Postoperative malodorous smell in open septorhinoplasty: the effect of intradomal suturing with mucosal release.

PURPOSE: The aim of this study was to test a mucosal release method for decreasing the occurrence of malodourous smells after septorhinoplasty by preventing formation of debris pockets after surgery. METHODS: This study included 50 adult patients from 18 to 45 years of age who underwent open septorhinoplasty from January to May 2019. Patients were divided into two groups. The first group had intradomal (transdomal) sutures without submucosal release, while the second group had mucosal release. All patients had scheduled post-op visits at 1, 2, 4, and 8 weeks and 6 months. RESULTS: The overall postoperative rate of malodorous smell in both mucosal release and non-mucosal release patients at 2 weeks, 8 weeks and 6 months was 43.1%, 31.4% and 5.9%, respectively. Patients 36-45 years of age had a higher rate of postoperative malodorous smell with 55.6% at 2 weeks, decreasing to 33.3% at 8 weeks, and to less than 1% at 6 months. At 2 weeks after surgery, only 20% of the mucosal release group reported a malodorous smell compared to 65.4% in the non-mucosal release group. The rate was 8% at 8 weeks, and less than 1% at 6 months in the mucosal release group compared to 53.8% at 8 weeks and 11.5% at 6 months in the non-mucosal release group. CONCLUSIONS: Utilizing absorbable polydioxanone sutures and releasing the vestibular mucosa of the LLC significantly reduced the rate of postoperative malodorous smell for septorhinoplasty patients with intradomal (transdomal) single-dome suturing.

Molecular dynamics study of mechanical stability of Ti4C3 MXene subjected to chirality, temperature, strain rate, and point-vacancy for Lithium-ion batteries.

Two-dimensional Ti4C3 MXene has recently emerged as a promising electrode for Lithium-ion batteries (LIBs) because of its outstanding ion-transport abilities and high Li-absorbability. This study employed molecular dynamics simulation to explore the mechanical stability of Ti4C3 MXene subjected to various temperatures, strain rates, and vacancy concentrations. A slightly superior tensile strength and elasticity modulus have been observed along zigzag directions, measuring 148.14 GPa and 29.17 GPa, respectively. On the other hand, armchair-oriented Ti4C3 MXene shows a considerably greater fracture strain of 0.259 due to its strain-hardening tendency at lower temperatures. Elevated temperature decreases both fracture strength and fracture strain, which is opposite to the effect of strain rate. Armchair loading has been revealed to be more sensitive to strain rate than its counter direction. Unlike temperature and strain rate, point vacancy significantly deteriorates the elastic modulus of Ti4C3 MXene. Carbon vacancies are more probable than titanium vacancies, which have less formation energy. The atomistic deformation profile supports the predicted values of fracture strain from stress-strain behavior. This in-depth study offers a detailed understanding of the mechanical behavior of Ti4C3 MXene under diverse circumstances, which will aid further experimental study and be beneficial for adopting Ti4C3 as anode materials in LIBs.

Efficacy of Cricotracheal Stenosis Resection (CTSR) Among Children with Congenital vs. Acquired Sub-glottic Stenosis.

Sub-glottic Stenosis (SGS) treatment in children is challenging because there is no standard algorithm to follow; however, the use of endoscopic techniques in SGS treatment has emerged over the last decades and has advanced. The aim of this study was to assess the efficacy of Cricotracheal Stenosis Resection (CTSR) among children with congenital vs. acquired SGS. In this retrospective study, we reviewed the charts of 22 patients who underwent endoscopic intervention as the primary modality of treatment for SGS at King Abdulaziz Medical City from January 1, 2011 to October 31, 2019. Successful treatment was defined as: resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. Out of 22 patients, 14 cases were acquired and 8 were congenital SGS. Most of the patients had grade 3 stenosis before surgery 15 (68%), followed by grade 1 stenosis among 4 (18.2%) and grade 2 stenosis was present in 3 (13.6%) patients. Postoperatively, 17 (77.3%) patients improved to grade zero, whereas grade 3 stenosis was not reported in any patient. The Mc-Nemar's test showed significant improvement between pre- and post-operative stenosis grade with test value = 22, and P value = 0.003. This technique was successful among 18 (82%) patients with P value ≤ 0.01. Irrespective of the differences in the age of patients, length, and character of stenosis among congenital and acquired groups, the endoscopic CTSR technique proved to be successful in both groups. We achieved a success rate of 86% in the acquired series, and 75% in the congenital series, which is a very promising result.

