Prevalence, and types of overuse injuries in gym centers: A cross-sectional study in Saudi Arabia.

Physical activity has numerous health benefits, enhancing overall wellbeing. However, it can also lead to injuries, impeding exercise capacity and hindering work. Limited knowledge exists about the prevalence of overuse gym injuries and whether they vary across different gym activities. This study aims to estimate sport injuries at fitness centers in Saudi Arabia, comparing injuries between various activities and session durations. This is a cross-sectional, questionnaire-based study surveyed regular gym-goers in Saudi Arabia with overuse injuries. The online survey, distributed through social media apps, collected data using a validated Google form questionnaire. Questioanire consists of 3 parts. First part of the questionnaire included demographic characteristics of participants. Second part contains characteristics related to gym as gym session's duration, frequency of attending gym per week, sport types, type of injuries and site of injuries. Third part contains Oslo Sports Trauma Research Centre (OSTRC) Overuse injury questionnaire that included 4 questions about difficulties in participation, reduction of training, affection of performance and symptoms. Study included 1012 participants, majority male (76.2%), with age range of 18 to 50 years, and significant proportion falling between 26 and 30 years (52.6%). Majority of participants were from Central Province (42.9%). Gym sessions typically lasted 1 to 2 hours (68.3%), and most common attendance frequency was 4 days/week (39.6%). Common injury sites were shoulder (25.2%), knee (20.2%), and lower back (17.7%). Bodybuilding (50.6%), running (45.8%), and weightlifting/powerlifting (45.1%) were predominant sports. Strain/muscle rupture/tear (35.70%) and muscle cramps/spasm (19.3%) were commonest injury types. Longer gym sessions (>2 hours) were associated with higher prevalence of strain/muscle rupture/tear, dislocation, and subluxation (P < .001). Shorter sessions (<1 hour) had higher prevalence of muscle cramps/spasm and contusion/hematoma/bruise (P < .001). Gym sessions lasting 1 to 2 hours had high prevalence in tendinosis/tendinopathy. Strain/muscle rupture/tear was significantly higher in bodybuilding, weightlifting/powerlifting, swimming, cycling, and running. Tendinosis/tendinopathy was higher in crossfit. (OSTRC) Overuse injury questionnaire revealed decreased participation, training volume, performance, and increased pain with longer gym sessions. In conclusion, gym-related injuries are common, with bodybuilding and running being prevalent activities. Preventative measures should be taken, and individuals are advised to undergo a physical and medical examination before engaging in physical activity at fitness centers.

Evaluating the properties that affect the quality of the charcoal product, determining the limits of toxic emissions during combustion, and studying their impact on human health.

This research focuses on examining the potential impact of charcoal briquettes and lumps on human health due to the emissions they release, and verifying their quality standards. Quality assessment was conducted using a device capable of measuring toxic gases to identify contaminants from various sources such as biomass, synthetic resins, coal, metals, and mineral matter. Toxicity assessments were carried out on five types of briquettes and two varieties of lump charcoal. All charcoal samples were subjected to elemental analysis (SEM/EDAX), including the examination of Ca, Al, Cr, V, Cu, Fe, S, Sr, Si, Ba, Pb, P, Mn, Rb, K, Ti, and Zn. The results showed that burning lump charcoal had toxicity indexes ranging from 2.5 to 5, primarily due to NOx emissions. Briquettes, on the other hand, exhibited higher toxicity indices between 3.5 and 6.0, with CO2 being the main contributor to toxicity. The average 24-h CO content of all charcoal samples exceeded the World Health Organization's 24-h Air Quality Guideline of 6.34 ppm, with a measurement of 37 ppm. The data indicates that most of the products tested did not meet the prevailing quality standard (EN 1860-2:2005 (E) in Appliances, solid fuels and firelighters for barbecuing-Part 2: Barbecue charcoal and barbecue charcoal briquettes-Requirements and test method, 2005), which specifies a maximum of 1% contaminants, with some products containing as much as 21% impurities. The SEM analysis revealed irregularly shaped grains with an uneven distribution of particles, and the average particle size distribution is quite broad at 5 µm. Malaysia Charcoal had the highest calorific value at 32.80 MJ/Kg, with the value being influenced by the fixed carbon content-higher carbon content resulting in a higher calorific value.

