Publications by authors named "Ahmed Alzahrani"

34 Publications

Efficacy of Arabic Coffee and Black Tea in Reducing Halitosis: A Randomized, Double-Blind, Controlled, Crossover Clinical Trial.

Healthcare (Basel) 2021 Mar 1;9(3). Epub 2021 Mar 1.

Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia.

The aim of the study was to objectively evaluate the short-term effect of Arabic coffee and black tea on oral halitosis. This study was a single-center, randomized, double-blind, placebo-controlled, crossover clinical trial on 17 healthy individuals. During the initial visit, pre-treatment breath samples were collected from each subject and analyzed using portable gas chromatography (OralChroma™). Four interventions were evaluated, with Arabic coffee and black tea as the test intervention tools, mouthwash containing a solution (0.05% chlorhexidine, 0.05% cetylpyridinium chloride, and 0.14% zinc lactate (CHX-CPC-Zn)) as a positive control, and drinking water as a negative control. Halitosis was induced by rinsing with 10 mL solution of L-cysteine for 30 s. Twenty minutes later, a breath sample was taken to record the baseline volatile sulfur compounds (VSC) levels (T0). Then, the participants were asked to rinse with 10 mL of a randomly-assigned solution for 30 s. Sixty minutes later, another breath sample was recorded (T1). Finally, after 120 min, the final breath sample was recorded (T2). It was found that rinsing with Arabic coffee decreased the level of HS both in the first hour (T1) and the second hour (T2). The reduction was significantly greater at T1 ( = 0.017). There was a similar result after the volunteers rinsed with black tea. At T2, Arabic coffee showed a substantially greater reduction in HS ( < 0.001). On the contrary, using CHX-CPC-Zn showed a significant and continuous decrease in HS values in the breath throughout the experiment ( < 0.001). Water showed no significant impact on the level of VSC ( = 0.71). This study demonstrates that black tea and Arabic coffee had inhibitory effects on halitosis that was greater in the first hour and was not sustained over a long period. Additionally, Arabic coffee had a greater inhibitory effect on halitosis than black tea.
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http://dx.doi.org/10.3390/healthcare9030250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000802PMC
March 2021

Five-year resistance trends in pathogens causing healthcare-associated infections at a multi-hospital healthcare system in Saudi Arabia, 2015-2019.

J Glob Antimicrob Resist 2021 Mar 21;25:142-150. Epub 2021 Mar 21.

Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Objectives: Awareness of antimicrobial resistance (AMR) patterns in a given healthcare setting is important to inform the selection of appropriate antimicrobial therapy to reduce the further rise and spread of AMR as well as the rate of healthcare-associated infections (HAIs) and multidrug-resistant (MDR) organisms. We aimed to describe resistance patterns to several antimicrobial agents in pathogens causing HAIs isolated from patients using data gathered at three private tertiary-care hospitals in Saudi Arabia.

Methods: Data on trends in AMR among bacteria causing HAIs and MDR events in children and adults at three private hospitals were collected retrospectively (2015-2019) using surveillance data.

Results: Over the 5-year period, 29 393 pathogens caused 17 539 HAIs in 15 259 patients. Approximately 57.3% of patients were female and the mean age was 38.4 ± 16.8 years (81.4% adults, 18.6% children). Gram-negative pathogens were four times more likely to cause HAIs compared with Gram-positive bacteria (79.3% vs. 20.7%). Ranking of causative pathogens in decreasing order was Escherichia coli (42.2%), Klebsiella spp. (16.8%) and Staphylococcus aureus (13.9%). Acinetobacter spp. were the only pathogens to decrease significantly (7% reduction; P = 0.033). The most common resistant pathogens were extended-spectrum cephalosporin-resistant E. coli (37.1%), extended-spectrum cephalosporin-resistant Klebsiella (27.8%), carbapenem-non-susceptible Acinetobacter spp. (19.5%), carbapenem-non-susceptible Pseudomonas aeruginosa (19.2%) and methicillin-resistant S. aureus (18.6%).

Conclusion: National collaboration is required by prompt feedback to local authorities to tackle regional differences in AMR. This can help plan timely containment interventions to stop and contain microbial threats and swiftly assess their impact.
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http://dx.doi.org/10.1016/j.jgar.2021.03.009DOI Listing
March 2021

Fractures of C2 (Axis) Vertebra: Clinical Presentation and Management.

Int J Spine Surg 2020 Dec 29;14(6):908-915. Epub 2020 Dec 29.

Department of Neurosurgery, Mansoura Faculty of Medicine, Mansoura University, Egypt, and Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia.

Background: Injuries of the upper cervical spine are a major cause of morbidity and mortality due to associated spinal cord and head injuries. The injury patterns of the upper cervical spine are numerous, and the neurologic sequelae are diverse. The axis (C2) is the most commonly fractured vertebra in the upper cervical spine; its unique anatomy and architecture pose difficulties in the diagnosis and the management of its fractures.

Methods: All cases of acute spinal injuries at Prince Mohammed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia, were screened for fractures of C2 vertebrae. These patients underwent computerized tomography (CT) imaging of the cervical spine with special attention paid to the cranio-cervical junction. Magnetic resonance imaging (MRI) and angiography of the neck were performed to exclude ligamentous tears and vascular injuries. Unstable fractures were fixed surgically. In the remaining cases, a conservative trial was given. All patients were followed up once every 3 months for a period of 1 year. During follow-up, some patients underwent additional CT imaging of the cervical spine to monitor the healing of fractures.

Results: Out of 230 spinal trauma patients, 43.5% suffered from cervical spine injury. C2 fractures were recorded in 26% cases, and fractures of the C2 vertebral body, including pedicles, laminae, lateral masses, and articular processes, were found in many cases, followed by odontoid fractures (50%). No case of atlanto-axial or atlanto-occipital dislocation was recorded. Road traffic accidents were found to be responsible for 92% of cases. The majority of patients were young males, and 96% of patients had no neurological deficit. Only 15% of the patients required surgery for their unstable fractures. Half of the patients attended outpatient follow -up appointments, all of whom underwent CT scanning of the cervical spine 9 months after the accident or operation.

