Adult Onset Acute Flaccid Myelitis: A Case Report.

We report a 23-year-old male who presented with acute dysarthria, dysphagia, and quadriparesis. These symptoms were preceded by fever and headache. His neurological symptoms were progressive and rendered him quadriplegic over three weeks. Extensive workup for infectious, inflammatory, and neoplastic etiologies was negative; however, the clinical course and magnetic resonance imaging of the brain and spinal cord were consistent with the United States Centres for Disease Control and Prevention (CDC) criteria of acute flaccid myelitis. The patient had various lines of therapy, including antimicrobial agents, intravenous immunoglobulin, plasma exchange, and corticosteroids but he was discharged with significant disability. Despite the increasing number of reported cases worldwide, many aspects of this condition remain unknown including its pathophysiology and optimal treatment regimen. In this case report, we shed light on this clinical entity to increase awareness among practitioners worldwide.

High Bacterial Contamination Load of Self-Service Facilities in Sakaka City, Aljouf, Saudi Arabia, with Reduced Sensitivity to Some Antimicrobials.

Although self-service facilities (SSFs) have been used on a large scale worldwide, they can be easily contaminated by microorganisms from the hands of their sequential users. This research aimed to study the prevalence and antimicrobial susceptibility/resistance of bacteria contaminating SSFs in Sakaka, Aljouf, Saudi Arabia. We randomly swabbed the surfaces of 200 SSFs, then used the suitable culture media, standard microbiological methods, and the MicroScan WalkAway Microbiology System, including the identification/antimicrobial susceptibility testing-combo panels. A high SSFs' bacterial contamination load was detected (78.00%). Ninety percent of the samples collected in the afternoon, during the maximum workload of the SSFs, yielded bacterial growth (p < 0.001 *). Most of the contaminated SSFs were supermarket payment machines, self-pumping equipment at gas stations (p = 0.004 *), online banking service machines (p = 0.026 *), and barcode scanners in supermarkets. In the antiseptic-deficient areas, 55.1% of the contaminated SSFs were detected (p = 0.008 *). Fifty percent of the contaminated SSFs were not decontaminated. The most common bacterial contaminants were Escherichia coli (70 isolates), Klebsiella pneumoniae (66 isolates), Staphylococcus epidermidis (34 isolates), methicillin-resistant Staphylococcus aureus (18 isolates), and methicillin-sensitive Staphylococcus aureus (14 isolates), representing 31.53%, 29.73%, 15.32%, 8.11%, and 6.31% of the isolates, respectively. Variable degrees of reduced sensitivity to some antimicrobials were detected among the bacterial isolates. The SSFs represent potential risks for the exchange of antimicrobial-resistant bacteria between the out-hospital environment and the hospitals through the hands of the public. As technology and science advance, there is an urgent need to deploy creative and automated techniques for decontaminating SSFs and make use of recent advancements in materials science for producing antibacterial surfaces.

Sudden unexpected death in epilepsy: What Saudi people with epilepsy want to know-A cross-sectional study.

OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a significant cause of mortality in people with epilepsy (PWE), with an incidence of 1 per 1000 members of the population. In Saudi Arabia, no data are available that inform local clinical practitioners about the attitudes of PWE regarding SUDEP. The aim of this study was to investigate the perspectives of Saudi PWE toward SUDEP and to assess their knowledge of SUDEP. METHODS: A cross-sectional questionnaire-based study was conducted at the neurology clinics of King Abdul-Aziz Medical City, Riyadh and Prince Sultan Military Medical City, Riyadh. RESULTS: Of the 377 patients who met the inclusion criteria, 325 completed the questionnaire. The mean age of the respondents was 32.9 ± 12.6 years. Of the study subjects, 50.5% were male. Only 41 patients (12.6%) had heard about SUDEP. Most patients (94.5%) wanted to know about SUDEP, of whom 313 (96.3%) wanted to receive this information from a neurologist. A total of 148 patients (45.5%) thought that the appropriate time to receive information about SUDEP was after the second visit, whereas only 75 (23.1%) wanted to learn about SUDEP during the first visit. However, 69 patients (21.2%) thought that the appropriate time to be informed about SUDEP was when seizure control had become more difficult. Almost half (172, 52.9%) of the patients thought that SUDEP could be prevented. SIGNIFICANCE: Our findings suggest that most Saudi PWE do not know about SUDEP and want to be counseled about their risk of SUDEP by their physicians. Therefore, education of Saudi PWE about SUDEP must be improved.

