Caregiver Knowledge, Attitude, and Behavior toward Care of Children with Cerebral Palsy: A Saudi Arabian Perspective.

The care of children with cerebral palsy (CP) requires a complex system of care that is not only dependent on health care resources, but is also strongly influenced by social and cultural attributes. Hence, it is important to explore the understanding and practices of caregivers within a regional perspective. This study was conducted to investigate the knowledge, attitude, and behavior (KAB) of parents with children diagnosed with CP in Saudi Arabia. A cross sectional survey was conducted on the caregivers of children with CP admitted for inpatient rehabilitation between October 2023 to January 2024. A total of 216 caregivers participated in this survey. About 82.9% of caregivers were the mothers of CP children, half (50.5%) were ≤36 years old, 53.7% were highly educated, and 89.2% lived in urban areas. More than half of the participants (57.7%) owned their homes. Regarding children, spastic quadriplegia was the most common type (46.3% of cases). Overall, the participants recorded good values for all variables for KAB. The mean value for attitude was higher (2.67 ± 0.20) when compared to behavior (2.49 ± 0.36) and knowledge (2.46 ± 0.25). Participants who had children with spastic quadriplegia CP reported lower behavior scores than their peers. Strategies with a special emphasis on improving the behaviors of caregivers for children with quadriplegia need to be adapted. Similarly, the living situations of families need to be taken into consideration given its significant association with the attitude of caregivers. A considerable lack of knowledge in handling emergency situations by caregivers signifies a gap in care, which could have potentially life-threatening consequences.

Diagnostic accuracy of ultrasonography in diagnosis of Carpal Tunnel Syndrome.

Objective: This study aimed to assess the diagnostic accuracy of Ultrasonography, considering nerve conduction study (NCS) as the gold standard diagnostic modality for carpal tunnel syndrome (CTS). Methods: A cross-sectional study was conducted at the Neurology Department of Allied Hospital, Faisalabad from August, 2020 to January, 2021. NCS and Ultrasonography of wrist were performed for diagnosis of CTS. The sensitivity, specificity, predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy (DA) were calculated for the screening test (Ultrasonography of the wrist), taking NCS as the gold standard. Results: The mean age of the study population was 41.53 ± 8.80 years, with female pre-dominance (71.66%). The right hand was involved in 24(40%) patients, left hand was involved in 4(6.66%) patients, and both hands were involved in 32(53.33%) patients. Among 60 patients, ultrasonography diagnosed 56 (TP+FN) as having CTS, confirmed via nerve conduction study. Sensitivity, specificity, NPV, PPV, and DA of Ultrasonography of the wrist for CTS were 92.8%, 75%, 42.8%, 98.1%, and 91.6%, respectively. Conclusion: Based on the sensitivity and specificity, Ultrasonography may assist in diagnosing CTS.

Complications of major lower limb amputations before prosthetic provision at a tertiary care rehabilitation facility.

BACKGROUND: Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge. OBJECTIVES: To investigate the complications following major lower limb amputations (MLLAs). STUDY DESIGN: Retrospective study. METHODS: One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included. RESULTS: Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology ( p value < 0.001), usage of assistive device ( p value = 0.002), and complications ( p value = 0.013). Complications were also significantly associated with time since amputation ( p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device ( p value = 0.012). CONCLUSIONS: Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs.

Delayed discharges at a tertiary rehabilitation centre in Saudi Arabia: contributing factors and cost impact.

There are various challenges in discharging hospitalized patients with disabilities. Discharge process for individuals with disabilities is multifactorial and can vary from one health system to another. The current study is aimed to explore the factors contributing to delayed discharges and to determine the number of exceeded bed days and subsequent cost impact at a government rehabilitation facility in Saudi Arabia. This retrospective cohort study was conducted at the Rehabilitation Hospital of King Fahad Medical City, Riyadh. All the 2285 discharges from inpatient rehabilitation from August 2011 to March 2017 were included in the study. Patients with delayed discharge were identified. Information about the diagnosis and reasons for delayed discharge was obtained from the rehabilitation hospital bed utilization data. The cost impact was calculated based on the number of days patients stayed beyond the estimated length of stay for each diagnosis. Of the 2285 discharges, 531 (23.3%) were delayed. The most common clinical conditions of patients with delayed discharge included spinal cord injury (n = 168, 31.6%) and traumatic brain injury (n = 145, 27.3%). The factors that led to delayed discharges were medical complications (n = 352, 66.7%), organizational factors (n = 83, 15.7%), family factors (n = 46, 8.7%), and external factors (n = 46, 8.7%). A total of 21 817 hospital bed days were exceeded, with an approximate estimated cost of 80 million Saudi Arabian Riyals. Early rehabilitation and enhancement of the discharge process may significantly decrease delayed discharge rates. Strategies need to be adapted to identify patients at risk of delayed discharge based on the factors highlighted in this study. Development of long-term care capacity, community services, and optimizing family and social support can promote timely discharge.

