Background: Fibrinogen (Factor I) is an essential factor in the coagulation cascade. The activation of prothrombin to thrombin by Factor X is followed by the activation of fibrinogen. In turn, thrombin converts fibrinogen to fibrin, which is the end target of both extrinsic and intrinsic pathways. A deficiency in fibrinogen results in the tendency to bleed [1].

The use of recombinant human growth hormone (rhGH) in patients with idiopathic short stature (ISS) has been an area of concern since some studies reported less desired effects of the drug in this group of patients as compared to patients with growth hormone deficiency (GHD). In addition, there were no studies addressing the effects of rhGH in Saudi children. Therefore, we conducted a retrospective study to observe the effects one year of treatment with rhGH on the mean height gain in patients with ISS and GHD. Methods This retrospective study took place at King Abdulaziz Medical City in Jeddah. The study subjects included two groups of patients (GHD vs ISS). Patients' files were reviewed from January 2000 to January 2018 using the following parameters: chronological age, bone age, height, weight, body mass index (BMI), insulin-like growth factor (IGF-1), growth hormone stimulation test, and growth velocity (GV). After one year of treatment, the height, weight, and BMI of the study subjects were monitored and assessed.

BackgroundInpatient dermatological care represents an opportunity to improve dermatological care among the population as well as to enhance clinical exposure for residents and medical trainees. ObjectiveWe conducted this study to analyze the pattern of dermatological conditions encountered in inpatient settings and the modalities of management at a tertiary care hospital. MethodWe retrospectively reviewed and analyzed electronic records of all inpatient consultations carried out by the dermatology consultants and specialists between January 1, 2020 and December 31, 2020. Demographic and specific and non-specific clinical data were collected and analyzed by dividing the skin disorders and treatments into categories, where relevant. ResultFive hundred and seventy-one inpatient dermatological consultations were carried out, involving 453 patients. Older age groups were predominant, including 50-70 years (27.4%) and >70 years (21.0%). The female to male ratio was 1.19. The majority of the consultations (388/571, 68.1%) were requested from the adult medical wards; internal medicine (23.8%), hematology (13.7%), and oncology (9.1%) being the most frequented wards. A biopsy was carried out in 57 (10.0%) of the cases. The most prevalent diagnoses included dermatitis (16.3%), intertrigo (8.1%), and xerosis (6.8%). Besides, 10 cases of skin cancer or metastasis were diagnosed by the dermatologist. The diagnosed skin condition was drug-induced in 57 (10.0%) of the cases, and nine of them were due to chemotherapy. Pharmaceutical treatments consisted of more frequently used corticosteroids (51.5%), antibiotics (36.4%), and antifungal agents (20.8%), with the majority of these by topical route. ConclusionA broad range of dermatological conditions are diagnosed in our inpatient setting, representing a good educational opportunity for trainee dermatologists. The implementation of digital photography could enhance the documentation of dermatological conditions, which would have beneficial effects on both care quality and education.

The febrile ulceronecrotic Mucha-Habermann disease is a rare and potentially lethal variant of pityriasis lichenoides et varioliformis acuta (PLEVA). It is characterized by a sudden onset of ulceronecrotic skin lesions associated with high fever and systemic symptoms. Herein, we report a 23-year-old male, not known to have any medical illnesses, presented with a month-long history of persistent fever of unknown origin associated with a sudden onset of progressive diffuse necrotic ulcers and widespread papulosquamous lesions. Pan CT showed enlarged lymph nodes in the cervix, chest, and abdomen. Unfortunately, a skin biopsy was done late, showing features consistent with PLEVA. Few days after admission, despite being on intravenous methylprednisolone, our patient rapidly deteriorated by showing severe acute respiratory symptoms and consequently died. In spite of the continuous addition of new case reports to the literature, no definite diagnostic criteria have been established, leading to late or missed cases, and an optimum treatment is still waiting.

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