Outcomes of biological therapy in patients with severe asthma with chronic rhinosinusitis in Saudi Arabia: patients with nasal polyps versus those without nasal polyps.

BACKGROUND: This study's purposes were to evaluate the impact of biological therapies on outcomes in patients with severe asthma (SA) and chronic rhinosinusitis (CRS) and to compare these effects among those with NP (CRSwNP) versus those without NP (CRSsNP) in the "real-world" setting in Saudi Arabian patients. METHODS: From March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital-Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of dupilumab therapy. Outcomes were assessed, including clinical outcomes, FEV1, and laboratory findings before and one year after dupilumab. Post-therapy effects were compared between CRSwNP and CRSsNP. RESULTS: Fifty subjects were enrolled, with a mean age of 46.56. There were 27 (54%) females and 23(46%) males. Significant improvements in clinical parameters (frequency of asthma exacerbations and hospitalizations, the use of OCs, anosmia, SNOTT-22, and the ACT), FEV1, and laboratory ones (serum IgE and eosinophilic count) were observed 6 and 12 months after using dupilumab (p < 0.001), respectively. However, after 12 months of dupilumab therapy, there were no significant differences between those with and without NP with regards to clinical (anosmia, ACT, and OCs use), laboratory (eosinophilic count, serum IgE level) parameters, and FEV1%. CONCLUSIONS: Patients with CRS experienced significant improvements in clinical, FEV1, and laboratory outcomes after dupilumab therapy. However, these improvements were not maintained when comparing CRSwNP with CRSsNP. There were no significant differences between those with and without NP regarding ACT and OCs use or laboratory (eosinophilic count, serum IgE level) parameters. Further prospective multicenter studies are warranted.

Meaning of the Skulls Depicted in Emblem Books of the 17th Century.

The aim of this study is to elucidate the meaning of the skulls depicted in emblem books of the 17th century. Three emblem books of the 17th century were reviewed and analyzed: (1) Rollenhagen emblem: Gabrielis Rollenhagii Selectorum emblematum centuria secunda (1613), (2) Quarles' emblems; illustrations engraved by William Marshall and others (1635), and (3) Wither's emblem: A collection of emblemes, ancient and moderne: quickened with metricall illustrations, both morall and divine: and disposed into lotteries (1635). Among the 100 illustrations in Rollenhagen's book, 4 (4.0%) had skulls. Among the 76 illustrations in Quarles' book, 6 (7.9%) had skulls. Among the 256 illustrations in Wither's book, 12 (4.7%) had skulls. Thereafter, 22 (5.1%) of 432 illustrations had skulls. Four emblems in Rollenhagen's book were exactly identical to those in Wither's book. Therefore, 18 emblems (6 Quarles' emblem, 12 Wither's emblem) were analyzed. The most frequent meaning of skulls in 18 emblems was death (12, 66.7%), followed by resurrection (2, 11.2%). Other meanings were grief, the brevity of life, vanity of love, and pain, respectively (1 each). The most frequent of the theme of the emblems, which included skulls, was 'Memento mori' (remember death, 6, 33.3%), followed by an earnest desire for salvation or resurrection (3, 16.7%), and importance of knowledge or learning (2, 11.1%). Since these emblem books were published after Vesalius' Fabrica (1543), the drawing of the bones of the arm and legs had anatomic correlations. However, skulls were not sufficiently precise, showing each part of the facial bones.

Craniofacial Features of Dwarfism in the Paintings of Velázquez.

