A Framework for Securing Saudi Arabian Hospital Industry: Vision-2030 Perspective

Recent transformation of Saudi Arabian healthcare sector into a reven-ue producing one has signaled several advancements in healthcare in the country.Transforming healthcare management into Smart hospital systems is one of them.Secure hospital management systems which are breach-proof only can be termed as effective smart hospital systems.Given the perspective of Saudi Vision-2030,many practitioners are trying to achieve a cost-effective hospital management sys-tem by using smart ideas.In this row,the proposed framework posits the main objectives for creating smart hospital management systems that can only be acknowledged by managing the security of healthcare data and medical practices.Further,the proposed framework will also be helpful in gaining satisfactory rev-enue from the healthcare sector by reducing the cost and time involved in mana-ging the smart hospital system.The framework is based on a hybrid approach of three key methods which include:employing the Internet of Medical Things(IoMT)and blockchain methodologies for maintaining the security and privacy of healthcare data and medical practices,and using big data analytics methodol-ogy for raising the funds and revenue by managing the bulk volume of healthcare data.Moreover,the framework will also be helpful for both the patients and the doctors,thus enabling the Kingdom of Saudi Arabia(KSA)to meet its goals of Vision-2030 by ensuring low cost,yet credible,healthcare services.

The Gut Brain Connection

The gut-brain connection is a bidirectional communication system that links the gut microbiome to the central nervous system (CNS). The gut-brain axis communicates through a variety of mechanisms, including the release of hormones, neurotransmitters, and cytokines. These signaling molecules can travel from the gut to the brain and vice versa, influencing various physiological and cognitive functions. Emerging therapeutic strategies targeting the gut-brain connection include probiotics, prebiotics, and faecal microbiota transplantation (FMT). Probiotics are live microorganisms that are similar to the beneficial bacteria that are naturally found in the gut. Prebiotics are non-digestible fibers that feed the beneficial bacteria in the gut. FMT is a procedure in which faecal matter from a healthy donor is transplanted into the gut of a person with a diseased microbiome. Probiotics, prebiotics, and FMT have been shown to be effective in treating a variety of gastrointestinal disorders, and there is growing evidence that they may also be effective in treating neurological and psychiatric disorders. This review explores the emerging field of the gut-brain connection, focusing on the communication pathways between the gut microbiome and the central nervous system. We summarize the potential roles of gut dysbiosis in various neurological and psychiatric disorders. Additionally, we discuss potential therapeutic strategies, research limitations, and future directions in this exciting area of research. More research is needed to fully understand the mechanisms underlying the gut-brain connection and to develop safe and effective therapies that target this pathway. However, the findings to date are promising, and there is the potential to revolutionize the way we diagnose and treat a variety of neurological and psychiatric disorders.

COVID-19 Related Multisystem Inflammatory Syndrome in Children: A Case Series from a Tertiary Hospital in Riyadh, Saudi Arabia

Introduction: We report an eight-case series of coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C). Methods: Children who tested positive for COVID-19, met the MIS-C criteria of the World Health Organization (WHO), and were <span style="font-family: ">hospitalized at a tertiary hospital in Riyadh from September to December 2021 were identified and their clinical data reviewed. Results: The age at diagnosis is <span style="font-family: ">between 4 to 13 years old. Fever, decreased oral intake, gastroenteritis, and abdominal pain were the most common symptoms. All cases showed hyperinflammation with high C-reactive protein, erythrocyte sedimentation rate, ferritin levels, and deranged coagulation profiles. Most of the cases had elevated B-type natriuretic peptide (75%) and troponin (100%) levels. However, two cases had cardiovascular involvement. Two patients presented with acute respiratory distress syndrome and required mechanical ventilation. The mean hospital stay was 13.1 days, with seven patients initially requiring intensive care management for ionotropic support. Most cases required broad-spectrum antibiotics, intravenous steroids, intravenous immunoglobulin, and aspirin. All patients recovered and were discharged from the hospital in good clinical condition. Conclusion: Children with COVID-19 are at risk of developing MIS-C. Practitioners must have a high index of suspicion for its diagnosis and should start treatment as soon as possible to prevent unfavorable outcomes.

