Perception of Rhinoplasty Outcome Utilizing Patients' Photography.

BACKGROUND: Patient satisfaction with rhinoplasty results is evaluated in a manner of subjective and qualitative values, and to a certain degree, it can indicate successful outcomes in rhinoplasty. METHODS: The present study was a descriptive study that assessed the rhinoplasty outcome of adult patients who underwent septorhinoplasty between January 2015 and August 2023 at a single center in Saudi Arabia utilizing Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores pre-operatively, postoperatively, and postoperatively with showing the patients their photo before surgery. RESULTS: The comparison of Rhinoplasty Outcome Evaluation scores and Nasal Obstruction Symptom Evaluation scores showed statistically significant with P value of 0.000 when comparing these scores pre-operatively, postoperatively, and postoperatively with showing the patient their photos before surgery. CONCLUSION: Presenting patients with pre-operative images may help them recognize changes in their clinical appearance and, consequently, score higher on the postoperative satisfaction scale. It can help the surgeon to increase patient satisfaction postoperatively.

Measurement of Nasal Skin Thickness and Body Mass Index in Preoperative Rhinoplasty Patients Utilizing Computed Tomography Scanning and Ultrasound Techniques: A Prospective Comparative Study.

One of the most important indicators of rhinoplasty success is nasal skin thickness. Nasal thickness can lead to irregularities over the osseocartilaginous framework among patients with thin nasal skin and difficulty making tip work changes in patients with thick nasal skin. This study aimed to compare different objective methods. These include computed tomography (CT) and ultrasound (US) techniques, and report the relationship between nasal skin thickness and body mass index (BMI). A prospective cross-sectional study that included all patients at the rhinoplasty clinic (King Abdul-Aziz University Hospital), Riyadh, Saudi Arabia, between December 2022 and March 2023. Age, sex, and Fitzpatrick skin type were collected from the patients' histories and physical examinations. Body mass index was calculated for the subjects. The study sample included 29 patients. The median age of the patients was 25 years (interquartile range: 20-32 y). Most of the included patients were Saudi (89.7%, n = 26). Females represented 62.1% of the study sample. The average BMI was 25.6 ± 4.95 kg/m2. The highest correlation was observed between the US and CT tip (r = 0.544, P < 0.01) and rhinion (r = 0.525, P < 0.01) measurements. Body mass index was not associated with any US or CT measurements when BMI was used as a continuous or ordinal variable. The correlation between the US and CT measurements was highest for rhinoin and tip measurements, whereas supratip measurements were not correlated (r = -0.029, P = 0.88). The correlation between mid-dorsum and nasion measurements was low (~0.3). The correlation between nasal skin thickness using CT and US varies depending on the nasal point and location. Body mass index was not associated with nasal skin thickness.

Correcting Different Degrees of Droopy Nose, an Overview of Techniques and Strategies at Tertiary Facial Plastic Center. A Retrospective Analysis.

BACKGROUND: The variety of noses in the mixed Saudi population keeps rhinoplasty surgeons on their toes. The main treatment goal for drooping nose tips is the first rotation of the nasal tip superiorly. Although droopy nose is a common disease in Saudi Arabia, none of the previous studies recognized the general features of droopy nose. METHODS: A retrospective analysis of 352 patients with nasal drooping nose from 2016 to 2022. The main outcome measurements were general characteristics of nasal tip ptosis, and the most common surgical techniques used to treat nasal tip ptosis in a tertiary hospital. RESULTS: Analysis of 352 patients with droopy nose showed that 29.0% were between 25 and 29 years old, and 56.3% were female patients. The most common characteristic seen with droopy nasal tip was a significant dorsal hump in 64.8% of patients, followed by amorphous, boxy, and bulbous nasal tip in 33.5%. Significant dorsal hump and bifid tip were more common between 18 and 24. Meanwhile, amorphous, boxy, and bulbous nasal tip were more common in female individuals. The surgical techniques mostly addressed the underlying cause, which was tip grafting (83.0%), lateral osteotomy (77.3%), hump removal (66.5%), lateral crura method (61.9%), and septal extension graft (40.9%). CONCLUSIONS: The research concluded that the surgeon should be familiar with the patient's underlying cause of nasal tip ptosis and use surgical techniques accordingly. To get a pleased long-term outcome, it is often essential to repair the inferiorly rotated tip using more than one surgical approach.

