Scrotal pain as a novel symptom of multisystem inflammatory syndrome in children (MIS-C): Report from Riyadh, Saudi Arabia.

A previously healthy child, presented with severe abdominal and scrotal pain with scrotal swelling for five days. There was associated fever, vomiting, and diarrhea. There was history of COVID-19 infection in the previous month. The patient was febrile (39°C), and in pain. His other vitals were unremarkable. Testicular torsion and appendicitis were ruled out by ultrasound. Abdominal CT scan showed signs indicating terminal ileitis. His MIS-C panel revealed elevated inflammatory markers and cardiac enzymes and positive SARS-CoV-2 IgG levels. All cultures and RT-PCR COVID-19 were negative. Echocardiogram showed only minor mitral and tricuspid regurgitation. The patient was diagnosed as a case of MIS-C. and recovered completely on management. Our patient showed an inexplicable previously unreported complaint of scrotal pain and swelling as a symptom of MIS-c. Further research tackling MIS-C's different presentations and comparing the efficacy of the different treatment methods will help us better manage this disease.

Role of cognitive assessment for high school graduates prior to choosing their college major.

[Purpose] Academic performance of college students can be impacted by the efficacy of students' ability and teaching methods. It is important to assess the progression of college students' cognitive abilities among different college majors and as they move from junior to senior levels. However, dearth of studies have been examined the role of cognitive ability tests as a tool to determine the aptitude of the perspective students. Therefore, this study assessed cognitive abilities of computer science and ART students. [Subjects and Methods] Participants were 130 college students (70 computer and 60 art students) in their first and final years of study at King Saud University. Cognitive ability was assessed using the Test of Nonverbal Intelligence, Third Edition. [Results] The cognitive ability of computer science students were statistically better than that of art students and were shown improvement from junior to senior levels, while the cognitive ability of art students did not. [Conclusion] The cognitive ability of computer science college students was superior compared to those in art, indicating the importance of cognitive ability assessment for high school graduates prior to choosing a college major. Cognitive scales should be included as an aptitude assessment tool for decision-makers and prospective students to determine an appropriate career, which might reduce the rate of university drop out.

The Effect of Visual Impairment on Postural Stability After Lumbar Spine Fracture: A Case Report and Review of the Literature.

The role of vision in maintaining postural stability is crucial, and its loss, whether congenital or acquired, can significantly impact sensory-motor interactions, leading to musculoskeletal abnormalities and defective gait patterns. This case report discusses the complex interplay between visual impairment, post-traumatic kyphosis, and the development of spinal deformity in a 79-year-old blind patient. The patient sustained a simple fall resulting in an L1 compression fracture in 2016. Despite conservative treatment for the fracture, progressive spinal deformity became evident both clinically and radiographically. Further assessments, including evaluation of bone healing, facet arthroplasty, disc degeneration, and canal compromise, were performed. The patient's altered gait and postural abnormalities were indicative of the impact of visual impairment on postural stability. After addressing osteoporosis through endocrinology consultation and medical management, the patient underwent posterior spinal instrumentation and deformity correction, leading to a successful post-operative recovery with a return to baseline functional status. Visual impairment disrupts postural stability by limiting sensory input and prompting compensatory mechanisms, which may increase postural sway and instability. This abnormal gait further contributes to spinal deformities, and the fear of falling can exacerbate postural instability, limiting mobility. Over time, persistent postural imbalance leads to the creation of a state of continual asymmetric stress related to the spinal axis, which can progress to the development of spinal deformities, creating a self-perpetuating cycle.  This case underscores the significance of vision in postural stability and the adverse effects of visual impairment on spinal alignment. The development of spinal deformities in visually impaired individuals, especially in the presence of risk factors like osteoporosis, emphasizes the need for early intervention and postural training to prevent irreversible deformities. Decisions regarding surgical or non-surgical interventions for spinal deformities in visually impaired patients must consider multiple factors, including clinical symptoms, appearance, pain, functional limitations, and social issues. Future research should explore effective interventions for improving postural stability in visually impaired individuals and preventing the development of spinal deformity.

