Sinonasal Glomangiopericytoma with Skull Base Involvement: A Diagnostic Dilemma.

Introduction: Glomangiopericytoma (GPC) is a rare type of neoplasm with hemangiopericytoma-like vasculature and perivascular hyalinization of capillary-sized veins. CD34 and S100 protein staining might be positive in a small percentage of GPC. Solitary fibrous tumors (SFTs) present clinically like GPC. However, challenges remain when differentiating GPC from SFT. Case Presentation: A 37-year-old male, smoker, presented with 3 years history of right-sided epistaxis and nasal congestion. He was also complaining of hyposmia but no headaches or visual complaints. On nasal endoscopy, he was found to have a right-sided nasal mass occupying the ethmoid cavity. Computed tomography showed a right sinonasal mass abutting the anterior skull base and magnetic resonance imaging demonstrated a hyperintense, enhancing mass within the right ethmoid cavity, superior septum, and anterior skull base. The patient underwent endoscopic resection with gross total resection and skull base reconstruction. Postoperative pathology initially was thought to be an SFT; however, subsequent STAT6 expression was negative, and therefore GPC diagnosis was confirmed. At the most recent follow-up (6 months), the patient remained free of local disease. Discussion: SFT, unlike GPC, stains strongly for CD34, in this case, due to strong CD34, the diagnosis of SFT was initially made. Nuclear STAT6 expression is highly specific and sensitive for SFT. This later returned as negative; therefore, GPC was confirmed. Conclusion: We present a case of sinonasal GPC with skull base involvement that was treated with endoscopic resection. At the most recent follow-up (6 months), the patient remained free of local disease.

Olfactory dysfunction among patients with COVID-19.

OBJECTIVES: To assess the frequency of olfactory dysfunction (OD) among individuals afflicted with coronavirus disease of 2019 (COVID-19). METHODS: A comprehensive literature search was carried out across several bibliographical databases (PubMed, Scopus, Google Scholar, and Web of Science) to extract publications in the English language between January 2020 and December 2021 to report the incidence of OD alone or together with gustatory dysfunction (GD) among COVID-19 patients. RESULTS: Based on eligibility criteria, 84 articles were included from 27 countries, comprising 36,903 patients, of whom 58.1% were females. The generality rates of olfactory impairment alone was 34.60% and in conjunction with GD was 11.36%. Patients with OD were subclassified into various categories, and the prevalence of anosmia was 20.85%, 5.04% for hyposmia, 8.88% for anosmia or hyposmia, 1.84% for parosmia, 0.78% for phantosmia, and 0.02% for hyperosmia, among COVID-19 patients. CONCLUSION: Clinical features associated with OD, either isolated or in combination with GD, are common in patients with COVID-19 and consider important signs of COVID-19 that may guide clinicians in the early phase of the disease.PROSPERO Reg. No.: 417296.

Quality of Life of Patients With Nasal Obstruction Who Underwent Septoplasty: Assessed With the Glasgow Benefit Inventory.

BACKGROUND: Septoplasty is considered the definitive treatment for symptomatic patients with deviated nasal septum. Although septoplasty is a commonly successful performed surgery, it has also been found to affect patients' quality of life (QoL). The Glasgow Benefit Inventory (GBI) scale is a validated questionnaire used to assess satisfaction after treatment. OBJECTIVE: The present study was conducted with the aim to assess the outcome of septoplasty using the GBI scale. METHODS: A retrospective study was conducted among patients with chronic nasal obstruction in Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia, to assess the outcome of septoplasty using the GBI. All patients who met the eligibility criteria were subjected to a detailed otorhinolaryngology, head and neck examination, including nasal endoscopy prior to septoplasty, followed by the distribution of a previously validated questionnaire translated into Arabic. Statistical analysis was performed using R version 3.6.3 software. Counts and percentages were used to summarize the distribution of categorical variables. RESULTS:  A total of 75 patients were enrolled in the study initially, among which 42 patients met the eligibility criteria; 65% were male and 35% were female. Most respondents reported improvement in the total GBI score (92.5%, n = 40). A similar improvement was observed in the general subscale domain (92.5%, n = 40) as compared to the social support domain (66.7%, n = 28) and physical health domain (66.7%, n = 28), which showed less improvement. CONCLUSION: We found a positive change in the QoL among the patients after septoplasty using a validated and reliable instrument.

