Maternal obesity and offspring cardiovascular remodelling - the effect of preconception and antenatal lifestyle interventions: a systematic review.

BACKGROUND: Preconception or antenatal lifestyle interventions in women with obesity may prevent adverse cardiovascular outcomes in the child, including cardiac remodelling. We undertook a systematic review of the existing data to examine the impact of randomised controlled trials of lifestyle interventions in pregnant women with obesity on offspring cardiac remodelling and related parameters of cardiovascular health. METHODS: This review was registered with PROSPERO (CRD42023454762) and aligns with PRISMA guidelines. PubMed, Embase, and previous reviews were systematically searched. Follow-up studies from randomised trials of lifestyle interventions in pregnant women with obesity, which included offspring cardiac remodelling or related cardiovascular parameters as outcome measures, were included based on pre-defined inclusion criteria. RESULTS: Eight studies from five randomised controlled trials were included after screening 3252 articles. Interventions included antenatal exercise (n = 2), diet and physical activity (n = 2), and preconception diet and physical activity (n = 1). Children were <2-months to 3-7-years-old, with sample sizes ranging between n = 18-404. Reduced cardiac remodelling, with reduced interventricular septal wall thickness, was consistently reported. Some studies identified improved systolic and diastolic function and a reduced resting heart rate. Risk of bias analyses rated all studies as 'fair' (some risk of bias). A high loss-to-follow-up was a common limitation. CONCLUSION: Although there is some evidence to suggest that lifestyle interventions in women with obesity may limit offspring cardiac remodelling, further high-quality longitudinal studies with larger sample sizes are required to confirm these observations and to determine whether these changes persist to adulthood. Child offspring cardiovascular health benefits of preconception and antenatal lifestyle interventions in women with obesity.

Navigating the practical-knowledge gap in deep margin elevation: A step towards a structured case selection - a review.

The deep margin elevation (DME) technique has gained popularity because of numerous supporting case reports. However, some clinicians are cautious regarding using this technique owing to the lack of clear case selection criteria for DME application. This review aimed to analyze case reports and a series of DME cases to determine pre-/post-operative evaluation methods that could be used to suggest a pre-operative case selection checklist for DME. An electronic database search was conducted in June 2021 and updated by June 2023 using selected terms from PubMed, Cochrane Library, Google Scholar, EBSCO, and Scopus. The search was limited to English-language publications and was not restricted to the date. The inclusion criteria were case reports/series addressing periodontal and restorative outcomes of DME. The search identified 217 articles, 76 of which were pertinent. However, only six case reports and one case series satisfied the inclusion criteria. None of the selected studies followed any reporting guidelines, which led to significant information gaps. While the reviewed studies reported favorable outcomes, standardized protocols for evaluating pre-/post-operative restorative and periodontal status were lacking. The post-operative follow-up period varied from 3 months to 6 years. Designing and implementing pre-/post-operative guidelines hold the potential for ensuring the safe application of the DME technique. This may enhance our understanding of the suitability and efficacy of such non-invasive technique in future clinical trials. Clinical significance: Handling deep cavities and preparing crowns are challenging. However, a lack of understanding of when to perform DME can lead to missed opportunities for conservative treatment, thereby a disservice to the patient. Provision of safe guidelines should be employed by clinicians until further evidence either supports or contradicts this treatment method.

Post-gastric Sleeve Surgery Chronic Symptoms From a Sample of Patients in Saudi Community.

