Psychological self-security and self-concept among Saudi epilepsy patients at a tertiary care center in KSA.

OBJECTIVE: While psychological issues in epilepsy patients have been studied extensively, the phenomena of self-concept and self-security have not been adequately addressed in such patients. Therefore, the aim of the current study is to assess the levels of psychological self-security and self-concept among Saudi epilepsy patients. METHODS: A case-control study was conducted on adult patients with epilepsy from the Epilepsy Monitoring Unit at King Fahad Medical City in Riyadh, Saudi Arabia. Healthy controls were obtained from the community. Demographic data including age, gender and education level were collected. Self-concept and self-security were assessed using validated scales. Descriptive statistics were obtained, and inferential testing was conducted. RESULTS: Data from 145 subjects was entered in the final analysis, including 100 patients with epilepsy and 45 controls (females = 32%). A significantly higher level of psychological insecurity was found in PWE (people with epilepsy) compared to controls. No significant difference was noticed on self-concept level between PWE versus controls. Education level was significantly lower in PWE than in controls. Those with higher education levels scored lower on psychological insecurity, although this effect disappeared when the data were split by health status. CONCLUSION: Level of psychological self-security was higher in PWE than controls, while no difference in self-concept was observed. This study highlights the areas of focus needed in epilepsy-related social services in order to improve the psychological wellbeing of patients with epilepsy.

Characteristics of Heat Illness during Hajj: A Cross-Sectional Study.

INTRODUCTION: Data regarding the characteristics and outcomes of heat illness are lacking in the literature. The present study aimed to identify the clinical characteristics, morbidity, management, and mortality associated with heat illness among Hajj participants. METHODS: A cross-sectional study was conducted during the Hajj in 2016 on patients who presented to emergency departments and were diagnosed with heat exhaustion or heatstroke. Data were collected using a structured collection sheet developed based on the literature. RESULTS: A total of 267 patients were recruited. Of these, 80 (29%) and 187 (67.75%) were diagnosed with heatstroke and heat exhaustion, with 6.3% and 0.0% mortality, respectively. The mean age of the patients was 54.0 ± 16 years. Diabetes mellitus was the most common comorbidity among both heatstroke and heat exhaustion patients. The majority of patients had hyperthermia and electrolyte imbalance. Most of the heat illness cases were treated per heat illness guidelines. CONCLUSIONS: Although authorities are working on research and forming interdisciplinary teams to prevent health problems during the Hajj, the mortality rate from heatstroke is high and the majority of the patients had hyperthermia, varied signs and symptoms, elevated creatinine levels, and electrolyte imbalances.

Knowledge, Attitudes and Perceptions of Saudis towards Participating in Clinical Trials.

AIM: To assess the knowledge, attitudes, and perceptions of Saudis towards participating in clinical trials (CTs). METHODS: A cross-sectional study was conducted on 232 Saudi adult patients and their companions visiting adult outpatient clinics at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected using a self-administered questionnaire based on information obtained from the literature. The questionnaire was divided into four sections, one covering the respondents' demographics, and the other three assessing knowledge, attitudes, and perceptions towards participating in CTs. RESULTS: A total of 148 (63.8%) respondents were males, and 52 (22.4%) participants had been invited to participate in a CT previously. Of those, 39 (75%) participated. Knowledge about the essential elements of informed consent ranged from 55.7% (number of participants needed) to 85.7% (confidentiality of personal information). The majority (163, 73.8%) of respondents was willing to participate in a CT after consulting their family physician and 130 (58.0%) respondents would be motivated to participate in a CT if they were healthy. Only 36.8% of the respondents believed that patients who participated in a CT received the best care. Moreover, 110 (48.7%) respondents believed that research was conducted in a responsible and ethical manner. CONCLUSIONS: The present study assessed the current understanding of CTs among Saudi participants. Although the majority of participants had an acceptable level of knowledge about CTs, they exhibited conditional attitudes and misperceptions towards participating in a CT. Increased patient awareness may improve patients' attitudes towards ethical conduct of CTs.

A comparison on the prevalence and outcomes of gestational versus type 2 diabetes mellitus in 1718 Saudi pregnancies.

