Awareness of Side Effects of Corticosteroids among Users and Nonusers in Saudi Arabia.

Background: Corticosteroids are anti-inflammatory medications that are used to reduce inflammation and inhibit the immune system in a variety of disorders, including allergies, asthma, systemic lupus erythematous, eczema, inflammatory bowel disease, and swollen joints or muscles. The goal of this study was to assess the level of awareness and sources of information about the side effects of corticosteroids among the general population in Saudi Arabia. Methods: This observational cross-sectional study was conducted in Saudi Arabia using an electronic questionnaire. A non-probability convenience sampling technique was used. Statistical Package for the Social Sciences (SPSS) was used for data analysis. Results: The study included 755 participants from Saudi Arabia (67.3% females and 32.7% males). Around 26.8% reported using corticosteroids, and 73.9% were aware of the side effects of glucocorticoids. Among steroid users (202 participants), the most common conditions were allergies (36.1%), asthma or chronic obstructive pulmonary disease (COPD) (21.8%), and skin diseases (27.7%). The majority of respondents (57.9%) used steroids for less than 2 weeks, and topical application (52.5%) was the most common form. Only 30.7% received information about side effects at the time of prescription. The most reported side effects were truncal obesity, moon face, skin thinning, bruising, and slower wound healing. Conclusion: This study highlights the importance of promoting awareness and knowledge regarding the side effects of corticosteroids in Saudi Arabia. While overall awareness levels were relatively satisfactory, specific side effects require further attention in educational efforts.

Traumatic thoracic spine fracture: can we predict when MRI would modify the fracture classification or decision-making compared to CT alone?

PURPOSE: To determine the impact of magnetic resonance imaging (MRI) on fracture classification for thoracic spine fractures (TSFs) compared to computed tomography (CT) alone. METHODS: This study was a retrospective review of 63 consecutive patients with TSFs who underwent CT and MRI within ten days of injury. Three reviewers classified all fractures according to the AOSpine Classification and the Thoracolumbar AOSpine Injury severity score (TLAOSIS). Posterior ligamentous complex (PLC) injury on MRI was defined by "black stripe discontinuity" and on CT by the presence of vertebral body translation, facet joint malalignment, horizontal laminar or spinous process fracture, and interspinous widening. The proportion of patients with AO type A/B/C and with TLAOSIS ≤ 5 and ≥ 6 was compared between CT and MRI. Classification and regression trees were used to create a series of predictive models for the probability of PLC injury in AO type A fractures. RESULTS: AO classification using CT was as follows: type A in 35 patients (55%), type B in 18 patients (29%), and type C in 10 patients (16%). Thirty-three patients (52%) had a TLAOSIS ≤5, while the remaining 30 (48%) had TLAOSI ≥6. The addition of MRI after CT upgraded type A to type B fractures in 10 patients (16%) and changed TL AOSIS from ≤5 to ≥6 in 8 cases (12.8%). Type A fractures with load sharing score (LSC) ≥6 had a 60% chance of upgrading to type B, while LSC <6 had a 12.5% chance of upgrading to type B. CONCLUSIONS: CT yielded (89%) accuracy in diagnosing PLC injury in TSFs. The addition of MRI after CT substantially changed the AO classification or TLAOISS, compared to CT alone, thus suggesting an added value of MRI for PLC assessment for TSFs classification.

Desmoplastic Small Round Cell Tumor Presenting as an Intra/Extracranial Mass.

Desmoplastic small round cell tumors (DSRCTs) are highly malignant tumors, with distinct reciprocal chromosome translocation (11;22)(p13;q12). Intracranial metastasis is a very rare complication of this tumor, with only a few cases reported in the literature. To our knowledge, this is the only case presenting an extracranial extension of intracranial metastasis of DSRCT. A 33-year-old man was diagnosed with DSRCT in the pelvic cavity. He presented with a scalp lump and right-sided weakness. A biopsy showed metastasis from DSRCT. Metastatic DSRCT to the brain is extremely rare. Surgical resection followed by adjuvant treatment, including chemotherapy and radiation, is indicated as it has a poor prognosis. Moreover, aggressive treatment is warranted to prevent progression and relapse.

