The Accuracy of Cone Beam Computed Tomography Scans in Determining the Working Length in Teeth Requiring Non-surgical Endodontic Treatment: A Retrospective Clinical Study.

BACKGROUND: Endodontic treatment aims to eradicate both microbial infection and inflammatory processes within the root canal space as well as in the periapical (PA) region of the tooth. To achieve this, the canals should be cleaned, shaped, disinfected, and obturated to the proper working length. Clinically, the working length is described as the measurement from the coronal reference point to the physiological apex located at the apical foramen. In the available literature, electronic apex locators (EAL) with periapical (PA) radiographs are the most reliable and precise tools for determining the working length in routine root canal treatment. Therefore, the aim of this retrospective clinical study is to evaluate if cone beam computed tomography (CBCT) scans are reliable and accurate in measuring endodontic working length compared to standard clinical measurement methods. METHODS: Patients who fit the inclusion criteria were identified. A postgraduate endodontic resident blinded to the cone beam computed tomography scan results treated all teeth in the field of view that needed endodontic treatment. The root canal length was determined using J Morita Root ZX II apex locator (J Morita Corp., Kyoto, Japan) and periapical radiographs. The dental radiology specialist interpreted the pre-existing cone beam computed tomography (CBCT) scan images and determined the working length. Statistical comparisons of the working length measurements of EAL and CBCT were performed using paired sample t-tests after verifying normality. RESULTS: No statistically significant differences in the working lengths were found in all canals with the exception of the palatal canal only (t=2.16, p=0.034), suggesting consistent measurements between EAL and CBCT. CONCLUSION: In teeth requiring endodontic treatment, pre-existing cone beam computed tomography scan images are accurate as electronic apex locators when determining the working length. A limitation of this study is that it only includes a limited number of samples and is affected by operator variation.

Impact of Breathing Control Training Program on sonographic quantification of abdominal vasculature.

OBJECTIVES: To compare vascular scanning parameters (vessel diameter, peak systolic velocity, end-diastolic velocity, and resistive index) and scanning time before and after breathing control training program for selected abdominal vessels. METHODS: This study was pre and post quasi-experimental. The researchers designed a breathing training program that gives participants instructions through a video describing breathing maneuvers. Data were collected at the ultrasound laboratory/College of Health and Rehabilitation Sciences in Princess Nourah bint Abdul Rahman University, Riyadh, Saudi Arabia from January 2023 to November 2023. About 49 volunteers at the university participated in the study. Scanning was performed two times for the right renal artery, upper abdominal aorta, inferior vena cava, and superior mesenteric artery. Scanning time was measured before and after the program as well. A paired sample t-test was used to compare the parameters means and time before and after the program. RESULTS: The program had a significant effect on the following parameters: right renal artery peak systolic velocity (p=0.042), upper abdominal aortic peak systolic velocity, and resistive index (p=0.014, p=0.014 respectively), superior mesenteric artery and inferior vena cava diameters (p=0.010 and p=0.020). The scanning time was reduced significantly (p<0.001). CONCLUSION: The breathing training program saves time and improves ultrasound measurement quality. Hospitals and health centers should consider the importance of breathing control training programs before abdominal scanning.

Utilizing Artificial Intelligence Among Patients With Diabetes: A Systematic Review and Meta-Analysis.

Diabetes mellitus, a condition characterized by dysregulation of blood glucose levels, poses significant health challenges globally. This meta-analysis and systematic review aimed to evaluate the effectiveness of artificial intelligence (AI) in managing diabetes, underpinned by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review scrutinized articles published between January 2019 and February 2024, sourced from six electronic databases: Web of Science, Google Scholar, PubMed, Cochrane Library, EMBASE, and MEDLINE, using keywords such as "Artificial intelligence use in medicine, Diabetes management, Health technology, Machine learning, Diabetic patients, AI applications, and Health informatics." The analysis revealed a notable variance in the prevalence of diabetes symptoms between patients managed with AI models and those receiving standard treatments or other machine learning models, with a risk ratio (RR) of 0.98 (95% CI: 0.88-1.08, I2 = 0%). Sub-group analyses, focusing on symptom detection and management, consistently showed outcomes favoring AI interventions, with RRs of 0.97 (95% CI: 0.87-1.08, I2 = 0%) for symptom detection and 0.97 (95% CI: 0.56-1.57, I2 = 0%) for management, respectively. The findings underscore the potential of AI in enhancing diabetes care, particularly in early disease detection and personalized lifestyle recommendations, addressing the significant health risks associated with diabetes, including increased morbidity and mortality. This study highlights the promising role of AI in revolutionizing diabetes management, advocating for its expanded use in healthcare settings to improve patient outcomes and optimize treatment efficacy.

