Conventional surgery versus botulinum toxin injection for the management of esotropia in children with Down syndrome.

PURPOSE: To compare the success rates of strabismus surgery and botulinum toxin injection (BTX) in treating esotropia in patients with Down syndrome (DS). METHODS: This multicenter retrospective cohort study included all consecutive patients having DS with esotropia between 2014 and 2021 at King Abdullah Specialist Children Hospital, King Abdullah International Medical Research Center, and King Khaled Eye Specialist Hospital, Saudi Arabia. We divided the patients into two groups according to interventions. Success was defined as angle of deviation of <10Δ at final visit. RESULTS: A total of 53 patients were included: 23 in the surgery group and 30 in the BTX group. There were no significant differences between groups with regard to age, sex, diagnosis, spherical equivalent, and preoperative deviation angle. Before the intervention, the median angle of deviation was 30.0Δ (IQR, 30Δ-45Δ) in the surgery group and 37.5Δ (IQR, 28.8Δ-50.0Δ) in the BTX group (P = 0.802). Postoperatively, the median (IQR) deviation angle was 0.0Δ (0.0Δ-16.0Δ) in the surgery group and 22.5Δ (6.75Δ-30.0Δ) in the BTX group (P = 0.006). The success rate in the surgery and BTX groups was 65% and 30%, respectively (P = 0.011). Two patients developed dissociated vertical deviation in the surgery group. One patient presented consecutive exotropia and one inferior oblique overaction in the BTX group. CONCLUSIONS: In this study, conventional surgery showed a higher success rate than BTX in the management of esotropia.

Comparison of performance of medical students between two teaching modalities "Flip the classroom" and traditional lectures: A single center educational interventional study.

OBJECTIVES: This study aims to compare the students' performance in Obstetrics and Gynecology by using two teaching modalities, i.e., Flip the classroom (FTC) compared to Traditional lectures (TL) among final year medical students and assessment of the students' satisfaction towards FTC as learning modality. METHODS: An educational interventional study was conducted on 136 females final year medical students at Umm Al-Qura University, Makkah, Saudi Arabia from September to December; 2017. Out of 40 core topics of Obstetrics and Gynecology, eight were chosen for FTC and eight for TL. The performance in each teaching modality was assessed by comparing the score of the students in multiple choice question (MCQ) and objective structured clinical examination (OSCE) in the final examination. The final performance was compared between the FTC and TL selected topics. The data was analyzed by using SPSS version 16 (SPSS Inc., Chicago, IL, USA). RESULTS: MCQ and OSCE grades of students (n=136) were significantly higher in FTC versus TL topics, i.e., mean ± standard deviation (13.4 ± 2.7 vs. 12.3 ± 2.4; p < 0.001) and (33.9 ± 4.3 vs. 30.4 ± 4.7; p < 0.001), respectively. Almost 60% of the students expressed their satisfaction with FTC modality. CONCLUSION: Scores were significantly high for Flip the classroom topics compared to Traditional lectures.

The impact of stone composition on renal function.

BACKGROUND: Nephrolithiasis is a common condition that has various classifications according to stone composition. Stone formation can affect renal function; it can be a strong risk factor for chronic kidney disease (CKD). The main objective of this study is to explore the association between creatinine clearance and different stone compositions. METHODS: This is a retrospective cohort study conducted in a tertiary center in Jeddah, Saudi Arabia, between 2005 and 2014. Renal function was assessed by the estimating glomerular filtration rate (eGFR) by the Cockcroft-Gault equation. Stone composition was determined by urinary calculi analysis with infrared spectrometry. RESULTS: Stones of 365 patients, with a mean age of 48.2 ± 13.6 years and a male to female ratio of 3.2:1, were analyzed. Stage 2 CKD has been documented. It involved oxalate, struvite, cystine, and uric acid stones. The worst eGFR was reported for stones containing uric acid. The eGFR was least affected with apatite stones followed by brushite stones. CONCLUSION: Stone disease can affect renal function. Different stone compositions show factor for renal impairment, and this should be considered in patient management. A special precaution should be considered for higher risk groups. Multidisciplinary patient care and immediate referral to a nephrologist are strongly advised.

Evaluating the effectiveness and safety of hydrocortisone therapy in cancer patients with septic shock.

PURPOSE: To evaluate the effectiveness and safety of hydrocortisone (HC) in cancer patients with septic shock. METHODS: This was a retrospective study of adult cancer patients with septic shock who received low-dose HC therapy (200 mg/day). The effectiveness of HC was assessed by determining the proportion of patients with reversal of septic shock, time to reversal, and mortality. The safety was assessed by determining the incidences of hyperglycemia, hypernatremia, and secondary infections, using a case-control approach. RESULTS: During the study period, 96 patients were enrolled. Reversal of septic shock was reported in 46 (47.9%) patients, median time to reversal was 1.9 days (range 0.2-7.6), ICU mortality was reported in 62 (65.26%) patients, and 28-day mortality in 64 (66.7%) patients. The incidence of secondary infections was higher in patients who received HC therapy, compared to patients who did not receive HC during septic shock: 44.8% vs 27.4%, P = 0.028. CONCLUSIONS: HC therapy was associated with resolution of septic shock in about half of the patients and a high incidence of secondary infections. Prospective studies are needed to fully assess the efficacy and safety of HC in cancer patients with septic shock.

Fatal case of cryptogenic organizing pneumonia associated with everolimus.

Noninfectious pneumonitis (NIP) has been reported with everolimus; however, the majority of the reported cases were mild to moderate. We report a fatal case of cryptogenic organizing pneumonia (COP) in a 61-year-old man. About 4 weeks after starting everolimus, the patient was admitted to the hospital with complaints of a 1-week history of progressive dyspnea with exertion and cough. The chest radiograph showed bilateral multifocal dense opacities, and he was started on antibiotics. However, his respiratory status deteriorated, and he was subsequently intubated and transferred to the intensive care unit. Chest computed tomography showed bronchocentric consolidation associated with widespread bilateral fine reticular opacification. Video-assisted thoracoscopic lung biopsy showed noncaseating granulomatous inflammation and features of COP. All cultures were negative for bacterial, viral, and fungal infections. Despite discontinuing everolimus and initiating corticosteroids, the patient died of progressive respiratory failure secondary to COP.