Clinical pharmacists' knowledge, attitude, perception, and beliefs about the role of pharmacogenetic testing for genes polymorphisms when prescribing mercaptopurine.

Background: Single nucleotide polymorphisms in the gene encoding proteins involved in mercaptopurine metabolism can influence drug efficacy and safety. This study aims to assess clinical pharmacists' knowledge about mercaptopurine-related genes and their polymorphisms and investigate their attitudes, perceptions, and beliefs about the need for and importance of pharmacogenetic testing for mercaptopurine. Methods: A cross-sectional descriptive study was conducted among oncology/hematology clinical pharmacists in Saudi Arabia using an online-questionnaire developed by experts in the field. The questionnaire consists of four-sections exploring clinical pharmacists' knowledge, attitudes, perceptions, and beliefs about the importance of gene testing and genes polymorphism when prescribing mercaptopurine. Descriptive statistics were used to analyze the data in the study. Results: A total of 41 oncology/hematology clinical pharmacists responded to the survey invitation. Almost half of them had more than 10 years of work experience, but only 17 % of them received formal training in pharmacogenetics. The overall level of knowledge about pharmacogenetics among participants was low, with a mean score of 2.8 points (1.7) out of 8 items. However, around 76 % agreed that it is important to perform pharmacogenetic screening prior to prescribing mercaptopurine, and almost 93 % state that it will influence their dosage recommendation. Most of the participants had a good perception (95.1 %) of their role in genetic testing for medication selection, dosing, and monitoring; however, about 10 % of surveyed pharmacists reported not being completely responsible about recommending pharmacogenetic testing. The surveyed pharmacists had a good belief in the importance of pharmacogenetic testing and their overall attitude was positive toward the use of pharmacogenetic testing, with emphasis on the importance of training on the proper assessment and interpretation of pharmacogenetic tests. Conclusions: Pharmacists demonstrated good perception and positive attitude toward pharmacogenetic testing, despite the low level of knowledge and limited formal training. Thus, more attention to developing national guidelines on pharmacogenetic testing is warranted to ensure successful pharmacogenetic testing implementation.

Prevalence of Periodontal Disease among Obese Young Adult Population in Saudi Arabia-A Cross-Sectional Study.

Background and objectives: We aimed to assess the prevalence of periodontal disease among obese young adults in Saudi Arabia and to analyze the association between different body mass indexes and the severity of periodontal disease. Materials and methods: This descriptive cross-sectional study consisted of 307 obese patients aged 18-39 years, with body mass index (BMI) ≥30. Demographic variables for periodontal disease, anthropometric parameters such as BMI along with clinical parameters such as oral hygiene index-simplified, community periodontal index (CPI) score and loss of attachment (LOA), were assessed. Multivariate binary logistic regression analysis was used to identify the predictors for chronic periodontitis in obese young adults between 18-40 years of age. Results: The majority of the participants (71.3%) had periodontal disease. Obese and extremely obese patients together showed a statistically significant difference in the age group of 21-30 years in terms of CPI score for inflammation (p < 0.05) and LOA (p < 0.001). Logistic regression analysis showed age (OR: 3.180; 95%CL: 1.337-7.561; p <.001), occasional dental visit (OR: 5.965; 95%CL: 3.130-11.368; p < 0.001), smoking >10 cigarettes (OR: 11.868; 95%CL: 3.588-39.254; p < 0.001) and poor oral hygiene status (OR: 17.250; 95%CL: 6.958-42.764; p < 0.001) were associated with a significantly higher risk of having periodontal disease. Conclusions: This study showed a high prevalence of periodontal disease in obese patients among the Saudi Arabian population.

Dental Anomalies in Primary Dentition among Arabian Children: A Hospital-Based Study.

