Age-Specific Differences in Laryngotracheal Trauma Characteristics: A Retrospective Study of Clinical Profiles, Outcomes, and Mortality Risk.

Background: Laryngotracheal trauma is associated with a substantial risk of mortality. Age can be a critical factor in trauma management, as older adults often have diminished airway protective reflexes and preexisting respiratory conditions. Objective: This study aimed to characterize the clinical profiles and outcomes in different age groups of adult patients with laryngotracheal trauma using data from the National Trauma Data Bank (NTDB). Methods: We retrospectively analyzed the NTDB and included adult patients (aged ≥ 18 years) who had laryngotracheal fractures (closed or open) and were admitted directly after the injury. The patients were categorized into different age groups for analysis. A multivariate logistic regression analysis was performed to assess whether the elderly population (age ≥ 65 years) was predisposed to post-trauma death under care. Results: The study included 1171 patients, with the following age distributions: 13.7% aged 18-24 years, 21.6% aged 25-34 years, 55.2% aged 35-64 years, and 9.6% aged ≥ 65 years. Notable differences were observed in comorbidities, mechanisms, types of injuries, and associated injuries among age groups. There was no significant trend in airway surgical outcomes according to age. In-hospital mortality was highest among patients aged ≥ 65 years (22.3%), compared to 14.4% for those aged 18-24 years. Regression analysis indicated that age ≥ 65 was an independent mortality predictor. Conclusions: These findings underscore significant age-related differences in the presentation and outcomes of laryngotracheal trauma, emphasizing the need for age-specific treatment protocols, primarily to address the elevated risk among elderly patients.

Prevalence of Risk Factors of Chronic Rhinosinusitis With Nasal Polyps Among the Saudi Population.

Background The burden of chronic rhinosinusitis symptoms experienced by Saudi citizens is considered an important factor in getting an overall insight of the problem in the region, therefore our study aimed to determine the prevalence of risk factors of chronic rhinosinusitis with nasal polyps and correlate the risk factors with various sociodemographic parameters among Saudi population. Methods This study analyzed five-year cross-sectional data from 2017-2021. A total of 386 participants were enrolled and subsequently divided into four groups: aged 18-25 years, 26-35 years, 36-45 years, and > 45 years. A study was conducted utilizing non-probability sampling targeting a population of Saudi nationality living in selected regions of Saudi Arabia. Data was collected through an online questionnaire which had been distributed through social media and had been analyzed accordingly using a statistical package for social sciences. Results In this study, 272 (70.5%) participants were female and 114 (29.5%) were male. A total of 374 (96.9%) participants were Saudis while 12 (3.1%) were non-Saudis. Risk factors were compared by age and gender of study participants. Having polyps in the nose (p-value 0.016) and a family history of polyps (p-value 0.049) showed a significant association with the gender of study participants. The frequency of having nasal polyps was significantly higher among male participants, however, having a family history of nasal polyps was significantly higher among female participants. The educational status of study participants showed a significant association with the use of cortisone (p-value 0.032) and having a broken nose (p-value 0.032). Having a family history of nasal polyps showed a significant (p-value 0.017) association with the socioeconomic status of study participants. Conclusion Nasal polyps are more common in males than females, however, having a family history of nasal polyps was significantly higher among female participants.

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies.

BACKGROUND: The coronavirus disease (COVID-19) pandemic significantly disrupted surgical care worldwide, affecting different specialties in various ways. Lockdowns, surges in COVID-19 cases, and changes in hospital policies notably impacted patient attendance, management practices, and access to surgical services. This scoping review examines the adverse impacts of the COVID-19 pandemic on surgical services and the policies adopted to address these care barriers. METHODS: We conducted a comprehensive literature review using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Our search, spanning 31 December 2019, to 29 January 2023, focused on understanding the multifaceted impacts of COVID-19 on surgical services, particularly across different specialties. RESULTS: An analysis of 75 articles indicated that the pandemic challenged surgeons worldwide to maintain a balance between delivering emergency and elective surgical care, and implementing safety measures against viral transmission. There was a marked decline in the surgical volume, leading to extended waitlists and decreased operating theater usage. Strategies such as prioritizing medically necessary and time-sensitive surgeries and integrating telemedicine have emerged as pivotal for ensuring the continuity of urgent care. Despite the reduced rates, essential surgeries such as appendectomies and cancer-related operations continued, yet faced hurdles, including reduced staffing, limited operating theater capacity, and complications in patient transfers. CONCLUSIONS: This review emphasizes the steep reduction in surgical service utilization at the beginning of the pandemic and emergence of new compounded barriers. Policies that designated surgeries as essential, and focused on equitable and timely access, were effective. Incorporating these findings into post-pandemic assessments and future planning is crucial to sustain adequate surgical care during similar health emergencies.

Comprehensive Highlights of the Universal Efforts towards the Development of COVID-19 Vaccine.

The world has taken proactive measures to combat the pandemic since the coronavirus disease 2019 (COVID-19) outbreak, which was caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). These measures range from increasing the production of personal protective equipment (PPE) and highlighting the value of social distancing to the emergency use authorization (EUA) of therapeutic drugs or antibodies and their appropriate use; nonetheless, the disease is still spreading quickly and is ruining people's social lives, the economy, and public health. As a result, effective vaccines are critical for bringing the pandemic to an end and restoring normalcy in society. Several potential COVID-19 vaccines are now being researched, developed, tested, and reviewed. Since the end of June 2022, several vaccines have been provisionally approved, whereas others are about to be approved. In the upcoming years, a large number of new medications that are presently undergoing clinical testing are anticipated to hit the market. To illustrate the advantages and disadvantages of their technique, to emphasize the additives and delivery methods used in their creation, and to project potential future growth, this study explores these vaccines and the related research endeavors, including conventional and prospective approaches.