Diagnostic accuracy of intrathecal fluorescein versus other radiological modalities in evaluating non-congenital skull base defects: a systematic review and meta-analysis.

PURPOSE: The intraoperative detection of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery is critical to ensure watertight sealed defects. Intrathecal fluorescein (ITF) is a valuable adjunct to intraoperative investigation. Hence, our aim is to summarize the evidence of the efficacy of ITF as an accurate diagnostic modality and reconstruction guide for non-congenital skull base defects. METHODS: Using the Cochrane Central, MEDLINE, and Embase databases, we identified studies involving the use of ITF in non-congenital CSF leaks which were published until November 2023. The STATA 18 software was used for meta-analysis. RESULTS: Fourteen studies met the inclusion criteria, in which seven studies were included in the meta-analysis. ITF was used in 1898 (90.3%) of patients, with a detection rate of 88.1%. The overall detection rate of non-congenital CSF leaks among ITF concentrations of 5% and 10% had a statistically significant pooled effect size of 2.6 (95% CI = 2.25, 2.95), while when comparing the ITF to other alternative radiological tests, it was not statistically significant with a mean difference of 0.88 (95% CI = - 0.4, 2.16). Moreover, the pooled prevalence was statistically significant in regards of the complications associated with ITF with an effect size of 0.6 (95% CI = 0.39, 0.82), indicating that 60% of patients who underwent ITF would experience at least one of the measured complications. CONCLUSION: ITF is considered as an efficient tool in localizing skull base defects. However, there was no significant results when comparing the ITF to other alternative radiological tests. Accordingly, if the ITF intervention is indicated, patients should be carefully selected based on their clinical need.

Assessment and diagnostic methods of internal nasal valve: Systematic review and meta-analysis.

Background: Accurate methods are needed to evaluate the anatomy of the internal nasal valve (INV), yet there is currently no ideal measurement technique. Our systematic review aims to establish a comprehensive INV assessment tool, compare different INV diagnostic tools, and establish the most ideal measurement technique for the evaluation of the INV. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines, and the study was recorded in PROSPERO under reference number CRD42023407950. A systematic search was performed in PubMed, MEDLINE, The Cochrane Library (Cochrane Databases of Systematic Reviews), and the Cochrane Register of Controlled Trials (CENTRAL) for studies assessing INV that were conducted between 1996 and 2023. Result: Of the 421 total database searches, 23 studies were found, covering a total of 974 patients (6 studies assessed the accuracy of different diagnostic methods, with 2 of these studies comparing two different diagnostic modalities, and 17 studies measured INV angle). Based on the STROBE tool for quality appraisal the mean score was 16.92 ± ± 2.29, indicating a moderate quality. When comparing INV angle values from preoperative and postoperative records as obtained from CT readings, results showed no significant differences between the pre- and postoperative values (MD = -1.8, 95% CI, -4.8 to 1.2, p = .227). Conclusion: Acoustic rhinometry has the highest accuracy, followed by rhinomanometry then CT scan then endoscopy. Meta-analysis showed no significant differences between the pre- and postoperative values and a significant heterogeneity in the reported INV angle values across studies.

Olfactory and gustatory dysfunction, evaluation and the impact on quality of life among COVID-19 patients: a multi-centre study.

Background: Olfactory and gustatory dysfunctions are frequently reported symptoms among COVID-19 patients. However, several reports suggested that there might be significant variation in the prevalence and clinical picture of chemosensory dysfunction in COVID-19 patients among different population. Objective: To study the prevalence of chemosensory dysfunction, recovery time and its impact on quality of life (QoL) among COVID-19 patients in Saudi population. Methods: This multi-centre observational study was conducted at three COVID-19 centres in Saudi Arabia. Epidemiological and clinical data were extracted at baseline and within the 2-month post-infection. Olfactory and gustatory dysfunctions were assessed via valid taste and smell questionnaire, electronically collected via online survey. Short version of questionnaire of Olfactory disorders-negative statements (sQOD-NS) was used to assess the impact on QoL. Result: Total 1734 patients [926 males and 808 females, the mean age of patients was 37.7±11.6 years] with laboratory confirmed COVID-19 were recruited for this study. Chemosensory dysfunction was reported in 56.5% cases. olfactory and gustatory dysfunctions were significantly high in females (66.2%) and age group younger than or equal to 40 years (62.2%). Among patients with olfactory dysfunction and gustatory dysfunction, recovery rate was 757 (77.2%) and 702 (71.6%). Furthermore, the recovery time was within 8 days of onset of symptoms in 53.6% and 61.3% of olfactory dysfunction and gustatory dysfunction cases, respectively. Overall mean QoL score indicated Olfactory and gustatory dysfunction has significant impact on QoL [11.3±6.2 (P value<0.001)]. female as compared to males (12.8±7). Females had significant impact on QoL (11.4±6.6) as compared to males [12.8±7 (P value<0.001)]. Conclusion: Chemosensory dysfunction among Saudi population was comparable to the European data and significantly higher than Asian supporting the fact that these symptoms vary as per ethnicity. Olfactory and gustatory dysfunction significantly impaired QoL and could present as an early symptom of COVID-19. Recovery rate of these symptoms can serve as a good prognostic data for patient's counselling. Further long-term follow-up studies would lead to better understanding of prognosis and clinical outcomes.