Conclusions: The axis (C2) is the most commonly affected vertebra in cervical spine trauma, and odontoid fractures make up 50% of all C2 fractures. C2 fractures rarely cause any neurological deficit or vascular injury, and the majority of affected patients can be managed conservatively; only a small proportion requires surgical intervention. Surgical intervention leads to early and complete healing.
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http://dx.doi.org/10.14444/7139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872410PMC
December 2020

Post-Infectious Glomerulonephritis With Crescents in an Elderly Diabetic Patient: Good Prognosis.

Cureus 2020 Nov 11;12(11):e11440. Epub 2020 Nov 11.

Pathology, King Abdullah International Medical Research Centre, National Guard Health Affairs, Jeddah, SAU.

Post-infectious glomerulonephritis (PIGN) is an injury to glomerules mediated by the immune response after infection, and it is commonly seen in children. However, the elderly with immunocompromised conditions are at higher risk of developing PIGN after a recent infection. A 74-year-old female presented to the ER with a history of severe, sharp, on and off left flank pain for two days. Initial laboratory results workup were suggestive of acute kidney injury with no obvious reason. Dialysis was required as the renal function was deteriorating. Serologic test was negative for ANA (anti-neutrophil antibodies), C-ANCA (anti-neutrophil cytoplasmic antibodies), and P-ANCA (perinuclear anti-neutrophil cytoplasmic antibodies). C3 level was low, and anti-streptolysin O titer was high. Renal biopsy was performed. With reference to the clinical and histological examination, she was diagnosed with PIGN and diabetic nephropathy. After six months, the renal function was improving gradually until hemodialysis was stopped, and the Permcath (Medtronic) was removed with a creatinine level of 120 µmol/L. The elderly diabetic female developed PIGN with crescents that required dialysis, and dialysis was stopped after six months with good prognosis. Since PIGN is a very rare entity, the suspicion of PIGN in the elderly with acute kidney injury should be raised after a history of upper respiratory tract or skin infection.
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http://dx.doi.org/10.7759/cureus.11440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732803PMC
November 2020

Synchronous Colon Adenocarcinoma With Right Inguinal Lymph Node Metastasis: A Case Report and Brief Literature Review.

Cureus 2020 Nov 16;12(11):e11501. Epub 2020 Nov 16.

General Surgery, King Abdulaziz Medical City, Jeddah, SAU.

Colon cancer is one of the common cancers and a major reason for cancer-related deaths with reported metastasis to the lungs and liver. Metastasis to inguinal lymph nodes from the adenocarcinoma of the colon is very rare and needs to be managed distinctly. We present a case of moderately differentiated adenocarcinoma of colon confirmed pathologically in an elderly male patient with locally extensive malignancy with involvement of the right-sided inguinal lymph nodes.
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http://dx.doi.org/10.7759/cureus.11501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671169PMC
November 2020

Giant hydronephrosis management in the Era of minimally invasive surgery: A case series.

Int J Surg Case Rep 2020 23;75:513-516. Epub 2020 Sep 23.

Prince Sultan Military Medical City, Urology Department, Riyadh, Saudi Arabia. Electronic address:

Introduction: Giant hydronephrosis (GH) is a rare urological entity, described as more than 1 L of fluid contained in the renal collecting system. Ureteropelvic junction obstruction (UPJO) is the most common cause. GH if not discovered and managed early can result in long term complications. We present our experience in the late presentation of adult Giant hydornephrosis.

Presentation Of Cases: We reviewed all the cases of patients with giant hydronephrosis who presented to our institute from December 2017-December 2019 at our institute. Pre-operative renal ultrasound, computed tomography with contrast and MAG-3 were performed on all patients to establish their diagnoses. The patients' demographic data, clinical presentation, preparatory investigations, indications for intervention, type of intervention, pre- and post-operative complications and durations of hospital stay were reported. Laparoscopic transperitoneal nephrectomy was completed in three cases without open conversion. One case proceeded to open conversion owing to a lack of space and severe adhesions. The mean operating time was 79.7 min (range: 65-95 min), estimated blood loss was 75 mL and the mean hospital stay was 4 days (range: 2-6 days).

Discussion: The first case of GH was described in 1746. Since then, few cases have been described in the literature. A radiological definition, is the occupation of the hemi-abdomen by the kidney with a midline cross which is the height of five vertebral bodies. GH may be congenital or acquired. The most common presentation of GH is abdominal distention followed by fever and flank pain.

Conclusion: When nephrectomy is indicated in giant hydronephrosis, the laparoscopic trans-peritoneal approach is feasible. Pre-operative decompression using a nephrostomy tube and suspension stitch use facilitate the surgery.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530226PMC
September 2020

A cross-sectional survey to evaluate acquaintance about dental photography among dental students in daily clinical practice.

J Public Health Res 2020 Jul 10;9(3):1866. Epub 2020 Sep 10.

Department of Prosthetic Dentistry.

In today's world of digital dentistry, dental photography plays an important role as multilevel significance and represents the synonym of contemporary dentistry. Thus, we aimed at evaluating the acquaintance of practice, opportunity and morals of dental photography in everyday practice among undergraduate dental students. The current research was an observational cross-sectional study. Total 233 students participated; each was given questionnaire consisted of three parts covering the following aspects: questions 1 to 3 on the practice of dental photography, questions 4 to 7 on morals in dental photography and question 8 to 11 on opportunities of dental photography. The answers were tabulated and statistically analysed and association with the factors were tested for significance using Chi-square tests, and P<0.05 was considered statistically significant. The total response rate was 86%. Among the 201 respondents, 100 were males and 101 females; 96% male students were taking photographs and 93% females were taking photographs, on regular basis. Phone cameras (41.3%) were the most commonly used device followed by DSLR cameras. Surveyed students mentioned patient education (53.2%) as most needed requirement for taking photographs, followed by treatment planning (49.8%) and monitoring of the treatment outcome (34.3%). Ninety-one percent of students feel that there is an opportunity for advancement in dental photography techniques. The participants aware of dental photography, but they require detail insight on proper capturing of photographs and morals, with regards to confidentiality of the patient and patient consent.
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http://dx.doi.org/10.4081/jphr.2020.1866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499099PMC
July 2020

Renal Leiomyoma: Case Report and Literature Review.