Time of onset and factors associated with delayed response post intradetrusor injection of onabotulinumtoxin a in patients with neurogenic and idiopathic overactive bladder syndrome.

Objective: The objective of this study was to determine risk factors for delayed response in patients with neurogenic and idiopathic overactive bladder (OAB) after intradetrusor onabotulinumtoxin A injection. Subjects and Methods: This is a retrospective study that included 87 patients who underwent onabotulinumtoxin A intradetrusor injection from October 2011 to November 2019. Patients were followed up at 2, 4, and 12 weeks post intervention in the outpatient clinic and over the phone. The data of patients with early response were compared with those with late response using univariate and multivariate analyses. Results: The study included 87 patients. The mean age was 41 ± 15.3 standard deviation, and 69% of the participants were female. Fifty-one percent were diagnosed with neurogenic OAB. A median response time to onabotulinumtoxin A injection of 7 days was demonstrated, and patients who responded during the first 7 days post procedure were considered early responders. Independent predictors for late response include diabetes (Relative risk: 3.89, P = 0.018, and 95% confidence interval [CI]: 1.26-11.98), >1 BTX-A session (Relative risk: 4, P = 0.011, and 95% CI: 1.38-11.6), and wet OAB (RR: 9.94, P = 0.002, and 95% CI: 2.31-42.17). Conclusions: The median time of onset post intradetrusor injection of onabotulinumtoxin A was found to be 7 days. Diabetes mellitus, wet OAB, and <1 Botox sessions were independent risk factors for late onset of response.

The Preferred Route for the Diagnosis and Management of Thyroid Carcinoma Among the General Population in Saudi Arabia.

BACKGROUND:  Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) is a specific subgroup of PTC. Given their small size, PTMCs are often asymptomatic and behave benignly. This puts physicians in a challenging situation about how to prevent overdiagnosis and overtreatment of PTMC. This study aimed to assess the preferences regarding the route of PTMC diagnosis and treatment among Saudi Arabia's general population. METHODS:  This is a cross-sectional questionnaire-based-study conducted among the general population in Saudi Arabia. The target subjects were the general population of Saudi Arabia both genders and different age groups from various regions of Saudi Arabia (Western, Central, Eastern, Southern, and North). Participants who did not complete the questionnaire or did not agree to participate were excluded. A self-administered questionnaire was distributed on different social media platforms to collect data from different regions. Data analysis was conducted by using Statistical Package for the Social Sciences (SPSS) 24.0 version (IBM Inc., Chicago, USA) statistical software. A Chi-square test was used to compare categorical variables. RESULTS:  A total of 1,428 participants were included. The majority of them were females (64.4%), and most of them were aged between 19 and 25 years. Moreover, we found that 4.8% of the study population had a medical history of thyroid cancer. Our results revealed that more than half of respondents (54.6%) would select surgical operation immediately if they have a thyroid nodule less than 1 cm in maximal diameter, which turns out to be a PTC. The vast majority of participants (90.1%) would prefer to do cytologic confirmation immediately if they have a thyroid nodule less than 1 cm in maximal diameter, which has suspicious characteristics of PTC in neck ultrasound examination. Regarding PTMC operation, 59.8% of responders were more concerned about complications than recurrences. We found that neither age nor gender significantly affects decision-making for management or operative extent for PTC. There was a significant difference between age and decision-making for the diagnosis of suspicious thyroid nodules (p value = 0.041). CONCLUSION:  Our results concluded that most of the participants preferred to select immediate surgery and cytologic confirmation regarding the management and diagnosis of PTC. More research is advised. The need to inform patients about their disease state and treatment options should be highlighted more.

Evaluate the effectiveness technology for the treatment of oily wastewater.

