Introduction:The performance of tracheotomy is a common procedural request by critical care departments to the surgical services of general surgery, thoracic surgery and otolaryngology -head & neck surgery. A Canadian Society of Otolaryngology -Head & Neck Surgery (CSO-HNS) task force was convened with multi-specialty involvement from otolaryngology-head & neck surgery, general surgery, critical care and anesthesiology to develop a set of recommendations for the performance of tracheotomies during the COVID-19 pandemic. Main body: The tracheotomy procedure is highly aerosol generating and directly exposes the entire surgical team to the viral aerosol plume and secretions, thereby increasing the risk of transmission to healthcare providers. As such, we believe extended endotracheal intubation should be the standard of care for the entire duration of ventilation in the vast majority of patients. Pre-operative COVID-19 testing is highly recommended for any nonemergent procedure. Conclusion: The set of recommendations in this document highlight the importance of avoiding tracheotomy procedures in patients who are COVID-19 positive if at all possible. Recommendations for appropriate PPE and environment are made for COVID-19 positive, negative and unknown patients requiring consideration of tracheotomy. The safety of healthcare professionals who care for ill patients and who keep critical infrastructure operating is paramount.

Abstract. Tumor biopsy samples from 25 Floridian and 15 Hawaiian green turtles (Chelonia mydas) with spontaneous green turtle fibropapillomatosis (GTFP) and from 27 captive-reared green turtles with experimentally induced GTFP were examined microscopically to differentiate the histologic features that result from GTFP pathogenesis and those that result from incidental factors that may vary according to geographic region. Common histologic features for spontaneous and experimentally induced tumors included fibroblast proliferation in the superficial dermis, epidermal acanthosis and hyperkeratosis, epidermal basal cell degeneration with dermalepidermal cleft formation, spinous layer degeneration with intraepidermal vesicle and pustule formation, and ulceration. Visceral tumors, found in eight of 10 (80%) free-ranging turtles with cutaneous disease that were examined after death, had extensive interstitial fibrous proliferation. The presence of spirorchid trematode eggs and associated foreign body granulomas, common secondary findings within spontaneous tumors, varied by geographic location, and these findings were not observed in experimentally induced tumors. Eosinophilic intranuclear inclusions and intranuclear herpesvirus-associated antigen immunoreactivity were found in 18 of 38 (47%) experimentally induced cutaneous tumors and nine of 119 (7.5%) spontaneous tumors from Floridian but not Hawaiian turtles. The possible involvement of GTFP-associated herpesvirus in the pathogenesis of epidermal degenerative changes and GTFP pathogenesis is discussed.Key words: Chelonia mydas; dermatitis; fibropapilloma; green turtles; herpesvirus; immunohistochemistry; tumor.Green turtle fibropapillomatosis (GTFP) is a disease of green turtles (Chelonia mydas) that is characterized by multiple cutaneous papillomas, fibromas, and fibropapillomas, as well as occasional visceral fibromas. Concern over recent increases in the prevalence of GTFP around the world has focused attention on identifying the cause and understanding the pathogenesis of this disease so that management strategies can be developed to minimize its impact on populations of endangered green turtles. 18 A thorough description of the disease process should identify the relevant histologic features seen in spontaneous lesions and distinguish these from features that are incidental or result from secondary processes. In addition, any proposed etiologic hypothesis should account for the major histologic features of the disease, and the pathogenesis of these lesions should be consistent with what is known about the pathobiology of closely related pathogens. Therefore, careful systematic evaluation of lesions from different populations can sometimes yield the etiologic agent but more effectively can eliminate candidates not present in all groups.The first histologic descriptions of GTFP were published about 60 years ago. 41,58,59 Subsequently, Jacobson et al. 31 provided a more detailed description of light and electron microscopic features of GTFP. These basic histolog...

Persistent ill health after acute COVID-19—referred to as long COVID, the post-acute COVID-19 syndrome, or the post-COVID-19 condition—has emerged as a major concern. We undertook an international consensus exercise to identify research priorities with the aim of understanding the long-term effects of acute COVID-19, with a focus on people with pre-existing airways disease and the occurrence of new-onset airways disease and associated symptoms. 202 international experts were invited to submit a minimum of three research ideas. After a two-phase internal review process, a final list of 98 research topics was scored by 48 experts. Patients with pre-existing or post-COVID-19 airways disease contributed to the exercise by weighting selected criteria. The highest-ranked research idea focused on investigation of the relationship between prognostic scores at hospital admission and morbidity at 3 months and 12 months after hospital discharge in patients with and without pre-existing airways disease. High priority was also assigned to comparisons of the prevalence and severity of post-COVID-19 fatigue, sarcopenia, anxiety, depression, and risk of future cardiovascular complications in patients with and without pre-existing airways disease. Our approach has enabled development of a set of priorities that could inform future research studies and funding decisions. This prioritisation process could also be adapted to other, non-respiratory aspects of long COVID.

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Transmission experiments were conducted to further characterize the filterable transmissible agent that causes GTFP, fibropapillomatosis of green turtles Chelonja mydas. Cell-free homogenates (unfiltered or 0.45 pm filtered), prepared from fibropapillomas of free-ranging green turtles (donors) and inoculated into 18 captive-reared recipients, induced tumors in recipients with an overall success rate of 83.3 % (range: 0 to 100 %). Chloroform treatment prior to inoculation destroyed tumorigenic activity of these homogenates. These data are consistent with the hypothesis that the GTFP agent contains a lipid component, such as a viral envelope, necessary for tumorigenicity. Ultracentrifugation of tumor homogenates for 2 h at 100 000 X gcleared the supernatant of tumorigenic activity. Tumorigenicity was recovered in the ultracentrifuge pellet. The pellet, however,was less effective at inducing tumors than the starting material, indicating that the GTFP agent was damaged by these ultracentnfugation conditions. The possibility that the GTFP-associated herpesvirus is the etiologic agent of GTFP was further supported by the observation of eosinophAc intranuclear inclusions in 24.3% of experimentally induced tumors in thls study. Tumorigenic activity survived storage for several months at -80°C and at least 1 yr at -180°C, making it feasible to isolate the GTFP agent and its genome from frozen archived material once methods have been optirnized.