Tube Insertion Research Articles

Accuracy and costs of bedside methods for confirming nasoenteral feeding tube position: a diagnostic accuracy study.

To analyze the accuracy and costs of bedside methods for confirming the position of a nasoenteral feeding tube newly inserted blindly by nurses. Diagnostic accuracy study of three clinical methods (ultrasound, epigastric auscultation, and pH measurement) compared to radiography. The direct costs of each method used to confirm the positioning of the nasoenteral tube were also measured. Seventy-six adult patients underwent a total of 87 nasoenteral tube insertion procedures in hospital units located within the Northeast region of the State of São Paulo, Brazil. The clinical methods were conducted on all study participants in the specified sequence: ultrasound (as index test), followed by epigastric auscultation and pH measurement (also index tests). The outcomes regarding the confirmation of the accurate positioning of the nasoenteral tube are as follows: ultrasonography demonstrated sensitivity and specific of 79.0% and 66.7%, respectively. Epigastric auscultation exhibited a sensitivity of 81.3% and specificity of 83.3%. The pH measurement method displayed sensitivity and specificity of 89.3% and 100% respectively. Additionally, in terms of estimated direct costs, the pH measurement method incurred a higher cost (USD $8.31) compared to the other methods, with a difference of USD $6.68. Based on these results, X-ray examination remains the primary method for confirming the placement of nasoenteral tubes recently inserted blindly at the bedside. However, when considering the costs of the evaluated methods, it is advisable to consider the variations in expenses between non-radiological methods and X-ray examinations.

Efficacy of facilitated tucking position and Reiki given to preterm infants during orogastric tube insertion: A randomised controlled trial.

This research was conducted to evaluate the effects of Reiki and facilitated tucking position on pain, stress and physiologic parameters in preterm infants during orogastric tube (OGT) insertion. The study used a single-blind, parallel-group randomised controlled experimental design. It was carried out in the neonatal intensive care unit of a hospital in Niğde/Turkey between February 2022 and January 2023. A total of 45 preterm infants, who met the study criteria and whose sample size was determined according to power analysis, were randomly divided into three groups. As an intervention, the facilitated tucking position was applied to the first group, and Reiki was applied to the second group during OGT insertion. Routine application continued in the control group. The Infant Introductory Information Form, Physiological Parameter Follow-up Chart, Infant Stress Scale (ISS) and Premature Infant Pain Profile Scale-Revised (PIPP-R) were used for data collection. Significance was accepted as P < 0.05 in the statistical analysis. It was determined that the infants were homogeneously distributed between the experimental and control groups (P > 0.05). Infants who received the facilitated tucking position and Reiki intervention had better physiological stability compared to the control group (P < 0.05). The group with the lowest average stress (1.53 ± 0.99) and pain scores (4.06 ± 1.22) during OGT insertion was the facilitated tucking group (P < 0.001). After the procedure, stress and pain scores in both the facilitated tucking group and the Reiki group were found to be significantly lower than those in the control group (P < 0.001). The results of the study showed that the facilitated tucking position during OGT insertion was especially effective in reducing the pain and stress of infants. Both the facilitated tucking position and Reiki were determined to be effective interventions in reducing the pain and stress of infants more quickly after the procedure. The results of study contribute to the recommendation that NICU nurses should include non-pharmacological methods to decrease the pain of preterm infants during procedural pain.

Experience of preputiotomy performing in bull with acroposthitis and fibrous affect of penis’ S-shaped curve

The aim of this study was to perform a preputiotomy with the formation of an artificial opening in a breeding bull to realize his reproductive potential. Scientific and production research was conducted in the spring of 2024. In a 3.5-year-old Holstein breeding bull, kept at a breeding station for keeping breeding bulls, acroposthitis and fibrous lesion of the penis in the area of the S-shaped bend were detected due to the developed infectious process caused by Pseudomonas aeruginosa. The resulting pathology prevented the penis from fully extending beyond the preputial sac when collecting sperm for an artificial vagina (the last sperm collection was performed on 02/07/2024). The operation performed consisted of the following stages: insertion of a thick-walled tube into the preputial sac for better orientation in the tissues; making a V-shaped incision of all layers of the prepuce near its fornix; excision of the prepuce section necessary for free removal of the penis when collecting sperm; formation of an artificial opening by connecting the parietal preputial layer to the skin with an interrupted suture. The postoperative period included daily monitoring of the animal's condition, antibiotic therapy (amoxicillin (0.15 g), three injections every 48 hours), and the use of non-steroidal anti-inflammatory drugs (meloxicam (0.002 g), 3 days). A month after the operation, sperm was collected (06.05.2024, three months later) and the presence of all unconditioned reflexes was noted. At the same time, the copulatory reflex was full, painless and ended in ejaculation. The obtained volume of sperm after two mountings was 2.5 ml, the concentration was 1.3x108, the activity was 8 points. Thus, preputiotomy is an effective method for surgical correction of lesions of the preputial sac and adhesions in the area of the S-shaped bend of the penis in breeding bulls.