Lateral epicondyle to the joint line distance is a precise landmark for determination of an accurate knee joint line: an observational retrospective study.

PURPOSE: To assess a quantitative and reproducible association between the position of the knee joint line and recognizable anatomical landmarks around it in order to help in restoring joint line in arthroplasty cases. METHODS: Magnetic resonance imaging (MRI) of 130 normal knees were investigated. Anatomical measurements of the knee joint distances on the obtained planes were performed manually by distance measurements using a ruler tool, followed by 6 anatomical bony landmarks determination about the knee to identify the joint line which included the joint line, medial epicondyle, lateral epicondyle, medial flare, lateral flare, and proximal tibiofibular joint. The entire process was examined twice by two independent fellowship trained musculoskeletal radiologists, with a 2-week interval between the first and second sets of readings. RESULTS: The lateral epicondyle to the joint line of the knee (LEJL) could be a reliable landmark for accurate distance measurements for the knee joint line level, with an absolute distance of 24.4 ± 2.8 mm. The analysis showed that the femorotibial ratio between the LEJL and proximal tibiofibular joint (PTFJ) was 1.0 (LEJL/PTFJJL = 1.0 ± 0.1), confirming the location of the knee joint at the midpoint between the lateral epicondyle and PTFJ, revealing two identifiable landmarks. CONCLUSIONS: LEJL is the most precise landmark for determination of an accurate knee joint line because the knee is located at the midline between the lateral epicondyle and PTFJ. These reproducible quantitative relationships can be widely employed in various imaging modalities to help restore the knee JL in arthroplasty surgeries.

Barriers and Facilitators of Telemedicine Among Physicians at a University Hospital.

Background and aims This study explored the perceived barriers and facilitators to the implementation of telemedicine among physicians and estimated and compared the prevalence of telemedicine use among physicians before and during coronavirus disease 2019 (COVID-19). Methods This cross-sectional study was conducted at King Saud University in Riyadh. A convenience sample of 163 physicians working at King Khalid University Hospital (KKUH) completed an online survey. Demographic data, patterns of use, and perceived barriers and facilitators of telemedicine were collected using a 5-point Likert scale. Results Our research showed that 61.3% (n = 100) of the physicians surveyed had used telemedicine in their careers. The prevalence of telemedicine before the onset of COVID-19 was 18.4%, whereas during COVID-19, it increased to 59.5%, which is an increase of 330% (P < .001). Most of the respondents (50.9%; n = 83) used it weekly (27%) or occasionally (23.9%). The most prevalent perceived barrier was technical difficulties (68.7%; n = 112), and the most prevalent perceived facilitator was that telemedicine can reduce unnecessary face-to-face appointments (86.5%; n = 141). Conclusion The use of telemedicine to provide health care is on the rise, especially in the case of emergencies. Different specialties face different facilitators and barriers, and the potential of telemedicine implementation depends on the work environment and the needs of the specialty. Several obstacles need to be overcome before telemedicine becomes a consistently used method for providing health care.

Alkaptonuria Diagnosis Following a Discectomy: A Case Report.

Alkaptonuria is a rare genetic disorder characterized by the excessive production of homogentisic acid, leading to the formation and deposition of pigment polymers throughout the body. It is extremely rare, affecting only around one in 100,000 individuals. Despite the normal life expectancy, it can cause severe morbidities. Alkaptonuria is typically managed supportively with pain medication, dietary modifications, and surgical interventions, which are considered to be the gold standard of therapy. Here we present a case of a 33-year-old male with no previous medical or surgical history who presented with severe acute back pain radiating to the left leg. Genetic testing confirmed a homozygous pathogenic variant for alkaptonuria. This case highlights the challenges in diagnosing alkaptonuria, emphasizing the significance of early detection, and clinical evaluation for improved outcomes. Furthermore, it underscores the need to consider alkaptonuria as a multidimensional disease, necessitating further research to enhance our understanding and develop effective management. Therefore, this study serves as an opportunity for future trials and studies aimed at digging deeper into the intricacies of alkaptonuria to increase our understanding and establish comprehensive management plans for affected individuals.