Cross-Cultural Adaptation, Validation, and Arabic Translation of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7)

Abstract Introduction The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) scale is used to assess the effectiveness of the treatment and to determine the severity of the eustachian tube dysfunction (ETD). There is currently no validated Arabic version of the ETDQ-7. Objectives The aim of the present study is to test the validity and the reliability of a translated Arabic version of the ETDQ-7. Methods A multicenter prospective validation study was conducted in Riyadh, Saudi Arabia. The ETDQ-7 was adapted and translated into Arabic using a standard validation methodology. Fifty-one patients diagnosed with Eustachian tube dysfunction and 45 healthy individuals were enrolled in the study. The known-groups method was used in the validity analysis. The test-retest method, item-total score correlation, and internal consistency analysis were used for the reliability analyses. Result The overall internal consistency of the Arabic ETDQ items was measured using Cronbach α (Cronbach α = 0.803). The average and total ETDQ scores were significantly higher in the ETD group (17.6) than in the control group (9.87) (p < 0.001). The results indicate a good to excellent correlation (> 0.7). The area under the curve for the total ETDQ score was 88.6% (95% confidence interval [CI]: 80.3-96.8%) Conclusion The Arabic version of the ETDQ-7 scale is a valid instrument for evaluating ETD. It can also be used as an important tool for diagnosis, patient follow-up, and treatment management.

Cross-Cultural Adaptation, Validation, and Arabic Translation of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7).

Introduction The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ-7) scale is used to assess the effectiveness of the treatment and to determine the severity of the eustachian tube dysfunction (ETD). There is currently no validated Arabic version of the ETDQ-7. Objectives The aim of the present study is to test the validity and the reliability of a translated Arabic version of the ETDQ-7. Methods A multicenter prospective validation study was conducted in Riyadh, Saudi Arabia. The ETDQ-7 was adapted and translated into Arabic using a standard validation methodology. Fifty-one patients diagnosed with Eustachian tube dysfunction and 45 healthy individuals were enrolled in the study. The known-groups method was used in the validity analysis. The test-retest method, item-total score correlation, and internal consistency analysis were used for the reliability analyses. Result The overall internal consistency of the Arabic ETDQ items was measured using Cronbach α (Cronbach α = 0.803). The average and total ETDQ scores were significantly higher in the ETD group (17.6) than in the control group (9.87) ( p < 0.001). The results indicate a good to excellent correlation (> 0.7). The area under the curve for the total ETDQ score was 88.6% (95% confidence interval [CI]: 80.3-96.8%) Conclusion The Arabic version of the ETDQ-7 scale is a valid instrument for evaluating ETD. It can also be used as an important tool for diagnosis, patient follow-up, and treatment management.

Assessment of the ability, perception, and readiness of nurses to manage tracheostomy-related complications in Riyadh City: a cross-sectional study.

BACKGROUND: Nursing staff play a key role in the bedside management of tracheostomized patients in both intensive care units and general floors. Effective provision of postoperative care to these patients by nurses is critical. This study aimed to assess the readiness of nursing staff to manage tracheostomy-related complications in Riyadh, Saudi Arabia. METHODS: This cross-sectional study enrolled 395 nurses in Riyadh, Saudi Arabia. A self-administered questionnaire developed by the authors was distributed to nurses via an online survey. The questionnaire assessed nurses' socio-demographic characteristics and their knowledge and practices regarding tracheostomy indications, postoperative care, and management of its complications. RESULTS: Of respondents, approximately 59% (232/395) had poor knowledge regarding tracheostomy-related complications and indications, 39% (154/395) had moderate knowledge, and only 2%(9/395) had good knowledge. Several factors were associated with increased knowledge, including having a higher education degree, working in a tertiary/quaternary hospital, being a government employee, caring for tracheostomized patients, and attending courses or lectures on managing tracheostomized patients. CONCLUSIONS: Knowledge level and practices regarding tracheostomy-related complications and indications among nurses remain limited. In-service continuous professional development programs for nurses working in all hospital settings are strongly recommended. Further research is warranted to elicit the major factors contributing to inadequate knowledge and practices among nurses in Riyadh.

