A Negative-Pressure Face-Mounted System Reduces Aerosol Spread during Endonasal Endoscopic Surgery.

Purpose Due to the potential risk of COVID-19 transmission during endonasal surgery, we studied methods to reduce droplet and aerosol generation during these procedures. Methods Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence in the operative field and surgeon's personal protective equipment. Density of aerosols sized <10 µm was measured using a photometric particle counter. We designed a face-mounted negative-pressure mask placed on the patients' face during endoscopic endonasal surgery. Sixteen patients were recruited between October 2020 and March 2021 and randomly assigned to the mask and no-mask groups. We compared droplet spread and aerosols generated in both groups, with copious irrigation and continuous suction during drilling forming the mainstay of surgical technique in all cases. Results Droplet contamination due to direct spillage of fluorescein from the syringe was noted in two patients. Aerosol density rose during sphenoid drilling in both groups, with no significant difference when continuous suction and irrigation were employed (1.27 times vs. 1.07 times the baseline, p = 0 .248 ). Aerosol density rose significantly when suction and irrigation were interrupted in the no-mask group (44.9 times vs. 1.2 times, p = 0 .028) , which was not seen when the mask was used. Conclusion Aerosol generation increases during drilling in endonasal procedures and is a concern during this pandemic. The use of a rigid suction close to the drill along with copious irrigation is effective in reducing aerosol spread. The use of a negative pressure mask provides additional safety when inadvertent blockage of suction and inadequate irrigation occur.

Successful Treatment of Subclavian Artery Thrombosis by Catheter-Based Thrombus Aspiration and Thrombolytic Therapy: A Case Report

Clinical Information Patient Initials or Identifier Number: BP4****/22 Relevant Clinical History and Physical Exam: A 55 Y / Female C/C : Pain, numbness, cold sensation & weakness of left upper limb for 2 hours. Risk Factor : Hypertension, diabetes mellitus O/E : Pale, cold and absent of radial, ulnar, brachial pulse of left upper limb. Muscle power 3/5 left side. So2 86%, BP undetectable. Right upper limb were normal. BP 160/90 mm of hg, pules : 112 b/min, RR : 26/min. Body Temperature 37.5 C [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: CBC : WBC 7450, HB % 10.8 g/dl, ESR 20mm in 1st hour, Platelets : 262000, SARS Cov2 Antigen : Negative PT 14.3 sec, INR : 1.07 APTT : 32.4 sec. blood group: O positive Serum Creatinine : 1.1 mg/dl Plasma glucose 9.7 mmmol/l HIV Ab : Negative HBs Ag : Negative Anti-HCV : Negative Urine R/E : Normal lipid profile : Cholesterol 280mg/dl Vascular duplex ultrasound of left upper limb : A dilated echogenic thrombus had blocked the left subclaviav artery lumen. Relevant Catheterization Findings: Conventional angiography with the lowest amount of contrast agent through the right femoral artery, revealed that left subclavian artery thrombosis with total occlusion distal to Left internal mammary artery. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: A5Fr MPA catheter with side holes was negotiated through a right femoral sheath and was placed in the left subclavian artery. Initially thrombus aspiration was done with Eliminate aspiration catheter (TERUMO) with no success. Then suction was done with the MPA catheter itself with partial removal of thrombus. Then a 5Fr Pigtail catheter was placed inside the thrombus and kept in situ. For residual thrombus 250,000u of Inj. Streptokinase as a thrombolytic drug was given through the Pigtail catheter as bolus over 30 min. The maintenance dose 100,000 u per hour was given over 24 hours through the Pigtail catheter via infusion pump. After 24 hours of thrombolytic therapy, her pain was reduced, the left hand became slightly warm, and distal pulses were feebly palpable. Moreover, the skin colour returned to near normal with improvement of pallor. Bleeding was well controlled at the catheter site. Doppler sounds revealed partial improvement of arterial flow. After evaluation of partial improvement, a low dose 1000 iu per hour of heparin (UFH)was infused intravenously for 24 hours. After 48 hours, repeat angiography via the inserted catheter at the site did not reveal any atherosclerotic plaque and confirm the thrombosis-dissolution. The latter practice demonstrated a good blood flowto the left upper distal limb leaving a little thrombus in the superficial palmer arch. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Catheter-based thrombus aspiration and thrombolytic therapy is primarily reserved for patients with acute viable limb ischemia. As observed in the presented case, thrombus aspiration and thrombolytic therapy is recommended to be considered as an alternative therapeutic method for patients with arterial thrombosis due to the rapid response, shorter treatment time and lower cost, compared to common and sometimes unsuccessful therapies.Copyright © 2023

