Search

BACKGROUND: Non-communicable diseases (NCDs) are a major public health challenge globally, including in Saudi Arabia. However, measuring the true extent of NCD prevalence has been hampered by a paucity of nationally representative epidemiological studies. OBJECTIVES: Assess the prevalence of selected NCDs, using population-based electronic health records and applying novel analytical methods to identify cases of NCDs. DESIGN: Retrospective SETTINGS: A large healthcare network in Saudi Arabia. PATIENTS AND METHODS: We included all beneficiaries aged 16 years or older (n=650 835[a]) and used the International Classification of Disease (ICD-10) codes, laboratory results, and associated medications to identify individuals with diabetes, obesity, hypertension, dyslipidemia, mental disorders, and injuries. For diabetes and hypertension, we used natural language processing (NLP) on clinical notes in the electronic health records. The prevalence of multimorbidity across age groups was also tabulated, and logistic regression was used to examine its association with glycemic control. MAIN OUTCOME MEASURES: The primary outcomes measured were the prevalence of diabetes, hypertension, and multimorbidity, and their association with glycemic control. SAMPLE SIZE: 650 835 individuals aged 16 years or older. RESULTS: The study population was relatively young, with 41.2% aged between 26 and 45 years, and around two-thirds were married. The prevalence of diabetes and hypertension was 18.5% (95% CI: 18.5-18.7) and 13.0% (95% CI: 12.9-13.1), respectively. Approximately 26.7% (95% CI: 26.7-26.8) of the population had multimorbidity, with levels increasing to 62.9% for those aged 65 or older. Multimorbidity was associated with a four-fold increase in the likelihood of poor glycemic control. NLP analysis suggested that the prevalence of diabetes or hypertension may be underestimated by no more than 1.5%. CONCLUSIONS: The study suggests a higher prevalence of NCDs than earlier national estimates. Electronic health records with regular analysis provide an opportunity to estimate changes in the prevalence of NCDs in Saudi Arabia. Health policies and interventions are needed to address the high levels of multimorbidity, which adversely impact glycemic control. LIMITATIONS: Retrospective design and reliance on electronic health records, which may not capture all cases of NCDs.

Abstract Ephedra alata Decne is a medicinal plant widely used in traditional medicine for the management of bronchial asthma and cancer. Phytochemical analysis and biological activities, including antioxidant and anticancer effects, were investigated in the current work as new findings for the plant E. alata, a species growing wildly in the marsh and saline environments of the central area of Saudi Arabia. The Ultra Pressure Liquid Chromatography coupled with Electron spray ionization-Quadropole-Time of flight (UPLC-ESI-Q-TOF) system was used for the phytochemical analysis of the plant constituents. In addition, Polyphenolic profiling including the total phenolic (TPC) and flavonoid (TFC) contents of the plant extracts were measured. Phenolic acids were found at the highest relative percentages among all the identified compounds and were measured at 66.07 mg GAE (Gallic acid equivalent). The UPLC analysis of the E. alata extract indicated the presence of chlorogenic acid, syringic acid, caffeic acid, vanillic acid, rosmarinic acid, umbelliferone, isorhoifolin, and apigenin at the highest relative percentages. Mineral analysis indicated that the microelement content of E. alata was relatively low, except for magnesium (Mg). In vitro antioxidant assays revealed the ability of the plant to scavenge DPPH free radicals, reduced molybdenum ions, and ferrous at levels of 14.63, 19.97, and 27.78 mg Trolox equivalents, respectively. The extract induced transition metal chelation at 31.36 mg EDTA equivalents. The extract induced cytotoxic effects against MDA-231 and A549 cell lines at IC50 levels of 25.31 and 39.81 µg/mL, respectively. The plant extract inhibited the colonization and migration of cancer cells as part of its potential anticancer effects. In addition, major E. alata constituents like isorhoifolin, chlorogenic acid, apigenin, and rosmarinic acid exhibited the lowest binding energy to the CAIX enzyme at − 8.41, − 6.64, − 6.32, and − 6.26 kcal/mol, respectively, compared to the binding energy (− 7.72 kcal/mol) of the co-crystallized ligand (Y0R). The docking results further supported the selection of the CAIX enzyme as a standard predictive therapeutic target, since it exhibited significant binding interactions with the major constituents of the plant.

Liver transplant (LT) candidates undergo transthoracic echocardiography (TTE) before surgery to assess cardiac function and evaluate the echocardiographic probability of pulmonary hypertension (PHT). The improvement of pulmonary artery systolic pressure (PAPS) after transplant is associated with higher survival rates in patients with mild or moderate PHT. Although studies analyze the outcomes of LT in patients treated for PHT, the prognostic value of PAPS in patients without PHT in the follow-up is unknown. The aim of our study is to evaluate pre- and post-LT cardiac function, right ventricular function, pulmonary artery pressure, and their association with long-term mortality. 102 patients who underwent LT between 2011 and 2018 were compared for echocardiographic and hemodynamic parameters pre- and post-LT. After LT, systolic blood pressure, heart rate (HR), and PASP significantly increased, while tricuspid annular plane systolic excursion/PAPS decreased. Moreover, the higher difference in HR and PASP between pre- and post-LT was highlighted in those patients who died during the follow-up period after LT. Among all the parameters tested, in the multi-variable Cox regression for mortality, left ventricular ejection fraction and PASP difference were predictors of mortality. This study highlights the importance of TTE in LT screening as a tool to stratify patients at higher risk of death due to advanced cirrhotic cardiomyopathy and the importance of the change of echocardiographic parameters, in particular right and left ventricular hemodynamics, during the follow-up period. These parameters could be used to guide a more aggressive therapy.

Background: Children with medical complexity (CMC) account for a substantial proportion of healthcare spending, and one-third of their expenditures are due to readmissions. However, knowledge regarding the healthcare-resource utilization and characteristics of CMC in Saudi Arabia is limited. Objectives: To describe hospitalization patterns and characteristics of Saudi CMC with an unplanned 30-day readmission. Methodology: This retrospective study included Saudi CMC (aged 0–14 years) who had an unplanned 30-day readmission at six tertiary centers in Riyadh, Jeddah, Dammam, Alahsa, and Almadina between January 2016 and December 2020. Hospital-based inclusion criteria focused on CMC with multiple complex chronic conditions (CCCs) and technology assistance (TA) device use. CMC were compared across demographics, clinical characteristics, and hospital-resource utilization. Results: A total of 9139 pediatric patients had unplanned 30-day readmission during the study period, of which 680 (7.4%) met the inclusion criteria. Genetic conditions were the most predominant primary pathology (66.3%), with one-third of cases (33.7%) involving the neuromuscular system. During the index admission, pneumonia was the most common diagnosis (33.1%). Approximately 35.1% of the readmissions were after 2 weeks. Pneumonia accounted for 32.5% of the readmissions. After readmission, 16.9% of patients were diagnosed with another CCC or received a new TA device, and the in-hospital mortality rate was 6.6%. Conclusion: The rate of unplanned 30-day readmissions in children with medical complexity in Saudi Arabia is 7.4%, which is lower than those reported from developed countries. Saudi children with CCCs and TA devices were readmitted approximately within similar post-discharge time and showed distinct hospitalization patterns associated with specific diagnoses. To effectively reduce the risk of 30-day readmissions, targeted measures must be introduced both during the hospitalization period and after discharge.

