Is naso-pharyngeal swab always safe for SARS-CoV-2 testing? An unusual, accidental foreign body swallowing.

Long and sharp objects can be foreign body intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, localization in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms, or onset of complications. We present a case of a 47-year-old male with no known comorbidity, who accidentally swallowed a portion of a naso-pharyngeal swab half-broken during the second diagnostic test for SARS-CoV-2. The intact swab had a total length of 15 cm and was made of wood. The patient was asymptomatic, laboratory tests were normal, and neck-chest-abdominal X-ray and CT scan were negative for major complications. Upper gastrointestinal endoscopy was promptly performed to prevent the long sharp swab from crossing the pylorus leading to serious complications and, therefore, risk surgical intervention. The patient was intubated and the procedure was carried out under general anesthesia. In the gastric body, broken naso-pharyngeal swab was detected among the food debris, and using a latex rubber hood, the 7.5 cm foreign body was removed with a retrieval alligator-tooth forceps. Our hospital is located in a high-risk area of COVID-19 outbreak where many naso-pharyngeal swabs are performed, and to our knowledge, this is the first report of swab ingestion during SARS-CoV-2 test.

MRI scanning in patients with new and existing CapSureFix Novus 5076 pacemaker leads: randomized trial results.

BACKGROUND: Magnetic resonance imaging (MRI) can be safely performed in patients with magnetic resonance (MR)-conditional pacemaker systems but remains relatively contraindicated with non-MR-conditional pacemaker systems. OBJECTIVE: The purpose of this study was to evaluate the safety of MRI without positioning restrictions in patients with an MR-conditional pacemaker and currently a non-MR-conditional Medtronic CapSureFix Novus 5076 lead(s). METHODS: The study randomized 266 patients in a 2:1 ratio to the MRI group (177 patients) or to the control group (89 patients). At 9-12 weeks postimplant, the MRI group underwent MRI at 1.5 T. Primary end points were MRI-related complication-free rate and noninferiority of the MRI group compared to the control group with regard to the proportion of patients with an increase of ≤0.5 V in right atrial (RA) and right ventricular (RV) pacing capture thresholds from immediately before MRI to 1-month after MRI. RESULTS: No MRI-related complications occurred in 156 MRI-scanned patients who were followed through 1-month post-MRI. Differences in the proportion of patients with ≤0.5 V pacing capture threshold changes from pre-MRI to 1-month post-MRI were minimal between the groups for RA (proportions of 100% in both groups; a P value cannot be calculated) and RV leads (proportions of 99.3% in the MRI group and 100% in the control group; noninferiority test, P < .0001). Proportions of patients with acceptable sensing amplitude changes from pre-MRI to 1-month post-MRI were also similar between the 2 groups for RA and RV leads (noninferiority test, P < .0001 and P = .0004, respectively). No arrhythmias occurred during MRI. CONCLUSION: MRI scans can be performed safely without positioning restrictions in patients with Medtronic CapSureFix Novus 5076 leads connected to an MR-conditional pacemaker.

Diagnostic uses of metal detectors: a review.

Metal detectors have been used for diagnostic purposes since 1881. They have been utilised to localise a myriad of foreign objects including bullets, intraocular metallic fragments, swallowed coins and other foreign bodies and medical devices. Rapid detection of metallic objects may facilitate diagnosis or treatment. Metal detectors are diagnostically useful because of their low expense, lack of radiation exposure and ease of use. This article reviews the history of metal detection in the practice of medicine and provides an overview of the utility of metal detectors in current diagnostic practice.

Prevalencia de terapias inadecuadas con cardiodesfibriladores en la Clínica de Arritmias del Hospital México / Prevalence of inadequate therapies with cardiodesfibrillators of the Clínica de Arritmias of Hospital México

Introducción: Los cardiodesfibriladores implantables están indicados en los pacientes que han tenido paro cardiorrespiratorio y/o taquicardia ventricular/fibrilación ventricular. Las terapias que administran son estimulación antitaquicardia, cardioversión y desfibrilación y existen diversos métodos matemáticos mediante los cuales estos dispositivos pueden discriminar si una taquiarritmia es ventricular o supraventricular. Cuando hay errores en la discriminación, administran terapias en forma inadecuada con consecuencias negativas en la calidad de vida y la vida útil de la bateria. Metodología: El objetivo de este estudio es conocer la prevalencia de terapias inadecuadas en los pacientes portadores de cardiodesfibriladores implantables que se han controlado en la clínica de arritmias de nuestro centro en el período junio 2002 a julio 2004. Se interrogó por telemetría a todos los pacientes y se estableció si la terapia administrada por el dispositivo era adecuada en base a los electrogramas almacenados. Resultados: Se registraron 99 eventos almacenados en 16 pacientes. El número total de visitas a la clínica de marcapasos, fue 33 (2.05 visitas/paciente). De los 99 eventos registrados, se consideró 22 como inadecuados (22.22 por ciento); se excluye del análisis a un paciente con displasia arritmogénica del ventrículo derecho que tuvo 64 eventos adecuados el mismo día y otro con 17 cardioversiones el mismo día debidas a fibrilación atrial aguda, se obtiene una prevalencia de terapias inadecuadas del 45.45 por ciento. Conclusión: La prevalencia de terapias inadecuadas es relativamente frecuente y la más común en esta serie fue la fibrilación atrial interpretada como fibrilación ventricular debidas a errores en la discriminación. Palabras clave: cardiodesfibriladores, terapias inadecuadas

Intraoperative measurement of lumbar spine motion segment stiffness.

STUDY DESIGN: Prospective trial. OBJECTIVES: To test an intraoperative diagnostic tool to determine if it provided the surgeon with a safe, reproducible, accurate, quantitative measure of lumbar spine motion segment stability. SUMMARY OF BACKGROUND DATA: Several devices have been developed to measure motion segment stiffness, however, few have been tested intraoperatively on humans, and none, to the best of the authors' knowledge have been tested as extensively as the device described in this study. Objective criteria, such as those provided by an intraoperative gauge, can be helpful in determining when and what type of fusion of a degenerated spinal motion segment unit should be performed following decompressive surgery. METHODS: The spinal stiffness gauge, placed between spinous processes of adjacent vertebrae, applies a controlled, constant loading rate along the spine's longitudinal axis, producing a load-displacement curve from which stiffness, range of motion, and hysteresis can be computed. Measurements from this tool were then used to investigate differences in stiffness of the motion segment before and after decompressive surgery, between spine levels, and between male and female subjects. RESULTS: The spinal stiffness gauge stiffness measurements correlated with the surgeon's subjective stiffness measurements on the same motion segments. The stiffness measurements had excellent repeatability. Stiffness was dependent on the spine level, gender, and degree of disc degeneration. CONCLUSIONS: This study demonstrated the efficacy of the spinal stiffness gauge for providing an objective, quantitative, intraoperative stiffness (stability) measurement of the lumbar spine motion segment.