Metal Allergy in Tracheostomy Tube Placement Resulting in Complete Subglottic Stenosis: A Case Report

Objectives: Metal hypersensitivity reaction to surgical implants is a well- known phenomenon that is associated with pain, swelling, inflammation, and decreased efficacy of the implant. We present a unique case of a patient with placement a metal Jackson tracheostomy tube that led to expeditious total subglottic stenosis. Methods: The patient was a 33-year old, severely atopic woman with history of asthma exacerbations requiring several intubations for acute respiratory failure with several subsequent tracheal dilations with steroid injections, and eventual tracheostomy placement with a metal Jackson tracheostomy tube that led to expeditious total subglottic stenosis. Results: Initial intervention included performing an airway evaluation, CO2 laser, and steroid injection of the area of complete subglottic stenosis. Follow up several months later revealed little improvement in level of tracheal narrowing proximal to the tracheostomy tube. Patient did not have shortness of breath but continued to be aphonic. Cricotracheal versus tracheal resection have been proposed but surgical morbidity was deemed too high due to patient’s obesity. Conclusions: Metal hypersensitivity reactions are well known phenomena as it relates to surgical implants in other surgical specialties but are seldom reported within the ear, nose and throat literature. Oftentimes, it takes astute observation to diagnose and establish a connection. Prompt recognition and treatment can be acquired from interdisciplinary collaboration with allergy.

FERRAMENTA DE APOIO AOS COMANDANTES DAS OPERAÇÕES DE SOCORRO EM INTERVENÇÕES ESTRUTURAIS DAS EQUIPAS DE BOMBEIROS

In a scenario of structural intervention situation, the On-Scene Commanders (COS) only have at their disposal the data provided by the one who gave the alert, which are insufficient to provide a secure and informed decision-making. Through a quantitative, descriptive, observational, and cross-sectional research, using a questionnaire applied to operational staff who perform the COS function, results a survey of the COS information needs. According to the results, it is concluded that the purpose of knowing the risks and outlining a more effective, faster and safer combat strategy for operational personnel involved, could be compromised by the limited information available. A proposal for a new support tool for COS function - the Initial Intervention Plan (PII) - was developed, which is a document of quick and intuitive consultation, supplying the needs of information for COS.

FIRST: Enhancing Agency Dementia Capability through Dementia-Specific Interventions and Supportive Services

Through the First Identify and Refer then Serve and Track (FIRST) Project, individuals and caregivers have critical connections to community organizations and resources to learn ways to handle living with memory problems. The FIRST project integrated new practices into existing programs to address gaps in service and piloted a new dementia-specific case management program. The initial intervention is a system-level change within the County of San Diego’s Aging & Independence Services (AIS) department to identify, pilot, and implement a brief Alzheimer’s Disease and Related Dementias (ADRD) screening tool. The tool was used by non-clinical personnel to identify potential ADRD cases. Individuals who screened positive for possible ADRD were referred to their physicians for an accurate diagnosis. The second intervention consisted of two components: a behavioral symptom management intervention for social workers to use in the home with caregivers and a dementia-specific case management program (including respite care) to improve quality of life and future planning for those with ADRD living alone or with a family caregiver. As of January 2021, 536 clients across several AIS programs have been screened for ADRD, of which, 60% screened positive. FIRST case management has served 196 clients, 70 who lived alone and 126 who lived with their caregiver. Respite was provided to 98 clients totaling to 3,666 hours. This poster evaluates the effectiveness of the program components in increasing dementia capability of an agency, and where applicable, its effect on caregiver burden and self-efficacy.

Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing

Purpose To determine whether Hispanic residents receiving the Healthy Fit intervention enhanced with Motivational Interviewing (MI) experienced greater improvements in body composition, relative to participants receiving the initial intervention. Design Quasi-experimental evaluation. Setting El Paso, Texas. Sample Among 656 baseline participants, 374 (54%) completed the 12-month assessment. Intervention In Healthy Fit, community health workers (CHWs) promote nutrition and exercise. To strengthen intrinsic motivation and help participants overcome barriers to change, we incorporated a 30-minute motivational interview into the baseline assessment. Follow-up phone calls at 1, 3, and 6 months were identical across conditions. Measures CHWs assessed body mass index (BMI) and body fat percentage (BFP) using a bioelectrical impedance scale. Analysis Regression models estimated differences between intervention conditions on change in BMI and BFP from baseline to the 12-month assessment. Results Participants receiving MI had 2.13 times higher odds of losing weight (OR = 2.14, 95% CI [1.30, 3.53], P = .003) and 2.59 times higher odds of reduced BFP (OR = 2.59, 95% CI [1.51, 4.41], P < .001), relative to initial intervention participants. MI participants lost an average of 1.23 kg (2.71 lbs.) and their BFP declined 2% over 12 months. Conclusion Findings suggest CHW use of MI is a promising approach for promoting incremental changes in diet and exercise, which Healthy Fit integrates into a low-cost intervention.

Factors Influencing Reintervention Following Ductal Artery Stent Implantation for Ductal-Dependent Pulmonary Blood Flow: Results From the Congenital Cardiac Research Collaborative

Background: Stenting of the patent ductus arteriosus (PDA) is an established palliative option for infants with ductal-dependent pulmonary blood flow. Following initial palliation, reintervention on the PDA stent is common, but risk factors have not been characterized. Methods: Infants with ductal-dependent pulmonary blood flow palliated with PDA stent between 2008 and 2015 were reviewed within the Congenital Cardiac Research Collaborative. Rates and risk factors for reintervention were analyzed. Results: Among 105 infants who underwent successful PDA stenting, 41 patients (39%) underwent a total of 53 reinterventions on the PDA stent, with all but one occurring within 6 months of the initial intervention. Stent redilation constituted the majority of reintervention (n=35; 66%) followed by additional stent placement (n=11; 21%) and surgical shunt placement (n=7; 13%). The majority of reintervention was nonurgent, and there were no deaths during the reintervention procedure. All but one reintervention occurred within 6 months of the initial procedure. On univariate analysis, risk factors for reintervention included anticipated single-ventricle physiology, lack of prior balloon pulmonary valvuloplasty, use of drug-eluting stent, and increased ductal tortuosity. Conclusions: In infants with ductal-dependent pulmonary blood flow palliated with PDA stent implantation, reintervention is common, can be performed safely, and is associated with both anatomic/procedural factors and anticipated final physiology.

What we can learn from 2018 liquefaction in Central Sulawesi: Stories from the survivors

This paper provides the stories of the liquefaction survivors about their experiences during and after the disaster. It is a phenomenological study that used the semi-structured interview to obtain the data. The data were acquired from 30 participants. There are some important points that can be summarised from the stories of the survivors. During the disaster, local people inclined to underestimate the quake at the beginning of the shaking. It could indicate the level of their risk perception and awareness on disaster. In addition, a unique finding from this study was that the survivors had conducted the initial intervention priority as basic resources for survival such as shelter and information of the victims’ identity. Also, regarding the post-disaster data, the results indicated that the survivors experienced the symptoms of trauma due to the disaster. It indicates that the psychological aspect of the survivors was neglected during the recovery process. On that regard, long-term traumatic recovery activities should be put into accounted during the recovery processes for all the victims of a disaster regardless of their ages and genders. Another implication of this study is the opportunity to use these stories into learning activities, both in learning about science or disaster mitigation.

Comparative Effects of Dental Treatment and Two Different Physical Therapy Interventions in Individuals with Bruxism: A Randomized Clinical Trial

Objective: To compare the efficacy of dental treatment and two different physical therapy interventions in individuals with bruxism. Methods: A total of 72 individuals with bruxism were randomly allocated to the massage (massage with stretching exercises), relaxation (relaxation with imagination therapy) groups (n=24 each; biweekly 40-min sessions over 6 weeks) or the dental group (n=24; direct restoration; two 2-h sessions 1 week apart). Primary outcomes included muscle pain and symptoms, and mandibular opening. Secondary outcomes included anxiety, stress, depression, oral health and sleep quality. Outcomes were evaluated at baseline, 6 weeks and 2 months post-initial intervention by a blinded assessor. Physical therapy interventions included individual sessions that lasted 40 min biweekly for 6 weeks and dental treatment, two 2-h individual sessions conducted a week apart. The level of significance established was α=5%. RESULTS: After 6 weeks, the improvement with difference among massage and relaxation groups and dental group was observed in muscle pain, symptoms, anxiety, stress, depression and sleep quality (p<0.001). Relaxation group exhibited significantly greater improvement in oral health than dental group (p<0.001). These effects were sustained for up to 2 months. Conclusion: Therefore, two physical therapy interventions are superior to dental treatment in the improvement of muscle pain, symptoms, anxiety, stress, depression and sleep quality in individuals with bruxism. Oral health improves more with relaxation with imagination therapy than with dental treatment.

