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2.
Am Fam Physician ; 107(1): Online, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36689968
3.
Am Fam Physician ; 107(1): 35-41, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36689967

RESUMO

Tonsillitis, or inflammation of the tonsils, makes up approximately 0.4% of outpatient visits in the United States. Tonsillitis is caused by a viral infection in 70% to 95% of cases. However, bacterial infections caused by group A beta-hemolytic streptococcus (Streptococcus pyogenes) account for tonsillitis in 5% to 15% of adults and 15% to 30% of patients five to 15 years of age. It is important to differentiate group A beta-hemolytic streptococcus from other bacterial or viral causes of pharyngitis and tonsillitis because of the risk of progression to more systemic complications such as abscess, acute glomerulonephritis, rheumatic fever, and scarlet fever after infection with group A beta-hemolytic streptococcus. A variety of diagnostic tools are available, including symptom-based validated scoring systems (e.g., Centor score), and oropharyngeal and serum laboratory testing. Treatment is focused on supportive care, and if group A beta-hemolytic streptococcus is identified, penicillin should be used as the first-line antibiotic. In cases of recurrent tonsillitis, watchful waiting is strongly recommended if there have been less than seven episodes in the past year, less than five episodes per year for the past two years, or less than three episodes per year for the past three years. Tonsilloliths, or tonsil stones, are managed expectantly, and small tonsilloliths are common clinical findings. Rarely, surgical intervention is required if they become too large to pass on their own.


Assuntos
Faringite , Infecções Estreptocócicas , Tonsilite , Adulto , Humanos , Faringite/tratamento farmacológico , Streptococcus pyogenes , Antibacterianos/uso terapêutico , Abscesso , Infecções Estreptocócicas/diagnóstico
4.
Ann Afr Med ; 22(1): 61-69, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36695224

RESUMO

Background: Rheumatic heart disease (RHD) is the only preventable cardiovascular disease that still causes significant morbidity and mortality in low- and middle-income countries like Nigeria where it is classified as a neglected disease. The inciting agent causes pharyngitis often not properly treated. Aim and Objectives: To study the knowledge and preventive practices of RHD amongst primary healthcare workers who are in contact with larger ratio of populace in order to recommend appropriate interventions. Methodology: A cross-sectional study conducted among health workers in primary health centres in Sokoto metropolis. Multi-stage sampling technique was used to recruit the study participants. A structured questionnaire and focus group discussion guide was used to collect the information. Data was analysed using IBM SPSS version 25. Results: Majority (109/182; 59.8%) had RHD inadequate knowledge of causes, risk factors and treatment of pharyngitis which predisposes to RHD. Only 49 (26.9%) of the respondents knew the name of the causative agent. The knowledge gap was related to length of training and attendance at a training (ꭓ2 = 8.38; P=0.015 & ꭓ2 = 7.92; P=0.004). Majority of the respondents with 168 out of 182 (92.3%) had positive attitude. Practice grading was adequate in only less than half of the respondents (88/182; 48.4%). Male gender and negative attitude were predictors of adequacy of preventive practices (aOR= 0.49; 95% C.I =0.267-0.929; P=0.03 & aOR= 3.87; 95% C.I =1.027-14.586; P=0.046). Conclusion: The health workers had inadequate knowledge and poor practice on prevention of rheumatic heart disease. It is necessary to upscale information available to them by medical specialists and upgrade their curriculum.


Résumé Arrière-plan: La cardiopathie rhumatismale (RHD) est la seule maladie cardiovasculaire évitable qui cause encore une morbidité et une mortalité importantes dans les pays à revenu faible et intermédiaire comme le Nigeria où elle est classée comme une maladie négligée. L'agent incitant provoque une pharyngite souvent mal traitée. But et objectifs: Étudier les connaissances et les pratiques préventives de RHD parmi les agents de santé primaires qui sont en contact avec une plus grande proportion de la population afin de recommander des interventions appropriées. Méthodologie: Une étude transversale menée auprès des agents de santé des centres de santé primaires de la métropole de Sokoto. La technique d'échantillonnage à plusieurs degrés a été utilisée pour recruter les participants à l'étude. Un questionnaire structuré et un guide de discussion de groupe ont été utilisés pour recueillir les informations. Les données ont été analysées à l'aide d'IBM SPSS version 25. Résultats: La majorité (109/182 ; 59,8 %) avaient une connaissance inadéquate des causes, des facteurs de risque et du traitement de la pharyngite qui prédispose à la RHD. Seuls 49 (26,9%) des répondants connaissaient le nom de l'agent causal. Le déficit de connaissances était lié à la durée de la formation et à la participation à une formation (ꭓ2 = 8,38 ; P=0,015 & ꭓ2 = 7,92 ; P=0,004). La majorité des répondants avec 168 sur 182 (92,3%) avaient une attitude positive. La notation de la pratique n'était adéquate que pour moins de la moitié des répondants (88/182 ; 48,4 %). Le sexe masculin et l'attitude négative étaient des prédicteurs de l'adéquation des pratiques préventives (aOR = 0,49 ; IC à 95 % = 0,267-0,929 ; P = 0,03 et aOR = 3,87 ; IC à 95 % = 1,027-14,586 ; P = 0,046). Conclusion: Les agents de santé avaient des connaissances insuffisantes et de mauvaises pratiques en matière de prévention des cardiopathies rhumatismales. Il est nécessaire de valoriser les informations mises à leur disposition par les médecins spécialistes et d'améliorer leur cursus. Mots-clés: rhumatisme articulaire aigu, attitude, GABHS, savoir, pharyngite, pratique, prévention, soins de santé primaires, cardiopathie rhumatismale, Sokoto.


