Deep Anomaly Detection Framework Utilizing Federated Learning for Electricity Theft Zero-Day Cyberattacks.

Smart power grids suffer from electricity theft cyber-attacks, where malicious consumers compromise their smart meters (SMs) to downscale the reported electricity consumption readings. This problem costs electric utility companies worldwide considerable financial burdens and threatens power grid stability. Therefore, several machine learning (ML)-based solutions have been proposed to detect electricity theft; however, they have limitations. First, most existing works employ supervised learning that requires the availability of labeled datasets of benign and malicious electricity usage samples. Unfortunately, this approach is not practical due to the scarcity of real malicious electricity usage samples. Moreover, training a supervised detector on specific cyberattack scenarios results in a robust detector against those attacks, but it might fail to detect new attack scenarios. Second, although a few works investigated anomaly detectors for electricity theft, none of the existing works addressed consumers' privacy. To address these limitations, in this paper, we propose a comprehensive federated learning (FL)-based deep anomaly detection framework tailored for practical, reliable, and privacy-preserving energy theft detection. In our proposed framework, consumers train local deep autoencoder-based detectors on their private electricity usage data and only share their trained detectors' parameters with an EUC aggregation server to iteratively build a global anomaly detector. Our extensive experimental results not only demonstrate the superior performance of our anomaly detector compared to the supervised detectors but also the capability of our proposed FL-based anomaly detector to accurately detect zero-day attacks of electricity theft while preserving consumers' privacy.

Multi-Label Active Learning-Based Machine Learning Model for Heart Disease Prediction.

The rapid growth and adaptation of medical information to identify significant health trends and help with timely preventive care have been recent hallmarks of the modern healthcare data system. Heart disease is the deadliest condition in the developed world. Cardiovascular disease and its complications, including dementia, can be averted with early detection. Further research in this area is needed to prevent strokes and heart attacks. An optimal machine learning model can help achieve this goal with a wealth of healthcare data on heart disease. Heart disease can be predicted and diagnosed using machine-learning-based systems. Active learning (AL) methods improve classification quality by incorporating user-expert feedback with sparsely labelled data. In this paper, five (MMC, Random, Adaptive, QUIRE, and AUDI) selection strategies for multi-label active learning were applied and used for reducing labelling costs by iteratively selecting the most relevant data to query their labels. The selection methods with a label ranking classifier have hyperparameters optimized by a grid search to implement predictive modelling in each scenario for the heart disease dataset. Experimental evaluation includes accuracy and F-score with/without hyperparameter optimization. Results show that the generalization of the learning model beyond the existing data for the optimized label ranking model uses the selection method versus others due to accuracy. However, the selection method was highlighted in regards to the F-score using optimized settings.

Nanosecond Laser Induced Surface Structuring of Cadmium after Ablation in Air and Propanol Ambient.

In the present study KrF Excimer laser has been employed to irradiate the Cadmium (Cd) targets for various number of laser pulses of 500, 1000, 1500 and 2000, at constant fluence of 3.6 J cm-2. Scanning Electron Microscopy (SEM) analysis was utilized to reveal the formation of laser induced nano/micro structures on the irradiated target (Cd) surfaces. SEM results show the generation of cavities, cracks, micro/nano wires/rods, wrinkles along with re-deposited particles during irradiation in air, whereas subsurface boiling, pores, cavities and Laser Induced Periodic Surface Structures (LIPSS) on the inner walls of cavities are revealed at the central ablated area after irradiation in propanol. The ablated volume and depth of ablated region on irradiated Cd targets are evaluated for various number of pulses and is higher in air as compared to propanol ambient. Fast Fourier Transform Infrared spectroscopy (FTIR), Energy Dispersive X-ray Spectroscopy (EDS) and X-ray Diffraction (XRD) analyses show the presence of oxides and hydro-oxides of Cd after irradiation in propanol, whereas the existence of oxides is observed after irradiation in air ambient. Nano-hardness tester was used to investigate mechanical modifications of ablated Cd. It reveals an increase in hardness after irradiation which is more pronounced in propanol as compared to air.

Prediction models based on soil properties for evaluating the heavy metal uptake into Hordeum vulgare L. grown in agricultural soils amended with different rates of sewage sludge.

