Left Middle Phalanx Tuberculous Dactylitis Masquerading as a Tumor: First Case Report in Saudi Arabia.

Tuberculous dactylitis can cause osteomyelitis, which is a rare extrapulmonary manifestation of tuberculosis, often misdiagnosed due to its nonspecific presentation and resemblance to other conditions like neoplasms. A 15-year-old male patient reported to our clinic with a 1-year history of left index finger pain and swelling following a football-related injury. Despite conservative management, the symptoms had progressively worsened over the past few months. Clinical examination revealed deformity and swelling of the middle phalanx, along with induced pain on range of motion. Bacteriological analysis indicated polymorphic nuclear cells and the presence of coagulase-negative Staphylococcus (Staphylococcus hominis). Radiographic evaluation, including x-ray and magnetic resonance imaging, revealed medullary expansion, trabecular thinning, and focal soft tissue swelling. Magnetic resonance imaging displayed extensive soft tissue and bone marrow involvement, raising concerns of a tumor. An open biopsy was performed, yielding unexpected findings of necrotizing and suppurative granulomatous inflammation, strongly suggesting an ongoing infectious process. The subsequent Quantiferon TB Gold Test confirmed tuberculosis infection. Treatment encompassed debridement, synovectomy, and initiation of an antituberculosis regimen. The patient showed significant improvement after treatment. Timely diagnosis and treatment of tuberculous dactylitis are crucial, as highlighted by the patient's positive response to combined surgical and pharmacological intervention, despite initial diagnostic challenges.

The Role of Ventricular Assist Devices in Patients With Heart Failure Due to Dilated Cardiomyopathy: A Systematic Review.

Dilated cardiomyopathy (DCM) is a prevalent heart muscle disease characterized by ventricular dilation and systolic dysfunction, leading to severe heart failure (HF) and often requiring heart transplantation (HTx). This systematic review aimed to synthesize information regarding the role of ventricular assist devices (VADs) in managing HF patients due to DCM. A comprehensive search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane databases for studies published between 2014 and 2024. Inclusion criteria were studies involving adult patients with HF due to DCM treated with VADs. Exclusion criteria included non-human studies, pediatric populations, and non-peer-reviewed articles. Thirty-one studies met the inclusion criteria. The included studies demonstrated that the use of VADs in patients with DCM resulted in significant improvements in left ventricular ejection fraction (LVEF), myocardial fibrosis reduction, and reverse ventricular remodeling. Studies reported enhanced survival rates, reduced symptoms, and better quality of life. VADs served as a critical bridge to HTx and, in some cases, as long-term destination therapy. However, complications such as thrombus formation, anemia, and kidney failure were noted, emphasizing the need for vigilant monitoring and management. Continuous advancements in VAD technology and patient management protocols were found to be essential for optimizing outcomes. We conclude that VADs play a crucial role in managing advanced HF due to DCM by providing mechanical circulatory support, improving cardiac function, and enhancing patient survival and quality of life. Despite associated complications, VADs are invaluable for patients with severe HF, offering both immediate and long-term therapeutic benefits. Future research should focus on minimizing complications and further improving VAD technology to enhance patient outcomes.

Composite Autonomic Symptom Score-31 for the diagnosis of cardiovascular autonomic dysfunction in long-term coronavirus disease 2019.

