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STUDY OBJECTIVES: The objective of this study was to evaluate interrater reliability between manual sleep stage scoring performed in 2 European sleep centers and automatic sleep stage scoring performed by the previously validated artificial intelligence–based Stanford-STAGES algorithm. METHODS: Full night polysomnographies of 1,066 participants were included. Sleep stages were manually scored in Berlin and Innsbruck sleep centers and automatically scored with the Stanford-STAGES algorithm. For each participant, we compared (1) Innsbruck to Berlin scorings (INN vs BER); (2) Innsbruck to automatic scorings (INN vs AUTO); (3) Berlin to automatic scorings (BER vs AUTO); (4) epochs where scorers from Innsbruck and Berlin had consensus to automatic scoring (CONS vs AUTO); and (5) both Innsbruck and Berlin manual scorings (MAN) to the automatic ones (MAN vs AUTO). Interrater reliability was evaluated with several measures, including overall and sleep stage-specific Cohen’s κ. RESULTS: Overall agreement across participants was substantial for INN vs BER (κ = 0.66 ± 0.13), INN vs AUTO (κ = 0.68 ± 0.14), CONS vs AUTO (κ = 0.73 ± 0.14), and MAN vs AUTO (κ = 0.61 ± 0.14), and moderate for BER vs AUTO (κ = 0.55 ± 0.15). Human scorers had the highest disagreement for N1 sleep (κ(N1) = 0.40 ± 0.16 for INN vs BER). Automatic scoring had lowest agreement with manual scorings for N1 and N3 sleep (κ(N1) = 0.25 ± 0.14 and κ(N3) = 0.42 ± 0.32 for MAN vs AUTO). CONCLUSIONS: Interrater reliability for sleep stage scoring between human scorers was in line with previous findings, and the algorithm achieved an overall substantial agreement with manual scoring. In this cohort, the Stanford-STAGES algorithm showed similar performances to the ones achieved in the original study, suggesting that it is generalizable to new cohorts. Before its integration in clinical practice, future independent studies should further evaluate it in other cohorts. CITATION: Cesari M, Stefani A, Penzel T, et al. Interrater sleep stage scoring reliability between manual scoring from two European sleep centers and automatic scoring performed by the artificial intelligence–based Stanford-STAGES algorithm. J Clin Sleep Med. 2021;17(6):1237–1247.

Objective Sleep complaints are frequent after acute COVID-19. Aim of this study was to videopolysomnographically evaluate sleep and sleep disorders after SARS-Cov2 infection. Methods Patients with suspected sleep disorders after acute COVID-19 underwent video-polysomnography (v-PSG) at the Sleep Disorders Clinic, Department of Neurology, Medical University Innsbruck. V-PSG was conducted 4.2 (SD = 1.3) months after diagnosis of SARS-CoV-2 infection. Results Eleven patients [nine men, age 52.5 (SD = 11.7) years; BMI 29 (SD = 5.2) kg/m2] were included. At 60 days follow-up after diagnosis, persisting breathing complaints were present in 7/11 (64%) patients. After v-PSG four patients (36%) were diagnosed with obstructive sleep apnea (OSA). Respiratory frequency during sleep was normal and no tachypnea, thoracoabdominal asynchrony, or periodic deep sighing were detected. Four patients (36%) showed REM sleep without atonia (RWA), and two additional patients showed an RWA index within the highest range of normality. Conclusion We report videopolysomnographic findings in a series of eleven patients after acute COVID-19. A major finding of this study was the presence of isolated RWA, a recognized prodromal stage of RBD, in more than one third of the patients. Future videopolysomnographic investigations including quantification of RWA in patients after COVID-19 will give more insights into a possible acute or post-infectious CNS pathology related to the SARS-CoV-2 infection.

