Spinal Accessory Nerve Injury following Spinal Adjustment: Case Report and Literature Review of the Outcome of Accessory Nerve Pathology as Result of Blunt Trauma (Spinal Accessory Nerve Palsy after Spinal Adjustment).

Spinal accessory nerve palsy (SANP) is rare and is commonly presented following iatrogenic injury. Their diagnosis is often missed on initial presentation. Injury following blunt trauma is rare, with few cases reported in literature describing blunt-associated SANP and their treatment and recovery. We present and discuss a case of SANP following an aggressive soft tissue adjustment by an uncertified individual that has been responsive to nonsurgical measures over 18 months. We also reviewed the related literature on similar cases that were presented as result of direct pressure on the nerve from soft tissue manipulation or heavy lifting and their outcome following treatment. Chiropractic is generally a safe complimentary medicine and must only be practiced by trained personnel. We found that blunt-caused SANP injuries should initially be treated conservatively as they are likely to respond and recover unlike when presented following invasive trauma accordingly to what we found in literature.

Clinical Manifestations of Systemic Lupus Erythematosus in a Tertiary Center in Saudi Arabia.

Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystemic involvement. The clinical presentation and immunological findings of SLE patients from different regions in Saudi Arabia have been studied. There have been no studies on the clinical manifestations of SLE in patients in Saudi Arabia's southern region. This article aims to explore the clinical manifestations of SLE in a tertiary center in the southern region of Saudi Arabia. Methods A retrospective study was carried out on 108 SLE patients who were seen in the rheumatology clinic at Aseer Central Hospital over six months from January 2022 to June 2022. Patients' demographics, clinical and serological characteristics, and therapeutic data were reviewed. Results The male-to-female ratio was 1:12.5, with a mean age at presentation of 28.6 ± 10 years. The mean disease duration was 9.06 ± 5.96 years. Mucocutaneous and musculoskeletal manifestations were the most common, accounting for 76% and 57% of all cases, respectively. Neuropsychiatric involvement and lupus nephritis were present in 29% and 31% of patients, respectively. The hematological abnormalities that were present included anemia (60%), leukopenia (37%), and thrombocytopenia (15%). Antinuclear antibody (ANA) was detected in 100%, anti-double-stranded DNA (anti-dsDNA) antibody in 55%, anti-Smith antibody in 13%, and hypocomplementemia in 52% of patients. Hydroxychloroquine was received by 98% and oral steroids by 41% of the patients. Other drugs include azathioprine (23%), mycophenolate mofetil (15%), methotrexate (23%), belimumab (9%), cyclophosphamide (10%), and rituximab (6%). Conclusion The main clinical features of our patients were in parallel with previous studies in Saudi Arabia as well as in Arab countries. We found a lower prevalence of lupus nephritis, serositis, and anti-dsDNA antibody. Further multicenter studies are required to investigate the long-term outcome and survival of SLE patients.

Identification and quantification of Cr, Cu, and As incidental nanomaterials derived from CCA-treated wood in wildland-urban interface fire ashes.

In addition to the combustion of vegetation, fires at the wildland-urban interface (WUI) burn structural materials, including chromated copper arsenate (CCA)-treated wood. This study identifies, quantifies, and characterizes Cr-, Cu-, and As-bearing incidental nanomaterials (INMs) in WUI fire ashes collected from three residential structures suspected to have originated from the combustion of CCA-treated wood. The total elemental concentrations were determined by inductively coupled plasma-time of flight-mass spectrometry (ICP-TOF-MS) following acid digestion. The crystalline phases were determined using transmission electron microscopy (TEM), specifically using electron diffraction and high-resolution imaging. The multi-element single particle composition and size distribution were determined by single particle (SP)-ICP-TOF-MS coupled with agglomerative hierarchical clustering analysis. Chromium, Cu, and As are the dominant elements in the ashes and together account for 93%, 83%, and 24% of the total mass of measured elements in the ash samples. Chromium, Cu, and As phases, analyzed by TEM, most closely match CrO3, CrO2, eskolaite (Cr2O3), CuCrO2, CuCr2O4, CrAs2O6, As2O5, AsO2, claudetite (As2O3, monoclinic), or arsenolite (As2O3, cubic), although a bona fide phase identification for each particle was not always possible. These phases occur predominantly as heteroaggregates. Multi-element single particle analyses demonstrate that Cr occurs as a pure phase (i.e., Cr oxides) as well as in association with other elements (e.g., Cu and As); Cu occurs predominantly in association with Cr and As; and As occurs as As oxides and in association with Cu and Cr. Several Cr, Cu, and As clusters were identified and the molar ratios of Cr/Cu and Cr/As within these clusters are consistent with the crystalline phases identified by TEM as well as their heteroaggregates. These results indicate that WUI fires can lead to significant release of CCA constituents and their combustion-transformed by-products into the surrounding environment. This study also provides a method to identify and track CCA constituents in environmental systems based on multi-element analysis using SP-ICP-TOF-MS.

