Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients, providing further evidence that chronic rhinosinusitis should be targeted with maximal medical therapy in the first instance, with surgical treatment being reserved for cases refractory to medical therapy. The presence of nasal polyps does not imply any negative effect on the quality of life after CRS therapy, either medical or surgical.

Background and aims The prevalence of internet addiction (IA) varies widely in the Gulf Cooperation Council (GCC) countries (4%–82.6%). We aimed to assess the quality of IA studies from the GCC and pool their data to get an accurate estimate of the problem of IA in the region. Methods A systematic review of available studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane Controlled Register of Trials were systematically searched; studies conducted in GCC countries (i.e., Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) with a validated instrument for internet addiction assessment were eligible. Ten studies were eligible for the systematic review, all of which were included in the meta-analysis. The Newcastle Ottawa Scale was used for quality assessment. Results Nine out of ten of the included studies had either adolescent and/or young adult participants (age < 25). Two studies were of ‘good’ quality, six were of ‘satisfactory’ quality, and two were of ‘unsatisfactory’ quality. The pooled internet addiction prevalence was 33%; it was significantly higher among females than males (male = 24%, female = 48%, P = 0.05) and has significantly increased over time (P < 0.05). Discussion and conclusions One in every three individuals in GCC countries was deemed to be addicted to the internet, according to Young's Internet Addiction Test. A root cause analysis focusing on family structure, environment, and religious practices is needed to identify modifiable risk factors.

Objective Saudi Arabia ranks second in the number of coronavirus disease 2019 (COVID-19) cases in the Eastern Mediterranean region. It houses the two most sacred religious places for Muslims: Mecca and Medina. It is important to know what the trend in case numbers will be in the next 4–6 months, especially during the Hajj pilgrimage season. Methods Epidemiological data on COVID-19 were obtained from the Saudi Arabian Ministry of Health. A susceptible-exposed-infectious-recovered (SEIR) prediction model was constructed to predict the trend in COVID-19 in Saudi Arabia in the next 6 months. Findings The model predicts that the number of active cases will peak by 22 May 2020. The cumulative infected cases are predicted to reach 70,321 at that time. The total number of infected individuals is estimated reach to 114,580 by the end of the pandemic. Conclusion Our estimates show that by the time the Hajj season commences in Saudi Arabia, the pandemic will be in the midst of its deceleration phase (phase 3). This information will likely be useful to policymakers in their management of the outbreak.

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Superior vena cava obstruction (SVCO) and associated thrombus formation can occur in patients with upper mediastinal or right apical masses. While stenting is useful in relieving obstruction, it can facilitate the passage of upper extremity deep vein thrombus to the pulmonary arterial tree, resulting in a potentially fatal pulmonary embolism (PE). We present a case that illustrates a novel technique, which protects the patient from PE while also relieving the SVCO. This involves placing an inferior vena cava filter in an inverted position within a superior vena cava (SVC) stent to capture emboli. This procedure offers a potentially lifesaving endovascular therapeutic option to patients who would otherwise be deemed unsuitable for SVC stenting.

Objective: Saudi Arabia ranks second in the number of coronavirus disease 2019 (COVID-19) cases in the Eastern Mediterranean region. It houses the two most sacred religious places for Muslims: Mecca and Medina. It is important to know what the trend in case numbers will be in the next 4-6 months, especially during the Hajj pilgrimage season. Methods: Epidemiological data on COVID-19 were obtained from the Saudi Arabian Ministry of Health, the World Health Organization, and the Humanitarian Data Exchange. A susceptible-exposed-infectious-recovered (SEIR) prediction model was constructed to predict the trend in COVID-19 in Saudi Arabia in the next 6 months. Findings: The model predicts that the number of active cases will peak by 20 May 2020. The cumulative infected cases are predicted to reach 59,663 at that time. The total number of infected individuals is estimated reach to 102,647 by the end of the pandemic. Conclusion: Our estimates show that by the time the Hajj season commences in Saudi Arabia, the pandemic will be in the midst of its deceleration phase (phase 3). This information will likely be useful to policymakers in their management of the outbreak.

Abdominal aortic aneurysms with hostile anatomy are a recognized hindrance to the continuing application of endovascular aortic interventions. Narrowed aneurysm necks pose technical difficulties, particularly in the absence of customized endografts. There are multiple suggested approaches to overcome shortened and angulated necks endovascularly; however, none of these address narrowed necks. We present a case where an endograft was used outside of its “instruction for use” by combining the thoracic and iliac branch technologies to overcome this problem. Expanding the use of commercially available endografts for aortic aneurysms with hostile anatomy could have significant practical and financial benefits.

Intraosseous pneumatosis is a rare and often fatal condition characterised by air accumulation in the bone that may be brought about by infection, trauma (surgical or otherwise), degenerative disease or neoplastic processes. Here, we present a case of pelvic emphysematous osteomyelitis following repair of an infected abdominal aortic aneurysm. A 56-year-old Saudi male, known to have diabetes and hypertension, presented to the emergency department complaining of intermittent abdominal pain over the right lower quadrant. The patient was later diagnosed intraoperatively with an infected abdominal aortic aneurysm and treated appropriately. During multiple follow-up imaging studies, the patient was noted to have multiple intra-abdominal fluid collections, as well as intraosseous pneumatosis in the pelvis and right femur. 3 months later, intervention was again required due to patient deterioration and possible aortic graft leakage. Graft abscess was diagnosed and managed. We present a case of an infected abdominal aortic aneurysm that eventually led to emphysematous osteomyelitis of the pelvis. This case report sheds light on intraosseous pneumatosis and emphysematous osteomyelitis, which is characterised by the former, in addition to signs of an underlying infection or abscess formation.