Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia.

Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.

Detection and diagnosis of posterior circulation calcification: An interobserver agreement study.

Background: Posterior cerebral ischemic stroke and its underlying causes can be easily misdiagnosed in routine practice. Therefore, more than a third of positive cases can be easily missed during routine CT image reporting unless expert neuroimaging radiologists carefully report it. Objective: To assess the inter-rater agreement level between senior residents and general radiologists and a specialized expert neuroradiologist when detecting and diagnosing posterior cerebral circulation calcification. Methods: This was a cross-sectional observational study. A total of fifteen senior radiology residents (SRRs) and fifteen general radiologists (GRs) at four different hospitals in Riyadh, Saudi Arabia, were included in the study. A total of four CT-scanned brain cases with the presence of posterior circulation calcification (PCC) with different degrees of severity and one brain case with negative PCC were selected. These cases were predefined by expert neuroradiologists at our center. The cases were uploaded into the picture archiving and communication systems (PACS) at four different centers as outsider cases. These cases were then randomly assigned to the participating SRRs and GRs for reporting. All radiologists were blinded to the findings of the cases. Inter-observer agreement was assessed using the weighted kappa coefficient of agreement (k) between the two groups. Results: The cerebral calcification misdiagnosis rate for the SRRs and GRs was > 93% for most of the positive cases. There was 1) poor inter-observer agreement between the SRRs and GRs for the detection of severe posterior cerebral calcification(PCC) in a negative stroke case (agreement for misdiagnosis, k = 0.93; correct diagnosis, k = 0.00), 2) poor inter-observer agreement for mild PCC in a negative stroke case (agreement for misdiagnosis, k = 0.93; correct diagnosis, k = 0.00), 3) moderate PCC in a positive posterior stroke case (agreement for misdiagnosis, k = 0.92; correct diagnosis, k = 0.00), and 4) poor interobserver agreement for severe PCC in a positive posterior cerebral stroke case (agreement for misdiagnosis, k = 0.846; correct diagnosis, k = 0.00). There was excellent agreement between the SRRs and GRs when reporting negative cases of PCC and stroke. Conclusion: Our study concluded that most of the SRRs and GRs missed the diagnosis of posterior cerebral calcification in the presented cases.

Absent right internal carotid associated with posterior cerebral artery aneurysm: A case report.

Introduction: and importance: An uncommon condition is congenital unilateral agenesis of the internal carotid artery (ICA). Most instances are asymptomatic due to adequate collateral circulation via the circle of Willis, but individuals might potentially manifest (or show) ischemic or aneurysmal dilatation hemorrhagic cerebrovascular lesions. The bony carotid canal must be absent from distinguishing this abnormality from chronic ICA blockage. Neuroradiologists must be aware of this condition since these patients have a higher risk of developing numerous intracranial diseases. Case presentation: This report focuses on the case of 39 years male with an absent right internal carotid artery with posterior cerebral artery aneurism whose main symptoms were on and off headaches. In a discussion that includes demographic characteristics, clinical manifestations, radiologic findings, and an assessment of the risks associated with ICA agenesis. Conclusion: Congenital agencies absence of carotid artery is rare variant anatomy although most of the time they are asymptomatic, it is known to increase the risk of aneurism and therefore, they need screening and close follow up.

Physician Perception of Disease Severity and Treatment Outcomes for Children and Adolescents with Atopic Dermatitis in Emerging Economies.

INTRODUCTION: Pediatric atopic dermatitis (AD) leads to a considerable reduction in quality of life for patients and their families. Therapeutic options for pediatric patients with moderate-to-severe disease are limited and treatment is challenging. As little is understood about physician perceptions of pediatric AD in countries with emerging healthcare, we conducted a questionnaire-based study to identify treatment patterns and gaps. METHODS: Physicians treating children (aged 6-11 years) and adolescents (aged 12-17 years) with AD in 11 emerging economy countries were interviewed regarding their beliefs and behaviors relating to the disease. Physicians gave an initial assessment of patient disease severity and control, which was then compared with patient records and pre-specified criteria to assess concordance and discordance between physician perception and recorded patient presentation. RESULTS: A total of 574 physicians completed the study, with an assessment of 1719 patients. Only 51% of patients whose disease criteria matched 'severe disease' to pre-specified criteria and SCORing Atopic Dermatitis scores (SCORAD) were also initially identified by physicians as having severe disease. Patients with moderate-to-severe disease experienced flares for an average of 263 days in the preceding year. Ninety and 74% of patients experienced chronic flares and unpredictable flares, respectively. Control of flares could only be achieved within 7 days in 14% (n = 153) of patients. Most physicians listed elimination of skin symptoms as their primary treatment goal, and for moderate and severe cases, 59% and 33% of physicians reported that they were able to achieve this respectively. Nearly 24% and 40% of physicians were slightly dissatisfied with the treatment options for moderate disease and severe disease and severe disease, respectively. CONCLUSIONS: AD severity of children (aged 6-11 years) and adolescents (aged 12-17 years) appears to be underestimated by physicians in emerging economy countries. Practical, easy-to-use, and validated objective measures for assessment of disease severity and control, as well as effective use of novel therapies, are essential to ensure that patients are appropriately managed.

Atopic dermatitis (AD) is a common childhood disease that occurs in up to 30% of individuals under 18 years of age. Although most forms are mild, more severe disease forms of AD including symptoms such as pruritus, xerosis, lichenification, and excoriation of the skin can cause significant problems, such as lack of sleep, lack of productivity, poor self-image, and mental health disorders among patients. It also places a burden on patients' families, which affects home, school, and work life. In children with moderate-to-severe disease, treatment options are limited especially since doctors may not be keen to prescribe high-dose treatments to children such as potent and super-potent topical corticoid steroids and progress to systemic therapies. Relatively little is understood about how doctors determine whether the disease is mild, moderate, or severe and what they consider to be the best treatment options for patients. Therefore, we conducted a series of interviews with doctors in 11 countries with emerging healthcare to better understand their beliefs and behaviors about treating childhood AD. Our results indicated that doctors tended to underestimate the severity of a patient's disease. Additionally, 59% of doctors felt that they were able to successfully eliminate itching and skin syndrome frequently (that is, in 70% or more of their patients) in patients with moderate disease and 33% of doctors for their patients with severe disease. These results suggest that there are many unmet needs in the treatment of children and adolescents with AD in emerging economies, whose treatment could be further optimized. Improving how doctors measure the severity of a patient's disease should help them select the most appropriate and effective treatments for their patients.