Epigenetics, Nutrition, and the Brain: Improving Mental Health through Diet.

The relationship between nutrition and brain health is intricate. Studies suggest that nutrients during early life impact not only human physiology but also mental health. Although the exact molecular mechanisms that depict this relationship remain unclear, there are indications that environmental factors such as eating, lifestyle habits, stress, and physical activity, influence our genes and modulate their function by epigenetic mechanisms to shape mental health outcomes. Epigenetic mechanisms act as crucial link between genes and environmental influences, proving that non-genetic factors could have enduring effects on the epigenome and influence health trajectories. We review studies that demonstrated an epigenetic mechanism of action of nutrition on mental health, focusing on the role of specific micronutrients during critical stages of brain development. The methyl-donor micronutrients of the one-carbon metabolism, such as choline, betaine, methionine, folic acid, VitB6 and VitB12 play critical roles in various physiological processes, including DNA and histone methylation. These micronutrients have been shown to alter gene function and susceptibility to diseases including mental health and metabolic disorders. Understanding how micronutrients influence metabolic genes in humans can lead to the implementation of early nutritional interventions to reduce the risk of developing metabolic and mental health disorders later in life.

The prevalence of sedentary behavior among university students in Saudi Arabia.

BACKGROUND: A considerable body of research has demonstrated that reducing sitting time benefits health. Therefore, the current study aimed to explore the prevalence of sedentary behavior (SB) and its patterns. METHODS: A total of 6975 university students (49.1% female) were chosen randomly to participate in a face-to-face interview. The original English version of the sedentary behavior questionnaire (SBQ) was previously translated into Arabic. Then, the validated Arabic version of the SBQ was used to assess SB. The Arabic SBQ included 9 types of SB (watching television, playing computer/video games, sitting while listening to music, sitting and talking on the phone, doing paperwork or office work, sitting and reading, playing a musical instrument, doing arts and crafts, and sitting and driving/riding in a car, bus or train) on weekdays and weekends. RESULTS: SBQ indicated that the total time of SB was considerably high (478.75 ± 256.60 and 535.86 ± 316.53 (min/day) during weekdays and weekends, respectively). On average, participants spent the most time during the day doing office/paperwork (item number 4) during weekdays (112.47 ± 111.11 min/day) and weekends (122.05 ± 113.49 min/day), followed by sitting time in transportation (item number 9) during weekdays (78.95 ± 83.25 min/day) and weekends (92.84 ± 100.19 min/day). The average total sitting time of the SBQ was 495.09 ± 247.38 (min/day) and 58.4% of the participants reported a high amount of sitting time (≥ 7 hours/day). Independent t-test showed significant differences (P ≤ 0.05) between males and females in all types of SB except with doing office/paperwork (item number 4). The results also showed that male students have a longer daily sitting time (521.73 ± 236.53 min/day) than females (467.38 ± 255.28 min/day). Finally, 64.1% of the males reported a high amount of sitting time (≥ 7 hours/day) compared to females (52.3%). CONCLUSION: In conclusion, the total mean length of SB in minutes per day for male and female university students was considerably high. About 58% of the population appeared to spend ≥7 h/day sedentary. Male university students are likelier to sit longer than female students. Our findings also indicated that SB and physical activity interventions are needed to raise awareness of the importance of adopting an active lifestyle and reducing sitting time.

Prevalence of Dyslipidemia and Its Determinants Among the Adult Population of the Jazan Region.

