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with a white coat (30.3%). The least preferred outfit was the full (traditional) Saudi outfit with a white coat (25.4%), followed by a Western business suit without a white coat (23.2%). The choices of most and least preferred attire were found to be impacted by different demographic factors, such as age, gender, and nationality, but not the educational background. Conclusion Physicians practicing in Saudi Arabia should note that their attire will earn the patient's trust and encourage compliance with advice or treatment. The most preferred outfits were surgical scrubs with a white coat and a Western shirt and tie worn with a white coat, whereas the least preferred ones were the traditional Saudi thobe, with and without shemagh or ghutra, and the Western business suit without a white coat.Ovotesticular disorder or true hermaphroditism is defined as the presence of both ovarian and testicular tissues in the same individual irrespective of the patient's karyotype. Ovotesticular disorder represents 5% of disorders of sex development. Cases of true hermaphroditism must be treated like men or women based on their age, external genitalia and the orientation of the patient. Here we report a case of true hermaphroditism which was diagnosed with seminoma on histopathological examination. The patient underwent orchiectomy, followed by two cycles of chemotherapy.Introduction The T790M resistance mutation is present in about one-half of epidermal growth factor receptor (EGFR)-positive advanced non-small cell lung cancer (NSCLC) patients at disease progression. We aimed to assess the prevalence of this mutation in a real-world setting and the clinical impact of repeated biopsies in its detection. Methods This was a single-center retrospective cohort study of patients with EGFR-positive advanced NSCLC diagnosed between 2016 and 2018, who experienced radiographic disease progression during first-line treatment with first- or second-generation EGFR-tyrosine kinase inhibitor (TKI). The frequency of T790M detection and the number of rebiopsies were determined. Results A total of 88 patients were included, with a median age of 65 years (range 38-84 years). The majority of the participants were females (63 (72%)) and non-smokers (70 (81%)). Upon disease progression, 80 (91%) patients were tested for T790M mutation, and the resistance mutation was detected in 57 (71%) cases (58% in plasma samples and 42% in tissue/cytology samples). In 14 (25%) cases, T790M mutation was only detected after rebiopsy (57% by liquid biopsy), which increased the rate of mutation detection in 17%. Subsequent treatment with third-generation EGFR-TKI was possible in 42 (74%) of T790M-positive cases. Detection of T790M mutation was more likely in patients who were less than 65 years old, with EGFR exon 19 deletions and duration of first-line treatment of more than 12 months (p less then 0.05). Conclusions The frequency of T790M mutation in this study was higher than previously reported, suggesting that repeated biopsies after a negative result are beneficial. [https://www.selleckchem.com/products/ABT-263.html https://www.selleckchem.com/products/ABT-263.html] This allowed a greater percentage of patients to receive sequential osimertinib in our clinical practice.<br /><br /> Diffusion-weighted MRI is shown to be equally effective, as a CTscan, in diagnosing ischemic and hemorrhagic strokes. Would it be cost-effective to perform an early MRI instead of a CT head?<br /><br /> A retrospective chart review was conducted between October 1, 2015, through October 1, 2017, for patients admitted for possible cerebrovascular accident (CVA). Inclusion criteria were age &gt;/= 18 years and symptoms suggestive of a stroke. Exclusion criteria were pregnancy and age &lt;18 years. We obtained information regarding patients' length of hospital stay, imaging modalities performed, and the related cost. We performed a cost analysis by calculating the total duration and cost of hospitalization, and cost for each investigation.<br /><br /> The study included 828 patients who underwent CT head without contrast initially. A total of 634 (76.5%) patients got MRI brain without contrast, 261 (31.5%) had MRI brain with and without contrast, 406 (49%) had magnetic resonance angiography (MRA) head without contrast, 60 patientsf hospitalization and cut some health care costs. However, more studies are required to develop appropriate patient selection criteria.Snake bites involving the eye are an uncommon cause of ocular trauma; herein, we present one of the few known instances of a snake bite directly to the globe, specifically by the way of a Coluber constrictor, also known as the "Black Racer." In this case report, we describe a nine-year-old girl who presented immediately following a snake bite to the right eye. The patient's vision was unaffected despite visualized puncture wounds through the conjunctiva with associated near-total subconjunctival hemorrhage. The patient was taken to the operating room emergently for globe exploration. Circumferential peritomy and direct view to the sclera did not reveal any lacerations or puncture and subconjunctival vancomycin, gentamycin, and dexamethasone were administered intraoperatively. Post-operatively, the patient was discharged on a regimen of oral Cephalexin. Throughout multiple follow-ups, she continued to maintain excellent vision without sequelae. Trauma to the globe via snake bite is an exceedingly rare occurrenloplegia and steroid administration.Lichen striatus is a rare dermatological condition seen in children. The exact etiology of this self-limiting eruption is unknown. A combination of genetic predisposition with an infectious trigger is the most accepted hypothesis for the etiology. Treatment is typically not necessary, as the disease is self-limiting. Treatment options with topical low to mid-potency corticosteroids may be used for symptomatic treatment of pruritus, however, it does not alter the course of the disease or post-inflammatory dyspigmentation. Successful treatment of skin lesions with calcineurin inhibitors is reported in isolated studies. The rapidly growing lesion of lichen striatus can cause considerable parental anxiety. Familiarity with this condition for primary care pediatricians is necessary to make the correct diagnosis and to alleviate parental anxiety. Here, we present a case of lichen striatus albus, a variant of lichen striatus, in a five-year-old girl presenting as a skin rash.