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Saeed Aljohani,1 Jingyun Wang,2 Mitchell Scheiman,3 Qing-Qing Tan,4 Hongxin Xu,5 Nawaf Almutairi,1 Saleh Alshammeri1 1Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia; 2SUNY College of Optometry, New York, NY, USA; 3Salus University, Wyncote, PA, USA; 4Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China; 5Panorama Windows Ltd, New York, NY, USACorrespondence: Saeed Aljohani, Email sa.aljohani@qu.edu.saBackground: Previous studies have shown that it is necessary to evaluate adherence during the treatment process, using educational intervention methods which have been shown to improve adherence with patching treatment. A previous study reported that an educational cartoon had significantly improved adherence with patching. However, this black-white cartoon is not commercially available.Objective: This study investigates the feasibility of a 4-minute educational cartoon video in improving adherence with patching therapy for amblyopic children.Methods: Children (3 to 10 years old) with unilateral amblyopia who were prescribed 2 hours or 6 hours of patching per day were enrolled. Objective adherence to the treatment was tracked using a microsensor. Children returned after 4 weeks ± 2 days to measure adherence. Participants with adherence ≤ 50% were eligible to watch the educational cartoon video. They continued with the previously prescribed treatment (2 hours or 6 hours patching) for an additional week to evaluate the follow-up adherence.Results: A total of 27 participants were enrolled. The mean age (SD) was 6.6 (1.5) years. Twenty-two participants (12 in the 2 hours patching group and 10 in the 6 hours patching group) had adherence ≤ 50% and watched our cartoon video. The cartoon video improved mean adherence (SD) from 29.6% (11.9%) to 56.8% (12.1%) in all 22 participants from both regimens (paired 2-tailed t-test, t= − 11, P < 0.000).Conclusion: The Educational cartoon video is feasible for use in a clinical setting. These data showed a trend of improvement in adherence with both patching regimens in children after watching the educational cartoon video.Keywords: educational cartoon, amblyopia, adherence, patching

OBJECTIVE: This study aimed to evaluate the efficacy and tolerability of perampanel, which was used in a cohort of patients with refractory epilepsy for up to 3.5 years in a real-world setting in Saudi Arabia. PATIENTS AND METHODS: Data from the medical records of patients treated with perampanel between March 13th, 2017, and September 6th, 2020, at neurology clinics at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh and Jeddah, Saudi Arabia, was collected. The Liverpool Adverse Events Profile (LAEP) scale was also used to measure the adverse effects of perampanel. RESULTS: Of the 75 included patients, 66.7% responded to perampanel at the last follow-up, including 22.7% seizure-free for at least the last six months, and 44% of patients responded with a ≥ 50% reduction in seizure frequency from baseline. The overall incidence of adverse effects that led to perampanel discontinuation was 13.3%; the most common adverse effect was aggressive behavior followed by sedation. Pre-existing psychiatric comorbidity was significantly associated with the incidence of psychiatric and behavioral adverse effects on perampanel (p = 0.0206). The mean score of LEAP was 40. The most frequently rated adverse effects in LEAP were "feelings of anger and aggression to others", "nervousness and/or agitation" and "sleepiness". The efficacy and tolerability of perampanel were dose-dependent. Dose 6 mg/day was the most frequently used dose that was taken by about one-third of patients at their last visit. CONCLUSIONS: Perampanel was effective as an adjunctive treatment for intractable seizures, with a responder rate of 66.7%. The long-term tolerability of perampanel was generally good. Aggressive behavior was the most common reason for perampanel discontinuation. Patients should be counseled and monitored for these adverse effects, particularly those with a history of previous psychiatric and behavioral problems. [ABSTRACT FROM AUTHOR]

Abstract. – OBJECTIVE: The aim of this study was to assess the extrusion bond values of fiber post to radicular dentin when disinfected using different final irrigants lemon garlic extract (LGE), riboflavin (RFP) activated by PDT (photodynamic therapy), and Q-mix 2-in-1. MATERIALS AND METHODS: Forty single-rooted mandibular premolar teeth were decoronated. Endodontic treatment was performed, and the canals were continually irrigated with normal saline, dried with paper points, and obturated. Post space was prepared by removing gutta-percha using peso-reamers. All specimens were randomly allocated into four groups based on the final irrigant used. Specimens in Group 1 irrigated with: 5.25% NaOCl+17% EDTA, group 2: 5.25% NaOCl+Q-mix 2-in-1, group 3: 5.25% NaOCl+RFP, and group 4: 5.25% NaOCl+LGE. Following final irrigation, a fiber post was placed in the canal space and luted. Samples were sectioned and each section was placed in a universal testing machine to assess bond values. Debonded samples were assessed for failure modes, EBS and modes of failure. For comparisons among groups, the one-way analysis of variance (ANOVA) test and the Post-Hoc Tukey HSD test were used keeping the level of significance at p=0.05 RESULTS: The cervical section of samples in group 2 (NaOCL+Qmix) (7.11±0.81 MPa) exhibited the maximum value of EBS. However, the apical section of samples in group 3 (5.25% NaOCl+RFP) (3.33±0.26 MPa) displayed minimum extrusion bond values. Group 3 specimens in which final irrigation was performed with RFP established significantly lower bond integrity values than all the other investigated groups coronal (3.77±0.13 MPa), middle (3.60±0.41 MPa), and apical (3.33±0.26 MPa) (p<0.05). Intragroup ison analysis, the coronal and middle root sections of all the experimental groups displayed comparable outcomes of EBS (p>0.05). However, near the apical section of the root, the bond strength of all the groups declined considerably. CONCLUSIONS: Q-mix 2-in-1 as the final irrigant displayed the highest extrusion bond strength of fiber-reinforced composite to canal dentin at all three levels coronal, middle and apical. Lemon garlic extract has the potential to be used alternative to ethylene diamine tetra acetic acid as a final irrigant. [ABSTRACT FROM AUTHOR]

