An adaptive enhanced human memory algorithm for multi-level image segmentation for pathological lung cancer images.

Lung cancer is a critical health issue that demands swift and accurate diagnosis for effective treatment. In medical imaging, segmentation is crucial for identifying and isolating regions of interest, which is essential for precise diagnosis and treatment planning. Traditional metaheuristic-based segmentation methods often struggle with slow convergence speed, poor optimized thresholds results, balancing exploration and exploitation, leading to suboptimal performance in the multi-thresholding segmenting of lung cancer images. This study presents ASG-HMO, an enhanced variant of the Human Memory Optimization (HMO) algorithm, selected for its simplicity, versatility, and minimal parameters. Although HMO has never been applied to multi-thresholding image segmentation, its characteristics make it ideal to improve pathology lung cancer image segmentation. The ASG-HMO incorporating four innovative strategies that address key challenges in the segmentation process. Firstly, the enhanced adaptive mutualism phase is proposed to balance exploration and exploitation to accurately delineate tumor boundaries without getting trapped in suboptimal solutions. Second, the spiral motion strategy is utilized to adaptively refines segmentation solutions by focusing on both the overall lung structure and the intricate tumor details. Third, the gaussian mutation strategy introduces diversity in the search process, enabling the exploration of a broader range of segmentation thresholds to enhance the accuracy of segmented regions. Finally, the adaptive t-distribution disturbance strategy is proposed to help the algorithm avoid local optima and refine segmentation in later stages. The effectiveness of ASG-HMO is validated through rigorous testing on the IEEE CEC'17 and CEC'20 benchmark suites, followed by its application to multilevel thresholding segmentation in nine histopathology lung cancer images. In these experiments, six different segmentation thresholds were tested, and the algorithm was compared to several classical, recent, and advanced segmentation algorithms. In addition, the proposed ASG-HMO leverages 2D Renyi entropy and 2D histograms to enhance the precision of the segmentation process. Quantitative result analysis in pathological lung cancer segmentation showed that ASG-HMO achieved superior maximum Peak Signal-to-Noise Ratio (PSNR) of 31.924, Structural Similarity Index Measure (SSIM) of 0.919, Feature Similarity Index Measure (FSIM) of 0.990, and Probability Rand Index (PRI) of 0.924. These results indicate that ASG-HMO significantly outperforms existing algorithms in both convergence speed and segmentation accuracy. This demonstrates the robustness of ASG-HMO as a framework for precise segmentation of pathological lung cancer images, offering substantial potential for improving clinical diagnostic processes.

Severity of scorpion envenomation in Saudi Arabia: A systematic review.

Over the course of five years, 72,168 scorpion stings were recorded in Saudi Arabia. Though a number of articles have been published on scorpion stings in the country, no review studies have sought to determine the severity of scorpion envenomation using a standardized scale. The purpose of this systematic review is, thus, to explore the signs and symptoms of scorpion envenomation victims in Saudi Arabia and classify them using the Abroug's severity scale. This review identified 49 articles published between January 1953 and September 2024 on scorpion sting incidents in Saudi Arabia. Out of this total, 26 (53.1 %) articles met the systematic review criteria. The selected articles were reviewed by an emergency physician, a pediatrician, an assistant professor, and a consultant in toxicology, knowing that all examined articles were published in peer reviewed journals indexed in PubMed, EMBASE, Scopus, Web of science and CINAHL. Preset keywords and medical subject headings (MeSH terms) were used for the review. Three reviewed studies reported that 20-52 % of scorpion victims are asymptomatic. Other studies confirmed that Class I local manifestations, such as pain, erythema, swelling, and burning are present in the majority of scorpion sting victims (47.4-100 %). Class II systemic symptoms, such as hypertension, tachycardia, restlessness, cold extremities, gastrointestinal abnormalities and priapism, were reported in 15 studies, while bleeding was recorded in 2 patients in the same study. More complicated Class III cases manifested neurological deteriorations (seizures, neurotoxicity and unconsciousness), pulmonary edema, and pulmonary/cardiac arrest. Jointly, the studies revealed that a total of 16,745 scorpion sting victims were admitted and hospitalized for more than 24 h, and hospital stay duration varied, for all patients, between 3 h and 4 weeks. Around 1371 cases in six studies refused treatment and were discharged against medical advice. Fifteen victims across ten studies died from the scorpion stings. Children and patients with pre-existing clinical conditions generally reported more severe signs and symptoms. Study findings showed that practitioners should be aware of the early warning signs of pulmonary edema, cardiac toxicity and myocarditis, which are not uncommon post scorpion envenomation. Practitioners should also take into consideration that electrolyte imbalances might occur, but they do not usually pose serious clinical problems. Hemorrhages might happen, but they are mostly treatable. In conclusion, it is advised that practitioners utilize the standardized Abroug's classification for grading signs and symptoms of scorpion stings.

