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The risk of type-2 diabetes and cardiovascular disease is higher in subjects with metabolic syndrome, a cluster of clinical conditions characterized by obesity, impaired glucose metabolism, hyperinsulinemia, hyperlipidemia and hypertension. Diuretics are frequently used to treat hypertension in these patients, however, their use has long been associated with poor metabolic outcomes which cannot be fully explained by their diuretic effects. Here, we show that mice lacking the diuretic-sensitive Na+K+2Cl−cotransporter-1 Nkcc1 (Slc12a2) in insulin-secreting β-cells of the pancreatic islet (Nkcc1βKO) have reduced in vitro insulin responses to glucose. This is associated with islet hypoplasia at the expense of fewer and smaller β-cells. Remarkably, Nkcc1βKO mice excessively gain weight and progressive metabolic syndrome when fed a standard chow diet ad libitum. This is characterized by impaired hepatic insulin receptor activation and altered lipid metabolism. Indeed, overweight Nkcc1βKO but not lean mice had fasting and fed hyperglycemia, hypertriglyceridemia and non-alcoholic steatohepatitis. Notably, fasting hyperinsulinemia was detected earlier than hyperglycemia, insulin resistance, glucose intolerance and increased hepatic de novo gluconeogenesis. Therefore, our data provide evidence supporting the novel hypothesis that primary β-cell defects related to Nkcc1-regulated intracellular Cl−homeostasis and β-cell growth can result in the development of metabolic syndrome shedding light into additional potential mechanisms whereby chronic diuretic use may have adverse effects on metabolic homeostasis in susceptible individuals.

The risk of type-2 diabetes and cardiovascular disease is higher in subjects with metabolic syndrome, a cluster of clinical conditions characterized by obesity, impaired glucose metabolism, hyperinsulinemia, hyperlipidemia and hypertension. Diuretics are frequently used to treat hypertension in these patients, however, their use has long been associated with poor metabolic outcomes which cannot be fully explained by their diuretic effects. Here, we show that mice lacking the diuretic-sensitive Na + K + 2Cl − cotransporter-1 Nkcc1 ( Slc12a2 ) in insulin-secreting β-cells of the pancreatic islet ( Nkcc1 βKO ) have reduced in vitro insulin responses to glucose. This is associated with islet hypoplasia at the expense of fewer and smaller β-cells. Remarkably, Nkcc1 βKO mice excessively gain weight and progressive metabolic syndrome when fed a standard chow diet ad libitum . This is characterized by impaired hepatic insulin receptor activation and altered lipid metabolism. Indeed, overweight Nkcc1 βKO but not lean mice had fasting and fed hyperglycemia, hypertriglyceridemia and non-alcoholic steatohepatitis. Notably, fasting hyperinsulinemia was detected earlier than hyperglycemia, insulin resistance, glucose intolerance and increased hepatic de novo gluconeogenesis. Therefore, our data provide evidence supporting the novel hypothesis that primary β-cell defects related to Nkcc1 -regulated intracellular Cl − homeostasis and β-cell growth can result in the development of metabolic syndrome shedding light into additional potential mechanisms whereby chronic diuretic use may have adverse effects on metabolic homeostasis in susceptible individuals.

The objective of the study was to retrospectively assess the clinical performance of dental prostheses, single crowns, and three-unit bridges to identify clinical biological and mechanical complications in the Ha'il province of Saudi Arabia. The study was conducted between March 2021 to October 2021 and included 421 patients who underwent crown and tooth-supported fixed partial denture (FPD) procedures at the Dental Polyclinics Center in the Ha'il region of Saudi Arabia from 2010-2020. The planned sampling approach was applied. Patients who underwent crown and FPD placements at the dental center within the scheduled period were identified through clinical assessments. The inclusion criteria were met by patients with three-unit FPDs and a single crown containing a natural contralateral tooth or teeth. A total of six general dentists conducted clinical exams. Patient satisfaction and technical and biological issues were the evaluation criteria for crowns and FPDs. The frequency and percentage of the various characteristics employed in the current investigation were ascertained using cross-tabulation. The Chi-square test was employed to assess the associations between categorical variables, with p-values ≤ 0.05 considered significant.  Results: Marginal integrity was recorded in 332 participants (78.9%), which was satisfactory for the majority of the restoration. The acceptance morphology was present in 252 (59.9%) restorations. The highest rate of the restorations 274 (66.2%) had satisfactory color. In 86 cases (20.4%), there was visible periodontal depth of at least 5 mm. Three hundred and six (72.7%) of the fixed restorations had gingival bleeding connected to them, and 96 (22.8%) teeth had periapical lesions. A total of 311 patients (73.9%) reported they were satisfied with their fixed restorations. The technical and biological complications noted in the current study were not higher compared with other studies of crowns and fixed dental prostheses. The majority of patients were satisfied with the restoration.

