In view of the worldwide coronavirus disease 2019 (COVID-19) pandemic, hospitals need contingency planning. This planning should include preparation for an unexpected patient surge. This measure is evolving concomitantly with the implementation of the needed infection control rules. Here, we present our experience in contingency planning at four large tertiary hospitals in Saudi Arabia during this global pandemic, with a focus on dealing with COVID-19 patients who need to undergo surgery. The planning covers response measures required in the operating room and supporting units, including the administrative department, intensive care unit, and different sections of the surgical department. Furthermore, it covers the role of education and simulation in preparing health care providers and ensuring smooth workflow between all sections. We additionally discuss the guidelines and policies implemented in different surgical specialties. These measures are necessary to prevent the transmission of COVID-19 within healthcare facilities. Throughout the COVID-19 pandemic, the healthcare system should develop a comprehensive pandemic plan and set guidelines addressing the management of urgent and malignant cases. The guidelines should be in concordance with internal guidelines.

Objectives:To determine pattern and impact of physical rehabilitation on dependency and functional performance of patients.Methods:This retrospective chart review was carried out between July and August 2012 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were collected using demographic, clinical, and dependency assessment checklists.Results:Patients who underwent major lower limb amputations between January 2007 and April 2012 (n=121) were included in the study. There were 84 (69.4%) male and 37 (30.6%) female patients with a mean ± standard deviation of 63.3±17.4 years old. Diabetes mellitus was the most frequent cause in 63.6% of patients. Only one-third of the amputees (32.2%) have records of completion of their rehabilitation programs, although 20.7% of them completed the <50% of the scheduled rehabilitation sessions, 17.2% attended between 50% and 80%, and the remaining 62.1% attended more than 80% of the scheduled sessions. Muscle power scores in each side of the upper and lower limbs were significantly better following rehabilitation (p<0.0001). Basic functions of mobility and transfer have also significantly improved (p<0.05).Conclusions:Overall dependency and functional performance were significantly better following implementation of the physical rehabilitation programs. A multidisciplinary team approach is mandatory to improve compliance of patients toward the rehabilitation programs.

BackgroundAn atypical case of a traumatic posterior C1-C2 dislocation with an anterior arch fracture of C1 is reported. A novel conservative treatment for this rare lesion is described.Case presentationAn eighty-nine-year-old male fell off a ladder at home and presented with an acute traumatic cervical spine trauma, which we believe involved a distraction mechanism. The patient was neurologically intact; he denied any weakness, numbness or paresthesia. A preoperative CT-scan demonstrated a posterior dislocation with an anterior arch of C1 fracture. Conservative management was elected. Reduction was achieved by closed manual reduction under general anesthesia. A postoperative CT demonstrated a complete reduction of the atlanto-axial dislocation.ConclusionBased on this case report and relevant literature, we present an unusual lesion of the upper cervical spine treated nonoperatively with closed manual reduction under general anesthesia. To date, there is no available consensus for the management of these lesions.

Here, we report a case of idiopathic epidural lipomatosis presented with a clinical picture of lumbar canal stenosis with neurogenic claudication which resolved completely only by weight loss. A 53-year-old obese male with a body mass index of 36 without significant past medical history presented to the outpatient clinic with neurogenic claudication and bilateral sciatic radiculopathy. Initially, magnetic resonance imaging (MRI) showed epidural lipomatosis at the level of L5 vertebral body and L5–S1 intervertebral disc. A conservative treatment was decided with dietary regime program. After 6 months of follow-up, his bilateral sciatic radiculopathy disappeared, and updated MRI showed complete disappearance of epidural lipomatosis. Based on the Grand Round case and relevant literature, we present a case of an unusual epidural lipomatosis with mixed clinical picture of degenerative lumbar disease. This case report set out the importance of Borré classification for differentiating the mixed clinical complaint of degenerative discopathy and epidural lipomatosis.