Gastric perforation leading to the diagnosis of classic Ehlers-Danlos syndrome: a case report.

BACKGROUND: Ehlers-Danlos syndrome is a clinically and genetically heterogeneous group of heritable connective tissue disorders caused by a defect in collagen synthesis and structure. The vascular subtype (Ehlers-Danlos syndrome IV) is reported to be associated with a higher incidence of gastrointestinal perforations. The most reported site of perforation is the colon, followed by the small bowel. Perforation of the stomach is very rare, and there are no reported cases to date of classic types I and II. CASE PRESENTATION: We present the case of a 14-year-old Saudi girl who visited our emergency department with abdominal pain and vomiting. Initially, she was diagnosed with gastroenteritis and discharged once her condition stabilized. After 48 hours, she developed severe abdominal pain with recurrent vomiting and peritonitis evident on clinical examination. Initial abdominal x-ray failed to show any free air; however, enhanced computed tomography revealed free air and contrast extravasation in the proximal gut. During exploratory laparotomy, a large perforation was found on the anterior wall of the stomach due to the underlying ischemia. The posterior wall had ischemic mucosa with an intact healthy serosa. A free-hand partial gastrectomy was performed to resect all ischemic parts of the stomach. Detailed examinations and laboratory workup were carried out after the surgery to figure out the possible underlying cause. The clinical findings during the physical examination supported marfanoid features. Marfan's syndrome and related disorders sequencing panel was requested, and Deoxyribonucleic acid (DNA) samples were sent. Given results were supporting the diagnosis of classical Ehlers-Danlos syndrome, the patient was labeled as a case of Ehlers-Danlos syndrome. During the postoperative period, she developed a wound infection that was managed successfully with vacuum-assisted closure dressing. She recovered well without gastrointestinal sequelae in the 4 years of follow-up. CONCLUSIONS: Heritable systemic connective tissue diseases must be given serious consideration in young patients with unusual spontaneous perforation. Such patients might develop life-threatening conditions that require immediate intervention. Hence, correct and timely diagnosis is important to prepare for the anticipated complications.

Osteoporosis knowledge, attitudes, and practices among female Princess Nourah University students in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVE: Osteoporosis is characterized by decreased normal bone density. More than 8.9 million fractures worldwide annually are caused by osteoporosis; these fractures are a significant cause of morbidity and mortality. Evidence suggests that the modification of several lifestyle habits could assist in lowering the incidence of osteoporosis. However, limited studies have been conducted in Saudi Arabia to assess the knowledge, attitudes, and lifestyles associated with osteoporosis among college-age females. This study aimed to provide evidence to assist in the development of effective strategies against osteoporosis. MATERIALS AND METHODS: This cross-sectional study was conducted at Princess Nourah Bint Abdul Rahman University (PNU), in February 2018; a self-administered questionnaire was used. The different components of the questionnaire assessed knowledge, attitudes, and lifestyles with regard to osteoporosis. The participants were divided into groups on the basis of their age as follows: juniors, 17-20 years of age; seniors, 21-25 years of age. RESULTS: Of the 250 included participants, 122 (49%) and 128 (51%) were seniors and juniors respectively. Only 16% of all participants achieved a good score on the knowledge questionnaire; in particular, knowledge regarding osteoporosis risk factors was inadequate. Media was the only source of information of the included participants. Only 49% of participants believed that osteoporosis is a serious disease. Overall, only 32% and 27% of juniors and seniors are consumed sufficient dairy products, and 13% and 11% of juniors and seniors engaged in physical exercise, respectively. CONCLUSION: Osteoporosis misconceptions were extremely prevalent among PNU students, as was poor knowledge and lifestyle habits regarding osteoporosis. Information regarding osteoporosis presented through the media needs to be revised and simplified. Concerned institutions should combine their efforts eventually practice. Information about osteoporosis presented through media need to be revised, simplified, and implement a national program to improve osteoporosis awareness and prevention.

Wound Care Knowledge and Perception of the Saudi General Population in Riyadh Region.

Objective: Proper wound care and management are essential in health care facilities to prevent complications. There are many statistical studies on wound management both globally and in the Middle East. However, patient perception and knowledge regarding wound care have not been assessed in depth. Therefore, this study explored patient perception, attitude, and knowledge of wound care as well as the factors influencing patient perception among the Saudi population. Approach: This cross-sectional study included 414 individuals (mean age, 34 years; females, 64%) from varied social backgrounds who met the inclusion criteria. It was conducted in Riyadh, Kingdom of Saudi Arabia (KSA), from June to December 2019. Data were obtained from the participants using a pretested, validated self-administered questionnaire. Results: Of the participants, 78.0% completed a bachelor's degree or higher. The majority (71.7%) had an average level of knowledge regarding wound care. Most of the participants sought medical information from nonmedical resources-from social media (42.8%) and from relatives and friends (40.6%). Moreover, most of them (73.3%) used home remedies, 77.1% Vaseline, 71% butter, 70.2% coffee beans, 71.5% toothpaste, and 83.1% Zamzam water for their wounds. Innovation: This study is the first study to address the beliefs of the Saudi nonhealth care community toward wound care. Conclusion: Our findings revealed a gap between the level of education and knowledge and beliefs of our population, which could negatively affect clinical outcomes. To address this issue, there is a need to develop an awareness program on wound care and management for patients and providers.