Asiatic acid rescues intestinal tissue by suppressing molecular, biochemical, and histopathological changes associated with the development of ulcerative colitis.

Asiatic acid (AA) is a polyphenolic compound with potent antioxidative and anti-inflammatory activities that make it a potential choice to attenuate inflammation and oxidative insults associated with ulcerative colitis (UC). Hence, the present study aimed to evaluate if AA can attenuate molecular, biochemical, and histological alterations in the acetic acid-induced UC model in rats. To perform the study, five groups were applied, including the control, acetic acid-induced UC, UC-treated with 40 mg/kg aminosalicylate (5-ASA), UC-treated with 20 mg/kg AA, and UC-treated with 40 mg/kg AA. Levels of different markers of inflammation, oxidative stress, and apoptosis were studied along with histological approaches. The induction of UC increased the levels of lipid peroxidation (LPO) and nitric oxide (NO). Additionally, the nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream antioxidant proteins [catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH), glutathione peroxidase (GPx), and glutathione reductase (GR)] were downregulated in the colon tissue. Moreover, the inflammatory mediators [myeloperoxidase (MPO), monocyte chemotactic protein 1 (MCP1), prostaglandin E2 (PGE2), nuclear factor-kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1ß)] were increased in the colon tissue after the induction of UC. Notably, an apoptotic response was developed, as demonstrated by the increased caspase-3 and Bax and decreased Bcl2. Interestingly, AA administration at both doses lessened the molecular, biochemical, and histopathological changes following the induction in the colon tissue of UC. In conclusion, AA could improve the antioxidative status and attenuate the inflammatory and apoptotic challenges associated with UC.

Exploring the attitudes and practices of female doctors towards cervical cancer screening in primary health care centers.

Cervical cancer is a significant cause of female mortality worldwide, and early detection through regular screening is crucial for reducing mortality rates. However, in developing countries, the uptake of Pap smear tests (PST) is low, mostly due to cultural and social factors and a lack of knowledge. This cross-sectional study assessed knowledge, attitude, and practice of cervical cancer screening among practitioners working at primary healthcare centers in Saudi Arabia. Furthermore, the study aimed to identify the potential barriers that prevent female physicians from performing cervical cancer screening tests. A self-administrated, well-structured questionnaire was used to survey 95 female physicians, including residents, specialists, and consultants in several primary health care centers (PHCCs) in Jeddah managed by the Ministry of Health during September 2019. The results showed that 80% of participants knew about cervical cancer, and 97.8% were aware that PST is a screening tool. However, only 47% advised female patients to get tested for cervical cancer. The factors identified as barriers to test uptake included asymptomatic females (34%), lack of time on the part of the practitioner (24%), and a lack of evidence for risk factors (23%). Additionally, only 42.2% of the participating physicians had undergone a Pap smear test themselves. The study highlights the need for further research to assess HPV status in the population and explore the correlation between circumcision and cervical cancer, as well as polygamy and cervical cancer. The findings suggest that while a good level of knowledge about cervical cancer exists, there is a need to improve compliance with cervical cancer screening guidelines among female physicians in Saudi Arabia.

Early and accurate detection of melanoma skin cancer using hybrid level set approach.

Digital dermoscopy is used to identify cancer in skin lesions, and sun exposure is one of the leading causes of melanoma. It is crucial to distinguish between healthy skin and malignant lesions when using computerised lesion detection and classification. Lesion segmentation influences categorization accuracy and precision. This study introduces a novel way of classifying lesions. Hair filters, gel, bubbles, and specular reflection are all options. An improved levelling method is employed in an innovative method for detecting and removing cancerous hairs. The lesion is distinguished from the surrounding skin by the adaptive sigmoidal function; this function considers the severity of localised lesions. An improved technique for identifying a lesion from surrounding tissue is proposed in the article, followed by a classifier and available features that resulted in 94.40% accuracy and 93% success. According to research, the best method for selecting features and classifications can produce more accurate predictions before and during treatment. When the recommended strategy is put to the test using the Melanoma Skin Cancer Dataset, the recommended technique outperforms the alternative.

The association of thrombophilia in women with severe obstetric complications.

