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Introduction: Recent advancements in medical imaging, such as point shear wave elastography (pSWE), offer non-invasive methods to assess tissue stiffness and structural changes. This study explores the use of pSWE to evaluate pancreatic stiffness and dimensions in three different pancreas parts., Methods: This study was conducted at diagnostic radiology department, King Abdulaziz University Hospital, Jeddah, between June 2022 and November,2022. Thirty-one diabetic patients and thirty-one healthy controls were included. Ultrasound pSWE examination was performed using a ultrasound system (Philips Elite Epic 7) to measure stiffness across different pancreatic parts. Pancreatic stiffness was quantified in meters per second (m/s), and the dimensions of each pancreatic part were recorded. Different parameters, including age, sex, height, weight, body mass index (BMI), and comorbidities, were collected and analyzed., Results: Diabetic patients exhibited significantly higher shear wave velocities (SWVs) compared to healthy controls, indicating increased pancreatic stiffness. The mean shear wave velocity was 1.7 m/s in diabetic versus 0.6 m/s in controls (p < 0.001). Additionally, the pancreatic head dimensions were significantly large in diabetic patients (2.1 cm vs. 1.8 cm; p = 0.003), while the body and tail part showed no significant differences. A positive correlation was found between SWVs and BMI., Conclusion: The findings underscore the potential of pSWE as a non-invasive diagnostic tool for early detection and monitoring of diabetes-related pancreatic alterations. Assessing pancreatic stiffness and dimensions through pSWE can help in identify patients at risk for pancreatic complications and optimize management strategies., Implications for Practice: Point shear wave elastography (pSWE) could be a useful, non-invasive tool for early detection of pancreatic changes in diabetic patients, identifying those at risk for complications. Integrating pSWE into routine diabetes check may enhance early interventions and improve outcomes., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Objectives: To assess and compare the Caprini and Padua risk assessment models (RAMs) for predicting venous thromboembolism (VTE) in hospitalized patients., Methods: We retrospectively reviewed 28 VTE and 450 non-VTE patients hospitalized at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, in 2019. Their baseline medical, demographic, and radiological reports were recorded. We compared Caprini scores (defined at admission) and Padua scores (calculated retrospectively) for their ability to predict VTE. A cumulative risk score was created by adding the individual scores for each risk factor. We also analyzed the sensitivity, specificity, and diagnostic accuracy of the RAM scores., Results: Major differences in risk factors were shown between patients with and without VTE. Previous VTE was significantly associated with a higher risk of VTE (28.6%), as was reduced mobility (57.1%), acute infection (25%), high Caprini score (50%), and high Padua score (64.3%, p <0.05). The sensitivity of the Caprini score (96%) was higher than that of the Padua score (64.3%), as was the specificity (92.1% vs. 46.9%), positive predictive value (93% vs. 7%), and accuracy (94.1% vs. 47.9%). The specificity of the Caprini score was higher than that of the Padua score in Critical Care, Gynecology/Obstetrics, and Surgical departments. The Caprini RAM showed the lowest level of specificity in the medical department., Conclusion: The Caprini RAM demonstrated higher sensitivity, specificity, and predictive accuracy than did the Padua RAM and thus distinguished low and high VTE risk in hospitalized patients., (Copyright: © Saudi Medical Journal.)

Background This study aimed to compare the accuracy of different imaging modalities in the preoperative localization of parathyroid pathology in primary hyperparathyroidism. Methodology This prospective study enrolled 70 patients who were biochemically diagnosed with primary hyperparathyroidism between 2021 and 2022 at our center. Patients underwent scanning using three imaging modalities, namely, Tc99m sestamibi scan (sestamibi), parathyroid ultrasonography, and four-dimensional computed tomography (4DCT). A descriptive analysis was performed to determine and compare the respective localizing sensitivities. Results The most common site of parathyroid adenoma (PA) was the left inferior parathyroid gland, seen in 28 (40%) patients. Three patients had false-positive imaging studies with no parathyroid pathology identified surgically or on histological examination. The median levels of parathyroid hormone decreased significantly (p < 0.001) after the surgery, with a median of 24.3 (1.90-121). Furthermore, 4DCT accomplished a sensitivity of 97.14% for diagnosing the side and 94.03% for overall localization of PA. This sensitivity was superior to the sensitivity of ultrasonography and sestamibi scan to detect the side and quadrant of the adenoma. 4DCT was significantly higher in sensitivity when compared to the combination of ultrasound and sestamibi (p < 0.001). Conclusions 4DCT yielded the highest sensitivity in localizing parathyroid pathology from the imaging modalities studied with the lowest false-negative rate. Using ultrasound with 4DCT could be the most cost-effective combination for detecting primary hyperparathyroidism., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Merdad et al.)

