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Background: Brucellosis is a zoonotic disease that is widely spread across the globe, with the number of cases increasing annually. Spinal brucellosis is known to affect about half of patients with brucellosis. Nevertheless, data on the optimal antibiotic regimens for spinal brucellosis are limited. Therefore, this study aims to compare antibiotic treatment regimens for spinal brucellosis at our center in Makkah, Saudi Arabia. Methods: This is a retrospective cohort study of an 11-year period from 2010 to 2021 conducted at a single center in Makkah, Saudi Arabia. All patients with spinal brucellosis were included. Patients were excluded if the duration of the received antibiotic regimen or follow-up was poorly documented. Data analysis was conducted using RStudio (R version 4.1.1). Categorical variables of each regimen used by the patients were presented as frequencies and percentages, while numerical variables were summarized using the median and interquartile range (IQR). Results: A total of 35 patients were included; the median (IQR) age of the patients was 58.0 (48.0 to 63.0) years. The most frequently reported symptoms upon admission included low back pain (83.3%). The most frequently administered regimen was the combination of streptomycin + doxycycline + rifampicin (SDR) (20 patients, 55.6%), followed by the combination of streptomycin + rifampicin + trimethoprim/sulfamethoxazole (SRT) (eight patients, 22.2%). Overall, out of the total 35 patients who received first-line treatment, only six patients experienced therapy failure. Out of the total six patients who experienced first-line treatment failure with SDR (five patients, 83%) and SDT (one patient, 17%), surgery was indicated for three patients. Surgical intervention was deemed necessary in 12 patients (34%). Three patients chose not to undergo surgical intervention but still showed complete improvement upon completing the treatment duration. One patient experienced a postoperative complication, resulting in paraplegia. Conclusions: In this study, we found that among 35 patients, treatment failure was observed only in six patients who received triple therapy. In addition, surgical intervention was indicated in 12 patients; however, three patients refused surgery and improved ultimately after changing or extending the duration of the antibiotic regimen.
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Background Nowadays, radiology is considered one of the most important disciplines of medicine as it guides physicians to reach the proper diagnosis by using many types of medical imaging modalities, such as x-ray radiography, computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). These modalities are used to create dynamic images of different parts of the human body, which are being used to accurately diagnose and follow up on a variety of medical conditions. Moreover, in recent decades, radiology has experienced substantial growth and transformation, establishing itself not just in diagnostics but also in the domain of medical interventions, which includes the increasingly recognized discipline of interventional radiology. Methodology A descriptive cross-sectional study was conducted at Umm Al-Qura University (UQU) in Makkah from October 2022 to April 2023. The population size of medical students from the fourth to sixth year at Umm Al-Qura University is about 820 students. Results The total number of participants was 359, but two did not fill out properly. Hence, data was analyzed for (n=357), whereas more than half of them were female, 195 (54.6%). About 133 (37%) of the students were in their sixth year, while 106 (29%) were in their fourth year. Regarding their grade point average (GPA), 209 (58%) had >3.5, and 119 (33%) had 3.0-3.5. The maximum number of females 77 (57.9%) students were in the sixth year. Regarding knowledge, 291 (81.5%) had heard about interventional radiology before, while 66 (18.5%) had never heard about interventional radiology before. Moreover, 270 (75.6%) believe that the years in radiology residency are the same as other specialties. Regarding perceived knowledge about radiology, 183 (51.3%) said it is adequate. Conclusion This study showed that medical students at Umm Al-Qura University have a positive attitude towards radiology. However, the majority of the students do not have adequate knowledge regarding radiology as well as radiation hazards. We can improve this by increasing radiology experience in our institutions. Also, courses should be designed and incorporated into the curriculum to increase the knowledge of medical students about ionizing radiation.
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Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS). It has many types, which include tumefactive multiple sclerosis (TMS), one of the most uncommon types. We present the case of a 36-year-old woman who presented with right-sided numbness of the body. Magnetic resonance imaging (MRI) of the brain revealed a large mass (3 cm × 2.5 cm) in the deep white matter of the right frontal lobe along with smaller lesions of variable sizes. After considering the MRI features, the CSF results, and the improvement of the symptoms with a high dose of steroids, the diagnosis of tumefactive multiple sclerosis was made. A biopsy was not done on our patient as the symptoms resolved after treatment, although sometimes it is necessary for diagnosing tumefactive multiple sclerosis to rule out tumors or abscesses. The current study described the clinical presentation, the role of imaging, the differential diagnosis, and the treatment options. This case report aimed to report a rare presentation of TMS, which highlights the importance of differentiating TMS from other space-occupying lesions for prompt and proper management.
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Acquired dermal macular hyperpigmentation (ADMH) is a recently coined term to encompass lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and Riehl's melanosis. Here we report a 60 -year- old female, with an insignificant past medical history, who presented to the dermatology clinic, with slightly itchy skin lesions on her body. The lesions were slowly increasing in number over the last 10 years. The patient was otherwise healthy and was not taking any medications. A review of systems was unremarkable. There was no similar case in the family and the parents did not show consanguinity. Skin examination revealed multiple well-defined non-scaly brownish macules scattered on her body. In addition, bilateral macules and papules were present in the inframammary folds. There were no skin lesions in the axillae, groin, and intergluteal folds. Differential diagnoses include Dowling Degos Disease (DDD), LPP, and EDP. A 4 mm punch skin biopsy was taken from skin lesions under the breast. It revealed hyperkeratosis, hypergranulosis, and acanthosis. The dermis showed a band-like infiltrate of mononuclear histiocytic cellular infiltrate with basal layer degeneration. According to the above clinicopathological findings, the diagnosis of lichen planus was made. The patient was reassured. She was started on hydroxychlorquine 200 mg tab bid, a topical steroid, and topical calcineurin inhibitors, and was asked to follow up regularly in the dermatology clinic.
