Search results for: Lama M. AlGhamdi

Authors: Rakan Hassan M. Alzahrani, Ziyad Alzahrani, Bader Bashrahil, Abdulrahman Elyasi, Abdullah a Ghaddaf, Rayan Alzahrani, Mohammed Alkathlan, Nawaf Alghamdi, Dakheelallah Almutairi

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Background: Corticosteroid irrigations, which regularly involve the off-label use of budesonide mixed with normal saline in high volume Sino-nasal irrigations, have been more commonly used in the management of post-operative chronic rhinosinusitis (CRS). Objective: This article attempted to measure the efficacy of post-operative budesonide nasal irrigation compared to normal saline-alone nasal irrigation in the management of chronic rhinosinusitis (CRS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched by two independent authors. Only RCTs comparing budesonide irrigation to normal saline alone irrigation for CRS with or without polyposis after functional endoscopic sinus surgery (FESS) were eligible. A random effect analysis model of the reported CRS-related quality of life (QOL) measures and the objective endoscopic assessment scales of the disease was done. Results: Only 6 RCTs met the eligibility criteria, with a total number of participants of 356. Compared to normal saline irrigation, budesonide nasal irrigation showed statically significant improvements in both the CRS-related quality of life (QOL) and the endoscopic findings (MD= -4.22 confidence interval [CI]: -5.63, -2.82 [P < 0.00001]), (SMD= -0.50 confidence interval [CI]: -0.93, -0.06 [P < 0.03]) respectively. Conclusion: Both intervention arms showed improvements in CRS-related QOL and endoscopic findings in post-FESS chronic rhinosinusitis with or without polyposis. However, budesonide irrigation seems to have a slight edge over conventional normal saline irrigation with no reported serious side effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression.

Keywords: Budesonide, chronic rhinosinusitis, corticosteroids, nasal irrigation, normal saline

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Authors: Julio Jesus Salazar, Max Jesus De Lama

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The challenges of water management are aggravated by global change, which implies high complexity and associated uncertainty; water management is difficult because water networks cross domains (natural, societal, and political), scales (space, time, jurisdictional, institutional, knowledge, etc.) and levels (area: patches to global; knowledge: a specific case to generalized principles). In this context, we need to apply natural and non-natural measures to manage water and soil. The Basin Management Methodology considers multifunctional measures of natural water retention and erosion control and soil formation to protect water resources and address the challenges related to the recovery or conservation of the ecosystem, as well as natural characteristics of water bodies, to improve the quantitative status of water bodies and reduce vulnerability to floods and droughts. This method of water management focuses on the positive impacts of the chemical and ecological status of water bodies, restoration of the functioning of the ecosystem and its natural services; thus, contributing to both adaptation and mitigation of climate change. This methodology was applied in 7 interventions in the sub-basin of the Shullcas River in Huancayo-Junín-Peru, obtaining great benefits in the framework of the participation of alliances of actors and integrated planning scenarios. To implement the methodology in the sub-basin of the Shullcas River, a process called Climate Smart Territories (CST) was used; with which the variables were characterized in a highly complex space. The diagnosis was then worked using risk management and adaptation to climate change. Finally, it was concluded with the selection of alternatives and projects of this type. Therefore, the CST approach and process face the challenges of climate change through integrated, systematic, interdisciplinary and collective responses at different scales that fit the needs of ecosystems and their services that are vital to human well-being. This methodology is now replicated at the level of the Mantaro river basin, improving with other initiatives that lead to the model of a resilient basin.

Keywords: climate-smart territories, climate change, ecosystem services, natural measures, Climate Smart Territories (CST) approach

