A preliminary evaluation of surgical field contamination risk from surgeon's oro-nasopharyngeal commensal organisms while using reusable FFP3 respirator masks and power hoods with relevance to the COVID 19 pandemic - A pilot study

xlomafota13 shared this article with you from Inoreader A preliminary evaluation of surgical field contamination risk from surgeon's oro-nasopharyngeal commensal organisms while using reusable FFP3 respirator masks and power hoods with relevance to the COVID 19 pandemic - A pilot study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Dec 23:S1748-6815(21)00660-4. doi: 10.1016/j.bjps.2021.12.001. Online ahead of print. ABSTRACT In early 2019 in the UK, concern about the risk of COVID-19 transmission to surgeons who operate near to the airway led to wide scale adoption of different masks, including valved types used in industry. It was noted early on that although these masks protect clinicians, they may represent a risk to the patient due to unfiltered air being directed towards them during close contact1 and the National Health Service circulated guidance to that effect2. Subsequently, an increased incidence of surgical site infection (SSI) was noticed, postulated to be due to contamination of the surgical field by microbial particles from valved masks or hoods leading to a National Patient Safety Alert3. A study recommended that a surgical mask be placed over the exhaust valves of these mask type s4. We reviewed the literature using the key words surgical masks, power hoods, FFP3 masks and surgical site infection. Most studies showed no reduction in the incidence of SSI with surgical masks5, but some showed an increase6. There were no studies comparing bacterial contamination of the surgical site with different types of masks. A pilot study was designed to evaluate if FFP3 respirators and powerhoods allowed bacterial contamination of the surgical field in comparison with standard surgical masks and no masks. The results appeared to confirm our methodology and suggested that reusable valved FFP3 masks are associated with bacterial dissemination. Subsequent examination of these masks identified a potential mechanism for this bacterial contamination. A larger scale study is needed. PMID:34991973 | DOI:10.1016/j.bjps.2021.12.001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Critical Quality and Readability Analysis of Online Patient Education Materials on Parotidectomy: A Cross-Sectional Study

xlomafota13 shared this article with you from Inoreader Critical Quality and Readability Analysis of Online Patient Education Materials on Parotidectomy: A Cross-Sectional Study Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Jan 6:34894211066670. doi: 10.1177/00034894211066670. Online ahead of print. ABSTRACT PURPOSE: Complications related to parotidectomy can cause significant morbidity, and thus, the decision to pursue this surgery needs to be well-informed. Given that information available online plays a critical role in patient education, this study aimed to evaluate the readability and quality of online patient education materials (PEMs) regarding parotidectom y. METHODS: A Google search was performed using the term "parotidectomy" and the first 10 pages of the search were analyzed. Quality and reliability of the online information was assessed using the DISCERN instrument. Flesch-Kincaid Grade Level (FKGL) and Flesch-Reading Ease Score (FRE) were used to evaluate readability. RESULTS: Thirty-five PEMs met the inclusion criteria. The average FRE score was 59.3 and 16 (46%) of the online PEMs had FRE scores below 60 indicating that they were fairly difficult to very difficult to read. The average grade level of the PEMs was above the eighth grade when evaluated with the FKGL. The average DISCERN score was 41.7, which is indicative of fair quality. There were no significant differences between PEMs originating from medical institutions and PEMs originating from other sources in terms of quality or readability. CONCLUSION: Online PEMs on parotidectomy may not be comprehensible to the average individual. This study highlight s the need for the development of more appropriate PEMs to inform patients about parotidectomy. PMID:34991334 | DOI:10.1177/00034894211066670 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Metal Allergy in Tracheostomy Tube Placement Resulting in Complete Subglottic Stenosis: A Case Report

xlomafota13 shared this article with you from Inoreader Metal Allergy in Tracheostomy Tube Placement Resulting in Complete Subglottic Stenosis: A Case Report Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Jan 6:34894211070135. doi: 10.1177/00034894211070135. Online ahead of print. ABSTRACT OBJECTIVES: Metal hypersensitivity reaction to surgical implants is a well- known phenomenon that is associated with pain, swelling, inflammation, and decreased efficacy of the implant. We present a unique case of a patient with placement a metal Jackson tracheostomy tube that led to expeditious total subglottic stenosis. METHODS: The patient was a 33-ye ar old, severely atopic woman with history of asthma exacerbations requiring several intubations for acute respiratory failure with several subsequent tracheal dilations with steroid injections, and eventual tracheostomy placement with a metal Jackson tracheostomy tube that led to expeditious total subglottic stenosis. RESULTS: Initial intervention included performing an airway evaluation, CO2 laser, and steroid injection of the area of complete subglottic stenosis. Follow up several months later revealed little improvement in level of tracheal narrowing proximal to the tracheostomy tube. Patient did not have shortness of breath but continued to be aphonic. Cricotracheal versus tracheal resection have been proposed but surgical morbidity was deemed too high due to patient's obesity. CONCLUSIONS: Metal hypersensitivity reactions are well known phenomena as it relates to surgical implants in other surgical specialties but are seldom reported within the ear, nose and throat literature. Oftentimes, it takes astute observation to diagnose and establish a connection. Prompt recognition and treatment can be acquired from interdisciplinary collaboration with allergy. PMID:34991357 | DOI:10.1177/00034894211070135 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Non‐Squamous Cell Malignancies of the Larynx

