The outcome and complications of total parenteral nutrition in pediatric hematopoietic stem cell transplantation.

BACKGROUND: Nutritional support posthematopoietic stem cell transplantation (HSCT) with total parenteral nutrition (TPN) or nasogastric tube feeding (NGT) in pediatric patients is associated with benefits and risks. METHODS: We retrospectively reviewed the indication of TPN use in our pediatric HSCT patients and its impact on survival and possible related complications. RESULTS: A total of 228 HSCTs were performed during the study period. TPN was used in 144 patients (63.2%) for a median of 14 days, while 8.8% had NGT feeding and 28% were able to tolerate oral feeding. Severe mucositis was seen in 104 TPN patients (72.2%) in comparison with 22 patients (26.2%) who were on Enteral Nutrition (EN) (p = <.001). Sinusoidal obstruction syndrome (SOS) was seen in 19 (13.2%) patients who had TPN compared to none in the patients who received EN (p = .001). The majority of patients who had SOS received myeloablative conditioning (MAC) therapy for hemoglobinopathy. Acute graft-versus-host disease (aGVHD) was seen in 24.8% of TPN patients and 9.1% of non-TPN patients (p = .01). However, there were no statistically significant differences in chronic GVHD, bacteremia, and patients' survival between both groups. CONCLUSIONS: TPN is commonly used after pediatric HSCT in cases of severe mucositis. NGT feeding was found to be the least used nutritional support method. SOS and aGVHD were associated more frequently in TPN patients compared to EN patients. This suggests the possible disadvantages of TPN and importance of SOS preventative measures in high-risk patients.

The Effectiveness of Students' Performance in Preclinical Fixed Prosthodontics Course in Predicting Subsequent Clinical Performance.

PURPOSE: To evaluate the correlation between students' achieved grades in a preclinical fixed prosthodontics course and their performance in the same discipline's clinical courses. MATERIALS AND METHODS: This study was conducted in 2019 on 76 students who passed all preclinical and clinical fixed prosthodontics courses. Their final examination grades in preclinical and clinical prosthodontics courses were compiled and made anonymous. The Statistical Package for the Social Sciences (SPSS Version 23) was used to analyze the data. Descriptive statistics and correlation coefficient were used to assess the relation between preclinical and clinical grades. RESULTS: A statistically significant positive correlation existed between the students' preclinical and combined clinical final examination grades (r = 0.45, p < 0.001). In relation to sex, females showed a significantly higher correlation (r = 0.56, p = 0.001) compared to males (r = 0.25, p = 0.1). In addition, students' clinical grade prediction from their preclinical performance was 20.5%. CONCLUSION: These findings emphasize the importance of preclinical courses and suggest that maximizing preclinical years' efforts can reflect positively on students' competence in their future clinical practice.

Elevated level of creatine phosphokinase in newborn: Clinical significance and association with congenital muscle diseases.

OBJECTIVES: To establish the normal Creatine phosphokinase (CPK) range in newborns of all 3 modes of delivery and prove that high CPK level in neonates is not specific a indicator for muscular pathology. METHODS: This is a prospective cohort study that is conducted in King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh and included 504 term neonates who were born between March 2021 and August 2021. Two hundred and fifty three were males and 251 were females. Data and consents were managed and collected using 2 coordinators. RESULTS: Duration of the second stage of labor, age on the first CPK test and fetal gestational age were significantly correlated with CPK values (r=0.197, r=-0.234, r=0.274, respectively). The normal ranges for each delivery type were 334 U/L-2667U/L in normal spontaneous vaginal delivery, 265U/L-1182U/L in elective cesarean section, and 223U/L-3082 U/L in emergency cesarean section. CONCLUSION: The CPK was elevated in all neonates in all 3 modes of deliveries. An elevated levels of CPK in neonates is not a specific indicator for any congenital muscular pathology.

Significant differences in FcγRIIa, FcγRIIIa and FcγRIIIb genes polymorphism and anti-malarial IgG subclass pattern are associated with severe Plasmodium falciparum malaria in Saudi children.

