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Coronavirus disease 2019 (COVID-19), a mystified cryptic virus has challenged the mankind that has brought life to a standstill. Catastrophic loss of life, perplexed healthcare system and the downfall of global economy are some of the outcomes of this pandemic. Humans are raging a war with an unknown enemy. Infections, irrespective of age and gender, and more so in comorbidities are escalating at an alarming rate. Cardiovascular diseases, are the leading cause of death globally with an estimate of 31% of deaths worldwide out of which nearly 85% are due to heart attacks and stroke. Theoretically and practically, researchers have observed that persons with pre-existing cardiovascular conditions are comparatively more vulnerable to the COVID-19 infection. Moreover, they have studied the data between less severe and more severe cases, survivors and non survivors, intensive care unit (ICU) patients and non ICU patients, to analyse the relationship and the influence of COVID-19 on cardiovascular health of an individual, further the risk of susceptibility to submit to the virus. This review aims to provide a comprehensive particular on the possible effects, either direct or indirect, of COVID-19 on the cardiovascular heath of an individual.

BACKGROUND:Drowning is the third leading cause of unintentional death among children worldwide. Although natural waters pose a risk of drowning in low-income countries, swimming pools are more prevalent in high-income countries. In Saudi Arabia, injuries and drowning are a significant threat to population health. Local data is limited, which affects an understanding of the extent of the burden and the development of prevention strategies.OBJECTIVE:Determine the epidemiological characteristics, risk factors, and clinical outcomes of drowning among children.DESIGN:Retrospective chart review.SETTING:Patients admitted to the tertiary care unit of a hospital in Riyadh.PATIENTS AND METHODS:Data was collected on children who drowned (age 0-14) between January 2015 and August 2020. Cases were identified from the electronic health record system where the diagnosis was drowning. Differences in characteristics and outcomes between nonfatal cases with no neurological damage and fatal cases with neurological damage were analyzed.MAIN OUTCOME MEASURE:Drowning mortality and morbidity.SAMPLE SIZE:99.RESULTS:Of the 99 drowning cases, 22 (22.2%) had a fatal outcome or resulted in neurological damage. The most-reported drowning site was private pools (82%). The majority of cases involved children younger than the age of two (54%). Eighty-four cases (84.8%) occurred on holidays. Cardiopulmonary resuscitation was performed in 61 (61.6%) of cases. A significant association was found between the delay in initiating resuscitation and an unfavorable outcome (PPCONCLUSION:These findings warrant investment to increase public awareness of the risks of leaving children unsupervised in swimming pools. In addition, there is a need to ensure early resuscitation of drowning victims by promoting life support courses in order to facilitate positive outcomes.LIMITATIONS:The study was conducted in one tertiary center located in a non-coastal city so the results may not be generalizable.CONFLICT OF INTEREST:None.

Neurodegeneration is a prevalent and one of the emerging reasons for morbidity, mortality, and cognitive impairment in aging. Dementia is one of such conditions of neurodegeneration, partially manageable, irreversible, and worsens over time. This review is focused on biological and psychosocial risk factors associated with Alzheimer's and Parkinson's diseases, highlighting the value of cognitive decline. We further emphasized on current therapeutic strategies from pharmacological and non-pharmacological perspectives focusing on their effects on cognitive impairment, protein aggregation, tau pathology, and improving the quality of life. Deeper mechanistic insights into the multifactorial neurodegeneration could offer the design and development of promising diagnostic and therapeutic strategies.

