A diaphragmatic hernia in a traumatic patient simulating a hemorrhage: A case report

A traumatic diaphragmatic rupture occurs in approximately 5 % of all trauma cases, making diagnosis difficult. Images can be used for most diagnoses; however, some can be detected intraoperatively. Based on its presentation, mechanism, side, diagnostic modality, and surgical approach, the diaphragmatic hernia can be discussed from several perspectives. In this report, we present the case of a 39-year-old female who suffered a rupture of her right diaphragm following a motor vehicle accident. Her symptoms mimic those of hemorrhage. A repair was performed through an abdominal approach, and the patient was discharged from the hospital without complications

Surgical outcomes of the surgical techniques following management of iatrogenic trigeminal nerve injuries: A systematic review

Objective: To investigate the effectiveness of the microsurgical treatment in restoring full sensory recovery following trigeminal nerve injuries caused by iatrogenic oral and maxillofacial surgical interventions. Methods: A detailed search was conducted on the Cochrane central register of controlled trials, Medline and Embase. Clinical studies with at least twelve months of follow up were included and assessment of risks of bias was made using the Robbin I assessment tool. Results: Six studies were identified in the searches which include 227 patients. The lingual nerve was the most common injured nerve, followed by the inferior alveolar nerve. Third molar removal was the most frequent cause of nerve injury, followed by root canal treatment, pathology excision, coronectomy, orthognathic surgery, dental implants and then local anaesthetic injections. Overall, surgical interventions for nerve injuries showed neurosensory improvement postoperatively in the majority of patients. Conclusion: Direct neurorrhaphy is still the gold-standard technique when the tension at the surgical site is minimal. Promising results have been noted on conduit applications following traditional repair or grafting. Further research is needed on the efficacy of allografting and conduit applications in nerve repair

Diabetic Retinopathy and Eye Screening: Diabetic Patients Standpoint, Their Practice, and Barriers; A Cross-Sectional Study

Diabetes mellites (DM) is one of the most common systemic disorders in Saudi Arabia and worldwide. Diabetic retinopathy (DR) is a potentially blinding ophthalmic consequence of uncontrolled DM. The early detection of DR leads to an earlier intervention, which might be sight-saving. Our aim in this cross-sectional study is to assess patients’ knowledge and practices regarding DR, and to detect the barriers for eye screening and receiving a check-up from an ophthalmologist. The study included 386 diabetic patients. One hundred and thirty-one patients (33.9%) had T1DM and 188 (48.7%) had T2DM. Most of the diabetic patients (73.3%) know that they must have an eye check-up regardless of their blood sugar level. DM was agreed to affect the retina in 80.3% of the patients, 56% of patients agree that DM complications are always symptomatic, and 84.5% know that DM could affect their eyes. The fact that blindness is a complication of diabetic retinopathy was known by 65% of the diabetic patients. A better knowledge was detected among patients older than 50 years of age (54.9%) compared to those aged less than 35 years (40.9%), which was statistically significant (p = 0.030). Additionally, 61.2% of diabetic patients who were university graduates had a significantly better knowledge in comparison to 33.3% of illiterate patients (p = 0.006). Considering the barriers to not getting one’s eyes screened earlier, a lack of knowledge was reported by 38.3% of the patients, followed by lack of access to eye care (24.4%). In conclusion, there is a remarkable increase in the awareness of DR among the Saudi population. This awareness might lead to an earlier detection and management of DR

Comparing the effectiveness of corticosteroid and surgery in managing chronic subdural hematoma: A systematic review and meta-analysis

Background: The optimal treatment for Chronic Subdural Hematoma (CSDH), corticosteroids or surgery, remains controversial. This meta-analysis compares the efficacy and safety of these interventions. Methods: We searched four databases until July 2023 for relevant studies. Data extraction was independently performed by two authors. Risk ratios (RR) with a 95% confidence interval (CI) were calculated for dichotomous outcomes and mean difference (MD) with a 95% CI for continuous outcomes. Results: Six studies involving 804 patients were included. Dexamethasone showed non-inferiority to surgery for good neurological outcomes (pooled RR = 1.02, 95% CI [0.95, 1.09], P = 0.60). No significant differences were found in mortality, recurrence rate, and hospital stay length between the two groups. Conclusion: Our analysis indicated that there was no statistically significant difference in terms of good neurological outcomes, length of hospital stay, mortality, and recurrence rate between the surgical interventions and dexamethasone. However, we noticed only clinical and numerical differences between the surgical interventions and dexamethasone regarding length of hospital stay, mortality, and recurrence rate. On the other hand, dexamethasone was associated with statistically higher complications compared to surgery. However, we should treat these results with caution as the only included RCT reported a high recurrence rate with dexamethasone indicating that surgery may be the first-line treatment for patients with CSDH