Khalid A Bin Abdulrahman,1 Badr Abdullatif Alobaida,2 Rakan Abdullah Alzabadin,2 Abdulaziz Khalid Alosaimi,2 Nafea Saad Almutairi,2 Faisal Abdullah Alayed,2 Basil Khalid Alsahabi,2 Abdullah Khalid Alqumaizi2 1Department of Medical Education, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 2College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaCorrespondence: Khalid A Bin Abdulrahman, Department of Medical Education, College of Medicine, Imam Mohammad Ibn Saud Islamic University, P.O. Box 7544 – Othman Bin Affan Road, Al-Nada, Riyadh, 13317 – 4233, Saudi Arabia, Tel +966 505445384, Email kab@imamu.edu.saBackground: Medical education is a challenging profession requiring students to acquire various skills and develop them continuously before and after graduation. The study aimed to assess the students’ preference toward specialty and determine their preferred residency program and future ambitions regarding administrative and leadership positions.Methodology: This is a cross-sectional self-administered survey that included medical students in 1st year, and 5th year and internship at Imam Mohammad Ibn Saud Islamic University (IMSIU). The questionnaire consisted of demographic information and questions about the student’s choices regarding plans.Results: Four hundred and fifty-eight (458) medical students out of 583 students (55.5% junior and 44.5% senior students) enrolled themselves in the study and completed the survey. Findings revealed that medical students’ top five preferred future general medical specialties were surgery (34.5), followed by internal medicine (18.3), family medicine (17.2), dermatology (14.6), and emergency medicine (15.9). The junior students were found to be more inclined toward dermatology, medical genetics, and surgical general specialties. The findings showed that 63% of the students were interested in becoming future leaders, with 52.8% of them wishing to become head of a medical department. When asked about their desired qualifications, 85.8% preferred the Saudi Board.Conclusion: Surgery was the most favorable specialty among medical students, followed by internal medicine, family medicine and dermatology, and emergency medicine. The study showed a significant difference between males and females and seniors and juniors in preference of specialty and medical qualification, the female medical students prefer to specialize in dermatology (p=0.027), neurology (p=0.028), and obstetrics and gynecology (p=0.001) as a general specialty significantly more than male medical students. It shows that students are interested in future leadership goals.Keywords: career preference, students’ dreams, future specialties, medical students, Saudi Arabia

Closed form discrete transfer functions are derived for finite-difference time domain (FDTD) grids in two- and three-dimensional (3D) space. The transfer functions can be used directly to synthesise the grid impulse response as part of modelling accurate and transparent embedded field sources in FDTD simulations. This approach eliminates the need for measuring grid impulse responses by end users from large and time consuming homogeneous unbounded simulations. The transfer functions were determined through designing fifth order infinite impulse response (IIR) digital filters using a combination of the Prony method and non-linear regression. It was found that the impulse response of equally spaced FDTD grids is independent of absolute values of temporal and spatial steps and rather depends only on the relative ratio of the used time step to the maximum allowed by the stability criterion. Sets of IIR filters are presented and validated for two-dimensional and 3D FDTD grids employing the standard as well as high-order FDTD update equations. [ABSTRACT FROM AUTHOR]

This article introduces a new endoscopic technique for anterior laryngotracheal reconstruction (LTR) using costal rib cartilage grafting in a 2-year-old patient with acquired Grade III subglottic stenosis. The procedure involves an endoscopic incision in the cricoid cartilage's anterior midline and successful outcomes were achieved without complications. The study emphasizes the benefits of this approach, such as reduced hospital stays, shorter operation time, and decreased scarring, but acknowledges the necessity for further human trials to validate its effectiveness in treating different grades of laryngeotracheal stenosis. Laryngoscope, 134:4770-4773, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: In this study, we used atomic force microscopy (AFM) to quantify the size of surface pore apertures of enamel white spot lesions and then demonstrated the penetration of fluorapatite nanocrystals (nFA) into the subsurface of these lesions., Methods: For the porosity study, enamel lesions were created on three sound human teeth using a demineralizing gel for 8 days. The interface between sound enamel and the artificial lesion was analyzed by AFM. To visualize the penetration of nFA tagged with a calcium-binding fluorophore (Fluo-4) into the subsurface of white spot lesions, we used two-photon microscopy. Sixteen extracted human teeth with either active, natural, or in vitro-created carious lesions in enamel were randomly divided into three groups. The teeth were treated for 2 min with either a suspension of tagged nFA crystals, Fluo-4 alone, or deionized water, and left for 30 min before being washed with distilled water and examined microscopically., Results: A greater concentration of surface pores with larger areas was observed on the in vitro demineralized enamel (29 % of pores greater than 1.0 µm 2 ) when compared with the adjacent sound enamel (8 % of pores greater than 1.0 µm 2 ) (p=0.012, Fisher exact test). In vitro and natural lesions treated with tagged nFA showed fluorescence at depths ranging from 50 to 170 µm, demonstrating penetration of the nFA into the lesion subsurface. The lesions treated with Fluo-4 alone with no crystals showed mostly surface fluorescence (restricted to the outer 25 µm), while those treated with deionized water showed minimal (restricted to the outer 20 µm) to no fluorescence., Conclusion: We have demonstrated the use of AFM to quantify the surface pore apertures and two-photon microscopy to visualize nFA crystals in the subsurface of non-cavitated enamel lesions., Clinical Significance: The restoration of the subsurface of non-cavitated caries lesions is a clinical challenge. This study demonstrated that a 2 min application of nFA could penetrate through the surface apertures of non-cavitated enamel lesions into their subsurface., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: The objective of our study was to document the feasibility of a novel endoscopic anterior cricoid split and rib grafting technique in a goat airway model., Study Design: Feasibility pilot animal study., Setting: Animal surgical laboratory at a tertiary hospital and research center., Methods: Three Ardhi goats were utilized. After harvesting and shaping the rib graft, 2 sutures were inserted transversely into the graft. An endoscopic midline anterior cricoid split was performed and extended down through the first tracheal ring, followed by a balloon dilation of the site. Next, the 2 lower and upper graft suture ends were sequentially passed as endo-extra laryngeal sutures and tied on the anterior neck skin. Laryngeal stent was utilized in 1 goat following graft placement., Results: The surgery was successful in all included animals and bronchoscopy performed 7 days after surgery, revealed that the anterior graft was in good position. One goat developed surgical site infection leading to partial graft resorption., Conclusion: This study demonstrated the feasibility of this novel procedure which is potentially useful for patients who are candidates for a single-stage reconstruction. Future studies should investigate the safety and validity of this technique in a model with subglottic stenosis., Level of Evidence: NA., Competing Interests: None., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Background: Whole blood is a product that contains all three blood components (plasma, red blood cells, and platelets). This systemic review and meta-analysis was conducted to identify barriers and obstacles to establishing whole blood transfusion protocols in civilian hospitals. Methods: The study was conducted using PRISMA guidelines with PROSPERO registration No. CRD42024519898. Traumatic patients who needed or received whole blood transfusion were included. A systematic literature review employed a comprehensive search strategy through the PubMed, Google Scholar, Web of Science, ScienceDirect, and ProQuest databases. Meta-analysis was utilized to analyze the outcomes. The risk of bias was assessed using the Newcastle-Ottawa Scale. Results: In total, 310 studies were identified, and 11 studies met the inclusion criteria. The following intervals were used to assess the prevalence of mortality: 6 h 12.15% (0.081, 95% CI [0.023, 0.139]), 24 h 14.08% (0.141, 95% CI [0.111, 0.171]), delayed mortality (28-30 days) 22.89% (0.284, 95% CI [0.207, 0.360]), and in-hospital 18.72%, with relative risk (0.176, 95% CI [0.114,0.238]). Conclusions: Traumatic patients can be effectively resuscitated and stabilized with whole blood transfusion (WBT), but it is essential to provide ongoing critical care, address logistical challenges, and prevent blood product wastage. We recommend utilizing WBT in the early stages of resuscitation for adult civilian trauma patients.

