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The mean duration of the disease was 7.06 ± 4.7 years. We determined that 89.9% (n = 214) of the patients showed mild to severe depression symptoms (55.46% of the females, and 34.4% of the males; p = 0.474). We further found that 37.39% (n = 89) and 65.13% (n = 155) of the depressed patients were unemployed (p = 0.039) and were non-smokers (p = 0.097) respectively. Furthermore, depression severity is significantly associated with education (p = 0.005). Conclusion High levels of depression symptoms were found among MS patients in Saudi Arabia. The relationship between MS and psychiatric conditions exists despite the uncertainty of its pathogenesis. Further longitudinal studies should be carried out to obtain more valid outcomes. Neurologists treating MS patients can play a role in studies related to the condition by investigating depressive symptoms actively and providing the data. Copyright © 2020, Alhussain et al.Cardiac tamponade is a life-threatening condition characterized by slow or rapid compression of the heart due to the accumulation of fluid in the pericardial space and rarely presents mainly as a headache. We report an unusual presentation of cardiac tamponade associated mainly with severe headache over three days and mild shortness of breath in a 60-year-old male not known to have any previous heart disease. Immediate computed tomography (CT) scan of the head ruled out intracranial hemorrhage. A chest x-ray showed cardiomegaly, and further echocardiography revealed a large pericardial effusion on a transthoracic echocardiogram compromising the right ventricular output. Urgent pericardiocentesis was performed and removed 800 ml of hemorrhagic fluid that led to a complete resolution of his severe headache. Copyright © 2020, Iqbal et al.Diabetic mastopathy is a rare benign breast condition. It is strongly associated with type I diabetes mellitus and commonly presents similar to malignancy. Here, we report a case of a 29-year-old Saudi female with a long history of type I diabetes mellitus (DM) who presented with a painless hard breast mass and had a strong family history of breast cancer. Further evaluation with ultrasound (US) imaging revealed a highly suspicious, ill-defined hypoechoic lesion. Mammographic examination revealed that both breasts were of normal shape with bilateral dense glandular parenchyma. US-guided true-cut biopsy was carried out, which showed acellular fibro-sclerotic tissues with normal-looking lobules and ducts surrounding by a dense lymphocytic infiltrate. Subsequently, a diagnosis of diabetic mastopathy was established. Results were discussed with the patient, and an agreement was reached to proceed with an excisional biopsy for further reassurance and exclusion of malignancy. Local surgical excision of the lesion was performed and histopathological examination revealed extensive fibrosis of the specimen with no cellular atypia. Awareness of such a condition, with its clinical, radiographical, and histopathological characteristics, is essential in order to alleviate the patient's anxiety and avoid unnecessary surgical interventions. MEK inhibitor Copyright © 2020, Alkhudairi et al.There has been an outbreak of lung injury associated with e-cigarettes and vaping in the United States since early 2019. We present two cases who were admitted to the hospital with shortness of breath and cough. Chest imaging showed they had interstitial changes. They were diagnosed with e-cigarette and vaping product use-associated lung injury (EVALI) and treated with steroids and supportive management. With an improvement in symptoms, they were discharged home. On follow-up in the clinic, both patients were asymptomatic and had complete resolution of radiographic abnormalities. However, pulmonary function testing showed reduced diffusion capacity for carbon monoxide (DLCO). Total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in the first one second (FEV-1), and the FEV-1/FVC ratio were normal. Copyright © 2020, Ahmad et al.A rectoperineal fistula (RPF) is a relatively rare, non-life-threatening form of anorectal malformation that nevertheless causes significant physical discomfort, and remains technically challenging for surgeons to treat. We present a case of a 72-year-old female with a history of a recurrent perianal fistula with multiple approaches including endorectal advancement flap previously attempted. Our procedure involved laparoscopic loop ileostomy with transversus abdominis plane (TAP) block, and RPF repair through the perineal approach with primary repair involving Martius flap and house advancement flaps. The patient tolerated the procedure well with no known peri-operative complications and resolution of stool incontinence at subsequent post-operative visits, the first within a month of the procedure. This case was used to demonstrate and highlight the surgical technique of the RPF repair by Martius flap. Informed consent was obtained from the patient for video recording for educational purposes. Copyright © 2020, Terry et al.Transit neonatal hyperparathyroidism (TNHP) is a very rare recessive mutation in the calcium channel transporter. TNHP is defined as an impairment of calcium transportation from the mother to the fetus prenatally and mainly in the third trimester. TNHP classically presents with skeletal deformities and subsequently affects multiple systems. TNHP has been linked to a mutation in the transient receptor potential cation channel, subfamily V, member 6 ​(​TRPV6). We report a case of a full-term male infant diagnosed with TNHP prenatally from a medically free mother. The patient was discharged home at the age of 28 days after an excellent response to the trial of calcium infusion. Copyright © 2020, Almidani et al.Klebsiella pneumoniae notoriously causes life-threatening community-acquired or hospital-acquired pneumonia. In the United States, community-acquired pneumonia is a relatively common diagnosis. However, community-acquired pneumonia due to Klebsiella pneumoniae is fairly uncommon. Delayed antibiotic administration can result in bacteremia, septicemia and other systemic complications. Infective endocarditis arising as a complication of community-acquired Klebsiella pneumoniae infection has rarely been reported. Our patient is an 88-year-old diabetic female, who was admitted to our intensive care unit due to a high-grade fever, worsening dyspnea and hypotension. Chest x-ray and blood culture were conclusive for pneumonia due to Klebsiella pneumoniae. Importantly, the species was only susceptible to colistin. Furthermore, an echocardiogram revealed mobile vegetations of the non-coronary cusp of the aortic valve. Treatment with colistin resulted in clinical improvement and an uneventful discharge from the hospital.