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Almutairi N, Alshathri A, Alshareef W, Sindi A, Aljasser A, Alammar A. Clinical evaluation of pediatric patients with recurrent respiratory papillomatosis.: A longitudinal study at a Saudi Arabian tertiary care center. Saudi Med J 2024; 45:205-210. [PMID: 38309731 DOI: 10.15537/smj.2024.45.2.20230529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/27/2023] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To study the clinical evaluation of recurrent respiratory papillomatosis (RRP) patients and the factors associated with the improvement in the Derkay's score as a measure of disease severity. METHODS A retrospective cohort that included all juvenile RRP patients who were admitted to King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between September 2015 and June 2022 and underwent surgical debulking. RESULTS A total of 16 patients were eligible to join our study. Among them, 7 patients were males. Hoarseness of voice was the most frequent symptom. The median period of the follow-up was 56 months. Complete remission was achieved in 31.3%. The univariate linear regression model revealed that the cidofovir-treated patients had a significant reduction in the change value of Derkay's score compared to those without treatment (regression coefficient= -5.83, 95% confidence interval [CI]: [-11.5 to -0.143], p=0.045). Also, the increased first Derkay's score decreased the change value and subsequently increased the improvement chance of the disease (regression coefficient= -0.424, 95% CI: [-0.764 to -0.083], p=0.018). However, in the multivariate regression model, both variables showed non-significant results. CONCLUSION cidofovir treatment and higher Derkay's scores affected the disease improvement.
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Affiliation(s)
- Nasser Almutairi
- From the Department of Otolaryngology-Head and Neck Surgery (Almutairi), King Faisal Specialist Hospital and Research Center, from the Department of Otolaryngology-Head and Neck Surgery (Almutairi, Alshathri, Alshareef, Sindi, Aljasser, Alammar), King Saud University Medical City, and from the College of Medicine (Almutairi), Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Alanoud Alshathri
- From the Department of Otolaryngology-Head and Neck Surgery (Almutairi), King Faisal Specialist Hospital and Research Center, from the Department of Otolaryngology-Head and Neck Surgery (Almutairi, Alshathri, Alshareef, Sindi, Aljasser, Alammar), King Saud University Medical City, and from the College of Medicine (Almutairi), Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Alshareef
- From the Department of Otolaryngology-Head and Neck Surgery (Almutairi), King Faisal Specialist Hospital and Research Center, from the Department of Otolaryngology-Head and Neck Surgery (Almutairi, Alshathri, Alshareef, Sindi, Aljasser, Alammar), King Saud University Medical City, and from the College of Medicine (Almutairi), Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Sindi
- From the Department of Otolaryngology-Head and Neck Surgery (Almutairi), King Faisal Specialist Hospital and Research Center, from the Department of Otolaryngology-Head and Neck Surgery (Almutairi, Alshathri, Alshareef, Sindi, Aljasser, Alammar), King Saud University Medical City, and from the College of Medicine (Almutairi), Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aljasser
- From the Department of Otolaryngology-Head and Neck Surgery (Almutairi), King Faisal Specialist Hospital and Research Center, from the Department of Otolaryngology-Head and Neck Surgery (Almutairi, Alshathri, Alshareef, Sindi, Aljasser, Alammar), King Saud University Medical City, and from the College of Medicine (Almutairi), Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alammar
- From the Department of Otolaryngology-Head and Neck Surgery (Almutairi), King Faisal Specialist Hospital and Research Center, from the Department of Otolaryngology-Head and Neck Surgery (Almutairi, Alshathri, Alshareef, Sindi, Aljasser, Alammar), King Saud University Medical City, and from the College of Medicine (Almutairi), Alfaisal University, Riyadh, Kingdom of Saudi Arabia
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Almutairi N, Alshareef W, Almakoshi L, Zakzouk A, Aljasser A, Alammar A. Is adenotonsillectomy effective in improving central apnea events in patients with obstructive sleep apnea? A systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:5205-5217. [PMID: 37642712 DOI: 10.1007/s00405-023-08202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To evaluate the effects of adenotonsillectomy on improving central sleep apnea events in children with obstructive sleep apnea (OSA). METHODS We searched four online databases for relevant articles published from inception until October 2022. We included studies that measured the number of central apnea events per sleep and central apnea-hypopnea index (CAHI) or central apnea index (CAI) scores in children with OSA before and after adenotonsillectomy. Our primary outcomes were changes in CAI scores, the number of central apnea events per sleep, and CAHI scores after surgery. Our secondary outcomes were changes in total and mixed apnea events, improvement of sleep outcomes, and differences in oxygen or carbon dioxide saturation during sleep. We performed meta-analyses by pooling the mean changes of all included studies with a 95% confidence interval using Stata 17. Subsequently, we performed subgroup analyses based on the presence of comorbidities. RESULTS We included 22 studies comprising 1287 patients. Central and total sleep apnea parameters, except for CAHI and mixed apnea index scores, showed significant improvements after surgery. In addition, all respiratory parameters and second and third stages of non-rapid eye movement sleep showed significant postsurgical improvements. Patients with comorbidities showed significant improvements only in the total apnea-hypopnea index, oxygen desaturation index, and minimal oxygen saturation. CONCLUSION Adenotonsillectomy improves central apnea events in patients with OSA but not in those with comorbidities.
