Outcomes of carotid endarterectomy: Insights from a single-center retrospective cohort study.

OBJECTIVES: To analyze the outcomes of carotid endarterectomy in individuals with carotid artery stenosis in the context of a tertiary care center. METHODS: We carried out a retrospective cohort investigation between 2015-2022. Patient data includes demographics, risk factors, preoperative medications, and operative details. The primary outcomes were 30-day postoperative stroke and mortality rates, while the secondary outcome of the study was to assess the morbidity of the procedure. RESULTS: The mean age of the 54 patients was 66.9±9.88 years, and 57.4% were men. The 30-day stroke rate was 3.7%, and the mortality rate was 1.9%. Most patients did not develop postoperative complications; however, surgical site hematoma was the most common complication encountered (12.9%). Long-term follow-up showed disease regression in 68.5% of patients, with a minority of patients developing ipsilateral restenosis. Admission to an intensive care monitoring unit was the only independent predictor of postoperative complications. CONCLUSION: This study provided insights into the outcomes of carotid endarterectomy in patients with carotid artery stenosis, emphasizing the importance of careful patient selection and postoperative monitoring. Perioperative risks, including stroke and mortality, were within acceptable limits. Further research incorporating structured and non-structured data for predictive analyses, should explore refining patient profiling and optimizing treatment approaches for different carotid artery stenosis clinical and morphological presentations.

Mobilizing a Kingdom During a Pandemic: The Health Marketing Campaigns Applied by the Saudi Ministry of Health to Promote (COVID-19) Vaccine Confidence and Uptake.

BACKGROUND: COVID-19 vaccination hesitancy is threatening the global intended herd immunity. Social marketing integration rocketed in promoting public health through awareness campaigns. Saudi Arabia was one of the countries that used social marketing to promote COVID-19 vaccinations for all age groups through successive campaigns. This study aims to describe the content of the campaigns held by the Saudi Ministry of Health to promote COVID-19 vaccine uptake. METHODS: A track's working strategy was created to contain COVID-19 spread in Saudi Arabia followed by a vaccination track. Six tracks were maintained over six months extended from June 2020 to December 2020. As a result, different campaigns were launched, and key performance indicators were identified and collected. Data from campaigns and key indicators were collected to determine outreach and impact. RESULTS: Five campaigns were initiated receiving high interactions from governmental entities and the public. The individuals' percentage who received full vaccination doses and booster vaccinations increased. Moreover, the last campaign promoting vaccinations in children achieved a 60% willingness rate among adults to vaccinate their children. CONCLUSION: COVID-19 awareness campaigns achieved successful outcomes in Saudi Arabia and currently the Kingdom sustained higher vaccination proportions than the average vaccination attainment worldwide.

Spontaneous external iliac artery dissection treated conservatively: A case report and review of the management options.

INTRODUCTION AND IMPORTANCE: Spontaneous iliac artery dissection (IAD) is a rare condition that is usually associated with connective tissue diseases. Complications include ischemia due to malperfusion and bleeding due to rupture. Treatments vary depending on the expertise and presenting symptoms; they include conservative, endovascular, and surgical options. PRESENTATION OF CASE: Here, we present the case of a 45-year-old man who presented with right lower quadrant pain and hypertension as well as normal laboratory results. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed an isolated dissection of the right external iliac artery. The patient had intact distal pulses and no other abnormal findings. He was admitted to the intensive care unit to control his high blood pressure with antihypertensive medications. The patient recovered well and was discharged home in stable condition with antiplatelet and antihypertensive therapy. The follow-up with the patient continued for one year. DISCUSSION: Given the rarity of this disease, the treatment protocols and outcomes are still a matter of ongoing debate. Complicated cases with rupture should be treated on an emergency basis using open and endovascular repairs. In asymptomatic and symptomatic patients without rupture, medical treatment and possibly endovascular treatments are considered. CONCLUSION: Conservative management of uncomplicated asymptomatic IAD should be considered as first-line therapy.

Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience.