This study describes the craniofacial features of achondroplastic dwarfism in the paintings of Velázquez. In a PubMed search, using [Velázquez] and [dwarf], 13 titles were found. In a Google Image search, [Velázquez] and [dwarf] retrieved 5 paintings. The craniofacial manifestations of the dwarfs depicted in the paintings were analyzed. Frontal bossing, antimongoloid slant, depressed nasal bridge (saddle nose), bulbous tip, malar hypoplasia, malocclusion, and chin asymmetry were observed. The presence of each manifestation was checked. In 5 paintings, portraits of 6 dwarfs having craniofacial deformities were found: Mariabárbola Asquin (left) in Las Meninas , Nicolasito Pertusato (right) in Las Meninas , Portrait of Sebastián de Morra, Portrait of Francisco Lezcano, The Jester Don Diego de Acedo, and Prince Balthasar Charles with a Dwarf. The most frequent craniofacial manifestation was malar hypoplasia (100%), followed by a bulbous tip (83.3%), saddle nose (66.7%), and frontal bossing (50%). Antimongoloid slant, malocclusion, and chin asymmetry were relatively rare (16.7% each). Through an analysis of 6 dwarfs in Velázquez's paintings, we can show that he realized and frequently expressed the craniofacial manifestations of achondroplasia: malar hypoplasia, bulbous tip, saddle nose, and frontal bossing. Despite the rarity of these presentations, he was also aware of antimongoloid slant, malocclusion, and chin asymmetry. Velázquez was a famous painter in the 17th century (i.e., during the Baroque period). Based on his excellent expression of the craniofacial manifestations of dwarfism, we can assume that he had a sound knowledge of anatomy, as well as malformations.

How Do the Faces of Kyrgyz Beauties Look? A Photogrammetric Analysis of Beauty Pageant Winners.

The aim of this study was to assess how the eyes of Kyrgyz beauties look through an anthropometric analysis of beauty pageant winners. Eleven winners of the Miss Kyrgyzstan contest (2011-2021) were included. Ten other beauty contest winners were added, resulting in a total of 21 beauties who were included. The horizontal corneal diameter, which is 11.75 mm, was used as a standard distance. Other distances were calculated in millimeters based on the proportions of the pixels measured. Twenty-six distances (face: 10, eyebrows: 2, eyes: 4, nose: 4, lips: 4, and chin: 2) and 9 angles (forehead-brow, cantal tilt, 5 face angles, the mandible angle, and the chin angle) were measured. Thereafter, 16 indices (forehead: 1, eyes: 5, nose: 4, lips and chin: 3, and contours 3) were calculated. The forehead-brow angle was 82.2±7.2 degrees. The canthal tilt was 9.0±2.0 degrees. The overall face angles 1 and 2 were 108.6±4.1 degrees and 69.6±2.3 degrees, respectively. The midface angles 1 and 2 were 129.9±3.8 degrees and 125.1±3.9 degrees, respectively. The lower face angle was 139.6±4.1 degrees. The mandible angle and chin angle were 136.9±4.0 degrees and 106.0±4.0 degrees, respectively. The ratio of forehead height to total face height was 0.33±0.03. The ratio of nose height to total face height was 0.25±0.02. The lower face width/face width ratio was 0.82±0.05. The ratio of face width to total face height was 0.72±0.03. The ratio of midface height to total face height was 0.34±0.02. The data from this study might serve as the recommended esthetic proportions for performing plastic surgical procedures.

A trial of doramectin injection and ivermectin spot-on for treatment of rabbits artificially infested with the ear mite "Psoroptes cuniculi".

The ear mite "Psoroptes cuniculi" is the main cause of ear mange, a highly contagious parasitic skin disease in rabbits all over the world. In the current work, a preliminary therapeutic trial to study the effect of the broad use acaricides doramectin and ivermectin on P. cuniculi was performed on artificially infested rabbits. Twenty five adult New Zealand white rabbits were used in this study. The rabbits were assigned randomly into five groups/ 5 rabbits in each group. Each rabbit was experimentally infested with 100 mites/ ear. The first group was designated the positive control group and was not treated. The second and third groups were treated with doramectin 200 and 400 µg/kg bw, respectively. Groups 4 and 5 were treated by dressing with ivermectin in one dose and 2 doses with a 1 week interval. After the therapy, all rabbits were examined microscopically on the 7th, 14th, and 28th day post treatment and the number of live mites (larvae, nymphs, and adults) on each rabbit was counted at the end of the experiment (28th day). The results showed that the rabbits treated subcutaneously with doramectin at a single dose of 200 µg /kg bw showed a very low effect, although there was significant improvement when the dose was doubled to 400 µg /kg bw, with the number of mites counted decreasing significantly. Rabbits treated topically with ivermectin spot-on, a single dose or 2 doses, showed great improvement of the lesion: the number of mites was reduced to zero. In conclusion, this work showed that ivermectin spot-on applied locally on infested ears proves to be more effective against P. cuniculi than doramectin injected subcutaneously. Further trials on ear mange therapeutics in rabbits are to be encouraged.

