Total Number of Lymph Nodes in Neck Dissection and Its Relation to Cancer-Positive Lymph Nodes as a Prognostic Indicator in Aerodigestive Tract Cancers: A Multi-Center Study.

Objectives Few studies have been conducted on the total number of lymph nodes (LNs) in neck dissection and the lymph node ratio (LNR; number of positive lymph nodes divided by number of excised lymph nodes), or their potential use as a prognostic indicator for cancers of the upper aerodigestive tract (UADT) and its treatment. We aimed to measure the number of lymph nodes dissected and the LNR to assess their prognostic value for cancers of the UADT, as well as their effect on overall survival and disease-free survival. Methods We performed a retrospective study of patients diagnosed with cancer of the UADT who underwent neck dissection as the primary or secondary modality of their treatment plan at King Abdulaziz University Hospital and the National Guard Hospital, Jeddah, Saudi Arabia. Data were collected through medical records and analyzed to assess prognosis and calculate survival rates in relation to the number of lymph nodes and LNR. Results A total of 121 patients were included: 14 women (11.57%) and 107 men (88.43%). The median age was 60 years and the mean follow-up period was 2.7 years. Of the malignancies, 44.63% were of the oral tongue and 35.54% were laryngeal. A median of 38 lymph nodes were dissected during neck dissections. The distribution of the individual LNRs was characterized by mean values. A mean LNR of 0.04 was considered the cutoff value, an LNR of > 0.04 a high LNR, and an LNR of < 0.04 a low LNR. Kaplan-Meier survival estimates for the cohort showed a three-year overall survival rate of 88% (95% confidence interval [CI]: 77% to 94%) for patients with a low LNR, but 71% (95% CI: 47% to 85%) for patients with a high LNR, which was statistically significant. A similar significant decreasing trend persisted at the four-year follow-up, where the disease-free survival rate was 73% (95% CI: 61% to 82%) for patients with a low LNR compared with 56% (95% CI: 35% to 72%) for patients with a high LNR. Conclusion The number of excised lymph nodes in neck dissections and the LNR might be a good prognostic indicator for overall survival and disease-free survival in patients with cancers of the UADT and may serve as a valuable tool in deciding on different treatment plans.

A Rare Case of Parotid Nodular Fasciitis in a Six-Month-Old Female.

Nodular fasciitis (NF) is a rare benign self-limiting lesion that is often mistaken for malignancy due to its progressive nature. Reported cases of nodular fasciitis in the parotid gland are uncommon, and its incidence is variable among different age groups. Histopathological and immunohistochemical studies are helpful in distinguishing these kinds of lesions. We report a case of a six-month-old baby with a two-month history of progressive rapid-growing mass in the left parotid region. Clinical examination showed some mild facial nerve weakness with no other significant findings locally or systemically. Fine-needle aspiration (FNA) was inconclusive, and surgical excision was the choice of treatment. On histological examination, the mass was confirmed to be nodular fasciitis, and on follow-up, the patient had no signs of recurrence. Nodular fasciitis can appear in young infants and, if confirmed histopathologically and immunohistochemically, should be treated conservatively.

Worst pattern of invasion and other histopathological features in oral cancer as determinants of prognosis and survival rate: A retrospective cohort analysis.

Oral cavity squamous cell carcinoma (OCSCC) is a well-recognized malignancy of the head and neck. Studies on patients with early-stage oral cancer have shown that they develop locally recurring and/or regional lymph node metastasis, which results in disease-associated mortality. Thus, early-stage oral cancer does not always present good prognoses. The present study aimed to determine the efficacy of using worst pattern of invasion (WPOI) and other histopathological features, such as prognostic factors in OCSCC, and analyze the impact of resection margin status and histopathological prognostic indicators on local recurrence (LR) and overall survival (OS) in patients with OCSCC. A retrospective cohort study was conducted by reviewing the charts of 63 patients with OCSCC treated with primary surgery at King Abdulaziz University Hospital between 2012 and 2019. An author and an experienced pathologist reviewed pathology slides. Associations of histopathological factors, including differentiation, stage, lymphovascular invasion, extracapsular extension, perineural invasion (PNI), WPOI and surgical margins, with LR or disease-free survival (DFS) were evaluated. Univariate analysis identified WPOI and PNI, and multivariate analysis identified the WPOI as predictive factors for LR and DFS. Kaplan-Meier analysis identified the WPOI and PNI as predictive factors for OS and WPOI as a predictive factor for DFS. Therefore, it may be concluded that WPOI and PNI are significant independent prognostic factors for local tumor control and DFS in patients with OCSCC.