Efficacy of a chairside extraoral suction system in the reduction of aerosol contamination.

The dental setting is regarded as a high-risk environment for aerosol concentrations and transmission of respiratory infectious agents, especially in relation to the COVID-19 pandemic. Although a number of approaches and practices have evolved to reduce the spread of pathogens in the dental setting, the risk of airborne infection remains a concern. Several new extraoral suction (EOS) devices have been marketed recently; further investigation is warranted to determine their clinical effectiveness. The aim of this study was to evaluate the efficacy of a chairside EOS device (PAX 2000 Extraoral Dental Suction System) in reducing aerosol contamination from patients receiving ultrasonic scaling by a registered hygienist as a part of initial or supportive periodontal therapy. The number of colony-forming units (CFUs) was measured with agar plates before, during, and after ultrasonic scaling at 3 different locations in the dental operatory (instrument table, patient chest area, and patient foot area). Forty subjects were randomly allocated into 2 test groups (n = 20) in which ultrasonic scaling was performed with or without the use of the EOS device. The CFUs retrieved after incubation were quantified and identified by their bacterial or fungal taxon. The use of the EOS device reduced the number of CFUs during scaling at all 3 locations, but the difference was only statistically significant (P = 0.018; Mann-Whitney U test) at the patient's chest area, where the highest number of CFUs was present. The aerosols consisted of 74 different taxa of human origin. The results suggest that the tested EOS system may reduce aerosol contamination in the clinical dental setting, especially in proximity to the patient's head, where most aerosols are generated.

Percutaneous Thrombectomy Using Angiovac System as a Diagnostic and Therapeutic Tool in Managing Right Atrial Mass in a High-Risk Patient

Background Right atrial (RA) masses often pose a dilemma in accurate diagnosis and management. We describe a challenging case of a large mobile RA mass in a febrile cancer patient. Case A 36-year-old female with newly diagnosed breast cancer on chemotherapy for 4 months via Port-A-Cath presented initially with COVID-19 pneumonia but continued to have persistent fever and dyspnea. A CT of the chest ruled out pulmonary embolism but showed an incidental RA mass. Echocardiography confirmed a large (2.7 x 1.6 cm), pedunculated mobile mass in the RA, attached to the free wall near the Eustachian valve (Fig.1). For a suspected thrombus, anticoagulation was initiated and a percutaneous thrombectomy using AngioVac was attempted. The mass was tightly attached to the atrial wall and too large to suction, resulting in only partial extraction of multiple tumor-like masses. Decision-making In addition to catheter-related thrombus and COVID-19 infection-related thrombus in transit, possibilities of myxoma, metastasis and fungal vegetation were considered due to its atypical features. A week later, pathology confirmed the diagnosis of an organized thrombus. Surgery was deferred and instead a repeat AngioVac using a larger aspiration catheter successfully aspirated the entire RA mass without complications. Conclusion Percutaneous aspiration of RA masses can prove to be of both diagnostic and therapeutic use, especially in high-risk patients. It can help avoid invasive surgical intervention in clinical dilemmas. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Successful Use of Biventricular Assist Devices in Fulminant Myocarditis

