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OBJECTIVE: This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS: Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS: 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS: In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to describe conditional recurrence‐free survival (RFS) of patients after an index episode of diverticulitis managed without surgery, and to estimate the difference in conditional RFS for diverticulitis according to specific risk factors. Methods: This was a multicentre retrospective cohort study including all patients managed without surgery for acute sigmoid diverticulitis at two university‐affiliated hospitals in Montreal, Quebec, Canada. Conditional RFS for diverticulitis was estimated over 10 years of follow‐up. A Cox proportional hazards model was performed at the index episode and again 2 years later. Results: In total, 991 patients were included for analysis. The 1, 2‐ and 3‐year actuarial diverticulitis RFS rates were 81·1, 71·5 and 67·5 per cent respectively. Compared with the 1‐year actuarial RFS rate of 81·1 per cent, the 1‐year conditional RFS increased with each additional year survived recurrence‐free, reaching 96·0 per cent after surviving the first 4 years recurrence‐free. A similar phenomenon was observed for 2‐year diverticulitis conditional RFS. Lower age (hazard ratio (HR) 0·98, 95 per cent c.i. 0·98 to 0·99), Charlson Co‐morbidity Index score of 2 or above (HR 1·78, 1·32 to 2·39) and immunosuppression (HR 1·85, 1·38 to 2·48) were independently associated with recurrence of diverticulitis from the index episode. At 2 years from the index episode, immunosuppression was no longer associated with diverticulitis recurrence (HR 1·02, 0·50 to 2·09). Conclusion: The conditional RFS of patients with diverticulitis improved with each year that was survived recurrence‐free. Although several factors at index presentation may be associated with early recurrence, the conditional probability of recurrence according to many of these risk factors converged with time. [ABSTRACT FROM AUTHOR]

Background Diabetes mellitus is one of the causes to use complementary and alternative medicine (CAM), which can be classified into nutritional, psychological and physical. The study's objective was to estimate the prevalence and pattern of using CAM among patients with diabetes mellitus who followed the endocrine and diabetes center in Taif. Materials and methods A cross-sectional study was carried out in Taif city from 1 June to 31 July 2023 among diabetic patients aged 14 years and above who followed the endocrine and diabetes center. A valid, reliable, English questionnaire was used in data collection. It was composed of three parts: demographic data, diabetes mellitus history and use of CAM. Patients visited the diabetic center during the study period for their regular appointments were selected randomly and interviewed by trained interns and medical students. By using the Raosoft calculator, the minimal sample size was 361. The chi-square test and independent two-sample t-test were used to investigate the association between categorical variables and continuous numerical variables, respectively. Multivariate logistic regression analysis was performed to control the confounding effect. Results A total of 361 patients were included. Their age ranged between 14 and 84 (51.2 ± 16.9 years). Females represented 57.6% of them. Overall, more than a quarter (28.3%) reported using CAM, while 22.4% used CAM for treating diabetes in the last 12 months. The majority of patients (97.1%) used herbs, mainly cinnamon (48.5%), fenugreek/helba (31.3%) and rosemary (20.2%). Their main source of information was family and friends (64.7%). A history of improvement of blood sugar reading with CAM was reported by 61.8%. Multivariate logistic regression analysis revealed that females were at doubled likelihood to use CAM compared to males (Adjusted odds ratio "AOR" = 2.40; 95% confidence interval "CI": 1.27-4.52, p=0.007). Compared to never-smokers, ex-smokers were more likely to use CAM (AOR=2.87; 95% CI: 1.28-6.43, p=0.010). Conclusion The use of CAM, particularly herbs, to treat diabetes is a relatively common practice among Saudi patients. However, the history of informing treating physicians about CAM was reported by a minority of patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. IRB Registration Number With KACST, KSA: HAP-02-T-067 issued approval 806. I am pleased to inform you that submission dated (17 MAY 2023) for the study titled, "Prevalence and pattern of complementary and alternative medicine use among patients with diabetes following in diabetic center, King Abdulaziz Specialist Hospital, Taif, 2023" was reviewed and approved. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almalki et al.)

