Fiber-Reinforced Hybrid Prosthesis Veneered With Composite Resin for 4 Implant-Supported Fixed Provisional and Definitive Restorations.

This technical note describes the fabrication and benefits of fiberglass-reinforced hybrid prosthesis veneered with composite resin for 4 implant-supported fixed professional and final restorations. The described prosthesis reduces rehabilitation time, minimizes impression problems, and ensures a passive fit of professional restoration. The prosthesis provides immediate rehabilitation of 4 implants with ease of adjustments and repair during the entire provisional phase. Moreover, it can be easily converted to final restoration with minimal modifications, excellent esthetic results, and reduced costs.

Radiographic Assessment of Three-implant-retained Mandibular Overdentures: A Clinical Study of Alveolar Bone Height Changes (Randomized Clinical Trial).

AIM: To evaluate the residual alveolar ridge bone height changes regarding the impact of the block-out spacer used during the pick-up procedures of implant-assisted mandibular complete overdentures. MATERIALS AND METHODS: This study was a randomized clinical trial conducted on 18 patients. All patients received three mandibular dental implants with definitive locator attachments which were directly picked up with two different techniques. Patients were classified randomly without any bias into two equal groups (Group I block-out spacer) and (Group II without block-out spacer). Over a year, the digital radiographic technique with new technique of reference points was employed to evaluate the changes in the residual alveolar ridge bone heights. The data were statistically analyzed to test the significance difference between groups. RESULTS: Concerning the residual alveolar ridge resorption RRR, group I exhibited a significantly higher RRR than group II. CONCLUSION: In terms of residual alveolar ridge preservation, not using the block-out spacer was more beneficial than using it. CLINICAL SIGNIFICANCE: Alveolar bone heights can be affected by the use of block-out spacer during pick-up procedure within accepted physiologic values. The removal of the block-out spacer could be more beneficial with respect to the preservation of the residual alveolar ridge. How to cite this article: Mohammed REL, Askar OM, El-Waseef FAE, et al. Radiographic Assessment of Three-implant-retained Mandibular Overdentures: A Clinical Study of Alveolar Bone Height Changes (Randomized Clinical Trial). J Contemp Dent Pract 2023;24(11):847-852.

A Reliable Auto-Robust Analysis of Blood Smear Images for Classification of Microcytic Hypochromic Anemia Using Gray Level Matrices and Gabor Feature Bank.

Accurate blood smear quantification with various blood cell samples is of great clinical importance. The conventional manual process of blood smear quantification is quite time consuming and is prone to errors. Therefore, this paper presents automatic detection of the most frequently occurring condition in human blood-microcytic hyperchromic anemia-which is the cause of various life-threatening diseases. This task has been done with segmentation of blood contents, i.e., Red Blood Cells (RBCs), White Blood Cells (WBCs), and platelets, in the first step. Then, the most influential features like geometric shape descriptors, Gray Level Co-occurrence Matrix (GLCM), Gray Level Run Length Matrix (GLRLM), and Gabor features (mean squared energy and mean amplitude) are extracted from each of the RBCs. To discriminate the cells as hypochromic microcytes among other RBC classes, scanning is done at angles (0∘, 45∘, 90∘, and 135∘). To achieve high-level accuracy, Adaptive Synthetic (AdaSyn) sampling for imbalance learning is used to balance the datasets and locality sensitive discriminant analysis (LSDA) technique is used for feature reduction. Finally, upon using these features, classification of blood cells is done using the multilayer perceptual model and random forest learning algorithms. Performance in terms of accuracy was 96%, which is better than the performance of existing techniques. The final outcome of this work may be useful in the efforts to produce a cost-effective screening scheme that could make inexpensive screening for blood smear analysis available globally, thus providing early detection of these diseases.

Association between medication adherence and quality of life of patients with diabetes and hypertension attending primary care clinics: a cross-sectional survey.

