Delayed Inflammatory Reaction to Hyaluronic Acid Dermal Filler Following Zoledronic Acid Administration: A Case Report.

Zoledronic acid is a bisphosphonate that can be administered intravenously and used to treat several bone disorders. It decreases bone resorption, thereby improving bone mineral density (BMD) and reducing fractures. The Food and Drug Administration (FDA) has approved zoledronic acid for the prevention and treatment of osteoporosis in postmenopausal females and males and for other conditions. Zoledronic acid is generally well tolerated, with most side effects being musculoskeletal or gastrointestinal. Cutaneous side effects include maculopapular rash and other mild skin reactions. Rare severe skin rashes, such as toxic epidermal necrolysis, have been reported. Here, we report the case of a 64-year-old female with a medical history of breast cancer status post-radical mastectomy and chemotherapy presenting with delayed hypersensitivity reaction to a hyaluronic acid dermal filler two days after receiving zoledronic acid intravenously given to maintain bone density, symptoms completely resolved with oral prednisolone 20 mg once daily and cetirizine 10 mg. Cases of delayed inflammatory reaction to hyaluronic acid soft tissue filler have previously been reported in patients who have received vaccination or those with viral infections. However, to our knowledge, there have been no reports of delayed inflammatory reactions to facial hyaluronic acid injections after zoledronic acid administration.

Electronic and Molecular Adsorption Properties of Pt-Doped BC6N: An Ab-Initio Investigation.

In the last two decades, significant efforts have been particularly invested in two-dimensional (2D) hexagonal boron carbon nitride h-BxCyNz because of its unique physical and chemical characteristics. The presence of the carbon atoms lowers the large gap of its cousin structure, boron nitride (BN), making it more suitable for various applications. Here, we use density functional theory to study the structural, electronic, and magnetic properties of Pt-doped BC6N (Pt-BC6N, as well as its adsorption potential of small molecular gases (NO, NO2, CO2, NH3). We consider all distinct locations of the Pt atom in the supercell (B, N, and two C sites). Different adsorption locations are also considered for the pristine and Pt-doped systems. The formation energies of all Pt-doped structures are close to those of the pristine system, reflecting their stability. The pristine BC6N is semiconducting, so doping with Pt at the B and N sites gives a diluted magnetic semiconductor while doping at the C1 and C2 sites results in a smaller gap semiconductor. We find that all doped structures exhibit direct band gaps. The studied molecules are very weakly physisorbed on the pristine structure. Pt doping leads to much stronger interactions, where NO, NO2, and NH3 chemisorb on the doped systems, and CO2 physiorb, illustrating the doped systems' potential for gas purification applications. We also find that the adsorption changes the electronic and magnetic properties of the doped systems, inviting their consideration for spintronics and gas sensing.

Community-Based Cross-Sectional Assessment Survey On Herpes Zoster Vaccination Practices.

Background: Herpes Zoster (HZ), also known as Shingles, is a commonly occurring infection especially among the elderly. It is due to the reactivation of the dormant virus in the sensory ends that were present since the primary infection with the virus. Objective: Our study aims at assessing the knowledge, attitudes practices beliefs and current barriers towards the Shingrix vaccine to fully understand where we stand and come up with proper recommendations to services these at-risk individuals and ultimately have a positive impact on the healthcare system. Methods: Questionnaire based cross sectional study using a translated version of a previously developed and tested questionnaire. Results: more than 8000 participants responded to the survey. The vast majority had chicken pox before and did hear about the vaccine from different sources. Most of the participants had minimal knowledge regarding the vaccine and were willing to take it regardless of some safety concerns. Conclusion: more efforts need to be conducted to enhance vaccine uptake in at risk populations in Saudi Arabia.

IgA Vasculitis following AstraZeneca/Oxford COVID-19, case report.

