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Background: Spina bifida is one of the neural tube defects substantially related to significant morbidity and mortality worldwide. A complex of environmental and genetic factors has been a risk factor for spina bifida. This study aims to assess the prevalence of spina bifida and related risk factors in Taif city, Saudi Arabia. Methods: A retrospective chart review was done at Taif Hospitals, Saudi Arabia. The study was conducted by reviewing medical files of all infants and children born with spina bifida between January 1, 2018 and December 31, 2020. All files fulfilling the inclusion criteria were reviewed for data extraction using pre-structured data extraction sheet. Results: A total of 15 infants and children with spina bifida among 43,890 live births in Taif city were identified with an incidence of 3.5 per 100,000 children. Among the 15 studied subjects, 9 were females, and the other 6 children were males. The exact of nine (60%) children with spina bifida had Myelomeningocele. Mothers ages at child delivery were 30 years or more was among 60% of the cases mothers. Two-thirds of cases mothers had no folic acid supplements during pregnancy. Conclusion: In conclusion, the current study revealed that spina bifida was around the global reported incidence, which was more common with more serious complications among females. Lack of folic acid supplementation at the periconceptional period was found to be the most reported risk factor.

Patient: Male, 4-day-old Final Diagnosis: Gastric perforation and necrosis Symptoms: Acute abdominal distension • metabolic acidosis • respiratory distress Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology • Surgery Objective: Congenital defects/diseases Background: Gastric necrosis and perforation are rare life-threatening conditions in preterm neonates, which require urgent diagnosis and surgical intervention. Case Report: We report a case of a 4-day-old patient with neonatal gastric necrosis. The patient presented with sudden acute abdominal distension, respiratory distress, and metabolic acidosis. The abdomen was markedly distended, tender, and tympanic with collateral circulation. An X-ray of the abdomen showed a huge pneumoperitoneum. An urgent exploratory laparotomy revealed 2 wide horizontal perforations and necrosis of the fundus and gastric body. Subtotal gastrectomy with esogastric anastomosis was done. Postoperatively, the patient was administered total parenteral nutrition and triple antibiotics and improved gradually. He passed stool and the abdomen was soft, lax, and non-distended and the wound healed. An upper gastrointestinal tract (UGIT) contrast study 1 week after the operation showed no leakage or stricture. The patient was discharged 2 months postoperatively with a bodyweight of 2 kg and was followed in the Outpatient Department (OPD). The patient survived after 80% gastric resection for necrosis of the stomach, which was a unique outcome for this major surgery. Conclusions: Gastric perforation is a rare life-threatening condition in preterm neonates, usually managed by direct closure in layers. Exceptionally, partial gastrectomy is needed, which is a major operation, with a high mortality rate and poor outcome. We present a case of a preterm neonate who survived after 80% gastric resection for stomach necrosis.

Khalid M Alshehri,1 Raghad A Althobaiti,2 Athar I Alqurashi,3 Nada E Algethami,4 Khaled A Alswat5 1Medicine and Endocrinology, AlHada Armed Forced Hospital, Taif, Saudi Arabia; 2Obstetrics and Gynecology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 3Internal Medicine Department, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia; 4Medical College, Taif University, Taif, Saudi Arabia; 5Department of Medicine, School of Medicine, Taif University, Taif, 21944, Saudi ArabiaCorrespondence: Raghad A Althobaiti, Obstetrics and Gynecology Department, Prince Sultan Military Medical City, Al Sulaimaniah, Riyadh, Saudi Arabia, Tel +966 505388455, Email Ralthobaiti@hotmail.comBackground: Women with diabetes mellitus or thyroid disorders are at risk of sexual dysfunction. This study aimed to estimate the prevalence of female sexual dysfunction (FSD) in women with diabetes and/or thyroid disorders and the impact of disease control on the ASEX score.Methods: A cross-sectional study for female patients who had a routine clinic visits was included. The Arizona Sexual Experience Scale (ASEX) was used to evaluate for FSD. Those with a total score of ≥ 19 or scored ≥ 5 on any item or ≥ 4 on three items were considered to have FSD.Results: A total of 253 female patients with a mean age of 39.1 ± 7.3 years were included. Two-thirds of the participants have no FSD. More than half (57.7%) of the participants had a strong desire for sex, and about 20% of the participants were unsatisfied with their orgasm. Compared to those with no FSD, those with FSD had lower BMI (P = 0.375), more likely to have a master’s degree or higher (P = 0.117), diabetes (P = 0.879), hypothyroidism (P = 0.625), diabetes-related microvascular and macrovascular complications (P = 0.049), higher HbA1c, fasting glucose, and TSH (P = 0.731, P = 0.161, and P = 0.561, respectively), lower total cholesterol and LDL (P = 0.368 and P = 0.339, respectively), and exercise more regularly (P = 0.929).Conclusion: FSD was highly prevalent in our study population. Those with type 1 diabetes had the highest ASEX scores. We showed non-significant negative correlations between total ASEX score and both BMI and TSH, as well as a non-significant positive correlation between total ASEX score and both HbA1c and fasting glucose value.Keywords: diabetes mellitus, thyroid disorders, female sexual dysfunction, prevalence