Chaotic RIME optimization algorithm with adaptive mutualism for feature selection problems.

The RIME optimization algorithm is a newly developed physics-based optimization algorithm used for solving optimization problems. The RIME algorithm proved high-performing in various fields and domains, providing a high-performance solution. Nevertheless, like many swarm-based optimization algorithms, RIME suffers from many limitations, including the exploration-exploitation balance not being well balanced. In addition, the likelihood of falling into local optimal solutions is high, and the convergence speed still needs some work. Hence, there is room for enhancement in the search mechanism so that various search agents can discover new solutions. The authors suggest an adaptive chaotic version of the RIME algorithm named ACRIME, which incorporates four main improvements, including an intelligent population initialization using chaotic maps, a novel adaptive modified Symbiotic Organism Search (SOS) mutualism phase, a novel mixed mutation strategy, and the utilization of restart strategy. The main goal of these improvements is to improve the variety of the population, achieve a better balance between exploration and exploitation, and improve RIME's local and global search abilities. The study assesses the effectiveness of ACRIME by using the standard benchmark functions of the CEC2005 and CEC2019 benchmarks. The proposed ACRIME is also applied as a feature selection to fourteen various datasets to test its applicability to real-world problems. Besides, the ACRIME algorithm is applied to the COVID-19 classification real problem to test its applicability and performance further. The suggested algorithm is compared to other sophisticated classical and advanced metaheuristics, and its performance is assessed using statistical tests such as Wilcoxon rank-sum and Friedman rank tests. The study demonstrates that ACRIME exhibits a high level of competitiveness and often outperforms competing algorithms. It discovers the optimal subset of features, enhancing the accuracy of classification and minimizing the number of features employed. This study primarily focuses on enhancing the equilibrium between exploration and exploitation, extending the scope of local search.

Determinants of influenza and COVID-19 vaccine intent or uptake in Lebanon: a scoping review of the literature.

BACKGROUND: Vaccination is essential to protect from influenza and recently from COVID-19, yet uptake in Lebanon is suboptimal. Several factors determine uptake including knowledge, attitude and policies. We conducted a scoping review of the literature to explore the determinants of influenza and COVID-19 vaccine intent or uptake in Lebanon. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, thirty one peer reviewed studies indexed in six databases Pub Med, EMBASE, Scopus, CINAHL, Medline, and the Cochrane Library were screened. Two students, a senior Librarian and an Associate Professor in nursing searched for eligible studies. The library search strategy followed a combination of three broad concepts (viral influenzas; vaccines; Lebanon). The search timeframe was up till December 31, 2022. Determinants of influenza and COVID-19 vaccine intent or uptake were categorized following the constructs of the Theory of Planned Behavior. RESULTS: Nine studies investigated influenza vaccine intent or uptake among the public community, parents and healthcare workers. Twenty one studies investigated COVID-19 vaccine intent or uptake among the public community, older refugees, university students, patients with cancer, dentists, and social media users. One study investigated both types of vaccines. A conceptual model of the determinants of vaccine intent and uptake within the Lebanese context was developed. Various determinants included environmental factors, norms, knowledge, perceptions, attitudes, past experiences, behavioral control and hesitancy. CONCLUSIONS: Research on vaccine intent and uptake in Lebanon is still in its infancy, while that of COVID-19 is on the rise. Multifaceted reasons behind the low vaccination rates were observed yet few attempts were made to target vulnerable groups. Further research studies are needed to target vulnerable groups.

Unravelling the predictors of late cancer presentation and diagnosis in Jordan: a cross-sectional study of patients with lung and colorectal cancers.

OBJECTIVES: Late presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one's chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan. DESIGN: This correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used. SETTING AND PARTICIPANTS: The study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation. RESULTS: 382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97). CONCLUSIONS: This study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.

