Patient perspectives on ionising radiation exposure from computed tomography in Saudi Arabia: a knowledge and perception study

The objective of this study was to evaluate patient knowledge and understanding of ionising radiation and dosage, as well as the accompanying risks related to computed tomography scans. A total of 412 outpatients who underwent computed tomography (CT) scans were surveyed to assess their understanding of radiation dose and exposure risks. CT was correctly classified as an ionising radiation by 56.8% of the respondents. More than half of the patients reported that a CT scan increases the probability of inducing cancer. Awareness of varying radiation doses in different CT exams was noted in 75.2% of patients, but only 21.4% reported having discussions with their physician about radiation dose. Gender, age and employment were significantly correlated with knowledge levels. The survey findings indicate a limited understanding of the hazards associated with ionising radiation used in CT scans, highlighting a need for increased awareness and education on radiation protection to ensure informed consent.

Tubermycin B coated on Galactosylated Chitosan Nanoparticles synthesized by eco-friendly method ameliorates intracellular free radical production and reduces oxidative stress, reducing phosphorylation of IKKα/β/pIкBα/NF-кB pathway

OBJECTIVE

The objective of the current study was to investigate the cytotoxic potentials of Galactosylated Chitosan Nanoparticles. Specifically, the study aimed to develop Tubermycin B coated on Galactosylated Chitosan Nanoparticles using a new green method that replaces sodium borohydride in the reduction process.

MATERIALS AND METHODS

The study synthesized Tubermycin B coated on Galactosylated Chitosan Nanoparticles through a new green method. The cytotoxicity of these nanoparticles was evaluated in a mice intestinal tract model that had been induced with chlorpyrifos, which causes oxidative stress-related enterotoxicity. Multiple activities, including the apoptosis of intestinal macrophages and the activation of Ikappa α/β kinase (IKKα/β), were examined as indicators of the nanoparticles' efficacy. The stability of the synthesized Chitosan Nanoparticles was also assessed. Additionally, the encapsulation efficiency of Boscia angustifalia and Boscia senegalensis extracts within the nanoparticles was determined.

RESULTS

The results of the study showed that Tubermycin B coated on Galactosylated Chitosan Nanoparticles effectively alleviated the oxidative stress-related enterotoxicity in the mice intestinal tract induced by chlorpyrifos. The nanoparticles prevented the apoptosis of intestinal macrophages and inhibited the activation of IKKα/β. The synthesized chitosan nanoparticles exhibited high stability. The encapsulation efficiency of Boscia angustifalia extract was recorded as 46.58%, whereas for Boscia senegalensis extract, it was 9.77%. The nanoparticles showed no cytotoxicity at all tested concentrations and demonstrated a medium-level anticancer effect.

CONCLUSIONS

Based on the findings, it can be concluded that Tubermycin B coated on Galactosylated Chitosan Nanoparticles has the potential to alleviate oxidative stress-related enterotoxicity in the mice intestinal tract. The nanoparticles showed high stability and exhibited a medium-level anticancer effect. Furthermore, the study demonstrated that Boscia angustifalia extract exhibited higher anti-hepatitis C virus antibodies (anti-HCV) activity compared to Boscia senegalensis extract in an in-vitro system. Therefore, Boscia angustifalia could be considered a promising candidate for the development of an anti-HCV drug for future in-vivo studies.

Provision of Safe Anesthesia in Magnetic Resonance Environments: Degree of Compliance with International Guidelines in Saudi Arabia

BACKGROUND

The lack of local guidelines and regulations for the administration of anesthesia in magnetic resonance imaging (MRI) units presents a potential risk to patient safety in Saudi Arabia. Hence, this study aimed to evaluate the extent to which hospitals in Saudi Arabia follow international guidelines and recommendations for the safe and effective administration of anesthesia in an MRI environment.

METHODS

This study used a questionnaire that was distributed to 31 medical facilities in Saudi Arabia that provided anesthesia in MRI units.

RESULTS

The findings of the study revealed that the mean compliance with the 17 guidelines across the 31 sites was 77%; 5 of the 31 sites (16.1%) had a compliance rate of less than 50% with the recommended guidelines. Only 19.4% of the institutes provided general safety education. Communication breakdowns between anesthesia providers and MRI teams were reported.

