The predictive value of nasolacrimal sac biopsy in endoscopic dacryocystorhinostomy

Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia

Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical college students in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.

Efficacy of Hyaluronic Acid in Endoscopic Dacryocystorhinostomy: A Systematic Review and Meta-Analysis

Objective

The aim of this meta-analysis is to compare the surgical results of endoscopic dacryocystorhinostomy (Endo-DCR) for chronic dacryocystitis (CD) with and without intraoperative hyaluronic acid (HA) application.

Methods

An electronic literature search was performed using the PubMed, Embase, Cochrane Library, CNKI, and Wan Fang databases in April 1, 2022. Review Manager software version 5.4 was used for data synthesis and a forest plot was generated for each outcome measure.

Results

Seven randomized control trials (RCTs), which involved 739 eyes, were included in this meta-analysis. Overall, compared with the control group, intraoperative HA application significantly enhance the success rate (odds ratio [OR] = 3.27, 95% confidence interval [CI]: 2.15–4.98, P < .00001), promote re-epithelization (OR = 2.93, 95% CI: 1.83–4.68, P < .00001), reduce granulation (OR = 0.41, 95% CI: 0.21–0.80, P = .008), and scar (OR = 0.39, 95% CI: 0.22–0.68, P = .001) formation after Endo-DCR.

Conclusion

Intraoperative HA application seems to be a useful adjuvant that could enhance success rate by promoting re-epithelization and inhabiting granulation and scar formation around the ostium.

Oral cancer knowledge and practice among medical students: A cross-sectional study during the Syrian crisis

Background

lack of medical practitioners' knowledge about oral cancer has contributed to delays in referral and treatment. Oral cancer is amenable to treatment when detected early, which leads to better prognosis and survival rates. In this study, we aimed to assess the knowledge of the Syrian medical students about the risk factors of oral cancer, oral cavity changes associated with oral cancer, and the relation between the relation with Human Papilloma Virus (HPV) and oral cancer.

Methods

This is a cross-sectional study conducted at the Syrian Private University. Data were collected through self-administered questionnaires, which targeted social demographic information, general knowledge, risk factors, oral changes and HPV knowledge associated with oral cancer. Data was categorized and analyzed to assess and compare the levels of knowledge between clinical and preclinical students.

Results

301 out of 401 medical students responded to the questionnaires bringing the response rate to 75.25%. The study revealed adequate knowledge about oral cancer, general information, clinical features, risk factors and relation to HPV. Clinical students showed higher levels of awareness compared to pre-clinical students. No significance in knowledge was found between the genders.

Conclusion

The findings of the present study suggest that there is a need to reinforce the medical curriculum concerning oral cancer education, particularly in prevention and early detection to improve practices.

Incidental finding of metastatic prostatic adenocarcinoma of frontotemporal bone presenting as subdual hematoma: A case report and review of literature

Introduction

and important: Prostatic cancer is often prone to metastasis and bone invasion. Skull metastasis in prostate cancer is uncommon, accounting for less than 2% of all metastases. However, frontotemporal bone metastasis without dural or brain metastasis is rare.

Case presentation

Herein, we report the case of a 91-year-old male patient who presented with a sudden-onset dizziness, a fall to the ground, and gradual loss of consciousness. Computed tomography (CT) of the brain revealed an aggressive bony lesion secondary to locally advanced metastatic malignancy and subdural hematoma. Subsequently, he underwent decompressive craniectomy. Histopathological and immunohistochemical (IHC) examinations demonstrated metastatic prostatic adenocarcinoma (PCa). Although after treatment by a multidisciplinary team, unfortunately, the patient expired two months after the surgery and could no longer be traced.

Clinical discussion

In the majority of reported cases, CT scans of the brain are often mistaken for subdural hematoma or meningioma. The present case suggests is a preliminary incidental case of a single frontotemporal bony lesion. This is the first case described in the literature of incidental finding of metastatic PCa presenting with asymptomatic characteristics.