Assuntos
Faringite , Cardiopatia Reumática , Humanos , Masculino , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/prevenção & controle , Nigéria/epidemiologia , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Pessoal de Saúde , Faringite/prevenção & controle
5.
Artigo em Inglês | MEDLINE | ID: mdl-36674238

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has changed the course of human history and killed millions of people worldwide. Its long-term consequences remain uncertain. This study aimed to describe the short- and long-term symptoms of COVID-19 among individuals in Goiás, central Brazil, who experienced acute mild or non-symptomatic SARS-CoV-2 infection during the first wave of the pandemic. This prospective cohort study included 110 healthcare workers, 18 safety workers, and 19 administrative support workers, who were followed up for 12 months after the onset of COVID-19. Most participants were healthy adult female healthcare professionals. At the onset of infection, the major symptoms were headache, myalgia, nasal congestion, cough, coryza, anosmia, ageusia, sore throat, fatigue, diarrhea, and dyspnea. Furthermore, 20.3% of the participants had three or more COVID-19 symptoms that persisted for at least 12 months. These included coryza, congestion, hair loss, sore throat, headache, myalgia, cough, memory loss, anosmia, and fatigue. This study revealed a high prevalence of persistent symptoms of COVID-19 in healthy individuals from central Brazil, which may present an additional burden on healthcare services. Further studies are required to investigate the sequelae of COVID-19 over periods greater than 12 months.


Assuntos
COVID-19 , Faringite , Adulto , Humanos , Feminino , COVID-19/epidemiologia , SARS-CoV-2 , Mialgia , Anosmia , Tosse/epidemiologia , Estudos Prospectivos , Cefaleia/epidemiologia , Cefaleia/etiologia , Faringite/epidemiologia , Pessoal de Saúde , Fadiga/epidemiologia , Fadiga/etiologia , Atenção à Saúde
6.
Anesth Analg ; 136(2): 338-345, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36638513

RESUMO

BACKGROUND: Postoperative sore throat (POST) is a distressing complaint in adults after endotracheal intubation. This study aimed to evaluate the effect of topical application of a eutectic mixture of local anesthetics (EMLA) cream over the endotracheal tube (ETT) cuff on the incidence and severity of POST, cough, and hoarseness of voice in adults after surgery. METHODS: In this randomized, placebo-controlled study, adult patients 18 to 65 years old, in American Society of Anesthesiologists (ASA) physical status I and II, and of either sex were scheduled to receive 5% EMLA cream (intervention arm) or lubricant gel (placebo-controlled arm) applied over the ETT cuff. POST was graded as none (0), mild (1), moderate (2), or severe (3). A score of ≥2 was considered as significant POST. The incidence of POST at the sixth postoperative hour was the primary outcome. Secondary outcomes included the incidence of POST at 0, second, and 24 hours, and the incidence of significant POST (score ≥2). The incidence and severity of postoperative cough and hoarseness of voice were recorded simultaneously. RESULTS: Two hundred and four patients completed the study. The incidence of POST was significantly lower in the EMLA group versus placebo at the sixth postoperative hour (4.9% vs 40.1%; relative risk [RR], 0.12; 95% confidence interval [CI], 0.05-0.29; P < .001); and at 0 hour (74.5% vs 93.1%; RR, 0.8; 95% CI, 0.7-0.9; P < .001) and second hour (51.9% vs 84.3%; RR, 0.61; 95% CI, 0.5-0.75; P < .001) but comparable at 24 hours (1.9% vs 3.9%; RR, 0.5; 95% CI, 0.09-2.67; P = .4). The number needed to treat to prevent POST with EMLA cream application was 5 at 0 hour and 3 at the second and sixth hour. The proportion of patients with significant POST over 24 hours were less in the EMLA group (9.8% vs 43.1%; P < .001). The incidence of postoperative cough and hoarseness of voice was significantly less at the 0, second, and sixth hours in the EMLA group, but comparable at 24 hours. The incidence of severe cough (8.8% vs 31.4%; P < .001) and hoarseness of voice (2% vs 7.4%; P < .001) over 24 hours was less in the EMLA group. CONCLUSIONS: The application of EMLA cream over ETT cuff reduces the incidence and severity of POST, cough, and hoarseness of voice in adults after general anesthesia in the early postoperative period compared to lubricant gel.


