Histological findings of tracheal samples from COVID-19 positive critically ill mechanically ventilated patients.

OBJECTIVES: This study examines the histological findings of tracheal tissue samples obtained from COVID-19 positive mechanically ventilated patients, to assess the degree of tracheal inflammation/ulceration present. DESIGN AND PARTICIPANTS: Retrospective single-centre observational cohort study. All patients admitted to Adult Intensive Care Unit (AICU) with COVID-19 infection, requiring mechanical ventilation and surgical tracheostomy between 1 April and 1 May 2020, were included (Group 1). Tracheal windows excised at tracheostomy underwent histological analysis. Comparison was made with: tracheal windows from COVID-19 positive AICU ventilated patients admitted between 1 January and 1 March 2021 (Group 2); tracheal windows from COVID-19 negative AICU ventilated patients (Group 3); and, tracheal autopsy samples from COVID-19 positive patients that died without undergoing prolonged mechanical ventilation (Group 4). RESULTS: Group 1 demonstrated mild/moderate inflammation (tracheitis) in nearly all samples (15/16, 93.8%), with infrequent micro-ulceration (2/16, 12.5%). Group 2 demonstrated similar mild/moderate inflammation in all samples (17/17, 100%), with no ulceration. Histological findings of Groups 1 and 2 COVID-19 positive patients were similar to Group 3 COVID-19 negative patients, which demonstrated mild/moderate inflammation (5/5, 100%), with uncommon superficial erosion (1/5, 20%). Group 4 demonstrated mild chronic inflammation or no significant inflammation, with uncommon micro-ulceration (1/4, 25%). CONCLUSIONS: Severe tracheal inflammation was not demonstrated in mechanically ventilated COVID-19 positive patients at the level of the second/third tracheal rings, at the stage of disease patients underwent tracheostomy. Histological findings were similar between mechanically ventilated COVID-19 positive and negative patients. Tracheal ulceration may be a feature of early or severe COVID-19 disease.

The donkey skin trade: a growing global problem / O comércio de peles de jumento: um problema global em crescimento

Growing demand for ejiao ­ gelatin produced from donkey skin and used in Traditional Chinese Medicine ­ is putting global donkey populations at risk and threatening the livelihoods of millions of people that depend on them in lower and middle-income countries. Hundreds of thousands of donkeys are slaughtered for their skins and exported annually, mostly from Africa to China. However, the trade is spreading across the globe, including Brazil. This article highlights the appalling welfare conditions for donkeys caught up in both the legal and illegal trade, as well as the effects on vulnerable people and the potential for disease spread and hazards to human health.(AU)

A crescente demanda por ejiao ­ uma gelatina produzida a partir da pele de jumento e usada na medicina tradicional chinesa ­ está colocando em risco as populações globais de jumentos e ameaçando a subsistência de milhões de pessoas que dependem delas em países de renda média e baixa. Centenas de milhares de jumentos são abatidos para obter suas peles e exportados anualmente, principalmente da África para a China. No entanto, o comércio está se espalhando pelo globo, inclusive para o Brasil. Este artigo destaca as péssimas condições de bem-estar para os jumentos apanhados no comércio legal e ilegal, bem como os efeitos sobre as pessoas vulneráveis e o potencial de propagação de doenças e riscos para a saúde humana.(AU)

Assessment of Emergency Department Eye Examinations in Patients Presenting with Mid-Face Injury.

BACKGROUND: One-fifth of patients with severe facial trauma suffer ophthalmic injury. Currently, patients presenting with mid-face injury to the emergency department (ED) undergo visual examination and then further assessment by ophthalmologists and with computed tomography (CT) scanning. The utility of the initial visual examination in the ED, performed by nonophthalmologists, remains unclear. OBJECTIVE: We aimed to objectively identify whether a more thorough initial visual assessment, performed by nonophthalmologists in the ED, was associated with improved ophthalmic outcomes. METHODS: Patients (n = 100) were retrospectively recruited from a tertiary craniomaxillofacial center. Visual examinations performed in the ED were scored objectively and measured against defined management and prognostic outcomes. RESULTS: There was no significant difference between more thorough initial visual examination and reduced time to ophthalmology assessment or reduced visual complications. There was no correlation between more comprehensive examination and incidence of CT scanning. CONCLUSIONS: We identified no significant difference between a comprehensive visual examination performed by nonophthalmologists in the ED, and improved ophthalmic outcomes. Physicians assessing patients with mid-face trauma in the ED should rule out eye emergencies, including retrobulbar hemorrhage and penetrating globe injury, and initiate expeditious CT scan and assessment by specialist ophthalmologists.

