Objective The epidemiology and treatment of peripheral neuropathy in systemic sclerosis (SSc) is poorly understood. The objectives of this study were to evaluate the incidence, prevalence, risk factors, and treatments of peripheral neuropathy in SSc. Methods A systematic review of Medline, Embase and CINAHL databases for literature reporting peripheral neuropathy in SSc was performed. Studies evaluating incidence, prevalence, risk factors, and treatments were synthesized. Meta-analysis using a random effects model was used to evaluate the prevalence of peripheral neuropathy. Results 113 studies reported 949 subjects with at least one type of peripheral neuropathy out of 2143 SSc patients studied. The mean age was 48.5 years. The mean time between SSc onset and detection of peripheral neuropathy was 8.85 years. The pooled prevalence of neuropathy was 27.4% (95%CI 22.4% - 32.7%). Risk factors for peripheral neuropathy in SSc included advanced diffuse disease, anticentromere antibodies, calcinosis cutis, ischemia of the vasa nervosum, iron deficiency anemia, metoclopramide, pembrolizumab, silicosis and uremia. There were 73 subjects with successful treatments (n=36 restoring sensation, n=37 restoring motor or sensorimotor function). Treatments included decompression surgery, prednisone, cyclophosphamide, carbamazepine, transcutaneous electrical nerve stimulation, tricyclic antidepressants and IVIG. Conclusion All-cause peripheral neuropathy is not uncommon in SSc. Compression neuropathies can be treated with decompression surgery. Observational data reporting immunosuppressive and anticonvulsants to treat peripheral neuropathy in SSc is limited and conflicting. This data provides the signal of effect to justify RCT to evaluate the efficacy of these interventions.

Background The 2021 American College of Rheumatology (ACR) rheumatoid arthritis (RA) guideline considers the specific context of the United States which differs from that of Saudi Arabia in many aspects that may impact recommendations. The objective of this project was to adapt a set of prioritized recommendations from the 2021 ACR guideline for the treatment of rheumatoid arthritis RA for the context of Saudi Arabia, by the Saudi Society for Rheumatology (SSR). Methods The process followed the GRADE-ADOLOPMENT methodology, and the reporting adhered to the RIGHT-Ad@pt checklist. Working groups included a coordination group and a 19-member panel representing different stakeholder groups. The Evidence to Decision (EtD) tables included evidence on health effects from the source guideline and contextual information from the Saudi setting. Results The panel prioritized and adapted five recommendations from the source guideline. The process led to modifying two out of the five prioritized recommendations, all listed here. In naive patients with low disease activity, methotrexate (MTX) is conditionally recommended over sulfasalazine (SSZ) (modified direction); hydroxychloroquine (HCQ) is conditionally recommended over SSZ (unmodified). Initiation of csDMARDs with short-term glucocorticoids is conditionally recommended over csDMARDs alone in naive patients with moderate to high disease activity (modified direction). Switch to subcutaneous MTX is conditionally recommended over addition/switch to alternative DMARD(s) in patients taking oral MTX who are not at target (unmodified). Discontinuation of MTX is conditionally recommended over gradual discontinuation of the bDMARD or tsDMARD for patients taking MTX plus a bDMARD or tsDMARD who wish to discontinue a DMARD (unmodified). Conclusion Rheumatologists practicing in Saudi Arabia can use the adoloped recommendations generated by this project while adopting the rest of the recommendations from the 2021 ACR guidelines.

