Generalized morphea following COVID-19 vaccine: Case report and literature review.

Physicians should be vigilant for COVID-19 vaccine side effects and investigate any associated cutaneous manifestations. This will ultimately facilitate better understanding and recognition of various skin reactions related to the vaccine.

The Youngest Case of Metachronous Bilateral Acinic Cell Carcinoma of the Parotid Gland: A Case Report and Literature Review.

Introduction: Acinic cell carcinoma (ACC) is a low-grade malignant salivary neoplasm that represents 17% of all salivary gland malignancies. It has a tendency to affect young individuals, especially females. ACC mainly originates in the parotid gland and has a potential for recurrence and metastases. Rarely, ACC can affect both parotid glands in a single individual. A bilateral ACC of the parotid gland could either present as a synchronous or a metachronous tumor. Case Report. Our patient is a 19-year-old female known case of ACC of the right parotid gland. The tumor was resected in December 2017. After 3 years, she presented with a left parotid pain and swelling, which raised the suspicion of a contralateral metachronous tumor of the left parotid gland. In September 30, 2020 we proceeded with ultrasound-guided fine needle aspiration of the left intraparotid lesion, and the results turned out to be consistent with ACC. Here, we report a case of a 19-year-old female presenting with metachronous bilateral ACC of the parotid gland with an interval of 3 years, which is the 6th of its kind in the literature and the youngest amongst them. Conclusion: Despite the rareness of metachronous occurrence of bilateral ACC of the parotid gland, it is still encountered in the medical practice. Here, we are highlighting the importance of follow-up with a periodic clinical and radiological examinations, bearing in mind the contralateral nonaffected parotid gland.

Challenges Facing Undergraduate Medical Education in Ambulatory Care Clinics at Tertiary Care Hospitals.

Background: Medical education has been rapidly growing and transforming due to the enormous evolution of medicine. There have been many proficient ways to learn in medicine, but academic lectures, attending wards, and ambulatory care clinics (ACC) remain the three main ways of gaining clinical knowledge and experience for medical students. Over the past decade, there has been a dramatic shift in care by focusing on ambulatory care rather than inpatient settings, which provides a golden opportunity to reinforce medical education. Purpose: Most of the published studies that have focused on the teaching barriers in ACC were descriptive rather than analytic studies. Herein, we aim to detect and determine the barriers to teaching in ACC settings using qualitative analysis. Methods: This is a cross-sectional, observational study, involving medical students in their clerkship years (i.e., fourth and fifth) from two different medical colleges in Riyadh, Saudi Arabia. Faculty who are involved in undergraduate medical education in both colleges were also included. Main Results: A total of 387 medical students studying at the two universities were enrolled in the study. Most of the participants preferred attending outpatient clinics with consultants (44.2%) and the majority preferred attending internal medicine (IM) and IM subspecialties clinics (40.4%). Regarding the challenges, students believe the top three barriers are related to: faculty (39%), environment (34.8%), and patients (14.8%). Faculty on the other hand see that the top three barriers are related to environment (55.6%), patients (24.4%), and faculty (20%). Conclusion: Undergraduate medical education in outpatient settings has many challenges. In our study, the most significant challenges were COVID-19-related restrictions, patient refusal, and insufficient time for teaching. Future studies are needed to investigate these barriers and explore potential solutions that can decrease their burden on undergraduate medical education.

The Effectiveness of Propranolol in Managing Hemorrhagic Choroidal and Exudative Retinal Detachment following Ahmed Glaucoma Valve Implantation in Sturge-Weber Syndrome: Case Report and Literature Review.

Sturge-Weber syndrome (SWS) is a congenital neurological disorder that is characterized by hamartomas involving the skin, brain, and eyes and marked by the presence of the facial port-wine stain, which consequently leads to various ocular complications. Among all ocular comorbidities, glaucoma is the most frequently witnessed in SWS patients with a prevalence of 30%-70%. If glaucoma is refractory to conventional medical management, surgical intervention can be considered. Common complications of glaucoma procedures in SWS are choroidal detachment and suprachoroidal hemorrhage. Moreover, we report a 6-year-old girl, known case of unilateral congenital glaucoma secondary to SWS. Despite being on maximal antiglaucoma drops and undergoing multiple surgical interventions, the patient had uncontrolled intraocular pressure of her right eye. A decision to proceed with Ahmed glaucoma valve implantation (AGVI) to the right eye was made. In the immediate postoperative period, the patient developed hemorrhagic choroidal detachment and exudative retinal detachment. A trial of oral propranolol (1.5-2 mg/kg/day) was then initiated for 4 months. After 30 days from oral propranolol course initiation, we started noticing a significant improvement of the hemorrhagic choroidal and exudative retinal detachment. Spontaneously, a marked reduction in subretinal fluid and suprachoroidal hemorrhage was also seen. Thus, the improvement was correlated with the propranolol therapy. Here, we report a significant improvement of the postoperative complications of AGVI in a patient with SWS, following 4 months of oral propranolol course (1.5-2 mg/kg/day). Further studies are needed to determine the dosage, duration, and optimal mechanism by which propranolol works in this situation.

The Relationship Between Reactive Oxygen Species and Endothelial Cell Metabolism.

Cardiovascular disease (CVD) has been the leading cause of death for many decades, highlighting the importance of new research and treatments in the field. The role of hypoxia and subsequent free radical production [reactive oxygen species (ROS)] have become an area of particular interest in CVD. Interestingly, our laboratory and other laboratories have recently reported positive roles of subcellular ROS in modulating endothelial cell (EC) metabolism, proliferation, and angiogenesis. This bidirectional relationship between ROS and EC metabolism, as well as functional changes, continues to be an area of active research. Interestingly, ECs have been shown to rely on anaerobic processes for ATP generation, despite their direct access to oxygen. This paradox has proven to be beneficial as the major reliance on glycolysis produces ATP faster, preserves oxygen, and results in reduced ROS levels in contrast to oxidative phosphorylation. This review will address the relationship between ROS and carbohydrate, lipid, and nitrogen metabolism in ECs, and their effects on EC phenotype such as sprouting angiogenesis.