Extraintestinal manifestations (EIMs) are common in inflammatory bowel disease (IBD), in both Crohn's disease and ulcerative colitis. Almost any organ system can be affected, including the musculoskeletal, dermatologic, renal, hepatopancreatobiliary, pulmonary and ocular systems. However, the musculoskeletal and dermatologic systems are the most commonly involved sites of manifestations. While some manifestations such as peripheral arthritis and erythema nodosum have an association with IBD activity, others such as axial arthropathy, pyoderma gangrenosum and primary sclerosing cholangitis have an independent disease course. This review provides a summary of the most common EIMs in IBD and their prevalence and management.

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Background and Objective: Deficient knowledge on antibiotics causes misuse. This study aimed to investigate parents' knowledge, attitudes and practices on antibiotic use by children in various cities of Saudi Arabia. Methods: This cross-sectional study was carried out using a previously validated questionnaire. The questionnaire was translated into Arabic and hosted on Google Forms. Parents of children aged ≤14 years, whose contact details were available with the author, were contacted and requested to participate in the study. For those who agreed to participate, the Google Forms link was shared through WhatsApp between July and August 2016. The respondents were also encouraged to share the link with contacts who had children aged ≤14 years. Descriptive and inferential statistical analyses were performed. Results: In total, 544 parents responded from various cities of Saudi Arabia. Of these, about 75% were males (mean age = 49.9 years) and the majority (~68%) had a university degree and above. In the 6 months preceding the study, 431 respondents had taken their children to physicians. Of these, only 7.2% reported not being prescribed any antibiotics, whereas 66.8% were prescribed an oral antibiotic one or two times and 26% were more than three times. In terms of prescription, 373 respondents (68.6%) purchased antibiotics without a prescription, whereas 171 (31.4%) purchased it only after obtaining a prescription. However, only seven (1.3%) followed instructions regarding antibiotic usage, whereas 50% did not receive any advice from their doctor regarding use. All demographic characteristics, except gender and residence, were found to have significant effect on parents' knowledge on antibiotic use (P < 0.05). Conclusion: This study found that in various cities of Saudi Arabia, parents' knowledge, attitudes and practices on antibiotics for their children are poor. These findings highlight the need for parental education programs regarding antibiotic use and for implementing more stringent regulations on antibiotic prescription.

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Background: Acute chest syndrome is a major cause of pulmonary disease and mortality in sickle cell disease patients. Its diagnosis can be delayed due to differing imaging patterns between children and adults. Objective: The purpose of this study was to describe the pulmonary and extrapulmonary imaging findings in sickle cell disease patients with acute chest syndrome and determine differences in findings between adult and pediatric patients. Patients and Methods: This retrospective study analyzed the data of all sickle cell disease patients who were admitted with a diagnosis of acute chest syndrome to King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between January and June 2015 (n = 150). After grouping the patients into adults and pediatrics, the pulmonary and extrapulmonary characteristics were identified and the digital radiography, computed tomography and laboratory findings were compared. Results: A total of 116 patients with 163 acute chest syndrome episodes met the inclusion criteria, of which 69 (60%) were adults. In both adult and pediatric patients, the most frequent pulmonary finding was consolidation of the lung parenchyma. The right lung was most frequently involved: the lower lobe in adult patients and the middle lobe in pediatric patients. In addition, pleural effusion was observed in both age groups. Extrapulmonary radiological findings, such as avascular necrosis and cardiomegaly, were significantly more common in adult patients than in pediatric patients (P < 0.05). Compared with adults, pediatric patients had significantly lower hemoglobin levels (P = 0.001) and oxygen tension fraction in arterial blood (P = 0.007). Conclusions: Pediatric and adult sickle cell disease patients with acute chest syndrome typically exhibited similar pulmonary characteristics, whereas extrapulmonary findings were more prominent in adult patients. Furthermore, low levels of hemoglobin and oxygen tension fraction were dependent predictors of acute chest syndrome.

