Tonsillitis Research Articles

The Role of lL-6, Vitamin D Deficiency and TSH on Chronic Tonsillitis Children: A Clinical Study

Background. It is very normal for kids to get tonsillitis. Tonsillectomy is the most common surgery done on kids who get tonsils over and over again. When a child is three to ten years old, their tonsils are at their most immune-boosting. Because of this, the tonsils stand out more during this time and eventually show age-dependent involution. Aims of the study. Evaluating the role of vitamin D, interleukin 6, and thyroid-stimulating hormone in tonsilitis and the relationship of these biomarkers in controlling the severity of the disease in children. Methodology. A case- control study was conducted including 30 children with chronic pharyngitis with an average age of 14.19 years, as well as a control group of 25 healthy children. The study took place at the Al-Kadhimiya Teaching Hospital from 10/2/2022 to 10/8/2023, after approval by the Research Committee of the College of Medicine at Al-Nahrain University and obtaining verbal consent from the parents. Blood samples were collected and the necessary analyzes were performed. CRP, ASO, and interleukin-6 levels were measured using an ELISA. The total number of white blood cells was calculated using a Sysmex CBC device, and the ESR was measured with a Fast ESR device. TSH and vitamin D levels were analyzed using a Cobas E411 device. Result. The levels of several biochemical and immune markers were very different between the patient group and the control group (P< 0.001). In the patient group, levels of ASOT, CRP, ESR, WBC, TSH, and IL-6 all went up, while levels of vitamin D went down. The results also showed that TSH and IL-6 levels were different in men and women with chronic tonsillitis. However, there were no statistically significant changes in the other indicators (P> 0.05). Conclusions. The results indicate that there are significant differences in biochemical and immunological indicators between children with chronic tonsillitis and healthy children. This can be explained by the increased inflammatory response in patients, which raises ASOT, CRP, ESR, and IL-6 levels and lowers vitamin D levels.

Coblation Reduced Post-operative Pain Over Bipolar Diathermy in Tonsillectomy Operation

Background: Tonsillectomy is a common surgical procedure performed for conditions like chronic tonsillitis and obstructive sleep apnea. Coblation and Bipolar Diathermy are advanced techniques that offer potential benefits over traditional methods; however, comparative studies evaluating these techniques in Bangladesh are scarce. Methods: A prospective analysis of 750 tonsillectomy cases (420 Coblation, 330 Bipolar Diathermy) was conducted at the Department of ENT, Rajshahi Medical College Hospital and Metropolitan Hospital, Rajshahi, Bangladesh, from January 2021 to June 2024. Data were collected on primary outcomes (pain duration, post-operative bleeding rates, healing time) and secondary outcomes (operation time, analgesic use, intra-operative bleeding, diet, and healing degree). Statistical analysis included chi-square and t-tests. Results: Coblation tonsillectomy significantly reduced post-operative pain duration compared to Bipolar Diathermy. In the pediatric group (ages 3-15 years), 85% of Coblation patients reported pain resolution within 5-7 days, while only 60% in the Bipolar group achieved resolution within 8-12 days. In adults (>15 years), 70% experienced pain resolution within 8-10 days with Coblation versus 55% with Bipolar Diathermy. Coblation was associated with lower reactionary hemorrhage rates (pediatric: 0.24% vs. 1.21%; adult: 0.1% vs. 0.61%) and secondary hemorrhage rates (pediatric: 1.67% vs. 3.33%; adult: 2.17% vs. 3.57%). Healing times were shorter with Coblation, with reduced analgesic use, lower intra-operative bleeding (average 1.5 ml vs. 3.5 ml), earlier return to a normal diet, and faster healing in the tonsillar fossa. Conclusion: Coblation tonsillectomy provides superior outcomes in terms of pain management, bleeding complications, and healing time compared to Bipolar Diathermy. These findings support Coblation as a preferred tonsillectomy technique for both pediatric and adult patients in a tertiary care setting in Bangladesh.