PURPOSE: To evaluate the association between medication adherence and quality of life (QoL) of patients with diabetes and/or hypertension attending primary care clinics. METHODS: In this cross-sectional study, patients with at least one long-term condition (hypertension or diabetes mellitus) meeting the eligibility criteria were recruited from five primary care clinics in Saudi Arabia. Arabic version of Morisky Medication Adherence Scale (MMAS-8) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool were used to assess medication adherence and QoL, respectively. Patients' sociodemographic, medical and medication data were collected using a structured, pilot-tested data collection form. RESULTS: Three hundred patients with a mean (± SD) age of 56.79 (12.8) years participated in the study. Fifty-eight had hypertension only, 96 had diabetes (Type 1 or 2), and 146 had both hypertension and diabetes. After adjusting for socioeconomic characteristics, multiple linear regression analysis found that adherent patients had significantly higher mean overall perception of QoL and health scores by 14.6 (P = 0.001) and 17.2 (P = 0.001) points, respectively, compared to non-adherent patients. In addition, irrespective of the type of long-term condition, adherence status was found to be an independent predictor of all QoL domains. CONCLUSION: There is an association between medication adherence and QoL among patients with diabetes and/or hypertension attending primary care clinics. Medication adherence should be assessed and emphasised during routine clinical consultations in primary care in order to achieve the desired clinical outcomes and overall well-being of patients.

Health Knowledge, Cosmetic Interests, Attitude, and the Need for Health Education Regarding the Use of Topical Bleaching Agents Among Women in West Saudi Arabia: A Cross-Sectional Study.

We aimed at investigating the cosmetic interests, public confidence in cosmetic industry, health knowledge, practice, and need for health education regarding using topical bleaching agents (TPAs) among a relatively big sample size in Al-Madinah (west Saudi Arabia, a conservative eastern society that acquires its social customs from Islam). Islamic values increased women respect and esteem in this society. This is reflected on cosmetic practices and attitude, e.g. women use face cover outdoors. This issue is vital for both women health and beauty, and is rarely discussed. TPAs use is affected by culture, social customs, and health awareness regarding TPAs chemical constituents, e.g. hydroquinone, mercury, steroids that may harm skin and general health. Ethical committee approval was done for our study that included 531 women (attending the outpatient clinics in March-April 2016) of targeted 571 (response rate was 89.8%). 43.3% (230 women) are current TPAs users. Three hundred and eight-nine women (73.3%) regularly used TPAs to heal pigmented areas like freckles (75.8%) and just to lighten skin color (58.7%). Side effects of discontinuation were restoration of normal skin color (44.3%) or even darker skin (27%), skin dryness (20%) and rash (9.6%). Mercury is recognized as harmful to human health by 30.2%, whereas cortisone was chosen by others (53.2%). Unexpectedly, minority of investigated women (10%) considered using TPAs safe and recognized harms of some ingredients as mercury whereas the majority (70.2%) does not encourage others for TPAs use although they themselves kept using TPAs for different reasons. Cosmetic interest is high among women using TPAs, highest among the middle age (26-40 years), and lowest among women more than 40 years (50% versus 17.9%) (p < 0.001). Using skin TPAs in west Saudi Arabia is comparable with international standards, higher among educated women, house wives and employed women. This denotes care of married employed women to use TPAs to express beauty to husbands. This is not reduced by work duties and is controlled by conservative Islamic modesty. Health education is mandatory regarding TPAs components and use during pregnancy and lactation. Cosmetic science and industry needs more research to improve TPAs use through providing better safe alternatives for many TPAs components, e.g. mercury and hydroquinone.

Morphological and molecular descriptions of Moniliformis saudi sp. n. (Acanthocephala: Moniliformidae) from the desert hedgehog, Paraechinus aethiopicus (Ehrenberg) in Saudi Arabia, with a key to species and notes on histopathology.

