Antibiotic Prophylaxis Prescribing Practice in Head and Neck Tumour Resection and Free Flap Reconstruction

Background Adherence to guidelines for antibiotic prophylaxis is often poor and is an important target for antimicrobial stewardship programs. Prescribing audits that suggested poor adherence to guidelines in a plastic surgery department led to a targeted education program to bring antibiotic prescriptions in line with hospital guidelines. We reviewed whether this intervention was associated with changed perioperative prescribing and altered surgical outcomes, including the rate of surgical site infections, specifically looking at clean-contaminated head and neck tumour resections with free flap reconstruction. Methods A retrospective cohort study was performed on 325 patients who underwent clean-contaminated head and neck tumour resection and free flap reconstruction from January 1, 2013 to February 19, 2019. Patients were divided into two groups, those before (pre-intervention) and after (post-intervention) the education campaign. We analysed patient demographic and disease characteristics, intraoperative and postoperative factors and surgical outcomes. Results Patients pre-intervention were prescribed longer courses of prophylactic antibiotics (median = 9 [interquartile range = 8] vs. median = 1 [interquartile range = 1], p < 0.001), more topical chloramphenicol ointment (21.82% vs. 0%, p < 0.001) and more oral nystatin (36.9% vs. 12.2%, p < 0.001). Patients post-intervention had higher rates of recipient infections (36.11% vs. 17.06%, p < 0.001) and donor site infections (6.94% vs. 1.19%, p = 0.006). Conclusion Following the education campaign, patients were prescribed shorter courses of prophylactic antibiotics, more of the recommended cefazolin-metronidazole regimen and less use of topical antibiotics. However, patients also had a higher rate of surgical site infections.

Prevalence, therapy and tumour response in patients with rheumatic immune-related adverse events following immune checkpoint inhibitor therapy: a single-centre analysis

Background: Immune checkpoint inhibitors (ICIs) improved cancer therapy by inducing a higher immune system activity. This effect can cause rheumatic immune-related adverse events (rh-irAEs), which have not yet been extensively studied. Methods: We analysed 437 patients between 2014 and 2019, treated with ipilimumab (anti-CTLA-4) and/or nivolumab (anti-PD-1) or pembrolizumab (anti-PD-1) at the Clinic for Internal Medicine III, Oncology, Haematology and Rheumatology at the University Hospital Bonn, Germany. Results: Of the 437 patients 60% were males. Patients were mainly treated for melanoma, lung cancer, head and neck tumour and urothelial carcinoma. At least one immune-related adverse event (irAE) was observed in 163 patients (37.3%), including rh-irAE. Most common side effects were rash, colitis and hepatitis. We identified 19 patients (4.3%) with a minimum of one rh-irAE due to ICI therapy; three of those had a pre-existing rheumatic disease. Arthralgia developed most frequently in eight patients (42.1%). Other rh-irAEs were: arthritis ( n = 7; distinguished in rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and undifferentiated arthritis), myalgia ( n = 2) and myositis ( n = 3). Most rh-irAEs were classified as moderately severe (Common Terminology Criteria of Adverse Events grade 2: 68.4%). Median time between starting ICI therapy and the occurrence of rh-irAE was 109 days (interquartile range 40–420 days). Fifteen patients (78.9%) were treated with glucocorticosteroids. In four cases additional therapy with methotrexate or tocilizumab was required. Even though patients benefited from ICI treatment, therapy had to be discontinued in six of the participants due to rh-irAE. Interestingly, patients with rh-irAE had a significantly higher tumour response compared with patients without rh-irAE (94.4% versus 43.5%; p < 0.0001). Conclusion: Rh-irAEs occur under ICI therapy, especially in patients with higher tumour response. However, they are not the most frequent irAE after ICI exposure: 9.3% of all irAEs were rheumatic (20 rh-irAE cases in 19 patients of a total of 215 irAE cases in 163 patients).

PROGNOSTIC SIGNIFICANCE OF EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) IN HEAD AND NECK TUMOURS AT SOME SELECTED HOSPITAL IN GHANA

Abstract: Background: Head and neck Tumour (HNT) are tumour of the paranasal sinuses, the salivary glands and the upper aero¬digestive tract. EGF can stimulate cell proliferation, cell differentiation, cell growth, migration, and inhibit apoptosis. The aim of this study was to investigate the expression of EGFR in head and neck tumour. Method: EGFR expression was analyzed using quantitative real-time PCR (qRT-PCR) and immunohistochemical staining on tissue samples from a consecutive series of 150 head and neck tumour patients who underwent tumor resections between 2014 and 2018. Results: The relationship between EGFR expressions, clinicopathological factors, was investigated. qRT-PCR results showed that the EGFR expression was high in tumor tissue samples than in the normal head and neck tissues. High and low EGFR was compared with ages ≤40,>40 in the head and neck cancer of p- value 0.03. There was a significant difference between the histological differentiation of the malignant tumour with p values of 0.001, when well, moderate and poor was compared. There was a significant difference (p-value 0.012) between the I-II and III-IV tumour stages when the high level and low expression of EGFR were compared. Conclusion: Our data suggest that EGFR plays an important role in head and neck tumour progression and that its expression will provide baseline data to facilitate identification of new molecular targeting therapeutics. Keywords: EGFR, Head and neck tumour, Clinicopathological factors.

Subjective morbidity following radial free flap reconstruction in head and neck tumour patients

ObjectiveEvaluation of post-operative donor site disability remains unaddressed in radial forearm free flap cases. This study aimed to assess donor site dysfunction following radial forearm free flap harvest using validated general, disease-specific and site-specific disability questionnaires.MethodsIn this retrospective case series of 24 patients at a tertiary academic medical centre, patients were assessed using the Short Form 36 Health Survey, Short Musculoskeletal Function Assessment questionnaire, and Disabilities of the Arm, Shoulder and Hand questionnaire. One-sample z-tests were performed, comparing means of the cohort to controls.ResultsCompared to population controls, the cohort had higher mean scores for the Disabilities of the Arm, Shoulder and Hand questionnaire (18.22 vs 10.1, p &lt; 0.01), and Short Musculoskeletal Function Assessment questionnaire bothersome index (21.44 vs 13.77, p = 0.04), and a lower mean score for the Short Form 36 Health Survey physical component (38.88 vs 50, p &lt; 0.01), indicating a greater disability for the cohort compared to controls.ConclusionRadial forearm free flap harvest causes significant long-term donor site disability in head and neck tumour patients. The Disabilities of the Arm, Shoulder and Hand questionnaire is a concise tool for measuring this dysfunction.