Osteochondrolipoma of the foot treated by surgical excision: a case report and literature review.

BACKGROUND: Osteochondromas, classified as a new benign subtype of lipomas and characterised by chondroid and osseous differentiation, are rare lesions that have been infrequently reported in previous literature. The maxillofacial region was reported as the most frequent localization, with infrequent occurrence in the lower limb. This paper represents the first documented case report of osteochondrolipoma in the foot. CASE PRESENTATION: A 51-year-old male patient presented with a chief complaint of right foot pain at the plantar aspect, accompanied by the observation of swelling between the first and the second metatarsal shafts. His complaint of pain and swelling started 10 and 4 years prior, respectively. Since their onset, both symptoms have progressed in nature. Imaging revealved a large mass exhibiting a nonhomogenous composition of fibrous tissue and bony structures. Surgical intervention through total excision was indicated. CONCLUSION: Osteochodrolipoma is a benign lesion that can affect the foot leading to decreased functionality of the foot due to the pain and swelling. Surgical excision is the recommended approach for this lesion, providing both symptomatic relief and confirmation of the diagnosis through histopathological examination.

Prevalence and Severity of Social Anxiety Symptoms and Their Relationship With Body Dysmorphic Symptoms.

Background Social anxiety disorder (SAD) is a subtype of anxiety characterized by avoidance, fear, and physical symptoms such as dry mouth, sweating, palpitations, and blushing. SAD is one of the most common mental disorders. Body dysmorphic disorder (BDD) is a mental disorder marked by a distressing or impairing preoccupation with imagined or minor flaws in one's physical appearance. Both disorders share similar symptoms. No satisfactory data have been provided about the prevalence of social anxiety symptoms in our region. In our study, we measured the prevalence and severity of SAD symptoms among adults in Riyadh City, as well as the sociodemographic factors associated with it. Additionally, the correlation between SAD and BDD was assessed. Methods Our study is quantitative, observational, and cross-sectional. It was conducted by administering a translated Arabic version of the Severity Measure for Social Anxiety Disorder scale and BDD scales in five locations in Riyadh, which include two general hospitals and three shopping malls. Data were analyzed using the SPSS version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistical data are presented through mean values, standard deviations, and percentages. Results A total of 752 responses were received, of which 509 (68.32%) were from females with a mean age of 30.12 years. The majority of the sample had a low to middle family income, with 64% earning less than $2555 monthly. The sample possessed a good educational level; 63% had a bachelor's degree or higher. Our study also shows that 233 subjects (30.98%) had scores indicating a moderate to severe form of SAD. Among these participants, 86 (36.9%) had scores indicating a moderate to severe form of BDD. There was a significant positive correlation between SAD and BDD (r = 0.496). Conclusion The prevalence of SAD was 30.98%, which is higher compared to Western countries. Low income, education, and female gender have roles in the disease condition. Moreover, there was a linear relationship between SAD and BDD.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Harris Hip Score.

Background: The Harris Hip Score (HHS) questionnaire has been translated and validated into many languages including Italian, Portuguese, and Turkish but not Arabic. The goal of this study was to translate HHS into the Arabic language with cross-cultural adaptation to include and benefit Arabic speaking communities as it is the most widely used instrument for disease-specific hip joint evaluation and measurement of total hip arthroplasty outcome. Methods: This questionnaire was translated following a clear and user-friendly guideline protocol. The Cronbach's alpha was used to assess the reliability and internal consistency of the items of HHS. Additionally, the constructive validity of HHS was evaluated against the 36-Item Short Form Survey (SF-36). Results: A total of 100 participants were included in this study, of which 30 participants were re-evaluated for reliability testing. Cronbach's alpha of the total score of Arabic HHS is 0.528, and after the standardization, it changed to 0.742 which is within the recommended range (0.7-0.9). Lastly, the correlation between HHS and SF-36 was r = 0.71 (P < .001) which represents a strong correlation between the Arabic HHS and SF-36. Conclusions: Based on the results, we believe that the Arabic HHS can be used by clinicians, researchers, and patients to evaluate and report hip pathologies and total hip arthroplasty treatment efficacy.

