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Background: The department of emergency medicine is well-known for its mental and physical difficulties. Previous research has shown that emergency medicine physicians experience higher levels of burnout than the general population, which has detrimental consequences for both patients and physicians. Aim: This systematic review and meta-analysis aims to estimate the current burden of burnout syndrome among emergency physicians in Saudi Arabia. Methods: This study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Systematic search was conducted on 6 databases using keywords relevant to burnout syndrome among emergency professionals in Saudi Arabia. We used Rayyan-Qatar Computing Research Institute (QCRI) [18] for importing and managing search results, as well as for detection and removal of duplicates. Quantitative data synthesis was done using Review Manager 5.4. Random effects model was applied. Higgin’s I2 test has been used in order to detect heterogeneity. Results: A total of 7 studies including a total population of 671 EMS professional have been enrolled for the pooled estimation of the prevalence of high emotional exhaustion (51% (95% CI: 33%-69%)), high depersonalization (37% (95% CI: 24%-50%)), low personal accomplishments (31% (95% CI: 25%-37%)), and overall burnout syndrome prevalence (28% (95% CI: -45%-101%)). Significant heterogeneity was evident in all pooled estimates except for low PA and prevalence of overall burnout. Conclusion: This meta-analysis demonstrates high rates of high EE, high DP, and low PA among emergency physicians in Saudi Arabia. Evident from literature, our study suggests that EM physicians are more prone to burnout in comparison to physicians in other departments and other medical staffs.

Some macro-benthic organisms, such as macroalgae, bryozoans, sponges, and gorgonian corals, can create heterogeneous frameworks of habitats in the surrounding seabed. Such frameworks are important benthic ecosystems, but knowledge of them is fairly limited in the Arabian Gulf, the hottest sea in the world. In this study, the presence of macroalgae, bryozoans, sponges, and gorgonian corals was discovered in the seabed of the western Arabian Gulf. These organisms had positive co-occurrences with a preference for depths of 20 to 50 m. A hotspot of spatial distribution of macroalgae and bryozoans was also identified, located in the northwestern part of the Arabian Gulf. These habitat forming organisms were distributed in a patchy pattern with low to moderate levels of density. They were positively associated with several commercial fishes, suggesting their importance to fishery. Our discovery extends the distribution of marine habitat-forming organisms into the offshore waters of the subtropical Arabian Gulf. info:eu-repo/semantics/publishedVersion

The study has aimed to identify the relationship between Spiritual Intelligence and Psychological Resilience and the correlation relation between them for a sample of special education teachers by following the relational descriptive approach. The sample consisted of (134) female teachers who were selected randomly from the Integration Schools in Jeddah, the study adopted the statistical package program in social sciences (SPSS) to analyze the data. The spiritual intelligence scale was developed and prepared using the scales of Al-Shawi (2012), Ibrahim (2017) and the psychological resilience scale for Al-Tallaa (2016), the results yielded: the study sample has high level of spiritual intelligence and Psychological Resilience. There is a positive correlation and statistical function between the degrees of the study sample individuals on the spiritual intelligence scale and their degrees on the psychological resilience scale. The dimensions of spiritual intelligence (sense –excellence –merit) contribute to predicting psychological resilience for special education teachers. The most important recommendations were represented in the possibility of the teacher's contribution in implementing training programs to develop spiritual intelligence and psychological resilience. Increasing attention to psychological factors can help families with disabilities to cope with stress in life and creates a supportive group culture in the school environment to spread spiritual practices with educational staff.

An asymptomatic 4.5 years-old Saudi girl was referred to the pediatric hepatology service with presumed liver disease because of the persistently elevated transaminases which were discovered accidently during routine laboratory workup. Alanine aminotransferase was 128 IU/L and aspartate aminotransferase was 143 IU/L. Subsequent investigations in the hepatology clinic revealed normal hepatic workup. Muscle related work up revealed increased creatine phosphokinase, abnormal electromyography and motor nerve conduction. Muscle biopsy was suggestive of early stage muscular dystrophy, and analyses were compatible with limb-girdle-muscle-disease Type 2C. Further confirmation was reached by molecular genetic testing. This case demonstrates that increased transaminases do not always suggest liver disease, and occult muscle disease should always be taken into account while investigating patients with unexplained persistent hypertransaminasemia.

