Chest Trauma Experience: Incidence, associated factors, and outcomes among patients in Saudi Arabia.

BACKGROUND AND OBJECTIVE: Worldwide chest trauma is considered one of the leading causes of morbidity and mortality. There is a lack of sufficient information on the etiology, pattern, and management of these injuries in Saudi Arabia. Therefore, the current study was conducted to determine the spectrum of chest trauma and its associated factors among patients admitted to King Khalid University Hospital, Riyadh, Saudi Arabia. METHODS: A quantitative observational cross-sectional analysis was performed, data obtained from the medical records of the chest trauma patients which were admitted in the thoracic surgery unit, King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia from January 2013 to Jan 2019. The records of all these patients were reviewed and data were collected and analyzed prospectively. RESULTS: A total of 236 patients (male: 87.3%; mean age: 32.4 years) were included in the analyses. The majority of these chest trauma cases (n=205; 86.9%) were caused by road traffic accidents (RTA). Blunt trauma predominated the cases n=225 (95.3%). Ribs fracture had the highest prevalence among the chest injuries with a number of 150 (63.5%) followed by lung contusion 140 (59.3%). Pneumothorax occurred in 131 (55.5%) and hemothorax occurred in 80 (33.8%) with most common indication for emergency thoracotomy. Extra-thoracic injuries involving the head/brain, limbs, and abdominal organs occurred in 189 (80%). 130 (55%) were intubated and ventilated, and almost half of the patients 115 (48.7%) were required a chest tube insertion. CONCLUSIONS: Chest trauma is a major health issue particularly in young male adults and road traffic accidents are the leading cause of chest trauma in Saudi Arabia. Early recognition of the patterns, etiology and appropriate management of trauma reduce the incidence of chest trauma related injuries.

Progress and prospects of medical education research in Asian Countries.

BACKGROUND AND OBJECTIVES: Medical education has a profound impact on health care system. Progress in achieving medical education research goals varies over time and across countries. This study aimed to investigate the medical education research ambience in Asia during the period 1965-2015. METHODS: We investigated the bibliometric indicators of 49 Asian states in medical education research from 1965-2015. The data about Asian countries, their per capita GDP, expenditure on R&D, universities and indexed scientific journals were collected. We recorded medical education related research documents published in Institute of Scientific Information (ISI) Web of Science, Thomson Reuters during the period 1965-2015. RESULTS: Asian countries collectively published 12721799 research articles, among them 40628 (0.31%) publications were in medical education. China contributed total of 3351565 articles among which 5414 (0.16%) research articles were in medical education; India added 1328725 papers with 4563 (0.34%) in medical education; Japan produced 3080257 papers with 4199 (0.13%) in medical education; Israel 561531 with 3848 (0.68%) in medical education; and lastly, Georgia contributed a total of 296532 research articles with 2565 (0.86%) in medical education. CONCLUSIONS: In Asia, the top five countries in medical education research are China, Georgia, Israel, Japan and India. The countries at low ranking are Yemen, Palestine, Myanmar, Kazakhstan, Syria and Armenia. In Asian states, the overall performance in medical science research needs policies to enhance its impact globally. Medical universities should offer research programs for learning and understanding the challengeable issues in medical education research.

Antibiotics use and misuse in upper respiratory tract infection patients: Knowledge, attitude and practice analysis in University Hospital, Saudi Arabia.