Chorioamnionitis: clinical, anamnestic and molecular-genetic parallels

Aim: to determine clinical, anamnestic and molecular-genetic parallels in emergence of clinical chorioamnionitis (CA) and severe forms of intrauterine infections (IUI) in high-risk pregnant women.Materials and Methods. A single-center prospective cohort comparative case-control study was conducted by examining 58 pregnant female patients aged 18 to 42 years with a verified CA diagnosis during pregnancy and childbirth at different gestation stages (main group), and 35 age-matched pregnant women with uncomplicated pregnancy and no significant extragenital pathology, aggravated factors of obstetric and gynecological history and risk factors for developing CA (control group), observed and performed a delivery in Yudin City Clinical Hospital. All women underwent clinical, anamnestic, laboratory, instrumental and molecular-genetic examitation. We studied the polymorphism of genes FCGR2A (Fc fragment of immunoglobulin G receptor IIa), IFN-γ (interferon gamma), IL-10 (interleukin-10), IL-6 (interleukin-6) and MBL2 (mannose binding lectin 2) to determine their role in assessing a risk of maternal and neonatal infection.Results. Among the patients with developed clinical CA vs. control subjects, more of them had a history of abortion and miscarriages (17.24 %), comorbid with chronic arterial hypertension (13.79 %), previous surgical interventions (27.59 %), as well as chronic inflammatory diseases (chronic tonsillitis, bronchitis, pyelonephritis, sinusitis; 27.59 % vs. 17.14 %). In addition to risk factors directly related to the infectious and inflammatory unfavorable background, they also had a significantly higher rate of obstetric complications: moderate preeclampsia – 6 (10.34 %) cases, threat of miscarriage or premature birth – 14 (24.14 %) cases vs. 1 (2.86 %) case in control group (p = 0.007), polyhydramnions – 4 (6.9 %) cases, placental insufficiency – 6 (10.34 %) cases. The frequency of premature rupture of membranes was 31.03 % in women with CA. Questionable cardiotocography (CTG) type was found in 24 (41.38 %) women with CA vs. 4 (11.4 3%) women without CA (p = 0.003), the pathological CTG type was observed only in women with CA. In the group with clinical CA and neonatal IUI, the combination of genotypes AG rs1801274 FCGR2A, ТT rs2430561 (IFN-γ)+874, GC rs1800795 (IL-6)-174 occurs in 80.65 % (25/31), whereas in women without severe neonatal IUI – in 37.04 % (10/27) (odds ratio (OR) =7.08; 95 % confidence interval (CI) = 2.166–23.166). In addition, the combination of alleles TT rs2430561 (IFN-γ)+874, GC+CC rs1800795 (IL-6)-174, AA rs1800450 MBL2 codon 54 was detected in 60.86 % (62/102) vs. 47.52 % (370/778) in main and control group (OR = 11.667; 95 % CI = 2.842–47.886), respectively.Conclusion. The study data evidence about importance of identifying genes for developing CA and neonatal septic complications to optimize and personalize management of high-risk patients (premature birth, infections during pregnancy, premature rupture of membranes).

Impact of Low-Temperature Plasma Radiofrequency Tonsillectomy on Pain, Inflammatory Markers, and Sleep Quality in Adults with Chronic Tonsillitis.

