Analysis of Scheimpflug Tomography Parameters for Detecting Subclinical Keratoconus in the Fellow Eyes of Patients with Unilateral Keratoconus in the Eastern Province of Saudi Arabia.

Purpose: We compared the characteristics of subtle morphological changes in subclinical keratoconus (KC) and normal corneas using Scheimpflug tomography (Pentacam®) and assessed the efficacy of these parameters for distinguishing KC or subclinical KC from normal eyes. Patients and Methods: In this multicenter comparative study at Dhahran Eye Specialist Hospital and Al Kahhal Medical Complex in the Eastern Province of Saudi Arabia, we analyzed the Scheimpflug tomography charts of patients with topographically normal eyes and those with unilateral KC. Patients were divided into the normal (NL: patients considered for refractive surgery and with normal topographic/tomographic features, 129 eyes), KC (30 patients with manifest KC in one eye based on biomicroscopy and topographical findings), and forme fruste KC (FFKC: fellow eyes of patients in the KC group that met the NL group criteria) groups. Corneal morphological parameters were analyzed using the area under the receiver operating characteristic (ROC) curves (AUCs). Results: For distinguishing NL and KC groups, all measured corneal morphological parameters, except for flat keratometry, maximum Ambrósio relational thickness index, and minimum sagittal curvature, had AUCs >0.75. The surface variance index yielded the largest AUC (0.999). For distinguishing NL and FFKC groups, all corneal morphological parameters had AUCs <0.8. Total higher-order aberrations (RMS HOA) yielded the highest AUC, followed by Belin/Ambrosio Enhanced Ectasia total deviation (BAD-D), back elevation at the thinnest location, average pachymetric progression index (PPIave), and deviation of Ambrosio relational thickness (Da) (AUC 0.74-0.78). Conclusion: The diagnostic performance of all tested topographic and tomographic parameters measured using Scheimpflug tomography for discriminating subclinical KC was fair at best, with the top parameters being RMS HOA, BAD-D, back elevation at the thinnest location, PPIave, and Da. Distinguishing between subclinical KC and healthy eyes remains challenging. Multimodal imaging techniques may be required for optimal early detection of subtle morphological changes.

Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis.

Tension-type headache (TTH) is the most common type of headache worldwide. It is defined and classified according to the International Classification of Headache Disorders. TTH is treated with over-the-counter medications, mostly paracetamol or ibuprofen. The purpose was to assess the effectiveness of paracetamol versus ibuprofen in treating episodic tension-type headache (ETTH) through direct and indirect comparisons of randomized controlled trials (RCTs). We included RCTs comparing paracetamol with a placebo, ibuprofen with a placebo, or paracetamol with ibuprofen for acute ETTH treatment that were published between 1988 and 2022. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and the Web of Science. The Cochrane Collaboration risk of bias tool was used to assess the risk of bias. We identified 14 studies including 6521 people with ETTH. None of the studies had a low risk of bias for all domains; this was most likely due to inadequate reporting and a small sample size. Ibuprofen (odds ratio (OR): 1.73, 95% confidence interval (CI): 1.17-2.56) showed better efficacy than paracetamol (OR: 1.62, 95% CI 1.24-2.13) for pain-free status at 2 h, while paracetamol (OR: 1.42, 95% CI 0.87-2.30) showed better efficacy than ibuprofen (OR: 1.20, 95% CI 0.58-2.48) for pain-free status at 1 h. Paracetamol was associated with the lowest likelihood of rescue medication use (OR: 0.49, 95% CI 0.37-0.65). Ibuprofen was associated with a lower likelihood of the occurrence of any events and gastrointestinal adverse events compared with placebo and paracetamol (OR: 0.95, 95% CI 0.64-1.41 and OR: 0.81, 95% CI 0.44-1.50, respectively). Paracetamol and ibuprofen showed better efficacy than placebo in treating ETTH; there was no statistically significant difference in efficacy between the two drugs. For individuals at a higher risk (like renal insufficiency or risk of GI bleeding), paracetamol may be considered as a preferred option instead of Ibuprofen. Further meta-analyses of head-to-head trials are needed for direct comparisons in the future.PROSPERO registration number: CRD42022340936.