Metastatic Breast Cancer Presenting as Acute Appendicitis: A Case Report and Literature Review.

Breast cancer is considered one of the most common cancers worldwide. The most common sites for breast cancer to metastasize are the lymph nodes, bones, lungs, brain, and liver. Involvement of the gastrointestinal tract is uncommon, and metastasis to the appendix is rare. We report a case involving a 43-year-old woman with no previous history of malignancy who presented with acute appendicitis and underwent laparoscopic appendectomy, with the final histopathological assessment revealing metastatic breast cancer.

Efficacy of Lasers in Debonding Ceramic Brackets: Exploring the Rationale and Methods.

The development of ceramic brackets in orthodontics three decades ago emerged as a response to the increasing patient demand for less visible orthodontic appliances. While these brackets provide superior aesthetics, they are characterized by lower fracture toughness and higher bond strength in contrast to metal brackets. These properties present challenges during the debonding step, including the risk of enamel micro-fractures and cracks. Historically, various strategies have been developed to address challenges associated with debonding, reduce patient discomfort, and ensure that the bond failure site is confined to the bracket-adhesive interface. This included the use of specially designed debonding pliers, electrothermal debonding, ultrasonic technique, and chemical agents. Recently, there has been a shift towards utilizing different types of laser irradiation for this purpose. The burgeoning strategy, however, requires diligent scientific scrutiny to establish a standardized protocol with particular laser parameters and ultimately achieve the goal of enhancing the patient experience by reducing discomfort. This article offers a narrative review of laser-aided debonding of ceramic brackets, aimed at comparing different laser types, presenting their benefits and downsides, validating the efficiency of each method, and summarizing the published literature on this subject. It also provides insights for orthodontists on reducing patient discomfort that usually accompanies debonding ceramic brackets by delving into the science behind the use of lasers for this purpose.

Renomedullary Interstitial Cell Tumor in the Background of a Renal Oncocytoma: A Case Report.

Renomedullary interstitial cell tumors (RMICTs) are rare benign renal tumors that arise from the renal medulla. They are rarely symptomatic and are mostly discovered incidentally. Radiologically, their co-presence ipsilaterally in the background of a larger mass introduces a miscellaneous presentation that raises the suspicion of metastatic disease. A characteristic presentation does not exist. Therefore, an individualized, patient-centered approach should be tailored depending on the nature of the presentation. We report the clinical, radiological, and histopathological presentation of a 46-year-old woman presenting with an RMICT in the background of a renal oncocytoma.

Correction: Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City.

[This corrects the article DOI: 10.1371/journal.pone.0249292.].

An adaptable and personalized framework for top-N course recommendations in online learning.

In recent years, the proliferation of Massive Open Online Courses (MOOC) platforms on a global scale has been remarkable. Learners can now meet their learning demands with the help of MOOC. However, learners might not understand the course material well if they have access to a lot of information due to their inadequate expertise and cognitive ability. Personalized Recommender Systems (RSs), a cutting-edge technology, can assist in addressing this issue. It greatly increases resource acquisition through personalized availability for various people of all ages. Intelligent learning methods, such as machine learning and Reinforcement Learning (RL) can be used in RS challenges. However, machine learning needs supervised data and classical RL is not suitable for multi-task recommendations in online learning platforms. To address these challenges, the proposed framework integrates a Deep Reinforcement Learning (DRL) and multi-agent approach. This adaptive system personalizes the learning experience by considering key factors such as learner sentiments, learning style, preferences, competency, and adaptive difficulty levels. We formulate the interactive RS problem using a DRL-based Actor-Critic model named DRR, treating recommendations as a sequential decision-making process. The DRR enables the system to provide top-N course recommendations and personalized learning paths, enriching the student's experience. Extensive experiments on a MOOC dataset such as the 100 K Coursera course review validate the proposed DRR model, demonstrating its superiority over baseline models in major evaluation metrics for long-term recommendations. The outcomes of this research contribute to the field of e-learning technology, guiding the design and implementation of course RSs, to facilitate personalized and relevant recommendations for online learning students.