Background Pneumocystis pneumonia (PCP) is a fatal infectious disease caused by Pneumocystis jirovecii (PJP). The major factor relevant to morbidity and mortality seems to be the host inflammatory reaction. The objective of this study was to evaluate the role of IL-2, IL-4, IL-10, and IL-13 cytokine mRNA expression among suspected P. jirovecii infection. Methods This was a cross-sectional analytical study undertaken in Aseer region, Saudi Arabia. One hundred suspected PCP cases and 100 healthy controls were included in the study. Basic clinical manifestations, radiological findings, microbiological and immunological findings were extracted from the hospital records from January 2019 to August 2019, Pneumocystis detection was done by immune-fluorescent staining (IFAT, Gomorimethanamine silver staining (GMSS), Giemsa staining, Toluidine blue O (TBO), and Pneumocystis RT-PCR. Results Increased more than 5 fold, 3 fold, 4 fold, and 7 fold of IL-2, IL-4, IL-10, and IL-13 mRNA expression were observed in PCP cases compared to controls. Higher expression of IL-2 mRNA was connected with crept, wheezing and chest X-ray findings like central perihilar infiltrate, patchy infiltrate, consolidation, hilar lymphadenopathy, pneumothorax, pleural effusion which showed higher expression compared to counterpart (pp=0.002), dyspnea (p=0.003), crept (p=0.01), and chest X-ray findings (p Conclusion Confirmed cases of P. jirovecii showed higher IL-2, IL-4, IL-10, and IL-13 mRNA expression comparatively to negative cases. Increased expression of cytokines may be indicative of infection severity and could help in patients’ management.

Monogenic diseases that result in early pregnancy loss or neonatal death are genetically and phenotypically highly variable. This often poses significant challenges in arriving at a molecular diagnosis for reproductive planning. Molecular autopsy by proxy (MABP) refers to the genetic testing of relatives of deceased individuals to deduce the cause of death. Here, we specifically tested couples who lost one or more children/pregnancies with no available DNA. We developed our testing strategy using whole exome sequencing data from 83 consanguineous Saudi couples. We detected the shared carrier state of 50 pathogenic variants/likely pathogenic variants in 43 families and of 28 variants of uncertain significance in 24 families. Negative results were seen in 16 couples after variant reclassification. In 10 families, the risk of more than one genetic disease was documented. Secondary findings were seen in 10 families: either genetic variants with potential clinical consequences for the tested individual or a female carrier for X-linked conditions. This couple-based approach has enabled molecularly informed genetic counseling for 52% (43/83 families). Given the predominance of autosomal recessive causes of pregnancy and child death in consanguineous populations, MABP can be a helpful approach to consanguineous couples who seek counseling but lack molecular data on their deceased offspring.

This within subject clinical experiment assessed oral health impacts before and after Invisalign orthodontic treatment and their relationships with personality characteristics. 50 patients (26 females and 24 males; mean age = 27.62 ± 8.25 years, SE = 1.17, 95% CI = 24.71–29.89 years) were assessed before and after treatment with Invisalign orthodontic treatment. Treatment clinical success was evaluated according defined clinical guidelines. Oral health impacts before and after Invisalign orthodontic treatment were measured via the Oral Health Impact Profile (OHIP). Personality features were measured via the NEO Five-Factor Inventory (NEO-FFI). Probability of α = .05 was utilized to identify significant findings. Females scored less OHIP scores after treatment (had less negative impacts) in comparison to baseline OHIP scores (t = 3.782, df = 25, P = .001, 95% CI of mean difference = 2.750–9.327). Among males, openness scores (R2 = .911, B = 5.235, 95% CI for B = 0.062–10.407, t = 2.601, P = .048) were able to predict OHIP scores before treatment; meanwhile, extraversion (R2 = .959, B = − 8.224, 95% CI for B = − 14.605–1.843, t = − 3.313, P = .021), openness (R2 = .959, B = 21.795, 95% CI for B = 10.737–32.853, t = 5.067, P = .004), and conscientiousness (R2 = .959, B = 10.293, 95% CI for B = 4.796–15.790, t = 4.813, P = .005) scores were useful to predict OHIP scores after treatment (R2 = .959, P P > .05). These findings demonstrate that oral health impacts of Invisalign orthodontic treatment and personality profiles contribution to oral health impacts were different between genders.