Purpose: To assess the prevalence of dyslipidemia and its determinants among adults in the Jazan region of Saudi Arabia. Methods: This data was collected during interviews utilizing a structured questionnaire. The questionnaire measured the demographics, diagnosis with dyslipidemia, and distribution of dyslipidemia determinants among the sample, including dietary habits and lifestyle practices. A chi-square test was used to examine the statistical difference between the characteristics of individuals who had reported checking their lipid profile to those who reported never performing a lipid profile check-up among participants not diagnosed with dyslipidemia. Results: The current study included a total of 244 participants. The median age of the participants was 27 years, most participants were female (66.8%), and about 59% had a university education or above. Approximately 40% of the participants had ever had their lipid profile checked, 20.1% of the participants had been diagnosed with dyslipidemia, and 20.9% had family history of dyslipidemia. Most of the undiagnosed participants (79.9%) had more than one risk factor for developing dyslipidemia. All the participants without a dyslipidemia diagnosis had not been meeting the recommended levels of physical activity, and more than half consumed a high-fat diet. The results of the inferential analysis indicate that among those who had not been diagnosed with dyslipidemia, participants who were older than 27 years, male, unemployed, married, had a university education or above, and a minimum monthly income of 5000 Saudi Arabia Riyals were more likely to check their lipid profile compared to other groups (p-values <0.05). Conclusion: The findings suggest that most of the participants who had not been diagnosed with dyslipidemia are at high risk of developing dyslipidemia. About 60% of the participants had never checked their lipid profile, suggesting a need to promote routine lipid profile check-ups among individuals at high-risk for dyslipidemia.

Assessment of the Association Between Use of WhatsApp for Work-Related Purposes and Levels of Depression, Anxiety, and Stress Among Healthcare Workers from Jazan, Saudi Arabia.

Purpose: This study aims to investigate the potential association between use of WhatsApp in healthcare settings for work-related purposes and depression, stress, and anxiety levels among a sample of healthcare workers in Saudi Arabia. Methods: This was a cross-sectional study of healthcare employees working in different hospitals in Jazan. The data was collected via a semi-structured, self-administered questionnaire with three components that measured the demographics of the sample; the presence of depression, anxiety, and stress; and their use of WhatsApp in the work environment. A multivariate regression analysis was carried out to estimate the statistical likelihood of depression, anxiety, and stress as a result of using WhatsApp and how these factors affected occupational and social relationships. Results: A total of 294 healthcare workers participated in the current study. The median age of the participants was 32 years, and the gender distribution was almost even. Over 90% of the participants stated that they were members of work-related WhatsApp groups, and nearly 70% agreed that use of WhatsApp in work-related settings could be stressful. Among the recruited sample, 48.6% exhibited abnormal levels of depression, 55.8% had abnormal levels of anxiety, and 63% showed abnormal levels of stress. The findings of the regression analysis (P values <0.05) indicated that the likelihood of these participants suffering with depression, anxiety, and stress was high, with the participants themselves agreeing that using WhatsApp in work settings could be stressful and affect their relationships with colleagues, friends, and family members. Conclusion: The findings suggests the presence of a potential association between use of WhatsApp for work-related purposes and levels of depression, anxiety, and stress, especially among those who perceive its use as a stressor and influencer on occupational and social relationships.

Methyl Donors, Epigenetic Alterations, and Brain Health: Understanding the Connection.

Methyl donors such as choline, betaine, folic acid, methionine, and vitamins B6 and B12 are critical players in the one-carbon metabolism and have neuroprotective functions. The one-carbon metabolism comprises a series of interconnected chemical pathways that are important for normal cellular functions. Among these pathways are those of the methionine and folate cycles, which contribute to the formation of S-adenosylmethionine (SAM). SAM is the universal methyl donor of methylation reactions such as histone and DNA methylation, two epigenetic mechanisms that regulate gene expression and play roles in human health and disease. Epigenetic mechanisms have been considered a bridge between the effects of environmental factors, such as nutrition, and phenotype. Studies in human and animal models have indicated the importance of the optimal levels of methyl donors on brain health and behavior across the lifespan. Imbalances in the levels of these micronutrients during critical periods of brain development have been linked to epigenetic alterations in the expression of genes that regulate normal brain function. We present studies that support the link between imbalances in the levels of methyl donors, epigenetic alterations, and stress-related disorders. Appropriate levels of these micronutrients should then be monitored at all stages of development for a healthier brain.

Validity and reliability of the Arabic sedentary behavior questionnaire among university students aged between 18-30 years old.

