Preoperative COVID-19 RT-PCR Testing of Asymptomatic Patients for Ophthalmic Surgery: Experience from Two Tertiary Referral Centers

Purpose: The aim of this study was to evaluate how prevalent asymptomatic SARS-CoV-2 virus infection (COVID-19) is among patients undergoing ophthalmic surgery at two tertiary referral hospitals. Material(s) and Method(s): This retrospective study included patients without COVID-19 symptoms who underwent preoperative screening using reverse transcription-polymerase chain reaction (RT-PCR) before ophthalmic surgery at the Kocaeli University and Gaziantep University departments of ophthalmology [between September 1, 2020, and December 15, 2020 (group 1);between March 1, 2021, and May 30, 2021 (group 2)]. Patients scheduled for surgery and followed up in the retina, glaucoma, pediatric ophthalmology and strabismus, cataract and refractive surgery, and cornea departments were examined. Result(s): RT-PCR was positive for SARS-CoV-2 in 12 (1.4%) of 840 patients in group 1 and 7 (1.1%) out of 600 patients in group 2. None of the patients were symptomatic of COVID-19. The majority of the patients were scheduled for retina or cataract and refractive surgery in both groups (group 1;retina: 29.2%, cataract and refractive: 57.0%, group-2;retina: 31.3%, cataract and refractive: 54.5%). SARS-CoV-2 RT-PCR testing was positive for seven patients in group 1 (7/245, 2.9%) and five patients in group 2 (5/188, 2.6%) who were scheduled for retinal surgery. Conclusion(s): The necessity, availability, and practicality of COVID-19 RT-PCR testing prior to ophthalmic surgeries varies depending on the protocols of each institution. COVID-19 RT-PCR testing is suggested especially before vitreoretinal surgeries and general anesthesia procedures, because of the difficulty in managing postoperative complications.Copyright © 2023 Gazi Eye Foundation. All rights reserved.

Eye Sight - A Bull's Eye Target of COVID-19

Aim: To determine the effect of COVID-19 on eye sight due to increase screen time in undergraduate students of medical school. Study design: Cross-sectional study. Place and duration of study: This survey was carried out from October 2022 to December 2022 in Army Medical College Rawalpindi. Questionnaires were filled in person and also online-based platform was used to distribute the e-questionnaire, developed using the Google Form. The participants were asked to share the e-questionnaire with their friends using Facebook and Messenger. Method(s): Participants were selected for the study using non-probability consecutive sampling. College students of 20-25 years were included in the study. Sample size was 400 according to a study done internationally. Participants with comorbidities (cataract, glaucoma) were excluded from study. Participants having (trouble concentrating on things such as reading the newspaper, books or watching television) were included in the study. Digital eye strain was calculated using validated computer vision syndrome (CVS-Q) questionnaire to measure the symptoms such as eye fatigue, headache, blurred vision, double vision, itching eyes, dryness, tears, eye redness and pain, excessive blinking, feeling of a foreign body, burning or irritation, difficulty in focusing for near vision, feeling of sight worsening, and sensitivity to light. Qualitative data was analyzed using Chi square test. Results A total number of 470 responses were recorded, out of which 257 (54.7%) were males and 213(45.3%) were females. In our study, the most common symptom was headache, affecting 58.1% of the population before COVID 19 which has increased to 83.2% and the P value is less than 0.001.Theother symptoms which also showed P value less than 0.001 were blurred vision while using digital device, irritated or burning eyes, dry eyes and sensitivity to bright light. Conclusion The practical implication of the study is to create awareness among general population about COVID, that eye sight is Bull`s Target to be affected by it and simple preventing measures can be taken. The purpose of this study is to limelight the importance that during COVID 19 lockdown the excessive use of digital devices and their cons on the ocular health among future health care workers.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Emergency visits of otorhinolaryngology department during COVID-19 pandemic, Saudi Arabia, 2020