Chronic tonsillitis (CT) is a very common ear, nose, and throat disease worldwide, and in severe cases it can cause sleep apnea hypoventilation syndrome, which can affect the patient's health and can even be life-threatening. Low-temperature plasma radiofrequency tonsillectomy is one of the commonly used methods for treating CT with remarkable results, but more detailed reports are lacking. In this study, we aimed to explore the impact of low-temperature plasma radiofrequency tonsillectomy on pain, inflammatory markers, and sleep quality in adult CT patients for clinical reference. A retrospective study was performed on adult patients diagnosed with CT at our hospital between June 2019 and October 2023. Patients were categorized into a control group receiving traditional tonsillectomy and a treatment group undergoing low-temperature plasma radiofrequency tonsillectomy. The groups were compared in terms of baseline characteristics, surgical parameters, visual analogue scale (VAS) scores, 36-item short form (SF-36) health survey questionnaire scores, inflammatory markers, and Pittsburgh Sleep Quality Index (PSQI) scores. Group differences in postoperative complications were also analyzed. There were 160 patients, 80 in the treatment group (50 males and 30 females, mean age 28.90 ± 2.46 years) and 80 in the control group (46 males, 34 females, mean age 28.89 ± 2.01 years). Differences between the two groups in terms of age, sex, duration of disease, smoking history, body mass index, and other baseline characteristics were not statistically significant (p > 0.05). Operation time, intraoperative bleeding, return to normal diet, and pseudomembrane detachment time in the treatment group were all significantly lower than in the control group (p < 0.05). There were no significant differences in VAS or SF-36 scores before treatment (p > 0.05). Post-treatment, both groups had lower VAS scores and higher SF-36 scores in the treatment group compared to the control group (p < 0.05). There were no significant differences in levels of inflammatory markers before treatment (p > 0.05). Both groups showed increased levels of inflammatory markers post-treatment, but the treatment group had lower post-treatment levels of Interleukin-6 (IL-6) and hypersensitive-C reactive protein (hs-CRP) than the control group (p < 0.05). No significant difference was observed between the two groups in PSQI scores before treatment (p > 0.05). Following treatment, both groups had decreased PSQI scores, with lower scores in the treatment group than in the control group (p < 0.05). The complication rate was lower in the treatment group than in the control group, with rates of 8.75% and 23.75%, respectively (p < 0.05). Low-temperature plasma radiofrequency tonsillectomy for adult CT patients offers advantages such as shorter surgical time, reduced intraoperative bleeding, minimal trauma, and fewer postoperative complications. This procedure significantly alleviates pain, improves quality of life, reduces levels of inflammatory markers, and enhances sleep quality.

Chronic Tonsillitis and IgA Nephropathy: Findings From a Nationwide Japanese Cohort Study

Rationale & ObjectiveLittle is known regarding the association between chronic tonsillitis and the onset of IgA nephropathy (IgAN). In the present study, we examined the potential relationship between chronic tonsillitis and a subsequent risk of developing IgAN. Study DesignObservational cohort study. Setting& Participants: 4,311,393 individuals without a history of IgAN identified between January 2005 to May 2022 within a Japanese nationwide epidemiological database, the JMDC Claims Database, representing health claims to over 60 insurers. ExposureComorbid chronic tonsillitis based on diagnosis codes. OutcomeIgAN occurrence. Analytical ApproachCause-specific Cox proportional hazards analysis adjusting for potential confounding factors were employed to estimate hazard ratios (HRs). ResultsComorbid chronic tonsillitis was identified in 12,842 individuals, constituting 0.3% of the cohort. The cohort had a median age of 44 years (interquartile range: 36-53), and males accounted for 57.9%, with a follow-up of 1,089 days (interquartile range: 532-1,797), during which 2,653 cases of IgAN developed. Cumulative incidence curve showed a higher cumulative incidence of IgAN in individuals with chronic tonsillitis compared to their counterparts without this condition. Multivariable cause-specific analysis further demonstrated that individuals with chronic tonsillitis had an elevated risk of developing IgAN, with a HR of 2.72 (95% confidence interval: 1.79-4.14). LimitationsPotential residual confounders, and lack of consideration for ethnic distinctions. ConclusionsUsing a largescale epidemiological dataset, these findings suggest a relationship between chronic tonsillitis and an elevated risk of IgAN development in the general Japanese population.

A Comprehensive Research Review of Herbal Textual Research, Phytochemistry, Pharmacology, Traditional Uses, Clinical Application, Safety Evaluation, and Quality Control of Trollius chinensis Bunge.

Trollius chinensis Bunge (TCB) is a perennial plant of the Ranunculaceae family with medicinal and edible values. It is widely distributed and commonly used in various regions, including Asia, Europe, and North America. The main chemical components of TCB include alkaloids, flavonoids, phenolic acids, and volatile oil compounds. TCB is renowned for its anti-inflammatory, heat-clearing, detoxifying, and eyesight-improving properties. Its dried flowers are commonly used as a traditional Chinese medicine indicated for the treatment of upper respiratory tract infections, chronic tonsillitis, pharyngitis, influenza, and bronchitis. Modern pharmacology has demonstrated the anti-cancer, anti-inflammatory, antihypertensive, and antioxidant effects of TCB. This study presents a comprehensive overview of various aspects of TCB, including herbal textual research, botany, phytochemistry, pharmacology, traditional uses, clinical application, and quality control, aiming to provide new ideas on the scientific application of TCB as well as the integration of modern research with traditional medicinal uses.