The Prevalence and Factors Associated with Low Back Pain Among People with Flat Feet.

BACKGROUND: A positive relationship between flat feet and low back pain (LBP) has not gained consensus in literature. The aim of this study was to determine the prevalence and factors associated with low back pain (acute and chronic) among individuals with flat feet. METHODS: In 2018, a cross-sectional study was conducted at a national festival in Saudi Arabia, and 1798 adult visitors were invited to participate in face-to-face interviews. Participants' characteristics were stratified by the type of foot and they were questioned on acute low back pain (ALBP) or chronic low back pain (CLBP). The odds ratio (OR) were presented as a measure of this association, followed by a multivariate analysis. RESULTS: The prevalence of LBP among participants with flat feet was 65.9%, among whom 51.6% suffered ALBP and 48.4% suffered from CLBP. Flat feet increased the chances of having ALBP by 3.28 times and CLBP by 4.5 times. After stratification, ALBP and CLBP were both significantly higher among all participants with flat feet in comparison with their counter groups. Multivariate analyses showed that females were more likely to complain of ALBP. Participants who did no physical activity were more likely to complain of ALBP. Female participants and older participants were more likely to complain of ALBP and CLBP. CONCLUSION: Flat feet are associated with both ALBP and CLBP. Significant factors of low back pain also included sex, age, occupation, and physical activity.

Tocilizumab for the Treatment of COVID-19-Induced Cytokine Storm and Acute Respiratory Distress Syndrome: A Case Series From a Rural Level 1 Trauma Center in Western Pennsylvania.

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, initially in December 2019 at Wuhan, China, subsequently spread around the world. We describe a case series of COVID-19 patients treated at our academic medical center with focus on cytokine storm and potential therapeutic role of tocilizumab. A 59-year-old female admitted for shortness of breath (SOB), productive cough, fever, and nausea in the setting of COVID-19 pneumonia. Oxygen saturation was 81% necessitating supplemental oxygen. She was transferred to intensive care unit (ICU) for worsening hypoxia; intubated and received tocilizumab following which her oxygen requirements improved. A 52-year-old female admitted from an outside hospital with SOB, intubated for worsening hypoxia, in the setting of COVID-19 pneumonia. She received tocilizumab 400 mg intravenous for 2 doses on ICU admission, with clinical improvement. A 56-year-old female hospitalized with worsening SOB, fever, and cough for 8 days saturating 88% on room air in the setting of COVID-19 pneumonia. Worsening hypoxia necessitated high flow nasal cannula. She was transferred to the ICU where she received 2 doses of tocilizumab 400 mg intravenous. She did not require intubation and was transitioned to nasal cannula. A hyperinflammatory syndrome may cause a life-threatening acute respiratory distress syndrome in patients with COVID-19 pneumonia. Tocilizumab is the first marketed interleukin-6 blocking antibody, and through targeting interleukin-6 receptors likely has a role in treating cytokine storm. We noted clinical improvement of patients treated with tocilizumab.

Seasonal variation in indoor concentrations of air pollutants in residential buildings.

Indoor concentrations of PM10, PM2.5, CO, and CO2 were measured in 25 naturally ventilated urban residences during the winter and summer seasons in Alexandria, Egypt. Ambient air samples were also collected simultaneously for comparison to indoor measurements. Furthermore, data for air exchange rates, home characteristics, and indoor activities during sampling were collected. It was found that the average indoor PM10, PM2.5, CO, and CO2 concentrations for all homes in winter were 119.4 ± 30.9 µg/m3, 85.2 ± 25.8 µg/m3, 1.6 ± 0.8 ppm, and 692.4 ± 144.6 ppm, respectively. During summer, the average indoor levels were 98.8 ± 21.8 µg/m3, 67.8 ± 14.9 µg/m3, 0.5 ± 0.5 ppm, and 558.2 ± 66.2 ppm, respectively. The results indicate that the indoor daily averages of PM10 and PM2.5 concentrations were higher than the World Health Organization (WHO) guidelines for all selected homes in the two sampling periods. For CO and CO2 levels, the indoor daily averages for all monitored homes were less than the WHO guideline and the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ANSI/ASHRAE) Standard 62.1, respectively. A strong seasonal variability was observed, with air quality being particularly poor in winter. Due to increased ventilation rates in summer, indoor levels of air pollutants were strongly dependent on ambient levels, while in winter the indoor concentrations were more strongly affected by indoor sources due to increased human activities and poor ventilation. In addition, stronger indoor/outdoor correlation of air pollutants' levels was found in summer than in winter probably due to higher ventilation and infiltration in the summer. The study also attempted to understand the potential sources and the various determinants that influence indoor PM, CO, and CO2 concentrations in the two seasons. The findings can assist policymakers to better understand the indoor air pollution problem and to provide a sound basis for the development of proper national IAQ standards in Egypt.Implications: Personal exposure is considerably influenced by indoor air pollution which increases health risks. Assessment of indoor air quality has become a more significant issue in Egypt as people tend to spend most of their time inside buildings, especially in their homes. Currently, there is a lack of research on residential indoor air quality in Egyptian cities in terms of the spatial and temporal variation which prevents an accurate assessment of the current situation to develop effective mitigation measures and to establish national indoor air quality standards. This article is considered the first research studying the effect of seasonality on indoor concentrations of PM10, PM2.5, CO, and CO2 in urban residences in Alexandria. It also studies the indoor/outdoor relationship of air pollutants' levels and identifies their major sources as well as the various determinants that influence their indoor concentrations.