An observational study was carried out in a teaching hospital in Saudi Arabia to determine the occurrence of dental anomalies among Arabian children. The study included children of Saudi nationality with primary teeth. The study assessed the prevalence of dental anomalies in their primary dentition. The assessment and data collection were conducted by a single examiner, utilizing clinical examination and intra-oral radiographs. A comparative analysis was conducted to examine dental anomalies in relation to gender (boys and girls) and arch type (maxillary and mandibular). In addition, the study explored the occurrence of gender-specific dental anomalies depending on arch type. The data analysis was conducted using IBM Statistics (version 21.0) with a significance level of p < 0.05. In total, there were 245 children included in the final analysis. The study population consisted of boys (66%) and girls (34%), with an average age of 4.87 ± 0.9 years. Taurodontism was the most prevalent dental abnormality, occurring in 2.8% of the individuals in the study sample. The study sample exhibited hypodontia in 2%, supernumerary teeth in 2.4%, double teeth in 2%, and microdontia in 1.2%. Talon cusp and macrodontia have a relatively low incidence of 0.4%. Boys exhibit supernumerary teeth, microdontia, macrodontia, talon cusp, and taurodontism, whereas hypodontia and double teeth were more frequent in girls.

Epidemiology and clinical characteristics of Morganella morganii infections: A multicenter retrospective study.

BACKGROUND: Morganella morganii is a Gram-negative, opportunistic pathogen that can cause a variety of infections, including bloodstream infections, especially in those with compromised immune systems. It is often resistant to antibiotics, making it a difficult organism to treat. Limited studies have addressed M. morganii, but the organism is becoming increasingly recognized as a public health threat. More research is needed to understand the epidemiology and virulence factors of M. morganii in Saudi Arabia, as well as to develop effective treatment strategies. METHODS: This retrospective study included all M. morganii bloodstream infections patients admitted to five tertiary care hospitals in Saudi Arabia between 2015 and 2022. RESULTS: The study population included 75 patients (45 males and 30 females) between the age of 53-72 with a 54% ICU admission rate. The most comorbidities were hypertension followed by diabetes. The most common symptoms were fever, cough, shortness of breath, vomiting, and fatigue. The study also found that M. morganii was often resistant to multiple antibiotics, including ciprofloxacin, trimethoprim/sulfamethoxazole, gentamicin, amoxicillin, nitrofurantoin, and colistin. The most common treatment for M. morganii bacteremia was carbapenems, followed by aminoglycosides, ciprofloxacin, and colistin. Source control measures, such as surgery, line removal, drainage, and tissue removal, were also used in some cases. The study found that the in-hospital mortality rate for M. morganii bacteremia was 41%. The risk of mortality was increased in patients who were admitted to the ICU, who were older than 65 years, and who had Klebsiella pneumoniae co-infection. CONCLUSION: M. morganii bacteremia is a serious infection that is often resistant to antibiotics. Elderly patients and patients with comorbidities are at increased risk of mortality. Source control measures and appropriate antibiotic therapy are important for improving outcomes.

Interplay of Demographic Influences, Clinical Manifestations, and Longitudinal Profile of Laboratory Parameters in the Progression of SARS-CoV-2 Infection: Insights from the Saudi Population.

Understanding the factors driving SARS-CoV-2 infection progression and severity is complex due to the dynamic nature of human physiology. Therefore, we aimed to explore the severity risk indicators of SARS-CoV-2 through demographic data, clinical manifestations, and the profile of laboratory parameters. The study included 175 patients either hospitalized at King Abdulaziz Medical City-Riyadh or placed in quarantine at designated hotels in Riyadh, Saudi Arabia, from June 2020 to April 2021. Hospitalized patients were followed up through the first week of admission. Demographic data, clinical presentations, and laboratory results were retrieved from electronic patient records. Our results revealed that older age (OR: 1.1, CI: [1.1-1.12]; p < 0.0001), male gender (OR: 2.26, CI: [1.0-5.1]; p = 0.047), and blood urea nitrogen level (OR: 2.56, CI: [1.07-6.12]; p = 0.034) were potential predictors of severity level. In conclusion, the study showed that apart from laboratory parameters, age and gender could potentially predict the severity of SARS-CoV-2 infection in the early stages. To our knowledge, this study is the first in Saudi Arabia to explore the longitudinal profile of laboratory parameters among risk factors, shedding light on SARS-CoV-2 infection progression parameters.

Obesity Prevalence and Association with Spirometry Profiles, ICU Admission, and Comorbidities Among Patients with COPD: Retrospective Study in Two Tertiary Centres in Saudi Arabia.