Factors Influencing the Preference of Medical Students at Umm Al-Qura University for Otorhinolaryngology-Head and Neck Surgery as a Future Specialty: A Cross-Sectional Study.

BACKGROUND: Otorhinolaryngology (ORL) specialists treat patients of different ages, ranging from elderly patients with head and neck tumors to neonates with respiratory problems. No studies have been conducted to explore the factors that affect the preference for ORL among Umm Al-Qura University students. We aimed to investigate factors and motivators influencing medical students at Umm Al-Qura University in Makkah, Saudi Arabia, who choose to pursue a career in ORL-head and neck surgery. METHODS AND MATERIALS: This cross-sectional study was conducted over two months in 2023 among 439 students in the pre-clinical, clinical, and internship years of the Faculty of Medicine at Umm Al-Qura University, Saudi Arabia. We shared a Google Forms questionnaire (Google, Inc., Mountain View, CA) and explored factors associated with interest in ear, nose, and throat (ENT) as a future specialty. We used Pearson's chi-square test to arrive at the results. RESULTS: A total of 339 (77.2%) participants were female. Participants were evenly divided between pre-clinical years (213 (48.5%)) and clinical years (207 (47.2%)), with a smaller percentage in the internship category (19 (4.3%)). ORL involvement was reported in 159 (36.2%) of the participants. CONCLUSION: The surgical specialty of ORL focuses mostly on conditions affecting the head, neck, nose, and ears. Since students found this specialty fascinating, we recommend that senior doctors make a greater effort to enlighten doctors-in-training about this field of expertise through lectures and campaigns at hospitals and universities.

Assessing the awareness, knowledge, and attitudes of adults in the general population in Saudi Arabia towards testicular torsion: A cross-sectional study.

Introduction: Testicular torsion (TT) is a rare but urgent condition; it leads to severe pain and swelling that must be diagnosed and treated immediately, where there is an expectant period of 6-8 h. It is an important prognostic factor in the arrival time to the emergency department. Raising awareness about TT is essential to ensure early diagnosis and timely treatment, which can prevent irreversible damage and loss of fertility. Aim: Our study aimed to measure the awareness, knowledge, and attitude toward testicular torsion (TT) among the general population in Saudi Arabia. Subject and Methods: This is a cross-sectional study conducted among the general population living in Saudi Arabia. A self-administered questionnaire was distributed among the population using an online survey. The questionnaire includes socio-demographic characteristics (i.e., age, gender, region, etc.), a questionnaire to assess the knowledge of testicular torsion, and questionnaires to assess the prevalence, management, and attitude toward testicular torsion. Results: Of the 473 participants, 56% were males, and 61% were aged between 18 to 30 years old. Unfortunately, One quarter of our population has a good knowledge level about testicular torsion. The overall mean knowledge about Testicular Torsion score was below average (3 out of 8 points). Factors associated with increased knowledge include younger age, male gender, living in the Central Region, working in the medical field, having heard of testicular torsion, and having a personal or family history of testicular torsion. Conclusion: In conclusion, there was a lack of testicular torsion knowledge among the general population. Further studies and social campaigns should be done to encourage the general population's understanding and increase their knowledge level.

ALL classification using neural ensemble and memetic deep feature optimization.

