Security Forces Hospital

Educational activities (EAs) in health professional education play a crucial role in healthcare training curricula through a variety of methods, such as lectures, small-group discussions, simulation, case-based learning, and workplace-based experiences, that aim to develop knowledge, specific skills, and professional behaviours for clinical practice. In postgraduate education, EAs are frequently organised around learning competencies and Entrustable Professional Activities (EPAs)/national standards. However, there are few studies on how these activities systematically translate into structured postgraduate programs. A qualitative research study using descriptive and comparative document analysis was conducted in consecutive stages to identify gaps in the curricula of the postgraduate training programs of the Saudi Commission for Health Specialities (SCFHS). At first, the data, including 124 randomly sampled curricula, were independently reviewed and coded by two reviewers, after which the results were categorised into themes and subthemes. Then, these themes were further developed into more comprehensive themes and subthemes as a proposed educational framework through a literature review and discussions with a team of experts. Initially, four key themes emerged regarding the structuring of EAs in the reviewed curricula. The four key themes were: Academic Instruction, Experiential Learning, Self learning and Evaluation, and EAs framework design recommendation. Additionally, these reviews noted significant variations and a lack of congruence in the educational activities implemented by training programs. To address this variability, expert discussions were undertaken to refine and standardise the thematic structure. This resulted in the development of a comprehensive framework comprising five major themes: Academic Activities, Practice-based Learning, Skills Training and Procedures, Scholarly Project, and Professional and Personal Development. The integration of EAs into a cohesive structural framework better prepares trainees for clinical competency, professional behaviour, and practice readiness. The proposed framework provides a robust approach to implementing and evaluating competency-based postgraduate medical education programs.

Abstract Background Hashimoto’s thyroiditis (HT) and papillary thyroid microcarcinoma (PTMC) often coexist. Their relationship is paradoxical and unclear. Materials and Methods This retrospective study reviews 1,509 thyroidectomies from 2018–2025, focusing on PTMC cases compared with benign thyroidectomy controls to assess the link between PTMC and HT. Results 37% of PTMC cases have HT, versus 27% of controls. The odds ratio (OR) for PTMC among HT patients is 1.6 (95% CI: 1.046–2.46; p = 0.03), indicating an increased risk. The risk is higher in euthyroid HT, with 63% prevalence in PTMC vs. 12% in controls. The OR for PTMC in euthyroid HT is 13 (95% CI: 4.53–37.04; P < 0.0001). PTMC occurs at a younger age with HT (40 vs. 44; p < 0.05). HT with PTMC reduces lymph node metastasis (LNM) without affecting tumor size. The tumor immune microenvironment (TIME) differs: the immune-inflamed “hot” subtype is more common in HT, while the immune-desert (ID) subtype is more common in non-HT cases. The “hot” type is immunosuppressive and is associated with increased lymph node metastasis, particularly in non-HT-associated PTC. Conclusion Euthyroid HT is associated with increased PTMC risk, likely arising early in chronic inflammation before autoimmunity. The dominant “hot” TIME subtype appears immunosuppressive, suggesting a potential role for immunotherapy in PTC.

Cardiac implantable electronic devices (CIEDs) substantially improve outcomes in cardiac patients, but device-related infection can negate these benefits. Data on the epidemiology of CIED infections in Saudi Arabia are limited. We performed a multicenter retrospective cohort study of consecutive patients receiving CIEDs (pacemakers [PPM], implantable cardioverter-defibrillators [ICD], and cardiac resynchronization devices [CRT]) at three tertiary hospitals in Riyadh, Saudi Arabia, from January 2017 through December 2021. Patients were followed for at least one year post-implantation. Data collected included patient demographics, device type (new implant, replacement, revision), infection timing and microbiology, management (device extraction vs conservative treatment), and outcomes. Of 4080 CIED recipients, 114 (2.8 %) developed device infections (incidence 98.8 per 10,000 person-years). CRT-P (cardiac resynchronization therapy pacemaker) devices had the highest infection rate (7.7 %). Revision procedures carried higher infection rates than initial implants or generator replacements (10.0 % vs 2.1 % vs 2.7 %; P < 0.001). The most common pathogens were Staphylococcus aureus (30.1 %), coagulase-negative staphylococci (10.6 %), and Pseudomonas aeruginosa (8.8 %); 38.9 % of infections were culture-negative. Systemic infections and patients managed without device removal had significantly higher mortality (32.3 % vs 8.2 % for systemic vs pocket; 48.4 % vs 12.0 % for no extraction vs extraction; P < 0.001 for both). In this large Saudi cohort, CIED infection occurred in 2.8 % of patients, particularly following revision procedures and in CRT-P recipients. Infections were often culture-negative and associated with substantial mortality, especially in systemic cases or when devices were not removed. These findings highlight the importance of strict infection-prevention protocols, early recognition, and prompt complete device extraction to improve patient outcomes.