BACKGROUND: A common bariatric procedure known as gastric sleeve surgery can cause significant weight loss and co-morbid condition alleviation. However, patients could experience persistent problems such as gastrointestinal, musculoskeletal/neural, and psychiatric disorders after surgery. This study aims to identify the most prevalent chronic symptoms following sleeve gastrectomy among a sample of Saudi patients and the impact these symptoms have on patients' lives. METHODOLOGY: Patients who underwent gastric sleeve surgery at the Ensan Clinic, a facility specializing in gastroenterology, were the subjects of this retrospective cohort analysis. The study population consisted of patients who underwent gastric sleeve surgery, showed up for follow-up after the procedure, and met the inclusion and exclusion criteria. The data collection sheet is divided into seven sections. Sociodemographic information was required in the first section, gastric sleeve surgery information in the second, vital signs in the third, lab results in the fourth, past medical history in the fifth, current treatments in the sixth, and postoperative complications and chronic symptoms in the seventh and final sections. RESULTS: In 117 patients, the study evaluated the effects of gastric sleeve surgery. Participants had an average age of 40.21 years, and 61.5% were female. Regarding persistent symptoms after surgery, a sizable percentage of patients mentioned digestive issues such as GERD (44.4%), dyspepsia (60.7%), vomiting (23.1%), nausea (39.3%), and abdominal distention (45.3%). A total of 34.2% of patients reported experiencing anxiety, compared to 11.1% who said they had depression or 2.6% who said they had social issues. A few patients reported experiencing neurological or musculoskeletal issues, including exhaustion (7.7%), faintness (5.1%), back or joint discomfort (7.7%), and shortness of breath (8.5%). CONCLUSION: After undergoing gastric sleeve surgery, a sizable proportion of patients complained of various chronic symptoms and nutritional inadequacies, primarily gastrointestinal problems and musculoskeletal/neurological issues. The study's findings show a connection between these symptoms and surgery.

Healthcare transformation journey in the Eastern Region of Saudi Arabia: an overview, challenges and lessons learned.

The Kingdom of Saudi Arabia has embarked on a transformation journey referred to as "Vision 2030", which commenced in June 2016. The healthcare sector is currently going through a radical transformation under this Vision. The new Model of Care shifts the focus of the healthcare sector towards proactive care and wellness, aiming to achieve better health, better care, and better value. This paper aims to provide an overview of the Model of Care and review its achievements and progress in the Eastern Region. The paper will further discuss the challenges faced and lessons learned through the implementation process. Internal documents were reviewed, and a comprehensive literature search was undertaken in relevant search engines and databases. Some of the successes of the Model of Care implementation include improved data management, collection and visualization, and better patient and community engagement. Nevertheless, there is a sense of urgency to face the many challenges identified in the Saudi Arabian health system over the coming decade. Although the Model of Care focuses on addressing these identified challenges and gaps, there are many difficulties facing its implementation in the country and several lessons learned during the first few years since its launch, which this paper mentions. Hence, there is a need to measure the successes of pathways and the overall impact of the Model of Care on both the healthcare provision as well as improved population health.

An analysis of dental articles in predatory journals and associated online engagement.

OBJECTIVE: We aimed to assess the extent of social media sharing of presumed predatory (PP) dental journals and to compare level of engagement, type of accounts and characteristics of the articles published in presumed legitimate (PL) and PP journals. METHODS: Six hashtags were searched across three social media platforms (Instagram, Facebook and Twitter). Data extraction was performed and journals were classified into PP or PL in a multistep approach using MEDLINE, Beall's list and Directory of Open Access Journals (DOAJ). A checklist was created and used for studies not found in the aforementioned recognized databases. RESULTS: A total of 1742 posts were identified, with the majority (94%) found on Instagram. Of the identified journals, 15.6% were PP. Over one-third of articles from PP journals (35.42%) were indexed on PubMed. The majority of presumed legitimate publications were published in dental specialty only journals (56.44%), compared to 24% in the PP group. The majority of accounts were those of healthcare professionals with most publications related to prosthodontics and implantology (26.3%) and restorative and esthetic dentistry (14.4%), in PL and PP groups, respectively. Similar median number of followers/friends and comments were found among the PL and PP groups. CONCLUSION: Our findings highlight that presumed predatory publications have comparable reach to PL journals on social media risking the sharing of unreliable and misleading information. CLINICAL SIGNIFICANCE: Researchers, students and social media users should be capable of identifying presumed predatory dental publications. Means of moderating the influence of these publications should be explored.

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia.