BACKGROUND: The FcγRs genotypes have been reported to play a key role in the defence against malaria parasites through both cellular and humoral immunity. This study aimed to investigate the possible correlation between FcγR (IIa, IIIa, and IIIb) genes polymorphism and the clinical outcome for anti-malarial antibody response of Plasmodium falciparum infection among Saudi children. METHODS: A total of 600 volunteers were enrolled in this study, including 200 malaria-free control (MFC) subjects, 218 patients with uncomplicated malaria (UM) and 182 patients with severe malaria (SM). The FcγR genotypes were analysed using PCR amplification methods, and measurements of immunoglobulin were determined using enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: The data revealed that the FcγRIIa-R/R131 showed a statistically significant association with SM patients when compared to UM patients. Furthermore, higher levels of IgG1, IgG2, and IgG4 were associated with the FcγRIIa-H/H131 genotype among UM patients. Although the FcγRIIa-F/V176 genotype was not associated with UM, it showed a significant association with severe malaria. Interestingly, the FcγRIIIa-V/V176 genotype offered protection against SM. Moreover, SM patients carrying the FcγRIIIa-F/F genotype showed higher levels of AMA-1-specific IgG2 and IgG4 antibodies. The FcγRIIIb-NA1/NA1 and FcγRIIIb-NA2/NA2 genotypes did not show significant differences between the UM and the MFC groups. However, the genotype FcγRIIIb-NA2/NA2 was statistically significantly associated with SM patients. CONCLUSIONS: The data presented in this study suggest that the influence of the FcγRIIa-R/R131, FcγRIIIa-F/F176 and FcγRIIIb-NA2/NA2 genotypes are statistically significantly associated with SM patients. However, the FcγRIIa-H/H13 and FcγRIIIa-V/V176 genotypes have demonstrated a protective effect against SM when compared to UM patients. The impact of the FcyR (IIa, IIIa and IIIb) gene variants and anti-malaria IgG subclasses play an important role in susceptibility to malaria infection and disease outcome in Saudi children.

Introducing free response short answer questions in anatomy spot tests: experiment study.

PURPOSE: A spot test is commonly used to assess practical knowledge through a series of specific questions related to the marked anatomical structures on cadavers. However, the continuous reviewing and developing of the medical curricula demands the need to improve the assessment method of the practical examination of anatomical knowledge. Therefore, the aim of the study was to examine the effectiveness of a free response short-answer questions (FRSAQs) test and traditional questions on medical students' performance. METHODS: This is an experimental study using a Randomized Posttest-Only Control Group Design to compare the mean of students' performance in addition to their perceptions about the two versions of the spot tests. Two hundred and ninety preclinical-year medical students were invited to participate in this study. RESULTS: Only 109 (38%) students participated in this study. The data analysis showed a significant improvement in students' performance in the FRSAQs test (5.3 ± 2.7) than the traditional spot test (4.7 ± 2.6), (P = 0.04). The majority of the students (70%) preferred the FRSAQs spot test, citing that it is good test to assess practical knowledge. The psychometric analysis revealed that the FRSAQs produced more ideal stations (60%) when compared to the traditional spot test (10%). CONCLUSION: The current study found that the FRSAQs spot test had a significant impact on students' performance, and it was considered an ideal, flexible, and stress-free assessment method when compared to the traditional spot test. Implementation of the strategy in teaching and in assessment is recommended.

Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia.

