Iatrogenic pharyngo-esophageal diverticulum post-anterior cervical discectomy and fusion: A case report and review of literature.

Objectives: The purpose of this study is to report a case of iatrogenic pharyngoesophageal diverticulum post-anterior cervical discectomy and fusion (ACDF) surgery, its management and management of postoperative complications. We also did a thorough review of literature about iatrogenic pharyngoesophageal diverticulum which is a rarely encountered complication occurring after a commonly performed surgery; ACDF. Methods: Here we describe a case of iatrogenic pharyngoesophageal diverticulum post-ACDF surgery. In this paper we also make comparisons to the 23 cases reported in the literature in terms of: presentations, clinical findings, management courses, and complications. This study was approved by the Institution Review Board of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. (Ref. no.: IRB-2023-01-473). The reported subject provided written informed consent before initiation of this study. Results: Our case is a 45-year-old male with a history of ACDF surgery 8 years ago. He presented with dysphagia and regurgitations which started 1 year after ACDF. He was labeled as a case of Zenker's diverticulum and underwent multiple failed open and endoscopic surgeries prior to presenting to us. Upon presenting to our center, barium swallow showed the pharyngoesophageal diverticulum. Patient definitive diagnosis of iatrogenic rather than Zenker's diverticulum was established intra-operatively with esophagoscopy which revealed exposed hardware inside the diverticulum. He underwent open diverticulectomy and diverticulopexy. Postoperatively he developed pharyngocutanous fistula and right vocal fold palsy, both successfully managed conservatively. Conclusion: Iatrogenic Pharyngoesophageal diverticulum is a rare complication following ACDF, however prolonged dysphagia shall warrant further investigation by contrast studies. Open diverticulectomy with muscle reinforcement is a good management modality. Due to the complicated anatomy secondary to previous operations, we recommend conservative management for patients with postoperative pharyngocutaneous fistula.

Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review.

Objectives: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP. Data Source: Systematic Review of three electronic databases. Review Methods: Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs. Results: A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported. Conclusion: The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03144-8.

Central pontine myelinolysis and locked-IN syndrome associated with tacrolimus after pediatric heart transplantation.

BACKGROUND: Locked-in syndrome represents the most severe form of central pontine myelinolysis and varies in presentation from asymptomatic to fully developed locked-in-syndrome characterized by the combination of quadriplegia, loss of the ability to communicate except through the use of the eyes, and an inability to follow commands. METHODS: We report a 10-year-old boy who developed a severe case of locked-in syndrome after heart transplantation. RESULTS: Patient had a spontaneous recovery, treated with supportive treatment and the improvement was detected with cessation of calcineurin inhibitor therapy by substituting with an mTOR inhibitor (sirolimus). No cases of locked-in syndrome post-heart transplant in pediatrics cases have been documented in the literature. CONCLUSION: Physicians should recognize a rapid progression of central pontine myelinolysis and locked-in syndrome in the context of heart transplant and although several factors likely contributed to this outcome, adjustment of immunosuppression including by substituting tacrolimus with sirolimus could be effective.

Assessment of seismic hazards in Yemen.

The seismic hazard analyses for Yemen have attracted the attention of researchers during the last two decades. However, the studies are limited and mainly use deterministic or approximate conventional probabilistic approaches. The conclusions drawn from these studies do not fit with current seismic design codes (International Building Code). This article presented the method and findings of a probabilistic seismic hazard assessment for Yemen in accordance with current seismic design building regulations. All the data sources, available nationally and internationally, were utilized in compiling earthquake database by covering the recent records and the seismic activity maps of the study region. The study area was regionalized to 11 seismotectonic area sources on the basis of the seismicity maps and available tectonic maps. On the analytical side, the earthquake recurrence analysis was evaluated for each source, and logic tree concept was used to model the seismic sources that may have significant effect on seismic hazard evaluation of Yemen as a combination of area and line sources. A probabilistic forecasting model was formulated, appropriate ground motion attenuation relationships were used, and seismic hazard contour maps were developed for the entire Yemen area. The maps present dense contours of peak ground accelerations and short and long period spectral accelerations for different return periods. The highest predicted seismic hazard is found in Dhamar City. This study provides basic and essential requirements that will be valuable in developing advanced seismic design criteria for Yemen.

An Unusual Maxillary Sinus Foreign Body: A Case Report.