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Authors: Musa Alghamdi

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Although Saudi students’ motivation to learn English language as a foreign language in Saudi Arabia have been investigated by a number of studies; these have appeared almost completely as using the quantitative research paradigm. There is a significant lack of research that explores the Saudi students’ motivation using qualitative methods. It was essential, as an investigator, to be immersed in the community to understand the individuals under study via their actions and words, their thoughts, views and beliefs, and how those individuals credited to activities. Thus, the study aims to explore the Saudi students’ motivation to learn English language as a foreign language in Saudi Arabia employing qualitative methodology via applying ethnography. The study will be carried out in Saudi Arabia. Ethnography qualitative approach will be used in the current study by employing formal and informal interview instruments. Gardner’s motivation theory is used as frameworks for this study to aid the understanding of the research findings. The author, an English language lecturer, will undertake participant observations for 4 months. He will work as teaching-assistant (on an unpaid basis) with EFL lecturers in different discipline department at a Saudi university where students study English language as a minor course. The researcher will start with informal ethnographical interview with students during his existence with the informants in their natural context. Then the researcher will utilize the semi-structural interview. The informal interview will be with 14-16 students, then, he will carry out semi-structural interview with the same informants to go deep in their natural context to find out to what extent the Saudi university students are motivated to learn English as a foreign language. As well as, to find out the reasons that played roles in that. The findings of this study will add new knowledge about what factors motivate universities’ Saudi students to learn English language in Saudi Arabia. Very few chances have given to students to express themselves and to speak about their feelings in a more comfortable way in order to gain a clear image of those factors. The working author as an EFL teacher and lecturer will provide him secure access into EFL teaching and learning setting. It will help him attain richer insights into the nature EFL context in universities what will provide him with richer insights into the reasons behind the weakness of EFL level among Saudi students.

Keywords: motivation, ethnography, Saudi, language

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Authors: Faizah Asiri, Mohammed Fathy, Saeed Alghamdi, Nahlah Ayoub, Faisal Asiri

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Background: - The strategies for this study were based on the toxic effect of long-term inhalation of Benzene on hormones and liver enzymes and various parameters related to it. The following databases were searched: benzene, hepatotoxic, benzene metabolism, hormones, testosterone, hemotoxic, and prolonged exposure. A systematic strategy is designed to search the literature that links benzene with the multiplicity and different types of intoxication or the medical abbreviations of diseases relevant to benzene exposure. Evidence suggests that getting rid of inhaled gasoline is by exhalation. Absorbed benzene is metabolized by giving phenolic acid as well as meconic acid, followed by urinary excretion of conjugate sulfates and glucuronides. Materials and Methods :- This work was conducted in the Al-Khadra laboratory in Taif 2020/2021 and aimed to measure some of the possible endocrinal and liver toxicities associated with benzene's long-term exposure in Saudi Arabia at the station workers who are considered the most exposed category to gasoline. One hundred ten station workers were included in this study. They were divided into four patient groups according to the chronic exposure rate to benzene, one control group, and three other groups of exposures. As follows: patient Group 1 (controlled group), patient Group 2 (exposed less than 1y), patient Group 3 (exposed 1-5 y), patient Group 4 (more than 5). Each group is compared with blood sample parameters (ALT, FSH and Testosterone, TSH). Blood samples were drawn from the participants, and statistical tests were performed. Significant change (p≤0.05) was examined compared to the control group. Workers' exposure to benzene led to a significant change in hematological, hormonal, and hepatic factors compared to the control group. Results:- The results obtained a relationship between long-term exposure to benzene and a decrease in the level of testosterone and FSH hormones, including that it poses a toxic risk in the long term (p≤0.05) when compared to the control. We obtained results confirming that there is no significant coloration between years of exposure and TSH level (p≤0.05) when compared to the control. Conclusion:- We conclude that some hormones and liver enzymes are affected by chronic doses of benzene through inhalation after our study was on the group most exposed to benzene, which is gas station workers.

Keywords: toxicities, benzene, hormones, station workers

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Authors: Alsulami H., Alghamdi N., Alasker A., Almohen N., Shome D.

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Most conventional chemotherapeutic agents which are used for the treatment of cancers not only eradicate cancer cells but also affect normal hematopoietic Stem cells (HSCs) that leads to severe pancytopenia during treatment. Therefore, a need exists for novel approaches to treat cancer without or with minimum effect on normal HSCs. Parthenolide (PTL), a herbal product occurring naturally in the plant Feverfew, is a potential new chemotherapeutic agent for the treatment of many cancers such as acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). In this study we investigated the effect of different PTL concentrations on the viability of normal HSCs and also on the ability of these cells to form colonies after they have been treated with PTL in vitro. Methods: In this study, 24 samples of bone marrow and cord blood were collected with consent, and mononuclear cells were separated using density gradient separation. These cells were then exposed to various concentrations of PTL for 24 hours. Cell viability after culture was determined using 7ADD in a flow cytometry test. Additionally, the impact of PTL on hematopoietic stem cells (HSCs) was evaluated using a colony forming unit assay (CFU). Furthermore, the levels of NFҝB expression were assessed by using a PE-labelled anti-pNFκBP65 antibody. Results: this study showed that there was no statistically significant difference in the percentage of cell death between untreated and PTL treated cells with 5 μM PTL (p = 0.7), 10 μM PTL (p = 0.4) and 25 μM (p = 0.09) respectively. However, at higher doses, PTL caused significant increase in the percentage of cell death. These results were significant when compared to untreated control (p < 0.001). The response of cord blood cells (n=4) on the other hand was slightly different from that for bone marrow cells in that the percentage of cell death was significant at 100 μM PTL. Therefore, cord blood cells seemed more resistant than bone marrow cells. Discussion &Conclusion: At concentrations ≤25 μM PTL has a minimum or no effect on HSCs in vitro. Cord blood HSCs are more resistant to PTL compared to bone marrow HSCs. This could be due to the higher percentage of T-lymphocytes, which are resistant to PTL, in CB samples (85% in CB vs. 56% in BM. Additionally, CB samples contained a higher proportion of CD34+ cells, with 14.5% of brightly CD34+ cells compared to only 1% in normal BM. These bright CD34+ cells in CB were mostly negative for early-stage stem cell maturation antigens, making them young and resilient to oxidative stress and high concentrations of PTL.

