Objective: Surgical masks and N95 filtering facepiece respirators (FFRs) prevent the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. Increased demands for surgical masks and N95 FFRs during the Coronavirus disease 2019 (COVID-19) pandemic has resulted in the shortage crisis. However, there is no standard protocol for safe reuse of the N95 FFRs. This systematic review aims to evaluate the effectiveness of existing decontamination methods of surgical masks and N95 FFRs and provide evidence-based recommendations for selecting an appropriate decontamination method. Methods: Systematic searches of Ovid MEDLINE and Ovid EMBASE electronic databases were performed. The date of the last search was 11 April 2020. Any trials studying surgical masks and/or N95 FFRs decontamination were included. Outcomes were disinfections of virus and bacteria, restorations of the filtration efficiency and the physical structure of the masks. Results: Fifteen studies and fourteen decontamination methods were identified. Low level of evidence supported four decontamination methods, which were ultraviolet germicidal irradiation (9 studies), moist heat (5 studies), microwave generated steam (4 studies), and hydrogen peroxide vapor (4 studies). Therefore, recommendations as an ‘option’ were given to these four methods while ‘recommendation against’ was given to the other ten methods. Conclusions: Low level of evidence supported the use of ultraviolet germicidal irradiation, moist heat, microwave generated steam, and hydrogen peroxide vapor for decontamination and reuse of N95 FFRs. These decontamination methods were effective for virus and bacterial disinfection, and restoration of the filtration efficiency and the physical structure of the FFRs.
Refractory esophageal stricture is an undesired complication after caustic ingestion associated with increased morbidity and mortality. Prevention rather than treatment of the stricture is a desirable goal. The objective of this study was to report the safety and outcome of our novel endoscopic technique using Repeated endoscopy with Intraluminal Fibrinous adhesioLysis of the Esophagus (RIFLE) during the first 2 weeks of caustic ingestion aiming to prevent the development of refractory esophageal stricture and bypass surgery. Patients with Zagar’s grade IIb-IIIa corrosive esophageal injury were included. Patients undergoing emergent surgery were excluded. Since 2018, upper endoscopy with lysis of intraluminal fibrinous adhesion by advancing endoscopic tip through the lesions has been gently performed initially at the third day and then repeated twice a week during the first 2 weeks of the ingestion in 15 patients of the study group. Before 2018, a standard ‘wait and see’ treatment with early dilation at 4–6 weeks after injury had been applied only patients with evidence of esophageal stricture. Patients in the standard were 1:1 matched to the study group. A median number of endoscopic RIFLE session was 4, and there was no treatment-related complication in all 15 patients in the study group. Fifteen out of the 102 patients with grade IIb-IIIa esophageal injury in our database with standard treatment were well matched to the study group. At the median follow-up of 30 months, the frequency of esophageal stricture, refractory esophageal stricture, esophageal replacement procedure, and a median number of dilation session between the study and standard treatment group were 4/15 (27%) vs 10/15 (67%), p = 0.02, 1/15(7%) vs 7/15(47%), p = 0.01, 1/15(7%) vs 6/15(40%), p = 0.03, and 4 vs 11, p < 0.001, respectively. In patients with severe non-transmural caustic esophageal injury, repeated endoscopy with intraluminal fibrinous adhesiolysis of the esophagus during the first 2 weeks of the ingestion is safe and associated with decreasing proportion of patients with refractory esophageal stricture and requiring esophageal replacement procedure.
Long-term outcome of colonic interposition in patients with severe corrosive upper gastrointestinal tract injury is less known. Patients diagnosed of severe corrosive upper digestive tract injury were included. Patients with full-thickness organ necrosis underwent emergent surgical resection without primary reconstruction. Subsequent esophageal reconstruction with substernal colonic interposition approximately 6 months after the ingestion was undertaken in physically and mentally fit patients. Esophageal dilatation program was applied as first line treatment in all patients with esophageal stricture at a median duration of 5 weeks after the injury. Esophageal replacement procedure was offered to the patients who had failed dilatation. Late complications, swallow function, nutritional autonomy and overall survival in patients who underwent colonic interposition were evaluated. There were 70 patients undergoing colonic interposition. Of 70 patients, 50 (71%) had cervical pharyngo-colonic and 20 had cervical esophago-colonic anastomoses. There was one (1.4%) 90-day hospital mortality. Anastomosis leakage was 8%. At median follow up of 58 months, late deaths were observed in 6 patients causing by nesidioblastosis (2), resuicidal attempt (2) and intestinal volvulus (2). Adhesive small intestinal obstruction requiring laparotomy was observed in 7(10%). Nutritional autonomy was achieved in 55 of 60 (92%) patients. Strictures were developed in 10 (16%) and dumping syndrome in 20 (30%) patients. Five- and ten-year overall survival were 72% and 61%, respectively. Colonic interposition in patients with severe corrosive upper digestive tract injury was safe and effective. Long-term survival, function and nutritional outcome are good regardless of the proximal level of cervical anastomosis. However, the late negative impact of the reconstructive procedure on metabolic derangement and small intestinal obstruction cannot be overemphasized.
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