Challenges University Students Face while Studying away from Hometown: A Cross-Sectional Study.

This study aims to highlight the challenges that undergraduates face when traveling a significant distance from home to study. These challenges are psychological, financial, and nutritional. The study was descriptive and based on a survey conducted to investigate the challenges faced by university students while studying away from their hometown. A questionnaire was used to collect data from 214 undergraduates between February and April 2021. The collected data were analyzed using the computer program SPSS version 24. Pearson's Chi-square and Fisher's exact tests were applied to observe associations between qualitative variables. A total of 214 undergraduates participated in the study, with a median age of 22 years. The study found significant relationships between weight change and housing (P < 0.001), weight change and distance (P < 0.001), level of homesickness and housing (P < 0.001), level of homesickness and college distance (P < 0.001), and financial status with housing (P = 0.025). The study revealed that a significant number of undergraduate participants face psychological, financial, and nutritional challenges. These challenges include psychosocial issues, such as homesickness financial difficulties, such as money issues, and nutritional concerns, such as weight changes.

Efficacy of Visual Oral Health Reinforcement in Reducing Plaque Accumulation and Gingival Bleeding: A Pilot Randomized Controlled Trial.

AIM: To compare oral hygiene (OH) differences during verbal or video OH instructions with or without images displaying poor oral health consequences. MATERIALS AND METHODS: Twenty-one healthy females (18-30 years) were randomly and equally divided into three intervention OH instruction groups: (1) verbal, (2) video-based, (3) video-based with image displaying the consequences of poor OH. Gingival bleeding on probing (BOP), gingival bleeding index (BI), and plaque score (PS) were assessed at baseline and after 4 weeks. Within- and between-group differences were assessed by non-parametric tests. RESULTS: Plaque score only showed a statistical group difference after follow-up [H(2) = 9.214, p = 0.01]. The post hoc test revealed that group III showed a significantly lower PS than groups I and II (p = 0.04 and p = 0.017, respectively). No differences were observed in PS between groups I and II. Group I showed no follow-up reduction in PS, BI, and BOP, while group II showed a statistically significant reduction in BI only after follow-up (p = 0.028). However, group III showed a statistically significant reduction in BOP and PS (p = 0.023 and p = 0.045, respectively) but not BI. CONCLUSIONS: Verbal and video-alone OH instructions similarly affect gingival health, while participants who were exposed to images displaying the severe OH consequences had lower PS than verbal or video-alone groups. CLINICAL SIGNIFICANCE: The mode of OH instructions is not influential for optimum oral health. However, employing visuals highlighting the severe consequences of poor OH leads to short-term reduction of plaque accumulation. How to cite this article: Aleid AA, Alnowaiser A, AlSakakir A, et al. Efficacy of Visual Oral Health Reinforcement in Reducing Plaque Accumulation and Gingival Bleeding: A Pilot Randomized Controlled Trial. J Contemp Dent Pract 2024;25(2):186-190.

Impact of telepharmacy on patients’ outcome during COVID-19: a systematic literature review

Background: Coronavirus disease (COVID-19) continues to be a major global public health issue. COVID-19 is highly contagious, and numerous mitigation strategies have recently been implemented to prevent the spread of this disease. Pharmacists utilize telecommunication technology to provide patient care services, thus increasing patient access to pharmaceutical services. There was a scarcity of evidence regarding the impact of telepharmacy on patient outcomes during COVID-19. Therefore, the aim of this study was to summarize the available research evidence on the impact of telepharmacy on patient outcomes during COVID-19. Methods: A systematic literature search was conducted between January 2020 to September 2022 in Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials, using appropriate terms on telepharmacy, COVID-19, and patient outcomes. Only studies that investigated the impact of telepharmacy on patient outcomes during COVID-19 were included. A systematic literature search was conducted between January 2020 to September 2022 in Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials, using appropriate terms on telepharmacy, COVID-19, and patient outcomes. Only studies that investigated the impact of telepharmacy on patient outcomes during COVID-19 were included. Results: A total of three studies were included in the review. The telepharmacy services were offered via virtual anticoagulation clinic, retail community telepharmacy through information technology tools, and RxLive® telepharmacy program. All studies included in the review demonstrated that the provision of telepharmacy services during COVID-19 had an overall positive impact on the patient outcomes such as a reduction in the rates of hospitalisation and medication-related problems and maintaining the international normalized ratio values within the therapeutic range (AU)

Quality of Reporting Randomized Controlled Trials Published in Three of the Most Citable Periodontal Journals from 2018 to 2022.