xlomafota13 shared this article with you from Inoreader Non‐Squamous Cell Malignancies of the Larynx Via The Laryngoscope Objectives/Hypothesis Non-squamous cell carcinoma (SCC) malignancies are rare, but well described laryngeal pathologies. However, the epidemiology and clinical behavior of these tumors is not well studied. Study Design Retrospective cohort study. Methods Patients diagnosed with non-squamous cell larynx cancer from 2004 to 2017 in the National Cancer Database were selected. Demographic, clinicopathologic factors, treatments, and survival were analyzed. Univariable and multivariable cox regression were performed. Survival was compared with a propensity score-matched (PSM) population of laryngeal SCC patients. Results A total of 136,235 cases of larynx cancer were identified. After excluding SCC variants, 2,172 (1.6%) patients met inclusion criteria. The most common histology was chondrosarcoma (374, 17.2%), followed by small cell (345, 15.9%), and spindle cell carcinoma (268, 12.3%). The most common treatment was surgery (683, 31.4%) followed by chemoradiation (409, 18.8%) and surgery and adjuvant radiation (288, 13.3%). Overall, 3- and 5-year survival was 67.9% and 59.4%, respectively. In multivariate analysis controlling for age, stage, comorbidity, histology, and treatment modality; chondrosarcoma had the best survival (hazard ratio [HR] 0.11, confidence interval [CI] 0.07–0.19, P < .001). In a PSM population, matched for age, stage, comorbidity, and treatments; non-SCC patients had significantly lower survival (51.5% vs. 59.9%, P < .001). Conclusion A diverse range of non-squamous cell malignancies occur in the larynx. In general, these tumors have poor survival, with few exceptions such as chondrosarcoma. While the majority of these histologies undergo surgical-based treatments in other sites, only 53% of patients underwent surgical-based treatment in the larynx. These data could guide clinicians in determining the outcome of treatment in these patients. Level of Evidence 4 Laryngoscope, 2022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pathophysiology and Management of Tongue Involvement in COVID-19 Patients

xlomafota13 shared this article with you from Inoreader Pathophysiology and Management of Tongue Involvement in COVID-19 Patients Via Otolaryngology Indian Abstract Evaluate the lingual manifestations of COVID-19, and provide a clinical guide in managing these symptoms. Electronic databases, such as PubMed/Medline, and Scopus were searched until November 1, 2020, and only randomized controlled trials, cross-sectional and cohort studies, as well as case reports and series, and review articles in English were considered. A total of 40 studies were included in this study. Lingual involvement has been extensively reported in patients with coronavirus disease 2019 (COVID-19). The most common features of lingual involvements were red or light red, yellow coating, and greasy coating tongue, though other complications, such as pale, purple, white coating, grayish-black coating, rough, tender, puffy, spotty, prickles, fissured, and tooth-marked tongue was also reported. Poor oral hygiene, opportunistic infections (OIs), medications, and hyper-inflammatory response to infection are the most common predisposing factors for the onset of oral lesions in patients with COVID-19. In conclusion, the current review described the lingual manifestations of COVID-19, and as oral complaints are relatively common in COVID-19 patients, an intraoral examination should be conducted in all suspected cases of SARS-CoV-2 infection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Robotic system for top to bottom MRgFUS therapy of multiple cancer types

