Background: Several studies have reported that iron-deficiency anemia (IDA) and its treatment might lead to a distorted reading of glycated hemoglobin (HbA1c) value. Hence, this review aims to systematically investigate the effect of iron replacement therapy (IRT) on HbA1c levels, as the literature is deficient in assessing this clinical phenomenon. Methods: An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by four independent authors. Results: Among the 8332 articles identified using the search strategy, 10 records (with a total of 2113 participants) met the inclusion criteria and were analyzed. In nine of the studies, IRT was found to decrease HbA1c levels; in the remaining study, IRT was found to increase HbA1c levels. The effect size of the pooled standardized mean difference in HbA1c levels between the treatment and control groups with IDA was 1.8 (95% CI = −0.5, 2.31). Heterogeneity was assessed using the I² and χ² tests, and the resultant values were 98.46% and p = 0.09, respectively. Additionally, the mean difference between the HbA1c levels (pre-IRT and post-IRT) showed a drop in the HbA1c levels which ranged from 1.20 to 0.43 mg/dL. Conclusions: The results suggest that IRT decreases HbA1c levels, and it is helpful in treating IDA patients with poor glycemic control. Accordingly, the results provide an added perspective on antidiabetic medication dosing and physicians’ interpretation of initially elevated HbA1c values.

Introduction: Child abuse refers to any type of mistreatment of a child, perpetrated by a parent, caregiver, or another individual in a custodial capacity, which may lead to instances of physical, sexual, or emotional abuse. Physicians play a crucial role in identifying and managing this phenomenon in the healthcare setting, as the number of unreported cases increases globally. Methods: A questionnaire-based cross-sectional study was conducted between 2022 and 2023 among physicians practicing in Saudi Arabia to assess their knowledge, awareness, and attitude toward child abuse. The data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results: A total of 153 physicians were involved in this study, in which 65 participants (42.5%) indicated poor awareness of child abuse, while 79 participants (51.6%) indicated moderate knowledge of child abuse. Additionally, lack of knowledge was the most common barrier to reporting child abuse in 87 participants (56.9%). A positive significant correlation was identified between awareness and knowledge and between knowledge and attitude. Also, it was found that a higher attitude score was more associated with being male, having less experience, practicing in the emergency medicine department, and working in a governmental hospital. Conclusion: These results highlight the significance of implementing specialized training programs and workshops focused on identifying and reporting child abuse, as well as providing guidelines for recognizing signs of abuse and taking appropriate intervention measures.

Purpose: Triage systems play a vital role in effectively prioritizing patients according to the seriousness of their condition. However, conventional emergency triage systems in pediatric care predominantly rely on subjective evaluations. Machine learning technologies have shown significant potential in various medical fields, including pediatric emergency medicine. Therefore, this study seeks to employ pediatric emergency department records to train machine learning algorithms and evaluate their effectiveness and outcomes in the triaging system. This model will improve accuracy in pediatric emergency triage by categorizing cases into three urgency levels (nonurgent, urgent, and emergency). Patients and Methods: This is a retrospective observational cohort study that used emergency patient records obtained from the Emergency Department at King Faisal Specialist Hospital & Research Centre. Using the emergency severity index (a scale of 1 to 5), various machine learning techniques were employed to build different machine learning models, such as regression, instance-based, regularization, tree-based, Bayesian, dimensionality reduction, and ensemble algorithms. The accuracy of these models was compared to reach the most accurate and precise model. Results: A total of 38,891 pediatric emergency patient records were collected. However, due to numerous outliers and incorrectly labeled data, clinical knowledge and a confident learning algorithm were employed to preprocess the dataset, leaving 18,237 patient records. Notably, ensemble algorithms surpassed other models in all evaluation metrics, with CatBoost achieving an F-1 score of 90%. Importantly, the model never misclassified an urgent patient as nonurgent or vice versa. Conclusion: The study successfully created a machine learning model to classify pediatric emergency department patients into three urgency levels. The model, tailored to the specific needs of pediatric patients, shows promise in improving triage accuracy and patient care in pediatric emergency departments. The implication of this model in the real-life sitting will increase the accuracy of the pediatric emergency triage and will reduce the possibilities of over or under triaging.

Black fungus, also known as mucormycosis, is one of the most serious infections affecting immunocompromised individuals. Invasive fungal sinusitis due to mucormycosis is quite rare globally. Hence, this article presents a case report of invasive fungal sinusitis in a 53-year-old diabetic female who presented to the emergency department with a severe case of diabetic ketoacidosis secondary to acute sinusitis, which was confirmed by histopathology to be mucormycosis. An extensive surgical debridement and liposomal amphotericin B were the mainstay of treatment. The treatment of mucormycosis consists of treating the underlying disease, antifungal therapy, and surgical debridement. Also, previous studies have discussed the use of medical therapy alone, surgical therapy alone, and combination therapy. It was found that the combination of medical and surgical therapy was the most effective method in treating this condition. However, the high mortality rate of this disease indicates the need for a possible adjuvant therapy which could increase the survival rate. Therefore, recent studies have proposed new adjuvant modalities, such as hyperbaric oxygen therapy and local treatment with amphotericin B. In this study, we propose a new adjuvant therapy using local miconazole cream which showed a good prognosis with the combination of oral amphotericin B and surgical debridement. This highlights the necessity for extensive future clinical trials to validate its effectiveness in treating isolated sinus mucormycosis.

Allergic fungal rhinosinusitis (AFRS) is defined as a benign, extramucosal, non-invasive fungal condition of the paranasal sinuses, resulting from a type 1 IgE-mediated hypersensitivity reaction. AFRS is most commonly seen in young adults, although it also occurs in the pediatric population. Currently, biological therapy has been proposed as an effective treatment for adult patients with AFRS. However, the use of biologics in the pediatric population has not yet been introduced in the literature. Hence, this study reports a unique case involving the use of Dupilumab to treat a pediatric patient with refractory AFRS and bronchial asthma. A 13-year-old girl with a long-standing history of bronchial asthma who was diagnosed with AFRS, started Dupilumab with a loading dose of 600 mg, followed by 300 mg biweekly. The patient showed improvement in her condition after the initiation of Dupilumab, in terms of clinical, endoscopic, and radiological outcomes. Additionally, Dupilumab was shown to be a helpful treatment in controlling the patient's bronchial asthma. In conclusion, Dupilumab appears to be a promising treatment for pediatric patients with refractory AFRS to improve their clinical, endoscopic, and radiological outcomes. However, further studies are needed in the future to validate these findings.

Giant rhinoliths are uncommon, mineralized concretions that usually develop around an intranasal foreign substance in the nasal canal. These lesions frequently cause respiratory problems, foul-smelling discharge, and nasal blockage. Clinical examination, endoscopy, and radiological imaging are used to make the diagnosis, and surgical removal is the only effective therapy. A giant rhinolith was discovered in a 42-year-old female patient with metastatic breast cancer came with nasal blockage. After 6 months, there were no complications or recurrences following the surgical removal of the calcified tumor. The significance of taking rhinoliths into account in individuals who have prolonged symptoms and unilateral nasal blockage is demonstrated by this case study. Consequently, early diagnosis and management are necessary to avoid potential complications and ensuring an excellent outcome.