Background Fulminant myocarditis can cause biventricular dysfunction with a mortality rate over 40%. We report a case with severe biventricular failure due to fulminant myocarditis that was successfully supported by left and right ventricular assist devices. Case A 65-year-old woman presented with chest pain, abdominal pain and diarrhea. She was hypotensive and labs revealed elevated troponin-T of 13.5 ng/mL and lactate of 4.3 mmol/L. She was positive for COVID by antigen testing. She was started on multiple vasopressor infusions and admitted to the intensive care unit. Echocardiogram revealed a severely reduced left ventricular ejection fraction of 15% and severe global hypokinesis. The following day, she developed a wide complex tachycardia that was refractory to amiodarone, lidocaine and multiple defibrillation attempts. She was transferred emergently to the cardiac cath lab where coronary angiography revealed an isolated 70% stenosis of the distal left circumflex artery. A Swan-Ganz catheter was placed that yielded a cardiac index by Fick of 1.2 L/min/m2, systemic vascular resistance of 1270 dynesseccm-5 and mixed venous oxygen saturation of 35%. Decision was made to emergently insert an Impella CP device. That evening, she developed complete heart block and transvenous pacing wire was inserted. Due to frequent suction alarms, decision was made to insert ProtekDuo device, which resulted in hemodynamic stabilization. A temporary coronary sinus pacing lead for atrial capture was inserted to improve atrioventricular synchrony. After several days of monitoring, repeat echocardiogram showed complete recovery of biventricular function and Impella CP and ProtekDuo devices were removed. Decision-making The decision of early implantation of ProtekDuo device was made to provide adequate blood flow to the left ventricular assist device for hemodynamic support. In addition, increased atrioventricular synchrony via insertion of temporary coronary sinus pacing wire improved cardiac output. Conclusion Fulminant myocarditis involving biventricular dysfunction can be supported by the use of simultaneous left and right ventricular assist devices.Copyright © 2023 American College of Cardiology Foundation

COVID-19: An Opinion of Prevention and Dietary Based Management Hypothesis

Mentions the pandemic as starting in China, with a subsequent worldwide spread. The viral infection can seriously affect multiple organs, mainly lungs, kidneys, heart, liver, and brain, and may lead to respiratory, renal, cardiac, or hepatic failure. Vascular thrombosis of unexplained mechanism may lead to widespread blood clots in multiple organs and cytokine storms that are a result of over-stimulation of the immune system subsequent to lung damage, may lead to sudden decompensation due to hypotension and cause more damage to liver, kidney, brain or lungs. Until now, no drug has proved to be efficient in getting rid of the problem and controlling the pandemic mainly depends on preventive measures. Many measures can be considered to prevent the worldwide spread of the viral transmission. Polyunsaturated long chain fatty acids (PUFAs), medium chain saturated fatty acids (MCSFAs), and their corresponding monoglycerides have high antiviral activities against the enveloped viruses, which reached more than 10,000-fold reduction in the viral titers in vitro and in vivo after testing for gastric aspirate, and can contribute to the systemic immunity against the enveloped viruses.Copyright © 2021 Bentham Science Publishers.

Masking effect of sounds during treatment on dental drill sound

Sound environment of dental clinics has changed with the COVID-19 pandemic. Because the use of dental suction devices for infection control measures during dental treatment has increased compared to their use before the COVID-19 pandemic. Many dental patients experienced unpleasant feeling with the sound of a dental drills in dental clinics. In this study, the sounds emitted by dental drills and sound related to dental suction devices were prepared and psychoacoustic evaluation of the stimuli combined the both noises was conducted. The results showed that masking of some prominent frequency components of dental drill noise changed subjective impression and it may help to improve the discomfort feeling in the dental sound environment. © 2022 Internoise 2022 - 51st International Congress and Exposition on Noise Control Engineering. All rights reserved.

