Efficacy of povidone-iodine nasal rinse and mouth wash in COVID-19 management: a prospective, randomized pilot clinical trial (povidone-iodine in COVID-19 management).

OBJECTIVES/HYPOTHESIS: To assess the efficacy of 0.23% povidone-iodine (PVP-I) nasal rinses and mouth washes on detectability of the coronavirus disease 2019 (COVID-19) virus and cycle threshold (Ct) values in nasopharyngeal swabs. STUDY DESIGN: This was an open-label, prospective, randomized, placebo-controlled clinical trial. SETTING: The study was conducted in King Saud University Medical City, Riyadh, Saudi Arabia, from August 2021 to July 2022. METHODS: Participants diagnosed with SARS-CoV-2 were randomly assigned to one of three groups, with participants receiving either 0.23% PVP-I, 0.9% normal saline (NS) nasal rinses and mouth washes, or no intervention (control group). Nasopharyngeal swabs were taken 4, 8, 12, and 18 days after the first swab to measure the detectability of the virus and the Ct. RESULTS: A total of 19 participants were involved in this study. The mean viral survival was 9.8, 12, and 12.6 days for the PVP-I, NS, and control groups, respectively, with a statistically significant difference (p = 0.046). The Ct mean values were 23 ± 3.4, 23.5 ± 6.3, and 26.3 ± 5.9 at the time of recruitment and 25.2 ± 3.5, 15 ± 11.7, and 26.9 ± 6.4 after 4 days for the PVP-I, NS, and control groups, respectively. CONCLUSIONS: When used continuously at a concentration of 0.23%, PVP-I showed promising results in terms of decreasing the pandemic burden by reducing the period of infectiousness and viral load. However, the use of PVP-I did not result in significantly different changes in the quality-of-life parameters in recently vaccinated and mild COVID-19 patients.

Risk Factors Associated With the Development of Acute Peripancreatic Fluid Collections on Follow-Up Imaging After Acute Pancreatitis: What Physicians Need to Know.

OBJECTIVES: This study aims to identify various risk factors for acute peripancreatic fluid collections (APFCs) in patients presenting with acute pancreatitis (AP). METHODS: A blinded retrospective case-control study was conducted at a tertiary care hospital in Riyadh. Data from 327 patients who presented with AP between January 2008 and 2021 were analyzed. Following the application of inclusion/exclusion criteria, the final sample size consisted of 82 patients. Patients were divided into cases and controls based on the presence or absence of APFCs, respectively. APFCs were defined as fluid collections in the peripancreatic region that develop within four weeks of presentation without well-defined walls or solid internal components. Demographic, clinical, and laboratory variables were collected and subjected to multivariate binary regression analysis to assess the odds of developing APFCs. RESULTS: A total of 34 patients were categorized as cases, while 48 patients were controls. A significant association was found between age (P=0.022), total bilirubin (P=0.012), lipase level (P<0.001), albumin level (P=0.038), and lactate dehydrogenase (LDH) (P=0.037) on admission and the odds of developing APFCs. CONCLUSION: Older age, higher levels of bilirubin and lipase, and low levels of albumin and LDH were found to be risk factors for developing APFCs. No other variables were found to be significant. The findings of this study may provide insight into how often clinicians can expect APFCs in patients presenting with AP.

Validity and Reliability of the Arabic Version of the Glottal Function Index in Dysphonic Patients.

OBJECTIVES/HYPOTHESIS: The Glottal Function Index (GFI) is a four-item self-administered survey suitable for the evaluation and treatment of patients with glottal dysfunction. To date, it has been translated into Lithuanian, Persian, and Hebrew. This study is intended to translate and cross-culturally adapt the GFI for use in Arabic-speaking patients with dysphonia. STUDY DESIGN: This work is a cross-sectional study involving the administration of the GFI to participants with dysphonia (cases) and patients without dysphonia (controls). The validation process included reliability and validity assessments. METHODS: The GFI was translated using forward and backward translation methods from English into Arabic. The questionnaire's reliability was assessed using Cronbach's alpha and test-retest reliability (intraclass correlation coefficient, ICC). The Mann-Whitney test evaluated validity by comparing cases and controls. Finally, the Kruskal-Wallis test examined differences in the GFI across various pathologies. RESULTS: The GFI demonstrated favorable internal consistency (Cronbach's alpha = 0.848) and excellent test-retest reliability (ICC = 0.993). Significant differences in the A-GFI score between the cases and controls were also observed (P < 0.001), supporting the instrument's validity. However, no statistically significant differences were found in A-GFI across different diagnoses (P = 0.712). CONCLUSIONS: The A-GFI is a valid and reliable screening tool for clinicians to assess dysphonia and voice impairment in patients in Arabic-speaking countries. The tool is easy to administer in daily clinical practice given its brevity and self-administration.

An Absent Lingual Frenulum in a Non-syndromic Premature Infant.

The lingual frenulum (LF) is a fold of tissue that connects the tongue to the oral cavity's floor. Abnormal frenula are associated with speech alterations. The absence of the LF is associated with Ehler's Danlos syndrome (EDS). In this case report, we present a premature infant incidentally found to have an absent lingual frenulum, with recurrent desaturations during feeding. The desaturations were believed to be due to the absent lingual frenulum, but they resolved after one month without treatment and were then attributed to apnea of prematurity. Whole exome sequence showed no genetic disorders. The infant is now doing well with no interventions. An absent lingual frenulum warrants molecular genetic testing for EDS. However, it does not warrant any treatment; special considerations are only required during intubation.

Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia.

OBJECTIVES: To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications. METHODS: In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board. RESULTS: We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect. CONCLUSION: The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.

