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Introduction Hyperlactatemia, a problem reported in up to 30% of cardiac surgery patients, results from excessive production of or decreased clearance of lactate. It is typically a symptom of tissue hypoperfusion and may be associated with the prevalence of postoperative acute mesenteric ischemia and renal failure, or prolonged intensive care unit (ICU) and hospital stay, and increased 30-day mortality. Methods and measurements Eighty cardiac surgery patients using cardiopulmonary bypass (CPB) were randomly assigned into either a placebo (n = 39) or norepinephrine 0.05–0.2 µg/kg/min (n = 41) as well as norepinephrine boluses during CPB to maintain mean arterial blood pressure (MAP) at 65 to 80 mm Hg. Patient assignments were done after receiving ethical approval to proceed. The primary result was the perioperative changes in lactic acid level. Secondary findings were also recorded, including hemodynamic variables, the incidence of vasoplegia, intraoperative hypotension, myocardial ischemia, the need for vasopressor support, postoperative complications, and mortality. Results The peak levels and perioperative changes in blood lactate during the first 24 postoperative hours, the number of patients who experienced early hyperlactatemia on admission to the ICU (Placebo: 46.2%, Norepinephrine: 51.2%, p = .650), vasoplegia, hemodynamic changes, incidences of intraoperative hypotension, myocardial ischemia, postoperative complications, and mortality rates were similar in the two groups. Patients in the norepinephrine group received lower intraoperative rescue norepinephrine boluses to maintain the target MAP (p = .039) and had higher MAP values during the CPB and intraoperative blood loss [mean difference [95% confidence interval]; 177 [20.9–334.3] ml, p = .027]. Conclusion norepinephrine and placebo infusions during the CPB with the maintenance of MAP from 65 to 80 mmHg had comparative effects on the changes in blood lactate and incidence of vasoplegia after cardiac surgery. Norepinephrine infusion maintained higher MAP values during the CPB.

The prevalence of autism spectrum disorder (ASD) is close to 1% in the United States of America and other countries. Special attention should be given to oral health in individuals with ASD as they are often affected by oral diseases. However, gingival health in children with ASD and adolescents is controversial in terms of the severity of disease and number of people affected. Aim: To conduct a systematic review and meta-analysis to assess the gingival health status of children and adolescents with ASD. Methods: The search was conducted using eight databases for articles that met the inclusion and exclusion criteria. This search produced 742 relevant papers, but only five with sufficient data on gingival and plaque indices were eligible for inclusion in this systematic review and meta-analysis. Results: The homogeneity of the sample was tested using the Cohen Q test, which identified significant heterogeneity (P

Burns are serious injuries, resulting in high morbidity and healthcare costs. Effective first aid improves outcomes. The aim of this study was to assess the knowledge and practice of first aid for burn injuries among medical and non-medical students in Saudi Arabia. A cross-sectional study (N = 408) was conducted, in which a questionnaire was administered assessing students’ experience with burns, as well as their hypothetical responses to vignettes involving patients with burn injuries. Although most students reported having personal experience with burns, and had received some information regarding burn first aid, only about half were able to provide correct responses regarding first aid techniques, and medical students were no more accurate than non-medical students in their responses. Results suggest that members of the Saudi Arabian population may lack appropriate knowledge about burn first aid, and education and public information resources may help to remedy this problem.

Objective: The objective of the study was to determine the current prevalence of Helicobacter pylori infection among Dyspepsia patients and correlate this with Endoscopic findings. Methodology: A retrospective, descriptive facility-based study conducted from June to December 2017 to estimate the prevalence of Helicobacter pylori among dyspepsia patients from Majmaah, Sudair, Zulfi and Shaqra areas of Riyadh region, Saudi Arabia. Four years data from January 2012 to December 2016 were reviewd by a checklist and analyzed by SPSS. Results: Out of 1398 dyspepsia patients, 485 (34.7%) were positive, and 913 (65.3%) were negative for H-Pylori infection. Majority of patients (81.7%) had gastritis, out of which, 39.9% of gastritis patients were H-pylori positive. The frequency of H-pylori infection was significantly higher among patients with gastritis (p < 0.001). There was no statistically significant difference in the frequency of H-pylori infection among patients with erosion, ulcer, polyp and cancer (p > 0.05). Conclusion: The prevalence of H.Pylori was low as compared to other governorates in the kingdom and regional countries. Gastritis was dominating finding on upper gastrointestinal (GI) endoscopy. Keywords: Helicobacter pylori, Prevalence, Dyspepsia, Riyadh region