Keywords: stem cell, parthenolide, NFKB, CLL

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Authors: Shujon Mohammed Alazzam, Sarah Saad Alamer, Omar Hassan Kasule, Lama Suliman Aleid, Mohammad Abdulaziz Alakeel, Boshra Mosleh Alanazi, Abdullah Abdulelah Altowairqi, Yahya Ali Al-Asiri

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Background: Interventional radiology (IR) is a specialized field within radiology that diagnose and treat several conditions through a minimally invasive surgical procedure that involves the use of various radiological techniques. In the last few years, the role of IR has expanded to include a variety of organ systems which have been led to an increase in demand for these Specialties. The level of knowledge regarding IR is relatively low in general. In this study, we aimed to investigate the perceptions of interventional radiology (IR) as a specialty among medical students and medical interns in Riyadh, Saudi Arabia. Methodology: This study was a cross section. The target population is medical students in January 2023 in Riyadh city, KSA. We used the questionnaire for face-to-face interviews with voluntary participants to assess their knowledge of Interventional radiology. Permission was taken from participants to use their information. Assuring them that the data in this study was used only for scientific purposes. Results: According to the inclusion criteria, a total of 314 students participated in the study. (49%) of the participants were in the preclinical years, and (51%) were in the clinical years. The findings indicate more than half of the students think that they had good information about IR (58%), while (42%) reported that they had poor information and knowledge about IR. Only (28%) of students were planning to take an elective and radiology rotation, (and 27%) said they would consider a career in IR. (73%) of the participants who would not consider a career in IR, the highest reasons in order were due to "I do not find it interesting" (45%), then "Radiation exposure" (14%). Around half (48%) thought that an IRs must complete a residency training program in both radiology and surgery, and just (36%) of the students believe that an IRs must finish training in radiology. Our data show the procedures performed by IRs that (66%) lower limb angioplasty and stenting (58%) Cardiac angioplasty or stenting. (68%) of the students were familiar with angioplasty. When asked about the source of exposure to angioplasty, the majority (46%) were from a cardiologist, (and 16%) were from the interventional radiologist. Regarding IR career prospects, (78%) of the students believe that IRs have good career prospects. In conclusion, our findings reveal that the perception and exposure to IR among medical students and interns are generally poor. This has a direct influence on the student's decision regarding IR as a career path. Recommendations to attract medical students and promote IR as a career should be increased knowledge among medical students and future physicians through early exposure to IR, and this will promote the specialty's growth; also, involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.

Keywords: knowledge, medical students, perceptions, radiology, interventional radiology, Saudi Arabia

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Authors: Allulu Yousef Alturki, Raghad Abdullah Alshafi, Sara Abdulaziz Alghashem, Sahar Saleh Alghamdi, Rasha Saad Suliman, Zeyad Alehaideb, Rizwan Ali