Assessing the implementation of guidelines surrounding aerosol generating procedures

This paper assesses the changing guidelines regarding Aerosol Generating Procedures and fallow time in Oral and Maxillofacial Surgery Departments in the UK. Many departments have variable local policies and protocols and this could be a contributing factor in increased waiting lists for patients during a time when patients have less access to primary and secondary care.Copyright © 2021

Real world experience of single use flexible bronchoscopy over six months in a tertiary centre

The development of single use flexible bronchoscopes (SUFBs) has accelerated in recent years, with the reduced risk of infectious transmission and reduced need for endoscopy staff particularly advantageous in the COVID-19 era. Despite complex cleaning systems for reusable flexible bronchoscopes (RFBs), disinfection is often inadequate with the consequent risk of cross infection. We trialled the routine use of The Surgical Company Bronchoflex © SUFB in a tertiary bronchoscopy service. 139 procedures were performed by five consultants from January to July 2021, with the main indications being infection (45%) and malignancy (32%). Most were performed in the endoscopy suite;eight procedures took place in the Intensive Care Unit, six at ward level and three in theatre as an adjunct to rigid bronchoscopy. SUFBs were used across a range of procedures including bronchoalveolar lavage, brushings, endobronchial biopsy, transbronchial needle aspiration, argon plasma coagulation, cryobiopsy and stent placement. 85% of procedures had no complications related to the use of a SUFB with a user satisfaction score of above 4/5 in 89% of cases (Figure 1). Issues with image quality (6%) or suction (5%) meant the reversion to reusable bronchoscope in some cases. Overall, the use of SUFBs has significant benefits in patient care with the ability to use the SUFB across a range of indications and procedures with high user satisfaction.

Quantifying strategies to minimize aerosol dispersion in dental clinics.

Many dental procedures are aerosol-generating and pose a risk for the spread of airborne diseases, including COVID-19. Several aerosol mitigation strategies are available to reduce aerosol dispersion in dental clinics, such as increasing room ventilation and using extra-oral suction devices and high-efficiency particulate air (HEPA) filtration units. However, many questions remain unanswered, including what the optimal device flow rate is and how long after a patient exits the room it is safe to start treatment of the next patient. This study used computational fluid dynamics (CFD) to quantify the effectiveness of room ventilation, an HEPA filtration unit, and two extra-oral suction devices to reduce aerosols in a dental clinic. Aerosol concentration was quantified as the particulate matter under 10 µm (PM10) using the particle size distribution generated during dental drilling. The simulations considered a 15 min procedure followed by a 30 min resting period. The efficiency of aerosol mitigation strategies was quantified by the scrubbing time, defined as the amount of time required to remove 95% of the aerosol released during the dental procedure. When no aerosol mitigation strategy was applied, PM10 reached 30 µg/m3 after 15 min of dental drilling, and then declined gradually to 0.2 µg/m3 at the end of the resting period. The scrubbing time decreased from 20 to 5 min when the room ventilation increased from 6.3 to 18 air changes per hour (ACH), and decreased from 10 to 1 min when the flow rate of the HEPA filtration unit increased from 8 to 20 ACH. The CFD simulations also predicted that the extra-oral suction devices would capture 100% of the particles emanating from the patient's mouth for device flow rates above 400 L/min. In summary, this study demonstrates that aerosol mitigation strategies can effectively reduce aerosol concentrations in dental clinics, which is expected to reduce the risk of spreading COVID-19 and other airborne diseases.

Development of a Novel Tabletop Device With Suction and Sanitization of Droplets against COVID-19.

Background Coronavirus disease 2019 and other viruses are transmissible by aerosols and droplets from infected persons. This study aimed to develop a portable device that can trap droplets and deactivate viruses, and verify whether the device in an enclosed room can suction droplets and sanitize them using a filter and an ultraviolet-C (UVC) light-emitting diode. Materials and methods The portable device was evaluated by placing it 50 cm away from the droplet initiation point. A particle image velocimetry laser dispersed into a sheet form was used to visualize the droplets splashed on the irradiated sagittal plane and captured using a charge-coupled device camera at 60 frames per second. The images were overlaid and calculated to determine the percentage of the droplets beyond the portable device. Droplets with a particle size larger than 50 µm that dispersed and were deposited more than 100 cm away were measured using a water-sensitive paper. The effect of UVC sanitization on viruses captured by a high-efficiency particulate air (HEPA) filter was determined using a plaque assay. Results The percentage of droplets was 13.4% and 1.1% with the portable device OFF and ON, respectively, indicating a 91.8% reduction. The deposited droplets were 86 pixels and 26 pixels with the portable device OFF and ON, respectively, indicating a 68.7% reduction. The UVC deactivated more than 99% of the viruses on the HEPA filter surface in 5 minutes. Conclusions Our novel portable device can suck and fall the dispersed droplets, and an active virus was not observed on the exhaust side.

