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Background: Idiopathic normal pressure hydrocephalus (iNPH) is a disease that primarily affects the geriatric population. It was first introduced by Adams et al. in 1965. A gradual decline in cognitive function, urinary incontinence, and gait disturbances characterizes the disease. This condition is believed to be underdiagnosed, and awareness of such pathology is vital, as the treatment is very effective and can reverse the symptoms. Methods: This questionnaire-based cross-sectional study aimed to assess awareness levels regarding iNPH among non-neuroscience healthcare providers in Saudi Arabia. Results: A total of 269 healthcare providers participated in this study, with data collected through an online questionnaire. About 80.6% of the participants had heard of the disease, while 56.5% were aware of the disease symptomology. About 50% of physicians did not encounter iNPH patients in clinical practice. Previous clinical exposure to iNPH patients correlates significantly with an awareness of disease symptoms, investigation, treatment modalities, and outcome. Clinical experience positively impacts physicians' awareness as it correlates with a better understanding of diagnostic methods and disease outcomes. Conclusion: The study highlights the need for targeted educational interventions, especially among family physicians and general practitioners with no previous experience with iNPH patients, as well as interdisciplinary collaboration to address gaps in awareness and enhance early diagnosis of iNPH patients.
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Background and objective The use of radiation imaging techniques in operation theaters is essential for numerous surgical procedures and patients' overall well-being. Radiation imaging techniques enable the surgeon to have a real-time visualization of the anatomy and to perform operations with a greater chance of success, decrease rates of patient morbidity, and enable surgeons to obtain imaging records before the patient leaves the theater room. However, with the increased use of imaging techniques in orthopedic surgical operations, orthopedic surgeons are being exposed to higher levels of radiation, and hence they can be classified as a high-risk group for occupational radiation exposure. This study aimed to assess orthopedic surgeons' awareness and knowledge regarding radiation exposure safety. Materials and methods A questionnaire-based descriptive cross-sectional study was conducted from January to March 2022 to assess the knowledge regarding ionizing radiation exposure safety among orthopedic surgeons, including consultants, specialists, and residents, at both private and governmental hospitals in Al-Madinah city, Saudi Arabia. Ethical approval was obtained from the Ministry of Health (MOH) of Al-Madinah (approval number: H-03-l.l-084). The applied statistical tests were frequency and MCT tests for univariate variables while Chi-square was applied for bivariate variables. With a 95% confidence interval (CI), a p-value of more than 0.05 was used as the cut-off value for the significance level. Results A total of 57 surgeons participated in the study, of which 57.9% were exposed to radiation two to three times per week. Additionally, more than half of the physicians (66.7%) were not trained to use fluoroscopy (C-arm machine). Of note, 78.9% of orthopedic surgeons reported that they used the protective apron as protective equipment, while 17.5% of them used both a protective apron and thyroid shield. However, only less than half of the orthopedic surgeons (43.9%) in our study practiced radiation safety in the operating room. Conclusion Our study revealed a lack of knowledge and awareness related to ionizing radiation exposure safety among orthopedic surgeons in Al-Madinah city, Saudi Arabia.
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Background: Diabetic peripheral neuropathy (DPN) is a leading cause of morbidity. This systematic review and meta-analysis evaluate the efficacy of lower extremity nerve decompression in reducing DPN symptoms and complications. Methods: A database search was performed using Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials. Articles addressing surgical decompression of lower limb peripheral nerves in patients with diabetes were screened for inclusion. Two independent reviewers undertook the assessment. Methodological quality measures were the Cochrane risk of bias and Newcastle-Ottawa scale. Results: The pooled sample size from 21 studies was 2169 patients. Meta-analysis of 16 observational studies showed significant improvement in the visual analog scale (VAS) (P < 0.00001) and two-point discrimination (P = 0.003), with strong reliability. Decompression of the tarsal tunnel region had the highest improvement in VAS [MD, 6.50 (95% CI, 3.56-9.44)]. A significant low-risk ratio (RR) of ulcer development and lower limb amputation was detected (P < 0.00001). Lowest RR of ulcer development was detected with tarsal tunnel release [RR, 0.04 (95% CI, 0.00-0.48)]. Improvements in VAS, two-point discrimination, and nerve conduction velocity were nonsignificant in the meta-analysis of five randomized controlled trials (RCTs). The RCT analysis was limited to only two studies for each outcome. Conclusions: Meta-analysis of observational studies highlights the efficacy of lower extremity nerve decompression in reducing DPN symptoms, ulcerations, and amputations. Releasing the tibial nerve in the tarsal tunnel region was the most effective observed procedure. Nevertheless, high-quality RCTs are required to support the utility of this intervention in DPN.
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The control of the risks associated with major hazard events is critical to the safe and continuous operation of the process industry. Over the last decades, the process industry has been successful at establishing and implementing robust Process Safety Management (PSM) systems to prevent and mitigate the consequences of such major hazard events. While there exist some industry guidelines developed relatively recently for events initiated by natural disasters and security-related threats, for initiating events like outbreaks of pathogens and pandemics, there is currently a clear lack of understanding of the impact of the restrictions and disruption caused by a pandemic on the ability of companies operating major hazard facilities to keep controlling the risks associated to their hazardous operations. Moreover, there is no industry guideline on how to account for such an impact in PSM systems for process safety hazards. The recent COVID-19 outbreak caused serious disruptions to normal operations that have challenged industry in their ability to control risks. The objective of this paper is to perform an analysis of the impact of a pandemic situation on the implementation of selected elements of PSM systems related to the identification and evaluation of the risks of a major hazard and their control. The approach chosen involves the analysis of the root causes of the failure of the selected PSM elements using a Fault Tree Analysis method. The findings provide the first steps in the establishment of recommendations for the upgrade of PSM systems to face events such as pandemics.