A new acanthocepohalan species, Moniliformis saudi sp. n. is described from the desert hedgehog, Paraechinus aethiopicus (Ehrenberg), in central Saudi Arabia. Fourteen other valid species of Moniliformis Travassos, 1915 are recognised. The new species of Moniliformis is distinguished by having a small proboscis (315-520 µm long and 130-208 µm wide) with two apical pores, 14 rows of 8 hooks each and small hooks, thre largest being 25-31 µm long anteriorly. Distinguishing features are incorporated in a dichotomous key to the species of Moniliformis. The description is augmented by scanning electron microscopical (SEM) observation and DNA analysis of nuclear (18S rRNA) and mitochondrial (cytochrome oxidase subunit 1; cox1) gene sequences. Attached worms cause extensive damage to the immediate area of attachment in the host intestine. This includes tissue necrosis and blood loss due to damage to capillary beds. Worms also obstruct essential absorbing surfaces.

Tale of two cities: comparison of educational environment of two colleges (Jeddah and Rabigh) affiliated with one university.

OBJECTIVE: To evaluate students' perception about the educational environment at two medical colleges. METHODS: The cross-sectional study was conducted at King Abdulaziz University, Rabigh and Jeddah campuses, in Saudi Arabia, during the first semester of the year 2014 using Dundee Ready Education Environment Measure inventory. Data was collected from undergraduate medical students and analysed using SPSS 16. RESULTS: Of the 279 subjects in the study, 141(50.5%) belonged to the Rabigh campus, and 138(49.5%) to the Jeddah campus. Overall mean Dundee Ready Education Environment Measure inventory score was 124.90±20.66. The score for Jeddah was 131.38±21.37 and for Rabigh it was 118.56±17.85 (p=0.0001). The difference was also statistically significant in all domains of the inventory (p<0.05 each). CONCLUSIONS: Students' perception of their educational environment was positive in both campuses, it was more positive in Jeddah compared to Rabigh.

Prevalence of nasal obstruction and its impact on quality of life in Saudi Arabia.

Purpose/Background: Nasal obstruction is a significant issue influencing the patient's quality of life. Chronic nasal obstruction is frequently associated with other symptoms such as headache, sleep disturbance, and daytime sleepiness. This study aims to investigate the prevalence of nasal obstruction in Saudi Arabia and examine its effect on patients' quality of life. Methods: This is a cross-sectional study conducted in Saudi Arabia. Data were collected using a self-administered combination of two previously validated questionnaires (the NOSE scale and the WHOQOL-BREF) translated into Arabic. The Mann-Whitney test was used to investigate the association between nasal obstruction prevalence and the participants' QOL. Results: The study included 1039 participants from different regions of Saudi Arabia. The prevalence of nasal obstruction was 60.3% among the participants. Several factors significantly affected the prevalence of nasal obstruction, including sex, suffering from a chronic disease, having a family member with nasal obstruction, and using medications (P < 0.001 for all factors). A better score was shown in the four domains of the WHOQOL-BREF questionnaire by the participants who had no nasal obstruction: the physical health domain, psychological health, social relationships, and environment (P < 0.001 for all factors). Conclusions: Quality of life is affected by nasal obstruction. The subjective assessment is essential in evaluating the severity of nasal obstruction disease. It is recommended that healthcare providers use subjective tools combined with objective tools to assess the degree of nasal obstruction severity.

Ameliorative effects of androstenediol against acetic acid-induced colitis in male wistar rats via inhibiting TLR4-mediated PI3K/Akt and NF-κB pathways through estrogen receptor ß activation.

