Liposomal Bupivacaine Suspension Can Reduce the Length of Stay of Patients Undergoing Open Reduction and Internal Fixation of Mandibular Fracture.

BACKGROUND: Poorly controlled postoperative pain results in prolonged length of stay (LOS). The use of liposome bupivacaine injectable suspension (LB) for postoperative pain control is a relatively recent practice. PURPOSE: The purpose of this study was to investigate the following. In patients undergoing open reduction and internal fixation of mandibular fracture(s), does the use of LB reduce LOS compared with regular bupivacaine? STUDY DESIGN, SETTING, SAMPLE: We implemented a retrospective cohort study of consecutive patients with mandibular fracture(s) presented to Grady Memorial Hospital in Atlanta, GA, from January 2021 to January 2022. Adult patients diagnosed with 1 or more isolated mandibular fracture(s) and treated by open reduction and internal fixation were included. We excluded patients with non-isolated mandibular fracture(s), isolated condyle, infected, previously treated fractures, and documented allergy to amide local anesthetics and/or its preservatives. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Primary predictor variable was local anesthetic (regular bupivacaine alone or LB/regular bupivacaine). MAIN OUTCOME VARIABLE(S): Primary outcome variable was LOS, defined as the number of days from surgical procedure until discharge. Secondary outcome variables were number of opioid prescription refill(s) and postoperative pain at discharge, determined with visual analogue scale. COVARIATES: The covariates were Demographics, American Society of Anesthesiologists classification, smoking, alcohol exposure, illicit drug use, etiology, location, laterality, number of fracture(s), surgical approach, and method of maxillomandibular fixation. ANALYSES: Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS: Sixty-two subjects met the inclusion criteria (31 subjects in each group). The mean ages in LB/regular bupivacaine and regular bupivacaine alone groups were 33.3 (±12) and 35.1 (±15.6), respectively (P = .94), the mean LOS in days was 0.23 (±0.44) in LB/regular bupivacaine and 1.48 (±1.77) in regular bupivacaine alone (P= < .001), and the mean VAS pain scores for LB/regular bupivacaine and regular bupivacaine alone groups were 0.53 (±1.07) and 1.87 (±2.66), respectively (P = .02). Mean number of opioid prescription refill(s) was 0 in LB/regular bupivacaine and 1 in regular bupivacaine alone group, respectively (P = .01). CONCLUSION AND RELEVANCE: The use of LB/regular bupivacaine for mandibular fracture(s) results in decrease in LOS and number of opioid refills compared to regular bupivacaine alone.

Does a Point-of-Care 3-Dimensional Printer Result in a Decreased Length of Surgery for Orbital Fractures?

BACKGROUND: Utilization of point-of-care 3-dimensional printing (3DP) has decreased length of surgery in facial trauma. Little is known regarding 3DP's impact on length of surgery in orbital fracture. PURPOSE: The purpose of this study was to compare length of surgery between 3DP/preadapted (3DPPA) orbital plates and intraoperative adapted plates (IOAP) for orbital fracture reconstruction. STUDY DESIGN, SETTING, SAMPLE: This was a prospective, non-blinded, randomized clinical study of consecutive subjects with orbital fractures presented to Grady Memorial Hospital in Atlanta, Georgia, between January 2018 and June 2021. Subjects ≥ 18 years, unilateral fracture, no previous orbital surgery, and/or congenital craniofacial anomaly were included. We excluded subjects <18 years and bilateral fractures. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Primary predictor variable was the treatment approach. Randomization software was used, and subjects were randomized to 3DPPA or IOAP groups. MAIN OUTCOME VARIABLE(S): Primary outcome variable was length of surgery in minutes. Secondary outcomes were the time required for plate insertion and fixation in minutes, operating room (OR) charges, and orbital volume (OV) calculation. COVARIATES: Age, sex, race, etiology, laterality, location, dimension, indication for surgery, postoperative enophthalmos, and diplopia. ANALYSES: Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS: Twenty-five subjects met the inclusion criteria. Mean ages in 3DPPA and conventional IOAP groups were 41.5 (±9) and 38.2 (±10, P = .31), respectively. The mean length of surgery was 32.6 (±13.7) in 3DPPA and 53.3 (±12.8, P < .001) in conventional IOAP. The mean time required for plate insertion and fixation was 15.8n (±14.4) in 3DPPA and 41.4 (±9.4, P < .001) in conventional IOAP. The mean OR charges were $1,072.5 (±524.6) in 3DPPA and $1,757.3 (±422.6, P ≤ 0.001) in conventional IOAP. The mean calculated OV of uninjured and reconstructed orbit for the 3DPPA was 23.5 (±3.2)cm3 and 23 (±3.5, P = .37)cm3, respectively. The mean calculated OV of uninjured and reconstructed orbit for conventional IOAP was 28.6 (±3.6)cm3 and 22.8 (±2.6, P < .001)cm3, respectively. CONCLUSION AND RELEVANCE: Using 3DP to produce a model that enables preoperative plate bending/adaptation reduces the length of surgery, decreases OR charges, and results in predictable OV.

