Removal of an Impacted Foreign Body from The Upper Airway with a Gastroscope in a Tertiary Hospital in South-West Nigeria – A Case Report

Foreign body ingestion and food bolus impaction are encountered commonly in clinical practice and are a common endoscopic emergency. A wide variety of objects could be ingested which could get impacted, and the site of impaction is commonly the oesophagus but can also be the airway depending on the nature of the substance ingested, the age of the patient and the presence of a neurologic disorder. The predominant clinical features of a patient will depend on the site of impaction of the foreign body; the airway or the oesophagus. Endoscopy remains the gold standard for the diagnosis and management of foreign body ingestion of which there are different modalities and equipment types. For foreign body in the airway laryngoscopy, tracheoscopy and bronchoscopy are the modalities indicated and there are also different types of retrieval devices some of which include standard biopsy forceps, retrieval graspers, retrieval forceps and polypectomy snares. The management of foreign body ingestion cuts across different specialties including Pulmonology, Otorhinolaryngology, General surgery, Cardiothoracic surgery and Gastroenterology all of which are involved in various different endoscopic procedures and their endoscopy equipment have a lot of similarities and in certain instances they can be adapted to perform varying roles. Foreign bodies in the airway require urgent endoscopic removal because it can become rapidly life threatening with associated high morbidity and mortality, therefore the available equipment should be immediately deployed to save lives. We present a case of foreign body impaction in the upper airway (larynx) that was removed with a flexible video Gastroscope using a polypectomy snare

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways