Evaluating accuracy and reproducibility of ChatGPT responses to patient-based questions in Ophthalmology: An observational study.

Chat Generative Pre-Trained Transformer (ChatGPT) is an online large language model that appears to be a popular source of health information, as it can provide patients with answers in the form of human-like text, although the accuracy and safety of its responses are not evident. This study aims to evaluate the accuracy and reproducibility of ChatGPT responses to patients-based questions in ophthalmology. We collected 150 questions from the "Ask an ophthalmologist" page of the American Academy of Ophthalmology, which were reviewed and refined by two ophthalmologists for their eligibility. Each question was inputted into ChatGPT twice using the "new chat" option. The grading scale included the following: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Totally, 117 questions were inputted into ChatGPT, which provided "comprehensive" responses to 70/117 (59.8%) of questions. Concerning reproducibility, it was defined as no difference in grading categories (1 and 2 vs 3 and 4) between the 2 responses for each question. ChatGPT provided reproducible responses to 91.5% of questions. This study shows moderate accuracy and reproducibility of ChatGPT responses to patients' questions in ophthalmology. ChatGPT may be-after more modifications-a supplementary health information source, which should be used as an adjunct, but not a substitute, to medical advice. The reliability of ChatGPT should undergo more investigations.

Silicone Oil Utilized in Pars Plana Vitrectomy for Patients with Advanced Proliferative Diabetic Retinopathy: Physico-Chemical and Optical Properties.

Objective: Silicone oils have the role in maintaining the attachment of the retina in conditions where the risk of retinal re-detachment is high. However, silicone oils have the tendency to emulsify with subsequent complications. In this work, analyses have been performed to understand changes that occurred to the optical, and physical characteristics of the oil after removal from the vitreous cavity of patients underwent pars plana vitrectomy (PPV) for fibrovascular membranes/tractional retinal detachment (FVM/TRD). Methods: Four samples of silicone oil were allocated from patients who underwent PPV for FVM/TRD. The Fourier-transform infrared (FTIR) spectroscopy, micro-viscometry, and ultraviolet-visible spectrometer analyses were utilized to determine the changes in its chemical bondings, viscosity, absorbance, transmittance, buoyance, and specific gravity. Results: The mean age of the patients was 49.0 years. The mean duration of silicone oil implantation was 18.9 months. FTIR analysis showed significant breaking in the chemical bonding that was related to the lens status during the primary PPV, the presence of significant retinal hemorrhages, the duration of silicone oil implantation, and the degree of silicone oil filling. Similarly, viscosity and contact angle analyses revealed a reduction in the viscosity with similar factors to the FTIR analysis. Moreover, absorbance and transmittance were largely affected by the aggressiveness of FVM/TRD. Conclusion: This study revealed that certain factors such as the age of the patient, duration of silicone oil implantation, lens status, and the presence of retinal hemorrhages, the degree of silicone oil filling and aggressiveness of FVM/TRD may contribute to the emulsification process.

Vitreous Levels of Vascular Endothelial Growth Factor and Platelet-Derived Growth Factor in Patients with Proliferative Diabetic Retinopathy: A Clinical Correlation.