Interest in Rhinoplasty and Awareness of Postoperative Complications Among Female High School Students in Riyadh, Saudi Arabia.

Background Rhinoplasty and revision rhinoplasty are facial cosmetic operations that have potentially profound psychological implications for an individual.In recent years, rhinoplasty has increased internationally because of body dysmorphic disorders but also social media influence. As with any surgery, rhinoplasty carries risks, and the aim of this study was to explore female high school students' interest in rhinoplasty and their awareness about its postoperative complications in Riyadh, Saudi Arabia. Methods We employed a cross-sectional design for the study, which included 413 female high school students aged 14 to 17 years. Participants signed a consent form, and data were collected through an online survey from September to November 2022. A validated questionnaire tested for reliability was used. The level of knowledge and interest in rhinoplasty was compared with the socio-demographic characteristics of the female students using the chi-squared test. A p-value of 0.05 was considered statistically significant. Results A total of 413 female high school students responded to our survey, and 135 completed questionnaires were received. Nearly half (48.7%) of the students were happy about the current form of their nose. Among the students, 74.3% would not consider undergoing rhinoplasty, and the most common reason was satisfaction with their nose (69.4%). Those who did intend to undergo rhinoplasty (25.7%) were primarily interested in improving their appearance (74.5%). The total mean knowledge score was 6.01 (SD 3.27) out of 12 points, with 61.7% classified as having poor knowledge levels, and the rest (38.3%) were considered as having good awareness. Conclusions In our perception, the number of teenagers wanting rhinoplasty is increasing. Questions about their knowledge level, attitude, and perspective regarding the procedure should be important considerations for the surgeon.

Atomistic reaction mechanism of CVD grown MoS2 through MoO3 and H2S precursors.

Chemical vapor deposition (CVD) through sulfidation of MoO3 is one of the most important synthesis techniques to obtain large-scale and high-quality two-dimensional (2D) MoS2. Recently, H2S precursor is being used in the CVD technique to synthesize 2D MoS2. Although several studies have been carried out to examine the mechanism of MoS2 growth in the presence of sulfur and MoO3 precursors, the growth of MoS2 in the presence of H2S precursor has largely remained unknown. In this study, we present a Reactive molecular dynamics (RMD) simulation to investigate the reaction mechanism of MoS2 from MoO3 and H2S precursors. The intermediate molecules formation, the reason behind those formations, and the surface compositions of MoOxSyHz during the initial steps of CVD have all been quantified. Surprisingly, a sudden separation of sulfur atoms from the surface was observed in the H2S precursor system due to the substantial oxygen evolution after 1660 K. The sulfur detachments and oxygen evolution from the surface were found to have a linear relationship. In addition, the intermediate molecules and surface bonds of MoS2 synthesized by MoO3 and H2S precursors were compared to those of a system using S2 and MoO3 precursors. The most stable subsidiary formation from the H2S precursor was found to be H2O, whereas in case of S2 precursor it was SO. These results provide a valuable insight in the formation of large-scale and high-quality 2D MoS2 by the CVD technique.

Outcomes of flexible fiberoptic laryngoscopy in patients with stridor: a cross-sectional study in a tertiary care pediatric center in Saudi Arabia.