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Affiliation(s)
- Nasser Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia.
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Waleed Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Latifah Almakoshi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, P.O Box 245, 11411, Riyadh, Saudi Arabia
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Alshareef W, Almutairi N, Sindi A, Almakoshi L, Zakzouk A, Aljasser A, Alammar A. Spirometry in laryngotracheal stenosis: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4783-4792. [PMID: 37522909 DOI: 10.1007/s00405-023-08159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE This study aimed to assess the changes in spirometry parameters or indices after relieving laryngotracheal stenosis (LTS) in adult patients. METHODS A systematic review and meta-analysis of studies from PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO databases was conducted for assessing changes in spirometry values after endoscopic balloon dilatation of LTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant data, such as changes in mean spirometry values between preoperative and postoperative interventions, and findings of receiver operating characteristic curve analyses for predicting the need for surgical intervention, were extracted. RESULTS Ten studies including 330 patients overall met the inclusion criteria. Significant improvements were observed from preoperative to postoperative mean values of different spirometry parameters and indices. The overall mean differences in peak expiratory flow (ΔPEF), expiratory disproportion index (ΔEDI), and peak inspiratory flow (ΔPIF) were 2.26 L/s (95% CI 2.14-2.38), 27.94 s (95% CI 26.36-29.52), and 1.21 L/s (95% CI 0.95-1.47), respectively. ΔPEF and ΔPIF values increased, while ΔEDI decreased. In predicting the need for surgical intervention, EDI had the highest sensitivity (88%), and forced expiratory volume per second/forced vital capacity had the highest specificity (85%). CONCLUSION Spirometry is a valuable tool for assessing patients with LTS. PEF, EDI, and PIF were the most commonly reported spirometry parameters that significantly improved after airway stenosis was relieved.
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Affiliation(s)
- Waleed Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia.
- Department of Otolaryngology-Head and Neck Surgery, Maternity and Children Hospital, Makkah, Saudi Arabia.
| | - Nasser Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Sindi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Latifah Almakoshi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Alouda N, Almujaiwel N, Alrabiah A, Aljasser A, Bukhari M, Alammar A, Habib S. Effect of Intralesional Steroid Injections Among Patients with Acquired Laryngotracheal Stenosis Undergoing Endoscopic Balloon Dilation Using Pulmonary Function Tests. Ear Nose Throat J 2023:1455613231205534. [PMID: 37864361 DOI: 10.1177/01455613231205534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Objectives: Laryngotracheal stenosis (LTS) is characterized by an abnormal decrease in the upper airway diameter. The pulmonary function test (PFT) is an effective adjunctive diagnostic tool for upper airway obstruction. LTS can be managed with either open surgery or less invasive endoscopic approaches, among which endoscopic balloon dilation is the main method; this may include concurrent intralesional steroid injection (ILSI), which has the potential of improving the outcomes. However, the effectiveness of ILSI is unclear. We aimed to compare the improvement in PFT parameters among patients with acquired LTS following endoscopic balloon dilation who received and did not receive ILSIs. We also compared the recurrence times and rates between the 2 patient cohorts. Methods: We retrospectively collected data regarding pre- and postoperative PFTs, as well as inter-dilation interval records, obtained between June 2015 and April 2020. Results: We included 34 patients with acquired etiologies. The most common cause of stenosis was intubation (52.9%), followed by trauma (29.4%). Further, 52.9% of the patients received ILSIs. Symptom recurrence was reported in 23 (67.6%) cases, with no significant between-group difference -0.1389 [95% confidence interval (CI): -0.4483, 0.1705]. The mean (standard deviation) duration of the first reintervention was 8.62 (8.00) and 7.38 (3.20) months among patients who did and did not receive ILSIs, respectively (mean difference -1.23, P = .614, 95% CI -6.30, 3.84). Conclusion: Our findings indicated that PFT parameters improved following endoscopic balloon dilation, with forced expiratory volume in 1 second being significantly higher with concurrent ILSI. However, there was no between-method difference in the treatment effectiveness. Additionally, the restenosis recurrence rate was consistent with that reported in the literature.