Background: With the onset of the spread of the Coronavirus around the world, the Saudi Ministry of Health has taken protective measures early to prevent the spread of the disease in the region, and the most effective of these measures is Quarantine and home isolation, which can have an impact on the individual's mental health. The purpose of this study is to assess the compliance of Quarantine in a family with an allergic and immunologically diseased child and its psychological impact on them. Methods: A cross-sectional study conducted between June-August 2020 was conducted via a selfreported online questionnaire that includes fear of COVID-19 scale for parents, Revised children's anxiety and depression scale to assess Quarantine's psychological effect, fear of getting the infection and also to know the family's attitude towards COVID-19 and public health measures. Results: This study included 4,436 participants, and the findings revealed that (13.3%) of participants had a child with allergies or immune diseases, (30.2%) had children between 6-10 years of age, the mean fear score was 18.74 ± 6.48 (7-35) which is nearly moderate;the mean values of the Child Anxiety and Depression Sub-Scale for Parents (RCADS) were 4.81 5.61 and 18.74 ± 6.48, respectively. This study showed a highly statistically significant positive relationship between the mean values for fear of COVID-19 Score scale and mean scores for child anxiety and depression (P =

Galactocele is cystic dilatation of the mammary gland, which contains milk. Galactocele is usually presented as a painless breast enlargement with a fluctuant, soft, mobile, and non-tender mass in the breast. It is a rare disorder in the male pediatric age group, with only 31 cases reported in the literature. In this article, we present another case of unilateral galactocele in a 14-month-old male infant. Ultrasound imaging confirmed a simple cystic hypoechoic mass in the right breast, and needle aspiration was performed before surgery as a diagnostic procedure (a 1-cc extract revealed a milky-colored fluid).

الملخص: أهداف البحث: فحص تأثير التدريب بمقياس التنفس المحفز على الوظائف العضلية للفم، ووظائف التنفس عند أطفال متلازمة داون. طرق البحث: تم تقسيم ٣٤ طفلا مصابين بمتلازمة داون من الجنسين من عمر ٦ -٢١ سنة عشوائيا لمجموعتين. المجموعة أ تلقت تمرينات عضلية للفم، والمجموعة ب تلقت تمرينات عضلية للفم بالإضافة إلى التدريب بمقياس التنفس المحفز. تم استخدام قياس التنفس المحوسب ذي شاشة رئيسة لاختبار وظيفة الرئة لقياس وظائف التنفس (القدرة الحيوية القسرية، وتدفق الزفير القسري في ثانية واحدة والزفير)، واستخدام التقييم العضلي الفموي بالدرجات لتقييم الوظائف العضلية للفم قبل وبعد تلقي العلاج. النتائج: نتائج ما بعد العلاج أوضحت فرقا إحصائيا واضحا في الوظائف العضلية للفم ووظائف التنفس في كل من المجموعتين ولكن لم يوجد فرق واضح بين المجموعتين في النتائج. الاستنتاجات: التمرينات العضلية للفم أكثر تأثيرا من التدريب بمقياس التنفس المحفز في تحسين كلا من وظائف التنفس والوظائف العضلية للفم لدى أطفال متلازمة داون. Abstract: Objectives: This study investigated the effect of incentive spirometry training on oromotor and pulmonary functions in children with Down's syndrome. Methods: Thirty-four children with Down's syndrome were randomly divided into two groups; the children were of both sexes and aged between 6 and 12 years. Group A received only oromotor exercises, while Group B received oromotor exercises and incentive spirometry training. The pulmonary function test was performed using computerized spirometry model master screen that assessed pulmonary functions (peak expiratory flow, forced vital capacity, and forced expiratory volume in 1s), while the orofacial myofunctional evaluation with score (OMES) was used to evaluate oromotor function before and after treatment. Results: The post treatment results showed significant difference in oromotor and pulmonary functions within both groups, but no significant differences were found between the two groups. Conclusions: Oromotor exercises are more effective than incentive spirometry training in improving both pulmonary and oromotor functions in children with Down's syndrome. الكلمات المفتاحية: متلازمة داون, وظائف التنفس, الوظائف العضلية للفم, القدرة الحيوية القسرية, التقييم العضلي الفموي بالدرجات, Keywords: Down's syndrome, Oromotor functions, Orofacial myofunctional evaluation with score, Peak expiratory flow, Pulmonary functions