The current study aims at forming new prediction models to be employed in the approximating the possible uptake of a range of 10 heavy metals (HMs) (Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb and Zn) by Hordeum vulgare tissues including roots, shoots and grains following its growth in soil amended with sewage sludge (SS) using conditions employed in greenhouses. The present study determined an insignificant difference between the actual and predicted quantities of the HMs in the three tissues using t values. The majority of the predicted quantities of the HMs were acceptable with the exception of Cd in the shoots, Cu in grains and Pb in roots. Consequently, it is possible to use these models in assessing the cultivation of barley plants in soil amended with SS in a safe way, while simultaneously monitoring any potential risks to the health of humans.

MYH1 is a candidate gene for recurrent rhabdomyolysis in humans.

Rhabdomyolysis is a serious medical condition characterized by muscle injury, and there are recognized genetic causes especially in recurrent forms. The majority of these cases, however, remain unexplained. Here, we describe a patient with recurrent rhabdomyolysis in whom extensive clinical testing failed to identify a likely etiology. Whole-exome sequencing revealed a novel missense variant in MYH1, which encodes a major adult muscle fiber protein. Structural biology analysis revealed that the mutated residue is extremely well conserved and is located in the actin binding cleft. Furthermore, immediately adjacent mutations in that cleft in other myosins are pathogenic in humans. Our results are consistent with the finding that MYH1 is mutated in rhabdomyolysis in horses and suggest that this gene should be investigated in cases with recurrent rhabdomyolysis.

Cadmium Chloride Induces Memory Deficits and Hippocampal Damage by Activating the JNK/p66Shc/NADPH Oxidase Axis.

This study investigated whether the mechanism underlying the neurotoxic effects of cadmium chloride (CdCl2) in rats involves p66Shc. This study comprised an initial in vivo experiment followed by an in vitro experiment. For the in vivo experiment, male rats were orally administered saline (vehicle) or CdCl2 (0.05 mg/kg) for 30 days. Thereafter, spatial and retention memory of rats were tested and their hippocampi were used for biochemical and molecular analyses. For the in vitro experiment, control or p66Shc-deficient hippocampal cells were treated with CdCl2 (25 µM) in the presence or absence of SP600125, a c-Jun N-terminal kinase (JNK) inhibitor. Cadmium chloride impaired the spatial learning and retention memory of rats; depleted levels of glutathione and manganese superoxide dismutase; increased reactive oxygen species (ROS), tumor necrosis factor α, and interleukin 6; and induced nuclear factor kappa B activation. Cadmium chloride also decreased the number of pyramidal cells in the CA1 region and induced severe damage to the mitochondria and endoplasmic reticulum of cells in the hippocampi of rats. Moreover, CdCl2 increased the total unphosphorylated p66Shc, phosphorylated (Ser36) p66Shc, phosphorylated JNK, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, cytochrome c, and cleaved caspase-3. A dose-response increase in cell death, ROS, DNA damage, p66Shc, and NADPH oxidase was also observed in cultured hippocampal cells treated with CdCl2. Of note, all of these biochemical changes were attenuated by silencing p66Shc or inhibiting JNK with SP600125. In conclusion, CdCl2 induces hippocampal ROS generation and apoptosis by promoting the JNK-mediated activation of p66Shc.

Potential Decontamination of Drinking Water Pathogens through k-Carrageenan Integrated Green Bottle Fly Bio-Synthesized Silver Nanoparticles.

The wide distribution of infections-related pathogenic microbes is almost related to the contamination of food and/or drinking water. The current applied treatments face some limitations. In the current study, k-carrageenan polymer was used as supporting material for the proper/unreleased silver nanoparticles that showed strong antimicrobial activity against six pathogenic bacteria and yeast. The bio-extract of the pupa of green bottle fly was used as the main agent for the synthesis of silver nanoparticles. The qualitative investigation of biologically synthesized silver nanoparticles was determined using UV-Vis spectrophotometric analysis; however, the size of nanoparticles was in range of 30-100 nm, as confirmed by scanning electron microscopy (SEM), transmission electron microscopy (TEM), and particle size analyzer. The proper integration of silver nanoparticles into the polymeric substrate was also characterized through fourier transform infrared (FT-IR), thermogravimetric analysis (TGA), SEM, and tensile strength. The antimicrobial activity of k-carrageenan/silver nanoparticles against Gram positive, Gram negative, and yeast pathogens was highly effective. These results indicate the probable exploitation of the polymeric/nanoparticles composite as an extra stage in water purification systems in homes or even at water treatment plants.

