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A persistent stapedial artery (PSA) is a rare embryologic remnant that typically involutes at week 10 of embryogenesis. However, if it is persistent, it may lead to conductive hearing loss and pulsatile tinnitus. It is of utmost importance to identify such an anomaly, as it leads to serious complications intraoperatively if overlooked. Proper clinical and radiological assessment helps an otologist recognize the PSA. We describe the case of a 24-year-old female presenting with a chronically discharging ear in addition to pulsatile tinnitus and conductive hearing loss with an incidental finding of a PSA upon otoscopy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, AlOtaibi et al.)

Objective: This study examined the prevalence of major adverse cardiovascular events (MACE) among Saudi patients with SLE and the general population and considered factors associated with such outcomes were taken into consideration., Methods: This is a cohort study evaluating the period prevalence of MACE from 2020 to 2023. The study used two datasets, namely the Saudi national prospective cohort for SLE patients and the Prospective Urban-Rural Epidemiology Study Saudi subcohort (PURE-Saudi) for the general population. Participants in both studies were monitored using a standardised protocol. MACE was defined as myocardial infarction (MI), stroke or angina. The analysis was adjusted for demographics, traditional cardiovascular risk factors and SLE diagnosis through logistic regression models., Results: The PURE and national SLE cohorts comprised 488 and 746 patients, respectively. Patients with SLE from the SLE cohort were younger (40.7±12.5 vs 49.5±8.6 years) and predominantly female (90.6% vs 41.6%). The prevalence of traditional risk factors was greater in the PURE cohort compared with the SLE cohort. These factors included dyslipidaemia (28.9% vs 49.4%), obesity (63% vs 85%) and diabetes (7.8% vs 27.2%), but not hypertension (19.3% vs 18.8%). MACE (defined as MI or stroke or venous thromboembolism or heart failure) occurred more frequently in patients with SLE (4.3% vs 1.6%, p=0.004). Older age and lupus diagnosis were independently associated with MACE after adjusting for conventional risk factors. The odds of MACE were significantly related to age and lupus diagnosis (p=0.00 and p=0.00, respectively), but not cardiovascular disease (CVD) risk factors (p=0.83)., Conclusion: Patients with SLE have a significantly higher risk of developing MACE than the general population. This risk is not well explained by traditional risk factors, which may explain the failure of CVD risk scores to stratify patients with SLE adequately. Further studies are needed to understand CVD risk's pathogenesis in SLE and mitigate it., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Neuroendocrine tumors are rare and highly heterogeneous neoplasms with a wide spectrum of histological differentiation, functional, and biological features. Small cell neuroendocrine carcinomas (SNECs) of the sinonasal tract are particularly rare. Pathological features of SNECs of the nasal cavity and paranasal sinuses, which are aggressive tumors, are similar to those of anaplastic small cell carcinomas of the lung. We present a case of high-grade sinonasal SNECs in a patient with Xeroderma pigmentosum complementation group C (XPC) gene-positive xeroderma, which, to our knowledge, is the first case reported worldwide., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The effectiveness of canakinumab may change according to the different times it is used after Still's disease onset. This study aimed to investigate whether canakinumab (CAN) shows differences in short- and long-term therapeutic outcomes, according to its use as different lines of biologic treatment., Methods: Patients included in this study were retrospectively enrolled from the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to Still's disease. Seventy-seven (51 females and 26 males) patients with Still's disease were included in the present study. In total, 39 (50.6%) patients underwent CAN as a first-line biologic agent, and the remaining 38 (49.4%) patients were treated with CAN as a second-line biologic agent or subsequent biologic agent., Results: No statistically significant differences were found between patients treated with CAN as a first-line biologic agent and those previously treated with other biologic agents in terms of the frequency of complete response ( p  =0.62), partial response ( p  =0.61), treatment failure ( p  >0.99), and frequency of patients discontinuing CAN due to lack or loss of efficacy ( p  =0.2). Of all the patients, 18 (23.4%) patients experienced disease relapse during canakinumab treatment, 9 patients were treated with canakinumab as a first-line biologic agent, and nine patients were treated with a second-line or subsequent biologic agent. No differences were found in the frequency of glucocorticoid use ( p  =0.34), daily glucocorticoid dosage ( p  =0.47), or concomitant methotrexate dosage ( p  =0.43) at the last assessment during CAN treatment., Conclusion: Canakinumab has proved to be effective in patients with Still's disease, regardless of its line of biologic treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Vitale, Caggiano, Sfikakis, Dagna, Lopalco, Ragab, La Torre, Almaghlouth, Maggio, Sota, Tufan, Hinojosa-Azaola, Iannone, Loconte, Laskari, Direskeneli, Ruscitti, Morrone, Mayrink Giardini, Panagiotopoulos, Di Cola, Martín-Nares, Monti, De Stefano, Kardas, Duran, Campochiaro, Tomelleri, Alabdulkareem, Gaggiano, Tarsia, Bartoloni, Romeo, Hussein, Laymouna, Parente de Brito Antonelli, Dagostin, Fotis, Bindoli, Navarini, Alibaz-Oner, Sevik, Frassi, Ciccia, Iacono, Crisafulli, Portincasa, Jaber, Kawakami-Campos, Wiesik-Szewczyk, Iagnocco, Simonini, Sfriso, Balistreri, Giacomelli, Conti, Frediani, Fabiani and Cantarini.)

