Assessment of bifid mandibular canals using cone beam computed tomography in general population: a retrospective evaluation

OBJECTIVE

To evaluate the prevalence of bifid mandibular canals (BMC) using cone-beam computed tomography (CBCT) in the Saudi population subset.

MATERIALS AND METHODS

In the study, three hundred and forty-three CBCT scans (661 sides) were evaluated for the presence of BMC, involving 162 males and 181 females. Tomographic acquisitions were performed on the device Planmeca®. The image analysis was performed on the Planmeca Romexis® software, aided by image filters associated with transverse, oblique, and panoramic reconstruction cuts for analysis of the BMC. Naitoh's classification (2009) was employed to classify mandibular canals. The prevalence of BMC was determined according to location, gender, and age of participants. The data were analyzed with Chi-square and one-way ANOVA tests at a significance level of 95%.

RESULTS

The BMC was observed in 37 (12.34%) out of 343 participants, of whom 20 (54.05%) were males and 17 (45.94%) were females. There was no significant difference in the proportion of bifid canals in both genders and various age groups. The most common BMC was the retromolar canal type, with 56.75% occurrence. The dental canal type was observed in 18.91% of BMC participants. The presence of a forward canal without confluence was observed in 16.21% of participants in the BMC, whereas a forward canal with confluence was noted in 8.10% of participants.

CONCLUSIONS

The prevalence of bifid mandibular canals (BMC) within a subset of the Saudi population was 12.3%. The retromolar canal was identified as the most frequently occurring type, accounting for 56.7% of cases. No significant variations in BMC prevalence were observed concerning age and gender. Consequently, it is strongly advised to conduct a thorough assessment of the mandibular canal and its potential variations using CBCT imaging before undertaking mandibular surgical procedures, in order to minimize the risk of complications.

Assessing Knowledge, Acceptance, and Anticipated Impact of Telepathology in Saudi Arabia: Insights From Healthcare Workers and Patients

INTRODUCTION

Telepathology, a rapidly evolving field in modern healthcare, has the potential to significantly impact the diagnosis and management of diseases. This study aimed to assess the prevalence of acceptance and knowledge, the likelihood of future use, and the perceived advantages and disadvantages of telepathology among healthcare workers (HCWs) and patients in Saudi Arabia.

METHODS

A cross-sectional study was conducted with 388 participants, including 179 HCWs and 209 adult patients across Saudi Arabia. Data were collected using a bilingual, self-administered, and anonymous computer-based questionnaire. The Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY) was employed for data analysis.

RESULTS

The participants had an average knowledge rate of 80.3% (n=312) concerning telepathology. A substantial 88.16% (n=342) were inclined towards its acceptance, and an optimistic 89.97% (n=349) foresaw its potential utility. Among the respondents, 70% (n=272) pinpointed "expedited results" as the principal merit of telepathology. However, 60% (n=233) flagged "the necessity for costly infrastructure" as its chief limitation.

CONCLUSIONS

The insights derived underscore a prominent knowledge and endorsement of telepathology among the Saudi population and HCWs. Despite certain drawbacks, participants believe that telepathology is feasible and offers numerous benefits that could greatly enhance the healthcare system in Saudi Arabia. Future research should focus on evaluating its practical implementation and efficacy within healthcare facilities.

Comparison of implant-supported rehabilitation in smokers and non-smokers with conventional and short tuberosity implants: an evaluation of prosthetic, peri-implant, and cytokine profiles

OBJECTIVE

This study aimed to assess periodontal parameters, radiographic (CBL), and prosthetic parameters along with levels of matrix metalloproteinase-9 (MMP-9) and interleukin-1β (IL-1β) in smokers undergoing rehabilitation using conventional implants and short tuberosity implants (STIs).

