Dynamic Compression Plating Versus Antegrade Intramedullary Nailing for the Treatment of OTA/AO 12-A Fractures: A Retrospective Cohort Study.

BACKGROUND: Fractures of the humerus diaphysis are common and often result from motor vehicle accidents (MVAs). Treatment methods range from nonoperative approaches to various operative techniques, including antegrade intramedullary nailing (AIMN) and dynamic compression plate (DCP) fixation. This study aimed to compare the cost effectiveness and outcomes of plating and nailing for humerus diaphyseal fractures. METHODS:  A retrospective cohort study involving 59 cases of humerus diaphyseal OTA/AO 12-A fractures was conducted at King Saud Medical City (KSMC), a level I trauma center located in the center region in Riyadh, Saudi Arabia. Patients treated with AIMN, anterolateral plating, or posterior plating were included. Data on demographics, clinical parameters, radiographic healing, and costs were collected and analyzed. RESULTS: The average surgical duration was shorter in the AIMN group compared to the anterolateral and posterior plating groups but with no statistical significance (P > 0.05). The average length of stay (LOS) was shorter, and the change in hemoglobin levels was lower in the AIMN group when compared to other groups but without a statistically significant difference (P > 0.05). The average cost of AIMN was significantly higher than that of anterolateral and posterior plating groups (P < 0.0001). CONCLUSION:  While both nailing and plating procedures are options for treating OTA/AO 12-A fractures, AIMN carries a higher overall procedural cost. The practice of drain placement in our study population is likely the cause of the increased LOS in the plating groups. Relative additional analgesic requirements were associated with AIMN. Surgeons should consider meticulous hemostasis to avoid drain placement, which can decrease LOS, thus possibly decreasing unnecessary treatment costs of humerus shaft fractures.

Air-gun pellet at C1: a case report and literature review.

Background: Air-gun pellet injuries commonly occur in children between the age of 1-18 years old. These injuries could be fetal because it linked to injury to vital organs such as brain, heart, and eyes. In the literature, there are few studies that reported spine injury by air-gun pellet. Our case is a C1 foreign body in a pediatric patient without any neurological deficits after an air-gun injury. Case Description: A 6-year-old boy, known case of Hirschsprung disease presented to the emergency department after an air-gun injury in June 2021. On examination, the patient was hemodynamically stable, and asymptomatic. Neurological exam was intact with power 5/5 in C5-S1 and sensation 2/2 in C5-S1. Computed tomography (CT) of the cervical spine showed a foreign body at C1. After discussing the treatment options with his parents, we treat the patient conservatively by close follow-up and analgesia only. After 1 week, the patient presented to the clinic and the patient was still asymptomatic. A cervical X-ray at that time done and showed no changes in the position from the initial CT. Weekly follow-up was difficult for the family to adhere to due to their socioeconomic status. Therefore, the patient was followed up over the phone call through telemedicine at 6 months and 1 year after the injury. Conclusions: The treatment of these types on injuries is highly controversial. The treatment options could be surgical or non-surgical (conservative) such as antibiotic use. Also, there is always a debate about the choice of the treatment options.

Surgical correction of foot equino-cavocarus deformity in Klippel-Trénaunay-Weber syndrome: a case report.

Klippel-Trénaunay-Weber syndrome (KTWS) is a rare condition characterized by a classic clinical triad. However, it can also have other features, such as cavocarus foot deformity, which is a rare presentation in a patient with KTWS. In this case report, we present our surgical technique of correcting such a complex deformity. Also, there are no other similar cases reported in the literature. An 18-year-old girl who is a known case of KTWS with a complaint of progressive unilateral left foot deformity. Her examination, revealed a rigid pes cavus with an equinus deformity in the left foot. Radiography of the left foot revealed marked cavus as well as hindfoot and forefoot varus. A successful surgical correction of the deformity was described in a stepwise fashion. The management of foot cavocarus deformity in KTWS patients is associated with high intra- and post-operative risk due to its complexity. Therefore, the management requires a multidisciplinary team approach.

Blunt Abdominal Trauma Leading to an Incidental Finding of Duplicate Inferior Vena Cava (DIVC): A Case Report and Literature Review.

BACKGROUND With a prevalence of about 2% to 3%, duplication is the most common anomaly associated with the inferior vena cava (IVC). In general, systemic venous anomalies are being more frequently diagnosed in asymptomatic patients. We report the case of a young man with an incidental finding of an asymptomatic duplicated IVC, along with a literature review. CASE REPORT A 36-year-old man was brought to our Emergency Department (ED) following a high-speed motor vehicle collision (MVC), reporting right flank and hip pain. Upon examination, the "seatbelt sign" was noticed, along with abrasions over his right side. He sustained a small-bowel mesenteric injury, for which he was admitted and was treated conservatively. A CT scan incidentally revealed a duplicate IVC (DIVC). He later underwent a laparotomy with limited right hemi-colectomy and was discharged home in good condition. CONCLUSIONS Undiscovered and asymptomatic DIVCs pose a potential risk to patients during clinical interventions. Advancements in diagnostic imaging contribute greatly to the incidental discoveries of inferior vena cava duplication.