Background Parathyroid adenoma is a benign parathyroid gland tumor that causes excessive parathyroid hormone production, leading to primary hyperparathyroidism. High serum calcium levels characterize it. Accurate diagnosis and localization of adenomas are crucial for effective surgical management. Computed tomography is a fundamental imaging technique used to identify and characterize parathyroid adenomas. This study aimed to provide a comprehensive overview of the absolute and relative contrast washout rates of parathyroid adenoma and the thyroid gland, and compare enhancement patterns to establish the absolute and relative washout rates of parathyroid adenoma. Materials & methods This retrospective study analyzes the CT findings of 33 patients with histopathologically proven parathyroid adenomas. All patients with 4D CT scans have been included with no exclusion criteria. The mean attenuation was measured in Hounsfield units for the parathyroid adenoma and thyroid gland in the non-enhancing, arterial, venous, and delayed phases, depending on the region of interest. All statistical analyses were performed using SPSS (IBM Corp., Armonk, NY, USA). Student's t-test was used to evaluate the differences in measurements between the parathyroid adenoma and thyroid tissue. One-way ANOVA was used to evaluate the difference in calculations between the parathyroid adenoma and thyroid tissue. P-values <0.001 were considered statistically significant. Results The most common location of parathyroid adenomas is inferior to the thyroid gland. The average pre-contrast attenuation of the parathyroid adenoma is 61.8 ± 15.5 HU compared to 105.5 ± 15.2 HU of the thyroid gland. The arterial attenuation of the parathyroid adenoma is 170.3 ± 40.7 HU, relatively comparable to the thyroid gland arterial attenuation, which is 188.0 ± 9.6 HU. The venous and delayed-phase attenuation of the parathyroid adenoma were 146.8 ± 37.5 and 96.8 ± 26.7 HU, respectively, and 178.8 ± 20.2 HU and 149.3 ± 15.2 HU for the thyroid gland, respectively. The calculated absolute and relative arterial washout rates for the parathyroid adenoma were 69.4 ± 13.4% and 43.2 ± 8.0%, respectively, as compared to 46.4 ± 9.9% and 20.6 ± 6.7% for the thyroid gland. The calculated absolute and relative venous washout rates for the parathyroid adenoma were 58.0 ± 21.4% and 33.0 ± 13.7%, respectively, as compared to 37.2 ± 17.2% and 15.9 ± 9.6% for the thyroid gland. Conclusions Parathyroid adenoma demonstrated a significantly higher washout rate than the thyroid gland tissue. Absolute arterial washout ≥69% and relative arterial washout ≥43% indicate parathyroid adenoma. Moreover, absolute venous washout ≥58% and relative venous washout ≥33% can be considered diagnostic factors for parathyroid adenoma. Further, pre-contrast attenuation of <60 Hounsfield units has a substantial predictive value for parathyroid adenoma in addition to the described washout rate. Increased awareness of the washout rate can increase the success rate of four-dimensional computed tomography interpretation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Wazzan et al.)

Acute appendicitis is a prevalent condition that requires accurate and timely diagnosis and management to avoid potential complications. Classically, the diagnosis of appendicitis is made using the appendicular outer-to-outer wall diameter. In this study, we examined the sensitivity and specificity of computed tomography (CT) scans for diagnosing acute appendicitis using wall thickness and lumen thickness rather than diameter. This study included data from 350 patients who presented to the emergency department with clinically suspected acute appendicitis. All patients underwent a CT scan, and 62 radiologically positive patients underwent surgery. A radiological diagnosis was made using the conventional outer-to-outer wall diameter with a cut-off of 6 mm for a positive diagnosis. These 62 positive CT scans were reviewed and compared with surgical results. The study showed that a threshold of 2.25 mm for appendicular lumen thickness is an excellent diagnostic tool for acute appendicitis, demonstrating a high sensitivity of 96.4% and a lower specificity of 67%. In contrast, 1.6 mm wall thickness indicates acute appendicitis, with 81.8% sensitivity and 84% specificity. However, the wall thickness remains inferior to the conventionally used measurement of 6.75 mm for appendicular diameter, with a sensitivity of 87.5% and a specificity of 100%., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Wazzan et al.)

