Background: Nurses are central to achieving Saudi Arabia’s Vision 2030 goals, particularly in improving healthcare quality and workforce well-being. However, their well-being may be influenced by toxic leadership behaviours such as abusive supervision, authoritarianism and unethical practices. Aim: This study examined the association between toxic leadership and nurses’ well-being in selected hospitals within Riyadh’s Second Health Cluster and the Al-Qassim Health Cluster. Methods: A cross-sectional survey was conducted among 400 staff nurses using two validated tools: the Toxic Leadership Behaviours of Nurse Managers (ToxBH-NM) Scale and the BBC Well-being Scale (BBC-WBS). Toxic leadership was rated on a 1-5 scale (mean = 2.10, SD = 0.74), while well-being was measured similarly (mean = 2.90, SD = 0.61). Correlation and regression analyses were used to examine associations, adjusting for demographic factors. Results: A statistically significant positive correlation (p < 0.01) was found between toxic leadership and well-being scores, indicating that higher perceived toxic leadership was unexpectedly linked with higher reported well-being. This counterintuitive finding may reflect contextual or methodological factors, such as cultural norms, social desirability or measurement limitations. Demographic variables (age, gender, educational qualification, marital status, nationality, contract type, years of experience and weekly work hours) also showed statistically significant associations with well-being, but effect sizes were generally small and varied in direction. Conclusion: The observed positive association between toxic leadership and well-being diverges from prior evidence and should be interpreted with caution. Given the cross-sectional design, no causal claims can be made. Future research, preferably longitudinal or mixed-method, should further investigate these dynamics and clarify the contextual influences on nurse well-being in Saudi Arabia.

Background: Menstrual health is a critical but often neglected component of adolescent well-being. Despite increasing attention in India, knowledge gaps, unsafe practices, socio-cultural restrictions, and inequities persist. Evidence from Himachal Pradesh is limited, despite its high literacy rates and strong cultural traditions. This study aimed to assess menstrual knowledge, hygiene practices, socio-cultural restrictions, and health-seeking behavior among school-going adolescent girls in Shimla district, and to examine their associations with socio-demographic variables. Methods: A school-based cross-sectional survey was conducted by Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pardesh among 5,433 adolescent girls enrolled in government secondary and senior secondary schools in Shimla. Data were collected using a structured, pretested questionnaire administered via Google Forms, circulated to school principals by the Department of Education. Domains included socio-demographic profile, knowledge and awareness, hygiene practices, socio-cultural restrictions, and health-seeking behavior. Data were analyzed using descriptive statistics and chi-square tests to assess associations, with p<0.05 considered statistically significant. Results: Most girls (92.1%) had heard about menstruation before menarche, primarily from mothers (84.8%), but misconceptions persisted regarding the source of menstrual blood (uterus: 43.9%; bladder: 43.4%). Sanitary pad use was near-universal (94.3%), yet safe disposal practices varied, and 2.5% reported unsafe disposal (flushing/open). Socio-cultural restrictions were widespread, with 83.4% restricted from temples and 46.8% made to stay separately during menstruation. Health-seeking behavior was relatively high (81.3% consulted someone), but only half (50.6%) recognized all warning signs requiring medical attention. Across domains, better outcomes were consistently associated with older age, higher class, parental education, and family income (p<0.001 in most cases), while family type showed no significant effect. Conclusion: Although menstrual hygiene adoption was encouraging, significant knowledge deficits, unsafe disposal practices, entrenched cultural restrictions, and incomplete recognition of menstrual morbidities remain. Socio-economic and educational disparities strongly shape menstrual experiences. Targeted interventions—strengthening school-based education, engaging parents and communities, improving waste management, and promoting adolescent-friendly health services—are urgently needed. Addressing both informational and cultural dimensions of menstruation will advance adolescent health, gender equity, and dignity.

Placenta accreta spectrum (PAS) is a significant obstetric complication characterized by abnormal placental attachment and invasion into the myometrium, leading to severe risks during delivery, including substantial hemorrhage. This systematic review the evolving role of interventional radiology (IR) in the conservative management of PAS. It highlights various IR techniques, including pelvic arterial embolization, pre-operative arterial access with intra-operative embolization, and balloon occlusion methods. Those innovative techniques can effectively control hemorrhage, reduce the need for hysterectomy, and preserve fertility in appropriately selected PAS patients. The review underscores the importance of a multidisciplinary approach and individualized management strategies to optimize patient outcomes in this challenging obstetric condition.

Background: Effective post-procedural management in dentistry is essential for optimal healing and prevention of complications. The mode of delivering post-procedural instructions influences both patient comprehension and compliance, as well as dental students’ learning and confidence. Objective: This study aimed to compare the effectiveness of verbal communication, printed handouts, and virtual reality (VR)/Metaverse-based instructions in delivering post-operative care information to patients and dental students. Methods: A cross-sectional survey was conducted among 279 patients (150 males, 129 females) who underwent dental procedures and 100 dental students at different stages of training. Two structured questionnaires assessed comprehension, accessibility, confidence, and preference. Chi-square tests were applied to evaluate associations between instruction method and participant responses. Results: A majority of patients preferred verbal instructions for comprehension (55.2%) and confidence (51.9%), whereas VR was considered more systematic by a subset (21.5%). Among students, verbal instruction was valued for communication skills (46%), but VR/Metaverse was rated highest for accessibility (38%) and completeness (55%). Chi-square analysis showed no significant association between instruction method and patient preferences (p = 0.18), but a significant association was observed among students (p < 0.001). Conclusion: Verbal communication remains central to patient education due to its reassurance and trust-building value, whereas immersive technologies such as VR/Metaverse offer distinct advantages in accessibility and thoroughness for dental students. A hybrid approach combining traditional and digital methods may optimize post-operative care delivery and education.

Background: Systemic Sclerosis (SSc) is a rare autoimmune disease with significant ethnic and geographic variability. Autoantibody patterns and organ involvement influence prognosis. Data on SSc from Saudi Arabia are scarce. To describe the clinical presentation, autoantibody profile and organ involvement of Saudi SSc patients and to explore associations between autoantibodies and Interstitial Lung Disease (ILD). Methods: We conducted a retrospective observational study at a single tertiary hospital in Saudi Arabia. Adult patients fulfilling the 2013 ACR/EULAR classification criteria for SSc between 2015-2024 were included. Demographic, clinical and serologic data were extracted from medical records. Associations between SSc subtypes, antibody profiles and ILD were analyzed. Results: Twenty-one patients were included (95.2% female; mean age 50.0±13.4 years; mean age at disease onset 33.7±10.4 years). Diffuse cutaneous SSc (dcSSc) accounted for 76.2% and limited cutaneous SSc (lcSSc) for 23.8%. Common manifestations included gastroesophageal reflux disease (95.2%), Raynaud’s phenomenon (90.5%), sclerodactyly (90.5%) and ILD (76.2%). Autoantibodies were frequent: ANA (95.2%), anti-topoisomerase I (ATA, 57.1%) and Anti-Centromere (ACA, 10%). ILD was strongly associated with dcSSc (100% vs. 0% in lcSSc, p<0.001) and trended toward association with ATA positivity (91.7% vs. 8.3%, p = 0.055). All ACA-positive patients (n = 2) were ILD-negative. Conclusion: This first Saudi cohort demonstrates a younger age at diagnosis and a high prevalence of ILD compared to international reports. ATA was associated with ILD, while ACA appeared absent among ILD cases. Given the very small sample size, these findings should be considered hypothesis-generating and warrant confirmation in larger, multicenter studies.

