Outcome of tracheostomy among COVID-19 patients in a tertiary hospital setting: Our experience

INTRODUCTION

The COVID-19 pandemic is unprecedented. Amongst those who contracted COVID-19, a number required intubation and prolonged ventilation. This increased the number of ventilated patients in the hospital and increased the requirement for tracheostomy of severe COVID-19 patients. Our objective is to study the outcome of patients with COVID-19 who underwent tracheostomy.

MATERIALS AND METHODS

This study is a novel retrospective study in a tertiary centre in Malaysia. Case notes of COVID- 19 patients who underwent tracheostomy in Hospital Ampang were collected using the electronic Hospital Information System. Data were analysed using the SPSS system.

RESULTS

From a total of 30 patients, 15 patients survived. All patients underwent either open or percutaneous tracheostomy. The median age is 53 (range: 28-69) with a significant p-value of 0.02. Amongst comorbidities, it was noted that diabetes mellitus was significant with a p-value of 0.014. The median time from the onset of COVID-19 to tracheostomy is 30 days. The median duration of intensive care unit (ICU) stay is 30.5 days, with the median duration of hospital length of stay of 44 days (p = 0.009 and <0.001, respectively). No complications that contributed to patient death were found. Survivors had a median of 29.5 days from tracheostomy to oxygen liberation.

CONCLUSION

Tracheostomy in COVID-19 patients that requires prolonged ventilation is unavoidable. It is a safe procedure and mortality is not related to the procedure. Mortality is primarily associated with COVID-19.

Health-Related Quality of Life Changes Among Oral Cancer Patients Treated With Curative Intent: Experience of a Developing Country

Background: Standard outcome disease parameters like tumor control, overall survival and complications are now complemented with health-related quality of life (HRQoL) data as an important source of information concerning the impacts of disease and treatment outcomes for head and neck cancer patients. Aim: This study aims to assess changes in oral cancer patients' HRQoL and the impact of disease stage on HRQoL scores from the point of diagnosis (pretreatment) through the one, three and six month follow-ups. Differences in characteristics between patients presenting early and late were also explored. Methods: HRQoL data were collected from seven hospital-based centers using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) V4.0. A total of 300 patients were recruited. Independent sample t-test, χ2 and paired sample t-test were used to analyze data. The Statistical Package for Social Sciences (SPSS) version 12.0 was used, whereby P < 0.05 was considered to be statistically significant. Results: Mean age was 61.0 ± 13.7 years old with most of them being females (60.7%) and of Indian ethnicity (35.0%). Betel quid chewing was the most common risk habit practiced (48.2%). The most common subsite was tongue and floor of mouth (42.6%). Surgical intervention (41.1%) was the most common treatment. Significant differences in ethnicity and treatment modality were observed between early and late stage patients. Among late stage patients, attrition rate increased significantly with increasing age, with higher proportions of attrition at later follow-ups. At pretreatment, HRQoL scores were significantly lower for late than early stage patients. At one month posttreatment, GF, H&N domains and FACT-H&N (TOI) summary scores showed significant deterioration among both early and late stage patients. In contrast, emotional domain showed significant improvement for early and late stage patients at 1, 3 and six month posttreatment. Although HRQoL deterioration was still observed among early and late stage patients at six months posttreatment, it did not achieve statistical significance. Conclusion: Advanced disease is associated with poorer HRQoL. Domains most commonly affected were the functional, physical and head and neck concerns. Although ethnic differences were observed across different disease stages, its influence on patients' HRQoL was not evident in this study.

Mouth Self-Examination (MSE) As a Screening Tool for Oral Potentially Malignant Disorders Among a High-Risk Indigenous Population With a Low Socioeconomic Status

Background: Oral cancer can be preceded by a group of conditions termed oral potentially malignant disorders (OPMDs). Oral cancers are associated with a 5-year survival of less than 50%, largely attributed to diagnoses at advanced stages. As pain associated with oral cancer manifests only at late stages, delay in detection often occurs. Screening has been found to aid in detection at an early stage, however it is only feasible if targeted toward high risk individuals. Mouth self-examination (MSE) is a relatively quick, inexpensive and simple to perform method of screening. Aim: To evaluate the efficacy of MSE as a screening tool for detection of oral mucosal lesions and OPMDs in a high risk indigenous population with a high prevalence of tobacco and betel quid chewing habit. Methods: Two villages were selected as the sampling frame based on prevalence of tobacco and betel quid chewing habit. Respondents were asked to check their mouth for presence of lesion or abnormalities. Education on oral cancer, including MSE was provided. Subsequently, respondents were asked to perform MSE. Finally, a comprehensive oral examination (COE) was done by a specialist and the presence of oral mucosal lesions was recorded. Results: Almost 64.5% of respondents exhibited high levels of difficulty and low mucosal visualization and retracting ability, whereas 3.0% demonstrated high attention level when performing MSE. Prevalence of oral mucosal lesions was 59.0%, whereas the prevalence of oral potentially malignant disorders (OPMDs) was 9.0%. Detection of oral lesions by respondents using MSE was lower than detection by the gold standard. Sensitivity and specificity of MSE for detection of all types of lesions were 8.6% and 95.0% respectively. When analyzing each lesion type separately, MSE was found to be most sensitive in detection of swellings (10.0%), and most specific in identifying red lesions (100.0%). For detection of OPMDs, MSE yielded a high specificity of 98.9%, with an accuracy rate of 91.8%. Conclusion: MSE is a potentially good screening tool for OPMDs and oral cancer; however, awareness level of the public on oral cancer and its associated signs and symptoms needs to be improved.

[Hysteroscopically assisted laparoscopic salpingostomy in the treatment of tubal pregnancy]

OBJECTIVE

To present a case of conservative - Fallopian tube preserving - surgical therapy of tubal pregnancy.

DESIGN

Case report.

SETTING

Department of Obstetrics and Gynecology, Strakonice Hospital.

CASE DESCRIPTION

Due to the desire to preserve the Fallopian tube in a hemodynamically stable primigravida, we decided for laparoscopic salpingostomy using hysteroscopy for assisted removal of pregnancy tissue from the oviduct.

CONCLUSION

In well-selected cases, this treatment is an effective method of choice and can be performed even under conditions of a smaller hospital performing a common spectrum of laparoscopic surgery.