OBJECTIVES: To present the experience on stroke thrombolysis of a tertiary care center in Riyadh, KSA. METHODS: Cross-sectional, observational study of patients thrombolyzed between January 2012 and December 2018. RESULTS: Thrombolysis was performed in 148 patients (mean age: 58.2±14.5 years), 94 (63.5%) of them were men. The median onset-to-door time was 81 minutes, and 25% of the patients arrived within 1 hour. The median National Institute of Health Stroke Scale score upon admission was 13. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were the most common risk factors for stroke. The most common mechanism of stroke was cardioembolism (43.2%), which was associated with a more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 patients (66.2%); the rest received intravenous tissue plasminogen activator plus endovascular therapy or endovascular therapy alone. The median door-to-needle (DTN) time was 70.5 min, with a significant improvement from 2012 (111.6 minutes) to 2018 (69.9 minutes) (p<0.001). Among the patients, 53 (35.8%) showed a good outcome (with a modified Rankin score of 0-2) whereas 14 (9.5%) died. Symptomatic intracranial hemorrhage (sICH) was seen in 8.1%. All vascular risk factors were more common in patients aged >60 years, except smoking, which was more common in the younger age group (p=0.007). CONCLUSION: In our cohort, the utilization of thrombolysis and the DTN time improved over time. One-thirds of the patients received endovascular treatment. Moreover, the frequency of the vascular risk factors was high. Compared with the published findings, our results showed that cardioembolic strokes were the most frequent and had severe presentation and were likely the cause of the slight increase in mortality and sICH.

Cervical spine clearance in unconscious pediatric trauma patients: a level l trauma center experience.

PURPOSE: To radiographically assess cervical spine clearance in unconscious pediatric trauma patients. METHODS: A retrospective cohort study was conducted to review pediatric patients with suspected cervical spinal injuries between 2005 and 2018 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All pediatric patients aged 15 years and less, who sustained trauma (motor vehicle accident, pedestrian, fall, all-terrain vehicle accident, and sports injures) and were intubated at the scene or in the emergency department, were included. RESULTS: A total of 62 patients were included. The average age for children was 8 ± 3.9 years. The average Glasgow coma scale (GCS) for children at initial trauma was 7.6 + 3.7. The average injury severity score (ISS) was 24.1 + 17.7. The most frequent abnormal finding identified on CT scan was cervical spine straightening (N = 8; 13.1%). A total of 13 children had abnormal MRI findings, with the most common injury being ligamentous in nature (N = 13; 46.42%). The sensitivity and specificity of CT scan in cervical spine clearance in unconscious children are 84.8% and 100%, respectively. CONCLUSION: Utilizing CT scans in clearing the cervical spine is of paramount importance to promptly detect possible injuries. The role of MRI in cervical spine clearance still cannot be undervalued, especially when the clinical suspicion for injury is high.

Incidence of postoperative pain after canal shaping by using Reciproc and Twisted File Adaptive systems: a prospective, randomized clinical trial.

OBJECTIVES: The aim of this prospective clinical trial was to investigate the incidence of postoperative pain after initial root canal treatment using Twisted File Adaptive (TFA) and Reciproc systems. MATERIALS AND METHODS: A total of sixty-four previously initiated or necrotic posterior teeth were randomly assigned to two groups based on the rotary system used; TFA (SybronEndo, Orange, Ca) (n = 35) and Reciproc (VDW, Munich, Germany) (n = 29). All teeth were treated in a single visit. Patients were contacted to assess the level of postoperative pain on a visual analog scale after treatment by 6 h, 24 h, 48 h, 72 h, and 1 week. Patients were also asked to report if any medication was taken during the follow-up period. The postoperative pain scores were analyzed by Mann-Whitney test with respect to follow-up interval at a significance level of 0.05. RESULTS: Patients treated with TFA reported significantly lower postoperative pain levels at 24 h, 48 h, and 72 h compared with those in Reciproc group (p < 0.01). There were no significant differences between the two groups at 6 h and 1-week follow-up intervals (p > 0.05). About 11% (TFA) and 24% (Reciproc) of the treated patients took analgesics, but none of them took antibiotics during the follow-up period. CONCLUSIONS: The tested rotary systems induced postoperative pain after root canal treatment. The TFA system was found to induce less pain scores compared with the Reciproc system after the treatment by 24 h, 48 h, and 72 h. CLINICAL RELEVANCE: The level of postoperative pain was low after the root canal treatment with the Twisted File Adaptive system compared with the Reciproc system.

