Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species ( Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.

Objectives:To develop a more comprehensive explanation and understanding of the prevalence of and factors associated with burnout for residents of the Saudi Plastic Surgery Residency Program.Methods:This is a cross sectional study. Data was gathered using a survey, which was distributed during April 2015, among all 57 plastic surgery residents enrolled in training programs across all regions of Saudi Arabia, 38 of whom responded (60% response rate). The dependent variable was professional burnout, which was measured by 3 subscales of the validated Maslach Burnout Inventory (MBI). High scores on emotional exhaustion (EE) or depersonalization (DP) or low scores on personal accomplishment (PA) were taken to be indicative of professional burnout. Variables evaluating possible predictors of burnout, such as sociodemographic and professional characteristics, were also included.Results:The validated rate of high burnout status was 18%. Nearly three quarters (71%) of residents scored high in emotional exhaustion, and half (50%) scored high in depersonalization. A third (34%) scored low in personal accomplishment. However, only 5% were dissatisfied with the plastic surgery specialty as a career, and 69% would choose the same specialty again. Workload was not found to play a significant role in the development of burnout (mean 70 hours per week).Conclusion:Approximately half of plastic surgery trainees in the Kingdom of Saudi Arabia have signs of professional burnout.

Introduction. Middle East respiratory syndrome (MERS) outbreaks have had a considerable negative impact on health systems in Saudi Arabia. We aimed to study the psychological impact of a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak on emergency room resident physicians (ERRPs). Methods. We assessed the MERS-related psychological impact and concerns of ERRPs using a self-report questionnaire. Results. The majority (91%) of the ERRPs agreed that their work put them at risk of infection, but most (65%) did not agree that they should not be looking after patients infected with MERS. Despite that, 54% of ERRPs reported being afraid of contracting the infection from infected patients and only 4.2% of them were willing to change their current job. The majority of the ERRPs (85%) felt that their job would expose their families to risk of infection. Conclusions. Our study demonstrated the considerable psychological impact of MERS outbreaks on ERRPs. The ERRPs' concerns and the psychological impact of MERS outbreaks should be considered in greater detail by hospital policymakers.