Title : Cisplatin-associated ototoxicity in cervical cancer patients in South Africa
Name : Jessica Paken
University : University of KwaZulu-Natal
Country : South Africa
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Cervical cancer is the second most prevalent cancer in African and South African women. Early sexual debut and multiple sexual partnerships are a leading cause of the Human Papillomavirus (HPV) infection, causally associated with cervical cancer and partially responsible for some of the stigma associated with this cancer. This stigma can result in late screening and/or diagnosis of this disease, which may warrant brachytherapy and chemotherapy containing cisplatin. However, cisplatin affects the auditory system, potentially placing exposed patients at risk of developing ototoxicity. Given the permanency yet invisible nature of high-frequency ototoxic hearing loss, its effect on the affected individual’s quality of life cannot be underestimated. Therefore, the implementation of an ototoxicity monitoring programme (OMP) is essential not only for these individuals’ hearing health but also for their safety and functioning within the community and society and, essentially, their quality of life. However, ototoxicity monitoring is not commonplace in South Africa. There has also been an absence of context-specific research to expedite the implementation of an accountable and effective OMP in this country, particularly for this patient population. Identifying the need for such a programme through prospective data on the extent and severity of cisplatin-associated ototoxicity in South Africa would serve as motivation to amalgamate audiological clinical practice within the oncology context, employing a team approach. Given the paucity of information on this condition among cervical cancer patients, the study investigated the extent of cisplatin-associated ototoxicity and the feasibility of an ototoxicity monitoring programme among this cohort. This concurrent embedded mixed-methods real-world study was conducted at a tertiary-level hospital in KwaZulu-Natal, South Africa. In attempting to inform a contextually relevant ototoxicity monitoring programme, this concurrent embedded study adopted a structured approach to achieve its aim, with each objective feeding into the other. The first three objectives: (1) To undertake a review of ototoxicity associated with cisplatin chemotherapy, (2) to describe the perspectives and practices of healthcare professionals in relation to cisplatin-associated ototoxicity at an institution treating patients with cancer, and (3) to evaluate the extent and severity of ototoxicity amongst patients with cervical cancer receiving cisplatin-based chemotherapy, served as the foundation to achieve objective 4, i.e., to evaluate the ototoxicity monitoring programme with the feasibility of integration into the clinical environment. In so doing, the study offered key considerations for a locally responsive ototoxicity monitoring programme. A scoping review of the literature highlighted key concepts essential to implementing an OMP. Insights into the perspectives and practices of healthcare personnel (HCP) at the study site revealed that only 33% of nursing personnel were aware of cisplatin-associated ototoxicity compared to oncologists (100%) and pharmacists (100%). Whilst HCP (82%) considered the audiologist a part of the oncology team, provision for ototoxicity monitoring in the chemotherapy protocols was not evident, nor was any OMP in place. Prospective recruitment of incident cervical cancer cases and regular audiological assessments allowed for the temporal study of ototoxic hearing loss. The incidence of ototoxicity was 98% (cumulative cisplatin dose 150 mg/m2). Cisplatin dosage was significantly associated with ototoxicity severity at one- (p=0.017), three- (p=0.010), and six-month (p=0.015) post-treatment. Human Immunodeficiency Virus (HIV)-seropositivity (53.7%) was also significantly associated with the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) Grading Scale at three- (p=0.022) and six-months (p=0.023) post-treatment. Multiple Tobit regression revealed a cumulative dose effect bilaterally, evident from 9 000 Hz in the right ear, while a plateau effect was observed at 250 mg/m2 in the left ear. Feasibility assessment revealed that HCP (91%) and patients (89%) found the OMP beneficial, with clinicians (77%) providing information on the effects of chemotherapy medication and referring patients for audiological evaluation. Costs to the service provider (equipment, personnel) and patient (transport, daily loss of income) were paramount to successfully implement and continue the programme. This study highlighted cisplatin’s ototoxic effect in cervical cancer patients, with a greater impact on HIV-positive patients and provides clear evidence for the need for an OMP. This study shows that through meaningful engagements with- and considerations from- patients and service providers regarding planning, delineation of responsibilities, and cost implications, such a program is feasible in South Africa.
