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Introduction: Many laryngeal-related problems have been attributed to laryngopharyngeal reflux including dysphonia, frequent throat clearing, chronic cough, and globus sensation. However, there is still controversy regarding diagnosis and clinical presentation of this disorder. Objective: The main objective of this study is to describe laryngopharyngeal reflux characteristics of different reflux position patterns in laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. Methods: A retrospective chart review was conducted for 161 laryngopharyngeal reflux patients diagnosed with 24 h oro-pharyngeal pH monitoring. Study subjects were categorized into upright and supine laryngopharyngeal reflux groups based on the pH results. The two groups were compared regarding the clinical presentation and pH characteristics. Results: Significant higher rates of upright laryngopharyngeal reflux position than supine laryngopharyngeal reflux position (P

Resumo Introdução: Muitos problemas relacionados à laringe têm sido atribuídos ao refluxo laringofaríngeo, inclusive disfonia, pigarro frequente, tosse crônica e sensação de “globus” faríngeo. No entanto, ainda há controvérsias quanto ao diagnóstico e à apresentação clínica dessa condição clínica. Objetivo: Descrever as características do refluxo laringofaríngeo de diferentes posições, em pacientes diagnosticados por meio de pHmetria orofaríngea. Método: Foi feita uma revisão retrospectiva de prontuários de 161 pacientes com refluxo laringofaríngeo diagnosticado por pHmetria orofaríngea de 24 horas. Os indivíduos do estudo foram categorizados em grupos com refluxo laringofaríngeo na posição ortostática e refluxo laringofaríngeo na posição supina com base nos resultados do pH. Os dois grupos foram comparados quanto à apresentação clínica e às características do pH. Resultados: Foram encontradas taxas significativamente mais altas de refluxo laringofaríngeo na posição ortostática em comparação à posição supina (p < 0,0001). Os resultados do índice de sintomas de refluxo foram significativamente maiores no grupo com refluxo laringofaríngeo na posição ortostática em comparação com o grupo com refluxo laringofaríngeo na posição supina. O uso do escore de Ryan composto (composite Ryan score) para a pHmetria orofaríngea de 24 horas foi significantemente maior no grupo com refluxo laringofaríngeo ortostático em relação ao grupo supino (p < 0,0001). Nenhuma diferença significante foi encontrada entre os grupos refluxo laringofaríngeo na posição ortostática e posição supina em relação à frequência da apresentação clínica ou classificações do índice de desvantagem vocal. Conclusão: O refluxo laringofaríngeo foi mais prevalente na posição ortostática entre os grupos de estudo. As características relacionadas ao refluxo, inclusive parâmetros de pH, foram mais evidentes no refluxo laringofaríngeo na posição ortostática.

Additional file 1: Table S2. Characteristics of and reasons for the excluded studies.

Stiff elbow is a common clinical consequence in the elbow joint. Impairment in active daily living is noted in flexion-extension stiffness as well as rotational stiffness. Elbow stiffness can be divided into 3 different types: intrinsic, extrinsic and mixed type. The intrinsic type is referred to as articular deficit and loss of conformity resulting from trauma, infection or arthritic changes of intra-articular origin. The extrinsic stiffness is caused by fibrotic changes or scar formation of surrounding muscles, ligaments or skin. Ectopic ossification is a typical example of the extrinsic type of stiff elbow. The mixed type is defined when both intrinsic and extrinsic causes are combined, and is most common among post-traumatic elbow stiffness. Arthroscopic release of the anterior capsule for flexion contracture can be done in a safe way. In cases of severe joint contracture, however, it is safe to release and isolate the ulnar nerve with minimal incision before the arthroscopic capsular release; otherwise sudden gain of flexion after extensive release of the capsule may tether the ulnar nerve around posterior aspect of the medial epicondyle. A recent trend of arthroscopy is to draw equal clinical outcomes compared to existing open surgery by incising minimally and starting early rehabilitation to lessen patients' pain and achieve better range of motion. But a thoughtful understanding of the elbow anatomy and skillful arthroscopic technique is essential to minimize neurovascular insult or other surgical complication caused by inexperience.