This study aimed to evaluate the reporting quality of randomized clinical trials (RCTs) in periodontology. Three leading periodontology journals, the Journal of Periodontology (JOP), the Journal of Clinical Periodontology (JOCP), and the Journal of Periodontal Research (JOPR), were selected for this investigation. The RCTs were identified by manually searching for human trial articles published in these three journals. Two authors independently conducted the literature search, and a pre-piloted extraction sheet was used to screen the potential RCTs. The CONSORT checklist guidelines were employed to calculate the score value. Intra-examiner reliability was assessed by scoring a random sample of 10% of the papers in a second round conducted by the first examiner three months after the initial data collection. A search of abstracts published over a five-year period yielded 176 articles that reported RCTs, accounting for 11.7% of all articles published in the three journals. The highest number of RCTs was published in 2020, and more than half of the included RCTs (51%) originated from Europe. Many of the analyzed RCTs inadequately reported almost half of the items on the CONSORT checklist. Furthermore, univariate analysis revealed significant associations between certain factors and the overall CONSORT score, such as publication in JOP (p = 0.048), publication year of 2019 (p = 0.041) and 2021 (p = 0.042), first author from North America (p = 0.016), and RCTs with more than six authors (p = 0.042). Clinical trial research in periodontics has made significant progress in the past five years. However, there is room for improvement in adhering to the CONSORT guidelines.

Assessment of Bone Loss Around Dental Implant in Smokers.

Objectives: This research was done to assess how much bone is lost around dental implants in smokers. Material and Method: There were 80 participants total in the study, 40 of whom were smokers (Group I) and 40 of who were non-smokers (Group II). By evaluating the patients' clinical and radiographic data, the marginal bone-level measurements were determined. The acquired information underwent statistical analysis. Results: Smokers were found to have worse overall clinical parameters than non-smokers (P 0.05). Smokers experience more marginal bone loss around implants than non-smokers do. Conclusion: Smoking has a negative impact on the outcome rate of dental implants.

Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials.

Hemorrhoidectomy is one of the most common surgical interventions to remove the third and fourth degrees of prolapse hemorrhoid. We carried out this systematic review and meta-analysis of the randomized controlled trials (RCTs) to comprehensively evaluate the efficacy of harmonic scalpel (HS) versus bipolar diathermy (BD) methods in terms of decreasing intraoperative and postoperative morbidities among patients undergoing hemorrhoidectomy. Suitable citations were found utilizing digital medical sources, including the CENTRAL, Web of Science, PubMed, Scopus, and Google Scholar, from inception until December 2022. Only RCTs that matched the inclusion requirements were selected. We used the updated Cochrane risk of bias (ROB) tool (version 2) to assess the quality of the involved citations. The Review Manager (version 5.4 for Windows) was used to perform the pooled analysis. Data were pooled and reported as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in random-effects models. Overall, there was no significant difference between HS and BD in terms of decreasing intraoperative morbidities like operative time, intraoperative blood loss, mean duration of hospital stay, and mean duration of first bowel movement (P>0.05). Similarly, the rate of postoperative complications like pain, bleeding, urinary retention, anal stenosis, flatus incontinence, and wound edema; was similar in both groups with no significant difference (P>0.05). In conclusion, our pooled analysis revealed there was no substantial difference between HS and BD in terms of intraoperative and postoperative endpoints. Additional RCTs with larger sample sizes are needed to consolidate the power and quality of the presented evidence.

Increased prevalence of fungemia in Medina, Saudi Arabia.

