Search Results (1,894)

Background/Objectives: Eustachian Tube Dysfunction (ETD) is a prevalent condition affecting middle ear pressure regulation, yet nationwide epidemiological data in Saudi Arabia remain limited. This study aimed to assess the prevalence of ETD and identify its associated factors among Saudi adults using a validated screening tool. Methods: A nationwide cross-sectional study was conducted between June 2024 and March 2025 among 1124 Saudi adults (aged ≥ 18 years) across five geographic regions. ETD was assessed using the validated Arabic version of the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), with scores ≥ 14.5 indicating dysfunction. Data on demographic, anthropometric, clinical, and lifestyle characteristics were collected via an online questionnaire. Multiple linear regression analysis identified independent predictors of ETDQ-7 scores, with statistical significance set at p < 0.05. Results: The prevalence of ETD was 33.9% (95% CI: 31.1–36.8%), substantially higher than the 7% self-reported rate. Of affected participants, 29.6% had mild-to-moderate ETD and 4.3% had severe dysfunction. Multivariable regression analysis identified four significant independent predictors: higher body mass index (BMI) (β = 0.08; 95% CI: 0.03–0.16; p = 0.049), family history of hearing loss (β = 1.87; 95% CI: 0.90–2.83; p < 0.001), prior bariatric bypass surgery (β = 14.37; 95% CI: 3.33–25.41; p = 0.011), and allergies (β = 3.19; 95% CI: 2.30–4.07; p < 0.001). No significant associations were found with demographic factors, smoking, or other comorbidities. Conclusions: ETD affects approximately one-third of Saudi adults, with significant underdiagnosis. Obesity, genetic predisposition, bariatric surgery, and allergic conditions represent key modifiable and non-modifiable risk factors. These findings support implementing routine ETDQ-7 screening in primary care and targeted interventions for high-risk populations. Full article

Background/Objectives: Anatomical variation in the ethmoid roof and lateral lamella play an important role in anatomical vulnerability during endoscopic sinus and skull base surgery. However, widely used classifications, including the Keros system, primarily focus on vertical depth and may not fully reflect the complex geometric relationship between the ethmoid roof, lateral lamella, and the anterior ethmoidal artery (AEA). This study aimed to characterize ethmoid roof and lateral lamella anatomy using high-resolution CT and to propose a descriptive radiological framework—the Akcan Classification—that integrates AEA exit patterns with multiple morphometric parameters. Given the complexity of thin skull base structures, interobserver reproducibility of all morphometric parameters was additionally assessed to ensure measurement robustness. Methods: High-resolution paranasal sinus CT scans from 175 adults (350 sides) were retrospectively evaluated. Measurements included ethmoid roof width, lateral lamella depth, anterior–posterior length, lamellar angle, AEA–lamella distance, and sinonasal anatomical variations. Interobserver reliability was quantified using ICCs. AEA morphology was categorized as in-canal (Type 1), partially suspended (Type 2), or fully suspended (Type 3) based on radiological appearance of bony canalization. Appropriate statistical tests were used to compare morphometric features across groups. Results: Suspended AEA configurations demonstrated progressively wider ethmoid roofs, deeper lateral lamellae, steeper lamellar inclination, and shorter AEA–lamella distances (all p < 0.001). Supraorbital ethmoid cells were more frequently observed in Type 3 cases (p < 0.001). Other anatomical variations showed no significant association with ethmoid roof morphology. Interobserver reliability was excellent for all measurements (ICC range 0.87–0.94). Conclusions: The findings suggest that AEA configuration is associated with broader patterns of ethmoid roof and lateral lamella morphology. Rather than serving as a validated predictor of surgical outcomes, the Akcan Classification provides a structured anatomical and radiological descriptor that complements depth-based systems such as the Keros classification. The high reproducibility of measurements supports its potential utility for standardized anatomical assessment and preoperative radiological interpretation, while further studies incorporating surgical correlation are required. Full article

