A preliminary study on benthic nutrient exchange across sediment-water interfaces in a shallow marine protected area of the Northwestern Arabian Gulf.

Sedimentary processes are expected to play a crucial role in macronutrient cycling of the shallow Arabian Gulf. To investigate this aspect, sediment cores were collected from the shallow intertidal and subtidal expanses of the first Marine Protected Area (MPA) of Kuwait in the Northwestern Arabian Gulf (NAG). Porewater nutrient profiling and whole core incubation experiments were conducted to measure the nutrient fluxes, both with and without the addition of the nitrification inhibitor allylthiourea (ATU). The porewater data confirmed the potential of sediments to host multiple aerobic and anaerobic pathways of nutrient regeneration. The average (±SD) of net nutrient fluxes from several incubation experiments indicated that ammonium (NH4+) predominantly fluxed out of the sediment (3.81 ± 2.53 mmol m-2 d-1), followed by SiO44- (3.07 ± 1.21 mmol m-2 d-1). In contrast, the average PO43- flux was minimal, at only 0.06 ± 0.05 mmol m-2 d-1. Fluxes of NO3- (ranged from 0.07 ± 0.005 to 1.16 ± 0.35 mmol m-2 d-1) and NO2- (0.03 ± 0.003 to 0.71 ± 0.21 mmol m-2 d-1) were moderate, which either reduced or reversed in the presence of ATU (-0.001 ± 0.0001 to 0.01 ± 0.0001 mmol m-2 d-1 and -0.001 ± 0.0003 to 0.006 ± 0.001 mmol m-2 d-1 for NO3- and NO2- respectively). Thus, this study provides preliminary experimental evidence that nitrification can act as a source of NO3- and NO2- as well as contribute towards the relatively high concentrations of NO2- (>1 in the gulf waters.

Aeolian dust and hydro-biological characteristics: Decoding dust storm impacts on phytoplankton in the northern Arabian Gulf.

Aeolian dust is an essential source of growth-limiting nutrients for marine phytoplankton. Despite being at the core of the Global Dust Belt, the response of the Arabian Gulf ecosystem to such atmospheric forcing is rarely documented. Here, the hydro-biological effect of mineral dust was studied in the northern Arabian Gulf (NAG) off Kuwait through monthly water sampling (December 2020 to December 2021), dust-storm follow-up sampling, and mineral dust and nutrient addition in-situ experiments. The multivariate analysis of oceanographic data revealed pronounced hydro-biological seasonality. The mineral dust deposition during two severe dust storm events in March and June 2021 showed a spatially varying effect of dust on coastal waters. The dust storms elevated the surface dissolved iron levels by several magnitudes, increased the dissolved inorganic nitrogen and phosphorous levels, changed their stoichiometry, and offset the hydrobiological seasonality. In the microcosms, dust input temporarily reduced phytoplankton phosphorous limitation in a dose-dependent manner when mesozooplankton (copepods) grazing was minimal. The microphytoplankton response to mineral dust inputs was comparable to that with nitrogen and phosphorous treatment. While Both treatments increased diatom size structure and biomass, the abundance of single-celled diatoms was comparatively higher in dust treatment. Multivariate analysis indicated that dust deposition alters the hydrographical properties of the surface ocean during dust storm events. The effects, though transient, were traceable for 3-16 days post-storm in coastal waters. The response of the summer phytoplankton to these changes, if delayed or muted, should be interpreted with caution given the summer water column stratification, the high nitrogen: phosphorous ratio and the low phosphorous solubility of aerosol dust, and the complex pelagic microbial food web interactions in the NAG. This study thus underlines the importance of a multivariate approach in documenting the ecological implications of Aeolian dust storms on marine environments closer to the dust source regions.

Molecular characterization of gliotoxin-producing Aspergillus fumigatus in dairy cattle feed.

