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Feras Zeyad Alotaibi,1– 3 Sajida Agha,1,2 Emad Masuadi1,2 1Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; 3Excellence Center for Simulation and Medical Education, Emergency Department, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaCorrespondence: Feras Zeyad Alotaibi, Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P. O. Box 3660, Riyadh 11481, Internal Mail Code 3118, Riyadh, Saudi Arabia, Tel +966597-555462, Email FerasBinZeyad@gmail.comPurpose: This study explores the healthcare educators’ orientations about medical simulation in clinical skills training —its benefits, needs, challenges, and implications for proper implementation and integration into curricula.Methods: The study used a Q-sort technique, allowing quantitative and qualitative representation of the participants’ orientations and was conducted at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A total of 22 healthcare educators from different roles were included. Participants pre-sorted into three categories and then ranked statements related to medical simulation, by level of agreement, and they answered open-ended and demographic questions. Data was uploaded to Ken-Q Analysis application to conduct Q-factor analysis.Results: A total of 22 healthcare educators participated in the study. Q-factor analysis was performed with principal component analysis and varimax rotation, identifying three factors. Most educators shared a similar orientation regarding the benefits of using simulation-based learning. Most participants considered medical simulation a simple, effortless, and beneficial method of learning. However, challenges in scheduling sessions and obtaining the necessary resources, such as human resources and funds, and lack of training had a negative impact on some participants’ motivation to use medical simulation.Conclusion: Healthcare educators shed light on the influence of multiple factors on using medical simulation. The possibility for students to learn practical and clinical skills was a leading factor. Financial resources, funds, and faculty training were identified as challenges and needs. It is important for institutions and leaders to be aware of the variations in faculty perceptions and to provide resources and training to improve the current use of medical simulation.Keywords: medical education, by-person factor analysis, simulation-based training, educators’ perception, Q-sort study

Objectives: To assess the frequency of olfactory dysfunction (OD) among individuals afflicted with coronavirus disease of 2019 (COVID-19)., Methods: A comprehensive literature search was carried out across several bibliographical databases (PubMed, Scopus, Google Scholar, and Web of Science) to extract publications in the English language between January 2020 and December 2021 to report the incidence of OD alone or together with gustatory dysfunction (GD) among COVID-19 patients., Results: Based on eligibility criteria, 84 articles were included from 27 countries, comprising 36,903 patients, of whom 58.1% were females. The generality rates of olfactory impairment alone was 34.60% and in conjunction with GD was 11.36%. Patients with OD were subclassified into various categories, and the prevalence of anosmia was 20.85%, 5.04% for hyposmia, 8.88% for anosmia or hyposmia, 1.84% for parosmia, 0.78% for phantosmia, and 0.02% for hyperosmia, among COVID-19 patients., Conclusion: Clinical features associated with OD, either isolated or in combination with GD, are common in patients with COVID-19 and consider important signs of COVID-19 that may guide clinicians in the early phase of the disease. PROSPERO Reg. No.: 417296 ., (Copyright: © Saudi Medical Journal.)

Pharyngoesophageal diverticula are rare causes of dysphagia. Zenker's diverticulum is the most common type, followed by Killian-Jamieson diverticulum. A 44-year-old male presented to our clinic with a longstanding history of dysphagia and globus sensation. Bilateral pharyngoesophageal diverticula were confirmed by imaging CT and esophagogastroscopy. He underwent transcervical resection, and a right Killian-Jamieson diverticulum was observed during surgery. The left diverticulum was found to originate above the cricopharyngeus muscle and was labeled as Zenker's diverticulum. Bilateral pharyngoesophageal diverticula are rare, and physicians should be aware of the variable clinical presentations and management options for pharyngoesophageal diverticula., Competing Interests: No funds, grants, or other support were received, and there are no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Laryngeal abscesses are rare in the modern antibiotic era. This report presents a novel case of an epiglottic abscess in a patient with diabetes who developed respiratory distress and was managed by awake intubation in the emergency room followed by transoral incision and drainage of the abscess and tracheostomy. Full recovery after 1 week of intravenous antibiotic treatment was observed. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described risk factor for spontaneous epiglottic abscess development., Competing Interests: The author declares that there is no conflict of interest regarding the publication of this article., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)

Objective: This comprehensive review aims to explain the disease pathophysiology, clinical presentation, and management options., Methods: A review was carried out in the following databases: Medline, Scopus, Web of Science, and Cochrane. The following terms were used alone and combined: Retrograde, Cricopharyngeus muscle, Dysfunction, Abelchia, and inability to burp., Results: A total of 68 articles were identified, and only 11 were found to be relevant and included in writing this review. Retrograde cricopharyngeal dysfunction (R-CPD) is a relatively new disease entity that has recently been described in clinical literature. It is caused by the inability of the cricopharyngeus muscle to relax. Unlike cricopharyngeal dysfunction (CPD), which is well-known and characterized by dysphagia, R-CPD is characterized by the inability to belch in almost all patients, which is considered diagnostic for the condition., Conclusions: High-resolution manometry (HRM) is the definitive diagnostic modality. Most patients reported in the literature responded well to treatment with botulinum toxin injection., Competing Interests: The author declares no conflict of interest., (© 2023 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.)