Primary prevention of depression in head and neck cancer patients: a scoping review.

OBJECTIVES: To conduct a scoping review of the literature on psychological interventions directed to identify primary prevention strategies for depression among adult head and neck cancer (HNC) patients. METHODS: Systematic searches were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review including relevant studies within the PubMed, PsycINFO, and EMBASE databases. Two authors independently screened the searches and reviewed the included articles according to the predetermined eligibility criteria based on the PICOS format. Studies included subjects with previous or current diagnosis of depression were excluded. The risk of bias assessment of these trials was conducted following the Cochrane tool for assessing the risk of bias in randomized trials. The search was repeated prior to submission to ensure all current articles meeting criteria were included. RESULTS: The search yielded 875 studies. The title and abstract screen, followed by the review of full texts identified five articles that met inclusion criteria. Four were randomized controlled trials (RCT) and the fifth was a non-randomized but controlled study. Different psychosocial interventions were used, including psycho-educational interventions, psychosocial counseling, and pharmacotherapy. All studies established the diagnosis of depression or screened for the diagnosis using standardized psychiatric assessment tools, either Diagnostic and Statistical Manual of Mental Disorders criteria or validated patient reported outcome measures. The average follow-up periods after intervention was 9.8 months. There was a significant decrease in the incidence of depression or depressive symptoms favoring the intervention group in three out of the five studies that were included. CONCLUSION: Psychological interventions identified thus far studying primary prevention of depression in HNC patients show promising results. However, the paucity of data and heterogeneity of the interventions challenges the ability to compare the prevention modalities and outcomes. Future well-designed RCTs with large sample sizes are recommended to better conclude a result of effectiveness.

Accuracy of Four-Dimensional Computed Tomography and Different Imaging Modalities in Primary Hyperparathyroidism.

Background This study aimed to compare the accuracy of different imaging modalities in the preoperative localization of parathyroid pathology in primary hyperparathyroidism. Methodology This prospective study enrolled 70 patients who were biochemically diagnosed with primary hyperparathyroidism between 2021 and 2022 at our center. Patients underwent scanning using three imaging modalities, namely, Tc99m sestamibi scan (sestamibi), parathyroid ultrasonography, and four-dimensional computed tomography (4DCT). A descriptive analysis was performed to determine and compare the respective localizing sensitivities. Results The most common site of parathyroid adenoma (PA) was the left inferior parathyroid gland, seen in 28 (40%) patients. Three patients had false-positive imaging studies with no parathyroid pathology identified surgically or on histological examination. The median levels of parathyroid hormone decreased significantly (p < 0.001) after the surgery, with a median of 24.3 (1.90-121). Furthermore, 4DCT accomplished a sensitivity of 97.14% for diagnosing the side and 94.03% for overall localization of PA. This sensitivity was superior to the sensitivity of ultrasonography and sestamibi scan to detect the side and quadrant of the adenoma. 4DCT was significantly higher in sensitivity when compared to the combination of ultrasound and sestamibi (p < 0.001). Conclusions 4DCT yielded the highest sensitivity in localizing parathyroid pathology from the imaging modalities studied with the lowest false-negative rate. Using ultrasound with 4DCT could be the most cost-effective combination for detecting primary hyperparathyroidism.

Determining the Site of Upper Airway Narrowing in Snorers Using a Noninvasive Technique.

