Synthesis of a New Schiff Base: Nonlinear Optical Properties Investigations.

A Schiff base is prepared by the reaction of 7-hydroxy-1-naphthaldehyde with 4-aminoben-zenesulfonamide. The prepared Schiff base L4 compound was characterized by 1H NMR, Mass and FTIR spectroscopies. The optimization of the prepared L4 compound is carried out via DFT-B3LYP and 6-311G (d,p). The nonlinear optical (NLO) properties of the prepared L4 compound are investigated theoretically by the calculation of some quantum chemical descriptors (QCDs). TD-DFT via B3LYP and 6-311G calculations are used to study L4 compound UV-vis. spectrum at the same theoretical method and level. The L4 compound NLO properties are examined via irradiation with a CW laser beam, where the nonlinear index of refraction (NLIR) is calculated via diffraction patterns (DPs) and the Z-scan and as high as 4.579 × 10-11 m2/W of NLRI is obtained. Static (S) and dynamic (D) all optical switching (AOS) are examined using two CW and pulsed laser beams of wavelengths (473 and 532) nm.

Exploring the correlates of frailty among hospitalized older adults: A cross-sectional study in a Saudi teaching hospital.

Frailty is an important public health concern associated with aging. It increases the risk of adverse clinical outcomes, such as falls, late-life dependency, hospitalization, disability, and mortality. The objectives of this study were to estimate the prevalence of frailty and to identify factors associated with frailty among older adults (≥65 years) admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This cross-sectional study was conducted at King Abdulaziz University Hospital. The data were collected during the months of January and February 2022 and included demographic characteristics, comorbidities, length of stay, and hospital mortality. Frailty status of participants was assessed using the Clinical Frailty Scale. A total of 147 patients (aged ≥ 65 years) were included in our study. The prevalence rates of frailty and non-frailty were 71.4% and 28.6%, respectively. Frail patients had higher comorbidity index (P = .003), polypharmacy (P = .003), heart failure (P = .001), and prolonged hospital stays (P = .007). The results of the multiple logistic regression revealed that the tall patients had a lower risk of frailty (odds ratio = 0.0089, 95% confidence interval: 0.0001-0.7588, P = .042) and patients with higher comorbidity indexes had higher risk of frailty (odds ratio = 1.4907, 95% confidence interval: 1.1449-1.9927, P = .004). In this study, more than two-thirds of the hospitalized older patients were classified as frail. High comorbidity index, heart failure, and polypharmacy were strong predictors of frailty. Patients with frailty were more likely to have a prolonged hospital stay than those without frailty. Therefore, early detection of frailty and proper intervention are essential for improving health outcomes in this vulnerable population.

Deepfake forensics: a survey of digital forensic methods for multimodal deepfake identification on social media.

The rapid advancement of deepfake technology poses an escalating threat of misinformation and fraud enabled by manipulated media. Despite the risks, a comprehensive understanding of deepfake detection techniques has not materialized. This research tackles this knowledge gap by providing an up-to-date systematic survey of the digital forensic methods used to detect deepfakes. A rigorous methodology is followed, consolidating findings from recent publications on deepfake detection innovation. Prevalent datasets that underpin new techniques are analyzed. The effectiveness and limitations of established and emerging detection approaches across modalities including image, video, text and audio are evaluated. Insights into real-world performance are shared through case studies of high-profile deepfake incidents. Current research limitations around aspects like cross-modality detection are highlighted to inform future work. This timely survey furnishes researchers, practitioners and policymakers with a holistic overview of the state-of-the-art in deepfake detection. It concludes that continuous innovation is imperative to counter the rapidly evolving technological landscape enabling deepfakes.

Effect of mitomycin C on the corneal endothelial cells of Saudi patients with myopia after transepithelial photorefractive keratectomy: a two-armed cohort study.

