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Vol. 1, Issue. 1, 27th of March 2024

Central nervous system (CNS) malformations, especially when concurrent with congenital heart disease, pose challenges for accurate prenatal characterization. Two-dimensional ultrasound has limitations in capturing the complexity of fetal anatomy. Three-dimensional ultrasound (3D US) and magnetic resonance imaging (MRI) offer enhanced visualization. Objectives: The study aims to assess expert 2D and 3D US accuracy in diagnosing fetal CNS anomalies and evaluate the clinical utility of MRI as a second-line procedure, contributing to the ongoing debate on optimal fetal brain imaging approaches. The 8-year analysis of 773 cases provides real-world insights and trends in clinical practice. Methods: A retrospective comparative analysis over 8 years (2015-2023) assessed 2D and 3D neuro-sonography (NSG) and magnetic resonance imaging (MRI) in diagnosing fetal CNS anomalies. Data from 773 cases were analyzed for diagnostic accuracy and clinical impact. Ethical considerations were prioritized, and statistical analyses, including ROC curve and multivariate analysis, were conducted using SPSS 24.0. Validation checks ensured data integrity.

This prospective study aimed to assess the utility of three-dimensional (3D) ultrasound (US) as an adjunct to two-dimensional (2D) US in evaluating fetal abnormalities. Conducted from March 2022 to January 2023, the research compared the diagnostic efficacy of 2D and 3D imaging modalities using consistent scanning methods. Objectives: The primary objectives were to investigate the additional information provided by 3D US in fetal anomaly cases, analyze the impact on patient management, and determine the diagnostic confidence levels achieved with 3D imaging. Methods: Sixty-three participants with 103 abnormalities underwent both 2D and 3D US scans. Ethical approval was obtained, and patients meeting inclusion criteria, including prior abnormal 2D US or relevant medical history, were selected. Experienced physicians performed the scans, ensuring consistent expertise levels for 2D and 3D evaluations.

Vaccination against Hepatitis B (HBV) has significantly reduced global infections, yet the prevalence persists worldwide, posing a substantial health threat. Saudi Arabia continues to grapple with the morbidity and mortality associated with HBV, underscoring its status as a significant public health concern. Despite the global success of HBV vaccination, Saudi Arabia still harbors a sizable cohort, necessitating a comprehensive understanding of the natural course of chronic hepatitis B (CHB) and the impact of follow-up on disease progression. Objectives: To analyze all the CHB data from 2008 to 2019 in the SOLID registry and then analyze the effects of follow-up in both treated and untreated subjects with 12 months. SOLID is a multi-centered official registry of CHB in Saudi Arabia. Methods: In a retrospective study using the SOLID registry (Saudi observatory liver disease) data from 2008 to 2019, we analyzed 1564 chronic hepatitis B (CHB) patients. Part 1 focused on baseline characteristics, categorizing patients into active or inactive disease based on international guidelines. Exclusion criteria included co-infections and significant deficiencies in baseline parameters. Part 2 included 699 subjects with follow-up >12 months, comparing untreated and treated groups.

Antenatal musculoskeletal anomalies pose complex challenges for expectant mothers and healthcare providers. Fetal defects vary widely, necessitating a sophisticated diagnostic approach. Objectives: Our study aims to determine whether fetal MRI provides superior diagnostic information for suspected musculoskeletal anomalies compared to US, with secondary objectives exploring non-musculoskeletal anomalies and the role of low-dose CT. By advancing diagnostic accuracy and clinical practices, our research contributes to the understanding of antenatal musculoskeletal anomalies. Methodology: This prospective cohort study focused on pregnant females aged above 45 with a history of babies with musculoskeletal anomalies. Out of 1070 initially enrolled, 930 participants met inclusion criteria. The study, conducted between May 2022 and October 2023 in Riyadh, KSA, utilized Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Ultrasonography (US). Ethical guidelines were strictly followed, and comprehensive data collection, analysis, and statistical evaluations were performed to compare diagnostic performances and assess maternal risk factors associated with congenital musculoskeletal anomalies.