Knowledge and Attitude towards Clinical Trials among General Population of Northern Saudi Arabia during COVID-19 Era: A Cross-Sectional Study.

Recruiting and retaining sufficient participants is one of the biggest challenges researchers face while conducting clinical trials (CTs). This is due to the fact of misconceptions and insufficient knowledge concerning CTs among the public. The present cross-sectional study was conducted from April 2021 to May 2022. We evaluated knowledge and attitude among 480 participants using a pretested Arabic questionnaire. The correlation between knowledge and attitude score was tested through Spearman's correlation test, and the logistic regression test evaluated the associated factors for knowledge and attitude. Of the studied participants, 63.5% were male and belonged to the age group less than 30 years (39.6%). Nearly two-thirds (64.6%) of them had never heard of CT. More than half of the participants had poor knowledge (57.1%) and attitude (73.5%) towards CTs. Participants' knowledge scores were significantly associated with education level (p = 0.031) and previous participation in health-related research (p = 0.007). Attitude scores were significantly related to marital status (p = 0.035) and the presence of chronic diseases (p = 0.008). Furthermore, we found a significant positive correlation between knowledge and attitude scores (p < 0.001, Spearman's rho = 0.329). The present study revealed that most of the study population had poor knowledge and moderate attitudes towards CT. Targeted health education programs at different public places are recommended to improve the public's knowledge of the importance of CT participation. In addition, exploratory and mixed-methods surveys in other regions of KSA is required to recognize the region-specific health education needs.

UV Sterilization Effects and Osteoblast Proliferation on Amorphous Carbon Films Classified Based on Optical Constants.

Optical classification methods that distinguish amorphous carbon films into six types based on refractive index and extinction coefficient have garnered increasing attention. In this study, five types of amorphous carbon films were prepared on Si substrates using different plasma processes, including physical and chemical vapor deposition. The refractive index and extinction coefficient of the amorphous carbon films were measured using spectroscopic ellipsometry, and the samples were classified into five amorphous carbon types-amorphous, hydrogenated amorphous, tetrahedral amorphous, polymer-like, and graphite-like carbon-based on optical constants. Each amorphous carbon type was irradiated with 253.7 nm UV treatment; the structure and surface properties of each were investigated before and after UV treatment. No significant changes were observed in film structure nor surface oxidation after UV sterilization progressed at approximately the same level for all amorphous carbon types. Osteoblast proliferation associated with amorphous carbon types was evaluated in vitro. Graphite-like carbon, which has relatively high surface oxidation levels, was associated with higher osteoblast proliferation levels than the other carbon types. Our findings inform the selection of suitable amorphous carbon types based on optical constants for use in specific medical devices related to osteoblasts, such as artificial joints and dental implants.

A qualitative study to explore opinions of Saudi Arabian radiologists concerning AI-based applications and their impact on the future of the radiology.

Objective: The aim of this study was to explore opinions and views towards radiology AI among Saudi Arabian radiologists including both consultants and trainees. Methods: A qualitative approach was adopted, with radiologists working in radiology departments in the Western region of Saudi Arabia invited to participate in this interview-based study. Semi-structured interviews (n = 30) were conducted with consultant radiologists and trainees. A qualitative data analysis framework was used based on Miles and Huberman's philosophical underpinnings. Results: Several factors, such as lack of training and support, were attributed to the non-use of AI-based applications in clinical practice and the absence of radiologists' involvement in AI development. Despite the expected benefits and positive impacts of AI on radiology, a reluctance to use AI-based applications might exist due to a lack of knowledge, fear of error and concerns about losing jobs and/or power. Medical students' radiology education and training appeared to be influenced by the absence of a governing body and training programmes. Conclusion: The results of this study support the establishment of a governing body or national association to work in parallel with universities in monitoring training and integrating AI into the medical education curriculum and residency programmes. Advances in knowledge: An extensive debate about AI-based applications and their potential effects was noted, and considerable exceptions of transformative impact may occur when AI is fully integrated into clinical practice. Therefore, future education and training programmes on how to work with AI-based applications in clinical practice may be recommended.

