We investigate the effectiveness of business shutdowns to contain the Covid-19 disease. In March 2020, Italy shut down operations in selected sectors of its economy. Using a difference-in-differences ...approach, we find that municipalities with higher exposure to closed sectors experienced subsequently lower mortality rates. The implied life savings exceed 9,400 people over a period of less than a month. We also find that business closures exhibited rapidly diminishing returns and had large effects outside the closed businesses themselves, including spillovers to other municipalities. Overall, the results suggest business shutdowns are effective, but should be selectively implemented and centrally coordinated.
•The recent outbreak of SARS‐CoV‐2 has assumed worldwide proportion.•Tracheostomy in intubated COVID-19 patients requires adjunctive safeguards.•A step-by-step approach named CORONA is proposed in ...order to recall essential recommendations during the surgical procedure.•The CORONA-method would allow a secure space in which health workers can guarantee their activity, safely.
COVID‐19: Nasal and oropharyngeal swab Petruzzi, Gerardo; De Virgilio, Armando; Pichi, Barbara ...
Head & neck,
June 2020, Volume:
42, Issue:
6
Journal Article
Peer reviewed
Open access
Performing a proper nasal and oropharyngeal swab procedure is essential in the screening of COVID‐19 infection. The video illustration of nasal and oropharyngeal swab is presented (Video S1). To ...correctly perform the nasopharyngeal swab, the patient must be seated comfortably with the back of their head against the headrest. The swab is inserted in the nose horizontally, along an imaginary line between the nostril and the ear. Oropharyngeal sampling is easier to perform. The swab is directed toward the rear wall of the oropharynx and it is rotated a few times before removal. After taking the sample, it is necessary to insert both swabs in the same tube, breaking the rod with one swift and controlled movement. Finally, carefully reset the cap. It appears to be extremely important to properly collect nasopharyngeal and oropharyngeal swabs in order to minimize the false negative rate among COVID‐19 positive patients.
Background
Laryngeal carcinoma (LC) remains a significant economic and emotional problem to the healthcare system and severe social morbidity. New tools as Machine Learning could allow clinicians to ...develop accurate and reproducible treatments.
Methods
This study aims to evaluate the performance of a ML‐algorithm in predicting 1‐ and 3‐year overall survival (OS) in a cohort of patients surgical treated for LC. Moreover, the impact of different adverse features on prognosis will be investigated. Data was collected on oncological FU of 132 patients. A retrospective review was performed to create a dataset of 23 variables for each patient.
Results
The decision‐tree algorithm is highly effective in predicting the prognosis, with a 95% accuracy in predicting the 1‐year survival and 82.5% in 3‐year survival; The measured AUC area is 0.886 at 1‐year Test and 0.871 at 3‐years Test. The measured AUC area is 0.917 at 1‐year Training set and 0.964 at 3‐years Training set. Factors that affected 1yOS are: LNR, type of surgery, and subsite. The most significant variables at 3yOS are: number of metastasis, perineural invasion and Grading.
Conclusions
The integration of ML in medical practices could revolutionize our approach on cancer pathology.
Transoral laser microsurgery (TLM) represents one of the most effective treatment strategies for Tis-T2 glottic squamous cell carcinomas (SCC). The prognostic influence of close/positive margins is ...still debated, and the role of narrow band imaging (NBI) in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS) and disease-specific survival (DSS).
We retrospectively studied 507 cases of pTis-T1b (Group A) and 127 cases of pT2 (Group B) glottic SCC. We identified the following margin status: negative (
= 232), close superficial (
= 79), close deep (CD) (
= 35), positive single superficial (
= 146), positive multiple superficial (
= 94), and positive deep (
= 48) and analyzed their impact on RFS and DSS. Close margins were defined by tumor-margin distance <1 mm. Pre-TLM margins were defined by white light in 323 patients, whereas NBI was employed in 311 patients.
In Group A, DSS and RFS were reduced in positive multiple superficial and positive deep margins (DSS = 96.1 and 97%, both
< 0.05; RFS = 72%,
< 0.001 and 75.8%,
< 0.01). In Group B, DSS was reduced in positive multiple superficial margins (82.4%,
< 0.05). RFS was reduced in positive single superficial, positive multiple superficial, and positive deep margins (62.5, 41.2, and 53.3%,
< 0.01). In the entire population, RFS was reduced in CD margins (77.1%,
< 0.05). Use of NBI led to improvement in RFS and DSS.