Knowledge of Thyroid Disease Manifestation and Risk Factors Among the General Population in the Tabuk Region of Saudi Arabia.

Background Thyroid disorders are caused either by excessive or inadequate thyroid hormone production or by the enlargement of the thyroid gland. Various types of thyroid disorders exist, including primary (related directly to the gland itself), secondary (related to thyroid function), and other types. This study aimed to assess the knowledge of thyroid disease manifestation and its risk factors among individuals living in Tabuk, Saudi Arabia. Methodology An observational cross-sectional study was conducted among 400 adults living in Tabuk city of Saudi Arabia aged 18 years or above. Data was collected using an electronic questionnaire through a simple random sampling method. Data was then coded, entered, and analyzed using both descriptive and inferential statistical methods using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results A total of 403 participants were enrolled in this study. More than half (n=265, 65.8%) were females, and 188 (46.7%) were in the age group of 18-35 years. The educational level of the majority of them was a bachelor's degree (n=296, 73.4%). Hypothyroidism was the most common thyroid disorder among family members (n=51, 62.4%). Inadequate iodine intake was thought to be a risk factor for thyroid disorders, as mentioned by 276 (68.5%) participants. Exact 284 (70.5%) participants believed that females are more at risk of having thyroid disease. The mean total knowledge score was found to be 25.1±4.48 out of a total of 34. Exact 216 (53.6%) participants had good knowledge about thyroid disorders. The female gender had significantly higher levels of knowledge as compared to males (p-value=0.002) regarding the manifestation and risk factors of thyroid disorders. In terms of educational level, a bachelor's or above was found to be significantly associated with a higher level of knowledge (p-value=0.003). Conclusion A good level of knowledge and awareness about thyroid disorders was observed among more than half of the participants. Few knowledge gaps were identified regarding knowledge about symptoms of hypothyroidism and certain medications which might cause thyroid disorders.

Public Views About Cosmetic Procedures in Riyadh, Saudi Arabia.

Background In the past decade, there has been a clear, massive increase in the number of patients undergoing cosmetic procedures in Riyadh, Saudi Arabia. This study aims to compare the demographic characteristics of patients in Riyadh undergoing cosmetic procedures. Methodology This is an analytical, observational, and cross-sectional study used to seek the public views about cosmetic procedures in Riyadh, Saudi Arabia using the snowball sampling technique. A self-administered questionnaire was distributed electronically among the target population via social media. The questionnaire was pre-tested in a pilot study of 10 individuals to ensure comprehension and ease of administration and to determine the time needed to complete it. The final adjustments were made after the pilot study. Statistical analysis was performed using SPSS Statistics version 25.0 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Results In the current study, we were able to collect the data from 600 participants, of whom females represented 527 (87.8%) of the sample. Satisfaction with their current physical appearance (370, 61.7%), financial factors (73, 12.2%), and fear of having the procedure (59, 9.8%) were the main reasons for refusing to undergo cosmetic procedures, while pleasing themselves (432, 72.1%), influence from others who have undergone cosmetic procedures (188, 31.4%), and personal dislike of one's appearance (184, 30.7%) were the main reasons for conducting cosmetic procedures. Firstly, gender showed a significant relationship with having undergone a cosmetic procedure (p-value = 0.018), with 9 (12.3%) of males and 131 (24.9%) of females reporting having undergone such a procedure. Age also played a role, with the 29-39 age group having the highest number of individuals (31.9%) who had undergone a cosmetic procedure. Conclusion This study provides valuable insights into the demographic characteristics, attitudes, and perceptions surrounding cosmetic procedures in Riyadh. The findings highlight the influence of cultural expectations, self-acceptance, social factors, and media on individuals' motivations and decision-making processes. The increasing acceptability of cosmetic interventions and the rising demand for aesthetic modifications in the locality suggest a shifting societal landscape.

