Human Herpesvirus 8 (HHV-8) Staining: A Savior in Early Kaposi Sarcoma.

Kaposi sarcoma (KS) is a low-grade vascular neoplasm associated with human herpesvirus 8 (HHV-8) infection. The disease has various phases, and the morphology of the lesion may vary, especially in the early course of the disease, where the morphological features may not be even suggestive of Kaposi sarcoma. The authors take this opportunity to report a case of Kaposi sarcoma where the diagnosis was established because of HHV-8 staining rather than its histopathological features.

Incidence, predictors and outcomes of redo pancreatectomy in infants with congenital hyperinsulinism: a 16-year tertiary center experience.

PURPOSE: Recurrent severe hypoglycemic attacks often persist even after performing pancreatectomy for medically unresponsive congenital hyperinsulinism (CHI). In this study, we present our experience with redo pancreatectomy for CHI. METHODS: We reviewed all children who underwent pancreatectomy for CHI between January 2005 and April 2021 in our center. A comparison was made between patients whose hypoglycemia was controlled after primary pancreatectomy and patients who required reoperation. RESULTS: A total of 58 patients underwent pancreatectomy for CHI. Refractory hypoglycemia after pancreatectomy occurred in 10 patients (17%), who subsequently underwent redo pancreatectomy. All patients who required redo pancreatectomy had positive family history of CHI (p = 0.0031). Median extent of initial pancreatectomy was lesser in the redo group with borderline level of statistical significance (95% vs. 98%, p = 0.0561). Aggressive pancreatectomy at the initial surgery significantly (p = 0.0279) decreased the risk for the need to redo pancreatectomy; OR 0.793 (95% CI 0.645-0.975). Incidence of diabetes was significantly higher in the redo group (40% vs. 9%, p = 0.033). CONCLUSION: Pancreatectomy with 98% extent of resection for diffuse CHI, especially with positive family history of CHI, is warranted to decrease the chance of reoperation for persistent severe hypoglycemia.

Conservative Management of an Unusual Congenital Abdominal Wall Defect: A Case Report.

Congenital abdominal wall defects comprise a spectrum of anatomical anomalies of the abdominal wall. Most of these anomalies are located in the midline. However, in rare cases, it was lateral and usually found to be a fascial defect with intact skin coverage. We report an unusual case of lateral musculocutaneous abdominal wall defect in a full-term baby boy. The defect is not classified under any of the well-known abdominal wall anomalies. Non-operative management achieved excellent and satisfactory results. Conservative management should always be considered whenever applicable, as it is safe and cost effective.

Telemedicine Practice in Saudi Arabia During the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic has led to an increased use of telemedicine. The primary objective of the study was to evaluate attitudes and behaviors of licensed physicians in the region to telemedicine. METHODOLOGY: A cross-sectional design using an electronic survey as the primary tool was done. The questionnaire had a demographic component of the respondent (first part), covering age, specialty, and experience with telemedicine during the COVID pandemic, and a second part, which was in the form of a Likert scale, covering perceptions related to telemedicine. The Likert scale itself had two main areas: (1) attitudes toward telemedicine and (2) perceived barriers. RESULTS: There were 392 valid responses of which 228 (58.1%) had used some form of telemedicine (other than standard phone calls) during the COVID-19 pandemic. The most common platforms used for telemedicine include WhatsApp® (211, 53.8%), Zoom® (131, 33.4%), Microsoft Teams® (27, 6.2%), Sehha App (65, 16.5%), Email (84, 21.4%). There was a strong agreement on the following statements: "Telemedicine can reduce unnecessary outpatient visits" (87.5%), "Effectiveness of telemedicine depends on the specialty" (89.5%), and "Telemedicine can be used to monitor chronic patients from home" (88.3%). Concerning the barriers to telemedicine, the ones having the most concordance were technological limitations (66.6%) and concerns of diagnostic reliability (66.1%). CONCLUSIONS: The responses from our study seem to suggest that while the attitudes toward telemedicine are positive, practicing physicians are concerned about a perceived lack of clarity regarding related legal frameworks and barriers such as technological issues, cultural factors, and diagnostic concordance.

The Clinical and Laboratory Impact of Upgrading Clostridioides (formerly Clostridium) difficile Infection Testing from Routine to Molecular Based-Algorithm: an Observational Case-Study from the Eastern Province, Saudi Arabia.

BACKGROUND: Clostridioides (formerly Clostridium) difficile infection (CDI) is linked to misuse of antimicrobials. The prevalence of disease varies with difficulties of establishing the diagnosis because of the lack of sensitivity and specificity of laboratory tests. The clinical impact of upgrading CDI testing from routine to molecular based-algorithm is still unclear. The aim of this study is to assess the impact of upgrading CDI testing from routine to molecular based-algorithm on the management of CDI and evaluate the role of antimicrobials on the course of CDI. METHODS: This is an observational case-study. A total of 564 patients were included from whom stool samples were tested by enzyme immunoassay (EIA) and Xpert for C. difficile. Data on the number and results of tests ordered, antimicrobial exposure, comorbidities, and treatment with metronidazole or vancomycin were collected. The main outcome measures were C. difficile tests (EIA and Xpert C. difficile Assay) and prevalence of CDI. RESULTS: CDI was found in 9 and 10 cases out of 313 and 254 patients tested by the EIA and Xpert C. difficile assay, respectively, giving an overall incidence of 0.03 per 1,000 patient tested. Reduction was noted in the number of tests ordered per patient for presumptive CDI after shifting to the Xpert C. difficile assay which was not statistically significant (p-value 0.2). Also, there was less metronidazole and vancomycin therapy initiated for patients with a negative C. difficile test (p-value 0.2) observed with molecular testing. CONCLUSIONS: Xpert C. difficile testing is a supportive tool for diagnosing CDI with rapid turnaround time that is helpful for patient management and initiating effective infection control measures. The clinical accuracy of the assay is still to be determined in the context of low carriage rate in the local patient population.