A comprehensive study of Chuanwang Xiaoyan capsule based on characterization of chemical constituents in vitro and in vivo using ultra-high-performance liquid chromatography-quadrupole-Exactive Orbitrap mass spectrometry and pharmacokinetic study of multiple components in rats using ultra-high-performance liquid chromatography-triple quadrupole-tandem mass spectrometry.

Chuanwang Xiaoyan (CWXY) capsule is primarily used to treat a variety of acute and chronic inflammations, including acute and chronic pharyngitis and tonsillitis. However, a systematic study of its chemical constituents is still not available. This study evaluated the chemical constituents in vitro and metabolite profiles in vivo of CWXY using ultra-high-performance liquid chromatography (UHPLC) coupled with Q-Exactive Orbitrap mass spectrometry, and the pharmacokinetic behaviors of the nine main components in rats were detected using ultra-high-performance liquid chromatography-triple quadrupole-mass spectrometry (UPLC-QQQ-MS/MS). A total of 92 chemical constituents in CWXY were preliminarily identified in vitro. After oral administration to rats, 56 prototype components and 128 metabolites of CWXY were detected in the biological samples of rat plasma, urine, bile, and feces. Of these prototype components and metabolites, seven new compounds, namely M15, M16, M25, M30, M31, M71, and M128, were detected for the first time. The quantitation method of nine components in rat plasma was developed using a pharmacokinetic study. To the best of our knowledge, this study was the first to investigate the pharmacokinetic behavior of triumbelletin.

Potential efficacy and safety of Xiyanping injection as adjuvant therapy in treatment of suppurative acute tonsillitis: a meta-analysis, trial sequential analysis, and certainty of evidence.

Background: Antibiotic resistance has emerged as a global concern. Xiyanping injection (XYP), a traditional Chinese medicine injection, has been extensively utilized for the treatment of suppurative acute tonsillitis (SAT) in China, exhibiting clinical efficacy. Consequently, there is a need for further evaluation of the potential effectiveness and safety of this treatment. This meta-analysis consolidated data from multiple independent studies to assess the overall treatment efficacy of XYP as adjuvant therapy in patients with SAT. Methods: The search for randomized controlled trials (RCTs) encompassed databases from their inception to 1 April 2024, including the Cochrane Library, PubMed, Embase, SinoMed, CNKI, Wanfang, VIP, and CBM. Data extraction, methodological quality assessment, and meta-analysis were performed independently by two researchers. Review Manager 5.4 was used for data analysis. Various tools were employed for assessment, including forest plots to visualize results, funnel plots to detect publication bias, trial sequential analysis to estimate sample size, and GRADE to evaluate evidence quality. Results: A comprehensive analysis of 32 RCTs involving 4,265 cases was conducted. When compared to conventional treatments (CTs; β-lactams/clindamycin hydrochloride injection/ribavirin) alone, the combination of XYP with CTs demonstrated significant reductions in symptom duration. This included sore throat (MD = -21.08, 95% CI: -24.86 to -17.29, p < 0.00001), disappearance of tonsillar redness and swelling (mean difference [MD] = -20.28, 95% confidence interval [CI]: -30.05 to -10.52, p < 0.0001), tonsil purulent discharge (MD = -22.40, 95% CI: -28.04 to -16.75, p < 0.00001), and normalization of temperature (MD = -19.48, 95% CI: -22.49 to -16.47, p < 0.00001). Furthermore, patients receiving CTs combined with XYP exhibited lower levels of interleukin-6 (MD = -7.64, 95% CI: 8.41 to -6.87, p < 0.00001) and interleukin-8 (MD = -5.23, 95% CI: -5.60 to -4.86, p < 0.00001) than those receiving CTs alone. Additionally, the combination therapy significantly improved the recovery rate (relative risk [RR] = 1.55, 95% CI: 1.37 to 1.77, p < 0.00001), white blood cell count recovery rate (RR = 1.13, 95% CI: 1.04 to 1.23, p = 0.004), and disappearance rate of tonsillar redness and swelling (RR = 0.51, 95% CI: 1.14 to 1.38, p < 0.00001), with no significant increase in adverse events (RR = 0.47, 95% CI: 0.20 to 1.10, p = 0.08). Conclusion: The current systematic review and meta-analysis tentatively suggest that the combination of XYP and CTs yields superior clinical outcomes for patients with SAT compared to CTs alone, with a favorable safety profile. Nonetheless, these findings warrant further confirmation through more rigorous RCTs, given the notable heterogeneity and publication bias observed in the included studies. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296118, identifier CRD42022296118.