Hyaline Fibromatosis Syndrome Presenting with Nasal Mass: A Case Report.

Hyaline fibromatosis syndrome (HFS) is a rare, autosomally-recesfvsive disease characterized by papulonodular skin lesions, soft tissue masses, joint contractures, gingival overgrowth, and osteolytic bone lesions. Mutations in capillary morphogenesis gene 2 are responsible for both these conditions. Generally, an autosomal recessive pattern is assumed to be the most common mode of inheritance. Here, we report an unusual case of a twenty-three-year-old female patient with HFS who reported with a chief complaint of growing nasal mass for three months. There was no history of pain or bleeding associated with the nasal mass. Due to the growing mass, she experienced right nasal obstruction, which compromised her quality of life. There was an unremarkable family history. Her physical examination revealed multiple asymptomatic pinkish-white papulonodular lesions located at multiple sites. Intra orally, she had generalized gingival enlargement. Her nasal examination revealed a right sided nasal mass, bright red in color. The lesion was soft on palpation. All the results of hematological and biochemical tests were normal. However, skeletal radiographic examination showed the joint contractures on her knees and elbows without the presence of osteolytic bone lesions. The nasal lesion was surgically excised and histopathological examination revealed features suggestive of HFS.

Emotional Intelligence and Burnout Among Otorhinolaryngology-Head and Neck Surgery Residents.

Background: Burnout syndrome is common among surgical residents, negatively affecting their mental health, physical wellbeing, and work performance. We investigated the relationship between emotional intelligence (EI) and burnout among Otorhinolaryngology-Head and Neck surgery residents. Methods: This cross-sectional study examined 51 residents across different Otorhinolaryngology-Head and Neck surgery programs at various hospitals in Saudi Arabia using a survey conducted between January 2021 and March 2021. The questionnaire had different validated measurements of burnout and included the Trait EI Questionnaire-Short Form, Maslach Burnout Inventory-Human Services survey, and questions regarding demographics and job satisfaction. Results: Of all the residents, 17.6% had a high risk of burnout, 39.2% had emotional exhaustion (EE), 29.4% had depersonalization (DP), and 43.1% had a low sense of personal accomplishment (PA). A statistically significant negative association was observed between the total EI score and EE (r = -0.577, p < 0.001) and DP (r = -0.765, p < 0.001), indicating that higher total EI scores were associated with lower EE levels. Conclusions: Positive associations existed between high levels of EI, PA, and satisfaction with both surgical skills and specialty choice. Therefore, residency programs should use EI modifiers as tools to reduce the risk of burnout.

Occupational and environmental exposures, the association with chronic sinusitis.

OBJECTIVES: To find the association between environmental and occupational exposures and chronic rhinosinusitis (CRS) development. METHODS: The Preferred Reporting Items Of Systematic Reviews Guidelines were used when a systematic literature review was conducted to find all published cases of CRS by searching PubMed database and Google Scholar. Published articles between 1989 and 2021 that reported chronic and occupational rhinosinusitis were included. However, articles that reported allergic rhinitis or upper airway diseases and non-English articles were excluded from this study. RESULTS: A total of 97 articles were extracted initially, and 15 articles were reviewed after excluding 82 articles that did not match our inclusion criteria. Most studies linked CRS development to smoke exposure (n=9734), followed by living in rural areas as farms (n=5504). Exposure to pesticides (n=4248) contributed to a higher prevalence of CRS. Blue-collar occupations, such as fire fighters, farmers, and fishermen were significantly related to CRS development in a total of 5260 patients. Chronic rhinosinusitis mainly affected more men (n=8912) than women (n=8076). CONCLUSION: We found that smoking was the most aggravating environmental factor. Chronic rhinosinusitis symptoms' severity increased with direct contact with allergens. Thus, the greatest proportion of patients with CRS was those with blue-collar occupations, such as firefighters, farmers, and fishermen.