Background: Obesity is common among chronic obstructive pulmonary disease (COPD) patients and is associated with an increase in acute exacerbation episodes. However, data on obesity's impact on and association with clinical outcomes among patients with COPD are limited. This study aimed to determine overweight and obesity prevalence and associations with spirometry profiles, intensive care unit (ICU) admission, and comorbidities in patients with COPD. Methods: In this retrospective cohort study, we reviewed the electronic health records of adult individuals diagnosed with COPD who visited the studied pulmonary clinics between 1 January 2018 and 31 December 2022 and then collected key demographic variables and relevant clinical outcomes and comorbidities. Results: A total of 474 patients with COPD were included in the final analysis, of whom 60% were male. The occurrences of overweight and obesity were 32.7% and 38.2%, respectively. The presence of comorbidities was high in obese patients (78.4%), followed by overweight patients (63.8%) with COPD. Obese and overweight patients had the highest ward admission rates (38.3% and 34.2%, respectively). ICU admissions were higher in obese and overweight patients (16% and 12%, respectively) compared with normal-weight patients (9%). Although no significant correlation was found between body mass index and spirometry parameters, comorbidities and ICU admission were linked to overweight and obesity in COPD patients (AOR: 1.82 95% CI: 1.15 to 2.86 and AOR: 3.34 95% CI 1.35 to 8.22, respectively). Conclusion: Our findings imply that obesity in COPD is prevalent and is associated with adverse clinical outcomes including a greater number of comorbidities and higher rates of hospitalization and admission to ICUs although no associations were found between body weight and spirometry parameters. Further studies are needed to assess whether implementing and optimising obesity screening and management at an early stage in COPD can prevent further deterioration.

Parent perceptions regarding virtual pediatric dental clinics during COVID-19 pandemic: a cross-sectional study.

Objective: To assess the attitudes and responses of parents of pediatric patients towards virtual dental clinics during COVID-19. Material and Method: A total of 102 parents of pediatric patients who were scheduled for virtual (video or telephonic) clinic appointments for new patient consultations and follow-up clinics were included in the study. Parents and patients could attend the virtual clinic from a personal computer, tablet, or smartphone. An electronic self-administered questionnaire was sent to the parents through email after consultation (video or telephonic) which consisted of demographic data and a ten-item, five-point Likert-scale assessing: (i) parent satisfaction; (ii) ease of use; (iii) the effectiveness including increasing access to clinical services; (iv) reliability of the teledentistry system and (v) usefulness for patients. Statistical analyses used were t-test, one-way ANOVA test, Shapiro-Wilk and histogram. Result: Out of 102 parents, 52 attended video clinics and 50 attended the telephonic clinic. The majority of the parents were between 30-39 years of age, and about 73% had no previous experience with either virtual or telephonic consultation. Ninety-four percent of parents were satisfied with vide clinic consultation, and most of them agreed that accessing clinical services through a video clinic was easy to understand, comfortable, and time-saving. The majority of the parents (94%) agreed and strongly agreed that they will use video clinics again in the future for consultation. Conclusion: Parents' response to the use of virtual clinics for pediatric dentistry during COVID was positive. The majority of the parents stated that they would consider using teledentistry for future consultation.

Influence of Tooth Brushing and Previous Dental Visits on Dental Caries Status among Saudi Arabian Children.