A Survey of the Perception of Female Surgical Residents of Their Training in the Examination of Male Genitalia in Makkah Hospitals, KSA

The basic aims of medical schools are to graduate doctors to be competent in eliciting physical signs across all body systems. Deficiency in the clinical examination skills of female surgical residents of the male groin hernia and genitalia has not been explored and not enough investigated in the Arab and Muslim communities, despite obvious cultural restrictions and religious traditions. The cultural background of the students also has had an impact on their future training and skills. Certain systems’ examination for patients is considered very sensitive to perform by students and doctors of both sexes due to their sensitive nature. This might be due to cultural issues which affect the skills on these areas. Aim of this survey was to explore the different reasons and the influence of gender on clinical examination skills of female surgical trainees to male patient intimate. Methods: A cross-sectional design based on a self-administered questionnaire which was distributed to 80 female surgical resident trainees across five Hospitals in Makkah, Holy city, Saudi Arabia. The study was carried out between the period of September 2020 to July 2021 and involved all the female surgical residents from level 1 - 5 (R1 to R5). Result: Our study showed that overall perception of most of female residents on their performance on clinical examinations is less than expected. This study revealed that the main factor affecting the female resident’s clinical examination of the opposite sex intimate is the gender difference. 56 (81.2%) participants stated that their gender impacted their confidence and skills in examination of intimate of opposite sex, while 13 (18.8%) stated that gender has no effect. Conclusion: In conservative community, there are numerous areas where gender influences medical student clinical learning, including clinical exposure, supervisor support and patient willingness and consents, as well as some of the undergraduate methods of learning clinical skills not aligned with the post graduates needs.

Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension(PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy(EGD) for the presence of esophageal varices(EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder(GB) wall thickness(GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, Pub Med, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cutoffs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy.Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced(grade Ⅲ-Ⅳ) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

Schistosomal(bilharzial)polyps:Travel through the colon and beyond

Schistosomiasis(bilharziasis)is a major neglected tropical disease.It is endemic in many tropical and subtropical communities.Schistosomal polyps(S.polyps)are not uncommon presentation of this infection.Although the colon is the most commonly affected organ,many other organs are affected.S.polyps are associated with a variable range of morbidity independent of the Schistosomal infection.S.polyps are frequently described in endemic areas and increasingly reported in non-endemic areas mainly among immigrants and visitors to the endemic areas.This review aimed to increase awareness of practitioners,especially gastroenterologists,for this peculiar type of polyps caused by this neglected infection hence improving patient outcomes.Web-based search of different databases was conducted for the literature focusing the development of S.polyps in the colon and other organs with analysis of the clinical manifestations,diagnosis and treatment.The following key words were used in the search,“Schistosomiasis”OR“Bilharziasis”AND“Polyps”OR“Polyp”AND“Colon”OR“Small intestine”OR“Duodenum”OR“Stomach”OR“Esophagus”OR”Gallbladder”OR”Pharynx”OR“Larynx”OR“Trachea”OR”Urinary bladder”OR“Ureter”OR“Renal Pelvis”OR“Urethra”.All publication types including case reports,case series,original research,and review articles were retrieved and analyzed.S.polyps are not infrequent presentation of acute or chronic Schistosomal infection.S.polyps are described in many organs including the bowel,genitourinary tract,skin,gallbladder and the larynx.Presentation of S.polyps is variable and depends on the site,number as well as the polyp size.The relationship of S.polyps to malignant transformation is a matter of discussion.Presence of S.polyps is sometimes the only manifestation of Schistosomiasis.Small polyps can be treated medically with praziquantel,while large accessible polyps are amendable for endoscopic excision through different polyp resection techniques.However,huge,complicated,non-accessible and suspicious polyps are indicated for surgical management or advanced endoscopic resection when appropriate.Clinicians and endoscopists should be aware about these facts when treating patients living in,immigrated from or visiting endemic areas.

Concept Analysis: Emergency Department Crowding and Length of Stay before and after an Increase in Catchment Area

Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.

Theory Critique of Kristen Swanson’s Theory of Caring

Theory is considered essential for integral assessment, adopting its foundations and concepts is of great utility. The theory provides different templates to help nurses provide care that respects patients and improves outcomes. Through understanding the intersection of nursing, patients, health, and the environment, theories aim to simplify the complicated, ever-evolving relationship that nurses have with their profession. Nursing theory helps distinguish nursing as a separate discipline from medicine and related sciences, and assists nurses in understanding their patients and their needs. The behaviors of healthcare providers affect how patients participate in and experience care situations. In the nursing discipline, the theoretical structures of caring have been established as the core concept of guidance in all nurses’ work. The aim of this paper is to develop a critique of Kristen Swanson’s theory of caring—a theory structured around five caring principles (maintaining belief, knowing, being with, doing for, and enabling) by applying it to nursing practice. When applied to nursing practice, each of these five stages stimulates the caregiver’s attitude, which in turn improves the overall patient’s well-being. Implications to nursing practice are mentioned [1] [2].

