Clinical and ultrasonographic features in cancer risk stratification of indeterminate thyroid nodules.

OBJECTIVES: To estimate the risk of malignancy in indeterminate thyroid nodules and to determine whether certain clinical or radiological parameters can predict the risk of malignancy. METHODS: This retrospective study enrolled all adult patients (age ≥14 years) with a cytological diagnosis of atypia/follicular lesion of undetermined significance and follicular neoplasm/suspicious for a follicular neoplasm between January 2014 and January 2020. Fifty patients with surgically treated primary thyroid nodules, documented final histological diagnosis, and ultrasound examination records were included. Thyroid nodules were evaluated radiologically using Thyroid Imaging Reporting and Data System introduced by the American College of Radiology (2017). RESULTS: Forty-two (84.0%) female and 8 (16.0%) male patients were enrolled in the study. The malignancy risks were 44.8% for Bethesda III and 28.6% for Bethesda IV. The malignancy risks for the Thyroid Imaging Reporting and Data System categories were 33.3% (TR2), 39.1% (TR3), 35.3% (TR4), and 50% (TR5). No significant associations were observed between age, gender, Bethesda category, and Thyroid Imaging Reporting and Data System and the risk of malignancy. CONCLUSION: None of the clinical or radiological characteristics evaluated in this study contributed to the cancer risk stratification of thyroid nodules with indeterminate cytology. A prospective multicenter study is needed to better understand cytologically indeterminate thyroid nodules.

Development and Validation of an Arabic Version of the Drug Abuse Screening Test-10 (DAST-10) among Saudi Drug Abusers.

The Drug Abuse Screening Test-10 (DAST-10) is a valid and reliable screening tool for drug use-related problems, however there is no Arabic version. To our knowledge, this is the first study to develop and validate an Arabic DAST-10 version. Saudi young adults participated in the study as two groups; drug users (n=360) recruited from Alamal Complex for Mental Health, Jeddah, and drug non-users (n=100). Three measures were used: (1) Demographic and drug use description questionnaire, (2) Arabic DAST-10 version, and (3) Urine analysis for drug use. The developed Arabic DAST-10 version demonstrated adequate internal consistency. High correlations were shown between its scores and the two standard measures (urine analysis and self-reporting question) indicating good criterion validity. Sensitivity and specificity values were between 91.5 - 99.7% and 57 - 92.5% with different DAST-10 cutoff values. An optimal performance at a cutoff score of 3 or more was most likely to significantly identify drug users. Discriminant analysis showed that more than 90% of cases were correctly classified. Distribution of participants in categories of DAST-10 scores according to degree of problems was reasonable. It is concluded that the developed Arabic DAST-10 version is a reliable and valid screening tool for drug use-related problems in Arabic speakers.

Association of body dysmorphic disorder with anxiety, depression, and stress among university students.

OBJECTIVES: This study aims to estimate the prevalence of body dysmorphic disorder (BDD) and identify its association with depression, anxiety, and stress. METHOD: We conducted a cross-sectional study in Jeddah, KSA. In 2019, a validated questionnaire with items on sociodemographic characteristics and body dysmorphic disorder, as well as the Depression, Anxiety, and Stress Scale - 21 items (DASS 21) was distributed to 1,112 students of King Abdulaziz University. SPSS version 23 was used for data analysis, which included descriptive statistics, chi-square tests, and binary logistic regression models. The association was presented as an odds ratio (OR) along with its 95% confidence Interval (CI). RESULTS: The overall prevalence of BDD was 13.9% (95% CI of 11.8-16.2.) with the highest reported sites being the skin (81.6%) and waist (68.8%). BDD was found to be a significant predictor of depression with an OR of 4.2 (95% CI 2.9-6.1), anxiety OR of 2.2 (95%1.6-3.2), and stress OR of 3.2 (2.2-4.7). Females were significantly associated with anxiety, OR of 1.4 (95% CI 1.1-1.9) and stress, OR of 1.5 (1.1-2). Affiliation to the administration, arts, humanities, and social colleges was also a significant predictor of anxiety as reflected by an OR of 1.4 (95% CI 1.1-1.8). CONCLUSIONS: Our study shows that BDD is relatively common among university students in Jeddah and associated with depression, anxiety, and stress.

Acute Necrotizing Encephalopathy of Childhood: A Multicenter Experience in Saudi Arabia.

Background: Acute necrotizing encephalopathy of childhood (ANEC) is a rapidly progressing encephalopathy characterized by fever, depressed level of consciousness, and seizures. Diagnosis depends on clinical presentation and characteristic neuroimaging findings of abnormal signal intensity involving the thalami as well as the supra and infra-tentorial areas. Treatment modalities are not well-established; empirical treatment with antibiotics and antiviral agents is the initial step, followed by steroids and immunoglobulin, as well as supportive care. Patients with ANEC have a variable prognosis, but mortality is very high. Methods: A retrospective chart review of patients diagnosed with ANEC in five tertiary centers from January 2015 to October 2018 was performed. Clinical and radiological findings, as well as the therapeutic approach and outcomes, were described. Results: Twelve children were included ranging in age from 10 months to 6 years. All patients presented with preceding febrile illness, altered level of consciousness, and seizure. Radiological features showed abnormal signals in the thalami, and five patients (41.7%) had brainstem involvement. All patients received empirical treatment with antibiotics and antiviral agents. Ten patients (83.3%) received intravenous immunoglobulin (IVIG) and IV Methylprednisolone therapy. Outcomes were variable ranging from good outcomes with minimal neurological deficits to poor outcomes and death in 25% of cases. Conclusion: ANEC is a rare fulminant disease in children. The treatment is challenging. Early interventions with the use of IVIG and IV Methylprednisolone may change the outcome; however, further studies are needed to establish a consensus guideline for the management.