5-androstenediol (ADIOL) functions as a selective estrogen receptor ß (ERß) ligand with a protective effect against many diseases. So, we conducted a novel insight into its role in acetic acid (AA)-induced colitis and investigated its effect on TLR4-Mediated PI3K/Akt and NF-κB Pathways and the potential role of ERß as contributing mechanisms. METHODS: Rats were randomized into 5 Groups; Control, Colitis, Colitis + mesalazine (MLZ), Colitis + ADIOL, and Colitis + ADIOL + PHTPP (ER-ß antagonist). The colitis was induced through a rectal enema of acetic acid (AA) on the 8th day. At the end of treatment, colons were collected for macroscopic assessment. Tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), nuclear factor kappa b (NF-κB), toll-like receptor (TLR4), and phosphorylated Protein kinase B (pAKT) were measured. Besides, Gene expression of interleukin-1beta (IL-1ß), metalloproteases 9 (Mmp9), inositol 3 phosphate kinase (PI3K), Neutrophil gelatinase-associated lipocalin (NGAL), ERß and NLRP6 were assessed. Histopathological and immunohistochemical studies were also investigated. RESULTS: Compared to the untreated AA group, the disease activity index (DAI) and macroscopic assessment indicators significantly decreased with ADIOL injections. Indeed, ADIOL significantly decreased colonic tissue levels of MDA, TLR4, pAKT, and NF-κB immunostainig while increased SOD activity and ß catenin immunostainig. ADIOL mitigated the high genetic expressions of IL1ß, NGAL, MMP9, and PI3K while increased ERß and NLRP6 gene expression. Also, the pathological changes detected in AA groups were markedly ameliorated with ADIOL. The specific ERß antagonist, PHTPP, largely diminished these protective effects of ADIOL. CONCLUSION: ADIOL could be beneficial against AA-induced colitis mostly through activating ERß.

Lipid-Lowering Medications for Managing Dyslipidemia: A Narrative Review.

Dyslipidemia refers to the change in the normal levels of one or more lipid components in the bloodstream, which include triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Dyslipidemia represents a substantial source of danger for cardiovascular disease (CVD). Effectively managing dyslipidemia involves a thorough strategy that includes changing one's lifestyle and using medications that are specifically designed to target the complex processes involved in lipid metabolism. Lipid-lowering treatments play a crucial role in this approach, providing a wide range of medications that are developed to specifically target different components of dyslipidemia. Statins are the main drug among these medications. Other drugs that are used with statin or as monotherapy include fibrates, omega-3 fatty acids (OM3FAs), ezetimibe, bile acid sequestrants, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and bempedoic acid. Using the PubMed database, we reviewed the literature about dyslipidemia, drugs used for treating dyslipidemia, their efficacy parameters, and common adverse events. We also reviewed the international guidelines for treating dyslipidemia and discussed the future of lipid-lowering medications. More trials and experiments are still required to verify the effectiveness of many lipid-lowering drugs and to know their common adverse events to be able to manage them properly.

A novel technique for multi-track percutaneous balloon mitral valvoplasty.

Percutaneous balloon mitral valvoplasty (PBMV) has become the treatment of choice for severe pliable rheumatic mitral stenosis. The multi-track system is a recent variation of the double-balloon technique and is easier owing to the use of a monorail balloon and a simple, single-guidewire approach. In the present study, we used the double-coil Inoue metal wire with a multi-track balloon instead of the conventional multi-track wire. We studied 62 consecutive patients (55 females) with significant symptomatic rheumatic mitral valve stenosis who underwent multi-track PBMV. Patients were randomized into 2 groups: the first group included 32 patients treated with the novel multi-track technique using the double-coil Inoue metal wire, and the second group included 30 patients treated with the conventional multi-track technique using a balloon endhole catheter and multi-track 0.035 inch stiff wire. None of the patients had cardiac tamponade, systemic thromboembolism, or any groin complications. No statistically significant differences were found between the 2 groups regarding any of the studied variables. There were no in-hospital deaths or complications necessitating emergent cardiac surgery in either group. In conclusion, this new technique with the double-coil Inoue metal wire achieves the double benefit of being as safe as (and indeed easier than) the conventional technique, and it utilizes fewer materials, making the multi-track system more cost-effective.

