Pterygopalatine fossa schwannoma-case report and literature review.

INTRODUCTION: Schwannomas are well-differentiated, benign tumours that originate from the Schwann cells of nerve sheaths. They constitute 25-45% of all the head and neck tumours and can cause significant morbidity depending on the site of origin. The pterygopalatine fossa is the rarest site of involvement, with only a few cases reported in the literature. CASE PRESENTATION: This is the case of a 46-year-old male who presented with a twelve [12] month history of left-sided facial pain and progressive swelling. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large soft tissue lesion located in the left pterygopalatine fossa (PPF). Surgical management is presented, and technical details of the repair are discussed. At one year follow-up, there were no signs of recurrence, and the cosmetic outcome was satisfactory. DISCUSSION: This case is one of a handful of reported cases of PPF schwannomas in the English literature. Although a significant percentage of schwannomas arise in the head and neck region, the pterygopalatine fossa is the rarest site of involvement. Due to its clinically inaccessible location and complex connections, the pterygopalatine fossa can act as a natural conduit for the spread of inflammatory and neoplastic diseases in the head and neck. CONCLUSION: Currently, the endoscopic endonasal approach (EEA) is preferred due to its safety and good oncologic outcome. There is also decreased morbidity as it is minimally invasive. Furthermore, surgeons embarking on the EEA should be equipped with an image guidance system and be trained in advanced endoscopic techniques. However, the open approach remains a reliable and proven surgical method to treat large tumours located within this intricate and inaccessible area.

Prevalence and factors associated with depression, anxiety and stress among healthcare workers of Trinidad and Tobago during COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: To determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic. DESIGN: Cross-sectional online survey. SETTING: HCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago. PARTICIPANTS: 395 HCWs aged ≥18 years. MAIN OUTCOME MEASURES: Depression, anxiety and stress scores. RESULTS: Among the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI -5.233 to -1.692) and stress, p<0.001 (95% CI -5.364 to -1.591). CONCLUSIONS: This study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.

A cross sectional study comparing traditional risk factors with N-terminal pro-BNP in high risk groups for cardiovascular disease in Trinidad, West Indies.

OBJECTIVE: Cardiovascular disease is a leading cause of morbidity and mortality worldwide and traditional risk factors for cardiovascular disease have been well-elaborated. In recent years, the use of biomarkers has emerged for identifying individuals at high risk with the aim of earlier identification and risk mitigation. Among the most promising non-traditional markers are BNP and NT-proBNP. This study aims to compare whether serum NT-proBNP co-segregates with traditional cardiovascular risk factors in elderly type 2 diabetic and non diabetic in a population with high prevalence of CVD. METHODS: This study utilized a cross sectional design. Blood samples collected were analyzed for hs-CRP, total serum cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, fasting glucose, insulin, and NT-proBNP. RESULTS: Mean serum NT-proBNP levels were significantly elevated in diabetics (X=125.5 ± 49.7) compared to non diabetics (X = 64.3 ± 34.6). In diabetics, NT-proBNP demonstrated statistically significant spearman's coefficients with respect to systolic blood pressure, triglyceride, hs-CRP, fasting glucose and insulin. Among non diabetics there was no relationship between NT-proBNP, blood pressure and insulin. Multivariate logistic regression revealed relation between diabetics; elevated NT-proBNP, blood pressure, triglyceride, CRP, fasting glucose and plasma insulin compared with non diabetics where NT-proBNP showed significant relation only to diastolic blood pressure. Diabetics showed significant correlation with elevated NT-proBNP and traditional risk factors (hypertension, diabetes, dyslipidemia and elevated hs-CRP) as compared with non diabetics. CONCLUSIONS: NT-proBNP co-segregates with traditional risk factors for CVD among elderly diabetics and may be a useful additional screening test for those at risk for CVD.