Background: The global epidemic status of diabetic retinopathy (DR) and its burden presents an ongoing challenge to health-care systems. It is of great interest to investigate potential prognostic biomarkers of DR. Such markers could aid in detecting early stages of DR, predicting DR progression and its response to therapeutics. Herein, we investigate the prognostic value of intravitreal concentrations of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) in a DR cohort. Materials and methods: Vitreous sample acquisition was conducted at King Abdullah University Hospital (KAUH) between December 2020 and June 2022. Samples were obtained from any patient scheduled to undergo a pars plana vitrectomy (PPV) for any indication. Included patients were categorized into a DR group or a corresponding non-diabetic (ND) control group. Demographics, clinicopathological variables, standardized laboratory tests results, and optical coherence tomography (OCT) data were obtained for each included individual. Intravitreal concentrations of VEGF and PDGF were assessed using commercial enzyme-linked immunosorbent assay (ELISA). Results: A total of 80 eyes from 80 patients (DR group: n = 42 and ND control group: n = 38) were included in the analysis. The vitreous VEGF levels were significantly higher in the DR group compared to the ND control group (DR group 5744.06 ± 761.5 pg/mL versus ND control group 817.94 ± 403.1 pg/mL, p = 0.0001). In addition, the vitreous PDGF levels were also significantly higher in the DR group than those in the ND control group (DR group 4031.51 ± 410.2 pg/mL versus ND control group 2691.46 ± 821.0 pg/mL, p = 0.001). Bassline differences between test groups and clinical factors impacting VEGF and PDGF concentrations were investigated as well. Multiple regression analysis indicated PDGF as the sole independent risk factor affecting best-corrected visual acuity (BCVA) at the last follow-up visit: the higher the PDGF vitreous levels, the worst the BCVA. Conclusions: Vitreous concentrations of VEGF and PDGF are correlated with DR severity and may exhibit a possible prognostic potential value in DR. Further clinical and experimental data are warranted to confirm the observed findings and to help incorporate them into daily practice.

Refractive errors among medical students in Jordan: prevalence, types and possible risk factors.

Aim: This study aims to determine the prevalence of refractive errors among medical students in Jordan. Materials & methods: Cross-sectional model through an online questionnaire was conducted. The questionnaire was distributed randomly to 700 medical students. Results: Females participated more than males. It was revealed that 525 (75%) of the total students were found to have a refractive error. Myopia was the most common type. About 79.0% of students have a positive family history of refractive errors which was more significant in students with refractive errors. Spectacles were the most common used method of treatment. Conclusion: The prevalence of refractive errors was high among medical students in Jordan. A positive family history was associated with students having refractive errors.

Many reports have studied refractive errors and their risk factors in different groups and ethnicities. Also, types of refractive errors were found to have a different prevalence in different age groups. Whilst refractive errors in medical students have been studied in many countries, the prevalence of refractive errors has never been studied in Jordanian medical students before. In this study, we found that myopia (with or without astigmatism) was the most common type of refractive error in medical students.

The largest malignant peripheral nerve sheath arising from the gluteal region: case report.

We report a unique case of a huge malignant peripheral nerve sheath tumor with probable smooth muscle differentiation.

Unique case of successful surgical treatment of recurrent spinal epidural hematoma after lumbar disc surgery in a Glanzmann thrombasthenia patient.

We report a case of recurrent postoperative spinal hemorrhage after lumbar disc surgery in a Glanzmann thrombasthenia patient.

Optical and Physical Properties of Silicone Oil Extracted from the Vitreous of Patients Who Underwent Vitrectomy for Retinal Detachment.

Purpose: Silicone oil (SO) is a crucial tool in vitreoretinal surgery. SO has the tendency to emulsify depending on certain factors. In this work, detailed analyses have been conducted to understand changes that occurred to the physical, optical, and chemical characteristics of the oil after removal from the vitreous cavity. Methods: Five samples of SO were collected from patients who underwent vitrectomy for rhegmatogenous retinal detachment. The fourier-transform infrared (FTIR) spectroscopy, ultraviolet-visible spectrometer, and contact angle analysis were utilized to determine the changes in its chemical bondings, transmittance, absorbance, viscosity, buoyance, and specific gravity. Results: FTIR analysis showed significant changes in the chemical bonding that might be related to the age of the patient, lens status, the presence of retinal hemorrhages, and the exposure to laser after implantation of SO. In addition, contact angle analysis revealed that the viscosity might be affected by duration of implantation and the age of the patient. Moreover, transmittance and absorbance were largely affected by the exposure to laser retinopexy after implantation. Conclusion: This study showed that certain factors such as the age of the patient, the exposure to laser, lens status, and the presence of retinal hemorrhages may contribute to the emulsification process.

Anterior Versus Retropupillary Iris-Claw Intraocular Lens: Indications, Visual Outcome and Postoperative Complications.

