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Neovascular glaucoma (NVG) is an aggressive type of glaucoma, which often results in poor visual outcomes. Antivascular endothelial growth factor is frequently used for various conditions in which VEGF release is induced in response to retinal ischemia. Bevacizumab is a humanized anti-VEGF monoclonal IgG1 antibody. The potential of antivascular endothelial growth factor (anti-VEGF) agents to modify the disease course of neovascular glaucoma (NVG) was recognized shortly after their use in the treatment of age-related macular degeneration was reported. These medications were noted to induce rapid regression of the anterior segment neovascularization that characterizes NVG. Several studies as well as extensive clinical experience have demonstrated a rapid regression of anterior segment neovascularization following the injection of anti-VEGF agents. This review aims to summarize current evidences regarding effectiveness of Bevacizumab in management of neovascular glaucoma.

Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness and pulmonary manifestations are the typical presentations of the disease. However, it became evident that the COVID-19 is not limited to the respiratory system. Specifically, gastrointestinal involvement in patients with COVID-19 is very common, particularly in patients with a critical illness. We present a case of a 52-year-old man who was diagnosed as having severe COVID-19 pneumonia and underwent endotracheal intubation and mechanical ventilation. The patient remained in the intensive care unit for seven days. Following his recovery, he started to experience generalized abdominal pain. The pain did not resolve with conservative measures. A computed tomography scan of the abdomen demonstrated small bowel loops clustered with a surrounding thin membrane. Such findings conferred the diagnosis of sclerosing encapsulating peritonitis. The patient was prepared for laparoscopic surgery. Resection of the membrane was performed without any injury to the encapsulated bowel. Analysis of peritoneal fluid by reverse transcription-polymerase chain reaction (RT-PCR) was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient had an uneventful recovery. Sclerosing encapsulating peritonitis is a very rare condition associated with COVID-19 pneumonia. The present case is the first reported case to document the presence of the SARS-CoV-2 virus in the peritoneal fluid in a patient with sclerosing encapsulating peritonitis.

Background Depression is considered one of the most common psychiatric disorders that affects more than 260 million people in all age groups worldwide. Yet, among the geriatric population, in which it can show nonspecific symptoms, depression can be easily underdiagnosed. The objectives of this study are to assess the prevalence of depression among the geriatric population in primary healthcare centers and to estimate the effects of different sociodemographic and medical factors. Methodology A total of 408 patients aged 60 years or older were approached in the primary healthcare centers of the eastern region of Saudi Arabia. Using the Patient Health Questionnaire-9, patients were either interviewed or filled the questionnaire by themselves. Questions about sociodemographic data and medical and medication histories were included in the questionnaire. Results Of the 408 participants, 173 (42.4%) reported depressive symptoms; 115 (28.2%) of the participants had mild depression, 50 (12.3%) had moderate depression, and 8 (2%) reported moderately severe depression. Correlates of depression included elderly patients aged 75 years or more, of whom 78.9% showed depression compared to 39.3% of those who were 60-65 years old (P = 0.001). Furthermore, the female elderly showed higher rates of depression compared to males (52.8% vs. 35.7%; P = 0.001). A reported 81.1% of the elderly were diagnosed with chronic diseases; approximately half of them were depressed, while only 32.9% of the elderly free of diseases were depressed (P = 0.001). Conclusions The prevalence of depression is high among the elderly in the eastern province of Saudi Arabia, especially in those who complain of chronic diseases, older patients, and females. Screening for depression must be employed early to manage depressive symptoms and prevent further complications.

Subcutaneous emphysema refers to the abnormal presence of free gas within the subcutaneous tissue. Its cause can be broadly classified into 3 main causes: (1) infection by gas-forming microorganisms, (2) visceral perforation of luminal organs, and (3) spontaneous alveolar rupture. We report a case of a 48-year-old lady who developed extensive subcutaneous emphysema after undergoing VASER-assisted liposuction and J-Plasma® therapy at a local cosmetic clinic. The patient was admitted to our tertiary plastic surgery department where she was managed conservatively and discharged at day 3 without any complications. Subcutaneous emphysema is a known but rare complication of liposuction. While subcutaneous emphysema is usually self-limiting, fatal complications can occur. As such, patients considering these procedures should be informed of its risks and benefits to allow them to make an informed decision. This report highlights the importance of meticulous surgical technique in liposuction and its postoperative assessment.

