ccupational transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a substantial risk to health care workers. 1,2 Preliminary data from the US Centers for Disease Control and Prevention show that health care professionals account for approximately 20% of cases of coronavirus disease 2019 in the United States. 2 Early in the outbreak, health care workers in otolaryngology were particularly vulnerable to nosocomial infection. [3][4][5][6] This is thought to be in part owing to the nature of work in otolaryngology, which often requires frequent, prolonged exposure to and manipulation of aerodigestive tract mucosa, where viral loads are often highest. 7 In particular, the use of flexible fiberoptic laryngoscopy (FFL) is potentially an aerosolgenerating procedure (AGP) that has garnered widespread caution as a high-risk procedure. 4 Flexible fiberoptic laryngoscopy is an integral tool for ambulatory evaluation of the larynx and is commonly used in the diagnosis and management of many head and neck cancers and other upper airway conditions. Procedures are most commonly performed in offices and other low-acuity settings where precautionary measures such as negative pressure isolation rooms may not be available. Many otolaryngology clinics have taken measures to reduce or completely stop the use of FFL during the SARS-CoV-2 outbreak. 4,8 Recent recommendations from a group of 300 US laryngologists support limiting FFL to only critical cases involving airway compromise or malignant neoplasm. 9 As otolaryngologists redefine clinical care pathways amid a global pandemic, it is important to understand the science behind these recommendations. Methods Systematic ReviewA comprehensive review of literature was performed on April 19, 2020, from the PubMed/MEDLINE (1966 to April 2020), Embase IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reportedly infected otolaryngologists disproportionately in the early parts of the coronavirus disease 2019 pandemic. Recommendations from national and international health organizations suggest minimizing the use of flexible laryngoscopy as a result.OBJECTIVE To review evidence on the risks of aerosolization and transmission of SARS-CoV-2 from patients to health care personnel during endoscopy of the upper aerodigestive tract.
BackgroundMalaria is a major world health issue and its continued burden is due, in part, to difficulties in the diagnosis of the illness. The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests (RDT) for all cases of suspected malaria. In regions where Plasmodium species are indigenous, there are multiple etiologies of fever leading to misdiagnoses, especially in populations where HIV is prevalent and children. To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda, Cameroon, we evaluated the clinical efficacy of the Flourescence and Staining Technology (FAST) Malaria stain and ParaLens AdvanceTM microscopy system (FM) and compared it with conventional bright field microscopy and Giemsa stain (GS).MethodsPeripheral blood samples from 522 patients with a clinical diagnosis of “suspected malaria” were evaluated using GS and FM methods. A nested PCR assay was the gold standard to compare the two methods. PCR positivity, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined.ResultsFour hundred ninety nine samples were included in the final analysis. Of these, 30 were positive via PCR (6.01%) with a mean PPV of 19.62% and 27.99% for GS and FM, respectively. The mean NPV was 95.01% and 95.28% for GS and FM, respectively. Sensitivity was 26.67% in both groups and specificity was 92.78% and 96.21% for GS and FM, respectively. An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS, which was not seen with FM.ConclusionsThe frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’ clinical suspicions. A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM. Additionally, FM increased the specificity and improved the PPV, suggesting this relatively low cost approach could be useful in resource-limited environments. Anecdotally, physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis, highlighting the need for further physician education to avoid this practice of overtreatment. A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0251-0) contains supplementary material, which is available to authorized users.
In light of a detailed characterization of genetic aberrations in cancer, nucleic acid targeting represents an attractive therapeutic approach with significant translational potential. Head and neck squamous cell carcinoma (HNSCC) is a leading cause of cancer deaths worldwide with stagnant 5-year survival rates. Advances in conventional treatment have done little to improve survival and combined chemoradiation is associated with significant adverse effects. Recent reports have characterized the genetic alterations in HNSCC and demonstrated that mutations confer resistance to conventional and molecular targeted therapies. The ability to use specific nucleic acid sequences to inhibit cancer-associated genes including non-druggable targets facilitates personalized medicine approaches with less adverse effects. Additionally, advances in drug delivery mechanisms have increased the transfection efficiency aiding in greater therapeutic responses. Given these advances, the stage has been set to translate the information garnered from genomic studies into personalized treatment strategies. Genes involved in the tumor protein 53 (TP53) and epidermal growth factor receptor (EGFR) pathways have been extensively investigated and many promising preclinical studies have shown tumor inhibition through genetic modulation. We, and others, have demonstrated that targeting oncogene expression with gene therapy approaches is feasible in patients. Other methods such as RNA interference have proven to be effective and are potential candidates for clinical studies. This review summarizes the major advances in sequence-specific gene modulation in the preclinical setting and in clinical trials in head and neck cancer patients.
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