Chondroid syringoma of the nose: A rare case report and literature review.

INTRODUCTION AND IMPORTANCE: A chondroid syringoma is an exceptionally rare benign lesion of the sweat glands also known as mixed tumor of the skin (MTS). It can occur in different areas of the head and neck such as the lips, cheek, nose and scalp (Gotoh et al., 2022 [1]). It is usually painless and grows slowly. Based on pathological features it can be differentiated into apocrine or eccrine (Mixed cutaneous tumor: chondroid syringoma a case report, 2019 [2]). CASE PRESENTATION: Our patient presented with a nasal lesion in the left soft triangle, progressively increasing in size. He did not undergo any surgeries to the nose or any history of trauma. Due to the COVID-19 lockdown our patient did not seek early medical advice. In addition, the implementation of facemasks enabled for the concealment of the abnormality, which reduced the need of seeking treatment. CLINICAL DISCUSSION: Chondroid syringoma is a non-ulcerative tumor that grows slowly with an average diameter between 0.5 and 3 cm, however lesions reaching 9 cm have been also seen (Wan et al., 2018 [4]). The mainstay method of management is surgical excision while maintaining the aesthetic appearance of the patient. CONCLUSION: Owing to its rarity, clinical misdiagnosis is common, however absolute diagnosis is achieved by histopathology. This case delineates the rarity of this lesion and the mainstay method of management, which is surgical excision.

Management of a pediatric patient with spontaneous cerebrospinal fluid leak in the lateral recess of sphenoid sinus and meningoencephalocele: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Spontaneous cerebrospinal fluid (CSF) leak in the lateral recess of the sphenoid (LRS) sinus in a pediatric population is rare and is surgically challenging to repair. CASE PRESENTATION: We report a case of a 13-year-old girl with hydrocephalus and a ventriculoperitoneal shunt who presented with a two-month history of clear rhinorrhea from the right nostril. Computed tomography (CT) of the head was performed and showed CSF leak through a defect in the lateral recess of the sphenoid sinus. Defect closure was achieved using an endoscopic endonasal approach. CLINICAL DISCUSSION: CSF leak with meningoencephalocele from the sphenoid sinus is amongst the most difficult cases for repair. Yet the successful rate of repair is as high as 90 % if done endoscopically. Moreover, the location of the defect determines the surgical approach. CONCLUSION: Spontaneous CSF rhinorrhea from the lateral recess of the sphenoid (LRS) sinus, although rare, requires prompt diagnosis and treatment, as it may lead to significant mortality and morbidity.

Glossopharyngeal schwannoma a rare case report: Diagnostic and surgical approach.

INTRODUCTION AND IMPORTANCE: Schwannomas are tumors of the nerve sheath that consist of Schwann cells that are often described as slow-growing. Glossopharyngeal schwannomas are rare tumors present in the region of the posterior fossa, with limited case reports present in literature. While patients may present asymptomatically, some present with vestibulocochlear symptoms or lower cranial nerve dysfunction. CLINICAL PRESENTATION: We report an extremely rare case of a left para-pharyngeal carotid space glossopharyngeal schwannoma in a 26-year-old female. The presentation was a 3-month left sided neck swelling and a hoarse voice. Radiological investigations were completed (neck ultrasound; CT; MRI scans). Investigations revealed a solid lesion measuring about 29 × 10 mm. The final decision was to excise the mass under microsurgery. CLINICAL DISCUSSION: CN 9-11 schwannomas are often called jugular foramen schwannomas. Intraoperatively, these get differentiated as glossopharyngeal schwannomas. Diagnosis involves a physical examination, a detailed history, audiological assessments, and radiological investigations. While MRI scans are known as the most effective pre-operative diagnostic test, cases are in majority discovered intra-operatively. Surgical excision is the recommended approach. Post-operative recurrence is rare. Pre-operative diagnosis is often difficult due to the rarity and similarly presenting differential diagnoses. CONCLUSION: Schwannomas of the glossopharyngeal nerve are extremely rare tumors that may present with lower cranial nerve or vestibulocochlear deficits. Magnetic resonance imaging is a useful tool in diagnosing this unordinary tumor. This case report intends to provide further data regarding the clinical presentation, the patient population, and the diagnostic and surgical approach in dealing with this incredibly rare tumor.

Knowledge, attitude, practice, and barriers of evidence-based medicine among physicians in general hospitals in Kuwait: A cross-sectional study.

BACKGROUND: Evidence-based medicine (EBM) is renovating the field of medicine as it is being acknowledged as the standard and basis of clinical judgment. As general governmental hospitals are at the forefront of health-care in Kuwait, the practice of EBM among physicians could improve the health of the population. The aim was to assess the knowledge, attitude, practice, and barriers of EBM among physicians practicing in general governmental hospitals in Kuwait. METHODS: A cross-sectional study with self-reported questionnaires was used to survey 439 physicians in Kuwait's 6 general hospitals with a response rate of 74%. RESULTS: Respondent's knowledge of EBM was considerably low with a median knowledge score of 13 out of 20. Overall female physicians, undergraduates from Kuwait and Ireland, and those that received formal EBM training scored higher knowledge scores. Most respondents were unaware of well-known EBM resources, however more than half (69.3%) were aware of 'Up-to-date' and used it for clinical decisions. Most of the respondents had positive attitudes towards EBM: 88.2% either 'strongly welcomed' or 'welcomed' the promotion of EBM. Lack of investment by health-care authorities was the main perceived barrier to EBM. CONCLUSION: Overall, even though participants were not well-informed in regards to EBM, half of them claim that their practice is EBM-based and use EBM resources to support clinical decisions. Formal EBM training and integration of EBM in undergraduate programs considerably promotes EBM practice.