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Khalid Al Sulaiman,1– 4 Faisal Alsuwayyid,2 Abdulrahman Alrashidi,2 Mohammed Alhijris,2 Faisal Almutairi,2 Fahad Alharthi,2 Laila Carolina Abu Esba,1– 3 Ohoud Aljuhani,4,5 Hisham A Badreldin1– 3 1Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Biostatistics and Bioinformatics Department, Riyadh, Saudi Arabia; 4Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh/Jeddah, Saudi Arabia; 5Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Khalid Al Sulaiman, King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), Riyadh, Saudi Arabia, Email alsulaimankh@hotmail.comBackground: Historically, warfarin was the mainstay anticoagulant agent to manage patients presenting with thrombotic disorders caused by Protein C or S deficiency. Several direct oral anticoagulants (DOACs) were introduced over the past decade. They showed superiority over warfarin in patients with venous thromboembolism in many landmark trials. Insufficient data are available that examine the outcome of utilizing apixaban in patients with protein S deficiency induce thrombosis.Case(s) Presentation: We reported the clinical outcomes of utilizing apixaban in four patients with systemic thrombosis caused by protein C or S deficiency who presented to a tertiary hospital in Riyadh, Saudi Arabia. Four patients exhibited typical features of thrombotic events. After confirming the diagnosis, one patient was initially started on apixaban, and the other three patients were converted from warfarin to apixaban. Three of the four patients tolerated the apixaban during the follow-up period. Additionally, they did not have any bleeding or thrombotic complications. However, one patient developed recurrent thrombotic events despite switching to different type of DOAC and was ultimately transitioned back to warfarin.Conclusion: Based on the available emerging evidence and our case series, the use of apixaban could be effective in preventing recurrent thrombotic events in patients with inherited thrombophilia without safety concerns. Further, large studies are warranted to investigate the safety and efficacy of apixaban in these population.Keywords: apixaban, protein S deficiency, thrombosis, bleeding

Heba Ashi,1 Marwah A Afeef,2 Faris M Almutairi,3 Razin H Subahi,4 Emad A Aljohani,5 Zuhair S Natto1 1Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 2Department of Research & Studies, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 3Department of Respiratory Therapy, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 4Specialty Dental Centre. Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 5Department of Health Services and Hospital Management, Al-Thagher Hospital, Jeddah, Kingdom of Saudi ArabiaCorrespondence: Marwah A Afeef, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia, Tel +966535732762, Email mafeef@moh.gov.saObjective: In this study, we aim to determine post-pandemic level of secondary traumatic stress and the associated factors among healthcare workers practicing in the Western province of Saudi Arabia.Methods: Healthcare workers practicing at public health sector of the Western province of Saudi Arabia. Received Web-based Self-administered questionnaire, assessing post-pandemic Secondary Traumatic Stress (STS), using Secondary Traumatic Stress Scale (STSS).Results: A total of 380 responses received. Logistic regression analysis identified significant predictors of secondary traumatic stress (STS). Females had a significantly higher likelihood of experiencing STS (OR=2.425, p< 0.001). Doctors were significantly more likely to experience STS compared to other specialties (OR=2.863, p=0.016). Participants sleeping 7 hours were associated with a lower likelihood of STS (OR=0.427, p=0.016), while sleeping 6 hours showed a trend towards lower STS but was not statistically significant (p=0.068). Participants aged 50 and above were significantly less likely to experience STS (OR=0.275, p=0.021). Lastly, Saudi nationals were significantly more likely to experience STS compared to non-Saudis (OR=2.717, p=0.014).Conclusion: Female healthcare workers, doctors, and those younger than 50 years old were all found to be at a significantly higher risk of STS. Interestingly, sleep duration emerged as a potential protective factor, with those sleeping 7 hours exhibiting a lower risk of STS. Finally, the analysis revealed a higher prevalence of STS among Saudi nationals compared to non-Saudis.Keywords: secondary traumatic stress, post-pandemic, healthcare workers, Saudi Arabia, public sector

Oral malignant lesions are the most common malignancy of which majority are diagnosed in advanced stages in Saudi Arabia. Patients with oral malignant lesion are first seen by general dental practitioners and dental students. Multiple surveys have been conducted and published to assess the students, interns, and dentists’ awareness and attitude toward oral premalignant lesions worldwide. However, little is known about this issue in Saudi Arabia. We aimed to assess knowledge and awareness of detecting oral premalignant lesions among dental students, dental interns, and practitioners in Saudi Arabia. A cross-sectional questionnaire-based survey was conducted and electronically distributed. The questionnaire comprised of three sections including demographic variables, knowledge of risk factors of oral malignancy, and six clinical case scenarios. Descriptive statistics were used, and the results were reported using cross-tabulation and the Chi-square test. A 300 participants answered to the questionnaire, and 83% of respondents strongly agreed that smoking is a risk factor for oral malignancy. However, there was some uncertainty in responses for some more specific oral-related factors, such as a sharp-edged tooth and irritation from dental restoration. Furthermore, the knowledge and awareness of detecting frankly benign and frankly malignant lesions such as fibroma and squamous cell carcinoma are higher comparing to potentially malignant lesion, i.e. lichen planus. Knowledge and awareness of detecting oral premalignant lesions vary based on malignancy factors and by participants academic level. Fibroma and SCC are detected easily among all participants. However, lichen planus was the hardest to diagnose among oral lesions.

Abeer Salman Alzaben,1 Asma Abdulaziz Aloudah,1 Fatimah Naif Almutairi,1 Maram Khalid Alshardan,1 Salha Ali Alasmari,1 Shatha Jubran Alsihman,1 Dalal Fahad Alshamri,2 Saeed S Alshlwi,3 Eman M Mortada1 1Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 2Department of Nutrition, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 3Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi ArabiaCorrespondence: Eman M Mortada, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Email emmortada@pnu.edu.saBackground: Sleeve gastrectomy (SG) is considered as the most common bariatric procedure in Saudi Arabia. It is a non-reversible procedure defined as removal of a large portion of the stomach.Objective: The objective of the current study is to compare the appetite and quality of life (QoL) between adults’ post-sleeve gastrectomy and obese/morbidly obese adults (pre-SG).Methods: A cross-sectional study design was conducted in adults (aged between 18 and 65 years), post-sleeve gastrectomy (n = 80, 41 Males and 39 Females) and obese group (n = 60, 28 Males and 32 Females). The study population was recruited from the bariatric surgery clinic of King Abdullah Bin Abdul-Aziz University Hospital. A self-reported questionnaire was collected that included a visual analogue scale (VAS) to assess the appetite level, and SF-36 QoL questionnaire.Results: No significant differences were found in age and gender between the study groups (p > 0.05). The median score feeling of fullness was significantly higher in the SG group (77.5, IQR: 48 and 50, IQR: 40, respectively) than in the obese group (p < 0.001). The amount of food eaten was statistically lower in the SG group (30, IQR: 20) than the obese group (50, IQR: 60) (p = 0.005). Patients post SG had significantly higher QoL scores in all physical and mental scales, physical component summary and mental component summary (p < 0.003).Conclusion: Patients post SG have improved appetite and QoL. Satiety, less prospective food consumption, BMI, age, gender and comorbidities are associated with QoL. Future studies are needed to compare the QoL in post-SG patients with the normative values of the QoL in Saudi Arabia.Keywords: appetite, obesity, quality of life, SF-36, sleeve gastrectomy, VAS