Normal saline injection and rapid rollover; preventive effect on incidence of pneumothorax after CT-guided lung biopsy: a retrospective cohort study

BackgroundComputed tomography (CT)-guided lung biopsy is a widely used technique for the diagnosis of pulmonary lesions and with a high technical success rate and diagnostic accuracy. On the other hand, it is associated with a high risk of complications, especially pneumothorax. Various methods have been tried to reduce the incidence of pneumothorax, but no established method exists. The purpose of this study was to evaluate whether the combination of tract sealing with normal saline and rapid rollover can reduce the rate of pneumothorax and chest tube insertion after CT-guided lung biopsy.MethodsWe reviewed all CT-guided lung biopsies performed at a single institution between October 2016 and December 2021. Before August 2019, no specific additional techniques were employed to mitigate complications (Group 1). In contrast, after September 2019, normal saline for tract sealing was injected during needle removal, and if pneumothorax was observed during the intervention, the patient was rolled over into the puncture-site down position immediately after needle removal (Group 2). The rate of complications was compared between the two groups.Results130 patients in Group 1 and 173 in Group 2 were evaluated. There was no significant difference in pneumothorax rate between the two groups (30.0% vs. 23.1%, P = .177). A chest tube was inserted in 10 of 130 patients in Group 1 and only in 1 of 173 in Group 2 (P = .001). There were no complications associated with this combinational technique.ConclusionsThe combination of normal saline injection and rapid rollover significantly reduced the incidence of pneumothorax requiring chest tube insertion after CT-guided lung biopsy. Therefore, normal saline injection and rapid rollover can serve as a preventive method for severe pneumothorax in CT-guided lung biopsy.

Transoral Laser or Robotic Surgery Outcomes for Oropharyngeal Carcinoma

Transoral robotic surgery (TORS) or transoral laser microsurgery (TLM) offer excellent oncological outcomes for oropharyngeal squamous cell carcinoma caused by human papillomavirus (HPV) infection. TORS may offer greater margin clearance around tumors than TLM. To determine whether the differing energy sources used and surgical technique of TORS or TLM is associated with postoperative early swallowing function, feeding tube use, and specific factors related to quality of life. This prespecified cohort study was performed within the Postoperative Adjuvant Treatment for HPV-Positive Tumours (PATHOS) randomized clinical trial at 40 centers in the UK, Germany, France, the US, and Australia between November 1, 2015, and August 31, 2023. PATHOS trial participants with HPV-positive oropharyngeal carcinoma of stages T1 to T3 and N0 to N2b M0 (TNM7) who underwent TLM or TORS were eligible. Of 989 consecutively recruited patients on the PATHOS trial, 508 were eligible for this substudy. The exposure of interest was TORS or TLM. Preplanned outcome measures included nasogastric tube insertion rates within 4 weeks after surgery, length of in-hospital stay following surgery, specific scales from the MD Anderson Dysphagia Inventory (MDADI), 35-item European Organization for Research and Treatment of Cancer Head and Neck Questionnaire (H&N35), and 30-item Quality of Life Questionnaire (QLQ C30), water swallow test results, and videofluoroscopy scores. Of the 508 patients included in the analysis (390 [76.8%] male; median age, 58.3 [IQR, 52.8-63.6] years), 195 had TLM and 313 had TORS. Nasogastric tube insertion rates were higher after TORS than TLM (85 of 189 [45.0%] vs 10 of 126 [7.9%]; adjusted odds ratio [OR], 4.41 [95% CI, 1.01-19.32]). Mean scores favored TLM with small effect sizes in all MDADI domains and the H&N35 swallowing item at 4 weeks after surgery; between-group difference for the MDADI composite score was -4.89 (95% CI, -8.27 to -1.50); for the MDADI physical functioning score, -6.37 (95% CI, -10.15 to -2.59); for the MDADI global score, -10.02 (95% CI, -16.50 to -3.54); and for H&N35 swallowing score, 7.24 (95% CI, 2.17-12.30). No other measures showed evidence of clinically meaningful differences. In this cohort study, functional outcomes were moderately less impaired 4 weeks following TLM compared with TORS. Once the longer-term outcomes for these patients are known, these findings could aid the design and use of future head and neck-specific surgical robots. ClinicalTrials.gov Identifier: NCT02215265.

