Advances in Clinical and Experimental Medicine

Prevalence of Anxiety and its Effect on Academic Performance Among Secondary School Students in Al-Ahsa City, Eastern Saudi Arabia, 2020: Cross-Sectional Study

Shaima Al-Makinah (1) *, Zahra Al-Aithan (1), Ahmed Al-Quryan (2) — 2022-02-28

Introduction: One out of five adolescents with anxiety refuses to attend school and half the adolescents with anxiety are perceived by their parents as having impairment while concentrating on schoolwork, when giving oral reports or when taking an exam. There were few studies aiming to assess anxiety among school students in Saudi Arabia. This study aimed to estimate the prevalence and determinants of anxiety among secondary school students and its association with sleep quality.
Methods: The study design is a descriptive cross-sectional study that included secondary school students in Al-Ahsa city. The sample size was determined based on the number of students in secondary schools in Al-Ahsa which was taken from the ministry of education, and it was calculated by a website-based statistical calculator with a 5% margin of error and 95% confidence level. Self-completed questionnaires were distributed to all participants, via electronic link, which contains sociodemographic questions, General Anxiety Disorder (GAD 7) scale.
Results: Out of 719 secondary school students responded to the survey, 70.1% were females and 41.9% were in the second year of the secondary school. Regarding anxiety levels, about 35% were considered to be non-anxious, 54% were considered to have mild to moderate anxiety levels, and 10.8% had severe anxiety. Female gender was significantly associated with anxiety as 69.2% of the female students were anxious in comparison to 54.4% of male students. Having inadequate sleep, having a stressful event in the past 6 months, and having working mothers were potential predictors for anxiety among the students.
Conclusions: The prevalence of anxiety among secondary school students is high and more than a tenth of the students had severe anxiety which may require a sort of professional intervention. Certain subgroups of high-risk students should be targeted by public health interventions, such as females or those with stressful events, aiming at improving mental health of school students in Saudi Arabia.

Outcomes of Vitamin D Deficiency among Women in Saudi Arabia

2022-11-07

Introduction: Although sun exposure is considered a major source of vitamin D, the prevalence of its deficiency is paradoxically much higher in countries with sunny climates, such as Saudi Arabia, Egypt, Oman, the United Arab Emirates, and Jordan. This discrepancy has been attributed to cultures and traditions that may limit exposure to the sun in these countries. Hence, this review aimed to investigate the magnitude of vitamin D deficiency among Saudi women.
Methods: An online database were searched to identify articles related to vitamin D deficiency among women in Saudi Arabia. Articles that addressed the problem among children or the male population were excluded. The resulting articles were reviewed by 3 independent reviewers to ensure their eligibility and further exclusion of ineligible articles. The data regarding vitamin D deficiency were excluded from this review. The extracted data were synthesized in the form of a narrative review. The results were discussed in the following section.
Results: A total of 12 studies were eligible in this review, as they discussed vitamin D deficiency among women. The high prevalence of vitamin D deficiency in the Kingdom of Saudi Arabia has been well-established in several subpopulations. Vitamin D deficiency may result from one and/or more of the following including decreased cutaneous synthesis, decreased dietary intake, impaired hepatic and/or renal activation, or resistance to vitamin D action. Vitamin D level was not influenced by lifestyles, dietary habits, education level, or household income. However, none of the predictors was significant enough to predict serum Vit D level. These results suggest that Vit D deficiency is common even in very sunny areas emphasizing the importance of screening for Vit D deficiency in these populations.
Conclusions: Vitamin D deficiency in Saudi women is further impacted during pregnancy itself, with a noted deteriorating vitamin D status, which may arise in part due to the increased nutritional demands of the growing fetus. This decline in vitamin D levels is also common in Arab Gulf countries, where many mothers about half of their neonates, at the time of delivery, have sub-optimal serum levels of 25(OH)D, highlighting that in Saudi Arabia the answer may be more complicated than sunlight exposure alone.

Association between Physical Activity and Coronary Artery Diseases: A Narrative Review

2022-11-30

Introduction: Regular physical activity decreases the incidence of cardiovascular disease but the mechanisms determining this reduction are related to the modulation of classic risk factors and maintenance of endothelial function. This narrative review highlighted physical activity and exercise a role in the prevention of CAD, which postulates that exercise is influenced by variables at multiple levels.
Methods: A systematic literature search of RCTs were conducted in PubMed Web of Science, and Cochrane Library. Moreover, reference lists of retrieved articles were hand-searched for trials that may meet inclusion criteria but cannot be retrieved in the initial search. The literature search was performed independently by two reviewers. Irrelevant studies and duplicates were removed, and then titles and abstracts were fully screened. We decided not to include outcomes in the search string, in order to include a wide range of literature on the central subject, including only population and intervention.
Results: In the included studies, a total of 15 studies were included in this review with a total of 1,272 participants with a dropout rate ranging from 0% to 38%. The main reason for dropout was low compliance with exercise protocols or withdrawal of consent, rather than medical reasons. A total of six patients failed to complete the study because of angina, atrial fibrillation, pericarditis, or myocardial infarction. Most of the trials enrolled both male and female patients except four, which only recruited males.
Conclusions: Many studies recommended the length, intensity, and duration of physical activity to prevent coronary artery diseases, as well as other cardiovascular diseases. Physical activity with at least 30 minutes of moderate-intensity physical activity on most days of the week reduces the risk of coronary artery diseases.

Prevention of Brucellosis in Saudi Arabia: A Narrative Review

2022-12-20

This review provides a detailed description of brucellosis infection in the Kingdom of Saudi Arabia. Four databases were searched for journal articles, reviews, and case reports in the English language; the search was performed on June 2022. The aim of the current review is to enrich the literature on the brucellosis infection in the kingdom. Brucellosis was reported as a prevailing endemic infection in the kingdom that represents a health problem and socio-economic burden in all parts of the country. The endemicity of brucellosis in this country might be explained due to difficulty in controlling the importation of animals for slaughtering during the Hajj and Umra periods and for several other predisposing factors. The distribution of the disease is over the country and the most prevalent part is the south followed by the north and then the east and central parts. There are two main types of brucellosis species reported in Saudi Arabia include; Brucella abortus, and Brucella melitensis. The brucellosis clinical features range from asymptomatic to acute clinical features, the most frequent signs and symptoms include fever, joint pain, muscle pain, headache, nausea/vomiting, anorexia, and malaise in addition to the subsequent complications that might occur. However, the complexity of brucellosis control measures, there are several activities that have been implemented to tackle the disease such as mass vaccination of animals, regulating importation of slaughtered animals, and improving public awareness.

Laboratory Biomarkers of Brain Damage among Hospitalized Patients: A Systematic Review

2023-09-19

Introduction: This systematic review aims to explore the role of biomarkers in predicting unfavorable events associated with traumatic brain injuries and ischemic strokes. We conducted a search in PubMed, resulting in the identification of eleven potentially relevant studies.

Methods: Our search yielded a total of eleven potentially relevant studies from PubMed. After excluding three studies, as two had insufficient information and one was a review, the review included eight studies. The overall sample size across these studies ranged from 37 patients to 6,315 patients.

Results: Most of the included studies demonstrated the ability of various biomarkers to serve as prognostic indicators for predicting unfavorable outcomes in the context of ischemic or traumatic brain injuries. Higher levels of these biomarkers were associated with an increased risk of traumatic injuries or ischemic strokes. For instance, Zhong et al. identified MMP-9 as a potential prognostic factor for acute ischemic stroke, with higher serum MMP-9 levels correlating with an elevated risk of mortality and disability at three months. Similarly, Tsai et al. observed significantly higher concentrations of serum thiobarbituric acid-reactive substances (TBARS) in acute ischemic stroke patients, suggesting its potential as a predictor for three-month outcomes. Kwon et al. found that elevated serum homocysteine levels were independent predictors of acute ischemic stroke and early neurological deterioration. FABP4, copeptin, and NT-proBNP were also identified as independent prognostic markers for functional outcomes, mortality, or cardiovascular disease (CVD) in ischemic stroke patients. Conversely, lower concentrations of serum ficolin-3 were proposed as an independent prognostic biomarker for post-severe traumatic brain injury. Additionally, reduced levels of serum 25-hydroxyvitamin D (25(OH) D) were associated with increased stroke severity and poorer functional outcomes in acute ischemic stroke patients.

Conclusions: The findings from this systematic review suggest that a range of biomarkers, when assessed in patients with traumatic brain injuries and ischemic strokes, can serve as valuable prognostic tools, aiding in the prediction of unfavorable outcomes. These biomarkers may contribute to better risk assessment and patient management in these critical clinical scenarios.

Interventions for Assessment and Enhancement of Pain Management Competencies among Healthcare Professionals

2023-12-08

Introduction:

Understanding the current landscape of interventions is important to enhance pain management competencies among healthcare professionals. This systematic review aimed to assess the prevalence and efficacy of interventions targeted at enhancing pain management competencies among healthcare professionals, with the goal of informing evidence-based practices and facilitating improvements in patient care.

Methods:

A comprehensive search strategy, tailored to electronic databases including PubMed, MEDLINE, Embase, and the Cochrane Library, was employed to systematically identify relevant studies until August 2023. Eligible studies, meeting specific criteria and published within the last 10 years, underwent a rigorous screening process, with inclusion based on primary research articles focused on pain management competencies among healthcare professionals. The subsequent data extraction and quality assessment, conducted by two independent reviewers, ensured a thorough and methodologically sound review of the literature.

Results:

The review included seven studies with diverse samples and interventions aimed at enhancing pain management competencies among healthcare professionals. The sample sizes varied from 82 to 358 participants, with an average improvement of 27% in sample knowledge representation. The interventions, spanning educational programs, simulation training, and collaborative strategies, demonstrated consistent effectiveness in improving knowledge and self-efficacy, with simulation training showcasing tangible improvements in practical skills and collaborative approaches leading to enhanced teamwork skills, quantified by a 40% improvement. The quantitative assessments revealed significant overall improvements, including a 23% increase in knowledge scores, a 28% rise in self-efficacy, and a 37% improvement in teamwork.

Conclusions:

Our study contributes to the existing literature by quantifying the substantial improvements observed in pain management competencies among healthcare professionals through diverse interventions, including educational programs,simulation training, and collaborative approaches, emphasizing the importance of a multifaceted strategy, with calculated odds ratios and percentages providing concrete measures for the development of evidence-based practices and educational strategies.

Antimicrobial Stewardship in Rural and Remote Primary Healthcare Centers: A Systematic Review

2023-12-28

Introduction:

Studies have shown that the rate of antibiotic prescription in these areas is significantly higher than in urban settings, with one study reporting that rural general practitioners (GPs) prescribe antibiotics. This systematic review aimed to evaluate the current state of antimicrobial stewardship in rural and remote primary health care settings.

Methods:

This systematic review, adhering to PRISMA guidelines, focused on evaluating the impact of antimicrobial stewardship programs in rural and remote primary health care through interventional studies and clinical trials. A comprehensive literature search across multiple databases and registries, including PubMed and ClinicalTrials.gov, was conducted, using tailored search terms to identify relevant studies conducted between January 2000 and August 2023. The review process involved stringent screening, data extraction, and quality assessment, culminating in a detailed synthesis of the interventions' effectiveness on antimicrobial use, resistance patterns, and improvements in patient care in these specific healthcare settings.

Results:

The systematic review analyzed seven interventional studies and clinical trials on antimicrobial stewardship in rural and remote primary health care, revealing a diversity in methodology, location, focus, and sample sizes ranging from 58 to over 500 participants. These studies incorporated various interventions, such as educational programs, patient awareness campaigns, and digital decision support systems, leading to a range of outcomes. Key findings included a significant reduction in antibiotic prescription turnover, with risk differences as high as -20%, and an increase in healthcare provider satisfaction, reaching up to 30%, underscoring the effectiveness of tailored stewardship approaches in these unique healthcare settings.

Conclusions:

This systematic review on antimicrobial stewardship in rural and remote primary health care settings analyzed seven interventional studies, revealing significant improvements in antibiotic prescribing practices and healthcare provider satisfaction. The interventions, including educational programs, digital tools, and patient campaigns, led to a substantial reduction in antibiotic prescription turnover

A Cross-sectional Study to Examine the Acceptance of COVID-19 Vaccine among Family Medicine Board Residents, Saudi Arabia, 2021

Ahmad Alqadheb (1) *, Fahad Alrwili (2) — 2022-08-10

Introduction: Different levels of vaccine acceptance and many factors were found responsible for low vaccine acceptance such as perceived severity of infection, education, ethnicity, and cultural background. We aimed to determine the acceptance of the COVID-19 vaccine among family medicine residents as an important portion of health staff who expected to have a high level of vaccine acceptance.
Methods: This is a cross-sectional web-based study targeting all family medicine board residents in Saudi Arabia. The questionnaire is self-administered and consists of two sections of questions, section “A” about demographics and clinical related factors of the residents, and section “B” contains questions related to vaccine acceptance and preference. The questionnaire is based on previous surveys, one of them done in Saudi Arabia. Descriptive statistics such as frequencies and percentages were calculated to summarize nominal and ordinal data. Chi-squared test was applied to evaluate the association between the determinants and the outcome variables. Any P-value < 0.05 was considered an indication of a statistically significant association or difference.
Results: Out of 215 family medicine residents who responded to the questionnaire, 60% were males and 40% were females. We found about 69.8% of the residents were probably or definitely willing to receive the COVID-19 vaccine if it was free or covered by health insurance, while 13.5% and 16.7% were unwilling or unsure about that, respectively. The main reasons for not being willing to receive the vaccine were worries about vaccine safety followed by worries about vaccine efficacy. Knowing patients with COVID-19 in their immediate social network and perceived knowledge about COVID-19 vaccine side effects were significantly associated with acceptance of the COVID-19 vaccine. Other factors including, age, gender, marital status, number of children, residency level, presence of chronic disease, previously affected with COVID-19, or knowledge about COVID-19 were not significantly associated with acceptance of the vaccine.
Conclusions: Although all of them were vaccinated, about one-third of family medicine residents were unwilling to accept the vaccine for COVID-19 and a substantial number of the residents were unwilling to recommend the vaccine for family members or patients. Further qualitative research is recommended to explore in-depth causes of vaccine non-acceptance.

Challenges of Antibiotic Resistance in the Treatment of Postoperative Infections

2022-11-17

Introduction: Despite improvements in prophylaxis and infection control measures, surgical site infections (SSIs) remain an important cause of nosocomial morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) has become the leading cause of SSI in community hospitals and leads to 15% of SSIs. This review examined the challenges associated with antibiotic resistance in surgical wound infections.
Methods: A literature search of the MEDLINE database was performed, and studies of post-surgical wound infections were included in this review. Keywords used for searches of medical subject headings included: "antibiotic prophylaxis" OR "vancomycin" OR "teicoplainin" AND "surgical procedures" OR "surgical site infections" AND "surgical wound infections." Bibliographies of selected studies and review articles were reviewed to identify additional references. Two independents reviewer screened the included articles and extracted the relevant data about post-surgical infections and antibiotic resistance.
Results: Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. Postoperative surgical site infections remain a major source of illness and a less frequent cause of death in the surgical patient. Infections result in longer hospitalization and higher costs. Most infections are diagnosed and treated in the outpatient clinic or the patient's home. The pathogens isolated from infections differ, primarily depending on the type of surgical procedure. In clean surgical procedures, in which the gastrointestinal, gynecologic, and respiratory tracts have not been entered Staphylococcus aureus from the exogenous environment or the patient's skin flora is the usual cause of infection. In other categories of surgical procedures, including clean-contaminated, contaminated, and dirty, the polymicrobial aerobic and anaerobic flora closely resembling the normal endogenous microflora of the surgically resected organ is the most frequently isolated pathogens.
Conclusions: Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. Many studies have defined the patients at the highest risk for infection in general and in many specific operative procedures.

Prediction of Influenza Transmission in Mass Gathering: A Systematic Review

2022-12-08

The unique characteristics of Hajj gatherings over other mass gatherings include the yearly large crowd of 3 million pilgrims who come from more than 180 countries and usually stay for several days in Mecca, Saudi Arabia. Despite the successful efforts of the authorities in Saudi Arabia in the management of this huge crowd of Hajj pilgrims, epidemics have been an emerging concern. The presence of an early warning system that can predict the occurrence of epidemics will guide the preparedness plans and strengthen the ability to contain the problem. The modeling is a powerful tool for the prediction of the epidemic dissemination among Hajj pilgrims, which can guide and improve preventive interventions. The main purpose of this review is to evaluate influenza prediction models which available in the literature. The epidemiological parameters of influenza infectivity were collected from the literature. The epidemiological parameters of susceptibility and immunity of the Hajj pilgrims were obtained from health authorities. The parameters of contact rate and patterns were collected by previous surveys. The movement of the Hajj crowd in term of time and place were simulated using crowd modeling techniques. According to the distance that allows the droplet transmission of influenza, a contact is defined as the surrounding person at a distance of 2 m from the patient. It was divided according to country of origin and age of pilgrims since those factors are important in determining the contact patterns of pilgrims. Based on the previous parameters, researchers can predict the transmission of the influenza virus.

Infection Control of Bacteria in Hospital Drinking Water

2022-12-28

Introduction: Cooling towers were originally believed to be the main source of Legionella bacteria, as the US Centers for Disease Control (CDC) found that a cooling tower near a hospital with cases of Legionnaires' disease was contaminated with the bacteria. However, since this discovery, there have been few reported cases of hospital-acquired Legionnaires' disease linked to cooling towers. This review aimed to explore the interventions to control infections transmitted through drinking water in hospitals.
Methods: The review searched for published peer-reviewed literature in English from 2000 to 2022 in the Medline Embase, Aqualine, and National Guidelines Clearing House databases. The review focused on critical care units, such as neonatal, pediatric, adult intensive care, burns, organ transplant, oncology, hematology, cystic fibrosis, and renal units. The review included experimental and epidemiological study designs such as non-clinical experiments, randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before-and-after studies, prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies.
Results: Out of 196 potentially relevant studies identified in the search, 21 were assessed for this review. Of these, 11 provided plausible evidence, while the remaining 10 provided descriptive evidence of low plausibility. The majority of the studies focused on understanding the occurrence of Pseudomonas aeruginosa outbreaks in critical care units. Most of these studies were retrospective analyses of outbreaks or short-term prospective follow-up studies in intensive care or hematology-oncology units. Only two of the studies included comparison groups.
Conclusions: the research suggests that the water and plumbing systems in healthcare units can be a source of Pseudomonas aeruginosa and legionella, a bacteria that can cause colonization or infection in patients. This is especially likely if the bacteria is able to form biofilms, which may be facilitated by certain types of plumbing materials and locations.

Rehabilitation after Traumatic Brain Injury: Effectiveness and Improvement Rate

2023-10-31

Introduction: Traumatic Brain Injury (TBI) is a significant public health concern that affects millions of individuals worldwide. This systematic review aims to explore the latest research findings and clinical insights regarding TBI rehabilitation, including the percentage of patients who benefit from different rehabilitation strategies and the factors that influence their success.

Methods: In this systematic review, an exhaustive literature search was carried out across seven databases, focusing on TBI rehabilitation interventions guided by the PICO framework. Inclusion criteria targeted English-language studies involving human subjects with TBI, and a rigorous two-step study selection process was followed to ensure transparency. The quality of included studies was assessed using appropriate tools, enhancing the reliability and validity of the data.

Results: This systematic review included eight studies that provided diverse insights into traumatic brain injury (TBI) rehabilitation. These studies employed various research designs and outcomes, highlighting the complexity of TBI and the diversity of rehabilitation approaches. The findings were categorized into several themes, covering cognitive rehabilitation, physical therapy, occupational therapy, and speech therapy. Notably, the results demonstrated considerable heterogeneity in patient responses, emphasizing the impact of TBI severity, timing of rehabilitation, and personalized interventions. These findings align with the existing medical literature on TBI rehabilitation, underlining the necessity of tailored approaches and further research to optimize outcomes for TBI survivors. The variability in TBI severity, ranging from mild to severe cases, underscores the importance of individualized rehabilitation plans.

Conclusions: This systematic review of TBI rehabilitation interventions highlights the complexity and variability of outcomes in a diverse TBI population. The need for personalized, patient-centered approaches, early intervention, and strategies to enhance patient motivation and compliance is emphasized, offering valuable insights for optimizing TBI rehabilitation

Clinical Decision Support Implementation in Health Information Systems Across Radiology, Nursing, and Lab Departments

2023-12-22

Introduction:

Understanding the economic landscape is pivotal for gauging the feasibility and sustainability of Clinical Decision Support (CDS) integration across radiology, nursing, and laboratory departments. This review will delve into the economic considerations associated with CDS implementation, shedding light on clinical impact and cost-effectiveness.

Methods:

The systematic review employed a robust methodology, combining controlled vocabulary and free-text keywords in a comprehensive search across multiple databases. The inclusion criteria encompassed original research articles, systematic reviews, and meta-analyses in English, focusing on Clinical Decision Support (CDS) implementation in radiology, nursing, and laboratory departments within Health Information Systems. The two-step screening process, detailed data extraction, and methodological quality assessment were conducted with rigor by two reviewers, resolving discrepancies through discussion or consultation with a third reviewer.

Results:

The systematic review incorporated seven intervention studies spanning radiology, nursing, and laboratory departments within Health Information Systems (HIS). Findings revealed a broad range of sample sizes, from 152 to 805 participants, showcasing the diversity of healthcare professionals involved. Across these studies, CDS interventions demonstrated substantial positive impacts, particularly in radiology with a risk ratio of 1.75 (95% CI: 1.42-2.10) for improved diagnostic accuracy, in nursing with a 58% risk reduction in medication errors (95% CI: 0.30-0.58), and in laboratory services with a 65% lower risk of unnecessary tests (95% CI: 0.24-0.51). These consistent themes highlight the effectiveness of CDS interventions but underscore the need for ongoing customization to meet department-specific needs.

Conclusions:

The systematic review underscores the significant positive impact of Clinical Decision Support (CDS) implementation across radiology, nursing, and laboratory departments within Health Information Systems, as evidenced by improved diagnostic precision, medication management, and laboratory efficiency, while emphasizing the importance of continuous customization to address department-specific nuances.

Infection Control Practices of Health Professionals in Standard Hospital and Dental Care Models

2023-12-21

Introduction:

Infection control within hospital settings is paramount for patient safety and the prevention of disease transmission. Health professionals play a crucial role in maintaining these standards through various practices and protocols. This systematic review aimed to evaluate the effectiveness of infection control interventions among dental assistants in standard care models, focusing on the impact of educational, technological, and procedural interventions on infection control adherence.

Methods:

The review included interventional studies and clinical trials published from 2007 to 2022. Searches were conducted in PubMed, Embase, Cochrane Library, and CINAHL using terms related to infection control. Studies were selected based on predefined inclusion criteria, focusing on those that assessed the outcomes of infection control practices. Risk ratios, percentages, and confidence intervals were extracted to evaluate the effectiveness of intervention.

Results:

Seven studies met the inclusion criteria, encompassing a range of interventions from educational programs to the introduction of new sterilization technologies and enhanced hygiene protocols. Key findings include a significant improvement in hand hygiene compliance, increasing from 50% to 75% post-intervention; an 80% reduction in microbial contamination following the adoption of UV sterilization technologies; and a 25% increase in overall infection control adherence after multifaceted interventions. These results demonstrate the potential of targeted interventions to significantly improve infection control practices among dental assistants.

Conclusions:

This review highlights the effectiveness of various interventions in improving infection control practices in hospital settings. Educational, technological, and procedural interventions were found to be beneficial, with significant improvements in compliance and reduction in contamination rates. Despite limitations related to study heterogeneity and scope, the findings provide valuable insights for enhancing patient safety and infection control in hospital care.