OBJECTIVE: To evaluate the dental caries status and its association with tooth brushing frequency and previous dental visits among Arabian children. METHODS: Arabian school children attend a specialty pediatric dental clinic at Majmaah University, Saudi Arabia. Only children of Saudi origin with primary dentition were included in the study, and only one examiner was involved in the assessment and data collection. The parents of children completed a questionnaire to investigate possible explanatory variables for caries status, including tooth brushing frequency and previous dental visits. Dental caries were diagnosed according to the criteria recommended by the World Health Organization (2013). The comparison performed was based on sex, age, tooth brushing frequency, and previous dental visits. The descriptive statistics were carried out using SPSS (version 21.0) with a p-value of <0.05 significance. RESULTS: The study involved 268 Saudi children with a mean age of 4.6 ± 1.1 years. The caries prevalence was 78.8%, and the mean dmft was 5.82 ± 4.48, while the overall mean scores for decayed, missing, and filled were 3.903 ± 3.69, 1.18 ± 1.69, and 0.73 ± 1.35, respectively. The mean dmft scores for the <3 years, 3.1-6 years, and >6 years old children were found to be 1.74, 6.58, and 4.58, respectively. Among the children, the females reported higher dmf scores (7.51 ± 4.18) compared to males (4.97 ± 4.39) with a statistically significant difference (p < 0.001). Fifty percent of the children had tooth brushing habits of once daily, followed by never (22.4%), twice daily (15.7%), and rarely (11.2%) brushed their teeth. Statistically significant correlations were found between the children's dental caries status, age, and dental visits, while sex and tooth brushing did not find a correlation. CONCLUSION: The prevalence of dental caries among Arabian preschool children was higher. Mandibular second molars were commonly affected by dental caries, while mandibular central incisors were less frequently affected. The child's age and frequency of dental checkups were positively related to the prevalence of dental caries.

Assessing Barriers and Facilitators for Implementing Clinical Practice Guidelines in Middle Eastern and North African Region: Delphi Study.

BACKGROUND: Clinical practice guidelines (CPGs) improve clinical decision making and patient outcomes, but CPG implementation is poor. The success of CPGs is influenced by several factors related to barriers and facilitators. For this reason, it can be extremely useful to explore key barriers and facilitators of CPG implementation in the Middle East and North Africa (MENA). METHODS: A three-round Delphi study was performed using the input of 30 experts involved in the clinical practice guidelines. In the first two rounds, participants were asked to score each statement relevant to barriers or facilitators for CPG implementation on a five-point Likert scale. These statements were identified from existing systematic reviews and expert input. In round three, participants ranked the most important barriers and facilitators identified from rounds one and two. A descriptive analysis was conducted on the barrier and facilitators statements using frequencies, percentages, and medians to summarize the variables collected. RESULTS: We identified 10 unique barriers and 13 unique facilitators to CPG implementation within the MENA region. The two highest-ranked barriers related to communications and available research and skills. The most important facilitator was the availability of training courses for healthcare professionals. CONCLUSIONS: Key barriers and facilitators to the implementation of clinical practice guidelines seem to exist in professional, organizational, and external contexts, which should all be taken into account in order to increase implementation success within MENA region. The results of this study are useful in the design of future implementation strategies aimed at overcoming the barriers and leveraging the facilitators.

Clinical and Genetic Characteristics of Arrhythmogenic Right Ventricular Cardiomyopathy Patients: A Single-Center Experience.

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited progressive cardiomyopathy. We aimed to define the long-term clinical outcome and genetic characteristics of patients and family members with positive genetic tests for ARVC in a single tertiary care cardiac center in Saudi Arabia. Methods: We enrolled 46 subjects in the study, including 23 index-patients (probands) with ARVC based on the revised 2010 ARVC Task Force Criteria (TFC) and 23 family members who underwent a genetic test for the ARVC between 2016 and 2020. Results: Of the probands, 17 (73.9%) were males with a mean age at presentation of 24.95 ± 13.9 years (7 to 55 years). Predominant symptoms were palpitations in 14 patients (60.9%), and syncope in 10 patients (43.47%). Sustained ventricular tachycardia (VT) was documented in 12 patients (52.2%). The mean left ventricular ejection fraction (LVEF) by echocardiogram was 52.81±6.311% (30-55%), and the mean right ventricular ejection fraction (RVEF) by cardiac MRI was 41.3±11.37% (23-64%). Implantable cardioverter-defibrillator (ICD) implantation was performed in 17 patients (73.9%), and over a mean follow-up of 13.65 ± 6.83 years, appropriate ICD therapy was noted in 12 patients (52.2%). Genetic variants were identified in 33 subjects (71.7%), 16 patients and 17 family members, with the most common variant of plakophilin 2 (PKP2) in 27 subjects (81.8%). Conclusions: ARVC occurs during early adulthood in Saudi patients. It is associated with a significant arrhythmia burden in these patients. The PKP2 gene is the most common gene defect in Saudi patients, consistent with what is observed in other nations. We reported in this study two novel variants in PKP2 and desmocollin 2 (DSC2) genes. Genetic counseling is needed to include all first-degree family members for early diagnosis and management of the disease in our country.