Background Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinicians and there are few reports on the outcomes of the ILD-MDT approach. We therefore describe the experience of the ILD-MDT meetings at our institution.

This paper proposes a novel cache replacement technique based on the notion of combining periodic popularity prediction with size caching. The popularity, size, and time updates characteristics are used to calculate the value of each cache item. When it comes to content replacement, the information with the least value is first eliminated. Simulation results show that the proposed method outperforms the current algorithms in terms of cache hit rate and delay. The hit rate of the proposed scheme is 15.3% higher than GDS, 17.3% higher than MPC, 20.1% higher than LRU, 22.3% higher than FIFO, and 24.8% higher than LFU when 350 different categories of information are present. In real-world industrial applications such as including supply chain management, smart manufacturing, automation energy optimization, intelligent logistics transportation, and e-healthcare applications, it offers a foundation for the selection of caching algorithms.

Wireless communications have lately experienced substantial exploitation because they provide a lot of flexibility for data delivery. It provides connection and mobility by using air as a medium. Wireless sensor networks (WSN) are now the most popular wireless technologies. They need a communication infrastructure that is both energy and computationally efficient, which is made feasible by developing the best communication protocol algorithms. The internet of things (IoT) paradigm is anticipated to be heavily reliant on a networking architecture that is currently in development and dubbed software-defined WSN. Energy-efficient routing design is a key objective for WSNs. Cluster routing is one of the most commonly used routing techniques for extending network life. This research proposes a novel approach for increasing the energy effectiveness and longevity of software-defined WSNs. The major goal is to reduce the energy consumption of the cluster routing protocol using the firefly algorithm and high-efficiency entropy. According to the findings of the simulation, the suggested method outperforms existing algorithms in terms of system performance under various operating conditions. The number of alive nodes determined by the proposed algorithm is about 42.06% higher than Distributed Energy-Efficient Clustering with firefly algorithm (DEEC-FA) and 13.95% higher than Improved Firefly Clustering IFCEER and 12.05% higher than another referenced algorithm.

PurposeTo identify experiences of boredom and associations with psychosocial well-being during and following homelessness.MethodsUsing a convergent, mixed-methods explanatory design, we conducted quantitative interviews with 164 participants) (n = 102 unhoused; n = 62 housed following homelessness) using a 92-item protocol involving demographic components and seven standardized measures of psychosocial well-being. A sub-sample (n = 32) was approached to participate in qualitative interviews. Data were analyzed by group (unhoused; housed). Quantitative data were analyzed using descriptive statistics designed to generate insights into boredom, meaningful activity engagement, and their associations with psychosocial well-being during and following homelessness. Qualitative data were analyzed using thematic analysis. Quantitative and qualitative findings were integrated at the stage of discussion.ResultsQuantitative analyses revealed small to moderate correlations between boredom and increased hopelessness (rs = .376, p < .01), increased drug use (rs = .194, p < .05), and lowered mental well-being (rs = -.366, p < .01). There were no statistically significant differences between unhoused and housed participants on any standardized measures. Hierarchical regression analyses revealed that housing status was not a significant predictor of boredom or meaningful activity engagement (p>.05). Qualitative interviews revealed profound boredom during and following homelessness imposing negative influences on mental well-being and driving substance use.ConclusionsBoredom and meaningful activity are important outcomes that require focused attention in services designed to support individuals during and following homelessness. Attention to this construct in future research, practice, and policy has the potential to support the well-being of individuals who experience homelessness, and to contribute to efforts aimed at homelessness prevention.

SARS-CoV-2 causes COVID-19. COVID-19 has led to severe clinical illnesses and an unprecedented death toll. The virus induces immune inflammatory responses specifically cytokine storm in lungs. Several published reports indicated that pregnant females are less likely to develop severe symptoms compared with non-pregnant. Putative protective role of maternal blood circulating fetal mesenchymal stem cells (MSCs) has emerged and have been put forward as an explanation to alleviated symptoms. MSCs with immune-modulatory, anti-inflammatory and anti-viral roles, hold great potential for the treatment of COVID-19. MSCs could be an alternative to treat infections resulting from the SARS-CoV-2 and potential future outbreaks. This review focuses on the MSCs putative protective roles against COVID-19 in pregnant females.

Background: Childhood obesity has increased in Saudi Arabia over the past few decades. However, a representative burden of obesity remains unclear, as most studies had relied on small samples and/or used international growth references, which may have resulted in over-or underestimations of prevalence. Objective: The study aimed to determine the prevalence of obesity among children and adolescents in Saudi Arabia using the Saudi growth chart. Methods: This population-based retrospective study included children and adolescents aged 2–19 years who visited any facility within the National Guard Health System (5 hospitals and 24 primary care centers) across Saudi Arabia between 2016 and 2021. The Saudi growth reference for children and adolescents was used for classification. Those with body mass index ≥95th percentile were considered as obese and ≥85th to

Background: Drug abuse is a public health problem in any country and road safety in particular as it poses serious consequences while driving, affecting the safety of all road users. This study aimed to investigate the drug prevalence and alcohol abuse among motor vehicle crash (MVC) survivors. Methods: This descriptive study was based on a review of the retrospective chart involving patients that were admitted to the Emergency Department (ED) of a level-I trauma center in Riyadh following an MVC. Injured patients in 2018 were identified from the electronic medical record system, and substance investigation was documented. After the hospital discharge, the research team contacted patients via phone to obtain further details about the nature of the crash and illegal substance use. Results: During the study, 209 patients were admitted to the ED following MVCs. The population was primarily males (84.7%) with an average age of 30 years. Forty subjects (19.14%) were screened for illegal substances by blood, urine, or both, 35 of which had confirmed intoxication. Alcohol was used in almost two-thirds of the 35 lab-confirmed intoxicated subjects (n = 23, 65.71%) either alone or in combination with other types of drugs. Conclusion: The widespread use of alcohol and other drug abuse among those involved in MVC is alarming and endangers road safety. There is a need to implement well-defined guidelines to screen, detect, and impose a penalty on driving under the influence to reduce MVC and improve population health. [SJEMed 2022; 3(2.000): 145-150]

Introduction: Over the past twenty years, dental practice in Saudi Arabia has developed considerably, along with increase in population’s knowledge of their rights. However, there is a lack of evidence and research on dental malpractice lawsuit cases in Saudi Arabia. The aim of this study was to assess the prevalence and content of legal suits regarding dental malpractice in Saudi Arabia, and to explore the factors and circumstances that were associated with these cases. Methods: This was a retrospective study on dental malpractice litigation cases between January 2017 and December 2020. Only cases with final court verdicts were included. The cases were collected from 13 Medico-Legal Committee (MLC) across Saudi Arabia while practitioners’ data were retrieved from the General Directorate of Healthcare Licensing at Ministry of Health (MOH). A designed data sheet was used, which was categorized into three main sections: plaintiff demographic data, defendant demographic, data case details in the court. Results: During the four years period, 864 cases with verdicts were studied. Most of the cases were against general dental practitioners, and majority of complaints involved prosthodontic procedures followed by endodontics. The majority of the malpractice lawsuit cases (93 %) were against non-Saudi dental practitioners and 72 % were against experienced practitioners with more than ten years of experience. Almost all cases were in the private sector. Only 10 % of cases had a consent form previously provided to the patients before treatment, and most of cases lacked proper medical documentation. The mean average trial period was 3.3 months and 76 % of defendants were found guilty. Conclusion: The number of cases is rising since 2017. Good documentation, compliance to informed consent protocols and dental privileges helped practitioners to avoid being found guilty.