Clostridioides difficile is an opportunistic pathogen of the gastrointestinal tract that can cause illnesses ranging from diarrhea to pseudomembranous colitis. Recurrent Clostridioides difficile infection remains a major clinical challenge, with substantial relapse rates after standard antibiotic therapy. Emerging evidence suggests that rifaximin can be used after the conventional therapy to reduce risk of the recurrence. However, rifaximin resistance in Clostridioides difficile remains the primary concern. The aim of this systematic review and meta-analysis is to estimate the risk of rifaximin resistance in Clostridioides difficile infection and among different ribotypes. The search included PubMed, Scopus, Web of Science, and Cochrane Library for studies reporting rifaximin resistance in Clostridioides difficile isolates. After systematically screening 731 records from all databases and excluding 664 studies, a total of 67 studies were included in the meta-analysis. The findings of the meta-analaysis indicated a resistance rate of 15.1% (95%CI,12.0%-18.9%) for rifaximin and/or rifampicin and 12.8% (95%CI,8.8%-18.2%) for rifaximin alone. Ribotype-specific analysis revealed high rifaximin resistance in RT017(72.3%), RT027(47.0%), and RT018(20.9%), while RT012, RT002, RT112, and RT014/020 demonstrated low resistance. The study finding indicate that rifaximin/rifamycin resistance in Clostridioides difficile is concerning and not randomly distributed but is more frequently associated with certain ribotypes.

IntroductionDrowning is a leading cause of mortality in children worldwide. Near-drowning is a state of survival after asphyxia due to submersion in water. Drowning-related incidents have significantly increased in developed countries. Even survivors suffer from various long-lasting morbidities. Early prediction of mortality and morbidly life-threatening events is life-saving and guides decision-making in such critical situations. This study aimed to identify early predictors of mortality and other unfavorable outcomes (hypoxic brain injury and respiratory failure necessitating mechanical ventilation) in children diagnosed with near-drowning.MethodsThis retrospective cross-sectional study enrolled 247 children who nearly drowned and were admitted to National Guard Hospitals, Saudi Arabia, between 2,015 and 2024. The studied patients were categorized into two groups: patients with favorable outcomes and those with unfavorable outcomes. The all-subset regression method was employed to identify the best predictors for the investigated outcomes.ResultsThe death rate and incidence of brain insults constituted 15% each, while 25% of the investigated patients were complicated by respiratory failure. Most admissions (60%) occurred in the summer, and 86% of drownings occurred at swimming pools. Death was significantly associated with greater prehospital delay (time from exposure until arrival at emergency services) (p < 0.05). A proposed model that exhibited a performance of 92% identified the Glasgow Coma Scale score on admission as a significant predictor of brain insults. Significant predictors of mortality included lower bicarbonate levels [adjusted odds ratio (OR) = 0.598, p < 0.001], higher sodium levels (adjusted OR = 1.802, p < 0.001), lower chloride levels (adjusted OR = 0.721, p = 0.008), and greater red cell distribution width (adjusted OR = 2.158, p = 0.009).ConclusionThis study identified several available laboratory markers as early predictors of mortality in pediatric near-drowning patients. These markers help to identify patients at increased risk of life-threatening events when combined with established clinical predictors. This study emphasized the critical roles of prehospital factors, initial clinical presentation, and physiological derangements in pediatric near-drowning patients. The observed findings highlight possible areas accessible for public health interventions, including intensifying preventive measures at night, in the summer, and in swimming pools. Offering optimum on-scene resuscitation and rapid hospital transfer are other recommended actions expected to be associated with fewer adverse events.

[This corrects the article DOI: 10.3389/fpubh.2025.1713092.].

Overdentures provide better stability, retention, and patient comfort compared to conventional complete dentures, representing a significant advancement in removable prosthodontics. Their effectiveness is strongly influenced by the type of support, whether tooth-supported or implant-supported, as well as the chosen attachment system, including ball-bar-clip locators, telescopic mechanisms, and magnetic mechanisms. Mandibular implant overdentures in particular demonstrate high clinical predictability and remain the standard of care for patients with severe ridge resorption. This review evaluates the performance of overdentures by examining implant survival, mechanical and biological complication patterns, functional outcomes, and patient satisfaction. According to available data, implant overdentures greatly improve oral health-related quality of life while increasing bite force and masticatory efficiency. Long-term success requires taking into account attachment-specific maintenance requirements, such as the wear of bar components or the periodic replacement of nylon inserts in locator systems. To achieve similar results, maxillary overdentures may need extra implants or changes to the palatal design. The review also covers emerging trends influencing overdenture therapy in the future, clinical implications, and maintenance procedures. Clinicians can choose the best attachment systems to predict maintenance needs and enhance long-term treatment outcomes for edentulous patients by having a thorough understanding of these factors.

