In this issueReview articleOriginal ArticlesCase Report
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# Review article {#article-title-2}

**Radiation therapy in head and neck cancer**

Alfouzan et al summarizes the beginning of radiotherapy, techniques of modern radiation therapy with different types, toxicities induced by radiotherapy and their management. They conclude that over the past decade, improvements in head and neck management through radiotherapy have been added. Modern radiotherapy techniques resulted in the improvement of cancer control. Several types of management of toxicity-induced radiotherapy were implemented to improve the patients’ quality of life. The field of radiotherapy is still growing to control tumors and improve radiation-induced toxicity.

***see page 247***

# Original Articles {#article-title-3}

**COVID-19 in children ranging from asymptomatic to a multi-system inflammatory disease. *A single-center study***

Shahin et al identify clinical and laboratory characteristics of the Saudi children with confirmed COVID-19. Eighty-eight children (0-14 years) with COVID-19 were recruited. Mean age was 5.74 ± 4.7 years with 41 (49.4%) males and 42 (50.6%) females. The length of hospital stay (LOS) ranged from 1 to 17 days. The main source of infection was infected family members. Mean values of C-reactive protein (CRP), serum ferritin, and lactate dehydrogenase (LDH) were noticeably above normal. Degree of severity and length of stay was significantly correlated with lymphopenia (r= -0.36; *p*=0.001), whereas it was positively correlated with absolute neutrophil count and with high inflammatory markers, such as CRP, LDH, and others. They conclude that a high index of suspicion is needed for cases presenting with multi-system inflammatory disease, which represented 5.7% of the included study population.

View this table:
[Table1](http://smj.org.sa/content/42/3/245/T1)

***see page 299***

#  {#article-title-4}

**Health care worker burnout during the COVID-19 pandemic. *A cross-sectional survey study in Saudi Arabia***

Alsulimani et al estimate the prevalence of burnout among health care workers (HCWs) who are working in Saudi Arabia during the COVID-19 pandemic, and explore individual and work-related factors associated with burnout in this population. In this cross-sectional study, they invited HCWs through social channels to complete a questionnaire. The questionnaire inquired about demographics, factors related to burnout, and used the Copenhagen Burnout Inventory scale to indicate burnout. A total of 646 HCWs participated. The mean (SD) age of participants was 34.1 (9.5) years. Significant factors associated with burnout were age, job title, years of experience, increased working hours during the pandemic, average hours of sleep per day, exposure to patients with COVID-19, number of times tested for COVID-19, and perception of being pushed to deal with COVID-19 patients.

***see page 306***

# Case Report {#article-title-5}

**Insulinoma in tuberous sclerosis. *An entity not to be missed***

Al Qahtani et al present a 47-year-old male known tuberous sclerosis patient with an insulinoma. The tumor was incidentally detected in follow-up imaging for a previous ampulla of Vater tubular adenoma. However, the patient reported symptoms of hypoglycemia. The insulinoma was enucleated successfully. Histopathology revealed a well-differentiated, grade one neuroendocrine tumor measuring around 2 cm in diameter. Seven cases were reported in the literature of tuberous sclerosis-associated insulinoma. The 7 reported cases had different hypoglycemia related symptoms. The reported tumors varied in size and location on the pancreas. This paper details the eighth case worldwide where an insulinoma occurred in a tuberous sclerosis patient.

![Figure1](http://smj.org.sa/https://smj.org.sa/content/smj/42/3/245/F1.medium.gif)

[Figure1](http://smj.org.sa/content/42/3/245/F1)

Maximum intensity projection (MIP) image, with arrow pointing to the head of pancreas, showing octreotide avid lesion

***see page 332***

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