BACKGROUND: Composite Autonomic Symptom Score-31 (COMPASS-31) is an easy-to-use screening tool for the evaluation of autonomic dysfunction in various diseases affecting neural function but has rarely been used in the assessment of long coronavirus disease 2019 (COVID-19). This study aimed to evaluate the diagnostic accuracy of the COMPASS-31 score in detecting dysfunction of the autonomic nervous system in patients 3 months after COVID-19 infection. MATERIALS AND METHODS: Fifty-nine subjects were recruited and grouped into 2: (a) controls (n = 31) who had never had positive polymerase chain reaction results for COVID-19 before and (b) the post-COVID-19 patients (n = 28) who had confirmed COVID-19 infection 3-6 months before recruitment. COMPASS-31 questionnaire was utilized to evaluate subjective symptoms or evidence of autonomic dysfunction. Autonomic dysfunction was assessed objectively by cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV). For comparison of quantitative variables between two groups, t-test or Mann-Whitney U test, as appropriate, were used. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio (LR), and positive LR were used as measures of diagnostic accuracy. Receiver operating characteristic (ROC) curve analysis determined the overall accuracy of COMPASS-31. RESULTS: The median COMPASS score was found to be significantly higher in post-COVID-19 participants than controls (15.5 vs. 10, P = 0.021). The median total CART score was also significantly higher in post-COVID-19 participants (0 vs. 1, P < 0.001). Out of 6 domains of the COMPASS score, the median value for orthostatic dysfunction was found to be significantly higher in post-COVID-19 participants than controls (12 vs. 0, P = 0.008). There was significantly fair accuracy of the COMPASS score with an area under the receiver operating curve 0.68 (0.54-0.82) following the total CART score ≥2 as the gold standard in the diagnosis of autonomic dysfunction (P = 0.021). The best cutoff point of the total COMPASS score was 12.5, where the optimal values of sensitivity, specificity, and positive and negative predictive values were achieved. Nonsignificant and weak correlations between CARTs, HRV parameters, and COMPASS score were found. CONCLUSION: COMPASS-31 could be used as a user-friendly screening tool to detect autonomic dysfunction in post-COVID-19 cases with acceptable sensitivity and specificity.

Effects of Shading Nets Color on the Internal Environmental Conditions, Light Spectral Distribution, and Strawberry Growth and Yield in Greenhouses.

Greenhouses are used to create the appropriate environment for plant growth. Controlling the level of lighting using shading nets is one of the most commonly used methods for making suitable environmental modifications in greenhouses. The objective of this study was to examine the impact of three colored shading nets (green, black, and beige at shading rates of 50%) on inside air temperature, relative humidity, and spectral distribution of light in a greenhouse, as well as their effect on the growth and yield of strawberry plants. Data were collected during winter (December and January) and spring (March and April) months from shaded and unshaded blocks. The green net had the highest transmittance to solar radiation (τSR) during the two periods (38% and 35%, respectively) and the highest transmittance to photosynthetically active radiation (τPAR) of 34% during spring months, while the beige net had the highest τPAR of 27% during winter months. The black net had the smallest τPAR values during the two periods (22% and 29%, respectively). The lowest total light levels per season for solar radiation (SR) and photosynthetically active radiation (PAR) (746.8 and 293.7 MJ·m-2, respectively) were obtained under the black net, compared with (906.7 and 320.8 MJ·m-2, respectively) for the beige net, and (969.6 and 337.2 MJ·m-2, respectively) for the green net. The ratio of PAR to SR (PAR:SR) was 41% and 44% outside and inside the greenhouse for the control (without shade), respectively. The black net had the highest ratio of PAR:SR (39%) among the treatment nets. The green net transmitted more light in the blue-green region (400 to 570 nm) and transmitted the highest photon flux at 480 nm, while the beige net increased the infrared radiation flux from 730 nm and above and transmitted the highest photon flux at 604 nm. The study found that the green net increased the ratio of blue to red light (B/R), while the beige and green nets reduced the red to far-red light (R/FR) ratio. The photosynthetic rate, conductance to water, and transpiration were significantly higher for strawberries grown under the beige net. These results indicate that the beige net positively influenced leaf and stem characteristics, leading to improved strawberry yields. The best yields of strawberries were obtained under the beige net and the control group (no shade), surpassing the yields achieved under the black net by 26.3% and 21.4%, respectively.

Comprehensive Systematic Review of Breast Implant Illness: Symptoms, Management, and Long-Term Outcomes.

BACKGROUND: Breast augmentation using silicone implants is common, with over 300,000 annual US surgeries. It was initially approved in 1962, there were safety concerns with the use of silicone implants, leading to a 1992-2006 FDA moratorium. Recently, Breast Implant Illness (BII) was described as a cluster of symptoms associated with silicone implants, with a lack of diagnostic criteria, which increased the likelihood of implant removal and a variety of treatment options. This comprehensive review aims to shed light on the extent, symptoms, management, and outcomes of BII. METHODS: Multiple electronic databases were systematically searched in May 2023 for studies on Breast Implant Illness utilizing terms related to BII and its symptoms, diagnosis, and treatment. Out of 1204 studies, 20 met the inclusion criteria and were included in the systematic review. The Newcastle-Ottawa Scale for the included cohort prospective and retrospective studies, and the tool for evaluating the methodological quality of case reports and case series were utilized during quality assessment. RESULTS: There were 20 papers on Breast Implant Illness published between 1995 and 2022, including a peak of papers published in 2020 and 2022. The majority of the studies came from the USA, with a variety of research methods, including case reports. Reports of arthralgia and fatigue were common findings. These symptoms were frequently alleviated by surgical procedures such as en bloc explantation and capsulectomy, highlighting the intricacy of the problem and the need for individualized treatment plans. CONCLUSION: The review underscores the critical need for further research into BII, advocating for a multidisciplinary strategy that prioritizes patient safety, informed decision-making, and comprehensive care. As the medical community progresses in understanding and managing BII, emphasizing evidence-based practices and patient-provider communication will be essential in addressing this complex condition effectively. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. 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 .

