Fibromatosis Colli: A Case Report.

Fibromatosis colli is an infrequent and self-limiting disorder in newborns with an unknown etiology. It usually presents with an abnormal head position or cervical swelling. The clinical diagnosis of fibromatosis colli is important to avoid unnecessary invasive interventions. The condition is treated conservatively with physiotherapy. In this article, we report the case of a two-month-old infant who presented with an abnormal head position and was diagnosed with fibromatosis colli based on ultrasonographic examination, which is the non-invasive diagnostic intervention of choice.

A Giant Eyelid Molluscum Contagiosum Revealing an HIV Infection: A Case Report and Literature Review.

Molluscum contagiosum (MC) is a common benign cutaneous viral infection. It can affect any part of the skin with a high propensity for facial skin, especially in human immunodeficiency virus (HIV) patients with low CD4 count. We report a case of a 16-year-old female patient who presented with a giant isolated right upper eyelid MC lesion that served as the first clinical indicator of her HIV infection and acquired immunodeficiency syndrome (AIDS). A final diagnosis of MC was made based on the history, clinical findings, and histopathological examination. Moreover, due to its vital location, large size, and atypical presentation, a surgical excision by simple unroofing and curettage was performed under local anesthesia to speed recovery, prevent corneal complications, and reduce transmission. Her follow-up visits showed satisfactory clinical and cosmetic outcomes. Patients presenting with giant atypical eyelid lesions must be thoroughly investigated for immunosuppressive states, especially HIV infection. MC can have atypical presentations in HIV patients. To our knowledge, this is one of a few cases in the literature reporting a giant isolated eyelid MC lesion leading to a diagnosis of HIV infection with AIDS.

Modified Early Warning Score (MEWS) as a predictor of intensive care unit admission in cancer patient on chemotherapy with positive blood culture: A retrospective cohort study.

BACKGROUND: Although the usefulness of the Modified Early Warning Score (MEWS) in predicting clinical deterioration or the need for intensive care unit (ICU) admission has been evaluated in several studies, only few reports have considered the immune status of the patient. Patients receiving chemotherapy for cancer are at risk of sepsis. This study aimed to assess the validity of MEWS in predicting clinical deterioration, ICU admission, and mortality among immunocompromised cancer patients on chemotherapy (CPOC). METHODS: This retrospective cohort study was conducted at a tertiary care center in Jeddah, Saudi Arabia. Subjects aged>14 years with positive blood cultures, who were hospitalized between June 2016 and June 2017, were included. MEWS was calculated at different time intervals: before, after, and at the time (0-time) of positive blood culture. RESULTS: Overall, 192 patients were enrolled, including 89 CPOC and 103 immunocompetent individuals (controls). ICU admission rate was significantly lower in the CPOC group than in the control group (21 % vs. 50 %, P < .001). Positive MEWS rate (score ≥4) at 0-time was lower in the CPOC group, but the difference was not significant (39.7 % vs. 60.3 %, P = .129). In the CPOC group, positive MEWS rate (score ≥4) had a sensitivity, specificity, positive predictive value, and negative predictive value of 52.6 %, 70 %, 32.3 %, and 84 %, respectively, which was comparable to that observed in the control group. Furthermore, the receiver operating characteristic curve in the CPOC group showed that MEWS calculated 12-36 h before positive blood culture was a significant predictor of ICU admission. The optimal threshold of MEWS with the best sensitivity and specificity was ≥ 3 for the CPOC group and ≥ 4 for the control group to predict ICU admission. MEWS was a generally poor predictor of mortality. CONCLUSION: MEWS ≥ 3 calculated 12-36 h before positive blood culture is the best predictor of ICU admission for CPOC.

Knowledge and attitude toward eye disorders in children among pediatricians and family physicians: a survey study.

