Added value of 3D printing technology in the manufacturing of customised septal buttons: A scoping review of the literature.

BACKGROUND: In recent years, Three-dimensional printing (3-DP) technology, has had several applications in many fields of medicine, including rhinology. The aim of this review is to evaluate the use of 3-DP buttons as a treatment option for nasal septal perforations (NSP). METHODS: We conducted a scoping review of the literature until June 07, 2022, on the online databases PubMed, Mendeley, and Cochrane Library. All articles referred to treatment of NSP with custom made buttons created by 3-DP technology were included in this study. RESULTS: A total of 197 articles were generated by the search. Six articles met the inclusion criteria. 3 of the articles referred to clinical cases or clinical series. A total of 35 patients used the 3-DP custom made button as a treatment for NSP. The retention rate of this buttons ranged from 90.5 % to 100 %. An overall decrease in NSP symptoms was also observed in the majority of patients, especially regarding the most common complaints such as nasal bleeding and crusting. CONCLUSION: The manufacturing of 3-DP buttons is a complex, time consuming process that requires both special laboratory equipment and trained staff. This method has the advantage of reducing the NSP related symptoms and an improving the retention rate. This could make the 3-DP custom made button a first-choice treatment for patients with NSP. However, as a new treatment option, it needs studies with more patients to determine its superiority over conventional buttons and its long-lasting therapeutic effects.

Clival Mucocele: A Rare Yet not Forgotten Pathology.

Primary clival mucoceles are a rare clinical entity that usually represents an incidental finding on computed tomography or magnetic resonance imaging scanning. There are only a few reports in the literature of patients who presented with vague symptoms such as headaches, facial paresthesia, and numbness. Clival mucoceles can also be secondary, by extension of a sphenoid mucocele to the clivus. We present a case of primary clival mucocele, aiming to highlight the importance of a multidisciplinary approach.

The use of tissue adhesive in management of genitourinary fistulas: a systematic review and case report.

INTRODUCTION AND HYPOTHESIS: Articles are getting published on the use of tissue adhesive for vesicovaginal fistula. The objective is to carry out a systematic review on their effectiveness and complications. METHODS: A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers screened abstracts and full-text and extracted data independently. A narrative synthesis was conducted given the heterogeneity of studies. RESULTS: A total of 1032 studies were identified after searching the database, and 14 articles were included in this systematic review. Of the 84 women included, 12 (14.3%) presented failure or recurrence of their fistula tract. The mean time of follow-up was 11.46 months. The average size of the fistula was 1.05 (range 0.1 to 3.9) cm. Most fistulas (81) included were vesicovaginal fistulas. Nine papers reported the usage of fibrin glue in which only three (6.5%) women reported recurrence of the fistula in a delay of 2 weeks to 26 months. The other studies used cyanoacrylate (14 women) and autologous fibrin injection from the patients' blood (31 women). No significant complications were reported. Complications reported were urinary tract infections in 3 women (3.6%), hematuria in 2 women (2.4%), overactive bladder symptoms in 6 women (7.2%) and septic pelvic thrombosis in one woman (1.2%). CONCLUSIONS: Tissue adhesive appears to be a promising alternative for management of urogenital fistulas without reported important complications.

Preoperative anemia and complications after surgery for pelvic organ prolapse: an analysis of the national surgical quality improvement program database.

INTRODUCTION AND HYPOTHESIS: Preoperative anemia is a well-established risk factor for adverse perioperative outcomes in major surgery, but studies exploring complications after pelvic reconstructive surgery are limited. The objective of this study is to examine the impact of preoperative anemia on 30-day adverse outcomes in patients undergoing pelvic organ prolapse surgery. METHODS: A retrospective cohort of women undergoing pelvic organ prolapse surgery was captured from the National Surgery Quality Improvement Program database (2014-2019). The primary outcome was a composite of postoperative medical complications such as pulmonary embolism, acute renal failure, stroke, myocardial infarction, cardiac arrest, deep vein thrombosis, and sepsis. Secondary outcomes included surgical site infection, bleeding requiring blood transfusion, readmission within 7 days of surgery, and return to the operating room within 30 days. Multivariate logistic regression was used to adjust for important pre-specified potential confounders. RESULTS: A total of 50,848 women were included in the analysis and 9.9% (4,579) met the criteria for anemia (hematocrit <36%). Potentially serious medical complications were rare, occurring in only 348 women (0.7%), and were more common among anemic patients (1.1% vs 0.6%, p < 0.001). On multivariate analysis, preoperative anemia was associated with higher odds of both potentially serious medical complications (OR 1.38, 95% CI 1.01-1.88) and returning to the operating room (OR 1.55, 95% CI 1.23-1.94). Anemic patients had a four-fold increase in the odds of requiring a blood transfusion (OR 4.47, 95% CI 3.60-5.56). CONCLUSIONS: Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in women having surgery for pelvic organ prolapse.

