A Challenging Diagnosis of Kawasaki Disease Shock Syndrome Complicated by Bilateral Pleural Effusion: A Case Report and Literature Review.

Kawasaki disease (KD) is an acute illness primarily affecting children under the age of five. It is characterized by fever and inflammation of small to medium-sized arteries. This case report presents the case of a nine-year-old boy with KD who developed Kawasaki disease shock syndrome (KDSS) complicated by bilateral pleural effusion, which is a rare occurrence. KDSS is defined as KD accompanied by low blood pressure or signs of inadequate blood flow, leading to increased cardiovascular complications. The patient exhibited typical KD symptoms, including conjunctivitis, mucosal changes, rash, extremity swelling, and lymphadenopathy. Additionally, he presented with shock symptoms, such as hypotension and tachycardia. Laboratory findings showed elevated inflammatory markers. Prompt diagnosis and treatment are crucial to prevent coronary artery lesions and other severe complications. The patient received intravenous immunoglobulin and showed significant improvement, with resolution of fever and respiratory distress. Follow-up echocardiography revealed normal results. While pulmonary involvement in KD is rare, the presence of bilateral pleural effusion underscores the challenges in diagnosing KDSS. Early recognition and management are essential for favorable outcomes in KD and its complications.

Identification of a Novel Interferon-Stimulated (ISG15) Gene Variant Associated With Inflammatory Cutaneous Lesions and Zinc Deficiency in a Unique Family: A Case Series and Literature Review.

Interferon-stimulated gene 15 (ISG15) is a pivotal protein involved in antiviral defense and immune regulation. This study presents a remarkable case series of a consanguineous family with a homozygous variant in the ISG15 gene, leading to a complex interplay of intriguing dermatological manifestations and concurrent zinc deficiency. The range of cutaneous phenotypes observed in the family members, from severe ulcerative lesions to atopic dermatitis, highlights the intricate relationship between the identified genetic variant and dermatological conditions. Furthermore, zinc deficiency adds another layer of complexity to the understanding of these conditions. Comprehensive assessments of zinc levels were conducted for three siblings, while the fourth sibling's evaluation was impeded. This extraordinary case series offers a unique opportunity for scientific exploration, shedding light on complex genetic disorders and potentially paving the way for novel diagnostic and therapeutic strategies in medical science. The convergence of familial genetics, the homozygous ISG15 variant, and the captivating spectrum of cutaneous manifestations hold promise for advancing our understanding of these conditions and their underlying mechanisms.

Primary Central Nervous System Burkitt Lymphoma, Presenting with Long-Term Fluctuating Level of Consciousness: A Case Report and Literature Review on Challenges in Diagnosis and Management.

BACKGROUND Burkitt lymphoma (BL) is an aggressive subtype of B-cell non-Hodgkin lymphoma (NHL) rarely affecting the central nervous system (CNS) as a primary disease. Over the past years, only a few cases of primary CNS Burkitt lymphoma were reported. There is a challenge in early recognition and diagnosis of this type of brain lymphoma. Furthermore, there is no specific treatment protocols for primary CNS Burkitt lymphoma, which adds to the difficulty in managing those patients. We introduce a case of a 65-year-old who presented with fluctuating memory disturbance diagnosed as cerebral Burkitt lymphoma. CASE REPORT A 65-year-old man developed a gradual decrease in his level of consciousness over a span of 4 days, associated with fluctuating memory disturbances. A CT scan showed a hyperdense mass in the region of the trigon of the left lateral ventricle and marked obstructive hydrocephalus involving the temporal, occipital horns, and the left lateral ventricle, with no evidence of other suspicious lesions. A brain biopsy of the lesion revealed features of encephalitis initially, but the patient presented later with worsening symptoms, and a repeated brain biopsy showed features of Burkett lymphoma, with normal pan-CT scan. CONCLUSIONS Primary CNS Burkitt lymphoma (PCNSBL) is a rare disease with no clear evidence in the literature of how to deal with it. Reporting such cases provides a better understanding of how to approach such unusual presentations. Treatment of PCNSBL is challenging and even with the currently adopted approaches, the disease still has a very poor outcome.

University students' behavioral intention and gender differences toward the acceptance of shifting regular field training courses to e-training courses.

During the COVID-19 lockdown, all the courses at Imam Abdulrahman Bin Faisal University (IAU) were delivered fully online, including field-training courses. Since there was no previous experience in offering field-training courses in a distance format, the current study aims to identify factors that could impact students' behavioral intention to accept the e-training approach in teaching field training courses at IAU. In order to gather the data, the researchers designed a questionnaire based on the UTAUT model and they ensured the face, content, and construct validity of the questionnaire by sending it to five experts in the relevant field and by using exploratory factor analysis. Also, all the questionnaire's items were reliable since the Cronbach's alpha values were above 0.77 for all the items. A total of 397 participants provided valid responses. The result of this study indicated that Effort Expectancy (EE), Facilitating Condition (FC), Performance Expectancy (PE), and Social Influence (SI), respectively were the primary predictors for students' intention to use e-training. These factors explained 32.1% of the variance in students' behavioral intentions. As far as students' gender is concerned, there were significant differences between students' PE, FC, and SI. Based on these results, policymakers at IAU will have a clear image of the most essential factors that colleges should target to increase students' acceptance of e-training.

Study of Post-COVID-19 Syndrome in Saudi Arabia.