Pictorial health warnings on cigarette packs and effect on smoking: Medical student's perspective.

OBJECTIVE: To evaluate the knowledge, attitude and practice of medical students towards pictorial warnings on cigarette packets. METHODS: The cross-sectional study was conducted from October 2017 to December 2018 at King Saud bin Abdulaziz University for Health Sciences Riyadh, Saudi Arabia, Riyadh, Saudi Arabia, and comprised medical students from third to sixth year. Data was collected using a self-administered structured questionnaire which was validated through pilot-testing. A five-point Likert scale was used to access each item, with 1 as strongly disagree and 5 as strongly agree. Data was analysed using SPSS 22. RESULTS: Of the 335 subjects, 181(54%) were males. The overall mean age was 23±2.2 years and 307(92%) were non-smokers. The overall knowledge, attitude and practice was low with a total median score of 3.3 (interquartile range: 3.1-3.6). However, knowledge was better 4 (interquartile range: 3.7-4.7). Males had significantly more knowledge about the pictorial health warnings compared to females (p<0.001). Having a smoker friend had significantly better effect on the overall knowledge and attitude with (p<0.05). CONCLUSIONS: The study concludes that pictorial warnings are not helpful in persuading the current smokers to give up smoking. The knowledge about who take the decision of printing these warnings is not known to majority of the participants. Those who had a friend smoker had considerably better knowledge about pictorial warnings. Display of pictorial warnings might not be enough to serve the purpose of discouraging future smokers. Innovative strategies involving the non-smokers (peers and friends) should also be considered in the new era for cessation of smoking.

The Impact of Socio-Economic and Home Environmental Factors on Oral Health-Related Quality of Life Among Children Aged 11-14.

Background and Objectives: Oral diseases are known to negatively impact physical, functional, and emotional well-being, and thus adversely affect quality of life. The aims of the study were (1) to assess the oral health-related quality of life (OHRQoL) and (2) to explore socio-demographic, -economic, and -environmental factors that are associated with OHRQoL among a sample of children aged 11-14 in Saudi Arabia. Materials and Methods: A cross-sectional design was used. The Child Perceptions Questionnaire (CPQ)-a self-administered, validated, and standardized questionnaire was used to collect data on OHRQoL in four domains: oral symptoms, functional limitations, and emotional and social well-being. In addition, data were collected on home environment, socioeconomic/demographic characteristics, and oral hygiene practices of participants and their parents or adult guardians. Univariate descriptive statistics, Spearman's correlation, and Kruskal-Wallis H and Mann-Whitney tests were used. Data were analyzed using SPSS 23 Software. Significance was set at α = 0.05. Results: In total, 534 children participated in the study (91% response rate), of which 60% were females. Twenty percent of children described their oral health as "poor" and one in every four children reported that their oral health had at least some effect on their overall well-being. Children who were male, attending public schools, and living with both parents were more likely to report poor OHRQoL. Conclusions: A considerable proportion of children aged 11-14 could discern that their oral health had some effect on their overall well-being. The results identified potential predictors of OHRQoL. Disparities in OHRQoL exist among certain sub-populations. Active efforts and local interventions are necessary to improve OHRQoL.

Recall Practice among Dental Practitioners in Riyadh, Kingdom of Saudi Arabia.