Acute lymphoblastic leukemia (ALL) is a fatal blood disorder characterized by the excessive proliferation of immature white blood cells, originating in the bone marrow. An effective prognosis and treatment of ALL calls for its accurate and timely detection. Deep convolutional neural networks (CNNs) have shown promising results in digital pathology. However, they face challenges in classifying different subtypes of leukemia due to their subtle morphological differences. This study proposes an improved pipeline for binary detection and sub-type classification of ALL from blood smear images. At first, a customized, 88 layers deep CNN is proposed and trained using transfer learning along with GoogleNet CNN to create an ensemble of features. Furthermore, this study models the feature selection problem as a combinatorial optimization problem and proposes a memetic version of binary whale optimization algorithm, incorporating Differential Evolution-based local search method to enhance the exploration and exploitation of feature search space. The proposed approach is validated using publicly available standard datasets containing peripheral blood smear images of various classes of ALL. An overall best average accuracy of 99.15% is achieved for binary classification of ALL with an 85% decrease in the feature vector, together with 99% precision and 98.8% sensitivity. For B-ALL sub-type classification, the best accuracy of 98.69% is attained with 98.7% precision and 99.57% specificity. The proposed methodology shows better performance metrics as compared with several existing studies.

Extracorporeal Membrane Oxygenation (ECMO) Use as Supportive Therapy in a Patient With Acute Respiratory Distress Syndrome Due to Rupture of a Pulmonary Hydatid Cyst.

Pulmonary echinococcosis is a parasitic infection that accounts for 20% of the infected cases with echinococcosis. Patients may present after a cyst rupture associated with a variety of complications, including acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is known as supportive therapy for patients with respiratory and cardiac failure, including ARDS associated with multiple causes. Parasitic infection associated with ARDS due to cyst rupture managed with ECMO as bridging to definitive surgical intervention is documented in two previous case reports only. Here, we are presenting a 21-year-old female with a pulmonary hydatid cyst complicated by ARDS and managed with ECMO.

The Utilization of Computed Tomography in the Pediatric Emergency Department for Patients With Ventriculoperitoneal Shunts.

Introduction Despite all the advantages of computed tomography (CT) scanning, there is a significant concern due to the rising use of CT scans in children with ventriculoperitoneal (VP) shunts. High doses of radiation are absorbed by patients, raising their chance of acquiring cancer. Evaluating a potential VP shunt malfunction is a frequent encounter in the pediatric emergency room, often necessitating the utilization of a CT scan. This study aims to recognize and quantify the utilization of CT scans in an emergency setting for pediatric patients with a clinical suspicion of VP shunt malfunction. Methods This retrospective chart review was conducted on patients who visited the emergency department with suspected VP shunt malfunction in a pediatric tertiary care hospital (King Abdullah Specialist Children Hospital), Riyadh, Saudi Arabia. The study included the files of children between the years 2018 and 2019. Results A total of 119 children were included; the main indication for VP shunt insertion was congenital hydrocephalus at 46.8% (n=52). The median number of CT scans done per patient was seven (IQR=3-9). CT findings were abnormal among 55.6% (n=60). The univariate analysis examining the impact of different factors on CT findings showed an association between an abnormal CT finding and female gender (P=0.017), younger age (P=0.03), and the presence of a cerebral cyst (P=0.001); however, subsequent multivariate analysis was not significant for any of these factors. Twenty-two point three percent (n=25) of the patients required neurosurgical intervention, and the associated factors with neurosurgical intervention included changes in activity level (P=0.04), weakness (P=0.004), and altered mental status (P=0.001). Conclusion Children with VP shunts are susceptible to significant radiation exposure through the utilization of CT scans whenever they present to the ER with suspected shunt malfunction during their lifespan, which puts them at risk of radiation-related complications, such as cancers. CT imaging remains a helpful tool aiding physicians in making accurate decisions. However, in this study, almost half of the children had unremarkable CT findings. Thus, it is imperative to rationalize its use by establishing tailored guidelines that delineate the appropriate circumstances warranting its application.

An ensemble computational model for prediction of clathrin protein by coupling machine learning with discrete cosine transform.