Heba M Ashi,1 Marwah A Afeef,2 Faris M Almutairi,3 Razin H Subahi,4 Emad A Aljohani,5 Zuhair S Natto1 1Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 2Department of Research & Studies, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 3Department of Respiratory Therapy, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 4Specialty Dental Centre. Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 5Department of Health Services and Hospital Management, Al-Thagher Hospital, Jeddah, Kingdom of Saudi ArabiaCorrespondence: Marwah A Afeef, Department of Research & Studies, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia, Tel +966535732762, Email mafeef@moh.gov.sa

Abstract Purpose To investigate the health-related factors and analyze the expression of epigenetic related genes and inflammatory genes in metabolic syndrome Trigger Finger (TF) and smoker TF. Methods Samples from patients’ fingers with symptomatic TF were collected. There were seven groups: healthy control group, carpal tunnel syndrome (as a control for gene expression analysis), TF, diabetic TF, hypertensive TF, dyslipidemic TF and smoker TF. The expression levels of epigenetic related genes and inflammatory genes in metabolic syndrome TF and smoker TF were evaluated by the reverse transcription–polymerase chain reaction (RT-PCR) technique. The Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) questionnaires, disability of the arm, shoulder and hand (DASH) and numeric pain rating scale were given to the participants to fill out. Results There was a significant increase in hand dysfunction in the metabolic TF groups and smoker group compared to the TF group (p

Alanoud Aladel,1 Fahmida Khatoon,2 Mohammad Idreesh Khan,3 Azzah Alsheweir,1 Malak Ghazi Almutairi,4 Sami Owaidh Almutairi,4 Faisal Khalid Almutairi,5 Kudaibergen Osmonaliev,6 Mirza Masroor Ali Beg6,7 1Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Biochemistry Department, College of Medicine, University of Ha’il, Ha’il, Saudi Arabia; 3Department of Clinical Nutrition, College of Applied Health Sciences in Ar Rass, Qassim University, Ar Rass, 51921, Saudi Arabia; 4Department of Clinical Nutrition, Almethnab General Hospital, Qassim Health Cluster, Ministry of Health, Al Mithnab, Saudi Arabia; 5Laboratory Department, Armed Forces Hospital in Qassim, Medical Services, Ministry of Defense Qassim Buraydah Al-Rass, Buraydah, Saudi Arabia; 6Faculty of Medicine, Alatoo International University, Bishkek, Kyrgyzstan; 7Centre for Promotion of Medical Research, Bishkek, KyrgyzstanCorrespondence: Mirza Masroor Ali Beg, Email mirzamasroor1986@gmail.comObjective: Growing epidemics of type-2 diabetes mellitus (T2DM) and obesity have become a serious health concern. Since miRNAs and vitamin levels affect the development and progression of numerous pathogenic diseases, including diabetes, the present study aimed to evaluate miRNA-143 and miRNA-145 expression and vitamin-D status among obese and non-obese T2DM patients.Methods: The study included 100 clinically confirmed newly diagnosed obese and non-obese T2DM cases and 100 healthy subjects. Total RNA was extracted from collected blood samples and 100 ng of RNA was used for cDNA synthesis, then TaqMan assay was performed to evaluate the miRNA-143 and miRNA-145 relative expression.Results: T2DM cases with hypertension (4.08 fold, p=0.01; 5.36 fold, p=0.009), fatigue (5.07 fold, p=0.04; 5.32 fold, p=0.03) and blurred vision (5.15 fold, p=0.01) showed higher miRNA-143 and miRNA-145 relative expression compared with their counterparts, respectively. A positive correlation was observed between miRNA-143 and miRNA-145 expression and decreased vitamin-D status in T2DM had significant association with impaired blood glucose fasting (p=0.001) and HDL level (p< 0.0001). Obese T2DM cases showed higher miRNA-143 and miRNA-145 expression compared with their counterparts. Vitamin-D deficient T2DM cases had higher miRNA-143 and miRNA-145 expression (5.69 fold, 5.91 fold) compared with insufficient (4.27 fold, p=0.03; 4.61 fold, p=0.03) and sufficient (4.08 fold, p=0.002; 4.29 fold, p=0.003). ROC curve for miRNA-143 and miRNA-145 between obese T2DM vs non-obese T2DM cases, at best possible cutoff value of 4.39 fold, 4.0 fold showed increased miRNA-143 and miRNA-145 expression, the sensitivity and specificity were 85%, 88% and 61%, 53% respectively (AUC=0.83, p< 0.0001; AUC=0.81, p< 0.0001).Conclusion: Higher miRNA-143 and miRNA-145 expression could be a predictive indicator for obese T2DM cases, decreased status of vitamin-D was also significantly associated with impaired fasting blood sugar and HDL level, therefore it is important to evaluate the vitamin-D status among T2DM cases for better clinical outcome during the intervention.Keywords: type 2 diabetes, obesity, vitamin-D, miRNA, expression, prognostic marker

