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Background: The rapidly ongoing coronavirus disease 2019 (COVID-19) pandemic worldwide is adversely affecting the population, and all health services, hospital visits, and regular check-ups, or even routine childhood immunization programs were disrupted and were not able to commence. The present study aimed at evaluating the impact of the COVID-19 pandemic on childhood immunization status, aiming to increase the awareness of the importance of vaccination to prevent the outbreaks of vaccine-preventable diseases. Methodology: In this cross-sectional study, 548 participants were included and selected via convenience sampling. This study’s desired population was parents ≥18 years old who are caring for children their age limit within the routine childhood immunization in Saudi Arabia. Data were collected using a tailored questionnaire. Results: 75.5% of the participants were aware of the Ministry of Health’s recommendation not to delay children vaccination during the COVID-19 pandemic, 41.4% of the participants said that the COVID-19 pandemic affected their children vaccination schedule. 15% reported a delay in the vaccination without rescheduling it and 24.3% reported a delay but they have been rescheduled, 2.1% canceled the rest of their children’s vaccination, and 42.3% attributed the delay of immunization to avoid catching COVID-19. Also, we found that the most affected age group was children at 21.2 months. The following factors were significantly associated with lower childhood vaccination rates: fathers with intermediate school education, fathers with high school education, and being a student. Conclusion: Our findings in this study showed that more than one-third of the participants had been affected by the COVID-19 pandemic regarding their children’s vaccination schedule; the impact presented as delaying or canceling the vaccination.

Purpose The neuroimaging correlates of lateralized rhythmic delta activity (LRDA) are not well defined, and imaging findings between different epileptiform patterns have seldom been compared directly. Methods Patients were retrospectively selected from a critical care EEG database between December 2014 and December 2017. Patients were included if they had greater than 6 hours of continuous EEG that contained LRDA, lateralized periodic discharges LPDs), or generalized rhythmic delta activity (GRDA) and had an MRI within 48 hours of the EEG. Clinical, EEG, and MRI characteristics were collected and compared. Results All the following results showed statistical significance between the groups: Patients with GRDA were more likely to have a normal MRI (LRDA, 0%; LPDs, 0.8%; GRDA, 17.3%), although the majority were abnormal. In patients with LRDA and LPDs, the MRI abnormalities were much more likely lateralized to one side, whereas in those with GRDA, they were more likely to have bilateral or multifocal abnormalities. Across all groups most abnormalities were acute, although this proportion was higher in patients with LRDA and LPDs compared with that in those with GRDA (LRDA, 91.3%; LPDs, 86.0%; GRDA, 70.4%). An MRI abnormality that was concordant with the side of LRDA was present in 66.3%, with 17.3% having discordant findings. These were similar in patients with LPDs (concordant 67.4%; discordant 11.6%). Conclusions Patients with LRDA had a similarly high rate of acute focal abnormalities ipsilateral to the EEG pattern compared with those with LPDs. Patients with GRDA were more likely to have a normal MRI, but the majority of patients with GRDA still had acute focal findings.

To describe the clinical and radiological characteristics of neuromyelitis optica spectrum disorders (NMOSD) patients from the Arabian Gulf relative to anti-aquaporin 4 antibody serostatus.Retrospective multicentre study of hospital records of patients diagnosed with NMOSD based on 2015 International Panel on NMOSD Diagnosis (IPND) consensus criteria.One hundred forty four patients were evaluated, 64.3% were anti-AQP4 antibody positive. Mean age at onset and disease duration were 31±12 and 7 ± 6 years respectively. Patients were predominantly female (4.7:1). Overall; relapsing course (80%) was more common than monophasic (20%). Optic neuritis was the most frequent presentation (48.6%), regardless of serostatus. The proportion of patients (54.3%) with visual acuity of ≤ 0.1 was higher in the seropositive group (p = 0.018). Primary presenting symptoms of transverse myelitis (TM) were observed in 29% of patients, and were the most significant correlate of hospitalization (p0.001). Relative to anti-APQ4 serostatus, there were no significant differences in terms of age of onset, course, relapse rates or efficacy outcomes except for oligoclonal bands (OCB), which were more often present in seronegative patients (40% vs.22.5%; p = 0.054). Irrespective of serostatus, several disease modifying therapies were instituted including steroids or immunosuppressives, mostly, rituximab and azathioprine in the cohort irrespective of serostatus. The use of rituximab resulted in reduction in disease activity.This is the first descriptive NMOSD cohort in the Arabian Gulf region. Seropositive patients were more prevalent with female predominance. Relapsing course was more common than monophasic. However, anti-AQP4 serostatus did not impact disease duration, relapse rate or therapeutic effectiveness. These findings offer new insights into natural history of NMOSD in patients of the Arabian Gulf and allow comparison with patient populations in different World regions.