AIM: To study the effect of mitomycin C (MMC) applied during transepithelial photorefractive keratectomy (TPRK) on the corneal endothelium one week (W1) and three months (M3) after surgery and its determinants. METHODS: In this two-armed cohort study conducted in 2022, eyes treated with MMC during TPRK (group 1) were compared with eyes not treated with MMC (group 2). The corneal endothelial cell (EC) count, EC density (ECD; cells/mm2), average (µm2), standard deviation (µm2), coefficient of variation (CV%), ECmax, ECmin, and EC percentage of hexagonality were estimated at W1 and M3. The postoperative changes in the EC count in the two groups were compared and correlated with the other independent variables. RESULTS: Group 1 had 26 eyes, and group 2 had 78 eyes. All TPRK indices were significantly higher for the eyes in group 1 than for those in group 2. The MMC usage was not a significant predictor of the change in ECD (P=0.644), change in CV (P=0.374), and change in the percentage of hexagonality of EC (P=0.164) at W1. However, the use of MMC was a significant predictor of changes in CV (P=0.014) and the change in the percentage of hexagonality of EC (P=0.039) at M3. The duration of laser exposure and the size of the optical zone influenced the correlation of MMC use with the changes in EC indices, postoperatively. CONCLUSION: The use of MMC doesn't affect ECD, CV, and percentage of hexagonality at W1 if other surgical indices are considered. At M3 after operating myopic eyes by TPRK, MMC significantly influence the CV and percentage of hexagonality. The duration of the laser application and the size of the optical zone should be considered when determining the effect of MMC on the EC indices.

Young-onset dementia following chronic abuse of amphetamine-type stimulants.

Young-onset dementia (YOD) is influenced by various risk factors, including substance abuse. In this report, we present the case of a 54-year-old man who developed YOD following prolonged abuse of amphetamine-type stimulants. The patient exhibited insidious cognitive decline over a three-year period before seeking medical attention. Neuroimaging revealed atrophy of the temporal lobe, suggesting a connection between amphetamine-induced neurotoxicity and the cognitive abnormalities observed in the patient condition. Our case highlights the importance of considering amphetamine-type stimulants as potential risk factors for YOD and emphasizes the need to recognize cognitive impairment resulting from substance abuse. Additionally, we look into relevant literature to provide further context and insights.

Cavernous Hemangioma in the Parotid Gland of an Adult: A Case Report and Review of Literature.

Hemangiomas are benign vascular tumors and are classified into cavernous, capillary, and mixed, with the head and neck area as the most common site. Hemangiomas are common in pediatrics and rare in adults. Diagnosing cavernous hemangioma is challenging and requires a complete history, proper physical examination, and several radiological modalities to improve diagnostic accuracy because it is uncommon in adults. Herein, we present a case of a 66-year-old female Saudi patient with cavernous hemangioma from the diagnosis until the surgical treatment. No previous studies are reported in Saudi Arabia and this is a rare presentation of cavernous hemangioma at this age. Cavernous hemangioma in the parotid gland in adults is uncommon and is difficult to diagnose. Therefore, a thorough physical examination and several radiological modalities are required to improve diagnostic accuracy. The most effective treatment of cavernous hemangioma in adults is surgical resection.

Thermal and Nonlinear Optical Properties of Sudan III.

We report the experimental and theoretical study of the diffraction patterns (DPs) and thermal properties of Sudan III. DPs are used in the calculation of the Sudan III nonlinear refractive index (NLRI), n 2 . As high as n 2 = 7.69 ×10-6 cm2/W is obtained. The study of the Sudan III thermal conductivity, TC, shows the reduction of the TC against the increase of the Sudan III temperature. The property, all-optical switching (AOS), is studied in details, both static and dynamic ones, using two, cw, visible, single mode laser beams of wavelengths 473 and 635 nm.

Nonlinear Optical Properties and All Optical Switching of Curcumin Derivatives.

In this work OR1(E1,6E) -1,7-bis (4-propyloxy phenyl) hepta-1,6-diene-3,5 dione compound is synthesized. The compound has been characterized via computational technique by studying the molecule's electronic structures through calculating its HOMO and LUMO energies, and its band gap energy (EHOMO-ELUMO). The nonlinear refractive index (NLRI) of the solution of OR1 compound in DMF solvent is determined using diffraction patterns (DPs) which resulted when a continuous wave laser beam of wavelength 473 nm traversed the compound solution in a glass cell of 1 mm thickness. By counting the number of rings under maximum beam input power, the NLRI of value 10- 6 cm2/W resulted. The NLRI is calculated once more via the Z-scan technique and a value of 0.25 × 10- 7 cm2/W is obtained. The vertical convection current in the OR1 compound solution appears to be responsible for the asymmetries noticed in the DPs. The temporal variation of each DP is noticed together with the evolution of DPs against beam input power. DPs are numerically simulated based on the Fresnel-Kirchhoff integral with good accord compared to the experimental findings. Dynamic and static all-optical switching in the OR1 compound using two laser beams (473 and 532 nm) is tested successfully.

