Time to FIRE NORSE: A single acronym for a heterogeneous presentation. Further information from a case series and discussion of the literature.

PURPOSE: New-Onset Refractory Status Epilepticus (NORSE) is a rare and severe form of refractory status epilepticus without an apparent underlying cause at presentation or prior history of epilepsy. We aimed to describe the clinical features, etiology, treatment, and outcomes of NORSE in adults in a quaternary-level hospital in Saudi Arabia. METHODOLOGY: In this retrospective cohort study, inclusion criteria involved patients over 14 years old who met the 2018 consensus definition for NORSE. Patients were identified using a combination of medical record admission labels 'status epilepticus' and 'encephalitis', and continuous EEG reports documenting status epilepticus. Demographic, clinical, and radiological data were collected and then analyzed for factors correlated with specific etiologies, better functional outcomes, and future diagnosis of epilepsy. RESULTS: We found 24 patients presenting with NORSE between 2010 and 2021. Fever/infectious symptoms were the most common prodrome. Elevated inflammatory serum and cerebrospinal fluid markers in most patients. Brain MRI revealed T2/FLAIR hyperintensity patterns, predominantly affecting limbic and perisylvian structures. The etiology of NORSE varied, with immune-related causes being the most common. Long-term outcomes were poor, with a high mortality rate and most survivors developing drug-resistant epilepsy. CONCLUSION: This study provides valuable insights into NORSE's clinical characteristics, highlighting the heterogeneity of this condition. The poor outcome is likely related to the progressive nature of the underlying disease, where refractory seizures are a clinical symptom. Thus, we propose to focus future research on the etiology rather than the NORSE acronym.

Awareness of Interventional Radiology Among Medical Students at Majmaah University, Saudi Arabia.

INTRODUCTION: Interventional radiology (IR) is a medical specialty that employs imaging techniques such as X-rays, ultrasound, CT scans, and MRI to guide minimally invasive procedures for diagnosing and treating a variety of medical disorders. The purpose of this investigation was to determine the level of IR awareness among medical students at Majmaah University. METHODS: The cross-sectional investigation was carried out among the medical students at Majmaah University in Saudi Arabia. A self-administered questionnaire that had been pretested was used to gather the data. SPSS Statistics (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp) was used to analyze the data. The chi-square test was used to compare qualitative data, and a p-value <0.05 was considered significant. RESULTS: There were 202 students who participated in this study, and among them, the majority were males, 126 (62.4%), and the majority of them were pre-clinical students, 105 (52.0%). Knowledge of routinely performed procedures by IR (only by a radiologist) was assessed; 116 (57.4%) of them responded with paracontinuous transluminal coronary angioplasty, 105 (52.0%) with central venous access, and 100 (49.5%) with lower arterial limp percutaneous transluminal angioplasty, which are routinely performed procedures by the radiologists. There was no significant difference in knowledge levels between genders. CONCLUSION: Increasing awareness of IR among medical students is essential to improving patient outcomes and addressing healthcare challenges. Efforts to educate and expand access to IR services must be prioritized to ensure that medical students receive a comprehensive education and that patients receive the highest quality care possible.

A Prospective Comparison Between Soft Tissue Dissection Techniques in Pterional Craniotomy: Functional, Radiological, and Aesthetic Outcomes.

BACKGROUND AND OBJECTIVES: Given the complex anatomy of the operative region and individual surgeon preferences, some techniques for soft tissue dissection before pterional craniotomy have gained more popularity than others. This prospective study used subjective and objective measurements to compare the functional, radiological, and aesthetic outcomes of 3 such dissection techniques. METHODS: This multicenter prospective cohort study included all patients who underwent elective pterional craniotomy between 2018 and 2020 at 3 centers in Riyadh, Saudi Arabia. All patients underwent 1 of 3 soft tissue dissection techniques: myocutaneous flap, interfascial, and subfascial dissection techniques. Clinical and radiological assessments were performed upon discharge and at the 3- and 6-month follow-ups. RESULTS: We included 78 patients, with a mean age of 44.9 ± 16.3 years. Myocutaneous flap, interfascial, and subfascial dissections were performed in 34 (43%), 24 (30%), and 20 patients (25%), respectively. The myocutaneous flap method had the shortest opening ( P = .001) and closure ( P = .005) times; tenderness was more evident in this group than in the others ( P = .05). The frontalis muscle was most affected in the interfascial dissection group ( P = .05). The frontalis nerve function was similar in all groups after 6 months ( P = .54). The incidence of temporomandibular joint dysfunction was highest in the myocutaneous flap group (29%). Decreased temporalis muscle thickness at the 6-month postoperative follow-up was most severe in the subfascial dissection group (12.6%), followed by the myocutaneous flap (11.9%) and interfascial dissection (9.9%) groups, with no significant difference ( P = .85). Temporal hollowing was more prominent in the myocutaneous flap group ( P = .03). Cosmetic satisfaction was highest in the interfascial dissection group, with no significant difference ( P = .4). CONCLUSION: This study provides important information for neurosurgeons in weighing the benefits and risks of each technique for their patients.