Background Post-COVID-19 syndrome may be predisposed by organ damage as a complication of COVID-19. Patients may experience persistent symptoms after recovering from their initial illness. Objectives To identify manifestations and predisposing factors for post-COVID-19 syndrome in Saudi Arabia. Methods A cross-sectional study was conducted from May 2021 through June 2021 using an online structured pre-coded closed-ended, pilot-tested questionnaire in Arabic. It included male and female inhabitants of Saudi Arabia aged 18 years and above with a past history of COVID-19 infection. Descriptive statistics were carried out for all variables. A univariate analysis Chi-square test and independent t-test were used. A p-value of less than 0.05 was considered significant. Results A total of 85.3% of post-COVID-19 cases had general manifestations: 77.3% had musculoskeletal and joint complaints, 61.3% had mental and psychological problems, 58.7% had gastrointestinal manifestations, 44% had renal complaints, 41.3% had respiratory complaints, and 36.0% had cardiovascular symptoms. Gender, age, smoking, BMI, associated morbid condition, number of previous COVID-19 attacks, the severity of illness, place of treatment, and complications of COVID-19 due to treatment or hospitalization were significantly correlated with the occurrence of post-COVID-19 syndrome. Conclusion Post-COVID-19 syndrome could be manifested by fatigue, malaise, myalgia, joint pain, depression, anxiety, sleep, memory and concentration disturbances, cough, dyspnea, palpations, arrhythmias, and chest pain. It may be influenced by male gender, smoking, old age, high BMI, comorbidities, and past COVID-19 attacks with regard to the number, place of treatment, and occurrence of complications.

Digitalization of learning in Saudi Arabia during the COVID-19 outbreak: A survey.

Following the outbreak of the novel coronavirus (COVID-19) in China in late December 2019, more than 217 countries became almost immediately infected in the resulting pandemic. Consequently, many of them decided to close their educational institutions as a way of preventing the spread of this virus. For many of them, though, the closure made them unable to deliver learning materials to students owing to their inability to provide the right technology for the purpose. To assist with the digitalizing of learning during this time, this study reviews the most common technologies used in the delivery of learning materials, with the experience of most infected countries being considered. Major challenges in online learning are discussed in this study as well. Further, Saudi Arabia was considered as a case study for the effectiveness of distance learning during the 2020 spring semester, where 300 undergraduate students were surveyed on their opinions of distance learning. The responses to the survey indicated that distance learning was effective in providing the required knowledge to the students during the outbreak of COVID-19. The findings showed that although the lack of interaction and poor internet connections were factors affecting comfortable and successful learning of physics and mathematics, 63% of students were satisfied with learning management systems, 75% of students found it easy to understand course materials, and 67% of students found it easy to understand assignments and could deal with them comfortably. The study findings can encourage educational institutions to digitalize their learning materials in the future.

Malignant Transformation and Spine Metastasis of an Intracranial Grade I Meningioma: In Situ Immunofluorescence Analysis of Cancer Stem Cells Case Report and Literature Review.

BACKGROUND: Malignant meningiomas are rare neoplasms of the central nervous system that occur de novo or rarely as a result of transformation. They have a higher rate of recurrence and metastasis accompanied by a significantly shorter survivorship compared with benign variants. Meningioma cancer stem cells (CSCs) have been previously shown to be associated with resistance and aggressiveness. However, the role they play in meningioma progression is still being investigated. CASE DESCRIPTION: We report a 29-year-old man who underwent a resection of a grade I meningioma in 2011. The patient had multiple local recurrences of the tumor that showed an aggressive change in behavior and transformation to grade III meningioma, and developed extracranial metastasis to the cervical spine. He underwent multiple operations and received radiotherapy. Analysis of the tissues indicated the presence of CSC markers before metastasis, and showed increased expressions of associated markers in the metastasized tissue. In addition, similar to the patient's profile, the pharmacological testing of a primary cell line retrieved from the metastasized tissues showed a high level of drug tolerance and a diminished ability to initiate apoptosis. CONCLUSIONS: Malignant progression of grade I meningioma can occur, and its eventuality may be anticipated by detecting CSCs. We performed a comprehensive literature review of relevant cases and discussed the clinical, diagnostic, and management characteristics of the reported cases.

Aspiration-related organizing pneumonia complicating laparoscopic adjustable gastric banding: A lung cancer mimicker.

There are several described pulmonary complications due to laparoscopic adjustable gastric banding. We report a rare case of a 32-year-old male who presented with pulmonary symptoms and a solitary lung mass 12 years after laparoscopic adjustable gastric banding. A bronchoscopic lung biopsy showed organizing pneumonia that was induced by aspiration pneumonia. The atypical radiological appearance of the aspiration pneumonia may pose a diagnostic challenge, and clinicians' awareness regarding such an entity is needed to avoid unnecessary intervention.

Spontaneous extradural hemorrhage due to Langerhans cell histiocytosis of the skull in a child: A rare presentation.

Eosinophilic granuloma (EG) represents a local form of Langerhans cell histiocytosis that occurs mostly in children. It usually presents with a gradually enlarging painless skull mass, and rarely presents a rapid clinical deterioration. This 7-year-old boy who was diagnosed with EG, based on a magnetic resonance imaging scan, after presenting with a painless right parietal swelling of 7-week duration. Three weeks prior his scheduled surgery, he presented to the emergency department with a 2-day history of sudden increased of the subcutaneous swelling associated with a headache, vomiting, and decreased the level of consciousness; there was no history of trauma. Brain computed tomography revealed a right parietal bone defect with large subgaleal and extradural hematoma. He underwent emergent surgical excision of the skull lesion and evacuation of the hematoma. Histopathological examination confirmed the diagnosis of EG. We aim to raise the awareness of physicians of this rare spontaneous hemorrhagic complication of EG and review the literature.