Assuntos
Anestesia Endotraqueal , Faringite , Adulto , Humanos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Anestésicos Locais/uso terapêutico , Combinação Lidocaína e Prilocaína/uso terapêutico , Anestesia Endotraqueal/efeitos adversos , Rouquidão/diagnóstico , Rouquidão/epidemiologia , Rouquidão/etiologia , Tosse/diagnóstico , Tosse/epidemiologia , Tosse/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Faringite/diagnóstico , Faringite/epidemiologia , Faringite/etiologia , Intubação Intratraqueal/efeitos adversos , Anestesia Geral/efeitos adversos , Dor , Lidocaína
7.
Saudi Med J ; 44(1): 74-79, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36634950

RESUMO

OBJECTIVES: To explore the differences between COVID-19 and upper respiratory tract infections (URTI) in the pediatric population, emphasizing smell and taste disturbances. METHODS: A case-control study included 468 patients, 234 with COVID-19 (cases) and 234 with URTI (controls) at a tertiary hospital, Riyadh, Saudi Arabia, from 2020-2021. Patients with bacterial URTI, lower tract respiratory infections, and speech or developmental delays were excluded. Statistical analysis was carried out using Statistical Analysis System, 9.2 version. A p-value of ≤0.05 was considered significant. RESULTS: The male-to-female ratio was almost equal, with a mean age of 9.90±2.34. Multivariable logistic regression analysis showed that a change in taste significantly increases the probability of COVID-19 by 21.98 times. On the other hand, sore throat (81.5%), dyspnea (63.5%), nasal obstruction (72.7%), and otalgia significantly (74.8%) decrease the likelihood of COVID-19. CONCLUSION: Taste disturbances increase the probability of COVID-19 infections, whereas sore throat, dyspnea, nasal obstruction, and otalgia increase the likelihood of other URTIs. The described differences might aid physicians in their differential diagnosis and treatment during the pandemic.


Assuntos
COVID-19 , Obstrução Nasal , Faringite , Infecções Respiratórias , Humanos , Masculino , Criança , Feminino , COVID-19/epidemiologia , Dor de Orelha , Estudos de Casos e Controles , Infecções Respiratórias/epidemiologia , Dor , Dispneia
8.
BMC Anesthesiol ; 23(1): 2, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36597027

RESUMO

BACKGROUND: Coughing caused by tracheal extubation is common following general anaesthesia. Heavy aerosol production by coughing during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) may be one of the highest risk factors for infection in healthcare workers. The application of local anaesthetics to the endotracheal tube is an effective method to reduce coughing. The most commonly used anaesthetics are compound lidocaine/prilocaine cream and tetracaine spray. However, coughing still occurs when the two anaesthetics are used alone. We speculated that the application of compound lidocaine/prilocaine combined with tetracaine spray would better prevent coughing caused by tracheal extubation. METHODS: Patients scheduled for laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anaesthesia were randomly assigned to Group C (saline spray), Group L (2 g compound lidocaine/prilocaine cream contains 5 mg of lidocaine and 5 mg prilocaine)), Group T (tetracaine) and Group F (compound lidocaine/prilocaine cream combined with tetracaine). The incidence of coughing, the endotracheal tube tolerance assessment, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were recorded and analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the plasma concentrations of epinephrine and norepinephrine were measured immediately before extubation and 1 min after extubation. RESULTS: A total of 211 patients were randomly assigned to Group C (53 cases), Group L (52 cases), Group T (52 cases) and Group F (54 cases). The primary result is assessment of the incidence of cough. The patients emerged from general anaesthesia, 96% of Group C had cough, which was significantly reduced in Group L (61.5%, P < 0.001), Group T (75%, P < 0.05) and Group F (22.2%, P < 0.001). Group F had a significantly reduced incidence of cough compared to Group L and Group T (P < 0.05 or P < 0.01, respectively). The secondary results were assessed. The endotracheal tube tolerance score in Group C ((1, 3) 4, P < 0.001) was higher than Group L ((0, 1) 2), Group T ((0, 1.25) 3) and Group F ((0, 0) 1). Group F had a significantly lower score than Group L and Group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in Group C (96.2% and 71.7%, respectively, P < 0.001) than Group L (48.1% and 15.4%, respectively), Group T (61.5% and 26.9%, respectively) and Group F (17.3% and 7.7%, respectively). Blood pressure, HR and plasma concentrations of epinephrine and norepinephrine were significantly higher in Group C than in all other groups at the time of extubation and 1 min after extubation (P < 0.001). Group F exhibited significantly reduced blood pressure, heart rate and plasma concentrations of epinephrine and norepinephrine compared to Group L and Group T (P < 0.05, P < 0.01 or P < 0.001, respectively). The incidence of postoperative pharyngeal pain and the incidence of postoperative cough were not significantly different among the groups. CONCLUSIONS: Compound lidocaine/prilocaine cream combined with tetracaine may be a more effective approach for preventing coughing and stabilising circulation during extubation following general anaesthesia. This may play an important role in preventing medical staff from contracting respiratory infectious diseases. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) "retrospectively registered".


