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RATIONAL: Pleomorphic adenoma (PA) is a rare benign tumor mainly affecting the major salivary glands, known for its diverse histological appearances that can mimic malignancies. When it occurs in the hard palate it present diagnostic and management challenges compared to other sites due to the anatomical location and potential proximity to critical structures. This case reports a rare presentation PA starting as an ulcer, alongside a review of rare cases of PA reported in last 5 years. We aim to highlight clinical challenges and emphasize the need for awareness in diagnosis of this diverse entity amongst the clinicians before reaching a definitive conclusion. PATIENT CONCERNS: A 41-year-old female reported an asymptomatic large swelling on the right side of the posterior palatal region. Clinical diagnosis revealed a firm, rubbery, and non-tender swelling of approximately 4 cm × 4 cm diameter. A triangular incisional biopsy was performed to confirm the diagnosis. DIAGNOSIS: The histopathological evaluation confirmed the presence of a PA with a well-encapsulated and compressed salivary gland. A wide surgical dissection was made to remove the entire encapsulated tumor mass, including the mucoperiosteum and eroded bone of the palate. The borderline of the tumor was carefully identified in the surrounding healthy tissue. The hemostasis was obtained using a simple interrupted suture. LESSON: The diagnosis of PA is difficult as it usually involves extensive squamous and mucous metaplasia, confusing it with malignant disorders. Histopathological and clinical examinations are important for differentiating this lesion from other tumors. Complete surgical excision is reported as the first line of treatment.

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Introduction Gout, a chronic inflammatory joint disease, is increasingly prevalent worldwide, mainly affecting men, young females, and post-menopausal women. This study aims to investigate gout epidemiology in Al-Baha, Saudi Arabia, addressing the dearth of localized data on prevalence, risk factors, and management practices. Methods A cross-sectional analysis was conducted at King Fahad Hospital, Al-Baha, Saudi Arabia, covering 116 patients from March 2016 to November 2017. Data encompassed demographics, clinical presentations, and biochemical markers relevant to gout. Results Among 116 patients, 41 (35.3%) were diagnosed with gout, with males exhibiting a significantly higher prevalence than females (43.9% vs. 24%). Significant associations were found between gout prevalence and residency, occupational status, education level, clinical presentations (podagra, arthralgia/arthritis), and biochemical markers. Conclusion This study enriches global knowledge by providing localized insights into gout's epidemiology and highlighting demographic influences and clinical presentations specific to the Saudi context. The findings underscore the importance of tailored approaches in gout management, considering regional variations in prevalence, risk factors, and clinical manifestations.

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[This retracts the article DOI: 10.7759/cureus.18956.].

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Introduction: About 2-3 million pilgrims come to Makkah, Saudi Arabia from all countries to perform Hajj. During the Hajj season of 2019 (1440 H), the total number of pilgrims was 2,489,406, of whom 1,855,027 came from foreign countries. This study aims to investigate the prevalence, pattern, and findings of emergency health problems among pilgrims travelling through King Abdul Aziz International Airport Health Care Center (KAIA-HC) at Hajj Terminal in Jeddah during hajj season of 1440-H. Methodology: A cross-sectional study was conducted by reviewing the medical records of pilgrims coming for treatment at KAIA-HC, before and after Hajj between 1 Dhul Qi'dah to 29 Dhul Hijjah 1440 AH (Corresponding to 4 July to 31 August 2019 AD). The collected data included demographics, medical history, diagnoses of the emergency health problems, infections, and their findings. Data were analyzed using Epi Info 7 and SPSS 25. Results: About 296 (3.87%) of 7,643 pilgrims treated at KAIA-HC were emergency cases. Their average age was 43 years (Standard Deviation (SD) ±7.5); 51.3% were females; the highest (45.3%) was between 30 - 59 years age group, both males and females; the highest two nationalities were Indonesian (14.2%) and Egyptian (12.5%). Diagnoses included hypertension 59(19.9%), bronchial asthma 53 (17.9%), and 23 cases (10.5%) were suffering from hypotension. 16 (5.4%) of patients had a myocardial infarction and 10 (3.4%) had cerebrovascular accidents. In 13 cases (4.4%), a chest infection was reported. Diabetes complications (hyperglycemia, hypoglycemia, and diabetic ketoacidosis) were reported in 28 (9.4%) of the cases. There were 28 (9.5%) surgical diagnoses, 13 (4.4%) were cut wounds, 11 (3.7%) were bone fracture and dislocation, and 4 (1.4%) were head trauma. With regard to the findings, 82 (27.7%) were referred to hospitals; 10 (3.3%) cases required Cardio-Pulmonary Resuscitation, seven of whom survived. The most common referral causes were myocardial Infarction amounting 12(4.05%), followed by cerebrovascular accident 10(3.3%) and chest infection in 8 (2.7%). 13 (4.4%) of the total cases died. The most common causes of death were myocardial infarction, asthma, hypertension and hyperglycemia. Conclusion: Our study emphasizes that emergency cases presented at KAIA-HC were few. Cardiovascular diseases represented the main reason for emergency cases, followed by respiratory diseases. 51% of patients were discharged without the need for a higher level of medical care.

