The COVID-19 scamdemic: A survey of phishing attacks and their countermeasures during COVID-19.

The COVID-19 pandemic coincided with an equally-threatening scamdemic: a global epidemic of scams and frauds. The unprecedented cybersecurity concerns emerged during the pandemic sparked a torrent of research to investigate cyber-attacks and to propose solutions and countermeasures. Within the scamdemic, phishing was by far the most frequent type of attack. This survey paper reviews, summarises, compares and critically discusses 54 scientific studies and many reports by governmental bodies, security firms and the grey literature that investigated phishing attacks during COVID-19, or that proposed countermeasures against them. Our analysis identifies the main characteristics of the attacks and the main scientific trends for defending against them, thus highlighting current scientific challenges and promising avenues for future research and experimentation.

Increasing the Efficiency of a Control System for Detecting the Type and Amount of Oil Product Passing through Pipelines Based on Gamma-Ray Attenuation, Time Domain Feature Extraction, and Artificial Neural Networks.

Instantaneously determining the type and amount of oil product passing through pipelines is one of the most critical operations in the oil, polymer and petrochemical industries. In this research, a detection system is proposed in order to monitor oil pipelines. The system uses a dual-energy gamma source of americium-241 and barium-133, a test pipe, and a NaI detector. This structure is implemented in the Monte Carlo N Particle (MCNP) code. It should be noted that the results of this simulation have been validated with a laboratory structure. In the test pipe, four oil products-ethylene glycol, crude oil, gasoil, and gasoline-were simulated two by two at various volume percentages. After receiving the signal from the detector, the feature extraction operation was started in order to provide suitable inputs for training the neural network. Four time characteristics-variance, fourth order moment, skewness, and kurtosis-were extracted from the received signal and used as the inputs of four Radial Basis Function (RBF) neural networks. The implemented neural networks were able to predict the volume ratio of each product with great accuracy. High accuracy, low cost in implementing the proposed system, and lower computational cost than previous detection methods are among the advantages of this research that increases its applicability in the oil industry. It is worth mentioning that although the presented system in this study is for monitoring of petroleum fluids, it can be easily used for other types of fluids such as polymeric fluids.

A Subset of Primary Polydipsia, "Dipsogneic Diabetes Insipidus", in Apparently Healthy People Due to Excessive Water Intake: Not Enough Light to Illuminate the Dark Tunnel.

Dipsogenic diabetes insipidus (DDI) is a subtype of primary polydipsia (PP), which occurs mostly in healthy people without psychiatric disease. In contrast, PP is characterized by a polyuria polydipsia syndrome (PPS) associated with psychiatric illness. However, the pathogenesis of DDI is not well established and remains unexplored. In order to diagnose DDI, the patient should exhibit excessive thirst as the main symptom, in addition to no history of psychiatric illness, polyuria with low urine osmolality, and intact urine concentrating ability. Treatment options for DDI remain scarce. On this front, there have been two published case reports with successful attempts at treating DDI patients. The noteworthy commonalities in these reports are that the patient was diagnosed with frequent excessive intake of water due to a belief that drinking excess water would have pathologic benefits. It could therefore be hypothesized that the increasing trend of excessive fluid intake in people who are health conscious could also contribute to DDI. Hence, this review provides an overview of the pathophysiology, diagnosis, and treatment, with a special emphasis on habitual polydipsia and DDI.

Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article.

BACKGROUND: Choanal Atresia is an obliteration by an atretic plate of the posterior choanae due to a failure of the bucconasal membrane to rupture. The insertion of stents post choanal atresia repair is familiar. Still, there are limited studies in the literature that specify the time to remove it, the best materials, and the effectiveness of each kind. OBJECTIVE: Our study aims to compare different types of choanal atresia stents and flaps and the outcome of different kinds of stents and flaps that use post-operatively. Also, to assess the risk of restenosis post-operatively with varying types of Stent and flaps. METHODS: A systematic review via databases for different types of stents and flaps used in choanal atresia, including 31 studies with precise technique, variety of stents, restenosis rates, and risk factors (unilaterality, the component of the atretic plate). And about 10 different approaches to flaps reconstruction were mentioned. RESULTS: According to the data, we observed a successful rate of choanal atresia repair by using the ordinary ETT post-operatively ranged from 28 to 94.2%, which could be explained due to many factors. Post-operative Instructions on care and suctioning provided a good impact. Other types of stents found in case series like steroid eluting stents, Nelaton catheters, Silastic stents, or modified ETT have a promising future during 26 to 39 weeks follow-up. Still, they need further studies with randomization and more data. Flaps with different approaches and techniques showed promising results and fewer complication rates with or without stents, also now have been used in practice providing suitable alternatives for stents. CONCLUSION: The original types of choanal atresia stents were shown to have a wide variety of results, while innovative materials of stents showed promising results, however, in relatively small case studies. Flaps were now used in practice giving other choices for stents with fewer complications, better healing, and new choana formation.