Aim: This study evaluated oral health status, the prevalence of work-related musculoskeletal disorders (WRMSDs), and physical activity readiness among industrial workers in Irungattukottai, Tamil Nadu. The analysis included demographic variables, BMI, and occupational factors. Methods: A cross-sectional study was conducted among 122 tyre and steel factory workers employed for at least six months (Sept-Dec 2023). Data collection included a structured questionnaire (demographics, occupational details, PAR-Q, Nordic Musculoskeletal Questionnaire), BMI assessment, and clinical oral examination using WHO protocols. Statistical analyses were performed using SPSS v26, including chi-square tests, one-way ANOVA with post-hoc comparisons, and Kendall’s tau-b correlation (p<0.05). Results: Participants were predominantly male (90.2%), aged 18-30 years (55.7%). DT and DMFT/def scores increased significantly with age (p<0.001). BMI was significantly associated with neck discomfort (p<0.001). Longer weekly work hours were correlated with upper limb discomfort, while work experience showed negative correlations with neck and lower back pain—likely reflecting a healthy worker effect. No significant correlations were found between work experience and most PAR-Q items. Conclusion: The dual burden of oral disease and WRMSDs among industrial workers underscores the need for integrated occupational health programs combining ergonomic interventions, nutrition counselling, and oral health care.

Polycystin-1 (PC1), a large membrane glycoprotein encoded by PKD1, is mutated in ~85% of autosomal dominant polycystic kidney disease (ADPKD) cases. It forms a ciliary ion channel with polycystin-2. PC1's extracellular REJ domain, homologous to a sea urchin egg-sperm binding domain, has unclear intracellular roles. This study identifies its protein interactome to reveal links to ADPKD pathogenesis. The author employed a combined biochemical and computational strategy. A recombinant PET21-MBP(TEV)-REJ fusion protein (encompassing the human REJ segment) was expressed in E. coli, purified, and used as bait in pull-down assays with HEK293 cell lysates. Interacting proteins were identified using MALDI-TOF mass spectrometry (peptide mass fingerprinting), revealing four novel REJ-binding partners: YWHAZ (14-3-3ζ, a signaling adaptor protein), DNAH11 (dynein heavy chain 11, a ciliary motor protein), PPIA (cyclophilin A, a peptidyl-prolyl isomerase), and PCYOX1 (prenylcysteine oxidase 1 enzyme). Functional relationships among these proteins were assessed using STRING network analysis and gene ontology enrichment, identifying associations with ciliary trafficking, signal transduction, oxidative metabolism, and protein homeostasis. AlphaFold2 modelling predicted a stable multimeric complex involving REJ, PPIA, YWHAZ, and PCYOX1, with PPIA occupying a central structural role. Interface visualisation using Pymol suggested stabilising hydrogen bonding and hydrophobic interactions. Disease enrichment revealed significant links to ADPKD and related ciliopathies. These findings support a broader role for the REJ domain in intracellular signalling and protein complex formation, expanding the current understanding of PC1 function beyond its extracellular interactions and suggesting novel directions for therapeutic targeting in ADPKD.

Introduction: Tooth loss continues to be a global health challenge with significant functional, psychological, and social consequences. Emerging evidence suggests that inhibition of USAG-1 (uterine sensitization-associated gene-1), a negative regulator of tooth development, may enable biological tooth regeneration. Understanding dental professionals’ knowledge, attitudes, and practices (KAP) regarding this novel approach is critical for its future integration into clinical and educational frameworks. Methods: A descriptive cross-sectional survey was conducted among 195 dental professionals (60 students, 75 practitioners, and 60 faculty). A structured, pilot-tested, and content-validated questionnaire (20 items) assessed knowledge, attitudes, and practices related to USAG-1 and regenerative dentistry. Descriptive and inferential statistics (Chi-square and ANOVA) were performed using SPSS v25. Results: Of the participants, 68.2% had heard of USAG-1, yet only 41% correctly identified its biological mechanism. While 82% believed USAG-1 would impact clinical dentistry, only 36.4% felt confident discussing it with patients. Interest in formal training was high (73.8%). Significant differences were observed between students, practitioners, and faculty in knowledge and practice scores (p<0.05). Conclusion: Awareness of USAG-1 among dental professionals is promising, but critical gaps exist in mechanistic knowledge and clinical preparedness. Targeted curricular integration and continuing education are essential to bridge these gaps and responsibly translate preclinical research into future practice.

Background: Total knee arthroplasty (TKA), also known as total knee replacement (TKR), is an increasingly common surgical procedure, especially in the elderly population. Its primary benefits include pain relief and improved mobility for advanced-stage osteoarthritis patients. The procedure’s success rate is high, with only 4% to 7% of patients reporting dissatisfaction. Total knee replacements in the US surpassed 700,000 in 2012, and this number was predicted to reach 3.5 million by 2030. Studies reported high satisfaction rates, with one highlighting a 96% satisfaction rate in patients with severe arthritis. Given the growing number of TKAs performed worldwide, assessing patient satisfaction and understanding potential outcomes became critical. Objectives: This study aimed to evaluate patient satisfaction with total knee arthroplasty (TKA) in Saudi Arabia, its impact on daily life, and to identify preoperative and postoperative predictors of satisfaction. Methods: A study was conducted in Saudi Arabia from 2023 to 2024 on 228 individuals of both genders who had undergone total knee arthroplasty. The data were gathered by researchers and analyzed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (Chicago, IL, USA). Results: This study examined satisfaction following total knee replacement among 228 Saudi Arabian patients (mean age 57.9 years, 59.2% female), with prevalent comorbidities (diabetes 42.9%, hypertension 37.7%). Single knee replacement predominated (87.3%), and 35.1% held bachelor’s degrees. Overall, 79.8% reported high satisfaction, 86.4% improved functionality, 94.7% reduced pain, and 88.6% willingness to recommend. Post-surgery, 70.6% rated their health “Excellent/Very Good,” while emotional limitations affected 13.6%. Most (84.2%) were highly satisfied, correlating strongly with quality-of-life improvements. Significant satisfaction predictors included region, education, marital status, surgery date, height, weight, and gender. These findings underscored the procedure’s effectiveness and influential demographic factors. Conclusion: Our study illustrated high levels of patient satisfaction associated with total knee replacement surgery in Saudi Arabia, aligning with existing literature on the effectiveness of TKA in improving quality of life and functional outcomes. The intertwining relationship between demographic factors and satisfaction levels highlighted the importance of personalized care strategies that consider individual patient contexts.

Background: Sodium valproate (NaV) is a widely prescribed antiepileptic and mood-stabilizing drug that also functions as a histone deacetylase inhibitor (HDACi). HDAC deregulation contributes to cancer and neurodegenerative disorders, yet the feedback regulation of HDAC genes under pharmaceutical inhibition remains unclear. Methods: This pilot study evaluated mRNA expression of class I HDACs (HDAC1, HDAC2, HDAC3, HDAC8) and class IIa HDACs (HDAC4, HDAC5, HDAC7, HDAC9) using RT-qPCR in peripheral blood from 50 NaV-treated epileptic patients and 50 age/sex-matched neurological controls. Results: NaV treatment was associated with significant upregulation of HDAC1 (↑2.6-fold) and HDAC3 (↑2.1-fold), alongside downregulation of HDAC7 (↓1.9-fold). HDAC2 expression was unaffected by NaV but significantly reduced in smokers across groups. Obesity was linked to increased HDAC1 and reduced HDAC3 and HDAC9 expression. Conclusions: NaV therapy induces distinct de novo expression changes in HDAC genes, suggesting feedback regulation mechanisms. These findings provide a basis for larger studies examining HDAC superfamily expression as potential biomarkers of treatment response.

Background: The COVID-19 pandemic significantly influenced tobacco use, presenting both challenges and opportunities for behavioural change. Understanding these shifts is crucial for targeted public health strategies. Objectives: This study aimed to evaluate changes in tobacco use among adults in Chennai during the COVID-19 pandemic, identify high-risk subgroups, and assess associations between smoking behaviour and self-perceived physical and psychological health. Methods: A cross-sectional survey was conducted among 500 adults (18–65 years) using structured questionnaires. Data included demographics, tobacco consumption before and after the pandemic, COVID-19 infection severity, and self-rated health. Statistical tests and logistic regression were applied. Results: Of the 500 participants, 54% reduced smoking, 32% quit, and 12% increased use. Average daily cigarettes decreased from 15.2 to 9.1 (p<0.001). Rural residents reported greater reduction than urban (p<0.05). Quitting/reducing smoking was associated with improved self-rated health and lower odds of hospitalisation (OR=0.42, 95% CI 0.25–0.72) and ICU admission (OR=0.35, 95% CI 0.19–0.65). Conclusion: The pandemic served as a catalyst for smoking reduction and cessation, with disparities observed among men, long-term smokers, and urban residents. Integrating cessation support into digital platforms and mental health services could consolidate public health gains.