PURPOSE: The study aimed to test the validity and reliability of the Arabic version of the sedentary behavior questionnaire (SBQ). METHODS: A total of 624 university students (273 males; 351 females, mean age = 20.8 years) were recruited from Taibah University, Madinah, Saudi Arabia. For criterion and constructive validity (n = 352), the Arabic SBQ was compared with total sitting time from the International Physical Activity Questionnaire-short form (IPAQ-SF) and the International Physical Activity Questionnaire-long form (IPAQ-LF). For concurrent validity, the English and Arabic SBQ versions were given concurrently to bilingual university students (n = 122) once. For test-retest reliability, the Arabic SBQ was given twice to participants (n = 150) at a one-week interval. RESULTS: Sitting time of IPAQ-SF (7th question: sitting time on weekdays) and IPAQ-LF (21st question: sitting time on weekdays and 22nd question: sitting time on weekends) correlated significantly with total sitting time/week of the Arabic SBQ (r = 0.29, p = 0.003; r = 0.14, p = 0.02, respectively). Motorized transportation measured with the IPAQ-LF correlated significantly with time spent driving in a car, bus, or train from the Arabic SBQ on weekdays and weekends (r = 0.53, p < 0.001; r = 0.44 p < 0.001, respectively). The total sitting time of the Arabic SBQ was inversely correlated with BMI (r = -0.18, p = 0.001). The correlations between the Arabic and the English SBQ versions ranged from 0.25-0.96; p < 0.001 on weekdays and 0.50-0.90; p < 0.001 on weekends. Moderate to good reliability was also found between test and retest for all SBQ items and total score during weekdays (0.72 to 0.8), and weekends (0.64 to 0.87), with exception of the 7th item "play musical instrument", ICC = 0.46). Mean difference of test-retest of the Arabic SBQ was not significantly different from zero for the total sitting time of the Arabic SBQ (t = -0.715, P = 0.476). CONCLUSION: The Arabic SBQ had satisfactory levels of reliability, with total sitting time of the Arabic SBQ correlating significantly with sitting times derived from IPAQ-SF, IPAQ-LF, and the English SBQ versions. Hence, the Arabic SBQ can be used as a tool to measure sedentary behavior among adult Arabs aged between 18 to 30 years old in future epidemiologic and clinical practice.

Gene amplification mutations originate prior to selective stress in Acinetobacter baylyi.

The controversial theory of adaptive amplification states gene amplification mutations are induced by selective environments where they are enriched due to the stress caused by growth restriction on unadapted cells. We tested this theory with three independent assays using an Acinetobacter baylyi model system that exclusively selects for cat gene amplification mutants. Our results demonstrate all cat gene amplification mutant colonies arise through a multistep process. While the late steps occur during selection exposure, these mutants derive from low-level amplification mutant cells that form before growth-inhibiting selection is imposed. During selection, these partial mutants undergo multiple secondary steps generating higher amplification over several days to multiple weeks to eventually form visible high-copy amplification colonies. Based on these findings, amplification in this Acinetobacter system can be explained by a natural selection process that does not require a stress response. These findings have fundamental implications to understanding the role of growth-limiting selective environments on cancer development. We suggest duplication mutations encompassing growth factor genes may serve as new genomic biomarkers to facilitate early cancer detection and treatment, before high-copy amplification is attained.

Body Mass Index Profile and Its Association with Social Determinants Among Adolescents from Jazan, Saudi Arabia.