Immunoglobulin A (IgA) vasculitis, also known as Henoch-Schönlein purpura, is an immune-mediated vasculitis that affects small vessels. IgA vasculitis could be triggered by numerous conditions including infectious and non-infectious conditions. So far, few reported cases of Covid-19 vaccines related vasculitis. We report a case of IgA vasculitis after AstraZeneca/Oxford COVID-19 vaccine. A 29-year-old healthy man who developed purpuric skin lesions one week after his second AstraZeneca/Oxford COVID-19 vaccine which complicated by glomerulonephritis and gastrointestinal involvement. Skin biopsy revealed fibrinoid necrosis and leukocytoclasia consistent with small vessel vasculitis. Due to the temporal association, AstraZeneca/Oxford COVID-19 vaccine-related IgA vasculitis would be the most likely explanation.

Evaluation of the shear bond strength of a tricalcium silicate-based material to four self-adhering glass ionomer materials: an in vitro study.

Background: This study aimed to evaluate and compare the shear bond strength (SBS) of EQUIA Forte HT with that of other restorative materials, including EQUIA Forte, glass ionomer cement (GIC), and resin-modified glass ionomer cement (RMGIC) when bonded to NeoMTA 2. Materials and methods: A total of 120 holes were created in Teflon molds and filled with NeoMTA 2. The restorative materials were immediately applied using customized silicone molds. The samples were randomly divided into two main groups: one to measure the immediate SBS and the other to measure the delayed SBS. These two main groups were further divided into four subgroups based on the restorative material used: EQUIA Forte HT, EQUIA Forte, GIC, and RMGIC. Results: The study groups showed statistically significant differences in the mean SBS (p < 0.0001). The immediate SBS of the RMGIC group (mean ± SD: 5.43 ± 1.22) was significantly higher than those of the GIC and EQUIA Forte groups, with no significant difference found compared to the SBS of EQUIA Forte HT. In the delayed SBS, both the RMGIC and EQUIA Forte HT groups (4.98 ± 0.67 and 4.93 ± 0.60, respectively) demonstrated significantly higher bond strengths than the GIC and EQUIA Forte groups (3.81 ± 0.57 and 4.2 ± 0.63, respectively). However, there were no statistically significant differences between the RMGIC and EQUIA Forte HT groups or between the GIC and EQUIA Forte groups. Conclusion: Based on our findings, EQUIA Forte HT has shown promising outcomes when used as a restorative material following pulpotomies, with results comparable to those of RMGIC.

Microbiological trends and mortality risk factors of central line-associated bloodstream infections in an academic medical center 2015-2020.

BACKGROUND: Despite tremendous efforts to prevent central line-associated bloodstream infections, they still remain life-threatening complications among hospitalized patients with significant morbidity and mortality worldwide. The emerging antibiotic-resistant bacteria and other risk factors, including patient comorbidities, complicate patient management. METHODS: A single-center retrospective observational study was conducted at King Fahad Hospital of the University, Eastern Province, Saudi Arabia. Hospitalized patients with confirmed central line-associated bloodstream infections between January 2015 and December 2020 were included. The primary objectives were to investigate the trends in antibiotic susceptibility patterns of the causative agents, coexisting comorbid conditions, and other risk factors associated with mortality. RESULTS: A total of 214 patients with confirmed central line-associated bloodstream infections were included (CLABSI). The overall 30-day mortality rate was 33.6%. The infection rates per 1000 central line days for medical, surgical, and pediatric intensive care units were 4.97, 2.99, and 4.56 per 1000 CL days, respectively. The overall microbiological trends showed a predominance of Gram-negative agents, a steady increase of fungal CLABSI up to 24.0% in 2020, and a high prevalence of multidrug resistance up to 47% of bacterial CLABSI. In addition, the study indicates a significant negative surviving correlation with diabetes mellitus, cardiovascular disease, lung disease, chronic kidney disease, and the presence of ≥ 3 comorbidities (P < 0.05). CONCLUSION: The microbiological trends of the study population demonstrated a steady increase of CLABSI caused by Candida spp. with a predominance of Gram-negative pathogens. Stratifying the patients according to relevant mortality risk factors, including patient comorbidities, will help reduce CLABSI rates and improve patient outcomes.

Parents' Knowledge, Awareness, and Attitude Toward Children With Epilepsy in the Al Baha Region, Saudi Arabia: A Cross-Sectional Study.