Circulating biomarkers for detection of ovarian cancer and predicting cancer outcomes.

BACKGROUND: Securing a diagnosis of ovarian cancer and establishing means to predict outcomes to therapeutics remain formidable clinical challenges. Early diagnosis is particularly important since survival rates are markedly improved if tumour is detected early. METHODS: Comprehensive miRNA profiles were generated on presurgical plasma samples from 42 women with confirmed serous epithelial ovarian cancer, 36 women diagnosed with a benign neoplasm, and 23 comparably age-matched women with no known pelvic mass. RESULTS: Twenty-two miRNAs were differentially expressed between healthy controls and the ovarian cancer group (P<0.05), while a six miRNA profile subset distinguished presurgical plasma from benign and ovarian cancer patients. There were also significant differences in miRNA profiles in presurgical plasma from women diagnosed with ovarian cancer who had short overall survival when compared to women with long overall survival (P<0.05). CONCLUSION: Our preliminary data support the utility of circulating plasma miRNAs to distinguish women with ovarian cancer from those with a benign mass and identify women likely to benefit from currently available treatment for serous epithelial ovarian cancer from those who may not.

The soluble isoform of CTLA-4 as a regulator of T-cell responses.

CTLA-4 is a crucial immune regulator that mediates both negative costimulation signals to T cells, and regulatory T (Treg)-cell extrinsic control of effector responses. Here we present evidence supporting a novel mechanism for this extrinsic suppression, executed by the alternatively spliced soluble CTLA-4 isoform (sCTLA-4). Analyses of human T cells in vitro show that sCTLA-4 secretion can be increased during responses, and has potent inhibitory properties, since isoform-specific blockade of its activity significantly increased Ag-driven proliferation and cytokine (IFN-γ, IL-17) secretion. Treg cells were demonstrated to be a prominent source of sCTLA-4, which contributed to suppression in vitro when their numbers were limiting. The soluble isoform was also produced by, and inhibited, murine T cells responding to Ag in vitro, and blockade of its activity in vivo protected against metastatic spread of melanoma in mice. We conclude that sCTLA-4 is an important immune regulator, responsible for at least some of the inhibitory effects previously ascribed to the membrane-bound isoform. These results suggest that the immune system exploits the different CTLA-4 isoforms for either intrinsic or extrinsic regulation of T-cell activity.

Molecular genetic conspecificity of Spiculopteragia houdemeri (Schwartz, 1926) and S. andreevae (Drózdz, 1965) (Nematoda: Ostertagiinae) from wild ruminants in Japan.

Male dimorphism of the subfamily Ostertagiinae (Nematoda: Trichostrongylidae) is a well-known phenomenon, and two or more morphotypes of a single species have previously been described as different species. Two Spiculopteragia spp., S. houdemeri (syn. S. yamashitai) and S. andreevae (syn. Rinadia andreevae) recorded in Asian cervids and wild bovids, are considered to represent major and minor morphs of S. houdemeri, respectively, based solely on their co-occurrence in the same host individual along with monomorphic females. In this study, males of morph houdemeri ( = S. houdemeri) and morph andreevae ( = S. andreevae) as well as females with three different vulval ornamentations were collected from sika deer (Cervus nippon) and Japanese serows (Capricornis crispus) distributed on the mainland of Japan. Morphologically characterized worms were subjected to molecular genetic analyses based on the internal transcribed spacer region of the ribosomal RNA gene and a partial region of the cytochrome c oxidase subunit I gene of mitochondrial DNA. Of 181 collected sika deer, 177 (97.8%) and 73 (40.3%) deer harboured males of morphs houdemeri and andreevae, respectively. Worm numbers of the former morph were found to range between 1 and 444 per individual, whereas only 1-25 worms per individual were detected for the latter morph. Five out of six serows harboured 47-71 or 2-9 males of morphs houdemeri and andreevae per individual, respectively. Females with one or two vulval flaps were predominant, but there was a substantial presence of flapless females in both host species. All the morphs of male and female adults had an identical genetic background, thus directly confirming the morphological polymorphism of S. houdemeri.

