Gender specific considerations in septorhinoplasty, a retrospective observational study and review of the literature.

Introduction: In our service experience, we found we had a high proportion of male patients undergoing septorhinoplasty. This encouraged us to research gender specific differences in anatomy, surgical techniques, expectations and outcomes. Methods: We performed a retrospective chart review of patients who have had rhinoplasty surgery under a single otolaryngology consultant with a special interest in rhinoplasty. Patient information and results of the 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey for Functional and Cosmetic Rhinoplasty pre and post-surgery were collected. Results: There was no statistically significant difference in the mean pre-operative symptom (29.31 vs 32.29 p = 0.559), change in symptom (23.25 vs 24.14 p = 0.827) or satisfaction scores (8.69 vs 7.29 p = 0.089) between male and female patients. A discussion on gender specific anatomical features and deformities is presented. Conclusion: All patients reported improved symptoms and high levels of satisfaction. Careful patient counselling and patient-specific surgical planning help to achieve optimal outcomes.

Epistaxis in the Sars-CoV-2 Era.

Introduction Epistaxis was the third most common unscheduled ENT surgical intervention in Ireland in 2019. Otorhinolaryngologists are exposed to a high viral reservoir of Sars-CoV-2, as they are dealing with pathology in the upper respiratory tract. Risk analysis is required to minimise nosocomial transmission. Methods A prospective audit of epistaxis management in the outpatients at a tertiary hospital was undertaken pre pandemic. A retrospective review of patients records during the Sars-CoV-2 pandemic. Comparative analysis was utilised to assess outcomes. Results Pre Sars-CoV-2 analysis revealed 14 patients (70%) were manged with rigid endoscopy compared to one (5%) interpandemic. Cauterization treated 20 patients (100%) pre pandemic and four patients (20%) interpandemic. Nasal packing modality differed in that 13 patients (65%) were treated with Nasopore pre pandemic and 14 (70%) with Rapid Rhino interpandemic. This exhibited a paradigm shift in that 18 (90%) patients were managed conservatively with nasal packing interpandemic. Conclusion A paradigm shift in the management of Epistaxis during the pandemic has led to treatment which is less invasive, has less morbidity for the patient, requires less hospital admissions and lessens nosocomial transmission of the Sars-CoV-2. Further study is required given the advent of vaccines and development of various strains Sars-CoV-2.

Prognostic markers in well differentiated papillary and follicular thyroid cancer (WDTC).

OBJECTIVES: WDTC (papillary and follicular thyroid cancer) make up around 90% of all thyroid tumours. Overall, the prognosis in patients with WDTC is excellent. However, there are small cohorts of patients who experience a more aggressive form of disease which is often associated with certain poor prognostic factors. Identifying these patients at an early stage is imperative for guiding treatment decisions. With recent developments in this area we plan to discuss the current evidence surrounding prognostic markers. METHODS: The literature regarding prognostic factors in WDTC was reviewed using an electronic database Medline - Pubmed. Using the MeSH search engine specific prognostic factors including age, size, grade, lymph node involvement, distant metastasis, extension/invasion, ethnic background, radioactive iodine avidity, and thyroglobulin level and their association with WDTC were evaluated. A broader search of prognostic markers in thyroid cancer was also carried out to avoid missing other pertinent markers. RESULTS: Multiple clinical and pathologic variables have been shown to be poor prognostic factors in WDTC with statistical significance. Extensive extrathyroidal extension and age may be the most important factors when predicting clinical outcomes in WDTC, although the age threshold may be increased from 45 to 55 years in due course. CONCLUSIONS: Management of WDTC has changed considerably over the last two years as reflected in evolving British and American Thyroid Guidelines. In all cases a combined multi-disciplinary approach, with consideration of the available guidelines and stratification systems should be utilised when planning an individualised treatment program to offer the best contemporary care to WDTC patients.

Assessing the efficacy of different microfibre cloths at removing surface micro-organisms associated with healthcare-associated infections.

