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 Traumatic atlantoaxial (upper cervical spine) leads to instability in weightbearing movement and neurological deficit. Presently, C1 (axial) lateral mass or pedicle screws for fixation are the most popular because of excellent mechanical performance for internal fixation. C1 pedicle screw fixation can reduce intraoperative blood loss and postoperative occipital neuralgia more than C1 lateral mass screws. However, screws cannot be inserted completely through the pedicle in some patients due to C1 size.  We aimed to determine the ideal pedicle screw entry point, angle of screw projection, and pedicle height in the Thai population.  Patient data were collected and measured using the INFINITT program at Mukdahan Hospital from September 2020 to June 2021. The C1 measurements, i.e., distance from the midline to the medial edge of the posterior arch (DPA) and medial edge transverse foramen (DTF), angle of screw projection, and length and height of the pedicle were recorded. Descriptive statistics and -test were used to analyze the data.  The mean Thai pedicle dimensions were DPA = 14.17 mm (range: 11.19-19.70 mm), DTF = 22.09 mm (range: 18.13-26.44 mm), ideal screw entry point = 18.13 mm (range: 15.19-22.00 mm), ideal angle of screw projection medial angulation = 2.67 degrees (range: 0-7 degrees), and height of posterior arch (pedicle) = 4.77 mm (range: 2.68-7.22 mm). Forty of 167 patients (24.0%) had a pedicle height less than 4.0 mm (bilateral 11 patients and unilateral 29 patients).  The ideal C1 pedicle screw entry point is approximately 18.13 mm from the midline. In the Thai samples with C1 pedicle height less than 4.0 mm, the screws cannot be inserted completely through the pedicle. Therefore, screw insertion should be partially through the pedicle (notching technique).

Background In this retrospective study, we aimed to investigate the effect of chlorhexidine digluconate-flurbiprofen spray (Klorhex Plus® oral spray) on postoperative sore throat (POST) and hoarseness (POH) in patients undergoing rhinoplasty. Methodology Patients who underwent rhinoplasty alone in our clinic between April 01, 2021, and February 28, 2022, were enrolled in the study. Patients' demographics such as age, gender, height, and smoking status that could affect sore throat, difficult intubation, and operation time were recorded from the patients' files. Patients were grouped as those who received Klorhex Plus oral spray before the surgery (Klorhex P group) and those who did not (control group). POST and POH were recorded from the patients' postoperative surgery files. Postoperative pain evaluation was performed using the Numerical Rating Scale (NRS) at the postoperative first hour (PPL1h), 12th hour (PPL12h), and first day (PPL1d) from the postoperative nursing files. Results A total of 354 patients who underwent rhinoplasty alone were included in this study. No significant difference was found between the groups in terms of the demographic data. Statistically, PPL1h, PPL12h, and PPL1d were significantly lower in the Klorhex P group compared to the control group (for all, p < 0.001). POST and POH were also significantly higher in the control group (both, p < 0.001). Conclusions The results of this study indicate that Klorhex Plus oral spray is an efficient agent for preemptive analgesia before rhinoplasty. It significantly decreases the postoperative pain level, POST, and POH. However, further comprehensive prospective studies are needed to introduce Klorhex Plus oral spray to rhinology practice.

Introduction Hydrocephalus is a build-up of cerebrospinal fluid (CSF) in the brain and is characterized by abnormal dilatation of the cerebral ventricles. Patients can be either asymptomatic, have symptoms related to primary tumors, or have hydrocephalus-related symptoms. Generally, symptomatic patients are candidates for ventriculoperitoneal (VP) shunt placement to reduce acute symptoms. Little evidence exists regarding the resolution of symptomatic hydrocephalus secondary to brain tumors using stereotactic radiosurgery (SRS) alone as a primary treatment option. Methods The present study is a retrospective series of eight patients (six men and two women) diagnosed with obstructive hydrocephalus due to brain tumors treated with radiosurgery between April 2013 and February 2021. The primary endpoint of the present study is to report our institutional experience regarding the control of symptomatic obstructive hydrocephalus due to brain tumors treated with upfront radiosurgery. Results The mean age was 52 years (range, 5-79). The most common presenting symptoms included headache (100%), vision-related symptoms (75%), and ataxia (37.5%). All patients showed symptom improvement after radiosurgery, five (62.5%) patients showed resolution in less than three days and the rest of the patients resolved hydrocephalus in a longer timeframe (more than three days). All patients lowered their Evans index compared to the index documented before radiosurgery, in a range from 0.02 to 0.17. Conclusion Radiosurgery is a non-invasive alternative treatment for primary and secondary brain tumors that debut with obstructive hydrocephalus, tumors expected to have a high alpha/beta ratio might be suitable to attempt radiosurgery to avoid permanently implanted devices such as VP shunts or other invasive procedures such as a third ventriculostomy. The present study demonstrated that in selected cases SRS can lead to hydrocephalus symptom resolution along with a decrease in ventricular size in a relatively short time frame. Little evidence exists regarding the effect of SRS on symptomatic hydrocephalus resolution and further histology-specific studies are required. We acknowledge that this approach requires immediate access to radiosurgery and close clinical follow-up to ensure success.

