This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers). The origin, branching, and exits in relation to the psoas major muscle, the absence of these nerves or the presence of double nerves, and their retroperitoneal course were carefully examined. All the images were recorded by photographing. In this study, we mainly observed variations in exits, branching patterns, and their retroperitoneal course. The iliohypogastric nerve was absent in 2 cases (8.3%). In the type I pattern, in 1 case (4.2%), the common trunk descends anteriorly to the iliac vessels from the iliolumbar vessels. In 4 cases (16.7%), the double ilioinguinal nerve with different branch patterns and retroperitoneal courses was observed. In 1 single nerve case (4.2%), the ilioinguinal nerve descends anterior to the iliac vessels from the iliolumbar vessels. To our knowledge, the branching pattern of the double ilioinguinal nerves and their retroperitoneal course have not been reported in any available data. Sound knowledge of the variations in the origin, branches, and retroperitoneal course of the iliohypogastric and ilioinguinal nerves is very helpful for the improvement of peripheral nerve blocks and other various surgical procedures to avoid complications and nerve injuries.

Metoclopramide and domperidone are dopamine antagonists that can cause an acute dystonic reaction. Metoclopramide is a rare but major contributor to serotonin syndrome, particularly when used with other serotonergic agents. Serotonin syndrome is a rare, potentially life-threatening adverse reaction characterized by a triad of altered mental status, autonomic dysfunction, and neuromuscular hyperactivity that typically results from exposure to serotonergic agents. Herein, we report a previously healthy 9-year-old girl who was brought to the emergency department with an alteration in the level of conscious and involuntary repetitive movements after approximately 24 hours of receiving a therapeutic dose of metoclopramide and domperidone. Physical examination showed tachycardia, hyperthermia, and a Glasgow Coma Scale score of 11, as well as mydriasis and hyperreflexia. In addition to resolving the symptoms after administering midazolam and diphenhydramine, the diagnosis of serotonin syndrome was made based on the classical symptoms and signs, which met the Hunter criteria. This case indicates the need for clinical awareness of the life-threatening syndrome and caution with medications having potential interactions with metoclopramide.

BACKGROUND: At present osteoporosis has come into view as a major health concern. Skeletal diseases typified by weak and fragile bones have imposed threats of fissure. Hydroxyapatite (HAP) is known to induce osteoblast like differentiation and provide mechanical strength, hence, used in bone tissue engineering; whereas, Nigella Sativa has also demonstrated potential to treat bone and muscle diseases. This study was aimed to develop potential orthopedic scaffold exploiting natural resources of Saudi Arabia which can be used as prospective tissue engineering implant. METHODS: The bone scaffold was developed by grafting biogenic HAP with Nigella Sativa essential oil. Nigella Sativa was applied for boosting osteogenesis and to stimulate antimicrobial potential. Antimicrobial potential was investigated utilizing S. aureus bacteria. Spectroscopic and surface characters of Nigella Sativa grafted HAP scaffolds were analyzed using Fourier-transform infrared spectroscopy, X-ray crystallography and Scanning electron microscopy. To ensure biocompatibility of scaffolds; we selected C2C12 cell-lines; best model to study mechanistic pathways related to osteoblasts and myoblasts differentiation. RESULTS: Grafting of HAP with Nigella Sativa did not affect typical spherical silhouette of nanoparticles. Characteristically; protein loaded polynucleated myotubes are result of in vitro myogenesis of C2C12 myoblasts in squat serum environment. CONCLUSION It is first study of unique combination of Nigella Sativa and HAP scaffold as a possible candidate of implantation for skeletal muscles regeneration. Outcome of this finding revealed Nigella Sativa grafted HAP enhance differentiation significantly over that of HAP. The proposed scaffold will be an economical natural material for hard and soft tissue engineering and will aid in curing skeletal muscle diseases. Our findings have implications for treatment of muscular/ bone diseases.

BACKGROUND: At present osteoporosis has come into view as a major health concern. Skeletal diseases typified by weak and fragile bones have imposed threats of fissure. Hydroxyapatite (HAP) is known to induce osteoblast like differentiation and provide mechanical strength, hence, used in bone tissue engineering; whereas, Nigella Sativa has also demonstrated potential to treat bone and muscle diseases. This study was aimed to develop potential orthopedic scaffold exploiting natural resources of Saudi Arabia which can be used as prospective tissue engineering implant. METHODS: The bone scaffold was developed by grafting biogenic HAP with Nigella Sativa essential oil. Nigella Sativa was applied for boosting osteogenesis and to stimulate antimicrobial potential. Antimicrobial potential was investigated utilizing S. aureus bacteria. Spectroscopic and surface characters of Nigella Sativa grafted HAP scaffolds were analyzed using Fourier-transform infrared spectroscopy, X-ray crystallography and Scanning electron microscopy. To ensure biocompatibility of scaffolds; we selected C2C12 cell-lines; best model to study mechanistic pathways related to osteoblasts and myoblasts differentiation. RESULTS: Grafting of HAP with Nigella Sativa did not affect typical spherical silhouette of nanoparticles. Characteristically; protein loaded polynucleated myotubes are result of in vitro myogenesis of C2C12 myoblasts in squat serum environment. CONCLUSION It is first study of unique combination of Nigella Sativa and HAP scaffold as a possible candidate of implantation for skeletal muscles regeneration. Outcome of this finding revealed Nigella Sativa grafted HAP enhance differentiation significantly over that of HAP. The proposed scaffold will be an economical natural material for hard and soft tissue engineering and will aid in curing skeletal muscle diseases. Our findings have implications for treatment of muscular/ bone diseases.

Stress and depression among physicians are recognized as important problems because of the potential risks they impose on individual health and medical care. This study aims to assess level of stress and depression and associated factors among family medicine residents in Al-Madinah, Saudi Arabia. Methods: This cross-sectional study was conducted among 75 residents in the family medicine residency programs in Al-Madinah. Stress and depression were assessed by using the stress and depression subscales of the validated Depression, Anxiety and Stress Scale-21 item (DASS-21). Sources of stress were assessed by 22 items. Results: Most participants had stress (57.3%) and depression (53.3%). Stress was associated with work overload (P=0.032), work demands affect personal/home life (P<0.001), inability to participate in decision making (P=0.026) and inability to make full use of skills and abilities (P=0.019). Depression was associated with ‘work demands affect personal/home life’ (P<0.001). Conclusion: The prevalence of stress and depression among family resident doctors was high. Establishing a residency counseling office is suggested to deal with the resident's problems in a way that supports their needs and leads to the best working environment.

Purpose: Atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes. Both carotid artery endarterectomy and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis. CAAS is under-reported in Saudi Arabia, as evidenced by a thorough literature search. In this article, we aim to share our experience of CAAS to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS. Materials and Methods: A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria consisted of all adult patients (18 years and above) with carotid stenosis who were treated with CAAS. Results: A total of 16 patients were included in the study. The mean age of the participants was 66.9±13.5 years (range 30–87 years). All patients were symptomatic (had a previous stroke or transient ischemic attack). The procedure was successful in 14 patients (87.5%), while it failed in 2 patients (12.5%) due to technical reasons. All patients had no stroke or myocardial infarction within 30 days of the procedure. Conclusion Despite the advancement in medicine with free healthcare services in Saudi Arabia, the interventional procedures for secondary prevention of strokes are underutilized. Collaboration between different hospitals will be extremely helpful since few centers in each city are providing such treatments by an expert neurointerventionist and/or strokologist. The good selection of candidates, optimal management of comorbid conditions, and multidisciplinary care may improve outcomes and reduce mortality.