Introduction: Provisional crowns are essential intermediate restorations in fixed prosthodontics, and marginal fit is a key determinant of periodontal health, pulpal protection, and long-term clinical success. Present CAD/CAM technologies allow for production by subtractive milling or additive manufacturing, each with inherent technical properties potentially influencing marginal fit. Comparative in-vitro evidence under controlled conditions, however is still limited in this regard, and controlled assessments have to be applied to inform fabrication method choice. Methods: The laboratory-based experimental setup was used to compare the marginal fit of provisional crowns produced through digital CAD design followed by fabrication through 3D printing (n = 10) or milling (n = 10). Both the groups used a standardized tooth preparation and master die. All the crowns were produced from PMMA-based materials following the manufacturer's suggested parameters. Marginal gap was measured at four standardized positions on each crown, mid-buccal, mid-lingual, mid-mesial, and mid-distal, using a 50× magnification stereomicroscope. The data were 40 measurements per group. The data were tested for normality and compared using independent samples t-tests with the significance level at p<0.05. Intra- and inter-examiner reliability were also tested using intraclass correlation coefficients (ICCs). Results: The group mean marginal gap in the 3D-printed cohort was 95.8±8.5 μm, whereas the milled cohort had a mean of 73.1±7.0 μm. The mean difference recorded between the cohorts was 22.7 μm, the difference that was statistically significant (t = 8.56, p<0.001), with a substantial effect size (Cohen's d = 1.92). Site-specific tests also revealed that at all four marginal sites measured, the milled crowns had consistently smaller gaps, with p-values of less than 0.001 for all the tests. Intraclass correlation coefficients (ICCs) for intra- and inter-examiner measurements were greater than 0.97, reflecting excellent measurement reliability. Qualitative synthesis revealed that the crowns 3D-printed showed slightly greater variability at the marginal areas, which was generally because of small differences in junction surface smoothness, whereas the milled crowns showed more uniform adaptation. Conclusion: Within the constraints of this in vitro investigation, milled provisional crowns exhibited significantly reduced marginal discrepancies with improved fit uniformity over their 3D-printed counterparts. Both techniques yielded results within clinical acceptable margins, demonstrating, however, that although milling may be more suited, 3D printing is also a useful alternative if manufacturing efficiency or material usage is the priority.

Background: The incidence of cancers affecting the gastrointestinal tract is increasingly recognised as a significant public health issue, especially among marginalised and indigenous communities. This investigation sought to evaluate the association between sociodemographic and lifestyle factors and the emergence of gastrointestinal cancers within the indigenous community of Arunachal Pradesh, India. Methods: A case-control study was carried out from January 2021 to April 2024 at TRIHMS, Naharlagun. This study comprises Two hundred thirty-two participants, in that 116 were cases of gastrointestinal cancer confirmed through histopathological examination and 116 matched controls without any malignancy, based on age and gender. Information regarding sociodemographic traits, patterns of substance use, and clinical profiles was gathered via structured interviews and medical documentation. The analysis of statistical data was conducted utilising SPSS version 26.0. An independent t-tests, Chi-square tests, and odds ratios (OR) accompanied by 95% confidence intervals (CI) were employed. A p-value <0.05 was considered as statistically significant outcome. Results: Findings indicate notable correlations between gastrointestinal cancers and reduced educational attainment (p = 0.0001), the consumption of local made fermented beverages (OR = 12.17, p<0.0001), tobacco usage (OR = 6.21, p<0.0001), and the intake of commercial alcohol (OR = 2.22, p = 0.003). The majority of cases were found within the age range of 35 to 71 and were located in urban settings. Gastric cancer emerged as the most frequently occurring type, accounting for 37.93%, while chemotherapy represented the predominant treatment approach, utilised in 81.89% of cases. A mere 7.7% cases showed positive family history for GIT cancer. Conclusion: The results reveal a strong association between traditional substance use, lower levels of education, and an increased risk of gastrointestinal cancers among indigenous populations. These trends are consistent with observations from other parts of Asia, underscoring the importance of implementing comprehensive cancer control strategies that prioritize education, early diagnosis, and culturally appropriate health promotion initiatives.

Objectives: Triphasic Computed Tomography (CT) has been used extensively as a non-invasive imaging technique for the assessment of focal liver lesions, especially in cirrhotic patients where the differentiation between benign and malignant lesions continues to be important. While extensively used in clinical practice, heterogeneity in study diagnostic performance resulted in a systematic evidence synthesis. Methods: A systematic review and meta-analysis were conducted following PRISMA. Cross-sectional and cohort studies that reported the diagnostic performance of triphasic CT using histopathology as the reference standard were included in the review. Extraction of data was for sensitivity, specificity, positive and negative predictive values and overall accuracy. Risk of bias was assessed using ROBINS-I and AXIS tools and GRADE was used to grade the certainty of evidence. A fixed-effects model was used in the meta-analysis and sensitivity analyses were conducted to assess the stability of the findings. Results: Eleven studies were analyzed. Pooled sensitivity and specificity of malignant lesions were 98.3% (95% CI: 95.9-100%) and 82.9% (95% CI: 71.4-94.4%), respectively. Positive and negative predictive values were 94.2% (95% CI: 90.1-98.4%) and 94.4% (95% CI: 86.9-100%), respectively. Diagnostic accuracy was 94.3% (95% CI: 90.6-97.9%) on average. Qualitative synthesis suggested that triphasic computed tomography was able to adequately depict typical imaging features of hepatocellular carcinoma like arterial phase hyperenhancement and delayed washout. Diagnostic difficulties were noted in lesions with atypical vascular patterns and in cirrhotic settings where benign regenerative nodules can be confused with malignancy. Conclusion: Triphasic CT was demonstrated to be excellent for differential diagnosis of benign versus malignant focal liver lesions in cirrhotic patients with extremely high sensitivity. Specificity, although mildly reduced, was probably due to background liver changes and atypical patterns of disease. The modality remains of clinical utility. Prospective multicentric validation should be performed to further define diagnostic criteria.

Background: Oral health-related quality of life (OHRQoL) provides a subjective dimension to oral health assessment that complements clinical indices. Residential schoolchildren represent a unique population in whom the impact of oral diseases on daily functioning has not been well studied. Methods: A cross-sectional study was conducted among 520 children aged 12-14 years from 10 residential schools in Bangalore, selected through stratified random sampling. Oral examinations were carried out using the WHO Oral Health Assessment Form (2013). The Child-Oral Impacts on Daily Performances (Child-OIDP) index was administered through structured interviews. Descriptive statistics and inferential tests (t-test, ANOVA, chi-square) were applied, with significance set at p<0.05. Results: Among participants, 50% were 12 years, 18.1% were 13 years, and 30% were 14 years of age. Commonly reported oral problems included sensitive teeth (43.7%), gum bleeding (41%), and dental caries (35.8%). The mean DMFT score was 1.01, mean CPI score was 1.84, and mean DAI score was 13.8. The overall mean Child-OIDP score was 7.62, with no gender difference. Caries, gingival bleeding, toothache, and malocclusion significantly impacted daily performances such as eating, cleaning teeth, sleeping, smiling, and social interactions (p<0.05). Conclusion: Oral health significantly influences the quality of life of residential schoolchildren. Routine assessment of OHRQoL should be incorporated into oral health needs assessments and school dental programs.

