US guidelines for the management of insomnia in adults. Data included documented diagnosis, use of CBT-I (Cognitive Behavioral Therapy for Insomnia), use of BZDs and Z-drugs including treatment regimen, and whether physicians prescribed anti-histamines for insomnia. The data were analyzed using STATA 14 after transcription to a MS XL file. Of the 504 records reviewed, 379 patients (75%) were prescribed BZDs or Z-drugs; only 182 (48%) of them had clearly documented indications for their use. Three hundred and seven patients (60%) were diagnosed with insomnia; none of them received CBT-I as initial treatment. No patients on long-term use of hypnotics were reviewed by their physicians after they began using the medication. More than 43% of patients were prescribed anti-histamines for insomnia. No records met all (or even six) of the seven criteria. KFCH physicians do not follow US guidelines. Therefore, the Ministry of Health (MOH) should improve its administrative systems including documentation, and instead of using international guidelines that are seldom followed, physicians should be trained in prescribing hypnotics and national guidelines need to be developed.