Background and Aim: Several strains of Aspergillus fumigatus produce mycotoxins that affect the health and productivity of dairy cattle, and their presence in dairy cattle feed is a serious concern. This study aimed to determine the densities of A. fumigatus and gliotoxin in commercial dairy feed. Materials and Methods: More than 60 dairy feed samples were examined for fungal contamination, specifically for A. fumigatus, using phenotypic approaches and DNA sequencing of the internal transcribed spacer (ITS) and ß-tubulin regions. Thin-layer chromatography and high-performance liquid chromatography (HPLC) were used to assess gliotoxin production in A. fumigatus. Real-time polymerase chain reaction (RT-PCR) was used to investigate the expression of gliZ, which was responsible for gliotoxin production. High-performance liquid chromatography was used to detect gliotoxin in feed samples. Results: Aspergillus was the most commonly identified genus (68.3%). Aspergillus fumigatus was isolated from 18.3% of dairy feed samples. Only four of the 11 A. fumigatus isolates yielded detectable gliotoxins by HPLC. In total, 7/11 (43.7%) feed samples tested had gliotoxin contamination above the threshold known to induce immunosuppressive and apoptotic effects in vitro. The HPLC-based classification of isolates as high, moderate, or non-producers of gliotoxin was confirmed by RT-PCR, and the evaluation of gliZ expression levels corroborated this classification. Conclusion: The identification of A. fumigatus from animal feed greatly depended on ITS and ß-tubulin sequencing. Significant concentrations of gliotoxin were found in dairy cattle feed, and its presence may affect dairy cow productivity and health. Furthermore, workers face contamination risks when handling and storing animal feed.

Effect of low-pressure pneumoperitoneum on pain and inflammation in laparoscopic cholecystectomy: a randomized controlled clinical trial.

OBJECTIVE: We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers. BACKGROUND: The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12-14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines. METHODS: A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8-10 mmHg) vs. standard-pressure (12-14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed. RESULTS: one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs. 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons. CONCLUSION: low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022).

Isolation and Detection of Drug-Resistant Bacterial Pathogens in Postoperative Wound Infections at a Tertiary Care Hospital in Saudi Arabia.

Background: Surgical site infections (SSIs), especially when caused by multidrug-resistant (MDR) bacteria, are a major healthcare concern worldwide. For optimal treatment and prevention of antimicrobial resistance, it is important for clinicians to be aware of local drug-resistant bacterial pathogens that cause SSIs. Objective: To determine the frequency patterns of drug-resistant bacterial strains causing SSIs at a tertiary care hospital in Saudi Arabia. Methods: This retrospective study was conducted at the Microbiology laboratory of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, and included wound swab samples from all cases of SSI between January 01, 2017, and December 31, 2021. The swabs were processed for the identification of bacterial strains and their resistance pattern to antibiotics according to the Clinical and Laboratory Standards Institute. Results: A total of 5409 wound swabs were analyzed, of which 3604 samples (66.6%) were from male. Most samples were from the Department of Surgery (43.3%). A total of 14 bacterial strains were isolated, of which 9 were Gram-negative bacteria. The most common isolates were Klebsiella pneumoniae, followed by Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and vancomycin-resistant S. aureus (VRSA). In terms of MDR in 2021, the highest rate of carbapenem-resistance was in A. baumannii (97%). MDR was as follows: A. baumannii, 97%; K. pneumoniae, 81%; E. coli, 71%; MRSA, 60%; P. aeruginosa, 33%; VRE, 22%; and VRSA, 2%. Conclusion: This study showed that in the city of Makkah, Saudi Arabia, the rates of MDR bacteria are high, with the majority being Gram-negative.

Antimicrobial Resistance Pattern of Pseudomonas aeruginosa: An 11-Year Experience in a Tertiary Care Hospital in Makkah, Saudi Arabia.

Purpose: Pseudomonas aeruginosa (P. aeruginosa) is a common causative pathogen in healthcare settings and displays increasing levels of resistance to common antimicrobial drugs. Its capacity to resist has been reported in multiple locations across the world. This study evaluates current levels of antibiotic resistance and seeks to understand antibiotic resistance patterns in the context of the clinical isolates of P. aeruginosa. Methods: All clinical isolates were cultured at 37 °C for 24 h in different media: blood sheep agar, McConkey agar, and cystine-lactose-electrolyte-deficient agar (CLED), bacterial identification and antibiotic susceptibility patterns were determined using the Vitek-2 (bioMérieux) automated system. Results: In total, there were 61,029 patient specimens, of which 5534 were identified as non-duplicated P. aeruginosa clinical isolates, most being from males aged over 60 years. The research findings revealed that the maximum antibiotic resistance associated with P. aeruginosa isolates was found in colistin (97%), which was followed by piperacillin/tazobactam (75.8%). The maximum resistance rates in P. aeruginosa isolates were found in relation to cefepime (42.7%,) which was followed by ciprofloxacin (34.3%). Conclusion: The antibiotic resistance rate during the first six years of the research period was notably higher than in the last years, due to the application of infection control protocols and strict policies to control antibiotic prescriptions in all Saudi hospitals.