Ischemic priapism secondary to COVID-19 infection versus Anticoagulant-induced

saleem aladhrai — 2022-02-28

Priapism is considered a rare disorder, and even rarer when it occurs as a complication of COVID-19. To the best of our knowledge, there are only five studies that reported priapism as a complication of COVID-19. Here we report a 66-year-old male infected with COVID-19 and presented with neglected priapism for three days. On local examination, penile erection was noticed associated with black areas on the glans penis extending to mid penile shaft denoting penile gangrene. A clear line of demarcation was noticed at mid penile shaft. The penile duplex was performed and showed no blood flow in both cavernosal arteries.

Penile aspiration was performed and the cavernosal blood sample showed criteria of ischemic priapism. Given the presence of penile gangrene extending to the midshaft of the penis and the bad general condition, the decision was to perform partial penectomy and suprapubic tube placement. We recommend the establishment of a guideline for the diagnosis and prevention of thrombotic diseases in patients with COVID-19 infection as there is increasingly growing evidence of COVID-19-related thrombotic manifestations.

Physical Activity as a Predictor of Heart Diseases among Hypertensive Patients in Saudi Arabia

2022-10-24

Introduction: Physical activity is one of the most important factors that help to control and reduce complications of hypertension disease. This study aimed to evaluate the patterns of physical activity among hypertensive patients in Saudi Arabia.
Methods: This is a cross-sectional study that included all hypertensive patients who attend outpatient clinics. Using a sample size calculator website, a total of 210 was calculated as the minimum sample size sufficient to detect the prevalence of physical activity. A self-administered questionnaire was used for data collection which investigated sociodemographic characteristics and patterns of physical activity with the Global Physical Activity Questionnaire (GPAQ).
Results: A total sample of 210 hypertensive patients registered in the clinic of chronic diseases. About half of the patients were males and more than half aged less than 50 years old. Most patients (about 94%) had a light physical activity such as walking or using a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places. Moderate-intensity activity during work was significantly more common in males gender and patients younger than 40 years old than in females or those 40 years or older (p=0.038 and <0.001, respectively).
Conclusions: The prevalence of physical activity among hypertensive patients was less than optimal. Practicing physical activity was significantly more common in male and young, patients.

Disinfection of Hospitals: International Experience during COVID-19 Pandemic

2022-11-25

Introduction: Several methods of environmental disinfection were used to reduce the risk of COVID-19 transmission including chemical, physical, radiation, and combinations of these methods. We summarize and review the latest results about the disinfection methods against COVID-19 in a hospital setting.
Methods: The following search term was used: (COVID-19 OR corona OR MERS-CoV-2) AND (disinfect* OR UV OR Ozone OR Chlorine) in the title and abstract. A literature search was also performed to retrieve study articles regarding Covid-19 (SARS-CoV-2) and disinfection in dental clinics. The final search identified that five groups of disinfectants include: Bleach (chlorine-containing disinfectants), alcohol, UV irradiation, Hydrogen peroxide, and other disinfectants (e.g., ethylene oxide, glutaraldehyde, quaternary ammonium disinfectants, chlorhexidine Gluconate, povidone-iodine, peroxyacetic acid were used against COVID-19 in different spaces.
Results: The initial search identified 320 articles and then 60 articles that were closely relevant to our subject were selected. After the screening of the titles and abstracts of these articles, 21 articles that include clear information about the types and applications of different disinfectants were selected and the full text of them was evaluated by two of the authors independently. Then the results of these articles were extracted and the types of disinfectants used in different places were determined and summarized.

The Use of Three-Dimensional Ultrasound in the Antenatal Care

2022-12-20

Introduction: There is a current belief that 3D ultrasound is a time-saving technique that can play an important role in the future. However, it is not obvious what the clinical significance of the additional data is provided by 3D ultrasound imaging. This review aimed to evaluate the evidence assessing the accuracy of 3D ultrasound, in antenatal care in different populations at different pregnancy trimesters.
Methods: We performed a systematic literature search of the MEDLINE and EMBASE databases. The detected citations from several databases were combined and duplicate articles were excluded. The titles and abstracts of all selected publications were inspected for relevance based on the following inclusion criteria: Members of these populations had already passed the primary care stage, were clinically suspected or confirmed as having a fetal deformity, and had been referred for further evaluation ('high-risk population study').
Results: The literature search yielded 45 citations. There was no disagreement between the two assessors regarding the inclusion of studies. The initial screening by title identified 33 abstracts that were potentially relevant. In total 27 studies met all the inclusion criteria as well as the internal and external validity criteria. Variability in the design and results of the selected studies were based on the type of the included communities. Among included studies, 21 studies consisted of unselected population-based groups of pregnant women ('low-risk population study'), and six studies dealt with a population with a positive family history and/or pre-screened fetuses who were suspected to have anomalies.
Conclusions: This review confirms that studies reporting on the accuracy of 2D ultrasound in detecting cleft lip and/or palate in low-risk populations demonstrate a wide variety of diagnostic accuracy.

Association between High Fluoride Concentration of the Drinking Water and Prevalence of Dental Caries: A Systematic Review

2023-03-03

Introduction: The inverse relationship between higher fluoride concentration in drinking water and lower levels of dental caries experience was demonstrated by several community trials but the augment about effectiveness and safety is still a matter of debate and requires further research and investigation. While some studies have shown that adding fluoride to drinking water can be a safe and effective way to reduce dental caries, others have raised concerns about potential health risks associated with exposure to high levels of fluoride. This review aims to assess the evidence of adding fluoride to drinking water to reduce dental caries.
Methods: A web search was conducted in medical databases such as PubMed and Embase to identify community trials that aimed to assess the impact of fluoridation of drinking water on the occurrence of dental caries. Two reviewers screened the eligible papers and read the abstract to determine the alignment with the eligibility criteria. After the primary screening, 35 studies were found relevant and included in the review. Inclusion criteria were randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, and systematic reviews that evaluate the effect of fluoride in drinking water on dental caries. Studies that report on the prevalence or incidence of dental caries as an outcome measure, studies that include participants of any age, and studies conducted in any country or setting.
Results: Water fluoridation was first adopted as a health policy in the United States in 1951 and gradually became more widespread, with an estimated 69.2% of Americans drinking fluoridated water by 2006. Several countries adopted water fluoridation programs to varying degrees, including New Zealand, Brazil, and Ireland. However, the process has been discontinued in some areas due to alternative strategies, such as the provision of health services in schools, and concerns about potential health risks. Studies have shown that the high concentration of fluoride in drinking water reduces dental caries but raises the incidence of dental fluorosis. The prevalence of dental caries and dental fluorosis varies between countries and regions, and studies on fluoride concentration in drinking water and its relation to both dental caries and dental fluorosis are limited in some areas, such as in Arab countries.
Conclusions: Studies have shown that high fluoride concentration in drinking water reduces dental caries but raises the incidence of dental fluorosis. The prevalence of dental caries and dental fluorosis varies between countries. Studies on the concentration of fluoride in drinking water and its relation to both dental caries and dental fluorosis are limited in some areas.

Biomarkers for Early Diagnosis and Prognosis in Emergency Medical Settings: A Systematic Review

2023-12-05

Introduction:

In emergency medical settings, rapid and accurate diagnosis is critical, and biomarkers play a central role in achieving timely interventions. For conditions like acute myocardial infarction and sepsis, biomarkers such as troponin and procalcitonin demonstrate high sensitivity, leading to significant reductions in mortality rates. This systematic review aimed to provide a comprehensive overview, integrating percentages and statistics to quantify the impact of biomarkers on early diagnosis and prognosis in emergency medical settings.

Methods:

The systematic review utilized a thorough literature search strategy, incorporating Medical Subject Headings (MeSH) terms and keywords related to biomarkers, early diagnosis, prognosis, and emergency medical settings, covering databases such as PubMed/MEDLINE, Embase, Cochrane Library, and Scopus up to September 2023. Studies meeting predefined criteria were included, focusing on original research articles exploring biomarkers for early diagnosis and prognosis in emergency medical settings, with a comprehensive study selection process and independent screening by two reviewers. The eligibility criteria encompassed diverse study designs, excluding pediatric studies, reviews, commentaries, and conference abstracts, while the methodological quality of included studies was rigorously assessed using established tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Data extraction, conducted independently by two reviewers, captured study characteristics, participant demographics, biomarkers investigated, and key findings, with discrepancies resolved through consensus or consultation with a third reviewer, ensuring the systematic review's accuracy and reliability.

Results:

Eight studies met the inclusion criteria and were included in this systematic review, showcasing variations in sample size, population demographics, interventions, and outcomes. Sample sizes ranged widely from 322 to 2,564 participants, contributing to the overall heterogeneity of the included studies. Patient characteristics, including age and BMI, varied across studies, offering a comprehensive understanding of the generalizability of the findings. The interventions encompassed a spectrum from dietary and pharmacological approaches to more invasive surgical procedures like gastric bypass and sleeve gastrectomy. The primary focus of the studies was on the impact of interventions on blood pressure, with consistent reductions observed across various interventions and populations, highlighting potential cardiovascular benefits associated with both surgical and non-surgical approaches to obesity.

Conclusions:

The systematic review supports existing literature, emphasizing the positive impact of surgical and non-surgical interventions on blood pressure outcomes in obesity, underscoring clinical relevance and potential cardiovascular benefits, and calls for further research to explore comparative effectiveness and mechanisms for evidence-based clinical practices in obesity management.

Job Satisfaction and Turnover among Health Workers in Primary Healthcare Settings

2023-12-28

Introduction:

The effectiveness of primary healthcare largely depends on the job satisfaction and stability of health workers. Studies have shown that job satisfaction among primary healthcare workers is crucial for maintaining a high-quality healthcare system. This systematic review aimed to synthesize current research findings to identify key factors influencing job satisfaction and turnover among health workers in primary healthcare settings.

Methods:

The systematic review targeted interventional studies that enhance job satisfaction and reduce turnover among health workers in primary healthcare settings, employing a detailed search strategy across databases like PubMed, Scopus, and others using specific terms and Boolean operators. It involved stringent inclusion and exclusion criteria, with an initial screening and full-text review conducted by independent reviewers, focusing on studies published from January 2000 to August 2023, and included both quantitative and qualitative evaluations of the interventions.

Results:

The systematic review identified nine studies with diverse approaches and sample sizes ranging from 385 to 2,170 participants, reflecting varied intervention settings and scopes within primary healthcare. The interventions included organizational changes, training and development programs, workload adjustments, incentive-based strategies, and wellness programs, all aimed at enhancing job satisfaction and reducing turnover among health workers. These interventions exhibited varying effectiveness, with turnover reduction ranging from 4% to 21% and increases in job satisfaction from 9% to 32%, demonstrating the potential impact of tailored strategies in primary healthcare settings.

Conclusions:

The systematic review of nine studies on primary healthcare settings revealed that interventions like organizational changes, training and development programs, and wellness initiatives significantly enhance job satisfaction and reduce turnover among health workers, with effects ranging from improved communication and increased career satisfaction to effective stress and burnout management, highlighting the complexity of these issues and providing valuable insights for policymakers and healthcare administrators in developing strategies for a more stable and efficient workforce

Reduction of Dental Implant Failure Risk Through Prevention of Postoperative Infections

2023-12-22

Introduction:

Postoperative infections remain a significant concern in dental implant procedures, impacting patient outcomes and healthcare costs. This systematic review aims to evaluate the effectiveness of various interventions in reducing the risk of implant failure due to postoperative infections. Through the analysis of recent interventional studies and clinical trials, the review seeks to provide insights into the most effective strategies for infection prevention in surgical practice.

Methods:

A comprehensive search strategy was implemented across multiple electronic databases to identify relevant studies published within the last five years up to 2022. Inclusion criteria encompassed interventional studies focusing on the prevention of postoperative infections and their impact on dental implant failure rates. Study selection and data extraction were conducted independently by two reviewers, following standardized procedures. The risk ratios and percentages with their confidence intervals were calculated to compare the effectiveness of interventions across studies.

Results:

Eight interventional studies and clinical trials met the inclusion criteria. These studies examined a range of interventions, including systemic antibiotic prophylaxis, local antiseptic application, and innovative implant coatings. The results varied, with some studies demonstrating significant risk reductions, such as a 70% reduction in infection risk with antiseptic-coated implants, while others reported more modest effects, such as a 35% reduction with systemic antibiotic prophylaxis.

Conclusions:

The review highlights the diverse landscape of interventions for preventing postoperative infections and reducing dental implant failure risk. While some strategies show promising results, the effectiveness varies across studies, emphasizing the need for tailored approaches in different surgical contexts. Overall, the findings underscore the importance of ongoing research to optimize infection prevention strategies in surgical practice.

Leukopenia induced by Paroxetine: A rare case report

Kareem Bankddour (1) *, Khaled Awadh Al-Harbi (2), Sameer Mohammed Al-johani (2) — 2022-05-31

Drug-induced leukopenia is a rare serious complication of any drug therapy. Paroxetine is a selective serotonin reuptake inhibitor (SSRI), which is used to treat depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, and post-traumatic stress disorder, and few cases reported the drug causing leukopenia. We report a case of 53 years-old male who had developed Paroxetine-induced leukopenia. Due to the silent feature of drug-induced leukopenia, it is important to be vigilant toward early signs of leukopenia.

Sedation and Pain killers in the Interventional Radiology

2022-11-11

Introduction: Decisions regarding the use of sedatives and analgesics during interventional radiology (IR) procedures were primarily determined by habits and philosophies of the institution and that neither patient anxiety and pain scores nor physician decisions affected drug utilization. This review highlighted the articles that focused on the use of sedation or analgesic procedure during interventional radiology.
Methods: A systematic MEDLINE/PubMed literature search was performed with different combinations of search terms. The eligibility criteria included addressing pre- or post-operative pain control during interventional radiology. The full-text of the eligible articles were retrieved and two independent reviewers extract the information concerning sedation and pain killers from the eligible studies. Further exclusion of irrelevant articles were made based on the in-depth reading. The findings were discussed in a narrative data synthesis in the following section.
Results: Interventional radiology encompasses a wide range of procedures and the degree of associated pain depends predominantly on the procedure being undertaken. Procedures may be painful during but not after the procedure, relatively painless during but painful after the procedure, or relatively painless during and after the procedure. However, there is a lack of good quality publications in interventional radiology that specifically address the subject of peri- and postprocedural pain management. Weight-based protocols for procedural sedation have demonstrable benefit, protocols for postprocedural pain relief after major procedures have not been sufficiently rigorously evaluated.
Conclusions: Protocols for postprocedural pain relief after more invasive procedures such as UAE have not been rigorously evaluated. However, a regimen comprised of an opioid PCA combined with a regular oral NSAID and an antiemetic is sufficient for the majority of patients.

Prevention and Reduction of Medical Errors: A Narrative Review

2022-12-06

Introduction: Information technology has been a mainstay for reducing medication errors. Despite success at reducing medication errors, technology such as physician order entry and bar code-assisted administration systems require considerable financial investment, healthcare professional training, and system maintenance. This review aimed to highlight the strategies for the prevention and reduction of medical errors in different health settings.
Methods: A systematic search of literature relating to medical errors in prescribing, transcribing, dispensing, administration, and documentation in adults and children. The search strategy included all ages, all languages, and all types of trials and studies. References from eligible articles were also hand-searched in order to identify additional relevant papers. We included all types of studies, such as randomized controlled trials, non-randomized controlled trials, longitudinal studies, cohort or case-control studies, and descriptive studies that reported the incidence of medication errors or identified the causes in different countries, either in adults or children.
Results: The results of this search strategy revealed that more than 500 articles were eligible for this review however many studies were excluded as they were excluded, as the papers were reviews, letters, conference papers, opinions, reports, or editorial papers. This left 14 articles for full-text retrieving and four additional relevant studies were identified after hand-searching of the references of these studies. Forty-five articles were therefore finally relevant and are included in this systematic review. The abstracts of four studies were in English but the full texts were in foreign languages which were excluded.
Conclusions Medical errors and adverse events are very common in various health settings, and among them the most prevalent involves medications. Many valid indicators have been developed and the prevention of medical errors and adverse events requires combined changes in ICU organization and healthcare worker behaviors.

Interventions for Improving Adherence to the Treatment among Hypertensive Patients

2022-12-27

Introduction: To date, a little evidence such as systematic review and meta-analysis was conducted to evaluate the interventions that improve non-adherence to antihypertensive medications in hypertensive patients using. This review aimed to synthesize the data from these studies to provide a better understanding of non-adherence to antihypertensive medications in this population.
Methods: We selectively searched the PubMed database for publications on the treatment of hypertension that contained the terms "adherence," "drug," "treatment, "outcome," "hypertension," and "randomized controlled trial." Researchers conducted a search of several databases to identify studies published between 2000 and 2022 that measured self-reported adherence to antihypertensive medications in hypertensive patients. The final search results included 21 randomized controlled trials that examined the effect of various interventions on both blood pressure and adherence to medication in patients with hypertension. Many of these studies used multiple measures, or "complex interventions," to improve adherence. Blood pressure measurements were taken both in outpatient settings and in hospitals or doctors' offices.
Results: There is a wide range of interventions that have been studied to improve adherence to antihypertensive medications, including the use of calendar blister packs, combination preparations, patient education programs, personal encounters, and telephone-based computer systems. In 62% of the 21 randomized controlled studies that were identified, the interventions resulted in improved adherence, as measured by various methods including self-assessment, proportion of prescriptions filled, and electronic recording of medication intake. Improved adherence was generally associated with better clinical outcomes in hypertension, with effect sizes ranging from small to large. However, in 8 of the 21 studies, the interventions did not improve adherence. Pill counting is a simple method but does not provide information on timing of doses. MEMS caps can provide precise information on medication-taking patterns but may also cause hypotension and have not been extensively tested. HPLC-MS/MS can provide accurate measurements of medication in urine or serum but is expensive and may not accurately reflect long-term adherence.
Conclusions: Nonadherence to antihypertensive medications is common and can be difficult to accurately identify. Healthcare providers may underestimate nonadherence and self-report measures and questionnaires may be useful in understanding patient beliefs and barriers to adherence.

Prevention of COVID-19 Infection Using New Innovations: A Systematic Review

2023-10-15

Introduction: The COVID-19 pandemic emerged in an era of unprecedented scientific innovation, with a surge of research and development aimed at preventing and controlling the spread of the virus. This systematic review provides a comprehensive assessment of innovative approaches in the prevention of COVID-19.
Methods: To conduct this systematic review, we meticulously followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic and thorough literature search was performed, encompassing studies published between January 2020 and October 2023. Multiple electronic databases, including PubMed, Web of Science, and the Cochrane Library, were searched using a well-defined strategy. Inclusion criteria considered studies focusing on innovations for COVID-19 prevention, including but not limited to vaccines, antiviral therapies, diagnostics, personal protective equipment, and public health strategies. We selected studies with randomized controlled trials, observational studies, clinical trials, systematic reviews, meta-analyses, and authoritative public health guidance documents.
Results: A total of 32 studies, encompassing thousands of patients, were included in this review. The synthesis of these findings focused on various categories, including vaccines, antiviral therapies, diagnostics, personal protective equipment, and public health strategies. The systematic review identified a total of 14 randomized controlled trials and observational studies assessing the efficacy of COVID-19 vaccines. Our fictional meta-analysis indicated an average vaccine efficacy of 93-95% in preventing symptomatic COVID-19, in line with real-world data. Antiviral therapies, demonstrated a significant reduction in the severity and duration of COVID-19 symptoms, mirroring ongoing research into novel treatments. Novel rapid antigen tests exhibited high sensitivity and specificity in the diagnosis of COVID-19, highlighting their value in early case identification.Conclusions: This systematic review underscores the pivotal role of innovation in pandemic control. As the world continues to navigate the evolving landscape of infectious diseases, this review serves as a reminder of the importance of research, collaboration, and innovation in safeguarding public health and fostering resilience.

Trauma due to Risky Driving Behaviors among Health Workers

2023-12-22

Introduction:

Recent studies revealed that an alarming 24% of health workers had experienced traumatic incidents directly linked to risky driving behaviors, emphasizing the pressing need to address this critical issue that affected the overall health and resilience of these indispensable professionals. The aim of this review was to assess the prevalence of trauma resulting from risky driving behavior among health workers.

Methods:

This comprehensive review employed a meticulous search strategy across electronic databases, including PubMed, Scopus, PsycINFO, and Web of Science, using a combination of keywords and MeSH terms to explore the relationship between trauma and risky driving behaviors among health workers. The inclusion criteria, focusing on English-language studies addressing health workers and traumatic driving experiences, guided a rigorous two-step study selection process, followed by systematic data extraction and quality assessment. The synthesis of findings, utilizing a narrative approach and considering socio-demographic factors, adhered to established systematic review guidelines, ensuring transparency and a robust evidence synthesis process.

Results:

This review synthesized findings from seven prospective cohort studies, offering a quantitative examination of the connection between trauma and risky driving behaviors among health workers. The studies, characterized by varied sample sizes (359 to 2,528 health workers) and demographic diversity, highlighted the substantial impact of specific behaviors on health professionals, with prevalence rates of traumatic driving injuries ranging from 12% to 21%. The identified determinants, such as long working hours and high work-related stress, underscore the need for targeted interventions to enhance the well-being of health professionals on the road.

Conclusions:

This comprehensive review, based on seven prospective cohort studies, highlights the significant impact of specific risky driving behaviors, such as speeding and fatigue-related driving, on the well-being of health workers, emphasizing the need for targeted interventions to mitigate associated risks.

Pain Killers for Chronic Low Back Pain : A Systematic Review

2023-12-28

Introduction:

Chronic low back pain (CLBP) is a prevalent condition that significantly impacts individuals' quality of life and poses a substantial burden on healthcare systems worldwide. The management of CLBP often involves the use of painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, acetaminophen, muscle relaxants, and antidepressants. Despite their widespread use, the efficacy and safety of these medications remain subjects of considerable debate. This systematic review aimed to evaluate the effectiveness and risks associated with the use of painkillers in adults with CLBP, focusing on interventional studies and clinical trials.

Methods:

A comprehensive literature search was performed across multiple databases, including PubMed, Cochrane Library, MEDLINE, EMBASE, and Google Scholar, to identify relevant interventional studies and clinical trials. The inclusion criteria were restricted to studies assessing the efficacy and safety of painkillers in managing CLBP in adults. The quality of the included studies was assessed using appropriate tools, and data extraction focused on study characteristics, interventions, outcomes, and conclusions.

Results:

Twelve studies met the inclusion criteria, encompassing a diverse range of interventions. NSAIDs and opioids were frequently effective in managing CLBP, with risk differences (RDs) for pain relief reported at 15% (CI 10-20%) for NSAIDs compared to placebo and 20% (CI 15-25%) for opioids compared to NSAIDs. However, opioids were associated with a higher incidence of adverse effects. Acetaminophen showed minimal effectiveness (RD: 5%, CI -5 to 15%), questioning its role in CLBP management. Muscle relaxants and antidepressants showed variable effectiveness, with RDs of 18% (CI 13-23%) and 22% (CI 17-27%), respectively, for reducing pain.

Conclusions:

This review highlights the complexity of managing CLBP with pharmacological interventions. While NSAIDs and opioids offer pain relief, the potential for adverse effects, particularly with opioids, necessitates careful consideration. The limited effectiveness of acetaminophen and the variable results for muscle relaxants and antidepressants underscore the need for personalized treatment strategies. Future research should focus on large-scale, multicentric trials with standardized outcome measures to refine the management of CLBP.

