Trauma-related pneumopericardium (TRPP) is the collection of air in the pericardial space secondary to trauma, potentially leading to tension pneumopericardium (TPP) in which the entrapment of air generates sufficient pressure to compromise cardiac output leading to a life-threatening cardiac tamponade and circulatory failure. We aim to classify the diagnostic and therapeutic approaches of TRPP and the causes of the subsequent development of TPP. A computer-based search of all published reports on TRPP in the medical literature from database inception to March 2020, on MEDLINE, Ovid, and Scopus; analyzing the data regarding initial status at presentation, extent of injuries, diagnostic and treatment measures with the intention to have an understanding of the clinical behavior and management outcomes of TRPP. The search identified 84 published case reports of 105 patients with TRPP. In conclusion, TRPP leading to TPP is described in the literature as a condition that involves a young male who is subjected to blunt trauma, most commonly in a motor vehicle collision, presenting as a polytrauma patient in a state of shock and low systolic blood pressure, or possibly in cardiac arrest. In addition, he might have a tracheobronchial injury with or without pneumothorax or pneumomediastinum and might require mechanical ventilation.

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Background: Coronaviruses are the important pathogens of humans and animals that can cause diseases ranging from the common cold to more severe or even fatal respiratory infections. Regarding nervous system complications, existing literature has revealed increasing reports of neurological manifestations in coronavirus disease 2019 (COVID-19)-positive patients ranging from mild-to-severe manifestations. Aim: In this study, we aimed to determine the prevalence of neurological manifestations in COVID-19-positive patients. Furthermore, we sought to ascertain the most common and most severe manifestations and to find the significant associations with laboratory or clinical findings. Setting and Design: This is a retrospective cross-sectional observational study that was conducted at two centers. Materials and Methods: Patient data were collected in periods from of March 1 to of July 30, 2020 labeled as the first wave, and from December 1, 2021 to January 30, 2022 labeled as the second wave in two tertiary care hospitals, Al-Noor Specialist Hospital and King Abdullah Medical City, situated in Makkah city, Saudi Arabia. The study included patients who were ≥ 18 years of age and were found to have any neurological manifestations and/or complications secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study was conducted in different periods to assess the different waves of the COVID-19 pandemic and to allow the comparison between them. Results: From a total number of 4751 patients with confirmed SARS-CoV-2 infection eligible during the periods included in our study, we found neurological manifestations in 263 patients, particularly 229 from the first wave and 34 from the second wave. In the first wave patients, 102 (44.5%) were aged between 18 and 39 years of age. The prevalence of neurological manifestations was 6.4% in the first wave and 2.9% in the second wave. Conclusion: Our study showed a large variety of neurological manifestations in COVID-19-positive patients. The most common neurological manifestations were headache and impaired level of consciousness, whereas the most severe conditions were cerebrovascular events, seizure, encephalopathy, and brain death.

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Background: Nursing students should develop sufficient professional competence during their nursing education as a prerequisite for providing safe care of high quality utilizing a holistic approach that suits the caring context of their patients. Despite the abundance of studies on professional competence in international literature such as the Scandinavian countries, there are no studies conducted in the Middle East in general and in Saudi Arabia in particular. Aim: The current report is part of a larger study that assessed the self-reported professional competence of newly graduated nursing students in Saudi Arabia. Setting and Design: A cross-sectional correlational study was carried out with a convenience sample of 317 senior Saudi students at the point of graduation from a nursing college affiliated with a public university in Saudi Arabia. Materials and Methods: Data was collected using the Nurse Professional Competence (NPC) Scale – a short version consisting of 35 items and the 10-item General Self-Efficacy (GSE) Scale. Statistical Analysis: The mean scores were calculated for the competency areas, and the median score and interquartile were used for nonparametric variables that were not normally distributed (Shapiro–test). The Chi-square test for data between groups, the Kruskal–Wallis test for comparing more than two independent groups, and Mann–Whitney U-test for comparing two independent groups. In addition, Spearman correlation coefficients to test correlations between groups and the NPC Scale. Results: Students scored highest in the competence areas of nursing care, value-based nursing care, and care pedagogics and lowest scores in the areas of documentation and administration of nursing care, development, leadership and organization of nursing care, and medical and technical care. Professional competence was significantly associated with students' quality of health and GSE. Conclusion: It is important to incorporate competencies in the nursing program and to assess newly graduated students' competence upon graduation. We suggest a follow-up study of these graduates to assess the development of professional competencies and self-efficacy across their internship years.

