SMaRT-PCR: sampling using masks and RT-PCR, a non-invasive diagnostic tool for paediatric pulmonary TB.

Key challenges in paediatric TB diagnosis are invasive sampling and poor sensitivity of standard methods. This study demonstrates the diagnostic potential of non-invasive sampling of bioaerosols from children using SMaRT-PCR, comprising mask sampling combined with reverse transcriptase-polymerase chain reaction (RT-PCR) for TB.Exhaled bioaerosols were captured on modified N-95 masks in a 10-min talk-cough-breathe process from 51 children (30 with TB confirmed using standard sampling methods and 21 without TB) aged 2-15 years. All mask samples were tested using in-house RT-PCR for 16s and rpoB RNA transcripts. Additional mask samples from children with TB were tested using Xpert® MTB/RIF (n = 3) and Xpert® MTB/RIF Ultra (n = 27).SMaRT-PCR sensitivity for detecting TB among treatment-naïve children was 96% if 16s or rpoB was present, and 75% if both genes were present, comparable to standard methods (71%) in the same cohort. Specificity was better for both genes, at 95%, than 85% for a single gene detection. Mask sampling with Xpert MTB/RIF or Ultra had a sensitivity of only 13%.This is the first study to provide evidence for testing bioaerosols as a promising alternative for detecting paediatric TB. Sampling is non-invasive and simple, with the potential for point-of-care applications. This pilot study also suggests that RNA transcript-based detection may improve TB diagnostic sensitivity in children; however, further investigation is required to establish its adaptability in clinical settings..

Clinical utility of target-based next-generation sequencing for drug-resistant TB.

BACKGROUND: In high TB burden countries, access to drug susceptibility testing is a major bottleneck. Targeted next-generation sequencing (tNGS) is a promising technology for rapid resistance detection. This study assessed the role of tNGS for the diagnosis of drug-resistant TB (DR-TB).METHODS: A total of 161 samples from bacteriologically confirmed TB cases were subjected to tNGS using the Deeplex® Myc-TB kit and sequenced using the MiSeq platform. These samples were also processed for conventional phenotypic DST (pDST) using 13 drugs on Mycobacteria Growth Indicator Tube and line-probe assays (MTBDRplus and MTBDRsl).RESULTS: There were 146 DR-TB and 15 drug-susceptible TB (DS-TB) samples. About 70% of patients with DR-TB had no previous TB treatment history. Overall, 88.2% had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), 58.5% pre-extensively drug-resistant TB (pre-XDR-TB) and 9.2% had XDR-TB as defined by the WHO (2020). Around 8% (n = 13) of samples were non-culturable; however, identified 8 were resistant to first and second-line drugs using tNGS. Resistance frequency was similar across methods, with discordance in drugs less reliable using pDST or with limited mutational representation within databases. Sensitivities were aligned with literature reports for most drugs. We observed 10% heteroresistance, while 75% of strains were of Lineages 2 and 3.CONCLUSIONS: Programme data supported tNGS in the diagnosis of DR-TB for early treatment using individualised regimens.

Endoscopic laser management of bilateral abductor palsy.

OBJECTIVE: To assess the results of endoscopic laser surgery in cases of bilateral abductor palsy on basis of respiration, preservation of voice (phonation) and swallowing. METHODS: This retrospective study includes 48 patients (34 males and 14 females) from 5 years to 68 years of age at the time of intervention. 41 cases were operated with subtotal arytenoidectomy and 7 with unilateral posterior cordectomy. 32 patients were operated with tracheostomy and 16 with combination of intuabtion and jet ventilation. RESULTS: 29 out of 32 tracheostomised patients were decannulated (91%). Respiration was adequate for daily routine activities in most of the operated patients. Phonation was normal to near normal in 32 cases out of the operated 34 adult patients (95%). Most of the patients had normal swallowing following surgery. CONCLUSION: Subtotal arytenoidectomy with endoscopic laser surgery in cases of bilateral abductor paralysis has established its place as a preferred surgical method to obtain good respiration, phonation and swallowing. It minimizes the surgical time, hospital stay and morbidity.

