Unintended Side Effects of Electronic Cigarettes in Otolaryngology: A Scoping Review

Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity. The US Food and Drug Administration defines side effects as unwanted or unexpected events or reactions. Our objective was to examine the unintended otolaryngology-related side effects associated with E-cigs. Data Sources Medline, EMBASE, CINAHL, Web of Science, and CENTRAL databases. Review Methods Study selection was independently performed by 2 authors in accordance with the PRISMA-ScR statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews); discrepancies were resolved by the senior author. English studies from database inception to May 1, 2020, with a sample size >5 were included. In vitro, animal, and lower respiratory tract studies were excluded. The main outcome was defined as otolaryngology-related side effects following E-cig use. Levels of evidence per the Oxford Centre for Evidence-Based Medicine were used to determine study quality. Results From 1788 articles, 32 studies were included. The most common unintended side effects were throat irritation (n = 16), cough (n = 16), mouth irritation (n = 11), and oral mucosal lesions (n = 8). A large proportion of participants also reported conventional tobacco use in addition to E-cigs. Eight studies investigated the effectiveness of vaping on smoking cessation. The quality of the literature was level 2 to 4. Given the significant heterogeneity in the studies, meta-analysis was not performed. Conclusion The most reported side effects were throat and mouth irritation, followed by cough. The long-term impact of E-cigs is not known given the recent emergence of this technology. Future studies are warranted.

Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature

Background There is a concern that glioma patients undergoing repeat craniotomies are more prone to complications. The study’s goal was to assess if the complication profiles for initial and repeat craniotomies were similar, to determine predictors of complications, and to compare results with those in the literature. Methods A retrospective study was conducted of glioma patients (WHO grade II–IV) who underwent either an initial or repeat craniotomy performed by the senior author from 2012 until 2019. Complications were recorded by discharge, 30 days, and 90 days postoperatively. New neurologic deficits were recorded by 90 days postoperatively. Multivariate regression was performed to identify factors associated with complications. A meta-analysis was performed to identify rates of complications based on number of prior craniotomies. Results Within the cohort of 714 patients, 400 (56%) had no prior craniotomies, 218 (30.5%) had undergone 1 prior craniotomy, and 96 (13.5%) had undergone ≥ 2 prior craniotomies. There were 27 surgical and 10 medical complications in 30 patients (4.2%) and 19 reoperations for complications in 19 patients (2.7%) with no deaths by 90 days. Complications, reoperation rates, and new neurologic deficits did not differ based on number of prior craniotomies. On multivariate analysis, older age (OR1.5, 95%CI 1.0–2.2) and significant leukocytosis due to steroid use (OR12.6, 95%CI 2.5–62.9) were predictors of complications. Complication rates in the cohort were lower than rates reported in the literature. Conclusion Contrary to prior reports in the literature, repeat craniotomies can be as safe as initial operations if surgeons implement best practices.

The Air Force Visiting Surgeon Program: Development, Outcomes, and Future Application

ABSTRACT Introduction Active duty service members and their families have limited access to subspecialty surgical care when assigned OCONUS. To address this issue, the Air Force Visiting Surgeon Program (VSP) was created to push subspecialty care to these locations. Visiting Surgeon Program was accomplished using temporary duty (TDY) orders. We conducted this 12-year review, 2009-2021, of the program to assess objective measures of impact, identify key lessons learned, and consider the program’s future. Materials and Methods In 2009, the senior author, Col Latham, performed a cost analysis of plastic surgery care provided at OCONUS installations and found that TRICARE Overseas often paid rates substantially higher than a TDY assignment for a single procedure. To improve beneficiaries’ access to care while providing a cost savings to the health care system, 2-week plastic surgery missions were proposed to interested OCONUS military treatment facilities (MTFs). Ultimately, four sites selected to host the program in Alaska, Italy, England, and Japan. These sites were selected based on patient volumes, operating room capacity, and local command and surgeon support. By 2015, the Air Force formalized the program via Air Force Instruction 44-102 which outlined roles and responsibilities of MTF Commanders; established points of contact; and instituted key safety measures. Results To date, 58 missions have been completed by 21 surgeons through the VSP at Aviano Air Base (Italy; 24.1%), Joint Base Elmendorf-Richardson (Alaska; 31.0%), Royal Air Force Lakenheath (England; 27.6%), and Yokota Air Base (Japan; 17.2%). While primarily an Air Force program, 17% (10/58) of missions were supported Army or Navy surgeons. Overall, 2,000 patient consultations and 865 surgical cases were performed avoiding $6.7 million in cost. In addition to direct beneficiary care, the VSP also contributed to the participating surgeon and host surgical teams mission readiness. Conclusions The VSP provides a template to make select subspecialty surgical care available in a cost-effective manner across the military health system, while also providing a model for the forward deployment of military plastic surgeons and triservice collaboration.

