The Case of the "Disappearing Ventricle": A Report

Embolization of entrapped intracardiac air represents a significant risk to the patient undergoing open-heart surgery. Entrapment of as little as 0.5 mL of gas in the heart can cause temporary myocardial dysfunction, cardiac arrhythmias, and systemic emboli. In contrast, larger emboli can disrupt the evaluation of heart function by limiting visualization during echocardiography. We present the case of a 67-year-old male who presented with dizziness, nausea, and chest pain. A left heart catheterization revealed multi-vessel disease. Undergoing general anesthesia, the patient received three-vessel coronary artery bypass grafting, mitral valve repair, ring annuloplasty, and left atrial appendage closure. Upon aortic unclamping, transgastric echocardiography showed significant gas almost wholly obscuring the left heart chambers despite de-airing maneuvers. Successful resolution relied upon higher mean blood pressure and time, demonstrating the importance of intraoperative imaging and interdisciplinary collaboration.

Intralesional cidofovir vs. bevacizumab for recurrent respiratory papillomatosis: a systematic review and indirect meta-analysis

BACKGROUND

Specific HPV types cause recurrent respiratory papillomatosis (R.R.P.). When administered intralesionally, cidofovir, an antiviral agent, has shown favorable outcomes in reducing papilloma. Bevacizumab, an angiogenesis inhibitor, has demonstrated improved R.R.P. However, both treatments lack FDA approval for R.R.P. Our study aims to evaluate the efficacy and safety of intralesional Cidofovir and Bevacizumab for R.R.P. and compare the two interventions.

METHODS

We searched five electronic databases to find relevant studies. After the screening, data were extracted from the included studies. Pooled ratios with 95% confidence intervals (CIs) were used for categorical outcomes, and mean difference (MD) was used for continuous outcomes. Statistical heterogeneity was evaluated using the chi-squared test for I2 statistics. The Cochrane Risk of Bias assessment tool was used to assess the methodological quality of randomized controlled trials (RCTs), while the National Institutes of Health's tool was used for observational studies. Analysis was done by Review Manager software.

RESULTS

In our comprehensive meta-analysis of 35 articles involving 836 patients, cidofovir demonstrated an overall remission ratio of (0.90 [95% CI: 0.83, 0.98], p = 0.01), while bevacizumab (0.92 [95% CI: 0.79, 1.07]), p = 0.3). The complete remission ratio for cidofovir was (0.66 [95% CI: 0.57, 0.75], p > 0.0001), while bevacizumab was (0.29 [95% CI: 0.12, 0.71], p = 0.07). In partial remission, Bevacizumab showed a higher ratio than Cidofovir 0.74 [0.55, 0.99] vs. 0.40 [0.30, 0.54]. Bevacizumab had a pooled ratio of 0.07 [95% CI: 0.02, 0.30] in terms of no remission, indicating better outcomes compared to Cidofovir with a ratio of 0.28 [95% CI: 0.16, 0.51]. Additionally, Cidofovir showed a favorable decrease in the Derkay Severity Score (DSS) with a mean difference (MD) of 1.98 [95% CI: 1.44, 2.52].

CONCLUSION

Cidofovir had a higher impact on complete remission compared to Bevacizumab. Both showed partial remission, with Bevacizumab having a higher ratio. Moreover, Cidofovir showed a significant decrease in DSS. Bevacizumab had lower rates of no remission and recurrence and fewer adverse events compared to Cidofovir. However, the difference between the two treatments was not significant, except for partial remission.

Total laryngectomy and readmission: causes, rates and predictors

BACKGROUND

Total laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL.

METHODS

This is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission.

RESULTS

Of 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029).

CONCLUSION

One in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.

