Experimental capabilities for liquid jet samples at sub-MHz rates at the FXE Instrument at European XFEL.

The Femtosecond X-ray Experiments (FXE) instrument at the European X-ray Free-Electron Laser (EuXFEL) provides an optimized platform for investigations of ultrafast physical, chemical and biological processes. It operates in the energy range 4.7-20 keV accommodating flexible and versatile environments for a wide range of samples using diverse ultrafast X-ray spectroscopic, scattering and diffraction techniques. FXE is particularly suitable for experiments taking advantage of the sub-MHz repetition rates provided by the EuXFEL. In this paper a dedicated setup for studies on ultrafast biological and chemical dynamics in solution phase at sub-MHz rates at FXE is presented. Particular emphasis on the different liquid jet sample delivery options and their performance is given. Our portfolio of high-speed jets compatible with sub-MHz experiments includes cylindrical jets, gas dynamic virtual nozzles and flat jets. The capability to perform multi-color X-ray emission spectroscopy (XES) experiments is illustrated by a set of measurements using the dispersive X-ray spectrometer in von Hamos geometry. Static XES data collected using a multi-crystal scanning Johann-type spectrometer are also presented. A few examples of experimental results on ultrafast time-resolved X-ray emission spectroscopy and wide-angle X-ray scattering at sub-MHz pulse repetition rates are given.

Leveling the curve of Spee using different sized archwires: a randomized clinical trial of blood flow changes.

OBJECTIVES: To compare blood flow (BF) changes of teeth subjected to orthodontic forces during curve of Spee (COS) leveling using different archwires (AW). MATERIAL AND METHODS: Thirty subjects with COS > 5 mm were randomly assigned (1:1:1) into three groups based on the AW used: group 1: 0.017 × 0.025-inch stainless-steel (SS)AW, group 2: 0.019 × 0.025-inch SSAW, and group 3: 0.021 × 0.025-inch ß-titanium (TMA)AW. In the 3 groups, a 5 mm-depth reverse COS was placed in the AWs. A laser Doppler flowmeter was used to measure BF at different time intervals (T0-T4). RESULTS: In the 3 AWs group, BF of all measured teeth was reduced 20 min after force application. Afterwards, the BF values started to increase until the baseline values were almost restored within 1 week. Differences in BF changes between the extrusion and intrusion subgroups were observed within groups 1 and 3 during the first 20 min of force application (P < 0.05). Similar BF changes were recorded using the 3 different AWs. BF changes were associated with tooth type and the amount of COS depth change. CONCLUSIONS: During CoS leveling, similar BF changes were recorded using the 3 different AWs. Tooth type and the amount of COS depth change were associated with BF changes within the first 20 min of force application. Greater BF reduction was found in premolars compared to incisors during the first 20 min of AW placement. CLINICAL RELEVANCE: It is important to select a type of applied forces that minimally affect the BF. Intrusive forces appeared to have lower negative effects on the BF of teeth during COS leveling. TRIAL REGISTRATION: ClinicalTrial.gov (# NCT04549948).

Efficacy of lower arch leveling, lower incisors' root resorption, and pain associated with the correction of curve of Spee using different orthodontic archwires: a randomized clinical trial.

