A cross-sectional analysis of preterm birth incidence and survival in Al Kharj, Saudi Arabia.

OBJECTIVES: To understand the prevalence and survival rates of preterm birth (PTB) is of utmost importance in informing healthcare planning, improving neonatal care, enhancing maternal and infant health, monitoring long-term outcomes, and guiding policy and advocacy efforts. METHODS: The medical records of preterm infants admitted to the Neonatal Intensive Care Unit (NICU) with a diagnosis of prematurity at the Maternity and Children's Hospital (MCH), Al Kharj, Saudi Arabia, were reviewed between January 2018 and December 2022. Data were collected on birth weight (BW), gender, number of live births, gestational age, mortality, nationality, APGAR score, length of stay in the NICU, and maternal details. RESULTS: A total of 9809 live births were identified between 2018 and 2022, of which 139 (3.9%) were born preterm. The overall mortality rate of the included sample was 7.19%, whereas the mortality rate according to BW was 38.4% of those born with extremely low birth weight (ELBW). The most common intrapartum complications were malpresentation (15.1%), placental complications (4.3%), and cord complications (3.6%). CONCLUSION: This study provides valuable insights into the prevalence of PTB in the country, particularly focusing on the vulnerability of extremely preterm babies.

Quality of Life in Children With Eosinophilic Esophagitis in Saudi Arabia.

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that can adversely affect the quality of life (QOL) in children. We aim to investigate the burden of EoE on the QOL in children aged 2-18 years and identify factors that influence their QOL. METHOD: A multicenter cross-sectional study was conducted in six Saudi pediatric hospitals. Pediatric Quality of Life 3.0 EoE Module was used to measure the QOL of children with EoE. RESULTS: Thirty-six families (36 parents and 33 children) were enrolled. The most reported symptoms were vomiting (50%), dysphagia (44.4%), and food impaction (36.1%). The mean total score of the parent-proxy report of the Pediatric Quality of Life EoE was 82.9 ± 10.3 versus the children's self-reported score of 77.28 ± 13.6 (p = .043). DISCUSSION: Recurrent emergency department visits were associated with a lower QOL, and a positive family history of EoE was associated with a better QOL.

Prevalence of canine impaction in different cities of Saudi Arabia: A systematic review.

Background: To our knowledge, no systematic review assessed and gathered information about the prevalence of impacted canines among the Saudi population. The purpose of this study was to critically assess the previously published studies about the prevalence of canine impaction according to impaction type (buccal/ palatal), gender (male/female), and location (maxillary/mandibular, right/left), are among the Saudi population. Methods: PubMed (MEDLINE), Scopus, the Web of Science, Dimensions, and Semantic Scholar databases were searched systemically for articles related to the topic of the study published between 1987 and 2022. The PRISMA statements were used to conduct a systematic review with the help of the Best Practice for Survey and the Public Opinion Research scales by the American Association for Public Opinion Research (AAPOR) to assess and evaluate the selected studies' quality. Results: The initial search of the databases yielded 221 articles. After discarding duplicates, 161 were selected for further evaluation. Eventually, 16 articles were selected for inclusion in this study. Regarding the quality of the selected articles, all articles, except one, were of high quality. Only one was of medium quality. Conclusion: It was found that the incidence of palatal canine impactions was higher than buccal impactions. Females had a higher prevalence of canine impactions as compared to males. There were more canine impactions in the maxilla than the mandible and more on the left side than the right one.

The Prevalence of Depression in Survivors of Acute Myocardial Infarction and Gender Differences in King Abdulaziz Medical City (KAMC), Riyadh.

BACKGROUND: Myocardial infarction (MI) stands as a prevalent worldwide cause of mortality. The aftermath of an MI often entails an unpleasant experience for individuals, who frequently find themselves overwhelmed. Extensive literature suggests that a significant proportion of patients develop depressive symptoms subsequent to MI. Consequently, the primary objective of this study is to ascertain the prevalence of post-MI depression among affected individuals. METHODS: This is a cross-sectional study involving a survey distributed to patients admitted to the King Abdulaziz Medical Center (KAMC) located in Riyadh, Saudi Arabia. The study involved 210 patients; 72.1% of the sample were men and 27.9% were female. RESULTS: The average age of the participants in this study was 61.96 years old. The mean age of the male participants was 61.10 years old, while the females' mean age was 64.35 years old. Males made up 75.27% of the participants, while 24.73% were females. Overall, 33.64% of the participants had an abnormal score (depression). The majority of male patients had a normal score, which means that they do not suffer from depression. Among the female patients, 38.60% had an abnormal score. CONCLUSION: Mental illness is a significant concern, particularly depression. Individuals should go for depression screening post-MI as it will determine their compliance with visiting the hospital, caring for themselves, and taking medications.

