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Magbool Alelyani,1 Moawia Gameraddin,2 Azah Alasmari,1 Fay Alshahrani,1 Nada Alqahtani,1 Alamin Musa1 1Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61413, Saudi Arabia; 2Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Almadinah, Kingdom of Saudi ArabiaCorrespondence: Moawia GameraddinDepartment of Diagnostic Radiologic Technology Faculty of Applied Medical Sciences, Taibah University, Almadinah, Kingdom of Saudi ArabiaEmail gameraldinm@gmail.comPurpose: To assess the knowledge and attitudes of Saudi patients toward the safety of magnetic resonance imaging (MRI).Methods: A cross-sectional study was conducted on 142 Saudi patients at King Khalid hospital, Asir, Saudi Arabia. Data were collected using a self-questionnaire based on MRI safety issues gained from the literature. The questionnaire was divided into two sections, one containing the respondents’ sociodemographic information and the other assessing their knowledge and attitudes toward participating in MRI.Results: A total of 142 patients responded to the survey, and their average age was 31.5 ± 4 years. The majority were married and held a bachelor’s degree. The mean knowledge score regarding MRI safety was 0.29 ± 0.25, which reflects poor knowledge, whereas the attitude score was 0.67 ± 0.20, reflecting a moderately positive attitude. Awareness and attitude among patients improved as education levels increased. Finally, only 53.5% of the respondents were aware of the noise produced by the MRI scanner.Conclusion: This study demonstrated that the awareness of MRI safety among patients in the Asir Region is poor, although they showed positive attitudes toward the issue. Thus, education is necessary for patients to improve awareness of MRI safety to facilitate MRI examinations, which will help decrease scan time and image artefacts.Keywords: perceptions, attitudes, MRI safety, awareness, patients

Naif A Almosa,1 Beshayer S Sibai,2 Olla A Rejjal,3 Nasser Alqahtani1 1Department of Pediatric Dentistry and Orthodontics, King Saud University, Riyadh, Saudi Arabia; 2National Guard Hospital, Dammam, Saudi Arabia; 3State University of New York, Buffalo, NY, USA Aim: To evaluate the degree of enamel demineralization of teeth bonded with ceramic and metal brackets.Materials and methods: In this cross-sectional experimental in vitro study, 60 extracted human premolar teeth were selected according to the experimental criteria. They were divided into three groups; 20 premolar teeth in each group. Teeth in group 1 were bonded with “ceramic brackets”, and teeth in group 2 were bonded with “metal brackets”, while teeth in group 3 served as the “control group” without any brackets. Teeth in all groups were then immersed in demineralization media, de-bonded, sectioned into three parts (proximal 1, middle, and proximal 2), and evaluated to determine the level of enamel demineralization under a Scanning Electron Microscope.Results: On tooth level, the results show that the control group has significantly less enamel demineralization compared to the other two experimental groups, with mean values of 145.3 µm and 192.7 µm, respectively (P=0.000). The mean value of enamel demineralization in the metal group is 55.93 µm, compared to 72.55 µm in the ceramic group, which is significantly less (P≤0.05), while there is no difference between the control and metal group with regard to enamel demineralization. On section level, the control group has significantly less enamel demineralization in all three sections compared to the ceramic group, while a significant difference is found in one of the proximal sections when compared with the metal group. Moreover, the ceramic group has significantly higher enamel demineralization in the middle section compared to the metal group (73.54 µm, 46.5 µm, respectively) (P=0.000), while there is no statistical significant difference between the two experimental groups in proximal sections.Conclusion: In vitro, non-bonded teeth show least demineralization compared to the bonded teeth. Teeth bonded with ceramic brackets show significantly higher enamel demineralization compared to teeth bonded with metal brackets. Keywords: ceramic, demineralization, metal, orthodontic brackets, decalcification, white spot lesions, orthodontic material, adhesive

Waeil Batwa,1 Hala A Almarhoon,2 Khalid A Almoammar,2 Nasser Alqahtani,2 Sahar F Albarakati,2 Thikriat Al-Jewair3 1Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; 3Advanced Education Program in Orthodontics and Dentofacial Orthopedics, UMKC School of Dentistry, Kansas City, MO, USA Objective: The objective of this study was to compare the cephalometric skeletal and dental characteristics of unilateral complete cleft lip and palate (UCCLP) subjects with and without missing teeth.Design: A retrospective records review was conducted for patients who are being treated at the cleft lip and palate (CLP) clinics in the College of Dentistry.Methods: Ninety-six consecutive records of non-syndromic UCCLP subjects were recruited (33 subjects without missing teeth, 50 subjects with only one missing tooth, and 13 subjects with two or more missing teeth). Skeletal and dental characteristics were assessed using lateral cephalometric radiographs in UCCLP subjects with missing teeth and compared to the group with no missing teeth. A total of 25 linear and angular measurements were analyzed and compared between the sample groups.Results: Of the dental variables tested, overjet was significantly different between the three groups. The UCCLP subjects with multiple missing teeth had the smallest overjet (–3.89±2.75 mm; P=0.015) among the three groups. None of the skeletal characteristics reached statistical significance.Conclusion: Missing teeth influence the dental but not skeletal characteristics of UCCLP. Overjet is significantly reduced in UCCLP subjects with multiple missing teeth. Future studies with larger sample sizes are warranted. Keywords: missing teeth, cleft lip, cleft palate, hypodontia