Background: The prevalence of fungal infection is increasing globally due to an increase in the immunocompromised and aging population. We investigated epidemiological changes in fungemia in one of the major centers in Medina over seven years period with 87,447 admissions. Methods: Retrospective search of records for causative agents of fungemia in inpatients at King Fahad Hospital (KFH) in 2013-2019. Fungal-positive blood cultures, demographic, and treatment data were extracted. Results: A total of 331 fungemia episodes proven by blood culture were identified in 46 patients. The annual prevalence of fungemia increased from 0.072 in 2013 to 1.546 patients per 1,000 in 2019. The mean age of fungemia episodes was 56 years, and 62% of episodes occurred in females. Samples from central blood incubated aerobically yielded the highest fungemia rate, accounting for 55% (n = 182). Among yeast species, Candida parapsilosis was responsible for the highest number of episodes 37% (n = 122), followed by Candida glabrata (32%; n = 107), Candid albicans (29%; n = 94), and Cryptococcus neoformans (1%; n = 4). Among molds, Lichtheimia (Absidia) species was the most common (1%; n = 3). Yeast-like fungi Trichosporion mucoides accounted for (0.003% n = 1). The use of antifungal treatment has increased (96%) over the years (2013-2019). An increase in resistance rate of 2% was found in C. albicans and C. glabrata. The most prevalent comorbidity was renal disease (24.2%). Conclusions: C. parapsilosis was the leading cause of fungemia. The association of renal disease with increased candidemia was alarming. This study is a fundamental resource to establish management policies for fungal infection in the region.

An NLP tool for data extraction from electronic health records: COVID-19 mortalities and comorbidities.

Background: The high infection rate, severe symptoms, and evolving aspects of the COVID-19 pandemic provide challenges for a variety of medical systems around the world. Automatic information retrieval from unstructured text is greatly aided by Natural Language Processing (NLP), the primary approach taken in this field. This study addresses COVID-19 mortality data from the intensive care unit (ICU) in Kuwait during the first 18 months of the pandemic. A key goal is to extract and classify the primary and intermediate causes of death from electronic health records (EHRs) in a timely way. In addition, comorbid conditions or concurrent diseases were retrieved and analyzed in relation to a variety of causes of mortality. Method: An NLP system using the Python programming language is constructed to automate the process of extracting primary and secondary causes of death, as well as comorbidities. The system is capable of handling inaccurate and messy data, this includes inadequate formats, spelling mistakes and mispositioned information. A machine learning decision trees method is used to classify the causes of death. Results: For 54.8% of the 1691 ICU patients we studied, septic shock or sepsis-related multiorgan failure was the leading cause of mortality. About three-quarters of patients die from acute respiratory distress syndrome (ARDS), a common intermediate cause of death. An arrhythmia (AF) disorder was determined to be the strongest predictor of intermediate cause of death, whether caused by ARDS or other causes. Conclusion: We created an NLP system to automate the extraction of causes of death and comorbidities from EHRs. Our method processes messy and erroneous data and classifies the primary and intermediate causes of death of COVID-19 patients. We advocate arranging the EHR with well-defined sections and menu-driven options to reduce incorrect forms.

Risk Factors, Prevention, and Primary and Secondary Management of Sciatica: An Updated Overview.

Sciatica is a chronic condition causing crippling low back pain radiating down to the sciatic nerve innervation area, which is the posterior thigh. It remains a major public health problem worldwide with significant socio-economic, physical, and psychological impacts. Studies suggested different diagnostic methods due to the lack of consensus on diagnostic and treatment guidelines. When it comes to the management and treatment, there is ambiguous evidence about the use of painkillers, surgical interventions, and alternative options and their effectiveness, with most studies contrasting one another in addition to the lack of high-quality trials. This review presents the available data on the current understanding of sciatica covering clinical manifestations, diagnosis and treatment modalities, prognosis, and complications since a disagreement is observed in the scientific community regarding sciatica, starting with a definition of sciatica, its epidemiological characteristics, to the management and treatment. Our review would help raise knowledge and awareness about sciatica in the health professional community and the general public since the prevalence of low back pain is high in most parts of the world and there is insufficient knowledge of sciatica in the literature.

Dental Students' Experience, Impact, and Response to Patient Aggression in Saudi Arabia: A Nationwide Study.

