Benign glandular schwannoma

We report a case of a benign glandular schwannoma in a 63-year-old male who presented with a solitary subcutaneous mass on the left knee, with no previous history of neurofibromatosis type 1. This histological subtype is rare, with only 38 cases reported in the literature. Some of the glands found in this patient resembled sweat glands. These lining stromal spindle cells were positive for S-100 but negative for EMA. S100 was faintly staining the glandular elements. All the glands in the tumor were positive for EMA, particularly at the luminal borders. They were also positive for pancytokeratin. The cystic areas variably show intraluminal, foamy, and hemosiderin-laden macrophages. The different glands expressed two patterns. Some of these were reactive for CK7 and low molecular weight keratin. Immunohistochemical workup is mandatory to assess the neoplastic nature of this glandular component

Fatal case of a child harboring Enterobius vermicularis

Enterobius vermicularis is a threadlike parasite also known as “pinworms”. It is the most common helminth infection, affecting the gastrointestinal tracts of children worldwide, although it seldom causes any fatalities. Enterobius vermicularis infections are usually asymptomatic and may only cause anal pruritis, with occasional reported cases of ectopic migration into the appendix or the female genital tract by adult pinworms. Here, we report a case of a 15-year-old girl who presented to the emergency department with high-grade fever, vomiting, and vague abdominal pain for three days. She was diagnosed with acute abdominal pain and underwent emergency ileocecectomy, but died the following day. Pathological examination of ileocecal junction showed intraluminal and intramural Enterobius vermicularis, which were attributed as the cause of her death in the absence of any other pathologies. Death due to Enterobius vermicularis is rare; this case calls for clinicians to be vigilant in exploring Enterobius vermicularis infections in patients with undiagnosed acute abdominal pain, since it could be a potential cause of death

External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data

Nawfal A Aljerian,1,2 Abdullah A Alharbi,3 Hani A Alghamdi,4 Meshary S Binhotan,5,6 Reem S AlOmar,7 Ali K Alsultan,1 Mohammed S Arafat,1 Abdulrahman Aldhabib,1 Mohammed K Alabdulaali1 1Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; 2Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 3Family and Community Medicine Department, Jazan University, Jazan, Kingdom of Saudi Arabia; 4Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 5Emergency Medical Services Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 6King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia; 7Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi ArabiaCorrespondence: Hani A Alghamdi, Department of Family and Community Medicine, College of Medicine, King Saud University, P.O Box 12372, Riyadh, 7065, Kingdom of Saudi Arabia, Tel +966507022266, Email [email protected]: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA).Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals.Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25– 64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value < 0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25– 64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50).Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.Keywords: e-referrals, health policy, epidemiology, public healt

Histopathological Findings in Laparoscopic Sleeve Gastrectomy Specimens from Patients with Obesity in Saudi Arabia

Laparoscopic sleeve gastrectomy is a bariatric surgical procedure performed in patients with morbid obesity that provides the opportunity to review histopathological changes. The aim of this study was to characterize resected gastric specimens obtained from a Saudi patient population at a single center for a prospectively maintained database of laparoscopic sleeve gastrectomy cases. The histopathological findings from all patients undergoing laparoscopic sleeve gastrectomies at King Khalid University Hospital between 2010 and 2015 were retrospectively reviewed. Of the 602 cases reviewed, the majority (83.4% [n=502]) exhibited chronic gastritis, whereas 22.3% (n=134) involved Helicobacter pylori infections with active gastritis, 1% (n=6) had intestinal metaplasia, and one case (0.17%) revealed gastric adenocarcinoma. As the findings revealed conditions that are treatable, I highly recommend histological examinations of all sleeve gastrectomy specimens from a Saudi patient population

Pyoderma Gangrenosum Induced by BNT162b2 COVID-19 Vaccine in a Healthy Adult

(1) Background: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of unknown etiology. Coronavirus disease 2019 (COVID-19) vaccines can cause a variety of adverse cutaneous manifestations. PG associated with mRNA vaccines has not previously been described. This case study reports on the first patient to develop PG after receiving BNT162b2. (2) Case Presentation: An otherwise-healthy 27-year-old man developed multiple skin lesions 24 h after receiving the first dose of the messenger RNA-based Pfizer/BioNTech BNT162b2 COVID-19 vaccine. When in hospital, he developed a new painful ulcerative lesion on his right hand. Skin ulcer edge biopsy showed severe epidermal neutrophilic infiltrate with epidermal and dermal edema, underlying superficial dermal necrosis, and characteristic undermining with extensive mixed inflammatory infiltration of the dermis and abscess formation consistent with an ulcer with mixed dermal inflammation compatible with pyoderma gangrenosum. The lesion showed rapid improvement after the initiation of immunosuppressive therapy. (3) Conclusions: PG may be a rare adverse event related to the BNT162b2 vaccine, which could be more frequently encountered with the wide-scale use of mRNA vaccines. The continuous monitoring and surveillance of skin manifestations post-vaccination is essential