Complications of Intrathecal Baclofen Pump Therapy: An Institutional Experience from Saudi Arabia.

The intrathecal baclofen pump (ITB) is one of the advanced treatment options in the management of spasticity. This retrospective cohort study was conducted to identify the complications of ITB treatment at a tertiary care rehabilitation facility. Various demographic and technical factors were analyzed, which are less often reported in the literature. All patients with ITB who had their refill at the ITB clinic between November 2019 and March 2020 were included. Of 48 patients, 17 patients had 18 (37.5%) ITB-related complications. Catheter-related complications were most common, whereas loss of efficacy (16.7%) and baclofen withdrawal (14.5%) were the most common outcomes of complications. Only catheter occlusion had a significant relationship with the pattern of spastic quadriparesis (p = 0.001). Gender, rehabilitation diagnosis, patients' residence, and facility of ITB placement did not have significant association. Similarly, age, distance from hospital, disease onset, ITB therapy duration, and baclofen dose were not statistically significant in relation to ITB-related complications.

The impact of CSR and green consumption on consumer satisfaction and loyalty: moderating role of ethical beliefs.

The present study introduces an innovative conceptual framework for analyzing the influence of corporate social responsibility and green consumption on customer satisfaction and loyalty. The study employed a quantitative methodology, wherein data was gathered through face-to-face surveys from a sample of 329 participants in Pakistan during the period from November 2022 to February 2023. The collected data was subsequently subjected to analysis using partial least squares structural equation modeling (PLS-SEM). The results demonstrate that corporate social responsibility (CSR) has a significant and positive impact on consumer satisfaction, which subsequently serves as a significant predictor of loyalty. The research findings indicate a significant correlation between consumers' ethical beliefs, specifically idealism and relativism, and their engagement in green consumption. Furthermore, it is observed that green consumption positively influences consumer satisfaction. Additionally, the research revealed that the variables of idealism and relativism do not exert a moderating influence on the association between corporate social responsibility (CSR) and consumer satisfaction. The results underscore the significance of managers directing their attention towards cultivating more robust customer relationships through the prioritization of satisfaction within their corporate social responsibility (CSR) initiatives. This study aimed to assess a theoretical framework that delineates the fundamental connections between corporate social responsibility (CSR), green consumption, consumer satisfaction, and loyalty. While prior research has predominantly concentrated on corporate viewpoints and employee attitudes towards CSR, this research sought to fill the gap by examining the aforementioned relationships from a consumer perspective.

One-pot multicomponent synthesis of novel pyridine derivatives for antidiabetic and antiproliferative activities.

Background: Due to the close relationship of diabetes with hypertension reported in various research, a set of pyridine derivatives with US FDA-approved drug cores were designed and integrated by artificial intelligence. Methods: Novel pyridines were designed and synthesized. Compounds MNS-1-MNS-4 were evaluated for their structure and were screened for their in vitro antidiabetic (α-amylase) activity and anticancer (HepG2) activity by methyl thiazolyl tetrazolium assay. Comparative 3D quantitative structure-activity relationship analysis and pharmacophore generation were carried out. Results: The study revealed MNS-1 and MNS-4 as good alternatives to acarbose as antidiabetic agents, and MNS-2 as a more viable, better alternative to doxorubicin in the methyl thiazolyl tetrazolium assay. Conclusion: This combination of studies identifies new and more active analogs of existing FDA-approved drugs for the treatment of diabetes.

The Responsiveness Of Childhood/Adolescent Chronic Myeloid Leukaemia Patients Of Pakistani Origin To Tyrosine Kinase Inhibitor.

Chronic myelogenous leukaemia is a disease in which bone marrow produces too many white blood cells. It is more common in middle age and its incidence is rare in children. Imatinib is the standard first-line treatment in chronic myeloid leukaemia. It improved the prognosis with lesser side effects. Our point of interest is to highlight its role in the paediatric age group. we present case series of a patient with chronic myeloid leukaemia responsive to imatinib. Because of the rare incidence of chronic myeloid leukaemia in this age room limited studies to explore the role of treatment modalities in the paeds group. Our case series highlights imatinib's effectiveness in treatment and improving the prognosis of the disease in this age group.