The study indicates that close and positive single superficial margins do not affect DSS. By contrast, all types of margin positivity predict the occurrence of relapses, albeit with different likelihood, depending on stage/margin type. CD margins should be considered as a single risk factor. Use of NBI granted better intraoperative margins definition.
Preoperative assessment is critical to decide the most adequate surgical strategy for oral squamous cell carcinoma (SCC). Magnetic resonance (MR) and intraoral ultrasonography (US) have been reported ...to be of great value for preoperative estimation of depth of invasion (DOI) and/or tumor thickness (TT). This review aims to analyze the accuracy of MR and intraoral US in determining DOI/TT in oral SCC, by assuming histological evaluation as the reference method.
The procedure was conducted following the modified 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We performed a systematic search of papers on PubMed, Scopus, Web of Science, and Cochrane Library databases until July 31st, 2019. For quantitative synthesis, we included nine studies (487 patients) focused on MR, and 12 (520 patients) focused on intraoral US. The Pearson correlation coefficient (
) between DOI/TT evaluated with MR or intraoral US was assumed as effect size. A meta-analysis (MA) for each study group (MR and US) was performed by using the random-effects models with the DerSimonian-Laird estimator and
-to-
transformation.
In the MA for MR studies, a high heterogeneity was found (
= 94.84%;
= 154.915,
< 0.001). No significant risk of bias occurred by evaluating funnel plot asymmetry (
= 0.563). The pooled (overall)
of the MR studies was 0.87 (95% CI from 0.82 to 0.92), whereas the pooled
-to-
transformed was 1.44 (95% CI from 1.02 to 1.85). In the MA for US studies a high heterogeneity was found (
= 93.56%;
= 170.884,
< 0.001). However, no significant risk of bias occurred (
= 0.779). The pooled
of the US studies was 0.96 (95% CI from 0.94 to 0.97), whereas the pooled
-to-
transformed was 1.76 (95% CI from 1.39 to 2.13). These outputs were confirmed in additional MA performed by enrolling only MR (
= 8) and US (
= 11) studies that evaluated TT.
MR and intraoral US seem to be promising approaches for preoperative assessment of DOI/TT in oral SCC. Remarkably, a higher pooled
and
-to-
transformed were observed in the intraoral US studies, suggesting that this approach could be more closely related to histopathological findings.
Pediatric Laryngo-Tracheal Stenosis (LTS) comprises different conditions that require precise preoperative assessment and classification. According to the guidelines, the optimal diagnostic work-up ...of LTS patients relies both on a comprehensive anamnesis and on endoscopic and radiological assessments. All the causes of LTS result in an impairment in airflow, mucociliary clearance, phonation, and sometimes in swallowing disorders. The main goals of treatment are to maintain an adequate respiratory space and restore the Upper Aero-Digestive Tract (UADT) physiology. The first step when dealing with LTS patients is to properly assess their medical history. The main causes of pediatric LTS can be divided into two groups, i.e., congenital and acquired. The most common causes of congenital LTS are: laryngomalacia (60%), vocal fold paralysis (15-20%), subglottic stenosis (SGS) (10-15%), laryngeal webs and atresia (5%), subglottic hemangioma (1.5-3%), and others. On the other hand, 90% of acquired pediatric LTS cases are subsequent to post-intubation injuries. Other less frequent causes are: iatrogenic complications from endoscopic laryngeal interventions, benign tumors, caustic or thermal injuries, external blunt force injury or trauma, chronic inflammatory disorders, or idiopathic causes. Diagnostic work-up consists in a step-by-step investigation: awake and asleep transnasal fiberoptic laryngoscopy (TNFL), direct laryngoscopy with 0° and angled telescopes to investigate the type of stenosis (arytenoid mobility, craniocaudal extension, involved anatomical sites, and active or mature scar tissue), and broncho-esophagoscopy to rule out associated mediastinal malformations. To date there are several available classifications for each of the involved sites: Cohen's classification for anterior glottic stenosis, Bogdasarian's for posterior glottic stenosis (PGS) and Myer-Cotton's for subglottic stenosis, even though others are used in daily practice (Lano-Netterville, FLECS, etc.). The European Laryngological Society recently proposed a new classification which is applicable in all LTS cases. In this chapter we deal with preoperative assessment and staging, reviewing the most relevant classifications applicable in patients affected by LTS,
in order to tailor the best treatment modality to each subject. We'll also detail the comprehensive radiological, endoscopic and functional assessment for the correct use of each staging classification.