The study aimed to provide valuable insights into the best approach for managing pregnancies within cesarean scars, helping healthcare providers make informed decisions about the most appropriate treatment option for their patients in such cases. Methods: A total of 82 women who were diagnosed with pregnancies within cesarean scars were enrolled. These women were randomly assigned to one of two treatment groups: Uterine Artery Embolization Group 42 cases. Systemic Methotrexate Group 40 cases. The primary focus was on measuring bleeding loss, monitoring serum HCG levels, and evaluating any side effects that occurred during or after treatment. Results: No severe side effects observed in either group. Patients in the UAE group had a significantly shorter hospitalization time, with an average of 11.73 ± 0.80 days. In contrast, patients in the MTX group had a significantly longer hospitalization time, averaging 39.63 ± 4.57 days. In the UAE group, the average bleeding volume was 36.93 ± 6.01 mL. In contrast, in the MTX group, the average bleeding volume was significantly higher at 415.63 ± 68.37 mL. All findings were statistically significant.

"Cesarean scar pregnancy" (CSP) is characterized by the attachment of a blastocyst to the site of a previous cesarean delivery scar, typically occurring around seven days after fertilization. The increasing prevalence of cesarean deliveries in recent decades has resulted in a higher frequency of CSP cases. Potential complications associated with Cesarean scar pregnancy encompass morbidly adherent placental conditions (accreta and percreta), uterine rupture, significant hemorrhaging, and premature labor. There is a suspicion that Cesarean scar pregnancies embedded within a dehiscent scar may exhibit distinct behaviors when contrasted with those implanted over a fully healed scar. Nevertheless, there are currently no existing studies that have compared the pregnancy outcomes of Cesarean scar pregnancies situated on a well-healed scar versus those within a dehiscent scar. Objective: Comparison of the outcomes of implanted blastocyst in a well healed cs scar and in to a dehiscent scar. Methods: This study retrospectively examined 20 patients diagnosed with Cesarean scar pregnancy during weeks 5 to 9 of gestation (with a median of 8 weeks) across two medical centers. All Cesarean scar pregnancies were classified into two groups: those situated "atop the well-healed scar" (Group A) and those located "within a dehiscent scar" (Group B), determined based on their initial trimester transvaginal ultrasound assessments. Clinical outcomes, including gestational age at delivery, delivery method, delivery-related blood loss, neonatal weight, and placental histopathology, were compared between these groups using the Mann-Whitney U-test. For patients necessitating hysterectomy and those who did not, myometrial thickness above the placenta was assessed using the Mann-Whitney U-test. Additionally, a correlation analysis using Spearman's correlation examined the relationship between myometrial thickness and gestational age at delivery.

Image by João Paulo de Souza Oliveira

Understanding organizational culture and malpractice risk perceptions in NICU settings is crucial for enhancing patient care, promoting a positive work environment, and informing targeted interventions to improve healthcare delivery. Objectives: Explore themes of organizational culture in NICU settings. Investigate healthcare provider perceptions of malpractice risk. Examine interrelationships between organizational culture dimensions and malpractice risk perceptions. Methods: This qualitative study investigates the impact of organizational culture on malpractice risk perceptions among Neonatal Intensive Care Unit (NICU) healthcare providers. Utilizing purposive sampling, 750 participants from four tertiary university hospitals were interviewed. Thematic analysis revealed nuanced insights into organizational culture's influence on malpractice risk perceptions. Trustworthiness was ensured through prolonged engagement, member checking, peer debriefing, and adherence to ethical guidelines, enhancing the study's credibility. Results: The thematic analysis of organizational culture within Neonatal Intensive Care Unit (NICU) settings uncovered several key themes. Participants highlighted teamwork, collaboration, and commitment to patient care. Notably, mutual respect, interdisciplinary communication, and a supportive work environment emerged prominently.