Patient aggression and violence comprise a wide range of behaviors and actions that may include verbal aggression and physical aggression. The aim of this study is to report dental students' experience with, impact from, and response to patient aggression in Saudi Arabia. A cross-sectional analytical study was conducted among dental students from various health universities representing each region of Saudi Arabia. Data were collected using a self-administered, structured and validated questionnaire. A total of 375 participants responded to the questionnaire and 121 (32.3%) study participants reported experiencing patient aggression. Out of those, 91 (75.21%) experienced patients displaying anger or raising their voice toward them, 37 (30.58%) reported being insulted by a patient, 22 (18.18%) reported being threatened, 12 (6.2%) had experienced sexual harassment, and 65 (50.41%) had experienced verbal harassment. Furthermore, 91 (75.21%) participants reported being abandoned by patients because they were students. A total of 55 (45.45%) participants stated that aggressive patient behavior had an impact on their clinical performance, and 44 (36.36%) considered themselves stressed out. A total of 24 (19.83%) participants took time off due to incidents and 22 (18.18%) thought about quitting dentistry. Prevalence of patient aggression was significant among dental students in Saudi Arabia. These episodes of patient aggression negatively impacted students' academic performance and wellbeing, necessitating urgent attention. Educational institutions should conduct periodic workshops for students in order to address these issues. Policymakers should develop better policies in order to reduce violence and aggression against health care providers.

A Pituitary Abscess Caused by Morganella morganii: A Case Report.

BACKGROUND Pituitary abscess (PA) is a rare pituitary lesion accounting for less than 1% of all pituitary diseases and is associated with high mortality rates. The non-specific clinical symptoms and radiological features preclude accurate diagnosis of the disease. Hence, surgical intervention is still considered the criterion standard method for PA diagnosis. Most PAs occur as a primary disease or due to complications such as surgery, sepsis, and adjacent inflamed lesions. CASE REPORT A 53-year-old man presented to the Emergency Department with a headache associated with nausea, vomiting, and constipation. The patient had no visual disturbances, polyuria, polydipsia, nocturia, or abnormal discharges. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large suprasellar mass. The patient underwent left-side trans-nasal transsphenoidal microscopic surgery for mass removal. An abscess with discharge was noticed and sent for microbiological evaluation, revealing an infection with a commensal enteric bacterium that rarely causes nosocomial infection, known as Morganella morganii. The patient was discharged after completing the intravenous antibiotic course and was given oral antibiotics. CONCLUSIONS Pituitary abscess is a rare pituitary lesion. However, taking the history of recent meningitis, sinusitis, and/or surgery may help to reach an early diagnosis, prompt surgical intervention, and vital therapeutic steps to reduce mortality rates and improve patient's outcomes. PA should always be considered when patients demonstrate signs of pituitary dysfunction associated with signs of infection. Furthermore, antibiotics should be administered immediately once the PA case is confirmed and should last for at least 6 weeks postoperatively.

Oral Nystatin Prophylaxis for the Prevention of Fungal Colonization in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the prophylactic role of oral nystatin in the prevention of fungal colonization in very low birth weight (VLBW) infants compared with placebo or no treatment intervention. From inception until June 2022, we screened four major databases for pertinent RCTs and examined their risk of bias. The main outcomes were the rate of fungal colonization, rate of invasive fungal infection, rate of mortality, mean length of stay in the neonatal intensive care unit (NICU), and mean duration of antibiotic treatment. We summarized data as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI), using the fixed-effects model. Five RCTs met our inclusion criteria. One RCT was evaluated as having "high risk," one RCT was evaluated as having "some concerns," and three RCTs were evaluated as having "low risk" of bias. Compared with the control group, oral nystatin prophylaxis was correlated with substantial decrease in the frequency of fungal colonization (n=4 RCTs, RR=0.34, 95% CI {0.24, 0.48}, p<0.0001), the rate of invasive fungal infection (n=4 RCTs, RR=0.15, 95% CI {0.12, 0.19}, p<0.0001), and the mean duration of antibiotic treatment (n=3 RCTs, MD=-2.79 days, 95% CI {-5.01, -0.56}, p=0.01). However, there was no significant difference between both groups regarding the rate of mortality (n=4 RCTs, RR=0.87, 95% CI {0.64, 1.18}, p=0.37) and mean length of stay in NICU (n=3 RCTs, MD=-2.85 days, 95% CI {-6.52, 0.82}, p=0.13). In conclusion, among VLBW infants, the prophylactic use of oral nystatin was correlated with favorable antifungal benefits compared with placebo or no treatment intervention.

