Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis.

OBJECTIVE: To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy. STUDY DESIGN: Patients with index admission of AP between 2013 and 2023 were included. Those who received >1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received <1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed. RESULTS: Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; P = .015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (>2x maintenance) did not have higher rates of organ dysfunction or severe disease. CONCLUSIONS: Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.

#BrazilianButtLift: The Reel Problem Regarding Gluteal Augmentation Surgery.

NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Knowledge about metabolic dysfunction-associated steatotic liver disease among the medical professionals from countries in the MENA region.

INTRODUCTION AND OBJECTIVES: Given the substantial burden of metabolic dysfunction-associated steatotic liver disease (MASLD), there is an urgent need to assess knowledge and awareness levels among physicians. We assessed MASLD knowledge among healthcare providers from Saudi Arabia, Egypt, and Türkiye. MATERIALS AND METHODS: Two global surveys containing 54-59 items assessed awareness and knowledge of MASLD/NAFLD- one was for hepatologists and gastroenterologists, and the second was for non-specialists (e.g. endocrinologists, primary care providers [PCPs], and other healthcare professionals). Data were collected using an electronic data collection form. Knowledge scores and variables associated with higher knowledge scores were compared across all specialties. RESULTS: A total of 584 physicians completed the survey (126 hepatologists, 178 gastroenterologists (GEs), 38 endocrinologists, 242 PCPs/others). Practice guidelines were the primary source for knowledge across all specialties (43-51%), then conferences (24-31%) except PCPs/others who selected the internet as the second common source (25%). Adherence to societal guidelines varied by specialty (81-84% of specialists vs 38-51% of non-specialists). Hepatologists and GEs showed similar mean knowledge scores (51-72% correct answers across three knowledge domains, p > 0.05); endocrinologists outperformed PCPs/others in knowledge scores in all knowledge domains, including Epidemiology/Pathogenesis (72% vs. 60%), Diagnostics (73% vs. 67%), and Treatment (78% vs. 67%) (all p < 0.01). Hospital-based practice and seeing a greater number of patients with MASLD/NAFLD were identified as independent predictors of higher knowledge scores among specialists (both p < 0.05). CONCLUSIONS: A knowledge gap in the identification, diagnosis, and management of MASLD/NAFLD was found despite the growing burden of MASLD/NAFLD in Saudi Arabia, Egypt, and Türkiye. Education to increase awareness is needed.

Euterpe oleracea Mart. Bioactive Molecules: Promising Agents to Modulate the NLRP3 Inflammasome.

Inflammation is a vital mechanism that defends the organism against infections and restores homeostasis. However, when inflammation becomes uncontrolled, it leads to chronic inflammation. The NLRP3 inflammasome is crucial in chronic inflammatory responses and has become a focal point in research for new anti-inflammatory therapies. Flavonoids like catechin, apigenin, and epicatechin are known for their bioactive properties (antioxidant, anti-inflammatory, etc.), but the mechanisms behind their anti-inflammatory actions remain unclear. This study aimed to explore the ability of various flavonoids (isolated and combined) to modulate the NLRP3 inflammasome using in silico and in vitro models. Computer simulations, such as molecular docking, molecular dynamics, and MM/GBSA calculations examined the interactions between bioactive molecules and NLRP3 PYD. THP1 cells were treated with LPS + nigericin to activate NLRP3, followed by flavonoid treatment at different concentrations. THP1-derived macrophages were also treated following NLRP3 activation protocols. The assays included colorimetric, fluorometric, microscopic, and molecular techniques. The results showed that catechin, apigenin, and epicatechin had high binding affinity to NLRP3 PYD, similar to the known NLRP3 inhibitor MCC950. These flavonoids, particularly at 1 µg/mL, 0.1 µg/mL, and 0.01 µg/mL, respectively, significantly reduced LPS + nigericin effects in both cell types and decreased pro-inflammatory cytokine, caspase-1, and NLRP3 gene expression, suggesting their potential as anti-inflammatory agents through NLRP3 modulation.

APIS: a paired CT-MRI dataset for ischemic stroke segmentation - methods and challenges.