Internal Hernia as a Rare Complication of Acute Appendicitis.

Appendicitis is a well-known and highly common surgical emergency disease, yet it presents with a wide variety of manifestations. This is a case report of a 47-year-old female who presented with a complaint of having constant crampy right lower abdominal pain for two weeks. The patient reported having a sudden onset of symptoms that went with the typical picture of acute appendicitis that occurred two weeks ago. Our pre-op workup was inconclusive; therefore, we planned to go for a diagnostic laparoscopy, where surprisingly, the appendix was long, inflamed, and attached to the posterior wall of the cecum. Thus, a ring-like structure was developed, in which 8 to 10 cm of the terminal ileum (the last part of the small bowel) was going through and causing an internal hernia. Although blood and radiology workups provide valuable assistance in diagnosing common cases, a highly suspicious sense and skillful surgeons with good clinical experience play a major role in managing such rare presentations.

Psychological Impact and Quality of Life in Adults With Tinnitus: A Cross-Sectional Study.

BACKGROUND: Tinnitus may directly or indirectly influence professional, personal, and leisure activities and disrupt family and social relationships in severe cases. This study aimed to explore the impact of tinnitus on the quality of life (QoL) and psychological well-being among Saudi Arabian adults. METHODS: This study used a cross-sectional design to collect data from adults experiencing tinnitus. Data collection took place between September 5, 2023 and October 7, 2023 at King Khalid University, Abha, Saudi Arabia. The study involved adults aged 18 to 65 with tinnitus. Participants were recruited from audiology clinics. A multi-stage stratified random sampling method was used to recruit the study participants. The severity of tinnitus handicap was assessed using the 25-item Tinnitus Handicap Inventory (THI) questionnaire. THI consists of 25 items divided into functional, emotional, and catastrophic subscales. The total score ranges from 0 to 100, with higher scores indicating greater tinnitus-related handicap. THI scores are categorized into 0-16, 18-36, 38-56, 58-76, and 78-100. RESULTS:  A total of 163 participants were included in this study. The largest age group category was 18-29 years, comprising 57.05% (n = 93) of the sample. The study included a slightly higher percentage of female participants (65.03%, n = 106). More than three-fifths (61.96% ) of the participants were from the Western Region (n = 101), 91.40% (n = 149) were Saudi nationals, 55.21% (n = 90) were single, 67.5% (n = 110) had university education, 46.0% (n = 75) had income less than 500 SAR, 44.78% (n =73) was employed, and 74.23% (n = 121) did not smoke. Tinnitus hurts emotions and QoL. The largest proportion of the studied patients with tinnitus faced catastrophic handicaps (24.5%, n = 40), and nearly equal proportions experienced mild and moderate handicaps (23.3%, n = 38 and 23.9%, n =39, respectively). Severe handicap was reported in 15.3% (n = 25), while a slight effect was reported in (12.9%, n = 21). Tinnitus affected their hearing (36.81%, n = 60); interfered with daily life (33.74%, n = 55), social activities (30.06%, n = 49), social relationships (29.45%, n = 48), and concentration (37.42%, n = 61); caused fatigue (38.04%, n = 62) and sleep disturbances (36.81%, n = 60); and prevented them from enjoying life (25.77%, n = 42). Tinnitus caused anger (47.85%, n = 78), confusion (42.94%, n = 70), anxiety (43.56%, n = 71), feeling unsafe (33.74%, n = 55), desperation (36.81%, n = 60), frustration (30.06%, n = 49), being upset (38.04%, n = 62), experiencing depression (30.67%), and challenges in coping with stress (31.29%). There was a significant association between the THI score and region of residence (p = 0.02), income (p = 0.041), occupation (p = 0.013), and smoking (p = 0.014). CONCLUSIONS: Our research underscored the profound impact of tinnitus on the QoL among adults in Saudi Arabia. A significant portion of the studied patients faced catastrophic handicaps, emphasizing the severity of the condition. These findings underscore the multifaceted and far-reaching consequences of tinnitus, highlighting the need for comprehensive support and management strategies tailored to the unique sociodemographic factors influencing individuals' experiences.