OBJECTIVE: To assess the awareness and causes of antibiotics use and misuse in patients with upper respiratory tract infections. METHODS: This cross-sectional study was conducted at King Saud University, Riyadh, Saudi Arabia, from January 2014 to December 2015, and comprised patients suffering from upper respiratory tract infections. A well-established, self-administrated questionnaire was randomly distributed to the patients. The questionnaire consisted of 3 parts: demographic variables, knowledge, and beliefs, and behaviour towards antibiotic use and misuse. SPSS 21 was used for data analysis. RESULTS: Of the 400 participants, 193(48.25%) were males and 207(51.75%) were females. Besides, 182(45.5%) participants used antibiotics without prescription (p=0.050) and 43(10.8%) used the mover a pharmacist's advice (p=0.030). Also, 69(17.3%) participants forced the physicians to prescribe antibiotic (p=0.014), and 207(51.7%) patients stopped taking antibiotics when they felt better (p=0.007). Moreover, 180(45%) had the antibiotic stocks at home in case of emergencies. In addition, 67(16.8%) were ignoring the instructions when taking antibiotics (p=0.004). Furthermore, 48(12%) participants denied that an antibiotic could cause an allergic reaction (p=0.054) and the same number of participants believed that the effectiveness of the treatment would not be affected if a full course of antibiotic was not completed (p=0.029). In addition, 29(7.3%) participants with high educational level believed that all antibiotics did not have side-effects (p=0.002) and 71(17.8%) of them believed that if symptoms were improving the antibiotic course could be interrupted without completing (p=0.037). CONCLUSIONS: Misconceptions existed about the use and indications of antibiotics.

Clinical psychomotor skills among left and right handed medical students: are the left-handed medical students left out?

BACKGROUND: There is a growing perception that the left handed (LH) medical students are facing difficulties while performing the clinical tasks that involve psychomotor skill, although the evidence is very limited and diverse. The present study aimed to evaluate the clinical psychomotor skills among Right-handed (RH) and left-handed (LH) medical students. METHODS: For this study, 54 (27 left handed and 27 right handed) first year medical students were selected. They were trained for different clinical psychomotor skills including suturing, laparoscopy, intravenous cannulation and urinary catheterization under the supervision of certified instructors. All students were evaluated for psychomotor skills by different instructors. The comparative performance of the students was measured by using a global rating scale, each selected criteria was allotted 5-points score with the total score of 25. RESULTS: There were no significant differences in the performance of psychomotor skills among LH and RH medical students. The global rating score obtained by medical students in suturing techniques was: LH 15.89 ± 2.88, RH 16.15 ± 2.75 (p = 0.737), cannulation techniques LH 20.44 ± 2.81, RH 20.70 ± 2.56 (p = 0.725), urinary catheterization LH 4.33 ± 0.96 RH 4.11 ± 1.05 (p = 0.421). For laparoscopic skills total peg transfer time was shorter among LH medical students compared to RH medical students (LH 129.85 ± 80.87 s vs RH 135.52 ± 104.81 s) (p = 0.825). However, both RH and LH students completed their procedure within the stipulated time. CONCLUSIONS: Among LH and RH medical students no significant difference was observed in performing the common surgical psychomotor skills. Surgical skills for LH or RH might not be a result of innate dexterity but rather the academic environment in which they are trained and assessed. Early laterality-related mentoring in medical schools as well as during the clinical residency might reduce the inconveniences faced by the left-handed medical personnel.

Interosseous ganglion cyst of the ribs with unusual presentation of hemoptysis.

An interosseous ganglion cyst is a very rare entity, found mostly in skeletally mature patients, particularly in long bones such as the tibia and femur. However, we are the first to report here an unusual case of interosseous ganglion cyst of the upper ribs in a young female patient, which she had an unpredicted presentation of cough and hemoptysis and a large painful lump over the anterior left upper chest. The radiological and pathological workup confirmed the presence of a benign interosseous ganglion cyst arising from the left first rib, invading the second rib and the apex of the left lung. The patient has been treated successfully by surgical resection of this rib cyst. However, we could not find any reported cases in the current literature of an interosseous ganglion cyst pathology arising in the ribs with a similar presentation of cough and hemoptysis.

Role of artificial intelligence (Google bard) in morphological, histopathological, and radiological image identifications: Objective Structured Practical Examination (OSPE) type-based performance.

