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[english] We describe diffuse colonic calcification detected on CT scan of the abdomen in a young female patient who presented to our clinic with vague intermittent abdominal pain of four weeks duration. Her investigative profile was normal and her colonoscopy did not reveal any mucosal changes. Colonic calcification has been known to occur mostly as a result of ischemic phenomenon but the index case had no such features or any other predisposing factor. The patient is currently symptom-free and is following our clinic for the last 8 months. After the review of literature and thorough investigations her colonic calcification remains unexplained.[german] Wir berichten über eine diffuse Kalkeinlagerung im Colon einer jungen Frau, die beim CT des Abdomens entdeckt wurde. Die Patientin wurde wegen unklarer, wiederholt auftretender Bauchschmerzen von 4 Wochen Dauer in unserer Klinik vorgestellt. Die allgemeine Untersuchung ergab einen regelrechten Befund, bei der allgemeinen Colonoskopie wurden keine Mucosa-Schäden gefunden. Verkalkungen im Colon wurden bisher als Folge von Ischämien angenommen, aber im vorliegenden Fall gab es keine derartigen Hinweise oder andere prädisponierende Faktoren. Die Patientin ist derzeit frei von Beschwerden und wird von unserer Klinik seit 8 Monaten überwacht. Nach Durchsicht der Literatur und gründlicher Untersuchung bleibt die Ursache der Verkalkung im Colon nicht erklärbar.

Objective: The goal of this study was to compare the pulp temperature increase during light curing of different composite thicknesses in deep class I cavities using two thermal sensing tools. Methodology: Round occlusal class I cavities with a remaining dentin thickness (RDT) of 1 mm from the cavity floor were performed on 15 extracted sound molars. Samples were divided into three groups (n = 5). In group A, cavities were restored using the Filtek Z350 XT conventional composite through the incremental filling technique, whereas group B cavities were restored using the Filtek Bulk-Fill flowable composite through the bulk-fill technique. Specimens of the Filtek Bulk-Fill flowable composite using the incremental filling technique were used to restore cavities in group C. An infrared thermal camera (IRT; Flir, Wilsonville, OR, USA) and K-type thermocouple (Perfect Prime TC0520, New York, NY, USA) were used to measure the heat generated during composite photo-polymerization. Results: There were no significant differences within the same group using either the thermocouple or IRT (p > 0.05). One-way ANOVA showed no significant differences between groups A and C (p > 0.05), whereas group B was significantly different from groups A and C with each sensing tool (p < 0.05). Conclusion: IRT and thermocouple heat readings were comparable. Based on the current findings, the bulk-fill technique resulted in the lowest heat generation among the groups. Therefore, increasing the light-curing time and the number of composite increments was directly correlated with increases in intra-pulpal temperature. [ABSTRACT FROM AUTHOR]

Background: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) 4C mortality score has been used before as a valuable tool for predicting mortality in COVID-19 patients. We aimed to address the utility of the 4C score in a well-defined Saudi population with COVID-19 admitted to a large tertiary referral hospital in Saudi Arabia. Methods: A retrospective study was conducted that included all adults COVID-19 patients admitted to the Armed Forces Hospital Southern Region (AFHSR), between January 2021 and September 2022. The receiver operating characteristic (ROC) curve depicted the diagnostic performance of the 4C Score for mortality prediction. Results: A total of 1,853 patients were enrolled. The ROC curve of the 4C score had an area under the curve of 0.73 (95% CI: 0.702-0.758), p<0.001. The sensitivity and specificity with scores >8 were 80% and 58%, respectively, the positive and negative predictive values were 28% and 93%, respectively. Three hundred and sixteen (17.1%), 638 (34.4%), 814 (43.9%), and 85 (4.6%) patients had low, intermediate, high, and very high values, respectively. There were significant differences between survivors and non-survivors with regard to all variables used in the calculation of the 4C score. Multivariable logistic regression analysis revealed that all components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Conclusions: Our data support previous international and Saudi studies that the 4C mortality score is a reliable tool with good sensitivity and specificity in the mortality prediction of COVID-19 patients. All components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Within the 4C score, odds ratios increased proportionately with an increase in the score value. Future multi-center prospective studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Outbreaks of scabies have been documented in 2018 among school children in Western and Central regions of Saudi Arabia. There have been concerns about the awareness of healthcare providers. Objective: The objective of the current study was to evaluate the knowledge of primary health care physicians about scabies diagnosis and management, as well as the factors influencing such knowledge. Methods: An observational cross-sectional study was conducted between September and October 2019. The target population was physicians working in primary care centers in Riyadh. Filling either hard or soft copies of the study questionnaire was used for data collection. The knowledge score was calculated from the answers for 16 knowledge questions. Results: A total of 216 physicians were included in the final analysis, mainly general practitioners (56.5%) and registrars (31.5%). The overall knowledge score was 67.5%± 13.9%. The highest level of knowledge was associated with age susceptibility (80.6%), followed by clinical presentation and diagnosis (78.1%), mode of transmission (75.8%), pathogen cause & incubation period (66.9%), and finally management (61.7%). In multivariate logistic regression models, a shorter time since last time information about scabies was reviewed was significantly associated with better knowledge (defined as score > median), with odds ratio = 5.84 (95% confidence interval = 2.43–14.01). Similarly, older age and higher qualification were significantly associated with better knowledge.Discussion: As expected, the knowledge about scabies among primary care physicians was generally inadequate. The current findings highlight the need for educational and training programs lead by health care authorities, targeting these physicians. [ABSTRACT FROM AUTHOR]

