Demographic and clinical determinants of the quality of life in adults with inherited and acquired myopathies.

BACKGROUND AND PURPOSE: Measuring health-related quality of life (QOL) is vital for understanding the disease impact, but the complex relationship between clinical parameters and QOL remains unclear. The objective was to determine the demographic and clinical factors that influence the QOL in adults with inherited and acquired myopathies. METHODS: The study was of cross-sectional design. Detailed demographic and clinical details were collected. Patients answered Neuro-QOL and Patient-Reported Outcomes Measurement Information System short-form questionnaires. RESULTS: Data was collected from 100 consecutive in-person patient visits. Mean age of the cohort was 49.5 ± 20.1 (18-85) years, and the majority were male (53, 53%). Bivariate analysis between the various demographic and clinical features with the QOL scales revealed single simple question (SSQ), handgrip strength, Medical Research Council (MRC) sum score, female gender, and age to be nonuniformly associated with the QOL scales. There was no difference between inherited and acquired myopathies for any of the QOL scores, except for the poorer lower limb function domain in inherited myopathies (36.7 ± 7.3 vs. 40.9 ± 11.2, p = 0.049). Linear regression models revealed lower SSQ, lower handgrip strength, and lower MRC sum score to independently predict poor QOL. CONCLUSIONS: Handgrip strength and SSQ serve as novel predictors of QOL in myopathies. Handgrip strength has a significant impact on physical, mental, and social domains and deserves special attention with respect to rehabilitation. SSQ correlates well with QOL and can be employed as a quick and global assessment of a patient's well-being. Differences in QOL scores between patients with inherited and acquired myopathies were minimal.

Retrospective study on the safety of COVID-19 vaccination in myasthenia gravis.

INTRODUCTION/AIM: Given the lack of information on safety of coronavirus disease 2019 (COVID-19) vaccination in myasthenia gravis (MG) patients, we aimed to review our experience after surveying patients, as part of routine clinical practice, to ensure that advice on safety is accurate. METHODS: We performed a retrospective chart review of MG patients from the Prosserman Family Neuromuscular Clinic at the Toronto General Hospital who received two injections of any COVID-19 vaccine from February to August 2021. Demographic data were abstracted from the patient medical records. We assessed changes in the severity of MG using the virtual Myasthenia Gravis Impairment Index (vMGII), the simple single question (SSQ), and Patient Acceptable Symptom State (PASS). We also assessed adverse effects after vaccination. RESULTS: We included 200 patients with a mean age of 64.3 ± 13.9 y, 51.5% were men, and 82% had generalized MG. The vMGII, SSQ, and PASS scores remained stable after each vaccine dose, and at last follow-up. Of the patients, 60% reported an adverse reaction after the first injection, and 56% after the second. The most common adverse reactions reported were local pain at the injection site, fatigue, headache, and fever. DISCUSSION: COVID-19 vaccinations were well tolerated in MG patients and were not associated with worsening severity of their MG. The prevalence of vaccine-related adverse reactions was the same as in the general population.

Telephone consultation for myasthenia gravis care during the COVID-19 pandemic: Assessment of a novel virtual myasthenia gravis index.

INTRODUCTION/AIMS: The aim of the study was to determine the association between the virtual Myasthenia Gravis Impairment Index (vMGII) with other patient-reported outcomes (PROs) of myasthenia gravis (MG) and its usefulness in telephone consultations with MG patients. METHODS: This was a retrospective case series in which vMGII score along with virtual Single Simple Question (vSSQ), virtual Patient-Acceptable Symptom State PASS (vPASS) response, and patient disease status based on Myathenia Gravis Foundation of America postintervention status were collected during telephone consultation along with the MGII, SSQ, and PASS responses during the preceding in-person clinic visits. RESULTS: In 214 patients, the mean difference of vMGII between the vPASS "Yes" and "No" groups was -14.2 ± 1.4 (95% confidence interval, -16.9 to -11.3; P < .001) with mean vMGII for vPASS "Yes" group being 6.4 ± 7.7 and vPASS "No" being 20.5 ± 11.5. A vMGII of 11.5 or higher predicted vPASS "yes" response with a sensitivity of 78.7% and specificity of 81.4%. A strong negative correlation was found between the vMGII and vSSQ (r = -.667; P < .001). The mean vMGII was 0.48 ± 1.42 for patients in remission, and 9.31 ± 10.93 for improved, 9.32 ± 8.79 for stable, and 22.58 ± 14.04 for worsened groups (P < .001). These associations were the same as those obtained during the preceding in-person clinic visit and the direction of change in MGII scores also indicated change in disease status. DISCUSSION: vMGII is an effective measure to assess an MG patient's disease status in telephone consultations and relates well with other PRO measures. The vMGII remains reliable for assessing MG disease status even with removal of the physical examination component.

