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BACKGROUND: The prime concern of an implant-supported prosthesis (ISP) is to maintain an optimal proximal contact tightness, which further maintains arch integrity, improves masticatory effectiveness, and minimizes peri-implantitis. OBJECTIVE: To investigate the loss of proximal contact tightness between single tooth implant-supported prosthesis and the adjacent natural teeth. METHODS: Forty patients treated by a single mandibular first molar ISP, aged between 18–50 years were selected. All were randomly allocated in Group I and Group II. Group I, 20 subjects who have received ISP without an insertion of Essix retainer, and Group II patients received an insertion with Essix retainer. The groups were subdivided into Subgroup A, B, and Subgroup C, D, in which A and C are control groups. To measure the tightness at proximal contact points, a digital force analyzer was used. Proximal contact tightness (PCT) was measured immediately after the placement of the prosthesis, 3 months, 6 months, and 1-year follow-up respectively, and the PCT values at end of 1 year were statistically evaluated. Statistical analysis was done, mean and standard deviation was calculated by independent sample t-test wit p< 0.05 as a statistically significant value. RESULTS: In Group I, towards the end of 1 year, 2.09 N (65.5%) and 1.50 N (53.1%) loss of PCT were found on mesial and distal contact areas respectively. In Group II, loss of PCT at mesial contact area was 0.87 N (28.9%) and at distal contact area was 1.77 N (53.3%), which is significantly less compared with the non-usage of Essix retainer (p< 0.05). CONCLUSION: The usage of Essix retainer, PCT increases especially on the mesial contact area. The frequency of contact loss was decreased. Thus, to minimize the loss of proximal contact the usage of Essix retainer is recommended.

Nowadays, smartphone applications are widely used in different areas of life, including medical science. The present study aimed to assess the effectiveness of a smartphone application of oral hygiene instructions (OHI) on periodontal health compared to the traditional chairside OHI. All the participants (n = 39) were divided into two groups: control group and test group. Participants of the control group were given verbal OHI and participants of the test group were asked to use a smartphone application to upkeep their oral habits. The gingival index (GI) and Quigley–Hein Turesky modification index (QHTMI) were used for scoring the plaque accumulation at baseline and after one month of the periodontal treatment. A paired t-test and an independent t-test were performed to compare the mean of GI and QHTMI between intra-group and inter-group, respectively. The paired t-test showed significant differences in GI and QHTMI improvement after one month in both groups. Moreover, the independent t-test showed no significant differences between the two groups. However, the test group showed a lower mean score in GI and QHTMI assessments compared to the control group. Smartphone applications in oral health applications did not exhibit any superiority in periodontal health over the traditional OHI method in the current study.

BackgroundA needle stick injury is a serious occupational health hazard in health care settings. Health care workers are at risk of bloodborne diseases and the psychological consequences of these injuries. This study aims to estimate the incidence of needle stick injuries among healthcare workers during the previous 12 months and to assess their knowledge, attitude, and practice toward these injuries.MethodsThis cross-sectional study was conducted from 1st August 2019 till 15th February 2020, and included 786 healthcare workers in Abha city, Saudi Arabia. A structured questionnaire was used to collect the data.ResultsThe incidence of needle stick injury among healthcare workers during the previous 12 months was (91/786) 11.57%. Nurses, females, and Saudis reported most needle stick injuries. More than half (52.7%) of the injuries went unreported. About 52.7% of needle stick injuries occurred during using sharp devices, and 42.9% of injuries happened in the patient room. The incidence of needle stick injury was significantly higher among those working at the secondary healthcare level (p= 0.003) and those practicing surgery (p< 0.001). Out of 786 participants, 94.7% knew the definition of needle stick injury, and 81.0% were aware of the procedure and guidelines to follow on sustaining a needle stick injury. Only 61.2% recognized that the recap of the needle is not recommended. Almost half of the participants (47.1%) agreed, and 33.6% strongly agreed that needle stick injury is preventable. A majority of healthcare workers (89.1%) had been vaccinated against Hepatitis B. Nearly 27.5% of healthcare workers incorrectly practiced recapping the needles with two hands and 8.7% bent needles before disposal. Recapping the needles was statistically significantly higher among healthcare workers who had a history of needle stick injury (p= 0. 046).ConclusionNeedle stick injury and its under reporting among healthcare professionals is still a prevalent risk. Raising awareness among healthcare workers and improving the reporting systems for needle stick injuries to ensure more protection and early use of post-exposure prophylaxis is required. Implementation of safety precautions and safe injection practices and providing engineered safety devices may further reduce the risk.

