Clinical and genetic evaluation of hereditary myopathies in an adult Saudi cohort.

BACKGROUND: Diagnosis of hereditary myopathy is often challenging owing to overlapping clinical phenotypes and muscle histopathological findings. This retrospective study aimed to identify the phenotypic and genotypic spectra of hereditary myopathies at a tertiary hospital in Riyadh, Saudi Arabia. METHODS: We reviewed the medical records of patients with hereditary myopathy who were evaluated between January 2018 and December 2022. RESULTS: Eighty-seven patients (78 families) were included, two-thirds were men with a mean age of 35 (SD 14.2) years. Limb-girdle muscular dystrophy (LGMD) was the most prevalent clinical diagnosis (25 cases; 29%), of whom, a genetic diagnosis was achieved in 15 of 22 patients tested (68%). In genetically confirmed LGMD, the most prevalent disorders were dysferlinopathy (27%) followed by fukutin-related protein (FKRP) - related limb girdle muscular dystrophy (20%), sarcoglycanopathy (20%), lamin A/C related myopathy (13%), and calpain-3 myopathy (13%). In 26 patients with pathogenic/likely pathogenic variants, the genetic testing method was whole exome sequencing (WES) (42%), Next generation sequencing (NGS) (31%), and targeted single gene analysis (27%). The sensitivity of each genetic testing method was as follows: 100% for targeted single-gene analysis, 100% for targeted analysis of D4Z4 repeat array units, 88% for myotonic dystrophy protein kinase (DMPK) repeat expansion analysis, 42% for NGS-neuromuscular panel, and 46% for WES. CONCLUSION: The prevalent types of hereditary myopathies were consistent with those reported locally and internationally. This study highlights the diagnostic yield of various molecular genetic tests for the diagnosis of hereditary myopathy in an adult cohort and the need for improved access to advanced molecular testing in cases suspected to have facioscapulohumeral muscular dystrophy (FSHD) or mitochondrial myopathies.

The impact of electronic gaming on upper-limb neuropathies among esports athletes.

BACKGROUND: The authors aimed to explore carpal tunnel syndrome (CTS) among electronic sports (esports) athletes, to compare hand symptoms and their severity between esports athletes and the control group and within the esports athletes, and to study the relationship between esports athletes' variables. MATERIAL AND METHODS: A cross-sectional survey study via telephone with systematic randomized approach was used for esport athletes sampling. Control group were non-esports athletes who do not use computer for prolonged duration. The survey consisted of sports athletes' characteristics, hand symptoms and functions, and the Boston Carpal Tunnel Questionnaire (BCTQ). The unpaired student's t-test, Mann-Whitney U test, and χ2 test were utilised for statistical comparison, with p < 0.05. Pearson's and Spearman's correlation coefficient tests were used for relationship analyses. RESULTS: Eligible participants were 198 out of 229. Compared to control group, esport athletes reported more CTS (p = 0.01), and radiated pain and numbness in their hands (p = 0.05). Males complained of hand symptoms (p < 0.01) and its radiation (p < 0.01) more than females among esports athletes. Higher BCTQ Symptom Severity Scale (BCTQ-SSS) scores were reported for esports athletes who had been playing esports for prolonged periods compared to those who had playing recently (p = 0.003), with a moderate positive correlation (+0.59, p = 0.004). A significant moderate positive correlation was reported for BCTQ Functional Severity Symptoms (BCTQ-FSS) scores in terms of hours of playing (+0.44, p = 0.04). Esports athletes who used armrests and a PC with a controller for gaming reported less hand symptoms and had milder BCTQ scores than those who used a PC with a keyboard/mouse. Generally, esports athletes spend 5-10 h/day on gaming. CONCLUSIONS: Esports athletes might be at risk of developing upper-extremity nerve compression and CTS. Prolonged playing, hours of playing, type of esports device, and using armrests are possible risk factors. Med Pr Work Health Saf. 2023;74(4):279-87.

Performance of dialysis patients on the standard and basic Arabic versions of the Montreal Cognitive Assessments.