Recoverability of the adaptive potential of the tonsils in chronic tonsillitis. A Review

Recoverability of the adaptive potential of the tonsils in chronic tonsillitis. A Review

Antibiotic use in the emergency department for acute sore throat

Acute sore throat is a frequent cause of inappropriate antibiotic prescribing in primary care, despite the majority of cases being viral in nature. Following changes in consulting behaviour, many patients are now turning to emergency departments for their primary care needs. The aim of this study was to determine whether clinical scores are used between staff groups when treating acute tonsillitis in an emergency department and whether antibiotics are prescribed appropriately. A retrospective service evaluation of patients diagnosed with ‘tonsillitis’ in the emergency department over a 12-month period was conducted. Patient records were reviewed for Centor or FeverPAIN scoring documentation, antibiotic prescriptions and the clinician group providing treatment. The review found that a clinical score was documented for only 38 patients and that 44% of antibiotics were prescribed inappropriately. It is concluded that clinical scores are not being used appropriately in the emergency department to guide antibiotic prescribing for tonsillitis, leading to a high number of inappropriate prescriptions.

Application of bacteriophage therapy in the treatment of children with acute tonsillitis

Context In pediatrics, there is an increasing interest in the therapeutic efficacy of inhaled bacteriophages for treating infectious diseases of the upper respiratory tract in children. Aim To analyze the effectiveness of inhaled bacteriophage therapy in children with acute tonsillitis (AT). Settings and Design Clinical observation of patients was based on a randomized, controlled research method. Methods and Material A total of 212 sick children aged 4–15 years who had AT were examined. Bacteriophage therapy was carried out by nebulizer inhalation using the liquid polyvalent piobacteriophage. Patients were divided into two groups based on the treatment method. One group of patients received a course of bacteriophage therapy against the background of standard treatment. Results When patients sought medical help, during the general clinical examination, the following were noted: cervical lymphadenopathy (98.6%), hyperemia of the tonsils and hyperplasia (98.1%), against the background of hyperthermia. Bacteriological analysis of the pharynx mucus showed that the main causative agents of AT in children were the bacteria Streptococcus pyogenes, Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Patients who underwent inhaled bacteriophage therapy in the early stages of treatment experienced a 1.4-fold greater disappearance of objective signs of pathological processes in the tonsils against the backdrop of rapid improvement in the well-being of sick children. Moreover, the use of a combination of antibiotic therapy and bacteriophage therapy led to a decrease in the detection of pathogenic bacteria, and the effectiveness of drug treatment increased four times. Conclusion The use of bacteriophage therapy in the complex treatment of AT in children contributes to a more rapid relief of the acute period against the background of an improvement in the subjective assessment of well-being by up to 25%, and a decrease in the detection of pathogenic bacteria.

Pattern of Diseases Presenting in ENT Outpatient Department in a Postgraduate Teaching Hospital in S.I.T.E. Area Karachi

Ear, Nose and Throat (ENT) diseases are one of the public health problems and affect a huge number of the patient around the globe. Objective: To determine the pattern of ENT disorders or diseases in those patients who were attended outpatient department of ORL in a postgraduate teaching hospital of Karachi. Methods: Patients presenting at ENT OPD were selected randomly for the study. Data about ENT problems and information were collected through well structured questionnaire. After data collection, it was entered and analyzes by using software SPSS-23. Variables were age, sex, residence, socioeconomic status and different ENT diseases including wax, otitis media, allergic rhinitis, pharyngitis, tonsillitis, Deviated Nasal Septum (DNS) etc. Results: Male patients were 585 (46.8%) while female patients were 665 (53.2%) out of 1250 patients. Most of the patients were from industrial areas 775 (62%) and 475 (38%) were from city areas. 355 (28%) were suffering from wax followed by acute otitis media 300 (24%), acute tonsillitis and deviated nasal septum each in 225 (18%), otitis externa 150 (12%) and acute pharyngitis 145 (11%). In our study, a huge number of 72% of cases had ear disorders. 43.2% of patients had nasal issues, while 45.2% were related to laryngopharyngeal issues. Conclusions: Majority of the patients attending outpatient ENT department were related to ear wax followed by acute otitis media, acute tonsillitis, DNS, otitis externa, acute pharyngitis and many patients have multiple diseases.