Objectives: To identify demographic characteristics, and types of stroke in Southwestern (Aseer) Region, Saudi Arabia. Methods: This study is a retrospective and hospital-based. The data of all stroke patients (n=562) admitted to the tertiary care hospital in the province, Aseer Central Hospital (ACH) within the period from January 2016 until December 2017 are included. Results: The mean ± SD of stoke patients’ age was 62.6 ± 17.0 years. Male patients were more than female patients (62.6% and 37.4%, respectively). The majority (93.2%) were Saudi, while 91.5% had below university education and 6.4% were smokers. Interestingly, only 2% of patients had a family history of stroke, while 68.1% were diabetic, 80.4% were hypertensive, 91.6% had high serum cholesterol level, and 10.7% had history of transient ischemic attacks (TIA). Despite the lack of awareness, and leading to delay in reaching health care facility, 58.1% of stroke patients, were arriving to emergency department (ED) in less than 24 hours (potential endovascular therapeutic window). Conclusions: In Aseer Region, Saudi Arabia, stroke affects mainly those who are older, less educated, diabetic, hypertensive, with hypercholesterolemia and previous history of TIA. Associated factors for stroke differ significantly according to their nationality.

Objectives: To assess the epidemiological pattern and correlates with the clinical outcome of Cerebral venous thrombosis (CVT) in Abha, Kingdom of Saudi Arabia. Methods: A retrospective record-based cohort design was conducted including all patients admitted with diagnosis of CVT in 2 main tertiary hospitals in Aseer Region between 2015 to the end of 2018. The study hospitals were Aseer Central Hospital and Armed Forces Hospitals Southern Region. The data were collected by structured data sheets, including sociodemographic data. Assessment of known risk factors for CVT, clinical presentation, treatment received, and clinical outcome after treatment were extracted. Results: The study included 119 patients with CVT, whose ages ranged from 15 to 97 years, with a mean age of 35.5-+14.1 years. Majority of the patients were females (81.5%). Headache was the most presenting (82.4%) symptom, followed by vomiting (30.3%) and a decreased level of consciousness. Thirty-three cases (27.7%) had complications, and recanalization was recorded among 92 cases (94.8%) based on follow up vascular imaging. Conclusion: The study revealed that most of the cases of CVT had favorable clinical outcome and recanalization, especially those who had a shorter duration untildiagnosis. Young females were the most affected group.

Health care systems worldwide are overwhelmed by the current Coronavirus disease 2019 (COVID-19) pandemic. While it is ongoing, patients continue to present to hospitals with other serious conditions, including stroke. Since April 2020, Saudi Arabia has witnessed an increase in the number of

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). Methodology: A retrospective descriptive study targeted all death (29,291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health’s death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. Results: 7055 (24.9%) died at the middle age (40–59 year), and 19,212 (65.6%) were males, and 18,110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15,340 (62.1%), mainly Cardiovascular diseases (CVDs) 10,103 (34.5%). There was a significant relationship between the main causes of deaths and sex (p < 0.05) and nationality (p = 0.01). Conclusion: NCDs mainly CVDs are the leading cause of death. The COVID-19 mortalities were mainly in males, and old age > 55 year. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

This study examines partnerships between schools and businesses that are intended to foster training and employment opportunities for secondary students with developmental and other disabilities in Saudi Arabia. A survey was developed to investigate employers’ perspectives on students’ skills, practical strategies for training, and their contribution. Fifty-two employers participated in the survey. The findings revealed the most valued skills on job sites, such as self- determination, social, and job skills, and believed that coordination, job matching, and joint supervision are successful practices that improve training. The employers concluded that some of their contributions to such partnerships include participation in curriculum development, training students in their workplaces under their supervision, and offering financial support.