BACKGROUND: Prescribing habits during admission have largely contributed to the opioid epidemic. Orthopedic surgeons represent the third-highest opioid-prescribing specialty. Since more than half of body fractures in Saudi Arabia have been lower extremity fractures, it is imperative to understand opioid administration patterns and correlates among opioid-naïve inpatients. OBJECTIVES: Assess opioid administration patterns and correlates among opioid-naïve inpatients with lower extremity fractures. DESIGN AND SETTINGS: Retrospective cohort PATIENTS AND METHODS: Opioid naïve individuals aged 18 to 64 years, admitted due to lower extremity fracture from 2016 to 2020 were included. Data was collected from health records of the Ministry of National Guard Health Affairs (MNG-HA) at five different medical centers. The high-dose (≥50 MME) patients were compared with low dose (

Abstract Chronic lymphocytic leukemia (CLL) is an incurable malignancy of B-cells. In this study, bioinformatics analyses were conducted to identify possible pathogenic roles of CK2α, which is a protein encoded by CSNK2A1, in the progression and aggressiveness of CLL. Furthermore, various computational tools were used to search for a competent inhibitor of CK2α from fungal metabolites that could be proposed for CLL therapy. In CLL patients, high-expression of CSNK2A1 was associated with early need for therapy (n = 130, p

Abstract Authentication using keystroke dynamics (KD) has become an active research area due to its usability and security aspects. Nowadays, the scale of touch keyboard use has expanded to include most modern devices. Although KD typically focuses on a single device at a particular time, authentication systems are adjustable within their environments, as these systems’ users frequently switch between multiple devices. Thus, this paper assesses users’ typing behavior on different tablet devices with varying touch keyboard sizes. In particular, we empirically assess whether the validation results from free-text KD authentication vary depending on the touch keyboard size. The results reveal interesting research directions for future feasibility studies on changing the dynamic keystroke typing-pad effect on user-security and trust-authentication analysis.

Objectives: To determine the spectrum of kidney diseases in Omani children < 13 years of age and to evaluate the complications following kidney biopsy. Methods: This study retrospectively investigated the hospital data of children who underwent kidney biopsies from January 2014 to June 2019 at Royal Hospital, Muscat, Oman. Results: The subjects comprised of 78 children with a median age of 8.0 years (range = 0–13 years). Histopathology showed minimal change disease in 15 (19.2%) children, lupus nephritis in 13 (16.7%), and focal segmental glomerulosclerosis in 13 (16.7%). The most common post-biopsy complications were pain that required analgesia (38; 49.4%) followed by gross hematuria (10; 13.0%). No patient required blood transfusion or surgical intervention. Conclusions: Minimal change disease was the most common histopathological finding in this cohort of Omani children. The records did not mention any major complications following the renal biopsy procedure.

BACKGROUND: Since the occurrence of coronavirus disease in 2019 (COVID-19), the global community has witnessed its exponential spread with devastating outcomes within the general population and specifically within hemodialysis patients. OBJECTIVES: Compare the state of immunity to SARS-CoV-2 among hemodialysis patients and staff. DESIGN: Cross-sectional study with a prospective follow-up period. SETTING: Hemodialysis centers in Madinah region. PATIENTS AND METHODS: We prospectively tested for SARS-CoV-2 antibodies in dialysis patients using dialysis centers staff as controls. The participants were tested on four occasions when feasible for the presence of anti-SARS-CoV-2 antibodies. We also analyzed factors that might be associated with seropositivity. MAIN OUTCOME MEASURES: SARS-CoV-2 positivity using immunoglobulin G (IgG) levels SAMPLE SIZE: 830 participants, 677 patients and 153 dialysis centers staff as controls. RESULTS: Of the total participants, 325 (257 patients and 68 staff) were positive for SARS-CoV-2 IgG antibodies, for a prevalence of 38.0% and 44.4% among patients and staff, respectively (P=.1379). Participants with a history of COVID-19 or related symptoms were more likely to have positive IgG (P

The burden of road traffic injuries (RTIs) continues to impact healthcare systems, with considerable economic losses worldwide. Risk factors associated with RTIs include young age, male sex, speeding, driving under the influence, non-use of seatbelts, unsafe road infrastructure, unsafe vehicles, diminished post-crash care, and inadequate traffic law enforcement. The rate of RTIs in the Kingdom of Saudi Arabia (KSA) has increased with more than 25,000 injuries and approximately 13.2 deaths per 100,000 population in 2020. In line with the KSA 2030 vision, a new trauma epidemiology center was established by the Saudi Red Crescent Authority, the national provider of prehospital services in KSA. It aims to reinforce traffic safety by identifying high-risk groups, providing updated traffic safety-related scientific materials, and reducing the mortality rate caused by vehicular crashes. [SJEMed 2022; 3(1.000): 001-004]

Background: Tracheal intubation (TI) is an intervention in the Emergency Department (ED) to stabilise children and to protect the airway. The aim of the study was to investigate the prevalence of TI, the number of attempts to achieve successful intubation, the indications and the adverse outcomes related to TI in the paediatric population. Methods: A quantitative cross-sectional study, using a chart review of the hospital's electronic database, was conducted with paediatric patients who required intubation, from May 2015 to the current date. Results: A total of 159 paediatric patients' records were analysed. The proportion of a successful first intubation attempt was 87.4% (n = 139), two attempts 6.9% (n = 11), and three or more attempts 5.7% (n = 9). The most frequent indication for TI in the sample was trauma (35.3%, n = 55). In terms of TI-related complications, 22% (n = 35) experienced at least one complication. Of the successful first attempt group, cardiac arrest without return of spontaneous circulation (ROCS) was observed in 12.9% (n = 18). Other TI-related adverse events included hypotension requiring treatment (5.8%, n = 8), emesis (1.4%), bleeding through the tube (2.9%) and secretions via the tube (2.9%). For the two attempts group (n = 11), 18.2% (n = 2) had secretions from the tube and 18.2% experienced bleeding through the tube. For the three or more attempts group, cardiac arrest with ROCS (22.2%, n = 2), and secretions from the tube (22.2%, n = 2), were observed. The majority (96.2%) of the patients had a successful extubation, 8.7% (n = 13) experienced postextubation stridor, 2% (n = 3) became agitated, and 5.3% (n = 8) experienced respiratory distress. Conclusion: The TI success rate was 87.4%, and adverse outcomes occurred in 22% of all attempts. There is a higher prevalence of TI-related adverse events with multiple attempts to intubate. It is urgent that ED healthcare providers maximise their efforts to achieve success with the first intubation. [SJEMed 2021; 2(2.000): 142-146]