Clathrin protein (CP) plays a pivotal role in numerous cellular processes, including endocytosis, signal transduction, and neuronal function. Dysregulation of CP has been associated with a spectrum of diseases. Given its involvement in various cellular functions, CP has garnered significant attention for its potential applications in drug design and medicine, ranging from targeted drug delivery to addressing viral infections, neurological disorders, and cancer. The accurate identification of CP is crucial for unraveling its function and devising novel therapeutic strategies. Computational methods offer a rapid, cost-effective, and less labor-intensive alternative to traditional identification methods, making them especially appealing for high-throughput screening. This paper introduces CL-Pred, a novel computational method for CP identification. CL-Pred leverages three feature descriptors: Dipeptide Deviation from Expected Mean (DDE), Bigram Position Specific Scoring Matrix (BiPSSM), and Position Specific Scoring Matrix-Tetra Slice-Discrete Cosine Transform (PSSM-TS-DCT). The model is trained using three classifiers: Support Vector Machine (SVM), Extremely Randomized Tree (ERT), and Light eXtreme Gradient Boosting (LiXGB). Notably, the LiXGB-based model achieves outstanding performance, demonstrating accuracies of 94.63% and 93.65% on the training and testing datasets, respectively. The proposed CL-Pred method is poised to significantly advance our comprehension of clathrin-mediated endocytosis, cellular physiology, and disease pathogenesis. Furthermore, it holds promise for identifying potential drug targets across a spectrum of diseases.Communicated by Ramaswamy H. Sarma.

Glycemic Control in the era of bariatric surgery: A systematic review and meta-analysis of published studies on the Saudi-Arabian population.

We aim in our systematic review and meta-analysis to summarize and evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (RYGB) as two types of bariatric surgery in reducing the body mass index (BMI) and controlling the glycemic state in obese, diabetic patients. Our systematic review and meta-analysis (MA) were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for randomized studies. We searched PubMed, Web of Science, Scopus, and Cochrane library for included studies. We chose randomized controlled trials (RCTs) assessing the efficacy of LSG and RYGB in controlling the glycemic state in obese patients; then we used Review Manager software to pool the outcomes of our MA. Three RCTs were included in our meta-analysis. The outcomes evaluated were BMI and HbA1C. As for the BMI, the results were significant and favor LSG and RYGB post-operatively as follows: mean difference (MD) 0.30; confidence interval (CI) 0.07-0.54; P value 0.010. Also, the results were significant regarding HbA1C as follows: MD 0.30; CI 0.07-0.54; P value 0.010. Bariatric surgeries, especially LSG and RYGB, improve the glycemic state and reduce BMI in obese diabetic patients.

How frequently MRI modifies thoracolumbar fractures' classification or decision-making? A systematic review and meta-analysis.

PURPOSE: To provide the first meta-analysis of the impact of magnetic resonance imaging (MRI) on thoracolumbar fractures (TLFs) classification and decision-making. METHODS: A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, Cochrane, and Web of Science from inception to June 30, 2023 for studies evaluating the change in TLFs classification and treatment decisions after MRI. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the pooled frequency of change in AO fracture classification or treatment decisions from surgical to conservative or vice versa after MRI. RESULTS: This meta-analysis included four studies comprising 554 patients. The pooled frequency of change in TLFs classification was 17% (95% CI 9-31%), and treatment decision was 22% (95% CI 11-40%). An upgrade from type A to type B was reported in 15.7% (95% CI 7.2-30.6%), and downgrading type B to type A in 1.2% (95% CI 0.17-8.3%). A change from conservative to surgery recommendation of 17% (95% CI 5.0-43%) was higher than a change from surgery to conservative 2% (95% CI 1-34%). CONCLUSIONS: MRI can significantly change the thoracolumbar classification and decision-making, primarily due to upgrading type A to type B fractures and changing from conservative to surgery, respectively. These findings suggest that MRI could change decision-making sufficiently to justify its use for TLFs. Type A subtypes, indeterminate PLC status, and spine regions might help to predict a change in TLFs' classification. However, more studies are needed to confirm the association of these variables with changes in treatment decisions to set the indications of MRI in neurologically intact patients with TLFs. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mri_spine/ .

Image synthesis of apparel stitching defects using deep convolutional generative adversarial networks.