Thrombophilia, where multiple genetic and acquired risk factors interact synergistically, are associated with thrombosis and pregnancy-related complications. Despite being studied profusely, an inconsistent association exists between thrombophilia and pregnancy complications. Between 2018 and 2020, ninety-three women with pregnancy complications were enrolled in the study. Twenty-five healthy pregnant women without pregnancy complications reported to the same hospital were also recruited as controls. Blood samples were tested for homocysteine, coagulation studies, and molecular diagnosis included FVL, PTH and MTHFR genes amplified using PCR strip assay (Vienna Lab Diagnostics, Austria). Other thrombophilia screening, including testing for AT, PC, and LA, were done by chromogenic assays (Dade Diagnostica, Munich, Germany). Homocysteine level was determined by fluorescence polarization immunoassay technology (Axsym, Abbot company, Germany). Overall, 29.03% of women with pregnancy complications had thrombophilia relative to 16% in the control group. However, the difference between the case and control groups did not reach a significant level (p=0.1175). Additionally, combined thrombophilia was more prevalent among cases (10.75%) than in the control group (4%). However, the difference did not reach statistical significance (p=0.1046). Our study demonstrated that the frequency of thrombophilia among healthy women was 16%, and among women with pregnancy-related complications, 29%. Relative to control, all measured thrombophilia markers were more frequent in women with pregnancy-related complications except for LA. Including all the studies on the Saudi population in a meta-analysis study could reveal more information about thrombophilia and pregnancy-related complications in our population.

Dupilumab efficacy and safety in patients with moderate to severe asthma: A systematic review and meta-analysis.

Background: Dupilumab is a human monoclonal antibody directed against the alpha subunit of the interleukin-4 receptor and inhibits the signaling of IL-4 and IL-13. It is approved for treating asthma and other type-2 inflammatory diseases. There is a conflict in the literature regarding the safety and efficacy of dupilumab. Thus, we aimed to assess the safety and efficacy of dupilumab in patients with moderate to severe asthma. Methods: Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane library, and clinicaltrials.gov registry) were searched until January 2022. We included randomized controlled trials that compared dupilumab with the placebo in moderate to severe asthma patients. We extracted the data at 12 and 24 weeks and analyzed them using review manager 5.4. Findings: Thirteen trials were included. Dupilumab significantly improved the forced expiratory volume in 1 s, asthma control questionnaire score, the fraction of exhaled nitric oxide level, and immunoglobulin E level at 12 and 24 weeks (p < 0.05). However, it was associated with increased blood eosinophils at 12 and 24 weeks. Dupilumab was generally a safe agent for asthmatic patients. It showed no significant difference compared with the placebo regarding most adverse events. Conclusion: Dupilumab improves pulmonary function and reduces local and systemic inflammatory markers with minimal adverse events in patients with moderate to severe asthma.

Electrospun Nanofiber Composites for Drug Delivery: A Review on Current Progresses.

A medication's approximate release profile should be sustained in order to generate the desired therapeutic effect. The drug's release site, duration, and rate must all be adjusted to the drug's therapeutic aim. However, when designing drug delivery systems, this may be a considerable hurdle. Electrospinning is a promising method of creating a nanofibrous membrane since it enables drugs to be placed in the nanofiber composite and released over time. Nanofiber composites designed through electrospinning for drug release purposes are commonly constructed of simple structures. This nanofiber composite produces matrices with nanoscale fiber structure, large surface area to volume ratio, and a high porosity with small pore size. The nanofiber composite's large surface area to volume ratio can aid with cell binding and multiplication, drug loading, and mass transfer processes. The nanofiber composite acts as a container for drugs that can be customized to a wide range of drug release kinetics. Drugs may be electrospun after being dissolved or dispersed in the polymer solution, or they can be physically or chemically bound to the nanofiber surface. The composition and internal structure of the nanofibers are crucial for medicine release patterns.

Impact of a Preparatory Year Programme on the Students of Health Professions Education Colleges: Perception of students and faculty members.

Objectives: The preparatory year programme (PYP) at King Abdulaziz University, Jeddah, Saudi Arabia, is a one-year programme for students preparing for a full multi-year degree curriculum at a university. It offers a bridge between high-school and university-level studies of the students. This study aimed to evaluate the impact of the King Abdulaziz University PYP on students of the health professions education colleges from the viewpoints of the students and the faculty. Methods: This descriptive study was conducted between May 2019 and January 2020 at King Abdulaziz University, in Jeddah, Saudi Arabia and was based on data collected from both students and faculty to assess their perceptions. The data were collected from students through self-administered questionnaires and from faculty members through structured interviews. Descriptive statistics were used for analysis. Results: A total of 633 students responded to the questionnaire (response rate: 88.3%), of which almost half agreed that the PYP made them self-confident and reinforced their discipline (49.2% and 46.9%, respectively). Less than two-thirds agreed that the preparatory year reinforced their sense of responsibility and helped them adapt to the university educational environment (60.6% and 64.3%, respectively). Conversely, more than half (58.5%) disagreed that the preparatory year classes helped them select their majors as well as that the preparatory year prepared them for their major classes (57.2%). A total of 24 faculty members who taught PYP students claimed that there should be careful consideration of the contents of the courses offered to the students in the preparatory year programme, especially the content related to the healthcare profession education. They argued that it is better to have a separate track in the PYP that includes subjects directly related to the study of health professions (such as molecular sciences, genetics, medical terminology, English for medical purposes, etc.). Conclusion: The impact of the PYP on students attending the health professions colleges was found to be weak as per the perceptions of both students and faculty members. In-depth studies are necessary for further investigation of this impact.

Phyto-Phospholipid Conjugated Scorpion Venom Nanovesicles as Promising Carrier That Improves Efficacy of Thymoquinone against Adenocarcinoma Human Alveolar Basal Epithelial Cells.

Lung cancer is a dangerous type of cancer in men and the third leading cause of cancer-related death in women, behind breast and colorectal cancers. Thymoquinone (THQ), a main compound in black seed essential oils, has a variety of beneficial effects, including antiproliferative, anti-inflammatory, and antioxidant properties. On the other hand, scorpion venom peptides (SV) induce apoptosis in the cancer cells, making it a promising anticancer agent. THQ, SV, and Phospholipon® 90H (PL) were incorporated in a nano-based delivery platform to assess THQ's cellular uptake and antiproliferative efficacy against a lung cancer cell line derived from human alveolar epithelial cells (A549). Several nanovesicles were prepared and optimized using factorial experimental design. The optimized phytosome formulation contained 79.0 mg of PL and 170.0 mg of SV, with vesicle size and zeta potential of 209.9 nm and 21.1 mV, respectively. The IC50 values revealed that A549 cells were significantly more sensitive to the THQ formula than the plain formula and THQ. Cell cycle analysis revealed that THQ formula treatment resulted in significant cell cycle arrest at the S phase, increasing cell population in this phase by 22.1%. Furthermore, the THQ formula greatly increased cell apoptosis (25.17%) when compared to the untreated control (1.76%), plain formula (11.96%), or THQ alone (13.18%). The results also indicated that treatment with THQ formula significantly increased caspase-3, Bax, Bcl-2, and p53 mRNA expression compared to plain formula and THQ. In terms of the inflammatory markers, THQ formula significantly reduced the activity of TNF-α and NF-κB in comparison with the plain formula and THQ only. Overall, the findings from the study proved that a phytosome formulation of THQ could be a promising therapeutic approach for the treatment of lung adenocarcinoma.

Repurposing of Sitagliptin- Melittin Optimized Nanoformula against SARS-CoV-2: Antiviral Screening and Molecular Docking Studies.

The outbreak of the COVID-19 pandemic in China has become an urgent health and economic challenge. The objective of the current work was to evaluate the efficacy of the combined complex of Sitagliptin (SIT) with melittin (MEL) against SARS-CoV-2 virus. SIT-MEL nano-conjugates were optimized by a full three-factor bi-level (23) factorial design. In addition, SIT concentration (mM, X1), MEL concentration (mM, X2), and pH (X3) were selected as the critical factors. Particle size (nm, Y1) and zeta potential (mV, Y2) were assessed as responses. Characterization of the optimized formula for Fourier-transformed infrared (FTIR) was carried out. The optimized formula showed particle size and zeta potential values of 77.42 nm and 27.67 mV, respectively. When compared with SIT and MEL, the combination of SIT-MEL complex has shown anti-viral potential against isolate of SARS-CoV-2 with IC50 values of 8.439 µM with significant improvement (p < 0.001). In addition, the complex showed IC50 in vitro 3CL-protease inhibition with IC50 7.216 µM. Molecular docking has revealed that formula components have good predicted pocket accommodation of the SARS-CoV-2 3-CL protease. An optimized formulation of SIT-MEL could guarantee both enhanced delivery to the target cells and the enhanced cellular uptake with promising activities against SARS-CoV-2.

Perceptions and attitudes of different healthcare professionals and students toward interprofessional education in Saudi Arabia: a cross-sectional survey.