Background: Periprosthetic joint infections (PJIs) of the hip and knee are one of the most severe complications in arthroplasty, often requiring prolonged antibiotic therapy and multiple revision surgeries. The increasing prevalence of multidrug-resistant organisms and biofilm-associated PJIs has renewed interest in bacteriophage therapy as a targeted, adjunctive treatment option in refractory cases. This investigation systematically reviews and discusses the current evidence regarding the application, outcomes, and safety profile of bacteriophage therapy in the management of PJIs. Methods: This systematic review was conducted in accordance with the 2020 PRISMA statement. PubMed, Google Scholar, EMBASE, and Web of Science were accessed in August 2025. No time constraints were used for the search. All clinical studies investigating bacteriophage therapy for bacterial PJIs were considered for eligibility. Results: A total of 18 clinical studies, comprising 53 patients treated with bacteriophage therapy for PJI, were included. The mean follow-up was approximately 13.6 months. Staphylococcus aureus was the most frequent pathogen (18 cases); phage cocktails were used in 33 patients and monophage preparations in 9, all combined with suppressive antibiotic therapy. Persistent or resistant joint pain was reported in only two patients (3.8%), while signs of ongoing infection despite phage therapy were observed in four patients (7.5%). Adverse events following BT were inconsistently reported. Conclusions: Bacteriophage therapy shows promise as an adjunctive treatment for hip and knee PJIs, especially in refractory or multidrug-resistant cases. Current evidence is limited and methodologically weak, underscoring the need for well-designed clinical trials to clarify efficacy, safety, and optimal integration into existing orthopaedic infection protocols. Full article

Background/Objectives: Unstable intertrochanteric femur fractures (IFFs) in geriatric patients are associated with high rates of morbidity and mortality due to poor bone quality, multiple comorbidities, and limited functional capacity. This study aimed to compare the clinical outcomes of cementless bipolar hemiarthroplasty (BHA) performed via a transtrochanteric approach and proximal femoral nailing (PFN) in elderly patients with unstable IFFs. Methods: This retrospective comparative study included 131 patients aged ≥70 years who underwent surgery for AO/OTA 31-A2 and 31-A3 unstable fractures between January 2021 and July 2025 were retrospectively reviewed. 64 patients received cementless BHA and 67 underwent PFN. Eligible patients were ambulatory prior to fracture (independently or with a cane/walker); patients with pathological fractures/malignancy, alternative procedures (cemented or posterolateral BHA, total hip arthroplasty, tumor prosthesis, or other osteosynthesis methods), incomplete records, or <6 months of follow-up were excluded. Demographics, perioperative variables, mechanical complications, revision requirement, time to mobilization, and 1- and 6-month mortality rates were analyzed. Primary outcomes were mortality and perioperative clinical parameters. Results: The two groups were comparable in age, sex, ASA scores, and fracture patterns. Intraoperative blood loss and transfusion requirements were significantly higher in the BHA group (both p < 0.001). Mobilization was observed earlier in patients treated with BHA (1 [1,2] vs. 3 [2,3] days; p < 0.001). Mechanical complications were more frequently observed after PFN, which was associated with a higher revision requirement (17.9% vs. 4.7%; p = 0.018). Operative time, hospital stay, and 1- and 6-month mortality rates showed no significant differences between the groups. Conclusions: In geriatric patients with unstable IFFs, cementless BHA performed via a transtrochanteric approach may be considered a viable surgical option with appropriate patient selection, taking into account its association with earlier mobilization and the observed mechanical complication profile. PFN offers advantages of reduced blood loss and lower transfusion needs. Surgical decision-making should be individualized based on fracture morphology, bone quality, and the patient’s overall medical condition. Given the heterogeneity of unstable fractures within the AO/OTA classification and the retrospective nature of the present study, larger, multicenter prospective investigations incorporating functional outcomes are warranted to further clarify optimal treatment strategies. Full article