Are Deep Odontogenic Infections Associated With an Increased Risk for Sepsis?

BACKGROUND: Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure. PURPOSE: The purpose of the study was to measure the association between OI location and risk for sepsis at admission. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample. PREDICTOR VARIABLE: The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral. MAIN OUTCOME VARIABLES: The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis. COVARIATES: Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay. ANALYSES: Descriptive and bivariate analyses were performed. A χ2 test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05. RESULTS: The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001). CONCLUSION AND RELEVANCE: The study findings suggest that the OI location is associated with the qSOFA score >0.

Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck.

PURPOSE: Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. METHODS: This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P < .05. RESULTS: Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI = 32.2; SFI = 42.2; P ≤ .001) and/or Black patients (AFI: n = 483, 86.3%; SFI: n = 40, 29.9%; P ≤ .001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range = 3.7 to 99.7; SFI: 54.4, range = 2.8 to 98; P ≤ .001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range = 3 to 15; SFI: 5.5, range = 3 to 15; P ≤ .001), and/or required tracheostomy (AFI: n = 56, 10%; SFI: n = 27, 20.1%; P = .005). CONCLUSIONS: Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.

Management of MACROGLOSSIA: Case Series and Suggested Algorithm.

PURPOSE: Idiopathic macroglossia is a rare entity of true tongue enlargement without an underlying etiology. There are only a few case reports on the diagnosis and management of idiopathic macroglossia. This study's purpose was to present a series of patients with idiopathic macroglossia and suggest a treatment algorithm. METHODS: This was a retrospective case series of a cohort of patients with macroglossia who were treated by the Oral and Maxillofacial Surgery service at the University of Texas Health Science Center at Houston (UTHealth)and Emory University. The patient's medical comorbidities, history of present illness, clinical presentation, radiographic findings, and disease management were studied. The outcome variables include normalization of the tongue size, dependence on parenteral nutrition, and tolerating tracheostomy decannulation. RESULTS: Five patients with a mean age of 45 years were included in the study. All of the patients (n = 5, 100%) in our cohort developed macroglossia following prolonged oral intubation, with 3.5 weeks being the average length of intubation. All patients presented with difficulty feeding orally and breathing. The average tongue dimension was 12.20 x 6.25 cm. All tongue enlargements were located in the anterior 2/3 of the tongue, and all patients had displaced anterior dentition. In addition, 60% of the patients (n = 3) experienced altered tongue sensation (pain and/or decreased taste). These patients were surgically managed with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement followed by partial glossectomy (n = 5, 100%). We defined successful outcomes as 1) modifying the tongue to a functional, nonprotruding form, 2) tracheostomy decannulation and 3) PEG tube removal. Tracheostomy decannulation and PEG tube removal were achieved in 80% of the patients (n = 4). CONCLUSIONS: In this patient cohort, we were unable to identify the cause of the pathology based on existing clinical data. When the etiology is unclear or irreversible, management should involve tracheostomy and surgical feeding access for the initial stabilization, followed by modified glossectomy to improve form, function, and cosmesis thereby improving the overall quality of life.

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

PURPOSE: There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS: This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS: A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION: ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

Do Gender Differences Exist Among Victims of Head and Neck Injuries due to Intimate Partner Violence?

PURPOSE: The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study was to characterize and compare patterns of IPV-related head and neck injuries between men and women. MATERIALS AND METHODS: This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS: One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 [39.2%] vs 7 [19.4%]; P = .03), positive alcohol exposure (27 [22.5%] vs 19 [52.8%]; P = .0001), positive illicit drugs toxicology screen (25 [20.8%] vs 13 [36.1%]; P < .02), report physical abuse (24 [20%] vs 0; P = .004), have subarachnoid hemorrhage (14 [11.7%] vs 0; P = .04), and/or lower extremity injuries (39 [32.5%] vs 5 [13.9%]; P = .03). CONCLUSION: Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males.

Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck?