The presence of either diabetes mellitus type 2 (DMT2) or GDM constitute a high-risk pregnancy. Given the high rate of DMT2 and GDM in the kingdom of Saudi Arabia (KSA), no study has ever compared whether GDM outcomes are comparable to those with DMT2. The present study aims to compare for the first time, maternal and neonatal outcomes among Saudi patients with GDM, DMT2 and non-DM groups. This is a retrospective study covering data from 1718 pregnant patients admitted at King Fahad Medical City, Riyadh, KSA from April 2011 to March 2013. The prevalence of GDM was 13.8%, DMT2 was 0.9%. DMT2 group had the highest mean parity and shortest mean gestational age as compared to other groups. Half of all the subjects in the DMT2 group also experienced preterm labor, as opposed to only 10% in GDM and 14% in the non-DM group, respectively. Finally, neonates delivered by DMT2 mothers had the highest percentage of admissions to NICU (33%) as compared to 10% in the non-DM group and only 5% in the GDM group. Outcomes of the GDM group are almost comparable with the non-DM group. While the results of the present study reflect the efficient management of GDM cases in Saudi patients, DMT2 complicated pregnancies, which are considered to be at a much higher risk for maternal and neonatal complications, should be given equally special attention.

Impact of the 2011 Revolution on Hospital Disaster Preparedness in Yemen.

OBJECTIVE: Hospitals are expected to serve the medical needs of casualties in the face of a disaster or other crisis, including man-made conflicts. The aim of this study was to evaluate the impact of the 2011 Yemeni revolution on hospital disaster preparedness in the capital city of Sana'a. METHODS: The study was conducted in September 2011 and 2013. For evaluation purposes, the hospital emergency response checklist published by the World Health Organization (WHO) was used. Additional information was also obtained to determine what steps were being taken by hospital authorities to improve hospital preparedness. RESULTS: The study selected 11 hospitals. At the time of the first evaluation, 7 hospitals were rated "unacceptable" for level of preparedness and 4 were rated "insufficient," receiving a WHO checklist rating of 10 to 98. At the second evaluation, 5 hospitals were rated "unacceptable," 3 "insufficient," and 1 "effective," receiving a rating of 9 to 134. CONCLUSIONS: Unfortunately, this study shows that between 2011 and 2013, no significant progress was made in hospital disaster preparedness in Sana'a. In a disaster-prone country like Yemen, the current situation calls for drastic improvement. Health system authorities must take responsibility for issuing strategic plans as well as standards, guidelines, and procedures to improve hospital disaster preparedness.

Prevalence and risk factors of hearing loss among infants in Jordan: initial results from universal neonatal screening.

OBJECTIVE: To determine the association of reported risk factors with hearing loss, and explore the possible contribution of other risk factors that may improve identifying Jordanian children for whom interventions should be provided. DESIGN: A cross-sectional study was performed in 37 hospitals and mother-child clinics from different health sectors in Jordan. The hearing screening protocol was performed in three stages. Data collected as risk factors for infant hearing loss included those on the 2007 Joint Committee on Infant Hearing list as well as other factors believed to be possibly significant. STUDY SAMPLE: All babies born in or attending any of these hospitals or clinics were screened for hearing loss, which included a total of 63 041. RESULTS: Of the 63 042 infants, 966 (1.5%) were confirmed to have significant hearing loss. We identified additional risk factors that were associated with hearing loss in infants. CONCLUSION: These preliminary data add to the understanding of the epidemiology of hearing loss in Jordan. The presence of at least one JCIH risk factor, admission to NICU for > 5 days, age, birth weight, postnatal hypoxia, and mode of delivery were independently associated with hearing loss.

Incidence of kidney stones with topiramate treatment in pediatric patients.

PURPOSE: We ran this study to assess the incidence of nephrolithiasis in a group of children on topiramate (TPM) therapy for at least 1 year. METHODS: In this retrospective observational surveillance study, we reviewed the medical charts of children on TPM for at least 1 year seen at the pediatric neurology department during the period from 2005 to 2010 at King Fahad Medical City. Children with a normal baseline ultrasound report were included. Follow-up ultrasound reports after at least 1 year were collected. However, patients with any evidence of chronic illness or medications that may affect the kidney functions in addition to those who are not compliant with the prescribed dose were excluded. Family history of renal stones, symptoms suggestive of urologic disorders, and comorbidities were recorded. KEY FINDINGS: Medical charts of 96 children on TPM with a mean age of 6.9 (±3.8) years were reviewed; 52 (54.2%) of the children were male. The follow-up ultrasound showed that five children (5.2%) had developed kidney stones. The occurrence of kidney stones was found in four female patients (80%) versus one male (20%) (p > 0.05). SIGNIFICANCE: Long-term use of TPM may result in increased incidence of asymptomatic kidney stones in the pediatric population. Hence, routine baseline and follow-up ultrasound of the urinary system should be recommended during the use of TPM in children.

Effects of estrogen and progesterone treatment on rat hippocampal NMDA receptors: relationship to Morris water maze performance.