Assessing the Ability of Non-dermatology Physicians to Recognize Urgent Skin Diseases

Introduction Many patients present to the emergency department with skin conditions that are not true dermatologic emergencies. Urgent skin conditions are uncommon. Because these conditions are rare, they can be sometimes challenging to diagnose. Few works of literature discussed the accuracy of non-dermatologists' initial judgment on dermatologic conditions concluding that non-dermatologists misdiagnose many common and uncommon skin conditions. Because the study was never done in our region, we aim to conduct an online assessment using a questionnaire assessing the ability of non-dermatologists to recognize urgent skin diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Methods A cross-sectional study was conducted. Non-dermatologist physicians were contacted through their verified emails, provided by the secretaries of each department and the academic affairs unit. The questionnaire consisted of two main sections, the first section covered demographics, specialty, and academic level. The second part had eight questions, each containing a brief case scenario about an urgent dermatological condition with a picture of the condition attached. Participants were required to answer the questions and assess on a scale from one to 10 how confident they were about their answers. The responses were collected and analyzed. Results Out of all 161 responses, this study included 93 male physicians (57.8%) and 68 female physicians (42.2%). The mean age in the study was approximately 45 ± 3 years. This study showed that the percentage of accuracy by non-dermatologists in diagnosing urgent skin diseases given the typical presentation of the condition was (61.33%); nevertheless, the percentage decreased when it was recalculated in relation to the full level of confidence to (25.3%). Herpes zoster appeared to be the most recognizable urgent skin disease, and Pemphigus vulgaris was the least recognizable one. Conclusion This study shows that it is difficult for physicians to recognize some urgent skin diseases, which affects offering the optimum health care for the patients. Moreover, more dermatology-focused courses are needed to strengthen the knowledge about dermatological diseases.

The Incidence of Hypothyroidism Following Hemithyroidectomy in a Tertiary Academic Center in Saudi Arabia

Background Hemithyroidectomy is a common procedure used to treat various benign and malignant conditions. It is often associated with complications, of which hypothyroidism is an underappreciated sequel. We sought to comprehend the rate and associated risk factors for developing hypothyroidism following hemithyroidectomy at King Abdulaziz University Hospital (KAUH). Methods In this retrospective study, we reviewed the medical records of all patients who had hemithyroidectomies for benign and malignant conditions between January 2008 and August 2022. Patients were analyzed for age, gender, body mass index (BMI), comorbidities, family history of thyroid disease, thyroid antibodies, and pre- and postoperative thyroid-stimulating hormone (TSH). Pre- and postoperative TSH levels were compared using the Wilcoxon signed-rank test. Results From 153 cases, 39 patients met the inclusion criteria; 31 (79.5%) were females. Seventeen (43.59%) patients developed biochemical hypothyroidism within two years following hemithyroidectomy; the majority (64.71%) of those with hypothyroidism developed it within the first six months. There was a significant increase in TSH levels following surgery (p < 0.001). Conclusion The overall incidence of hypothyroidism within two years of hemithyroidectomy is 43.59%; among those who developed hypothyroidism, the majority (64.71%) did so within the first six months. Thus, we strongly recommend continuous monitoring of TSH levels in the first six months, as it may aid in the decision to begin treatment before symptoms develop.

Rates and Causes of Readmission Within 60 Days Following Hysterectomy in a Tertiary Care Center in Saudi Arabia

INTRODUCTION

Unplanned readmissions are frequent, costly, and perhaps avoidable. We aim to identify the rate, causes, and predictive factors of hospital readmission after hysterectomy within 60 days post-discharge at King Abdulaziz University Hospital (KAUH).

METHODS

Retrospective record review of all patients who underwent hysterectomy for benign and malignant conditions from January 2017 to December 2022. Patients were evaluated for demographics, comorbidities, and causes for readmission.

RESULTS

Of 117 patients, the unplanned readmission rate was 9.4% and 7.7% for benign and malignant conditions, respectively. Infections (25%) and abdominal pain (20%) were common causes. Patients with increased intraoperative bleeding (P = 0.013) and cancer patients (0.044) had an increased risk for readmission. Readmitted patients had significantly higher baseline health burdens when compared to non-readmitted patients using the American Society of Anesthesiology scores (ASA) (p = 0.011) and the Cumulative Illness Rating Scale (CIRS) (p = 0.004).

CONCLUSION

The 60-day readmission rate after a hysterectomy was 17.1%. Infections and abdominal pain represented common causes. Malignancy and increased intraoperative blood loss are significant risk factors. In order to decrease the readmission rate, addressing common reasons may be beneficial.