Background: Diabetic ketoacidosis (DKA) is a common emergency and life-threatening illness. Also, if not detected early, early treatment in the emergency room can cause serious complications. The goal of managing type 1 diabetes is to maintain the correct levels of blood sugar, glycated hemoglobin (HbA1c), blood pressure, lipid levels, and body weight while avoiding hypoglycemia. Treatment of type 1 diabetes requires proper insulin treatment, proper nutrition, physical activity, preventive education, and patient self-care Objective: The purpose of this study is to determine parental perceptions of DKA symptoms in children with type 1 diabetes in the Northern Region of Saudi Arabia. Methods: In the Northern Region of Saudi Arabia, a cross-sectional study was conducted from November 2020 to May 2021 among parents with diabetic children at the Diabetes Center in the Northern Region of Saudi Arabia using a pre-designed online questionnaire distributed on social media web-sites to collect data.  Data was analyzed by using statistical package for the social sciences (SPSS, version 23) and results was presented by tabular and graphical presentation according to the study objectives. Results: only 42.9% of our participants responded that they have good knowledge about DKA. 19.2% thought it only occurs in children. 43.3% of our participants knew that DKA is a complication of diabetes due to hyperglycemia. Regarding the source of information about DKA among our participants, our data demonstrated that only 22.9% of our participants got their information about DKA from the doctors, and 31.8% of the participants had the internet as their source of information regarding DKA. In the current study, 14% of the participants said that they had a child had DKA at least one, and 91.6% of them were admitted to the hospital. There was a significant relation with gender, age of the parent, and educational level, while it showed insignificant relation with marital status. Conclusion: In conclusion, knowledge of most of parents of diabetic children about diabetic ketoacidosis is poor. Their main knowledge source is not trustful or adequate. Their main knowledge source is not trustful or adequate. Therefore, we recommend policy makers to held health education to parents and/or caregivers of type 1 diabetic children regarding all aspects of DKA. It must be properly achieved in a structured manner based on a general outline that should include education at the onset of treatment and then repeated based upon an annual assessment of patients’ training needs or upon their own request. Areas of poor knowledge related to diabetes and diabetic ketoacidosis should be emphasized during health education sessions.

Gallstones cause biliary obstruction in about 5 out of 1000 people, whereas 10 to 15% of the adult population in the United States will have gallstones at some point in their lives. Gall stones, also known as cholelithiasis, are the precursor of choledocholithiasis, which occurs when gall stones pass through the cystic duct and lodge in the common hepatic ducts, causing an obstruction. Routine labs and some specialized labs are used in the diagnosis of biliary blockage. Severe complications can happen if left unchecked such as damaging the hepatic dysfunction, renal failure, nutritional deficiencies, bleeding problems, and infections. Treatment depends on the causing effect of bile duct obstruction. Sphincterotomy with lithotripsy, choledochotomy, choledochoduodenostomy, choledochojejunostomy, or cholecystectomy are the most used for large gall stones treatment. This review looks at the prevalence, etiology and management of the disease.

Moyamoya disease (MMD) is an isolated chronic, usually bilateral, vasculopathy disease of undetermined etiology. The clinical presentations of MMD include TIA, ischemic stroke, hemorrhagic stroke, seizures, headache, and cognitive impairment. Intra- and extra-cranial revascularization for the prevention of recurrence of bleeding in patients with hemorrhagic MMD is controversial. Surgical revascularization of MMD includes 3 types: Direct revascularization, indirect revascularization and combined revascularization. The surgical goal of cerebral revascularization is to prevent progression of symptomology, alleviate intracranial hemodynamic stress, and reduce the incidence of subsequent ischemic or hemorrhagic stroke. However, surgical treatments pose various complications due to the sudden increase in cerebral blood flow or hemodynamic changes caused by perioperative risk factors and anesthesia, such as HS, cerebral hemorrhage and cerebral infarction, bypass occlusion caused by distal vascular resistance, bypass occlusion caused by compression of the temporalis, and anastomotic aneurysm.

Acute and chronic sinusitis are common primary care presentations. They are caused by mucosal inflammation, which inhibits mucociliary function of the nose and paranasal sinuses. Because it affects the mucous membranes that line both the nose and the sinuses, the complete medical word for sinusitis is "rhinosinusitis". Sinusitis is usually caused by a viral upper respiratory tract infection, with bacterial sinusitis occurring in about 2% of cases, yet in most cases overall antibiotics are being used and prescribed which is in most part are not needed, and cases often resolves without antibiotics need, most general practitioners rely on clinical findings to make the diagnosis. Watchful waiting and symptom treatment with nasal oxymetazoline, pseudoephedrine, and saline nasal irrigation are recommended. In this paper, we overview the presentation and management of sinusitis.

Levothyroxine is a synthetic T4 hormone that is biochemically and physiologically identical to the natural hormone, and it is used when the body is deficient in the natural hormone. This study was conducted to summarize the current evidence that compare evidence supporting morning dose to evening dose of levothyroxine in patients with hypothyroidism‎. A simple systematic review was carried out, searching databases PubMed, Google Scholar, and EBSCO. The authors extracted the needed data. There is conflicting data regarding effectiveness of morning dose versus evening dose in management of levothyroxine. More studies reported effectiveness of bedtime dose more than breakfast dose in hypothyroidism management. Numerous studies reported effectiveness of bedtime dose more than breakfast dose in hypothyroidism management. The most resent evidences recommended that, if possible, L‐T4 be consistently taken either 60 minutes before breakfast or at bedtime (3 or more hours after the evening meal), for optimal, consistent absorption.