Urothelial carcinoma (UC) of the urinary bladder is the ninth most common cancer worldwide. The majority of these patients present with non-muscle invasive bladder cancer (NMIBC). GATA3 has recently emerged as one of the diagnostically helpful immunohistochemical markers for UC. The published literature, however, lacks comprehensive studies on the impact of GATA3 expression on the prognosis of UC patients. This study evaluated and statistically analyzed the immunohistochemical expressions of GATA3 and Ki67 in 50 Egyptian patients with NMIBC and correlated the markers' expressions with clinicopathological variables and patients' outcome. Ten control cases were included. The expressions of GATA3 and Ki67 were significantly downregulated and upregulated respectively in UC cases compared to the control group. GATA3 down-expression was significantly associated with high grade tumors and tumor progression with 72% prediction accuracy. Higher proliferative activity was significantly correlated with high grade, non-papillary growth pattern, and lamina propria invasion. The predictive performance of GATA3 and Ki67 in predicting malignancy and tumor grade was good. We concluded that GATA3 downregulation and increased proliferative activity might be implicated in UC tumorigenesis, loss of differentiation, and aggressiveness. Reduced GATA3 expression could predict progression in NMIBC with an accuracy of 72% and thus it constitutes a potentially promising novel prognostic marker in patients with urothelial carcinoma.

Background Globally, less than 10% of graduating medical students select pathology as a future career. Many factors were reported from different settings to influence the choice of pathology. The aim of this study was to investigate the factors that determine medical students’ preferences in choosing pathology as a future career. Methods This cross-sectional study surveyed students from three governmental medical schools in Riyadh, Saudi Arabia. A self-administered questionnaire that contained demographic questions and items that addressed perceived factors that affect the choice of pathology was distributed to medical students. Collected data were analyzed using Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 25.0 (Armonk, NY: IBM Corp). A chi-square test was used to determine the association between independent variables and interest in pathology. Results Out of the 400 questionnaires distributed, 338 students completed the survey with a response rate of 84.5%. Overall, surgery (24%) and internal medicine (20%) were the most favored, specialties with only 5% of the students selecting pathology as their first choice. Patient-doctor interaction (72.2%) was perceived as the most important factor in not choosing pathology as a future career. Taking an elective course, younger age groups, and year in medical school were all significantly associated (p

Radioactive iodine (RAI) is being increasingly used for remnants ablation of low/intermediate-risk differentiated thyroid carcinoma (DTC). Importantly, total thyroidectomy (TT) is in common use in the treatment of low-grade DTC to facilitate RAI despite the recommendations for lobectomy. Intermediate-risk DTC has been an arena of controversy (fueled by weighing the risks and benefits of RAI). This meta-analysis aimed to assess the role of RAI following TT in comparison to lobectomy in low/intermediate-risk patients with DTC. We identified 482 references through PubMed, Cochrane Library, EBSCO, and Google Scholar databases. The keywords used were "differentiated thyroid carcinoma", "low/intermediate risk", "radioactive iodine following total thyroidectomy", "total thyroidectomy versus lobectomy and RAI", "remnants ablation", "recurrence", "survival rate", "tumor-specific cancer death", "overall mortality", and "tumor-specific mortality". From the 67 full texts screened, only seven studies fulfilled the inclusion and exclusion criteria. The studies were from the USA, Australia, Asia, Mexico, and South America (63,268 patients included; five were retrospective and two prospective cohorts). No differences were found regarding recurrence and survival rate between TT followed by RAI and lobectomy alone. However, the current data were limited by the observational studies included, the pooling of both recurrence and survival rate, and the significant heterogeneity observed. The ongoing randomized controlled trials are awaited to resolve the issue.

Cardiovascular disease is a well-known and widely studied disease. Epidemiological studies indicated that the mortality rate due to cardiovascular diseases increases every year. According to the WHO (world health organization) report, cardiovascular disease is one of the most prevalent non-communicable diseases in Saudi Arabia. Moreover, the Ministry of Health, Kingdom of Saudi Arabia, also reported that 42% of the non-communicable disease death is associated with cardiovascular disease in Saudi Arabia. Various reports suggest that heart disease is associated with several risk factors. Moreover, diabetes is one of the high-risk factors. Clinical result suggests a good association between diabetes and cardiovascular complications. In the present work, we focus on some of the important risk factors responsible for heart disease such as weight, blood pressure, age, and diabetes. A set questionnaire, which includes all the parameters associated with cardiovascular disease, was prepared. Data collected from the heart patient's records of different hospitals in Al-Qassim, Saudi Arabia. We applied statistical tools to analyze the data. Our results shows very interactive and significant pattern. We found significant inter-correlation between the different risk factors. In conclusion, the inter-correlation among different risk factors of heart disease is found. It is suggested that both pre and post-heart patients should be more concern about these risk factors. Moreover, this study can be used for further research, and, will increase people awareness regarding their healthy choice.