Assessment of the psychological impact of dental aesthetics among undergraduate university students in Iraq.

AIM: This study aimed to assess Iraqi university students' oral health-related quality of life (OHRQoL) according to sociodemographic variables and compare dental and non-dental students. METHODS: A cross-sectional study was carried out for students in multiple Iraqi universities from June 15, 2022, to July 15, 2022. A total of 771 individuals participated in the study using an online questionnaire. A pre-tested and validated Arabic version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was adopted as an evaluation tool. A P value of less than 0.05 was considered statistically significant. Reliability analysis was conducted using Cronbach's alpha. RESULT: Cronbach's alpha score for the overall scales was 0.942, indicating excellent internal consistency. There were 69.8% (n = 538) dental students in the total sample. A significant difference was found between dental and non-dental students in the total PIDAQ scores and other subscale domains (P < 0.05). Statistically significant differences in means were also noted in the residency (P = 0.005) and household income of students (P = 0.000). CONCLUSIONS: This study shows the reliability of the PIDAQ scale for assessing the psychological impact of dental aesthetics on undergraduate Iraqis. It was found that the perception of OHRQoL varies between dental and non-dental university students, and according to socioeconomic status and residency.

Effect of Intravenous Aminophylline on Hemodynamics and Recovery of Patients Undergoing Functional Endoscopic Sinus Surgery Under Dexmedetomidine Hypotensive Anesthesia: A Randomized Controlled Study.

Background: The sympatholytic property of dexmedetomidine (DEX) makes it suitable as a hypotensive drug during functional endoscopic sinus surgery (FESS); however, delayed emergence from anesthesia and high postoperative sedation have been reported. Objectives: Delayed emergence from anesthesia and high postoperative sedation are associated with a prolonged length of stay in the operating room and the postanesthesia care unit (PACU), which increases health care costs. This study aimed to overcome the negative impact of DEX on recovery by using aminophylline. Methods: This randomized, double-blind, placebo-controlled study was conducted on 52 patients planned for elective FESS under general anesthesia with DEX infusion for controlled hypotension during surgery. Patients were equally divided into 2 groups. The aminophylline group received 4 mg/kg aminophylline diluted in 50 mL saline 0.9% over 30 minutes after positioning in a 20-degree reverse Trendelenburg position. The control group received 50 mL saline 0.9% with a similar volume and period as the aminophylline group. Results: The extubation time was significantly shorter in the aminophylline group (6.5 (5.25 - 7.75) minutes) than in the control group (9 (7.25 - 10) minutes) (P-value < 0.001). The PACU discharge time was significantly shorter in the aminophylline group (15 (10 - 20) minutes) compared to the control group (20 (15 - 28.75) minutes) (P-value = 0.036). Intraoperative heart rate and mean arterial pressure were nonsignificantly different between the 2 groups. Ramsay sedation score measurements at 15 min, 30 min, and 60 min after extubation were significantly lower in the aminophylline than in the control group (P-value < 0.05). Complications were nonsignificantly different between the 2 groups. Conclusions: Intraoperative aminophylline infusion enhances the recovery of patients undergoing FESS under DEX hypotensive anesthesia without intraoperative hemodynamic alterations and decreases their postoperative sedation without significant postoperative side effects.

The potential anti-osteoporotic effect of exercise-induced increased preptin level in ovariectomized rats.

