RESUMEN
Spinal dural arteriovenous fistulae (SDAVF) are rare diseases that exhibit abnormal connections between arteries and veins. They are even rarer in the pediatric population and pose diagnostic and treatment challenges for physicians. Its presentation varies depending on the site and size of the SDAVF. Multiple management options are available, which are usually tailored depending on the patient's condition. Here, we present a rare case of SDAF in a four-year-old girl who initially presented with bilateral lower limb weakness. The patient was then treated successfully using primary major fistula point stenting and intra-stent coiling, with complete closure achieved. Full recovery was achieved over the course of follow-ups. The deep analysis of SDAVF, its classification, and the utilization of the best available endovascular tools by a dedicated neurovascular team offer the best outcome in dealing with complex spinal neurovascular pathologies.
RESUMEN
Background Acute otitis media (AOM) is one of the most common conditions in the pediatric population and a common reason for physicians to prescribe antibiotics. Most children will develop otitis media at least once during their life. Objectives Our study aimed to evaluate and compare the adherence of family medicine physicians, otolaryngologists, pediatricians, and emergency medicine physicians to the American Academy of Pediatrics and American Academy of Family Physicians guidelines for the diagnosis and the management of AOM. Methods This is a retrospective study that was conducted at the Ministry of National Guard - Health Affairs affiliated hospitals and primary clinics in Riyadh, Saudi Arabia. All patients diagnosed with AOM and treated between 2016 and 2019 were included in the study. Exclusion criteria included any patient above the age of 18 years old or patients with incomplete data on their files. Variables included demographic data of the patients and treating physicians, associated infections, and whether the treating physician followed the diagnosis and management guidelines. Results Most patients were below the age of two years. Emergency medicine physicians were the most common to treat patients with AOM. Although most documentations were sufficient, 39.8% were insufficient or not written. Most (74%) physicians adhered to the diagnosis guidelines, while 57.5% adhered to management guidelines. Conclusion Although most physicians adhered to the diagnosis and treatment guidelines, stressing on the matter is essential to avoid unnecessary antibiotics use. We recommend further prospective studies with a bigger sample size of more than one center to have a more accurate reflection of the current situation.