The impact of antibiotic use in gastrointestinal tumors treated with immune checkpoint inhibitors: systematic review and meta-analysis.

Background: Immune checkpoint inhibitors (ICI) have improved overall survival in patients with different cancer types. However, treatment efficacy varies between patients depending on several factors. Recent research suggested that antibiotic-induced dysbiosis can impair ICI efficacy. Here we review the impact of antibiotic use in clinical outcome of patients with gastrointestinal cancer treated with ICI. Methods: This is a systematic review and utilized a thorough search of MEDLINE, Cochrane, Scopus, EB-SCO, Web of Science of studies published till September 2023. The aim of the study is to determine the association between antibiotic use and ICI treatment efficacy in patients with gastrointestinal cancers (GI). We utilized a meta-analysis of the association between the use of antibiotics and overall survival and progression-free survival. Results: Nine studies met the inclusion criteria with a total of 2,214 patients. The most common type of cancers was hepatocellular carcinoma (HCC). The majority of the studies were retrospective, and one was collective of clinical trials. The use of antibiotics was associated with decreased both overall survival [haz-ard ratio (HR) 1.92, 95% confidence interval (CI) 1.41, 2.63] and progression-free survival [HR 1.81, 95% CI 1.29, 2.54]. Conclusion: The use of antibiotics may affect clinical outcomes in patients with GI cancers treated with ICI. Further prospective studies are needed to improve the understanding of this phenomenon. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023462172.

Aeluropus littoralis stress-associated protein promotes water deficit resilience in engineered durum wheat.

Global climate change-related water deficit negatively affect the growth, development and yield performance of multiple cereal crops, including durum wheat. Therefore, the improvement of water-deficit stress tolerance in durum wheat varieties in arid and semiarid areas has become imperative for food security. Herein, we evaluated the water deficiency resilience potential of two marker-free transgenic durum wheat lines (AlSAP-lines: K9.3 and K21.3) under well-watered and water-deficit stress conditions at both physiological and agronomic levels. These two lines overexpressed the AlSAP gene, isolated from the halophyte grass Aeluropus littoralis, encoding a stress-associated zinc finger protein containing the A20/AN1 domains. Under well-watered conditions, the wild-type (WT) and both AlSAP-lines displayed comparable performance concerning all the evaluated parameters. Ectopic transgene expression exerted no adverse effects on growth and yield performance of the durum wheat plants. Under water-deficit conditions, no significant differences in the plant height, leaf number, spike length, and spikelet number were observed between AlSAP-lines and WT plants. However, compared to WT, the AlSAP-lines exhibited greater dry matter production, greater flag leaf area, improved net photosynthetic rate, stomatal conductance, and water use efficiency. Notably, the AlSAP-lines displayed 25 % higher grain yield (GY) than the WT plants under water-deficit conditions. The RT-qPCR-based selected stress-related gene (TdDREB1, TdLEA, TdAPX1, and TdBlt101-2) expression analyses indicated stress-related genes enhancement in AlSAP-durum wheat plants under both well-watered and water-deficit conditions, potentially related to the water-deficit resilience. Collectively, our findings support that the ectopic AlSAP expression in durum wheat lines enhances water-deficit resilience ability, thereby potentially compensate for the GY loss in arid and semi-arid regions.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Introduction: Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. Methods: A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. Results: The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. Discussion: The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study.

