Background The authors aim to present a comprehensive review detailing the present state of evidence with regard to complications following tissue expansion in the head and neck. Methods A systematic literature search was conducted to identify all studies reporting complications of tissue expansion in the head and neck between 2000 and 2019. Subgroup comparisons based on expander locations and planes were conducted. Results A total of 7058 patients were included. Tissue expansion was associated with an overall complication rate of 8.73% (616/7058). The most common complications were extrusion (207/7009; 3.0%) and hematoma (200/7009; 2.9%). Overall complications were highest in the scalp (65/238; 27.3%) and lowest in the mastoid (347/5688; 6.1%). Complications were more common with expansion in the non‐subcutaneous plane (63/590; 10.7%). Conclusion In the absence of large clinical trials, systematic reviews such as these can help inform clinical guidelines and provide practitioners with an evidence‐based reference to improve informed consent.

BackgroundPalliative care is recognized as an important component of care for children with cancer and other life-limiting conditions. In resource limited settings, palliative care is a key component of care for children with cancer and other life-limiting conditions. Globally, 98% of children who need palliative care live in low- or middle-income countries, where there are very few palliative care services available. There is limited evidence describing the practical considerations for the development and implementation of sustainable and cost-effective palliative care services in developing countries.ObjectivesOur aim is to describe the key considerations and initiatives that were successful in planning and implementing a hospital-based pediatric palliative care service specifically designed for a resource-limited setting.SettingBangabandu Sheikh Mujib Medical University (BSMMU) is a tertiary referral hospital in Bangladesh. Local palliative care services are very limited and focused on adult patients. In partnership with World Child Cancer, a project establishing a pediatric palliative care service was developed for children with cancer at BSMMU.ResultsWe describe four key elements which were crucial for the success of this program: (1) raising awareness and sensitizing hospital administrators and clinical staff about pediatric palliative care; (2) providing education and training on pediatric palliative care for clinical staff; (3) forming a pediatric palliative care team; and (4) collecting data to characterize the need for pediatric palliative care.ConclusionThis model of a hospital-based pediatric palliative care service can be replicated in other resource-limited settings and can be expanded to include children with other life-limiting conditions. The development of pilot programs can generate interest among local physicians to become trained in pediatric palliative care and can be used to advocate for the palliative care needs of children.

Background: There is a global concern that the emergence of antimicrobial resistance (AMR) threatens our ability to treat infectious diseases. The Canadian Antimicrobial Resistance Surveillance System (CARSS) was created in response to the Government of Canada's commitment to address AMR. CARSS integrates information from nine different national surveillance systems for tracking antimicrobial use (AMU) and AMR in both humans and animals to inform AMU/AMR research and policy.

PURPOSE The majority of pediatric cancer deaths occur in low- and middle-income countries (LMICs). Pediatric palliative care (PPC) focuses on relieving physical, psychosocial, and spiritual suffering throughout the continuum of cancer care and is considered integral to cancer care for children in all settings. There is limited evidence from LMICs about the characteristics, symptoms, and outcomes of children with cancer who receive PPC, which is needed to define the global need and guide the development of these services. METHODS This retrospective review of clinical records of children who received PPC was conducted during a pilot project (January 2014-August 2015) that implemented a PPC team at a tertiary hospital in Dhaka, Bangladesh. Clinical data on diagnosis, symptoms, treatment status, deaths, and key palliative care interventions were collected and analyzed using descriptive statistics. RESULTS There were 200 children who received PPC during the pilot project. The most common diagnoses were acute lymphoblastic leukemia (62%) and acute myeloid leukemia (11%). Psychosocial support for children (n = 305; 53%) and management of physical symptoms (n = 181; 31%) were the most common types of interventions provided. The most frequently recorded symptoms were pain (n = 60; 30%), skin wounds (n = 16; 8%), and weakness (n = 9; 5%). The most common medications prescribed were morphine (n = 32) and paracetamol (n = 21). CONCLUSION A hospital-based PPC service addresses pain and symptom concerns as well as psychosocial needs for children with cancer and their families in a setting where resources are limited. Health care facilities should incorporate palliative care into the care of children with cancer to address the needs of children and their families.

Background: Historically, patients with HIV have been at the highest risk of infection with opportunistic protozoans such as Toxoplasma, Cryptosporidium, and Isospora. Among patients with HIV who are compliant with antiretroviral therapy, the likelihood of acquiring an opportunistic infection is low. The risk of infection is harder to mitigate in the growing number of HIV-negative immunodeficient patients, such as people with hematological malignancies or those who are post-transplantation. Methods: We conducted a retrospective case series of patients with documented Toxoplasma infections between 2008 and 2017 and with Cryptosporidium and Isospora infections between 2014 and 2017 at the Ottawa Hospital. Results: During the study period, there were 10 confirmed cases of toxoplasmosis, 20 cases of cryptosporidiosis, and 2 cases of isosporiasis. Cryptosporidiosis (95%) and toxoplasmosis (60%) occurred more frequently among HIV-negative patients, whereas isosporiasis cases were limited to HIV-positive patients. Among patients with cryptosporidiosis, the most common underlying cause of immunosuppression in HIV-negative individuals was solid organ transplantation (15.79%), followed by diabetes (10.53%), end-stage renal disease (5.26%), and hematologic malignancy (5.26%). Seventy percent of patients had no known cause of immunosuppression. The most common underlying condition associated with toxoplasmosis was hematological malignancy (50%), followed by solid organ transplantation (33.33%), and solid tumours (16.66%). Conclusions: This study’s results suggest that Cryptosporidium infections are more common among immunocompetent patients in Ottawa, whereas Toxoplasma infections are more common among HIV-negative patients with acquired immunodeficiencies. As the demographics of immunocompromised individuals continue to evolve, screening for protozoal infections in high-risk populations may become clinically important.