CONCLUSIONS

To conclude, this survey highlights the status of anesthesia standards in Saudi Arabian MRI units and emphasizes areas that require better adherence to international guidelines. The results call for targeted interventions, including the formulation of specific national anesthesia guidelines for MRI settings. Communication breakdowns between anesthesia providers and MRI teams were reported at a rate of 83.9% during the administration of a gadolinium contrast agent. There were additional breakdowns, particularly for high-risk patients with implants, such as impaired respirators (74.2%), thus requiring further investigation due to potential safety incidents during MRI procedures. While considering the limitations of this study, such as potential biases and the low response rate, it provides a valuable foundation for refining protocols and promoting standardized practices in Saudi Arabian healthcare.

Modification of Dispersin B with Cyclodextrin-Ciprofloxacin Derivatives for Treating Staphylococcal

To address the high tolerance of biofilms to antibiotics, it is urgent to develop new strategies to fight against these bacterial consortia. An innovative antibiofilm nanovector drug delivery system, consisting of Dispersin B-permethylated-β-cyclodextrin/ciprofloxacin adamantyl (DspB-β-CD/CIP-Ad), is described here. For this purpose, complexation assays between CIP-Ad and (i) unmodified β-CD and (ii) different derivatives of β-CD, which are 2,3-O-dimethyl-β-CD, 2,6-O-dimethyl-β-CD, and 2,3,6-O-trimethyl-β-CD, were tested. A stoichiometry of 1/1 was obtained for the β-CD/CIP-Ad complex by NMR analysis. Isothermal Titration Calorimetry (ITC) experiments were carried out to determine Ka, ΔH, and ΔS thermodynamic parameters of the complex between β-CD and its different derivatives in the presence of CIP-Ad. A stoichiometry of 1/1 for β-CD/CIP-Ad complexes was confirmed with variable affinity according to the type of methylation. A phase solubility study showed increased CIP-Ad solubility with CD concentration, pointing out complex formation. The evaluation of the antibacterial activity of CIP-Ad and the 2,3-O-dimethyl-β-CD/CIP-Ad or 2,3,6-O-trimethyl-β-CD/CIP-Ad complexes was performed on Staphylococcus epidermidis (S. epidermidis) strains. The Minimum Inhibitory Concentration (MIC) studies showed that the complex of CIP-Ad and 2,3-O-dimethyl-β-CD exhibited a similar antimicrobial activity to CIP-Ad alone, while the interaction with 2,3,6-O-trimethyl-β-CD increased MIC values. Antimicrobial assays on S. epidermidis biofilms demonstrated that the synergistic effect observed with the DspB/CIP association was partly maintained with the 2,3-O-dimethyl-β-CDs/CIP-Ad complex. To obtain this "all-in-one" drug delivery system, able to destroy the biofilm matrix and release the antibiotic simultaneously, we covalently grafted DspB on three carboxylic permethylated CD derivatives with different-length spacer arms. The strategy was validated by demonstrating that a DspB-permethylated-β-CD/ciprofloxacin-Ad system exhibited efficient antibiofilm activity.

Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety

Gadolinium-based contrast agents (GBCAs) are commonly used in magnetic resonance imaging (MRI) to enhance the visualisation and characterisation of the region of interest/lesion. Internal structures are well seen with MRI with good spatial resolution. Although MRI is generally considered safe during pregnancy, concerns have been raised regarding the safety of GBCAs, particularly during the first trimester. Limited studies have been conducted to assess the safety of GBCAs in pregnant women, with conflicting results. A comprehensive literature search was conducted using PubMed, SpringerLink, Medscape, ResearchGate and Wiley Online Library. The search terms included various combinations of MRI, pregnancy, first trimester, gadolinium contrast agents, foetus, risk, and toxicity. The search criteria were articles published in English in the last 20 years and indexed in the MEDLINE or Embase databases. The majority of studies found no definitive evidence that GBCAs are harmful during pregnancy, particularly during the first trimester. Some studies reported no increased risk of adverse outcomes in infants exposed to GBCAs during the first trimester. However, other studies showed inconsistent results. Retrospective cohort studies provided some reassurance regarding the safety of GBCAs when indicated in pregnant women but did not address potential long-term adverse outcomes in infants exposed to GBCAs during gestation. The literature review also highlights the importance of further evaluating the subacute and chronic effects of GBCA exposure in infants. The safety of GBCAs during pregnancy, particularly during the first trimester, remains uncertain. More large-scale, long-term studies are needed to clarify the safety of GBCAs in pregnant women and their potential effects on foetal and neonatal outcomes. Until conclusive evidence is available, healthcare providers should carefully weigh the benefits and risks of using GBCAs during pregnancy and consider alternative imaging modalities, such as non-contrast MRI or ultrasound, when necessary.