Inhaled therapies targeting prostacyclin pathway in pulmonary hypertension due to COPD: systematic review.

Background: Pulmonary hypertension due to chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is classified as group 3 pulmonary hypertension. Inhaled treprostinil, a prostaglandin I2 analogue also known as prostacyclin, has recently been approved as a first drug for patients with pulmonary hypertension secondary to ILD. However, due to a lack of evidence, no therapies are currently approved for those with COPD-associated pulmonary hypertension. Thus, this systematic review aims to summarise the current evidence to assess the impact of inhaled prostaglandin I2 analogue use on the pulmonary hemodynamics, exercise function, lung function, and gas exchange in patients with pulmonary hypertension due to COPD. Methods: We systematically searched the electronic databases of Medline, Embase, Scopus and Cochrane from inception to 1 February 2023. Studies of adult patients with a confirmed diagnosis of COPD-associated pulmonary hypertension who received inhaled drugs targeting the prostacyclin pathway were included in the systematic review. Case reports, systematic reviews, conference abstracts with no full text, non-full-text articles, non-English manuscripts and book chapters were excluded from this systematic review. A risk-of-bias assessment was carried out for the studies included in this review, using two different Cochrane risk-of-bias tools for randomised and non-randomised clinical trials. Results: A total of four studies met our inclusion criteria and were included in this systematic review. The results of one prospective clinical trial showed an improvement in the pulmonary hemodynamics (e.g., cardiac index, cardiac output and mean pulmonary artery pressure) in response to inhaled prostacyclin use in patients with pulmonary hypertension secondary to COPD. However, the severity of dyspnoea, lung function, exercise capacity and gas exchange were not affected when inhaled prostacyclin was used for patients with COPD-related pulmonary hypertension. Conclusion: This systematic review demonstrated that although inhaled prostacyclin does not seem to improve COPD-related outcomes (e.g., lung function and exercise capacity), short-term use of inhaled prostacyclin has the potential to reduce mean pulmonary artery pressure and pulmonary vascular resistance without impairing ventilation-perfusion mismatch. Further studies with larger sample sizes are warranted. Systematic review registration: CRD42022372803, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=372803.

Vincristine-Induced Neuropathy in Patients Diagnosed with Solid and Hematological Malignancies: The Role of Dose Rounding.

BACKGROUND: Vincristine is a vital constituent of chemotherapeutic regimens. Vincristine-induced neuropathy is a challenging adverse effect that impacts quality of life and treatment course. The dose rounding of chemotherapies is a strategy that is commonly used in clinical practice. Nevertheless, the frequency of developed neuropathy in vincristine first-time users and the potential association with dose rounding remains elusive. METHODS: A retrospective analysis was conducted on patients administered vincristine for the first time between 2016 and 2022 using the King Saud University Medical City (KSUMC) database. Patients were stratified into pediatric and adult groups. Neuropathy frequency, its association with demographic and clinical parameters, and the Impact of dose rounding were assessed using SPSS software version 28. RESULTS: Approximately 34.6% of patients were diagnosed with neuropathy after vincristine administration. Autonomic neuropathy was common among affected adults and pediatric patients (55.1% and 56.1%, respectively), while cranial neuropathy was more frequent in pediatric patients. Higher BSA (p = 0.038) and Scr (p = 0.044) in the pediatric group, the presence of respiratory comorbidities (p = 0.044), and the use of azole antifungals (p < 0.001) in the adult group were significantly associated with neuropathy episodes. The rounding-up of vincristine doses was significantly associated with increased neuropathy occurrence (p < 0.001), while dose rounding-down was significantly associated with a decrease in neuropathy in both groups of patients (p < 0.001). CONCLUSIONS: Our findings demonstrate that autonomic neuropathy is the most common vincristine-related neuropathy, regardless of the patient's age. Dose rounding is a significant determinant of vincristine-induced neuropathy in both groups. Further studies are needed to evaluate the variables that exacerbate or prevent neuropathy associated with the first-time use of vincristine.

Role of prostanoids, nitric oxide and endothelin pathways in pulmonary hypertension due to COPD.

