Background: Increased intra-abdominal pressure (IAP), autonomic reactions, and anesthetics all contribute to hemodynamic alterations during laparoscopic cholecystectomy. This study’s objectives are to measure noninvasively the intraoperative individual responses in cardiac and systemic hemodynamics, focusing on cardiac output (CO. L/min), stroke volume (SV, mL/min), systemic vascular resistance (SVR, dyn.s.cm⁻⁵), and noninvasive mean arterial blood pressure (MABP, mmHg) during and after peritoneal insufflation (cmH₂O). The secondary objective was to evaluate the utility of EC as an adjunct to standard monitoring and to assess the individual differences. Methods: The CO and associated parameters were continuously and noninvasively monitored with the electrical cardiometry (EC, ICON, Osypka, Berlin Germany). Results: Seventy-three patients showed that when the IAP increased to 13 [IQR: 13-14] cmH₂O, there was an overall percentage decrease in CO (−11.29%), MABP (−9.31%), and SVR (−23.16%) compared to pre induction with minimal changes in heart rate (HR). Individual variation and extreme reactions among certain patients were noted, with CO falling by −47.14% and MABP by −61.59, respectively, which can have major repercussions. Conclusions: The EC enabled real-time, non-invasive CO monitoring and detected significant cardio-hemodynamic changes that conventional monitors could miss. EC can supplement traditional monitors and give attending anesthesiologists access to more of patients’ vital information.

Salmonella typhi (S. typhi) infections typically present with fever and gastrointestinal symptoms. This case report on S. typhi enteritis documents atypical clinical, radiological, and endoscopic findings raising diagnostic challenges. A 31-year-old male in the Kingdom of Saudi Arabia (KSA) presented with severe abdominal pain, vomiting, bloody diarrhea, and no fever. Initial diagnosis included amebiasis and other gastroenteritis infections. Despite treatment with ciprofloxacin and metronidazole, the patient's condition did not improve, and he kept having intractable abdominal pain and vomiting. Subsequent investigations, including abdominal ultrasound and esophagogastroduodenoscopy, revealed extensive and rapidly progressive intestinal inflammation with wall thickening and ascites. Stool culture eventually identified a multidrug-resistant strain of S. typhi, sensitive only to ceftriaxone. Treatment with ceftriaxone and continuous infusion of proton pump inhibitor (PPI) led to significant improvement. The absence of fever in the context of bloody diarrhea, and the rapid development of ascites not improving with first-line treatment of gastroenteritis, led to the search for other diagnoses such as inflammatory bowel syndromes or tuberculosis. The presentation of diffuse intestinal wall thickening with intractable vomiting, bloody diarrhea, and progressively increasing ascites is not frequently encountered with S. typhi. The case also underscores the growing concern of antibiotic-resistant S. typhi strains. The patient's response to targeted antibiotic therapy emphasizes the importance of accurate microbial identification and susceptibility testing in managing infectious diseases. This case report illustrates an atypical presentation of S. typhi enteritis with progressively increasing ascites and increased intestinal wall thickening. The uncommon complicated clinical picture led to challenges in diagnosis and management. It emphasizes the need for high clinical suspicion and comprehensive diagnostic approaches in atypical cases of common infections, especially in the context of increasing antibiotic resistance.

Introduction: The fabella exhibits variable prevalence across populations and is associated with musculoskeletal disorders. Limited research exists on fabella-related studies, particularly in Saudi Arabia, necessitating further investigation to understand its prevalence and association with knee osteoarthritis (OA). Methods: A retrospective multicenter study was conducted in AlAhsa, Saudi Arabia, reviewing knee X-rays of patients diagnosed with knee OA. Statistical analysis assessed potential associations between fabella presence, demographic factors, and OA severity using the Kellgren-Lawrence classification. Results: Among 348 participants, 96 (27.6%) exhibited fabella presence, with 38 (39.6%) of them showing fabellar degenerative changes. No significant associations were found between fabella presence and gender, age, knee side, or OA severity, except for a marginal trend in age groups. However, there was an increasing trend in fabellar degeneration with advancing OA grades. Conclusion: Our study emphasizes the importance of investigating fabella prevalence and its associations with knee OA in diverse populations. While no significant correlations were found in this cohort, the findings prompt further exploration, emphasizing the need for multicenter studies to enhance understanding and clinical management of fabella-related conditions in knee OA.