OBJECTIVES: To compare between 3 archwires (AWs) for leveling curve of Spee (COS) in terms of efficacy of reduction, external apical root resorption (EARR), pain experienced, and the lower arch dimensional changes during COS leveling. TRIAL DESIGN: Randomized clinical trial. SETTING: Jordan University of Science and Technology Postgraduate dental clinics. MATERIAL AND METHODS: Fifty-three subjects with COS > 5 mm were included in this study. The subjects were randomly divided into three groups based on the AW used: group 1, 0.017 × 0.025-inch stainless-steel (SS) AW; group 2, 0.019 × 0.025-inch SS AW; and group 3, 0.021 × 0.025-inch ß-titanium (TMA) AW. The intervention was randomly allocated using the permuted random block size of 3 with a 1:1:1 allocation ratio. In the three groups, a 5-mm depth reverse COS was placed in the AWs. The following time points were defined for COS assessment: T1, before interventional leveling AW placement; and T2-T7, 1-6 months after interventional leveling AW placement. Records consisted of dental study models and periapical (PA) radiographs. Pain scores were recorded using visual analogue scale. Patients were followed up on a monthly basis until COS < 1.5 mm. MAIN OUTCOME MEASURES: COS depth reduction, lower incisors' EARR, pain scores, and arch dimensional changes. RESULTS: An overall reduction of 3.82 mm, 4.47 mm, and 3.85 mm of the depth of COS was achieved in groups 1, 2, and 3, respectively. The mean differences of 0.65 mm between groups 1 and 2 and 0.62 mm between groups 2 and 3 were significant at P < 0.05. Lower incisors' EARR during leveling COS ranged from 0.68 to 0.72 mm, from 0.63 to 0.82 mm, and from 0.53 to 0.88 mm in groups 1, 2, and 3, respectively (P > 0.05). Higher pain scores were reported by group 2 subjects during the first 24 h. Arch length and width increased significantly in groups 2 and 3 (P < 0.05). In all groups, COS leveling was achieved by lower incisor intrusion and proclination and lower molar extrusion. CONCLUSIONS: All investigated AWs were effective in leveling COS with minimal lower incisors' EARR (< 1 mm). COS was leveled by lower incisors' intrusion and proclination and lower molar extrusion. Pain scores were the highest in group 2 during the first 24 h. CLINICAL RELEVANCE: The 3 investigated leveling AWs were effective for the leveling COS and at the same time safe on the roots of the lower anterior teeth.

L-carnosine mitigates interleukin-1α-induced dry eye disease in rabbits via its antioxidant, anti-inflammatory, antiapoptotic, and antifibrotic effects.

OBJECTIVE: To elucidate the implications of L-carnosine on interleukin-1α (IL-1α)-induced inflammation of lacrimal glands (LGs). MATERIALS AND METHODS: Forty rabbits were divided equally into four groups: control group (G1), IL-1α (G2), L-carnosine (G3), and L-carnosine plus IL-1α (G4). Several clinical, histopathological, immunohistochemical, morphometric, and biochemical investigations were performed, followed by statistical analysis to diagnose the presence of dry eye disease (DED). RESULTS: The LGs of G2 rabbits showed degeneration of the acinar cells, increased deposition of collagen fibers, and marked immunoexpression of FasL; elevated levels of interferon-γ, tumor necrosis factor-α, transforming growth factor-ß1, and malondialdehyde; and decreased levels of glutathione peroxidase, superoxide dismutase, catalase, and reactive oxygen species compared with those of G1 rabbits. In contrast, administration of L-carnosine to G4 rabbits revealed marked improvement of all previously harmful changes in G2 rabbits, indicating the cytoprotective effects of L-carnosine against IL-1α-induced inflammation of LGs. CONCLUSIONS: IL-1α induced inflammation of LGs and eye dryness via oxidative stress, proinflammatory, apoptotic, and profibrotic effects, whereas L-carnosine mitigated DED through antioxidant, anti-inflammatory, antiapoptotic, and antifibrotic effects on LGs. Therefore, this work demonstrates for the first time that L-carnosine may be used as adjuvant therapy for the preservation of visual integrity in patients with DED.HighlightsIL-1α induced dry eye disease through its oxidative stress, proinflammatory, apoptotic and profibrotic effects on the lacrimal glands of rabbit.L-carnosine has antioxidant, anti-inflammatory, antiapoptotic and antifibrotic effects.L-carnosine mitigated IL-1α induced dry eye disease via elevating the levels of FasL, IFN-γ, TNF-α, TGFß1 and MDA as well as reducing the levels of antioxidants (GPx, SOD, and catalase) and ROS in the lacrimal glands of rabbit.L-carnosine could be used as a novel adjuvant therapy for the treatment of dry eye disease.

Single incision technique for implantation of subcutaneous implantable cardioverter defibrillators.