Spigelian hernia-undescended testes (SH-UDT) syndrome is a rare disorder, with only 57 cases reported in the literature. The presentation can be asymptomatic or symptomatic in the form of pain, tenderness, or a lump. We present a case of a 50-day-old boy with SH-UDT syndrome. The patient presented with signs and symptoms of acute intestinal obstruction. Exploration confirmed a Spigelian hernia containing small bowel loops and right undescended testis. Orchidopexy was done after ligation of the hernial sac. A follow-up visit after two years revealed right testicular atrophy.

There are many well-known risk factors for keloids and hypertrophic scars (HTS) including ethnicity, family history, and history of previous keloids or HTS. An association, which has been previously observed, exists between pregnancy and growth and worsening of keloid and HTS. This association is less well known amongst physicians and less documented in the literature. In this paper we discuss two cases of extreme worsening of keloid scars during pregnancy. We have also witnessed the transformation of a pre-existing scar into a keloid scar during puberty. We attribute this to the hormonal effects of pregnancy and puberty hormones which could potentially trigger the growth of pre-existing keloids and HTS. This may have an impact on many patients and we therefore recommend women and girls who have keloid and hypertrophic scarring be made aware of this potential effect.

Glaucoma is a leading cause for worldwide blindness and is characterized by progressive optic nerve damage. The etiology of glaucoma is unknown, but elevated intraocular pressure (IOP) and advanced age have been identified as risk factors. IOP reduction is the only known treatment for glaucoma. Recently, drugs that inhibit Rho associated protein kinase (ROCK) have been studied in animals and people for their ability to lower IOP and potentially treat POAG. ROCK inhibitors lower IOP through a trabecular mechanism and may represent a new therapeutic approach for the treatment of glaucoma. Ripasudil is the first Rho-kinase inhibitor ophthalmic solution developed for the treatment of glaucoma and ocular hypertension in Japan 2014. ROCK inhibition not only reduces intraocular pressure (IOP) but also increases ocular blood flow.

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50–75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2–3 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15–45 mg) or a sulfonylurea (5–15 mg glibenclamide, 2–6 mg glimepiride, or 30–120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57·3 months. The primary outcome occurred in 105 patients (1·5 per 100 person-years) who were given pioglitazone and 108 (1·5 per 100 person-years) who were given sulfonylureas (hazard ratio 0·96, 95% CI 0·74–1·26, p=0·79). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p

Elevated serum levels of cystatin C are found to be related to poor outcome and metastatic potential of some malignant disorders. To evaluate the clinical prominence of serum cystatin C in diffuse large B-cell lymphoma (DLBCL), blood samples were obtained from 58 patients at the time of diagnosis and paired blood samples were obtained from 22 patients at the time of remission. Also, serum cystatin C level was measured in matched healthy controls. Serum cystatin C levels were significantly more elevated in DLBCL patients than in controls (p < 0.0001). Furthermore, paired-sample analysis revealed that pretreatment cystatin C levels were reduced significantly in patients who achieved remission after therapy (p = 0.016). High serum cystatin C levels were correlated with age over 60 years (p = 0.049), extra-nodal involvement (p = 0.005) and with high serum lactate dehydrogenase (LDH) (p < 0.013). Elevated serum cystatin C levels were associated with extra-nodal involvement and they were significantly reduced to normal range after the remission. However, Kaplan–Meier curves revealed no survival difference in the pretreatment serum cystatin C levels. Therefore, serum cystatin C may be a novel biomarker that reflects tumor burden in DLBCL but bears no prognostic significance regarding survival.