Observations from opening of a novel geotextile tube connection in field test site

A novel connection configuration for geotextile tubes was proposed, involving the insertion of an auxiliary tube between two main tubes, to ensure proper alignment and leveling when connecting them in a series, thus consolidating individual tubes into a unified structure while maintaining a consistent horizontal level. The novel connection was implemented at a test bed site in the Saemangeum reclaimed area, South Korea, to test exposure to the marine environment including sea waves, sun light exposure and reclamation process. This study presents the observations made upon opening the connection tube after 8 years. The observation shows that the connected geotextile tubes using the proposed auxiliary tube are suitable for use in long-term reclamation projects.

The safety and efficacy of additional chest tube placement in patients with prolonged air leaks after pulmonary resection: a propensity score-matched analysis.

This study evaluates the symptomatic management of prolonged pleural air leaks following pulmonary resection, assesses the efficacy and safety of chest tube placement, and introduces experiences with high-positioned chest tube insertion. We retrospectively reviewed 84 patients with prolonged pleural air leaks after lung surgery at Ningbo No.2 Hospital from January 2022 to December 2023. These patients were divided into a conservative treatment group (Group A, n = 64) and a chest tube placement group (Group B, n = 20). The propensity score matching method was applied to balance confounders between the two groups, resulting in 12 matched pairs. The study compared the time to chest tube removal, average hospital stays time, postoperative drainage volume, and facial visual analog pain score between the two groups. The average hospital stays and chest tube removal time of patients in group B were significantly lower than those of patients in group A (8.00 ± 1.12 vs. 9.75 ± 1.60 days, P = 0.003, 6.92 ± 1.08 vs. 8.58 ± 1.67 days, P = 0.005, respectively). However, the mean facial visual analog pain score in group B was higher than that in group A (1.58 ± 0.58 vs. 1.00 ± 0.01, P = 0.020). There were no significant differences between the two groups in terms of postoperative drainage volume. For patients with prolonged air leaks, additional chest tube placement postoperatively significantly reduces both hospitals stay duration and chest tube indwelling time compared to conservative treatment. This method may be a potential treatment measure for prolonged air leak in selected patients.

Is the BioSentry Tract Sealant System Effective in Reducing the Pneumothorax Rate After CT-Guided Transthoracic Lung Biopsy With an 18G Biopsy Needle?

This study evaluated whether the BioSentry Tract Sealant System (BTS) (Merit Medical Systems, South Jordan, Utah) reduces pneumothorax rates in CT-guided lung biopsies (CTLB) using an 18G biopsy/17G introducer needle. A total of 272 patients underwent CTLB between January 2015 and February 2019 using a 17G/18G system. BTS was used in 125 patients, while no pleural sealant was used in 147. The variables assessed included pneumothorax on post-biopsy CT images or chest X-ray, chest tube insertion, lesion size, pleura-to-lesion distance, and the presence of emphysema. The two groups were compared using T-tests with a significance level of 0.05. In the BTS group, 23 subjects (18%) had a pneumothorax compared to 38 (26%) in the control group (p < 0.05). Four patients (17%) in the BTS group required a chest tube, compared to three patients (8%) in the control group (p = 0.28). The mean lesion size in patients with a pneumothorax was 1.62 cm in the BTS group and 2.44 cm in the control group (p = 0.27). The mean pleura-to-lesion distance in those with pneumothorax was 2.23 cm in the BTS group and 1.52 cm in the control group (p = 0.17). Emphysema was present in 47% of patients in the BTS group and 30% in the control group (p < 0.05). BTS reduced pneumothorax rates in CTLB patients using a 17G/18G system, despite a higher proportion of emphysema patients in the BTS group. No significant difference in the rate of chest tube insertion was observed with or without BTS, which contrasts with previous studies where 19G/20G biopsy systems were used.