Background Epilepsy is a prevalent pediatric neurological disorder, with widespread implications globally. Parents' knowledge and attitudes toward their epileptic children play a pivotal role in the well-being and management of the condition. Despite its prevalence in Saudi Arabia, awareness and perceptions vary across communities. Objective This study aimed to assess parents' knowledge, awareness, and attitudes toward children with epilepsy in the Al Baha region of Saudi Arabia. Methods A descriptive, cross-sectional study was conducted in the Al Baha region from November 2022 to January 2023. An anonymous, self-administered questionnaire was distributed among 390 parents, targeting those aged 18-60 years. Results While the majority recognized that epilepsy is not contagious, misconceptions persisted. Nearly 67.7% of families lacked clarity on the causes of epilepsy. Most believed in the potential curability of epilepsy, favoring medication as the primary treatment. A significant association was identified between having an epileptic child and knowledge of seizure-first aid. The majority held an optimistic view regarding the academic and extracurricular achievements of epileptic children. Conclusion The study highlights a mix of informed and misinformed beliefs among parents in the Al Baha region. While many perspectives were encouraging, certain misconceptions underlined the need for continued awareness campaigns and educational initiatives. Addressing these gaps is essential for providing comprehensive care and inclusion of children with epilepsy in the community.

Delayed Recurrent Erythema Nodosum Following COVID-19 Vaccine: A Case Report.

Erythema nodosum (EN) is a skin lesion that presents due to an inflammation of the subcutaneous fat, which is manifested clinically as a sudden onset of tender erythematous lesions. These lesions are typically localized to the pretibial surface. The cause of EN is mainly idiopathic, other causes are drugs, infections, autoimmune diseases, and inflammatory bowel disease. As vaccines are rarely known to cause EN, we are reporting a case of a 19-year-old female with a delayed recurrent reaction following the second dose of the COVID-19 vaccine.

Atypical Presentation of Herpes Simplex Virus Infection in an Immunocompromised Patient.

Immunocompromised patients are at risk of developing atypical herpes simplex virus (HSV) infection, which can be easily misdiagnosed. We present a case of a 69-year-old female who was receiving methotrexate and tofacitinib for a known case of rheumatoid arthritis. She was admitted to the ICU under neurology care after presenting with status epilepticus secondary to bacterial meningitis. She complained of a group of vesicles on the erythematous base accompanied by a burning sensation, erosions with a hemorrhagic crust that extended onto the vermilion lip, and painful oral mucosa erosion that involve the buccal, palatine, and tongue. The clinical differential diagnosis was herpes simplex infection, pemphigus vulgaris, paraneoplastic pemphigus, early drug-induced Stevens-Johnson syndrome, erythema multiform major, and methotrexate-induced mucositis. As the presentation was atypical, steroid treatment was initiated. Subsequent histopathology showed infectious dermatitis consistent with herpes virus infection. After discontinuing steroid treatment and starting an antiviral drug, the patient's symptoms improved within a week. There has been heightened clinical awareness about the atypical clinical presentation of herpes simplex infection in immunocompromised patients. HSV infection should be included in the differential diagnosis along with other vesiculobullous diseases.

Focal Dermal Hypoplasia Associated With Lymphedema: A Case Report From Saudi Arabia.

Focal dermal hypoplasia (FDH), also known as Goltz syndrome, is a rare syndrome described in the literature. Patchy skin hypoplasia is the most evident sign. Hyperpigmentation, hypopigmentation, papillomas, limb defects, and orofacial manifestations have also been reported. A 12-year-old Saudi girl with unremarkable family history presented with FDH. The diagnosis was confirmed using a genetic study. Physical examination revealed asymmetrical streaks of vermiculate dermal atrophy, telangiectasia with hyperpigmentation, and hypopigmentation on the left half of the face, trunk, and bilateral extremities. It appears along Blashko lines. No mental impairment was observed. Intraoral examination generalized plaque-induced gingivitis with erythematous gingival hyperplasia. Examination of the teeth showed generalized enamel hypoplasia with abnormal tooth formations, malalignment, microdontia, spacing and tilting, and minimal caries. As reported cases of FDH are rare worldwide, this syndrome is yet to be fully understood. As the manifestation of the syndrome varies among cases, the management of each case is unique. This emphasizes the importance of reporting cases of FDH.