Purpose: Type 2 diabetes mellitus (T2DM) self-management is a comprehensive approach that individuals with T2DM employ to manage and control their condition. Patients' activation, "an individual's knowledge, skill, and confidence for managing their health and health care", has been used as a major driver of self-management. This study aimed to assess the relationship of patient activation with T2DM self-management and clinical outcomes., Design: A cross-sectional study., Subjects: Patients with type T2DM who age 18-years and older., Setting: The primary care centers in Saudi Arabia., Measures: Patient activation measure (PAM) and the Summary of Diabetes Self-Care Activities (SDSCA)., Analysis: Descriptive statistic, T-test, One-way ANOVA test, Chi-square test, and linear and logistic regressions were performed., Results: A total of 398 patients, mostly male (54.9%) with a mean age of 53.2 (±10.7) years old participated in the study. The participants' mean of Hemoglobin A1c (HbA1c) was 8.4% (±1.7%) and most of them (74.5%) had an uncontrolled HbA1c level (>7% %). The mean patient activation score was 55.9 (±13.5). 24.4% were at [PA1], 26.7% at [PA2], 37.4% at [PA3], and 11.5% at [PA4]. Patient activation level was positively associated with better glycemic control and self-management behaviors including diet, physical activity, blood glucose self-testing, foot care, and smoking ( P < .05) but not with adherence to medication., Conclusions: Our findings reveal a positive association between patient activation level and enhanced glycemic control and self-management behaviors and suggest that patient activation-informed self-management interventions are more likely to yield promising health outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Root caries caused by cariogenic bacteria are a burden on a large number of individuals worldwide, especially the elderly. Applying a protective coating to exposed root surfaces has the potential to inhibit the development of caries, thus preserving natural teeth. This study aimed to develop a novel antibacterial coating to combat root caries and evaluate its effectiveness using the antibacterial monomer dimethylaminohexadecyl methacrylate (DMAHDM). DMAHDM was synthesized and incorporated into a resin consisting of 55.8% urethane dimethacrylate (UDMA) and 44.2% TEG-DVBE (UV) at a 10% mass fraction of glass filler. Multiple concentrations of DMAHDM were tested for their impact on the resin's mechanical and physical properties. S. mutans biofilms grown on resin disks were analyzed for antibacterial efficacy. Cytotoxicity was assessed against human gingival fibroblasts (HGFs). The results showed an 8-log reduction in colony-forming units (CFUs) against S. mutans biofilm (mean ± sd; n = 6) ( p < 0.05) when 5% DMAHDM was incorporated into the UV resin. There was a 90% reduction in metabolic activity and lactic acid production. A low level of cytotoxicity against HGF was observed without compromising the physical and mechanical properties of the resin. This coating material demonstrated promising physical properties, potent antibacterial effects, and low toxicity, suggesting its potential to protect exposed roots from caries in various dental procedures and among elderly individuals with gingival recession.

Background: Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19's long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland., Research Design and Methods: A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and "4C"-antibiotics., Results: Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β 1 ), but a decline in the level immediately after the first (β 2 ) and second lockdowns (β 4 ) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β 5 ) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of "4C" antibiotic reduced significantly after the second lockdown., Conclusions: Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

Purpose: To examine the factors that affect graft healing after laryngotracheal reconstruction (LTR)., Methods: We conducted a retrospective chart review at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between January-2008 and October-2023. We included all patients who underwent LTR and required anterior and/or posterior graft placement, while those who underwent procedures without graft placement and those with incomplete information were excluded., Results: Forty-nine patients were analyzed. Most patients were pediatric (65.3%), male (65.3%), had no coexisting comorbidities (55.1%), and harbored grade 3-4 stenosis (59.2%). Thirty patients (61.2%) underwent open surgery. Various graft complications occurred including infection (n = 1, 2%), dehiscence (n = 3, 6.1%), scar (n = 6, 12.2%), and granulation (n = 29, 59.2%). Only 15 patients (30.65%) achieved the composite status of "healthy" graft. Among 43 patients who had postoperative cultures, positive results for Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were observed in 10 and four patients, respectively. Open surgery and double-stage procedure were significantly associated with higher rates of granulation tissue formation. Pediatric-age group had significantly higher rate of complete epithelization compared to adult-age group. A significantly greater proportion of patients who had unhealthy grafts had open surgery. The rate of double-stage LTR was significantly higher in unhealthy grafts compared to healthy grafts. Prolonged stent duration was linked to various graft-related complications. Multivariate logistic regression analyses showed no statistically significant correlations between various factors and postoperative graft-related complications., Conclusion: Open surgery, double-stage procedure, pediatric age group, and stent duration were not significant risk factors associated with postoperative graft-related complications during LTR in multivariate analysis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Age/stage sensitivity is considered a significant factor in toxicity assessments. Previous studies investigated cadmium (Cd) toxicosis in Caenorhabditis elegans, and a plethora of metal-responsive genes/proteins have been identified and characterized in fine detail; however, most of these studies neglected age sensitivity and stage-specific response to toxicants at the molecular level. This present study compared the transcriptome response between C. elegans L3 vs L4 larvae exposed to 20 µM Cd to explore the transcriptional hallmarks of stage sensitivity. The results showed that the transcriptome of the L3 stage, despite being exposed to Cd for a shorter period, was more affected than the L4 stage, as demonstrated by differences in transcriptional changes and magnitude of induction. Additionally, T08G5.1, a hitherto uncharacterized gene located upstream of metallothionein (mtl-2), was transcriptionally hyperresponsive to Cd exposure. Deletion of one or both metallothioneins (mtl-1 and/or mtl-2) increased T08G5.1 expression, suggesting that its expression is linked to the loss of metallothionein. The generation of an extrachromosomal transgene (PT08G5.1:: GFP) revealed that T08G5.1 is constitutively expressed in the head neurons and induced in gut cells upon Cd exposure, not unlike mtl-1 and mtl-2. The low abundance of cysteine residues in T08G5.1 suggests, however, that it may not be involved directly in Cd sequestration to limit its toxicity like metallothionein, but might be associated with a parallel pathway, possibly an oxidative stress response., (© The Author(s) 2024. Published by Oxford University Press.)