Assessment of Knowledge of Monkeypox Viral Infection among the General Population in Saudi Arabia.

Monkeypox is re-emerging and spreading over the world, posing a serious threat to human life, especially in non-endemic countries, including Saudi Arabia. Due to the paucity of research on knowledge about monkeypox in Saudi Arabia, this study aimed to evaluate the general population's knowledge of monkeypox in a sample of the country. A web-based cross-sectional survey was conducted from 25 May 2022 to 15 July 2022. Participants' knowledge about monkeypox on a 23-item scale and socio-demographic characteristics were gathered in the survey. Pearson's Chi-square test was used to compare knowledge level (categorized into high and low) and explanatory variables. Out of 480, only 48% of the respondents had high knowledge (mean score > 14). Participants' age, marital status, residential region, living in the urban area, education level, employment status, being a healthcare worker, income, and smoking status were significantly associated with the level of knowledge about monkeypox (p < 0.01). Overall, social media (75.0%) was the most frequently reported source from where participants obtained monkeypox-related information followed by TV and radio (45.6%), family or friend (15.6%), and healthcare provider (13.8%). We found that overall knowledge of monkeypox infection was slightly poor among the Saudi population. These findings highlight the urgent need for public education on monkeypox to promote awareness and engage the public ahead of the outbreak.

Predictors of Anti-TNF Therapy Failure among Inflammatory Bowel Disease (IBD) Patients in Saudi Arabia: A Single-Center Study.

BACKGROUND: The advent of monoclonal antibodies (mAbs) has revolutionized the management of many immune-mediated diseases such as inflammatory bowel disease (IBD). Infliximab and adalimumab were the first mAbs approved for the management of IBD, and are still commonly prescribed for the treatment of both Crohn's disease (CD) and ulcerative colitis (UC). Although mAbs have demonstrated high effectiveness rates in the management of IBD, some patients fail to respond adequately to mAbs, resulting in disease progression and the flare-up of symptoms. OBJECTIVE: The objective was to explore the predictors of treatment failure among IBD patients on infliximab (INF) and adalimumab (ADA)-as demonstrated via colonoscopy with a simple endoscopic score (SES-CD) of ≥1 for CD and a Mayo score of ≥2 for UC-and compare the rates of treatment failure among patients on those two mAbs. METHODS: This was a prospective cohort study among IBD patients aged 18 years and above who had not had any exposure to mAbs before. Those patients were followed after the initiation of biologic treatment with either INF or ADA until they were switched to another treatment due to failure of these mAbs in preventing the disease progression. Univariate and multiple logistic regressions were conducted to examine the predictors and rates of treatment failure. RESULTS: A total of 146 IBD patients (118 patients on INF and 28 on ADA) met the inclusion criteria and were included in the analysis. The mean age of the patients was 31 years, and most of them were males (59%) with CD (75%). About 27% and 26% of the patients had penetrating and non-stricturing-non-penetrating CD behavior, respectively. Patients with UC had significantly higher odds of treatment failure compared to their counterparts with CD (OR = 2.58, 95% CI [1.06-6.26], p = 0.035). Those with left-sided disease had significantly higher odds of treatment failure (OR = 4.28, 95% CI [1.42-12.81], p = 0.0094). Patients on ADA had higher odds of treatment failure in comparison to those on INF (OR = 26.91, 95% CI [7.75-93.39], p = 0.0001). CONCLUSION: Infliximab was shown to be more effective in the management of IBD, with lower incidence rates of treatment failure in comparison to adalimumab.

Organophosphate Poisoning in a Paediatric Intensive Care Unit: A Retrospective Analysis Based on Ten Years of Experience.