Conclusion

Awareness of the possibility of metastatic PCa involving the skull bones, as well as histopathological and IHC examinations, are important to arrive at a correct initial diagnosis.

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Prostatic cancer (PCa) metastasis to frontotemporal bone is extremely rare.

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PCa metastasis to the frontotemporal bone had atypical clinical manifestations.

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Awareness of the possibility of skull metastasis of PCa is important for diagnosis.

The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis

BACKGROUND

Acute invasive fungal rhinosinusitis (AIFRS) is aggressive morbidity affecting immunocompromised patients. Coronavirus disease 2019 (COVID-19) may allow secondary fungal disease through a propensity to cause respiratory infection by affecting the immune system leading to dysregulation and reduced numbers of T lymphocytes, CD4+T, and CD8+T cells, altering the innate immunity. The aim of this study is to evaluate the incidence of acute invasive fungal rhinosinusitis (AIFRS) in COVID-19 patients.

METHODOLOGY

Data for acute invasive rhinosinusitis was obtained from the Otorhinolaryngology departments at our tertiary hospital at the period from January 2017 to December 2020. Then the risk factors of comorbid diseases and fungal types between post-COVID-19 and non-COVID-19 groups regarding the incidence of AIFRS are compared.

RESULTS

Consequently, the incidence of AIFRS showed a more significant difference (P < 0.05) in post-COVID-19 patients than in non-COVID-19 especially in immunocompromised patients, diabetic, renal, and liver dysfunction patients as well as patients with risk factors of AIFRS. The most common organisms affecting patients with AIFRS are Rhizopus oryzae, Aspergillus fumigatus, and Absidia mucor.

CONCLUSIONS

The incidence of AIFRS is markedly prominent in post-COVID-19 patients than in those of non-COVID-19, especially in immunocompromised, diabetic, renal, and liver dysfunction patients and patients with risk factors for rhinosinusitis.

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

Introduction

and Objectives: Leakage of cerebrospinal fluid (CSF) from the frontal sinus is a challenging condition facing the ENT surgeon. Repair of this condition has been changed nowadays due to the newer instruments and techniques of nasal endoscopy. This study aims to evaluate the outcome of frontal sinus CSF leak endoscopic repair.

Patients and methods

Twenty-seven patients who had frontal sinus CSF leaks were included in this study. They were 9 females and 18 males. They underwent endoscopic repair of the leak site at the period of five years from 2015 to 2020. A retrospective evaluation of these patients includes reconstructive procedures, complications, and postoperative follow-up.

Results

The frontal leaks were present in the frontal recess (8 patients, 29.6%), ethmoidal roof (5 patients, 18.5%), and the majority was in the posterior wall (14 patients, 51.9%); 11 in the medial side and 3 in the lateral side. All cases, 27 (100%) were treated successfully, no failed treatment was observed. Postoperative complications were minimal; two patients had elevated intracranial pressure (ICP), infection with fever were found in four patients (7.4%), and meningitis was observed in only two cases (7.4%), treated conservatively.

Conclusion

For frontal sinus CSF leak repair, the endonasal endoscopic approach is the treatment of choice due to higher success rates and lower morbidity profile. A favorable result is possible with proper diagnosis, precise localization, and an appropriate strategy.

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CSF leakage from the frontal sinus is a challenging condition for ENT surgeons.

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Repair has been changed nowadays due to the newer techniques of nasal endoscopy.

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We report favorable results of the endonasal endoscopic approach in 27 patients.

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Proper diagnosis and precise localization are acheived.

Acanthamoeba keratitis in contact lens wearers in a tertiary center of Tunisia, North Africa

PURPOSE

To analyze the epidemiological and clinical features of Acanathamoeba keratitis AK and to assess the risk factors of this corneal infection in contact lens CL wearers in a tertiary center of Tunisia, North Africa.

METHODS

We carried out a retrospective study between January 2008 and December 2019 in the ophthtalmology department of a referral center, Sousse, Tunisia. A review of the chart of 248 patients using CL and diagnosed with presumed infectious keratitis was done.Socio demographic, risk behaviors and microbiological findings in case of AK were analyzed. The mean follow-up was 18 months (1 month-4 years).