BACKGROUND: Exposure to stressful working conditions without adequate stress-coping strategies may lead to stress and even psychiatric morbidity. There are a dearth of studies on stress-coping strategies among consultant physicians in the Arabian Gulf. OBJECTIVES: Determine stress-coping strategies among consultants in Saudi Arabia and the relationship of strategies to level of stress. DESIGN: Analytical cross-sectional study. SETTINGS: Conducted between November 2014 and March 2015 among physician consultants registered at the Saudi Commission for Health Specialties. SUBJECTS AND METHODS: Text messages were used to directly ask consultants to complete an online questionnaire. MAIN OUTCOME MEASURES: The 28-item Brief COPE inventory and the Perceived Stress Scale. SAMPLE SIZE: 582. RESULTS: The consultants were largely males (71%) and Saudi (56%), and their mean age was 46.9 (7.9) years. Adaptive stress-coping strategies were more frequently used than maladaptive stress-coping strategies (68% versus 49%). Stress levels were positively correlated with maladaptive stress-coping strategies (r=0.41, P

Objectives: The aim of this study was to document clinical features of inguinal hernia (IH) in the pediatric populace. It delivers data to assess related risk factors of incarcerated hernia, its reappearance in addition to the occurrence of contra lateral metachronous hernia. Materials and Methods: We report a retrospective analytic study comprising 230 children presenting with IH and operated from April 2015 to June 2017 in the pediatric surgery department, King Abdulaziz Hospital. Results: We managed 36 girls (15.6%) and 194 boys (84.4%). The mean age was 3 years; The median age in the studied group was 3 years (range 22 days to 12 years). Males were predominantly affected (84.4%, n = 194). The rate of IH was more important in the youngest group (age < 2 years); thus, we accounted 43.5% (n = 100) infants. The cumulative incidence of hernia in the 2–6-year age group was 34.7% (n = 80). Thirteen percent (n = 31) of these patients presented with an incarceration mostly on the right side (62.6%, n = 154). We recognized that the total rate of incarcerated hernia incidence in premature group was evaluated at 27%. This rate was high, particularly in neonates and infants. Prematurity and hypotrophy were documented in 9% and 7% respectively. The mean follow-up period was 3.8 years. We think that incarceration can be related to several risk factors such as feminine gender, prematurity, and the initial left side surgical repair of the hernia. Conclusion: IH occurs mainly in male infants. Prematurity and male gender was identified as risk factors of incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left side surgical repair of the hernia.

The Coronavirus-19 pandemic continues at full speed, and the number of patients who die from Covıd-19 is increasing. It was aimed to evaluate the demographic information and laboratory findings of 86 patients who died while being followed up in our hospital with a pre-diagnosis of Covıd-19. Identifying these characteristics of deceased patients will be essential to guide clinicians in identifying critically ill patients. Data on demographic information, comorbidities, time from hospitalization to death, molecular test results, thorax CT findings, biochemical findings, culture, antibiotic susceptibility, and the given treatments of the cases were collected from the electronic system Kastamonu Training and Research Hospital. While the RT-PCR test of 21 of the cases was positive, in 9 of the cases, control PCR tests were negative after a while. The CT results of 18 of the 21 initially RT-PCR positive cases were compatible with Covid-19, and the CT result of 3 could not be reached. When the blood test results of the cases were examined, neutrophil increase, white blood cell increase, lymphocyte reduction, and inflammatory markers increase were determined. A total of 43 bacterial growths were found in 21 cases. It has been observed that deaths in patients who were followed up with the pre-diagnosis of Covıd-19 generally occur in older people, males, and those with underlying diseases. It was thought that the cause of death could be underlying diseases, pathologies caused by inflammation, and secondary bacterial infections in addition to viral infection. Clinicians should be more careful about elderly patients, patients with secondary bacterial infections, or patients with neutrophilia, lymphopenia.

