Identification of Child Abuse and Neglect Based on the Perception of Training Physicians in Jeddah, Saudi Arabia.

Introduction Child abuse and neglect (CAN) affects many countries, including Saudi Arabia (SA). CAN in SA is more commonly detected in hospitals. Therefore, healthcare professionals must identify and report the cases. This study aims to assess knowledge and perceptions toward CAN among training physicians. Methodology A cross-sectional survey was conducted through a self-administrated structured questionnaire and involved 123 residents and fellows who deal with children in Jeddah, SA. The participants were recruited using convenient sampling methods. Descriptive statistics, t-test, and Chi-square test were used for statistical analysis. Results We found that approximately 78% would report their findings to the legal authority, document them, and assess their consistency with parents and the child's explanation. However, only 41.5% of the participants would report CAN to the proper authority. Most participants believed that CAN should be redefined according to Saudi culture and religious standards. In contrast, 68.9% of the participants believed that CAN cases are under-reported in SA. The main barrier to not reporting is the fear of consequences (63.4%). About 77% of the participants agreed to the need for further training. Identifying the CAN indicators was higher among those who handled a CAN case previously (median = 66.67, p = 0.023). Conclusions In conclusion, the study showed that appropriate undergraduate and postgraduate curriculum training should be developed to strengthen future healthcare practitioners in dealing with CAN cases to protect children's welfare.

Effects of intermittent fasting regimens on glycemic, hepatic, anthropometric, and clinical markers in patients with non-alcoholic fatty liver disease: Systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: Intermittent fasting (IF) regimens have been hypothesized to influence several markers of cardiometabolic and liver function. The objective of our meta-analysis was to investigate the impact of IF regimens on cardiometabolic and liver markers in subjects diagnosed with non-alcoholic fatty liver disease (NAFLD). METHODS: We searched several online databases (PubMed/Medline, Web of Science, Scopus and Embase) in order to identify suitable publications for inclusion in the meta-analysis. Results were expressed as weighted mean differences (WMD). RESULTS: From 12343 articles identified in different databases, a total of 7 RCT arms were entered into the quantitative synthesis. The manuscripts were published between 2019 and 2023. IF regimens (the 5:2 diet, 16/8 time-restricting feeding, and alternate day fasting) varied from 2 months to 3 months. IF regimens reduced steatosis scores (WMD: -33.22 CAP dB/m, 95 % CI: -50.72 to -15.72), anthropometric characteristics of obesity (WMD: -0.77 kg/m2, 95 % CI: -1.38 to -0.17 for body mass index; WMD: -3.16 kg, 95 % CI: -4.71 to -1.61 for body weight; WMD: -1.90 kg, 95 % CI: -3.51 to -0.29 for waist circumference), as well as ALT (WMD: -9.10 U/L, 95 % CI: -12.45 to -5.75), triglyceride (WMD: -20.83 mg/dl, 95 % CI: -39.01 to -2.66), total cholesterol (WMD: -7.80 mg/dl, 95 % CI: -15.18), HbA1c (WMD: -0.14 %, 95 % CI: -0.20 to -0.08) and HOMA-IR (WMD: -1.21, 95 % CI: -2.08 to -0.34) levels versus controls. Nevertheless, no between-group differences were detected for other biomarkers, e.g., fasting blood glucose, insulin, AST, HDL-C or LDL-C values, and fibrosis scores. CONCLUSION: IF regimens can improve some markers of cardiometabolic and liver function in patients with NAFLD. However, the available evidence to support the benefits of IF regimens is limited and derived from a small number of studies, thus further research is needed to clarify the impact of IF on the cardiometabolic health of NAFLD patients.

Quality of life in children with Down syndrome and its association with parent and child demographic characteristics: Parent-reported measures.