Unusual presentation of tractional retinal detachment in beta thalassemia minor.

Purpose: To report a case of proliferative retinopathy with tractional retinal detachment associated with beta thalassemia minor in a 27-year-old female. Observations: A young lady having beta thalassemia minor presented with decreased vision in both eyes, the effect being more severe in her right eye. The patient's other systemic history, including ophthalmic history, was unremarkable. The fundus examination revealed peripheral retinal ischemia in both eyes and tractional retinal detachment in the right eye. Conclusion: Beta thalassemia minor is not associated with striking retinal pathology, nevertheless proliferative retinopathy. However, in this case the patient developed tractional retinal detachment that required surgery. This indicates that proliferative changes may develop in patients with beta thalassemia, and routine fundus examinations could be recommended for these patients.

The Barriers to Seeking Mental Health Services at King Saud Bin Abdulaziz University for Health Sciences.

BACKGROUND: The mental health of college students, especially medical students, is a major issue worldwide. Depression and anxiety are among the top causes of death among people aged 15-29 years old. Mental health disorders, especially mood disorders such as depression and anxiety, are common among university students. Psychological problems can negatively impact academic performance and life satisfaction. The earlier mental illness is detected, the better the treatment and outcome. The aim of this study is to determine the barriers among students to seeking mental health services. METHODS: This cross-sectional questionnaire-based study was carried out at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia The cross-sectional questionnaire-based study involved 434 students: 72.1% men and 27.9% women. This study had a response rate of 28.5% and responses were gathered in May 2023. RESULTS: The top three barriers identified in this study were "Feeling that my problems are not important," "Concern that no one will understand my problems," and "Difficulty with access to care." The majority of students reported feeling "I feel reluctance a little" to use mental health services; 31.4% chose "I need it a little" when asked whether they needed to use mental health services. Furthermore, 34.8% of students reported having mild anxiety, and 34.1% reported having mild depression. CONCLUSION: Mental illness is a serious issue, which is why medical students should be aware of it to improve their quality of life and reduce the stress and obstacles they face. Medical schools should address awareness of mental illness and how to approach a clinic. This is important for students to succeed and overcome the psychological difficulties that might affect academic performance. In addition, recognizing the barriers will help achieve better outcomes in seeking help and utilizing existing services.

Utility of the 4C ISARIC mortality score in hospitalized COVID-19 patients at a large tertiary Saudi Arabian center.

Background: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) 4C mortality score has been used before as a valuable tool for predicting mortality in COVID-19 patients. We aimed to address the utility of the 4C score in a well-defined Saudi population with COVID-19 admitted to a large tertiary referral hospital in Saudi Arabia. Methods: A retrospective study was conducted that included all adults COVID­19 patients admitted to the Armed Forces Hospital Southern Region (AFHSR), between January 2021 and September 2022. The receiver operating characteristic (ROC) curve depicted the diagnostic performance of the 4C Score for mortality prediction. Results: A total of 1,853 patients were enrolled. The ROC curve of the 4C score had an area under the curve of 0.73 (95% CI: 0.702-0.758), p<0.001. The sensitivity and specificity with scores >8 were 80% and 58%, respectively, the positive and negative predictive values were 28% and 93%, respectively. Three hundred and sixteen (17.1%), 638 (34.4%), 814 (43.9%), and 85 (4.6%) patients had low, intermediate, high, and very high values, respectively. There were significant differences between survivors and non-survivors with regard to all variables used in the calculation of the 4C score. Multivariable logistic regression analysis revealed that all components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Conclusions: Our data support previous international and Saudi studies that the 4C mortality score is a reliable tool with good sensitivity and specificity in the mortality prediction of COVID-19 patients. All components of the 4C score, except gender and O2 saturation, were independent significant predictors of mortality. Within the 4C score, odds ratios increased proportionately with an increase in the score value. Future multi-center prospective studies are warranted.

Primary leiomyosarcoma of the thyroid with concurrent papillary thyroid cancer: a rare case report and a review of literature.