OBJECTIVES: To evaluate the role of artificial intelligence (Google Bard) in figures, scans, and image identifications and interpretations in medical education and healthcare sciences through an Objective Structured Practical Examination (OSPE) type of performance. METHODS: The OSPE type of question bank was created with a pool of medical sciences figures, scans, and images. For assessment, 60 figures, scans and images were selected and entered into the given area of the Google Bard to evaluate the knowledge level. RESULTS: The marks obtained by Google Bard in brain structures, morphological and radiological images 7/10 (70%); bone structures, radiological images 9/10 (90%); liver structure and morphological, pathological images 4/10 (40%); kidneys structure and morphological images 2/7 (28.57%); neuro-radiological images 4/7 (57.14%); and endocrine glands including the thyroid, pancreas, breast morphological and radiological images 8/16 (50%). The overall total marks obtained by Google Bard in various OSPE figures, scans, and image identification questions were 34/60 (56.7%). CONCLUSION: Google Bard scored satisfactorily in morphological, histopathological, and radiological image identifications and their interpretations. Google Bard may assist medical students, faculty in medical education and physicians in healthcare settings.

Immune response after systematic lymph node dissection in lung cancer surgery: changes of interleukin-6 level in serum, pleural lavage fluid, and lung supernatant in a dog model.

BACKGROUND: Systematic nodal dissection (SND) is regarded as a core component of lung cancer surgery. However, there has been a concern on the increased morbidity associated with SND. This study was performed to investigate whether or not SND induces significant immune response. METHODS: Sixteen dogs were divided into two groups; group 1 (n = 8) underwent thoracotomy only, and group 2 (n = 8) underwent SND after thoracotomy. We compared interleukin-6 (IL-6) levels in serum, pleural lavage fluid and lung supernatant at the time of thoracotomy (T0) and at 2 h(T1) after thoracotomy (group 1) or SND (group 2). Severity of inflammation and IL-6 expression in lung tissue were evaluated in a semi-quantitative manner. RESULTS: The operative results were comparable. IL-6 was not detected in serum in either group. IL-6 in pleural lavage fluid marginally increased from 4.75 ± 3.74 pg/mL at T0 to 19.75 ± 8.67 pg/mL at T1 in group 1 (P = 0.112), and from 7.75 ± 5.35 pg/mL to 17.72 ± 8.58 pg/mL in group 2 (P = 0.068). IL-6 in lung supernatant increased from 0.36 ± 0.14 pg/mL/mg to 1.15 ± 0.17 pg/mL/mg in group 1 (P = 0.003), and from 0.25 ± 0.08 pg/mL/mg to 0.82 ± 0.17 pg/mL/mg in group 2 (P = 0.001). However, the degree of increase in IL-6 in pleural lavage fluid and lung supernatant were not different between two groups (P = 0.421 and P = 0.448). There was no difference in severity of inflammation and IL-6 expression between groups. CONCLUSIONS: SND did not increase IL-6 in pleural lavage fluid and lung supernatant. This result suggests that SND could be routinely performed in lung cancer surgery without increasing the significant inflammatory response.

Repair of coronary sinus shear stress injury following blunt chest trauma using adenosine-induced asystole.

Blunt chest trauma following a motor vehicle accident is the leading cause of non-penetrating cardiac injuries. Major structural heart injuries are fatal due to acute tamponade. We present the case of a 17-year-old male who was involved in a motor vehicle accident. He had an isolated coronary sinus rupture, which was successfully repaired. We propose a potential mechanism implicated in this rare injury, and we summarize a novel repair technique with adenosine-induced transient asystole.

Ultrasound gel-nerve contact: an experimental animal histologic study.

BACKGROUND: Ultrasound (US) regional nerve block requires the use of gel applied over the skin. With subsequent needle insertion, some of the gel may adhere either on the shaft or within the needle lumen and may be carried to the perineural structures or intraneurally. We performed this experimental animal study to investigate the effects of US gel contact on the nerve histologic structure. METHODS: Nine male beagle dogs were studied. Dogs 1 to 3 were the control group and dogs 4 to 9 were the study group. Bilateral posterior tibial nerves were dissected and exposed for the control group. Nerve specimens were obtained for histologic examination immediately for the first dog, at 24 hours for the second dog, and at 48 hours for the third dog followed by wound closure. For the study group, bilateral posterior tibial nerves were exposed, and 2 mL US gel was applied locally directly on the nerve, followed by wound closure. Nerve specimens were excised at 24 hours from one side and at 48 hours from the other side. Nerve specimens were examined by a neuropathologist for evidence of nerve inflammation. RESULTS: The control nerve specimens showed no significant pathology. Nerve specimens of the study group at the end of 24 hours of gel-nerve contact showed mild focal perineural inflammatory changes with clusters of polymorph leukocytes. At 48 hours, perineural moderate inflammatory changes with clusters of lymphocytes and macrophages were demonstrated in 2 animals. Long-term neurologic deficit in the form of limping was observed for all dogs. CONCLUSION: Histologic features after perineural exposure to US gel are rather nonspecific and likely of no clinical significance. However, further studies are needed to determine the effect of US gel injection on intraneural tissues.