INTRODUCTION: In cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations. METHODS: We retrospectively examined the characteristics and outcomes of patients who underwent iris-claw "Artisan®" intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications. RESULTS: In this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior iris-claw IOL patients had more high intraocular pressure readings and macular edema. CONCLUSIONS: This study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.

Evaluating the Prognostic Role of Monocytopenia in Chemotherapy-Induced Febrile Neutropenia Patients Treated with Granulocyte Colony-Stimulating Factor.

OBJECTIVE: Chemotherapy-induced febrile neutropenia is a common and serious oncological emergency which carries a substantial mortality and morbidity. The main objective of this study is to evaluate the usage of absolute monocyte count (AMC) at presentation as a prognostic factor for patients with chemotherapy-induced febrile neutropenia who were subsequently treated with granulocyte colony-stimulating factor (G-CSF). STUDY DESIGN: The electronic medical records of our center were used retrospectively to identify patients diagnosed with unprecedented chemotherapy-induced febrile neutropenia treated with G-CSF between January 2010 to December 2020 and diagnosed with solid and hematological malignancies. Patient's demographics, disease characteristics and laboratory investigations were extracted. Disease progression measures were statistically compared between the study groups in the short-term period of follow-up (six days) including absolute neutrophil count (ANC), ANC difference compared to the baseline readings, hospitalization period, and mortality. RESULTS: A total of 80 patients were identified and categorized into two groups namely monocytopenia (n = 34) and non-monocytopenia (n = 46) with an AMC cutoff point of 0.1×109 cells/L. The monocytopenia group exhibited a worse prognosis with lower ANC values and slower improvement illustrated by the low ANC difference values at all follow up points (P-value ≤ 0.05) apart from day 5. A statistically significant lower hospitalization period was also observed in the non-monocytopenia group (P-value = 0.006). Linear regression analysis evaluated the association between AMC values at admission and ANC values at admission along with subsequent days of follow up which were found to be statistically significant (P-value ≤ 0.05). Receiver operating characteristic curves suggest a satisfactory predictability of ANC changes by AMC values at admission, days1, 2, 3, 4 and 6. CONCLUSION: Monocytopenia holds a worse prognosis in chemotherapy-induced febrile neutropenia patients treated with G-CSF. In addition, AMC values at presentation represents a potential risk factor that can predict short-term changes regarding ANC measures.

Complete remission of advanced low-grade endometrial stromal sarcoma after aromatase inhibitor therapy: a case report.

BACKGROUND: Low-grade endometrial stromal sarcoma is a rare neoplastic growth in the uterine cavity, representing less than 1% of uterine tumors. Such tumors usually affect premenopausal and perimenopausal women, with a mean age of 46 years. Treatment generally starts with surgical resection of the tumor, followed by chemotherapy, radiotherapy, or hormonal therapy. CASE PRESENTATION: In the current report, we again present a case of low-grade endometrial stromal sarcoma in a 51-year-old Mediterranean woman presenting with abdominopelvic pain. Computed tomography scan revealed a primary uterine tumor measuring 17 × 9 × 9 cm metastasizing to the lungs, bladder, and ureteral orifice, along with lymphovascular involvement. The patient underwent total abdominal hysterectomy, omentectomy, and lymph node dissection. Estrogen deprivation was accomplished by bilateral salpingo-oophorectomy. Lifelong hormonal therapy consisting of letrozole 2.5 mg per day was prescribed, which demonstrated remarkable efficacy, resulting in a partial remission of lung metastasis within 8 months after surgery. Full remission was observed after 18 months of hormonal therapy, with no recurrence. Another scan was performed after 2.5 years, revealing complete remission with no recurrence. CONCLUSION: We again report a case of complete remission of low-grade endometrial stromal sarcoma after surgical removal of the tumor along with first-line hormonal therapy without the use of chemotherapy or radiotherapy, emphasizing the role of hormonal therapy in the treatment of such tumors.

Intractable Biliary Candidiasis in Patients with Obstructive Jaundice and Regional Malignancy: A Retrospective Case Series.