A Case of Clinically Diagnosed ANCA Negative Granulomatosis With Polyangiitis.

SIGNIFICANCE STATEMENT: Granulomatosis with polyangitis (GPA) is a systemic necrotizing vasculitis comprising of inflammation of small and medium-sized vessels.1 It typically presents with involvement of the upper and lower airways as well as the kidneys. If left untreated, end-organ damage may occur. Hematological investigations typically demonstrate the presence of antinuclear cytoplasmic antibodies (ANCA).2 Here, we discuss an unusual presentation of ANCA negative GPA, presenting initially with nasal symptoms.

Local Foods Can Increase Adequacy of Nutrients Other than Iron in Young Urban Egyptian Women: Results from Diet Modeling Analyses.

BACKGROUND: Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient. OBJECTIVE: This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women. METHODS: Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19-30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify "limiting nutrients" and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed. RESULTS: Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation. CONCLUSIONS: A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women.

Patient attitudes toward pooled surgical waitlists in urogynecology.

INTRODUCTION AND HYPOTHESIS: Pooled surgical waitlists are used to maximize the use of surgical resources; however, patients' views of this strategy are poorly understood. We sought to evaluate patients' attitudes toward a pooled waitlist for urogynecology and pelvic reconstructive surgical procedures. METHODS: Patient and provider focus groups were used to inform the design of a survey that was distributed to patients at the time of consent for female pelvic reconstructive surgical procedures. All responses were collected anonymously. Patient attitudes toward surgical wait times and the potential for a pooled surgical waitlist were explored. Grouped responses by age, procedure type, and perceived disease severity were examined. RESULTS: One hundred seventy-six patients were surveyed. Thirty-four percent were amenable to the option of a pooled surgical waitlist; 86% agreed or strongly agreed that they preferred to have their surgery performed by their own care provider. Only 18% would agree to be on a pooled surgical waitlist if it shortened their wait time. Older women (≥ 65 years) were more likely to disagree or strongly disagree that they "would like the option of having surgery done by the next available skilled surgeon" (56.2% vs. 72.0%, p = 0.028). Self-perceived severe disease and mid-urethral sling surgery were not associated with a higher acceptance of pooled surgical waitlists. CONCLUSIONS: Acceptance of pooled surgical waitlists among urogynecology patients was overall low, irrespective of disease severity. Improving our understanding of urogynecology patients' concerns and potentially negative perceptions of surgical waitlists is needed to ensure patient comfort and satisfaction are not compromised if this strategy is adopted.

Correction to: Patient attitudes toward pooled surgical waitlists in urogynecology.

Table 3 in the originally published article contains layout error. Corrected Table 3 shown below.

Microdebrider-Assisted Rhinophyma Excision.

Rhinophyma represents a progressive deformity of the nose which leads to cosmetic disfigurement and has a significant impact on the patient's quality of life. This pathological entity originates from hyperplasia of sebaceous gland tissue, connective tissue, and vessels of the nose and is associated with rosacea and more specifically, stage III rosacea. Surgical treatment is the method of choice. We present five cases of rhinophyma that we treated with microdebrider-assisted excision. The procedure was divided in two main steps: scalpel excision of the main bulk of the rhinophyma and then further contouring with the microdebrider. All patients had weekly follow-up for the first four weeks, and then three-monthly. All patients had uneventful recovery and satisfactory cosmetic outcomes. No postoperative infections or other complications were reported in our case series. The use of the microdebrider reduces the operating time, preserves the islands of skin regeneration, and allows finer manipulations than the standard scalpel techniques. Microdebrider-assisted rhinophyma excision is a safe approach, with good aesthetic results. Larger series of patients need to be examined in order to establish the value of the method.

Occult Vaginal Evisceration: A Case Report.

BACKGROUND: Vaginal evisceration is a rare gynaecologic emergency that necessitates surgical intervention. It may manifest with obvious vaginal rupture, or it may be occult, specifically in patients with chronic pelvic organ prolapse. CASE: A 66-year-old woman with a history of bowel cancer and irradiation presented with occult vaginal evisceration. This was discovered during a routine follow-up appointment. It was repaired in two layers with xenograft derived from porcine intestinal mucosa (Surgisis, Cook Medical, Bloomington, IN) interposition and a concomitant colpocleisis. Long-term complications of the procedure included recurrent prolapse, but her vaginal vault evisceration did not recur. CONCLUSION: In patients with chronic pelvic organ prolapse, especially in those with additional risk factors for poor tissue strength, the possibility of vaginal vault evisceration or dehiscence should be considered. These patients would benefit from close follow-up.

Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. METHODS: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. RESULTS: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. CONCLUSIONS: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.

Orbital infections: a complete cycle 7-year audit and a management guideline.

OBJECTIVES: Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. METHODS: (1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes. RESULTS: Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.

A Case of Invasive Sinonasal Carcinosarcoma: The Importance of Early Detection.

Sinonasal carcinosarcomas represent rare neoplasms, with aggressive character and unfavourable prognosis. We present a case of extensive sinonasal carcinosarcoma extending into the anterior cranial fossa and into the orbit and also a review of the current international literature regarding this rare yet aggressive neoplasm. There is currently a lack of specific guidelines on the optimal management of sinonasal carcinosarcoma and the treatment represents a challenge for the clinician. The key message that we would like to disseminate to our colleagues is the importance of suspicion and early detection, as well as the necessity to adopt a holistic approach when counselling patients.

Complications after minimally invasive sacrocolpopexy with and without concomitant incontinence surgery: A National Surgical Quality Improvement Program (NSQIP) database study.

AIMS: To compare surgical complications for patients having minimally invasive sacrocolpopexy (MISCP) with concomitant incontinence procedure, to those having MISCP alone. METHODS: Patients undergoing MISCP with and without a concomitant incontinence procedure between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. The main outcome of interest was a composite of surgical site infection, bleeding requiring blood transfusion, return to the operating room within 30 days, and surgical stay >48 h. Log-binomial regression was used to identify independent risk factors for the outcome and to generate adjusted effect measures for variables of interest. RESULTS: Seven thousand ninety-seven women met the inclusion criteria, of which 2433 (34%) underwent a concomitant incontinence procedure. Patients having incontinence procedures were slightly older (59 ± 11 vs 58 ± 12, P < 0.0001) and had longer total operating time (225 IQR 170-267 vs 184 IQR 120-232 min, P < 0.0001). Pre-operative steroid use, wound class III/IV (vs I/II), and longer operative time were independent predictors of the composite outcome. After adjusting for baseline patient characteristics and co-morbidities, no association was observed between concomitant incontinence procedure and the composite outcome (adjusted RR 0.87, 95%CI 0.65-1.18) but there was an increased likelihood of urinary tract infection (adjusted RR 2.47 95%CI 1.89-3.27). CONCLUSIONS: Despite being associated with a longer operative time, performing an incontinence procedure at the time of MSCIP was not associated with an increased risk of clinically important surgical complications other than urinary tract infection.

An evaluation of medical student-led podcasts: what are the lessons learnt?

BACKGROUND: Student-led podcasts were developed by 5th year Peninsula Medical School students as part of an educational grant. The students completed 35 video podcasts using PREZI software, and based on clinical indicative presentations of the Peninsula Medical School curriculum. METHODS: Third, 4th and 5th year medical students were invited to complete the evaluation of the indicative presentation video podcasts they watched. Both quantitative and qualitative data were collected through anonymized questionnaires. A thematic analysis of qualitative data was carried out. RESULTS: Seven hundred and fifty students were invited to evaluate the podcasts of which 142 responded to the email. One hundred and forty-two students were assigned podcasts, of whom 122 completed the podcast questionnaire (85.9%), with 20 students dropping out for unknown reasons. The majority of the students found the podcasts to be clear, of an appropriate length, targeted at the right academic level and providing a good method of learning. However, there were mixed views in relation to the preference of podcasts over conventional learning methods. The thematic analysis identified positive comments and areas of improvement for the podcasts. CONCLUSION: Podcasts conducted in an interview style with an engaging voice and images are thought to help maintain student engagement from their perspective. Further evaluation/research is required to help establish the correct depth and breadth of information to be included in podcasts.

Patient-targeted websites on overactive bladder: What are our patients reading?

