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This narrative review examines different aspects of homicide among mentally ill individuals to compare the rates of homicide by offenders with and without mental illness and investigate the stigma of mental illness and its consequences. It also evaluates the motives of mentally ill perpetrators and their characteristics and explores weapons of choice in homicides related to different mental disorders. Studies confirmed higher homicide rates among specific categories of mentally ill individuals who experienced maltreatment, unemployment, abuse in childhood, and substance abuse resulting from stigma and discrimination. The motives were mainly revenge, argument, financial gain, sexuality, sadism, and filicide, with revenge being the top motive. Offenders were found to have close relationships with their victims in most cases. Sharp instruments were the most commonly used weapons. Our review confirms the lack of evidence linking mental illness independently with homicide, both globally and in Arab countries, and highlights the impact of discrimination toward mentally ill individuals. This discrimination and stigma lead to delayed care-seeking and self-destructive behavior, which is linked to higher homicide rates among persons with and without mental illness.

Substance use disorder and the availability of certain over-the-counter drugs are worldwide issues that affect many individuals, both mentally and physically. As a result, the frequent use of this substance can lead to substance abuse. This phenomenon is also becoming more prevalent with time, and it does not differentiate between genders, ages, races, or religions. This review aimed to provide an overview of studies related to substance abuse, the individuals who tend to abuse these substances, and their risk factors. We also aimed to discuss, identify, and analyze the factors that increase the risk of substance abuse among young adults. We performed a thorough search for related studies using PubMed to provide a comprehensive review of the risk factors and side effects experienced by young adults. The selected indexing terms included "substance abuse,""risk factors," and "personality traits," among others. Information was gathered from relevant peer-reviewed publications, and thereafter refined, and summarized.

Diabetes mellitus (DM) is one of the three most common chronic diseases worldwide. This study aimed to determine the prevalence of diabetic polyneuropathy (DPN) among patients with diabetes.This cross-sectional study was carried out on DM patients who visited King Abdulaziz University Hospital (KAUH) between August 2021 and February 2022. We used the Michigan Neuropathy Screening Instrument (MNSI) questionnaire to determine if the patients had DN. In addition, we used the Global Physical Activity Questionnaire (GPAQ) to assess the level of physical activity (PA) in these DM patients.A total of 336 patients consented to participate in the study. We found a DN prevalence of 23.8% amongst DM patients treated at the KAUH. In addition, the prevalence of DN amongst T1DM and T2DM patients was found to be 16% and 24.4%, respectively. Furthermore, we found that 65% of DM patients developed complications, with a significant correlation observed between the duration of DM and the development of complications. However, patient age and sex were non-statistically significantly correlated with the development of complications. Analysis of the GPAQ showed that among the 249 patients who completed the questionnaire, none had a high physical activity level, while 4% and 96% had moderate and low physical activity levels, respectively. No association was found between physical activity and patients' age, sex, type of DM, duration of DM, and development of complications.DN prevalence amongst DM patients treated at KAUH was 23.8%. The duration of diabetes was found to be a risk factor for DN. However, patient age and sex were non-statistically significantly associated with DN.