Agreement Between International Radiologists on the Appropriateness and Urgency in Lumbar Spine MRI Referrals.

Purpose: To determine how radiologists across health-care jurisdictions internationally assess the appropriateness and urgency levels of lumbar spine Magnetic Resonance Imaging MRI referrals. Patients and Methods: Clinical information was extracted from 203 lumbar spine MRI referrals. Texts were divided into 10 datasets and embedded into a software to facilitate the classification process. Participant radiologists were recruited at the Image Perception Lab, at the Radiological Society of North America Congress, 2019 and through the institution radiology network. Radiologists were asked if they use referral guidelines in their practices. Radiologists assigned appropriateness and urgency levels based on the referral text. Appropriateness level descriptors were: indicated, indicated but needs more information or not indicated. Urgency levels were categorized: urgent, semi-urgent, or not urgent. All cases containing neurological symptoms with/without red flags were extracted and exact agreement between radiologists' responses on the indication status was calculated. Results: Seventy radiologists from 25 countries participated; 42% of participants indicated non-use of referral guidelines. Poor-moderate radiology agreements were recorded for appropriateness and referral urgency level decisions. 79.6% of responses indicated that cases containing neurological symptoms with/without red flags were indicated for scanning. Conclusion: Despite referral guidelines promotion, nearly half of participants stated non-usage. Subsequently, a varied agreement levels were found in assigning the appropriateness of the referrals. Appropriateness of referrals with neurological symptoms (with/without red flags) recorded good agreement.

Correlation of Cell Proliferation with Surface Properties of Polymer-like Carbon Films of Different Thicknesses Prepared by a Radio-Frequency Plasma CVD Process.

In this study, correlation of cell proliferation with surface properties of the polymer-like carbon (PLC) films of different thicknesses prepared by radio-frequency plasma CVD are investigated. Four PLC samples were prepared via radio frequency plasma chemical vapor deposition on Si substrates. Each PLC film was analyzed using spectroscopic ellipsometry to determine its thickness, refractive index (n), and extinction coefficient (k); the thickness ranged from 29.0 to 356.5 nm. Based on their n−k plots, all the samples were classified as PLC-type films. The biological response of the PLC films was evaluated in vitro using a cell culture. The samples with relatively thick PLC films (>300 nm) exhibited stronger cell proliferation properties than those with thinner films. Moreover, the results of the surface analysis showed no significant differences in the surface composition of those PLC samples, as analyzed using X-ray photoelectron spectroscopy, but that as the PLC films became thicker, their surfaces became rougher on the nanoscale and their wettability improved. Overall, this study showed that careful control of the film growth of PLC films, which affects their surface properties, is essential for their use in bio-interface applications.

Adherence of Saudi women with epilepsy to folic acid intake in the preconceptional period in two tertiary care hospitals in Riyadh: A cross sectional study.

Antiseizure medication have been associated with an increasing risk of congenital anomalies. Medical authorities recommend taking folic acid during the pre-conceptional period to reduce the risk of congenital malformations in the newborns of women with epilepsy (WWE). In this cross-sectional study, we aimed to measure the adherence of Saudi WWE to folic acid intake. We included WWE visiting outpatient epilepsy clinics in King Abdulaziz Medical City and King Fahad Medical City in Riyadh between September 2017 and August 2018. By consecutive non-probability sampling, we identified 85 patients who met the inclusion criteria of the study. The data were collected by a self-administrated questionnaire. We found that the mean age of the subjects was 33 ± 7.5 years. One third were university graduates. Eighty percent were aware of the role of folic acid in preventing congenital anomalies, and 63.9% were taking it during the preconceptional period. No association was found between educational level and adherence to folic acid intake. In conclusion, adherence to folic acid intake among Saudi WWE is not optimal. More efforts are needed to increase patient adherence to folic acid intake.