Effects of potassium and sodium fluoride in different concentrations on micro-shear bond strength and inhibition of demineralization.

The aim of this study was to investigate the effects of potassium fluoride (KF) and sodium fluoride (NaF) in different concentrations on micro-shear bond strength (µSBS) and their protective effects against acid. The enamel blocks were treated with several concentrations of KF and NaF. For µSBS, Clearfil SE Bond 2 was applied to the treated surface and resin composite was light-cured, then examined using a universal testing machine. For acid resistance test, the specimens were immersed in acidic solution (pH 4.5), then examined under 3D confocal laser scanning microscope (CLSM). In µSBS, KF at 1,000, 9,000, and 10,000 ppm did not show differences compared with the control, while other concentrations of KF and NaF led to decreased µSBS. Higher concentrations of NaF and KF showed higher resistance to the acid challenge. So, we concluded that various concentrations of KF and NaF solutions had specific effects on µSBS and acid resistance.

Phytochemical profile, antioxidant and cytotoxic potential of Parkinsonia aculeata L. growing in Saudi Arabia.

Parkinsonia aculeata L. growing in Saudi Arabia was investigated for its phytochemical profile, antioxidant, and cytotoxic properties. UPLC-ESI-MS/MS was employed as a powerful technique for the characterization of secondary metabolites from a hydroalcoholic extract, dichloromethane, and ethyl acetate fractions of P. aculeata L. aerial parts. Sixty-nine compounds (flavonoids, anthocyanins, phenolics and fatty acids) were detected and characterized; flavonoids were the abundant components in the analyzed samples. The dichloromethane fraction was rich in phenolics as vanillic acid hexoside, flavonols as 3,7-dimthylquercetin, and flavones as 3'-hydroxymelanettin. However, the ethyl acetate fraction was rich in flavonoid-C-glycosides as luteolin-8-C-ß-D-glucoside (orientin) and apigenin-8-C-glucoside (vitexin), flavonoid- O, C-diglycosides such as luteolin 7-O-[6''-dihydrogalloyl]-glucosyl-8-C-pentosyl-(1 → 2)-glucoside and 2''-O-rhamnosyl isoorientin. These compounds were identified for the first time in dichloromethane and ethyl acetate fractions of Saudi P. aculeata L. Additionally, all the samples were assessed for antioxidant activity using DPPH radical scavenging method and for cytotoxic activity through MTT assay. Accordingly, the most active fraction was the ethyl acetate which showed the highest antioxidant activity (SC50 = 57.4 ±â€¯1.2 µg/mL) compared with the positive control, ascorbic acid (SC50 = 12.4 ±â€¯0.5 µg/mL) and moderate cytotoxicity against HepG-2 (hepatocellular carcinoma) and MCF-7 (breast carcinoma) cell lines with IC50 = 56.9 ±â€¯3.1 and 95.8 ±â€¯3.8 µg/mL, respectively compared with cisplatin (IC50 = 3.67 ±â€¯0.22 and 5.71 ±â€¯0.57 µg/mL, respectively for both cell lines). The antioxidant and cytotoxic activities may be attributed to the presence of high percentage of phenolic compounds and hydroxylated flavonoids detected in ethyl acetate fraction using UPLS-ESI-MS/MS.

Foreign bodies in otorhinolaryngology. Management and outcome.