Background: PSAP encodes saposin C, the co-activator of glucocerebrosidase, encoded by GBA. GBA mutations are associated with idiopathic/isolated REM sleep behavior disorder (iRBD), a prodromal stage of synucleinopathy. Objective: To examine the role of PSAP mutations in iRBD. Methods: We fully sequenced PSAP and performed Optimized Sequence Kernel Association Test in 1,113 iRBD patients and 2,324 controls. We identified loss-of-function (LoF) mutations, which are very rare in PSAP, in three iRBD patients and none in controls (uncorrected p = 0.018). Results: Two variants were stop mutations, p.Gln260Ter and p.Glu166Ter, and one was an in-frame deletion, p.332_333del. All three mutations have a deleterious effect on saposin C, based on in silico analysis. In addition, the two carriers of p.Glu166Ter and p.332_333del mutations also carried a GBA variant, p.Arg349Ter and p.Glu326Lys, respectively. The co-occurrence of these extremely rare PSAP LoF mutations in two (0.2%) GBA variant carriers in the iRBD cohort, is unlikely to occur by chance (estimated co-occurrence in the general population based on gnomAD data is 0.00035%). Although none of the three iRBD patients with PSAP LoF mutations have phenoconverted to an overt synucleinopathy at their last follow-up, all manifested initial signs suggestive of motor dysfunction, two were diagnosed with mild cognitive impairment and all showed prodromal clinical markers other than RBD. Their probability of prodromal PD, according to the Movement Disorder Society research criteria, was 98% or more. Conclusion: These results suggest a possible role of PSAP variants in iRBD and potential genetic interaction with GBA, which requires additional studies.

Suboptimal knowledge and negative attitudes on medication use and its safety, coupled with irrational practices, negatively impact the general public health. The major objective of this study was to measure public knowledge, identify their attitudes and practices on medication use and safety, and identify predictors of the three studied domains (knowledge, attitudes, and practices). Two cross-sectional surveys (Public-based and internet-based) were conducted from June to October 2015. Adult (> 18 years old) Saudi residing in Taif City, KSA were included. The convenience sampling method was adopted. Data was collected using a structured- questionnaire. Multivariate logistic regression analysis was performed. P-value < 0.05 was considered statistically significant. SPSS was used to analyse the data. A total of 788 people(386 for the public study and 402 for the internet study, respectively) were recruited . 302 (75.1%) of respondents recruited electronically had adequate knowledge of medication use, compared to 234 (60.6%) recruited manually (P = 30 years) and higher educational level were significantly associated with satisfactory knowledge [OR= 0.6; 95 percent CI (0.4-1.0); P = 0.032] and [OR= 1.9; 95 percent CI (1.1-3.2); P = 0.015], respectively.Misconceptions about medication use and safety were discovered in knowledge, attitudes, and practises. It is critical to provide public education that results in positive changes.

PSAP encodes saposin C, the co-activator of glucocerebrosidase, encoded by GBA. Since GBA mutations are associated with idiopathic/isolated REM sleep behavior disorder (iRBD), a prodromal stage of synucleinopathy, we examined the role of PSAP mutations in iRBD. We fully sequenced PSAP and performed Optimized Sequence Kernel Association Test in 1,113 iRBD patients and 2,324 controls. We identified loss-of-function (LoF) mutations, which are very rare in PSAP, in three iRBD patients and none in controls (uncorrected p=0.018). Two variants were stop mutations, p.Gln260Ter p.Glu166Ter, and one was an in-frame deletion, p.332_333del. All three mutations have a deleterious effect on saposin C, based on in silico analysis. In addition, the two carriers of p.Glu166Ter and p.332_333del mutations also carried a GBA variant, p.Arg349Ter and p.Glu326Lys, respectively. The co-occurrence of these extremely rare PSAP LoF mutations in two (0.2%) GBA variant carriers in the iRBD cohort, is unlikely to occur by chance (estimated co-occurrence in the general population based on gnomAD data is 0.00035%). Although none of the three iRBD patients with PSAP LoF mutations have phenoconverted to an overt synucleinopathy at their last follow-up, all manifested initial signs suggestive of motor dysfunction, two were diagnosed with mild cognitive impairment and all showed prodromal clinical markers other than RBD. Their probability of prodromal PD, according to the Movement Disorder Society research criteria was 98% or more. These results suggest a possible role of PSAP variants in iRBD and potential genetic interaction with GBA, which requires additional studies.