Sulphamic acid (SA) crystals supplemented with l-methionine (LM) were grown at moderate temperatures using a slow evaporation procedure. The powder XRD pattern showed that LM supplemented with SA (LMSA) crystals have an orthorhombic crystal structure. The FTIR studies confirmed the presence of various vibrational modes. Using a UV-Vis spectrometer, the transmittance of LMSA in the UV and visible range was observed, and the band gap of the LMSA was also calculated. The hardness value of LMSA was higher compared to that of pure SA. Photoluminescence emission studies of LMSA pointed out emissions at 491 and 542 nm, which were attributed to the transition from the 5D4 state to 7F6 and 7F5 ground, respectively. LMSA crystals were effective in killing pathogenic bacteria, according to the studies on their anti-bacterial activity.

Osamah Ahmad Hakami,&ast; Refah Asheer Alsubaie,&ast; Bayan Abdulhadi Albaqami, Haifa Matar Almutlaq, Nourah Mushabab Alqahtani, Manal Alkhonezan, Farah Fahad Almuqrin, Abdullah Hussien Alghamdi, Abdullah Abdulaziz Alaryni, Rayan Abubakker Qutob Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Refah Asheer Alsubaie, Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, 7544 Othman Bin Affan Road Al-Nada, Riyadh, 13317, Saudi Arabia, Tel +966 50 255 2509, Email raalsubaie18@sm.imamu.edu.saBackground: Helicobacter pylori (H. pylori) is a key pathogen causing several gastrointestinal diseases. Fortunately, H. pylori infection is treatable, which can lower its comorbidities. However, data assessing physicians’ awareness of H. pylori is lacking in Saudi Arabia.Objective: To assess the knowledge and awareness of physicians of different specialties who practice in Saudi Arabia about H. pylori infection.Methods: This is a cross-sectional study conducted between May and September 2022 on physicians across all regions in Saudi Arabia using a validated online questionnaire covering their knowledge and awareness of H. pylori infection. An independent t-test, one-way ANOVA, and Games-Howell as a post hoc test were used to analyze the data. A General Linear Model was also employed to determine significant predictors among the variables reliant on H. pylori awareness.Results: The results showed that the mean awareness score of 474 physicians was 76.99± 6.9, indicating that participants had sufficient knowledge about H. pylori infection. In general, the internal medicine specialists (28.3%) had better awareness of H. pylori infection than the other specialties. Moreover, the university hospital sector performed the best, scoring 80.68± 13.3, and the southern region had the highest-ranked physicians with a score of 81.56 ± 13.7 in terms of H. pylori awareness. Furthermore, the general linear model revealed a statistical significance (p< 0.05) for the following demographic aspects concerning H. pylori awareness: the physicians’ age group of 30– 39 years, duration of experience of 11– 15 years, the hospital sectors of Nation Guards (NGH) and Security Forces (SFH), and the southern and central regions of practice in Saudi Arabia.Conclusion: Physicians in Saudi Arabia have relatively sufficient awareness of H. pylori; however, they are highly influenced by age, years of experience, the hospital sector involved, and the region where the physicians practice.Keywords: H. pylori, awareness, doctors, internal medicine, gastroenterology

Background/Aim. Diabetes mellitus is a common metabolic disease-causing high mortality and morbidity worldwide. So, physicians need to identify this condition early to implement prevention strategies. The study aimed to test the concept of a novel periodontal device that can be attached to a glucose monitoring device as an innovative tool to screen for periodontitis and diabetes mellitus simultaneously during a routine dental examination. Therefore, correlation of blood glucose between the conventional finger-prick blood glucose (FPBG) and gingival crevicular blood glucose (GCBG) method, along with estimation of patient's pain perception by visual analogue scale (VAS). Methods. A crosssectional comparative study was conducted among 250 participants whose GCBG and FPBG were estimated. VAS score scale was recorded for each patient immediately after the procedure. Results. The mean GCBG value was 151.19 ± 42.64 mg/dL, while mean FPBG was 150.48 ± 42.95 mg/dL, showing a high Pearson's correlation (r=0.9932; p< 0.00001). Mann-Whitney U for VAS score between both the groups showed a statistically significant difference (p < 0.00001). Conclusion. The GCBG method was well tolerated by patients, and highly correlated with peripheral blood glucose levels. The proposed concept of the novel periodontal device appeared to be a feasible option for examining periodontium and screening diabetes simultaneously in dental clinics.

