Adult Sinonasal Rhabdomyosarcoma With Spinal Metastasis: A Case Report and Review of the Literature.

Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumor mainly seen in the pediatric population. Here, we describe a case of an aggressive sinonasal RMS with distant metastasis in an adult patient. A 51-year-old male presented to the otolaryngology clinic with a unilateral painless neck mass and nasal obstruction. A flexible transnasal endoscope showed a huge fungating mass obstructing more than 80% of the right nasal cavity. A contrasted computed tomography (CT) scan of the paranasal sinuses showed an enhancing soft-tissue density mass involving the right nasal cavity. A biopsy revealed RMS, an embryonal variant. The patient responded well to chemoradiotherapy but later developed spinal metastasis and cord compression. He was admitted for palliative care but died due to cardiopulmonary arrest 10 months after diagnosis. A high index of clinical suspicion for malignancy is required in adult patients with unilateral nasal symptoms.

Dandy-Walker syndrome with bilateral choanal atresia: A case report.

INTRODUCTION: Dandy-Walker syndrome is a rare congenital brain malformation characterized by cerebellar vermis agenesis or hypoplasia, cystic dilatation of the fourth ventricle and a large posterior fossa causing upward displacement of tentorium and torcula. In this paper, we present a case of bilateral choanal atresia with Dandy-Walker Syndrome in a female newborn. CASE PRESENTATION: We present a case of a female patient who was born at 38th weeks of gestation via emergency cesarean section due to non-reassuring cardiotocography and abnormal antenatal ultrasounds findings. The imaging revealed the presence of Dandy-walker malformation. The patient presented with cyanosis and respiratory distress. Bedside flexible nasoendoscopy revealed bilateral choanal atresia which is confirmed by computed tomography of sinuses. Endoscopic bilateral choanal atresia repair was performed. On postoperative follow up, nasal endoscopy showed bilateral intact flap and patent neochoana. DISCUSSION AND CONCLUSION: Dandy-Walker syndrome is a congenital disorder that can be diagnosed prenatally. The syndrome is associated with multiple anomalies. However, there are few published reports of bilateral choanal atresia in Dandy-Walker Syndrome. Bilateral choanal atresia is considered a life-threatening condition in newborns that requires early surgical intervention.

Risk factors for the systemic inflammatory response syndrome and sepsis following surgical management of acute intestinal obstruction.

OBJECTIVES: Infection is one of the major complications following intestinal obstruction surgery, yet predictors of its occurrence are not sufficiently reported. In this study, we examine the factors leading to postoperative inflammatory response syndrome (SIRS) and sepsis. METHODS: The data of 213 patients who underwent intestinal obstruction surgery between 2015 to 2020 in King Abdulaziz Medical City, Riyadh, Saudi Arabia, were reviewed retrospectively. Patients' demographic characteristics and preoperative, intraoperative, and 30-day postoperative data were compared between patients who had postoperative SIRS/sepsis and patients who had no complications. RESULTS: Ninety-six patients (44%) developed SIRS/sepsis within 30 days after surgery. More than half of the patients were males (55.8%), and the mean age at operation was 56.7(SD=20.0)years. Preoperative high heart rate, low albumin levels, and postoperative intensive care unit (ICU) admission were independently and significantly associated with developing SIRS/sepsis post-operation. The mortality rate in this study was estimated to be 7.5%; of those, 93.8% had SIRS/sepsis. CONCLUSION: The 30-day mortality rate is considerably higher among patients who developed SIRS/sepsis after intestinal obstruction surgery. The independent risk factors of developing SIRS/sepsis after operation were elevated heart rate, low albumin levels preoperation, and ICU admission post-operation.

Hypopharyngeal Perforation Following Foreign Body Ingestion: A Case Report.

Foreign body ingestion is a common complaint frequently seen in otolaryngology. Some sharp foreign bodies may get impacted in the aerodigestive tract causing a perforation. However, hypopharyngeal perforation is a rare injury that needs early recognition due to its significant morbidity. In this case report, we report a case of hypopharyngeal perforation caused by foreign body ingestion in an adult patient. A 60-year-old female presented with a foreign body sensation in the throat, dysphagia, and odynophagia. A neck CT scan showed a foreign body in the hypopharynx with a collection of free air along the posterior pharyngeal wall. She underwent laryngoscopy and esophagoscopy for examination and foreign body removal. Following the procedure, the patient was treated conservatively for a week and then discharged home in a stable condition. Hypopharyngeal perforation following foreign body ingestion is uncommon. A high index of suspicion is required to reach an early diagnosis and treatment.

The use of mobile application in primary health care in Saudi Arabia: A cross-sectional study.

BACKGROUND: Technology implantation, for example, smartphone application, in primary health care (PHC) is an approach to enhance healthcare services via availability and convenient access. This study described the factors contributing for not booking an appointment using the mobile application, and why patients visit PHC physicians. METHOD: This is a cross-sectional study that included 477 participants who visited the PHC physicians. Eligible subjects who present in the patients' waiting area were asked to participate by giving them a self-administered questionnaire. RESULTS: With a total of 477 participants' appointments, 83.5% (N = 398) of them were booked through the mobile application. Out of 398, 54.6% (N = 217) were not booked by the patients themselves. The most common reasons for the visits were follow-up (38.8%), lab/imaging results (34%), and acute complaint (27.3%). Gender, age, and the number of comorbidities the patient has were significantly associated with those who didn't book the appointment by themselves through the mobile application (P-value <0.001). Males were more likely to book for themselves than females. The average age for patients who booked for themselves through the mobile application was significantly low (Mean = 39.4, SD = 14.5). Those who were able to book for themselves had a lower number of comorbidities. CONCLUSION: Age, gender, and number of comorbidities were significant factors contributing to not to book an appointment/use mobile application by the patients themselves. The mobile application might cause difficulties and influence the appointment booking process. The application should be expanded throughout the country with further modification to meet the patient's needs.