J Endourol Case Rep 2019 2;5(4):181-183. Epub 2019 Dec 2.

Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

Renal leiomyomas are rare benign tumors of the kidney originating from muscle cells. They are usually found by an autopsy, whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, and palpable mass). Today the widespread use of ultrasonography and CT has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histologic examination. Radiologic examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behavior and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 78-year-old man who presented with hematuria and flank pain. We also review the literature and provide a summary of clinical, radiologic, and histologic features of renal leiomyomas.
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http://dx.doi.org/10.1089/cren.2019.0049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383428PMC
December 2019

Levels of Practice and Determinants of Diabetes Self-Care in Primary Health Care in Jeddah City, Saudi Arabia.

Cureus 2020 Jun 25;12(6):e8816. Epub 2020 Jun 25.

Epidemiology and Public Health, Ministry of Health, Saudi Board of Preventive Medicine, Mecca, SAU.

Objective To assess the level and determinants of practice in diabetes self-management at primary health care centers (PHCCs) and to analyze the association of self-management with the level of glycemic control. Method A cross-sectional study was conducted among patients with type 1 and type 2 diabetes, aged ≥ 17 years, and being followed at PHCCs in Jeddah, Saudi Arabia, from December 1, 2019, to December 30, 2019. A multistage cluster sampling technique was used to select 350 participants from five PHCCs. The level of practice in self-management was assessed using the Arabic version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The tool was administered as a face-to-face interview, followed by the collection of sociodemographic and relevant clinical data. In addition, blood was collected to measure fasting blood glucose (FBG) and HbA1c levels. The association of the overall SDSCA score with diabetes control was analyzed using linear regression and the receiver operator characteristics (ROC) curve. Multivariate binary logistic regression was carried out to analyze independent factors of inadequate practice. Result The overall mean (SD) SDSCA score was 3.13 (1.13)/7. Of the five dimensions of self-care, medication adherence yielded the highest score (mean=5.39 days per week), followed by diet (2.83) and blood glucose monitoring (2.78), while footcare had the lowest level of practice (2.26). The SDSCA score showed a negative correlation with the level of HbA1c, with a correlation coefficient r-squared =0.530 and regression coefficient B=-0.648 (p <0.001). ROC curve analysis showed that optimal glycemic control was associated with SDSCA score cutoff ≥3.5 with 82.0% sensitivity and 77.0% specificity, and the model showed that 38.0% of participants had adequate practice in self-management. Inadequate practice in diabetes self-management was independently associated with age >50 years (OR=2.00 [95%CI=1.02, 3.89]), rental accommodation (OR=0.42 [95%CI=0.23, 0.76]), independent job (OR=3.98 [95%CI=1.66, 9.57]), and longer duration of diabetes (≥8 years) (OR=4.25 [95%CI=1.82, 9.92]). Conclusion There are low levels of diabetes self-management among patients being followed at Jeddah PHCCs. This is associated with suboptimal glycemic control among the majority of the patients, indicating the importance of self-management to improve diabetes control. Patient health literacy and education for self-management should be considered the standard of care for diabetic patients in all PHCCs, with specific attention to subcategories of patients with the lowest levels of practice in self-management such as those with a longer duration of diabetes and the elderly.
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http://dx.doi.org/10.7759/cureus.8816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384715PMC
June 2020

Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations.

Int J Med Inform 2020 09 15;141:104232. Epub 2020 Jul 15.

Centre for Arts, Memory and Communities, Coventry University, Coventry, UK.

Background: Despite attempts to reform the healthcare delivery system in the Middle East, expectations for its progress have been-and for some still are-somewhat slow.

Objective: This study reviewed progress in the use and adoption of telemedicine in Middle Eastern countries. The key dimensions affecting the progress of telemedicine in these countries were identified.

Method: A systematic review of the literature was conducted on 43 peer reviewed articles from 2010 to 2020. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of identification, selection, assessment, synthesis, and interpretation of findings.

Results: The results showed that progress made in the utilization of telemedicine was insufficient and varies across Middle Eastern countries. Certain cultural, financial, organizational, individual, technological, legal, and regulatory challenges were found to prevent telemedicine from being fully used to the point where the full range of medical services can be provided. For example, doctor and patient resistance, poor infrastructure, lack of funding, poor system quality, and lack of information technology training were associated with the low adoption of telemedicine in the region.

Conclusion: This review provides a number of recommendations that will help policymakers to move toward the integration of innovative technologies in order to facilitate access to health information, health services, and training. It also recommends that health initiatives should focus on health education and health promotion in order to increase public awareness of the benefits of telemedicine services in the region.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104232DOI Listing
September 2020

Survival benefit of surgical resection after first-line triplet chemotherapy and bevacizumab in patients with initially unresectable metastatic colorectal cancer.

World J Surg Oncol 2020 Jul 8;18(1):163. Epub 2020 Jul 8.

Medical Oncology Section, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11211, Saudi Arabia.

Background: Surgical resection of metastatic disease in patients with initially non-resectable colorectal cancer (CRC) has improved overall survival. Intensified chemotherapy regimens have increased the probability of converting unresectable metastasis to resectable. Here, we report the result of combining intensive chemotherapy (triplet) and surgical resection of metastatic lesions in patients with metastatic CRC.

Patients And Methods: Patients with unresectable metastatic CRC were enrolled in phase I/II trial of triplet chemotherapy consisting of capecitabine, oxaliplatin, irinotecan, and bevacizumab. Patients were given 5-8 cycles induction chemotherapy of the above regimen followed by maintenance capecitabine and bevacizumab until disease progression, unacceptable toxicity, or patient request. All patients were assessed at a multidisciplinary conference for possible surgical resection of their metastatic disease at the time of inclusion in the trial and 2 monthly intervals thereafter. Patients who underwent R0 resection of their metastatic disease received adjuvant oxaliplatin and capecitabine to complete a total of 6 months of chemotherapy.