Aim: In this study, we aimed to assess the frequency of patient emergency visits to the Otorhinolaryngology (ORL) Department during coronavirus COVID-19 pandemic and compare it with that before coronavirus COVID-19. Material(s) and Method(s): A retrospective comparative study was performed at Al-Al-Hada Armed Forces Hospital, Taif (Saudi Arabia), and data regarding various diagnoses of ORL cases were collected from medical records of patients who visited/admitted to ORL-ED during the lockdown (Group 1) and those who visited/ admitted to ORL-ED before the pandemic (Group 2). Result(s): Group 2 had a significantly higher percentage of cases who had no ENT-related disorders, hypertrophy inferior turbinate (HIT), stridor, obstructive sleep apnea (OSA), epistaxis and who had no complications, had general ENT, foreign body ingestion-aspiration, trauma, otology and who had more than one disorder and Group 1 had a significantly higher percentage of those having nasal obstruction, tonsil hypertrophy grade 3, had emergency head and neck cancer, had deep neck space infections and who had complicated. Discussion(s): During coronavirus COVID-19 pandemic period, cold ENT visits were much less and foreign body ingestion remains the highest reason for ENT visits. Additionally, telemedicine has been shown to be effective in reducing ED visits during the pandemic period. Furthermore, older cases with chronic ENT problems who had regular follow-up ENT visits were less likely to visit ED during the pandemic.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Mistakes and complications in the diagnosis and treatment of children with organic foreign body aspiration

The reason for the publication of this article was the increase in the number of children with long-standing organic foreign bodies in the respiratory tract, the late diagnosis of which causes severe complications. The article presents the three most significant cases from the general series, when the diagnosis and treatment tactics at the stages of treatment were associated with errors both at the prehospital stage and in the hospital. In the first clinical case, as it turned out, the child had aspired multiple foreign bodies. The first bronchoscopy revealed one solid foreign body. Due to severe fibrinous-purulent endobronchitis and contact bleeding, the bronchoscopy procedure was aborted. However, after 10 days, the child independently coughed up the second seed, which was a surprise to us. Control bronchoscopy after 3 weeks revealed no foreign bodies. In the second clinical observation, a child developed bronchiectasis due to a long stay of a foreign body in the respiratory tract. The third case demonstrates the diagnosis and treatment tactics in a child with a foreign body against the background of a coronavirus infection. In the first and third cases, the results of treatment were satisfactory. In the second case, a long stay of peanuts in the respiratory tract led to bronchiectasis in the lower lobe of the left lung, which required its removal. In the follow-up, there are no complaints, the child grows and develops according to age. The study analyzes the mistakes made at the stages of diagnosis and treatment of children with foreign bodies in the respiratory tract. Conclusion. Young children with long-term and atypically current respiratory diseases, dubious and even normal radiological picture with the absence of comprehensive information on the anamnesis of diseases should alert the doctor to the possibility of aspiration of a foreign body in the respiratory tract and serve as the basis for performing bronchoscopy.Copyright © 2023 National Academy of Pediatric Science and Innovation. All rights reserved.

Upper Aerodigestive Tract Procedures in COVID-19 Pandemic

Since the late 2019 months' pandemic of Corona Virus Disease-2019 (COVID-19), it has spread globally and claimed abundant lives due to its expeditious interpersonal transmission and high mortality rate. Early studies showed that the upper aerodigestive tract procedures had the highest rates of nosocomial spread due to high viral load in upper respiratory and pharyngeal secretions. Between March 10 and April 10, 2020, a total of 28 rigid endoscopies were performed under general anesthesia for the removal of esophageal foreign bodies at our center. All the patients were screened on admission for symptoms of COVID-19 and a chest CT scan was performed and they were later followed up for further investigations. No patient had symptoms of COVID-19 (fever, cough, and dyspnea) on admission, and only one patient (3.57 %) had a suspicious CT scan for COVID-19. The mean age of 27 asymptomatic cases, including 14 men and 13 women, was 45.2 years old. Their average hospital stay was 0.8 days. all patients were later interviewed, inspected, and closely observed for any upcoming symptoms which would raise suspicion for COVID-19 during isolation. Of the 27 patients who cooperated, none showed COVID-19 symptoms. What makes this experiment prominent is that with suitable plans in a careful and precautionary manner, we can provide first-rate care for patients and meanwhile protect physicians during this pandemic promptly.Copyright © 2023 Tehran University of Medical Sciences.

