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Early versus late DNR orders and its predictors in a Saudi Arabian ICU: A descriptive study
(2022) Aletreby, Waleed; Mady, Ahmed; Al-Odat, Mohammed; Balshi, Ahmed; Mady, Anas; Al-Odat, Adam; Elshayeb, Amira; Mostafa, Ahmed; Abd Elsalam, Shereen; Odchigue, Kriz
Background: Practices of Do-Not-Resuscitate (DNR) orders show discrepancies worldwide, but there are only few such studies from Saudi Arabia. Objective: To describe the practice of DNR orders in a Saudi Arabian tertiary care ICU. Methods: This retrospective study included all patients who died with a DNR order at the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 1 to December 31, 2021. The percentage of early DNR (i.e., ≤48 hours of ICU admission) and late DNR (>48 hours) orders were determined and the variables between the two groups were compared. The determinants of late DNR were also investigated. Results: A total of 723 cases met the inclusion criteria, representing 14.9% of all ICU discharges and 63% of all ICU deaths during the study period. The late DNR group comprised the majority of the cases (78.3%), and included significantly more patients with acute respiratory distress syndrome (ARDS), community acquired pneumonia (CAP), acute kidney injury, and COVID-19, and significantly fewer cases of readmissions and malignancies. Septic shock lowered the odds of a late DNR (OR = 0.4, 95% CI: 0.2–0.9; P = 0.02), while ARDS (OR = 3.3, 95% CI: 2–5.4; P < 0.001), ischemic stroke (OR = 2.5, 95% CI: 1.1–5.4; P = 0.02), and CAP (OR = 2, 95% CI: 1.3–3.1; P = 0.003) increased the odds of a late DNR. Conclusion: There was a higher frequency of late DNR orders in our study compared to those reported in several studies worldwide. Cases with potential for a favorable outcome were more likely to have a late DNR order, while those with expected poorer outcomes were more likely to have an early DNR order. The discrepancies highlight the need for clearer guidelines to achieve consistency.
Clinical characteristics of Crohn's disease in a cohort from Saudi Arabia
(2022) Qari, Yousef
Objective: In Saudi Arabia, there are limited studies on the clinical characteristics of patients specifically with Crohn's disease (CD). This study was conducted to describe the clinical characteristics of CD at a tertiary care center in Jeddah, Saudi Arabia. Methods: This retrospective study included all patients aged >14 years who had a definitive diagnosis of CD and were managed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between 2012 and 2018. Data were collected for the following categories: clinical, laboratory, radiological, histological features at presentation, and disease-related complications. Results: The study included 245 newly diagnosed CD patients, aged 14–73 years (median: 26.3 years). All subjects presented with abdominal pain. Majority of the patients (59.7%) received a definitive diagnosis of CD >3 months after the onset of symptoms; 15.1% were initially suspected to have intestinal tuberculosis. Diarrhea and bleeding per rectum were reported in 60.8% and 49.7% of the patients, respectively. Sacroiliitis was the most frequent extraintestinal manifestations (11.4%). In terms of disease location, the terminal ileum (L1) was the most affected area (46.9%). Twenty-five patients had perianal disease, of which 40% had complex fistulae and 36% had perianal abscesses. The majority had hemoglobin levels >10 g/dl (74.1%), decreased serum iron (69.6%) and ferritin (50.5%) levels, and elevated erythrocyte sedimentation rate (68.2%) and C-reactive protein (82.2%). Conclusions: The majority of the patients in our cohort presented with the characteristic quartet of abdominal pain, weight loss, fever, and diarrhea. This study also found a significant number of patients with CD in Saudi Arabia experience diagnostic delay, which may contribute to disease morbidity and complications. These findings highlight the need for future studies to determine factors influencing this diagnostic delay.
