A full-term male infant born from consanguineous Saudi parents, with one other live child, is suspected to have skeletal dysplasia on a fetal anomaly scan. Clinical findings at birth included short stature, bowed long bone affecting the lower limbs more than the upper limbs, severe joint contractures with restricted movement, failure to thrive, hypertonia, and camptodactyly of the index fingers. During infancy, the baby is noted to have sucking and swallowing difficulties necessitated nasogastric tube feeding, and recurrent respiratory distress episodes with frequent admissions due to respiratory failure required intensive care admission and mechanical ventilation. The skeletal survey demonstrated dysplasia of long bones and spine. To investigate a suspect genetic syndrome, a whole-exome sequencing test was performed, which identified a novel homozygous mutation in the LIFR gene.

IntroductionNeuraxial anesthetic techniques are the method of choice for cesarean section (CS) deliveries, and spinal anesthesia (SA) is the preferred technique. Although the use of SA has greatly improved the outcomes of CS deliveries, SA-related complications are still a matter of concern. The study's primary aim is to measure the incidence of SA complications after a CS, specifically hypotension, bradycardia, and prolonged recovery, as well as to identify the risk factors for these complications. MethodThe data of patients who had elective CS using SA from January 2019 to December 2020 was collected from a tertiary hospital in Jeddah, Saudi Arabia. The study design was a retrospective cohort study. The data collected included age, BMI, gestational age, comorbidities, the SA drug and dosage used, the site of the spinal puncture, and the patient's position during the spinal block. Also, the patient's blood pressure measurements, heart rate, and oxygen saturation levels were collected at baseline and at 5, 10, 15, and 20 minutes. SPSS was used for statistical analysis. ResultsThe incidence of mild, moderate, and severe hypotension was 31.4%, 23.9%, and 30.1%, respectively. In addition, 15.1% of the patients experienced bradycardia, with 37.4% experiencing a prolonged recovery. Two factors were associated with hypotension, including BMI and the dosage of the SA, with a p-value of 0.008 and a p-value of 0.009, respectively. The site of the SA punctures equal to or lower than L2 was the only factor associated with bradycardia (p-value = 0.043). ConclusionThe present study concludes that BMI and the dose of SA were the factors associated with SA-induced hypotension during a CS, and the site of the SA puncture equal to or lower than L2 was the only risk factor associated with spinal anesthesia-induced bradycardia.

Furuncular myiasis is a rare disease that affects the skin and is caused by growing maggots of different types of fly species within the arthropod order Diptera. The symptoms of the disease include itching, a sensation of movement, and sometimes fever. The disease predominantly occurs in tropical and subtropical areas. In Saudi Arabia, furuncular myiasis is reported to occur frequently in the Western region. Herein, we present a case of a 10 months-old Saudi girl who came with multiple lesions over her scalp and left hand starting five days following a trip to Al Shafa, southwest of Saudi Arabia. The patient’s lesion was red, solid, and increased in size gradually. On examination, a papule with a central punctum was present on the left hand at the dorsal aspect of the first web space. The patient underwent an urgent operation to extract the larvae under general anesthesia. Excision of the furuncular myiasis larvae was done using a punch-biopsy blade with pressurized irrigation of the pocket with normal saline and diluted betadine solution. After two weeks, the patient showed a completely recovered skin infection. Having sufficient clinical awareness is necessary to prevent such disease, diagnose it, and prevent further spreading.