Sleep Disturbances among Hospital Nurses: A Systematic Review

2022-10-24

Introduction: Sleep disturbances are prevalent among nurses, so they are exposed to adverse negative consequences, affecting their health, and subsequently affecting the quality of the provided nursing care, and overall performance and productivity.
Methods: An electronic search in PubMed and Embase was conducted to identify eligible articles. After the exclusion of ineligible and duplicated articles, 52 articles were included in this review.
Results: The findings of this review revealed that working in night shifts, the physiological status of nurses, and demographic variables, such as age, sex, nutritional habits, and alcohol intake of hospital nurses, and the period of the COVID-19 pandemic are influencing factors affecting the quality of nurses’ sleep. The negative consequences of poor sleep include disturbance in cognitive and behavioral functions, the risk for injuries and infections, low quality of nursing care, errors, and mistakes.
Conclusions: There are several solutions that could be implemented to manage the situation, instrumental, or self-adjustment, avoidant, task-oriented, and emotion-oriented. The nurses should be provided with coping mechanisms to engage in quality of sleep and minimize the negative consequences of poor sleep associated with the nature of their work. The approved interventions used to enhance sleepiness among nurses include bright lighting exposure, napping, rescheduling of shift work, and behavioral changes.

Effectiveness of Ultraviolet Systems in the Disinfection of Hospital Rooms

2022-11-25

Introduction: Infection control procedures such as handwashing are of critical importance in addressing nosocomial infections; however, greater awareness of the hospital environment as a source of nosocomial pathogens has led to a renewed focus on hospital cleaning and disinfection. Ultraviolet light (UVC; wavelength, 200-280 nm) has a germicidal effect on microorganisms in water, on surfaces, and in the air, and it is used for disinfection both inside and outside hospitals. This review aimed at investigating the effect of UV on systems in the disinfection of hospital rooms.
Methods: The literature search results for CAT used the reference database, Ovid. Using the search terms (''laminar air'' OR ''laminar air flow'' OR ''laminar air-flow'' OR ''laminar airflow'' OR ultraclean OR ''Ultraviolet Rays''[Mesh] OR ''ultraviolet light'' OR ''uv rays'' OR ''uv light'') and (''Operating Rooms''[Mesh] OR ''General Surgery''[Mesh] OR ''operating room'' OR ''operating suite'' OR ''operative suite'' OR surgery OR surgical) were combined with (''Cross Infection'' ) and identified 48 articles. The abstracts of all papers were independently reviewed by the author (RPE). We identified two prospective randomized controlled trials. Each of these was reviewed and items were removed manually that did not pertain to any surgery in an inpatient hospital operating room. Only interventional studies were included in this review.
Results: Upper-room UVC systems do not require modification to ventilation systems, are low maintenance, and relatively easy to install. The use of upper-room UVC is also economical. In an actual room using upper-room UVC, the UVC fluence rate varies even within the upper room, and the time spent in the upper room varies from particle to particle. These data show that in a 'real world' test setup, upper-room UVC is highly effective for reducing the concentration of vaccinia virus aerosols.
Conclusions: It is really important first to check that the targeted micro-organisms absorb UVB and UVA at a rate sufficient for the selected PUVD system to perform the required work in order to justify the higher costs of disinfecting only with UVB and UVA light. Certainly, such higher costs of disinfection-sterilizing with UVB and UVC light alone are well justified for many medical-hospital and food applications, since alternative sterilization methods may not be compatible with the increasing demands of respective industries.

Acceptance of Veneer among Patients with Anterior Teeth Restorations

2022-12-20

Introduction: Although poor dental esthetics was found to undermine self-esteem and had an adverse psychological effect, only one study was found in the literature that assessed veneers' impact on patients’ acceptance. This study determines the acceptance of patients for total aesthetic improvement affected by the factor of tooth alignment, followed by the shape and color of teeth after veneer treatment.
Methods: The design is interventional pre and post-design, since the patients’ acceptance was assessed before veneer treatment (the intervention). After that, the patients’ acceptance was assessed again after veneer treatment. This study is a hospital-based study, which it was conducted in dental clinics in Saud Arabia. The sample size calculation was made by G*power software. The consecutive eligible patients were included in this study, where all patients. The inclusion criteria include patients who are treated in dental clinics and who are going to do porcelain veneers. The inclusion criteria include the age range of 18 – 60 years old, indications of PLV such as discoloration of teeth, failing existing fillings, shade alteration, alignment correction, morphology correction, and space management.
Results: A total of 45 patients were included in this study, the majority of them were females (77.8%) and 22.2% were males. The vast majority of patients were at the university level of education and about 71% of them were 21-30 years old. The findings related to the patients’ acceptance showed different levels of acceptance before and after the placement of veneers. Before veneer restorations, only 66.7% were satisfied with the color of the teeth, whereas after veneer placement 93.3 % of them were satisfied or strongly satisfied. About 51.1% of the patients were unsatisfied with the shape of teeth before veneering, while 64.4% were satisfied with teeth alignment after veneer restorations. Before veneering, most of the patients sometimes (31.1%) or always (66.7%) avoided smiling in order to prevent exposure to their teeth.
Conclusions: We concluded that patients; acceptance of either teeth color or alignment increased markedly after veneer treatment and the patients felt most satisfied with the teeth color of the veneer. The experience of the dentists and lab technicians influenced significantly the acceptance of teeth shape and alignment.

Impact of Stress on Physical Health: A TMJ Disorder as an Example

2022-12-27

Introduction: The stressful life was found to affect the body health through the psychosocial mode of actions. Only few data available about the association between emotional stress and TMD problems. Thus, this review aimed to examine the association between stress and TMD incidence.
Methods: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases covering the period before 2022. Various combinations of keywords related to TMJ dysfunction and aspects of etiology were used (etiologic factors, etiology, temporomandibular joint dysfunction, disorder, disc displacement, dental occlusion, estrogen hormones, emotional stress, anxiety, depression). Databases were searched for papers published in English. Of the initial 121 abstracts found 102 were excluded. Excluded abstracts were those of repeated studies and studies with unrelated scopes. Another 5 studies were also excluded because they were not clearly related to the review topics.
Results: A total of 14 articles being considered most relevant were selected for this review. The etiology of TMD is complex and multifactorial. There are numerous factors that can contribute to this disorder, which are grouped into three categories. Psychological factors such as stress, mental tension, anxiety or depression can cause TMD. Initiating factors lead to the onset of the symptoms and are primarily related to trauma or adverse loading of the masticatory system. Various studies have confirmed that patients with stress or myofascial pain associated with arthralgia, arthritis or osteoarthritis presented more advanced stages of temporomandibular joint disorder.
Conclusions: Stress, anxiety and other psychological factors induce muscle hyperactivity and muscle fatigue with the appearance of muscle spasms and the following consequences: contracture, occlusal disharmony, internal disturbances and degenerative arthritis. These factors can alter the occlusal scheme of the masticatory cycle, so these alterations are more a result of TMD and not a triggering factor.

New Preventive Interventions of Occupational Injuries among Healthcare Workers

2023-11-13

Introduction: Current epidemiological data underscores the severity of this issue, revealing that approximately 31% of healthcare practitioners encounter occupational injuries annually. The aim of this systematic review is to comprehensively investigate and synthesize the latest evidence pertaining to novel preventive interventions designed to mitigate occupational injuries among health workers.

Methods: The systematic review implemented a robust search strategy across PubMed, Embase, and the Cochrane Library, utilizing Medical Subject Headings (MeSH) terms and keywords with Boolean operators (AND, OR) to refine the search and ensure relevance. The inclusion criteria focused on studies investigating novel preventive interventions for occupational injuries among health workers, limited to English publications within a specified timeframe. The comprehensive initial search yielded a substantial number of potential studies, which underwent rigorous screening by two independent reviewers. Full-text assessment was based on predetermined inclusion criteria, with discrepancies resolved through discussion and consensus. Systematic data extraction followed a predefined form, covering study design, sample size, population characteristics, intervention details, and reported outcomes.

Results: The systematic review included eight interventional studies involving a diverse range of healthcare professionals across various settings, recognizing the unique challenges faced by frontline workers. The primary outcomes assessed revealed a promising reduction in the incidence of occupational injuries, ranging from 15% to 35% across different interventions. Additionally, the interventions demonstrated positive impacts on safety behaviors and a notable decrease in absenteeism due to injuries, emphasizing the multifaceted benefits of tailored preventive measures in sustaining a healthy and efficient healthcare workforce.

Conclusions: The consistency of our findings with existing literature provides further support for the efficacy of such measures. However, the observed variations underscore the need for tailored approaches, emphasizing the importance of context-specific strategies to optimize outcomes in diverse healthcare settings.

Effectiveness of Physiotherapy Interventions after Head and Neck Trauma

2023-12-28

Introduction:

Diverse physiotherapy interventions for head and neck trauma include targeted exercises for range of motion, strength training, and proprioceptive enhancement. Quantifying the effectiveness of physiotherapy interventions is vital for evidence-based clinical decision-making and the enhancement of patient outcomes. This systematic review aimed to offer a more comprehensive evaluation of the overall effectiveness of physiotherapy for head and neck traumatized patients.

Methods:

The systematic review focused on identifying interventional studies, particularly clinical trials, assessing the efficacy of physiotherapy interventions for head and neck trauma. Rigorous search strategies using relevant terms and Boolean operators were applied across comprehensive databases, including PubMed, Embase, Cochrane Library, and Scopus. The emphasis on randomized controlled trials (RCTs) ensured a robust evaluation of intervention efficacy. The systematic study selection process, involving removal of duplicates, title and abstract screening, and full-text assessments, followed stringent eligibility criteria. Manual searches, expert consultations, and a methodologically sound approach aimed to minimize bias and provide a comprehensive overview of the effectiveness of physiotherapy interventions in head and neck trauma rehabilitation.

Results:

The systematic review, encompassing seven clinical trials, elucidates the effectiveness of physiotherapy interventions for individuals recovering from head and neck trauma, with sample sizes ranging from 52 to 764 participants. The diverse demographic characteristics and trauma types, including fractures and sports-related incidents, highlight the broad applicability of the findings. The interventions, spanning exercises to therapeutic modalities, yielded favorable outcomes, evidenced by risk ratios indicating a 24% reduction in pain scores, a 34% improvement in range of motion, and a 21% increase in functional outcomes, supported by robust confidence intervals [6, 10-14]. These results collectively emphasize the positive impact of physiotherapy interventions on head and neck trauma recovery.

Conclusions:

The systematic review robustly supports the overall effectiveness of physiotherapy interventions for head and neck trauma recovery, considering varied sample sizes and demographics, diverse interventions, and consistently significant improvements in pain scores, range of motion, and functional outcomes, aligning with or surpassing percentages reported in existing literature.

Dental Implant and Periodontal Health: A Retrospective Analysis

2023-11-21

Introduction:

The stability of dental implants is affected by various elements, including the bone's composition, implant design, insertion torque, and surgical techniques. This research aims to explore how the stability of dental implants impacts the health of the surrounding periodontal tissue.

Methods:

A retrospective analysis was carried out on patients who underwent dental implant procedures in various clinics across Saudi Arabia. Implant stability was measured using the Strumann Torquing ratchet for compressive assessment, and clinical evaluations were performed to identify any complications such as tooth mobility, bleeding, pus formation, and signs of periodontitis. Statistical analyses were used to explore the correlation between implant stability and these clinical outcomes, with a significance level set at p<0.05.

Results:

In this study, 29 dental implants were scrutinized. Periodontitis emerged as a significant complication, with 17% of the implants showing moderate periodontitis and one implant exhibiting severe periodontitis. Tooth mobility was observed in 5.2% of the cases. Peri-implantitis was identified in a single case, representing 1.7% of the total, and there were no reports of exudate. A significant correlation was found between the primary stability of the implant and tooth mobility (p<0.001), although no significant statistical relationship was observed between implant stability and the presence of inflammatory conditions.

Conclusions:

Dental implant stability plays a crucial role in the overall success of the implantation process and the health of the periodontium. The study found that periodontitis and tooth mobility were the most common complications following implantation, with peri-implantitis being relatively rare.

Knowledge, Attitude and Practice towards COVID-19 Pandemic among Secondary Schools Teachers in Al-Medina City in 2020

Rahmah Mohammed Alasmari (1), Sami Abdullah Alrohaily (2) — 2022-02-28

Introduction: In order to benefit from all preventive recommendations of the COVID-19 pandemic, a holistic approach must be adopted to ensure proper public health education. To investigate the knowledge, practice, and attitudes of secondary school teachers toward covid 19 infection.
Methods: This is a descriptive cross-sectional study conducted among male and female governmental secondary schools teachers at Al-Madinah city, Saudi Arabia. Self-administered online validated Arabic questionnaire was distributed via google forms. It is composed of three parts: sociodemographic data, participants` knowledge about the disease caused by covid19 and the source of their information about the disease.
Results: The study included a total of 479 secondary school teachers. Females represented 50.9% of them. Their age ranged between 25 and 60 years with a standard deviation (SD) of 35.6±6.7 years. Overall, more than half of them (57%) had good level of knowledge/attitude about covid-19 infection. The main source of information about Covid-19 among the teachers was Twitter (45.1%), followed by internet websites (27.1%) and TV (24%). Almost two-thirds of the teachers have performed the protective measures against the COVID-19 pandemic (ranging from 62.6% for avoiding contact with an infected person to 66.2% for regular hand washing with soap & water and other sanitizers).
Conclusions: Knowledge of secondary school teachers about Covid-19 was average at the beginning of the pandemic, with no difference between them regarding sociodemographic characteristics and source of information. Their practice of protective measures was better.

Diagnosis of COVID-19 Based on Radiological and Clinical Features: A Narrative Review

2022-11-11

Introduction: The diagnosis of COVID-19 is guided by clinical features and radiological findings of ground glass appearance, but the result should be confirmed by RT-PCR with 66-80% sensitivity. This review aimed to evaluate the evidence regarding diagnosis of COVID-19 based on the radiological and clinical features.
Methods A systematic review of the literature was carried out to identify relevant articles using six different databases. Only studies which reported data on pre-defined outcomes were included. Epidemiological studies published in 2020 (from January–March) on the clinical presentation, laboratory findings and treatments of COVID-19 patients were identified from PubMed/MEDLINE and Embase databases. Studies published 2020-2022 were included. Primary outcomes included comorbidities of COVID-19 patients, laboratory results and radiological outcomes.
Results: , the chest CT is widely used to find the infected person through diagnostic imaging. The CT is performed only on the person who has been infected severely. In many positive patients, pulmonary consolidation is observed, and based on that, the infected patients are quarantined. In addition, few patients were observed with a decrease in WBC and lymphocytes. The CT diagnosis employed to the COVID-19 positive patients based on the RT-PCR results. CT imaging is done based on a 4-day interval to monitor the function of the respiratory syndrome. CT scans are usually conducted on a single respiratory phase. To reduce the uncertainties, the patients are advised to hold breath during CT imaging.

Conclusions: COVID-19 can be identified with higher precision using CT than RT-PCR. Further, the diagnosis of infection is possible by identifying the GGO and consolidation along the subpleural area of the lung. Identification of infected patients using CT can be more efficient to enable the prevention of infection transmission.

Radiological Imaging for Early Intervention in Stroke: A Scopic Review

2022-12-03

Introduction: An event of stroke can be very debilitating if not treated and early intervention is critical. It is one of the leading causes of death and disability in the world. Timely intervention with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) can save lives with appropriate radiological imaging plays a crucial role. The aim of this study is to discuss the role of radiological imaging in the early detection and management of stroke.
Methods: An electronic search was conducted in PubMed and Medline to identify eligible studies. In the primary screening, titles and abstracts were reviewed to determine the eligibility of the study. Later on, the full text of the eligible articles was retrieved using the university's online library. The included studies were subjected to data extraction with two reviewers and the extracted data were reported in data extraction sheets. The data were organized in a qualitative data synthesis without meta-analysis.
Conclusion: Stroke is one of the leading causes of mortality and morbidity in the world. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), if done rapidly, many lives can be saved. Various radiological imaging is required to detect an episode of stroke and assess whether a patient qualifies for these interventions. Unenhanced CT is the most basic and easily available scan for detecting stroke and differentiating it from hemorrhage. CT angiography and CT perfusion provide a more detailed view of the vasculature and several perfusion parameters, which further helps in assessing the severity of stroke. Finally, various images of MRI can be used to assess structural changes in the brain parenchyma, but the availability and duration of the scan limit their use.

Patient Safety in Emergency Medical Departments: A Systematic Review

2022-12-22

Introduction: Emergency medicine is a complex and high-risk specialty, and the environment of the emergency department (ED) is significantly different from traditional care environments such as ambulances, operating rooms, and outpatient clinics. The main objective of this review is to examine the impact of emergency department (ED) overcrowding on patient safety and public health, as well as to identify the various contributing factors and potential solutions to the overcrowding crisis.

Methods: Systematic searches were conducted in October 2022 using the databases MEDLINE (EBSCO), PubMed, CINAHL (EBSCO), and EMBASE (OVID). The searches were not limited by year of publication and included all types of peer-reviewed systematic reviews, as well as quantitative or qualitative studies in real clinical practice or simulation situations. After full-text inclusion, reference lists were hand-searched to identify relevant studies. All articles were screened on title and abstract by two independent reviewers. The search strategies used in this study were designed to identify terms related to patient safety in the emergency department. Due to the heterogeneity of the studies in terms of patient populations, interventions, and outcomes, a meta-analysis was not feasible.

Results: The search yielded a total of 177 potential articles that were reviewed for relevance, and 23 articles were selected for this review. Some of these cases of delayed treatment resulted in unexpected deaths. the number of critically ill patients presenting to California emergency departments (EDs) increased by 59% from 2000 to 2020. In California, a 12.3% decrease in the number of EDs from 2000 to 2010 led to a 27% increase in the number of visits per ED. ED overcrowding was found to be a complex problem with roots in "issues of inpatient capacity, the inadequacy of alternatives for hospitalization, and hospital resource shortages.

Conclusions: Much of the research on patient safety in emergency departments (EDs) has focused on errors, with the assumption that errors can lead to harm. However, it is becoming increasingly recognized that efforts to improve patient safety should focus on both preventing errors and preventing adverse events.

The Role of Simulation Training in Enhancing Competences of Emergency Medical Service Providers

2023-09-19

Introduction: This systematic review investigates the impact of simulation training on the competences of Emergency Medical Service (EMS) providers. EMS professionals play a critical role in delivering life-saving care during emergencies, making the enhancement of their competences through effective training methods a vital concern.

Methods: A systematic search was conducted across various databases, including PubMed, MEDLINE, Embase, Scopus, and Web of Science, up to [insert end date of the search], using predefined search terms related to "simulation training," "competences," and "Emergency Medical Service providers." Eligible studies included randomized controlled trials, observational studies, and other experimental designs that assessed the influence of simulation training on the competences of EMS providers. From a total of 56 initially identified studies, this review includes a comprehensive analysis of 13 studies that met the predefined inclusion criteria. Data extraction was performed following a structured protocol, and the methodological quality of included studies was assessed using appropriate tools. A narrative synthesis of the findings was conducted, focusing on the impact of simulation training on the competences of EMS providers, including improvements in clinical skills, decision-making, teamwork, and patient outcomes.

Results: The systematic review, which included a total of 13 studies, identified a diverse range of simulation training interventions, including high-fidelity manikins, simulated patient encounters, and virtual reality simulations. The findings revealed that simulation training significantly enhanced the competences of EMS providers across various domains. Specifically, simulation training was associated with improved clinical skills, increased confidence in handling complex cases, enhanced teamwork and communication, and ultimately, improved patient outcomes. However, the effectiveness of simulation training varied depending on the design of the training program, the fidelity of the simulations, and the duration of training sessions.

Conclusions: Simulation training emerges as a valuable tool for enhancing the competences of Emergency Medical Service providers. The findings of this systematic review, which analyzed 13 studies from a total of 56 initially identified, underscore the potential of simulation-based education to improve clinical skills, decision-making abilities, teamwork, and patient care outcomes among EMS professionals. To maximize the benefits of simulation training, future research should focus on refining training methodologies and evaluating long-term competency retention. These insights have significant implications for the continuous improvement of EMS training programs and the delivery of high-quality emergency medical care.

Nursing Interventions to Enhance Patient Safety in Acute Care Settings

2023-12-18

Introduction:

Despite the individual effectiveness of specific nursing interventions, a comprehensive synthesis of the evidence is lacking. The aim of this systematic review is to systematically evaluate and synthesize the existing literature on nursing interventions designed to enhance patient safety in acute care settings.

Methods:

This systematic review employed a meticulous and comprehensive search strategy across multiple databases, utilizing MeSH terms and keywords to target nursing interventions for patient safety in acute care settings. The systematic study selection process, inclusion/exclusion criteria, rigorous quality assessment, and transparent data extraction contributed to a reliable and valid synthesis of evidence, minimizing bias and ensuring a robust review of nursing interventions' impact on patient safety in acute care.

Results:

The six randomized clinical trials included in this systematic review displayed significant variation in sample sizes, ranging from 129 to 632 participants. This diversity enabled a comprehensive investigation into the impact of nursing interventions on patient safety across various acute care settings. The trials covered a broad range of clinical settings, including urban tertiary care hospitals, community hospitals, and specialized surgical centers, providing insights into the generalizability of nursing interventions across diverse healthcare contexts. The evaluated nursing interventions addressed multiple facets of patient safety, such as enhanced medication reconciliation processes, nurse-led communication training programs, increased nursing staff ratios, and a standardized infection prevention protocol. This diversity allowed for a nuanced exploration of the distinct contributions of various nursing-led approaches to enhancing patient safety in acute care settings.

Conclusions:

This systematic review highlighted the crucial role of nursing-led interventions in enhancing patient safety within acute care settings, supported by diverse randomized clinical trials demonstrating reductions in medication errors, improved communication, and decreased adverse events and healthcare-associated infections, emphasizing the need for public health decision makers to invest in nursing education, optimal staffing, standardized infection prevention protocols, and interdisciplinary collaboration to foster a safer patient care environment.

Exploring Stress Perceptions and Coping Mechanisms among Health Workers in Saudi Arabia

2023-12-15

Introduction:

The coping mechanisms employed by these professionals are diverse, ranging from seeking social support to engaging in personal hobbies, yet approximately 50% report not having adequate resources or strategies to manage stress effectively. This systematic review aimed to explore the perceptions of stress and the coping mechanisms among health workers in Saudi Arabia.

Methods:

To conduct this systematic review, a comprehensive literature search was executed with the aim of identifying interventional studies that explore stress perceptions and coping mechanisms among health workers in Saudi Arabia over the last 20 years. Inclusion criteria were strictly defined to ensure the relevance and quality of the selected studies. Only interventional studies that directly addressed stress perceptions, coping strategies, or both among health workers in Saudi Arabia were considered. Discrepancies between reviewers were resolved through discussion or, if necessary, consultation with a third reviewer.

Results:

Nine studies were included in the systematic review which revealed that interventions, including cognitive-behavioral strategies, mindfulness and relaxation techniques, educational workshops, and physical activity programs, have demonstrated effectiveness in reducing stress levels among health workers in Saudi Arabia. Notably, cognitive-behavioral approaches showed up to a 40% reduction in stress levels, mindfulness techniques resulted in a 35% decrease, educational workshops varied in effectiveness but generally led to a 15-25% reduction, and physical activity interventions showed a 20% decrease in stress indicators.

Conclusions:

The findings underscore the potential of multifaceted and tailored interventions in addressing the stress experienced by healthcare professionals. Implementing these evidence-based strategies can significantly contribute to enhancing the well-being of health workers, thereby improving the overall quality of healthcare delivery.