Assuntos
COVID-19 , Faringite , Humanos , Tetracaína , Extubação/efeitos adversos , Tosse/etiologia , COVID-19/complicações , Combinação Lidocaína e Prilocaína , Anestésicos Locais , Lidocaína/uso terapêutico , Prilocaína/uso terapêutico , Faringite/epidemiologia , Anestesia Geral/efeitos adversos , Norepinefrina , Epinefrina , Método Duplo-Cego , Dor/etiologia
9.
Zhonghua Er Ke Za Zhi ; 61(1): 61-65, 2023 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-36594123

RESUMO

Objective: To investigate the clinical characteristics of children with allergic diseases suffering from SARS-CoV-2 Omicron variant strains. Methods: This was a cross-sectional study. A total of 43 pediatric patients with allergic diseases infected by SARS-CoV-2 from April 25, 2022 to June 8, 2022 in Shanghai Jiao Tong University School of Medicine were selected as the allergic disease group, while 114 cases without underlying diseases and 16 cases with other underlying diseases were selected as control groups diagnosed at the same period. Clinical data including clinical features, laboratory tests, duration of hospitalization, and the time to negative turn of novel coronavirus nucleic acid were collected and analysed. Kruskal-Wallis H test, chi-square test or Fisher exact test were used for comparison among three groups. Results: Among the 43 patients with allergic diseases, 28 were males and 15 were females, with an age of 4.4 (2.1, 8.2) years on admission, including 32 mild cases and 11 common cases. The allergic disease group included 20 cases (46.5%) of atopic dermatitis and eczema, followed by 14 cases (32.6%) of rhinitis, 8 cases (18.6%) of food allergies, 7 cases (16.3%) of asthma, 4 cases (9.3%) of allergic conjunctivitis and 2 cases (4.7%) of drug allergy. Among the 114 cases without underlying diseases, 57 were males and 57 were females, with an age of 2.8 (1.2, 5.6) years on admission, including 93 mild cases and 21 common cases. Among the 16 cases with other underlying diseases, 9 were males and 7 were females, with an age of 3.0 (2.6, 10.8) years on admission, including 13 cases mild and 3 cases common cases. Children with allergic diseases had higher frequency of sore throat and vomiting than those without underlying diseases (10 cases (23.3%) vs.9 cases (7.9%), 14 cases (32.6%) vs. 11 cases (9.6%), χ²=6.93, 12.24, both P<0.05). The lymphocyte count of patients with allergic disease was lower than those without underlying disease (1.1 (0.7,1.7)×109 vs. 1.6 (1.1,2.7)×109/L, H=-28.00,P=0.005). There were no significant differences in age, gender, typing of SARS-CoV-2, the duration of hospitalization, cycle threshold values of SARS-CoV-2 and the time to negative turn of novel coronavirus nucleic acid among the three groups (all P>0.05). Conclusions: Children with allergic diseases may suffer from sore throat and vomiting more frequently when infected with SARS-CoV-2 Omicron variant. The combination of allergic diseases hardly influenced the disease course of SARS-CoV-2 in children.


Assuntos
COVID-19 , Hipersensibilidade Alimentar , Faringite , Masculino , Feminino , Humanos , Criança , SARS-CoV-2 , Estudos Transversais , China/epidemiologia
10.
Influenza Other Respir Viruses ; 17(1): e13081, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36480419