Background/Objectives: Ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis produce long-segment spinal ankylosis, altered biomechanics, and high fracture risk in the cervical spine. Paraspinal muscle degeneration (“spine-specific sarcopenia”) has been linked to pain, disability, and worse outcomes after cervical spine surgery, but the relationship between vertebral ankylosis and cervical paraspinal muscle health is unknown. We aimed to evaluate the association between vertebral ankylosis and cervical paraspinal muscle health using MRI-based measures of muscle quantity and quality. Methods: Adult patients with cervical vertebral ankylosis and available cervical MRI were identified at a single academic center and propensity score-matched 1:1 to patients without ankylosing conditions based on age, sex, body mass index, American Society of Anesthesiologists class, and comorbidity index. Axial T2-weighted images at C2-3 through C7-T1 were used to manually trace bilateral deep extensor and deep flexor muscles to obtain bilateral cross-sectional areas (CSAs) at each level. Extensor fatty infiltration was graded using the Goutallier classification. CSAs and Goutallier grades were compared between the matched groups. Results: Compared with matched controls, patients with vertebral ankylosis demonstrated significantly smaller deep extensor CSA at multiple cervical levels and higher Goutallier grades in the lower cervical spine and at the cervicothoracic junction. Deep flexor CSA tended to be smaller in the ankylosis group, but differences did not reach statistical significance. Conclusions: Vertebral ankylosis is associated with poorer cervical paraspinal muscle health, characterized by reduced extensor muscle bulk and increased fatty degeneration. These findings support conceptualizing ankylosing spinal conditions as disorders of both bone and muscle and highlight the cervicothoracic extensors as a potential target for risk stratification and rehabilitation strategies. Full article

Background/Objectives: Biodegradable implants have emerged as a promising alternative to traditional metallic fixation devices in pediatric orthopedic surgery. Avoiding implant removal is especially advantageous in children, who would otherwise require a second operation with additional anesthetic and surgical risks. This study reviews the current use of poly(lactic-co-glycolic acid) (PLGA) implants in pediatric fracture fixation and evaluates how they address limitations associated with traditional hardware. Methods: A narrative review was conducted summarizing current evidence, clinical experience, and case examples involving PLGA-based devices used in pediatric trauma. Special emphasis was placed on the degradation mechanism of PLGA, its controlled hydrolysis profile, and the capacity of the material to provide temporary mechanical stability during bone healing before complete resorption. The review included studies of PLGA use in forearm, distal radius, ankle, and elbow fractures, comparing outcomes to those obtained with metallic implants. Results: Across multiple clinical reports and case series, PLGA implants demonstrated effective fracture healing, stable fixation, and complication rates comparable to traditional metallic devices. Patients treated with resorbable implants benefited from reduced postoperative morbidity, no requirement for implant removal, and improved imaging compatibility. Conclusions: PLGA-based bioabsorbable implants represent a safe and effective alternative to conventional metal fixation in children. Their favorable degradation kinetics and clinical performance support their growing use in pediatric trauma surgery, while ongoing advances in polymer design and bioresorbable alloys continue to expand future applications. Full article

Background: Advances in pediatric electrophysiology have revolutionized cardiac care by offering patients treatments for increasingly complex cardiac rhythm and conduction disorders. However, despite these innovations, there are a number of potential complications that clinicians have to deal with. Case presentation: This clinical case study describes a rare complication in a child following pacemaker implantation, namely the appearance and accumulation of air in the pacemaker pocket. The child underwent multiple cardiac surgery for a complex congenital heart defect (CHD). Unfortunately, during surgical repair of a ventricular septal defect, the conduction pathways were disturbed. This caused second-degree atrioventricular block and required implantation of an epicardial pacemaker system. Heart block developed several days postoperatively and the child underwent a series of diagnostic tests and was successfully treated. Discussion: Pneumothorax and pneumomediastinum with air dissemination into the pacemaker pocket may develop postoperatively. But this a rare complication of pacemaker implantation, especially in children. This complication can cause pacemaker malfunction and be life-threatening. In the presented clinical case, the most likely cause was spontaneous pneumothorax expanding to the mediastinum and into the pacemaker pocket. Conclusions: Early identification of this complication will minimize the risk of pacemaker dysfunction and improve clinical outcomes. Full article

