Dammam Central Hospital

Endo-perio lesions present complex diagnostic and therapeutic challenges due to combined endodontic and periodontal pathology when managed in isolation. Therefore, it is of interest to evaluate multimodal treatment with laser curettage, crown rehabilitation and orthodontic therapy in 48 teeth from 42 patients. AI-assisted CBCT assessments showed 78.4±12.3% periapical lesion reduction, 45.6±8.9 HU bone density increase and 2.84±0.92 mm periodontal bone gain at 12 months. The integrated protocol achieved superior healing across compartments compared to traditional sequential approaches. AI-guided laser-prosthetic-orthodontic management advances endo-perio care by establishing a predictable, comprehensive standard with enhanced radiographic outcomes.

Background: Flail chest is a severe thoracic injury defined by fractures of multiple ribs in at least two locations, resulting in paradoxical chest wall motion and impaired ventilation. It most commonly arises from high-energy blunt trauma and is frequently associated with pulmonary contusions and multisystem injuries. Aim: This article aims to provide an integrated overview of the etiology, epidemiology, pathophysiology, clinical assessment, radiologic evaluation, and management strategies for flail chest to guide effective multidisciplinary care. Methods: A comprehensive narrative review approach was used, synthesizing current trauma guidelines and contemporary evidence on diagnosis, imaging, respiratory support, analgesia, and surgical stabilization of rib fractures (SSRF). Results: Findings indicate that flail chest significantly compromises respiratory mechanics, increases the risk of hypoxemia and pneumonia, and often necessitates hospitalization or mechanical ventilation. CT imaging provides the most accurate diagnosis. Optimal outcomes rely on multimodal analgesia, respiratory support, pulmonary hygiene, and selective early SSRF, which reduces ventilation duration, pneumonia rates, and hospital stay. Conclusion: Early recognition and individualized, multidisciplinary management substantially improve outcomes. Surgical stabilization is particularly beneficial in severe cases with persistent instability or ventilatory dependence.

Background: Colonoscopy is the gold standard for detecting colorectal pathology, but its diagnostic accuracy depends on adequate bowel preparation. Poor preparation compromises mucosal visualization, increases procedural risk, and leads to missed lesions and repeat procedures. Aim: To review bowel preparation strategies, contraindications, and interprofessional roles in optimizing patient safety and diagnostic outcomes. Methods: A comprehensive literature-based analysis was conducted, synthesizing evidence on preparation regimens, physiologic considerations, contraindications, and team-based interventions. The review emphasizes pharmacologic classifications, dosing strategies, and quality assessment tools such as the Boston Bowel Preparation Scale (BBPS). Results: Isosmotic polyethylene glycol (PEG)-based regimens remain the safest and most effective, particularly in patients with comorbidities. Low-volume PEG with ascorbic acid improves tolerability but is contraindicated in G6PD deficiency. Hyposmotic PEG-3350 regimens may cause electrolyte disturbances, while hyperosmotic agents like magnesium citrate and sodium sulfate require caution in renal impairment. Sodium phosphate is largely avoided due to nephropathy risk. Split-dose administration consistently improves cleansing quality and adenoma detection rates. Interprofessional collaboration—physicians, nurses, and pharmacists—enhances adherence and safety, while patient education significantly improves outcomes. Conclusion: Effective bowel preparation is a multidisciplinary process integrating regimen selection, patient-centered education, and objective quality assessment. Individualized planning and team-based interventions reduce incomplete colonoscopies, improve lesion detection, and enhance patient safety.