The authors report a previously healthy 23-year-old male patient who presented with subarachnoid hemorrhage and was found to have a ruptured right distal anterior cerebral artery aneurysm. He was treated by endovascular coiling technique, which was uneventful perioperatively. After a few days of mechanical ventilation and upon extubation, he expressed symptoms of apathy, drowsiness, lack of motivation, and lack of spontaneous motor function consistent with akinetic mutism. The magnetic resonance imaging of the brain revealed infarction of the whole body of corpus callosum. He remained in akinetic mutism status for twenty-one days before he started to show improvement until he fully recovered in 3 months. The authors report a unique finding where akinetic mutism resulted from infarction of the corpus callosum rather than medial frontal lobe (cingulate gyrus).

Obesity is a major global health issue, which directly impacts on health and is associated with multiple comorbidities. This editorial explores the challenges and clinical decision making relating to imaging patients with obesity.

BACKGROUND: Studies investigating the association between developmental dysplasia of the hip (DDH) and risk factors in Saudi Arabia are rare. OBJECTIVE: Investigate the association between DDH and several risk factors among Saudi children. METHODS: The medical records of 82 children born in or admitted to King Abdul Aziz Medical City in Riyadh, Saudi Arabia with clinical suspicion of hip dislocation (HD) were included. The association between DDH and the following risk factors was investigated: age < 3 y, female-gender, twinning, first-born child, C-section, breech presentation, prematurity, positive family history and presence of associated abnormalities. RESULTS: HD was confirmed in 73 (89%) children (Positive HD) and excluded in 9 (11%) children (Negative HD). Eleven (13.4%) children were excluded from the positive cases as it was confirmed that they have paralytic hip dislocation not DDH. DDH was confirmed in 62 children (75.6%). The Chi square test (χ2) and odds ratios (OR) revealed that the positive family history, female-gender, age < 3 years, and presence of associated abnormalities had significant associations with the presence of DDH with P values and OR equal 0.00 (16.4), 0.002 (3.1), 0.005 (2.6), and 0.04 (1.9) respectively. Breech presentation, twinning, first-born children, prematurity, and C-section were not associated with DDH with P values and OR equal 0.93 (1.1), 0.46 (0.4), 0.11 (0.4), 0.08 (0.3), and 0.002 (0.3) respectively. CONCLUSIONS: Positive family history, female-gender, age < 3 years, and presence of associated abnormalities had approximately 16, 3, 2.5, and 2 times increased risk for DDH.

Anterior choroidal artery (AChA) strokes have a varied pattern of tissue injury, prognosis, and clinical outcome. It is unclear whether perfusion deficit in AChA stroke is associated with the clinical outcome. This study aims to determine the frequency of perfusion abnormalities in AChA stroke and association with clinical outcome.The study cohort was derived from ischemic stroke patients admitted to 2 stroke centers between July 2001 and July 2014. All patients received an acute magnetic resonance imaging (MRI) scan. Patients with ischemic stroke restricted to the AChA territory were included in the study. Lesion size was measured as the largest diameter on diffusion-weighted imaging (DWI) or apparent diffusion coefficient and divided into 2 groups (20 mm or ≥20 mm). Group comparisons were performed among patients with and without perfusion abnormalities and based on diffusion diameter. Favorable clinical outcome was defined as discharge to home.A total of 120 patients were included in the study. Perfusion deficits were identified in 67% of patients. The admission National Institutes of Health Stroke Scale (NIHSS) was higher in patients with perfusion abnormalities (P = .027). Diameter lesion size on DWI was larger among patients with a perfusion deficit median [interquartile range], 1.63 [1.3-2.0], as compared with those without, 1.18 [1.0-1.7], P .0001. Patients with a perfusion deficit were less likely to be discharged to home than those without (36% versus 60%, P = .013).Two thirds of patients with an AChA stroke have a perfusion deficit on MRI, higher admission NIHSS, and larger DWI lesion size at presentation.