Objective: Intraoperative hypothermia is a common perioperative complication. This large-scale, multicenter, prospective clinical study aimed to delineate the occurrence patterns of intraoperative hypothermia in adults and to identify its major independent risk factors, thereby providing evidence-based support for early clinical risk assessment and intervention. Methods: This study adopted a multicenter, prospective, observational design. Eligible participants were screened based on predefined inclusion and exclusion criteria, and a total of 4516 surgical patients (≥18 years) from 12 tertiary general hospitals across China were ultimately enrolled. Core body temperature was continuously monitored intraoperatively using standardized methods. Data on demographic characteristics, surgical and anesthesia-related parameters, and perioperative temperature management interventions were collected. Patients were stratified into groups according to the presence or absence of hypothermia (core temperature <36.0 °C). Univariate analyses were first conducted to identify associated factors, followed by multivariable logistic regression to determine factors independently associated with intraoperative hypothermia. Results: The overall incidence of intraoperative hypothermia among surgical patients was 23.82%. Hypothermia occurred most frequently in patients with a preoperative baseline core temperature ≤ 35.9 °C (85.93%). Among surgical specialties, hand surgery had the highest incidence of hypothermia (51.35%), and among surgical sites, procedures involving the upper extremities showed the highest rate (35.00%). Multivariable logistic regression analysis identified the following as independent risk factors for intraoperative hypothermia: Type of anesthesia (OR = 1.743, 95% CI: 0.834–3.644), ASA classification (OR = 1.408, 95% CI: 1.197–1.657), Surgical approach (OR = 0.735, 95% CI: 0.577–0.936), Skin disinfection site (OR = 2.024, 95% CI: 1.534–2.670), Volume of cold intravenous fluids infused (mL) (OR = 1.365, 95% CI: 1.140–1.633), Volume of transfused blood (U) (OR = 1.116, 95% CI: 0.807–1.542), Intraoperative blood loss (mL) (OR = 1.252, 95% CI: 0.892–1.756), and Duration of surgery (hours) (OR = 2.014, 95% CI: 1.683–2.411). Conclusions: The incidence of intraoperative hypothermia in adults was relatively high at 23.82% and was observed to be associated with multiple modifiable perioperative factors. These findings support the need to strengthen risk assessment and implement individualized temperature management strategies in clinical practice, with the goal of reducing the risk of intraoperative hypothermia and improving perioperative safety and outcomes. Full article

Background/Objectives: Arteriovenous malformations (AVMs) in the dominant temporo-parieto-occipital (TPO) junction of the brain are extremely rare and very difficult to remove surgically because this area includes multiple sensory and language networks. Due to the fact that many patients present with bleeding, surgeons have to find a delicate balance between removing all of the AVM tissue and preserving the functional areas of the brain where important functions occur. This study is reporting a case demonstrating how precise clinical–radiologic correlation, detailed anatomical knowledge, and deliberate microsurgical techniques can allow safe removal of the AVM and improve the patient’s neurologic function without the need for additional intraoperative technology. Case Presentation: A 47-year-old right-handed male patient experienced persistent neurological deficits after experiencing a hemorrhage from an AVM in his dominant posterior hemisphere, which included mild language difficulties, right hemifacial–brachial spasticity, parietal sensory loss and a visual field defect of his right eye known as an inferior quadrantanopia localized to the TPO junction. Cerebral angiography identified a small, compact, high-flow AVM (40 × 30 mm) fed by distal branches of the middle cerebral artery (M4), posterior cerebral artery (P4), anterior cerebral artery (A4), as well as a small branch of the superior cerebellar artery (SCA). Blood drained into two veins of the Trolard and Labbé. The authors removed the AVM completely by circumferential dissection of the nidus along gliotic planes using a microscope. Feeders were then sequentially disconnected, and the venous outflow was preserved until the AVM could be removed en bloc. Post-operative angiograms demonstrated complete removal of the AVM with normalization of blood flow to the surrounding cortex. The patient’s neurologic function improved over time and at three months post-operatively, he was functioning independently (modified Rankin Scale = 1; Barthel Index = 100) and there was no evidence of residual nidus or edema on imaging. Conclusions: High-flow AVMs in the dominant TPO junction can be completely removed using a disciplined microsurgical approach and a feeder first/vein last disconnection method based on anatomy. The patient’s improvement in function represented reperfusion and reintegration of an injured but still functional network of the brain, reinforcing the idea that careful observation, a deep understanding of brain anatomy, and restrained surgical technique are critical to achieving long-term results in AVM surgery. Full article