This work deals with the treatment of oily wastewater produced from the washing of oil-contaminated soil. Untreated oily wastewater contains toxic compounds that might be mutagenic or carcinogenic as total petroleum hydrocarbon (TPH) and heavy metals. Based on the water quality analysis, the tested samples contained a high concentration of TPH, chemical oxygen demand (COD) and turbidity with an average value of 67,500 mg/l, 48,240 mg/l and 176 (nephelometric turbidity unit, NTU), respectively. Several technologies were used, such as centrifuging, powdered activated carbon (PAC) and sawdust. The mean values of COD values for sawdust, centrifuging and PAC were 41,067, 25,600 and 13,133 mg/l, respectively. The present study indicated that the coagulation/flocculation processes were more efficient by using aluminium sulphate alum, while the preliminary conclusion derived was that the secondary treatment using an aeration system is capable of lowering the COD values as well as increasing the flocculent mass floc well equal to 4,784 mg/l and 0.69 g, respectively. The microbial seed was able to degrade the biosurfactant, which allows the stability of oil emulsion to be broken down and released easily.

Multicenter Study for the Effect of COVID-19 Lockdown on Patients With Sacral Neuromodulation Implants.

INTRODUCTION: The massive spread of COVID-19 affected many aspects of medical and surgical services. Many patients with sacral neuromodulation (SNM) devices needed integrated follow-up and close communication regarding the programming of the device. In this study, we aimed to explore the effect of COVID-19 lockdown on patients with SNM devices. MATERIALS AND METHODS: This was a multicenter study designed and conducted in four centers performing SNM (Toronto Western Hospital, Toronto, Canada; King Abdulaziz University Hospital, Jeddah, Saudi Arabia; Al-Amiri Hospital, Kuwait City, Kuwait; and Austin and Western Health, University of Melbourne, Australia). An online questionnaire was created through Google Forms and circulated among patients with SNM devices in all four mentioned centers. The questionnaire was sent to patients during the forced lockdown period in each country. RESULTS: A total of 162 responses were received by September 2020. Data showed that most patients had their device implanted before the lockdown period (92.5%, 150/162). Most patients did not experience any contact difficulties (91.9%, 149/162). When patients were requested for their preference of programming, 89.5% (145/162) preferred remote programming. Correlation analysis did not show any significant relation between patient diagnosis and COVID-19-related difficulties or preferences. CONCLUSION: The difficulties with access to care experienced during the pandemic and the patient's expressed willingness to participate in virtual care should provide impetus for manufacturers of SNM devices to move forward with developing remote programming capabilities.

Influence of Propolis, Ozone and Photodynamic therapy in root canal disinfection on resin bond strength to radicular dentin.

AIM: The aim of the present study was to assess post space disinfection using different irrigants and their effect on radicular dentin bond to SERC. MATERIALS AND METHODS: Forty single rooted mandibular 2nd premolars were collected and disinfected. All samples were decoronated maintaining root length of 12 mm and embedded vertically in acrylic resin. Shaping of the canal was performed using reciprocating system. Canals were dried using paper points and obturated with gutta percha via lateral condensation. Peso-reamers were used to create post space up to 10 mm. The post space was irrigated with 1% NaOCl before being randomly allocated into four groups (n = 10) according to different methods of canal disinfection. Samples in group 1 were subjected to photoactivated disinfection (PAD), group 2 irrigated with ethanol based propolis group 3 disinfected using ozone and group 4 irrigated with 2.25 % NaOCl with 17 % EDTA and ECL. GFP was fitted using SERC. Each sample was cut into 1 mm from coronal, middle and apical and subjected to pushout bond strength (PBS) via universal testing machine. Fracture analysis were confirmed by stereomicroscope at 40x magnification. For comparison of means, Analysis of variance (ANOVA) and Tukey multiple comparison test was used maintaining the level of significance at p <  0.05. RESULTS: The highest PBS at all three levels were found in group 4, canal disinfected with 2.5 % NaOCl with 17 % EDTA and ECYL. Whereas, the lowest PBS was observed in group 1. Inter group comparison, prosthetic space disinfected with propolis extract showed no significant difference to group 4 canal disinfected with 2.5 % NaOCl with 17 % EDTA and ECYL at all three levels (p > 0.05). Intra group comparison in all experimental groups showed no significant difference was noted in coronal and middle thirds of group 1, group 2 and group 3 respectively (p > 0.05). CONCLUSION: 2.5 % NaOCl with EDTA and ECL treatment (group 4) remains the gold standard when used as a final canal irrigant. Propolis can be used as potential irrigant for canal disinfectant provided if the composition becomes standardized.

