Philipp Schorscher has completed his International Baccalaureate at the United World College of Southern Africa, Swaziland. Having developed an interest in medicine after setting up a medical emergency education program he moved to the UK to further his knowledge at the Brighton and Sussex Medical School. Currently in year 3 of his studies, Philipp Schorscher is an active member of a variety of committees and current president of the University’s MSF society. His interest in Management led him to join the Imperial College Medical Management intercalation program for the upcoming academic year.

Background: A predicted 60% of any population experience a nosebleed at some point in their lifetime making Epistaxis the most common ENT emergency. Despite this, variation in management across UK emergency departments remains. New change-management theories in healthcare acknowledge the importance of identifying stakeholders and utilising grass roots approach to change. Aims: We developed an acute ENT emergency pathway which identified potential discharge patients for 24hour outpatient review post nasal packing. Medical students were recruited for a “fresh eyes” approach, and stakeholders from different departments were involved to coordinate implementation. Methods: A retrospective study of A&E epistaxis patients between Jan 2014-Jan 2015 (N=365, mean age 55yrs) was performed. Using formal reflective methodology we identified areas for improvement and suggestions for other organisations to consider when instigating similar pathway changes. Results: 29.0% (n=106) of patients were admitted (mean length of stay 2.8 days). Of these, 26.4% (n=28) were eligible for discharge under the new pathway, saving 78.4 bed days. No patients eligible for discharge experienced rebleeding or readmittance. Implementation was dependent on modality of communication, establishment of interdepartmental meetings, staff development programmes, effective communication environment and accurate and constant reporting. Whilst time consuming, continuous reinforcement and flow was indispensable for success. Conclusions: Inter-departmental collaboration has enabled an organisation-wide introduction and review of a new epistaxis pathway. This pathway is a safe and potentially effective way to improve our ENT service. We believe an awareness of the challenges we faced and the solutions developed will be of be nefit to other organisations interested in amending their practice towards recent epistaxis guidelines..

Jeremy Goh is presently working at Medical Officer in Tan Tock Seng Hospital, Singapore. He completed his MBBS in Singapore and MRCS in Edinburg Scotland.

Up to 75% of patients with lingual thyroid have no normally located thyroid tissue and the ectopic lingual thyroid is the only functional tissue present. As a result, hypothyroidism occurs in up to 70% of patients with lingual thyroid, especially during periods of physiological stress. Hyperthyroidism in patients with lingual thyroid is exceedingly rare and has only been reported in a handful of case reports. Enlarged lingual thyroids may cause dyspnea, dysphagia, dysphonia, globus sensation or obstructive sleep apnea. Due to its location which makes achieving adequate surgical exposure challenging, traditional removal of the lingual thyroid is via open approach which is associated with high morbidity and postoperative complications. Transoral robotic surgery (TORS) is an emerging surgical option which offers a minimally invasive approach with improved view of surgical field and tissue manipulation. We present a unique case of a 69-year-old patient diagnosed with Graves’ disease who was incidentally found to have a hyperfunctioning lingual thyroid that was successfully treated with TORS.

Bjarki Stefansson obtained his BS in Biochemistry from the University of Iceland (Iceland) and his PhD in Microbiology and Molecular Biology in the Department of Microbiology, University of Virginia School of Medicine (USA). He works in Design & Development at Zymetech, an Icelandic biotechnology company involved in research, purification and therapeutic application of enzymes extracted from Atlantic cod.

ColdZyme® Mouth Spray (ColdZyme) is a medical device that is designed to form a barrier on the mucuous membrane of the oropharynx and to degrade attachment proteins on viral surfaces to protect against diseases such as the common cold. ColdZyme is primarily composed of glycerol and Atlantic cod trypsin and has a high safety profile to match a mild disease such as the common cold. It is intended to directly inhibit infection by blocking viruses at their point of entry, reduce the probability of catching a cold and help shorten the duration of a cold. Based on its design, duration of ColdZyme in the oropharynx and its ability in deactivating common cold viruses was tested. The presence and duration of the ColdZyme barrier was measured in the oropharynx in a clinical investigation. The half-life of the barrier was measured to be about 4.5 minutes, resulting in the duration of the barrier being around 10 to 20 minutes. Most cases of common cold are caused by rhinovirus followed by human coronavirus, respiratory syncytial virus and adenovirus. The virus deactivating ability of ColdZyme was demonstrated against these four major common cold viruses and influenza in a virucidal efficacy suspension test. Based on the results, ColdZyme showed an effective broad-spectrum impact against common cold viruses. These findings and its duration in the oropharynx indicate that ColdZyme represents a device with clinical benefits in prevention and treatment of respiratory viral infections by deactivating viruses within the respiratory tract.

