Objectives/Hypothesis: To evaluate the effectiveness of gelatin-thrombin matrix for first line treatment of posterior epistaxis. Secondarily, we evaluated discomfort during treatment and the cost savings of treatment with gelatin-thrombin matrix compared to posterior packing, endoscopic, or endovascular treatment at our institution.Study Design: Prospective pilot, nonblinded, noncontrolled registered clinical trial (NCT01098578).Methods: Twenty patients with posterior epistaxis were enrolled into this study. Gelatin-thrombin matrix was used for posterior epistaxis treatment with simultaneous ipsilateral choanal occlusion. Patients were discharged within 2 hours of being successfully treated. A visual analog scale (range 0-10) was used to assess treatment discomfort. Patients were evaluated in clinic 5 and 30 days after treatment to assess for intranasal complications and recurrent epistaxis.Results: Gelatin-thrombin matrix successfully treated epistaxis in 80% of the patients. The procedure was associated with a mean discomfort of 3.6 (range 0-9.7). The institutional per case cost of treatment of patients with posterior epistaxis with gelatin-thrombin matrix is 80.3%, 87.4%, and 89.4% less than with endoscopic surgery, posterior packing, or embolization, respectively. There were no complications.Conclusion: This pilot study demonstrated that gelatin-thrombin matrix is a safe and both a clinically effective and costsaving means of treating posterior epistaxis. In this study, its use is associated with a low level of discomfort. This treatment method may improve the quality of care for patients with posterior epistaxis.

NA Laryngoscope, 2443-2447, 2018.

Our study was performed to identify the clinical findings, risk factors, and complications of deep neck space infections (DNSI) at our center and compare our experience with the experiences of others. Methods Retrospectively, 183 cases of DNSI met our inclusion criteria from 2000 to 2018 at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia. Results In our study, analysis showed that males are more likely to have DNSI (88.7%). The most common site of infection is the peritonsillar abscess (30.6%). Dental infections were found to be the most common etiological factor for DNSI (42.6%). Streptococcus pyogenes was found to be the most common microorganism (39.3%) followed by Staphylococcus aureus (21.3%). Diabetes and hypertension (45.2% and 23.7%, respectively) are the most commonly associated disorders in patients with DNSI. Extension to another space was the most common complication of DNSI. Conclusion Despite the wide usage of antibiotics, DNSI still occur and are life-threatening conditions that need urgent management to avoid unpleasant complications.

Background Thyroid nodules have become relatively common in clinical practice, and their prevalence increases with age. The majority of thyroid nodules are benign, with 5-15% being malignant. There are a number of well-established predictors of malignancy in thyroid nodules, but thyroid nodule size has been a cause for concern for many researchers and results of the studies are still controversial about their probability of malignancy. Up to the current knowledge, there is no published study that evaluates if thyroid nodule size is associated with the risk of malignancy in Saudi Arabia, so in this study, we aim to find that. Methods This is a retrospective study of 987 patients who underwent thyroid nodule fine-needle aspiration (FNA) and subsequent thyroidectomy for thyroid nodules measuring ≥ 1 cm. Results Thyroid cancer was more prevalent in males than females, and in patients who were older than or equal to 45 years. Nodular size of 1-1.9 cm was more prevalent among cancer patients than in benign cases (p<0.001). Conclusions The highest malignancy risk was observed in nodules <2 cm and no increase in malignancy risk for nodules >2 cm. Nevertheless, when examined by type of thyroid malignancy, the rate of follicular carcinoma and other rare malignancy increased with increasing nodule size.

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Our study was performed to identify the clinical findings, risk factors, and complications of deep neck space infections (DNSI) at our center and compare our experience with the experiences of others. Methods Retrospectively, 183 cases of DNSI met our inclusion criteria from 2000 to 2018 at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia. Results In our study, analysis showed that males are more likely to have DNSI (88.7%). The most common site of infection is the peritonsillar abscess (30.6%). Dental infections were found to be the most common etiological factor for DNSI (42.6%). Streptococcus pyogenes was found to be the most common microorganism (39.3%) followed by Staphylococcus aureus (21.3%). Diabetes and hypertension (45.2% and 23.7%, respectively) are the most commonly associated disorders in patients with DNSI. Extension to another space was the most common complication of DNSI. Conclusion Despite the wide usage of antibiotics, DNSI still occur and are life-threatening conditions that need urgent management to avoid unpleasant complications.

Since its outbreak in late 2019, the COVID-19 pandemic has seen a sharp rise in the demand for oxygen and ventilation facilities due to the associated extensive damage that it causes to the lungs. This study is considered the first and largest study in Saudi Arabia to evaluate the outcomes of tracheostomy in intubated COVID-19 patients. This is a retrospective, observational cohort study that was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia and King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. The findings of the study revealed that seventy-one patients with COVID-19 underwent tracheotomy between 1 March 2020 and 31 October 2020. The average period between intubation and tracheostomy was 9.97 days. Hypertension, diabetes, lung disease and obesity (BMI > 30) were significant risk factors of mortality. The overall 30-day mortality rate was 38.4%.

Background Acetylcholinesterase inhibitors (ACEIs) and memantine are drugs used in Alzheimer's disease (AD) and dementia with Lewy bodies or associated to Parkinson's disease (LB-P). Their efficacy is limited and deprescription strategies are necessary when clinical, functional decline, advanced dementia and/or end of life occurs. Purpose To evaluate the use of anti-dementia drugs of institutionalised people who died throughout a year in the nursing homes studied. Material and methods Retrospective analysis of patients who died in seven nursing homes between July 2017 and June 2018. We analysed the Global Impairment Scale (GDS-FAST), the Barthel Index (BI), anti-dementia drugs and their withdrawal prior to the death of people diagnosed with dementia. The data were obtained from the electronic prescription system and analysed with SPSS v20. Results Among 1125 people attended during the analysed period, 183 (16.3%) died, identifying 128 (69.94%) cases of dementia. Of these, 56% were female, with a mean age of 89.9 (s=6.54) for females and 84 (s=6.9) for males, and the median stay was 613 days (IQR 1679). Cognitive and functional assessments were: GDS-FAST median 6 (IQR 1) and BI median 17 (IQR 32).The distribution of dementias had the following pattern: AD 51 (39.8%), vascular dementia 14 (10.9%), LB-P six (4.7%), mixed dementia three (2.3%), frontotemporal dementia two (1.6%) and other types 52 (40.6%).Forty-one (32%) patients had a specific drug for dementia during their stay: ACEIs 27 (65.9%), memantine nine (22%) and ACEIs +memantine five (12.2%). 73.2% of patients diagnosed with AD or LB-P had been prescribed one of these drugs.Eighty-five per cent and 70% of the patients persisted with their treatment in the past 12 and 6 months, respectively. The median number of days from the suspension of the drugs to death was 11 (IQR 259.5). For this analysis, four cases with a stay shorter than 30 days were excluded. Conclusion A high percentage of patients had been prescribed anti-dementia drugs close to their death.We have to do an early identification of patients at the end of life and re-evalute the effectiveness of these drugs during this period, applying if necessary, deprescription strategies.