AIMS: Patients often turn to the Internet for information on medical conditions. We sought to evaluate the quality and readability of highly visible websites on overactive bladder (OAB). METHODS: A survey of 42 consecutive patients attending outpatient urogynecology clinics was performed to identify the most commonly used Internet search engines and search terms for information on OAB. The three most commonly used search engines (Google, Bing, and Yahoo!) were then queried using the three most commonly used search terms. The first 20 relevant websites from each search were reviewed. After excluding duplicates, 35 websites were analyzed. Website quality of information on OAB was evaluated using the DISCERN score, JAMA benchmark criteria, and Health on the Net code (HONcode) accreditation status. Readability was assessed using the Simplified Measure of Gobbledygook (SMOG) and Dale-Chall indices. RESULTS: Websites were classified as advertisement/commercial (31%), health portal (29%), professional (26%), patient group (6%), and other (9%). The overall mean DISCERN score was 44 ± 18 (maximum possible score of 80). Three websites (9%) met all four JAMA benchmark criteria. Seventeen percent of websites provided adequate information on content authorship and contributions. Median SMOG and Dale-Chall indices were 9.9 (IQR 9.3-11.2) and 9.0 (IQR 8.1-9.4), respectively. Nine websites (26%) were HONcode certified. CONCLUSIONS: Popular websites on OAB are of low quality, written for a high school to college-level readership, and often lack adequate information to assess the potential for commercial bias. Patients should be cautioned that incomplete and potentially biased information on OAB is prevalent online.

Complete Mesh Infection Following Repeat Retropubic Tension-Free Vaginal Tape.

BACKGROUND: Midurethral slings are the most widely used surgical treatment for stress urinary incontinence. Complications include bladder injury, voiding dysfunction, mesh exposure/erosion, dyspareunia, and failure to correct the incontinence. Complete mesh infection is rare. CASE: A 48-year-old woman underwent a repeat retropubic tension-free vaginal tape (TVT) procedure for stress urinary incontinence. She presented eight weeks postoperatively with a tender suprapubic mass and urinary retention. A CT scan demonstrated thickening of the bladder wall and cystoscopy revealed severe inflammation with no intramural injury. The sling appeared to be infected and was removed vaginally. The patient's symptoms resolved following removal of the sling. CONCLUSION: Mesh infection following a midurethral sling procedure is rare. In suspected cases, cystoscopy should be performed to rule out bladder injury. Antibiotic therapy may be successful, but removal of the sling may be required for resolution of symptoms.

Management of CSF leak in base of skull fractures in adults.

AIMS: CSF leaks are not uncommon after a base of skull fracture. Currently there is no standardised algorithm for the investigation and management of post-traumatic CSF leaks. In this paper we aim to provide an evidence-based framework for managing post-traumatic CSF leaks. METHODS: We searched the English literature over the past 45 years using CINAHL, EMBASE and MEDLINE for the terms (1) post-traumatic CSF leaks or fistulas, and (2) basilar or base of skull fractures, but excluded papers on post-operative and non-traumatic CSF leaks, and papers on paediatric post- traumatic CSF leaks. RESULTS: The diagnosis of a base of skull fracture and any resultant CSF leak can be challenging. Therefore a combination of biochemical and radiological studies are needed to optimise the diagnosis of this condition. Post-traumatic CSF leaks are generally treated conservatively, and a majority of them resolve without further surgical management. However for patients who are refractory to such treatments, surgical closure of the CSF fistula is necessary. Surgical obliteration of CSF leaks can be challenging and requires the involvement of multiple surgical specialties such as neurosurgery, otolaryngology, and maxillofacial surgery. CONCLUSION: Although we have formulated a simple algorithm to aid the investigation and management of post-traumatic CSF leaks, there are still many important unresolved questions requiring further well powered studies to answer.

A comparison of teaching three common ear, nose, and throat conditions to medical students through video podcasts and written handouts: a pilot study.

BACKGROUND: This pilot study conducted at the Peninsula Medical School is one of very few studies to compare the use of video podcasts to traditional learning resources for medical students. METHODS: We developed written handouts and video podcasts for three common ear, nose, and throat conditions; epistaxis, otitis media, and tonsillitis. Forty-one second-year students were recruited via email. Students completed a 60-item true or false statement test written by the senior author (20 questions per subject). Students were subsequently randomized to podcast or handouts. Students were able to access their resource via their unique university login on the university homepage and were given 3 weeks to use their resource. They then completed the same 60-item test. RESULTS: Both podcasts and handouts demonstrated a statistically significant increase in student scores (podcasts mean increase in scores 4.7, P=0.004, 95% confidence interval =0.07). Handout mean increase in scores 5.3, P=0.015, 95% confidence interval =0.11). However, there was no significant difference (P=0.07) between the two, with the handout group scoring fractionally higher (podcasts average post-exposure score =37.3 vs handout 37.8) with a larger average improvement. A 5-point Likert scale questionnaire demonstrated that medical students enjoy using reusable learning objects such as podcasts and feel that they should be used more in their curriculum. CONCLUSION: Podcasts are as good as traditional handouts in teaching second-year medical students three core ear, nose, and throat conditions and enhance their learning experience.