Introduction: The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis., Methods: A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic., Results: A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient's condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic., Conclusion: Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff., Competing Interests: Source of Support: None. Conflict of Interest: None.

Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis. For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding. The success of a pulpotomy depends on the clinician's experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions., 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 AUTHOR.)

Introduction Teledentistry has emerged as a promising solution to enhance dental healthcare accessibility and quality. Understanding public awareness and attitudes toward teledentistry is crucial for its successful implementation, especially in regions like Saudi Arabia where digital health initiatives are rapidly expanding. This study aims to assess the level of awareness, attitudes, and perceptions toward teledentistry among the Saudi Arabian population, as well as examine the demographic factors influencing its acceptance. Methods A cross-sectional survey was conducted with 474 participants, employing a structured questionnaire to collect data on demographics, awareness, knowledge, perceptions, and attitudes toward teledentistry. Statistical analyses, including correlation and chi-square tests, were performed to analyze the data. Results The majority of respondents (64%) reported awareness of teledentistry, primarily through the Internet (44.5%) and healthcare providers (36.3%). The average self-assessed knowledge score was 3.04 out of 5, indicating moderate familiarity with teledentistry concepts. Attitudes toward teledentistry were generally positive, with 54% expressing belief in its effectiveness. However, a significant portion of the sample showed reluctance toward using teledentistry for routine dental check-ups, with only 45.1% showing willingness. High technological accessibility was reported, yet 55.9% of participants preferred traditional in-person consultations. Correlation analysis revealed a moderate positive relationship between knowledge and belief in effectiveness (r = 0.21), but a negligible correlation with willingness to use teledentistry (r = 0.016). A strong positive correlation was found between belief in effectiveness and willingness for routine check-ups (r = 0.673). Educational level significantly influenced teledentistry acceptance, with higher education correlating with greater receptiveness. Conclusion While there is a moderate level of awareness and a generally positive attitude toward teledentistry among the Saudi population, hesitance remains regarding its use for routine care. The findings highlight the need for educational initiatives to improve knowledge and perceptions of teledentistry, potentially enhancing its acceptance and integration into the healthcare system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alhur et al.)

Objective: It is well known that celiac disease has a negative influence on patients' health and quality of life. It has a wide range of presentation from symptomless to multiple organ dysfunction but mainly gastrointestinal symptoms. Consequently, it is considered a main cause of mortality, morbidity, and health burden. We aim to evaluate the quality of life affected in gluten-free diet and to identify the serological characteristics of celiac disease patients in the Qassim Region of Saudi Arabia and King Fahad Specialist Hospital., Methods: This is a cross-sectional-based study conducted in King Fahad Specialist Hospital, Saudi Arabia, composed of 58 patients with celiac disease for 9 years between August 2011 and August 2020., Results: Fifty-eight patents were included (79.3% females and 65.5% married), who were divided according to their ages into five groups. Abdominal pain, diarrhea, and/or weight loss were the major patient complaints. A total of 64% of the patients had a +ve (tTG) IgA test at the time of diagnosis, while 17% were -ve. Of the studied patients, 78% reported that they had undergone a duodenal biopsy sampling. No other significant abnormalities were detected between females and males or among the five diagnosed age groups., Conclusion: Patients with celiac disease reported poor health-related quality of life across the board. However, social interaction, emotional role functioning, and emotional well-being were the most important factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Objective: This study aimed to evaluate the efficacy and tolerability of perampanel, which was used in a cohort of patients with refractory epilepsy for up to 3.5 years in a real-world setting in Saudi Arabia., Patients and Methods: Data from the medical records of patients treated with perampanel between March 13th, 2017, and September 6th, 2020, at neurology clinics at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh and Jeddah, Saudi Arabia, was collected. The Liverpool Adverse Events Profile (LAEP) scale was also used to measure the adverse effects of perampanel., Results: Of the 75 included patients, 66.7% responded to perampanel at the last follow-up, including 22.7% seizure-free for at least the last six months, and 44% of patients responded with a ≥ 50% reduction in seizure frequency from baseline. The overall incidence of adverse effects that led to perampanel discontinuation was 13.3%; the most common adverse effect was aggressive behavior followed by sedation. Pre-existing psychiatric comorbidity was significantly associated with the incidence of psychiatric and behavioral adverse effects on perampanel (p = 0.0206). The mean score of LEAP was 40. The most frequently rated adverse effects in LEAP were "feelings of anger and aggression to others", "nervousness and/or agitation" and "sleepiness". The efficacy and tolerability of perampanel were dose-dependent. Dose 6 mg/day was the most frequently used dose that was taken by about one-third of patients at their last visit., Conclusions: Perampanel was effective as an adjunctive treatment for intractable seizures, with a responder rate of 66.7%. The long-term tolerability of perampanel was generally good. Aggressive behavior was the most common reason for perampanel discontinuation. Patients should be counseled and monitored for these adverse effects, particularly those with a history of previous psychiatric and behavioral problems.

The chemical properties of toxic cadmium and essential zinc are very similar, and organisms require intricate mechanisms that drive selective handling of metals. Previously regarded as unspecific "metal sponges", metallothioneins (MTLs) are emerging as metal selectivity filters. By utilizing C. elegans mtl-1 and mtl-2 knockout strains, metal accumulation in single worms, single copy fluorescent-tagged transgenes, isoform specific qPCR and lifespan studies it was possible to demonstrate that the handling of cadmium and zinc by the two C. elegans metallothioneins differs fundamentally: the MTL-2 protein can handle both zinc and cadmium, but when it becomes unavailable, either via a knockout or by elevated cadmium exposure, MTL-1 takes over zinc handling, leaving MTL-2 to sequester cadmium. This division of labour is reflected in the folding behaviour of the proteins: MTL-1 folded well in presence of zinc but not cadmium, the reverse was the case for MTL-2. These differences are in part mediated by a zinc-specific mononuclear His 3 Cys site in the C-terminal insertion of MTL-1; its removal affected the entire C-terminal domain and may shift its metal selectivity towards zinc. Overall, we uncover how metallothionein isoform-specific responses and protein properties allow C. elegans to differentiate between toxic cadmium and essential zinc., Competing Interests: Declaration of competing interest 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., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To study the clinical evaluation of recurrent respiratory papillomatosis (RRP) patients and the factors associated with the improvement in the Derkay's score as a measure of disease severity., Methods: A retrospective cohort that included all juvenile RRP patients who were admitted to King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between September 2015 and June 2022 and underwent surgical debulking., Results: A total of 16 patients were eligible to join our study. Among them, 7 patients were males. Hoarseness of voice was the most frequent symptom. The median period of the follow-up was 56 months. Complete remission was achieved in 31.3%. The univariate linear regression model revealed that the cidofovir-treated patients had a significant reduction in the change value of Derkay's score compared to those without treatment (regression coefficient= -5.83, 95% confidence interval [CI]: [-11.5 to -0.143], p =0.045). Also, the increased first Derkay's score decreased the change value and subsequently increased the improvement chance of the disease (regression coefficient= -0.424, 95% CI: [-0.764 to -0.083], p =0.018). However, in the multivariate regression model, both variables showed non-significant results., Conclusion: cidofovir treatment and higher Derkay's scores affected the disease improvement., (Copyright: © Saudi Medical Journal.)