Complications and Risk Factors of Patients Undergoing Computed Tomography-Guided Core Needle Lung Biopsy: A Single-Center Experience.

Objectives To determine the risk factors and complications of transthoracic computed tomography (CT)-guided core needle lung biopsy. Methods This is a retrospective study of 124 patients who underwent CT-guided core lung biopsy in King Khalid University Hospital (KKUH), Riyadh. This retrospective study was conducted between January 2016 and January 2020. Patient data were collected using a standardized data form that was entered into an Excel sheet in accordance with the variables. The Statistical Package for the Social Sciences software (SPSS, version 24.0 [SPSS Inc., Chicago, IL, USA]) was used to compute for the risk of complications after CT-guided core lung biopsy and perform all statistical comparisons, and the results were reported. Results The overall complication rate due to CT-guided core needle biopsy was 34.7% (43) (P<0.001) of the total sample. Of the total complications, 69.76% (n = 30) had pneumothorax, 20.94% (n = 9) had hemorrhage, 6.98% (n = 3) had both pneumothorax and hemorrhage, and 2.32% (n = 1) had both air embolism and pneumothorax. Of all patients who developed pneumothorax, 20% (n = 6) required chest tube insertion. Patients with secondary chronic obstructive pulmonary disease (COPD) had a complication rate of 80% among the whole sample. Lung lesions less than 3 cm had a complication rate of 48.8% (P<0.034). The needle size showed a higher rate of complications between 20 and 18 gauge with 47.4% (n = 9) and 32.4% (n = 34), respectively. Conclusions We conclude that CT-guided lung biopsy is a well-established low-risk procedure that is less invasive. However, it still carries a risk of complications with some risk factors, such as small lung lesion size and secondary COPD.

The effect of low versus high tidal volume ventilation on inflammatory markers in animal model undergoing lung ventilation: A prospective study.

BACKGROUND AND AIMS: Mechanical ventilation (MV) with high tidal volume (Vt.) may induce or aggravate lung injury in critically ill patients. It might also cause an overwhelming systemic inflammation leading to acute lung injury (ALI), diffuse alveolar damage (DAD) and multiple organ failure (MOF) with subsequent high mortality. The objective of this study was to compare the effects of different Vt. on the inflammatory markers of the broncho-alveolar lavage (BAL) fluid and lung biopsy in a group of animal model (Beagle dogs). METHODS: A two-phased prospective study involving 30 Beagle dogs (15 dogs/phase), each phase divided into three groups (each 5 dogs/group). In the first phase each group received MV with Vt. of 8 (low), 10 (normal, control group), and 12 (high) ml/kg body weight (b.w.) respectively. BAL fluid was obtained at the time of induction of anesthesia immediately following tracheal intubation and one hour later following MV to count the macrophages, neutrophils and lymphocytes. In the second phase of the experiment, in addition to obtaining (BAL) fluid similar to the phase one, mini thoracotomy and lung biopsy obtained from the upper lobe of the right lung at same timings for histopathological examination study. Mann-Whitney-Wilcoxon test was used for statistical analysis of the data obtained. RESULTS: BAL fluid analysis showed increase in the counts of macrophages and lymphocytes with Vt. of 12 ml/kg b.w. compared to the control group (10 ml/kg b.w.) (P < 0.05). in the second phase, similar findings obtained. The histopathological study of the lung tissue obtained in the second phase of the study from the group that received a high Vt. of 12 ml/kg b.w. showed significant inflammatory changes with presence of neutrophil infiltration and edema in the bronchial wall compared to the control group (10 ml/kg b.w.) (P < 0.05). CONCLUSIONS: The use of high Vt. in ventilated animal lung model may increase the risk of inflammation and subsequent damage in healthy lungs, these findings may help physicians to avoid using high Vt. in short-term mechanically ventilated patients in the operating room setting.

