Objectives:To examine the incidence and predictors of blood transfusion following total knee replacement (TKR).Methods:A retrospective study on 462 patients of primary TKR at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Descriptive statistics were compared by blood transfusion status and significant variables were further included in the multivariable model.Results:Overall transfusion rate following TKR was 35.3%. Regression analyses identified bilateral surgery, low preoperative hemoglobin (Hb) level, and high amount of blood loss as predictors of blood transfusion.Conclusion:Correction of Hb level prior to surgery, careful hemostasis, and avoiding bilateral surgery may reduce the rate of blood transfusion following TKR.

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HighlightsSuccessful unifocal tibial lengthening of 14.5 cm without using intramedullary nail guide.Bone transport demands high compliance from the patient to achieve optimal results.Bone transport proves to be an excellent alternative in managing massive bone loss.

Background The coronavirus disease 2019 pandemic has affected millions of people since its outbreak in December 2019. Limited data exist on otolaryngology manifestations of COVID-19 in pediatrics. This study aims to discuss the clinical features of COVID-19 in pediatrics, with an emphasis on otolaryngology manifestations. Methods The study included 660 COVID-19 laboratory-confirmed positive pediatric patients (aged 3–15 years) diagnosed at King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia. Data were retrospectively retrieved from January to July 2020 from electronic medical records and included patients' epidemiological and clinical features. Patients were then followed-up via phone calls to document any symptoms encountered after the first visit. Patients were categorized into three main groups according to age (3-6 years, 7-10 years, 11-15 years). Results Nearly half of the patients (43.6%) had asymptomatic infections. Fever and cough were the most commonly reported manifestations accounting for 39.2% and 19.8%, respectively. The most frequently reported otolaryngology symptoms were sore throat (17.3%) and rhinorrhea (14.4%). Moreover, 10.4% and 13.1% of children aged 7-15 years old experienced smell and taste disturbances, respectively. Older children (11-15 years) were more likely to report taste disturbances when compared to the younger children (17.2% vs 9.8%, p-value 0.02). Children aged between 3 to 6 years had significantly higher rates of admission (13.7%) and mortality (0.9%) when compared to the older groups (p-value 0.00). Conclusion COVID-19 in pediatrics has a milder disease course and a better prognosis than adults. Multiple otolaryngology symptoms were reported in pediatric patients with COVID-19, which can help identify the suspected cases before the test result.

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

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Foreign body ingestion is a common complaint frequently seen in otolaryngology. Some sharp foreign bodies may get impacted in the aerodigestive tract causing a perforation. However, hypopharyngeal perforation is a rare injury that needs early recognition due to its significant morbidity. In this case report, we report a case of hypopharyngeal perforation caused by foreign body ingestion in an adult patient. A 60-year-old female presented with a foreign body sensation in the throat, dysphagia, and odynophagia. A neck CT scan showed a foreign body in the hypopharynx with a collection of free air along the posterior pharyngeal wall. She underwent laryngoscopy and esophagoscopy for examination and foreign body removal. Following the procedure, the patient was treated conservatively for a week and then discharged home in a stable condition. Hypopharyngeal perforation following foreign body ingestion is uncommon. A high index of suspicion is required to reach an early diagnosis and treatment.

Objective With the increased prevalence of incidental thyroid cancer, determining the predictors of thyroid malignancy has become a source of debate. This study aimed to determine the impact of Thyroid Stimulating Hormone (TSH) levels on thyroid cancer incidence in euthyroid nodules. Methods A retrospective study included 421 patients who underwent thyroidectomy at a tertiary hospital between 2016 and 2020. Patients' demographics, history of cancer, preoperative workup, and final histology reports were obtained. The study sample was divided into two groups based on the final histopathology (benign vs. malignant). The two groups were compared using the appropriate statistical tests to determine the predictors of thyroid cancer in euthyroid nodules. Results TSH level was significantly higher in malignant nodules compared to benign nodules (1.94 vs. 1.62, p = 0.002). It was 1.54 times more likely for thyroid nodules to be malignant when TSH levels were higher (p = 0.038). Meanwhile, larger nodules (> 4 cm) were significantly more prevalent in benign nodules (43.1%) than in malignant nodules (21.1%). Larger nodules decreased the possibility of thyroid cancer by 24% (OR = 0.760, p-value 0.004). Conclusion High TSH levels in euthyroid nodules were significantly correlated with the risk of thyroid malignancy. In addition, as Bethesda category proceeded toward malignancy, TSH levels increased. High TSH levels and small nodule sizes can be used as additional parameters in predicting thyroid cancer in euthyroid nodules.