Abstract. Subclinical hypothyroidism (SH), defined as an asymptomatic state characterized by normal serum concentrations of free thyroxine and elevated serum concentrations of TSH. The aim of this study is to investigate the complex interplay between insulin resistance and low grade chronic inflammation in Kuwaiti women with subclinical hypothyroidism. Thirty four women with subclinical hypothyroidism (SH) and 20 healthy women as controls matched to the patient group for sex, age and body mass index (BMI), were enrolled in this prospective study. TSH, FT4, C reactive protein, glucose, insulin, Homeostasis Model assessment (HOMA), total cholesterol (TC), triglycerides (TG), lowdensity lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) were estimated. Total cholesterol and LDL-C were significantly higher in patients with SCH as compared with control subjects, however triglyceride and HDL-C were not statistically different. CRP was not statistically different between the SCH patients and control group (3.64 ± 0.94 Vs 3.18 ± 0.71 P>0.05). Insulin levels were significantly higher in the SCH group comparable to the control (12.5 ± 2.67 Vs 10.80 ± 2.01 p<0.05), however HOMA-IR was not statistically different (2.85 ± 0.64 Vs 2.54 ± 0.64 P>0.05). Patients with subclinical hypothyroidism exhibited elevated atherogenic parameters (hyperinsulinemia, total cholesterol, LDL-C). Therefore screening and treatment for subclinical hypothyroidism may be warranted due to its adverse effects on lipid metabolism.

Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs.

ObjectiveChronic sinusitis is a very common yet poorly understood medical condition with significant morbidity. Hence, it remains an entity that is difficult to treat with unsatisfactory outcomes of current management options. This necessitates research into the etiology and pathophysiology of the condition to enhance our knowledge and the therapeutic options. Unfortunately, this kind of research is not always feasible on human subjects due to practical and ethical limitations. Therefore, an alternative model that simulates the disease had to be found in order to overcome these limitations. These models could either be in vivo or in vitro. The aim of our review is to summarize the research findings and key discoveries of both in vivo and in vitro models of chronic sinusitis that have enhanced our understanding of the condition today and have paved the way for the future research of tomorrow. Data Sources: PubMed literature review.MethodsA review of the literature was conducted to identify the main successful in vivo and in vitro models for chronic sinusitis.ResultsCreating a successful model for chronic sinusitis is no easy task. Over the years, both in vivo animal models and in vitro tissue culture models were proposed, with each model having its accolades and pitfalls, with the ideal model remaining elusive to this day. However, advancing three‐dimensional cell culturing techniques seems to be a promising new way to find a more accurate model.ConclusionNone of the current models is perfect for a thorough study of chronic sinusitis. However, three‐dimensional cell cultures have the potential to bridge the gap between in vivo and in vitro studies.Level of EvidenceNA

Objective: Piezosurgery, used in different otolaryngology procedures, was a breakthrough in surgery. We systematically reviewed the differences in outcomes after lateral nasal osteotomy with peizosurgery and conventional osteotome and quantified the differences through a meta-analysis.Methods: Medline, Embase, and Cochrane library databases were selected to search for randomized clinical trials (RCTs) published before January 2019 that detailed differences between piezosurgery and conventional osteotomy. The key search terms included "rhinoplasty" and "piezosurgery." Only RCTs in English with patients >18 years who underwent lateral osteotomy by percutaneous or internal approaches were included. PRISMA guidelines were followed in data extraction and study inclusion. Two independent reviewers assessed the relevance of the studies. The point of estimate in the meta-analysis was the standardized mean difference and was pooled with the random-effects model. The measured outcomes were ecchymosis, edema, postoperative pain, and duration of surgery.Results: Five RCTs met our criteria and were analyzed in primary subsequent meta-analyses. Piezosurgery demonstrated significantly lower edema (SMD = -0.75; 95% CI, -1.26, -0.24) and ecchymosis scores (SMD = -0.85; 95% CI, -1.49, -0.20) on postoperative days (POD) 2 or 3 than conventional surgery. They were also significantly lower with piezosurgery than conventional surgery on POD 7 (SMD = -0.64; 95% CI, -1.21, -0.06; and SMD = -0.64; 95% CI, -1.14, -0.14, respectively). Two studies that estimated the degree of pain showed that after piezosurgery, patients experienced lesser pain than after conventional surgery. The mean difference was -0.73 (95% CI, -1.06, -0.39).Conclusions: Piezosurgery causes less ecchymosis, edema, and pain than conventional osteotomy, without extending the duration of surgery.