BACKGROUND: Candida species are infrequently grown in bile cultures. An association between biliary candidiasis and regional malignancy may exist. The role of fungus membranes in frequent biliary stent occlusion is also presented in this case series. METHODS: We retrospectively identified patients who underwent percutaneous trans-hepatic cholangiogram (PTC) for obstructive jaundice between January 2014 and January 2019. The results of bile cultures - obtained by PTC - for all patients were analyzed, and patients with fungus growth were determined; their medical records were reviewed. RESULTS: A total of 71 patients with obstructive jaundice underwent PTC between January 2015 and January 2019. Five patients (all male; mean age 55.8 years) had candida species growth in bile cultures. Two patients were diagnosed with cholangiocarcinoma, one with adenocarcinoma of the head of the pancreas, one with gallbladder cancer, and one with locally advanced gastric adenocarcinoma. Formation of fungal balls predisposed to frequent PTC drain clogging. Eradication of Candida was achieved in 4 patients after 10 days to 3 weeks of antifungal therapy. CONCLUSION: We present a case series of biliary candidiasis in patients with obstructive jaundice and regional malignancy. We suggest that patients with obstructive jaundice and regional malignancy should be screened for biliary candidiasis. Persistent cholestasis may be caused by the recurrent formation of fungal membranes (balls).

Inter-Gender Pelvic Shape Variations as a Cause of DDH Overdiagnosis.

OBJECTIVE: Developmental dysplasia of the hip (DDH) is an abnormal relationship between the acetabulum and the head of the femur. Plain x-ray of both hips at the age of 3 months is still in use in some countries. On plain films, classic lines and angles are evaluated to meet current guidelines for positive DDH. Among these is the acetabular angle (AA), which most did not exceed 30° in normal pelvis regardless of gender. A flat promontory gives the impression of a high AA angle, whereas a sharp promontory gives the impression of a low AA angle. MATERIALS AND METHODS: All anteroposterior (AP) pelvic digital x-ray studies performed to rule out DDH were collected from the PACS systems. A novel angle was measured between a line parallel to the lateral aspect of the region of the inferior iliac spines and a line that extends along the acetabular roof to quantify the roundness of the iliac promontory. We called the former line the Miral line and the formed angle the iliac promontory angle. RESULTS: We show that the promontory shape is significantly different between genders, and therefore it is mistaken to generalize an upper AA limit for males and females. In addition, we show that the current guideline of the upper limit of AA did not predict the incidence of DDH. CONCLUSION: We suggest that the current practice is introducing a high rate of false positive, especially among females, and the current guidelines on AA should be reviewed and assigned separately for males and females. This is more important for countries that did not utilize the ultrasonographic assessment for DDH.

Coronary artery anomalies in patients with zero calcium score: A new evidence supports the 2016-NICE guidance.

BACKGROUND: Currently, guidelines from around the world endorse measurement of coronary artery calcium (CAC) to improve clinical risk prediction in appropriately selected asymptomatic and stable symptomatic individuals. A CAC score of zero may discourage from further testing as coronary computed tomography angiography (CCTA). We investigate the presence of malignant coronary artery anomalies (CAA)s among stable symptomatic patients with zero CAC. METHODS: A total of 281 individuals' information was obtained. These individuals had low to intermediate pre-test probability of coronary artery disease, complained of stable typical or atypical chest pain, were not known to have CAD, and had CAC scan score of zero. After investigating the CCTA, Angelini's classification system for CAA was utilized in adapted form to determine the presence, the class and type of the CAA. RESULTS: The CAAs were detected in 16 (5.7 %) patients on CCTA, 15 (8.1 %) of them were below 45 years. The mean age for patients with CAAs was 31.8. According to Angelini classification system, most of the detected CAAs were malignant such as the origination of the coronary artery from the opposite sinus with arterial course between the aortic and pulmonary trunks and the intramural muscular bridge course. CONCLUSION: It is preferable to perform CCTA in young patients with cardiac symptoms, especially in Asian and Middle Eastern countries even of the CAC score is zero.

Diaphragmatic Lipoma in a Woman with Rheumatoid Arthritis: A Case Report and Literature Review.