Breast Cancer Screening using Film Mammography versus Digital Mammography: A Systematic Review

2022-10-24

Introduction: Digital mammography may provide better images than film mammography in women who are younger than 50 years, the age group usually associated with dense breast tissue because greater density reduces the sensitivity of mammography, and increases the risk of breast cancer. This review aims to study breast cancer screening using film mammography versus digital mammography.
Methods: Electronic databases including PubMed and Embase were searched by two independent reviewers. Furthermore, the search was conducted in databases and repositories of grey literature such as Open Grey. The databases of the systematic review and clinical trials such as Cochrane libraries and the Center for Reviews and dissemination were screened for eligible primary studies. An electronic search with keywords in the titles and abstracts of these articles was conducted to identify eligible studies. Based on the primary screening results the irrelevant studies, duplicates and reviews were excluded. Finally, four eligible studies were included in this review.
Results: A comparison between film mammography and digital mammography was done by estimation of the sensitivity and specificity of each in a Cohort study done by Pisano et al., 2005, in which the sensitivity ranged between 35% - 38% when using film mammography, and between 38%- 49% when using digital mammography. While the specificity was 97%-98% for film mammography and 79% for digital mammography. The cancer detection rate was evaluated in two studies. The first study was a Prospective study done on 43,429 women, aged between 45–69 years. The cancer detection rate was 41% when using film mammography.
Conclusions: Digital mammography offers other advantages over film mammography easier access to images and computer-assisted diagnosis, improved means of transmission, retrieval, and storage of images, and the use of a lower average dose of radiation without a compromise in diagnostic accuracy.

Crown Cementation as a Risk Factor of Peri-implantitis: A Systematic Review

2022-11-20

Introduction: Cemented crowns are usually used on implant abutments instead of screw-retained crowns. The amount of cement excess that is left in the peri-implant tissues depended on the depth of the crown margins. The remnants of cement in peri-implant tissues can trigger an inflammatory response because it is considered a foreign body.
Methods: Electronic databases were searched including MEDLINE and EMBASE using the PubMed search engine. Furthermore, the search will be conducted in databases and repositories of grey literature such as Open Grey and OAIster. The databases of a systematic review and clinical trials such as Cochrane libraries and the Center for Reviews and dissemination were screened for eligible primary studies. Based on the primary screening results the irrelevant studies, duplicates and reviews were excluded. We used checklists containing items used to judge the quality of sampling, data collection, and statistical analysis, in addition to the risk of bias within included studies.
Results: Five of included studies evaluated only implants supported by single crowns and five studies assessed different types of implants supported by single crowns or FPDs. Only one study, a randomized clinical trial, focused on implants supported FPDs using split mouth design. The sites of implant placement were different, however commonly anterior teeth, bicuspid teeth, and first molars. Concerning the type of cementation, zinc oxide cement was reported in some studies, other studies used glass ionomer cement, resin cement, zinc phosphate cement, and temporary cement. Only two studies reported the detection of cement remnants, while other studies reported the use of procedures to reduce or remove excess cement.
Conclusions: Peri-implant disease has been shown to be associated with residual cement in particular in patients with predisposing periodontal disease. Cement remnants in patients without a history of periodontitis may cause less severe peri-implant disease or may not predispose to infection at all. Screw-retained implant restorations might be considered in periodontally susceptible patients.

The Effect of Strict Infection Control Strategies on the Rate of Antibiotic Resistance Bacteria

2022-12-16

Introduction: Because interhospital variation in susceptibility patterns may be substantial, hospitals should be cautious when extrapolating infection control data or data from other hospitals to their particular institution. Hence, this review aims to highlight the effect of strict infection control strategies on the rate of antibiotic resistance bacteria.
Methods: Articles were identified by searching MEDLINE and Current Contents. The search was limited to English-language articles published till 2022. We used the search terms resistance, antibiotics, nosocomial, infection, and intensive care. Eligible articles presented at these meetings were included if they were available for review and had been accepted for publication in a peer-reviewed medical journal.
Results: The threat of antimicrobial resistance (AMR) is growing at an alarming rate and the situation is perhaps aggravated in developing countries due to gross abuse in the use of antimicrobials. It is well known that any use of antimicrobials however appropriate and justified, contributes to the development of resistance, but widespread unnecessary and excessive use makes the situation worse. Misuse of antimicrobials is facilitated in developing countries by their availability over the counter, without prescription, and through unregulated supply chains. Non-compliance with the use of antimicrobials has many repercussions upon resistance and poverty is a major root factor of antimicrobial misuse in developing countries.

Conclusions: Self-medication is a common practice in developing countries where patients often get antimicrobials without prescription and through unregulated supply chains These actions result in the exposure of surviving pathogens to sub-therapeutic concentrations of antimicrobials thus increasing the chances of acquiring resistance.

Knowledge of Non-medical Individuals about Cardiopulmonary Resuscitation in Case of Cardiac Arrest: A Cross-Sectional Study in the Population of Marat City, Saudi Arabia

2022-12-19

Introduction: High-quality cardiopulmonary resuscitation is a fundamental component of initial care, as most sudden cardiac arrests happen at home. The aim of this study is to assess the knowledge and attitude of non-medical people related to cardiopulmonary resuscitation in the case of out-of-hospital cardiac arrest among individuals in Marat City, Saudi Arabia.
Methods: This is a cross-sectional study that included 140 of non-medical individuals in Marat city. A self-administered questionnaire was distributed to the participants to assess the community's willingness to perform CPR and determine the barriers to performing CPR. It consists of 3 sections, the first section questioning demographic and background variables. The second section is a checklist for collecting data about the willingness to perform CPR, while the third section will focus on participants’ barriers to performing CPR. The data were analyzed to present the findings in the descriptive and inferential statistics at a level of 0.05 significance.
Results: Out of 140 participants, 88 (62.9%) were females with a mean age of (28.1 ± 2.4) years. The main manifestation of more than half of the respondents suggested that the main sign of sudden cardiac arrest is chest pain (72.%). The main feature of consciousness evaluation that was reported by more than two quarters was “no response when called” 77.1%, which is followed by “no response when touched” (52.9%). The main reason that may prevent someone from giving a chest compression to a stranger was reported as “making a mistake” (67.9%) followed by “punishment due to legal reasons” (8.6%). More than half of the sample (61.4%) defined the device defibrillator as It is a device used to restart a heart that has stopped working, while (72.1%) of the sample don't have any idea about where an ‘automated external defibrillator' or a ‘pacemaker' can be found.
Conclusions: Community knowledge of CPR is limited when compared to neighboring countries' knowledge levels. Furthermore, some false beliefs exist. By generalizing CPR training to the general public, the level of knowledge and awareness of CPR among adults in society can be increased; as a result, the rate of witnesses who begin CPR can be improved.

Best Practices in Laboratory Medicine: Systematic Review and Evaluation Methods for Quality Improvement

2023-11-04

Introduction: The field of laboratory medicine occupies a pivotal role in modern healthcare, serving as the bedrock for informed clinical decision-making. Accurate and reliable diagnostic testing is paramount to the delivery of high-quality patient care. The aim of this review is to provide a comprehensive and evidence-based resource for laboratory professionals and healthcare decision-makers, guiding them toward best practices in laboratory medicine and quality improvement.

Methods: A comprehensive search strategy was employed, utilizing multiple academic databases and a combination of Medical Subject Headings (MeSH) and keywords to identify eight relevant interventional studies focused on quality improvement in laboratory medicine. The study selection process adhered to predefined inclusion and exclusion criteria, ensuring the inclusion of studies conducted in various laboratory settings and involving human participants. The selection process involved two phases, with independent screening of titles and abstracts, followed by the evaluation of full-text articles for eligibility. The final set of included studies was assessed for relevance and methodological quality, with a goal of incorporating a minimum of eight high-quality interventional studies to provide a comprehensive overview of quality improvement in laboratory medicine.

Results: This systematic review employed a rigorous search strategy across various academic databases to identify eight interventional studies focused on quality improvement in laboratory medicine. The study selection process adhered to predefined inclusion and exclusion criteria, ensuring the inclusion of studies conducted in diverse laboratory settings and involving human participants, reported in English. The selection process involved two phases, initial screening of titles and abstracts, followed by the evaluation of full-text articles for eligibility, ultimately aiming to incorporate a minimum of eight high-quality interventional studies for a comprehensive overview of quality improvement in laboratory medicine.

Conclusions: In this systematic review, various factors influencing the effectiveness of quality improvement interventions in laboratory medicine were examined. Key findings underscored the importance of tailored interventions, supportive leadership,resource allocation, staff engagement, and the role of data and metrics in improving laboratory services. These insights offer laboratories a strategic framework to optimize quality improvement efforts and ensure the delivery of accurate, efficient, and high-quality services in healthcare.

Impact of Health Information Technology on Quality and Efficiency of Healthcare

2022-12-28

Introduction:

In light of the dynamic landscape of health information technology and its multifaceted influence on healthcare delivery, a systematic review is an excellent approach to report the updates about health information systems. This review aims to critically analyze existing literature to provide a comprehensive understanding of the impact of health information technology on the quality and efficiency of healthcare.

Methods:

The systematic review employed a comprehensive search strategy, utilizing carefully chosen search terms, including Medical Subject Headings (MeSH) terms, to balance sensitivity and specificity. The search covered major databases such as PubMed/MEDLINE, Embase, CINAHL, Scopus, and the Cochrane Library, ensuring a thorough retrieval of relevant studies on the impact of health information technology on healthcare quality and efficiency. The inclusion criteria targeted primary interventional research articles within a specified timeframe, up to September 2023. The transparent study selection process involved initial screening of titles and abstracts, followed by a detailed assessment of full-text articles. Rigorous data extraction using a standardized form encompassed study characteristics, demographics, technology interventions, and outcomes. The synthesis of findings employed a narrative approach, while the assessment of risk of bias contributed to the overall quality appraisal, collectively ensuring the reliability and validity of the systematic review's outcomes.

Results:

The eight interventional studies included in the systematic review demonstrated a wide range of impacts from health information technology (HIT) interventions. Notable reductions in medication errors were reported, ranging from 22% to 45% with the integration of advanced functionalities. Telehealth interventions showcased a 19% to 53% decrease in hospital admissions through remote monitoring and virtual consultations. Across the studies, significant improvements in healthcare quality metrics were observed, including a 21% to 35% reduction in medication errors and a 15% to 27% enhancement in adherence to evidence-based clinical guidelines. The implementation of health information exchange (HIE) systems contributed to a substantial 18% to 33% reduction in redundant diagnostic testing. These percentages underscore the potential of HIT to enhance patient care and operational efficiency in diverse healthcare settings.

Conclusions:

For decision-makers in healthcare, the synthesis of findings underscores that well-designed health information technology interventions show significant, measurable benefits, including reduced medication errors, decreased hospital admissions, and improved adherence to clinical guidelines, affirming their potential to optimize patient care and enhance operational efficiency.

Non-Pharmacological Approaches to Manage Pain and Anxiety in Pediatric Care

2023-12-21

Introduction:

The management of pain and anxiety in pediatric dentistry is a significant challenge, impacting children's attitudes towards dental care and their overall oral health. Previous studies have indicated a high prevalence of dental anxiety among children, with traditional pharmacological methods posing potential risks. This systematic review aimed to evaluate the effectiveness of non-pharmacological approaches in managing pain and anxiety in pediatric dental settings, providing an evidence-based perspective on their utility and implications for clinical practice.

Methods:

A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, Web of Science, PsycINFO, and the Cochrane Library, focusing on interventional studies and clinical trials published up to 2022. The inclusion criteria targeted studies that employed non-pharmacological interventions for pain and anxiety management in pediatric dentistry, with a clear reporting of outcomes. The quality of the studies was assessed, and data extraction focused on intervention type, sample size, effectiveness, and risk ratios with confidence intervals.

Results:

Seven studies met the inclusion criteria, encompassing a range of interventions such as virtual reality, guided imagery, cognitive strategies, and audiovisual aids. The interventions demonstrated a significant reduction in anxiety and pain, with risk ratios indicating a 40% reduction in anxiety levels for virtual reality interventions (95% CI, 30-50%) and a 35% decrease in pain scores for guided imagery and relaxation techniques (95% CI, 25-45%). Cognitive strategies improved coping abilities by 50% (95% CI, 40-60%), highlighting the varied but consistently positive impact of these approaches.

Conclusions:

Non-pharmacological interventions offer a viable and effective alternative for managing pain and anxiety in pediatric dentistry, with significant implications for enhancing patient experience and outcomes. These findings support the integration of such approaches into pediatric dental practice, underscoring the need for further research to explore the full potential of these interventions and their practical implementation.

Prevalence of Depression among Geriatric Population Attending Primary Healthcare Settings in Al-Madinah

2022-02-28

Introduction: The prevalence of depression is higher among the geriatric population compared to the general population. Depression is associated with several adverse health outcomes including reduced quality of life, functional decline, increased health cost, and increased mortality. To estimate the rate and determinants of depression among the elderly population (aged 60 years or more) in Al Madinah city, Kingdom of Saudi Arabia
Methods: A descriptive cross-sectional study was carried out among elderly patients (aged over 60 years) attending the primary healthcare centers inside AL-Medinah city, Saudi Arabia during the period (June-December, 2021). A self-administered questionnaire was utilized for data collection. It included four main sections; Personal and socio-demographic characteristics, lifestyle habits, clinical data and Arabic version of Geriatric Depressive Scale- Short form (GDS-SF).
Results: The study included 360 elderly patients. They equally distributed between males and females. Their age ranged between 61 and 88 years with a mean±SD of 70.8±4.7 years. The majority of the participating geriatric patients (96.7%) were depressed; mostly mild (54.4%) and moderate degrees (38.9%). Severe depression was observed among only 3.3% of the participants. Multivariate logistic regression analysis revealed that the only two significant factors for moderate/severe depression were participants` marital status and history of diabetes. Widowed persons were at almost triple risk for moderate/severe depression compared to married persons (Adjusted odds ratio “AOR”=2.82; 95% confidence interval “CI”=1.32-6.01), p=0.008. Diabetic patients were more likely to develop moderate/severe depression compared to those without diabetes (AOR=2.40, 95% CI=1.52-3.77), p<0.001.
Conclusions: Depression is a very prevalent health problem affecting geriatric patients attending primary healthcare centers in Al-Madinah. However, most cases are of mild or moderate severity.

Effect of Self-management on Diabetic Complications among Patients with Type II Diabetes Mellitus

2022-11-07

Introduction: The prevalence of diabetes mellitus in Saudi Arabia dramatically increased from 3.4 % in 1996 to 19.42% in 2012 and reached 23.9% in 2013. The Saudi Press Agency (SPA) reported that the annual cost of diabetic care and its complication is exceeding four billion Saudi Riyals. Despite the importance of diabetic educational programs in reducing healthcare expenditure and improving the quality of care. This study aimed to review the evidence regarding the impact of self-management on the outcomes of diabetic mellitus.
Methods: A systematic search of articles focused on diabetes self-management education and support services was conducted. Articles were included if published between January 2013 and January 2022. We searched MEDLINE, CINAHL, EMBASE, ERIC, and PsycINFO for interventions that included elements to improve participants’ knowledge, skills, and ability to perform self-management activities as well as informed decision-making around goal setting.
Results: Previous systematic reviews and meta-analyses sought to find evidence that self-management intervention using educational or behavioral strategies stimulates the individual’s performance of diabetes self-care to increase target behavior actions such as blood glucose monitoring, diet care, physical activity, and medical care among adults. These studies indicated modest but significant improvements in glycemic control in educational and behavioral interventions in diabetes, although, the improvement in glycemic control seemed to decrease over time.
Conclusions: The effect of self-management intervention on the reduction in glycated hemoglobin seemed to be affected by baseline values of HbA1c. The higher the baseline values of HbA1c, the greater the control of hyperglycemia after the implementation of self-management.

Comparison between Laser and Sodium Hypochlorite in the Disinfection during Root Canal Treatment

2022-12-01

Introduction: Various laser techniques have been considered as alternative methods for root canal disinfection and are suggested to more effectively affect bacteria located deep in the dentine than traditional chemo-mechanical methods. This review aimed to investigate the role of dental lasers in the disinfection of root canals during endodontic treatment.
Methods: A search was conducted using PubMed and Medline using combinations of specific keywords. The results of this search were limited to English-language articles. Lastly, the reference lists from published articles were checked. Moreover, we included studies that utilized various wavelengths ranging from 600 to 2940 nm of the electromagnetic spectrum which included LED, halogen lamps Nd:YAG Er, Cr:YSGG Er:YAG and quartz tungsten halogen with blue light laser.
Results: The initial search process yielded 254 publications. Nine were included in the systematic review and were assessed. The main reason for the low-quality assessment was that no study reported a rationale for sample size: none presented a power analysis. None of the assessed studies reported blinding during the operative procedure or outcome analysis. As described later, heterogeneity in performance was extensive.
Conclusions: Results showed that although dental laser precisely reduces canal bacterial count, sodium hypochlorite was more effective. Laser light can affect bacteria further than 1mm in dentin, hence results showed that this laser is effective for sealing dentinal tubules and eliminating bacteria such as Escherichia coli and Enterococcus Faecalis. So it is recommended to use this laser with the rinsing solution for canal disinfection.

Efficacy and Safety of Lipid Lowering Therapy: A Systematic Review

2022-12-20

Introduction: Dyslipidemia is the most important modifiable risk factor for myocardial infarction worldwide. We conducted a systematic review and meta-analysis to highlight the evidence for the safety, efficacy of lipid-lowering therapy, and clinical effectiveness from trials comparing more intensive statin therapy with less intensive statin therapy.
Methods: A comprehensive electronic search was conducted in MEDLINE, EMBASE, and Cochrane databases to identify articles that aimed to assess the preventive effect of lipid-lowering therapy, particularly in CHD. The titles and abstracts of the resultant articles were read by two independent reviewers to identify relevant articles as a primary screening step and to exclude irrelevantly, duplicated or review articles. The full texts of these relevant articles were retrieved and the in-depth reading was conducted to exclude the irrelevant articles as a secondary screening step. The articles were assessed against inclusion criteria such as clinical trials, published in the last 10 years and written in English language. The population studied should be patients with CHD, while included intervention was lipid-lowering therapy. The outcomes assessed were the mortality indicators in rates or percentages.
Results: Seventy-five studies reporting RCTs of head-to-head comparisons on statins were included. Most studies had similar baseline characteristics, except the rosuvastatin-related studies. A daily dose of atorvastatin 10 mg, fluvastatin 80 mg, lovastatin 40–80 mg, and simvastatin 20 mg could decrease LDL-C by 30–40%, and fluvastatin 40 mg, lovastatin 10–20 mg, pravastatin 20–40 mg, and simvastatin 10 mg could decrease LDL-C by 20–30%. The only two statins that could reduce LDL-C more than 40% were rosuvastatin and atorvastatin at a daily dose of 20 mg or higher. Meta-analysis indicated a statistically significant but clinically minor difference (<7%) between statins in cholesterol-lowering effect. Comparisons of coronary heart disease prevention and safety could not be made because of insufficient data.
Conclusions: The HDL-elevating and triglyceride-lowering effects are similar among different statins at equivalent doses. The current data are not sufficient to determine the relative safety of the different statins or their relative effectiveness in CHD prevention.

Brain Incidental MRI-Findings among COVID-19 Patients: A Systematic Review

2023-09-19

Introduction: Currently, case reports and case series are the main source of evidence regarding brain MRI findings in patients with COVID-19. Due to limited information of neurological findings of COVID-19 during MRI scanning, we conducted a systematic search with the aim to review and assess brain MRI findings linked to COVID-19.

Methods: Electronic search was conducted in to a comprehensive approach in major medical databases such as PubMed, Embase, and the Cochrane Library. Initially, for inclusion in this review, studies had to satisfy the following criteria: (1) Recruitment of patients diagnosed with COVID-19; (2) Examination of brain MRI findings; (3) Provision of adequate information to enable assessment of brain MRI outcomes; (4) Utilization of either observational or interventional study designs; (5) Publication of the study in the English language; and (6) Availability of the publication as an original research article within a peer-reviewed journal. Case reports and case series were excluded and only cohort and case-control studies were included in the review. A careful conduction of a systematic data extraction was performed, using excel sheets to perform data extraction by two independent reviewers. Finally, a narrative synthesis of the results were reported in the following section of the review.

Results: The electronic search yielded a comprehensive collection of 105 brain neuroimaging studies concerning individuals affected by COVID-19. Among these, 53 studies centered on assessing neurological symptoms devoid of detailed brain topography, thus excluding them from further consideration. Subsequently, a total of 23 studies, which focused on the examination of brain changes associated with SARS-CoV-2 infection, were finally selected for the conclusive review. This selection comprised 9 cohort studies and 14 case-control studies, each contributing unique insights. Furthermore, the assessment of the quality of included articles was conducted with precision, employing the Joanna Briggs Institute (JBI) Critical Appraisal Checklists designed for observational studies. This evaluation yielded results of commendable compliance, ranging from 67% to 100% across the evaluated studies.

Conclusions: The observed brain changes linked to SARS-CoV-2 infection in individuals affected by both acute and mild cases of COVID-19 predominantly centered around the olfactory brain network, encompassing limbic and prefrontal regions. The exact mechanisms behind these disruptions within these brain areas, whether they stem from direct viral involvement or indirect influences, still remain to be definitively established.

Antibiotic Resistance in Respiratory Tract Infections: Patterns, Mechanisms, and Intervention Strategies

2023-12-08

Introduction:

Understanding the intricate mechanisms governing antibiotic resistance in respiratory tract infections is imperative for the development of targeted intervention strategies. This review aims to inform the design and implementation of effective interventions to mitigate the escalating threat posed by resistant strains in the realm of respiratory tract infections.

Methods:

A comprehensive search strategy, employing keywords such as "antibiotic resistance," "respiratory tract infections," and "intervention strategies," was implemented across PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library to identify relevant literature on antibiotic resistance in respiratory tract infections published before September 2023. The study selection process involved title/abstract screening and full-text assessment, conducted by two independent reviewers with a third consulted in cases of disagreement, ensuring a rigorous and thorough review. Inclusion criteria focused on English-language original research articles and systematic reviews exploring antibiotic resistance in human subjects with predefined eligibility criteria, while exclusion criteria targeted non-English publications and non-human studies. A standardized data extraction form facilitated the synthesis of key information, and a systematic assessment of methodological quality and risk of bias was conducted using appropriate tools.

Results:

The systematic review encompassed eight randomized clinical trials (RCTs) with diverse sample sizes and populations, revealing varied patterns of antibiotic resistance across respiratory tract infections. The trials highlighted the substantial contribution of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to resistance, with documented rates ranging from 21% to 38% for commonly prescribed antibiotics. Intervention strategies, including antimicrobial stewardship programs and innovative approaches, showcased a multifaceted response to mitigate resistance. Additionally, findings from the systematic review provided nuanced insights into the complex interplay between bacterial pathogens and antibiotic use, exemplified by odds ratios reflecting moderate associations between antibiotic use and resistance in S.pneumoniae and H. influenzae. Overall, the review contributes comprehensive knowledge to the current state of research in antibiotic resistance in respiratory tract infections, emphasizing the need for tailored interventions.

Conclusions:

Antibiotic resistance in respiratory tract infections elucidates nuanced patterns, emphasizing moderate associations between antibiotic use and resistance development, with observed odds ratios providing quantifiable insights and underscoring the impact of antimicrobial stewardship programs, while comparisons with existing literature underscore both consistencies and evolving concerns, advocating for targeted strategies and innovative interventions.

Multidisciplinary Approaches to Reduce Occupational Injuries in Different Health Professions

2023-12-28

Introduction:

The variety in the nature of these occupational hazards necessitates a multidisciplinary approach to effectively mitigate them. The aim of this systematic review is to explore multidisciplinary approaches to reduce occupational injuries among different health professions.

Methods:

Initially, the search strategy was developed to identify interventional studies that provided insights into the effectiveness of various strategies. The search was conducted across several electronic databases to ensure a thorough coverage of the literature. These included PubMed, Scopus, Web of Science, and the Cochrane Library. These databases were chosen for their extensive coverage of medical and health sciences literature. Only interventional studies that specifically addressed occupational injuries among healthcare professionals were included.

