Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. METHODS: This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. RESULTS: The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value = < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value = < 0.001); ear/facial symptoms (t-test = 6.34, p-value = < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value = < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = - 2.16, df = 66, p = 0.035). CONCLUSION: Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. LEVEL OF EVIDENCE: Prospective observational.

Symptomatic Abdominal Wall Schwannoma Mimicking Infected Subcutanous Soft Tissue Lesion. A Case report.

INTRODUCTION AND IMPORTANCE: Schwannomas are benign tumors of the nerve sheath, they do not typically present on the abdominal wall and cause symptoms. To the best of our knowledge, this is the second symptomatic case of schwannoma in upper abdominal wall reported according to the reviewed English medical literature. CASE PRESENTATION: A 25-year-old man post renal transplant two year ago. He presented with left hypochondrial painfull swelling, and redness. On examination, local examination revealed a lesion located in the anterior abdominal wall swelling, 3 × 3 cm, tender with minimal erythema and hotness but no discharge. An ultrasound showed superficial oval shaped with thick wall and mildly increased peripheral vascularity without internal vascularity. He underwent surgical excision and the histopathology result was schwannoma. CLINICAL DISCUSSION: Usually, a patient presents asymptomatic with a slow growing mass. However, the symptoms can vary and depending on the location. Furthermore, a growing lump can start putting pressure on the nerves around the area, and patients can show symptoms accordingly. The likability of ultrasound to pick up a well-circumscribed mass and reaching a definitive diagnosis without histopathology is nearly impossible. Therefore, a complete excision and histopathology confirmed the presence of schwannoma. CONCLUSION: Upon the rarity of schwannomas presenting in atypical regions, such as the abdominal wall. A painful mass on the abdominal wall should raise the suspicion of benign schwannoma. The recurrence rate after the treatment of choice is unusual. Moreover, complete surgical excision of the mass is the definitive treatment.

Common errors in writing the cause of death certificate in the Middle East.

A death certificate is an official document in which the medical practitioner primarily records the cause of death sequence, the time interval between the onset of the cause of death and death, and personal details of the deceased. Errors in death certificate documentation are not uncommon. We aim to review the common errors in writing the cause of death certificate in the Middle East. For this review, we searched the PubMed database using a comprehensive search strategy to identify studies from the Middle East that reported errors in the cause of death certification from inception to August 17, 2019. Of the 308 items initially identified, 5 were eligible for inclusion. These studies were reported from only a few countries (Saudi Arabia, Iran, Lebanon and Palestine) in the Middle East and did not represent all the countries geographically located in the Middle East. The Middle East is not immune to errors in the medical certification of the cause of death. The absence of the cause of death, inappropriate listing and sequencing of the causes of death, mentioning the mechanism or mode of death instead of the cause of death, absence of time interval between the onset of the cause of death and death, use of abbreviations and symbols instead of formal medical terminology, and absence of the certifying medical practitioner's signature were the commonly death certification errors observed in this regional literature review. Additional studies to assess death certification errors in all the Middle East countries are needed. Efforts should be made to compulsorily include the teaching and learning of the cause of death certification in the undergraduate medical curriculum. Interactive workshops on drafting the cause of death certificate should be periodically conducted for the benefit of the interns and residents.