Different estimation techniques for constant-partially accelerated life tests of chen distribution using complete data.

The issue of various estimation techniques in constant partially accelerated life tests with complete data is the main subject of this research. The Chen distribution is regarded as an item's lifetime under use conditions. To estimate the distribution parameters and the acceleration factor, maximum likelihood estimation, least square estimation, weighted least square estimation, Cramér Von-Mises estimation, Anderson-Darling estimation, right-tail Anderson-Darling estimation, percentile estimation, and maximum product of spacing estimation are presented for classical estimation. For illustrative purposes, two real data sets are analyzed. The investigation of the two real data sets reveals that the suggested techniques are practical and can be used to solve some engineering-related issues. In order to compare the results of the several estimation techniques that have been offered based on mean square error and absolute average bias, a simulation study is presented at the end. When adopting the smallest values for mean square error and absolute average bias, this study demonstrates that maximum product of spacing estimation is the technique that is most effective among the alternatives in most cases.

Endoscopic appearance of duplicated middle turbinate, case series and literature review.

INTRODUCTION AND IMPORTANCE: Duplication of the middle turbinate is an extremely rare condition encountered in rhinology clinic. Knowledge and awareness of the nasal turbinates' variations are important to perform a safe endoscopic surgery and evaluate patients with inflammatory sinus diseases. CASE PRESENTATION: Case series of two patients who visited rhinology clinic in academic university hospital. Case 1: presented with 6-month history of nasal blockage. Nasal endoscopy revealed bilateral duplication of the middle nasal turbinates. Computed tomography scans showed bilateral medially curved and anteriorly folded uncinate process, and right middle turbinate concha bullosa and its superior end of the middle turbinate was turned medially. Case 2: A 29-year-old gentleman presented with nasal obstruction mainly to the left side for several years. Nasal endoscopy showed bifid right middle turbinate and severe deviated nasal septum to the left. Upon imaging, a sinus computed tomography scan demonstrated a duplication of the right middle turbinates in the form of two middle nasal concha. CLINICAL DISCUSSION: Different rare anatomical variations can occur at different points during the embryological development. These rare variations include double middle turbinate, accessory middle turbinate, secondary middle turbinate, and bifid inferior turbinate. The appearance of double middle turbinate can be encountered in rhinology clinic only 2 % of the time. Upon reviewing the literature, only few case reports were found regarding the double middle turbinate. CONCLUSION: A double middle turbinate has important clinical implications. Anatomical variation may lead to narrowing in the middle meatus which makes the patient vulnerable to sinusitis or maybe associated with secondary symptoms. We report rare cases of middle turbinate duplication. Awareness of the nasal turbinates' variations is important for detection and management of inflammatory sinus diseases. Further studies are needed to identify the association of other pathology.

Retropharyngeal Emphysema Following Local Palate Trauma.

Retropharyngeal emphysema (RPE) is a condition that occurs when air is trapped in the retropharyngeal space. It is a rare condition that is either spontaneous or secondary to various etiologies. A case of a three-year-old patient with retropharyngeal emphysema secondary to local palate trauma was presented to King Fahd Hospital of the University. The patient was further investigated by flexible nasopharyngoscopy; however, it showed no additional complications. The patient was admitted to the hospital and managed conservatively with analgesia and antibiotics. Lateral neck X-ray showed complete resolution of retropharyngeal emphysema a few days after admission. The patient was discharged on oral antibiotics and a follow-up after one week was arranged. Upon follow-up, the patient's condition improved with no further complications.