Results: Fifty-three patients were enrolled. The median age was 52 years (range 23-74), 29 (55%) were males, ECOG PS 0-1 was 13 (66%), 11 (42%) had a right-sided tumor, 29 (55%) had resection of their primary tumor, 22 (42%) had a single metastatic site, and 8 (15.1%) had a liver-limited disease. Thirteen patients (24.5%) underwent surgical resection of residual metastatic disease +/- the primary tumor with 10 (18.9%) of them were R0. The surgical group had a higher incidence of males compared to the non-surgical group (69.3% vs 47.2%, p = 0.2), equal performance status, lower median number of metastatic sites (1 vs 2, p = 0.09), higher mutant Kras (53.8% vs 34.2%, p = 0.3), and higher response rate (84.6% vs 56.2%, p = 0.3). With a median follow-up duration of 89 months, the median PFS for the whole group was 16.1 months [95% confidence interval (CI) 9.1-20] and the median OS was 28.2 months (95% CI 22.5-53.3). The median PFS for the surgery group was 18.9 months (95% CI 12.6-not reached) compared to 9.6 months (95% CI 7.0-18.3) for the non-surgical group, log-rank p = 0.0165. The median OS for both groups was not reached (95% CI 53.3-not reached) and 23.2 months (95% CI 17.0-28.4) respectively, log-rank p = 0.0006. Five-year PFS and OS for the surgery group were 46.2% and 67.6% respectively.

Conclusions: Patients with unresectable metastatic CRC and fit for triplet chemotherapy should have the benefit of combining this intensified regimen and surgical resection of their metastatic disease if possible.

Trial Registration: Clinicaltrials.gov , NCT01311050 , registered March 6, 2011, retrospectively registered.
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http://dx.doi.org/10.1186/s12957-020-01930-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346377PMC
July 2020

The Adult Patient with a Fontan.

Cardiol Clin 2020 Aug;38(3):379-401

Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Zahrawi Street, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia. Electronic address:

The authors summarize the most important anatomic and physiologic substrates of Fontan circulation. Common anatomic substrates include hypoplastic left heart syndrome, tricuspid atresia, double inlet left ventricle, and unbalanced atrioventricular septal defects. After the Fontan operation exercise capacity is limited and the key hemodynamic drivers is limited preload due to a relatively fixed pulmonary vascular resistance. The authors provide contemporary data on survival, morbidity, and need for reintervention. Operative morality is now expected to be less than 1% and 30 year survival approximately 89%. The authors delineate potential therapeutic approaches for the potential late complications.
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http://dx.doi.org/10.1016/j.ccl.2020.05.002DOI Listing
August 2020

The interplay between mindfulness, depression, stress and academic performance in medical students: A Saudi perspective.

PLoS One 2020 3;15(4):e0231088. Epub 2020 Apr 3.

Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

There is a growing body of research that shows a significant association between mindfulness and mental health. However, studies on Saudi populations are still in their infancy. Mindfulness is a personal tendency to focus on the present time in a non-judgmental manner, including the interior and exterior experience of feelings and events. The first aim of this study is to examine the relationship between mindfulness, stress, depression, and academic performance in a sample of medical students from King Saud University. The second aim is to explore the potential moderation effects of mindfulness on the impact of stress on academic performance and depression in the study population. This cross-sectional study examined 289 medical students who were selected by a stratified random sampling technique and completed validated online questionnaires measuring mindfulness, stress, and depression. The data were analyzed using SAS version 9.2, and R software was used for graphs. Correlation analysis showed that mindfulness is inversely associated with depression and stress, but not with academic performance. Furthermore, multiple logistic regression showed that mindfulness can predict both depression and stress. We also found that two subscales of mindfulness can moderate the relation between stress and depression: non-judging of inner experience and describing. The findings suggest that a higher mindfulness score is associated with lower depression and stress levels and could buffer against depression in a stressful environment. There is a need for further research to investigate the relation of mindfulness with positive psychological outcomes, as well as experimental trials to examine the efficacy of mindfulness training on improving mental wellbeing in our community.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231088PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7122761PMC
July 2020

Assessment of Different Modalities and Their Impact on Patients with Ruptured Intracranial Arteriovenous Malformation Treated in King Abdulaiziz Medical City in Jeddah, Saudi Arabia.

Cureus 2020 Feb 12;12(2):e6969. Epub 2020 Feb 12.

Radiation Oncology, King Abdulaziz Medical City, Jeddah, SAU.

Background Intracranial arteriovenous malformation (AVM) is a rare congenital disease that is characterized by an abnormal tangle of blood vessels where arteries abnormally shunt into veins with no intervening capillary bed. Several treatment modalities, such as microsurgical removal, embolization, and stereotactic radiosurgery (SRS), are used to treat AVM either solely or in combination. We aimed to assess and compare the effect, morbidity, and mortality outcomes of mono-treatment with embolization and combined treatment for AVM obliteration. Methodology This retrospective cohort study was conducted in the National Guard Hospital Jeddah and reviewed all the AVM patients that visited the center between 2008 and 2017. We assessed presenting symptoms at diagnosis and any co-morbidities as the clinical characteristics and the patients' AVM and Spetzler-Martin grade as the morphological characteristics. Moreover, we performed a three-year follow-up on suitable patients and assessed their outcomes using the modified Rankin Scale. In addition, we performed follow-up imaging on the patients to evaluate AVM obliteration after any of the procedures. Results We included 29 patients treated in our hospital (72.4%, males; 27.6%, females; mean age 40 years). About 65% of the patients underwent mono-therapy consisting of one or more embolization sessions while about 34% underwent combined treatment (embolization + surgery or embolization + SRS). We found more cases of complete obliteration among patients who underwent mono-therapy (52.6%) than among those who underwent combined treatment (30%). Patients who underwent mono-therapy showed better outcomes compared to those who underwent combined therapy; however, the difference did not reach statistical significance. Conclusions Embolization mono-therapy appears to be more effective with regards to the obliteration rate and outcome compared to combined therapy with either SRS or surgery in patients treated in our center.
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http://dx.doi.org/10.7759/cureus.6969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067571PMC
February 2020

Efficacy and Prognostic Factors of Sunitinib as First-Line Therapy for Patients With Metastatic Renal Cell Carcinoma in an Arab Population.

