Knowledge and Attitude of Patients Attending Primary Health Care (PHC) or Family Medicine Clinics About Periodic Health Assessment

Background This study assesses the awareness and perceptions of periodic health assessments (PHA) among patients at primary health care (PHC) and family medicine clinics. Despite PHC's importance in preventive health, previous research indicates a significant gap in the public's knowledge and routine practice of PHA, potentially affected by various demographic factors. Materials & methods A cross-sectional approach was employed in Riyadh, Saudi Arabia, with data gathered via self-administered questionnaires from 382 participants. The survey focused on socio-demographic information, knowledge about PHA, and attitudes towards it. Statistical analysis explored the influence of demographic and clinical factors on individuals' knowledge and attitudes. Results Findings showed that 300 (78.5%) participants had engaged in routine medical examinations, displaying substantial knowledge of PHA. Nevertheless, issues like healthcare accessibility and provider availability were identified as the major barriers, affecting 125 (32.7%) and 84 (22%) participants, respectively. The overall attitude towards PHA was positive, especially among individuals with chronic conditions, emphasizing its perceived benefits in health management. Conclusion The research underscores a generally positive attitude and fair knowledge level regarding PHA among the studied population, alongside significant barriers to participation. Targeted interventions that address these barriers and capitalize on the positive attitudes may enhance PHA uptake, promoting better health outcomes. This study contributes to the understanding of public engagement with PHA, offering insights for improving health promotion and disease prevention strategies.

Pharmacist-led vaccination services in the Middle East

Successful Vaccine uptake relies heavily on the effectiveness of vaccination services. Expanding the scope of pharmacists' involvement in vaccination services can significantly improve vaccination coverage. The level of pharmacists' engagement in immunization services varies globally. The aim of this paper is to describe the current role of pharmacists in vaccination services in the Middle Eastern countries. The provision of vaccination services by pharmacists in the region has evolved notably in recent years. The extent of pharmacists' involvement in immunization services varies from one country to another in the region. They play a more active role in the delivery of vaccinations, not only facilitating but also administering vaccines. Future studies on pharmacist-led vaccination services in these countries are necessary to assess the value of the expanded practice of pharmacists in this field, especially due to the scarcity of evidence.

Development and validation of an Arabic language eye-tracking paradigm for the early screening and diagnosis of autism spectrum disorders in Qatar

Abnormal eye gaze is a hallmark characteristic of autism spectrum disorder (ASD). The primary aim of the present research was to develop an Arabic version of an objective measure of ASD, the "autism index" (AI), based on eye gaze tracking to social and nonsocial stimuli validated initially in the United States. The initial phase of this study included the translation of English language eye-tracking stimuli into stimuli appropriate for an Arabic-speaking culture. During the second phase, we tested it on a total of 144 children with ASD, and 96 controls. The AI had excellent internal consistency and test-retest reliability. Moreover, the AI showed good differentiation of ASD from control cases (AUC = 0.730, SE = 0.035). The AI was significantly positively correlated with SCQ total raw scores (r = 0.46, p < 0.001). ADOS-2 scores were only available in the ASD group and did not show a significant relationship with AI scores (r = 0.10, p = 0.348), likely due to the restricted range. The AI, when implemented using Arabic-translated stimuli in a Qatari sample, showed good diagnostic differentiation and a strong correlation with parent-reported ASD symptoms. Thus, the AI appears to have cross-cultural validity and may be useful as a diagnostic aide to inform clinical judgment and track ASD symptom levels as part of the evaluation process.

Radiolucent lesions that may resemble inflammatory periapical lesions: A review article

Non-endodontic lesions (NEL) closely resemble lesions of endodontic origin. Its etiology can be odontogenic, non-odontogenic, neoplastic, or anatomic variations that can resemble inflammatory periapical lesions in the periapical area. Inflammatory periapical lesions are caused by pulpal pathoses and require endodontic treatment. Since numerous NEL may resemble inflammatory periapical lesions, they can lead to misdiagnosis and inappropriate management. Thus, a detailed review of the patients' medical and dental histories with clinical examination, including radiographic findings, is essential for the proper assessment of periapical lesions. Numerous cases of misdiagnoses of NEL have been reported in literature. Thus, this review aimed to strengthen the awareness of clinicians on periapical radiolucency, which may resemble inflammatory periapical lesions.

