Marital status among patients with epilepsy in Saudi Arabia.

There are no adequate studies on Saudi Arabia regarding the effect of the social environment on marriage among people with epilepsy (PWE). To fill this gap in the literature, we investigated the marital status of PWE to determine the factors affecting their marital prospects. The subjects of the study included PWE aged 18 years or above, recruited between 1998 and 2019 from the Epilepsy Registry of King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We collected a wide range of socio-demographic data on age, gender, location, education level, employment status, and marital status. In total, 1857 PWE, comprising 1086 men (58.48%) and 771 women (41.52%), were enrolled in the study. The data analysis showed that those 'married' and those who 'had been married' comprised 46.96% of the sample, while those 'never married' comprised 53.04%; 65.37% of the sample held a 'high school diploma or less' or had 'no education', 26.85% reported ongoing university education or had already obtained a bachelor's or higher degree; 50.08% of the respondents were employed, while 47.98% were not. Of the sample, 40.28% resided in Riyadh, whereas 13.14% were from the Asir region. We found that socio-demographic factors, especially employment status, had a major influence on the marital prospects of PWE.

Patterns of antiseizure medication prescription in pregnancy and maternal complications in women with epilepsy: A retrospective study in Saudi Arabia.

Aim: To evaluate patterns of antiseizure medication (ASM) prescription in pregnancy and changes over a 16-year period: 2005-2020, and to investigate maternal complications in pregnant women with epilepsy (WWE). Method: Data of pregnant WWE was retrospectively reviewed at the King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah, Saudi Arabia. Results: Out of 162 pregnancies, 81.5% were prescribed ASMs. During the study period, the prescription rate increased from 68.8% to 93.5%. Between 2005 and 2020, the use of new ASMs increased from 15.4% to 75.5% (p < 0.0001). Furthermore, valproate use markedly decreased from 23.08% to 2.04%. The rate of maternal and delivery complications was 29.6%; the most frequent was gestational diabetes (5.6%), followed by bleeding during pregnancy (4.9%). Furthermore, preeclampsia and eclampsia were documented in 3.7% and 1.8%, respectively. ASMs use and other factors were not found to be associated with maternal complications (p > 0.05). However, first generation ASMs, i.e. carbamazepine (38.71%) and valproate (41.67%), were associated with higher maternal complication rates than new ASMs, i.e. levetiracetam (25%) and lamotrigine (20%), but the difference was not statistically significant (p = 0.4403). Conclusion: ASM prescription in pregnancy is increasing as is the use of new ASMs. The rate of maternal and delivery complications was relatively low, particularly preeclampsia and eclampsia. ASMs use was not found to associated with these complications. However, exposure to first generation ASMs seemed to be a predictor of adverse pregnancy outcomes.

Antiseizure medications use during pregnancy and congenital malformations: A retrospective study in Saudi Arabia.

AIM: To evaluate the incidence of congenital malformations in children exposed prenatally to antiseizure medications (ASMs), to assess other perinatal and fetal complications, and to determine the potential predictors for these complications. METHOD: A retrospective review of pregnancy outcomes of women with epilepsy. Patients were followed up at the King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah, Saudi Arabia, between Dec 1993 and Oct 2020. RESULTS: Of 162 pregnancies included, 10 (6.17%) congenital malformations were observed, 6.82% in ASM-exposed babies versus 3.33% in babies of epilepsy-untreated mothers (P = 0.69). The overall incidence of perinatal and fetal complications was 53%; most frequent were low birth weight (24%), preterm birth (19%), transfer to neonatal intensive care unit (18%) and abortion (8%). These complications were higher in the untreated group (66.67%) than in the ASM group (50%). The use of other non-antiseizure medications during pregnancy was the only factor that significantly increased the risk of complications. CONCLUSION: Prenatal exposure to ASMs was associated with increased risk of congenital malformations. However, overall perinatal and fetal complications were higher in the untreated group than in the ASM group, which could be explained by maternal seizures. Therefore, taking ASMs to control epilepsy and prevent perinatal complications may outweigh the risks of teratogenicity.

Epidemiology and Clinical Characteristics of People with Confirmed SARS-CoV-2 Infection during the Early COVID-19 Pandemic in Saudi Arabia.

This study provides epidemiologic and clinical characteristics of 492 consecutive patients diagnosed with SARS-CoV-2 infection at King Faisal Specialist Hospital and Research Centre in Saudi Arabia between March and September 2020. Data were collected from electronic case reports. The cohort was 54% male, with 20.4% aged >60 years, 19.9% aged 31−40 years, and 17% aged 41−50 years. The median incubation period was 16 days, with upper and lower 95% quartiles of 27 and 10 days, respectively. Most patients (79.2%) were symptomatic. Variables significantly different between symptomatic and asymptomatic patients were age, blood oxygen saturation percentage, hemoglobin level, lymphocyte count, neutrophil to lymphocyte (NTL) ratio, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level. Asymptomatic patients were mostly younger, with lower body mass index and ALT and AST levels but higher lymphocyte counts, NTL ratio, and CD4, CD8, natural killer cell, IgG, and IgM levels. Factors associated with increased risk of mortality were age (>42 years) and comorbidities, particularly diabetes mellitus and hypertension. Patients who were not given an antiviral regimen were associated with better prognosis than patients who received an antiviral regimen (HR, 0.07; 95% CI, 0.011−0.25). These findings will help clinicians and policymakers adopt best management and treatment options for SARS-CoV-2 infection.

