Patterns of multiple sclerosis presentation to the emergency department.

Background: Multiple sclerosis (MS) patients are no strangers to the emergency department (ED) due to the relapsing and progressive nature of the disease and the associated complications. This study aimed to identify patterns of ED visits among patients diagnosed with MS, the underlying causes of these visits, and the factors associated with these visits. Methods: This was a single center retrospective cohort study which utilized a non-probability consecutive sampling technique to include all patients diagnosed with MS (471 patients) from March 2016 to October 2021 in King Abdulaziz Medical City, Jeddah, Saudi Arabia. ED visits were categorized as directly related to MS, indirectly related to MS, or unrelated to MS. Results: One in four people with MS visited the ED at least once with a total of 280 ED visits. Most ED visits were ones directly related to MS 43.6%, closely followed by unrelated to MS 41.1%, and then indirectly-related MS visits 15.4%. The most common presenting symptoms in directly-related MS visits were weakness 56.6% and numbness/tingling 56.6% followed by gait impairment 29.5%. Indirectly related to MS or unrelated to MS ED visits were commonly due to neurological 17.7% and gastrointestinal 17.1% causes. Using disease modifying therapy (DMT) was significantly associated with no ED visits (p < 0.001). The use of high-efficacy DMTs was significantly associated with no ED visits than using moderate efficacy DMT (p < 0.001). The use of B-cell depleting therapy (ocrelizumab and rituximab) was significantly associated with no visits to the ED than using any other DMT (p < 0.001). Evidence of brain atrophy on imaging was significantly associated with patients who presented to the ED ≥3 times (p = 0.006, UOR = 3.92). Conclusion: Due to the nature of the disease, many MS patients find themselves visiting the ED due to MS related and unrelated issues. These patients are not only required to be treated by neurologists but also by multiple disciplines. The use of high-efficacy DMTs and B-cell depleting therapy may reduce the total frequency of ED visits. Special attention should be paid to patients who have evidence of brain atrophy on imaging.

Utility of Initial Arterial Blood Gas in Neuromuscular versus Non-Neuromuscular Acute Respiratory Failure in Intensive Care Unit Patients.

Background: The arterial blood gas (ABG) parameters of patients admitted to intensive care units (ICUs) with acute neuromuscular respiratory failure (NMRF) and non-NMRF have not been defined or compared in the literature. Methods: We retrospectively collected the initial ABG parameters (pH, PaCO2, PaO2, and HCO3) of patients admitted to ICUs with acute respiratory failure. We compared ABG parameter ranges and the prevalence of abnormalities in NMRF versus non-NMRF and its categories, including primary pulmonary disease (PPD) (chronic obstructive pulmonary disease, asthma, and bronchiectasis), pneumonia, and pulmonary edema. Results: We included 287 patients (NMRF, n = 69; non-NMRF, n = 218). The difference between NMRF and non-NMRF included the median (interquartile range (IQR)) of pH (7.39 (7.32−7.43), 7.33 (7.22−7.39), p < 0.001), PaO2 (86.9 (71.4−123), 79.6 (64.6−99.1) mmHg, p = 0.02), and HCO3 (24.85 (22.9−27.8), 23.4 (19.4−26.8) mmol/L, p = 0.006). We found differences in the median of PaCO2 in NMRF (41.5 mmHg) versus PPD (63.3 mmHg), PaO2 in NMRF (86.9 mmHg) versus pneumonia (74.3 mmHg), and HCO3 in NMRF (24.8 mmol/L) versus pulmonary edema (20.9 mmol/L) (all p < 0.01). NMRF compared to non-NMRF patients had a lower frequency of hypercarbia (24.6% versus 39.9%) and hypoxia (33.8% versus 50.5%) (all p < 0.05). NMRF compared to PPD patients had lower frequency of combined hypoxia and hypercarbia (13.2% versus 37.8%) but more frequently isolated high bicarbonate (33.8% versus 8.9%) (all p < 0.001). Conclusions: The ranges of ABG changes in NMRF patients differed from those of non-NMRF patients, with a greater reduction in PaO2 in non-NMRF than in NMRF patients. Combined hypoxemia and hypercarbia were most frequent in PPD patients, whereas isolated high bicarbonate was most frequent in NMRF patients.

The Risk of Developing Lymphoma among Autoimmune Thyroid Disorder Patients: A Cross-Section Study.