Jaber Alyami,1– 3 Walaa Alsharif,4 Fahad F Almutairi,1– 3 Ali S Alyami,5 Nahla Khalifa,6 Blal Angawi,1 Hussam Alotaibi,1 Haitham Aljedaani,1 Majed Alaabsi,1 Abdulrahman M Alfuraih,7 Mohammed H Alyami8 1Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia; 2Animal House Unit, King Fahd Medical Research Center, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia; 3Smart Medical Imaging Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; 4Diagnostic Radiology Technology Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia; 5Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 6Department of Respiratory Therapy, Faculty of Medical Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia; 7Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Kharj, Saudi Arabia; 8Clinical Nutrition Department, Maternity and Children Hospital, Ministry of Health, Najran, Saudi ArabiaCorrespondence: Jaber Alyami, Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz, University (KAU), Jeddah, Saudi Arabia, Email jhalyami@kau.edu.saBackground: Effective teaching and supervision within hospitals play an essential role in training radiography students. However, inadequate preparation of teaching roles has been highlighted over the last three decades as a problem for many radiographers. This can lead to inadequate preparation and a lack of confidence in the supervisory role, which may affect the students’ learning experience. Few studies in Saudi Arabia have investigated the skills and resources needed by radiographers to become effective and confident teachers. Therefore, this study aimed to explore the experiences and confidence of clinical radiographers in teaching radiography students and establish the areas of support they require to be more effective in their clinical teaching role.Methods: An online questionnaire and semi-structured interviews were used to collect data from radiographers working in Saudi Arabia’s radiology departments. Radiographers who were involved in the supervision of students are included in the study. A total of 159 radiographers participated in the study.Results: The findings showed that radiographers were reasonably confident in four domains: introducing students and familiarizing them within the practice environment, supervision, facilitating students’ learning, and assisting students to integrate into the practice environment while some areas required further development. The finding also indicated high number of students believed that providing an accurate perspective on the philosophy of the environment is not applicable to them.Conclusion: The article concludes with a recommendation for further support and guidance for radiographers in teaching roles from institutions. The study provided insights into the world of clinical supervisors in radiology departments. Informative feedback to students during their clinical training by clinical supervisors is a key strategy to fill the gap between theory and practice experienced by students. Additionally, the importance for implementation of ongoing professional development for radiographers is advised to ensure the quality of clinical placement for radiography students.Keywords: medical education, clinical practice, confidence, experience, supervision, radiology

Lobna A Saleh,1– 3 Farooq M Almutairi,2,4 Wejdan K Alorabi,1 Bashayr A Alkuhayli,1 Shaden S Alzaidi,1 Shahad B Alzahrani,1 Futun A Aljumayi,1 Maram H Abduljabbar,1 Ayidh S Alharthi,1 Mashhour A Alsufyani,1 Mohammed H Alhazmi,1 Abdulbari A Althobaiti,1 Fahad N Almutairi,1 Fahad S Alshehri,5 Ebtehal Altowairqi,1 Yusuf S Althobaiti1,2,6 1Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 2Addiction and Neuroscience Research Unit, College of Pharmacy, Taif University, Taif, Saudi Arabia; 3Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 4Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, University of Hafar Al-Batin, Hafar Al-Batin, Saudi Arabia; 5Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 6General Administration for Precursors and Laboratories, General Directorate of Narcotics Control, Ministry of Interior, Riyadh, Saudi ArabiaCorrespondence: Yusuf S AlthobaitiDepartment of Pharmacology and Toxicology, College of Pharmacy, Taif University, Health Science Campus, P.O. Box 11099, Airport Road, Al Haweiah, Taif, 21944, Saudi ArabiaTel +966 545736200Email ys.althobaiti@tu.edu.saPurpose: Depression is one of the most common psychological disorders. The nutritional etiology of the depression proposes that vitamin D may play a significant role in the pathogenesis of depression. Further, vitamin D deficiency has been found to aggravate depression in animals. Therefore, vitamin D treatment might be a potential therapeutic aid in depression management. This study aimed to explore the antidepressant effects of vitamin D in a Bacillus Calmette-Guerin (BCG)-induced depression model.Methods: Thirty-six mice were randomly assigned to short-term and long-term experimental groups. In each group, mice were randomly subcategorized into three subgroups: 1. control (received vehicle), 2. BCG (received BCG [107 CFU/mouse]), and 3. BCG + vitamin D (received vitamin D [60.000 IU/kg] before BCG [107 CFU/mouse] inoculation). After completion of the two experimental periods (3 days for the short-term group and 2 weeks for the long-term group), the mice underwent three behavioral tests: locomotor activity, the forced swimming test (FST), and the tail suspension test (TST).Results: Locomotor activity did not significantly differ among the subgroups in either the long-term or short-term groups. In the short-term group, the total immobility time on the FST was decreased in the vitamin D-treated group compared to the BCG group. However, in the TST, no significant difference was found between the vitamin D-treated group and the BCG group. In the long-term group, the immobility time on the FST was decreased in the vitamin D-treated group compared to the BCG group. Similarly, the total immobility time on the TST was also significantly lower in the vitamin D-treated mice than in the BCG-treated mice.Conclusion: Vitamin D is useful in the management of depressive behavior. The potential role of vitamin D in the etiology of depression should be investigated in future work.Keywords: depression, natural supplements, tail suspension test, forced swimming test

Introduction: Autism spectrum disorder (ASD) is a developmental disability characterized by communication and social impairments. Alexithymia has been continuously associated with ASD due to deficiency in emotional component in both disorders. Measuring Emotional Intelligence (EI) in both disorders may reveal more insight about this relation. Objectives: To determine the prevalence of ASD among Saudi university students and to explore the link between ASD and alexithymia focusing on EI. Methods: We conducted a Cross-sectional study that included 600 students recruited via a convenient sampling technique. Data were collected using the following validated scales: Autism Spectrum Quotient (AQ10), Toronto Alexithymia Scale (TAS-20) and Trait Emotional Intelligence Questionnaire - Short Form (TEIQue-SF). Results: revealed 7.7% prevalence of ASD, 34.8% possible Alexithymia and 42.2% true Alexithymia. Male students &participants with a low GPA also were significantly associated with ASD (P = 0.032 and 0.012, respectively). Females had higher emotional intelligence than males (P = 0.022). Younger participants expressed a measurable link to emotional intelligence (P < 0.05). Alexithymia score was significantly higher among females and among those below 21 years old (P = 0.001). Approximately 16% of people with possible ASD also reported positive alexithymia. Total EI score showed no significant relation neither with ASD nor with Alexithymia. Conclusions: Prevalence of ASD and Alexithymia were considerably high among Saudi University students. male gender and low GPA were significantly associated with ASD. Alexithymia was higher among females and younger participants. The association between total EI score and both ASD and Alexithymia was statically insignificant. [ABSTRACT FROM AUTHOR]

A new design method for a second-order bandstop filter is presented. The proposed filter is based on the source follower configuration with a partial positive feedback. The positive feedback is used to increase the quality factor of the filter, and the feed-forward paths are used to create complex zeros. The proposed bandstop filter has electronically tunable centre frequency, bandwidth and attenuation with low power consumption. The proposed design has been simulated in TSMC 180 nm CMOS technology. The filter achieves 5.8 nV/√Hz input-referred noise density. For a 2 GHz input signal, the filter achieves a signal-to-noise ratio of 60 dB for 238 mV0−P, diff input signal amplitude. The simulated results show that the centre frequency tuning range is between 1.6 and 3 GHz and the bandwidth is tunable from 0.6 to 1 GHz. The filter consumes about 2.5mW for a supply voltage of 1.8 V at a centre frequency of 2.3 GHz. [ABSTRACT FROM AUTHOR]

The article discusses study that examines the deal in diagnosis of Malignant melanoma. Topics include identification of the diagnosis using the dermatology biopsy logbook, seeking medical attention for patients after noticing a new or changing lesion, relationship between patient delay and the breslow thickness of their melanoma.

