ABSTRACT Smile aesthetic, known as the static and dynamic relationship of the dentition and supporting structures to the facial soft tissues, is one of the most important elements of facial attractiveness. The objective of the study was to assess the perception of smile aesthetics and attractiveness through digital image manipulation of aesthetic variables and to compare those perceptions according to diverse sociodemographic data among female Saudi laypeople attending the dental clinic. A crosssectional study of 193 female Saudi participants were randomly selected and consented to answer the study questionnaire. Nine smile photograph images were created to compare different smile aesthetic perceptions. Two groups were recruited: 120 participants in the first group (under 30 years old) and 73 participants in the second group (30 years old or above). All participants in both groups were asked to choose the attractiveness of each smile image using multiple-choice options. A statistically significant finding showed that normal buccal corridors were chosen as the most attractive smile by 42.5% of the participants in the younger group and by a significantly higher ratio of the participants with a bachelor’s degree or higher level of education at 49% (p < 0.05). Laypeople’s preferences regarding smile attractiveness vary, but a normal appearance was the ideal choice for the majority. Orthodontic treatment should consider the general sociocultural understanding of smile perception.
Esthetics, Dental--psychology ; Facial Recognition ; Saudi Arabia

BACKGROUND: Transfusion-transmissible hepatitis B virus (HBV) infection is a major problem worldwide. Recently, confirmatory nucleic acid tests (NATs) for HBV DNA have been employed in several countries. We assessed the prevalence and yearly trends of HBV infection in blood donors in the Eastern Province of Saudi Arabia, screening for HBV surface antigen (HBsAg), antibody against HBV core antigen (anti-HBc), and HBV DNA. METHODS: Between 2011 and 2015, a total of 22,842 donors were screenedfor HBsAg, anti-HBc, and HBV DNA using the HBsAg Qualitative II kit (Abbott, Ireland Diagnostics Division, Sligo, Ireland), ARCHITECT Anti-hepatitis B core antigen antibody (HBc) II Assay kit (Abbott GmbH & Co. KG, Wiesbaden, Germany), and NAT Procleix Ultrio Elite Assay kit (Grifols Diagnostic Solutions Inc., Los Angeles, CA, USA), respectively. RESULTS: A total of 739 (3.24%) donors were HbsAg(+), anti-HBc(+), or HBV DNA(+); 63 (0.28%) were HbsAg(+), anti-HBc(+), and HBV DNA(+). Twelve (0.05%) were anti-HBc(+) and HBV DNA(+) but HBsAg(−); they were considered to have occult infection. Further, 664 (2.91%) were HBsAg(−) but anti-HBc(+), indicating chronic or resolving infection. HBV prevalence increased significantly from 2011 to 2012, increased marginally till 2013, and showed a decreasing trend from 2013 (P>0.05). CONCLUSIONS: The five-year prevalence of HBV infection among blood donors in the Eastern Province of Saudi Arabia (3.24%) is lower than that reported for other regions in the country. The occult HBV infection rate of 0.05% emphasizes the importance of NATs in isolating potential infectious blood units.
Antigens, Surface ; Blood Donors* ; DNA ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Ireland ; Mass Screening ; Prevalence* ; Retrospective Studies* ; Saudi Arabia* ; Tissue Donors