Misdiagnosis of Facial Nerve Palsy: A Case Report of Sporadic Vestibular Schwannomas (Non-NFM2) Causing Facial Nerve Palsy Be Misled by Bell’s Palsy in a Child

We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.

Case Report: Four Siblings with Osteopetrosis and Pyloric Stenosis and Three Cousins with Osteopetrosis

Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis is 1 in 300 - 900 newborns. Hypertrophic pyloric stenosis is due to hypertrophy of the smooth muscle of the pyloric sphincter. The classic age of occurrence is the first few months of life, and the classic presentation is non-bilious projectile vomiting after feeding. We report a rare association of osteopetrosis and pyloric stenosis in four siblings and osteopetrosis in three cousins. All four patients were operated on and followed by nephrology and metabolic departments for osteopetrosis and metabolic acidosis.

Magnusiomyces capitatus in Immune-Competent Patients with Pulmonary Haemorrhage and Systemic Lupus Erythematosus

Invasive fungal infections have grown significantly over the last two decades, owing to an increase in immunocompromised hosts and geriatric patients. When the host’s defenses are compromised, such infections are associated with severe morbidity and mortality. Here, a rare case of fungal infection in a 61-year-old immunocompetent male patient from Saudi Arabia was reported, who suffered from pulmonary hemorrhage and Systemic Lupus Erythematous. Bronchoalveolar Lavage was used as a diagnostic tool to identify the fungus reported in the case. The pathogenic fungal specie identified as Magnusiomyces capitatus, in macroscopic and microscopic morphological characteristics of the colonies. Based on clinical evidence, liposomal amphotericin formulation was recommended for initial therapy against fungal infection. Also, liposomal amphotericin B induced mycological eradication up to 70 percent in patients with proven Magnusiomyces capitatus infection. In addition to addressing suspected Systemic lupus erythematosus, the patient’s health has improved with no evidence of pulmonary bleeding and hemoptysis.

Knowledge and awareness of infection control practices among nursing professionals:A cross-sectional survey from South Asia and the Middle East

BACKGROUND The proficiency of nursing professionals in the infection prevention and control(IPC)practices is a core component of the strategy to mitigate the challenge of healthcare associated infections.AIM To test knowledge of nurses working in intensive care units(ICU)in South Asia and Middle East countries on IPC practices.METHODS An online self-assessment questionnaire based on various aspects of IPC practices was conducted among nurses over three weeks.RESULTS A total of 1333 nurses from 13 countries completed the survey.The average score was 72.8%and 36%of nurses were proficient(mean score>80%).43%and 68.3%of respondents were from government and teaching hospitals,respectively.79.2%of respondents worked in<25 bedded ICUs and 46.5%in closed ICUs.Statistically,a significant association was found between the knowledge and expertise of nurses,the country’s per-capita income,type of hospitals,accreditation and teaching status of hospitals and type of ICUs.Working in high-and upper-middleincome countries(β=4.89,95%CI:3.55 to 6.22)was positively associated,and the teaching status of the hospital(β=-4.58,95%CI:-6.81 to-2.36)was negatively associated with the knowledge score among respondents.CONCLUSION There is considerable variation in knowledge among nurses working in ICU.Factors like income status of countries,public vs private and teaching status of hospitals and experience are independently associated with nurses’knowledge of IPC practices.

Cardiac involvement in disseminated diffuse large B-cell lymphoma,successful management with chemotherapy dose reduction guided by cardiac imaging: A case report and review of literature