Biography:
Dr Jessica Paken is currently a senior lecturer and Head of Department at the Discipline of Audiology at the University of KwaZulu-Natal in Durban, South Africa. With expertise in audiology, specifically electrophysiology, hearing aids and ototoxicity, she has contributed to the scientific community through numerous national and international publications and conferences. She has served as a reviewer for reputed journals both locally and internationally. Dr Paken is the recipient of research accolades namely, the Archbishop Denis Hurley Scholarship and the South African Medical Research Council National Health Scholarship. Other accolades include (1) being awarded the best poster presentation at the UKZN College Symposium (2013), and the South African Speech-Language and Hearing Association/ENT Conference (2015), (2) being awarded the best oral presentation at the South African Speech-Language and Hearing Association Conference (2019) and the UKZN College of Health Science Research Symposium (2023). Her research interests include ototoxicity and patient quality of life.
Title : Successful endoscopic resection of a rare extension of peripheral giant cell granuloma into the infratemporal fossa via the maxillary sinus: A case report study
Name : Waddah Al-Saadie
University : Damascus University
Country : Syria
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Introduction and significance: Peripheral giant cell granuloma (PGCG) is a benign reactive lesion commonly found in the mandible but rarely in the maxillary sinus and extending to the infratemporal fossa, which poses a major challenge in excision in this case. It can occasionally lead to bone erosion. Complete surgical excision is the primary treatment.
Case presentation: We present a rare case of PGCG in the maxillary sinus of a male patient following the extraction of the maxillary second molar, resulting in destruction of the bony margins. The patient underwent complete endoscopic resection with a flap to repair the bone loss in the maxilla.
Clinical discussion: Clinicians should be aware of this uncommon location of PGCG to ensure accurate diagnosis and appropriate treatment with minimal patient trauma and excellent outcomes.
Conclusion: Endoscopy is a highly effective method for removing PGCG located in the maxillary sinus and extending to the infratemporal fossa, even in cases of large size. It offers excellent results and provides good visualization of the maxillary sinus.
Biography:
Waddah Al-Saadie M.D. is a Otolaryngologist at Damascus University in Damascus Hospital, Damascus, Syria.
Achievements and Awards:
Published numerous articles in peer-reviewed medical journals.
Author and Reviewer in the International Journal of Surgery Case Reports.
Research: Focused research on pediatric otolaryngology and sinus disorders.
Notable publications include: “Successful endoscopic resection of a rare extension of peripheral giant cell granuloma into the infratemporal fossa via the maxillary sinus: A case report study “ ( published )“Doxycycline sclerotherapy as a primary treatment of head and neck giant cystic hygroma: A Case Report Study” (under publication)
Conferences and Workshops: Speaker at the Syrian Society of Otolaryngology Annual Meeting (2023)
Organized and led workshops on endoscopic sinus surgery techniques.
Title : Acoustic voice Analysis as an Objective Tool to Measure Benefits of Cochlear Implantation in Partial Deafness.
Name : Karol Myszel
University :
Country : Poland
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Acoustic analysis of voice is a valuable technique that enables objective assessment of voice features both for diagnostic and follow-up purposes. In contrary to subjective (perceptual) assessment objective measurements give mathematical values referring to specific parameters, then can be subsequently analyzed, compared and elaborated statistically. The purpose of the study was an objective analysis of voice in partial deafness patients. Two tools, MDVP and VOXplot systems were used, and subsequently the results were compared to check for consistency between both of the tools. MDVP and VOXplot measures were taken in patients with partial deafness before and 9 months after cochlear implantation. MDVP analysis showed that all parameters correlating with hoarseness were elevated, and five of them (Jitt%, vF0, Shim dB, APQ, NHR) presented a statistical increase. VOXplot parameters associated with hoarseness were also changed, and all of them presented a statistically significant change indicating hoarseness: Shim %, Shim dB increased whilst HNR, Slope, and CPPS decreased. As result, AVQI (acoustic voice quality index) was elevated too
with a statistical significance. Both tools of objective analysis detected hoarseness in voice of partially deaf individuals. Analysis conducted 9 months after cochlear implantation presented with a significant improvement of parameters both in MDVP and VOXplot. MDVP parameters improved, normalization was observed in indices describing frequency, amplitude, tremor and noise. AVQI in VOXplot significantly improved (decreased). Therefore, both objective measures reflected an improvement noticed as decrease of hoarseness. When it comes to MDVP parameters correlating with breathiness, all of them (Shim dB, APQ, NHR, SPI and NSH) were increased in partial deafness patients reflecting a breathy voice. Only one parameter SPI, did not present a statistical importance. VOXplot parameters associated with breathy voice were also changed, and all but PSD, were
increased with statistical significance. As result, ABI was elevated with a statistical significance. Both tools of objective analysis detected a breathy voice of partially deaf individuals. Analysis conducted 9 months after cochlear implantation presented with a significant improvement of parameters both in MDVP and VOXplot. MDVP parameters improved and normalization was observed in indices correlating with breathiness. ABI (acoustic
breathiness index) in VOXplot significantly improved (decreased). Therefore, both objective measures reflected an improvement noticed as decrease of breathiness. As it was concluded based on the study, both objective tools of objective voice analysis are efficient in detecting voice abnormalities in partial deafness patients and their mprovement after cochlear implantation. Therefore, they can be used to measure vocal benefits of cochlear implantation.