There is limited epidemiological information on swallowing dysfunction (SwD) in otherwise healthy infants and toddlers (OHITs). Cost, invasiveness, expertise, and resources constrain the repeatability and utility of instrumental diagnostic tests. A parent-reported outcomes (PRO) tool has the potential to mitigate these disadvantages. Hence, we set out to develop and validate a novel PRO tool to assess SwD in OHITs.A mixed-method study.Tertiary pediatric center.We recruited parents of OHITs with SwD and excluded those with a confounding diagnosis (syndromes or neurological impairment). Interviews were conducted and thematically analyzed to extract the relevant domains and items. A similar analytical method was performed on the reports from a systematic review and literature search. Four verification sessions of parents and experts were conducted to maintain rigor. A panel of experts assessed and established the content validity of the items using a modified Delphi technique.We achieved information saturation after interviewing 10 parents and generated 7 domains with 72 items. Over the course of 3 rounds of modified Delphi content validation, the domains were reduced to 3 (swallowing, breathing, and illness) containing 21 items; a content validity index of 82.1% was achieved.We validated the content of a new PRO instrument to assess SwD in OHITs. The instrument is composed of 3 primary domains representing 21 items. This tool has the potential to screen for swallowing dysfunction and can assess management outcomes specifically for this population at a community level.

Que peut exprimer le roman yéménite dans le contexte d’une réalité violente et changeante, alors que les guerres et les conflits locaux ont indubitablement circonscrit l’espace d’expression des écrivains au traitement de questions humaines fondamentales ? L’expérience littéraire au Yémen ne semble pas avoir nourri une réflexion intellectuelle dépassant les limites de la réalité vécue et diversifiant ses thèmes, ce qui fut observé dans d’autres contextes. La question reste brûlante à propos d’...

Precise identification and preservation of the facial nerve is mandatory to avoid dysfunction of the facial nerve during parotidectomy. In this article, the authors are introducing a new landmark to identify the facial nerve for parotidectomy that is more protective for the facial nerve. The authors use a simple approach to predict the position of facial nerve main trunk intraoperatively without geometric calculations and a lot of landmarks. An imaginary almost 2 cm line is drawn between mastoid tip inferiorly and bony-cartilaginous junction of the external auditory canal superiorly. The main trunk of the facial nerve can be visualized at the midpoint of this line. The authors have been using this landmark successfully for the last 10 years, without any functional deficit of the parotid nerve. Identifying the facial nerve at the trunk level by this landmark renders following the branches forward in the glandular parenchyma less complicated.

Key Clinical Message Erythromelanosis follicularis faciei et colli (EFFC) is a distinct, rare, and underdiagnosed condition of unknown etiology that is characterized by well‐demarcated erythema, hyperpigmentation, and follicular papules. The pigmentation is usually on both maxillary, preauricular regions, and the cheeks. We report a case of a 12‐year‐old boy with EFFC that was associated with reticulated pigmentation of the extremities.

Objectives: To evaluate sleep quality and daytime sleepiness in health care professionals who are performing shift work. Methods : This cross-sectional study was conducted on 510 health care professionals at Prince Sultan Military Medical City and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia between December 2015 and April 2016. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Participants were divided into 2 groups: shift workers and non-shift workers. Results : We compared both groups regarding the effect of shift work on the total score of PSQI and ESS. We found that the PSQI global score ( p less than 0.001) and the total ESS score ( p= 0.003) were significantly higher in shift work health care professionals. Conclusion : Shift work among health care professionals is associated with poor sleep quality but not excessive daytime sleepiness. Health care professionals performing shift work have PSQI and ESS scores slightly higher than non-shift work health professionals. Saudi Med J 2017; Vol. 38 (8): 846-851 doi: 10.15537/smj.2017.8.19025 How to cite this article: Alshahrani SM, Baqays AA, Alenazi AA, AlAngari AM, AlHadi AN. Impact of shift work on sleep and daytime performance among health care professionals. Saudi Med J . 2017 Aug;38(8):846-851. doi: 10.15537/smj.2017.8.19025. Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0in; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

[Purpose] The aim of the present study was to investigate the association between sleep duration, quality and obesity in the medical students of Saudi population. [Subjects and Methods] This is a cross-sectional study carried out in 408 medical students from King Khalid University Hospitals, Riyadh, Saudi Arabia, based on well-designed questionnaire study and consent form. [Results] The results of this study revealed 39.9% of subjects perform the exercise on regular basis and 61.5% of them reduced their weight, which may be due to diet plan (52.9%) also. Only 68.6% of the subjects were affected with the weight. The maximum number of subjects was lying down after the lunch (88.2%), sitting and reading (80.1%) are prone to develop obesity in future. [Conclusion] Our study confirms sleep disturbance has affected the weight gain and the maximum number of subjects was lying down after the lunch and sitting and reading will be prone to develop obesity in future.