AIM: The study aims to assess recall practice among dental practitioners in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A 24-item questionnaire was used to collect information about the general practice, knowledge of dental recall, and factors affecting dental recall from general dental practitioners in Riyadh. The questionnaire elicited data on personal information (8 items), practice information (3 items), knowledge about the dental recall (3 items), recall practice (6 items), and patient factors that might influence recall (4 items). A five-point Likert scale showed the level of agreement in cases that required recall visits, reasons for patients not returning for recall, and techniques to encourage return for recall. RESULTS: A total of 315 questionnaires were analyzed (response rate = 46.3%). The mean age of participants was 32.4 years old and 52.4% of participants were male. Eighty-four percent of respondents reported that they routinely perform regular recall with their patients. Recall practice was significantly associated with practitioner experience, country of graduation, and workplace. Practitioners who graduated from Saudi universities were found to be less likely to practice regular recall visits compared to others (p <0.01). On the other hand, practitioners who are working in university hospitals are more likely to practice dental recall compared to those who are working only in dental clinics (p = 0.02). CONCLUSION: A low percentage of dentists advocated and practiced regular recall visits in their private practice. Efforts should be undertaken to educate the practitioners on the importance of regular recall visits in their healthcare settings. CLINICAL SIGNIFICANCE: Scheduling appropriate recall visits is an essential component for achieving successful treatment outcomes. This study highlights the poor recall practice among dentists and the need to raise the awareness of the importance of recall visits.

Candida Bloodstream Infection: Changing Pattern of Occurrence and Antifungal Susceptibility over 10 Years in a Tertiary Care Saudi Hospital.

BACKGROUND: Candida has emerged as one of the most important pathogens that cause bloodstream infection (BSI).Understanding the current Candida BSI trends, the dominant species causing disease and the mortality associated with this infection are crucial to optimize therapeutic and prophylaxis measures. OBJECTIVES: To study the epidemiology and to evaluate the risk factors, prognostic factors, and mortality associated with candidemia and to compare these findings with previously published studies from Saudi Arabia. DESIGN: A retrospective medical record review. SETTING: Tertiary hospital in Riyadh. PATIENTS AND METHODS: The analysis included all cases of Candida blood stream infection who are >18 years old over the period from 2013 to 2018. Continuous variables were compared using the parametric T-test while categorical variables were compared using the Chi-squared test. MAIN OUTCOME MEASURE: Incidence, resistance, and hospital outcomes in Candida blood stream infection. SAMPLE SIZE: 324 patients. RESULTS: Three hundred and twenty-four episodes of Candida blood stream infections were identified. Median age of patients was 49.7 SD ± 28.1 years, and 53% of patients were males. More than half of the patients had an underlying disease involving the abdomen or laparotomy, 78% had an indwelling intravenous catheter, and 62% had suffered a bacterial infection within 2 weeks prior to candidemia. Candida albicans represents 33% of all isolates with decreasing trend overtime. There was an increase in the number of nonalbicans Candida overtime with Candida tropicalis in the lead (20%). Use of broad spectrum antibiotics (82%), prior ICU admission (60%) and use of central venous catheters (58%) were the most prevalent predisposing factors of candidemia. Azole resistance was variable overtime. Resistance to caspofungin remained very low (1.9%). Fourteen days crude mortality was 37% for ICU patients and 26.7% in non-ICU patients, while hospital crude mortality was 64.4% and 46.7%, respectively. CONCLUSION: There is an increasing trend of nonalbicans Candida blood stream infection. Fluconazole resistance remained low to C. albicans. Most isolates remain susceptible to caspofungin, voriconazole, and amphotericin B. Candida bloodstream infection is associated with high 14-day hospital mortality.

A study of resident duty hours and burnout in a sample of Saudi residents.

BACKGROUND: Work hour restrictions in residency programs have been implemented over the last several decades in Europe, USA, and Canada. To best of our knowledge, there is no study of resident duty hours in the Kingdom of Saudi Arabia. In addition, few studies have looked at the prevalence of burnout amongst Saudi residents. The present study explored resident duty hours and burnout amongst residents in Saudi Arabia. METHODS: A paper-based questionnaire was designed to survey resident duty hours in Saudi Arabia and was administered along with the Maslach Burnout Inventory. The questionnaires were administered to residents in medical and surgical residency programs at King Abdulaziz Medical City-Riyadh and two hospitals in Buraidah, Qassim Province. RESULTS: A total of 181 residents from the three hospitals participated in the survey. In terms of average number of work hours per week, 50% of all residents reported working 60-79 h while 30% reported working 80 or more hours per week. The prevalence of burnout was 81%. There was no association between higher number of working hours and the prevalence of burnout. CONCLUSION: This was the first study describing resident duty hours and exploring the relationship between duty hours and burnout in Saudi Arabia. Our main findings were that the majority of residents work 60 or more hours per week, and there was a very high degree of burnout amongst residents. A larger multi-centre study of resident duty hours and its effect on patient safety and resident well-being is needed to develop work hour regulations in Saudi Arabia. In addition, there is an urgent need to develop programs that address resident burnout.