Awareness, Knowledge, and Attitudes Regarding Basic Life Support Among the General Population in the Al-Majma'ah Region, Saudi Arabia.

BACKGROUND: Cardiac arrest is a critical medical emergency that can strike individuals of any age or background, often occurring suddenly and unpredictably. The administration of Basic Life Support (BLS) techniques by laypersons in the first few crucial minutes following a cardiac arrest can substantially increase the chances of survival and minimize potential neurological damage. Despite the vital role of BLS in saving lives, there remains a gap in public awareness, knowledge, and attitudes regarding BLS among the general population in many regions worldwide, including Saudi Arabia. In recent years, there has been a growing emphasis on the importance of community-based interventions to enhance cardiac arrest survival rates. Public involvement in the early stages of cardiac arrest management is a key component of the chain of survival, and improving BLS awareness and knowledge among the general population is central to this effort. OBJECTIVE: This study aimed to assess the awareness, knowledge, and attitudes with regard to BLS among the general population in the Al-Majma'ah region, Saudi Arabia. METHODS: This is a descriptive cross-sectional study adopted among the population living in the Al-Majma'ah region of Saudi Arabia. The data was collected by a pre-tested and self-administered questionnaire. Data was analyzed by using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The questions included information on social demographic information, awareness and knowledge, and attitudes related to BLS. RESULTS: More than half the participants (n=352; 52.5%) understand that during cardiac arrest, the heart is still beating and pumping blood, but the person is not breathing normally. This is an important understanding for providing proper care during a cardiac arrest situation. On the other hand, the study found that 384 (57.2%) had various reasons for their lack of knowledge about cardiopulmonary resuscitation (CPR). The biggest reason was lack of interest (n=98; 14.6%). This highlights a need for increased awareness and education about the importance of CPR. The findings from the Pearson correlation conducted in this study show that age has a significant influence on the level of awareness and knowledge of cardiac arrest BLS. The p-value obtained for the test was 0.014, indicating that there is a significant relationship between age and awareness and knowledge of BLS. Similarly, the study findings also show that gender has a significant influence on the attitude of cardiac arrest BLS. CONCLUSION: The participants had a decent understanding of BLS, particularly regarding concepts like cardiac arrest and the role of automated external defibrillators (AEDs). However, they showed confusion or gaps in awareness, especially concerning the correct initial steps when encountering a collapsed person. Many participants felt uncomfortable performing Hands-Only CPR in a real-life situation due to a lack of knowledge and skills, which acted as a significant barrier to public CPR performance.

Knowledge and attitudes of gout patients and their perspectives about diagnosis and management: A cross-sectional study in Saudi Arabia.

BACKGROUND: Gout is a chronic noncommunicable disease that might lead to multiple systemic complications if it is left untreated. The knowledge, attitudes, and perceptives among patients toward the diagnosis and management of gout are important indicators in determining the prognosis and predicting sequelae of the disease. This cross-sectional survey aimed to assess the knowledge, attitudes, and perspectives of patients diagnosed with gout toward the disease diagnosis and treatment. METHODOLOGY: An observational cross-sectional study was conducted at university clinics and local health facilities in central Riyadh, Saudi Arabia, for the duration between April and August 2022. Pearson χ2 test was used to determine the difference in the proportion of patients who adapt different attitudes and perspectives in terms of their demographic variables. Statistical significance was defined as a p value less than .05. RESULTS: Two-hundred thirteen patients were involved in this study. The majority of the patients (84.0%) were diagnosed for more than 1 year. The majority of the patients (76.5%) were aged 25-60 years when they were diagnosed with gout. The most common complaint at the time of the diagnosis was joint pain (73.7%). The most commonly reported gout medication treatment being used was allopurinol accounting for 23.0%. The majority of the patients (83.6%) were satisfied regarding the effects of gout management on their job performance, work life, and careers. The vast majority (97.5%) reported that they are satisfied with the health service provided. CONCLUSION: The patients diagnosed with gout in Saudi Arabia exhibited a satisfactory level of information, attitude, and perspectives regarding their condition. The participants expressed a significant degree of satisfaction with the impact of gout management on their occupational performance, work-life balance, and professional plans. Additional research is necessary to ascertain the risk factors associated with gout and provide suitable preventative interventions.