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Affiliation(s)
- Nada Alouda
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nasser Almujaiwel
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alrabiah
- Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Syed Habib
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Almutairi N, Alshareef W, Almakoshi L, Zakzouk A, Aljasser A, Alammar A. Comparison Between Flap and Primary Closures of Persistent Tracheocutaneous Fistula: A Scoping Review. Ear Nose Throat J 2023:1455613231179690. [PMID: 37291885 DOI: 10.1177/01455613231179690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Objectives: To compare the susceptibility and complication rates between flap and primary closures for tracheocutaneous fistula (TCF). Methods: We searched 4 online databases (Web of Science, Cochrane Library, PubMed, and Scopus) for relevant articles published from study inception until August 2022. Studies including at least 5 adult or child patients with persistent TCFs who underwent closure surgery via primary or flap repair were included. All included studies reported outcomes of surgical repairs such as successful closure rates and complications. In addition, we performed single-arm meta-analyses for each surgical method using the Open Meta-Analyst software to calculate the pooled event rate with a 95% confidence interval (CI); compared the 2 surgical procedures using the Review Manager software using the risk ratio with 95% CI; and assessed study quality based on the National Heart, Lung, and Blood Institute criteria. Results: Overall, 27 studies with 997 patients were included. No significant difference was observed between the closure success and major complication rates of surgical methods. The primary and flap closures had overall success rates of 0.979 and 0.98, respectively. The overall major complication rates in primary and flap closures were 0.034 and 0.021, respectively; and that of minor were 0.045 and 0.04, respectively. In primary closure, a significant decrease in the success rate with increasing age at the time of decannulation was observed. In addition, the risk of major complications increased with increasing time from decannulation to closure. Conclusions: Both the primary and flap repairs of TCF are effective based on closure success and complication rates; therefore, they are both acceptable therapeutic alternatives, and flap repair can be considered when other techniques have failed. However, further prospective randomized studies comparing these 2 procedures are needed to support our results.
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Affiliation(s)
- Nasser Almutairi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Waleed Alshareef
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Latifah Almakoshi
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Aljasser A, Alsaleh N. PMON311 45,X/46,XY mixed gonadal dysgenesis: a case report from Saudi Arabia. J Endocr Soc 2022. [PMCID: PMC9627652 DOI: 10.1210/jendso/bvac150.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Mixed gonadal dysgenesis is a sex developmental disorder where the gonads are abnormal from there being some cells with XY chromosomes and some with just asingle X, known as chromosome Y mosaicism. This results in a wide range of male/female genitalia that are not typically, or clearly, male or female The case: 3 years old Saudi boy was born term to 35 year old G5P5 Normal anti natal and history of consanguinity. Birth weight 2 kilogram and found to have genital ambiguity in the form of short phallus structure and hypospiadius testis were felt at the right inguinal canal. his investigation showed abnormal chromosomes 45×46XY musiac . Mother chromosomes were 46XX normal female karyotype. normal siblings and Wes WES: CNV DESCRIPTION*: seq[GRCh37] Yp11.31q11.23 (mosaic∼50% of the cells) SIZE (KB): ∼26Mb, GENE COUNT**: 116, INTERPRETATION***: Pathogenic. RELATED DISORDER: 45,X/46,XY mixed gonadal dysgenesis The radiological investigations showed small oval shaped mass over the right inguinal canal 0.8/0.6/0.8 cm in size .the left testis couldn't be seen . And Genetogram showed presence of vagina and small uterus. his laboratory investigations showed at age of 2.5 years LH: less than o.3 and his Testosterone basal was less than 0.09 and Testosterone post HCG 8.29 which should excellent response to HCG.. the case was discussed with the paediatric urologist and the decision was as per the anatomical finding and results of the stimulated Testosterone to give Testosterone injections and asses the response. The child respond very well to the testosterone treatment which leads to