Interprofessional education (IPE) is now regarded as an extremely important approach in the academic field for preparing healthcare students to provide patient care in a collaborative team environment. In this study, we examine the perceptions and attitudes toward IPE in a Saudi specialized health sciences university. This study is a cross-sectional survey at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Medical City in Jeddah, Saudi Arabia. The instruments used in this study were pre-designed self-administered questionnaires identified from the literature (The Nebraska Interprofessional Education Attitudes Scale (NIPEAS) and The Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R). A total of 668 individuals participated in the study. The majority of the participants were between the ages of 18 and 25 (79.2%) and were students (77.1%) from medicine, nursing and applied medical science. The participants' responses were primarily positive for all items of the NIPEAS and most of the items of the SPICE-R. The results of this study indicate that students and healthcare professionals have positive perceptions and readiness toward IPE, and implementation of shared learning is highly encouraged. The integration of IPE in the curriculum is recommended to improve teamwork and patient care outcomes.

Awareness, Self-Use, Perceptions, Beliefs, and Attitudes toward Complementary and Alternative Medicines (CAM) among Health Professional Students in King Saud bin Abdulaziz University for Health Sciences Jeddah, Saudi Arabia.

BACKGROUND: Around 75% of the world's population relies on the use of complementary and alternative medicines (CAM) for their healthcare. Thus, we aimed at assessing the attitude and perception of health professional students about CAM and correlate the results with their demographical data. METHODS: An observational cross-sectional study was conducted at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia, by enrolling 350 students. A self-administered questionnaire was used for data collection. Descriptive and inferential statistical analysis was performed using SPSS. RESULTS: Results of our data suggested that majority of students were aware of the CAM modalities and considered prayers/spirituality (83.6%), massage (72.5%), nutritional supplements (74.1%), cupping (68.5%), herbal medicine (66.2), and yoga (61.6%) as most effective and least harmful CAM modalities. The students acquired more information about CAM from media (55%), books (56%), friends/relatives (59.7%), and other health professionals (58.4%), however, very little information from formal CAM courses or training (36.7%), which shows the lack of courses and trained health professional in the field of CAM. Despite utilizing nonreliable sources of CAM information, the majority of students had positive attitudes and perceptions about CAM usage. Majority of the students (75.8%) believe in the use of CAM for the mental and spiritual aspect of health and think that CAM providers give good information on maintaining a healthy lifestyle. The data also showed a significant (P < 0.05) association between awareness about CAM and gender. A significantly higher percentage of female students were using yoga and aromatherapy, while cupping was mostly used by male students. Similarly, a significant association was found among the different colleges and level of students in most of the CAM modalities. However, no association was found between the awareness and use of CAM with the educational level of parents or relatives in health sector except for acupuncture and cupping, where student's awareness about acupuncture and cupping was found to have a significant positive association with mother educational level. On the other hand, a significant inverse association was found between acupuncture, yoga, cupping, and aromatherapy with family income. CONCLUSION: In conclusion, despite the lack of proper courses and professionally trained healthcare providers in the field of CAM, students demonstrated positive attitudes and beliefs toward the safety and effectiveness of CAM.

Learning styles and satisfaction with educational activities of Saudi Health Science University Students.

OBJECTIVES: Medical knowledge is constantly changing; this puts pressure on educators to adapt instructional strategies to their students' learning styles (LSs). Therefore, identifying the LSs of medical students could help teachers to develop teaching strategies to achieve better outcomes. The purpose of this study was to determine the LSs of health science university students, and to assess the relationship between LSs and student satisfaction with educational activities. METHODS: This cross-sectional descriptive study was conducted in the Colleges of Medicine and Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Jeddah. We used Kolb's LS and a modified Student Satisfaction Survey from Mott Community College, Michigan. All participants received self-administered questionnaires; LS and demographic data were used as predictor variables. Students' satisfaction levels were considered the outcome variable. RESULTS: A total of 359 students were recruited (mean age 19.0 ± 1.4 years; 53.5% males). The most popular LS was Accommodator (29.2%), followed by Assimilator (27.9%) and Diverger (25.6%), while the Converger style (17.3%) was the least preferred LS. The satisfaction scores of the students showed that they were generally satisfied with a mean score of 64.4%. Males were found to have higher satisfaction across all variables than females (p = 0.002). CONCLUSIONS: This study could not find a predominant LS or satisfaction difference across LSs among health science students. Thus, the current educational programmes in KSAU-HS meet students' LSs and satisfaction. Educators need to broaden their strategies for instruction, so as to build an effective learning environment.