De novo sensorineural hearing loss sequelae of narrow, duplicated internal auditory canal: Case series and literature review.

INTRODUCTION: A narrow duplicated internal auditory canal (IAC) is an extremely rare anomaly, likely associated with congenital sensorineural hearing loss due to aplasia/hypoplasia of the vestibulocochlear nerve or the cochlear branch alone. We aimed to review our experience with IAC duplication, describe its clinical characteristics, and present a literature review. CASE PRESENTATION: Our Otology database was searched for children who showed duplication of the IAC. Clinical characteristics of two children with bilateral duplication of the IAC are described. Data regarding clinical history, auditory assessment, magnetic resonance imaging (MRI), and computed tomography (CT) were collected and analyzed. The separated, accessory bony canals were demonstrated on high-resolution CT scans, and the nerves were demonstrated on MRI. DISCUSSION: To date, a few cases of narrow duplicate IAC have been reported in the literature, Approximately 20% of patients with congenital SNHL are found to show inner-ear bony abnormalities on CT, but much uncertainty still exists about the mechanism underlying IAC stenosis.5 Imaging findings of the temporal bone in our case series demonstrated asymmetrical narrowing of both IACs, there is no clear evidence in the literature supporting the predominance of one side over the other. In our series, facial nerve function was intact bilaterally. As for our cases, both patients were enrolled in a single-sided deafness evaluation for a trial of options such as BAHA, CROS, cochlear implants, and other non-implantable hearing aids. Furthermore, addressing the important factors will optimize the outcomes including surgery at early age to optimize neural plasticity, with intense long-term therapy. CONCLUSION: Congenital duplication of the IAC likely convoying sensorineural hearing loss due to aplasia/hypoplasia of the vestibulocochlear nerve. Early diagnosis and intervention are essential to optimize patient outcomes.

Tracheostomy Practice Questionnaire: Development of a Valid and Reliable Tool for Assessing Tracheostomy Practice.

BACKGROUND: Tracheostomy is among the oldest and most common surgical procedures for critically ill patients. Over the past decade, tracheostomy practice has changed regarding its indication, timing, technique, decannulation, and follow-up procedures. A systematic assessment tool for tracheostomy could maximize the quality of care and improve patient outcomes. This study develops a tool for systematically evaluating tracheostomy-related practices, assesses its validity and reliability, and conducts pilot testing of the tool. METHODS: The questionnaire development process involved three rounds using the Delphi technique with eight experts in airway management. The experts were selected from multiple healthcare specialties and workplace backgrounds. There was a two-week interval between each discussion round. In February 2019, the questionnaire themes and statements were identified through qualitative content analysis. Subsequently, in March 2019, the developed tool was emailed to 31 heads of tracheostomy care teams at multiple national hospitals for further validity and reliability assessment. RESULTS: The developed tool demonstrated reliability of 0.975. Tracheostomy-related practices showed acceptable levels in all 31 assessed hospitals with areas for improvement in the long-term follow-up domain. CONCLUSION: This study designed a tool for the comprehensive assessment of tracheostomy-related practices. It can be used to monitor institutional outcomes, which can reduce costs. Moreover, this tool can be employed to track the improvement or deterioration of tracheostomy-related procedures and long-term follow-up to facilitate institutional progress. In addition, this tool could be used for formative and summative assessments of tracheotomy practices at national and international levels.

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia: A multicenter study.

OBJECTIVES: To assess the otorhinolaryngological (ORL) symptoms, including their prevalence, severity, and early presentations among coronavirus disease-19 (COVID-19) patients in the Saudi population. METHODS: This was a multicentric, cross-sectional study carried out on severe acute respiratory syndrome coronavirus-2 positive patients at 3 COVID-19 centres; Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, ALKhobar, Qatif Central Hospital, AlQatif, and Ohud Hospital, Al Madinah Al Munawarah, Saudi Arabia. The validated survey consisted of sociodemographic data, general symptoms of COVID-19, and ORL manifestations. RESULTS: A total of 1734 COVID-19 positive patients were included in the study (mean age: 37.7±11.6 years). Most of the cases were mild (51.8%), followed by moderate (45.6%), and severe (2.6%) cases. Approximately 33.7% were asymptomatic. Severity of symptoms was significantly associated with male gender (p=0.017), higher age-group (p=0.04), and smoking (p<0.001). The most common initial ORL presentations were sore throat (20.9%), anosmia (15.5%), hyposmia (10%), and loss of taste (11.4%). Overall, 79.5% showed ORL symptoms as the initial presenting symptoms for COVID-19, with anosmia and sore throat being the most common symptoms. CONCLUSION: This study confirmed the prevalence of ORL symptoms among COVID-19 patients in Saudi Arabia. Moreover, these symptoms could also be considered for early detection of COVID-19 as they might appear prior to other symptoms.