BACKGROUND: Subcutaneous implantable cardioverter defibrillators (S-ICDs) have gained increasing popularity because of certain advantages over transvenous ICDs. However, while conventional ICDs require a single surgical incision to implant, S-ICDS need two or three incisions, making them less appealing. OBJECTIVE: This study sought out to investigate the feasibility of using a single-incision technique to implant S-ICDs. METHODS: Patients qualifying for S-ICDs were considered for a single incision. A single incision is performed by making a left inframammary incision and then the subcutaneous tissue is dissected medially toward the lower sternum. Two sutures are placed in the fascia in the xiphoid area to anchor the lead and a tunneling tool is used to dissect the tissue to place the lead parallel to the sternum. Then subcutaneous tissues are dissected down the lateral chest wall over the muscle fascia to create the pulse generator pocket in the vicinity of the fifth and sixth intercostal spaces and near the mid-axillary line. RESULTS: Eleven patients (six males and five females) successfully underwent S-ICD implantation with a single incision without acute complications (64% for primary prevention). The mean age is 47.4 ± 15.8 years. There were no lead dislodgements, inappropriate shocks, or any other issues during a median follow-up of 10 months (interquartile range 5-17). One patient had a successful appropriate shock for ventricular fibrillation about one year after device implant. CONCLUSIONS: A single incision for subcutaneous ICDs is feasible and safe in our early experience.

Loss-of-Function Mutations in KIF15 Underlying a Braddock-Carey Genocopy.

Braddock-Carey Syndrome (BCS) is characterized by microcephaly, congenital thrombocytopenia, Pierre-Robin sequence (PRS), and agenesis of the corpus callosum. BCS has been shown to be caused by a 21q22.11 microdeletion that encompasses multiple genes. Here, we report a BCS genocopy characterized by congenital thrombocytopenia and PRS that is caused by a loss-of-function mutation in KIF15 in a consanguineous Saudi Arabian family. Mutations of mitotic kinesins are a well-established cause of microcephaly. To our knowledge, KIF15 is the first kinesin to be associated with congenital thrombocytopenia.

Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter.

BACKGROUND: Dormant conduction unmasked by adenosine predicts clinical recurrences of cavotricuspid isthmus (CTI) dependent atrial flutter following catheter ablation. Conventional practice involves a waiting period of 20 to 30 minutes after achievement of a bidirectional line of block (BDB) to monitor for recovery of conduction. OBJECTIVE: Assess whether abolition of dormant conduction with adenosine immediately after CTI ablation and BDB can predict the lack of CTI conduction recovery during the following 30 minutes. METHODS: Consecutive patients undergoing catheter ablation for CTI-dependent atrial flutter were studied. Following the completion of CTI ablation and documentation of BDB, adenosine (≥12 mg IV) was administered immediately. In cases of dormant conduction, the CTI was ablated again until its abolition. After the achievement of BDB without dormant conduction, spontaneous CTI reconnection during the following 30 minutes and dormant conduction with adenosine at 30 minutes were evaluated. RESULTS: A CTI block was achieved in 171 patients. Nine patients (5.3%) had dormant conduction across the CTI immediately after ablation and BDB, and required further ablation. Two patients (1.2%) had subsequent spontaneous time-dependent reconnection within 30 minutes. Two other patients (1.2%) developed late dormant conduction with adenosine at 30 minutes. All 4 patients underwent further ablation. CONCLUSION: A negative adenosine challenge immediately after CTI ablation with bidirectional block, or after abolition of dormant conduction with further ablation, strongly predicted the absence of subsequent spontaneous reconnection within 30 minutes. Based on these results, the conventional waiting period is unnecessary in 97.6% patients without dormant conduction after CTI-dependent flutter ablation.

The influence of frequently consumed beverages and snacks on dental erosion among preschool children in Saudi Arabia.