BACKGROUND: Leiomyosarcoma (LMS) is a soft tissue malignant tumor that has a predilection to the abdominopelvic and limb smooth muscles. LMS of the thyroid is exceptionally rare. Papillary thyroid cancer (PTC) is the most common thyroid malignancy and originates from the thyroid epithelial layer. To our knowledge, the presence of both tumors in the same patient has not been reported previously. CASE PRESENTATION & LITERATURE REVIEW: A 42-year-old woman presented with a progressively enlarging neck mass for a few months. She underwent left thyroid lobectomy, and the histology showed high-grade primary LMS of the thyroid. She subsequently underwent a complete thyroidectomy, which identified a classical PTC on her right lobe. Our comprehensive literature review identified 39 published cases of primary LMS of the thyroid. The average tumor size was 5.88 cm and occurred more in women. The most common presentation was neck mass, followed by compressive symptoms. Recurrence and metastasis were uncommon at 15% and 10-25%, respectively. CONCLUSION: Thyroid LMS is a rare malignancy with a worse prognosis than PTC. A thorough workup must be done to rule out metastasis before labeling it as primary thyroid cancer.

Impact of viral co-infection on clinical outcomes and mortality of COVID-19 patients: a study from Saudi Arabia.

Background: In COVID-19 patients undetected co-infections may have severe clinical implications associated with prolonged hospitalization, ICU admission, and mortality. Therefore, we aimed to investigate the impact of viral coinfections on the outcomes of hospitalized patients with COVID-19 in a large tertiary Saudi Arabian Hospital. Methods: A total of 178 adult patients with confirmed SARS-CoV-2 who were hospitalized at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia, from March 1st to June 30th 2022, were enrolled. Real-time PCR for the detection of viral co­infections was carried out. Cases (SARS-CoV-2 with viral coinfections) and control (SARS-CoV-2 mono-infection) groups were compared. Results: 12/178 (7%) of enrolled COVID-19 patients had viral coinfections. 82/178 (46%) of patients were males. 58% of patients had comorbidities. During the study period, 4/12 (33%) and 21/166 (13%) cases and control patients died, p=0.047, respectively. Duration of hospitalization was the only significant independent factor associated with SARS-CoV-2 coinfections, OR 1.140, 95% CI 1.020-1.274, p=0.021. Conclusions: The findings of this study from a large tertiary Saudi Arabian Center revealed a prevalence of 7% for SARS-CoV-2 viral coinfections. SARS-CoV-2 coinfected patients had a significantly prolonged duration of hospitalization and higher mortality than those with SARS-CoV-2 alone. Future studies are needed.

The Toothbrushing Effects on Surface Properties and Color Stability of CAD/CAM and Pressable Ceramic Fixed Restorations-An In Vitro Study.

Pressable ceramic restorations have been introduced and investigated, and found comparable to CAD/CAM ceramic in terms of mechanical properties; however, the effect of toothbrushing on the pressable ceramic has not been thoroughly investigated. The objective of the current study was to assess the effect of artificial toothbrushing simulation on the surface roughness, microhardness, and color stability of different ceramic materials. Three lithium disilicate-based ceramics (IPS Emax CAD [EC], IPS Emax Press [EP]; (Ivoclar Vivadent AG), and LiSi Press [LP] (GC Corp, Tokyo, Japan)) were examined. For each ceramic material, eight bar-shaped specimens were prepared and subjected to 10,000 brushing cycles. Surface roughness, microhardness, and color stability (∆E) were measured before and after brushing. Scanning electron microscopy (SEM) was used for surface profile analysis. The results were analyzed using one-way ANOVA, Tukey's post hoc test, and paired sample t-test α = 0.05. The findings revealed a non-significant decrease in the surface roughness of EC, EP, and LP groups (p > 0.05), and both LP and EP have the lowest surface roughness values (0.64 ± 0.13, 0.64 ± 0.08 µm) after brushing, respectively. Toothbrushing showed a decrease in the microhardness of the three groups: EC and LP, p < 0.001; EP, p = 0.012). EP showed the lowest hardness value after brushing (862.45 ± 273.83). No significant changes (∆E) were observed in all groups (p > 0.05); however, the EC group was found to be considerably affected by color changes, in comparison to the EC and LP groups. Toothbrushing had no effect on surface roughness and color stability of all tested materials, but it decreased the microhardness. Material type, surface treatments, and glazing of ceramic materials contributed to the surface changes in the ceramic materials, necessitating further investigations in terms of the toothbrushing effect with different glazing as variables.