Background: Nurse leaders have a crucial impact in healthcare settings. Hospitals require qualified nurses with leadership skills to provide healthy work environments and enhance the outcomes related to staff nurses and patients. This study aimed to investigate the effect of nursing experience on leadership skills among staff nurses and intern nursing students., Methods: A mixed methods design was applied (quantitative survey design for quantitative part and open-ended questions for qualitative part). Convenience sampling of staff nurses and intern nursing students in Saudi Arabia was applied. There were148 participants who completed the survey of the quantitative part, and 50 of them completed the qualitative part. Participants completed the Leadership Practice Inventory Questionnaire. SPSS v26 was used to analyze quantitative part, and thematic analysis was used to analyze qualitative part., Results: This study found a significance difference among participating groups regarding to the years of experience (F = 5.05, p = 0.00). Three themes were found for the qualitative part which were strategies to enhance leadership skills, factors affecting leadership skills, and obstacles facing participants related to leadership skills. The qualitative data also revealed that participants found that clinical supervision and education ways to enhance the leadership skills, while work pressure, work environment and communication were obstacles of developing their leadership skills., Conclusion: Leadership skills are considered as a significant component of the function of qualified nurses and should be viewed as central to intern nursing students' learning development. Moreover, leadership skills are essential for the patient and organization outcomes. Nursing colleges and educators play an important role in enhancing to leadership skills as well as experience. Nurse leaders can create healthy care environments that have high quality and safety for patients. Management systems in healthcare organizations must motivate and support clinical leaders who can recognize both individual and clinical requirements and address current issues in their field., (© 2024. The Author(s).)

Data on how Stone Age communities conceived domestic and utilitarian structures are limited to a few examples of schematic and non-accurate representations of various-sized built spaces. Here, we report the exceptional discovery of the up-to-now oldest realistic plans that have been engraved on stones. These engravings from Jordan and Saudi Arabia depict 'desert kites', humanmade archaeological mega-traps that are dated to at least 9,000 years ago for the oldest. The extreme precision of these engravings is remarkable, representing gigantic neighboring Neolithic stone structures, the whole design of which is impossible to grasp without seeing it from the air or without being their architect (or user, or builder). They reveal a widely underestimated mental mastery of space perception, hitherto never observed at this level of accuracy in such an early context. These representations shed new light on the evolution of human discernment of space, communication, and communal activities in ancient times., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Crassard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The presence of spore-forming microorganisms and their adhesion to contact surfaces in dairy plants is a major concern because dairy products are prone to cross-contamination. Spore formers and their spores can survive milk processing treatments due to their heat resistance. One source of these spore formers is bacterial biofilms, which grow and accumulate on most surfaces in dairy industrial plants, such as pipes, heat exchangers, pasteurized plates, and storage tanks. Their endospores form biofilms by attaching to these surfaces and germinating when conditions become more favorable. The cross-contamination of dairy products by bacterial biofilms may lead to reduced shelf life and spoilage. To minimize the problem caused by thermoduric bacteria, the dairy industry adopts several approaches. Pasteurization is an irreplaceable technique for milk processing. Unfortunately, some bacteria and endospores are resistant to heat treatment, which can grow and cause spoilage of dairy products. Thus, alternative approaches that could help to reduce microbial counts are needed. In our previous study, we demonstrated the effectiveness of ultrasonication to inactivate spore formers and reduce the overall microbial counts in milk. In the current study, we investigated the recovery of cavitation-induced injured cells during the storage of ultrasonicated skim milk. Three common spore formers- Geobacillus stearothermophilus (ATCC 15952), Bacillus licheniformis (ATCC 6634), and Bacillus sporothermodurans (DSM 10599)-were selected to conduct challenge studies by inoculating skim milk samples and exposing them to ultrasonication (10 min each at 80% amplitude). This treatment was done in an ice bath to control the resultant temperature increase. The ultrasonicated skim milk samples were then held for 1, 2, 4, or 12 h in the refrigerator (4°C) to study the recovery of cells following cavitation-induced injury. Ultrasonication resulted in cell injury, as demonstrated by scanning electron microscopy. The injured cells can potentially recover under appropriate conditions during the storage of ultrasonicated milk and could affect the microbiological quality of milk and products manufactured with such milk. The respective bacterial counts for the 3 organisms in the spiked skim milk, on average, were approximately 6.0 log cfu/mL; immediately after ultrasonication, these counts decreased to 3.50 ± 0.02, 4.38 ± 0.02, and 3.75 ± 0.05 log cfu/mL for G. stearothermophilus , B. licheniformis , and B. sporothermodurans , respectively. During 12 h of subsequent incubation at 4°C, their counts increased to 4.17 ± 0.05, 5.25 ± 0.1, and 5.69 ± 0.06 log cfu/mL, respectively. All experiments were done in triplicate for all 3 bacteria. To conclude, slow recovery of injured cells of spore-forming bacteria is possible in ultrasonicated milk during storage under refrigeration conditions., (© 2021.)