BACKGROUND: This study aims to explore the association between the quality of life (QoL) in children with Down syndrome (DS) and its relationship with demographic characteristics of both parents and children. The investigation encompasses five domains: physical and psychological well-being, autonomy and parental relationship, social well-being, and peers, as well as school and the learning environment. METHOD: An online questionnaire, the KIDSCREEN-27, was used to measure the QoL of 112 families with DS in Saudi Arabia, referred to as "Parent-Reported Measures." Descriptive statistics were analyzed using the Statistical Package for Social Sciences. RESULTS: The study found that the QoL of children with DS showed high scores in the psychological well-being, autonomy, parental relations, school, and learning environment domains. However, the physical and social well-being and peer domains had lower scores, although still considered "good scores." Family income had a positively significant influence on all QoL domains. Specifically, higher family income was associated with better QoL outcomes, except for social well-being. Parental age was found to influence psychological well-being, while parental education and the relationship between the parent and child influenced social well-being. Lastly, the child's gender was found to have an impact on the school and learning environment domain. CONCLUSION: The study highlights the importance of understanding the impact of the demographic variability of children with DS and their parents on the QoL of their children. It emphasizes the need to address the needs of families with lower incomes and the importance of parental education and relationships with their children in improving social well-being. The findings could aid policymakers and healthcare providers in improving the QoL for families with children who have DS.

Polymorphisms in the Drug Transporter Gene ABCB1 Are Associated with Drug Response in Saudi Epileptic Pediatric Patients.

Epilepsy is one of the most common chronic neurodisorders in the pediatric age group. Despite the availability of over 20 anti-seizure medications (ASMs) on the market, drug-resistant epilepsy still affects one-third of individuals. Consequently, this research aimed to investigate the association between single-nucleotide polymorphisms (SNPs) of the ATP-binding cassette subfamily B member 1 (ABCB1) gene in epileptic pediatric patients and their response to ASMs. This multicentric, cross-sectional study was conducted among Saudi children with epilepsy in Jeddah, Saudi Arabia. The polymorphism variants of ABCB1 rs1128503 at exon 12, rs2032582 at exon 21, and rs1045642 at exon 26 were genotyped using the Sanger sequencing technique. The study included 85 children with epilepsy: 43 patients demonstrated a good response to ASMs, while 42 patients exhibited a poor response. The results revealed that good responders were significantly more likely to have the TT genotypes at rs1045642 and rs2032582 SNPs compared to poor responders. Additionally, haplotype analysis showed that the T-G-C haplotype at rs1128503, rs2032582, and rs1045642 was only present in poor responders. In conclusion, this study represents the first pharmacogenetic investigation of the ABCB1 gene in Saudi epileptic pediatric patients and demonstrates a significant association between rs1045642 and rs2032582 variants and patient responsiveness. Despite the small sample size, the results underscore the importance of personalized treatment for epileptic patients.

Demographic and Clinical Predictors of Drug Response in Epileptic Children in Jeddah.

Epilepsy is a chronic neurological disease of the brain. Over 20 antiseizure medications are available on the market, but a third of patients still have drug-resistant epilepsy. This study was designed to assess the impact of the demographic and clinical characteristics of epileptic children on their likelihood of developing drug resistance. This study was a multicenter, hospital-based, cross-sectional, case-control study of pediatric patients diagnosed with epilepsy in Jeddah, Saudi Arabia. The study included 101 children with epilepsy. Fifty-six patients showed good response to antiseizure medications (ASMs), and forty-five patients had a poor response. A statistically significant good response to ASMs was reported among younger patients, those who did not report parental consanguinity, those who did not have a family history of epilepsy, and those diagnosed with partial seizures, with no reported adverse effects. The levetiracetam regimen was statistically significant regarding the responsiveness to ASMs. Patients on a monotherapy regimen elicited a significantly better response to levetiracetam than patients on polytherapy (p < 0.001). No significant association was found between the response to ASMs and the sex, nationality, body mass index, complete blood count, or vitamin B12 level. In conclusion, the ASM response in epileptic patients can be predicted by knowing the patient's demographic and epileptic history. However, the complete blood count and vitamin B12 level failed to predict patients' response to ASMs.

The Association of Sociodemographic Factors, Postictal Symptoms, and Medical History With Seizure Type in Patients With Epilepsy: A Cross-Sectional Study.