Method development for evaluating the effectiveness of hydrocarbons on BOD, UBOD and COD removal in oily wastewater.

The effects of different operating parameters on the treatment efficiency of oily wastewater in terms of biological oxygen demand (BOD) and chemical oxygen demand (COD) were measured. The analyses of BOD using OxiTop biosensors are reviewed regarding performance characteristics like linearity, response time, precision, agreement between BOD28 values obtained from the biosensors and the ultimate BOD (UBOD), as well as toxic resistance and COD. The wastewater samples were seeded with the bacteria, which were isolated in the current study from Kuwaiti oil-contaminated sand, such as Bacillus mycoidesis and Bacillus subtilis. After 18 days, the margin for saponin solution and oily wastewater using either Rhododcoccus (R), a mixture of Bacillus mycoidesis and Bacillus subtilis (M) or a mixture of R&M exhibited the maximum rate of BOD. It was found that the corresponding COD of the saponin solution (SS) ranged from 1,525 mg/l to 3,890 mg/l by distilled water and the mixture (RM), respectively. The COD of oily wastewater (WW) ranged from 2,900 mg/l to 4,450 mg/l by distilled water and the mixture of (RM), respectively. Moreover, the higher values of BOD28 were recorded when mixtures of bacteria were added together with the saponin solution or oily wastewaters. Furthermore, the average values of UBOD for the oily wastewater with RM or with amendment substance were increased by about 33.5% and 49.5%, respectively. However, BOD 28 /COD ratios for all the selected have been found to be less than 0.4, indicating low aerobic degradability.

Validation of the Arabic linguistic version of the 8-item overactive bladder questionnaire (OAB-V8).

INTRODUCTION AND HYPOTHESIS: This study aimed to translate and validate the 8-item overactive bladder questionnaire (OAB-V8). METHODS: Utilizing a multistep process, the English version of the OAB-V8 was translated into Arabic by three urologists and one independent translator. It was validated by asking 46 patients with overactive bladder and 58 healthy individuals to complete the questionnaire. Healthy individuals were involved in establishing the discrimination validity. The scores of both groups were compared using the Mann-Whitney test. The reliability of the Arabic version was evaluated utilizing Cronbach's alpha test for internal consistency. Spearman's correlation coefficient (r) was utilized to evaluate the domain structures and the inter-domain associations. RESULTS: Internal consistency was high (Cronbach's alpha = 0.923). There were good correlations among frequency, urgency, sudden urge to urinate, waking up at night to urinate and uncontrollable urge to urinate. There were weak or no correlations among urge, incontinence and nocturia. For discrimination validity, there were significant changes in all domain scores when comparing patients with ureteric stents and healthy individuals (P < 0.001). CONCLUSIONS: The Arabic version of the OAB-V8 proved to be a reliable and valid tool, which can be easily utilized to evaluate symptoms in Arabic patients. It is feasible in evaluating quality of life in relation to this disorder, as patients are able to demonstrate their symptoms accurately with the comfort of their first language, Arabic.

Direct detection of saponins in crude extracts of soapnuts by FTIR.

Direct detection of saponins in soapnuts (Sapindus mukorossi) using Fourier transform infrared (FTIR) spectroscopy is investigated in this project. Potassium bromide powder was mixed with extracted powder of soapnuts and compressed to a thin pellet for examination process. The outcome of the FTIR spectra of saponin demonstrated characteristic triterpenoid saponin absorptions of OH, C = O, C-H, and C = C, while the glycoside linkages to the sapogenins were indicated by the absorptions of C-O. The significance of this study is that saponin absorption peaks are directly detectable in crude aqueous and 95% ethanol extracts of soapnuts powder using FTIR spectroscopy, thereby eliminating the need of further expensive and exhaustive purification steps. The extracts of soapnuts were screened for saponins along with controls by phytochemical tests, and advanced spectroscopic techniques such as ultra fast liquid chromatography and ultra performance liquid chromatography quadrupole-time of flight-mass spectrometry were also implemented to validate the saponins.