A rare case of xanthomatous meningioma
(2022) Altindag, Sultan; Cakalagaoglu, Fulya; Karaca, Gokay; Yuceer, Nurullah
Xanthomatous meningioma is an extremely rare subtype of metaplastic meningiomas with few cases reported in the literature. Histopathologically, it is composed of oval-shaped cells that have central nuclei and cytoplasm with lipid-filled vacuoles, resembling macrophages. Here, the authors present a case of xanthomatous meningioma and discuss the hypotheses related to its origin and the differential diagnosis. A 40-year-old woman presented with an increased headache complaint over the past month. A computed tomography scan revealed a heterogeneous mass on the right parietal lobe, following which a right craniotomy was done. Microscopic examination showed neoplastic meningothelial cells with whorl formation and areas of xanthomatous changes. Both meningothelial and xanthomatous cells were positive with vimentin, progesterone, and epithelial membrane antigen. CD68 and lysozyme were expressed only in the xanthomatous component, and there was no expression with periodic acid-Schiff (PAS) stain and PAS–diastase. As the diagnostic criteria of atypical meningioma were not observed, a diagnosis of xanthomatous meningioma, WHO grade I, was made. Owing to the characteristic xanthomatous changes, its differential diagnosis includes grade II clear cell meningioma, Rosai–Dorfman disease, and hemangioblastoma. To avoid misidentifying these cells as macrophages, a high degree of awareness of this unique subtype of meningioma is required.
Spontaneous intracerebral hemorrhage among hypertensive patients in Saudi Arabia: Study from a tertiary center
(2022) Albakr, Aishah
Background: Spontaneous intracerebral hemorrhage (ICH) is the second most common cause of stroke, yet there is paucity of evidence regarding the same from Saudi Arabia. Objectives: To describe the clinical characteristics of spontaneous ICH as well as determine the role of gender in ICH and the usefulness of the ICH scoring system for assessing the 30-day mortality risk. Patients and Methods: This retrospective study included all patients diagnosed with spontaneous ICH at King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between April 01, 2014, and April 30, 2019. Data regarding clinical characteristics, risk factors, and radiological features of ICH were extracted. Further, gender-related differences were determined. The 30-day mortality rates were assessed using the ICH score. Results: A total of 148 patients were diagnosed with spontaneous ICH during the study period. Of these, 100 (67.5%) were male and the overall mean age was 60 ± 15 years. About 48% of the male patients were aged ≤50 years compared to 27% of the female patients (P = 0.016). Impaired renal function (35.8%) and diabetes (33.7%) were the most frequent risk factors; hemiparesis (51%) and language impairment (42%) were the most common presenting symptoms; and basal ganglia (40.5%) was the most common location. The 30-day mortality rate was 30%. The mean ICH score at presentation was significantly high in those who died within 30 days of presentation (2.2 ± 1.6; P < 0.0001). Each increase in the ICH score was associated with an increase in mortality rate (P < 0.001 for trend). Conclusion: Patients with spontaneous ICH were found to have a high prevalence of vascular risk factors and mortality rate. The ICH scoring system was shown to be a useful clinical tool for evaluating the 30-day mortality risk.
Anterior subcapsular cataract formation with pupil sphincter tear after using massage device over the globe
(2022) Al Habash, Ahmed; Al Somali, Abdulaziz; Otaif, Wael
Thymectomy in myasthenia gravis: A narrative review
(2022) Aljaafari, Danah; Ishaque, Noman
Myasthenia gravis (MG) is a rare condition caused by autoantibodies against acetylcholine receptors on postsynaptic membrane that leads to weakness of skeletal muscles. About 7 of 10 patients with MG have thymic hyperplasia and about 1 of 10 patients have thymoma. Thymectomy has increasingly been used as a treatment modality for MG. Several observational studies have shown that thymectomy results in improvement in MG and a randomized trial has established that thymectomy leads to a better outcome in non-thymomatous generalized MG. However, thymectomy is yet controversial in some disease subtypes and there are potential concerns regarding the selection of the ideal surgical approach to achieve complete removal of the thymic tissue to achieve stable remission rates. This review highlights the role of thymectomy in non-thymomatous and thymomatous MG, the effectiveness of various thymectomy methods, postoperative myasthenic crisis, and remission after thymectomy.
