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To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
To compare the outcomes of endoscopic repair of bilateral congenital choanal atresia using a flap technique without stenting versus endoscopic repair using stenting without a flap.
A prospective randomised controlled study was conducted, comprising 72 patients with bilateral congenital choanal atresia. The patients were randomised into two groups. Group A (42 patients) underwent endoscopic repair using a mirrored L-shaped flap without stenting, and group B (30 patients) underwent endoscopic repair using stenting without a flap.
At a mean follow-up period of 18.2 months, endoscopic assessment revealed a patent posterior choana in 81 per cent and 83.33 per cent of patients in group A and group B respectively. Choanal stenosis occurred in 21.40 per cent and 33.33 per cent of patients in group A and group B respectively. Granulation tissue was observed in 28.6 per cent and 53.3 per cent of patients in group A and group B respectively.
The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate.
Anabolic steroid abuse by women is associated with a number of adverse effects, including laryngeal changes. The epidermal growth factor receptor is related to regulation of the cell life cycle. This study aimed to investigate the structural changes and immunohistochemical localisation of epidermal growth factor receptor in rat vocal folds following anabolic steroid administration, and also to assess the effect of anti-androgens.
Material and methods:
Thirty-two adult female albino rats were divided into: group I (controls), group II (receiving anabolic steroids for two months) or group III (receiving anabolic steroids plus anti-androgen for two months).
Group II rat true vocal folds showed thicker epithelial layers with many mitotic figures, thicker lamina propria and thicker muscle fibres; epithelial cells were also immunohistochemically positive for epidermal growth factor receptor. Group III rats showed similar changes, but thin muscle fibres and extravasated red blood cells within the lamina propria.
Anabolic steroids caused structural and immunohistochemical changes within the female rat true vocal fold. Co-administration of anti-androgens did not prevent these changes, suggesting that anti-androgens have a limited role in the management of such changes in humans.
Laryngotracheal stenosis is currently one of the most common complications associated with nasal and orotracheal intubation and tracheotomy. Once established, tracheal stenosis can be a complex and difficult problem to manage.
Patients and methods:
We retrospectively analysed 2004–2010 data for 12 male patients with postintubation cervical tracheal stenosis (grade III–IV) treated in the otolaryngology department, Mansoura University Hospitals. All patients had a tracheostomy at presentation, and all underwent tracheal resection with primary cricotracheal anastomosis and suprahyoid release.
Grade III stenosis was present in five patients (41.7 per cent) and grade IV stenosis in seven patients (58.3 per cent). The length of trachea resected ranged from 2 to 4 cm, representing one to four tracheal rings. In all 12 patients, the procedure allowed successful tracheotomy decannulation. Minor complications comprised surgical emphysema (n = 2) and wound infection (n = 1), and were managed conservatively. Major complications consisted of restenosis (n = 3), managed in two patients by repeated dilatation; one patient was lost to follow up.
Segmental tracheal resection with cricotracheal anastomosis was successful in 11/12 (92 per cent) patients with severe cervical tracheal stenosis. The strategy for treatment of airway stenosis is now well established and success rates are high, with minimal or no sequelae.
To study the effect of Silastic® sheeting placed in the middle ear during tympanoplasty, including the effect on hearing.
Chronic inflammation of the middle ear is common. Surgical treatment sometimes results in middle-ear adhesions and hearing deterioration.
Materials and methods:
We selected 106 patients with chronic otitis media, middle-ear adhesions and intact ossicles, based on intra-operative findings. These patients underwent single-stage tympanoplasty either with or without insertion of Silastic sheeting. Audiometry was undertaken pre-operatively and one and 12 months post-operatively.
Patients who had undergone Silastic sheet insertion showed significantly better air conduction, bone conduction and air–bone gap averages one year post-operatively, compared with those who had not.
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