Air under pressure: a case report on tension pneumomediastinum arising from traumatic injury

Abstract Background Tension pneumomediastinum (TPM) is a rare but critical condition characterized by the accumulation of air in the mediastinum, leading to increased intrathoracic pressure and cardiovascular compromise. This case report is novel due to the rarity of TPM arising from blunt chest trauma and the necessity for emergent surgical intervention after initial conservative management failed. Case presentation A 63-year-old male presented with severe chest pain and dyspnea following a high-impact motor vehicle collision. Initial assessment revealed tachypnea, tachycardia, and hypotension, along with extensive subcutaneous emphysema over the chest and neck. Imaging confirmed pneumomediastinum and bilateral pneumothoraxes, consistent with TPM. Despite initial management with high-flow oxygen and bilateral chest tube insertion, the patient’s condition deteriorated, necessitating emergent mediastinal decompression via an anterior subxiphoid incision. This intervention resulted in immediate hemodynamic improvement. Conclusions This case underscores the importance of recognizing TPM in patients with chest trauma and highlights the need for prompt surgical intervention in cases of hemodynamic instability. Early and accurate diagnosis and timely surgical management are crucial for improving patient outcomes in TPM.

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures

BackgroundCongenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.Case presentationA two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.ConclusionThis case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

Comparison of the Intrauterine Enabler Device Technique and Conventional Method for Inserting Copper 380 mm² Intrauterine Device: A Pilot Randomized Controlled Trial.

Background This pilot study compared the intrauterine enabler device technique with the conventional method for inserting the copper 380 mm² intrauterine device (Cu-IUD), focusing on the fundal placement achieved by both methods. Methods This randomized controlled trial compared the provider and client experiences as well as the technique for inserting the Cu-IUD using the intrauterine enabler device and the conventional no-touch technique. A total of 100 clients underwent Cu-IUD insertion: 50 participants (Group A) received the conventional no-touch technique, while 50 participants (Group B) were treated with the intrauterine enabler device. Results Pain experienced during sounding with the Esa (plastic sound provided with an inserter device) was significantly lower compared to the metallic sound (p < 0.0001). Providers in Group B reported that loading the arms of the Cu-IUD was easy 94% of the time, compared to only 26% in Group A (p < 0.0001). Setting the measurement of uterine depth on the inserter tube was achieved easily every time in Group B and 90% of the time in Group A (p = 0.054). The placement technique for the device was easy every time in Group B, while it was reported as easy 86% of the time in Group A (p = 0.012). Overhandling of the device was significantly easier with the intrauterine enabler (98%) compared to the conventional method (64%) (p < 0.0001). Additionally, the time taken for insertion was significantly shorter with the intrauterine enabler compared to the conventional method (p < 0.0001). Conclusions The insertion of the Cu-IUD using a novel intrauterine enabler device is as safe and effective as the conventional method. The overall experience of insertion is more comfortable for the provider and less painful for the client.

A Rare Case of Uvulitis Following Endotracheal Intubation Using C- Mac Videolaryngoscope and How To Avoid It

Uvular injuries are uncommon after general anesthesia and can result from direct trauma to the posterior part of the soft palate or compression and restriction of blood flow to the uvula caused by the inadvertent placement of the airway or suction devices in the oral cavity. There have been cases of inflammation and ulceration occurring in the midline oropharyngeal structures such as the uvula after general anesthesia with a tube or laryngeal mask airway, even in the absence of direct trauma or infection, presumably due to compression ischemia. While sore throat following general anesthesia is a common symptom, it is important to evaluate any severe or persistent pain to exclude uvulitis. Here we present a case of uvulitis that developed after the insertion of a flexometallic endotracheal tube using the midline technique during C-Mac video laryngoscopy. We also emphasize the measures that can be implemented to prevent such a complication. The entrapment of the uvula during intubation often goes unnoticed due to limited oral space after insertion of the video laryngoscope blade, with the intubating anesthetist staying focused on the monitor. This complication following the use of a C-Mac video laryngoscope has not been previously documented.

Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between combined lateral position with throat pack in situ and lateral position alone

Background: Although the proper placement of nasogastric tube (NGT) is usually a simple procedure, it may be challenging one in case of its placement in anesthetized intubated patients. At times, it may be tiresome even for the expert anesthesiologist. Different techniques have varying success rates. Many novel techniques are entering the avenue to be tested. Combinations of different techniques are showing improved success rates over individual techniques. Aims and Objectives: This interventional study primarily aimed at comparing the success rates of proper placement of NGT in the first attempt between the “combined lateral position with throat pack in situ” and “lateral position alone.” Materials and Methods: The present study was performed on 180 adults (≥18 years), posted for abdominal surgeries requiring NGT insertion. Patients received NGT placement using the “combined lateral position with throat pack in situ” technique (Group A, n=80) or lateral position alone (Group B, n=80). The proportion of patients in whom correct placement of NGT was possible in the first attempt using either of the techniques (primary outcome), the procedure time for successful placement of NGT, and the incidence of adverse events were compared between the groups. Results: Correct placement of NGT in the first attempt was possible in considerably higher proportions of patients using the combined technique over lateral position alone (87.5% vs. 68.75%, P=0.007). The procedure time was comparable in both groups (23.7±6.6 vs. 25.2±5.2, combined vs. lateral position alone, P=0.093). Coiling was found to be considerably reduced in the combined method compared with the “lateral position alone” (8.75% vs.17.5%, P=0.03). Conclusion: Combined lateral position with throat pack in situ technique can be a better alternative to “lateral position alone” for NGT insertion in anesthetized, intubated adult patients.

Efficacy and safety of radial probe endobronchial ultrasound-guided biopsy for peripheral lung lesions in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) is associated with frequent complications after transthoracic biopsy. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used to diagnose peripheral pulmonary lesions (PPLs). However, the efficacy and safety of this procedure for the diagnosis of PPLs in patients with COPD remain poorly understood. We investigated the usefulness of RP-EBUS-TBLB for diagnosing PPLs in patients with COPD. This retrospective observational study aimed to identify clinical outcomes of RP-EBUS-TBLB in patients with COPD. A total of 175 patients with COPD and 439 patients without COPD were included in this study. RP-EBUS-TBLB was performed without fluoroscopy using a guide sheath. The overall diagnostic accuracies in patients with COPD and without COPD were 80.6% (141/175) and 78.8% (346/439), respectively. There was no significant difference in the diagnostic yield based on the severity of airflow limitation (80.0%, 81.4%, and 79.2% for mild, moderate, and severe to very airflow limitations, respectively; P=0.97). In patients with COPD, diagnostic yields for malignant and benign lesions were 85.6% (95/111) and 71.9% (46/64). In multivariable analyses, larger lesion size [≥30 mm; odds ratio (OR), 2.86; 95% confidence interval (CI): 1.10-7.45; P=0.03] and within the lesion on EBUS image (OR 9.29; 95% CI: 3.79-22.79; P<0.001) were associated with diagnostic success in patients with COPD, whereas lesion location of upper lobe (OR, 0.36; 95% CI: 0.14-0.92; P=0.03) were associated with diagnostic failure. The overall complication rate in our study was 7.4% (13/175) in patients with COPD. Pneumothorax occurred in 4.6% (8/175), and chest tube insertion was needed in 1.7% (3/175) of the patients. RP-EBUS-TBLB can be used as an appropriate method to diagnose PPLs in patients with COPD. The size of the lesion (≥30 mm) and having the probe within the lesion were important for successful diagnosis. The location of the lesion in the upper lobe is associated with diagnostic failure. No difference was observed in the diagnostic yield based on the severity of airflow limitation. The complication rates were acceptable.

Assessing Chest Tube Insertion Skills Using a Porcine Rib Model-A Validity Study.

Assessments require sufficient validity evidence before their use. The Assessment for Competence in Chest Tube Insertion (ACTION) tool evaluates proficiency in chest tube insertion (CTI), combining a rating scale and an error checklist. The aim of this study was to collect validity evidence for the ACTION tool on a porcine rib model according to the Messick framework. A rib model, consisting of a porcine hemithorax that was placed in a wooden frame, was used as simulator. Participants were recruited from the departments of surgery, pulmonology, and emergency medicine. After familiarization with the rib model and the equipment, standardized instructions and clinical context were provided. They performed 2 CTIs while being scored with the ACTION tool. All performances were assessed live by 1 rater and by 3 blinded raters using video recordings. Generalizability-analysis was performed and mean scores and errors of both groups on the first performance were compared. A pass/fail score was established using the contrasting groups' method. Nine novice and 8 experienced participants completed the study. Generalizability coefficients where high for the rating scale (0.92) and the error checklist (0.87). In the first CTI, novices scored lower than the experienced group (38.1/68 vs. 47.1/68, P = 0.042), but no difference was observed on the error checklist. A pass/fail score of 44/68 was established. A solid validity argument for the ACTION tool's rating scale on a porcine rib model is presented, allowing formative and summative assessment of procedural skills during training before patient contact.