Ruscogenin protects against deoxynivalenol-Induced hepatic injury by inhibiting oxidative stress, inflammation, and apoptosis through the Nrf2 signaling pathway: An In vitro study
(2022) Elsawy, Hany; Rajendran, Peramaiyan; Sedky, Azza; Alfwuaires, Manal
Background: Deoxynivalenol (DON) is a trichothecene mycotoxin with demonstrated cytotoxicity in several cell lines and animals, primarily owing to inflammation and reactive oxygen species accumulation. Ruscogenin (RGN), a steroidal sapogenin of Radix Ophiopogon japonicus, has significant anti-thrombotic/anti-inflammatory effects. Objective: The aim of this study was to assess the protective role of RGN against DON-induced oxidative stress, which occurs through the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway and is regulated by phosphoinositide 3-kinases/protein kinase B (PI3K/AKT). Methods: The effects were examined using the HepG2 cell line. RGN and DON were suspended in serum-free medium. Cells were seeded onto plates, and then RGN, DON, or both were added over 24 h in triplicates for each group. Results: RGN conferred protection against DON-exhibited cytotoxicity against HepG2 cells. RGN pretreatment downregulated the expression of DON-induced TNF-α and COX-2 and the formation of reactive oxygen species in a dose-dependent manner. RGN upregulated the expression of Nrf2 and its antioxidant proteins as well as mRNA levels of HO-1/NQO-1/HO-1/Nrf2. Similarly, treatment with DON + RGN resulted in upregulation of the pI3K/pAKT signaling pathway in a dose-dependent manner. Finally, RGN was also found to inhibit the DON-induced apoptosis by upregulating the levels of cleaved proteins and downregulating the expression of Bcl2. Conclusion: The study demonstrates that RGN suppresses hepatic cell injury induced by oxidative stress through Nrf2 via activation of the pI3K/AKT signaling pathway.
Awareness and knowledge of postoperative surgical site infections in patients from Saudi Arabia: A multi-regional cross-sectional study
(2022) Alsahli, Alaa; Alqarzaie, Abdullah; Alasmari, Ali; AlOtaibi, Mohammed; Aljuraisi, Abdulrahman; Khojah, Abdulaziz; M. Alzahrani, Nadia; Alaqeel, Faten
Background: Knowledge regarding surgical site infections (SSIs) can help reduce hospital stay, morbidity, and mortality associated with SSI. Objectives: This study aimed to determine the knowledge and awareness of SSI among patients undergoing surgeries across Saudi Arabia. Methods: This multi-center cross-sectional study included adult patients (aged >18 years) who underwent surgery at six centers located across the five regions of Saudi Arabia. A 36-item questionnaire was used to elicit data regarding demographics, patient's health status, procedures, and hospitalization history and awareness and knowledge about SSIs. Results: A total of 375 patients were included (equally for all five regions of Saudi Arabia). Most patients were male (55.7%) and aged 18–34 years (44%). Most respondents (49.1%) had poor awareness; being illiterate and from the Northern region were significant factors (P = 0.001). Patients with no history of surgery (P = 0.001) or SSI (P = 0.003) also had poor awareness levels. In terms of knowledge, 45.8% and 35.2% of the participants had fair and poor knowledge, respectively, with the level of knowledge being significantly associated with region (P = 0.001). Patients those aged >65 years had poor knowledge (P = 0.033), while of males had good knowledge (P = 0.02). Patients with no history of surgery had poor knowledge of SSIs (P = 0.003). Only 32.8% of the patients recalled having been educated by healthcare workers. About 42% learned of SSIs from sources outside the hospital, with internet/social media platforms accounting for 48.4% of such sources. Conclusion: A significant proportion of the patients included in this study had poor awareness and knowledge of SSIs. The study highlights the need for strengthening the preoperative patient education in Saudi Arabia to reduce the likeliness of SSIs.
