Kuwait Institute for Medical Specialization

Background: Laryngospasm is defined as glottis closure due to reflex constriction of the laryngeal muscles. It is one of the most common complications following pediatric anesthesia that can lead to hypoxemia, bradycardia, or aspiration. Laryngospasm following tracheal extubation has different reasons: presence of secretions, foreign body in the airway, or pain at the site of surgery. Propofol is usually used as an induction or maintenance agent. However, its use with the subhypnotic dose (0.5 mg/kg) is increasing nowadays for reducing the incidence of laryngospasm. This systematic review and meta-analysis aim to assess the efficacy of subhypnotic propofol in reducing the incidence of laryngospasm and respiratory complications in children following tonsillectomy or adenotonsillectomy and before extubation. Methods: We systematically searched the following databases: PubMed, Cochrane Library, Scopus, and Web of Science. Studies were included if they used propofol with a low dose (0.5 mg/kg) following tonsillectomy and before extubation. Both Randomized Controlled Trials (RCTs) and cohort studies published up until 27 December 2025 were included. We used the R software for statistical analysis. We employed a random-effects model for the analysis. Continuous outcomes were analyzed as mean differences (MD) and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics. Results: Our review included four RCTs and one prospective cohort study with 593 participants. Our analysis showed that propofol was significantly associated with a low incidence of laryngospasm (RR = 0.25, 95% CI 0.13-0.49), cough (RR = 0.08, 95% CI 0.01-0.62), and agitation (RR = 0.15, 95% CI 0.03-0.72) compared with the control group. However, there were no significant differences regarding laryngeal occlusion (RR = 0.70, 95% CI 0.20-2.46), cyanosis (RR = 1.13, 95% CI 0.14-9.43), stridor (RR = 1.38, 95% CI 0.76-2.50), and the duration of surgery (MD = 1.81, 95% CI -0.74 to 4.36). Conclusions: Our findings state that propofol had a lower significant incidence of laryngospasm than the control. Trial sequential analysis for laryngospasm indicated that evidence is conclusive. However, regarding the other outcomes, the evidence is still inconclusive, which suggests the need for future large-scale RCTs with larger sample sizes to validate these findings.

Women diagnosed with hyperglycemia in pregnancy represent a heterogeneous population. A distinct subgroup, those with overt diabetes or diabetes in pregnancy (DIP) diagnosed at the first prenatal visit or during pregnancy (fasting plasma glucose (FPG) ≥ 7.0 mmol/L or glycated hemoglobin (HbA1c) ≥ 6.5%), may carry a significantly higher long-term cardiometabolic risk than women with standard gestational diabetes mellitus (GDM). This study aimed to review and meta-analyse the risk of postpartum type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), and cardiovascular risk markers in women diagnosed with overt diabetes during pregnancy compared to those with GDM. PubMed/MEDLINE, Embase, Web of Science, and Cochrane Library were searched from inception to December 2025. Observational studies comparing maternal postpartum cardiometabolic outcomes between women with overt diabetes (excluding known pre-existing diabetes) and women with GDM were included. Two independent reviewers extracted data and assessed quality using the Newcastle-Ottawa Scale and JBI checklists. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was performed. The primary outcome was incident postpartum T2DM. Certainty of evidence was evaluated using theGrading of Recommendations Assessment, Development, and Evaluation (GRADE)approach. Seven studies (n = 3,293 participants) from Asia, Africa, Oceania, and Europe met the inclusion criteria. Women with overt diabetes had a substantially increased risk of developing postpartum T2DM compared to women with GDM (pooled odds ratio (OR) 10.69; 95% CI 5.32-21.48;p< 0.001; high certainty evidence). They exhibited a more than two-fold higher risk of MetS (OR 2.29; 95% CI 1.49-3.53;p< 0.001; moderate certainty evidence). Mean BMI was numerically higher in the overt diabetes group (mean difference 1.60kg/m²), though not statistically significant (p= 0.07). Heterogeneity was negligible for the primary outcome (I2 = 0.5%). These findings support the urgent need for stratified postpartum surveillance and intensive, early preventive interventions for women with overt diabetes, rather than managing them under general GDM protocols.

Chronic plaque psoriasis is a common immune-mediated inflammatory skin disease; however, facial involvement is relatively uncommon and may present diagnostic and therapeutic challenges. Facial psoriasis can mimic other inflammatory dermatoses and may demonstrate variable responses to systemic therapy. We report a case of a 37-year-old male with chronic plaque psoriasis who presented with extensive plaques involving the elbows and knees, along with diffuse, generalized facial erythema. The patient had severe disease with extensive body surface area involvement, reflected by a Psoriasis Area and Severity Index (PASI) score of approximately 50. Histopathological examination of skin punch biopsies confirmed the diagnosis of psoriasis. Initial treatment with systemic cyclosporine resulted in partial improvement. Due to persistent disease activity and the need for long-term control, therapy was escalated to risankizumab, leading to near-complete systemic clearance. Despite excellent overall disease control, residual facial erythema persisted and was managed with topical therapy and adjunctive pulsed dye laser treatment, selected to target persistent vascular erythema. This case highlights the site-specific variability in treatment response observed in facial psoriasis and underscores the importance of individualized, multimodal management strategies to optimize both clinical and psychosocial outcomes.