Outcomes of tracheal resection and anastomosis in patients with tracheal stenosis: a clinical perspective

BackgroundTracheal stenosis results from an altered inflammatory response to mucosal damage, which leads to impairment of breathing and can even be fatal if not treated promptly (Ind J Otolaryngol Head Neck Surg 73(4):447–454, 2020). ENT and head and neck surgeons face difficulties while treating tracheal stenosis. Mechanical stress from extended endotracheal intubation or tracheostomy, combined with hypoxic metabolic disturbances during an underlying event, is the most frequent cause of tracheal stenosis (Al-Azhar Int Med J 3(10):149-57, 2022). The main objective of the study is to assess the outcomes of tracheal resection and anastomosis in patients who presented with tracheal stenosis. This emphasizes the need for proper case selection and timely surgical intervention to relieve the airway obstruction and to ensure the effectiveness of tracheal resection and anastomosis as the less morbid approach by avoiding a midline sternotomy.The study was conducted in a tertiary care center on 25 patients who were admitted in ENT ward from the year 2011 to year 2021. Case records of those patients who underwent tracheal resection and anastomosis were analyzed on a retrospective basis. Detailed history taking and clinical examination with appropriate investigations like flexible bronchoscopy, computed tomography with 3-dimensional reconstruction, video laryngoscopy, direct laryngoscopy, and lung function tests were carried out for all the patients in the study as required. An evaluation of GERD was also done. Appropriate surgical procedure was done with regular post-operative follow-up for 18 months.ResultsIn our study, 92% of patients had satisfactory outcomes following tracheal resection and anastomosis, while some patients experienced minor complications. In 8% of patients, the primary surgery failed, among whom one patient underwent revision surgery and is doing well. The other patient with post-traumatic stenosis with a long stenotic segment underwent Shiann Yann Lee procedure in an outside center which resulted in failure following which T tube insertion was done. The patient showed improvement and was decannulated after a month.In our study of 25 patients with tracheal stenosis, postoperative complications occurred and were managed accordingly. However, there was no significant correlation between these complications and patient age, sex, extent of stenosis, preoperative Cotton-Myer grading, or the type of surgical procedure performed. This lack of correlation may be attributed to the limited sample size.ConclusionTracheal resection and anastomosis are challenging procedures and should be done only in centers with experience. Standard treatment consists of resection of the stenotic segment with end-to-end anastomosis. The geometry of the ends to be anastomosed is matched properly to avoid gaps or weak points and for air-tight seal anastomosis.

Is intranasal dexamethasone effective in reducing sore throat following surgery?

ABSTRACT Objectives: Postextubation, individuals may experience the discomfort of a sore throat. Our main aim of the study was to investigate if intranasal dexamethasone is successful in reducing postoperative sore throat occurrence. Materials and Methods: The study involved 96 adult individuals who were scheduled for elective eye surgery at Faiz Medical Center, which is affiliated with Isfahan University, between July 2020 and March 2021. The individuals were assigned by chance to two cohorts of 48 people each, with one cohort getting dexamethasone (IND) through the nose and the other cohort getting normal saline (INS) through the nose right after the endotracheal tube insertion. The presence of symptoms such as aching throat, cough, and hoarseness after surgery was recorded and examined with version 23 of the SPSS software. Results: Upon analysis, it was observed that there were no statistically significant alterations in demographic attributes, tracheal intubation variables, duration of surgery, and postoperative outcomes (P &lt; 0.05). Within the IND cohort, a notable 80.2% decrease in the occurrence of sore throat was noted immediately following the surgical procedure, along with a 34% reduction within the initial 6 hours of hospital stay (P &lt; 0.001). Moreover, dexamethasone also decreased the occurrence of cough and hoarseness by 31.7% and 38.2% during recovery, as well as 19% and 25.4% within the initial 2 h upon admission to the ward (P &lt; 0.001). Conclusion: The current study showcased the preventive impact of dexamethasone intranasally in decreasing the occurrence of sore throat in the early stages of postoperative period. Nevertheless, its efficacy diminished after 6 h. Furthermore, the intranasal application of dexamethasone exhibited the ability to alleviate hoarseness and cough within the first 2 h following surgical intervention.