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Background: Pregnancy is often anticipated as a positive experience for women with the expectation of having a healthy infant in the end. However, some pregnancies end in fetal loss, which can have profound effects on parents and families and is characterized by shock, anger, emptiness, helplessness, and loneliness. Aims: The study aimed to describe the lived experiences of nurses and midwives regarding care provided for mothers and families during the fetal loss at King Abdul-Aziz Medical City, Western region. Setting and Design: The study setting was the labor and delivery units at King Abdul-Aziz Medical City, Western region, Saudi Arabia. Husserl's phenomenological approach was used. Materials and Methods: Purposive sampling included 11 nurses and midwives were included. Data were collected through in-depth interviews that were audio reordered and then transcribed verbatim. Statistical Analysis: Thematic analysis using Giorgi's data analysis steps was used. Results: Two themes emerged regarding the experiences of nurses in caring for mothers and families who experience fetal loss, namely emotional turmoil with subthemes, heavy heart, feeling helpless, lack of self-control, feeling guilty, feeling extreme sadness, feeling isolation; and barriers with subthemes culture, lack of nursing care, and limited skill. Conclusion: Two major themes emerged from the study that highlighted that nurses found caring for patients and families after a fetal loss a challenging experience and, at times, were unable to manage their own emotions.

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Background: Chest X-ray plays a vital role in diagnosis of tuberculosis (TB) in HIV infection. These patients present with variable chest radiographic presentation, making diagnosis and treatment of TB notoriously challenging and increasing the risk of treatment failure, relapse, and even death. Aims: The objective of this study was to identify various radiological patterns of TB in HIV-TB-co-infected patients and to correlate with CD4 count. Setting and Design: This was an analytical cross-sectional study conducted in a tertiary care center in the southern part of Rajasthan, India. Materials and Methods: In our study, 110 consecutive patients with pulmonary TB-HIV co-infection were subjected to chest radiographs and evaluated for the types of lesion/TB; anatomical distribution, and type of radiological shadows. The findings were correlated with CD4 counts and sputum acid-fast bacilli (AFB) status. The main outcome measures were radiological shadows and their correlation with level of immune suppression. The sample size was 110 patients. Results: Patients of Group I (CD4 <200) had significantly more involvement of mid and lower zones than Group II (CD4 >200). Nodular shadow (54.1% vs. 46.9%), consolidation (28.4% vs. 25.0%), hilar lymphadenopathy (23.0% vs. 9.4%), and miliary shadow (9.5% vs. 3.1%) in Group I, while cavitation (25.0% vs. 20.3%) and pleural effusion (18.8% vs. 16.2%) were more frequent in Group II. In Group I, consolidation (44.8% vs. 17.8%, P = 0.012) while in Group II, both consolidation (46.2% vs. 10.5%, P = 0.038) and cavitation (46.2% vs. 10.5%, P = 0.038) were present in significantly higher proportion in AFB-positive cases. Conclusion: A wide spectrum of radiographic shadows in consonance with varying CD4 counts was observed in the study. Along with well-known atypical radiological findings, some features were present throughout spectrum of CD4 counts, indicating that TB should be considered in this group of patients with these radiographic presentations, regardless of CD4 count. The small study population, majority of the patients' already hospitalized indicating serious nature of illness. In addition, no prospective follow-up of the study population to identify over the time changes in radiological pattern.