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Background: Faculty members are crucial elements of an educational institution, and their job satisfaction is likely essential for success of the educational process. Leadership support, work conditions and perceived job security could be factors affecting academic job satisfaction. Objective: The aim of the study was to investigate the effect of leadership support, work conditions and perceived job security on the overall academic job satisfaction of faculty. Materials and Methods: A cross-sectional survey, using a structured questionnaire, was conducted to determine the effect of leadership support, work conditions and perceived job security on academic job satisfaction among faculty and teaching staff at the College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Multiple regression analysis was performed to examine the significance of these relationships at 95% confidence interval and P < 0.05 level of significance. Results: Leadership support (β = 0.187, t = 2.714, P= 0.007), work conditions (β = 0.199, t = 2.628, P= 0.009) and perceived job security (β = 0.264, t = 3.369, P= 0.001) were found to be significantly associated with overall academic job satisfaction. Conclusion: The results of this study support the hypothesis that faculty and teaching staff working with supportive leaders and favorable work conditions as well as having an optimized sense of perceived job security demonstrate significantly higher levels of overall academic job satisfaction. These findings provide input for policymakers, and their implementation could enhance an institution's vitality and performance, and thus enable it to fulfill its goals.

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Background: Elderly patients with diabetes receiving social support are likely to have better compliance with their disease self-care. However, no previous study from Turkey has assessed the effect of social support on diabetes burden among elderly patients. Objective: The objective of this study was to assess the association between social support and disease burden among elderly patients with diabetes in Turkey. Materials and Methods: This cross-sectional study included 271 randomly selected elderly patients with diabetes who presented to the internal medicine and diabetes polyclinics of three state hospitals (Sindirgi State Hospital, Balikesir Ataturk State Hospital and Balikesir State Hospital) in Balikesir, Turkey, between April and November 2017. A single interviewer collected all data using a sociodemographic form, the Elderly Diabetes Burden Scale (EDBS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Data were analyzed using arithmetic averages, percentages and Pearson's correlation. Results: The mean age of the participants was 72 ± 5.2 (65–88) years, and most (53.6%) were females and lived with their family: spouse (58.3%), children (18.5%) or both (17.7%). The mean EDBS score was 35.21 ± 6.94 (25–69), and the mean MSPSS score was 67.81 ± 17.33 (12–112). A significant negative correlation was found between the mean total of both assessment tools (P < 0.05), indicating diabetes burden was higher among those with lower social support. A similar significant correlation was observed between symptom burden, social burden, burden of dietary restrictions, burden by tablets or insulin and the total EDBS score. Conclusion: This study found that in Balikesir, Turkey, social support for elderly patients with diabetes was mostly provided by their families and that their diabetes burden decreased with increased social support levels.

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Background: Human metapneumovirus (hMPV) is a Paramyxovirus known to cause acute respiratory tract infections in children and young adults. To date, there is no study from the Aseer region of Saudi Arabia determining the proportion and severity of hMPV infection among pediatric hospitalized patients with respiratory infections. Objectives: The objective of this study is to determine the presence of hMPV antigens in the nasopharyngeal secretions of pediatric patients hospitalized with respiratory tract infections in the Aseer region of Saudi Arabia. Materials and Methods: This prospective, serological hospital-based study included all pediatric patients who were admitted to Aseer Central Hospital, Abha, Saudi Arabia, from July 2016 to November 2017 with upper and/or lower respiratory tract infections. Basic demographics of patients and their clinical data on and after admission were recorded. Direct fluorescent antibody assay was used to detect the presence of hMPV antigens in the obtained nasopharyngeal secretion specimens. Results: During the study, 91 pediatric patients were hospitalized due to upper and/or lower respiratory tract infections, of which 9.9% were positive for hMPV. These patients were aged 9 months to 16 years, were from Abha city or its surrounding localities and were mostly (77.8%) hospitalized during autumn or winter. The most common diagnosis on admission was bronchopneumonia (55.5%) and aspiration pneumonia (22.2%), and some patients also had underlying chronic conditions such as chronic heart disease (22.2%) and bronchial asthma (11.1%). Conclusions: The results obtained indicated that hMPV is a potential etiologic factor for the commonly occurring acute respiratory infections in hospitalized children from the Aseer region of Saudi Arabia. hMPV infection was also found to be associated with complicated respiratory conditions such as bronchopneumonia, chronic heart disease and bronchial asthma.