A case report of hepatic fetus-in-fetu: Approach to diagnosis.

Multiple theories have been proposed about the pathophysiology of Fetus-in-fetu (FIF). The most widely accepted theory is abnormal embryogenesis in diamniotic monochorionic pregnancies, in which a malformed parasitic fetus is found within the body of a twin host. Hepatic FIF has been reported in almost 1% of FIF cases, with only 2 case reports being published in the literature. This article presents the third case report of intrahepatic FIF. Additionally, we review the role of radiology in diagnosing these cases and guiding their proper management. This case report supports the monozygotic twin theory of FIF and the diagnostic dilemma of FIF vs. teratoma can be solved through collaborative work between radiologists and pathologists.

Systematic Comparison of Muscle Ultrasound Thickness in Polyneuropathies and Other Neuromuscular Diseases.

BACKGROUND: We have aimed to assess whether muscle thickness ultrasound (US) shows differences between patients with chronic inflammatory demyelinating polyneuropathy (CIDP), chronic axonal polyneuropathy (CAP), and other neuromuscular (NM) diseases compared to controls and to each other. METHODS: We performed a cross-sectional study from September 2021 to June 2022. All subjects underwent quantitative sonographic evaluation of muscle thickness in eight relaxed muscles and four contracted muscles. Differences were assessed using multivariable linear regression, correcting for age and body mass index (BMI). RESULTS: The study cohort consisted of 65 healthy controls, and 95 patients: 31 with CIDP, 34 with CAP, and 30 with other NM diseases. Both relaxed and contracted muscle thickness in all patient groups were lower than in the healthy controls, after controlling for age and body mass index (BMI). Regression confirmed that the differences persisted between patient groups and healthy controls. Differences between patient groups were not apparent. CONCLUSION: The current study shows that muscle ultrasound thickness is not specific in NM disorders, but shows a global reduction in thickness compared with healthy controls after corrections for age and BMI.

Prevalence of and Risk Factors for Skin Picking Disorder Symptoms Among Adults in an Arab Middle Eastern Population: A Cross-Sectional Study.

Introduction: Skin Picking Disorder (SPD) is a skin-related disease, also recognized as psychogenic excoriation, dermatillomania, or excoriation disorder. SPD is defined as a habitual picking of skin, which in turn harms skin tissue. Given the paucity of information on SPD symptoms, their prevalence, and risk factors in Saudi Arabia, the present study seeks to fill this gap by investigating these factors in a community sample from Jeddah. Methods: This descriptive cross-sectional study was conducted in the city of Jeddah. The Skin Picking Scale-Revised (SPS-R) scale was administered to a convenience sample of 520 respondents. A partial least squares path model (PLS-PM) for "impairment" and "symptoms severity" subscales was assessed by evaluating the validity of measurement and structural models. Results: Skin picking behavior was reported by 28.8% (n=150). A significant level of skin picking disorder symptoms was present in 1.2% (n=6). Skin picking visual effect, depressive symptoms, and being unmarried were the only positive independent predictors of the total SPS-R score. Conclusion: SPD symptoms are relatively common among the adult population in Jeddah, but those with threshold symptoms indicative of SPD are relatively few. Such behavior is particularly common in vulnerable groups such as those with depressive symptoms and the unmarried. More attention to this condition by clinicians will improve the quality of life of those affected, and reduce the emotional and physical health consequences of this often unrecognized condition.

Awareness, knowledge, and attitude toward nonmelanoma skin cancer and actinic keratosis among the general population of western Saudi Arabia.

