Atraumatic Fractures in Multi-Morbid Older Adults: A Series of Five Cases and Review of Literature.

Atraumatic fractures (ATFs) are a fragility fracture subtype with occasional medicolegal issues. ATFs are defined as fractures because of a "low-energy mechanism that is usually considered incapable of producing a fracture." They are an underreported disorder, with epidemiological variations. ATF phenomena were previously reported not only in older adults, but also in children, young adults, older adults, and animals. This study is a short retrospective case series exploring atraumatic fractures in a tertiary care university hospital. Over a period of two years, a total of seven ATF cases were identified. However, only five fulfilled the inclusion criteria. Local causes of pathologic fractures (e.g., metastasis) and elder abuse or neglect were excluded. Comparison of the cases' clinical profile, fracture profile, and management was done. All five cases were frail females with significant osteotoxic burdens from medications and multi-morbidities. ATF presentations included typical (as pain) and atypical (as painless, loud crack, and sudden giveaway) symptomatology. One ATF had a coincident unexplained aseptic fever. Three cases had more than one fracture (fracture cascade), confirmed and followed up by x-rays. All the cases were managed conservatively except for one case that underwent hip hemiarthroplasty. Plans of care included managing the osteotoxic multi-morbidities burden, focusing on the whole body, not only on the fracture or bone. The study provided insights about challenges in presentations of ATF (as the bone fracture acute phase reaction: osteogenic aseptic fever). Risk factors are classically assumed to be osteoporosis, but it is usually systemic and multifactorial. A high risk of fracture warning sign could help decrease ATF occurrence or fracture cascades. Four ATF categories were detected to help healthcare systems identify high-risk patients and raise awareness among medical staff, families, and caregivers. Future studies of the at-risk groups are needed to understand ATF knowledge gaps, challenges, and the best treatments.

Meningitis Relapse in a Neonate: From Extended-Spectrum Beta-Lactamases-Producing Escherichia coli to Escherichia coli K1.

We report the case of a 10-day-old preterm neonate with extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli meningitis that was treated appropriately and yet relapsed with E. coli K1 meningitis at the age of one month. Although the patient had multiple risk factors for ESBL-producing E. coli, the patient did not follow the reported pattern of the risk of E. coli K1 infection in relapse.

Assessing knowledge of Saudi mothers with regard to parenting and child developmental milestones.

BACKGROUND: Knowledge about childrearing and development of children greatly impacts on how parents can adequately and safely raise and interact with a child. This study aimed to assess Saudi mothers' level of knowledge of parenting and developmental milestones and describe the associated factors that affect their knowledge. MATERIALS AND METHODS: This cross-sectional study was conducted in the Eastern Province of Saudi Arabia from January to February 2020. Four hundred Saudi mothers with children up to 6 years of age were included in the study from 20 randomly selected primary healthcare centers. The Knowledge of Infant Developmental Inventory Tool (KIDI-P) was used. Relevant demographic data were collected. Data were analyzed using the Statistical Package for the Social Sciences software version 21 (SPSS). One-way ANOVA and t-test were used to detect any significant differences in mother's knowledge about developmental milestones related to the research variables. RESULTS: The majority of mothers (42.2%) were between 28 and 35 years of age. Knowledge about parentaging scored on the average 53.3%, health and safety scored 63.4%, general principles 55.9%, and developmental milestones 51.8%. Data showed a statistically significant relation between mothers' age and parenting subscale (mean = 0.54, standard deviation [SD] = 0.18, P = 0.001), and mothers' education and parenting (mean = 0.52, SD = 0.18, P = 0.015). Significant differences were found between planned pregnancy and parenting (mean = 0.53, SD = 0.178, P = 0.044) and between planned pregnancy and child developmental milestones (mean = 0.51, SD = 0.12, P = 0.042). CONCLUSION: Saudi mothers have limited overall knowledge of childrearing and developmental milestones of their children. Mothers' age, parental education, parity, and planned pregnancies had a positive effect on mother's knowledge of parenting and milestones parameters.

Laparoscopic Management of Gallbladder Duplication: A Case Report.

Laparoscopic cholecystectomy has become one of the most commonly performed abdominal surgeries worldwide. Several anatomic variations and congenital malformations in the gallbladder and biliary anatomy have been described. We reported the case of a middle-aged woman who presented with jaundice and abdominal pain. Her laboratory investigations revealed an elevated bilirubin level (mainly the direct component). The patient showed an improvement in the clinical and laboratory parameters after conservative management. Then, the patient was prepared for a laparoscopic cholecystectomy which revealed a duplication of the gallbladder with two distinct cystic ducts draining independently to the common bile duct. The procedure was completed uneventfully. This type of gallbladder duplication is among the least common types. The case highlights the importance of having a meticulous intraoperative evaluation of the biliary anatomy to avoid potential complications and injuries.

Unicentric Castleman's Disease with an Unusual Clinical Behavior.

Castleman's disease is a rare clinicopathological condition characterized by hyperplasia of lymph nodes. We report the case of a 12-year-old boy who presented with painful oral and genital ulcers, who was assumed to have Behçet's disease. However, the patient did not show any clinical improvement on colchicine and systemic corticosteroids. Later, the patient developed severe abdominal pain and vomiting. Abdominal CT revealed a mass lesion superior to the right kidney. After a thorough investigation, he was diagnosed with unicentric Castleman's disease. Despite the complete resection of the mass, the patient continued to have the symptoms of abdominal pain and orogenital ulcers. Immunomodulatory therapy resulted in remarkable clinical improvement. This case report demonstrates how unicentric Castleman's disease can share similar clinical behavior to the multicentric disease.