Rare disease Combined factor V and factor VIII deficiency (F5F8D) is a rare bleeding disorder with an incidence of 1: 1 000 000. The identified mutations were observed in LMAN1 and MCFD2 genes. This case report presents the cases of 3 Saudi siblings with the genetic mutation of LMAN1 causing F5F8D, and highlights the challenges in diagnosis and treatment. Patient X, a 7-year-old boy, was misdiagnosed with hemophilia A after a history of prolonged circumcision bleeding and epistaxis. He was referred to our clinic for pre-operative assessment. Blood workup showed prolonged PT and aPTT, which were normalized by mixing studies. Since his previous diagnosis could not explain a prolonged PT, further investigations were performed, revealing low levels of FVIII and FV. Genetic testing confirmed a c.822G>A homozygous LMAN1 mutation. The other 2 siblings (patient Y and Z), who were 5- and 12-year-old, respectively, girls, were also assessed. They both had a history of epistaxis. The younger sibling also had an episode of bleeding after tooth extraction, and physical examination of this patient revealed a bruise over her left thigh. The older sibling had menorrhagia. Blood workup of both revealed prolonged PT and aPTT, with complete correction by mixing study, and low levels of FV and FVIII. The patients’ backgrounds and lab results were highly suggestive of F5F8D. This case report describes an extremely rare bleeding disorder. More attention should be directed toward this disease, and a careful evaluation of suspicious cases should be performed to better diagnose and manage these patients.

The novel Coronavirus disease 2019 (COVID-19) pandemic has resulted in many adverse outcomes and challenges, and a false-positive result is one of them. Despite that this issue has a substantial impact, there is a scarcity in the literature of its prevalence or impact, and more knowledge is needed. This case report will present the case of a 54-years-old female who was misdiagnosed as COVID-19. The misleading COVID-19 diagnosis can result in significant consequences such as delaying surgeries, unnecessary quarantine and treatments, transplant lists omission, and unnecessary sick leaves. Moreover, as seen in our case, it delayed the other investigations and admitted a healthy patient to a COVID-19 isolation ward. Therefore, physicians should consider the possibility of false-positive results and utilize other investigation tools to further diagnose suspicious cases.

This study aimed to identify the characteristics of pediatric primary health care (PHC) visits and evaluate the outcomes of patients presenting with complaints along with their referral and consultation capabilities. This was a retrospective medical record-based study. The study population included any pediatric patient (≤14 years old), including females and males, Saudis, and non-Saudis. Research data were gathered for visits from 2016–2021. Sampling was performed using a stratified random sample based on age groups, followed by simple random sampling with proportional allocation to different age groups. The number of pediatric visits included was 1439 (males, 52.2%). The most common age group was toddlers, and 60% of the total sample was from Saudi Arabia. The most common cause of visits was vaccination (32%), followed by general checkups and/or a well-baby visit (25.4%), and fever (11.2%). Approximately 10% of visits needed referral to other subspecialties. Approximately 50% of visits with complaints concerning ophthalmology, cardiology, and surgical intervention were referred to a specialized department. More awareness needs to be raised about the important role of PHC services in the pediatric age group, as it was capable of handling approximately 90% of their cases.

Background: Polypharmacy, or the routine use of five or more medications, can result in impacting patients' quality of life. Objective: to examine the association between multi-morbidities and polypharmacy, and to examine prescription practices in the elderly. Methods: This is a retrospective cross-sectional study. Data were gathered from electronic medical records (EMR) at King Fahad University Hospital (KFHU) and the Family & Community Medicine Center (FCMC) of Imam Abdulrahman bin Faisal University (IAU), between January 1, 2019, and December 31, 2020. We included individuals aged 60 and above with at least one dispensed prescription in 2019 and 2020. Of the 76,216 patient records reviewed, 5,060 met the inclusion criteria. Polypharmacy was defined as a monthly average of five or more prescribed medications. The prevalence of polypharmacy was calculated by year, sex, and age group, and findings were summarized using mean medication numbers and standard deviations for each stratum. An app using R programming language was developed to help visualize patients' medication histories through interactive plots. Results: Polypharmacy prevalence was 46% in 2019 and 44.6% in 2020. The mean and standard deviation of medications per person was 5.17 (3.42) in 2019 and 5.04 (3.37) in 2020. Females had a higher average number of medications than males, 5.17 (3.47) vs 5.04 (3.32). The age group of 80-85 had the highest number of medications at 5.6 (3.6), while those aged 90 and above had the lowest number at 4.48 (2.64). The presence of comorbidities was positively associated with the mean monthly medication count (P value < 0.01). Conclusion: Our study revealed a high prevalence of polypharmacy among elderly patients at KFHU/FCMC, and a positive association with multi-morbidities. Consequently, measures must be taken to mitigate this globally emerging issue's impact and rapid progression.

Background: Urinary tract infection (UTI) is a major public health issue that affects millions of people each year, and a common reason for hospital admission and Emergency Department (ED) visits. ED is a common yet crucial setting for antibiotic prescription. Unfortunately, antibiotic therapies that are unnecessarily prescribed continue to contribute to the global issue of bacterial resistance. Our study aims to determine the prevalence and reasons for inappropriate antibiotic use for UTI in the ED, to highlight the most commonly prescribed antibiotic, and to define the most sensitive antibiotic and most common pathogen based on urine cultures. Methods: A retrospective cohort review conducted at King Fahad University Hospital in Al Khobar, eastern province of Saudi Arabia. Data was collected during the duration of 2017 – 2022 from electrical medical records for all patients who had a urinalysis and urine culture in the ED and were managed as outpatients. Antibiotic prescription was considered Inappropriate if: Asymptomatic patient, Negative urinalysis, Negative or contaminated urine culture or Prescribed antibiotic did not demonstrate sensitivity to the tested bacteria. R-Jamovi software (version 2.3, 2022) was used for analysis. Results: The total sample included 2531 patients. 70.4 % (n= 1781) were females. The most common age group was adults (from 15- 63 years old. Dysuria was the most reported symptom, representing 28.3 % (n = 606). Only ~ 21% of the prescribed antibiotics were appropriate (P< 0.001). The most common reason for inappropriateness was that the tested antibiotic was not sensitive to growth. Ciprofloxacin was the most commonly prescribed antibiotic, representing 34.8%. E. coli was the most common pathogen causing UTI, representing 37.5%. Gentamicin was the most sensitive antibiotic among the urine culture results, representing 90% (P