Distance learning: studying the efficiency of implementing flipped classroom technology in the educational system.

Technology development and the general availability of information have affected modern society in such a way that the educational system requires immediate and decisive changes. The situation escalated during the pandemic when distance learning became an integral part of life of every teacher and student. Modern researchers call the educational system built on the flipped classroom model a pedagogical breakthrough, so it is important to study its impact from all sides; this explains the relevance of this paper. The purpose of this research was to study the effectiveness of flipped classroom as a distance learning component for students. The study was conducted at St. Petersburg State University and enrolled 56 students in the control and experimental groups (n = 28 per group). The researchers used the questionnaire "Studying the motives of students' educational activities" by A.A. Rean and V.A. Yakunin and a cross-section of grades to obtain information about academic performance and a survey for feedback from students. The findings show that flipped classroom had a positive effect on academic performance and student motivation. The number of "excellent" students increased by 17.9% and the numbers of "good" and "satisfactory" students decreased by 3.6% and 14.3%, respectively. The overall motivation of the group increased from 4.8 to 5.0. At the same time, the number of students with low motivation decreased by 7.2%, with medium motivation increased by 10.7%, and with high motivation decreased by 3.4%. A feedback survey showed that the vast majority of students were satisfied with the flipped classroom. At that, 89.2% of students answered that this model is suitable for knowledge assimilation, 92.8% believe that flipped classroom arouses their research interest, and 82.1% call the flipped classroom model the most suitable for interesting learning. The respondents noted the following advantages of the flipped classroom: saving time (82.7%), the opportunity to discuss more interesting topics in class (64.2%), the absence of dependence on time and place (38.1%), and the possibility of a deeper study (53.5%). The disadvantages included the inability to independently study the material (10.7%), a large amount of material (17.8%), and technical problems (7.1%). These findings are of value for further study of the effectiveness of flipped classroom introduction into the educational system and may be used to compile statistics or as a basis for a similar experiment.

Influence of teacher on student motivation: Opportunities to increase motivational factors during mobile learning.

Amid the COVID-19 lockdown many countries have replaced traditional learning with remote or mobile one. It was noted that students' motivation has become much less with the transition to distance learning. This study analyzes how motivational processes influence mobile learning quality and aimed to analyze the factors boosted the motivation of students to learn in modern conditions of isolation and identify the major demotivating factors affecting the quality of mobile learning. Motivation is considered a key factor in improving students' involvement in distance learning. The author surveyed 200 students and 46 teachers of The University of Jordan and Jordan University of Science and Technology regarding the factors that influenced their motivation in terms of mobile learning. The results revealed that 178 out of 200 participants agreed that intrinsic motivation impacted their interest in mobile learning. Some 78% of the students approved of mobile learning, while the remaining 22% believe it is necessary to return to the traditional face-to-face education format. The importance of feedback and communication with teachers and its impact on the process of mobile learning is considered. The role of built-in mechanisms in information systems and the positive role of gamification is equally important. Plug-ins compatible with the convenient WordPress system, i.e. applications that help organize the educational process were examined in the scientific work. The specific recommendations for raising the motivation of students in the learning process, which can be used by relevant institutions worldwide presented.

Prevalence and Antibiogram Pattern of Klebsiella pneumoniae in a Tertiary Care Hospital in Makkah, Saudi Arabia: An 11-Year Experience.