The aim of the present clinical trial is to evaluate the clinical, bacterial, and immunological outcomes of photodynamic therapy (PDT) in adolescent patients with orthodontic treatment-induced gingival enlargement (OTGE).A total of 26 adolescent patients, 16 girls and 10 boys, of mean age 16.8 years, undergoing fixed orthodontic treatment for at least 6 months (mean duration in months, 8.3 ± 1.9) and presenting with GE were included in the clinical trial. All patients undergoing fixed orthodontic treatment with clinical diagnosis of OTGE were divided into two groups: Patients receiving full-mouth periodontal debridement (FMPD) 'Group-FMPD' and 'Group-PDT' included participants receiving methylene blue-assisted PDT in the selected area along with FMPD. Clinical periodontal assessments included the evaluation of plaque scores (PS), bleeding on probing (BOP), probing depth (PD) and hyperplastic index (HI). The total bacterial counts of Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), and Tannerella forsythia (T. forsythia) were estimated and expressed as log CFU/mL of each bacteria. Cytokines including interleukin (IL)-1β and IL-6 were analyzed using enzyme-linked immunosorbent assay (ELISA) kit.The mean percentage of PS and BOP statistically significantly reduced with both FMPD and PDT from baseline to 4 weeks (p0.05). Although mean PD significantly reduced in both the groups at all time points, there was significantly higher reduction with PDT as compared to FMPD at 2 weeks post treatment (p0.05). Inter-group comparison showed PDT demonstrated significantly higher HI at 2- and 4-weeks post treatment (p0.05). The mean log CFU/mL of P. gingivalis and T. forsythia showed statistically significantly higher reduction with PDT than FMPD (p0.05) at both 2-and 4-weeks follow-up. T. denticola reported significantly reduced levels at 2 weeks follow-up period only with PDT (p0.05). No statistically significant difference appeared when both treatment modalities were compared with one another (p0.05). Four weeks after periodontal treatment, IL-6 significantly reduced with PDT compared to FMPD (p0.05).PDT assisted in reducing bacterial counts and improving hyperplastic index in OTGE.

The aim of the present study was to evaluate the effectiveness of photodynamic therapy (PDT) on clinical gingival inflammatory parameters, bacterial load, proinflammatory cytokine status, and pain scores in adolescent patients undergoing fixed orthodontic treatment with gingivitis.Thirty adolescent undergoing fixed orthodontic treatment with gingivitis were randomly divided into two groups: Group A - patients undergoing dental scaling (DS) with adjunctive photodynamic therapy (PDT) and Group BDS alone. Clinical gingival parameters including plaque scores, (PS), bleeding on probing (BOP) and probing depth (PD) were assessed. Visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ) were used to report the values of present pain intensity. Crevicular fluid was sampled to quantify the levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α using enzyme-linked immunosorbent assay. The total bacterial counts for Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) were assessed. All examinations were performed at baseline, 1 week and 4 weeks.Both the treatment regimens reported statistically significant reduction in PS and BOP (p0.05). However, no significant difference was observed in PS and PD values when Group B was compared with Group A (p0.05). There was a statistically significant reduction noted for BOP in Group B when compared to Group A (p0.05). There was a statistically significant reduction in the microbial counts of T. forsythia in Group A when compared to Group B at week-1 (p0.05). During the 4-week follow-up, the counts for T. forsythia significantly increased. No significant changes could be seen in either of the pain scores in both the groups (p0.05). Both groups showed statistically significant reduction in the IL-6 and TNF-α levels. However, IL-6 was significantly reduced at 1 week, while TNF-a significantly reduced at 4 weeks of follow up among the participants in Group B.PDT has a positive effect in significantly reducing the periodontal microbial load in established gingivitis in adolescent patients undergoing fixed orthodontic treatment.