To explore physical activity (PA) habits among the medical students and examine the correlation with their grade point average (GPA) achievement at College of Medicine, King Saud University, Riyadh, Saudi Arabia.A cross-sectional study was conducted among the medical students (n = 409), during the academic year 2012-2013. Students' physical activity habits were self-reported. GPA, body mass index (BMI) and body fat percent (BF%) were collected and analyzed with SPSS software.Out of 409 students, 193 (47.2%) students reported being physically active. Our result showed a significant positive association between students' PA habits and high-GPA achievement (χ(2 )= 10.65, p = 0.001). The greatest odds ratio of high GPA was found among the fourth year students (OR = 3.08, CI: 1.15-8.28, p = 0.025) and fifth year students (OR = 5.07, CI: 1.48-17.31, p = 0.010). In addition, significant association was found between the normal BMI and high-GPA achievers (χ(2 )= 8.30; p = 0.016). However, no statistically, significant association was found between BF% and GPA.The present study showed a positive associations was found between PA habits and high academic achievement. In addition, positive association was found between PA, obese students and GPA achievement. Therefore, there is a need for the establishment of physical activity education and public health programs to promote importance of PA in Saudi population.

Background and Objectives.Laryngopharyngeal reflux (LPR) exhibits nonspecific clinical presentations, and these symptoms may be associated with other conditions such as allergies, including allergic rhinitis and laryngitis. However, there is a gap in the literature regarding the correlation of laryngopharyngeal reflux with allergic rhinitis/laryngitis. Hence, the aim of this study is to explore the correlation between these two conditions.Patients and Methods.A total of 126 patients with suggestive manifestations of laryngopharyngeal reflux were included in this study. Patients were classified into LPR positive and negative groups based on the results of a 24-hour oropharyngeal pH monitoring system while allergic rhinitis status was assessed with the score for allergic rhinitis (SFAR).The results of the two groups were compared regarding the SFAR score. Correlation between the pH results and SFAR score was explored. Results.The LPR positive group demonstrated significantly higher SFAR scores compared to the negative LPR group(p<0.0001). In addition, the Ryan score was significantly correlated with theSFAR total score and its symptomatology-related items (r ranged between 0.35 and 0.5). Conclusion.It seems that laryngopharyngeal reflux increases patients’ self-rating of allergic manifestations. It appears that there is an association between laryngopharyngeal reflux and allergic rhinitis/laryngitis.

BACKGROUND: Allergic rhinitis (AR) is a common inflammation of the nasal mucosa in response to allergen exposure. We translated and validated the Score for Allergic Rhinitis (SFAR) into an Arabic version so that the disease can be studied in an Arabic population. OBJECTIVES: SFAR is a non-invasive self-administered tool that evaluates eight items related to AR. This study aimed to translate and culturally adapt the SFAR questionnaire into Arabic, and assess the validity, consistency, and reliability of the translated version in an Arabic-speaking population of patients with suspected AR. STUDY DESIGN: Cross-sectional. SETTING: Tertiary care hospital in Riyadh. PARTICIPANTS AND METHODS: The Arabic version of the SFAR was administered to patients with suspected AR and control participants. MAIN OUTCOME MEASURE: Comparison of the AR and control groups to determine the test-retest reliability and internal consistency of the instrument. RESULTS: The AR (n=173) and control (n=75) groups had significantly different Arabic SFAR scores (P

Objectives: To compare the audiological outcomes of two different approaches of stapes surgery, stapedotomy versus partial stapedectomy. Specifically, our experience in this area will be reviewed and compared to results from other centers performing this kind of surgery. Methods: A retrospective chart review of patients who underwent a stapes surgery between 1997 and 2015. A total of 84 surgeries were performed during this period. Seventy-seven subjects were included in the present study. The audiological results as well as the postoperative vertigo were compared. Results: There is significant improvement demonstrated in postoperative closure of Air Bone Gap in both groups. The partial stapedectomy group showed a significant improvement of air–bone gap closure of 10 dB or more (500 Hz to 2000 Hz) compared with the stapedotomy group, which was achieved in 53.1% and 42.2% of both group respectively. Interestingly, by including the full range of speech frequencies (500 Hz to 4000 Hz), the stapedotomy procedure showed better audiological results than partial stapedectomy. The postoperative vertigo was higher in the partial stapedectomy group. Conclusion: The results of this study clearly show that stapedotomy provides good audiometric results and a lower incidence of complications compared to partial stapedectomy.

OBJECTIVE To investigate the association of PRBC transfusion and the development of NEC in VLBW preterm infants at a tertiary care neonatal unit. METHODS A retrospective case-control study was performed. All VLBW infants (gestational age ≤32 week and birth weight