BACKGROUND: although liver injuries are one of the most critical complications of abdominal trauma, choosing when to operate on these injuries is challenging for surgeons worldwide. METHODS: We conducted a retrospective analysis of liver injury cases at our institution from 2016 to 2022 to describe the operative and nonoperative management (NOM) outcomes in patients with traumatic liver injuries. Baseline patient characteristics, liver injury details, treatments, and outcomes were analyzed. RESULTS: Data from 45 patients (male, 77.8%) were analyzed. The mean age was 29.3 years. Blunt trauma was the most common injury mechanism (86.7%), whereas penetrating injuries were 8.9% of cases. Conservative management was associated with 18.9% of complications. The overall complication rate was 26.7%; delirium and sepsis were the most common (13.3%), followed by acute renal failure (4.4%), pneumonia, biliary leaks, and meningitis/seizures. CONCLUSIONS: Notwithstanding its limitations, this retrospective analysis demonstrated that NOM can serve as a safe and effective strategy for hemodynamically stable patients with liver trauma, irrespective of the patient's injury grade. Nevertheless, careful patient selection and monitoring are crucial. Further investigations are necessary to thoroughly evaluate the management of traumatic liver injuries, particularly in the context of multiorgan injuries.

Exploring Predictors of Patient Satisfaction in Dental Services: A Secondary Analysis Study.

Purpose: Understanding the factors that influence the level of patient satisfaction with dental services and identifying the strengths and weaknesses in dental clinics will subsequently increase patient satisfaction and contribute to improving dental care quality. This study aims to evaluate the variables that impact patients' satisfaction with dental services received in specialized dental care centers of the Ministry of Health in Saudi Arabia. Patients and Methods: Secondary data at the national level from a patient experience program were used in this study. Completed Press Ganey® surveys submitted by patients during the first half of 2022 were included. The effect of the different domains (access to dental clinic, moving through dental visit and dentist) on the overall assessment rating of patient satisfaction was assessed using Pearson's correlation coefficient (r) and multiple linear regression models. Results: A total of 964 surveys were completed and subsequently analyzed. The overall assessment rate of patient satisfaction was 73.4%. All items of the domains showed highly significant correlation levels (P < 0.001). However, the Dentist domain exhibited the highest correlation with the overall assessment rate of patient satisfaction. Conclusion: The dentist acts as the most significant predictor of patient satisfaction.

Percutaneous versus Cutdown Access for Endovascular Aortic Repair.

BACKGROUND: This study aimed to compare the outcomes of the percutaneous femoral access and open surgical cutdown access approaches in patients undergoing thoracic/abdominal endovascular aortic repair. METHODS: We retrospectively reviewed the medical records of 59 patients who underwent a thoracic/abdominal endovascular aortic repair at a single tertiary care hospital between 2015 and 2022. Based on their femoral access type, the patients were categorized into the "percutaneous" or "cutdown" groups. Using a computerized sheet, relevant patient data (including demographic information and patient risk factors) were collected. The operative duration, complication rates, mortality rates, intensive care unit admission and stay durations, and total hospital stay were compared between the two groups. The primary outcomes were differences in the postoperative morbidity and mortality associated with the two approaches. RESULTS: The cutdown and percutaneous groups comprised 24 (41%) and 35 (59%) patients, respectively. The two groups displayed comparable demographic and clinical characteristics (p > 0.05). However, the vascular anatomy differed with the common femoral artery diameter being larger in the percutaneous group compared to the cutdown group (9.63 ± 1.81 mm vs. 8.49 ± 1.54 mm, p = 0.028). The ratio of the sheath diameter to the common femoral artery diameter was significantly lower in the percutaneous group than in the cutdown group (0.73 ± 0.16 vs. 0.85 ± 0.20, p = 0.027). A ratio of ≥0.74 was associated with a higher risk of complications (odds ratio, 12.0; 95% confidence interval, 1.4-102.2; p = 0.023) and mortality (odds ratio, 5.79; 95% confidence interval, 1.13-29.6; p = 0.035). Additionally, the operative duration was significantly shorter in the percutaneous group than in the cutdown group (141.43 ± 97.05 min vs. 218.46 ± 126.31 min, p = 0.001). Compared to the cutdown group, the percutaneous group experienced a shorter total hospital stay (21.54 ± 21.49 days vs. 11.60 ± 12.09 days, p = 0.022) and lower intensive care unit-admission rates (66.7% vs. 40%, p = 0.044). CONCLUSION: The percutaneous approach is a viable and more time-efficient alternative to the traditional cutdown method for delivering vascular endografts. It is associated with a significantly shorter operative duration and briefer hospital stays. Additionally, the ratio of the sheath diameter to the common femoral artery diameter can help surgeons preoperatively predict and anticipate the risks of complications and mortality. Future in-depth research is necessary to better understand the association between this ratio and postoperative outcomes and complications.