Biography:
Karol Myszel born in 1967, he is a medical doctor who graduated from medical faculty of University of Medical Sciences in Poznan, Poland in 1992. He holds a specialty in audiology and phoniatrics. He received his medical specialty from Institute of Physiology and Pathology of Hearing in Warsaw, Poland in 2012. In 2023 he got his Ph.D. degree based on the thesis: “Quality of voice in patients with partial deafness”, which was the first elaboration of the topic worldwide. The area of his special interests is voice abnormalities associated with hearing impairment. He is a senior consultant and manager of a branch of Center of Hearing and Speech in Konin, Greater Poland. He also works as assistant professor in Health Sciences Department, Academy of Applied Sciences in Konin, Poland.
Title : Transfers of the Sternal head of pectoralis major and Latissimus Dorsi to treat Sprengel Syndrome
Name : Ricardo Berriel Mendes
University : Naeon Group
Country : Brazil
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This technical note introduces a novel surgical procedure for the treatment of Sprengel’s Syndrome, a rare congenital condition characterized by an elevated, hypoplastic, and malrotated scapula. Traditional treatments have had limited success, prompting the development of this new approach. The technique, grounded in orthopedic principles, combines muscle and bone repositioning to improve range of motion, reduce pain, and achieve aesthetic normalization. The surgery involves clavicle morcellation and a posterior longitudinal approach for muscle release and transfer. The patient is positioned laterally under general anesthesia, with evoked potential monitoring to prevent neurological complications. Clavicle morcellation is performed to facilitate scapula movement and prevent brachial plexus impingement. The procedure includes releasing fibrous bands and specific muscles around the scapula, with careful attention to avoid nerve damage. The innovative aspect lies in the transfer of the sternal head of the pectoralis major and the latissimus dorsi to the inferior aspect of the scapula, aiming to restore functional scapula movement. A case report of a 4 year old patient demonstrates the procedure’s efficacy, highlighting improvements in scapular elevation and deltoid strength. Cosmetic enhancements are also noted. This approach potentially offers significant advantages for patients with Sprengel’s Syndrome. Conclusion: The note concludes with a discussion on the rationale behind muscle transfers and their role in enhancing scapular movements, providing a promising outlook for this challenging congenital condition.
Biography:
He earned his Medical Degree from Estácio de Sá University in Rio de Janeiro, Brazil, from 2008 to 2014, followed by a Medical Residency in Orthopedics and Traumatology at the Federal University of the State of Rio de Janeiro from 2016 to 2019. In 2019, he became a member of the Arthroscopy Association of North America (AANA), and in 2020, he joined both the Brazilian Society of Orthopedics and Traumatology (SBOT) and the Brazilian Medical Association (AMB). By 2021, he was also a member of the Brazilian Society of Shoulder and Elbow Surgery (SBCOC) and the Brazilian Society for Tissue Regeneration (SBRET). He pursued a subspecialty in Sports Medicine with the NAEON Group in São Paulo, Brazil, between 2021 and 2022. In 2022, he joined the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS). Currently, he serves as the Director and Head of the Fellowship Program in Shoulder and Elbow Subspecialty at the NAEON Group in São Paulo, Brazil. Additionally, in 2023, he completed fellowships at Clinique Bizet in Paris and Clinique de L’Union in Toulouse, France.