Introduction This case report describes the treatment of a 37‐year‐old male who presented in an orthodontic clinic with a protruded lower jaw and difficulty chewing with his front teeth. The case was treated by a clear aligner with an arch bar and orthognathic surgery. Also, this report describes alternative methods to facilitate maxillomandibular repositioning and stabilization. Method The treatment plan includes (1) presurgical alignment and leveling of the teeth by clear aligners (Eon), (2) insertion of the arch bar, (3) mandibular setback surgery, (4) postsurgical fixation using elastics and removal of the arch bar, (5) re‐evaluating the need for refinements or reusing the previous aligners, and (6) retention by using an upper Essix retainer and a lower fixed retainer from the canine to canine overlay by Essix retainer. The patient allowed personal data processing and informed consent was obtained. The informed consent was obtained from the patient. Result Correction of skeletal and dental Class III malocclusion was obtained (Class I canine in both sides). Midlines were corrected with positive overjet, and overbite and patient′s profile and facial balance were improved. Conclusion This treatment approach successfully met the patient′s demands and resulted in high levels of satisfaction with the treatment outcomes.

Ivermectin, a widely used antiparasitic drug, gained global attention during the COVID-19 pandemic for its proposed antiviral effects. This study explores how ivermectin research evolved between 2020 and 2025, identifying key trends, emerging topics, and thematic changes. A data-driven bibliometric and informatics-based analysis was conducted using the Scopus database. Original articles were examined through advanced co-citation, co-word, and bibliographic coupling techniques. We employed artificial intelligence-enabled clustering algorithms, including Walktrap and hierarchical models, using tools such as VOSviewer and Bibliometrix (R package), to explore the conceptual landscape and research dynamics. A total of 1,041 ivermectin-related articles were included. Research topics shifted from antiparasitic and veterinary uses to newer areas like COVID-19 treatment, drug repurposing, oxidative stress, and vector control. We identified 12 thematic clusters and six co-word clusters. Although citation impact declined after 2021, interest remained strong in molecular and pharmacological mechanisms. Key authors, journals, and studies were also identified. This is the first AI-enhanced bibliometric mapping of ivermectin literature in the post-pandemic era. The findings uncover underexplored but promising research directions-such as apoptosis, immunomodulation, and nanodelivery-and highlight the added value of machine learning tools in uncovering complex thematic transitions and research frontiers. This approach offers deeper insights than traditional bibliometric methods by uncovering nuanced thematic transitions through AI-powered clustering.

Pericoronitis is an inflammatory condition of the soft tissues surrounding a partially erupted tooth, commonly associated with the eruption of permanent molars. While it is more frequently reported in adolescents and adults, children are not exempt from its occurrence, particularly during the mixed dentition phase. In pediatric patients, the clinical presentation can vary widely, ranging from mild gingival discomfort to more severe symptoms such as swelling, trismus and lymphadenopathy. These manifestations are often misinterpreted as routine teething issues or gingivitis, leading to delayed recognition and management. The unique anatomical and behavioral factors present in children significantly influence the risk profile for pericoronitis. Immature gingival tissue, limited space for erupting molars, poor oral hygiene and uncoordinated brushing habits all contribute to the accumulation of debris and bacterial plaque beneath the operculum. Dietary habits rich in fermentable carbohydrates and insufficient caregiver awareness further heighten the risk. In some cases, systemic health conditions or immunosuppression may alter the inflammatory response, complicating diagnosis and prolonging healing. Management strategies in children must account for their developmental stage, level of cooperation and overall health. Conservative treatments such as irrigation, improved oral hygiene and analgesics are commonly effective in early cases. In more advanced or recurrent presentations, antibiotics or minor surgical interventions like operculectomy may be necessary. Laser-assisted procedures offer advantages in pediatric settings by minimizing discomfort and improving healing. Across all treatment options, preventive care and caregiver education are vital to reducing recurrence and improving outcomes. Understanding the clinical diversity, risk factors and treatment responses in children is essential for early detection and effective management of pericoronitis. Pediatric-focused approaches that integrate preventive strategies, timely intervention and interdisciplinary care can significantly reduce the burden of this condition during critical stages of dental development.