Renewable energy utilization for electricity supply has increased significantly. Technology maturity, cost reduction, and environmental friendliness are significant factors that encourage this increase. The expansion of distributed generation is increasing significantly due to the concern of many householders and entrepreneurs in minimizing the energy costs at residential and commercial properties due to the high significance of the energy costs at total expenses of most families and business. This study focuses on exploring optimization process of energy costs of a grid-connected hybrid PhotoVoltaic (PV)/Battery/Grid. The profile of a big commercial load located in Brazilian Amazon area is used as an optimization example. The system performance and optimization results are verified by using Hybrid Optimization of Multiple Energy Resources (HOMER).

Background Pantothenate kinase-associated neurodegeneration (PKAN), sickle cell anemia, and thalassemia are autosomal recessive disorders that can cause iron deposition in tissues during childhood. PKAN is characterized by accumulation of iron in the basal ganglia causing progressive extrapyramidal manifestations. Thalassemia and sickle cell disease can cause iron overload and deposition in tissues, including central nervous system. Presentation of case we herein report the first report of comorbidity of PKAN, β-thalassemia-major, sickle cell and glucose-6-phosphate dehydrogenase deficiency (G6PD) anemias in a 9 years old Saudi female patient who presented with gait disturbance, speech difficulty, and progressive movement disorders of the neck, upper and lower limbs. Conclusion Although extremely rare, β-thalassemia-major, sickle cell and G6PD anemias can be associated with PKAN. It is unknown whether this association is random or due to an unknown factor that may have caused several mutations., Highlights • This is the first report of comorbidity of PKAN, β-thalassemia-major, sickle cell disease and G6PD deficiency. • We highlight the pathophysiology of comorbidity of PKAN and chronic hemolytic anemias. • A missense mutation in homozygous status in PANK2 gene on chromosome 20p13.

Background Pediatric and Adolescent populations both have special needs for vitamin D especially for growing bone. Inadequate vitamin D is defined as 25 (OH) D(25hydroxy vitamin D)

Autoimmune diseases are considered the 3rd leading cause of morbidity and mortality in the industrialized countries. Autoimmune thyroid diseases (ATDs) are associated with high prevalence of nonorgan-specific autoantibodies, such as antinuclear antibodies (ANA), antidouble-stranded deoxyribonucleic acid (anti-dsDNA), antiextractable-nuclear antigens (anti-ENAs), rheumatoid factor (RF), and anticyclic-citrullinated peptides (anti-CCP) whose clinical significance is unknown. We aimed to assess the prevalence of various nonorgan-specific autoantibodies in patients with ATD, and to investigate the possible association between these autoantibodies and occurrence of rheumatic diseases and, if these autoantibodies could be considered as predictor markers for autoimmune rheumatic diseases in the future. This study had 2 phases: phase 1; in which 61 ATD patients free from rheumatic manifestations were assessed for the presence of these nonorgan-specific autoantibodies against healthy 61 control group, followed by 2nd phase longitudinal clinical follow-up in which cases are monitored systematically to establish occurrence and progression of any rheumatic disease in association to these autoantibodies with its influences and prognosis. Regarding ATD patients, ANA, anti-dsDNA, Anti-ENA, and RF were present in a percentage of (50.8%), (18%), (21.3%), and (34.4%), respectively, with statistically significance difference (P

Purpose Short stature affects approximately 2%–3% of children, representing one of the most frequent disorders for which clinical attention is sought during childhood. Despite assumed genetic heterogeneity, mutations or deletions in the short stature homeobox-containing gene (SHOX) are frequently detected in subjects with short stature. Idiopathic short stature (ISS) refers to patients with short stature for various unknown reasons. The goal of this study was to screen all the exons of SHOX to identify related mutations. Methods We screened all the exons of SHOX for mutations analysis in 105 ISS children patients (57 girls and 48 boys) living in Taif governorate, KSA using a direct DNA sequencing method. Height, arm span, and sitting height were recorded, and subischial leg length was calculated. Results A total of 30 of 105 ISS patients (28%) contained six polymorphic variants in exons 1, 2, 4, and 6. One mutation was found in the DNA domain binding region of exon 4. Three of these polymorphic variants were novel, while the others were reported previously. There were no significant differences in anthropometric measures in ISS patients with and without identifiable polymorphic variants in SHOX. Conclusion In Saudi Arabia ISS patients, rather than SHOX, it is possible that new genes are involved in longitudinal growth. Additional molecular analysis is required to diagnose and understand the etiology of this disease.

