Development of Calvarial Bone Osteomyelitis in a Noonan Syndrome Patient Following Fronto-Orbital Advancement of Craniosynostosis: A Novel Technique of Treatment Using Povidone and Hydrogen Peroxide Solutions.

This is a case of a pediatric patient with Noonan syndrome (NS) and craniosynostosis who developed calvarial bone osteomyelitis following corrective surgery. Despite complications, such as postoperative bleeding and infections, including osteomyelitis, multidisciplinary management strategies were employed, including antibiotics, debridement, and novel use of hydrogen peroxide and povidone solutions due to bone thinning. The discussion highlights challenges in managing syndromic craniosynostosis, emphasizing the importance of tailored approaches and prophylactic antibiotics. The innovative treatment approach using hydrogen peroxide and povidone presents a potential alternative for bone infections and osteomyelitis post-cranial reconstruction, offering insights for future management strategies. Lessons learned regarding infection rates and novel treatment modalities contribute to evolving approaches in managing complications in syndromic craniosynostosis.

Splenectomy perspective for non-malignant hematological disorders: A cross-sectional study in the Eastern Province of KSA.

Objectives: Splenectomy is considered a therapeutic modality for several hematological diseases, although complications are possible. This study assessed the effects of splenectomy on various hematological disorders and the roles of prophylactic measures on postoperative outcomes. Methods: This was a cross-sectional study performed in KSA on adult patients with underlying non-malignant hematological disorders who had undergone splenectomy. Results: This study examined 179 patients with various hematological disorders, 38 (21.1%) of whom had undergone a splenectomy. Of those 38 patients, more than two-thirds (73.7%) had an open splenectomy. The average hospital stay was 2-7 days, and no significant difference was observed between the open and laparoscopic approaches. Approximately 95% of the patients showed overall improvements in their condition after splenectomy. However, 26.3% of patients reported a recurrence or need for further treatment 1 year or more after splenectomy. Approximately 16% of patients had an increased incidence of postoperative infectious complications, particularly patients with sickle cell disease and beta thalassemia. More than half the patients who developed complications had not received vaccination preoperatively, whereas 44.4% of vaccinated patients experienced complications (p = 0.04). Conclusion: Splenectomy is considered a universal line of treatment for most non-malignant hematological diseases. Although splenectomy is an effective treatment, the reasons why patients with the same disease can have different responses remains unclear. Infection is a common postoperative complication, and vaccinations are underused. This study emphasizes the roles of patient education, scheduled vaccinations and proper selection of patients in the use of splenectomy for the treatment of non-malignant hematological diseases.

The Correlation Between Surgical Procedures and Quality of Life Among Sickle Cell Disease Patients: A Perspective Saudi Study.

INTRODUCTION: Sickle cell disease (SCD) is among the common prevalent diseases in Saudi Arabia. It is associated with several complications that sometimes necessitate surgical procedures. Those patients can also have a lower quality of life (QoL) due to several reasons. Our aim in this study is to highlight the association between sociodemographic data, clinical data, and SCD-related surgeries in patients with their QoL. METHODS: A cross-sectional study was performed using a validated Arabic version of the World Health Organization QoL-BREF (WHOQOL-BREF) questionnaire distributed in electronic form. Male and female Arabic speakers (18+ years old) of Saudi origin were included in this study; those who did not meet these criteria were excluded. RESULTS: We distributed 309 questionnaires to the targeted subjects; however, only 204 met our inclusion criteria. Our findings revealed 135 female respondents and 69 male respondents. Interestingly, splenectomy was not significantly associated with a difference in all aspects of QoL in SCD patients. However, the data showed significantly lower respective mean scores for physical health (p=0.002 & p=0.022) and overall QoL (p=0.024 & p=0.042) for those who underwent cholecystectomy and hip arthroplasty. In contrast, shoulder arthroplasty appeared to be associated with significantly lower mean scores for physical health (T=-2.597; p=0.010) and the environmental aspect of QoL (T=-2.016; p=0.045). CONCLUSION: Cholecystectomy, hip arthroplasty, and shoulder arthroplasty were significantly associated with lower QoL in SCD patients.