Background In this study, we aimed to determine the site of obstruction if surgical treatment is considered. Flexible nasopharyngoscopy is an invasive procedure currently used for the assessment of snoring and the level of obstruction. Here, we examine the role of Somnoscreen™ plus, a noninvasive cardiorespiratory polysomnographic device, in identifying the site of obstruction in patients presenting with snoring. Methodology This cross-sectional study was conducted in the Sleep Research Center at King Abdulaziz University Hospital. Polysomnography was conducted using Somnoscreen™ plus. All participants underwent flexible nasopharyngoscopy after polysomnography. Results Nasopharyngoscopy revealed that the most common site of obstruction was the nose and the soft palate (35.4%), followed by the soft palate alone (25%). Somnoscreen revealed that the site of obstruction was the nose and the soft palate in 18 (37.5%) patients and the nose alone in 16 (33.3%) patients. However, distal obstructions were not detected using Somnoscreen. The concordance of nasopharyngoscopy and Somnoscreen was 52.9%. However, it showed a discrepancy in identifying distal obstructions, which Somnoscreen™ plus failed to detect. Conclusions Somnoscreen appears to be sensitive for identifying proximal airway obstructions. The audio signal recordings can potentially be used as a tool to detect the site of airway obstruction in snoring; however, further studies are needed.

Short and Long-Term Voice and Swallowing-Related Quality of Life in Patients Who Underwent Total Laryngectomy and Tracheoesophageal Puncture.

Background Voice and swallowing disorders can create a profound psychosocial impact on the patient's quality of life. The focus of this study is to assess the psychosocial disabling effects on patients after total laryngectomy (TLP) using pre-validated surveys called the Voice Handicap Index 10 (VHI) for voice disorders and the Dysphagia Handicap Index (DHI) for swallowing disorders. Methodology This is a retrospective cohort study that was done on a total of 21 patients. The study was conducted at King Abdulaziz University Hospital between 2017 and 2022. The Cronbach's alpha value was used to evaluate internal consistency reliability. The relationship between DHI, VHI, and demographic and clinical variables was analyzed by correlation analysis. A p-value of <0.05 was considered statistically significant, and all the tests were two-sided. Results The Cronbach's alpha coefficient satisfied the internal consistency reliability for VHI and DHI for both total and their subscale scores. For DHI, the total score and emotional subscale obtained an alpha of greater than 0.9, indicating excellent internal consistency, whereas both physical and functional alpha scores indicated good internal consistency (α = 0.888 and α = 0.863, respectively). For VHI, the total score and physical subscale of the VHI had excellent internal consistency (α = 0.957 and α = 0.937, respectively), while the functional and emotional subscales had good internal consistency (α = 0.865 and α = 0.894, respectively). The total DHI scores, as well as the functional subscale scores, were significant (p = 0.033, p = 0.025, respectively) in terms of self-reported dysphagia severity. A moderately severe group (69.00 ± 19.17) had higher mean total scores, whereas severe individuals had higher subscale mean scores according to self-reported dysphagia severity. Self-reported dysphagia severity was as follows: normal (n = 3, 14.3%), mild (n = 4, 19%), moderate (n = 8, 38.1%), and severe (n = 6, 28.6%). Conclusions The disability caused by voice and swallowing disorders can be evaluated by VHI and DHI which have been statistically validated as reliable tools to assess the effects of dysphagia and dysphonia on quality of life. Patients after laryngectomy have higher mean DHI and VHI overall and functional subscale scores. However, this study failed to establish any relationship between clinical and demographical characteristics of the patients with DHI and VHI index.

Prophylactic Central Neck Dissection for Clinically Node-Negative Papillary Thyroid Carcinoma.

OBJECTIVE: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients. METHODS: We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI). RESULTS: Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups. CONCLUSION: For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events. LEVEL OF EVIDENCE: 1 Laryngoscope, 132:1320-1328, 2022.

The Association between Adenotonsillectomy and Frequency of Vaso-Occlusive Crises in Patients with Sickle Cell Disease.