Categorical versus dimensional structure of autism spectrum disorder: A multi-method investigation

Background

A key question for any psychopathological diagnosis is whether the condition is continuous or discontinuous with typical variation. The primary objective of this study was to use a multi-method approach to examine the broad latent categorical versus dimensional structure of autism spectrum disorder (ASD).

Method

Data were aggregated across seven independent samples of participants with ASD, other neurodevelopmental disorders (NDD), and non-ASD/NDD controls (aggregate Ns = 512-16,755; ages 1.5-22). Scores from four distinct phenotype measures formed composite "indicators" of the latent ASD construct. The primary indicator set included eye gaze metrics from seven distinct social stimulus paradigms. Logistic regressions were used to combine gaze metrics within/across paradigms, and derived predicted probabilities served as indicator values. Secondary indicator sets were constructed from clinical observation and parent-report measures of ASD symptoms. Indicator sets were submitted to taxometric- and latent class analyses.

Results

Across all indicator sets and analytic methods, there was strong support for categorical structure corresponding closely to ASD diagnosis. Consistent with notions of substantial phenotypic heterogeneity, the ASD category had a wide range of symptom severity. Despite the examination of a large sample with a wide range of IQs in both genders, males and children with lower IQ were over-represented in the ASD category, similar to observations in diagnosed cases.

Conclusions

Our findings provide strong support for categorical structure corresponding closely to ASD diagnosis. The present results bolster the use of well-diagnosed and representative ASD groups within etiologic and clinical research, motivating the ongoing search for major drivers of the ASD phenotype. Despite the categorical structure of ASD, quantitative symptom measurements appear more useful for examining relationships with other factors.

Social attention as a cross-cultural transdiagnostic neurodevelopmental risk marker

The primary objectives of this study were to evaluate the structure and age-related stability of social attention in English and Arabic-speaking youth and to compare social attention between children with autism spectrum disorder (ASD), other developmental disabilities (DD), and typically-developing controls. Eye-tracking data were collected from US (N = 270) and Qatari (N = 242) youth ages 1-17, including children evaluated for possible ASD. Participants viewed 44 stimuli from seven social paradigms. Fixation was computed for areas of interest within each stimulus. Latent variable models examined the structure of social attention. Generalized estimating equation models examined the effect of age, sex, culture, and diagnostic group on social attention. The best-fitting model included a general social attention factor and six specific factors. Cultural differences in social attention were minimal and social attention was stable across age (r = 0.03), but females showed significantly greater social attention than males (d = 0.28). Social attention was weaker in DD (d = -0.17) and lowest in ASD (d = -0.38) relative to controls. Differences were of sufficient magnitude across areas-of-interest to reliably differentiate DD from controls (AUC = 0.80) and ASD-only from all other cases (AUC = 0.76). A social attention dimension that represents an early-life preference for socially salient information was identified. This preference was cross-culturally consistent and stable across development but stronger in females and weaker in DD, especially ASD. Given rapid and easy-to-collect remote eye tracking administration, social attention measurement may be useful for developmental monitoring. Acquisition of population norms, analogous to height/weight/head circumference, might enhance early screening and tracking of neurodevelopment. LAY SUMMARY: This research found that social attention is a single dimension of behavior that represents a strong preference for social stimuli, is consistent across cultures, stable across age, and stronger in females. Children with developmental disabilities had lower levels of social attention than neurotypical children and children with autism spectrum disorder had the lowest levels of social attention.

The role of the epilepsy monitoring unit in the investigation of patients with epilepsy and intellectual disabilities

BACKGROUND

A significant proportion of the people with intellectual disabilities (ID) has epilepsy and lives in institutions. These patients tend to have atypical presentations of epileptic seizures with an increased risk of misdiagnoses. They often have drug-resistant epilepsy (DRE) requiring polypharmacy with increased risk of morbidity. The aim of this study was to determine the usefulness of Epilepsy Monitoring Unit (EMU) in the diagnosis and management of these patients.