During the pandemic, health care resources were primarily focused on treating COVID-19 infections and its related complications, with various Clinical units were converted to COVID-19 units, This study aims to investigate the impact of the COVID-19 pandemic on the clinical course of patients who had developed acute coronary syndrome (ACS) including ST-elevation myocardial infarction (STEMI). In this large nationwide observational study utilizing National Inpatient Sample 2019 and 2020.The primary outcomes of our study were in-hospital mortality, length of stay (LOS), total hospital charges and time from admission to percutaneous coronary intervention (PCI). Using the National Inpatient Sample 2020 database we found 32,355,827 hospitalizations in 2020 and 521,484 of which had a primary diagnosis of STEMI that met our criteria. Patients with COVID-19 infection were similar in mean age, more likely to be men, were treated in the same hospital settings as those without COVID-19 and had higher rates of diabetes with chronic complications. These patients had a similar prevalence of traditional coronary artery disease risk factors including hypertension, peripheral vascular disease and obesity. There was higher inpatient mortality (adjusted odds ratios 3.10; 95% CI, 2.40-4.02; P < 0.01) and LOS (95% CI 1.07-2.25; P < 0.01) in STEMI patient with concurrent COVID-19 infection. The average time from admission to PCI was significantly higher among unstable angina (UA) and None ST-segment elevated myocardial infarction (NSTEMI) in patients with a secondary diagnosis of COVID-19 infection compared to patients without: 0.45 days (95% CI: .155-758; P < 0.01). The COVID-19 pandemic had a significant impact on the treatment of patients with ACS, resulting in increased inpatient mortality, higher costs, and longer lengths of stay. During the pandemic, for patients with UA and NSTEMI the time from admission to PCI was significantly longer in patients with a secondary diagnosis of COVID-19 compared to patients without. When comparing ACS outcomes between pre-pandemic to pandemic periods (2019 versus 2020), the 2020 data showed higher mortality, higher hospital costs, and a decrease in LOS. Finally, the time from admission to PCI was longer for UA and NSTEMI in 2020 but not for patients with STEMI., (Published by Elsevier Inc.)

Background: The aim of this systematic review is to determine microRNAs (miRs) that are differently expressed between diseased pulpal and periapical tissues., Design: This systematic review used PubMed, Scopus, EBSCO, ProQuest, Cochrane database as well as manual searching to extract studies from January 2012 up to February 2022., Results: A total of 12 studies met the eligibility criteria were included. All selected studies were of case-control type. Twenty-four miRNAs associated with apical periodontitis, 11 were found to be upregulatedand 13 were downregulated. Four out of the 44 miRs associated with pulpal inflammation were upregulated, whereas forty were downregulated. Six miRs, namely hsa-miR-181b, hsa-miR-181c,hsa-miR-455-3p,hsa-miR-128-3p, hsa-miR199a-5p, and hsa-miR-95, exhibited considerable downregulation in both periapical and pulp tissues., Conclusion: MiRs have been investigated for their role in pulpal and periapical biology and may be utilised in diagnostic and therapeutic purposes. Further investigations are required to determine why certain irreversible pulpitis situations progress to apical periodontitis and others do not, based on the various miR expressions. Moreover, clinical and laboratory trials are needed to support this theory., Competing Interests: The authors declare there are no competing interests., (©2023 Al Gashaamy et al.)

Anemia affects approximately a quarter of the global population, and improved detection may reduce the associated morbidity and mortality. This study investigated correlations between the results of laboratory hematological determinations of hemoglobin levels and attenuation values measured in the lumina of the abdominal aorta and inferior vena cava (IVC) via unenhanced computed tomography (CT) with the aim of expanding diagnostic options for anemia. The data of 423 patients who underwent abdominal unenhanced CT examinations and laboratory examinations at a tertiary hospital were retrospectively evaluated. CT data were collected using a standard abdominal protocol without contrast. The 151 patients who met the inclusion criteria were categorized by hemoglobin values as follows: <8 (severe anemia), 8-10.9 (moderate anemia), 10.9-12 (mild anemia in females), 10.9-13 (mild anemia in males), and >13 g/dL (non-anemic). The mean CT attenuation values in the aorta and IVC were 37.7 and 36.1 Hounsfield units (HU), respectively. A regression analysis performed to evaluate the correlation and predictability of hemoglobin-based aortic and IVC density yielded a coefficient of determination, R 2 : 0.42 (F ratio: 149.23, p < 0.0001). The highest contribution in the dependent variable (hemoglobin) was reported to IVC density, showing a significant positive correlation between hemoglobin and IVC density. Our study results demonstrate significant correlations between the densities of the aorta, IVC, and hemoglobin value. Accordingly, radiologists and clinicians can use these readily available values to facilitate diagnosis and patient care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wazzan et al.)

