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Background. The presence of extensive workload and pressure associated with COVID19 has resulted in a lot of mental and physical trauma in primary health care physicians (PHCC) across the world. Aim of the study. The present study is aimed at understanding the level of dissatisfaction in PHCC physicians in the Asser region of Saudi Arabia. The various risk factors associated with dissatisfaction also have been analyzed in this study. Method. An analytical cross-sectional study was performed on various PHCCs who were working in the Ministry of Health in the Asser region. Results. The overall analysis showed that around 73% of the physicians who responded showed dissatisfaction. The major factors that were found to affect satisfaction based on the variables analyzed include physicians who are males, Saudi Nationals, training residents, and those who received recognition. These four variables had a p value of less than 0.0001 making it statistically significant. Conclusion. The study observed that there is dissatisfaction amongst PHCC physicians towards the management of pandemics. The factors identified should help officials in order to address these issues

Breast cancer is the most common malignancy affecting women, manifesting as a heterogeneous disease with diverse molecular characteristics and clinical presentations. Recent studies have elucidated the role of epigenetic modifications in the pathogenesis of breast cancer, including drug resistance and efflux characteristics, offering potential new diagnostic and prognostic markers, treatment efficacy predictors, and therapeutic agents. Key modifications include DNA cytosine methylation and the covalent modification of histone proteins. Unlike genetic mutations, reprogramming the epigenetic landscape of the cancer epigenome is a promising targeted therapy for the treatment and reversal of drug resistance. Epidrugs, which target DNA methylation and histone modifications, can provide novel options for the treatment of breast cancer by reversing the acquired resistance to treatment. Currently, the most promising approach involves combination therapies consisting of epidrugs with immune checkpoint inhibitors. This review examines the aberrant epigenetic regulation of breast cancer initiation and progression, focusing on modifications related to estrogen signaling, drug resistance, cancer progression, and the epithelial–mesenchymal transition (EMT). It examines existing epigenetic drugs for treating breast cancer, including agents that modify DNA, inhibitors of histone acetyltransferases, histone deacetylases, histone methyltransferases, and histone demethyltransferases. It also delves into ongoing studies on combining epidrugs with other therapies and addresses the upcoming obstacles in this field.

Background Critically ill patients are at a higher risk of developing infections and related complications, which can lead to death. Each additional day of antipseudomonal β-lactam use increases the risk of resistance; therefore, de-escalation is highly recommended to improve antibiotic use. To our knowledge, there are limited studies that have evaluated the clinical impact of de-escalation in critically ill patients with proven Methicillin-Susceptible Staphylococcus aureus (MSSA) pneumonia alone. Therefore, our study aimed to assess the clinical impact of the de-escalation strategy compared with the non-de-escalation strategy in critically ill patients with proven MSSA pneumonia. Methods This multicenter retrospective cohort study was conducted in three tertiary hospitals from January 2016 to July 2021. Adult critically ill patients admitted to the intensive care unit with proven MSSA respiratory culture who received antibiotics with anti-MSSA activity were screened for eligibility. Eligible patients were categorized into two groups according to their de-escalation status: De-escalated and Non-de-escalated. The De-escalation was defined as the reduction of the antimicrobial activity spectrum of antibiotics by switching to a narrower-spectrum agent that targets MSSA. The primary outcome was treatment failure rate, while other outcomes were considered secondary. Propensity score (PS) matching was applied at a 1:1 ratio, and multivariate regression analyses were utilized as appropriate. Results After PS matching (1:1), 58 patients were included in the study (29 patients in non-deescalated vs 29 patients in de-escalated). The treatment failure rate was significantly higher in the de-escalated group compared to the non-de-escalated (OR 16.98; 95% CI (3.304–87.225), p  = 0.0007). In contrast, no significant differences were found in 30-day mortality, hospital and ICU length of stays, ventilator-free days, ICU readmission rate, or MSSA infection recurrence rate. Conclusion Our results showed that de-escalation of antibiotics in critically ill patients with confirmed MSSA pneumonia was associated with significantly higher rate of treatment failure while no significant differences were observed in the other clinical outcomes. These findings highlight the need for prospective studies to better inform safe and effective de-escalation strategies in this population.

Clinical pharmacists play a critical role in cardiology by optimizing pharmacotherapy and improving patient outcomes. However, despite their growing importance, standardized quality indicators to evaluate their impact in clinical practice remain lacking. This study aimed to develop and validate a set of cardiology-specific Quality Indicator Drug Therapy Problems (QI-DTPs) defined as medication-related quality indicators focused on identifying, preventing, and resolving drug therapy problems-using a modified Delphi technique in Saudi Arabia. Twenty-three candidate QI-DTPs were developed based on a comprehensive review of current cardiology guidelines and evidence-based literature, refined by an expert advisory group. A panel of sixteen experienced clinical pharmacists with cardiology expertise from Saudi Arabia evaluated these indicators using a modified Delphi approach conducted over three iterative rounds. Each indicator was rated on a nine-point Likert scale (1 = strong disagreement to 9 = strong agreement). Indicators achieving ≥75% consensus were considered validated. Sixteen expert clinical pharmacists participated (69% male, 31% female), most of whom had completed a pharmacy residency and had cardiology-related clinical experience. High levels of agreement were achieved across the Delphi rounds, and all 23 proposed QI-DTPs met the predefined ≥75% consensus threshold, demonstrating strong agreement regarding their relevance, clarity, and applicability in cardiology practice. The study successfully identified and validated 23 QI-DTPs, reflecting strong consensus among clinical pharmacists in Saudi Arabia. Implementation of these indicators in clinical practice could enhance the quality of cardiovascular care, reinforce pharmacist-led interventions, and promote medication safety. Future research should assess the direct impact of these quality metrics on patient outcomes.