Purpose: Assess adolescents' body mass index (BMI) profile and the association between BMI category and social determinants. Methods: This cross-sectional study targeted adolescents aged between 12 and 19 from Jazan, Saudi Arabia. Data was collected via an online self-administered questionnaire during 2023. The tailored questionnaire measured items related to student demographics, their history of diagnosed chronic conditions, their familial history of chronic diseases, and their eating behavior. A standard chi-square test investigated the relationship between BMI category and social determinants. Results: Five hundred and seventy students completed the study's questionnaire. The mean age of the sample was 16 (SD: 1.9), and most of the respondents were female (60%). Among the recruited sample, 107 students (20%) are categorized as underweight, while 121 students (22%) are classified as either overweight or obese according to their age. The respondents' eating behavior indicated that the most frequently consumed meal was dinner, and the majority skipped breakfast some days of the week. Nearly one-third of the sample exhibited emotional eating. Low consumption of healthier food options, such as fruits, vegetables, low-fat products, and whole grain products among the adolescents was noted. An assessment of BMI level distribution among the respondents according to their demographic characteristics indicated a higher frequency of overweight and obesity among male adolescents, students in the secondary level, students living with a lower number of siblings, and students with a parental history of diabetes, obesity, and dyslipidemia (p values < 0.05). Conclusion: A high frequency of BMI abnormality among adolescents was detected. Dietary behavior among the respondents suggests the presence of several unhealthy behaviors. The results of the current study detected an important influence of the family on weight status among these adolescents.

The Experience and Satisfaction of Physicians with Electronic Health Systems in Healthcare Establishments in Jazan, Saudi Arabia.

Purpose: The Saudi Ministry of Health's electronic health (e-health) initiative aims to promote the higher use of electronic medical records and has established multiple health applications to facilitate access to healthcare. The current investigation measured the satisfaction and experience of physicians concerning e-health systems and identified the factors associated with their satisfaction level. Methods: This study was a cross-sectional investigation targeting physicians working in primary healthcare centers and hospitals in the Jazan region of Saudi Arabia. Data were collected via a self-administered questionnaire between July and September 2022, which was distributed via online platforms. The questionnaire included sections measuring the physicians' demographic data and their experiences with e-health systems, including information technology (IT) support, training, software design, workload, physician and patient support, and data quality. Chi-square or Fisher's exact tests were used to assess associations between physicians' satisfaction levels and the measured demographics. Results: A total of 445 physicians participated in the current investigation. The median age of the participants was 27, and more than half (58.4%) were male. The median level of the satisfaction score was 4 and varied between -30 (indicating the lowest satisfaction level) and 23 (indicating the highest satisfaction level). Employment rank and work settings were statistically associated with the level of satisfaction (P values < 0.05). The participating physicians were overall satisfied with the e-health systems' impact on their clinical workflow and ability to reduce their work hours but were less satisfied with the training required to use these systems. Conclusion: A good overall satisfaction level with the established e-health systems in the Jazan region was detected. Senior physicians and physicians working in primary healthcare settings exhibited lower satisfaction levels, indicating a need for further investigations to identify the challenges of using e-health systems in these settings, especially among senior physicians.

The Importance of the Thyroid Nodule Location in Determining the Risk of Malignancy: A Retrospective Study.

Introduction Thyroid nodules are very common. However, the majority of thyroid nodules are benign. Ultrasound is the first-line imaging investigation of choice for thyroid nodules. Certain sonographic features are associated with an increased risk of malignancy. Recent studies suggested that the location of the nodule may be associated with the malignancy risk. Hence, this study aims to investigate this association. Methods After obtaining approval from the ethics committee, we conducted a retrospective study that involved all patients who attended our hospital, and who underwent fine-needle aspiration cytology for the evaluation of suspicious thyroid nodules (TR3-5). Electronic medical records were used to obtain data about the ultrasound and cytology reports. A multivariable binary logistic regression analysis model was conducted to identify the independent factors significantly associated with malignant thyroid nodules. Results The study included 366 patients who underwent fine-needle aspiration cytology for suspicious nodules on thyroid ultrasound. In total, 52 (14.2%) nodules were found to be malignant on cytology. By far, the most common thyroid malignancy was papillary carcinoma. The multivariable analysis model revealed that women were 24% less likely to have malignant thyroid nodules compared with men. After adjusting for the age, gender, and Thyroid Imaging Reporting and Data System (TI-RADS) group, the nodules located within the isthmus were four times more likely to be malignant compared to those located in the right or left lobes. Conclusions The study demonstrates that the isthmus location of thyroid nodules is associated with a higher risk of malignancy. Physicians should have a lower threshold to biopsy such nodules. Further studies are needed to confirm this interesting finding.

