Assessment of Knowledge, Perception, Experience and Phobia toward Corticosteroids Use among the General Public in the Era of COVID-19: A Multinational Study.

BACKGROUND: Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic conditions. To date, population-based studies on knowledge and attitudes concerning corticosteroids are scarce. This study aims to comprehensively assess knowledge, perception, experience and phobia toward corticosteroid use among the general population in the era of COVID-19. METHODS: A cross-sectional self-administrated questionnaire was used to collect the data from 6 countries. Knowledge and corticophobia scores, descriptive statistics and logistic regression were computed. RESULTS: A total of 2354 participants were enrolled in this study; the majority were females (61.6%) with an average age of 30. Around 61.9% had been infected previously with COVID-19, and about one-third of the participants had experience with corticosteroid use. The mean knowledge score was relatively satisfactory (8.7 ± 4.5 out of 14), and Corticophobia ranked a high score in all countries. Age, female gender, and history of COVID-19 were positively correlated with developing corticophobia. CONCLUSION: Our study highlights that the general knowledge about steroids was satisfactory. However, the phobia toward its use upon indication is high. Therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia.

Opinion article: Neurosurgical treatment for neuro-ophthalmologic conditions.

A significant role of the neuro-ophthalmologist is to counsel patients on appropriate management and anticipated visual prognosis for conditions affecting the afferent and efferent visual systems, including those requiring neurosurgical treatment. However, the literature regarding anticipated neuro- ophthalmologic prognosis after neurosurgical intervention for cerebral aneurysms, sellar lesions, optic pathway tumors, and elevated intracranial pressure is limited with many key questions unanswered. For example, if a cerebral aneurysm is equally amenable to clipping or endovascular coiling, is there a preferred approach in terms of visual prognosis based on aneurysm location? Is dural venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) superior, equivalent or inferior to shunting in terms of visual recovery and safety profile? Landmark studies on pituitary tumors using pre-operative optical coherence tomography (OCT) imaging of the optic nerve head to predict visual recovery after surgical decompression of the optic chiasm have changed neuro-ophthalmologic practice and enabled patients to be better informed regarding expected visual outcomes. 1,2 In order to optimize an interdisciplinary team approach to patient care, further studies of visual outcomes for neuro- ophthalmologic conditions requiring neurosurgical intervention are needed.

Current developments in the diagnosis and treatment of giant cell arteritis.

Giant cell arteritis is the most common vasculitis in adults above 50 years old. The disease is characterized by granulomatous inflammation of medium and large arteries, particularly the temporal artery, and is associated acutely with headache, claudication, and visual disturbances. Diagnosis of the disease is often complicated by its protean presentation and lack of consistently reliable testing. The utility of color doppler ultrasound at the point-of-care and FDG-PET in longitudinal evaluation remain under continued investigation. Novel techniques for risk assessment with Halo scoring and stratification through axillary vessel ultrasound are becoming commonplace. Moreover, the recent introduction of the biologic tocilizumab marks a paradigm shift toward using glucocorticoid-sparing strategies as the primary treatment modality. Notwithstanding these developments, patients continue to have substantial rates of relapse and biologic agents have their own side effect profile. Trials are underway to answer questions about optimal diagnostic modality, regiment choice, and duration.

Evaluation of hepatitis B knowledge, practices, and beliefs among the Jordanian population: A cross-sectional study.