We present the case of a 63-year-old male with a history of multiple comorbidities, including lung adenocarcinoma, who experienced fatal anaphylactic shock following Tazocin administration. Case Presentation: On March 15, 2024, the patient presented with respiratory distress and was transferred to the medical intensive care unit (MICU) for further management. Despite initial stabilization efforts, the patient's condition deteriorated rapidly, leading to anaphylactic shock attributed to Tazocin administration. Despite intensive care interventions, the patient ultimately succumbed to respiratory arrest on March 17, 2024. Discussion: This case underscores the importance of vigilant medication administration practices, particularly in patients with known allergies. It highlights the potential life-threatening consequences of medication errors and the need for prompt recognition and management of anaphylactic reactions in clinical settings. Conclusion: The tragic outcome of this case emphasizes the critical importance of medication safety protocols and the need for enhanced awareness among healthcare providers regarding the management of allergic reactions. Further research is warranted to explore strategies for preventing medication errors and optimizing patient safety in clinical practice.

The safety and efficacy of bone marrow-derived mesenchymal stem cell (BMSC) transplantation in maxillary sinus and alveolar ridge augmentation represent a cutting-edge approach in regenerative dentistry. The findings hold significance for advancing regenerative therapies and enhancing long-term outcomes in patients requiring extensive dental interventions. Objectives: The study aimed to assess the safety, feasibility, and long-term outcomes of bone marrow-derived mesenchymal stem cell (BMSC) transplantation in maxillary sinus floor and alveolar ridge augmentation. Objectives included evaluating BMSC-induced bone regeneration, conducting safety assessments, and ensuring ethical compliance, with a 7-year follow-up to assess dental implant survival and stability. Methodology: This study outlines a meticulous methodology for bone marrow-derived mesenchymal stem cell (BMSC) transplantation in maxillary sinus floor and alveolar ridge augmentation. Incorporating safety checks, donor screening, autologous serum preparation, and a detailed surgical procedure, the study evaluated feasibility and long-term outcomes. Ethical considerations were paramount, with adherence to the Declaration of Helsinki and explicit participant consent. The comprehensive evaluation included radiographic assessments, CT scans, histomorphometric analysis, and a 7-year follow-up, emphasizing sustained success and ethical integrity.

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Comprehensive rehabilitation is frequently necessary for whiplash-associated disorders (WAD) stemming from non-fatal motor vehicle accidents. This study concentrated on participants in a specialized residential WAD rehabilitation program, with the main goal being to offer patients referred by county councils and regional social insurance offices therapy and functional evaluation. Objectives: The study's objectives were to evaluate the effects of a therapeutic jaw exercise (TJE) program combined with general rehabilitation on the symptoms, clinical markers, and general well-being of individuals with temporomandibular disorders (TMD) and (WAD). Methods: The program enrolled ninety-four individuals with TMD and persistent WAD. They were randomly assigned to a control group (CG) and a jaw exercise group (JEG). While the CG just got general rehabilitation, the JEG participated in a TJE program in addition to it. The participants' symptoms and clinical indicators were assessed using clinical and anamnestic methods at baseline, three weeks later, and six months later. To evaluate patients' capacity to manage everyday duties and their compliance with exercises, a questionnaire was given out. To ascertain the degree and kind of pain endured, body sketches were studied.

X-rays
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Electro-myo-graph (EMG) is a valuable diagnostic and monitoring tool for both Temporomandibular Joint Disorders (TMD) and Myo-fascial pain syndrome (MPS) patients. It helps identify abnormal muscle activity and provides insights into the muscle imbalances and tension associated with these conditions. Objectives: We conducted RCT to provide valuable insights into the efficacy of occlusal splints for TMD patients and their impact on EMG amplitude records. Methods: 40 participants (23 females, 17 males) with myofascial pain, a complication of Temporomandibular Disorder (TMD), were examined. Patients of various genders and ages (22-46 years) were included. Diagnostic criteria based on clinical standards and Helkimo's Dysfunction Index were applied. Panoramic radiographs assessed the TMJ, with exclusion criteria for systemic conditions and TMJ pathologies. Patients were randomly divided into two groups: Group A received occlusal splint therapy, while Group B served as a control. Patients were informed about the study, provided informed consent.