BACKGROUND: To determine the prevalence of dental erosion and its association to commonly used beverages and snacks among 3 to 5 year old preschool children in Riyadh, Saudi Arabia. METHODS: Three hundred eighty-eight preschool children between 3 and 5 years old were selected from 10 different schools using a cluster random sample selection; there were 184 (47%) boys and 204 (53%) girls. The surfaces of each tooth were examined for erosion, and the level of tooth wear was recorded. Data on the frequently used beverages and snacks were obtained by questionnaires completed by the parents of the preschool children. RESULTS: Among the 388 children examined, 47% exhibited low erosion, 10% exhibited moderate erosion and 4% exhibited severe erosion. There was no statistically significant difference between boys and girls in terms of the prevalence of erosion. Sixty percent of the children regularly consumed juice drinks. Among daily consumers, 84% of children showed erosion prevalence with strongly significant association (p < 0.005). Holding the drink in the mouth also showed a significant association with erosion (p < 0.02). CONCLUSION: It was concluded that an association was found between the prevalence of dental erosion and the frequency of citrus and carbonated juice consumed by the preschool children in Saudi Arabia.

Atrioventricular dyssynchrony from empiric device settings is common in cardiac resynchronization therapy and adversely impacts left ventricular morphology and function.

BACKGROUND: Echocardiographic atrioventricular (AV) optimization after cardiac resynchronization therapy (CRT) is uncommon due to time constraints and the use of vendor-specific device algorithms. It remains unclear whether optimization of mitral inflow velocities can still be useful. We aimed to investigate post implantation left ventricular (LV) inflow patterns to determine the incidence of AV dyssynchrony from empirically set devices. METHODS: This was a retrospective study of patients undergoing CRT using empiric device settings. Forty-eight patients with clinical, echocardiographic, and pacemaker follow-up were grouped by their post implantation LV filling pattern. Baseline characteristics and echocardiographic measurements were compared with post implantation findings at median 6.3 months (interquartile range [IQR], 3.9-17.0). RESULTS: Twenty-four patients demonstrated AV dyssynchrony (Group 1) after CRT, and 24 patients did not (Group 2). Group 1 patients had less LV reverse remodeling compared to Group 2 patients (ΔLV end-diastolic volume: -3.6 mL vs -49.5 mL, P<.05; ΔLV end-systolic volume: -16.9 mL vs -53.5 mL, P<.05) and did not experience significant improvements in LV outflow tract velocity time integral, stroke volume, or LV ejection fraction. There were no differences in new-onset atrial fibrillation, heart failure readmissions, or mortality between groups. CONCLUSION: Our study suggests that up to 50% of patients with empiric device settings have AV dyssynchrony at 6 months despite atrioventricular delay optimization (AVO) algorithms. As AV dyssynchrony is common and has proven to be modifiable, a strategic approach to Doppler echocardiography-guided AVO after CRT is warranted, particularly in nonresponders where the LV filling pattern is fused or truncated.

Study on Personality Types of Dentists in different Disciplines of Dentistry.

AIM: The purpose of this study was to determine the most common personality type among dentists in seven selected clinical dentistry specialties using the Myers-Briggs Type Indicator (MBTI) and to compare between these different types of personalities. MATERIALS AND METHODS: A survey containing the MBTI and demographic and practice questions was used to assess the personality styles of 243 dental specialists in Riyadh, Saudi Arabia. The survey results were analyzed using descriptive statistics. RESULTS: The results of the MBTI for 243 specialist dentists revealed, generally, a higher percentage of scoring for introversion (I) with an average of 65% than extroversion (E). The study identified 10 common personality types among these specialists: ISTJ, ISFJ, INFJ, ISTP, INFP, INTP, ENFP, ENTP, ENFJ, and ENTJ (extraversion-introversion (E-I), sensing-intuition (S-N), thinking-feeling (T-F), and judging-perception (J-P)). The dominant personality type in all seven clinical specialties in dentistry was ISTJ, with an average of 54%. CONCLUSION: The personality types showed variation among the seven clinical dentistry specialties. However, among these seven clinician's specialties in dentistry, more than 50% of the individuals shared one common type of personality (ISTJ). CLINICAL SIGNIFICANCE: The identification of the personality type might help in their association with coworkers, students, and patients as well as knowing the individual preferences toward different specialties in dentistry.

Radiofrequency and Cryo-Ablation Effect on Transvenous Pacing and Defibrillatory Lead Integrity: An In Vitro Study.