The Outcome of COVID-19 Infection on Kidney Transplantation Recipients in Southern Saudi Arabia: Single-Center Experience.

BACKGROUND: To report the incidence, risk factors, and outcome of severe COVID-19 disease in kidney transplant recipients attending a Saudi hospital at a single center in the Kingdom of Saudi Arabia. METHODS: A retrospective chart-based cohort study involving all kidney transplant recipients tested for COVID-19 in the Armed Forces Hospital Southern Region, KSA. RESULTS: Of 532 kidney transplant recipients who reported to the center, from March 2020 to June 2022, 180 were tested for COVID-19. Of these recipients, 31 (17%) tested positive. Among the 31 positive recipients, 11 were treated at home, 15 were admitted to the noncritical isolation ward, and 5 were admitted to the intensive care unit (ICU). Older age (P = .0001), higher body mass index (P = .0001), and history of hypertension (P = .0023) were more frequent in the COVID-19-positive recipients. Admission to the ICU was more frequent in older recipients (P = .0322) with a history of ischemic heart disease (P = .06) and higher creatinine baseline (P = .08) presenting with dyspnea (P = .0174), and acute allograft dysfunction (P = .002). In the ICU group, 4 (80%) patients required hemodialysis, and 4 (80%) died. CONCLUSIONS: Kidney transplant recipients with COVID-19 could have a higher risk for developing acute kidney injury, dialysis, and mortality than the general population. ICU admission and renal replacement therapy were more evident in older recipients with a history of ischemic heart disease, presenting with shortness of breath (P = .017) and a higher serum creatinine baseline. Acute allograft dysfunction was the independent predictor of mortality among patients admitted to the ICU.

Computer vision syndrome: Symptoms, risk factors, and practices.

Background: According to computer vision syndrome (CVS). Due to constant use of computers by the students, it has become one of the growing health risks associated with technology (cell phones and tablets). CVS is a combination of eye and vision disorders associated with activities that affect near vision and is experienced in relation to or during the use of computers. The main aim of the study was to find the risk factors of CVS, its symptoms, and other factors associated with CVS. Materials and Methods: In this cross-sectional study, data was collected using a purposely constructed E-questionnaire. The questionnaire consisted of demographic items and items related to the usage of E-devices and the symptoms of eye problems. After data collection, data was coded and entered in the Statistical Package for the Social Sciences (SPSS) ver. 20 software for analyses. Descriptive statistics (mean and standard deviation, frequencies and percentages) were computed. To measure the significant differences, Chi-square test was used at 5% level of significance. Results: The mean (SD) age of 400 respondents was 22.5 (11.5) years. We computed the internal consistency, and the overall Cronbach alpha was 0.81. Also, 40% of the respondents were females, while 60% were males. Results showed that 20% of the respondents had multiple symptoms of eye problems, while 9% had no symptoms, 9% had eye pain, 8% had dryness of eye, and 6% had watering of eyes and redness of eye symptoms. The rest of the symptoms was found in less than 5% of the respondents. Conclusion: This worldwide issue requires immediate attention. Long-term computer use has been linked to significant visual impairments, particularly in people who use computers and similar gadgets for extended periods of time.

Dental Student's Awareness and Perception toward Nicotine Replacement Therapy in Riyadh Region Saudi Arabia.

Background: Tobacco use is one of the leading causes of death in the world. Dentists have a greater role in tobacco cessation and counseling. Dental institution is a platform from where they can inculcate the habit of tobacco counseling. Nicotine replacement therapy (NRT) aims to reduce motivation to consume tobacco and the physiological and psychomotor withdrawal symptoms through the delivery of nicotine. Objectives: The aim of this study is to assess dental students' awareness and perception toward NRT. Materials and Methods: A cross-sectional study was done on 348 dental students studying in different universities in Riyadh Region, KSA. Questions related to awareness of NRT, perception, and motivation to use NRT were asked. Statistical Analysis: Data were analyzed using descriptive statistics; Chi-square test was used to compare results according to the year of study. Results: About 74.4% of participants were aware of NRT nearly 50% of students think motivating about NRT is waste of time. About 65.2% of the students think it is difficult to quit smoking. Conclusion: It is necessary to consider programs giving importance about tobacco cessation and NRT among dental students.

