Breast Cancer Management Timelines in a Tertiary Care Center During the COVID-19 Pandemic, Makkah City, Saudi Arabia: A Retrospective Study.

BACKGROUND: Breast cancer (BC) is a prevalent form of cancer and a leading cause of death among women worldwide. In Saudi Arabia, it accounted for 31.8% among females of all new cancer cases reported in 2018. Following the declaration of COVID-19 as a global pandemic, there was a complete redistribution of healthcare resources to face this crisis, which caused a significant delay in the management of various diseases, including BC. There is currently a lack of research in our region on the facility time interval in BC management. Therefore, this study aimed to fill this gap by determining the timelines of diagnosis, management, and factors influencing the delay. METHODS: This observational retrospective study included all female patients diagnosed with BC at or referred to King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia, between January 2020 and August 2021. The data for this study were obtained from a centralized electronic chart review of all included patients at the KAMC center. RESULTS: A total of 76 patients were included in the study, with a mean age of 50 ± 11 years. In terms of the disease management duration, 20 patients (26.3%) completed their management within 30 days, 28 patients (36.8%) had a management duration between 31 and 60 days, and the management duration of 28 patients (36.8%) exceeded 60 days. Patient deposition showed a significant association with delay (p = 0.033). A higher incidence of delays at the initiation of treatment was observed in patients who failed to attend appointments (p < 0.001). Among patients who skipped two or more appointments, 12 individuals (80%) experienced a delay of more than 60 days. Moreover, appointment cancellation was associated with delayed treatment initiation (p = 0.03). Patients' age and comorbidity showed no significant association (p = 0.49, p = 0.24, respectively). CONCLUSION: Our findings highlight the significant impact of patient deposition and canceled or skipped appointments on delayed initiation of therapy for BC patients. Further research should be conducted to evaluate the impact of COVID-19 on other malignancies.

Seroprevalence of toxoplasmosis among individuals with intellectual disability in Hormozgan Province, southern Iran.

BACKGROUND: People with mental defects are more likely to get the infection due to their low levels of health care and personal hygiene. The current study aimed to determine the seroprevalence of Toxoplasma infection among individuals with intellectual disabilities in Hormozgan province, southern Iran. METHODS: The study population was 117 individuals with intellectual disabilities. Venous blood (3 mL) was taken from each subject. A commercial ELISA kit was used to determine anti-Toxoplasma IgG antibodies. RESULTS: Of 117 recruited subjects, 55 (47.0%) were men and 62 (53.0%) were women. The mean age of participants was 27.6 (±12.31) years. Out of 117 studied subjects, 76 had severe and 41 had profound intellectual disabilities. Anti-Toxoplasma IgG antibodies were detected in the sera of 35 out of 117 (29.9%) individuals. Seropositivity to toxoplasmosis was significantly higher in severe than in individuals with profound intellectual disabilities (P < 0.05). There was no statistically significant association between Toxoplasma infection and age, sex and duration of residency in the rehabilitation centre. CONCLUSIONS: The findings of this study indicate that the prevalence of Toxoplasma in people with intellectual disabilities is not much different from other groups of the community.

Iselin Disease With a Rare Presentation in an Elderly Patient: A Case Report.

We report the case of a 55-year-old female with a rare presentation and different pathophysiology of Iselin's disease. Iselin's disease is a rare condition caused by traction apophysitis of the peroneus brevis tendon at the base of the fifth metatarsal bone. It is usually a case in the adolescent age group due to their repetitive use of the peroneus tendon in daily activities, but not in the elderly group.  This type of apophysitis is rare and easily missed or misdiagnosed as a fracture in the base of the fifth metatarsal bone. However, a simple radiographic image can confirm the diagnosis. In this case, we aim to raise awareness of Iselin's disease for better comprehension of the clinical presentation, differential diagnosis, radiological features, management, and prognosis of Iselin's disease.

Prevalence of post-COVID symptoms of obsessive-compulsive disorder in Saudi Arabia.

OBJECTIVES: To determine the prevalence of Obsessive-Compulsive Disorder (OCD) symptoms in patients who have survived COVID-19. METHODS: The study used an observational cross-sectional design between July and October 2021. The target population was adult patients who had confirmed COVID-19 infection prior to joining the study, OCD symptoms were assessed using the Arabic OCD scale created by Abohendy and colleagues, which included 83 questions covering 12 different domains and was administired online. RESULTS: A total of 356 patients were included in the analysis. Approximately 9.0% and 1.7% of the patients had a history of psychiatric disease and OCD diagnosis (respectively). The total symptom score was 32.8%. The most frequently reported domains were rumination of ideas (55.5%), re-checking compulsions (37.0%), and slowness (34.0%), while the least frequently reported domains included obsessive impulses (26.3%), obsessive images (26.5%), and religious compulsions (26.8%). Unlike other domains, the purity and cleanliness compulsions scores were significantly higher than the scale reference population. A higher total symptom score was observed in psychiatric patients (p=0.004) and, to a lesser extent, in OCD patients (p=0.250). CONCLUSION: Overall, OCD symptoms, including cleanliness and fear of disease obsessions, tend to be higher in psychiatric and OCD patients, these findings are valuable for future studies.