Background: Hypertension and diabetes are leading contributors to global morbidity and mortality, with the burden disproportionately affecting low-resource communities. Primary health care (PHC) facilities serve as the first point of contact and are pivotal in early detection and long-term management of chronic diseases. However, the effectiveness of PHC systems in resource-limited settings remains underexplored. Methods: This cross-sectional analytical study was conducted enrolling 295 adult patients attending PHC facilities. Data were collected through structured interviews, clinical assessments, and review of medical records, focusing on sociodemographic characteristics, disease prevalence, detection methods, treatment initiation, follow-up adherence, and patient satisfaction. Results: Out of 295 patients, 48.1% had hypertension, 33.2% diabetes, and 13.9% both conditions. The mean age was 52.4±11.8 years, with older age associated with dual disease (p = 0.018). PHC screening detected 66.9% of hypertension and 65.3% of diabetes cases, though the average diagnostic delay was 7.6±4.2 months for hypertension and 8.3±5.1 months for diabetes. Pharmacological therapy was initiated in 89.3% of patients, and 75.8% received lifestyle counseling, yet only 60.9% reported consistent medication availability. Regular follow-up adherence was 59.9% for hypertension, 59.2% for diabetes, and 46.3% for dual conditions. Control rates were modest: 53.5% for hypertension, 52.0% for diabetes, and 31.7% for both diseases. Regression analysis identified higher education, income >$200, consistent follow-up, and reliable drug supply as significant predictors of disease control (p < 0.05). Patient satisfaction was moderate, with 66.8% satisfied overall, though barriers such as drug shortages, financial difficulties, and transport issues were frequently reported. Conclusion: It is concluded that PHC services are effective in detecting hypertension and diabetes and initiating treatment in low-resource settings, but systemic barriers limit long-term disease control, particularly in patients with dual conditions. Strengthening PHC through reliable supply chains, standardized care protocols, and community engagement is essential to improve outcomes and reduce the burden of noncommunicable diseases.

Background: Interstitial lung disease (ILD) is a major extra-muscular manifestation of dermatomyositis (DM) and polymyositis (PM), yet data from Middle Eastern populations remain sparse. We aimed to characterize radiologic ILD patterns, severity, clinical-serologic correlates, and treatment usage among Saudi patients with PM/DM-ILD managed at a tertiary centre. Methods: We conducted a retrospective cohort study (2006-2022) at a single tertiary hospital in Riyadh, Saudi Arabia. Adult patients (≥18 years) with PM/DM by 2017 ACR/EULAR classification were re-adjudicated, and ILD was confirmed by high-resolution CT (HRCT) after blinded re-review by a thoracic radiologist. ILD patterns followed ATS/ERS categories (NSIP, UIP, OP, RB-ILD, unclassifiable). Severity was treated separately from pattern and operationalized as “mild” if HRCT parenchymal involvement was <20% or, when imaging was equivocal, if FVC ≥80% predicted. Demographics, clinical features, standard serologies, pulmonary function tests (PFTs), echocardiography, and treatments were abstracted using a standardized form with double-entry checks. Analyses were descriptive and exploratory; between-group comparisons were limited to subgroups with n≥5 and adjusted for multiple testing (Holm). Results: Thirty-five patients met criteria (80% female; DM 60%, PM 40%). On HRCT rereview, NSIP was the most frequent pattern (37.1%, 13/35), followed by unclassifiable (14.3%, 5/35), UIP (5.7%, 2/35), RB-ILD (2.9%, 1/35), and OP (2.9%, 1/35). In parallel, severity was mild in 37.1% (13/35) across patterns. ILD timing relative to myositis was PM/DM-preceding in 48.6%, concomitant in 31.4%, and ILD-preceding in 20%. Exertional dyspnoea (74.3%) and non-productive cough (62.9%) were frequent; heliotrope rash and Gottron papules each occurred in 34.3%. ANA was positive in 82.9%; anti-Jo-1 in 34.3%. FVC (mean ± SD) approximated 71% predicted overall; DLCO ~90% predicted where available. As pre-specified, no inferential tests were performed for subgroups with n<5 (UIP, RB-ILD, OP), and signals from small cells were treated descriptively only. Glucocorticoids were universally used; 77.1% were maintained at ≤7.5 mg/day. Mycophenolate mofetil (54.3%) and rituximab (48.6%) were the most common steroid-sparing agents; azathioprine (40%), methotrexate (34.3%), and IVIG (25.7%) were also used; antifibrotics were prescribed in 11.4%. Conclusion: In this Saudi tertiary-care cohort, NSIP predominated as the ILD pattern, while mild severity at presentation was common but distinct from pattern. The dataset underscores heterogeneity in serology and treatment and highlights the need for standardized radiologic severity grading, prospective PFT capture, and multicentre registries to refine prognosis and guide therapy in regional PM/DM-ILD.

Communication is a cornerstone of quality healthcare, particularly in palliative care, where emotional, cultural, and informational needs differ across age groups. Despite its importance, systematic assessment of communication needs in different age groups remains underexplored in India. Objective: To identify communication gaps and needs among different age groups in palliative care settings and to suggest strategies for age-specific communication improvement. Methods: A descriptive cross-sectional study was conducted among 450 participants spanning adolescents, adults, and older adults in Chennai. Data were collected using structured questionnaires covering preferred communication channels, perceived barriers, and satisfaction with healthcare provider communication. Statistical analysis included chi-square tests and logistic regression. Results: Younger participants (15-24 years) preferred digital communication platforms, while older adults (≥60 years) valued face-to-face communication. Communication barriers included lack of empathy (42%), use of medical jargon (37%), and insufficient information (29%). Logistic regression showed older adults were significantly more likely to report unmet communication needs (OR = 2.14, 95% CI 1.25-3.67, p<0.01). Conclusion: Communication preferences and barriers differ significantly by age. Tailored strategies such as digital integration for youth and personalised counselling for older adults may improve patient satisfaction and outcomes in palliative care.

Background: High sugar consumption is a major contributor to dental caries in children. Schools, being central to children’s daily routines, offer a strategic setting for preventive health interventions. Methods: A 12-month cluster-controlled, non-randomized interventional study was conducted across five primary schools involving 400 children aged 6–12 years. Two schools (n = 160) received a multifaceted sugar monitoring program comprising daily sugar intake tracking, monthly dietary counseling, and oral health education. Three schools (n = 240) served as controls with standard curriculum. Caries incidence was assessed using DMFT/deft indices at baseline and after 12 months. Statistical analyses (paired t-tests, ANOVA, and regression with confounder adjustment) were performed, though clustering at the school level was not accounted for. Results: At baseline, mean DMFT/deft scores were comparable (intervention: 2.8±0.6; control: 2.6±0.7). After 12 months, intervention group scores declined to 1.9±0.5 (p<0.001), while control scores increased to 3.2±0.8 (p = 0.04). New caries incidence was significantly lower in the intervention group (12.5%) versus control (28.3%). Awareness of sugar intake improved from 45% to 78% in the intervention group. Conclusion: The school-based sugar monitoring program demonstrated effectiveness in reducing caries incidence and improving dietary awareness. Incorporating such interventions into school health policies could play a pivotal role in pediatric oral health promotion.

Objectives: The Vasoactive-Inotropic Score (VIS) has been proposed as a simple marker of illness severity and predictor of outcomes in pediatric critical illness. However, its prognostic role in pediatric septic shock remains incompletely studied. This study aimed to evaluate the predictive value of VIS for mortality and morbidity in children with fluid-refractory septic shock. Methods: A prospective observational study was conducted on 68 children admitted with fluid-refractory septic shock to the PICU of a tertiary care center between January 2021 and June 2022. VIS was calculated at predefined intervals and maximum VIS values were recorded. Outcomes assessed included mortality, length of PICU stay and duration of mechanical ventilation. VIS performance was compared with PRISM-IV score and lactate clearance. Results: High VIS values were significantly associated with mortality and mechanical ventilation. A cut-off value of >70 demonstrated strong predictive accuracy for mortality. Higher PRISM-IV scores and poor lactate clearance at 6 hours were also independently associated with adverse outcomes. Notably, non-survivors had shorter PICU stays due to early mortality. Conclusion: VIS was independently predictive of mortality and adverse outcomes in pediatric septic shock and outperformed PRISM-IV in prognostic accuracy. Incorporation of VIS into clinical protocols may enable timely identification of high-risk children. Multicenter studies with larger cohorts are warranted for external validation.