Prevalence of diabetic peripheral neuropathy among type II diabetic patients in King Fahd University Hospital, Khobar, Kingdom of Saudi Arabia.

Background: Diabetic peripheral neuropathies (DPN) are a common complication of diabetes mellitus (DM). DPN can be either painless or painful.General objective: To determine the prevalence of DPN among DM type II patients at King Fahd University Hospital (KFUH), Al-Khobar, Kingdom of Saudi Arabia (KSA).Specific objectives: To see the association between the prevalence of DPN and patient demographics and body mass index (BMI).To assess the relationship between the prevalence of DPN and DM type II and duration of disease.To provide awareness and education of DPN by pamphlets to the recruited diabetic patients at KFUH, Al-Khobar, KSA.Methods: questionnaire-based cross-sectional study, recruited DM type II patients from the internal medicine outpatient clinics at KFUH, Khobar, KSA. The investigators recorded patients' demographics (age, sex, and nationality), height, weight, and BMI, diabetes duration in years and laboratory results of fasting blood glucose (FBG), Hemoglobin A1C and the Michigan Neuropathy Screening Instrument (MNSI) has been applied.Results: among 187 recruited patients with type II DM, the prevalence of DPN was 37.4%. The mean age range of the sample was 56.4 ± 11.2 years. Females to males were 62.6% vs 37.4%. Saudis represented a great proportion of the participants constituting nearly 95.2%. The mean BMI of patients was 33.6 ± 7.08 kg/m2. The mean FBG was 161.4 ± 62.9 mg/dL while the mean value of HbA1c was 8.11%±1.63%. HbA1c levels were significantly associated with DPN. Duration of DM of more than 1 year and FBG levels were significant predictors for patients to have DPN. Other socio-demographic variables such as age, gender, nationality, and BMI levels were not significantly associated with DPN.Conclusion: DPN affects 37.4% of type II diabetic patients at King Fahd University Hospital in Saudi Arabia. Approximately 60% of patients were not aware of the importance of daily foot care. Thus, foot care pamphlets were distributed to patients.

Quality of Life and Cochlear Implant: Results in Saudi Children.

Objective To assess the quality of life (QoL) in Saudi children with cochlear implants (CI) and determine sociodemographic and clinical factors that have an impact on the perceived QoL. Methods A cross-sectional study is performed by comparing the QoL of Saudi toddlers and young CI recipients with normal children, using the Paediatric Quality of Life Inventory 4.0 - Generic core scale (PedsQLTM 4.0 - GCS). A self-administered questionnaire was sent to parents of paediatric patients, who had cochlear implantation at King Abdulaziz University Hospital (KAUH), from March 2016 to March 2018. Mothers of age-matched normal children who attended the obstetrics and gynaecology clinics at King Khalid University Hospital (KKUH), in November 2019 were considered as a control group. Results When children with CI and normal children PedsQLTM 4.0 - GCS subscales (physical, emotional, social, and school) and total functioning scores were compared, no single significant difference was noted between the groups. The sociodemographic and clinical factors that have an impact on the perceived QoL were: gender, birth order, and distance from the CI center. Emotional, social, psychosocial, and total functioning were the main dimensions affected. Conclusion The QoL of Saudi children with CI is comparable to those of normal children. However, among children with CI, gender, birth order, and distance from the CI center were found to have different effects on the QoL dimensions.

Severity and depression can impact quality of life in patients with myasthenia gravis.

BACKGROUND: The revised 15-item Myasthenia Gravis (MG) Quality of Life Questionnaire (MGQoL15R) is a validated scale of quality of life in patients with MG. We aimed to study the factors causing the variability within the Arabic version of the MGQoL15R (MGQoL15R-A). METHOD: A standardized questionnaire was completed by 118 patients. Correlations and hierarchical regression analyses were used to assess the contribution of sociodemographic variables, clinical factors, Patient Health Questionnaire-9 (PHQ9-A), and Generalized Anxiety Disorder-7 (GAD7-A) to the variability in the MGQoL15R-A. RESULTS: The MGQoL15R-A was highly correlated with PHQ9-A (r = 0.76), and moderately correlated with GAD7-A (r = 0.52). Clinical factors and PHQ9-A independently explained 30.4% and 34.5% of the variability, respectively. Among the clinical factors, uncontrolled MG status, relapse within the past year, and a higher number of current MG therapies were significantly associated with a higher MGQoL15R-A score. CONCLUSIONS: MG severity and depressive symptoms (measured by PHQ9-A) can affect the MGQoL15R-A score.