improvement in the size and length of the phallus. Discussion mixed gonadal dysgenesis is one of the causes of DSD .45, X/ 46, XY mosaic: At birth around 90 per cent of babies with 45,X/46,XY have normal-appearing external male genitals, five per cent have normal-appearing female genitals and in five percent the external reproductive organs are neither fully male nor fully female. They may find one or two gonads that are very inadequate testes, possibly with some ovary-like tubules present. They may find one streak gonad and one immature, dysgenetic or normal testis. They may find an internal vagina, cervix and uterus, although these are usually quite small compared to a normal female. Some people with a 45,X/46,XY karyotype have reduced fertility and some are infertile. No judgment can be made about fertility until well after puberty in the apparently normal males. Children with a 45,X/46,XY karyotype can have any of the medical conditions that are more common among girls with Turner syndrome (who have a 45,X karyotype), which includes heart and disorders, autoimmune disorders and short stature. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Aldriweesh B, Khan A, Aljasser A, Bukhari M, Alrabiah A, AlAmmar A. Correlation of airway ultrasonography and laryngoscopy findings in adults with subglottic stenosis: a pilot study. Eur Arch Otorhinolaryngol 2021; 279:1989-1994. [PMID: 34842971 DOI: 10.1007/s00405-021-07195-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Ultrasonography of the airway has potential as an alternative, non-invasive, method to monitor patients with subglottic stenosis in an outpatient setting. This prospective, interventional, double-blinded study aimed to correlate ultrasound-based and laryngoscopy-based subglottic stenosis assessment in adults. METHODS The study was conducted between July 2020 and March 2021 at a tertiary referral center. Consecutive adult patients with subglottic stenosis were evaluated using airway ultrasonography 1 day prior to scheduled laryngoscopy. The radiologist was blinded to the preoperative endoscopic findings, and the primary surgeon was blinded to the ultrasonographic measurements. The intraoperative subglottic diameter was defined as the outer diameter of an endotracheal tube passing through the subglottis without producing an air leak. RESULTS Sixteen patients (11 females; age range, 17-66 years; mean = 44.06, SD = 12.79) were included. The ultrasonographic subglottic diameter ranged from 5.20 mm to 8.00 mm (mean = 6.24 mm, SD = 0.90). In 15 of 16 patients, the diameter difference between the ultrasonographic and intraoperative measurements ranged from -0.80 mm to 0.30 mm (mean = -0.20 mm, SD = 0.35). However, patient 6 had a difference of - 2.10 mm between the two measurements, which was attributed to thick laryngotracheal secretions interfering with the ultrasonographic air shadow. Data analysis of all 16 patients showed a statistically significant correlation between the readings obtained by the two techniques (r = 0.84, P = 0.000051). CONCLUSION This study found a significant correlation between ultrasonography-based and laryngoscopy-based subglottic stenosis assessment in adult patients. It provides a basis for an alternative and potentially reliable method to monitor patients with subglottic stenosis.
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Affiliation(s)
- Bshair Aldriweesh
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,Department of Otolaryngology-Head and Neck Surgery, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
| | - Adeena Khan
- Department of Radiology, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Alrabiah
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed AlAmmar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Alrabiah A, Jomah M, Alduraywish S, Shaikh S, Meo S, Aljasser A, Almohizea M, Bukhari M, Alammar A. Significance of the pulmonary function test for the diagnosis of subglottic stenosis: a systematic review. B-ENT 2021. [DOI: 10.5152/b-ent.2021.20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Alrabiah A, Alhussinan K, Alyousef M, Alsayed A, Aljasser A, Alduraywish S, Alammar A. Microbiological profiles of tracheostomy patients: a single-center experience. Multidiscip Respir Med 2021; 16:811. [PMID: 35070294 PMCID: PMC8743611 DOI: 10.4081/mrm.2021.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year. Methods A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter. Results Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%). Conclusions The most common post-tracheostomy microorganism was P. aeruginosa. MRSA showed a strong association with tracheostomy for obstructive indications.