Stroke, the second leading cause of mortality globally, predominantly results from ischemic conditions. Immediate attention and diagnosis, related to the characterization of brain lesions, play a crucial role in patient prognosis. Standard stroke protocols include an initial evaluation from a non-contrast CT to discriminate between hemorrhage and ischemia. However, non-contrast CTs lack sensitivity in detecting subtle ischemic changes in this phase. Alternatively, diffusion-weighted MRI studies provide enhanced capabilities, yet are constrained by limited availability and higher costs. Hence, we idealize new approaches that integrate ADC stroke lesion findings into CT, to enhance the analysis and accelerate stroke patient management. This study details a public challenge where scientists applied top computational strategies to delineate stroke lesions on CT scans, utilizing paired ADC information. Also, it constitutes the first effort to build a paired dataset with NCCT and ADC studies of acute ischemic stroke patients. Submitted algorithms were validated with respect to the references of two expert radiologists. The best achieved Dice score was 0.2 over a test study with 36 patient studies. Despite all the teams employing specialized deep learning tools, results reveal limitations of computational approaches to support the segmentation of small lesions with heterogeneous density.

Designing mixed cationic/anionic supports to covalently immobilize/stabilize enzymes with high isoelectric point by enzyme adsorption and support-enzyme glutaraldehyde crosslinking.

Ficin fully immobilized on Asp-agarose beads at pH 7 but not on an aminated support. This made enzyme adsorption plus glutaraldehyde modification non-viable for this enzyme. Modifying glyoxyl-agarose beads with mixtures of Asp and 1,6-hexamethylenediamine (HA) at different ratios, mixed anion/cation exchanger supports were built. Only if HA greatly exceed Asp in the support, immobilization did not work. While only using the Asp-agarose support immobilized enzyme molecules were only ionically adsorbed after glutaraldehyde treatment (visualized in SDS-PAGE analysis), the mixed supports gave covalent immobilization. The glutaraldehyde modification of these biocatalysts permitted to establish covalent bonds with the support, and this was more effective when using higher amounts of HA in the support. When around 60 % of the groups in the support were HA, the treatment with glutaraldehyde fully suppressed enzyme release from the support after boiling in SDS. The glutaraldehyde treated biocatalysts were more stable than just the adsorbed enzymes or the enzyme adsorbed only on Asp supports and then treated with glutaraldehyde (the optimal biocatalyst retained 90 % of the initial activity while the just adsorbed ficin retained 50 % of the initial activity). This strategy can be utilized to immobilize other proteins with high isoelectric points following this immobilization strategy.

Exposing illegal hunting and wildlife depletion in the world's largest tropical country through social media data.

Globally, illegal sport hunting can threaten prey populations when unregulated. Due to its covert nature, illegal sport hunting poses challenges for data collection, hindering efforts to understand the full extent of its impacts. We gathered social media data to analyze patterns of illegal sport hunting and wildlife depletion across Brazil. We collected data for 2 years (2018-2020) across 5 Facebook groups containing posts depicting pictures of illegal sport hunting events of native fauna. We described and mapped these hunting events by detailing the number of hunters involved, the number of species, the mean body mass of individuals, and the number and biomass of individuals hunted per unit area, stratified by Brazilian biome. We also examined the effects of defaunation on hunting yield and composition via regression models, rank-abundance curves, and spatial interpolation. We detected 2046 illegal sport hunting posts portraying the hunting of 4658 animals (∼29 t of undressed meat) across all 27 states and 6 natural biomes of Brazil. Of 157 native species targeted by hunters, 19 are currently threatened with extinction. We estimated that 1414 hunters extracted 3251 kg/million km2. Some areas exhibited more pronounced wildlife depletion, in particular the Atlantic Forest and Caatinga biomes. In these areas, there was a shift from large mammals and reptiles to small birds as the main targeted taxa, and biomass extracted per hunting event and mean body mass across all taxonomic groups were lower than in other areas. Our results highlight that illegal sport hunting adds to the pressures of subsistence hunting and the wild meat trade on Brazil's wildlife populations. Enhanced surveillance efforts are needed to reduce illegal sport hunting levels and to develop well-managed sustainable sport hunting programs. These can support wildlife conservation and offer incentives for local communities to oversee designated sport hunting areas.