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Cancer is recognized as a worldwide public health concern. Therefore, there is a continuous quest to discover new effective medications with less side-effects. In recent years, researchers have shown an increased interest in medicinal plants as several plant species have shown promising biological activities. Thus, we seek to investigate three medicinal herbs that are commonly-found in the Middle Easternregion and yet have not been explored in depth, including plants belonging to the Rhamnaceae, Polygonaceae, and Apocynaceaeplant families. Initially, we investigated using three types of cancer cell lines for breast, colorectal, and liver cancers. We performed high Content Imaging (HCI)-Apoptosis Assay and ApoTox-Glo™ Triplex Assay on KAIMRC2 and HCT8 cell lines. The highest activity of HCI-Apoptosis Assay was with Calligonumcomosum and Ziziphusnummularia in ethanol, followed by Calotropis procera and Ziziphusnummularia in ethyl acetate. The IC50values for the families of Rhamnaceae, Polygonaceae, and Apocynaceae in HepG2 and HCT8 cell lines ranged from 0.089 to 9.84mg/mL and 0.080to 15.08mg/mL, respectively. Further screening was conducted on an additional two cell lines, namely the MDA-MB-231 and KAIMRC2, for selected seven extracts with the highest activity having IC50values ranged from 0.058 to0.51mg/mL and 0.029 to0.19mg/mL, respectively. Continuous scientific investigations to isolate and characterize the potent bioactive phytochemical(s) are warranted. Funding: The authors acknowledge financial support from King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. Institutional Review Board Statement: The study was approved by the Institutional Review Board of the Institutional Review Board of King Abdullah International Medical Research Center (SP21R/463/12, 24 January 2022). Acknowledgments: The authors want to express their gratitude to the College of Pharmacy (COP) at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and King Abdullah International Medical Research Center (KAIMRC) for their continued support.

Keywords: rhamnaceae, polygonaceae, apocynaceae, natural products

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Authors: Ganga Brahma

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Boro employs verbs hooked up with morphemes which lead verbs to adjust with their arguments and hence, affecting the whole of sentence structures. This paper is based on few such syntactic parameters which are usually considered as argument decreasing parameters in linguistic works. Passivizing of few transitive clauses which are usually construed from the verbs occurring with certain morphemes and representation in middle constructions are few of such strategies which lead to conceptualizing of decreasing of syntactic arguments from a sentence. This paper focuses on the mentioned linguistic strategies and attempts to describe the linguistic processes as for how these parameters work in languages especially by concentrating on a particular Tibeto-Burman language i.e. Boro. Boro is a Tibeto-Burman language widely spoken in parts of the north-eastern regions of India. It has an agglutinative nature in forming words as well as clauses. There is a morpheme ‘za’ which means ‘to happen, become’ in Boro whose appearances with verb roots denotes an idea of the subject being passivized. Passivization, usually has notions that it is a reversed representation of its active sentence forms in the terms of argument placements. (However, it is not accountably true as passives and actives have some distinct features of their own and independent of one and the other.) This particular work will concentrate on the semantics of passivization at the same time along with its syntactic reality. The verb khɑo meaning ‘to steal’ offers a sense of passivization with the appearance of the morpheme zɑ which means ‘to happen, become’ (e.g Zunu-ɑ lama-ɑo phɯisɑ khɑo-zɑ-bɑi; Junu-NOM road-LOC money steal-PASS-PRES: Junu got her money stolen on the road). The focus, here, is more on the argument placed at the subject position (i.e. Zunu) and the event taken place. The semantics of such construction asks for the agent because without an agent the event could not have taken place. However, the syntactic elements fill the slots of relegated or temporarily deleted agent which, infact, is the actual subject cum agent in its active representation. Due to the event marker ‘zɑ’ in this presentation it affords to reduce one participant from such a situation which in actual is made up of three participants. Hence, the structure of di-transitive construction here reduces to mono-transitive structure. Unlike passivization, middle construction does not allow relegation of the agents. It permanently deletes agents. However, it also focuses on the fore-grounded subject and highlighting on the changed states on the subjects which happens to be the underlying objects of their respective transitive structures (with agents). This work intends to describe how these two parameters which are different at their semantic realization can meet together at a syntactic level in order to create a linguistic parameter that decreases participants from their actual structures which are with more than one participant.

Keywords: argument-decrease, middle-construction, passivization, transitivity-intransitivity

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Authors: Julio Jesus Salazar, Manuel Andres Jesus De Lama