Osteoporosis increases bone fragility and fractures. Preptin hormone is regulated by moderate exercise training and increases bone formation. Therefore, this study was conducted to see how estradiol administration and moderate exercise training affected osteoporotic changes in ovariectomized (OVX) rats. To achieve this aim, 36 healthy adult female Wistar albino rats were randomized into Sham, OVX, ovariectomized estradiol-treated (OVX + E) (OVX + E rats were treated using subcutaneous estradiol benzoate 2.5 µg/kg body weight/day), ovariectomized practicing moderate exercise training, ovariectomized estradiol-treated and practiced a moderate exercise training, and ovariectomized alendronate-treated (OVX + Alen) (OVX + Alen rats were treated orally with alendronate 3 mg/kg body weight/week) groups. Alendronate was used as a standard anti-osteoporotic drug. Moderate exercise training, including therapy with estradiol and alendronate for OVX rats began on the fourth week and lasted for six weeks. Results showed that OVX rats had estrogen and preptin deficiency in serum. These deficiencies were associated with a significant increase in bone resorption biomarkers (urinary deoxypyridinoline and hydroxyproline), and bone formation biomarkers (serum osteocalcin and bone-specific alkaline phosphatase). Also, serum pro-inflammatory cytokines (tumor necrosis factor alpha and interleukin-6) were increased, while bone osteopontin (OPN) expression was decreased. Subsequently, the osteoporotic alterations were verified based on histopathological changes. From the results, estradiol therapy and moderate exercise training significantly improved these findings to the same extent as that of the standard alendronate treatment. Therefore, through their anti-inflammatory properties, increasing bone OPN expression, and regulating serum preptin; estradiol therapy and moderate exercise training can reduce osteoporotic alterations in OVX rats. Thus, combined estradiol therapy and moderate exercise training could be a promising potential therapeutic protocol to reduce postmenopausal osteoporosis. Also, targeting serum preptin and bone osteopontin regulation could have a critical role in the treatment of postmenopausal osteoporosis.

Impact of gut Microbiome alteration in Ulcerative Colitis patients on disease severity and outcome.

BACKGROUND: Ulcerative colitis is a heterogeneous disease in terms of disease course, location, and therapeutic response. The current study was done to assess the alteration of the gut microbiome in UC patients and its relationship to severity, response to therapy, and outcome. PATIENTS AND METHODS: The study included 96 participants who were divided into a case group (n = 48, recent onset, treatment naive ulcerative colitis patients who were subdivided into mild, moderate, and severe subgroups based on Truelove-Witts and endoscopic severity) and a healthy control group (n = 48). All were subjected to a thorough history, clinical examination, colonoscopy, routine laboratory tests, and quantitative real-time PCR to quantify Bacteroides, Lactobacilli, Faecalibacterium prausnitzii, Veillonella, and Hemophilus in fecal samples at baseline and 6 months after treatment. RESULTS: Bacterial 16S rRNA gene sequencing revealed a significant reduction in the phylum Firmicutes in UC patients, with a significant predominance of the phylum Bacteriodetes. F. prausnitzii and lactobacilli were inversely proportional to disease severity, whereas Bacteroides, Hemophilus, and Veillonella were directly proportional to it. Six months after therapy, a statistically significant increase in F. prausnitzii and lactobacilli was observed, with a decrease in the levels of other bacteria. Lower baseline F. praustinizii (< 8.5) increased the risk of relapse; however, lower ESR (< 10), lower post-treatment CRP (< 6), lower Bacteroides (< 10.6) indefinitely protect against relapse. CONCLUSION: The gut microbiome of recently diagnosed UC showed lower levels of Lactobacilli, Faecalibacterium, and higher levels of Bacteroides and Veillonella, and the change in their levels can be used to predict response to therapy.

Rehabilitation of distal extension maxillary ridges with fixed and removable implant-supported prostheses: Preliminary 12-month randomized clinical trial.