Association of oral parafunctional habits with anxiety and the Big-Five Personality Traits in the Saudi adult population.

BACKGROUND: Oral parafunctional habits are related to any abnormal hyperactivity of the oromandibular system. They are prevalent in all societies in varying intensity and have potential physical and psychological implications. The aim of this study was twofold: (1) to determine the prevalence of various types of oral parafunctional habits in the Saudi adult population, and (2) to examine their association with and the level of anxiety and personality factors. METHODS: This cross-sectional study was conducted with an electronic data collection form distributed to the public through social media. The questionnaire comprised of the following: (a) demographic information, (b) the Hamilton Anxiety Rating Scale (HAM-A), (c) the Ten-Item of Big-Five Personality Traits, (d) a list of oral parafunctional habits. Data were analysed using a Pearson's Chi square and binary logistic regression. RESULTS: The participants reported several parafunctional habits including daily gum chewing (86%), lip/object biting (59%), clenching (45%), nail biting (36%) and grinding (32%). Males were 3 [2.3-3.7] times and younger age groups were 1.5 [1.1-2.0] times more likely to be associated with nail biting compared to their counter groups (adj.P < 0.001 and adj.P = 0.007). Lip/object biting was significantly 1.3 [1.1-1.7] times more prevalent in males (adj.P = 0.015). Participants who reported being extroverts were more likely to be associated with clenching (46.4%) (P = 0.024). An emotionally stable person was significantly less likely to be associated with nail biting (28.4%), grinding (24.9%), clenching (35.8%), and lip/object biting (48.4%) (P < 0.001each). Participants who reported conscientiousness and emotional stability were significantly less associated with TMD (P = 0.007, P < 0.001). CONCLUSION: Oral parafunctional habits are highly prevalent in the Saudi adult population in varying degrees. Possible risk factors include males, younger age groups, single people, and being financially constrained.

Outdoor and indoor factors influencing particulate matter and carbon dioxide levels in naturally ventilated urban homes.

The present study investigated indoor and outdoor concentrations of two particulate matter size fractions (PM10 and PM2.5) and CO2 in 20 urban homes ventilated naturally and located in one congested residential and commercial area in the city of Alexandria, Egypt. The results indicate that the daily mean PM2.5 concentrations measured in the ambient air, living rooms, and kitchens of all sampling sites exceeded the WHO guideline by 100%, 65%, and 95%, respectively. The daily mean outdoor and indoor PM10 levels in all sampling sites were found to exceed the WHO guideline by 100% and 80%, respectively. The indoor PM10 and PM2.5 concentrations were significantly correlated with their corresponding outdoor levels, as natural ventilation through opening doors and windows allowed direct transfer of outdoor airborne particles into the indoor air. Most of the kitchens investigated had higher indoor concentrations of PM2.5 and CO2 than in living rooms. The elevated levels of PM2.5 and CO2 in domestic kitchens were probably related to inadequate ventilation. The current study attempted to understand the sources and the various indoor and outdoor factors that affect indoor PM10, PM2.5 and CO2 concentrations. Several domestic activities, such as smoking, cooking, and cleaning, were found to constitute important sources of indoor air pollution. The indoor pollution caused by PM2.5 was also found to be more serious in the domestic kitchens than in the living rooms and the results suggest that exposure to PM2.5 is high and highlights the need for more effective control measures. Implications: Indoor air pollution is a complex problem that involves many determinant factors. Understanding the relationships and the influence of various indoor and outdoor factors on indoor air quality is very important to prioritize control measures and mitigation action plans. There is currently a lack of research studies in Egypt to investigate determinant factors controlling indoor air quality for urban homes. The present study characterizes the indoor and outdoor concentrations of PM10, PM2.5, and CO2 in residential buildings in Alexandria city. The study also determines the indoor and outdoor factors which influence the indoor PM and CO2 concentrations as well as it evaluates the potential indoor sources in the selected homes. This research will help in the development of future indoor air quality standards for Egypt.