OBJECTIVES: To assess cognitive performance in Saudi patients on dialysis using Arabic versions of the Montreal Cognitive Assessment (MoCA) and assess the reliability of the scales. METHODS: We performed a cross-sectional study at the dialysis unit of King Saud University Medical City, Riyadh from April 2019 to March 2020. Patients ≥ 18 years of age with no history of dementia underwent cognitive assessment with the standard (MoCA-A) and basic (MoCA-B) Arabic versions, with repeat testing in a subset of participants. RESULTS: Recruitment included 83 participants, 56 on hemodialysis (HD) and 27 on peritoneal dialysis (PD). The mean±SD for age was 49.99 (15.48), and for years of education was 10.29 (5.5). The mean score for MoCA-A was 21.03±5.35, and for MoCA-B was 23.45±5.14. Younger age, longer years of education and peritoneal dialysis were significantly associated with higher MoCA scores on both versions (p<0.05). The ICC was 0.81 (95% CI 0.65, 0.91) and 0.77 (95% CI 0.58, 0.89) for MoCA-A and MoCA-B, respectively. The performance on the executive and calculation tasks were higher in the PD group on the MoCA-B. The recall mean score was higher in the PD group on the MoCA-A. CONCLUSION: The HD patients are at higher risk for cognitive impairment compared to PD patients. Age and education are important variables influencing performance. Both Arabic versions of the MoCA are reliable screening tools.

Common diagnoses and factors associated with abnormal neuroimaging in headache patients in the emergency department.

OBJECTIVES: To determine causes of headaches in patients who presented to the emergency department (ED) and underwent neuroimaging, and to determine the clinical features associated with abnormal neuroimaging. METHODS: Patients were retrospectively selected from a database between June, 2015 and May, 2019. Patients were included if they had neuroimaging requested from the ED mainly for headache. Associations between clinical characteristics and abnormal neuroimaging were assessed. RESULTS: We included 329 patients (33.4% men, 66.6% women). The mean (SD) age was 39.7 (18.4) years. Neurological signs were reported in 43.8% of the patients, head-computed tomography was requested in 79.6%, magnetic resonance imaging in 77.5%, and both in 57.1%. Abnormal neuroimaging was reported in 31.9%. The most common reported diagnoses were secondary headache disorders (48.9%), followed by primary headache disorders (16.4%). The remainder were nonspecific-headaches (35%). Variables associated with abnormal neuroimaging were headache onset ≤1 month (OR 3.37, CI 1.47-7.70, p=0.004), and presence of an abnormal neurological sign (OR 3.60, CI 1.89-6.83, p<0.001). CONCLUSION: Secondary headache disorders are common in patients who undergo neuroimaging in the ED. Those who have a neurological sign and recent onset of headache are more likely to have abnormal neuroimaging.

Utility of Initial Arterial Blood Gas in Neuromuscular versus Non-Neuromuscular Acute Respiratory Failure in Intensive Care Unit Patients.

Background: The arterial blood gas (ABG) parameters of patients admitted to intensive care units (ICUs) with acute neuromuscular respiratory failure (NMRF) and non-NMRF have not been defined or compared in the literature. Methods: We retrospectively collected the initial ABG parameters (pH, PaCO2, PaO2, and HCO3) of patients admitted to ICUs with acute respiratory failure. We compared ABG parameter ranges and the prevalence of abnormalities in NMRF versus non-NMRF and its categories, including primary pulmonary disease (PPD) (chronic obstructive pulmonary disease, asthma, and bronchiectasis), pneumonia, and pulmonary edema. Results: We included 287 patients (NMRF, n = 69; non-NMRF, n = 218). The difference between NMRF and non-NMRF included the median (interquartile range (IQR)) of pH (7.39 (7.32−7.43), 7.33 (7.22−7.39), p < 0.001), PaO2 (86.9 (71.4−123), 79.6 (64.6−99.1) mmHg, p = 0.02), and HCO3 (24.85 (22.9−27.8), 23.4 (19.4−26.8) mmol/L, p = 0.006). We found differences in the median of PaCO2 in NMRF (41.5 mmHg) versus PPD (63.3 mmHg), PaO2 in NMRF (86.9 mmHg) versus pneumonia (74.3 mmHg), and HCO3 in NMRF (24.8 mmol/L) versus pulmonary edema (20.9 mmol/L) (all p < 0.01). NMRF compared to non-NMRF patients had a lower frequency of hypercarbia (24.6% versus 39.9%) and hypoxia (33.8% versus 50.5%) (all p < 0.05). NMRF compared to PPD patients had lower frequency of combined hypoxia and hypercarbia (13.2% versus 37.8%) but more frequently isolated high bicarbonate (33.8% versus 8.9%) (all p < 0.001). Conclusions: The ranges of ABG changes in NMRF patients differed from those of non-NMRF patients, with a greater reduction in PaO2 in non-NMRF than in NMRF patients. Combined hypoxemia and hypercarbia were most frequent in PPD patients, whereas isolated high bicarbonate was most frequent in NMRF patients.