Background The presence of critical illness-induced corticosteroid insufficiency (CIRCI) is correlated with elevated concentrations of circulating biomarkers associated with inflammation and coagulation in multiple domains. The management of adrenal insufficiency remains a topic of ongoing debate and disagreement among endocrinologists and intensivists. This study aimed to assess the extent of understanding regarding CIRCI among endocrinologists and intensivists who are actively practicing in Saudi Arabia. Methods This is an online cross-sectional survey study that was conducted between June and August 2023 to assess knowledge of CIRCI among endocrinologists and intensivists working in Saudi Arabia. The questionnaire tool for this study was constructed based on a previous literature review. Binary logistic regression analysis was used to define factors that affect participants' knowledge of CIRCI. Results A total of 76 physicians were involved in this study. Around 32.9% (n= 25) of the participants described CIRCI correctly as an impairment of the hypothalamic-pituitary axis during critical illness. Around 35.5% (n=27) of the participants identified that widespread use of corticosteroids in critically ill patients prompted the need to revisit the concept, diagnosis, and management of CIRCI, and a similar proportion of the participants (35.5%) (n=27) identified that the role of corticosteroids in the management of CIRCI in critically ill patients may be beneficial in selected cases. Around 42.1% (n=32) of the participants identified that CIRCI is specific to critically ill patients while AI can occur in any individual. Around 17.1% (n=13) of the participants confirmed that there is no task force agreement on whether corticosteroids should be used in adult patients with sepsis but without shock. The mean knowledge score of the study participants was 3.6 (sd: 2.2) out of 10, which demonstrates a weak level of knowledge of CIRCI (36.0%). Binary logistic regression analysis identified that physicians from the southern and western regions were less likely to be knowledgeable of CIRCI compared to physicians from the central region (p< 0.05). Conclusion The study revealed that the level of familiarity with CIRCI among endocrinologists and intensivists in Saudi Arabia fell short of the desired benchmark. Clinicians may opt to utilize delta cortisol levels following cosyntropin administration and random plasma cortisol levels as diagnostic measures for CIRCI, instead of relying on plasma-free cortisol or salivary cortisol levels in conjunction with plasma total cortisol. Adherence to customized treatment protocols is crucial to attain the most favorable results for patients.

Disability inclusion assessment in primary healthcare centers in Eastern Saudi Arabia: a way forward.

Individuals with disabilities often experience barriers in accessing healthcare facilities, including physical barriers such as inaccessible facilities, transportation difficulties, and a lack of assistive devices. Other barriers may include a lack of communication assistive devices and stigma or negative attitudes from healthcare personnel or society. Published literature emphasizes the value of creating a supportive and safe environment for the inclusion of persons with disabilities in society. Establishing guidelines for disability inclusion becomes imperative to ensure equitable access to healthcare services. This study aimed to identify challenges related to accessibility in infrastructure, services, equipment, processes, and training in primary healthcare settings. The study was conducted in Dammam, AlKhobar, and AlQatif in August 2022, using an analytical, quantitative cross-sectional approach. A total of 56 primary healthcare centers (PHCs) were assessed across multiple domains. Government-built PHCs had an average accessibility rate of 83.2%, while those located in rented buildings scored an average of 67.1%. One domain that scored highly among both building types was the clinic rooms domain, with an average score of 90%. Conversely, the services domain showed significant differences, with an average accessibility rate of 47% for rented buildings and 75% for government-built buildings. Finally, the study looked into recommendations drawn from other health systems and recommended ways to help improve disability needs inclusion in the Eastern Region of Saudi Arabia.

Risk Factors, Prevention, and Primary and Secondary Management of Sciatica: An Updated Overview.

Sciatica is a chronic condition causing crippling low back pain radiating down to the sciatic nerve innervation area, which is the posterior thigh. It remains a major public health problem worldwide with significant socio-economic, physical, and psychological impacts. Studies suggested different diagnostic methods due to the lack of consensus on diagnostic and treatment guidelines. When it comes to the management and treatment, there is ambiguous evidence about the use of painkillers, surgical interventions, and alternative options and their effectiveness, with most studies contrasting one another in addition to the lack of high-quality trials. This review presents the available data on the current understanding of sciatica covering clinical manifestations, diagnosis and treatment modalities, prognosis, and complications since a disagreement is observed in the scientific community regarding sciatica, starting with a definition of sciatica, its epidemiological characteristics, to the management and treatment. Our review would help raise knowledge and awareness about sciatica in the health professional community and the general public since the prevalence of low back pain is high in most parts of the world and there is insufficient knowledge of sciatica in the literature.

The reach, influence and tenor of professional orthodontic societies on social media: A cross-sectional content analysis.