Pulmonary hypertension (PH) due to chronic obstructive pulmonary disease (COPD) is classified as Group 3 PH, with no current proven targeted therapies. Studies suggest that cigarette smoke, the most risk factor for COPD can cause vascular remodelling and eventually PH as a result of dysfunction and proliferation of pulmonary artery smooth muscle cells (PASMCs) and pulmonary artery endothelial cells (PAECs). In addition, hypoxia is a known driver of pulmonary vascular remodelling in COPD, and it is also thought that the presence of hypoxia in patients with COPD may further exaggerate cigarette smoke-induced vascular remodelling; however, the underlying cause is not fully understood. Three main pathways (prostanoids, nitric oxide and endothelin) are currently used as a therapeutic target for the treatment of patients with different groups of PH. However, drugs targeting these three pathways are not approved for patients with COPD-associated PH due to lack of evidence. Thus, this review aims to shed light on the role of impaired prostanoids, nitric oxide and endothelin pathways in cigarette smoke- and hypoxia-induced pulmonary vascular remodelling and also discusses the potential of using these pathways as therapeutic target for patients with PH secondary to COPD.

Oral Facial Manifestations of Sanjad-Sakati Syndrome: A Literature Review.

AIM: To perform a comprehensive review of orofacial manifestations of Sanjad-Sakati syndrome (SSS). METHODS: A comprehensive electronic literature search was performed using PubMed, Scopus and Cochrane library databases. The search keywords included were "Sanjad-Sakati syndrome (SSS)", "dental manifestations", "dental management", "oral health", "dental care for patients with SSS", "dental health of people with SSS", "caries", and "oral hygiene". The inclusion criteria were papers published only in English, papers published by August 2021, and papers discussing orofacial manifestations of SSS and language. RESULTS: The search of the databases retrieved eleven case reports and three case series studies. Overall, 56 cases (11 case reports and 3 case series studies) were reported on Sanjad-Sakati syndrome in the published literature. The majority of the reports are from the Middle Eastern region. CONCLUSIONS: The reported orofacial manifestations of SSS include beaked nose, depressed nasal bridge, enamel hypoplasia, hypodontia, low-set ears, posteriorly rotated ears, deep-set eyes, microcephaly, microdontia, micrognathia, prominent forehead, retrognathia, and thin lips. The review paper also establishes the importance of the dental under general anesthesia in SSS individuals.

Effect of denture cleansers on the surface properties and color stability of 3D printed denture base materials.

OBJECTIVES: To evaluate the effect of denture cleansers on surface roughness, hardness and color stability of 3D printed resins compared to heat-polymerized resin. METHODS: Acrylic specimens (N = 160) were prepared using one heat-polymerized (HP) and three 3D printed denture base resins. Specimens per material were randomly divided into four groups (n = 10) according to immersion solutions as follows: distilled water (DW), sodium hypochlorite (NaOCl), effervescent tablet 1 or effervescent tablet 2. Color changes (∆E) were measured using a spectrophotometer. Surface roughness (Ra, µm) and microhardness were evaluated. The results were analyzed using one- and three-way ANOVA with Tukey's post hoc test (α = 0.05). RESULTS: After 360 days of cleaning protocols, we observed a significant increase in the surface roughness of tested materials (P<0.001). Hardness values significantly decreased in all groups (P<0.001), except HP and ND specimens, cleaned with effervescent tablet 1 (P>0.05) and AS specimens with effervescent tablet 2 (P = 0.051). According to the National Bureau of Standards (NBS) score, all denture base specimens had 'perceivable' to 'extremely marked' color change after immersion in NaOCl, while immersion in effervescent tablets 1 and 2 resulted in a 'slight' to 'marked' color change. CONCLUSION: 3D printed denture bases exhibited changes in surface roughness, hardness and color similar to HP denture base material. The use of denture cleansers resulted in a time-dependent increase in surface roughness and a decrease in hardness. The color change was significant with NaOCl, while effervescent denture cleansers produced a minimal color difference. CLINICAL SIGNIFICANCE: Denture cleansers seem to influence surface properties over time. The degree of impact is mainly dependent on the type of cleanser selected, regardless of the type of denture base material.