Patterns of Otorhinolaryngological Manifestations of Covid-19: A Longitudinal Questionnaire-Based Prospective Study in a Tertiary Hospital in Saudi Arabia.

OBJECTIVE: Many studied investigated the manifestations of COVID-19, yet few described the pattern and severity of otolaryngological symptoms. We aim to describe the picture of COVID-19-associated otorhinolaryngological manifestations and recovery to explore individualized treatment, onward referral, and complications prevention. DESIGN: Prospective longitudinal questionnaire-based study. SETTING: The online questionnaire was filled 3 times through a remote interview over a period of 1 month from June 2020 to July 2020. PARTICIPANTS: Patients with confirmed COVID-19 by RT-PCR who were clinically stable. MAIN OUTCOME MEASURES: Date of diagnosis, sociodemographic data, and the presence of predictive factors, such as nasal and paranasal disease, anosmia and dysgeusia. Validated tools were used, such as Sino-nasal Outcome Test (SNOT-22), smell test (medical academy screening tool), Voice Handicap Index (VHI), and Reflux Symptoms Index (RSI). RESULT: The questionnaire was sent to 363 patients and the response rate was 70.80% (n = 257). The mean age was 34.58 years (SD = 11.22) and the rate of male participants was 60.7%. The most common otorhinolaryngological symptoms at the time of enrollment was fever (48.6%), whilst the commonest severe symptom was cough (57%). After 1 month, only 11 participants had persistent severe symptoms, especially sleep and psychological symptoms (73%), and the majority were female (63.6%). All of them had at least 1 comorbidity. There was a significant difference between the mean age of participants with severe symptoms (mean = 27.45, SD = 8.39) and without severe symptoms (mean = 34.90, SD = 2.53, t(255) = 2.17, P = .031). CONCLUSION: COVID-19 has a wide-ranged spectrum of presentations, with otorhinolaryngological symptoms being the commonest and most serious. Studying these symptoms is vital to advance management options.

Seasonal influenza vaccination coverage and its association with COVID-19 in Saudi Arabia.

Coronavirus Disease 2019 (COVID-19) pandemic is still on-going worldwide. The available information regarding the seasonal influenza vaccine (SIV) coverage during the COVID-19 pandemic and its impact on SARS-CoV-2 spread are limited. Moreover, it is argued that SIV may or may not lessen the COVID-19 severity. No previous studies have been revealed SIV coverage among COVID-19 patients and its association with COVID-19 spread and severity, especially in Saudi Arabia. Hence, this study aimed to estimate the influenza vaccine uptake in confirmed COVID-19 patients and investigate its impact on COVID-19 spread and severity. Accordingly, 1734 COVID-19 confirmed patients were included from three government hospitals in Saudi Arabia (SA). The data were collected electronically through a newly formed, self-administrated questionnaire. Among those patients, 335 were covered with SIV (19.31%), and the coverage rate of females and males was 23.4% and 15.8%, respectively. Severe COVID-19 cases were less in vaccinated patients than in non-vaccinated (2.69% vs. 3.5%, respectively). Additionally, the results showed a significant decrease in getting infected by SARS-CoV-2 after receiving SIV (P = 0.022). Even with the tremendous efforts to promote SIV uptake among the general population and high-risk groups, the SIV coverage in SA is not optimal yet. Nevertheless, there is a significant decrease in the probability of getting infected with SARS-CoV-2 after receiving SIV. Such findings with the continuous progression of the COVID-19 pandemic call for a novel approach regarding vaccination policies to increase SIV and COVID-19 vaccine uptake.

Perceptions, barriers, and attitudes toward research among in-training physicians in Saudi Arabia: A multicenter survey.