Sickle cell disease (SCD) typically manifests in early childhood as attacks of pain known as vaso-occlusive crises. Infection and hypoxemia have been linked with these recurrent episodes and with prolonged hospitalization in SCD patients. However, adenoids and tonsils as sources of infection and causes of hypoxemia have not been adequately investigated in association with vaso-occlusive crises in SCD. To assess the association between adenotonsillectomy and frequency of vaso-occlusive crisis in SCD patients who underwent this procedure at our Hospital, and between adenotonsillectomy and frequency of blood transfusions and emergency department and intensive care unit admissions. We used medical record data to conduct a retrospective review of SCD patients who underwent adenoidectomy and/or tonsillectomy between 2005 and 2017. Eligible subjects were assessed for frequency of vaso-occlusive crises, blood transfusions, and emergency department and intensive care unit admissions. Using the Wilcoxon signed rank test, we compared the frequencies of each outcome preoperatively and 1, 3, 5, and 10 years postoperatively. Of 524 records reviewed, 40 eligible patients were included in the study. Minimal reduction was observed in the frequency of vaso-occlusive crisis episodes within 1 and 3 years after adenotonsillectomy (p = 0.337 and p = 0.549, respectively). Although the 5- and 10-year postoperative vaso-occlusive crisis frequency tended to be higher than that in the preoperative period, none of the results reached statistical significance. The number of emergency department admissions showed a statistically significant increase 3 years postoperatively compared with that in the preoperative period (P = 0.043). There were no statistically significant differences in perioperative blood transfusion frequency or number of intensive care unit admissions in any period. Adenotonsillectomy in SCD patients does not seem to be related to the frequency of vaso-occlusive crises, blood transfusions, or emergency department or intensive care unit admissions. Prospective studies with larger sample sizes are recommended to further evaluate these findings.

Arabic Translation and Validation of Olfactory-Specific Quality of Life Assessment Questionnaire.

BACKGROUND:  Olfaction plays a critical role in our health, emotions, social life and safety, which is why olfactory dysfunction has a great impact on a person's life. This has been highlighted with the recent coronavirus disease 2019 (COVID-19) pandemic. Despite Arabic being the fifth most commonly spoken language and one of the six official languages of the United Nations, there is no Arabic version for an olfactory-specific quality of life assessment tool. METHOD:  The Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) is a validated questionnaire that assesses many aspects of a patient's daily life. We translated this questionnaire to the Arabic language following European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group Translation Procedure guidelines. A pilot-testing of the Arabic version was done among 20 participants, 10 of whom were confirmed to have normosmia based on scoring at least 11/12 on the Sniffin' Sticks (SS) olfactory testing (Group 1) and another 10 participants who reported anosmia and scored less than 7/12 on the SS test. Patients could agree, partially agree, partially disagree, or disagree with each questionnaire statement. RESULTS:  The pilot study revealed that participants with confirmed anosmia had higher questionnaire scores compared to participants with normosomia (median 22 compared to 1, p value < 0.001). For each statement on the Arabic questionnaire, all questions scored at least 80% of intra-rater reliability, and the overall intra-rater reliability was 90%. CONCLUSION:  The Arabic translation of QOD-NS is a validated questionnaire that can be used both in academic and clinical practice.

Elective node dissection versus observation for management of patients with early-stage cT1/T2N0 tongue carcinoma: A systematic review and meta-analysis of prospective studies.

OBJECTIVE: To carry out a meta-analysis of prospective literature comparing the clinical efficacy of elective neck dissection (END) vs observation (OBS) in patients with early-stage cT1/T2N0 tongue carcinoma. DESIGN/SETTING/PARTICIPANTS/OUTCOME MEASURES: We systematically reviewed four databases from inception to 30-October-2020. We considered all studies meeting the following PICOS conditions: (a) Patients: early-stage cT1/T2N0 tongue carcinoma, (b) Intervention: END, (c) Comparator: OBS, (d) Outcomes: local tongue recurrence, cervical nodal recurrence, disease-specific survival (DSS) rate, and disease-free survival (DFS) rate and (e) Study design: prospective reports. We pooled dichotomous data as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Four studies (one case-control study and three randomised controlled trials) met our inclusion criteria. There were 448 eligible patients (225 and 223 patients were treated with END and OBS, respectively). END significantly correlated with improved DSS rate (RR = 1.15, 95% CI: 1.04-1.27, P = .007). Nonetheless, there were no significant differences between END and OBS groups regarding the rates of local tongue recurrence (RR = 1.23, 95% CI: 0.50-3.03, P = .65), cervical nodal recurrence (RR = 0.45, 95% CI: 0.16-1.27, P = .13) and DFS rate (RR = 1.08, 95% CI: 0.91-1.27, P = .38). Pooled analysis for cervical nodal recurrence was heterogeneous, and sensitivity analysis revealed a significantly lower cervical nodal recurrence rate in favour of END group (RR = 0.30, 95% CI: 0.13-0.67, P = .004). CONCLUSION: END correlated with a significant decrease in cervical nodal recurrence and improved DSS rate. END might be superior to OBS in patients with early-stage cT1/T2N0 tongue cancer.