The abdominal aorta is the largest artery in the abdomen. It then bifurcates giving the two common iliac arteries. Knowing the normal abdominal aorta diameter is a basis for diagnosing abdominal aortic aneurysms (AAAs) and subsequently developing an optimal management plan. In order to diagnose AAA, one must have a reference for the normal abdominal aortic diameter that represents the anatomical variation in the population being studied. The aim of this research is to establish normal abdominal aortic diameters in the Saudi population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wazzan et al.)

In recent times, organisations in a variety of businesses, such as healthcare, education, and others, have been using the Internet of Things (IoT) to produce more competent and improved services. The widespread use of IoT devices makes our lives easier. On the other hand, the IoT devices that we use suffer vulnerabilities that may impact our lives. These unsafe devices accelerate and ease cybersecurity attacks, specifically when using a botnet. Moreover, restrictions on IoT device resources, such as limitations in power consumption and the central processing unit and memory, intensify this issue because they limit the security techniques that can be used to protect IoT devices. Fortunately, botnets go through different stages before they can start attacks, and they can be detected in the early stage. This research paper proposes a framework focusing on detecting an IoT botnet in the early stage. An empirical experiment was conducted to investigate the behaviour of the early stage of the botnet, and then a baseline machine learning model was implemented for early detection. Furthermore, the authors developed an effective detection method, namely, Cross CNN&#95;LSTM, to detect the IoT botnet based on using fusion deep learning models of a convolutional neural network (CNN) and long short-term memory (LSTM). According to the conducted experiments, the results show that the suggested model is accurate and outperforms some of the state-of-the-art methods, and it achieves 99.7 accuracy. Finally, the authors developed a kill chain model to prevent IoT botnet attacks in the early stage.

Background: Crohn's disease (CD) is a complex autoimmune disease that results in chronic inflammation of the gastrointestinal tract. CD activity is determined through clinical, laboratory, endoscopic, and radiological evaluations. Studies that examine the data of radiological modalities of evaluation are lacking, particularly in Saudi Arabia. This study compares magnetic resonance enterography (MRE) and ultrasonography (US) findings among patients diagnosed with CD, to uncover a possible correlation between these techniques., Methods: All patients were assessed for disease activity using MRE and US., Results: A total of 376 patients with CD were recruited. The mean age was 14.9 ± 4.3 years (range, 8-27 years), and males constituted 64% (n = 239) of the cohort. Overall, a strong positive correlation was found between US and MRE evaluations of disease activity (r = 0.83, P < 0.001). US activity correlated positively with MRE findings of enlarged lymph nodes (P < 0.001), bowel wall enhancement (P < 0.001), distal jejunal thickness (P < 0.001), and distal ileal thickness (P < 0.001). The mean difference in wall thickness was significant based on gender (P < 0.001), age in proximal jejunal thickness (P < 0.001), and distal ileal thickness (P = 0.011)., Conclusions: MRE and US correlate significantly as imaging techniques for the assessment of CD activity., Competing Interests: None

Background: The aim of this systematic review was to address the clinical effectiveness of space maintainers and space regainers in the prevention and correction of dental arch decreases in mixed dentition., Methods: An electronic search was conducted using five databases: the Cochrane Database for Systematic Reviews, EBSCO Host, ScienceDirect, PubMed, and Scopus (until February 2021) and 6 relevant journals. Inclusion criteria were: Randomized Controlled Clinical Trials (RCTs), Controlled Clinical Trials (CCTs), cohort studies and case-control studies of children in the mixed dentition requiring a space maintainer or a space regainer, children with mild to moderate crowding, and with Class I and mild Class II or Class III skeletal pattern. All articles included in this review were examined independently by three teams of investigators to assess the level of bias using the Cochrane risk of bias tools RoB 2.0 (for RCTs) and ROBINS-I (for non-RCTs)., Results: Following the three phases of a systematic search, 11 studies were included for the final analysis, of which nine used space maintainers (a lower lingual arch) and two used space regainers (one lip bumper and one transpalatal arch) with contradicting results. Four of the former and one of the latter devices showed a significant increase in arch length. Out of the 11 articles, one was found to be of critical risk, two of serious risk and eight of moderate risk of bias., Conclusions: There is very low evidence to suggest that space maintainers and regainers are effective in preserving arch length and preventing mild to moderate crowding in children during the mixed dentition stage at the expense of lower incisor proclination. However, considering the low evidence provided by this systematic review, high-quality studies are needed., 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., (© 2021 The Authors.)