INTORDUCTION: Medical societies and cardiac implantable electronic device (CIED) manufacturers recommend avoiding close or direct contact between the body of transvenous leads and ablation catheters used to treat cardiac arrhythmias. These recommendations are made despite the lack of clinical studies. However, the target myocardium for successful ablation can be contiguous to CIED leads. METHODS AND RESULTS: We examine in vitro the effects of direct application of radiofrequency (RF) and cryo-ablation energy on the integrity and functionality of CIED leads (excluding the pacing electrodes and defibrillation coils). A saline bath was created to mimic the body milieu. CIED leads, including all commercially available lead insulation materials, were connected to a CIED pulse generator and placed in direct contact with an ablation catheter in the tissue bath. RF and cryo-ablation energy were delivered under various conditions, including maximal ablation power, temperature, and impedance via the RF generator. CIED lead functionality, reflective of conductor integrity, was evaluated through lead impedance monitoring during ablation. CIED leads were then visually inspected, and examined with optic and electron microscopy as per protocol. A total of 42 leads were studied. All leads showed the absence of insulation damage at the site of ablation visually and with microscopy. Lead functionality was also preserved in all leads. CONCLUSION: Catheter ablation in contact with CIED leads using radiofrequency or cryo-ablation in vitro did not affect lead body integrity and function despite aggressive ablation settings. It may be reasonable to perform ablation in contact with the body of CIED leads when clinically necessary.

Prevalence of dental caries and associated social risk factors among preschool children in Riyadh, Saudi Arabia.

OBJECTIVES: To determine the prevalence of dental caries, and associated social risk factors among preschool children in Riyadh, Saudi Arabia. METHODS: The study consisted of a random sample of 3 to 5 years- old preschool children who were examined in Riyadh, Saudi Arabia; 388 children (184 boys and 204 girls) were examined from 10 different preschools. Each surface of their teeth was examined for dental caries utilizing modified WHO criteria (WHO, 1997). Data information about age, gender and social factors status were obtained by questionnaires that had been answered by parents. RESULTS: About 69% of children had dental caries with dmft score of 3.4 (± 3.6) and dmfs of 6.9 (± 9.9). There was no statistically significant difference between boys and girls. Less caries was observed among children whose parents worked and it was statistically significant as well as whose mothers had high or low educational level. Increased number of family members appeared to have a high incidence of dental caries which was also statistically significant. There was no significant difference in dental caries prevalence with birth order. CONCLUSIONS: Dental caries among preschool children in Saudi Arabia was still very common. Improvement of preventive measure at early age should be emphasized by parents and dental health professionals. More attention is required for Non-working parents telling them about the risk of dental caries affecting their children and the awareness of preventive care of dental health.

A Practical ECG Criterion to Unmask Left Accessory AV Connections in Patients With Subtle Preexcitation.

BACKGROUND: Accessory AV-connections capable of antegrade conduction need to be recognized because of the potential for life-threatening arrhythmias. However, the preexcited ECG pattern may be subtle, especially among left-sided AV-connections. We explored whether additional ECG criteria might help identify left-sided AV-connections. METHODS: We analyzed 156 patients who underwent an electrophysiology study (EPS) and ablation for paroxysmal supraventricular tachycardias (PSVT). Patients were divided into 2 groups: those with left-sided AV-connections (Group 1) and all other PSVT (Group 2). Various ECG parameters were compared before and after ablation in both groups. RESULTS: The EPS identified left-sided AV-connections among 43 patients (Group 1) and excluded it among 113 (Group 2). Baseline ECG in Group 1 demonstrated obvious preexcitation among 24/43 patients (55.8%), the remaining 19/43 missing obvious preexcitation. R/S ratio > 0.5 in V1 was noted in 38/43 (88.4%) patients in Group 1 before ablation (median 1.00; IQR 0.58-2.20), including 16/19 (84.2%) patients lacking obvious left-sided AVconnections. Conversely, only 10/113 (8.8%) patients in Group 2 had R/S ratios in V1 ≥ 0.5 (0.20; 0.10-0.31), P < 0.0001. After ablation, the R/S ratio decreased significantly in Group 1 (0.29; 0.17-0.45), P < 0.0001. Thus, a combined criterion of classic preexcitation or R/S ratio ≥ 0.5 on ECG identified 40/43 left-sided AV-connections (sensitivity 93.0%). The negative predictive value of this combined criterion was 103/106 (97.2%). CONCLUSIONS: In symptomatic patients, combining the R/S ratio (≥ 0.5) in lead V1 with the classic preexcitation pattern on ECG markedly improved the sensitivity to diagnose left-sided AV-connections. This ratio may be particularly useful among patients lacking obvious preexcitation.