BACKGROUND: Successful evaluation of a patient with stridor requires a thorough history and physical examination followed by a flexible fiberoptic laryngoscopy (FFL), which provides visualization of the upper airway. OBJECTIVES: Estimate the prevalence of causes of stridor in children who underwent FFL and compare different age groups. Find any significant associations between symptoms and laryngoscopic findings. Identify patients who needed further evaluation using direct laryngobronchoscopy (DLB). DESIGN: Retrospective, cross-sectional. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: We included all pediatric patients aged 1 month to 14 years who underwent fiberoptic laryngoscopy for stridor evaluation from January 2015 to January 2018 (37 months). Patients older than the age of 14 years, and patients with a workable diagnosis with adenotonsillar hypertrophy, choanal atresia, or laryngotracheo-bronchitis (croup) were excluded. MAIN OUTCOME MEASURES: Findings of FFL. SAMPLE SIZE: 217 pediatric patients. RESULTS: The median (interquartile range) age of the patients was 5 (8) months. Laryngomalacia was the most common diagnosis (n=149, 69%) followed by laryngopharyngeal reflux (n=42, 19%). Subglottic stenosis was the most common finding in patients who underwent DLB for further evaluation (n=19, 49%). Laryngomalacia was more frequent in children ≤12 months of age (83% vs 43% in children >12 months, P<.001). Vocal cord paralysis was more common in children >12 months of age (27% vs 9%, P<.001). FFL was effective in finding the diagnosis in 178 (82%) patients; only 39 (18%) patients needed further assessment using DLB. CONCLUSION: FFL is an effective and important tool for evaluating patients with stridor. LIMITATIONS: Retrospective design and single-centered. CONFLICTS OF INTEREST: None.

Laser-Assisted Endoscopic Cricotracheal Stenosis Resection (CTSR) in Paediatric Congenital Cartilaginous Subglottic Stenosis.

Subglottic stenosis (SGS) in children can be a congenital condition or acquired through injury such as from prolonged intubation. Surgeons face challenges in choosing the best SGS treatment for a particular patient because of variability in the success rate of each technique. Conventional open surgical resection and reconstruction have been proven effective but, in recent years, endoscopic surgery has become more prevalent as it eliminates the incision and reduces the surgery time and subsequent hospital stay. The purpose of this retrospective case study was to report on an endoscopic technique using a CO2 laser for cricotracheal stenosis resection (CTSR) for high-grade congenital SGS. From forty-five paediatric patients who underwent endoscopic intervention as a primary modality of treatment for high-grade SGS in a tertiary referral centre, a total of eight patients who met the inclusion criteria have been included in our study. This small patient series is the first to use a CO2 laser alone as a single excision tool to eliminate complex congenital SGS and restore airway patency. The procedure's goal was to return the airway to an early stage of postintubation injury prior to scar formation; therefore, surgical sessions at intervals of 2-3 weeks were performed to ensure natural epithelization, to remove any granulation tissue, and manage fibrosis. Successful treatment was defined as a resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. The success rate was 75%. Two outcomes need to be highlighted. First, the CO2 laser should be reconsidered as an excision tool for congenital SGS because of its low risk of exacerbating preexisting stenosis. It allows the surgeon to restore and augment the airway without the need for open surgery or dilatation. Second, the shorter interval between procedures is crucial for controlling the healing process and making sure that it is proceeding properly.

Social Media Impact on Aesthetic Procedures Among Females in Riyadh, Saudi Arabia.

Aesthetic procedures represent one of the most commonly performed procedures in the medical field. Such procedures have been growing in popularity. Social media is a term used to describe electronic platforms that promote the dissemination of information to targeted users. These platforms play a critical role in promoting aesthetic procedures. Objective The objective of this study was to assess the impact of social media on aesthetic procedures among the female population in Riyadh, Saudi Arabia. Methods A cross-sectional study was performed. A validated online questionnaire, consisting of 26 questions, was distributed among females visiting the facial plastic clinic at King Abdulaziz Medical City, in Riyadh, Saudi Arabia. Results Out of 1449 participants, 81% were aged between 25 and 34 years. The majority (78.8%) were aware of the complications that may follow aesthetic procedures. The decision to undergo such procedures was affected by the price in 77%. Overall, 97% thought that cosmetic specialized accounts on social media are helpful, yet 77.8% believed that such accounts do not provide sufficient information. The influence of social media upon participants was 68%; 31.9% claimed that social media had no influence. Instagram was the most influential application followed by Snapchat and then Twitter; 50% of the participants routinely apply Snapchat filters and 42% decided to undergo facial changes after applying Snapchat filters. Conclusion Social media is an important source of information with Instagram being the most influential platform. Facial filters have led to an increase in the number of aesthetic procedures carried out.