RESUMO

BACKGROUND: Public health organizations have recommended various definitions of influenza-like illnesses under the assumption that the symptoms do not change during influenza virus infection. To explore the relationship between symptoms and influenza over time, we analyzed a dataset from an international multicenter prospective emergency department (ED)-based influenza-like illness cohort study. METHODS: We recruited patients in the US and Taiwan between 2015 and 2020 with: (1) flu-like symptoms (fever and cough, headache, or sore throat), (2) absence of any of the respiratory infection symptoms, or (3) positive laboratory test results for influenza from the current ED visit. We evaluated the association between the symptoms and influenza virus infection on different days of illness. The association was evaluated among different subgroups, including different study countries, influenza subtypes, and only patients with influenza. RESULTS: Among the 2471 recruited patients, 45.7% tested positive for influenza virus. Cough was the most predictive symptom throughout the week (odds ratios [OR]: 7.08-11.15). In general, all symptoms were more predictive during the first 2 days (OR: 1.55-10.28). Upper respiratory symptoms, such as sore throat and productive cough, and general symptoms, such as body ache and fatigue, were more predictive in the first half of the week (OR: 1.51-3.25). Lower respiratory symptoms, such as shortness of breath and wheezing, were more predictive in the second half of the week (OR: 1.52-2.52). Similar trends were observed for most symptoms in the different subgroups. CONCLUSIONS: The time course is an important factor to be considered when evaluating the symptoms of influenza virus infection.


Assuntos
Influenza Humana , Orthomyxoviridae , Faringite , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Tosse , Estudos Prospectivos , Estudos de Coortes
11.
Eur J Haematol ; 110(1): 67-76, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36193973

RESUMO

BACKGROUND: The SARS-COV-2 (Covid-19) pandemic has impacted the management of patients with hematologic disorders. In some entities, an increased risk for Covid-19 infections was reported, whereas others including chronic myeloid leukemia (CML) had a lower mortality. We have analyzed the prevalence of Covid-19 infections in patients with mastocytosis during the Covid-19 pandemic in comparison to data from CML patients and the general Austrian population. MATERIALS AND METHODS: The prevalence of infections and PCR-proven Covid-19 infections was analyzed in 92 patients with mastocytosis. As controls, we used 113 patients with CML and the expected prevalence of Covid-19 in the general Austrian population. RESULTS: In 25% of the patients with mastocytosis (23/92) signs and symptoms of infection, including fever (n = 11), dry cough (n = 10), sore throat (n = 12), pneumonia (n = 1), and dyspnea (n = 3) were recorded. Two (8.7%) of these symptomatic patients had a PCR-proven Covid-19 infection. Thus, the prevalence of Covid-19 infections in mastocytosis was 2.2%. The number of comorbidities, subtype of mastocytosis, regular exercise, smoking habits, age, or duration of disease at the time of interview did not differ significantly between patients with and without Covid-19 infections. In the CML cohort, 23.9% (27/113) of patients reported signs and symptoms of infection (fever, n = 8; dry cough, n = 17; sore throat, n = 11; dyspnea, n = 5). Six (22.2%) of the symptomatic patients had a PCR-proven Covid-19 infection. The prevalence of Covid-19 in all CML patients was 5.3%. The observed number of Covid-19 infections neither in mastocytosis nor in CML patients differed significantly from the expected number of Covid-19 infections in the Austrian population. CONCLUSIONS: Our data show no significant difference in the prevalence of Covid-19 infections among patients with mastocytosis, CML, and the general Austrian population and thus, in mastocytosis, the risk of a Covid-19 infection was not increased compared to the general population.


Assuntos
COVID-19 , Leucemia Mielogênica Crônica BCR-ABL Positiva , Leucemia Mieloide , Mastocitose , Faringite , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Pandemias , SARS-CoV-2 , Incidência , Tosse , Áustria/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Febre , Dispneia
12.
J Int Med Res ; 50(12): 3000605221141556, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36545835

RESUMO

OBJECTIVE: This study was performed to compare the performance of rotational versus standard insertion of the i-gel® (Intersurgical, Wokingham, Berkshire, England) in patients of advanced age. METHODS: This single-center, randomized, double-blind trial involved 140 patients of advanced age undergoing general anesthesia. The patients were randomized into the standard group and rotational group. The primary objective of this study was to compare the success rate of the first attempt. The secondary outcome indicators were the insertion time and postoperative complications. RESULTS: The placement success rate on the first attempt was significantly higher in the rotational group than in the standard group (92% vs. 73%, respectively). The overall success rate was 100% for the rotational method and 95% for the standard method. The mean ± standard deviation insertion times were similar (15 ± 7.34 vs. 14 ± 7.26 s, respectively). The incidence rates of blood staining of the i-gel®, hoarseness, and sore throat did not increase with the rotational technique and were not significantly different from those of the standard method. CONCLUSION: Compared with the standard method, the rotational method of i-gel® insertion had a higher success rate and did not increase the insertion time and complications in patients of advanced age.Trial registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR2000038763, Date of registration: 30/09/2020).