Determination of quality gap for educational services in undergraduate medical education. A cross-sectional study in Saudi Specialized Health Sciences University.

OBJECTIVE: To assess the perception and expectation of students about the quality of educational services and identify the gap in educational services. METHODS: This cross-sectional study was conducted at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) colleges across all regions (Riyadh, Jeddah, and Al-Ahsa) within one academic year (September 2017- April 2018). The difference between the students' perceptions and expectations was calculated to identify the gap between these 2 opinions. RESULTS:   A total of 416 (83.2%) questionnaires were completed with an almost equal ratio of male to female (51% and 49%). There was a significant difference in mean (gap) between students' expectations and perceptions of educational service quality at KSAU-HS (p less than 0.05). The results showed negative values for most of the items. It revealed that there is a significant difference between male and female in responsiveness, empathy, and tangible. CONCLUSION: The findings of this study showed that all the dimensions were not up to the expectations of students. The results will help the higher management to initiate a protocol to address all weaknesses.

Antiepileptic Drugs Usage in Pregnant Women with Epilepsy in Saudi Arabia.

BACKGROUND AND PURPOSE: Epilepsy is one of the most common neurological disorders requiring continuous treatment during pregnancy. In Saudi Arabia, there is only one publication that studied the outcome of pregnancies in women with epilepsy, published in 1999. The aim of the study is to determine the major congenital malformations in infants resulting from exposure to antiepileptic drugs in pregnant women with epilepsy. METHODS: This is a retrospective observational study that was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, involving pregnant women with epilepsy using antiepileptic drugs during pregnancy. We also studied babies born to those mothers. The study period was 5 years from 2014 to 2018. RESULTS: Six hundred babies were included in the study, born to 154 mothers with epilepsy using antiepileptic drugs during pregnancy. In addition, there were 111 losses of fetuses before 20 weeks of gestation. The only malformation detected was a ventricular septal defect in one child, whose mother was using polytherapy (valproic acid and levetiracetam). Three babies were born with epilepsy, and four babies had other associated disorders (Down syndrome, osteoporosis, esotropia, and hearing impairment). CONCLUSIONS: The results of this small study are an urgent call for the establishment of congenital malformations registry in Saudi Arabia. In addition, specialized epilepsy clinics utilizing multidisciplinary care are highly recommended. A specific group of interest for such clinics are married women, who have epilepsy and are using antiepileptic drugs since planning of pregnancy is not part of the culture in Saudi Arabia.

Establishment and characterization of female reproductive tract epithelial cell culture.

The oviductal and uterine epithelial cells have a crucial role, but are still poorly understood. Numerous studies have tried to isolate the epithelial cells from different organs in various models. The current study aimed to establish and characterize an in vitro monolayer culture of the oviduct and uterine horn epithelial cells by using two different techniques. Female reproductive epithelial cells from sows were cultured in follicular phase. Combined protocols to isolate the epithelial cells were performed. The viability and cell number were determined. Monolayers of epithelial cells from each group were cultured in four-well plates and were subjected to immunostaining using a Vector ABC Elite Kit. The immunohistochemical staining step was performed to evaluate the quality of the epithelial cells. Oviductal cells reached confluence faster than uterine horn cells. Cilia were seen in oviduct and uterine horn tissue culture. All the isolated cells reached confluence prior to harvesting. The number of cells was increased over the time of incubation. Monolayer culture using the trypsin/EDTA method took longer than culture with the collagenase method. Immunohistochemistry of epithelial cells showed strong staining for cytokeratin. Oviductal and uterus epithelial cells were cultured and established. Both techniques used in this experiment were useful and showed no significant differences. This cell culture model has the potential to study the secretory interactions of the female reproductive tract with spermatozoa, oocytesor embryos.

Neurological complications of bariatric surgery.

OBJECTIVE: To review and analyze the neurological complications from bariatric surgery in Kingdom of Saudi Arabia. METHODS: This cross sectional study was carried out in King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia from January 2009 to December 2015. Important personal and clinical data were collected from the charts of the patients who underwent bariatric surgery. Data on follow up visit and remote complication if present, was also collected. All patients with neurological complications were reviewed in detail. The significant difference was calculated by using T-test and p-value<0.05 was considered significant. RESULTS: A total of 451 patients underwent bariatric surgery, 15 cases had neurological complications (3%). Axonal polyneuropathy was the most frequent neurological complication, but cases of Wernicke syndrome, vitamin B12 deficiency, Guillain-Barre syndrome and copper deficiency were also identified. Fourteen patients (93.3%) had full recovery from the neurological signs and symptoms; one patient died. CONCLUSION: Bariatric surgery is not free of potential neurological complications. Complications may affect both central and peripheral nervous system and death is a possibility. Multidisciplinary care including consultation of different teams is highly recommended.