Exposición de la caza ilegal y la reducción de fauna en el país tropical más grande del mundo por medio de datos de las redes sociales Resumen En todo el mundo, la caza recreativa ilegal puede amenazar a las poblaciones de presas cuando no está regulada. Debido a su naturaleza encubierta, la caza recreativa ilegal plantea dificultades para la recopilación de datos, lo que dificulta la comprensión de su impacto. Recopilamos datos de redes sociales para analizar los patrones de caza recreativa ilegal y agotamiento de la vida silvestre en todo Brasil. Recopilamos datos durante 2 años (2018­2020) a través de cinco grupos de Facebook que contenían publicaciones que mostraban imágenes de eventos de caza recreativa ilegal de fauna nativa. Describimos y mapeamos estos eventos de caza detallando el número de cazadores involucrados, el número de especies, la masa corporal media de los individuos y el número y la biomasa de los individuos cazados por unidad de área, estratificados por bioma brasileño. También examinamos los efectos de la deforestación en el rendimiento y la composición de la caza mediante modelos de regresión, curvas de abundancia e interpolación espacial. Detectamos 2,046 puestos de caza recreativa ilegal que mostraban la caza de 4,658 animales (∼29 t de carne sin desollar) en los 27 estados y 6 biomas naturales de Brasil. De las 157 especies autóctonas objetivo de los cazadores, 18 están actualmente en peligro de extinción. Se calcula que 1,414 cazadores extrajeron 3,251 kg/millón de km2. Algunas zonas mostraron una defaunación más pronunciada, en particular los biomas de la Mata Atlántica y la Caatinga. En estas áreas, se produjo un cambio de grandes mamíferos y reptiles a pequeñas aves como principales taxones objetivo, y la biomasa extraída por evento de caza y la masa corporal media en todos los grupos taxonómicos fueron menores que en otras áreas. Nuestros resultados ponen de manifiesto que la caza recreativa ilegal se suma a las presiones de la caza de subsistencia y el comercio de carne salvaje sobre las poblaciones de fauna de Brasil. Es necesario intensificar los esfuerzos de vigilancia para reducir los niveles de caza recreativa ilegal y desarrollar programas de caza recreativa sostenibles y bien gestionados. Estos programas pueden contribuir a la conservación de la fauna y ofrecer incentivos a las comunidades locales para que supervisen las zonas designadas para la caza recreativa.

Catastrophic floods and antimicrobial resistance: Interconnected threats with wide-ranging impacts.

•Climate change and AMR combined worsen vulnerabilities, accelerating AMR spread.•Floods can spread AMR-related pathogens, impacting health, agriculture, and ecosystems.•Integrated strategies are needed to address climate change and AMR, enhancing sanitation.

The cognitive triad network - oscillation - behaviour links individual differences in EEG theta frequency with task performance and effective connectivity.

We reconcile two significant lines of Cognitive Neuroscience research: the relationship between the structural and functional architecture of the brain and behaviour on the one hand and the functional significance of oscillatory brain processes to behavioural performance on the other. Network neuroscience proposes that the three elements, behavioural performance, EEG oscillation frequency, and network connectivity should be tightly connected at the individual level. Young and old healthy adults were recruited as a proxy for performance variation. An auditory inhibitory control task was used to demonstrate that task performance correlates with the individual EEG frontal theta frequency. Older adults had a significantly slower theta frequency, and both theta frequency and task performance correlated with the strengths of two network connections that involve the main areas of inhibitory control and speech processing. The results suggest that both the recruited functional network and the oscillation frequency induced by the task are specific to the task, are inseparable, and mark individual differences that directly link structure and function to behaviour in health and disease.

Spectral indices with different spatial resolutions in recognizing soybean phenology.

The aim of the present research was to evaluate the efficiency of different vegetation indices (VI) obtained from satellites with varying spatial resolutions in discriminating the phenological stages of soybean crops. The experiment was carried out in a soybean cultivation area irrigated by central pivot, in Balsas, MA, Brazil, where weekly assessments of phenology and leaf area index were carried out. Throughout the crop cycle, spectral data from the study area were collected from sensors, onboard the Sentinel-2 and Amazônia-1 satellites. The images obtained were processed to obtain the VI based on NIR (NDVI, NDWI and SAVI) and RGB (VARI, IV GREEN and GLI), for the different phenological stages of the crop. The efficiency in identifying phenological stages by VI was determined through discriminant analysis and the Algorithm Neural Network-ANN, where the best classifications presented an Apparent Error Rate (APER) equal to zero. The APER for the discriminant analysis varied between 53.4% and 70.4% while, for the ANN, it was between 47.4% and 73.9%, making it not possible to identify which of the two analysis techniques is more appropriate. The study results demonstrated that the difference in sensors spatial resolution is not a determining factor in the correct identification of soybean phenological stages. Although no VI, obtained from the Amazônia-1 and Sentinel-2 sensor systems, was 100% effective in identifying all phenological stages, specific indices can be used to identify some key phenological stages of soybean crops, such as: flowering (R1 and R2); pod development (R4); grain development (R5.1); and plant physiological maturity (R8). Therefore, VI obtained from orbital sensors are effective in identifying soybean phenological stages quickly and cheaply.