Patient Satisfaction in Dental Healthcare Settings at Saudi Ministry of Health: A Descriptive Study.

Background: Patient satisfaction is crucial for assessing healthcare quality and identifying strengths and weaknesses in healthcare organizations. In Saudi Arabia, the Ministry of Health (MOH) implemented the Patient Experience Measurement Program to enhance patient experience and healthcare quality. This study aimed to identify specific aspects of patient satisfaction with dental visits in Saudi Arabia to improve dental care quality and inform dental services development. Methods: The study used a standardized self-administered questionnaire (Health Links/Press Ganey) and analyzed surveys from patients who visited MOH-specialized dental clinics in Saudi Arabia during the first half of 2022. The dental section comprised 20 questions across five domains, with patients rating their experience on a 5-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics 25. Results: A total of 964 patients were surveyed. The overall patient satisfaction with dental settings was 3.61 out of 5.0 (72.2%). The highest satisfaction score was for personal issues with the dental clinic domain (3.93/5; 78.6%), while the least satisfaction score was for access to the dental clinic domain (3.29/5; 65.8%). Among all items, the cleanliness of the facility showed the highest satisfaction score (4.11/5; 82.2%). The least satisfaction was for the ease of contacting the dental clinic (2.71/5; 54.2%). Conclusion: The study found high levels of satisfaction among Saudi patients with dental services provided through MOH facilities across various component domains. This highlights the crucial role of dentists in ensuring high-quality dental care and serves as an indication of the overall healthcare quality in MOH facilities.

Patients' Satisfaction With the Quality of Services at Primary Healthcare Centers in Saudi Arabia.

BACKGROUND: Patients' satisfaction is an essential indicator used to measure the quality of healthcare services. The evaluation of patients' satisfaction with primary healthcare center (PHC) visits is therefore essential when it comes to assessing the quality of healthcare services provided. AIM: To assess patients' overall satisfaction with the quality of services provided at PHCs in different regions of Saudi Arabia. METHODS: A retrospective cross-sectional study was conducted using secondary data collected from 2,390 PHCs in different regions of Saudi Arabia. Data were collected by the Patient Experience Measurement Program in the Ministry of Health (MOH) using the Press Ganey Survey from January 2022 to December 2022. The Press Ganey Survey is a standardized tool used by the Saudi MOH to assess patients' satisfaction with the health services provided in different specialties and healthcare facilities. The assessment tool (Press Ganey survey) involves six domains (Access, Moving through, Nurse, Care provider, Personal issue, and Overall assessment). The data were tabulated and analyzed using the Statistical Package for the Social Sciences (SPSS). RESULTS: In total, there were 536,406 study participants, with their mean age being 28.7±21.1. The overall patients' satisfaction score was 4.2 out of 5 (83.8%). Male participants reported more satisfaction with PHC services than did females (86.6%, 81%), respectively. The domain with the highest patients' satisfaction scores was that of the Care provider (84.8%), while the domain with the lowest rating was Moving through (82.8%). CONCLUSION: This baseline study found that patients were generally satisfied, with the highest levels of satisfaction with their care providers, highlighting the crucial role of professionals in the patient experience. Further research is recommended to give a more in-depth analysis and thus highlight additional correlating and predicted elements of patients' satisfaction with PHC treatments in Saudi Arabia.

Obstructive Sleep Apnea Awareness Among Dentists in Saudi Arabia: A Cross-Sectional Study.

OBJECTIVES: This study aims to assess the knowledge and clinical practices among dentists in Saudi Arabia regarding obstructive sleep apnea (OSA). MATERIAL AND METHODS: This cross-sectional study was conducted over a period of 8 months across the whole country. A self-administered questionnaire was used to assess the OSA knowledge and practices. The developed questionnaire was closed-ended questions and consisted of three parts: (1) demographic information such as age, gender, work experience, workplace, and specialty; (2) knowledge of OSA; and (3) OSA management practice. The knowledge score was calculated based on six questions, each of which gives one point when answered correctly. RESULTS: A total of 450 dentists from all over the country were surveyed, with a predominance of females (55.6%) and Saudis (59%). About 56% learned about OSA in their undergraduate study, with theoretical lectures being the main source of information. The overall knowledge score was 3.09, with specialists having a higher score than general practitioners (GPs) (p<0.001) and those who learned about OSA in their post-graduate study having higher scores (p<0.001). Despite this, 58.89% never asked their patients about sleep history, and only 19.11% diagnosed patients with OSA before. Only 7.56% used oral appliances to treat OSA, and only one-quarter referred patients to a physician for a sleep-disordered diagnosis. However, 79.33% were willing to attend a continuing education course on managing OSA patients. CONCLUSION: Our study shows that dentists in Saudi Arabia lack fundamental understanding regarding OSA and their role in screening, diagnosing, and treating patients with OSA, highlighting the need to educate the dental fraternity. Dental GPs and specialists, including orthodontists, must be actively involved in diagnosing and treating this life-threatening health issue.