Comparing the prevalence of impacted teeth through radiographic evidence among orthodontic and general populations: A secondary data analysis.

Introduction: There is noticeable variability in reporting the prevalence of impacted teeth, which can be attributed to the variability in the age, gender, and type of populations investigated. Materials and Methods: Panoramic radiographs were examined retrospectively for patients who attended dental clinics at King Abdulaziz Medical City and the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Riyadh, Saudi Arabia. The sampling frame for the orthodontic population included digital records of 2998 patients randomly selected from an original 8000 patients treated from 2016 to 2022 in the orthodontic clinic. For the general population, 3002 patients were randomly selected from an original 15000 patients treated at the dental college from 2016 to 2022. A tooth was considered impacted if it failed to erupt after two years of the expected complete root formation. Results: The prevalence of at least a single impacted tooth was higher in the orthodontic population (13.2 %) than in the general population (11.2 %). However, this difference was not statistically significant, p = 0.103. The orthodontic population had a significantly higher prevalence of impacted #13, #11,#23,#25. In contrast, the general population had a significantly higher prevalence of all third molars impaction (p < 0.005). Conclusion: Although the prevalence of at least a single tooth impaction between the orthodontic and general populations was not significantly different, the type of teeth differs. Hence, understanding the type of population investigated while reporting the prevalence of impacted teeth is critical in understanding the variability between different reports.

A Study on Renal Failure Management in Patients Diagnosed With Multiple Myeloma.

BACKGROUND: Renal impairment, often occurring as a result of multiple myeloma, poses a significant risk to patient health and quality of life. Therefore, the study was conducted with the objective of investigating the management of renal failure in patients diagnosed with multiple myeloma in Saudi Arabia. METHODS: A retrospective observational study was conducted during the period from January to August 2023 for the duration of eight months. The data were collected from the patients diagnosed with multiple myeloma, available from the medical records of Prince Sultan Military Medical City, Saudi Arabia. RESULTS: The data were collected from a cohort of 85 patients with multiple myeloma. Among patients, males were 62 (72.94%), and females were 23 (27.06%). The mean (SD) age was 68.43 (7.24) years. Among the cohort, 42 (49.1%) were International Staging System (ISS) stage III, and 32 (37.6%) were light chain myeloma. Most patients underwent novel agent-based treatment regimens (a combination of immunomodulator, proteasome inhibitor, and monoclonal antibody; 59, 69.41%), followed by conventional therapy; 16, 18.82%). Multivariate analysis of patient survival showed significant associations with three variables: increased calcium level (P=0.007), eGFR <30 mL/min (P=0.004), and novel agent induction (P=0.001). CONCLUSION: This study sheds light on the intricate management of renal failure in multiple myeloma patients, specifically within the Saudi population. The observed associations between survival and various variables emphasize the critical role of renal function in overall patient outcomes.

Identification of Gut Microbiota Profile Associated with Colorectal Cancer in Saudi Population.

Colorectal cancer (CRC) is a significant global health concern. Microbial dysbiosis and associated metabolites have been associated with CRC occurrence and progression. This study aims to analyze the gut microbiota composition and the enriched metabolic pathways in patients with late-stage CRC. In this study, a cohort of 25 CRC patients diagnosed at late stage III and IV and 25 healthy participants were enrolled. The fecal bacterial composition was investigated using V3-V4 ribosomal RNA gene sequencing, followed by clustering and linear discriminant analysis (LDA) effect size (LEfSe) analyses. A cluster of ortholog genes' (COG) functional annotations and the Kyoto Encyclopedia of Genes and Genomes (KEGG) were employed to identify enrichment pathways between the two groups. The findings showed that the fecal microbiota between the two groups varied significantly in alpha and beta diversities. CRC patients' fecal samples had significantly enriched populations of Streptococcus salivarius, S. parasanguins, S. anginosus, Lactobacillus mucosae, L. gasseri, Peptostreptococcus, Eubacterium, Aerococcus, Family XIII_AD3001 Group, Erysipelatoclostridium, Escherichia-Shigella, Klebsiella, Enterobacter, Alistipes, Ralstonia, and Pseudomonas (Q < 0.05). The enriched pathways identified in the CRC group were amino acid transport, signaling and metabolism, membrane biogenesis, DNA replication and mismatch repair system, and protease activity (Q < 0.05). These results suggested that the imbalance between intestinal bacteria and the elevated level of the predicated functions and pathways may contribute to the development of advanced CRC tumors. Further research is warranted to elucidate the exact role of the gut microbiome in CRC and its potential implications for use in diagnostic, prevention, and treatment strategies.

