Patient: Female, 68-year-old Final Diagnosis: Pleural effusion Symptoms: Breathlessness • shortness of breath Medication: — Clinical Procedure: Arthroscopic Rotator Cuff repair Specialty: Orthopedics and Traumatology Objective: Unusual or unexpected effect of treatment Background: Airway compromise caused by massive fluid extravasation in association with arthroscopic shoulder surgery is rare. However, it is even more rare to occur as a result of pleural effusion. We present this case to increase the awareness of this rare complication and show how to minimize the likelihood of this uncommon incident. Case Report: We describe a case of a 68-year-old woman who underwent elective shoulder arthroscopy for rotator cuff repair. She had immediate postoperative shortness of breath and was found to have bilateral pulmonary edema and pleural effusion accompanied by metabolic acidosis. She was managed conservatively in the intensive care unit and then transferred to the general ward after clinical and radiological improvement the next day. Conclusions: This uncommon complication was self-limiting, and the patient recovered uneventfully. High clinical suspicion is required to address this event so proper rapid management can be made.

Background and objectiveHypertension (HTN) is a common disease among patients who visit primary healthcare clinics. Uncontrolled HTN is associated with increased morbidity and mortality; therefore, awareness of its risk factors and adherence to treatment can lead to better control of HTN. In this study, we aimed to determine the level of adherence to treatment and satisfaction among Saudi hypertensive patients. MethodsIn this cross-sectional study, we used an interviewer-administered questionnaire among hypertensive patients aged 40 years or older who attended primary healthcare centers in the five main regions within Saudi Arabia. We excluded patients with mental disorders, dementia, or those unable to provide consent to participate. The estimated sample size was 384 patients as calculated by Raosoft® based on the AlNozha study (prevalence of HTN in Saudi Arabia is 26.1%). The questionnaire included questions about demographic data, awareness about HTN risk factors and complications, adherence to treatment, and patient satisfaction along with the information related to management from their physicians. Microsoft Excel was used for data entry, and SPSS Statistics version 23 (IBM, Armonk, NY) was used for statistical analysis. ResultsOf the 384 hypertensive patients recruited, most were in the age group of 40-49 years (36.5%), and the majority of them were female (75%). Most patients (n=305, 79.4%) reported good adherence to the management plan. Also, most of the patients (73.4%) were satisfied in terms of receiving simplified information and justification of the management plan from their physicians. ConclusionsA good level of satisfaction was observed among patients of HTN in Saudi Arabia with respect to information, simplification, and justification of treatment plans provided by health professionals. This high satisfaction level accounts for the high adherence to the treatment plan.

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Objectives: To clarify the spectrum of morphological and molecular subtypes of medulloblastoma (MBL), in addition to MYC and MYCN amplification statuses in a cohort of Saudi patients. The latter was correlated with patient outcome. Methods:We conducted a retrospective cohort study of 57 patients with MBL, diagnosed at the central laboratory of King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2006 and 2019. Molecular analysis for MYC and MYCN amplification was performed for the 19 most recently diagnosed patients.Results: Classic MBL was the most prevalent histologic subtype and MBL with extensive nodularity was the rarest. The non-WNT/non-SHH molecular subgroup was the most common while the WNT-activated was the least common. Among 19 patients analyzed, MYC and MYCN amplifications were discovered in 2 (10.5%) and 1 (5.3%) cases, respectively, using interphase fluorescence in-situ hybridization. The 2 MYC amplified cases belonged to the large cell/ anaplastic subtype and had the worst outcomes. Conclusion:The MYC amplification corresponded with poor prognosis, the large cell/anaplastic variant of MBL, and the non-WNT/non-SHH molecular subtype.

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