In industrial manufacturing, the detection of stitching defects in fabric has become a pivotal stage in ensuring product quality. Deep learning-based fabric defect detection models have demonstrated remarkable accuracy, but they often require a vast amount of training data. Unfortunately, practical production lines typically lack a sufficient quantity of apparel stitching defect images due to limited research-industry collaboration and privacy concerns. To address this challenge, this study introduces an innovative approach based on DCGAN (Deep Convolutional Generative Adversarial Network), enabling the automatic generation of stitching defects in fabric. The evaluation encompasses both quantitative and qualitative assessments, supported by extensive comparative experiments. For validation of results, ten industrial experts marked 80% accuracy of the generated images. Moreover, Fréchet Inception Distance also inferred promising results. The outcomes, marked by high accuracy rate, underscore the effectiveness of proposed defect generation model. It demonstrates the ability to produce realistic stitching defective data, bridging the gap caused by data scarcity in practical industrial settings.

Satisfaction Rate After Laser Correction of Presbyopia (Presbyond) Among Patients Aged 40 Years and Older in Taif, Saudi Arabia.

Background Presbyopia is a physiological condition arising due to the loss of accommodation within the crystalline lens. One of the most widely accepted theories of the mechanism of accommodation was that in response to ciliary muscle contraction, the crystalline lens thickness increases, the lens diameter decreases, and both the anterior and posterior curvature of the lens increase, resulting in an increase in lenticular power therefore, accommodation. A contrasting theory suggests that ciliary muscle contraction leads to a selective increase in equatorial zonular tension, with the lens equator moving toward the sclera and the equatorial diameter of the lens increasing. This results in a change of lens optical power. Until now, clinical approaches to correct presbyopia have included monovision, multifocality, and extended depth of focus, all three of which can be achieved surgically on the cornea or by lens surgery. Methods This was a cross-sectional study adopted among patients who had Presbyond surgery in Taif City, Saudi Arabia, and were aged 40 years and older. The data was collected by conducting phone interviews to increase the response rate with a prepared questionnaire that was studied to achieve equality between participants to determine whether they were satisfied or not about the results after this surgery. The contact information was retrieved based on hospital records about patients who underwent Presbyond surgery. Data was analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). The data was collected for the period beginning on the first of January 2019 until the first of February 2023. Results From the study findings, a significant number of participants (28.1%, n=25) reported experiencing complete improvement and returning to normal life within 1-30 days after surgery. A slightly larger percentage (39.2%, n=35) experienced this within 1-3 months. Most of the participants (80.9%, n=72) reported an overall improvement in their quality of life after the surgery. This included activities such as reading and using a mobile phone. This indicates that the surgery had a positive impact on their daily lives and activities. In terms of recommendations, a total of 49 (55.1%, n=49) participants stated that they were very likely to recommend refractive surgery to a family member or friend experiencing vision problems. The study found that the mean patients' satisfaction score after one month of surgery is 2.494 units higher than the mean satisfaction score before surgery. This difference was statistically significant (p < .001). Conclusion The majority of participants did not experience any problems during the surgery, and most were able to resume their normal activities within a relatively brief period of time. The surgery achieved its goals for the majority of participants, resulting in an improvement in their quality of life. However, some short-term discomfort or adjustment period was reported. Overall, the participants were satisfied with the surgery, with the majority being very likely to recommend it to others. There is room for improvement in addressing concerns such as blurred vision, the need for glasses, and dry eyes. The study also found that patient satisfaction increased significantly after one month of surgery, and the timing of complete improvement and perception of achieving surgical goals were strongly associated with perceived outcomes.

Healthcare Quality from the Perspective of Patients in Gulf Cooperation Council Countries: A Systematic Literature Review.