Background: Persistent (or ongoing) diverticulitis is a well-recognized outcome after treatment for acute sigmoid diverticulitis; however, its definition, incidence, and risk factors, as well as its long-term implications, remain poorly described., Objective: The purpose of this study was to assess the incidence, risk factors, and long-term outcomes of persistent diverticulitis., Design: This was a retrospective cohort study., Settings: Two university-affiliated hospitals in Montreal, Quebec, Canada were included., Patients: The study was composed of consecutive patients managed nonoperatively for acute sigmoid diverticulitis., Intervention: Nonoperative management of acute sigmoid diverticulitis was involved., Main Outcome Measures: Persistent diverticulitis, defined as inpatient or outpatient treatment for signs and symptoms of ongoing diverticulitis within the first 60 days after treatment of the index episode, was measured., Results: In total, 915 patients were discharged after an index episode of diverticulitis managed nonoperatively. Seventy-five patients (8.2%; 95% CI, 6.5%-10.2%) presented within 60 days with persistent diverticulitis. Factors associated with persistent diverticulitis were younger age (adjusted OR = 0.98 (95% CI, 0.96-0.99)), immunosuppression (adjusted OR = 2.02 (95% CI, 1.04-3.88)), and abscess (adjusted OR = 2.05 (95% CI, 1.03-3.92)). Among the 75 patients with persistent disease, 42 (56.0%) required hospital admission, 6 (8.0%) required percutaneous drainage, and 5 (6.7%) required resection. After a median follow-up of 39.0 months (range, 17.0-67.3 mo), the overall recurrence rate in the entire cohort was 31.3% (286/910). After excluding patients who were managed operatively for their persistent episode of diverticulitis, the cumulative incidence of recurrent diverticulitis (log-rank: p < 0.001) and sigmoid colectomy (log-rank: p < 0.001) were higher among patients who experienced persistent diverticulitis after the index episode. After adjustment for relevant patient and disease factors, persistent diverticulitis was associated with higher hazards of recurrence (adjusted HR = 1.94 (95% CI, 1.37-2.76) and colectomy (adjusted HR = 5.11 (95% CI, 2.96-8.83))., Limitations: The study was limited by its observational study design and modest sample size., Conclusions: Approximately 10% of patients experience persistent diverticulitis after treatment for an index episode of diverticulitis. Persistent diverticulitis is a poor prognostic factor for long-term outcomes, including recurrent diverticulitis and colectomy. See Video Abstract at http://links.lww.com/DCR/B593., Repercusiones a Largo Plazo De La Diverticulitis Persistente Estudio De Una Cohorte Retrospectiva De Pacientes: ANTECEDENTES:La diverticulitis persistente (o continua) es un resultado bien conocido posterior al tratamiento de la diverticulitis aguda del sigmoides; sin embargo, la definición, incidencia y factores de riesgo, así como sus repercusiones a largo plazo siguen estando descritas de manera deficiente.OBJETIVO:Evaluar la incidencia, los factores de riesgo y los resultados a largo plazo de la diverticulitis persistente.DISEÑO:Estudio de una cohorte retrospectiva.AMBITO:Dos hospitales universitarios afiliados en Montreal, Quebec, Canadá.PACIENTES:pacientes consecutivos tratados sin cirugia por diverticulitis aguda del sigmoides.INTERVENCIÓN:Tratamiento no quirúrgico de la diverticulitis aguda del sigmoides.PRINCIPALES RESULTADOS EVALUADOS:Diverticulitis persistente, definida como tratamiento hospitalario o ambulatorio por signos y síntomas de diverticulitis continua dentro de los primeros 60 días