Ameen Z. Alherabi

Is Suction Drainage an Effective Means of Preventing Hematoma in Thyroid Surgery? A Meta-Analysis

OBJECTIVE To evaluate the efficacy of suction drainage in preventing postoperative hematoma formation in thyroid surgery. METHODS We conducted a meta-analysis using only randomized controlled trials in which the incidence of post-thyroidectomy hematoma was compared directly in patients with and without suction drains (eight studies since 1980; N = 944). The odds ratio (OR) with respective confidence intervals (CIs) using the fixed effects model was reported. We used an OR < 1.0 as being in favour of treatment (ie, the use of suction drains). RESULTS In our meta-analysis, there was no statistically significant difference between the rates of post-thyroidectomy hematoma whether or not suction drains were used when the results were combined using a fixed effects model (OR 1.04, 95% CI-1.93), with p = .90. In this comparison, a fixed effects model was used rather than a random effects model because there was no statistically significant heterogeneity (chi2 = 6.26, p = .28). CONCLUSIONS We conclude that the use of suction drains in thyroid surgery to prevent postoperative hematoma is not evidence based.

A case of Lemierre syndrome

emierre syndrome, also known as postanginal septicemia or necrobacillosis was first reporteeed in 1890 by Courmont and Cade, although Lemierre, a French physician and professor of microbieology best described the syndrome in 1936 in a review of 20 cases that was published in the Lancet.

Development and testing for an operative competency assessment tool for nasal septoplasty surgery.

Background Assessing surgical competency in otolaryngology is challenging, and residency programs are now responsible for ensuring the surgical competency of their graduates. Therefore, more objective assessment tools are being incorporated into the evaluation process. Objective structured assessment of technical skills (OSATSs) tools have been developed for multiple otolaryngology procedures. These include tonsillectomy, endoscopic sinus surgery, thyroidectomy, mastoidectomy, direct laryngoscopy, and rigid bronchoscopy. The purpose of this study was to develop and test a new assessment tool for septoplasty surgery and ensuring its feasibility, reliability, and construct validity. This study was designed develop an test a valid, reliable, and feasible evaluation tool designed to measure the development of trainees’ surgical skills in the operating room for septoplasty surgery. Methods A new OSATSs-based instrument form for septoplasty was developed. During the study period of 2 years, 21 otolaryngology–head and neck surgery residents (ranging from postgraduate year 2 to 5) were evaluated intraoperatively by on faculty member obtaining al of 175 evaluations. Surgical performance was rated using a seven-item task-specific checklist (TSC) and a global rating scale (GRS). The TSC assessed specific septoplasty technical skills, and the GRS assessed the overall surgical performance. Results Our tool showed construct validity for both components of the assessment instrument, with increasing mean scores with advancing clinical levels. Cronbachs α, a measure of internal consistency, was 0.911 for TSC and 0.898 for GRS. Strong correlation between the TSC and GRS was established (r = 0.955; p < 0.01). Conclusion This study proved our educational tool to be a valid, reliable, and feasible method for assessing competency in septoplasty surgery. It can be integrated into surgical training programs to facilitate direct formative feedback. Assessing trainees’ learning curves enables insight into their progression, ensuring their appropriate development.

Desmoid tumor (fibromatosis) of the head and neck

Desmoid tumors (fibromatosis) are rare benign tumors, they arise from musculoaponeurotic structures throughout the body. They are locally infiltrative, resulting in a high rate of local recurrence following surgical resection. Due to the rarity of these tumors in the head and neck region, we report a case of a patient with a desmoid tumor in the upper neck that was diagnosed and treated in our institution, to increase the awareness of the Otolaryngology-Head and Neck surgeons, and report available treatment options of this condition.

