The Behavior of Primary Healthcare Doctors Toward Antibiotic Prescriptions for Upper Respiratory Tract Infections.

BACKGROUND: Unnecessary prescription of antibiotics for patients with upper respiratory tract infections (URTIs) carries the potential risk to the development of bacterial resistance. OBJECTIVE: This study aimed to investigate the behavior of primary healthcare (PHC) physicians toward an antibiotic prescription for URTI, Al-Madinah City, Saudi Arabia in 2021. METHODS: A cross-sectional study was conducted at PHC centers in Al-Madinah City, Saudi Arabia. The study invited all physicians in the randomly selected 28 PHC centers to participate in the study. A master sheet adopted from a researcher done in the Asir region of Saudi Arabia about the pattern of prescription for URTI was used and included data about socio-demographic characteristics and data about presenting symptoms and signs of URTIs, the clinical diagnosis, type of medication prescribed, and duration of treatment also, included data about the factors that press physicians to prescribe antibiotics and their response. The questionnaire was filled out and returned back by 140 physicians. The collected data were analyzed and tabulated using appropriate statistical tests. RESULTS: The mean age of the studied physicians was 34.4 ± 7.6 years (25-59 years). General practitioners and specialists were 66.4% and 33.6%, respectively. The prevalence of antibiotic prescriptions was 44.3%. The most prescribed antibiotics were amoxicillin (58.6%) and Augmentin (28.6%). Congested tonsils (87.1%), ear discharge (84.2%), and cervical lymphadenopathy (89.3%) were the most clinical factors that affected physicians' decisions to prescribe antibiotics for URTI. The non-clinical factors affecting physicians' decisions include patient request (52.8%) and press (28.5%), with no statistically significant difference detected between general practitioners and specialists. CONCLUSION: The study findings indicate the need to develop intervention programs targeting physicians as well as the general population to decrease inappropriate antibiotic prescriptions in primary care centers.

Gradenigo Syndrome: A Case Report of a Rare Complication of Otitis Media.

Otitis media, a common inflammation of the middle ear, frequently complicates upper respiratory infections. Gradenigo's syndrome, a rare complication, manifests as suppurative otitis media, abducens nerve palsy, and severe trigeminal nerve pain. Prompt recognition is vital because of the proximity of the infection to critical neurovascular structures. We present the case of a 38-year-old female who presented with facial pain, otalgia, and diplopia following an upper respiratory infection. Examination revealed facial weakness and abducens nerve palsy. Laboratory results showed elevated inflammatory markers. Imaging confirmed middle ear involvement. Antibiotics were initiated, and myringotomy was performed, resulting in a successful outcome. This case report contributes to understanding Gradenigo's syndrome's clinical nuances, emphasizing the necessity of a structured diagnostic and therapeutic approach. Ongoing research is crucial for refining diagnostic criteria, optimizing treatment, and enhancing pathophysiological understanding. Increased medical education is imperative to ensure early detection and improved patient outcomes.

Polysplenia Syndrome Complicated by Splenic Infarction: A Report of a Rare Case.

Polysplenia syndrome is a rare congenital anomaly characterized by multiple spleens and associated organ anomalies, which can present with serious complications such as splenic infarction. Diagnosis and management of the disorder can be challenging due to the presence of associated anomalies and the condition is often diagnosed incidentally. We report a case of a six-year-old girl with no significant medical history who presented to the emergency department with fever, abdominal pain, and vomiting. Physical examination and laboratory investigations showed leukocytosis, anemia, and elevated levels of C-reactive protein. A computed tomography scan revealed splenic infarction with polysplenia syndrome. The patient received intravenous antibiotics and pain management and was closely monitored for complications such as sepsis. Early diagnosis and appropriate management are essential to prevent complications, and close monitoring and follow-up are necessary for long-term management.

A Rare Complication of Abdominal Aortic Aneurysm: A Case Report of Aortocaval Fistula.

