Bilateral horizontal gaze palsy as an initial presentation of a clinically isolated syndrome: A case report

Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system. It has a wide range of manifestations and commonly affects the visual system. Many patients with MS report decreased vision, diplopia, nystagmus, and abnormal ocular motility. Nevertheless, bilateral horizontal gaze palsies are exceptionally rarely seen. We present the case of a 24-year-old female who came to our pediatric ophthalmology clinic complaining of bilateral horizontal gaze palsy, photophobia, and eye pain for 2 days. Although the patient had a family history of MS, there was no similar or previous complaint, with an unremarkable past medical and surgical history. During the examination, she was found to have a complete bilateral absence of horizontal saccade and pursuit, with slight limitations in vertical ones. There was no nystagmus or skew deviation, and the rest of the cranial nerves (CNs) were intact. Her ocular vital signs were normal, and her corrected visual acuity was 20/20 with full-color vision. The rest of the physical and neurological examinations were unremarkable. After referral to neurology, the magnetic resonance imaging showed multiple hyperintense lesions in deep white matter, pons, and midbrain. The correlation of imaging findings with clinical presentation confirmed the diagnosis of a clinically isolated syndrome. Extra-ocular motility (EOM) significantly improved after pulse steroid therapy and five sessions of plasma exchange, but the patient developed 35 prism diopter of acquired concomitant esotropia. She underwent a right medial rectus botulinum toxin injection which dramatically improved her condition, and became orthotropic during the last 2 months of follow-up after the injection.

Voice Disorders Among Teachers in Al-Ahsa, Eastern Region, KSA: Vocal Complaints, Treatment-Seeking Behaviors, and Knowledge of Vocal Care

BACKGROUND

Voice disorders are a serious and common complaint among teachers, yet there are no published studies on these conditions in the context of Al-Ahsa city in the eastern region of the Kingdom of Saudi Arabia. This study analyzed the vocal complaints of Saudi teachers, investigated their treatment-seeking behaviors, and assessed their knowledge of vocal care.

METHODS

A cross-sectional online survey was randomly distributed to 604 Saudi teachers from December 2021 to March 2022. The data included sociodemographic characteristics, academic statuses, vocal symptoms and their effects, and attitudes toward voice problems. Statistical analysis was done using the Statistical Package for the Social Sciences (v. 23). Categorical variables were expressed as frequencies and percentages. A chi-square test was conducted to verify the association between the categorical variables.

RESULTS

Of the participants, 62.1% were female. 65.4% reported having voice-related problems, with the most frequently reported symptoms being hoarseness (68.35%), throat dryness (60.76%), and sore throat (56.46%). Out of the participants who reported voice problems, 32.15% stated being affected by absenteeism from school. Only a minority of teachers sought medical help (5.1%) or received information about the vocal care (29.5%). The factors that were found to be significantly associated with voice complaints include female gender, positive family history of vocal disorders, speaking in a loud voice, being non-smoker, and having the high number of classes per week (P < 0.05).

CONCLUSION

Voice-related complaints were highly prevalent among Saudi teachers for multiple factors, most of which were manageable. This study strongly recommends the vocal educational programs to be implemented during student teacher training.

Knowledge, Attitudes, and Practices Regarding Ocular Manifestations of COVID 19 among Students in a Medical College in Saudi Arabia- A Cross Sectional Study

Background: The coronavirus pandemic has forced governments of different countries to implement measures to control the spread of the virus and improve health awareness. Medical students are thought to have a significant role in public health promotion. Although there are studies assessing the level of knowledge of COVID-19 among medical students, there are very few assessing the level of knowledge about the ocular manifestations of COVID-19. Therefore, this study aims to assess the level of knowledge, attitudes, and practices regarding the ocular manifestations of COVID-19 among medical students a medical college in Saudi Arabia. Methods: An online, questionnaire based cross sectional study was conducted to assess the knowledge, attitudes, and practices regarding the ocular manifestations of COVID 19 among medical students. Results: The level of knowledge about COVID-19 was adequate. However, there was a deficient knowledge regarding some aspects of ophthalmological involvement in coronavirus disease. Female students and those of higher academic years demonstrated significantly higher knowledge. Attitudes and practices regarding prevention of infection and personal protective measures were satisfactory. The main source of information about COVID-19 was social media and internet. Conclusions: This is probably the first study investigating the ophthalmological knowledge of COVID-19 among medical students in this region. The level of knowledge about COVID-19 was adequate but knowledge about some ophthalmological aspects was insufficient. Students had adequate knowledge about COVID prevention and personal protective measures. It is suggested to include knowledge of COVID-19 in the curriculum to fill gaps in the knowledge, especially in the preclinical years. Seminars and training programmes could also add to the same.