Prevalence and the Associated Factors of Erectile Dysfunction Among Saudi Married Males.

OBJECTIVES: To estimate the prevalence of erectile dysfunction (ED) and to determine the associated factors of erectile dysfunction among Saudi married male subjects. METHODS:  A cross-sectional study based on data collected from 313 male subjects. The questionnaire was given to the randomly selected subjects from the appointment list in KKUH outpatient clinics using a simple random sampling method. The study questionnaire included the following sections: demographic, lifestyle, and medical history. The international index of erectile function-15 (IIEF-15) scale was used to assess ED. Statistical analyses were done using Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY, USA). RESULTS:  Out of 313 participants 33 had ED (10.53%). The associated factors were age (odds ratio= 14.4), lower education level (odds ratio= 15.85), mild physical activity (odds ratio= 7.69), and medical conditions like diabetes mellitus, hypertension, and hypercholesteremia (odds ratio= 3.6). CONCLUSION:  The diagnosis of ED in Saudi Arabia is underestimated and services for the diagnosis and treatment should be provided for diabetes, hypertension, hypercholesteremia and elderly patients.

Chronic Calcaneovalgus Deformity Treated With Tibialis Anterior Tendon Transversion: A Case Report.

We present a 21-year-old female with a previously known myelomeningocele who underwent myelomeningocele repair 10 years ago. She presented to the orthopedic outpatient clinic with bilateral calcaneovalgus deformity, causing non-healing ulcers and multiple hospitalizations for pressure ulcers, cellulitis, and osteomyelitis. She had successful tibialis anterior transfer surgery on her right foot six years ago. The patient arrived for treatment of her left foot deformity to underwent three hours of surgery that was uneventful without any complications and recovered well postoperatively and was discharged on day 2. On week 1, the patient came to the clinic for follow-up; the wound was healthy, placed in the full cast in the equinus position, and referred to physiotherapy. In the third month postoperatively, she was able to tolerate her weight with her foot back to a neutral position with full dorsiflexion.

Seroprevalence of SARS-Cov-2 IgG antibodies in patients at a single center in Saudi Arabia.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on public health as well as the economy. Understanding the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among undiagnosed individuals is important for developing an informed pandemic response. OBJECTIVE: Investigate the prevalence of undiagnosed COVID-19 disease. DESIGN: Cross-sectional. SETTING: Tertiary care center in Madinah, Saudi Arabia. SUBJECTS AND METHODS: All participants were on follow-up visits to various clinics and had not been previously diagnosed with COVID-19. Enzyme-linked immunosorbent assay was used to specifically assess the anti-spike IgG antibody seropositivity in serum samples. We associated the seropositivity rates of the participants with age, body mass index (BMI), nationality, blood groups, and sex with uni- and multivariate analyses. MAIN OUTCOME MEASURES: Seropositivity for IgG anti-spike antibodies against SARS-CoV-2. SAMPLE SIZE AND CHARACTERISTICS: 527 subjects, with a median (interquartile percentiles) age of the 527 subjects was 34 (24-41). RESULTS: Of the 527 samples, about one-fourth (n=124, 23.5%) were positive for anti-spike IgG antibody against SARS CoV-2. Age was associated with anti-spike IgG antibody positivity (P<.002). Participants >30 years were more likely to be seropositive (28-29%) than younger participants (15.4%). Additionally, seropositivity was associated with female gender (P<.001) and a higher BMI (P<.006). In the multivariate logistic regression, age >30, female gender and BMI >40 were associated with seropositivity. CONCLUSION: The percentage of seropositive individuals reflects the high level of undiagnosed COVID-19 patients among the population. Our results will help in a better evaluation of the public health measures applied during the COVID-19 pandemic and any future public health crises. LIMITATIONS: Sample size was small, single-center study and no rural areas were included. CONFLICT OF INTEREST: None.

Prevalence of autism spectrum disorder among Saudi children between 2 and 4 years old in Riyadh.