Optimisation of proteomic approaches to study the maternal interaction with gametes in sow's reproductive tract.

The applications of 2DE and MS have been successfully used in many studies utilising different biological samples. The complex nature of cellular proteomes is a big challenge for proteomic technologies. Much effort has been applied to develop and improve the preparation techniques for proteomic samples to be able to detect the low abundant proteins. This is one of the major and unsolved challenges facing the proteomic analysis of biological samples. One partial remedy is to deplete the proteomic samples. In this study, we compared two techniques (acetone precipitation and commercial kit) for the cleaning and purification of oviductal and uterine horn secretory proteomes in primary cell culture system. The samples prepared from acetone precipitation and commercial kit 2-D clean up kit were compared by 2-dimentioanl electrophoresis. We found that no significant difference was observed in number of spots detected between the samples prepared by acetone precipitation technique to those prepared by commercial kit. Protein samples were run through strong cation exchange (SCX) liquid chromatography in order to fractionate samples of major proteins. Protein identification by mass spectrometry revealed a significant detection of low abundant proteins in comparing to high abundant proteins. In conclusion, acetone precipitation was found to be more efficient and cost effect technique. Depletion of proteomic samples from the most abundant protein species is strongly recommended to allow the mid and low abundant protein to be detected. A better resolution of the gels will be achieved by removing the major proteins such as albumin and immunoglobulin.

Generalized myoclonus and spasticity induced by lamotrigine toxicity: a case report and literature review.

Lamotrigine (LTG) is a well-tolerated broad-spectrum antiepileptic drug, which is chemically unrelated to other existing antiepileptic medications. The drug has also some mood-stabilizing properties and, according to some studies, modest antidepressant effects. The exact mechanism of action is unknown, but some animal studies suggest the inhibition of neuronal glutamate release. Despite being relatively safe, LTG has been demonstrated to have proconvulsant effect especially in certain types of epilepsies like myoclonic status epilepticus. Myoclonic status epilepticus and its variations including generalized myoclonic status epilepticus, status myoclonus, and prolonged myoclonus describe a variety of clinical states, which have continuous, unremitting seizures lasting longer than 5 minutes. It is not a commonly reported treatment-emergent neurological complication, but the treatment is always a medical emergency. We report a case of a 46-year-old man who developed generalized myoclonus status epilepticus a few hours after suicidal ingestion of LTG. He remained hemodynamically stable throughout hospitalization and started to recover and achieved complete recovery 3 days later. This is the first reported case of this de novo complication induced by LTG toxicity. We proposed a subcortical mechanism for this complication induced by the toxic doses of LTG.

Cerebral venous sinus thrombosis.

Cerebral venous thrombosis is a rare serious neurological disorder that may cause vital or morbid consequences if not diagnosed and treated promptly. It is a unique cerebrovascular disorder that predominantly affects adults in their third and fourth decades. The incidence of CVST in adults is estimated to be 4 cases per million of the population, and 7 cases per million in children. In the last 2 decades, the awareness and prognosis of the disease have improved due to development of sophisticated neuroimaging techniques and effective treatment. This comprehensive review of the topic aims to improve knowledge among neurologists and internists who are involved in the management of these patients.

Acute paraplegia caused by Schistosoma mansoni.

Schistosomiasis affects over 200 million people worldwide. Involvement of the CNS is a rare occurrence. We report 2 young males who presented with rapidly progressing paraparesis associated with urinary incontinence. In both cases, MRI of the spine demonstrated a diffusely enhancing mass at the conus medullaris with extensive spinal cord edema. Laboratory investigations revealed mild peripheral eosinophilia and abnormal, but non-specific, CSF analysis. In one patient, the diagnosis was made based on a rising schistosomal titer with a positive rectal biopsy. In the other patient, spinal cord biopsy revealed a granuloma. Both cases were caused by Schistosoma mansoni and patients were treated with praziquantel and steroid therapy. They both made a remarkable neurological recovery. We emphasize that a high index of suspicion should be raised in the differential diagnosis of transverse myelitis in endemic areas.