Histomorphological Spectrum of Lung Lesions at Autopsy-A Tertiary Care Centre Experience

Background and aims: A wide variety of pathological conditions involve the lungs. In autopsy, the lungs are examined for disease, injury and other findings suggesting cause of death or related changes.Aims & Objectives: The present study aimed to study the histomorphological spectrum of lung lesions at autopsy and to assess the frequency of different types of lesions;and to associate histomorphological changes with cause of death.Material and Methods: It was a one-year observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. Lung tissue pieces from all medicolegal autopsies received were fixed, examined grossly, processed;paraffin embedded sections obtained were stained with Hematoxylin and Eosin stain and examined under microscope. Findings were recorded and tabulated. Result(s): Out of 264 cases, males were predominantly affected (84%);median age was 38 years. The various changes observed were congestion (68%), edema (45.4%), pneumonia (5%), granulomatous inflammation (3%), diffuse alveolar damage (1.5%), haemorrhage (14.4%), interstitial changes (60%), malaria (0.4%) and malignancy (0.4%). Natural deaths were the commonest cause (75, 28%) followed by asphyxial deaths (65, 24.6%). Conclusion(s): Histopathological examination of lung autopsies highlights many incidental findings, establishes underlying cause of death, serves as a learning tool and also holds scope for detection of newer diseases.Copyright © 2023 JK Science.

Unmasking a New Type of Gastrointestinal Foreign Body in the COVID-19 Era.

The incidence of foreign body ingestion has increased during the coronavirus disease 2019 pandemic. As face masks became increasingly available, we report a case of accidental ingestion of the metal strip insert of a surgical mask. After initially progressing, its progress halted after 24 hours. This case highlights the challenges of timing the endoscopic removal of long objects, especially considering the reduced endoscopic availability during the pandemic. Despite only causing local trauma, the strip was impacted at the duodenojejunal flexure with the potential to cause obstruction. Limiting morbidity relies on urgent removal and prevention of similar ingestions by emphasizing the safe use and storage of masks.

Post-Traumatic Cilia Remaining Inert in the Posterior Chamber for 50 Years.

Intraocular foreign body injuries (IOFB) can lead to a number of intraocular pathologies; the visual results depend on the mechanism of the injury, the type of foreign body and the subsequent complications. The presence of intraocular cilia (eye lashes) following penetrating injury or surgical intervention is uncommon. In the present paper, we present a case of a 58-year-old woman with a history of eye trauma and a perforated corneal wound in the left eye that occurred 50 years ago. On the ophthalmological exam we noticed in the anterior chamber a straight linear extension, resembling cilia, extending behind the iris. The patient reports that it appeared during COVID-19 infection, after repeated episodes of coughing. After a follow-up period, we decided to remove the eyelash; 24 h after surgery, the patient complained of severe eye pain. Intraocular pressure (IOP) in LE was 54 mmHg. The slit-lamp examination showed perikeratic congestion, corneal edema and mydriasis. Eye hypotensive treatment was started immediately and the patient's general condition slightly improved. Intraocular cilia can be tolerated for many years without causing any ocular reaction. The decision for surgical intervention must be taken according to the individual needs of the patient and his ocular characteristics with careful pre- and post-operative follow up.

The hidden dangers of SARS-CoV-2 testing

A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test.Copyright © 2021 The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

Mistakes and complications in the diagnosis and treatment of children with organic foreign body aspiration.

The reason for the publication of this article was the increase in the number of children with long-standing organic foreign bodies in the respiratory tract, the late diagnosis of which causes severe complications. The article presents the three most significant cases from the general series, when the diagnosis and treatment tactics at the stages of treatment were associated with errors both at the prehospital stage and in the hospital. In the first clinical case, as it turned out, the child had aspired multiple foreign bodies. The first bronchoscopy revealed one solid foreign body. Due to severe fibrinous-purulent endobronchitis and contact bleeding, the bronchoscopy procedure was aborted. However, after 10 days, the child independently coughed up the second seed, which was a surprise to us. Control bronchoscopy after 3 weeks revealed no foreign bodies. In the second clinical observation, a child developed bronchiectasis due to a long stay of a foreign body in the respiratory tract. The third case demonstrates the diagnosis and treatment tactics in a child with a foreign body against the background of a coronavirus infection. In the first and third cases, the results of treatment were satisfactory. In the second case, a long stay of peanuts in the respiratory tract led to bronchiectasis in the lower lobe of the left lung, which required its removal. In the follow-up, there are no complaints, the child grows and develops according to age. The study analyzes the mistakes made at the stages of diagnosis and treatment of children with foreign bodies in the respiratory tract. Conclusion. Young children with long-term and atypically current respiratory diseases, dubious and even normal radiological picture with the absence of comprehensive information on the anamnesis of diseases should alert the doctor to the possibility of aspiration of a foreign body in the respiratory tract and serve as the basis for performing bronchoscopy.Copyright © 2023 National Academy of Pediatric Science and Innovation. All rights reserved.