Reconstruction of an anterior chest wall defect in a child using a latissimus dorsi muscle-thoraco-lumbar fascia composite flap - A case report.

INTRODUCTION: Reconstruction of chest wall defects in children poses a challenge because the use of hard implants will impair chest wall growth. In this report, we demonstrate the reconstruction of a chest wall defect in a pediatric patient with an innovative technique using the latissimus dorsi muscle-thoraco-lumbar fascia composite flap. CASE REPORT: A 5-year old boy presented to the clinic with a congenital anterior right chest wall defect. Reconstruction was done using this composite flap. Drill holes were made in the sternum and remaining ribs at the edges of the chest wall defect. The muscle-fascia composite flap was then sutured over the defect using polypropylene sutures anchored to these drill holes. There were no post-operative complications. At final follow-up 11 years later, the chest wall depression was still present but to a lesser degree when compared to the pre-operative depression. There was no bulging of the lung through the defect. DISCUSSION: The composite flap technique was compared to other options of chest wall reconstruction in children. CONCLUSIONS: Congenital anterior chest wall defects that are not associated with breathing problems may be reconstructed in early childhood with a pedicled latissimus dorsi muscle-thoraco-lumbar fascia composite flap. The flap is rigid enough to prevent bulging of the lung though the defect and hence, it provides an adequate reconstruction. However, the remaining chest wall depression and further chest wall rigidity requires a second operation after puberty.

Comparison of the Outcomes Between Bilateral Thoracoscopic Maximal Thymectomy Versus Trans-Sternal Maximal Thymectomy for Non-Thyomomatous Myasthenia Gravis Patients: A Local University Hospital Experience.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune disease characterized by excessive and intense weakness of both respiratory and skeletal muscles. Management of MG involves both medical and surgical treatment. The surgical management includes resection of the thymus gland by many approaches, either bilateral thoracoscopic maximal thymectomy (BTT) or trans-sternal maximal thymectomy (TS). We hypothesized that bilateral thoracoscopic maximal thymectomy is as effective as trans-sternal maximal thymectomy to treat and control the disease. OBJECTIVE: This study aimed to compare the two approaches (BTT and TS) and determine which is better in terms of outcomes. METHODOLOGY:  A retrospective cohort study was conducted among 50 myasthenia gravies patients; 30 patients underwent bilateral thoracoscopic maximal thymectomy (BTT) and 20 were operated by trans-sternal maximal thymectomy (TS). The study was conducted at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, between 2007 and 2017. RESULT: The mean age of the MG patients was 32.6 years, ranging from 14 to 75. Thirty-four (68%) patients were females, and 16 (32%) were males. The BTT showed less operation time (P<0.0001) and less intubation time (anesthesia time), which was statistically significant (P<0.0001). Hospital stay and ICU stay were both reported to be less in BTT (4.03 and 0.37, respectively) with p-values of 0.006 and 0.0001, respectively. There was no significant association between all categorical study variables and the MG patients' outcome (BTT/TS) in terms of mortality, morbidity, complete stable remission, pharmacological remission, and complications. CONCLUSION: Bilateral thoracoscopic maximal thymectomy is as effective as trans-sternal maximal thymectomy to control and treat the disease.

Mobile Phone Base Station Tower Settings Adjacent to School Buildings: Impact on Students' Cognitive Health.