Background: Purpose: Valproate (VPA) is an antiepileptic drug widely used to treat various psychiatric and neurological disorders. Although its use is generally considered safe, chronic administration may lead to kidney injury. The mechanisms underlying VPA kidney toxicity are not entirely explored. This has prompted our investigation into a novel molecular signaling pathway involved in VPA-induced kidney injury and the exploration of strategies to ameliorate this toxicity using indole-3-acetic acid (IAA) and chenodeoxycholic acid (CDCA)., Methods: Rats were divided as follows: group I (control); group II (VPA group), where rats were administered VPA (500 mg/kg, i.p.) daily to induce kidney injury for 3 weeks; and groups III and IV, where rats were orally treated with either IAA (40 mg/kg) or CDCA (90 mg/kg), respectively, 1h post-VPA dose, for 3 weeks. The effects of these compounds on kidney tissues were evaluated with a focus on their antioxidant and anti-inflammatory properties using biochemical, histopathological, and immunohistochemical analyses., Results: VPA caused a significant reduction in renal glutathione (GSH) and heme oxygenase-1 (HO-1) levels, and superoxide dismutase (SOD) activity, along with a significant elevation in malondialdehyde (MDA) levels. Similarly, tumor necrosis factor-α (TNF-α), interleukin-1beta (IL-1β), and interleukin-6 (IL-6) levels were significantly increased. Immunohistochemical analysis demonstrated a significant decline in the immunoreactivity of nuclear factor erythroid 2-related factor (Nrf2) and cytoglobin antigens in renal cells. However, administration of either IAA or CDCA significantly ameliorated these altered parameters, including Nrf2/HO-1 and cytoglobin levels., Conclusion: IAA and CDCA alleviated the kidney injury induced by VPA via downregulating the inflammatory response and upregulating the antioxidant capacity in renal tissue., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Vulvo-vaginal-oral lichen planus (VVO-LP) is a chronic inflammatory condition affecting the mucous membranes of the oral cavity, skin, and genital areas. The exact etiology remains unclear, although immune-mediated mechanisms are considered likely contributors. It is a rare form of lichen planus, which typically presents in adults and is more common in middle-aged women. Key clinical features include painful ulcerative lesions in the oral, vaginal, and cutaneous regions, often resistant to conventional treatment. This condition can significantly impact the patient's quality of life due to persistent symptoms and complications such as scarring and infection. In this review, we present a case of a 43-year-old Saudi female who presented to our Oral Medicine Clinic with recurrent painful ulcerative lesions affecting the mouth, skin, and vaginal mucosa. Her medical history included type II diabetes mellitus and hypercholesterolemia. Oral biopsy results confirmed the diagnosis of lichen planus, with no signs of dysplasia. The patient was treated with a variety of topical and systemic therapies, including corticosteroids and immunosuppressants, but showed only temporary improvement. Despite short-term remission with all provided medications, the lesions recurred after discontinuation of treatment in a more severe form. This case report emphasizes the challenges associated with the diagnosis and management of VVO-LP, particularly its resistance to standard therapies. The patient's case underscores the need for further research into novel treatment strategies and long-term management plans for this rare and debilitating condition., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Health Sciences Colleges Research on Human Subjects King Saud University issued approval E-22-7371. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almutairi et al.)

Introduction: As 3D design and printing technology gains popularity, there remains limited evidence on dental students' perceptions in Saudi Arabia regarding its use. This study aims to assess the knowledge and awareness of dental students in Saudi Arabia about 3D design and printing technology., Methods: A cross-sectional questionnaire-based study was conducted among dental students in their third, fourth, and fifth years at multiple universities in Saudi Arabia between February and October 2023. A validated self-administered questionnaire with 15 close-ended items, including demographic and knowledge-related questions about 3D design and printing, was used. Statistical analysis was performed using Chi-square and Fisher exact tests to identify factors associated with knowledge and awareness levels., Results: A total of 374 dental students participated in the study, with 63.1% being female students. Of the participants, 40.4% identified the cost of equipment as the primary barrier to 3D printing usage in dentistry in Saudi Arabia. The majority (94.4%) recognized the advantages of 3D models for implant placement. Awareness of 3D printing utilization in the field was reported by 69.3% of participants, and 74.3% acknowledged its increasing popularity. Furthermore, 73.8% of participants expressed confidence in the biocompatibility and safety of 3D printed materials. A significant percentage (64.0%) were aware of 3D printing's role in creating Invisalign aligners, and 42.4% believed in the value of 3D printed drill guides for root canal treatment. The study found statistically significant regional differences ( p  < 0.05) across all questions. Participants primarily relied on colleges (64.8%) as their source of information, and a high proportion (82.4%) expressed interest in further exploring the usage of 3D printing in dentistry., Conclusion: Our study found that students' knowledge and awareness in Saudi Arabia are generally satisfactory. Integrating 3D printing into dental curricula and providing workshops is crucial to meet dental students' interest in exploring its usage and equipping them for its future implementation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor AA declared a shared affiliation with the author(s) ABR, MA, HA at the time of review., (© 2024 Alamri, Alshammari, Bin Rahmah, Alsaif, Almutairi, Alolaywi, Altariqi, Alotaibi, Almutairi, Almadhoon and AlMoharib.)

Objectives: The aim of this study was (i) to design and develop a portable BCA device for measuring body composition parameters such as body weight, body fat (BF) %, total body water (TBW), fat-free mass (FFM), muscle mass (MM), and bone mass (BM); (ii) to validate the developed portable BCA with the Tanita MC 980 MA BCA device., Methods: For this current study, two hundred healthy and obese subjects, whose ages ranged from 8 to 12 years (8.4 ± 1.7), were considered., Results: The highest percentage difference between the two study groups was found to be in BFat (50.39%), followed by body mass index (BMI) (41.73 kg), FFM (38.32 kg), and MM (37.89 kg), and this was found to be statistically significant. The results obtained from the designed prototype of the body composition analyzer were validated using Tanita MC 980MA BCA. The overall error% was calculated as ±3% for measuring the different body composition parameters., Conclusions: Due to its low standard error and high overall accuracy, the BCA prototype demonstrates the potential to be a dependable instrument for evaluating and tracking the body composition of children.

