Metastatic sinonasal malignancies of colorectal origin: Case report and comprehensive review of the literature.

Primary adenocarcinomas represent a small percentage of sinonasal malignancies. Metastasis of colorectal malignancies to the paranasal sinuses is rare, poorly understood, and typically fatal. This case documents an unusual source of metastatic sinonasal malignancy and offers comparison to a cohort of similar patients found in the literature.

The Role of Immunosuppression on Postoperative Outcomes in Facial Fracture Repair.

Objectives: To assess postoperative outcomes in immunosuppressed patients with facial fractures. Methods: TriNetX, a large de-identified health research database, was utilized to compare outcomes within 30 days of treatment between immunosuppressed and immunocompetent patients with facial fractures. Subgroup analysis was conducted based on use of immunosuppressive therapy, human immunodeficiency virus (HIV) status, diabetes, and chronic kidney disease (CKD). Results: Nine thousand four hundred seventy-five patients were identified. On subgroup analysis, 555 patients were on immunosuppressants, 429 patients had HIV, 619 patients had CKD, 1322 patients with liver disease, and 3133 had diabetes. Immunosuppressed patients more frequently experienced postoperative infections [odds ratio (OR) 1.37 (1.9-1.54), P < .001], thromboembolic events [OR 1.71 (1.33-2.20), P < .001], hemorrhage [OR 1.46 (1.10-1.92), P = .0087], hospital readmission [OR 1.36 (1.28-1.44), P < .001], subsequent emergency department encounters [OR 1.08 (1.01-1.15), P = .0249], and wound disruptions [OR 1.52 (1.17-1.97), P = .0017]. Analyses comparing outcomes by immunosuppression type found increased rates of infection [OR 1.59 (1.25-2.01), P < .001], thromboembolic events [OR 1.56 (1.07-2.26), P = .0196], wound disruption [OR 1.57 (1.03-2.39), P = .0357], and hospital readmission [OR 1.28 (1.16-1.42), P < .001] in diabetic patients. Patients with CKD [OR 1.7 (1-2.90), P = .0478] had higher rates of infection [OR 2.02 (1.18-3.46), P = .0092] and readmission [OR 1.43 (1.14-1.79), P = .0017]. Patients with liver disease had higher rates of infection [OR 1.54 (1.07-2.23), P = .0210], thromboembolic events [OR 2.84 (1.37-5.87), P = .0033], and readmission [OR 2.14 (1.83-2.51), P < .001]. No significant differences were seen between groups for HIV patients. Conclusions: Immunosuppressed patients with facial trauma have a higher prevalence of postoperative complications compared to immunocompetent patients. Diabetics had a higher prevalence of most complications while patients with CKD and liver disease had higher rates of infections. Surgeons may consider measures to decrease postoperative risk in these patients and to provide preoperative patient counseling.

Impact of USMLE Pass/Fail Step 1 Scoring on Current Medical Students.

OBJECTIVES: The aim of this study was to examine students' perceptions of pass/fail scoring for Step 1, particularly when applying to competitive specialties. This study also investigated whether this transition increased anxiety among medical students and elicited student perspectives on the most critical components of residency applications. INTRODUCTION: The United States Medical Licensing Exam (USMLE) Step 1 Board Exam transitioned from a traditional numeric score to pass/fail for exams taken on or after January 26, 2022. One justification for this change, according to a statement from USMLE, was to ease the transition between undergraduate and graduate medical education. Although many factors are considered when selecting candidates to interview for residency, Step 1 scores were historically used as an important metric. Few studies specifically evaluated medical student's attitudes toward the change in Step 1 grading. METHODS: An online survey was distributed to Penn State College of Medicine medical students in the 2024 to 2027 classes. Statistical analysis was conducted on responses to research plans, attitudes regarding Step 1 pass/fail, match rates, and importance of application components. RESULTS: There was a 21.3% response rate (127/596) to the survey with 30.7% pursuing a competitive specialty. Students applying into competitive specialties felt their chances of matching changed significantly compared to students applying to other specialties (either increased (25.6% vs 10.2%, P < .001), or decreased (28.2% vs10.3%, P < .001). Majority of students (73.2%) agreed with the decision to make Step 1 pass/fail, however, students reported increased anxiety surrounding Step 2 scores. There was a significant association between which aspects students believed were most important for matching (letters of recommendation and performance on Acting Internships) and those they believed program directors would weigh heaviest (P < .001). CONCLUSION: Medical students report increased anxiety with Step 2 after Step 1 became pass/fail, although students overwhelmingly agreed with this change. To address this, medical schools should offer further guidance and resources to students, focusing on mentorship and methods to optimize residency applications for their chosen specialties.