BACKGROUND: In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE: The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE: This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S): The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES: Patient, injury, and hospital-related covariates were collected. ANALYSES: Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS: Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE: HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.

The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

INTRODUCTION: The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. MATERIALS AND METHODS: This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. RESULTS: Eight patients (mean age 55.8 y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9 cm 2 (range 17-85 cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90 d). CONCLUSION: Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

Do Racial Differences in Orbital Volume Influence the Reconstruction of Orbital Trauma.

PURPOSE: Successful orbital reconstruction relies on an accurate restoration of orbital volume (OV). The purpose of this study was to determine if the OV of African American (AA) subjects differs from that of Caucasian subjects. METHODS: The authors implemented a retrospective observational study of successive subjects who received a maxillofacial computed tomography (CT) scan at a level I trauma center between 2017 and 2020. The primary predictor variable was race (AA/Caucasian). The primary outcome variable was orbital volume. Two independent examiners calculated OV with an open access OsiriX MD software version 10.0.5 (Pixmeo, Switzerland). Inter-rater reliability was calculated. Differences between races, genders, and sides were tested using independent samples t test with a significance of P < .05. RESULTS: Sixty subjects (120 orbits) were included in the study. The mean age was 36.7 (SD ± 13.2) years with a range of 22 to 78 years. Gender distribution was equal with 30 male (50%) and 30 female (50%) subjects. Inter-examiner reliability was 0.973. The mean OV of AA and Caucasians was 22.38 and 23.23 cm3, respectively (P = .07). The mean OV of AA and Caucasian males was 23.92, and 24.17cm3, respectively (P = .71). The mean OV in AA and Caucasian females was 20.84 and 22.28cm3, respectively (P = .013). CONCLUSIONS: African-American female subjects appear to have a smaller OV when compared with Caucasians which may influence orbital reconstruction. Laterality does not appear to be associated with any differences in OV.

How Accurate Are Surgeons at Calculating Orbital Volumes?

PURPOSE: Bilateral orbital volume (OV) symmetry is imperative for successful orbital reconstruction to prevent complications such as enophthalmos, diplopia, and orbital dystopia. The purpose of this study was to determine the accuracy of surgeon-led in-house OV calculation for reconstructed orbits after orbital floor fracture. MATERIALS AND METHODS: This is a retrospective cross-sectional observational study of maxillofacial computed tomography scans for patients undergone orbital fracture repair by Emory Oral and Maxillofacial service at Grady Memorial Hospital (Atlanta, Georgia) from 2018 to 2020.The primary predictor variable was OV calculation approach (outsourced vs surgeon-led in-house approach). The primary outcome variable was OV. Secondary variables were age, gender, and race. Interobserver reliability was calculated with a 2-way mixed-effects model, intraclass correlation coefficients, 95% confidence intervals, and P values. Differences between OV (in-house and outsourced) were calculated using student t-test. Statistical significance was determined at P < .05. RESULTS: During the study period, 172 patients sustained orbital floor fracture. Of them, 49 patients (31 male, 18 females; 98 orbits) with the mean age of 41.3 years (range, 19 to 89 years) met inclusion criteria. Subjects with incomplete medical records and inadequate computed tomography scans were excluded from the study. The racial distribution in descending order was 87.8% African American, 8.2% Caucasian, 2% Hispanic, and 2% Asian. There was excellent inter-rater reliability for calculating uninjured OV (OV-U, P < .0001) and reconstructed OV (OV-R, P < .0001). The mean OV difference of outsourced approach was 0.8 cm3and for surgeon-led in-house approach was 0.07 cm3. There was no significant difference in OV difference between outsourced and in-house approach (P = .16). CONCLUSIONS: In conclusion, using open-source 3-dimensional imaging software is a reliable and a predictable method at calculating reconstructed OV in patients who underwent open reduction and internal fixation of orbital fractures. By having this software in our personal computers and laptops, one can easily calculate OVs in an efficient manner.

Synergistic inhibition of Pseudomonas fluorescens growth and proteases activities via sodium chlorite-based oxyhalogen.