Prostate cancer focal therapy: surgeon experience influences oncological results.

INTRODUCTION: Characterization of the index lesion of prostate cancer (PCa) has facilitated the development of focal therapy to reduce complications caused by radical treatments. In the present study, we sought to identify factors associated with the oncological results of focal therapy for PCa. METHODS: Between April 2017 and February 2020, 123 PCa patients received focal therapy performed with high-intensity focused ultrasound (HIFU). The patients presented unilateral localized disease, PSA < 20 ng/dl, clinical stage T1-T2, ISUP grade 1-3, and more than 10 years of life expectancy. Five certified surgeons with different levels of experience performed the procedures and were divided into groups #1 and #2 (>30 HIFUs performed) and #3 (10-15 HIFUs performed each). All patients were prospectively followed and underwent surveillance biopsy 1 year post-treatment. The primary endpoint was radical treatment, and secondary endpoints included focal therapy failure and in-field recurrence. Univariate and multivariate logistic regression were used to detect associations between clinical and procedure variables and the endpoints. RESULTS: The median follow-up was 54.3 months, with a mean age of 64.4 years. The mean PSA was 6.6 ng/dl; 59.3% of patients had intermediate-risk disease, and the remaining had low-risk. During follow-up, 29 (23.6%) patients required radical treatment (external beam radiation therapy), 37 (30.1%) experienced treatment failure, and 26 (21.1%) had an in-field recurrence with an ISUP grade of ≥2. Radical treatment in the follow-up was associated with patients treated by surgeons in group #3 and with elevated post-HIFU PSA concentrations. Baseline PSA concentrations, group #3 surgeons, and post-HIFU PSA concentrations were associated with treatment failure. In-field positive biopsies were associated with baseline and post-HIFU PSA concentrations. Furthermore, patients treated by surgeons in group #3 were independently associated with radical treatment and focal therapy failure. CONCLUSION: Focal therapy with HIFU has acceptable oncological outcomes in the medium term, and the surgeon's experience and technique are independently associated with the need for subsequent radical treatment and focal therapy failure.

Environmental drivers of Euphorbia resinifera seed germination and seedling establishment for conservation purpose.

Euphorbia resinifera O. Berg is a prickly, leafless and succulent, Moroccan endemic shrub. Field data indicate that the plant faces many challenges related to its natural regeneration and its gradual decline that can lead to a probability of extinction, at least in some areas. Successful seed germination and survival of E. resinifera seedlings during the dry period is one of the main obstacles encountered in establishing natural seedlings. With this in mind, 3080 seeds of two morphotypes of E. resinifera (M1 and M2) were harvested in the Atlas of Beni Mellal to study their germinative potential and determine suitable conditions for growth and development of the seedlings. In the laboratory, five temperatures (10 °, 15 °C, 18 °C, 25 °C, and 35 °C) and two photoperiods (12 h light/12 h dark and 24 h dark) were tested. Whereas in field research, two factors were considered: the availability of water and the type of substrate (clay, peat, and limestone). Results show a maximum germination rate of around 52% for M2 at 15 °C and 48% for M1 at 18 °C. The Monitoring of plant seedling establishment and growth revealed a high vulnerability to prolonged periods of drought. However, consolidated soil is more conducive to seedling establishment. For this species, it is therefore essential to conserve the habitat within the karst geosystem. Furthermore, the variability of this species' morphotypes and their growth form architecture shows a tendency to favor the dwarf, cushion-shaped morphotype, which is the most widespread in the study area.

Drosophila suzukii (Diptera: Drosophilidae) Population Dynamics and Infestation in a Raspberry Orchard of Loukkos Area, Morocco.

