Vagal Nerve Stimulation in the Pediatric Population and Correlation Between Family and Treatment Team Perspectives: Single-center Experience.

BACKGROUND: Vagal nerve stimulation (VNS) is an adjunctive therapy to pharmacological treatment in patients with drug-resistant epilepsy. This study aimed to assess the efficacy of VNS therapy for seizure frequency reduction and improving quality of life (QOL) measures in children with refractory epilepsy and to evaluate the correlation between the perspectives of families and those of the treating team. METHODS: This was a prospective cohort study conducted at Abha Maternity and Children's Hospital, Saudi Arabia, from 2018 to 2022. A total of 21 pediatric patients who completed one year of follow-up after VNS implantation were included. Patients were aged between 2 and 14 years, with a mean age of 8.14 ± 3.92; 11 (52.4%) patients were female. Family and physician assessments were collected blinded to each other using Clinical Global Impression of Improvement (CGI-I) scores and QOL assessments to evaluate the correlation between the families' and treating team's perspectives on VNS outcomes. RESULTS: In this study involving 21 patients with intractable epilepsy, VNS showed significant efficacy in reducing the frequency of seizures. VNS significantly reduced the number of seizures per week from a baseline median of 35 to a median of 0.25 at the end of the follow-up period, representing a dramatic reduction of 99.3% (p < 0.001). The number of emergency department visits per year decreased from a baseline median of 12 to a median of 2, a reduction of 83.3% (p < 0.001), whereas the number of hospital admissions per year decreased from a baseline median of 3 to a median of 1, a 66.7% decrease (p < 0.001). The number of antiepileptic medications taken decreased from a median of 4 to 3 (p < 0.001). Notably, 28.57% of the patients achieved complete seizure freedom, and 38% exhibited significant improvement, with at least 50% reduction in seizure frequency. Importantly, none of the patients experienced an escalation in seizure frequency following VNS treatment. The family and physician assessments showed varying degrees of alignment in perceptions, with "concentration" exhibiting a significant positive correlation (r = 0.498, p = 0.022), indicating noteworthy agreement, whereas verbal communication did not show a substantial correlation (r = -0.062, p = 0.791), indicating a divergence of views. CONCLUSION: VNS is a promising and well-tolerated therapy for individuals with intractable seizures, offering clinical benefits and potential enhancements in various aspects of QOL. The varying perceptions between family and physician assessments highlight the importance of considering multiple perspectives when evaluating treatment outcomes.

Gender-Related Microaggressions in Orthopedic Surgery: A Comprehensive Survey of Women Orthopedists and Implications for Progress, Saudi Arabia.

Background: Microaggressions are subtle and often unintentional acts that can be verbal, nonverbal, or environmental, and they convey negative messages to individuals belonging to marginalized social groups. This study aims to determine the prevalence of microaggressions experienced by female Saudi orthopaedic surgeons. Methods: This cross-sectional study was conducted online and targeted female in orthopedic surgery across different regions of the Kingdom of Saudi Arabia. The survey was uploaded to Google Forms and distributed through social media platforms like Twitter, Instagram, and WhatsApp by well-trained data collectors. Results: In this survey we included 96 female Saudi orthopedics. Their mean age was 27.46 ± 12.20 years. Most respondents were either residents (52.63%), or specialists (23.16%). Most participants (92.63%) were still in training or early in their careers, with the vast majority (93.68%) had their residency in Saudi Arabia. Nearly three-fifths (61.05%) have reported experiencing microaggressions as victims, 76.84%, did not see themselves as perpetrators of microaggressions, 23.16% acknowledged having engaged in such behavior. Patients or their families were reported to be involved in microaggressions in 43.16% of cases, while male surgeons and male support staff were implicated at 51.58% and 23.16%, respectively. Additionally, other male medical doctors participate in microaggressions in 33.68% of instances. Female surgeons were identified as being involved in 22.11% of microaggressions, whereas 29.47% involve female support staff. Conclusion: The study's outcomes can help inform strategies to promote a supportive and inclusive environment within the field of orthopaedic surgery, encouraging positive interactions and equitable opportunities for all practitioners.

Smartphone use and its association with body image distortion and weight loss behaviours among adolescents in Saudi Arabia.

BACKGROUND: Concerns about the harmful effects of smartphone use on teenage development have been raised as the use of cell phones among adolescents has risen. OBJECTIVE: This study aimed to examine the associations of smartphone usage patterns with Body Image Distortion (BID) and weight loss behaviors among adolescent smartphone users in Saudi Arabia. METHODS: This population-based, cross-sectional study was conducted from July to October 2022. We assessed the mean daily length of smartphone use and classified it into quartiles using data from a self-reported survey and data on weekday and weekend use. Self-reported body weight and height were collected via an online survey. Out of the 11384 adolescents, the majority was females (65.7%) and was secondary school students (68.9%). RESULTS: The prolonged smartphone use (301 min/d) was found in 36.4% of adolescents, 181-300 min/d in 27.6% of respondents, 121-180 min/d in 22.4% of respondents, while the modest smartphone use (1-120 min/d) was found only in 13.6% of participants. The duration of smartphone use was significantly associated with BID (P= 0.000); students with middle perceived stress levels (51.4%) and no depressive symptoms (68.9%) used smartphones 121-180 min/d sparingly. However, prolonged smartphone use was significantly associated with the presence of depressive symptoms (42.6%) and high perceived stress levels (21.5%). Weight loss behaviors were significantly associated with smartphone use duration. Modest smartphone use was significantly found in students with normal weight (P= 0.00, 71.9%); however, aerobic physical activity weight loss strategy (P= 0.00, 30.9%) was correlated with prolonged smartphone use. CONCLUSION: Adequate parental advice is required to assist teenagers in developing healthy smartphone usage practices. Digital platform companies may increase their social responsibility for the information generated and delivered on their networks, boosting its beneficial effect.