A Multidisciplinary Perspective Addressing the Diagnostic Challenges of Late-Onset Pompe Disease in the Arabian Peninsula Region Developed From an Expert Group Meeting.

Pompe disease is a rare, metabolic, autosomal recessive disorder. Early diagnosis is critical for progressive Pompe disease as delays can significantly alter the clinical course of the disease. Diagnostic modalities, including dried blood spot testing and genetic testing, are available and are effective for diagnosing patients with late-onset Pompe disease (LOPD). However, clinicians face numerous clinical challenges related to the diagnosis of the disease. Two expert group committee meetings, involving 11 experts from the United Arab Emirates, Kuwait, the Kingdom of Saudi Arabia, and Oman, were convened in October 2019 and November 2020 respectively to develop a uniform diagnostic algorithm for the diagnosis of pediatric and adult LOPD in the Arabian Peninsula region. During the first meeting, the specialty-specific clinical presentation of LOPD was defined. During the second meeting, a diagnostic algorithm was developed after a thorough validation of clinical presentation or symptoms, which was performed with the aid of existing literature and expert judgement. A consensus was reached on the diagnostic algorithm for field specialists, such as neurologists, rheumatologists, general practitioners/internal medicine specialists, orthopedic specialists, and pulmonologists. This specialty-specific diagnostic referral algorithm for pediatric and adult LOPD will guide clinicians in the differential diagnosis of LOPD.

Early postictal temperature changes in patients presenting to the emergency department.

OBJECTIVE: Understanding the elevations in body temperature after a seizure helps detect etiologies and monitor for complications. We aim to determine the proportion of patients who develop elevated temperatures after a seizure and to examine the trend in temperature change over time. We also seek to examine the effects that an infection or impaired ambulatory status might have on body temperature course, as well as the effect of elevated temperature on the length of hospital stay. METHODS: A retrospective chart review was conducted at King Saud University Medical City. The included patients were individuals older than 12 years of age who presented to the emergency department with seizures between May 2015 and August 2018. Temperature recordings were documented from 18 four-hour time intervals (0-72 h from presentation). Information about age, gender, seizure duration, seizure type, polytherapy, anti-seizure medication, infection, ambulatory status, and length of stay were collected. Logistic regression and a mixed-effects model were used to determine which variables were associated with temperatures of 37.5 °C or higher in the first 12 h of presentation and to estimate the change in temperature over the ensuing time intervals. RESULTS: 416 encounters were identified. The presence of an infection was significantly associated with developing temperature elevation, with an odds ratio (OR) of 2.8 (95% CI [1.54, 5.32]). Ambulatory patients were less likely to have elevations compared to non-ambulatory patients (OR = 0.33; 95% CI [0.18, 0.6]). Temperatures were highest within the first hours of presentation and gradually decreased with each interval by 0.03 °C (p < 0.0001), which increased to 0.12 °C (p = 0.005) if a patient was ambulatory. Temperatures substantially increased across the intervals in patients with infections by 0.21 °C (p < 0.0001). Elevated temperatures were significantly associated with longer hospital stays (p < 0.0001). CONCLUSION: Elevated temperatures can occur after seizures in general, and subside over the ensuing 72 h in the absence of an infection. Physicians should still conduct thorough evaluations in patients with temperatures of 37.5 °C or higher to rule out an underlying infection. The absence of an elevated temperature is favorable and associated with a shorter hospital stay.

Finger Flexor Weakness in Myasthenia Gravis.

Myasthenia gravis (MG) affects the ocular, bulbar, and proximal limb muscles. The involvement of distal limb muscles is uncommon. MG-related weakness that severely affects the finger flexors and spares finger extensors and intrinsic hand muscles have never been reported. Here, we report a 35-year-old woman with acetylcholine receptor-antibody positive generalised MG who presented with severe bilateral asymmetric (left worse than right) finger flexor weakness during an MG relapse. The remaining muscles including the median and ulnar intrinsic hand muscles were normal. Repetitive nerve stimulation test showed decremental responses of more than 10%. Magnetic resonance imaging showed short-T1 inversion recovery sequences and increased signal intensities in the volar forearm muscles. Needle electromyography revealed fibrillations and positive sharp waves, small amplitude, short-duration, and polyphasic early recruiting motor unit action potentials. Myositis-specific autoantibodies were negative. Muscle biopsy showed neurogenic features. The patient had a good recovery with immunotherapy. We conclude that clinicians should be aware that marked weakness of the finger flexors can occur as a result of an MG relapse and may require early aggressive therapy. Key Words: Electromyography, Finger flexors, Muscle, Biopsy, Myasthenia gravis.

