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BACKGROUND Myelolipoma is a benign tumor, commonly found in the supra-renal gland, which is composed of mature fatty tissue admixed with hematopoietic elements. However, there are several extra-adrenal sites reported in the literature and thoracic myelolipoma is an unusual location for extra-adrenal myelolipoma. CASE REPORT We present the case of a 71-year-old man previously diagnosed with hypertension who was admitted due to a motor vehicle injury with a lumbar spine fracture. The patient developed non-ST segment elevation myocardial infarction during admission. A coronary angiogram revealed three-vessel disease. Triple coronary artery bypass grafting (CABG) surgery was planned. Upon opening the chest through median sternotomy, a retrosternal adherent mass was incidentally discovered. The mass was excised and histopathological evaluation showed it was myelolipoma in the anterior part of the mediastinum. CONCLUSIONS It is well known that myelolipoma occurs in extra-adrenal sites, and is rarely found at unexpected site, as in our case, which was found incidentally at the anterior mediastinum. With an extensive literature review, we found only 1 case located in the anterior mediastinum. It is crucial to know that myelolipoma can occur in the anterior mediastinum to avoid pitfalls with other differential diagnoses, especially when it is found incidentally and requires a frozen section examination, as it is difficult to diagnose through radiologic imaging only because it can overlap with tumors that are rich in either adipose tissue or hematopoietic elements. However, it affects patient management, and patients usually need only follow-up instead of going through invasive procedures for resection of non-functional tumors, especially in older patients or patients with comorbid diseases.

This study aimed to assess the knowledge and attitude of medical students toward complementary and alternative medicine. A cross-sectional design was used, in which a total of 319 fourth- to sixth-year medical students at a local university hospital participated in self-administered questionnaires during the academic year of 2018-2019. The questionnaire assessed levels of perceived knowledge, attitude, and willingness to recommend complementary and alternative therapies. It showed that most students (95.6%) have heard of complementary and alternative medicine previously, and 74.6% of students held a positive attitude toward it. The majority had perceived knowledge about nutritional supplements (63.2%), prayer (60.9%), and yoga/meditation (60.9%), but less than 50% had perceived knowledge about other common therapies. Only 8.7% of the participants thought that their current knowledge about complementary and alternative medicine is adequate. Students were willing to recommend therapies that they were most familiar with, namely prayer (82%), massage (74%), and yoga/meditation (72.6%). Most students (60.5%) got their information about complementary and alternative medicine from the university curriculum. Yet, they did not believe that it provided them with adequate information. In conclusion, medical students showed a positive attitude toward complementary and alternative medicine despite their limited perceived knowledge. We recommend incorporating a complementary and alternative medicine course in the medical curricula that focuses on common therapies in Saudi Arabia.

Abdulelah Almansour,1 Jumana Alagil,2 Naela B Alamoudi,3 Rahmah M Alamrie,3 Sundus Alarifi,4 Sarah AlUrifan,4 Abdullatif Althunyan,1 Abdullah Alghumlas,1 Abdullah Alreedy,1 Adam Aldhawyan,1 Shaher Alshehri,1 Arwa Alumran5 1Family and Community Medicine Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4General Dentist, Ministry of Health, Dammam, Saudi Arabia; 5Health Information Management and Technology, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Abdulelah Almansour, Family and Community Medicine Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 32275, Saudi Arabia, Email ahmansour@iau.edu.saBackground: Physical activity is a known preventive measure for many worldwide public health issues. The purpose of this study is to assess the association between physical activity and the susceptibility to COVID-19 infection.Patients and Methods: This was a retrospective matched case–control study involving adult participants quarantined with IAU, Dammam, Saudi Arabia. The total randomized sample of study participants were 142, in which 73 of them were tested positive for COVID-19 test and matched for both age and sex with their respective healthy controls who tested negative for COVID-19 test to determine the risk associated with that exposure.Results: Several variables are assessed regarding their influence on the susceptibility of COVID-19 infection. Exactly half indicated that they were physically active (n = 71). Physical activity did not show any significant association with COVID-19 contraction (x2= 0.254, P= 0.614) nor self-rated level of physical activity (x2= 0.122, P= 0.727). Less than half of the participants who had contact with a COVID-19 patient within 14 days of admission to quarantine appeared to have a significantly higher incidence of positive COVID-19 swab results compared to those who did not (x2= 27.121, P= < 0.001). While third of the participants who indicated that they have had a contact with someone who have Respiratory symptoms or fever within 14 days before admission were tested positive for COVID-19. Participants with lower educational degrees are more likely to be infected with COVID-19. While the rest of the demographic variables appear to be not significantly related to the likelihood of being COVID-19 infected, these include gender, marital status, employment status, age, and BMI.Conclusion: The present study showed no significant association between physical activity and susceptibility to COVID-19 infection. We recommend a larger sample size to further clarify the relationship between other variables and susceptibility of COVID-19.Keywords: physical activity, COVID-19, quarantine, susceptibility, prevention