Objective This study aimed to determine the persistence of induced immunity against hepatitis B virus (HBV) among adults routinely vaccinated during their infancy and correlate the level of induced immunity with participant characteristics. Methodology This was a cross-sectional study conducted among visitors to primary care centers of the Ministry of Health (MOH) in Riyadh, the Kingdom of Saudi Arabia (KSA) during the period from August 2020 to January 2021. The study population included healthy adults of both genders who had received full doses of the HBV vaccine in infancy. Data related to participant characteristics were collected using a self-administered questionnaire. A blood sample was then taken from each participant to measure the serum level of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and antibodies against hepatitis B core antigen (ani-HBc). Results A total of 400 subjects participated in the study; the mean age of the cohort was 25 years. Almost all of them were Saudis (99.30%), and more than half (57.50%) were males. Only 24.30% had an anti-HBs antibodies level of ≥10 IU/L, and all respondents were negative for HBs antigen. No significant association between participant characteristics and anti-HBs antibody levels was found. Conclusion A decline in immunity many years after HBV vaccinations taken in infancy has been well-documented. However, for low-risk populations, the boosting of HBV vaccines is probably unnecessary since the immune memory provides sufficient protection despite low or undetectable anti-HBs antibodies.

The risk of type-2 diabetes and cardiovascular disease is higher in subjects with metabolic syndrome, a cluster of clinical conditions characterized by obesity, impaired glucose metabolism, hyperinsulinemia, hyperlipidemia and hypertension. Diuretics are frequently used to treat hypertension in these patients, however, their use has long been associated with poor metabolic outcomes which cannot be fully explained by their diuretic effects. Here, we show that mice lacking the diuretic-sensitive Na.sup.+ K.sup.+ 2Cl.sup.- cotransporter-1 Nkcc1 (Slc12a2) in insulin-secreting [beta]-cells of the pancreatic islet (Nkcc1.sup.[beta]KO) have reduced in vitro insulin responses to glucose. This is associated with islet hypoplasia at the expense of fewer and smaller [beta]-cells. Remarkably, Nkcc1.sup.[beta]KO mice excessively gain weight and progressive metabolic syndrome when fed a standard chow diet ad libitum. This is characterized by impaired hepatic insulin receptor activation and altered lipid metabolism. Indeed, overweight Nkcc1.sup.[beta]KO but not lean mice had fasting and fed hyperglycemia, hypertriglyceridemia and non-alcoholic steatohepatitis. Notably, fasting hyperinsulinemia was detected earlier than hyperglycemia, insulin resistance, glucose intolerance and increased hepatic de novo gluconeogenesis. Therefore, our data provide evidence supporting the novel hypothesis that primary [beta]-cell defects related to Nkcc1-regulated intracellular Cl.sup.- homeostasis and [beta]-cell growth can result in the development of metabolic syndrome shedding light into additional potential mechanisms whereby chronic diuretic use may have adverse effects on metabolic homeostasis in susceptible individuals.

There is no doubt that digitalization or the application of advanced information technologies plays a vital role in the functioning of healthcare institutions in the modern era (G. Gopal,2019).However, it also brings some challenges. One of them is cybersecurity (M. Mijwil,2023). Protecting information is one of the most important tasks of healthcare organizations. (X. Liu,2022) Most use health information systems such as “electronic prescribing systems, electronic health record systems, practice management support systems, clinical decision support systems, radiological information systems, and computerized order entry systems.” Doctors\", to name a few. (N. Al-Shorbaji,2022) These systems are usually connected to the Internet of Things, the Internet, etc. and have the possibility of remote access (R.T. Sutton,2020). The fact is that these technological systems simplify various tasks and help in managing healthcare processes.

This study investigated healthcare workers’ perceptions of hand hygiene practices by comparing personal reports, as assessed by questionnaires, to direct observations of the workers’ hand hygiene practices. The study employed a cross-sectional research design. Observations were made using a 16-item checklist, based on three sources: Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and Boyce and Pittet’s guidelines of hand hygiene. The checklist was used for both direct-observation and self-reported data collection purposes. Pearson correlation and Multivariate Analysis of Covariance (MANCOVA) were utilized to statistically determine the relationship between healthcare workers’ reports of hand hygiene practices and observed hand hygiene behaviors. The study was conducted in the outpatient examination rooms and emergency departments of three types of hospitals in the Eastern region of Saudi Arabia where Middle East respiratory syndrome coronavirus (MERS-CoV) is endemic and is observed in routine cases and outbreaks. The total sample size included 87 physicians and nurses recruited while on duty during the scheduled observation periods, with each healthcare worker being observed during individual medical examinations with at least three patients. No statistically significant correlations between the healthcare workers’ perceptions of hand hygiene practices and healthcare workers’ actual behaviors were evident. Based on the self-report questionnaires, significant differences were found between physicians’ and nurses’ hand hygiene practices reports. Healthcare workers clearly understand the importance of careful hand hygiene practices, but based on researchers’ observations, the medical personnel failed to properly implement protocol-driven hand hygiene applications. However, the significant differences between physicians’ and nurses’ self-reports suggest further inquiry is needed to fully explore these discrepancies.