Assuntos
Máscaras Laríngeas , Faringite , Humanos , Intubação Intratraqueal/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Anestesia Geral/métodos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Faringite/etiologia
13.
Nagoya J Med Sci ; 84(4): 900-905, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36544607

RESUMO

Primary laryngeal cryptococcosis is an extremely rare infection and presents with non-specific symptoms such as hoarseness or sore throat, resulting in delayed diagnosis. Here, we report the patient of a 56-year-old female patient with primary laryngeal cryptococcosis, who was being treated with oral and inhaled steroids for rheumatoid arthritis and bronchial asthma. The patient suffered from prolonged hoarseness and sore throat, and endoscopic biopsy was performed several times under local anesthesia, demonstrating only inflammatory cell infiltration. Considering the possibility of laryngeal malignancy, a third biopsy was performed by endoscopic laryngomicrosurgery under general anesthesia. Intraoperative frozen section revealed non-neoplastic laryngeal mucosa with erosion and severe inflammatory cell infiltration. However, we could not confirm the definite diagnosis of the lesion in the intraoperative consultation. Postoperative histopathological examination revealed a small number of yeast-type fungi and a definitive diagnosis was established by special stains including Alcian blue stain. Finally, the patient was diagnosed as primary laryngeal cryptococcosis. Daily oral administration of fluconazole (400 mg/day) was performed for 6 months according to the treatment protocol for pulmonary cryptococcosis. The symptoms gradually improved, and endoscopy revealed no recurrence 6 months post-treatment. Clinicians should consider the possibility of laryngeal cryptococcosis when severe inflammation is found in the larynx and discuss the disease history and pathological results with pathologists more closely.


Assuntos
Criptococose , Neoplasias Laríngeas , Laringe , Faringite , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Rouquidão , Laringe/patologia , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/patologia
14.
Artigo em Japonês | MEDLINE | ID: mdl-36560902

RESUMO

We compared rapid antigen detection kits widely used for the rapid diagnosis of group A streptococcal pharyngitis, evaluating their minimum detection sensitivity and operability in five levels. Five kits based on the immunochromatographic method were used: ImunoAce Strep A (Tauns), ImunoAce Strep A Neo (Tauns), Quick Navi-StrepA2 (Denka), Quick Vue Dipstick Strep A (SB Bioscience) and RapidTesta Strep A (SEKISUI MEDICAL). Thirteen strains were tested: 10 clinical isolates of Streptococcus pyogenes, 2 strains of Streptococcus dysgalactiae subsp. equisimilis (SDSE), and S. pyogenes ATCC 19615. All kits had the same or higher minimum detection sensitivity than previously reported. ImunoAce StrepA Neo had the highest detection sensitivity and the best overall evaluation among the group A streptococcal rapid antigen detection kits used in this study. The detection sensitivity of SDSE with group A polysaccharide antigen was comparable to that of S. pyogenes. Although culture tests are necessary to confirm the causative organism, SDSE may present with clinical symptoms similar to those of S. pyogenes, and detection with a rapid antigen detection kit may be of therapeutic value.


Assuntos
Faringite , Infecções Estreptocócicas , Humanos , Streptococcus pyogenes , Infecções Estreptocócicas/diagnóstico , Faringite/diagnóstico , Faringite/microbiologia , Kit de Reagentes para Diagnóstico
15.
Am Fam Physician ; 106(6): 628-636, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36521460

RESUMO

Upper respiratory tract infections are responsible for millions of physician visits in the United States annually. Although viruses cause most acute upper respiratory tract infections, studies show that many infections are unnecessarily treated with antibiotics. Because inappropriate antibiotic use results in adverse events, contributes to antibiotic resistance, and adds unnecessary costs, family physicians must take an evidence-based, judicious approach to the use of antibiotics in patients with upper respiratory tract infections. Antibiotics should not be used for the common cold, influenza, COVID-19, or laryngitis. Evidence supports antibiotic use in most cases of acute otitis media, group A beta-hemolytic streptococcal pharyngitis, and epiglottitis and in a limited percentage of acute rhinosinusitis cases. Several evidence-based strategies have been identified to improve the appropriateness of antibiotic prescribing for acute upper respiratory tract infections.


