The use of antibiotic therapy has led to a major transformation in medicine with a substantial reduction in mortality. Due to the adverse effects associated with inappropriate antibiotic use, antibiotic stewardship interventions have been promoted to improve antibiotic prescription. However, delayed antibiotic therapy, when clinically needed, may result in increased morbidity. Here, we report the case of a previously healthy young man with an untreated acute upper respiratory infection for two weeks, who presented with headache and fever. Physical examination suggested meningitis as evident by neck stiffness and positive Kernig sign. Purulent tonsilitis was also noted. Laboratory findings showed leukocytosis and elevated inflammatory markers. The patient underwent a computed tomography scan to rule out space-occupying lesions prior to lumbar puncture. The scan revealed thrombophlebitis of the left internal jugular vein that extended to the dural venous sinuses. Magnetic resonance imaging confirmed the intracranial dissemination of the disease. Such findings conferred the diagnosis of Lemierre’s syndrome. The patient was admitted to the intensive care unit where he received systemic anticoagulation and prolonged intravenous antibiotics. He developed a good response and was discharged with no residual deficits after six weeks of hospitalization. Lemierre’s syndrome is a serious infection that develops after a pharyngeal infection. Considering the high mortality rate of untreated Lemierre’s syndrome, physicians should keep a high index of suspicion for this condition when they encounter a patient with upper respiratory tract infection with clinical or radiological findings consistent with internal jugular thrombophlebitis.

Background The 12-lead electrocardiogram (ECG) is an indispensable screening and diagnostic tool used to identify cardiovascular abnormalities as well as fatal cardiac emergencies. Our aim was to identify whether a competency difference in interpreting ECG strips between medical students, interns, and family residents exists. Methods A cross-sectional, single-center study conducted at tertiary health care facility and its academic institution. Participants were given a self-administered questionnaire which consisted of a demographic sheet and 10-ECGs each with 9 multiple choice questions about the basic ECG parameters. Correct answer was given a 1-point score, with the minimum and maximum scores being 0 and 90, respectively. Results The total participants were 93; 54 (58.1%) medical students, 27 (29.0%) interns, and 12 (12.9%) family Medicine residents. Medical students had a statistically significant higher mean score 84.7±9.5 when compared to the medical interns 73.4±12.9 (p<0.001) and family medicine residents 58.2±18.0 (p<0.001). There were no differences in the mean scores between male and female medical students and interns. However, female family medicine residents had a higher mean score when compared to their male colleagues (p-value=0.04). Medical students performed better in detection of more than 65% of all ECG parameters when compared to the interns and residents. Fifty-seven (61.3%) reported that ECGs exposure during their medical program was not sufficient. Lectures were reported as the most effective modality of ECG teaching among 38 medical students (70.4%) and 9 residents (75.0%). However, 9 medical interns reported self-teaching (33.3%) as effective as standard lectures (33.3%) in teaching ECG. Conclusion Among our study cohort, medical students had higher ECGs-related skills, interpretation skill and more reading competency than medical interns and family residents. Most used method of learning ECG in all levels was lectures. Although Study generalizability is limited, refining ECG reading skills is required. Funding Acknowledgement Type of funding source: None

SUMMARY Objectives This study aimed to report the rate of thyroid malignancy in benign fine-needle aspirations (Bethesda II) at King Abdulaziz Medical City and evaluate the factors that affect false-negative outcomes of FNA. Methods All patients referred for thyroidectomy from 2009 to 2019 were reviewed (n = 1968). Only patients with a benign FNA, corresponding to the Bethesda II, were included (n = 384). Information on age, gender, body mass index (BMI), serum thyroid-stimulating hormone, type of surgery and histopathological outcomes were retrieved. Results Of the sample (n = 384) with an initial benign FNA, 63 patients had a malignancy on postoperative pathological examination, yielding an overall false-negative rate of 16.4%. The most frequently reported histopathological type was papillary thyroid microcarcinomas (n = 52). For the false-negative group, the mean age was 43.8 years (range 21-70 years) with an 84.1% female predominance. The surgical choice for 74% (n = 46) of cases was total thyroidectomy. Age, gender, thyroid function and BMI did not affect the false-negative rate of benign FNA (p > 0.05). Conclusions This study found a higher risk of malignancy compared to the literature related to benign FNA. The risk of malignancy should be considered, even with benign FNA.