Acute rhinosinusitis during Hajj season 2014: Prevalence of bacterial infection and patterns of antimicrobial susceptibility

BACKGROUND The presence of large number of pilgrims during Hajj in Makkah region increases the risk of respiratory diseases. In this study, we aimed to assess the bacteriology of acute rhinosinusitis (ARS) during Hajj season and to demonstrate the antimicrobial susceptibility patterns that should guide the clinicians towards more appropriate antibiotic use. METHODS Patients with ARS presenting during Hajj season of 2014 were prospectively enrolled. According to EPOS2012 criteria. Sampling of sinus secretions was performed from the middle meatus adjacent to the maxillary sinus ostium via endoscopic guidance. Over all, the study has covered all ENT, emergency and outpatient departments in Hajj. RESULTS Two hundred and twenty six patients with ARS were enrolled in the study. Pathogenic bacteria were identified in 93 (41.2%) patients. Of the 93 patients with bacterial ARS, Staphylococcus aureus was isolated in 46 (49.5%) patients, out of which 13 (28.3%) were methicillin-resistant Staphylococcus aureus (MRSA).The second most common group of bacterial isolates was Enterobacteriaceae such as Escherichia coli, and various Klebsiella species. Antibiotic sensitivity showed that methicillin-sensitive Staphylococcus aureus (MSSA) was also sensitive to cephalosporins, quinolones and clindamycin, while exhibiting relatively less sensitivity rates to amoxicillin-clavulinic acid and macrolides. CONCLUSION Our study demonstrates the importance of assessing the bacteriology of ARS to help implement guidelines for proper treatment and prevention protocols during Hajj season.

Percutaneous ultrasound-guided alcohol ablation of solitary parathyroid adenoma in a patient with primary hyperparathyroidism.

Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a single parathyroid adenoma, which represents the most common cause of chronic hypercalcemia. However, in few cases, surgery may be technically difficult or risky. We report the use of percutaneous ultrasound-guided alcohol ablation of a parathyroid adenoma as an alternative to surgery in an 88-year-old male patient with significant medical comorbidities.

POTENTIAL RISK OF STREPTOCOCCUS PNEUMONIAE IN NASOPHARYNGEAL CARRIAGE DURING UMRAH AND HAJJ SEASONS IN MAKKAH, SAUDI ARABIA.

A cross sectional prospective study was carried out over a period of one year from (April 2008-March 2009 ), depending on prestructured questionnaire, study was carried out on a total of two hundred patients with different age, sex and with clinically suspected cases with tinea capitis and corporis. Specimens were obtained from skin scales of the lesion. Hair specimens were collected by plucking the hair with forceps. The aim of this study to identify the etiological agents involved in these infections. Out of 200 patients who presented with suspected superficial fungal and to determine prevalence of tinea capitis and tinea corporis in Benghazi population. Infected, 113 (56.5%) were male and 87 (43.5%) were female. Out of these, 117 children (65 male and 52 female) were provisionally diagnosed with tinea capitis and corporis. The youngest patient was a 5 months old infant, whereas the eldest patient a 71 year old man. Greater number of positive cases of dermatophytes is seen in children under the age of 15 year. Tinea capitis was predominant in 31 (57.4%) children, while tinea corporis were (14.8%) children. 125 (62.5%), were found to be positive by direct microscopic examination only, while 50 (25%) by culture only and 45 (22.5%) positive by both techniques. In addition 36 (18%) patients give positive family history of dermatophytosis, 9 patients of them were positive culture while 55 (27.5%) patients had history of contact with animals 16 of them were positive culture. Also17 (8.5%) were foreign patients, of these 8 were soudanense. In this study, the most common sites where dermatophytes in Tinea corporis isolated were the neck and back. Also we observed that, T. violaceum was the most common dermatophyte isolated 13 (24%) (mainly among children under age of 15 years). T. soudanense 9 (16%) was the second common isolated, followed by T. schoenleinii 8 (14.8%), other dermatophytes in descending order, were M. canis 5 (9.3%), T. mentagrophytes 4 (7.4%), M. ferrugineum 3 (5.5%), T. rubrum 3 (5.5%), T. tonsurans 2 (3.7%), M. nanum 2 (3.7%), T. yaoundi 1 (1.8%), T. terrestre 1 (1.8%), T. verrucosum 1 (1.8%), M. audouinii 1 (1.8%) and 1 (1.8%) were unidentified. Culture the isolates were a mixed of dermatophytes, in 2 cases of tinea capitis the culture revealed in mixed of T. violaceum and T. mentagrophytes, while 2 cases of tinea corporis; T. tonsurans and T. schoenleinii where the culture revealed a growth of T. rubrum and M. nanum. The infection was found to occur more frequently in males (29 cases than in females (25 cases). In the present study, grey patch was the predominant type of tinea capitis 32 (16%), black dot 2 (1%) and kerion 2 (1%) was the least common types.W investigated the anti-influenza virus activity of Acacia nilotica and possible mechanisms of action in vitro. We found that Acacia nilotica has anti-influenza-virus activity and both pre-incubation of virus prior to infection and post-exposure of infected cells with Acacia nilotica extract significantly inhibited virus yields. Influenza-virus-induced hemagglutination of chicken red blood cells was inhibited by Acacia extract treatment, suggesting that Acacia can inhibit influenza A virus infection by interacting with the viral hemagglutinin. Furthermore, Acacia extract significantly affect nuclear transport of viral nucleoprotein (NP). To best of our knowledge, this study revealed for the first time that Acacia nilotica extract can inhibit both viral attachment and replication and offers new insights into its underlying mechanisms of antiviral action. The fruit husk of Acacia nilotica collected from Sudan and extracted with 70% methanol. The crude extract was screened for its cytotoxicity against MDCK cell line by alamarBlue assay and WST-1 assay. Antiviral properties of the plant extract were determined by cytopathic effect inhibition assay and virus yield reduction assay (plaque assay). Time of addition assay and nuclear export mechanism were also performed.