Introduction In Saudi Arabia, the epidemiology of rheumatoid arthritis (RA) is not well studied and is marked by inconsistencies in clinical diagnosis. Therefore, in this study, we explored the prevalence, clinical characteristics, and diagnostic validity of a prediction score based upon disease markers in orthropedic clinics’ patients in the Madinah region of Saudi Arabia. Method The clinical data for this retrospective cross-sectional study were retrieved from the database registry of orthopedic clinics in selected hospitals of the Medinah province of Saudi Arabia. Sociodemographic features, disease markers and the clinical characteristics were collected for a period of 6 months, from December 1, 2020, to May 31, 2021. The prediction score was generated from the sum of disease markers, coded as dichotomous variables. Results The total sample size of our study was 401. The prevalence of RA in the study subjects (n = 401) was 14.46% (n = 58). Among RA patients, the majority were females (60.3%). Painful joints (69%) and swollen joints (51.7%) were the most common clinical complaints among RA patients. RA patients suffered from arthritis (51.7%) and experienced fatigue (46.6%), weight loss (44.8%), and loss of appetite (41.4%). Diabetes (55.2%) was the most common comorbidity in the RA patients. The sensitivity and specificity of the prediction score at the criterion score of 2.5 were 67.3% and 63.0%, respectively. The area under the curve was 0.69 (95% CI [0.62–0.76]). Conclusion There was a moderately high prevalence of RA in patients visiting the orthropedic clinics of the selected hospitals of Madinah region of Saudi Arabia. The diagnostic validity of the prediction score, though promising, was slightly lower than the acceptable range.

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 (P

This study aimed to identify the incidence and risk factors of sleep-disordered breathing (SDB) using an Arabic version of the pediatric sleep questionnaire (PSQ). A total of 2000 PSQs were circulated to children aged 6–12 years who were randomly selected from 20 schools in Al-Kharj city, Saudi Arabia. The questionnaires were filled out by the parents of participating children. The participants were further divided into two groups (younger group: 6–9 years and older group: 10–12 years). Out of 2000 questionnaires, 1866 were completed and analyzed (93.3% response rate), of which 44.2% were from the younger group and 55.8% were from the older group. Among all the participants, a total of 1027 participants were female (55%) and 839 were male (45%) with a mean age of 9.67 ± 1.78 years. It showed that 13% of children were suffering from a high risk of SDB. Chi-square test and logistic regression analyses within this study cohort showed a significant association between SDB symptoms (habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting) and risk of developing SDB. In conclusion: habitual snoring; witnessed apnea; mouth breathing; being overweight; and bedwetting strongly contribute the to development of SDB.

Objective: To evaluate the knowledge and attitude of dental students in Riyadh city toward the effect of mouthwash on surface roughness and color stability of some esthetic restorations. Materials and methods: This cross-sectional study is directed toward dental students in Riyadh city. The inclusion criteria include both undergraduate students and interns. The exclusion criteria include postgraduate dentist and those in the preparatory year. Also, dental students outside Riyadh are excluded, A questionnaire in English language was distributed through randomized selected participants in both social media (WhatsApp, Twitter) via link in a google sheet. The survey items were divided into two sections that include socio- demographic data and knowledge subscales. Results: A total of 455 dental students have filled the survey, among them 168 were excluded because they did not meet the inclusion criteria (they were preparatory year students), making the number of included responses 287. There was a significant difference between males in females when answering the questions related to 1) indication of mouthwash prescription (P = 0.044), 2) if mouthwashes increase surface roughness of esthetic restorations (P= 0.007) and 3) the type of toothbrush used with esthetic restoration (P= 0.016). conclusion: there is high awareness and using of mouthwashes among dental students in Riyadh the correlation between mouthwashes and restorative materials needs more spot lightening in the dental education process.

BACKGROUND: Motor vehicle crashes (MVCs) are the leading cause of death among children in Saudi Arabia. Childhood injuries can be prevented or minimized if safety measures, such as car seats, are implemented. The literature on the epidemiology of head and facial injury among children is limited, which affects the ability to understand the extent of the burden and hinders investment in public health prevention. OBJECTIVE: Describe the epidemiology of head and facial injuries among children admitted to the hospital following MVCs. DESIGN: Retrospective chart review. SETTING: Five hospitals in several regions. PATIENTS AND METHODS: We collected data on all patients ≤16 years old, who were admitted to the hospital following MVCs between 2016-2019. Differences in various characteristics like head injury status and age groups were compared. MAIN OUTCOME MEASURES: Head and facial injuries. SAMPLE SIZE: 253 patients. RESULTS: Of the injured population, 97 (38.3%) sustained a head injury, and 88 (34.8%) had a facial injury. Thirteen (9.1%) children were driving the car at the time of the crash. About half of the children were seated in the back (53.8%) without a seatbelt or safety seat. CONCLUSION: The prevalence of head and facial injuries is striking. In addition, the study revealed that driving among children is not uncommon, which warrants monitoring and implementing interventions. Improved documentation of restraint use and police enforcement of safety laws can play a significant role in reducing associated injuries. The study findings highlight the importance of combination or rear seating as well as age-appropriate restraint in order to reduce the likelihood of head or facial injuries among children. LIMITATIONS: Retrospective study using the electronic search system to identify patients, but may have missed cases that were not coded correctly. Large amount of missing data for some variables. Additionally, the analysis was limited to those admitted to the hospital. CONFLICT OF INTEREST: None.

BackgroundObesity and type 2 diabetes (T2DM) are increasing in Saudi Arabia (SA). Among other conditions, these risk factors increase the likelihood of non-alcoholic fatty liver disease (NAFLD), which in turn increases risks for advanced liver diseases, such as non-alcoholic steatohepatitis (NASH), cirrhosis and cancer. The goal of this study was to quantify the health and economic burden of obesity-attributable T2DM and liver disease in SA.MethodsWe developed a microsimulation of the SA population to quantify the future incidence and direct health care costs of obesity-attributable T2DM and liver disease, including liver cancer. Model inputs included population demographics, body mass index, incidence, mortality and direct health care costs of T2DM and liver disease and relative risks of each condition as a function of BMI category. Model outputs included age- and sex-disaggregated incidence of obesity-attributable T2DM and liver disease and their direct health care costs for SA's working-age population (20-59 years) between 2020 and 2040.ResultsBetween 2020 and 2040, the available data predicts 1,976,593 [± 1834] new cases of T2DM, 285,346 [±874] new cases of chronic liver diseases, and 2,101 [± 150] new cases of liver cancer attributable to obesity, amongst working-age people. By 2040, the direct health care costs of these obesity-attributable diseases are predicted to be 127,956,508,540 [± 51,882,446] USD.ConclusionsThe increase in obesity-associated T2DM and liver disease emphasises the urgent need for obesity interventions and strategies to meaningfully reduce the future health and economic burden of T2DM, chronic liver diseases and liver cancer in SA.