BACKGROUND: Anterior loops of the mental nerve are important anatomical variations in which the inferior alveolar canal extends anteriorly beyond the mental foramen before looping back. These structures pose a risk of neurosensory injury during procedures such as dental implant placement and bone grafting in the interforaminal region. Cone-beam computed tomography (CBCT) provides high-resolution, three-dimensional images that are crucial for accurately identifying and mapping anterior loops, thereby helping prevent surgical complications. This CBCT study was designed to investigate the prevalence, radiographic characteristics, morphometric dimensions, and demographic correlations of anterior loops of the mental nerve in a subpopulation from the Najran Region. MATERIALS AND METHODS: In this retrospective CBCT study, 1000 hemimandibles from 500 patients were systematically evaluated using CBCT scans. Two calibrated examiners assessed the scans to categorize the mandibular canal configuration, measure the length of identified anterior loops, and document associated parameters, including mental foramen position, shape, and exit direction, as well as the presence of accessory mental foramina. Statistical analyses, including chi-squared and nonparametric tests, were used to determine associations with demographic variables such as gender (male and female), age groups (20–40, 41–60, and > 60), and side (right or left). A p value of less than 0.05 was considered statistically significant. RESULTS: Anterior loops had a prevalence of 6.5%, with a statistically significant association between gender and mandibular canal patterns (p = 0.0016). Higher prevalence rates were noted in males (9.1%) than in females (4.2%). Anterior loopshad a mean length of 2.10 ± 0.42 mm and ranged from 1.49 to 3.72 mm. No significant differences in length were detected by gender, age, or side, with p values of 0.618, 0.264, and 0.849, respectively. The most common position of the mental foramen was type II, located between the apices of the first and second premolars (61.0%), and the predominant mental foramen shape was round (66.5%). Additionally, a highly significant side-specific prevalence of accessory mental foramina was observed (p < 0.001). CONCLUSIONS: The occurrence of anterior loops was significantly associated with gender and mandibular side, and accessory mental foramina were more prevalent on the left side than on the right. Preoperative CBCT assessment of anterior loops is essential to prevent mental nerve injury during interforaminal surgery. The identified prevalence, gender- and side-specific variations, and measured loop lengths support a recommended safety margin of at least 2 mm anterior to the mental foramen in implant planning.

The aim of this study was to compare the preclinical and clinical undergraduate dental students' perceptions of their educational climate (EC). In addition it will be compared with other local and international studies. Students enrolled in their third and fourth years (preclinical phase) and students in their fifth and sixth years (clinical phase) of the Bachelor of Dental Science at the University of Jazan, Saudi Arabia, were invited to complete a WhatsApp media survey, which included demographics and the Dundee Ready Education Environment Measure (DREEM). This scale measured students' overall perceptions of the EC in five domains: learning, teaching, academic self-perception, atmosphere, and social self-perception. Data were analyzed with Student's -tests and ANOVA to compare between and within groups. A total of 272 participants, 140 (51.5%) preclinical and 132 (48.5%) clinical students,took part in the study. Students were generally positive about their learning climate, with overall DREEM scores of 125.19 and 126.21 (preclinical) to 124.10 (clinical) out of a possible score of 200 phases. Student's perceptions of teaching (26.18±3.24/72.72%) and atmosphere (28.08±5.29/63.82%) were the highest and lowest scores, respectively, and both scores were positive. No differences between the preclinical and clinical phases of the curriculum point to the structure of learning, teaching, academic, social self-perception in health professional degrees. Further research should investigate the weak points in the social and atmospheric climate.