Novel homozygous pathogenic mitochondrial DNAJC19 variant in a patient with dilated cardiomyopathy and global developmental delay.

BACKGROUND: Dilated cardiomyopathy with ataxia syndrome (DCMA) or 3-methylglutaconic aciduria type V is a rare global autosomal recessive mitochondrial syndrome that is clinically and genetically heterogeneous. It is characterized by early-onset dilated cardiomyopathy and increased urinary excretion of 3-methylglutaconic acid. As a result, some patients die due to cardiac failure, while others manifest with growth retardation, microcytic anemia, mild ataxia, and mild muscle weakness. DCMA is caused by variants in the DnaJ heat shock protein family (Hsp40) member C19 gene (DNAJC19), which plays an important role in mitochondrial protein import machinery in the inner mitochondrial membrane. METHODS: We describe a single affected family member who presented with cardiomyopathy, global developmental delay, chest infection, seizures, elevated excretion of 3-methylglutaconic acid, and 3-methylglutaric acid in the urine. RESULTS: Whole-exome sequencing followed by Sanger sequencing revealed a homozygous frameshift variant in the reading frame starting at codon 54 in exon 4 in the DNAJC19 gene (c.159del [Phe54Leufs*5]), which results in a stop codon four positions downstream. Quantitative gene expression analysis revealed that DNAJC19 mRNA expression in this patient was substantially reduced compared to the control. CONCLUSIONS: We present a novel variant in the DNAJC19 gene that causes rare autosomal recessive mitochondrial 3-methylglutaconic aciduria type V. By comparing the current case with previously reported ones, we conclude that the disease is extremely heterogeneous for reasons that are still unknown.

Susac syndrome with a unique involvement of the thoracic spinal cord.

A woman in her late 20s presented with headaches and subacute encephalopathy. MRIs showed multiple punctate subcortical and periventricular white matter hyperintensities with diffusion restriction, infratentorial lesions, leptomeningeal enhancement of the cervical spinal cord, brainstem and cerebellum and two areas of high-signal abnormality at T4 and T6 raising suspicion for multiple sclerosis or acute disseminated encephalomyelitis.Further studies and evolution of her symptoms during her hospital stay confirmed the clinical triad of encephalopathy, branch retinal artery occlusions and hearing loss pathognomonic for Susac's syndrome.While cervical spinal cord and cauda equina involvement have been reported in Susac's syndrome previously, no thoracic spinal cord involvement has been reported.We report the novel MRI finding of thoracic spinal cord involvement in Susac's syndrome. In order to avoid misdiagnosis, neurologists and neuroradiologists should be aware that any part of the spinal cord can be involved in Susac's syndrome.

Assessment of Multiple Sclerosis Awareness and Knowledge among the Community of Jeddah, Saudi Arabia.

Objective Multiple sclerosis (MS) is a degenerative disease of the central nervous system that can lead to lifelong disabilities. There is a significant increase in the global incidence of the disease. In Saudi Arabia (SA), the western region has the greatest number of MS cases. However, there is a lack of studies and research to assess public knowledge in the region. Thus, we aim to assess the public's knowledge of MS in Jeddah, SA. Methodology We conducted a cross-sectional study surveying 468 participants from the general population of Jeddah. A validated MS knowledge questionnaire (MSKQ-25) was used. Results Most participants were female 347 (74.1%) with a mean age of 35.73 ± 14.71 standard deviation (SD). MS was found in 14 (3%) of the participants. The average score of the (MSKQ) was 7.42 SD ± 4.568 versus the average score of people with MS with a mean of 13.92 SD ± 3.33 and a p value > 0.001. No significant variation was found in knowledge between gender and age groups, but there was a significant correlation between the educational level and the knowledge level. Conclusion The mean knowledge score was below average, which indicates poor knowledge of MS. Since the western region has the highest number of MS cases in SA, the level of understanding needs to increase. This can be improved by conducting educational programs using various types of media.

Early Life Nutrition and Mental Health: The Role of DNA Methylation.

