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This review aims to identify prevalence and use of herbal medicine in Saudi Arabia. The review included data published between 2007 and 2017. The literature search was conducted in conformity to the standards established by Prisma guidelines. Total 24 primary research evidences were included. Majority of the studies identified were cross-sectional designs with only two randomised controlled trials. Majority of the studies have been conducted during 2014, 2015, and 2017. The prevalence of herbal medicine use ranged between 10.3% -75.0%. The herbal medicine use in Saudi Arabia is associated with following factors: spiritual beliefs and perceived effectiveness and hopelessness for the modern medicines, followed by chronic illnesses such as cancer and neurological disorders. Physicians and pharmacists both support the use of herbs, latter showing limited knowledge. More research should be conducted to determine effectiveness of herbal medicines. Efforts should be made to promote knowledge regarding correct herbal practices.

Diabetic macular edema (DME) is a significant cause of diabetic retinopathy and a major cause of vision loss. In this study, we aimed to evaluate and compare the efficacy of two injectable drugs; intravitreal Aflibercept and intravitreal Ranibizumab for the treatment of DME of the eyes. A retrospective chart review was conducted for patients diagnosed with DME from March 2014 to January 2019 who received either intravitreal Aflibercept or intravitreal Ranibizumab injection. A total of 57 eyes were included, of which 19 eyes were treated with intravitreal Ranibizumab injection, and 38 eyes were treated with intravitreal Aflibercept injection; all eyes were examined for 3 months. Two outcomes were assessed in this study, namely; visual acuity (VA) and central macular thickness (CMT). The mean age in the Ranibizumab group was 61.1±9.5 vs 64.3±10.2 in the Aflibercept group with no significant difference (p-value=0.25). The ratio of improvement in visual acuity (VA) in the Ranibizumab group was 68.4% vs 44.7% in the Aflibercept group; (p-value=0.038) which demonstrates the superiority of Ranibizumab over Aflibercept concerning visual acuity result. However, there is no statistically significant difference between the ratio of improvement in central macular thickness (CMT) results in both groups; (p-value=1.00). In fact, the ratio of improvement in CMT in both groups was the same 78.9% for both the groups. The pre and post results demonstrated improvement in post-procedural for CMT among both the groups but only Ranibizumab group showed VA improvement post-procedural. Through this study, we concluded that both injectable drugs improve visual acuity (VA) and decrease central macular thickness (CMT) in eyes with DME. However, Ranibizumab is superior in improving visual acuity compared to Aflibercept. Further comparative effectiveness trials between Aflibercept and Ranibizumab are still warranted.

Most facial palsies comprise of lower motor neuron type or Bell’s palsy. The mean incidence of recurrence of Bell’s palsy is 6.5% and can recur at any age. Although it was first reported in the year 1871, most of its etiology, pathology, management and progression are still neither fully described nor reported. We reported a case of Bell’s palsy in a young Saudi female who was presented with a unilateral recurrent episode of Bell’s palsy. Patient came to the emergency department with facial asymmetry, severe neck pain, loss of sensation on the left side of face and headache, while she was also not responding to oral medications. She was admitted to the hospital for an intravenous treatment and for further evaluation. Her serologic investigation was unremarkable. Similar episode had occurred five years ago as well, which was completely resolved after treatment. Her brain MRI localized T2 and T2 weighted sequence showed hyperintense lesion at the superior anterior aspect of left orbit and could represent lipoma versus hemangioma. Her presenting complaint responded well on IV treatment and patient was discharged on 11th day. She was also referred for plastic and neurosurgery services for the treatment of underlying cause. Recurrent Bell’s palsy is infrequent with etiology not fully elucidated. However, our case emphasizes that the timely medical treatment with regular follow-up is necessary for better prognosis and identification and treatment of underlying cause.

Most women experience some premenstrual symptoms regularly. Because of this, PMS/ PMDD has emerged as a 20 th century phenomenon, mostly since women now have better control over reproduction. The symptoms associated with these conditions may be minimal, moderate, or severe depending on the ratings of the symptoms recorded daily. Women also continue to report lower levels of productivity in the 5 to 10 days after the start of menses. As part of exploring these conditions, the study sought to examine the screening of premenstrual symptoms and self-medication acts among women in Riyadh, Saudi Arabia. The findings were as follows. There were 56 participants in the study, with their ages ranging between 18 and 54. Most of the participants were also either working or students. Regarding diagnosis, nearly half of the sample (n=27, 48.2 %) were diagnosed as normal, while 4 out of 10 study participants (n=23, 41.1 %) had PMS. Additionally, 10.7 % were diagnosed as having both PMDD and PMS. On self-medication, the findings revealed that 1 out of every 2 study participants (n=28, 50 %) self-medicated to ease PMS/PMDD. Among the 28 persons, only 17 (60.17 %) had PMS/PMDD. These findings suggest that nearly half of persons who did not have PMS/PMDD self-medicated themselves thinking that they had PMS/PMDD. The findings of this study provide government and other policymakers with the data required to inform debate and to increase access to public health. Having established a sensible belief that PMS may substantially affect women in Saudi Arabia, further studies might estimate the magnitude of the problem.