Utility and Limitations of Transient Elastography to Monitor Hepatic Steatosis,Hepatic Fibrosis,and Methotrexate-Associated Hepatic Disease in Psoriasis: A Systematic Review

ObjectivePsoriasis is associated with hepatic steatosis, fibrosis, and methotrexate-associated liver injury. There is a need for reliable methods to monitor liver disease in psoriasis. Transient elastography (TE) is a validated non-invasive method for assessing hepatic steatosis and fibrosis. Psoriasis-specific TE studies have been limited until recently. Here, we review the utility and limitations of TE to detect and monitor liver disease in the context of psoriasis.MethodsA comprehensive search using OVID, PubMed, and gray literature was conducted (2005–November 2019) to identify studies of TE use in psoriasis for assessment of hepatic steatosis and fibrosis.ResultsFifteen studies met inclusion criteria. A total of 1,536 patients with psoriasis or psoriatic arthritis were represented. TE-detected liver fibrosis is associated with age, diabetes, obesity, and severity of psoriasis. TE successfully evaluates hepatic steatosis and fibrosis. Elastography has a high negative predictive value and specificity in the context of methotrexate-associated liver fibrosis in psoriasis; however, reported associations between abnormal elastography results and cumulative methotrexate dose varied significantly despite methotrexate’s association with hepatotoxicity and fibrosis. The presence of central adiposity is associated with increased TE failure rate.LimitationThe TE studies included in this review date from 2007 to 2019, which could contribute to publication bias, as the technique of TE has improved over this time period.ConclusionTE is a useful and non-invasive modality to detect hepatic steatosis and fibrosis in psoriasis. Dermatologists might consider TE in psoriatic patients and concomitant risk factors for fibrosis with the understanding that failure rates may be higher in patients with central adiposity.     

Detection of SARS-CoV-2 RNA in a conjunctival swab sample in real-time-polymerase chain reaction positive COVID-19 patients and its association with comorbidity and severity at a designated COVID-19 hospital in Central India

Purpose:To evaluate the presence of SARS-CoV-2 RNA in the conjunctival swab sample of positive confirmed COVID-19 patients and to find out its association with comorbidity and severity of COVID-19 disease.Methods:We conducted an observational cross-sectional study at a dedicated tertiary COVID-19 hospital in central India for a period of 8 weeks from February 2021to March 2021. We included patients who tested positive for SARS-CoV-2 RNA through nasopharyngeal swab and were above 18 years of age. Swab samples have been collected within 48 h of admission. Conjunctival swab was taken from the lower fornix of both eyes and sent to microbiology laboratory for real-time- polymerase chain reaction (RT-PCR).Results:Out of 150 patients, conjunctival swab RT-PCR was positive in five patients (3.33%). Two patients had conjunctival manifestations in the form of conjunctivitis but conjunctival swab RT-PCR was negative in those patients. Among the RT-PCR positive patients, two (40%) were from mild, one (20%) was from moderate, and two (40%) were from severe category. No association could be established between conjunctival swab RT-PCR positivity and severity of the disease or associated comorbidity.Conclusion:Our study provides evidence that SARS-CoV-2 RNA could be detected in conjunctival secretions, and though the risk is relatively low, the eye may act as source of transmission. Extra caution should be taken by healthcare workers, and use of proper precautions like face shields and goggles should be encouraged.     

Investigation on Rheological Properties of Water-Based Novel Ternary Hybrid Nanofluids Using Experimental and Taguchi Method

This study presents the rheological behavior of water-based GO-TiO₂-Ag and rGO-TiO₂-Ag ternary-hybrid nanofluids. The impact of nanoparticles’ volumetric concentration and temperature on the rheological properties were studied. All experiments were performed under temperatures ranging from 25 to 50 °C in the solid volume concentration range of 0.5–0.00005%. The data optimization technique was adopted using the Taguchi method. The types of nanomaterials, concentration, temperature, and shear rate were chosen to optimize the viscosity and shear stress. The effect of shear stress, angular sweep, frequency sweep, and damping factor ratio is plotted. The experimental results demonstrated that the rheological properties of the ternary hybrid nanofluid depend on the ternary hybrid nanofluid’s temperature. The viscosity of ternary hybrid nanofluids (THNf) change by 40% for GO-TiO₂-Ag and 33% for rGO-TiO₂-Ag when temperature and shear rates are increased. All the ternary hybrid nanofluids demonstrated non-Newtonian behavior at lower concentrations and higher shear stress, suggesting a potential influence of nanoparticle aggregation on the viscosity. The dynamic viscosity of ternary hybrid nanofluid increased with enhancing solid particles’ volume concentration and temperature.     