Pulpotomy Medicaments used in Deciduous Dentition: An Update.

The aim of this paper was to review the history and the scientific literature published on pulpotomy medicaments and to present the findings of these studies. The review showed that pulpotomy of primary teeth has been treated with many different techniques and medicaments, that some of these approaches are controversial and that their results have presented variables of success rates in term of clinical, radiographic and histologic observation. It is important that all clinicians, particularly for pediatric dentists, be up to date with the recent trends in this area of dental treatment for children.

Validity of moyers mixed dentition analysis for Saudi population.

OBJECTIVES: To evaluate the applicability of Moyers probability tables and to formulate more accurate mixed dentition prediction tables in the Saudi population. METHODS: A cross-sectional study was conducted at the College of Dentistry, Kind Saud University, Saudi Arabia. The data were collected from 410 (203 males and 207 females) orthodontic study models, which had erupted mandibular permanent incisors, maxillary, mandibular canines and premolars. The mesiodistal widths were measured using a digital caliper with an accuracy of 0.01 mm. Student's paired t-test was used to compare the mean width values derived from this study with the values derived using the Moyers table. Simple linear regression was used to evaluate the linear relationship between the combined mesiodistal widths of the mandibular permanent incisors and the canine-premolar segments in each dental arch. RESULTS: The regression equations for the maxillary canine-premolar segment (males: Y=10.27+0.48X; females: Y=11.71 + 0.39X) and the mandibular canine-premolar segment (males: Y=9.71 + 0.40X; females: 11.28 + 0.39X) were used to formulate new probability tables on the Moyers pattern. Statistically significant differences were observed between predicted widths in our subjects and the widths obtained using Moyers tables. CONCLUSIONS: The new prediction tables derived in this study provided a more precise mixed dentition space analysis than Moyers prediction tables in estimating tooth dimensions in the Saudi population.

Dental health status of children with diabetes in Riyadh, Saudi Arabia.

Objective: The impact of diabetes on oral diseases remains debatable. We aimed to determine the prevalence of dental caries, gingival health status and knowledge, and oral hygiene level and practice in children with type 1 diabetes mellitus in Riyadh, Saudi Arabia. Methods: The teeth of Sixty children with diabetes (33 males and 27 females; age 11.3 ± 2.2 [7-14] years) were examined for dental caries following the modified World Health Organization criteria. Data on age, sex, medical history, gingival health status and knowledge, and oral hygiene level and practice were collected from parents. Results: In this study, 53 % of the children had dental caries with decayed, missing, and filled primary and permanent teeth scores of 5.6 ± 3.8 and 3.6 ± 3.2, respectively, with similar scores for male and female children. Children with and without caries had similar oral hygiene practices and oral health knowledge but differed in the rates of good or fair oral hygiene status (89.2 vs. 56.6 %; P = 0.024) and normal gingival health status or mild gingivitis (96.5 vs. 81.3 %; P = 0.010). Conclusions: We found that the oral hygiene status and rate of gingivitis differed in children with type 1 diabetes mellitus with or without dental caries.

Adapting Laplace residual power series approach to the Caudrey Dodd Gibbon equation.

In real-life applications, nonlinear differential equations play an essential role in representing many phenomena. One well-known nonlinear differential equation that helps describe and explain many chemicals, physical, and biological processes is the Caudrey Dodd Gibbon equation (CDGE). In this paper, we propose the Laplace residual power series method to solve fractional CDGE. The use of terms that involve fractional derivatives leads to a higher degree of freedom, making them more realistic than those equations that involve the derivation of an integer order. The proposed method gives an easy and faster solution in the form of fast convergence. Using the limit theorem of evaluation, the experimental part presents the results and graphs obtained at several values of the fractional derivative order.