BACKGROUND Secondary cardiac involvement by lymphoma has received limited attention in the medical literature, despite its grave prognosis. Although chemotherapy improves patients' survival, a subgroup of treated patients dies suddenly due to myocardial rupture following chemotherapy initiation. Reducing the initial chemotherapy dose with dose escalation to standard doses may be effective in minimizing this risk but the data are limited. We report on the successful management of a patient with disseminated diffuse large B-cell lymphoma(DLBCL) involving the heart using such approach.CASE SUMMARY An 18-year-old male presented to our hospital with six months history of progressive dyspnea, orthopnea and cough. On physical examination, the patient was found to have a plethoric and mildly edematous face, fixed elevation of the right internal jugular vein, suggestive of superior vena cava obstruction, and a pelvic mass. Investigations during admission including a thoracoabdominal computed tomography(CT) scan with CT guided biopsy of the pelvic mass,echocardiography and cardiac magnetic resonance imaging led to the diagnosis of disseminated DLBCL with cardiac involvement. The patients were successfully treated with chemotherapy dose reduction followed by dose escalation to standard doses, under the guidance of cardiac imaging. The patient completed chemotherapy and underwent a successful bone marrow transplant. He is currently in remission and has a normal left ventricular function.CONCLUSION Imaging-guided chemotherapy dosing may minimize the risk of myocardial rupture in cardiac lymphoma. Data are limited. Management should be individualized.

The Use of Standardized Reporting and Time-in-Range in the Management of Diabetes: A Consensus Report

Introduction: The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. Methods: The gathered task force gath-ered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommenda-tions of this expert panel. Results: HbA1c and self-monitoring blood glu-cose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Ara-bia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients’ barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs. Conclusion: The expert panel recom-mended using CGMs technology in people with type 1 diabetes (T1DM) children and adults, type 2 diabetes (T2DM) on multiple insulin injections, gestational diabetes (GDM) who need further glycemic control, and those at high risk for hypoglycemia. In addition, we recommend using them for a short period for those who require intensive BG control or during acute illness or stress. In addition, Ambulatory Glucose Profile (AGP) could be used as an educational tool for any individuals with DM to study the im-pact of certain elements of lifestyle modifications on their immediate BG level.

Effect of 2% fluorescein on Scheimpflug central corneal thickness measurements

AIM： To assess central corneal thickness （CCT） changes measured with Scheimpflug device following instillation of 2% fluorescein in normal subjects. ~ METHODS： This was a prospective randomized study of 60 hospital volunteers. After baseline CCT measurements of both eyes of 40 subjects were obtained using Scheimpflug system, a drop of preservative-free 2% fluorescein, was instilled in one eye and in other eye, one drop of normal saline （control）. Measurements were repeated after 1, 2, 5, 10, 20, 30, 40, 50 and 60min （continuous assessment group）. Twenty subjects had baseline CCT taken, then fluorescein was instilled in one eye and measurements were taken at lmin. Ten eyes had saline rinse after lmin and 10 other eyes did not, measurements were repeated at 2min （eye rinse group）. RESULTS： The mean baseline CCT for continuous assessment group was 546.2±32.1um （range, 489.0-606.0）, control eyes was 546.6~±30.7 um （range, 489.0-602.0）. At lmin after fluorescein instillation, CCT significantly increased by 37.0±34.0um （P〈0.001）, then decreased gradually, reaching baseline at 60min. CCT variations were not significant in control group （P〉0.05）. For eye rinse group, CCT mean differences between baseline and 2min were 18.2um （95 % Ch -54.7 to 18.3） with rinse and 26.5um （95% CI： -62.9 to 9.9） without rinse; paired sample tests were not significant （P〉0.05）. CONCLUSION： The presence of fluorescein increased CCT value to a clinically relevant level of 6.8%. Eye rinse did not significantly reduce the effect at 2min post fluorescein timepoint.

Furuncular myiasis by Wohlfahrtia magnifica(Diptera:Sarcophagidae)in a healthy child

Rationale:Human myiasis is the invasion of tissue or organs by fly larvae.This could be obligatory,facultative,or accidental.Patient concerns:A 4-year-old Saudi boy complained of fever over the past three days with multiple inflamed painful dermal furuncles and worms-like discharge.Diagnosis:Furuncular obligatory myiasis caused by Wohlfahrtia magnifica.Interventions:Maggots were removed for identification.The wounds were cleaned with antiseptic dressings.Topical and oral antibiotics were applied.Outcomes:Seven days later,the wounds completely healed.Lessons:Although several reports correlated human myiasis with old age,low health status,mental retardation,and low socioeconomic status,but the patient in our case was a healthy child from a family with good socioeconomic status,good hygiene,no history of diseases or mental disability,but traveled to a village where the climate is suitable for fly breeding.

