Tracheoesophageal fistulas in coronavirus disease 2019 pandemic: A case report

BACKGROUND

Tracheoesophageal fistulas (TEFs) can be described as a pathological communication between the trachea and the esophagus. According to their origin, they may be classified as benign or malignant. Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation, particularly among patients exposed to endotracheal cuff overinflation. During the severe acute respiratory syndrome coronavirus 2 virus pandemic, the amount of patients requiring prolonged ventilation rose, which in turn increased the incidence of TEFs.

CASE SUMMARY

We report the cases of 14 patients with different comorbidities such as being overweight, or having been diagnosed with diabetes mellitus or systemic hypertension. The most common symptoms on arrival were dyspnea and cough. In all cases, the diagnosis of TEFs was made through upper endoscopy. Depending on the location and size of each fistula, either endoscopic or surgical treatment was provided. Eight patients were treated endoscopically. Successful closure of the defect was achieved through over the scope clips in two patients, while three of them required endoscopic metal stenting. A hemoclip was used to successfully treat one patient, and it was used temporarily for another patient pended surgery. Surgical treatment was performed in patients with failed endoscopic management, leading to successful defect correction. Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications.

CONCLUSION

The incidence of TEFs increased during the coronavirus disease 2019 pandemic (from 0.5% to 1.5%). We believe that endoscopic treatment should be considered as an option for this group of patients, since evidence reported in the literature is still a growing area. Therefore, we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.

First Report of Plant-Parasitic Nematodes on Seashore Paspalum (Paspalum vaginatum) in Barbados

Seashore paspalum (Paspalum vaginatum Swartz) is a warm-season perennial turfgrass commonly used for golf courses that are grown in saline environments or using saline water for irrigation. However, seashore paspalum is also grown in non-saline conditions due to its low fertilizer and water requirements (2). In Barbados, on a newly constructed golf course, seashore paspalum 'Sea Isle Supreme' sprigs were imported from Georgia (United States) and were planted over 2006 and 2007 on greens, tees, fairways, and rough. Golf greens were constructed following the United States Golf Association Green Section (Far Hills, NJ) putting green guidelines. Tees and fairways were constructed using native soil. Two years after the grow-in, the putting greens began to exhibit irregular chlorotic patches, followed by gradual thinning and decline of turfgrass stand density in those areas. Additionally, turfgrass roots sampled from those symptomatic patches appeared to be abbreviated compared to non-symptomatic areas of the greens. A survey was conducted in May 2013 to determine if plant-parasitic nematodes were present coinciding with the observed symptoms, which were similar to those described in a previous report (3). Consequently, two samples were collected from each green with a total of four greens sampled. Each sample consisted of 20 soil cores (15 cm depth × 1.2 cm in diameter) from either areas of the greens showing symptoms or from non-symptomatic areas. Nematodes were extracted from 100 cm³ soil samples using a modified centrifugal-sugar flotation technique (4). No plant parasitic nematodes were present in any of the samples from the non-symptomatic areas. Three genera of plant parasitic nematodes were found in all the samples from the symptomatic areas: Helicotylenchus. Mesocriconema, and Pratylenchus. Nematode populations of these genera averaged 30, 60, and 200 nematodes per 100 cm³, respectively. Populations of the genera Helicotylenchus and Mesocriconema were below the action threshold levels for seashore paspalum used by the University of Florida Nematode Assay Laboratory (1). Currently, no threshold exists for Pratylenchus for seashore paspalum. Conversely, the genera Helicotylenchus. Mesocriconema, and Pratylenchus were found associated with the irregular chlorotic patches but not with the non-symptomatic areas. To our knowledge, this is the first report of plant parasitic nematodes associated with seashore paspalum maintained as putting greens in Barbados. References: (1) W. T. Crow. Nematode management for golf courses in Florida. EDIS. Accessed 31 July 2013 from: http://edis.ifas.ufl.edu/in124 , 2001. (2) R. R. Duncan and R. N. Carrow. Seashore Paspalum: The Environmental Turfgrass. John Wiley & Sons, Inc., Hoboken, New Jersey, 2000. (3) A. C. Hixson and W. T. Crow. Plant Dis. 88:680, 2004. (4) W. R. Jenkins. Plant Dis. Rep. 48:692, 1964.

Angiopyroplasty using electromagnetically induced focused heat

A metal-tipped catheter capable of inducing and withstanding extremely high temperatures suitable for angiopyroplasty has been developed. The probe utilizes external radiofrequency (RF) energy focused on the tip. A relatively inexpensive catheter and RF source make this a very plausible alternative to laser systems.