COVID-19 induced aorto duodenal fistula following evar in the so called “negative” patient

Objectives Since October 2019, SARS-CoV-2 pandemic represents a challenge for the international healthcare system and for the treatment and survival of patients. We normally focus on symptomatic patients, and symptoms can range from the respiratory to the gastrointestinal system. In addition, we consider patients without fever and respiratory symptoms, with both a negative RT nasopharyngeal swab and lung CT, as a “Covid-19 negative patient.” In this article, we present a so called Covid-19 “negative” patient, with an unsuspected vascular clinical onset of the viral infection. Methods An 80 y.o. man, who previously underwent endovascular aortic repair for an infrarenal abdominal aortic aneurysm, presented to our department with an atypical presentation of an aorto-enteric fistula during the pandemic. While in hospital, weekly nasopharyngeal swab tests were always negative for SARS-CoV-2. However, the absence of aortic endograft complications, the gross anatomy of duodenal ischemic injury, and the recent history of the patient who lived the last months in Bergamo, the Italian city with the highest number of COVID-19 deaths, lead the senior Author to suspect an occult SARS-CoV-2 infection. The patient underwent to resection of the fourth portion of the duodenum and the first jejunal loop, with subsequent duodenum–jejunal latero-lateral anastomosis and the direct suture of the aortic wall. The intestinal specimen was investigated as suspected SARS-CoV-2 bowel infection by the means of immune-histochemistry (IHC). An ileum sample obtained in the pre-COVID-19 era was used as a control tissue. Results The histological analysis of the bowel revealed sustained wall ischemia and liponecrosis of the duodenal wall, with intramural blood vessels thrombosis. Blood vessel endotheliitis and neo-angiogenesis were also observed. Finally, the IHC was strongly positive for SARS-CoV-2 RNA and for HLA-G presence, with a particular concentration both in blood vessels and in the intestinal villi. The control tissue sample was not positive for both SARS-CoV-2 and HLA-G. Conclusions Coronavirus pandemic continues to be an international challenge and more studies and trials must be done to learn its pathogenesis and its complications. As for thromboembolic events caused by SARS-COV-2, vascular surgeons are involved in treatment and prevention of the complications of this syndrome and must be ready with general surgeons to investigate atypical and particular cases such as the one discussed in this article.

BreastGAN: Artificial Intelligence-Enabled Breast Augmentation Simulation

Background Managing patient expectations is important to ensuring patient satisfaction in aesthetic medicine. To this end, computer technology developed to photograph, digitize, and manipulate three-dimensional (3D) objects has been applied to the female breast. However, the systems remain complex, physically cumbersome, and extremely expensive. Objectives The authors of the current study wish to introduce the plastic surgery community to BreastGAN, a portable, artificial intelligence-equipped tool trained on real clinical images to simulate breast augmentation outcomes. Methods Charts of all patients who underwent bilateral breast augmentation performed by the senior author were retrieved and analyzed. Frontal before and after images were collected from each patient’s chart, cropped in a standardized fashion, and used to train a neural network designed to manipulate before images to simulate a surgical result. AI-generated frontal after images were then compared to the real surgical results. Results Standardizing the evaluation of surgical results is a timeless challenge which persists in the context of AI-synthesized after images. In this study, AI-generated images were comparable to real surgical results. Conclusions This study features a portable, cost-effective neural network trained on real clinical images and designed to simulate surgical results following bilateral breast augmentation. Tools trained on a larger dataset of standardized surgical image pairs will be the subject of future studies.

