Misericordia Community Hospital

Virtual Surgical Planning (VSP) for tongue reconstruction promises patient-specific optimizations, but its utility is limited by the difficulty of translating a digital plan to a deformable organ. This study evaluated the feasibility and anatomical accuracy of a patient-specific, additively manufactured surgical toolkit through benchtop experiments on soft-tissue phantoms. Four distinct hemiglossectomy reconstruction cases were planned using VSP and executed on patient-specific silicone tongue phantoms. The guided workflow, performed by an independent surgeon, incorporated: (1) resection marking guide, (2) intraoperative volume inspection guide, (3) donor flap harvesting guide with decoupled planar and volumetric control, and (4) marker-guided flap insetting. High-resolution 3D surface scans were used to quantify anatomical fidelity by measuring the surface deviation between the pre- and post-procedure scans. All four guided reconstructions were successfully completed. Mean surface deviation was 0.76-1.26 mm, and the 99th percentile (robust maximum) ranged 3.37-4.13 mm. This accuracy is comparable to that reported for established patient-specific osseous reconstructions. The operating surgeon found the toolkit intuitive, the workflow sequencing clear, and the volumetric inspection step practical. This benchtop study demonstrates that a patient-specific, guided surgical toolkit can feasibly and reliably translate tongue VSP into accurate reconstructions on soft-tissue phantoms. By introducing a volume feedback mechanism and decoupling the flap's planar shape from its volume, the system provides adaptive guidance that is both geometry- and volume-aware. These findings support progression to cadaveric studies and early clinical validation to evaluate overbulking strategies, intraoperative adaptability, and correlation with functional outcomes.

The choice of a specific anatomic site for vaccine administration may influence rates of acceptance but has not been studied before. We conducted a randomized controlled trial in a pretravel clinic, comparing reported levels of satisfaction and pain on a scale of 0 to 10, and the frequency of adverse events (AEs) for vaccination in different anatomic sites. Travelers receiving one vaccine were randomized to be immunized in the deltoid or the vastus lateralis muscle. Travelers receiving multiple vaccines were randomized to be immunized in both the vastus lateralis and deltoid muscles or preferably in either the deltoid or the vastus lateralis muscles. For the 159 participants receiving multiple vaccines day 0 and day 7 satisfaction levels for the vastus lateralis, combined strategy or the deltoid injection sites were 9.00 ± 1.63, 9.46 ± 1.16 and 9.82 ± 0.52 (p = 0.001), and 6.62 ± 3.16, 8.87 ± 1.91 and 8.87 ± 2.05 (p < 0.001), respectively. For the 33 participants who received a single vaccine, day 0 and day 7 satisfaction levels for the vastus lateralis and deltoid muscles were 8.9 ± 2.2 and 10 ± 0.0 (p = 0.048) and 7.8 ± 2.7 and 9.8 ± 0.5 (p = 0.04), respectively. Pain levels on day 0 were similar across all study groups. However, muscle pain on day 7 was reported more frequently among participants vaccinated in the thigh region (61.7%) compared to those vaccinated in the deltoid muscle (31.9%) or at both sites (43.8%) (p < 0.01). Additionally, localized adverse events were reported more often by females (74.2%) than by males (48.8%) (p = 0.002). We found lower levels of satisfaction in travelers vaccinated in the thigh region. Such data may aid in increasing vaccination coverage and may influence practice guidelines. The trial was registered in accordance with local regulatory requirements under study identification number RMB518-18.

Abstract Introduction: viral infections trigger 85 to 95% of asthma attacks in children; however, each infectious agent has different characteristics, and the intensity of the attack varies among patients. Our objective was to evaluate and characterize patients with asthma attacks and the viral isolation identified through molecular tests and/or antigens, as well as to assess predictors of prolonged hospital stay based on the findings. Methodology: crosssectional analytical study using a binary logistic regression model to analyze the outcome of prolonged hospital stay. Results: all patients who attended San Ignacio Hospital from January 2021 to December 2022 were analyzed, resulting 775. Of these, 534 patients met the inclusion criteria, with 284 (53.2%) being male.The median age was 5 years, IQR 5 years. A viral panel was performed on 344 (64.4%), PCR for SARS-CoV-2 on 351 (65.7%), and a Film Array on 183 (34.3%).Rhinovirus/enterovirus was isolated in 127 patients, Respiratory Syncytial Virus (RSV) in 67 (12.5%), COVID-19 in 48 (9%), Adenovirus in 27 (5.1%), Metapneumovirus in 18 (3.4%) and Influenza in 13 (2.4%). The median length of stay was 3 days, with an IQR of 5 days. The 75th percentile was 6 days. A prolonged stay was defined as being hospitalized for 7 days or more, with 85 (16%) in this group, and associated predictors were evaluated. A total of 187 (35%) children experienced a mild crisis, 223 (41.8%) had a moderate crisis, and 124 (23.2%) had a severe crisis requiring admission to an intensive care unit; 119 (22.3%) received highflow nasal cannula (HFNC). In the bivariate analysis, a statistical significance was found with the variables age, having a positive test for SARS-CoV-2, RSV, any comorbidity, experiencing a severe crisis, the need for HFNC, Venturi mask and the service in which care was received. Using these variables, a logistic regression model was run, which found independent predictors of prolonged stay to be having a positive PCR for SARS-CoV-2 OR 3.50 (1.47-8.32) p 0.004 and, as a protective factor, admission to basic care hospitalization OR 0.21 (0.21-0.96) p: 0.00. Conclusion: Viruses are an important cause of asthma exacerbations. In our group of patients, SARS-CoV-2 infection was a factor related to prolonged stay, a noteworthy finding since it has not been frequently reported in the literature and reinforces the need for infection prevention. General hospitalization reflects the severity of the crisis, so children who do not require special care have shorter hospital stays.