Pseudomonas fluorescens is considered among the main spoilage microorganisms due to its ability to produce proteases. Food deterioration caused by spoilage microorganisms has a major impact on food quality and the environment. The inactivation of Pseudomonas fluorescens growth and protease production was intensively investigated with the use of Salmide®, A Sodium Chlorite-Based Oxy-halogen Disinfectant. A unique M9 media was also developed to assure sufficient protease productions with different mutants of Pseudomonas fluorescens as a microbioreactor. Mutations were induced by classical whole-cell mutagenesis using N-methyl-N'- nitro-N-nitrosoguanidine (NTG). A dramatic decrease occurred in protease activity when different Salmide concentrations (5, 10, and 15 ppm) were added to the growth culture followed by a complete inhibition concentration (20, 25, 50, and 100 ppm) of Salmide. However, no significant inhibition occurred once it is secreted out of cells. Some mutants were resistant and remains highly stable with high protease production under stressful conditions of Sodium Chlorite-Based Oxy-halogen. The production of the protease showed a linear correlation with the increase in incubation time using a continuous culture bioreactor system and recorded maximum protease activity after 40 h. Our findings would offer alternative antimicrobial procedures for food and industrial sectors.

Consolidating food safety measures against COVID-19.

BACKGROUND: The world is facing an extraordinarily unprecedented threat from the COVID-19 pandemic triggered by the SARS-CoV-2 virus. Global life has turned upside down, and that several countries closed their borders, simultaneously with the blockage of life cycle as a result of the shutdown of the majority of workplaces except the food stores and some few industries. MAIN BODY: In this review, we are casting light on the nature of COVID-19 infection and spread, the persistence of SARS-CoV-2 virus in food products, and revealing the threats arising from the transmission of COVID-19 in food environment between stakeholders and even customers. Furthermore, we are exploring and identifying some practical aspects that must be followed to minimize infection and maintain a safe food environment. We also present and discuss some World Health Organization (WHO) guidelines-based regulations in food safety codes, destined to sustain the health safety of all professionals working in the food industry under this current pandemic. CONCLUSION: The information compiled in this manuscript is supporting and consolidating the safety attributes in food environment, for a prospective positive impact on consumer confidence in food safety and the citizens' public health in society. Some research is suggested on evaluating the use and potentiality of native and chemical modified basic proteins as possible practices aiming at protecting food from bacterial and viral contamination including COVID-19.

Diagnosis and Treatment of Lip Infections.

PURPOSE: Staphylococcus aureus is a gram-positive, facultative anaerobic, cocci bacterium that naturally colonizes the skin. S aureus can cause a mild to severe infection depending on the location, depth of invasion, and immune status. Guidelines regarding treatment of patients with lip infections are scant. The purpose of this study was to present the diagnosis, management, and outcome of a cohort of patients with lip infections caused by S aureus. MATERIALS AND METHODS: This was a retrospective cohort study of patients with a lip infection caused by S aureus treated by Emory Oral and Maxillofacial Surgery Service (Atlanta, GA). Predictor variables were patient demographic characteristics, clinical presentation, laboratory findings, imaging characteristics, intervention, and length of stay. The outcome variable was infection resolution or persistence. Data were collected using a standardized collection form. Descriptive statistics were computed. RESULTS: Seven patients (mean age, 38 years) with lip swelling met the inclusion criteria. The patients did not undergo recent hospitalization and/or recent surgery. Patients had immunodeficiency virus or other medical comorbidities. Radiographic findings were consistent with abscess formation. Management consisted of antibiotics only or surgical intervention with antibiotics. Lip cultures showed S aureus with methicillin-sensitive or -resistant S aureus. Treatment was intravenous followed by oral antibiotics. The average length of inpatient stay was 4 days. There were no postoperative complications. All lip infections achieved complete clinical resolution. CONCLUSIONS: In this cohort, treatment of lip swelling caused by S aureus required surgical intervention and/or antibiotics. Immune compromise and antibiotic resistance should be considered in a patient with a similar presentation.

Frequency of Firearm Injuries to Head and Neck Increased During Covid-19 Pandemic.

PURPOSE: During coronavirus disease-19 (COVID-19) pandemic, hospitals faced challenges which were different than previous years. The purpose this study was to report frequency of firearm injuries (FI) to head and neck during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study reviewed patients in the Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, GA. Patients were included if they sustained FI to head and neck, were listed in TR, and were treated at GMH. Patients were stratified according to date of injury into 1) before COVID-19 pandemic, (BC19) or 2) during initial 5 months of COVID-19 pandemic, (C19). Variables were patient demographics, illegal substance use, etiology, place of injury, distressed communities index, location of injury, Glasgow Coma scale on arrival, cardiopulmonary resuscitation in Emergency Department (ED), shock on admission, disposition from ED, length of stay, days on mechanical ventilation and discharge status. Descriptive, univariate, and bivariate analysis were completed. Chi square test was used for categorical variables. Statistical significance was P < .05. RESULTS: There were 215 patients who met inclusion criteria. There were 96 patients (78 males) with a mean age of 31.5 years old during BC19. There were 119 patients (101 males) with a mean age 32.7 years old during C19. There was a 10.4% increase in FI to head and neck during COVID-19. Our data showed that alcohol use was associated with FI during C19 (P≤ .0001). FI to base of skull occurred 34.5% more often during C19 (P = .002). Cranial injuries occurred 26% more often during BC19 (P = .03). During BC19, 85.4% of the patients arrived alive to GMH, but only 16% arrived alive during C19 (P ≤ .0001). CONCLUSIONS: There were more FI to head and neck during COVID-10 pandemic than during the previous time period.