Aim: To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields., Methodology: The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant., Results: Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001)., Conclusions: According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered., (© 2023 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

Background: Dentistry is a complex field that utilizes both theoretical and practical knowledge along with a distinct coordination of the hand, brain, and eye of an individual, forming a major part of endodontic therapy. Assessing the understanding and practical knowledge of undergraduates from time to time is essential in evaluating the success of the undergraduate education system. Therefore, the purpose of this study was to evaluate the challenges that are associated with endodontic therapy and are faced by undergraduate students at College of Dentistry, Qassim University.  Methodology: Ninety-seven undergraduates who had completed their preclinical training and had done endodontic treatments were included in this questionnaire-based study. The Chi square test and Fisher's exact test have been used to determine whether or not there is a significant difference on a categorical scale between two or more groups of study parameters., Results: According to our results, de-roofing of the pulp chamber and recognizing the canal orifices are the two areas that need more consideration. The gender-wise difference in the challenges faced by the students while performing the majority of steps during endodontic treatment was found to be insignificant. However, a significant difference was noted in relation to the complete deroofing of the pulp chamber (p-value=0.04) and locating the canal orifices (p-value=0.04). Moreover, fifth year students rarely faced difficulties in performing anesthesia and rubber dam placement, whereas fourth year students faced difficulties in both procedures., Conclusion: The study concludes that de-roofing the pulp chamber and identifying the orifices of canals are two areas where more attention should be given while training undergraduate dental students., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Almutairi et al.)

Background: To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores., Methods: This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman's correlation and simple linear regression., Results: Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, P  = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, P  < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was -2.7 ± 7 and -24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated ( r  = .522, P  < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (β = .178, 95% confidence interval 0.12-0.23, P  < .0001)., Conclusion: CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Reactive arthritis is an acute inflammatory aseptic arthritis that is preceded by an infectious process in genetically predisposed individuals. It has been associated with gastrointestinal or genitourinary infection. Reactive arthritis is rare in children. In this review, we present two index cases that need biologic treatment followed by a thorough review of reactive arthritis in children and adolescents with proposed treatment algorithm., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: Lack of awareness about chronic kidney disease is prevalent and disrupts glycaemic control. In Saudi Arabia many authors highlighted the problem and called for educational interventions to be designed. Our study is the first to address this issue in Saudi Arabia and evaluate a brief educator-led educational intervention in terms of boosting awareness about and knowledge of chronic kidney disease among type two diabetes patients., Method: This was an educational interventional investigation of patients with type two attending diabetes clinic in Taif, Saudi Arabia. The effect of a brief educational intervention focused on awareness about chronic kidney disease was assessed using chronic kidney disease knowledge scale before and after the intervention., Results: We included (n = 100) type two diabetes patients. We estimated good reliability and internal consistency for the knowledge score (Cronbach's alpha was 0.79). Following the educational session, awareness about chronic kidney disease rose from 77 to 100% and knowledge score increased form 7.6 points at baseline to a 15.2 points; paired t value = 15.984, p < 0.00001). Improvement in awareness of chronic kidney disease was associated with being in employment, female sex, and shorter diabetes duration., Conclusion: Brief educational intervention among patients with type two diabetes in Saudi Arabia leads to substantial improvement in awareness of and knowledge about chronic kidney disease. All items related to knowledge about chronic kidney disease improved substantially following educational intervention. It is recommended that all patients attending diabetes clinics receive focused education about chronic kidney disease., Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01366-3., Competing Interests: Competing interestsAuthors disclose no financial nor non-financial interests that could be related to the current paper either directly or indirectly., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

In this work, we present a design for a Newton-Leipnik system with a fractional Caputo-Fabrizio derivative to explain its chaotic characteristics. This time-varying fractional Caputo-Fabrizio derivative approach is applied to solve the model numerically, and to check the solution's existence and uniqueness. The existence and uniqueness of results of a fractional-order model under the Caputo-Fabrizio fractional operator have been proved by fixed point theory. As well, we achieved a stable result by applying the Ulam-Hyers concept. Chaos is controlled by linear controllers. Furthermore, the Lyapunov exponent of the system indicates that the chaos control findings are accurate. Based on weighted covariant Lyapunov vectors we construct a background covariance matrix using the Kaplan-Yorke dimension. Using a numerical example, this suggested method is illustrated for its applicability and efficiency., (© 2023. The Author(s).)

This paper proposes some updated and improved numerical schemes based on Newton's interpolation polynomial. A Burke-Shaw system of the time-fractal fractional derivative with a power-law kernel is presented as well as some illustrative examples. To solve the model system, the fractal-fractional derivative operator is used. Under Caputo's fractal-fractional operator, fixed point theory proves Burke-Shaw's existence and uniqueness. Additionally, we have calculated the Lyapunov exponent (LE) of the proposed system. This method is illustrated with a numerical example to demonstrate the applicability and efficiency of the suggested method. To analyze this system numerically, we use a fractal- fractional numerical scheme with a power-law kernel to analyze the variable order fractal- fractional system. Furthermore, the Atangana-Seda numerical scheme, based on Newton polynomials, has been used to solve this problem. This novel method is illustrated with numerical examples. Simulated and analytical results agree. We contribute to real-world mathematical applications. Finally, we applied a numerical successive approximation method to solve the fractional model.•The purpose of this section is to define a mathematical model to study the dynamic behavior of the Burke-Shaw system.•With the Danca algorithm [1,2] and Adams-Bashforth-Moulton numerical scheme, we compute the Lyapunov exponent of the system, which is useful for studying Dissipativity.•In a generalized numerical method, we simulate the solutions of the system using the time-fractal fractional derivative of Atangana-Seda., 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., (© 2023 The Authors. Published by Elsevier B.V.)