Comprehensive mapping of mutations in TDP-43 and α-Synuclein that affect stability and binding.

Abnormal aggregation and amyloid inclusions of TAR DNA-binding protein 43 (TDP-43) and α-Synuclein (α-Syn) are frequently co-observed in amyotrophic lateral sclerosis, Parkinson's disease, and Alzheimer's disease. Several reports showed TDP-43 C-terminal domain (CTD) and α-Syn interact with each other and the aggregates of these two proteins colocalized together in different cellular and animal models. Molecular dynamics simulation was conducted to elucidate the stability of the TDP-43 and Syn complex structure. The interfacial mutations in protein complexes changes the stability and binding affinity of the protein that may cause diseases. Here, we have utilized the computational saturation mutagenesis approach including structure-based stability and binding energy calculations to compute the systemic effects of missense mutations of TDP-43 CTD and α-Syn on protein stability and binding affinity. Most of the interfacial mutations of CTD and α-Syn were found to destabilize the protein and reduced the protein binding affinity. The results thus shed light on the functional consequences of missense mutations observed in TDP-43 associated proteinopathies and may provide the mechanisms of co-morbidities involving these two proteins.Communicated by Ramaswamy H. Sarma.

Awareness of Diabetic Retinopathy Among Patients With Type 2 Diabetes Mellitus in Primary Healthcare Centers in Madinah, Saudi Arabia: A Cross-Sectional Study.

Background The prevalence of diabetes mellitus (DM) in Saudi Arabia is among the highest in the Middle East and North Africa (MENA) regions. Various complications of DM can cause problems in the long term. One of the most prevalent microvascular problems and the primary cause of blindness is diabetic retinopathy (DR), and a significant proportion of the population with diabetes eventually develop diabetes retinopathy. Recognizing and understanding DR may be crucial for patients in identifying and averting this complication.  Objectives The objective of this atudy is to assess the awareness of DR among patients with type 2 DM at primary healthcare centers in Madinah, Saudi Arabia.  Methods This cross-sectional study involved a survey of patients with diabetes who attended Madinah primary care clinics between August and September 2023. The study was conducted in Madinah, Saudi Arabia, from May to November 2023.  Results A total of 240 patients participated with a median age of 49.7 years and a gender distribution of 121 (50.4%) men. Overall, less than half of patients had a fair level of knowledge (47.1%) and a good level of knowledge (42.1%) about DR, whereas 10.8% had poor knowledge. Physicians were the primary source of information for patients, followed by the internet, family, and friends. Higher levels of education, diabetes that had been present for a longer period, and regular eye exams were associated with better understanding. This study emphasizes the importance of improving patient knowledge and awareness of DR.  Conclusions We observed a high level of awareness of DR among participants. Furthermore, higher awareness was associated with longer disease duration and compliance with diabetes treatment.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS: Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS: 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS: In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Advanced load frequency control of microgrid using a bat algorithm supported by a balloon effect identifier in the presence of photovoltaic power source.

Due to the unpredictability of the majority of green energy sources (GESs), particularly in microgrids (µGs), frequency deviations are unavoidable. These factors include solar irradiance, wind disturbances, and parametric uncertainty, all of which have a substantial impact on the system's frequency. An adaptive load frequency control (LFC) method for power systems is suggested in this paper to mitigate the aforementioned issues. For engineering challenges, soft computing methods like the bat algorithm (BA), where it proves its effectiveness in different applications, consistently produce positive outcomes, so it is used to address the LFC issue. For online gain tuning, an integral controller using an artificial BA is utilized, and this control method is supported by a modification known as the balloon effect (BE) identifier. Stability and robustness of analysis of the suggested BA+BE scheme is investigated. The system with the proposed adaptive frequency controller is evaluated in the case of step/random load demand. In addition, high penetrations of photovoltaic (PV) sources are considered. The standard integral controller and Jaya+BE, two more optimization techniques, have been compared with the suggested BA+BE strategy. According to the results of the MATLAB simulation, the suggested technique (BA+BE) has a significant advantage over other techniques in terms of maintaining frequency stability in the presence of step/random disturbances and PV source. The suggested method successfully keeps the frequency steady over I and Jaya+BE by 61.5% and 31.25%, respectively. In order to validate the MATLAB simulation results, real-time simulation tests are given utilizing a PC and a QUARC pid_e data acquisition card.

