Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), improves outcomes in HFrEF but may cause hyperkalemia. Methods: A single-center retrospective cohort study was conducted at King Abdulaziz Cardiac Center, Riyadh, including 238 HFrEF patients initiated on sacubitril/valsartan (2016–2021). Potassium levels were assessed pre-initiation and at 0–3, 3–6, and 6–12 months post-initiation. Hyperkalemia was analyzed at thresholds >5.0, >5.5, and >6.0 mmol/L. Results: Median age was 58 years (IQR 48–69); 75.2% were male. Hyperkalemia >5.0 mmol/L occurred in 44.4% (95% CI: 38.1–51.0) within three months post-initiation versus 8.2% (95% CI: 5.3–12.4) pre-initiation. Only 17.3% exceeded 5.5 mmol/L. Treatment discontinuation occurred in 7.1% of patients, with 1.3% stopping due to clinically significant hyperkalemia. McNemar’s test confirmed a significant increase in prevalence across time points (p < 0.0001). Conclusions: Despite increased hyperkalemia incidence, discontinuation rates were low, consistent with prior trials (PARADIGM-HF, PARAGON-HF). Sacubitril/valsartan remains an effective and generally safe therapy for HFrEF, with hyperkalemia manageable through monitoring. Limitations include missing potassium data, potential confounding factors, and the lack of a control group; future prospective studies with regular electrolyte monitoring are recommended.

Background: The acute care surgery (ACS) model employs a 24/7 multidisciplinary team—surgeons, nurses, and residents—supported by an electronic consultation system to optimize emergency The acute care surgery (ACS) model provides 24/7 multidisciplinary management of emergency surgical patients. This study aimed to describe the demographic and clinical characteristics of patients admitted from the emergency department (ED) under general surgery, identify the most common presenting complaints and operative procedures, and determine which general surgery subspecialties were most frequently consulted at King Abdulaziz Medical City (KAMC). Methods: We conducted a retrospective study at KAMC, Riyadh (MNGHA), from September 2022 to November 2023. A total of 384 ED patients admitted under general surgery were included. Data were extracted from the BestCare electronic medical record and analyzed for demographics, presenting complaints, operative procedures, and subspecialty consultations. Results: Of 384 patients, 204 (53.1%) were male and 180 (46.9%) were female. The largest age group was 30–45 years (n = 112, 29.2%), followed by <30 years (n = 98, 25.5%). Leading presenting complaints were abdominal pain (n = 243, 63.3%), fever with nausea/vomiting (n = 68, 17.7%), and rectal pain/bleeding (n = 44, 11.5%). Laparoscopic cholecystectomy was the most common procedure (n = 123, 32.0%), followed by laparoscopic appendectomy (n = 57, 14.8%). ACS received most consultations (n = 231, 61.8%), with additional referrals to colorectal surgery (n = 86, 23.0%) and upper gastrointestinal surgery (n = 40, 10.7%). Nearly all consult requests originated in the ED (n = 355, 98.9%). Conclusions: Abdominal pain was the predominant ED complaint prompting surgical referral, and laparoscopic cholecystectomy and appendectomy were the most frequently performed procedures. ACS was the primary subspecialty consulted, underscoring its central role in emergency surgical care at KAMC.

Granular cell tumors are uncommon neoplasms of neural origin that may involve the skin and often present with nonspecific clinical features, making diagnosis challenging. Cutaneous granular cell tumors rarely exhibit overlying hypertrichosis, a finding that may obscure their clinical recognition. In this report, we describe a rare case of a primary cutaneous granular cell tumor with prominent overlying terminal hair growth in an adult patient. A 27-year-old woman presented with a slowly enlarging, firm, pigmented plaque on the upper back associated with pruritus and increased hair growth. Histopathologic examination revealed sheets of large polygonal cells with abundant granular eosinophilic cytoplasm, and immunohistochemical staining was positive for S100, SOX10, CD68, and calretinin, confirming the diagnosis. The lesion was completely excised with no evidence of malignancy. To our knowledge, this represents the second reported instance of a cutaneous granular cell tumor associated with hypertrichosis and the first described in an adult. It underscores the importance of clinicopathologic correlation in evaluating unusual cutaneous lesions and expands the spectrum of recognized presentations of cutaneous granular cell tumors.

Background/Objectives: To systematically evaluate and compare the clinical efficacy and safety of non-cryotherapy modalities versus standard liquid nitrogen cryotherapy for the treatment of plantar warts, while exploring the influence of specific cryotherapy procedural parameters and intervention-related subgroup characteristics on treatment outcomes. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted according to PRISMA guidelines. We searched four major databases from inception until 1 July 2026. The primary outcome was complete clearance. Secondary outcomes included partial clearance, recurrence, and treatment-related adverse events. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models. Results: Thirty-one RCTs involving 2313 patients were included. No statistically significant difference was detected between non-cryotherapy modalities and cryotherapy in complete clearance rates (RR = 1.09, 95% CI: 0.98–1.20; p = 0.10; I² = 0.00%) or recurrence outcomes (RR = 0.90, 95% CI: 0.56–1.44; p = 0.66). Partial clearance significantly favored cryotherapy (RR = 0.65, 95% CI: 0.44–0.95; p = 0.03), particularly in subgroup analyses using two freeze–thaw cycles and treatment intervals of every two weeks. Regarding safety, topical therapies demonstrated significantly lower erythema rates than cryotherapy, while no statistically significant differences were observed in blistering, scarring, or secondary bacterial infection. Conclusions: No statistically significant difference was detected between non-cryotherapy modalities and cryotherapy regarding complete clearance or recurrence of plantar warts. Cryotherapy may offer better partial clearance under optimized treatment parameters, whereas topical therapies may be better tolerated in selected patients.