xlomafota13 shared this article with you from Inoreader Robotic system for top to bottom MRgFUS therapy of multiple cancer types Via The International Journal of Medical Robotics and Computer Assisted Surgery ABSTRACT Background A robotic system for Magnetic Resonance guided Focused Ultrasound (MRgFUS) therapy of tumours in the breast, bone, thyroid, and abdomen was developed. Methods A special C-shaped structure was designed to be attached to the table of conventional MR imaging (MRI) systems carrying 4 computer-controlled motion stages dedicated to positioning a 2.75 MHz spherically focused transducer relative to a patient placed in the supine position. The developed system was evaluated for its MRI compatibility and heating abilities in agar-based phantoms and freshly excised tissue. Results Compatibility of the system with a clinical high-field MRI scanner was demonstrated. FUS heating in the phantom was successfully monitored by MR thermometry without any evidence of magnetically-induced phenomena. Cigar-shaped discrete lesions and well-defined areas of overlapping lesions were inflicted in excised tissue by robotic movement along grid patterns. Conclusions The developed MRgFUS robotic system was proven safe and efficient by ex-vivo feasibility studies. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Deltopectoral Flap Reconstruction of the Posterior Pharyngeal Wall: A Single Stage Pedicle Flap Alternative Solution to the Free Flap Reconstruction of Circumferential Laryngopharyngeal Defects

xlomafota13 shared this article with you from Inoreader Deltopectoral Flap Reconstruction of the Posterior Pharyngeal Wall: A Single Stage Pedicle Flap Alternative Solution to the Free Flap Reconstruction of Circumferential Laryngopharyngeal Defects Via Otolaryngology Indian Abstract The first option for reconstruction of a circumferential pharyngeal defect following extensive pharyngo-laryngectomy is free tissue transfer. Despite that, pedicled flaps can be used when microsurgical expertise is not available or if other patient related or region related issues deem free tissue transfer unfavourable. The aim of this study was to review the operative feasibility and functional outcomes following dual flap reconstruction of circumferential pharyngeal defects.This was a retrospective study of all patients (n = 8) who underwent either primary (n = 5) or salvage (n = 3) circumferential laryngopharyngectomy + /– cervical oesophagectomy, followed by dual flap reconstruction, with a deltopectoral flap to reconstruct the posterior wall from 2005 to 2020. The main outcome measures were operative complications, hospital stay and functional outcomes (speech and swallowing). The operation was feasible in all patients, with dual flap recon struction using a deltopectoral flap, combined with a pectoralis major flap (n = 5) or a supraclavicular flap (n = 3). All patients developed a small, lateralised, self-healing fistula at the site of the deltopectoral flap 3-point junction. This did not require any intervention, or impact on adjuvant treatment. Functional outcomes were favourable, with all patients achieving oral diet. One patient required gastrostomy diet supplementation, and one patient required stricture dilatation. Of the patients able to receive a speech valve (n = 4), all achieved intelligible speech. Dual flap reconstruction of circumferential pharyngeal defects represents a feasible alternative option for a complex reconstructive problem. The predictable operative recovery and favourable functional outcomes indicate that the use of both a deltopectoral flap and a second flap is a robust reconstructive solution. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bhramari Pranayama

xlomafota13 shared this article with you from Inoreader Acoustic Description of Bhramari Pranayama Via Otolaryngology Indian Abstract The study's aim was (1) To describe the acoustic characteristics of Bhramari pranayama, and (2) to compare the acoustic features of nasal consonant /m/ and the sound of Bhramari pranayama produced by yoga trainers. Cross-sectional study design. Thirty-three adult male yoga trainers performed five repeats of nasal consonant /m/ and Bhramari pranayama. These samples were recorded into Computerized Speech Lab, Kay Pentax model 4500b using a microphone (SM48). Formant frequencies (fF1, fF2, fF3, & fF4), formant bandwidths (BF1, BF2, BF3, & BF4), anti-formant, alpha and beta ratio were analyzed. Nasal consonant /m/ had higher fF2 and anti-formant compared to Bhramari pranayama. Statistical significant differences were noted in fF2, BF3, and anti-formant s. Bhramari pranayama revealed a low alpha ratio and a higher beta ratio than /m/. However, these differences were not statistically significant. Findings are discussed from acoustic and physiological perspectives. Bhramari pranayama was assumed to be produced with a larger pharyngeal cavity and narrower velar passage when compared to nasal consonant /m/. Verification at the level of the glottis and with aerodynamic parameters may ascertain the above propositions. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Measuring functional outcome in upper extremity soft-tissue sarcoma: Validation of the Toronto extremity salvage score and the QuickDASH patient-reported outcome instruments

