Airway stenting with the LT-Mold™ for severe glotto-subglottic stenosis or intractable aspiration: experience in 65 cases

The purpose of this study was to assess the safety and efficacy of stenting in upper airway reconstructions for benign laryngotracheal stenosis (LTS) with a newly designed prosthesis, the LT-Mold™. The LT-Mold and its proper use during open surgery and endoscopy are described, and the experience gathered from a prospectively collected database on 65 patients treated for complex LTS or severe aspiration is reported. This series is compared to the results of other stenting methods. All patients were available for evaluation. In all but one case, the prosthesis was removed at the end of the study. The new prosthesis did not induce any stent-related trauma to the supraglottis, glottis and subglottis. Before adding a distal round-shaped silicone cap to the LT-Mold, granulation tissue was usually seen at the stent-mucosal interface at the tracheostoma level. In 14 cases, there has been a spontaneous extrusion of the prosthesis through the mouth; this problem was solved by fixing the prosthesis through the reinforced portion of the prosthesis at the cap level and by adding one fixation stitch in the supraglottis. We have to document the loss of the silicone cap in three cases. This problem was resolved by designing a new prototype with an integrated cap, glued with a slow hardening silicone glue. Fifty-four (83%) of 65 patients were decannulated after a mean duration of stenting of 3months (range 1-12months). The mean follow-up after decannulation was 23months (range 1month to 10years). The experience gathered with the LT-Mold shows that long-term stenting for complex LTS is safely achieved when the prosthesis is used with its distal integrated silicone cap. The softness and smoothness of the prosthesis with a round-shaped configuration of both extremities help avoid ulceration and granulation tissue formation in the reconstructed airway. Adequate fixation is mandatory to avoid extrusio

Challenges and Opportunities in Community Nursing

Community health nursing is a comprehensive, holistic specialty. It is one of the ways through which the Health Department provides health care. Community health nursing not only focuses on the individual\u27s health needs, but the health of the collective population. By working with whole communities and the health care system, a community health nurse can greatly influence the health of a population. Community health nursing offers the nurse a unique opportunity to be involved with a changing area of health care. It is a rapidly evolving field. It is challenging, dynamic, and extremely rewarding. Because of changes in the health care system, shifts in disease patterns, a globalized world, and health disparities between populations, the role of the community nurse is more important than ever. As with any area of nursing, there are and will continue to be many challenges in this field. However, these challenges come with many opportunities. In the proceeding paper we will explore numerous facets of community health nursing, in addition to the aforementioned challenges and opportunities. We will begin with the history of community health nursing and how it came to be. We will also look at the definition of community, and the evolving roles of the community nurse. Then we will explore the various theoretical concepts common to the practice, including the social determinants of health, health promotion, and the epidemiological approach. Finally, we will focus on certain global issues in community health nursing, and the role of the WHO in the community

Laparoscopic Cholecystectomy (LC) and the Risk Factors in the Conversion to Open Cholecystectomy (OC) Surgery: Jordan Statistical Review

This study aimed at exploring the risk factors in the conversion from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) Surgery, and overview the Jordanian statistics for patients over the year 2016 in the Jordanian hospitals. Results show that male gender with symptomatic cholelithiasis was associated with higher conversion rates. And results also showed that the age (>65 years) to be a risk factor for increased perioperative morbidity and conversion rates because of associated acute cholecystitis. Laparoscopic cholecystectomy is a safe procedure in patients, with no increased risk of complications compared with the open procedure. The recovery is faster and the hospital stay, shorter

Effect of intake of food hydrocolloids of bacterial origin on the glycemic response in humans: Systematic review and narrative synthesis

Diabetes mellitus is a chronic condition characterized by increased blood glucose levels from dysfunctional carbohydrate metabolism. Dietary intervention can help to prevent and manage the disease. Food hydrocolloids have been shown to have favorable properties in relation to glycaemic regulation. However, the use of food hydrocolloids of bacterial origin to modulate glucose responses is much less explored than other types of hydrocolloids. We, therefore, carried out the first review examining the impact of intake of food hydrocolloids of bacterial origin (as a direct supplement or incorporated into foods) on glycemic response in humans. Fourteen studies met the inclusion criteria. They used either xanthan gum, pullulan, or dextran as interventions. There was a wide variation in the amount of hydrocolloid supplementation provided and methods of preparation. Postprandial blood glucose responses were reduced in half of the studies, particularly at higher intake levels and longer chain hydrocolloids. When xanthan gum was added to the cooking process of muffins and rice, a significant reduction in postprandial blood glucose was observed. The use of these hydrocolloids is potentially effective though more research is needed in this area

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Analyzing Arabic Translation Methods of English Similes: A Case Study of \u3cem\u3eThe Old Man and the Sea\u3c/em\u3e by Ernest Hemingway

Case study examining the methods of rendering simile in two Arabic translations of The Old Man and the Sea. Notes the difficulty of working with the novella’s textual ambiguity, which results in mistranslation and reliance on literal translation

Laser-Assisted Endoscopic Cricotracheal Stenosis Resection (CTSR) in Paediatric Congenital Cartilaginous Subglottic Stenosis

Subglottic stenosis (SGS) in children can be a congenital condition or acquired through injury such as from prolonged intubation. Surgeons face challenges in choosing the best SGS treatment for a particular patient because of variability in the success rate of each technique. Conventional open surgical resection and reconstruction have been proven effective but, in recent years, endoscopic surgery has become more prevalent as it eliminates the incision and reduces the surgery time and subsequent hospital stay. The purpose of this retrospective case study was to report on an endoscopic technique using a CO2 laser for cricotracheal stenosis resection (CTSR) for high-grade congenital SGS. From forty-five paediatric patients who underwent endoscopic intervention as a primary modality of treatment for high-grade SGS in a tertiary referral centre, a total of eight patients who met the inclusion criteria have been included in our study. This small patient series is the first to use a CO2 laser alone as a single excision tool to eliminate complex congenital SGS and restore airway patency. The procedure’s goal was to return the airway to an early stage of postintubation injury prior to scar formation; therefore, surgical sessions at intervals of 2–3 weeks were performed to ensure natural epithelization, to remove any granulation tissue, and manage fibrosis. Successful treatment was defined as a resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. The success rate was 75%. Two outcomes need to be highlighted. First, the CO2 laser should be reconsidered as an excision tool for congenital SGS because of its low risk of exacerbating preexisting stenosis. It allows the surgeon to restore and augment the airway without the need for open surgery or dilatation. Second, the shorter interval between procedures is crucial for controlling the healing process and making sure that it is proceeding properly

Lymphoepithelial carcinoma in the maxillary sinus: a case report

Abstract Introduction Lymphoepithelial carcinoma of the maxillary sinus is a very rare malignancy and it can be difficult to make a pre-operative diagnosis. Case presentation A 72-year-old Caucasian woman presented to our facility with an isolated right-side epistaxis that had been present for three months, with the results of a computed tomography scan showing a soft tissue mass in the right maxillary sinus with an impacted tooth. The results of a transnasal endoscopic biopsy were compatible with a lymphoepithelial carcinoma, following which our patient underwent a radical excision of the mass. The final histology results revealed lymphoepithelial carcinoma of the maxillary sinus with negative assays for Epstein-Barr virus. Our patient was given post-operative external radiotherapy and has remained disease-free at three-year follow-up. Conclusions This report details the diagnosis and management of a case of lymphoepithelial carcinoma of the maxillary sinus, which is a very rare malignant tumor with very little mention in the literature. Only a strong suspicion with systematic use of various patho-immunological tests helps to arrive at a definitive diagnosis by excluding other better-known tumors.</p