Inn Chul Nam pursued his MD and PhD from The Catholic University of Korea, Republic of South Korea He is curently an Assistant Professor of the College of Medicine at the same university. He has served as the Head Surgeon of the Division of Head and Neck Surgery, Department of ORL-HNS of Incheon St. Mary`s Hospital.

Percutaneous dilatational tracheostomy (PDT) is a technique that can place a tracheostomy tube safely without visually identifying trachea. This technique has many advantages such as less bleeding, easier technique and shorter procedural time compared to conventional open tracheostomy. The aim of this study is to evaluate the feasibility of PDT during the head and neck cancer surgery. Twelve patients who underwent PDT during the head and neck cancer surgery from September 2016 to March 2018 were enrolled and their medical records were reviewed retrospectively. For comparison, medical records of another twelve patients who underwent conventional trahceostomy during the head and neck cancer surgery were randomly acquired and analyzed. PDT was performed using Ciglia Percutaneous Tracheostomy SetⓇ (Cook Critical Care, Bloomington, USA). The tracheotomy point was determined by palpation without the guidance of bronchoscopy or ultrasonography. Parameters of blood loss, procedural time, communication between the cervical wound and tracheostomy wound and complications were compared between the PDT group and the conventional group. PDT group showed less blood loss and less procedural time and less incidence of communication between the cervical wound and tracheostomy wound. On complication, there was one case of convertion to conventional tracheostomy due to wrong tracheal penetration in PDT group. There were two cases of tracheostomy site minor bleeding in convetional group. PDT is a safe and effective procedure as the adjunctive procedure during the head and neck cancer surgery.

Glen Davison obtained his PhD (Nutrition and Exercise Immunology) in 2006 from Loughborough University, UK (BSc, 2001; MSc, 2002; Sheffield Hallam University respectively). He is a Chartered Scientist (CSci) and BASES accredited Sport and Exercise Scientist (Physiology). He is the Director of graduate studies and Coordinator of the Endurance Research Group at the University of Kent, UK. His interests include: immune system function in athletes and how the human immune system responds to exercise; nutrition and exercise immunology; exercise immunology in people with Diabetes; exercise and immune function in people with chronic obstructive pulmonary disease (COPD) and exercise in people with Parkinson's disease.

Introduction: Endurance athletes have a high incidence of upper respiratory tract infection (URTI). ColdZyme® Mouth Spray (ColdZyme) is a CE-marked medical device in the form of a mouth spray that forms a barrier in the throat against common cold viruses. Aim: The aim of this study is to assess the effects of ColdZyme on URTI incidence and symptom ratings in endurance athletes under free-living conditions. Methodology: The methodology involved a prospective, open label pilot study. Design & Participants: Thirty Five endurance-trained, competitive athletes were randomized to control (no treatment) or ColdZyme. They were monitored over the study period (December 2017 - February 2018) via training and illness symptom logs (Jackson common cold questionnaire). total of 35 completed (n=17 control; n=18 ColdZyme). Results & Discussion: At least one episode was recorded during the study period in 91% of all participants (94% control, 89% treatment). Fifty episodes were recorded in total over the study period with no difference between groups in the mean incidence rate (episodes/person: 1.4±0.7 Control, 1.6±0.9 Treatment, P=0.266). Episode duration was 10.9±10.2 days in Control and 8.3±6.3 days in Treatment (P=0.098). When use compliance was examined, those in the treatment group with good compliance to the product instructions for use (IFU) were observed to have significantly lower (P=0.038) episode duration (7.1±6.6 days). Conclusions: ColdZyme did not influence self-reported URTI incidence. However, the duration was significantly lower in the treatment group but only when the device is used in accordance with the manufacturer IFU.