This study aimed to assess the knowledge, practices, and beliefs among the Jordanian population regarding hepatitis B virus (HBV) infection. A cross-sectional questionnaire was designed and used to recruit participants from October 5th through December 12th. Statistical analysis was conducted using SPSS. Descriptive statistical analysis was used to analyse the sociodemographic data, the Shapiro-Wilk test was used to assess the normality, Cronbach's α was used to evaluate the reliability of the questionnaire and Point-biserial correlation was used to figure out whether there is an association between Score of knowledge and the dichotomous variables. A random sample of 432 participated in the study. The majority were females (n = 310, 71.8%), the mean age was 21 (42.0%) years,416 (96.3%) were urban inhabitants and most of them (n = 351, 81.3%) had bachelor's degree. School/university (n = 280, 64.8%) were reported as a major source of information followed by TV/internet/social media 276 (63.9%). The total mean (± SD) of knowledge score regarding HBV infection symptoms, transmission modes and treatment was found 12.28 ± 3.2. Participants' knowledge regarding symptoms including nausea, vomiting and loss of appetite was 73 (16.9%). More than 80% had good knowledge regarding the complications of HBV infection. Only 100 participant reported vaccination (23.1%) against the virus. Poor knowledge and low vaccination rate against HBV were found thus implementing comprehensive educational program for people highlighting the importance of vaccination against the virus is crucial.

Perceptions of COVID-19 symptoms, prevention, and treatment strategies among people in seven Arab countries: A cross-sectional study.

BACKGROUP: the widespread COVID-19 infection worldwide has resulted in the inability of healthcare facilities to receive all infected patients; therefore, most are treated at home. In addition, factors such as high mortality, types and severity of symptoms, and the prevalence of unreliable information have prompted patients to resort to self-treatment. OBJECTIVES: To assess prevention, treatment, degree of symptoms, and sources of information among patients with COVID-19 in Arab countries METHOD: A cross-sectional study was conducted in seven Arab countries: Algeria, Egypt, Iraq, Lebanon, Libya, Tunisia, and the United Arab of Emirates. People who have recovered from COVID-19 completed the study questionnaire. Score of symptoms during and after COVID-19 infection has been calculated by giving the participants a list of 13 symptoms. RESULTS: A total of 3519 participants completed the survey. Mostly females (68.3%), and aged between 18 and 40 years old (59.4%). Prophylaxis treatments, including vaccines and antibiotics, have been used in around 40% of the participants. The total average score of symptoms during the infection period was found 7.31 ± 3.66 out of 13. However, the symptoms score upon recovery was low (0.48 ± 1.11 score). The significant associations with increased incidence of symptoms during infection were reported with older people, married, divorced or widowed, people with chronic diseases, and obese. Moreover, significant associations with decreased symptoms were reported with those who worked in the health sector, non- or ex-smokers, and vaccinated people. CONCLUSION: The use of medication and other treatments to prevent infection with COVID-19 was common among the participants in the seven countries. Taking the vaccine was the only effect on the number of symptoms experienced by patients. Although nearly two years have passed since the onset of the disease, there is still a need to raise treatment awareness among patients at home.

The era of E-learning from the perspectives of Jordanian medical students: A cross-sectional study.

Introduction: Online learning is becoming a crucial part of the educational process worldwide, especially after the recent COVID-19 pandemic. This study was designed to assess medical students' perception toward online learning and their perceived preparedness and barriers during the COVID-19 pandemic. Methods: An electronic-based, cross-sectional survey was used to recruit eligible students in Pharmacy, Doctor of Pharmacy, Medicine, Nursing, Dentistry, and Veterinary Medicine programs at various Jordanian universities (public and private). Descriptive and linear regression analysis were conducted using S.P.S.S. software. The perception score was calculated based on a 5-point Likert scale. Results: A total of 939 students agreed to participate in this study. The prominent category was females (n = 691, 73.6%), the median age of students was 22.0 years (IQR = 2.0), and around 56% of the students study in private universities (n = 520, 55.6%). More than half of the students reported that their experiences were unsatisfactory or very unsatisfactory (n = 510, 54.3%). The majority of students preferred face-to-face communication with their professors and colleagues and considered it more effective (n = 682, 72.6%). The median of the mean perception score was 2.4 (IQR = 1.1). Regarding challenges and barriers, more than 70% reported weak internet connection, E-learning boredom, and lack of motivation (n = 723, 77.0%). Conclusion: This study reported inadequate satisfaction and perception towards the current experience in E-learning during the COVID-19 pandemic. It also discussed the barriers and challenges hindering this transition, such as weak internet connection and the lack of motivation, indicating a need for implementing new pedagogies to enhance students' experiences regarding online education.