Wildland-urban interface fire ashes as a major source of incidental nanomaterials.

Although metal and metalloid concentrations in wildfire ashes have been documented, the nature and concentrations of incidental nanomaterials (INMs) in wildland-urban interface (WUI) fire ashes have received considerably less attention. In this study, the total metal and metalloid concentrations of 57 vegetation, structural, and vehicle ashes and underlying soils collected at the WUI following the 2020 fire season in northern California - North Complex Fire and LNU Lightning Complex Fire - were determined using inductively coupled plasma-time of flight-mass spectrometry after microwave-assisted acid digestion. The concentrations of Ti, Zn, Cu, Ni, Pb, Sn, Sb, Co, Bi, Cr, Ba, As, Rb, and W are generally higher in structural/vehicle-derived ashes than in vegetation-derived ashes and soils. The concentrations of Ca, Sr, Rb, and Ag increased with increased combustion completeness (e.g., black ash < gray ash < white ash), whereas those of C, N, Zn, Pb, and In decreased with increased combustion completeness. The concentration of anthropogenic Ti - determined by mass balance calculations and shifts in Ti/Nb above the natural background ratios - was highest in vehicle ash (median: 30.8 g kg-1, range: 4.5-41.0 g kg-1) followed by structural ash (median: 5.5 g kg-1, range: of 0-77.4 g kg-1). Various types of carbonaceous INM (e.g., amorphous carbon, turbostratic-like carbon, and carbon associated with zinc oxides) and metal-bearing INMs (e.g., Ti, Cu, Fe, Zn, Mn, Pb, and Cr) with sizes between few nanometers to few hundreds of nanometers were evidenced in ashes using transmission electron microscopy, including energy dispersive X-ray spectroscopy. Overall, this study demonstrates the abundance of a variety of metals and metalloids in the form of INMs in WUI fire ashes. This study also highlights the need for further research into the formation, transformation, reactivity, fate, and effects of INMs during and following fires at the WUI.

Effect of Uncomplicated Diabetes Mellitus on Acute Respiratory Distress Syndrome Among COVID-19 Patients in Aseer Region, Saudi Arabia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; an ssRNA virus), which mainly affects the respiratory system but can also cause damage to other body systems. Acute respiratory distress syndrome (ARDS) is a serious complication of COVID-19 that requires early recognition and comprehensive management. ARDS is a diffuse inflammatory process that causes diffuse alveolar damage in the lung.  Aim: The study aimed to assess the effect of uncomplicated diabetes mellitus on ARDS among COVID-19 patients in the Aseer region. METHODOLOGY:  A retrospective cohort study was conducted in Aseer Central Hospital between July 10, 2021 to Jan 15, 2022 where confirmed inpatient COVID-19 cases in the Aseer region were classified into two groups. The first group was diabetic patients without any diabetes-related complications and confirmed for COVID-19 infection (diabetes group). The second group was confirmed COVID-19 patients free from any chronic disease. Extracted data included patients' diabetes status, medical history, socio-demographic data, COVID-19 infection data and vaccination, experienced signs and symptoms, tachypnea, use of accessory muscles of respiration, nasal flaring, grunting, cyanosis, need for hospitalization, need for mechanical ventilation and ICU admission.  Results: The study included 144 patients with uncomplicated diabetes and 323 healthy patients with COVID-19 infection. The mean age of the diabetic group was 65.4 ± 12.9 years old compared to 40.2 ± 11.9 years old for the healthy group. Only one case of the diabetic group was vaccinated against COVID-19 at the study period versus two cases of the healthy group (P=.925). Also, 14 (9.7%) of the diabetic group were contacted with confirmed COVID-19 cases in comparison to 44 (13.6%) healthy cases (P=.238). A total of five (3.5%) diabetic cases needed mechanical ventilation during hospitalization compared to 23 (7.1%) healthy cases with no statistical significance (P=.125). Also, 12 (8.3%) diabetic cases admitted to ICU versus 42 (13%) of healthy cases (P=.145).  Conclusions: In conclusion, there is a great controversy regarding the effect of diabetes on the progression of COVID-19 infection to ARDS. The current study showed that there was no significant difference between diabetic and healthy COVID-19 infected cases regarding ARDS related clinical factors mainly need of ICU admission and mechanical ventilation.