Color stability has a vital role in several factors. Including the cosmetic appearance, confidence while smiling, and facial emotions, and in some patients, it denoted healthy and vital dental health. Dental discoloration denotes the lack of dental care. This varies from excessive use of external artificial coloration materials such as coffee, tea, and fizzy drinks. Also, in some cases, the dental discoloration is due to internal pathological conditions or due to medical treatments usage. Radiation has been remarked as one of the causes that cause dental discoloration. In addition to that, chemotherapy was also associated with dental discoloration. Some medications, such as tetracycline and antihistamines, were linked to dental discoloration. The literature discussed in-vitro experiments for the substances affecting the teeth' color status. Coffee was the most significant cause for dental discoloration, either human use (in-vivo) or laboratory experiments (in-vitro). The sociodemographic status was linked to the variance of dental discoloration. Future recommendations are concerned about the public health sector. The WHO should offer comprehensive dental care for all people all over the world, and not exclusive for specific socioeconomic areas. Practical plans for screening dental pathologies should be investigated and for systematic pathologies that might be associated with dental issues.

Digoxin has a narrow therapeutic index, such as complicated pharmacokinetics and dynamics. Many drug interactions may occur when the administration of one drug alters the clinical effects of another. As a result, digoxin toxicity can be a common condition within clinical settings that might lead to the development of many morbidities and even mortality. Many studies were published to investigate the efficacy and safety of different management modalities to enhance the outcomes that follow digoxin administration. The aim of the study was to discuss the approaches to systematically treat and prevent the development of cardiac digoxin toxicity. The findings are based on evidence from previous studies in the literature. To be specific, Fab fragments are the most effective modalities that can be used to treat severe cases within ideal periods. However, evidence regarding their administration for asymptomatic or mild cases is still poor regarding the cost-efficacy and the development of serious adverse events. Physicians should primarily care for a better intervention as it is usually associated with a significantly more enhanced prognosis and clinical outcomes. Nevertheless, adequate monitoring of the patients and evaluation of their personal and medical history are important steps in the process, and further approaches are still needed. Also, detailed information about our intended outcomes is furtherly discussed within the manuscript.

The development of squamous cell carcinoma in sites of split skin graft harvest is a rare complication with only 12 documented cases in the literature. The growth of squamous cell carcinoma after arterial puncture is a rarer phenomenon, with no previous cases documented. This series describes two cases. The first case is of a 70-year-old male who developed rapidly growing squamous cell carcinoma in a graft donor site, 9 weeks after split skin graft repair of pretibial squamous cell carcinoma excision. The second case is of an 84-year-old male who developed a large exophytic squamous cell carcinoma in the right wrist that developed 5 months after radial artery puncture. This case series explores the various mechanisms of de-novo squamous cell carcinoma development in areas of cutaneous surgical intervention, including graft harvest. It also provides recommendations regarding the necessary precautions to avoid implantation of squamous cell carcinoma into distant sites. Lastly it highlights the importance of surveillance for any suspicious lesions arising from areas of previous cutaneous surgical intervention.

Background: chronic low back pain is one of the most common causes of chronic pain. Low back pain can have many causes but most cases have nonspecific etiology. There are many approaches in the management of chronic low back pain. Methodology: we carried out a systematic review on observational (nonrandomized) of 43 studies using PUBMED. Aim: to evaluate the use of analgesics, mainly Non-Steroidal Anti-inflammatory Drugs and opiates, compare their efficacies for symptomatic treatment of low back pain, and study the side effects briefly for both category of drug. Conclusion: management of chronic low back pain aims mainly to improve function, and quality of life, and to decrease level of disability, and therefore, it remains as a big challenge for the general practitioner. More studies must be done to compare efficacies of various lines of management for both short and long term.

Admission rate to neonatal intensive care units (NICU) was considerably increased over the past few decades. Short-term outcomes had been enhanced, and mortality rates had decreased. However, the impact of advanced neonatal care interventions on long-term outcome of infants was not thoroughly reviewed. Objectives: the aim of this review is to investigate the effect of NICU admission on long-term developmental and nutritional outcomes in early childhood years. Methods: Medical database, particularly Medline and Cochrane Library were searched for studies, researches, and review articles about the long-term outcome of neonates who were admitted at neonatal intensive care unit, particularly from the nutritional and developmental perspectives. Results: Overall impact of NICU admission on long-term outcome is generally related to the etiological indication of admission; Hypoglycemia, tetanus, low birth weight, and prematurity had a negative impact on childhood development. Adequate nutrition and rapid growth velocity in NICU improved nutritional and physical development. Discussion: Long-term outcome of neonatal intensive care unit admission depends to a large degree on the etiology of admission. Adequate nutritional support at neonatal intensive care units had improved developmental and nutritional outcome of preterm and very preterm infants. Term and late term infants admitted at NICUs were not significantly different from their counterparts who were not admitted at NICUs on long-term outcomes. Conclusions: Admission at NICU is not an independent risk factor for poor nutritional or developmental outcome at early childhood years, but the etiological indication of NICU admission was more predicting. Early nutrition for low birth weight babies improved nutritional development.