Impact of Magnetic Resonance Imaging on Healthcare in Low- and Middle-Income Countries

Magnetic resonance imaging (MRI) played a significant role in the digital health platforms that influenced and supported modern medicine. However, there is a shortage of MRI in low- and middle-income countries (LMICs). The International Society of Radiology offers a detailed plan for LMICs to advance imaging quality in the global health agenda. The overarching objective of this scoping review was to determine the impact of MRI in healthcare in LMICs. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between 2018 and 2021, namely, Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for gray literature. The search identified 54 articles. We identified a range of reasons for introducing MRI in LMICs. Nonetheless, some challenges to accepting MRI as a method of healthcare have been reported, including technological, regulatory, and economical challenges. To implement the proposed plan, the involvement of professional and international organizations is considered crucial. The establishment of an International Commission on Medical Imaging under the umbrella of international organizations is suggested and collaboration with other diagnostic disciplines is encouraged to raise awareness of the importance of upscale diagnostics at large and to foster its integration into the care pathway globally.

Examining the prevalence of obesity in school children through an on-site obesity outpatient clinics survey based on student's lifestyles

OBJECTIVE

The purpose of this study was to identify the prevalence of obesity, overweight, and risk factors in pediatric patients attending outpatient clinics at a public sector hospital in the central province of Saudi Arabia.

SUBJECTS AND METHODS

This cross-sectional study was conducted in Riyadh, the capital of Saudi Arabia, between January 2022 and October 2022. The target population was aged 6-15 years. We conducted on-site obesity assessments utilizing questionnaire-based interviews with patients attending outpatient clinics. Data collection was carried out with the help of parents, where required. Using BMI growth charts for Saudi children and teenagers, the weight, height, and body mass index (BMI) of subjects were computed.

RESULTS

A total of 576 responses with a response rate of 64% were received and included in the study. In the current study, the majority (41.1%) of the patients were aged between 11 and 12 years old, followed by 37.0% of the students aged between 13 and 15 years old, and 21.9% of students aged between 8 and 10 years old. In the current study, 54.2% of the patients had normal weight, 15.6% of patients were underweight, 16.7% of patients were overweight, and 13.5% were obese. In this study, the prevalence of overall obesity was 2.3 times more prevalent in children aged 11 to 12 years (OR=2.30; p=0.03), followed by ~2 times higher levels in children aged 13 to 15 years (OR=2.30; p=0.03). Moreover, 2.11 times higher prevalence of obesity (OR=2.11; p=0.77) in those who regularly took food (especially lunch) from the school cafeteria. A significant ~2.5 high obesity level was recorded for students who consumed fizzy/soft drinks four or more times per week (OR=2.38; p=0.007).

CONCLUSIONS

Saudi Arabia still has a high rate of overweight and obesity among children of school-going age, which is a significant public health issue. To properly address and control this issue, policies at the national, local, and individual levels must be implemented. Notably, there was also a high prevalence of being underweight, and this issue needs to be brought up as well.

Safety Survey on Lone Working Magnetic Resonance Imaging Technologists in Saudi Arabia

PURPOSE

The American College of Radiology (ACR) requires MR personnel not to work alone due to the increased risk of safety issues such as projectiles, aggressive patients, and technologist fatigue. As a result, we intend to assess the current safety of lone-working MRI technologists in MRI departments in Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study using a self-report questionnaire was conducted in 88 Saudi hospitals.