Infectious disease is one of the greatest causes of morbidity and mortality worldwide, and with the emergence of antimicrobial resistance, the situation is worsening. In order to prevent this crisis, antimicrobial resistance needs to be monitored carefully to control the spread of multidrug-resistant bacteria. Therefore, in this study, we aimed to determine the prevalence of infection caused by Klebsiella pneumoniae and investigate the antimicrobial profile pattern of K. pneumoniae in the last eleven years. This retrospective study was conducted in a tertiary hospital in Makkah, Saudi Arabia. Data were collected from January 2011 to December 2021. From 2011 to 2021, a total of 61,027 bacterial isolates were collected from clinical samples, among which 14.7% (n = 9014) were K. pneumoniae. The antibiotic susceptibility pattern of K. pneumoniae revealed a significant increase in the resistance rate in most tested antibiotics during the study period. A marked jump in the resistance rate was seen in amoxicillin/clavulanate and piperacillin/tazobactam, from 33.6% and 13.6% in 2011 to 71.4% and 84.9% in 2021, respectively. Ceftazidime, cefotaxime, and cefepime resistance rates increased from 29.9%, 26.2%, and 53.9%, respectively, in 2011 to become 84.9%, 85.1%, and 85.8% in 2021. Moreover, a significant increase in the resistance rate was seen in both imipenem and amikacin, with an average resistance rate rise from 6.6% for imipenem and 11.9% for amikacin in 2011 to 59.9% and 62.2% in 2021, respectively. The present study showed that the prevalence and drug resistance of K. pneumoniae increased over the study period. Thus, preventing hospital-acquired infection and the reasonable use of antibiotics must be implemented to control and reduce antimicrobial resistance.

Dosimetric Study of Heat-Treated Calcium-Aluminum-Silicon Borate Dosimeter for Diagnostic Radiology Applications.

The production of thermoluminescence (TL) dosimeters fabricated from B2O3-CaF2-Al2O3-SiO2 doped with Cu and Pr for use in diagnostic radiology is the main goal of this research. The TL samples were synthesized via the melt-quench technique processed by melting the mixture at 1200 °C for 1 h, and, after cooling, the sample thus created was divided into two samples and retreated by heating for 2 h (referred to as TLV30) and for 15 h (referred to as TLV17). SEM and EDS analyses were performed on the TL samples to confirm the preparation process and to investigate the effects of irradiation dosimetry on the TL samples. Furthermore, the TL samples were irradiated with γ-rays using a 450 Ci 137Cs irradiator and variable X-ray beams (5-70 mGy). Two important diagnostic radiology applications were considered: CT (6-24 mGy) and mammography (2.72-10.8 mGy). Important dosimetric properties, such as the glow curves, reproducibility, dose-response linearity, energy dependence, minimum dose detectability and fading, were investigated for the synthetized samples (TLV17 and TLV30), the results of which were compared with the Harshaw TLD-100. The TLV17 dosimeter showed higher sensitivity than TLV30 in all applied irradiation procedures. The dose-response linearity coefficients of determination R2 for TLV17 were higher than TLD-100 and TLV30 in some applications and were almost equal in others. The reproducibility results of TLV17, TLV30 and TLD-100 were less than 5%, which is acceptable. On the other hand, the results of the fading investigations showed that, in general, TLV17 showed less fading than TLV30. Both samples showed a significant decrease in this regard after the first day, and then the signal variation became essentially stable though with a slight decrease until the eighth day. Therefore, it is recommended to read the TL dosimeters after 24 h, as with TLD-100. The SEM images confirmed the existence of crystallization, whilst the EDS spectra confirmed the presence of the elements used for preparation. Furthermore, we noticed that TLV17 had grown dense crystals that were larger in size compared to those of TLV30, which explains the higher sensitivity in TLV17. Overall, despite the fading, TLV17 showed greater radiation sensitivity and dose-response linearity compared with TLD-100. The synthetized TL samples showed their suitability for use as dosimeters in diagnostic radiology radiation dosimetry.

Association between serum vitamin D levels and age in patients with epilepsy: a retrospective study from an epilepsy center in Saudi Arabia.