The aim of this study was to appraise the bibliometric parameters of pulpotomy in the past 24 years from January 2000 to December 2023. The dataset was obtained from the Web of Science (WoS) database. The filter publication years were applied. The bibliographic details of all types of documents indexed in the WoS database under keywords of " Dental pulp exposure " or " Coronal pulpotomy " or " Partial pulpotomy " or " Permanent pulpotomy " or Pulpectomy published in the targeted period (2000-2023) were downloaded. The bibliometric characteristics such as the type of documents, growth of publications and citations by years, level of evidence, top publication channels, top countries, top contributing organizations, top authors, and keywords were analyzed. MS Excel, VOSviewer, and R were utilized for data analysis. A total of 738 documents were identified, and they were published in 213 sources contributed by 3,017 authors from 75 countries. A fluctuated growth was recorded and the majority of the research (82.12%) was published in the latter half (2012-2023) of the targeted period. Most of the studies utilized the Level of Evidence (LoE) IV but the studies on LoE-I gained the highest average citations. The majority of papers were produced by India, closely followed by Brazil and the United States. Thus, the upward trend in the latter half was suggestive of advancement in oral health education along with enhancement in research publications., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arun Gopinathan et al.)

Objective: This study aimed to evaluate the knowledge and awareness of dental students and interns in Saudi Arabia regarding human papillomavirus and oral cancer using a cross-sectional web-based survey., Materials and Methods: A cross-sectional survey was undertaken to assess the knowledge of dental students and dental interns regarding oral cancer and awareness of human papillomavirus (HPV) in public and private dental schools in Saudi Arabia. The survey included 18 questions grouped into three sections. The responses were analyzed for variations between dental students and interns, among males and females, and those attending private or public colleges. The Chai-square test assessed the correlation between participants' demographic data and their knowledge/awareness of oral cancer and HPV., Results: A total of 451 dental students and dental interns responded. The results show that dental students at private and public dental schools in Saudi Arabia are generally knowledgeable regarding knowledge of oral cancer and awareness of human papillomavirus. The dental interns exhibited significantly superior knowledge compared to the undergraduate dental students (p<0.05), particularly in the areas of identifying the most common location of oral cancer and recognizing the signs and symptoms of oral cancer (76.5% versus 65.1% correct answers). The dental interns showed a significant difference and better awareness (p<0.05) than dental students regarding HPV having a relationship with AIDS and HPV causing common warts., Conclusion: Dental students and interns in this study presented a good but less than optimal knowledge and awareness regarding HPV and its prevention. Improving education courses and training for dental students in Saudi Arabia is crucial for improving their knowledge and awareness regarding oral cancer and HPV infection.

Background: Fasting headaches frequently occur during the first few days of Ramadan, and treatment is challenging because of fasting., Objective: This study aimed to evaluate the effect of extended-release paracetamol on preventing fasting headaches., Methods: A randomized, open-label clinical trial investigated the efficacy of extended-release paracetamol at a daily dose of 1330 mg in preventing fasting headache. Adults aged 18 years and older were recruited through the Clinical Trial Unit at the King Saud University Medical City. The eligible participants in the study fasted 13.5 h daily during the first week of Ramadan. Participants in the treatment and control arms were followed up to investigate the occurrence, severity, and timing of headache symptoms via self-reporting using a standardized headache diary scale with a daily online link or phone call. The primary outcome was the frequency of headache episodes while fasting during the first week of Ramadan., Results: A total of 238 participants were enrolled and randomized. Of these, 173 followed the protocol (80 treated, 93 control) for at least the first day and were included in the analysis. Most participants were young and healthy, with a mean age of 32.2 ± 10.2 years. More men were included in the study (102/173; 59.0%), a small proportion of participants were smokers (31/173; 17.9%), and almost all participants reported being coffee drinkers (165/173; 95.4%); nonetheless, these characteristics were evenly distributed between the two groups in the study. The overall incidence of headache episodes was 33.0% (57/173) on day 1 and decreased to 11.3% (18/159) on day 7. On average over the 7 days, no significant effect was observed for the treatment on the incidence of headache, as the findings from the generalized estimating equation model indicated (β = -0.398, p = 0.084; odds ratio = 0.67, 95% confidence interval [CI] 0.42-1.06). Moreover, there was initially no significant difference in the incidence of headache episodes between the treatment and control groups. However, the treatment group had significantly fewer headache episodes during fasting than the control group on day 3 (4/72 [5.6%] vs. 15/91 [16.5%], p = 0.031; relative risk [RR] = 0.34, 95% CI 0.12-0.97) and day 6 (5/69 [7.2%] vs. 20/90 [22.2%], p = 0.010; RR = 0.33, 95% CI 0.13-0.82). No adverse effects were observed during the study period., Conclusion: No significant differences were observed in the occurrence of fasting headaches between the two groups on most days during the study period. Additional studies are required to address fasting headaches during the first week of Ramadan., (© 2024 American Headache Society.)

Background/objectives: We aimed to assess the prevalence and risk factors for acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli ( E. coli ) in children admitted with urinary tract infection (UTI) at a tertiary university hospital in Saudi Arabia, as well as to investigate antibiotic resistance patterns., Methods: This retrospective cross-sectional study involved hospitalized children aged 0-14 years from January 2018 to December 2022 with urine cultures that grew E. coli or ESBL-producing E. coli . Data of the antimicrobial susceptibility for isolated bacteria were collected., Results: This study analyzed 242 urine samples obtained from 119 children with E. coli UTIs. Of these, 20.7% ( n = 50) were ESBL producers. Previous antibiotic use (last 3 months), prophylactic antibiotic use, prior UTI (last 3 months), recurrent UTIs, and underlying co-morbidities ( p = 0.011, <0.001, 0.025, <0.001, and 0.013, respectively) had a significant relationship with increased risk of ESBL E. coli UTIs. Generally, the highest resistance rates in the ESBL-producing isolates were for ampicillin and third-generation cephalosporin. Conversely, all ESBL-positive isolates were sensitive to meropenem, with variable resistance rates to other antibiotics as amikacin, nitrofurantoin, quinolones and trimethoprim/sulfamethoxazole (2%, 8%, 56% and 64%, respectively)., Conclusions: There is a high prevalence of ESBL production among children hospitalized with E. coli UTIs. Addressing ESBL UTI risk factors helps to recognize high-risk cases and enhance proper antibiotic use.