Background. Violence against health-care workers (HCWs) showed increasing worldwide concern. No previous studies addressed violence against HCWs in the Northern region, Saudi Arabia. Objectives. To determine the prevalence of violence against HCWs in public hospitals and primary health-care centers in Arar city, KSA, and to identify its associated factors. Methods. A cross-sectional study was conducted on 352 HCWs in the Ministry of Health (MOH) facilities in Arar city from 1st October to 31st December 2018. Consented HCWs completed a structured self-administered questionnaire which was modified from the WHO questionnaire for violence. Results. Out of 352 health-care workers, 171 (48.6%) reported exposure to violence during work in the past year. The verbal violence was the most common form experienced (83%). Physicians were the main exposed group (59%). Being non-Saudi HCWs, older with longer duration of experience, working in hospitals, working in the emergency room, and working in evening or night shifts were significantly associated with more exposure to violence. The unmet demand for the patient and deficient staff number were the leading reasons for aggression. Only 16.4% of assaulted HCWs reported the violent acts to the higher health affairs authority with the most frequent reasons for nonreporting were their perception that it was useless and their fear of negative consequences. Conclusions. Violence against HCWs in Arar city, KSA, is a prevalent problem. Improving health security system and increasing staffing and their training on proper dealing with violence are highly recommended. Also, enforcing rules and regulations is an important demand to control and prevent violence against HCWs.

Background The iPad is a promising tool for supporting the academic skills of students with disabilities, including young adults with intellectual disability (ID). These students may struggle to gain or retain employment because they lack functional reading skills. Therefore, improving functional reading will help these students comprehend text and master reading. Method Using a single-subject design, this study is a comparison of repeated reading and iPad text-to-speech techniques for three young adults with ID. Results The results show that two participants improved their reading comprehension in both conditions, with no significant difference between conditions. However, iPad instruction helped these students access text in almost one third of the time that the repeated reading required. Conclusion This demonstrates that iPads may be effective tools for supporting the academic skills of students with ID.

Patient: Male, 51 Final Diagnosis: Radiation therapy induced unilateral tongue atrophy Symptoms: — Medication: — Clinical Procedure: EMG Specialty: Neurology Objective: Rare disease Background: Isolated unilateral hypoglossal nerve injury is extremely rare. It may be caused by radiation therapy targeting neoplasms of the cephalic region. Case Report: A 51-year-old man with synovial sarcoma of the left upper arm status post extensive radiation therapy in 1980 presented in late 2014 with gradual onset of speech difficulty and difficulty moving his tongue for a couple of weeks. Neurological examination revealed isolated left-sided unilateral tongue atrophy. Postradiation residual extensive cicatrix with erythema over the whole left upper extremity extending to the neck on the affected side was noticed. On head magnetic resonance imaging (MRI) before and after administration of gadolinium, he was found to have asymmetrically fatty striations, atrophy, and fibrosis in the left tongue consistent with radiation toxicity. The patient’s tongue weakness persisted without improvement. Conclusions: The diagnosis of unilateral hypoglossal nerve injury is usually difficult. Detailed neurological examinations and thorough investigations including head MRI are very helpful. Previous exposure to radiation therapy is a potential cause of hypoglossal nerve injury. To our knowledge, this is the first case report that presents isolated unilateral tongue atrophy as a late complication of juxta cephalic radiation therapy.