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Postoperative myoclonic movement (PMM) is an uncommon side effect after general anesthesia (GA), and the exact cause of this neurologic complication is still unknown. Many factors such as anesthesia, psychological stresses, and surgical stress could trigger PMM. We are here reporting a case of PMM in the post-anesthetic care unit (PACU) following general anesthesia in an apparently healthy patient.

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Glucometers are commonly used in a variety of healthcare settings and use in critically ill patients should not be assumed without appropriate tool validation. The study objective was to evaluate the accuracy of three point-of-care glucometers (POCGs) to assess glucose concentration in human blood sample. The POCGs tested included three different instruments and utilized three factors (hematocrit [Hct], galactose and ascorbic acid) in glucose measurements to determine the glucometers' accuracy and compared to the reference laboratory biochemical analyzer (Cobs 8000, Roche, Basal, Switzerland). In this study, the Nova StatStrip glucometer showed no significant variation compared to the laboratory method at high glucose level with various Hct%. ACCU-Chek Inform II overestimated the glucose results at Hct 22% and underestimated at Hct 62%. The Freestyle glucometer showed lower glucose levels compared to the Cobas 8000 at Hct 62%. The ACCU-Check showed significant increase of blood glucose with low Hct% levels when compared to the laboratory method. The Freestyle showed a decreased level of glucose with high Hct 62% interference compared to the Cobas 8000. Galactose interference 100 and 200 mg/dL dramatically affected the accuracy of ACCU-Chek Inform II. Nevertheless, among all three POCGs in this study, the Nova StatStrip showed the most reliable and stable results for glucose level in the presence of interference. Especially, those in critical care units, whereas the Freestyle Precision Pro and ACCU-Chek Inform II were insufficiently accurate for critically ill patients.

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The current work reports the biosynthesis of silver nanoparticles (AgNPs) using the antimicrobial activities of ethyl acetate extract of Urtica diocia (UD) leaves as a reducing and capping agent. The synthesized UD-AgNPs were characterized using UV−visible spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray analysis (EDAX), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), and dynamic light scattering (DLS). The UD-AgNPs were evaluated against Gram-positive and Gram-negative bacteria, and their size, shape, and distribution were recorded. The average size of an NP was 19.401 nm. The zone of inhibition (ZOI) for 75 µL of UD-AgNPs against Pseudomonas aeruginosa (P. aeruginosa) was 21 ± 0.4 mm more than that of the control drug Ciprofloxacin (16 ± 10 mm). The minimum inhibitory concentration (MIC) was the lowest against Escherichia coli (E. coli) (36 ± 3 µg/mL) and Staphylococcusepidermidis (S. epidermidis) (38 ± 3 µg/mL). Moreover, the minimum bactericidal concentration (MBC) was the lowest against E.coli (75 ± 00 µg/mL) and Enterococcus faecalis (E. faecalis (83 ± 16 µg/mL). Thus, the UD-AgNPs synthesized using the ethyl acetate extract of UD can be used as a new antimicrobial drug.

