Is routine pathological examination required in South African children undergoing adenotonsillectomy?

Objective. We aimed to determine the incidence of abnormal pathological findings in the tonsils and/or adenoids of children undergoing tonsillectomy and/or adenoidectomy, and the incidence of tuberculosis of the tonsils and adenoids; suggest criteria to identify children at risk for adenotonsillar tuberculosis; and investigate the association between HIV and adenotonsillar abnormality, the cost-effectiveness of routine pathological examination of adenotonsillectomy specimens, and criteria to decide which specimens to send for histological examination. Methods. We undertook an 8-month prospective study on all children (≤12 years) undergoing consecutive tonsillectomy or adenotonsillectomy (T&A) at Red Cross War Memorial Children’s Hospital. Patients were assessed pre-operatively and tonsil sizes graded pre- and intra-operatively. Blood was taken for HIV testing, and all tonsils and adenoids were examined histologically. A cost-benefit analysis was done to determine the cost-effectiveness of adenotonsillectomy routine pathology. Results. A total of 344 tonsils were analysed from 172 children (102 boys, 70 girls); 1 patient had nasopharyngeal tuberculosis, and 1 lymphoma of the tonsils; 13 (7.6%) patients had clinically asymmetrically enlarged tonsils but no significant abnormal pathological finding. The average cost of detecting a clinically significant abnormality was R22 744 (R45 488 ÷ 2 abnormalities). Conclusions. The following criteria could improve cost-effectiveness of pathological examination of adenotonsillectomy specimens: positive tuberculosis contact at home, systemic symptoms of fever and weight loss, cervical lymphadenopathy >3 cm, suspicious nasopharyngeal appearance, HIV-positive patient, rapid tonsillar enlargement or significant tonsillar asymmetry. On our evidence, routine pathological investigation for South African children does not seem to be justified

Parotidectomy in Cape Town - a review of pathology and management

Background: The spectrum of parotid disease in southern Africa has not previously been reported. Methods: A review of all parotidectomies performed by a single surgeon over a period of 10 years (1994 - 2004) in Cape Town, South Africa, is presented. Data were collected from a retrospective chart review. Results: One hundred and ninety-nine parotidectomies were performed and 196 pathology reports were reviewed. Pleomorphic adenoma was the most common benign tumour and metastatic cutaneous squamous cell carcinoma (SCC) was the most common malignancy. Warthin's tumour had an equal gender distribution. Forty-five per cent of parotid tumours in males were malignant. The sensitivity, specificity and accuracy of fine-needle aspiration cytology (FNAC) in diagnosing malignancy were 73%, 98% and 94% respectively. Conclusions: In South African males almost half of parotid tumours are malignant. Warthin's tumours are less common in Africa than in the West, and did not show a male preponderance. FNAC is a highly reliable method of excluding malignancy

From riding to driving:The effects of the COVID-19 pandemic on public transit in Metro Vancouver

This study analyzed a panel-based dataset to understand the effect of COVID-19 on transport behavior in Metro Vancouver, Canada, between December 2020 and May 2021. Findings from the sample indicate a decline in transit users compared to pre-pandemic levels and an increase in car use. On the other hand, we saw a shift to a more positive perception of transit in May 2021, while also capturing an increase in perceived levels of crowding. The study underscores the necessity for transit agencies to focus on instilling the feeling of safety among the population, as the majority of those who have not used transit since the beginning of the pandemic reported their willingness to return only with widespread vaccination, community immunity, or other broad successful treatments

Is diagnostic tonsillectomy indicated in all children with asymmetrically enlarged tonsils?

Objectives. The aims of the study were: (i) to determine the necessity for diagnostic tonsillectomy in children with asymmetrically enlarged tonsils; (ii) to determine the accuracy of clinical assessment of tonsillar asymmetry; and (iii) to determine how to manage children with clinical tonsillar asymmetry in a developing-world practice. Methods. A prospective study was carried out at Red Cross War Memorial Children's Hospital in Cape Town, over an 8-month period. All children undergoing tonsillectomy or adenotonsillectomy had a clinical assessment of tonsil symmetry done, and all tonsil and adenoid specimens were examined histologically. The maximum diameter and volume of the resected tonsils were measured. A comparison was done of true tonsil asymmetry in patients with asymmetrical tonsils and a subgroup of matched controls with symmetrical tonsils. Results. A total of 344 tonsils were analysed (172 patients). The 13 patients (7.6%) diagnosed as having clinically asymmetrically enlarged tonsils had no significant pathological diagnosis. In the patients with symmetrical tonsils there were 2 abnormal pathological findings (tuberculosis of the adenoids and T-cell lymphoma of the tonsils and adenoids). In the clinically asymmetrical tonsil group, true tonsillar asymmetry was 3 mm (maximum diameter), and 2.2 cm3 (volume), compared with 1.9 mm and 1.5 cm3 in the symmetrical tonsil group. When patients with clinical tonsillar asymmetry and symmetry were compared, the difference in maximum diameter (p = 0.62) and volume (p = 0.73) was not significantly different. Conclusions. Clinical tonsillar asymmetry is usually apparent rather than real. The incidence of significant pathology in children with asymptomatic, asymmetrical tonsils is low. Diagnostic tonsillectomy is indicated in children with asymmetrically enlarged tonsils associated with constitutional symptoms, cervical lymphadenopathy, rapid tonsil enlargement or significant tonsillar asymmetry

Commuting to the future: Assessing the relationship between individuals’ usage of information and communications technology, personal attitudes, characteristics and mode choice

Innovations in transportation and communications technologies influence the development of cities and how people move through them. Since the widespread adoption of smartphones, mobility and information and communication technology (ICT) have become increasingly interconnected, and there may be a possibility for mobile technologies to nudge, or influence, individuals to travel using sustainable, and collective modes. It remains unclear whether social, financial, or ICT incentives would be effective to nudge the use of sustainable modes. The objective of the study is to understand the reasons affecting modal choices and how the use of ICTs and personal opinions and attitudes influence the decision-making process. A discrete choice model is used to consider five transportation alternatives including three single modes, namely bicycle, transit, and car, and two multimodal possibilities, bicycle and transit as well as park and ride (car and transit). The target population for this study are Utrecht University employees, who travel to a large university campus located in Utrecht, the Netherlands. The results of the person-based mode-choice model demonstrate that strong correlations exist between the kinds of mobile applications individuals use, their attitudes towards travel, their personal characteristics and their transportation mode. No mobile application seems to favor the use of active modes, which cast doubts upon the use of ICT to promote sustainable transportation. However, social incentives may play an important role for certain groups as individuals who are influenced by their friends, family, and colleagues, are less likely to travel by car or to use park & ride facilities