The burden of leukemia in the Kingdom of Saudi Arabia: 15 years period (1999-2013).

BACKGROUND: Leukemia is a malignant neoplasm that arises from hematopoietic cells. The number of leukemia cases has dramatically increased from 297,000 to 437, 033 cases worldwide. As result, the the Saudi Cancer Registry ramked leukemia as the 5th type of cancer cases among both genders in Saudi Arabia. Data on the trend and incidence of leukemnia in Saudi Arabia is lacking. This study aims to report the trend and incidence of leukemia in Saudi Arabia using available data from the Saudi Cancer Registry (SCR), as a population-based cancer registry in the country over a period of 15 years (1999-2013). METHODS: Data of registered leukemia cases between years 1999-2013 were retrieved from the Saudi Council of Health, Saudi Cancer Registry. Data were coded using the International Classification of Diseases for Oncology (ICD-O). Main and essential variables were retrieved such as age, sex, years of incidence, residency, and histopathological type of leukemia. RESULTS: A total of 8712 cases of leukemia were analyzed in this study, 57.2% were males and 42.8% were females. Around 33.6% of cases were from the central region of Saudi Arabia. The most diagnosed type of leukemia was the Precursor B-cell lymphoblastic leukemia (18.7%), followed by Precursor cell lymphoblastic leukemia, NOS (17.3%) with equal percentage of reported cases between males and females in these subsets. CONCLUSION: Ove a period of 15 years, the trend of leukemia showed the likelihood of increase in rate particularly in males with highest incidence reported from the central region of Saudi Arabia which needs more investigation. Resources for diagnosis and treatment should be planned with more orientation toward the accurate diagnosis of leukemia to minimize the number of "none specific diagnosis".

Antimicrobial consumption in three pediatric and neonatal intensive care units in Saudi Arabia: 33-month surveillance study.

BACKGROUND: Despite their critical role in antimicrobial stewardship programs, data on antimicrobial consumption among the pediatric and neonatal population is limited internationally and lacking in Saudi Arabia. The current study was done as part of our antimicrobial stewardship activities. OBJECTIVES: To calculate overall and type-specific antimicrobial consumption. METHODS: A prospective surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in two pediatric and one neonatal intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as days of therapy (DOT) per 1000 patient-days and as frequency of daily consumption. RESULTS: During the 33 months of the study, a total of 30,110 DOTs were monitored during 4921 admissions contributing 62,606 patient-days. Cephalosporins represented 38.0% of monitored antimicrobials in pediatric ICUs followed by vancomycin (21.9%), carbapenems (14.0%), aminoglycosides (8.8%), and piperacillin/tazobactam (8.8%). Their consumption rates were 265.1, 152.6, 97.6, 61.4, and 61.4 DOTs per 1000 patient-days (respectively). Aminoglycosides represented 45.4% of monitored antimicrobials in neonatal ICU followed by cephalosporins (30.4%) vancomycin (13.6%), and carbapenems (8.3%). Their consumption rates were 147.5, 98.7, 44.3, and 27 DOTs per 1000 patient-days (respectively). CONCLUSION: Cephalosporins are frequently used in pediatric ICU while aminoglycosides are frequently used in neonatal ICU. The local consumption of cephalosporins and carbapenems in both ICUs is probably higher than international levels. Such data can help in establishing and monitoring the functions of antimicrobial stewardship activities aiming to ensure judicious consumption of antimicrobials.

Curcumin induces apoptosis of multidrug-resistant human leukemia HL60 cells by complex pathways leading to ceramide accumulation.