The role of brain magnetic resonance imaging on the timing of antiepileptic drugs withdrawal following mesial temporal lobe epilepsy surgery

Objectives:To assess the influence of magnetic resonance imaging (MRI) brain findings on the timing of antiepileptic drugs (AEDs) withdrawal following anterior temporal lobectomy (ATL) in patients with mesial temporal lobe epilepsy (MTLE).Methods:We conducted a retrospective chart review at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia from Jan, 2004 – Dec, 2017 of patients with MTLE who underwent ATL and included patients who had a minimum of 2 years of follow-up. We evaluated the association between the time required to start tapering and discontinuing AEDs after ATL in patients with Engel class I outcomes and their preoperative brain MRI.Results:We studied 64 patients who underwent ATL. The majority of patients (63%) had hippocampal sclerosis (HS) on histopathology. Following ATL, the mean time to start tapering AEDs was 10 months and AEDs were discontinued at a mean of 48 months. Abnormal brain MRI was observed in 53 (83%) patients, with findings suggestive of mesial temporal sclerosis (MTS) accounting for 75% of these abnormalities. The presence of any MRI abnormality was associated with a 10-month earlier tapering of AEDs (p<0.01), and an 18-month earlier complete withdrawal of AEDs (p<0.01). The odds of being seizure-free within the first year were higher if MTS was present in the brain MRI (adjusted OR=16). Similarly, this was associated with seizure freedom after the first year (adjusted OR=14.8, p<0.01). The presence of unilateral temporal IEDs on preoperative EEG were also associated with earlier tapering and discontinuation of AEDs as well as a seizure-free state after ATL surgery (OR=8.5 and 4.2, for the first and second year respectively, p<0.01).Conclusion:Patients with abnormal MRI findings and unilateral IEDs had earlier tapering of AEDs with an overall shorter AED discontinuation plan. Moreover, the presence of MTS on MRI, along with unilateral IEDs, were predictors of seizure freedom following ATL.

Anterior temporal lobectomy (ATL) is the standard treatment for medically refractory mesial temporal lobe epilepsy (MTLE), achieving seizure remission in approximately 70% of patients. ^1-3 However, the feasibility and timing of antiepileptic drug (AEDs) withdrawal after ATL are debatable. ⁴ The need for AEDs withdrawal stems from the adverse effects following long-term use, ^5,6 difficulties in maintaining compliance, and their high cost. ^7,8 Moreover, AEDs withdrawal following successful ATL is generally considered safe. ⁴ There are no evidence-based guidelines for managing AEDs withdrawal after resective epilepsy surgery. ^9,10 Moreover, few prospective and retrospective studies have assessed postoperative AEDs management exclusively in patients with MTLE. ^4,11-13 Hence, the timing of AEDs withdrawal after temporal lobectomy is controversial. ^12,14,15 The difficulties faced are how to taper AEDs, how soon it is safe to taper, which clinical profiles favor tapering, and what is the optimal time to start the tapering process. Predicting successful AEDs withdrawal following ATL has been examined in a few studies; however, the results were inconsistent. ^9,12,16-18 In one study, brain magnetic resonance imaging (MRI) findings were associated with seizure outcomes following ATL with successful AEDs discontinuation. ¹² The MRI can detect brain abnormalities, predict postoperative seizure, and AEDs freedom ² Despite this, data are lacking regarding the role of MRI in determining the time to start tapering AEDs postoperatively, as well as the time until AEDs discontinuation in those who do not require postoperative AEDs treatment. These data are essential for establishing guidelines that could assist clinicians with AED management following ATL.We aimed to assess the role of brain MRI in planning the tapering of AEDs and determining when to discontinue AEDs in patients with MTLE following ATL. We also evaluated seizure outcomes in patients with a minimum of 2 years of postoperative follow-up.     

Kawasaki disease in an infant after administration of hexavalent vaccine

Kawasaki disease is a vascular disorder of unknown etiology that affects children. Kawasaki disease mainly involves medium-sized blood vessels and may cause cardiovascular complications, particularly coronary artery aneurysms. Concern has been raised against various types of vaccines becoming potential risk factors for Kawasaki disease. Here, we describe a case of a 4-month-old Saudi infant who presented with incomplete Kawasaki disease a few hours after receiving his hexavalent vaccine and there was a significant dilatation of all coronary arteries. Although a relationship between vaccinations and Kawasaki disease has been suggested, there is no strong evidence of an increased risk or causal association. This possibility of adverse effects is rare but should be observed and further investigated.     

Study of Nutraceuticals and Phytochemicals for the Management of Alzheimer's Disease: A Review

Background Alzheimer''s disease (AD) affects several people worldwide and has devastating impacts on society with a limited number of approaches for its pharmacological treatment. The main causes of AD are not clear yet. However, the formation of senile plaques, neurofibrillary tangles, hyper-phosphorylation of tau protein, and disruption of redox homeostasis may cause AD. These causes have a positive correlation with oxidative stress, producing reactive ions, which are responsible for altering the physiological condition of the body.Conclusion Ongoing research recommended the use of phytochemicals as acetylcholinesterase inhibitors to hinder the onset and progression of AD. The natural compound structures, including lignans, flavonoids, tannins, polyphenols, triterpenes, sterols, and alkaloids have anti-inflammatory, antioxidant, and anti-amyloidogenic properties. The purpose of this article is to provide a brief introduction to AD along with the use of natural compounds as new therapeutic approaches for its management.     