Outcomes and complications of microscopic transcallosal colloid cyst resection: A single institution experience.

Background: Colloid cysts have always provoked the interest of neurosurgeons due to their benign histology, wide variety of clinical presentations, and differences in reported surgical outcomes. Although recent studies have reported favorable outcomes with different surgical resection approaches, the transcallosal approach remains the most popular approach to date. In this series, we report the clinical and radiological outcomes of the transcallosal approach for the resection of third ventricle colloid cysts in 12 patients. Methods: We present a case series of 12 patients who were radiologically diagnosed with a third ventricle colloid cyst who underwent transcallosal resection by a single surgeon in one center over a 6-year period. Clinical, radiological, and surgical data were collected, and surgical outcomes and complications were analyzed. Results: Of the 12 patients diagnosed with colloid cysts, 10 (83%) presented with headache, and five (41%) presented with memory disturbance. All 12 patients showed improvement or resolution of their symptoms following resection. Nine patients (75%) presented with hydrocephalus on radiology. All the patients required preoperative or intraoperative external ventricular drain insertion. Four patients (33%) experienced transient postoperative complications. None of the patients required long-term cerebrospinal fluids shunting. One (8%) of 12 patients experienced transient memory loss. No mortality was recorded during the follow-up. Conclusion: Transcallosal resection of colloid cysts has a favorable prognosis. It allows for complete resection of the cyst with minimal transient postoperative complications. Most patients with postoperative complications show complete resolution of symptoms, with no long-term morbidity.

The Outcome of BNT162b2, ChAdOx1-Sand mRNA-1273 Vaccines and Two Boosters: A Prospective Longitudinal Real-World Study.

To date, the effectiveness of COVID-19 vaccines and booster doses has yet to be evaluated in longitudinal head-to-head studies. This single-center longitudinal study assessed the effectiveness of ChAdOx1 nCoV-19, BNT162b2, and mRNA-1273 vaccines and assessed two BNT162b2 boosters in 1550 participants, of whom 26% had comorbidities. In addition, the SARS-CoV-2 antibody dynamics was monitored. A group of 1500 unvaccinated subjects was included as the controls. The study's endpoint was the development of virologically-proven COVID-19 cases after vaccine completion, while the secondary endpoint was hospitalizations due to severe COVID-19. Overall, 23 (4.6%), 16 (3%), and 18 (3.8%) participants vaccinated with ChAdOx1 nCoV-19, BNT162b2, and mRNA-1273, respectively, developed COVID-19 after vaccine completion, with an effectiveness of 89%, 92%, and 90%. Ten COVID-19 cases were reported in participants with comorbidities, three of whom were hospitalized. No hospitalizations occurred after boosters. SARS-CoV-2 antibody levels peaked 2-4 weeks after the second vaccine dose but declined after a mean of 28.50 ± 3.48 weeks. Booster doses significantly enhanced antibody responses. Antibody titers ≤ 154 U/mL were associated with a higher risk of COVID-19 emergence. Thus, COVID-19 vaccines effectively reduced COVID-19 and prevented severe disease. The vaccine-induced SARS-CoV-2 antibody responses declined after 28-32 weeks. Booster doses induced significant maintained responses. SARS-CoV-2 antibody levels may help determine the timing and need for vaccine booster doses.

Undergraduate health sciences students' response regarding COVID-19 pandemic in Saudi Arabia: an observational study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic represents a major health problem, and its influences may persist with emerging viral variants. The current work was to evaluate the knowledge, attitude, and learning satisfaction of health sciences students (HSS) regarding the COVID-19 pandemic. METHODS: A questionnaire-based cross-sectional study was conducted from 20 February 2021 to 20 March 2021. Participants were undergraduate HSS at Prince Sattam bin Abdulaziz University in Al Kharj, Saudi Arabia. The questionnaire has been generated and distributed via online form. The questionnaire used was based on previous studies and included demographic information and knowledge, attitudes, perception, and learning satisfaction related to the COVID-19 pandemic. RESULTS: Out of the 400 questionnaires distributed to eligible students, the current study included a total of 330 HSS (82.5% response rate) from colleges of medicine (25.5%), dentistry (11.8%), pharmacy (33.6%), and Applied Medical Sciences (29.1%) of participants. The mean scores of knowledge, attitude, and learning satisfaction attained by students were 5.63 ± 0.65 out of 6, 4.22 ± 1.01 out of 5, and 11.28 ± 2.9 out of 19, respectively. Results show an association between the knowledge score of students and their age-group and specialty-college. Students with chronic diseases reported lower attitude scores and rate of COVID-19 vaccine-willingness. Younger HSS had a higher learning satisfaction score than the older participants. CONCLUSION: Overall, participants show high knowledge level and positive attitude toward COVID-19 but fair learning satisfaction during the pandemic. Further studies are needed to improve the learning satisfaction and attitude of HSS in the future.