JCO Glob Oncol 2020 02;6:19-26

Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Purpose: Antiangiogenic tyrosine kinase inhibitors have been the mainstay first-line therapy for metastatic renal cell carcinoma (mRCC). We reviewed the efficacy of first-line therapy with sunitinib in patients with mRCC in an Arab population.

Methods: Medical records of patients with mRCC treated at a tertiary care center in Saudi Arabia, during the period from 2007 to 2016, were reviewed. Demographic data, treatment received, response, and prognostic factors were analyzed.

Results: Fifty-five patients who received sunitinib were identified. The median age was 60 years (range, 18 to 78 years), and 42 of the 55 patients were men (76.3%). International Metastatic RCC Diagnostic Consortium prognostic scores for favorable/intermediate/poor were 14.5%/43.6%/38.2%, respectively. The median performance status was 1, and the median Charlson comorbidity index score was 9. Thirty-seven patients (67.2%) had cytoreductive nephrectomy. Thirty-seven patients (67.2%) had clear cell histology. Twenty-two patients (40%) underwent dose reduction. Twenty-seven patients (49%) received second-line therapy, and seven patients (12.7%) received third-line therapy. Response rates were complete response in one patient (1.8%), partial response in 17 (30.9%), stable disease in 10 (18.1), and disease progression in 20 (36.3%). Progression-free survival (PFS) and overall survival (OS) were 6.0 and 24.7 months, respectively. Univariate analysis showed statistically improved PFS for dose reduction ( = .015) and the development of hypothyroidism ( = .03). It also showed statistically improved OS for dose reduction ( = .035), hypothyroidism ( = .0002), and cytoreductive nephrectomy ( = .0052). Multivariate analysis showed statistically improved PFS for dose reduction ( = .01) and OS for development of hypothyroidism ( = .007).

Conclusion: Our data for sunitinib in mRCC show significantly lower PFS than expected. The absence of prognostic value of the International Metastatic RCC Diagnostic Consortium scoring system and pathologic subtype warrant further investigation and possible inclusion of genetic scoring in this ethnic group of patients.
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http://dx.doi.org/10.1200/JGO.19.00111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998020PMC
February 2020

The Significance of Sidedness in Patients with Metastatic Colorectal Cancer Treated with Triplet First-line Chemotherapy.

Asian Pac J Cancer Prev 2019 Oct 1;20(10):2891-2896. Epub 2019 Oct 1.

Research Unit, Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Background: Recent data have shown that right-sided colon cancer carries poorer prognosis compared to left-sided tumors. This study was aimed to evaluate the progression-free survival, overall survival of patients with metastatic colon cancer of right-sided versus left-sided primaries treated with triplet chemotherapy regimen.

Methods: The medical records of patients with metastatic colorectal cancer treated on phase I-II trial of combination Irinotecan, oxaliplatin, capecitabine, and bevacizumab were reviewed for sidedness of the primary. The analysis was performed for progression-free survival and overall survival according to the sidedness and other known prognostic factors.

Results: Out of 53 patients treated with triplet therapy, 11 had right sided and 42 had left-sided primaries. The median age for right-sided primaries was 46 (range 24-55) compared to 53 (range 32-74) in left-sided primaries. Median progression-free survival was 14 months for right vs 18 months for left sided tumors (Hazard ratio 0.72, 95% confidence interval 0.27-1.88, p=0.492) and median overall survival was 21 months for right vs 29 months for left sided tumors (Hazard ratio was 0.86, 95% CI 0.32-2.26, p=0.752).

Conclusion: First-line triplet chemotherapy may overcome the difference in prognosis between right sided and left sided primaries in metastatic colorectal cancer. A larger analysis is warranted.
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http://dx.doi.org/10.31557/APJCP.2019.20.10.2891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982651PMC
October 2019

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia.

Int J Infect Dis 2019 Nov 2;88:21-26. Epub 2019 Aug 2.

Aix Marseille Université, MEPHI, IHU-Méditerranée Infection, Marseille, France; IHU-Méditerranée Infection, Marseille, France.

Background: Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE.

Methods: We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed.

Results: Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified.

Conclusion: This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever.

Key Points: We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.
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http://dx.doi.org/10.1016/j.ijid.2019.07.035DOI Listing
November 2019

Hand hygiene knowledge and attitude of medical students in western Saudi Arabia.

PeerJ 2019 25;7:e6823. Epub 2019 Apr 25.

Sixth-year Medical Students, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.

Background: The practice of hand hygiene (HH) has prime importance among Health Care Professionals (HCPs) and non-compliance could cause adverse consequences. By keeping the importance of HH in mind, this study aims at investigating the knowledge and attitudes towards HH among medical students and interns at King Abdulaziz University (KAU), Jeddah, Saudi Arabia (SA).

Methods: The study includes 453 medical students and interns (189 males & 264 females). This study was completed in three months; from September to November 2017. The World Health Organization (WHO) HH questionnaire was used and data were analyzed on SPSS-21.