Several government-sponsored reporting systems have stated mild to moderate side effects of COVID-19 vaccines. However, patient-reported data on COVID-19 vaccine-associated adverse effects in adolescents are lacking. Our objective was to assess the short-term side effects of Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273 vaccinations among teenagers in Saudi Arabia.A retrospective, cross-sectional study was conducted among individuals aged 12-18 years old who received one of the two mentioned vaccines between July 2021 and March 2022 in Riyadh, Saudi Arabia.The most common short-term side effects reported for COVID-19 vaccines among teenagers in our study were fatigue, pain at the site of injection, fever, chills, headache, nausea, and vomiting. Female participants, individuals who had a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and those who received two doses of the vaccine are at higher risk to develop side effects after getting the vaccine. Importantly, asthmatic participants have a higher incidence of COVID-19 vaccine side effects when compared to those with no history of chronic diseases.Our findings might enhance public trust in the COVID-19 vaccine, which could speed up the immunization procedure.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple systems with a range of clinical presentations caused by the production of antibodies, activation of complements, and deposition of immune complexes. The exact cause of SLE is still unknown. The effectiveness of traditional treatment methods for SLE is very little. Nowadays, resistance to conventional therapy, steroids, and immunosuppressants is common among SLE patients. Patients with refractory disease and nephritis generally have severe drug-induced toxicity which contributes to organ dysfunction, despite available therapies. Different biologic agents and therapeutic antibodies have become an alternative and have been under experiment in clinical trials, enrolling patients whose disease is inadequately controlled by conventional treatment. Belimumab is the only targeted therapy approved for SLE treatment. This systematic review discusses one such biological agent for treating systemic lupus erythematosus, namely, belimumab. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included randomized clinical trials (RCTs) from 2005 to 2021 on adult SLE. patients treated with monoclonal antibodies to assess the efficacy and safety. Methodological quality was assessed using PubMed, PMC, the Cochrane Risk of Bias tool, and the QUality In Prognosis Studies Tool (QUIPS) for RCTs. Two independent reviewers performed an electronic search on MEDLINE, Cochrane Library, SCIELO, Scopus, and ResearchGate. Based on a systematic review of articles we found that belimumab appears to be efficacious and generally well-tolerated in the treatment of SLE as compared to other drugs. The long-term use of belimumab combined with standard therapy showed a low incidence of organ damage. A lower incidence of organ damage was seen after initiating treatment in patients with a high risk for organ dysfunction. Patients who test for antinuclear antibody or anti-dsDNA-positive SLE, with moderate symptoms in the skin and musculoskeletal systems despite immunosuppressants, are treated with belimumab as an adjunct therapy. Patients with severe lupus nephritis or active CNS lupus cannot be treated with belimumab. Belimumab is effective in most races, as a clinical trial done in North-East Asia showed improvement in SLE symptoms and decreased dependence on prednisone. Belimumab also decreased disease activity and severe flares. Belimumab had greater efficacy in children.

Introduction In late 2019, a novel coronavirus was identified as the pathogen responsible for a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. Elevated cardiac troponin is a marker of myocardial injury, which is commonly seen in hospitalized patients with COVID-19 due to unclear reasons. The frequency of elevated troponin levels in patients with COVID-19 is variable and is reported in up to 7-36% of patients. The troponin level may be associated with the severity of COVID-19, and mild cases of COVID-19 tend to have a normal troponin level. This study aims to determine the frequency of patients with COVID-19 who had elevated troponin levels on presentation to the ED and determine the factors associated with elevated troponin levels. Additionally, the study aims to identify the association of elevated troponin and the outcome of COVID-19. Methodology A retrospective study wherein the factors associated with elevated troponin levels in COVID-19 pneumonia were evaluated. The study was conducted in King Fahd Hospital of the Imam Abdulrahman Bin Faisal University. The Hospital Information System was used to identify all visits to the ED from March 2020 to November 2020 for patients who tested positive for SARS-CoV-2. In addition, a structured data collection form was used to collect data from the electronic health records. The data collection was conducted by emergency medicine physicians who were given a detailed explanation of the purpose of the study and had training and supervision by the principal investigator. Results The study involved 214 patients who presented to the ED and had positive results on the SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test and had troponin-I levels measured. Patients with elevated troponin levels were more likely to require supplementary oxygen compared with those with normal troponin levels (88.0 vs. 58.5%

Pancreatic cancer with bone metastasis is considered a very rare malignancy. Although the incidence rate of people with pancreatic cancer who develop bone metastasis is unknown, it is estimated as between 5% and 20%. We report a 61-year-old lady who had multiple emergency department visits complaining of lower back pain radiating to the lower limbs for five months. Clinical and imaging workup suggested pancreatic adenocarcinoma metastasis to the second lumbar vertebra (L2), lungs, and ovaries.

Scabies is a common contagious ectoparasitosis. The association of scabies and leukocytoclastic vasculitis (LCV) is unclear, and only a few cases of scabies-related LCV have been documented. Here, we report a case of scabies complicated by LCV in an 86-year-old woman diagnosed with scabies and treated accordingly. The patient presented to our hospital with a one-day history of fever, increased rash, and itchiness. Histologic examination of a purpuric lesion revealed signs of LCV. Although histologic examination did not identify the scabies mite in the purpuric lesion, the LCV was likely a post-scabetic presentation following infestation based on other case reports, despite this being a rare occurrence.