SUBJECTS AND METHODS

The duration of the study was six months. A structured questionnaire was made to be filled out by all participants. The participants were included in the study based on predefined inclusion and exclusion criteria for smokers and non-smokers with STIs. Peri-implant parameters were assessed based on peri-implant plaque index (PIPI), bleeding on probing (BoP), and peri-implant periodontal depth (PIPD) ≥4 mm. Collection of peri-implant crevicular fluid (PICF) and measurement of MMP-9 and IL-1β was performed using ELISA. Data related to peri-implant clinical and radiographic parameters were reported in mean and percentages. Pearson Chi-square test was employed for categorical data sets, whereas the Kruskal-Wallis test was used for the comparison of means between groups. Bonferroni post hoc adjustment test was applied for multiple comparisons. Differences were found to be significant p<0.01 RESULTS: Among the four groups, one hundred participants were included. The mean age of participants in groups 1 (44±4.5 yrs) and 3 (44±2.1 yrs) showed no significant difference from participants in groups 2 (42±3.8 yrs) and 4 (43±3.5 yrs). The duration of the smoking habit in cigarette smokers with STIs was 22.7±1.4 yrs, and cigarette smokers with conventional implants were 23.8±1.9 yrs with a daily frequency of 11.2±2.5 in group 1 and 11.33±2.1 in group 3. The means for PIPI and PIPD were found to be significantly worse in cigarette smokers with STIs (PIPI 62.4±5.9; PIPD 5.3±2.1) and conventional implants (PIPI 63.3±6.1; PIPD 5.5±1.9) compared to non-smokers with STIs (PIPI 29.2±3.6; PIPD 3.1±0.1) and conventional implants (PIPI 28.1±3.4; PIPD 3.2±0.3). BoP was significantly higher in non-smokers compared to smokers with STIs (smokers 24.2±8.3; non-smokers 36.5±21.2) and conventional implants (smokers 21.6±7.4; non-smokers 38.4±24.1) (p<0.01). The level of IL-1β (pg/ml) and the level of MMP-9 (ng/ml) were found to be significantly higher in cigarette smokers with STIs and conventional implants in comparison to non-smokers (p<0.01).

CONCLUSIONS

Periodontal (PIPI, PIPD, and BoP) along with radiographic (CBL) and prosthetic parameters were compromised in smokers compared to non-smokers. Patients with conventional implants and STI showed comparable clinical, radiographic, and prosthetic parameters among smokers. Utilization of dental services along with cessation programs should be encouraged for smokers.

Self-medication for acne among Saudi Undergraduate University Students: A cross-sectional study

Background

Understanding the perceptions and practices associated with self-medication among undergraduate university students is of significant importance since there is evidence showing that self-medication is prevalent among this group.

Aims

The aim of this study is to evaluate the perceptions and extent of self-medication among undergraduate university students as well as assess their knowledge and patterns of self-medication for acne. A cross-sectional study was conducted with undergraduate university students aged between 18 and 25 years.

Materials and Methods

Students were briefed about the purpose of the study, and a pretested questionnaire was used for assessment. Statistical analyses were performed using SPSS version 25.

Results

Five hundred and nineteen students participated in this study. Approximately 55.3% had self-medicated, and 38.2% of the participants reported self-medicating because they thought the situation was simple and did not require a doctor's visit. Adapalene was the most commonly administered medication (53%). Furthermore, 74.7% of the respondents said that they saw improvement after treatment.

Conclusions

A high percentage of students self-medicate their acne, many of whom use medication without a prescription. However, inappropriate use of drugs can increase the risk of adverse effects.

Natural and synthetic photosensitizers activated by photodynamic therapy on enamel reconditioning rebonded to metallic brackets: an in vitro study

OBJECTIVE

To evaluate the bond efficacy and failure rates of rebonded metallic brackets after enamel reconditioning with chemical 37% phosphoric acid (PA) and natural and synthetic photosensitizers activated by PDT.

MATERIALS AND METHODS

A total of 50 non-cavitated, and cautiously extracted human premolars were congregated after sample size calculation. The enamel exterior was etched, washed, dried for adhesive application, and cured. Metallic brackets were then oriented and adapted to enamel surface using composite. Later, brackets were debonded from the surface via a Weingart plier. Enamel was finished for ensuing surface reconditioning. Ultimately, specimens were randomly distributed into five groups (n=10). Enamel surface before rebonding was reconditioned with curcumin photosensitizer (CP), riboflavin photosensitizer (RP), rose bengal photosensitizer (RBP), methylene blue photosensitizer (MBP), and 37% PA (control) respectively. After following reconditioning protocol, brackets were rebonded to the enamel exterior employing a composite adhesive system. Then, specimens were subjected to the universal testing machine for analyzing shear bond strength (SBS), and bond failures were predicted using an ARI index. One-way ANOVA and Tukey multiple comparison tests were used for statistical analysis at a variance value of p < 0.05.

RESULTS

Enamel reconditioned with 37% PA demonstrated the highest SBS for bracket rebonding, and the lowest SBS was presented by CP actuated by PDT. Enamel reconditioned with RP and RBP corroborated the analogous SBS outcome to 37% PA. Likewise, enamel surface treatment with MBP revealed a statistically significant result to CP for metallic bracket rebonding. The most prevalent failure scores anticipated among groups were 0 and 1 indicating an adhesive failure with the exemption of group 5 (control) that encountered more score 2 cohesive failure on debonding metallic brackets from enamel exterior.

CONCLUSIONS

Rose bengal and riboflavin photosensitizers activated by photodynamic therapy with low ARI scores have the potential to be used as viable enamel reconditioning alternatives to 37% phosphoric acid for rebonding metallic brackets.