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There are very few models that serve to analyze the use of water in the socio-economic process. On the supply side, the joint use of groundwater has been considered in addition to the simple limits on the availability of surface water. In addition, we have worked on waterlogging and the effects on water quality (mainly salinity). In this paper, a 'complex' water economy is examined; one in which demands grow differentially not only within but also between sectors, and one in which there are limited opportunities to increase consumptive use. In particular, high-value growth, the growth of the production of irrigated crops of high value within the basins of the case study, together with the rapidly growing urban areas, provides a rich context to examine the general problem of water management at the basin level. At the same time, the long-term aridity of nature has made the eco-environment in the basins located on the coast of Peru very vulnerable, and the exploitation and immediate use of water resources have further deteriorated the situation. The presented methodology is the optimization with embedded simulation. The wide basin simulation of flow and water balances and crop growth are embedded with the optimization of water allocation, reservoir operation, and irrigation scheduling. The modeling framework is developed from a network of river basins that includes multiple nodes of origin (reservoirs, aquifers, water courses, etc.) and multiple demand sites along the river, including places of consumptive use for agricultural, municipal and industrial, and uses of running water on the coast of Peru. The economic benefits associated with water use are evaluated for different demand management instruments, including water rights, based on the production and benefit functions of water use in the urban agricultural and industrial sectors. This work represents a new effort to analyze the use of water at the regional level and to evaluate the modernization of the integrated management of water resources and socio-economic territorial development in Peru. It will also allow the establishment of policies to improve the process of implementation of the integrated management and development of water resources. The input-output analysis is essential to present a theory about the production process, which is based on a particular type of production function. Also, this work presents the Computable General Equilibrium (CGE) version of the economic model for water resource policy analysis, which was specifically designed for analyzing large-scale water management. As to the platform for CGE simulation, GEMPACK, a flexible system for solving CGE models, is used for formulating and solving CGE model through the percentage-change approach. GEMPACK automates the process of translating the model specification into a model solution program.

Keywords: water economy, simulation, modeling, integration

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Authors: Julio Jesus Salazar, Julio Jesus De Lama

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the fundamental objective of hydrological studies applied to the engineering field is to determine the statistically consistent volumes or water flows that, in each case, allow us to size or design a series of elements or structures to effectively manage and develop a river basin. To determine these values, there are several ways of working within the framework of traditional hydrology: (1) Study each of the factors that influence the hydrological cycle, (2) Study the historical behavior of the hydrology of the area, (3) Study the historical behavior of hydrologically similar zones, and (4) Other studies (rain simulators or experimental basins). Of course, this range of studies in a certain basin is very varied and complex and presents the difficulty of collecting the data in real time. In this complex space, the study of variables can only be overcome by collecting and transmitting data to decision centers through the Internet of things and artificial intelligence. Thus, this research work implemented the learning project of the sub-basin of the Shullcas river in the Andean basin of the Mantaro river in Peru. The sensor firmware to collect and communicate hydrological parameter data was programmed and tested in similar basins of the European Union. The Machine Learning applications was programmed to choose the algorithms that direct the best solution to the determination of the rainfall-runoff relationship captured in the different polygons of the sub-basin. Tests were carried out in the mountains of Europe, and in the sub-basins of the Shullcas river (Huancayo) and the Yauli river (Jauja) with heights close to 5000 m.a.s.l., giving the following conclusions: to guarantee a correct communication, the distance between devices should not pass the 15 km. It is advisable to minimize the energy consumption of the devices and avoid collisions between packages, the distances oscillate between 5 and 10 km, in this way the transmission power can be reduced and a higher bitrate can be used. In case the communication elements of the devices of the network (internet of things) installed in the basin do not have good visibility between them, the distance should be reduced to the range of 1-3 km. The energy efficiency of the Atmel microcontrollers present in Arduino is not adequate to meet the requirements of system autonomy. To increase the autonomy of the system, it is recommended to use low consumption systems, such as the Ashton Raggatt McDougall or ARM Cortex L (Ultra Low Power) microcontrollers or even the Cortex M; and high-performance direct current (DC) to direct current (DC) converters. The Machine Learning System has initiated the learning of the Shullcas system to generate the best hydrology of the sub-basin. This will improve as machine learning and the data entered in the big data coincide every second. This will provide services to each of the applications of the complex system to return the best data of determined flows.

Keywords: hydrology, internet of things, machine learning, river basin

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Authors: Ahmed Mohammed Omer Alghamdi