PURPOSE: This trial evaluated clinical outcomes of fixed and removable implant-supported prostheses for rehabilitation of atrophied distal extension maxillary ridges. MATERIALS AND METHODS: A total of 54 participants with atrophied distal extension maxillary ridges were randomly assigned into three groups (n = 18/group). Group I (SLF); participants treated with fixed restoration supported by three long implants after sinus augmentation, Group II (SF); participants treated with fixed restoration supported by one long and two short implants, and Group III (OD): participants treated with removable partial denture assisted by one long implant that was placed mesial to maxillary sinus (IARPD). Modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and crestal bone loss (CBL) were measured after prosthesis insertion (T0), 6 (T6), and 12 months (T12) after insertion. Patient satisfaction was measured at T12 using a visual analog scale (VAS). RESULTS: The implant survival rates were 96.8%, 92.4%, and 84.6% for SLF, SF, and OD groups respectively. The SLF recorded the highest MPI, MGI, PD, and IS values, followed by the SF, and the OD showed the lowest values. The OD recorded the highest CBL followed by the SF and the SLF showed the lowest CBL. With exception of satisfaction with surgery and cleaning, SLF and SF groups recorded significantly higher patient satisfaction than the OD for all VAS questions. CONCLUSION: Fixed restorations supported with either long or short implants were associated with improved implant stability, reduced bone loss, and increased patient satisfaction compared to implant-assisted RPDs. However, implant-assisted RPDs were associated with more favorable peri-implant soft tissue health and increased satisfaction with surgery, healing, and cleaning.

Cardiovascular Outcomes of Redo-coronary Artery Bypass Graft Versus Percutaneous Coronary Intervention of Index Bypass Grafts Among Acute Coronary Syndrome: Regression Matched National Cohort Study.

Procedural and hospital outcomes of Percutaneous coronary intervention (PCI) versus Coronary artery bypass grafting (CABG) among ACS patients with prior history of CABG remains understudied. PCI and CABG formed the 2 comparison cohorts. Nationwide Inpatient Sample (NIS) from 2015 to 2020 were analyzed using the ICD-10 coding system. Demographic characteristics, baseline comorbidities, and outcomes such as inpatient mortality, cardiogenic shock, mechanical circulatory support, length of stay (LOS), and cost of hospitalization were compared between the two cohorts. A total of 503,900 ACS hospitalizations with prior history of CABG were identified who underwent PCI and CABG (141650 vs 7715, respectively). Median age was 71 vs 67, with male predominance (74.6% vs 75.4%), Caucasian had the most hospitalizations (79.3% vs 75.1%) in the PCI group compared to patients who underwent CABG. A higher burden of smoking (57.1% vs 52.6%, P < 0.0001) was noted in the CABG group. On adjusted analysis, ACS patients undergoing Redo- CABG had a higher risk of in-hospital mortality (aOR 1.69, CI 1.53-1.87, P < 0.0001) compared to those undergoing PCI. In addition, Redo-CABG group were more likely to have CS (aOR 1.37, CI 1.26-1.48, P < 0.0001), MCS devices use (aOR 2.61, CI 2.43-2.80, P < 0.0001), AKI (aOR 1.42, CI 1.34-1.50, P < 0.0001) and respiratory failure (aOR 1.39, CI 1.29-1.47, P < 0.0001) as compared to PCI group. CABG in acute myocardial infarction with prior history of CABG is associated with higher cardiovascular complications compared to PCI. Further exploration and individual-patient level risk assessment is crucial.

Prevalence of emergency cases among pilgrims presenting at King Abdulaziz International Airport Health Care Center at Hajj Terminal, Jeddah, Saudi Arabia during Hajj Season, 1440 H - 2019.