BACKGROUND: This study evaluated the levels of awareness, knowledge, and attitude, including sun-protection habits, toward basal cell carcinoma and actinic keratosis among the Saudi population. MATERIALS AND METHODS: A cross-sectional study was conducted among the general population of Jeddah, Saudi Arabia using a 12-item survey concerning the knowledge and awareness of basal cell carcinoma and actinic keratosis, as well as associated preventive measures. A Chi-square test was used to determine associations among variables. RESULTS: The majority of participants were unaware of basal cell carcinoma and actinic keratosis (80.7%), while 8.6% were aware of both, and 9.8% and 1% were aware of only basal cell carcinoma or actinic keratosis, respectively. The majority of participants who were educated up to high school level had no knowledge of either condition (96%, P < 0.0001). Among participants with high levels of awareness of basal cell carcinoma and actinic keratosis, medical practitioners were identified as the main source of information (72.5%, P < 0.0001, and 70.6%, P < 0.0001, respectively). The majority of participants whose knowledge of the relationship between sun exposure and skin cancer was insufficient also lacked sufficient awareness of either basal cell carcinoma or actinic keratosis (92.6%, P < 0.0001). The majority of participants (62.8%) declared using sunscreen "rarely". CONCLUSION: This study showed a low level of knowledge about the risks associated with sun exposure and suitable protection methods, with only a small fraction of participants declaring a regular use of sunscreen. Public education campaigns are required to increase the awareness of cancer risks and protection methods among the Saudi population.

The Influence of Gender on the Choice of Radiology as a Specialty Among Medical Students in Saudi Arabia: Cross-Sectional Study.

BACKGROUND: Medical undergraduates are the future doctors of the country. Therefore, determining how medical students choose their areas of specialty is essential to obtain a balanced distribution of physicians among all specialties. Although gender is a significant factor that affects specialty choice, the factors underlying gender differences in radiology are not fully elucidated. OBJECTIVE: This study examined the factors that attracted medical students to and discouraged them from selecting diagnostic radiology and analyzed whether these factors differed between female and male medical students. METHODS: This cross-sectional study conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, used an electronic questionnaire sent to medical students from all medical years during February 2018. Subgroup analyses for gender and radiology interest were performed using the chi-square test and Cramér's V test. RESULTS: In total, 539 students (276 women; 263 men) responded. The most common factor preventing students from choosing radiology as a career was the lack of direct patient contact, which deterred approximately 47% who decided against considering this specialty. Negative perceptions by other physicians (P<.001), lack of acknowledgment by patients (P=.004), and lack of structured radiology rotations (P=.007) dissuaded significantly more male students than female students. Among those interested in radiology, more female students were attracted by job flexibility (P=.01), while more male students were attracted by focused patient interactions with minimal paperwork (P<.001). CONCLUSIONS: No significant difference was found between the genders in terms of considering radiology as a specialty. Misconception plays a central role in students' judgment regarding radiology. Hence, early exposure to radiology, assuming a new teaching method, and using a curriculum that supports the active participation of students in a radiology rotation are needed to overcome this misconception.

Awareness of Interventional Radiology Among Medical Students at a Saudi Medical School: Clerkship versus Pre-clerkship Years.

OBJECTIVES: We sought to assess the awareness of interventional radiology (IR) as a specialty among medical students and determine any difference between the clerkship and pre-clerkship years. METHODS: We conducted a cross-sectional, survey-based study in February 2018 at King Abdulaziz University, Jeddah, Saudi Arabia. Five hundred and forty-two medical students were enrolled. The survey consisted of 17 items canvassing student awareness of and interest in IR. The data were compared using the chi-square test. RESULTS: A large proportion of the respondents (n = 199, 36.7%) rated their knowledge of IR as poor, and 85 (15.7%) reported that they knew nothing about IR. Only 87 students (16.1%) responded that they would consider a career in radiology. The most common reason for not considering IR was lack of knowledge (42.9%). Students in their clerkship years had more interest and exposure to IR than pre-clerkship students (73.0%, p < 0.001 and 55.7%, p = 0.030, respectively). Awareness of IR was significantly more common among those interested in diagnostic radiology and IR (65.5%, p < 0.001 and 61.5%, p = 0.010, respectively). CONCLUSIONS: Awareness of and exposure to IR is poor among medical students, and can only be increased by a direct contribution from IR physicians to the undergraduate curriculum. Lack of a unified radiology curriculum in medical schools across the country should be addressed by the Council of Deans of Saudi Medical Schools. Involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.