The use of mobile phones has remarkably increased and become a basic need of daily life. Increasing subscriptions of mobile phones boost the installation of mobile phone base station towers (MPBSTs) in crowded commercial and residential areas including near school buildings. This study investigated the impact of exposure to radiofrequency electromagnetic field (RF-EMF) radiation generated by MPBSTs on cognitive functions. Two hundred and seventeen volunteer male students aged between 13 and 16 registered from two different intermediate schools: 124 students were from School 1 and 93 students were from School 2. The MPBSTs were located within 200 m from the school buildings. In School 1, RF-EMF was 2.010 µW/cm2 with a frequency of 925 MHz and in School 2, RF-EMF was 10.021 µW/cm2 with a frequency of 925 MHz. Students were exposed to EMFR for 6 hr a day, 5 days a week for a total period of 2 years. The Narda Safety Test Solution device SRM-3006 was used to measure RF-EMF in both schools, and cognitive functions tasks were measured by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Significant impairment in Motor Screening Task (MOT; p = .03) and Spatial Working Memory (SWM) task ( p = .04) was identified among the group of students who were exposed to high RF-EMF produced by MPBSTs. High exposure to RF-EMF produced by MPBSTs was associated with delayed fine and gross motor skills, spatial working memory, and attention in school adolescents compared to students who were exposed to low RF-EMF.

Benign Broncho-esophageal Fistula Presenting as Unresolved Pneumonia.

Benign acquired broncho-esophageal fistula (BEF) in adults is a very rare entity and has not been reported properly in the literature, compared to malignant BEF. Nonetheless, infection has predisposed most of the reported benign acquired BEF cases. We report here a case of tuberculous BEF, in a patient with a history of pulmonary tuberculosis (TB). He presented with recurrent chest infections, and choking. Upper gastrointestinal (GI) endoscopy showed BEF due to tuberculous mediastinal lymphadenopathy, and the patient was managed by surgery successfully. He was prepared for surgery for one month by nutritional support and anti-tuberculous treatment.

Cardioprotective Effects of Sphingosine-1-Phosphate Receptor Immunomodulator FTY720 in a Clinically Relevant Model of Cardioplegic Arrest and Cardiopulmonary Bypass.

Objective: FTY720, an immunomodulator derived from sphingosine-1-phosphate, has recently demonstrated its immunomodulatory, anti-inflammatory, anti-oxidant, anti-apoptotic and anti-inflammatory properties. Furthermore, FTY720 might be a key pharmacological target for preconditioning. In this preclinical model, we have investigated the effects of FTY720 on myocardium during reperfusion in an experimental model of cardioplegic arrest (CPA) and cardiopulmonary bypass. Methods: 30 Sprague-Dawley rats (300-350 g) were randomized into two groups: Group-A, treated with FTY720 1 mg/kg via intravenous cannulation, and Group-B, as control. After 15 min of treatment, rats underwent CPA for 30 min followed by initiation of extracorporeal life support for 2 h. Support weaning was done, and blood and myocardial tissues were collected for analysis. Hemodynamic parameters, inflammatory mediators, nitro-oxidative stress, neutrophil infiltration, immunoblotting analysis, and immunohistochemical staining were analyzed and compared between groups. Results: FTY720 treatment activated the Akt/Erk1/2 signaling pathways, reduced the level of inflammatory mediators, activated antiapoptotic proteins, and inhibited proapoptotic proteins, leading to reduced nitro-oxidative stress and cardiomyocyte apoptosis. Moreover, significant preservation of high-energy phosphates were observed in the FTY720-treated group. This resulted in improved recovery of left ventricular systolic and diastolic functions. Conclusion: The cardioprotective mechanism in CPA is associated with activation of prosurvival cell signaling pathways that prevents myocardial damage. FTY720 preserves high-energy phosphates attenuates myocardial inflammation and oxidative stress, and improves cardiac function.

The quality of life and satisfaction rate of patients with upper limb hyperhidrosis before and after bilateral endoscopic thoracic sympathectomy.