BACKGROUND Paranasal sinus foreign bodies are rarely encountered in otolaryngology practice. CASE REPORT We present the case of a 32-year-old man who presented to our Emergency Department with his left eye bleeding after a nail gun injury. The initial physical examination revealed the presence of a left eye ruptured globe, which led to left eye blindness. An urgent plain X-ray scan was done, in which the presence of a metallic object impacted in the left maxillary sinus was demonstrated. The patient was managed surgically by an external approach using the Caldwell-Luc procedure, with no intra- or postoperative complications. CONCLUSIONS Paranasal sinus foreign bodies, if improperly treated, can cause serious morbidity. Surgical removal, either endoscopically or through an external approach, is required.

A diagnostic negative ultrasound finding in blunt abdominal trauma.

INTRODUCTION: Ultrasound is an extension of the clinical examination and its findings should be correlated with the clinical picture as a whole to be useful. Hereby, we report a unique negative diagnostic ultrasound finding in blunt abdominal trauma which was not reported before. CLINICAL PRESENTATION: A 50-year-old obese man presented complaining of severe generalized abdominal pain and inability to pass urine of three days duration after he slipped on his abdomen. The abdomen was distended and tender all over. There was no blood on the urethral meatus. FAST scan showed significant intra-peritoneal fluid. The urinary bladder could not be seen. A Foley catheter was inserted which drained 3 L of clear urine. The abdominal distention became less. Repeated FAST scan was completely negative. A clinical diagnosis of major intra-peritoneal rupture of the urinary bladder was made. Trauma CT scan and laparotomy confirmed the diagnosis. CONCLUSIONS: The change of a positive FAST to a negative FAST was diagnostic of a major intra-peritoneal urinary bladder rupture even before performing a trauma CT scan. When performing FAST in blunt abdominal trauma, it is more useful to perform FAST before inserting a urinary catheter and it is advised to repeat it.

Molecular Characterization and Antibiotic Susceptibility Pattern of Acinetobacter Baumannii Isolated in Intensive Care Unit Patients in Al-Hassa, Kingdom of Saudi Arabia.

BACKGROUND: Acinetobacter baumannii, is an emerging nosocomial multidrug resistance pathogen with the rapid spread of clones being reported in health-care settings and hospitals worldwide. Carbapenem resistance in this bacterium has been attributed to D OXA ß-lactamases with OXA-51-like ß-lactamase, being present in all A. baumannii isolate. The present study looks into the antibiotics susceptibility and molecular characterization of clinical A. baumannii isolates from Intensive Care Unit (ICU) samples in Al-Hofuf, South-eastern region of Saudi Arabia. MATERIALS AND METHODS: Eleven strains of ICU A. baumanni i isolates were used for the investigation. Bacteria isolation was by basic microbiological techniques. Organisms identification and antibiogram susceptibility testing was by the BioMerieux VITEK 2 compact automated system (BioMerieux, Marcy I'Etoile France), according to the manufacturers guidelines. Confirmation of A. baumannii was by the presence of the OX-51 gene, also, carbapenemase encoding resistant genesblaOXA-23, blaOXA-40, and blaOXA-51, were analyzed using multiplex PCR. The Student's t test was used to analyze the obtained data for between group comparisons with statistically significance level set at P < 0.05. RESULTS: Eight of the isolates were confirmed to be A. baumannii. Five of which were resistant to the carbapenems against which they had been tested. One isolate was resistant to tigecycline, whereas three tested intermediate to the drug. OXA-23 was detected in isolates 1, 4, 5, 6, and 7. CONCLUSION: It can, therefore, be concluded that the probable predominate carbapenems resistant genes in ICU isolates from the present investigation, are those associated with OXA-23.

Spectral subtraction denoising preprocessing block to improve P300-based brain-computer interfacing.

BACKGROUND: The signals acquired in brain-computer interface (BCI) experiments usually involve several complicated sampling, artifact and noise conditions. This mandated the use of several strategies as preprocessing to allow the extraction of meaningful components of the measured signals to be passed along to further processing steps. In spite of the success present preprocessing methods have to improve the reliability of BCI, there is still room for further improvement to boost the performance even more. METHODS: A new preprocessing method for denoising P300-based brain-computer interface data that allows better performance with lower number of channels and blocks is presented. The new denoising technique is based on a modified version of the spectral subtraction denoising and works on each temporal signal channel independently thus offering seamless integration with existing preprocessing and allowing low channel counts to be used. RESULTS: The new method is verified using experimental data and compared to the classification results of the same data without denoising and with denoising using present wavelet shrinkage based technique. Enhanced performance in different experiments as quantitatively assessed using classification block accuracy as well as bit rate estimates was confirmed. CONCLUSION: The new preprocessing method based on spectral subtraction denoising offer superior performance to existing methods and has potential for practical utility as a new standard preprocessing block in BCI signal processing.