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We present the case of a 69-year-old man patient who was brought with a history of gait disturbances, memory impairment, and urinary incontinence with gradual worsening over the past six months. The patient underwent magnetic resonance imaging of the brain which demonstrated enlarged ventricles, widening of the Sylvian fissure, and narrow sulci at the vertex. Subsequently, the patient underwent a lumbar puncture which revealed a normal opening pressure with normal cerebrospinal fluid analysis. The diagnosis of normal pressure hydrocephalus was established. The patient underwent a ventriculoperitoneal shunt for the management of his symptoms. Three years after the placement of the shunt, the patient was brought to the emergency department with an expanding right-sided subcutaneous abdominal mass. A computed tomography scan of the abdomen showed the subcutaneous mass superficial to the right rectus muscle and was containing the coiled distal end of the shunt. Such findings were consistent with a subcutaneous cerebrospinal fluid pseudocyst. The mass was aspirated and the fluid analysis was in keeping with the cerebrospinal fluid characteristics. The fluid culture revealed no bacterial growth. The ventriculoperitoneal shunt was replaced with a minimally invasive technique.

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Bone regeneration using beta-tricalcium phosphate (ß-TCP) can be practiced using a biocomposite scaffold. Poly(ethylene-co-vinylalcohol)/poly(δ-valerolactone)/ß-tricalcium phosphate (PEVAV/ß-TCP) composite scaffolds showed promising in vitro results. This study evaluated the bone regenerative potential of PEVAV/ß-TCP biocomposite scaffolds in standardized calvarial defects in a rat model over 4 and 10 weeks. Bilateral calvarial defects (5 mm in diameter and about 1.5 mm thick, equivalent to the thickness of the calvaria) were created in 40 male Wistar albino rats. The defects were grafted with either commercially available ß-TCP (positive control), PEVAV/ß-TCP 70, or PEVAV/ß-TCP 50, or left empty (negative control), depending on the group to which the animal was randomly assigned, to be covered before flap closure with resorbable collagen membrane (RCM). At 4 and 10 weeks post-surgery, the collected rat calvaria were evaluated using micro computed tomography (micro-CT) analysis, to assess the newly formed bone volume (NFBV), newly formed bone mineral density (NFBMD), and remaining graft volume (RGV). The results showed that calvarial defects grafted with the PEVAV/ß-TCP biocomposite exhibited higher NFBV than did control defects, both at 4 and 10 weeks post-surgery. Furthermore, calvarial defects grafted with PEVAV/ß-TCP 70 showed the highest NFBV among all grafting conditions, with a statistically significant difference recorded at 10 weeks post-surgery. The PEVAV/ß-TCP composite scaffold showed potentiality for the regeneration of critical-sized calvarial bone defects in a rat model.

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Amyloid fibril formation of proteins is associated with a number of neurodegenerative diseases. Several small molecules can accelerate the amyloid fibril formation in vitro and in vivo. However, the molecular mechanism of amyloid fibrillation is still unclear. In this study, we investigated how the food dye quinoline yellow (QY) induces amyloid fibrillation in α-lactalbumin (α-LA), a major whey protein, at pH 2.0. We used several spectroscopy techniques and a microscopy technique to explore how QY provokes amyloid fibrillation in α-LA. From turbidity and Rayleigh light scattering experiments, we found that QY promotes α-LA aggregation in a concentration-dependent manner; the optimal concentration for α-LA aggregation was 0.15 to 10.00 mM. Below 0.1 mM, no aggregation occurred. Quinoline yellow-induced aggregation was a rapid process that escaped the lag phase, but it depended on the concentrations of both α-LA and QY. We also demonstrated that aggregation switched the secondary structure of α-LA from α-helices to cross-ß-sheets. We then confirmed the amyloid-like structure of aggregated α-LA by transmission electron microscopy measurements. Molecular docking and simulation confirmed the stability of the α-LA-QY complex due to the formation of 1 hydrogen bond with Lys99 and 2 electrostatic interactions with Arg70 and Lys99, along with hydrophobic interactions with Leu59 and Tyr103. This study will aid in our understanding of how small molecules induce aggregation of proteins inside the stomach (low pH) and affect the digestive process.