Subcutaneous Fat Thickness on Erect Radiographs Is a Predictor of Infection Following Elective Posterior Lumbar Fusion.

BACKGROUND: Posterior lumbar fusions are a common and successful procedure, yet surgical site infection (SSI) is still prevalent and causes significant morbidity. Obesity is a well-established risk factor for SSI. Still, the accuracy of the body mass index (BMI) caused some to suggest other metrics that are more representative of the thickness of the soft-tissue envelope in the surgical site. METHODS: A retrospective review of all cases that developed SSI following posterior lumbar fusion over the past 5 years was done. An age and gender-matched control group was formed from the lumbar fusion cases that did not develop SSI. Demographic and clinical data were collected, and morphometric measurements of the soft-tissue envelope were performed at the level of L4 for all cases on standing x-ray imaging and magnetic resonance imaging (MRI). RESULTS: A total of 366 patients underwent posterior lumbar fusion, 26 of whom developed SSI. BMI and skin to spinous process measurements on x-ray imaging-not MRI-were found to be significantly associated with SSI. Regression analysis further confirmed the strength of the association. CONCLUSION: While BMI and MRI measurements are useful, wound depth measurements on x-ray imaging can be predictive of SSI in lumbar fusion cases. CLINICAL RELEVACE: Wound depth measurements are predictive of lumbar wound infection. The information within this study can help surgeons better predict and manage infections of posterior lumbar wounds.

Characteristics of Patients with Charcot's Arthropathy and its Complications in the Saudi Diabetic Population: A Cross-Sectional Study.

BACKGROUND: Charcot's arthropathy (CA) is a destructive rare complication of diabetes, and its diagnosis remains challenging for foot specialists and surgeons. We aimed to assess the clinical presentation and characteristics of CA and the frequencies of its various types. METHODS: This cross-sectional study was conducted from January 1, 2007, to December 31, 2016, and included 149 adults with diabetes diagnosed as having CA. Cases of CA were classified based on the Brodsky anatomical classification into five types according to location and involved joints. RESULTS: The mean ± SD age of the studied cohort was 56.7 ± 11 years, with a mean ± SD diabetes duration of 21.2 ± 7.0 years. The CA cohort had poorly controlled diabetes and a high rate of neuropathy and retinopathy. The most frequent type of CA was type 4, with multiple regions involved at a rate of 56.4%, followed by type 1, with midfoot involvement at 34.5%. A total of 47.7% of the patients had bilateral CA. Complications affected 220 limbs, of which 67.7% had foot ulceration. With respect to foot deformity, hammertoe affected all of the patients; hallux valgus, 59.5%; and flatfoot, 21.8%. CONCLUSIONS: There is a high rate of bilateral CA, mainly type 4, which could be attributed to cultural habits in Saudi Arabia, including footwear. This finding warrants increasing awareness of the importance of maintaining proper footwear to avoid such complications. Implementation of preventive measures for CA is urgently needed.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Intermittent and Constant Osteoarthritis Pain Questionnaire.

This study aimed to translate and adapt the Intermittent and Constant Osteoarthritis Pain questionnaire into the Arabic language and evaluate the validity and reliability of this scale for participants with knee or hip osteoarthritis. This questionnaire was translated based on the Manufacturers Alliance for Productivity and Innovation protocol. The test-retest reliability was calculated using the Intraclass Correlation Coefficient. Then, Cronbach's alpha was used to assess the internal consistency of Intermittent and Constant Osteoarthritis Pain questionnaire. After that, the criterion validity was evaluated against the Knee injury and Osteoarthritis Outcome Score. A total of 90 participants were included in this study, of which 29 participants were re-evaluated for reliability testing. The Intraclass Correlation Coefficient of the Knee Intermittent and Constant Osteoarthritis Pain questionnaire were 0.841, 0.923 and 0.911 for the total, constant, and intermittent knee pain, respectively. Cronbach's alpha was 0.88, 0.93 and 0.94 for the total score, the intermittent knee pain and the constant knee pain, respectively. Eventually, criterion validity was r=0.24(P<0.05). Intermittent and Constant Osteoarthritis Pain in Arabic is a valid and reliable instrument to be used in Arabic-speaking patients with knee/hip osteoarthritis.