Cyanoacrylate glue reactions: A systematic review, cases, and proposed mechanisms.

OBJECTIVE: Cyanoacrylate glue closure was first used in humans 10 years ago to treat venous reflux of the axial veins. Studies have since shown its clinical efficacy in vein closure. However, great need exists to elucidate further the types of specific adverse reactions that cyanoacrylate glue can cause for better patient selection and to minimize these events. In the present study, we systematically reviewed the literature to identify the types of reported reactions. In addition, we explored the pathophysiology contributing to these reactions and proposed the mechanistic pathway with inclusion of actual cases. METHODS: We searched the literature for reports of reactions following cyanoacrylate glue use in patients with venous diseases between 2012 and 2022. The search was performed using MeSH (medical subject headings) terms. The terms included cyanoacrylate, venous insufficiency, chronic venous disorder, varicose veins, vein varicosities, venous ulcer, venous wound, CEAP (clinical, etiologic, anatomic, pathophysiologic), vein, adverse events, phlebitis, hypersensitivity, foreign body granuloma, giant cell, endovenous glue-induced thrombosis, and allergy. The search was limited to the literature reported in English. These studies were evaluated for the type of product used and the reactions noted. A systematic review, in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) method, was performed. Covidence software (Melbourne, VC, Australia) was used for full-text screening and data extraction. Two reviewers reviewed the data, and the content expert served as the tiebreaker. RESULTS: We identified 102, of which, 37 reported on cyanoacrylate use other than in the context of chronic venous diseases and were excluded. Fifty-five reports were determined appropriate for data extraction. The adverse reactions to cyanoacrylate glue were phlebitis, hypersensitivity, foreign body granuloma, and endovenous glue-induced thrombosis. CONCLUSIONS: Although cyanoacrylate glue closure for venous reflux is generally a safe and clinically effective treatment choice for patients with symptomatic chronic venous disease and axial reflux, some adverse events could be specific to the properties of the cyanoacrylate product. We propose mechanisms for how such reactions can occur based on histologic changes, published reports, and case examples; however, further exploration is necessary to confirm these theories.

The importance of vaginoscopy in premenarchal girls with vaginal bleeding- call for more PAG practioners

Introduction: Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to both parents and physicians. The variable etiologies of vulvovaginitis are the most common causes of vaginal bleeding during the prepubertal period. We report a series of three cases observed during covid" period of 2020-2022. Case report: two patients 8 and 9 year -old girls, were refered to pediatric secondary center due to of external vaginal bleeding. Hormonal levels were pre-pubertal and bone age was not advanced. Both girls were hospitalized and sellar X-ray and pelvic MRI were done during further course, not revealing the etiology of bleeding. Six months after the first bleeding, they were reffered to a pediatric gynecologist where foreign bodies (grass seed) were found during vaginoscopy. Third patient, a 3-year- old girl, was examined by her pediatrician because of heavy bleeding. Hormonal analysis and bone age were not suggestive of precocious puberty. Additional analyses revealed elevated alpha fetoprotein level (>5000 IJ,), which led to the diagnosis of yolk sac tumor in vagina wall, which was then confirmed by vagionoscopy and biopsy. It is important to perform vaginoscopy in premenarchal girls with repeated vaginal bleeding because in patients older than five years, a common reason for vaginal bleeding is foreign body but in younger patients, the primary goal is to exclude a malignant tumor.Copyright © 2023

Foreign Bodies Detector Based on DETR for High-Resolution X-Ray Images of Textiles

Foreign bodies (FBs) detection for X-ray images of textiles is a novel and challenging task. To solve the problem of poor performance of anchor-based detectors for FBs detection, we propose a feature-enhanced object detection framework with transformer (FE-DETR). Based on the split-attention of residual split-attention network (ResNeSt), we add convolutional block attention module (CBAM) between residual blocks and replace the $3\times $ 3 convolutional layer of the last residual block with deformable convolution network (DCN) to adapt FBs with different scales. Then, we propose a multiscale feature encoding (MSFE) module to solve the feature dispersion caused by deep convolution. Meanwhile, the transformer module is selected as the prediction head of the detector. During training, several heuristic strategies are used to further optimize the performance of FE-DETR. In addition, we construct a benchmark dataset for the textile FBs detection task. With end-to-end training, FE-DETR achieves higher performance than the baseline and mainstream state-of-the-art methods, with mean average precision (mAP) = 0.74, average precision (AP) = 0.992, average recall (AR) = 0.971, and $F1$ -score = 0.987. This article has been applied to the production line of medical protective clothing during the Corona Virus Disease 2019 (COVID-19) period and has yielded impressive results in actual production. © 1963-2012 IEEE.

