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The insular cortex had been considered a mysterious structure for years and consists of only 2% of all cortical surface area. It is a separate lobe of the cerebral cortex and lies close to the limbic system, which makes it a paralimbic structure, and forms the floor of the lateral sulcus. Despite the myriad of research regarding the insular cortex over the years, it is still considered an obscure and incompletely known structure. Thus, this study aimed to summarize the previous studies regarding the structure, embryology, location, connections, and functions of the insular cortex. Moreover, this review would tend to reorganize the data in a more comprehensive fashion to facilitate reaching the information regarding the insular cortex. The results of the studies were summarized from three perspectives that is neuroanatomy, physiological function, and pathologies commonly affecting the insular cortex. Overall, many textbooks, reviews, case reports, and clinical trials have demonstrated that the insular cortex has a crucial, active, and integrative role in functions throughout the body, from the brain to feeling pain in dorsal part of the foot. Moreover, ischemic stroke cases have demonstrated clearly, how much important the insular cortex is, in normal physiological functioning. More studies, especially clinical trials, should be performed to evaluate the effects of impeding this important intracranial structure.

Shaya Yaanallah AlQahtani,1 Ahmed Anwer Alabdulqader,2 Waleed Abdulrahman Al Mashhour,3 Zahra Mohammed Aldawood,4 Osama Ali Al Masari,1 Thabit Alotaibi,1 Zeead M AlGhamdi,5 Ibrahim M Alzahrani,6 Noor Nabil Albaloushi7 1Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2King Fahad Hospital Hofuf, Hofuf, Saudi Arabia; 3Dammam Medical Complex, Dammam, Saudi Arabia; 4King Khalid Hospital- AlKharaj, Alkharaj, Saudi Arabia; 5Thoracic Surgery Division, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Department of Internal medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 7Ministry of Health, Dammam, Saudi ArabiaCorrespondence: Shaya Yaanallah AlQahtani, Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box. 2208, Dammam, 31952, Saudi Arabia, Email saalQahthani@iau.edu.saObjective: We aim to identify the clinical characteristics and outcome of vaccine breakthrough infection in critically ill COVID-19 patients and to compare the clinical course of disease between vaccinated and non-vaccinated patients.Methods: A retrospective review of all adult patients aged ≥ 18 years admitted to the ICU in King Fahd Hospital of the University in Saudi Arabia with positive COVID-19 RT-PCR test between the period of January 1st to August 31st, 2021, were included. The recruited patients were grouped in to “vaccinated and non-vaccinated group” based on their immunization status. The demographic data, co-morbidities, modality of oxygen support, ICU length of stay (ICU LOS) and mortality were collected and analyzed.Results: A total of 167 patients were included. Seventy-two patients (43%) were vaccinated. Cardiovascular diseases were higher among the vaccinated group (33.3% vs 12.6%, p value < 0.001). Requirements of Non-invasive ventilation was significantly lower in vaccinated group compared to non-vaccinated group (73.6% vs 91.6%, p value < 0.011). The rates of intubation were similar between both groups. The total intubation days was longer in non-vaccinated patients compared to vaccinated patients and the median duration of intubation was 8 days vs 2 days, respectively (p value 0.027). In subgroup analysis, the P/F ratio was significantly higher in patients who received two doses of vaccine compared to single dose (p value < 0.002).Conclusion: In critically ill COVID-19 patients, the vaccinated group has significantly less need for Non-invasive ventilation, fewer intubation days and less hypoxia compared to non-vaccinated patients. We recommend more policies and public education nationwide and worldwide to encourage vaccination and raise awareness of the general population.Keywords: COVID-19 vaccine, breakthrough infection, intensive care unit, vaccine effectiveness, inflammatory markers

Background: Subtrochanteric fractures account for around 7% to 34% of all femur fractures. Cephalo-medullary nailing is the gold standard in the repair of subtrochanteric femur fractures. Case presentation: We present a case of a medically free 21-year-old man, who was admitted with right thigh deformity and inability to bear weight after a motor vehicle accident. Standard pelvis and right femur radiographs showed a subtrochanteric femur with deformity forces of the fracture fragments. The patient was operated on with cephalo-medullary nailing using a Lowman bone holder. The fracture remained stable after cephalo-medullary fixation. The patient was discharged and was advised to continue follow-up. Conclusion: Fixation of femur subtrochanteric fracture with cephalo-medullary nailing technique using a Lowman clamp showed excellent clinical and radiographic results and a low complication rate.

Good quality of tear film is essential for healthy vision in both animals and humans. Therefore, improving the quality of tears through the addition of electrolytes is important.To assess the effect of adding various electrolyte solutions on tear ferning (TF) patterns collected from goats and camels.Tear samples (20 ƒÊL) were collected from 5 goats (2 males and 3 females; 3.4 }1.6 years) and 5 camels (2 males and 3 females; 4.0 }1.1 years) using microcapillary tubes. A tear sample (0.5 ƒÊL) from each animal was mixed with various volumes (0.5.5 ƒÊL) of each electrolyte solution to produce homogenous mixtures. A sample (1 ƒÊL) of each mixture was dried on a microscopic glass at 22°C with a humidity .40%. The obtained TF pattern was observed, graded and compared with those obtained for the corresponding pure tear samples. The effect of dilution using purified water on the TF patterns of animals was also tested.The TF grades of animals were generally enhanced when mixed with electrolyte solutions. Specifically, the TF grade for tears collected from a goat was improved from 1.4 to 0.7 and to 0.8 when magnesium chloride hexahydrate and calcium chloride were added, respectively. Similarly, the TF grade for tears collected from a camel was improved from 1.8 to 0.9 and to 1.1, when calcium chloride and sodium dihydrogen phosphate solutions were added, respectively.The TF grades of tears collected from both goats and camels were improved after adding electrolyte solutions, and they were most remarkably improved when divalent electrolyte solutions were added, followed by the hydrogenated electrolyte.

Drilling complex wells with minimum risk and optimizing well placement with the least possible cost are key goals that oil companies strive to achieve. Service companies and operators apply several pre-well planning processes and methods to enhance drilling operations effectively and attain objectives. One of these processes involves a thorough understanding and application of the geological structure, not only within the reservoir section, but also in the over-burden where typically most of the time efficiency gains can be achieved. This can be best accomplished by fostering intense and effective communication between all stakeholders. In this paper, the authors present the latest integrated pre-well planning (IPWP) process that defines a methodology for conducting a formal planning, a process incorporating all aspects of drilling, well design, formation evaluation, bit selection and bottom hole assembly proposal. It also lists key considerations required in planning, coordination, and successful implementation of these services on the customer’s well with a means to assess potential technical risks that may influence the success of the job. The paper also describes a complex water injection well drilled in a Middle East onshore field where the integrated pre-well-planning process played a significant part in successfully achieving the aim of this challenging job.