The Impact of the COVID-19 Pandemic on Medical Interns' Education, Training, and Mental Health: A Cross-Sectional Study.

Background and objectives The novel coronavirus disease 2019 (COVID-19) pandemic has challenged healthcare systems worldwide. Various studies have revealed the negative impact of the pandemic on the education and mental health of medical students and residents. In this study, we aimed to explore the effects of the COVID-19 pandemic on medical interns' educational experience, clinical practice, and mental health. We also engage in a discussion on the compensatory methods that have been adopted to improve medical interns' learning processes during the ongoing pandemic. Methods This cross-sectional survey-based study was conducted at the King Saud University Medical City (KSUMC) in Riyadh, Kingdom of Saudi Arabia (KSA) from March to October 2020. The participants consisted of medical interns. The survey collected information on participants' demographics, training, and the educational and psychological impact of the pandemic. Results The survey was distributed to 480 medical interns, of whom 345 (71.8%) participated. Most of our sample (75.6%) believed that the COVID-19 pandemic has negatively impacted their cumulative experience. Regarding the pandemic's impact on training and education, it was found that the emergency department rotation was the most affected rotation (60.3%). The majority of the participants (55.9%) believed that all tracks have received equal education and the volume of patients seen by interns decreased by 91.9%. As for the compensatory methods, 73.3% reported the utilization of remote platforms. Regarding the pandemic's mental health impact, 36% believed that it has affected their mental health, where increased stress levels were noticed in 47.8% of participants. Statistical significance was found in both Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores, which indicated that during the pandemic, 20.6% of the participants suffered from depression, and 13.9% had moderate to severe anxiety. Conclusions This study highlights the negative educational and psychological impact of COVID-19 on medical interns. With emerging infectious diseases on the rise, recognizing the impact of COVID-19 on medical interns is vital to improving interns' educational experiences and mental health during future crises.

Translation, validation, and diagnostic accuracy of the Arabic version of the Michigan neuropathy screening instrument.

ABSTRACT: The Michigan Neuropathy Screening Instrument (MNSI) is used to screen patients for diabetic neuropathy (DNP). We aimed to translate the MNSI questionnaire into Arabic (MNSIq-Ar) and to assess the validity and diagnostic performance of the MNSI Arabic version (MNSI-Ar).Cronbach alpha α and the interclass correlation coefficient were used to measure the reliability and reproducibility of the MNSIq-Ar. The instrument's validity was assessed by Spearman correlation with the Utah Early Neuropathy Scale (UENS), the Modified Toronto Neuropathy Score (mTCNS), diabetic neuropathy symptoms (DNS), and sural nerve amplitude (SNA). The construct validity of the MNSI-Ar was assessed by its ability to differentiate the severity of DNP (using the Kruskal-Wallis test). The diagnostic performance was assessed through the receiver operator curve area.We recruited 89 participants (mean [SD] age, 50.8 [12.3] years; 48% men). The MNSIq-Ar showed an α of 0.81 and intraclass correlation coefficient = 0.94, and the correlation coefficients with UENS, mTCNS, DNS, and sural nerve amplitude were 0.67, 0.83, 0.73, and -0.49, respectively (all P < .0001). The MNSI-Ar was able to differentiate the different severities of DNP. The receiver operator curve area was 0.93 with a high sensitivity of 95.9% and 100% for probable and confirmed DNP, respectively.MNSI-Ar is a reliable and valid tool to screen for diabetic neuropathy in the Arabic language with a good diagnostic performance and high sensitivity.

Effect of Culturally Mediated Right-Favoritism on the Direction of Pseudoneglect on Line Bisection Tasks.