Results:

The systematic review conclusively demonstrates that multidisciplinary interventions are effective in reducing occupational injuries among healthcare professionals. The analysis of seven key studies revealed that ergonomic training combined with assistive devices, comprehensive injury prevention programs, and the implementation of safety-engineered devices significantly reduce injury rates, with risk reductions ranging from 25% to 50%. Specifically, ergonomic adjustments were found to be more effective than physical exercises in addressing musculoskeletal disorders. Additionally, the use of ceiling lifts was preferred over mobile lifts for injury prevention among nursing staff.

Conclusions:

These findings highlight the necessity of tailored, profession-specific interventions in healthcare settings to effectively mitigate the risk of occupational injuries. The integration of technological, educational, and ergonomic solutions emerges as a pivotal strategy to enhance workplace safety and reduce the physical burden on healthcare workers.

Patterns of Violence against Health Workers and Awareness about Anti-Violence Regulations in Saudi Arabia

2022-10-10

Introduction: There is limited data on the awareness of healthcare workers about the regulations that concern violence against healthcare workers in Saudi Arabia. The aim of this study is to assess the effect and types of violence against primary healthcare workers and possible association with the work experience of health workers. Moreover, this study investigated the response of the health workers and their knowledge regarding the policies and regulations of the Ministry of Health in Saudi Arabia.
Methods: This is a cross-sectional study design that targets all healthcare workers who work in primary healthcare centers or outpatient units of governmental hospitals, during the proposed study period from April – May 2022. The sample was stratified according to the percentage of each profession in the statistics of the Ministry of Health. A structured online questionnaire was sent to healthcare workers in order to collect data about study variables. Descriptive statistics such as frequencies, and percentages were calculated to summarize nominal and ordinal data, while mean, median, and standard deviation or the range to describe numerical variables. Chi-squared test was applied to evaluate the association between the determinants and the outcome variables at the level of 0.05 significance.
Results: A total of 288 health workers in primary health centers were recruited in this study. The majority of the health workers were females. About 23% of the health workers were doctors, while 45% were nurses and the rest were distributed over other health professions. The prevalence of workplace violence among health workers was 46.7%, of them, about 90% reported verbal violence, 34.3% have been intimidated, and 3% reported physical violence. Regarding the reporting system, 40.2% of the health workers said their institute has reporting system of violence, but 27.3% said they don’t know. Furthermore, among those who reported the presence of the system, 47.3% did not know how to use this reporting system. The outdoor workplace was associated with a higher percentage of physical violence than the indoor workplace.
Conclusions: The prevalence of violence among healthcare workers is high as slightly less than half of the workers were exposed to some sort of violence, particularly verbal violence. Regarding the reporting system, more than one-quarter of the health workers did not know if their institute has a reporting system of violence or not.

Effect of Microleakage in Composite Filling on the Health of Dental Pulp

2022-11-17

Introduction: Clinical consequences of microleakage are secondary caries, pulp inflammation, marginal discoloration, postoperative sensitivity, and the reduction of the longevity of filling. Dentists expect from modern technology a composite material with high aesthetic value, less polymerization shrinkage, perfect marginal integrity, and relevant physicomechanical properties. This review aimed to investigate the problem of microleakage in the composite filling, as well as the effect of microleakage on dental pulp.
Methods: An online search of relevant papers was conducted, which include PubMed indexed literature, was performed by combining the term "bulk fill" and “microleakage” using the AND operator, from time to time to the terms of class II, class III, and V to try to introduce the studies that referred to the design of the cavity. The search strategy, performed using the PubMed controlled vocabulary and free terms, was defined on the basis of the following elements of the PICO question: The eligibility criteria are: in vitro or in vivo studies, published in the last 20 years (given the date of introduction of the material on the market) and written in English. It was decided to include studies on human teeth and in vitro studies to have a standardization of the cavity, which would not be possible to obtain in an in vivo study. We included studies that explicitly described that a cavity margin of the preparation was in the root cement.
Results: In comparison to conventional composite, the enamel micro-leakage in flowable bulk-fill composite was found comparable to conventional at score 0, lower than conventional at score 1, higher than conventional in score 2, and equal at score 3. However, the dentine micro-leakage was higher than conventional at score 0, equal at score 1 and 3, lower than conventional at score 2. Regarding cavity preparation, using a less traumatic system such as laser system may be favorable in pediatric dentistry. Hence, lasers can ablate enamel and dentin more effectively due to the highly efficient absorption in both water and hydroxyapatite. Concerning the bond strength, In comparison to conventional composite, the bond strength in flowable bulk fill composite was found comparable at 2 mm and higher than conventional composite at 4 and 6 mm. In regards to paste-like bulk fill composite, there was no study found in the literature aimed to assess the bond strength to dentine, according to the search strategy used in this review.

Prevention of Blood-borne Infections in Hospital Settings

2022-12-16

Introduction: Blood-borne virus infections are caused by HIV, HBV, or HCV and are known for a high prevalence worldwide and significant associated morbidity and mortality. This review focused on the occurrence and prevention of blood-borne infections among health workers.
Methods: The electronic databases for the reviewed articles including Embase, CINAHL, OVID Medline, PubMed, Web of Science, and Foreign Medical Literature Retrieval Service (FRMS), were searched systematically and independently by two authors. The language of the literature was limited to English. Meanwhile, the System for Information on Grey Literature was also searched to reduce publication bias. Two authors performed the literature selection independently. The review question was formed in terms of PICOD elements (population, intervention, comparison, outcome, and design of the study. The primary result of this review was healthcare worker exposure rates to bloodborne pathogens.
Results: the literature points to a number of opportunities for intervention and engagement such as pre-and post-travel advice, use of HIV treatments as prevention to reduce community viral load, in-country outreach, and online and other health promotion interventions. This is despite a number of previously completed reviews and policy documents, which provide explicit recommendations such as developing and increasing links and partnerships with affected communities and creating closer cooperation with policy and support sectors in both origin and destination regions. Such methods may be disposed to a measurement error which may weaken the validity of findings. High-income countries have seen increasing acquisitions of overseas acquired blood-borne infections. Whist those traveling to and from countries with significant prevalence, particularly of HIV have been identified as priority populations in a number of strategic frameworks.
Conclusions: The risk of health workers being exposed to rare ''exotic'' pathogens increases with intercontinental travel and migrations. Emerging disease risks are also associated with progress in medical techniques, changes in nutritional or other social habits, or ecological changes. Although the principal threats to which PEP experts are confronted are linked with HIV, HCV, and HBV, these experts must also be able to suspect other, less common transmissible pathogens. Clinicians should systematically follow up with personnel who have sustained exposure to other pathogens.

Nosocomial Infections: Prevention, Control and Surveillance

2022-12-28

Introduction: Nosocomial infections can have significant negative consequences, including extra hospitalization days, additional costs, and even deaths, depending on the site of infection. These consequences and associated costs can be substantial, and it is important to identify patients at highest risk for infection in order to prioritize prevention and control efforts. In this review, we aimed to include all preventive, control and surveillance strategies targeting nosocomial infections.
Methods: A systematic review was conducted to examine the effects of modifications to hospital architecture on nosocomial infections in intensive care units (ICUs), surgical departments, isolation units, and hospitals in general. The review included experimental and nonexperimental studies published before 2022 in English. The search was conducted using a combination of keywords and abbreviated terms related to hospital architecture and nosocomial infections, and was carried out through seven medical databases, reference lists, and expert consultation. In addition, the Cochrane Controlled Trials Database and the internet were checked. The bibliographies of reviewed papers, reports, and textbooks were searched by hand and experts in the field of hospital hygiene were consulted. The principal outcome measure was the rate of nosocomial infections.
Results: The search identified 178 articles that met the inclusion criteria, but only 17 of these described completed concurrent or historical cohort studies that matched the criteria. Most of the articles were categorized at the lowest level of evidence and did not include a meta-analysis, systematic review, or randomized controlled trial. The interventions in hospital architecture generally resulted in more space per hospital bed, single rooms, or easily accessible handwashing facilities. Of the 17 included studies, three documented a statistically significant decrease in nosocomial infection after the intervention. However, none of the studies addressed other types of nosocomial infection, such as postoperative pneumonia or urinary tract infection.

Conclusions: To effectively control these infections, healthcare institutions should implement infection control programs and use appropriate antimicrobials, including prophylactic use when appropriate. Efficient surveillance methods, including data collection from multiple sources and regular evaluation and maintenance, are also important for effectively implementing interventions and maintaining the effectiveness of surveillance systems.

Stress Management Interventions in Healthcare Workers using Mindfulness Approach

2023-11-04

Introduction: Recent surveys indicate that approximately 60% of healthcare professionals experience high levels of work-related stress. To address these challenges, there has been growing interest in utilizing mindfulness-based stress reduction (MBSR) and other mindfulness-based interventions. This systematic review aims to provide a comprehensive overview of the existing literature on stress management interventions in healthcare workers that employ a mindfulness approach.

Methods: The systematic review used a rigorous methodology to comprehensively analyze stress management interventions in healthcare workers through mindfulness. This involved a structured search strategy, database selection, and specific inclusion criteria for eligible studies, ensuring relevance and focus. Data extraction collected key information from each study, including participant demographics, intervention details, and various outcomes related to stress and well-being. The review employed both narrative synthesis and, if applicable, meta-analysis to provide a comprehensive overview of the results.

Results: The systematic review encompassed seven clinical trials involving diverse healthcare professionals and assessed the effectiveness of mindfulness-based stress management interventions. It revealed consistent positive outcomes, with an average reduction of approximately 25% in self-reported stress levels and a notable impact on reducing burnout among healthcare workers. Secondary outcomes showed significant improvements in emotional regulation, job satisfaction, and patient care outcomes, emphasizing the potential of mindfulness interventions in enhancing the well-being of healthcare professionals and the quality of patient care.

Conclusions: The effectiveness of mindfulness-based stress management interventions in healthcare settings, as observed in this systematic review, aligns with or exceeds findings from existing literature, emphasizing their potential. These interventions have demonstrated promise in reducing stress, improving emotional regulation, and enhancing job satisfaction among healthcare workers, ultimately benefiting patient care outcomes

Prevalence and Determinants of Fall Injury among Elderlies in Najran, Saudi Arabia

2023-12-28

Introduction:

There is a need for estimations about falls prevalence among elderly as a high-risk group. Inclusion of patients from primary healthcare setting will be more generalizable to elderly population than that obtains by including only hospitalized patients. By targeting PCH attendants with specific age group (>65 years) we will be able to estimate a more generalizable prevalence and to identify potential risk factors of falls among elderlies. We aimed to determine the prevalence and determinants of self-reporting fall injury among elderlies in Najran city, Saudi Arabia.

Methods:

The cross-sectional study conducted in Najran city from March to April 2023 focused on falls among individuals aged 65 and older attending primary healthcare centers. With a sample size of 377 participants, determined through the Raosoft web-calculator, the study aimed to identify risk factors using a self-administered questionnaire validated by public health experts. The investigation encompassed various independent variables, including demographics and health-related factors, with data analyzed using SPSS version 26. Descriptive statistics and regression analysis were employed to explore associations between determinants and outcomes, emphasizing the multifaceted nature of falls in the elderly population.

Results:

The study, involving 377 participants aged 65 and older in Najran. Notably, among individuals aged 81 and older, a 37% fall rate was observed, while postgraduates exhibited a 37% fall rate. Health and lifestyle factors unveiled compelling associations, with incontinence (25%) significantly linked to a 37% fall rate (p = 0.02), and impaired functional mobility (35%) associated with a 31% fall rate (p = 0.03). Logistic regression highlights the heightened likelihood of falls related to incontinence (odds ratio: 1.82, p = 0.160*), impaired functional mobility (odds ratio: 1.29, p = 0.042*), chronic pain affecting function (odds ratio: 1.63, p = 0.023*), and exposure to environmental hazards (odds ratio: 1.48, p = 0.245).

Conclusions:

Falls among individuals aged 65 and older, identifying significant risk factors such as incontinence, impaired functional mobility, chronic pain affecting function, and exposure to environmental hazards, emphasizing the need for tailored interventions and integrated fall risk assessments in geriatric care to address the multifaceted nature of falls in the region and contribute valuable insights to healthcare practices and public health initiatives

Medical Errors Reporting Among Healthcare Professionals: Innovative Solutions

2023-12-18

Introduction:

Medical errors represent a significant challenge to patient safety in healthcare settings worldwide. Despite the known impact of these errors, underreporting by healthcare professionals remains a substantial barrier to improving patient safety and care quality. The aim of this systematic review was to assess the effectiveness of innovative solutions for reporting medical errors among healthcare professionals.

Methods:

A comprehensive search strategy was employed across multiple databases, including PubMed, MEDLINE, EMBASE, CINAHL, and PsycINFO, to identify relevant interventional studies and clinical trials. The inclusion criteria targeted recent interventions aimed at enhancing error reporting, while exclusion criteria omitted non-interventional studies, reviews, and studies not in English. The selection process involved an initial screening of titles and abstracts, followed by a full-text review of selected studies. Data on the interventions, sample sizes, and outcomes were extracted, with a particular focus on the effectiveness of interventions measured through risk ratios and percentages with confidence intervals.

Results:

The review included ten studies, revealing that interventions such as digital reporting systems, training programs, feedback mechanisms, and organizational culture changes can significantly increase the reporting of medical errors. Risk ratios ranged from 1.4 to 3.0, indicating a substantial improvement in reporting rates post-intervention. Studies implementing digital reporting tools combined with cultural initiatives showed the most considerable increase in error reporting, highlighting the importance of multifaceted approaches.

Conclusions:

Innovative interventions, particularly those integrating technology with efforts to shift organizational culture, are effective in improving medical error reporting among healthcare professionals. The findings underscore the potential of these strategies to enhance patient safety by promoting transparency and accountability in reporting errors. Future research should explore the sustainability of these interventions and their long-term impact on patient outcomes.

Prevalence and Gender Difference in Microalbuminuria among Diabetic Patients Attending Primary Healthcare Center at Security Forces Hospital, Riyadh, Saudi Arabia

2023-10-09

Introduction: Diabetic nephropathy is a common cause of end-stage renal disease, and kidney failure is a main cause of death in type 2 DM patients. An early significant marker for diabetic nephropathy is microalbuminuria which can lead to end-stage renal disease. This study focused on the prevalence of microalbuminuria and gender difference among patients with type II diabetes mellitus, in Riyadh, Saudi Arabia.
Methods: This is a cross-sectional study based on electronic medical records. This study included 283 diabetic patients, who attended primary care centers at security forces hospital in 2019. Included patients from both genders who had type II diabetes mellites and aged 20-60 years old. Patients with congestive cardiac failure, urinary tract infection, or pregnant patients were excluded from this study. Detection of difference in the mean of microalbuminuria is done by t-test and Mann-Whitney test. Significant associations between demographic and background variables were detected at < 0.05 significance level.
Results: A total of 283 diabetic patients were included in this study. Female patients accounted for 4.2% while males constituted 45.8% of the diabetic patients. After exclusion of patients with overt albuminuria, the prevalence of microalbuminuria was 9.8%. Patients with normal albuminuria accounted for 90.2%, while only three patients had overt albuminuria. There was no significant difference between medians of gender groups using the Mann-Whitney test (p=0.300).
Conclusions: Prevalence of microalbuminuria is low among T2DM patients in Riyadh city which may indicate a high quality of healthcare provided for diabetic patients. Gender was not a significant risk factor for microalbuminuria among diabetic patients.

Impact of Portable Pre-Hospital Ultrasound on Patients’ Outcomes: A Narrative Review

2022-11-07

Introduction: Training of emergency staff to use portable prehospital ultrasound machines is not a potential barrier to the adoption of the technique. Moreover, being a general doctor or paramedic was not a significant barrier to the training of ambulant or emergency health staff on prehospital ultrasound. This review aimed to evaluate the use of prehospital ultrasound among nurses and emergency medical services providers.
Methods: An electronic search in PubMed and Embase was conducted to identify relevant studies. The title and abstract of the relevant study were screened for eligibility criteria. The eligible articles were referred to two reviewers for in-depth reading. A total of 9 studies were included in this review aiming at providing evidence for the use of prehospital ultrasound.
Results: As the progression of bedside ultrasound utilization from radiologists to non-radiologists continues, we have seen penetration of ultrasound use by non-physicians as well. As the cost, machine size, and ease of use continue to improve, the applications of field ultrasound may continue to increase. Ultrasound may provide additional diagnostic information to guide therapy. The utility of this information will depend on the transport time as well as the training level of the provider in the ambulance.
Conclusions: Several types of practitioners (physicians, emergency medical technicians, nurses, and flight crews) have used portable ultrasound in a variety of practice environments including air and ground deployment.

Control of Respiratory Tract Infections during Hajj Pilgrimage: A Narrative Review

2022-11-25

Introduction: Factors that contribute to the high prevalence of respiratory disease among Alhaj pilgrims include physical exhaustion, sleep deprivation, and heat stress, inevitable overcrowding, both in housing and ritual sites. The aim of this review was to determine the magnitude and determinants of respiratory infections and pneumonia during the Hajj pilgrimage.
Methods: An online search was conducted in PubMed, Scopus, and Cochrane to identify eligible articles. Published studies and reviews explored pre and post-Hajj health education interventions for the prevention of respiratory infections and literature covering various prevention guidelines such as the use of facemasks, vaccination, cough etiquette, and social distancing during Hajj were included. Non-experimental studies such as reviews, letters, case reports, and systematic reviews were excluded from the review. Each of the selected articles was reviewed in full by two reviewers.
Results: Before each Hajj, the Saudi Ministry of Health disseminates the health requirements for the issuance of travel visas, and provides advice about public health guidelines to prevent the spread of respiratory and gastrointestinal infections. Current evidence indicates that simple physical interventions would be useful for reducing the spread of respiratory viruses. Some studies have addressed the impact of face mask use during the Hajj on the prevalence of both respiratory symptoms and viral pathogens using PCR assays from pilgrim nasal samples, and no significant effect was observed. By contrast, no positive effect of frequent hand washing or using hand sanitizer was observed among pilgrims on the occurrence of respiratory symptoms during the Hajj or on the prevalence of respiratory viruses as investigated by PCR assays on nasal swabs during the Hajj.

Prevalance of Stress among Healthcare Workers in Saudi Arabia

2022-12-20

Introduction: Factors leading to workers' stress include role overload, poor learner behavior, lack of resources, hospital size, diversity in individuals with whom they have to work, and lack of motivation from coworkers. This study aimed to assess stress among healthcare workers working in Saudi Arabia.
Methods: This is a cross-sectional observational study design conducted on health workers using an online questionnaire in Saudi Arabia. The total number of hospital healthcare workers does not exceed 430 workers. We assumed that the confidence level is 95% and the error of estimation is 5%. Based on the equation of sample size calculation for proportion (below), we use epi-info software (Statistical package). The sample size after correction for population size (which is a small population in this study) is 203 workers.
Results: The majority of respondents (64.5%) were aged below 30 years, 31% were aged 31-50 years (middle), and 4.4% were aged more than 50 years (old). The majority of respondents were healthcare workers (96.1%) while 3.9% held managerial positions. More than 73% of the respondents were working in one school, 15.3% hospitals and 11.3% were working in more than 3 hospitals. A number of 97% (47.8%) sometimes were feeling that they were capable of making decisions at the hospital. Most of the respondents 58.1% sometimes were feeling that most problems they were encountering at the hospital could be surmounted. The majority of respondents were sometimes (54.2%) feeling happy at work, 33% were mostly and 12.8% often had that feeling.
Conclusions: There is a considerable amount of stress among healthcare workers in Saudi Arabia. Females aged below 30 years were found sometimes more significantly feel capable of making decisions at hospitals compared to males. While males aged 31-50 years were sometimes more significantly felt capable of making decisions at hospitals compared to females. However, the study showed that those aged below 30 years were significantly greater feel capable of making decisions at the hospital compared to those aged 31-50 years and those aged above 50 years.

Paramedic Knowledge of Infection Control Principles and Standards

2023-05-16

Introduction: Infection control is crucial for patient safety in healthcare settings, and paramedics play a vital role in preventing the spread of infections. However, their knowledge and awareness of infection control measures may vary, leading to potential risks. This study aimed to assess the knowledge levels of infection control among paramedics and identify areas for improvement.

Methods: A cross-sectional study design was employed, and paramedics working in various healthcare settings were recruited in Saudi Arabia. A structured questionnaire was used to assess their knowledge of infection control measures. The questionnaire consisted of multiple-choice questions, and the responses were categorized into low, moderate, and high knowledge levels. Descriptive statistics were used to analyze the data.

Results: A total of 160 paramedics participated in the study. The results revealed a mixture of knowledge levels among paramedics, with approximately 63% demonstrating moderate or high knowledge and 67% exhibiting lower levels of understanding regarding infection control measures. Paramedics' knowledge varied across different aspects of infection control, including hand hygiene, personal protective equipment (PPE) use, and disinfection practices.

Conclusions: The findings emphasize the need for targeted interventions and ongoing education to address knowledge gaps and improve infection control practices among paramedics. By implementing comprehensive training programs and promoting knowledge sharing, healthcare organizations can enhance patient safety and reduce the risk of healthcare-associated infections.

Medication Safety Practices in Healthcare Settings: An Analysis of Support Staff Contributions

2023-12-05

Introduction:

An analysis of recent trends, gleaned from diverse healthcare institutions globally, indicates a rising demand for support staff to undertake expanded roles, such as medication reconciliation and patient education. This systematic review aimed of this review is to provide insights that will inform evidence-based strategies for optimizing support staff contributions to medication safety in healthcare settings.

Methods:

In this systematic review, a meticulous literature search utilizing MeSH terms and keywords related to medication safety and support staff contributions, conducted until August 2023, covered major databases including PubMed/MEDLINE, Cochrane Library, Embase, and CINAHL. The inclusion criteria were limited to clinical trials investigating support staff roles in medication safety within healthcare settings, with rigorous screening processes involving title and abstract reviews followed by full-text assessments. Data extraction involved key elements such as study design, sample size, interventions, and outcomes, contributing to a qualitative synthesis of included clinical trials. Methodological quality was evaluated using the Cochrane Risk of Bias Tool, ensuring a comprehensive and ethically sound past-tense methodology, enhancing the reliability and validity of the review's findings in understanding support staff contributions to medication safety in healthcare settings, with a particular emphasis on clinical trials.

Results:

In this systematic review encompassing seven clinical trials with diverse sample sizes (155 to 1,822 participants), aggregated data indicated a notable 25% average reduction in reported medication errors post-intervention, emphasizing the substantial enhancement in medication safety practices linked to support staff contributions [9-16]. Patient demographics across the trials exhibited diversity, with participants spanning various age groups, genders, and ethnic backgrounds. Notably, targeted interventions, including training programs and technological solutions like CPOE systems, demonstrated statistically significant improvements, such as a 21% increase in successful interprofessional communication and a 15% reduction in medication errors attributed to data entry issues [18-20]. These findings underscore the multifaceted impact of support staff in optimizing medication safety across varied patient populations and healthcare contexts.

Conclusions:

Our systematic review strengthens the evidence base affirming the pivotal contribution of support staff to medication safety in healthcare, as evidenced by reductions in medication errors and adverse drug events, improved patient satisfaction, and the positive impact of technological interventions, offering crucial insights for advancing medication safety practices.

Prevention of Surgical Site Infections in Saudi Hospitals Based on the International Guidelines

2023-12-28

Introduction:

Surgical Site Infections (SSIs) remain a significant concern in healthcare, posing serious risks to patient safety and increasing healthcare costs. . In Saudi Arabia, the incidence of SSIs has been reported to be around 2-5%, varying by surgical procedure and hospital settings. This review aimed to evaluate the effectiveness of various interventions for the prevention of SSIs in the Saudi healthcare context.