Bone Mineral Density in Patients with Newly Diagnosed Inflammatory Bowel Disease: Frequency and Risk Factors in Tunisian Population. Results of a Prospective Study

Background and Aims: Osteopenia and osteoporosis are frequently encountered with Inflammatory Bowel Disease (IBD). Our aims were to determine the prevalence of low bone mineral density (BMD) in patients with recently diagnosed IBD, and to assess predictive factors of reduced BMD. Patients and Methods: Prospective study conducted from January 2008 to December 2012 and involved patients with IBD treated in the Department of Gastroenterology of the Internal Security Forces Hospital. The data collected included: age, gender, body mass index (BMI), diagnostic delay, disease activity, and disease localization. Laboratory findings included serum calcium, phosphate, albumin, hemoglobin, and C-reactive protein. BMD was assessed by dual energy X-ray absorptiometry (DEXA) of the lumber spine and femoral neck. According to WHO criteria, osteopenia was defined as a T-score between -1 and -2 SD, and osteoporosis as a T-score less than -2 SD. Results: A total of 34 patients (17 men, 17 women) were enrolled. Mean age was 37.1 ± 13.8 years (range 16 - 62). Twenty-two patients (65%) had Crohn’s disease (CD) and 12 patients (35%) had ulcerative colitis (UC). Mean BMI was 20.5 ± 4 kg/m2. Low BMD occurred in 50% of patients (12 CD, 5 UC). Thirteen patients (38.2%) exhibited osteopenia and 4 patients (10.8%) showed osteoporosis. Mean vertebral T-score was -0.933 ± 1.41 (range -4.1 to 1.7) and BMD in this site was 1.079 ± 0.17 g/cm2 (range 0.674 to 1.380). Mean femoral T-score was -0.398 ± 1.2 (range -3.1 to 2.4) and BMD in this site was 0.990 ± 0.173 g/cm2 (range 0.633 to 1.600). There was a positive correlation between T-score and albuminemia. Low BMI was found to be predictive factor of reduced BMD at the moment of IBD diagnosis. However, no correlation was found between BMD and the other studied variables (age, gender, smoking, history of fracture, disease location, duration of disease, activity, small bowel resection, serum calcium level, phosphate, C-reactive protein and hemoglobin). Conclusion: Our study showed that the half of patients with IBD had a low BMD in newly diagnosed IBD patients. Low BMI and hypoalbuminemia were the major factors affecting BMD in these patients. Bone density measurement should be performed in all patients with IBD in an early stage of the disease.

Satisfaction of Adult Patients about Their Smile Aesthetics Compared to Dental Professionals Observation

Objective: The aim of the present study was to evaluate personal satisfaction of adult dental patients about their smiles aesthetics in comparison to dental professionals view. Method: One hundred twenty adult patients (76 male and 44 female) visiting the screening clinics of Riyadh colleges of dentistry and Pharmacy were asked to evaluate their smiles by completing a questionnaire containing five questions concerning five aesthetic elements which are: Overall smile;color;shape;alignment of their teeth;and appearance of their gum during smiling. They were asked to rate each of the five categories in Visual Analog Scale (VAS) graded from 0 to 10. A smiling photograph was taken for each patient to be evaluated by two restorative specialists using the same scale. Patients and dental professional mean evaluation scores were statistically analyzed for any significant differences. Result: The average age of the patients was 39.1 years. The mean patients’ satisfaction with their own smiles was [6.47] on the VAS which was statistically higher than the average of dentists’ evaluation scores [4.95] (p Conclusion: Patients’ satisfaction about their dental aesthetics was statistically higher than the dental professional assessments. Dental professionals appear to be more critical in their evaluation of patients smile aesthetics. Age showed no significant relation with the level of satisfaction while gender and reason of dental visit showed a significant relation with patients smile satisfaction.

Clinical Practice Recommendations for Assessment and Management of Hypothyroidism

Hypothyroidism is a common disorder, potentially severe, often clinically ignored, easily diagnosed by laboratory tests, and highly treatable. It may cause chronic illnesses if left untreated. Saudi Society of Endocrinology and Metabolism (SSEM) assembled a panel of twelve endocrinologists with experience in thyroid diseases in adults and children and made up a task force. An initial concept proposal that included types of hypothyroidism, population, scope, and prevalence in Saudi Arabia was obtained. The proposal was divided into several topics discussed in February 2022. The panel approved that the consensus will include all types of hypothyroidism in Saudi Arabia, screening, diagnosis, management, and special population. A literature review was carried out. Most of the latest international guidelines were screened in Europe and USA. The literature search was completed in March 2022. They drafted a report that was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval. The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on April 2022. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

Upper Extremities Injuries in Children Attending Pediatric Emergency Department-SFH, Riyadh-Saudi

Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572);also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.