RESULTS

A response rate of 64% (174/270) was obtained among the 270 MRI technologists which were identified. The study discovered that 86% of MRI technologists had prior experience working alone. In terms of MRI safety training, 63% of MRI technologists received such training. A question about lone MRI workers' awareness of the ACR's recommendations revealed that 38% were unaware of such recommendations. Furthermore, 22% were misinformed, believing that working alone in an MRI unit is optional or depends on the individual's desire to work alone. Working alone has the primary consequence of being statistically significantly associated with projectile/object-related accidents/mistakes (p = 0.03).

CONCLUSION

Saudi Arabian MRI technologists have extensive experience working alone without supervision. Most MRI technologists are unaware of lone working regulations, which has raised concerns about accidents/mistakes. There is a need for MRI safety training and adequate practical experience to raise awareness of MRI safety regulations and policies related to lone working among departments and MRI workers.

Assessment of MRI Safety Practices in Saudi Arabia

Aim

The aim of this study is to investigate the safety practices used by MRI departments in Saudi Arabia.

Methods

A cross-sectional study across 113 private and public hospitals was conducted in Saudi Arabia. A survey questionnaire was designed and sent to 113 MRI units. The questionnaire consisted of 43 items under 14 sections for the assessment of MRI safety practices. These 14 sections are related to (i) MRI and its safety, (ii) MRI usage and its safety, and (iii) safety of the MRI technologists and reporting of adverse effects during the usage. The American College of Radiology (ACR) guidance document on MRI safety practices was used as a template for this survey. Data were analyzed using IBM SPSS Statistical software for Windows version 26.0 (IBM Corp., Armonk, NY, USA).

Results

Of the 43 items assessed, only 3 items' binary responses (Yes & No) did not differ much. A greater proportion of positive responses for 40 items (93%) regarding MRI safety practices. More than 50% of the participants claimed that their departments lacked a Magnetic Resonance Safety Officer (MRSO). Regarding regular safety training programs, less than 50% received training in MRI safety. Handheld metal detectors were found in only 39% of the MRI units.

Conclusion

The majority of MRI units in Saudi Arabia have demonstrated compliance with majority of ACR MRI safety recommendations; nonetheless, there are two main items for which the guidelines may not be attained: MRSO and regular MRI safety training programs. By taking into account the limitations of this study, it is strongly recommended to assign MRSO and implement annual MRI safety training to improve MRI safety practices for both patients and healthcare workers.

Assessment of Patient Knowledge Level Towards MRI Safety Before the Scanning in Saudi Arabia

Purpose

Magnetic resonance imaging (MRI) is an important diagnostic method in modern clinical medicine. Patients’ ‎‎knowledge about MRI is of utmost importance for optimizing the workflow, ‎safety, and patient comfort and saving valuable time for the MRI department. This study investigates patient knowledge levels regarding MRI safety before an MRI examination.

Patients and Methods

A cross-sectional survey was completed by 200 patients who required MRI. Recruitment occurred over eight weeks in ‎governmental and private hospitals in Saudi ‎Arabia; both hospitals and participants were selected randomly. The ‎questionnaire was given to the patients prior to ‎their MRI scans. Descriptive statistics and chi-square tests were performed to identify relationships between knowledge of MRI safety and selected demographic groupings (age, gender, education level, income level). It also evaluates their source of information and assesses the patient’s previous experience regarding MRI scans.‎

Results

The study sample consisted of 200 patients from 230 surveys distributed in ‎Saudi Arabia, and the response rate was ~ 87%. Depending on the P-values of the chi-square statistical test to find the relationship between ‎socio-demographic factors and patient’ knowledge level, the results showed a significant association (p-value=0.006) between age and gender and the level of knowledge relating to MRI safety issues. A similar significance (p-value=0.042) is observed between the knowledge level of patients and their educational level and annual income. In addition, a highly significant association (p-value<0.001) is found between education level or previous experience and whether people seek information about MRI safety.

Conclusion

The study findings suggest that a complex combination of factors affects patient knowledge regarding MRI safety before an MRI examination. Hence, the hospital and radiological department must ‎‎provide the ‎patient with accurate information about MRI.‎

Improving cervical spinal cord lesion detection in multiple sclerosis using filtered fused proton density-T2 weighted images

Background

Magnetic Resonance Imaging (MRI) is considered a vital in depicting multiple sclerosis (MS) lesions. Current studies demonstrate that proton density (PD) weighted images (WI) are superior to T2 WI in detecting MS lesions (plaques) in the spinal cord.