Pneumatosis Intestinalis and hepato-portal venous gas are rare but ominous radiological findings that are synonymous with mesenteric ischaemia and bowel infarction in the majority of cases. Very uncommonly benign pathology have been implicated, including respiratory and inflammatory bowel disease. We provide a case of a 69-year-old gentleman with extensive peripheral vascular disease, who presented with generalized abdominal pain and findings of both pneumatosis intestinalis and hepato-portal venous gas. Laboratory investigations were unequivocal, with only mild lactatemia. Emergency laparotomy was performed, which revealed no obvious cause and only some turbid pelvic free fluid. The patient had an uncomplicated recovery. This case illustrates the importance of guiding decisions based on the patient’s clinical state, and of keeping an open mind to benign pathology. It also highlights the importance of early surgical intervention in cases of high clinical suspicion.

Many applications have been previously reported that laser is used in the field of endodontics. It is used in pulp diagnosis, shaping and disinfection of the root canal, endodontic surgeries, modifying the dentin structures, pulpotomy and pulp capping. Our present study aims to review some applications of laser used in the field of endodontics. According to the evidence from current studies in the literature, vital pulp therapeutic approaches for pulpotomy can significantly lead to efficacious and bloodless outcomes by using laser for the following processes: Coagulation, vaporization, and sealing of the blood vessels with potentially sterile minute wounds with no complications. Many advantages have been previously reported for using laser within endodontic surgical procedures, such as coagulation, sterilization, selective absorption, precision, lower rates of complications as inflammation and edema, getting clean, well-sealed surgical wounds, enhanced disinfection characteristics, reduced painful sensations, decreased required sutures due to better hemostasis, and reduced bleeding. On the other hand, applying some laser modalities might not be adequately efficacious according to previous studies in the literature. We recommend that further human prospective to conduct investigations for further validation of the current evidence.

Simple Summary Behavioral characteristics of living organisms may affect the metabolism and its underlying molecular basis. The lifestyles of some modern communities include prolonged light exposure at night, and a high-fat/high-sugar-containing diet is frequently investigated. The molecular mechanisms of this unhealthy behavior might involve Adropin and some related nuclear receptors. This study examines the effect of long-term continuous light exposure and high fat/sucrose (HFS) diet on Adropin expression, RORα, Rev-erb-α nuclear receptors, key enzymes of lipid metabolism, and energy homeostasis in a rat model. The results of this study demonstrate the deleterious effects of this modern behavior on the metabolism, histology of many organs and general health. In conclusion CL and WD produced widespread derangements of energy homeostasis and lipid metabolism. The pathogenesis of this disturbance includes, at least in part, the Adropin hormone with the involvement of the RORα and Rev-erb-α nuclear receptors. Future therapeutic potential may involve Adropin. Abstract Long-term continuous light exposure (CL) and western diet (WD) effects on Adropin expression, RORα, and Rev-erb-α nuclear receptors and energy homeostasis were studied in rats. Thirty-two male Wistar rats (250–290 g) were enrolled for 3 months in the following groups (n = 8/group): (a) Normal control group (NC), (b) CL group, (c) WD group, and (d) CL + WD group. Then, indirect calorimetry and food intake (FI) were measured. Finally, Adropin, hormone-sensitive lipase (HSL), adipocyte triglyceride lipase (ATGL), and free fatty acids (FFA) were measured. Additionally, the histopathology and gene expression of Enho, RORα, and Rev-erb-α genes were done. The CL alone elevated the Adropin plasma level and gene expression, increased RORα expression, and decreased the Rev-erb-α nuclear receptor expression mainly in the liver and kidney. Besides, CL increased the total energy expenditure (TEE) and decreased the respiratory quotient. WD alone or in combination with the CL reversed gene expression of Enho, RORα, and Rev-erb-α. Combined CL and WD increased the TEE, reduced the food intake, increased the ATGL, and reduced the Adropin level in addition to widespread degenerative changes in the liver, spleen, and renal tissues. The deleterious effects of CL and WD on energy homeostasis may include Adropin with the involvement of the RORα and Rev-erb-α nuclear receptors.