Impact of the COVID-19 Pandemic on the Incidence, Etiology, Demographics, and Treatment of Craniomaxillofacial Trauma.

OBJECTIVE: To compare the incidence, etiology, demographics, and treatment of craniomaxillofacial (CMF) trauma before, during, and after COVID-19. STUDY DESIGN: Retrospective cohort. SETTING: Eighty-three health care organizations across the United States. METHODS: The TriNetX Research Network identified 77,977,880 patients during 2017 to 2022. CMF fractures and soft tissue injuries during March to August of each year, aligning with the 2020 pandemic lockdown, were analyzed. RESULTS: In 2020, compared to immediately prepandemic in 2019, there were significant reductions of -17.5% in facial fractures and -19.0% in soft tissue injuries (P < .001). Conversely, in 2021, both injury types increased by +16.7% and +16.3%, respectively, compared to 2020 (P < .001). Changes in injury mechanisms in 2020 included significant decreases in athletic injuries (-57.6%), falls (-16.8%), assaults (-15.5%), motor vehicle collisions (-8.7%), and pedestrian accidents (-6.9%) (P < .01), while off-road vehicle (+48.4%), bicycle (+16.2%), and motorcycle (+8.9%) accidents increased (P < .01). The 10- to 14- and 5- to 9-year-old age groups experienced the most substantial reductions in facial fractures (-39.7% and -29.9%, respectively) and soft tissue injuries (-29.2% and -28.3%, respectively) in 2020 compared to 2019 (P < .001). Operative management of fractures and soft tissue injuries dropped by -20.3% and -12.4%, respectively, in 2020 versus 2019, and then rebounded with +15.8% and +14.6% increases in 2021 compared to 2020 (P < .001). In 2022, compared to prepandemic rates of 2019, there were fewer patients with facial fractures (-2.8%), soft tissue injuries (-4.5%), and operative repairs (-6.9% for fractures, -1.2% for soft tissue injuries) (P < .03). CONCLUSION: CMF trauma decreased in 2020, with subsequent years showing a rebound to levels slightly below those immediately prior to pandemic onset. Changes in etiology, demographics, and treatment highlight the complex dynamics of traumatic injuries during periods of societal disruption.

Impact of COVID-19 on facial plastic surgery volumes: A large database analysis of pre- and post-pandemic trends.

Objective: During the COVID-19 pandemic, elective surgeries faced cancelations due to quarantine measures. The objective of this study was to assess facial plastic and reconstructive surgery (FPRS) volume before, during, and after the height of the pandemic on a national scale. Methods: The TriNetX Research Network identified 68,101,098 individuals aged 18+ with healthcare interactions from 2017 to 2022. Rates of common FPRS surgeries and procedures were compared during March-August of each year, aligning with the pandemic lockdown. Results: Compared to immediately before the pandemic in 2019, the 2020 pandemic peak saw an overall surgical volume reduction of -36.8%, with specific surgeries decreasing significantly: rhinoplasty (-28.6%), septoplasty (-34.0%), rhytidectomy (-54.9%), blepharoplasty (-40.7%), brow lift (-43.8%), ectropion/entropion repair (-35.6%), repair of blepharoptosis (-45.6%), correction of lagophthalmos (-29.9%), correction of lid retraction (-36.8%), and lipectomy (-41.8%) (p < .001). The procedural volume also decreased by 28.6%, encompassing reductions in various procedures: botulinum toxin A (-18.7%), facial filler (-40.7%), dermabrasion (-62.3%), chemical peel (-36.6%), and intralesional injection (-33.3%) (p < .001). In contrast to 2020, 2021 witnessed an increase of +75.0% in total surgical and +61.3% procedural volume: rhinoplasty (+81.0%), septoplasty (+74.7%), rhytidectomy (+143.4%), blepharoplasty (+81.7%), brow lift (+64.5%), ectropion/entropion repair (+55.2%), repair of blepharoptosis (+62.7%), correction of lagophthalmos (+39.0%), correction of lid retraction (+73.0%), lipectomy (+121.2%), botulinum toxin A (+52.4%), filler (+59.6%), dermabrasion (+91.8%), chemical peel (+78.8%), and intralesional injection (+67.3%) (p < .001). In 2022, rates of total surgeries (+8.5%) and procedures (+12.8%) surpassed pre-pandemic levels from 2019 (p < .001). Conclusions: FPRS experienced significant pandemic-induced decreases, followed by a notable recovery in subsequent years, with certain surgeries and procedures surpassing pre-pandemic levels. Level of Evidence: 4.