BACKGROUND AND OBJECTIVES: Orthodontic societies should support the profession and improve patient awareness. We aimed to investigate the scope and influence of orthodontic societies on social media. METHOD: A total of 120 orthodontic societies were identified on the World Federation of Orthodontists (WFO) affiliates list. Presence of orthodontic societies on Instagram, Facebook and Twitter was ascertained. All societies with Instagram accounts were included for further analysis of the nature and content of posts as well as user engagement. Pilot coding and thematic analysis were undertaken (n=200 posts). The most recent 20% of the total number of posts for each account were then analysed for content. RESULTS: Only 10 (8.3%), 34 (28.3%) and 52 (43.3%) orthodontic societies had accounts on Twitter, Instagram and Facebook, respectively. A total of 2124 Instagram posts were analysed. On average, 318 posts were identified per account (range=1 to 1901). The average number of followers was 2337 (range=85 to 11,400) with average user engagement of 1.25% (range=0.0%-7.17%). A total of 6 themes (subthemes; n=28) were identified including "announcements on professional events" (51.6%), "patient education, enlightenment and commendation" (26%), "running and operation of the society" (9.1%), "highlighting research and evidence" (3.1%), "COVID-related advice and updates" (4%) and "observance and commemoration" (10.4%). The posts targeting patients were limited (18.7%). CONCLUSIONS: The limited reach of the accounts of international orthodontic societies highlights the need to develop a more effective and influential social media presence. Orthodontic societies should involve members, providers and patients in developing more effective social media resources.

Fungal burn wound infection caused by Fusarium dimerum: A case series on a rare etiology.

INTRODUCTION: Fusarium dimerum is a filamentous mold associated with poor outcomes in immunocompromised hosts and burn victims. It can be acquired via inhalation or through skin dehiscence. METHODS: Our work presents a Case series of 8 patients from ages 3-57 years who were admitted with multiple burn wounds over the past 6 months. After initial stabilization measures, they all underwent debridement for the lesions after negative initial fungal cultures. The 44-year-old male was the first patient to develop punched-out eruptions on burn areas 7 days after admission; all the other patients experienced similar lesions during the next 6 days. Tissue cultures of the lesions exhibited Fusarium dimerum growth. The patients were managed accordingly with amphotericin B or voriconazoles. All the patients recovered except the 11-year-old boy, who expired on day 9 due to ARDS and sepsis complications. OUTCOMES: Infection with Fusarium dimerum carries a high risk of dissemination in burn infections. Hence, appropriate screening should be carried out via histologic and mycologic diagnostics early in the disease course. CONCLUSION: Considering the sparse literature that is available regarding Fusarium infection in burn victims, this study aims to improve the knowledge surrounding different facets of this disease including its epidemiology, diagnosis, management, and the need to maintain high suspicion of this fungal disease in burn patients.

Practices and Attitudes of Dental Loupes and Their Relationship to Musculoskeletal Disorders among Dental Practitioners.

OBJECTIVE: A dental loupe is a tool used by many dentists and dental students to improve visual field and performance. This study aims to assess the practices and attitudes about dental magnification loupes and their relationship to musculoskeletal disorders. MATERIALS AND METHODS: A cross-sectional study was conducted involving 400 dental students and dentists in four dental colleges in Jeddah, Saudi Arabia. The mean age was 28.35 years (SD = 8.50), and 56% of the participants were male. Also, 70.75% were students or interns, while 29.25% were dentists. Data gathering was conducted using a questionnaire that was composed of four sections: demographic, magnification devices usage, attitude toward dental loupes, and the Nordic questionnaire to assess musculoskeletal disorders. RESULTS: A total of 66% of participants had used dental magnification tools before, but only 12.25% were using dental loupes at the time of the study. The main reported advantages of dental loupes were comfort in vision (59.25%) and improved work accuracy (53%), while the main disadvantage was difficulty in visual measurement (28.5%). A total of 73.25% reported that price was the main barrier to the use of dental loupes. Lower back (63.5%), neck (65.25%), and shoulder (46.25%) pain were the most frequently reported areas of discomfort. There was a significant relationship (<0.05) between the use of dental loupes and lowered levels of reported discomfort in the lower back, neck, shoulders, elbows, upper back, and feet. CONCLUSION: There are few dental professionals who use dental loupes in Saudi Arabia. There was a significant relationship between dental loupes use and reduction of musculoskeletal disorders among dental students and dentists.