Conventional ultrasound (US) has long been central to hepatocellular carcinoma (HCC) surveillance in cirrhotic patients, due to its low cost, wide availability, non-invasiveness, and adequate sensitivity for detecting small nodules. However, its specificity in distinguishing HCC from other lesions is limited. Contrast-enhanced ultrasound (CEUS) has significantly improved the characterization of nodules first identified on conventional US. Yet, when CEUS is performed using sulfur hexafluoride (SonoVue)—the only contrast agent available in Western countries—assessment remains restricted to a single nodule per examination, and enhanced CT or MRI is still required for full characterization and staging. In clinical settings, such as hepatology, internal medicine, infectious diseases, and surgery, CEUS offers the advantage of immediate availability, enabling rapid characterization of suspicious nodules in cirrhotic livers and facilitating timely therapeutic decisions. Although the introduction of direct-acting antivirals (DAAs) has substantially reduced HCV-related HCC, HCC incidence is increasingly driven by metabolic dysfunction-associated steatohepatitis (MASH). Evidence on surveillance strategies for MASH patients remains limited, and current EASL guidelines recommend monitoring only patients with >F2 fibrosis. Additionally, the effectiveness of US in obese or diabetic/obese populations is under ongoing investigation; abbreviated non-contrast MRI has been proposed as an alternative surveillance tool, but its adoption would entail significant economic implications for healthcare systems. HCC arising from MASH—sometimes even without cirrhosis—exhibits different sonographic and pathological features. Instead of small, hypoechoic nodules, typically seen in HCV-related cirrhosis, clinicians increasingly encounter larger or multiple lesions, often accompanied by macrovascular invasion, limiting access to curative treatments. Furthermore, typical CEUS LI-RADS patterns are less frequently observed. This review summarizes the evolving US findings in the era of MASH-related HCC and underscores the continued importance of US as the primary imaging tool in routine clinical practice. Full article

Introduction: White coat hypertension in geriatric patients can complicate dental procedures in the presence of intense anxiety. Objective: To evaluate the effectiveness of a combined approach of psychological intervention and sedation for the control of the syndrome during multiple extractions. Case presentation: A 76-year-old woman with a diagnosis of white coat hypertension (WCH) and a history of dental anxiety. In two previous attempts, the surgery was suspended due to blood pressure elevation. The Dental Perception Reprogramming Protocol (DPRP) was applied along with conscious sedation (midazolam, fentanyl, dexmedetomidine) which allowed agitation, so deep sedation with propofol was used. Result: The patient had stable blood pressure (119/82 mmHg) and successfully completed the intervention without complications. Conclusions: The integration of psycho-behavioral and pharmacological techniques allowed effective hemodynamic control, and a key interdisciplinary approach is suggested for the management of the syndrome in older adults. Full article

Background and Objectives: Obesity is a major public health concern associated with reduced quality of life (QoL) and multiple comorbidities. Bariatric surgery is an effective treatment for severe obesity; however, postoperative QoL outcomes in Latvia remain insufficiently studied. This prospective study evaluated short-term changes in QoL, weight loss, and selected health parameters six months after bariatric surgery. Materials and Methods: Data were collected from 17 adults who underwent bariatric surgery at a single centre in Riga, Latvia. QoL was assessed preoperatively and six months postoperatively using the validated Bariatric Quality of Life (BQL) questionnaire. Anthropometric measurements, self-reported comorbidities, and medication use were obtained at both time points. Statistical analysis was performed using non-parametric methods (p < 0.05). Results: Participants had a median age of 54 years, and 76% were female. Six months after surgery, significant reductions were observed in BMI (39.7 to 31.6 kg/m²; p < 0.0001), total weight (−23.3%), and excess weight (−60.7%). The total BQL score increased from 44.5 to 52.0 points (p = 0.004), indicating improved QoL. Self-reported hypertension and sleep apnoea decreased, and all individuals with preoperative reflux symptoms reported resolution. Waist circumference declined but often remained above metabolic risk thresholds. Hair loss was the most frequently reported postoperative adverse effect. Conclusions: Bariatric surgery was associated with short-term improvements in QoL, weight loss, and several obesity-related symptoms. Hair loss was common but expected. Given the small sample size and single-centre design, findings should be interpreted as exploratory. Larger studies with longer follow-up are needed to better characterize long-term outcomes and support the development of bariatric care in Latvia. Full article