Background: Stroke and its associated complications are a major cause of long-term disability worldwide, with spasticity being a common and severe issue. Physical therapy, involving stretching exercises and electrical stimulation, is crucial for managing spasticity. Therefore, this study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) combined with a conventional rehabilitation program (CRP) on plantarflexor muscle spasticity and walking performance among individuals with chronic stroke., Methods: A pilot randomized clinical trial (RCT) with two groups (active NMES and placebo) was conducted at the physical therapy departments of King Fahad Specialist Hospital, Buraydah, and Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia (November 2020). The assessor and participants were blinded for the group assignment. The active NMES group received exercise and stimulation at the dorsiflexor muscles on the paretic leg for 30 min for 12 sessions. The placebo group received exercise and sham stimulation at the same position and duration as the active group. Of interest were the outcomes for plantarflexor muscle spasticity measured by the modified Ashworth scale (MAS), gait speed measured by 10 m walk test (10-MWT), and functional mobility measured by functional ambulatory category (FAC)., Results: Nineteen participants were randomized into active NMES ( n = 10) and sham NMES ( n = 9) groups, with no significant baseline differences. Within the active NMES group, significant improvements were observed in MAS ( p = 0.008), 10-MWT ( p = 0.028), and FAC ( p = 0.046), while only 10-MWT time improved significantly in the sham NMES group ( p = 0.011). Between-group analysis showed that only MAS was significantly lower in the active NMES group ( p = 0.006). Percent change analysis indicated a significantly higher increase in percent change for MAS in the active NMES group compared to the sham NMES group ( p = 0.035), with no significant differences in other outcome measures., Conclusions: This study showed that NMES in the active group led to significant improvements in spasticity, walking performance, and functional ambulation. Further research is needed to determine the ideal parameters, protocols, and patient selection criteria for NMES interventions in stroke rehabilitation.

Purpose: To evaluate the effects of adenotonsillectomy on improving central sleep apnea events in children with obstructive sleep apnea (OSA)., Methods: We searched four online databases for relevant articles published from inception until October 2022. We included studies that measured the number of central apnea events per sleep and central apnea-hypopnea index (CAHI) or central apnea index (CAI) scores in children with OSA before and after adenotonsillectomy. Our primary outcomes were changes in CAI scores, the number of central apnea events per sleep, and CAHI scores after surgery. Our secondary outcomes were changes in total and mixed apnea events, improvement of sleep outcomes, and differences in oxygen or carbon dioxide saturation during sleep. We performed meta-analyses by pooling the mean changes of all included studies with a 95% confidence interval using Stata 17. Subsequently, we performed subgroup analyses based on the presence of comorbidities., Results: We included 22 studies comprising 1287 patients. Central and total sleep apnea parameters, except for CAHI and mixed apnea index scores, showed significant improvements after surgery. In addition, all respiratory parameters and second and third stages of non-rapid eye movement sleep showed significant postsurgical improvements. Patients with comorbidities showed significant improvements only in the total apnea-hypopnea index, oxygen desaturation index, and minimal oxygen saturation., Conclusion: Adenotonsillectomy improves central apnea events in patients with OSA but not in those with comorbidities., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Intussusception (ISN) is a dangerous condition where a portion of the intestine slides into an adjacent area of the intestine. This telescoping motion frequently prevents liquids or food from flowing through. Developing management guidelines for ileocolic (IC) intussusception was the aim of this systematic study. Data sources were PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Embase databases. Our review investigated English-language articles (from 2010 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The search identified 561 studies; 15 were eligible for inclusion in the analysis. Further understanding of the management of intussusception may help improve evaluation and management in the future. The use of preventive antibiotics does not reduce problems following radiologic reduction. When clinically appropriate, repeated attempts at enema reduction may be made. After the enema reduction of ileocolic intussusception, patients can be safely watched in the emergency room (ER), thereby avoiding hospitalization. Success rates for laparoscopic reduction are high. When it comes to intussusception in children who are hemodynamically stable and do not have a serious illness, there is no need for pre-reduction antibiotics. Prioritizing nonoperative outpatient (OP) therapy is recommended as the primary approach, with the utilization of minimally invasive procedures to avoid the necessity for laparotomy. The management of colonic intussusception involves complete removal in one piece, while enteric intussusception can be addressed through reduction followed by resection. A targeted approach is recommended, recognizing the intermediate forms of intussusception that may exist between the colonic and enteric types. It is essential to note that the prevailing treatment for adult intussusception remains to be surgical intervention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Attoun et al.)

Background: Type 2 diabetes mellitus (T2DM) is a global public health challenge. T2DM self-management, including diet, physical activity, blood glucose self-monitoring, foot care, and adherence to medication, is considered a primary tool for managing diabetes. Patient activation, an individual's knowledge, skill, and confidence in managing their health and healthcare, was recognized to be associated with better T2DM self-management and clinical outcomes. Patient activation intervention has been described as a potential approach for enhancing chronic disease self-management. This study is aimed at examining the effect of a patient activation-tailored intervention on T2DM self-management and clinical outcomes in primary care settings in Saudi Arabia., Method: A pre- and postintervention study was conducted among ≥18 years old T2DM patients attending primary healthcare centers in Saudi Arabia. Collected data included demographics, clinical data, the Patient Activation Measure (PAM), the Summary of Diabetes Self-Care Activities (SDSCA), the diabetes knowledge test (DKT2), the problem area in diabetes test (PAID-5), and the diabetes quality of life test (DQOL). The intervention was tailored based on the participants' patient activation level. The intervention consisted of monthly face-to-face sessions for three months and a telephone follow-up per month for three months postintervention. Descriptive statistics, a paired sample t -test for scale variables, and Wilcoxon's signed-rank test for categorical variables were used for data analysis., Results: A total of 82 patients, mostly female (61%) with a mean age of 51.3 ± 9.9 years old, completed baseline and postintervention surveys. After six months of intervention, there was a significant change in patient activation score from 54.74 to 61.58 ( p < 0.001), hemoglobin A1c (HbA1c) from 8.38 to 7.55 ( p < 0.001), and body mass index (BMI) from 30.90 to 29.16 ( p < 0.001). Also, there was a significant change in SDSCA scores (diet from 3.12 to 3.67, exercise from 2.54 to 3.49, and blood glucose self-testing from 2.37 to 3.24) ( p < 0.001) and DKT from 6.29 to 7.22 ( p = 0.01)., Conclusion: Our findings suggested that tailoring interventions based on patients' activation levels is more likely to yield promising T2DM self-management and clinical outcomes., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2023 Nasser Almutairi et al.)