Methods:

In the initial phase of our systematic review, we conducted a thorough search of electronic databases, including PubMed, Embase, Scopus, and the Cochrane Library, up to September 2023, using carefully selected search terms to identify relevant literature on interventions for preventing Surgical Site Infections (SSIs) in Saudi hospitals. Inclusion criteria encompassed studies that investigated SSI prevention interventions aligned with international guidelines, while exclusion criteria eliminated studies unrelated to SSI prevention in Saudi hospitals, theoretical studies without empirical data, editorials, commentaries, and reviews, ensuring a rigorous and focused study selection process.

Results:

The systematic review included six diverse studies focused on interventions for preventing Surgical Site Infections (SSIs) in Saudi hospitals, highlighting variations in sample size, intervention types, and effectiveness. Sample sizes ranged from 150 to 1,930 patients, reflecting the diverse healthcare settings in which SSI prevention strategies were implemented. Interventions, such as surgical hand antisepsis protocols, antimicrobial prophylaxis optimization, and controlled operating room ventilation, demonstrated varying degrees of effectiveness, with risk differences ranging from 4% to 16% and percentage reductions ranging from 5% to 20% across the studies. These variations underscored the context-specific nature of SSI prevention.

Conclusions:

This systematic review examines interventions for preventing Surgical Site Infections (SSIs) in Saudi hospitals, revealing varying effectiveness among interventions and emphasizing the need for context-specific approaches guided by international guidelines. The findings offer valuable insights for healthcare practitioners and policymakers in Saudi Arabia, providing a foundation for evidence-based strategies to enhance patient safety and reduce SSIs.

Knowledge about Management of the Diabetic Foot among Physicians in Makkah, Saudi Arabia

2022-08-09

Introduction: In Saudi Arabia, the largest country in the Middle East, diabetes mellitus is identified as a common chronic disease with rapidly increasing incidence. Saudi Arabia has the second rank in the prevalence of diabetes among Middle East countries and the seventh rank internationally. This study aims to evaluate the level of physicians ’ awareness about diabetic foot and associated complications; and the influence of demographic factors on this knowledge.
Methods: This study followed a cross-sectional design. Physicians who work in hospitals and public health centers were included in this study. Physicians who were working in clinical practice for at least one year were included in the study. Physicians who were unwilling to participate in the study were excluded. A self-administered questionnaire was used to collect data from physicians using the Google forms application. It consists of two sections, the first section questioning demographic and background variables such as age, sex, nationality, education, and source of knowledge about diabetes. The second section contains questions regarding the knowledge about diabetic complications such as the diabetic foot.
Results: A total sample of 388 physicians, working in the Eastern province, were included in this study. More than half of the respondents were females (59.3%) and the majority (98%) were Saudis. Regarding the specialty of the physicians, about 60% were either general practitioners or residents, whereas 29.4% and 10.8% were specialists or consultants, respectively. The knowledge about diabetes mellitus, majority (55.9%) of the physicians had poor knowledge about diabetes mellitus. Significant determinants for knowledge among the physicians were specialty and presence of previous training in diabetes mellitus.
Conclusions: The level of knowledge about diabetes foot among physicians was insufficient as the majority had inadequate levels of knowledge. Significant determinants for knowledge were a specialty and the presence of previous training on diabetes mellitus.

Effect of Anti-Osteoporotic Drugs in Prevention of Bone Fracture: A Scoping Review

2022-11-13

Introduction: Fragility fractures due to osteoporosis account for 9 million of the total fractures registered annually worldwide. Osteoporosis can be successfully treated with both antiresorptive and anabolic drugs, whose efficacy in reducing fracture incidence. Despite this, only a small proportion of osteoporotic patients are currently treated for fracture prevention. This scoping review describes how osteoporosis and various categories of anti-osteoporotic drugs impact fracture healing.
Methods: We performed a systematic search of the available literature in MEDLINE In-Process and Other Non-Indexed Citations Embase.com, and Cochrane Central Register of Controlled Trials. For each separate anti-osteoporotic agent PubMed was searched for evidence from randomized clinical trials (RCTs) in patients and animal studies with osteoporosis on anti-osteoporotic (antiresorptive). The main search was completed independently by four investigators. Criteria for inclusion/exclusion of studies were established prior to the literature search. Eligible for the systematic review were retrospective, observational prospective, and randomized controlled trials (RCTs), which investigated the efficacy of the anti-osteoporotic drugs on fracture risk BMD.
Results: Earlier studies that demonstrated the anti-osteoporotic effect of drugs had limited sample size and focused on single fracture type and/or a specific anti-osteoporotic treatment regimen . There are also no comprehensive reviews that present the effectiveness of the existing anti-osteoporotic drugs in use for patients with osteoporotic fractures. We found animal studies, preclinical and clinical trials, in addition to three reviews.

Conclusions: A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.

Prevention of Tetanus after Medical and Surgical Procedures: A Narrative Review

2022-12-07

The World Health Organization was committed to eliminating neonatal tetanus by 1995. Three years after this date, the infection killed over 400,000 babies a year, even though a safe, effective vaccine had been available for most of this century. The frequency of tetanus in the developing world epitomizes the healthcare disparity between the developed and the developing world. Consequently, the priority of the medical profession must be prevention, with the development of simpler immunization schedules with longer protection. Consequently, the purpose of this collective review is to provide an overview to the management of tetanus as well as to review the immunization strategy that will prevent this potentially deadly illness. Tetanus is caused by Clostridium tetani, which is an obligately anaerobic, gram-positive rod that is motile and readily forms endospores. Although C. tetani is located everywhere, the disease is encountered largely in underdeveloped, overcrowded, and economically disadvantaged countries. C. tetani is widespread in the feces of domestic animals and humans, while spores of C. tetani are abundant in soil and in the environment surrounding the habitation of humans and animals. Tetanus usually follows deep penetrating wounds where anaerobic bacterial growth is facilitated. Three basic forms of tetanus may be distinguished: local, cephalic, and generalized. At least 80% of the cases are in the generalized form. In the adult patient, the most characteristic sign of generalized tetanus is lockjaw or trismus. The diagnosis of tetanus is most frequently made on clinical manifestations, rather than on bacteriologic findings. The three objectives of the management of tetanus are: (1) to provide supportive care until the tetanospasmin that is fixed in tissue has been metabolized; (2) to neutralize circulating toxin; and (3) to remove the source of tetanospasmin. Because there is essentially no immunity to tetanus toxoid, the only effective way to control tetanus is by prophylactic immunization

Management of Migraine Using Pain Killers: A Systematic Review

2022-12-27

Introduction: Migraine is a disabling disease that can significantly impact work or school productivity and lead to absenteeism. The overuse of analgesics and anti-migraine drugs have been published in recent years. This review aimed to identify the advancement in management of migraine using various types of pian killers.
Methods: A systematic search was conducted of English-language articles in PubMed, Cochrane, and EMBASE databases to identify studies on the prevalence and incidence of chronic migraines. The search included terms related to chronic migraines, as well as epidemiological terms such as burden, prevalence, and incidence, and terms related to other types of chronic headache. Studies were included if they were population-based, conducted in adults, and reported prevalence and/or incidence estimates for CM or provided sufficient information to calculate these estimates.
Results: A total of 21 studies were included in a review of treatments for migraines. These studies included 11 randomized controlled trials, 5 retrospective reviews, and 4 prospective chart review studies. The studies evaluated a variety of treatments, including intravenous fluids, analgesics, dopamine receptor antagonists, valproic acid, propofol, magnesium, bupivicaine, triptan medications, and dihydroergotamine. The primary outcome in most of the studies was the change in pain on a visual analog scale at 30 minutes. One study found that ibuprofen had nearly three times the odds of efficacy compared to placebo at 2 hours, and was twice as effective as acetaminophen. Another study found that acetaminophen was superior to placebo in reducing headache intensity.
Conclusions: The use of recommended first-line therapies varied greatly within the healthcare system and the frequent use of narcotics was concerning due to the limited effectiveness of these drugs in the treatment of migraines and the increased risk of adverse side effects and drug abuse.

Application of The New Guidelines for Sepsis Management in Emergency Departments: A Systematic Review

2023-10-30

Introduction: Sepsis is a widespread issue, affecting millions of individuals worldwide. According to the World Health Organization (WHO), sepsis is a leading cause of death in hospitals, accounting for up to 30% of all hospital deaths. This review aimed to identify gaps in guideline application and highlight areas where improvements are required, with the ultimate goal of substantially reducing sepsis-related deaths.

Methods: A comprehensive search strategy was employed, encompassing prominent electronic databases from their inception until 2023. The search combined keywords and medical subject headings (MeSH terms), with a focus on "sepsis," "emergency department," "guidelines," "application," and "management." The study selection process involved a two-step approach, with initial screening of titles and abstracts followed by a detailed examination of full-text articles to meet predefined inclusion criteria. This meticulous methodology aimed to enhance the systematic review's reliability and comprehensiveness, enabling the extraction of valuable insights on the application and effectiveness of new sepsis management guidelines in emergency departments.

Results: This systematic review encompassed 12 studies with diverse research designs, focusing on the application of new sepsis management guidelines in various healthcare settings. The review revealed an average guideline adherence rate of 58%, indicating a moderate level of compliance with recommended protocols. Furthermore, most studies demonstrated positive impacts on patient outcomes, with timely and guideline-compliant sepsis management associated with a notable reduction in mortality rates, potentially reaching a statistically significant decrease of up to 20%. Additionally, common implementation barriers, such as time constraints and resource limitations, were consistent across healthcare settings, and substantial variability in guideline adoption was observed among different regions and institutions.

Conclusions: This systematic review contributes to the expanding knowledge on the implementation of new sepsis management guidelines in emergency departments. It reinforces the critical themes of guideline adherence, overcoming implementation obstacles, standardizing practices, and utilizing risk stratification tools to improve patient outcomes and healthcare system efficiency within the emergency department context.

Assessment of the Efficacy of Vaccination Programs in Healthcare Workers for Infection Control

2023-12-22

Introduction:

The alarming prevalence of infectious diseases in this population underscores the critical importance of implementing effective preventive measures to mitigate the risks faced by healthcare professionals. In this review, we aim to enhance the existing knowledge base and guide future efforts toward optimizing infection control measures among this critical demographic.

Methods:

The systematic review rigorously evaluated the efficacy of vaccination programs in healthcare workers for infection control through a meticulous and iterative search strategy, utilizing key terms and targeted databases known for extensive medical literature coverage. This comprehensive approach aimed to systematically retrieve studies that provided valuable insights into vaccination program effectiveness, particularly in mitigating infection risks among healthcare workers, a population at heightened exposure to infectious agents. The systematic and transparent methodology employed in the search strategy, database selection, and study selection processes enhanced the reliability and relevance of the findings, contributing to a comprehensive assessment of vaccination program impact on infection control among healthcare workers and guiding evidence-based practices in healthcare settings.

Results:

The systematic review synthesized data from nine randomized clinical trials (RCTs) on vaccination programs for infection control among healthcare workers, revealing a broad range of sample sizes (520 to several thousand participants) and diverse population characteristics, including various healthcare specialties and settings. The interventions, encompassing vaccines against influenza, hepatitis B, and measles-mumps-rubella, demonstrated vaccination coverage rates ranging from 72% to 93%, reflecting variations in vaccine types and delivery methods. The overall effectiveness, quantified by a pooled risk ratio of 0.65 (95% CI: 0.55-0.75), indicated a substantial reduction in vaccine-preventable infections, with individual risk ratiosranging from 0.5 to 0.8. Notably, these findings underscored the robust protection conferred by vaccination, supporting its integration into routine healthcare practices for infection control among healthcare workers.

Conclusions:

The findings supports the crucial role of vaccination programs in healthcare workers for infection control, showcasing consistently significant effectiveness across various infectious diseases and emphasizing their vital contribution to safeguarding healthcare professionals and public health.

Infection Control among Saudi Health Professionals during COVID-19 Pandemic: A Systematic Review

2023-12-21

Introduction:

The COVID-19 pandemic has significantly impacted healthcare practices worldwide, with dental professionals facing unique challenges due to their close contact with patients and exposure to bodily fluids. This systematic review aimed to evaluate the effectiveness of infection control measures implemented by Saudi dental professionals during the pandemic, focusing on interventional studies and clinical trials to provide evidence-based recommendations for enhancing safety in dental settings.

Methods:

A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, for studies published between 2007 and 2022. The review focused exclusively on interventional studies and clinical trials conducted in Saudi Arabia that assessed infection control measures in dental practices during the COVID-19 pandemic. Studies were selected based on predefined inclusion and exclusion criteria, with data extraction and quality assessment performed independently by two reviewers. The effectiveness of various interventions was synthesized narratively, given the expected heterogeneity in study designs and outcomes.

Results:

Nine interventional studies were included, covering a range of infection control measures such as enhanced PPE protocols, UV-C light disinfection, pre-procedural mouth rinses, educational interventions, and the use of teledentistry. Key findings include significant improvements in PPE usage with risk ratios ranging from 1.1 to 1.5, over 90% effectiveness in reducing surface contaminants with UV-C light disinfection, and a reduction in viral load in aerosols with a risk ratio of 0.8 for pre-procedural mouth rinses. Educational interventions led to up to an 85% compliance rate with infection control practices.

Conclusions:

This review highlights the effectiveness of a multifaceted approach to infection control in dental settings during the COVID-19 pandemic. Enhanced PPE, UV-C light disinfection, pre-procedural mouth rinses, and educational programs are among the interventions that showed significant benefits in reducing the risk of virus transmission among dental professionals and patients. Implementing these evidence-based strategies can contribute to safer dental care practices amid the pandemic.

Prevalence and Determinants of Performance-Enhancing Substances among Gym Attenders in Saudi Arabia

2022-10-24

Introduction: Side effects associated with PESs varied from mild effects such as acne, enlargement of testes, and pain in injection site to severe effects such as liver diseases, cardiovascular conditions, and cancer. This study aimed to assess the prevalence and determinants of PESs use among gym attenders in Saudi Arabia. Methods: This is a cross-sectional study included 244 adult gymnasts in Saudi Arabia. A self-administered questionnaire was distributed through online surveying. The link was sent to the mobile phones of gym attenders and a reminder was send one week later. The researchers described the aim and objectives of the study for the residents and ask them to provide a written consent. No names required to assure confidentiality of data and all information were kept confidential only for this study purposes. Results: A total of 244 gym attenders were included in this study, most of them were males. The study included respondents aged 21-68years old with mean age of 38±12. The prevalence of gym-performance enhancing substances was 29.4% and only 31.1% knew the chemical composition of these substances. Online shopping and fitness stores were the most common sources of gym-performance enhancing substances in 23% and 20.5% of the respondents, respectively. The prevalence of substance use in few included females was zero in comparison to 31.5% of the males but the difference was not statistically significant (p=0.100). similarly, as the age group be older, the prevalence of using gym-enhancing substances decreased from 32.5% to 16.7%. Conclusions: There is a substantial prevalence of performance-enhancing substances which is similar to that reported in western countries.

Effectiveness of Gaseous Ozone as a Disinfectant for Nosocomial Pathogens

2022-11-25

Introduction: Ozone is a potent oxidizing agent and is characterized as a highly rapid and effective microbicide. This review is aimed to discuss ozone administration and disinfection strategies in both air and surface applications.
Methods: A literature review is one of the methods used in evidence-based practice that includes the analysis of studies relevant to decision-making and improving care practices. A literature search was conducted through October 2022 without restrictions concerning language or period of publication in the following databases: MEDLINE, SCOPUS, and COCHRANE using the descriptors ozone and sterilization from the Medical Subject Headings Section (MeSH). Only primary studies addressing the use of O3 as a sterilizing agent for health products were included. These were selected by the title and abstract and only those that met the inclusion criteria were fully read. Papers identified in more than one database were analyzed only once.
Results: Recent studies have also demonstrated equal efficacy of ozone treatments of samples in a wet and dry state. Continual monitoring of the ozone concentration in the operator area confirmed that no ozone toxicity. Given the urgent need for new processing methods and the continuous development of new technology added to the large diversity of shapes and raw materials, the O3 gas is, according to the analyses, a promising method. In order to quickly reduce the ozone level to a safe level for humans working in the room after ozonation, an amount of fresh air is added to the room through a filter as a substitute for the highly ozonated air.

Conclusions: Ozone is considered to be an environment-friendly disinfectant that leaves no residual or by-products after the disinfecting process. Ozone with concentration higher than 1 ppm has adverse effects on human health and the use of ozone for air disinfections generally is not recommended if people are around. Nonetheless, further research of an experimental nature is required to gather evidence concerning its possibilities and limitations.

Cardiovascular Diseases and Diabetes Mellitus in Saudi Arabia

2022-12-20

Introduction: The availability of figures about the risk of cardiovascular diseases (CVDs) could guide the planning and conduct of specific preventive programs that target CVDs among diabetic patients in Saudi Arabia. Thus, this study aimed to assess the risk of cardiovascular diseases in diabetic patients among the population in Saudi Arabia.
Methods: This is an analytical cross-sectional observational study design conducted on people attending primary health care (PHC), in Najran city. The cases and controls were subjected to clinical examination and laboratory investigations to identify the occurrence of the study outcomes including CVDs, diabetic nephropathy, and retinopathy. Cases and controls were examined to ensure that both groups are comparable in regards to main demographical variables such as age and sex.
Results: The non-adjusted odds ratio of the association between CVDs and diabetes mellitus was 11.5 (P value= 0.001). The findings of logistic regression showed that diabetes mellitus and smoking were significant independent predictors for the occurrence of CVDs, while age, gender, nationality, and BMI were not significant predictors for CVDs.
Conclusions: This study concluded that diabetic patients in Saudi Arabia are at a higher risk of CVDs than that non-diabetic persons. Hypertension and dyslipidemia were important risk factors for CVDs among diabetic patients, while gender, age, and nationality showed a non-significant effect. Diabetes mellitus and smoking were considered significant independent predictors for the occurrence of CVDs.

Stress and Musculoskeletal Disorders: TMJ Disorder as an Example

2022-12-28

Introduction: The stressful life was found to affect the body health through the psychosocial mode of action. Only a few data are available about the association between emotional stress and TMD problems. Thus, this review aimed to examine the association between stress and TMD incidence.
Methods: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases covering the period before 2022. Various combinations of keywords related to TMJ dysfunction and aspects of etiology were used (etiologic factors, etiology, temporomandibular joint dysfunction, disorder, disc displacement, dental occlusion, estrogen hormones, emotional stress, anxiety, depression). Databases were searched for papers published in English. Of the initial 121 abstracts found 102 were excluded. Excluded abstracts were those of repeated studies and studies with unrelated scopes. Another 5 studies were also excluded because they were not clearly related to the review topics.
Results: A total of 14 articles considered most relevant were selected for this review. The etiology of TMD is complex and multifactorial. There are numerous factors that can contribute to this disorder, which are grouped into three categories. Psychological factors such as stress, mental tension, anxiety or depression can cause TMD. Initiating factors lead to the onset of the symptoms and are primarily related to trauma or adverse loading of the masticatory system. Various studies have confirmed that patients with stress or myofascial pain associated with arthralgia, arthritis or osteoarthritis presented more advanced stages of temporomandibular joint disorder.
Conclusions: Stress, anxiety, and other psychological factors induce muscle hyperactivity and muscle fatigue with the appearance of muscle spasms and the following consequences: contracture, occlusal disharmony, internal disturbances and degenerative arthritis. These factors can alter the occlusal scheme of the masticatory cycle so that these alterations are more a result of TMD and not a triggering factor.

Effect of Surgical versus Non-Surgical Treatment of Obesity on Blood Pressure among Non-compliant Patients

2023-11-21

Introduction: Evaluating the comparative effectiveness of surgical versus non-surgical interventions on blood pressure outcomes is crucial for guiding clinical decisions. Existing literature suggests that bariatric surgeries not only result in significant weight loss but also lead to a notable reduction in blood pressure. This review aims to quantify the effects of each intervention and to identify potential mechanisms underlying these observed effects.

Methods: A thorough literature search encompassing multiple electronic databases, including PubMed/MEDLINE, Embase, Cochrane Library, and Scopus, was executed from inception to September 2023. The study selection process involved a two-step approach, initially screening titles and abstracts independently, with subsequent retrieval and assessment of full-text articles against predetermined eligibility criteria. Criteria included adult participants diagnosed with obesity, exclusive consideration of randomized controlled trials (RCTs) and controlled clinical trials (CCTs), and exclusion of pediatric studies, observational designs, reviews, and non-English language publications. Rigorous data extraction procedures, independently conducted by two reviewers, aimed at ensuring the reliability of this systematic review.

Results: Eight clinical trials, with a combined sample size ranging from 322 to 2,564 participants, were included in the systematic review, reflecting the diverse nature of obesity and its associated comorbidities. Notable findings from individual trials include a significant reduction in systolic blood pressure by an average of 12 mmHg and diastolic blood pressure by 8 mmHg in the gastric bypass group compared to lifestyle intervention over 12 months. Similarly, sleeve gastrectomy demonstrated a substantial decrease in systolic blood pressure by 15 mmHg and diastolic blood pressure by 10 mmHg compared to pharmacotherapy over 24 months. Collectively, the trials consistently indicate a more significant reduction in blood pressure with surgical interventions, emphasizing their potential cardiovascular benefits in obesity management and highlighting the importance of further research on long-term outcomes.

Conclusions: The systematic review of eight clinical trials presents compelling evidence supporting the superior impact of surgical interventions on blood pressure outcomes in individuals with obesity compared to non-surgical approaches. The consistently significant reductions in both systolic and diastolic blood pressure across diverse patient populations underscore the clinical relevance of bariatric surgery in addressing obesity-related hypertension, emphasizing the statistical advantage and potential long-term benefits of surgical interventions in the comprehensive management of obesity-related cardiovascular risks.

Applications of Artificial Intelligence in Dentistry: A Narrative Review

2023-12-28

The rapid growth of AI-related dental publications reflects the burgeoning interest in dentistry. A systematic analysis revealed an unprecedented increase in AI dental publications, indicating a trend towards widespread implementation across various dental disciplines. This narrative review aimed to provide a comprehensive understanding of AI's current applications and future in dentistry. Artificial Intelligence (AI) is making significant strides in dental radiology, enhancing diagnostic accuracy and efficiency. Studies have demonstrated that AI outperforms clinicians in terms of accuracy and efficiency, particularly in tasks like caries detection and marginal bone loss identification. In prosthodontics, AI is revolutionizing the field by offering patient-specific prosthesis construction and precise color matching for better aesthetic and functional outcomes. It also plays a crucial role in dental implant design, ensuring accurate color matching in challenging cosmetic scenarios. In orthodontics, AI is increasingly used for tasks like landmark identification and skeletal classification, with performance comparable to or exceeding that of human experts. AI is seen as a valuable tool to improve clinical decision-making in orthodontics. In periodontics, AI-assisted monitoring has shown substantial improvements in various periodontal parameters, positively impacting treatment outcomes for patients with periodontitis. AI, when combined with human counseling, leads to even better results. Hence, AI is transforming different branches of dentistry, offering more accurate diagnostics, patient-specific treatments, and enhanced clinical decision-making. These advancements have the potential to improve patient care, treatment outcomes, and cost-effectiveness in dental healthcare.

Infections Associated with Dry Mouth Impact on the Efficacy of Prosthetic Restorations

2023-12-21

Introduction:

Dry mouth, commonly known as dry mouth, substantially diminishes life quality, particularly among edentulous individuals utilizing dental prostheses. Given the scarcity of data on this condition's prevalence and its repercussions for those dependent on denture prosthesis, this investigation seeks to elucidate the relationship between xerostomia, its influencing factors, and its implications for the oral health-related quality of life among denture users.

Methods:

A systematic exploration of scholarly articles published before 2022 was undertaken across six databases, including Ovid MEDLINE, Evidence Based Medicine Reviews Database, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, and the Cochrane Central Register of Controlled Trials. The search was refined to English-language studies involving human participants. Two independent reviewers assessed the articles to determine their relevance based on predefined inclusion criteria.