Accuracy of Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Acute Appendicitis: A Single-Center Retrospective Study.

OBJECTIVE:  Investigate the potential use of the neutrophil-to-lymphocyte ratio (NLR) in the identification and differentiation of acute appendicitis patients, specifically between simple and complicated presentations. METHODS:  An observational retrospective cohort study was conducted in Aseer Central Hospital, Saudi Arabia. RESULTS: In total, 103 patients were included in this study, in which males (50.5%) were more common than females (49.5%), and the most common age group was found to be 36-45 years (56.3%), followed by 18-25 years (23.3%). All patients (100%) had a diagnosis of acute appendicitis. The means of neutrophils, lymphocytes, and NLR were found to be 68.970%, 22.067%, and 5.020, respectively. The majority (69%) had non-complicated appendicitis, while (31%) had complications. A significant association was seen between NLR and the occurrence of complications (p-value = 0.00001). CONCLUSION: This study can comprehensively support the evidence presented in the literature review. The use of the NLR demonstrates a notable level of accuracy in diagnosing acute appendicitis and differentiating between complex and uncomplicated cases.

Advancing Surgical Education: A Comprehensive Systematic Review with Meta-Analysis and Novel Approach to Training Models for Local Skin Advancement Flaps.

Performing local skin flaps is a challenging task that requires cognitive and technical skills to design flaps with proper orientation to avoid distorting normal anatomy. Junior trainees need adequate exposure to gain confidence and expertise in such procedures. This article systematically reviews the literature's different local skin advancement flap training models and describes a new, easy-to-use training model. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Web of Science, and Google Scholar databases were searched from their inception until August 2022 for articles about local skin advancement flap training models. The meta-analysis results were pooled across the studies using a random-effects model and presented as a weighted mean difference with a 95% confidence interval (95% CI). Out of 773 reviewed articles, 18 were included in the systematic review, and four reported enough data to be included in the meta-analysis. Rhomboid and Z-plasty flaps were the most commonly taught flaps by training models. The most commonly used training models were synthetic-based, followed by animal-based models. The training models significantly increased the trainees' confidence and expertise regarding local skin flap procedures (p<0.00001) for both domains. Training models, per our reported data, significantly improve the trainees' confidence and expertise in performing local skin advancement flap procedures; continuous efforts in developing and establishing new, simple-to-use, and effective training models are strongly encouraged to further improvement of surgical education and enhance the trainees' surgical skills.

Memory, Attention, and Concentration Dysfunction Post-COVID-19 Among College Students in Saudi Arabia: A Case-Control Study.

Introduction Multiple studies have demonstrated the multi-systemic involvement of COVID-19, and among all of these systems, there is mounting evidence that COVID-19 is linked to neurocognitive impairment, particularly when neurological symptoms are present. Our aim is to study the concept of cognitive dysfunction post-COVID-19 among college students in Saudi Arabia and its potential effect on their academic performance.  Methods A population-based, observational case-control study was conducted across the Kingdom of Saudi Arabia, from May 2022 to September 2022. A total of 2,150 eligible students have completed the study questionnaire. An exact 776 (36.1%) of them had COVID-19 infection (group 1), while 1,374 (63.9%) students had not (group 2). The sample population was college-enrolled students from 18 to 28 years old, with a mean age of 21.3 for group 1 and 20.8 for group 2. Both groups were handed the same data collection tool to establish whether the COVID-19 survivors had cognitive deficits more than the control group. Results There was no significant difference between the two groups regarding their bio-demographic data, study methods, or vaccination rate. However, both Neurological Fatigue and Big Five Inventory score were significantly higher among infected students, comparable to non-infected students. A negative relation was found between the infected students' neurological fatigue (rho=-0.14), cognitive failure (rho=-0.10), and depression and anxiety scale with their GPA (rho=0.03). Contrarily, infected students showed a positive relationship between their GPA and the Big Five Inventory (rho=0.13) and Short Grit Scale (rho=0.14). Also, there was a significant inverse relation between students' apathy motivation with their Big Five Inventory. Likewise, there was an inverse relation between their neurological fatigue, cognitive failure, and apathy motivation with their Short Grit Scale. Conclusion We demonstrated that college students who have survived COVID-19 infection mostly complain of cognitive impairment, even though most of them have no comorbidities or psychological disorders.