Surface Reformation of Medical Devices with DLC Coating.

We evaluated the adhesion, friction characteristics, durability against bodily acids, sterilization, cleaning, and anti-reflection performance of diamond-like carbon (DLC) coatings formed as a surface treatment of intracorporeal medical devices. The major coefficients of friction during intubation in a living body in all environments were lower with DLC coatings than with black chrome plating. DLC demonstrated an adhesion of approximately 24 N, which is eight times stronger than that of black chrome plating. DLC-coated samples also showed significant stability without being damaged during acid immersion and high-pressure steam sterilization, as suggested by the results of durability tests. In addition, the coatings remained unpeeled in a usage environment, and there was no change in the anti-reflection performance of the DLC coatings. In summary, DLC coatings are useful for improving intracorporeal device surfaces and extending the lives of medical devices.

Acute Brucellosis with a Guillain-Barre Syndrome-Like Presentation: A Case Report and Literature Review.

INTRODUCTION: Brucellosis is a zoonotic disease that can affect the central and peripheral nervous system and it has variable neurological manifestation. However, brucellosis infection that presents with acute peripheral neuropathy mimicking Guillain-Barre syndrome (GBS) is rarely reported in the literature. OBJECTIVE AND METHOD: We report a 56-year-old man who was initially diagnosed with GBS, and then he was confirmed to have acute Brucella infection. We also did a systematic literature review to study the natural history and management of previously reported cases of brucellosis that presented with manifestations consistent with GBS. RESULTS: We found 19 (including our patient) cases of brucellosis that presented with GBS-like manifestations. The age range was 9-62 years. Eight (42.1%) patients had a history of fever. Seven (36.8%) patients had no constitutional symptoms. Five (26.3%) patients had splenomegaly. Brucella serological tests were positive in all patients, while blood Brucella culture was positive in three (37.5%) out of eight patients. Albuminocytological dissociation was present in nine (64.3%) out of 14 patients. Nerve conduction studies and electromyography were consistent with demyelination polyneuropathy in eight (42.1%) patients, with axonal polyneuropathy in six (31.6) patients, and with mixed axonal and demyelinating polyneuropathy in one (5.3%) patient. Spine MRI showed root enhancement in three (42.9%) patients. CONCLUSION: In regions endemic with brucellosis, acute peripheral neuropathy presentation may warrant investigations for Brucella infection.

Genomic testing and counseling: The contribution of next-generation sequencing to epilepsy genetics.

INTRODUCTION: Currently, next-generation sequencing (NGS) technology is more accessible and available to detect the genetic causation of diseases. Though NGS technology benefited some clinical phenotypes, for some clinical diagnoses such as seizures and epileptic disorders, adaptation occurred slowly. The genetic diagnosis was mainly based on epilepsy gene panels and not on whole exome and/or genome sequencing. METHOD: We retrospectively analyzed 420 index cases, referred for NGS over a period of 18 months, to investigate the challenges in diagnosing epilepsy. RESULT: Of the 420 cases, 65 (15%) were referred due to epilepsy with one third having a positive family history. The result of the NGS was 14 positive cases (21.5%), 16 inconclusive cases (24%), and 35 (53%) negative cases. No gene has been detected twice in the inconclusive and positive groups. Comparative genomic hybridization has been performed for all 30 NGS negative cases and four cases with pathogenic variants (deletion in 15q11.213.1, deletion of 2p16.3, deletion in Xq22.1, and deletion in 17p13.3) were identified. CONCLUSION: These findings have implications for our understanding of the approach to genetic testing and counseling of patients affected with seizures and epilepsy disorders. The overall diagnostic yield of exome/genome sequencing in our cohort was 23%. The main characteristic is genetic heterogeneity, supporting NGS technology as a suitable testing approach for seizures and epilepsy disorders. Genetic counseling for newly identified disease-causing variants depends on the pedigree interpretation, within the context of disease penetrance and variable expressivity.