Clinical Presentation and outcome of acute disseminated encephalomyelitis in Saudi Arabia. Tertiary Center Experience.

OBJECTIVE: To evaluate the clinical presenation of acute disseminated Encephalomyelitis (ADEM) in pediatric age group, treatments, and to asses the outcome at King Abdulaziz Medical City, Riyadh, Kingdom of Saudia Arabia. METHODS: The medical records of all patients younger than 18 years of age with a diagnosis of ADEM and treated at King Abdulaziz Medical City from January 1996 to Decemeber 2016 were collected. A total of 20 patients were included. RESULTS: Of 20 patients enrolled in our study, 13 (65%) were female. Autumn and summer were the most common seasons in which ADEM presented (60%); 19 (95%) patients had a history of preceding viral illnesses. The most common neurological deficits on presentation were weakness (85%), ataxia (45%), and nystagmus (45%). Cortical and subcortical lesions (60%) were the most common finding on cranial magnetic resonance imaging. Seventeen patients (85%) received steroid only. Only 16 patients continued with follow-up, with a mean duration of 7 months. All 16 patients improved: 11 patients were recovered and 5 patients still had a neurological deficit at the clinic visits. No patient had relapsed. CONCLUSION: Most of the patients in this case series have an excellent outcome and attended follow-up visits and no disease relapses were identified. Further exploration of the disease is recommended.

Relationship of body mass index to sleep duration, and current smoking among medical students in Tabuk City, Saudi Arabia.

BACKGROUND: Being overweight is associated with cardiometabolic risk, and lifestyles including smoking and good sleep hygiene are also implicated. We aimed to assess the dietary habit, time spent on social media, and sleep duration relationship to body mass index (BMI) among medical students in Tabuk, Saudi Arabia. METHODS: A cross-sectional study was conducted among 147 clinical phase medical students in the Medical College, University of Tabuk (Saudi Arabia) from January 2018 to May 2018. A checklist questionnaire was used to measure variables such as age, sex, smoking, level of exercise, whether taking meals and snacks regularly, eating fast food, fruit and vegetable consumption, sleep duration, time spent on social media, and breakfast skipping. Data were analyzed by IBM-SPSS version 20, using one-way ANOVA and Pearson's production-moment correlation (r). A p-value of less than 0.05 was considered statistically significant. RESULTS: Participants consisted of 51% males, mean age (Mean ± SD) was 22.90±1.27 years, sleep duration was 7.50±2.17 hours, time spent on social media was 5.54±3.49 hours, body mass index was 24.8±5.19, and breakfast skipping, fast food consumption, smoking, and regular exercise were reported in 52.4%, 87.7%, 12.9%, and 36.1% respectively. A significant negative correlation was evident between BMI and sleep duration (r= -0.185, p=0.025), cigarette smokers were more likely to be obese compared to their counterparts (27.28±6.85 vs. 24.10±4.98, p=0.018). No significant statistical relationship was evident between BMI, breakfast skipping, fast food, fruit and vegetable intake, and time spent on social media. CONCLUSION: BMI was higher among smokers and those with shorter sleep duration, there was no association between BMI and other students' characteristics. Measures to smoking quitting and good sleep hygiene are recommended.

Impact of Cognitive Dysfunction in the Middle East Depressed Patients: The ICMED Study.

BACKGROUND: Major depressive disorder is a common condition with a high rate of recurrence, chronicity, and affecting economic burden, including disability in the workplace, which leads to negative consequences on both individuals and society. OBJECTIVES: This study aimed to estimate the impact of cognitive dysfunction, as declared by the patient, on performing daily tasks/activities among patients with major depression disorder (MDD). METHODS: This investigation is based on multinational cross-sectional survey of 499 workers recruited from the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). We assessed the severity of depression by Hamilton Depression Rating Scale (HDRS). Impact of Depression in the Workplace in Europe Audit (IDEA) survey and trial making test (TMT) parts A and B were used to assess the impact of cognitive dysfunction on performing daily tasks/activities in adult patients presented with MDD. RESULTS: A total of 499 persons were included in this study, aged 18-66 years, current workers and managers. Of them, 17.8% were normal (remitted), 22.4% were mildly depressed, 23.4% were moderately depressed, 8.6% were severely depressed, and 27.7% were very severely depressed at the time of the study according to HDRS. Common symptoms attributable to depression were low mode or sadness (89.8%), followed by insomnia (75.2%) and crying (70.9%). Of them, low mode or sadness was the most common factor affecting the work performance (90.2%). About 66.3% of participants diagnosed with depression by a doctor/medical professional. Awareness of the disease was recognizable by patients' managers in only 31.9% of the cases. Furthermore, 45.3% of cases had taken off work due to depression with mean duration of 38.7 (95% CI 37.7 to 39.7) days. The mean TMT parts A and B score were 69.2 (95% CI 66.3 to 72.2) and 126.6 (95% CI 121 to 132), respectively. Lastly, a significant positive correlation between the mean score for HDRS and TMT-A and B scores was observed. CONCLUSION: Depression affects work productivity and work environment with negative consequences to countries' economy. Awareness of depression in the workplace in KSA and UAE is still suboptimal. The personal and societal burden of this issue cannot be neglected when we become aware of the proportion of affected people.