Patient Satisfaction as a Determinant of Patient Loyalty to the Dentist in Dental Clinics.

The aim of this study was to investigate the impact of patient satisfaction with a dentist on their loyalty to that dentist in Saudi Ministry of Health dental clinics. Retrospective data were recruited from the patient experience program (Press Ganey Survey) during the first half of 2022. Descriptive statistical analysis, Pearson correlation coefficient (r), and multiple linear regression models were used to assess the impact on loyalty to that dentist. Among the 964 respondents who submitted their responses to the survey, the highest mean satisfaction score was for the item concerning the good listening of the dentist to the patient (3.86 of 5; 77.2%). There was a highly significant correlation between each item related to the dentist and the likelihood of the patient to recommend a certain dentist to others "that is, patient loyalty" (P < .001). The highest predictor of patient loyalty to his dentist was the dentist's explanation of the treatment options to his patient (t: 8.632, P < .001). Dentists have a crucial role to play in boosting patient satisfaction and thereby patient loyalty.

Unexpected arterial thrombosis and acute limb ischemia in a young male patient with COVID-19: A case report.

Introduction: The spread of severe acute respiratory syndrome coronavirus 2 has resulted in coronavirus disease 2019 (COVID-19) pandemic, raising significant concerns. COVID-19 can lead to thrombotic complications such as acute limb ischemia (ALI). In patients with COVID-19, thrombotic complications may increase the risk of morbidity and mortality. Presentation of case: We report the case of a 37-year-old man who presented with a 2 weeks history of right foot pain, toes blackish discoloration, and numbness. He tested positive for COVID-19 10 days prior to his presentation. Computed tomography angiography (CTA) of the lower limbs revealed near-complete occlusion of the right popliteal artery with single-vessel posterior tibial artery runoff. The patient was brought to a hybrid operating room, and diagnostic angiography confirmed the diagnosis. He underwent popliteal artery thromboembolectomy and intraoperative thrombolysis through a posterior approach. A completion angiography demonstrated a patent popliteal artery with a 2-vessels patency to the foot. His postoperative recovery was uneventful. After surgery, the popliteal, anterior tibial, and posterior tibial arteries were all palpable. The patient was discharged home on antiplatelet therapy with frequent postoperative follow-ups during the last 1 year in our outpatient clinic. Discussion: The frequency of ALI has reduced worldwide, and the hypercoagulable condition remains an infrequent cause of limb ischemia. Patients with COVID-19 have a 35%-45% thromboembolic complication rate. In many studies, the virus launches a second attack between 7 and 14 days after symptom onset, possibly causing hypercoagulability. If conservative treatment fails, various surgical methods, including thromboembolectomy, thrombolysis, and thrombosuction, can be performed to treat ALI. Conclusion: In mild ALI symptoms, unfractionated heparin can be used with vigilant follow-up. Open and endovascular procedures are currently used to treat patients with acute limb ischemia, and technological advancements continue to make interventions easier and safer.

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports.