Objectives: Arabs have a right-to-left language and engage in favoring of the right side or limb when implementing daily routine practices. The purpose of this research is to explore the effect this cultural attitude might have on pseudoneglect, by comparing with a southeast Asian sample that has a left-to-right language structure. Methods: Participants were from two separate ethnic groups (Arabs and Filipinos), residing in Saudi Arabia, healthy individals 18 years and above were allowed to volunteer in the study. The participants were recruited at King Saud University Medical City and the general community by both convenience and snowball sampling. Social demographic information such as gender, age, years of education, dominant hand, was also documented. The line bisection task (LBT) contained 36 randomly assorted lines of three different lengths placed at five different locations on a white sheet. The percent deviation score (PDS) was used to quantify pseudo-neglect. Tests of statistical significance including t-tests and mixed-effects regression were performed to determine if differences existed among different demographic variables or among line properties, respectively. Results: A total of 256 were enrolled (Arabs 52.3%). The overall PDS mean and standard deviation (SD) was -0.64 (2.87), p = 0.0004, which shows a significant leftward deviation in the entire cohort. PDS was -1.26 (2.68) in Filipinos, and -0.08 (2.94) in Arabs. The difference was statically significant (p < 0.0001). Mixed effects model showed positive changes in the PDS value as the length of the line increased (p < 0.0001) and as the line was more rightward placed (p < 0.0001). However, Filipino participants would still exhibit negative changes in the PDS value in comparison to Arabs (p < 0.0001); There were no significant associations between PDS and other factors such as age, years of education and gender. Conclusion: Differences found here between two distinct ethnic groups support the hypothesis that certain cultural aspects such as language direction and other cultural practices influence direction and degree of pseudo-neglect.

The Common Neurological Presentations and Clinical Outcomes of Coronavirus Disease 2019 in Saudi Arabia.

Background: Neurological manifestations have increasingly become recognized in COVID-19. People from different ethnic backgrounds are experiencing different outcomes related to SARS-CoV-2 infection. Several cohort studies reported the common neurological manifestations and complications associated with COVID-19 disease around the world however, the prevalence of neurological complications associated with SARS-CoV-2 infection in the Arab countries and Saudi Arabia is still unknown. Objective: To study the prevalence, risk factors, and characteristics of the neurological complications associated with COVID-19 and their relationship with clinical outcomes. Methods: We conducted a prospective, single-center, observational, cohort study of consecutive hospitalized adults COVID-19 patients with and without neurological manifestation admitted between March 2020 until the end of December 2020. Data was collected prospectively using electronic medical records; Cases and controls were observed until they either get discharged from the hospital or died. The primary outcomes were death, survival, and survival with sequalae. Results: Among 497 patients with COVID-19, 118 patients (23.7%) had neurological complications, 94 patients (18.9%) had encephalopathy, and 16 patients (3.2%) had cerebrovascular accidents (CVA). Patients with COVID-19-related neurological complications were older and more likely to have a pre-existing neurological disease. The most common neurological syndrome associated with COVID-19 were encephalopathy (18.9%) and headache (13.7%). Pre-existing neurological disease and an elevated neutrophil count were the strongest predictors of developing any neurological complications. Death form COVID-19 was associated with age (OR 1.06, 95% CI 1.02-1.10, P = 0.001), invasive ventilation (OR 37.12, 95% CI 13.36-103.14), COVID-19-related-neurological complications (OR 3.24, 95% CI 1.28-8.21, P = 0.01), and elevated CRP level (OR 1.01, 95% CI 1.00-1.01, P = 0.01). Conclusions: COVID-19 is associated with a wide range of neurological manifestations in people living in Saudi Arabia, with older individuals and those with underlying neurological disorders being most at risk. The presence of neurological complications was associated with increased mortality and poor outcomes.

Clinical features and outcome of Guillain-Barre syndrome in Saudi Arabia: a multicenter, retrospective study.