The Uses of Photodynamic Therapy Versus Anti-vascular Endothelial Growth Factor in the Management of Acute Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis.

Central serous chorioretinopathy (CSCR) is an idiopathic chorioretinal disease characterized by localized serous detachment of the neurosensory retina at the macula. To date, there is no high-quality evidence of recent updates on treating acute CSCR, focusing on photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF). Hence, this review aims to conduct a comprehensive systematic review of the most recent therapeutic approaches for acute CSCR using the following electronic databases for a comprehensive and systematic literature review: MEDLINE, EMBASE, and Cochrane. In addition, we analyzed studies comparing PDT with placebo, anti-VEGF with placebo, or PDT with anti-VEGF in treating acute CSC eyes with no previous intervention. Seven studies were included, with a total of 292 eyes. The overall positive results were significantly higher among patients who received PDT compared to control groups (odds ratio [OR] = 7.96, 95% confidence interval [CI], 3.02 to 20.95, p < 0.001). The proportions of positive results were 81.0% and 97.1% among patients who received anti-VEGF and PDT, respectively, with no statistically significant differences between the groups. In addition, there were no significant differences between anti-VEGF and control groups. In contrast, PDT was significantly associated with lower recurrence odds than the control groups (OR = 0.12, 95% CI, 0.04 to 0.39, p = 0.042). According to our findings, PDT showed higher positive results than anti-VEGF in acute CSCR. In addition, PDT was significantly associated with a lower recurrence rate than the control group. However, the analysis needs to be confirmed and updated by large-scale, well-designed randomized clinical trials.

Congenital Ptosis Associated With Adduction as a Dysinnervation Disorder: A Report of a Rare Case.

The levator palpebrae superioris is the primary muscle responsible for elevation of the eyelid. This muscle is innervated by the third intracranial nerve. Any pathology affecting the muscle or the supplying nerve can lead to blepharoptosis. In this study, we share our experience of a two-year-old baby boy patient who presented with a rare congenital disorder manifested as blepharoptosis increased with adduction bilaterally with no limitation of ocular muscles action except bilateral underaction of inferior oblique muscles. To our knowledge, this unusual presentation has not been previously reported in the literature. We aim in this report to build more knowledge on such a rare clinical presentation. Based on the findings, this could be a case of congenital innervation dysgenesis syndrome (CID)/congenital cranial dysinnervation disorders (CCDDs). CCDDs/CID is a group of conditions that includes blepharoptosis as part of their clinical presentation. This group of conditions includes Duane's retraction syndrome, congenital fibrosis of extraocular muscles, and monocular elevation defect.

Bardet-Biedl Syndrome: A Rare Case From Ophthalmology Perspective.

Bardet-Biedl syndrome (BBS) is a rare multisystem disease, with autosomal recessive inheritance and genetic heterogeneity characterized by post-axial polydactyl, cone-rods dystrophy, and central obesity. BBS involves many organs in the body with variable complications and the life span of affected individuals. Clinical confirmation of the disorder can be done using a revised criterion that consists of primary or major features and secondary or minor features. Primary features of BBS include hypogonadism, polydactyly, obesity, retinitis pigmentosa, and learning disability. While ataxia, poor coordination, brachydactyly, diabetes mellitus, speech abnormalities, liver fibrosis, hearing loss, spasticity, and cardiovascular anomaly constitute the secondary features. In this study, we report a case of a five-year-old Saudi girl who presented with language delay, delay in milestones, progressive weight gain, excised polydactyly, and retinitis pigmentosa. An integrated medicine approach would substantially improve the quality of life of the affected individuals and their families by enhancing both physical and mental health.

Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis.