BackgroundSarcopenia is an age-related muscular disease manifesting as a loss of muscle function and mass-leads to detrimental consequences at both individual and community levels. Modifiable lifestyle factors (such as physical behaviors and nutritional habits) may be involved in sarcopenia etiology. European Working Group on Sarcopenia in Older Population (EWGOSP2) established a cut-off point for sarcopenia diagnosis based on the European population and they recommend the use of a regional normative population. However, no sufficient data on sarcopenia prevalence is presently available in Saudi Arabia. Therefore, this project aims to define appropriate reference values from healthy Saudi young adults (Phase I) and to investigate the prevalence of sarcopenia in Saudi Arabia (Phase II) and examine selected modifiable lifestyle correlates of sarcopenia (Phase I, II).MethodsThe project will involve two phases. Phase I will include 1532 healthy Saudi young adults aged between 20-40 years. While, Phase II will include 1532 Saudi older adults aged ≥50 years. The study will measure vital signs, anthropometrics, muscle mass using bioelectrical impedance analysis and dual-energy X-ray absorptiometry, muscle strength using handgrip strength and maximal isometric strength, physical function using short physical performance battery, and 6-minute walk test to measure aerobic endurance. To explore the associations between lifestyle behaviors with sarcopenia indices, physical activity, sedentary behaviour and sleep will be evaluated subjectively using Global Physical Activity Questionnaire and Pittsburgh Sleep Quality Index and objectively via ActivPAL accelerometers. A three-day dietary food record will also be used to evaluate dietary intake. Additionally, EuroQOL five-dimension questionnaire will be utilized to assess health-related quality of life.DiscussionThe study will have significant implications in recognizing the prevalence of sarcopenia in Saudi population, which will guide our future interventional studies aimed at early prevention and treatment of this disease.

BackgroundSevere complications from COVID-19 and poor responses to SARS-CoV-2 vaccination were commonly reported in cancer patients compared to those without cancer. Therefore, the identification of predisposing factors to SARS-CoV-2 infection in cancer patients would assist in the prevention of COVID-19 and improve vaccination strategies. The literature lacks reports on this topic from the Kingdom of Saudi Arabia (KSA). Therefore, we studied clinical and laboratory data of 139 cancer patients from King Abdulaziz Medical City, Riyadh, KSA.MethodsThe cancer patients fall into three categories; (i) uninfected with SARS-CoV-2 pre-vaccination and remained uninfected post-vaccination (control group; n = 114; 81%), (ii) pre-vaccination infected group (n = 16; 11%), or (iii) post-vaccination infected group (n = 9; 6%). Next, the clinical and lab data of the three groups of patients were investigated.ResultsComorbidity factors like diabetes and hemodialysis were associated with the risk of infection in cancer patients before the vaccination (pConclusionCollectively, this is the first study from KSA to report potential risk factors of SARS-CoV-2 infection in cancer patients pre- and post-vaccination. Further investigations on these risk factors in a larger cohort are worthwhile to draw a definitive conclusion about their roles in predisposing cancer patients to the infection.

Background: This study aimed to assess sleep medicine physicians’ knowledge and attitudes toward the role of oral appliances (OAs) in managing obstructive sleep apnea (OSA) in Saudi Arabia. Methods: An online questionnaire was administered to the registered physicians practicing sleep medicine (otolaryngology, internal medicine, pulmonology, and family medicine) in Saudi Arabia. The questionnaire included 26 questions under five domains. All the collected data were analyzed using descriptive statistics and Chi-square tests. Results: One hundred sleep physicians (43% Saudi, 75% male) from Saudi Arabia participated in this study. Almost 43% of participants reported inadequate knowledge of the treatment of OSA patients using OAs. Half of the participants were unaware of how OAs work in managing OSA. Most physicians (62%) never referred the patient for treatment of OSA using OAs, whereas 4% referred at least one patient every month. The majority (60%) believed that there are barriers to referring a case for OA treatment, mainly the lack of knowledge of the suitable cases (60%) and the lack of qualified dentists in this area (43%). Conclusion: Most sleep physicians reported poor knowledge of OA indications and mechanism of use, with most never referring a case for OA therapy.

The Internet of Things (IoT) is essential in innovative applications such as smart cities, smart homes, education, healthcare, transportation, and defense operations. IoT applications are particularly beneficial for providing healthcare because they enable secure and real-time remote patient monitoring to improve the quality of people’s lives. This review paper explores the latest trends in healthcare-monitoring systems by implementing the role of the IoT. The work discusses the benefits of IoT-based healthcare systems with regard to their significance, and the benefits of IoT healthcare. We provide a systematic review on recent studies of IoT-based healthcare-monitoring systems through literature review. The literature review compares various systems’ effectiveness, efficiency, data protection, privacy, security, and monitoring. The paper also explores wireless- and wearable-sensor-based IoT monitoring systems and provides a classification of healthcare-monitoring sensors. We also elaborate, in detail, on the challenges and open issues regarding healthcare security and privacy, and QoS. Finally, suggestions and recommendations for IoT healthcare applications are laid down at the end of the study along with future directions related to various recent technology trends.

Introduction: The ongoing coronavirus disease 2019 (COVID-19), which emerged in December 2019, is a serious health concern throughout the world. Despite massive COVID-19 vaccination on a global scale, there is a rising need to develop more effective vaccines and drugs to curb the spread of coronavirus. Methodology: In this study, we screened the amino acid sequence of the RNA-dependent RNA polymerase (RdRp) of SARS-CoV-2 (the causative agent of COVID-19) for the identification of B and T cell epitopes using various immunoinformatic tools. These identified potent B and T cell epitopes with high antigenicity scores were linked together to design the multi-epitope vaccine construct. The physicochemical properties, overall quality, and stability of the designed vaccine construct were confirmed by suitable bioinformatic tools. Results: After proper in silico prediction and screening, we identified 3 B cell, 18 CTL, and 10 HTL epitopes from the RdRp protein sequence. The screened epitopes were non-toxic, non-allergenic, and highly antigenic in nature as revealed by appropriate servers. Molecular docking revealed stable interactions of the designed multi-epitope vaccine with human TLR3. Moreover, in silico immune simulations showed a substantial immunogenic response of the designed vaccine. Conclusions: These findings suggest that our designed multi-epitope vaccine possessing intrinsic T cell and B cell epitopes with high antigenicity scores could be considered for the ongoing development of peptide-based novel vaccines against COVID-19. However, further in vitro and in vivo studies need to be performed to confirm our in silico observations.