Incidence and severity of adverse events among platelet donors: A three-year retrospective study.

ABSTRACT: Adverse events (AEs) are unfortunate consequences of platelet donation. This study reports the incidence and severity of AEs and the associated risk factors in platelet donation at a major blood donation center in Riyadh, Saudi Arabia.A review of donation records was conducted between 2014 and 2017. Eligible study participants were 5007 platelet donors who had donated 7969 times. Each donation was accounted for as a single study subject. Participants' characteristics were described and analyzed as potential contributing factors to adverse events.The average age of platelet donors was 30.0±7.3 years. First-time donors comprised (n = 3,100, 61.9%) of the sample, and 1907 (38.1%) were multiple donors (periodic/routine). Their average BMI was 28.6 ±â€Š4.9 kg/m2. Most donors have blood type "O" and Rheo "positive". The range of blood volume processed was 0 to 5273 ml, while the procedure duration ranged from 0 to 90 minutes. The average platelet yield was 3.8 ±â€Š3.5 ∗1011 platelets per unit, and the average collected volume was 257.6 ±â€Š86.1 ml. Incidence of AEs was 4.2%, of which 91.3% were mild and 8.7% were severe. AEs were vascular injuries (65.3%), vasovagal reactions (11.6%), and citrate toxicity (5.3%). AEs were associated with first-time donation, adj.OR (95%CI) = 1.5 (1.1-1.8) and lower BMI, adj. OR (95% CI) = 1.4 (1.1-1.8). Citrate toxicity was present in severe forms, unlike vascular injuries and vasovagal reactions that tended to be milder. Donors with hemoglobin levels above 16 g/dl, adj. OR (95% CI) = 1.3 (1.1-1.7) and platelet levels below 250,000, adj. OR (95% CI) = 1.3 (1.1-1.6) were more likely to contract AEs than others.Reporting adverse events is essential to establish a benchmark for the annual incidence rates to be compared against local and international figures. Blood donor centers should also take notice of blood donors characteristics that are associated with higher incidence and more severe forms of AEs during or after platelet donation.

Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study.

BACKGROUND: Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia. METHODS: This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics. RESULTS: WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018. CONCLUSION: WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.

The prevalence of emergence delirium and its associated factors among children at a postoperative unit: A retrospective cohort at a Middle Eastern hospital.

BACKGROUND: Emergence delirium (ED) has been reported among children at a postoperative setting, which delays their recovery and exposes them to traumas. The aim of this study was to determine the prevalence of ED and its associated factors among children who underwent surgeries at a major tertiary healthcare facility in Saudi Arabia. MATERIALS AND METHODS: Between March and August 2018, a retrospective cohort study was conducted based on a review of 413 medical charts of children (<14 years) who underwent an elective/nonemergency surgery and then were admitted to a Post Anesthesia Care Unit. Patient and surgery-related characteristics were analyzed as potential factors associated with ED. The anxiety level was assessed preoperatively using the Modified Yale Preoperative Anxiety Scale (four domains), while the ED was detected after surgery using the Watcha scale (child is agitated and thrashing around). RESULTS: The leading surgery category was ear, nose, and throat surgeries [184 (44.6%)] and dental surgeries [109 (26.4%)]. Almost one-third received only general anesthesia (31.2%), while 271 (68.8%) received an additional regional block/skin infiltrate. The anxiety domains preop showed that the percentage mean score ± standard deviation of expression of emotions was 37.1 ± 21.6, apparent arousal 33.7 ± 20.4, activeness 30.1 ± 13.5, and vocalization 26.9 ± 20.3. The prevalence of ED among children who underwent surgeries during the 6-month period was 23 (6.6%). Almost 18.8% of those who received opioid analgesics (fentanyl alone) developed ED, while 12% of those who received both opioid and nonopioid analgesics (fentanyl/paracetamol) developed ED. ED was significantly associated with longer recovery duration 69.5 + 27.1 min, P = 0.007. Binary logistics regression analysis showed that participants who did not receive Precedex were adj. odds ratio = 10.3 (2.4-48.9) times more likely to develop ED, compared with those who received it, adj. P = 0.003. Lower preoperative scores of expression of emotions and higher scores of apparent arousal were significantly associated with ED, adj. P = 0.035 and adj. P = 0.023, respectively. CONCLUSION: ED appears to be inevitable in postoperative settings. It is crucial to address any preoperative anxiety assessment as it is associated with ED. Anxiety remains a modifiable factor that can be managed, as well as to the administration of Precedex and adjunct analgesic treatments.