Does the quality of our diet during early life impact our long-term mental health? Accumulating evidence suggests that nutrition interacts with our genes and that there is a strong association between the quality of diet and mental health throughout life. Environmental influences such as maternal diet during pregnancy or offspring diet have been shown to cause epigenetic changes during critical periods of development, such as chemical modifications of DNA or histones by methylation for the regulation of gene expression. One-carbon metabolism, which consists of the folate and methionine cycles, is influenced by the diet and generates S-Adenosylmethinoine (SAM), the main methyl donor for methylation reactions such as DNA and histone methylation. This review provides current knowledge on how the levels of one-carbon metabolism associated micronutrients such as choline, betaine, folate, methionine and B vitamins that play a role in brain function can impact our well-being and mental health across the lifespan. Micronutrients that act as methyl donors for SAM formation could affect global or gene methylation, altering gene expression and phenotype. Strategies should then be adopted to better understand how these nutrients work and their impact at different stages of development to provide individualized dietary recommendations for better mental health outcomes.

The Cholinergic System, the Adrenergic System and the Neuropathology of Alzheimer's Disease.

Neurodegenerative diseases are a major public health problem worldwide with a wide spectrum of symptoms and physiological effects. It has been long reported that the dysregulation of the cholinergic system and the adrenergic system are linked to the etiology of Alzheimer's disease. Cholinergic neurons are widely distributed in brain regions that play a role in cognitive functions and normal cholinergic signaling related to learning and memory is dependent on acetylcholine. The Locus Coeruleus norepinephrine (LC-NE) is the main noradrenergic nucleus that projects and supplies norepinephrine to different brain regions. Norepinephrine has been shown to be neuroprotective against neurodegeneration and plays a role in behavior and cognition. Cholinergic and adrenergic signaling are dysregulated in Alzheimer's disease. The degeneration of cholinergic neurons in nucleus basalis of Meynert in the basal forebrain and the degeneration of LC-NE neurons were reported in Alzheimer's disease. The aim of this review is to describe current literature on the role of the cholinergic system and the adrenergic system (LC-NE) in the pathology of Alzheimer's disease and potential therapeutic implications.

Clinical characteristics and outcomes of bone marrow transplantation patients presenting to the ED of a tertiary care center.

BACKGROUND: Bone marrow transplantation is a breakthrough in the world of hematology and oncology. In our region, there is scarce literature studying emergency department visits among BMT patients, as well as their predictors of mortality. OBJECTIVES: This study aimed to assess the frequency, reasons, clinical characteristics and outcomes of patients presenting to the ED after a BMT, and to study the predictors of mortality in those patients. This study also compares those variables among the different types of BMT. METHODS: This was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and visited the ED. RESULTS: Our study included 115 BMT patients, of whom 17.4% died. Those who died had a higher median number of ED visits than those who did not die. Around 36.5% presented with fever/chills with 29.6% diagnosed with pneumonia on discharge. We found that the odds of mortality were significantly higher among those who presented with dyspnea (p < .0005) and AMS (p = .023), among septic patients (p = .001), those who have undergone allogeneic BMT (p = .037), and those who were admitted to the ICU (p = .002). Moreover, the odds of mortality were significantly higher among hypotensive (p ≤0005) and tachycardic patients (p = .015). CONCLUSION: In our study, we have shown that BMT patients visit the ED very frequently and have high risk of in-hospital mortality. Moreover, our study showed a significant association between mortality and patients with dyspnea, AMS, sepsis, allogeneic BMT type, ICU admission, hypotension and tachycardia.

Comparison of diet quality among female students in different majors at Taibah University.

