Laryngeal Mucosa Alterations in Mice Model of Gastroesophageal Reflux: Effects of Topical Protection.

OBJECTIVES/HYPOTHESIS: The objectives of this study were to evaluate laryngeal inflammation and mucosal integrity in a murine model of reflux disease and to assess the protective effects of topical agents including alginate, hyaluronic acid, and cashew gum. STUDY DESIGN: Animal study. METHODS: A surgical murine model of reflux disease was evaluated at 3 or 7 days postsurgery, and laryngeal samples were collected to measure inflammation (wet weight and myeloperoxidase [MPO]) and mucosal integrity (transepithelial resistance [TER] and mucosal permeability to fluorescein). Additional groups of animals were administered one of several topical agents (alginate, hyaluronic acid, or cashew gum) daily, and laryngeal inflammation and mucosal integrity were evaluated at 3 days postsurgery. RESULTS: At 3 days, and not 7 days postsurgery, we observed increased laryngeal wet weight and MPO, decreased laryngeal TER, and increased laryngeal mucosa permeability. Alginate partially decreased laryngeal inflammation (wet weight and not MPO) and dramatically improved laryngeal mucosal integrity. Conversely, hyaluronic acid eliminated the inflammation; however, it had no effect on laryngeal mucosal integrity impairment. Cashew gum eliminated laryngeal inflammation as well as the impairment in laryngeal mucosal integrity. CONCLUSIONS: This study shows that a surgical model of reflux disease induced laryngeal inflammation and impairment in laryngeal barrier function. These observed alterations were partially attenuated by alginate and hyaluronic acid and completely reversed by cashew gum. LEVEL OF EVIDENCE: NA Laryngoscope, 2020.

Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review.

Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, -20.31 h, 95% CI -27.06 to -13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat-inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37-0.71), pharyngitis (RR 0.31, 95% CI 0.12-0.83) and laryngitis (RR 0.44, 95% CI 0.29-0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotics.

Laringitis aguda obstructiva o crup viral / Acute laryngotracheitis or viral croup

We present the problem of viral croup or acute laryngotracheitis as an important respiratory issue in children that often prompts parents to seek physician consultation. Despite its frequency, there is still controversy among the medical team regarding its treatment. The problem will be defined and analyzed in-depth in terms of pathogenesis, to finally suggest a simple, clinically effective treatment than can be applied in any emergency service. We highlight the importance of epinephrine and corticosteroids in the acute treatment of these patients...

Consecuencias del reflujo gastroesofágico en la esfera O. R. L. y los síntomas laríngeos: revisión clínica / Consequence of the gastroesophageal reflux in the sphere O. R. L. and of the symptoms larygeal: clinical review

La presente revisión evidencia la asociación entre el reflujo gastroesofágico (RG) y los síntomas laríngeos de tipo persistente, entre ellos disfonía, tos, globus hystericus, carraspera, etc, así como también la correspondencia clínica patológica de estos síntomas. En las últimas tres décadas, se sugirió la idea de que el RG podía ser un factor predisponente en el desarrollo de las patologías relacionadas al espectro de la laringitis posterior ácida, tales como úlceras de contacto, granulomas, eritema interaritenoide. Fue cuando a partir de entonces, en múltiples estudios clínicos realizados a pequeñas escala se ha intentado establecer la causalidad de esa relación. La hipótesis encuentra uno de sus más sólidos argumentos, en la consistente remisión de los síntomas laríngeos observados en pacientes que han recibido tratamiento antirreflujo. De ser comprobada la relación de causalidad, se pondría de manifiesto la necesidad de realizar despistaje de RG en todo paciente que se presente con síntomas laríngeos, en especial a predominio nocturno.

Rifampin chemoprophylaxis for household contacts of patients with invasive infections due to Haemophilus influenzae type b.

To determine the efficacy of rifampin chemoprophylaxis in eradication of oropharyngeal carriage of Haemophilus influenzae type b, we conducted a multicenter, double-blind, placebo-controlled trial among household contacts of patients hospitalized for invasive HIB infection. Seventy-nine index patients and 400 close contacts were studied; 26.5% of contacts were colonized. The efficacy of rifampin (10 mg/kg/dose, 600 mg/dose maximum, twice daily for two days) in eradicating carriage was 52% and varied with age (75.6% in persons greater than or equal to 5 and 27% in those less than 5 years). Eradication rates in those less than 5 years were not significantly better than for placebo. No resistant isolates were encountered in sensitivity testing. The low efficacy of this rifampin regimen in young children precludes its routine use as a chemoprophylactic agent for family contacts. The occurrence of three cases of invasive HIB infection in individuals outside the defined contact group raises concern regarding the efficacy of any chemoprophylactic regimen.