In Saudi Arabia, non-traumatic spinal etiologies are the most frequent cause of spinal cord dysfunction in the elderly. Male gender, hypertension, and diabetes mellitus were high-risk factors among the geriatric age group with SCI/D. Elderly individuals with SCI/D without complications can have a shorter hospitalization period and higher functional gains during rehabilitation.

alzheimer's disease (ad) is a neurodegenerative disorder characterized by cognitive decline and brain neuronal loss. A pioneering field of research in AD is brain stimulation via electromagnetic fields (EMFs), which may produce clinical benefits. Noninvasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS), have been developed to treat neurological and psychiatric disorders. The purpose of the present review is to identify neurobiological changes, including inflammatory, neurodegenerative, apoptotic, neuroprotective and genetic changes, which are associated with repetitive TMS (rTMS) treatment in patients with AD. Furthermore, it aims to evaluate the effect of TMS treatment in patients with AD and to identify the associated mechanisms. The present review highlights the changes in inflammatory and apoptotic mechanisms, mitochondrial enzymatic activities, and modulation of gene expression (microRNA expression profiles) associated with rTMS or sham procedures. At the molecular level, it has been suggested that EMFs generated by TMS may affect the cell redox status and amyloidogenic processes. TMS may also modulate gene expression by acting on both transcriptional and post-transcriptional regulatory mechanisms. TMS may increase brain cortical excitability, induce specific potentiation phenomena, and promote synaptic plasticity and recovery of impaired functions; thus, it may re-establish cognitive performance in patients with AD. Contents1. introduction 2. TMS 3. ad and niBS by TMS 4. Neurobiological changes associated with TMS in AD 5. Potential side effects associated with TMS treatment 6. discussion 7. conclusion

Infection with COVID-19 is associated with significant morbidity, especially in patients with chronic medical conditions. At least one-fifth of cases require supportive care in intensive care units, which have limited availability in most developing countries. A literature search was conducted on PubMed, Medline, Scopus, Embase, and Google Scholar to find articles published by May 7, 2020 on the role of comorbidities in patients with COVID-19 and the impact of comorbidities on the disease. This review highlighted that patients with comorbidities are more likely to experience severe disease than those with no other conditions; that is, comorbidities correlated with greater disease severity in patients with COVID-19. Proper screening of COVID-19 patients should include careful inquiries into their medical history; this will help healthcare providers identify patients who are more likely to develop serious disease or experience adverse outcomes. Better protection should also be given to patients with COVID-19 and comorbidities upon confirmation of the diagnosis. This literature review showed that the comorbidities most often associated with more severe cases of COVID-19 are hypertension, cardiovascular disease, and diabetes. Individuals with these comorbidities should adopt restrictive measures to prevent exposure to COVID-19, given their higher risk of severe disease.

Background: Motor deficits are common after stroke and are a major contributor to stroke-related disability and the potential for long-lasting neurobiological consequences of stroke remains unresolved. There are only a few treatments available for the improvement of motor function in stroke patients. However, the mechanisms underlying stroke recovery remain poorly understood, and effective neurorehabilitation interventions remain insufficiently proven for widespread implementation. Methods: Herein, we propose to enhance the effects of brain plasticity using a powerful noninvasive technique for brain modulation consisting of navigated transcranial magnetic stimulation (TMS) priming with transcranial direct current stimulation (tDCS) in combination with motor-training-like constraint-induced movement therapy (CIMT). Our hypothesis is that navigated low-frequency rTMS stimulus priming with precise location provided by neuronavigation on the healthy side of the brain and with anodal tDCS on the affected side combined with CIMT will induce a greater motor function improvement than that obtained with sham tDCS combined with CIMT alone. We predict that the application of this technique will result in a large reduction in cortical excitability and dis-inhibition in the affected hemisphere and lead to improvements in behavioral measures of hand function in stroke patients. Discussion: The proposed study, therefore, is important for several reasons. The results could potentially lead to improved stroke therapeutics, and the approach makes use of 2 potential pathways to modulate brain function. Trial registration: This study protocol was registered in Clinical Trials Registry (https://clinicaltrials.gov/ct2/show/NCT04646577). Ethics and dissemination: The study has been reviewed and approved by the Human Research Ethics Committee of the King Fahad Specialist Hospital Dammam. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.