Hepatic spheroid-on-a-chip: Fabrication and characterization of a spheroid-based in vitro model of the human liver for drug screening applications.

The integration of microfabrication and microfluidics techniques into cell culture technology has significantly transformed cell culture conditions, scaffold architecture, and tissue biofabrication. These tools offer precise control over cell positioning and enable high-resolution analysis and testing. Culturing cells in 3D systems, such as spheroids and organoids, enables recapitulating the interaction between cells and the extracellular matrix, thereby allowing the creation of human-based biomimetic tissue models that are well-suited for pre-clinical drug screening. Here, we demonstrate an innovative microfluidic device for the formation, culture, and testing of hepatocyte spheroids, which comprises a large array of patterned microwells for hosting hepatic spheroid culture in a reproducible and organized format in a dynamic fluidic environment. The device allows maintaining and characterizing different spheroid sizes as well as exposing to various drugs in parallel enabling high-throughput experimentation. These liver spheroids exhibit physiologically relevant hepatic functionality, as evidenced by their ability to produce albumin and urea at levels comparable to in vivo conditions and the capability to distinguish the toxic effects of selected drugs. This highlights the effectiveness of the microenvironment provided by the chip in maintaining the functionality of hepatocyte spheroids. These data support the notion that the liver-spheroid chip provides a favorable microenvironment for the maintenance of hepatocyte spheroid functionality.

Schwannoma at an Unusual Site: Case Report and Surgical Technique Discussion for Nasal Dorsum.

Peripheral nerve sheath tumors (PNSTs), while uncommon, can have a significant impact on appearance and quality of life, especially when they form in prominent areas such as the nose dorsum. We discuss a case of a 29-year-old woman who developed a benign PNST on the right side of her nasal ala. This tumor gradually grew, impairing her face appearance. Diagnostic tests, such as computed tomography (CT) and magnetic resonance imaging (MRI), revealed the tumor as a slowly growing, well-defined mass. The tumor was removed via open rhinoplasty under general anesthesia, and pathological investigation verified its benign nature. After surgery, the patient's quality of life improved significantly, and there were no evidence of tumor recurrence after eight months. This case emphasizes the need of including PNST in the differential diagnosis of nasal tumors.

In-silico evaluation of Bismurrayaquinone-A phytochemical as a potential multifunctional inhibitor targeting dihydrofolate reductase: implications for anticancer and antibacterial drug development.

Dihydrofolate reductase (DHFR) has gained significant attention in drug development, primarily due to marked distinctions in its active site among different species. DHFR plays a crucial role in both DNA and amino acid metabolism by facilitating the transfer of monocarbon residues through tetrahydrofolate, which is vital for nucleotide and amino acid synthesis. This considers its potential as a promising target for therapeutic interventions. In this study, our focus was on conducting a virtual screening of phytoconstituents from the IMPPAT2.0 database to identify potential inhibitors of DHFR. The initial criterion involved assessing the binding energy of molecules against DHFR and we screened top 20 compounds ranging energy -13.5 to -11.4 (kcal/Mol) while Pemetrexed disodium bound with less energy -10.2 (kcal/Mol), followed by an analysis of their interactions to identify more effective hits. We prioritized IMPHY007679 (Bismurrayaquinone-A), which displayed a high binding affinity and crucial interaction with DHFR. We also evaluated the drug-like properties and biological activity of IMPHY007679. Furthermore, MD simulation was done, RMSD, RMSF, Rg, SASA, PCA and FEL explore the time-evolution impact of IMPHY007679 comparing it with a reference drug, Pemetrexed disodium. Collectively, our findings suggest that IMPHY007679 recommend further investigation in both in vitro and in vivo settings for its potential in developing anticancer and antibacterial therapies. This compound holds promise as a valuable candidate for advancing drug research and treatment strategies.Communicated by Ramaswamy H. Sarma.