OBJECTIVES: To analyze the data of patients with otorhinolaryngological foreign bodies and to evaluate the management and outcomes of foreign bodies to prevent complications. METHODS: A retrospective study was conducted over 8 years at Aseer Central Hospital to examine all admitted cases with foreign bodies in the ear, nose, throat, esophagus and bronchus during the period from January 2011 to January 2019. Patient demographic data, type of foreign body, and most common site were analyzed. RESULTS: A total of 184 patients were admitted, including 72 (39.1%) males and 112 (60.9%) females. The age range was from one year old to 70 years old; the mean±standard deviation of age was 10.6±12.55 years. Foreign bodies were most commonly located in the esophagus (n=97, 52.7%), followed by the bronchus (n=55, 29.9%). A statistically significant difference was found, with a p-value of 0.00001. The most common site in children was the bronchus (n=39, 21%); the most common site in adults was the esophagus (n=18, 72%). CONCLUSION: Otorhinolaryngological foreign bodies are found most frequently in preschool-aged children. The most common site in children was the bronchus, and the most common site in adults was the esophagus. Prevention measures are essential to reduce the risk of ingestion and admission, which can be challenging.

The common motives for appendectomy in Hail Region Saudi Arabia.

BACKGROUND: Appendectomy remains the most common emergency surgery. With the lack of literature from Saudi Arabia regarding the treatment for appendix disorders, this study aimed to identify the common motives for appendectomy in Northern Saudi Arabia. METHODOLOGY: Data referring to be resected appendix patients who were diagnosed during the period from January 2018 to December 2018 were included in the present study. The diagnosis of the resected appendix was confirmed by conventional histopathology. RESULTS: The most common cause for the appendectomy was acute appendicitis followed by gangrenous perforated appendicitis, chronic appendicitis, and lymphoid hyperplasia, representing 85/129(66%), 33/129(26%), 8/129(6%), and 3/129(2%), in this order. CONCLUSION: Appendectomy is a common procedure for the treatment of a large section of patients with appendicitis and appendicitis like clinical features. Acute appendicitis was the most motive for appendectomy followed by gangrenous perforated appendicitis in Northern Saudi Arabia.

Modulation of doxorubicin-induced expression of the multidrug resistance gene in breast cancer cells by diltiazem and protection against cardiotoxicity in experimental animals.

BACKGROUND: Doxorubicin (DOX) is one of the most important anticancer agents used in treating breast cancer. However, chronic cardiotoxicity and multidrug resistance limit the chemotherapeutic use of DOX. METHODS: This study aimed to evaluate the capability of calcium channel blocker diltiazem (DIL) to reverse DOX resistance in breast cancer MCF-7 cells and to confer protection against DOX-induced cardiotoxicity in Wistar rats. For this purpose, we explored the effects of DOX on cell cycle phase distribution and expression of ABCB1, FOXO3a, and p53 genes in the presence and absence of DIL (20 µg/ml) and studied the ability of DIL to prevent DOX-induced cardiotoxicity after a single injection of DOX (15 mg/kg) in male Wister rats. RESULTS: We found that compared with DOX alone treatment, DIL + DOX treatment down regulated the ABCB1 gene expression by > fourfold but up regulated the FOXO3a and p53 genes expression by 1.5 fold. DIL treatment conferred protection against DOX-induced cardiotoxicity, as indicated by a decrease in the levels of the cardiac enzyme creatine kinase MB and malondialdehyde and an increase in the total antioxidant capacity and glutathione peroxidase levels. These biochemical results were further confirmed by the histopathological investigation of cardiac cells, which showed normal cardiac cells with central vesicular nuclei and prevention of DOX-induced disruption of normal cardiac architecture in the DIL to DOX group. CONCLUSIONS: Taken together, our results indicate that DIL treatment can reverse the resistance of breast cancer cells to the therapeutic effects of DOX and can protect against DOX-induced cardiotoxicity in rats.

Phytochemical analysis and anti-diabetic, anti-inflammatory and antioxidant activities of Loranthus acaciae Zucc. Grown in Saudi Arabia.