Survival From Ninety-Five Percent Total Body Surface Area Burn: A Case Report and Literature Review.

Burns can be devastating and result in unwanted consequences with prolonged length of hospital stay. The mortality rate increases as the total body surface area increases, so proper management of patients with extensive degrees of burns is crucial for their survival. We present the hospital course, management, and survival of a patient after he sustained a 95% total body surface area, second-degree burn from a gas flame. Furthermore, we present from the literature different cases of patients with large total body surface area burns and survived after being managed in burns specialty centers. Although large total body surface area burns can result in significant morbidity and mortality, early management and intervention by an expert surgical team can result in positive outcomes.

Clinical and Laboratory Predictors of Painful Vaso-Occlusive Crisis Among Sickle Cell Disease Patients: A Single-Center Study in Saudi Arabia.

Introduction Vaso-occlusive crisis (VOC) episodes are considered to be the cause of 95% of hospitalizations for sickle cell disease (SCD) patients. The frequency of VOC is significantly associated with higher or lower lactate dehydrogenase levels, higher hemoglobin concentration, higher white blood cell, and neutrophil count, and lower platelet counts. In this study, we highlighted the association and predictors of VOC episodes in Saudi Arabia. Methods This is a retrospective observational study that was conducted in a period from January 2018 to December 2019 which included patients who were admitted and treated as sickle cell disease patients were included in this study. Retrieved data included patients' age, sex, and other demographic data items as well as the clinical history of SCD. The patients were divided into two groups. Those patients who developed one or two VOC episodes in the period between 2018-2019 were considered mild in severity and patients who developed three or more VOC episodes in the period between 2018-2019 were categorized as moderate to severe. Results A total of ninety-four patients (58 males and 36 females) with a male to female ratio of 1.6 were included in this study. The prevalence of patients who had severe vaso-occlusive crisis was 39.4% while mild-moderate were detected among 60.6% of the patients. It was found that there was no significant difference between the frequency of vaso-occlusive crisis and all the hematological parameters (all p>0.05). It was found that the risk of having vaso-occlusive crisis for those patients who were admitted more than three times was 30 times higher than those patients who were admitted by three times or less [adjusted odds ratio (AOR) = 30.081; 95% confidence interval (CI) = 8.204 - 110.3; p<0.001)]. Conclusion It was found that those patients who had three times VOC episodes in our studied period are more liable to have frequent episodes in the future which might necessitate urgent intervention for these patients.

Reasons for Hospitalization of Sickle Cell Disease Patients in the Eastern Province of Saudi Arabia: A Single-Center Study.

BACKGROUND: Sickle cell disease (SCD) is among the prevalent chronic diseases in the Eastern Province of Saudi Arabia. To our knowledge, there is no published research that reports the reasons for hospitalization in the Eastern Province of the country. Therefore, this study aimed to fill this gap. DESIGN AND METHODS: This is a retrospective cohort study that was conducted in the period from January 2018 to December 2019. Patients with sickle cell disease who were admitted and treated in the hospital were included in this study. Patients' sociodemographic data and reasons for hospitalization were collected and analyzed using the statistical package for social sciences, version 21 (SPSS, Chicago, IL, USA). RESULTS: There were 103 SCD patients, and the age range was from 18 to 62 years old. The majority of the patients were males (56.3%) and were in the younger age group (≤30 years old; 60.2%). The results showed that the most frequent cause of admission was a vaso-occlusive crisis (VOC) (n=94, 91.3%), followed by acute chest syndrome (ACS) (n=32, 31.1%), and then by hemolytic crisis (27 of the cases; 26.2%). However, we found that a higher number of hip avascular necrosis (AVN) cases were statistically significant in relation to the higher number of hospital admissions (p<0.05), whereas other reasons were not found to have a statistically significant association. CONCLUSION: The most frequent cause of admission was VOC episodes, followed by ACS, and then by hemolytic crises. Also, a higher number of hip AVN episodes were statistically significant with the higher number of hospital admissions.