The main aims of this study were to measure the level of diabetes management self-efficacy and adherence to self-care activities management and to identify the influence of self- efficacy on management of self-care activities and the outcome of treatment among type 2 diabetic patients. A cross-sectional study was conducted at the Diabetes Clinic; King Faisal Medical Complex during the period of June –August 2016. Patients aged >20 years and diagnosed with type 2 diabetes for at least one year. Data was collected through face-to-face interview method using a pretested and validated questionnaire. Data was processed by the software SPPS (21.0 SPSS Inc., Chicago IL, USA). P value

Background: High level of self-efficacy and adherence to self-care activities have a positive impact on the achievement of glycemic goal among diabetic patients. In Sudan, there is a gap in knowledge related to self-efficacy management and its influence on adherence to self-care activities and overall disease control. Objective: To identify the influence of management self-efficacy on adherence to self-care activities and treatment outcome among Sudanese patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted at two health care facilities in Sudan from April to May 2016. Patients with type 2 diabetes mellitus were included. Convenience sampling method was adopted. Diabetes Management Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were used to collect data through a face-to-face interview. Logistic regression analysis was performed. A p value

Suboptimal knowledge on medication use and safety and negative attitudes has negative impact on drug use. The major objective of this study was to measure the public knowledge and to identify their attitudes and practices on medication use and safety. Two cross -sectional surveys (Public-based and internet-based) were conducted during June to October 2015. Adult (> 18 years old) Saudi residing in Taif City; KSA were included. Convenience method of sampling was adopted and data was collected by mean of a structured questionnaire. Data was processed by SPSS. A total of 788 (386 and 402 in the public-based and the internet-based study, respectively) was recruited. Respondents recruited electronically with satisfactory knowledge on medication use were 302 (75.1%), compared to 234 (60.6%) included manually, (P= 30 years) and higher educational level were significantly associated with satisfactory knowledge among electronically responded participants (OR= 0.6; 95% CI (0.4- 1.0); P = 0.032) and (OR= 1.9; 95% CI (1.1-3.2); P = 0.015), respectively. Misconceptions in knowledge, attitudes and practices on medication use and safety were identified. Public education that brings about positive changes is imperative.

Background : Mothers’ attitudes are strong predicators of choice of infant feeding method. This study was conducted to measure attitudes towards breastfeeding among Saudi mothers. Methods : A cross-sectional survey was conducted during April 2013 among Saudi nursing mothers in Taif Region; Kingdom of Saudi Arabia (KSA). Data was collected by trained pharmacy female students through face-to-face interview method using structured questionnaire. Mothers’ attitudes towards breastfeeding were assessed by The Iowa Infant Feeding Attitude Scale (IIFAS). Results : A total of 387 mothers were included of them 204 (52.7%) aged 32 years) 63 (34.4%), ( P < 0.001). Cross tabulation of the method of infant feeding and mothers’ total attitudes towards breastfeeding showed that mothers used formula feeding or mixed feeding method 120 (49.0%) had significantly positive attitudes towards breastfeeding more than breastfeeding ones 61(43.0%), ( P =0.025). Conclusion : The rate of exclusive breastfeeding was low. Positive attitudes towards breastfeeding was found to be more among mothers used formula or mixed feeding method. Educational interventions are needed to raise awareness and upgrade mothers’ knowledge on infant breastfeeding.

Diabetes mellitus is a complex disorder that requires constant adherence to certain lifestyle measures and medication to achieve good glycaemic control. The main aim of this study was to measure adherence to self- care practices (diet, exercise and medication) among diabetic patients and to identify predicators of adherence. A hospital-based study was conducted in King Abdul Aziz Specialized Hospital, Taif, KSA during June – October 2013. Convenient method of sampling was adopted, whereby all adult (> 18 years) male diabetic patients were recruited. Data was collected through face-to-face interview method using structured questionnaire. Data was processed using the software Statistical Package for Social Science (SPSS) (Version 21). Overall 378 patients were eligible; 191 (50.5%) > 50 years old and nearly two third had secondary or university education. Overweight and obese patients constituted more than two third of the respondents. Generally adherence to diet, exercise was found to be low. Multivariate analysis showed that only presence of other diseases {adjusted OR 2.8 (1.3-6.0), P = 0.011} and marital status {adjusted OR 3.4 (1.0-11.7), P = 0.049} were found to be significantly associated with adherence to diet.Patients’ age was the only predicator for patients’ commitment to practicing exercise {adjusted OR 4.7(1.3-17.8), P = 0.020)}. Non adherence to medication was found to 80.6 % (n=305). In conclusion non-adherence to the studied self-care practices was suboptimal. Proper and continuous health education accompanied with patients’ motivation may improve patients’ adherence.