Aortocaval fistula is a rare but serious complication of an abdominal aortic aneurysm characterized by communication between the dilated abdominal aorta and inferior vena cava. Prompt diagnosis and treatment are essential to reduce the mortality rate. A 66-year-old man with a history of poorly controlled hypertension, diabetes mellitus, and dyslipidemia presented to the emergency department with sudden, severe lower back pain. Laboratory investigations showed a rapid drop in hemoglobin levels and increased lactate levels. A CT scan revealed an aortocaval fistula resulting from a rupture of the abdominal aorta. The patient underwent emergency surgery, but a cardiac arrest occurred during the procedure, and he could not be resuscitated. Despite advances in imaging and surgical techniques, the mortality rate of aortocaval fistula remains high. It is crucial for clinicians to maintain a high level of suspicion for aortocaval fistula in patients with an abdominal aortic aneurysm who present with a sudden onset of abdominal and back pain and to initiate appropriate resuscitative measures and an urgent surgical consultation.

Wandering Spleen: A Rare Case From the Emergency Department.

The spleen is typically located in the left upper quadrant and is held in position by the suspensory ligaments, which include the gastrosplenic ligament, the splenorenal ligament, and the phrenicocolic ligament. Abnormalities within these ligaments result in the mobility of the spleen, so it may be located in the pelvis or iliac region, which is termed a wandering spleen. We present a case of a middle-aged man who presented to the emergency department with generalized abdominal pain and diffuse guarding and tenderness. The patient had a previous history of peptic ulcer disease and multiple emergency department visits for gastritis. Given the assumed diagnosis of perforated viscus, the patient underwent a computed tomography scan that demonstrated the absence of the spleen in its usual location and showed an ectopic pelvic spleen. The patient underwent successful surgical treatment with splenopexy. The wandering spleen is a rare medical condition that presents a clinical diagnostic challenge and requires a high index of suspicion. Despite its rarity, the wandering spleen should be considered in patients with recurrent abdominal pain.

Spontaneous Rupture of Arachnoid Cyst in a Child: A Rare Case Report.

An arachnoid cyst is a benign lesion filled with cerebrospinal fluid that usually develops in the middle cranial fossa. The arachnoid cyst may become symptomatic if it has a large size or when it gets ruptured. Spontaneous rupture of an arachnoid cyst is a very rare complication. We report the case of an 11-year-old girl who was brought to the emergency department with a complaint of a progressive headache that was associated with vomiting. On examination, she was found to have papilledema. Subsequently, magnetic resonance imaging of the brain was performed to exclude any space-occupying lesion. The scan demonstrated a right extra-axial temporal lesion, measuring 7.8 x 5.4 x 4.9 cm on maximum dimensions, along with an extension to the right cerebral convexity in a crescentic shape. The lesion follows the signal intensity of cerebrospinal fluid on all sequences and exhibited no post-contrast enhancement or restricted diffusion. The lesion exerted a mass effect in the form of compression of the right temporal lobe. These findings were consistent with an arachnoid cyst with subdural hygroma. The patient was referred to the neurosurgery team. Then, the right temporal arachnoid cyst was drained through the right temporal craniotomy and the subdural hygroma was drained through a frontal Burr hole. The patient was seen after one month in the pediatrics clinic and was completely asymptomatic.

Pituitary ​​​​Apoplexy​​ With Pituitary Macroadenoma in a Patient With ​​Asymptomatic ​​​COVID-19: ​​A Case ​​​Report.

Pituitary apoplexy is a rare and potentially life-threatening condition that usually occurs in the setting of a pre-existing pituitary tumor, which may be undiagnosed. There are a growing number of reports describing the pituitary apoplexy associated with coronavirus disease 2019 (COVID-19). We present the case of a 41-year-old man who presented with a gradually worsening headache for four days. It was a bilateral frontal headache of sharp quality with no radiation. He scored the headache as 9 out of 10 on the 10-point severity scale. He had no previous episodes of similar headaches. Fundoscopic examination revealed bilateral optic disc blurring suggestive of papilledema and cranial nerves examination revealed bilateral hemianopia. The patient was admitted for further investigation and management. As part of the admission protocol, the patent underwent a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which yielded positive results. Computed tomography demonstrated a large solid intrasellar mass with areas of high density suggesting hemorrhage along with a small amount of subarachnoid hemorrhage space in the left parietal lobe. The findings were consistent with pituitary apoplexy in the setting of pituitary macroadenoma. Intravenous hydrocortisone was administered. The patient underwent transsphenoidal surgical resection of the pituitary tumor, which resulted in significant improvement in the patient's symptoms. Pituitary apoplexy is a rare condition. The case suggests that COVID-19 may predispose to the development of pituitary apoplexy.