Peritonsillar Block with Triamcinolone as a Preemptive Analgesia in Tonsillectomy with Bipolar Electrocauter

Background: Tonsillectomy is one of the common types of ear, nose, and throat (ENT) surgery. Patients undergoing tonsillectomy frequently experience significant postoperative pain due to oropharyngeal muscle spasms and irritation of afferent nerve fibers. According to previous studies, triamcinolone for peritonsillar block was used to reduce postoperative pain in patients who have undergone tonsillectomy. The aims and objectives of this study were to observe the effectiveness of peritonsillar block using triamcinolone for reducing pain in patients with post-tonsillectomy using the bipolar electrocautery technique. Case: A 34-years-old male patient with chronic tonsillitis and obstructive sleep apnea (OSA) was undergoing tonsillectomy with general anesthesia and peritonsillar block after general anesthesia with triamcinolone 0,5 mg/kg body weight in the right and left fossa peritonsillar. Postoperative hemodynamic monitoring was carried out in the inpatient room. Patients were assessed for pain scale after tonsillectomy and side effects of triamcinolone, with pain indicator using the Wong-baker faces pain rating scale, numeric pain rating scale, and Face, legs, activity, cry and consolability (FLACC) Scale. Pain scales were assessed 1 hour after the tonsillectomy in the recovery room, 3 hours after the tonsillectomy in the inpatient room, 8 hours after the tonsillectomy in the inpatient room, 1 day after the tonsillectomy in the inpatient room, and 2 days after the tonsillectomy by phone. The patient went out of the hospital after 1 day of tonsillectomy. Conclusion: Peritonsillar block with triamcinolone is effective in reducing pain after tonsillectomy and can be the drug of choice when administering peritonsillar block.

Serial neutrophils count as a stratifying tool for early follicular tonsilitis remission

Background/Aim: This study examines the correlation between sequential serum neutrophil levels and the overall improvement status or reduction rate of intravenous antibiotic administration. This study seeks to identify a cost-effective and easily accessible biomarker that can accurately predict the need for hospitalisation in patients with acute tonsillitis who are receiving intravenous broad-spectrum antibiotics. The goal is to determine the patients' suitability for early discontinuation of intravenous antibiotics and discharge. Methods: This study was conducted at the King Hussein Medical Centre in Jordan, focusing on patients with severe acute tonsillitis who did not respond to oral antibiotics. Data was collected from the electronic medical record system (Hakeem) from January 2018 to May 2021. The study classified serial serum neutrophil measurements during the first week of hospital admission into four categories. The levels were compared between the non-penicillin Cohort (Group I) and penicillin Cohort (Group II) using an Independent-T Test. The outcomes of interest included a drop in neutrophil counts exceeding 50%, a decrease in the use of intravenous antibiotics in favor of oral antibiotics, and early eligibility for discharge. The study also examined serial neutrophil counts over the tested days and compared to the outcomes of positive and negative states using receiver operating curve analyses. The optimal cutoff operating point for each ROC curve was determined by selecting the highest Youden's index of each prognosticator day level. The analysis of all results was conducted using SPSS version 20 with a significance level set at p-value &lt;0.05. Results: This study analyzed 1638 adult and elderly patients admitted to KHMC, RMS, Amman, Jordan between January 2018 and May 2021. The average age was 51.88±16.22 years, with patients dependent on intravenous penicillin being slightly older. The distribution of males and females was significant, with males making up 2.55 times the number of females. The odds ratio for positive outcomes was 4.12, with a high rate of poor outcomes in 1318 out of all eligible patients. A total of 994 (60.7%) medical patients were treated with intravenous administration, while 644 (39.3%) surgical patients were scheduled for a tonsillectomy procedure. The risk estimate for patients admitted from medical wards compared to surgical wards was an odds ratio of 0.562. The study also provided sensitivity analysis for the four tested serial neutrophil prognosticators at different day levels. Conclusion: The study supports the use of Somatic Nucleated Cell (SNC) as a reliable measure for evaluating EFR in cases of catarrhal acute tonsillitis. The maximum SNC count in Group one was 11,269 cells per cubic millimeter. Acute streptococcal infection often exhibits an ESR higher than 40, but this may be concealed by other complications. The SNC test has advantages like simplicity, quickness, and cost-effectiveness, but lacks specificity. Monitoring SNC and EFR fluctuations can initiate treatment cessation, preventing relapse and severe complications during recovery.