Efficacy of an aerosol suction device Free-100 M in removing aerosols produced by coughing to minimize COVID-19 infection.

PURPOSE: The healthcare workers are at the greatest risk of being exposed to viral infection during airway management of a patient with coronavirus disease 2019 (COVID-19). An air extractor which suctions air around the patient's face would reduce the spread of viral aerosols during coughing, but no study has confirmed this. We assessed whether or not an air extractor reduces the amount of aerosols spreading toward the operator's face, during coughing of simulated patients. METHODS: After obtained approval of the study by a research ethics committee and written informed consent from 20 volunteers (and additional 20 volunteers), we asked each volunteer to lie supine on a table in a positive-pressure management operating room. As a cross-over design, we used an airborne particle counter (Handheld 3016, SGY company, Tokyo) to measure the aerosols approximately 30 cm above the participant's mouth, while the volunteer was coughing, with and without the use of an air extractor Free-100 M (Forest-one, Funabashi), facing the participant's mouth. In another 20 volunteers, the aerosols were measured, while each volunteer was lying supine, without coughing, and without the use of the air extractor. RESULTS: The aerosol count during coughing was significantly lower when the air extractor was used [median: 55 (interquartile range: 15-128)] than when it was not used [73 (44-201)] [p = 0.001, difference: 19 (95%CI: 4-70)]. CONCLUSIONS: The Free-100 M air extractor would reduce, but do not remove all, aerosols produced by coughing of a patient, and thus may reduce the risk of infection of COVID-19.

Safety and immunogenicity of the bi-cistronic GLS-5310 COVID-19 DNA vaccine delivered with the GeneDerm suction device.

OBJECTIVES: The CoV2-001 phase I randomized trial evaluated the safety and immunogenicity of the GLS-5310 bi-cistronic DNA vaccine through 48 weeks of follow-up. DESIGN: A total of 45 vaccine-naïve participants were recruited between December 31, 2020, and March 30, 2021. GLS-5310, encoding for the SARS-CoV-2 spike and open reading frame 3a (ORF3a) proteins, was administered intradermally at 0.6 mg or 1.2 mg per dose, followed by application of the GeneDerm suction device as part of a two-dose regimen spaced either 8 or 12 weeks between vaccinations. RESULTS: GLS-5310 was well tolerated with no serious adverse events reported. Antibody and T cell responses were dose-independent. Anti-spike antibodies were induced in 95.5% of participants with an average geometric mean titer of ∼480 four weeks after vaccination and declined minimally through 48 weeks. Neutralizing antibodies were induced in 55.5% of participants with post-vaccination geometric mean titer of 28.4. T cell responses were induced in 97.8% of participants, averaging 716 site forming units/106 cells four weeks after vaccination, increasing to 1248 at week 24, and remaining greater than 1000 through 48 weeks. CONCLUSION: GLS-5310 administered with the GeneDerm suction device was well tolerated and induced high levels of binding antibodies and T-cell responses. Antibody responses were similar to other DNA vaccines, whereas T cell responses were many-fold greater than DNA and non-DNA vaccines.

Efficiency of HEPA-filtered extra-oral suction unit on aerosols during prosthetic dental preparation: A pilot study.