Most anti-cancer agents induce apoptosis, however, a development of multidrug resistance in cancer cells and defects in apoptosis contribute often to treatment failure. Here, the mechanism of curcumin-induced apoptosis was investigated in human leukemia HL60 cells and their HL60/VCR multidrug-resistant counterparts. In both cell lines curcumin induced a bi-phasic ceramide generation with a slow phase until 6 h followed by a more rapid one. The level of the ceramide accumulation correlated inversely with the cell viability. We found that the ceramide elevation resulted from multifarious changes of the activity of sphingolipid-modifying enzymes. In both cell lines curcumin induced relatively fast activation of neutral sphingomyelinase (nSMase), which peaked at 3 h, and was followed by inhibition of sphingomyelin synthase activity. In addition, in HL60/VCR cells the glucosylceramide synthase activity was diminished by curcumin. This process was probably due to curcumin-induced down-regulation of P-gp drug transporter, since cyclosporine A, a P-gp blocker, also inhibited the glucosylceramide synthase activity. Inhibition of nSMase activity with GW4869 or silencing ofSMPD3 gene encoding nSMase2 reversed the curcumin-induced inhibition of sphingomyelin synthase without affecting the glucosylceramide synthase activity. The early ceramide generation by nSMase was indispensable for the later lipid accumulation, modulation of Bax, Bcl-2 and caspase 3 levels, and for reduction of cell viability in curcumin-treated cells, as all these events were inhibited by GW4869 or nSMase2 depletion. These data indicate that the early ceramide generation by nSMase2 induced by curcumin intensifies the later ceramide accumulation via inhibition of sphingomyelin synthase, and controls pro-apoptotic signaling.

Advanced trends in controlling Helicobacter pylori infections using functional and therapeutically supplements in baby milk.

Helicobacter pylori is a common human pathogen infecting about 30 % of children and 60 % of adults worldwide. It is responsible for diseases such as gastritis, peptic ulcer and gastric cancer. H. pylori treatment based on antibiotics with proton pump inhibitor, but therapy failure is shown to be higher than 20 % and is essentially due to an increasing in prevalence of antibiotic-resistant bacteria, which has led to the search for alternative therapies. In this study, we discuss the usage of natural extracts mixture as alternative or complementary agents in controlling H. pylori infection so here, we focused on the plant extracts of (Cloves, Pepper, Cumin, Sage, Pomegranate peel, Ginger, Myrrh and Licorice). To that end, Phytochemical constituents detection like Tannins, Glycosides, Alkaloids, Flavonoids, Terpenoids, Saponins, Phenolic compounds, Reducing sugars, Volatile oils, Amino acids and Proteins was demonstrated. Each plant extract was examined individually or in combination for its antimicrobial activity against H. pylori. Out of the used extracts, four mixes were prepared and tested against H. pylori. The antibacterial activities of the four mixes, represented by the diameter of inhibition clear zone, recorded 21, 39, 23 and 28 mm. The most potent mix (mix2) was chosen and mixed with baby milk as a new combination for H. pylori infections treatment in babies.

Implementation of pharmacist-managed anticoagulation clinic in a saudi arabian health center.

BACKGROUND: During the past 2 decades, a paradigm shift in the management of oral anticoagulation therapy has occurred. A multidisciplinary approach has been used and has proved beneficial from both a cost and quality perspective. However, this approach to anticoagulation therapy is not well established in Saudi Arabia and the Middle East, and the traditional way of managing anticoagulation patients is still the mainstay of care. The Pharmacy Services Division (PSD) in collaboration with physician, nursing, and medical support enterprises at the Dhahran Health Center established the pharmacy-managed anticoagulation clinic (ACC). OBJECTIVE: To describe the implementation process of the first pharmacist-managed anticoagulation clinic in the eastern province of Saudi Arabia and its impact on patient care. METHODS: The PSD in collaboration with medical staff successfully created a care delivery model utilizing clinical pharmacists' expertise to provide comprehensive anticoagulation management services at Saudi Aramco Medical Services Organization (SAMSO). Planning included analyzing existing practices, reviewing the relevant literature, obtaining physician input, formulating a business proposal, and developing clinical protocols and guidelines. Collaborative relationships were established with the center laboratory, scheduling services, and nursing and medical departments. Clinic services include patient assessment, anticoagulation monitoring, warfarin dosage adjustment, medication dispensing at the clinic, patient education, and feedback to referring physicians. Data (2 years before and after clinic inception) for all patients enrolled at the anticoagulation clinic were reviewed to evaluate the impact of the clinic on anticoagulation management, adverse events, and patient satisfaction. RESULTS: A total of 578 patients were enrolled in the ACC. The total percentage of international normalized ratio (INR) within the target range was 59% versus 48% when compared to the previous traditional practice. The number of INR tests per patient dropped by 19%. Minor and major adverse events occurred in 10% and 1.5% of patients, respectively. Overall, the patients were very satisfied with the new clinic compared to the previous practice. CONCLUSION: Implementation of the pharmacist-managed ACC in the eastern province of Saudi Arabia had a positive impact on patient care based on the improvements in the number of patients whose INR was within therapeutic range and patient satisfaction scores.