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Affiliation(s)
- Abdulaziz Alrabiah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh.,Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh
| | - Khaled Alhussinan
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh
| | - Mohammed Alyousef
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh
| | - Ahmed Alsayed
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh
| | - Abdullah Aljasser
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh
| | - Shatha Alduraywish
- Department of Family and Community Medicine, Prince Sattam bin Abdulaziz Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh
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Alrabiah A, Almohanna S, Aljasser A, Zakzouk A, Habib SS, Almohizea M, Bukhari M, Alammar A. Utility of Spirometry Values for Evaluating Tracheal Stenosis Patients Before and After Balloon Dilation. Ear Nose Throat J 2020; 101:NP62-NP67. [PMID: 32692288 DOI: 10.1177/0145561320936968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and then confirmed using direct laryngobronchoscopy. Other adjunctive diagnostic methods, including spirometry, have been proposed. This study aimed to evaluate the relationship between tracheal stenosis severity and pre- and post-balloon dilatation spirometry parameters in order to assess for significant changes in spirometry values and to evaluate for the effects of stenosis-associated factors on post-dilation spirometry values, including vertical length and grade of the stenosis, as well as the role of wound-modifying agents. METHODS This retrospective study included adults (>18 years of age) with isolated tracheal stenosis who underwent endoscopic balloon dilations at King Saud University Medical City from June 2015 to May 2019, with detailed documentation of operative findings and valid spirometry measurements pre- and post-balloon dilation. Basic demographic data and operative note details, including information about the percentage of tracheal stenosis, distance of tracheal stenosis from vocal cords, vertical length of stenotic segment, and use of wound-modifying agents (topical mitomycin C or triamcinolone injections), were extracted. RESULTS Fourteen patients with spirometry measurements obtained on 50 occasions (25 pre-balloon dilation and 25 post-balloon dilation) were included. Each 1-unit increase in the vertical length of the stenosis showed a statistically significant negative relationship (-1.47 L/s) with pre-balloon dilation peak expiratory flow (PEF; P = .034). Post-balloon dilation spirometric values showed statistically significant improvements for most variables. CONCLUSIONS The vertical length of an isolated tracheal stenosis can be predicted before surgical interventions using PEF values and may be a significant indicator of anticipated post-balloon dilation surgical success. Our study suggested that spirometry is a very useful technique for evaluating patients with tracheal stenosis due to its noninvasiveness, cost-effectiveness, with a good clinical value.
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Affiliation(s)
- Abdulaziz Alrabiah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shahad Almohanna
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Syed Shahid Habib
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almohizea
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Aljifri A, Alkhalawi M, Sulaiman A, Alhakeem R, Abdalla O, Alhakawi A, Aljasser A, Al-Zaid S, Bahkali M, Alsarhani A, Kheiamy A, Assiri A. Characteristics of influenza patients and risk factors for death: retrospective analysis of sentinel surveillance data, Saudi Arabia, 2017. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Aljathlany Y, Aljasser A, Alhelali A, Bukhari M, Almohizea M, Khan A, Alammar A. Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging. Ear Nose Throat J 2020; 100:629S-635S. [PMID: 31914813 DOI: 10.1177/0145561319900390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart. STUDY DESIGN Retrospective chart review. SETTING Tertiary care center. MATERIALS AND METHODS The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size. RESULTS One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm2 and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm2 and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively. CONCLUSION One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.