Management of Post-Traumatic Maxillofacial Pseudoaneurysms: Review of the Literature and Suggested Algorithm.

A pseudoaneurysm (PA) is a collection of blood caused by an incomplete tear in the vessel wall. PA can be arterial or venous in origin. In the maxillofacial region, arterial PA can result from surgical interventions. Venous PAs in the maxillofacial region have never been described. A standardized protocol for management of post-traumatic PAs in the maxillofacial region would help clinicians make treatment decisions. On the basis of the available literature and our institutional experience, we present an algorithm for management of post-traumatic maxillofacial PAs. We also present patients from our institution who illustrate some of the management options in the algorithm.

Patterns of Craniomaxillofacial Trauma at an Urban Level I Trauma Center.

Background: There is a paucity in the literature concerning craniomaxillofacial trauma (CMF) in the USA. Better recognition of these fracture patterns and their management clarifies how to best evaluate and treat them. Methods: A retrospective chart review was conducted of CMF trauma patients who required surgical intervention at a level I trauma center between 2015 and 2018. Descriptive statistics and univariate and bivariate analyses were conducted (α = 0.05). Results: A total of 1001 patients were included. Most patients were Black (n = 665; 66%) and/or male individuals (n = 813; 57%) with an average age of 37 years (range 15 -110). The most common etiologies were assault (n = 471; 44%), motor vehicle collision (n = 238; 22%), and fall (n = 117; 11%). The mechanism of injury was a determinant of fracture type (P = 0.045). The most common CMF injuries were mandibular fracture (n = 953; 95%), maxillary fracture (n = 815; 81%), and orbital fracture (n = 206; 21%). Male sex predicted panfacial fractures (P = 0.045). Black patients experienced more severe CMF trauma compared with other races (P < 0.001). ORIF was the most common treatment for mandibular (n = 481; 73%) and maxillary (n = 62; 66%) fractures. Conclusions: Etiology and patterns of CMF trauma differ globally, with assault and motor vehicle collisions being the leading causative factors in our patient population. Patient demographics are relatively consistent worldwide, with most injuries occurring in 30- to 40-year-old men. This study offers insight into at-risk populations and guidance on their management.

Diversity, molecular phylogenetics, and antibiotic biosynthetic potential of endophytic Actinobacteria isolated from medicinal plants in Nigeria.

Actinobacteria that are found in nature have enormous promise for the growth of the pharmaceutical sector. There is a scarce report on the antimicrobial activities of endophytic Actinobacteria from Nigeria. As a result, this study evaluated the Actinobacteria isolated from Nigerian medicinal plants in terms of their biodiversity, phylogenetics, and ability to produce antimicrobial compounds. Following accepted practices, Actinobacteria were isolated from the surface-sterilized plant parts. They were identified using 16S rRNA sequencing, microscopic, and morphological methods. The cell-free broth of Actinobacteria isolates was subjected to antimicrobial assay by agar well diffusion. Molecular evolutionary and genetic analysis (MEGA) version X was used for phylogenetic analysis, and the interactive tree of life (iTOL) version 6.0 was used to view the neighbour-joining method-drawn tree. A total of 13 Actinobacteria were recovered, belonging to three genera including 10 strains of Streptomyces, 2 strains of Saccharomonospora, and only 1 strain of Saccharopolyspora. They showed inhibitory activity against several bacterial pathogens. The phylogenetic tree generated from the sequences showed that our isolates are divergent and distinct from other closely related strains on the database. Further, optimization of the antibiotic production by selected Saccharomonospora sp. PNSac2 was conducted. It showed that the optimal conditions were the ISP2 medium (1-2% w/v salt) adjusted to pH of 8 at 30-32℃ for 12-14 days. In conclusion, endophytic Actinobacteria dwelling in Nigerian soils could be a promising source of new antibiotics. Future research is warranted because more genomic analysis and characterization of their metabolites could lead to the development of new antibacterial medicines.