Knowledge and attitude towards total knee arthroplasty among the public in Saudi Arabia: a nationwide population-based study.

PURPOSE: Studies on total knee arthroplasty (TKA) in Saudi Arabia are scarce, and none have reported the knowledge and attitude of the procedure in Saudi Arabia. Our study aims to measure the knowledge and attitude of TKA among the adult Saudi population. METHODS: To encompass a representative sample of this cross-sectional survey, all 13 administrative areas were used as ready-made geographical clusters. For each cluster, stratified random sampling was performed to maximize participation in the study. In each area, random samples of mobile phone numbers were selected with a probability proportional to the administrative area population size. Sample size calculation was based on the assumption that 50% of the participants would have some level of knowledge, with a 2% margin of error and 95% confidence level. To reach our intended sample size of 1540, we contacted 1722 participants with a response rate of 89.4%. RESULTS: The expected percentage of public knowledge was 50%; however, the actual percentage revealed by this study was much lower (29.7%). A stepwise multiple logistic regression was used to assess the factors that positively affected the knowledge score regarding TKA. Age [P = 0.016 with OR of 0.47], higher income [P = 0.001 with OR of 0.52] and participants with a positive history of TKA or that have known someone who underwent the surgery [P < 0.001 with OR of 0.15] had a positive impact on the total knowledge score. CONCLUSIONS: There are still misconceptions among the public in Saudi Arabia concerning TKA, its indications and results. We recommend that doctors use the results of our survey to assess their conversations with their patients, and to determine whether the results of the procedure are adequately clarified.

Learning methods and strategies of anatomy among medical students in two different Institutions in Riyadh, Saudi Arabia.

BACKGROUND: Anatomy instructors adopt individual teaching methods and strategies to convey anatomical information to medical students for learning. Students also exhibit their own individual learning preferences. Instructional methods preferences vary between both instructors and students across different institutions. AIMS: In attempt to bridge the gap between teaching methods and the students' learning preferences, this study aimed to identify students' learning methods and different strategies of studying anatomy in two different Saudi medical schools in Riyadh. MATERIALS AND METHODS: A cross-sectional study, conducted in Saudi Arabia in April 2015, utilized a three-section questionnaire, which was distributed to a consecutive sample of 883 medical students to explore their methods and strategies in learning and teaching anatomy in two separate institutions in Riyadh, Saudi Arabia. RESULTS: Medical students' learning styles and preferences were found to be predominantly affected by different cultural backgrounds, gender, and level of study. Many students found it easier to understand and remember anatomy components using study aids. In addition, almost half of the students felt confident to ask their teachers questions after class. The study also showed that more than half of the students found it easier to study by concentrating on a particular part of the body rather than systems. Students' methods of learning were distributed equally between memorizing facts and learning by hands-on dissection. In addition, the study showed that two thirds of the students felt satisfied with their learning method and believed it was well suited for anatomy. CONCLUSIONS: There is no single teaching method which proves beneficial; instructors should be flexible in their teaching in order to optimize students' academic achievements.

Patient Expectations and Satisfaction With Foot and Ankle Surgery in Saudi Arabia: A Retrospective Cohort Study.