BACKGROUND: Vision-related disorders are common in children. Therefore, eye examination and thorough visual assessment by first-contact physicians are crucial in children. This study aimed to evaluate the knowledge of and attitude toward children's eye disorders among pediatricians and family physicians in the Ministry of National Guard Health Affairs-Western Region (MNGHA-WR) of Saudi Arabia. METHODS: In this observational, cross-sectional study, we used a self-administered, web-based questionnaire. The sample size was calculated to be 148 pediatricians and family physicians (of 240 in total) currently working at MNGHA-WR. The first section of the questionnaire dwelled on demographics, while the second section addressed the physician's knowledge of and attitude toward commonly encountered ophthalmological pathologies in children. Data collected were entered into Microsoft Excel and then transferred to IBM SPSS version 22 for statistical analysis. RESULTS: A total of 148 responses (92 family physicians and 56 pediatricians) were received. Most of the participants were residents or staff physicians (n = 105, 70.9%). The mean knowledge score of the respondents was 54.67% ± 14.5%. Participants' knowledge was further subclassified using Bloom's original cutoff points into high (n = 4, 2.7%), moderate (n = 53, 35.8%), and low (n = 91, 61.5%) levels of knowledge. Regarding practices, 120 (81%) participants performed ophthalmic examinations; however, only 39 (26.4%) conducted routine examinations as part of every child's visit. Fundus examinations were performed by 25 (16.9%) physicians. A significant deficiency in knowledge was noted in those with < 1 year of work experience (P = 0.014). Although statistically not significant (P = 0.052), family physicians possessed better knowledge than pediatricians regarding children's eye disorders. On the contrary, more pediatricians performed eye examinations than family physicians (P = 0.015). The male sex was also associated with higher rates of eye examination (P = 0.033). CONCLUSION: An unsatisfactory level of knowledge of eye disease among participating doctors was reported. The proportion was significantly higher among residents and staff physicians. Therefore, awareness efforts should be incorporated in both family medicine and pediatrics residency programs to limit the number of cases of ocular disorders going undiagnosed in children.

Relationship Between Screen Time and Dry Eye Symptoms During the COVID-19 Pandemic in the Pediatric Population of the Western Region of Saudi Arabia.

Objective To measure the prevalence of dry eye disease (DED) and study the relationship between screen time and dry eye symptoms in the pediatric population during the coronavirus disease 2019 (COVID-19) pandemic using the Ocular Surface Disease Index (OSDI) questionnaire. Methods In this descriptive, observational, cross-sectional study, our survey included the pediatric population, ages 1 to 18 years, of both genders, who attended outpatient clinics of two main hospitals in Jeddah, Saudi Arabia. Collected data included age, gender, dry eye symptoms, and common DED risk factors, followed by the Ocular Surface Disease Index (OSDI) questionnaire, which consists of 12 items graded on a five-point scale (0 = never to 4 = all the time). Results A total of 329 pediatric participants were included, with more than half of the participants (56.1%) males and 58.5% aged 12-18 years. The most frequently reported symptoms (reported as often or always) were decreased vision (23.0%) and itchy eyes (22.1%). Environmental factors have an effect on developing DED symptoms, as some participants (21.8%) have reported being uncomfortable in windy weather and 15.8% have reported this in places with air conditioners. Based on the OSDI diagnostic criteria, 250 (76.1%) participants had DED. Furthermore, in terms of severity, 44 (13.3%) participants had mild DED, 62 (18.8%) participants had moderate DED, and 145 (43.9%) participants had severe DED. We found that prolonged exposure to mobile screens for two to three hours or four hours or more was associated with a higher DED incidence compared to those exposed for shorter periods. Older age categories were more likely to experience DED (80.8% and 78.2% in age categories 12-18 and 7-12, respectively, versus 57.6% in the youngest age category (p = 0.001)). Additionally, DED was independently associated with participants with a previous history of eyeglasses prescription and those experiencing dry eyes while using electronic devices. Conclusion Since many children use electronic devices for education and entertainment, we found that symptoms of DED due to prolonged screen time have increased among the pediatric population during the COVID-19 pandemic. Therefore, awareness efforts should be directed to reduce the rate of controllable risk factors like personal computer use. In addition, educational campaigns are warranted to provide all possible preventive measures against DED, especially to children with uncontrollable risk factors for developing DED.