Modern modified aerosol box: Isolation aid for oral health care professionals during dental procedures.

COVID-19 affected healthcare professionals globally, especially dentists, which is airborne and transmitted through contact. Most dental procedures are aerosol generated and these aerosols in dental practice tend to transmit acute respiratory infections like COVID-19. Recently, a few authors recommended using the aerosol box to reduce the aerosol count in a dental setting. However, the study aims to describe and recommend a reformed aerosol box desand to practice safe dentistry.

Determinants of Acute Kidney Injury in Children Undergoing Cardiopulmonary Bypass: Single-Center Experience in Saudi Arabia.

Introduction Cardiopulmonary bypass (CPB) is a machine used in open cardiac surgeries and has been linked to many complications, one of which is acute kidney injury (AKI). Also, the Kidney Disease Improving Global Outcomes (KDIGO) criteria are used to diagnose AKI in the pediatric population. The study aimed to investigate the association between cardiopulmonary bypass duration and renal function impairment in pediatric patients who had cardiac surgery. Methods  This was an observational, cross-sectional study conducted at the King Abdulaziz Medical City, King Faisal Cardiac Center, the section of the Pediatric Cardiac Intensive Care Unit (PICU), Ministry of National Guard Health Affairs, from January 2016 to December 2019. Patients younger than 14 years old, those having a cardiac surgery where CPB was implemented, normal pre-operative kidney functions, and having a cardiac surgery longer than 60 minutes (min) were included. The exclusion criteria were patients known to have pre-operative renal impairment and patients with pre-operative hemodynamic instability or cardiac arrest. Demographics of pre-operative, intra-operative, and post-operative data were extracted, and Statistical Package for the Social Sciences (SPSS) version 25 (Armonk, NY: IBM Corp.) was used for analysis. For descriptive statistics, frequencies and percentages for qualitative data were examined, while mean and standard deviation (SD) or median and interquartile range (IQR) quantitative data were used accordingly. Student's t-test, Mann-Whitney (median test), chi-square, or Fisher's exact tests were used for univariate analysis accordingly. Logistic regression analysis was used to determine significant predictors for developing AKI. A p-value of <0.05 would be considered significant. Results Of the 111 patients, 87 patients were included in the analysis. The median age was six months, IQR two to 13 months, body mass index (BMI) mean of 13.8, and SD 3.6. There was similar sex distribution, male 47.1% vs. female 52.9%. There were no patients in Risk Adjustment for Congenital Heart Surgery (RACHS) who scored 5 or 6. The AKI prevalence was 31% (27/87) within three days after surgery. One patient had stage 2 AKI; the rest were mild. One patient (3.7%) died. The CPB time was significantly longer in patients who developed AKI 150 (104-202), vs. non-AKI 104 (82-142) min, p=0.004. In the AKI group, the mean baseline (pre-operative) serum creatinine (sCr) was significantly lower, whereas, it was significantly higher at 24 hours (h), and 48 h post-operation (p=0.001, 0.001, and 0.036, respectively). Additionally, the estimated Glomerular Filtration Rate (eGFR) was significantly higher in the AKI group at 24 h (p=0.007).  In logistical regression analysis, CPB time (per min unit time) was a significant predictor for developing AKI, OR 1.015, p=0.011 as a measured outcome. However, only CPB time >180 min was highly significant with OR 16.2, p=00.6 compared to CPB time 121-180 min OR 2.3, p=0.29 and CPB time 91-120 min OR 1.2, p=0.84. Conclusion Acute kidney injury is an expected complication of pediatric congenital heart surgery receiving CPB. Although in our single-center experience, CPB duration was a significant predictor for AKI; however, it is considered a mild complication that does not contribute significantly to short-term morbidity or mortality. A larger multicenter, national prospective data registry is recommended to explore long-term effects.

Correlation between BMI and Oral Health Status (DMFT, PI, mSBI, and Salivary 1,5-AG) among the Pediatric Population in Saudi Arabia: A Clinico-Biochemical Study.

