Early Data From Case Series of Tracheostomy in Patients With SARS-CoV-2.

Thirty-eight tracheostomies were performed on patients with respiratory failure secondary to SARS-CoV-2 infection over the month of April at North Shore University Hospital and Lenox Hill Hospital (members of Northwell Health System in Long Island and New York City). Follow-up by May 14 revealed that 21 (55.2%) had been weaned from ventilators and 7 (18.4%) underwent decannulation. Two patients (5.3%) expired in the weeks following tracheostomy. Between the 2 institutions, 10 attending surgeons performed all of the tracheostomies using appropriate personal protective equipment, and none demonstrated seroconversion within 1 to 2 weeks of this article.

48-week efficacy and safety of dolutegravir relative to commonly used third agents in treatment-naive HIV-1-infected patients: a systematic review and network meta-analysis.

BACKGROUND: A network meta-analysis can provide estimates of relative efficacy for treatments not directly studied in head-to-head randomized controlled trials. We estimated the relative efficacy and safety of dolutegravir (DTG) versus third agents currently recommended by guidelines, including ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r), efavirenz (EFV), cobicistat-boosted elvitegravir (EVG/c), ritonavir-boosted lopinavir (LPV/r), raltegravir (RAL), and rilpivirine (RPV), in treatment-naive HIV-1-infected patients. METHODS: A systematic review of published literature was conducted to identify phase 3/4 randomized controlled clinical trials (up to August 2013) including at least one third agent of interest in combination with a backbone nucleoside reverse transcriptase inhibitor (NRTI) regimen. Bayesian fixed-effect network meta-analysis models adjusting for the type of nucleoside reverse transcriptase inhibitor backbone (tenofovir disoproxil fumarate/emtricitabine [TDF/FTC] or abacavir/lamivudine [ABC/3TC]) were used to evaluate week 48 efficacy (HIV-RNA suppression to <50 copies/mL and change in CD4+ cells/µL) and safety (lipid changes, adverse events, and discontinuations due to adverse events) of DTG relative to all other treatments. Sensitivity analyses assessing the impact of NRTI treatment adjustment and random-effects models were performed. RESULTS: Thirty-one studies including 17,000 patients were combined in the analysis. Adjusting for the effect of NRTI backbone, treatment with DTG resulted in significantly higher odds of virologic suppression (HIV RNA<50 copies/mL) and increase in CD4+ cells/µL versus ATV/r, DRV/r, EFV, LPV/r, and RPV. Dolutegravir had better or equivalent changes in total cholesterol, LDL, triglycerides, and lower odds of adverse events and discontinuation due to adverse events compared to all treatments. Random-effects and unadjusted models resulted in similar conclusions. CONCLUSION: Three clinical trials of DTG have demonstrated comparable or superior efficacy and safety to DRV, RAL, and EFV in HIV-1-infected treatment-naive patients. This network meta-analysis suggests DTG is also favorable or comparable to other commonly used third agents (ATV/r, LPV/r, RPV, and EVG/c).

Excision of laryngocele via transcervical midline approach.

Acute airway obstruction in the adult can be caused by a rapidly enlarging laryngeal cyst that may present unusually as a midline neck mass. In this case report we present a different surgical technique for the removal of a large combined laryngocele via midline transcervical approach that did not require laryngofissure. This technique allowed simple and fast access, excellent exposure and complete removal of the lesion without resection of thyroid cartilage or associated morbidities.

Quantifying smoking cessation outcomes: from The Women's Initiative for Nonsmoking Study (X): methodological implications.

BACKGROUND: Classification of smoking status has a major impact on the conclusions drawn from smoking cessation intervention research, yet few studies have addressed this critical issue. OBJECTIVES: The aim of this study was to compare three classifications (naïve, optimistic, and pessimistic) of smoking cessation outcomes or smoking status from the Women's Initiative for Nonsmoking Study (WINS). METHODS: This is a longitudinal prospective study nested within a randomized clinical trial (RCT) design of WINS, an RCT of 277 women over the age of 18 years who reported smoking cigarettes continuously for 1 month prior to a cardiovascular event requiring hospital admission. Women were randomized to either the usual care group (UC) or the intervention group (IG). Recruitment for WINS occurred between October 1996 and December 1998 in 10 hospitals in the San Francisco Bay area. Follow-up data on smoking status was obtained from the UC and the IG using a structured telephone interview at 6 and 12 months from baseline and was confirmed by family members and salivary cotinine levels. RESULTS: Seven-day point prevalence(self-report of not smoking in the past 7 days; "not even a puff") using the naïve (the most liberal) classification yields a greater number of nonsmokers than the pessimistic or most conservative classification (cotinine level verification of smoking status). The classification of smoking status also affects time to continuous smoking. The pessimistic classification results in the shortest time to continuous smoking, whereas the opposite is observed with the naïve classification. DISCUSSION: It is important to critically evaluate the underlying assumptions made by study investigators when measuring and reporting smoking status. The classification of smoking status and the selection of analysis, meaning point prevalence versus survival analysis, affect study results and contribute to the variability observed in the research findings of smoking cessation intervention trials and the challenges faced in making appropriate comparisons across studies.

Tracheal resection with end-to-end anastomosis for benign tracheal stenosis.

To review our experience with tracheal resection with end-to-end anastomosis for tracheal stenosis, we performed a retrospective review at a tertiary-care academic medical center. Twenty-eight patients underwent circumferential tracheal resection with end-to-end anastomosis by 2 attending otolaryngologists from 1989 to 2002. Patients were excluded if they were under 12 years of age or if the surgical indication was tracheal or thyroid neoplasm. The indications for tracheal resection were postintubation stenosis (n = 9; 32%), posttracheotomy stenosis (n = 7; 25%), both postintubation and posttracheotomy stenosis (n = 9; 32%), external tracheal trauma (n = 2; 7%), and presence of a foreign body (n = 1; 4%). Two to 8 rings were resected. The follow-up periods ranged from 18 months to 13.5 years. The anastomotic success rate was 89% (n = 25). No patients died as a result of the procedure. We conclude that tracheal resection with end-to-end anastomosis is a relatively safe and reliable procedure for the treatment of tracheal stenosis in appropriately selected patients.