AIM: To compare between the rehabilitation of atrophied maxilla with fixed prosthesis using two posterior zygomatic implants and two conventional anterior implants or four implants inserted according to the all-on-four concept regarding the patient quality of life and satisfaction after one year of prosthesis insertion. MATERIALS AND METHODS: Thirty-six patients with atrophic edentulous maxillae were randomized into two groups: Group I (rehabilitated with fixed prostheses supported by two zygomatic and two conventional implants in the anterior region) and group II (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after the placement of the definitive prostheses, patients completed oral health impact profile-14 and satisfaction questionnaires. RESULTS: All patients were satisfied regarding retention, stability, occlusion, comfort, cleaning, speaking, chewing, bolus quality, appearance, handling, prosthesis apart, and embarrassing, with no significant significance between two groups except satisfaction with surgical procedures and healing period. CONCLUSIONS: Using two distally tilted zygomatic implants or all-on-four concept to rehabilitate atrophied maxilla by fixed detachable prosthesis could be considered a promising functional and esthetic treatment option regarding the patient satisfaction. CLINICAL SIGNIFICANCE: Traditionally, treatment of maxillary atrophied ridges was done by bone grafting or sinus-lifting techniques; however, using all-on-four concept or zygomatic implants was a successful treatment as it has high success rates and highly satisfied by the patients. How to cite this article: Nagib MA, Ibrahim AM, Abdel-Rahman FH, et al. Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(2):141-147.

The effects of protein supplementation, fumagillin treatment, and colony management on the productivity and long-term survival of honey bee (Apis mellifera) colonies.

In this study, we intensively measured the longitudinal productivity and survival of 362 commercially managed honey bee colonies in Canada, over a two-year period. A full factorial experimental design was used, whereby two treatments were repeated across apiaries situated in three distinct geographic regions: Northern Alberta, Southern Alberta and Prince Edward Island, each having unique bee management strategies. In the protein supplemented treatment, colonies were continuously provided a commercial protein supplement containing 25% w/w pollen, in addition to any feed normally provided by beekeepers in that region. In the fumagillin treatment, colonies were treated with the label dose of Fumagilin-B® each year during the fall. Neither treatment provided consistent benefits across all sites and dates. Fumagillin was associated with a large increase in honey production only at the Northern Alberta site, while protein supplementation produced an early season increase in brood production only at the Southern Alberta site. The protein supplement provided no long-lasting benefit at any site and was also associated with an increased risk of death and decreased colony size later in the study. Differences in colony survival and productivity among regions, and among colonies within beekeeping operations, were far larger than the effects of either treatment, suggesting that returns from extra feed supplements and fumagillin were highly contextually dependent. We conclude that use of fumagillin is safe and sometimes beneficial, but that beekeepers should only consider excess protein supplementation when natural forage is limiting.

A Review of Different Manufacturing Methods of Metallic Foams.

Metallic foam is a popular topic due to its diverse industrial applications and unique combination of properties. Metallic foam is significantly lighter than nonfoam metal materials due to its porous structure, which incorporates a substantial amount of air or voids. This lower density makes metallic foam advantageous in applications in which weight reduction is critical. This makes it ideal for the aerospace, automotive, and construction industries; also, its versatile nature continues to make it an attractive material for various industrial applications such as impact absorbers, heat exchangers, and biomedical and marine engineering. However, the choice between metallic foam and nonfoam metal also depends on other factors like mechanical properties, cost, and specific application requirements. This review describes various fabrication methods of metallic foam that include the liquid metallurgy route which uses liquid or semiliquid metal, the powder metallurgy route uses metal in powder form, metal ion, and the metal vapor route which uses electrolytic deposition method to produce metallic foam. These methods include direct gas injection, adding blowing agents in solid or liquid metals, investment casting, the addition of a space holder in the precursor, metallic ion, vapor deposition on a polymer sponge, and many more. The morphology of metallic foam depends upon the method that is chosen for fabrication, and up to 98% porosity can be achieved by these methods. Additive manufacturing for metallic foam fabrication is an emerging field based on selective laser melting and electron beam melting principles. It has exceptional possibilities for generating complicated 3D shapes and customizing the material characteristics. The main purpose of this review article is to give significant insights into the various production procedures for metallic foams to researchers, engineers, and industry experts, assisting in the selection of acceptable methods depending on individual application needs. This review investigates the manufacturing conditions for metallic foams and finally discusses their advantages, drawbacks, and obstacles in mass production. The findings add to current efforts to expand metallic foam technology and encourage its wider application across diverse sectors, opening the path for future research and development.

Knowledge and Attitude Regarding Cutaneous Leishmaniasis Among Adult Population in Tabuk, Saudi Arabia.

