Supporting Direct Breastfeeding in a Tracheostomy-Dependent Neonate: A Case Report

Objectives: There are numerous well-described benefits to breastfeeding to both infant and mother. Even in healthy children with an uncomplicated perinatal course, there may be significant struggles maintaining a breastfeeding relationship. Infants with a complicated clinical course have been shown to benefit even more from the provision of breastmilk, however they are seldom encouraged to feed directly at the breast. There are no reports of successful direct breastfeeding in an infant with a tracheostomy. Methods and Results: We present the case of a breastfeeding dyad including a trach-dependent infant with congenital idiopathic bilateral vocal fold immobility who successfully initiated and maintained an inclusive breastfeeding relationship. Conclusion: This case illustrates that successful direct breastfeeding can be achieved in an infant with a tracheostomy. If a patient is felt to be capable of oral feeding via bottle, there is no reason that there should not be a trial of direct feeding at the breast, for the benefit of both members of the breastfeeding dyad

STEM Inqueery: How Belonging in STEM Might Differ Depending on LGBTQ Identities and Identity Openness

Science, technology, engineering, and mathematics (STEM) studies have investigated gender (women versus men; Kim et al., 2018), race (Latinx and Black; Unfried et al., 2015), and culture differences (Asian versus American; Brown et al., 2018); however, few studies have looked at the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community (Stout & Wright, 2016). STEM has been stereotyped as a cis (same gender as birth) straight male field (Miller et al., 2020); STEM is viewed as an agentic (self-focused, achievement-oriented) field and lacking communal (other-oriented) opportunities (Diekman et al., 2010). When communal opportunities are integrated into fields that are stereotyped as being noncommunal, STEM interest is boosted (Brown et al., 2018). This raises the question: what happens to LGBTQ individuals in STEM? LGBTQ individuals may feel less open or out about their LGBTQ identity in a STEM field when it is more male-dominated (Yoder & Mattheis, 2016). Further, LGBQ students are less likely to stay in STEM compared to non-LGBQ students (Hughes, 2018); transgender students presenting feminine within STEM are not respected as much by their peers compared to other students (Kersey, 2018). This study will explore whether LGBTQ individuals’ desire for communal opportunities within STEM careers shapes their motivation to pursue STEM, their expectations for success in STEM, and their feelings of belonging in STEM. We hypothesize that LGBTQ individuals with low-openness about their LGBTQ identity will have less motivation, expectations for success, and feelings of belonging in STEM than LGBTQ individuals with high-openness and non-LGBTQ individuals

Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management

Background: Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis. Methods: Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region. Results: Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement. Conclusions: Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered

Chronic sclerosing osteomyelitis of the mandible treated with hemimandibulectomy and fibular free flap reconstruction

Primary chronic osteomyelitis of the mandible is a rare condition that presents with a long-standing chronic facial swelling over the mandible, pain with mastication, and trismus. With no clinically appreciated acute phase, the aetiology often remains unknown. Many patients achieve adequate symptom control with broad-spectrum antibiotics, hyperbaric oxygen therapy and surgical debridement, or decortication of bone sequestration. However, because of the rarity of primary chronic osteomyelitis and the extensive involvement of the mandible that can result, we present a case of a 32-year-old woman with chronic disease of the left mandible requiring a left hemimandibulectomy and fibular free flap reconstruction. Few such cases have been reported in the literature, which require such extensive resection and reconstruction to control long-standing symptoms

Changes to the practice of pediatric otolaryngology as a consequence of the COVID-19 pandemic

Background: The COVID-19 pandemic has shifted medical practice globally. The objective of this study was to examine the changes to the practice of pediatric otolaryngology internationally due to the COVID-19 pandemic and examine potential contributors. Method: An online survey was designed to assess practice demographics, patterns of COVID-19 related restrictions in communities, and changes to practice and referrals. This was disseminated via an international Covid-19 WhatsApp™ group of pediatric otolaryngologists. Results: There were 45 respondents of 177 group members (25.4%) from 15 countries. The mean estimated time spent under strictest lockdown measures was 16.2 (±10.7) weeks (range: 1–45 weeks). Operating room time was reduced for 82.9%, with an average reported reduction of 41.5%. Almost all (\u3e75%) of respondents reported reduced referrals for five common conditions: otitis media with effusion (average reported decrease – 56.1%); acute otitis media (average decrease 62.8%); acute mastoiditis (average decrease 66.6%); recurrent pharyngotonsillitis (average decrease 51.0%); and peritonsillar abscess (average decrease 52.1%). COVID-19 cases per million population significantly influenced the acuity of referrals received (p \u3c.05). No conditions were reported as increased in frequency and the acuity of most conditions was reported as unchanged by the majority of respondents. Conclusion: The measures taken to reduce the spread of COVID-19 have resulted in many changes to pediatric otolaryngology practice and the referral patterns of common conditions. Some of these changes may have enduring sequelae