Athletes' knowledge and attitude concerning the meniscus, meniscal injury, and management.

Introduction: Knee injuries largely vary including cartilaginous, ligamentous, bony, and tendinous injuries. Greatest of the reported knee injuries associated with in a non-contact method includes mainly the anterior cruciate ligament (ACL). Additionally, medial and lateral menisci act as shock absorbers with an additional role in stabilizing the joint which can be or partially or totally torn. The current study aimed to assess athletes' knowledge and attitude concerning the meniscus, meniscal injury, and management. Methodology: A descriptive cross-sectional study was conducted to achieve the objectives. A pre-structured electronic questionnaire was used to collect the data, covered participants socio-demographic data, personal and family history of meniscus injury and surgery, physical activity during past year, and also knowledge regarding the meniscal injury and management. Results: A total of 448 athletes fulfilling the inclusion criteria completed the study questionnaire. Participants 'age ranged from 18 to 60 years with mean age of 26.7 ± 7.7 years old. A total of 256 (57.1%) participants were males. Exact of 21 participants had meniscus surgery. As for family history, 75 (16.7%) had family history of meniscus injury. Exact of 95 (21.2%) athletes had good knowledge level, while vast majority (78.8%; 353) had poor knowledge level. Conclusions: In conclusion, the study showed that the estimated rate of meniscus injury and surgery was not high (within the international range). The participants' knowledge regarding meniscus injury and meniscus surgery with its related management was unsatisfactory, where 1 out of each 5 was knowledgeable.

Handwashing Knowledge, Attitudes, and Practices among Students in Eastern Province Schools, Saudi Arabia.

Background. Lack of knowledge about appropriate handwashing practices has caused great concerns for human health, especially in the risk of many communicable diseases. The objective of the current study is to determine the level of handwashing knowledge, attitudes, and practices among school students in Eastern Province Schools, Saudi Arabia. A cross-sectional survey was recruited from November 2019 to March 2020 to assess the level of the students' handwashing knowledge. A reliable questionnaire was prepared (Cronbach's alpha = 0.608) and conducted using a two-stage sampling technique. A total of 271 students participated in the study from primary, middle, and high schools; 80% were boys, most of whom displayed an acceptable level of knowledge on hand hygiene. Nearly 75% and 74% of boys and girls, respectively, gained knowledge about hand hygiene practices from their parents. Only 46% of the students thought that handwashing is a potential protective measure against diseases, whereas 34% thought it only removes dirt. Prevalence of handwashing with soap after using the toilet was recognized among 52% of the students. Additionally, 93% of the students used water and soap to wash their hands (p value < 0.001) and 97% suggested that soap and water are the best methods to wash their hands (p value < 0.001). There was a positive correlation between the mother's education and hand hygiene practices (p value = 0.044). Results collectively indicated that handwashing knowledge and practices among school students in the Eastern Province are acceptable interventions in preventing the transmission of infectious diseases such as COVID-19. Indeed, further improvement conducted through specific health education programs to emphasize the role of handwashing in health hygiene is highly recommended.

Is the surgical site infection rate higher in sublay or onlay mesh repair of incisional hernia?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In mesh repair of incisional hernia, which technique has a lower rate of surgical site infection (SSI), Sublay or Onlay? The best evidence showed that there is no statistically significant difference in the rate of SSI among the two techniques.

Is the recurrence rate of incisional hernia is affected by mesh positioning?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In open mesh repair of incisional hernia, which technique has a lower recurrence rate, Sublay or Onlay? The best evidence showed that there is no statistically significant difference in the rate of recurrence among the two techniques.

Avulsion Fracture of the Tibial Tuberosity Combined with Lateral Tibial Plateau in an Adolescent.

Avulsion fractures of the tibial tuberosity are commonly sustained in adolescent males during sport activities which involve jumping and tackling. Tibial tuberosity avulsions combined with lateral tibial plateau in an adolescent are rare injuries. We received an unusual case of left Ogden type IIIB avulsion fracture of the tibial tuberosity with an articular involvement of the lateral tibial plateau (Salter Harris type IV) in a 14-year-old boy. The injury was sustained after jumping from three stairs where the boy predominantly landed on his left lower limb. Unlike other cases reported, since they were athletes and injuries were sustained during sport activities, our case is an obese individual who jumped off few stairs. The results following surgical treatment are excellent since the fracture united, and the articular surface was restored without the need of arthrotomy with gaining full range of motion. Therefore, displaying this case in the literature will be helpful since it is rare and was successfully treated differently from the previously reported cases.