Copper oxide integrated perylene diimide self-assembled graphitic pencil for robust non-enzymatic dopamine detection

Exploring a robust, extremely sensitive, cost-effective and reliable assay platform for the precise analysis of dopamine (DA) has become a big challenge predominantly at the clinical level. To participate in this quest, herein, we fabricated a perylene diimide (PDI) self-assembled graphitic surface of the graphitic pencil electrode (GPE) anchored copper oxide (CuO). The self-assembled N-rich PDI led to the fast movement of ions by decreasing the bandgap and improved the electron transport kinetics with more exposed catalytic active sites, thus resulting in the robust electrochemical sensing of DA. The designed sensor exhibited good sensitivity (4 μM⁻¹ cm⁻²), high structural stability, repeatability and excellent reproducibility with an RSD value of 2.9%. Moreover, the developed system showed a wide linear range (5 μM to 500 μM) and reliable selectivity even in the presence of co-existing interferants, such as ascorbic acid and uric acid. The fabricated nanohybrid was eventually employed to analyze DA in spiked physiological fluids and provided satisfactory recoveries. The designed PDI-CuO based interface also showed a very low detection limit of 6 nM (S/N = 3), consequently confirming its suitability for clinical and biological applications.

Exploring a robust, extremely sensitive, cost-effective and reliable assay platform for the precise analysis of dopamine (DA) has become a big challenge predominantly at the clinical level.     

The Saudi Critical Care Society extracorporeal life support chapter guidance on utilization of veno-venous extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome and special considerations in the era of coronavirus disease 2019

Extracorporeal membrane oxygenation (ECMO) is considered as a supportive treatment that provides circulatory and ventilatory support and can be thought off as a bridge to organ recovery. Since 2009, it has been applied as a rescue treatment for patients with severe adult respiratory distress syndrome (ARDS) mainly due to viral causes. In December 2019, several patients presented with a constellation of symptoms of viral pneumonia in China. A new strain of the corona virus family, called COVID-19, has been discovered to be the cause of this severe mysterious illness that was named severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). This new virus continued to spread across the globe leading to the World Health Organization announcing it as a pandemic in the early 2020. By the end of March 2021, the number of COVID-19 cases worldwide exceeded 126 million cases. In Saudi Arabia, the first confirmed case of COVID-19 was reported in the 2nd March 2020. By the end of March 2021, the total number of confirmed COVID-19 cases in Saudi Arabia is just above 360,000. In anticipation of the need of ECMO for the treatment of patients with SARS‑CoV‑2 based on the previous Middle East respiratory syndrome coronavirus pandemic experience, the Saudi Extra-Corporeal Life Support (ECLS) chapter that is under the umbrella of the Saudi Critical Care Society (SCCS) convened a working group of ECMO experts. The mission of this group was to formulate a guidance for the use of ECMO as a last resort for patients with severe ARDS, especially with COVID-19 based on available evidence. The ECLS-SCCS chapter wanted to generate a document that can be used to simple guide, with a focus on safety, to provide ECMO service for patients with severe ARDS with a special focus on SARS‑CoV‑2.     

Perceived awareness of sleep paralysis phenomenon (old hag syndrome) and its most common risk factors among people from Al-Ahsa,Saudi Arabia

Objectives:To assess prevalence and perception of sleep paralysis and its relationship with socioeconomic determinants, and risk factors in a cross-sectional sample of Saudi general population from Al-Ahsa city.Methods:A cross-sectional sampling survey was conducted during 2020 to 2021. The targets were aged above 18 and belonged to Al-Ahsa. Patients were sent self-reported anonymous questionnaires to complete.Results:A total of 524 participants, whose ages ranged from 18 to 60 years, were analyzed. Among 85.7% of participants aged 55 years and over, compared to 65.8% of those who were aged under 35, 379 (72.3%) respondents were females. Moreover, 438 (83.6%) participants were university graduates, 271 (51.7%) were students and 40.8% had psychological disorders including anxiety (25.2%) and depression (5.7%). Family history of sleep paralysis was reported by 369 (70.4%) participants. A total of 97.5% study participants were aware of sleep paralysis.Conclusion:Sleep paralysis is a common occurrence in people residing in Al-Ahsa, Saudi Arabia. A considerable number of the society held wrong beliefs regarding sleep paralysis. Therefore, raising public of identity of sleep paralysis is crucial. We recommend applying the study in other cities within Saudi Arabia to identify common risk factors and perceptions among the society.