The effect of poor glycemic control on cognitive function in children and adolescents with type 1 diabetes mellitus: A single-center cross-sectional study (2019-2020).

OBJECTIVES: To investigate the effect of chronic hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA) on the cognitive function of children and adolescents with type 1 diabetes mellitus (T1DM), and explore whether early disease onset correlated with cognitive impairment. METHODS: Children and adolescents with T1DM who attended the Pediatric Diabetes Clinic between January 2019 and 2020, aged between 5-14 years, with a mean of 3 glycated hemoglobin (HbA1c) readings ≥7% (53 mmol/mol) during the study period reflecting a hyperglycemic status and who agreed to participate were interviewed about their history of hypoglycemia and DKA. Participants were personally interviewed by a clinical psychologist to assess their cognitive function using a validated Arabic version of the Stanford-Binet test. RESULTS: Higher mean HbA1c levels were associated with cognitive dysfunction in three verbal domains: fluid reasoning, quantitative reasoning, and working memory. Frequent hypoglycemia negatively affected verbal knowledge. In contrast, significant hypoglycemia affected both verbal and nonverbal domains of cognition, specifically verbal and nonverbal fluid reasoning, knowledge, and working memory. Children with recurrent DKA performed below average in nonverbal fluid reasoning tasks. Additionally, moderate or severe DKA, regardless of its frequency, affected children's overall intelligence quotient. CONCLUSION: Regardless of disease onset, exposure to glycemic variability subjects children and adolescents to subtle and measurable cognitive dysfunction resulting in significant morbidity.

Green-Mediated Synthesis of NiCo2O4 Nanostructures Using Radish White Peel Extract for the Sensitive and Selective Enzyme-Free Detection of Uric Acid.

The ability to measure uric acid (UA) non-enzymatically in human blood has been demonstrated through the use of a simple and efficient electrochemical method. A phytochemical extract from radish white peel extract improved the electrocatalytic performance of nickel-cobalt bimetallic oxide (NiCo2O4) during a hydrothermal process through abundant surface holes of oxides, an alteration of morphology, an excellent crystal quality, and increased Co(III) and Ni(II) chemical states. The surface structure, morphology, crystalline quality, and chemical composition were determined using a variety of analytical techniques, including powder X-ray diffraction (XRD), scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HR-TEM), and X-ray photoelectron spectroscopy (XPS). The electrochemical characterization by CV revealed a linear range of UA from 0.1 mM to 8 mM, with a detection limit of 0.005 mM and a limit of quantification (LOQ) of 0.008 mM. A study of the sensitivity of NiCo2O4 nanostructures modified on the surface to UA detection with amperometry has revealed a linear range from 0.1 mM to 4 mM for detection. High stability, repeatability, and selectivity were associated with the enhanced electrochemical performance of non-enzymatic UA sensing. A significant contribution to the full outperforming sensing characterization can be attributed to the tailoring of surface properties of NiCo2O4 nanostructures. EIS analysis revealed a low charge-transfer resistance of 114,970 Ohms that offered NiCo2O4 nanostructures prepared with 5 mL of radish white peel extract, confirming an enhanced performance of the presented non-enzymatic UA sensor. As well as testing the practicality of the UA sensor, blood samples from human beings were also tested for UA. Due to its high sensitivity, stability, selectivity, repeatability, and simplicity, the developed non-enzymatic UA sensor is ideal for monitoring UA for a wide range of concentrations in biological matrixes.