Background: Graves' disease (GD) and Hashimoto's thyroiditis (HT) are the most common types of autoimmune thyroid diseases (AITD), and both are characterized by the infiltration of lymphocytes into the thyroid gland. Moreover, autoimmune diseases like HT have a higher risk of developing lymphoma. This study is aimed at assessing the prevalence and association of lymphoma in patients with AITD. Methods: This cross-sectional study was conducted in King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were gathered from the medical records of patients aged 18 years or older who developed AITD. A total number of 140 medical records were collected, and 72 patients were included after applying in exclusion criteria. Data on the subtype, clinical-stage, treatment modality, patient status, remission, and relapse were collected for patients who developed lymphoma. Results: Among 72 patients who developed AITD, HT was diagnosed in 58 (80.6%) patients and GD in 14 (19.4%). Five (7%) patients were diagnosed with lymphoma all of whom had a history of HT. The subtypes of lymphoma were diffuse large B-cell lymphoma (DLBCL 3; 4.2%), follicular lymphoma 1 (1.4%), and Hodgkin's lymphoma 1 (1.4%). Conclusion: The prevalence of PTL in patients with AITD, specifically HT, was 7%. Most patients developed NHL, with DLBCL being the most common subtype. The onset of lymphoma in this study was lower than reported in the literature. All patients with PTL had HT in their backgrounds. Further national studies are warranted to explore the relationship between the two diseases to provide more insight into the comprehension of this association.

Association of Alzheimer's Disease and Insulin Resistance in King Abdulaziz Medical City, Jeddah.

Background Alzheimer's disease (AD) and insulin resistance (IR) are common in the elderly. IR reduces the ability of insulin to work effectively on target tissues. This results in hyperglycemia, increased triglyceride levels, decreased high-density lipoprotein (HDL) levels, elevated blood pressure, and central obesity, a condition known as metabolic syndrome (MetS). MetS eventually affects cognition, but its relationship with AD is unclear. Therefore, we studied the association between AD and IR and the relation between AD and diabetic patients treated with insulin. Methods This was a record-based retrospective cohort study using data from King Abdulaziz Medical City, Jeddah, Ministry of National Guards-Health Affairs. for all patients with dementia and AD, from 2009 to 2018. We examined 354 patient files. The triglyceride-glucose (TyG) index was used for the assessment of IR. Results There was no significant association between patients' demographic data, glycated hemoglobin, and co-morbidities and developing AD. Statistical models showed that, after adjustment for age, patients with IR had a significantly higher likelihood of AD (adjusted OR = 1.4; 95% CI: 1.01-2.33). After multivariate adjustment, patients with IR still had a 20% higher probability of developing AD than others (adjusted OR = 1.2; 95% CI: 1.0-3.1). Conclusion These results suggest that AD is associated with IR. Moreover, the association may be confounded by many patient-related factors.

Clinical features and outcome of Guillain-Barre syndrome in Saudi Arabia: a multicenter, retrospective study.

BACKGROUND: Guillain-Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on the characteristic of GBS in Saudi Arabia are limited. This study aimed to describe the clinical, electrophysiological, and laboratory characteristics and outcome of a multicenter cohort of patients with GBS. METHODS: This is a retrospective multicenter nationwide study. Patients who had GBS, identified through Brighton Criteria, between January 2015 and December 2019 were included. Data collected included demographics, clinical features, cerebrospinal fluid profile, reported electrophysiological patterns, treatment, and outcome. Reported GBS subtypes were compared using chi-square, Fisher's exact, or Mann-Whitney U tests, as appropriate. RESULTS: A total of 156 patients with GBS were included (men, 61.5%), with a median age of 38 (interquartile range, 26.25-53.5) years. The most commonly reported antecedent illnesses were upper respiratory tract infection (39.1%) and diarrhea (27.8%). All but two patients (98.7%) had weakness, 64.1% had sensory symptoms, 43.1% had facial diplegia, 33.8% had oropharyngeal weakness, 12.4% had ophthalmoplegia, and 26.3% needed mechanical ventilation. Cytoalbuminological dissociation was observed in 69.1% of the patients. GBS-specific therapy was administered in 96.8% of the patients, of whom 88.1% had intravenous immunoglobulin, and 11.9% had plasmapheresis. Approximately half of the patients were able to walk independently within 9 months after discharge, and a third regained the ability to walk independently thereafter. Death of one patient was caused by septicemia. Acute inflammatory demyelinating polyradiculoneuropathy was the most commonly reported GBS subtype (37.7%), followed by acute motor axonal neuropathy (29.5%), and acute motor-sensory axonal neuropathy (19.2%). CONCLUSION: The clinical and laboratory characteristics and outcome of GBS in the Arab population of Saudi Arabia are similar to the international cohorts. The overall prognosis is favorable.