Background: Slipped capital femoral epiphysis, is a common condition of the proximal femoral physis that leads to slippage of the epiphysis relative to the metaphysis. Diagnosis can be confirmed with radiographs of the hip. Treatment is usually percutaneous screw fixation.Objective: To study the outcome and complications of closed reduction and internal fixation by percutaneous screw fixation in unstable slipped capital femoral epiphysis.Patient and methods: Our case report is 11 years old obese male patient with history of progressive right hip pain for 10 days prior to presentation to the hospital. BMI was 36.1 kg/m2. Patient presented with right hip pain and inability to bear weight, radiological evaluation confirmed right hip unstable slipped capital femoral epiphysis that required emergency in situ fixationResult: close follow up of the patient to 6 months, patient regain full functional activity, he achieved a complete range of motion of the right hip with good outcomes and with no complications. The goal in such injuries is to achieve a stable hip joint with gradual rehabilitation to reach a good functional outcomeConclusion: Slipped capital femoral epiphysis occurs in adolescent age group, more affecting male and obese patient, and they are idiopathic in the majority of cases. The goal of treatment in such patients is to achieve a stable hip joint with gradual rehabilitation to reach the optimal functional outcomes

Background: The preference of medical specialty for students can start even before enrollment into medical school, or as late as following their graduation. During their senior years, students often get a prospective on the working environment and the difficulties faced in the field. This, along with other factors, can strongly alter their career choice. This study aims to explore the degree of interest in neurosurgical specialty among medical students and the factors influencing their choice of becoming a neurosurgeon in the western region of Saudi Arabia. Methods: This is a cross-sectional study which was done across three universities of the western region of Saudi Arabia including King Saud bin Abdulaziz University for Health Sciences, Umm Al Qura University, and King Abdulaziz University. Results: A sample of 1023 students from the second medical year up to the internship was conducted, and out of them, 585 (57.2%) were males and 438 (42.8%) were females. Three hundred and fifty-nine (35.1%) of the students were interested in neurosurgery, while 664 (64.9%) were not. The data show that females have more interest (40.8% of females) compared to males (35.1% of males). Furthermore, there was a general trend toward a decrease in the interest in neurosurgery with time. The impact on patients “rewarding feeling” was the most reported attraction to the specialty, followed by income. Stress was the most reported deterring factor among students. Neurosurgery is one of the most challenging specialties, yet it is still considered one of the most competitive ones. Conclusion: Many factors have been found to influence medical students’ choices to apply for neurosurgical training as we described. Interestingly, we noted higher interest among female students, and among college freshmen compared to their counterparts. Further studies should be conducted on a larger scale to analyze these findings.

Laryngotracheal reconstruction is the most common and effective treatment in childhood subglottic stenosis (SGS). Our aim is to review the success rate of laryngotracheoplasty (LTP) in pediatric high grade SGS cases in our tertiary center. The retrospective review was conducted on children with high grade subglottic stenosis who had undergone laryngotracheoplasty over a 7-year period (2013–2020) in tertiary pediatric care. A total of 20 patients who had history of high grade SGS during the stipulated period were included. All of them had undergone LTP. Decannulation was considered the primary outcome measure of success. Surveillance bronchoscopy was performed one year post airway reconstruction to detect residual stenosis. From January 2013 to December 2020, 20 patients aged between 1 and 16 years old underwent LTP. Among them, 10 patients (50%) had Grade III SGS while 5 had Grade III SGS with glottis stenosis (25%). The remaining 5 (25%) had severe Grade IV stenosis. Decannulation was achieved in 14 patients overall (70%) including 1 with revision. These 14 patients who achieved decannulation included 7 out of the 10 patients (70%) with Grade III, 2 out of the 5 (40%) patients with Grade III with glottic involvement, and 4 out of the 5 patients (80%) with Grade IV SGS. Fifteen (80%) patients had double stage LTP while 5 patients had single stage LTP. The study suggests that LTP is a promising approach in the treatment of Complex SGS. Furthermore, pediatric SGS, which is inherently complicated, can be treated with LTP effectively.

