Background/Aims: Bisphosphonates have been reported to decrease fractures related to osteogenesis imperfecta (OI). We assessed the efficacy and long-term safety of pamidronate therapy in patients with moderate-to-severe OI. Methods: We conducted an open-label uncontrolled study in 14 boys and 13 girls whose mean age was 6.8 years at baseline. Intravenous pamidronate, 1 mg/kg/day, was given for 3 consecutive days every 4 months for 2–6 years, with physical therapy and orthopedic surgery as appropriate. Mobility score, fracture rate, height, bone mineral density (BMD) and bone healing were evaluated throughout follow-up. Results: In 24 (89%) patients, the fracture rate decreased to ≤2/year and/or the mobility score improved. The remaining 3 (11%) patients continued to experience more than 2 fractures per year with mobility scores <2 despite significant BMD gains. Delayed radiographic fracture healing (>6 months) occurred in 8 (29.6%) patients; their BMD gains, baseline age and treatment duration were not significantly different from those in the other patients. Tolerance was good. Conclusion: Pamidronate with physiotherapy and orthopedic management improved outcomes without delaying fracture healing in 19 (70%) of 27 patients. Delayed fracture healing occurred in 8/27 patients. Pamidronate should be reserved for severe OI with multiple fractures and/or flattened vertebras.

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Background: Keratoconus (KC) causes visual disability in young adults. To improve its early detection and compliance, improving the awareness of patients and their relatives is crucial. We present the level of awareness about KC among the adult population of western Saudi Arabia and its determinants. Methods: This web-based survey was carried out from June to August 2020 in urban and semi-urban areas in western Saudi Arabia. Demographic and eye ailment profiles were collected. To generate responses on the presentation, causes, management and prevention of KC, a five-point Likert scale was used. The logit values were calculated and graded into good and poor awareness. Awareness was associated with other determinants. Results: We surveyed 420 Saudi adults. The median logit score of awareness about KC among participants was 2.86 (inter quartile range (IQR) 0.86; 2.95). The median score of knowledge about the causes and presentation of KC was 2.86 (IQR 1.1; 2.86) and for management, it was 0.00 (IQR 0.00; 0.18). The level of awareness was good in 286 participants (68.1%) and poor in 134 (31.9%). Residents of major cities (P < 0.04) and women (P < 0.001) had significantly better awareness about KC. Knowledge about KC mainly came from friends and reading about it. The mass media and social media were rarely used to seek knowledge. Conclusions: Awareness about the presentation, causes and management of KC was good in two-thirds of adults but with some variation. Strategies to involve the community and stress health education need to be urgently implemented. Campaigns should target the male and semi-urban population in western Saudi Arabia.

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In this review, we discuss the treatment options for male hypogonadism and the associated benefits and potential short-and long-term risks. The choice for treatment may depend on the cause of hypogonadism and the desire for maintaining or improving fertility. We also highlight surgical management of male hypogonadism. Comprehensive searching strategy through Well-known medical databases (MIDLINE/ PubMed, and Embase) searching articles that published in English language up to December 2017, and discussing the surgical management of male hypogonadism. Malehypogonadism is identified by the presence of symptoms or signs of male hypogonadism and consistent serum testosterone levels that are below the normally accepted adult male range. Once the medical diagnosis is confirmed, the primary goal of treatment is testosterone substitution to accomplish serum testosterone levels that remain in the mid-adult range and the symptoms and signs of hypogonadism are eliminated. Recent developments led to numerous delivery systems for testosterone. For patients with primary hypogonadism testosterone therapy is the approach of choice. The patient needs to be completely informed about expected benefits and side-effects of the treatment option. The option of the preparation should be a joint decision by a notified patient and the doctor.