Background/purpose: Salivary markers of bone turnover are useful biomarkers for screening patients advanced periodontal diseases with alveolar bone loss. Hence, the purpose of this study was to determine the diagnostic accuracy of deoxypyridinoline-containing degradation fragment of the C-terminal telopeptide region of type I collagen (CTX), Osteocalcin (OC) and Osteonectin (ON) in identifying patients with alveolar bone loss (BL) due to periodontitis. Materials and method: Salivary levels of CTX, OC and ON were evaluated in ninety patients (group I, II and III with healthy, periodontitis without Type2 diabetes mellitus-T2DM and periodontitis with T2DM respectively). Group III was included since T2DM is very common among patients attending our clinics. Bleeding on probing (BOP), probing pocket depth (PPD) and BL were recorded for these patients. Results: The concentrations of salivary CTX, OC, and ON were higher in subjects with periodontitis than in controls. Significant correlations were found between these biomarkers and periodontal parameters. CTX, OC, and ON could discriminate between healthy (group I) and diseased (group II & III) regarding BL with excellent sensitivity (90.2–100%) and good specificity (62.1–96.6%). ROC curve gave excellent discrimination regarding BL (AUC: 0.926–0.958) and PPD (AUC: 0.904–0.915). However, none of the cut-off values gave good discrimination regarding BOP. Conclusion: It can be concluded that CTX, OC, and ON correlated well with BL and PPD. Among the three biomarkers, ON at 81.80 ng/ml gave the best discrimination for presence or absence of bone loss. Keywords: Salivary, C-terminal telopeptide region of type I collagen (CTX), Osteocalcin (OC), Osteonectin (ON), Alveolar bone loss (BL), Probing pocket depth (PPD)

Fares S Al-Sehaibany,1 Danah Z Almubarak,2 Reem A Alajlan,2 Mohammad A Aldosari,1 Nasser D Alqahtani,1 Nassr S Almaflehi,3 Sahar F AlBarakati1 1Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; 2Dental Intern, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; 3Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia Aim: This study investigated the knowledge of elementary school staff regarding the management of traumatic dental injuries (TDIs) in children.Methods: The present cross-sectional study analyzed data collected between September 2016 and April 2017. The sample consisted of 2,027 elementary school staff members in Riyadh, Saudi Arabia. A stratified cluster random sampling technique was used to select the required sample. Those who agreed to participate in the study completed a 4-part self-administered questionnaire comprising questions regarding demographic data, knowledge on management of tooth fracture, and avulsion using photographs of TDI cases.Results: The majority of the school staff showed inadequate basic knowledge regarding the importance of saving the broken piece of the tooth and identifying the tooth involved in the trauma (67% and 66.3%, respectively), P

Background: With its rapid introduction in 2009, concerns about the safety of the H1N1 vaccines have been raised. Data were especially limited on the pediatric safety of H1N1 vaccine in Saudi Arabia.Objectives: The objectives of this study were to investigate the safety of the H1N1 vaccine (Pandemrix(®)) in children and examine the feasibility of obtaining information on possibly associated adverse reactions using mobile telephone contact with child caregivers.Methods: A cohort study was conducted in Riyadh, Saudi Arabia. Patients were included if they were aged between 6 and 18 years and had received one dose of the H1N1 vaccine. A control group involved children from the same school system who had not received the vaccine. Six months following vaccination, a clinical pharmacist called the caregiver of the child to ask about hospitalization, emergency room visits and events related to H1N1 vaccine administration using a standardized questionnaire.Results: Caregivers of 372 school-age children were contacted. The response rate was 97% (n = 359). A total of 169 children who received at least one dose of the H1N1 vaccine were compared with 190 children in the control group who had not received the vaccine. Controlling for age, sex, education and use of medications, the odds ratio (OR) of hospitalization or emergency room visits for children within the 6 months after vaccination relative to the unvaccinated children was 1.25 (95% CI 0.47, 3.35). The risk of influenza-like symptoms was significantly reduced in vaccinated children compared with unvaccinated children (OR 0.63; 95% CI 0.41, 0.99).Conclusion: School-age children in Saudi Arabia who received the H1N1 vaccine did not have an increased risk of hospitalization or emergency room visits. Larger studies are needed to confirm these results. Proactive pharmacovigilance is important in assessing the safety of vaccines and other medications. It is feasible to collect information on adverse drug reactions using mobile telephones, a method that can be of benefit in both developed and developing countries. [ABSTRACT FROM AUTHOR]

C32H20O2S2, monoclinic, P21/c (no. 14), a = 10.2763(8) Å, b = 19.9178(15) Å, c = 11.8597(10) Å, β = 92.828(3)°, V = 2424.3(3) Å3, Z = 4, Rgt(F) = 0.069, wR(F2) = 0.1782, T = 293(2).