Morbidities and health-seeking behavior of elderly patients attending primary health care in the Kingdom of Bahrain
(2022) Bahram, Samya; AlSayyad, Adel; Al Nooh, Fatima; Al Farra, Wafa; Al Ekri, Ali
Background: Understanding the health-seeking behaviors help in increasing the effectiveness and efficiency of the health-care system; however, there is lack of knowledge regarding the health-seeking behavior of the elderly population in the Kingdom of Bahrain. Objective: The objective of this study was to identify the morbidity profile and determine the health-seeking behavior of the elderly population. Methods: This cross-sectional study included all elderly patients (≥60 years) who attended four primary health-care centers that represent four governorates with the largest catchment area in the Kingdom of Bahrain between June 19 and August 31, 2021. Information concerning their sociodemographic data, morbidity profile and health-seeking behavior were collected through direct interviewing using a structured, predesigned and pretested questionnaire. Results: A total of 414 elderly patients were included, with the majority being Bahraini (89.1%) and male (55%). The most prevalent morbidity was hypertension (67.6%), followed by hyperlipidemia (54.7%), diabetes (52.6%), and arthritis (32.1%); arthritis was significantly more common among females than males (P < 0.001). The majority reported the reason for their visit being “repeat prescription” (32.1%). Almost one-third (28.2%) attempted self-management prior to their visit, and almost half (46.7%) reported seeking non-professional medical advice. The majority rated their health as good (39.4%) and moderate (38.2%). Less than one-third (28%) reported having had a health problem for which they did not attend to a health care facility. Conclusion: The study highlighted the morbidity profile and the health-seeking behavior among elderly population in Bahrain, which may serve as a point from which further efforts may be directed to improve the services.
NGAL/MMP-9 as a biomarker for epithelial ovarian cancer: A case–control diagnostic accuracy study
(2022) Gupta, Rohit; Dholariya, Sagar; Radadiya, Madhuri; Agarwal, Pragati
Background: Epithelial ovarian cancer (EOC) are often diagnosed late due to lack of specific symptoms and efficient tumor markers. Neutrophil gelatinase-associated lipocalin/matrix metallopeptidase-9 (NGAL/MMP-9) complex are involved in the development and progression of various cancers and have potential as a biomarker for diagnosing ovarian cancer. Objectives: To compare the serum NGAL/MMP-9 complex levels in patients with EOC, benign ovarian tumor, and healthy controls, and determine the potential cut-off values of NGAL/MMP-9 complex for diagnosing EOC. Materials and Methods: The study included 50 patients each with EOC and benign ovarian tumor, along with 50 age-matched healthy controls (N = 150). The level of serum NGAL/MMP-9 complex was estimated based on sandwich ELISA. The mean and median of the three groups were compared, and the ROC curve was used to determine the optimum cut-off, sensitivity, and specificity of serum NGAL/MMP-9 complex levels in the diagnosis of EOC. Results: A significant difference was found in the median values of the NGAL/MMP-9 complex (malignant EOC: 67.5 ng/ml, benign ovarian tumor: 53.7 ng/ml, controls: 29.2 ng/ml; P < 0.01). NGAL/MMP-9 complex level was also significantly associated with the FIGO staging (Stages I and II: 42.9 ng/ml; Stages III and IV: 70.5 ng/ml; P < 0.003). At a 55.0 ng/ml cut-off value, the NGAL/MMP-9 complex had 82.0% sensitivity and 78.0% specificity in diagnosing EOC. Conclusion: The NGAL/MMP-9 complex may be a promising biomarker for determining the progression of EOC as well as in detecting advanced-stage ovarian cancer.
