Coronavirus disease 2019 (COVID-19) has emerged as an unforeseen challenge for head and neck cancer care providers. A similar challenge is also faced by other oncological fields, but the severity of this challenge is highest in otolaryngology because of the need for additional precautionary measures and curbs on the possibility of aerosol forming interventions related to the upper aerodigestive tract. In this narrative review, provision of ethical and consistent care on moral and professional grounds to head and neck cancer patients during the pandemic are discussed for professionals who provide head and neck oncology care.
Background and objectiveHead and neck cancers are prevalent in Pakistan. Oral squamous cell carcinomas are primarily treated via surgical removal, and complete surgical resection is the paramount prognostic factor. A resection margin of 5 mm on the final histopathology report has been accepted as adequate in the existing literature. Negative margins on the frozen section do not guarantee adequate disease-free resections on the final histopathology report. In this study, we aimed to ascertain how accurately tumor-free margins can be detected on frozen sections, which are reported intraoperatively compared to permanent sections of the same tissues reported after proper staining in oral squamous cell carcinoma patients.
MethodsA cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan; 94 patients presenting between January and October 2016 were included in this study and a total of 432 tumor margins were assessed.
ResultsAmong the total 94 patients included in the study, 79% were male and 21% were female. Buccal mucosa was the most commonly involved subsite (57%), followed by the tongue (25%). The most common T stage was T4 (33%), followed by T2 and T3 at 28% and 21% respectively, while the most common N stage was N0 (55%) followed by N1 at 16% and N2 at 22%. The sensitivity of the frozen section in comparison to the permanent section was found to be 50%, while specificity was calculated to be 99.8%. The positive predictive value was 75% and the negative predictive value was 99.3%.
ConclusionThe frozen section is a highly useful tool for the evaluation of tumor margins. However, while it has high diagnostic accuracy rates, it can produce altered results and therefore requires high clinical correlation.
Owner and Responsible Manager on behalf of the Turkish Otorhinolaryngology Head and Neck Surgery Society / Türk Kulak Burun Boğaz ve Baş Boyun Cerrahisi Derneği adına Sahibi ve Sorumlu Yazı İşleri Müdürü: Özgür YİĞİT •
The purpose of this chapter is to understand the business environment for the family businesses in the Gulf Cooperation Council (GCC) based on the theoretical foundation of organisational ecology and open system perspective during the COVID-19 pandemic. More specifically, the reader can understand the business environment of the family firms and how firms can recover from the pandemic by fighting against the infodemic in the GCC region. The authors have used a survey to collect data online from the family firms from Oman during the first and second waves of COVID-19 (i.e., Feb.-Dec. 2020). The results of the study demonstrate that business infodemic negatively moderates the linkage between the business environment-innovation performance nexus and positively moderates between the business environment-commerce association. This research implies the scanning of the Gulf business environment and continuous innovation by family-owned enterprises is vital to avoid a U-shaped recovery in the Arab economies.
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