BACKGROUND A lipoma is a benign tumor made of fat tissue. Diaphragmatic lipomas are frequently reported in case studies. CASE REPORT This study presents a case of diaphragmatic lipoma in a woman with rheumatoid arthritis who was complaining of shortness of breath. A literature review of previously reported diaphragmatic lipoma cases was also carried out. In our patient, normal vital signs were detected, and laboratory results showed that antinuclear antibody, complete blood count, erythrocyte sedimentation rate, and C-reactive protein levels were high. A high-resolution CT scan showed pulmonary nodules and an incidentally found diaphragmatic lipoma. The patient was prescribed corticosteroids, methotrexate, folic acid, and chloroquine. The 3-month follow-up visit revealed symptomatic improvements in breathing difficulties and joint attacks. CONCLUSIONS Diaphragmatic lipoma should be identified to avoid misdiagnosis. Most cases of lipoma require observation. Surgical treatment is indicated only if the mass is symptomatic, increasing in size, or of uncertain nature.

Chronic rhinosinusitis due to cyano-acrylic glue after endoscopic transsphenoidal pituitary surgery.

BACKGROUND: To reduce the risk of cerebrospinal fluid leak, clinicians utilize a filling material placed in the sella followed by floor reconstruction with various materials, including glue sealing. Cyano-acrylic glue Glubran®2 glue is commercially available and is generally used as embolizing agent and for the prevention of cerebrospinal fluid leakage. CASE DESCRIPTION: A 25-year-old woman underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma. After tumor resection, sellar floor reconstruction was performed by mucosal graft and Glubran®2 glue. The early post-operative period was uneventful. However, 2 months after surgery, the patient complained of headache, facial pain and greenish foul-smelling nasal discharge with solid particles dripping from the nose. Medical treatment was unsuccessful. Brain MRI showed inflammation and thickening of the sphenoidal and para-sphenoidal mucosa. The patient underwent endoscopic endonasal surgery and a solid glass-like mass surrounded by inflamed infected mucosa was seen in the inferior and lateral aspects of the sphenoid sinus. Efforts were made to erupt and de-crust the solid mass until total resection was achieved. Early post-operative period was uneventful, and a course of antibiotics was continued until total disappearance of the discharge. CONCLUSION: To the best of our knowledge, this is the first case reporting of acrylic glue (Glubran®2)-related sinusitis. Surgeon should be aware about similar side effects for the glue material that would complicate the surgery.

Prevalence of sleep disorders among medical students and their association with poor academic performance: A cross-sectional study.

BACKGROUND: Sleep quality is of paramount importance for human health. This multi-site study measures the proportion and types of self-reported sleep disorders in medical students and evaluates their association with academic performance by Grade Point Average (GPA). MATERIALS AND METHODS: A cross-sectional survey was conducted on medical students from two medical schools in Jordan during the 2018/2019 academic year. The study utilized the SLEEP-50 questionnaire to estimate the proportion of several sleep disorders and their effects on daily functioning. Below average GPAs were considered poor academic performance. RESULTS: 1041 medical students' online surveys were analyzed from two medical schools' campuses, representing a 29.7% response rate. Their mean age was 22 ± 2.1 years (ranging from 18 to 37) and 52.6% were female. The mean body mass index was 24.2 ± 4.4 kg/m2. According to the SLEEP-50 questionnaire, the prevalence of sleep disorders among studied medical students ranged from 0.6% for sleep state misperception (SSM) to 23.1% for hypersomnia. Using binary logistic regression, after adjusting for gender and obesity, poor academic performance was associated with a risk for insomnia [adjusted odds ratio (OR) = 1.96, p < 0.001]; affective disorder [OR = 2.24, P < 0.001]; SSM [OR = 6.40, p = 0.045]; narcolepsy [OR = 9.54, p = 0.045]; and circadian rhythm disorders [OR = 2.03, p < 0.001]. CONCLUSION: Sleep disorders are common among medical students. Several sleepdisorders were associated with poor academic performance. Proper diagnosis and treatment of sleep disorders may remedy this issue.

WITHDRAWN: Mechanical ventilation in COVID-19: Is it due to patient or virology factors?