Frequency of Preoperative Localization Techniques of Parathyroid Adenoma at King Abdulaziz University Hospital, Saudi Arabia.

Background Accurate preoperative radiological localization of parathyroid pathologies paves the way to enable less invasive surgical procedures. Results on the accuracy of the different diagnostic measures are conflicting. Also, little is known about the most common location of parathyroid lesions. This paper aims to determine the most common location of parathyroid adenoma and evaluate the diagnostic performance of radiological modalities such as ultrasonography, sestamibi scintigraphy/single-photon emission computerized tomography (SPECT), magnetic resonance imaging (MRI), and computed tomography (CT) scan for the preoperative localization of parathyroid pathologies. Methods This is a retrospective study. Data were collected from patients who underwent total or partial parathyroidectomy at King Abdulaziz University Hospital between January 2000 and March 2020. The parathyroid adenoma site was detected preoperatively by a radiological method and confirmed postoperatively by the histopathology report. The performance of each preoperative localizing radiological method was evaluated based on the accuracy in localizing parathyroid pathology. Results A total of 73 patients were included in the analysis, with females being the most common gender in the study at 64%. Only complete data files were included and incomplete data files were excluded. The most frequent mode of detecting parathyroid adenoma was a sestamibi/SPECT scan (62.5%) followed by a CT scan (50%), ultrasound (34.6%), and MRI (25%). The most common location of a parathyroid adenoma was the left side. Conclusion Sestamibi/SPECT is a frequent radiological method for detecting the parathyroid lesion site as compared with CT, MRI, and ultrasonography.

Human papillomavirus knowledge and vaccine acceptability among male medical students in Saudi Arabia.

Human papillomavirus (HPV), the most common sexually transmitted infection worldwide, is responsible for a variety of cancers. HPV vaccines can help prevent this infection and its potentially devastating carcinogenic outcomes. Although the incidence of HPV-related oropharyngeal cancers among males is increasing, few studies have been published on HPV knowledge and vaccine acceptability among males. In this cross-sectional study, we assessed knowledge about HPV and the vaccine, as well as its acceptability, among third- and fourth-year male medical students in Jeddah, Saudi Arabia. Respondents were enrolled in any of the medical colleges in Jeddah from February to December 2018. A validated survey was used to collect information on HPV infection and vaccine knowledge and to ask questions assessing vaccine acceptability. HPV knowledge scores were created, and vaccine acceptability predictors were assessed with logistic regression. We collected data from 517 participants. Approximately 74% of the students had heard of HPV, with a mean knowledge score of 5.9 ± 4.6 out of 16; only 42% had heard of the HPV vaccine, with a mean knowledge score of 0.9 ± 1.6 out of 7. Among the respondents, 48.9% were interested in receiving the HPV vaccine. Although HPV infection and vaccine knowledge did not correlate with vaccine acceptability, those who had previously received the hepatitis B vaccine were more interested in receiving the HPV vaccine. In conclusion, male medical students had low HPV knowledge. Improving their HPV knowledge is important, as they are future health-care providers. The promotion of HPV vaccines in this potentially influential group is crucial for achieving effective disease prevention.

Effect of Intranasal Corticosteroids on Intraocular Pressure and Nerve Fiber Layer Thickness: A Cross-Sectional Study at a Tertiary Care Hospital in Western Saudi Arabia.

Background Rhinitis represents a global health problem, affecting 10%-20% of the population in Saudi Arabia. Topical intranasal corticosteroids (INCS) are widely used by otolaryngologists to treat patients with rhinitis for long periods. Although the effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity are well established, the impact of INCS is not well defined. In the present study, we aimed to assess the effect of using INCS on IOP over a six-month period in patients with rhinitis. Methodology In this study, a questionnaire was distributed to 93 patients diagnosed with rhinitis in the Ear, Nose, and Throat Clinic of King Abdulaziz University Hospital, Saudi Arabia, between February and July 2019. Thereafter, each patient was evaluated in the Ophthalmology Clinic with optical coherence tomography of the optic nerve using Cirrus HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA) optic disc scans, visual acuity testing, and Goldmann applanation tonometry. Pearson correlation coefficients and two-tailed tests of significance were used to assess the relationships between variables. Results All 93 patients were using a dose of two puffs at least twice daily for each nostril. Their IOPs, as depicted by Goldman applanation tonometry, were found to be within normal limits. Retinal nerve fiber layer thickness was also found to be normal in 95% of the participants. Conclusions Our study showed no correlation between INCS and IOP. As an increase in IOP can lead to glaucoma, our data demonstrate the safety profile of INCS use. For patients with rhinitis, this finding could change compliance to medication and reduce the burden of the disease.