Clinical and epidemiological characteristics of road traffic accidents patients received at 2 intensive care units in Saudi Arabia-A cross-sectional study.

BACKGROUND: Road traffic accidents (RTAs) lead to major trauma, which is the greatest cause of morbidity and mortality worldwide. The purpose of the study was to determine the clinical epidemiological profiles of the patients received in intensive care units (ICU) with road traffic injuries (RTIs). METHODS: The study, which included 300 patients, was conducted at emergency departments and two reference ICUs in Saudi Arabia. The patients were of varying ages and genders from different demographic backgrounds with different modes of injuries, varying degrees of shock, and multiple types of injury. Study variables included demographics, clinical presentations, and the types of fractures and lacerations. RESULTS: Most of our study population was male (n = 273; 91%). Car accidents were found to be the prevalent cause of injury (n = 267; 89.0% cases). Only 21.7% of the study population (n = 65) needed ICU admission compared to non-ICU patients (n = 235; 78.3%). Injuries to the chest (P = 0.0001), abdomen (P = 0.0001), upper limbs (P = 0.022), and spine (P = 0.001) significantly contributed to ICU admissions. CONCLUSION: The burden on ICUs due to RTIs can be reduced in Saudi Arabia by adopting strict preventive measures against RTAs.

The epidemiology of drowning among Saudi children: results from a large trauma center.

BACKGROUND: Drowning is the third leading cause of unintentional death among children worldwide. Although natural waters pose a risk of drowning in low-income countries, swimming pools are more prevalent in high-income countries. In Saudi Arabia, injuries and drowning are a significant threat to population health. Local data is limited, which affects an understanding of the extent of the burden and the development of prevention strategies. OBJECTIVE: Determine the epidemiological characteristics, risk factors, and clinical outcomes of drowning among children. DESIGN: Retrospective chart review. SETTING: Patients admitted to the tertiary care unit of a hospital in Riyadh. PATIENTS AND METHODS: Data was collected on children who drowned (age 0-14) between January 2015 and August 2020. Cases were identified from the electronic health record system where the diagnosis was drowning. Differences in characteristics and outcomes between nonfatal cases with no neurological damage and fatal cases with neurological damage were analyzed. MAIN OUTCOME MEASURE: Drowning mortality and morbidity. SAMPLE SIZE: 99. RESULTS: Of the 99 drowning cases, 22 (22.2%) had a fatal outcome or resulted in neurological damage. The most-reported drowning site was private pools (82%). The majority of cases involved children younger than the age of two (54%). Eighty-four cases (84.8%) occurred on holidays. Cardiopulmonary resuscitation was performed in 61 (61.6%) of cases. A significant association was found between the delay in initiating resuscitation and an unfavorable outcome (P<.01). A high Glasgow Coma Scale score upon admission was a predictor of normal recovery (P<.01). CONCLUSION: These findings warrant investment to increase public awareness of the risks of leaving children unsupervised in swimming pools. In addition, there is a need to ensure early resuscitation of drowning victims by promoting life support courses in order to facilitate positive outcomes. LIMITATIONS: The study was conducted in one tertiary center located in a non-coastal city so the results may not be generalizable. CONFLICT OF INTEREST: None.

Two hepatic cavernous hemangiomas mimicking colorectal liver metastasis: A rare case report.