Client's satisfaction with healthcare services received at the hospital outpatients department and the primary healthcare facilities in Al-Qassim, Saudi Arabia: A review of service users' satisfaction.

OBJECTIVES: To assess the level of satisfaction expressed for services rendered in the public health sector to clients who were seen at outpatient departments (OPDs) and primary healthcare (PHC) facilities in Al-Qassim Health Cluster in Saudi Arabia. METHODS: This study used a comparative cross-sectional study design, and data were obtained as secondary data from The Patient's Experience Platform. Data analysis was carried out using Stata (version 16), and the significance level was 5%. RESULTS: In comparing the mean satisfaction in 9 domains, statistically significantly higher means for the PHC facilities than the OPDs were seen across 7 domains: patients navigating health facilities (p=0.008), nursing services (p<0.001), physicians' services (p=0.004), radiological services (p<0.001), personal issues (p=0.003), the pharmacy (p=0.005), and general experience (p=0.036). CONCLUSION: This study's findings are significant. They indicate that client satisfaction with services at PHC facilities was significantly higher than with services at hospital OPDs in Al-Qassim region. This underscores the need to improve the quality of services provided at OPDs to bring them to the same level as those provided by PHC facilities. Policymakers and implementers should, therefore, sustain efforts to make OPDs and PHC facilities more desirable for clients.

A Selective Gas Chromatography-Tandem Mass Spectrometry Method for Quantitation of Ethylene and Diethylene Glycol in Paediatric Syrups.

Ethylene Glycol (EG) and diethylene Glycol (DEG) are two contaminants known to cause various human health problems. These glycols might be present in drug syrups that are based on glycerol, sorbitol, or polyethylene glycol. In late 2022, several batches of cough, antipyretics, and antihistamine syrups were reported to contain toxic levels of EG and DEG in multiple countries; this incident concerned the World Health Organization (WHO). From an analytical perspective, several methods of glycols analysis in pharmaceuticals have been reported in the literature, with the majority being dedicated to raw material analysis. This study aims to develop a selective method capable of evaluating a wide range of paediatric syrups in order to assess the safety of commercially available paediatric syrups currently distributed in the local market. This research introduces a method for determining glycols utilizing gas chromatography-tandem mass spectrometry (GC-MS/MS), which offers significantly higher selectivity than conventional single quadrupole gas chromatography-mass spectrometry (GC-MS). The developed method meets the current International Council for Harmonisation (ICH) guidelines for validation. The absence of any interfering peaks in both the unspiked sample of promethazine syrup and the reference standard solutions proved the method's selectivity. Furthermore, 2,2,2-trichloroethanol was used as an internal standard, and a new GC-MS/MS method was developed to analyze it. The calibration curves for EG and DEG were linear within the selected concentration range of 1-10 µg/mL. The detection limit for both EG and DEG was 400 ng/mL, while the quantification limit was 1 µg/mL. Recovery values for both EG and DEG met the accuracy acceptance criterion. Thus, the developed method proved to be efficient and accurate for determining EG and DEG levels in suspected contaminated syrups.

Simulation of temperature swing adsorption process to purify hydrogen for fuel cell uses by SAPO34 as adsorbent.