BACKGROUND: Diet quality is a term used to assess both the quality and variety of food intake by comparing dietary guidelines. The quality of dietary intake can be used to determine the association between food intake and health status. Studies comparing diet quality among students from different departments are limited. AIM: The aim of this study was to determine the dietary quality of female college students with majors in different departments at Taibah University, Madinah, Kingdom of Saudi Arabia. METHODS: This study was a cross-sectional study conducted with 658 female participants. The Diet Quality Index-International (DQI-I) was used to describe dietary quality. RESULTS: The total DQI-I score of the College of Applied Medical Sciences (CAMS) students (55.5%) was higher than those of the College of Sciences (CS) (52.3%) and College of Arts and Humanities (CAH) (50.4%) students. The risk of having a poor diet was higher among the CS (odds ratio (OR) = 1.154, 95% confidence interval (CI) (95% CI) = 1.007-1.879) and CAH students (OR = 1.624, CI = 1.012-2.604) than among the CAMS students. Having a low DQI-I score was associated with a high risk of obesity (OR= 2.478, 95% CI = 1.007-3.879) and a high body fat % (OR = 3.920, 95% CI = 1.757-8.749). CONCLUSION: This study showed the need to raise awareness among the younger population about the importance of healthy eating, which involves implementing healthy habits to improve one's quality of life.

The Use of Evaluation Tool for Ultrasound Skills Development and Education to Assess the Extent of Point-of-Care Ultrasound Adoption in Lebanese Emergency Departments.

BACKGROUND: Previously acknowledged as "bedside ultrasound", point-of-care ultrasound (PoCUS) is gaining great recognition nowadays and more physicians are using it to effectively diagnose and adequately manage patients. To measure previous, present and potential adoption of PoCUS and barriers to its use in Canada, Woo et al established the questionnaire "Evaluation Tool for Ultrasound skills Development and Education" (ETUDE) in 2007. This questionnaire sorted respondents into innovators, early adopters, majority, and nonadopters. OBJECTIVES: In this article, we attempt to evaluate the prevalence of PoCUS and the barriers to its adoption in Lebanese EDs, using the ETUDE. MATERIALS AND METHODS: The same questionnaire was again utilized in Lebanon to assess the extent of PoCUS adoption. Our target population is emergency physicians (EPs). To achieve a high response rate, hospitals all over Lebanon were contacted to obtain contact details of their EPs. Questionnaires with daily reminders were sent on daily basis. RESULTS: The response rate was higher in our population (78.8%) compared to Woo et al's (36.4%), as the questionnaire was sent by email to each physician with subsequent daily reminders to fill it. In fact, out of the total number of the surveyed (85 physicians), respondents were 67, of which 76.1% were males and of a median age of 43. Using ETUDE, results came as nonadopters (47.8%), majority (28.3%), early adopters (16.4%), and innovators (7.5%). Respondents advocated using PoCUS currently and in the future in five main circumstances: focused assessment with sonography in trauma (FAST) (current 22.9%/future 62.9%), first-trimester pregnancy (current 17.1%/future 68.6%), suspected abdominal aortic aneurysm (current 5.7%/future 51.4%), basic cardiac indications (current 8.6%/future 57.1%), and central venous catheterization (current 22.9%/future 85.7%). CONCLUSION: This study is the first to tackle the extent of use and the hurdles to PoCUS adoption in Lebanese emergency medicine practice, using ETUDE. The findings from this study can be used in Lebanon to strengthen PoCUS use in the future.

Meningitis due to Weissella Confusa.

Bacterial meningitis is a life-threatening condition that should be addressed as an emergency. The typical culprit microorganisms are targeted empirically with ceftriaxone and vancomycin, in the absence of an immunocompromised state. In this case report, however, we are describing a case of meningitis secondary to Weissella confusa, bacteria inherently resistant to the two drugs commonly used to empirically treat meningitis. Weissella spp. are Gram-positive, catalase-negative coccobacilli and an infrequent cause of infection in humans. Bacteremia followed by endocarditis are the typical clinical manifestations of W. confusa in humans. Other reported manifestations include post-operative osteomyelitis, thumb abscess, infected prosthetic joint, infected peritoneal fluid and peritonitis. To our knowledge, this is the first case of meningitis due to Weissella confusa in the literature. Therefore, we conclude that the isolation of Gram-positive coccobacilli resistant to vancomycin, especially in an immunocompromised host, should raise the suspicion of W. confusa.