An outbreak of Middle East Respiratory Syndrome (MERS) among healthcare workers in Saudi Arabia in 2012 led to an investigation of hand-hygiene behaviors among healthcare professionals. Direct contact with patients is a major pathway for MERS, a droplet virus, which refers to a virus that lays on surfaces. This study investigated factors associated with respiratory disease transmission (e.g., MERS) in hospital settings among healthcare workers (i.e., physicians and nurses). I developed a 16-item checklist based on three sources: the CDC standards, the WHO Five Moments for Hand Hygiene, and Boyce and Pittet’s (2002) guidelines of hand hygiene. I used those 16 items in both direct-observation and self-reported questionnaire formats. The checklist addressed three time frames of contact: before, during, and after contact with patients, devices, and surrounding surfaces. Hand-hygiene behaviors surrounding these time frames were assessed. The study also explored healthcare workers’ beliefs about hygiene practices by comparing personal reports of hand hygiene assessed by questionnaire to observed actual hand-hygiene practices. The study was a cross-sectional research design and was conducted in the outpatient examination rooms and emergency departments of three hospitals (public, private, and military) in the Eastern region of Saudi Arabia. The total sample size included 87 physicians and nurses who were recruited while on duty during the researcher’s observation periods. To provide clear results, I used two independent sample t-tests to test each of the 8 hypotheses. I found that no statistically significant differences were found among health-care workers when observing their behaviors of hand-hygiene practices. However, when using the self-reported questionnaire data, I found statistically significant differences between physicians’ and nurses’ hand-hygiene practices before, during, and after interacting with patients. Also, I found statistically significant differences between male and female hand-hygiene practices during interacting with patients, and I found statistically significant differences between health-care workers in public and military hospitals hand-hygiene practices during interacting with patients. For the primary hypothesis, I used Pearson correlation to determine the relationship between healthcare workers’ reports of hand-hygiene practices, and observed healthcare workers behaviors of hand-hygiene practices. I found that no statistically significant correlation between the two data collection instruments. To provide a further analysis, a multivariate analysis of covariance (MANCOVA) was used to examine whether healthcare workers’ hand-hygiene practices before, during, and after were different while controlling for their gender, department, and hospital type. I found that no statistically significant differences were found when observing the healthcare workers behaviors of hand-hygiene practices. However, when using the self-reported questionnaire data, I found that nurses and females reported better hand-hygiene than physicians and males. From these data, I conclude healthcare workers understand the importance of hand-hygiene and fail to appropriately implement the practice.

The increasing prevalence of mental health disorders among children and adolescents has highlighted the urgent need for effective and accessible mental health care. Psychiatric Mental Health Nurse Practitioners (PMHNPs) have emerged as essential providers in this landscape, playing a pivotal role in improving mental and behavioral health care delivery for young populations. This article explores the multifaceted contributions of PMHNPs, emphasizing their unique training, scope of practice, and the impact they have on treatment outcomes. PMHNPs are equipped with advanced clinical skills that enable them to conduct comprehensive assessments, diagnose mental health disorders, and develop individualized treatment plans that incorporate evidence-based psychotherapeutic interventions and medication management. Their holistic approach not only addresses the psychological aspects of mental health but also considers the physical and social factors that influence a child's well-being. Furthermore, PMHNPs prioritize family involvement in the treatment process, recognizing that caregivers play a crucial role in supporting their child's mental health. By engaging families in discussions about treatment options and providing education and resources, PMHNPs empower caregivers to actively participate in their child's care, fostering a supportive environment conducive to recovery. Additionally, PMHNPs serve as advocates for mental health awareness, working to reduce stigma and improve access to care within communities. Their involvement in school-based programs and community outreach initiatives enhances the overall mental health infrastructure, ensuring that at-risk youth receive timely and appropriate services. This article underscores the critical need for PMHNPs in the mental health care system, particularly in light of the growing demand for services. By examining their roles and contributions, we aim to highlight the importance of integrating PMHNPs into mental health care teams to enhance the quality of care for children and adolescents. Ultimately, the involvement of PMHNPs is essential for addressing the mental health crisis facing young populations and promoting healthier futures for the next generation.