Introduction: Self-medication with antibiotics (SMA) is a major health problem in the developing world including the kingdom of Saudi Arabia (KSA). This practice remains an emerging challenge for the healthcare providers. A few previous studies have estimated the prevalence of SMA among the general population of KSA, but there had been no such studies on healthcare students. We aimed to estimate the prevalence of SMA among medical, non-medical students and to evaluate its determinants. Methodology: A survey-based cross-sectional study using validated questionnaire was conducted amongst students at King Faisal University in KSA. Chi-square test and logistic regression analysis were applied to identify the determinants of SMA. Results: The prevalence of SMA was 58.4% with significantly lower proportion among medical students. Tonsillitis was the most common symptom for which SMA was used and was reported by a significantly higher proportion of medical (54.1%) students. Despite, the awareness of medical students about SMA is unsafe and mal-practice (79.9%), the prevalence of SMA practice remains high. Logistic regression analysis showed that students who incorrectly, identified the effectiveness of antibiotics in treating bacterial infections, the reasons of the antibiotics discontinuation had a higher likelihood to SMA. (OR = 2.16, 95% CI: 1.52-4.503, P = 0.001), (OR = 1.575, 95% CI: 0.923-2.686, P = 0.09), respectively. Conclusions: SMA remains noticeably high among the medical students. To overcome this problem, we highly recommend improving the health education to better address this malpractice and improve the students’ knowledge, attitudes and awareness towards the antibiotics use and prescription pattern.

Foot pain is a prevalent musculoskeletal complaint with plantar fasciitis being one of the most common underlying etiologies. Diagnostic imaging studies are rarely performed for patients with plantar fasciitis. We report the case of a 34-year-old woman with a six-month history of left heel pain that was worsened by prolonged standing and walking. She was diagnosed as having plantar fasciitis. Considering the lack of clinical improvement on conservative measures, the patient underwent a plain radiograph, which demonstrated a geographic radiolucent lesion in the calcaneus with well-defined non-sclerotic margins. Subsequently, a computed tomography scan re-demonstrated the lesion as having a fat-attenuation appearance that was classic of lipoma. The patient underwent surgical excision of the tumor and the histopathological examination of the specimen revealed spindle cell lipoma. The patient had complete resolution of the pain following the surgery. Intraosseous lipoma is a very rare benign primary bone tumor. The case demonstrated that the intraosseous lipoma may have similar clinical features to plantar fasciitis. Hence, physicians should keep a high index of suspicion for the alternate diagnoses of plantar fasciitis in patients who do not exhibit any clinical improvement despite a prolonged period of conservative management.

The abdominal aortic aneurysm (AAA) is a vascular condition that commonly affects individuals over the age of 65, leading to complications such as rupture, thrombosis, and embolization that can result in significant morbidity and mortality. Aorto-enteric fistula (AEF), a rare but life-threatening complication of abdominal aortic aneurysms, occurs when there is communication between the aneurysm and adjacent bowel loops. A 63-year-old man presented to the emergency department (ED) with severe abdominal pain, nausea, vomiting, and dark, tarry stools. Prior to his current presentation, the patient sought medical care from several primary care centers for vague abdominal pain that was diagnosed as dyspepsia, and he was prescribed omeprazole. During the current presentation, the patient had hemodynamic instability and a diffusely tender abdomen. Subsequently, a computed tomography (CT) scan revealed an abdominal aortic aneurysm with AEF. Although the patient underwent exploratory laparotomy, he suffered cardiac arrest and ultimately died in the operating room. This case underscores the importance of early recognition and management of AEF, which is crucial for improving patient outcomes.

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Artery of Percheron infarction is a serious but rare condition that can result in acute bilateral thalamic infarction and a wide range of neurological symptoms. It occurs due to occlusion of the single arterial branch that supplies the medial thalamus and rostral midbrain bilaterally. In this case report, we describe a 58-year-old female with a history of hypertension and hyperlipidemia who presented with sudden confusion, speech difficulties, and right-sided weakness. An initial CT scan showed ill-defined hypodensity in the left internal capsule, which, when combined with the clinical features, suggested acute ischemic stroke. The patient received an IV tissue plasminogen activator within the recommended time window. Several days later, repeated imaging showed bilateral thalamic hypodensity consistent with subacute infarction in the territory of the artery of Percheron. The patient was subsequently discharged to a rehabilitation facility for further recovery and rehabilitation with residual mild hemiparesis. It is important for healthcare providers to maintain a high index of suspicion for the artery of Percheron infarction and be aware of its potential to cause acute bilateral thalamic infarction and a variety of neurological symptoms.