Concha Bullosa of the Inferior Turbinate.

Inferior concha bullosa is a rare disease that has been related to sinonasal symptoms. This study aimed to determine the characteristics of concha bullosa in the inferior turbinate and assess its common clinical manifestations, computed tomography findings, and the surgical techniques used to treat the condition. We conducted a search of the PubMed database, using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis, for articles published until May 2021 using the following terms: "inferior turbinate and concha bullosa"; "inferior turbinate and pneumatization"; and in combination with other terms such as "concha bullosa release and concha bullosa excision", among others. We found 12 papers that met our inclusion criteria. The main presenting symptom was a nasal obstruction in 13 patients (100%), followed by headache in 10 patients (77%). The site of inferior concha bullosa was bilateral in six cases and left-sided in five cases. Computed tomography was conducted in all cases in this review. The type of intervention performed was medical, surgical, and both in 23%, 54%, and 23% of the cases. Despite multimodal surgical approaches and medical treatment, all the outcomes were good and no compactions were noted. All cases also had good prognoses.

Artificial intelligence in radiology: does it impact medical students preference for radiology as their future career?

OBJECTIVE: To test medical students' perceptions of the impact of artificial intelligence (AI) on radiology and the influence of these perceptions on their choice of radiology as a lifetime career. METHODS: A cross-sectional multicenter survey of medical students in Saudi Arabia was conducted in April 2019. RESULTS: Of the 476 respondents, 34 considered radiology their first specialty choice, 26 considered it their second choice, and 65 considered it their third choice. Only 31% believed that AI would replace radiologists in their lifetime, while 44.8% believed that AI would minimize the number of radiologists needed in the future. Approximately 50% believed they had a good understanding of AI; however, when knowledge of AI was tested using five questions, on average, only 22% of the questions were answered correctly. Among the respondents who ranked radiology as their first choice, 58.8% were anxious about the uncertain impact of AI on radiology. The number of respondents who ranked radiology as one of their top three choices increased by 14 when AI was not a consideration. Radiology conferences and the opinions of radiologists had the most influence on the respondents' preferences for radiology. CONCLUSION: The worry that AI might displace radiologists in the future had a negative influence on medical students' consideration of radiology as a career. Academic radiologists are encouraged to educate their students about AI and its potential impact when students are considering radiology as a lifetime career choice. ADVANCES IN KNOWLEDGE: Rapid advances of AI in radiology will certainly impact the specialty, the concern of AI impact on radiology had negative influence in our participants and investing in AI education and is highly recommended.

Medical Students' Awareness of Smell Loss as a Predictor for Coronavirus Disease 2019.

Background: Anosmia has been reported as an early presentation of coronavirus disease 2019 (COVID-19). However, the pathophysiological mechanism of olfactory dysfunction is still unclear. Aim: The aim of this study to evaluate the knowledge regarding common symptoms, anosmia, treatment options, and PPE among medical students in three different universities of Saudi Arabia. Methods: This cross-sectional survey conducted among medical students in Saudi Arabia. Google Forms was used to create the survey. The questionnaire included demographic information, knowledge of COVID-19 symptoms, sources of information, and the level of awareness of specific symptoms (loss of smell and taste). Results: A total of 494 students completed the questionnaire. The majority of the participants were aware of common COVID-19 symptoms like fever and cough (79.8 and 67.2%, respectively), but less than half were aware that smell or taste dysfunction might be a symptom of COVID-19 (44.3 and 30.2%, respectively). The present study revealed that the source of information also plays a critical role in medical students' awareness regarding the symptoms of COVID-19. Students using international organization's websites, medical databases, or published research had better knowledge of anosmia as a COVID-19 symptom compared to those who used WhatsApp, Google, or unofficial social media pages. In our study, a minority (11.9%) of the participants relied on unofficial social media pages as the main source of their information. Conclusion: Saudi medical students understand that smell or taste dysfunction can be a potential symptom of COVID-19, but this knowledge was not as widespread as the knowledge regarding the most common COVID-19 symptoms.

