To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD).
Single institution retrospective review.
Tertiary care academic hospital.
...A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence.
Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94).
There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.
Social determinants of health (SDOH) can influence access to cancer care, clinical trials, and oncologic outcomes. We investigated the association between SDOH, distance from treatment center, and ...treatment type with outcomes in human papillomavirus associated oropharyngeal squamous cell carcinoma HPV(+)OPSCC patients treated at a tertiary care center.
Retrospective review.
HPV(+)OPSCC patients treated surgically from 2006 to 2021 were selected from our departmental Oropharyngeal Cancer RedCap database. Demographic data, treatment, and oncologic outcomes were extracted. Distance was calculated in miles between the centroid of each patient zip code and our hospital zip code (zipdistance).
874 patients (89 % male; mean age: 58 years) were identified. Most patients (96 %) reported Non-Hispanic White as their primary race. 204 patients (23 %) had a high-school degree or less, 217 patients (25 %) reported some college education or a 2-year degree, 153 patients (18 %) completed a four-year college degree, and 155 patients (18 %) had post-graduate degrees. Relative to those with a high-school degree, patients with higher levels of education were more likely to live further away from our institution (p < 0.0001). Patients who received adjuvant radiation therapy elsewhere lived, on average, 104 miles further away than patients receiving radiation at our institution (Estimate 104.3, 95 % CI 14.2-194.4, p-value = 0.02). In univariable Cox PH models, oncologic outcomes did not significantly differ by zipdistance.
Education level-and access to resources-varied proportionally to a patient's distance from our center. Patients travelling further distances for surgical management of OPSCC were more likely to pursue adjuvant radiation therapy at an outside institution. Distance traveled was not associated with oncologic outcomes. Breaking down barriers to currently excluded populations may improve access to clinical trials and improve oncologic outcomes for diverse patient populations.
We present a case of subglottic thrombus formation after administration of nebulized tranexamic acid (TXA) for postoperative hemoptysis following CO2 laser wedge excision of subglottic stenosis. ...Although other factors certainly could have resulted in postoperative bleeding and subsequent thrombus formation, the patient's rapid decompensation following administration of nebulized TXA suggests a direct effect. We recommend implementing an airway action plan regarding TXA use for patients presenting to the emergency department with postoperative hemorrhage following otolaryngology procedures.
Laryngoscope, 134:1356–1358, 2024
In response to the challenges faced as diverse students when first encountering the intricacies of scrubbing into the operating room (OR), we have prepared a rudimentary surgical skills guide to ...supplement the knowledge of students and educators alike. In keeping with the need to adapt standard protocols to accommodate religious and cultural practices, this guide focuses on hijab, natural hair, dastar, protective styles, and beard protocol in the OR. It addresses some of the personal protective equipment needs of Muslims, Orthodox Jews, Sikhs, and groups maintaining beards as a part of cultural or religious practices. We intend this guide to serve as a foundation on which the medical field can update its educational practices in line with the increased diversity of the medical professions, while also continuing to ensure the safety of OR and ICU patients. This guide also highlights COVID-19-specific changes in personal protective equipment and seeks to open up a conversation about the necessity of currently held surgical practices.
IntroductionAfrican, Caribbean and Black (ACB) communities are disproportionately infected by HIV in Ontario, Canada. They constitute only 5% of the population of Ontario yet account for 25% of new ...diagnoses of HIV. The aim of this study is to understand underlying factors that augment the HIV risk in ACB communities and to inform policy and practice in Ontario.Methods and analysisWe will conduct a cross-sectional study of first-generation and second-generation ACB adults aged 15–64 in Toronto (n=1000) and Ottawa (n=500) and collect data on sociodemographic information, sexual behaviours, substance use, blood donation, access and use of health services and HIV-related care. We will use dried blood spot testing to determine the incidence and prevalence of HIV infection among ACB people, and link participant data to administrative databases to investigate health service access and use. Factors associated with key outcomes (HIV infection, testing behaviours, knowledge about HIV transmission and acquisition, HIV vulnerability, access and use of health services) will be evaluated using generalised linear mixed models, adjusted for relevant covariates.Ethics and disseminationThis study has been reviewed and approved by the following Research Ethics Boards: Toronto Public Health, Ottawa Public Health, Laurentian University; the University of Ottawa and the University of Toronto. Our findings will be disseminated as community reports, fact sheets, digital stories, oral and poster presentations, peer-reviewed manuscripts and social media.
Objective
To compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and ...characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE).