Criticism of the implementation of existing risk prediction models (RPMs) for cardiovascular diseases (CVDs) in new populations motivates researchers to develop regional models. The predominant usage of laboratory features in these RPMs is also causing reproducibility issues in low–middle-income countries (LMICs). Further, conventional logistic regression analysis (LRA) does not consider non-linear associations and interaction terms in developing these RPMs, which might oversimplify the phenomenon. This study aims to develop alternative machine learning (ML)-based RPMs that may perform better at predicting CVD status using nonlaboratory features in comparison to conventional RPMs. The data was based on a case–control study conducted at the Punjab Institute of Cardiology, Pakistan. Data from 460 subjects, aged between 30 and 76 years, with (1:1) gender-based matching, was collected. We tested various ML models to identify the best model/models considering LRA as a baseline RPM. An artificial neural network and a linear support vector machine outperformed the conventional RPM in the majority of performance matrices. The predictive accuracies of the best performed ML-based RPMs were between 80.86 and 81.09% and were found to be higher than 79.56% for the baseline RPM. The discriminating capabilities of the ML-based RPMs were also comparable to baseline RPMs. Further, ML-based RPMs identified substantially different orders of features as compared to baseline RPM. This study concludes that nonlaboratory feature-based RPMs can be a good choice for early risk assessment of CVDs in LMICs. ML-based RPMs can identify better order of features as compared to the conventional approach, which subsequently provided models with improved prognostic capabilities.

ObjectiveTo assess the demographic, clinical, and survival profile of people living with HIV.MethodsA retrospective cohort study was conducted among patients enrolled at a single antiretroviral therapy center in North Karnataka. A total of 11,099 were recruited from April 2007 to January 2020, out of which 3,676 were excluded and the final 7,423 entries were subjected to analysis. The outcome of interest was the time to death in months of people living with HIV on antiretroviral therapy (ART). The clinical and demographic characteristics were examined as potential risk factors for survival analysis. To investigate the factors that influence the mortality of patients using ART, univariate and multivariate Cox regression were performed. Hazard ratio (HR), 95% confidence interval (CI), and p-values were presented to show the significance. The log-rank test was used to determine the significance of the Kaplan–Meier survival curve.ResultsOut of 7,423 HIV-positive people, majority were female (51.4%), heterosexual typology (89.2%), and in the age group 31–45 years (45.5%). The risk of death in male patients was 1.24 times higher (95% CI: 1.14–1.35) than female patients. Patients with age >45 were 1.67 times more likely to die than patients ≤30 (95% CI: 1.50–1.91). In the multivariable analysis, the hazards of mortality increased by 3.11 times (95% CI: 2.09–2.79) in patients with baseline CD4 count ≤50 as compared to those who had baseline CD4 count >200. The risk of death in patients who were diagnosed with TB was 1.30 times more (95% CI: 1.19–1.42) than in those who did not have TB. The survival probabilities at 3 and 90 months were more in female patients (93%, 70%) compared with male patients (89, 54%), respectively.ConclusionThis study proved that age, sex, baseline CD4 count, and tuberculosis (TB) status act as risk factors for mortality among people with HIV. Prevention strategies, control measures, and program planning should be done based on the sociodemographic determinants of mortality.

Background Professional competency of graduates of an institute reflects its teaching and learning environment (TLE). This study aimed to provide a preliminary assessment of the TLE at the College of Medicine at Majmaah University. Methods A cross-sectional survey was conducted during the 2019-20 academic year among students at the College. A validated scoring tool “the Experience of Teaching and Learning Questionnaire” (available at https://bit.ly/3sVBuEw) was used. The mean score of each section and statement, the difference between the mean scores of different demographic groups, and correlations between sections were analysed. Results A total of 234 (72.2%) enrolled students participated in this survey, with a male-to-female ratio and a ratio of participants from basic to clinical years being 2:1 and 1:1, respectively. Most participants reported a GPA of above 3/5. The overall mean score was 3.52/5 points. Section one “approaches to learning and studying” has the highest mean score (3.68), and no section scored a mean below three, though section three “demands made by the course” scored a borderline mean of 3.08. Students in clinical years had a significantly higher overall mean score compared to their counterparts (3.66 vs. 3.39, p < 0.001). Conclusions Students at the College had a positive perception of the TLE, but face challenges in coping with the demands of acquiring knowledge and subject-based skills, and in appreciating the TLE especially during basic science years, highlighting the need for an atmosphere that allows them to meet demands and develop greater appreciation.

