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General Dentistry

General Medicine, Otorhinolaryngology, and Surgery

General Pharmacology, Toxicology and Pharmaceutics and Pharmacy

Clinical Neurology and Neurology

AcademicSubjects/MED00910, jscrep/070, and Case Report

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

Computer Science Applications and Education

Education

General Medicine, Surgery, Case Report, Acute gastric volvulus, Organoaxial volvulus, Borchardt's triad, and Gastric gangrene

Introduction and importance Gastric volvulus is the abnormal gastric rotation upon itself. It carries a considerable risk for gastric strangulation which may lead to gangrene and perforation, which can be fatal. It commonly presents with non-specific and vague abdominal symptoms making prompt diagnosis and management imperative. This is a case report describing a case of acute organo-axial gastric volvulus. Case presentation A 74-year-old female, with no comorbidities, presented to our department with non-specific abdominal symptoms. Gastric outlet obstruction was suspected. The patient was reviewed by the gastroenterologist and was offered an urgent upper endoscopy. The upper endoscopy findings described a gastric volvulus, and a Computed Tomography (CT) scan was done to confirm the diagnosis. The patient underwent exploratory/diagnostic laparoscopy and successful reduction and fixation followed. There was no evidence of tissue compromise or ischemia. The patient was discharged on post-operative day 4 following an unremarkable postoperative course. Clinical discussion Acute gastric volvulus is a surgical emergency which can be associated with a high morbidity and mortality, if complications occur. The most important factor in diagnosing acute volvulus of the stomach is a high index of suspicion of the clinical symptoms and should be confirmed by imaging. Contrast enhanced computed tomography (CT) scan is the preferred imaging modality. Urgent surgical intervention is needed to prevent potentially fatal complications. Conclusion Acute Gastric Volvulus is rare and carries the risk of significant morbidity and mortality. Prompt recognition and treatment is required to prevent complications.
Highlights • Acute gastric volvulus is a rare potentially life-threatening condition. • Prompt diagnosis and treatment is vital to improve patient outcome. • Contrast enhanced Computed Tomography is the preferred imaging modality used to confirm the diagnosis of gastric volvulus. • Surgical repair is the treatment of choice.

Computer Science Applications and Education

General Chemistry

General Medicine

Purpose of the studyThis study aims at identifying the predominant learning approaches by Saudi medical students across Saudi Arabia and assess its possible associations with sociodemographic and educational characteristics.Study designA cross-sectional study design using the Approaches and Study Skills Inventory for Students questionnaire. The questionnaire gives rise to three possible learning approaches; deep, strategic and surface approaches. Bivariate analyses were performed through independent samples t-test and χ2 tests where appropriate. A multinominal regression analysis was performed to obtain risk estimates and 95% CIs.ResultsA total of 3767 students participated and were included in the analysis. The predominant learning approach was the deep approach, followed by the strategic and surface approaches (40.59%, 37.81% and 21.60%, respectively). Males and students belonging to private medical schools were more likely to adopt a strategic rather than a deep one (relative risk ratio (RRR) 1.22, 95% CI 1.06 to 1.42 and RRR 1.32, 95% CI 1.05 to 1.65, respectively). Students with an A grade point average (GPA) were less likely to adopt a surface approach, whereas those with a C GPA were more likely to adopt it (RRR=0.67, 95% CI 0.54 to 0.83 and RRR=1.29, 95% CI 1.02 to 1.61, respectively).ConclusionThe findings from this study show that medical students predominantly favour the deep learning approach. Results from this study encourage the continuous adaptation of clinical teaching in medical schools to optimise students’ learning experiences.

Research Article, COVID-19, Telemedicine, Remote programing, Cochlear implant, Questionnaire, Speech and Hearing, Sensory Systems, Otorhinolaryngology, and Physiology

Introduction: The daily escalation in incidence and mortality caused by Coronavirus disease (COVID-19) has mandated forced curfew in our country (same as many other countries) to limit the spread of infection. This is predicted to have a more negative impact on cochlear implant (CI) patients since this group of patients needs a unique type of psychological, medical, and technical care in addition to a daily rehabilitation program. Methods: A cross-sectional study based on Arabic questionnaire that looked into the collateral consequences of COVID-19 on the pediatric CI patients. The questionnaire was designed to highlight different problems such as exposure to head trauma or ear infection, difficulties in device maintenance and getting spare parts, impacts of the delay of programing or switch on appointments, and the impacts of missing rehabilitation sessions. Different ways of management of these problems are presented and discussed. Results: A total of 174 parents responded to the questionnaire. The main problem met by the patients was missing their device programing and rehabilitation sessions. Many children had device maintenance and spare parts problems. Virtual clinics were helpful in solving different problems. Additionally, children who needed device programing were scheduled for remote programing sessions. Conclusion: Although the inevitable consequences of the COVID-19 pandemic are catastrophic, they are forcing the medical field to explore new opportunities by sitting up an infrastructure for future usage of telemedicine. Telemedicine is cost-effective and more convenient and enables health-care providers to be immune to future circumstances.

Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270, Public Health, Environmental and Occupational Health, Community and Home Care, Original Research, COVID-19, Parkinson’s disease, SARS-CoV-2, neurological, and ACE2

BackgroundCOVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host’s angiotensin-converting enzyme2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson’s disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. PD is also been associated with certain post-viral infections apart from COVID-19, such as HSV, Influenzavirus A, Measles virus, Cytomegalovirus, and Mumps.ObjectiveIn this systematic review, we aim to provide a thorough analysis of associations between COVID-19 and neurological outcomes for patients with PD.MethodsUsing PRISMA statement 2020, a systematic review was conducted to isolate confirmed COVID-19 patients and analyze the PD-associated neurological outcomes. A systematic literature search was conducted using the following databases: PubMed, Science Direct, Google Scholar, and Cochrane databases. The following keywords were used “COVID19, SARS-CoV-2, Parkinson’s disease, Pandemic, Mortality.” A modified Delphi process was employed to include the studies and ensure that the clinical outcome measures were addressed.ResultsOf the 355 records located during the initial round of screening, 16 were included in the final synthesis. Of PD patients who tested positive for SARS-CoV-2, worsening motor symptoms and other viral-associated symptoms were reported. These symptoms included bradykinesia, tremors, gait disturbances, delirium and dementia, and severe spasms of arms and legs. Encephalopathy was presented in two of the included studies. Increased mortality rates were identified for hospitalized patients due to COVID-19 and PD as compared to other patient groups, albeit with limited generalizability due to high bias of included studies.ConclusionPatients with PD may experience substantial worsening of motor and non-motor symptoms due to COVID 19. Given the novelty of neurological-viral associations, clinical studies in the future ought to explore the disease severity and neurological outcomes in COVID-19 positive patients with PD as compared to non-PD patients, in addition to understanding the role of ACE2 in increased vulnerability to contracting the infection and as a treatment modality.

Otolaryngology, tonsillectomy, post-tonsillectomy complication, surgical emphysema, gag-reflex, facial emphysema, respiratory tract diseases, and respiratory system

Subcutaneous facial emphysema is a rare complication of tonsillectomy that can lead to infection, upper airway obstruction or invasion into the thorax. The latter can cause pneumomediastinum or pneumothorax, with possible subsequent cardiorespiratory function impairment. Although multiple causes are suggested in the literature, the main causative factor is still unclear. Moreover, the rationale for its management is inconsistent and the outcomes are unpredictable. We report a case of a 14-year-old pediatric male patient, known to have a hypersensitive gag reflex, who developed post-tonsillectomy cervicofacial subcutaneous emphysema; management has achieved complete clinical resolution after two weeks of complication onset. Additionally, we present a literature review that showcases the potential causes and management of subcutaneous emphysema.

Dermatology, Allergy/Immunology, chronic idiopathic urticaria, antihistamines, leukotriene receptor antagonists, montelukast, singulair, immune system diseases, and respiratory tract diseases

Introduction Chronic urticaria (CU) is a common disorder that can significantly affect the quality of life. The goal of treatment is complete symptomatic relief. Conventional therapy, with antihistamines, is not always effective in all patients. Leukotrienes are believed to be involved in the pathogenesis of urticaria. Leukotriene receptor antagonists (LTRAs), such as montelukast, have been suggested as useful agents in patients with chronic idiopathic urticaria. Our objective is to document the efficacy of montelukast in our patients. Materials and methods Patients who received montelukast were identified from clinic letters. Data including clinical features were collected and analyzed. The main endpoint was adequate disease control. Results A total of nine patients who met the inclusion criteria were included in this study. Four patients reported having a good response to montelukast and three patients reported full control of the disease. Conclusion These findings suggest that leukotriene antagonists, such as montelukast, are effective as an add-on therapy to anti-histamines and their use in histamine resistant patients is justifiable.

Genetics, Molecular Biology, Biochemistry, and Biotechnology

Genetics, Molecular Biology, Biochemistry, and Biotechnology

Ophthalmology

Public Health, Environmental and Occupational Health, Nutrition and Dietetics, and Medicine (miscellaneous)

Objective: Preventing a food allergy reaction depends primarily on eliminating allergens from the diet. In October 2019, the Saudi Food and Drug Authority (SFDA) introduced new legislation requiring food establishments providing and selling non-prepacked foods to state the presence of the top fourteen food allergens on their menus. The current study aimed to assess the allergen-labelling knowledge, practices, preferences and perceptions towards the new SFDA allergen-labelling legislation among consumers with food allergy in Saudi Arabia. Design: Observational cross-sectional study using an online questionnaire. Setting: Saudi Arabia; February – March 2020. Participants: Residents of Saudi Arabia with food allergy (n 427), aged 18–70 years. Results: Among participants, only 28·1 % knew that there were governmental regulations in Saudi Arabia regarding food-allergen labelling and approximately two-thirds (67 %) check labels on prepacked food products for allergens. The majority of the participants preferred food products carrying safety statements (84·1 %) and symbols (80·1 %). A total of 47·1 % were aware that regulations in Saudi Arabia require allergens to be declared in ingredient lists, while 51·3 % were aware that advisory allergen labelling is not required by law. Only 26·2 % were aware of the new SFDA legislation regarding provision of allergen information by food establishments. However, the majority (94·4 %) were supportive of the new legislation, and most of them were more likely to eat at restaurants that reported allergen information for food items on the menu. Conclusions: The new SFDA food allergen-labelling legislation needs to be more widely and effectively disseminated to increase the level of awareness among adults with food allergy in Saudi Arabia.