Assessing the Anxiety and Knowledge about Monkeypox Virus: A Cross-Sectional Cohort Study.

Introduction Recent cases of human monkeypox virus (MPXV) infections have raised global health concerns, as sporadic instances have occurred in various regions, prompting investigations into the potential for increased transmission. This underscores the importance of effective communication strategies in addressing the emerging challenges associated with this viral ailment. The study was conducted to understand public anxiety and knowledge related to MPXV infection, particularly in the context of emerging infectious diseases. Our aims included assessing anxiety levels and knowledge about monkeypox infection among the Saudi population, as well as their willingness to receive vaccinations if available. Methods A cross-sectional cohort study among the adult Saudi population was conducted. A questionnaire with four sections, including demographic data and disease knowledge, comprised optimized questions of the standard generalized anxiety disorder assessment (GAD-7) as well as questions related to acceptance of getting the vaccine if it could be afforded. Results Out of a total of 5298 participants, 927 (17.5%) showed different degrees of GAD-7 anxiety. Females showed a significantly higher rate of anxiety (487/2189, 22.2%) than males (440/3109, 14.2%). People aged 46 to 55 and >55 years old showed significantly higher rates of anxiety (30.7% and 27.2%). There is an overall decrease in knowledge and awareness about the MPXV. Interestingly, 59% of the participants admitted that they would get the MPXV vaccine if it were made available. There was a positive correlation between the anxiety level and the response of people toward the MPXV vaccine if it were available. Conclusion Our study underscores a significant level of anxiety and a notable lack of awareness concerning MPXV infection. Although a substantial number of participants expressed their willingness to receive an MPXV vaccine, our findings emphasize the pressing need for improved public education and awareness campaigns to alleviate anxiety levels and enhance understanding of this infectious disease. This effort is crucial for mitigating health concerns and facilitating well-informed decision-making among the Saudi population.

Successful removal of a congenital fibrovascular pupillary membrane in 2 cases with variable age at presentation and sparing of the crystalline lens.

INTRODUCTION AND IMPORTANCE: Congenital fibrovascular pupillary membranes (CFPMs) represent a rare poorly understood condition that has been sporadically reported in the literature. The presence of such a membrane can cause pupillary block and further complications, therefore must be properly diagnosed and managed. CASE PRESENTATION: We are presenting the successful treatment of 2 cases with CFPM. The first patient presented 2-days after birth with an absent red reflex and had a less complicated clinical course. The second presented at a later age of 5-months and was referred as a case of congenital cataract. This baby had associated pupillary block glaucoma. Each of these cases was managed surgically by membrane peeling with sparing of the lens, which was found to be clear in the second case. DISCUSSION: Even though CFPM has been rarely reported, it should be correctly identified since it can progress with the development of glaucoma and lens changes. The etiology of CFPM is not well understood but might be related to the presence of ectopic iris tissue, which was suspected as an etiology in our second case. Several techniques have been described to remove the membrane, and occasionally this might necessitate removal of the lens. We described successful removal of CFPM in 2 cases without affecting the crystalline lens. CONCLUSION: General Ophthalmologists and Pediatricians should be aware of CFPM, especially when dealing with an absent or dull red reflex in a newborn. Referral for definitive diagnosis and treatment is essential to preserve vision.

EMS operation in a female restricted university, Saudi prospective.

This paper was written to explain the process and steps and to describe the experience with building a women-only operated collegiate emergency medical service (EMS) system in the largest women-only university in the world. To the best of the authors' knowledge, the EMS system described in this report is the first collegiate EMS system in the Gulf region. The concept of the collegiate EMS system at the university, the factors that mandated the creation of this system, the process steps, the challenges faced, and, finally, the reported outcome have been evaluated. The women-only campus conferred unique challenges and additional pressure during the planning and implementation stages of this project; our system had helped in decreasing response time to medical emergency, provided back up support during mass gathering events in the university, and helped in decreasing the load on other national EMS services.

Mini-thoracotomy vs. conventional sternotomy mitral valve surgery: a systematic review and meta-analysis.