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Objective: To assess the self-perceived pain perception (PP) and whole salivary cortisol levels (CL) among adolescents with and without temporomandibular disorders (TMD).Methods: Adolescents between 15 and 17 years were included. Participants were categorized into three groups: Group 1: patients with TMD; Group 2: nocturnalbruxers without TMD; and Group 3: controls. Demographic data CL and self-rated PP were assessed. A p-value < 0.05 was proposed as statistically significant.Results: Fifty-four patients (18 per group) were included. Scores of self-rated PP in the affected TMJ were higher in Group 1 than Group 2 (p < 0.001). Whole salivary CL were higher in groups 1 and 2 (p < 0.01) than in Group 3. Whole salivary CL were higher in Group 2 than Group 3 (p < 0.05).Conclusion: Whole salivary CL are higher in adolescents with TMD, and there is a direct relationship between self-rated PP in the TMJ area and salivary CL.

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Regeneration and reconstruction of segmental bone defects (SBD) is a clinical challenge in maxillofacial surgery and orthopedics. The present study evaluated efficacy of guided bone-regeneration (GBR) of rat femoral SBD using osteoconductive equine-bone (EB) and beta-tricalcium phosphate (beta-TCP) grafts, either with or without platelet-derived growth-factor (PDGF). Following ethical-approval, 50 male Wistar-Albino rats (aged ~12-15 months and weighing ~450-500 g) were included. A 5 mm femoral critical-size SBD was created and animals were divided into five groups depending on the graft material used for GBR (EB, EB + PDGF, Autograft, beta-TCP, beta-TCP + PDGF; n = 10/group). Following 12-weeks of healing, animals were sacrificed and femur specimens were analyzed through qualitative histology and quantitative histomorphometry. There was new bone bridging femoral SBD in all groups and qualitatively, better bone formation was seen in autograft and EB + PDGF groups. Histomorphometric bone-area (BA %) was significantly high in autograft group, followed by EB + PDGF, beta-TCP + PDGF, EB, and beta-TCP groups. Addition of PDGF to EB and beta-TCP during GBR resulted in significantly higher BA%. After 12-weeks of healing, EB + PDGF for GBR of rat femoral segmental defects resulted in new bone formation similar to that of autograft. Based on this study, GBR with EB and adjunct PDGF could be a potential clinical alternative for reconstruction and regeneration of segmental bone defects.

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Two poly(δ-valerolactone)/poly(ethylene-co-vinylalcohol)/beta-tricalcium phosphate (PEVAL/PDVAL/ß-TCP) composites containing an equal ratio of polymer and filled with 50 and 70 wt% of ß-TCP microparticles were prepared by the solvent casting method. Interconnected pores were realized using the salt leached technique, and the porosity of the resulted composites was evaluated by the scanning electron microscopy (SEM) method. The homogeneity of the hybrid materials was investigated by differential scanning calorimetry (DSC) and X-ray diffraction (XRD) analysis. The prepared materials' SEM images showed interconnected micropores that respond to the conditions required to allow their uses as scaffolds. The porosity of each scaffold was determined from micro computed tomography (micro-CT) data, and the analysis of the mechanical properties of the prepared materials was studied through the stress-strain compressive test. The proliferation test results used human mesenchymal stem cells (MSCs) to grow and proliferate on the different types of prepared materials, reflecting that the hybrid materials were non-toxic and could be biologically acceptable scaffolds. The antibacterial activity test revealed that incorporation of amoxicillin in the specimens could inhibit the bacterial growth of S. aureus. The in vitro study of the release of amoxicillin from the PEVAL/PDVAL/amoxicillin and PEVAL/PDVAL/ß-TCP/amoxicillin drug carrier systems in pH media 7.4, during eight days, gave promising results, and the antibiotic diffusion in these scaffolds obeys the Fickian model.