eConsult allows specialists to diagnose and recommend treatment plans for nonurgent conditions without the need for patient travel. Our purpose is to evaluate the effectiveness of eConsult in reducing unnecessary in-person retinal consultations in Manitoba. Retrospective eConsult chart review. Any person for whom an eConsult was submitted for a retina problem in Manitoba between November 2020 and October 2023 (n = 196). The primary objective was to quantify eConsults requiring no in-person referral, routine in-person referral, or urgent (within 4 weeks) in-person referral. Secondary objectives included describing characteristics of eConsults and quantifying the amount of time spent on the platform by both the referring provider and the specialist. On the basis of these variables, patient travel, consultation time, and specialist billings savings were calculated. 66.8% of eConsults did not require in-person assessment (n = 131), 24.5% required to be seen on a routine basis (n = 48), and 8.7% required to be seen within 4 weeks (n = 17). This translated to a net cost of $2,660.43 for the provincial government in billings over 3 years, but 81 990 km saved in patient travel. 99% of eConsults came from optometrists (n = 194). Referring providers spent an average of 10.6 ± 9.4 minutes on the platform per referral, and the specialist consultant spent 9.1 ± 6.6 minutes. eConsult is a potentially cost-effective way to address increasing demand for retinal services, reduce wait times by reducing unnecessary referrals, and facilitate data sharing between optometrists and ophthalmologists.

Restoration of dental occlusion and oral rehabilitation is the ultimate goal of functional jaw reconstruction. To evaluate the prefabricated fibula flap (PFF) technique in occlusion-driven jaw reconstruction for benign or previously treated malignant disease. This cohort study was conducted from January 2000 to December 2019 at the University of Alberta Hospital and Institute of Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada, among patients who underwent PFF or bone-driven and delayed osseointegrated implant installation (BDD). Patients were followed up for a minimum of 1 year after occlusal rehabilitation. Data were analyzed from July 2021 to June 2022. Patients underwent BDD or PFF, which consists of osseointegrated dental implant installation and skin grafting of the fibular bone 3 to 6 months before jaw tumor resection or defect reconstruction. The implant osseointegration is completed at the time of jaw reconstruction, allowing for full reconstruction, loading, and restoration of the dental occlusion in the immediate postoperative period. Safety, effectiveness, accuracy, timeliness of occlusal reconstruction, and aesthetic appeal were compared between PFF and BDD. Groups were compared for the following variables: postoperative complications, number of bony segments used, number of procedures needed, total operative time, time to occlusal rehabilitation, and number of implants installed, exposed, lost, and used (ie, exposed implants - lost implants). Aesthetic appeal was assessed using standardized full-face and profile digital photographs taken before and 6 to 12 months after the operation and analyzed by 3 naive raters. Among 9 patients receiving PFF (mean [SD] age, 43.3 [13.0] years; 7 men [77.8%]) and 12 patients receiving BDD (mean [SD] age, 41.9 [18.0] years; 8 men [66.7%]), the overall complication rate was similar (4 patients [44.4%] vs 3 patients [25.0%], respectively; relative risk, 1.78 [95% CI, 0.52 to 6.04]). The number of patients with implant loss was similar between PFF and BDD groups (0 patients vs 3 patients [25.0%], respectively; difference, -25.0 percentage points [95% CI, -48.4 to 9.7 percentage points]). PFF had a clinically meaningful faster mean (SD) occlusal rehabilitation compared with BDD (12.1 [1.9] months vs 60.4 [23.1] months; difference, -48.3 months [95% CI, -64.5 to -32.0 months]). The mean (SD) difference in preoperative to postoperative aesthetic score was similar between PFF and BDD groups (-0.8 [1.5] vs -0.2 [0.8]; difference, -0.6 [95% CI, -1.6 to 0.4]). This study found that PFF compared with BDD was a safe, effective, and aesthetic reconstructive option for patients with benign or previously treated jaw malignant tumors. This technique may provide rapid occlusal reconstruction and oral rehabilitation.