The reverse zygomatic implant: a new implant for maxillofacial reconstruction.

This case report describes the rehabilitation of a patient who had been treated with a hemimaxillectomy, reconstruction with a latissimus dorsi vascularized free flap, and radiotherapy for carcinoma of the sinus some years previously. Limited jaw opening, difficult access through the flap to the bony site, and the very small amount of bone available in which to anchor the implant inspired the development and use of a new "reverse zygomatic" implant. For this treatment, site preparation and implant insertion were accomplished using an extraoral approach. The implant was used along with two other conventional zygomatic implants to provide support for a milled titanium bar and overdenture to rehabilitate the maxilla. Two years later, the patient continues to enjoy a healthy reconstruction. The reverse zygomatic implant appears to show promise as a useful addition to the implant armamentarium for the treatment of the patient undergoing maxillectomy.

A comparison of non-invasive imaging modalities: Infrared thermography, spectrophotometric intracutaneous analysis and laser Doppler imaging for the assessment of adult burns.

BACKGROUND: Currently, the only evidence-based adjunct to clinical evaluation of burn depth is laser Doppler imaging (LDI), although preliminary studies of alternative imaging modalities with instant image acquisition are promising. This is a study to investigate the accuracy of infrared thermography (IRT) and spectrophotometric intracutaneous analysis (SIA) for burn depth assessment, and compare this to the current gold standard: LDI. We include a comparison of the three modalities in terms of cost, reliability and usability. METHODS: We recruited 20 patients with burns presenting to the Chelsea and Westminster Adult Burns Service. Between 48h and 5 days afterburn we recorded imaging using moorLDI2-BI-VR (LDI), FLIR E60 (IRT) and Scanoskin™ (SIA). Subsequent clinical management and outcome was as normal, and not affected by the extra images taken. RESULTS: 24 burn regions were grouped according to burn wound healing: group A healed within 14 days, group B within 14-21 days, and group C took more than 21 days or underwent grafting. Both LDI and IRT accurately determined healing potential in groups A and C, but failed to distinguish between groups B and C (p>0.05). Scanoskin™ interpretation of SIA was 100% consistent with clinical outcome. CONCLUSION: FLIR E60 and Scanoskin™ both present advantages to moorLDI2-BI-VR in terms of cost, ease-of-use and acceptability to patients. IRT is unlikely to challenge LDI as the gold standard as it is subject to the systematic bias of evaporative cooling. At present, the LDI colour-coded palette is the easiest method for image interpretation, whereas Scanoskin™ monochrome colour-palettes are more difficult to interpret. However the additional analyses of pigment available using SIA may help more accurately indicate the depth of burn compared with perfusion alone. We suggest development of Scanoskin™ software to include a simplified colour-palette similar to LDI and additional work to further investigate the potential of SIA as an alternative to the current gold standard.

Re-thinking 3D printing: A novel approach to guided facial contouring.

Rapid prototyped or three dimensional printed (3D printed) patient specific guides are of great use in many craniofacial and maxillofacial procedures and are extensively described in the literature. These guides are relatively easy to produce and cost effective. However existing designs are limited in that they are unable to be used in procedures requiring the 3D contouring of patient tissues. This paper presents a novel design and approach for the use of three dimensional printing in the production of a patient specific guide capable of fully guiding intraoperative 3D tissue contouring based on a pre-operative plan. We present a case where the technique was used on a patient suffering from an extensive osseous tumour as a result of fibrous dysplasia with encouraging results.