Knowledge about cochlear implantation: A parental perspective.

Objectives: Cochlear implantation (CI) is used for children with severe to profound hearing loss who show little or no improvement using hearing aids. This study explored parental knowledge of their children's CI. Methods: A cross-sectional study involving the parents of 115 pediatric CI patients was conducted at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia. Parents were interviewed by telephone using a 50-question validated questionnaire. Results: Most parents of children with CI reported being comfortable in using the internet (68.7%) and social media (40.9%) to obtain information regarding CI. Although most parents of children with CI relied on health professionals and websites as their main sources of information, they were also able to obtain necessary information at meetings for CI patients and health professionals. Parents of children with CI felt they had sufficient information regarding the impact of hearing loss (78%) and CI (71%) on speech understanding and language development; however, they had insufficient information regarding criteria for CI candidacy, available brands of CI devices, and the advantages and disadvantages of each. Conclusion: Parents reported that health professionals were the ideal source of information regarding hearing loss and CI. Moreover, our study showed that parents should learn more about cochlear implant devices, the post-implantation process, and candidacy criteria.

Aggressive ossifying fibroma of right ethmoidal sinus: A case report.

BACKGROUND: Ossifying fibroma is a rare benign fibro-osseous lesion seen in the bones of the head and neck area. It is mostly found in the mandible followed by the maxilla and rarely in the paranasal sinuses along with the orbit and skull bones. CASE PRESENTATION: A 30-year-old male patient presented with headache and incidental finding of a right ethmoidal sinus ossifying fibroma by paranasal-sinuses CT scan and MRI of the face. A flexible fiber-optic nasal endoscopy examination revealed a right side fullness. A non-contrasted CT scan of the paranasal sinus showed hyperdense lesion at the right ethmoid air cells. Functional endoscopic sinus surgery was performed and multiple nasal-mass biopsies were taken which showed fibro-osseous lesion most consistent with aggressive ossifying fibroma. Later, a near total resection of skull base tumor by endoscopic surgery was done and patient was discharged next day in a good condition. CONCLUSION: Ossifying fibroma is a rare lesion found in the head and neck area and it is unusual to be found in the paranasal sinuses. Thus crucial attention to the clinical, radiographical and histopathological examination should be taken for more accurate diagnosis and thus appropriate management.

Intranasal Lobular Capillary Hemangioma with Multiple Sites of Origin during Pregnancy: A Case Report and Literature Review.

In the present case report, we describe a 33-year-old pregnant woman in the third trimester with a history of recurrent epistaxis leading to frequent visits to the emergency department. Each episode of epistaxis was managed by anterior nasal packing. During endoscopic examination, a left nasal mass was seen. She was admitted and managed conservatively until she delivered her baby without complication. After delivery, a CT scan was taken, which showed an enhancing mass in the middle and lower meatus of the nasal cavity with no bony erosions. For symptomatic relief and tissue diagnosis, endoscopic surgical removal was advised. An intraoperative examination revealed a red, smooth, and well-circumscribed mass occupying the left nasal cavity and originating from the medial surface of the inferior turbinate and the inferior surface of the posterior part of the middle turbinate. A complete en bloc resection of the mass was performed endoscopically. The mass was sent for histologic analysis, which confirmed the diagnosis of lobular capillary hemangioma. Eventually, upon follow-up at two weeks, one month, three months, and six months postsurgery, no evidence of recurrence was detected.

Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review.