Results: Two-third of the participants 292 (64.2%) had formal training in HH in the last three years. Almost half of the participants 254 (56.1%) had correct knowledge regarding the major course of transmission of potentially detrimental microbes among patients in the healthcare premises. Just 124 (27.4%) of the respondents had the correct knowledge about the most common basis of germs accountable for healthcare-related infections. Females had significantly better knowledge than males regarding the type of HH technique needed before palpation of the abdomen (177(54%) Vs. 151(46%);  < 0.002), before an injection (175(54.5%) Vs. 146(45.5%);  < 0.007), after emptying a bedpan (207(64.7%) Vs. 113(35.3%);  < 0.001), following discarding examination gloves (256(60.4% Vs. 168(39.6%);  < 0.001] and after exposure to blood (200(64.1%) Vs. 112(35.%);  < 0.001). Female participants had better knowledge than males regarding the type of HH actions. Females also had a significantly better attitude towards the importance of HH than males (240(62.5%) Vs. 144(37.5%);  < 0.001).

Conclusion: The majority of the participants' knowledge regarding HH was not up to the mark; however, female students had better knowledge compared to male students. The medical students and interns' knowledge and positive attitude towards HH can play a pivotal role in preventing HCPs associated infections and it would overall decrease the infection-related burden on the hospital and governmental budgets. It is suggested that multi-dimensional plans are required to change this low compliance to a higher rate.
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http://dx.doi.org/10.7717/peerj.6823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487179PMC
April 2019

Smarter Traffic Prediction Using Big Data, In-Memory Computing, Deep Learning and GPUs.

Sensors (Basel) 2019 May 13;19(9). Epub 2019 May 13.

Faculty of Computing and Information Technology, Northern Border University, Rafha 91911, Kingdom of Saudi Arabia.

Road transportation is the backbone of modern economies, albeit it annually costs 1.25 million deaths and trillions of dollars to the global economy, and damages public health and the environment. Deep learning is among the leading-edge methods used for transportation-related predictions, however, the existing works are in their infancy, and fall short in multiple respects, including the use of datasets with limited sizes and scopes, and insufficient depth of the deep learning studies. This paper provides a novel and comprehensive approach toward large-scale, faster, and real-time traffic prediction by bringing four complementary cutting-edge technologies together: big data, deep learning, in-memory computing, and Graphics Processing Units (GPUs). We trained deep networks using over 11 years of data provided by the California Department of Transportation (Caltrans), the largest dataset that has been used in deep learning studies. Several combinations of the input attributes of the data along with various network configurations of the deep learning models were investigated for training and prediction purposes. The use of the pre-trained model for real-time prediction was explored. The paper contributes novel deep learning models, algorithms, implementation, analytics methodology, and software tool for smart cities, big data, high performance computing, and their convergence.
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http://dx.doi.org/10.3390/s19092206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539338PMC
May 2019

An Enhanced Source Location Privacy based on Data Dissemination in Wireless Sensor Networks (DeLP).

Sensors (Basel) 2019 May 2;19(9). Epub 2019 May 2.

Department of Computer Science, Community College, King Saud University, Riyadh 11437, Saudi Arabia.

Wireless Sensor Network is a network of large number of nodes with limited power and computational capabilities. It has the potential of event monitoring in unattended locations where there is a chance of unauthorized access. The work that is presented here identifies and addresses the problem of eavesdropping in the exposed environment of the sensor network, which makes it easy for the adversary to trace the packets to find the originator source node, hence compromising the contextual privacy. Our scheme provides an enhanced three-level security system for source location privacy. The base station is at the center of square grid of four quadrants and it is surrounded by a ring of flooding nodes, which act as a first step in confusing the adversary. The fake node is deployed in the opposite quadrant of actual source and start reporting base station. The selection of phantom node using our algorithm in another quadrant provides the third level of confusion. The results show that Dissemination in Wireless Sensor Networks (DeLP) has reduced the energy utilization by 50% percent, increased the safety period by 26%, while providing a six times more packet delivery ratio along with a further 15% decrease in the packet delivery delay as compared to the tree-based scheme. It also provides 334% more safety period than the phantom routing, while it lags behind in other parameters due to the simplicity of phantom scheme. This work illustrates the privacy protection of the source node and the designed procedure may be useful in designing more robust algorithms for location privacy.
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http://dx.doi.org/10.3390/s19092050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539162PMC
May 2019

Efficacy of Regorafenib in Metastatic Colorectal Cancer: A Multi-institutional Retrospective Study.

Clin Med Insights Oncol 2019 30;13:1179554918825447. Epub 2019 Jan 30.

Medical Oncology Section, The Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Background: Regorafenib is a multi-kinase inhibitor approved for treatment of refractory advanced colorectal cancer. It was found in the clinical trials to have a modest benefit and significant toxicity. Our aim was to assess the outcome in our local clinic practice.

Patients And Methods: Records of patients with confirmed colorectal cancer treated with regorafenib were reviewed. Clinical, pathological, and molecular data were collected. Efficacy and factors of possible prognostic significance were analyzed.

Results: A total of 78 patients with metastatic colorectal cancer were treated with regorafenib from February 2014 to February 2016 in 4 different institutions (median age: 50.5 years; male: 40 [51.3%]; KRAS mutant: 41 [52%]; right colonic primary: 18 [23%]). A total of 52 patients (66.7%) had Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 1, whereas in 25 patients (32.1%) it was >1. In total, 58 patients (74%) had dose reduction. No patient achieved objective response, 15 patients (19%) achieved stable disease, and 56 patients (72%) had progressive disease. With a median follow-up of 6.5 months, the median progression-free survival was 2.8 months (95% confidence interval [CI], 2.5-3.3) and overall survival was 8.0 months (95% CI, 6.2-9.7). Only performance status of ⩽1 had a statistically significant impact on progression-free survival and overall survival in both univariate and multivariate analyses.

Conclusions: Regorafenib in our clinical practice has equal efficacy to reported data from pivotal registration trials. Our data suggest that performance status is the most important prognostic factor in patients treated with regorafenib, suggesting a careful selection of patients.
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http://dx.doi.org/10.1177/1179554918825447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354297PMC
January 2019

Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer.

J Gastrointest Cancer 2018 Jul 14. Epub 2018 Jul 14.

Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.

Purpose: Assess feasibility-rate of PCR, short-term toxicity after neoadjuvant concurrent chemoradiation (NACRT) delivered via simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique for locally advanced rectal cancer.