This study was conducted to identify attitudes of diab etic patients towards compliance to treatment and to measure their compliance to treatment. A cross sectional study was conducted in King Abdul Aziz Specialized Hospital; Taif; KSA during June – October 2013. Convenient method of sampling was adopted. Al l adult (> 18 years) diabetic males were recruited. Data was collected through face - to - face interview method using structure questionnaire. Data was processed using the software Statistical Package for Social Science (SPPS). A total of 378 patients was rec ruited, of them 219(57.9 %) aged 40 - 65 years. Patie nts who were living in the town were 307(81.2 %) and more than one third had either college or university education. Overall 185(48.9 %) of the patients had positive attitude s towards compliance to treatme nt, while 193(51.1 %) had negative ones. Significant associations were documented between patients’ attitude towards compliance and both patient’s marital status and employment status (* P = 0.015), (* P = 0.020) respectively. The prevalence of non adherence was found to be 80.7 % (n = 305). Out of the patients who had positive attitudes towards compliance 145(78.54 %) were non - adherent, and 40(21.6 %) were adherent. In contrast, of the patients who had negative attitudes towards compliance 160(82.9 %) were n on - adherent and 33(17.1 %) were adherent, ( P = 0.226). In conclusion in this setting non - adherence to treatment was prevalent. Continuous patient educational interventions tailored to individual patient are needed to improve both patients’ attitude s and ad herence to treatment.

Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751; of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.

Introduction: Surgical site infections account for 14%-25% of all nosocomial infections. The main aims of this study were to audit the use of prophylactic antibiotic, to quantify the rate of post-operative wound infection, and to identify risk factors for its occurrence in general surgery. Methodology: A cross-sectional study was conducted in the General Surgery Department in Khartoum Teaching Hospital– Sudan. All Adult patients (age ≥18 years) admitted during March 1st to 31st October 2010 were recruited. Multivariable logistic analysis was done to identify wound infection risk factors. Prescriptions were audited against predetermined criteria. Results: A total of 540 patients were recruited; (females73.7% of total ). The performed surgical procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis showed that; ASA score ≥ 3; (p=

Background Parents’ false beliefs about signs and symptoms associated with teething have been documented in many studies around the world. This study was conducted to assess parental knowledge on infant teething process and to investigate parents’ practices used to alleviate teething disturbances. Methods A cross-sectional survey was conducted among parents of children of 6 months–5 years old in Taif, Saudi Arabia during April 2013. Convenience method of sampling was adopted and the data was collected by mean of a structured-questionnaire. Data was processed by SPPS. Logistic regression analysis was performed. P value

Multiple myeloma is a malignant plasma cell disorder that accounts for approximately 10% of all hematological cancers. It is characterized by accumulation of clonal plasma cells, predominantly in the bone marrow. The prevalence of type 2 diabetes is increasing; therefore, it is expected that there will be an increase in the diagnosis of multiple myeloma with concomitant diabetes mellitus. The treatment of multiple myeloma and diabetes mellitus is multifaceted. The coexistence of the two conditions in a patient forms a major challenge for physicians.

Background: Parents’ knowledge and attitudes towards immunization are likely influence uptake. The objective of this study was to assess parental knowledge, and attitudes on childhood immunization among Saudi parents. Methods: A cross-sectional survey was conducted during April 2013 in Taif, Saudi Arabia. Convenient method of sampling was adopted. Parents with children of 0-12 years old were invited to participate. Data was collected through face- to -face interview method using a pre-tested structured questionnaire. Data was processed using the software Statistical Package for Social Science (SPPS) (Version 21). Descriptive statistics were used to describe all variables. Association between dependent variables (knowledge, and attitudes) and independent ones (parents’ demographics) were tested using Chi-square test. P values of < 0.05 were considered statistically significant. Results: A total of 731 parents were recruited. Parents had good knowledge on aspects related to the general role of vaccination in prevention of some infectious diseases 672(91.9%), timing of the first dose in vaccination schedule 635(86.9%). However, poor knowledge was documented among parents in other aspects like the importance of administration of multiple doses of the same vaccine to child immunity 304(41.6%), administration of multiple vaccines at the same time have no negative impacts on child immunity 271(37.1%), vaccination of children against seasonal influenza 334(45.7%) and contraindication to vaccination 287(39.3%). Parents attitudes towards immunization was positive expect in some aspects related to vaccination side effects 316 (34.2%) and the probability of occurrence of diseases against which the child was vaccinated 288(39.4%). Gender, residence and educational level were found to be significantly associated with both parents’ knowledge and attitudes towards immunization. Conclusions and recommendations: Although parents had good knowledge and positive attitudes on some aspects related childhood immunization, gaps in both studied domains were identified. Educational interventions are needed to upgrade parents’ knowledge with special emphasis on less educated and residents of rural areas.