Background: Hyperuricemia has been linked to various adverse clinical outcomes. Data on the clinical outcomes and the relationship between hyperuricemia and sepsis remain limited. The aim of this study was to evaluate the impact of hyperuricemia on clinical outcomes in sepsis patients and to identify whether it can predict the mortality in this patient population. Methods: This was a retrospective cohort study of adult patients with sepsis admitted to the intensive care unit (ICU) from 1 January 2021 to 31 December 2023. The patients were divided into hyperuricemia and non-hyperuricemia groups. Hyperuricemia was defined as a serum uric acid level > 416.4 µmol/L (7.0 mg/dL) in males or >357.0 µmol/L (6.0 mg/dL) in females based on the first serum uric acid reading within 24 h of ICU admission. The primary outcome of this study was ICU mortality. Secondary outcomes included in-hospital mortality, progression to septic shock, and ICU and hospital lengths of stay (LOSs). Results: A total of 599 patients were included in the study. Among these, 303 were in hyperuricemia group, while 296 were in the non-hyperuricemia group. The incidence of ICU and in-hospital mortality was higher in the hyperuricemia group compared to the non-hyperuricemia group (26.7% vs. 18.9% ( p < 0.001) and 34.7% vs. 19.3% ( p < 0.001), respectively). After adjusting for cofounders, hyperuricemia was not a predictor of ICU mortality (OR 1.52, 95% CI 0.95-2.43, p = 0.083). Most secondary outcomes were similar between the groups. However, the hyperuricemia group had a higher incidence of progression to septic shock (67.3% vs. 50.7%, p < 0.001), and hospital LOS was significantly longer in the hyperuricemia group (384 vs. 264 h, p = 0.004). Conclusions: Our findings demonstrated that hyperuricemia in sepsis patients was associated with worse clinical outcomes such as higher ICU and hospital mortality. Moreover, there was a higher incidence of septic shock progression and longer hospital LOS. The other outcomes were not statistically significantly different. Further prospective research is warranted to confirm these findings.

Background ENT disorders are common, leading many people to seek medical advice. A common misconception among the population is that upper respiratory tract viral infections can be treated with antibiotics, despite their ineffectiveness against viruses. Assessing the level of knowledge and awareness regarding common ENT-related issues among the population in the Qassim region is therefore crucial. Methods We conducted a cross-sectional study using a random sampling technique to survey 415 participants aged 18 and above. Data were collected through an online self-administered questionnaire and analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA). The questionnaire assessed participants' knowledge of various ENT issues, and scores were calculated to gauge overall awareness. Results The majority of participants demonstrated a satisfactory level of knowledge, with a mean knowledge score of 9.37 ± 3.59. Significant gender differences were observed, with females displaying higher knowledge levels (61.9%, p < 0.05). Additionally, higher educational attainment was positively correlated with better awareness of ENT issues. Conclusion While general awareness of ENT-related issues in the Qassim region is adequate, specific knowledge gaps remain, particularly regarding the treatment of viral infections. Targeted educational initiatives are needed to address these gaps, focusing on groups with lower awareness levels., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Regional Research Ethics Committee, Qassim Province issued approval 607/45/16889. We are pleased to inform you that your research proposal has been approved by the local ethics committee. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alenezi et al.)

Background: Fasting-induced headaches (FIHs) have been shown to occur on the first day of Ramadan and clearly decline thereafter. Despite the wealth of knowledge about different types of headaches (e.g., migraine-, cluster-, and tension-type headaches), research on the mechanism underlying FIHs, as well as their treatment, remains scarce. Our study aimed to investigate any association between FIHs during the first day of Ramadan and potential headache-related biomarkers, including fasting blood glucose (FBG), C-reactive protein (CRP), magnesium, vitamin B9, vitamin B12, homocysteine, and calcitonin gene related peptide (CGRP), and to assess whether a prophylactic use of paracetamol may influence these biomarkers., Methods: As part of a randomized, open-label clinical trial that evaluated the effect of paracetamol as a prophylactic therapy for FIH, blood samples from stratified subjects in the prophylaxis and control groups were withdrawn while fasting after the 1st dose of paracetamol (in the prophylaxis group) and prior to reporting headache occurrence., Results: Plasma and serum were separated for 61 subjects; 31 and 30 subjects from the prophylaxis and control groups, respectively. Overall, no significant differences were found in the levels of FBG, CRP, magnesium, vitamin B9, and vitamin B12 in headache-suffering subjects compared to those without headache despite the use of paracetamol for prophylaxis. Homocysteine, however, was significantly reduced in all subjects who experienced FIH compared to those without headache (median 6.9 [1.6] vs. 7.7 [2.7] umol/L; p = 0.041). On the contrary, when the CGRP was measured using immunoassay, it was found to be significantly elevated in all headache-suffering subjects compared to those without headache (median 126.1 [17.7] vs. 105.8 [19.6] pg/mL; p ≤ 0.0001). This difference was maintained upon comparing the headache to non-headache subjects in both the prophylaxis (median 121.5 [15.4] vs. 105.8 [9.4] pg/mL; p < 0.01) and control groups (median 128.5 [28.3] vs. 105.8 [23.8] pg/mL; p < 0.01). Additionally, an elevated CGRP level was found to increase the odds of having a FIH [OR = 1.32; 95%CI 1.06-1.22]., Conclusions: Our findings revealed the role of CGRP in FIHs for the first time and suggest further investigation in signaling pathways downstream CGRP receptors. Furthermore, the modulation CGRP or CGRP receptors could have a clinical application in the prevention of FIHs., Trial Registration: This study was registered with the Saudi Food and Drug Authority in the Saudi Clinical Trials Registry (SCTR; No. 22122102)., (© 2024. The Author(s).)

Gingival fibroma is a pathological condition that can manifest in pediatric and adult patients, often presenting diagnostic challenges due to shared histopathological characteristics among various lesions. It has been reported as a novel category with distinct histopathological features with new diagnostic criteria. A 40-year-old Saudi female patient with no significant medical history reported a 4×3 cm pedunculated, non-tender, firm, red gingival growth adjacent to the remaining root of tooth number 27 in the maxillary left side. Radiographic assessment yielded remarkable findings. An excisional biopsy was performed, and histopathology analysis confirmed the lesion to be a gingival fibroma. This case marks the first reported instance of gingival fibroma in Saudi Arabia. The recognition of such distinctive histopathological features contributes to improved diagnostic accuracy and highlights the need for vigilance in identifying emerging pathological entities within the gingival overgrowths. The recognition of gingival fibroma as a unique pathological entity is clinically significant, resolving diagnostic challenges in gingival growth cases. Specific diagnostic criteria enable accurate differentiation from similar lesions. The advancement improves patient care and refines the understanding of gingival overgrowth pathogenesis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almutairi et al.)