The in vitro cytotoxic efficacy of plant latex from Pergularia tomentosa L. was studied using five human cancer cell lines: HeLa cells (cervical carcinoma cells), A-549 (lung carcinoma), Panc-1 (pancreatic carcinoma cells), MDA-MB-231 (metastatic mammary adenocarcinoma), and MRC-5 (lung fibroblast cell line) cells. The phytonutrient content of plant latex was identified using the liquid chromatography/mass spectra-quadrupole time of flight (LC/MS-QTOF) technique. In silico studies of polyphenols were carried out to clarify the potential mode of action of the plant latex’s constituents. The treatment of different tumor cell lines with different concentrations of plant latex revealed a potent efficacy on the human lung carcinoma cell line (A-549) (IC50 = 3.89 µg/mL) compared with that with vinblastine as a positive control (IC50 = 7.12 µg/mL). The effect of the potent concentration of plant latex on the A-549 cell line induced cell arrest, upregulated the expression of pre-apoptotic markers, and downregulated the expression of antiapoptotic markers. Seven identified polyphenols were selected for the in silico study. A docking assessment using the epidermal growth factor receptor kinase (EGFRk) and eltronib as a positive control showed a higher affinity for the enzyme receptor of the selected polyphenols, except for methyl orsellinate and ginkgotoxin. The ADMET assessment demonstrated the inhibitory effect of the polyphenols on CYP450, except for ouabagenin and xanthyletine. The selected polyphenols obey Lipinski’s drug-likeness with no significant toxicity effect. In conclusion, the plant latex of P. tomentosa L. showed cytotoxic activity on the A-549 cell line, and the selected polyphenols showed a promising prodrug agent with a low profile of toxicity in the study.

BACKGROUND: Motor vehicle crashes are the third leading cause of death in Saudi Arabia. Motorcycle riders, in particular, are considered more vulnerable than occupants, yet there are no previous studies that have examined the epidemiology of their injuries and outcomes in the country. Better understanding is needed to inform policymakers and guide future prevention programs. OBJECTIVE: Describe patterns of injury among conscious and unconscious patients injured in motorcycle crashes. DESIGN: Retrospective chart review. SETTINGS: Level 1 trauma center in Riyadh. PATIENTS AND METHODS: This retrospective study included all patients involved in motorcycle crashes who were admitted between 2001 and 2017. Medical records were reviewed, and data about injury characteristics, outcomes and healthcare utilization were ascertained. MAIN OUTCOME MEASURES: Injury site and mortality rate. SAMPLE SIZE AND CHARACTERISTICS: 572 patients included 488 males (85.3%) and 232

BACKGROUND: A traumatic spinal fracture (TSF) is a serious condition that has a tremendous impact on patients and their families. Understanding the causes and patterns of TSF is critical in developing prevention programs. OBJECTIVES: Identify causes and patterns of TSF and explore predictors of neurological disability in Saudi Arabia. DESIGN: A retrospective medical record review. SETTING: Level 1 trauma center in Riyadh. PATIENTS AND METHODS: The analysis included all consecutive patients who met the inclusion criteria for any acute TSF in patients 18 years of age and older from January 2001 to January 2016. A multivariate logistic regression model was used to identify predictors of neurological disability following TSF. MAIN OUTCOME MEASURES: Neurological disability in patients sustaining TSF. SAMPLE SIZE: 1128 patients. RESULTS: Of 1128 patients, 971 patients (86%) were male with a mean (SD) age 34.4 (16.6) years. The most common mechanism of injury was motor vehicle accidents (88.4%). Cervical spine was the most commonly affected region (48%, n=468) with a mortality rate of 7.6%. Neurological disability occurred in 74 (6.7%) patients, and 41 (8.7%) of those with cervical fractures died in the hospital. The Injury Severity Score was a significant predictor of neurological disability following TSF. CONCLUSION: A high proportion of neurological disability following TSF was found. Further studies should attempt to improve the documentation rate of seatbelt status in all traumatic cases including mild injuries. This data will increase our understanding of adult TSF and possibly facilitate injury prevention strategies. LIMITATIONS: Single hospital and may not be generalizable. CONFLICT OF INTEREST: None.

Environmental exposure to arsenic has been profoundly associated with chronic systemic disorders, such as neurodegeneration, in both experimental models and clinical studies. The neuronal cells of the brain and the nervous system have a limited regeneration capacity, thus making them more vulnerable to exposure to xenobiotics, leading to long-lasting disabilities. The functional and anatomical complexity of these cells hinders the complete understanding of the mechanisms of neurodegeneration and neuroprotection. The present investigations aimed to evaluate the neuroprotective efficacy of a herbal formulation of Nobiletin (NOB) against the toxic insult induced by sodium arsenate (NA) in human neural progenitor cells (hNPCs) derived from human induced pluripotent stem cells (hiPSCs). Prior to the neuroprotective experiments, biologically safe doses of both NOB and NA were ascertained using standard endpoints of cytotoxicity. Thereafter, the hNPCs were exposed to either NOB (50 μM) or NA (50 μM) and co-exposed to biologically safe concentrations of NA (50 μM) with NOB (50 μM) for a period of up to 48 h. NOB treatment restored the morphological damage (neurite damage), the levels of stress granule G3BP1 (Ras-GTPase-activating protein (SH3 domain)-binding protein) and TIA1 (T cell-restricted intracellular antigen), and the expression of neuronal markers (Tuj1, Nestin, MAP2, and PAX6) when compared to NA-exposed cells. A substantial restoration of reactive oxygen species and mitochondrial membrane potential was also witnessed in the co-exposure group (NA + NOB) in comparison to the NA-exposed group. The findings suggest that NOB possesses a significant restorative/protective potential against the NA challenge in hNPCs under experimental conditions and imply that nobiletin may impart a potential therapeutic impact if studied adequately using in vivo studies.

Background After recovery from acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many patients experience long-term symptoms in different body systems. The aim of the present study was to identify these symptoms, their severity, and their duration as a first step in building a system to classify post-recovery long-term symptoms of coronavirus disease 2019 (COVID-19). Methods An online-based cross-sectional survey was administered between September and October 2020. Data regarding the severity of post-recovery symptoms and their duration were collected using an Arabic questionnaire divided into six categories encompassing the 20 most prevalent symptoms. Results A total of 979 patients recovered from COVID-19 in Saudi Arabia in the study period, of whom 53% were male and 47% were female. The most common symptoms included general fatigue and weakness (73% each), with moderate severity of neurological symptoms including mood changes (41%) and insomnia (39%). Among the special senses, loss of smell and taste of marked severity were reported by 64% and 55% among respiratory symptoms, cough of mild severity (47%), and dyspnea of moderate severity (43%). Loss of appetite of moderate severity was reported in 42%, and diarrhea, abdominal pain, and nausea of mild severity were reported by 53%, 50%, and 44% of respondents, respectively. Conclusions Long-term symptoms after recovery from COVID-19 warrant patient follow-up. The authors propose a classification system as a starting point to guide the identification and follow-up of long-term symptoms post-recovery, and recommend larger-scale studies to broaden the definition of recovery from COVID-19, which appears to have two phases, acute and chronic.