BACKGROUND: Vitamin D deficiency has been linked to various medical conditions such as bone loss, decreased mineralization, endocrine disorders, and central nervous system disorders, including epilepsy. Vitamin D deficiency is prevalent among patients with epilepsy (PWE). However, the specific association between vitamin D levels and age in PWE is unclear. OBJECTIVES: Identify the relation between vitamin D level and age in PWE and evaluate factors that may play a role in seizure control. DESIGN: Retrospective analytical medical record review SETTING: Outpatient epilepsy research clinic in Saudi Arabia PATIENTS AND METHODS: Between November 2016 and April 2020, we selected eligible PWE aged older than 14 years whose vita-min D levels were recorded at least once after reviewing 1550 patient electronic files. We analyzed data on serum vitamin D level by age and other factors, vitamin D supplement use, seizure classification, and conducted a multivariate logistic regression to assess associations with seizure control. MAIN OUTCOME MEASURES: Relationships between vitamin D levels and age and factors that might affect seizure control. SAMPLE SIZE: 524 patients RESULTS: The prevalence of low serum vitamin D levels was high (86.8%). The median vitamin D level in all patients was low (38 nmol/L), and was lower in young PWE than in adult PWE (P<.01). Only 146 patients received vitamin D supplements. High vitamin D levels were associated with a 40% seizure reduction. CONCLUSION: Vitamin D deficiency is underestimated in PWE in Saudi Arabia, and is more prevalent among young adults and patients on polytherapy than in other PWE. Patients with high vitamin D levels had good seizure control compared with those with low levels. The effect of vitamin D supplements on seizure control should be further investigated in randomized control trials. LIMITATIONS: Retrospective study and no categorization by presence of supplementation. CONFLICT OF INTEREST: None.

Dynamic hydrographic and water-quality variations in the northwestern Arabian Gulf, a sinking zone of reverse estuarine circulation.

Continuous measurements of hydrographic, hydrodynamic, and water quality showed marked diurnal, tidal, and seasonal variabilities in Kuwait Bay, a stressed coastal system in the northwestern Arabian/Persian Gulf. Advection of water masses and seasonality in vertical mixing regulated the Bay's hydrographic and water quality properties. Intensive stratification in summer had substantial implications on the Bay environment. Kuwait Bay constantly exports dense bottom water laden with dissolved inorganic nutrients and organic matter to the central basin of the Gulf. The export was largest in August under strong water column stratification. These in-situ findings agreed well with earlier studies that corroborated Kuwait Bay as an important area where the phenomenon of reverse estuarine circulation originates in the Gulf. Thus, Kuwait Bay is a significant source of nutrients and organic matter to the Gulf Deep Water that flows into the core of the oxygen minimum zone in the northwestern Indian Ocean.

Gas Chromatography-Mass Spectrometry (GC-MS) Metabolites Profiling and Biological Activities of Various Capsicum annum cultivars.

This study evaluates the quality variation for twenty-seven capsicum fruit (CF) samples, in terms of their volatile oil composition and biological activities. The GCMS analysis revealed the presence of seventy one chemical compounds from different chemical classes with an average (%) composition of: 26.13 (alcohols) > 18.82 (hydrocarbons) > 14.97 (esters) > 3.08 (ketones) > 1.14 (others) > 1.07 (acids) > 0.72 (sugar) > 0.42 (aldehydes) > 0.15 (amino compounds). Alcohols and hydrocarbons were the most abundant in these CF samples with 1-Decanol, 2-octyl- and docosanoic acid, docosyl ester as the major components, respectively. The % inhibition in cytotoxicity assays was observed in the range of 9−47 (MCF7) and 4−41 (HCT116) whereas, the zone of inhibition (mm) for the antimicrobial activity was found to be 0.0−17 (P. aeruginosa) > 0.0−13 (E. coli and S. aureus). Moreover, the samples with the largest zone of inhibition in the agar-well-diffusion method (C16, C19, and C26) upon further evaluation presented the least MIC and MBC values against P. aeruginosa with an MIC and MBC (µg/mL) of 6.3 and 12.5, respectively. The outcome for GCMS and biological activities were further supported by statistical tools of PCA and K-mean cluster analysis which confirmed the C16 CF sample with the best activity followed by C5, C13 (the best cytotoxic), and C19, C26 (the best antimicrobial). The statistical analysis exhibited a high Chi-square value of 5931.68 (GCMS) and 32.19 (biological activities) with p = 0.00 for KMO and Bartlett's Test of Sphericity. The 27-CF samples were effectively distinguished based on quality variation, and the C16 CF sample exhibited significant potential for further study.