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

The practice of intracytoplasmic sperm injection in Jordan: A clinical outcome study.

OBJECTIVE: The lack of appropriate guidelines and justified practice in most developing countries is a serious limitation to efforts to qualify the services provided. In this paper, we evaluate and assess the clinical practice of an assisted reproductive technique of intracytoplasmic sperm injection (ICSI) in Jordan. METHODS: Retrospectively, we identified women who achieved a successful pregnancy by ICSI over a period of ten years. Information related to the ICSI procedure, foetus abnormalities, maternal complications and delivery outcomes were included. A control group of normal pregnancies were incorporated. RESULTS: In total, 291 cases were included as successful cases of ICSI with a success rate of 14.1%. For the control group, 466 pregnant women with normal pregnancies were included. No statistical difference was observed between both groups in foetus malformation. In normal pregnancy women, 42.1% delivered through caesarean section (CS) while 87.6% of ICSI patients underwent CS. Women with ICSI had significantly higher rates of multiple gestations, and their neonates were lower in birthweight. Women in the ICSI group tended to deliver females compared to the control group. Pregnancy-related hypertension was more commonly reported in the normal pregnancy group, while gestational diabetes, antepartum haemorrhage and preterm labour were more common in ICSI group. CONCLUSION: Services for the management of infertility are increasing in the Middle East. The clinical outcomes in Jordan is approaching that of other developed regions, although the success rate is lower than in other regions. Further studies and efforts should be carried out to maximize effective and successful practice in such low-income areas.

Azygos Lobe: Prevalence of an Anatomical Variant and Its Recognition among Postgraduate Physicians.

The right azygos lobe is a rare anatomical variant of the upper lung lobe that can be misdiagnosed as a neoplasm, a lung abscess, or a bulla. The aim of this study was to assess the prevalence of right azygos lobe and to evaluate the ability of postgraduate doctors to correctly identify right azygos lobe. We analyzed a total of 1709 axial thoracic multi-detector computed tomography (CT) images for the presence of an azygos lobe. Additionally, a paper-based survey was distributed among a sample of intern doctors and radiology and surgery residents, asking them to identify the right azygos lobe in a CT image and in an anatomy figure. Results showed that the prevalence of the right azygos lobe in the study sample was 0.88%. Men have more right azygos lobes than women. None of the intern doctors or surgery residents identified the right azygos lobe correctly, whereas more than half (57.1%) of the radiology residents did. Most of the incorrect answers about the CT scan were related to the bronchi (25.0%). The apex of the lung (17.7%) and the superior vena cava (17.7%) were the most common incorrect answers about the anatomy figure. In conclusion, the prevalence of the right azygos lobe in the current study is within the range of previously published literature. More education should be given for the identification of the right azygos lobe during anatomy and clinical teaching.

Prevalence of Frontal Sinus Aplasia in Jordanian Individuals.

Our paper aims to investigate the prevalence of frontal sinus aplasia among Jordanian individuals and compare it with values from different populations. Retrospectively, the study was done for 167 of the paranasal sinuses coronal tomography (CT) for patients who attended the clinic from January 2019 to August 2019 in King Abdullah University Hospital Irbid, Jordan. The authors analyzed the multiplanar CT scans to perform our work. The authors excluded the following images from our study: patients younger than 18 years old, patients with history of skull base trauma that impaired visualization of the frontal sinus, and images with fibro-osseous lesions that impaired the visualization of the frontal sinus. The prevalence of bilateral frontal sinus aplasia is 4.2% among Jordanian individuals and 6.6% is the prevalence of unilateral frontal sinus aplasia. Both values are consistent with average values among different populations. Moreover, we noticed the higher prevalence in both the bilateral and unilateral frontal sinus aplasia in males compared to females. The prevalence of frontal sinus aplasia among Jordanian individuals is almost within the same values among different populations. These numbers regarding the bilateral and unilateral frontal sinus aplasia is crucial to push the surgeon to evaluate CT of the paranasal sinuses preoperatively and focus on the presence of frontal sinuses on CT images to prevent unwanted complications during sinus surgeries.