Graphical abstract Proposed mechanism explaining the role of lower respiratory tract cytokines/chemokines during acute MERS-CoV infection 0.1: MERS-CoV; 2: Activated neutrophil; 3: Neutrophil degranulation; 4: Neutrophil extracellular trap (NET) formation., Highlights • MERS-CoV infection downregulates Th1 and Th2 cytokines and chemokines. • MERS-CoV infection provokes high levels of IL-1α, IL-1β and IL-8 (CXCL8). • Inflammatory cytokines/chemokines correlate with MERS-CoV case fatality rate. • Th1/Th2 downregulation may contribute to severe infection and evolution of ARDS., MERS-CoV, a highly pathogenic virus in humans, is associated with high morbidity and case fatality. Inflammatory responses have a significant impact on MERS-CoV pathogenesis and disease outcome. However, CD4+ T-cell induced immune responses during acute MERS-CoV infection are barely detectable, with potent inhibition of effector T cells and downregulation of antigen presentation. The local pulmonary immune response, particularly the Th1 and Th2-related immune response during acute severe MERS-CoV infection is not fully understood. In this study, we offer the first insights into the pulmonary gene expression profile of Th1 and Th2-related cytokines/chemokines (Th1 & Th2 responses) during acute MERS-CoV infection using RT2 Profiler PCR Arrays. We also quantified the expression level of primary inflammatory cytokines/chemokines. Our results showed a downregulation of Th2, inadequate (partial) Th1 immune response and high expression levels of inflammatory cytokines IL-1α and IL-1β and the neutrophil chemoattractant chemokine IL-8 (CXCL8) in the lower respiratory tract of MERS-CoV infected patients. Moreover, we identified a high viral load in all included patients. We also observed a correlation between inflammatory cytokines, Th1, and Th2 downregulation and the case fatality rate. Th1 and Th2 response downregulation, high expression of inflammatory cytokines, and high viral load may contribute to lung inflammation, severe infection, the evolution of pneumonia and ARDS, and a higher case fatality rate. Further study of the molecular mechanisms underlying the Th1 and Th2 regulatory pathways will be vital for active vaccine development and the identification of novel therapeutic strategies.

BACKGROUND Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain. METHODS We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during 1 January-30 June 2015 and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing. RESULTS During the study period, 216 MERS-CoV cases were reported. Full genome (n = 17) or spike gene sequences (n = 82) were obtained from 99 individuals. Most sequences (72 of 99 [73%]) formed a discrete, novel recombinant subclade (NRC-2015), which was detected in 6 regions and became predominant by June 2015. No clinical differences were noted between clades. Among 87 cases reported during February 2015, 13 had no recognized risks for secondary acquisition; 12 of these 13 also denied camel contact. Most viruses (8 of 9) from these 13 individuals belonged to NRC-2015. DISCUSSIONS Our findings document the spread and eventual predominance of NRC-2015 in humans in Saudi Arabia during the first half of 2015. Our identification of cases without recognized risk factors but with similar virus sequences indicates the need for better understanding of risk factors for MERS-CoV transmission.

This is a case report of an 11-year-old male Saudi who presented with osteomyelitis of the left pubic ramus who was misdiagnosed and treated as a case of septic arthritis of the hip. Subsequent re-evaluation upon referral was carried out using CT scan and MRI which clarified the diagnosis. The lesion was explored, the pus drained and necrotic material excised. The patient was subsequently managed on antibiotics with complete resolution. The rarity of pelvic osteomyelitis in childhood is stressed and the causes for delay in diagnosis are stressed. Key Words: Osteomyelitis, Pubic ramus, Misdiagnosed. Résumé II s'agit d'un rapport d'un saoudien du sexe masculin, âgé de 11 ans qui s'est présenté atteint de l'osteomyelite du pubis ramus du côté gauche chez qui on a fait une erreur du diagnostic donc a été traité pour un cas de l'arthrite septique de la hanche. Au cours d'une réévaluation ultérieure a la suite d'un envoi avec ;'utilisation du CT Scan et MRI qui ont éclairci le diagnostic. La lésion a été traitée, drain le pus et coupé le matériel nécrotique. Puis on a traité le patient avec l'administration des antiboitiques avec une résolution complète. On mis en relief la rareté d'ostéomyelite pendant l'enfance et les causes pour le retard pendant le diagnostic. West African Journal of Medicine Vol.23(3) 2004: 267-269