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Affiliation(s)
- Yousef Aljathlany
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alhelali
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Manal Bukhari
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almohizea
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adeena Khan
- Department of Radiology, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
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13
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Goldstein NA, Friedman NR, Nardone HC, Aljasser A, Tobey ABJ, Don D, Baroody FM, Lam DJ, Goudy S, Ishman SL, Arganbright JM, Baldassari C, Schreinemakers JBS, Wine TM, Ruszkay NJ, Alammar A, Shaffer AD, Koempel JA, Weedon J. The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing. Laryngoscope 2019; 130:2256-2262. [PMID: 31782808 DOI: 10.1002/lary.28428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/09/2019] [Accepted: 11/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assessment for pediatric sleep-disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS-15 in a multi-institutional fashion. METHODS Five hundred and thirty children from 13 sites with suspected sleep-disordered breathing were recruited, and the investigators completed the CAS-15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty-seven subjects had a follow-up CAS-15. RESULTS Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS-15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS-15 and the initial apnea-hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver-operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1. CONCLUSION This study establishes the generalizability of the CAS-15 as a useful office tool for the evaluation of pediatric sleep-disordered breathing. LEVEL OF EVIDENCE 2B Laryngoscope, 130:2256-2262, 2020.
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Affiliation(s)
- Nira A Goldstein
- Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Norman R Friedman
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Heather C Nardone
- Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Abdullah Aljasser
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Allison B J Tobey
- Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh
| | - Debra Don
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Comer Children's Hospital, Chicago, Illinois
| | - Derek J Lam
- Division of Pediatric Otolaryngology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon
| | - Steven Goudy
- Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jill M Arganbright
- Department of Pediatric Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri
| | - Cristina Baldassari
- Department of Otolaryngology, Children's Hospital of The King's Daughters, Norfolk, Virginia, U.S.A
| | - J B S Schreinemakers
- Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Todd M Wine
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado
| | - Nicole J Ruszkay
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ahmed Alammar
- Department of Otolaryngology-Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Amber D Shaffer
- Division of Pediatric Otolaryngology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh
| | - Jeffrey A Koempel
- Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeremy Weedon
- Research Division, State University of New York Downstate Medical Center, Brooklyn, New York
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Aljathlany Y, Alamari K, Aljasser A, Alhelali A, Bukhari M, Almohizea M, Khan A, Alammar A. Comparison Between Mathematical and Software Calculation Methods for the Measurement of the Cross-sectional Area in Upper Airway Imaging. Cureus 2019; 11:e6106. [PMID: 31886046 PMCID: PMC6901374 DOI: 10.7759/cureus.6106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional area (CSA) at four different upper airway segments. Methods The data from the retrospective chart reviews of patients older than 18 years who had undergone computed tomography (CT) of the neck at our tertiary care center between September 2014 and September 2018 were reviewed. Data of patients who were intubated, tracheostomized, had nasogastric tubes, tumors, craniofacial anomalies, trauma, or any pathology that may affect the normal airway anatomy were excluded. We measured the anteroposterior (APD) and transverse diameter (TD) utilizing the CT software. CSA was calculated using both the mathematical formula (MCM) and software (SCM) at the glottis, proximal subglottis, distal subglottis, and tracheal levels. A paired sample t-test was used to determine the significant difference between SCM and MCM at each level. Results The data of 100 patients (59% female) were reviewed. There was a significant difference between the SCM and MCM at all four levels. The mean differences between the SCM and MCM were -33.63 mm2, -24.20 mm2, 6.04 mm2 (p < 0.001) at the glottis, proximal subglottis, and trachea, respectively. The mean difference at the distal subglottis was -4.08 mm2 (p = 0.01). Conclusion Our study found a significant difference between the SCM and MCM in measuring the CSA of the four airway segments. Theoretically, the SCM is more accurate and precise than MCM in measuring CSA; however, we could not prove the superiority of either method.
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Affiliation(s)
- Yousef Aljathlany
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Kholoud Alamari
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Abdullah Aljasser
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Abdullah Alhelali
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Manal Bukhari
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Mohammed Almohizea
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
| | - Adeena Khan
- Radiology, King Saud University Medical City, Riyadh, SAU
| | - Ahmed Alammar
- Otolaryngology, Head and Neck Surgery Department, King Saud University Medical City, Riyadh, SAU
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Alobaysi S, Alsairi S, Aljasser A, Alkhaddam A, Alshamrani A. Iatrogenic injury to a vesicourachal diverticulum during laparoscopic appendectomy successfully managed conservatively. J Surg Case Rep 2019; 2019:rjz293. [PMID: 31632637 PMCID: PMC6792079 DOI: 10.1093/jscr/rjz293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/04/2019] [Indexed: 12/03/2022] Open
Abstract
A vesicourachal diverticulum is a rare congenital anomaly that arises from the incomplete closure of the urachus at the bladder end. We describe a 12-year-old boy who presented with severe persistent right iliac fossa pain associated with subjective fever, nausea, vomiting, and anorexia. A computed tomography (CT) scan of the abdomen and pelvis revealed findings consistent with appendicitis. The patient underwent a laparoscopic appendectomy; however, his postoperative course was remarkable for a low urine output and urine leakage from the suprapubic port site. A CT cystography showed a vesicourachal diverticulum and conservative management was offered. This management consisted of Foley catheter placement, hourly monitoring of the patient’s urine output, antibiotic prophylaxis, daily laboratory investigations and a cystography performed after 7 days. Overall, injury to the vesicourachal diverticulum is rare, and surgeons should be aware of this rare clinical entity and exercise caution during port placement. Surgeons should also have a high index of suspicion to identify these injuries and appropriately manage the condition early.