The success of surgery is associated not only with the quality of the procedure but also with the degree to which it meets the patient's expectations. Limited data are available on patient expectations related to foot and ankle surgery in Saudi Arabia. Our study assessed the preoperative expectations and postoperative satisfaction of patients who had undergone foot and ankle surgery at 1 hospital in Saudi Arabia. A survey-based, retrospective cohort study was conducted among patients who had undergone elective foot or ankle surgery at King Abdul-Aziz Medical City, Riyadh, from January 2010 to December 2015. The participants, who were randomly selected, were interviewed by telephone in April 2016. The average interval between the surgery and the telephone interview was 1 year. We performed stepwise multiple logistic regression analysis to assess the predictors of patient satisfaction with surgery. A total of 383 participants were interviewed (51.7% male). The sample included participants with a wide age range. Most participants had undergone surgery because of pain (74.9%) or movement difficulties (37.1%); only 9.4% had undergone surgery for cosmetic reasons. Most (80%) of the participants reported they were satisfied with the surgical results. Young age, bilateral surgery, efficient pain control, and fulfilled expectations had the greatest positive effects on satisfaction. The findings of the present study will help improve our understanding of the expectations of patients who undergo elective foot and ankle surgery in Saudi Arabia. Additionally, our results can give orthopedic surgeons insight into patients' ideas and concerns regarding their surgery, which might ultimately improve communication between surgeons and patients.

Prevalence of adverse childhood experiences and their cumulative impact associated lifetime health outcomes in the Emirate of Abu-Dhabi, United Arab Emirates.

BACKGROUND: Adverse Childhood Experiences have been associated with poor health outcomes later in life. OBJECTIVE: The objective of the study was to determine the relationship between cumulative ACEs, risky health behaviors, chronic diseases, and mental health among a large-scale sample from the Emirate of Abu Dhabi. PARTICIPANTS AND SETTING: A retrospective cross-sectional study was performed with 922 participants over the age of 18, living in Abu Dhabi. METHODS: The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess ACEs, alongside a survey of adult health outcomes, mental health outcomes, and risk-taking behaviors. RESULTS: Logistic regression models examined the association between retrospective ACEs and these outcomes. The respondents reported an average of 1.74 ACEs. The most prevalent ACEs were household violence, parental death or divorce, and community violence. The accumulation of ACEs significantly predicts increases in the risk of a variety of adult-onset health morbidities, all measured mental health morbidities, and all measured risk-taking behaviors, with evidence of thresholds of ACE accumulation dictating risk. CONCLUSIONS: The baseline presence of ACEs among this Abu Dhabi sample, along with the associated risks of physical and mental health morbidities, and risk-taking behaviors play a significant role in understanding the extent, nature, and associated sequalae of ACEs in this population; providing nuanced context for early intervention. Our findings will inform the planning and implementation of specific prevention and awareness raising programs while promoting safe environments where children are healthy and can thrive.

Breast Cancer in Young Women: Is It Different? A Single-Center Retrospective Cohort Study.

Introduction: Breast cancer (BC) is one of the commonest cancers among women worldwide. Differences regarding tumor biology, presentation, genetics, and molecular subtypes may contribute to the relatively poorer prognosis among younger women. Limited information exists regarding pathologic characteristics and long-term outcomes among this group. Methods: This retrospective cohort study included 695 BC patients diagnosed over a 10-year period and investigated the clinicopathological characteristics and long-term disease outcomes among patients diagnosed at age less than or equal to 40 years compared with older ones. Cox regression analysis was performed, and Kaplan-Meier curves were generated to assess overall survival (OS). Results: Compared with the younger patients (⩽40 years) estrogen receptor (ER) and progesterone receptor (PR) expression was mainly positive in older patients (>40 years) (76.2% vs 61.3% and 64.2% vs 49.6%, respectively). The most common molecular subtype in both age groups was luminal B (44.1% in older and 40.3% in younger). A clinical complete remission after neoadjuvant therapy was observed more frequently in older patients (76.7%; N = 442) in comparison with the younger patients (66.4%; N = 79) (P = .018). Recurrence and disease progression were significantly more likely to occur among younger patients accounting for 12.6% and 29.4% of the cases, compared with 6.3% and 18.2% in older patients (P = .016 and P = .006, respectively). The overall mortality was 132 (19%) of 695, with 88% cancer-related deaths. Estrogen receptor and PR expression (P ⩽ .001 and P = .003, respectively), molecular subtype (P = .002), tumor grade (P = .002), and N stage (P = .038) were the variables that were found to be significantly influenced by age. The OS was not statistically different among 2 age groups, but younger patients with luminal A molecular subtype showed significantly poor outcome (P = .019). Conclusion: Overall survival in women diagnosed with BC at age less than or equal to 40 years is not significantly worse than older patients. However, among patients with luminal A subtype, younger women had relatively poor survival. Further research is needed to understand this age-based disparity in outcomes.