OBJECTIVES: Aerosols formed during dental treatments have a huge risk for the spread of bacteria and viruses. This study is aimed at determining which part of the working area and at what size aerosol is formed and ensuring more effective use of HEPA-filtered devices. MATERIALS AND METHODS: Anterior tooth preparation was performed by one dentist with one patient. Particle measurements were made using an airborne particle counter and were taken at four different locations: the chest of the patient, the chest of the dentist, the center of the room, and near the window. Three groups were determined for this study: group 1: measurement in a 24-h ventilated room (before the tooth preparation, empty room), group 2: measurement with the use of saliva ejector (SE), and group 3: measurement with the use of saliva ejector and HEPA-filtered extra-oral suction (HEOS) unit. RESULTS: The particles generated during tooth preparation were separated according to their sizes; the concentration in different locations of the room and the efficiency of the HEOS unit were examined. CONCLUSIONS: The present study showed that as the particle size increases, the rate of spread away from the dentist's working area decreases. The HEPA-filtered extra-oral suction unit is more effective on particles smaller than 0.5 microns. Therefore, infection control methods should be arranged according to these results. CLINICAL RELEVANCE: The effective and accurate use of HEPA-filtered devices in clinics significantly reduces the spread of bacterial and viral infections and cross-infection.

Face And Mouth Openness Detection on Visual Servoing Robot Using Haar-cascade and Adaptive Boosting

The spread of Covid-19 virus occurs quickly, one of which is through sneezing and coughing (drops or saliva). This becomes an infectious material for dentists in carrying out dental care during the pandemic. Extra-oral suction (EOS) is a device for sucking the patient's Aerosol when performing surgery or dental treatment, but the nozzle of the suction device is still manually moved, therefore the position of the EOS nozzle is right above the patient's mouth. This allows for some aerosol particles that have not been inhaled by the device when the patient turns or changes his head position. In this paper, Visual Servoing (VS) is needed, which is an approach to guide a robot using visual information. Image processing (face and mouth detection), and controls are combined to be able to move or change the position of the nozzle automatically according to the position and direction of the patient's mouth. The human face and mouth openness pose detection can be done using the Haar-cascade method and the Adaptive Boosting (AdaBoost) algorithm. This system is expected to optimize performance in dentist operations and minimize the transmission of the Covid-19 virus. © 2022 IEEE.

Closed Endotracheal Suction Systems for COVID-19: Rapid Review.

BACKGROUND: The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. OBJECTIVE: This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. METHODS: A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." RESULTS: A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. CONCLUSIONS: Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.

Respirator with Air Blower and Air Quality Detector

This work is motivated by the challenges faced during the COVID-19 pandemic. Effective protection from the virus is needed. Masks is one way to protect from the virus. To support the efforots to control the spread of COVID-19 among the population, in this work we present an improved respiratory system consisting of a respiratory mask, air blower and a control system. Our design avoids some of the problems with available masks such as leak of unfiltered air and the irritation caused by these masks. To overcome this problem, the existing respirator is being modified to ensure user can breathe comfortably, no air gap on the side of respirator mask and respirator mask can measure air suction rate. Air blower will increase the air suction rate and sensor will detect the air quality and display it thru the monitor. User can monitor the air index surround them. A prototype is built. Testing of the prototype showed that the system functions as expected and achieves its objectives. On the downside, the prototype is heavier than existing products in the market. Further improvement in the design may lead to an improved version with reduced weight. © 2022 IEEE.

Clinical Efficacy of an Extraoral Dental Evacuation Device in Aerosol Elimination During Endodontic Access Preparation.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has caused many concerns in the dental field regarding aerosol production and the transmission of the severe acute respiratory syndrome coronavirus 2 virus during dental procedures. Because of the abrupt arrival of COVID-19, there has been little to no published research on the efficacy of dental suction devices in the removal of aerosols related to COVID-19 or the impact extraoral suction devices have on patients' experiences. Therefore, the aim of this study was to measure the amount of aerosol produced during endodontic access preparation for root canal therapy with and without the use of an extraoral dental suction device and to gather information through a survey regarding patients' experiences. METHODS: Aerosol measurements were recorded in 8 closed-door resident operatories each morning before the procedures, 1 minute during the procedure, and 15 minutes after the access was complete. The CICADA DTO KN99 Extraoral Dental Suction Device (Foshan Cicada, Guangdong, China) was placed in 4 operatories, whereas no DTO extraoral suction device was used in 4 control operatories. Twenty cases with DTO and 20 cases without it were completed, and the data were analyzed. RESULTS: Aerosols 1 minute after access were higher with and without DTO. There was a significant reduction after 15 minutes when the DTO device was used compared to high-volume suction alone. Composite and zirconia produced the most aerosols at 1 minute. CONCLUSION: The results show that the reduction of aerosols is enhanced when the extraoral suction device is used in combination with traditional high-volume evacuation. However, the increased noise level when using the device can have a negative impact on patients' dental experience.