Level of knowledge and quality of life among Saudi caregivers of Parkinson's disease patients: A study from a tertiary hospital in Riyadh, Saudi Arabia.

Purpose: We aimed to assess the family caregivers' level of knowledge and attitudes about Parkison's disease (PD), identify factors affecting their knowledge, evaluate their quality of life (QoL) and factors influencing it and to define the effect of PD on activities of daily living (ADLs) of PD patients. Method: We developed and validated a questionnaire to assess the level of knowledge and attitudes of family caregivers toward PD, effects of PD on caregivers' QoL as well as its effects on activities of daily living (ADLs) of patients from the caregivers' perspective. A scoring system was utilized and SPSS was used to evaluate the differences in responses between the groups; p < 0.05 indicated statistical significance. Results: 69 caregivers and their corresponding patients were included in the study. Family caregivers had a low level of knowledge, as reflected by a mean score of 3.45 out of 8. However, 62.3% were aware of all medications used by their patients. Additionally, the level of knowledge was associated with caregivers' gender as 57.1% of the female caregivers had medium PD knowledge scores while 58.5% of the male had low scores (p = 0.038). The level of knowledge was also associated with daily caregiving hours as only 44.5% of caregivers whom spending 0-5 h/day had medium and high knowledge scores while greater proportions with same scoring levels were found among those providing care > 5 h/day (75.0% in > 5-10 hrs; 52.4% in > 10-24 hrs; p = 0.024). Most caregivers confirmed their QoL had declined, yet the male caregivers had better QoL than females (p = 0.026). Longer caregiving time was associated with decline (p = 0.016) and severe effect on QoL of caregivers (p = 0.04). Conclusion: Caregivers of PD patients had a low level of knowledge. Female caregivers had significantly higher level of PD knowledge than their male counterparts. Low level of PD knowledge was significantly associated with shorter caregiving time per day. Longer caregiving time was significantly associated with a decline in caregivers' QoL. Increasing awareness and knowledge among caregivers is necessary to ensure better treatment outcomes and improve the QoL of both caregivers and patients.

Curcumin Analogue Spectral, Nonlinear Optical Properties and All-optical Switching Using Visible, Low Power Cw Laser Beams.

In this study, we conducted the synthesis and diagnosis of compound denoted as 1A3, specifically, (2E,4E,9E,11E)-7-chloro-2,12-diphenyltrideca-2,4,9,11-tetraene-6,8-dione. The photoluminescent and UV-vis spectral properties of this compound are investigated. The compound is dissolved in both chloroform and DMF for analysis purposes. Compound 1A3's nonlinear optical (NLO) characteristics when dissolved in DMF, are extensively studied through a series of experiments including diffraction patterns (DPs) and Z-scan. The optical limiting (OL) property of the 1A3 compound is tested and a threshold value of 12.4 mW at the wavelength 473 nm is obtained. Additionally, we explored its potential for all-optical switching utilizing two low-power visible laser beams. Notably, we achieved a significant nonlinear refractive index (NLRI) reaching up to 5.921 x 10-11 m2/W. To analyze the obtained diffraction patterns, we employed the Fresnel-Kirchhoff integral equation and conducted meticulous simulations. The numerical outcomes showed satisfactory agreement with the experimental observations.

Toxic trespassers: Uncovering phthalates and organophosphate flame retardants in children's rooms and their health implications.

Organophosphate flame retardants (OPEs) and phthalates have garnered significant attention due to their widespread presence in indoor environments. Many recent investigations have reported extensive contamination of indoor dust, air, children's toys, and other environmental compartments with these chemicals. This research aimed to analyze OPEs and phthalates in air (PM10) and dust samples collected from the bedrooms of children (N = 30) residing in various households in Jeddah, Saudi Arabia. High mean levels (ng/g) of phthalates namely DEHP (1438600) and DnBP (159200) were found in indoor dust while TPhP (5620) was the major OPEs in indoor dust. Similarly, DEHP and DnBP were the predominant phthalates in PM10 samples, exhibiting mean levels of 560 and 680 ng/m3, respectively. However, TCPP was the main OPEs with average levels of 72 ng/m3 in PM10 samples. The majority of individual phthalates and OPEs were detected in 90-100 % of the dust samples, whereas in PM10 samples, their presence ranged from 25 % to 100 %. The concentrations of OPEs were notably greater than those of PBDEs and other BFRs previously reported in these samples, suggesting their broader use than alternative BFRs. The estimated long-term non-carcinogenic risk, hazardous index (HI) and daily exposure via dust for children was above threshold levels for DEHP. On the other hand, the cumulative risk of cancer was below the concerning levels. Further research is required to explore diverse groups of chemicals in indoor microenvironments particularly significant for children, such as kindergartens, primary schools, and their rooms at home.