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BACKGROUND: Angiogenesis is critical for tumor growth and reflects the aggressive behavior of invasive odontogenic lesions [like Ameloblastoma (AM), Odontogenic Keratocyst (OKC) and Central giant cell lesion (CGCL)]. Mean vascular density (MVD) shows the angiogenic potential and CD105 is an ideal endothelial biomarker due to its specificity to new blood vessels for MVD detection. The aim of the study was to compare the MVD (angiogenic potential) among AM, OKC and CGCL in comparison to Pyogenic Granuloma (PG) using CD105 biomarker. METHODS: Sixty-four primary cases of odontogenic invasive tumors (AM, OKC and CGCL) and PG, diagnosed clinically and histologically were included in the study, with 16 samples in each group. Tissue samples of peripheral AM, Peripheral GCL of jaws, malignant AM, and specimen with insufficient tissue were excluded. Tissue sections were embedded, processed and stained using Hematoxylin and Eosin (H and E). Immunohistochemistry was performed using antibodies against CD105, with positive brown cytoplasmic staining in the endothelial cells of neo-vasculature. Distinct countable, positively stained endothelial cell or clusters were evaluated under light microscope for identification of MVD. ANOVA and t-test were applied for statistical analysis of data. RESULTS: Highest MVD was displayed in CGCL (32.99±0.77) and the minimum was observed in OKC (7.21± 0.75) respectively. CGCL showed significantly higher MVD to AM, OKC and PG lesions (p <0.05). AM (8.07± 0.36) and Odontogenic Keratocyst (7.21± 0.75) showed comparable MVD, which was lower than PG (14.7± 0.96) and CGCL vascular density (p < 0.01) respectively. CONCLUSION: CGCL was most aggressive, with highest MVD among the investigated odontogenic lesions (OKC, AM and PG). The proliferative aggressive behavior of Odontogenic Keratocyst is comparable to AM due to comparable mean vascular density.
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PURPOSE: Considering the important role of oral and maxillofacial surgeons in healthcare services and the stressful nature of their job, this study aimed to assess the occupational stress among oral and maxillofacial surgeons and residents in Saudi Arabia. MATERIALS AND METHODS: Cross-sectional questionnaires were developed, and they included the perceived stress scale and questions about potential sources of stress. A sample size of 180 was determined using a 0.05 level of significance and a precision of ±8%. The survey was distributed using a consecutive non-random sampling method to all oral and maxillofacial surgeons and residents in all regions in Saudi Arabia from May to December 2019. RESULTS: One hundred and seventy-two responses were received. Males were the predominant gender. The perceived stress scale revealed a moderate stress level among surgeons and residents. However, residents had a significantly higher score (P = 0.005). Increased working days were significantly associated with higher stress levels (P = 0.006). Long on-call periods were significantly and positively correlated with increased stress levels among residents since their work schedule was not flexible (P = 0.000). The majority of surgeons and residents believe that they have unconducive and stressful work environments and that working as a maxillofacial surgeon is stressful. CONCLUSION: The study results suggest that there is increased occupational stress among oral and maxillofacial surgeons and residents in Saudi Arabia. This study highlights the need for stress management programs to minimize stress factors at the workplace and to ensure a healthy working environment for the practitioners.