Comparison of Coblation versus Traditional Tonsillectomy for Patients with Chronic Tonsillitis: Impact on Serum Stress Indicators, Inflammatory Mediator Levels, Postoperative Pain, and Complications

Comparison of Coblation versus Traditional Tonsillectomy for Patients with Chronic Tonsillitis: Impact on Serum Stress Indicators, Inflammatory Mediator Levels, Postoperative Pain, and Complications

#1365 Clinical efficacy of tonsillectomy combined with steroid pulse therapy in IgA nephropathy

Abstract Background and Aims IgA nephropathy is the most common primary glomerulonephritis in the Asia–Pacific region, including Japan, and often leads to dialysis initiation. The etiology of IgA nephropathy remains unclear; however, focal infections such as chronic tonsillitis are proposed. Although tonsillectomy should not be performed for Caucasian IgA nephropathy patients, some Japanese studies reported that the combination of steroid pulse therapy with tonsillectomy (TSP) was more effective than steroid pulse therapy alone for the remission of urinary findings. However, the immunosuppressive treatment regimens vary among studies, and treatment effect of combination therapy in preventing renal functional decline is unclear. This study aimed to compare the efficacy of steroid pulse therapy alone versus TSP in improving the remission rate of urinary findings and preventing renal functional decline. Method This retrospective observational study included 116 patients diagnosed with IgA nephropathy based on renal biopsy and treated between January 1, 2010 and December 31, 2020 in Gifu University Hospital. TSP group underwent tonsillectomy received 0.5 g/day of methylprednisolone intravenously for 3 consecutive days at 1-3 weeks. TSP and steroid pulse therapy alone group had 83 and 33 patients, respectively. Of these, 25 patients per group were matched using propensity score matching based on clinicopathologic factors including age, urinary protein level, estimated glomerular filtration rate (eGFR), and the risk classification for progression to end-stage renal disease. The remission rate of urinary findings and the change in eGFR one year after treatment initiation were compared between the two groups. Remission of urinary findings was defined as a urinary protein level of &amp;lt;150 mg/day and &amp;lt;5 erythrocytes/high-power field in the urine sediment. Results The TSP and steroid pulse therapy alone groups did not significantly differ in baseline characteristics including median age (interquartile range) (58 [47–63] and 56 [49–68] years, respectively), female sex (9 and 7, respectively), mean eGFR (60 ± 20 and 63 ± 21 mL/min/1.73 m2, respectively), median urinary protein level (764 [440–1,472] and 990 [425–1,872] mg/day, respectively) (p &amp;gt; 0.05 for all). The remission rate of urinary findings was significantly higher in the TSP group than in the steroid pulse therapy alone group (72% vs. 20%; p &amp;lt; 0.001, χ2 test). Albeit statistically nonsignificant, the decline in eGFR was smaller in the TSP group than that in the steroid pulse therapy alone group (−1.5 ± 8.1 vs −3.7 ± 10.5 mL/min/1.73 m2, p = 0.416; t test). No severe side effect was observed in both treatment groups. Conclusion The higher remission rate of urinary findings observed in the TSP group compared to the steroid pulse alone group suggested that the addition of tonsillectomy to steroid pulse therapy was a clinically effective treatment for IgA nephropathy. Albeit not significant, the TSP group tended to have a smaller decline in eGFR reduction at one-year follow-up, indicating the need for further studies with long-term observation.