Maxillary Odontoma Associated With Noonan Syndrome: A Case Report.

Noonan syndrome (NS) is a common congenital syndrome characterized by multiple anomalies commonly observed in children. In this article, we describe a case of a patient with congenital heart disease, severe mitral regurgitation, and Nonaan syndrome presented with left maxillary swelling and pain, which was treated by complete surgical excision of the left maxillary odontoma. Based on this case, we conclude that numerous oral abnormalities may be related to NS and thus necessitate interdisciplinary treatment planning and prompt therapy. The importance of including oral manifestations as a scoring criterion in diagnosing NS cannot be overstated, as the significance of oral findings in NS has largely been overlooked.

Correlation of Anemia Due to Poor Iron Status With Obesity at King Fahad Medical City, Riyadh, Saudi Arabia.

Background Saudi Arabia has a high prevalence of chronic diseases such as obesity. Moreover, iron deficiency anemia (IDA) in developing countries is the most prevalent type of anemia. This study aims to assess the correlation between anemia related to poor iron status and obesity. Methods A cross-sectional observational study was conducted at the obesity center in King Fahad Medical City, Saudi Arabia, from April to September 2020. Two hundred and forty participants were needed to be included in the study. The data was gathered by utilizing a designed data collection form. Socio-demographic data, weight and height, questions related to the history of anemia, and gynecological data (for females) were collected. The data was analyzed using SPSS (Statistical Package for Social Science) version 28.0. Descriptive statistics were used to present numerical and categorical data and a Chi-square test was conducted to assess the correlation between categorical variables. Informed written consent was obtained from all participants and ethical approval was obtained from the Ethical Board Committee in King Fahad Medical City. Results The study included 240 participants. Two-thirds of the study population are females (64.6%), 66.7% are married, and 65.8% have obesity. Almost one-half of the study population (46%, N=128) was diagnosed with IDA with malnourishment being the most common reason for IDA (88.2%). The results indicated a correlation between obesity and the prevalence of IDA. The prevalence of IDA among participants with obesity (60.4%) was significantly higher compared to non-obese participants (39.5%), p=0.002. The study found that females and underweight individuals have a higher prevalence of IDA (p<0.001). Conclusion Results of the present study suggest that obesity could be associated with a risk of IDA. In addition, Saudi women could be more prone to IDA than men. Further prospective controlled studies among diverse populations in Saudi Arabia including laboratory assessment of inflammatory markers and iron status are required to better understand the correlation between obesity and IDA.

Development of novel polymer haemoglobin based particles as an antioxidant, antibacterial and an oxygen carrier agents.

This innovative work aims to develop highly biocompatible and degradable nanoparticles by encapsulating haemoglobin (Hb) within poly-ε-caprolactone for novel biomedical applications. We used a modified double emulsion solvent evaporation method to fabricate the particles. A Scanning electron microscope (SEM) characterized them for surface morphology. Fourier Transform Infrared Spectroscopy (FTIR) and Ultraviolet-visible spectroscopies (UV-visible) elucidated preserved chemical and biological structure of encapsulated haemoglobin. The airproof equilibrium apparatus obtained the oxygen-carrying capacity and P50 values. The DPPH assay assessed free radical scavenging potential. The antibacterial properties were observed using four different bacterial strains by disk diffusion method. The MTT assay investigates the cytotoxic effects on mouse fibroblast cultured cell lines (L-929). The MTT assay showed that nanoparticles have no toxicity over large concentrations. The well-preserved structure of Hb within particles, no toxicity, high oxygen affinity, P50 value, and IC50 values open the area of new research, which may be used as artificial oxygen carriers, antioxidant, and antibacterial agents, potential therapeutic agents as well as drug carrier particles to treat the cancerous cells. The novelty of this work is the antioxidant and antibacterial properties of developed nanoparticles are not been reported yet. Results showed that the prepared particles have strong antioxidant and antibacterial potential.