Background Approximately 50 million people globally suffer from epilepsy. The prevalence of epilepsy in Saudi Arabia has been reported at 6.5 per 1,000 persons, affecting nearly 1% of the entire population. However, limited data is available in the country regarding the sociodemographic factors affecting epilepsy and its associated postictal symptoms, which may lead to stigmatization and negatively impact patients. Methods A cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in a survey format. Ethical approval was obtained from the Research Ethics Committee of the Faculty of Medicine at King Abdulaziz University. The study population included patients with epilepsy who visited King Abdulaziz University Hospital's outpatient neurology clinics from October 2021 to March 2022. Results The study participants' average age at the time of the first seizure was 16.5 years, with patients experiencing seizures as early as within the first year of life and as late as 70 years of age. Patients who had had their first seizure during the first year of life did not have any schooling (p<0.0001) and had learning difficulties (p<0.00001). Focal onset impaired awareness seizures were significantly associated with motor weakness (p=0.023) and mood alterations (p=0.014), while postictal fear, anxiety or panic, and sleep disruption were statistically significant for focal onset aware seizures (p=0.015 and p=0.050). Conclusion This study highlights the sociodemographic differences between patients in Saudi Arabia and in other areas. It may also point to novel findings regarding the postictal symptoms associated with the various seizure types.

The Spectrum of MRI and Electrographic Findings in Pediatric Patients With Seizures: A Retrospective Tertiary Care Center Study.

Background Seizures constitute a serious public health concern, especially in pediatric patients. They are among the most prevalent medical issues affecting children. Magnetic resonance imaging (MRI) is a widely used imaging modality to evaluate, assess, and follow up on brain abnormalities. Objectives The purpose of the study is to explore the clinical findings of pediatric patients with seizures and their associated findings on MRI examinations. Material and methods A retrospective cohort study was conducted between 2021 and 2022 at King Abdulaziz University Hospital (KAUH). A total of 171 pediatric patients (ages 1-14 years old) who had seizures and underwent brain MRI examinations were included in the study. The mean age of the group was two years. Results Focal seizures represented the majority of seizure types in 62 (60.2%) patients compared to 42 patients who presented with generalized seizures and 67 patients who presented with normal findings based on magnetic resonance imaging (MRI) analysis. The most common finding in imaging was the presence of developmental anomalies, which were found in 31 (18.5%) patients. This was followed by hypoxic-ischemic injury in 12 patients, vascular abnormalities in 10 patients, inherited metabolic disorders in nine patients, and infection-related findings in six patients. Conclusion MRI has an invaluable role in managing pediatric patients with seizures. Accurate diagnosis of patients is an essential step for delivering proper care to patients. MRI is considered the main imaging modality to establish a correct diagnosis and thereby improve prognosis, and electroencephalogram (EEG) should be taken into account during standard neurodiagnostic testing.

Association of Polymorphism of the Methyl Tetrahydrofolate Reductase (MTHFR) Gene with Anti-Seizure Medication Response in Pediatric Patients in Jeddah, Saudi Arabia.

Background and ObjectivesEpilepsy is a chronic brain disease, with inherent and noninherent factors. Although over 20 anti-seizure medications (ASMs) are commercially available, nearly one-third of patients develop drug-resistant epilepsy. We evaluated the association between the clinical features and the methyl tetrahydrofolate (MTHFR) rs1801133 polymorphism and ASMs response among pediatric patients with epilepsy. Materials and Methods This was a multicenter, retrospective, case-control study of 101 children with epilepsy and 59 healthy children in Jeddah. The MTHFR rs1801133 polymorphism was genotyped using the real-time polymerase chain reaction TaqMan Genotyping Assay. Results Among the patients with epilepsy, 56 and 45 showed good and poor responses to ASMs, respectively. No significant genetic association was noted between the single-nucleotide polymorphism (SNP) rs1801133 within the MTHFR gene and the response to ASMs. However, a significant association was noted between reports of drug-induced toxicity and an increase in allele A frequencies. The MTHFR rs1801133 genotype was significantly associated with the development of electrolyte disturbance among good and poor responders to ASMs. Conclusion This is the first pharmacogenetic study of MTHFR in patients with epilepsy in Saudi Arabia that found no significant association between the MTHFR SNP rs1801133 and gene susceptibility and drug responsiveness. A larger sample size is needed for testing gene polymorphisms in the future.