Early Lessons Learned in Designing an Adaptive Shared Reading Intervention for Preschoolers With Autism

Project START (Students and Teachers Actively Reading Together) is an adaptive shared reading intervention designed to address the varied learning needs of preschool children with autism spectrum disorder (ASD). This report summarizes procedures and results of the developmental year of the project, which focused primarily on evaluating implementation fidelity and social validity of the intervention. The final sample consisted of four classrooms with 10 students with ASD ( Mage = 4.32 years) and their teachers ( N = 4). Classrooms were randomized to either a 4- or an 8-week first-stage small-group dialogic reading condition. Children who were early responders continued with the initial intervention; those who were slower to respond were randomized to one of two intensified reading conditions. Results indicate that teachers perceived the intervention as feasible and child outcomes as acceptable. Implementation fidelity was low during initial weeks (33%–50%), improving to 67% to 83% by the last weeks of the study. Neither children’s engagement nor vocabulary growth differed between treatment levels or conditions. We discuss lessons learned from the study’s developmental year and changes that will be made in subsequent years to improve implementation and feasibility.

The Role of the Smartphone in the Diagnosis of Vestibular Hypofunction: A Clinical Strategy for Teleconsultation during the COVID-19 Pandemic and Beyond

Introduction Vestibular disorders (VDs) are highly prevalent in primary care. Although in general they comprise conditions that are not life-threatening, they are associated with significant functional and physical disability. However, the current coronavirus disease 2019 (COVID-19) pandemic has imposed limitations on the standard treatment of benign conditions, including VDs. In this context, other resources may aid in the diagnosis and management of patients with VDs. It is well known that teleconsultation and teletreatment are both safe and effective alternatives to manage a variety of conditions, and we maintain that VDs should be among these. Objective To develop a preliminary model of clinical guidelines for the evaluation by teleconsultation of patients with suspected diagnosis of vestibular hypofunction during the COVID-19 pandemic and beyond. Methods A bibliographic review of the diagnostic feasibility in VDs by teleconsultation was carried out in the LILACS, SciELO, MEDLINE, and PubMed databases; books and specialized websites were also consulted. The legal, regulatory, and technical issues involving digital consultations were reviewed. Results We found 6 field studies published between 1990 and 2020 in which the efficiency of teleconsultations was observed in the contexts of epidemics and environmental disorders and disadvantageous geographical conditions. After reviewing them, we proposed a strategy to examine and address vestibular complaints related to vestibular hypofunction. Conclusion The creation of a digital vestibular management algorithm for the identification, counseling, initial intervention, monitoring and targeting of people with possible vestibular hypofunction seems to be feasible, and it will provide a reasonable alternative to in-person evaluations during the COVID-19 pandemic and beyond.

When acral malignant melanoma facades as diabetic foot!

An 85-year-old Indian man presented with non-healing foot ulcer over the left heel. There was initial response to wound size with standard treatment including offloading, debridement and antibiotic therapy. However, subsequently, there was no progress noted. Incidentally, two small black spots in the wound bed raised the suspicion of melanoma. Incisional biopsy confirmed acral lentiginous melanoma (ALM). The final diagnosis was ALM coexisting with diabetic foot ulcer (DFU). The wound was treated by surgical resection and flap reconstruction that resulted in complete healing. Fourteen months after the initial intervention, the patient developed a new lump and ulceration around the previous wound bed. This turned out to be recurrent disease with distant metastasis. The patient died eventually with palliative support. Through this case, we would like to highlight the importance of early biopsy and intervention in DFU especially for those wounds with atypical presentation or refractory to standard treatment.