Biallelic Optic Atrophy 1 (OPA1) Related Disorder-Case Report and Literature Review.

Dominant optic atrophy (DOA), MIM # 605290, is the most common hereditary optic neuropathy inherited in an autosomal dominant pattern. Clinically, it presents a progressive decrease in vision, central visual field defects, and retinal ganglion cell loss. A biallelic mode of inheritance causes syndromic DOA or Behr phenotype, MIM # 605290. This case report details a family with Biallelic Optic Atrophy 1 (OPA1). The proband is a child with a severe phenotype and two variants in the OPA1 gene. He presented with congenital nystagmus, progressive vision loss, and optic atrophy, as well as progressive ataxia, and was found to have two likely pathogenic variants in his OPA1 gene: c.2287del (p.Ser763Valfs*15) maternally inherited and c.1311A>G (p.lIle437Met) paternally inherited. The first variant is predicted to be pathogenic and likely to cause DOA. In contrast, the second is considered asymptomatic by itself but has been reported in patients with DOA phenotype and is presumed to act as a phenotypic modifier. On follow-up, he developed profound vision impairment, intractable seizures, and metabolic strokes. A literature review of reported biallelic OPA1-related Behr syndrome was performed. Twenty-one cases have been previously reported. All share an early-onset, severe ocular phenotype and systemic features, which seem to be the hallmark of the disease.

COVID-19 and role of pharmacists: Knowledge and perceptions of pharmacists from Iraq and Syria.

Objectives: To assess pharmacists from Syria and Iraq on their knowledge, readiness, and perspectives on their roles during the COVID-19 pandemic. In addition to investigate pharmacists' perceived barriers towards delivering their emergency roles during the COVID-19 pandemic and perceived policymakers' responsibilities. Methods: This cross-sectional study design was conducted in Iraq and Syria during COVID-19 outbreak over one month (April 2020). The study objectives were addressed through a validated online questionnaire. Data was analyzed using statistical package for social science (SPSS). Results: A total of 916 individuals participated in this study (447 from Iraq and 439 from Syria). Most of Iraqi participants were students while most of Syrian participants were graduates and technicians. The mean age for the Iraqi participants was 22.5 (SD= 4.1) while the mean age for the Syrian participants was 28.7 (SD= 9.1). A significant difference (p< 0.001) was found in following the latest coronavirus updates on management among pharmacy graduates and technicians and undergraduate students. Media was reported as the most used source for knowledge about epidemics/pandemics among the Iraqi and the Syrian participants. Around 72% strongly agreed/agreed that the faculties of pharmacy have a role in preparing them to deal with epidemics/pandemics. In addition, 64.3% strongly agreed/agreed that pharmacist associations and societies have a role in preparing them to deal with epidemics/pandemics such as the coronavirus. Moreover, 82.9% believed that pharmacists should receive training programs on how to provide mental health support for people during epidemic and pandemic outbreaks. Conclusion: Tertiary pharmacy education providers and pharmacy professional bodies have a strong role in preparing pharmacists to deal with pandemics. Therefore, the importance of providing beforehand training programs on epidemics/pandemics management, workshops, lectures, and online information resources for such circumstances is crucial for pharmacists.

Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan.

