Paediatric Sweet's syndrome with pulmonary involvement triggered by severe inflammatory bowel disease and emergent total abdominal colectomy with literature review

Sweet's syndrome (SS) is a neutrophilic dermatosis characterised by the acute onset of erythematous papules or plaques and a constellation of symptoms including fever, leucocytosis, and histopathology demonstrating nodular, pustular, or diffuse infiltrate of neutrophils with marked papillary oedema. SS can be a manifestation of inflammatory bowel disease and often coincides with periods of disease flares. Only a few cases of SS associated with ulcerative colitis are reported in the literature, and no cases have involved pulmonary manifestations in the paediatric population. We present a case of a 14-year-old girl presenting with new onset ulcerative colitis requiring emergent colectomy with subsequent development of pulmonary SS. Treatment consisted of intravenous and oral corticosteroids and dapsone. SS should be considered in the differential diagnosis of prolonged fever with cutaneous involvement and systemic symptoms. Special consideration should be given to paediatric patients with extracutaneous manifestations, particularly pulmonary involvement.

Arteriovenous malformation with hair collar sign

We report the case of a newborn who was noted at birth to have an occipital scalp nodule presenting with a hair collar sign (HCS). The nodule had enlarged since birth. An MRI revealed a soft tissue mass on the occipital scalp without deep extension or cranial bone involvement. A biopsy of the nodule led to a diagnosis of arteriovenous malformation (AVM). A vascular malformation with HCS has not been reported before in North America. This case highlights the complexity of diagnosing a lesion with a hair collar sign.

Severe eczema in Wiskott-Aldrich syndrome-related disorder successfully treated with dupilumab

Treatment of severe eczema in patients with primary immunodeficiencies can be particularly challenging as there are no guidelines with regards to these conditions. Dupilumab is an interleukin (IL)-4Rα antagonist that inhibits both IL-4 and IL-13 and is approved for the treatment of atopic dermatitis in pediatric patients. In this report, we describe a patient with a case of severe eczema in the context of Wiskott-Aldrich syndrome-related disorder, who was successfully treated with dupilumab.

TikTok as a Source of Medical Information: Port Wine Stain Birthmarks and Treatment Using Vascular Lasers

BACKGROUND

As social media usage grows, more patients are turning to various platforms to gain and share medical information. One platform, TikTok, has become immensely popular, with over one billion users. Despite its potential use as an educational tool, TikTok can be unreliable and misleading as a medical information source.

OBJECTIVE

 We aim to discuss the information available on TikTok regarding laser treatment for port wine stains (PWS).

METHODS

Two independent reviewers analyzed 200 TikTok videos with the hashtags #portwinestainlaser or #portwinestaintreatment, examining the video creator's role (e.g., patient, parent, physician, or other), tone towards PWS and treatment options, and content (e.g., educational or non-educational, mention of any treatment risks).

RESULTS

 Most videos were produced by non-medical professionals (83%), and only a small number discussed the potential adverse effects of PWS treatment options (15%).

CONCLUSION

While TikTok may have a role in educating patients about certain dermatologic conditions and treatment options, it is important to encourage patients to seek medical advice from a qualified medical professional before making any treatment decisions. Furthermore, the future of patient education may need to evolve to include social media platforms.

Prevalence and Risk Factors of Stroke Among Children With Sickle Cell Disease: A Retrospective Study at a Tertiary Care Center

Background Sickle cell disease (SCD) is a common autosomal recessive inherited hemoglobin disorder in many countries. Neurological complications are among the most disabling complications in SCD. Stroke and cerebral vasculopathy can lead to further neurological insult. Ischemic insults, stroke, and silent infarcts are preventable causes of morbidity and mortality in SCD patients. Understanding the epidemiology and characteristics of such patients will help to prevent complications.  Methodology This is a retrospective study conducted in a tertiary care center in Saudi Arabia. Cases of SCD admitted to the pediatric ward between the years 2019 to 2023 were included in the study. Demographic data, clinical diagnosis, and frequency of prior admissions were collected. Brain imaging results were reviewed and included. Furthermore, the study assessed common risk factors leading to developing a stroke in SCD pediatric patients. Risk factors and clinical outcomes after stroke were also included. Results Eighty-one patients were enrolled. The mean age of stroke patients was 8.21±3.50 years while the mean age of non-stroke patients was 6.24±3.76 years. More than half of the patients were females in both the stroke (61.50%) and non-stroke groups (52.90%). Thirteen SCD patients (16%) were diagnosed with stroke. Previous history of stroke, high mean corpuscular volume (MCV), and low red blood cells count (RBC) were statistically significant risk factors for stroke (p<0.0001), (p<0.0001), (p<0.03), respectively.  Conclusion Stroke is one of the most devastating complications of SCD. The prevalence of stroke among SCD patients in our study was 16%. Transcranial Doppler ultrasound screening is the most important predictor of stroke.