Introduction: The utilisation of telemedicine has been rapidly growing among patients with rheumatic diseases, especially following the corona virus disease 2019 pandemic. Ease and convenience appear to dominate the reasons for this growth. However, the effects of this approach in patients with systemic lupus erythematosus (SLE) are yet to be revealed. In this study, we examined the effect of telemedicine on disease activity assessment and damage scores in patients with SLE., Methods: This case-crossover study was nested within a national prospective cohort of patients with SLE in Saudi Arabia. Patients with SLE were included if they fulfilled the Systemic Lupus International Collaborating Clinics classification criteria between March 2020 and March 2021 and were assessed at three time points with 3 months between assessments, according to the standardised protocol of this cohort. Telemedicine was conducted for the first evaluation, while in-person assessments were used at the second and third visits. The primary outcome was the difference in the SLE disease activity index 2000 (SLEDAI-2K) score. The primary analysis was conducted using the repeated measure model and adjusted for potential confounders, including demographics, medications, and changes in steroid doses. Several sensitivity analyses were conducted to mitigate selection and time-varying confounders., Results: A total of 92 participants were included in this study. Most patients were females (88%), with a mean (±standard deviation [SD]) age of 36 (±13) years. The mean (±SD) disease activity scores at baseline were as follows: SLEDAI-2K, 5 (±5); SLE responder index, 3.8 (±3.5); Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, 1 (±1). The mean difference in SLEDAI-2K score was -1.641 (95% confidence interval -2.773 to -0.510, p = 0.005*) between telemedicine and follow-up visits. The results were consistent in all sensitivity analyses., Conclusion: We found that telemedicine assessment was associated with a much higher disease activity score than subsequent assessments, which may suggest an overestimation of disease activity and later assessment accuracy. Cautious adoption has been suggested for SLE patients with active disease., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: We aim to assess the validity and reliability of the Arabic language translation of the Summated Xerostomia Inventory (SXI)., Methods: A cross-sectional, self-administered, electronic Arabic SXI was sent to 79 patients with thyroid nodules (female: n = 34, 57%; male: n = 45, 57%) who visited the Otolaryngology-Head and Neck Surgery clinic at King Abdulaziz University Hospital and King Fahad Medical City between June 2023 and July 2023., Results: Dependability was assessed using Cronbach's alpha coefficients at two distinct instances (first: α = 0.824, second: α = 0.932), which reaffirmed the SXI's reliability and consistency. Legitimacy was ascertained using a test-retest method and correlation analysis between the two measurements., Conclusion: All SXI items displayed a potent positive correlation (between 0.746 and 0.871, p < 0.001), exhibiting remarkable consistency in responses over time. The outcomes of the paired t-tests showed nonsignificant differences for all queries, indicating that the responses were stable over time., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alqaryan et al.)

As people age, the likelihood that they will experience maladies of the skin increases. It is therefore important that older individuals possess the necessary knowledge and proper attitudes and practices regarding their skincare. The purpose of this study was to examine such knowledge, attitudes, and practices among older members of the Saudi Arabian population. The results of the study showed that among the majority of the participants, skincare practices could be considered insufficient and, surprisingly, elderly men undertake better skincare practices than women of this age category. It is recommended that more should be done to educate those within the older Saudi population regarding skin care practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bin Saif et al.)

Objectives To assess the general public's level of knowledge on glaucoma and cataract and measure their ability to differentiate between the two. Materials and methods This was an analytic, cross-sectional study. We used a self-explanatory questionnaire to obtain information regarding the level of knowledge of glaucoma and cataract and measured the ability of the public to differentiate between the two in Saudi Arabia. The obtained results were manually entered into an Excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. Results The levels of knowledge on glaucoma and cataract and those of education were significantly associated (chi-square: P < 0.001). There was a significant association between having an eye condition and the ability to correctly define glaucoma and cataract (chi-square: P = 0.002). Concerning the definition of glaucoma, 48.4% of the participants who had a previous eye disorder answered correctly, whereas 40.1% of the participants who had no previous eye disorder answered correctly. In addition, 20.9% of the participants with a previous eye disease and 17.6% of the participants without any previous eye disease defined glaucoma incorrectly as cataract. A total of 71.4% of the participants with a previous eye disease, compared with 49.6% of the participants without any previous eye disease, correctly defined cataract. In addition, only 7.3% of the participants with a history of eye disease answered the definition of cataract as that of glaucoma (glaucoma: chi-square, P = 0.002; cataract: chi-square, P < 0.001). Conclusion This study is in line with other studies measuring the knowledge of the two diseases, with glaucoma being less known than cataract. While many of the participants were able to define glaucoma and cataract, they had many difficulties identifying how they present and which symptom belonged to cataract and glaucoma. Glaucoma and cataract were confused by a number of participants especially in the case of glaucoma as more defined it as cataract rather than the opposite., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Alammar et al.)

Background Gastroesophageal reflux disease (GERD) is a common gastrointestinal (GI) tract disease and has an adverse effect on the quality of life (QoL) of patients. Studies on the QoL of GERD patients would increase awareness among healthcare providers about the magnitude of the problem and how to manage it. Objectives This study aimed to determine the essential variables that affected the QoL of GERD patients at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Method This was a cross-sectional study performed using quantitative questionnaires, which was conducted at KSUMC during the period from September 1, 2019, to April 1, 2020. We used the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) questionnaire. Additionally, the authors collected information about sociodemographic variables and concomitant diseases from each participant. Results The study included 200 participants; 58.5% of them were males. Around 34.9% of participants in the age group A (18-34 years) had poor QoL compared to 57.5% and 50% of participants from the counterpart groups, respectively. There was a statistically significant difference in the QoL among various age groups (p: 0.006). Furthermore, 58.9% of obese participants had poor QoL; there was a statistically significant difference in the QoL between normal-weight and obese groups (p: 0.013). Conclusion The QoL of GERD patients was found to be affected negatively by increasing age and high body mass index (BMI). None of the other demographic variables and concomitant diseases had any significant effect on the QoL of the participants., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Alshammari et al.)