Salah H Elsafi,1 Norah I Alqahtani,1 Nawaf Y Zakary,2 Eidan M Al Zahrani,3 1Clinical Laboratory Science Department, Prince Sultan Military College of Health Sciences, Dhahran, 2Gastroenterology and Endoscopy Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, 3Prince Sultan Military College of Heath Sciences, Dhahran, Kingdom of Saudi Arabia Objectives: To study the performance of a single test using two fecal occult blood tests with colonoscopy for the detection of colorectal cancer (CRC) for the first time in Saudi Arabia to determine possible implications for the anticipated colorectal screening program. Materials and methods: We compared the performance of guaiac and immunochemical fecal occult blood tests for the detection of CRC among patients of 50–74 years old attending two hospitals in the Eastern Region of Saudi Arabia. Samples of feces were collected from 257 asymptomatic patients and 20 cases of confirmed CRC, and they were tested simultaneously by the guaiac-based occult blood test and monoclonal antibody-based immunoassay kit. Colonoscopy was performed on all participants and the results were statistically analyzed with both positive and negative occult blood tests of both methods. Results: Of the 277 subjects, 79 tested positive for occult blood with at least one method. Overall, the number of those with an occult blood-positive result by both tests was 39 (14.1%), while for 198 (71.5%), both tests were negative (P

The human skin commensal Staphylococcus epidermidis produces diverse, therapeutically relevant bacteriocins. We report the complete whole-genome sequence of the nasal isolate S. epidermidis B273, which contains a plasmid with the biosynthetic gene cluster for epidermicin NI01, a broad-spectrum type II antimicrobial peptide.

Background: The advent of digital technologies has introduced novel methods for RPD fabrication, potentially enhancing the fit compared to the conventional approaches. This systematic review aimed to evaluate the methods to assess the accuracy of fit and precision of the RPD framework fabricated using conventional and digital (3D printed and milled) methods., Methods: A comprehensive literature search (Registration Number CRD42023459566) was conducted across different electronic databases like PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar. Studies investigating RPD fit and precision assessment using various techniques (Visual inspection and pressing test using silicone impression material, 3D digital analyses using a software, light microscopy, digital microscope at 50x, superimposition method /surface matching software program, µCT on silicone specimens and direct measurements) in in-vitro studies were included. Data extraction and quality assessment were performed to evaluate the methodological rigour of the selected studies. A narrative synthesis of the findings was carried out to evaluate the methods to assess the accuracy of fit and precision of the RPD framework fabricated through conventional and digital methods due to heterogeneity in study variables., Results: Out of 413 records, a total of 8 in-vitro studies were included in this review. The key findings of the review suggest that RPD fit accuracy varies across fabrication processes including conventional techniques, resin milling, selective laser melting (SLM), and digital superimposition. Resin milling with polyether ether ketone (PEEK) offers the best accuracy. Among the different methods used in assessing the fit accuracy of the RPD framework silicone-based fit evaluation and superimposition techniques/ surface matching are commonly used methods., Conclusion: Both traditional (non-computerized) and computerized methods for the assessment of fit and precision of conventional and digital RPD frameworks are used commonly. But still, formulation of a standard method for fit assessment of RPDs is warranted. In future with further refinements, digital methods would completely outperform the traditional methods., Competing Interests: Declarations. Ethics approval and consent to participate: N/A no human participants involved. The study was registered with the International Prospective Register of Systematic Reviews (Registration Number CRD42023459566). Consent for publication: N/A. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Angiosarcoma (AS) is a rare and aggressive soft tissue sarcoma originating from endothelial cells, with cutaneous manifestations often seen in the head and neck region. Despite its rarity, AS poses significant diagnostic challenges due to its variable presentation and ability to mimic other dermatological conditions. We report the case of an 87-year-old female that presented with a 4-month history of an asymptomatic nodule on her neck, which rapidly progressed into an indurated plaque spreading to her face, chest, and scalp. Initially misdiagnosed as cellulitis and dermatitis, the lesion was unresponsive to antibiotics and steroids. Imaging showed extensive infiltration in the neck, precluding surgical resection. This case underscores the diagnostic difficulty of AS, which can be mistaken for benign skin conditions. Despite a multidisciplinary approach, the prognosis for AS remains poor, with a 5-year survival rate of approximately 35%. Treatment options include surgery, radiation, chemotherapy, and immunotherapy tailored to the patient's condition and tumor characteristics.

This case report presents a three-year follow-up of a young male with bilateral hindfoot fractures due to a high-energy road traffic accident, resulting in a comminuted open calcaneal fracture on the left and an open fracture-dislocation of the right talus. Staged reconstruction was performed, including initial debridement, temporary cement spacers, and subsequent fixation with femoral head allografts (FHAs). The right foot underwent a tibiotalocalcaneal (TTC) fusion, and the left foot received a double arthrodesis. Follow-up imaging confirmed allograft integration and complete fusion. At three years, the patient had a stable, plantigrade foot and satisfactory function for daily activities. This case demonstrates the successful use of FHAs for complex hindfoot reconstructions, preserving limb length and functionality., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. King Fahad Medical City issued approval IRB00010471. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alhoukail et al.)