Results:

The search culminated in the identification of 10 relevant articles, though none reported on randomized controlled clinical trials. The existing body of clinical research on the relationship between reduced salivation and denture stability offers limited evidence, hindering the formulation of definitive clinical guidelines. Consequently, the impact of treating hyposalivation on both denture stability and patient quality of life remains uncertain. This underscores an urgent need for well-designed randomized controlled trials within the denture-using demographic afflicted by dry mouth.

Conclusions:

Our findings highlight xerostomia as a critical determinant of life quality among older denture wearers, overshadowing factors such as dental status or the nature of prosthetic solutions. However, it was observed that the number of teeth or implants in the upper jaw and the utilization of gum-supported dentures across both jaws could significantly detract from the quality of life in this population

Relation between Passive Smoking and Depression among Pregnant Women Attending Primary Health Care Centers in Al-Madinah, Saudi Arabia

2022-05-04

Introduction: Depression during pregnancy is linked to several negative effects on the mother and fetus. Several factors, including passive smoking exposure, were implicated in its risk. Little is known about this issue in Saudi literature. This study aimed to estimate the prevalence of depression in pregnant women and to investigate its association with passive smoking exposure during pregnancy.
Methods: A cross-sectional study was carried out in 8 primary health care centers in Madinah City, Saudi Arabia during the year 2018. The study analyzed data from 261 pregnant women attending the antenatal clinics at the studied centers. The data collection was based on a self-administered questionnaire including socio-demographic and reproductive data, passive smoking exposure status, and data assessing depression symptoms. Appropriate statistical analyses were done including logistic regression analysis.
Results: The overall prevalence of depression symptoms was 54.79 (95% CI= 48.5-60.9), and it varied by the studied women's characteristics. The low prevalence of depression was found among older, highly educated, and housewife women, and among women receiving husbands' emotional support. Passive smoking exposure among the studied women was 26.05% (95% CI= 20.8-31.8%), and the risk of depression was increased among women who reported passive smoking exposure outside the home in the non-adjusted regression model (OR= 1.75; 95% CI= 1.02-2.99). This significant association, however, disappeared in the adjusted model (OR= 1.5; 95% CI= 0.35-6.10).

Conclusions: A weak positive association between passive smoking exposure and the risk of depression was found. Young, low educated, and unemployed women as well as those who reported partner violence, previous pregnancy complications, and unplanned or unwanted pregnancy were at risk of depression.

Determinants of Spine Radiography among Patients with Severe Trauma

2022-11-11

Introduction: Radiographs have low sensitivity in detection of cause-specific backpain that resulted from trauma or infection. Thus, radiography could be considered as an initial diagnostic modality for backpain before referral to more sophisticated radiological techniques. The aim of the review is to study the determinants of spine radiography, particularly in patients with severe trauma.
Methods: The following databases were searched without language restrictions for articles published in any year up to January 2022: “PubMed, MEDLIN, EMBASE, and Google-Scholar”. Designing and conducting the electronic search strategy were performed by an expert reference librarian based on input data from investigators. The database searches were supplemented with manual searches of reference lists of the potentially eligible articles. Article about spine or pelvic radiography were included in this study.
Results: Several studies aimed to assess methodological radiographic factors that can improve the performance of radiography in different parts of the body. many studies focused on pelvic radiography found that body positioning and axial load were significant predictors for radiation dose and image quality. In lumber supine region, the most common cause of spinal pain in 70% of cases is diagnosed as “non-specific”. In such cases, radiographic assessment is recommended for patients with chronic backpain, patients with osteoporosis, patients suspected to have vertebral compression problems, or those under steroids treatment.
Conclusions: Improvement of the performance by identifying the key operational factors, in the lumber spine region, may significantly reduce the rejection rate of radiographs in the clinical practice.

Application of New Ultrasound Technology in Spinal Cord Injury: A Systematic Review

2022-12-04

Introduction: High-Intensity Focused Ultrasound is a non-invasive technique therefore, there is no need for surgery or ultrasound-guided puncture and no risk of bleeding. It can completely destroy lesions in the body, with no harm to ultrasound-penetrated tissues or normal areas lying outside the target. This review aims at highlighting the use of HIFU in spinal cord surgery.
Methods: The electronic search resulted in ten potentially relevant studies that reported assessing Outcomes of High-Intensity Focused Ultrasound in different surgical procedures. Eight studies were excluded because of that they were not have consistent outcomes.
Results: All the included studies were prospective studies except only one was a retrospective study which was done among 73 patients aged between 17-80 years with benign thyroid nodules. The treatment was done using an imaging transducer and HIFU transducer. The outcome of HIFU was varying among different surgical and spinal cord procedures. Five of included studies were measuring the survival rate, it was ranged between 38.5% and 89%.
Conclusions: The HIFU is a promising non-invasive technology that can enhance neurological surgery with faster recovery and fewer post-operative complications.

Overview of the Hepatitis B Epidemiology and Vaccination among Healthcare Workers

2022-12-26

Introduction: Healthcare workers (HCWs) who are at high risk for HBV infection, have been recommended to receive the HB vaccine for over 20 years. This review aimed to highlight the enablers and obstacle facing the universal coverage of hepatitis B epidemiology and vaccination among healthcare workers.
Methods: A search was conducted using the following terms related to hepatitis B, vaccination, and healthcare workers in Africa: hepatitis B, hepatitis B virus, vaccination, immunization, healthcare workers, health workers, and health personnel. This review included cross-sectional, case-control, and cohort studies. Studies in English or French from any location were selected. A search was conducted for articles published from 1970 to 2022 in PubMed and the Excerpta Medica Database (Embase) using search terms related to hepatitis B and healthcare workers.
Results: This study analyzed 25 cross-sectional studies on healthcare workers (HCWs) in African countries to determine the prevalence of hepatitis B vaccination. The majority of the studies were conducted in hospitals and included HCWs from West and East Africa. After assessing the quality of the studies, 5 (14.3%) were found to be of high quality, 17 (77.1%) were of moderate quality, and 3 (8.6%) were of low quality. The proportion of HCWs who were fully vaccinated against hepatitis B varied widely, ranging from 0.8% in Rwanda to 72.0% in Libya. The overall pooled full vaccination coverage among HCWs in Africa was 24.7%. Subgroup analyses showed significant variation in vaccination coverage among HCWs in different regions of Africa and Asia, with the highest coverage in North Africa and the lowest in Central and East Africa.
Conclusions: Healthcare workers (HCWs) are at higher risk of infection with Hepatitis B virus (HBV) compared to individuals who do not work in hospitals, with frequencies of infection up to 4 times higher. HBV can be transmitted between patients and HCWs, as well as between HCWs and their relatives, contributing to the ongoing chain of transmission.

Applications of Natural Language Processing in Cardiology using Text Clinical Data: A Systematic Review

Hamdi. A. Alhakimi* (1) , Tayseer Elsiddig Magzoub (2) — 2023-09-26

A low survival rate of heart failure (HF) is attributed to the under-diagnosis due to lack of the diagnostic reference standard. Heart failure usually is not well-documented in the administrative databases due to inconsistency in use of diagnostic codes and inter-examiner variability. The majority of EHR databases can export data for certain patients’ characteristics, such as demographics and lab results, in a structured and analysis-friendly format. However, a lot of clinical data are stored in text and unstructured format. The use of unstructured clinical text data can substantially enhance both discission-making and clinical research. A manual extraction of unstructured data is time- and money- consuming process, hence using NLP algorithms with automatic extraction and classification could enhance efficiency and accuracy of the process.

This review aimed to highlight the literature that addressing application of NLP in the analysis of clinical text data related to diagnosis and prognosis of cardiovascular diseases. A multiple-term search strategy was used in PubMed and resulted in 53 studies, while only 20 studies used NLP techniques to handle text data related to HF. The included studies used NLP in different clinical purposes such as clinical features extraction, HF classification, and prediction of various HF outcomes. Early detection of HF symptoms was achieved in many studies and sometimes a median time of 6 months was found between a symptom reporting and the clinical diagnosis. Not only symptoms were extracted, characteristics of self-management, social determinants, and home-care were successfully identified by NLP techniques. Ejection fraction in clinical notes was used mainly to determine the type and severity of HF and it was associated with very good performance of NLP classifiers. Using of semi-structured clinical data, such as radiological reports, were usually associated with a better performance than using unstructured data, such as nurse notes. However, a combination of different types of data, particularly those supported by expert-knowledge, showed a promising results in HF diagnosis or prognosis. Using NLP techniques in the future can reduce underestimation of HF, particularly, when computer-extracted features and expert-optimized concepts are combined.

Depression, Anxiety and Stress during COVID-19 Pandemic among Physicians and their Families at King Abdulaziz University, Rabigh, Saudi Arabia

2023-12-18

Introduction:

Physicians are the frontline warriors in the battle against the pandemic. Therefore, it is crucial to investigate the impact of this health crisis on healthcare professionals and their families. This study aims to examine the prevalence and factors influencing depression, anxiety, and stress among doctors and their family members during the COVID-19 pandemic.

Methods:

This is a cross-sectional study recruited doctors (or their family members) who work in the Faculty of Medicine, Rabigh, Saudi Arabia. A self-administered questionnaire containing Depression, Anxiety and Stress Scale - 21 Items (DASS-21) was used to collect participant data using an online link. Scores for depression, anxiety and stress are calculated by summing the scores for the relevant items. Descriptive statistics were computed based on variable types. Quantitative variables were summarized using means and Standard Deviation (SD), while qualitative variables were presented as frequencies and proportions. Univariate analysis with Chi-square was employed to assess goodness of fit at a significance level of 0.05. Regression models were utilized to identify potential predictors for each dimension of depression, anxiety, and stress.

Results:

A total of 143 participants were included in this study. Of them, 60.8% were doctors affiliated to Rabigh College, while 39.2% were relatives of doctors. Regarding depression, 46.2%.8% had depression with different degrees; 11.2% and 6.3 had "Severe" and "Extremely severe" depression, respectively. Similarly, 41.3% had abnormal anxiety levels, 11.2% had severe or extremely severe anxiety, and 30.1% experienced stress in different severity levels. Patients’ characteristics such as gender, nationality, marital status and occupation were found to be associated with different psychological problems.

Conclusions:

The study's findings revealed that a substantial proportion of the doctors and their family members had moderate to extreme levels of depression, anxiety and depression during the COVID-19 pandemic. These findings highlight the importance of considering cultural and contextual factors when assessing and addressing mental well-being within specific populations.

Impact of Domestic Violence Exposure on Children: A Systematic Review

2023-12-21

Introduction:

The psychological effects of witnessing domestic violence are profound, with evidence indicating that up to 60% of children exposed to such environments exhibit symptoms of post-traumatic stress disorder (PTSD). The aim of this systematic review was to critically evaluate the existing literature to better understand the scope and magnitude of these impacts.

Methods:

This systematic review employed a comprehensive search strategy across multiple electronic databases, including PubMed, PsycINFO, Scopus, and Web of Science, focusing on interventional studies and clinical trials related to children exposed to domestic violence. The inclusion and exclusion criteria were strictly defined to select high-quality, relevant studies, followed by a meticulous screening and assessment process to ensure the inclusion of only the most pertinent research on the topic.

Results:

The summarized results of the systematic review reveal that the interventions tested across six studies, with sample sizes ranging from 62 to over 1000 participants, showed significant effectiveness in various contexts. Cognitive-behavioral therapy (CBT) interventions, for example, led to a notable reduction in PTSD symptoms, achieving a risk ratio (RR) of 0.7 with a confidence interval (CI) of 0.5 to 0.9. Similarly, school-based interventions demonstrated improvements in academic performance and peer relationships with a RR of 0.6 (CI: 0.5 to 0.7), while family therapy interventions resulted in significant enhancements in family functioning and child behavioral outcomes, with a RR of 0.4 (CI: 0.2 to 0.6). These findings underscore the varied and significant impact of targeted interventions on children exposed to domestic violence.

Conclusions:

This systematic review highlights the effectiveness of various interventional approaches in mitigating the impacts of domestic violence exposure on children. Cognitive-behavioral therapy emerged as particularly effective in reducing PTSD symptoms and anxiety.

Impact of Smoking Cessation Clinics on the Prevalence of Smoking: A Systematic Review

2022-10-24

Introduction: The conceptual framework of smoking cessation showed that smokers firstly think to quit, plan to quit, try to quit, and finally sustain quitting or relapse. Clinics of smoking cessation aim to help smokers to plan, quit and sustain a healthy lifestyle. This review aimed to collect evidence about the impact of smoking cessation clinics.
Methods: Electronic databases were searched including PubMed and Embase. Furthermore, the search was conducted in databases and repositories of grey literature such as Open Grey and OAIster. The databases of the systematic review and clinical trials, such as Cochrane libraries and the Center for Reviews and dissemination, were screened for eligible primary studies. The flow of the information through the different stages of a systematic review (primary screening, secondary screening, and inclusion stage) was followed. Full texts of the eligible studies were retrieved to conduct an in-depth reading. The eligibility criteria were applied to the eligible studies which lead to exclusion of irrelevant studies.
Results: The findings of this review revealed that the referral rate from primary health centers to smoking cessation clinics was significantly improved. However, this increase was not translated into an improvement in the smoking quitting rate. Lack of effectiveness was attributed to the service pitfalls including delay in referral, shortage of experts, and low awareness among smokers. In Saudi Arabia, working within the faith-based paradigm, a National Tobacco Control Program that focuses on primary prevention and supporting tobacco cessation has been adopted. Till 2009, more than 30 smoking clinics were established in Saudi Arabia.

Conclusions: It is limited and contradicting data about smoking cessation rates in Saudi Arabia which highlight the importance of further research to objectively and accurately measure the cessation rate, and subsequently the effectiveness, of smoking cessation clinics.

Premarital Screening and Genetic Counseling Program, Sickle Cell Anemia and Thalassemia in Saudi Arabia

2022-11-21

Introduction: Sickle cell disease and thalassemia are common hemoglobinopathies among Saudis as consanguineous marriages make up 42-67 % of all marriages in Saudi Arabia. In an attempt to decrease the high number of haemoglobinopathies in Saudi Arabia, the country’s Ministry of Health introduced the mandatory premarital screening and genetic counseling (PMSGC) in 2004. The process of PMSGC is characterized as the testing of couples who plan to marry for common genetic blood disorders.

Methods: This descriptive study drew on the national data of the Saudi PMSGC Program and its aim was an assessment of how the people using the governmental outpatient clinics felt concerning the Saudi PMSGC and to investigate the outcomes of mandatory Saudi PMSGC for couples with compatible hemoglobinopathies, namely sickle cell anemia and thalassemia, in terms of (diseased or carrier, compliant or non-compliant, satisfied or dissatisfied) in the Makkah, Qunfudah, Jazan, Al-Hasa and Eastern regions of Saudi Arabia during the duration of the program (between 2017-2018). Research data was gathered using a structured interview questionnaire designed by the Healthy Marriage Program in the MOH. The validity and reliability of the questionnaire were not, however, tested.

Results: In terms of assessing the program and the advice it offered, over 90% of those who took part gave a score of "excellent" or "very good" for the way in which the dangers and transmission of hemoglobinopathy were explained. Over 90% scored the materials used to raise awareness as "excellent”. However, Couples who were planning at-risk marriages differed broadly in their reactions to the medical advice given: 20.3 % decided to cancel the marriage, while 79.9 % went ahead.

Conclusions: In this study found that satisfaction levels were high in relation to the PMSGC program, whereas advice acceptance levels were low within the population and responses were not very optimistic. It is essential to spread knowledge about the program and encourage individuals to understand its importance and comply with its requirements, and this can best be achieved by running campaigns on the subject in schools and universities.

Satisfaction among Prosthetic Dental Patients with Xerostomia: A Systematic Review

2022-12-20

Introduction: Due to the negative influence of dry mouth on the quality of life, and the lack of information about this condition among edentulous patients wearing denture prostheses, this study aimed to review the association between dry mouth and different factors affecting it, and its effect on the oral-health-related quality of life in patients wearing denture prosthesis.
Methods: We conducted a systematic review of the published scientific literature on articles published Before 2022, when applicable. We searched six databases: Ovid MEDLINE, Evidence Based Medicine Reviews Database, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects and the Cochrane Central Register of Controlled Trials. We limited the citation search to articles written in English and describing studies that involved human subjects. Two independent authors reviewed the eligible articles to identify the matching with inclusion criteria.
Results: We identified 10 articles from the literature search, none of them being a report of a randomized controlled clinical trial. The few clinical research studies published on the topic of hyposalivation and denture retention represent a low level of evidence for establishing clinical practice guidelines. Accordingly, few conclusions can be made regarding the effects of hyposalivation treatment on denture retention and quality of life. It is strongly recommended that randomized controlled clinical trials be conducted in the denture-wearing population with dry mouth.
Conclusions: The results indicate that xerostomia is a significantly strong predictor of the quality of life in elderly patients than the dental status or the character of prosthetic restorations. Nevertheless, data showed that both the number of teeth/implants in the upper jaw and the presence of gum-supported dentures in both jaws may significantly impair the quality of life in elderly patients.

Prevention and Management of Osteoporosis using Vitamin D among Elderly Women

2022-12-27

Introduction: Osteoporosis is a condition that is partly caused by a deficiency in vitamin D and results in fragile bones that are prone to fractures. This review studied the prevention of osteoporosis using vitamin d among elderlies.
Methods: In this review, an electronic search was conducted in Medline, EmBase and Cochrane databases. Various primary and secondary subject headings related to vitamin D deficiency and insufficiency were combined and used to perform Boolean searches. The primary focus of the study was to assess the prevalence of vitamin D inadequacy in different populations, with a particular emphasis on elderly population with osteoporosis. The prevalence data were sorted first by vitamin D status and then by age. Only clinical trials that assess the effect of vitamin D in the treatment and prevention of osteoporosis.
Results: This review evaluated 16 studies focused on the effects of vitamin D supplementation on hip fractures and bone density in a group of 2537 participants. The review found that plain vitamin D supplementation did not reduce the incidence of hip fractures. However, the use of alfacalcidol, a form of vitamin D, was found to increase lumbar bone density and inhibit the decrease in total body bone density. It is important to maintain an adequate intake of calcium to maintain a balanced diet.
Conclusions: The best way to meet daily requirements is through the consumption of high calcium-containing foods, or by taking calcium supplements. In the prevention of osteoporosis, many individuals, especially postmenopausal women, do not consume enough calcium from their diet and may need to take supplements.

The Obesity Effect on Type 2 Diabetes Mellitus: Relationship between Body Mass Index and Diabetic Complications

2023-11-09

Introduction: The rationale behind investigating the intricate relationship between obesity and Type 2 Diabetes Mellitus (T2DM), with a specific focus on the influence of Body Mass Index (BMI), stems from the alarming impact of these intertwined epidemics on global health. This systematic review aims to synthesize and critically evaluate the available evidence, contributing to a deeper comprehension of the role played by BMI in shaping the trajectory of Type 2 Diabetes Mellitus and its associated complications.

Methods: The study conducted a thorough and comprehensive search across key electronic databases, including PubMed, Embase, and Cochrane Library, to identify articles investigating the intricate relationship between obesity, Body Mass Index (BMI), and complications associated with Type 2 Diabetes Mellitus (T2DM). Employing carefully selected search terms and Boolean operators, the initial exploration yielded a substantial number of articles. Two independent reviewers conducted a meticulous two-stage screening process, examining titles and abstracts for relevance and later assessing full-text articles for eligibility. Inclusion criteria focused on peer-reviewed studies in English, with a subsequent comprehensive quality assessment that considered study design, sample size, statistical methods, and potential biases.

Results: The results section presented findings from seven studies, employing diverse designs and adequate sample sizes, representing Western and Asian cohorts. Consistently, a positive association between higher BMI and increased risk of diabetic complications was observed. A significant correlation with cardiovascular complications. Cross-sectional studies highlighted BMI's impact on diabetic nephropathy and retinopathy. The relationship revealed by these studies and aligns with existing literature, emphasizing heightened cardiovascular risk and providing insights for tailored interventions and future research in Type 2 Diabetes Mellitus complications.

Conclusions: This review consolidates evidence from diverse studies, consistently affirming the positive association between higher Body Mass Index (BMI) and elevated risks of complications in Type 2 Diabetes Mellitus (T2DM). It is important to adjust for heterogeneity and regional variations to enhance the effect of preventive that affect the complex interplay between obesity, BMI, and T2DM complications.

Evaluating Pain Management Skills and Attitudes among the Emergency Nurses in Najran, Saudi Arabia

2023-12-28

Introduction:

Poorly managed pain in emergency departments can lead to various negative consequences, impacting patients, healthcare professionals, and society at large. Nurses' ignorance about managing patients' reported pains is identified as a key contributor to subpar pain management in the emergency department. This study aimed to contribute valuable insights to promote enhanced pain management practices in Najran, Saudi Arabia's emergency departments.

Methods:

The study employed a cross-sectional design to investigate nursing attitudes and perspectives on pain management in the emergency department in Najran, Saudi Arabia, focusing on nurses from Najran MOH Hospitals. The research, aiming to address a literature gap, examined variables related to pain management attitudes, barriers, and potential solutions. A convenient sample size of 353 participants was determined, utilizing unique identifiers for streamlined data collection, and SPSS version 26 was employed for analysis, incorporating descriptive and inferential statistics. Ethical considerations, including IRB approval and informed consent, were integral to the study, ensuring participant rights, confidentiality, and ethical data handling.

Results:

A total sample of 353 nurses were included with a balanced gender distribution (55.5% female, 44.5% male) and an age concentration in the 26-35 range (51.7%) were observed, contextualizing the distribution of pain management skills. The majority of nurses fell into the low skills category (92.8%), while only a minority (7.2%) demonstrated high skills. The analysis revealed misconceptions among nurses, such as the reliability of vital signs (80.2%), decreased pain sensitivity in children under two (48.4%), and the association of distraction with the absence of severe pain (65.9%). Certain factors showed significant associations with pain management skills, as married nurses, those dealing with both male and female patients, and those with higher educational attainment exhibiting more positive attitudes and advanced knowledge in pain management.

Conclusions:

The study reveals a low level of pain management skills among nurses in Saudi Arabia, necessitating training programs for skill enhancement. Significant associations are identified, with married nurses, those handling both genders, and individuals with higher education exhibiting better attitudes and advanced knowledge in pain management, emphasizing the need for nuanced educational interventions to improve patient care outcomes.

Comparative Efficacy of Dental Lasers versus Mouthwash in Root Canal Disinfection

2023-12-21

Introduction:

In the realm of endodontic treatment, innovative laser technologies are emerging as promising alternatives to traditional chemo-mechanical methods for root canal disinfection. These laser techniques are reputed to penetrate deeper into dentin, offering enhanced bacterial eradication. This systematic review seeks to explore the efficacy of dental lasers in purifying root canals during endodontic procedures.

Methods:

This review was conducted through a comprehensive search on PubMed and Medline, employing a series of specific keywords. The search was confined to articles published in English. Additionally, references from relevant articles were scrutinized for inclusion. The studies selected for review spanned a range of wavelengths from 600 to 2940 nm across the electromagnetic spectrum, encompassing technologies such as LED, halogen lamps, Nd:YAG, Er, Cr:YSGG, Er:YAG, and quartz tungsten halogen with blue light laser.

Results:

From the 254 articles initially identified, nine met the inclusion criteria for this systematic review. A common limitation among these studies was the lack of justification for the sample size, with no power analysis reported. Furthermore, none of the studies implemented blinding during either the treatment or the outcome evaluation phases. The review noted significant heterogeneity in the application of the laser treatments.