To purify hydrogen gas from synthesis gas using a adsorption process, SAPO 34 adsorbent was used. Due to the strong adsorption of carbon dioxide in this adsorbent, it is not possible to recover the adsorbent by reducing the pressure alone, and it is necessary to use thermal operations for recovery. For this purpose, a temperature swing adsorption (TSA) process is used to increase the purity of hydrogen for use in fuel cells. To investigate the optimum operational conditions, various temperatures and different pressures of input gas were investigated to compare the purity and recovery of adsorption process. The TSA process was simulated for pressures of 11, 22 and 33 bars and the recovery percentage of each process was calculated. According to the results obtained, the recovery value at 33 bars is better than the other two pressures, but due to the fact that operational and initial costs increase at high pressures; 22 bar pressure was chosen to present the remaining results. In this work, the total amount of material and the molar rate are also reported. The average purity of the components in the product and waste outlet streams has also been presented. Accordingly, the average molar fraction of hydrogen in the product outlet stream is 99.96% in the temperature increase stage, 99.94% and in the stream used for temperature reduction is 99.96%.

Incidental Finding of an Acupuncture Needle in a Carpal Tunnel Release.

Acupuncture, one of the most ancient forms of Chinese medicine, is widely used to treat many chronic ailments, but the extant literature reveals uncertainty regarding its efficacy and adverse complications. A specific adverse complication reported multiple times is the finding of broken needles incidentally or after symptomatic presentation. We report a case of an incidental finding of an acupuncture needle after a carpal tunnel release.

Synthesis of an efficient MOF catalyst for the degradation of OPDs using TPA derived from PET waste bottles.

In this study, a method for degrading PET-waste plastic bottles using ZnCl2:Urea as a catalyst was developed, resulting in high conversion (87%). The terephthalic acid obtained from the degradation of Waste PET Bottles (WPTs) was combined with copper and zinc salts to synthesize bimetallic metal-organic frameworks (MOF). The effectiveness of a bimetallic Cu-Zn(BDC)-MOF in catalyzing the reduction reaction of organic pollutant dyes (OPDs) was investigated, and the degradation efficiency of individual dyes was optimized, achieving over 95% degradation within 6-12 min under optimal conditions. Various techniques, including FT-IR, XRD, FE-SEM, EDS, and TEM were used to characterize the synthesized MOF. Results showed that the catalytic activity of Cu-Zn-MOF in reduction reaction of OPDs was enhanced by increasing the copper content. The reaction kinetics were investigated following pseudo-first-order kinetics with rate constants of 0.581, 0.43, 0.37, and 0.30 min-1 for Methylene Blue (MB), Methyl Orange (MO), 4-Nitrophenol (4-NP), and 4-Nitroaniline (4-NA), respectively. The investigations revealed that the produced catalyst exhibited excellent stability and recoverability, while its activity remained well-preserved even after undergoing three reuse cycles.

Impact of Preoperative Neuropraxia on Surgical Duration Following Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort Study.

Background Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. Hypothesis Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. Patients and Methods This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. Result The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration ( p < 0.017). Bivariate binary regression analysis showed a significant correlation between the increase of surgery duration and flexion-type fracture (odds ratio = 11, p < 0.038) as well as ORIF (odds ratio = 26.2, p < 0.001). Conclusion Preoperative neuropraxia and flexion-type fractures convey a potential longer surgical duration in pediatric supracondylar fracture. Level of Evidence Prognostic III.

