Flood syndrome is a spontaneous rupture of an umbilical hernia. It has a high mortality and morbidity and presents many challenges in medical versus surgical management. We present a case of a 23-year-old Yamani woman with complicated umbilical hernia, newly diagnosed hepatitis B infection, and decompensated liver cirrhosis with ascites (Child-Pugh grade B). The patient was undergoing multiple abdominal ascitic tapping that eventually ruptured with an omentum evisceration, causing Flood syndrome. An urgent umbilical hernioplasty with mesh in a sublay technique was conducted.

Rectal procidentia is an uncommon perineal disease that is rare in males. There is no specific medical role in treatment of rectal procidentia and surgical intervention is the treatment of choice. Various surgical approaches have been performed, but there is no consensus on which procedure is most effective in terms of patient condition, recurrence rate, bowel function, and risk. This case presentation of a healthy male patient with experience of uncomplicated reducible rectal prolapse and a history of chronic constipation. Presented with complicated rectal prolapse in the presence of incarcerated rectal prolapse after a failed trial with conservative maneuvers, he ended up with abdominal approach sigmoidectomy and posterior mesh rectopexy.

Malaria presents a challenge to healthcare systems globally. It is associated with severe complications, notably splenic rupture. The prognosis of malaria complicated by splenic rupture is poor and sometimes leads to death even with timely intervention. Here, we report the case of a patient who presented with complicated malaria with spontaneous splenic rupture and coincidental acute appendicitis. A 34-year-old man was successfully treated for a grade IV ruptured spleen and acute appendicitis with splenectomy and appendectomy. Postoperative care took place in the intensive care unit and the patient was shifted to the general floor on the fifth day. Upon discharge the next day, he was prescribed amoxicillin twice daily for one year. Malaria can present with life-threatening complications requiring prompt surgical intervention.

Nontraumatic splenic rupture and hematoma are rare in sickle cell disease. We present a case of a 22-yearold Saudi male with sickle cell disease. He presented to our hospital with a history of nontraumatic abdominal pain, hemodynamic instability, and abdominal tenderness, with a large mass extending to the umbilicus. A computed tomography (CT) examination showed splenomegaly and a spleen infarction. The patient was admitted to the intensive care unit (ICU) and stabilized. He was transferred to the regular ward and discharged against medical advice (DAMA). Later on, he presented again with persistent abdominal pain. He underwent splenectomy with cholecystectomy. The patient did well postoperatively and was discharged in good condition. While conservative management is common, operative management should be considered in patient with persistent pain. Splenic rupture has a high mortality rate.

Background: Defect of use of antibiotics is bothering pediatricians. This defect is participating in the prevalence of one of global health problem called antibiotic Resistance. Many articles are supporting the idea that use of antibiotics is positively related to antibiotic resistance and this problem is increasing and growing up. By the way, incorrect use of antibiotics has many factors that contribute on, like patient attitude and deficiency of education from the physician who prescribed the antibiotic. Also, patient's knowledge and practice with the antibiotic like self-prescription. What is patient expecting from antibiotic and previous experience with antibiotics? Parents are responsible to give medications to children. So, we need to increase parents' knowledge, attitude and practice (KAP) toward antibiotics to reach new generation without antibiotic resistance. Regarding Saudi Arabia, antibiotic resistance already exists and the rate of resistance is increased in the last decade. Aim of the work: To assess how parents are aware of antibiotics those given to their children by evaluating knowledge, attitude, and practice of parents in Riyadh region, central Saudi Arabia. Methods: This is questionnaire based cross-sectional study. Authors were circulating on Riyadh Region to find volunteers to fill questionnaires among parents of children in public places by selecting parents of children up to 12 years old by choosing random samples from each place. The questionnaire has two parts: the first part, as usual, is containing demographic data. While the second part: is the part that is evaluating KAP of parents towards antibiotics. Then we compared the final results by Chi-Square test and p-values less than 0.05 was considered as significant value. Results: around 1058 parents volunteered to participate in this study (response rate was 88.16%) by mean age of 38. Around 89.6% used antibiotics for their children before. There are 9.5% of parents were believe that their children need antibiotics each time they get sick. More than 35% of our participants don't complete period of antibiotic use to their child as what is mentioned on prescription. About 82.3% believe that antibiotics can harm children. There are 41.7% of parents bought antibiotics to their children from the previous prescription. Around 61.1% don't know the term antibiotic resistance. There are 28.4% of participants could change their doctors if they don't prescribe antibiotics easily, while only 642(60.7%) could change their doctors if they prescribe antibiotics excessively. About 68.1% of participants believe that doctors prescribe antibiotics excessively. Nearly 49% have good KAP, 41% of participants have intermediate KAP and remaining 10% have poor KAP. Females are better than male in KAP, people with high degree education are better than other and parents who used antibiotics before are better than those who didn't (p-value < 0.05). Conclusion: Level of knowledge, attitude, and practice of people in Riyadh region is ranging between good to moderat...