Plasma levels of BAFF and APRIL are elevated in patients with asthma in Saudi Arabia.

B-cell activation factor (BAFF) and a proliferation-inducing ligand (APRIL) are members of the tumor necrosis factor superfamily of cytokines and can induce B cell activation, differentiation, and antibody production via interaction with their receptors, including transmembrane activator, calcium modulator, and cyclophilin ligand interactor (TACI), B-cell maturation antigen (BCMA), and B-cell activating factor receptor (BAFF-R). Herein, we assessed the plasma protein levels of BAFF and APRIL in patients with asthma to determine whether their expression is correlated with total IgE production and examined the surface expression of BAFF/APRIL receptors on B cells. Blood samples were collected from 47 patients with controlled asthma symptoms and 20 healthy normal controls, and plasma levels of APRIL, BAFF, and total IgE protein were quantified by corresponding ELISA assays. Furthermore, lymphocytes were isolated and B cells were analyzed for the presence of BAFF-R, BCMA, and TACI receptors using flow cytometry. Our results showed that IgE, BAFF, and APRIL plasma levels were markedly increased in patients with asthma compared with healthy controls. Moreover, expression of BAFF-R and BCMA, but not that of TACI, was significantly increased in patients with asthma compared with healthy controls. Overall, the findings suggest BAFF and APRIL as key mediators of asthma, and determination of their plasma levels may be useful in monitoring asthma symptoms and treatment response.

SARS-CoV-2: An Overview of Virus Genetics, Transmission, and Immunopathogenesis.

The human population is currently facing the third and possibly the worst pandemic caused by human coronaviruses (CoVs). The virus was first reported in Wuhan, China, on 31 December 2019 and spread within a short time to almost all countries of the world. Genome analysis of the early virus isolates has revealed high similarity with SARS-CoV and hence the new virus was officially named SARS-CoV-2. Since CoVs have the largest genome among all RNA viruses, they can adapt to many point mutation and recombination events; particularly in the spike gene, which enable these viruses to rapidly change and evolve in nature. CoVs are known to cross the species boundaries by using different cellular receptors. Both animal reservoir and intermediate host for SARS-CoV-2 are still unresolved and necessitate further investigation. In the current review, different aspects of SARS-CoV-2 biology and pathogenicity are discussed, including virus genetics and evolution, spike protein and its role in evolution and adaptation to novel hosts, and virus transmission and persistence in nature. In addition, the immune response developed during SARS-CoV-2 infection is demonstrated with special reference to the interplay between immune cells and their role in disease progression. We believe that the SARS-CoV-2 outbreak will not be the last and spillover of CoVs from bats will continue. Therefore, establishing intervention approaches to reduce the likelihood of future CoVs spillover from natural reservoirs is a priority.

Traumatic Frontal Sinus Fractures Management: Experience from High-Trauma Centre.

OBJECTIVE: Analysis of our traumatic brain injury data, reviewing current literatures and assessing planning valuable decision making in frontal sinus fracture for young neurosurgeons. METHODS: Hospital data base for head trauma was retrieved after board permission for retrospective analysis of cases admitted from 2010-2020. Patients with frontal sinus fractures and head trauma were identified according to a flow chart. Variables of the study included patients' demographics, mechanism of injury, incidence of cerebrospinal fluid (CSF) leakage, types of associated injuries, imaging findings and operative techniques. RESULTS: Three-hundred eighty two patients were eligible to be screened in our study and represented the sample size under investigations in the following sections, 206 (53.9%) of patients were treated conservatively while 176 patients (46.1%) were identified as having an indication for surgical intervention. Eighty-four percent of patients were males. The mean age was 36.2±9.4 years (14-86 years). Depressed skull fracture was commonly associated injury (17.61%). Leakage of CSF was found in 32.95% of patients. CONCLUSION: Frontal sinus fracture is not an easy scenario. It harbors many proportions and deliver many varieties in which, deep understanding of anatomy, naso-frontal outflow tract status, CSF leakage and neurological injury are of important points in decision. Our institutional algorithm provide rapid, accessible and applicable treatment protocol for resident and young neurosurgeons which minimizes consultations of other specialties.

Middle East Respiratory Syndrome - What Every Otolaryngologist Should Know: A Review.

In this study, we illustrate the history of Middle East respiratory syndrome corona virus (MERS-CoV) infection from the first reported case to the disease's outbreak and subsequent worldwide decline, with the aim of briefly defining the problem for the benefit of otolaryngologists. MERS-CoV belongs to the Coronaviridae family and causes a zoonotic disease, MERS, with strong camel to human and weak human to human transmission. The first documented case of MERS was reported in Saudi Arabia in June 2012. Viral replication produces inflammatory markers targeting T lymphocytes, with apoptosis being the end result. Nevertheless, the pathogenesis of this virus is not yet fully understood. The main symptomatic appearance is of mild lower respiratory tract infection with dyspnea and persistent cough in addition to systemic manifestations. The diagnosis is mainly based on the use of polymerase chain reaction for the detection of viral ribonucleic acid in the sputum or tracheal fluids. Otolaryngologic treatment mainly involves supportive adjuvant usage of interferon or antiviral drugs; however, approximately one-third of patients may not survive, and, therefore, otolaryngologists should be familiar with and remain mindful of the disease.