The purpose of the study was to evaluate, as a pilot trial, safety and tolerability of CAM-101 10% and 30% topical ophthalmic fibrinogen-depleted human platelet lysate (FD hPL) solution in patients with dry eye disease (DED) secondary to graft-versus-host disease (GvHD) after 6 weeks of treatment.

Cancer cervix is a major health problem responsible for causing a higher mortality rate in women worldwide; the exponential increase in such cases can be reduced by early screening of women. The cytology-based cervical screening had a higher success rate in reducing the incidence of cervical cancer. The present study aimed to evaluate the use of Pap smear screening to find cytological abnormalities and precancerous lesions.

The research was designed to assess the consequences of aqueous leaf extract (AILE) neuropathic pain in Wister rats and the role of the ATP-dependent potassium channel (K) as an underlying mechanism.

Stroke is a debilitating neurological disorder with hemiplegia as most common presentation. Hemiplegic shoulder pain (HSP) affects a large number of stroke survivors and is associated with significant morbidity and low quality of life (QoL). The etiology is multifactorial and therefore the management is multipronged. Traditionally, oral analgesics have been advised with physical therapy and intra-articular steroid injections. This narrative review discusses emerging treatment strategies for HSP. It focuses on four key new treatments; electric stimulation, the use of robotics, intraarticular injections of novel anti-inflammatory agents, and pulsed radiofrequency treatment. Multiple studies have assessed the efficacy of these techniques and have found the efficacy and side effect profile to be comparable or superior to current management strategies for HSP. Integrating these interventions in the multidisciplinary rehabilitation programmes for stroke patients, can improve the management of HSP and reduce stroke related morbidity and disability.

Introduction Inflammatory bowel diseases (IBD) (Crohn's disease (CD) and ulcerative colitis (UC)) are considered among the commonest gastrointestinal (GI) tract diseases manifesting with chronic, recurring episodes of gut inflammation, especially in the colon. Each disease has its pattern, symptoms, severity of pain, extension, management, and prognosis. However, these diseases share most of the various complications, including the GI tract and extending it to other systems such as musculoskeletal, skin, liver, and pulmonary systems. Objectives We aim to identify the demographic data, prevalence, risk factors, clinical presentation, and management (medications given and investigations ordered) of thromboembolic events (TEE) among inflammatory bowel disease patients at King Fahad Specialist Hospital (KFSH) in Buraydah, Al-Qassim, Saudi Arabia. Materials and methods This is a retrospective, cross-sectional study. All included patients with IBD who meet the inclusion criteria between January 2020 and January 2022 in KFSH were reviewed, and data were analyzed using the Statistical Package for the Social Sciences (SPSS) Statistics version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 187 participants were included in the current study. The mean age of the participants ± standard deviation (SD) was 28.7 ± 10.8 years old. Of the participants, 107 (57.2%) were males. A total of 121 (64.7%) participants were diagnosed with Crohn's disease (CD), 56 (29.9%) with ulcerative colitis (UC), and 10 (5.3%) with both CD and UC. In 156 (83%) participants, the duration of the disease was 1-5 years. Among the IBD patients, two (1.1%) had TEE in the interval resolution middle and left portal vein, as well as the inferior mesenteric vein. The majority of the participants (73.3%) were with no history of comorbid conditions. The most reported clinical symptoms were chest pain as reported by 3.2% of the participants. Abdominal computed tomography (CT) was the most reported method of diagnosis as reported by 35.8% of the participants. Of the participants, 8.6% used heparin prophylactically, 0.5% used heparin as a treatment, and 0.5% used enoxaparin as a treatment. Moreover, 20.3% of the participants used prophylactic treatment, whereas about 79.7% did not use prophylactic treatment. Old age, extensive disease, colorectal surgery, and pregnancy were not found to be associated with thromboembolic events (p = 1.000, 0.400, 0.164, and 0.053, respectively). Age, gender, and nationality were not significantly associated with thromboembolic events (p = 0.915, 1.000, and 1.000, respectively). Conclusion Despite IBD being one of the emerging health concerns in the Kingdom of Saudi Arabia, records showed that the prevalence of thromboembolic events was found to be lower when compared to the prevalence reported in the relevant multinational studies. The was no difference in factors affecting the development of thromboembolic events between IBD patients and the general population. Recommendations We should stress raising awareness of IBD patients about their condition, the increased risks of developing thromboembolic events, and the proper prevention methods.

Cytokine release syndrome (CRS) is caused by the release of inflammatory cytokines that appear during or immediately after administration of a therapeutic antibody and can cause a variety of symptoms. COVID-19 vaccination is effective in cancer patients and prevents breakthrough infections. The safety of vaccines during immune checkpoint inhibitor (ICI) therapy has been reported; however, multiple vaccinations have been developed in recent years, and it is unclear whether repeated vaccinations play a role in the development of CRS in patients receiving ICI.

People who inject drugs are disproportionately affected by acute/chronic bacterial and viral infections that are a cause of significant morbidity. Clinical presentations to the acute medical take vary from skin and soft tissue infections to complications of bacteraemias, and can be challenging with difficulties in adherence, pain management, early self-discharges and loss to follow-up.This review summarises the most recent UK epidemiology of injecting drug use and infection as well as clinical presentation and management.