Non-mydriatic fundus camera screening with diagnosis by telemedicine for diabetic retinopathy patients with type 1 and type 2 diabetes: a hospital-based cross-sectional study.

BACKGROUND: Diabetic retinopathy (DR) is considered the fifth leading cause of visual impairment worldwide and is associated with a huge social and economic burden. OBJECTIVE: Describe the practicality of non-mydriatic funduscopic screening photography for the detection of DR among patients with type 1 and type 2 diabetes. DESIGN: Cross-sectional hospital-based study. SETTING: Diabetes center, Riyadh. PATIENTS AND METHODS: Between July and December 2017, patients with diabetes and aged ≥18 years were selected by systematic random sampling from the University Diabetes Center. Fundoscopic eye examination was performed using the TRC-NW8 non-mydriatic camera, which performs ocular coherence tomography (OCT) to detect macular edema. Using telemedicine, pictures were graded by a retinal-specialized ophthalmologist using the international clinical DR disease severity scale. Patients were classified according to the type and severity of DR. MAIN OUTCOME MEASURES: Detection and classification of DR. SAMPLE SIZE: 978 Saudi patients with diabetes. RESULTS: Of 426 (43.5%) patients with DR, 370 had nonproliferative DR and 55 had proliferative DR. Nineteen (1.9%) had macular edema. The most important risk factors for DR were longer diabetes duration and poor glycemic control. Both older age and insulin use contributed to the higher prevalence of DR and macular edema. DR was more common among type 1 patients at 55.4% compared with 49% among type 2 patients. In addition, more females had macular edema (57.1% versus 42.9% among males). Nine patients with macular edema (47.3%) had hypertension while 154 of 426 patients with DR (36.2%) had hypertension. CONCLUSION: Non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes. LIMITATIONS: Conducted in a single center. CONFLICT OF INTEREST: None.

Medical specialty visits and diagnoses received by Saudi patients prior to a diagnosis of narcolepsy.

PURPOSE: Narcolepsy is an uncommon neurological disorder characterized by excessive daytime sleepiness (EDS) and multiple other symptoms. Due to the under-recognition of narcolepsy symptoms, patients are often misdiagnosed. This study aimed to assess the types of specialties visited and the diagnoses received by Saudi patients prior to their narcolepsy diagnosis. METHODS: The study included 55 consecutive patients with type-1 and type-2 narcolepsy who attended the narcolepsy clinic between August 2017 and December 2017. Narcolepsy was diagnosed according to the International Classification of Sleep Disorders-third edition criteria. We evaluated sociodemographic data, the specialties visited, and diagnoses and treatments received prior to visiting a sleep specialist. RESULTS: The mean diagnostic delay was 9.1 ± 8.4 years (1-43 years). Multiple linear regression analysis identified early onset as the only predictor of a delayed diagnosis (ß coefficient = - 0.262, p = 0.03). EDS was the main symptom that prompted patients to seek medical consultation, and only one patient had been (1.8%) referred with the diagnosis of narcolepsy. In the study group, 82% of the patients were misdiagnosed with a mental or neurological disorder or were thought to be afflicted by "envy," "evil eye," or "black magic" before receiving a correct diagnosis. No significant differences were detected between patients with narcolepsy type-1 and narcolepsy type-2. CONCLUSIONS: Delays in diagnosing narcolepsy remain a major problem for Saudi patients with this disorder. We found that Saudi patients with narcolepsy had visited several medical specialists and faith healers and were misdiagnosed prior to visiting a sleep specialist.