The burden of trauma in a regional trauma centre in the Western Province of Saudi Arabia – a descriptive study

Background and Objectives: While trauma is currently the second leading cause of death in Saudi Arabia, little statistical information is available about injury rates and related patient outcomes. There is a need to understand trauma epidemiology to determine strategies that can be put in place to prevent and treat such trauma. We aimed to describe trauma rates, types of injuries, demographic distribution of injury and body regions affected by trauma in King Fahad Hospital in the city of Medina. Methods: The study was undertaken in King Fahad Hospital, the first multi-speciality reference hospital in the Medina region and the only trauma centre in the city. We collected retrospective data on all the trauma victims who visited the Emergency Department from 1st January to 31st December 2018. Simple descriptive statistics were calculated. Trauma mortality was compared with trauma scores with Receiver Operator Curves. Results: During the study period, 8793 patients were evaluated, 5846 (66.5%) males. The mean age was 27.5 years. 5608 (64%) were admitted in one of the in-hospital departments and rest were referred to OPD. Traffic-related injuries (4086; 46.5%) and falls (2993; 34%) were the most common causes of injury. Extremities injury (5929; 67.5%) was recorded as the most common body part. From the in-hospital patients, 5077 (90.5%) were discharged home and 167 (3%) died. Considering the mortality prediction accuracy of RTS and NTS. The RTS score of ≤9 had sensitivity and specificity of 90.2% and 90.4%, respectively, in predicting mortality in >5-year-old patients. NTS score of ≤13 had 90% sensitivity and 97.3% specificity in predicting mortality in the age group of 0-5 year-old. Conclusion: This descriptive study is a crucial step in addressing the burden of trauma in Saudi Arabia. Information related to the characteristics of injuries and relevant patient 2 outcomes may assist in further research into possible causal factors. It may contribute to the creation of new protocols in preventing and managing injuries more efficiently

Alcoholic liver disease: Current insights into cellular mechanisms.

Alcoholic liver disease (ALD) due to chronic alcohol consumption is a significant global disease burden and a leading cause of mortality. Alcohol abuse induces a myriad of aberrant changes in hepatocytes at both the cellular and molecular level. Although the disease spectrum of ALD is widely recognized, the precise triggers for disease progression are still to be fully elucidated. Oxidative stress, mitochondrial dysfunction, gut dysbiosis and altered immune system response plays an important role in disease pathogenesis, triggering the activation of inflammatory pathways and apoptosis. Despite many recent clinical studies treatment options for ALD are limited, especially at the alcoholic hepatitis stage. We have therefore reviewed some of the key pathways involved in the pathogenesis of ALD and highlighted current trials for treating patients. [Abstract copyright: ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

Non-alcoholic fatty liver disease: Immunological mechanisms and current treatments.

Non-alcoholic fatty liver disease (NAFLD) causes significant global disease burden and is a leading cause of mortality. NAFLD induces a myriad of aberrant changes in hepatocytes at both the cellular and molecular level. Although the disease spectrum of NAFLD is widely recognised, the precise triggers for disease progression are still to be fully elucidated. Furthermore, the propagation to cirrhosis is poorly understood. Whilst some progress in terms of treatment options have been explored, an incomplete understanding of the hepatic cellular and molecular alterations limits their clinical utility. We have therefore reviewed some of the key pathways responsible for the pathogenesis of NAFLD such as innate and adaptative immunity, lipotoxicity and fibrogenesis, and highlighted current trials and treatment options for NAFLD patients. [Abstract copyright: ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

Unilateral Lower Limb Amputations from Traumatic Events: A Systematic Review and Meta-Analysis

Background Limb amputations are one of the most devastating injuries for young people in traumatic settings. People with lower extremity loss face challenges in performing daily activities and managing life-long complications; thus, rehabilitation and prostheses are critical in improving the quality of life. This systematic review and meta-analysis aims to determine the outcomes of people who had unilateral transtibial and transfemoral amputations in terms of mobility, physical activity, prosthesis usage, and associated pain. Methods An in-depth search was conducted on the electronic databases of PubMed and Science Direct databases in September 2022 to find studies that investigated the health outcomes of traumatic unilateral leg amputees. Observational studies, clinical studies, comparative studies, and randomized controlled trials in the English language and within the last 10 years (2012-2022)  were thoroughly screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The quality of search results was checked by the Newcastle-Ottawa Scale (NOS). The current meta-analysis included four observational studies which comprised 563 patients, 352 transtibial, and 211 transfemoral amputations. RevMan 5.4 software was used to calculate risk ratios (RRs) with 95% confidence intervals (CI) to conduct this meta-analysis. Results The pooled effect estimate showed no statistically significant difference between transtibial and transfemoral amputees(RR = 1.15, 95% CI [0.93, 1.43], P = 0.21) in terms of physical activity. People who had transfemoral amputations used prostheses more frequently than those who had transtibial amputations(RR = 1.21,95% CI [1.09, 1.35], P = 0.0004). There was no statistical difference between the two groups who reported pain during prosthesis wearing (RR = 1.03, 95% CI [0.62, 1.73], P = 0.91). Conclusion People who used leg prostheses more frequently were associated with more independent mobility and adequate physical activity. Leg prostheses with better accommodation and mobility benefit people with traumatic unilateral transfemoral amputations