Changes in serum hypoxia-inducible factor-1α and erythropoietin in allergic rhinitis patients: Correlation with the Th inflammatory profile and disease comorbidities.

OBJECTIVES: The balance between proinflammatory IFN-γ Th1 vs. the anti-inflammatory allergy-mediating IL-4-heralded Th2 reactions is pivotal in IgE-mediated allergic rhinitis (AR). Hypoxia-Inducible Factor (HIF)-1α is inducible by hypoxia and various cytokines. HIF-1α activates different anti-pathogen and allergic immune cells. This cross-sectional study assessed the changes in serum HIF-1α and its dependent erythropoietin (EPO) levels among hospital-characterized AR patients. Type of the immune reaction, Th1 vs. Th2, was stratified based on the calculated IL-4/IFN-γ direct ratio, after being measured using specific ELISA assays. METHODS: 147 AR patients (83 males/64 females), and age-, BMI-, and gender-matched 24 healthy controls (13 males/11 females) were sequentially enrolled at ENT Unit, Prince Muteb General Hospital, Sakaka, Saudi Arabia. Measurement of serum parameters was carried out using specific ELISA assays. RESULTS: Contrary to the majority of previous publications, all controls and the majority of patients (n = 137/147) exhibited naive Th0 immune response. IFN-γ and HIF-1α levels were greater in controls than in patients (168.9 ± 173.9 vs 108 ± 94.5 pg/mL; p<.012) and controls had a lower IL-4/IFN-ratio (2.439 ± 0.897 vs 3.33 ± 1.19; p<.001) than patients. The HIF-1α results disagree with earlier studies. Due to the wide inter-individual variations, serum IL-4 and EPO levels in controls were non-significantly higher than patients. Lower IL-4 levels (267.3 ± 79.95 vs 353.4 ± 320.6 pg/mL; p < .01) and the ratio (2.814 ± 1.335 vs 3.431 ± 1.137; p < .05) were associated with obstructive sleep apnea. Lower ratio was also associated with inferior turbinate hypertrophy (3.051 ± 1.026 vs 3.787 ± 1.310; p < .001). EPO and IL-4 levels were lower in patients with deviated nasal septum (66.69 ± 26.81 vs 84.24 ± 61.5 pg/mL; p < .021; and 299.5 ± 137.3 vs 391.1 ± 52.780 pg/mL; p < .001, respectively). Significant correlations were found between the recorded levels and AR comorbidities. CONCLUSION: These results confirmed a pathogenic implication for HIF-1α and IFN-γ in AR that warranted future bigger and longitudinal studies.

The Effects of Health Education on the Awareness of Antimicrobial Resistance Among High School Students in Riyadh, Saudi Arabia During 2023: A Quasi-experimental Study.

Introduction Antimicrobial resistance (AMR) is a major health threat, recently declared a crisis by the WHO, and recognized as one of the top 10 threats to global health. One of the strategies to curb AMR is interventional education to raise awareness. Therefore, this study evaluated the impact of interventional education on awareness of antimicrobial resistance among high school students in Riyadh, Saudi Arabia. Methods This was a quasi-experimental study that included 120 high school students as a control group and 120 students as the experimental group. It used a questionnaire pre- and post-educational intervention, which was a lecture by trained healthcare workers. Pearson's Chi-square test and ANOVA were used to assess the effects of the intervention, and the p-value was set at <0.05 for significance. Results Over half (53.4%) of the controls reported no prior exposure to an antibiotic awareness campaign, compared to 46.6% in the intervention (experimental) group. Half of the participants in both groups were without a family relative who works in the healthcare sector. Almost half (51.2%) in the intervention group used antibiotics compared to 48.2% of controls; 53.3% in the control group reported self-medication compared to 46.7% in the intervention group. We found a statistically significant increase in the overall mean scores regarding knowledge of antibiotics resistance before and after the education intervention in the control group (p<0.001) and intervention group (p<0.001). Post-intervention, there was a significant reduction in the mean scores of misbeliefs about antibiotic use (p<0.001). We found an improvement in the perception scores toward AMR and antibiotic resistance post-educational intervention (P=0.008), and the perception difference remained significant between the two study groups (p=0.002). Conclusion These findings showed that interventional education effectively raises awareness, knowledge, and perceptions toward AMR. Therefore, public health, medical, and scientific professionals in Saudi Arabia are urged to emphasize education to fight AMR, in addition to other strategies.