Functional Outcomes of Patients with Primary Brain Tumors Undergoing Inpatient Rehabilitation at a Tertiary Care Rehabilitation Facility in Saudi Arabia.

Rehabilitation services play a crucial role in improving the functionality and quality of life of individuals with a brain tumor; however, outcomes of inpatient rehabilitation based on tumor characteristics are not well known in the literature. This study was carried out to evaluate the effects of tumor characteristics on functional outcomes. A retrospective chart review was conducted for all adults with a diagnosis of primary brain tumor admitted for IPR between January 2014 and December 2019. Information was collected regarding demographics, characteristics of primary brain tumors, length of stay (LOS) and Functional Independence Measurement (FIM) scores. There were 46 patients, with the majority being male. The most common brain tumors were glioblastoma multiforme and meningioma. The mean LOS was 47.93 ± 26.40 days and the mean FIM gain was 78 ± 14. The type, grade and location of primary brain tumors did not show a significant correlation with the length of stay and functional gains during inpatient rehabilitation. There was a positive correlation between the FIM at admission and discharge, and a significant inverse correlation between the FIM score at admission and LOS. In-patient rehabilitation improved the functional outcomes in adult patients with primary brain tumors. Strategies to incorporate IPR in the care continuum of patients with brain tumors need to be adapted to improve regional services.

An approach to [Formula: see text]-single-valued neutrosophic submodules.

Dealing with erroneous, unexpected, susceptible, flawed, vulnerable, and intricate information is simplified with the use of a single-valued neutrosophic set (svns). This is because of the fact that these types of information are more sensitive to error. This is due to the fact that these particular kinds of information are more prone to error. The ideas of fuzzy sets and intuitionistic fuzzy sets have both undergone further development as a direct result of the development of this new theory. In svns, indeterminacy is quantified in a way that is both obvious and unambiguous, and truth membership, indeterminacy membership, and falsity membership are all completely independent of one another. In algebraic analysis, certain binary operations can be thought of as interacting with algebraic modules. These modules are intricate and ubiquitous structures. There are many different applications for modules to be used in. Modules find use in an extremely wide variety of different kinds of businesses and market segments. We investigate the idea of [Formula: see text]-svns and relate it to [Formula: see text]-single-valued neutrosophic module and [Formula: see text]-single-valued neutrosophic submodule, respectively. The goals of this research are to comprehend the algebraic structures of a [Formula: see text]-single-valued neutrosophic submodule of a classical module and enhance the legitimacy of this technique by discussing numerous essential aspects. Both of these goals will be accomplished through the course of this study. The strategies that we have developed in this manuscript are more generalizable than those that have been utilized in the past. These strategies include fuzzy sets, intuitionistic fuzzy sets, and neutrosophic sets.

Satisfaction of individuals with partial-hand amputations after they were fitted with cosmetic silicone prostheses.

BACKGROUND: Partial-hand amputations are the most common level of upper-limb amputations which can lead to cosmetic and functional problems. Partial-hand amputations can be acquired or congenital. Cosmetic silicone prostheses are used in the management of partial-hand amputation; however, a literature review shows that most of the studies are on the fabrication of prosthesis, and data remain deficient on the satisfaction of users with silicone prostheses. OBJECTIVES: To assess the satisfaction of individuals after they were fitted with cosmetic silicone prostheses for partial-hand amputations. STUDY DESIGN: Cross-sectional study. METHODS: Fifty-four participants with partial-hand amputations and who received cosmetic silicone prostheses participated in the survey using the validated Arabic version of the Client Satisfaction with Device (CSD-Ar). RESULTS: Nearly half of the participants were using their silicone prosthesis daily. Most of the patients reported satisfaction with durability and donning, whereas most of the patients were dissatisfied with comfort. The mean of CSD-Ar total score was 16.8 ± 4.7 of 32. The CSD-Ar total score was significantly associated with the side of amputation ( p -value = 0.014) and usage of prosthesis ( p -value < 0.001). CONCLUSION: The satisfaction of individuals with partial-hand amputations can be enhanced by fitting them with cosmetic silicone prostheses. However, these prostheses should meet certain criteria including fitting, weight, comfort, donning, appearance, durability, skin abrasion and irritation, and pain. Individuals' expectations and concerns should be considered as well.

Effectiveness of alteplase infusion for the management of prosthetic mitral valve thrombosis in paediatric age group and proposed algorithm.