Methods
A retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (DL), and distance from the glottis to superior‐most aspect of scar (DGS). Rates (in mm/procedure) of DΔL, reflecting an increase in length, and D−ΔGS, reflecting proximal migration, were calculated by dividing DΔL and D−ΔGS by the number of LWE procedures.
Results
213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and DGS decreased by 0.7 mm, reflecting a migration or decrease in DGS of 9.5% with each procedure with respect to initial DGS. Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively.
Conclusion
There appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients.
Level of Evidence
4 Laryngoscope, 133:875–882, 2023
The first study to evaluate proximal scar progression in idiopathic subglottic stenosis (iSGS) patients who have undergone CO2 laser wedge excision demonstrates a baseline glottic involvement rate of 4.5% in iSGS and low risk of glottic involvement resulting from the procedure.
Flexible endoscopic Zenker's diverticulotomy (FEZD) is a procedure performed primarily by gastroenterologists for treatment of symptomatic Zenker's diverticulum (ZD). Given the lack of prior ...investigations with large sample sizes, we report on one of the largest series of patients who underwent FEZD.
A review of patients who underwent FEZD at our institution from 2006 to 2021 was performed. Data were abstracted for patient demographics, clinical features, procedural characteristics, adverse events, and outcomes.
A total of 75 patients (37 women) with mean age of 77.9 (33–102) years and mean (range) follow-up of 1.1 (0–13.2) years were identified. 67.9 % of FEZD cases were performed under general anesthesia. The mean procedure time was 37.1 min. Same day discharge and resumption of oral intake was seen in 56.4 % and 57.1 % of cases, respectively. Adverse events included intraprocedural bleeding (15.7 %) controlled with endoscopic means, infection (4.8 %) exclusively managed with antibiotics in all but one case, subcutaneous emphysema (2.4 %), and perforation (10.7 %) conservatively managed in all but one case. 97.6 % of patients had sustained subjective improvement in symptoms following their procedure. Fifteen patients (20 %) experienced recurrence after undergoing initial FEZD—26.7 % percent of whom were sufficiently treated with repeat FEZDs. Younger age was associated with recurrence (p < 0.01).
FEZD is an effective, safe procedure for the management of symptomatic ZD. It is a viable alternative for patients in whom otorhinolaryngological procedures via rigid endoscopy are not an option.
In 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including ...Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023.
We reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia's IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed.
Between 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines.
From 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response.
The volumes of upper and lower extremity arthroplasty are increasing. Periprosthetic joint infection (PJI) after TEA remains a substantial cause of morbidity, with certain studies reporting primary ...total elbow arthroplasties (TEA) PJI rates over 10%. The odds ratio for hip and knee PJI after previous hip or knee PJI is 3 times, and it rises to 15 times for patients on chronic suppressive antibiotics. The risk of PJI for primary TEA in patients with a history of lower extremity PJI is unknown. The purpose of this study, therefore, was to compare the incidence of PJI after primary TEA in patients with a history of lower extremity PJI in a case-control study.
Our institutional joint registry database was queried to identify all patients who underwent primary TEA and had previously undergone treatment for lower extremity PJI between 1974 and 2021. Twelve elbows (10 patients) with a mean follow-up of 8.2 years were identified. There were 9 female elbows (75%) and 3 male elbows (25%) with a mean age of 63 years (range,44-78 years), and all patients had a diagnosis of rheumatoid arthritis. This cohort was 1:7 matched (age, sex, side, indication, and surgical year) to 84 elbows (83 patients) with no history of lower extremity PJI. There were no statistically significant differences between the cohorts with regard to body mass index or operative time. Survivorship analysis free of TEA PJI with death as a competing risk was calculated.
None of the 12 TEA included in the study group developed PJI. The cumulative incidence of PJI in the matched cohort at 10 years was 6.4% (5 elbows). There was 1 superficial infection in the study group (9.1%) and 5 (5.8%) in the matched cohort. In the study group, 2 elbows underwent revision and 4 underwent reoperation. Eight elbows in the matched cohort underwent revision and 23 underwent reoperation. The study cohort was associated with higher risk of revision and reoperation for any cause, but these differences did not reach statistical significance.
In this relatively small case control study, there was no incidence of PJI in patients who underwent primary TEA for rheumatoid arthritis and had previously undergone treatment for lower extremity PJI. The cumulative incidence of PJI in the matched cohort at 10 years was 6.4%. Although underpowered to make firm conclusions, it does draw from a very large population of patients and did not reveal an association between infection after TEA and a prior history of lower extremity PJI.
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