Assuntos
COVID-19 , Otite Média , Faringite , Infecções Respiratórias , Humanos , Estados Unidos , Antibacterianos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Faringite/tratamento farmacológico , Otite Média/tratamento farmacológico , Padrões de Prática Médica
16.
An. pediatr. (2003. Ed. impr.) ; 97(6): 398-404, dic. 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-213168

RESUMO

Introducción: El tratamiento antibiótico clásico de la faringoamigdalitis aguda estreptocócica es una pauta de 10 días; sin embargo, la aparición de resistencias antibióticas induce a explorar pautas más cortas. Material y métodos: Seleccionamos a aquellos pacientes diagnosticados de faringoamigdalitis aguda estreptocócica en 2 cupos de pediatría de un centro de salud entre junio de 2016 y abril de 2020. Se compararon los resultados de aquellos que recibieron tratamiento 8-10 días con el de aquellos que lo recibieron 5-7 días. Resultados: Se analizaron 350 episodios (252 pacientes). El 64% recibieron tratamiento durante 8-10 días (grupo 1) y el 36% durante 5-7 días (grupo 2). No se observaron diferencias significativas en la aparición de faringoamigdalitis aguda estreptocócica o escarlatina los 3 meses posteriores (OR 0,97; IC 95%: 0,46-2,03), con una proporción similar en ambos grupos (9,8 vs. 9,5%). Sin diferenciar el tipo de infección (faringoamigdalitis aguda estreptocócica, escarlatina u otro tipo de infección streptocócica), se observaron resultados similares (OR 0,81; IC 95%: 0,41-1,59) con el 13,4% en el grupo 1 y el 11,1% en el 2. Respecto a la aparición de reacciones adversas medicamentosas recogidas en la historia clínica, fue de 2,7% en el grupo 1 y 0,8% en el 2 (OR 0,29; IC 95%: 0,04-2,44). Conclusiones: Según nuestra experiencia, la pauta antibiótica corta (5-7 días) en faringoamigdalitis aguda estreptocócica no es menos efectiva ni más insegura que la clásica pauta de 10 días. (AU)


Introduction: Antibiotherapy regimens for management of acute streptococcal pharyngitis traditionally last 10 days, but the development of resistance to different antimicrobials has motivated the exploration of shorter courses. Material and methods: We selected patients given a diagnosis of streptococcal pharyngitis in 2 paediatric caseloads of one primary care centre between June 2016 and April 2020. We compared outcomes in patients treated with 8- to 10-day courses versus 5- to 7-day courses. Results: The analysis included 350 care episodes (252 patients). Sixty-four percent were managed with 8- to 10-day courses of antibiotherapy (group 1) and 36% with 5- to 7-day courses (group 2). There were no significant differences in the incidence of streptococcal pharyngitis or scarlet fever in the 3 months that followed (OR, 0.98; 95% CI: 0.46-2.03), with similar percentages in both groups (9.8 vs. 9.5%). Overall, without differentiating based on the type of infection (streptococcal pharyngitis, scarlet fever or other streptococcal infections), we found similar outcomes (OR, 0.81; 95% CI: 0.41-1.59): 13.4% in group 1 and 11.1% in group 2. We also found no differences in the frequency of adverse events documented in the health records (OR, 0.29; 95% CI: 0.04-2.44): 2.7% in group 1 and 0.8% in group 2. Conclusions: In our experience, a shorter antibiotic course (5-7 days) is not less effective or more unsafe for management of acute streptococcal pharyngitis than the traditional 10-day course. (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Streptococcus pyogenes , Resistência Microbiana a Medicamentos , Faringite/tratamento farmacológico , Estudos Retrospectivos , Epidemiologia Descritiva , Escarlatina
17.
Acta Biomed ; 93(6): e2022329, 2022 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-36533761

RESUMO

BACKGROUND AND AIM: An association between reflux and burning mouth syndrome (BMS) has been proposed. Aims of this study were: 1) to investigate the frequency of BMS in a sample of GERD patients; 2) to measure G17, in a sample of BMS patients; 3) to assess the efficacy of different therapeutical schedules for GERD in BMS patients. METHODS: We divided the study in 3 main steps. In step one, we analyzed 500 consecutive GERD patients' type and frequency of extraesophageal manifestations including BMS. In step two, we collected 124 consecutive BMS patients' symptoms and  G17.  In step three, we evaluate the efficacy of 3 different drugs on BMS. RESULTS: In step one, 204 patients complained heartburn; 31 globus pharyngeus; 52 chronic cough; 54 pharyngitis; 31 postnasal drip; 56 burning mouth symptoms; 34 noncardiac chest pain; 17 asthma and 21 sleep apnea. In step two, 29 patients had G17 ≤ 1 pg/L; 64 patients between 1 and 3; and 31 patients ≥ 3. In step three, 49 patients reported slight benefit with PPI, 75 no benefit. 61 patients reported slight benefit with sodium alginate and sodium bicarbonate, 63 no benefit. 23 reported an almost complete remission with HYCHSA, 26 slight benefit, 33 no benefit. CONCLUSIONS: Prevalence of BMS in GERD patients was similar to that reported for chronic chough and pharyngitis. Low levels of G17 were found in the majority of BMS patients. Finally, we observed a greater benefit from barrier drugs therapy than from PPI therapy in BMS patients. (www.actabiomedica.it).