Background and Aim: The anxiolytic effects of music have been studied during the past twenty years in different medical therapies. The aim of this study is to evaluate the effect of music therapy on patients' dental anxiety, salivary cortisol, heart rate, blood pressure and body temperature during dental treatment., Methods: In this randomized control study, 46 patients were randomly selected from the Urgent Care dental clinic who needed urgent endodontic treatment (endodontic access and pulp extirpation). Participants were divided into two groups: intervention group (N=23) which was exposed to slow rhythm melody music and had no lyrics throughout the entire procedure and a control group (N=23) who undergoes the same dental procedure without being exposed to music. Participants' blood pressure, heart rate, body temperature and salivary cortisol were measured before and after the treatment for both groups., Results: Patients in the intervention group showed lower salivary cortisol, blood pressure, heart rate and body temperature compared to those in the control group, however, the differences did not reach to statistical significance., Conclusion: -Despite the change in the dental anxiety and stress during treatment with music, the findings of this study could not establish evidence of the effect of music in reducing dental anxiety and lowering physiological stressors. Therefore, further studies with larger sample size may be needed. (www.actabiomedica.it).

Background Advanced bowel damage caused by Crohn's disease (CD) in the form of strictures and penetrating lesions has been associated with future surgical resection. However, in general, the degree of bowel damage in patients with CD is not examined at the time of diagnosis, and the natural history of CD may differ phenotypically between patients from Arabic countries as compared to patients from Europe and North America. Thus, we aimed to assess the degree of structural bowel damage in Saudi Arabian CD patients at diagnosis. We used the Lémann Index (LI) score, an instrument that measures cumulative digestive tissue damage by magnetic resonance enterography (MRE) and endoscopy, to establish any possible association between the duration of symptoms and the degree of bowel damage. Method This retrospective study was conducted by reviewing the data of all CD patients following up at King Abdulaziz University Hospital (KAUH) that were investigated by endoscopy and MRE at baseline. MRE-LI was calculated by scoring previous surgery, disease location and extension, and intestinal complications. A LI score of >2.0 was set as the cut-off point for bowel damage. Descriptive statistics were used to provide an overview of demographic and clinical characteristics, and hypothesis testing was applied to identify associations. Result Eighty-three patients with CD were included in this study. Fifty point six percent (50.6%) of the cohort comprised females and the median age was 27 years. With regards to CD location and extension, 34.9% showed ileal disease (L1), 9.6% showed colonic CD (L2), whereas 55.4% had ileocolonic involvement (L3). Moreover, 48.2% of patients presented with non-complicated behavior (B1), 25.3% had at least one stricture (B2), and 26.5% showed a penetrating phenotype (B3). Perianal CD was observed in 2.4% of subjects and 62.7% had undergone bowel resection. Mean LI was 2.4 (±2.6) with 34 patients (39.8%) exhibiting an LI score indicative of advanced bowel damage at the time of diagnosis. The duration of symptoms did not correlate with the degree of bowel damage according to the LI score. Conclusion A significant proportion of patients with CD presented with advanced bowel damage at the time of diagnosis, suggesting that a severe form of CD may be endemic in Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Halawani et al.)

In an acute care hospital, we demonstrated that the clothing and shoes that physicians and nurses wear home from health care facilities can be contaminated with health care-associated pathogens, particularly methicillin-resistant Staphylococcus aureus. These findings suggest that the clothing and shoes of personnel have the potential to serve as vectors for the transfer of health care-associated pathogens to the community., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.)

The Internet is one of the major sources for health information for patients and their families, particularly when patients face serious life-threatening conditions such as kidney cancer in adults. In this study, we evaluate the content and quality of health information on adult kidney cancer using several validated instruments. We accessed the three most popular search engines (Google, Yahoo, Bing), using two terms: "kidney cancer" and "renal cell carcinoma," and reviewed the top 30 hits. After exclusion of duplicated websites, websites targeting health care professionals, and unrelated websites, 35 websites were included. Content was assessed using a 22-item checklist adapted from the American Cancer Society. We assessed website quality using the DISCERN questionnaire, HONcode and JAMA benchmark criteria, readability using three readability scores, and ALEXA for global traffic ranking systems. The average website had 16 of 22 content items while 6 websites fulfilled all 22 items. Among all websites, the average DISCERN quality score was 42 out of 80, 15 (42.8 %) of websites had HONcode certification, and only 3 (8.5 %) fulfilled all JAMA benchmark criteria. The average website readability was at the ninth grade reading level. The content and quality of health-related information on the Internet for adult kidney cancer are variable in comprehensiveness and quality. Many websites are difficult to read without a high school education. A standardized approach to presenting cancer information on the Internet for patients and families may be warranted.