Evaluation of telephone cardiopulmonary resuscitation performance in current practice in Saudi Arabia

Objectives: out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system.Methods: a retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR.Results: a total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively.Conclusion: T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers’ locations could improve T-CPR performance

Squamous cell carcinoma with rhabdoid phenotype and osteoclast‐like giant cells in a renal–pancreas transplant recipient

Squamous cell carcinoma (SCC) is the commonest non‐melanotic malignant skin tumour encountered after solid‐organ transplantation. In this setting it is associated with a worse prognosis than sun‐damage‐induced SCC. Rhabdoid cells and osteoclastic giant cells are infrequently seen in SCC. This case highlights the unusual occurrence of rhabdoid cells and osteoclastic giant cells in a post‐transplant SCC

Expression of Glucose Transporters 1 and 3 in the Placenta of Pregnant Women with Gestational Diabetes Mellitus

Background: The annual prevalence of gestational diabetes mellitus—characterized by an increase in blood glucose in pregnant women—has been increasing worldwide. The goal of this study was to evaluate the expression of glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3) in the placenta of women with gestational diabetes mellitus. Methods: Sixty-five placentas from women admitted to the King Saud University Medical City, Riyadh, Saudi Arabia, were analyzed; 34 and 31 placentas were from healthy pregnant women and women with gestational diabetes, respectively. The expressions of GLUT1 and GLUT3 were assessed using RT-PCR, Western blotting, and immunohistochemical methods. The degree of apoptosis in the placental villi was estimated via a TUNEL assay. Results: The results of the protein expression assays and immunohistochemical staining showed that the levels of GLUT1 and GLUT3 were significantly higher in the placentas of pregnant women with gestational diabetes than those in the placentas of healthy pregnant women. In addition, the findings showed an increase in apoptosis in the placenta of pregnant women with gestational diabetes compared to that in the placenta of healthy pregnant women. However, the results of gene expression assays showed no significant difference between the two groups. Conclusions: Based on these results, we conclude that gestational diabetes mellitus leads to an increased incidence of apoptosis in the placental villi and alters the level of GLUT1 and GLUT3 protein expressions in the placenta of women with gestational diabetes. Understanding the conditions in which the fetus develops in the womb of a pregnant woman with gestational diabetes may help researchers understand the underlying causes of the development of chronic diseases later in life

Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility

Objective: The aim of this study was to determine the incidence of adverse events and patients’ outcomes in inter‑facility critical care transfers by paramedics. Methods: We conducted a retrospective cohort study of adults undergoing inter‑facility transfer to a tertiary medical facility by paramedics. We included all patients transferred between 1st June, 2011 and 31st December, 2014. The primary outcome is in‑transit adverse event and the secondary outcome is in‑hospital mortality. Multiple logistic regression models were fitted to assess predictor variables for adverse events and in‑hospital mortality. Results: The incidence of adverse events was 13.7% (31/227 patients had in‑transit adverse event); the most common adverse events reported were desaturation and hypotension. A unit increase in risk score for transported patients (RSTP) significantly increased the occurrence of adverse events (adjusted odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.07–1.72 and adjusted P = 0.01). Compared to medical patients, cardiac patients were less likely to develop adverse events (adjusted OR: 0.117, 95% CI: 0.02–0.52 and adjusted P < 0.01). The in‑hospital mortality was 30.4% and 30-day survival was 68.1%. For two patients whose age differed by 1 year, the older patient was more likely to die (adjusted OR: 1.03, 95% CI: 1.01–1.05 and P < 0.01) and a unit increase in RSTP significantly increased occurrence of in‑hospital mortality (adjusted OR: 1.30, 95% CI: 1.0–1.60 and P = 0.01). Conclusion: The incidence of adverse events was 13.7%. The most common observed adverse events were desaturation and hypotension. In‑hospital mortality was 30.4% and 30-day survival was 68.1%