BACKGROUND: The relationship between smoking and coronavirus disease-2019 (COVID-19) is still topical with mixed epidemiological evidence. However, the pandemic may affect people's beliefs toward smoking as well as their smoking behavior and quit intentions. Considering high smoking rates in Jordan, our current study aimed to assess the following domains in a community-based sample from Jordan: (i) the beliefs that surround smoking/vaping and COVID-19 and (ii) the pandemic impact on smoking behavior and quit intention. METHODS: A cross-sectional study was conducted in Jordan from March 9 to March 16, 2021, utilizing a web-based structured questionnaire. The questionnaire comprised 13 items on sociodemographic, health, and smoking profiles, 14 items to assess beliefs surrounding COVID-19 and the use of combustible cigarettes (CCs), waterpipe (WP), and electronic cigarettes (ECs), and 12 items to assess the pandemic impact on smoking behavior and quit intention. RESULTS: Of 2424 survey respondents who participated in our study, there were 1163 never-smokers, 1044 current smokers, and 217 ex-smokers. The mean age of participants was 35.2 years (SD: 11.06). Most participants have reported anti-smoking beliefs with around 72.9% believed that WP smoking is related to the risk of contracting COVID-19. Also, 71.7% believed that smoking CC may worsen the COVID-19 clinical course, while 74.1% of respondents believed that smoking has no protective effect against COVID-19. During the pandemic, about 28.1% and 19.3% of current smokers reported increased or reduced smoking, respectively. Besides, 459 current smokers have expressed their plans/intention to quit smoking during the pandemic, of whom 27.5% (n = 126) confirmed that the driving force for their decision is a COVID-19-related reason, such as self-protection (n = 123) and protection of family members (n = 121) which were the most cited reasons. Also, around 63 participants have successfully ceased smoking during the pandemic. However, only 22 of them reported that the main driving motivation of their successful quit attempt was the COVID-19 pandemic. CONCLUSION: Most participants' beliefs and attitudes were against smoking during the pandemic. Nevertheless, the double-edged effect of the pandemic on smoking habits should be carefully considered, and reliable anti-smoking measures should be strengthened and sustained in the country.

Perspectives of psychiatric patients in rural areas of Jordan: Barriers to compliance and pharmacist role.

BACKGROUND: Successful management of psychiatric disorders is affected by patient perspectives and several barriers, that is, conceptual, psychological, social, or logistic reasons that can decrease patient adherence to therapy. In this perspective, pharmacists have a vital role in identifying patients in need of help and in dealing with barriers. OBJECTIVE: The aim of this study was to investigate perspectives of patients diagnosed with psychiatric disorders, living in rural areas in Jerash, Jordan, regarding their awareness about their conditions, including religious and cultural factors, adherence to their treatment and related barriers, with special focus on pharmacist's role. METHODS: This cross-sectional survey study was conducted in Jordan from August to November 2019. A validated questionnaire was administered by two pharmacy students via a structured interview with patients waiting for their appointment in the psychiatric clinic. Data were analysed using the Statistical Package for the Social Sciences. RESULTS: One hundred twenty patients (age 39.4 ± 9.5, 66.7% males) completed the questionnaire. Most of them (71.0%) reported adherence to their medications, and 47.5% reported complete control of their symptoms with treatment. Most patients (59.2%) reported that they perceive their psychiatric problem in terms of religious faith as being counted for their favour in the Hereafter, and 52.5% of them always/usually looked at themselves positively and unaffected by their psychiatric problem; with both factors correlating significantly with better treatment adherence (P < .045 and P < .001; respectively). Barriers affecting adherence included mainly suffering from adverse effects (31.9%) and being unconvinced that they needed a medication (23.3%). Only 14.2% of patients reported that they refer to the pharmacist to get information about their medications. CONCLUSION: This study shows suboptimal symptom control of psychiatric patients in Jerash. Nonadherence is an issue, with barriers identified. Positive religious and self-image perspectives correlated with better adherence. Patient referral to pharmacists is minimal and needs to be optimised.

Corticosteroid Usage in Giant Cell Arteritis.