With the increased focus on patient-centered care, consensus on healthcare outcomes of importance to patients becomes crucial. Based on a systematic review of the literature, this study confirms the perspectives of patients on healthcare quality in GCC countries. Online databases were searched for relevant peer-reviewed articles published from 2012 to 2023. Twenty-two articles retrieved from the search were qualitatively analyzed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Most articles (90%) reported studies conducted in Saudi Arabia. Patients in GCC countries face common problems in the care delivery process, which contribute to negative perceptions of quality. These problems include diagnostic and medication errors, provider-patient communication problems, missed appointments with physicians, problems in emergency care access due to geographical distance and transportation barriers, long waiting times, and physical environments. Notably, healthcare quality is perceived to be an outcome of multiple factors dependent on the location and category of healthcare service providers; for instance, disparities in perceptions of quality were observed between patients attending Primary Health Care (PHC) centers in rural and urban areas. Issues such as lack of equitable healthcare delivery and deficiencies in Emergency Medical Services (EMS) effectiveness were disparately recognized as quality concerns by different patient populations. The findings provide insights into healthcare quality and area of weakness needing strategies and policies to ensure patient-centered, safe, equitable, timely, and effective healthcare. Healthcare providers and policymakers in GCC countries can use the results to plan, assess, and improve care delivery. Trial registration: PROSPERO ID: CRD42022326842.

Phase II Trial of FOLFIRINOX in Advanced Biliary Tract Cancer.

INTRODUCTION: Biliary tract cancers (BTCs), characterized by poor prognosis and limited treatment options, are increasingly prevalent malignancies with a five-year survival rate of less than 20% for advanced-stage disease. The standard first-line chemotherapy combining gemcitabine and cisplatin offers modest survival benefits, necessitating the exploration of more effective therapies. This study reports the results of a single-arm, open-label, phase 2 trial assessing the efficacy and safety of fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) as a first-line treatment for metastatic or locally advanced unresectable BTC. METHODS: Patients aged ≥18 with measurable disease and adequate organ function were enrolled, receiving biweekly FOLFIRINOX for up to 12 cycles with follow-up imaging every four cycles. The primary endpoint was the overall response rate (ORR), with progression-free survival (PFS), overall survival (OS), and safety as secondary endpoints. RESULTS: Thirteen patients were enrolled from December 2016 to September 2021 before early termination due to slow accrual and the emergence of immunotherapy. The ORR was 54%, with a disease control rate of 77%. Median PFS and OS were 6.8 and 19.25 months, respectively. Grade 3/4 toxicities were predominantly hematologic, with neutropenia being the most common severe adverse event. CONCLUSION: The trial suggests that FOLFIRINOX is a potentially effective first-line therapy for unresectable or metastatic BTC with a manageable safety profile. However, the early termination of the study and the introduction of immunotherapy warrant further research to confirm these findings.

Perceptions of Schoolteachers About Teledentistry Use in Makkah City.

OBJECTIVES: Teledentistry is a combination of communication technology and dentistry. Teledentistry is an alternative and useful way to remotely provide advisory, preventive, and emergency services in places with poor access to dental care. Few studies in Saudi have investigated the implementation of teledentistry at schools or assessed the perceptions of school personnel. This research aimed to evaluate teachers' perceptions about the use of teledentistry to examine schoolchildren in Makkah city. METHODS:  The study was conducted on 20 intermediate schools randomly selected from different regions of Makkah city using a multistage cluster sampling method. Two data collectors visited the schools to administer the study questionnaire, exploring teachers' perceptions of teledentistry. The questionnaire was adapted from a validated survey based on the technology acceptance model (TAM). Descriptive statistics, analysis of variance, Mann-Whitney U test, and the Kruskal-Wallis tests were conducted to compare the mean differences in participants' perceptions of teledentistry based on their demographics. RESULTS:  A total of 241 teachers completed the survey, 131 of whom were females (54.4%), and the mean age of participants was 42.5±7 years. Over 80% of participants taught ≥16 classes a week, and their experience ranged from less than a year to more than 31 years. Sixty participants (25%) knew teledentistry before watching the study video. The results revealed a significant difference between male and female teachers regarding perceptions of teledentistry. Female participants had higher scores in TAM dimensions than males. CONCLUSION:  This survey revealed a generally favorable attitude toward teledentistry utilization in schools. Including non-dental employees, such as teachers to provide such a service will assist in alleviating the shortage or unavailability of dentists at schools. This goes in line with the government's plans to promote telehealth as part of the Saudi Vision 2030.