METHODS

This is a retrospective observational study of people with epilepsy and ID living in institutions that were admitted to the EMU at London Health Sciences Center (LHSC), from January 2014 to December 2016.

RESULTS

Out of 1121 patients admitted to the EMU at the LHSC, 1.96% (N = 22) fulfilled the inclusion criteria for this study. The mean age was 34.5 years (interquartile range [IQR]: 28.8-53); 50%(N = 11) were female. Fourteen (63.6%) had generalized epilepsy. Six (27.3%) had a history of status epilepticus. The mean number of antiseizure medications (ASMs) in those patients was three (IQR: 2-4). Eight (36.4%) patients had severely impaired or no language skills and seven (31.8%) required wheelchair. Eleven (50%) had a mood disorder and seven (31.8%) of them were taking antipsychotic medications. The mean duration of admission duration was 6.6 days (IQR: 3.5-8.5). There was a clinical-electrographic correlation between the behavioral events and epileptic seizures in nineteen (86.4%) of the patients.

CONCLUSIONS

Admission to the EMU provided an accurate characterization of transient events in people with ID and epilepsy with improvement in their medical management.

Prevalence and correlates of autism spectrum disorder in Qatar: a national study

BACKGROUND

Few epidemiological data on autism spectrum disorders (ASD) exist for Arabic countries. We conducted the first survey of ASD in Qatar, a population with high consanguinity level.

METHODS

This cross-sectional survey was conducted from 2015 to 2018 in Qatar school-age children (N = 176,960) from national and immigrant families. Children diagnosed with ASD were identified through medical centers and special needs schools. Records were abstracted and supplemented by parental interviews. Additionally, children attending 93 schools were screened; ASD case status was confirmed in random samples of screen-positive and screen-negative children. Prevalence was estimated after taking into account different sampling fractions and participation rates at each survey phase.

RESULTS

One thousand three hundred and ninety-three children already diagnosed with ASD were identified. Among 9,074 school survey participants, 760 screen-negative children and 163 screen-positive children were evaluated; 17 were confirmed to have ASD including five children newly diagnosed. Prevalence was 1.14% (95% CI: 0.89-1.46) among 6- to 11-year-olds. ASD was reported in full siblings/extended relatives in 5.9% (95% CI: 0.042-0.080)/11.8% (95% CI: 0.095-0.146) families. First-degree consanguinity in Qatari cases (45%) was comparable to known population levels. Among 844 ASD cases (mean age: 7.2 years; 81% male), most children experienced language delay (words: 75.1%; phrase speech: 91.4%), and 19.4% reported developmental regression. At the time of the survey, persisting deficits in expressive language (19.4%) and peer interactions (14.0%) were reported in conjunction with behavioral problems (ADHD: 30.2%; anxiety: 11.0%). In multivariate logistic regression, ASD severity was associated with parental consanguinity, gestational diabetes, delay in walking, and developmental regression.

CONCLUSIONS

ASD prevalence in Qatar is consistent with recent international studies. The methods employed in this study should help designing comparable surveys in the region. We estimated that 187,000 youths under age 20 have ASD in Gulf countries. This figure should assist in planning health and educational services for a young, fast-growing population.

Validation of the Arabic version of the Social Communication Questionnaire

Validated screening and diagnostic tools for autism spectrum disorder for use in Arabic-speaking individuals are scarce. This study validated the Arabic version of the Social Communication Questionnaire. The total study sample included 206 children with autism spectrum disorder and 206 typically developing children (73.8% male; mean age: 8.5 (standard deviation = 2.6) years). The mean Social Communication Questionnaire total score was significantly higher in autism spectrum disorder children than in typically developing children (p < 0.0001). Scores on the three Social Communication Questionnaire subscales also differed significantly between the groups (p < 0.001). Of the 39 items, 37 were endorsed significantly more often in the autism spectrum disorder group. The total Social Communication Questionnaire score did not vary by age or gender. Internal consistency was excellent (alpha = 0.92). In the receiver operating characteristic analysis, the area under the curve for the total score showed excellent discrimination between autism spectrum disorder and typically developing children (area under the curve = 0.95; 95% confidence interval: 0.93–0.97). The areas under the curve for the scale subscores were 0.923 (95% confidence interval: 0.898–0.949) for the social interaction score, 0.872 (95% confidence interval: 0.838–0.905) for the communication score, and 0.856 (95% confidence interval: 0.819–0.893) for the repetitive behaviors score. The findings support the use of the Arabic Social Communication Questionnaire to successfully differentiate children with clinically diagnosed autism spectrum disorder using the established cutoff value for the English version.