Background: Organophosphate (OP) poisoning is one of the most common etiologies of poisoning in the pediatric age group. Objective: This study aimed to evaluate the demographic characteristics, clinical features, clinical course, and outcomes of children with toxicity from organophosphates admitted to the pediatric intensive care unit. Methods: A retrospective review of hospital medical records of all children aged 14 years and younger who were admitted to the PICU with a provisional diagnosis of organophosphate poisoning at King Fahad Hospital of the University (KFHU), Alkhobar, Saudi Arabia, between January 1, 2008, and December 31, 2018, was conducted. Patients with incomplete medical record information or with suspicion or evidence of one or more agents other than organophosphate were excluded from the study. Results: Thirty-one patients were enrolled in the study. The median age of the study population was 2 years, and 19 (61%) were males. The majority of patients (68%) had more than one route of organophosphate exposure. Skin exposure was reported in 26 patients (84%). Only three patients (10%) had suicidal organophosphate exposure from organophosphates, while the majority (28 patients; 90%) had accidental poisoning. Bronchorrhea was the most prevalent presenting feature, reported in 28 patients (90%). 17 patients (55%) were treated with intravenous atropine and (45%) were used a combination of pralidoxime with atropine for treatment. Five patients (16%) developed acute respiratory distress syndrome. Twelve patients (39%) needed endotracheal intubation and mechanical ventilation secondary to respiratory failure. Conclusion: The presenting features of organophosphate poisoning differ widely in children. Risk factors for mortality for PICU patients with organophosphate poisoning include delayed hospital arrival by more than 1 hour, inhalational route of exposure, need for mechanical ventilation, and high lactate levels in the first 24 hours post-exposure.

Brain MRI dataset of multiple sclerosis with consensus manual lesion segmentation and patient meta information.

Magnetic resonance imaging (MRI) provides a significant key to diagnose and monitor the progression of multiple sclerosis (MS) disease. Manual MS-lesion segmentation, expanded disability status scale (EDSS) and patient's meta information can provide a gold standard for research in terms of automated MS-lesion quantification, automated EDSS prediction and identification of the correlation between MS-lesion and patient disability. In this dataset, we provide a novel multi-sequence MRI dataset of 60 MS patients with consensus manual lesion segmentation, EDSS, general patient information and clinical information. On this dataset, three radiologists and neurologist experts segmented and validated the manual MS-lesion segmentation for three MRI sequences T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR). The dataset can be used to study the relationship between MS-lesion, EDSS and patient clinical information. Furthermore, it also can be used for the development of automated MS-lesion segmentation, patient disability prediction using MRI and correlation analysis between patient disability and MRI brain abnormalities include MS lesion location, size, number and type.

Orthopedic Surgeons' Views of Hyaluronic Acid Formulations in the Management of Knee Osteoarthritis: A Questionnaire-Based Cross-Sectional Study.

Background and Objectives: Multiple hyaluronic acid (HA) products were approved and marketed to manage osteoarthritis (OA). Although these products are widely prescribed by orthopedic surgeons to manage OA, especially knee OA, the therapeutic value of these products is highly uncertain. Few studies with significant limitations in their designs have indicated positive outcomes among OA patients treated with HA; however, their results were inconclusive. Thus, we aimed to explore the therapeutic value of different HA products in alleviating knee OA pain and improving patients' physical function from the orthopedic surgeons' perspective. Materials and Methods: This was a questionnaire-based cross-sectional study in which practicing orthopedic surgeons in two countries (e.g., Saudi Arabia and Jordan) were invited to participate. The 10-item, newly developed questionnaire inquired about the respondents' sociodemographic characteristics (e.g., age, gender, country, years of experience), and their opinions regarding the efficacy of HA products in the management of OA (e.g., efficacy in improving mobility and alleviating pain). Results: Out of the 200 orthopedic surgeons who were invited to participate, 122 (61%) filled out the questionnaire. Most of the respondents were from Saudi Arabia (58%), aged 35 to 55 years (68%), had at least 10 years of experience (69%), and male (98%). About 80% of the respondents reported prescribing HA, such as Hyalgan®, Orthovisc®, Hyalubrix®, and Crespine Gel®. About 66% of the respondents believed that HA was moderately to highly effective in managing knee OA, and 34% believed that HA was either ineffective or mildly effective. Pain at the site of injection (44.3%) and rash or local skin reactions (22.1%) were the most commonly reported adverse events. Conclusions: The variations in the formulation of different HA brands (e.g., molecular weight and cross-linking) did not seem to offer any therapeutic advantage. HA might have value in the management of knee OA; however, its value is highly uncertain and necessitates more well-designed studies to further examine its therapeutic value.