Background Antibiotic prophylaxis is effective at reducing the risk of postoperative infection for nearly all types of surgery. Objective To audit the use of prophylactic antibiotics for elective surgery. Setting Khartoum Teaching Hospital, Sudan, a 1,000 bed tertiary level hospital. Method A prospective study was conducted over a 9 month period; patients admitted for elective surgery were included consecutively. Main outcome measure The use and administration of prophylactic antibiotics for elective surgery. Results A total of 1,768 patients with mean age 37.8 ± 14 years were recruited (females, 83.3 % of total) who underwent 1,814 surgical interventions. Of these 1,277 (70.4 %) of procedures were clean-contaminated. A total of 1,758 patients (99.4 % of total) received antibiotics for prophylaxis; 1,730 patients (97.9 %) were given antibiotics in the operating room; for 1,288 (74.5 %) of cases the antibiotics were considered ‘recommended’, while for 442 (25.5 %) they were not. Out of the patients for whom prophylaxis was recommended and was given, 725 (56.3 %) of patients received a broad spectrum antibiotic or unnecessary combination, 913 (70.9 %) received a sub-therapeutic dose, 120 (9.3 %) were given the first preoperative dose within the proper time window, and 1,250 (97 %) of patients had an extended duration of prophylaxis. Compliance with all stated criteria was achieved in only 47 (2.7 %) of observed prescriptions. Conclusion This audit showed a wide gap between international standards and local practices; the authors call for urgent action to correct this situation through the development and implementation of local clinical guidelines.

Summary: Surveillance of wound infections has been shown to be a powerful preventive tool, and feedback to the clinical staff reduces wound infection rates. The main objectives of this study were to identify the applicability of telephone calls as a method of post-discharge wound infection surveillance, and to identify patients and procedures characteristics associated with loss for follow-up after hospital discharge. Materials and methods: This was a prospective cohort study conducted in Khartoum Teaching Hospital, Sudan. Patients, aged >18 years admitted for elective clean and clean-contaminated surgery during March 1st to 31st October 2010 were recruited. 1-month surveillance of wound infections was conducted with telephone interviews. Results: Overall 3656 patients were operated on. Of them 1769 (48.4%) were eligible {mean age 37.8 + 14 years; females, n = 1472 (83.3%)}. The performed surgical interventions were 1814. Of these 1277 (70.4%) were clean-contaminated and 537 (29.6%) were clean. Patients who successfully completed the follow-up were 1387 (78.4%), while 368 (20.8%) were lost, and 14 (0.8%) died. The percentage of male patients (85.3%) who successfully completed the follow-up was significantly higher than females (77.8%); (P = 0.002). Wound infection was detected in 15 (0.8%) cases during hospital stay and 110 (6.2%) others after hospital discharge. Conclusions: The majority of wound infections in the current study appeared in post-discharge period; this emphasis the need for establishment of surveillance program in the hospital. Surveillance of wound infections using telephone calls is applicable in this setting and can be used as an alternative method to clinic-based diagnosis of wound infections. Keywords: Surveillance, Wound infections, Telephone calls, Sudan

Background: Satisfaction with and adherence to oral anticoagulant treatment are important measures that decrease morbidity and mortality. Higher satisfaction and adherence to warfarin therapy was found to be associated among other factors with good International Normalized Ratio (INR) control. Objectives: To assess patient satisfaction with and adherence to oral anticoagulant therapy and to identify predictors of the two studied domains. Methods: A cross-sectional study was conducted at the Cardiothoracic Clinic in Alshaab Teaching Hospital; Khartoum; Sudan during March-April 2015. A representative sample of patients on oral anticoagulant treatment was recruited. Data was collected through face-to-face interview method using oral Anti-Clot Treatment Scale (ATCS) to measure satisfaction and the 4-items Morisky Scale to measure adherence to therapy. Data was processed using SPSS. Logistic regression analysis was performed. P value