Detailed description of malaria in low transmission areas is crucial for elimination. The current study aimed to provide a comprehensive description for malaria transmission in Jazan, a low transmission district, southwestern Saudi Arabia. Patients at a tertiary care hospital were recruited in our study between August 2016 and September 2018. Malaria diagnosis was performed through a species-specific nested polymerase chain reaction (nested PCR), microscopy and Paramax-3™ rapid detection test (RDT). Malaria was detected in 30 patients by the PCR, with point prevalence of 10.9%. Of these malaria infections, 80% was imported, 26.6% was asymptomatic and 23.3% was sub-microscopic. Malaria was reported throughout the year, with February/March and September/October peaks. Infection was significantly more in males than in females (P=0.01). Likewise, infections were detected more in febrile than in non-febrile patients (P=0.01). Adult aged 15–24 years, fever and travel were identified as high-risk factors. Malaria was primarily attributed to Plasmodium falciparum mono-infections, followed by P. vivax mono-infections and lastly to falciparum/vivax mixed infections accounting 76.6%, 16.6%, and 6.6% of PCR-confirmed malaria cases, respectively. The nested PCR was superior to the smear microscopy (sensitivity 76.6%; specificity 100%) and the RDT (sensitivity 83.3%, specificity 94.2%). The overall percent agreement between microscopy and the RDT was 92.7% (kappa=0.63). High proportion of imported malaria including sub-microscopic and sub-patent cases were described. We suggest that incorporation of molecular tool into the conventional malaria diagnosis is beneficial in Jazan district.
Adult ; Coinfection ; Diagnosis ; Female ; Fever ; Humans ; Malaria ; Male ; Microscopy ; Plasmodium falciparum ; Polymerase Chain Reaction ; Prevalence ; Saudi Arabia ; Sensitivity and Specificity ; Tertiary Healthcare

Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%-60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1-7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of < 150 × 10/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32-38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.
Adolescent ; Child ; Coronavirus Infections ; diagnosis ; physiopathology ; Diarrhea ; etiology ; Dyspnea ; etiology ; Female ; Fever ; etiology ; Humans ; Infant ; Lung ; diagnostic imaging ; Male ; Middle East Respiratory Syndrome Coronavirus ; genetics ; Pleural Effusion ; diagnostic imaging ; Radiography, Thoracic ; Saudi Arabia

Cupping therapy (Hijama in Arabic) is a popular traditional treatment especially in Asia, the Middle East and Central Europe. Traditionally, cupping therapy has been one of the most used practices in Saudi Arabia. Standardization of the practice of cupping therapy is a very important step to eliminate or reduce any adverse events related to cupping. This article gives a brief illustration and highlights the important points of the first accredited Saudi Arabian standards for the safe use of cupping equipment and its applications.
Equipment Safety ; standards ; Government Regulation ; Humans ; Medicine, Traditional ; instrumentation ; methods ; standards ; Safety ; standards ; Saudi Arabia

BACKGROUND AND PURPOSE: The objective of this study was to determine the frequencies of different clinical presentations and the phenotypic spectrum of multiple sclerosis (MS). METHODS: This cross-sectional study was performed in the Neurology Department of King Fahd Hospital of University Alkhobar in the Kingdom of Saudi Arabia (KSA). Data of 190 MS patients who fulfilled the McDonald criteria were retrieved from medical records and analyzed. RESULTS: The age at disease onset was 26.27±8.2 years (mean±SD) and disease duration was 6.38±5.10 years. The male-to-female ratio was 1:1.6. Optic neuritis and myelitis were the most-frequent first clinical presentations. Sensory (73.1%), motor (61%), and visual (58.4%) symptoms were the most-frequent established clinical symptoms. Relapsing-remitting multiple sclerosis (RRMS) was present in 75% of the cases. Supratentorial T2-weighted white-matter lesions and deep-gray-matter or juxtacortical lesions were the most-frequent magnetic resonance imaging (MRI) lesions, comprising 28% and 23.7% of all MRI lesions observed in 93.6% and 79.4% of the cases, respectively. The scores on the Expanded Disability Status Scale were within the range of 1.0–5.5 in 82.1% of the patients. There were 145 (76.3%) patients taking interferon β therapy. CONCLUSIONS: MS presenting in the hospital setting is more common in KSA than reported previously, and the number of diagnosed cases in increasing. It is therefore an emerging and disabling neurological illness in KSA with clinical characteristics not dissimilar to those in other middle eastern countries. A decrease in the frequency of patients with secondary progressive multiple sclerosis (SPMS) indicates either that more new cases of RRMS are being diagnosed or that adequate treatments of RRMS are preventing the evolution to SPMS. Further larger and population-wide epidemiological and clinical studies with the long-term follow-up of MS patients are required to better assess the clinical spectrum of MS in KSA.
Cross-Sectional Studies ; Epidemiology ; Follow-Up Studies ; Humans ; Interferons ; Magnetic Resonance Imaging ; Medical Records ; Multiple Sclerosis* ; Multiple Sclerosis, Chronic Progressive ; Multiple Sclerosis, Relapsing-Remitting ; Myelitis ; Neurology ; Optic Neuritis ; Phenotype ; Prevalence ; Saudi Arabia*

