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Pulmonary aspergillosis (PA) is a serious lung infection caused by species, primarily affecting individuals with structural lung abnormalities. Common risk factors include pulmonary tuberculosis (TB) and other chronic lung diseases. Voriconazole, a second-generation triazole, is the preferred first-line treatment for invasive PA, although few adverse events are reported. Liposomal amphotericin B (LAmB) serves as an alternative treatment, particularly in cases of azole resistance or intolerance. This case report describes a rare occurrence of probable voriconazole-associated hypotension in a 52-year-old immunocompetent male with post-TB aspergillosis. The patient, previously treated for TB, presented with pleuritic chest pain, productive cough, and hemoptysis. Initial treatment with voriconazole led to significant symptomatic relief but was complicated by persistent hypotension, despite normal blood parameters. A multidisciplinary team identified voriconazole as the cause of hypotension, and treatment was switched to LAmB. Consequently, his blood pressure stabilized, and the PA symptoms resolved without any adverse events. This case underscores the importance of monitoring rare side effects during voriconazole therapy and highlights LAmB as an alternative in voriconazole-intolerant scenarios and in situations where the availability of other azoles (posaconazole and itraconazole) is limited; however, further research is necessary to optimize therapeutic strategies.

To assess the effectiveness of bleaching tea-stained composite resin utilizing low concentration of hydrogen peroxide followed by ozone (7%HP and ozone) compared with high concentration of HP alone (30%HP). Also, to assess the effectiveness of bleaching utilizing ozone alone compared with bleaching utilizing 7% and 30% HP. A controlled randomized laboratory study was conducted on 80 composite discs that were divided into 4 groups. The composite discs were stained with tea solution, and then each group was bleached with ozone alone, 7%HP alone, 7%HP and ozone, or 30%HP alone. The shade of composite discs was recorded at baseline, after staining, and after bleaching. The shade was measured via conventional VITA classic and 3D Master shade guides, Easyshade Spectrophotometer, and Rayplicker Handy spectrophotometer which also measured CIELab shade values. Ozone alone had most inferior bleaching effects on stained composite material among the tested bleaching protocols ( P  < .05). Shade changes and values were not different between bleaching with 7%HP followed by ozone and bleaching with 30%HP alone ( P  > .05), except that bleaching with 30%HP alone was associated with higher L* value. Nevertheless, ΔE 00 and ΔE ab were not different between bleaching with 7%HP followed by ozone and bleaching with 30%HP alone ( P  > .05). Using ozone following 7%HP on stained composite discs yielded similar bleaching outcomes when compared with bleaching using 30%HP alone. Also, ozone alone yielded inferior bleaching effects than bleaching using HP alone or HP followed by ozone.

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD) with complex infectious and non-infectious etiologies. Bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms such as Mycoplasma pneumoniae, play crucial roles in ACS pathogenesis, particularly in immunocompromised SCD patients with functional asplenia. Despite the importance of infectious triggers, regional data on pathogen identification rates and antimicrobial management strategies in ACS remain limited, especially from high-prevalence SCD regions. This study aimed to investigate the infectious etiologies, pathogen identification patterns, and antimicrobial management outcomes of ACS in adult SCD patients in Eastern Saudi Arabia. A five-year retrospective analysis was conducted on patients aged ≥14 years with SCD who were admitted with ACS to Dammam Medical Complex between 2018 and 2022. Comprehensive microbiological evaluation included blood cultures, sputum cultures, and atypical pathogen testing (Mycoplasma pneumoniae, Chlamydia pneumoniae). Data on antimicrobial regimens, pathogen identification rates, vaccination status against encapsulated bacteria, and clinical outcomes were systematically analyzed. Empirical antibiotic strategies and their effectiveness in this immunocompromised population were evaluated. A total of 60 adult SCD patients experiencing 80 episodes of ACS were included. Despite comprehensive microbiological workup, specific infectious pathogens were identified in only 8 (10.0%) episodes, highlighting the complex multifactorial etiology of ACS. Blood cultures yielded pathogens in 5 (6.3%) cases, sputum cultures in 4 (5.0%) cases, and Mycoplasma pneumoniae was identified in 3 (3.8%) episodes. All patients received empirical broad-spectrum antimicrobial therapy, with ceftriaxone and azithromycin combination being the most frequent regimen (76 cases, 95.0%), providing coverage for both typical and atypical bacterial pathogens. Antibiotic escalation was required in 16 (20.0%) episodes. Vaccination rates against Streptococcus pneumoniae were suboptimal at 30 (50.0%), representing a significant risk factor for invasive bacterial infections in this functionally asplenic population. The intensive care unit (ICU) admission rate was 15 (18.8%), and in-hospital mortality was 3 (3.8%), with infectious complications contributing to severe outcomes. In this cohort of SCD patients, ACS demonstrated low rates of specific pathogen identification despite systematic microbiological investigation, supporting the multifactorial infectious and non-infectious etiology of this syndrome. The predominant use of broad-spectrum antimicrobial therapy targeting both typical and atypical bacterial pathogens proved effective in this immunocompromised population. However, suboptimal vaccination rates against encapsulated bacteria represent a critical gap in infection prevention strategies. These findings emphasize the importance of empirical antimicrobial coverage for suspected bacterial pathogens in ACS management and highlight the urgent need for enhanced vaccination programs to prevent infectious complications in functionally asplenic SCD patients.