Epilepsy awareness among Rabigh Province residents in Saudi Arabia: A cross-sectional survey study.

OBJECTIVES: To investigates the knowledge and attitudes toward epilepsy in Rabigh province in western Saudi Arabia. METHODS: A cross-sectional survey-based study was conducted from July to September 2020. Survey was distributed through the web to Rabigh province general population. Epilepsy awareness score (EAS) was estimated utilizing a generated questionnaire. RESULTS: The number of participants is 511. Most participants did not know what actions to take for an active seizure other than moving the person away from harm (87%). Participants who agreed that epilepsy was highly stigmatized represented 15%. Participants were refusing (27%) or undecided about their reaction (34%) if their child were to marry an epilepsy person (EP). The majority did not mind if their children socialized with EP. Some parents were anxious about having their children play or associated with EP. There are statistically significant associations between EAS and age (p=0.03), monthly income (p=0.03), having children (p=0.04). CONCLUSION: The data found in this study was similar to other Saudi and global studies. Further efforts are needed to strengthen community awareness regarding epilepsy. Stigma in society affects those that are afflicted and has consequences on their loved ones as well. Therefore, supplementary educational campaigns are needed to normalize and create acceptance. Also, to increase awareness regarding first aid of epilepsy.

Maternal polycystic ovary syndrome and the potential risk of attention-deficit/hyperactivity disorder and autism spectrum disorder in the offspring: a systematic review and meta-analysis.

OBJECTIVE: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two increasing important problems among children. This study aims to explore the link between maternal polycystic ovary syndrome (PCOS) and the risk of ASD and ADHD in the offspring. METHOD: The MOOSE guidelines were followed in the conduct of this meta-analysis. A literature search was done in PubMed/MEDLINE, Scopus, and Web of Science from inception until January 2021. The DerSimonian and Laird random-effects model was used to estimate the combined risk ratios (RR) and 95% confidence intervals (CI). Sensitivity analysis was also used to investigate the effect of each study on the combined results. RESULTS: Seven studies, with 1,358,696 participants, comprising 7,334 ADHD cases and 3,920 ASD cases, were included in this study. Children born to mothers with maternal PCOS had higher risks of developing ASD (RR = 1.46, 95% CI: 1.26-1.69, I2 = 64%) and ADHD (RR = 1.43, 95% CI: 1.35-1.41, I2 = 0%) when compared with children born to mothers without maternal PCOS. CONCLUSION: This study showed that there might be a link between maternal PCOS and the risk of developing ASD and ADHD in the offspring. This important issue must be considered in PCOS women during and after pregnancy.

Body mass index and its association with various features of migraine: A cross-sectional study from Saudi Arabia.

Introduction: Migraine is a highly prevalent condition, and prevalence of obesity is also increasing. Results of studies addressing association of body mass index (BMI) with migraine and its features are conflicting. In this cross-sectional study, we aim to assess association between BMI and various migraine features. Methods: This study was conducted in the Headache Clinic of King Fahd Hospital of University, Al Khobar, Saudi Arabia. Interviews were conducted by three consultant neurologists. Migraine was defined according to the International Headache Society and BMI was calculated as weight (kilograms)/height (m2). Results: Of total of 121 patients, 79% were female. Almost 87.6% of patients were taking prophylactic medications. Majority of patients had attack for more than 24 h (60.3%), pulsating character (81%), moderate-to-severe intensity (92.6%), associated with nausea and/or vomiting (75.2%), and photophobia/phonophobia (91.7%). About 29.8% of patients were normal weight, 28.1% were overweight, and 39.7% were obese and morbidly obese. There was insignificant association between various categories of BMI and features of migraine, that is, unilateral location (P = 0.385), pulsating character (P = 0.571), moderate-to-severe intensity (P = 0.187), nausea and/or vomiting (P = 0.582), and photophobia and/or phonophobia (P = 0.444). Conclusion: In our study, we did not find an association between BMI and various features of migraine.