INTRODUCTION: With the recent increase in interest in using autologous fat (AF) filler injections to enhance aesthetic facial appearance, there is a noticeable increase in the complications such as vascular compromise and blindness. This systematic review and meta-analysis aimed to understand the symptomatology of ophthalmic complications related to AF facial injections for cosmetic purposes, their underlying causes, management options, and the final clinical outcomes. METHODS: This review was conducted according to the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. In November 2021, we performed a systematic review of available literature using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Our search was limited to the published studies between 2000 and 2021. RESULTS: A total of 1052 publications and 34 articles published were included. Twenty case reports, two case series, one prospective cohort study, and eleven retrospective studies were evaluated. The forehead was the most common single injection site (n = 196, 55.36%). The most common initial symptom was periorbital swelling (92.7%). The pooled prevalence of ophthalmic artery occlusion was 50.4% out of all AF injection-related complications. Regarding the management, most patients were managed conservatively (n = 278, 51.38%). Complete improvement was observed among 423 patients (80.57%). CONCLUSION: Autologous facial fat injection is a minimally invasive procedure with a favorable safety profile in cosmetic applications. However, the common use of these injections in aesthetic surgery has resulted in a concomitant increase in devastating consequences, such as blindness. Therefore, a firm understanding of the potential complications of such interventions is essential. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Isolated Kimura Disease Presenting as a Brow Mass in a Saudi Male: A Rare Case Report.

This is a case of a 36-year-old male not known to have any medical illness complaining of left upper painless swelling in the eyebrow with no systemic symptoms, and normal physical examination apart from the eyebrow mass. Computed tomography (CT) of the head showed a well-defined hyperdense subcutaneous soft tissue lesion seen at the medial aspect of the left orbit (eyelid-extra orbital). Excisional biopsy of the eyebrow mass was done and sent for histopathological evaluation which reports consistent findings with Kimura disease (KD) as a definitive diagnosis.

Neonatal Endogenous Endophthalmitis: A Case Report.

The aim of this study is to share our experience of a baby boy patient who presented with rare endogenous endophthalmitis that ended up with exudative retinal detachment; emphasizing the clinical presentation, follow-ups progression, and the management plan. A case report of a one-month-old preterm baby boy presented with eye discharge in his left eye (OS) associated with eyelid swelling and chemosis for four days. His clinical examination revealed a congested left eye with proptosis, absent red reflex, and normal intraocular pressure (IOP) while a portable slit-lamp examination showed an edematous left eye with cloudy cornea but no infiltrates and no view to the posterior segment. Blood, cerebrospinal fluid (CSF), and ocular discharge were cultured, and all came negative and the patient started on empirical antibiotics. B-scan shows dense infiltrates in the vitreous cavity with subretinal fluid. Diagnostic intravitreal paracentesis was done which showed the growth of Pseudomonas aeruginosa and a diagnosis of endogenous endophthalmitis is made then a directed management plan was initiated. Unfortunately, a few days later a repeated B-scan was ordered to the left eye and it shows exudative retinal detachment, and a referral to retinal surgery service was consulted. After further follow-ups, B-scan showed resolving retinal detachment with a short shrunken eye, marked ocular wall thickening, and a relatively short axial length which is consistent with prephthisical changes hence, an oculoplasty referral was done for ocular prosthesis later on. Endogenous endophthalmitis is a rarely encountered intraocular infection yet it carries devastating consequences that may threaten vision. Therefore, a high index of suspicion is essential for early detection of the disease to prevent serious complications and achieve good visual outcomes.

Scorpion Stings in Saudi Arabia: An Overview.

BACKGROUND: Scorpion envenomation is an important cause of morbidity and mortality, especially in children and elderly worldwide. In Saudi Arabia it is an important issue as the climate and the desert terrain are ideal for scorpions' habitat. METHODS: A literature review of articles on the incidence of scorpion stings in Saudi Arabia. RESULTS: In Saudi Arabia, 28 species of scorpions were identified. Approximately 14,500 scorpion stings are annually reported, with full recovery and low morbidity and mortality rates. The highest risk groups to get envenomated are people living in the desert. And the highest incidence of scorpion stings was during the summer season. CONCLUSION: The number of scorpion stings in Saudi Arabia is considerable and there were insufficient studies regarding such topic. The aim of this study is to emphasize on the importance of scorpion stings in Saudi Arabia and providing updates regarding scorpion types, clinical presentations, and statistical data.