BACKGROUND AND OBJECTIVES: To share our experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and critically review the previously published studies. SETTING: Tertiary Referral Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia. PATIENTS AND METHODS: A retrospective case series study was conducted, where the case notes of all pediatric patients who underwent endoscopic management as a primary surgical intervention for acquired subglottic stenosis (SGS) from 2004 to 2014 were reviewed. All patients who underwent surgical correction with primary open laryngoplasty for congenital subglottic stenosis had been excluded. RESULTS: A total of 60 patients with a workable diagnosis of subglottic stenosis were reviewed. Forty-five patients were included in the study and 15 patients were excluded because they underwent open laryngoplasty as a primary treatment modality for congenital subglottic stenosis. The majority of the patients were males 29 (64%), with 16 (36%) females. The main presentation was stridor and intercostal recession. Thirty-nine (86%) patients had subglottic stenosis due to prolonged intubation; 5 (11%) patients were idiopathic and one patient (3%) had inflammatory reasons. The site of stenosis was isolated SGS in 41 while 4 patients had glottic-subglottic stenosis (GSGS). In terms of the grade of stenosis: 13 patients had grade I; 23 had grade II and 9 had grade III. The character of stenosis was soft except in 5 patients with hard (mature) scar. The number of dilatation procedures ranged from 1 to 6 with a mean of 2. The endoscopic management was considered to be successful when the patient is completely asymptomatic after the follow up period of one year. No major complications were recorded among the patients. Thirty-seven (82.3%) patients had a benign course post endoscopic intervention without complications and 8 (17.7%) underwent a secondary open surgical management due to re-stenosis (P value < 0.01). CONCLUSION: Our study showed that primary endoscopic management was successful in 82.3% of cases of acquired subglottic stenosis including those with high grade stenosis and long segment of more than 12 mm in terms of the craniocaudal length. CO2 laser was an important tool to convert mature hard stenotic segment into a soft one. The latter yielded to the lateral pressure created by balloon dilatation better.

Leiomyoma of the Vulva: A Diagnostic Challenge Case Report.

Uterine leiomyomas are common and can affect up to 30% of women older than 35 years. Despite this, leiomyomas of the vulva are rare, masquerading, and usually misdiagnosed as Bartholin cyst preoperatively. These smooth muscle tumors are typically painless, solitary, and well circumscribed and can affect female of any age group. We present a case of a 46-year-old female that presented to the clinic with 2-year history of right labial mass and was diagnosed as Bartholin cyst initially. The patient underwent elective excision under spinal anaesthesia and the mass was removed. The final diagnosis after microscopy result showed benign vulvar leiomyoma.

Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in an Urgent Care Center in Saudi Arabia.

OBJECTIVES: The objectives of the study is to review and assess the implementation of the applied modified five-level triage and acuity scale triage system in AL-Yarmook Urgent Care Center (UCC), King Abdulaziz Residential City, Riyadh, Saudi Arabia. METHOD: An observational cross-sectional study was conducted, where a data collection sheet was designed and distributed to triage nurses. The data collection was done during the triage process and was directly observed by the co-investigator. The triage system was reviewed by measuring three time intervals as quality indicators: time before triage (TBT), time before being seen by physician (TBP), and total length of stay (TLS) taking in consideration the timing of presentation and the level of triage. RESULTS: A total of 187 patients visiting the UCC during December 2014 were included. There was an almost equal distribution of males 98 (52 %) and females 89 (48 %) with most of the patients being in the age group of 14 years and younger (n = 85, 46 %). The visits of the patients were classified according to the level of triage from patients to be seen immediately by the physician to those who had been triaged out. Overall, 173 patients (92.5 %) were seen by the physician in a timely manner according to triage guidelines, while 14 patients (7.5 %) were not. The mean time was 5.36 min in TBT, 22.6 min in TBP, and 59 min in TLS. The median time to be seen by the physician was significantly greater (p = 0.001) for the urgent cases on the weekends (25 min; IQR, 21,30) as compared to the weekdays (17 min; IQR, 14,21). Generally, the results did not show significant increases in TBT, TBP, the number of patients not seen at the proper time, or referral and admission rates during weekends. CONCLUSION: The Canadian Emergency Department Triage and Acuity Scale (CTAS) is adaptable to countries beyond Canada and can be implemented successfully. The applied CTAS triage system in Al-Yarmouk UCC in Riyadh, Saudi Arabia, is considered to be well applied. Overall, urgent cases have been seen by physicians in a timely manner according to the triage system, and there was no delay in the management of critical cases which need prompt attention.