Estrogen modulates NMDA receptors function in the brain. It increases both dendritic spine density and synapse number in the hippocampus, an effect that can be blocked by NMDA antagonist. In this study, we investigated the effect of 17beta-estradiol and progesterone treatment on NMDA receptors in ovariectomized rats. Two different doses were used for 10 weeks. Receptor autoradiography was done on brain sections using [(3)H] MK-801 as a ligand. Our results showed a significant increase in [(3)H] MK-801 binding in the dentate gyrus, CA3 and CA4 areas of the hippocampus of ovariectomized compared to sham operated rats. In addition, we observed similar changes in CA1. 17beta-estradiol treatment in both doses reduced the binding back to the normal level while progesterone treatment did not show any effect. Spatial reference memory was tested on Morris water maze task. Ovariectomy severely impaired spatial reference memory. Estradiol but not progesterone treatment significantly improved the memory performance of the ovariectomized rats. Low dose treatment showed better learning than high dose estrogen treatment. The decrease in the antagonist sites by estradiol treatment could result in an increase in the sensitivity of the hippocampus to the excitatory stimulation by glutamate system and hence the effect of estradiol on learning and memory. The changes of NMDA receptors in the hippocampus support the concept that estrogen-enhancing effect on spatial reference memory could be through the enhancing of NMDA function.

Ovariectomy and gonadal hormone treatment: effects on insulin-like growth factor-1 receptors in the rat brain.

Various studies demonstrate that estradiol regulates structure and function of adult neurons. Long-term effect of estradiol in terms of neuroprotection is less documented compared to short-term one. It is well documented that estradiol interacts with insulin-like growth factor-1 (IGF-I) in the brain. The present study examines the effect of ovariectomy and two doses of ovarian hormone treatment on IGF-I receptor density in the adult rat by receptor autoradiography using (125)I-IGF-I as a ligand. Our result showed that ovariectomy decreased IGF-I receptor density in hippocampus, hypothalamus and parietal cortex compared to that of the sham-operated group. Treatment with low or high dose estrogen restored IGF-I receptor density to the control levels in nearly all areas studied in this investigation. It seems that low dose estrogen has more pronounced effect than the high dose in restoring IGF-I receptor density. On the other hand, progesterone treatment in high but not in low dose restored IGF-I receptor density to that of the control. These results demonstrate that both estrogen and progesterone significantly affects IGF-I receptor density in different areas of the brain. These effects indicate a dose-dependent modulator effect of ovarian hormones on IGF-I activity in the brain.

Loss of muscarinic M4 receptors in spinal cord of arthritic rats: implications for a role of M4 receptors in pain response.

Changes in the levels of muscarinic M4 receptors in spinal cord of acute and chronic arthritic rats (animal models of pain) were studied by receptor autoradiography using muscarinic M4 receptor subtype selective ligand. Arthritis was induced in female Lewis rats by single intradermal injection of heat-killed Mycobacterium butyricum and sacrificed 12 days (acute group) and 30 days (chronic and control groups) after induction of arthritis. Our results demonstrate significant reduction in the level of M4 receptors in the spinal cord (Rexed laminae I-X) of acute and chronic arthritic rats compared to controls. These findings suggest that the muscarinic M4 receptor subtype may be involved in cholinergic mechanisms of analgesia.

Estrogen and progesterone treatment: effects on muscarinic M(4) receptor subtype in the rat brain.

We investigated the effect of ovariectomy (OVX) and hormonal treatment for 10 weeks by estradiol and progesterone on muscarinic M(4) receptor subtype in different brain areas of female rats. Moreover, motor activity of OVX and hormone-treated rats was measured by automated open field exploration boxes. Receptor quantification in the hippocampus, frontal cortex, parietal cortex, amygdala and hypothalamus was done by receptor autoradiography using a selective ligand for muscarinic M(4) receptors. Ovariectomy up-regulated M(4) receptors in the dentate gyrus, CA1, CA3, frontal cortex and hypothalamus whereas the estrogen treatment restored M(4) binding to that of the sham group. Progesterone treatment had no effect on the ovariectomy-induced up-regulation of M(4) receptors. Ovariectomy significantly decreased the exploratory activity of the rats compared to the sham group. Estrogen treatment restored the exploratory behavior of the ovariectomized rats to that of the sham group whereas the progesterone-treated rats were less alert to the surrounding when compared to the sham and estrogen supplemented rats. The effect of estrogen on the hippocampal muscarinic M(4) receptor subtype is a novel finding and may have functional significance for cholinergic receptors especially in relation to postmenopausal memory problems and neurodegenerative disease like Alzheimer's disease.