The Prevalence of Simultaneously Ordering Amylase and Lipase for Diagnosing Pancreatitis.

Background: The simultaneous measurement of serum amylase and lipase levels in the diagnosis of pancreatitis was deemed unnecessary in several studies. We aim at evaluating the prevalence of the simultaneous co-ordering of serum amylase and lipase. Methods: This retrospective chart review was conducted at King Saud University Medical City in Riyadh, Saudi Arabia, between January 2021 and January 2022. We examined requests for serum amylase or serum lipase levels that had been sought for suspected pancreatitis within the electronic health system (EHS). Results: A total of 9,617 requests for serum amylase and serum lipase levels for 5,536 patients were made in a year; 6,873 (71.5%) were made for serum lipase alone; 1,672 (17.4%) were made for co-ordered serum lipase and amylase; 322 (3.3%) were made for amylase alone; and 750 (7.8%) were made for repeated amylase testing. Four hundred and thirteen tests (4.3%) yielded a diagnosis of pancreatitis. The estimated cost reduction when serum amylase was removed if serum lipase was co-ordered was 108,680 SAR (approximately US$28,960). Conclusion: Serum amylase and lipase were co-ordered for about 17.4% of pancreatitis diagnostic tests, all of which were unnecessary. Eliminating serum amylase testing for any patient who receives a test of their lipase levels would exert a significant impact on institutional costs and savings.

Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center.

Understanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age ( p < 0.018), respiratory cause ( p < 0.001), bradycardia ( p < 0.018), and short duration of CPR ( p < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome ( p < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR ( p = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.

Surgical Management of Congenital Pseudoarthrosis of the Clavicle: A Review of Current Concepts.

Nowadays, surgical intervention is an accepted treatment for congenital pseudoarthrosis of the clavicle (CPC). The purpose of this literature review is to evaluate the current body of evidence for methods and outcomes of surgical intervention for CPC. CPC is a rare deformity of the middle third of the clavicle not often identified until three to five years of age, at which time surgery is often recommended. The most common indication for surgery is cosmetic appearance, but other indications include pain, shoulder dysfunction, and prevention of complications later in life. Surgical intervention involves the resection and excision of the pseudoarthrosis, bone grafting (most commonly autologous tissue from the iliac crest), and internal fixation using plates or Kirschner wires (K-wires). Plate fixation tends to have fewer complications and better long-term outcomes. Following surgery, outcomes include satisfaction with cosmetic appearance, decreased pain, and improved shoulder function.

Prevalence and outcome of isoniazid-monoresistant tuberculosis at a university hospital in Saudi Arabia.

OBJECTIVES: To determine the prevalence and outcome in patients with isoniazid-monoresistant Mycobacterium tuberculosis complex and compare them to those in patients with non-isoniazid-monoresistant Mycobacterium tuberculosis. METHODS: This cross-sectional analytical study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. The data were retrospectively collected from the electronic medical records of patients who tested positive for Mycobacterium tuberculosis between May 2015 and April 2019. RESULTS: We identified 105 patients infected with Mycobacterium tuberculosis. The prevalence proportion of isoniazid-monoresistant tuberculosis was 8.6% (n=9). Five patients with isoniazid-monoresistant tuberculosis (55.6%) were successfully treated, while one patient died. In the nonresistant population, 51 (53.1%) patients were successfully treated. However, 12 (12.5%) patients with no isoniazid resistance had an unsuccessful treatment outcome. The resistant group had a longer treatment duration with a mean of 12 months compared to the non-isoniazid-resistant group, with a mean treatment duration of 9.5 months. Twenty-eight patients (26.7%) had adverse events, with the majority of them being in the non-isoniazid-resistant group. CONCLUSION: Isoniazid monoresistance is the most common form of drug resistance found in our population. Our study has not shown any significance in the outcome of isoniazid-resistant cases compared to non-isoniazid-resistant cases. This may be due to the low number of isoniazid-monoresistant cases in our population.

One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center.

BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years o age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications (P=.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.