Advanced Urea Precursors Driven NiCo2O4 Nanostructures Based Non-Enzymatic Urea Sensor for Milk and Urine Real Sample Applications.

The electrochemical performance of NiCo2O4 with urea precursors was evaluated in order to develop a non-enzymatic urea sensor. In this study, NiCo2O4 nanostructures were synthesized hydrothermally at different concentrations of urea and characterized using scanning electron microscopy and X-ray diffraction. Nanostructures of NiCo2O4 exhibit a nanorod-like morphology and a cubic phase crystal structure. Urea can be detected with high sensitivity through NiCo2O4 nanostructures driven by urea precursors under alkaline conditions. A low limit of detection of 0.05 and an analytical range of 0.1 mM to 10 mM urea are provided. The concentration of 006 mM was determined by cyclic voltammetry. Chronoamperometry was used to determine the linear range in the range of 0.1 mM to 8 mM. Several analytical parameters were assessed, including selectivity, stability, and repeatability. NiCo2O4 nanostructures can also be used to detect urea in various biological samples in a practical manner.

Green Synthesis of NiO Nanoflakes Using Bitter Gourd Peel, and Their Electrochemical Urea Sensing Application.

To determine urea accurately in clinical samples, food samples, dairy products, and agricultural samples, a new analytical method is required, and non-enzymatic methods are preferred due to their low cost and ease of use. In this study, bitter gourd peel biomass waste is utilized to modify and structurally transform nickel oxide (NiO) nanostructures during the low-temperature aqueous chemical growth method. As a result of the high concentration of phytochemicals, the surface was highly sensitive to urea oxidation under alkaline conditions of 0.1 M NaOH. We investigated the structure and shape of NiO nanostructures using powder X-ray diffraction (XRD) and scanning electron microscopy (SEM). In spite of their flake-like morphology and excellent crystal quality, NiO nanostructures exhibited cubic phases. An investigation of the effects of bitter gourd juice demonstrated that a large volume of juice produced thin flakes measuring 100 to 200 nanometers in diameter. We are able to detect urea concentrations between 1-9 mM with a detection limit of 0.02 mM using our urea sensor. Additionally, the stability, reproducibility, repeatability, and selectivity of the sensor were examined. A variety of real samples, including milk, blood, urine, wheat flour, and curd, were used to test the non-enzymatic urea sensors. These real samples demonstrated the potential of the electrode device for measuring urea in a routine manner. It is noteworthy that bitter gourd contains phytochemicals that are capable of altering surfaces and activating catalytic reactions. In this way, new materials can be developed for a wide range of applications, including biomedicine, energy production, and environmental protection.

Biogenic Preparation of ZnO Nanostructures Using Leafy Spinach Extract for High-Performance Photodegradation of Methylene Blue under the Illumination of Natural Sunlight.

To cope with environmental pollution caused by toxic emissions into water streams, high-performance photocatalysts based on ZnO semiconductor materials are urgently needed. In this study, ZnO nanostructures are synthesized using leafy spinach extract using a biogenic approach. By using phytochemicals contained in spinach, ZnO nanorods are transformed into large clusters assembled with nanosheets with visible porous structures. Through X-ray diffraction, it has been demonstrated that leafy spinach extract prepared with ZnO is hexagonal in structure. Surface properties of ZnO were altered by using 10 mL, 20 mL, 30 mL, and 40 mL quantities of leafy spinach extract. The size of ZnO crystallites is typically 14 nanometers. In the presence of sunlight, ZnO nanostructures mineralized methylene blue. Studies investigated photocatalyst doses, dye concentrations, pH effects on dye solutions, and scavengers. The ZnO nanostructures prepared with 40 mL of leafy spinach extract outperformed the degradation efficiency of 99.9% for the MB since hydroxyl radicals were primarily responsible for degradation. During degradation, first-order kinetics were observed. Leafy spinach extract could be used to develop novel photocatalysts for the production of solar hydrogen and environmental hydrogen.

Copper II Complexes Based on Benzimidazole Ligands as a Novel Photoredox Catalysis for Free Radical Polymerization Embedded Gold and Silver Nanoparticles.