Background and objectiveThis study aimed to determine the validity of using a single-question self-report of erectile dysfunction (ED) as a screening tool among Saudi men with type 2 diabetes mellitus (T2DM). Materials and methodsA cross-sectional study was conducted using a single-question self-report questionnaire to determine the association between the risk of ED and poor glycemic control among men with T2DM. The study was conducted in a hospital-based diabetes clinic in Riyadh, Saudi Arabia. Married adults (aged >18 years) suffering from T2DM for at least 1 year were included in the study. All statistical analy-ses were performed using SAS version 9.2 and R software (Foundation for Statistical Computing, Vienna, Austria). ResultsWith 86% response rate, 293 participants were included in this study. Over half (53.9%) of the partic-ipants were below 60 years of age. More than half (55.3%) were suffering from uncontrolled diabetes (i.e., HbA1c > 7%). There was significant correlation between the International Index of Erectile Function (IIEF) and self-reported question in terms of duration of T2DM (p < 0.001), type of treatment (p = 0.004), income of the participants (p = 0.005), age (p < 0.001), education level (p = 0.032), and occupation (p < 0.001). However, there was no significant correlation between IIEF and self-reported question in terms of body mass index (p = 743) and smoking. Regarding overall diagnostic accuracy of IIEF score to predict self-reported ED, receiver operating characteristic curve showed area under curve as 89.4%, which is sta-tistically significant. ConclusionSingle-question self-report of ED is a valid and reliable tool to screen diabetic patients suffering from sexual problems. Such tool may help to identify ED in diabetic patients and warrant early management.

This cross-sectional study aimed to determine the degree of visibility of maxillary and mandibular anterior teeth at rest in different age groups and to evaluate the smile line, smile arc, and number of maxillary teeth displayed during smiling among the Saudi population visiting King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia. A total of 157 participants (77 males and 80 females) were included in this study with an age range of 19 to 69 years. All participants had maxillary and mandibular anterior teeth without restorations. Crown length and visible portions of anterior teeth at rest were measured using a Fowler Electronic Digital Caliper. Three measurements of each variable were recorded by two independent dental interns and calibrating their measurements was performed. Smile line, smile arc, and number of teeth displayed during smiling were examined. The collected data were statistically analyzed using SPSS software. It was found that the average clinical crown lengths in the maxillary lateral incisor, mandibular central incisor, and canine were significantly higher in males than females. At rest position, females displayed more maxillary central and lateral incisors. The displayed length of maxillary teeth at rest is inversely proportional to increasing age; the reverse occurs in mandibular teeth. The common visibility of maxillary teeth during smiling was from the second bicuspid to its counterpart. Average smile line and consonant smile arc were the most common characteristics. It was concluded that both age and gender affect the characteristics of tooth display at rest and in smiling. These effects should be considered during treatment planning and restoration of anterior teeth to obtain a more predictable esthetic outcome.

Clinically, the management of severy atrophic maxilla might represent a significant challenge for the attending dentists and surgeons to successfully perform and achieve fabricated complete maxillary dentures. Making a hollow denture base for these defects has also been previously reported as a valid approach that can be used to decrease the weight of the maxillary prosthesis. Many modalities have been proposed for these procedures with favorable outcomes, and variable events of disadvantages and adverse events. This literature review aims to collect enough evidence regarding the different reported techniques of the hollow maxillary denture, according to the different studies. Many techniques have been previously reported as using magnets, using implants, intramucosal inserts, springs, suction disks, lightweight dentures, and modified impression techniques. Many materials have been previously used with the 3D spacers of the lightweight denture techniques as dental stone, silicon putty, cellophane-wrapped asbestos, light-body coated gauze, modeling clay, salt, thermocol, caramel, and glycerine soap. Favoring one of the modalities over the other requires the inauguration of future studies with an adequate sample size to validate the efficacy and safety of these modalities. All of this information is furtherly discussed within the manuscript based on the collected evidence from the different studies in the literature.

Background We all want to live a long, happy and healthy life with an abundance of energy and vitality to perform well both mentally and physically. A healthy lifestyle is a valuable resource for reducing the incidence and impact of health problems, enabling you better to cope with life stressors, as well as improving your quality of life. Aims The study was aimed to assess the lifestyle (eating habits and physical activity) of health sciences students studying at Majmaah University. Methods This cross-sectional institutional based study was conducted from 25th November 2014-3rd May 2015. A total of 450 students (370 males and 80 females) aged between 18–28 years were randomly chosen. Self-reported questionnaire was used for data collection from the College of Medicine, College of Applied Medical Sciences and College of Dentistry. Results Majority of the students, 62.4 per cent, were physically inactive. Students from the College of Medicine, 40.4 per cent, were the most physically active. The most common reason that restrained the students from being active was time limitation. In addition to that, many of the participants, 29.6 per cent, have never had breakfast at home. Also, most of the participants, 42.7 per cent, were not satisfied with their eating habits. Almost one quarter of students were consuming soft drinks more than four times a day. Conclusion There is a high prevalence of sedentary lifestyle, physical inactivity and unhealthy dietary habits among health sciences students studying at Majmaah University. There is an urgent need for arranging health education programs for promoting healthy and active living among health sciences students of Majmaah University in Saudi Arabia.

