Severe scalds sustained during steam inhalation therapy in an adult population: Analysis of patient outcomes and the financial burden to healthcare services.

BACKGROUND: Steam inhalation therapy (SIT) is a common home remedy for the treatment of upper respiratory tract infections. Literature reports are increasingly discouraging this practice in the paediatric population due to the risk of scalds, however, this is yet to be echoed for adults. METHODS: A retrospective review of patients admitted to a tertiary burns centre from 2015 to 2020 was undertaken identifying all adult patients requiring in-patient specialist treatment for scald injuries sustained during steam inhalation. Cost analysis and long-term patient outcomes were reviewed. RESULTS: Twelve adult patients required inpatient management with a mean length of admission of 8 nights. One patient required operative intervention, long-term sequelae included scarring, skin sensitivity, pain, or psychological morbidity. The estimated mean cost per patient was £5402 giving a mean cost per year of £12 964. CONCLUSION: SIT can be associated with severe scald injuries in adults and incur considerable costs for healthcare providers.

Head and neck research in plastic surgery-Ahead of the rest? An analysis of abstracts presented at British association of plastic reconstructive and aesthetic surgeons meetings.

INTRODUCTION & AIMS: Historically, the head and neck (H&N) discipline has been integral to the service a plastic surgeon provides. Recently, it has been postulated that its popularity is declining. The output of scientific meetings may indicate the popularity of each sub-speciality interest, also allowing comparison with other H&N conferences. AIM: To analyse the proportion of H&N themed, podium and poster presentations from British Association of Plastic Reconstructive and Aesthetic Surgeons' (BAPRAS) scientific meetings and the resulting contribution to published literature. MATERIAL AND METHODS: H&N-themed abstracts were identified from finalised programmes of the biannual BAPRAS meetings between 2008 and 2015. PubMed and Google Scholar databases were searched using keywords and author names from each abstract to identify subsequent publication in a peer-reviewed journal. RESULTS: Overall, 19.3% (350/1815) of BAPRAS abstracts were H&N themed. The publication rate of H&N abstracts was 40.3% (141/350), comprising 43.0% (114/265) of podium and 31.8% (27/85) of poster presentations. H&N reconstruction and cleft and craniofacial were the most frequent topics, with facial palsy having the lowest conversion rate at 15.4%. The mean time to publication was 17.8 months. Research was published in 39 journals, with a mean impact factor of 2.151 (range = 0.772-11.541). The most popular journal was Journal of Plastic, Reconstructive & Aesthetic Surgery (JPRAS; 31.7%; 45/141). Published abstracts originated from 17 different countries. The senior author was a plastic surgeon in 77.3% of abstracts. CONCLUSIONS: From the multiple potential sub-specialties, H&N-themed abstracts consistently contributed 20% of all research presented at BAPRAS. The 40.3% publication rate exceeds the international average of scientific meetings. H&N remains a prominent field in the armamentarium of a plastic surgeon.

Volatile organic compounds of Metarhizium brunneum influence the efficacy of entomopathogenic nematodes in insect control.

The entomopathogenic fungus (EPF) Metarhizium brunneum occupies the same ecological niche as entomopathogenic nematodes (EPN), with both competing for insects as a food source in the rhizosphere. Interactions between these biocontrol agents can be antagonistic or synergistic. To better understand these interactions, this study focussed on investigating the effect of M. brunneum volatile organic compounds (VOCs), 1-octen-3-ol and 3-octanone, on EPN survival and behaviour. These VOCs proved to be highly toxic to the infective juveniles (IJs) of the EPN Steinernema carpocapsae, Steinernema feltiae and Heterorhabditis bacteriophora with mortality being dose dependent. Chemotaxis studies of H. bacteriophora IJs in Pluronic F127 gel revealed significant preference for the VOCs compared with controls for all tested concentrations. The VOCs also impacted on the test insects in a dose-dependent manner with 3-octanone being more toxic to Galleria mellonella, Cydia splendana and Curculio elephas larvae than 1-octen-3-ol. Mortality of C. splendana and G. mellonella larvae was significantly higher when exposed to relatively high doses (>25%) of 3-octanone. Lower doses of 3-octanone and 1-octen-3-ol immobilised test insects, which recovered after exposure to fresh air for 2 hrs. In depth studies on H. bacteriophora showed that exposure of IJs to > 10% concentration of 3-octanone or 1-octen-3-ol negatively affected infectivity whereas exposure to lower doses (0.1%, 0.01%) had no effect. The VOCs affected IJs, reducing penetration efficacy and the number of generations inside G. mellonella but they failed to inhibit the bacterial symbiont, Photorhabdus kayaii. The ecological significance of VOCs and how they could influence EPF-EPN insect interactions is discussed.

Safety of limb-salvaging surgery for sarcomas compromising major vessels: A 15-year single-centre outcomes study.

INTRODUCTION: Limb-threatening sarcomas invading major vessels present an oncological and reconstructive challenge. Curative resection involves either performing an amputation or an immediate reconstruction of the invaded vessels. We present our 15-year experience of these cases at the North of England Bone and Soft Tissue Tumour Service. MATERIALS AND METHODS: A Strengthening the Reporting of Observational studies in Epidemiology (STROBE) compliant retrospective review of our prospective database was performed including patients who required major vessel reconstruction following sarcoma excision from 2003 until 2018. Patient demographic data along with tumour and histological subtypes, treatment modality, complications and outcomes were inquired. Autologous and prosthetic vessel reconstruction approaches were compared. RESULTS: Nineteen patients were identified with the most common tumour locations being the thigh and groin areas. Five cases involved recurrent tumours. Clear resection margins were obtained in 15 cases. Autologous vein grafts were preferred over polytetrafluoroethylene (PTFE) prosthesis in 17 cases. A pedicled flap or free flap was required to achieve adequate soft tissue cover in six patients, while the rest underwent primary closure. Five patients lost the patency of the reconstructed vessels with one of these requiring an amputation. The estimated disease-specific survival at 5 years was 58%. DISCUSSION: Limb-preservation surgery in the context of vessel compromise is not only safe, but also a functionally and psychosocially beneficial means of avoiding an amputation. We believe that careful pre-operative planning and discussion in a multidisciplinary setting is key for obtaining positive outcomes.

In patients undergoing video-assisted thoracic surgery for pleurodesis in primary spontaneous pneumothorax, how long should chest drains remain in place prior to safe removal and subsequent discharge from hospital?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how long chest drains should be left in place following video-assisted thoracic surgery (VATS) pleurodesis for primary spontaneous pneumothorax. Altogether, a total of 730 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We report that the main determining factor for the length of hospital stay following VATS pleurodesis is chest-drain duration. Providing no postoperative complications occur, and chest X-ray appearances of lung inflation are satisfactory, there is no documented contraindication to removing chest drains as early as 2 days postoperatively, with discharge the following day. Furthermore, leaving chest drains on water seal after a brief period of suction has been shown to benefit in reducing postoperative chest-drain duration and subsequent hospital stay. There is a paucity of literature directly addressing early vs late chest-drain removal protocols in this patient group. Hence, we conclude that, in clinical practice, the decision of when to remove chest drains postoperatively should remain guided empirically towards the individual patient.