BACKGROUND: Guillain-Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on the characteristic of GBS in Saudi Arabia are limited. This study aimed to describe the clinical, electrophysiological, and laboratory characteristics and outcome of a multicenter cohort of patients with GBS. METHODS: This is a retrospective multicenter nationwide study. Patients who had GBS, identified through Brighton Criteria, between January 2015 and December 2019 were included. Data collected included demographics, clinical features, cerebrospinal fluid profile, reported electrophysiological patterns, treatment, and outcome. Reported GBS subtypes were compared using chi-square, Fisher's exact, or Mann-Whitney U tests, as appropriate. RESULTS: A total of 156 patients with GBS were included (men, 61.5%), with a median age of 38 (interquartile range, 26.25-53.5) years. The most commonly reported antecedent illnesses were upper respiratory tract infection (39.1%) and diarrhea (27.8%). All but two patients (98.7%) had weakness, 64.1% had sensory symptoms, 43.1% had facial diplegia, 33.8% had oropharyngeal weakness, 12.4% had ophthalmoplegia, and 26.3% needed mechanical ventilation. Cytoalbuminological dissociation was observed in 69.1% of the patients. GBS-specific therapy was administered in 96.8% of the patients, of whom 88.1% had intravenous immunoglobulin, and 11.9% had plasmapheresis. Approximately half of the patients were able to walk independently within 9 months after discharge, and a third regained the ability to walk independently thereafter. Death of one patient was caused by septicemia. Acute inflammatory demyelinating polyradiculoneuropathy was the most commonly reported GBS subtype (37.7%), followed by acute motor axonal neuropathy (29.5%), and acute motor-sensory axonal neuropathy (19.2%). CONCLUSION: The clinical and laboratory characteristics and outcome of GBS in the Arab population of Saudi Arabia are similar to the international cohorts. The overall prognosis is favorable.

Normative and Equated Data of the Original and Basic Versions of the Montreal Cognitive Assessment among Community Dwelling Saudi Arabians.

INTRODUCTION: Currently, there are standard and basic versions of the MoCA, the latter designed for those with lower educational achievements. Community-based normative data on these versions of the MoCA from Arabic populations are deficient, and there is little data demonstrating how both scales perform in comparison. We aim to obtain normative performances from both versions and equate the measures of both scales. METHODS: Community-based recruitment of healthy volunteers ≥ 18 years of age. Participants underwent testing with both versions. Demographic data was collected with regard to age, gender, years of education, diabetes, and hypertension. Regression analysis was performed to determine significance of variables, and the circle-arc equating method was used to equate the two scores from each scale. RESULTS: 311 participants were included in the study. The mean (sd) age was 45.8 (15.96), females were 184 (59.16%), and the duration of education was 12.7 (5.67) years. The mean scores on the MoCA-A and MoCA-B were 21.47 (4.53) and 24.37 (4.71) (P < 0.0001), respectively. Multivariate regression showed significance of age and years of education in both versions (both variables with P < 0.0001). Correlation coefficient between the two scales was 0.77 (P < 0.0001). The largest equated difference between both MoCA versions was four points in those scoring from 10-20 on the MoCA-A. CONCLUSION: We present normative data from a large Saudi Arabian community-based sample with two different MoCA tests, and an equating graph is presented to determine the corresponding expected performance between the two scales.

A timed Phalen's test predicts abnormal electrophysiology in carpal tunnel syndrome.

OBJECTIVE: Previous studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen's test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS). METHODS: Patients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: In total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant. DISCUSSION: A positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS.

Effects of age, sex and education on verbal fluency tasks in a normal Saudi sample.

INTRODUCTION: This study's purpose is to describe the performance of healthy community dwelling Saudi Arabians on fluency tasks and explore the effects of age, sex and education. METHODS: Arabic-speaking Saudi Arabians > 18 were chosen through convenience sampling. Included were healthy community members whose first language is Arabic. Excluded were anyone with a past history of psychiatric or central neurological diseases, or who was taking medications that affect the central nervous system. Information regarding the variables sex, age, and education was collected. Participants were required to name as many words as they could that started with the letters Ain (ع), Sheen (Ø´), and Qaf (ق) (letter task), and words that belonged to the categories "countries," "boy names," "girl names," and "four-legged animals" (categorical task). Mean scores were derived for the three letters (ASQ) and four categories (TC). Descriptive statistics, percentile curves, and quantile regressions (0.05, 0.25, 0.5, 0.75, and 0.95) were conducted to determine performance range. RESULTS: The study included 301 participants, comprising 162 (53.47%) females. The M(SD) for age was 46.74 (16) and for years of education 14 (4.78). The M(SD) for ASQ was 26.26 (10.01), and for TC, 81.56 (20.77). Percentile curves demonstrated an initial increase, followed by a decrease, in performance with increasing age on letter and categorical fluency tasks. Performance scores showed an increase of 1 to 1.5 and 2 to 3.5 words in the letter and categorical tasks, respectively, for each additional year of education across the quantiles (both with p < 0.0001). Males scored higher in the 0.05 and 0.95 quantiles of the letter fluency task only. CONCLUSION: We demonstrated a range of normative performance from a Saudi Arabian community, with varying age and education levels. The assessment demonstrated the importance of education as a major variable linearly associated with performance, influencing both tasks.