BACKGROUND: One of the major perioperative complications for coronary artery bypass graft (CABG) is stroke. The risk of perioperative stroke after CABG is approximately 2%. Carotid stenosis (CS) is considered an independent predictor of perioperative stroke risk in CABG patients. The optimal management of such patients has been a source of controversy. One of the possible surgical options is synchronous carotid endarterectomy (CEA) and CABG. Here, we have presented 4 cases of successful synchronous CEA and CABG. CASE SUMMARY: Our center's experience with 4 cases of significant carotid artery stenosis, which were successfully managed with combined CEA and CABG, are detailed. The first case was a female who presented for CABG after a ST-elevation myocardial infarction. She had right internal carotid artery (ICA) occlusion and 90% left ICA stenosis. The second case was a male who was electively admitted for CABG. It was discovered that he had left ICA occlusion and 90% right ICA stenosis. The third case was a male with a history of stroke, two months prior to admission. He presented with non-ST-elevation myocardial infarction. Preoperatively, it was discovered that he had > 90% right ICA stenosis. The final case was a male who was electively admitted for CABG. It was discovered that he had bilateral > 90% ICA stenosis. We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG. CONCLUSION: Our case series demonstrated that synchronous CEA and CABG was safe. A multicenter study with additional patients is needed. It is necessary for clinicians to screen for CS in high-risk patients with features.

Stress levels among senior dental students in Saudi Arabia during fixed prosthodontics procedures.

Aims: To investigate self-perceived stress level of senior dental students in Saudi Arabia during different fixed prosthodontics procedures. Also, to explore the possible stress-related factors during each procedure. Settings and Design: A structured, close-ended, and open-ended, anonymous questionnaire was distributed in a website format to senior dental students of 19 dental schools in Saudi Arabia. Materials and Methods: Students were asked to rate the level of stress they feel during different fixed prosthodontics procedures on a scale from 0 to 10. They were also asked to rate the adequacy of their preclinical training in these procedures and how many times they have performed each of the procedures clinically. Statistical Analysis Used: Descriptive statistics were presented in means, percentages, and standard deviation and inferential statistics were performed using One-way ANOVA, independent t-test and Pearson's correlation. Results: About 423 students answered the questionnaire, in which 228 (54%) were females and 195 (46%) were males. Vital tooth preparation (5.27 ± 2.459) and pos space preparation (5.13 ± 2.766) were rated as the most stressful procedures (P < 0.05). Fear of error or mishaps was the most reported reason for stress during these two procedures. Pearson's correlation showed significant but weak negative correlation between stress scores and number of times the student has performed the procedure (P < 0.05). Students who believe that they had adequate preclinical training reported significantly lower stress scores (P < 0.05). Conclusion: Self-perceived stress among dental students is related to the type of procedure they perform in the clinic and how frequent they have been exposed to it during their preclinical training.

Self-reported stress among senior dental students during complete denture procedures.

Aims: Stress is a common problem that can have a considerable impact on student performance and subsequently the quality of treatment given to the patients. This study aimed to investigate the levels and reasons of stress among senior dental students when they perform different complete denture clinical procedures. Settings and Design: A questionnaire was designed and distributed electronically among senior dental students of 19 universities in Saudi Arabia. Materials and Methods: The students were asked to score the levels of stress during five complete denture clinical steps on a scale from zero to ten and report factors contributing to it. Statistical Analysis Used: Descriptive statistics and inferential statistics were carried out by One-way ANOVA and independent t-test to compare stress scores between different procedures. Results: A total of 419 responses were collected, 195 (46.5%) males and 224 (53.5%) females. One-Way ANOVA revealed statistically significant difference in the mean stress scores between the five procedures (P < 0.001). The highest mean stress score was for border molding and final impression procedure (4.06 ± 2.664) and jaw relation (4.20 ± 2.690). Moreover, the Stress scores were significantly higher among females when compared to males in all procedures (P < 0.05) except the placement of final denture (P > 0.05). Conclusion: Border molding, final impression, and jaw relation records cause more stress for dental students than the other complete denture procedures. Difficulty of these two procedures was the most common reported stress provoking factors.

Influence of dental college funding and time established on the satisfaction of dental graduates with their undergraduate experience in Saudi Arabia.

OBJECTIVE: With the emergence of graduates from all government and private-funded dental colleges in Saudi Arabia (SA), it is pressing to explore the graduates' satisfaction with the dental undergraduate education and training they received. The aim of the present study was to investigate the graduates' satisfaction with their education and training according to college funding arrangements (government vs private-funded) and time since establishment (established- >15 years vs new-<15 years). METHODS: A piloted, electronic questionnaire was emailed to all the members of the Saudi Dental Society who had graduated from government and and private dental colleges in SA (2,185 registrants). RESULTS: The response rate was 36.4%, with 580 government-funded college graduates (72.9%) and 216 private college graduates (27.1%) having completed and returned the questionnaire. The distribution of participants between established and new colleges was 'established' 396 (49.8%) and 'new' 400 (50.2%). Levels of dissatisfaction were recorded for graduates from established and new, government-funded and private colleges. The levels of dissatisfaction were greater amongst the graduates of established and government-funded colleges. CONCLUSION: The findings of the present study indicate concerning levels of dissatisfaction with important aspects of dental education in SA. It is suggested that there is a pressing need for more integration of basic and clinical sciences and an emphasis on hands-on training. National coordination of arrangements for dental curricula could make a major contribution to addressing the problems identified.