Methods: Retrospective evaluation of patients with locally advanced rectal cancer treated with VMAT-SIB technique preoperatively at an academic tertiary care center in Riyadh, Saudi Arabia between February 2013 and March 2017.

Results: One hundred patients with depth of invasion staged as T3/T4 or T2 in 93 and seven patients, respectively. Lymph node metastasis was staged as N1/N2 or N0 in 87 and 13 patients, respectively. Circumferential radial margin (CRM) was involved radiologically prior to treatment in 50 patients. A dose of 55 or 50 Gy was given to 71 and 29 patients, respectively. All treatments were completed without interruption. Grade 3/4 toxicity was not observed. Low anterior resection and abdominoperineal resection were performed with negative proximal, distal, and radial margins in 72 and 28 patients, respectively. There were no immediate significant postoperative complications. Histologically, no residual tumor (grade 0) was noted in 20 patients (pCR). Regression grade 1, 2, and 3 were noted in 31, 34, and 15 patients. Average number of lymph nodes retrieved in the surgical specimen was 12 (range 6-22). Lymph nodes were negative for cancer in 80 patients.

Conclusion: Dose escalation with SIB-VMAT as NACRT for rectal cancer is feasible. Moreover, it can increase the rate of pathological complete response with a favorable toxicity profile. Clinical benefit of this approach needs to be validated in a larger cohort of patients with longer follow-up.
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http://dx.doi.org/10.1007/s12029-018-0133-0DOI Listing
July 2018

Self-medication with Antibiotics in a primary care setting in King Khalid University Hospital, Riyadh, Saudi Arabia.

J Family Community Med 2018 May-Aug;25(2):95-101

Department of Family and Community Medicine, Prince Sultan Military Medical Center, Riyadh, Saudi Arabia.

Objectives: The objectives of this study are to estimate the prevalence of self-medication with antibiotics in King Khalid University Hospital population and evaluate the factors affecting this behavior.

Materials And Methods: This was a cross-sectional study conducted at King Khalid university hospital from April to May 2016. A pretested self-administered questionnaire was handed to a random selection of 519 patients attending the primary care clinics . Data were entered into Microsoft Office Excel 2007 and sent to SPSS version 20 for analysis. Descriptive statistics and logistic regression were applied.

Results: The prevalence rate of self-medication with antibiotics was 40.8%. Older patients and males were most likely to use antibiotics without a prescription. The most common illnesses that made patients use antibiotics was upper respiratory tract infections (73.2%). Commercial pharmacies were the major source 82.8%. Only 27.8% patients consulted their physicians for the correct dosage . The previous experience with a similar illness (67.2%) and difficulty in obtaining medical help (29.3%) were the most common reasons for self-administration of antibiotics. Improved health condition (57.8%) was the main reason for stopping the use of antibiotics while lack of improvement in health status led to a shift to another antibiotic in 62.5% of the respondents.

Conclusion: The prevalence of using antibiotics without a prescription is relatively high. Proper education of the public on the dangers of the misuse of antibiotics through the media might help to reduce this practice.
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http://dx.doi.org/10.4103/jfcm.JFCM_124_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958530PMC
June 2018

Gingival Crevicular Fluid Release Profile of Vascular Endothelial Cell Growth Factor and Platelet-Derived Growth Factors-BB Following Minimally Invasive Flap Reflection during Treatment of Intrabony Defects: A Randomized Clinical Trial.

J Int Acad Periodontol 2017 Dec 24;20(1):3-11. Epub 2017 Dec 24.

Division of Periodontics, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia.

Objectives: As a primary objective, we examined the gingival crevicular fluid (GCF) levels of the endogenously released platelet-derived growth factor (PDGF-BB) and vascular endothelial growth factor (VEGF) following the use of minimally invasive surgical flap reflection (MIS) and compared them with those in traditional open flap debridement (OFD). The secondary objective was to determine if any correlation exists between the expression of growth factors (GF), indicated by their levels, and associated clinical outcomes.

Materials And Methods: Twenty-eight non-smoking individuals with severe chronic periodontitis were recruited in this prospective, randomized and single-blinded trial. Each person presented one interproximal defect that was randomly assigned to either the experimental MIS group (14 sites) or the open flap debridement (OFD) control group (14 sites). Plaque index, gingival index, probing depth (PD), clinical attachment level (CAL) and the intra-bony depth of the defect (IBD) were measured at baseline for the patient's enrollment. Gingival crevicular fluid (GCF) samples were collected on days 1, 3, 7, 14, 21 and 30 after therapy. Clinical follow-ups were scheduled at 6 and 9 months following the therapy.

Results: In both groups, the highest levels of VEGF and PDGF-BB concentrations were found in the GCF during the period from 1 to 14 days. During the early stages of healing (1, 3, 7 and 14 days), the mean VEGF and PDGF-BB levels at sites treated with MIS were significantly higher than those at the OFD-treated sites. Growth factor levels decreased sharply in the samples obtained at days 21 and 30 in both groups, with non-significant differences between the patient and control groups. MIS-treated sites reported significantly more PD reduction and attachment gain 9 months following therapy. No significant difference in intrabony defect reduction was reported between the patient and control groups.

Conclusions: Within the limits of the present study, we can surmise that MIS treatment of periodontal defects is associated with initially higher GCF levels of the studied growth factors. These increased GF levels are well correlated with the improved soft-tissue parameters of the periodontal defects.
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December 2017

Photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review.

Photodermatol Photoimmunol Photomed 2018 May 22;34(3):167-174. Epub 2017 Dec 22.

Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.

Background: The aim of this systematic review was to assess the efficacy of photodynamic therapy (PDT) in the treatment of symptomatic oral lichen planus (OLP).

Methods: This systematic review aimed to address the following focused question: "Is PDT effective in the treatment of symptomatic OLP?" Indexed databases such as MEDLINE, EMBASE, and CENTRAL were searched up to and including August 2017.