Life-size photograph transparencies: a method for the photographic detection and documentation of recovery from facial paralysis.

We describe a simple and objective practical method for the detection of recovery from facial paralysis by multiple photographic assessments. The photographs are printed as life-size transparencies representing maximal effort. Each time the patient attends for review the new transparency is overlapped on the previous one and the difference can be detected easily. The prints are filed with the patient's notes for future reference. To achieve this system a specific photographic protocol is mandatory in order to avoid technical artefacts. We believe that this system avoids many of the complexities of other grading systems and is very suitable for use at outpatient follow-up.

A pilot study of the holmium YAG laser in nasal turbinate and tonsil surgery.

A pilot study of the holmium YAG laser (a solid-state pulsed laser, wavelength 2.1 mum) was performed for tonsillectomy and nasal turbinate surgery. In the nose, intraoperative bleeding was negligible, facilitating an excellent view of the operative field and avoiding the need for postoperative nasal packs. There was no occurrence either of primary or secondary hemorrhage. Some intranasal crusts separated with no difficulty between 3 and 6 weeks. There was no significant delayed tissue destruction. Tonsillectomy was almost bloodless. There was some minor difficulty in mobilizing the upper tonsillar pole. Postoperative pain was no worse than routine tonsillectomy pain and may have been less than would be expected. The tonsil beds healed within two weeks. The comparable roles of the CO 2, the neodymium YAG, and the KTP/532 laser for nasal and oropharyngeal surgery are discussed. These preliminary results suggest a potential role for the holmium YAG laser in nasal turbinate and tonsillar surgery and the need for further evaluation.

Radiation therapy of laryngeal cancer: a twenty year experience.

This paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow-up. All cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis. A policy of primary radiotherapy with surgery for salvage of treatment failures, produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature.

Anaesthesia for carbon dioxide laser laryngeal surgery in infants. A new tracheal tube.

Problems associated with the presence of a tracheal tube during anaesthesia for infant laryngeal surgery using the carbon dioxide laser are described. This paper discusses alternatives and describes an effective anaesthetic technique and a new tracheal tube.

Use of bronchoscopic CO2 laser in palliation of obstruction tracheobronchial malignancy.

A review of 15 patients, who underwent 34 CO2 laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.

Anaesthetic management for carbon dioxide laser surgery in tracheobronchial lesions.

There are technical difficulties associated with anaesthesia in patients who undergo laser surgery to the trachea and main bronchi using the carbon dioxide laser. An anaesthetic technique using spontaneous ventilation is described which has been used successfully in 33 patients.

The management of a neck mass: presenting feature of an asymptomatic head and neck primary malignancy?

Malignancy of the upper aerodigestive tract is not always associated with obvious localizing symptoms. Presentation may then only be prompted by the appearance of a hard mass in the neck, a metastasis to a cervical lymph node. Neck exploration without a prior diligent search for an occult head and neck primary tumour is to be avoided as it compromises subsequent treatment. The diagnostic investigation of 112 patients complaining solely of a painless and enlarging neck swelling is reviewed. An otolaryngologic examination identified an asymptomatic malignancy of the head and neck in 72 patients (64%). Excision biopsy of the neck mass was required to achieve a diagnosis in only 29 (29%) of those patients who had not already undergone surgery. These results are presented to emphasize the need for a specialist examination of the head and neck prior to embarking on excision of any suspicious neck mass.

Haemangiopericytoma of the nose and paranasal sinuses.

The uncertain course and rarity of haemangiopericytoma in the nose and paranasal sinuses has interested both pathologists and clinicians. This tumour arises from proliferation of pericytes which invest capillary endothelium. A benign course is more common in the nose and paranasal sinuses. The first nasal haemangiopericytoma was reported by Stout in 1949. Since then only twenty cases have been reported in the literature. We present three further cases.

Metal tube anaesthesia for ear, nose and throat carbon dioxide laser surgery.

Tracheal tube anaesthesia in ear, nose and throat surgery using the carbon dioxide laser is reviewed. The development of metal tubes and techniques is described.