Work-Related Musculoskeletal Symptoms in Otorhinolaryngology-Head and Neck Surgery Residents.

OBJECTIVES: Work-related musculoskeletal disorders in Saudi Arabia are not often reported in the literature. This study aimed to identify musculoskeletal symptoms among otorhinolaryngology residents in Saudi Arabia. METHODS: This cross-sectional survey-based study was conducted in May 2018 and included residents registered in the Saudi Otorhinolaryngology-Head and Neck Surgery Board Training programme, Riyadh, Saudi Arabia. The Nordic Musculoskeletal Questionnaire was used to assess musculoskeletal symptoms in addition to demographic and occupational factors, including operating position and the average number of operating hours. RESULTS: A total of 45 residents (response rate: 68.2%) completed the survey, including 33 males (73.3%) and 12 females (26.7%). Most residents (91.1%) reported at least one musculoskeletal symptom. The most commonly reported musculoskeletal over the previous 12 months were shoulder complaints (64.4%) followed by neck complaints (60%). In the short term (i.e. within seven days preceding the survey), neck complaints were more common than shoulder complaints (28.9% versus 20%). Lower back complaints were the most common cause of activity limitation (24.4%) followed by shoulder complaints (13.3%), while those with neck complaints reported it as a cause for visiting a physician (8.9%). Hip and thigh complaints were significantly more frequent among residents with operation times of eight hours or more compared to those who operating for less than eight hours (42.9% versus 5.9%; P = 0.021). CONCLUSION: A high incidence of shoulder, neck and lower back complaints was found in this study. Residency is an ideal time in an otorhinolaryngologist's career to implement programmes in ergonomic best practices before bad habits are developed.

Stress, Burnout, and Associated Risk Factors in Medical Students.

Objectives To determine the prevalence of and the risk factors associated with burnout and stress for medical students in Saudi Arabia. Methods A cross-sectional, survey-based study was distributed between January and February 2018 among all 500 medical students from the first to fifth years in a medical college; 356 of the students responded (71.2% response rate). Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS) while the stress level was measured using the 12-item General Health Questionnaire (GHQ-12). Socio-demographics, professional characteristics, and participation in extracurricular activities were also included as possible predictors of burnout and stress. Results The study revealed that the stress level was (51.7%, n= 184) and the rate of high burnout was (38.2%, n= 136), expressing high exhaustion (77.8%, n=277), high cynicism (65.7%, n=234), and low academic efficiency (45.5%, n=162). Half of the students (50%, n=178) participated in extracurricular activities and were involved in one or more activities such as organizing activities and medical volunteering (n = 52, 14.6%), research (n = 59, 16.6%), and physical exercise (n = 71, 10.4%). There was a statistically significant positive correlation between overall burnout and a lower grade point average (GPA) (OR = 0.581, p 0.004, 95% CI = 0.400 to 0.843). A statistically significant positive correlation was found between stress and students with a lower GPA (OR = 0.737, P = 0.0.23, 95% CI = 0.566 to 0.959); stress was also higher in students who were not involved in any extracurricular activities (OR 1.893, P = 0.004, 95% CI = 1.22 to 2.918). Conclusion Our study shows high burnout rates among medical students. Low GPA students in this study showed a higher overall burnout. Stress was high in our study participants and was higher in students with a low GPA and in students who were not involved in any extracurricular activities.