Neural Tube Defects from Antenatal Diagnosis to Discharge - a Tertiary Academic Centre Experience.

Background: Bleeding Worldwide, approximately 300,000 infants are born annually with neural tube defects (NTDs), which carry a high risk of morbidity and mortality. Objective: The aim of the study was to describe the experience with NTD patients born at a tertiary academic center. Methods: A retrospective record review of all neonates with NTD admitted to the neonatal intensive care unit over six years. Results: Out of the 39 patients identified, 32 (82.1%) were diagnosed antenatally. Most NTD cases were of the myelomeningocele 26 (66.7%) type. The most common site of the myelomeningocele was lumbar, and the thoracolumbar site had the worst prognosis. Conclusion: Early detection of the disease allows better planning of delivery and treatment decisions. Nevertheless, understanding the magnitude of the problem necessitates adopting public health prevention strategies for better outcomes.

Knowledge and awareness assessment of cross-contamination of dental floss containers in King Saud University dental hospital clinics.

Introduction: Infection control procedures are implemented in dental clinics to reduce the risk of cross-contamination; saliva, blood, or airborne droplets containing infective agents are example of direct contamination, while indirect exposure via contact with contaminated surfaces and dental equipments such as dental chair, tray, faucet, air syringe, suction tip, gutta percha, paper points, retraction cords, and dental floss containers. Dental floss is known to be an integral part of most dental procedures. Objectives: The objective of this study was to assess the knowledge and awareness regarding cross-contamination of dental floss containers among a selected population of dental assistants in dental clinics at King Saud University (KSU). Material and Methods: A swab was taken from 60 dental floss containers selected by simple random sampling among 60 different dental clinics at KSU and culture test was done using a charcoal transport swab to identify the type of bacteria that might be present on the dental floss containers. Also a Google forms questionnaire which consisted of 20 multiple choice questions, including demographic questions on gender, nationality, and professional experience, followed by questions to evaluate different infection control concepts and practices. Results: This study included 70 dental assistants, most of whom were female (94.3 %). A significant number (41.4 %) of the dental assistants have never heard of OSHA course, and most of them (77.1 %) have never taken an OSHA course. Some participants who attended > 2 infection control courses (37.8 %) did not disagree that it is a waste of material to use new gloves to clean each clinic. Regarding the laboratory results for the collected samples, the highest frequency was noted for Staphylococcus hominis (27.8 %). Conclusion: The present study concluded that there is still further need for implementation of infection control programs and raising more awareness regarding this subject.

The Epidemiology, Associated Factors and Bacterial Profile of Asymptomatic Bacteriuria in Pregnant Women: A Retrospective Chart Review Study in Saudi Arabia.

Purpose: Asymptomatic bacteriuria (ASB) is the presence of significant amounts of bacteria within the urinary tract in the absence of urinary tract infection (UTI) symptoms, resulting in negative neonatal and pregnancy consequences. This study determined the prevalence, bacteriology patterns, and associated factors with ASB among pregnant women in both primary and hospital levels of care in the Eastern Province of Saudi Arabia. Methods: This retrospective chart review study included pregnant women between 18 and 50 years who performed the screening urine culture test during their first antenatal visit between 2017 and 2021, without UTI symptoms. The collected data involved the demographic, medical, and obstetric characteristics, and urine culture results. T-tests and chi-squared tests were used for bivariate associations followed by binary logistic regression models. Results: ASB was positive among 03.42% of the 6471 pregnant women included in the study. Logistic regression revealed that the risk of positive ASB increased in pregnant women in the first and second trimesters (OR = 2.04, 95% CI = 1.41-2.93 and OR= 1.50, 95% CI = 1.03-2.19, respectively), as well as pregnant women with a history of previous UTI (OR = 2.98, 95% CI = 2.14-4.15). The predominant organism isolates were E. coli, followed by GBS, Klebsiella pneumoniae, and Enterococcus faecalis. Conclusion: With limited data on ASB among pregnant women in Saudi Arabia, findings from the current study could help decision-makers in the country assess the epidemiological characteristics of the condition. Further study is recommended to investigate the susceptibility patterns of commonly prescribed antibiotics with different uropathogens to guide the clinicians who deal with these cases. Additionally, a large national study across the other regions in the kingdom is suggested to calculate the prevalence of ASB in Saudi Arabia.