posteriores al tratamiento del episodio índice.RESULTADOS:Un total de 915 pacientes fueron dados de alta posterior al episodio índice de diverticulitis tratados sin cirugia. Setenta y cinco pacientes (8,2%; IC del 95%: 6,5-10,2%) presentaron diverticulitis persistente dentro de los 60 días. Los factores asociados con la diverticulitis persistente fueron una edad menor (aOR: 0,98, IC del 95%: 0,96-0,99), inmunosupresión (aOR: 2,02, IC del 95%: 1,04-3,88) y abscesos (aOR: 2,05, IC del 95%: 1,03-3,92). Entre los 75 pacientes con enfermedad persistente, 42 (56,0%) requirieron ingreso hospitalario, 6 (8,0%) drenaje percutáneo y 5 (6,7%) resección. Posterior a seguimiento medio de 39,0 (17,0-67,3) meses, la tasa global de recurrencia de toda la cohorte fue del 31,3% (286/910). Después de excluir a los pacientes que fueron tratados quirúrgicamente por su episodio persistente de diverticulitis, la incidencia acumulada de diverticulitis recurrente (rango logarítmico: p <0,001) y colectomía sigmoidea (rango logarítmico: p <0,001) fue mayor entre los pacientes que experimentaron diverticulitis persistente después el episodio índice. Posterior al ajuste de factores importantes de la enfermedad y del paciente, la diverticulitis persistente se asoció con mayores riesgos de recurrencia (aHR: 1,94, IC 95% 1,37-2,76) y colectomía (aHR: 5,11, IC 95% 2,96-8,83).LIMITACIONES:Diseño de estudio observacional, un modesto tamaño de muestra.CONCLUSIONES:Aproximadamente el 10% de los pacientes presentan diverticulitis persistente después del tratamiento del episodio índice de diverticulitis. La diverticulitis persistente, en sus resultados a largo plazo, es un factor de mal pronóstico, donse se inlcuye la diverticulitis recurente y colectomía. Consulte Video Resumen en http://links.lww.com/DCR/B593., (Copyright © The ASCRS 2021.)

Introduction and Importance: Elbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. "Terrible triad" injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to "terrible triad" injury of the elbow with no radial head injury., Case Presentation: The patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion., Clinical Discussion: Multi-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the "terrible triad" injury. Surgical options vary according to the surgeon's experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively., Conclusion: The injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: To date, the impact of family history on diverticulitis outcomes has been poorly described., Objective: This study aims to evaluate the association between family history and diverticulitis recurrence after an episode of diverticulitis managed nonoperatively., Design: This is a retrospective cohort study with prospective telephone follow-up., Settings: This study was conducted at 2 McGill University-affiliated tertiary care hospitals in Montreal, Canada., Patients: All immunocompetent patients with CT-proven left-sided diverticulitis who were managed nonoperatively from 2007 to 2017 were included., Intervention: A positive family history for diverticulitis, as assessed by a detailed telephone questionnaire, was obtained., Main Outcome Measures: The primary outcome was diverticulitis recurrence occurring >60 days after the index episode. Secondary outcomes included a complicated recurrence and >1 recurrence (ie, re-recurrence)., Results: Of the 879 patients identified in the database, 433 completed the telephone questionnaire (response rate: 48.9%). Among them, 173 (40.0%) had a positive family history of diverticulitis and 260 (60.0%) did not. Compared to patients with no family history, patients