INTRODUCTION: Minimal access mitral valve surgery (mini-MVS) approaches are becoming increasingly common. They are thought to be associated with less perioperative bleeding and postoperative pain, resulting in shorter hospital length-of-stay (LOS) and faster return to daily activities. However, there are concerns that this approach may have inferior surgical results - with resultant increases in morbidity and mortality - when compared to conventional mitral valve surgery. To address this gap in the literature, we undertook a systematic review and meta-analysis, comparing right thoracotomy mini-MVS (MT-MVS) to conventional mitral valve surgery using a median sternotomy (sternotomy-MVS) approach. EVIDENCE ACQUISITION: We searched the Cochrane Library, MEDLINE, PubMed, EMBASE and Clinicaltrials.gov for randomized trials comparing MT-MVS to sternotomy-MVS in adults. Outcomes of interest were mortality, stroke, hospital length of stay, bleeding, cardiopulmonary bypass (CPB) and cross-clamp times. Studies reporting reoperation data were excluded. References were screened independently and in duplicate, and studies deemed to be potentially relevant were evaluated for inclusion by full-text review. Risk of bias was assessed using the Cochrane tool. Extracted outcome data were pooled for meta-analysis using RevMAN 5.3. The overall quality of evidence for each outcome was evaluated using the GRADE framework. EVIDENCE SYNTHESIS: Three trials including 280 patients met eligibility criteria. Studies were considered to be at high risk of bias due to lack of blinding and small number of patients. Pooled results showed no significant difference in mortality (RR 0.50, 95% CI [0.05 to 5.39], low quality) or stroke (RR 0.50, 95% CI [0.05 to 5.39], low quality). Technique-related outcomes were also similar: cardiopulmonary bypass (CPB) time (MD 17.72 minutes, 95% CI [-7.22 to 42.67), very low quality), cross-clamp time (MD 5.31 minutes, 95% CI [-14.35 to 24.96), very low quality), and bleeding (MD -148.95 mL, 95% CI [-491.02 to 193.12), low quality). Length of stay was significantly shorter in the mini-MVS group (MD -1.89 days, 95% CI [-3.57 to -0.22], P=0.03, low quality). CONCLUSIONS: MT-MVS does not result in increased morbidity and mortality or procedural duration, and may decrease hospital LOS. Our preliminary results suggest that MT-MVS is a safe and potentially beneficial approach to the surgical management of mitral valve disease. However, current evidence is of low quality and larger, more methodologically rigorous randomized trials are required.

Augmented asymmetrical visual field dependence in asymptomatic diabetics: evidence of subclinical asymmetrical bilateral vestibular dysfunction.

BACKGROUND: Diabetes negatively affects the vestibular system in many ways, with vestibular dysfunction (VD), a co-morbidity with a high prevalence in diabetics. PROCEDURES: The ability to perceive subjective visual vertical (SVV), as a sign of vestibular dysfunction, and visual field dependence was measured using a computerized rod and frame test (CRAF). Alignment errors recorded from 47 asymptomatic Type II diabetics (no vertigo or falls, without peripheral neuropathy or retinopathy) were compared to 29 healthy age matched (46-69years) controls. FINDINGS: Visual field dependence was significantly larger and more asymmetrical in the diabetics than controls. In the absence of any visual references, or when a vertical reference frame was provided, SVV perception was accurate in both groups, with no significant difference between the controls and diabetics. During tilted frame presentations, the proportion of subjects with either SVV deviations, or an asymmetry index, larger than an upper limit derived from the control data was significantly greater in diabetics than controls. CONCLUSION: These results suggest that the decreased ability to resolve visuo-vestibular conflict in asymptomatic diabetic patients (free of retinopathy and peripheral neuropathy) compared to controls may be related to diabetic complications affecting vestibular structures and thus causing a decompensation of subclinical vestibular asymmetries.

A prospective, randomised comparison of probing versus bicanalicular silastic intubation for congenital nasolacrimal duct obstruction.

PURPOSE: To compare the success rates of probing versus bicanalicular silastic intubation as the primary treatment for congenital nasolacrimal duct obstruction (CNLDO) in children ≥1 year old. STUDY DESIGN: Prospective, randomised, comparison. METHODS: Participants were randomised to undergo probing or bicanalicular silastic intubation. In bilateral cases, the right eye was used for analysis. The procedure was considered successful when all preoperative manifestations disappeared with normal dye disappearance test and a positive Jones primary dye test at least 6 months postoperatively. Secondary outcomes were risk factors for failure. Outcomes were compared between treatments with p<0.05 indicating statistical significance. RESULTS: 207 eyes of 181 children between 1 and 8 years old with CNLDO who had not undergone previous surgical treatment were included in the study. 88 eyes underwent probing with a 84.1% success rate and 93 eyes that underwent bicanalicular silastic intubation had a 89.2% success rate (p=0.429). For simple CNLDO, there was a 94.2% (65/69) success rate with probing and a 90.9% (60/66) success rate with bicanalicular silastic intubation (p=0.687). In complex CNLDO, there was a 47.4% (9/19; p=<0.001) success rate with probing and an 85.2% (23/27; p=0.419) success rate with silastic intubation (p=0.016). Age was not a risk factor for failure in either procedure. CONCLUSIONS: Probing for simple CNLDO in young children is adequate. Bicanalicular silastic intubation seems to have a role in achieving successful outcomes in complex CNLDO.

Partial duplication of chromosome 19 associated with syndromic duane retraction syndrome.

