Michael Edwards

Background Epididymo-orchitis, in children and adolescents, presents with acute testicular pain. Diagnosis is usually made during emergency scrotal exploration for acute testicular pain. We conducted this study to assess the need of antibiotics and for follow-up renal imaging in this cohort. Methods A single institutional retrospective study was conducted in a tertiary paediatric surgical center from 2016–2020. All children and adolescents under 16 years of age who had a scrotal exploration for acute testicular pain and diagnosed with epididymoorchitis were included in this study. Electronic patient records and discharge summaries were used to gather information regarding admission, operation reports, antibiotic prescription, investigations and follow-up of these patients. Results A total of 353 boys had scrotal exploration in this period. Of these, 53 had an intraoperative diagnosis of epididymo-orchitis. Median age was 12 years (range 1 year to 15 years). Proportion of epididymo-orchitis among scrotal explorations each year remained fairly constant (15%). Only 1 boy with recurrent episodes of epididymo-orchitis had a positive urine culture which grew Escherichia Coli. Overall, 35% of children and adolescents were prescribed antibiotics. All patients had follow-up imaging requested to look for urological anomalies of which only a third attended the follow up appointment. Only 1 was diagnosed with urological anomaly which was attributable as a cause of recurrent epididymo-orchitis. Conclusion This study confirms a low incidence of bacterial aetiology and lack of evidence base for routine use of antibiotics and imaging after a single episode of paediatric epididymo-orchitis. Associated urological anomaly is rare after a single episode of epididymo-orchitis and most can be safely managed without the need for antibiotics or follow up renal imaging.

Objective: This observational study assesses trends in type 1 diabetes mellitus (T1DM) disease burden across the 19 countries of the European Union (EU) 15+ between 1990 and 2019. Methods: The Global Burden of Disease Study database was used to gather T1DM age-standardised incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life-year (DALY) rates per 100,000 for each EU15+ country (1990 – 2019). Joinpoint regression analysis was used to describe the trends. Results: From 1990 to 2019, T1DM ASIRs and ASPRs increased globally except for females in Finland (−2.9% and −9.4%), the largest increase in ASPR for males and females was observed in France (+144.4% and +137.5% respectively). All had reductions in ASMRs for males and females, with the largest observed in Spain (−56.7% and −79.0% respectively). Trends in DALYs were variable across countries, with increases in DALYs noted in 14/19 for males, and 9/19 for females. Denmark, Finland, Norway, Netherlands, and Sweden had a reduction in DALYs for both males and females. Conclusions: Mortality from T1DM is reducing across EU15+ countries, despite concomitant increases in incidence and prevalence rates. Trends in DALYs are variable across countries, reflecting differential trends in the disease burden across countries with similarly high health expenditure.

Since December 2019, when it was first detected in Wuhan, the SARS-CoV-2 (COVID-19) has spread across the globe. The pandemic has had an unprecedented impact on the global population with >110 million confirmed cases and 2.5 million deaths. The most common initial symptoms of COVID-19 infection are cough, dyspnoea, fever, malaise and anosmia. Severe clinical manifestations include respiratory compromise, pneumonia, organ failure and death. There have been many other less common symptoms as a result of COVID-19 described in the literature, including significant rates of olfactory dysfunction. However, we believe there has been only one other previously documented cases of bilateral hearing loss. Sudden sensorineural hearing loss is a relatively common presentation seen by otolaryngologists. It is defined as rapid hearing loss, ≥30 dB occurring over 3 consecutive days in three contiguous sound frequencies. The exact pathological process is yet to be fully characterised, though it is most commonly unilateral and commonly develops shortly following viral infection. Treatment typically consists of glucocorticoid steroids administered orally, via intratympanic injection or a combination of both routes though there are currently no standardised management of these patients. Bilateral sudden sensorineural hearing loss (SSNHL) is rare, accounting for <2% of all cases. We describe a case of bilateral SSNHL in a 68-year-old patient who presented with profound hearing loss shortly after symptomatic infection with COVID-19, which at the time of publication is the first such case reported in the literature.

Objectives: This study examined the uptake of ENT UK coronavirus disease 2019 adult tonsillitis and quinsy guidelines at our tertiary centre, and assessed perceived barriers to uptake.Methods: A retrospective case series of tonsillitis and quinsy patients was analysed in two arms: before and after the introduction of new ENT UK management guidelines. A survey assessed perceptions and practice differences between ENT and emergency department doctors.Results: Each study arm examined 82 patients. Following the introduction of new ENT UK guidelines, ENT clinicians demonstrated significant changes in practice, unlike their emergency department counterparts. Survey results from emergency department doctors highlighted a lack of appreciation of guideline change and identified barriers to guideline uptake.Conclusion: The introduction of new management guidelines for tonsillitis and quinsy patients during the pandemic resulted in disparate uptake within ENT and emergency department departments at the tertiary centre. Clearer dissemination to all affected clinicians is paramount for future rapidly introduced changes to practice, to ensure clinician safety.