Obstructive sleep apnea (OSA) is a serious and often underreported condition, despite its highly prevalent distribution. Primary care physicians (PCPs) play an integral role in screening and managing patients with a high risk of developing OSA. This northern Saudi Arabian cross-sectional survey assessed the knowledge and attitude towards OSA among 264 randomly selected PCPs using the OSA Knowledge and Attitude (OSAKA) questionnaire. Among the participating PCPs, 43.9% and 45.1% had low scores in the knowledge and attitude categories, respectively. More than three-fourths (78%) of them recognized that an overnight sleep study is the gold standard for diagnosing OSA. Regarding referral, 39.4% of the OSA patients encountered by the PCPs were referred to ENT specialists, while 21% were referred to sleep clinics, and 18.2% were referred to pulmonologists. Nearly half (50.8%) of the participants recognized OSA as an important clinical disease, and 56.8% were confident in caring for OSA patients. Spearman’s correlation of the current study identified a positive correlation between knowledge scores and attitude scores (rho—0.151, p = 0.017). It is important to improve PCPs’ knowledge regarding OSA and the necessity for referral through different training methods. Furthermore, the study findings emphasize the need to include appropriate OSA programs and continuing medical education for PCPs.

In recent years, the incidence of thyroid cancer has been increasing globally, with papillary thyroid cancer (PTCa) being the most prevalent pathological type, accounting for approximately 80% of all cases. Although PTCa has been regarded to be slow growing and has a good prognosis, in some cases, PTCa can be aggressive and progress despite surgery and radioactive iodine treatment. In addition, most cancer treatment drugs have been shown to be cytotoxic and nonspecific to cancer cells, as they also affect normal cells and consequently cause harm to the body. Therefore, searching for new targets and therapies is required. Herein, we explored a bioinformatics analysis to identify important theranostic markers for THCA. Interestingly, we identified that the DPP4/CTNNB1/MET gene signature was overexpressed in PTCa, which, according to our analysis, is associated with immuno-invasive phenotypes, cancer progression, metastasis, resistance, and unfavorable clinical outcomes of thyroid cancer cohorts. Since most cancer drugs were shown to exhibit cytotoxicity and to be nonspecific, herein, we evaluated the anticancer effects of the antidiabetic drug sitagliptin, which was recently shown to possess anticancer activities, and is well tolerated and effective. Interestingly, our in silico molecular docking results exhibited putative binding affinities of sitagliptin with DPP4/CTNNB1/MET signatures, even higher than standard inhibitors of these genes. This suggests that sitagliptin is a potential THCA therapeutic, worthy of further investigation both in vitro and in vivo and in clinical settings.

Intranasal corticosteroids (INCS) are generally safe and effective treatments for allergic rhinitis (AR). The improper use of INCS may not alleviate AR symptoms, and it could lead to complications and an impaired quality of life. We evaluated the knowledge of, attitudes towards, and practices of INCS usage and associated factors among AR patients using a pretested Arabic questionnaire. Of the 400 participating AR patients, 39.3%, 29.0%, and 36.5% had poor scores for knowledge, attitude, and practice, respectively. We found a significant association between knowledge and education (p < 0.001) and follow-up facilities (p = 0.036). The attitude category was significantly associated with age (p = 0.003), marital status (p = 0.004), and type of allergic patients (p < 0.001), and the practice category was significantly associated with education (p = 0.027), type of allergic patients (p = 0.008), and follow-up facilities (p = 0.030). Smoking status was significantly associated with all three categories. Furthermore, we found a positive correlation between knowledge and practice scores (Spearman’s rho of 0.451, p < 0.001). We recommend improving AR patients’ knowledge of the proper practices of INCS through health education programs. Furthermore, we recommend an exploratory mixed-method survey on the INCS usage among AR patients that involves other provinces in the KSA.

Sinusitis is a common condition with various forms and different etiologies. In the era of COVID-19, a large number of studies covered the association between sinusitis and COVID-19, while others reported the impact of COVID-19 on the development of acute invasive fungal rhinosinusitis (AIFR), together with the most commonly associated predisposing factors. Fungal sinusitis, particularly AIFR, can be life-threatening. It is important to dissect this association and improve current evidence and management. Therefore, we conducted this literature review to highlight the association between COVID-19 and sinusitis based on evidence from the available studies in the literature. Evidence shows that chronic sinusitis might have a negative impact on COVID-19 outcomes. However, current results are conflicting, and further studies are needed. On the other hand, COVID-19 can also cause olfactory dysfunction, which is usually temporary. In addition, we found several studies that indicated the association between COVID-19 and AIFR. The condition is usually associated with severe morbidities, as affected patients are usually immunocompromised, including those with uncontrolled diabetes, malignancy, immunosuppression, AIDS, the administration of chemotherapy and other immunosuppressive drugs, and COVID-19.

Background: Loss of smell and taste is one of the early and sensitive symptoms of COVID-19 that usually improves over time. Post-COVID-19 phantosmia, a smell distorted sensation without the presence of odorants, has deleterious and long-lasting effects on the patient's quality of life. We aimed to present our experience with phantosmia. Case presentations: We report a description of a series of eleven cases (age of 29 ± 9 years, and 54.5% females) of post-COVID-19 phantosmia without any other comorbidity, and the effects of combined treatment modalities (olfactory training, nasal irrigation with budesonide and oral prednisolone) on self-perceived improvement in phantosmia. Conclusions: We postulate that the combined 10 days oral prednisolone, smell training, and nasal irrigation for three months improved post-COVID-19 phantosmia assessed as post vs. pre self-perceived improvement, although this was not aimed at as a treatment since it was not compared to untreated controls.

Background: T cell subgroups and cytokines have an important immunopathogenic role in allergic rhinitis (AR). Retinoic acid (RA) controls immune and mucosal cell differentiation, function, and fate critical in adaptive immune tolerance. Objective: We assessed variation in serum RA in correlation with AR patients' and disease characteristics as a potential pathogenic and biomarker effector. Methods: This cross-sectional study enrolled 147 adults hospital-diagnosed AR patients and 33 matched healthy controls. Serum RA (in ng/mL) and IL-4/IFN-γ ratio (in pg/mL each), to confirm AR diagnosis, were assessed with quantitative specific ELISA assays. Results: Patients showed cytokine profile of Th0/2 cells with a ratio that was higher compared to controls (p <0.001) due mainly to higher INF-γ content (213 ± 215.8 vs. 107.9 ± 94.52 pg/mL; p <0.01). RA levels were reduced in patients compared to controls (1.799 ± 1.174 vs. 4.056 ± 4.994; p <0.015). Patients with Th2 reaction had higher RA than those with Th0 reaction (p <0.015). The presence of nasal polyps caused a further reduction in RA and IFN-γ levels than those without polyps (P γ, IL-4/INF-γ ratio and RA were significantly able to differentiate AR patients from a healthy control. Conclusion: The significant reduction in circulating levels of RA highlights its role in AR pathogenesis and comorbidities and its potential therapeutic utility in AR.