The outcomes of patient care are improved by adequate knowledge, practical skills, and positive attitude. Currently, there is a lack of data on medical research activities among resident doctors in Saudi Arabia. This study aimed to evaluate the perception, barriers, and research attitudes among various residency programs running in different cities of Saudi Arabia. A total of 434 surgical and medical residents participated in the current study. A cross-sectional study encompassing multiple training centers in the eastern province of Saudi. Convenient sampling technique was used to include all the working training residents. A self-administered questionnaire was formulated for data collection. Descriptive statistics were employed to analyze the data. The mean age of the residents with various specialties was 27.83 ± 2.41 years. Approximately 61.7% had participated in research, while 38.3% had never participated in any research. A total of 26% of junior and 44% of senior residents have one publication only. While 11% of junior and 9% of senior residents have three publications or more. Inadequate facilities for research, lack of baseline research skills, and personal commitments were the reasons which over 60% of respondents had agreed on. Institutional reasons: lack of professional supervisor support and lack of research curriculum in the training program was reported by 308 (71%) and 305(70.3%) residents, respectively. A lack of interest for research was prevailed more in males (19%) compared to females (14%) (OR 1.43, 95% CI: 0.86-2.38, p-value 0.17). A subset of residents had one or three publications, while some had none. A lack of baseline research skills and inadequate facilities for scientific explorations, time, and funds were the main constraints among training residents. However, several residents had a positive attitude toward research but fewer publications. Thus, training in medical research methodology should be obligatory in the residency curriculum in all specialties. Further research is needed.

Multiple Sclerosis Patients in Saudi Arabia: Prevalence of Depression and its Extent of Severity.

Background Multiple sclerosis (MS) is a serious chronic autoimmune disorder of the central nervous system of unknown etiology. MS-related depression is a common mood disorder recognized within the medical community. However, their association is ambiguous, underdiagnosed, undertreated and less reported. Objectives The study aimed to estimate the point prevalence and severity of depression among multiple sclerosis patients in Saudi Arabia. Materials and methods We conducted an observational cross-sectional study among multiple sclerosis patients in Riyadh region, Saudi Arabia. Patients filled demographic data and Patient Health Questionnaire-9 (PHQ-9) to determine depression. Those who did not meet the age, disease duration, and regular follow-up eligibility criteria were excluded from the study. Results We enrolled 238 MS patients in the study, male patients represented 39.1% (n = 93) while females accounted for 60.9% (n = 145) (male:female ratio 0.64). The mean age of the study population was 32.07 ± 7.93 years. The mean duration of the disease was 7.06 ± 4.7 years. We determined that 89.9% (n = 214) of the patients showed mild to severe depression symptoms (55.46% of the females, and 34.4% of the males; p = 0.474). We further found that 37.39% (n = 89) and 65.13% (n = 155) of the depressed patients were unemployed (p = 0.039) and were non-smokers (p = 0.097) respectively. Furthermore, depression severity is significantly associated with education (p = 0.005). Conclusion High levels of depression symptoms were found among MS patients in Saudi Arabia. The relationship between MS and psychiatric conditions exists despite the uncertainty of its pathogenesis. Further longitudinal studies should be carried out to obtain more valid outcomes. Neurologists treating MS patients can play a role in studies related to the condition by investigating depressive symptoms actively and providing the data.

Knowledge, Attitude and Practice Regarding Ramadan Fasting and Related Determinants in Patients with Type 2 Diabetes at a Saudi Diabetes Clinic.

OBJECTIVE: This study was carried out in type 2 diabetes mellitus (T2DM) patients to assess their knowledge, attitude and practice about fasting during Ramadan and to identify the sociodemographic determinants of the knowledge, attitude and practice. METHODS: A total of 107 T2DM patients were interviewed at a diabetes clinic in the Eastern Saudi Arabia. A questionnaire containing knowledge, attitude and practice questions about fasting during Ramadan was used to collect data. Data about age, gender, city of residence, nationality, level of education, and history of diabetes in family were also collected. Descriptive and inferential statistics were carried out using IBM-SPSS Version 21. RESULTS: The mean total score for knowledge, attitude and practice was 16.5 ±3.72 (out of 27). The individual scores for knowledge, attitude and practice were: 9.67±2.53 (out of 16), 4.10±1.28 (out of 6), and 2.77±1.08 (out of 5), respectively. Gender (OR: 4.08, 95% CI: 1.05,15.79 and p<0.041), education (OR: 0.068, 95% CI: 0.008,0.594, p<0.015) and family history (OR: 5.086, 95% CI: 1.095, 23.630 p<0.038) were identified as independent determinants of the total score. CONCLUSION: Gender, Family history of diabetes and Education are determinants of knowledge, attitude and practice regarding fasting during Ramadan in the T2DM patients. A significant knowledge practice gap exists that necessitates further strengthening of the Pre-Ramadan education program for T2DM patients.