Durability of COVID-19 humoral immunity post infection and different SARS-COV-2 vaccines.

BACKGROUND: The global challenge posed by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has been a major concern for the healthcare sector in recent years. Healthcare workers have a relatively high risk of encountering COVID-19 patients, making protective immunity against SARS-CoV-2 is a priority for them. This study aims to evaluate the longitudinal measurement of SARS-CoV-2 IgG spike protein antibodies in healthcare workers (HCWs) after COVID-19 infection and after receiving the first and second doses of SARS-CoV-2 vaccines, including Pfizer-BioNTech (BNT162b2) and Oxford-AstraZeneca (AZD1222). METHODS: This longitudinal cohort study involved 311 healthcare workers working in two tertiary hospitals in Saudi Arabia. All participants were followed between July 2020 and July 2022 after completing the study questionnaire. A total of 3 ml of the blood samples were collected at four intervals: before/after vaccination. RESULTS: HCWs post-infection had lower mean SARS-CoV-2 IgG levels three months post-infection than post-vaccination. 92.2% had positive IgG levels two weeks after the first dose and reached 100% after the second dose. Over 98% had positive antibodies nine months after the second dose, regardless of vaccine type. The number of neutralizing antibodies decreased and was around 50% at nine months after the second dose. CONCLUSION: The results show different antibody patterns between infected and vaccinated HCWs. A high proportion of participants had positive antibodies after vaccination, with high levels persisting nine months after the second dose. Neutralizing antibodies decreased over time, with only about 50% of participants having positive antibodies nine months after the second dose. These results contribute to our understanding of immunity in healthcare workers and highlight the need for the continuous monitoring and possible booster strategies.

Collecting behavioral evidence from a highly mobile and seasonal population: A protocol for a survey on quad bike injuries.

BACKGROUND: Quad bikes are popular recreational, four-wheeled bikes in the Middle East. Injury prevention programs targeting quad bike crashes in the United Arab Emirates (UAE) need evidence about the risk factors and behaviours associated with these crashes in the target population. This is a protocol for a study aiming to investigate quad bike rider behaviours and to assess the risk factors associated with related injuries in the UAE. METHODS: This is a cross-sectional observational study aiming to describe a seasonal sport in a desert environment. With an estimated sample size of 451, the survey will follow a three-stage, location-based sampling strategy using the line-transect method. A sampling frame of desert locations with high injury incidences was developed, using Dubai ambulance injury records. Further expansion of the sampling frame was participatory, involving police, enthusiasts, emergency responders and gas station employees. The data collection will be limited to the winter months in fifteen high-injury desert locations across three major Emirates in the UAE. Trained researchers will observe the riders directly in the desert to note their riding habits, followed by a researcher-administered interview on riding and injury history. The interviews will be administered in Arabic and English using Qualtrics software on handheld tablets with offline and online entry mode. In addition, paper-based entry with the same format will be used as a contingency in busy quad bike locations. CONCLUSION: The objective of this study protocol is to develop a comprehensive survey that will furnish substantial evidence for the formulation of effective injury prevention strategies. To enhance the credibility of the recorded riding behaviors, field observations will be employed. The uniqueness of this study lies in its innovative sampling strategy, custom-tailored to accommodate the highly mobile and transient population of desert bikers in the UAE.