A method of hollowing the obturator prosthesis and an overview on the pros and cons of the various materials used for hollowing.

Prosthetic rehabilitation of a partial or total maxillectomy with an obturator is the most acceptable treatment option. The hollowing of the obturator prosthesis is beneficial as it reduces the stresses over the underlying and surrounding tissues. A simple technique of fabricating a hollow bulb obturator has been discussed in this article. At the step of the packing of a denture, the hollow wax pattern of the defect area is formed with modeling wax. This hollow wax pattern is filled with water and is allowed to freeze to form an ice block. This ice block is removed from the wax pattern and is interposed between two layers for heat-cured acrylic resin and is then cured. After processing the denture, the water is retrieved by making a small hole in denture base, which is packed after hollowing with a cold cure acrylic resin. A lightweight prosthesis with a uniform thickness was achieved with a readily available and easily retrievable material, i.e., ice.

A nationwide survey assessing the satisfaction of dental colleges graduates with their undergraduate experience in Saudi Arabia.

OBJECTIVE: To date, there are no publications on the Saudi graduates' perceived value of their dental curriculum. The aim of this nation-wide survey was to investigate graduates' satisfaction with specific disciplines of their dental education and training. The first part of this study addressed findings according to the respondents' gender and the number of years of postgraduate experience (Graduate-related factors). METHODS: An electronic questionnaire was emailed to registrants of the Saudi Dental Society, specifically dental interns, general dentists, and specialized dentists who graduated from private and governmental dental colleges in Saudi Arabia (n = 2185). RESULTS: The response rate was 36.4 %. The number of male respondents was (n = 352, 44.2 %), the remainder being female (n = 444, 55.8 %). The number of recent dentists (≤ 5 years since graduation) was (n = 428, 53.8 %) and experienced dentists (n = 368, 46.2 %). There were statistically significant gender variations in satisfaction levels, and among dentists with different post-graduation experiences. Although male and female dental students are taught similar curriculums and have similar graduation requirements, there were statistically significant differences in various subjects covered. Similarly, recent and experienced dentists reported statistically significant differences in satisfaction in various subjects. CONCLUSION: This study provides graduates' perspectives on the strengths and weaknesses of their dental education in Saudi Arabia. The findings help in curriculum reform and collaborations between the dental colleges nationally. Ultimately this can lead to formulating a national dental accreditation and assessment body. CLINICAL SIGNIFICANCE: The findings of this study provide graduates' perspective on the dental education received in Saudi Arabia. This will help stimulate discussion and collaboration within and amongst the colleges on improving their curriculum in this fast-paced, evolving field of dentistry.

Factors associated with the use of fashion braces of the Saudi Arabian Youth: application of the Health Belief Model.

BACKGROUND: In spite of the fact that fashion braces (FBs) have been in the spotlight in recent years among both orthodontists and the general public in several countries, there is still limited evidence regarding FBs. The aim was to identify health-related behaviors in using FBs by considering the Health Belief Model (HBM). METHODS: A cross-sectional study with a random sampling technique was conducted in Jazan, Saudi Arabia. The data was obtained from different middle and high schools students, and first-year students at Jazan University. The questionnaire collected data on demographic characteristics and 27 items to examine the constructs of the HBM. Chi Square test was carried out to establish the factors associated with using, the intention to use, and previous knowledge on the use of fashion braces. Logistic regression analysis was utilized to determine the factors associated with the use of fashion braces. RESULTS: 406 study participants completed the questionnaire with a response rate of 88.3%. Majority of respondents were males (52.2%) and > 19 years old (44.3%). Only 9.9% students had used the FBs. However, 25.7% of students had the intention to use them. The perceived susceptibility, perceived benefits and cues to action constructs scores were fair with the mean values of 15.38 (SD = 9.4), 28.17 (SD = 10.8) and 6.65 (SD = 2.50), respectively. However, the perceived barrier score was high with the mean values of 22.14 (SD = 7.50), and lower score of self-efficacy with mean of 8.73 (SD = 3.30). Gender, age, monthly income (family), and education level were significantly (p < 0.05) associated with the use of fashion braces among the study's participants. Based on the results of logistic regression analysis family income, perceived susceptibility, and risk severity constructs predict the use of fashion braces in the study's sample. CONCLUSIONS: The current study suggests that the family income, perceived susceptibility, and risk severity of students significantly influence the use of fashion braces. Hence, it is recommended that researchers should investigate effective educational strategies and programs for improving young people's knowledge about fashion braces and focus more on low family income students so that their using of fashion brace will be decreased.