Vulvar lichen planus–induced vulvovaginal stenosis: A case report and review of the literature

The authors report a case of vulvar lichen planus–induced vulvovaginal stenosis along with a review of the current literature. The authors outline a case of a patient with biopsy-proven vulvar lichen planus who subsequently developed a vulvovaginal stenosis. Treatment was initiated with clobetasol ointment, oral prednisone, later transitioned to oral methotrexate and clobetasol, and then switched to acitretin. Collaboration with the patient’s family physician and the hypertension clinic has been sought to remove medications associated with lichenoid reactions from the patient’s regimen. Review of literature was conducted through Ovid MEDLINE. Only six cases of vulvar lichen planus–induced vulvovaginal stenosis had been found, suggesting the relative rarity of this severe disease presentation. The patient has achieved control with her current regimen, as well as some clinical improvement of the resulting vaginal stenosis. Vulvovaginal stenosis can be induced by vulvar lichen planus, and its management requires a multimodal and multidisciplinary approach.

Risk Factors of Hospital-Acquired Pneumonia Among Hospitalized Patients With Cardiac Diseases

Background To our knowledge, no studies have been done in Saudi Arabia to determine the risk factors of hospital-acquired pneumonia (HAP) among hospitalized cardiac patients. This study aimed to assess these risk factors. Methods A retrospective study was done at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Five hundred hospitalized patients diagnosed with pre-existing cardiovascular disease (CVD) were included. A checklist was used to collect data about patients' demographic characteristics; BMI; smoking and alcohol abuse; type of cardiac disease; other chronic diseases; exposure to immunosuppressives; chemotherapy and radiotherapy in the last six months; glucocorticoid use; application of ventilator; initial, follow-up chest X-ray results; pneumonia vaccination status; nasogastric tube use; general anesthesia received; use of loop diuretics; presence of pulmonary diseases; levels of WBC, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP); results of blood and respiratory cultures; number of hospitalizations and intensive care unit (ICU) admissions in the last six months; and Richmond Agitation and Sedation Scale (RASS) score. Results The prevalence of pneumonia was 7%. Females; patients with autoimmune diseases who were exposed to immunosuppressives or glucocorticoids; those with an initial or second abnormal chest X-ray; patients who used nasogastric tube, had pulmonary disease, and had high levels of WBC, ESR, or CRP; and patients hospitalized for more than two times had a significantly higher percentage of having pneumonia. Abnormal second chest X-ray, high ESR, and more than two times of hospitalization within the last six months were the risk factors of pneumonia on multivariate logistic regression analysis. Conclusion Better prevention and intervention programs are needed to assess the risk factors of pneumonia among admitted cardiac patients.

CBCT based study to analyze and classify root canal morphology of maxillary molars - A retrospective study

OBJECTIVE

The study aims to evaluate maxillary molars' root and root canal morphology among the Saudi population using Cone-Beam Computed Tomography scanning (CBCT).

SUBJECTS AND METHODS

Retrospectively, the CBCT scans of 483 Saudi nationals were evaluated to identify the number of roots and root canals in maxillary first and second molars. The records were tabulated and classified according to Vertucci and a new system for root and canal classification given by Ahmed and Dummer. Fisher's exact test was used to analyze the data statistically. To check for symmetry, comparisons were made between all the maxillary first molars (MFM's) and maxillary second molars (MSM's) on opposing quadrants. Inter Observer variability was seen using Cohen's Kappa test.

RESULTS

MFM's presented with three roots with Type II Vertucci canal configuration (VC) commonly seen among them. MSM's had more variations in the number of roots and canals, although three roots and Type I VC were predominantly seen. When comparing the two genders statistically significant difference was observed in both maxillary molars at a 5% level using Fisher's exact test. Three roots with four canals (3R4C) were predominantly observed in the MFM's (85.6%) and three roots with three canals (3R3C) identified in 51.95% were more common than 3R4C (43.55%) in MSM's. Both the maxillary molars bilaterally, exhibited a high percentage of symmetry in root and canal configurations.

CONCLUSIONS

Identification of root canal morphology of molars would reduce the chances of root canal failures by making sure all canals are obturated. This study provides supplemental information about the root canals of maxillary molars in a Saudi Arabian subpopulation.

Awareness, knowledge, attitudes, and practices before the second wave of the COVID-19 pandemic in Saudi Arabia

OBJECTIVE

The COVID-19 outbreak was first reported in Wuhan City, China in early December 2019. It was declared a pandemic by WHO in March 2020. This study aimed at assessing the knowledge, awareness, and attitudes of the general population in Saudi Arabia towards COVID-19, as well as its adherence to preventive measures and its willingness to take the vaccine.

PATIENTS AND METHODS

This descriptive cross-sectional study involved an online sample of 7,188 participants (from five regions of Saudi Arabia) who completed a self-administered online-based questionnaire. They were recruited from 23 November 2020 to 29 November 2020 based on the nonprobability convenience sampling method. The self-administered questionnaire comprised four main sections: gathering information about participants' demographics, knowledge and awareness of COVID-19, participants' practices (hygiene and other) against infection, and vaccine acceptability.