Foreign Body Ingestion: A Real Hazard during the Covid Pandemic

Children curiosity for exploring their surrounding environment make them prone to foreign body (FB) ingestion which may lead to injuries and surgical intervention. COVID pandemic and national lockdown has impacted children's normal environment in addition to the changes in the health care system provision. The aim was to determine if the pandemic had a direct impact on the number and management of FB ingestion cases. Method All patients who were referred to our institution with diagnosis of FB from March 2020 to December 2020 were included. They were compared with FB referral during the period March-Dec 2019 as a control. Data included patients' demographics time to presentation type of FB ingested and management approach. Results There was a total of 30 patients with diagnosis of gastrointestinal FB during the study period as compared to 12 patients during the control periods. Thus during the COVID pandemic there was 2.5 times rise in number of cases. The mean age at presentation was 6.4 years during the study period as compared to 4.6 years in the control group. Timing of presentation varied from 0 to 57 days during the COVID pandemic as compared to control group who presented within 24hr except one who presented after 48hr.The most common foreign bodies encountered during the pandemic were button batteries (12) magnets (7) coins (5), other sharp and metallic objects (6). Two third (67%) of patients in the study period required surgical intervention as compared to one third (33%) during the control period. Most common site of impaction was stomach (40%) followed by oesophagus (36.6%). Conclusion The total number of children diagnosed with FB ingestion had significantly increased during the COVID pandemic. Public campaigns should be focused on raising awareness about the danger and medical emergency as a result of FB ingestion.

Spontaneous embolization of an aortic prosthesis disc

We report the case of spontaneous disc embolization of a mechanical aortic prosthesis 4 years after its implantation. The reason for the implant was due to bacterial endocarditis. The patient was admitted with dyspnea and severe pulmonary edema due to aortic insufficiency that required immediate prosthesis replacement surgery. Cardiac catheterization revealed the absence of the disc, which was confirmed intraoperatively. Postoperative radiographic controls showed that the disc was embedded in the center of the longitudinal axis of the left iliac without causing obstruction to blood flow. The disc was never removed. The patient remained asymptomatic without vascular sym ptoms for 15 years. He died due to Fornier's gangrene complicated by Covid-19.Copyright © 2022 Sociedad Espanola de Cirugia Cardiovascular y Endovascular

The Prevalence of COVID-19 in Asymptomatic Cases and Its Effect on Complication Development in Children Scheduled for Emergency and Urgent Surgery.

Objective: Although COVID-19 in childhood is often asymptomatic or has a more benign course, the safety of healthcare workers should be the primary goal because of the risk of contamination. In our study, we aimed to investigate the asymptomatic COVID-19 PCR positivity and its effect on the development of complications in emergency and non-deferred surgery cases that will help both the patient, the operating room and the health care workers. Material(s) and Method(s): This is a prospective study that was performed in patients under 18 years of age who were operated on due to emergency and urgent cases in the Ankara City Children's Hospital, which was serving as an anti-pandemic hospital. The patients were evaluated from May 1 to October 1, 2020. Of the 458 patients, 433 patients who met the criteria were included in the study. COVID-19 Nasopharyngeal swab (PCR) samples were taken from all patients along with preoperative examinations. Result(s): Of the 433 cases included in the study, 155 (33.5%) were girls and 278 (66.5%) were boys. It was determined that emergency cases constituted 389 (89.8%) of all cases. The most common emergency pathologies according to age groups were intestinal obstruction or atresia in the neonatal period, foreign body aspirations of the respiratory tract in the preschool period, and acute appendicitis in the school age. Nasal swab PCR results were positive in only four patients, this rate was found to be 0.9% in the entire study group, and postoperative complications and transmission to healthcare workers were detected at none. Conclusion(s): In this prospective study, low COVID-19 PCR positivity (0.9% prevalence) was detected in asymptomatic children scheduled for emergency or non-deferred surgery, and we believe that it will shed light on the planning of safe procedure practices.Copyright © 2021 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