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Objective: To determine the frequency and types of medical complications that occur during stroke inpatient rehabilitation at a tertiary care rehabilitation hospital in Saudi Arabia. Design: Retrospective study Setting: Tertiary Care Rehabilitation Hospital. Participants: Our study included 60 patients with an age range of 20-95 years (mean¼63 years); Interventions: The data of 60 stroke patients discharged from inpatient stroke rehabilitation was collected retrospectively from medical records during the period from June 2010 to June 2011. Main Outcome Measures: Demographic and stroke characteristics, preexisting medical conditions, medical complications occurring during acute inpatient rehabilitation Results or Clinical Course: Our study included 60 patients with an age range of 20-95 years (mean¼63 years); 37(62%) males and 23(38%) females. Left side of body was more commonly involved (62%). The strokes were predominantly ischemic in origin (78.3%), The mean onset-to-rehabilitation ward admission interval was 23 days. The mean length of the rehabilitation stay was 49 days. The frequencies of preexisting medical conditions among the patients shows that hypertension (95%), diabetes mellitus (65%), and history of smoking (26.7%) prior stroke (26.7%), hyperlipidemia (21.7%), were the most common preexisting conditions. It shows that musculoskeletal pain (63.33%), depression (21.6%) urinary tract infection (18.33%), stroke progression(7%) identified most frequently occurring medical complications. One patient experienced sudden death due to cardiac arrest of unknown cause. There was significant association of UTI (P¼0.0490) and depression (P¼0.0249) with type of stroke. Depression was also significantly associated (P¼0.0015) with length of stay in rehab. Conclusions: Stroke inpatient rehabilitation is an active medical service. Medical complications are common during inpatient stroke rehabilitation. Management and prevention are very important in the rehabilitation stroke units. Most complications are potentially preventable or treatable if recognized. In rehabilitation stroke wards protocols for the prevention, detection, and treatment of the most common complications should be established. On a larger perspective, this measure may help in achieving better functional outcomes and reducing the cost of health care for stroke patients during inpatient rehabilitation.Poster 332

This case brings attention to development of rehabilitation protocols for patients with decompression sickness (DCS). A lack of data regarding DCS renders the need of conducting multicenter studies to document the epidemiology and outcomes of spinal cord DCS in Saudi Arabia.

We studied young hemorrhagic stroke patients (YHSP; 50 years cut off) admitted to Cleveland Clinic Abu Dhabi (CCAD). We studied demographics, risk factors, stroke subtype and outcomes. We used descriptive statistics and student t test for continuous variables (Pb0.05).There were 45 YHSP: (mean age 39.2 y; min 20, max 50), there were 13 women (28.9%) and 32 men (71.1%); there was no age difference between the two (40.0 vs. 39.3; p=ns); there were 8 UAEN (17.8%) and 37 expats (82.2%) and there was no age difference between the two (43.6 vs. 38.6; p=0.057). There were 21 (46.7%) intracerebral hemorrhage patients [ICH; 14 primary (31.1%); 7 secondary (15.6%)], and 24 (53.3%) subarachnoidal hemorrhage (SAH) patients; there was no age difference between the two (40.6 vs. 38.5y). The risk factors included hypertension (52%), dyslipidemia (27.1%), smoking 12 (25%), obesity 13 (27.1%) in the whole group. Initial mean NIHSS score was 13.6 (range 0-35); 37.8% of patients had mRS 0-1at discharge, case fatality was 20%.Our data show high prevalence of hypertension and dyslipidemia in YHSP. More than 1/3 of YHSP had favorable outcome at discharge. Larger scale studies are needed to further elucidate hemorrhagic stroke epidemiology and prognosis in UAE especially in young patients.