with family history had a younger median age (59.0 vs 62.0 years, p = 0.020) and a higher incidence of abscess (24.3% vs 3.5%, p < 0.001). After a median follow-up of 40.1 (17.4-65.3) months, patients with a positive family history had a higher cumulative incidence of recurrence (log-rank test: p < 0.001). On Cox regression, a positive family history remained associated with diverticulitis recurrence (HR, 3.74; 95% CI, 2.67-5.24). Among patients with a positive family history, >1 relative with a history of diverticulitis had a higher hazard of recurrence (HR, 2.93; 95% CI, 1.96-4.39) than patients with only 1 relative with a history of diverticulitis. Positive family history was also associated with the development of a complicated recurrence (HR, 8.30; 95% CI, 3.64-18.9) and >1 recurrence (HR, 2.03; 95% CI, 1.13-3.65)., Limitations: This study has the potential for recall and nonresponse bias., Conclusion: Patients with a positive family history of diverticulitis are at higher risk for recurrent diverticulitis and complicated recurrences. See Video Abstract at http://links.lww.com/DCR/B215. LOS ANTECEDENTES FAMILIARES ESTÁN ASOCIADOS CON DIVERTICULITIS RECURRENTE, DESPUÉS DE UN EPISODIO DE DIVERTICULITIS MANEJADA SIN OPERACIÓN: Hasta la fecha, el impacto de los antecedentes familiares en los resultados de la diverticulitis, ha sido mal descrito.Evaluar la asociación entre los antecedentes familiares y la recurrencia de diverticulitis después de un episodio de diverticulitis manejado de forma no operatoria.Estudio de cohorte retrospectivo con seguimiento telefónico prospectivo.Dos hospitales de atención terciaria afiliados a la Universidad McGill en Montreal, Canadá.Todos los pacientes inmunocompetentes con diverticulitis izquierda comprobada por TAC, que fueron manejados sin cirugía desde 2007-2017.Una historia familiar positiva para diverticulitis, según lo evaluado por un detallado cuestionario telefónico.El resultado primario fue la recurrencia de diverticulitis ocurriendo > 60 días después del episodio índice. Resultados secundarios incluyeron una recurrencia complicada y >1 recurrencia (es decir, re-recurrencia).De los 879 pacientes identificados en la base de datos, 433 completaron el cuestionario telefónico (tasa de respuesta: 48,9%). Entre ellos, 173 (40.0%) tenían antecedentes familiares positivos de diverticulitis y 260 (60.0%) no tenían. Comparados con los pacientes sin antecedentes familiares, los pacientes con antecedentes familiares tenían una mediana de edad más joven (59.0 vs 62.0 años, p = 0.020) y una mayor incidencia de abscesos (24.3% vs 3.5%, p < 0.001). Después de una mediana de seguimiento de 40.1 (17.4-65.3) meses, los pacientes con antecedentes familiares positivos tuvieron una mayor incidencia acumulada de recurrencia (prueba de log-rank: p < 0.001). En la regresión de Cox, un historial familiar positivo, permaneció asociado con recurrencia de diverticulitis (HR, 3.74; IC 95%, 2.67-5.24). Entre los pacientes con antecedentes familiares positivos, >1 familiar con antecedentes de diverticulitis, tuvieron mayores riesgos de recurrencia (HR, 2.93; IC 95%, 1.96-4.39) en comparación de los pacientes con solo 1 familiar. La historia familiar positiva también se asoció con el desarrollo de una recurrencia complicada (HR, 8.30; IC 95%, 3.64-18.9) y >1 recurrencia (HR, 2.03; IC 95%, 1.13-3.65).Potencial de recuerdo y sesgo de no respuesta.Los pacientes con antecedentes familiares positivos de diverticulitis tienen un mayor riesgo para diverticulitis recurrente y recurrencias complicadas. Consulte Video Resumen http://links.lww.com/DCR/B215. (Traducción-Dr. Fidel Ruiz Healy).