Raspberries (Rosales: Rosaceae) are considered to be one of most important crops in northwestern Morocco. However, this sector is seriously affected by the attack of Drosophila suzukii, which impairs the production and the export. Furthermore, the eco-ethology and population dynamics of D. suzukii under Moroccan conditions are still poorly understood. In Larache region, we monitored the population dynamics of D. suzukii adults using 4 traps baited with mashed ripe banana mixed with yeast, and reported the infestation levels during spring of 2022, 2023, and 2024 on raspberry cultivar Rubus idaeus var. Yazmin. Our results indicate that a maximum of 14, 20, and 28 D. suzukii adults per trap were caught weekly at the end of April 2022, in the middle of March 2023, and in the middle of April 2024, respectively. Furthermore, three peaks of D. suzukii adult flies were observed each year, whereas a total of six generations were predicted according to the accumulated degree-days. The male sex ratio of trapped D. suzukii was 1:0.32, 1:0.38, and 1:0.42 in 2022, 2023, and 2024, respectively. Raspberry fruit infestation reached a maximum of 76%, 75%, and 64% at the beginning of May 2022, middle of April 2023, and end of April 2024, respectively. Under the climate change scenario, knowledge of the eco-ethology of this insect and its population dynamics is essential for developing an IPM control strategy in Morocco, and further studies are ongoing to establish a biological and reasoned chemical approach based on degree-days.

Impact of Elevated Serum Triglycerides on Children with Acute Recurrent or Chronic Pancreatitis from INSPPIRE-2.

OBJECTIVE: To determine if mild-moderate hypertriglyceridemia (HTG) is associated with increased development of chronic pancreatitis (CP) or pancreatitis-associated complications in children with acute recurrent or CP. STUDY DESIGN: Longitudinal data from the INternational Study group of Pediatric Pancreatitis: In search for a cuRE-2 (INSPPIRE-2) cohort of children with acute recurrent or CP (n = 559) were analyzed. Subjects were divided into normal triglycerides (<150 mg/dL; 1.7 mmol/L), any HTG (≥150 mg/dL; ≥1.7 mmol/L), mild-moderate HTG (150-499 mg/dL; 1.7-5.6 mmol/L), moderate HTG (500-999 mg/dL; 5.6-11.3 mmol/L), and severe HTG groups (≥1000 mg/dL; ≥11.3 mmol/L), based on highest serum triglyceride value. Laboratory, imaging, pancreatitis and hospital events, complications, and quality of life data were analyzed. RESULTS: In children with acute recurrent or CP and HTG, there was no increase in the number of pancreatitis attacks per person-years, nor an increase in CP prevalence. However, HTG severity was associated with increased pancreatic inflammation, pancreatic cysts, pain, hospital days, number of hospitalizations, intensive care, and missed school days. CONCLUSIONS: Mild-moderate HTG in children with acute recurrent or CP was not associated with increased pancreatitis frequency, nor increased development of CP, but was associated with increased pancreatitis complications and disease burden. As a treatable condition, treatment of mild-moderate HTG may be considered to reduce pancreatitis-associated complications and medical burden in children with acute recurrent or CP.

Assessment of mental well-being and psychological distress in Moroccan breast cancer patients.

The quality of life of breast cancer patients is strongly affected by physical pain, psychological distress, and uncertainty about vital prognosis. Objective: To assess breast cancer patients' mental well-being and level of psychological distress at the Mohammed VI University Hospital in Marrakech. Methods: Cross-sectional study carried out from April to December 2023 at the Mohammed VI University Hospital of Marrakech. The data were collected via a questionnaire comprising a sociodemographic section and a section reserved for the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Kessler Psychological Distress Scale (K10). Data analysis was performed using SPSS software, version 25. Results: A total of 38.3% of patients experienced severe psychological distress. However, their mental well-being was high with a mean of 54.59 (±11.29). Older patients (>50 years) exhibited better mental well-being (56.46±10.39 vs. 52.99±11.81; p=0.020) and lower psychological distress (26.27±7.21 vs. 28.44±8.19; p=0.034) compared to their younger counterparts (≤50 years). As for the stage of cancer, patients with localized cancer presented a higher mental well-being score than patients with metastatic cancer (55.53±10.93 vs. 50.40±12.03; p=0.008). However, no statistically significant difference was recorded between mastectomy and lumpectomy patients regarding mental well-being or psychological distress. Conclusion: Breast cancer has not only a physical but also a psychological and emotional impact on patients. Thus, early diagnosis and referral to appropriate psychosocial services can improve patients' mental well-being.