Background Cutaneous leishmaniasis (CL) is a major health problem in Saudi Arabia. It is caused by the protozoa Leishmania. The vector is female sand flies. In order to develop preventive strategies to reduce the burden of this health problem, public awareness of the disease should be assessed. Objective This study aimed to investigate the knowledge and attitude toward CL among the adult population in Tabuk, Saudi Arabia. Methods A cross-sectional survey study was conducted on 385 adult participants of Tabuk between April and May 2022. The investigators assembled the survey questions from peer-reviewed articles with some modifications. Google Forms was used to create the online survey. Social media were used to distribute the survey. Results The study revealed that hearing about CL was much more common among participants older than 61 years and Saudi males. The most prominent sources of information for the participants on which their answers were based were as follows: families and friends, health care professionals, television or radio, and lastly, newspapers. Subjects older than 61 years also showed more knowledge of the risk factors for contracting CL. However, the participants showed overall poor knowledge of the clinical presentation of the disease, which gender or age group was mostly affected, or how the disease was transmitted. Likewise, their knowledge of sand flies was poor. Most participants did not know if CL was a health problem or not. Conclusions The study revealed overall poor awareness of the epidemiological aspects of CL, how it is transmitted, its clinical presentation, and proper management. Our study could help authorities correct the gap in knowledge regarding CL in Tabuk.

Rate and Predictors of Satisfaction after Noninvasive Facial Cosmetic Procedures: A National Study in Saudi Arabia.

Background: In response to the growing popularity of noninvasive facial cosmetic procedures, this study assessed the rate and predictors of satisfaction with such procedures in Saudi Arabia, filling a research gap and emphasizing the role of patient satisfaction in optimizing care and understanding the economic implications for healthcare. Methods: This cross-sectional study was conducted from May to June 2023 using an online self-administered questionnaire distributed across all regions of Saudi Arabia. Eligible participants were Saudi adults aged 18 years and older who had undergone noninvasive facial cosmetic procedures. Patients who underwent surgical/invasive cosmetic procedures, nonfacial interventions, or interventions performed by doctors other than plastic surgeons or dermatologists were excluded. Results: Most participants reported satisfaction with their procedures. Significant predictors of satisfaction included sex, income, and residential area. Women, higher-income individuals, and residents of certain areas were more likely to report satisfaction. Participants also expressed a high level of satisfaction with the friendly and polite treatment they received from their doctors but showed dissatisfaction with the difficulty they faced in securing immediate postprocedure appointments. Conclusions: This study provides valuable insights into the rate and predictors of satisfaction after noninvasive facial cosmetic procedures in Saudi Arabia. These findings underscore the importance of considering sociodemographic factors in patient satisfaction and suggest areas for improvement in patient care, particularly in facilitating immediate postprocedure appointments. Future research should continue to explore these and other potential predictors to further improve patient outcomes in the field of noninvasive facial cosmetic procedures.

Work stress, work-family conflict, and psychological distress among resort employees: a JD-R model and spillover theory perspectives.

The hospitality industry is well-known for its challenging and high-pressure work settings. In this context, employees commonly face a multitude of stressors originating from their roles and job responsibilities, which can significantly impact their psychological wellbeing. Hence, based on the job demands-resources (JD-R) model and the spillover theory, this study aims to empirically explore the direct and indirect effect of work stress (assessed by role overload, ambiguity, and conflict) on psychological distress among frontline employees in 3- and 4-star Egyptian resorts while considering the mediating influence of work-family conflict (WFC). Four hypotheses were put to the test through the application of the PLS-SEM 4.0 version (4.0.9.9). Based on the findings from 563 frontline employees who participated in this research, the study supports the four hypotheses affirming that work-related stressors significantly contributed to employees' psychological distress. Further, the findings highlighted that these stressors significantly spill over into employees' family lives, generating conflicts between work and family roles. In addition, the results emphasized the significance of WFC as a contributing factor to employees' psychological distress. Finally, the study concluded that WFC partially mediates the link between work stress and employees' psychological distress. Based on these findings, some theoretical and practical implications for hospitality scholars, resort management, and policymakers were suggested to enhance the employees' wellbeing and mitigate psychological distress in this vital sector.

Assessment of Adherence to Cardiovascular Medicines in Saudi Population: An Observational Study in Patients Attending a Tertiary Care Hospital.

BACKGROUND: Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia. METHODS: This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia. RESULTS: This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001). CONCLUSION: The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications.