BACKGROUND: Many oral presentations of osteoporosis-a bone metabolic disease-were recorded. Thus, we aimed to assess panoramic radiomorphometric indices with bone mineral density (BMD) values among Saudi postmenopausal women and its importance in the prediction of osteoporosis. METHODS: A total of 431 Saudi women were enrolled in this study. Panoramic radiographs were obtained at the time of BMD measurement. Subjects were fatherly classified into; normal BMD, osteopenia, and osteoporosis groups. Serum follicle-stimulating hormone, luteinizing hormone (LH), estradiol (E2), 25-hydroxy-vitamin D (25[OH]D) and intact-parathyroid hormone were measured. Moreover, serum creatinine, calcium, and phosphate, together with serum osteocalcin (s-OC), procollagen type I N-terminal propeptide (s-PINP) and cross-linked C-terminal telopeptide of type 1 collagen (s-CTX) were measured. Receiver-operator curve (ROC) curve analysis for use of mandibular cortical width (MCW), panoramic mandibular index (PMI), and maxillary-mandibular ratio (M/M ratio) to differentiate women with osteoporosis or osteopenia from normal subjects was calculated. Cut off values of 4.6 at T score <−1 and 4.1 at T score ≤−2.5 were used. RESULTS: Body mass index is significantly low in the osteoporotic group. There is no significant difference in serum levels of LH, E2, calcium, phosphate, and 25(OH)D between the studied groups. Moreover, s-OC, C-terminal propeptide of procollagen type I, s-PINP, s-CTX, and urinary-CTX are significantly higher in osteoporosis than normal and osteopenia groups. ROC curve analysis revealed that MCW and PMI showed significant data while M/M ratio is non-significant. CONCLUSIONS: It could be concluded that MCW as an important panoramic radiographic parameter can be used for prediction and diagnosis of osteoporosis in postmenopausal Saudi women with low BMD.
Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Calcium ; Collagen Type I ; Creatinine ; Diagnosis ; Estradiol ; Female ; Follicle Stimulating Hormone ; Humans ; Luteinizing Hormone ; Osteocalcin ; Osteoporosis* ; Postmenopause ; Radiography, Panoramic ; ROC Curve ; Saudi Arabia

OBJECTIVE: This study was performed to compare the perception of pain between patients treated with passive self-ligating fixed appliances and those treated with Invisalign aligners. METHODS: This prospective study conducted in Saudi Arabia used an estimated sample of 64 patients from a private dental clinic. After obtaining written informed consent, the patients were divided into two groups; one group (n = 32) was treated using passive self-ligating fixed appliances and the other group (n = 32) using Invisalign® aligners. Immediately after fitting the appliances, the patients' perception of pain was evaluated through a close-ended and coded self-administrated questionnaire by using a visual analog scale (VAS). Their responses were recorded at 4 hours, 24 hours, day 3, and day 7. Mann-Whitney U-test, Kruskal-Wallis test, and Pearson's chi-square test were performed for statistical analysis. RESULTS: A lower percentage of patients treated with Invisalign aligners reported pain than did patients treated with passive self-ligating fixed appliances, and these differences were statistically significant (p = 0.001). Similarly, the mean VAS score for the Invisalign group was significantly lower than that for the passive self-ligating fixed appliance group at different intervals during the first week of treatment. The intensity of pain with both appliances peaked at 24 hours (mean VAS score, 3.87) and was lowest (mean VAS score, 1.62) on day 7. CONCLUSIONS: During the first week of orthodontic treatment, patients treated with Invisalign aligners reported lower pain than did those treated with passive self-ligating fixed appliances.
Analgesics ; Dental Clinics ; Humans ; Informed Consent ; Pain Perception* ; Prospective Studies ; Saudi Arabia ; Visual Analog Scale