A qualidade de vida das pacientes com câncer de mama é fortemente afetada pela dor física, angústia psicológica e incerteza sobre o prognóstico vital. Objetivo: Avaliar o bem-estar mental e o nível de angústia psicológica das pacientes com câncer de mama no Hospital Universitário Mohammed VI, em Marrakech. Métodos: Este foi um estudo transversal realizado de abril a dezembro de 2023 no Hospital Universitário Mohammed VI de Marrakech. Os dados foram coletados por meio de um questionário composto por uma seção sociodemográfica e uma seção reservada para a Escala de Bem-Estar Mental de Warwick-Edinburgh (Warwick-Edinburgh Mental Well-being Scale ­ WEMWBS) e a Escala de Angústia Psicológica de Kessler (K10). A análise dos dados foi realizada utilizando o software SPSS V25. Resultados: Um total de 38,3% das pacientes experimentou angústia psicológica grave. No entanto, o bem-estar mental das pacientes foi alto, com uma média de 54,59 (±11,29). As pacientes mais velhas (>50 anos) apresentaram melhor bem-estar mental (56,46±10,39 vs. 52,99±11,81; p=0,020) e menor angústia psicológica (26,27±7,21 vs. 28,44±8,19; p=0,034) em comparação com as mais jovens (≤50 anos). Quanto ao estágio do câncer, as pacientes com câncer localizado apresentaram uma pontuação de bem-estar mental mais alta do que as pacientes com câncer metastático (55,53±10,93 vs. 50,40±12,03; p=0,008). No entanto, não foi registrada diferença estatisticamente significativa entre as pacientes submetidas a mastectomia e aquelas submetidas a lumpectomia em relação ao bem-estar mental ou angústia psicológica. Conclusão: O câncer de mama tem não apenas um impacto físico, mas também psicológico e emocional nas pacientes. Assim, o diagnóstico precoce e o encaminhamento para serviços psicossociais adequados podem melhorar o bem-estar mental das pacientes.

The effect of dexmedetomidine-ketamine combination versus dexmedetomidine on behavior of uncooperative pediatric dental patients: a randomized controlled clinical trial.

OBJECTIVE: Uncooperative behavior in pediatric dentistry is one of the most common manifestations of dental anxiety. Managing anxious patients can be attained by moderate sedation. This study aimed to compare the effect of sedation by dexmedetomidine-ketamine combination (DEX-KET) versus dexmedetomidine (DEX) on behavior of uncooperative pediatric dental patients. METHODOLOGY: In total, 56 uncooperative healthy children (3-5 years old) requiring dental treatment were divided randomly into two groups: Group I (study group), which received buccal dexmedetomidine (2 µg/kg) and ketamine (2 mg/kg), and Group II (control group), which received only buccal dexmedetomidine (4 µg/kg). Drugs effects were assessed in terms of hemodynamic parameters, patient's drug acceptance, child behavior, postoperative effect of sedation, amnesic effect, incidence of adverse events, as well as procedural induced stress measured by salivary secretory immunoglobulin A (s-IgA). RESULTS: Hemodynamic results did not reveal a statistically significant difference between the two study groups (P>0.05). There was a significant difference in patient's acceptance to sedative drug between both groups, favoring DEX (p=0.005). Children who received DEX-KET showed significantly better behavior than those who received DEX for local anesthesia (p=0.017) and during operative procedure (p=0.037). Adverse events, post-operative and amnesic effects of drugs were comparable in both groups (p>0.05). Moreover, the mean difference in the salivary s-IgA levels between initial and final value was not statistically significant between both groups (p=0.556). CONCLUSION: Both DEX-KET combination and DEX alone are effective in providing hemodynamic stability. DEX-KET combination significantly improved the behavior of sedated children compared to DEX alone but the drug acceptance was decreased in the DEX-KET group. Both regimens did not have a negative effect on postoperative behavior of children and had comparable amnesic effect with no significant adverse events. Salivary s-IgA is not considered a potential stress biomarker in sedated children.