Antibiotic-resistance genes in E. coli strains in GCC countries: A meta-analysis
(2022) Bindayna, Khalid; Joji, Ronni; Ezzat, Hicham; Jahrami, Haitham
Background: Antimicrobial resistance (AMR) in Escherichia coli is an alarming issue worldwide, including in the Gulf Cooperation Council (GCC) countries, yet the prevailing gene patterns have not recently been reviewed. This study was conducted to determine and report on the dominant E. coli antimicrobial resistant gene patterns in GCC countries. Method: A scoping review identified the predominant AMR genes in GCC countries: CTX M, TEM, SHV, NDM, OXA, and VIM genes. For the systematic review, two authors independently searched Scopus, PubMed, Google Scholar, Science Direct, and Web of Science for interventional, clinical, or observational studies on the chosen AMR-conferring genes in E. coli published from GCC countries between January 2013 and June 2019, when the last search was carried out. The sAearch strategy followed the PRISMA guidelines. The risk of bias was assessed using a 6-item standardized checklist. Random-effects modeling was used for all analyses. Results: A total 32 studies were included in the final synthesis of evidence. Overall, CTX-M (53.8%) was the most prevalent gene in the region followed TEM (40.6%), NDM-1 (28.4%), OXA (24.3%), VIM (8.5%), and SHV (7.8%). Most included studies were from Saudi Arabia: CTX-M was again most common with a prevalence of 46.8% from 5442 isolates. Conclusion: The risk of bias analysis showed a mean quality score of 4.25 ± 0.75, indicating high-quality in studies included in this meta-analysis. This review found that CTX-M gene is the most common AMR-conferring gene in E. coli strains from most GCC countries.
IRMC ABSTRACTS
(2022)
ARABIC ABSTRACTS
(2022)
Do mock medical licensure exams improve performance of graduates? Experience from a Saudi medical college
(2022) Al-Sheikh, Mona; Albaker, Waleed; Ayub, Muhammed
Background: All medical graduates in Saudi Arabia are required to pass a Saudi Medical Licensure Exam (SMLE) to be able to practice and/or enroll in postgraduate training. Mock exams are a useful preparatory tool, but no study from Saudi Arabia has assessed its impact on performance in the actual licensure examinations. Objectives: To evaluate the impact of a series of mock SMLEs with immediate personalized feedback on graduate scores and their performance in the actual SMLE. Methods: This retrospective study included medical students who graduated in the 2019-20 academic year from Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, and undertook mock SMLE exams offered in August 2020. Three mock exams were constructed using the SMLE blueprint and were offered to graduates 1 week apart. Immediately after each exam, a personalized learning outcomes achievement report was sent to each graduate. Exam reliability was measured by the Kuder–Richardson formula, and were 87%, 94%, and 96% for the first, second, and third exam, respectively. Results: A total of 71, 70, and 61 students completed the first, second, and third exams, respectively. Across the three mock exams, the mean (±SD) score showed an increasing trend, from 87.6 (±33.4; range: 28–191) in the first test to 93.5 (±45.6, range 15–204) in the second and 96 (±42.6; range: 25–203) in the third. Forty graduates completed all three mock exams; of these, the scores of 25 (62.5%) students significantly improved in both the second and third exams compared to the prior test (P = 0.002). A nonsignificant positive correlation was found between the average mock and the actual SMLE scores for whom data were available (r = 0.29; P = 0.27). Conclusion: The performance of graduates improved in subsequent mock exams, and there was a nonsignificant positive correlation between the mock and actual SMLE exam results. This study presents the usefulness of using mock exams as a preparatory tool for licensure examinations in Saudi Arabia.