Behçet’s disease (BD) is a multisystem vasculitis with heterogeneous phenotypes and notable geographic variability. Prior single-centre reports from Saudi Arabia are limited by small samples and inconsistent diagnostic capture. Methods: We conducted a retrospective cohort study (2015-2020) at a tertiary centre in central Saudi Arabia. Eligibility followed International Study Group (ISG) and International Criteria for Behçet’s Disease (ICBD) definitions. To ensure diagnostic consistency, the full chart cohort (N=59) is summarized for transparency where variable-level denominators were available. Data were abstracted via a structured instrument across socio-demographics, organ-system involvement, inflammatory markers (ESR/CRP), and therapies. Missingness was quantified a priori and handled via complete-case denominators. Proportions are reported with 95% Wilson CIs; small-cell comparisons used Fisher’s exact tests aligned to prespecified contrasts (sex differences in mucocutaneous disease; ESR/CRP vs organ involvement). Results: The full cohort comprised 59 patients (male 72.9%): oral ulcers 72.9% (43/59; 95% CI 60.4-82.6), genital ulcers 55.9% (33/59; 43.3-67.8), ocular involvement 44.1% (26/59; 32.2-56.7) with anterior uveitis 28.8% (17/59; 18.8-41.4) and posterior uveitis 11.9% (7/59; 5.9-22.5), vascular involvement 13.6% (8/59; 7.0-24.5), arthritis 23.7% (14/59; 14.7-36.0). ESR and CRP were elevated in 18.6% (11/59; 10.7-30.4) and 22.0% (13/59; 13.4-34.1), respectively. Corticosteroids were prescribed in 72.9% (43/59; 60.4-82.6), colchicine 61.0% (36/59; 48.5-72.2), azathioprine 47.5% (28/59; 35.3-60.0). Sex-stratified exact tests showed no significant difference for oral/genital ulcers; a female excess in cutaneous lesions lost robustness under small-sample-valid re-analysis and was treated as exploratory. Missing disease-duration data were substantial (35.6%). Findings were interpreted primarily within the oral-ulcer-confirmed analytic framework and secondarily against the full cohort for context. Conclusions: In central Saudi Arabia, BD presentations were dominated by mucocutaneous and ocular disease with comparatively modest vascular involvement. Inflammatory markers lacked stable associations with organ-system involvement. Given the modest sample, incomplete documentation for some fields, and small-cell structure, results are hypothesis-generating. This criteria-clean profile offers groundwork for a prospective, multi-centre registry with standardized phenotyping and time-locked biomarkers.

Pre-eclampsia is a pregnancy-related disorder characterized by hypertension and organ dysfunction, posing significant risks to both mother and fetus. While the exact etiology remains unclear, evidence suggests that biochemical alterations particularly oxidative stress, homocysteine, and vitamin B12 dysregulation play a pivotal role. This study explores the interplay between oxidative stress, homocysteine, and vitamin B12 in pre-eclampsia. Methods: This hospital-based cross-sectional study enrolled a total of 120 patients categorized into three groups: 40 pregnant women with pre-eclampsia, 40 healthy pregnant women matched for gestational age, and 40 healthy non-pregnant women matched for age. Serum malondialdehyde (MDA) levels were assessed using the Thiobarbituric Acid Reactive Substances (TBARS) assay. Homocysteine and vitamin B12 levels were measured via chemiluminescent immunoassay. Clinical parameters including blood pressure, proteinuria, liver enzymes, platelet counts, and serum uric acid were also evaluated. Data were analyzed using SPSS version 24. Results: Preeclamptic women exhibited significantly elevated serum MDA (2.84±0.30 nmol/mL) and homocysteine (20.21±2.78 µmol/L), with markedly reduced vitamin B12 (179.1±31.78 pg/mL), compared to both control groups (p<0.0001). MDA and homocysteine showed positive correlations with blood pressure, protein-creatinine ratio, and serum uric acid, while vitamin B12 was inversely correlated with MDA. Conclusion: The interplay of increased oxidative stress, elevated homocysteine, and reduced vitamin B12 levels appears to play a significant role in the pathogenesis of pre-eclampsia. These findings highlight the importance of early biochemical screening to identify at-risk women and open the possibility for preventive strategies such as antioxidant therapy and vitamin B12 supplementation. However, given the multifactorial nature of pre-eclampsia, robust longitudinal and large-scale prospective studies are essential to validate these associations, clarify underlying mechanisms, and translate them into clinically effective interventions.

Early detection of oral potentially malignant disorders (OPMDs) is crucial for improving outcomes in oral cancer, particularly in resource-limited settings. Recent advances in large language models (LLMs) and smartphone imaging provide new opportunities for AI-driven diagnostic support; however, their use in detecting oral mucosal lesions remains underexplored. Objective: To evaluate and compare the diagnostic performance of Few-shot prompting, Retrieval-Augmented Generation (RAG), and RAG with Chain-of-Thought (RAG + COT) models inthe binary classification of smartphone-captured intraoral buccal mucosa images as either normal or abnormal. Methods: Using a standardized smartphone protocol, 250 intraoral images from 125 patients were categorized as normal, variations, or lesions and split equally into training and testing sets. Few-shot prompting used a subset only 10 test images — 5 normal and 5 lesion — which may produce unstable estimates, while RAG and RAG + COT models trained on the full training set. Expert annotations guided COT descriptors. Variation images were used only in model training for RAG and RAG+COT to improve contextual representation but excluded from binary performance evaluation. Performance was evaluated via sensitivity, specificity, accuracy, F1 score, precision, recall, and 95% confidence intervals. Results: Few-shot prompting achieved 80% sensitivity, 100% specificity, 90% accuracy, and an F1 score of 0.88 with wide CIs due to the very small test set. The RAG model, with 54% sensitivity and 91% specificity, showed limited true positive detection. Adding chain-of-thought (RAG + COT) improved sensitivity to 90% and accuracy to 82% (F1: 0.86), though specificity dropped to 64% leading to a higher false-positive rate with potential implications for screening follow-up, however, highlighting the value of structured logical reasoning in enhancing lesion detection. Conclusion: The RAG + COT model outperformed Few-shot and RAG models in mucosal lesion detection, demonstrating high sensitivity and improved diagnostic accuracy. However, its low specificity highlights the need for human review before acting on AI results. Findings are promising but preliminary, requiring validation in larger and more balanced datasets before clinical adoption. Its structured logical reasoning highlights the potential of LLMs with COT prompting to strengthen community-based oral cancer screening.

Early Childhood Caries (ECC) remains a highly prevalent and preventable oral condition worldwide, including in Saudi Arabia. Parental knowledge, attitudes and practices (KAP) strongly influence children’s oral health outcomes. This study assessed parental KAP regarding children’s oral health in Jeddah and explored sociodemographic factors influencing these practices. Methods: A cross-sectional survey was conducted among 257 parents of children aged 0-12 years in three districts of Jeddah. A validated bilingual questionnaire (Arabic/English) assessed demographics, knowledge, attitudes and practices. Stratified random sampling across schools, clinics and community centres was employed. Data were analysed using Chi-square tests, with p<0.05 considered significant. Results: Most parents recognized dental caries as a major childhood condition (75.5%) and identified its causes (86.8%). However, knowledge of preventive strategies such as dental sealants (26.5%) and recommended first dental visit (26.5%) was limited. Mothers, Saudi nationals and those with higher education and income demonstrated significantly better knowledge (p<0.05). Although 93.4% of children brushed daily, only 47.1% brushed for 2-3 minutes, 17.1% used dental floss and 39.7% attended regular dental checkups. Attitudinal assessment revealed that 68.2% of parents considered primary teeth important, yet 42.5% delayed the first visit until problems arose. Conclusion: While parents in Jeddah showed adequate general awareness, significant gaps persist in preventive knowledge, early dental visits and flossing. Targeted, culturally tailored education programs are essential to improve preventive practices and reduce ECC prevalence.