RESULTS

More than half of the study participants were knowledgeable about COVID-19. The mean scores were 10.4 (SD=3.44, range: 0-18 - with high scores indicating better knowledge or awareness) for knowledge and 6.1 (SD=2.26, range: 0-11) for awareness, indicating a need for more educational campaigns to improve the level of knowledge and awareness among the Saudi Arabian population about COVID-19. The mean score for attitude was 5 (SD=1.67, range: 0-8 - from 0=very pessimistic to 8=very optimistic), indicating moderate optimism. As for practices, the mean score was 7.8 (SD=1.57, range: 0-10), indicating good practices to prevent or control infection. Concerning acceptability of the COVID-19 vaccine, 63.8% of the participants agreed to take the vaccine if it was proven to be 95% effective.

CONCLUSIONS

The findings of this study can help us designing effective measures against COVID-19 infections. Our results highlight the best practices adopted by the Saudi Arabian population, as well as those areas requiring improvement, including knowledge, attitudes, and practices against this disease.

Assessment of Patients' Knowledge in Managing Side Effects of Chemotherapy: Case of King Abdul-Aziz University Hospital

Patients education about chemotherapy and its side effects is important. The health-related distress among the patients can be decreased by promoting self-care behaviors. A cross-sectional study was conducted at the King Abdul-Aziz University Hospital with 90 patients from the hospital's oncology department in Jeddah during the period between December 2015 and January 2016. The study was performed by using a self-administered questionnaire among the sample of the study. Eight percent (n = 33) patients scored higher knowledge regarding chemotherapy and its side effects, while 11.1% (n = 8) had low knowledge. Moreover, 36.1% (n = 26) of patients reported complete compliance with the self-care behaviors to manage chemotherapy side effects, 43.1% (n = 31) reported partial compliance, and 20.8% (n = 15) reported less compliance. Physicians were reported as main source of information by 80.6% (n = 58) of their patients. Involving healthcare professionals in educating patients regarding chemotherapy can prove to have positive outcomes.

Clinical genomics expands the morbid genome of intellectual disability and offers a high diagnostic yield

Intellectual disability (ID) is a measurable phenotypic consequence of genetic and environmental factors. In this study, we prospectively assessed the diagnostic yield of genomic tools (molecular karyotyping, multi-gene panel and exome sequencing) in a cohort of 337 ID subjects as a first-tier test and compared it with a standard clinical evaluation performed in parallel. Standard clinical evaluation suggested a diagnosis in 16% of cases (54/337) but only 70% of these (38/54) were subsequently confirmed. On the other hand, the genomic approach revealed a likely diagnosis in 58% (n=196). These included copy number variants in 14% (n=54, 15% are novel), and point mutations revealed by multi-gene panel and exome sequencing in the remaining 43% (1% were found to have Fragile-X). The identified point mutations were mostly recessive (n=117, 81%), consistent with the high consanguinity of the study cohort, but also X-linked (n=8, 6%) and de novo dominant (n=19, 13%). When applied directly on all cases with negative molecular karyotyping, the diagnostic yield of exome sequencing was 60% (77/129). Exome sequencing also identified likely pathogenic variants in three novel candidate genes (DENND5A, NEMF and DNHD1) each of which harbored independent homozygous mutations in patients with overlapping phenotypes. In addition, exome sequencing revealed de novo and recessive variants in 32 genes (MAMDC2, TUBAL3, CPNE6, KLHL24, USP2, PIP5K1A, UBE4A, TP53TG5, ATOH1, C16ORF90, SLC39A14, TRERF1, RGL1, CDH11, SYDE2, HIRA, FEZF2, PROCA1, PIANP, PLK2, QRFPR, AP3B2, NUDT2, UFC1, BTN3A2, TADA1, ARFGEF3, FAM160B1, ZMYM5, SLC45A1, ARHGAP33 and CAPS2), which we highlight as potential candidates on the basis of several lines of evidence, and one of these genes (SLC39A14) was biallelically inactivated in a potentially treatable form of hypermanganesemia and neurodegeneration. Finally, likely causal variants in previously published candidate genes were identified (ASTN1, HELZ, THOC6, WDR45B, ADRA2B and CLIP1), thus supporting their involvement in ID pathogenesis. Our results expand the morbid genome of ID and support the adoption of genomics as a first-tier test for individuals with ID.

Excessively redundant umbilical skin as a potential early clinical feature of Morquio syndrome and FKBP14-related Ehlers-Danlos syndrome

Several umbilical abnormalities have been linked to and utilized to aid in the clinical diagnosis of certain syndromes. For instance, umbilical skin redundancy has long been recognized as a core feature of Rieger syndrome although its association with other disorders is unknown. In this article, we report for the first time the occurrence of this distinct clinical sign in association with two other syndromes: Morquio syndrome and FKBP14-related Ehlers-Danlos syndrome (EDS). Our observation is clinically significant because patients with Morquio syndrome are often diagnosed only after they develop typical skeletal manifestations, which reduces the efficacy of available enzyme replacement therapy, so the umbilical sign we report here can facilitate a much earlier diagnosis. In addition, the extreme rarity of FKBP14-related Ehlers-Danlos syndrome (EDS) can greatly delay the diagnosis of this condition unless it is recognized in the differential diagnosis of redundant umbilical skin as we argue in this report.