BACKGROUND: To evaluate possible monogenic and chromosomal anomalies in a patient with unilateral Duane retraction syndrome, modest dysmorphism, cerebral white matter abnormalities, and normal cognitive function. MATERIALS AND METHODS: Performing high-resolution array comparative genomic hybridization (array CGH) and sequencing of HOXA1, KIF21A, SALL4, and CHN1 genes. RESULTS: The proband had unilateral Duane retraction syndrome (DRS) type III on the right with low-set ears, prominent forehead, clinodactyly, and a history of frequent infections during early childhood. Motor development and cognitive function were normal. Parents were not related, and no other family member was similarly affected. MRI revealed multiple small areas of high signal on T2 weighted images in cerebral white matter oriented along white matter tracts. Sequencing of HOXA1, KIF21A, SALL4, and CHN1 did not reveal any mutation(s). Array CGH showed a 95 Kb de novo duplication on chromosome 19q13.4 encompassing four killer cell immunoglobulin-like receptor (KIR) genes. Conclusions. KIR genes have not previously been linked to a developmental syndrome, although they are known to be expressed in the human brain and brainstem and to be associated with certain infections and autoimmune diseases, including some affecting the nervous system. DRS and brain neuroimaging abnormalities may imply a central and peripheral oligodendrocyte abnormality related in some fashion to an immunomodulatory disturbance.

Childhood microbial keratitis.

PURPOSE: To evaluate risk factors for pediatric microbial keratitis and to describe the clinical picture, microbial spectrum, treatment modalities, posttreatment sequelae, and visual outcome in cases with pediatric microbial keratitis. MATERIALS AND METHODS: All cases of microbial keratitis that occurred in children 16 years or younger who had an initial examination between January 2000 and December 2010 at a tertiary referral eye hospital in Riyadh, Saudi Arabia, were identified. A retrospective review of medical records was conducted using a computer-based diagnosis code. Demographic data, predisposing factors, clinical course, microbial culture results, and visual outcomes were recorded. RESULTS: Sixty-eight eyes were included in this study. Predisposing factors were identified in 63 eyes (92.6%). All patients had unilateral microbial keratitis. The mean±SD age was 4.5 ± 4.8 years and 57.4% were male. Trauma was the leading cause [27 eyes (39.7%)], followed by systemic diseases [14 eyes (20.6%)], contact lens wear [11 eyes (16.1%)], and ocular diseases [11 eyes (16.1%)]. Corneal scraping was performed in all cases. Five patients needed general anesthesia to carry out the corneal scraping. Thirty-four (50.0%) eyes showed positive cultures. Gram-positive bacteria accounted for 67.8% and gram-negative bacteria for 38.2% of isolates. Streptococcus pneumoniae was the most commonly isolated organism [8 eyes (25.8%)], followed by Staphylococcus epidermidis [7 eyes (22.7%)]. Pseudomonas aeruginosa was the most commonly isolated gram-negative [6 eyes (17.6%)] organism. One eye had corneal perforation and required surgical intervention. Forty-five of 68 eyes (66.2%) had a best-corrected visual acuity evaluation at the last follow-up and 28 eyes (62.2%) of them had a best-corrected visual acuity of 20/40 or better. CONCLUSION: Children with suspected microbial keratitis require comprehensive evaluation and management. Early recognition, identifying the predisposing factors and etiological microbial organisms, and instituting appropriate treatment measures have a crucial role in outcome. Ocular trauma was the leading cause of childhood microbial keratitis in our study.

Polymethyl methacrylate intraocular lens opacification 20 years after cataract surgery: A case report in a tertiary eye hospital in Saudi Arabia.

Snowflake degeneration is a slow progressive opacification of polymethyl methacrylate (PMMA) intraocular lenses (IOLs). This late postoperative complication can occur a decade or later after implantation. The deposits are composed of IOL materials that tend to aggregate centrally. There is a relative paucity of the literature on snowflake degeneration of IOLs. Symptoms can range from mild visual disturbance to significant loss of visual acuity. In cases of opacification after IOL implantation, the different diagnosis should include snowflake degeneration to prevent surgical intervention such as lens exchange or explantation unless clinically warranted. We report a case of late optical opacification of a PMMA IOL, the clinical diagnosis and treatment that increased best corrected vision.

Non-viral microbial keratitis in children.

Microbial (non-viral) keratitis is a serious vision-threatening condition. The management of microbial keratitis in children is particularly complicated by the children's inability to cooperate during examinations and the lack of information prior to presentation. Predisposing factors vary according to geographical location and age. Corneal trauma is the leading cause for microbial keratitis in children, followed by systemic and ocular disease. Etiologic agents are most frequently Gram-positive and Gram-negative bacteria commonly found in contact lens-related microbial keratitis. Mycotic keratitis is a major risk factor in tropical weather conditions, particularly when associated with agricultural trauma. Early diagnosis, intensive drug treatment, and timely planned surgical intervention may effectively improve the outcome of pediatric microbial keratitis.

Long term visual outcomes in laser treated threshold retinopathy of prematurity in Central Saudi Arabia.

PURPOSE: To assess the long term visual outcomes and refractive status of patients who underwent diode laser for threshold retinopathy of prematurity (ROP) and to investigate the risk factors leading to poor visual outcomes. METHODS: Fifty-seven patients (114 eyes) with threshold ROP who underwent laser therapy were contacted for reassessment. A chart review was performed for all patients to collect data on visual acuity, retinal status and strabismus. A favorable visual outcome was defined as ⩾20/160 (Snellen acuity) for young adults (cooperative patients), and ⩾CSM for children (uncooperative patients) while unfavorable visual outcome was defined as <20/160 or