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

BACKGROUND: Color vision deficiency (CVD) affects approximately one in 12 men and one in 200 women in the world. It is considered a problem in the medical field since the color is often used as a sign in the practice of medicine, in observational assessment, diagnosis, and follow-up. These conditions make the appreciation of color essential in doctors’ lives, thus we aimed at finding the prevalence and predictors of CVD in medical students. MATERIALS AND METHODS: This cross-sectional study included 1115 medical students. A pretested questionnaire consisting of personal data, history of vision problems, familial color vision defect, eye surgery, bad trauma on the head or eyes, drugs taken or chemicals exposed to, other health problems, and whether sufficient amount of Vitamin A is taken was used. This was followed by the screening of the participants for CVD using the Ishihara 15-plates test. RESULTS: A total of 1115 students participated in the study; 52.2% were females and the mean age of the participants was 21.7 years (±1.4). The prevalence of definitive CVD was found to be 2.1%; all of which comprised males. Eighty-seven percent of the affected participants were not aware of their color vision problem. A highly statistically significant association was found between history of vision problems and CVD status (P < 0.008). No association were found for nationality, marital status, family history of CVD, history of eye surgery, and eye trauma. CONCLUSION: The percentage of CVD in the present study is lower than that reported by previous studies done in other countries. Many medical students with CVD remain unaware of their condition. Therefore, we recommend early screening of all school-age children, and proper counseling of medical students with definite CVD to take care of their own health and wellbeing.

Normal pressure hydrocephalus is a rare pathological condition of the brain where the cerebrospinal fluid accumulates in the ventricles thus enlarged, but with normal opening pressure on lumbar puncture. This results in three classical symptoms, namely, progressive mental impairment, gait disturbance, and urinary or bowel incontinence. It most commonly occurs in adults over the age of 60 years. It could be extremely misdiagnosed by many clinicians since the symptoms resemble other neurodegenerative disorders. Here, we are reporting a case of idiopathic Normal Pressure Hydrocephalus who was brought to the Emergency Department after falling down on the floor complaining of an imbalanced gait, with the typical triad of the aforementioned symptoms. He is a known case of diabetes mellitus. His walking problem was thought to be a complication of his diabetic foot and he had physical therapy for that, but it kept worsening with time. His gait was shuffling and brady-kinetic, with mild drifting toward the right side. The coordination was abnormal. All laboratory investigations were normal. A head CT revealed brain tissue volume loss with disproportionate dilation of the lateral and third ventricles. The patient refused lumbar puncture and so the diagnosis of NPH was made. Conn's stated, in his point of view, in a report where he was an NPH patient, that patients themselves and their families have the final decision of whether or not shunt surgery should be undertaken, rather than by their physicians [Conn H. Normal pressure hydrocephalus: a case report by a physician who is the patient. Clinical Medicine. 2007;7(3):296-299. https://doi.org/10.7861/clinmedicine.7-3-296]