Background The COVID-19 pandemic, which emerged in late December 2019, has significantly altered the dietary and oral health-related habits and lifestyles of nearly every age group within the global population. Aim The purpose of this research is to explore the impact of the COVID-19 pandemic on dietary behaviors, daily oral hygiene practices and caries risk among children, adolescents, and young adults from diverse regions within Saudi Arabia. Materials and methods A cross-sectional analytical study spanning multiple regions of Saudi Arabia was carried out to assess the effects of COVID-19 on dietary habits, oral hygiene practices, and caries risk across various age groups within the Saudi population. A total of 655 participants were included in the study after providing informed consent. Data collection was performed using a questionnaire divided into four sections: personal and demographic information, socioeconomic information, oral hygiene practices, and dietary habits, both prior to and during the COVID-19 lockdown. Results There was a notable increase in the caries experience rate, which escalated from 26.1% before the onset of the COVID-19 pandemic to 45.0% during the pandemic ( P  < 0.001). The findings suggest a significant shift in the dietary practices of children and adolescents when comparing the two timeframes. Specifically, there was a marked rise in meal frequency ( P  < 0.001), snacking patterns ( P  < 0.001), and the consumption of sugary products like candies, chocolates, milk, and coffee ( P  < 0.001) during the pandemic. Furthermore, the percentage of children and adolescents brushing their teeth three times a day plummeted from 47.8% before the pandemic to a mere 4.3% during it ( P  < 0.001). The proportion of individuals using fluoride toothpaste also experienced a decline, falling from 15.9% before the pandemic to 5.2% during this crisis ( P  < 0.001). Conclusions The study illustrates that the COVID-19 pandemic has substantially changed the dynamics of dental caries and oral health, resulting in an increased risk of caries and a worrying decline in daily oral hygiene practices. Additionally, there has been a significant drop in the application of topical fluoride via toothpaste. These findings point to the critical importance of personalized dental care during public health crises to alleviate negative effects and ensure the maintenance of oral health.

Plasma circular RNAs (circRNAs) are stable RNA molecules found in blood, which makes them potential noninvasive biomarkers for acute myocardial infarction (MI). The aim of this study was to describe the plasma circRNA profile in patients with acute MI and to identify circRNA markers that may help detect heart injury and reflect the biological processes involved. We compared plasma samples from patients with acute MI and healthy controls using total RNA sequencing with unique molecular identifiers (UMIs). After sequencing, reads were processed through quality control, alignment, duplicate removal, and circRNA detection. Differential expression was analyzed after adjusting for age, sex, smoking, and technical factors. Several circRNAs were significantly different between MI cases and controls and were able to separate the two groups in principal component and receiver operating characteristic analyses. Among the most increased circRNAs were hsa-PASK_0004, hsa-STXBP3_0002, hsa-RCAN3_0002, and hsa-RANBP9_0044, while hsa-HIF1A_0002, hsa-SUZ12_0049, hsa-PNRC1_0001, and hsa-RAB2A_0002 were decreased. Several candidates showed AUC values above 0.7. Pathway analysis linked the host genes of these circRNAs to inflammation, platelet activation, coagulation, and cardiomyocyte stress responses. Overall, these findings suggest that circulating circRNAs may serve as useful blood-based markers of MI and provide insight into the molecular changes that accompany acute MI.