Non-invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) Lowers the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology Diagnostic Categories.

Background: The introduction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been shown to decrease the risk of malignancy (ROM) in The Bethesda System for Reporting Thyroid Cytopathology. This knowledge may alter the management of patients with thyroid nodules. Objectives: To correlate cytological diagnosis with histological diagnosis for establishing the ROM of all Bethesda system categories after the introduction of NIFTP. Methods: This was a retrospective cohort study. All consecutive fine-needle aspiration cytology (FNAC) specimens collected from January 1, 2013, to December 31, 2017, at King Abdullah Medical City, Jeddah, Saudi Arabia, were assessed, and patients who underwent surgical excision of thyroid nodules were further analyzed. The ROM and overall ROM for each Bethesda category were calculated with and without considering NIFTP as a malignant tumor. Results: Overall, 1066 FNAC specimens were collected, of which 281 had a surgical correlation. Our cases included 18 (6.4%) non-diagnostic (ND), 109 (38.8%) benign, 28 (9.9%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 39 (13.8%) follicular neoplasm or suspicion for follicular neoplasm (FN/SFN), 20 (7.1%) suspicion for malignancy (SM), and 67 (23.8%) malignant (POM) cases. After considering NIFTP diagnosis on resection specimens, the ROM decreased as follows: ND, 38.8% to 27.7% (P = 0.2388); benign, 21.1% to 11.9% (P = 0.0343); AUS/FLUS, 50% to 39.2% (P = 0.2089); FN/SFN, 53.8% to 33.3% (P = 0.0336); SM, 85% to 75% (P = 0.2147); POM, 95.5% to 88% (P = 0.0582). Conclusion: The introduction of NIFTP would significantly decrease the ROM of thyroid FNAC in both benign and FN/SFN categories of the Bethesda system.

Evaluation of ultrasound point shear wave elastography reliability in an elasticity phantom.

PURPOSE: To date, limited studies have specifically addressed the reliability of ultrasound point shear-wave elastography (pSWE). Therefore, the aim of the present study was to assess the reproducibility of ultrasound pSWE within and between operators using two ultrasound scanners. METHODS: iU22 and EPIQ7 ultrasound scanners were used to assess the reliability of pSWE measurements of four inclusions [L I (8 kPa), L II (14 kPa), L III (48 kPa), and L IV (80 kPa)] at a depth of 3.5 cm in an elasticity phantom using a curvilinear 5-1 MHz transducer. The intraoperator, inter-operator, and inter-scanner reproducibility of pSWE was assessed using intraclass correlation coefficients (ICCs). Bland-Altman plots were used to establish bias and limits of agreement (LoA) between measurements. The accuracy of pSWE from manufacturer values was determined using the one-sample t-test. RESULTS: Intra-operator agreement was excellent, with an ICC >0.90. The bias in measurements for operator A was -0.36±3.13 kPa (LoA, -6.47 to 5.75), and for operator B it was 1.97±6.29 kPa (LoA, -10.25 to 14.21). Inter-operator agreement was excellent, with an ICC of 0.95. The bias in measurements between operators was -0.42±5.00 kPa (LoA, -10.24 to 9.38). The inter-scanner agreement between EPIQ7 and iU22 was excellent, with an ICC of 0.96. The bias in measurements between scanners was 1.74±4.44 kPa (LoA, -6.95 to 10.45). There was significant overestimation for L I (17.75%) and L II (31.14%) and underestimation for L III (-15.28%) and L VI (-98.00%) relative to the manufacturer-reported values. CONCLUSION: Phantom ultrasound pSWE was reproducible within and between operators, and between Philips ultrasound scanners; further studies using different ultrasound systems and transducers are required.