Bacteria associated with algae play a crucial role in the ecological balance of marine ecosystems. Actinomycetes have many advantageous characteristics that increase the bioavailability of vital nutrients in soil and regulate the growth of microbial pathogens. This study aimed to identify the culturable actinomycetes, associated with some algal samples from the Red Sea and investigate their antimicrobial and antioxidant activities. The actinomycetes were isolated from four algal species collected from Yanbu city on starch nitrate agar medium supplemented with 10% NaCl and tested for their antimicrobial activity against a panel of pathogenic multidrug-resistant bacteria and for their antioxidant potential using appropriate assays. The collected Algae were identified as Ulva lactuca and Codium tomentosum (green algae), Padina gymnospora (brown algae) and Hypnea valentia (red algae). The results demonstrated that out of 4 different algal samples collected from the Red Sea, 15 filamentous bacterial isolates were obtained, purified and screened for antibacterial activities. Five isolates showed detectable antibacterial activities using the agar plug diffusion assay. Excellent antibacterial activities were recorded by the isolate RAD3 against Staphylococcus aureus, Streptococcus pyogenes and Enterococcus faecalis in addition to Escherichia coli. At the same time, it exhibited lower antimicrobial activity against Pseudomonas aeruginosa, Salmonella typhi, Shigella sonnei and Serratia marcescens. The Minimal Inhibitory Concentrations (MICs) of the RAD3 extract were ranged from 50-100 µg/ml for the tested bacterial pathogens. No antibacterial activity was recorded against Klebsiella pneumonia and Acinetobacter baumannii. The isolate RAD3was the most active in bacterial inhibition and prevented E. faecalis biofilm formation by 63% and exopolymeric substances (EPS) by 47%. The ethyl acetate extracts of the five selected bacteria showed promising antioxidant potential by scavenging DPPH (2,2-diphenyl-1-picrylhydrazyl) method. Out of the 5 chosen bacteria, RAD3 showed 66.37% free radical scavenging with EC₅₀ = 29.0 µg/ml and the results were compared to the positive control and the synthetic antioxidant Butylated Hydroxytoluene (BHT) which showed 96% free radical scavenging with EC₅₀ = 19.7 µg/ml. The 5 chosen bacterial isolates were morphologically characterized and genetically identified by the analysis of 16S rDNA as species belonging to the genus Streptomyces. In conclusion, these findings highlight the potential of bacteria associated with the Red Sea algae as a source of novel antimicrobial and antioxidant compounds for food and medicine industries.

This study evaluated and compared the microhardness and microleakage performance of a newly formulated hydrophilic nano-sealant, a commercially available hydrophilic sealant (UltraSeal XT Hydro) and a formulated flowable nano-composite under thermocycling conditions. Methods: Sixty extracted human mandibular third molars were randomly allocated into three groups (n = 20 each). Group I: newly formulated hydrophilic nano-sealant; Group II: UltraSeal XT Hydro sealant; Group III: formulated flowable nano-composite. Occlusal surfaces were etched with 37% phosphoric acid for 20 s, rinsed, dried according to material specifications and the assigned material applied and light-cured for 20 s. All specimens underwent 1500 thermocycles between 5°C and 55°C. Microleakage was evaluated using 0.5% basic fuchsin dye penetration and confocal laser scanning microscopy, scored using Overbo and Raadal’s criteria. Microhardness was measured on the cured surface using the Vickers hardness test with a 200 g load for 20 s. Data were analyzed using the Kruskal–Wallis and Chi-square tests; median (IQR) values are reported for non-parametric data. Results: Group I (new hydrophilic nano-sealant) showed the lowest median micro-leakage score (0.5 [0–1.0]), significantly lower than Group III (flowable composite) (p = 0.032). Micro-hardness was highest in Group II (median 15.1 [14.5–15.6] VHN) and lowest in Group III (10.1 [9.6–10.8] VHN); differences did not reach statistical significance (p = 0.061). Conclusion: The newly formulated hydrophilic nano-sealant demonstrated superior microleakage resistance compared to the formulated flowable nano-composite, while microhardness differences among materials were not statistically significant. Further in vivo studies with defined material compositions and larger samples are required before clinical recommendations can be made.

 Recent years have seen major adjustments to the Saudi healthcare system with the goal of enhancing all individuals' access to high-quality healthcare services. The integration of healthcare providers and services within a certain geographic region is a primary strategy being pursued, known as health clusters. The purpose of this project is to check the perception and awareness of workers in healthcare about the transformation. Methods: This paper is a cross-sectional mono-quantitative paper since it relies on a survey to find answers to the research questions. This survey was distributed to healthcare practitioners and administrator in Riyadh city. Results: 131 healthcare practitioners and administrators participated in this study. Findings revealed that healthcare workers have a moderate knowledge regarding healthcare transformation programs. They should highly be aware of electronic health records; however, more awareness programs about pharma services with transformation must be applied as well as regarding the application of artificial intelligence and learning machines in the healthcare industry. Conclusion: Saudi health providers perceive this healthcare transformation program as improving health outcomes and increasing access to healthcare for all underprivileged individuals. Based on the results, frequent training must be created to develop the knowledge of health practitioners reading the healthcare transformation program.

Objectives: Composite resin restorations are widely used due to their favorable mechanical properties and aesthetics. However, polymerization shrinkage may compromise marginal adaptation, particularly in Class II cavities. This study evaluated the influence of Metal (MM) and Transparent Matrices (TM) on marginal gap formation in micro-hybrid and bulk-fill composite restorations. Methods: Forty caries-free extracted molars were randomly allocated into four groups (n = 10). Cavities were restored using either micro-hybrid composite with centripetal layering or bulk-fill composite with bulk-filling technique, combined with MM or TM (Tofflemire). Marginal adaptation was assessed using Scanning Electron Microscopy (SEM) after artificial aging and thermocycling. Statistical analysis was performed with paired and unpaired t-tests (α = 0.05), and effect sizes were calculated. Results: MM groups demonstrated superior marginal adaptation in dentin (ES = 0.93, p = 0.005) and enamel (ES = 0.76, p = 0.02) compared with TM. In bulk-fill composites, matrix type showed no significant effect (p = 0.16). Micro-hybrid restorations with MM exhibited a large effect size (ES = 1.48, p<0.001) compared to TM. No significant enamel margin differences were observed between composites (p = 0.89). Conclusion: Matrix choice significantly influenced marginal quality in micro-hybrid restorations, but not in bulk-fill composites. Bulk-fill composites demonstrated more consistent dentin adaptation, suggesting reduced matrix dependency.

Background: Maxillofacial reconstruction presents significant challenges due to the complex anatomy of the craniofacial region. Traditional surgical approaches have limitations in precision and outcomes. Robotic-assisted surgery has emerged as a promising technology to address these challenges. Objective: This study aimed to evaluate the clinical outcomes, precision, and surgical duration of robotic-assisted surgeries compared to conventional techniques in maxillofacial reconstruction. Methods: A prospective randomized controlled trial was conducted with 120 patients requiring maxillofacial reconstruction. Patients were randomly assigned to either robotic-assisted (n = 60) using the MaxFac Robotic System (Model MFR-2000) or conventional surgery (n = 60) groups. Surgical time, accuracy of reconstruction, postoperative complications, and patient-reported outcomes were assessed. Results: The robotic-assisted group demonstrated significantly higher precision in reconstruction (mean deviation 0.8±0.3mm vs. 2.1±0.7mm, p<0.001). Although operative time was longer in the robotic group (245±35 min vs. 195±28 min, p<0.001), it resulted in fewer complications (8.3% vs. 21.7%, p=0.032) and better patient-reported outcomes at 6 months follow-up (mean satisfaction score 8.7±1.2 vs. 7.2±1.5, p<0.001). Conclusion: This single study suggests that robotic-assisted surgery in maxillofacial reconstruction provides superior precision and better clinical outcomes despite longer operative times. Further research is needed to confirm these findings.