Giant cell arteritis (GCA) is a condition that can cause irreversible visual loss if untreated. While corticosteroids remain the mainstay of treatment to prevent visual loss, the type, dose, route, and duration of corticosteroid treatment of GCA remain controversial. Our study surveyed neuro-ophthalmologists to determine commonly prescribed dosages of corticosteroids for the treatment of GCA with or without visual loss. For patients with acute visual loss, 52% would use intravenous (IV), 46% would use IV or oral and 2% would use oral corticosteroids. Seventy-three per cent would use 500 to 1000 mg IV methylprednisolone in this group. For patients with GCA without acute visual loss, 67% would use the oral route, 30% would use IV or oral, and 3% indicated they would use IV route of treatment. Seventy-five per cent would use 1.0 to 1.5 mg/kg oral prednisone in this group. Our results suggest a majority but not a complete consensus for route and dose of corticosteroid treatment in GCA and confirm conventional recommendations for high dose IV corticosteroids for GCA with visual loss and lower dose oral regimens for GCA without visual loss.

Restricted Diffusion in the Optic Nerve Head After Shock-Induced Anterior Ischemic Optic Neuropathy.

ABSTRACT: Shock-induced anterior ischemic optic neuropathy (SIAION) is a known type of optic neuropathy in patients who experienced shock related to different etiologies such as anemia and severe intradialytic hypotension like in our patient. Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute unilateral known type of optic neuropathy in older patients with vasculopathic risk factors such as hypertension, diabetes mellitus, and obstructive sleep apnea. Although SIAION and NAION are similar optic neuropathies due to ischemia and, in particular, hypotension, they may have different pathogenic mechanisms (e.g., acute shock or intradialytic hypotension vs nocturnal hypotension), laterality (e.g., unilateral vs bilateral), and severity (e.g., light perception or worse vision). We presented a case with restricted diffusion on the apparent diffusion coefficient and the diffusion weighted imaging confined to the optic disc head in a patient with pallid edema after intradialytic hypotension. Although DWI of the optic nerve is neither 100% specific nor 100% sensitive for ischemia, we believe that restricted diffusion of the optic nerve head in our case is a clinico-radiologic correlate to pallid edema in SIAION.

Localizing Thalamomesencephalic Afferent and Efferent Pupillary Defects.

ABSTRACT: A 42-year-old Algerian man presented for binocular oblique diplopia, hypersomnolence with drop attacks, bilateral hearing loss, and thoracic pain. He had a right thalamomesencephalic hemorrhage due to an underlying cavernous malformation treated with subtotal surgical resection. On neuro-ophthalmic examination, the patient had a left relative afferent pupillary defect and a right oculosympathetic efferent pupillary defect (i.e., Horner syndrome) in addition to other thalamomesencephalic eye and neurologic signs (right fourth nerve palsy, hearing loss, hemiparesis, and thalamic pain). Clinicians should recognize the localizing value of this unique constellation of mesencephalic afferent and efferent pupillary defects.

Bilateral Scalp Necrosis in Giant Cell Arteritis.

ABSTRACT: Giant cell arteritis (GCA) is a medium-to-large vessel vasculitis of the elderly. Common constitutional clinical features include headache, scalp tenderness, and jaw claudication. Severe unilateral or bilateral visual loss is the most feared ophthalmic complication of GCA. Scalp necrosis is a known ischemic complication of GCA with approximately 100 cases reported in the literature to date. We report a case of scalp pain and an erythematous cutaneous lesion in the distribution of ophthalmic division of the trigeminal nerve that mimicked herpes zoster ophthalmicus. A temporal artery biopsy was positive for GCA, and small vessel arteritis was seen at the time of simultaneous skin biopsy. To the best of our knowledge, this is the first such report in the English language ophthalmic literature.

The sign of the cross.

Acute, painful, transient, right-sided, monocular visual loss lasting 4 hours developed in a 46-year-old man. This was followed by headache and left-sided transient hemiparesis. The association of ipsilateral transient vision loss with transient contralateral hemiparesis implicates involvement of the ipsilateral internal carotid artery (i.e., a crossed symptom).