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Background: Patients' satisfaction in emergency departments (EDs) could be improved by providing estimates of the expected waiting time. Aim: The aim of this study was to determine waiting time and assess patients' satisfaction in EDs. Setting and Design: A descriptive, cross-sectional study was carried out in Taif city included patients who come to EDs of three main hospitals throughout the period from mid-August to mid-September 2022 if they aged from 18 to 65 years. Materials and Methods: Data were collected through a pretested Arabic version of the Brief Emergency Department Patient Satisfaction Scale questionnaire. Statistical Analysis: Data were entered into the Statistical Package for the Social Sciences (SPSS) software version 26 for Windows. Results: The study included 612 patients. Almost a quarter (23%) aged 25–34 years. Regarding satisfaction of patients with ED, the highest score was observed concerning physicians' care (4.31 ± 0.88) whereas the lowest satisfaction score was reported regarding arrival in reception (AIR) (3.57 ± 1.08). The highest score was observed among those who attended King Faisal Medical Complex (4.19 ± 0.74), whereas the lowest score was observed among those who attended Alhada Armed Forces Hospital (3.75 ± 0.91), P < 0.001. The highest score of satisfaction was observed among patients aged 65 years/above (4.08 ± 0.76), P = 0.041. Non-Saudi patients were more likely to be satisfied compared to Saudi patients (4.33 ± 0.77 vs. 3.89 ± 0.87), P < 0.001. Patients who did not read/write were more likely to be satisfied compared to educated patients (4.23 ± 0.83 vs. 3.89 ± 0.87), P = 0.001. The waiting time exceeded 2 h among 13.9% of patients. With decreasing the waiting time, the patients' satisfaction with ED was increasing, P < 0.001. Conclusion: The overall patients' satisfaction with ED was high; it was lowest regarding AIR. In addition, longer waiting time was associated with patients' dissatisfaction.

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Background: Myasthenia gravis (MG), an autoimmune disease, affects the neuromuscular junction. The impaired neuromuscular transmission results in fatigable muscle weakness among MG patients. Positive antibodies are found among MG patients. Aims: The main aim of this study is to evaluate the correlation of MG severity with their anti-muscle-specific kinase (MUSK) and anti-acetylcholine receptor (AChR) antibody status. Moreover, the study also identifies the correlation between the antibodies profile and the severity of a seropositive MG. Setting and Design: This retrospective cross-sectional study was conducted in the tertiary center of the western region of Saudi Arabia named King Abdullah Medical City (Makkah) over 8 years, from January 2011 to December 2019. Materials and Methods: This retrospective cross-sectional study was conducted in Saudi Arabia in King Abdullah Medical City (Makkah) over 8 years, from January 2011 to December 2019 was reviewed. Seventeen patients out of 27 MG patients came out to be seropositive. The correlation was investigated between severity and antibody status. Statistical Analysis: Data were collected in an Excel sheet, and statistical analysis was performed using SPSS 21 software. Results: The results showed that most patients (87.5%) were positive for AChR antibodies only, while others (12.5%) were positive for anti-MUSK and anti-AChR. Thymoma and crisis were observed in 100% with dual seropositivity and 21% with single seropositivity. Conclusion: The study concluded that a severely aggressive course of MG is present among patients. However, detailed clinical trial studies are required for conforming MG severity and dual seropositivity.