PURPOSE: A cutting seton is used after a partial distal fistulotomy to treat patients with a high exrasphincteric fistula in ano to avoid fecal incontinence and recurrence. In Saudi Arabia, religious practices necessitate complete cleanness, which makes conditions affecting anal continence a major concern to patients affected by an anal fistula. Therefore, we aimed to evaluate the efficiency of the cutting seton in treating a high anal fistula among Saudi Arabians. METHODS: Between January 2005 and December 2014, a prospective study was done for 372 Saudi Arabian patients diagnosed as having a high anal fistula and treated with a cutting seton at Al-Ansar General Hospital, Medina, Saudi Arabia. 0-silk sutures were used. All patients underwent the same preoperative assessment, operative technique, and postoperative follow-up. Weekly, the seton was tightened in outpatient clinics. RESULTS: Two hundred ninety-eight patients (80.1%) were males and 74 (19.9%) females. The duration of symptoms varied from 3–21 months. The fistula healed completely in 363 patients (97.6%); 58 patients (15.6%) reported some degree of incontinence to flatus, but none to feces. In 9 patients (2.4%) the fistula recurred. CONCLUSION: The utilization of the cutting seton method in the treatment of patients with a high anal fistula is highly efficient as it simultaneously drains the abscess, cuts the fistulous tract, and causes fibrosis along the tract. Treatment of a high anal fistula by using a staged fistulotomy with a cutting seton was very rewarding to Saudi Arabian patients who feared anal incontinence for religious reasons and was associated with low postoperative complication and recurrence rates.
Abscess ; Ambulatory Care Facilities ; Fecal Incontinence ; Feces ; Female ; Fibrosis ; Fistula ; Flatulence ; Follow-Up Studies ; Hospitals, General ; Humans ; Male ; Methods ; Postoperative Complications ; Prospective Studies ; Rectal Fistula* ; Recurrence ; Reward ; Saudi Arabia ; Sutures

BACKGROUND: Cutaneous leishmaniasis is a tropical infection of public health importance. Numerous treatment approaches are in practice with variable degree of success however its management has no universal consensus or practice guidelines to follow. OBJECTIVE: Analyze the management of cutaneous leishmaniasis retrospectively at a central hospital of Jazan Province, Kingdom of Saudi Arabia to identify the current treatment pattern and compare the outcomes. METHODS: This cross-sectional study was conducted based on the hospital records of patients who attended the dermatology clinic for cutaneous leishmaniasis during the year 2012 to 2015. RESULTS: Forty three patients were included in the study. There was a male preponderance (65.1%) among the patients and 60.5% of them were of pediatric age group. Monotherapy was the initial choice for 58.1% of the patients. Intralesional sodium stibogluconate (SS-IL) was the most preferred treatment for initial therapy, as monotherapy and as part of combination therapy. A complete response was achieved in 22 patients (51.2%) with initial therapy. Among the different treatment groups, SS-IL+itraconazole showed significantly higher complete response rate compared to other treatments offered as initial therapy (p<0.01). Initial SS-IL monotherapy provided complete response in 41.2% patients receiving it, while itraconazole monotherapy provided complete response in 75% and 90.9% of the patients receiving initial itraconazole+SS-IL combination therapy with achieved complete response. CONCLUSION: The findings and observations suggest that initial combination therapy with SS-IL+itraconazole significantly improved the complete response rates and thus reduced the need for additional or prolonged therapies.
Antimony Sodium Gluconate ; Consensus ; Cross-Sectional Studies ; Dermatology ; Hospital Records ; Humans ; Injections, Intralesional ; Itraconazole ; Leishmania major ; Leishmania tropica ; Leishmaniasis, Cutaneous* ; Male ; Observational Study* ; Public Health ; Retrospective Studies ; Saudi Arabia