Purpose: This study aimed to assess the changes in spirometry parameters or indices after relieving laryngotracheal stenosis (LTS) in adult patients., Methods: A systematic review and meta-analysis of studies from PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO databases was conducted for assessing changes in spirometry values after endoscopic balloon dilatation of LTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant data, such as changes in mean spirometry values between preoperative and postoperative interventions, and findings of receiver operating characteristic curve analyses for predicting the need for surgical intervention, were extracted., Results: Ten studies including 330 patients overall met the inclusion criteria. Significant improvements were observed from preoperative to postoperative mean values of different spirometry parameters and indices. The overall mean differences in peak expiratory flow (ΔPEF), expiratory disproportion index (ΔEDI), and peak inspiratory flow (ΔPIF) were 2.26 L/s (95% CI 2.14-2.38), 27.94 s (95% CI 26.36-29.52), and 1.21 L/s (95% CI 0.95-1.47), respectively. ΔPEF and ΔPIF values increased, while ΔEDI decreased. In predicting the need for surgical intervention, EDI had the highest sensitivity (88%), and forced expiratory volume per second/forced vital capacity had the highest specificity (85%)., Conclusion: Spirometry is a valuable tool for assessing patients with LTS. PEF, EDI, and PIF were the most commonly reported spirometry parameters that significantly improved after airway stenosis was relieved., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A negative attitude toward sleep has greatly affected sleep habits. In addition to contributing to physical and metabolic disorders, poor sleep quality may cause emotional disturbances. This study aimed to measure sleep behavior and factors contributing to poor sleep quality in the Madinah region, Saudi Arabia. We also assessed whether the use of sleeping aids improved peoples sleep. Three hundred and ninety-nine adults in the Madinah region of Saudi Arabia participated in this cross-sectional study. Three data domains were collected using an online questionnaire between 30 January and 26 April 2022. In the first domain, the characteristics of participants were discussed. In the second domain, questions about sleep behavior were asked. In the third domain, we examined the types, frequency, and impact of sleep aid use. Out of the 399 participants, 154 (38.59%) reported sleep problems. A total of 64.94% of the 154 participants blamed stress as the leading cause of their sleep disorders, and 74.68% of those with sleep problems reported reduced productivity. Among those who reported having sleep problems, 46.10% used sleep aids, with Panadol night (antihistamine) being the most used, 49.30%, followed by Melatonin at 39.44%. Sleep quality improved by 67.6% among those who used sleep aids. A total of 71.8% of the participants think it is not safe to use sleep aids in the long term. Our findings suggest that sleep problems are a prevalent concern in Madinah, Saudi Arabia, and even though the use of sleep aids improved sleep quality, it should be considered an emerging and important public health objective in Saudi Arabia. Further studies are needed to evaluate sleep quality and the level of sleep aid usage among other Saudi Arabian regions.

Objective To explore perceptions of undergraduate dental students regarding difficulties faced during endodontic procedures. Methods An e-questionnaire was sent to 57 fourth-year and 45 fifth-year dental students. It comprised questions regarding demographic data and difficulties faced during different steps of the endodontic treatment. The responses were recorded on a 5-point Likert scale. During dichotomization, responses where one and two were chosen were considered yes whereas responses where three, four, and five were chosen were considered no. The sample size (SS) calculated using the Qualtrics SS calculator was 89. Data were analyzed using SPSS version 20. Frequencies and percentages were calculated. A p-value of less than 0.05 was considered significant. The chi-square test was applied for comparison based on the students' academic year and genders. Results Ninety students responded with an 88.2% response rate. Most students reported not facing any difficulty in differentiating healthy pulp and periapex from conditions of pulp pathosis (78.9%) and periapical pathosis (75.6%). Most males found access opening and de-roofing of the pulp chamber (35.6%) and working length determination (31.1%) difficult. Females reported having difficulty mostly in mesial and distal shift radiograph techniques (55.6%) and access openings (51.1%). No statistical difference was found based on an academic year or gender except in the use of mesial and distal shift techniques for radiograph acquisition Conclusion Assessing difficulties encountered by students during endodontic therapy can aid in the development of teaching strategies for preclinical and clinical instruction. Mesial and distal shift techniques, access cavity preparation, and working length determination are areas requiring more focus in the training process., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Almutairi et al.)

Introduction: Cardiopulmonary resuscitation (CPR) training is important for students of health professions to learn and be prepared to perform. Colleges have a responsibility to provide adequate training for their students to ensure that they are ready and confident to deal with life-threatening situations. However, studies have shown that some graduates and practitioners lack sufficient knowledge in performing CPR. The aim of this study is to assess the knowledge of health professions students in the Kingdom of Saudi Arabia (KSA) who have started clinical practice.  Methodology: This cross-sectional study was conducted in February 2022 and included health professions students in all academic years, including interns and residents, across colleges of King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA. The study questionnaire consisted of three sections: attitudes, knowledge, and demographics. The attitudes section included 11 questions, while the knowledge section included 10. The demographic section included university level, Grade Point Average (GPA), CPR training status, willingness to learn CPR, witnessing CPR, and family history of cardiac disease. Statistical analysis was conducted using chi-squared tests, t-tests, two-sample proportion tests, ANOVA, and bivariate correlation analyses., Results: The mean age of the participants was 21.2 (±1.9) years. Participants had a mean knowledge score of 5.1 (±1.8) out of 10 potential points. Also, the participants had a total attitude score of 42.7 (±6.2) out of 55 potential points., Conclusion: The study highlights the importance of CPR training for healthcare providers and the need for ongoing training to maintain knowledge and skills. The results suggest that attitudes towards providing CPR may be influenced by cultural beliefs and fear of liability or disease transmission. Higher participant GPA and positive attitudes towards chest compressions and CPR training were found to be associated with increased knowledge., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Awawdeh et al.)

Chest X-ray imaging is the most common X-ray imaging method for diagnosing coronavirus disease. The thyroid gland is one of the most radiation-sensitive organs of the body, particularly in infants and children. Therefore, it must be protected during chest X-ray imaging. Yet, because it has benefits and drawbacks, using a thyroid shield as protection during chest X-ray imaging is still up for debate.Therefore, this study aims to clarify the need for using a protective thyroid shield during chest X-ray imaging. This study was performed using different dosimeters (silica beads as a thermoluminescent dosimeter and an optically stimulated luminance dosimeter) embedded in an adult male ATOM dosimetric phantom. The phantom was irradiated using a portable X-ray machine with and without thyroid shielding. The dosimeter readings indicated that a thyroid shield reduced the radiation dose to the thyroid gland by 69% ± 18% without degrading the obtained radiograph. The use of a protective thyroid shield during chest X-ray imaging is recommended because its benefits outweigh the risks., 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., (© 2023 Elsevier Ltd. All rights reserved.)