Objective: To demonstrate that PerClot’s efficacy is non-inferior to other hemostatic treatments and its safety is non-inferior to the standard of care (SoC) during surgery. Methods: Applying keywords and inclusion criteria, we queried electronic databases to conduct a systematic (e.g., Embase and Cochrane Library, etc.) and manual search (e.g., Google Scholar, etc.) for studies from 1 January 2008 (first CE marked date) to 30 March 2024. Results: Five published studies were included in this systematic review. From the included studies, 691 patients received either PerClot (n = 315) or other hemostatic agents/SoC/control (n = 376) in different surgical specialties. All five studies had comparable outcome measures, interventions, and control groups, allowing for the pooling of the study data. The primary outcomes were the achievement of hemostasis and time to hemostasis. At 7 min post-application, PerClot demonstrated non-inferior hemostasis performance as compared to Arista (absolute difference: −1.4%; 95% CI: −7.54, 4.74; p = 0.65). The time to achieve hemostasis was comparable between PerClot and other hemostatic agents (mean difference: 0.00 min; 95% CI: 0.00, 0.00; p = 1.00). No statistically significant difference in adverse event occurrence was observed between PerClot and other hemostatic agents/SoC groups (absolute difference: 0.02; 95% CI: −0.30, 0.35; p = 0.2691) and the absence of new unknown adverse events indicates the safety profile of PerClot. The results of all outcome measures are statistically insignificant. Conclusions: Our systematic review demonstrated that PerClot achieved comparable hemostasis with no new safety concerns and a statistically significant reduction in postoperative drainage volume, indicating its safety, efficacy, and performance as an alternative for hemostasis across multiple surgical specialties. Full article

Glioblastoma (GB) is a highly aggressive brain tumor with a very poor prognosis. Treatment usually consists of surgery, followed by radiotherapy and chemotherapy, but the prognosis remains poor due to its resistance to therapies and a high recurrence rate. Multiple studies have reported the presence of human cytomegalovirus (HCMV) proteins and/or nucleic acids in GB tissues, suggesting its possible implication. These findings have led to the hypothesis that HCMV may contribute to tumor progression, immune evasion, angiogenesis, and resistance to therapy. Clinical trials using anti-HCMV therapies have shown promising preliminary results, indicating a potential therapeutic benefit. This review aims to provide a comprehensive overview of the current evidence linking HCMV to GB and the therapeutic implications. A deeper understanding of this complex interaction could unveil novel strategies for GB treatment. Full article

Background:The presence of visceral pleural invasion (VPI) is associated with increased risk of recurrence and reduced overall survival following surgical resection. We aimed to develop machine learning (ML)-based classification models that integrate clinical variables and both tumoral and peritumoral radiomic features to predict VPI in patients with lung adenocarcinoma before surgery. Methods: We retrospectively enrolled 118 patients, including 80 (68%) without VPI and 38 (32%) with histologically confirmed VPI. All patients underwent preoperative contrast-enhanced CT scans. Tumor volumes were manually segmented, and isotropic expansions of 3, 5, and 10 mm were automatically generated to define peritumoral regions. The dataset was randomly split into training (70%) and validation (30%) cohorts. Radiomic features and clinical data were used to train multiple ML algorithms. Results: Pleural Tag Sign and the Worst Histotype were identified as the strongest clinical predictors of VPI. The combined model, integrating radiomics from the lesion and clinical variables, achieved the highest training accuracy of 0.88 (95% CI: 0.80–0.92) and validation accuracy of 0.83 (95% CI: 0.68–0.92). Conclusions: VPI is associated with detectable alterations in both tumoral and peritumoral microenvironment on contrast-enhanced CT. Incorporating radiomic features with clinical data enabled improved model performance compared to clinical-only models, yielding very good accuracies. This approach may support surgical planning and patient risk stratification. Further prospective studies are needed to validate these findings and assess their clinical impact. Full article