Dental Surgery

The purpose of this research was to assess the impact of several distinct levels of mandibular protrusion, 50% versus 75% of maximum protrusive capacity, on somnographic factors following one year of dental appliance therapy in individuals with mild to moderate obstructive sleep apnea syndrome (OSAS). Another aim was to compare the quantity of unfavorable occurrences on the stomatognathic system. In a prospective study, 74 male patients were randomly assigned to receive a dental appliance with either 50% (38 patients) or 75% mandibular advancement (36 patients). After one year of therapy, 55 patients completed the follow-up. Somnography was conducted to measure treatment effects before and approximately 11 months post-treatment. The apnea, apnea/hypopnea, and oxygen desaturation indices decreased significantly in both groups after one year (P < 0.001); however, there were no distinctions between the groups. Normalization (apnea index <5 and apnea/hypopnea index <10) was observed in 79% in group 50 and in 73% in group 75. Few patients (<5%) reported symptoms from the stomatognathic system except for headache (> once a week), which was reported in one-third of the patients. Headache was significantly less frequent after one year of therapy in both groups (P < 0.001). No severe complications were observed except for several patients who reported a painful condition from the temporomandibular joint in either group.

At the Dentist

Collaboration across different disciplines in healthcare settings is a crucial element that impacts patient outcomes and the occurrence of adverse events. This systematic review and meta-analysis seek to consolidate evidence from multiple studies to assess the influence of efficient interdisciplinary communication and team ownership on patient outcomes and the occurrence of adverse events in healthcare. Method: The study approach for this systematic review and meta-analysis entails doing an extensive search across many electronic databases, such as PubMed/MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL. The search technique will utilize a blend of keywords and Medical Subject Headings (MeSH) concepts like "multidisciplinary communication," "ownership in healthcare," "patient outcomes," "adverse events," "systematic review," and "meta-analysis." The utilization of Boolean operators (AND, OR) and truncation will be employed to optimize search sensitivity. Results: Out of the total of 1063 articles initially considered, only 15 articles were found to match the specified criteria for inclusion. A PRISMA chart visually represents the quantity of articles that were identified, screened, and ultimately included in the final review. The articles underwent a final evaluation and were categorized accordingly.

Doctors

Letter to editor

Staffing Shortage of Healthcare Workers after the Pandemic: A New Hidden Challenge

Doctor Operating CT Scanner

We write to underscore a critical issue that has emerged in the aftermath of the COVID-19 pandemic - the alarming shortage of healthcare workers and its profound repercussions on patient care quality. As the healthcare landscape continues to grapple with the aftermath of the pandemic, addressing this issue becomes increasingly imperative to safeguard the well-being of patients and ensure the resilience of healthcare systems.

The staffing shortage crisis poses a direct threat to patient care quality across healthcare settings. With fewer healthcare workers available to meet the escalating demand for medical services, patients are confronted with prolonged wait times for consultations, delayed diagnoses, and compromised access to essential healthcare interventions. The repercussions of understaffing extend beyond mere inconveniences; they manifest as tangible risks to patient safety and well-being.

In the post-pandemic healthcare landscape, where healthcare facilities are already strained by the ongoing repercussions of the global health crisis, the impact of staffing shortages is particularly acute. The surge in patient volumes, coupled with the lingering effects of the pandemic on healthcare personnel, exacerbates the strain on healthcare systems and heightens the vulnerability of patients to lapses in care quality.

Moreover, the post-pandemic era heralds a paradigm shift in healthcare delivery, with evolving patient needs and expectations necessitating a more resilient and responsive healthcare workforce. The shortage of healthcare workers threatens to impede efforts to adapt to these changing dynamics and undermines the ability of healthcare systems to deliver patient-centered care that meets the evolving needs of diverse patient populations.

Doctor and Patient
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