The novel Coronavirus disease 2019 (COVID-19) pandemic has resulted in many adverse outcomes and challenges, and a false-positive result is one of them. Despite that this issue has a substantial impact, there is a scarcity in the literature of its prevalence or impact, and more knowledge is needed. This case report will present the case of a 54-years-old female who was misdiagnosed as COVID-19. The misleading COVID-19 diagnosis can result in significant consequences such as delaying surgeries, unnecessary quarantine and treatments, transplant lists omission, and unnecessary sick leaves. Moreover, as seen in our case, it delayed the other investigations and admitted a healthy patient to a COVID-19 isolation ward. Therefore, physicians should consider the possibility of false-positive results and utilize other investigation tools to further diagnose suspicious cases.

The clinical presentation of right iliac fossa pain, anorexia, and vomiting are the classic clinical features of acute appendicitis. However, a broad spectrum of manifestations may result in a similar clinical picture, including gastrointestinal, genitourinary, and gynecologic pathologies. Imaging studies are crucial to establishing the diagnosis. Here, we report the case of a 58-year-old man who presented to the emergency department with a one-week history of right lower quadrant abdominal pain. The pain was associated with nausea, vomiting, and frequent bowel motions. There was no history of fever or weight loss. The examination of the abdomen showed localized tenderness and guarding in the right iliac fossa. The basic laboratory investigation was within the reference range. The computed tomography scan demonstrated a well-circumscribed intraluminal mass lesion in the ascending colon with no evidence of complete obstruction. The mass was slightly heterogeneous but had fat attenuation. There was no evidence of invasion. There was no stranding of the adjacent fat. The radiological findings were consistent with colonic lipoma. The patient underwent laparoscopic surgery and had a segmental resection of the tumor with primary anastomosis. The appendix was also resected. Histopathological examination showed mature adipose cells along with thin-walled, capillary-sized vessels representing a benign angiolipoma. Further, the resected appendix was completely normal and showed no evidence of acute inflammation. Colonic angiolipoma is an extremely rare tumor. This case demonstrated that a large angiolipoma of the ascending colon may show a presenting clinical picture similar to that of acute appendicitis. Complete resection of the tumor is associated with an excellent outcome.

We herein report a case involving the development of a bilateral subacute subdural hematoma (SDH) after minor trauma, with only two wounds over the nose and no abnormal clinical and radiological findings at first presentation. A 25-year-old male patient presented to the emergency department (ED) after a minor trauma. X-ray was done on the facial bone to rule out nasal fracture which showed no abnormalities and then he was subsequently discharged. Three weeks later, the patient complained of a headache that persisted for a week, which brought him to the hospital. The initial impression was migraine after the primary healthcare visit, for which MRI was arranged, but as the headache persisted, he went to the ED twice again, and a CT scan was done during his second visit to the ED, which showed bilateral subacute SDH (SASDH).

Perforated viscus is a fatal condition associated with a high mortality rate that necessitating immediate management. In gastric cancer, perforation is a relatively late rare presentation. In this study, we report a case of a 40-year-old male who presented with perforated gastric cancer. In the emergency department (ED), the provisional diagnosis was septic peritonitis and shock. However, upon exploratory laparotomy, pyloric tumor was detected metastasizing to the duodenum, liver, and porta hepatis.

Normal pressure hydrocephalus (NPH) is a rare pathological condition of the brain in which the ventricles are enlarged due to cerebrospinal fluid accumulation and is associated with normal opening pressure on lumbar puncture with a large-volume cerebrospinal fluid (CSF) tap. This results in three classical symptoms: mental impairment, gait disturbance, and urinary or fecal incontinence. We present a case of idiopathic NPH in which a 64-year-old retired man with diabetes was brought to the emergency department after recurrent previous falls. The patient complained of an unsteady gait and presented with the typical triad of NPH which is mental impairment, gait disturbance, and incontinence. The patient was a known diabetic, and his gait was characterized by shuffling, bradykinesia, and mild drifting toward the right side. A head computed tomography scan revealed brain tissue volume loss, with disproportionate dilation of the lateral and third ventricles. A lumbar puncture with a large-volume CSF tapping produced normal opening pressure (18 mmHg); thus, the diagnosis of NPH was made. The patient underwent shunt surgery, and his balance and memory improved significantly after the procedure. Also, no event of fecal incontinence occurred. NPH resembles several neurodegenerative disorders. Due to this, it can be difficult to diagnose. Emergency physicians, as frontline healthcare providers, may encounter such cases.NPH should be considered in patients presenting with an unsteady gait, memory impairment, and urinary or fecal incontinence by taking a detailed history and conducting a physical examination to prevent future complications.