Corneal curvature (CC) is a crucial ocular optical system parameter, indicating the shape of the cornea expressed in radii. This study aims to investigate the relationship between CC, age, gender, refractive errors, and central corneal thickness (CCT) in Saudi Arabia, a field lacking in research. Data were gathered from Imam Medical Center in Riyadh and Dr. Sulaiman Al Habib Hospital in this randomized, hospital-based, retrospective analysis. Patients sent to the refractive surgery clinic for a laser-assisted in situ keratomileusis (LASIK) evaluation provided a total of 1,005 eyes for the study. Patients with stable refractions in all groups and those between the ages of 17 and 57 with no history of systemic illness, eye operations, or ocular pathology were included in the research, as were all groups with stable refractions. An ultrasound pachymeter was used to assess the CC and CCT. This study showed a mean CC of 42.93+/-1.4 at a mean age of 28.93+/-7.09. We found a significant negative, weak correlation between mean CC and CCT. Gender was not significantly associated with CC in myopic and hyperopic patients, while in patients with astigmatism, females were observed to have a significantly higher mean CC compared to males. A significant difference in the mean CC was observed across different refractive errors, and patients with astigmatism had the highest CC, followed by myopic and hyperopic patients., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Research Ethics Committee issued approval HAPO-00R-011. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almazrou et al.)

Background and Objective: Health literacy is the cognitive and social abilities that influence a person's motivation and capacity to learn, comprehend, and use information to improve and maintain good health. We aimed to investigate Healthcare Students' knowledge, attitudes, and practices regarding Health Literacy in the Riyadh Province of Saudi Arabia., Methods: This study used prevalidated electronic questionnaires among healthcare undergraduates from colleges affiliated with Saudi University in Riyadh, Saudi Arabia, from December to April 2024. Healthcare students were asked to answer a self-designed online questionnaire sent to them through social media platforms., Results: The response rate was 560 out of 600 (93.3%); 293 of the 560 students (52.3%) were aged between 23 and 24 years (mean age was 21.29 SD = 1.852). The mean GPA among the students was 4.31(± 0.682). The average overall score for health literacy among healthcare students was 100.92 ± 11.80. The mean scores for knowledge were 24.17 ± 4.67, attitudes were 38.65 ± 4.20, and practice in health literacy was 38.09 ± 5.09. Among all healthcare students, 50.2% reported good knowledge, 54.1% had good attitudes, and 50.1% exhibited good practices in health literacy. However, students' knowledge (p = 0.019) and training (p = 0.024) in health literacy were significantly associated with smoking cigarettes. Additionally, smoking shisha was significantly associated with students' knowledge (p = 0.022), attitudes (p = 0.001), and practices (p = 0.001) in health literacy., Conclusion: Our study highlights that half of the healthcare students reported limited knowledge, attitude, and practice in health literacy. Age, gender, and course of study did not show significant differences. Rather, students who did not smoke cigarettes or shisha were found to have higher knowledge, attitudes, and practice in health literacy compared to smokers. However, to improve health literacy, additional education and increased awareness are needed. Further investigation is warranted to address the factors related to poor health literacy., (© 2024. The Author(s).)

Objective: The use of virtual simulation in nursing education is an effective approach for improving nursing critical thinking and self-learning abilities, but the previous studies were limited to providing the required evidence that supports the association. This study aimed to assess the relationship between virtual simulation and critical thinking disposition and self-directed learning abilities among nursing students., Methods: This is a descriptive correlational, non-experimental study. It was conducted among 201 third- and fourth-year nursing students at the Academic Institution, Saudi Arabia. A non-probability convenience sampling technique was used to select the participants; then, an online, adapted questionnaire was sent to the participants, the data from which was analyzed by SPSS., Results: The study findings showed that virtual simulation benefited nursing students. Most participants (56%) agreed that it helped them to think critically, and approximately 27% strongly agreed. It also enhanced their self-directed learning abilities, and the majority of the students agreed that they often review the way nursing practice is conducted. Furthermore, the results showed a significant, positive relationship between virtual simulation and the critical thinking disposition of nursing students ( p -value = 0.03; correlation coefficient = 0.65), a strong positive relationship with self-directed learning abilities of nursing students ( p -value = 0.004; correlation coefficient = 0.78), and a strong positive relationship between critical thinking disposition with self-directed learning abilities of nursing students ( p -value = 0.01; correlation coefficient = 0.72)., Conclusion: There are significant relationships between virtual simulation and the critical thinking disposition and self-directed learning abilities of nursing students. Furthermore, virtual simulation made the students practice critical thinking and self-learning, so, they simulate events and try to seek out and solve the problems., Competing Interests: The authors declare there are no competing interests., (©2024 Alharbi et al.)

Background and objective Shared decision-making (SDM) in healthcare has transitioned from a paternalistic model to a collaborative approach, particularly significant in chronic disease management. This shift focuses on aligning healthcare decisions with patient preferences and values, thereby enhancing patient engagement and treatment adherence. However, patient preferences regarding involvement in SDM vary widely, influenced by demographic, disease-specific, psychological, cultural, and social factors. This study aimed to explore patient preferences related to SDM in chronic disease management in Saudi Arabia, by assessing attitudes toward SDM, the impact of decision aids, and the role of clinician communication in influencing these preferences. Methods A cross-sectional survey design was employed, involving 409 adult outpatients with chronic diseases attending four public hospitals in Saudi Arabia. Participants were selected using purposive and convenience sampling. The survey, translated into Arabic, collected demographic data and information on preferences and experiences in decision-making, communication, and information sharing. The data were analyzed using SPSS Statistics (IBM Corp., Armonk, NY) to identify patterns and correlations. Results Key findings indicated a strong preference among the participants for involvement in treatment decisions (n=303, 74.2%) and clear communication using layman's terms (n=338, 82.6%). Major barriers to active participation in SDM included lack of time during appointments (n=275, 67.2%), difficulty understanding medical terminology (n=220, 53.9%), and feeling intimidated to ask questions (297, 72.6%). Comfort in SDM was highest in the age group of 41-50 years [mean=4.16, standard deviation (SD)=28.44; F=2.3287, p=0.0739]. Patient satisfaction was significantly higher in the age group of 18-30 years (mean=3.42, SD=1.09; F=3.0503, p=0.0284). Conclusions Our findings highlight the need for incorporating patient preferences into chronic disease management strategies to enhance engagement and satisfaction., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee at Imam Abdulrahman Bin Faisal University issued approval 8. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alanzi et al.)