Background: SERI (Simple, Effective, Rapid, and Inexpensive) osteotomy is an accepted minimally invasive distal first metatarsal osteotomy performed to correct hallux valgus (HV). In the absence of reports of efficacy of the SERI technique in the Middle East, we studied 1-year outcomes of SERI osteotomy performed at our hospital in Saudi Arabia., Methods: We reviewed the medical charts of patients aged 20 to 60 years who underwent SERI osteotomy for HV between August 2013 and September 2016 and identified 29 patients, 2 (6.9%) men and 27 (93.1%) women, who met the criteria for inclusion in the study. Patients' clinical and operative characteristics were examined, their pre- and postoperative (1-year) radiographic measurements were compared, and the occurrence of any postoperative complication/event was noted., Result: Patients' mean age was 34.9 ± 13.6 years. Six patients (20.7%) were treated for severe HV. Mean operation time was 11.1 ± 2.3 min. Four patients (13.8%) reported postoperative pain. No revision surgery was done. Congruency of the hallux metatarsophalangeal joint increased significantly, documented in only 4 patients (13.8%) preoperatively but in 17 (58.6%) at 1 year. The mean hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were significantly decreased at 1 year. The HVA normalized in 20 patients (69.0%), the IMA normalized in 25 patients (86.2%), but the DMAA normalized in only 4 patients (13.8%). The number of patients with sesamoid subluxation decreased from 29 (100%) to 13 (44.8%)., Conclusion: Our study data indicate that SERI osteotomy reliably reduces a wide spectrum of HV deformities and it is a safe procedure with very minimal complications., Trial Registration: This study is registered in ClinicalTrials.gov under the following reference number: NCT03669900 .

Introduction: A calcaneal spur, also known as enthesophyte, is an abnormal bone outgrowth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence. Although there is consensus that a calcaneal spur is a common cause of heel pain, approximately 20% of calcaneal spurs are asymptomatic and its pathology remains not fully understood., Presentation of Case: In this report, we present a rare case of a very large and bizarre calcaneal spur in a young adult man. The calcaneal spur was painful, which affected his foot function and was associated with plantar fasciitis. The spur length was measured in the radiograph and exhibited the longest calcaneal spur reported in the literature. The patient was treated conservatively, and he fully recovered his foot function., Discussion: This case was unique because although the patient presented with an extremely large unilateral calcaneal spur, he was young and did not have any chronic disease; hence, he was treated conservatively. The pain subsided and he regained full function of his foot. This case questions the association between calcaneal spur length and plantar fasciitis symptoms., Conclusion: This case confirms that the length of calcaneal spurs, even extremely long ones, is not associated with the pathology of plantar fasciitis and that surgical treatment is not necessary., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The increasing emergence and spread of antimicrobial resistance (AMR) is a serious public health issue. Increasing the awareness of the general public about appropriate antibiotic use is a key factor for combating this issue. Several public media campaigns worldwide have been launched; however, such campaigns can be costly and the outcomes are variable and difficult to assess. Social media platforms, including Twitter, Facebook, and YouTube, are now frequently utilized to address health-related issues. In many geographical locations, such as the countries of the Gulf Cooperation Council (GCC) States (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain), these platforms are becoming increasingly popular. The socioeconomic status of the GCC states and their reliable communication and networking infrastructure has allowed the penetration and scalability of these platforms in the region. This might explain why the Saudi Ministry of Health is using social media platforms alongside various other media platforms in a large-scale public awareness campaign to educate at-risk communities about the recently emerged Middle East respiratory syndrome coronavirus (MERS-CoV). This paper discusses the potential for using social media tools as cost-efficient and mass education platforms to raise awareness of appropriate antibiotic use in the general public and in the medical communities of the Arabian Peninsula.

Osteoporosis is a major health problem characterized by compromised bone strength that predisposes patients to an increased risk of fracture. Osteoporotic patients differ from normal subjects in bone mineral composition, bone mineral content, and crystallinity. Poor bone quality in patients with osteoporosis presents the surgeon with difficult treatment decisions. Much effort has been expended on improving therapies that are expected to preserve bone mass and thus decrease fracture risk. Manipulation of both the local fracture environment in terms of application of growth factors, scaffolds and mesenchymal cells, and systemic administration of agents promoting bone formation and bone strength has been considered as a treatment option from which promising results have recently been reported. Surprisingly, less importance has been given to investigating fracture healing in osteoporosis. Fracture healing is a complex process of bone regeneration, involving a well-orchestrated series of biological events that follow a definable temporal and spatial sequence that may be affected by both biological factors, such as age and osteoporosis, and mechanical factors such as stability of the osteosynthesis. Current studies mainly focus on preventing osteoporotic fractures. In recent years, the literature has provided evidence of altered fracture healing in osteoporotic bone, which may have important implications in evaluating the effects of new osteoporosis treatments on fracture healing. However, the mechanics of this influence of osteoporosis on fracture healing have not yet been clarified and clinical evidence is still lacking.