Environmental impact of a series of flash flood events on a hypersaline subtropical system in the Northwestern Arabian Gulf.

A series of flash floods that swamped urban drainage systems in Kuwait in November-December 2018 drastically altered coastal hydrography. The phytoplankton responded quickly to the nutrient supply from land and reduced salinity despite elevated turbidity, as evident from rapid increases in chlorophyll a and net community production. Microphytoplankton was dominated by diatoms and the photosynthetic ciliate Myrionecta rubra. Both field observations and microcosm experiments suggested that although increased nutrient availability stimulates diatom growth, microzooplankton grazing controls their outbursts. This study revealed that in a hypersaline system similar to the northern Arabian Gulf, extreme events like flash floods have immediate but short-lived corollaries on coastal phytoplankton due to synergistic effects of bottom-up and top-down factors. The patterns are comparable to those reported from other tropical and sub-tropical systems.

Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

Adequate nutrition in early life is proposed to shape a child’s future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life.This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.

Mental health outcomes among health-care workers in Oman during COVID-19: A cluster analysis.

AIM: Despite the much heralded epidemic of adjustment difficulties, health-care workers (HCW), who are likely to be at risk and impacted with mental health issues, have received scant attention. This study aimed to determine whether definable profiles exist in a cohort of HCWs associated with demographic and mental health problems. METHODS: An online cross-sectional survey was conducted in Oman. Demographic and mental health data were collected from 8 to 17 April 2020. A total of 1132 participants returned their completed questionnaire. A two-step cluster analysis was used to split the sample into three clusters. RESULTS: Cluster A (n = 416) was from HCW in non-frontline roles, and constituted "low-risk and least-impacted". Cluster B (n = 412) and Cluster C (n = 304) were from frontline HCW and constituted 'high-risk and moderate-impacted' and 'high-risk and high-impacted' groups, respectively. HCWs in Cluster C reported more depression (P < 0.001), anxiety (P < 0.001), stress (P < 0.001) and clinical insomnia (P < 0.001) compared with those in the other clusters. HCWs in Cluster C were at the highest risk for mental health problems during the pandemic. CONCLUSIONS: Early psychological interventions targeting this vulnerable group may be beneficial. Management should develop different tailor-made strategic plans to address different mental health needs for each profile group.

The role of brain magnetic resonance imaging on the timing of antiepileptic drugs withdrawal following mesial temporal lobe epilepsy surgery.

OBJECTIVES: To assess the influence of magnetic resonance imaging (MRI) brain findings on the timing of antiepileptic drugs (AEDs) withdrawal following anterior temporal lobectomy (ATL) in patients with mesial temporal lobe epilepsy (MTLE). METHODS: We conducted a retrospective chart review at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia from Jan, 2004 - Dec, 2017 of patients with MTLE who underwent ATL and included patients who had a minimum of 2 years of follow-up. We evaluated the association between the time required to start tapering and discontinuing AEDs after ATL in patients with Engel class I outcomes and their preoperative brain MRI. RESULTS: We studied 64 patients who underwent ATL. The majority of patients (63%) had hippocampal sclerosis (HS) on histopathology. Following ATL, the mean time to start tapering AEDs was 10 months and AEDs were discontinued at a mean of 48 months. Abnormal brain MRI was observed in 53 (83%) patients, with findings suggestive of mesial temporal sclerosis (MTS) accounting for 75% of these abnormalities. The presence of any MRI abnormality was associated with a 10-month earlier tapering of AEDs (p<0.01), and an 18-month earlier complete withdrawal of AEDs (p<0.01). The odds of being seizure-free within the first year were higher if MTS was present in the brain MRI (adjusted OR=16). Similarly, this was associated with seizure freedom after the first year (adjusted OR=14.8, p<0.01). The presence of unilateral temporal IEDs on preoperative EEG were also associated with earlier tapering and discontinuation of AEDs as well as a seizure-free state after ATL surgery (OR=8.5 and 4.2, for the first and second year respectively, p<0.01). CONCLUSION: Patients with abnormal MRI findings and unilateral IEDs had earlier tapering of AEDs with an overall shorter AED discontinuation plan. Moreover, the presence of MTS on MRI, along with unilateral IEDs, were predictors of seizure freedom following ATL.