Early vascular embolization of large orbital and periorbital infantile capillary hemangiomas; A case report.

PURPOSE: Infantile hemangiomas (IH) are the most common benign vascular tumors in childhood. Although they tend to have a benign nature, some hemangiomas may be complicated with astigmatism or deprivation amblyopia. We report a unique case of using an interventional radiological vascular embolization treatment modality for the early management of amblyogenic large right orbital and periorbital infantile capillary hemangiomas. OBSERVATIONS: After the confirmation of the diagnosis using a magnetic resonance imaging (MRI) of the brain and orbit, and an initial trial of systemic propranolol, an early interventional radiological vascular embolization was done. This was combined with the use of a tapering systemic corticosteroid. The functional and cosmetic outcomes were satisfactory. CONCLUSIONS AND IMPORTANCE: The use of arterial embolization is a promising modality of treatment as a possible alternative or adjunct to medical and surgical treatment cases of IH. To the authors' knowledge, this is one of the rare cases reported in the ophthalmic literature addressing the use of this technique for early management of orbital and periorbital capillary hemangiomas.

Supernumerary Medial Rectus Muscle of the Orbit.

Supernumerary extraocular muscles (EOMs) are relatively rare in humans compared to other species. Therefore, few cases are reported on pediatric patients with strabismus.  We describe a case of an incidental intraoperative finding of a right eye accessory medial rectus (MR) muscle in a child with normal ocular motility. This supernumerary muscle was found inserted underneath the original MR muscle and was of a similar size. In this article, we discuss the anomaly and its clinical relevance.

A case report of retrograde intussusception 3 years post Roux-en-Y gastric bypass.

Retrograde jejuno-jejunal intussusception is a rare complication of bariatric surgeries. It causes acute sudden symptoms that require immediate surgical intervention. We report a case of a 46-year-old female who underwent Roux-en-Y gastric bypass (REYGP) 3 years prior. The patient presented to the emergency department with acute sudden abdominal pain, nausea and vomiting. Laparoscopically, intussuscepting small bowel segment was found gangrenous, and it was resected and end-to-end anastomoses were fashioned. The postoperative course was uneventful, and the patient remained asymptomatic for the 12 months of follow-up. Patients with retrograde intussusception experience an intolerable severe pain that necessitates surgical intervention. The etiology of intussusception as a complication after REYGP is unclear, yet theoretically some possible etiologies exist. The initial diagnosis of retrograde intussusception is made based on abdominal computed tomography. Early intervention significantly reduces morbidity and mortality.

Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: a cross-sectional study.

BACKGROUND: Low Back Pain (LBP) is the commonest musculoskeletal disorder and an important occupational hazard among healthcare workers (HCWs) that peaks among Operating Room (OR) staff. This cross-sectional study aimed to assess the prevalence, characteristics, and risk factors of low back pain among operating room (OR) staff in a tertiary healthcare center in Makkah, Saudi Arabia. METHODS: A 39-item self-administered questionnaire was distributed to all available OR staff. Data about personal, sociodemographic, general risk factors OR specific risky activities, and LBP characteristics were obtained. Descriptive, crosstabs, and univariate and multivariate logistic regression tests were employed. RESULTS: Out of the 143 distributed questionnaires, 84 % were received. LBP prevalence was 74.2 %. No statistically significant associations were detected between LBP and any of the general risk factors (p >0.05). However, most of the OR risky activities were significantly associated with the occurrence of LBP (p <0.05) e.g. lifting objects above the waist, rotating torso while bearing weight, transferring patients onto bed or chair, pulling a patient up the bed, and repositioning a patient in bed. These significant associations were preserved after adjustment for gender, perceived stress at work, educational level, and receiving education about LBP. Rest and analgesics were reported to be the most common relievers. CONCLUSIONS: LBP is a common health issue among KAMC OR staff. OR risky activities were found to contribute to this problem. We suggest designing educational interventional programs to teach OR staff the best way to prevent this problem.