This study focused on comparing the MVA and D&C, in terms of safety and efficacy in uterine evacuation for the management of clinically diagnosed pregnancies end in miscarriage. Randomized Control Trial was carried out in Alfashir Hospital in Northern Darfur, Sudan, between March and September of 2022. The study involved 200 women diagnosed with spontaneous and first-trimester miscarriage. One hundred women were managed using MVA, and the remaining 100 were managed with conventional D&C. 38% of cases were <25-year ,46% of cases were <35y and 16% of cases were <50y. Regarding the gestational age, 9% of cases were <6 weeks, 47.5% were 6-9 weeks, 24.5% were 10-12 weeks and 19% were 13-14weeks. According to time duration of the procedure, 35% of the cases are done in <5 min, 31% done between 6-10 min, 15% done in <15 min and 19% done in >15 min. According to the need for analgesia and anesthesia, all cases of D&C were done under analgesics and anesthesia, and 73% of MVA cases used analgesics. Regarding the blood loss, only one case in the MVA group had sever blood loss, however 6 cases had significant blood loss. One case in the D&C group had uterine perforation and no perforation in the other group. 2 cases had anesthetics complications and no anesthetics complication in the MVA group. Regarding the retained product of conception, both groups were completely evacuated without the need for re-evacuation. In conclusion Both MVA and D&C are equally effective in uterine evacuation and the possibility of returned product of conception after uterine evacuation is extremely rare, compared to D&C, MVA had a substantially lower rate of complications, procedure length, blood loss and bleeding.

Background: Toothbrushing is a key self-care practice for preventing dental caries, gingivitis and periodontal disease. Despite clear recommendations, many young adults fail to meet optimal brushing duration guidelines. Music, known to influence mood, attention and perception of time, may provide a low-cost strategy to enhance oral hygiene behaviours, but its effect on toothbrushing remains underexplored. Aim: To examine the association between music tempo and toothbrushing duration, plaque control and gingival health among dental students aged 18-30 years. Methods: A cross-sectional observational study was conducted among 100 dental students at Saveetha Dental College, Chennai, India. Participants self-reported their music listening habits during brushing and were grouped into slow-tempo (60-80 bpm), fast-tempo (120-140 bpm) or no music. A structured questionnaire assessed demographics, brushing habits and perceived effects of music, while oral hygiene was evaluated using the Silness and Loe Plaque Index (PI) and Loe and Silness Gingival Index (GI). Independent t-tests compared music vs. no music groups and one-way ANOVA with post-hoc Tukey tests compared tempo groups. Results: Participants who brushed with music had significantly longer brushing durations (2.7±0.7 min) than those without music (2.0±0.6 min; p<0.001) and lower PI (0.8±0.3 vs. 1.1±0.4; p<0.001) and GI scores (0.6±0.2 vs. 0.8±0.3; p<0.001). Slow-tempo music yielded the longest brushing duration (2.9±0.7 min) and lowest PI (0.7±0.3) and GI (0.5±0.2) scores compared to fast-tempo and no music (all p<0.05). Effect sizes were large (η² = 0.12-0.15). Conclusion: Listening to music, particularly slow-tempo music, was associated with longer brushing time and improved plaque and gingival scores among dental students. While promising, these results are based on self-reported habits and a non-experimental design, limiting causal inference and generalisability. Controlled trials with objective measurements are recommended to evaluate music as an adjunctive tool for promoting oral hygiene.

Abstract Objectives: Background: Pediatric traumatic Spinal Cord Injury (SCI) is a rare but profoundly disabling medical disorder with a high prevalence of secondary complications, which significantly impede long-term functional and developmental achievement. Although they are of clinical importance, current evidence on the patterns, severity, risk factors and treatment of these complications in pediatric SCI is piecemeal and variable in reporting. Method: A systematic review was conducted based on PRISMA 2020 standards, solely on nonrandomised observational studies that documented secondary complications in individuals aged 21 years and below with traumatic Spinal Cord Injury (SCI). Exhaustive searches were conducted in seven databases with Boolean operators and MeSH terms. Data extraction was carried out as per a preconceived protocol and study quality was evaluated using the ROBINS-I tool. The outcome measured was prevalence rates, measure of severity, risk factors and prevention or management of the reported complications. Certainty of the evidence was evaluated using the GRADE approach. Results: Nine eligible studies involving a total sample of more than 3000 pediatric patients were included. Neurogenic bladder showed the highest prevalence (91.2%), followed by urinary incontinence (69.8%), constipation (72.1%), spasticity (57%), pressure ulcers (20.4–57.3%) and UTIs (11.6-74%). Pain (69%), scoliosis (40-82%) and autonomic dysreflexia (19.7-42%) were also common. Odds ratios showed significant associations between cervical or complete injury and risk increase for UTIs (OR: 1.05–1.09), autonomic dysreflexia (OR: 1.08-1.09) and respiratory complications (OR: 1.09-1.16). Qualitative synthesis revealed that early assessment intervals ranged from acute hospitalization to more than 28 years after injury. Interventions used were catheterization training, early rehabilitation, surgical decompression, spasticity management and caregiver education. Risk factors like young age at injury, higher level of injury, completeness of neurological injury and non-compliance of families were found to be consistently associated with unfavorable outcomes. Conclusion: Synthesis of evidence revealed the prevalence and multicausal aetiology of paediatric traumatic SCI secondary complications. Inconsistencies between studies were revealed with evidence for early detection, longitudinal follow-up and person-centred interventions to prevent long-term morbidity. The findings also revealed a call for the urgent creation of age-sensitive assessment tools and paediatric-specific clinical guidelines to maximise care and reduce complication-related disability among the paediatric population.

Background: Paediatricians are pivotal in recognizing and responding to child abuse. However, there is limited evidence regarding their preparedness in the Western Province of Saudi Arabia. This study evaluated paediatricians’ knowledge, perceptions, professional experience and reporting practices related to child abuse. Methods: A cross-sectional survey was conducted among paediatricians (n = 117) working in hospitals and clinics across Jeddah, Makkah, Madinah and Taif. A structured, expert-reviewed questionnaire assessed knowledge, perception, professional experience and reporting practices. Descriptive statistics and Chi-square/Fisher’s exact tests were applied. Results: Most paediatricians (59.8%) demonstrated good knowledge, while 35.9% had fair knowledge and 4.3% poor knowledge. Perceptions were less favourable: only 15.4% reported good perception, while 49.6% showed poor perception. Professional experience was generally good (53.8%), but only 35.9% demonstrated good reporting practices. Male paediatricians reported better reporting (p = 0.004). Regional differences in perception were also significant (p = 0.002). Conclusion: While paediatricians displayed good knowledge and adequate professional experience, their perceptions and reporting practices remain suboptimal. Training programs tailored to regional challenges—emphasizing legal frameworks, reporting protocols and cultural sensitivities—are urgently needed to standardize responses and strengthen child protection outcomes.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and sputum retention. This study evaluated the efficacy of a Biofeedback-Enhanced Acapella device versus standard Acapella in moderate COPD patients (GOLD Stage II), with six mild COPD cases included due to recruitment challenges. Methods: A randomized, assessor-blinded experimental design enrolled 26 participants (14 Biofeedback-Enhanced, 12 Standard Acapella). Daily 20-minute sessions occurred for 5 days. Primary outcomes: FEV1, FVC, FEV1/FVC ratio, sputum weight. Secondary outcomes: Patient satisfaction (scores reported), vital signs (results included). Results: The Biofeedback-Enhanced group showed improvements in FEV1 (1.82L→2.25L, p=0.037), FVC (2.50L→3.00L, p = 0.049) and sputum weight (20.1g→35.2g vs. 18.5g→27.8g, p = 0.037). Patient satisfaction was higher (8.5±0.5 vs. 6.2±0.7, p = 0.021). Vital signs improved: heart rate (80→78.78 bpm), respiratory rate (15.5→14.0 breaths/min), oxygen saturation (94.85%→95.78%). Conclusion: Biofeedback-Enhanced Acapella may improve pulmonary function and sputum clearance in moderate COPD over short-term use. Further long-term studies are warranted.