INTRODUCTION: The incidence of prosthetic valve implantation is increasing in the paediatric population. Prosthetic valve thrombosis leading to obstruction could potentially be a life-threatening complication. There is a debate regarding optimal management of this complication, and there is limited use of thrombolytic therapy in childhood in the setting of valve thrombosis. OBJECTIVE: We aim to share our experience of successfully using fibrinolytic therapy in terms of alteplase for paediatric prosthetic mitral valve thrombosis and to propose a management algorithm. METHODS: This retrospective analysis of the database was conducted at our hospital including patients who underwent thrombolysis (alteplase) for prosthetic mitral valve thrombosis from June, 2011 to June, 2021. A total of 10 patients with 20 attempts of alteplase infusion were found in our record. RESULTS: Alteplase was successful in 19 attempts to relieve valve thrombosis. The safe and effective dose of alteplase was between 0.1 and 0.3 mg/kg/hour. There were no associated major bleeding complications and alteplase was administered either by central or peripheral line. CONCLUSION: Thrombolysis by alteplase infusion was found to be successful in relief of prosthetic mitral valve thrombosis in paediatric population without major bleeding complications.

Genetic overview of postaxial polydactyly: Updated classification.

Polydactyly or polydactylism, also known as a hyperdactyly, is a congenital limb defect with various morphologic phenotypes. Apart from physical and functional impairments, the presence of polydactyly is an indication of an underlying syndrome in the newborn. Usually, it follows as an autosomal dominant/recessive inheritance pattern with defects in the limb development's anteroposterior patterning. Although mutations in several genes have been associated with polydactyly; however, the exact underlying cause, pathways, and disease mechanisms are still unexplored, thus making it of multi-factorial origin. Polydactyly is divided into three subtypes; radial, ulnar, and central polydactyly. So far, 11 loci (PAPA1-PAPA11) and seven human genes have been reported to cause non-syndromic postaxial polydactyly in humans, including the ZNF141, GLI3, IQCE, GLI1, FAM92A1, KIAA0825, and DACH1. In this review, we discuss emerging evidences of clinical and molecular characterization of polydactyly types in term of the involvement of newly associated genes and loci for non-syndromic postaxial polydactyly, and how these might impact our understanding of the genetic mechanisms and molecular etiology involved in the cause of polydactyly.

Ethical and Legal Aspects of Telerehabilitation in Saudi Arabia.

Organizations have their own policies and procedures to govern operational aspects of health care facilities. With the advent of telemedicine, there has been a growing trend in providing telehealth practices without formally exploring the ethical and legislative aspects. The potential use of electronic and digital services in telerehabilitation can influence various ethical and legal factors, such as confidentiality, consent. and negligence. Thus, establishing clear strategies in this regard is necessary. Ethical and legal aspects of healthcare are influenced by cultural, religious, and legislative rulings of a state. At the same time, the multidimensional scope of rehabilitation in a health system has its own challenges. This narrative review intends to highlight the importance of incorporating the ethical and legislative framework in the telerehabilitation process in Saudi Arabia. A summary of various aspects in-line with unique local attributes is included, which can also help to facilitate regional telerehabilitation services in the Arab World.

Magnetic, Electronic, and Optical Studies of Gd-Doped WO3: A First Principle Study.

Tungsten trioxide (WO3) is mainly studied as an electrochromic material and received attention due to N-type oxide-based semiconductors. The magnetic, structural, and optical behavior of pristine WO3 and gadolinium (Gd)-doped WO3 are being investigated using density functional theory. For exchange-correlation potential energy, generalized gradient approximation (GGA+U) is used in our calculations, where U is the Hubbard potential. The estimated bandgap of pure WO3 is 2.5 eV. After the doping of Gd, some states cross the Fermi level, and WO3 acts as a degenerate semiconductor with a 2 eV bandgap. Spin-polarized calculations show that the system is antiferromagnetic in its ground state. The WO3 material is a semiconductor, as there is a bandgap of 2.5 eV between the valence and conduction bands. The Gd-doped WO3's band structure shows few states across the Fermi level, which means that the material is metal or semimetal. After the doping of Gd, WO3 becomes the degenerate semiconductor with a bandgap of 2 eV. The energy difference between ferromagnetic (FM) and antiferromagnetic (AFM) configurations is negative, so the Gd-doped WO3 system is AFM. The pure WO3 is nonmagnetic, where the magnetic moment in the system after doping Gd is 9.5599575 µB.

Perceived Clinical Barriers to Employment for Males with Spinal Cord Injury in Saudi Arabia.

