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Chest pain in pediatric patients is a common concern in pediatric emergency departments (ED). In most cases, benign conditions are related to noncardiac causes, and only a minority of the cases are caused by heart disease. This research aimed to evaluate the causes and characteristics of chest pain among children in a pediatric emergency department. This retrospective study evaluated children younger than 14 years of age who presented to the emergency department of a general pediatric hospital in the Eastern area of Saudi Arabia with non-traumatic chest pain between 2017 and 2022. The data included socioeconomic information, physical examination findings, and the results of basic investigations, such as chest X-ray and electrocardiogram. The Chi-square test was performed to compare various etiologies, with a 5% significant level. The study evaluated 310 patients with a mean age of 9.1±2.7 years. The majority of children presenting with chest pain had normal physical examinations, except 3.3% who showed respiratory and cardiac findings. The diagnostic tests indicated pneumonia in 2.9% and arrhythmia in 2.1% of children. Most patients were discharged with a diagnosis of idiopathic or muscular chest pain. The majority of patients (95%) were treated symptomatically in outpatient settings, with just one patient requiring hospitalization. The most common cause of chest pain prompting a child to visit the ED was idiopathic chest pain. Therefore, this study highlights the significance of obtaining a comprehensive medical history and physical examination to reveal important clues and help avoid unnecessary tests.

This study aimed to explore the Willingness To Pay (WTP) of uninsured individuals in Saudi Arabia and the factors influencing their decisions regarding telemedicine services. This study used a cross-sectional survey design and convenience sampling to gather data from respondents aged 18 years or older who had visited healthcare facilities at least once in the past year and were uninsured. WTP was determined using the contingent valuation method, and a two-part regression model was applied to analyze the factors influencing WTP. The study included 4232 participants and discovered that approximately 17.41% were willing to pay for telemedicine services. Those aged 60 and older, employed in the government or private sector, in higher socioeconomic quintiles, and experiencing chronic health issues showed a positive association with their WTP value. Conversely, individuals aged between 30 and 44 years, married, and unemployed exhibited a negative association with a lower WTP value. The findings indicate that most respondents hesitated to pay for telemedicine services, with a significant influence from sociodemographic characteristics, underscoring the need to promote telemedicine use among underserved populations and address health disparities.

Background Delirium, a neuropsychiatric syndrome characterized by acute disruptions in attention and awareness, significantly impacts children in Pediatric Intensive Care Units (PICUs), leading to prolonged hospitalization, increased infection risk, and dependence on mechanical ventilation. Despite growing recognition, its true burden and risk factors in children remain poorly understood. This prospective cohort study investigated the prevalence, characteristics, and potential therapeutic targets for delirium in 890 children admitted to a tertiary PICU between January and December 2022. Delirium was screened every 12 hours using the validated Cornell Assessment of Pediatric Delirium (CAPD). We analyzed data on demographics, comorbidities, medications, interventions, and clinical outcomes to identify associations with the development of delirium. Our study revealed a high prevalence of delirium, affecting 69.4% (95% CI: 66.33–72.3) of admitted children. Notably, infants were disproportionately affected, accounting for 33.5% of delirium cases. Respiratory diagnoses were significantly associated with delirium (78.6%), while oncology cases had the lowest prevalence (29.4%). Opioid use was identified as a risk factor, increasing the risk of delirium by 45.2%. Furthermore, 97.6% of children with withdrawal syndrome also experienced delirium, highlighting a strong association between these conditions. Delirium was significantly associated with longer PICU stays, and all 20 mortalities during the study period occurred in delirious patients. The adjusted odds ratios from multi-level regression modeling further elucidated the risk factors associated with the development of delirium. This study demonstrates a high prevalence of delirium in PICUs, with infants and those with respiratory diagnoses being particularly vulnerable. Opioid use and withdrawal syndrome emerged as risk factors. Further research is needed to elucidate the mechanisms underlying these associations and develop targeted interventions to prevent, manage, and improve outcomes for children suffering from delirium in critical care settings.

Congenital talipes equinovarus (CTEV), continues to rank among the most common congenital musculoskeletal deformities. The management of CTEV, particularly when it is part of a syndromic presentation or associated with conditions such as myelomeningocele (MMC), presents a significant challenge due to the deformity's tendency to be stiffer and more complex. Most children with CTEV may require surgical intervention. The current case report highlights the functional outcome of minimally invasive percutaneous surgical correction in a late-presenting, rigid, and severe foot deformity in an MMC patient, aiming to have accepted residual deformity that gave better function with less surgical complication. A case involving an eight-year-old girl having a deformity in her left foot secondary to low lumbar level MMC was referred for management. The Pirani score total was 6, signifying a severe deformity according to received initial assessments. Upon review of treatment alternatives, minimally invasive percutaneous surgical correction was performed consisting of percutaneous plantar fascia release followed by Achilles tendon lengthening and flexor digitorum tenotomy. We followed up with the patient for one year for wound healing and functional outcomes. An early weight bearing in cast was achieved 1 week with walker frame. Removal of cast and application of custom walker orthosis for walking on the 6th week post-operation. Following up to one year, she is a walker, and residual deformity of the foot did not affect her mobilization. As of the one-year follow-up, she is self-ambulatory, thanks to her custom walking orthosis. Residual deformity did not affect her functional outcome. We recommend further follow-up, and future surgery may be necessary if her deformity worsens. The functional outcome, the social and economic status of the family, and the psychological impact on the patient significantly influence the selection of the most suitable method.