OUTCOMES FROM CATHETER-DIRECTED EMBOLECTOMY VERSUS SURGICAL PULMONARY EMBOLECTOMY FOR PATIENTS WITH ACUTE PE

SESSION TITLE: Late Breaking Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Mortality from intermediate risk (IR) Pulmonary Embolism (PE) ranges from 1.9% to 14.5% and exceeds 31% in high risk (HR) PE. Catheter based therapies for IR PE offer an alternative to parenteral thrombolysis, and catheter directed embolectomy (CDE) may be associated with a low risk of bleeding. Surgical Pulmonary Embolectomy (SPE) is performed when thrombolysis is contraindicated or advanced therapies for IR, or HR PE have failed. Our aim was to compare the safety and efficacy of CDE versus SPE. METHODS: We performed a retrospective review of 34 consecutive patients with acute PE diagnosed by Chest CT angiography (CTA) admitted to three urban teaching hospitals from 8/2019-12/2021, who received FlowTriever Retrieval/Aspiration suction thrombectomy (CDE), or SPE. RESULTS: 15 patients received SPE, and 19 patients received CDE. Indications for SPE included failed CDE due to cardiac arrest n=1, failed catheter thrombolysis n=1, hemodynamic instability, and CTA evidence of chronic thrombi, or distal thrombi not accessible to CDE. All SPE had high clot burden, and echo evidence of RV failure. All following data are presented as SPE vs CDE. There was no statistically significant difference between both cohorts with respect to;female (%) (47 Vs 58), race, initial systolic BP (126 Vs 122 mmHg), and heart rate (101 Vs 99/min). Mean age was higher for CDE (56.4 Vs 67.6, p< 0.05). SPE patients had higher rate of dyspnea (93% Vs 53%) and longer duration of symptoms. PESI score (105 Vs 131) and PESI class were similar (p> 0.05). SPE patients included 53% IR and 47% HR, and CDE patients included 53% IR and 47% HR. On CTA, saddle PE was seen in SPE group (53% Vs 39%, p = 0.63) and 1 patient from SPE group and 2 patients from CDE group had clot in transit. Mean troponin 0.41 Vs 0.28, BNP 275 Vs 317, and D-dimer 8.5 Vs 16.5 were not significantly different. Procedure time was shorter for CDE (median 243 Vs 93 minutes, p<0.001). Median hospital length of stay (LOS) was similar (7.7 Vs 7 days p= 0.579), but median ICU LOS was shorter in CDE group (128 Vs 46.3 hours p<0.001). Survival rate on discharge was 93.4% Vs 89.5% (SPE Vs CDE). Causes of 30-day post procedure mortality included cardiac arrest due to RV failure and hypotension after CDE (10.5%). There was no 30-day post procedure mortality in the SPE cohorts. One death occurred 60 days post SPE for massive PE, from complications related to severe COVID-19 pneumonia. Major bleeding (need for 2 units PRBC) occurred in 27% Vs 5.3% following SPE Vs CDE. CONCLUSIONS: Acute PE patients who received CDE were older, had a shorter duration of symptoms, less dyspnea, reduced procedure time and shorter ICU stay vs SPE treated patients, but similar length of stay. CLINICAL IMPLICATIONS: CDE and SPE provided satisfactory results and SPE was effective for patients who had worse dyspnea, distal and or more chronic thrombo-emboli. DISCLOSURES: No relevant relationships by Samuel Acquah No relevant relationships by Hafiza Noor Ul Ain Baloch No relevant relationships by Madeline Ehrlich No relevant relationships by Yoshiko Ishisaka No relevant relationships by Omar Lattouf no disclosure on file for Robert Lookstein;No relevant relationships by Janet Shapiro No relevant relationships by David Steiger