Background: Mitral regurgitation (MR) is the second most prevalent valvular heart disease globally, with clinical presentations ranging from asymptomatic to life-threatening. Traditional surgical repair remains the gold standard, but high-risk patients often require less invasive alternatives. Aim: To review catheter-based interventions for MR, focusing on nursing care, anatomical considerations, procedural techniques, and clinical outcomes. Methods: This narrative review synthesizes evidence from pivotal trials (EVEREST I & II, COAPT) and current guidelines (ACC/AHA, ESC/EACTS), emphasizing anatomical prerequisites, device selection, procedural workflow, and complication management. Results: Transcatheter edge-to-edge repair (TEER), modeled on the Alfieri stitch, has emerged as the most validated percutaneous approach. Favorable anatomy includes adequate leaflet length, central jet location, and mitral valve area >4 cm². Technological advances (MitraClip G4, PASCAL Precision) enable treatment of complex anatomies such as flail segments and commissural jets. TEER demonstrates significant symptomatic improvement and reduced hospitalization in high-risk cohorts, with low rates of major complications (SLDA 1.5–5%, leaflet injury ≤2%, device embolization ≤0.7%). Nursing roles encompass preprocedural preparation, intraoperative monitoring, anticoagulation management, and postprocedural surveillance for complications such as tamponade, vascular injury, and residual MR. Conclusion: TEER represents a transformative option for patients unsuitable for surgery, offering durable MR reduction and improved quality of life when applied with rigorous anatomical assessment and multidisciplinary collaboration.

Myocardial stunning is a reversible form of cardiac dysfunction that can follow cardiac arrest. We report a case where its presentation was masked by a primary neurological complaint. A 67-year-old male with cardiovascular risk factors presented to the emergency department with acute profound confusion and amnesia, initially suspected to be an acute ischemic stroke. Within one hour, his condition deteriorated, and he suffered an in-hospital cardiac arrest due to pulseless ventricular tachycardia, requiring prolonged resuscitation. Post-return of spontaneous circulation, comprehensive neuroimaging, including CT angiography and MRI, conclusively ruled out an acute cerebrovascular event. The working diagnosis was revised to a stroke mimic of undetermined etiology. Workup revealed severe left ventricular dysfunction consistent with global myocardial stunning. The patient's cardiac function and mental status gradually recovered with supportive care. This case highlights that acute, primary cardiac pathology can manifest with dramatic neurological symptoms, leading to initial misdiagnosis. It underscores the importance of considering myocardial stunning in any patient with neurological symptoms and cardiovascular instability, as rapid deterioration can occur.

Emergency departments (EDs) are the frontline of healthcare systems, often faced with high patient volumes, critical time pressures, and increasingly complex cases. To address these challenges, multidisciplinary teamwork has emerged as a vital strategy to enhance patient care, safety, and overall departmental efficiency. This systematic review explores the role of multidisciplinary health teams—including physicians, nurses, paramedics, pharmacists, social workers, and allied health professionals—in strengthening ED performance. Following PRISMA guidelines, peer-reviewed literature published between 2010 and 2025 was analyzed to examine the impact of team-based collaboration on patient outcomes, quality of care, and operational efficiency. Evidence indicates that multidisciplinary approaches significantly reduce medical errors, improve triage accuracy, shorten patient waiting times, and enhance satisfaction for both patients and healthcare providers. However, barriers such as communication breakdowns, hierarchical structures, and resource limitations persist, potentially hindering effective collaboration. The review highlights strategies including interprofessional training, leadership support, standardized care pathways, and digital health integration as enablers of stronger team-based care in EDs. Ultimately, the findings underscore that effective multidisciplinary teamwork is not only essential for optimizing patient outcomes in emergency settings but also for sustaining healthcare system resilience and preparedness.

Streptococcus Agalactiae endocarditis is a rare clinical entity in newborns with a normal structured heart. It is generally characterized by acute onset, the presence of large vegetations, rapid valvular destruction and frequent complications, particularly embolization. Mortality is high with medical therapy alone. We are reporting a rare case of infective endocarditis (IE) with mitral valve vegetation in a 9 days old healthy newborn following Streptococcus Agalactiae sepsis, complicated by meningitis and micro-abscesses. Mitral valve (MV) vegetation was removed surgically; the patient received intravenous antibiotics for six weeks. Transthoracic echocardiography after surgery showed severe MV regurgitation and severe pulmonary hypertension which was successfully managed by conservative care with cardiac medications.