Abstract Secretory breast carcinoma (SBC) is a rare and distinct disease, comprising approximately 0.01% of all breast carcinomas. This is a case of an 8-year-old boy who presented with a 1.5-year history of a non-tender, slowly enlarging left subareolar mass, not associated with nipple discharge. Serologic workup revealed minimally elevated prolactin with normal-range FSH, LH, estradiol and testosterone, as well as normal-range beta-hCG, LDH and AFP. Ultrasound showed a circumscribed solid hypoechoic lesion with internal arterial vascularity, favoured to represent a sebaceous cyst. Excisional biopsy was performed, and histologic examination revealed the classic intra- and extracellular secretory material typically seen in SBC. Immunohistochemical (IHC) stains for mammaglobin, S-100 and high molecular weight keratin (CK5) were positive. ER was positive, though not strong staining, and PR and HER2 were negative. A screen for NTRK fusions with pan-TRK IHC was positive. No skin, perineural or lymphovascular invasion was identified. RNA-based NGS demonstrated ETV6-NTRK3 fusion and confirmed the diagnosis of SBC. The patient underwent mastectomy and SLNB, which showed no residual tumor and no positive lymph nodes. A full metastatic work-up was not performed and the patient did not receive neoadjuvant therapy. First described as “juvenile breast carcinoma,” SBC has since been recognized to occur across a wide age range, with most cases occurring in adults. SBC in male pediatric patients is exceptionally rare, with fewer than 20 cases reported in the literature. In this demographic, SBC is usually detected clinically as a subareolar mass not associated with nipple discharge, and appears as a well-circumscribed mass on imaging, mimicking benign entities. SBC is usually detected at a low stage, treated surgically, and follows a clinically indolent course with excellent outcomes. Positive axillary nodes have been identified in a few male children, who subsequently underwent chemo- and/or radiotherapy, with no recorded recurrences in these cases. Distant metastases are an extremely uncommon feature of SBC and have not been reported in the pediatric male population; however, due to the rarity of this diagnosis, particularly in this demographic, robust long-term follow-up data are still lacking. The name “secretory” derives from the histologic appearance of the dense eosinophilic secretory material seen in tumor lumina and bubbly material in the cytoplasm of tumor cells. Similar to the cytologic characteristics of other translocation-driven neoplasms, SBC shows minimal pleomorphism. Mitoses are absent or rare. IHC stains are typically positive for S-100 and high molecular weight keratins and negative for ER, PR, and HER2. Despite the immunophenotypic similarities to triple negative/basal-like carcinomas (TNBC/BLC) the molecular relationship between SBC and TNBC/BLC is unclear. Though initially defined by its distinctive secretions on histology, SBC is now chiefly characterized by a balanced translocation, t(12;15)(p13;q25), resulting in oncogenic ETV6-NTRK3 fusion. Recent cases have demonstrated this using a variety of molecular techniques, including FISH, RT-PCR, and in our case, RNA-based NGS. This translocation also characterizes non-breast secretory carcinomas and has been identified in several other neoplasms, including pediatric mesenchymal tumours and adult acute myeloid leukemia. The rarity of SBC, particularly in the male pediatric population, underlines the necessity of this case report. Additionally, this case highlights the importance of considering SBC as a potential diagnosis in male children presenting with a breast mass, even in the presence of benign imaging characteristics. Table 1: Clinicoradiologic and pathomolecular characteristics of SBC in pediatric males AND, axillary node dissection; CT, chemotherapy; ER, estrogen receptor; FISH, fluorescence in situ hybridization; LE, local excision; MRM, modified radical mastectomy; nd, no data; NED, no evidence of disease; NGS, next-generation sequencing; NS, nodal sampling; PA, periareolar; PR, progesterone receptor; RA, retroareolar; RM, radical mastectomy; PCR, polymerase chain reaction; RT, radiotherapy; SA, subareolar; SLNB, sentinel lymph node biopsy; SM, simple mastectomy; WLE, wide local excision *Not reported as strong staining Table 2: Immunohistochemical phenotype of secretory breast carcinoma EMA, epithelial membrane antigen; ER, estrogen receptor; PR, progesterone receptor *Not reported as strong staining Table 3: Laboratory investigations AFP, alpha fetoprotein; FSH, follicle stimulating hormone; hCG, human chorionic gonadotropin; LDH, lactate dehydrogenase; LH, luteinizing hormone Citation Format: Rebecca Brassington, Svetlana Silverman, Ioana Bratu. Secretory breast carcinoma (SBC) in an 8-year-old male: Report of an exceptionally rare case with review of clinicoradiologic and pathomolecular findings of SBC in the male pediatric population [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-25-08.