A prospective Saudi dental stem-cell bank from the perspective of the public and dental practitioners: A cross sectional survey.

OBJECTIVES: The aim of this study (1) To evaluate the Saudi public's knowledge and attitude on dental stem cells (DSC) for therapeutic/banking purposes, (2) To evaluate the perception of Saudi dentists towards DSC and their attitude towards banking of DSC. METHODOLOGY: This was a cross-sectional study based on an electronic survey distributed through the social media nationwide among the Saudi public, and through paper-based surveys among dentists in Riyadh. By convenience, eligible study participants were Saudi adults from the community and dentists from 17 dental centers in different regions of Riyadh. Using SPSS v. 25, descriptive statistics (n,%; PMS ± SD) and bivariate analyses (Pearson's Chi square, Mann Whitney) were conducted to determine factors associated with the study outcomes, with a P value statistically significant at <0.05. RESULTS: For the Saudi public, 1494 participants completed the survey. The PMS ± SD of public knowledge was 25.5 ± 25.9, while their attitude was 80.2 ± 27.0. Factors associated with higher knowledge scores were younger age groups, while female participants, older age groups, university educated and employed participants had higher attitude. For Saudi dentists, 246/262 (94%) dentists responded to the questionnaire. Their PMS ± SD of perception towards DSC research for regenerative purposes was 74.5 ± 15.6. Factors associated with higher perception scores were those with more experience. Dentists who had higher perception scores towards DSCs were significantly more willing to save teeth for regenerative dental treatment. CONCLUSION: The Saudi public community had poor knowledge about the therapeutic and research benefits of DSC, yet high degree of attitude to enroll in a future Saudi DSC bank. Saudi dentists had moderately high levels of perception towards DSC research.

Public awareness of forensic odontology and willingness to enroll in a prospective dental registry: A survey conducted in Saudi Arabia.

BACKGROUND: The establishment of a national dental registry provides a great opportunity for the healthcare and criminal investigation systems. Its feasibility would rely mainly upon public knowledge and a willingness to contribute dental profiles. The aim of this study was to evaluate the level of awareness among the Saudi public of forensic odontology and to evaluate their willingness to participate in a prospective national dental registry. METHODS: A cross-sectional survey based on a self-administered survey questionnaire was conducted in 2018 at the Al-Janadriyah National Festival in Riyadh, Saudi Arabia. Visitors were questioned about their demographic data and responded to 20 knowledge statements using the alternatives "correct", "incorrect", or "don't know". Their perception towards registries was assessed using 15 statements and a 5-point Likert scale. The percentage mean score (PMS) of knowledge, the mean positive response rate (MPRR) of participant perception, and their willingness to participate in a prospective dental registry were assessed with respect to their demographic characteristics. RESULTS: Complete surveys were received from 812 study participants (85.5% response rate). The PMS ±â€¯standard deviation of knowledge was 39.8 ±â€¯22.5 and the MPRR of perception was 64.7 ±â€¯25.5. More than two-thirds of the responders (n = 548, 67.5%) indicated a willingness to register in a future national dental registry. Differences in knowledge were identified with regard to sex, marital status, education, and occupation, while differences in perception and willingness to enroll were influenced by sex. After adjustment for possible confounders, female participants and employed participants were 1.7 times (95% confidence interval [CI] = 1.2-2.4) and 1.6 times [95% CI = 1.1-2.5] more likely to enroll in the proposed registry (P = 0.004 and P = 0.03, respectively). Higher knowledge and perception scores were associated with more willingness to enroll in the national dental registry (adjusted [adj.] P = 0.03 and adj. P < 0.001, respectively). CONCLUSIONS: A future national dental registry in Saudi Arabia is expected to be well-received by the public. An improvement in the public's knowledge regarding the importance of forensic dentistry is expected to encourage their active enrollment in such a registry. Although women and employed participants were more willing to enroll, it is too early to predict the rates of participation, given the fact that nationwide marketing surveys have yet to be launched.