Introduction: Risky behaviors are those that potentially expose people to harm, or significant risk of harm, which prevent them from reaching their potential in life and which can cause significant morbidity or mortality. Objectives: The objectives of the study were to determine the overall prevalence of risky behaviors among university students; to determine the prevalence of smoking, drifting, fast driving and physical inactivity among university students; and to determine the associations between such behavior and demographic characteristics. Materials and Methods: An observational cross-sectional study conducted in three colleges. The data were randomly collected from 340 students aged 18-30 years from February to March 2015 using a self-administered questionnaire in Arabic. The data were entered using SPSS v 22.0. Mean and standard deviation were calculated for quantitative variables, and frequency and percentages were computed for categorical variables. Chi-square or Fisher's Exact test, as appropriate, were used to test for statistical significance. Results: The overall prevalence of risky behaviors (smoking, drifting, fast driving, and physical inactivity) among students was 47.35%. Overall, 28% of the students were smokers, 25.2% were involved in drifting, 60.9% reported driving fast, and 66.4% were physically inactive. The age between 18-20 years was significantly associated with higher rates of drifting, fast driving, and physical inactivity. Conclusion: The prevalence of risky behaviors among university students was high. Physical inactivity and fast driving were the most common identified risky behaviors. Increasing awareness of these risks in the youth may significantly decrease related morbidities, complications, and even mortalities.

Introduction: Ideal cardiovascular health (CVH) promotion is effective for cardiovascular disease prevention. Whether increased CVH score improves oxidative stress is less clear. Our study examined the correlation between changes in ideal CVH status and oxidative stress. Hypothesis: Improvement in CVH score is correlated with changes in oxidative stress. Methods: A total of 569 actively working adult employees (51±11 years, 64% women, 21% Black) underwent a health partner-mediated lifestyle intervention. Serial counseling was delivered by a trained HP focused on promoting clinical self-knowledge and adoption of a healthier lifestyle, based on the subject’s personal schedule. Anthropometric, dietary and laboratory measurements were obtained at baseline and 1- and 2-year follow-up visits. Plasma levels of reduced (glutathione) and oxidized (cystine) aminothiols were measured by high performance liquid chromatography at baseline and follow-up to assess oxidative stress. Ratios of oxidized to reduced aminothiols (cystine/glutathione) were calculated. Linear mixed-effects model was used to examine the correlation between the changes in CVH score and changes in oxidative stress metrics overall 2 years follow-up. Results: Over 2-years, cystine (p=0.01) improved while cystine/glutathione (p=0.03) and glutathione (p Conclusion: Improvement in CVH with a lifestyle intervention was associated with early and sustained improvement in oxidative stress. Whether the impact of changes in CVH metrics on oxidative stress improves long-term morbidity and mortality needs further investigation in a controlled design.

The design of a PV-hydrogen gas turbine hybrid power plant is proposed to generate 100 MW electrical load. This electrical power is supplied directly from PV solar panels, and in the case of shortage or lack of solar radiation, it is supplied by a gas turbine power plant working on hydrogen fuel which is produced through using electrolysis of water by a PV generator. The hydrogen produced is stored directly in gas tanks under appropriate pressure. In the case of inability in supplying the load from PV generator, hydrogen fuel will be used through gas turbine. This study is examined in two cases; case (a): the design of the PV power plant based on worst case scenario; which corresponds to the minimum solar radiation and minimum sunshine hours during the year), and case (b): the design of the PV power plant based on average case scenario; which corresponds to the average solar radiation and average sunshine hours during the year. In both cases, the size of the gas turbine power plant and the size of the photovoltaic arrays required for operating day load, the number of water electrolysers, the capacity of hydrogen tanks required for storage purposes; all were calculated. The economic cost in each individual case was analysed taking into account, a profit of 25% of the initial cost. It was found that the price of the electricity produced is 0.12 $/kWh for worst case scenario, and 0.16 $/kWh for the average scenario. The payback period is 13 years and 15 years for the worst and the average scenarios respectively based on 8% interest rate.