Evaluating the Clinical Effectiveness and Safety of Semaglutide in Individuals with Uncontrolled Type 2 Diabetes. Real-World Evidence from Saudi Arabia: The Observational, Multicenter, 15-Month EVOLUTION Study.

INTRODUCTION: This study aimed to assess the safety and effectiveness of semaglutide, administered either by weekly subcutaneous (SC) injection or orally, in real-life practice in Saudi Arabia in individuals with type 2 diabetes mellitus (T2DM). METHODS: A retrospective chart review study was conducted at 18 Saudi Arabia centers. An accredited centralized institutional review board approved the study. Medical records were included for individuals of any age ≥ 18 years with uncontrolled T2DM. The primary outcome measure was the laboratory glycated hemoglobin (HbA1c) level. Secondary measures included fasting blood glucose (FBG), weight, and hypoglycemia. All variables were checked after 6 and 12 months of semaglutide initiation. RESULTS: The analysis of this study included 1223 patients with uncontrolled T2DM (HbA1c > 7%). The mean (SD) baseline HbA1c was 10.02% (1.17). HbA1c was reduced by an average of 3.02% (0.84) and 3.17% (0.84) at 6 and 12 months, respectively. Results of a repeated measure analysis of variance (ANOVA) indicated significant differences in HbA1c (p value < 0.001). HbA1c levels at 6 and 12 months were significantly lower, 7.00% (0.70) and 6.85% (0.69), than at baseline, 10.02% (1.17). About 193 patients (56.4%) of the 295 patients having HbA1c < 9% achieved HbA1c of 5.7% or less. The frequency of hypoglycemia events was 4.60 (1.10) in the 3 months before semaglutide was initiated. The frequency of hypoglycemia events in the last 3 months was 2.30 (0.80) events and 0.80 (0.50) events at 6-month and 12-month follow-up visits, respectively. The percent reduction in body mass index (BMI) was an average of 13.07% (1.53) and 19.89% (4.07) at 6 and 12 months, respectively. Lipid profile and blood pressure were improved at 6 and 12 months. CONCLUSION: Semaglutide, administered either by SC injection or orally, provided substantial glycemic and weight-loss benefits in adults with T2DM.

A population-based study of 15,000 people on Knowledge and awareness of lung cancer symptoms and risk factors in Saudi Arabia.

Background: Lung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases. Method: A cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer. Results: Majority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor's degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only ≤ 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001). Conclusion: Public awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socio-economic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms.

Life-Saving Treatments for Spinal Muscular Atrophy: Global Access and Availability.

Background and Objectives: Spinal muscular atrophy (SMA) is a neurodegenerative disorder manifesting with progressive muscle weakness and atrophy. SMA type 1 used to be fatal within the first 2 years of life, but is now treatable with therapies targeting splicing modification and gene replacement. Nusinersen, risdiplam, and onasemnogene abeparvovec-xioi improve survival, motor strength, endurance, and ability to thrive, allowing many patients to potentially attain a normal life; all have been recently approved by major regulatory agencies. Although these therapies have revolutionized the world of SMA, they are associated with a high economic burden, and access to these therapies is limited in some countries. The primary objective of this study was to compare the availability and implementation of treatment of SMA from different regions of the world. Methods: In this qualitative study, we surveyed health care providers from 21 countries regarding their experiences caring for patients with SMA. The main outcome measures were provider survey responses on newborn screening, drug availability/access, barriers to treatment, and related questions. Results: Twenty-four providers from 21 countries with decades of experience (mean 26 years) in treating patients with SMA responded to the survey. Nusinersen was the most available therapy for SMA. Our survey showed that while genetic testing is usually available, newborn screening is still unavailable in many countries. The provider-reported treatment cost also varied between countries, and economic burden was a major barrier in treating patients with SMA. Discussion: Overall, this survey highlights the global inequality in managing patients with SMA. The spread of newborn screening is essential in ensuring improved access to care for patients with SMA. With the advancement of neurotherapeutics, more genetic diseases will soon be treatable, and addressing the global inequality in clinical care will require novel approaches to mitigate such inequality in the future.