Background: Nursing staff play a key role in the bedside management of tracheostomized patients in both intensive care units and general floors. Effective provision of postoperative care to these patients by nurses is critical. This study aimed to assess the readiness of nursing staff to manage tracheostomy-related complications in Riyadh, Saudi Arabia., Methods: This cross-sectional study enrolled 395 nurses in Riyadh, Saudi Arabia. A self-administered questionnaire developed by the authors was distributed to nurses via an online survey. The questionnaire assessed nurses' socio-demographic characteristics and their knowledge and practices regarding tracheostomy indications, postoperative care, and management of its complications., Results: Of respondents, approximately 59% (232/395) had poor knowledge regarding tracheostomy-related complications and indications, 39% (154/395) had moderate knowledge, and only 2%(9/395) had good knowledge. Several factors were associated with increased knowledge, including having a higher education degree, working in a tertiary/quaternary hospital, being a government employee, caring for tracheostomized patients, and attending courses or lectures on managing tracheostomized patients., Conclusions: Knowledge level and practices regarding tracheostomy-related complications and indications among nurses remain limited. In-service continuous professional development programs for nurses working in all hospital settings are strongly recommended. Further research is warranted to elicit the major factors contributing to inadequate knowledge and practices among nurses in Riyadh., (© 2022. The Author(s).)

Objectives: Cerumen production is a protective process for the ear canal. Cerumen impaction causes unpleasant symptoms. There are various cerumen removal practices. These include irrigation, application of softeners/solvents, mechanical removal, and micro-suction. However, during the lockdown period of the COVID-19 pandemic, some patients opted for some procedures, such as ear candling, which are not evidence-based. This study aimed to explore the awareness of ear candling among otolaryngology doctors and record cases with complications of such practice in the Kingdom of Saudi Arabia (KSA)., Methods: This was a cross-sectional study. A questionnaire was developed after an extensive literature search, and distributed to otolaryngology residents, fellows, and consultants of different hospitals across the country. A total of 80 respondents agreed to participate in the study., Results: A total of 16 doctors reported seeing cases of ear candling, of which 13 patients had different complications, of which ear pain was the most commonly reported. The majority of participants (42.5%) thought the lack of medical access during lockdown enhanced the practice of alternative medicine for ear-related complaints in society compared to 35% of participants who had a neutral response regarding this idea and 22.5% who disagreed., Conclusions: Although the practice of ear candling is not widely spread in KSA, different types of ear complications were recorded by the otolaryngologist. We would like to encourage the doctors to report such complications, especially after the lockdown period., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

One of the most prevalent pediatric ailments around the world is voice disorders. Around 5-million children suffer from voice disorders, and three out of five of them suffer from vocal nodule-induced persistent dysphonia. Nineteen out of 20 otolaryngologists recommend voice therapies for the treatment of pediatric vocal fold nodules. However, the benefits of these therapies still remain to be assessed systematically. The objective of this study is to systematically review the impact of voice therapy (direct and indirect) on pediatric patients with vocal nodules. In this systematic review of randomized control trials (RCTs), four electronic databases, PubMed, CENTRAL (Cochrane), Science Direct, and Lancet, were explored for the literature survey. The impact of direct and indirect voice therapies on pediatric cases with vocal nodules was reviewed based on the results of the selected articles. Based on stringent inclusion and exclusion criteria, six articles were selected. All these studies examined the effects of direct and indirect voice therapies on two types of voice disorders, that is, dysphonia and vocal nodules. Only one of the six studies reported significant alleviation of the patient condition post-intervention. However, none of the studies discussed the clinical significance of the interventions. Three of the six included studies used both direct and indirect voice therapies and reported substantial differences in the data collected before and after the interventions. However, overall, the studies reported more significant improvements in patient conditions. More studies in this domain are still warranted, especially to help understand and define the meaning of the term "effectiveness" with respect to voice therapies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Al-Kadi et al.)

We report on an elderly male patient with headache and right-side weakness. Imaging studies revealed multiple space-occupying lesions in the parietal and occipital cerebral regions. Biopsy revealed broad aseptate ribbon-like structures branching at right angles, suggestive of mucormycosis. Improvement was observed after medical therapy with 20 weeks of liposomal amphotericin B (5 mg/kg/day) combined with posaconazole, followed by posaconazole (400 mg twice a day) alone for 1 month. The patient recovered without neurological deficits; however, multidrug-resistant bacteraemia and hospital-acquired pneumonia occurred, resulting in death. Nevertheless, our report shows that this lethal fungal infection can sometimes show favourable progress with drug therapy alone.