Return to work is a challenging aspect of community integration for individuals with disabilities. The reintegration of individuals with spinal cord injury (SCI) is multifactorial; hence, regional challenges need to be investigated in the context of their clinical attributes and perceptions. A total of 121 male participants above 18 years of age with diagnosis of SCI and living at home were included in this cross-sectional survey. The study was conducted at a tertiary care rehabilitation facility in Saudi Arabia. The most common reported clinical barriers to employment were mobility, bladder incontinence, spasticity, musculoskeletal pain, and neuropathic pain. Bladder incontinence and musculoskeletal pain were the most common perceived clinical barriers for individuals with paraplegia and tetraplegia, respectively. A significant difference was observed for bowel incontinence as a reported barrier (p = 0.024) among adults less than thirty years of age in comparison with those older than thirty years. Spasticity as a barrier was reported more among patients who were older than thirty years (54.0%) compared to those younger than thirty years of age (37.9%) (p = 0.077). Twenty-two (23.7%) participants with paraplegia reported transfers as a perceived barrier to employment, which was significant (p = 0.014), and it was also reported as a significant barrier (p = 0.001) in individuals with tetraplegia (56%). This study shows that clinical conditions associated with SCI are considered potential barriers to employment by individuals with SCI. In terms of priority, the perceived barriers between individuals with tetraplegia and paraplegia were mostly different. This shows the need to consider relevant secondary health care conditions in goal setting while planning for employment in individuals with SCI.

An effective modular approach for crowd counting in an image using convolutional neural networks.

Abrupt and continuous nature of scale variation in a crowded scene is a challenging task to enhance crowd counting accuracy in an image. Existing crowd counting techniques generally used multi-column or single-column dilated convolution to tackle scale variation due to perspective distortion. However, due to multi-column nature, they obtain identical features, whereas, the standard dilated convolution (SDC) with expanded receptive field size has sparse pixel sampling rate. Due to sparse nature of SDC, it is highly challenging to obtain relevant contextual information. Further, features at multiple scale are not extracted despite some inception-based model is not used (which is cost effective). To mitigate theses drawbacks in SDC, we therefore, propose a hierarchical dense dilated deep pyramid feature extraction through convolution neural network (CNN) for single image crowd counting (HDPF). It comprises of three modules: general feature extraction module (GFEM), deep pyramid feature extraction module (PFEM) and fusion module (FM). The GFEM is responsible to obtain task independent general features. Whereas, PFEM plays a vital role to obtain the relevant contextual information due to dense pixel sampling rate caused by densely connected dense stacked dilated convolutional modules (DSDCs). Further, due to dense connections among DSDCs, the final feature map acquires multi-scale information with expanded receptive field as compared to SDC. Due to dense pyramid nature, it is very effective to propagate the extracted feature from lower dilated convolutional layers (DCLs) to middle and higher DCLs, which result in better estimation accuracy. The FM is used to fuse the incoming features extracted by other modules. The proposed technique is tested through simulations on three well known datasets: Shanghaitech (Part-A), Shanghaitech (Part-B) and Venice. Results justify its relative effectiveness in terms of selected performance.

Return to driving post stroke; patients' perspectives and challenges in Saudi Arabia.

BACKGROUND: Returning to driving remains one of the most important goals for stroke survivors. In Saudi Arabia, there are no structured processes to address the issue of return to driving in individuals with disabilities. There are increasing rates of strokes in the country and road traffic accidents are the highest in the region. Returning to driving among male stroke survivors in Saudi Arabia is of particular importance due to socio-economic and cultural reasons. AIMS: The study aims to explore the factors involved in return to driving among stroke survivors in Saudi population. METHODS: This cross-sectional study was carried out on 100 male stroke survivors who had completed an inpatient rehabilitation program and had at least one follow-up assessment three months post-discharge. Information was collected regarding demographics, stroke characteristics, and factors related to pre and post-stroke driving. Data were analyzed using SPSS. RESULTS: Majority (60%) of patients were 51 years of age and above. Most commonly reported stroke impairments were weakness and spasticity with majority of participants having right-sided body involvement. Out of 94 stroke survivors who were driving prior to stroke, only 7 resumed driving. None of the stroke survivors who returned to driving reported receiving any formal driving assessment. Only one patient who reported being aware of the need of driving assessment did not resume driving after stroke. CONCLUSIONS: There is a dire need to increase awareness and to develop a structured integrated system in Saudi Arabia to facilitate stroke survivors to return to driving.

Impact of COVID-19 Pandemic on Disability Care and Persons with Disability in Pakistan.

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