Background: Diabetic retinopathy (DR) is one of the severe complications of diabetes that can result in complete blindness when it presents late in the course of the disease. The role of primary care physicians (PCPs) in the screening, prevention, and possibly referral of patients with this complication is of great importance. Materials and Methods: An analytic cross-sectional study was conducted in all primary care clinics in Buraidah city, Qassim region, Saudi Arabia. The sampling technique used is convenience sampling. The sample is PCPs (PCPs). Data were collected using a pretested, semi-structured questionnaire with sections for assessment of knowledge, attitudes, and practices toward DR in the PCPs. Results: Out of a total of 106 physicians, 100 have answered the questionnaire with a response rate of 94%, 75% have received postgraduate training. Eighty-seven percent of the PCPs have agreed that an ophthalmoscope is needed in their clinic while only (35%) have agreed that they can do an ophthalmoscopic examination confidently to detect DR in patients with diabetes. Around 23% have disagreed that diabetic patients can have DR despite having a good vision, and only 56% have agreed that pregnancy can actually worsen DR. Conclusions: The knowledge, attitudes, and practices of PCPs are sub-optimal. Dilated Fundus Examination using a slit-lamp ophthalmoscope is the best technique used in the screening of DR. Primary care centers should be equipped with more technologically advanced ophthalmic devices, and tele-screening should be utilized to precisely diagnose DR. Moreover, the communication with and referral to ophthalmology should be done on findings that are suggestive of DR. PCPs should stress the importance of screening to their diabetic patients. Finally, more efforts should be placed to increase knowledge in certain areas like DR effects in pregnant patients.

Background Little is known of how accurately a first-time seizure witness can provide reliable details of a semiology. Our goal was to determine how accurately first-time seizure witnesses could identify key elements of an epileptic event that would aid the clinician in diagnosing a seizure. Methods A total of 172 participants over 17 years of age, with a mean (sd) of 33.12 (13.2) years and 49.4% female, composed of two groups of community dwelling volunteers, were shown two different seizure videos; one with a focal seizure that generalized (GSV), and the other with a partial seizure that did not generalize (PSV). Participants were first asked about what they thought was the event that had occurred. They then went through a history-taking scenario by an assessor using a battery of pre-determined questions about involvement of major regions: the head, eyes, mouth, upper limbs, lower limbs, or change in consciousness. Further details were then sought about direction of movement in the eyes, upper and lower limbs, the side of limb movements and the type of movements in the upper and lower limbs. Analysis was with descriptive statistics and logistic regression. Results One hundred twenty-two (71.4%) identified the events as seizure or epilepsy. The accuracy of identifying major areas of involvement ranged from 60 to 89.5%. Horizontal head movements were significantly more recognized in the PSV, while involvement of the eyes, lateralization of arm movement, type of left arm movement, leg involvement, and lateralization of leg movement were significantly more recognized in the GSV. Those shown the GSV were more likely to recognize the event as "seizure" or "epilepsy" than those shown the PSV; 78 (84.8%) vs 44 (55.7%), (OR 0.22, p < 0.0001). Younger age was also associated with correct recognition (OR 0.96, P 0.049). False positive responses ranged from 2.5 to 32.5%. Conclusion First-time witnesses can identify important elements more than by chance alone, and are more likely to associate generalized semiologies with seizures or epilepsy than partial semiologies. However, clinicians still need to navigate the witness’s account carefully for additional information since routine questioning could result in a misleading false positive answer.