The copper II complex's novel benzimidazole Schiff base ligands were manufactured and gauged as a new photoredox catalyst/photoinitiator amalgamated with triethylamine (TEA) and iodonium salt (Iod) for the polymerization of ethylene glycol diacrylate while exposed to visible light by an LED Lamp at 405 nm with an intensity of 543 mW/cm2 at 28 °C. Gold and silver nanoparticles were obtained through the reactivity of the copper II complexes with amine/Iod salt. The size of NPs was around 1-30 nm. Lastly, the high performance of copper II complexes for photopolymerization containing nanoparticles is presented and examined. Ultimately, the photochemical mechanisms were observed using cyclic voltammetry. The preparation of the polymer nanocomposite nanoparticles in situ was photogenerated during the irradiation LED at 405 nm with an intensity of 543 mW/cm2 at 28 °C process. UV-Vis, FTIR, and TEM analyses were utilized for the determination of the generation of AuNPs and AgNPs which resided within the polymer matrix.

A Propensity-Matched Cohort Assessing Impact of a Neutralizing Monoclonal Antibody in Mild-to-Moderate Coronavirus Disease 2019.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoaV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic. In randomized clinical trials, patients who were treated with the anti-spike monoclonal antibody bamlanivimab had fewer COVID-19-related hospitalizations or emergency department (ED) visits than the control group. Methods: A retrospective cohort was assembled across a multisite healthcare system between November 20, 2020 and March 31, 2021. Ambulatory COVID-19 patients treated with bamlanivimab (n = 209) were propensity score matched without replacement (1:1) to a pool of 1024 eligible control patients who received similar care without bamlanivimab. The primary endpoint was all-cause mortality or admission at 30 days. Secondary endpoints included hospitalization, critical care admission, oxygenation requirements, and infusion-related reactions. Propensity score matching (PSM) analysis was used to assess the effect of bamlanivimab infusion on the composite endpoint and secondary endpoints. Results: A total of n = 209 matched patients were included in each arm of the study. The absolute standardized difference (stddiff) was calculated and indicated a balance between the groups. Almost all variables had a stddiff of less than 0.10, except for respiratory rate (RR) (stddiff = -0.11). For the primary composite endpoint of the matched cohort, 10.1% (n = 21) of patients in the intervention group were hospitalized or deceased within 30-day postbamlanivimab infusion versus 27.8% (n = 58) in the control group (adjusted odds ratio [aOR]: 0.29, 95% confidence interval [CI]: 0.17 to 0.51, P < .001). Conclusion: Patients with ambulatory COVID-19 who received bamlanivimab in the outpatient setting had a statistically significant reduction on the odds of admission postinfusion. Despite bamlanivimab's lack of efficacy on newer SARS-CoV-2 variants, this study demonstrates that neutralizing monoclonal antibodies can be effective against specific variants. If variant identification becomes a more accessible tool in outpatient centers or EDs, more targeted therapeutic options may be considered.

Study protocol of a randomized controlled trial of fistula vs. graft arteriovenous vascular access in older adults with end-stage kidney disease on hemodialysis: the AV access trial.

BACKGROUND: Treatment of end-stage kidney disease (ESKD) with hemodialysis requires surgical creation of an arteriovenous (AV) vascular access-fistula (AVF) or graft (AVG)-to avoid (or limit) the use of a central venous catheter (CVC). AVFs have long been considered the first-line vascular access option, with AVGs as second best. Recent studies have suggested that, in older adults, AVGs may be a better strategy than AVFs. Lacking evidence from well-powered randomized clinical trials, integration of these results into clinical decision making is challenging. The main objective of the AV Access Study is to compare, between the two types of AV access, clinical outcomes that are important to patients, physicians, and policy makers. METHODS: This is a prospective, multicenter, randomized controlled trial in adults ≥ 60 years old receiving chronic hemodialysis via a CVC. Eligible participants must have co-existing cardiovascular disease, peripheral arterial disease, and/or diabetes mellitus; and vascular anatomy suitable for placement of either type of AV access. Participants are randomized, in a 1:1 ratio, to a strategy of AVG or AVF creation. An estimated 262 participants will be recruited across 7 healthcare systems, with average follow-up of 2 years. Questionnaires will be administered at baseline and semi-annually. The primary outcome is the rate of CVC-free days per 100 patient-days. The primary safety outcome is the cumulative incidence of vascular access (CVC or AV access)-related severe infections-defined as access infections that lead to hospitalization or death. Secondary outcomes include access-related healthcare costs and patients' experiences with vascular access care between the two treatment groups. DISCUSSION: In the absence of studies using robust and unbiased research methodology to address vascular access care for hemodialysis patients, clinical decisions are limited to inferences from observational studies. The goal of the AV Access Study is to generate evidence to optimize vascular access care, based on objective, age-specific criteria, while incorporating goals of care and patient preference for vascular access type in clinical decision-making. TRIAL REGISTRATION: This study is being conducted in accordance with the tenets of the Helsinki Declaration, and has been approved by the central institutional review board (IRB) of Wake Forest University Health Sciences (approval number: 00069593) and local IRB of each participating clinical center; and was registered on Nov 27, 2020, at ClinicalTrials.gov (NCT04646226).