Corneal Cross-Linking With Verteporfin and Nonthermal Laser Therapy.

PURPOSE: To test whether verteporfin with a nonthermal laser increases corneal mechanical stiffness and resistance to enzymatic degradation ex vivo. METHODS: Thirty human corneas (n = 5 per group) were treated with verteporfin alone (V), irradiated with nonthermal laser therapy (689 nm) alone (NTL), or received combined treatment of verteporfin with nonthermal laser therapy for 1 sequence (V+NTL1) or 6 sequences (V+NTL6) of 1 minute of NTL exposure. Positive controls were pretreated with 0.1% riboflavin/20% dextran every 3 to 5 minutes for 30 minutes and irradiated with ultraviolet light type A (λ = 370 nm, irradiance = 3 mW/cm) for 30 minutes using the Dresden protocol (R+UVA). Untreated corneas were used as negative controls. The corneal biomechanical properties were measured with enzymatic digestion, compression, creep, and tensile strength testing. RESULTS: V+NTL6- and R+UVA-treated corneas acquired higher rigidity and more pronounced curvature than untreated corneas. The stress-strain tests showed that V+NTL6 and R+UVA corneas became significantly stiffer than controls (P < 0.005). The V+NTL6 group seemed to be slightly stiffer than the R+UVA group, although the differences were not statistically significant. V+NTL6 corneas were found to have a significantly lower absolute creep rate (-1.87 vs. -3.46, P < 0.05) and significantly higher maximum stress values (7.67 vs. 3.02 P < 0.05) compared with untreated corneas. CONCLUSIONS: Verteporfin-NTL (V+NTL6) increases corneal mechanical stiffness and resistance to enzymatic collagenase degradation. Although a clinical study is needed, our results suggest that V+NTL6 induces corneal cross-linking and corneal biomechanical changes that are similar to those induced by standard corneal collagen cross-linking.

Ex Vivo Study of Transepithelial Corneal Cross-linking.

PURPOSE: To perform in vitro assessment of different techniques of transepithelial corneal cross-linking (CXL) and to compare the results to deepithelialized CXL. METHODS: Transepithelial CXL was performed after pre-treatment with or without penetration enhancers (gum cellulose, 0.44% sodium chloride, and 0.01% benzalkonium chloride) for 15 or 60 minutes. Deepithelialized corneas underwent CXL after pretreatment with riboflavin for 15 minutes, according to the Dresden protocol. All corneas were incubated in 0.3% collagenase A solution and the time to total dissolution was measured. Corneas were also imaged with confocal microscopy to evaluate the corneal epithelium, subbasal nerve plexus, and depth of stromal keratocyte nuclei as a means of measuring the depth of collagen CXL. RESULTS: Deepithelialized CXL corneas with 15 minutes of pretreatment dissolved after 15.4 ± 3.1 hours, significantly longer (P = .001) than deepithelialized untreated corneas (8.5 ± 0.6 hours). Transepithelial CXL corneas with 15 minutes of pretreatment with or without penetration enhancers dissolved after 8.3 ± 2.1 and 7.4 ± 1.6 hours, respectively. A longer pretreatment of 60 minutes with penetration enhancers resulted in greater resistance to degradation of the transepithelial CXL corneas (14.6 ± 2.2 hours), which was similar to deepithelialized CXL corneas. The results of the biological assay correlated well with the imaging results obtained by confocal microscopy. CONCLUSIONS: Corneas treated by transepithelial CXL with an extended pretreatment time of 60 minutes and penetration enhancers exhibited similar characteristics as corneas treated by the deepithelialized CXL approach. By confocal imaging, the transepithelial approach with extended pretreatment time demonstrated evidence of epithelial damage, which may have improved the treatment effect of this group. [J Refract Surg. 2017;33(3):171-177.].

Anterior chamber depth in normal subjects by rotating scheimpflug imaging.

PURPOSE: Anterior chamber depth (ACD) is an important preoperative parameter in anterior segment surgery. Several factors are known to influence ACD, including race and geography. Our purpose was to sample data from various countries to characterize differences in ACD worldwide and, if any, assess their level of clinical significance. SETTING: International, multicenter. METHODS: Cross-sectional study. Using the Pentacam Eye Scanner (OCULUS GmbH, Wetzlar, Germany), we analyzed ACD measurements from 1077 eyes of 568 normal adults from nine countries spanning six continents. Differences between countries were assessed by comparison of 95% confidence intervals and by ANOVA. Normative thresholds were constructed at three standard deviations (SD) above and below the mean. RESULTS: Mean ACD was 3.11 mm overall, ranging from 2.91 mm (New Zealand) to 3.24 mm (United States). The ACD among New Zealanders was significantly shallower (P < .0001) than that among Chinese, Egyptians, Germans, Indians, and Americans. The maximum difference in the mean ACDs was 0.33 mm, between New Zealand and the United States. The shallowest 0.15% of normal ACD values occurred below 2.04 mm overall, ranging from 1.69 mm (New Zealand) to 2.42 mm (United States). The deepest 0.15% of normal ACD values occurred above 4.18 mm overall, ranging from 4.03 mm (Saudi Arabia) to 4.35 mm (Brazil). CONCLUSIONS: ACD did not vary significantly in the countries studied, with the notable exception of New Zealand. Surgeons should anticipate a greater likelihood of a shallow ACD when evaluating patients from New Zealand. Clinical examination and direct measurement of ACD are recommended. Finally, deep ACD has limited clinical utility in screening for keratoconus.