RésuméIntroduction: La migraine est une maladie très répandue, et la prévalence de l'obésité est également en augmentation. Résultats des études portant sur l'association de l'indice de masse corporelle (IMC) avec la migraine et ses caractéristiques sont contradictoires. Dans cette étude transversale, nous visons à évaluer l'association entre IMC et diverses caractéristiques de la migraine. Méthodes: Cette étude a été menée à la Headache Clinic de l'hôpital King Fahd de l'Université, Al Khobar, Arabie Saoudite. Les entretiens ont été menés par trois neurologues consultants. La migraine a été définie selon l'International La Headache Society et l'IMC ont été calculés en poids (kilogrammes)/taille (m2). Résultats: Sur un total de 121 patients, 79 % étaient des femmes. Presque 87,6 % des patients prenaient des médicaments prophylactiques. La majorité des patients ont eu une attaque pendant plus de 24h (60,3%), caractère pulsatile (81%), intensité modérée à sévère (92,6 %), associée à des nausées et/ou vomissements (75,2 %) et photophobie/phonophobie (91,7 %). Environ 29,8 % des les patients avaient un poids normal, 28,1 % étaient en surpoids et 39,7 % étaient obèses et obèses morbides. Il y avait une association insignifiante entre diverses catégories d'IMC et caractéristiques de la migraine, c'est-à-dire localisation unilatérale (P = 0,385), caractère pulsatile (P = 0,571), modéré à sévère intensité (P = 0,187), nausées et/ou vomissements (P = 0,582) et photophobie et/ou phonophobie (P = 0,444). Conclusion: Dans notre étude, nous n'ont pas trouvé d'association entre l'IMC et diverses caractéristiques de la migraine. Mots-clés: Indice de masse corporelle, fréquence, migraine, obésité, gravité.

The etiology and risk factors of convulsive status epilepticus in pediatric patients of tertiary center in Saudi Arabia.

OBJECTIVES: To assess the etiology of status epilepticus (SE) among the pediatric patients of a tertiary center in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS: Data from 88 cases was obtained retrospectively from 2006 to 2017 from King Abdulaziz University Hospital (KAUH). Patients aged between 28 days and 14 years with the symptoms of SE were selected for this study. RESULTS: The data show that the proportions of SE etiologies were 30.5% for febrile seizure, 11.9% for electrolytes imbalance, 8.5% for hydrocephalus, 6.8% for CNS infections, and 6.8% for neoplasm. The other etiologies of SE were trauma, fever, intractable epilepsy, cerebrovascular accident, hemorrhagic stroke, etc. There were no clear etiologies in 8 cases. Most of the patients were not of Saudi origin (64.3%), boys (67.8%), and had generalized epilepsy types (91.8%), and 58.6% of the patients complied with epilepsy medications. CONCLUSION: The most prevalent etiology of convulsive status epilepticus was a febrile seizure, followed by electrolyte imbalance and hydrocephalus. However, a nationwide study in KSA must be conducted to determine the major etiologies of SE for its effective management and prevention. Educating families and patients regarding antiepileptic drugs is necessary.

Efficacy and safety of mirogabalin treatment in patients with diabetic peripheral neuropathic pain: A systematic review and meta-analysis of randomised controlled trials.

AIM: We aimed to perform a systematic review and meta-analysis to examine the efficacy and safety of mirogabalin in patients with diabetic peripheral neuropathic pain (DPNP). METHODS: We searched four databases from inception to 1st July 2020. We included all randomised controlled trials (RCTs) which assessed the effectiveness and safety of mirogabalin in patients with DPNP. We evaluated the quality of the included RCTs using the Cochrane risk of bias assessment tool. We pooled dichotomous outcomes as risk ratios and continuous outcomes as mean differences with 95% confidence intervals, both under the random- or fixed-effects model. RESULTS: Three RCTs matched our inclusion criteria with a total of 1732 patients with DPNP: 1057, 534 and 141 patients received mirogabalin, placebo and pregabalin, respectively. The quality of included RCTs was marked as moderate-to-high. Mirogabalin treatment was significantly associated with a significant reduction in the average daily pain score (ADPS) compared with placebo over 7 weeks. Compared with pregabalin, mirogabalin was significantly associated with more decrease in ADPS only after 3, 4 and 5 weeks. The proportion of patients with ≥30% and ≥50% reduction in the ADPS was significantly higher in the mirogabalin vs placebo and pregabalin groups. Compared with placebo, mirogabalin was significantly associated with more adverse events of dizziness, increased weight, peripheral oedema and somnolence. The safety profile was comparable between mirogabalin and pregabalin. CONCLUSIONS: Our systematic review and meta-analysis revealed that in patients with DPNP, mirogabalin treatment was superior to placebo and pregabalin in decreasing the ADPS over time. Besides, mirogabalin was largely safe and associated with some adverse events that could be managed conservatively.