Kounis syndrome refers to acute coronary syndromes of varying degrees (myocardial ischaemia to infarction) induced by mast cell activation as a result of allergic and anaphylactic reactions. Following subclinical, acute or chronic allergic reactions, it has a clinical spectrum ranging from chest pain to ST segment elevated myocardial infarction. The trigger of the allergic reaction can be drugs, food, environmental factors (insect bite, bee sting, pollen, latex contact). We present a case of a patient who developed Kounis syndrome as a result of anaphylactic reaction to Voltaren (Diclofenac sodium) which is one of the drugs widely used in the emergency departments as intramuscular pain killer., Kounis sendromu mast hücrelerinin etkinleşmesi ile seyreden alerji, hipersensitivite, anaflaksi veya anaflaktoid reaksiyonlarla ilişkili olarak akut koroner sendromun değişik derecelerini ifade eder. Subklinik olarak akut veya kronik alerjik reaksiyona eşlik eden ve göğüs ağrısından başlayıp ST elavasyonlu miyokard enfarktüsü kadar uzanan bir klinik spektruma sahiptir. İlaçlar, yiyecekler, çevresel etkenler (böcek ısırması, arı sokması, polenler, lateks teması gibi) alerjik reaksiyonu tetikleyen neden olabilir. Burada, acil servislerde yaygın olarak kullanılan Voltaren’e (Diklofenak sodyum) bağlı gelişen anafilaktik reaksiyonu olan bir Kounis sendrom vakasını sunuyoruz.

We compared the effect of VIP on human blood monocytes infected with Salmonella typhimurium 4/74 or stimulated with LPS. VIP (10−7 M) increased monocyte viability by 24% and 9% when cultured for 24 h with 4/74 or Salmonella LPS (100 ng/ml), respectively. Significantly increased (P < 0.05) numbers of 4/74 were also recovered from monocytes co-cultured with VIP after 6 h post-infection (pi) and this remained high after 24 h pi. Both 4/74 and LPS increased (P < 0.05) the concentration of TNF-α, IL-1β and IL-6 measured in monocyte supernatants. However, LPS induced this effect more rapidly while, with the exception of IL-6, 4/74 induced higher concentrations (P < 0.05). VIP significantly decreased (P < 0.05) TNF-α and IL-1β production by 4/74-infected monocytes after 6 pi, but only after 24 h in LPS-cultured monocytes. This trend was reversed for IL-6 production. However, TNF-α and IL-1β production by 4/74-infected monocytes, cultured with VIP, still remained higher (P < 0.05) than concentrations measured in supernatants cultured only with LPS. VIP also increased (P < 0.05) production of anti-inflammatory IL-10 in both 4/74 and LPS cultures after 24 h. We also show a differential effect of VIP on the expression of TNFα and IL-6 receptors, since VIP was only able to decreased expression in LPS-stimulated monocytes but not in 4/74-infected monocytes. In conclusion, we show a differential effect of VIP on human monocytes infected with virulent Salmonella or stimulated with LPS. Our study suggests that the use of VIP in bacteraemia and/or sepsis may be limited to an adjunctive therapy to antibiotic treatment.

Objective: The patients with pulmonary embolus apply to different clinics according to various symptoms. The aim of this study is to report the characteristics and differences of pulmonary embolism (PE) patients diagnosed due to the admittion to the emergency department (ED) versus the other outpatient clinics (OC) of four hospitals in different cities of a university. Material and Methods: We reviewed the records of patients who had been newly diagnosed with pulmonary embolism in the ED and OC over a 20-months period. It was a retrospective multicenter study. The charts of patients were evaluated and fulfilled by two blind researchers on a form that was prestudy prepared. Results: There were a total of 152 patients studied. The ratio of patients 65 years old and older was 47.7% (n: 51); 57% (n: 61) were female in ED. 107 (70%) patients were diagnosed in the ED and 45 patients (29.6%) were diagnosed in OC. Twelve (7.9%) patients visited the same ED with same complaint within ten days before the visit during which the diagnosis of PE was made. Those diagnosed with PE in the OC were more frequently obese (p: 0.016) and had longer duration of symptoms before arrival (p:0.004), while ED patients had tachycardia (p:0.017) and higher WBC levels (p: 0.001). On chest X-ray, elevation of the diaphragm was significantly more common in OC patients (p: 0.033). Conclusion: PE patients diagnosed in OC were stabile, obese and had longer durations of complaints than those diagnosed in the ED.

Objective: To analyze clinical and sociodemographic properties of the patients as measured by the “Hospital Anxiety and Depression Scale-HADS” including the subscale regarding anxiety (HAD-A) in emergency department (ED) and to detect the effect of a session of Benson relaxation method (BRM) on high anxiety level. Methods: Adult patients presented to the state hospital ED in seven days were recruited in this prospective study. Patients with high (≥8) scores were randomized to the treatment or control groups. They were asked to pursue BRM to alleviate anxiety. Results: Six hundred thirty-four patients were recruited (mean age 44.1 and 52% were female). Patients with acute exacerbation or with psychiatric illness, with a systemic disease and higher acuity level had higher HAD-A scores (P