Objective:  The aim is to coat orthodontic brackets with two different bioactive materials and to compare the mechanical and morphological properties of coated brackets and tooth surfaces., Materials and Methods:  A total of 120 stainless steel brackets were divided equally into three groups, that is, the uncoated brackets and nanohydroxyapatite (nHA)-coated, and nanobioactive glass (nBG)-coated brackets using a spin coater machine. The brackets were bonded on the enamel surface and underwent remineralization/demineralization cycles for days 1, 7, 14, and 30. At each time interval, the bond strength of the brackets was assessed using mechanical loading. An optical and scanning electron microscope (SEM) were used for surface evaluation, and the adhesive remanent index (ARI) values were obtained and quantified., Statistical Analysis:  One-way analysis of variance using Tukey's test was used to compare the differences among the groups., Results:  A uniform distribution of nanoparticles occurred on the surfaces of brackets. The shear bond strength (SBS) showed no significant differences in any tested groups on days 1, 7, and 14. However, control and nBG showed a significant difference from nHA at day 30. On days 7, 14, and 30, the nHA group showed the highest SBS values among the groups. For ARI, most samples showed an adhesive nature of failure at the enamel-brackets interface. The images confirmed the presence of coated particles on brackets and remnants of adhesives after SBS., Conclusion:  This study confirmed that the nHA- and nBG-coated brackets have a high potential for application in orthodontics regarding structural and mechanical properties., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Turnover has a negative impact and can harm businesses, specifically the organizational structure and service delivery. The purpose of this review is to provide policymakers, healthcare administrators, and stakeholders in Saudi Arabia with approaches and strategies for reducing turnover and improving provider retention by synthesizing existing literature and identifying the key variables influencing turnover intention. This study conducted a comprehensive literature review to explore numerous variables associated with medical professional turnover intentions in Saudi Arabia from 2016 to 2024. The librarian assisted with the creation of the query string. The literature search was carried out using PubMed, Web of Science, and Google Scholar. By utilizing the key terms turnover AND healthcare providers AND healthcare facilities AND Saudi*. The authors separately examined and evaluated the risk of bias in each study using Joanna Briggs Institute (JBI) tools. The findings of this review show that all studies were executed using a cross-sectional design, and five studies were published in 2022. According to this review, ten studies were carried out in hospital settings. Ten studies examined elements associated with work. Moreover, five studies were associated with external variables, followed by five studies linked to personal factors. The most common factors for turnover were satisfaction, stress, and work. Turnover-related factors can have an impact on the long-term sustainability of the healthcare system. This review provides crucial information on the factors related to turnover, using the growing body of research in the Saudi context., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alkhurayji et al.)

Objectives: The aim of this study is to evaluate the effect of different surface treatments on the shear bond strength (SBS) of clear aligner attachments bonded to Bis-acryl provisional crowns., Methods: 120 cylindrical bisacrylic composite material (ProTemp type) specimens were prepared and divided into six groups ( n  = 20) based on surface treatment, control: (no treatment); super coarse grit diamond bur, carbide bur, alumina-blasting, non-thermal plasma treatment, and Er:YAG laser treatment. The features of treated surfaces were examined using scanning electron microscopy (SEM). A flowable composite resin (Transbond XT; 3M Unitek) was bonded to the specimens forming the attachment. Half of specimens were subjected to thermal cycling (5,000 cycles). SBS was measured before and after thermal cycling. Each specimen was loaded at the attachment/resin interface at a speed of 0.5 mm/min until failure. The nature of the failure was analyzed using the composite remnants index (CRI). Two-way ANOVA and Tukey HSD were used for data analysis α  =  0.5. For CRI scores analysis, Kruskal-Wallis test and Dunn's multiple comparison were used as post-hoc test., Results: SEM analysis showed that all surface treatments altered surface properties and increase surface bonding area. The specimens treated with plasma, Er:YAG laser, and alumina-blasting had higher SBS values before and after thermal cycling. In comparison to control plasma, Er:YAG laser, and alumina-blasting showed a significant increase in SBS ( P  < 0.001) while carbide and diamond bur groups showed no significant differences ( P  > 0.05). Thermal cycling significantly decreased the SBS of control, carbide bur, diamond bur, and Er:YAG laser while no significant effect of alumina-blasting and plasma group. Er:YAG laser and plasma groups significantly exhibited more dominance for scores 2 and score 3 and the absence of score 0., Conclusion: Alumina-blasting, Er:YAG laser, or non-thermal plasma surface treatments increased the shear bond strength between clear aligner attachments and resin-based restorations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Shahin, AlQahtani, Abushowmi, Siddiqui, Akhtar, Nassar and Gad.)