Prevalence of Musculoskeletal Disorder and its Relation to Stress Among Medical Student at Taif University, Saudi Arabia.

BACKGROUND: The purpose of this research is to determine the prevalence of musculoskeletal disorders and their association with psychological stress among medical students at Taif University, Saudi Arabia. METHODS: A total of 640 medical students were selected by multistage cluster sampling. The data were collected by trained students using a standardized Nordic questionnaire and 10-k questionnaire. Statistical analysis was carried out using the statistical package (SPSS.21). Standardized Nordic questionnaire and 10-k questionnaire besides questionnaire assessing sociodemographic characteristics (age, gender, study year, weight, height, smoking, marital status, chronic disease, and educational degree) were used. RESULTS: Among 640 medical students, 45.9% males and 54.1% females reported musculoskeletal pain, it was more prevalent among fourth - and sixth year students, in the last 7 days, neck pain was the highest site of complaint (33.4%) followed by low back pain (15.1%) and shoulder pain (12.8%). Prevention of work was highest due to neck pain (27.7%) and low back (25.1%) followed by knees (19.1%), the stress rate was highest in the second year (67.8%) and third year (67.3%) students followed by the sixth year (65.8%) students. CONCLUSIONS: Musculoskeletal disorders are a common health problem reported by more than half of medical students, with a significant association with females and preclinical students. Stress is a common psychological problem that affects two-thirds of medical students. However, we found a nonsignificant association between the onset of musculoskeletal disorders and the level of stress among medical students.

A Comprehensive Review Study on Glomerulonephritis Associated With Post-streptococcal Infection.

Post-streptococcal glomerulonephritis (PSGN) is an immune-complex mediated inflammation that used to be considered one of the commonest causes of acute nephritis amongst children. PSGN is characterized by the proliferation of cellular elements called nephritogenic M type as a result of an immunologic mechanism following an infection of the skin (impetigo) or throat (pharyngitis) caused by nephritogenic strains of group A beta-hemolytic streptococci, a gram-positive bacteria that enters the body across pores in the skin or mucus epithelia and is responsible for more than 500,000 deaths annually due to multiple subsequence diseases such as rheumatic heart disease, rheumatic fever, PSGN, and other invasive infections. After the infection, the formation of an immune complex of antigen-antibody and complement system will take place and will deposit in the glomeruli where the injury occurs and leads to inflammation. The manifestations of PSGN can be explained by nephritic syndrome manifestation. PSGN is diagnosed by laboratory tests like microscopy and urinalysis. The imaging studies in PSGN could be used to assess the possible complications of PSGN such as pulmonary congestion and chronic kidney disease. The management of PSGN is symptomatic. If PSGN is not treated, the patient may develop chronic kidney disease. The main way to prevent PSGN is to treat group A streptococcal (GAS) infections by giving good coverage of antibiotic therapy to a patient who has primary GAS infections to prevent the development of the complication.

Prevalence of Lower Back Pain and its Relation to Stress Among Medical Students in Taif University, Saudi Arabia.

BACKGROUND: Lower back pain (LBP) refers to pain in the back between the last rib and the gluteal fold. Recent psychological research indicates a relevant connection between severe pain and emotional stress. The etiology of musculoskeletal pain shown to be influenced by low social support, high job demands, and low job control. METHODS: A cross-sectional study of 640 medical students in Taif University was carried out from November 2018 to April 2019. A standardized Nordic questionnaire was employed to assess musculoskeletal pain and K10 was used to assess psychological stress. RESULTS: Our study found 33.3% of medical students reported lower back pain, 20.7% reported lower back pain 0-7 days during the last 12 months, and 18.8% reported reduction of activity due to lower back pain during the last 12 months. The mean stress score was 22.7 ± 8.8; 20.7% of students with mild stress reported lower back pain. LBP showed non-significant association to stress categories (P = 0.409). CONCLUSIONS: Our survey found no significant association between LBP and psychological stress. The three main risk factors associated with lower back pain were being a 2nd year medical student, female gender, and high working hours.