Follicular thyroid carcinoma within a thyroglossal duct cyst in adult

Thyroglossal duct cyst carcinoma is a rare malignancy, with an incidence of 0.7% to 1.6%. Most cases of thyroglossal duct cyst carcinoma are papillary carcinoma, with follicular carcinoma having been rarely reported. In this study, a 33-year-old man presented with a typical thyroglossal duct cyst and underwent surgical resection of the cyst, which was determined to be follicular carcinoma. We have reported this rare case to increase the awareness of such entities within the general otolaryngology and the community of head and neck surgeons, as well as among endocrine surgeons.

Endoscopic anatomy of the lacrimal sac for dacryocystorhinostomy. A cadaveric study

Objectives: To assist the endoscopic localization of the lacrimal sac (LS) relative to nearby landmarks. Methods: This is a descriptive prospective anatomical study. Sixteen lateral nasal walls were dissected endoscopically to identify and localize the LS between October and November 2015. Multiple measurements were obtained from the NS to the anterior and posterior walls of the LS, as well as to the middle turbinate axilla (MTA) and from the MTA to the LS borders. Results: The average distance from the NS to the anterior border of the LS was 42.0 mm and the posterior border was 48.5 mm. The average widths of the LS were 7.55 mm superiorly, and 6.6 mm inferiorly representing a mathematical proof that the LS is a trapezoid shape. The mean distance from the NS to the MTA was 47.3 mm. Nine of the 16 lacrimal sacs (56.3%) were found to be partially overlapped by the MTA. The LS was only totally overlapped and lying posterior to the MTA in one side (6.3%), while in 6 sides (37.5%) the LS lay anterior to the MTA. Conclusion: Endoscopic surgeons should be aware of the location of the LS relative to nearby landmarks, particularly the MTA. Representing a mathematical proof that the LS is wider at it upper part than lower part best presented as a trapezoid shape. We have provided additional measurements that may prove useful in cases of difficult exposure.

Bilateral combined laryngocele

Laryngocele is an uncommon condition that represents a benign dilatation of the laryngeal saccule with air and/or fluid, arising in the region of the laryngeal ventricle. Laryngoceles, or laryngomucocele can be classified as internal, or combined. The aim of presenting this rare case of a bilateral combined laryngocele, are to emphasize the importance of diagnostic laryngoscopy in upper airway pathologies evaluation, increase awareness in the general otolaryngologist community, and to highlight the external surgical method.