Alström Syndrome: A Challenging Case Study of a Female Saudi Patient With Type 2 Diabetes Mellitus and Complete Vision Loss.

Alström syndrome is a genetic disease that impacts numerous systems in the human body. The symptoms can vary and appear gradually. Childhood obesity, heart disease (cardiomyopathy), abnormalities in vision, and hearing issues are the main symptoms of this disorder in children. Diabetes mellitus, hepatic issues, and renal dysfunction can all occur over time. Genetic alterations in the ALMS1 gene are the cause of Alström syndrome. It has an autosomal recessive inheritance pattern. We address the case of a Saudi woman in her 20s. She had been initially referred for type 2 diabetes, intellectual disability since early childhood, metabolic acidosis, and micrognathia; however, she also exhibited blindness, chronic kidney disease (CKD), and hearing loss, all of which are indicative of Alström syndrome. DNA testing showed that she has a homozygous pathogenic variant in the ALMS gene. Autosomal recessive Alström syndrome has been confirmed as a genetic diagnosis. No other clinically significant variations were found that are associated with the mentioned phenotype. By reporting this mutation, we hope to learn more about the genotypic range of the disease, particularly in the Saudi population. As each member of the family underwent genetic testing, we established a stringent follow-up schedule for our patient and her family.

A Global Bibliometric Analysis of the Top 100 Most Cited Articles on Carotid Body Tumors.

The carotid body, situated at the common carotid artery bifurcation, comprises specialized glomus cells responsible for sensing blood oxygen, carbon dioxide, pH, and temperature changes, crucial for regulating breathing and maintaining oxygen homeostasis. Carotid body tumors (CBTs), arising from these cells, are rare, representing only 0.5% of head and neck tumors, often presenting as benign, slow-growing, vascularized masses. In February 2023, this bibliometric analysis was conducted, which involved screening 1733 articles from the Web of Science database. The screening process was based on citation count, and articles were selected for inclusion based on specific criteria that focused on CBTs located within the carotid bifurcation. Rigorous selection involved independent screening and data extraction by four authors. The top 100 articles, published between 1948 and 2019, totaled 6623 citations and were authored by 98 unique first authors from 22 countries and 77 institutions, spanning 42 journals. Treatment articles were the predominant category, comprising 49% of the literature. This analysis offers insights into publication trends, identifies literature gaps, and outlines areas of research focus, providing a valuable resource to guide future studies on CBTs.

Knowledge, Attitude, and Practice of Foot Care and the Risk of Foot Ulcers in Diabetic Patients in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Diabetic patients in Saudi Arabia are often underinformed about proper diabetic foot care. This study aims to determine the knowledge, attitude, and practice of the risk factors of diabetic foot ulcers among diabetic patients in the Jeddah region of Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was done on 210 diabetic patients attending the international diabetic center in Jeddah, Saudi Arabia, during the study period. A validated questionnaire was used to collect data about participants' demographics and knowledge, attitudes, and practices of diabetic foot care. RESULTS: Of the participants, 77 (36.7%) were aged 51-60 years; 161 (76.7%) were male; 153 (72.9%) had a university education; and approximately 138 (65%) had type 2 DM. A majority, 190 (90.5%), acknowledged that DM patients might have reduced foot sensation; 204 (97.1%) agreed that diabetics could develop gangrene; 188 (89.5%) concurred that poor foot sensation increases the risk of foot ulcers; and 193 (91.9%) agreed that poor blood flow to the feet heightens this risk. Among them, 152 (72.4%) demonstrated good knowledge about foot care and the risk of foot ulcers; eight (3.8%) exhibited a positive attitude; and 95 (45.2%) showed a good level of practice. Good knowledge was significantly higher among married patients, and good practice was notably higher among older patients (>50 years). A significant positive correlation was found between knowledge scores and both attitude and practice scores. CONCLUSION: The study revealed adequate knowledge and practice of foot care and the risk of foot ulcers among diabetic patients. However, a high percentage of negative attitudes toward these issues were observed.