Objective The objective of the study was to assess the quality of life (QoL) in patients with androgenetic alopecia (AGA). A secondary aim was to determine the correlation between dermatology life quality index and willingness-to-pay (WTP) among subjects of different disease duration, severity, and socioeconomic factors. Patients and methods A self-administered multiple-choice questionnaire distributed to subjects diagnosed with AGA attending the dermatology clinic at three specialized hospitals in Riyadh from June 2016 to March 2017. Results Of the 233 subjects, 207 (88%) completed the questionnaires. The dermatology life quality index scores ranged from 0 to 29, with a mean score of 7.8±5.8 indicating a moderate effect on QoL. In 28.5% of subjects, QoL was affected very large to extremely large by AGA. Women showed a significantly higher WTP than men (P Conclusion The present study suggests a moderate effect of AGA on the QoL. AGA impact women more than in men and women show more WTP than mem. More studies should pay more attention on the psychological status of patients with AGA.

Vaccinations in adults and older patients are of special importance due to two main reasons: physiological and anatomical alterations in the body as it ages, making diseases more serious and possibly fatal, and so that adult individuals have a decreased immunological response when they are exposed to infections. Major adult vaccination includes influenza, pneumococcal pneumonia and meningitis, pertussis, tetanus, diphtheria, and hepatitis. In this study, our aim was to understand the recent updates on adult immunization and their efficacy in disease prevention. We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE from January 1994 to March 2017. The following search terms were used: adult vaccination, adult immunization, influenza, pneumococcal pneumonia and meningitis, pertussis, tetanus, diphtheria, preventive measures, infection prevention. Several communicable diseases that affect the elderly population which can cause significant morbidity and mortality along with excessive costs on the health care system are easily preventable with the use of vaccination. Therefore, using vaccines to prevent these diseases should be updated and encouraged by all family health care practices.

Yabancı cisimlerin özofagusa impakte olması önemli morbidite ve mortaliteye neden olabilir. Genellikle çocukluk çağı sorunu olmakla birlikte erişkinlerde de karşılaşılabilmektedir. Bu olgu sunumunda, ilk endoskopik incelemede saptanamayan özofagustaki kemiğin ancak 10 gün sonraki kontrol endoskopisinde görülerek başarılı bir şekilde çıkarılışını sunuyoruz. Özofagusa impakte yabancı cisimlerin tanısı her zaman kolay olmayabilir. Bu nedenle endoskopik incelemenin en ideal şartlarda yapılması gerekirse kontrol endoskopisinin gerçekleştirilmesi önemlidir., Foreign body impaction in the esophagus can cause significant morbidity and mortality. Although it is generally accepted as a childhood problem, it can also be seen in adults. Herein, we present an adult patient who had swallowed a chicken bone. The impacted bone in the esophagus was not detected in the first endoscopic examination. The chicken bone was removed successfully under endoscopic control 10 days later. This case presentation shows that a first examination may fail to detect a foreign body in the esophagus, thus necessitating a second endoscopy.

Objective To determine the accuracy of the Faecal Occult Blood–Transferrin test (FOB–T; Certest Biotec, San Mateo de Gállego, Spain) for detection of blood in nasogastric aspirate, and its emergency diagnostic value for upper gastrointestinal bleeding (UGIB). Methods Nasogastric aspirate was collected from patients with haematemesis on admission to hospital. Haemoglobin was quantified on admission and after 12 h. FOB–T test was used to assess each nasogastric aspirate sample for the presence of haemoglobin and transferrin. Results Of 64 patients included in the study, 28 (43.8%) were hospitalized for UGIB based on physical examination, haemoglobin level. 24 were confirmed with endoscopy findings. Four were excluded from study due to lack of endoscopic confirmation. The remaining 36 patients had no clinical evidence of UGIB. FOB–T test findings were positive in 26/60 patients, including all 24 patients with UGIB. The FOB–T test had sensitivity 100%, specificity 94.4%, positive predictive value 92.3% and negative predictive value 100% for UGIB. Conclusions A negative FOB–T test may be sufficient to exclude the possibility of UGIB without other diagnostic tests.

Facial injuries can impair a patient’s ability to eat, speak and interact with others. Severe injuries occur as a result of interpersonal or domestic violence, or in motor vehicle collisions, including those involving motorcycles and all-terrain vehicles. The authors present a case of LeFort II fracture caused by a collision of opponents while heading the ball in a football match.