Abdominal X-Ray Findings of Patients With Crohn's Disease Presenting With Acute Abdominal Pain.

OBJECTIVES: The primary objective of this study is to describe the most common radiological findings found on abdominal X-rays of patients with Crohn's disease (CD) presenting with acute abdominal pain. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Riyadh. Data from CD patients who presented with acute abdominal pain between December 2016 and December 2021 was analyzed. A total of 144 abdominal X-rays met the inclusion and exclusion criteria and were included in the study. The medical records of patients who had the X-rays were subsequently reviewed for the presence or absence of follow-up imaging studies. RESULTS: Of the 144 abdominal X-ray studies, 54 (37.5%) had positive findings, while 90 (62.5%) were unremarkable. The most common category of findings was small bowel findings (32.6%), acute complications (32.6%), followed by extraintestinal findings (2.7%), and colonic findings (1.35%). About 29.2% of the abdominal X-rays had subsequent follow-up imaging done. The multivariate logistic binary regression analysis demonstrated that males had an odds ratio of 2.25 of undergoing follow-up imaging compared to females (p = 0.049). CONCLUSION:  The non-specific findings found on the majority of the abdominal X-rays may indicate that it is of limited diagnostic value in this patient population. However, they play an integral role in ruling out acute complications in CD patients presenting with abdominal pain and exhibiting disease activity.

Incidence of peripancreatic fluid collections in patients presenting with acute pancreatitis.

OBJECTIVES: To calculate the incidence of acute peripancreatic fluid collection (APFC) in patients with acute pancreatitis. The secondary objective is to determine the underlying etiologies of acute pancreatitis in the Saudi population. METHODS: A retrospective cohort study was carried out at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. The study analyzed data from patients who were diagnosed with acute pancreatitis between January 2008 and January 202. A total of 327 were included in the study after applying the inclusion and exclusion criteria. Their medical records were subsequently reviewed for the presence or absence of APFC on follow-up imaging studies, evidence of biliary stones, prior endoscopic retrograde cholangiopancreatography (ERCP), a history of alcohol use, and demographic variables. RESULTS: Of the 327 patients with acute pancreatitis, 158 (48.3%) developed APFC, while 169 (51.7%) did not. The majority of patients had an idiopathic etiology of acute pancreatitis (n=251; 76.8%); followed by a biliary etiology (n=51; 15.6%); post-ERCP complications (n=14; 4.3%), and other causes (n=11; 3.3%). CONCLUSION: The incidence of APFC in patients presenting with acute pancreatitis between January 2008 and January 2021 was 48.3%. The most common etiology of acute pancreatitis in this tertiary care hospital was idiopathic, followed by biliary etiologies and post-ERCP complications. More studies targeting the local complications of pancreatitis are needed to reach more definitive findings.

Dermatology Patients' Knowledge of Sunscreen Guidelines at a University Hospital in Saudi Arabia.

Objective: The goal of this study is to assess the knowledge and attitude of dermatology patients regarding sunscreen use as recommended by the American Academy of Dermatology. Methods: This was an observational cross-sectional study at a university hospital in Riyadh. Participants were asked to complete a questionnaire to measure their knowledge and attitude regarding sunscreen use. Results were analyzed using a chi-square test. Results: Most participants heard about sunscreen (93.4%) and had indicated previous sunscreen use (72%). Sunscreen use was higher among women and participants with a postgraduate education. Sunscreen knowledge was higher among women, participants with non-photosensitive disorders, and participants with Fitzpatrick I, II, and III skin types. A total of 80% knew the worst time for sun exposure, but only 20.5% of the participants knew that sunscreen should be applied daily throughout the year, and 13.5% knew the correct minimum recommended SPF. A total of 34% were aware of the minimum time allowed for sunscreen application before sun exposure, and 20% were aware of the longest period allowed between reapplications. Only 4.5% knew the proper amount of sunscreen to cover the entire body. Conclusion: Our study revealed that most participants had heard of sunscreen, however their knowledge of the guidelines for sunscreen use was poor. Only 33% of the participants had received a recommendation for using sunscreen from their general practitioner or dermatologist. More comprehensive and directed efforts need to be made in counselling and educating these patients on proper sunscreen practice.

Persistent median artery in carpal tunnel syndrome for a patient with end stage renal disease after thrombosis of the left radiocephalic AV forearm loop graft: A case report.

INTRODUCTION & IMPORTANCE: Carpal tunnel syndrome (CTS) is the most common neuropathy in the world and is caused by compression of the median nerve. It has many known risk factors, including hemodialysis and a persistent median artery (PMA), which can be an incidental finding during carpal tunnel release (CTR). CASE PRESENTATION: A 65-year-old woman with end-stage renal disease (ESRD) on dialysis for seven months presented with typical signs and symptoms of carpal tunnel syndrome. Nerve conduction studies (NCS) displayed severe neuropathy. Upon carpal tunnel release (CTR) a rare superficial non-calcified persistent median artery critical to the circulation of the hand was found. The patient's symptoms resolved completely within four weeks of the operation. CLINICAL DISCUSSION: The PMA is a relatively common anomaly and could cause carpal tunnel syndrome by: directly pressing the median nerve, thrombosing, or in the setting of an aneurysm. Although usually found deep to the flexor retinaculum, the PMA could also be found superficially. It can be critical to the blood supply of the hand and should therefore be dealt with carefully. CONCLUSION: Surgeons should be aware of the possibility of finding a PMA when performing CTR. The PMA could be deep or superficial to the transverse carpal ligament. Where possible, the PMA should be preserved. Especially if its contributions to the blood supply of the hand are undetermined.