Poems syndrome :s a rare multisistemic disorder. It manifestations are Polynueropathy, Organomegaly, Endocrinopathy,and / 01Edema. Monoclonal protein and changes in the Skin. (P.O.E.M.S.)Though some bibliography make no difference with osteoesclerotic mieloma it is considered a real syndrome.The polynueropathy is customarily severe. Although high levels of inrnullo- globulins has been found in the poems, it has not been isolatcd a specific antibody that explain the polynueropathy even though it is strongly suspected.The organomegaly, endocrinopathy, changes in the skin and other systems and involved organs could be in relationship toproducts secreted by plasmatic celis. Wc review the physiopathology and bibliography of the Poems, especially its neurological expression its nosologic location different from osteosclerotic myeloma and a possible relationship to the Herpes Virus S.It was crossed in Medline the terms P.O.E.M.S. and syndrome and were obtained 271 abstracts that were all examined and finallyselected the bibliography considerate meaningful for the objectives. It is presented briefly a case.P.O.E.M.S. is a syndrome that is associated to multiple plasma eclI dyscracia, included the osteoesclerotic myeloma.Prognosis and the treatment vary with the underlying diseasc. As physiopathology of this syndrome is insinuated the action of the interleukines 1- (IL-1 beta) and 6 (IL-6), the vascular growth endothelial factor (VGEF), the tunioral necrosis factor alpha (TNF-alpha) and antibodies anti- nerve. The P.O.E.M.S. is a syndrome with own Palabras claves: Síndrome de POEMS aso- identity. ciado con mieloma múltiple.The Herpes Virus 8 may plays a key rol Material y Métodos to uncover the Poems physiopathology.

Dysphagia is a consequence of oropharyngeal squamous cell carcinoma (OPSCC) treatments and often results in a devastating reduction in quality of life (QoL; Nguyen et al., 2005; Pauloski, 2008). This study aimed to report temporal trends in swallowing outcomes using the Modified Barium Swallow Impairment Profile (MBSImP) and the M.D. Anderson Dysphagia Inventory (MDADI) and to study the relationship between these two measures. This was a retrospective review of clinical data collected in January 2013 to December 2017 from a tertiary care center. MBSImP PI scores and MDADI composite scores were collected pretreatment and 1, 6, and 12 months posttreatment. Data were analyzed in aggregate and stratified by treatment modality. To address the primary objective, descriptive statistics were used. To address the secondary objective, four Spearman tests were run between MBSImP PI and MDADI composite scores. A total of 123 OPSCC participants were included. With respect to trends, MBSImP PI scores worsened 1 month posttreatment and remained impaired at 6 and 12 months. For MDADI composite scores, patient reports worsened 1 month posttreatment and subsequently improved at 6 and 12 months. MBSImP PI and MDADI composite scores were weakly negatively correlated (i.e., in agreement) at the pre- and 12-month posttreatment appointments. Swallowing outcomes in OPSCC patients have distinct yet predictable trends for both clinician-assessed and patient-reported swallowing outcomes during the first year following cancer treatment. However, unlike previous findings, these two types of measures were in agreement at the pretreatment and 12 months posttreatment appointments.

Purpose Mobile health (mHealth) technologies for dysphagia management may allow patients to complete rehabilitation exercises from home and their clinicians to remotely monitor them. However, clinicians are rarely formally consulted in the early stages of ideation. This study aimed to determine necessary elements to be included in a clinician web portal that would allow for remote monitoring of patients completing dysphagia exercises using mHealth equipped with surface electromyography (sEMG). Method Ten dysphagia clinicians were consulted individually using convergent interviewing. Interviews were transcribed and analysed using thematic analysis to identify themes and sub-themes. Result Themes identified included: perceived benefits of an mHealth system; clinical uptake of an mHealth system; clinical targets desired; preferred communication method; notification style and frequency; and user interface considerations. There was no consensus regarding clinical targets to display, notification frequency, method of clinician-patient communication, or layout for the user interface. Agreement existed on the importance of the simplicity and customisability for the clinician web portal user interface. Conclusion Lack of consensus on specific elements to be included in a clinician web portal could reflect low clinical exposure to sEMG. This study provides an example of formal end user feedback in the ideation phase of design.