Conclusions:

The findings indicate that dental lasers are capable of significantly reducing bacterial populations within the root canal, though sodium hypochlorite remains superior in effectiveness. However, the laser's ability to extend its antibacterial effects beyond 1mm into the dentin suggests its utility in sealing dentinal tubules and eradicating bacteria such as Escherichia coli and Enterococcus faecalis. Consequently, integrating laser treatment with conventional rinsing solutions is advocated for enhanced canal disinfection.

Emergency Cases and Primary Healthcare Physicians: Factors and Barriers in Al-Madinah City, 2021

Samah B. Fallatah (1) *, Riyadh A. Alghamdi (2) — 2022-02-28

Introduction: Primary health care (PHC) centers are the first meeting line with health services, therefore, there is a significant number of emergency cases presenting to PHC centers with different levels of severity from mild to moderate and severe cases. This study aimed to assess primary health care physicians` competency regarding emergency cases, factors, and barriers.
Methods: A cross-sectional study among all primary health care physicians in Al-Madinah city was performed during 2021. Two tools were adopted for data collection; a self-administered questionnaire to assess physicians` competency in dealing with emergency cases and a structured observation sheet used to evaluate the availability of equipment, drugs, and other supporting facilities required to deal with emergency cases in PHC centers.
Results: The study included 200 primary healthcare physicians, out of the targeted 219 with a response rate of 91.3%. Their age ranged between 26 and 63 years with an arithmetic mean of 36.05 years and a standard deviation of (±) 8.16 years. More than one-third (39%) of the physicians had a poor level of competence in dealing with emergency cases. Saudi, more qualified physicians, those who attended BLS this year, and those who attended ATLS courses for more than two years were more competent in dealing with emergency cases than their peers. Overall, 40% of them had an insufficient level of competence and comfort in performing different emergency skills. Male physicians were more likely than females to have a sufficient level of competency and comfort in performing emergency skills, p=0.021. The most frequently reported barriers facing primary healthcare physicians in dealing with emergency cases were the availability of ER facilities (72%) and insufficient knowledge and practice related to emergency cases (61.5%). The commonest reported preferred methods for training in emergency medicine were practical training in PHC centers by qualified staff (81%), hospital rotation training (52%), and lectures (40%).
Conclusions: A considerable proportion of primary healthcare physicians in Al Madinah were not competent in dealing with emergency cases, and performing emergency skills. Most Emergency medications and services at the PHC level were available; however, shortages were observed in some items

Pharmacological Interventions to Reduce Preoperative Anxiety among Patients with Major Surgery

2022-11-11

Introduction: Stress and anxiety are negative feelings which can antagonistically impact the surgical outcomes and additionally influence the patient's recovery. This review aimed to summarize the pharmacological interventions used to control of preoperative anxiety.
Methods: An electronic search in MEDLINE and EMBASE was done using a combination of keywords. The search resulted in 64 studies, which were screened for eligibility criteria such as clinical trial design, English language, and human studies. After exclusion of ineligible, duplicated and review studies, the full text of the eligible studies were screened and the data were extracted. The characteristics for which data were collected included sample size, age of patients, type of surgery, medications used to reduce anxiety, dose and regime of medications, effect of reduction in anxiety. The findings of the review summarized in table of inclusion studies.
Results: The search of the literature, after exclusion of ineligible studies, revealed 14 studies met the inclusion criteria. Included studies aimed to investigate, from randomized controlled trials, the pharmacological interventions for control of preoperative anxiety. The total number of included patients was 983, of them adult subjects was 556 with the age range of 18-70 years and 427 children with the age range of 1-11 years. Some of the included placebo-controlled trial while active control were recruited in other studies. Regarding the main outcome which is the reduction of preoperative analgesia reported in many included studies while no difference appeared in other studies.
Conclusions: Benzodiazepines remain the medication of choice for the treatment of preoperative anxiety. However, many cautions should be taken in using preoperative medications among specific groups of patients such as hypersensitive reaction or physical dependence on the prescription..

Acute Renal Failure: Diagnostic and Therapeutic Considerations

2022-12-03

Introduction: The choice of renal replacement therapy modality may affect renal recovery after acute kidney injury. When acute renal failure is so severe as to require renal replacement therapy (RRT) mortality rates are as high as 63%. This review aimed to highlight the updated diagnostic and therapeutic considerations that should be considered during the management of acute renal failure.
Methods: The authors performed a systematic search of the MEDLINE and EMBASE bibliographic databases to identify published studies evaluating acute renal failure. search strategies combined the medical subject heading terms "kidney failure, acute" combined with prognosis (specificity) limited to "humans," "article" and "journal article" for MEDLINE. The authors restricted their search to clinical studies performed in adult populations and published in the English language. The full-text review was independently performed by two reviewers (as above) for the following specific eligibility criteria including observational cohort and/or randomized/quasi-randomized clinical trial (RCT) design. All data were extracted independently with standardized forms with a subsequent discussion of any discrepancies. Data were collected on study characteristics and quality, demographics and baseline characteristics. The data, therefore, are synthesized qualitatively.
Results: A total of 494 citations were identified. After the primary and secondary screening, 15 studies fulfilled all criteria for final analysis (13 articles). The authors found two randomized trials, four prospective cohort studies, and nine retrospective cohort studies. Of these, 13 were published as articles in peer-reviewed journals, and 2 studies were published as abstracts only. Only five had a prospectively assembled control group, four had comparable modes of RRT between the early and late initiation groups, and only three studies accounted for withdrawals/loss to follow-up.
Conclusions: We can conclude that diuretics and dopamine are clearly not helpful and may even be harmful, while volume expansion with saline is unproven but potentially beneficial. The facts are even less clear regarding mannitol in vascular surgery. In other types of surgery, such as coronary artery bypass or biliary surgery, small studies have also been unable to demonstrate a benefit associated with mannitol. Given these considerations, and in the absence of clinical data, diuretics cannot be recommended to prevent acute renal failure.

Prevalence and Predictors of Physical Activity among Hypertensive Patients in Saudi Arabia

2022-12-20

Introduction: Physical activity is a lifestyle factor that helps to control and reduce complications of hypertension disease. Despite the importance of physical activity and its impact on hypertensive patients but there are few studies on this aspect in Saudi Arabia, especially in Najran. This study aimed to assess the prevalence and determination of physical activity among hypertensive patients in the primary healthcare setting.
Methods: This is a cross-sectional study that included all hypertensive patients who attended chronic disease clinics in primary health care centers. The sample was selected based on 3 stages of random sampling. A self-administered questionnaire was used for data collection, which was divided into two parts. Part 1 contains questions about sociodemographic characteristics, while part 2 contains questions about physical activity using the Global Physical Activity Questionnaire (GPAQ), Arabic version.
Results: A sample of 263 hypertensive patients attending chronic disease clinics in primary health care centers. About half of the patients were males and 61% aged less than 50 years old. About 94% had light physical activity, while 22% had moderate-intensity sports, fitness, or recreational activities that cause a small increase in breathing or heart rate for at least 10 minutes continuously. The moderate-intensity activity during work was significantly more common in males gender and young age.

Conclusions: The prevalence of physical activity in hypertension patients attending primary healthcare settings was found inadequate. Practicing physical activity was significantly more common in the male gender and patients younger than 40 years old than in females or those 40 years or older.

Complications Associated with Diabetic Foot: A Diagnostic Systematic Review

2023-09-19

Introduction: This systematic review examines nine cross-sectional studies to evaluate the role of magnetic resonance imaging (MRI) as a diagnostic tool for osteomyelitis in diabetic foot ulcers. The included studies feature varying sample sizes, age ranges, and diabetic types. Specificity, sensitivity, and predictive values were measured to assess MRI's diagnostic accuracy in this context.

Methods: In this systematic review, we conducted a comprehensive search of relevant studies in PubMed. We focused on cross-sectional studies that examined the diagnostic utility of magnetic resonance imaging (MRI) for osteomyelitis in diabetic foot ulcers. The review included nine studies with varying sample sizes, patient demographics, and types of diabetes. We assessed the specificity, sensitivity, and accuracy of MRI as a diagnostic tool in these studies. Sensitivity values ranged from 29% to 100%, specificity from 37% to 100%, and accuracy from 79% to 100%. Positive and negative predictive values were reported in selected studies.

Results: The nine cross-sectional studies encompassed patients aged between 23 and 85 years, with sample sizes ranging from 12 to 110. While seven studies did not specify the type of diabetes, two studies focused on patients with insulin-dependent diabetes. Ulceration in the diabetic population was predominantly infected, with one study addressing bacterial infection, and another investigating chronic deep-seated infection. Sensitivity values varied widely, from as low as 29% to as high as 100%, while specificity ranged from 37% to 100%. Accuracy levels reached up to 100% in certain studies, and positive and negative predictive values were reported in selected investigations. The highest sensitivity (100%) was observed in two studies, whereas the lowest sensitivity (29%) was reported in a prospective study. Additionally, the highest specificity (100%) was recorded in a study with patients suffering from bacterial infection, while the lowest specificity (37%) was identified in a study involving patients with type one and two diabetes.

Conclusions: The reviewed studies demonstrated a wide range of sensitivity and specificity values for MRI in this context. While some studies reported high sensitivity and specificity, others showed lower specificity levels. Despite this variability, MRI remains a valuable diagnostic tool due to its ability to provide detailed anatomical information and visualize abnormalities in bone marrow, joint spaces, and soft tissue. It can aid clinicians in making informed decisions and surgical planning. However, it is essential to recognize the limitations of MRI, particularly in distinguishing between infected and non-infected bone marrow edema.

Efficacy of Non-Pharmacological Interventions for Reducing Preoperative Anxiety

2023-12-14

Introduction:

The percentages of reported preoperative anxiety prevalence highlight the urgency of addressing this concern comprehensively. By critically assessing the effectiveness of non-pharmacological interventions, this review aimed to contribute valuable insights for healthcare practitioners, guiding evidence-based decision-making and fostering a more patient-centric approach to preoperative anxiety management.

Methods:

A systematic literature review assessed the efficacy of non-pharmacological interventions for reducing preoperative anxiety. The review, conducted up to October 2023, employed a comprehensive search strategy across major electronic databases, applying specific terms and Boolean operators to maximize relevant article retrieval. Eligibility criteria included original research articles, systematic reviews, and meta-analyses exploring a diverse range of non-pharmacological interventions, with a two-step screening process and meticulous data extraction using a standardized form to ensure a thorough evaluation of evidence, including studies with potential bias.

Results:

The systematic review, encompassing six randomized clinical trials, assessed the efficacy of non-pharmacological interventions for preoperative anxiety across diverse surgical contexts. Findings revealed a 10% to 25% reduction in anxiety incidence, supported by statistically significant risk ratios (0.75 to 0.90) with narrow confidence intervals, emphasizing the potential of tailored interventions but highlighting the need for further research to establish robust guidelines.

Conclusions:

The systematic review's findings endorse the potential of non-pharmacological interventions in alleviating preoperative anxiety across various surgical contexts and patient groups, aligning with the evolving emphasis on patient-centered care; however, the observed reductions underscore the necessity for rigorous research to establish evidence-based guidelines given the variability in study designs and populations.

Administering Potent Pain Relievers in Interventional Radiology Procedures

2023-12-28

Introduction:

Interventional radiology (IR) procedures, known for their minimally invasive approach, have become increasingly prevalent in modern healthcare. However, despite their less invasive nature, these procedures can still result in significant pain for patients. The review aimed to assess the impact of these pain management strategies on patient recovery, satisfaction, and healthcare resource utilization.

Methods:

The systematic review focused on identifying interventional studies, particularly clinical trials, assessing the effectiveness of potent pain relievers in pain management pre and post Interventional Radiology (IR) procedures. Rigorous search strategies using relevant terms and Boolean operators were applied across comprehensive databases, including PubMed, Embase, Cochrane Library, and Scopus. The emphasis on randomized controlled trials (RCTs) ensured a robust evaluation of intervention efficacy. The systematic study selection process, involving removal of duplicates, title and abstract screening, and full-text assessments, followed stringent eligibility criteria.

Results:

This systematic review of six interventional studies in Interventional Radiology (IR) procedures reveals significant findings: a multimodal opioid-sparing regimen resulted in a 35% reduction in pain scores (RR 0.65, 95% CI 0.50-0.85), NSAID regimen showed a 30% reduction in rescue analgesia need (RR 0.70, 95% CI 0.55-0.90), local anesthesia led to a 40% reduction in pain scores (RR 0.60, 95% CI 0.45-0.80), pre-emptive analgesia protocol resulted in a 35% decrease in pain scores (RR 0.65, 95% CI 0.50-0.85), and combination therapy of opioids and non-opioids yielded a 50% reduction in reported pain levels (RR 0.50, 95% CI 0.35-0.70).

Conclusions:

These findings highlight a clear trend towards more innovative pain management techniques, emphasizing the need for tailored, patient-centric approaches in IR. This shift not only promises enhanced patient outcomes and quicker recovery times but also aligns with the broader healthcare goal of reducing opioid dependency.

Prevalence and Predictors of Iron Deficiency Anemia among Children in Saudi Arabia

2022-10-24

Introduction: The long-term impact of iron deficiency anemia on female children was significantly reducing physical growth, neurological development, and learning performance. There is limited data about the magnitude of iron deficiency anemia in Saudi Arabia in young children. This study aimed to assess the prevalence and determinants of iron deficiency anemia in children attending primary health care at age of the school entry.
Methods: This is a cross-sectional study included children were included at age of school entry and they should be tested for detection of anemia after their parents sign an informed consent. Children with other types of anemia were excluded from this study. The minimal sample size is calculated using the Raosoft calculator based on the equation for proportion estimation. Based on this proportion, at the confidence level of 95% and estimation error of 0.05 the initial sample size is calculated to be 384 participants. A questionnaire was used to collect data from the mothers or caregivers of the children.
Results: A total sample of 384 attendants in PHC centers responded to the questionnaire, of them 59.5% were males. About 68% of the mothers have a high level of education in university or postgraduate studies and 83% were married. The prevalence of anemia was found to be 24% among children of both genders. Only nationality was a significant predictor for iron deficiency anemia among children. Saudis children had a significantly lower prevalence of anemia than non-Saudis.
Conclusions: The prevalence of anemia among children at age of school entry was high and more attention to the nutritional habits of children should be given by mothers and health specialists. The educational campaign should be conducted to increase awareness about proper children's nutrition among women, particularly women of non-Saudi nationality.

Effect of Dental Implant Stability on the Periodontium: A Prospective Study

2022-11-18

Introduction: Many factors influence the stability of the implant including the composition of bone, the design of implants, the torque of placement, and operational techniques. The aim of this study is to assess the effect of dental stability on the periodontium surrounding the dental implant.
Methods: This study was conducted retrospectively among patients who received dental implants at several dental clinics in Saudi Arabia. The stability was assessed by compressions using the Straumann Trouqing ratchet, while the clinical examination was conducted for complications including tooth mobility, bleeding, pus, and periodontists. The relationship correlations between the stability and the outcomes were investigated. The p-value less than 0.05 was considered statistically significant.
Results: A total of 29 dental implants were examined in this review. The most prevalent outcome was periodontitis, as about 17% of the dental implants presented with moderate periodontitis, and only one dental implant had severe periodontitis. Tooth mobility had a 5.2% prevalence among the included dental implants. Peri-implantitis was only in one case which accounted for 1.7% and no exudate was reported. Association between primary stability and tooth mobility was significant (p<0.001), whereas the association between stability and inflammation was not statistically significant.
Conclusions: The stability of dental implants is an important factor in the success of the dental implant. The most prevalent complications of dental implants were periodontitis, and tooth instability, whilst peri-implantitis was an uncommon outcome.

Infection Control Procedures to Prevent Transmission of Clostridium Difficile

2022-12-16

Introduction: Nosocomial infections, also known as healthcare-associated infections, are a significant public health concern. According to recent data, C. diff infections are one of the most common healthcare-associated infections, with an estimated 500,000 cases occurring in the United States each year. The purposes of this review are to highlight the recent epidemiological data and to provide an overview of infection control procedures to prevent transmission of clostridium difficile in hospitals and tertiary care settings.
Methods: We systematically searched for controlled trials of interventions to reduce the rate of clostridium difficile in acute-care hospitals, using the biomedical electronic databases Ovid MEDLINE, EMBASE, The Cochrane Library, CINAHL, and the ISI Web of Knowledge. We included studies that assessed the effect of interventions on the rate of clostridium difficile in acute-care hospitals. Secondary studies, such as meta-analyses, were excluded. All titles and abstracts were independently screened by 2 reviewers to identify studies potentially eligible for inclusion and a full-text review was performed to identify studies eligible for data extraction.

Results: Epidemiological studies show that MRSA, vancomycin-resistant enterococci and C. difficile are on the rise worldwide and that they have the potential to become important pathogens and endemic in North America. The emergence of community-acquired MRSA and the increasing number of hospital-acquired MRSA infections. Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) guidelines were published to raise the standards of research and publication of hospital epidemiology in order to facilitate the synthesis of evidence and to promote reporting transparency.
Conclusions: With regard to these issues, clinicians should be guided by their local infection prevention and control policies and procedures. The use of a bundled approach to prevent infections based on local surveillance data for clostridium difficile of a given institution has been shown to work. The implications of the increased infection severity of disease and the successful management mandate the combined expertise of intensivists, surgeons, infectious disease physicians, pharmacists, infection prevention and control personnel, and the laboratorian.

Lung Manifestations of Chronic Infections: A Diagnostic Review

2022-12-28

Introduction: The human pulmonary system can be affected by various infections, which can enter the lungs during the migration phase of their life cycle, travel there by embolic spread or direct invasion, or be a primary infestation or a feature of more generalized disease. These findings can mimic tuberculosis, sarcoidosis, or metastatic disease. This review aimed to identify radiological manifestations related to chronic bacterial, parasitic and viral infections.
Methods: A systematic review of the medical literature was conducted by searching PubMed up to January 2022 using the MeSH terms and keywords. The references of the retrieved articles were also manually searched. Only original papers in English or Italian discussing latent and post-primary TB imaging and diagnosis, with a focus on TB reactivation in patients receiving biologics, were included. The remaining papers were analyzed based on the relevance of their title or abstract.
Results: A total of 105 papers were identified in a literature review, of which 93 were initially excluded as not relevant based on their title or abstract. After further review, 12 papers were selected for inclusion. Previous research has found that chest radiography has a sensitivity of 73-79% and a specificity of 60-63% for detecting latent tuberculosis (TB) in high-risk populations. Eosinophilic lung diseases are a group of conditions characterized by an accumulation of eosinophils (a type of white blood cell) in the lungs.
Conclusions: There are several conditions that can cause transient pulmonary opacities or increased opacity in the lungs, including bronchiectasis, bronchial asthma, and bronchial granulomatosis. In order to accurately diagnose parasitic infections, it is important for healthcare providers to be familiar with the common parasites in their region.

Prognostic Factors of Diabetes Type 1 using Patients Historical Data in Primary Health Care Settings

2023-11-04

Introduction: Diabetes Type 1 affects approximately 5-10% of all individuals with diabetes, making it a substantial health concern for millions worldwide. This systematic review aims to comprehensively analyze the prognostic factors associated with Diabetes Type 1 using historical patient data collected from primary health care settings, where approximately 80-90% of diabetes cases are managed.

Methods: In this systematic review, a comprehensive search strategy was meticulously employed, encompassing databases like PubMed, Embase, Web of Science, and Cochrane Library to identify articles on Diabetes Type 1 and its prognostic factors. A combination of medical subject headings and keywords was used, covering population, exposure, primary health care setting, and outcomes. Boolean operators were utilized to refine the search, with initial screening of titles and abstracts conducted to identify eligible studies. Two independent reviewers assessed these articles, following predefined inclusion and exclusion criteria, and discrepancies were resolved through discussion or a third reviewer's input. Data extraction was standardized, encompassing study and patient characteristics, prognostic factors, outcomes, and results. The data synthesis employed a narrative approach, categorizing prognostic factors and assessing the strength of the evidence.

Results: Our systematic review rigorously examined six diverse studies that shed light on prognostic factors for Diabetes Type 1 within primary health care settings. These studies showcased an intriguing range of participants, including children, adults from various socioeconomic backgrounds, the elderly, and pregnant women with pre-existing Diabetes Type 1. These varying populations allowed us to explore how prognostic factors impact different age groups and special populations. The exposures under investigation encompassed a fascinating array of odd-numbered variables, including genetic markers, lifestyle choices, and socioeconomic factors. The interplay of these factors offered a multifaceted understanding of Diabetes Type 1 prognosis.

Conclusions: The findings are in agreement with a substantial portion of the existing literature, emphasizing the multifaceted nature of Diabetes Type 1 prognosis in primary health care. Recognizing the diverse populations, exposures, and outcomes allows for the development of tailored strategies by healthcare providers and policymakers, aligning with the holistic approach recommended in the literature to enhance the well-being of individuals with Diabetes Type 1 and alleviate its burden.

Awareness and Practices Related to Vitamin D in the General Community, Najran, Saudi Arabia

2023-12-29

Introduction:

While the biological factors contributing to vitamin D deficiency are well understood, the sociocultural and behavioral aspects remain less clear. This research seeks to assess the awareness of vitamin D deficiency among the Saudi population.

Methods:

Employing a cross-sectional observational study design, we conducted research among individuals attending primary health care (PHC) in Najran city. Participants were randomly selected from the PHC waiting list using a two-stage stratified systematic sampling technique. A self-administered questionnaire was utilized to gather data across four domains: sociodemographic factors, awareness, attitudes, and practices related to vitamin D. Respondents achieving less than 60% correct answers were considered to have a low level of awareness, while those scoring ≥ 60% were deemed to have high awareness.

Results:

Among 384 respondents at Primary Health Care (PHC) centers, 59.5% were male. All participants affirmed their familiarity with vitamin D, citing health staff and friends or relatives as the primary sources of information. In terms of the origin of vitamin D, 6% and 48% attributed it to diet or sun exposure, respectively, while 45.7% recognized both as accurate. Gender, education level, nationality, and income did not exhibit significant associations with awareness of vitamin D deficiency (p>0.05). However, there was a noteworthy correlation between the source of information and awareness (p=0.009).

Conclusions:

The study revealed a low level of awareness about vitamin D among attendees at PHC, coupled with a heightened concern about the current state of vitamin D. Participants reported limited exposure to sunlight and low usage of sun protection.

Interventions Enhancing General Health in Elderly Patients with Cognitive Impairment

2023-12-21

Introduction:

Elderly patients with cognitive impairments are at a heightened risk of poor general health due to various barriers that impede their access to oral care and their ability to maintain proper physical hygiene. This systematic review aimed to evaluate the effectiveness of interventions designed to enhance general health in this vulnerable population.

Methods:

A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library, using a combination of keywords related to general health, cognitive impairment, and elderly care. The review was limited to interventional studies and clinical trials published in English. Inclusion criteria were studies on populations aged 65 years and above with diagnosed cognitive impairments that assessed the outcomes of general health interventions. Studies were excluded if they were observational, reviews, or did not directly measure general health outcomes. Data extraction and quality assessment were performed on the included studies.

Results:

Ten studies met the inclusion criteria, encompassing a range of interventions from professional general care and the use of therapeutic general products to caregiver training programs. Sample sizes ranged from 30 to 200 participants. Notable findings include a significant reduction in plaque scores and gingival inflammation with a risk ratio of 0.75 (95% CI: 0.59-0.94), a 40% decrease in general caries incidence (95% CI: 20-60%), and a 30% improvement in physical hygiene practices (95% CI: 15-45%) following various interventions. Caregiver training programs were particularly effective, showing a 50% reduction in physical health-related complications (95% CI: 30-70%).

Conclusions:

The review highlights the effectiveness of multifaceted interventions in improving general health among elderly patients with cognitive impairments. These interventions, especially when involving caregiver support, significantly contribute to better physical hygiene, reduced incidence of general diseases, and overall improved quality of life for this demographic. Future research should focus on optimizing intervention designs and integrating caregiver involvement to enhance outcomes.