Antivirals vs Antivirals and Steroids for Treatment of Herpes Zoster-Related Ophthalmoplegia: A Case Series and Systematic Review.

BACKGROUND: Up to 1/3 of patients with herpes zoster ophthalmicus (HZO) may develop ophthalmoplegia. Although zoster-related ophthalmoplegia (ZO) is typically treated with antiviral agents, there is controversy regarding the therapeutic role of systemic steroids. METHODS: This was a retrospective case series and case report-based systematic review. For the case series, participants were recruited from tertiary neuro-ophthalmology clinics. Eligible participants were those who developed cranial nerve palsies (CNP) within 1 month of HZO diagnosis. In the systematic review, all adults with ZO in the literature who were treated with antivirals or steroids only, or combination therapy were included. Main outcomes were initial presentation, investigations, neuroimaging, treatment regimen, and final outcomes of ophthalmoplegia. RESULTS: Eleven immunocompetent patients with ZO were included. The most common CNP was CN III (5/11), followed by CN VI (2/11) and CN IV (2/11). One patient had multiple CNPs. All patients were treated with antivirals, and 4 also treated with a short course of oral steroids. At 6-month follow-up, 75% of patients treated with combination therapy and 85.7% treated with antivirals alone had complete recovery of ZO. The systematic review identified 63 studies consisting of 76 cases of ZO. When comparing patients treated with antivirals with those treated with antivirals and steroids, patients on combination therapy had more severe ocular findings, including complete ophthalmoplegia (P < 0.001). Age was the only significant predictor of complete recovery of ophthalmoplegia on multivariable logistic regression (P = 0.037). CONCLUSIONS: The rate of complete recovery in immunocompetent patients with ZO was similar in patients treated with antivirals alone vs those treated with antivirals and oral steroids. The systematic literature review affirmed these findings. However, age may influence recovery of ophthalmoplegia.

Breast Cancer Knowledge Among Male High School Students in Saudi Arabia.

Breast cancer (BC) accounts for 24 % of all women cancer cases diagnosed in Saudi Arabia each year. Awareness is extremely important in combating this disease. This study was undertaken to assess male high school students' response to BC. This cross-sectional survey was performed on male high school students across schools in Jeddah. A questionnaire gathered data on respondent demographics, beliefs about BC, BC risk factors, early screening methods, and role of men in BC. Statistical analysis was done using SPSS 20. A total of 824 students participated, with an average age of 17.0 years. There was more than 50 % agreement that early detection of BC enhances the chances of recovery, that BC is treatable, and that clinical breast examination and breastfeeding provide protection from BC. Around half the survey population thought that BC was fatal and contagious. Fewer than 50 % thought that BC was inherited and related to smoking, consumption of contraceptive pills, repeated exposure to radiation, obesity, and wearing a bra and that breast tumors were all malignant and spread to different parts of the body. Others knew that mammograms should be performed periodically. A high percentage persuaded their relatives to have mammograms and provided them with psychological support. Knowledge of BC among male high school students in Saudi Arabia is still limited, and, therefore, programs and activities need to be established to increase awareness among high school students.

Neurosyphilis in psychiatric practice: a case-based discussion of clinical evaluation and diagnosis.

OBJECTIVE: Neurosyphilis can present with a wide range of neuropsychiatric symptoms. Hence, psychiatrists need to be familiar with tests for syphilis screening and how to interpret syphilis serologic tests. METHODS: We present four cases of patients with positive syphilis tests encountered in a psychiatric hospital. RESULTS: Two cases were treated for neurosyphilis, while the other two cases did not have active syphilis infection despite positive results. CONCLUSION: We thus highlight the challenges encountered by psychiatrists in screening for and diagnosing cases of neurosyphilis.

Epigallocatechin-3-gallate inhibits tax-dependent activation of nuclear factor kappa B and of matrix metalloproteinase 9 in human T-cell lymphotropic virus-1 positive leukemia cells.

Epigallocatechin-3-gallate (EGCG) is the most abundant polyphenol molecule from green tea and is known to exhibit antioxidative as well as tumor suppressing activity. In order to examine EGCG tumor invasion and suppressing activity against adult T-cell leukemia (ATL), two HTLV-1 positive leukemia cells (HuT-102 and C91- PL) were treated with non-cytotoxic concentrations of EGCG for 2 and 4 days. Proliferation was significantly inhibited by 100 µM at 4 days, with low cell lysis or cytotoxicity. HTLV-1 oncoprotein (Tax) expression in HuT- 102 and C91-PL cells was inhibited by 25 µM and 125 µM respectively. The same concentrations of EGCG inhibited NF-kB nuclearization and stimulation of matrix metalloproteinase-9 (MMP-9) expression in both cell lines. These results indicate that EGCG can inhibit proliferation and reduce the invasive potential of HTLV-1- positive leukemia cells. It apparently exerted its effects by suppressing Tax expression, manifested by inhibiting the activation of NF-kB pathway and induction of MMP-9 transcription in HTLV-1 positive cells.

Research practices and publication obstacles among interns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2011-2012.

BACKGROUND: Medical students can play a vital role in health research at any institute. Moreover, scientific publication by medical students is a strong indicator of students' knowledge, skills and attitudes towards scientific research. Very little information exists, however, on this matter in Saudi Arabia. SUBJECTS AND METHODS: This cross-sectional study was conducted to assess the publication practices of medical interns who graduated from King Abdulaziz University Faculty of Medicine and to investigate barriers to conducting and publishing research during their medical studies. A questionnaire was distributed to 394 interns and 249 (63.2%) responded. RESULTS: About 31% of the responding interns started research during their undergraduate study years. About 12% discontinued their research, whereas only 7% submitted their research for publication. Only 3.2% of the interns had their research papers published and 3.2% had their research paper accepted for publication; 2% had research papers under revision. Interns had positive attitudes towards research, although only a few of them had submitted their papers for publication. Furthermore, interns expressed the need for training in research design, scientific paper writing and publication practice. They recommended devoting slots in medical school curriculum, in addition to other extracurricular training workshops, to teach and train students on such practices and also to provide more convenient opportunities for student participation in conferences. CONCLUSION AND RECOMMENDATIONS: Interns in King Abdulaziz University Faculty of Medicine have a positive attitude towards research; however, few students submit papers for publication. Lack of time and training in research methods were the main obstacles cited by the interns for conducting and publishing research. Interns welcome training in research, scientific writing and publication practice. These requirements will be issued to the main curriculum committee at the faculty of medicine and recommendations on possible actions will be discussed with the administration.