An Evaluation Of Antibiotics Prescribing Patterns In The Emergency Department Of A Tertiary Care Hospital In Saudi Arabia.

BACKGROUND: Antibiotic prescriptions at emergency departments (ED) could be a primary contributing factor to the overuse of antimicrobial agents and subsequently antimicrobial resistance. The aim of this study was to describe the pattern of antibiotic prescriptions at an emergency department of a tertiary care hospital in Saudi Arabia. METHODS: A cross-sectional study, based on a review of antibiotic prescriptions was conducted. All cases who visited the emergency department over a three-month period with a complaint of infection were analyzed in terms of patient characteristics (age, sex, infection type, and number of visits) and prescription characteristics (antibiotic category, spectrum, course and costs). The World Health Organization and International Network of Rational Use of Drugs prescribing indicators were presented. Descriptive and analytic statistics were applied. RESULTS: A total of 36,069 ED visits were recorded during the study period, of which 45,770 drug prescriptions were prescribed, including 6,354 antibiotics. The average number of drugs per encounter was 1.26, while the percentage of encounters with a prescribed antibiotic was 17.6%. Among antibiotic prescriptions, the percentage of encounters with injection antibiotics was 15.2%. Almost 77% of antibiotics were prescribed by their generic names, and the percentage of antibiotics prescribed from the essential list was 100%. CONCLUSION: The average number of drugs per encounter in general and antibiotics per encounter in specific at this setting was lower than the standard value. However, the percentage of antibiotics prescribed by its generic name was less than optimal.

Dietary Habits of Students Enrolled in Faculties of Health Sciences: A Cross-sectional Study.

Introduction It is often presumed that students of health sciences are more vigilant about their diet. This study assessed the prevalence of unhealthy dietary habits and identified its associated factors among students enrolled at a large university for health sciences in the Middle East. Methods A cross-sectional study, using a set of pre-validated and anonymous dietary tools, was conducted in 2018. The self-reported students' characteristics and prevalence of 10 unhealthy dietary habits were collected. Results Males were significantly more likely have irregular meal times (ß = 0.425, adjusted [adj.] odds ratio [OR] = 1.5) and insufficient seafood consumption (ß = 0.55, adj. OR = 1.7) compared to females, adj. P = 0.046 and adj. P = 0.012, respectively. Students in their third year and above (ß = 0.857, adj. OR = 2.2) reported more insufficient water intake compared to students in the first and second years, adjusted P = 0.003. Obesity in students was a significant associated factor with fast food consumption (ß = 0.48, adj. OR = 1.8), night-eating habits (ß = 0.27, adj. OR = 1.3) and skipping meals (ß = 0.41, adj. OR = 1.5) compared to normal weight students, adjusted P = 0.002, adj. P = 0.004, and adj. P = 0.003, respectively. Conclusions Compliance with healthy dietary habits among students was less than optimal. Special consideration should be paid to gender and obesity that have been associated with insufficient water intake, irregular meal times, skipping meals, night-eating habits, and fast food consumption.

Workplace bullying and its impact on the quality of healthcare and patient safety.

