Validation of the Arabic version of the short Geriatric Depression Scale (GDS-15)

BACKGROUND: This study aimed to examine the validity and reliability of an Arabic version of the 15-item Geriatric Depression Scale (GDS-15). METHODS: 121 community-dwelling older adults and primary care patients aged 60 and above participated in this study. Older adults with dementia, those with thyroid dysfunction, and hearing or speech impairments were excluded. Test-retest reliability was examined by re-administering the translated GDS-15 to a subset of 38 participants at least seven days after the initial interview. RESULTS: The Arabic GDS-15 had good psychometric properties, but the best properties were reported for the 7/8 cutoff. Cronbach's alpha as a measure of internal consistency reliability was high (0.88) and kappa ranged from 0.57 to 0.75. The performance of the GDS-15 was equally good for both community-dwelling older adults and those in primary care settings, and for both forms of the GDS (examiner administered vs. self-administered). CONCLUSION: The Arabic GDS is a useful measure to assess depression among community-dwelling older adults and primary care patients who do not have dementia. Because of the use of formal Arabic, GDS-15 can be widely used with all Arabic-speaking people.     

Sigmoid Volvulus in the Middle East

Little is known about sigmoid volvulus in the Middle East despite textbooks referring to the region as part of the “volvulus belt.” Our objectives were to assess the prevalence, clinical presentations, radiological findings, operative treatments, and postoperative outcomes of patients managed for sigmoid volvulus in Jordan as a model for the region. The medical records of patients with large bowel obstruction who were managed at King Abdullah University Hospital and its affiliated institutes, northern Jordan, over a 6-year period between January 2001 and January 2007 were retrospectively reviewed to identify patients with a confirmed diagnosis of sigmoid volvulus. Sigmoid volvulus was responsible for 9.2% of all cases of large bowel obstruction seen during the study period. There were 32 patients with sigmoid volvulus, 24 (75%) of whom were men. The median age of the patients was 59 years (range 21–83 years). Abdominal pain and distention were the main presentations. Colonoscopic detorsion was applied in 25 patients, which was achieved in 17 (68%) of them after the first attempt. Six patients had a gangrenous sigmoid colon, four of which required resection and a Hartmann procedure. Sigmoid resection with primary anastomosis was performed in 28 patients, including 2 with a gangrenous colon. Postoperative complications were observed in five patients, including one patient with viable colon who develop an anastomotic leak. Two patients died, making the mortality rate 6%. Sigmoid volvulus is uncommon in Jordan. Resection of the sigmoid colon with primary anastomosis appears to be the preferred procedure.     

Validation of the Arab Youth Mental Health scale as a screening tool for depression/anxiety in Lebanese children

Background  

Early detection of common mental disorders, such as depression and anxiety, among children and adolescents requires the use of validated, culturally sensitive, and developmentally appropriate screening instruments. The Arab region has a high proportion of youth, yet Arabic-language screening instruments for mental disorders among this age group are virtually absent.     

Early seizures in stroke – frequency,risk factors,and effect on patient outcomes in a tertiary center in Saudi Arabia

Objectives:To determine the frequency, risk factors, and outcomes of Early seizure (ES) after stroke in a Saudi cohort.Methods:A retrospective study was conducted in King Abdulaziz Medical City, Riyadh, KSA. All stroke patients whether they had first or recurrent stroke were included from February 2016 to December 2017. Data were analyzed using the SAS software version 9.4.Results:Out of 665 patients, 456 (68.6%) were males and 564 (85.2%) were Saudis; the cohort’s mean age was 60.6±12.6 years. Fifty-one (7.7%) patients had ES, which were more common in women (p=0.0123). Loss of consciousness (p=0.0402) and confusion (<0.0007) were associated with ES, whereas unilateral weakness (p=0.001) and unilateral numbness (p=0.0317) at presentation decreased the risk of ES. Vascular risk factors did not differ between patients with and without ES. Hemorrhagic stroke was associated with ES (p=0.0054), whereas patients with small vessel disease were less likely to develop ES (p=0.0013). Patients with ES had more severe stroke (NIHSS >5) (p=0.0139), more ICU admissions (49% vs. 26.2%; p=0.0005), longer length of hospital stay (44.9 days vs. 24.9 days; p=0.0018), higher rates of stroke-related complications (e.g. recurrent stroke, pulmonary embolism, hospital acquired infections, and need for tracheostomy and gastrostomy tube placement) (p≤0.0001), and were likely to be more severely disabled defined as mRS 3–5 at discharge (47.7% vs. 40.8%; p=0.0055) or to die in hospital (11.8% vs. 4.6%; p≤0.0001).Conclusion:The ES after stroke were common in our cohort. Increased stroke severity and confusion were independent predictors of ES. The ES were associated with higher rates of in-hospital complications, longer length of hospital stay, and worse outcomes at discharge.