Alzheimer's Behavioral and Psychiatric Burden in Saudi Arabia: Validation of the Saudi Version of the Neuropsychiatric Inventory.

BACKGROUND: The burden of behavioral and psychiatric symptoms in dementia (BPSD) has not been characterized in Saudi patients with Alzheimer disease (AD). Moreover, the Saudi version of the Neuropsychiatric Inventory (SNPI) has not been validated. OBJECTIVES: The purpose of this study was to validate the SNPI and describe frequency and determinants of BPSD in Saudi AD patients. METHODS: The SNPI and BEHAVE-AD instruments were administered to community-dwelling Saudi AD patients and their caregivers. RESULTS: The sample size was 192. The first 59 constituted the validation cohort. Cronbach alpha of the SNPI and BEHAVE-AD were 0.91 and 0.79, respectively. There were significant correlations between: (1) the total SNPI and BEHAVE-AD scores ( r =0.84, P <0.001); (2) analogous SNPI and BEHAVE-AD symptom subscores ( P <0.05); (3) SNPI and BEHAVE-AD caregiver distress ( F =22.6, P <0.001). Inter-rater reliability of the SNPI was excellent (kappa=0.74). Ninety percent of patients experienced 4 SNPI symptoms or more. Patients with stroke and prior psychiatric history were most likely to experience BPSDs. The most common symptom was apathy (82%). Caregiver distress was determined by the total NPI score and impulsiveness subscale score. CONCLUSIONS: The SNPI is valid and reliable for assessing BPSD in Saudi AD patients. Longitudinal studies of BPSDs in Saudi specialized dementia clinics are needed.

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC): Methods and quality assessment.

OBJECTIVES: To describe variations in characteristics of randomized controlled trials conducted in the Gulf Cooperation Council (GCC) countries, and critically appraising the quality of design, conduct and analysis of the trials. METHODS: We carried out a systematically comprehensive electronic search of articles published between 1990 and 2018 and indexed in several databases: i) MEDLINE/PubMed, ii) EMBASE, iii) Cochrane Central Register of Controlled Trials (CENTRAL), iv) ClinicalTrials.gov, and v) World Health Organization International Clinical Trials Registry Platform. We summarized the overall risk of bias present in all analyzed studies using the Cochrane Collaboration risk of bias tool (CCRBT). RESULTS: A remarkable shift in numbers of publications from 2006 onwards was found. The largest number of publications were from Saudi Arabia and consisted of hospitals/clinics based studies. Lack of randomization was found in the majority of reports, and nearly three-fourth of the studies involved the use of intention-to-treat (ITT) principle. However, the proportion of adequately generated random sequence methods has increased yearly, and this increase accounted for a relatively large proportion over the latter half of the studied period (p<0.001), in contrast to the proportion of allocation concealment and blinding. Journal impact factor was significantly correlated with the quality of random sequence generation (r=0.145; p=0.014). CONCLUSION: The randomization methods have gained more attention over the last 3 decades. Secondly, Journal impact factor can serve as an indicator of randomization quality. To mitigate the large rate of overall high risk of bias in GCC studies, high-quality trials must be considered by ensuring adequate allocation concealment and blinding methods. PROSPERO No. ID: CRD42022310331.

Severe Insomnia Induced by Isotretinoin Use for the Management of Acne Vulgaris: A Rare Side Effect.

Isotretinoin has been widely prescribed for the management of moderate to severe acne vulgaris worldwide. It has been associated with different sleep disorders, mainly sleep apnea and hypersomnia. To our knowledge, only one study has found an association between isotretinoin use and insomnia. In addition, psychiatric disorders, such as psychosis and depression, have been linked to the use of isotretinoin previously. Here, we present a case of a 21-year-old male patient with severe acne vulgaris that underwent a therapeutic course of isotretinoin. During the course of treatment, he developed severe insomnia and depression. By reducing the daily dose, his insomnia was treated, as well as his depression. This case led to the conclusion that isotretinoin is associated with severe insomnia, and the severity of insomnia is dose-dependent.