A Unique Case of Pericardial Effusion and Tamponade

Background We present a unique case of a female who developed a large pericardial effusion (PEff) from a rare cause. Case A 36-year-old female with recent COVID-19 infection presented with acute dyspnea. She had undergone liposuction, rectus plication and breast augmentation two months ago. Heart rate was 90/min and blood pressure 86/57mmHg. CT angiogram of the chest revealed a massive PEff with tamponade. She had large right-sided pleural effusion also. She underwent ultrasound-guided pericardiocentesis with the removal of 950 milliliters of serosanguineous fluid. Follow-up echocardiogram showed re-accumulation of fluid. Due to the rapid onset of PEff, she underwent a pericardial window and bilateral chest tube placement. Decision-making Pleural and pericardial fluid analysis showed silicone-gel particles (Figure. 1). Pericardial biopsy showed nonspecific chronic inflammation. Autoimmune workup was unremarkable. Elevated ESR and CRP in the presence of embolized gel particles indicated foreign body reaction from silicone embolism. Plastic surgery advised implant removal. Silicone embolism is known to cause silicone thorax, pleural effusions, and anaplastic large cell lymphoma. To our knowledge, this is the first reported case of PEff due to silicone embolism from breast implants. Conclusion Cardiologists should be aware of this rare but serious complication. Silicone embolism should be considered in the differential of PEff in patients with breast implants. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Pioneering wound treatment in a suffragette military hospital in World War 1

In the face of massive numbers of casualties returning to the UK in World War 1, health services were rapidly reorganized under the leadership of Sir Alfred Keogh. Hundreds of military hospitals were set up. Sir Alfred personally asked two women doctors, both militant suffragettes and members of the British Women's Social and Political Union, to set up and run a hospital in London. This remarkable hospital was to pioneer new antiseptic treatments for wounds. Endell Street Military Hospital was set up in 1915 by doctors Flora Murray and Louisa Garrett Anderson. The hospital was staffed and run solely by women, treating 26 000 patients in 520 beds over the course of the war. One of their most heroic contributions was to the care of wounds in injured soldiers returning from France. Throughout the war wound infections led to the deaths of thousands of soldiers and contributed to significant morbidity such as limb loss in countless others. In 1916 James Rutherford Morrison, Professor of Surgery in Durham, invented bismuth iodoform paste (BIPP) for the treatment of wound infections. The paste has significant antimicrobial properties. The Endell Street doctors contacted Morrison in June 1916 and started using his formulation on injured patients. By early 1917 they had treated > 400 patients with gunshot wounds, compound fractures, septic wounds, through-and-through wounds and foreign body wounds with BIPP, reporting their findings in The Lancet (Garrett Anderson L, Chambers H. The treatment of septic wounds with bismuth-iodoform-paraffin paste. Lancet 1917;189: 331-3). They reported no cases of tetanus or gas gangrene and were able to explain side-effects such as iodine and bismuth poisoning, why it occurred and how it could be avoided. BIPP has been in use constantly since 1916, and is still used today in ear, nose and throat departments, especially for packing nasal cavities. By changing from the traditional eusol (sodium hypochlorite solution) to BIPP Drs Murray and Anderson reduced dressing changes from daily to once every 7-14 days, saving staff time, costs and hugely improving outcomes. These women doctors saved hundreds of lives and pioneered wound treatments that are still used today. Both were awarded the CBE for their services, but sadly the hospital staff were sacked at the end of the war, when the hospital closed. This form of pioneering work, conducted under great strain with limited resources is still to be seen today in the COVID-19 pandemic.

SARS-CoV-2 Nasopharyngeal Swab as a Foreign Body: A Case Report.

The SARS-CoV-2 pandemic response utilizes nasopharyngeal swabbing as a prolific testing method for presence of viral RNA. The depth of the swab to the nasopharynx coupled with breakpoints along the shaft leads to a risk for foreign body retention. Here, we present a case of a nasopharyngeal swab that became a retained foreign body during routine swabbing to test for the SARS-CoV-2 virus. Bedside flexible fiberoptic endoscopy was performed and did not reveal a foreign body in the nasopharynx or larynx. Subsequent computed tomography (CT) scan demonstrated the radiopaque retained foreign body at the distal gastroesophageal junction. The patient remained asymptomatic and did not have any upper airway or gastrointestinal symptoms. This unique case demonstrates a potential risk associated with SARS-CoV-2 nasopharyngeal swab testing and highlights management strategies that serve the patient while adequately protecting health care providers. A standardized approach to evaluation optimally includes bedside flexible endoscopy with appropriate personal protective equipment, prompt airway evaluation if aspiration is suspected, and noncontrasted CT imaging if the known foreign body is not identified via other modalities.