This study investigated the ability of 10 different microfibre cloths to remove microbial contamination from three surfaces commonly found in hospital settings (stainless steel, furniture laminate and ceramic tile), under controlled laboratory conditions. Tests were conducted using organisms known to cause healthcare-associated infections, i.e. meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (in spore form) and Escherichia coli. For all the cloths tested, there was significant statistical evidence to suggest a difference in cleaning performance between them on first and single use (P<0.001). However, the overall performance of the nine re-useable cloths did not differ in practice with differences in log10 reductions of <1. The performance of the disposable microfibre cloth was notably worse. The performance of all cloths decreased with repeated use on a succession of contaminated surfaces. After repeated washing, re-usable cloth performance improved at 75 washes, and reduced after 150 washes, although, in most instances, performance after 150 washes was better than at first wash. For all cloths, price was not an indication of performance. Based on these laboratory findings, it is concluded that use of the microfibre cloths investigated is an effective way to reduce the levels of MRSA, E. coli and C. difficile (in spore form) on a range of surfaces found in the clinical environment and could therefore be of benefit to these environments.

Phage typing of Campylobacter jejuni and Campylobacter coli and its use as an adjunct to serotyping.

Campylobacter is the most commonly reported cause of gastro-intestinal infection in England and Wales, with over 50,000 reported cases in 1997. The majority of human campylobacter isolates in England and Wales are C. jejuni (c. 90%) with most of the remainder being C. coli. We describe the use of phage typing as an extension to serotyping for more detailed characterization within these two species. The scheme was piloted during a study of 2407 C. jejuni and 182 C. coli strains isolated in Wales between April 1996 and March 1997. Fifty-seven C. jejuni phage types were identified, with the ten most prevalent phage types accounting for 60% of isolates tested; 16% of isolates were untypable. The most common phage type was PT 1 which represented c. 20% of isolates. A further 7% of isolates reacted with the phages but did not conform to a designated type (RDNC). Only 12 phage types were identified among C. coli, with the two most common types, PT 2 and PT 7 accounting for 75.2% of isolates. When used in conjunction with serotyping, the ability of phage typing to identify between 6 and 29 subtypes within each of the predominant HS types has enabled a further level of discrimination to be achieved that enhances the epidemiological typing of C. jejuni and C. coli.

Heat-stable serotyping antigens expressed by strains of Campylobacter jejuni are probably capsular and not long-chain lipopolysaccharide.

The role of lipopolysaccharide (LPS) in the serotyping of Campylobacter jejuni based on heat-stable antigens was examined using SDS-PAGE and a silver stain for carbohydrate. None of the 32 type strains of Camp. jejuni expressed long-chain LPS. Rabbit antibodies, prepared to 10 selected strains of Camp. jejuni, reacted with surface-exposed carbohydrate antigens, which were not LPS. This study suggests that the heat-stable antigens of Camp. jejuni, which form the basis for the established Penner serotyping scheme, are probably capsular and not LPS.

A coupled pacemaker-slave model for the insect photoperiodic clock: interpretation of ovarian diapause data in Drosophila melanogaster.

A coupled circadian oscillator model for the insect photoperiodic clock is described which consists of a hierarchically arranged pacemaker and slave. The pacemaker is self-sustained, temperature compensated, and entrainable by the light cycle; the slave is a damping oscillation receiving entrainment from two sources, from the pacemaker via a coupling factor, and also directly from the light. The damping slave oscillation is seen as the "photoperiodic oscillator", equivalent to that proposed earlier by Lewis and Saunders (1987). The present simulations describe the effect of the strength of the coupling factor between hypothetical short- and long-period pacemaker oscillations (modelled on the "clock" mutants perS and perL2 in Drosophila melanogaster) and a slave oscillation with a period of about 24 hours. The output is presented in terms of photoperiodic response curves and Nanda-Hamner, or resonance, plots. With a high coupling strength, the pacemakers strongly entrain the slave, but with a low coupling strength the slave's properties are more evident. The model is presented as a possible explanation for recent ovarian diapause data in D. melanogaster "clock" mutants (Saunders 1990), but also as a more general model for the role of the insect circadian system in seasonal time measurement.

Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer.

In order to evaluate the prognostic significance of risk factors for developing breast cancer, a population-based study was conducted of 2,445 breast cancer patients diagnosed in Denmark, 1983-1984. Data on clinical and pathological characteristics of breast cancer were derived from the Danish Breast Cancer Cooperative Group and data on risk factors from a self-administered questionnaire. Among 1,744 patients (71%) with complete information, survival was determined primarily by size of the tumour, skin invasion, number of positive lymph nodes and grade. No significant association was found between survival and reproductive or hormonal risk factors, dietary variables, alcohol consumption and smoking. Low current body weight and weight loss indicated a poor prognosis, independent of the clinical characteristics of the tumour.