Background This study aimed to evaluate the knowledge, awareness, and practice of intraoral scanners (IOS) and the factors affecting their accuracy amongst dental interns and practitioners. Methods This was an observational cross-sectional study in which data was collected from a representative population in Saudi Arabia, with the help of online questionnaires. The forms were distributed to 500 dental interns and practitioners and the questionnaire’s validity and reliability were evaluated for vetting and remarks. The questionnaire consisted of three parts: the participants’ demographic details, questions on the awareness and knowledge of participants regarding IOS, and the factors affecting the accuracy in clinical use of IOS. Questions were to be answered with ‘yes’, ‘no’ and ‘I don’t know’. Descriptive statistical analysis was performed using the control chart technique and the chi-squared test, with statistical significance set at p  < 0.05. Results Most of the participants (58%) knew about the IOS and its applications (47.5%), but the majority of the participants did not use IOS in their clinics (43.5%). The majority of males (57.39%) and females (50.86%) strongly agreed that cost was a barrier to purchasing an IOS. To better get more knowledge on IOS, the specialists 66 (16.5%) and interns 54 (13.5%) chose continuing dental education programs and workshops. There was a significant association ( p  < 0.05) of knowledge and awareness, perception, and factors affecting parameters with different categories and years of experience. Conclusion Within the limitations of this study, most participants had a positive stance towards IOS but due to inadequate knowledge and understanding, its use and applications were minimal. IOS was well-received regardless of operator training and experience. There is a significant need to increase awareness of this concept, as it may increase treatment efficiency and effectiveness.

ObjectivesThis study investigated the level and associated factors, focusing on the number of individuals with chronic conditions, of out-of-pocket healthcare expenditures (OOPHE).DesignA cross-sectional study was conducted from January 2021 to June 2021.SettingRiyadh Province, Saudi Arabia.ParticipantsA total of 1176 households that used any healthcare services at least once in the past 3 months.Outcome measuresThe OOPHE incurred in the previous 3-month period when a household member is receiving health services. The effects of predisposing, enabling and need factors on the level of OOPHE. The association between the number of individuals with chronic conditions in a household and OOPHE along with the OOPHE distribution.ResultsThe average household OOPHE among all the surveyed households (n=1176) was SAR1775.30. For households affected by one chronic condition, OOPHE was SAR1806, and for households affected by more than one chronic condition, OOPHE was SAR2704. If the head of the household was older, better educated and employed, they were more vulnerable to a higher OOPHE (p<0.0001). At the household level, the increased number of family members with chronic conditions, the presence of a member less than 14 years old, higher socioeconomic status, coverage from health insurance plans, residence in an urban area and the presence of a member with a disability in the household were correlated with a considerably greater level of OOPHE (p<0.0001). The result of quantile regression analysis indicates that an increase in the number of members with chronic conditions in a household was significantly associated with greater overall OOPHE at higher health expenditure quantiles.ConclusionsThe burden of OOPHE on households with chronic conditions remains heavy, and some disparities still exist. The number of individuals with chronic conditions in a household plays a substantial and prominent role in increasing the risk of incurring OOPHE.