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BACKGROUND: Clinicoradiographic status of narrow-diameter implants (NDIs) among patients with prediabetes and type 2 diabetes mellitus (DM) is scarce. The aim was to address the clinicoradiographic status of NDIs placed prediabetic, type 2 diabetic, and non-diabetic individuals. In this retrospective cohort study, patients having undergone oral rehabilitation with NDI were included. The participants were divided into the following: (a) patients with prediabetes; (b) patients with poorly controlled type 2 DM; (c) patients with well-controlled type 2 DM; and (d) normoglycemic individuals. Demographic data was collected. In all groups, peri-implant plaque index (PI), gingival index (GI), probing depth (PD), and mesiodistal CBL were measured in all groups. Information related to implant dimensions, surface characteristics, insertion torque, implant geometry, duration of NDI in function, and jaw location of NDI was also recorded. Data normality was assessed and group comparisons were performed. A probability value under 0.01 was considered statistically significant. RESULTS: Eighty-three patients (20 patients had prediabetes, 22 with poorly controlled type 2 DM, 20 with well-controlled type 2 DM, and 20 self-reported non-diabetic individuals) were included. The mean HbA1c levels were significantly higher among patients with prediabetes (P < 0.01) and poorly controlled type 2 DM (P < 0.01) than patients with well-controlled type 2 DM and non-diabetic controls. Peri-implant PI, GI, PD, and mesiodistal CBL levels were significantly higher among patients with pre-diabetes (P < 0.01) and poorly controlled type 2 DM (P < 0.01) than patients with well-controlled type 2 DM and non-diabetic controls. Peri-implant PI, GI, PD, and mesiodistal CBL levels were significantly higher among patients with poorly controlled type 2 DM (P < 0.01) than patients with prediabetes. CONCLUSION: Chronic hyperglycemia increases the risk of peri-implant diseases around NDIs.

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In this study, the flavonoid, 6-hydroxyflavone was investigated for its renal protective activity in the cisplatin rat model of nephrotoxicity. Male Sprague-Dawley rats weighing 200-250 g were included in the study. 6-Hydroxyflavone was daily administered at 25 and 50 mg/kg (i.p.), while ascorbic acid was used as a positive control and injected (i.p.) at 50 mg/kg for 15 days. The nephrotoxicity was evoked with a single cisplatin injection at 7.5 mg/kg on the tenth day of treatment. The renal function and levels of oxidative stress markers were assessed. Each tissue slide of different groups was observed under a compound microscope attached with a digital camera. Cisplatin significantly decreased the overall body weight with an increase in serum creatinine and urea and production of severe histopathological and oxidative stress in the kidneys. The daily treatment with 6-hydroxyflavone significantly attenuated the cisplatin associated detrimental changes in the body weight, and serum levels of creatinine and urea at both 25 mg/kg (P<0.05) and 50 mg/kg (P<0.01). The 6-hydroxyflavone treatment also preserved the renal histoarchitecture from the toxicological influence of cisplatin as evident from a significant reduction in the severity of histopathological changes in the renal tissues. Moreover, 6-hydroxyflavone also reduced the cisplatin-induced lipid peroxidation and corrected the renal antioxidant status. A similar protective effect was observed with the positive control, ascorbic acid (50 mg/kg). These findings show that the flavonoid 6-hydroxyflavone has potential nephroprotective properties and can be used for the management of chemotherapy associated renal disturbances.

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The surface measures of machined titanium alloys as dental materials can be enhanced by adopting a decision-making algorithm in the machining process. The surface quality is normally characterized by more than one quality parameter. Hence, it is very important to establish multi-criteria decision making to compute the optimal process factors. In the present study, Taguchi-Grey analysis-based criteria decision making has been applied to the input process factors in the wire EDM (electric discharge machining) process. The recast layer thickness, wire wear ratio and micro hardness have been chosen to evaluate the quality measures. It was found that the wire electrode selection was the most influential factor on the quality measures in the WEDM process, due to its significance in creating spark energy. The optimal arrangement of the input process parameters has been found using the proposed approach as gap voltage (70 V), discharge current (15 A) and duty factor (0.6). It was proved that the proposed method can enhance the efficacy of the process. Utilizing the computed combination of optimal process parameters in surface quality analysis has significantly contributed to improving the quality of machining surface.