Vitamin D may play a role in the pathogenesis of type 1 diabetes (T1D). The aim of the current study was to determine the possible association between 25-hydroxyvitamin D [25(OH)D] levels and circulating levels of type 1 and type 2 cytokines, as well as the pathophysiology of T1D in children. A total of 250 T1D patients and 250 sex- and age-matched T1D-free controls were screened for 25(OH)D, hemoglobin A1c (HbA1c), type 1 and type 2 cytokines, C-reactive protein (CRP) and bone mineral metabolism, as well as antibodies against insulin, glutamic acid decarboxylase (anti-GAD 65) and islet cells. Our data showed that the plasma level of 25(OH)D was significantly lower in T1D patients and that there was a significant negative correlation between 25(OH)D levels and HbA1c values. There was a significant association between deficient levels of 25(OH)D and higher levels of cytokines (IFN-γ, TNF-α, IL-6, IL-1β, IL-4 and IL-10) and CRP. Total blood hemoglobin, the hematocrit percentage, body mass index SDS values, phosphate and magnesium levels were significantly lower in T1D patients than in T1D-free subjects. The levels of parathyroid hormone and alkaline phosphatase were significantly higher in T1D patients. Higher levels of cytokines were significantly associated with deficient levels of 25(OH)D. Moreover, in T1D patients, higher levels of islet antibodies, anti-GAD antibodies and anti-insulin antibodies were significantly associated with deficient levels of 25(OH)D. In type 1 diabetic children, deficient levels of 25(OH)D are associated with high levels of HbA1c, circulatory cytokines and antibody markers.

Rationale Pediatric idiopathic hypoparathyroidism with extensive intracranial calcifications outside the basal ganglia (BG) is extremely rare with less than 10 cases worldwide. Patient concerns An 11-year-old Saudi male child presented with tetany with otherwise normal neurological and other body system examination diagnoses severe hypocalcemia for differential diagnosis. Interventions Further investigations revealed hyperphosphatemia and undetectable serum intact parathyroid hormone. Brain computed tomography revealed BG and extensive brain calcifications. He has no dysmorphic features, vitiligo, mucocuataneous manifestations, or hair loss. He had normal hemoglobin, electroencephalogram, and skeletal survey, with negative autoantibodies to alpha and omega interferons and negative genetic testing for Glial Cell Missing 2 (GCM2) and calcium-sensing receptors (CaSRs) excluding known causes of hypoparathyroidism. Outcomes This case presents a rare entity of idiopathic hypoparathyroidism with extensive intracranial calcification, not only in BG but also outside the extrapyramidal system with normal mentality, development, pubertal achievement, and neurological examination. To our knowledge, this is the first report from Saudi Arabia in pediatrics. Lessons Idiopathic hypoparathyroidism is a diagnosis of exclusion after ruling out all known causes of hypoparathyroidism. It is associated with BG calcifications, but extensive intracranial calcifications outside the BG are extremely rare.

To investigate the effect of conventional periodontal therapy on serum C-reactive protein (CRP) level and periodontal status in obese and normal-weight chronic periodontitis patients.This is a controlled clinical trial conducted at the King Abdulaziz University Faculty of Dentistry, Jeddah, Kingdom of Saudi Arabia between December 2009 and March 2011. A total of 40 women affected with moderate to severe chronic periodontitis were selected (20 obese [test group] and 20 normal-weight [control]). Smokers, pregnant women, and subjects with any systemic disease were excluded. Serum CRP level and periodontal parameters, including clinical attachment level, probing depth, bleeding on probing and plaque scores were assessed at baseline, and 2 months after non-surgical periodontal treatment.Periodontal therapy was effective in reducing gingival inflammation, as well as serum CRP level in the total sample and within each group. The pre-treatment mean level of serum CRP was 0.78 (+/-0.51) and post- treatment was 0.55 (+/-0.41) mg/l in the total sample (p=0.001). A tendency was observed toward a better systemic response to treatment in normal-weight compared to obese women, however, it was not statistically significant (the mean changes in CRP levels after therapy were 0.28 [+/-0.43] and 0.19 [+/-0.32] mg/l).Periodontal treatment is effective in reducing systemic inflammation as measured by serum CRP level, and obesity does not have a major negative impact on response to periodontal therapy.