Purpose The aim of the present randomized controlled clinical trial was to evaluate the efficacy of photodynamic therapy (PDT) on halitosis in adolescent patients undergoing fixed orthodontic treatment. Materials and methods Forty-five adolescents with halitosis undergoing orthodontic treatment were equally randomized into three groups: Group – I: provision of treatment through PDT on dorsum of tongue; Group – II: provision of treatment with the help of tongue scrappers (TS); Group – III: provision of treatment with the help of TS and adjunctive PDT. Presence of halitosis confirmed on the basis of gas chromatography and estimation of oral malodour with a cysteine challenge and H2S values recorded ≥112 parts per billion (ppb). A portable device Oral Chroma™ was used for performing breath analysis. A total of 5 bacterial species including P. gingivalis, F. nucleatum, P. intermedia, T. forsythia and T. denticola were studied as the proportion of sites defined as having ≥1.0 × 105 bacterial cells. Results The mean age of the participants in Group-I, II and III were 15.4 years, 13.8 years, and 14.2 years, respectively. The median values for Group-I, II and III at initial breath analysis were 874 ppb, 613 ppb and 1089 ppb, respectively. After treatment with the respective therapeutic modalities, a statistically significant difference was seen among groups after 2-weeks (p Table 3 ). After applying Kruskal-Wallis test, group-III showed the highest amount of reduction in H2S concentration (100 %) at final 2-weeks breath analysis compared to group-I and group-II (p = 0.0001). Descriptive statistics for all bacteria showed that group-III (TS + PDT) statistically significantly reduced the proportional distribution of all bacteria at 2-week follow-up (p Conclusion PDT along with tongue scrapping showed effective immediate reduction of H2S concentration and reduction of oral pathogens in adolescent patients undergoing fixed orthodontic treatment with short-term follow up. Long-term evaluation and complete eradication of halitosis needs to be explored in further clinical trials. In addition, the cost of PDT and its potential side effects should not be disregarded.

Background External stressors such as high altitude and low oxygen are known to affect the human microbiome, and in light of the increased occurrence of dental caries and periodontitis in orthodontic patients, the effect of high altitude and the altered oral environment in orthodontic patients on the oral salivary microbiome was researched. Materials & methods 31 orthodontic patients from high altitude, Aseer region and 25 orthodontic patients, residing at sea level, as controls were included. DNA isolation was done from the saliva collected from the study participants. V3 area of 16s RNA was targeted by universal primers through PCR to decipher the salivary microbiome in both the groups. Results A total of 11 genera belonging to 4 phyla of bacteria were identified in both groups. The most abundant microbiome at the phylum level was: Firmicutes, Bacteroidetes Proteobacteria, and Cyanobacteria. The salivary microbiome was more diverse in sea level controls compared to that of the orthodontic patients at high altitude wherein the presence of only two main phyla: Firmicutes and Proteobacteria were seen. The controls revealed Firmicutes, Proteobacteria, Bacteroidetes and Cyanobacteria. Conclusions The findings of the study suggest that the biodiversity of the salivary microbiome is severely perturbed under the cumulative influences of high altitude and presence of fixed orthodontic appliance. Under these circumstances, a strict and meticulous oral hygiene regimen should be recommended and followed to avoid harmful effects on the periodontal tissues.

This cross-sectional study was done to evaluate linear and angular measurement of lip morphology in Saudi adults and their comparison with the norms. After taking their history and physical examination, the patients were referred for a lateral Cephalograph using Dolphin Imaging Software. Linear and angular measurements related to lip morphology were recorded. Significant differences were found in the lower lip to E line, upper and lower lip protrusion, upper and lower lip to S line and upper and lower lip thickness, nasolabial angle, Z angle, with Saudi males having more prominent, thicker lips than the Saudi females. Comparison with the norms revealed that both lips are prominent among Saudi males, while in females there is an increased prominence of the lower lip. Value of the lower lip to H line is increased in both genders, males have prominent and thicker upper lips compared to the females and the lower lip in both genders is more prominent compared to the norms.