Background. Osteosarcoma, the most frequent osteogenic malignancy, has become a serious public health challenge due to its high morbidity rates and metastatic potential. Recently, the neurokinin-1 receptor (NK-1R) is proved to be a promising target in cancer therapy. This study is aimed at determining the effect of aprepitant, a safe and Food and Drug Administration (FDA) approved NK-1R antagonist, on osteosarcoma cell migration and metastasis, and to explore its underlying mechanism of action. Methods. Colorimetric MTT assay was employed to assess cell viability and cytotoxicity. A wound-healing assay was used to examine migration ability. The desired genes’ protein and mRNA expression levels were measured by western blot assay and quantitative real-time PCR (qRT-PCR), respectively. Gelatinase activity was also measured by zymography. Results. We found that aprepitant inhibited MG-63 osteosarcoma cell viability in a dose-dependent manner. We also observed that aprepitant inhibited the migrative phenotype of osteosarcoma cells and reduced the expression levels and activities of matrix metalloproteinases (MMP-2 and MMP-9). Aprepitant also reduced the expression of an angiogenic factor, VEGF protein, and NF-κB as an important transcriptional regulator of metastasis-related genes. Conclusion. Collectively, our observations indicate that aprepitant modulates the metastatic behavior of human osteosarcoma cells, which may be applied to an effective therapeutic approach for patients with metastatic osteosarcoma.

Development of a biocompatible functional dental occlusion requires maxillo mandibular relation records. Clinical errors in these physical records are mostly caused by protracted clinical setting times. If dimensionally accurate and stable, recently introduced fast and superfast vinlpolysiloxane-based recording materials could reduce these inaccuracies, however such studies have yet not been attempted. This in-vitro study determined the post-polymerization dimensional accuracy of novel fast/superfast vinyl polysiloxane (VPS)-based jaw relation recording materials (JRRM). Four VPS-based JRRMs (Primo, Mark 3, Jetbite, and Defend) with three polymerization variants [regular, fast, and superfast] were investigated for dimensional accuracy. 180 samples allotted to four controls [PR, MR, JR, DR] and eight experimental [fast set (PF, MF, JF, DF); superfast (PSF, MSF, JSF, DSF)] were observed under a stereomicroscope using three different measurement coordinates between the X and Y axes, as specified by american dental association specification number 19. A one-way ANOVA (Kruskal-Wallis) rank test determined median scores, followed by a post hoc (Dunn) test. All probability “p” values were judged to be significant at 0.05. The one-way ANOVA showed significant differences between studied groups, with all regular setting JRRMs except Mark 3 showing the least overall linear changes, followed by super-fast set and fast set. Gp MR showed the highest [Mdn(IQR); 25.19(0.02)], while Gp DSF showed the least [25.00(0.02)] against original die measurements. All fast-set and superfast-set JRRMs showed expansion in terms of physical change. Mark 3 (regular, fast, and superfast) showed clinically unacceptable dimensional changes after 1 h of VPS-based JRRM setting. Defend Superfast was the most accurate material, including regular. Clinically, different variants fulfill dimensional accuracy and stability at various time intervals, therefore different variants may be indicated for specific purposes in fabrication of occlusion for a dental prosthesis.

Acceptance of COVID-19 vaccines needs a health promotion approach to address various social, environmental and personal factors leading to vaccine hesitancy. We assessed the vaccine hesitancy rate and applied social cognitive theory (SCT) to understand COVID-19 vaccine rejection in Qassim, Saudi Arabia. A cross-sectional study was conducted among visitors of 10 randomly selected primary health care centers in Buraidah, Saudi Arabia. Data was collected by a self-administrated questionnaire. The variables were grouped into six constructs of SCT. Logistic regression was used to assess the predictors of vaccine rejection. Out of 486 participants included in the study, 30.5% rejected the vaccine. The most common reason for vaccine rejection was uncertainty about the vaccine’s effectiveness (78%). Among various constructs of SCT, reciprocal determinism (nationality, income and suffering from COVID-19 infection), behavioral capability (knowledge about vaccine safety), self-efficacy (registered for vaccine), and observational learning (getting the vaccine after friends and family members) were significant predictors. Expectation and reinforcement constructs did not show significant association. There was high vaccine rejection in Qassim, KSA. This calls for further improving the mass education strategies. Social cognitive theory can be used to predict vaccine rejection and to develop strategies to increase the utilization of COVID-19 vaccines in Saudi Arabia.