BACKGROUND: Hyperhidrosis is a functional disorder identified by excessive sweating. Its incidence is approximately 1% in any population. Bilateral endoscopic thoracic sympathectomy (BETS) intervention is the definitive treatment of choice for palmar and axillary hyperhidrosis. AIMS AND OBJECTIVES: The purpose of this study is to evaluate and compare the quality of life (QOL) and satisfaction rate of patients with upper limb hyperhidrosis before and after BETS surgery and the influence of compensatory hyperhidrosis (CH) on patients' QOL after surgery. SETTINGS AND DESIGN: This study is a cross-sectional study designed to generate longitudinal data. SUBJECTS AND METHODS: This study is a cross-sectional study designed to generate longitudinal data pre- and postbilateral BETS prospectively. This study was conducted in the surgery department of University Hospital in Riyadh, Saudi Arabia. Hundred patients with upper limb hyperhidrosis who underwent BETS from 2014 to 2017 were included. A modified and validated QOL questionnaire for hyperhidrosis was completed by the patients themselves in order to compare the QOL for patients both before and after BETS. Patients' satisfaction and the occurrence of CH were obtained postoperatively. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS® statistical package for social studies, version 22.0 (SPSS 22; IBM Corp., New York, NY, USA) for Windows®. RESULTS: A total of 100 patients completed the questionnaire; 94% of patients had a positive QOL outcome after the surgery. The mean decrease in QOL scores was -42.0 points toward better QOL. The site of sweating had a significant effect on the patients' QOL before and after the surgery (P value < 0.001). Moreover, 76% of patients reported a high satisfaction rate. CONCLUSION: Primary hyperhidrosis can negatively impair patients' QOL in different domains. BETS showed to be an effective option for improving the QOL of patients and it provided both short- and long-term effectiveness in treating upper limb hyperhidrosis. CH did not interfere with the rate of patient satisfaction or their QOL postoperatively.

Endobronchial Tuberculosis Simulating Carcinoid Tumor.

Diagnosing endobronchial tuberculosis (EBTB) can be difficult due to the lack of specific signs and symptoms that differentiate it from other respiratory diseases, such as lung tumors. We hereby report a case of a very rare presentation of tuberculosis (TB) in a patient who presented with a dry cough and significant weight loss for 3 months. Chest X-ray and CT scan of the chest showed partial atelectasis and a segmental collapse of the right upper lobe and tumor-like arising from its bronchus along with a large right para-tracheal mediastinal lymphadenopathy, mimicking a metastatic (N2) disease. Fiber-optic bronchoscopy revealed a fleshy, highly vascularized mass occluding the right upper lobe bronchus, and thus the initial diagnosis of carcinoid tumor was made. Mediastinoscopy and biopsy of these mediastinal lymph nodes showed caseating chronic granulomatous inflammation consistent with TB, which changed the diagnosis to EBTB. The patient was treated with first-line anti-tuberculous drugs that led to a full resolution in terms of symptoms, radiological findings and complete disappearance of the endobronchial mass by bronchoscopy. To the best of authors' knowledge, there are no other similar cases in presentation and management in the literature.

Near-fatal presentation of bilateral pneumothorax in cutis laxa patient: Case report, and review of the literature.

Cutis laxa (CL) is a rare connective tissue disease characterized by a loose, wrinkled, and inelastic skin. Here, we report an unusual presentation in a 15-year-old male patient who is a known patient of CL who presented with bilateral pneumothorax. He was successfully managed initially by chest tube insertion and then he was treated surgically with bilateral staged thoracoscopy, apical bullectomy, and pleurodesis with full uneventful recovery.

Squamous Cell Carcinoma Arising in Zenker's Diverticulum: A Case Report and Review of the Literature.

The occurrence of squamous cell carcinoma (SCC) arising in a Zenker's diverticulum is a very rare incident. Complete excision of the diverticulum is considered as the procedure of choice for SCC in the pharyngeal pouch. Histopathological assessment of the pouch is the only modality to rule out SCC. Here, we report a case of a 71-year-old male with 20 years of history of Zenker's diverticulum, who recently presented with a history of weight and appetite loss. A barium swallow confirmed Zenker's pouch, the patient underwent diver-ticulectomy and cricopharyngeal myotomy; a histopathological examination of the specimen revealed a fungating mass of SCC within the pouch. This report highlights the suggestion of considering SCC not only in patients with a long history of Zenker's diverticulum but also when there is a clinical suspicion with new symptoms for a more aggressive management for diagnosis and complete excision of the pouch.