No abstract

Combined central and peripheral demyelination (CCPD) is not encountered frequently in the clinical practice, and it requires a high level of suspicion for diagnosis. We describe a case of a young man who was diagnosed with radiologically isolated syndrome (RIS) after presenting initially with symptoms suggestive of central nervous system (CNS) insult in the form of double vision, slurred speech, left-sided numbness, and unsteadiness. However, on the next day of admission, his neurological examination was remarkable for ataxia, areflexia, and ophthalmoplegia, the typical triad of Miller Fisher syndrome (MFS). After confirming both diagnoses, the final diagnosis of CCPD was made. The challenges one may face to diagnose and treat CCPD urge sharing of similar cases to open the door for further extensive and thorough investigations and to encourage further studies and analysis of available data to come up with consolidated management guidelines for rare disorders.

Peripheral arterial disease (PAD) is a common disease with multiple risk factors and affects patients worldwide. Several international studies have established correlations between anatomical topography/distribution of atherosclerosis and comorbidities in patients with PAD. In this cohort study, we aimed to analyze the patterns of atherosclerosis (site, distribution, and degree) in patients who underwent lower limb computed tomography angiography and arterial angiography by identifying the atherosclerotic plaque(s) that were possibly responsible for thrombi. Additionally, we aimed to determine any relationship between comorbidities and identified patterns. Patients and Methods: Between January 2015 and January 2021, we retrospectively recruited 140 patients at King Fahd Hospital of the University of Saudi Arabia. Data collected included patient characteristics, risk factors, and metabolic disorders, such as hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and chronic kidney disease. Patients with incomplete records or unavailable radiological images were excluded. Results: The infrapopliteal territory was the most common segment that was affected. HTN, DM, and dyslipidemia were found in 81.4%, 77.9%, and 62.9% of patients, respectively. Correlation analyses revealed that DM was the only independent metabolic disorder associated with a PAD distribution pattern in the femoropopliteal segment (p=0.039), thus denoting distal involvement. No significant association was found between PAD distribution and the severity of stenosis. Conclusion: Segmental involvement in PAD varies with the risk factors and metabolic comorbidities present in patients. DM is an independent predictor of the anatomical distribution of PAD. The identification of such an anatomical distribution is paramount for screening procedures, early detection of disease, and prevention of complications, particularly limb amputation.

Background: Multiple sclerosis (MS) is one of the neuroinflammatory disorders that commonly affect the young. Injectable interferons beta-1a (Rebif 22-44, Betaseron 250 and Avonex 30) are one of the most important first line disease modifying therapies with less side effects compared to others. But the injection site reaction (ISR) is an important side effect, which can decrease the patient's compliance to the medications that will lead to the disease progression. Objective: The purpose of this study was to compare the ISR in the three types of interferon (2 subcutaneous Rebif 22-44, Betaseron 250 and one intramuscular Avonex 30) and determine whether the route of administration (subcutaneous versus intramuscular) affects the frequency of ISR, and to reduce this side effect and ensure compliance. Methods: This was a single center, prospective observational study of 300 patients at King Fahad University Hospital (Al Khobar, Saudi Arabia) form September 2015 to August 2016 with a relapsing remitting form of multiple sclerosis for which 114 patents were receiving injectable interferon. A questionnaire was filled out by the participants including type of interferon, type of ISR and pain severity. Patients were then evaluated in our MS clinic and dermatology clinic after 1 week and 3 months. Data were analyzed by IBM-SPSS version 21. Appropriate statistical tests will be mandated per the collected data. Statistical significance is determined at p-value<0.05 with a confidence interval of 0.95. Frequency and proportion, and relative risks (RR) were calculated and Chi-square test was used. Results: ISRs in the form of erythema were reported by fewer patients on Avonex group 21.1% compared to the other two injectables, Betaseron group (77.8%, p<0.0001, RR=2.6) and Rebif groups (69.8%, p<0.0001, RR=2.3). Similar observations were noticed 3 months later, where the Avonex group had statistically significant less ISRs with no abnormality in 89.9% compared to (52.3%, p<0.0001, RR=3.5) and (44.4%, p<0.0001, RR=4.2) in Rebif and Betaseron respectively. Only patients on Rebif had skin ulceration 3.5% (n=3) at initial assessment; however, there was insignificant difference and none of the patients had skin ulceration at the 3 months' evaluation. Conclusions: Interferon beta-1a (Avonex) found to be the least to cause ISR compared to Rebif and Betaseron.