Complications of facial fillers: resource implications for NHS hospitals.

Facial rejuvenation seeks to reverse the negative sequelae of multiple factors but most importantly of genetic predisposition, sun damage and smoking. With the advent of the so-called 'non-surgical' techniques, and perhaps fuelled by these austere times, volumetric facial augmentation using dermal fillers has soared in popularity among both patients and practitioners. However, legislation has yet to keep pace with the change in clinical practices leaving patients poorly informed and with no protection against unscrupulous suppliers and unregulated practitioners. When things go wrong, patients often turn to the National Health Service (NHS) to rectify both the acute and chronic sequelae resulting in potentially difficult ethical and resource implications. Here, we report one of an increasing number of cases presenting to our NHS craniofacial service with acute filler-related complications.

'An unusual response of dental sepsis to antibiotics: parallels with the Jarisch-Herxheimer reaction'.

Spreading odontogenic infections are a common source of hospital admissions to Oral and Maxillofacial Surgery (OMFS) units. This report describes an unusual reaction to routine treatment for a spreading odontogenic infection in a healthy male with no known allergies, requiring the patient to be managed supportively in the resuscitation room. The patient deteriorated rapidly after the administration of paracetamol, intravenous fluids, steroids and antibiotics, demonstrating delusional behaviour, fever, rigors, tachycardia and hypoxia. Fever associated with sepsis can lead to confusional states, but similar symptoms have been described in the literature as a reaction to antibiotic therapy known as Jarisch-Herxheimer (J-H) reaction. This is potentially the first time a J-H like reaction has been described in the context of dental sepsis. The authors feel that the OMFS team should be aware of possible sequelae of medical therapy in patients with acute dental sepsis and be confident in their management of these complications.

Incidence and impact of previous orthodontic treatment in patients attending orthognathic combined clinics: a survey.

This prospective questionnaire-based study was designed to determine the incidence of patients attending orthognathic combined clinics who have previously had orthodontic treatment, and to assess the impact, if any, this has had on their proposed surgical treatment. Contemporaneous and historical data from consecutive patients at different stages of treatment who were attending clinics at two London hospitals during a three-month period were included. In total 22/56 patients (39%) had previously had orthodontic treatment, and of those, it had had an undesirable effect on the current management of 10 (45%). The effects included a reduced range of dental movements available to orthodontists (8/23, 35%), undesirable extractions (5/23, 22%), and a prolonging of preoperative orthodontics (5/23, 22%). The median age at which previous orthodontic treatment had been started was 13.5 (range 11-26). Nearly a third of patients reported that they had not been advised by their referring practitioner that a combined orthodontic and surgical approach might be required. The study suggests that preliminary assessment should be improved. Patients should be informed about and prevented from undergoing orthodontic treatment that may limit future surgical management, otherwise they may have to face repeated and prolonged orthodontic treatment, unexpected operations, and potential limitations to the outcome of surgical treatment. This could be achieved through the training and education of all practitioners and the development of referral guidelines.

Publish or perish? A survey of abstracts accepted for meetings of the British Association of Oral and Maxillofacial Surgeons, and subsequently published.

Publications are important for all surgeons, including those practising oral and maxillofacial surgery (OMFS). The results of relevant research are usually presented at the annual scientific meetings of the British Association of Oral and Maxillofacial Surgeons (BAOMS). The aim of this study was to find out how many abstracts that were accepted for presentation at the BAOMS go on to be published. Lists of abstracts accepted at BAOMS meetings 2002-2006 were obtained, and a thorough search was made for each article using the web-based search engine PubMed. Related publications were recorded. A total of 623 abstracts were accepted, of which only 147 (24%) resulted in peer-reviewed publication. Compared with clinical studies, scientific research was in the minority, but was more likely to appear in print and in journals with higher impact factors. Units with senior academic input had better records of publication. Currently only a small fraction of studies deemed worthy of presentation at the BAOMS become publications. This conversion from presentation to print is facilitated by strong academic support. Exposing trainees in OMFS training posts to basic research training might improve their ability to publish.