Aims To present the longitudinal data of the SUBITO-DE study, a prospective survey involving male patients with new or recently diagnosed type 2 diabetes mellitus (T2DM) (

Introduction: Several data have emphasized the importance of early diagnosis of erectile dysfunction (ED) and meticulous cardiovascular investigation in the type 2 diabetic mellitus (T2DM) patients. Aim: To estimate the prevalence of ED and its associated determinants in a sample of male patients with new or recently diagnosed T2DM. Methods: The SUBITO-DE study is an observational, multicenter, prospective study involving 27 Italian diabetes centers. Male patients recently diagnosed with T2DM were consecutively interviewed by their attending physician at the diabetes care centers and asked whether they had experienced a change in their sexual function or found it unsatisfactory. Those responding positively were then invited to participate in the study. Main Outcome Measure: Several hormonal and biochemical parameters were studied. Results: A nonselected series of 1,503 patients was interviewed, 499 of which (mean age, 58.8±8.8 years) entered the study, yielding a final enrolment rate of 33.3%. ED was classified as mild in 19.4%, mild-to-moderate in 15.4%, moderate in 10.4%, and severe in 21.6% of patients, respectively. In addition, premature ejaculation, delayed ejaculation, and hypoactive sexual desire (HSD) were comorbid in 28.3%, 32.9%, and 58.4%, respectively. Finally, hypogonadism, showed an estimated prevalence of almost 20%. Both organic (at least one chronic DM-associated complication) and psychological factors (severe depressive symptoms) increased the risk of ED. Severe depressive symptoms were also associated with ejaculatory problems, HSD, and hypogonadism. Conclusions: A high prevalence of sexual dysfunction in men with recently diagnosed T2DM was detected. Early diagnosis of ED could help prevent emotional and physical discomfort in men and aid in identifying reversible cardiovascular risk factors. Screening of sexual dysfunction should become a part of routine care in the management of T2DM patients. Corona G, Giorda CB, Cucinotta D, Guida P, Nada E, and Gruppo di studio SUBITO-DE. Sexual dysfunction at the onset of type 2 diabetes: The interplay of depression, hormonal and cardiovascular factors. J Sex Med 2014;11:2065-2073. © 2014 International Society for Sexual Medicine.

Objective: This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists. Materials and methods: Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions. Results: In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups. Conclusions: The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners. Keywords: Orthodontist, Pediatric dentist, General practitioners, Perception, Knowledge

Aims To evaluate the effect of linagliptin on left ventricular systolic function beyond glycaemic control in type 2 diabetes mellitus. Methods and results A multicentre, randomised, double-blind, placebo controlled, parallel-group study, was performed (the DYDA 2 trial). Individuals with type 2 diabetes mellitus and asymptomatic impaired left ventricular systolic function were randomly allocated in a 1:1 ratio to receive for 48 weeks either linagliptin 5 mg daily or placebo, in addition to their diabetes therapy. Eligibility criteria were age 40 years and older, haemoglobin A1c 8.0% or less (≤64 mmol/mol), no history of cardiac disease, concentric left ventricular geometry (relative wall thickness ≥0.42), impaired left ventricular systolic function defined as midwall fractional shortening 15% or less at baseline echocardiography. The primary end point was the modification of midwall fractional shortening over time. The main secondary objectives were changes in diastolic and/or in longitudinal left ventricular systolic function as measured by tissue Doppler echocardiography. One hundred and eighty-eight patients were enrolled, predominantly men with typical insulin-resistance comorbidities. At baseline, mean midwall fractional shortening was 13.3%±2.5. At final evaluation, 88 linagliptin patients and 86 placebo patients were compared: midwall fractional shortening increased from 13.29 to 13.82 (+4.1%) in the linagliptin group, from 13.58 to 13.84 in the placebo group (+1.8%, analysis of covariance P = 0.86), corresponding to a 2.3-fold higher increase in linagliptin than the placebo group, although non-statistically significant. Also, changes in diastolic and longitudinal left ventricular systolic function did not differ between the groups. Serious adverse events or linagliptin/placebo permanent discontinuation occurred in very few cases and in the same percentage between the groups. Conclusions In the DYDA 2 patients the addition of linagliptin to stable diabetes therapy was safe and provided a modest non-significant increase in left ventricular systolic function measured as midwall fractional shortening. Trial registration number ClinicalTrial.gov (ID NCT02851745)

The time to achieve good metabolic control after diagnosis is essential for type 2 diabetes patients because it can influence long-term prognosis. This study aimed to elucidate the predictive role of several clinical and organization factors in normalizing metabolism within 6 months. A multi-centered, retrospective, observational study on 960 patients, with diabetes duration of 12 months or less, consecutively seen in 123 Italian clinics, was undertaken. Information about clinic's organization, along with data abstracted from medical records at enrollment (first visit) and after 6 months (follow-up visit), was collected. At 6 months, HbA1c dropped by -3.1 ± 2.2 points in those who achieved HbA1c