The Loranthus genus has been demonstrated to be used in the treatment of wide range of diseases e.g. diabetes, inflammations and cancers. Many species of Loranthus represent a major source of biologically active constituents. Therefore, our study was carried out to investigate the anti-diabetic, anti-inflammatory and antioxidant effects of Loranthus acaciae Zucc. (Loranthaceae) grown in Saudi Arabia. Moreover, our research concerned the guided-fractionation and isolation of possible active compounds from this species. The crude ethanolic extract and its n-hexane, chloroform and n-butanol fractions were investigated for antidiabetic activity utilizing two methods namely, in alloxan-induced diabetic rats and glucose tolerance test in normal rats. Additionally, the anti-inflammatory activity was studied by the carrageenan-induced rat paw oedema method while DPPH free radical scavenging and ß-carotene bleaching assays were utilized to determine the antioxidant activity. Various chromatographic and spectroscopic techniques were utilized for the isolation and characterization of the active compounds. Our results exhibited that the crude extract and chloroform fraction has the greatest hypoglycemic and antidiabetic effects. The chloroform fraction and crude extract produced at a dose of 500 mg/kg a significant hypoglycemic effect in diabetic rats with 47.0 and 33.6% reduction in blood sugar levels and in normoglycemic rats 35.6 and 35.4% respectively. A potent anti-inflammatory effect (67.2% at 500 mg/kg) was detected for the chloroform fraction. In addition, the chloroform fraction exhibited a high antioxidative and DPPH-radical inhibitory activity (85.4 and 88.3% respectively). The phytochemical analysis of L. acaciae led to the isolation and characterization of four compounds namely, quercetin 3-O-ß-D-glucopyranoside (compound 1), quercetin 3-O-ß-(6-O-galloyl)-glucopyranoside (compound 2), (-) catechin (compound 3), and catechin 7-O-gallate (compound 4). Among these compounds quercetin 3-O-ß-D- glucopyranoside, quercetin 3-O-ß-(6-O-galloyl)-glucopyranoside and catechin 7-O-gallate, are isolated for the first time from this plant.

Myringoplasty outcome. Five-year experience at a tertiary teaching hospital.

OBJECTIVES: To assess the outcome of a myringoplasty procedure during a 5-year period at a tertiary teaching hospital in Abha, Kingdom of Saudi Arabia. METHODS: All patients with chronic suppurative otitis media (CSOM) who underwent elective myringoplasty between August 2012 and February  2018 were included in the study. Patients were investigated preoperatively and postoperatively by pure tone audiometry (PTA). The patients' demographic data were collected together with the surgical outcome. Postoperatively, patients were followed at the first week, at 6 weeks and then every 3 months, thereafter for one year. RESULTS: A total of 67 myringoplasty procedures were performed during the period of study. There were 41 females and 26 males, and they had an age range of 16-60 years and a mean age of 32.37±12.95 years. Preoperative PTA indicated that 58 (86.6%) patients had a hearing gap greater than 20 dB. However, after surgery, only 9 (13.4%) patients remained with hearing gaps greater than 20 dB. The success rate of graft stability at the end of one year was 94% with significant difference p=0.0001. However, one patient of the 4 patients with failed graft stability demonstrated graft atrophy, and the remaining 3 developed graft infection. Conclusion: Myringoplasty remains a useful technique for the management of CSOM. However, it depends on the surgeon's skills and expertise and on the site of perforation. The success rate of myringoplasty in this study was comparable with that of the quoted literature.

Effects of denture adhesive on the retention of milled and heat-activated maxillary denture bases: A clinical study.

STATEMENT OF PROBLEM: Clinical studies have identified advantages of digital complete denture technology including patient satisfaction, improved mastication, increased retention, and technique efficiency. However, studies that focus on the effect of denture adhesive on the retention of milled and heat-activated denture bases are lacking. PURPOSE: The purpose of this clinical study was to evaluate the effectiveness of denture adhesive on the retention of milled and heat-activated denture bases. MATERIAL AND METHODS: Twenty participants with complete maxillary edentulism were selected for this study (11 men and 9 women). Definitive impressions were obtained and scanned (iSeries impression scanner; Dental Wings). Digital data were sent to Global Dental Science for the fabrication of computer-aided design and computer-aided manufacturing (CAD-CAM) milled denture bases (MB condition). The physical impressions were poured in stone to produce casts for the fabrication of heat-activated acrylic resin denture bases (HB condition). A portable clinical motorized test stand and advance digital force gauge were modified to measure the amount of denture base retention in newtons. The denture bases were seated over the edentulous maxillary ridge and pulled 3 times vertically at 10-minute intervals without denture adhesive (MB and HB control conditions) and with denture adhesive (MBA and HBA test conditions). For statistical analysis, a repeated-measures ANOVA was performed (α=.05). RESULTS: The control MB condition had significantly higher retention values compared with all other conditions (P<.001). However, the use of adhesive significantly decreased the retention of the milled bases. No significant differences were found with or without the use of denture adhesive among heat-activated denture bases (P>.05). CONCLUSIONS: Significantly higher retention values were recorded with milled denture bases than heat-activated resin bases without the use of denture adhesive. However, denture adhesive did negatively affect the retention of milled complete dentures.

Could post-thyroidectomy bleeding be the clue to modify the concept of postoperative drainage? A prospective randomized controlled study.