INTRODUCTION: 1 Hepatic cavernous hemangioma (HCH) is a common benign lesion of the liver. The radiological features of HCH can resemble those of hepatic malignancies such as metastatic liver cancer, which make the preoperative definitive diagnosis difficult. PRESENTATION OF CASE: We report the case of a 77-year-old woman who presented with a 2-month history of abdominal pain and per rectum fresh bleeding. The initial diagnosis at the referral hospital, based on computed tomography (CT) scan of the chest, abdomen, and pelvis, was sigmoid colon cancer with liver metastasis. Further evaluation at our hospital, the patient underwent colonoscopy and biopsy. Histopathological examination of the biopsy revealed an invasive moderately differentiated adenocarcinoma. The patient underwent laparoscopic sigmoidectomy and left hepatectomy. The histopathological examination of the sigmoid colon mass revealed an invasive moderately to poorly differentiated adenocarcinoma. One out of twenty lymph nodes is positive for metastatic carcinoma. The pathological stage is pT3, pN1a, pM0. The histopathological examination of the left hepatic lobe revealed two hyalinized cavernous hemangiomas with no malignancy is seen. The postoperative recovery was uneventful, and the patient was discharged home with regular follow-up in our outpatient clinic. DISCUSSION: HCH is congenital vascular malformation and is the most common benign hepatic tumors. Fine-needle biopsy during diagnostic laparoscopy for undiagnosed multiple liver tumor can differentiate atypical HCH from colorectal metastasis but can potentially lead to rupture or seeding of cancer cells. CONCLUSION: Surgical resection is necessary to determine if the mass is malignant in some atypical HCH mimicking liver metastasis to confirm the diagnosis with histopathologic examination.

Knowledge, Attitude, and Practice of Paracetamol and Ibuprofen Administration Among Caregivers of the Pediatric Age Group in Jeddah.

Background Fever is one of the most common pediatric conditions usually managed by parents and the cause of nearly all pediatrician visits. However, many parents find the management of childhood fever and febrile diseases challenging owing to a lack of understanding of the nature, effects, and therapies of fever management. Objectives This study aimed to assess the knowledge, attitude, and practice of paracetamol and ibuprofen administration among caregivers of the pediatric age group. Design Observational cross-sectional survey. Setting Jeddah, Saudi Arabia. Materials and Methods Data were collected between April 2018 and April 2019 using a pretested interviewer-administered questionnaire consisting of 40 questions. Sample Size Overall, 493 caregivers were interviewed. Results Paracetamol was reported as the most common antipyretic used by the caregivers (54%) to control fever. Ibuprofen was the least preferred drug (18.5%). The majority of the participants (51.7%) admitted administering antipyretics at a body temperature of 38-38.5°C. A total of 90.7% of the participants measured children's temperature using a thermometer before administering antipyretics. Dosage was determined according to each child's age (40.4%), weight (32%), or illness severity (27.6%). However, 36.7% and 51.5% of the participants were unsure of the correct dosage of paracetamol and ibuprofen, respectively. Regarding the maximum frequency of paracetamol use, only 3.7% of the participants answered correctly. Most parents (70.4%) believed that a paracetamol/ibuprofen prescription was not necessary. Overall, 97% of the sample demonstrated inadequate knowledge about antipyretic administration. Conclusions Most caregivers had inadequate knowledge regarding factors that influence paracetamol and ibuprofen dosage and frequency of administration. This low level of knowledge increases the risk of improper drug intake, which can result in serious side effects, thereby indicating the need for the development of educational route programs to provide parents with appropriate education and information on fever and fever management.

Radiological environmental studies of Al Aziziah area and vicinity, Al Madinah Al Monawarah, Saudi Arabia.

The Al Aziziah area is built on volcanic and granitic rocks. The igneous rocks always contain a high amount of naturally radioactive elements such as uranium, thorium and potassium, which produce gamma rays causing environmental hazards when exceeding the permissible limit. Radon gas is a result from the decomposition of uranium/thorium leaks into enclosed areas (e.g. homes or offices). This leakage is controlled by many conditions, and one of them is the underlining rock type. To work on such an environmental study, a gamma ray spectrometer survey was used. The uranium, thorium and potassium contents, as well as their ratios and the total radiation, were determined and mapped. The radiation dose rate was calculated and mapped in mSv/y and nGy/h units. The radiation contamination of groundwater is detected from the contour map of the dose rate over the artificial drainage lines of rains and floods which move this water to the groundwater wells. The main results are as follows: granitic rocks show an average dose rate of about 2.4 mSv/y, while the deposits of these rocks have an average dose rate of 1.2 mSv/y. A low average dose is recorded over the basalt. The average radiation dose recorded in the study area is 1.08 mSv/y, while its range is from 0.001 to 4.41 mSv/y. The estimated effective doses within the Al Aziziah area and vicinity area were higher than 1 mSv/y, which is the public exposure limit, and lower than the occupational exposure limit of 20 mSv/y. We recommend ventilating homes and offices in these places on an ongoing basis and constant radon measuring in closed places.