Pediatric Burns: A Systematic Review and Meta-Analysis on Epidemiology, Gender Distribution, Risk Factors, Management, and Outcomes in Emergency Departments.

Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid.

Can a Machine Ace the Test? Assessing GPT-4.0's Precision in Plastic Surgery Board Examinations.

Background: As artificial intelligence makes rapid inroads across various fields, its value in medical education is becoming increasingly evident. This study evaluates the performance of the GPT-4.0 large language model in responding to plastic surgery board examination questions and explores its potential as a learning tool. Methods: We used a selection of 50 questions from 19 different chapters of a widely-used plastic surgery reference. Responses generated by the GPT-4.0 model were assessed based on four parameters: accuracy, clarity, completeness, and conciseness. Correlation analyses were conducted to ascertain the relationship between these parameters and the overall performance of the model. Results: GPT-4.0 showed a strong performance with high mean scores for accuracy (2.88), clarity (3.00), completeness (2.88), and conciseness (2.92) on a three-point scale. Completeness of the model's responses was significantly correlated with accuracy (P < 0.0001), whereas no significant correlation was found between accuracy and clarity or conciseness. Performance variability across different chapters indicates potential limitations of the model in dealing with certain complex topics in plastic surgery. Conclusions: The GPT-4.0 model exhibits considerable potential as an auxiliary tool for preparation for plastic surgery board examinations. Despite a few identified limitations, the generally high scores on key parameters suggest the model's ability to provide responses that are accurate, clear, complete, and concise. Future research should focus on enhancing the performance of artificial intelligence models in complex medical topics, further improving their applicability in medical education.

Nationwide Study: Public Adults' Perception of Cosmetic Surgery in Saudi Arabia.

Background: Knowing what influences people to pursue cosmetic surgery can aid current and aspiring cosmetic surgeons as they develop their techniques and enhance their market practice. This study aimed to evaluate Saudi adults' perceptions of cosmetic surgery using the three subscales of the Acceptance of Cosmetic Surgery Scale, namely Social, Consider, and Intrapersonal. Methods: This cross-sectional, nationwide study involved members of the public from all provinces of Saudi Arabia. The inclusion criteria were being a Saudi resident over 18 years old and consenting to participate; those who did not meet the criteria were excluded. The study was implemented between October 25 and December 16, 2022. The electronic survey was composed of a demographic characteristics section and a previously constructed questionnaire modified for Arabic speakers to assess the population's perceptions of cosmetic surgery. Statistical analysis was conducted using the SPSS 22 statistical package. Results: Of the 8006 Saudi adults who participated in the study, 5551 (69.3%) were women, and 2245 (30.7%) were men. We found that intrapersonal factors were the primary motivator, followed by factors addressed by the Consider and Social subscales. However, attitudes differed by gender, age, and other demographic characteristics: men and younger individuals (18-29) showed the lowest score for likelihood to pursue cosmetic surgery, whereas women and older individuals (40-50) ranked the highest on total scale scores. Overall, the Saudi adult population showed diminished perceptions of cosmetic surgery nationwide. Conclusion: The results confirmed the authors' hypothesis that there is a diminished perception of cosmetic surgery among adults in Saudi Arabia.

Application of CRISPR-Cas System to Mitigate Superbug Infections.

Multidrug resistance in bacterial strains known as superbugs is estimated to cause fatal infections worldwide. Migration and urbanization have resulted in overcrowding and inadequate sanitation, contributing to a high risk of superbug infections within and between different communities. The CRISPR-Cas system, mainly type II, has been projected as a robust tool to precisely edit drug-resistant bacterial genomes to combat antibiotic-resistant bacterial strains effectively. To entirely opt for its potential, advanced development in the CRISPR-Cas system is needed to reduce toxicity and promote efficacy in gene-editing applications. This might involve base-editing techniques used to produce point mutations. These methods employ designed Cas9 variations, such as the adenine base editor (ABE) and the cytidine base editor (CBE), to directly edit single base pairs without causing DSBs. The CBE and ABE could change a target base pair into a different one (for example, G-C to A-T or C-G to A-T). In this review, we addressed the limitations of the CRISPR/Cas system and explored strategies for circumventing these limitations by applying diverse base-editing techniques. Furthermore, we also discussed recent research showcasing the ability of base editors to eliminate drug-resistant microbes.