Background
Fine‐needle aspiration of a salivary gland lesion is a well‐established diagnostic procedure that aids management decisions. Recently, the Milan System for Reporting Salivary Gland ...Cytopathology (MSRSGC) classification has been proposed in order to improve the reproducibility and communication in the management of salivary gland lesions.
Methods
A total of 375 patient's cytological reports collected between January 2010 and December 2017 were reviewed and reclassified according to MSRSGC and a risk of malignancy was calculated for each of the category.
Results
The rate of malignancy in MSRSGC classification was 19.0%, 11.8%, 25.0%, 5.5%, 50.0%, 71.4%, and 94.6% for each of the category (I, II, III, IVa, IVb, V, and VI), respectively.
Conclusion
The MSRSGC classification is a valuable tool in everyday practice. The modified version of MSRSGC aims to improve the surgical relevance and facilitate uniform management.
Background: We present immunogenicity data 6 months after the first dose of BNT162b2 in correlation with age, gender, BMI, comorbidities and previous SARS-CoV-2 infection. Methods: An immunogenicity ...evaluation was carried out among health care workers (HCW) vaccinated at the Istituti Fisioterapici Ospitalieri (IFO). All HCW were asked to be vaccine by the national vaccine campaign at the beginning of 2021. Serum samples were collected on day 1 just prior to the first dose of the vaccine and on day 21 just prior to the second vaccination dose. Thereafter sera samples were collected 28, 49, 84 and 168 days after the first dose of BNT162b2. Quantitative measurement of IgG antibodies against S1/S2 antigens of SARS-CoV-2 was performed with a commercial chemiluminescent immunoassay. Results: Two hundred seventy-four HWCs were analyzed, 175 women (63.9%) and 99 men (36.1%). The maximum antibody geometric mean concentration (AbGMC) was reached at T2 (299.89 AU/mL; 95% CI: 263.53–339.52) with a significant increase compared to baseline (p < 0.0001). Thereafter, a progressive decrease was observed. At T5, a median decrease of 59.6% in COVID-19 negative, and of 67.8% in COVID-19 positive individuals were identified with respect to the highest antibody response. At T1, age and previous COVID-19 were associated with differences in antibody response, while at T2 and T3 differences in immune response were associated with age, gender and previous COVID-19. At T4 and T5, only COVID-19 positive participants demonstrated a greater antibody response, whereas no other variables seemed to influence antibody levels. Conclusions: Overall our study clearly shows antibody persistence at 6 months, albeit with a certain decline. Thus, the use of this vaccine in addressing the COVID-19 pandemic is supported by our results that in turn open debate about the need for further boosts.
Background
Oral lichen planus (OLP) lesions have an overall malignant transformation rate of 1.37%. In patients with chronic disease, the diagnosis of malignancy relies on histopathological ...examination guided by clinical suspicion. Narrow-band imaging (NBI) is a promising endoscopic technique which, using a filtered light with specific wavelengths, can highlight microvascular abnormalities associated with subclinical neoplastic changes of the upper aerodigestive tract epithelium.
Objectives
This study aimed to analyse the value of NBI in selecting patients for biopsy before the emergence of clinical changes, allowing early detection of oral malignancies arising from OLP.
Materials and methods
A prospective study was conducted, enrolling 32 consecutive patients with a histological diagnosis of OLP with no previous diagnosis of oral cancer or other oral inflammatory diseases. Patients with suspicious NBI lesions underwent biopsies, while other patients were included in the follow-up.
Results
Two patients were judged positive at NBI evaluation and squamous cell carcinoma was diagnosed after histological examination. None of the other patients developed clinical features of malignancies during follow-up.
Conclusion
NBI evaluation may increase the accuracy of detection of subclinical neoplastic transformation in OLP lesions and further encourage clinicians to perform biopsies in selected cases.
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