Clinical characteristics and outcome of candidemia: Experience from a tertiary referral center in Saudi Arabia
(2022) Alhatmi, Hind; Almansour, Sarah; Abanamy, Reem; Akbar, Abdullah; Abalkhail, Mohammed; Alharbi, Ahmad; Alsaedy, Abdulrahman; Mahmoud, Ebrahim; Alalwan, Bassam; AlJohani, Sameera; Aldibasi, Omar; Bosaeed, Mohammad; Alothman, Adel
Background: Candida bloodstream infections cause significant excess morbidity and mortality in the health-care setting. There is limited evidence regarding Candida species causing invasive infections in Saudi Arabia. Objective: To identify Candida species causing bloodstream infection and determine the clinical outcome and factors associated with mortality in a tertiary center in Saudi Arabia. Materials and Methods: This retrospective study included all cases of positive blood culture for Candida in patients admitted to King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia, between January 1, 2013 and June 30, 2019. Results: A total of 532 patients with candidemia were identified (male: 55.4%; mean age: 54 ± 26.2 years). The most common Candida species isolated was Candida albicans (26.7%), followed by Candida glabrata (22.7%), Candida parapsilosis (22.2%), and Candida tropicalis (18.4%). Non-albicans candidemia was more common in patients with diabetes (76.7%; P = 0.0560), neutropenia (89.8%; P = 0.0062), recent exposure to fluconazole (85.7%; P = 0.0394), and active chemotherapy (83.1%; P = 0.0128). In non-albicans, susceptibility to fluconazole varied from 95.9% with C. tropicalis to 41.5% with C. parapsilosis; nonetheless, all species were highly susceptible to echinocandins. The overall 30- and 90-day mortality rates were 39.9% and 56.4%, respectively. The mortality rate was nonsignificantly higher with non-albicans species at 30 days (41.2% vs. 35.9%; P = 0.2634) and 90 days (58.2% vs. 51.4%; P = 0.1620). Conclusion: This study found a changing pattern in the Candida species causing bloodstream infections and an epidemiological shift toward more non-albicans Candida species in Saudi Arabia.
Characteristics and management of papillary thyroid microcarcinoma in the United Arab Emirates: Experience from a large tertiary hospital
(2022) Malik, Azhar; Aziz, Faisal; Beshyah, Salem; Aldahmani, Khaled
Background: Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking. Objectives: To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE). Patients and Methods: This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables. Results: A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5–10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence. Conclusions: The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.
Endoscopic hemostasis of a bleeding diverticular Dieulafoy's lesion in the third portion of duodenum
(2022) Anam, Hameed; Abhilash, Perisetti; Sumant, Inamdar; Jiannis, Anastasiou
Situation-Background-Assessment-Recommendation technique improves nurse–Physician communication and patient satisfaction in cataract surgeries
(2022) Chen, Yu; Chen, Hung-Yi; Jong, Gwo-Ping
Background: Implementation of the Situation–Background–Assessment–Recommendation (SBAR) communication technique has been shown to increase nurse–physician communication and collaboration. However, data regarding its implementation in ophthalmology settings are limited. Objective: The purpose of this study was to evaluate the impact of implementing SBAR on nurse–physician communication and on the safety and satisfaction of patients undergoing cataract surgery. Materials and Methods: This cross-sectional study was conducted in the Ophthalmology Department of Zhongshan Hospital, Xiamen University, Xiamen, China, from April 2016 to December 2018. SBAR was implemented through a 1-h course that was repeated every 2 months for 2 years. All nurses and physicians completed the Physician–Nurse Communication Satisfaction Questionnaire before SBAR implementation and 1- and 2-year post-implementation. In addition, all patients who underwent cataract surgery during the defined pre-implementation and 1- and 2-year post-implementation periods were invited to complete a patient satisfaction questionnaire. Results: In total, 10 nurses and 6 physicians completed all three pre- and post-implementation surveys. In addition, 1215 patients undergoing cataract surgery participated: 358 in the pre-implementation phase, 425 in the 1-year post-implementation, and 432 in the 2-year post-implementation. Physician–nurse communication significantly improved in both 1- and 2-year post-implementation periods compared with the pre-implementation phase (P < 0.01). In addition, there was a significant increase in patient satisfaction scores (P < 0.01) and a decrease in medical complaints and malpractices (P < 0.01) between the pre- and post-implementation phases. Conclusion: SBAR is a useful tool for enhancing nurse–physician communication and for improving the safety and satisfaction of patients undergoing cataract surgery.
An extremely rare case of Bonneau syndrome with novel cardiac and eye manifestations
(2022) Aburawi, Elhadi; Dakilah, Fozi
Pleural epithelioid hemangioendothelioma: Clinical course and response to treatment
(2022) Al-Baali, Dana; Al-Mahrouqi, Tamadhir; Al-Sawafi, Yaqoob

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