Bilateral simultaneous rotational ankle fractures: case series and literature review

Bilateral Simultaneous rotational ankle injuries are rare entities with little number of cases reported in literature. Unlike axial type ankle fractures, they tend to happen as a result of pivoting trauma on the supportive limb. We conducted a case series and literature review of patients who presented with simultaneous bilateral ankle injuries and discussed their presentation and imaging. A total of Four cases in our institute and 6 separate cases reported in literature were found who sustained bilateral simultaneous rotational ankle fractures. There were 10 cases, nine of which were simultaneous and symmetrical ankle injuries. Injuries found were; Maisonneuve fracture, Tillaux fracture, Syndesmotic injury, Lauge-Hansen’s supination external rotation (SER), pronation external rotation (PER), supination adduction (SAD), and pronation abduction (PA). Four cases were presented in our institute over the last 10 years. A single case was asymmetrical in nature given the presence of an associated distal tibial metaphyseal fracture. Bilateral rotational ankle injuries are rare entity presenting simultaneously unlike axial type ankle fractures. When they present, they are likely caused by higher mechanism of injury than typical unilateral rotational ankle fractures. SER injuries are the most commonly found mechanism in both unilateral and bilateral ankle injuries.

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

COVAC: A Blockchain-based COVID Testing and Vaccination Tracking System

Blockchain is an emerging technology based on a distributed digital ledger system. Decentralized trust is one of the key factors behind the blockchain-based system. The transparency of such a system is better than a conventional centralized ledger system. By using a blockchain-based transaction system, any business organization can harness key benefits like data integrity, confidentiality, and anonymity without involving any third party in control of the transactions. Since the blockchain is used in numerous applications, the horizon is expanding at an unprecedented pace. It was found that tracking COVID vaccination in a transparent and accountable way is an emerging need, especially after the pandemic outbreak around the world. The blockchain platform is a good match for such applications. In this study, a blockchain-based COVID-19 testing and vaccination tracking system, called COVAC, has been designed to manage the COVID testing and vaccination process for local organizations. The “Prototype Software Development" approach was used to determine the system requirements according to the practical knowledge obtained through the vaccine monitoring and screening tests process and then communicated with local healthcare facilities to determine whether these requirements were satisfied. The blockchain-based implementation ensured the system transparency, integrity, and security of data on COVID-19 testing and vaccinatio

Coronavirus disease 2019 (COVID-19) in special groups: A single-center experience in sickle cell disease patients in Saudi Arabia

BACKGROUND: Sickle cell disease (SCD) is a group of hereditary diseases, inherited as autosomal recessive disorder, which causes mutation in the β-globin gene. As a result, there is a change in the sixth amino acid from glutamic acid to valine. The affected red blood cell is then prone to polymerization and sickling crisis under conditions of low oxygen tension. One of the major causes of mortality in SCD is acute chest syndrome (ACS). On the other hand, coronavirus disease 2019 (COVID-19) is a pandemic disease that carries significant mortality and morbidity worldwide with unknown outcomes in the affected SCD population. This study was created for that reason. MATERIALS AND METHODS: We report a case series of ten SCD patients who were affected by COVID-19 and required admission between May 1, 2020, and October 30, 2020, at a tertiary care hospital in Dhahran, eastern region of Saudi Arabia. Historical data were obtained retrospectively from electronic records. MS Excel was used for data entry, and SPSS version 23 was used for data analysis. RESULTS: The mean age of the patients involved in the study was 32 years, and the mean duration of symptoms was 5.7 days. None required critical care admission, and there was no mortality. All patients were discharged from hospital in good condition with no requirement of home oxygen. CONCLUSION: Although we expected a fatal outcome of SCD patients affected by COVID-19 infection, our limited case series showed favorable disease behavior and outcome, with a suspicion of underlying unclear protective mechanism from serious complications. However, further studies are required to better understand COVID-19 behavior in SCD patients

Prevalence of type 2 inflammation in patients with chronic rhinosinusitis with nasal polyps in Saudi Arabia

BackgroundChronic Rhinosinusitis (CRS) is a common condition causing a significant worldwide burden, affecting 5%–12% of the general population. CRS is classified into type 2 and non-type 2 disease based on endotype dominance. Type 2 inflammation is distinguished by the presence of IL-4, IL-5, and IL-13 cytokines, along with eosinophil and mast cell activation and recruitment. Evidence of type 2 inflammation is ascertained by tissue eosinophil count >10/high-power field (HPF) or serum eosinophil >250 cells/mcL or total immunoglobulin E (IgE) > 100 IU/ml.ObjectivesTo investigate the prevalence and characteristics of type 2 inflammation in patients who presented with nasal polyps and underwent Endoscopic Sinus Surgery (ESS) in Saudi Arabia.DesignA retrospective cross-sectional Study.MethodsThis study was conducted among patients who presented with nasal polyps and underwent ESS at King Saud University Medical City (KSUMC) from 2015 to 2020. Patients with nasal/sinus diseases other than Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) were excluded. Demographic data, olfaction status, and co-morbidities were collected, and radiological images were evaluated. Type 2-CRS was determined by meeting at least one of three predictor criteria (blood eosinophils ≥250 cells/mcL, tissue eosinophils ≥10/HPF, or total IgE levels ≥100 IU/ml). Blood parameters and histopathologic analysis were obtained for each patient.ResultsOf the 381 patients included in the study, the prevalence of type 2-CRS, based on the EPOS2020 criteria, was 99.7% in our population. Among these patients, 47.5% had hyposmia, 38.8% had anosmia, and 13.6% had normal olfaction. The most prevalent co-morbidity was allergic rhinitis, followed by bronchial asthma.ConclusionThis study aimed to determine the prevalence of type 2 inflammation among patients Diagnosed with CRSwNP and underwent ESS in Saudi Arabia. The results showed a prevalence of 99.7%, indicating that almost all recorded patients with CRSwNP in our population had type 2 inflammation

Pharmacovigilance Practices by Healthcare Providers in Oncology: A Cross-Sectional Study

Investigating pharmacovigilance (PV) practices among oncology healthcare providers (HCPs) is crucial for patient safety in oncology settings. This study aimed to assess the awareness, attitudes, and practices towards PV and identify barriers to effective adverse drug reaction (ADR) reporting for HCPs working in oncology-related settings. Employing a cross-sectional survey design, we collected data from 65 HCPs, focusing on their experiences with ADR reporting, education on ADR management, and familiarity with PV protocols. The results showed that about half of the responders were pharmacists. Around 58.9% of the respondents reported ADRs internally, and 76.9% had received some form of ADR-related education. However, only 38.5% were aware of formal ADR review procedures. Methotrexate and paclitaxel emerged as the drugs most frequently associated with ADRs. The complexity of cancer treatments was among the common reasons for the low reporting of ADRs by the study participants. The findings highlight the need for enhanced PV education and standardized reporting mechanisms to improve oncology care. We conclude that reinforcing PV training and streamlining ADR-reporting processes are critical to optimizing patient outcomes and safety in oncology, advocating for targeted educational interventions and the development of unified PV guidelines