Background: Intensive care unit (ICU) patients with neurological impairments often require neuroimaging. However, the relative sensitivity of various imaging modalities of the brain has not yet been explored in this population. Methods: In this study, we compare the findings of CT and MRI scans in ICU patients to (1) identify the number and rate of clinically relevant lesion detected by MRI while missed by CT and vice versa and (2) determine specific lesion types for which CT versus MRI discrepancies exist. A review of medical records included CT and MRI reports of patients who underwent these procedures while they were patients in our ICUs between July 2004 and July 2009. MRI and CT were compared regarding their ability to detect clinically relevant abnormalities. Odds ratios with 95% confidence limits were calculated to compare diagnostic categories regarding the rate of discrepant MRI versus CT findings, followed by power analyses to estimate sample sizes necessary to allow for further testing in a larger trial. Results: MRI revealed clinically relevant additional abnormalities over CT in 129 of 136 patients (95%) that included the detection of additional finding for 15/27 hemorrhagic lesions (55.6%), 33/36 (92%) ischemic strokes, 19/27 (70%) traumatic lesions, 8/14 (57%) infections, 15/24 (62.5%) metabolic abnormalities, and all seven neoplasms. Odds ratio analysis revealed the added sensitivity of MRI to be greater for ischemic and neoplastic lesions than for trauma, metabolic-related abnormalities, infection, or hemorrhage. Conclusions: MRI is more sensitive than CT in identifying clinically meaningful lesions in at least a subset of ICU patients, regardless of pathology.

Background Volume measurements of intracerebral haemorrhage are prognostically important and are increasingly used in clinical trials to measure the effects of potential interventions. The purpose of this work is to establish the reliability of haematoma volume measurements obtained using a computer-assisted method called Quantomo (for quantitative tomography) and the ABC/2 method. Hypothesis Quantomo reliably detects smaller changes in intracerebral haemorrhage volume as compared with the ABC/2 method because computer-assisted volume measurements are tailored to measure the geometry of individual haematoma volumes whereas the ABC/2 method approximates all haematoma volumes as ellipsoids. Methods Thirty randomly selected computed tomography scans with intracerebral haemorrhage were measured by four raters a total of four times each (two sessions using Quantomo and two using the ABC/2 method). Interrater and intrarater reliability for both techniques were calculated simultaneously using a two-way random-effects analysis of variance model. The precision of intracerebral haemorrhage volume measurement was quantified as the minimum detectable difference with 95% confidence intervals. Results The median (first quartile and third quartile) intracerebral haemorrhage volume measurements of all rater and sessions for Quantomo were 32·7 ml (6·2 and 54·4 ml) and for ABC/2 40·7 ml (8·6 and 76·0 ml). Quantomo intracerebral haemorrhage volume measurements were more precise, having an inter- and intrarater minimum detectable difference of 8·1 and 5·3 ml, while the inter- and intrarater minimum detectable difference for ABC/2 were 37·0 and 15·7 ml. Conclusions Quantomo is a computer-assisted methodology that is more reliable for quantifying intracerebral haemorrhage volume as compared with the ABC/2 method.