Culturally influenced performance on tasks of line bisection and symbol cancellation in Arabs.

The objective of this study was to administer line bisection (LB) and symbol cancellation (SC) tasks on a sample of healthy Arabs in Saudi Arabia, to determine if normative performance would differ from that of the Western population. A total of 136 healthy individuals were enrolled. Deviation direction from the veridical center and percentage deviation scores (PDS) were determined for LB. The overall performance on SC was calculated. Differences according to gender, education and age were measured. Out of the 2,287 times lines were bisected, 1025 (44.82%) deviated rightward (p < 0.0001). Mean (SD) PDS showed a rightward bias 1.57(3.4), (p < 0.0001). Rightward deviation odds modestly increased with age (OR 1.04, P 0.038). In SC, 63% started searching from the left and 67.5% used a horizontal strategy. The mean (SD) performance score was 0.468 (0.248) with no significant cancellation asymmetry. Female gender, education, and age significantly associated with performance. No correlation was found between the two tasks (p = 0.09). Line bisection error biases in Arabs are opposite of Western biases. Scanning for symbols started on the left side; however, this was smaller than that seen in existing Western reports. Normative performances are different from Western studies, but similarly influenced by the same demographic variables.

Exacerbation Rate in Generalized Myasthenia Gravis and Its Predictors.

OBJECTIVE: The aim of the study was to estimate the exacerbation incidence rate (IR) in acetylcholine receptor antibody (AChR)-positive generalized myasthenia gravis (MG) and its predictors. METHODS: The primary outcome in this retrospective study was to estimate moderate-to-severe (M-S) exacerbations IR in the early course of generalized MG. The secondary outcome was to explore the predictors of MG exacerbations. RESULTS: Between 1999 and 2015, we identified 78 AChR-positive generalized MG patients and 37 M-S exacerbations over the first 6 years following the onset of generalized MG symptoms. The M-S exacerbation IR was 12.2 per 100 person years (95% confidence interval [CI] 8.8-16.8). Any exacerbation (including mild) IR was 24.4 per 100 person years (95% CI 19.4-30.7). After controlling for confounding factors, MG exacerbation IR predictors included gender, disease severity at onset, and prednisone dose reduction with risk ratio of 0.34 (male gender), 2.67, and 20.8, respectively (all p values <0.05). M-S exacerbation occurred in 25 cases (32.1%), while any exacerbation (mild or M-S) was detected in 45 cases (57.7%). CONCLUSION: More than half of newly diagnosed AChR + MG cases experience an exacerbation in the first 6 years. Gender, disease severity at onset and prednisone dose reduction are predictors that could inform clinical practice and future research.

Reversible Cerebral Vasoconstriction Syndrome after Nifedipine Withdrawal.

Reversible cerebral vasoconstriction syndrome (RCVS) is an essential but often unrecognized cause of intracranial haemorrhage. While there are no specific causes of the syndrome, associations with many clinical conditions and drugs have been observed, and calcium channel blockers (CCBs) are often used to relieve the symptoms. This is a case of RCVS that was triggered by the sudden withdrawal of nifedipine, a CCB.

Amyotrophic lateral sclerosis care in Saudi Arabia: A survey of providers' perceptions.

OBJECTIVE: Provision of care for patients with amyotrophic lateral sclerosis (ALS) is complex and requires the contribution of multiple healthcare professionals. Several international ALS care measures were developed to ensure optimal care for ALS patients. We looked at the rate of inconsistency in providing standard ALS care measures in Saudi Arabia (SA). METHODS: A 5-point response survey was distributed to practicing neurologists in SA. They were asked to grade their perceived consistency of accessibility for 19 items of ALS care measures at their center. The list of ALS care measures items was derived from international ALS guidelines. RESULTS: The response rate from neurologists was 47.3% (62/131), and the responses of 39 neurologists who follow ALS cases were included. Most of the selected ALS care measure items, 63.1% (12/19), were perceived by 50% or more of the ALS care providers to be not consistently accessible to their patients. The perception of ALS care providers of the inconsistent accessibility for ALS patients to ALS care measures was high for communication devices (92.3%), supportive equipment such as motorized wheelchairs (76.9%), end-of-life discussion (74.4%), and respiratory monitoring (66.7%). CONCLUSION: Our data show that ALS patients in SA do not have consistent access to the recommended ALS care measures.