Results: Six clinical studies were included. The risk of bias was considered high in 5 studies and moderate in one study. Parameters of PDT such as wavelengths, energy fluence, power density and exposure time ranged between 320-660 nm, 120 J/cm , 130 mW/cm , and 70-150 seconds, respectively. The follow-up period ranged from 4 to 48 weeks. All included studies reporting clinical scores showed that PDT was effective in the treatment of OLP in adult patients at follow-up. However, PDT did not show significant improvement when compared with steroid therapy.

Conclusion: Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with long follow-up period, standardized PDT parameters, and comparing the efficacy of PDT with steroid therapy are warranted to obtain strong conclusions in this regard.
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http://dx.doi.org/10.1111/phpp.12371DOI Listing
May 2018

Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study.

Saudi Dent J 2017 Oct 2;29(4):149-155. Epub 2017 Aug 2.

Department of Periodontics, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia.

Aim: The aim of this study was to evaluate clinically and radiographically, extraction socket healing using autologous platelet rich fibrin (PRF).

Materials And Methods: Twenty-four subjects needing single tooth simple extractions were selected. Twenty-four extraction sockets were divided into test group (PRF, n = 12) and control group (blood clot, n = 12). PRF was prepared with blood drawn from individuals after extraction using standard technique. PRF was placed in test group sockets followed by pressure application and figure 8 sutures. Sockets in control group were allowed to heal in the presence of blood clot and received a figure 8 suture. Ridge width was assessed using cast analysis with the help of acrylic stent and a pair of calipers. Radiographic analysis of socket surface area was performed using computer graphic software program. The clinical follow up assessments were performed at 1, 4 and 8 weeks. Collected data was assessed using ANOVA and multiple comparisons test.

Results: Subjects were aged between 25 and 50 (mean 37.8) years, including 15 females. The mean horizontal ridge width for sockets in the test group were 11.70 ± 2.37 mm, 11.33 ± 2.30 mm and 10.97 ± 2.33 mm at 1, 4 and 8 weeks respectively. Ridge width proportions were significantly higher among test group as compared to control group between baseline to 4 and 8 weeks respectively. The mean radiographic bone fill (RBF) percentage in the test group, was 74.05 ± 1.66%, 81.54 ± 3.33% and 88.81 ± 1.53% at 1, 4 and 8 weeks respectively. The mean RBF was significantly higher in the test group than control group at all time intervals.

Conclusion: The study outcomes demonstrate that the use of PRF accelerate socket wound healing after tooth extraction as noticed by increased bone fill and reduced alveolar bone width resorption using clinical and radiographic methods.
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http://dx.doi.org/10.1016/j.sdentj.2017.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634795PMC
October 2017

Dietary habits, lifestyle pattern and obesity among young Saudi university students.

J Pak Med Assoc 2017 Oct;67(10):1541-1546

6th Year Student, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.

Objective: To investigate dietary habits, lifestyle pattern and obesity in young university students.

Methods: This cross-sectional study was performed at the Rabigh campus of King Abdulaziz University, Jeddah, Saudi Arabia, from March to May 2016, and comprised healthy male students. A close-ended questionnaire was filled by all students about their dietary habits and lifestyle pattern and the lipid profile, blood glucose levels and body mass index was determined. The participants were selected by convenience sampling method. SPSS 21 was used for data analysis.

Results: Of the 116 participants, 34(29.3%) were obese, 34(29.3%) were overweight and 48(41.4%) had normal body mass index. Overall, 66(57%) participants were taking 3 to 4 fast food meals weekly and was also taking junk food at least once in a day. Also, 50(43%) participants were using soft/energy drink more than once per day. Besides, 82(70.7%) respondents were spending 3 to 4 hours daily in watching TV, using the Internet or PlayStation. Significant differences were observed for low-density lipoprotein and high-density lipoprotein cholesterol levels (p=0.02 and p=0.006, respectively) among overweight and obese subjects as compared to those having normal weight. The majority of the overweight and obese participants' had experienced shame or other uncomfortable feelings and had a negative impact on their activity (p<0.001).

Conclusions: Dietary habits and lifestyle of the majority of the participants were not up to the mark and the obesity prevalence was common.
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October 2017

RFID of next generation network for enhancing customer relationship management in healthcare industries.

Technol Health Care 2017 Oct;25(5):903-916

This paper aims to analyze possible next generation of networked radio frequency identification (NGN-RFID) system for customer relationship management (CRM) in healthcare industries. Customer relationship and its management techniques in a specific healthcare industry are considered in this development. The key objective of using NGN-RFID scheme is to enhance the handling of patients' data to improve the CRM efficiency in healthcare industries. The proposed NGN-RFID system is one of the valid points to improve the ability of CRM by analyzing different prior and current traditional approaches. The legacy of customer relationship management will be improved by using this modern NGN-RFID technology without affecting the novelty.
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http://dx.doi.org/10.3233/THC-170934DOI Listing
October 2017

To what extent should dental implant placement be adopted as a standard for diabetic patients?

Saudi Med J 2016 Nov;37(11):1179-1183

Division of Periodontology, Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. E-mail.

Diabetes mellitus (DM) is considered one of the major chronic diseases in the world. Long-term hyperglycemia considerably affects the body tissues, and consequently, can lead to morbidity and mortality. Moreover, many oral complications have been observed with DM but little consideration in relation to the placement of dental implants has been investigated. Dental research has analyzed the relation of dental implants and bone osseointegration in diabetic patients. Theoretically, an impaired immune system and delayed wound healing of these patients might decrease the success rate of implant placement; however, with noticeable advances in evidence-based dentistry and statistically significant results, successful implant treatment could be achieved significantly in well-controlled diabetic patients.
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http://dx.doi.org/10.15537/smj.2016.11.15512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303793PMC
November 2016

Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review.

Case Rep Surg 2015 22;2015:845613. Epub 2015 Dec 22.

Division of General Surgery, Department of Surgery, King Abdulaziz Medical City, P.O Box 22490, Riyadh 11426, Saudi Arabia.

Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.
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http://dx.doi.org/10.1155/2015/845613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700168PMC
January 2016