BACKGROUND: In Saudi Arabia, injury is the leading cause of death. Even if nonfatal, the impact of injuries on population health is enormous, as thousands of young patients suffer permanent disabilities every year. Unlike in developed countries, private transportation (PT) is a common means to transport trauma patients. Outcome differences between patients transported via PT relative to emergency medical services (EMS) has not been previously explored. OBJECTIVES: To evaluate the association between transportation mode and in-hospital complications among trauma patients. DESIGN: Retrospective. SETTING: Tertiary care center. PATIENTS AND METHODS: The study included all patients (≥16 years), who were admitted following trauma. MAIN OUTCOME MEASURES: The main outcome in the study was the occurrence of any medical complications including stroke, sepsis, myocardial infarction, pulmonary embolism, pneumonia, renal failure, acute respiratory distress syndrome, and cardiac arrest. RESULTS: The 493 patients were relatively young (over two-thirds of the sample were 45 years old or younger) and over half the population sustained injuries due traffic crashes. More than half (58%) of patients arrived via private transportation. Regression analyses revealed that in-hospital complications following injuries were significantly lower among those who arrived via PT. However, after incorporating propensity score matching, we found no difference in hospital complications (OR=0.55, 95% CI 0.25-1.17). CONCLUSION: Multiple factors may influence this unexpected finding, such as distance to health care settings, the belief that PT is faster or lack of knowledge of the EMS contact number. Further efforts are needed to raise awareness of the importance of using EMS to transport trauma patients to hospitals. Prevention programs to reduce traffic crashes may facilitate reduction in traumatic injuries and associated complications. LIMITATIONS: Retrospective and conducted in one center only.

Background: Hepatitis B and C viral infections, which are the most common cause of liver infection worldwide, are major health issues around the globe. People with chronic hepatitis infections remain at risk of liver cirrhosis and hepatic carcinoma, while also being a risk to other diseases. These infections are highly contagious in nature, and the prevention of hepatitis B and C transmission during blood transfusion is a major challenge for healthcare workers. Although epidemiological characteristics of hepatitis B and C infections in blood donors in Saudi Arabia have been previously investigated in multiple studies, due to targeted cohorts and the vast geographical distribution of Saudi Arabia, there are a lot of missing data points, which necessitates further investigations. Aim of the study: This study aimed to determine the prevalence of hepatitis B and hepatitis C viral infections among blood donors in the northern region of Riyadh, Saudi Arabia. Methods: To determine the given objectives, a retrospective study was performed which included data gathered from serological as well as nucleic acid test (NAT) screening of blood donors. Clinical data of 3733 blood donors were collected for a period of 2 years (from January 2019 to December 2020) at the blood bank of King Khalid General Hospital and the associated blood banks and donation camps in the region. Statistical analysis of the clinical data was performed using SPSS. Results: The blood samples of 3733 donors were analyzed to determine the seroprevalence of hepatitis B and C among the blood donors in the northern region of Riyadh, Saudi Arabia. Among the total of 3733 blood donors, 3645 (97.65%) were men and 88 (2.36%) were women. Most of the donors were younger than 27 years of age (n = 1494). The most frequent blood group in our study was O-positive (n = 1534), and the least frequent was AB-negative (n = 29). After statistically analyzing the clinical data, we observed that 7 (0.19%), 203 (5.44%) and 260 (6.96%) donor blood samples were positive for the HBV serological markers HBsAgs, HBsAbs and HBcAbs, respectively, and 12 (0.32%) blood samples reacted positively to anti-HCV antibodies. Moreover, 10 (0.27%) and 1 (0.027%) samples were NAT-HBV positive and NAT-HCV positive, respectively. Conclusion: In the current study, low prevalence rates of HBV and HCV were observed in the blood donors. Statistical correlations indicated that both serological tests and NATs are highly effective in screening potential blood donors for HBV and HCV, which, in turn, prevents potential transfusion-transmitted hepatitis.

BACKGROUND: Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia. OBJECTIVE: To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system. DESIGN: Retrospective, analytical. SETTING: Trauma center of a tertiary care center in Riyadh. PATIENTS AND METHODS: The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods. MAIN OUTCOME MEASURE(S): Injury severity score (ISS), Glasgow coma scale (GCS) and mortality. RESULTS: The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (−3.1, 95% CI −4.6, −1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant. CONCLUSIONS: This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs. LIMITATIONS: The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.

Janus kinase-signal transducers and activators of transcription (JAK-STAT) signaling is critical to multiple cellular processes, including survival, differentiation, and proliferation. JAK-STAT signaling dysregulation has been noted in inflammatory disorders, and aberrant JAK2 pathway activation has been implicated in myelofibrosis and polycythemia vera. Moreover, 4 therapeutic JAK2 inhibitors (ruxolitinib, fedratinib, momelotinib, and pacritinib) have either been approved or are in advanced clinical development for myelofibrosis. Although all inhibit JAK2, reports indicate that they also inhibit other kinases. Profiling based solely on in vitro potencies is insufficient to predict the observed clinical effects. To provide further translational insights into clinical outcomes, we compared phenotypic biomarker profiles of ruxolitinib, fedratinib, momelotinib, and pacritinib in the BioMAP® Diversity PLUS panel of 12 human primary cell systems designed to recapitulate key aspects of tissue and disease states. Biomarker activity profiles that represent mechanistic signatures for each agent were compared with each other and a database of reference benchmark profiles. At clinically relevant concentrations, these agents had distinct biomarker impacts indicating diverse mechanistic signatures, suggesting divergent clinical effects for each agent. They disparately modulated inflammatory cytokine production and immune function. At clinically relevant concentrations, ruxolitinib had the broadest scope of activities across all 12 cellular systems, whereas pacritinib was more specific for the BT system (modelling T cell-dependent B cell activation) and exhibited the strongest inhibition of sIL-17A, sIL-2, and sIL-6. All 4 agents were antiproliferative to B cells, but ruxolitinib and momelotinib were also antiproliferative to T cells. These differential activities likely reflect distinct secondary pharmacology for these agents known primarily as JAK2 inhibitors. The phenotypic analysis reported herein represents key data on distinct modes-of-action that may provide insights on clinical outcomes reported for these agents. Such translational findings may also inform the development of next-generation molecules with improved efficacy and safety.

