Case report: Contraceptive implant migration.

Subdermal contraceptive implants are one of the effective and reversible methods of contraception available today. Implanon is a Saudi FDA-approved contraceptive that is commonly used by the Saudi population. Along with their hormonal side effects such as mood changes and acne, subdermal contraceptive implants can also lead to more life-threatening, albeit rare, mishaps, such as the deeper migration of them into the axillary and thoracic structures. Only a few cases exist in the literature regarding these rare complications. In this case report, we describe the case of a 31-year-old woman presenting with ulnar neuropathy due to deep proximal migration 3 years after the insertion of an Implanon. The foreign body was removed using intraoperative image-enhancing fluoroscopy, with neurological symptoms being resolved as a result.

An overview of pathophysiology and treatment options of osteonecrosis of femoral head in sickle cell disease.

Osteonecrosis of the femoral head (ONFH) is the most prevalent musculoskeletal pathologic manifestation of sickle cell disease (SCD) resulting in an osteonecrotic event. This review aimed to summarize mechanisms involved in pathophysiology of ONFH and treatment options available in Saudi Arabia to treat SCD patients with complication of osteonecrotic event. The pathophysiology of ONFH include genetic and micro particles involvement. The progression of osteonecrosis involves reduced levels of bioactive compounds in peripheral blood mononuclear cells and elevated CD4+T circulating levels to stimulate pro-inflammatory cytokines contributing to inflammation at target site. Initial treatment approach is pharmacological agents use to mitigate risk. Further, bone morphogenetic protein stimulation initiate bone formation and treatment can be improved with the use of bone morphogenetic protein, total hip arthroplasty and cell therapies. This review provides baseline information for future studies to be carried out in Saudi Arabia to improve treatment options in SCD patients with ONFH.

Levels of public awareness regarding cervical spine injury and the suitable first aid response among adults in Saudi Arabia.

OBJECTIVES: To evaluate the level of public awareness regarding cervical spine injuries among adult residents of the Kingdom of Saudi Arabia (KSA). METHODS: This descriptive cross-sectional study was carried out between June and November 2020. It involved structured questionnaires, collecting information on participant socio-demographic characteristics, first responder training status, and the awareness of cervical spine trauma and suitable first aid response. RESULTS: A total of 4914 respondents (age, 31.6 ± 11.8 years) completed the survey. Most participants (75.2%) reported road traffic accidents as a risk factor for cervical spine injury. Moreover, 79.4% of the participants reported that cervical spine injury may be accompanied by damage to the spinal cord. Motor and sensory disability, and trouble breathing were recognized as complications associated with cervical spine injuries by 52.1%, 39%, and 28.8% of the participants, respectively. Fewer than one in 3 participants was aware of cervical spine trauma or the suitable first aid response. CONCLUSION: Public awareness regarding cervical spine trauma is poor among the KSA residents, although most study participants were aware trauma victims should be immobilized at the site of the accident until the arrival of an emergency response team.

Western-designed total knee implants mismatch Saudi patient knees. Anatomical bony measurements documented by computed tomography.

OBJECTIVES: To determine the anthropometric features of Saudi knees compared with knees of other ethnicities and reveal mismatches among different knee implant systems. METHODS: All knee computed tomography images obtained between January 2016 and September 2016 for varying medical reasons in a tertiary care hospital in Southwestern Saudi Arabia were retrospectively evaluated. Patients aged less than 18 years, with trauma or soft tissue or bone tumors were excluded.  Eleven parameters were measured for each knee joint. RESULTS: We evaluated 100 knees of 50 Saudi patients (25 men, 25 women) aged 28-85 (mean, 57.3) years. No statistically significant differences were found in age and Sasaki angle measurements between male and female patients. All other parameters were significantly larger in male than female knees. Our measurements were close to those published for Chinese, Thai, and Korean patients; however, published measurements were larger for Caucasian and Indian knees than our measurements. CONCLUSION: The Saudi population has morphological features of knee bone anatomy that do not match with the widely available prostheses designed for Caucasian knees. As several studies of different ethnicities have documented considerable prosthesis mismatch; our study further indicates the need for new implant designs that take these variations into account.

Low-dose chemotherapy for extra-abdominal desmoid tumor.

OBJECTIVE: To assess the outcome of patients with extra-abdominal desmoid tumor treated with low dose chemotherapy (methotrexate and vinblastine) both for tumor response and treatment related toxicity. METHODS: We retrospectively reviewed the outcome of 12 patients who underwent low dose chemotherapy for extra abdominal desmoid of different locations. The study took place in the McGill University Health Center, Montreal, Canada between 1996 and 2003. We evaluated the patients for their compliance, tumor response, complications of treatment, and impact of treatment on symptoms. There were 7 females and 5 males with a mean age of 46 years. RESULTS: Disease related morbidity included pain in 7 patients, functional limitation in 7 and cosmetic defects in 3. The mean tumor size was 11 cm (3-20 cm). The mean follow-up was 43 months (15-71 months). Chemotherapy was administered weekly. Complications were significant. Only 2 patients did not experience the toxicity. According to Response Evaluation Criteria in Solid Tumors, 6 tumors showed a partial response and 6 remained stable. None showed progression. Of the 7 patients who had painful tumors, 6 achieved significant symptom relief. Function was improved in 3 and restored to normal in 4. Cosmesis was improved in 2 of the 3. At latest follow-up, tumors remained stable in 8, one has markedly regressed and 3 exhibited progression at an average of 54 months. Only one patient required surgery. The only long term side effect was a sensory peripheral neuropathy. CONCLUSION: Low dose chemotherapy was found to be a valuable adjunct to prevent local progression and improve symptoms.