Introduction: Glaucoma is a leading cause of irreversible visual impairment worldwide and its diagnosis is frequently delayed. Although the pathogenesis of glaucoma is not fully understood, its incidence increases with age, the patients often have numerous comorbidities and use various medications. Thus, management and understanding of this disease. Objective: We aimed to review the literature reviewing the pathophysiology, clinical features, risk factors, diagnosis, and management of glaucoma. Methodology: Pubmed was used to select eligible articles using these terms in Mesh "Glaucoma" "Glaucoma pathophysiology" "Glaucoma trials" "Glaucoma management and diagnosis" within the title or abstract. Conclusion: Glaucoma is a leading cause of blindness worldwide so it requires accurate evaluation of the stages and progression of the diseases in order to detect the possible ways of management. Management of decision making demands solid history, detailed investigations, and cautious follow-up. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Steroids are used as anti-inflammatory agents, administered for a variety of medical conditions, either as shortor long-term treatment. Steroid use is associated with many adverse effects, including hyperglycemia, but ketoacidosis is rare. Case Report: We present the case of a 53-year-old woman who developed diabetic ketoacidosis after administration of methylprednisolone during treatment of immune thrombocytopenic purpura. She did not have diabetes or a family history of diabetes. Steroid-induced hyperglycemia with insulin resistance, lipolysis, and ketogenesis occurred and were likely to have precipitated the ketoacidosis. Blood glucose, blood gases, and urine test results were diagnostic for ketoacidosis. Conclusions: The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, especially in patients who have risk factors for diabetes mellitus including obesity and long-term use of steroids, so that early identification of diabetic ketoacidosis can prevent further morbidity and mortality in chronic patients. [ABSTRACT FROM AUTHOR]

We describe diffuse colonic calcification detected on CT scan of the abdomen in a young female patient who presented to our clinic with vague intermittent abdominal pain of four weeks duration. Her investigative profile was normal and her colonoscopy did not reveal any mucosal changes. Colonic calcification has been known to occur mostly as a result of ischemic phenomenon but the index case had no such features or any other predisposing factor. The patient is currently symptom-free and is following our clinic for the last 8 months. After the review of literature and thorough investigations her colonic calcification remains unexplained. [ABSTRACT FROM AUTHOR]

