ABSTRACT
INTRODUCTION: Warfarin-induced necrosis is a rare complication associated with the use of warfarin in addition to antiphospholipid syndrome. CASE PRESENTATION: A 50-year-old female patient with a known case of antiphospholipid syndrome started warfarin treatment for ischaemic changes in her toes and subsequently experienced warfarin-induced necrosis in her left breast. Then, warfarin treatment was suspended, and she was started on enoxaparin. Debridement was performed, and a skin graft was applied without complications. DISCUSSION: Skin necrosis has many differential diagnoses, and physicians must take a proper history and perform a physical examination with proper investigations involving a multidisciplinary team, including plastic surgery, haematology, internal medicine, and wound care specialists. Plastic surgery offers many options for reconstruction depending on the patient's medical condition, the size of the wound and the location following the reconstructive ladder. CONCLUSION: This case report presents a rare complication of warfarin in the context of antiphospholipid syndrome and describes the management of unilateral breast necrosis. Physicians should be highly suspicious of this condition in patients with skin necrosis who were administered warfarin or have antiphospholipid syndrome.
ABSTRACT
PURPOSE: To assess the level and determinants of knowledge and practice regarding contact lens (CL) and its accessories among adult Saudi CL users. METHODS: This survey was conducted in 2015 for Saudi contact lens users visiting a Mall in Riyadh, Saudi Arabia. The questions were related to knowledge about contact lenses, correct CL and accessories usage. We inquired indication, initial prescription, CL use, complications experienced and their management. The knowledge and practice responses were correlated to their determinants. RESULTS: In this survey, 510 contact lens users participated. The level of knowledge was of excellent grade among 279 [54.7% (95% Confidence Interval 50.4-59)] CL users. The practice was of excellent grade in 210 [41.4% (95% CI 37.1-45.7)] CL users. Variation in knowledge was not associated to gender (P = 0.1), education (P = 0.4), type of work (P = 0.3), funding for CL (P = 0.1). Occasional users and those not having prescribed CL had significantly poor knowledge (P < 0.001). The excellent level of practice was associated to younger CL users (P = 0.004). While it was not associated to gender (P = 0.8), type of CL (P = 0.9), funding for CL (P = 0.2), education (P = 0.7) and occupation (P = 0.1). CONCLUSIONS: The knowledge and practice among CL users was less than desired. Those using contact lens for cosmetic purpose and procuring them without prescription need special focus for health promotion so that their CL related practice improve and eye complications are reduced.