Factors associated with completeness in documentation of diagnostic work-up and treatment in patients with breast cancer in Sudan.

Purpose: This study evaluates the relationship between geography and ethnicity on the completeness of documentation of diagnostic work-up and treatment modalities in Sudan for patients with breast cancer. Methods: This retrospective study used data abstracted from patients with breast cancer receiving cancer care at Sudan's largest cancer centre (Radiation and Isotopes Center Khartoum) in 2017. Patient demographic and clinical characteristics were abstracted from paper medical records. Odds ratios and 95% confidence intervals were estimated to evaluate complete diagnostic work-up on ethnic group, origin and residence using binomial logistic regression models. Results: Of 237 patients, the median age was 52 (interquartile range 43-61). Most often patients identified as Arab (68%), originated from Central, Northeastern and Khartoum regions (all 28%) and lived in the Khartoum region (52%). Overall, 49% had incomplete diagnostic work-up, with modest differences by ethnicity and geography. In adjusted analyses, non-statistical differences were found between the ethnic group, geographic origin and residence and having complete diagnostic work-up. For treatment modality, significant differences were observed between receptor status and receiving hormone therapy (p = 0.004). Only 28% of patients with HR+ breast cancer received hormonal therapy. For those with HR- or undocumented breast cancer subtype, 36% and 17% received hormone therapy, respectively. Conclusion: Approximately half of Sudanese patients with breast cancer had incomplete diagnostic work-up, irrespective of ethnicity and geography. Moreover, a high proportion of patients received inappropriate treatment. This underlines a considerable systems-based quality gap in care delivery, demanding efforts to improve diagnostic work-up for all patients with breast cancer in Sudan.

Knowledge and Awareness Regarding Bell's Palsy in the Al-Qassim Region, Saudi Arabia.

Introduction: Bell's palsy, characterized by acute onset unilateral facial weakness, is caused by the paralysis of the seventh cranial nerve, which controls the muscles of the face. This condition can result in functional disabilities, and early detection and management are crucial for quick recovery. Awareness was found to be one of the factors associated with early detection and interventions. Therefore, this study aimed to assess the awareness of the population of Al-Qassim, Saudi Arabia, regarding Bell's palsy. METHODS: We conducted a cross-sectional study on 1,198 participants in Al-Qassim, Saudi Arabia, between May and July 2023. We used a self-administered online questionnaire inquiring about knowledge and awareness of Bell's palsy. We performed descriptive and correlation analyses, and a p-value of less than 0.05 indicated a statistical significance. RESULTS: The mean (± SD) knowledge score was 7.02 ± 2.03 out of a total of 13 points. Almost a third of participants (n=353, 29.5%) expressed uncertainty about the causes of Bell's palsy, with 346 (28.9%) and 107 (8.9%) attributing it to idiopathic factors and viral infections, respectively. Most participants (n=520, 43.4%) believed both genders were equally affected, while 563 (46.9%) correctly identified cranial nerve 7 as the affected nerve. Treatment awareness varied, with 629 (58.2%) acknowledging physiotherapy and (n=777, 64.9%) acknowledging traditional medicine. Interestingly, only 111 (9.3%) thought that Bell's palsy was permanent, most participants (n=1023, 85.4%) recognized Bell's palsy as treatable, and 1,105 (92.2%) correctly perceived it as non-contagious. There were significant correlations between awareness and age (p<0.001), gender (p<0.001), marital status (p<0.001), occupation (p<0.001), information source (p<0.001), nationality (p=0.009), and education levels (p<0.031). Addressing these gaps and demographic nuances through targeted educational campaigns is crucial for enhancing overall awareness of Bell's palsy. CONCLUSION: These findings indicate suboptimal awareness among participants in general, poor knowledge about causes and clinical manifestation, and a relatively better awareness of treatments. We recommend further studies exploring awareness and associated factors.