Papillary Microcarcinoma of Sublingual Thyroid Gland: A Case Report.

Ectopic thyroid gland is a rare condition where the thyroid is not placed in the pre-tracheal region. Majority of cases are commonly located at the lingual portion. The malignant shift of ectopic thyroid is considered a rare manifestation with a challenging surgical approach. Here we report our management and surgical approach of a patient with papillary microcarcinoma of sublingual thyroid gland presented to our facility.

Awareness of the first aid management of foreign body aspiration among students: A cross-sectional study.

BACKGROUND: Pediatric foreign body aspiration (FBA) is a life-threatening condition responsible for many deaths every year, especially among children younger than 2 years. OBJECTIVE: This study aimed to determine the level of knowledge among students in Jeddah, Saudi Arabia. SUBJECTS AND METHODS: This observational, cross-sectional study was conducted between December and January 2018 at Jeddah, Saudi Arabia via a paper-based questionnaire survey of male and female high school and middle school students. The Chi-square test was used to compare frequencies, and the independent t-test was used to compare means. RESULTS: A total of 671 students participated in this survey. The second item, "It is possible for a child to choke on a small toy" had the highest rate of correct responses among both males and females (93.2% vs. 94%, respectively). The eighth item "Sudden cough is a sign of choking among children" had the lowest rate of correct responses among males (40.8%) and females (33%). Most female participants (74.2%) knew that batteries are the most dangerous items a child can swallow, which requires immediate medical attention (item 14), while only 56.2% of male participants knew that (P < 0.001). The only significant predictor on linear regression analysis was "Having treated anyone with FBA" (coefficient = -0.24, P = 0.03). CONCLUSIONS: There is inadequate knowledge regarding FBA among middle and high school students, as is the case among mothers. Moreover, only a small percentage of participants had any first aid training.

Utilization of cross-matched blood in elective thyroid and parathyroid surgeries: a single-center retrospective study.

BACKGROUND: Hospital blood banks face the common challenge of maintaining an adequate supply of blood products to serve all potential patients while minimizing the need to discard expired blood products. This study aimed to determine the risk of blood transfusion during elective thyroid and parathyroid surgery and potential factors related to blood loss and risk of transfusion in these cases. METHODS: The study included all thyroid and parathyroid surgeries performed at King Abdulaziz University Hospital between January 2015 and December 2017. After exclusion of patients with incomplete data, 179 patients with complete data who had undergone thyroid and parathyroid surgery were analyzed. RESULTS: Of the179 patients included in this study, 33 (18.4%) were male. Overall, patients had a mean age and body-mass index of 44.55±13.67 years and 27.66±5.38 kg/m2, respectively. The mean duration of surgery was 168.48±90.69 minutes. None of the patients had a history of previous radiotherapy, bleeding disorder, or blood transfusion. Benign goiter was the most common finding (n=78, 43.6%), followed by papillary carcinoma (n=49, 27.4%). During surgery, most patients (n=136, 76.0%) experienced minimal blood loss. None of the patients in our cohort (n= 179) required any blood transfusion or products. CONCLUSION: In this study, we aimed to audit the surgical blood-ordering and -transfusion practices associated with elective thyroid and parathyroid surgeries at our institution. These practices are intended to balance the availability of blood products with the avoidance of unnecessary wastage. In our study of patients who underwent elective thyroid and parathyroid surgeries, parathyroid surgeries, none required blood transfusion.

The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction.

