ABSTRACT
Introduction Septoplasty is a commonly performed surgery by otolaryngologists. This study examines the routine use of non-absorbable nasal packs in the postoperative period in Kuwait. Our aim is to assess the views of otolaryngologists in Kuwait regarding the routine use of non-absorbable nasal packing after septoplasty with or without turbinoplasty. Materials and methods A cross-sectional study, an anonymous survey, consisting of 10 questions, using Google Forms was conducted. It was distributed via WhatsApp and in person hard copies to otolaryngologists - head and neck surgeons in Kuwait. Data were securely stored and analyzed using Stata (StataCorp LLC, College Station, Texas) software. Results Fifty participants have completed the survey. The majority were routinely performing septoplasty for a symptomatic deviated nasal septum (n= 47, 94%). Out of those, 43% (n = 21) usually use silastic splints to prevent postoperative complications, including bleeding, hematoma formation, and adhesions. The use of quilting sutures for the same purpose was done by 21% (n = 10), and 17% (n = 8) used non-absorbable nasal packs. Only two participants believed that no specific intervention was required. More than half used postoperative nasal packs in the case of intra-operative bleeding (n=26, 52%), while 18% (n = 9) believed that it is only necessary in selected cases with predisposing factors to bleeding. Ninety-two percent (n = 46) thought that pain and discomfort were associated with the use of non-absorbable nasal packs, and 50% (n = 25) believed that it could cause hemodynamic instability. Moreover, 66% (n = 33) agreed that quilting or trans-septal sutures can safely substitute nasal packs following septoplasty. Awareness of recent updates on the complications related to nasal packing varied, with more than half of the otolaryngologists being knowledgeable (n = 29, 58%). Discussion Septoplasty, a common surgical intervention for correcting a misaligned nasal septum, addresses various symptoms, such as nasal obstruction, obstructive sleep apnea, epistaxis, and headache. While the practice of nasal packing for 24-48 hours post-septoplasty is widespread, it remains a topic of controversy. Current literature supports the continued use of nasal packing for patients at high risk of bleeding. However, potential drawbacks, including increased pain, headache, and prolonged hospital stay, raise concerns about its overall benefits. An alternative approach, utilizing quilting sutures without nasal packs, has shown promising results in comparative studies, demonstrating less pain and minimal bleeding. Additionally, trans-septal sutures emerge as a safe alternative, minimizing dead space and reducing post-operative complications. Conclusion It appears that otolaryngologists in Kuwait have diverse opinions with regard to nasal packing following septoplasty. Further research is needed to establish evidence-based guidelines for this common procedure.
ABSTRACT
Multifocal cystadenomatous oncocytic hyperplasia of the parotid gland is an extremely rare non-neoplastic lesion. We present a case involving a 73-year-old female with a painless, small mass in her right preauricular region for the past two months. Fine needle aspiration suggested a diagnosis of mucoepidermoid carcinoma. Following further investigations, the patient underwent an uneventful right superficial parotidectomy without neck dissection. Histopathological examination of the excised superficial parotid tissue revealed multifocal cystadenomatous oncocytic hyperplasia with negative surrounding margins. The patient's subsequent follow-ups in the outpatient department were satisfactory, with no reported issues, concerns, or evidence of recurrence.
ABSTRACT
Sialolithiasis, caused by stones in the salivary glands or their excretory ducts, is one of the most prevalent salivary gland diseases. However, it is uncommon in the pediatric population and in the parotid gland. Both conservative and surgical methods are satisfactory options for sialolithiasis treatment. Small stones (<4 mm) located distal to the intraparenchymal gland often respond to conservative treatment. If medical treatment is anticipated to fail or the stones are medium or large sized (≥4 mm), surgery is the preferred option. This report describes a rare case of intraglandular parotid stones in an adolescent patient.
ABSTRACT
The present study aims to design and optimize the lornoxicam dispersible tablet (LXDT) formulation using the Quality by design (QbD) approach. A randomized Box-Behnken experimental design was used to characterize the effect of the critical factors, such as filler (MCC/Mannitol) ratio, mixing time, and disintegrant concentration, and assessed for their impacts on the critical quality attributes (responses), including dispersibility time, friability, dissolution efficiency, and content uniformity, respectively. The drug-excipients interaction of the formulation was investigated using FTIR and DSC, respectively. The accelerated stability study at 40 °C/75% relative humidity was performed. FTIR revealed an absence of any significant chemical interaction in solid state. DSC thermogram suggested that LX endothermic peak was slightly decreased due to the dilution effect. LXDT formulations exhibited acceptable friability (0.2 to 0.9%). The dissolution efficiency of LXDT formulations ranged from 72.21 to 93.63%. The overall study showed that the optimum level of independent factors was found to be 3:1 MCC/Mannitol, 11 min mixing time, and 6.23% disintegrant concentration. Accelerated stability studies showed the compendial acceptable hardness, friability, and disintegration times. The application of QbD approach can help in the detailed understanding of the effect of CMAs and CPPs on the CQAs on LXDT final product.
ABSTRACT
Introduction The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing changing and suture removal since they are usually repaired with non-absorbable sutures. These visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the "potential" risk of wound infection. In the current study, our first objective was to determine the non-inferiority of absorbable sutures regarding infection rate after repairing traumatic wound lacerations in comparison to the conventional non-absorbable ones. Our second objective was to evaluate the superiority of absorbable sutures in regard to postoperative clinic visits for suture removal and wound dressing compared to the non-absorbable ones. Methods A sample of 471 patients with traumatic skin lacerations was analyzed during the COVID-19 pandemic in April 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone/video call follow-up after 21 days, several parameters regarding infection signs and clinic visits were compared between both groups. Results A significant decrease in total trauma patients (45.4%) and those who required suturing (51.2%) was observed in April 2020 compared to the same month of the previous four years (p = 0.001 (2016), p = 0.027 (2017), p = 0.027 (2018), and p = 0.001 (2019)). Regarding wound infection, no statistically significant difference (p = 0.623) was observed between the absorbable (3.2%) and non-absorbable (4.9%) groups. Using absorbable sutures resulted in significantly (p < 0.001) fewer postoperative hospital visits compared to using non-absorbable sutures (mean: one versus three visits). Conclusion Using absorbable sutures to repair traumatic wound lacerations is safe regarding wound healing and infection rates. They also reduce postoperative hospital visits since they are not intended to be removed. Therefore, they should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.
