Virus-Induced Cancers of the Skin and Mucosa:Are We Dealing with "Smoking Guns" or "Smoke and Mirrors" in the Operating Theatre?

Introduction: Human papillomavirus (HPV) alone is thought to cause ~610,000 cases of cancer per year, and is the dominant aetiological agent for ano-genital (esp. cervical) and head and neck cancers (esp. oropharyngeal). Merkel cell polyomavirus (MCV) is a more recently discovered virus which causes Merkel cell carcinoma, a rare but highly aggressive skin malignancy. Methods: We explored the available published evidence to see if transmission of live HPV or MCV virus in smoke generated by laser or diathermy was feasible, and would pose an infection risk. Long-term infection with such carcinogenic viruses would then pose an increased risk for the development of virus-induced cancers in medical personnel. Results: The morphological structures of both HPV and MCV are very similar, and the size, external capsids and genomic structures show striking similarity. Both viruses have a non-enveloped external protein capsid consisting of 72 capsomeres, and a double-stranded DNA core. Sizes of both viruses range from 50 to 60 nm. There are now recent data demonstrating live and infectious HPV in smoke, and that these viruses can be used to infect cells in vitro. Further, anecdotal reports of virus transmission leading to disease causation in the production of respiratory airway viral warts (benign disease), and, finally, reports of HPV-induced oropharyngeal carcinoma (malignant disease) in two gynaecological surgeons as an occupational health hazard have been published recently. Conclusion: There is now sufficient evidence to support the hypotheses that live infectious carcinogenic viruses can be transmitted via smoke generated from surgical procedures, and, in rare instances, actually cause significant disease. Protective measures such as smoke extraction and airway protection should be instituted for all healthcare personnel, particularly those with multiple repeated exposures such as gynaecological surgeons

Education qualification levels and school careers of unilateral versus bilateral hearing aid users.

Contains fulltext : 51872.pdf (publisher's version ) (Closed access)OBJECTIVE: Analyse the difference in school careers and secondary school qualification levels between unilateral hearing aid users and bilateral hearing aid users. STUDY DESIGN: Retrospective questionnaire study. SETTING: Postal-based questionnaire. PARTICIPANTS: Names of adults known to have been fitted with unilateral or bilateral hearing aids during childhood were retrieved. This resulted in 292 names. Participants were selected using the following criteria: availability of the medical record, presence of bilateral hearing loss, completed secondary school education, normal IQ and a minimum aided word-recognition score of 70% at 10 years of age. The questionnaire was sent to 50 potential participants of whom 40 responded, resulting in two groups comprising 19 unilateral and 21 bilateral hearing aid users. METHODS: A questionnaire was developed to obtain data on secondary school levels and aspects of the school careers, such as type of schools attended (mainstream versus special), repeating a school year and additional assistance (speech and language therapy, personal frequency modulation systems). MAIN OUTCOME MEASURES: Comparison of the benefit of bilateral hearing aid fitting versus unilateral hearing aid fitting on secondary school qualification level, type of school the children attended, class failure and additional assistance used. RESULTS: The group of bilaterally fitted hearing aid users eventually completed secondary school at a superior level than the unilaterally fitted users. 33% of binaural hearing aid users achieved qualifications giving access to a bachelors degree compared with 21% of unilateral users. There were no differences between those fitted with unilateral and bilateral hearing aids in the type of schools attended, repeating a school year and additional assistance. CONCLUSIONS: The bilateral hearing aid users obtained superior secondary school qualifications than the unilateral users but their school careers were comparable

Audiometria de alta freqüência: estudo com indivíduos audiologicamente normais High-frequency audiometry: study with normal audiological subjects

Pesquisas recentes apontam a Audiometria Tonal de Alta Freqüência (AT-AF) como um instrumento para o diagnóstico precoce de danos auditivos decorrentes de alguns agentes etiológicos principais, como envelhecimento e exposição a drogas ototóxicas e a intensidades elevadas de ruído. OBJETIVO: Apesar de já existirem várias técnicas desenvolvidas para essa avaliação, algumas não se aplicam à rotina clínica, em função da falta de praticidade e, por vezes, falta de consistência nos resultados. Segundo a literatura, ainda estão por emergir uma metodologia adequada a tal avaliação e valores indicados como referência à normalidade. Forma de Estudo: Clínico prospectivo. MATERIAL E MÉTODO: A presente pesquisa observou o comportamento dos limiares auditivos de alta freqüência em indivíduos jovens e audiologicamente normais e analisou variabilidades acústicas, inter e intra-indivíduos, que de acordo com a literatura, podem interferir na estabilidade dos resultados. CONCLUSÃO: Com os dados obtidos, pôde-se estabelecer valores de média, desvio padrão e mediana, além de valores mínimos e máximos para cada freqüência. Os testes estatísticos não identificaram diferenças significantes na maioria das análises realizadas (entre sexo, interaurais, variabilidades acústicas e intra-indivíduos, no mesmo dia de testes). A variabilidade dos resultados entre os exames de um mesmo indivíduo, realizados em dias deferentes de testes, mostrou ser significante, sendo as médias dos limiares no segundo dia sempre melhores que as do primeiro dia.<br>Recent research studies pointed to High-Frequency Audiometry (HFA) as a tool for early diagnosis of hearing impairment caused by the main etiological agents, such as aging, exposure to ototoxic drugs, and occupational noise. AIM: Although there are already several techniques developed for this assessment, some of them should not be applied to clinical routine, because of their lack of practicability and, sometimes, lack of reliable results. According to the literature, a suitable methodology for such assessment, as well as values indicated as normal reference, are still needed. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: The present research study observed auditory thresholds in young and audiologically normal individual with HFA and assessed some variables that could have an influence upon the results. CONCLUSION: Based on the collected data, we were able to established values for mean, standard deviation and median, besides minimum and maximum values for each frequency, for the entire population. Statistical analyses did not identify significant differences between gender and the ears. Moreover, questions related to inter-and intra-individual variability are discussed