LOOK BEFORE YOU LEAP: A REPORT OF A MISSED DIAGNOSIS

SESSION TITLE: Rare Pulmonary Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Tuberculosis (TB) rates in the USA are currently at the lowest in history. During 2010-17, only 5175 TB cases occurred in children in the USA. Even in Hidalgo County on the Texas-Mexico border there were only 36 cases of TB among all age groups in 2020. CASE PRESENTATION: An asymptomatic 3-year-old male presented to the PICU with a positive PPD and an infiltrate in the right lower lobe on chest x-ray. Once three morning gastric aspirates were obtained child was started on a 4 drug regimen recommended by the health department, and sent to the pulmonology clinic for further care awaiting identification and sensitivity of an organism. Child was born at 35 weeks gestation, spent 8 days in NICU for unclear reasons requiring intubation and oxygen. Upon review of patient history and chest x-ray, diagnosis of TB became less likely. This was further confirmed by gastric aspirate revealing no organisms and negative QuantiFERON Gold. CT with oral and IV contrast revealed a right-sided congenital diaphragmatic hernia (CDH) in the foramen of Morgagni. Patient received definitive outpatient surgery in October 2021. At 3-month follow-up there were no surgical complaints and patient reported increased exercise tolerance. DISCUSSION: TB is very rare in the US, even in the Rio Grande Valley where the proportion of cases are higher. This child received 42 doses of TB treatment after a positive PPD and consolidation on chest x-ray. However, x-ray did not clearly indicate TB infection and in fact was suspicious for bowel in the chest cavity. This case clearly indicates the need for careful examination of radiographs and ordering more tests such as the QuantiFERON Gold as needed before jumping to what may seem to be the obvious conclusion. Even though CDH are uncommon and Morgagni hernias are rare making up only 2-3% of CDH, a closer look at the case was warranted. This child's misdiagnosis led to more than simply unnecessary medical treatment, it also led to social stigma for the family that culminated in the father being terminated from his job. This child's surgical repair was delayed due to missed diagnosis of Morgagni hernia in NICU, PICU, and health department and delayed ordering of confirmatory TB tests. Furthermore, patient was referred to surgery in March 2020 but was delayed by 19 months due to COVID-19. The pandemic was also the stimulus for the outpatient nature of the complicated surgery. It is unclear why patient's PPD was positive. It is of note that mother's PPD was also positive due to contact with active TB years prior to child's birth. One hypothesis is this may have caused positive PPD in child and is a future question to pursue. CONCLUSIONS: We want to emphasize to look before you leap and investigate before you treat. There was harm to the child and family done by treating aggressively that could have been prevented and an opportunity to help the child that was delayed. Reference #1: Cowger TL, Wortham JM, Burton DC. Epidemiology of tuberculosis among children and adolescents in the USA, 2007–17: An Analysis of National Surveillance Data. The Lancet Public Health. 2019;4(10). doi:10.1016/s2468-2667(19)30134-3 Reference #2: Leeuwen L, Fitzgerald DA. Congenital diaphragmatic hernia. Journal of Paediatrics and Child Health. 2014;50(9):667-673. doi:10.1111/jpc.12508 Reference #3: Mohamed M, Al-Hillan A, Shah J, Zurkovsky E, Asif A, Hossain M. Symptomatic congenital Morgagni hernia presenting as a chest pain: A case report. Journal of Medical Case Reports. 2020;14(1). doi:10.1186/s13256-019-2336-9 DISCLOSURES: No relevant relationships by Isha Mittal No relevant relationships by Barbara Stewart