Introduction: Musculoskeletal disorders (MSDs) are rapidly rising in Saudi Arabia, reaching levels similar to those in the Western world. Hence, we aimed to assess the prevalence of neck, shoulder, and lower back pains (musculoskeletal pain, MSP) among students at King Khalid University in Abha, Saudi Arabia., Methods: This cross-sectional study was conducted at King Khalid University in Abha, Saudi Arabia, from March 2023 to August 2023. Inclusion criteria were: university students aged 18 years and older of both sexes who agreed to participate in the study. The modified Nordic questionnaire was used, which comprised three parts., Results: Out of 536 respondents, 337 were women and 199 were men. The average body mass index (BMI) of the study population was 25.3 ± 4.01. In total, 223 (41.60%) had a history of MSDs. Only 232 (43.28%) of the population did regular exercise. According to multiple logistic regression analysis, factors associated with MSDs are mobile device use (with both hands) with a large neck tilt below the horizon line position (OR = 2.276, CI 1.178-4.397, p  = 0.014), family history of trauma (OR = 5.450, 95% CI 3.371-8.811, p  = 0.000), family history of MSDs (OR = 4.241, 95% CI 2.296-7.835, p  = 0.000), coffee consumption (OR = 1.967, CI 1.281-3.020, p  = 0.002), and time spent on electronic devices: 1-3 h (OR = 0.252, 95% CI 0.124-0.511, p  = 0.0001), 4-6 h (OR = 0.455, 95% CI 0.237-0.873, p  = 0.018), and 6-9 h (OR = 0.348, 95% CI 0.184-0.660, p  = 0.001)., Conclusion: The present study concludes that MSP among university students is high. A history of trauma, a family history of MSDs, the hand and neck position when using electronic devices, the amount of time spent using them, and regular exercise are risk factors that are strongly associated with MSP. There is strong evidence to suggest that increasing physical activity plays a significant role in enhancing the functionality of the musculoskeletal (MSK) system and alleviating pain. It is recommended that universities implement educational programs to raise awareness and health screenings about the impact of device usage on MSK health and the benefits of regular exercise., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kandasamy, Almanasef, Almeleebia, Orayj, Shorog, Alshahrani, Prabahar, Veeramani, Amirthalingam, Alqifari, Alrashidi, Aldurum, Almutiri, Alzaidi and Almutairi.)

The aim and objective of the research are to develop an automated diagnosis system for the prediction of rheumatoid arthritis (RA) based on artificial intelligence (AI) and quantum computing for hand radiographs and thermal images. The hand radiographs and thermal images were segmented using a UNet++ model and color-based k-means clustering technique, respectively. The attributes from the segmented regions were generated using the Speeded-Up Robust Features (SURF) feature extractor and classification was performed using k-star and Hoeffding classifiers. For the ground truth and the predicted test image, the study utilizing UNet++ segmentation achieved a pixel-wise accuracy of 98.75%, an intersection over union (IoU) of 0.87, and a dice coefficient of 0.86, indicating a high level of similarity. The custom RA-X-ray thermal imaging (XTNet) surpassed all the models for the detection of RA with a classification accuracy of 90% and 93% for X-ray and thermal imaging modalities, respectively. Furthermore, the study employed quantum support vector machine (QSVM) as a quantum computing approach which yielded an accuracy of 93.75% and 87.5% for the detection of RA from hand X-ray and thermal images. In addition, vision transformer (ViT) was employed to classify RA which obtained an accuracy of 80% for hand X-rays and 90% for thermal images. Thus, depending on the performance measures, the RA-XTNet model can be used as an effective automated diagnostic method to diagnose RA accurately and rapidly in hand radiographs and thermal images.

The study's primary objectives encompass the following: (i) To implement the object detection of ovarian follicles using you only look once (YOLO)v8 and subsequently segment the identified follicles using a hybrid fuzzy c-means-based active contour technique. (ii) To extract statistical features and evaluate the effectiveness of both machine learning (ML) and deep learning (DL) classifiers in detecting polycystic ovary syndrome (PCOS). The research involved a two different dataset in which dataset1 comprising both normal (N = 50) and PCOS (N = 50) subjects, dataset 2 consists of 100 normal and 100 PCOS affected subjects for classification. The YOLOv8 method was employed for follicle detection, whereas statistical features were derived using Gray-level co-occurrence matrices (GLCM). For PCOS classification, various ML models such as Random Forest (RF), k- star, and stochastic gradient descent (SGD) were employed. Additionally, pre-trained models such as MobileNet, ResNet152V2, and DenseNet121 and Vision transformer were applied for the categorization of PCOS and healthy controls. Furthermore, a custom model named Follicles Net (F-Net) was developed to enhance the performance and accuracy in PCOS classification. Remarkably, the F-Net model outperformed among all ML and DL classifiers, achieving an impressive classification accuracy of 95% for dataset1 and 97.5% for dataset2 respectively in detecting PCOS. Consequently, the custom F-Net model holds significant potential as an effective automated diagnostic tool for distinguishing between normal and PCOS., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 S. et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Saudi Arabia has seen a significant improvement in its healthcare system over the past four decades resulting in an increase in life-expectancy. Transcatheter aortic valve implantation (TAVI) has spread widely in Saudi Arabia and has become a routine procedure in many centers. The expanding clinical indications and the availability of the technology have made it possible for many large and intermediate centers all over the country to commence their own TAVI programs. So, the aim of this document is to standardize TAVI practices in different Saudi Arabian centers through reasonable guidelines based on the evaluation and summarization of the best available evidence. The review committee, composed of different experts in several aspects of the management of patient undergoing TAVI, based their recommendations on the reviewed and analyzed evidence and the class and level of recommendations were discussed until a consensus was reached by the panel., Competing Interests: Conflict of interest: None declared., (© 2024 Saudi Heart Association.)