Papillary thyroid cancer recurrence 43 Years following Total Thyroidectomy and radioactive iodine ablation: A case report

Background: Recurrent papillary thyroid carcinoma (PTC) beyond the first two decades of definitive treatment (i.e. total thyroidectomy and radioactive iodine ablation) is a rare occurrence. Case presentation: We present a case of a 71-year old Caucasian female with a distant history of PTC treated with total thyroidectomy and radioactive iodine ablation who experienced recurrence of her disease 43 years following initial diagnosis and definitive treatment. She presented with palpable left-sided neck mass and subsequently underwent a level II, III, neck dissection and adjuvant iodine ablation. This case presents the latest recurrence in papillary thyroid cancer documented to date in the literature. Conclusion: This case exemplifies the need for the head and neck surgeon, radiation oncologist, general practitioner and radiologist to consider new lateral neck mass as late-presenting recurrence of PTC until proven otherwise regardless of low recurrence rates beyond two decades from treatment and low prognostic risk scores

Mapping Emotional Attachment as a Measure of Sense of Place to Identify Coastal Restoration Priority Areas

Our applied case study demonstrates how knowledge from community stakeholders about emotional attachment (as a key component of sense of place) can inform and influence future coastal restoration priorities at various scales in the Indian River Lagoon, Florida (USA). We map aggregate measures of emotional attachment from community stakeholders using Geographic Information Systems. We then analyze this human systems level data with kernel density estimation measures at the broader lagoon scale and with inverse distance weighted measures at more localized scales. By connecting these mapped results back to the primary reasons that participants provided for having high or low emotional attachment in a location, we show how varying spatial patterns of emotional attachment as a primary component of sense of place within and across broader geographic regions can be represented, mapped, and visualized to enhance future restoration priorities. We demonstrate how aggregate results gained from community stakeholders can help restoration teams prioritize their science communication and education strategies to align human systems level data with natural systems level data

Experiences of Kenyan Healthcare Workers Providing Services to Men Who Have Sex With Men: Qualitative Findings from a Sensitivity Training Programme

Introduction Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities. Results Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology

Serum microRNA profiling to distinguish papillary thyroid cancer from benign thyroid masses

Objectives: Papillary thyroid cancer (PTC) is increasing in incidence. Fine needle aspiration is the gold standard for diagnosis, but results can be indeterminate. Identifying tissue and serum biomarkers, like microRNA, is therefore desirable. We sought to identify miRNA that is differentially expressed in the serum of patients with PTC. Methods: Serum miRNA was quantified in 31 female thyroidectomy patients: 13 with benign disease and 18 with PTC. qPCR results were compared for significant fold-changes in 175 miRNAs, against a pooled control. Results: 128 miRNA qualified for analysis. There were identifiable fold-changes in miRNA levels between benign and control, and between PTC and control. There were statistically significant fold changes in the level of four miRNAs between benign and PTC: hsa-miR-146a-5p and hsa-miR-199b-3p were down-regulated, while hsa-let7b-5p and hsa-miR-10a-5p were up-regulated. Conclusions: MicroRNA is differentially expressed in the serum of patients with PTC. Serum miRNA has the potential to aid in thyroid cancer diagnosis

Serum microRNA profiling to distinguish papillary thyroid cancer from benign thyroid masses

Objectives: Papillary thyroid cancer (PTC) is increasing in incidence. Fine needle aspiration is the gold standard for diagnosis, but results can be indeterminate. Identifying tissue and serum biomarkers, like microRNA, is therefore desirable. We sought to identify miRNA that is differentially expressed in the serum of patients with PTC. Methods: Serum miRNA was quantified in 31 female thyroidectomy patients: 13 with benign disease and 18 with PTC. qPCR results were compared for significant fold-changes in 175 miRNAs, against a pooled control. Results: 128 miRNA qualified for analysis. There were identifiable fold-changes in miRNA levels between benign and control, and between PTC and control. There were statistically significant fold changes in the level of four miRNAs between benign and PTC: hsa-miR-146a-5p and hsa-miR-199b-3p were down-regulated, while hsa-let7b-5p and hsa-miR-10a-5p were up-regulated. Conclusions: MicroRNA is differentially expressed in the serum of patients with PTC. Serum miRNA has the potential to aid in thyroid cancer diagnosis