Background: Postoperative pain is a common concern in root canal treatment, and the choice of instrumentation technique can significantly impact patient comfort. This study aimed to evaluate the impact of different instrumentation techniques on the incidence of postoperative pain in patients undergoing root canal treatment., Methods: A randomized controlled trial was conducted on 208 patients randomly assigned to four groups: step-back preparation, crown-down preparation, hybrid technique, and conventional instrumentation. Pain intensity was assessed using a verbal rating scale (VRS) at six, 12, 24, 48, and 72 hours postoperatively. Data were analyzed using appropriate statistical methods., Results: The mean pain scores and standard deviations (SDs) were calculated for each instrumentation technique at different time intervals. At six hours, the step-back preparation group reported a mean pain score of 2.3 (SD = 0.8), the crown-down preparation group had a score of 2.8 (SD = 0.9), the hybrid technique group had a score of 2.5 (SD = 0.7), and the conventional instrumentation group had a score of 3.1 (SD = 0.1). The differences in pain scores between the groups were statistically significant at all time intervals (p < 0.05)., Conclusion: The choice of instrumentation technique significantly influenced the incidence of postoperative pain in root canal treatment. The step-back preparation technique was associated with lower pain intensity than the crown-down preparation, hybrid technique, and conventional instrumentation. These findings highlight the importance of considering the instrumentation technique to optimize patient comfort during and after root canal treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Agrawal et al.)

Patient engagement is currently considered the cornerstone of a revolution in healthcare for its positive impact on health outcomes, health behaviors and healthcare costs. Patient engagement is focused on personalized care to consumers through providing knowledge, skills and confidence. Mobile health (mHealth) applications are an innovative means to facilitate patient engagement. Nevertheless, the extent to which the current mHealth applications are designed to engage patients in managing their chronic diseases is unclear. This paper aims to identify the Persuasive System Design (PSD) features present in current mHealth applications that increased the engagement of patients with chronic diseases. This review also aims to identify patient engagement-related outcomes of these features. This paper conducted a systematic literature review and meta-analysis to find relevant studies published from all years up to 2020 through six databases: PubMed, Scopus, Web of Science, Cinahl plus with full text, MEDLINE with full text, and Cochrane Library (Central register of controlled trials). The database search returned 4939 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 13. A qualitative content analysis was performed to identify PSD model features and their patient engagement-related outcomes. The quality assessment has been done through the Cochrane Risk of Bias tool for RCTs. The systematic literature review and meta-analysis identified eleven PSD features that can increase patient engagement through using mHealth applications. The identified PSD features have been shown to have various patient engagement-related outcomes. Behavior Change Techniques (BCTs) were combined with the identified PSD features. This paper identified persuasive features of mHealth application design that influence the engagement of patients with chronic diseases toward changing their behavior. The impact of these features is also analyzed in this review. The results show that an mHealth technology-mediated patient engagement model is needed.

Background: Resection surgery in patients with colorectal cancer (CRC) patients is associated with potential complications, including surgical site infection (SSI)., Objectives: To estimate the prevalence rate of SSI, identify the common pathogens responsible for SSI, and determine potential risk factors for SSI development in a cohort from Saudi Arabia., Materials and Methods: Patients with CRC who underwent bowel resection surgery at King Abdulaziz Medical City, Riyadh, between January 01, 2016, and December 31, 2019, were retrospectively included. Demographics, comorbidities, surgical procedure data, and the results of preoperative laboratory tests were retrospectively collected from medical records through the health information system. The study population was divided into two groups: those who developed SSI and those who did not., Results: A total of 92 patients with CRC who underwent resection surgery were included, of which 54 (58.7%) were males. The median age was 65 (IQR 55.5-75.0) years. SSI was observed in 25 (27.2%) patients. The most frequently isolated organisms were Escherichia coli and Pseudomonas aeruginosa , followed by Klebsiella pneumoniae , vancomycin-sensitive Enterococcus faecium , and methicillin-resistant Staphylococcus aureus . Three E. coli isolates were producers of extended-spectrum beta-lactamases, and two K. pneumoniae isolates exhibited a multidrug resistance profile. Low preoperative serum albumin level was identified as a significant independent risk factor for developing SSI (AOR = 0.853, 95% CI = 0.748-0.973, P = 0.0181)., Conclusion: The study found a notable prevalence of SSI among the included patients. Gram-negative bacteria were more involved in SSI events and were also associated with drug-resistance patterns. Gut microbiota bacteria were most commonly involved in SSIs. Low preoperative serum albumin levels predicted the development of postoperative SSI, and thus its close monitoring and management before surgery could reduce the SSIs., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Saudi Journal of Medicine & Medical Sciences.)

Background: The Pain Behavioral Scale (PaBS) measures the presence and severity of pain behavior. We examine the longitudinal construct validity of the PaBS using convergent and known-groups approaches on a population of 23 participants with chronic lower back pain (LBP) undergoing routine physiotherapy care and pain neuroscience education. Methods: Participants who satisfied study inclusion and exclusion criteria were recruited from patients who attended two testing sessions at physiotherapy clinics in Saudi Arabia. Participant pain behavior was initially measured using the PaBS scale; participants performed standardized physical tests (e.g., repeated trunk flexion) and provided baseline demographic, clinical data, and self-reported measurements using the Modified Roland and Morris disability questionnaire (MODI), fear-avoidance questionnaire (FABQ), and pain catastrophizing scale (PCS). In subsequent visits, a physiotherapist provided usual care to participants, and weekly sessions were established for online pain-neuroscience education. During week six, participants repeated the same questionnaires and physical performance tests with the PaBS. Paired t -tests are used to compare changes in health characteristics from baseline responses to those in week six. Correlations between changes in PaBS from baseline to week six, with changes in outcome measures (i.e., disability, pain intensity, fear-avoidance beliefs, catastrophizing), were determined. To assess known-group validity, we also used a general linear model. Results: A total of 23 participants completed the PNE and follow-up data collection. The mean change from baseline in the PaBS score was statistically significant, as were changes in MODI, FABQ, and PCS. Almost 70% of participants improved their PaBS scores over the six-week period, with PaBS scores of almost 40% of them improving by three units or more. The change in PaBS score correlated significantly with changes in the PCS-rumination subscale, supporting a proposed approach to estimate convergent validity (r = 0.44, 95% CI = 0.04-0.72, p = 0.035). Conclusions: The mean change from baseline in the PaBS score is statistically significant, as are changes in MODI, FABQ, and PCS, supporting its convergent validity. According to our STarT Back groups, the medium to low-risk group had a lower PaBS score, and high-risk group had a higher PaBS score, indicating that PaBS use in clinical assessment may identify people according to pain-behavior severity, or those at increased risk of developing disability.