Objectives: We aimed to develop a streamlined algorithm for the management of intracoronary calcification that includes guidance on intracoronary imaging and the appropriate selection of atherectomy devices., Methods: National experts representing both the National Heart Center (NHC) and the Saudi Arabian Cardiac Interventional Society (SACIS) met to develop a consensus document on the assessment and management of intracoronary calcification in Saudi Arabia. The nominal group technique was utilized; a number of statements on the assessment and management of coronary artery calcification were developed based on a systematic review of the literature. The authors discussed the developed statements until a consensus was reached., Results: Twenty statements were discussed and agreed upon. Invasive and non-invasive imaging modalities in the assessment of coronary artery calcification, and management of intracoronary calcification using calcium ablation techniques, excimer laser coronary atherectomy, ballon-based techniques, and shockwave lithotripsy; were all thoroughly discussed in light of scientific evidence and the experts' clinical practice., Conclusions: We present a national consensus on the assessment and the multifaceted management of intracoronary calcification in Saudi Arabia., Competing Interests: Conflict of interest: None to declare., (© 2024 Saudi Heart Association.)

Kounis syndrome (KS) is commonly defined as acute myocardial infarction (AMI) secondary to exposure to an allergen. There are multiple identified allergens that are associated with KS, examples include medications, food, and contrast media. After exposure to an allergen, the allergic pathway is triggered leading to vasospasm in coronary vessels which later on presents as AMI. A high index of clinical suspicion is of crucial importance as there are multiple variants of KS. Each type requires a different management approach depending on the severity of the presenting symptoms. Here, we present a case of a 65-year-old female with a history of transient ischemic attack (TIA) who presented to our hospital with symptoms of urinary tract infection and received the first dose of ceftriaxone while in the ER. She then developed symptoms of shortness of breath, chest pain, and diaphoresis associated with overall skin itchiness with ECG evidence of ST-elevation myocardial infarction (STEMI) in the inferior leads. She was given initial measures to treat possible allergic reactions including steroids and diphenhydramine and her ECG showed complete resolution after that; therefore, she was presumed to have KS after exposure to antibiotics. In this case report, we elaborate more about our case and further explore management options for KS., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almegbel et al.)

Obesity is an established risk factor for numerous malignancies, although it remains uncertain whether the disease itself or weight-loss drugs are responsible for a greater predisposition to cancer. The objective of the current study was to determine the impact of dulaglutide on genetic and epigenetic DNA damage caused by obesity, which is a crucial factor in the development of cancer. Mice were administered a low-fat or high-fat diet for 12 weeks, followed by a 5-week treatment with dulaglutide. Following that, modifications of the DNA bases were examined using the comet assay. To clarify the underlying molecular mechanisms, oxidized and methylated DNA bases, changes in the redox status, levels of inflammatory cytokines, and the expression levels of some DNA repair genes were evaluated. Animals fed a high-fat diet exhibited increased body weights, elevated DNA damage, oxidation of DNA bases, and DNA hypermethylation. In addition, obese mice showed altered inflammatory responses, redox imbalances, and repair gene expressions. The findings demonstrated that dulaglutide does not exhibit genotoxicity in the investigated conditions. Following dulaglutide administration, animals fed a high-fat diet demonstrated low DNA damage, less oxidation and methylation of DNA bases, restored redox balance, and improved inflammatory responses. In addition, dulaglutide treatment restored the upregulated DNMT1, Ogg1, and p53 gene expression. Overall, dulaglutide effectively maintains DNA integrity in obese animals. It reduces oxidative DNA damage and hypermethylation by restoring redox balance, modulating inflammatory responses, and recovering altered gene expressions. These findings demonstrate dulaglutide's expediency in treating obesity and its associated complications., (© 2024 Wiley Periodicals LLC.)

Albers-Schönberg disease, also known as osteopetrosis or marble bone disease, is a rare genetic disorder characterised by increased cortical bone mass due to dysfunctional osteoclast cells. This case report presents a 34-year-old male with autosomal dominant osteopetrosis (ADO), who was referred for evaluation and treatment of a chronic mandibular abscess with associated osteomyelitis and fistula. The patient's medical history included multiple fractures necessitating open reduction and internal fixation. Radiological examinations revealed the presence of chronic osteomyelitis in the mandible, marked by an increase in bone density and obliteration of medullary spaces. The treatment approach included surgical debridement, extraction of adjacent teeth, sequestrectomy, and antibiotic therapy. Notably, Enterobacter cloacae bacteria were identified through culture, leading to a tailored antibiotic regimen. Follow-up assessments, including clinical photographs and postoperative CT scans, were conducted to monitor the patient's progress. Histopathological examination confirmed osteomyelitis showing both viable and non-viable bone, surrounded by significant inflammatory infiltrate. This case underscores the complexity of managing osteomyelitis in patients with osteopetrosis and highlights the importance of early diagnosis, particularly before dental extractions, to prevent disease exacerbation. The rarity of this condition emphasises the need for further research and awareness among healthcare providers for optimal patient care., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almutairi et al.)

Facial injuries, including maxillofacial trauma (MFT), are common in children and adolescents due to their age and bone maturation stage. Children's injuries are less common than adults' due to parental supervision and the flexibility of the facial bone. Causes of maxillofacial bone fractures (MFBF) vary based on socioeconomic, cultural, and environmental factors. Management of MFBF in children and adolescents should consider their growth and development stage. A systematic review is needed to understand the prevalence, pattern, and distribution of MFBF in Saudi Arabia. This systematic review aimed to identify papers on MFBF in children and adolescents in Saudi Arabia using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The search strategy involved searching electronic databases like PubMed/Medline, Web of Science, and Ebsco. The review included full-text original research papers, with inclusion criteria including English publications, human studies, and no restrictions on sample size, gender, date, or language. The selection process involved screening titles and abstracts, evaluating full texts, and identifying relevant studies. Data extraction involved two authors individually assessing selected studies. The PRISMA flow diagram of the literature search revealed that 26 papers were identified, of which 15 remained after excluding duplicates. After screening titles and abstracts, 10 articles were removed, and five papers were assessed for eligibility. Four papers met the inclusion criteria for the systematic review. The studies examined 1447 patients for the presence of MFBF in different regions. The majority of MFBF were caused by falls and road traffic accidents (RTAs) in children and adolescents. Mandibular fractures were the most common, followed by maxillary fractures. The majority of patients had tooth/teeth avulsions, followed by tooth luxation and crown fractures. Only one study described investigation methods for MFBF diagnosis. The systematic review reveals a high prevalence of MFBF among children and adolescents in Saudi Arabia, primarily due to falls and RTAs. The mandible is the most frequently fractured bone, and many children have concomitant teeth involvement. To reduce MFBF, effective initiatives and parental awareness strategies are recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Gaikwad et al.)