Sensing Technologies for Autism Spectrum Disorder Screening and Intervention

This paper reviews the state-of-the-art in sensing technologies that are relevant for Autism Spectrum Disorder (ASD) screening and therapy. This disorder is characterized by difficulties in social communication, social interactions, and repetitive behaviors. It is diagnosed during the first three years of life. Early and intensive interventions have been shown to improve the developmental trajectory of the affected children. The earlier the diagnosis, the sooner the intervention therapy can begin, thus, making early diagnosis an important research goal. Technological innovations have tremendous potential to assist with early diagnosis and improve intervention programs. The need for careful and methodological evaluation of such emerging technologies becomes important in order to assist not only the therapists and clinicians in their selection of suitable tools, but to also guide the developers of the technologies in improving hardware and software. In this paper, we survey the literatures on sensing technologies for ASD and we categorize them into eye trackers, movement trackers, electrodermal activity monitors, tactile sensors, vocal prosody and speech detectors, and sleep quality assessment devices. We assess their effectiveness and study their limitations. We also examine the challenges faced by this growing field that need to be addressed before these technologies can perform up to their theoretical potential.

Encephalopathy and Axonal Neuropathy Associated With Mycoplasma Pneumoniae Infection: Response to Intravenous Immunoglobulin Therapy

Mycoplasma pneumoniae infection frequently presents as a self-limited process, however, severe cases and even fatalities have been reported. The authors present a case of Mycoplasma pneumoniae infection associated with both encephalopathy and peripheral neuropathy that responded to intravenous immunoglobulin therapy. To our knowledge, this is the first documented case of Mycoplasma pneumoniae related to encephalitis and peripheral axonal neuropathy. To date, there is insufficient data on the effect of intravenous immunoglobulin on the course of mycoplasma-associated central nervous system/peripheral nervous system disease. While intravenous immunoglobulin has aided in a variety of autoimmune-mediated disorders, its efficacy in mycoplasma-mediated encephalitis treatment remains unclear. In this patient case, reversal of both central and peripheral nervous system symptoms after treatment with intravenous immunoglobulin suggested a possible therapeutic benefit.

Homozygosity analysis in subjects with autistic spectrum disorder

Autistic spectrum disorder (ASD) is a complex neurodevelopmental disorder that results in social and communication impairments, as well as repetitive and stereotyped patterns. Genetically, ASD has been described as a multifactorial genetic disorder. The aim of the present study was to investigate possible susceptibility loci of ASD, utilizing the highly consanguineous and inbred nature of numerous families within the population of Saudi Arabia. A total of 13 multiplex families and 27 affected individuals were recruited and analyzed using Affymetrix GeneChip(®) Mapping 250K and 6.0 arrays as well as Axiom arrays. Numerous regions of homozygosity were identified, including regions in genes associated with synaptic function and neurotransmitters, as well as energy and mitochondria-associated genes, and developmentally-associated genes. The loci identified in the present study represent regions that may be further investigated, which could reveal novel changes and variations associated with ASD, reinforcing the complex inheritance of the disease.

Neuronal ceroid lipofuscinosis caused by MFSD8 mutations: a common theme emerging

Neuronal ceroid lipofuscinoses (NCLs) are a group of lysosomal neurodegenerative disorders that have in common the characteristic accumulation of abnormal storage material. Old clinical classification based on age of onset is now being revisited with the quickly accumulating knowledge of the various genetic defects that underlie this group of genetically heterogeneous disorders. We report our linkage data on a family with late-infantile NCL and show that the disease in this family is due to a homozygous novel mutation in the most recently described NCL gene (MFSD8). We use clinical data from our patients and the few others that have previously been reported to delineate the phenotype associated with mutations in this gene. We conclude that the phenotype is fairly consistent, which is a helpful guide to clinicians as they decide on the most cost-effective molecular testing strategies for NCLs.