A mucocele is a benign, mucus-filled cystic lesion resulting from obstruction of the sinus ostium, leading to gradual mucus accumulation and remodeling of the surrounding bony walls. A mucocele affecting the maxillary sinus is known as a maxillary sinus mucocele. Although less common than frontal or ethmoidal mucoceles, large maxillary mucoceles may extend to adjacent structures, producing ophthalmic or dental manifestations. In severe cases, they can cause facial swelling, bony erosion, and midfacial disfigurement, sometimes mimicking aggressive or neoplastic pathology. Here, we present a case of a 27-year-old male with a history of multiple sclerosis who presented with right facial swelling, facial pain, nasal obstruction, and nasal discharge. Clinical examination showed a tender, fluctuant swelling over the right maxilla, and computed tomography demonstrated a large expansile cystic lesion occupying the right maxillary sinus. The patient underwent endoscopic marsupialization and resection under general anesthesia, with excellent postoperative recovery. Histopathology demonstrated a cystic cavity lined by attenuated simple squamous epithelium merging with native respiratory mucosa, indicating a maxillary sinus mucocele with an associated odontogenic epithelial component. This case highlights the importance of considering a maxillary sinus mucocele in the differential diagnosis of unilateral facial swelling and nasal obstruction. It underscores the diagnostic challenge it poses when mimicking chronic rhinosinusitis or odontogenic cysts, and emphasizes the crucial role of early radiologic evaluation and multidisciplinary collaboration in achieving accurate diagnosis and preventing complications.

Background and Objectives: Effective pain control after laparoscopic colorectal surgery is crucial for Enhanced Recovery After Surgery (ERAS) protocols. The transversus abdominis plane block (TAPB) provides somatic analgesia but lacks visceral coverage. The quadratus lumborum block (QLB) has emerged as an alternative, potentially offering both somatic and visceral blockade, but its superiority is debated. This systematic review and meta-analysis aimed to compare the analgesic efficacy of QLB versus TAPB in this setting. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for randomized controlled trials (RCTs) up to November 2025. Primary outcomes were 24 h postoperative and intraoperative opioid consumption. Secondary outcomes included pain scores, length of hospital stay (LoS), surgery duration, and adverse events. Standardized mean differences (SMD) and risk ratios (RR) were pooled. Results: Five RCTs involving 520 patients were included. No significant difference was found in 24 h postoperative opioid consumption (SMD: −1.62, 95% CI [−3.45, 0.20]; p = 0.08) or intraoperative opioid consumption (SMD: 0.38, 95% CI [−0.36, 1.12]; p = 0.31). QLB provided better, transient pain relief at rest at 12 h (SMD: −0.30, 95% CI [−0.52, −0.07]; p = 0.01) and during movement at 6 h (SMD: −0.20, 95% CI [−0.49, −0.09]; p = 0.01). No other time points for pain showed significant differences. QLB was associated with a shorter surgery duration (MD: −5.61 min, 95% CI [−10.38, −0.85]; p = 0.02), but not LoS (p = 0.53) or rates of PONV (p = 0.24) or dizziness (p = 0.32). Conclusions: With uncertain evidence, QLB and TAPB showed no significant difference in opioid consumption. QLB demonstrated a statistically significant but transient early analgesic advantage. This heterogeneity may be due to different QLB techniques, warranting further investigation.

Adenoidectomy is a common pediatric procedure with generally low complication rates; however, postoperative ear pain, pressure symptoms, and Eustachian tube dysfunction remain reported concerns. This systematic review compares traditional curettage with endoscopic techniques - specifically endoscopic microdebrider adenoidectomy (EMA) and endoscopic coblation adenoidectomy (ECA) - in terms of postoperative outcomes in the pediatric population.A systematic literature search was conducted across PubMed, Cochrane, and ScienceDirect databases between April and June 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Studies published in English within the past 10 years were included. Only randomized controlled trials (RCTs) were eligible. Eleven RCTs met the inclusion criteria.A total of 11 studies were included. Evaluated outcomes included middle ear pressure, hearing threshold, intraoperative time, bleeding, postoperative pain, and residual adenoid tissue. Endoscopic techniques demonstrated superior short-term postoperative results, with lower pain scores and improved middle ear pressure within the early recovery period; however, these differences were largely transient. Traditional curettage was associated with shorter operative time and slightly less intraoperative bleeding, while endoscopic techniques achieved more complete adenoid resection.Endoscopic adenoidectomy - particularly coblation - offers improved short-term recovery and more complete tissue removal compared to traditional curettage, though early advantages tend to normalize over time. Further large-scale RCTs with standardized pain scoring and cost analysis are warranted to optimize surgical decision-making.