Metastatic Mixed Adeno-Neuroendocrine Carcinoma of the Colon to the Liver with Multiple Peritoneal Deposits: A Case Report.

BACKGROUND Metastatic mixed adeno-neuroendocrine carcinoma (MANEC) is a rare malignancy. It is characterized by the presence of both neuroendocrine and epithelial components, each of which constitute at least 30% of the lesion to establish the diagnosis. CASE REPORT A 48-year-old man presented with a 1-month history of right upper-quadrant pain and unintentional weight loss of 18 kg. He was also complaining of constipation and fatigue for 6 days. The initial diagnosis from a referring hospital was colon cancer with liver metastasis based on a computed tomography (CT) scan of the chest, abdomen and pelvis. After re-evaluation at our hospital, the scan revealed multiple peritoneal deposits in addition to the previously reported findings. A colonoscopy and biopsy were performed, after which the histopathological examination demonstrated a mixed poorly differentiated large cell neuroendocrine carcinoma and adenocarcinoma. Based on the imaging and histopathology reports, he was diagnosed with a poorly differentiated MANEC of the colon with liver metastasis and multiple peritoneal deposits. His lesions were deemed unresectable, and he was referred to the oncology department for palliative care. There he received a total of 9 cycles of cisplatin and etoposide for 8 months. His CT scan showed a regression of the primary tumor indicating a good response to chemotherapy. The patient is still following up with his medical oncologist. CONCLUSIONS Although it is rare, MANEC is a complex neoplasm that requires a high index of suspicion to diagnose due to its nonspecific presentation. It is confirmed through histopathology and immunohistochemistry of the tumor biopsy. Imaging is performed for staging, with most patients presenting at advanced stages with metastases. The only curative option is complete surgical resection of both the primary and metastatic lesion. Many cases, however, are regarded as unresectable and are referred for palliative treatment.

Two hepatic cavernous hemangiomas mimicking colorectal liver metastasis: A rare case report.

INTRODUCTION: 1 Hepatic cavernous hemangioma (HCH) is a common benign lesion of the liver. The radiological features of HCH can resemble those of hepatic malignancies such as metastatic liver cancer, which make the preoperative definitive diagnosis difficult. PRESENTATION OF CASE: We report the case of a 77-year-old woman who presented with a 2-month history of abdominal pain and per rectum fresh bleeding. The initial diagnosis at the referral hospital, based on computed tomography (CT) scan of the chest, abdomen, and pelvis, was sigmoid colon cancer with liver metastasis. Further evaluation at our hospital, the patient underwent colonoscopy and biopsy. Histopathological examination of the biopsy revealed an invasive moderately differentiated adenocarcinoma. The patient underwent laparoscopic sigmoidectomy and left hepatectomy. The histopathological examination of the sigmoid colon mass revealed an invasive moderately to poorly differentiated adenocarcinoma. One out of twenty lymph nodes is positive for metastatic carcinoma. The pathological stage is pT3, pN1a, pM0. The histopathological examination of the left hepatic lobe revealed two hyalinized cavernous hemangiomas with no malignancy is seen. The postoperative recovery was uneventful, and the patient was discharged home with regular follow-up in our outpatient clinic. DISCUSSION: HCH is congenital vascular malformation and is the most common benign hepatic tumors. Fine-needle biopsy during diagnostic laparoscopy for undiagnosed multiple liver tumor can differentiate atypical HCH from colorectal metastasis but can potentially lead to rupture or seeding of cancer cells. CONCLUSION: Surgical resection is necessary to determine if the mass is malignant in some atypical HCH mimicking liver metastasis to confirm the diagnosis with histopathologic examination.