Krabbe disease: Neurophysiologic studies and MRI correlations

BACKGROUND

Krabbe disease (KD) is a rare hereditary leukodystrophy affecting children mostly in the first 6 months of life; later onset has been reported as well.

OBJECTIVE

To review abnormalities in neurophysiologic studies in children with KD and determine if there is a correlation between these studies and disease severity as measured by MRI scans.

METHODS

KD patients with at least one neurophysiologic study and one MRI scan at the authors' institution were reviewed. Relationships between KD type, neurophysiologic studies, and severity of disease as measured by MRI were explored.

RESULTS

Data were available for 26 children: 20 with early infantile KD (EIKD) and 6 with late-onset KD (LOKD). Flash visual evoked potentials were abnormal in 53% of EIKD children, whereas none of the LOKD children had an abnormal study. Brainstem auditory evoked potentials were abnormal in 88% of EIKD and 40% of LOKD children. EEGs were abnormal in 65% of EIKD and 33% of LOKD children. Nerve conduction studies were abnormal in all children with EIKD and in 20% of LOKD children. Abnormal neurophysiologic studies correlated with more extensive disease as measured by MRI scans.

CONCLUSIONS

Children with early infantile Krabbe disease and late-onset Krabbe disease have different patterns of abnormalities in neurophysiologic studies. These studies offer an objective means of assessing KD and correlate well with disease severity measured by MRI scans.

Brain-stem auditory and visual evoked potentials in children with Krabbe disease

OBJECTIVE

There are few reports in the literature detailing brain-stem auditory and visual evoked potentials (BAEP and VEP) in children with Krabbe disease (KD). The purpose of this study was to provide a descriptive analysis of the BAEP and VEP findings in these children.

METHODS

Charts of children with KD were reviewed. BAEP and VEP studies performed on these children were reviewed; findings in the early infantile and late onset KD (EIKD, LOKD, respectively) groups were also examined. Likelihood ratios (LR) for the neurophysiologic tests being abnormal in the various groups were also determined.

RESULTS

BAEP abnormalities were seen in 15/17 (88%) children with EIKD and 2/5 (40%) children with LOKD, LR statistically significant. In the EIKD group, all 13 symptomatic children had an abnormal BAEP, whereas 2/4 (50%) of the pre-symptomatic children had similar findings, LR statistically significant. VEP abnormalities were noted in 8/15 (53%) children with EIKD and none of the children with LOKD, LR statistically significant. In the EIKD group, the 8/12 (67%) symptomatic children had an abnormal VEP, whereas none of the pre-symptomatic children did, LR statistically significant. Subgroup analyses of the LOKD subgroups did not yield significant findings.

CONCLUSIONS

BAEP abnormalities are among the first objective indications of central nervous system disease in children with EIKD. VEP abnormalities occur later in the course of the illness. Both tests are less helpful in children with LOKD.

SIGNIFICANCE

BAEP and VEP testing is helpful in objective evaluation of children with KD.

Delayed visual maturation associated with auditory neuropathy/dyssynchrony

Delayed visual maturation is a term used to describe infants who initially seem blind but subsequently have a marked improvement. The mechanism of visual loss and the subsequent improvement remains unknown. Auditory neuropathy/dyssynchrony is a condition of hearing impairment associated with absent or severely abnormal brainstem auditory evoked potentials but normal cochlear functions as measured by otoacoustic emissions. In this report, a 9-month-old infant who had no visual fixation for the first 3 months of life and congenital hearing impairment is described. Her brainstem auditory evoked potential study at 2.5 months of age showed no response to click stimuli presented at 90 dB nHL, whereas her otoacoustic emissions were normal. Subsequently, her vision and hearing improved. A brainstem auditory evoked potential study at 9 months of age showed reproducible waveforms. This case suggests the need for a detailed hearing evaluation of children with delayed visual maturation. Furthermore, this case highlights the need for follow-up brainstem auditory evoked potential testing prior to pursuing any audiologic intervention.