Pre-exposure prophylaxis (PrEP) has emerged as a crucial tool in HIV prevention globally, yet its implementation in the Middle East and North Africa (MENA) region faces unique challenges. PrEP is expected to be effective in reducing HIV transmission. However, there is limited comprehensive data about its awareness, utilization, and effectiveness within MENA countries. The region's distinct cultural, social, and healthcare system characteristics create specific barriers that must be addressed. This study aims to evaluate PrEP's value and effectiveness and to develop targeted recommendations for overcoming barriers and expanding PrEP programs to better serve the region's specific needs and populations at risk. We searched PubMed, Scopus, and Web of Science databases through October 2024, using keywords related to HIV, PrEP, and the MENA region. Eligible studies included peer-reviewed clinical research on PrEP use in MENA countries, focusing on high-risk populations. Two independent reviewers screened titles, abstracts, and full texts using the Rayyan software, with disagreements resolved by a senior reviewer. Studies across the MENA region showed varying levels of PrEP awareness and willingness to use, with MSM communities showing higher interest. While PrEP proved effective for HIV prevention when properly used, implementation faced barriers, including costs, stigma, and accessibility. Despite the potential of PrEP implementation in HIV prevention, its efficacy in the MENA region remains unproven due to a lack of clinical studies. Successful implementation of PrEP in this region requires addressing key challenges, including financial accessibility, awareness, stigma, and healthcare integration. Morocco's pilot program serves as a promising example, but broader adoption must focus on improving accessibility and affordability. Future efforts should tailor interventions to meet the needs of at-risk populations, with an emphasis on enhancing adherence and retention rates to ensure effectiveness in diverse MENA settings.

Background Coronavirus disease 2019 (COVID-19) is an infectious disease that shortly progressed into an unprecedented pandemic spreading all over the world and causing millions of deaths. Many new COVID-19-specific therapies were suggested for the treatment of the patients at increased risk of progression to severe disease, especially those who were unvaccinated and those with a likely inadequate vaccine response. One of the preferred therapies in this setting is Paxlovid, a combination of the oral protease inhibitors nirmatrelvir and ritonavir. Paxlovid was authorized by the Saudi Ministry of Health for the treatment of mild to moderate COVID-19. This study aimed to report the effects of Paxlovid on the mortality of the COVID-19 patients at Dammam Medical Complex (DMC) and Qatif Complex Hospital (QCH), two hospitals in the Eastern Provence of Saudi Arabia, and compare the results with the international data. Methods The study was a retrospective study that included all the COVID-19 patients who were treated with Paxlovid at DMC and QCH between January and December 2022. Those patients were compared with control COVID-19 patients who did not receive Paxlovid. The patients were included irrespective of their COVID-19 vaccination status. All the patients were managed according to the Saudi Ministry of Health guidelines. They were followed up through the infectious disease virtual clinics and were monitored for ICU admissions and death of any cause for three months following their COVID-19 infections. Results A total of 92 COVID-19 patients were included. The patients consisted of 47 male and 45 female patients (51.09% and 48.91%, respectively). The mean ± standard deviation for the patients' age was 55.58±19.25 years. Twenty-eight patients were given Paxlovid (30.43%). Eighteen patients (19.57%) died. The use of Paxlovid was associated with lower ICU admissions (0.0% vs. 18.75%, P value <0.05) and with lower deaths (3.57% vs 26.56%, P value <0.05) but the Paxlovid group included less immunocompromised patients (7.14% vs. 60.94%, P value <0.001), cancer patients (0.0% vs. 42.19%, P value <0.001), and chronic kidney disease patients (7.14% vs. 29.69%, P value <0.05) than the control group. Conclusion This study suggests that Paxlovid is highly effective in reducing the risk of severe COVID-19 or mortality. However, larger studies with better qualities are needed for a full assessment of the role of Paxlovid in COVID-19 management in Saudi Arabia.