Our objectives of the study is to assess the sociodemographic profile and survival profile of HIV patients. A retrospective cohort study was conducted among patients enrolled at a single antiretroviral therapy center at North Karnataka. A total of 11099 were recruited during April 2007 to January 2020. The outcome of interest was the time to death in months of HIV patients on ART. R Studio Version 1.3.1093 was used for statistical analysis. Out of 7423 HIV-positive people majority were female (51.4%), heterosexual typology (89.2%), and in the age group 31 to 45 years (45.5%). In the multivariable analysis that hazards of mortality increased by 3.11 times and 2.11 times in patients with baseline CD4 count < = 50 and baseline CD4 count 51 to 200 respectively as compared to those who had baseline CD4 count > 200. The mortality rate was high in the initial three months after the start of ART and overall survival probabilities among HIV-infected patients declined over follow-up time. This study proved that age, sex, baseline CD4 count, and TB status act as risk factors for mortality among HIV-positive individuals. Prevention strategies, control measures, and program planning should be done based on the sociodemographic determinants of mortality.

Background: This study was conducted to assess the level of knowledge and awareness of hypothyroidism and its neuropsychiatric clinical manifestations among the Saudi population. Methods: This was a cross-sectional study employing a convenient sampling technique, conducted between February and May 2022. A questionnaire was distributed online to all participants in all five regions. Results: In this survey, a total of 2016 Saudi citizens participated. When asked about depression, more than half of the participants (59.6%) correctly identified depression as one of the neuropsychiatric clinical symptoms of hypothyroidism. Nearly half of the participants (47.5%) were unaware that anxiety was not a neuropsychiatric manifestation of hypothyroidism. With a percentage of 91.0%, the majority of participants exhibited poor knowledge. The regression analysis showed that males have significantly reduced knowledge about hypothyroidism than females (coefficient −3.686, p-value < 0.0001). Similarly, those who have “enough income and can save” were more knowledgeable than others (coefficient 0.731, p-value < 0.02). Regarding the source of information, journals provide three times more information (p-value 0.0001), and healthcare practitioners provides four times more information as compared to family and friends (p-value 0.0001). Conclusion: Due to a lack of knowledge about hypothyroidism and its complications, symptoms, risk factors, and treatment, the most viable solution to these misconceptions would be to implement a variety of educational programs to increase public awareness of this issue.

Background: Antimicrobial resistance is increasing at an alarming rate. The use of antibiotics without a prescription by  a patient or other family members and their inappropriate storage have caused serious health issues as it would lead to antibiotic resistance and exposure to risk of harmful adverse effects unnecessarily. Exploring causes behind their storage in homes and reuse will help us identify the problem in depth and help in recommending effective solutions. Methods: This is a cross-sectional study. Our target study population was the residents of Saudi Arabia. Data were collected by an online questionnaire and analysed by SPSS. Results: A total of 738 participants answered the online questionnaire, from all ages, genders, nationalities, and different socioeconomic backgrounds residing in different regions across the kingdom of Saudi Arabia. 76.42% knew that an antibiotic is a chemical substance used to treat infections. The participants were questioned about when do they start using antibiotics, to which 95.66% (n=706) responded, after consulting a physician, 3.25% (n=24) said when they felt ill for any reason, and 1.08% (n=8) replied after first attempting herbal medicine. 147 participants admitted that they store excess pills of antibiotics after being prescribed for an infection and re-use them later on for symptoms like sore throat and fever. Conclusions: Although strict measures have been put into effect from the Saudi Ministry of Health to reduce antimicrobial resistance caused by misuse of antibiotics by restricting the dispense of antibiotics from pharmacies without a medical prescription, a large portion of the population regardless of age, level of education, or professional background, have continued to store excess pills of antibiotics after an infection treatment and re-use them once they think they need them for new symptoms. This advises for further revision of the current measures to fill those gaps and reduce this habit.