Bayesian variable selection using partially observed categorical prior information in fine-mapping association studies.

Several methods have been proposed to allow functional genomic information to inform prior distributions in Bayesian fine-mapping case-control association studies. None of these methods allow the inclusion of partially observed functional genomic information. We use functional significance (FS) scores that combine information across multiple bioinformatics sources to inform our effect size prior distributions. These scores are not available for all single-nucleotide polymorphisms (SNPs) but by partitioning SNPs into naturally occurring FS score groups, we show how missing FS scores can easily be accommodated via finite mixtures of elicited priors. Most current approaches adopt a formal Bayesian variable selection approach and either limit the number of causal SNPs allowed or use approximations to avoid the need to explore the vast parameter space. We focus instead on achieving differential shrinkage of the effect sizes through prior scale mixtures of normals and use marginal posterior probability intervals to select candidate causal SNPs. We show via a simulation study how this approach can improve localisation of the causal SNPs compared to existing mutli-SNP fine-mapping methods. We also apply our approach to fine-mapping a region around the CASP8 gene using the iCOGS consortium breast cancer SNP data.

Acute profound sensorineural hearing loss as the initial manifestation of Hairy Cell Leukemia, Case Report and literature review.

INTRODUCTION: Hematologic diseases are rarely present with sudden hearing loss as an initial symptom. Although the precise cause of sudden sensorineural hearing loss has not been identified, several pathophysiological mechanisms have been proposed. However, a variety of hematologic diseases are among the causes of sudden onset deafness. This article represents the first reported case of Hairy cell leukemia (HCL) which presented with acute unilateral profound sensorineural hearing loss as an inital mainfestation. PRESENTATION OF CASE: A 41-year-old man presented with unilateral sudden hearing loss for one day's duration was found to have HCL during a worked up for his hearing loss. The disease worsened, and there was no improvement in his hearing. DISCUSSION: Sudden sensorineural hearing loss can rarely be seen as a paraneoplastic occurrence.Very few cases have been reported in the literature. It has been reported as a presenting symptom of leukemia in numerous clinical and histopathological reports concerning the hearing loss in hematologic diseases. Our case is an example of such a rare incidence. CONCLUSION: The purpose of this study is to draw physicians' attention to the possible association between acute sensorineural hearing loss to HCL, and to highlights permanent deafness as a complication secondary to HCL. Furthermore, it is important to increase awareness on early diagnosis and treatment that may improve treatment outcomes.

The Impact of using the term "Diabetic Ear" for the patients with Skull Base Osteomyelitis.

BACKGROUND: Diabetes and ear disease are some of the most widespread health concerns. The focus here is on the impact of using the term "Diabetic Ear" for patients with skull base osteomyelitis (SBM) in the context of malignant otitis externa (MOE). The aim of this study was to discover the awareness of general practitioners (GPs), residents, specialists, and consultants at Primary Health Care Centers about necrotizing otitis externa (NOE), also known previously as malignant external otitis (MOE), assess their deficiencies and provide solutions; also assist them for the early detection and possible prevention of diabetes- related ear diseases and their complications. MATERIALS AND METHODS: A cross-sectional study was conducted among a random sample of physicians (residents, specialists, and consultants) working at the Primary Health Care Centers in Al-Khobar and Dammam cities of the Eastern Province, Saudi Arabia. Data was collected using a standardized questionnaire. SPSS was used for data entry and analysis. RESULTS: The total number of medical practitioners was 84. Their mean age was 33.97 (±9.55). The proportion of females was higher than males, only 28.3% of the participants responded correctly when asked about MOE. Similarly, very few were aware of the risks of MOE (2.5%), complications associated with it (17.3%) and the necessary procedures for managing patients (24.2%). The awareness of doctors in the primary health clinics about MOE was significantly better than those in hospitals (P = 0.002). CONCLUSION: There was a significant deficiency in the knowledge of GPs on MOE. Therefore, health education and awareness programs on MOE are recommended. Furthermore, we recommend that it is necessary to encourage the use of the term "Diabetic EAR "to increase the level of awareness of physicians about MOE.