Emotional Intelligence and Burnout in Plastic Surgery Residents: Is There a Relationship?

BACKGROUND: The specific role of emotional intelligence (EI) in the field of plastic surgery has not been investigated. We aim to investigate the relationship between EI and the individual components of burnout among plastic surgery residents in Saudi Arabia. METHODS: In this cross-sectional study, all plastic surgery residents (n = 37) in Riyadh, Saudi Arabia, were invited to participate in a questionnaire based study in March 2018. The survey contained a validated measure of burnout (Maslach Burnout Inventory-Human Services Survey), validated measure of EI (Trait Emotional Intelligence Questionnaire-Short Form), and evaluated residents' demographics, professional and personal risk factors, and career satisfaction. RESULTS: The overall rate of high burnout was 37.9%, with 72.4% residents reporting high level of emotional exhaustion (EE), 41% reporting high depersonalization (DP) and 41% reporting low sense of personal accomplishment (PA). EI has shown to have a significant negative relationship with EE (95% confidence interval CI, -9.061 to -1.374; P = 0.010), DP (95% CI, -5.747 to -1.974; P < 0.001), and a significant positive correlation with PA (95% CI, 1.398-5.439; P = 0.002). Significant risk factors for burnout included dissatisfaction with plastic surgery as a career choice, dissatisfaction with income, and dissatisfaction with the role in the operating room (P < 0.05). CONCLUSIONS: We found a positive correlation between higher levels of EI and sense of personal achievement, whereas a negative correlation was observed between higher level of EI and EE and DP among the residents in this study. Plastic surgery residents who are satisfied with their salary have lower EE and DP. Residents who are satisfied with their role in the operating room have a better sense of PA.

Outcomes of Early-stage Glottic Carcinoma Treated with Radiation Therapy: A Single Institution Experience.

OBJECTIVE:  To evaluate the outcomes of radical intent radiation therapy in early glottic carcinoma (EGC), including local control rate (LCR), disease-free survival (DFS), death specific free survival (DSFS), and overall survival (OS) rates, in Saudi patients treated at a single institution.  Materials and methods: This is an institutional review board (IRB) approved, retrospective study of 27 patients with T1-2 N0 M0, early glottic carcinoma (EGC) who were treated from 2010 to 2015 at our institution with different radiotherapy (RT) fractionation regimens. The regimens included six different fractionation schedules of radiotherapy (RT): 50 Gy (20 x 2.5 Gy) dose prescribed to 95% isodose line, 52.4 Gy (20 x 2.52 Gy), 63 Gy (28 x 2.25 Gy), 66 Gy (33 x 2 Gy), and 70 Gy (35 x 2 Gy). The cohort was stratified into two groups, ≤ 52.5 Gy (n=15) and > 52.5 Gy (n=12). The median follow-up of all patients was 31.7 months (range 7-82). RESULTS: The mean age of the cohort was 64.5 years (median 65, range: 41-83). Eleven patients (40.7%) had a history of smoking. The majority of the cohort was with T1a EGC (70.4%, n=19), and anterior commissure invasion was seen in three patients (11.1%). The mean RT doses were 55.6 Gy (range: 50-70). The five-year LCR, DFS, DSFS, and OS rates were 83.1%, 80.0%, 96.2%, and 92.6%, respectively. The LCR rates for those receiving a dose of 52.5 Gy or less were 61.3 months compared to 89.5 months for those who received more than 52.5 Gy (p=0.994). Non-smokers and patients with an unknown smoking history achieved a five-year LCR of 100%, while patients with a positive smoking history achieved a five-year LCR of 60.6% (p=0.044). CONCLUSION:  Radiation therapy for EGC in our patients showed reasonable five-year LCR with larynx preservation at 83.1%, DFS 80.0%, five-year OS rate 92.6%, and DSFS rate 96.2%. We found that smoking had a significant correlation with LCR. However, large prospective trials are warranted to evaluate the efficacy of overall treatment time, dose per fraction of above 2 Gy, and smoking effect.