Background: The sleep disturbances are common at high altitudes. This study aimed to determine the prevalence and predictors of obstructive sleep apnea at high altitudes. Methods: This cross-sectional observational study was conducted from March 2018 to June 2018 to assess the predictors of obstructive sleep apnea based on Berlin, Stop-Bang and Epworth sleepiness scale questionnaire from adult population of Taif City at an altitude of 1879 m from sea level in Saudi Arabia. Results: Of 1002 participants, the majority (614 participants, 61.3%) were males and the mean± SD age of participants was 30.6± 10.3 years (Range 11 - 67 years). In this study 24.9% participants were found to be at a high risk of having sleep apnea. Male gender, older age and smoking were found to be significantly associated with higher risk of sleep apnea according to Berlin, Stop-Bang and Epworth sleepiness scale questionnaire. Diseases found to be associated with a high risk of developing sleep apnea included hypertension (p<0.001), hyperlipidemia (p<0.001), diabetes (p<0.001), psychological disorders (p<0.001) and asthma (p<0.001) .On the other hand, cardiac disorders were found to have an insignificant effect on sleep apnea (p=0.076) in this study. Almost one-third of the participants (34.9%; 95% CI= 32.0% to 37.9%) were found to have an abnormal level of daytime sleepiness according to Epworth Sleepiness Scale (ESS). These results were comparable to the previous studies at low altitude. Conclusions: Our study demonstrated that the predictors of OSA at high altitudes are comparable to those at low altitudes. [ABSTRACT FROM AUTHOR]

Abstract Background: Few studies have addressed the effects of biological therapies on laboratory outcomes and changes in FEV1 in patients with severe asthma (SA) and chronic rhinosinusitis (CRS). We aimed to study the effect of three biological therapies on laboratory outcomes and FEV1 in Saudi Arabian patients with SA and CRS., Methods: From March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital-Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of 3 biological therapies (benralizumab, dupilumab, and omalizumab) in adults with SA and concomitant CRS in terms of FEV1 and laboratory parameters (serum IgE and eosinophilic counts)., Results: Eighty patients were enrolled, with a mean age of 46.68. There were 45 (56%) females and 35 (44%) males. There were significant improvements in FEV1 and laboratory parameters (serum IgE and eosinophilic counts) after 6 &12 months of biological therapies compared to pre-biological therapies (p<0.001, each). The response was different among different biological therapies. The improvements in FEV1, serum IgE, and eosinophilic counts were manifest with benralizumab and dupilumab but not with omalizumab., Conclusions: Results from the first study from two large Saudi Arabian tertiary centers for patients with severe asthma and chronic rhinosinusitis agree with and support those of worldwide real-life ones. One-year follow-up of patients with SA and CRS showed the effectiveness of benralizumab and dupilumab, but not omalizumab, regarding FEV1, serum IgE, and eosinophilic counts. Further prospective multicenter studies are warranted.

Background: Studies found in the literature which describe the treatment of varicella pneumonia with a combination of acyclovir and corticosteroids tend to be retrospective in nature and limited with regard to the data supplied., Methods: This prospective study was performed at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. The study covered adult patients admitted with a diagnosis of varicella pneumonia over a period of 10 years (January 2003 to December 2012). All patients were treated uniformly according to the predefined protocol with acyclovir and corticosteroids. The clinical characteristics, laboratory investigations, hospital course, any complications and the treatment outcomes were studied., Results: A total of 32 patients (25 males, mean age 43.5 ±14.5 years) were enrolled into this study; 3 patients (2 patients aged <12 years, 1 patient with advanced cardiac failure) were excluded. Of these 32 patients, 18 (58%) were current smokers, 16 patients (50%) were admitted to the intensive care unit and of these, 14 (87.5%) required mechanical ventilation. The mean duration of intensive care unit stay was 5.59 ±5.37 days. All patients were treated with intravenous acyclovir, corticosteroids and antibiotics were added when indicated. 31 patients improved and were discharged home. There was one death (a 32 year-old female with underlying systemic lupus erythematosus)., Conclusions: Patients with varicella pneumonia are at high risk of respiratory failure. Early implementation of supportive therapy seems to positively influence the recovery rate and outcome. Our study supports treatment using a combination of acyclovir and corticosteroids.

We describe diffuse colonic calcification detected on CT scan of the abdomen in a young female patient who presented to our clinic with vague intermittent abdominal pain of four weeks duration. Her investigative profile was normal and her colonoscopy did not reveal any mucosal changes. Colonic calcification has been known to occur mostly as a result of ischemic phenomenon but the index case had no such features or any other predisposing factor. The patient is currently symptom-free and is following our clinic for the last 8 months. After the review of literature and thorough investigations her colonic calcification remains unexplained.