Robotics has moved beyond the experimental stage and is now beginning to influence clinical practice in dentistry by setting higher standards for precision, efficiency, and personalized care. Recognizing its potential to reduce variability, enhance treatment outcomes, and reshape clinical workflows makes it essential to evaluate its current role and trajectory. This narrative review explores the historical evolution of dental robotics from early mechanical devices to advanced systems, three-dimensional imaging, and real-time navigation. It provides a cross-specialty analysis of robotic applications and highlights key technologies. Despite the promise of improved clinical outcomes and workflow standardization, the widespread adoption of robotics in dentistry faces notable challenges, including high costs, integration difficulties, training requirements, and regulatory uncertainty. Future work is likely to focus on better decision-support software and on ways to extend access through remotely guided procedures. As innovation continues, robotics may become a cornerstone of digital dentistry, but its widespread impact will depend on overcoming cost barriers and integration challenges.

ABSTRACTBackground and AimsThe pathophysiology of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is complex and poorly understood. Genetic predispositions play a significant role. We aimed to explore the genetic factors and molecular mechanisms driving DRESS, focusing on gene expression, transcription factors (TFs), microRNAs (miRNAs), and chemical interactions.MethodsWe utilized RNA‐seq data from the GSE160369 data set in the gene expression omnibus (GEO) database to identify differentially expressed genes (DEGs) related to DRESS. The analysis was conducted using GEO2R for identifying upregulated and downregulated genes. Protein–protein interaction (PPI) networks were constructed using STRING and further analyzed with Cytoscape and CytoHubba. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to identify biological pathways. miRNAs and TFs were predicted using bioinformatics tools like TargetScan, miRDB, and ChEA3, while chemical interactions with key genes were explored using CTDbase.ResultsA total of 336 DEGs were identified, including 239 upregulated and 97 downregulated genes. The PPI network highlighted TNF, IL2, and CD40 as central genes involved in immune‐related pathways. Functional enrichment analyses revealed significant pathways related to immune activation, such as leukocyte‐mediated immunity. We predicted 15 miRNAs, including hsa‐miR‐1296‐5p, and identified 10 TFs, such as MTF1 and NFKB2, which regulate the expression of key genes. Chemical interaction analysis revealed decitabine and tetradecanoylphorbol acetate as prominent agents modulating gene expression.ConclusionmiRNAs, TFs, and chemical modulators, which play a key role in the development of DRESS syndrome. Knowledge of the molecular underpinnings of DRESS, imperative for therapeutic targets.

With the global rollout of COVID-19 vaccines, vaccine safety remains a priority. Emerging concerns have raised the potential risk of a long COVID-like syndrome following vaccination, informally called long Vax and provisionally termed post-COVID-19 vaccination syndrome (PCVS). Our narrative review describes the putative manifestation, pathophysiology, and therapeutic approaches of PCVS based on the available evidence, mostly from case reports/series and observational studies. Our review noted that PCVS typically manifests within days to weeks post-vaccination, with symptoms lasting months to years. PCVS may present as recognized diagnoses such as postural orthostatic tachycardia syndrome (POTS), small-fibre neuropathy (SFN), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), or as long-term sequelae of myocarditis, vaccine-induced thrombotic thrombocytopaenia (VITT), or immune thrombocytopaenia purpura (ITP). Symptomatically, PCVS overlaps with long COVID, such as fatigue and brain fog, but PCVS may involve more frequent paraesthesia and less dyspnoea. We also review pathophysiological hypotheses of PCVS, focussing on the vaccine-derived spike protein and related immune responses. Finally, we discuss potential therapies used to treat patients with PCVS or related conditions, primarily documented in case reports/series, which could guide future clinical research. Overall, PCVS remains a poorly understood condition that requires more research to elucidate its prevalence, prognosis, risk factors, and treatments.