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Since the COVID-19 pandemic started, a rapid, unexpected transition from face-to-face to virtual classroom (VC) teaching has involved several challenges and obstacles. However, there are also opportunities and thoughts that need to be examined and discussed. In addition, the entire world is witnessing that the teaching system and, more particularly, higher education institutes have been interrupted. To maintain the learning and teaching practices as usual, countries were forced to transition from traditional to virtual classes using various technology-based devices. In this regard, the Kingdom of Saudi Arabia (KSA) is no exception. Focusing on how the current situation has forced many higher education institutes to change to virtual classes may possibly provide a clear insight into adopted practices and implications. The main purpose of this study, therefore, was to investigate how both Saudi English as a foreign language (EFL) teachers and students perceived the implementation of virtual classes as a key factor for useful language teaching and learning process during the COVID-19 pandemic period at a Saudi university. The impetus for the research was, therefore, the need to find ways of identifying the deficiencies in this application and to suggest possible solutions that might rectify those deficiencies. This study seeks to answer the following overarching research question: “How do Saudi EFL instructors and students perceive the use of virtual classes during the COVID-19 pandemic period in their language teaching and learning context?” The following sub-questions are also used to guide the design of the study to answer the main research question: (1) To what extent are virtual classes important intra-pandemic from Saudi EFL instructors’ and students’ perspectives? (2) How effective are virtual classes for fostering English language students’ achievement? (3) What are the challenges and obstacles that instructors and students may face during the implementation of virtual teaching? A mixed method approach was employed in this study; the questionnaire data collection represented the quantitative method approach for this study, whereas the transcripts of recorded interviews represented the qualitative method approach. The participants included EFL teachers (N = 4) and male and female EFL students (N = 36). Based on the findings of this study, various aspects from teachers' and students’ perspectives were examined to determine the use of the virtual classroom applications in terms of fulfilling the students’ English language learning needs. The major findings of the study revealed that the virtual classroom applications during the current pandemic situation encountered three major challenges, among which the existence of the following essential aspects, namely lack of technology and an internet connection, having a large number of students in a virtual classroom and lack of students’ and teachers’ interactions during the virtual classroom applications. Finally, the findings indicated that although Saudi EFL students and teachers view the virtual classrooms in a positive light during the pandemic period, they reported that for long and post-pandemic period, they preferred the traditional face-to-face teaching procedure.

Keywords: virtual classes, English as a foreign language, COVID-19, Internet, pandemic

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Authors: Abdulwhab Alotaibi, Abdullah Alzahrani, Ziyad Bokhari, Abdulelah Alghamdi

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First described in 1975 by Dr. Miller, Medical dressings are uncommon but possible cause of hand digital ischemia due the tourniquet-like effect. The incident of this complication has been reported across wide range of age-groups, yet it seems like that the pediatric population are specifically vulnerable. Multiple dressing types were reported to have caused ischemic injury, such as elastic wrap, tubular gauze, and self-adherent dressings. We present a case of medical dressing induced digital ischemia in patient with Congenital insensitivity to pain and anhidrosis (CIPA), which further challenge the discovery of the condition. An 8-year-old girl known case of CIPA. Brought by her mother to the ER after nail bed injury, which she managed by application of elastic wrap that was left for 24 hours. When the mother found out she immediately removed the elastic band, and noticed the fingertip was black and cold with tense bullae. The color then changed later when she arrived to the ER to dark purple with bluish discoloration on the tip. On examination there was well demarcated tense bullae on the distal right fifth finger. Neurovascular intact, pulse oximetry on distal digit 100%, capillary refill time was delayed. She was seen under Plastic surgery and conservative management recommended, and patient was discharged with safety netting. Two days later the patient came as follow-up visit at which her condition demonstrated significant improvement, the bullae has since ruptured leaving behind sloughed skin, capillary refill and pulse oximetry were both within normal limits, sensory function couldn’t be assessed but her motor function and ROM were normal, topical bacitracin and bandage dressings were applied for the eroded skin. Patient was scheduled for a follow-up in 2 weeks. Preventatively it’s advisable to avoid the commonly implicated dressings such as elastic, tubular gauze or self-adherent wraps in hand or digital injuries when possible, but in cases where the use of these dressings is of necessity the appropriate precautions must be taken, Dr. Makarewich proposed the following 5 measures to help minimize the incidence of the injury: 1-Unwrapping 12 inches of the dressing before rolling the injured finger. 2-Wrapping from distal to proximal with minimal tension to avoid vascular embarrassment. 3-The use of 5-25 inch to overlap the entire wrap. 4-Maintaining light pressure over the wrap to allow adherence of the dressing. 5-Minimization of the number of layers used to wrap the affected digit. Also assessing the capillary refill after the application can help in determining the patency of the supplying blood vessels. It’s also important to selectively determine if the patient is a candidate for conservative management, as tailored approach can help in maximizing the positive outcomes for our patients.

Keywords: congenital insensitivity to pain, digital ischemia, medical dressing, conservative management

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