Awareness, knowledge, attitudes, and practices before the second wave of the COVID-19 pandemic in Saudi Arabia

OBJECTIVE

The COVID-19 outbreak was first reported in Wuhan City, China in early December 2019. It was declared a pandemic by WHO in March 2020. This study aimed at assessing the knowledge, awareness, and attitudes of the general population in Saudi Arabia towards COVID-19, as well as its adherence to preventive measures and its willingness to take the vaccine.

PATIENTS AND METHODS

This descriptive cross-sectional study involved an online sample of 7,188 participants (from five regions of Saudi Arabia) who completed a self-administered online-based questionnaire. They were recruited from 23 November 2020 to 29 November 2020 based on the nonprobability convenience sampling method. The self-administered questionnaire comprised four main sections: gathering information about participants' demographics, knowledge and awareness of COVID-19, participants' practices (hygiene and other) against infection, and vaccine acceptability.

RESULTS

More than half of the study participants were knowledgeable about COVID-19. The mean scores were 10.4 (SD=3.44, range: 0-18 - with high scores indicating better knowledge or awareness) for knowledge and 6.1 (SD=2.26, range: 0-11) for awareness, indicating a need for more educational campaigns to improve the level of knowledge and awareness among the Saudi Arabian population about COVID-19. The mean score for attitude was 5 (SD=1.67, range: 0-8 - from 0=very pessimistic to 8=very optimistic), indicating moderate optimism. As for practices, the mean score was 7.8 (SD=1.57, range: 0-10), indicating good practices to prevent or control infection. Concerning acceptability of the COVID-19 vaccine, 63.8% of the participants agreed to take the vaccine if it was proven to be 95% effective.

CONCLUSIONS

The findings of this study can help us designing effective measures against COVID-19 infections. Our results highlight the best practices adopted by the Saudi Arabian population, as well as those areas requiring improvement, including knowledge, attitudes, and practices against this disease.

WHO informal consultation on revision of guidelines on evaluation of similar biotherapeutic products, virtual meeting, 30 June – 2 July 2021

The WHO informal consultation was held to promote the revision of WHO guidelines on evaluation of similar biotherapeutic products (SBPs) adopted by the Expert Committee on Biological Standardization (ECBS) in 2009. It was agreed in the past consultations that the evaluation principles in the guidelines are still valid, but a review was recommended to provide more clarity and case-by-case flexibility. The opportunity was therefore taken to review the experience and identify areas where the current guidance could be more permissive without compromising its basic principles, and where additional explanation could be provided regarding the possibility of reducing the amount of data needed for regulatory approval. The meeting participants applauded the leading role taken by the WHO in providing a much-needed streamlined approach for development and evaluation of SBPs which will provide efficient and cost-effective product development and increase patient access to treatments. It was recognized that the principles as currently described in the draft WHO guidelines are based on sound science and experience gained over the last fifteen years of biosimilar approvals. However, since these guidelines when finalised will constitute the global standard for biosimilar evaluation and assist national regulatory authorities in establishing revised guidance and regulatory practice in this complex area, it was felt that further revision and clarity on certain perspectives in specific areas was necessary to dispel uncertainties arising in the current revised version. This report describes the principles in the draft guidelines, including topics discussed and consensus reached.

•

WHO guidelines serve as a basis for the development of national regulatory framework for biosimilars.

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Revision of guidelines is to provide more flexibility and clarification on data required for regulatory approval.

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Revised guidelines would contribute to improving consistency on regulatory decision and patient access to treatments.

Denial attitude towards COVID-19 among general population in Saudi Arabia

Introduction

During the current crisis of COVID 19, recent studies evident that it has a huge impact on public mental health and individuals’ behavior.

Objectives

Our study aimed to estimate the prevalence of high denial attitude towards the emerging pandemic of COVID 19 among the general population of Saudi Arabia.

Methods

A cross-sectional online survey was conducted from April 3, 2020 to May 5, 2020. All participants (N= 1817) were asked to complete an online questionnaire survey that included socio-demographic and other variables, and Denial Attitude Questionnaire towards COVID-19 pandemic (DAQ-COVID-19).

Results

High denial attitude was prevalent among 728 (40.1 %) of the participants. It was associated with old age, being married, having low educational level, working in a non-medical professions, do not have a past history of infectious diseases, spending less than one hour following COVID-19 news, satisfied with the government procedures for COVID-19, and highly depressed and anxious respondents, where p-values were 0.001, 0.019, <0.001, 0.027, <0.001, <0.001, 0.004, 0.008, and 0.026; respectively.

Conclusions

About two out of five participants had high denial attitude. To our knowledge, the current study is the first study that tries to evaluate a high denial attitude during the initial COVID 19 outbreaks, especially in Saudi Arabia. However, further exploration in this field is needed. We suggest conducting such a study at the end of the current pandemic or in the second wave of the outbreak

Effect of Post-Isometric Relaxation and Laser on Upper Trapezius Trigger Point Pain in Patients with Mechanical Neck Pain

Objective

The current study aimed to determine the effectiveness of post-isometric relaxation and LASER treatment in minimizing pain and increasing neck range of motion and function in people with upper Trapezius trigger point pain.