BACKGROUND Chat Generative Pre-Trained (ChatGPT) Transformer was created by OpenAI and has a powerful tool used in research. This study aimed to assess the awareness and perceptions of ChatGPT among researchers and academicians at King Saud University, Riyadh, Saudi Arabia. MATERIAL AND METHODS A self-administered cross-sectional study was conducted among academicians and researchers from November 2023 to March 2024 using electronic questionnaires prepared in Google Forms. The data were collected using the Tawasul platform, which sent the electronic questionnaires to the targeted population. To determine the association between variables, the chi-square or Fisher exact test was applied at a significance level of <0.05. To find predictors of use of ChatGPT, multiple linear regression analysis was applied. RESULTS A response rate of 66.5% was obtained. Among those, 60.2% (n=121) had expertise in computer skills and 63.7% were familiar with ChatGPT. The respondents' gender, age, and specialization had a significant association with familiarity with ChatGPT (p<0.001). The results of the multiple linear regression analysis revealed that there was a significant association between the use of ChatGPT, age (B=0.048; SE=0.022; t=2.207; p=.028; CI=0.005-0.092) gender (B=0.330; SE=0.067; t=4.906; p=.001; CI=197-.462) and nationality, (B=0.194; SE=0.065; t=2.982; p=.003, CI=.066-.322). CONCLUSIONS The growing use of ChatGPT in scholarly research offers a chance to promote the ethical and responsible use of artificial intelligence. Future studies ought to concentrate on assessing ChatGPT's clinical results and comparing its effectiveness to those of other ChatGPT and other AI tools.

Background: Recent guidelines recommend using direct oral anticoagulants (DOACs) as first-line agents in patients with non-valvular atrial fibrillation (NVAF). Research is currently investigating the use of Apixaban in underweight patients, with some results suggesting altered pharmacokinetics, decreased drug absorption, and potential overdosing in this population. This study examined the effectiveness and safety of standard Apixaban dosing in adult patients with atrial NVAF weighing less than 50 kg., Methods: This is a retrospective cohort study conducted at King Abdulaziz Medical City (KAMC); adult patients with a body mass index (BMI) below 25 who received a standard dose of Apixaban (5 mg twice daily) were categorized into two sub-cohorts based on their weight at the time of Apixaban initiation. Underweight was defined as patients weighing ≤ 50 kg, while the control group (Normal weight) comprised patients weighing > 50 kg. We followed the patients for at least one year after Apixaban initiation. The study's primary outcome was the incidence of stroke events, while secondary outcomes included bleeding (major or minor), thrombosis, and venous thromboembolism (VTE). Propensity score (PS) matching with a 1:1 ratio was used based on predefined criteria and regression model was utilized as appropriate., Results: A total of 1,433 patients were screened; of those, 277 were included according to the eligibility criteria. The incidence of stroke events was lower in the underweight than in the normal weight group at crude analysis (0% vs. 9.1%) p-value = 0.06), as well in regression analysis (OR (95%CI): 0.08 (0.001, 0.76), p-value = 0.002). On the other hand, there were no statistically significant differences between the two groups in the odds of major and minor bleeding (OR (95%CI): 0.39 (0.07, 2.03), p-value = 0.26 and OR (95%CI): 1.27 (0.56, 2.84), p-value = 0.40, respectively)., Conclusion: This exploratory study revealed that underweight patients with NVAF who received standard doses of Apixaban had fewer stroke events compared to normal-weight patients, without statistically significant differences in bleeding events. To confirm these findings, further randomized controlled trials with larger sample sizes and longer observation durations are required., (© 2024. The Author(s).)