Development, in vitro Evaluation, and in vivo Study of Adhesive Buccal Films for the Treatment of Diabetic Pediatrics via Trans Mucosal Delivery of Gliclazide.

Objective: Development and evaluation of bucco-adhesive films of Gliclazide for pediatric use. Methods: Sixteen films were formulated using a different combination of Gelatin, Hydroxy propyl methyl cellulose (HPMC), polyvinyl alcohol, Hydroxy propyl cellulose (HPC), chitosan, polyethylene glycol, sodium alginate, and carbopol. Compatibility study for drug and polymers was conducted using differential scanning calorimetry method and Fourier transform infrared spectroscopy. All films were examined for drug content, weight variation, thickness, swelling index, muco-adhesion and folding endurance. In vitro drug release has been completed for two hours. Stability studies were conducted at 4°C, 25°C, and 40°C for selected films. The optimized formulation based on in vitro data was selected for a bioavailability study in rabbits. Results: The selected film formula (carbopol 2%, HPMC 2%) did not demonstrate interactions between the drug and polymers, while it showed accepted content, muco-adhesion, and mechanical properties. The in vitro release study showed rapid and complete release of drug from films. Stability studies confirmed accepted stability of the selected film at 4°C and 25°C, but the film get hard with few particles at 40°C. The bioavailability studies conducted showed that there was 2.1 fold increase in the AUC0-24 of selected film compared with oral tablets. Conclusion: Bucco adhesive films of Gliclazide is a promising dosage form for the treatment of diabetes in children.

The Overriding of Computerized Physician Order Entry (CPOE) Drug Safety Alerts Fired by the Clinical Decision Support (CDS) Tool: Evaluation of Appropriate Responses and Alert Fatigue Solutions.

Introduction Most computerized physician order entry (CPOE) software come with clinical decision-support components (CDS) that provide prescribers assistance and notify them about adverse drug reactions. An excessive number of alerts in a repeated and non-relevant manner leads to alert fatigue and enforces physicians and pharmacists to alert overrides. King Abdulaziz Medical City (KAMC) in Jeddah still reports a higher percentage of drug alerts overridden by clinicians and pharmacists. Thus, this study was conducted to evaluate CDS alerts overriding and to determine which alerts are clinically irrelevant and need modifications. Methods The study was carried out in the inpatient setting at KAMC in Jeddah, from September 1, 2020, to December 31, 2020. It was designed as a retrospective chart review study that included all red alerts that required comments and were overridden by a physician and pharmacist. Results Among 11350 red alerts, potential drug-drug interaction (pDDI), dose, and allergy alerts represent 57%, 41%, and 2%, respectively, of the total alerts. The most common drug-drug interactions (DDIs) in category X were proton pump inhibitors and clopidogrel (9.9%). The appropriate response by prescribers and pharmacists toward allergy alerts was associated with the highest odds compared with the other alerts (p < 0.05) while there is a significant decrease in the odds of appropriate action being taken by both prescribers and pharmacists in the dose screen alerts (p < 0.05). Among all clinical specialties, there is an increased odds of appropriate action being taken by residents and fellows for allergy and dose alerts, respectively, compared to other groups (p < 0.05). For diminishing the unnecessary alerts, we provided 14 alert refinements strategies and advised turning off four alerts. Applying this will terminate 32% of irrelevant alerts. Conclusion Our study's findings indicated that a substantial number of alerts are ignored, and the rate of appropriateness varies significantly by alert type and prescriber level.