RESULTS

AK was diagnosed in 29 cases (11.7% of contact lens wearers with infectious keratitis). These 29 cases were analyzed. The mean age at the time of diagnosis was 33, 44 ± 26, 9 years. Almost of the patients (13; 44.82%) used soft monthly disposable contact lenses. Some risk behaviors related to contact lens wearing were found in our study like not washing and drying hands before CL wear, sleeping in CL, topping off, not respecting the adequate replacement frequency and showering or swimming in CL.After treatment, visual acuity improved only in 10 cases (34.48%), remained the same in 11 cases (37.93%) and worsened in 8 cases (27.58%).

CONCLUSION

Clinicians must suspect AK in each CL wearer with suggestive clinical signs to allow earlier treatment and better prognosis. Public prevention messages that encourage CL wearers to respect the hygiene rules should be broadly applicable to each person using any type of CL, to minimize the risk of AK.

Pancreatic schwannoma- CT and MRI findings: A rare case report and review of literature

Introduction

Pancreatic schwannoma (PS) is an extremely rare benign tumor. Here we describe the Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) results of PS in a 59 years old woman, as well as a review of the literature.

Case presentation

A 59-year-old woman consulted for atypical epigastralgia without fatigue, weight loss or fever. CT scan and MRI showed a 35 mm inhomogeneous lesion with well-defined margins located in the pancreas head. The diagnosis of pancreatic tumor was made. The pathologic examination of the biopsied mass yielded a diagnosis of pancreatic schwannoma.

Clinical discussion

On CT scans, almost all benign PS are well-defined cystic or low-density masses. MRI is helpful in characterizing their typical encapsulation.

Conclusion

The detection of pancreatic schwannoma is extremely rare. Although multiple imaging modalities are currently available, it is challenging to make an accurate diagnosis before operation.

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Although multiple imaging modalities are currently available, it is challenging to make an accurate diagnosis before operation.

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Pancreatic schwannomas of Antoni type A show solid masses with inhomogeneous enhancement. Those of Antoni type B show homogeneous cystic or multiseptated mass.

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Schwannoma must be discussed as one possibility in the list of differential of pancreatic neoplasms.

Clinicopathological characteristics and outcomes of eosinophilic cystitis: A retrospective study

Background

Eosinophilic cystitis (EC) is a rare inflammatory urinary bladder disorder whose etiology, pathogenesis, and treatment are unknown. The work aims to evaluate the clinical manifestations, cystoscopic characteristics, pathological features, treatment, and clinical outcome of EC patients.

Materials and methods

The clinical records and histopathology material of 22 patients diagnosed as EC during ten years were reviewed and analyzed for patient's age, sex, clinical data, cystoscopic features, biopsy procedures, treatment plan, follow-up, and prognosis. Frequencies, normality tests, descriptive statistics, and correlations were run.

Results

The mean age of patients was 46.5 + 17 years, 12 females and 10 males. Regarding the patient's complaints, dysuria was the most frequent main symptom, followed by hematuria. On cystoscopic examination, bladder mass was seen in 54.5% of patients. Six patients (27.3%) were associated with different allergic diseases; however peripheral eosinophilia was shown in two patients (9.1%). All cases revealed predominance of eosinophilic infiltration on microscopic examination. The most commonly used medications were corticosteroids for 72.7% of patients with tapering dose giving a significant improvement with a recorded recurrence in one patient after 12 months from the first lesion.

Conclusions

No specific clinical presentation for EC patients and histopathology is the standard diagnostic tool. Medical treatment including corticosteroids was the first line with good prognosis, although recurrence remains a possibility which emphasizes the importance of patients’ follow-up.

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Eosinophilic cystitis is a rare inflammatory disorder of the bladder.

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Etiology, pathogenesis, and treatment are unknown.

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A total of 22 patients were retrospectively studied and analyzed.

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Histopathological examination is standard tool for diagnosis.

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Oral steroids gave a significant improvement.