Stroke is one of the common causes of symptomatic seizures in the elderly. Post-stroke seizures (PSS) are commonly classified into early seizures (ES) and late seizures (LS). ¹ No specific cut-off point that delineates ES has been agreed upon, but most studies arbitrarily define ES as those that occur within 7–14 days of incident stroke. ^1-2 The PSS occurring beyond this period are considered LS. The incidence rate for ES after stroke is not well established, although it has been reported to be 2%–33%. ^2,3 A recent meta-analysis has found that ES incidence after ischemic stroke is 3.3%, whereas the LS incidence rate was found to be 18 per 1000 person-years. ¹ A study investigating seizures that occurred within 24 h of stroke onset has found an incidence of 3.1% in more than 6,000 stroke patients. ³ Not all patients with PSS develop epilepsy. Approximately 2-4% of patients develop epilepsy after stroke. ⁴ Data on the risk factors for ES after stroke are inconsistent. In some studies, cardioembolic stroke, cortical location of stroke, hemorrhagic transformation of ischemic stroke, increased severity of stroke, and history of coronary artery disease or atrial fibrillation were found to be the predictors of ES after stroke. ^2,4-5 The ES after stroke are associated with increased morbidity and mortality, and can affect the functional independence of stroke patients, resulting in poorer quality of life, as well as in increased resource utilization. ^3-6 However, evidence-based data on PSS and guidelines on PSS management remain lacking. ⁶ The PSS are not uncommon and are broadly classified into ES and LS. Not all patients with ES develop post-stroke epilepsy. ⁶ The pathophysiological mechanisms underlying ES and LS are widely different. Having a specific time window to define ES from LS is crucial, as this may help in predicting post-stroke epilepsy. In the acute phase of stroke, ionic shifts, excitotoxicity neurotransmitters, metabolic dysfunction, and changes in coagulation cascade can all contribute to the early onset of seizure after an ischemic event. ^7-8 By contrast, LS results from persistent structural changes and gliosis that occur in the late phase of stroke, causing disruption in neuronal firing, circuit dysfunction, and eventually epileptogenic changes. ^7-8 The PSS has been studied in different populations; considering the observed variations in incidence, risk factors, and outcomes of PSS, we find it important to investigate this condition in the Saudi population. Our study aimed to determine the frequency of post stroke seizures in our population, and to identify the predictors of ES. It also looked at the outcome of these patients. To the best of our knowledge, this is the earliest study to report data on ES after stroke in a Saudi cohort, and it may be useful in planning future large-scale studies on ES prevention and management.     

Effect of Different Wax Pattern Manufacturing Techniques on the Marginal Fit of Lithium Disilicate Crowns

Purpose: The present study evaluated the marginal gap of lithium disilicate crowns fabricated through three different wax pattern techniques; Conventional, Milling and 3D-printing. Materials and Methods: Thirty stone models were replicated from a stainless-steel model representing a prepared tooth; ten were sent to make conventional wax patterns while the remaining were sent to a digital dental scanner. The computer aided design was completed and STL (Standard Tessellation Language) files were sent to either milling or 3D-printing machines. All wax patterns (n = 30) were pressed, and a stabilizing instrument was used to secure the crowns on the master model. The marginal gap was measured at 18 points for each crown using a digital microscope (µm) (n = 540) and compared using One-way ANOVA (p ≤ 0.05). Results: There was a significant difference in the marginal gap value between all three groups (p < 0.01) where the milled group showed the least mean gap (28.87 ± 30.18 µm), followed by 3D printed (47.85 ± 27.44 µm), while the highest mean marginal gap was found in the conventional group (63.49 ± 28.05 µm). Conclusion: Milled and 3D-printed wax patterns produced better fitting crowns compared to conventional techniques.     

Effect of bariatric surgery on cardiac function in obese patients: An echocardiographic assessment

Objectives:To analyze the clinical and echocardiographic changes in individuals with morbid obesity who underwent bariatric surgery.Methods:In total, 59 obese patients with body mass index >35 kg/m ² were prospectively enrolled. We assessed baseline pre-operative and a 6-month post-operative lipid profile, hemoglobin A1c, echocardiography, lifetime, and a 10-year risks of atherosclerotic disease for all patients.Results:The mean patients’ age was 37±12 years, with 40 (67.8%) women. We found that the pre-operative total cholesterol (4.2±1.1 vs. 4.4±1.1, p=0.014) and triglyceride levels (1.4±0.7 vs. 1.8±0.8, p<0.0001) were significantly lower than post-operative levels, while post-operative high-density lipoprotein levels were significantly higher (1.5±0.5 vs. 1.2±0.3, p<0.0001). The calculated 10-year risk of atherosclerotic cardiovascular disease was significantly lower post-operatively (1.1±1.6% vs. 1.6±1.8%, p<0.0001). Echocardiography follow-up revealed that diastolic dysfunction was more prevalent pre-operatively than that post-operatively (41% vs. 10%, p<0.0001). Post-operative left ventricular (LV) mass was significantly lesser than the pre-operative mass (168±252 g vs. 187±255 g, p=0.019), whereas the post-operative LV diastolic (46.5±7 mm vs. 38.5±18 mm, p=0.002) and systolic dimensions (31±5 mm vs. 25±11 mm, p=0.001) were significantly smaller.Conclusion:Bariatric surgery resulted in a significant amelioration in lipid profile, reduction in LV mass, and LV cavity dimensions.