Methods

A total of 45 participants with upper Trapezius trigger point pain were studied. All the participants were randomly assigned into three equal groups (post-isometric relaxation, LASER, and Control) to receive the respective treatments for 1 week. The pressure threshold meter was used to assess the pain-pressure sensitivity of myofascial trigger point pain. Pain intensity and cervical range of motion were measured using the visual analogue scale and cervical goniometry, respectively. The neck disability index was used to assess neck function.

Results

The results of within group analysis indicate significant changes in all the outcomes in three groups (All groups, P = 0.001) except an insignificant improvement of pain pressure threshold in the control group (P = 0.069). Additionally, there were significant differences noted among three groups on pain-pressure threshold and visual analogue scale scores at posttest day 1, day 5, and day 12 (all P = 0.001). However, there was non-significant improvements of neck disability index and side flexion on both sides noted at all timelines except (all P > 0.05), a significant improvement at posttest day 5 (P = 0.015) among three groups.

Conclusions

Both PIR and LASER treatment have been effective in reducing pain-pressure threshold and pain intensity in the management of muscle trigger point pain. Long-term studies are warranted to further validate the effectiveness of these modalities in the management of upper Trapezius trigger point pain.

Insomnia among non-depressed multiple sclerosis patients: a cross-sectional study

Background

Insomnia is a common problem that affects approximately 50% of patients with multiple sclerosis (MS), who suffer from sleep disturbances. In general, persons with insomnia are at a higher risk of developing depression. This study was conducted to assess insomnia among non-depressed MS patients in Saudi Arabia.

Methods

Based on the Patient Health Questionnaire-9 (PHQ-9), those who scored 4 or less for depression out of 598 MS patients were selected (n = 112). A cross-sectional study was conducted to interview 112 non-depressed MS patients in order to assess insomnia among them. A data collection sheet has been designed by the researchers. It comprised socio-demographic variables (e.g., gender, age, area of residence, and marital status) and clinical variables (disease duration, age at disease onset, previous diagnosis of depression, and used antidepressant drugs). Insomnia was assessed by the Insomnia Severity Index (ISI), while severity of illness was assessed using the Patient Determined Disease Steps (PDDS).

Results

A total of 72 patients (64.3%) were females, and 62 (55.4%) were married. Their mean age was 32.6 years (SD = 8.9), ranging from 15 to 56 years. As for educational level, 64 (57.1%) had a Bachelor degree. The mean age at disease onset was 26 years (SD = 8.9). The mean duration of illness was 1.9 years. Symptoms of insomnia were present among 14 patients (12.5%). No statistical significance was found between the mean PDSS of insomnia and non-insomnia patients. Significant differences were present between insomnia and non-insomnia patients as regards their education level (P = 0.005) and use of antidepressant drugs (P = 0.008).

Conclusions

Prevalence of insomnia among non-depressed MS patients is low. Insomnia is associated with educational and use of antidepressants. Further research is needed to assess severity of different types of insomnia among depressed and non-depressed MS patients.

Prevalence of hyponatremia among patients who used indapamide and hydrochlorothiazide: a single center retrospective study

Hyponatremia is the most frequently encountered electrolyte abnormality among hospitalized patients and thiazide users. In this large single-center retrospective study, we aim to determine the prevalence and risk factors of hyponatremia among patients at the King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.To the best of our knowledge, this is the first such study in Saudi Arabia. A chart review was done for the years 2011-2012 of all admitted Saudi patients at KAMC who were treated with indapamide and hydrochlorothiazide. A total of 2000 patients were included [1237 females (629 indapamide and 608 hydrochlorothiazide) and 762 males (371 indapamide and 391 hydrochlorothiazide)]. Majority of the patients had type-2 diabetes mellitus (T2DM) with an overall prevalence of 72.2%. The overall prevalence of hyponatremia, regardless of severity, in the indapamide group was 37.3% versus 38.7% in the hydrochlorothiazide group. Stratification for age revealed that older patients had relatively higher levels of sodium (Na) as compared with younger patients, and this inverse association was significant (R = - 0.123; P <0.001). Increasing age, female gender and presence of T2DM were the significant risk factors for hyponatremia, explaining the 4.7% of the variance perceived (P <0.001). Our study suggests that the prevalence of hyponatremia among Saudi thiazide users is relatively high, and more so for the elderly and for those with T2DM. Early identification of this condition is important and caution should be exercised while prescribing thiazide drugs, particularly to those who are most at risk of developing hyponatremia to prevent related complications.