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Affiliation(s)
- Saad Alobaysi
- Department of Surgery, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia
| | - Saud Alsairi
- Department of Surgery, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aljasser
- Department of Surgery, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Alkhaddam
- Department of Surgery, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alshamrani
- Department of Surgery, Security Forces Hospital Program, Riyadh, Kingdom of Saudi Arabia
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16
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Sethia R, Rawlins KW, Aljasser A, Nogan S, Elmaraghy CA, Wiet GJ. Pediatric nasopharyngeal fibrolipoma: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2019; 125:103-106. [PMID: 31276891 DOI: 10.1016/j.ijporl.2019.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
A 3-year-old female presented for evaluation of progressive snoring since birth. MRI revealed a fatty-appearing mass measuring 2.4 cm × 1.5 cm x 3.0 cm arising from the predental space of C1 and extending anteriorly through the prevertebral space into the retropharyngeal space. The patient underwent endoscopic trans-oral excision of the mass using electrocautery and blunt dissection, and pathological analysis yielded a diagnosis of fibrolipoma. CT imaging twelve months post-surgery showed no recurrence, and the patient remains symptom free two years later. Very few reported cases of nasopharyngeal fibrolipomas exist, and this is the first report of 2-year clinical follow-up.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kasey W Rawlins
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Abdullah Aljasser
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephen Nogan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory J Wiet
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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Aljasser A. MON-364 Autoimmune Polyendocrinopathy Syndrome Type I Presented with Adrenal Insuffiency and Nail Fungal Infection Confirmed by Homozygous Pathogenic Variant in the AIRE Gene. J Endocr Soc 2019. [PMCID: PMC6551140 DOI: 10.1210/js.2019-mon-364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Autoimmune polyglandular syndrome type 1 (APS-1) is a rare and complex recessively inherited disorder. APS-1 diagnosed when patient have at least two of the three major conditions that result from this syndrome: chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenocortical insufficiency. APS-1 is caused by changes (mutations) in the autoimmune regulator (AIRE) gene. Chronic mucocutaneous candidiasis (CMC), a condition of recurrent candidiasis infections that may involve the skin, nails, oral, anal and genital mucosa, is a hallmark of APS-1. We report a7 years old boy with history of fungal infections since early childhood affecting nails and skin. Also he has alopecia . recurrent abdominal pain,lethargy and vomiting. At diagnosis his skin was hyper pigmented at gums and palms and nail dystrophy. His laboratory shows high ACTH 1251 pmol/l and low aldosterone 57 pg/ml. he has positive candida culture in the nail. We send genetic study Whole Exome Sequencing and came to be positive for A homozygous pathogenic variant in the AIRE gene. c.205_208dup p.(Asp70Alafs*148). The child was treated with hydrocortisone and fludrocortisone. We report a rare case of a homozygous pathogenic variant in the AIRE gene that illustrate the typical presentation of APS type 1
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Abstract
The diagnosis of subglottic stenosis (SGS) is usually made by clinical assessment and definitively by a direct endoscopic examination. This study aimed to evaluate different spirometric values in relation to anatomical grading and severity of subglottic stenosis cases of upper airway obstruction. Cases of SGS that underwent dilatational procedures endoscopically at the otolaryngology department of the King Saud University Medical City, Riyadh, Saudi Arabia, from June 2015 to October 2017 were collected. Pulmonary function test (PFT) pre- and postoperative parameters and the grades of subglottic stenosis were extracted. We compared different spirometric values to the severity of SGS and compared the pre- and postoperative results for each patient. There were 19 cases with a valid PFT study within 7 days preoperatively in addition to a documented intraoperative grading according to the Myer-Cotton grading system; 7 (36.8%) were grade 1, 8 (42.1%) were grade 2, and 4 (21.1%) were grade 3. The actual preoperative ratio of forced expiratory volume (FEV1) in 1 second to peak expiratory flow (PEF) for all 19 patients ranged from 7.34 to 21.40 mL/L/min. We found a significant improvement in all spirometric parameters postdilatation including PEF ( P < .001), FEV1 ( P < .001), FEV1/PEF ( P = .001), forced expiratory flow (FEF) from 25%, 50%, and 75% of vital capacity, respectively, FEF25 ( P < .001), FEF50 ( P = .001), FEF75 ( P = .048), and maximum mid-expiratory flow ( P = .002). We did not find any correlation between the severity of stenosis and spirometric values. This study revealed that spirometry is a useful marker in following up patients with subglottic stenosis and is also a good indicator to determine postairway surgery outcomes. However, these markers do not correlate with anatomical grading and the severity of subglottic stenosis.