Computational studies on the effect of geometric parameters on the performance of a solar chimney power plant

A solar chimney power plant (SCPP) is a renewable-energy power plant that transforms solar energy into electricity. The SCPP consists of three essential elements – solar air collector, chimney tower, and wind turbine(s). The present work is aimed at optimizing the geometry of the major components of the SCPP using a computational fluid dynamics (CFD) software ANSYS-CFX to study and improve the flow characteristics inside the SCPP. The overall chimney height and the collector diameter of the SCPP were kept constant at 10 m and 8 m respectively. The collector inlet opening was varied from 0.05 m to 0.2 m. The collector outlet diameter was also varied from 0.6 m to 1 m. These modified collectors were tested with chimneys of different divergence angles (0�–3�) and also different chimney inlet openings of 0.6 m to 1 m. The diameter of the chimney was also varied from 0.25 m to 0.3 m. Based on the CFX computational results, the best configuration was achieved using the chimney with a divergence angle of 2� and chimney diameter of 0.25 m together with the collector opening of 0.05 m and collector outlet diameter of 1 m. The temperature inside the collector is higher for the lower opening resulting in a higher flow rate and power

The Incidence of Root Canal Therapy after Full-Coverage Restorations: A 10-Year Retrospective Study

Introduction The process of restoring a tooth with a crown leaves many opportunities for pulpal irritation. The objective of this study was to identify and analyze the factors that contribute to the incidence of nonsurgical root canal therapy (NS-RCT) after the delivery of single-unit full-coverage restorations. Methods Insurance claims from 88,409 crown placements in the Delta Dental of Wisconsin insurance database were analyzed from the years 2008–2017. The Cox regression model was used to analyze the effect of the predictor variables on the survival of the tooth. Untoward events were defined as NS-RCT, tooth extraction, retreatment of root canal, or apicoectomy as defined by the Code on Dental Procedures and Nomenclature. Results Of 88,409 crowns placed, 8.97% were complete metal, 41.40% were all ceramic, and 49.64% were porcelain fused to metal (PFM). The probability of survival of all teeth with crowns placed was 90.41% after 9 years. NS-RCT was the most common untoward event. PFM crowns exhibited a higher rate of untoward events than complete metal crowns and a lower rate than all-ceramic crowns. Crowns placed on individuals 50 years of age and younger had higher rates of untoward events than those placed on individuals ages 51 years and older. Conclusions The risk of endodontic treatment after the placement of crowns is low. This risk increases with the placement of all-ceramic or PFM crowns and as the age of the patient decreases

Peripheral Cornea Crosslinking Before Deep Anterior Lamellar Keratoplasty

Since Cornea crosslinking (CXL) has been proven to halt progression and biomechanically stabilize keratoconus, we hypothesized that CXL of the corneal periphery 3 months prior to corneal transplantation can reduce the incidence of recurrent ectasia by strengthening the peripheral corneal tissue and causing apoptosis of diseased peripheral host keratocytes. Thus, the aim of this case-repot was to propose a novel peripheral CXL technique prior to keratoplasty and evaluate its safety. A 22-year-old woman was admitted with advanced right keratoconus and corrected distance visual acuities of 20/30 in the right eye and 20/200 in the left eye with a manifest refraction of -3.00 -8.00 × 36 and -17.00 -11.50 × 90, respectively. The proposed treatment involved crosslinking of peripheral corneal tissue (6.5-9.5mm), sparing the central cornea and limbus, three months prior to corneal transplantation as a means of biomechanically strengthening the peripheral cornea tissue. We performed peripheral CXL technique in a patient with keratoconus undergoing deep anterior lamellar keratoplasty (DALK). This procedure was feasible and safe with repopulation of the peripheral cornea with keratocytes and no significant endothelial cell loss. This method might reduce or eliminate the need for repeat corneal transplantation in patients with recurrent ectasia. Further studies are needed to confirm the results