Background/Objectives: Thalassemias, a hereditary condition commonly linked to chronic anemia, require regular blood transfusions and repeated blood draws for assessments of hemoglobin (Hb) content, which can be uncomfortable. A promising substitute for laboratory hemoglobin testing is non-invasive spectrophotometric hemoglobin (SpHb) monitoring; however, its applicability particularly among blood transfusion-dependent thalassaemic patients needs to be investigated. This study’s primary goal was to investigate the relationships and agreements between SpHb, g/dL, and an automated hematology analyzer (Hb, g/dL) in this particular patient population. The secondary goal was to track how blood transfusions affect SpHb, g/dL, laboratory Hb, and pleth variability index (PVI, %). Methods: In this study, sixty patients were included. A Masimo Radical-7 pulse CO-oximeter was used to measure the SpHb, and a Sysmex XN-1000 hematological analyzer measured the laboratory Hb. Results: The results revealed a significant correlation between SpHb and laboratory Hb (n = 108, r = 0.587, p < 0.001) but also demonstrated that SpHb consistently overestimated laboratory Hb levels, with a mean bias of −1.18 g/dL (95% CI: −1.4344 to −0.9267). The Bland–Altman analysis showed a good degree of reliability between this bias (SpHb–Hb) and laboratory Hb (g/dL), with an Intra Class Correlation (ICC) of 0.613 but with a wide 95% CI ranging from 0.557 to 0.736 (t = 3.817, p < 0.001). The 95% limits of agreement ranged from −3.7893 to +1.4228 g/dL. Conclusions: This significant bias restricted the application of SpHb as a trustworthy method for assessing hemoglobin levels in patients with blood transfusion-dependent thalassemia. Nonetheless, the capability to monitor SpHb and PVI variations during blood transfusions offered a real-time assessment of the impact of transfusions on patients’ hemoglobin levels and volume status.

Congenital pseudarthrosis of the clavicle (CPC) is a rare disorder diagnosed at birth or early childhood presenting with a painless, non-tender mass on the clavicle. Its etiology is unknown, caused by failure of fusion of the medial and lateral ossification centers of the clavicle. Left-sided CPC is rare and linked to other pathological abnormalities. Bilateral involvement is extremely rare and it is seen in association with other congenital malformations. A full-term newborn baby girl was examined after a complicated emergency cesarean section delivery. Upon initial pediatric examination, there was suspicion of bilateral clavicle fracture with no limitation of movement and equal moro reflex bilateral. Plain radiographs of the clavicle revealed a suspected bilateral fracture of the clavicle. At the two-month follow-up, X-rays were taken to assess the clavicle fractures showing persistent bilateral clavicle deformities and there was no interval callus formation which confirmed the diagnosis of bilateral CPC and excluded the presence of the fracture. Bilateral pseudarthrosis of the clavicle is a rare entity, and surgical correction is not required unless the patient develops symptoms of limitations of movement or for aesthetic causes.

Background: Emergency Departments (ED) are becoming one of the most overcrowded departments globally. This study aims to investigate the frequency and causes of unscheduled patient return to the ED in King Fahad Specialist Hospital in Dammam (KFSH-D) within 72 hours of discharge. Method: This study is a cross-sectional retrospective study done between February and May, of 2023 at KFSH-D, Saudi Arabia. A total of 295 patients where included. Patients were selected using a simple random sampling technique. Medical record numbers (MRNs) of patients with unscheduled return visits within 72 hours were gathered from the hospital's electronic medical record-integrated database (Medica Cloudcare) which were then entered on a random number generator. 295 MRNs were selected and included in the study. This study includes male and female patients older than 16 years who returned to the ED within 72 hours. Results: Results showed cancer as the most common comorbidity resulting in revisits within 72 hours. Regarding the emergency department triage category, category 3 was the most common category in revisiting patients (70.2%). Pain was the most common chief complain in the initial and second visit to emergency department, 61.0% and 61.4%, respectively. Most of the patients return due to patient-related causes, specifically no improvement (75.3%). Conclusion: The quality of patient care is negatively affected by the increasing patient demand. Although not much can be done for first visit patients, some simple actions could be done to reduce the rate of second visits.