xlomafota13 shared this article with you from Inoreader Measuring functional outcome in upper extremity soft-tissue sarcoma: Validation of the Toronto extremity salvage score and the QuickDASH patient-reported outcome instruments Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Dec 1:S1748-6815(21)00625-2. doi: 10.1016/j.bjps.2021.11.081. Online ahead of print. ABSTRACT Interest in functional outcome (FO) and health-related quality of life (HRQL) in extremity soft-tissue sarcoma (STS) patients has increased. The aim of this study was to validate two FO questionnaires for upper extremity STS patients: the Toronto Extremity Salvage Score (TESS) and short version of the Disability of Arm, Shoulder and Hand (QuickDASH), based on Finnish population data. A multi-center study was conducted at two academic sarcoma centers. Surgically treated upper extremity STS patients were invited to participate. Patients completed the TESS and the QuickDASH with HRQL questionnaires the 15D and the QLQ-C30. The scores were analyzed and compared. Fifty-five patients with a mean follow-up period of 4.7 years were included. Mean age was 63 years (standard deviation [SD] 14.6). The mean score for TE SS was 88.5 (SD 15.1) and for QuickDASH 17.8 (SD 19.6). The QuickDASH had a statistically significantly better score coverage. A ceiling effect was noted, 27% and 20% for TESS and QuickDASH, respectively. The TESS and QuickDASH scores were strongly correlated (r= -0.89). The TESS score strongly correlated with the QLQ-C30 (r = 0.79) and the 15D score (r = 0.70). The QuickDASH score correlated strongly with the QLQ-C30 score (r=-0.71) and moderately with the 15D score (r= -0.56). The TESS score had a statistically significantly stronger correlation with the 15D score than QuickDASH (p<0.005). Both the TESS and the QuickDASH provide reliable scores for assessing FO in upper extremity STS patients. The QuickDASH has a better coverage, whereas TESS showed a stronger correlation to HRQL scores. PMID:34996722 | DOI:10.1016/j.bjps.2021.11.081 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association between exposure to radioactive iodine after the Chernobyl accident and thyroid volume in Belarus 10-15 years later

xlomafota13 shared this article with you from Inoreader Association between exposure to radioactive iodine after the Chernobyl accident and thyroid volume in Belarus 10-15 years later Via radioactive iodine Environ Health. 2022 Jan 7;21(1):5. doi: 10.1186/s12940-021-00820-0. ABSTRACT BACKGROUND: While there is a robust literature on environmental exposure to iodine-131 (131I) in childhood and adolescence and the risk of thyroid cancer and benign nodules, little is known about its effects on thyroid volume. METHODS: To assess the effect of 131I dose to the thyroid on the volume of the thyroid gland, we examined the data from the baseline screening of the Bel arusian-American Cohort Study of residents of Belarus who were exposed to the Chernobyl fallout at ages ≤18 years. Thyroid dose estimates were based on individual thyroid activity measurements made shortly after the accident and dosimetric data from questionnaires obtained 10-15 years later at baseline screening. During baseline screening, thyroid gland volume was assessed from thyroid ultrasound measurements. The association between radiation dose and thyroid volume was modeled using linear regression where radiation dose was expressed with power terms to address non-linearity. The model was adjusted for attained age, sex, and place of residence, and their modifying effects were examined. RESULTS: The analysis was based on 10,703 subjects. We found a statistically significant positive association between radiation dose and thyroid volume (P < 0.001). Heterogeneity of association was observed by attained age (P < 0.001) with statistically significant association remain ing only in the subgroup of ≥18 years at screening (P < 0.001). For this group, increase in dose from 0.0005 to 0.15 Gy was associated with a 1.27 ml (95% CI: 0.46, 2.07) increase in thyroid volume. The estimated effect did not change with increasing doses above 0.15 Gy. CONCLUSIONS: This is the first study to examine the association between 131I dose to the thyroid gland and thyroid volume in a population of individuals exposed during childhood and systematically screened 10-15 years later. It provides evidence for a moderate statistically significant increase in thyroid volume among those who were ≥ 18 years at screening. Given that this effect was observed at very low doses and was restricted to a narrow dose range, further studies are necessary to better understand the effect. PMID:34996456 | DOI:10.1186/s12940-021-00820-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

New EMA drug approval: Nivolumab in association with chemotherapy as first line treatment for HER2-negative esophageal adenocarcinoma with PD-L1 expression (CPS≥5)

xlomafota13 shared this article with you from Inoreader New EMA drug approval: Nivolumab in association with chemotherapy as first line treatment for HER2-negative esophageal adenocarcinoma with PD-L1 expression (CPS≥5) Via Association française pour l'étude du cancer Bull Cancer. 2022 Jan 4:S0007-4551(21)00576-2. doi: 10.1016/j.bulcan.2021.11.012. Online ahead of print. NO ABSTRACT PMID:34996599 | DOI:10.1016/j.bulcan.2021.11.012 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.