The Women’s Leadership Gap in Diabetes: A Call for Equity and Excellence. Diabetes 2021;70:1623–1633

Recently, a series of articles on women’s leadership in diabetes, which reflects the gender disparity in academic medicine, was published in Diabetes (1–3), centered around the article by Dunne et al. (1). The underrepresentation of female talent in the field of clinical medicine has been a longstanding and well-established issue. Women in academia are disproportionately disadvantaged in terms of first author and senior author publications, representation on editorial boards of journals, and leadership roles within academic societies (4). Different strategies that enable leadership development and remove barriers have been proposed to attract and retain female talent (3).

Sex disparities in authorship in pulmonary hypertension research: a scoping review protocol

From Protocol Introduction: Our aim is to examine female authorship and sex disparities in the domain of pulmonary hypertension (PH) research. Despite PH disproportionately affecting females, we hypothesize that the proportion of studies with women as first or senior author will be < 50% and women will be underrepresented in publications in more prestigious journals.

Expanding Global Health Engagement through Fogarty Fellowship Programs

Training the next generation of global health researchers is vital for sustainable research partnerships and global health equity. The Fogarty International Center (National Institutes of Health) supports postdoctoral fellows and professional/graduate students in long-term, hands-on mentored research in low- and middle-income countries (LMICs). We surveyed 627 alumni (58% from the United States, 42% from LMICs) from three sequential Fogarty-sponsored global health research training programs (response rate: N = 257, 41%). Publications in the Index Medicus were used to ascertain scholarly output. Most alumni (63%) reported remaining engaged in LMICs and/or worked in academic/research careers (70%). Since completing their Fogarty fellowship, 144 alumni (56%) had received 438 new grants as principal investigator (PI), co-/multi-PI, or site PI. The 257 responding alumni had 5,318 publications during and since their Fogarty fellowships; 2,083 (39%) listed the Fogarty trainee as the first or senior author. These global health training programs highlight the value of LMIC research experience in nurturing the global health research workforce.

The Cartilage Rhinoplasty with Goldman Technique for Correcting the Broad Nasal Tip

In this paper, A retrospective review was performed for all the patients who underwent surgery with the Goldman technique by the senior author from 2004 to 2009 for correction of the broad nasal tip. The clinical and pathologic findings of these patients were reviewed, and an independent observer evaluated the pre- and postoperative photos of the patients using five parameters: projection, rotation, symmetry, shape, and distance of the tip-defining points. The evaluation was performed using a scale of -1 to +1 for each of the five parameters. Of the 205 patients who underwent the technique, 115 (56%) were patients with broad tips, and 90 (44%) were patients with broad (boxy) tips. A total of 189 cases (92.2%) involved primary rhinoplasties, and 16 cases (7.8%) involved revision. During this period, complications were observed in five patients (2.4%), who underwent revision rhinoplasty with a successful result. The average score for the five parameters already mentioned for primary rhinoplasties according to the scale of -5 to +5 showed a significant postoperative improvement (score, +4.3). It implied that the cartilage rhinoplasty with Goldman technique is safe when performed by experienced surgeons and according to specific indications. This conclusion is indicated by the low rate of complications in the large series of patients in this study.

Novel Use of an Internal Distractor for Metacarpal Lengthening

Background In patients who have had proximal digit amputation, metacarpal distraction osteogenesis is an option to improve digital length and function. One drawback is that traditional external distraction devices are large and cumbersome; the option of a low-profile internal device is therefore appealing. Internal distractors are commonly used in craniofacial reconstruction, but use in the hand has not been reported. We describe a case series of the novel use of an internal distractor in metacarpal lengthening. Methods In this single-center case series, patients who underwent metacarpal distraction by the senior author using a uniplanar internal distractor were reviewed, and indications, outcomes, and complications were analyzed. Results There were 5 cases in 4 patients (age range: 7-33 years). Indications were traumatic amputation in 4 cases and congenital hypoplasia in 1. All were successfully distracted, with a mean final length gain of 1.3 cm (range: 1.0-1.7 mm). Mean time from device placement to consolidation was 3.5 months. Complications included activation arm site infection in 2 cases, both occurring after the distraction period, necessitating device removal before full consolidation. In these cases, the device was removed after the distraction period and replaced with a Kirschner wire for stabilization through the consolidation period. Conclusions Metacarpal distraction was successfully achieved with an internal distraction device. Although infection was common, it occurred after the distraction period and did not preclude length gain. We feel that this low-profile device offers advantages over cumbersome external devices typically used for metacarpal lengthening.