BACKGROUND: Workplace bullying (WPB) is a physical or emotional harm that may negatively affect healthcare services. The aim of this study was to determine to what extent healthcare practitioners in Saudi Arabia worry about WPB and whether it affects the quality of care and patient safety from their perception. METHODS: A cross-sectional study was conducted in 2018. An online survey was distributed among all practitioners at a multi-regional healthcare facility. A previously validated tool was sourced from an integrative literature review by Houck and Colbert. Responses to 15 themes were rated on a 5-point Likert scale, converted to percentage mean scores (PMS) and compared across participants' characteristics using bivariate and regression analyses. RESULTS: A total of 1074/1350 (79.5%) completed the questionnaire. The overall median [interquartile range] score of worrying about WPB was 81.7 [35.0]. Participants were mainly worried about the effect of WPB on their stress, work performance, and communication between staff members. A significant negative relationship developed between the quality of care and worrying about WPB, P < 0.001. More educated practitioners were 1.7 times more likely to be worried about WPB compared with their counter group, adj.P = 0.034. Junior practitioners were 1.6 times more likely to be worried about WPB, adj.P = 0.017. The group who has not been trained in handling WPB (1.7 times), and those who had been exposed to WPB (2.2 times) were both more likely to be worried about WPB compared with their counter groups, adj.P = 0.026 and adj.P < 0.001 respectively. CONCLUSIONS: Most healthcare practitioners worry about WPB, especially its negative impact on the quality of care and patient safety. A greater proportion of practitioners with higher levels of education and their less experienced counterparts were more worried about WPB. Previous exposure to a WPB incident amplifies the practitioners' worry, but being trained on how to counteract bullying incidents makes them less likely to be worried.

Use of smartphone and perception towards the usefulness and practicality of its medical applications among healthcare workers in Saudi Arabia.

BACKGROUND: In Saudi Arabia, healthcare industry is undergoing major expansions to meet the demand of rapidly growing healthcare needs. The aims of this study were; (1) to assess the pattern of smartphone use in healthcare facilities, and (2) to determine perception towards its use among healthcare workers. METHOD: A cross-sectional survey of 351 healthcare workers (HCWs) at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia was conducted, from October to November 2016, using a previously validated perception domain to measure perception towards usefulness (5 statements) and practicality (5 statements) of smartphones in clinical settings. Pattern of use of smartphones and health-related applications in healthcare facilities was also investigated. Logestic regression models were applied to identify the predictors of smartphone use and installation of health-related applications for use in healthcare facilities. Significance was considered at p-value of < 0.05. RESULTS: Utilization rate of smartphone was 42.3%, and only 6.1% of all healthcare providers reported always using applications in their practice. Reasons for use were: as a source of drug information (69.8%), for disease diagnosis (56.4%), to access medical websites (42.5%), to review guidelines and protocols related to healthcare (34.1%), for procedure documentation (23.5%), and as a source of patients education materials (22.3%). Perceptions of HCWs towards smartphone use was less than satisfactory (Overall percentage mean score = 60.4 ± 18.7), with only 11.6% reporting positive perception. After adjusting for possible confounders, the total perception mean score was a significant predictor of both smartphone use (ß = 0.033, p < 0.001) and medical applications installation (ß = 0.033, p < 0.001). Installation of medical applications was also predicted by being a physician (ß = 0.008, p = 0.024). CONCLUSION: Smartphone utilization in healthcare facilities by HCWs in Saudi Arabia is low. This could be attributed to their less than satisfactory level of perception towards its use. Smartphone use and installation of medical applications for use in health facilities were predicted by perceived usefulness and practicality of its use. Intervention from higher health authorities is necessary to enforce the importance of smartphone use in clinical practice. Conduction of further studies on the impact of smart phone use on the healthcare quality in Saudi Arabia is recommended.

Effects of microstructure and alloy composition on hydroxyapatite precipitation on alkaline treated α/ß titanium alloys.

The current work aims at exploring the effects of the microstructure and alloy composition on enhancing the bone osseointegration in Ti-6Al-4V (Ti64) and Ti-6Al-7Nb (Ti67) alloys. This was revealed by investigating the alloy susceptibility to grow hydroxyapatite (HA) on their surfaces after immersion in simulated body fluid (SBF). The specimens were produced by two methods: forging and casting in order to study the influence of the microstructure on the precipitation process. The surface conditions investigated were the polished, alkaline and the hydrothermally treated. It was found that precipitation on both of Ti64 and Ti67 occurs after about 4 weeks and considerably dissolve back with further immersion. Precipitation process is enhanced at some pH levels lower than the neutral level. Forged Ti67 has less reactivity with Hank solution than Ti64 specimens; the reverse is true for cast specimens. In case of the alkaline treated specimens, precipitations on cast specimens were denser than on the forged ones. For the hydrothermally treated specimens, high amounts of Ca and P were observed on cast Ti67 indicating that hydrothermal treatment is considered the best surface modification treatment for alloy Ti67.