Factors Affecting Health Care Professionals' Adherence to COVID-19 Precautionary Measures.

Objective: COVID-19 is a public health emergency of international concern. There is still no definitive cure for this highly transmittable illness. Immunization and breaking the chain of infection is the only successful approach to mitigate its spread. Our study explored the adherence to COVID-19 preventive measures and its associating factors among Health Care Professionals (HCPs) working in Saudi Arabia. Methods: For this cross-sectional study, an online survey was conducted from December 01, 2020, to March 31, 2021, among 978 HCPs in Saudi Arabia. The self-administered questionnaire consisted of demographic information, COVID-19 preventive behaviors, knowledge, attitude, fear, and risk. Mann-Whitney U-test, Kruskal-Wallis one-way analysis, Spearman correlation, and binary logistic regression tests were used in data analysis. Results: Most of the HCPs were Saudi nationals (86.9%), females (63.1%), age group 20-29 years (42.3%), Middle Eastern ethnicity (82.5%), and working in the government sector (80.8%). A 52.2% of the participants were compliant with COVID-19 preventive behavior. The most and the least compliant preventive behaviors were "wearing masks" (88.8% compliance) and "keeping social distancing" (60.7% compliance). Preventive behavior was significantly higher in HCPs having a) more knowledge of COVID-19 (U=104849; p 0.001); b) positive attitude (U=84402; p 0.001); c) higher fear (U=103138; p less than 0.001) and d) nursing profession (p 0.01). COVID-19 knowledge (p<0.001), attitude (p<0.001), and fear (p<0.001) contributed significantly to the prediction of preventive behavior compliance. A unit increase in COVID-19 knowledge, attitude, and fear scores raised the odds of being compliant with preventive behavior by factors of 2.34, 1.87, and 1.53 respectively. Conclusion: About half of the study participants were compliant with COVID-19 preventive behavior. Preventive behavior is significantly higher among HCPs having more knowledge of COVID-19, more fear, a positive attitude, and the "nursing" profession. Having more knowledge, a positive attitude, and more fear of COVID-19 may increase the likelihood of being compliant with preventive behavior.

Forensic implications of fingerprint verification failure among people with skin diseases.

Fingerprint analysis is one of the earliest and most commonly used methods of personal identification by police and forensic scientists at crime scenes. It has two key advantages: permanence and uniqueness. However, some skin diseases like eczema, psoriasis and viral exanthems can hinder the process of analysis and thwart identification; so it is important to recognise the effects a skin condition may have on fingerprint identification. The aim of this narrative review is to provide an overview of common skin diseases that are associated with fingerprint recognition failures as well as to recapitulate the forensic implications.

Digital transformation in medical education: Factors that influence readiness.

Digital transformation has become inseparable from education, and its implementation has broadly increased due to the increased adoption of e-learning during the COVID-19 pandemic. The present study evaluated the levels and influence of computer anxiety and digital readiness for academic engagement among undergraduate students. A cross-sectional study was conducted on 272 medical students enrolled in a medicine program. Two previously validated instruments were adopted. We examined the association between students' sociodemographic variables, internet use, and perceived academic performance during e-learning and their computer anxiety and digital readiness. The results show a significant effect of gender, age, and internet use on students' computer anxiety and digital readiness. Males' information-sharing behavior and skills outperformed those of females, and students' computer anxiety decreased with increasing age. In addition, the results indicate that the greater the students' internet use, the better their digital readiness for academic engagement. Furthermore, computer anxiety and digital readiness affect students' perceptions of their academic performance in e-learning. The rapid rate of technological advancements and the integration of e-learning into education means that careful attention must be paid to student characteristics as well as their skills. This will allow educators to create a successful, personalized learning framework.

COVID-19: Risk Stratification of Healthcare Workers in the Eastern Province of Saudi Arabia and Their Knowledge, Attitude, and Fears.