Assuntos
Síndrome da Ardência Bucal , Refluxo Gastroesofágico , Faringite , Humanos , Síndrome da Ardência Bucal/epidemiologia , Síndrome da Ardência Bucal/etiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Tosse , Dor no Peito , Faringite/complicações
18.
J Am Board Fam Med ; 35(6): 1065-1071, 2022 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-36526329

RESUMO

BACKGROUND: Ordering a serologic test for infectious mononucleosis (IM) in all young patients with sore throat is costly and impractical. The test threshold to determine when to order a diagnostic test for IM based on the patient's symptoms has not been previously studied. OBJECTIVE: To determine the test threshold for IM in the management of patients with sore throat. DESIGN AND SETTING: Online surveys were sent to a convenience sample of US primary care clinicians regarding their decision making about whether or not to order a test for IM in a patient with sore throat. METHOD: 7 clinical vignettes were created, each with a different combinations of symptoms and signs. The probability of IM for each vignette was estimated by the investigator based on the number of symptoms present to generate a plausible range of disease probabilities. Clinicians were then asked to decide whether to test or not test for IM, and mixed-effect logistic regression was used to determine the test threshold for IM where half of physicians chose to test and half chose not to test. RESULTS: A total of 117 clinicians provided responses for a total of 819 clinical vignettes. The overall test threshold for IM as estimated using the logistic regression was 9.5% (95% CI: 8.2% to 10.9%). The test threshold for clinicians practicing greater than 10 years was significantly higher than for those practicing less or equal to 10 years (10.5% vs 7.3%, P = .02). No significant differences between specialties and practice sites were found with respect to the test threshold. CONCLUSION: This study identified a test threshold for IM of approximately 10% based on realistic clinical vignettes. This threshold was stable regarding the clinician's specialty and practice sites and could be used in the development of a clinical prediction rule to determine the cutoff for low- versus high-risk groups.


Assuntos
Mononucleose Infecciosa , Faringite , Médicos , Humanos , Mononucleose Infecciosa/diagnóstico , Faringite/diagnóstico , Testes Sorológicos/métodos , Probabilidade
19.
PLoS One ; 17(12): e0278871, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36520843

RESUMO

BACKGROUND: Conflicting outcomes have been reported for the i-gel™ and laryngeal mask airway (LMA) ProSeal™ in children and adults during general anesthesia. Randomized controlled trials (RCTs) that yielded wide contrast outcomes between i-gel™ and LMA ProSeal™ were included in this meta-analysis. METHODS: Two authors independently identified RCTs that compared i-gel™ with LMA ProSeal™ among patients receiving general anesthesia by performing searches in EMBASE, Cochrane, PubMed, and ScienceDirect. Discussion was adopted to resolve disagreements. Data were counted with Review Manger 5.3 and pooled by applying weighted mean difference (MD) and rlsk ratio (RR), and related 95% confidence intervals. RESULTS: A total of 33 RCTs with 2605 patients were included in the meta-analysis. I-gel™ provided a considerably lower oropharyngeal leak pressure [weighted average diversity (MD) = -1.53 (-2.89, -0.17), P = 0.03], incidence of blood staining on the supraglottic airway devices [RR = 0.44, (0.28, 0.69), P = 0.0003], sore throat [RR = 0.31 (0.18, 0.52), P<0.0001], and a short insertion time [MD = -5.61 (-7.71, -3.51), P<0.00001] than LMA ProSeal™. Compared with LMA ProSeal™, i-gel™ offered a significantly higher first-insertion success rate [RR = 1.03 (1.00, 1.06), P = 0.03] and ease of insertion [RR = 1.06 (1.01, 1.11), P = 0.03]. The gastric-tube-placement first insertion rate [RR = 1.04 (0.99, 1.10), P = 0.11], laryngospasm [RR = 0.76 (0.17, 3.31), P = 0.72], and cough [RR = 1.30 (0.49, 3.44), P = 0.60] between the two devices were similar. CONCLUSIONS: Both devices could achieve a good seal to provide adequate ventilation. Compared with the used LMA ProSeal™, the i-gel™ was found to have fewer complications (blood stainning, sore throat) and offers certain advantages (short insertion time, higher first-insertion success rate and ease of insertion) in patients under general anesthesia.


Assuntos
Máscaras Laríngeas , Faringite , Adulto , Criança , Humanos , Máscaras Laríngeas/efeitos adversos , Anestesia Geral/efeitos adversos , Faringite/epidemiologia , Faringite/etiologia , Dor
20.
MMW Fortschr Med ; 164(21-22): 9, 2022 12.
Artigo em Alemão | MEDLINE | ID: mdl-36510045

Assuntos
Faringite , Humanos , Dor
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