Saudi practical guidelines on biologic treatment of psoriasis.

The current treatment of psoriasis patients with biologic agents in the Kingdom of Saudi Arabia (KSA) is mainly based on clinical experience. Although there are published international guidelines for treatment with biologics, such as the European S3 guidelines (a joint project of the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the International Psoriasis Council), many nations have found it beneficial to develop country-based guidelines that incorporate specific regional aspects of therapy (legal and practical). With the expanded role of biologic agents in the treatment of psoriasis in Saudi Arabia, a need for local Saudi guidelines has become evident. Here we present a practical approach to the evidence-based clinical administration of biologics for professionals who treat patients with psoriasis.

Carcinoma erysipeloides as a presenting feature of breast carcinoma: A case report and brief review of literature.

Carcinoma erysipeloides (CE) is an uncommon but distinctive form of cutaneous metastasis that usually manifests clinically as a fixed erythematous patch or plaque resembling cellulitis or erysipelas. The inflamed area may show a distinct raised edge at the periphery and also edema secondary to lymphatic obstruction. Histologically, dense carcinoma cells in the dermal vascular channels and dense perivascular lymphocytic infiltrate may be seen. CE may rarely be the first sign of "silent" tumor of breast. We report a case of a 52-year-old married lady who presented with a three months history of pruritic erythematous patches over the left side of the breast that was resistant to all topical treatments and was diagnosed as erysipeloid breast carcinoma.

Nevus lipomatosus cutaneous superficialis with focal lipocytic pagetoid epidermal spread and secondary calcinosis cutis: a case report.

A case of nevus lipomatosus cutaneous superficialis is presented, wherein the lesion occurred as a gluteal swelling in a 6-year-old boy. On histopathology examination, it consisted of typical superficial expanses of mature adipose tissue in the papillary dermis of the polypoidal lesion. It was accompanied by 2 unusual findings, which consisted of the focal presence of lipocytes at the epidermal­dermal junction in the pagetoid manner and the prominent deposition of calcium resulting in calcinosis cutis­like lesions. Calcinosis cutis in the present case occurred as dystrophic calcification in focal fat necrosis changes of the lesion, whereas the focal pagetoid spread of fat cells is likely related to the same hamartomatous adipose tissue growth that ultimately results in the nevus lipomatosus.

Nevus comedonicus of the scalp.

A 10-year-old boy presented to us with a localized patch of hair loss on the scalp, first noticed by his mother a few months after birth. The lesion had shown very little increase in size since that time. There was a history of occasional redness and discharge from the lesion, which used to be controlled with topical applications. There was no history of any trauma to the site. There was no family history of any similar lesion or any associated systemic problems. On examination, grouped comedonal lesions were seen over a patch of partial alopecia located on the occipital area of the scalp (Figure 1). There was no evidence of inflammation. Systemic examination was normal. Biopsy specimen from the lesion on the scalp showed foci of wide and deep invaginations of the epidermis filled with keratin. There was no evidence of any significant perifollicular inflammatory infiltrate (Figure 2). A possibility of an atypical nevus comedonicus was considered. The patient was started on topical tretinoin 0.05% and is under follow-up.

Demographic features and seasonal variations in patients with acne vulgaris in Saudi Arabia: a hospital-based study.

AIM: To review the demographic features and seasonal variations of acne vulgaris in patients diagnosed at the Dermatology Outpatient Clinic, King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. METHODS: Two hundred and twenty cases (142 females, 78 males; mean age, 14.8 and 16.3 years, respectively) seen between January 1, 1999 and December 31, 2000 were studied. RESULTS: Patients suffering from acne vulgaris made up 19.6% of the new cases seen at the clinic. The male to female ratio was 1 : 1.8. The mean age of onset was 16.3 +/- 2.1 years for males and 14.8 +/- 3.9 years for females (P = 0.003). The largest numbers of patients were seen during the cold months of the year (November to February). CONCLUSIONS: Acne vulgaris constituted nearly one fifth of all visits to the dermatologist with female predominance. It appears nearly one and a half years earlier in females than in males. Seasonal variations were observed in acne as the condition exacerbates in winter, while if often improves during the summer months.

Clinical pattern of acne vulgaris and its associated conditions in the eastern province of kingdom of saudi arabia: a hospital-based clinical study.

OBJECTIVE: This study aims to review the clinical pattern of acne vulgaris cases referred to one hospital in the Eastern Province. METHODS: Two hundred cases diagnosed in the Dermatology Department at King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia were studied RESULTS: Inflammatory acne was the predominant type observed in both males and females (76% and, 79%, respectively). Seborrhea (greasy skin) was the most frequently associated condition 22 (11%) followed by dandruff 8 (4%). The difference between males and females was not statistically significant (p-value = 0.46, 0.93, respectively). In female patients, premenstrual flare was observed in 12 (9.8%), irregular period 5 (4.1%), and hirsutism 3 (2.5%).