Background: Intussusception (ISN) post-COVID-19 infection in children is rare but can occur. SARS-CoV-2 may play a role in the pathogenesis of ISN and trigger immune activation and mesenteric adenitis, which predispose peristaltic activity to “telescope” a proximal bowel segment into the distal bowel lumen. Objectives: To estimate the prevalence of SARS-CoV-2 infection in ISN children and analyze the demographic parameters, clinical characteristics and treatment outcomes in ISN pediatric patients with COVID-19 illness. Methods: We performed this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting on the incidence of ISN post-SARS-CoV-2 infection in children, published from 1 December 2019 until 1 October 2022, in PROQUEST, MEDLINE, EMBASE, PUBMED, CINAHL, WILEY ONLINE LIBRARY, SCOPUS and NATURE, with a restriction to articles available in the English language, were included. Results: Of the 169 papers that were identified, 34 articles were included in the systematic review and meta-analysis (28 case report, 5 cohort and 1 case-series studies). Studies involving 64 ISN patients with confirmed COVID-19 (all patients were children) were analyzed. The overall pooled proportions of the ISN patients who had PCR-confirmed SARS-CoV-2 infection was 0.06% (95% CI 0.03 to 0.09, n = 1790, four studies, I2 0%, p = 0.64), while 0.07% (95% CI 0.03 to 0.12, n = 1552, three studies, I2 0%, p = 0.47) had success to ISN pneumatic, hydrostatic and surgical reduction treatment and 0.04% (95% CI 0.00 to 0.09, n = 923, two studies, I2 0%, p = 0.97) had failure to ISN pneumatic, hydrostatic and surgical reduction treatment. The median patient age ranged from 1 to 132 months across studies, and most of the patients were in the 1–12 month age group (n = 32, 50%), p = 0.001. The majority of the patients were male (n = 41, 64.1%, p = 0.000) and belonged to White (Caucasian) (n = 25, 39.1%), Hispanic (n = 13, 20.3%) and Asian (n = 5, 7.8%) ethnicity, p = 0.000. The reported ISN classifications by location were mostly ileocolic (n = 35, 54.7%), and few children experienced ileo-ileal ISN (n = 4, 6.2%), p = 0.001. The most common symptoms from ISN were vomiting (n = 36, 56.2%), abdominal pain (n = 29, 45.3%), red currant jelly stools (n = 25, 39.1%) and blood in stool (n = 15, 23.4%). Half of the patients never had any medical comorbidities (n = 32, 50%), p = 0.036. The approaches and treatments commonly used to manage ISN included surgical reduction of the ISN (n = 17, 26.6%), pneumatic reduction of the ISN (n = 13, 20.2%), antibiotics (n = 12, 18.7%), hydrostatic reduction of the ISN (n = 11, 17.2%), laparotomy (n = 10, 15.6%), intravenous fluids (n = 8, 12.5%) and surgical resection (n = 5, 7.8%), p = 0.051. ISN was recurrent in two cases only (n = 2, 3.1%). The patients experienced failure to pneumatic (n = 7, 10.9%), hydrostatic (n = 6, 9.4%) and surgical (n = 1, 1.5%) ISN treatment, p = 0.002. The odds ratios of death were significantly higher in patients with a female gender (OR 1.13, 95% CI 0.31–0.79, p = 0.045), Asian ethnicity (OR 0.38, 95% CI 0.28–0.48, p < 0.001), failure to pneumatic or surgical ISN reduction treatment (OR 0.11, 95% CI 0.05–0.21, p = 0.036), admission to ICU (OR 0.71, 95% CI 0.83–1.18, p = 0.03), intubation and placement of mechanical ventilation (OR 0.68, 95% CI 0.51–1.41, p = 0.01) or suffering from ARDS (OR 0.88, 95% CI 0.93–1.88, p = 0.01) compared to those who survived. Conclusion: Children with SARS-CoV-2 infection are at low risk to develop ISN. A female gender, Asian ethnicity, failure to ISN reduction treatment (pneumatic or surgical), admission to ICU, mechanical ventilation and suffering from ARDS were significantly associated with death following ISN in pediatric COVID-19 patients.

We aimed to prospectively evaluate and compare the effectiveness of Alvogyl and Cutanplast as intra-alveolar dressings for managing pain associated with extraction and incidence of dry socket. All patients who underwent maxillary and mandibular teeth extraction and fulfilled our inclusion and exclusion criteria from Feb 2021 to Oct 2021 were included in our study. Patients who were diagnosed with postoperative pain after tooth extraction were randomly allocated to three groups: Group A (Alvogyl), Group B (Cutanplast), and Group C (placebo). Pain relief and healing of the socket were compared between these groups. The collected data were analyzed using the Chi-square test and Z test of proportionality. Alvogyl was superior to the other medication for providing initial pain relief, and the incidence of dry socket was significantly lower than in the Cutanplast and placebo groups (p<0.05). However, wound healing was statistically non-significant among groups A, B, and C (p>0.05). Alvogyl is still the material of choice in terms of pain relief, wound healing, and low incidence of dry socket. Furthermore, no statistically significant difference was detected between the groups in the biographic information, location, and condition of the extracted tooth, presence of a radiologic pathology, or type of extraction procedure. Moreover, whether it is the first extraction or not, Alvogyl and Cutanpast are comparable in postoperative pain management as intra-alveolar dressing materials.

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The healthcare profession is demanding and often involves high-stress environments where nurses are regularly exposed to challenging and emotionally taxing situations. These experiences can include caring for critically ill patients, managing complex clinical conditions, dealing with long working hours, and confronting difficult emotional scenarios. In such a demanding field, resilience becomes a critical factor that determines the well-being and effectiveness of nurses.This research aims to explore the concept of resilience in nursing, highlighting its significance in nursing practice and the healthcare system. By examining the theoretical foundations and practical strategies to enhance resilience, this study seeks to underscore the importance of resilience in ensuring that nurses are able to provide high-quality patient care while maintaining their own well-being and job satisfaction.