The Descriptive Features of Primary Spontaneous Pneumothorax Patients in King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background Primary spontaneous pneumothorax (PSP) is a fairly prevalent disorder in emergency medicine. PSP most frequently affects tall, thin male smokers and is most prevalent during adolescence. Published literature contains a wide range of Primary Spontaneous Pneumothorax (PSP) recurrence rates, but there is limited information on the variables affecting recurrence. Objective To identify the descriptive features of PSP in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods This retrospective cross-sectional study was conducted in Surgery King Abdulaziz Medical City, Riyadh, Saudi Arabia. Including all PSP patients from 2016-2021, excluding pediatric and geriatric patients. Participants were selected using a simple random sampling technique, and data were collected from hospital records. Data analysis was conducted by using SPSS. Results In this study, we included a total of 131 participants. Most were males (93.1%), and most were aged between 21-30 years. Our findings showed that most PSP events occurred in winter (28.6%). Followed by fall (25.7%), summer (25.0%), and spring (20.7%). Concerning the smoking status of our respondents, our results revealed that most of them were active smokers (72.5%). Left-PSP was the most commonly reported type of PSP (43.5 %), followed by right-PSP (38.9%), non-simultaneous bilateral PSP (14.5%), and bilateral simultaneous PSP (3.1%). Moreover, we found that the recurrence rate of PSP was 42%. Regarding the management of PSP, almost half of the respondents were managed initially by Chest tube. The most frequently used surgical option was VATS- Bullectomy with Abrasion Pleurodesis. Finally, the recurrence rate of PSP was 42% among the patients. The percentage of patients with one recurrence only was 65.5% among the patients with recurrent PSP, second recurrence at 29.1%. Third, Fourth, and Fifth had the same recurrence percentage of 1.8%, and these percentages came to be statistically significant. (P value < 0.001) Conclusion Our study concluded that PSP was more prevalent in tall, thin, young male smokers. Almost half of the respondents suffered from at least one recurrence attack of PSP. The majority of the patients with recurrences experienced one recurrence only, and the second recurrence was estimated to be almost one-third. There is no significant association between the occurrence and seasons of the attack at a time. Most of the participants were managed initially by a chest tube. The most frequently used surgical option was Video Assisted Thoracoscopic Surgery (VATS) with abrasion pleurodesis.

Tourniquet Practice Among Orthopaedic Surgeons in Saudi Arabia.

Introduction This study aimed to evaluate the knowledge of tourniquet use among orthopedic surgeons in Saudi Arabia and assess the practical aspects of their use of tourniquets and the complications they have experienced in their practices. Materials and methods This cross-sectional study was conducted from December 2022 to February 2023. An online questionnaire was distributed among orthopedic surgeons and trainees in Saudi Arabia, and the surgeons' knowledge of tourniquet use was assessed using 17 questions. To investigate tourniquet usage, the participants were divided into three groups: orthopedic residents, specialists, and consultants. An upper limb cuff pressure (CP) of 200 mmHg and a lower limb CP of 250 mmHg were chosen as the cut-off values, and the doctors' choices were compared against literature recommendations using these measures. Result A total of 205 participants filled out the questionnaires; 130 residents, 15 consultants, and 60 specialists, with more males (175/205) than females responding. One hundred and twenty-one surgeons placed the cuff on patients by themselves, while 50 (24.3%) surgeons asked nurses for aid; 135 (65.6%) of them work in teaching hospitals, while 50 (24.3%) work in community hospitals. The incidence of post-tourniquet syndrome was unrelated to expertise (p=0.12). Conclusion When applied properly, tourniquets prevent excessive bleeding and keep the operative field clean during limb surgeries. This study aims to inspire the orthopedic community to reconsider long-held practices, especially regarding tourniquet pressure. The addition of ligature safety education to orthopedics training and outlining the settings and procedures for applying pressure should also be considered. The orthopedic community should set CP and process criteria to avoid complications. This study showed the importance of modifying the training of orthopedic residents to raise awareness and prevent unpleasant events from occurring.

Osteoid Osteoma of the Calcaneus in a Young Patient Treated With Radiofrequency Ablation: A Case Report.

Osteoid osteoma (OO) is a common benign tumor that tends to affect children and young adults. Patients typically present with nocturnal pain that is relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and a unique round or oval radiolucent area with surrounding sclerotic bone on X-ray. The cortex of the diaphysis or metaphysis of long bones is the usual anatomical location, with only 4% of cases localizing to the foot and ankle. Treatment options include medical management, surgical excision, and less invasive techniques such as radiofrequency ablation (RFA). We present a case report of a 21-year-old female with an osteoid osteoma of the calcaneus, a rare presentation for this type of tumor. She was successfully treated with RFA and had an excellent functional outcome.