Purpose

To evaluate the diagnostic value of filtered fused PD/T2 weighted images in detecting cervical spinal cord MS lesions.

Material and Methods

In this retrospective study, we selected a sample size of 50 MS patients. Using contrast limited adaptive histogram equalization (CLAHE), a digital image processing filter was used on the (PD/T2) fused images. The produced images were inspected and compared to the original PD images by two experienced neuroradiologists using interobserver and intraobserver. An ROI analysis was also performed on the processed and original PD images.

Results

The repeatability measurement of the match between the two examinations was highly consistent for both neuroradiologists. The repeatability for both neuroradiologists was 96.05%, and the error measurement was 3.95%. The reproducibility measurement of the neuroradiologist’s evaluation shows that the processed images could help to identify lesions better [excellent (84.87%)] than PD images [good (61.19%)]. ROIs analysis was performed on 113 MS lesions and normal areas in different images within the sample size. It revealed an enhanced ratio of 2.2 between MS lesions and normal spinal cord tissue in processed fused images compared to 1.34 in PD images.

Conclusion

The processed images of the fused images (PD/T2) have superior diagnostic sensitivity for MS lesions in the cervical spine than PD images alone.

OCCUPATIONAL DOSES TO RADIOGRAPHY INTERNSHIP STUDENTS IN SAUDI ARABIA USING OPTICALLY STIMULATED LUMINESCENCE DOSIMETRY

This study aimed to estimate a baseline for the effective doses received by radiography internship students in Saudi Arabia. A retrospective study was conducted from 2015 to 2018 to discern the effective dose measurements for a total of 206 students using optically stimulated luminescence dosemeters. Readings were performed using the OSLR-250 Automatic Reader. Data analysis was carried out on 813 readouts. The annual mean effective dose averaged over a period of 4 y was found to be 0.55 mSv, with a standard deviation of 0.34 mSv and a range of 0.14-1.58 mSv. The results show that 92% ($\frac{190}{206}$) of the students received annual effective doses of <1 mSv. No annual dose record exceeded the limits recommended by authorities (20 mSv/y). The study concluded that the applied radiation protection measures along with education and training help create a safe work environment for radiography internship students.

Erythritol alters microstructure and metabolomic profiles of biofilm composed of Streptococcus gordonii and Porphyromonas gingivalis

The effects of sugar alcohols such as erythritol, xylitol, and sorbitol on periodontopathic biofilm are poorly understood, though they have often been reported to be non-cariogenic sweeteners. In the present study, we evaluated the efficacy of sugar alcohols for inhibiting periodontopathic biofilm formation using a heterotypic biofilm model composed of an oral inhabitant Streptococcus gordonii and a periodontal pathogen Porphyromonas gingivalis. Confocal microscopic observations showed that the most effective reagent to reduce P. gingivalis accumulation onto an S. gordonii substratum was erythritol, as compared with xylitol and sorbitol. In addition, erythritol moderately suppressed S. gordonii monotypic biofilm formation. To examine the inhibitory effects of erythritol, we analyzed the metabolomic profiles of erythritol-treated P. gingivalis and S. gordonii cells. Metabolome analyses using capillary electrophoresis time-of-flight mass spectrometry revealed that a number of nucleic intermediates and constituents of the extracellular matrix, such as nucleotide sugars, were decreased by erythritol in a dose-dependent manner. Next, comparative analyses of metabolites of erythritol- and sorbitol-treated cells were performed using both organisms to determine the erythritol-specific effects. In P. gingivalis, all detected dipeptides, including Glu-Glu, Ser-Glu, Tyr-Glu, Ala-Ala and Thr-Asp, were significantly decreased by erythritol, whereas they tended to be increased by sorbitol. Meanwhile, sorbitol promoted trehalose 6-phosphate accumulation in S. gordonii cells. These results suggest that erythritol has inhibitory effects on dual species biofilm development via several pathways, including suppression of growth resulting from DNA and RNA depletion, attenuated extracellular matrix production, and alterations of dipeptide acquisition and amino acid metabolism.