BACKGROUND/OBJECTIVE: To unveil the real effect of surgical drains on the outcomes of thyroidectomy for benign thyroid disorders. METHODS: A prospective randomized study was conducted at Abha Private Hospital, Saudi Arabia on 108 patients suffered from benign thyroid disorders undergoing elective thyroidectomy from 1 August 2015 to 28 February 2017. Patients were allocated randomly into drainage group (A) and non-drainage group (B). The demographic data, operation (type and duration), postoperative complications, histopathological results and length of stay were assessed, documented and statistically verified to check its significance. RESULTS: A total of 108 patients were enrolled in the study; 94 females and 14 males with mean age of 38.02 years, two patients developed hematoma (1.85%); one in each group and another two patients had seroma with no significant difference between both groups, the mean length of stay was significantly higher in group (A) (p = 0.001). CONCLUSION: This prospective study verified that routine drainage adds no significant advantage in the prevention of post-thyroidectomy bleeding, but it prolongs hospitalization. This aids in changing the concept from the "wide" use of drains into the "wise" use in selected patients with risk factors of bleeding.

Obstetric brachial plexus injury. Knowledge among health care providers in Saudi Arabia.

OBJECTIVES: To assess the basic knowledge on obstetric brachial plexus injury among obstetricians, pediatricians, and physio-/occupational therapists in major hospitals in Riyadh.  We aimed to identify if inadequate knowledge is the reason behind delayed referrals to the Hand Clinic. Methods: This is a cross-sectional questionnaire-based study  conducted at 5 major hospitals in Riyadh, Saudi Arabia between June 2015 and August 2015.  A questionnaire of 6 questions (multiple choice closed-ended questions) was given to obstetricians, pediatricians, and  physio-/occupational therapists' in these selected hospitals. The total score out of 6 was categorized as good, adequate, and inadequate knowledge if the score is 5-6, 3-4, and less than 3; respectively. The data were analyzed with Chi-square, fisher exact, Analysis of Variance, and Post-hoc tests where appropriate. Results:  A total of 323 subjects participated in the study.  For positions, the best mean score (for all 6 questions) was scored by consultants and the score was only 2.95 out of 6. For hospitals, Hospital IV scored the best mean score (2.99). The mean scores were not significantly different between different specialties. Conclusion: Inadequate knowledge seems to be a reason for delayed referrals of cases of obstetric brachial plexus injury to Hand Clinics in Riyadh, Saudi Arabia.

Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines.

The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

The Surgical Safety Checklist: Results of Implementation in Otorhinolaryngology.

OBJECTIVES: To assess the impact of implementing the surgical safety checklist (SSCL) on the outcome of patient safety in otorhinolaryngology (ENT) surgical procedures in two hospitals in Saudi Arabia: Aseer Central and Abha Private Hospitals. METHODS: This retrospective study conducted over seven years (1 July 2008 to 30 June 2015) followed a staff educational and training program for the implementation of the World Health Organization Surgical Safety Checklist (WHO SSCL). The program included the use of audiovisual aids and practical demonstrations. Incidents of non-compliance were treated as sentinel events and were audited by the process of root cause analysis. RESULTS: There were 5 144 elective ENT surgical cases in both hospitals in which the SSCL was utilized over the seven-year study period. The average compliance rate was 96.5%. Reasons for non-compliance included staff shortage, fast staff turnover, excessive workload, communication problems, and presence of existing processes. CONCLUSIONS: The implementation of the SSCL was a substantial leap in efforts towards ensuring surgical patients' safety. It is compulsory in the healthcare system in many countries. Such progress in healthcare improvement can be accomplished with the commitment of the operating suite staff by spending few moments checking facts and establishing an environment of teamwork for the benefit of the surgical patient.

Rates, Causes, and Reduction of 30-Day Readmissions of Otolaryngology-Head and Neck Surgical Cases.