Introduction: About 2-3 million pilgrims come to Makkah, Saudi Arabia from all countries to perform Hajj. During the Hajj season of 2019 (1440 H), the total number of pilgrims was 2,489,406, of whom 1,855,027 came from foreign countries. This study aims to investigate the prevalence, pattern, and findings of emergency health problems among pilgrims travelling through King Abdul Aziz International Airport Health Care Center (KAIA-HC) at Hajj Terminal in Jeddah during hajj season of 1440-H. Methodology: A cross-sectional study was conducted by reviewing the medical records of pilgrims coming for treatment at KAIA-HC, before and after Hajj between 1 Dhul Qi'dah to 29 Dhul Hijjah 1440 AH (Corresponding to 4 July to 31 August 2019 AD). The collected data included demographics, medical history, diagnoses of the emergency health problems, infections, and their findings. Data were analyzed using Epi Info 7 and SPSS 25. Results: About 296 (3.87%) of 7,643 pilgrims treated at KAIA-HC were emergency cases. Their average age was 43 years (Standard Deviation (SD) ±7.5); 51.3% were females; the highest (45.3%) was between 30 - 59 years age group, both males and females; the highest two nationalities were Indonesian (14.2%) and Egyptian (12.5%). Diagnoses included hypertension 59(19.9%), bronchial asthma 53 (17.9%), and 23 cases (10.5%) were suffering from hypotension. 16 (5.4%) of patients had a myocardial infarction and 10 (3.4%) had cerebrovascular accidents. In 13 cases (4.4%), a chest infection was reported. Diabetes complications (hyperglycemia, hypoglycemia, and diabetic ketoacidosis) were reported in 28 (9.4%) of the cases. There were 28 (9.5%) surgical diagnoses, 13 (4.4%) were cut wounds, 11 (3.7%) were bone fracture and dislocation, and 4 (1.4%) were head trauma. With regard to the findings, 82 (27.7%) were referred to hospitals; 10 (3.3%) cases required Cardio-Pulmonary Resuscitation, seven of whom survived. The most common referral causes were myocardial Infarction amounting 12(4.05%), followed by cerebrovascular accident 10(3.3%) and chest infection in 8 (2.7%). 13 (4.4%) of the total cases died. The most common causes of death were myocardial infarction, asthma, hypertension and hyperglycemia. Conclusion: Our study emphasizes that emergency cases presented at KAIA-HC were few. Cardiovascular diseases represented the main reason for emergency cases, followed by respiratory diseases. 51% of patients were discharged without the need for a higher level of medical care.

Recommendations for the prevention and management of obesity in the Iraqi population.

Obesity is a chronic metabolic disease that has become one of the leading causes of disability and death in the world, affecting not only adults but also children and adolescents. In Iraq, one third of the adult population is overweight and another third obese. Clinical diagnosis is accomplished by measuring body mass index (BMI) and waist circumference (a marker for intra-visceral fat and higher metabolic and cardiovascular disease risk). A complex interaction between behavioral, social (rapid urbanization), environmental and genetic factors underlies the etiology of the disease. Treatment options for obesity may include a multicomponent approach, involving dietary changes to reduce calorie intake, an increase in physical activity, behavioral modification, pharmacotherapy and bariatric surgery. The purpose for these recommendations is to develop a management plan and standards of care that are relevant to the Iraqi population and that can prevent/manage obesity and obesity-related complications, for the promotion of a healthy community.

On Smart Gaze Based Annotation of Histopathology Images for Training of Deep Convolutional Neural Networks.

Unavailability of large training datasets is a bottleneck that needs to be overcome to realize the true potential of deep learning in histopathology applications. Although slide digitization via whole slide imaging scanners has increased the speed of data acquisition, labeling of virtual slides requires a substantial time investment from pathologists. Eye gaze annotations have the potential to speed up the slide labeling process. This work explores the viability and timing comparisons of eye gaze labeling compared to conventional manual labeling for training object detectors. Challenges associated with gaze based labeling and methods to refine the coarse data annotations for subsequent object detection are also discussed. Results demonstrate that gaze tracking based labeling can save valuable pathologist time and delivers good performance when employed for training a deep object detector. Using the task of localization of Keratin Pearls in cases of oral squamous cell carcinoma as a test case, we compare the performance gap between deep object detectors trained using hand-labelled and gaze-labelled data. On average, compared to 'Bounding-box' based hand-labeling, gaze-labeling required 57.6% less time per label and compared to 'Freehand' labeling, gaze-labeling required on average 85% less time per label.