Fawaz Al-Hussain

Pattern of traditional medicine use by adult Saudi patients with neurological disorders

BackgroundTraditional medicine (TM) has been established as a two-edged sword. On one edge numerous forms of TM have been proven safe and effective, while on the other edge various modes of TM have been shown to be futile and potentially dangerous. Resorting to TM, especially for chronic diseases, is common world-wide and includes Saudi Arabia. Most neurological diseases are chronic. No data is available on the utilization of TM among patients with neurological disorders. We conducted this study to assess for the prevalence, pattern, perception and triggers for TM use by the adult Saudi patients with neurological disorders.MethodsA survey written in Arabic and comprised of 15 questions was used to collect data on the practice of TM among the neurology patients of King Saud University Ambulatory Clinic. The questions in the survey pertain mainly to the frequency of TM practice, its form and the patient’s opinion of this practice. The data was collected through a face to face interview by three medical students who were instructed on the survey questions prior to the launch of the study.Results292 patients completed the survey (35.9% males and 64.0% females). 67% (n = 196) of the sample used TM. Cupping or what is commonly known as “hojamah” was the most prevalent method (45.4%) followed by herbs, skin cauterization and the Reciting of the Holy Quran (42.3%, 33.7% and 20.4% respectively). The prevalence of TM use did not differ across gender (chi-sq = 2.02; p-value = 0.15), level of education (chi-sq = 4.02; p-value = 0.40), health status (chi-sq = 2.29; p-value = 0.68), age groups (chi-sq = 5.12; p-value = 0.16), or perception toward TM (chi-sq = 2.67; p-value = 0.26) in this population.ConclusionThe practice of TM is common among the neurology patients of Saudi Arabia. Cupping, herbs, and skin cauterization, which can be harmful when wrongly employed, are frequently utilized in this patient population. Measures and policies to endorse the appropriate use of TM by Saudi society must be implemented promptly.

Stroke Awareness in the Saudi Community Living in Riyadh: Prompt Public Health Measures Must Be Implemented

BACKGROUND Stroke is very prevalent in the Kingdom of Saudi Arabia, approaching 43.8 per 100,000 people. Stroke outcome is known to be affected by the level of stroke awareness in the community. We conducted this study to assess the level of stroke awareness in the Saudi population. METHODS A validated survey of 11 questions was used to assess the level of stroke awareness among the Saudi population. The survey was distributed in a 1-month period to every adult Saudi citizen visiting 10 shopping centers, 10 large supermarkets, 4 hospitals, and 2 universities. RESULTS Two thousand eight hundred sixty-two people completed the questionnaire (a 78% response rate). One thousand eight hundred forty-four people (64%) were able to define stroke correctly. One thousand four hundred twenty-eight people (49.9%) named mass media as the source of their knowledge. One thousand three hundred one (45.9%) believe stroke and brain death share the same pathologic mechanism and outcome, particularly those <40 years of age (P < .05). Six hundred twenty-two (21.7%) of the respondents correctly chose ≥5 risk factors and made ≤1 error. Five hundred twenty-seven (18.4%) of the participants in this study were able to correctly identify ≥3 symptoms of the list and make ≤1 error. CONCLUSIONS There is an alarming deficit in the level of stroke awareness in the Saudi population. Urgent public health measures to correct this deficiency are promptly needed.

Traditional treatment of epilepsy Trepanation revisited

A 29-year-old South Asian man, with epilepsy since childhood, presented to the emergency room with a seizure. CT scan (figure) showed multiple metallic needles projecting from the coronal suture into the brain. In order to expel the demon that a traditional healer believed was haunting the patient, the skull and brain were pierced with needles. It is unclear whether the demon was successfully expelled, but the seizures persisted and could have been worsened by this treatment. Measures are warranted to warn the public against dangerous modes of traditional medicine.1,2

Idiopathic Intracranial Hypertension Induced by Topical Application of Vitamin A.

A 21-year-old nonobese woman developed headaches and papilledema while excessively using 3 topical preparations of vitamin A. Neuroimaging studies were unremarkable and opening pressure on lumbar puncture was 300 mm H2O with normal cerebrospinal fluid composition. After discontinuation of the topical vitamin A preparations, the symptoms and signs of increased intracranial pressure resolved. The association of intracranial hypertension and topical vitamin A application has only been reported once previously.

The role of serum levels of thioredoxin and thioredoxin-interacting protein in stroke

Aims: Serum level of thioredoxin (TRX), a redox-regulating protein with antioxidant activity, increases under oxidative stress. The present study measured serum levels of TRX and its inhibitor TRX-interacting protein (TXNIP) in patients who experienced first-ever acute ischemic stroke (AIS). Subjects and Methods: We retrospectively enrolled 45 patients who experienced AIS and 33 age- and sex-matched healthy controls. Serum TRX and TXNIP levels in stroke patients and healthy controls were analyzed by performing solid-phase sandwich enzyme-linked immunosorbent assay. Results: Our results showed that mean serum TXNIP levels were significantly higher in stroke patients than in healthy controls (P = 0.044). However, serum TRX levels were not significantly different between stroke patients and healthy controls (P = 0.405). Moreover, we observed a significant positive correlation between TRX and TXNIP levels (R2 = 0.476, P < 0.003). Conclusions: These results suggest that TRX and TXNIP are rapid, inexpensive, and convenient biomarkers of stroke. However, additional studies should be performed to validate these preliminary observations and the role of TRX and TXNIP in AIS.

The impact of old versus new antiepileptic drugs on costs and patient reported outcomes among older adults

&NA; The aim of this prospective questionnaire‐based cross‐sectional study was to examine whether the new generation of Antiepileptic drugs (AEDs) with higher acquisition cost generate lower adverse effects than the old AEDs among a sample of 102 Arabic‐speaking older adults (60 years of age or older) with seizure disorders. The mean scores of the Arabic version of the Liverpool Adverse Events Profile (LAEP), which assessed the adverse effects of the AEDs, did not differ between patients taking the old and new generations of AEDs. Despite their 4‐fold higher cost, the new generation of AEDs were not characterized by lower LAEP scores of adverse effects. However, higher LAEP scores were associated with better health literacy. In conclusion, the use of new AEDs was not associated with lower self‐reported adverse effects scores among Arabic‐speaking older adults with seizure disorders despite their higher acquisition costs.