OBJECTIVES: The aim of this study was to determine risk factors associated with 30-day readmission for patients undergoing inpatient otolaryngologic head and neck surgery. STUDY DESIGN: Retrospective cohort study analysis. SETTING: Study at 2 tertiary hospitals. METHODS: A 10-year retrospective cohort analysis was performed for 30-day readmissions of otolaryngology surgical cases between July 1, 2006, and June 30, 2016, at Assir Central Hospital and Abha Private Hospital. Data included total number of patients, type of surgical procedure, number of and reasons for readmissions, and length of hospital stay. RESULTS: There were 32,662 discharges for otolaryngology operations over the 10-year period of the study, of which 364 patients were readmitted, giving a rate of 11.14 readmissions per 1000 operative procedures (95% CI, 10.1-12.3). The male:female ratio was 1.4:1. Period of postoperative stay ranged from 1 to 3 days and, after readmission, 2 to 5 days. The main reasons for readmission were bleeding in otolaryngologic cases and wound hematoma in head and neck surgical cases. Overall readmission rates dropped significantly from 12.72 per 1000 operative procedures in the first 5 years to 10.16 in the second 5 years. CONCLUSIONS: This study helped to establish special policies and procedures to prevent readmission by utilizing best practices, including addressing quality care, using preadmission clinics, preventing surgical site infection, and improving communication with community physicians. Plans based on these results also include the development of national model for predicting readmission within 30 days of discharge.

Influence of remaining dentin wall thickness on the fracture strength of endodontically treated tooth.

BACKGROUND: Remaining dentin wall thickness may influence the fracture resistance of tooth. AIMS: To investigate the effect of various coronal dentin wall widths on the fracture strength of root canal treated teeth. MATERIALS AND METHODS: Fifty recently extracted single canal mandibular premolars were used for the study. Ten unrestored teeth were used as control (Group 1); remaining teeth were root canal treated and divided into four groups (n = 10). The Groups 2a, 2b and 3a, 3b were having 2.5 mm, 1.5 mm remaining dentin with and without post, respectively. The samples fracture resistance was tested under the universal testing machine. The data were analyzed with one-way ANOVA and post-hoc Tukey test for comparative evaluation. RESULTS: The mean fracture strength observed in Group 1 was (29.75 Mpa) followed by Group 2a (28.97 Mpa), Group 2b (27.70 Mpa), Group 3a (23.39 Mpa), and Group 3b (16.38 Mpa). There was no statistically significant difference between control and Groups 2a and 2b with P > 0.05. The post contributed significantly for fracture resistance in Group 3a. CONCLUSION: The endodontic post is not required in root canal treated teeth >2.5 mm coronal dentin wall width while the post is essential for a tooth with <1.5 mm dentin wall width to improve fracture resistance.

The Dental Solid Waste Management in Different Categories of Dental Laboratories in Abha City, Saudi Arabia.

AIM: To study the awareness, attitude, practice and facilities among the different categories of dental laboratories in Abha city. MATERIALS AND METHODS: A total of 80 dental technicians were surveyed in the study. The dental laboratories included in the study were teaching institute (Group I), Government Hospital (Group II), Private Dental Clinic (Group III) and Independent laboratory (Group IV). The pre-tested anonymous questionnaire was used to understand knowledge, attitude, facilities, practice and orientation regarding biomedical waste management. RESULTS: The knowledge of biomedical waste categories, colour coding and segregation was better among Group I (55-65%) and Group II (65-75%). The lowest standard of waste disposal was practiced at Group IV (15-20%) and Group III (25-35%). The availability of disposal facilities was poor at Group IV. The continuous education on biomedical waste management lacked in all the Groups. CONCLUSION: The significant improvement in disposal facilities was required at Group III and Group IV laboratories. All dental technicians were in need of regular training of biomedical waste management. CLINICAL SIGNIFICANCE: The dental laboratories are an integral part of dental practice. The dental laboratories are actively involved in the generation, handling and disposal of biomedical waste. Hence, it is important to assess the biomedical waste management knowledge, attitude, facilities and practice among different categories of dental laboratories.

Replacement of missing anterior teeth in a patient with chronic mouth breathing and tongue thrusting.

The loss of anterior teeth has serious functional, esthetic disabilities, in addition to compromising the patients' quality of life. Various etiologies can be attributed to the anterior tooth loss, including trauma, caries, and periodontal diseases. The chronic mouth breathing due to nasal adenoids is known to enhance the gingival and periodontal diseases. The dental literature proves the association of nasal breathing, tongue thrusting, and anterior open bite. Arch shape and tooth position are primarily determined by the equilibrium of the forces from tongue and perioral musculature. Increased force from tongue musculature in the tongue thrusting patient leads to flaring of anterior teeth, making them susceptible for periodontal and traumatic tooth loss. Replacement of the anterior teeth in this patient will also help in restoration of anterior guidance, which is critical for the health of temporomandibular joint, posterior teeth, and musculature.