Introduction: The early detection and diagnosis of maxillary canine impaction affect the planning of its treatment. Certain radiographic features may be used in order to diagnose such impaction. Aim: To study the radiographic features for detection of the maxillary canine impaction in children and the changes associated with these features over time. Materials and Methods: This was a retrospective crosssectional study that included 37 children aged between 8-14- years-old. Each patient must be diagnosed orthodontically with canine impaction by the failure of its eruption clinically and by using Panoramic Radiographs (PRs). The patient must have at least two PR with at least a one-year interval (T1 and T2) between them both. The following radiographic features have been used to identify maxillary canine impaction: 1) the vertical canine crown height; 2) the degree of canine overlap in relation to any adjacent teeth; 3) the magnitude of canine to lateral incisor angle and 4) the magnitude of the canine to midline angle measurement. The null hypothesis for this study was that there is no difference in the radiographic features between impacted and non-impacted canines in children overtime. Results: An assessment of the panoramic radiographs that were obtained at a later stage (T2) was carried out, which revealed that 56.76% of the canines were impacted whilst 43.24% had erupted normally. Impacted canines showed a significantly higher vertical crown height in relation to the adjacent teeth at T1 (p=0.01). Around 60% of the non-impacted canines were located in a normal position apical to the primary canine. However, the crown of impacted canine was around 75% placed either distal or mesial to the permanent lateral incisor (p

Channelrhodopsins are light-sensitive ion channels whose reaction cycles involve conformation-coupled transfer of protons. Understanding how channelrhodopsins work is important for applications in optogenetics, where light activation of these proteins triggers changes in the transmembrane potential across excitable membranes. A fundamental open question is how the protein environment ensures that unproductive proton transfer from the retinal Schiff base to the nearby carboxylate counterion is avoided in the resting state of the channel. To address this question, we performed combined quantum mechanical/molecular mechanical proton transfer calculations with explicit treatment of the surrounding lipid membrane. The free energy profiles computed for proton transfer to the counterion, either via a direct jump or mediated by a water molecule, demonstrate that, when retinal is all-trans, water and protein electrostatic interactions largely favour the protonated retinal Schiff base state. We identified a conserved lysine group as an essential structural element for the proton transfer energetics in channelrhodopsins.

BACKGROUND AND OBJECTIVES: Diffuse alveolar hemorrhage (DAH) is a life threatening condition with very limited, often unsuccessful, therapeutic options. This study aimed at exploring the feasibility and efficacy of nebulized tranexamic acid TXA (n-TXA) and nebulized recombinant factor VIIa (n-rFVIIa) when used in a two-step therapy protocol in children with intractable DAH in a pediatric intensive care unit. METHODS: In a prospective trial, n-TXA (250 mg/dose for children 25 kg) was administered to 18 children (median age [interquartile range]; 24.0 months [11.3, 58.5]) with intractable DAH. N-rFVIIa (35 μg/kg/dose for children 25 kg) was added if no or minimal response was seen after 3 to 4 doses (18 to 24 hours) of n-TXA. RESULTS: DAH was stopped in 10 (55.6%) children with n-TXA alone within 24 hours of therapy. Documented concomitant respiratory infection showed a significant negative association with response to n-TXA in a stepwise regression analysis (OR=0.06; 95% CI=0.01–0.74). In the other 8 (44.4%) children, n-rFVIIa was added due to n-TXA failure. Six (75.0%) showed complete cessation of DAH, while two children failed to respond with the addition of n-rFVIIa (25.0%). None of the children who responded to therapy showed recurrence of DAH after therapy termination. No complications related to therapy were recorded. CONCLUSIONS: n-TXA and n-rFVIIa were effective and safe when used in a two-step-therapy protocol to control intractable DAH in pediatric patients in intensive care settings. This therapy modality warrants further exploration through larger multicenter clinical trials.

BACKGROUND AND OBJECTIVES: In Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA. DESIGN AND SETTINGS: Using data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA. PATIENTS AND METHODS: A staff nurse utilized a structured checklist to gather information on patients' demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group (≤14 vs >14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated. RESULTS: 10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P

BACKGROUND AND OBJECTIVES: Tuberculosis (TB) remains a global health problem. There is limited data on pediatric central nervous system tuberculosis (CNSTB) in Saudi Arabia on diagnosis and therapy. DESIGN AND SETTING: Retrospective review of health record of pediatric patients

BACKGROUND AND OBJECTIVES: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, systemic, aseptic, inflammatory disorder that involves different sites. Pathogenesis of chronic recurrent multifocal osteomyelitis is currently unknown. To our knowledge, there are no reports of CRMO from Saudi Arabia. We describe the clinical and laboratory features and treatment of a cohort of children with CRMO. DESIGN AND SETTING: Retrospective, patients referred to pediatric rheumatology clinic at a tertiary care center in Riyadh, Saudi Arabia. PATIENTS AND METHODS: The diagnosis of CRMO was based on evidence of recurrent osteomyelitis with radiographic evidence of chronic osteomyelitis involving at least two sites in the absence of infectious cause in a child less than 14 years old. RESULTS: Ten patients (9 female, 1 male) with CRMO; 2 patients presented in infancy. The referral diagnosis was inaccurate in all patients. All of them presented with pain and 8 of them had associated swelling and were found to have multifocal lesions. Imaging studies showed findings consistent with chronic osteomyelitis. Histopathological and microbiological examination confirmed the diagnosis in 9 patients. Cyclic pamidronate infusions induced good improvement in 6 patients. CONCLUSION: This report indicates that CRMO may be overlooked in our community. Early diagnosis and treatment are required to avoid potential complications.

BACKGROUND AND OBJECTIVE: Published data from Saudi Arabia regarding autoinflammatory diseases are scarce. In this study, we describe the clinical and laboratory features of autoinflammatory diseases in Saudi children. DESIGN AND SETTING: Restrospective, hospital-based study conducted from January 2010 until June 2010. PATIENTS AND METHODS: Patients with autoinflammatory disease treated at the Pediatric Rheumatology Clinic at King Faisal Specialist Hospital and Research Center, Riyadh, over the past 10 years were included. Autoinflammatory diseases included the following: familial Mediterranean fever (FMF); chronic recurrent multifocal osteomyelitis (CRMO); early-onset sarcoidosis (EOS); periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA); chronic infantile neurologic cutaneous and articular syndrome (CINCA); and Muckle-Wells syndrome (MWS). Demographic characteristics, diagnosis, age at onset, disease duration, follow-up duration, clinical and laboratory variables, and outcome data were compiled. Gathered laboratory data were part of patients' usual medical care. RESULTS: Thirty-four patients (females, 53%) with autoinflammatory diseases were included (mean age, 151 months. Mean disease duration was 118 months; mean age at onset was 32 months; consanguinity was present in 40%. Patients were diagnosed as follows: FMF, 50%; CRMO, 23.5%; CINCA, 8.8%; EOS, 8.8%; MWS, 6%; and PFAPA, 2.9%. The referral diagnosis was inaccurate in all patients except for FMF patients. Gene study was informative in 9 of 14 FMF patients who had molecular analyses. None of our cohort had amyloidosis. All CRMO patients had a favorable response to treatment except 1 patient, who had refractory, progressive disease. All patients with EOS had multiorgan involvement, including uveitis. All CINCA patients had a favorable response to anakinra. CONCLUSION: Our report shows that autoinflammatory diseases other than FMF may be overlooked. Increased awareness among pediatricians about these conditions will help to provide better health care to patients in the form of early diagnosis and management.

Cantharidin is an intoxicant found in beetles in the Meloidae (Coleoptera) family. Ingestion may result in haematemesis, impaired level of consciousness, electrolyte disturbance, haematurea and renal impairment. Here, we report two paediatric cases of meloid beetle ingestion resulting in cantharidin poisoning and the clinical presentation of the ensuing intoxication.