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Background: The increasing cases of carbapenemase resistant Enterobacteriaceae (CRE) across the world is a cause of concern. Asymptomatic carriage of CRE in critical care units is a menace to infection control. Aims: This study determines the carriage rate of CRE in patients admitted to the intensive care units (ICU's) and evaluates the potential risk factors, leading to colonization in patients with CRE. Materials and Methods: Sixty rectal swabs from patients in the ICU's were screened for carriage of CRE. The samples were inoculated onto ChromID CARBA SMART bi-plate. The organisms showing color appearances as per the manufacturer's instructions were considered as CRE. Routine disk diffusion technique was also employed and CRE was defined as an organism belonging to the Enterobacteriaceae family which was resistant to either imipenem or meropenem. Results: The organisms isolated were identified and the percentage of carriage of carbapenem-resistant organisms was 12 (20%), of which Klebsiella pneumoniae was 4 (33.3%), Escherichia coli 6 (50%), Citrobacter freundii 1 (8.3%), and Enterobacter spp. 1 (8.3%). Out of these, 2 (3.3%) showed OXA 48 type resistance seen with K. pneumoniae and E. coli. Prior hospitalization, the use of high-end antibiotics and patients who have undergone surgeries were the most common potential risk factors for colonization with CRE. Conclusion: The prompt detection of CRE by routine screening using cost-effective methods and reduction of potential risk factors for gut colonization reduce the transmission of drug resistance in any hospital setting and pave the way for better antibiotic stewardship and appropriate contact isolation precautions.

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Meckel's diverticulum (MD) is usually silent and asymptomatic. Acute diverticulitis, perforation, intestinal obstruction, hemorrhage, and other complications are seen in <4% of cases of MD. 27 year old female, presented with complaints of pain in her abdomen, clinically suspected of acute appendicitis, and finally diagnosed with tubercular Meckel diverticulitis. A clinical and laboratory diagnosis of Meckel's diverticulitis is challenging as it mimics appendicitis and is generally observed during surgical procedures. Meckel's diverticulitis should be suspected and explored, especially when the appendix appears normal in an acute abdomen. The presence of intestinal tuberculosis (TB) in unusual locations should be closely monitored, particularly in countries where TB is endemic.

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Background: Iron-deficiency anemia (IDA) in children and infants can have long-term adverse consequences on neurodevelopment and behavior, which can be irrevocable in some cases and detrimental to the immune system. Aim: The aim of this study was to investigate the role of IDA and its effects on immunity in CD8 and CD4 lymphocytes. Settings and Designs: This was a prospective study. Materials and Methods: A total of 40 pediatric cases (2–12 years) were first time diagnosed as IDA based on complete blood count (CBC) parameters, peripheral blood smear, and serum ferritin levels. Flow cytometric immune assays were used to determine the number of CD4+ and CD8+ lymphocytes and the ratio of CD4+/CD8+. Statistical Analysis: Pearson's correlation coefficient and Students' unpaired t-test were used. Results: The difference between the case and control groups in hemoglobin (Hb), red blood cell (RBC) indices, red cell distribution width, RBC count, and serum ferritin is highly significant. A significant linear positive association between CD3+ and CD4+ cell counts and serum ferritin and a significant linear positive correlation between CD4+ cell counts and Hb were observed. However, there was a nonsignificant linear positive association of both parameters, hemoglobin (Hb) and mean corpuscular volume (MCV) with CD3+ cell count, CD4+ cell count, and CD4+/CD8+ cell ratio. Conclusion: Iron deficiency does not affect total white blood cell count or differential leukocyte count on routine CBC, but it can alter cellular immunity (CD3+ cell count, CD4+ cell count, and CD4+/CD8+ cell ratio).

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Ortner Syndrome or Cardiovocal Syndrome encompasses any cardiovascular cause causing vocal cord paralysis by compression of the recurrent laryngeal nerve along its pathway. Historically, it was described as a case of vocal cord paralysis due to an enlarged left atrium compressing on the left recurrent laryngeal nerve in mitral valve stenosis. We describe a case of 71 years male, who presented with insidious onset hoarseness of voice. Contrast-enhanced computed tomography neck and chest revealed two aneurysms from the arch of aorta compressing on the left recurrent laryngeal nerve. With other causes being ruled out, the diagnosis of Cardiovocal syndrome was retained.

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