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Affiliation(s)
- Alhelali Abdullah
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - A Alrabiah
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sayed S Habib
- 2 Department of Clinical Physiology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Y Aljathlany
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - A Aljasser
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - M Bukhari
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - A Y Al-Ammar
- 1 Department of Otolaryngology, King Saud University Medical City, Riyadh, Saudi Arabia
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Alghamdi KA, Alsaedi AB, Aljasser A, Altawil A, Kamal NM. Extended clinical features associated with novel Glis3 mutation: a case report. BMC Endocr Disord 2017; 17:14. [PMID: 28253873 PMCID: PMC5335837 DOI: 10.1186/s12902-017-0160-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/15/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Mutations in the GLI-similar 3 (GLIS3) gene encoding the transcription factor GLIS3 are a rare cause of neonatal diabetes and congenital hypothyroidism with 12 reported patients to date. Additional features, previously described, include congenital glaucoma, hepatic fibrosis, polycystic kidneys, developmental delay, facial dysmorphism, osteopenia, sensorineural deafness, choanal atresia, craniosynostosis and pancreatic exocrine insufficiency. CASE PRESENTATION We report a new case for consanguineous parents with homozygous novel mutation in GLIS3 gene who presented with neonatal diabetes mellitus, severe resistant congenital hypothyroidism, cholestatic liver disease, bilateral congenital glaucoma and facial dysmorphism. There were associated abnormalities in the external genitalia in form of bifid scrotum, bilateral undescended testicles, microphallus and scrotal hypospadias which might be a coincidental finding. CONCLUSIONS We suggest that infants with neonatal diabetes associated with dysmorphism should be screened for GLIS3 gene mutations.
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Affiliation(s)
- K. A. Alghamdi
- King Abdullah Bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - A. B. Alsaedi
- Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - A. Aljasser
- Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - A. Altawil
- Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naglaa M. Kamal
- Pediatrics and Pediatric Hepatologist, Faculty of Medicine, Cairo University, Cairo, Egypt
- Pediatrics and Pediatric Hepatologist, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
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Hebaishi YA, Al-Johar A, Aljasser A, AlOnazi H, Ahmed A, AlFagih A. 10. Effect of pacemaker/defibrillator lead extraction on pulmonary artery systolic pressure. J Saudi Heart Assoc 2016. [DOI: 10.1016/j.jsha.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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AlFagih A, Al-Johar A, Aljasser A, AlOnazi H, Ahmed A, Hebaishi Y. 15. Sensitivity in visualizing vegetations in cardiac lead-induced endocarditis: A comparative study between transesophageal vs. transthoracic echocardiography. J Saudi Heart Assoc 2016. [DOI: 10.1016/j.jsha.2016.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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AlFagih A, Al-Johar A, Aljasser A, AlOnazi H, Ahmed A, Al Hebaishi Y. 9. Incidence of tricuspid valve regurgitation following pacemaker/defibrillator lead extraction. J Saudi Heart Assoc 2016. [DOI: 10.1016/j.jsha.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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