Development of Eco-Friendly Concrete Mix Using Recycled Aggregates: Structural Performance and Pore Feature Study Using Image Analysis.

The shortage of natural aggregates has compelled the developers to devote their efforts to finding alternative aggregates. On the other hand, demolition waste from old constructions creates huge land acquisition problems and environmental pollution. Both these problems can be solved by recycling waste materials. The current study aims to use recycled brick aggregates (RBA) to develop eco-friendly pervious concrete (PC) and investigate the new concrete's structural performance and pore structure distributions. Through laboratory testing and image processing techniques, the effects of replacement ratio (0%, 20%, 40%, 60%, 80%, and 100%) and particle size (4.75 mm, 9.5 mm, and 12.5 mm) on both structural performance and pore feature were analyzed. The obtained results showed that the smallest aggregate size (size = 4.75 mm) provides the best strength compared to the large sizes. The image analysis method has shown the average pore sizes of PC mixes made with smaller aggregates (size = 4.75 mm) as 1.8-2 mm, whereas the mixes prepared with an aggregate size of 9.5 mm and 12.5 mm can provide pore sizes of 2.9-3.1 mm and 3.7-4.2 mm, respectively. In summary, the results confirmed that 40-60% of the natural aggregates could be replaced with RBA without influencing both strength and pore features.

Engineering Properties of Waste Sawdust-Based Lightweight Alkali-Activated Concrete: Experimental Assessment and Numerical Prediction.

Alkali activated concretes have emerged as a prospective alternative to conventional concrete wherein diverse waste materials have been converted as valuable spin-offs. This paper presents a wide experimental study on the sustainability of employing waste sawdust as a fine/coarse aggregate replacement incorporating fly ash (FA) and granulated blast furnace slag (GBFS) to make high-performance cement-free lightweight concretes. Waste sawdust was replaced with aggregate at 0, 25, 50, 75, and 100 vol% incorporating alkali binder, including 70% FA and 30% GBFS. The blend was activated using a low sodium hydroxide concentration (2 M). The acoustic, thermal, and predicted engineering properties of concretes were evaluated, and the life cycle of various mixtures were calculated to investigate the sustainability of concrete. Besides this, by using the available experimental test database, an optimized Artificial Neural Network (ANN) was developed to estimate the mechanical properties of the designed alkali-activated mortar mixes depending on each sawdust volume percentage. Based on the findings, it was found that the sound absorption and reduction in thermal conductivity were enhanced with increasing sawdust contents. The compressive strengths of the specimens were found to be influenced by the sawdust content and the strength dropped from 65 to 48 MPa with the corresponding increase in the sawdust levels from 0% up to 100%. The results also showed that the emissions of carbon dioxide, energy utilization, and outlay tended to drop with an increase in the amount of sawdust and show more the lightweight concrete to be more sustainable for construction applications.

Effect of Alumina Nano-Particles on Physical and Mechanical Properties of Medium Density Fiberboard.

This research aims to explore the effects of nanoparticles such as alumina (Al2O3) on the physical and mechanical properties of medium density fiberboards (MDF). The nanoparticles are added in urea-formaldehyde (UF) resin with different concentration levels e.g., 1.5%, 3%, and 4.5% by weight. A combination of forest fibers such as Populus Deltuidess (Poplar) and Euamericana (Ghaz) are used as a composite reinforcement due to their exceptional abrasion confrontation as well as their affordability and economic value with Al2O3-UF as a matrix or nanofillers for making the desired nanocomposite specimens. Thermo-gravimetric analysis (TGA) and thermal analytical analysis (TAA) in the form of differential scanning calorimetry (DSC) are carried out and it has been found that increasing the percentage of alumina nanoparticles leads to an increase in the total heat content. The mechanical properties such as internal bonding (IB), modulus of elasticity (MOE) and modulus of rupture (MOR), and physical properties such as density, water absorption (WA), and thickness swelling (TS) of the specimens have been investigated. The experimental results showed that properties of the new Nano-MDF are higher when compared to the normal samples. The results also showed that increasing the concentration of alumina nanoparticles in the urea-formaldehyde resin effects the mechanical properties of panels considerably.