Purpose: Despite limited evidence supporting its effectiveness, most guidelines recommend long-term, routinely scheduled in-person surveillance of patients with early breast cancer (EBC). The COVID-19 pandemic led to increased use of virtual care. This survey evaluated patient perspectives on follow-up care., Methods: Patients with EBC undergoing surveillance were surveyed about follow-up protocols, perceptions, and interest in clinical trials assessing different follow-up strategies., Results: Of 402 approached patients 270 completed the survey (response rate 67%). Median age 62.5 years (range 25-86) and median time since breast cancer diagnosis was 3.8 years (range < 1-33 years). Most (n = 148/244, 60%) were followed by more than one provider. Routine follow-ups with breast examination were mostly conducted by medical/radiation oncologists every 6 months (n = 110/236, 46%) or annually (n = 106/236, 44%). Participants felt routine follow-up was useful to monitor for recurrence, manage side effects of cancer treatment and to provide support/reassurance. Most participants felt regular follow-up care would detect recurrent cancer earlier (n = 214/255, 96%) and increase survival (n = 218/249, 88%). The COVID-19 pandemic reduced the number of in-person visits for 54% of patients (n = 63/117). Patients were concerned this reduction of in-person visits would lead to later detection of both local (n = 29/63, 46%) and distant recurrences (n = 25/63, 40%). While many felt their medical and radiation oncologists were the most suited to provide follow-up care, 55% felt comfortable having their primary care provider (PCP) conduct surveillance. When presented with a scenario where follow-up has no effect on earlier detection or survival, 70% of patients still wanted routine in-person follow-up for reassurance (63%) with the goal of earlier recurrence detection (56%)., Conclusions: Despite limited evidence of effectiveness of routine in-person assessment, patients continue to place importance on regularly scheduled in-person follow-up., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study aims to assess the effectiveness of comprehensive licensure reviews and adaptive quizzing assignments on nursing students' clinical competence, self-efficacy, and work readiness-an under-researched topic. Additionally, it seeks to explore the mediating effect of self-efficacy in the relationship between students' clinical competence and work readiness. A quasi-experimental (pre- and post-test), single-group design was employed. The study was conducted in a public university in Saudi Arabia and included a total of 293 senior nursing students in their last year of the bachelor program. An intervention was developed based on the blueprints of the Saudi Nursing Licensing Exam and NCLEX-RN and consisted of a weekly 3-h synchronous comprehensive licensure review bundled with 23 adaptive quizzing assignments over 15 weeks. Data were collected prior to and after the intervention using three scales: clinical competence, self-efficacy, and work readiness. The mean scores of clinical competence, self-efficacy, and two subscales of work readiness (work competence and social intelligence) increased significantly post-intervention. Self-efficacy (β = 0.353, p  < 0.001) and clinical competence (β = 0.251, p  < 0.001) influenced work readiness ( F [5, 226] = 21.03, p  < 0.001) and accounted for 31.8% of the explained variability in work readiness. In the mediation analysis, clinical competence had a significant and indirect effect on work readiness through self-efficacy (B = 0.464, p  < 0.001, 95% CI 0.250 to 0.699). The proportion of mediation indicated that 37.2% of the total effect of clinical competence on work readiness was due to the indirect effect of self-efficacy. Comprehensive licensure review and adaptive quizzing assignments improve students' perceptions of clinical competence and self-efficacy. Such interventions could ease the transition of senior nursing students to clinical practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objectives: This study aimed to present the magnitude and determinants of awareness about refractive surgery among the adult Saudi population and recommend knowledge improvement., Methods: This web-based cross-sectional study was conducted between June 2020 and May 2021 across various regions of Saudi Arabia on the adult Saudi population. A total of 11 close-ended questions regarding indication, contraindication, preparation and surgery procedures were asked. The awareness scores were grouped as 'good' (≥6) or 'poor' (≤5). Demographic and ocular parameters were associated with the outcomes., Results: Of the 6,746 participants, 6,580 (response rate = 97.5%) completed the survey. The participation of younger women and older men was greater than their proportions in the population, while older women participated less than their proportion. Good awareness about refractive surgery was noted in 1,165 (17.7%; 95% confidence interval: 16.2-18.0) participants. Women ( P <0.001), the 18-29 age group ( P <0.001), residents of the central region of Saudi Arabia ( P <0.001), health professionals ( P <0.001), health sector students ( P = 0.0004), people with myopia ( P <0.001) and history of refractive surgery ( P <0.001) were associated with good awareness. Women (adjusted odds ratio [AOR] = 1.5; P <0.001), health sector students (AOR = 1.57; P <0.001), and residents in the central region (AOR = 1.27; P <0.001) were independent predictors of awareness. Knowledge about contraindications for surgery was good in more than one-third of the participants. Of the 535 participants who underwent surgery in the past, 452 (84.5%) were satisfied with their outcomes., Conclusion: Awareness of refractive surgeries is low in the adult Saudi population. Targeted counseling is recommended to improve the knowledge and acceptance of refractive surgery., Competing Interests: CONFLICT OF INTEREST: The authors have no conflict of interest to declare., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Antagonistic bacterial interactions often rely on antimicrobial bacteriocins, which attack only a narrow range of target bacteria. However, antimicrobials with broader activity may be advantageous. Here we identify an antimicrobial called epifadin, which is produced by nasal Staphylococcus epidermidis IVK83. It has an unprecedented architecture consisting of a non-ribosomally synthesized peptide, a polyketide component and a terminal modified amino acid moiety. Epifadin combines a wide antimicrobial target spectrum with a short life span of only a few hours. It is highly unstable under in vivo-like conditions, potentially as a means to limit collateral damage of bacterial mutualists. However, Staphylococcus aureus is eliminated by epifadin-producing S. epidermidis during co-cultivation in vitro and in vivo, indicating that epifadin-producing commensals could help prevent nasal S. aureus carriage. These insights into a microbiome-derived, previously unknown antimicrobial compound class suggest that limiting the half-life of an antimicrobial may help to balance its beneficial and detrimental activities., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)