Background: This study examined the time to sputum smear and culture conversion and determinants of conversion, as well as variables associated with treatment outcomes among drug-resistant pulmonary tuberculosis (DR-PTB) cases. Methods: The electronic database and written medical records of patients were utilized to assess the sociodemographic, clinical, microbiological, and treatment characteristics and outcomes of study participants. Results: Among 736 patients with pulmonary tuberculosis (PTB), the mean age was 36.5 ± 16.5 years, with males comprising 53.4% and a mean weight of 47.76 ± 11.97 kg. The median time period for sputum smear conversion and sputum culture conversion was a month. The first-month culture conversion ( p < 0.001, aOR = 5.817, and 95% CI = 3.703–9.138) was the determinant of sputum smear conversion and receiver operating curve analysis with AUC = 0.881, 95% CI = 0.855–0.907, and p < 0.001, which showed a high level of predictive ability for the regression model for the initial sputum smear conversion. However, the first-month sputum conversion ( p < 0.001, aOR = 7.446, and 95% CI = 4.869–11.388) was attributed to sputum culture conversion, and the model has shown excellent predictive ability for regression with ROC curve analysis demonstrating AUC = 0.862, 95% CI = 0.835–0.889, and p < 0.001. A total of 63.2% of patients showed favorable treatment outcomes, with 63.1% of cases achieving treatment-cured status. The previous use of SLD, history of smoking, duration of illness ≤ 1 year, extensively drug-resistant tuberculosis, and first-month sputum conversion were the variables attributed to favorable treatment outcomes observed in drug-resistant pulmonary tuberculosis cases. ROC curve analysis with AUC = 0.902, 95% CI = 0.877–0.927, and p < 0.001) has shown outstanding ability for regression model prediction for the variables influencing treatment outcomes. Conclusions: Within 2 months of treatment, most patients had converted their sputum cultures and sputum smears. The determinants of early sputum smear and sputum culture conversion, as well as favorable treatment outcomes, were identified. These factors should be considered during the design and implementation of effective strategies for drug-resistant tuberculosis control programs.

Vaccines are considered to be the most beneficial means for combating the COVID-19 pandemic. Although vaccines against SARS-CoV-2 have demonstrated excellent safety profiles in clinical trials, real-world surveillance of post-vaccination side effects is an impetus. The study investigates the short-term side effects following the administration of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines in Saudi Arabia. A cross-sectional quantitative study was conducted among the general population with age ≥ 18 years, from five regions (Central, Northern, Eastern, Southern, and Western Regions) of Saudi Arabia for a period of 6 months (July to December 2021). A self-administered study instrument was used to record the side effects among the COVID-19 vaccine recipients. Of the total 398 participants (males: 59%), 56.3% received Pfizer and 43.7% were vaccinated with AstraZeneca. Only 22.6% of respondents received the second dose of the COVID-19 vaccines. The most commonly reported side effects were pain at the injection site (85.2%), fatigue (61.8%), bone or joint pain (54.0%), and fever (42.5%). The average side effects score was 3.4 ± 2.2. Females, young people, and Oxford-AstraZeneca recipients had a higher proportion of side effects. The Oxford-AstraZeneca vaccine recipients complained more about fever (p < 0.001), bone and joint pain (p < 0.001), fatigue (p < 0.001), loss of appetite (p = 0.001), headache (p = 0.008), and drowsiness (p = 0.003). The Pfizer-BioNTech vaccinees had more pain and swelling at the injection site (p = 0.001), and sexual disturbance (p = 0.019). The study participants also reported some rare symptoms (<10%) including heaviness, sleep disturbance, fainting, blurred vision, palpitations, osteomalacia, and inability to concentrate. This study revealed that both Pfizer-BioNTech and Oxford-AstraZeneca administration was associated with mild to moderate, transient, short-lived side effects. These symptoms corroborate the results of phase 3 clinical trials of these vaccines. The results could be used to inform people about the likelihood of side effects based on their demographics and the type of vaccine administered. The study reported some rare symptoms that require further validation through more pharmacovigilance or qualitative studies.

Background Effective communication between healthcare providers and patients is essential for high-quality care and patient satisfaction. Barriers to communication can lead to misunderstandings and poorer health outcomes. This study aims to identify communication obstacles between physical/occupational therapists (PTs/OTs) and patients in the Saudi Arabian context. Methods This cross-sectional study, which was conducted from September 2022 to January 2023, involved 228 patients and 46 therapists from the rehabilitation services department. Data were collected via two self-administered questionnaires and analyzed via Pearson’s chi-square test of independence and Fisher’s exact test for categorical nominal data to assess associations between variables. A p value of less than 0.05 was considered statistically significant. Results Most patients (25.4%) were young adults aged 18–30 years, predominantly Saudi nationals (96.5%), with undergraduate degrees (63%). High satisfaction with therapists was reported by 69.3% of patients. The key barriers identified included limited consultation time (15.8%) and the use of medical records (4.8%). Therapists, primarily young professionals aged 25–30 years (54.3%) with 3–5 years of experience (43.5%), also reported time limitations (30.4%), physical setup issues (37.0%), and poor patient history-taking (56.5%) as significant barriers. Additional findings from our study indicated that monolingual Arabic-speaking therapists faced greater challenges in understanding language (p = 0.02), and younger therapists (aged 25–30) reported greater difficulties in managing multiple problems during sessions (p = 0.03), highlighting age and linguistic background as significant factors influencing communication efficacy. Conclusions Addressing communication barriers through targeted interventions, such as enhanced training, improved clinical structures, and advanced electronic health records, can improve patient satisfaction and treatment outcomes. Future research should focus on longitudinal studies and specific communication training programs.

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.