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Atrial fibrillation is a common cardiac arrhythmia worldwide. In patients with hyperthyroidism, atrial fibrillation is the most common comorbid cardiac condition. Here, the authors report a case of a 47-year-old female with no significant medical history who presented with heart failure symptoms. Further analysis confirmed atrial fibrillation with a dilated atria and severe mitral regurgitation. In addition, she was found to be hyperthyroid. Accordingly, electrical cardioversion treatment was initiated, and her hyperthyroidism was managed. This resulted in her normal sinus rhythm being restored and subsequently being maintained. A repeat echocardiography 6 months later showed resolution of mitral regurgitation, improvement of atrial size and normalization of the left ventricular systolic function. Therefore, based on this case report, the authors suggest that atrial remodeling and functional mitral regurgitation secondary to atrial dilatation can be reversed by restoring and maintaining the sinus rhythm.

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Bariatric surgery has rapidly emerged as a modality for managing morbid obesity; however, despite being considered safe, some complications do exist. Formation of a gastrobronchial fistula is a rare complication of laparoscopic sleeve gastrectomy that is associated with high morbidity and mortality. Nowadays, novel endoscopic techniques have widely been adopted in the management of such cases, as they provide minimally invasive options that decrease the morbidity and mortality. Here, the author presents a report of a middle-aged, morbidly obese male who had previously undergone laparoscopic sleeve gastrectomy and returned with a 3-month history of productive cough. On upper gastrointestinal series, the patient was found to have a fistula communicating the stomach to the bronchial tree of his left lung (gastrobronchial fistula). He was treated with endoscopic fistula closure using an over-the-scope clip and a fully-covered Niti-S metallic stent. After this treatment, the patient's symptoms improved dramatically, and the stent was successfully removed 12 weeks later. This report highlights the management of a patient with gastrobronchial fistula formation following laparoscopic sleeve gastrectomy as well as provides a literature review of using combined endoscopic management to treat gastrobronchial fistulas.

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Burkitt's lymphoma is a rapidly growing, high-grade B-cell non-Hodgkin lymphoma that has three distinct variants. Of these, sporadic Burkitt's lymphoma most frequently involves the gastrointestinal system, and the hypopharynx is a rare site of occurrence. Here, the authors report a case of sporadic Burkitt's lymphoma in a 28-year-old male who presented with change of voice as the only complaint. On examination, a mass was found in the hypopharynx that obstructed the laryngeal inlet. The patient underwent an elective examination under general anesthesia and biopsy of the lesion. Histopathological examination confirmed the diagnosis of sporadic Burkitt's lymphoma, following which surgical tracheostomy was performed with complete excision of the mass. A prompt diagnosis is vital to ensure appropriate management of rapidly evolving tumors, such as Burkitt's lymphoma. When diagnosing hypopharyngeal masses, a high index of suspicion is required, as other diseases may appear with similar presentations.

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A 54-year-old male presented to our ophthalmology clinic with a diagnosis of the right central retinal vein occlusion with macular edema. The patient was treated with dexamethasone intravitreal implant. Three days after the implant insertion, the patient experienced pain, redness and blurred vision in the same eye. With a provisional diagnosis of acute endophthalmitis, a combination of ceftazidime 2.25 mg/0.1 ml and vancomycin 1 mg/0.1 ml was injected intravitreally. One week after the treatment, endophthalmitis signs and symptoms subsided. This report presents a case of endophthalmitis following dexamethasone intravitreal implant, with a favorable outcome after treatment with intravitreal antibiotic injection without removal of the implant.

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