Background: With road crashes contributing significantly to national fatalities, enhancing first aid preparedness is crucial. This study focuses on female drivers in Saudi Arabia, a newly emerging group following the 2018 lifting of the driving ban for women. The influx of new drivers underscores the need for essential first aid skills. By assessing knowledge, awareness, and attitudes toward first aid, this study identifies educational gaps and proposes targeted interventions. Female drivers were chosen due to their pivotal role as new participants in the driving landscape and their potential to enhance community safety through improved first aid awareness. Methods: A cross-sectional survey was conducted among 831 female drivers across Saudi Arabia, using self-administered questionnaires distributed via social media. All participants provided informed consent prior to participation. The survey assessed participants' knowledge of first aid measures, attitudes toward first-aid training, and personal experiences with emergencies. Data analysis was performed using SPSS version 27, applying descriptive and inferential statistics to summarise variables and explore associations between demographic factors and first aid knowledge. Results: The study identified substantial gaps in first aid knowledge and training among 831 female drivers in Saudi Arabia, despite 798 (96%) participants recognizing its importance. Only 233 (28%) had formal first aid training, and 345 (42%) knew correct CPR procedures. Key deficiencies included knowledge of bleeding control (308, 37%) and safe removal of injured individuals from vehicles (214, 26%). Confidence in providing first aid was low, with 235 (28%) participants reporting no confidence and only 44 (5%) feeling very confident. Sociodemographic factors, such as age, education, and driving experience, significantly influenced awareness and knowledge scores. Conclusion: There is an urgent need for targeted educational interventions to address key gaps in first aid knowledge among female drivers in Saudi Arabia. Integrating first aid training into the driver’s licensing process and promoting regular public health campaigns can enhance emergency preparedness and road safety. These findings emphasize the importance of policy-driven approaches to ensure that all drivers, especially female drivers, are equipped with essential first aid skills, ultimately contributing to more comprehensive driver education and improved emergency response outcomes.

Background: Microleakage at the gingival margin of Class II composite restorations remains a key failure pathway, driven by polymerization-shrinkage stress in high configuration-factor (C-factor) cavities and the lower bond-ability of dentin/cementum. Objective: To compare microleakage scores (primary endpoint) at gingival margins between a Nano-filled composite and a conventional micro-hybrid; secondarily, to compare score distributions and enamel-margin (occlusal) sealing as indicators of marginal sealing ability. Methods: Forty extracted, non-carious human molars were randomized to restoration with a Nano-filled composite (Filtek™ Supreme Ultra) or a micro-hybrid (Filtek™ Z250) using a total-etch adhesive (Adper™ Single Bond 2). Standardized Class II mesio-occlusal cavities extended 1.0 mm apical to the CEJ. After thermocycling (5000 cycles, 5-55°C), specimens were immersed in 2% methylene blue, sectioned into two halves and scored (0-4) at gingival and occlusal margins under stereomicroscopy by two blinded examiners. The worst of two sections per tooth was used a priori; sensitivity analysis using the mean of two sections was concordant. Non-parametric analyses (Mann-Whitney U; Fisher-Freeman-Halton exact test) with Holm correction for multiplicity were applied. Inter-examiner reliability was excellent (Cohen’s κ = 0.89); intra-examiner κ = 0.91. Results: Gingival-margin microleakage was lower with Nano-filled composite: median (IQR) 1 [1-2] vs 2 [2-3] for micro-hybrid; U = 102.5; Z = -2.96; p = 0.003; Rosenthal’s r = 0.47 (medium-large). Minimal/no leakage (scores 0-1) occurred in 65% of Nano-filled vs 25% of micro-hybrid restorations; severe leakage (scores 3-4) occurred in 5% vs 30%, respectively (exact p = 0.028). Occlusal (enamel) margins showed low leakage in both groups with no significant difference (median 0 in both; p>0.40). Conclusions: Under standardized in vitro conditions, the Nano-filled composite reduced gingival-margin microleakage compared with a micro-hybrid by one full score unit in the median, with a medium-large effect size (r≈0.47) and excellent scoring reliability. Given method and model limitations, these findings suggest improved marginal sealing ability for Nano-filled composites in Class II restorations and warrant validation with 3D methods and clinical studies.

Background: Paediatric dental fear is a common challenge that requires effective behaviour management techniques (BMTs). Dentists’ knowledge, attitudes, and practices (KAP) in this area influence treatment outcomes and children’s acceptance of care. This study assessed the KAP of dentists in Jeddah, Saudi Arabia, regarding BMTs. Methods: A cross-sectional study was conducted among 116 licensed dentists who manage paediatric patients in governmental and private practices. A bilingual (English and Arabic) questionnaire was distributed electronically. The tool assessed demographics, knowledge, attitudes (confidence, training adequacy, and willingness for further education), and practices regarding BMTs. Descriptive statistics and chi-square/Fisher’s exact tests were applied, with significance set at p<0.05. Results: Of 116 respondents, 76.7% were under 40 years, and 65.5% were general dentists. Awareness of BMTs was high (91.4%), yet only 38.8% reported adequate confidence in managing fearful children. Tell-Show-Do (54.3%) was the most used technique, followed by distraction (14.7%) and positive reinforcement (8.6%). Awareness was significantly higher among older dentists (>40 years, p = 0.001), postgraduates (p = 0.007), and those in the public sector (p = 0.043). However, 44.8% had not attended any postgraduate training in dental fear, and only 15.5% had attended several. Most dentists (74.1%) expressed willingness to attend workshops on behaviour management. Conclusion: While knowledge of BMTs was widespread, gaps remained in confidence and postgraduate training, especially among younger and non-specialist dentists. Targeted curricula and structured continuing education are recommended to strengthen non-pharmacological behaviour management and reduce reliance on pharmacological interventions.

Introduction: Polydopamine, inspired by the adhesive properties of mussel proteins, has recently drawn considerable interest in biomedical science for its antimicrobial and anti-inflammatory capabilities. In this work, a toothpaste formulation was prepared using eco-friendly synthesised polydopamine, integrated with polymethyl methacrylate (PMMA)—a biocompatible polymer valued in dentistry for its mechanical strength and resistance to degradation. PMMA was incorporated to improve the formulation’s physical stability without compromising its bioactive potential. Aim: To investigate the antimicrobial and anti-inflammatory effects of a polydopamine–PMMA toothpaste formulation. Methods: Dopamine (50 mg) was dissolved in 1 mL of distilled water at 25°C and added to a continuously stirred mixture of 5 mL ethanol, 9 mL water, and 0.15 mL ammonium solution. Over a 24-hour reaction period, the solution gradually shifted from pale brown to deep brown, indicating successful polydopamine formation. The product was blended into a toothpaste base containing 2% w/w PMMA. Antimicrobial activity was evaluated against Streptococcus mutans, Lactobacillus spp., Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. Anti-inflammatory effects were examined using bovine serum albumin (BSA) denaturation, egg albumin denaturation, and membrane stabilisation assays. Results: The polydopamine–PMMA toothpaste exhibited marked antimicrobial activity against all tested microorganisms and demonstrated notable anti-inflammatory effects across all experimental models. Conclusion: This formulation shows promise as a bioactive oral care product with both antimicrobial and anti-inflammatory benefits. However, further research—including cost-effectiveness studies, environmental impact analysis, and clinical evaluation—is required before confirming its suitability for large-scale use. Clinical Significance: Incorporating polydopamine with PMMA may yield a durable and biologically active toothpaste capable of supporting oral health by reducing microbial load and inflammation.