OBJECTIVES: We aimed to estimate the prevalence of autism spectrum disorder between 2 and 4 years old in Riyadh, Saudi Arabi Methods: A cross-sectional study was conducted among Saudi children aged 2-4 years between December 2017 and March 2018 at five different hospitals in Riyadh. RESULTS: A Total of 398 children were included. The prevalence of ASD was estimated to be (2.51%, 1:40, 25 per 1000)), with a male to female ratio of 3:1. CONCLUSION: The estimated high prevalence rate of ASD is close to recent trends in international studies. Future population-based studies are required.

PLXNA2 as a candidate gene in patients with intellectual disability.

Intellectual disability (ID) is one of the most common disabilities in humans. In an effort to contribute to the expanding genetic landscape of ID, we describe a novel autosomal recessive ID candidate gene. Combined autozygome/exome analysis was performed in two unrelated consanguineous families with ID. Each of the two families had a novel homozygous likely deleterious variant in PLXNA2 and displayed the core phenotype of ID. PLXNA2 belongs to a family of transmembrane proteins that function as semaphorin receptors. Sema5A-PlexinA2 is known to regulate brain development in mouse, and Plxna2-/- mice display defective associative learning, sociability, and sensorimotor gating. We note the existence of variability in the phenotype among the three patients, including the existence of variable degree of ID, ranging from borderline intellectual functioning to moderate-severe ID, and the presence of cardiac anomalies in only one of the patients. We propose incomplete penetrance as a possible explanation of the observed difference in phenotypes. Future cases will be needed to support the proposed link between PLXNA2 and ID in humans.

Adapting evidence-based clinical practice guidelines for people with attention deficit hyperactivity disorder in Saudi Arabia: process and outputs of a national initiative.

BACKGROUND: We recently adapted the published National Institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia. METHODS: We used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology. RESULTS: The group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include: (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources. CONCLUSIONS: The finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder.

BACKGROUND: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Evaluation of Silver Nanoparticles Incorporated Acrylic Light Cure Resin Trays.

The conventional denture base resins had many drawbacks. Hence, the objective of this study was to compare the effect of incorporation of silver nanoparticles on mechanical properties of light-cured resin material. MATERIALS AND METHODS: Specimens of acrylic resin (control group) and acrylic resin reinforced with 2% silver nanoparticles (test group) were evaluated for mechanical properties such as impact strength, transverse strength, modulus of elasticity, and deflection. Unpaired t test was used for statistical analysis. RESULTS: Mechanical properties of light cure reinforced with silver nanoparticles were significantly higher than conventional light-cured resin (P < 0.05). CONCLUSION: The incorporation of silver nanoparticles into light-cured resin increases the mechanical properties making it more stronger material.

Toll-like-Receptor Gene Polymorphisms in Tunisian Endemic Pemphigus Foliaceus.

Pemphigus foliaceus (PF) is considered to be caused by the combined effects of susceptibility genes and environmental triggers. The polymorphisms of Toll-like receptors (TLRs) genes have been associated with the risk of various autoimmune diseases. The aim of this study was to evaluate the potential association of TLR2-3-4 and 7 gene polymorphisms with Tunisian PF. Fourteen polymorphisms were analyzed in 93 Tunisian PF patients compared to 193 matched healthy controls: rs5743703-rs5743709 and (GT)n repeat (TLR2); rs5743305, rs3775294, and rs3775291 (TLR3), rs4986790 and rs4986791 (TLR4); and rs3853839 (TLR7). Our results showed that the genetic factors varied depending on the epidemiological feature stratification. In fact, in the whole population, no association with the susceptibility to PF was found. The TLR2 GT repeat seems to be closely associated with PF risk in patients originated from the endemic localities (group 3); the GT18 allele and the heterozygous genotype GT18/GT19 seem to confer risk to endemic PF (P = 0.02; OR = 2.3 [1.1-4.9] and P = 0.0002, OR = 20 [2.5-171], respectively). In contrast, the GT23 repeat could be considered as protector allele (P = 0.02, OR = 0.2 [0.06-0.87]). Furthermore, medium GT alleles which induce high promoter activity were also significantly more frequent in patients versus short or long GT repeats (P = 0.0018 with OR = 3.26 [1.5-7]). On the other hand, the TLR3-rs574305 AA genotype and A allele were significantly more frequent in patients whose age of the onset was above 35 years (group 2) (P = 0.038, OR = 1.78 and P = 0.009, OR = 3.92, respectively). Besides, the TLR4>rs3775294 A allele was found to be protector only in patients with sporadic features (groups 2 and 4) (P = 0.03, OR = 0.57 [0.3-0.9] and P = 0.006, OR = 0.24 [0.08-0.74], respectively). No statistically significant difference was observed in the genotypic and allelic frequencies of TLR-4 and TLR-7 gene polymorphisms. The present data suggest that TLR2and TLR3 polymorphisms are significantly associated with increased susceptibility to PF in the Tunisian population.