The study aimed to investigate the association of varying body mass index (BMI) with oral health status among children aged 5−14 years and correlate the concentration of salivary levels of 1,5-AG with varying BMI, dental caries, and periodontal disease. This cross-sectional study was conducted on subjects aged 5 to 14 years. The children were recruited from the Pediatric Dental Clinic, College of Dentistry, Majmaah University, by convenient sampling method. Sociodemographic details and clinical parameters, including body mass index (BMI), DMFT/def (deciduous decayed tooth (d), deciduous extracted tooth (e), deciduous filled tooth (f), permanent tooth decayed (D), permanent missing tooth (M), and permanent filled tooth (F)), plaque index (PI), and modified sulcular bleeding index (mSBI), were evaluated. Salivary 1,5-anhydroglucitol (1,5-AG) was analyzed using an enzyme-linked immunosorbent assay (ELISA) for all the subjects. Statistical analyses performed using SPSS v. 27 (IBM Statistics, Chicago, IL, USA) and the Kruskal−Wallis and chi-square tests were used for comparisons. The Spearman rank correlation coefficient was used to examine the association between the study subjects' independent variables, BMI, and caries activity. The mean def score, PI, and mSBI scores were higher in obese children. PI score, mSBI score, and salivary concentrations of 1,5-AG between the BMI categories were statistically significant (p < 0.001). The study emphasizes promoting preventive oral health regimes, health awareness campaigns, and nutritional educational programs among the pediatric population.

Morphometric Analysis of Permanent Canines: Preliminary Findings on Odontometric Sex Dimorphism.

AIM: This study aims to investigate the morphometrics of permanent canines in establishing sexual dimorphism in the native Arabian population. METHODS: Thirty (male = 12; female = 18) native Arabian subjects, with ages ranging between 20-45 years. The mesiodistal (MD), cericoincisal (CI) and labiolingual (LL) widths of the teeth 13, 23, 33, and 43 and the inter-canine distance in maxillary (MaxICW) and mandibular (ManICW) arches were measured using a digital caliper. The gran method was used for establishing sex dimorphism among the study subjects. Descriptive statistics were employed using SPSS version 20.0 (Armonk, NY, USA, IBM Corp.). RESULTS: The comparison of either of the measurements (MD, CI, LL, MaxICW and ManICW) were shown to be statistically significant (p > 0.05). The overall mean values of teeth 13, 23, 33, and 43 for CI, LL, MaxICW, and ManICW were lower for females than males (p > 0.05). The MD width was higher in females than that of males (p > 0.05). The sex dimorphism value for teeth 13, 23, 33, and 43 were 0.98, 0.99, 1, and 0.99, respectively. The standard canine index was high for mandibular teeth and lower for mandibular teeth, and SCI values for teeth 13, 23, 33, and 43 were 0.219, 0.218, 0.257 and 0.256, respectively. CONCLUSION: The morphometrics of permanent canines are helpful in sex determination with the aid of odontometric analysis.

Correlation between Salivary Levels of IGF-1, IGFBP-3, IGF-1/IGFBP3 Ratio with Skeletal Maturity Using Hand-Wrist Radiographs.

Objective: The relevance of growth determination in orthodontics is driving the search for the most precise and least invasive way of tracking the pubertal growth spurt. Our aim was to explore whether minimally invasive salivary estimation of biomarkers Insulin-like growth factor (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) could be used to estimate skeletal maturity for clinical convenience, especially in children and adolescent age groups. Materials and Method: The cross-sectional study was conducted on 90 participants (56 girls and 34 males) with ages ranging from 6 to 25 years. Each subject's hand-wrist radiograph was categorized based on skeletal maturity, and saliva samples were estimated for IGF-1 and IGFBP-3 using the respective ELISA kits. Kruskal−Wallis nonparametric ANOVA was applied to compare different skeletal stages. Results: The study demonstrated low salivary IGF-1 levels at the prepubertal stage, with increase during pubertal onset and peak pubertal stage followed by a decline during pubertal deceleration to growth completion. Spearman's correlation coefficient demonstrated a strong positive association (r = 0.98 p < 0.01) between salivary IGF/IGFBP-3 ratio and different stages of skeletal maturity. Conclusion: Salivary IGF-1, IGFBP-3, and IGF/IGFBP-3 ratio could serve as a potential biochemical marker for predicting the completion of skeletal maturity.