Introduction: Lifestyle modification is effective for cardiovascular disease prevention. Whether lifestyle intervention also preserves vascular health is less clear. Our study examined the role of a Health Partner-administered lifestyle intervention on vascular function. Hypothesis: Lifestyle intervention improves and preserves vascular function. Methods: A total of 711 university employees (48±11 years, 66% women, 22.5% Black) enrolled in a program that promoted healthier lifestyles at Emory University. Participants collaborated with a Health Partner to generate a personalized plan focused on achieving ideal health metrics. Anthropometric, laboratory and vascular function measurements were performed at baseline and at 1-year and 2-years of follow-up. Arterial stiffness was assessed by carotid-femoral pulse wave velocity and radial tonometry-derived central augmentation index. Microvascular function was assessed as digital reactive hyperemia index. Flow-mediated dilation was measured using ultrasound. The sample was divided into individuals within the lowest tertile and those in the upper two tertiles for vascular function at baseline. Paired t-test was used to assess the changes in vascular functions at 1 and 2 years of follow-up compared to baseline. Results: At each of the 1-year and 2-year follow-up visits, vascular function improved in the group within the abnormal tertile at baseline. Flow-mediated dilation increased by 1.6% and 2.0% (P Conclusion: A personalized, goal directed Health Partner intervention was associated with better vascular stiffness, endothelial and microvascular function in those with baseline abnormal values. These effects were evident at 1 year following enrollment and were sustained for 2 years. Whether the impact of Health Partner intervention on vascular function improves long-term morbidity and mortality needs further investigation in a controlled design.

Background: Cholesterol is one of the body substances presents in the blood and important for the health. When the level of cholesterol exceeds the normal, it is called hypercholesterolemia and usually accompanied by high risk of developing coronary heart disease, strokes, and other health problems. Efforts were paid in the developed countries to control and prevent this problem and accordingly age-adjusted mortality from coronary artery disease (CAD) is gradually falling, but it is still high in developing countries, and in the future probably become the most important health problem. Objectives: The objectives of the study were to estimate the prevalence and risk factors of hypercholesterolemia among Saudi adults visiting Al Majmaah primary health care centers. Methodology: The study was cross-sectional. The sample size was collected as 353. The data was collected by a structured, pre-coded and pre-tested questionnaire. In addition, we measured height and weight to calculate the body mass index. The total serum cholesterol level was measured for all participants. Results: The overall prevalence of hypercholesterolemia (total cholesterol more than 200 mg/dl) was 45.3%. The prevalence of hypercholesterolemia increased with age reaching a maximum at the fifth decade. The logistic regression results concluded that, marital status (married patients) had significant relation (p = 0.007) and had the main effect on hypercholesterolemia among Saudi Adults in Majmaah. Conclusion: The study concluded that hypercholesterolemia prevalence among Saudi adults is high. The disease is associated with marital status; divorces and widowed showed high prevalence of the disease.

Background: Medical Education and Medical Profession are among the most challenging and stressful ones. It also poses many new, challenging and potentially threatening situational demands on the incoming students. Anxiety and depression represents an escalating public health problem among medical students. Objectives: The objectives of the study were; to find the prevalence of mental distress among undergraduate medical students studying at College of Medicine, Majmaah University; to explore associations between socio-demographic characteristics and mental distress and to identify mental health and support service needs at Majmaah University for distressed students. Methods: It was a cross-sectional study. The data was collected from undergraduate medical students’ of either gender studying at College of Medicine, Majmaah University using complete enumeration method. General Health Questionnaire (GHQ-28) was used to collect the data from 162 students. Result: The prevalence of mental distress among students was 35.8%. Psychosocial disorder (27.2%) was the most prevalent among students, followed by anxiety (24.7%), somatic (14.2%) and depression (10.5%). Male students had higher mental distress as compared to female students (67.6% vs 43.5%, p

Background: The balance between career and family life of women doctors is a topic of research worldwide. This relation has a significant impact on both work and family obligations. Aims & Objective: To determine the reported effect of career on family life and vice versa among Saudi female physicians. Material and Methods: A cross sectional study was conducted included all Saudi women doctors who ever married and in current clinical practice at KAMC, Riyadh, between 1 January and 28 February 2013. A self-administrated questionnaire has been used for data collection containing: demographic data, impact of career on family life, common obstacles and suggested solution. Pearson’s chi-square was used to analyze the relationship between variables. Results: The study included 174 Saudi female doctors. More than half of them (56.3%) reported discrimination from colleagues because of their marital status. Seventy-five Saudi female physicians (43.1%) were unsatisfied in balancing their career and family life. More than half of the participants (51.7%) thought their work has a negative impact on their relationship with their spouses/children. Type of job (on call status) was significantly associated with difficulty in transportation to the hospital (p=0.006). Providing childcare in medical centers (79.9%) and more days off for maternity leave (75.3%) were most reported solutions suggested. Conclusion: Poor satisfaction of Saudi female physicians in balancing career and family life is a common problem among those working in KAMC.