The diagnostic yield of the routine EEG at a tertiary care center in Saudi Arabia: A retrospective study.

BACKGROUND: The Routine Electroencephalography (REEG) records cerebral electrical activity to aid in the diagnosis and classification of Epilepsy. Indiscriminate use of the REEG may lower its clinical yield. The pretest clinical variables contributing to the yield of the REEG outcome have not been well-established in the context of developing healthcare systems where REEG utilization may differ from well-established centers. The aim of this study is to determine the yield of the REEG and the pretest clinical variables predicting the yield of the REEG at a single center in the context of the developing healthcare system in Saudi Arabia. MATERIALS AND METHODS: We reviewed REEG reports at a single center in Jeddah, Saudi Arabia between 2015 and 2018. We collected demographic and clinical data from the patients' electronic files. Patients of age ≥18-year-old were included. We collected age, gender, nationality, the indication for the REEG, co-morbidities, antiseizure medicines (ASMs), and details related to the yield of the REEG (normal or abnormal, epileptiform or non-epileptiform, focality, and the presence of rhythmic or periodic patterns or seizures). RESULTS: We included 500 records. Fifty-nine percent were females. The mean age was 39 ±â€¯17 years. Of the recorded REEGs, 42.4% were abnormal, 14.6% of them showing definite epileptiform discharges and 85.4% showing only slowing. Half of the REEGs of individuals previously diagnosed with epilepsy revealed abnormal findings. ASM use was associated with slowing in the REEG (p < .05). Using logistic regression, history of a previous stroke and use of carbamazepine or lamotrigine were predictors of the presence of abnormalities in the REEG, while use of ≥2 ASMs predicted the presence of epileptiform discharges. Stroke also predicted abnormal slowing alongside increased age. CONCLUSION: The clinical yield of the REEG in this sample of patients from a single institution in the context of a developing healthcare system was relatively low. History of stroke and being on more than one ASM may predict that the REEG will show relevant abnormalities.

Treatment of infantile spasms in Saudi Arabia.

OBJECTIVE: To evaluate the treatment approach and compliance of pediatric neurologists with evidence-based guidelines across Kingdom of Saudi Arabia (KSA). These guidelines that clarify the optimal management of infantile spasms (IS) are not widely followed for various practical reasons. METHODS: Physicians practicing in the field of pediatric neurology in KSA were contacted from the database of national societies. A cross-sectional study was conducted using a structured 20-item on-line survey designed to examine their clinical experience with IS and their treatment choices. RESULTS: A total of 52 pediatric neurologists completed the survey (69% estimated capture rate). They received their formal training within KSA (40%), North America (33%), or Europe (14%). The majority practiced in 2 major cities, Riyadh (46%) or Jeddah (19%). Vigabatrin was favored over adrenocorticotropic hormone (ACTH) as first line drug for patients without tuberous sclerosis complex (48% vs. 21%). Several factors correlated with correctly selecting ACTH as first line including western training (33% vs. 5%, p=0.001), practicing in the city of Riyadh (25% vs. 14%, p=0.001), or having >10 years of clinical experience (25% vs. 5%, p=0.017). Reasons for not complying with the recommended treatment guidelines included lack of availability of ACTH (42%), side effect profile of steroids (29%), and personal preferences (14%). Only 4% admitted lack of awareness of the currently published management guidelines. CONCLUSION: Many pediatric neurologists in KSA are not following the published IS management guidelines. Using ACTH as first line correlated with their training, practice location, and years of experience. Lack of drug availability and side effect profile were common reasons for not complying with the management guidelines.