Predictors of waterpipe smoking among university students in the Qassim region, Saudi Arabia.

INTRODUCTION: Waterpipe smoking has gained global popularity among adolescents and young adults. This study aimed to identify the predictors of waterpipe smoking among university students in the Qassim region of Saudi Arabia. METHODS: A cross-sectional study was conducted using a pre-tested, validated, and self-administered questionnaire to identify the predictors of waterpipe smoking among university students aged >18 years in the Qassim region. RESULTS: Of the 1158 questionnaires distributed, 928 were returned with complete responses. Of these 928 participants, 820 were men (88.7%) and the majority were unmarried (95.6%). The risk of waterpipe smoking was significantly higher in students aged >26 years (OR=3.39; 95% CI: 1.30- 8.80), those who had a brother who smoked (OR=1.78; 95% CI: 1.13-2.79), and those who were married (OR=3.21; 95% CI: 1.36-7.59). Furthermore, participants who had smoked cigarettes (OR=3.18; 95% CI: 1.89-5.34) or other tobacco products (OR=6.39; 95% CI: 3.69-11.07) within the past 30 days, and students who believed that waterpipe smoking was less harmful than cigarette smoking (OR=2.61; 95% CI: 1.54-4.41) had a higher risk of engaging in waterpipe smoking. However, the risk was lower among students receiving a monthly financial aid of more than US$264 (OR=0.34; 95% CI: 0.13-0.89). CONCLUSIONS: This study revealed that higher age, being male, being married, low student financial aid, waterpipe smoker sibling, cigarette and other types of tobacco smoking in the past 30 days, and believing waterpipe smoking to be less harmful than cigarette smoking, were significant predictors of waterpipe smoking. Educational programs targeted at improving awareness of the adverse effects of waterpipe smoking should be considered for early prevention in young adults.

Caregivers' perceptions and experience of caring for persons with Down syndrome in Kuwait: a qualitative study.

Aim and Objective: This study aimed to explore how caregivers of persons with Down syndrome (DS) believe caring had an impact on their own lives. A secondary objective was to understand their experience of seeking educational, social, and health care services for the persons with DS. Methods: This qualitative exploratory study was conducted with 21 caregivers of persons with DS in Kuwait. Results: Caregivers struggled to accept the diagnosis initially that led them to search for answers to many of their concerns about raising a person with DS. For the caregivers, who mostly comprised of mothers, dealing with health conditions that persons with DS suffered from was initially difficult. Caring for these individuals led to heavy impact upon their caregivers' own lives who took extraordinary efforts to cope with the burden. Seeking quality education for the persons with DS and participation in social activities was also challenging, and the caregivers believed that better services, facilities, and benefits for the families of persons with DS may help them better cope with the socioeconomic and psychological burden. Conclusions: Improving the availability of specialized services, the delivery of guidance and counselling, and social integration may help overcome challenges of raising a person with Down Syndrome.

Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child.

We report a child with multiple sclerosis who presented with sixth nerve palsy. She is a twelve-year-old Bahraini female presented to the ophthalmology department complaining of double vision. She also had imbalance and paraesthesia. Extraocular muscle examination showed restriction of abduction in the right eye. There was no change in vision. MRI showed right eye optic neuritis (ON) and demyelination which was indicative of multiple sclerosis (MS). Ocular coherence tomography (OCT) showed thinning of nerve fibres of both eyes which was consistent with subclinical optic neuritis. Neurological examination showed brisk knee jerk on the left side and incoordination of movement on the same side. Disability Status Scale (EDSS) showed a score of 3.0. She was given Solu-medrol 500 mg intravenously (IV) in addition to omeprazole 40 mg IV and Vitamin D3 (cholecalciferol) 50,000 IU cap weekly for 8 weeks and Neurorubine forte tablets (vitamin B1, 6, 12) once a day for 2 months. She became asymptomatic in her follow-up visits. Children with MS can present as sixth cranial nerve palsy. Clinicians should have a high index of suspicion for early diagnosis and treatment. In addition to MRI, OCT is a useful diagnostic tool for optic neuritis and MS especially in children.