The Use Of Simulation To Develop, Test And Implement A Multidisciplinary Team Care Pathway Bundle For Inpatients With Parkinson’s Disease

Abstract Background Hospitalised PD patients experience poorer outcomes. Model-2 hospitals lack onsite subspecialty neurology services whilst frequently managing PD inpatients. Aiming to enhance care of PD inpatients our multidisciplinary team (MDT) utilise simulation to design and deliver a new PD care pathway bundle. Methods The developed care bundle aims to facilitate i) screening for causes of PD deterioration, ii) identification of time sensitive and contraindicated medications and iii) prioritisation of timely MDT referral within the first 24 hours of admission. Using simulation of the NPO PD patient, usability of the bundle was tested through correct medication conversion (via Parkinsons calculator) and MDT clinical review for NG tube insertion with patient inclusion. Results Simulation delivery and structured debrief thereafter, further enhanced development and improvement of the simulation. It reinforced how the care bundle initiated early MDT referral and highlighted the pros/cons of MDT discussion with and without the patient. Once deemed satisfactory by all team members, ward-based simulation facilitated staff education and awareness of the new tool. Conclusion Simulation in the test and clinical environment facilitated implementation of a new MDT care pathway bundle at hospital level. Evaluation of effectiveness of the new care pathway require future audits and additional simulation campaigns.

Glaucoma drainage devices in patients following injector-assisted implantation of an artificial iris into the ciliary sulcus : Video article

The aim of this surgical technique is the implantation of aglaucoma drainage device (GDD) in eyes with aphakic glaucoma following injector-assisted implantation of an artificial iris into the ciliary sulcus. This atraumatic tube insertion technique can be performed during GDD implantation after implantation of an artificial iris into the ciliary sulcus. Following injector-assisted implantation of an artificial iris into the ciliary sulcus of eyes, the iris can shift into the chamber angle. The GDD should be positioned in the quadrant in which the iridectomy is located. Otherwise, GDD implantation is not possible due to the resistance of the artificial iris. Alternatively, the artificial iris can be easily and non-traumatically rotated in the ciliary sulcus by flushing the anterior chamber with balanced salt solution (BSS) to move the iridectomy into the desired area and position the GDD tube in the anterior chamber. Asurgical video, which is available online, shows the surgical technique in detail. After GDD, dexamethasone eye drops should be applied 8 times daily for 1 week tapering down by 1 drop per week thereafter. Antibiotic eye drops, e.g., ofloxacin eye drops, are prescribed 4times daily for 1 week and might be discontinued thereafter. To date, this is the first description of arotation of an artificial iris located in the ciliary sulcus by irrigation of the anterior chamber during GDD implantation.

Firearm Injuries in Children: Four-year Experience from a Rural Tertiary Care Centre of Northern India.

Firearm injuries (FAIs) continue to be a global public health problem possessing substantial emotional, physical and financial burdens on hospital resources. Although FAIs are rare in children, their incidence is gradually increasing. The aim of this study was to evaluate various aspects of FAI in children that were managed at a tertiary care centre located in the rural part of India. This clinical observational study of children <18 years of age, all due to FAI, was conducted at a tertiary care centre located in the rural part of India. Data of all children admitted with FAI over 4 years from January 2016 to December 2019 were collected. Recorded data included age, sex, motive (intentional/unintentional) and circumstances leading to injury, type and license status of firearm used, time of injury, pre-hospital care, mode of transport to hospital, duration between injury and arrival to hospital, body parts and organs injured, trauma scores, management, complications, length of hospital stay and outcomes. The recorded data were entered into a worksheet and analysed. Out of 283 cases of FAI admitted, only 24 were children with age <18 years (8.48%). The mean age was 12.66 years (male:female = 2.4:1). Sixteen were intentional (66.67%) and eight were unintentional (33.33%). The family feud was the most common reason in case of intentional FAI (43.75%), and mishandling was the most common reason in case of unintentional FAI. Country made gun was the most common firearm used (62.5%). The chest and upper back were the most common sites of injury (54.16%). Intercostal drainage tube insertion was the most common surgical procedure performed (33.33%). There were three mortalities (12.5%). The present study found that intentional FAIs in children were more common than unintentional FAIs with family feuds and mishandling being the most common causes, respectively. The unlicensed country-made gun was the most common firearm causing injury in children.