Introduction With the expeditious spread of coronavirus disease 2019 (COVID-19), healthcare workers have undoubtedly faced a higher risk of contracting the disease compared to the general public. This study aimed to stratify the risk of coronavirus disease 2019 infection among healthcare workers in the Eastern province of Saudi Arabia and shed light on their level of knowledge, attitude, and fear towards the disease. Methods A quantitative cross-sectional study, involving 978 Arabic and English-speaking healthcare workers, was conducted using a self-administered online questionnaire. The knowledge, attitude, and fear scales were developed by researchers using the most updated information regarding coronavirus disease 2019. The Objective Risk Stratification tool developed in the United Kingdom was used to measure the risk level of contracting coronavirus disease 2019. Collected data were analyzed and interpreted using the Statistical Package for Social Sciences software. Results Out of the 978 participants, 63.1% were female, 74.6% were 20-39 years old, 86.9% were Saudis, and 31.3% worked as physicians. The most common health-related risk factors for severe coronavirus disease 2019 among the study participants were smoking (23.4%), sickle cell trait (22.8%), and asthma (21.2%). The risk of contracting coronavirus disease 2019 was found to be low in 87.2% of participants, with those significantly at higher risk being male, non-Saudis, black Africans, and 70-79 years old. The knowledge level was found to be high among 54.7% of participants, with significantly higher levels being reported among females, non-Saudis, and participants who were either physicians or pharmacists. The most commonly cited source of knowledge was the Saudi Ministry of Health (82%). Participants largely demonstrated a positive attitude towards the disease (53.9%), particularly those working as physicians and in the governmental sector. The majority of participants (54.4%) were found to have a high level of fear toward the disease, with significantly higher levels being reported among females, 30-39 years old, and those who were either nurses or pharmacists. Conclusion The present study demonstrated significant sociodemographic variability among healthcare workers in the Eastern province, with respect to their risk of contracting coronavirus disease 2019 and their levels of knowledge, attitude, and fear toward the disease.

Serum IgE and IgG reactivity to Aspergillus recombinant antigens in patients with cystic fibrosis.

PURPOSE: The diagnosis of aspergillosis in cystic fibrosis (CF) patients remains a challenge due to overlapping features of both diseases. This is further complicated by inconsistent antibody reactivity to the currently used crude antigen, which has led a more focused evaluation of the efficacy of IgE response to a number of pure Aspergillus fumigatus recombinant proteins in patients with CF and asthma. In this study, we dissected the IgE and IgG responses to multiple A. fumigatus recombinant antigens in CF patients with different Aspergillus diseases. METHODOLOGY: Serum IgE and IgG antibodies were measured in 12 CF patients with allergic bronchopulmonary aspergillosis (ABPA), 12 with Aspergillus sensitization (AS) and 12 with Aspergillus bronchitis (AB) against recombinant antigens Asp f1, f2, f3, f4 and f6. RESULTS: The ABPA group showed significantly greater IgE reactivity to Asp f1, f2, f3 and f4 compared to patients with AS. Patients with AB expressed higher IgG positivity to Asp f1 and Asp f2 compared with those with ABPA. There were very low IgE antibody levels against all recombinant antigens in patients with AS. Aspf1 IgG reactivity in ABPA patients correlated with positive culture. CONCLUSION: The use of multiple recombinant antigens may improve the diagnostic accuracy in CF complicated with ABPA or AB. Asp f1 reactivity may relate to the presence of actively growing Aspergillus spp., which might be a useful marker for guiding antifungal therapy in ABPA.

Cutaneous Polyarteritis Nodosa Treated with Pentoxifylline and Clobetasol Propionate: A Case Report.

Cutaneous polyarteritis nodosa is a rare type of cutaneous vasculitis. It affects the small- and medium-sized arteries of the dermis and subcutaneous tissue without extracutaneous involvement. The diagnosis is by skin biopsy, and the characteristic finding is a leukocytoclastic vasculitis. We report a case of a 14-year-old Saudi girl who was referred to the dermatology service because of multiple ulceronecrotic lesions on the frontal aspects of the distal lower limbs. She had past medical consultations and treatment but without improvement. The histopathology confirmed the clinical diagnosis of cPAN, and ultimately, she responded to treatment with pentoxifylline and topical clobetasol propionate. It is important to be aware of this disease and refer the patient to the dermatology service for the appropriate evaluation and treatment.