BACKGROUND: To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC). METHODS: A retrospective review of a prospectively collected database of all patients with OPSCC diagnosed and treated from 1998 to 2009. Speech, swallowing, and quality of life data were gathered at 3 different evaluation points. HPV status was determined using p16 positivity as a surrogate marker. Univariate and multivariate statistical analyses were performed to identify whether p16 status is a significant predictor of functional outcome and QOL. RESULTS: One hundred twelve patients with OPSCC and known p16 status were treated with primary surgery between 1998 and 2009, with mean age of 56 years. Out of those patients 63 (56%) were p16 positive. Speech intelligibility remained high at 1-year post operation (95.4%). Only 11.5% of the patients required a feeding tube at 1 year after surgery to maintain their daily caloric requirements and the risk of aspiration after surgery was not significant (p = 0.097). There was no statistically or clinically significant difference in speech, swallowing ability, swallowing safety and QOL outcomes between p16-positive and negative OPSCC. CONCLUSIONS: Surgically treated OPSCC patients demonstrate excellent swallowing function and can achieve excellent speech perception. P16 status may not be predictive of functional outcomes or QOL in surgically treated OPSCC.

An Enlarged Goiter Presenting with a Rare Diffuse Lipomatosis of the Thyroid Gland.

BACKGROUND Diffuse lipomatosis of the thyroid gland is a particularly rare histopathological condition characterized by diffuse fatty infiltration within the thyroid stroma. CASE REPORT We report a case of a 53-year-old woman who presented with a 2-year history of massive neck goiter and mild dysphagia. A computed tomography (CT) scan revealed heterogeneous enhancing of an enlarged thyroid gland with left lobe cranial extension and compression of the pharynx, and caudal bilateral retrosternal growth. The patient underwent total thyroidectomy and histopathological examination revealed mature fatty tissue diffusely distributed throughout the thyroid gland. Excision of the gland was somewhat challenging due to the very thin thyroid capsule and recurrent protrusion of fat from the capsule. CONCLUSIONS Diffuse thyroid lipomatosis is an extremely rare histopathological condition characterized by diffuse fatty infiltration in thyroid stroma. Despite its rarity, it should be considered in the differential diagnoses of a patient presenting with a goiter.

Prevalence and clinical predictors of LPR among patients diagnosed with GERD according to the reflux symptom index questionnaire.

Background/Aims: Gastroesophageal reflux disease (GERD) is a common condition that can lead to significant morbidity. Laryngopharyngeal reflux (LPR) is a distinct clinical entity that can occur simultaneously with GERD, necessitating additional treatment measures. The degree of overlap and clinical predictors of LPR among patients with GERD remains unknown. We aim to measure the prevalence of LPR in patients with GERD and identify clinical predictors. Patients and Methods: We performed a cross-sectional study involving patients with confirmed GERD according to the GERD questionnaire (GerdQ) using the reflux symptom index (RSI). Data on demographics, comorbidities, past and current medications, and GERD-related lifestyle measures were documented. The prevalence of LPR was calculated. Linear and logistic regression analyses were conducted to correlate GerdQ and RSI, and to identify clinical predictors of LPR, respectively. Results: A total of 80 patients with confirmed GERD were consecutively recruited and surveyed. Mean age was 43 (±16) and 60% were females. The majority of patients were Saudis (51%) and only 24% were smokers. The mean duration of GERD was 7 (±4.4) years and the average body mass index (BMI) was 36 ± 22. Sixty-six percent of the patients consumed coffee on regular basis. On simple and multiple linear regression analyses, a strong, positive correlation was observed between the GerdQ and RSI scores (coefficient = 1.13, 95%CI = 0.39-1.86), and ipratropium bromide inhaler was positively associated with RSI scores (coefficient = 13.12, 95%CI = 0.16-26.09). LPR was identified in 57 patients (71%). On simple and multiple logistic regression analyses, GerdQ scores (OR = 1.78, 95%CI = 1.13-2.80), BMI (OR = 1.07, 95%CI = 1.01-1.14), duration of GERD in years (OR = 1.42, 95%CI = 1.04-1.93), and the type of gender (OR = 49.67, 95%CI = 1.32-1870) appeared to increase the risk of LPR, whereas coffee consumption (OR = 0.0005, 95%CI = 1.82e-06, 0.13) appeared to be negatively associated with LPR. Conclusions: Contradictory to what is frequently reported, LPR commonly occurs and positively correlates with GERD. Several modifiable clinical predictors of LPR might exist, which highlight the importance of performing a complete clinical assessment of the patients with reflux symptoms.