THE ISSUE OF INFECTIOUS DISEASE INCIDENCE AMONG MEDICAL STUDENTS

Introduction. The training of future medical professionals involves not only development of skills and professional background, but also maintaining a sufficient health status; therefore the relevance of studying an incidence of infectious pathologies in medical students is exceptionally important. The purpose of the study is to investigate, analyze, and compare incidence of some infectious diseases among medicine students. Materials and methods. We utilized various research methods including analysis of scientific sources, synthesis and comparison of studies by other researchers, surveys, observations, interviews, and statistical data on the incidence of infectious diseases in Ukraine and worldwide. Additionally, we conducted a poll among first-year students of the medical faculty at Vinnytsia National Pirogov Memorial Medical University using Google Forms to gather data on the incidence of respiratory and digestive system infections. The study revealed that approximately 65% of the surveyed students had experienced coronavirus disease, mostly in a mild form. Among acute respiratory viral infections, flu (55.3%), sore throat (31.3%), and rhinopharyngitis (21.3%) were the most common (79.1%) among medical students. About 74% of respondents reported no chronic diseases of the upper and lower respiratory tract, while the rest mentioned conditions such as allergic rhinitis (10%), chronic tonsillitis (10%), chronic pharyngitis (3.4%), and vocal cord diseases (2%). In terms of infectious pathologies of the digestive system, food poisoning of unspecified etiology (33.3%) and viral intestinal infections (11.7%) were the most prevalent. Conclusion. The relevance of the issue of infectious disease incidence among medical students necessitates further investigation and analysis to identify contributing factors, develop monitoring methods, and promote healthy lifestyles to maintain optimal health status.

Histological Correlation between Tonsillar and Glomerular Lesions in Patients with IgA Nephropathy Justifying Tonsillectomy: A Retrospective Cohort Study.

Tonsillectomy with steroid pulse therapy (SPT) has been established as an effective treatment for immunoglobulin A nephropathy (IgAN) in Japan. However, the underlying mechanisms supporting tonsillectomy remain unclear. This study assessed palatine tonsils from 77 patients with IgAN, including 14 and 63 who received SPT before and after tonsillectomy, respectively. Tonsils from 21 patients with chronic tonsillitis were analyzed as controls. Specific tonsillar lesions were confirmed in patients with IgAN, correlating with active or chronic renal glomerular lesions and SPT. T-nodule and involution of lymphoepithelial symbiosis scores in tonsils correlated with the incidence of active crescents and segmental sclerosis in the glomeruli, respectively. The study revealed an essential role of the tonsil-glomerular axis in early active and late chronic phases. Moreover, the SPT-preceding group demonstrated no changes in the T-nodule score, which correlated with active crescent formation, but exhibited a considerable shrinkage of lymphatic follicles that produced aberrant IgA1. The study underscores the involvement of innate and cellular immunity in IgAN and advocates for tonsillectomy as a necessary treatment alongside SPT for IgAN, based on a stepwise process.

At Early Rheumatoid Arthritis Stage, the Infectious Spectrum Is Driven by Non-Familial Factors and Anti-CCP Immunization.

Background/Objectives: Patients with rheumatoid arthritis (RA) are prone to develop infections. Methods: Accordingly, 195 untreated early (e)RA patients and 398 healthy controls were selected from women in Tatarstan's cohort to study infectious history in the anamnesis (four criteria) and in the previous year (16 criteria). Information about annual infections was collected face-to-face from year to year by a qualified rheumatologist/general practitioner and included the active use of information from medical records. Results: In the anamnesis, tuberculosis, and pneumonia, and in the previous year, respiratory tract infections, skin infections, and herpes simplex virus reactivation incidence were reported to be increased in eRA patients, as well as the event number and duration of acute and chronic tonsillitis. Moreover, more bacterial-suspected upper respiratory infections and urinary tract infections were retrieved in sporadic eRA patients as compared to familial eRA patients. An elevated immunization against CCP prevented respiratory tract infection in those with HSV exacerbation. Finally, associations were retrieved between infection (event number/delay) and RA indices: (i) chronic tonsillitis exacerbations with disease activity and health assessment (HAQ) in familial eRA; (ii) bacterial-suspected upper respiratory infections with the number of swollen and tender joints in sporadic eRA; and (iii) HSV exacerbation with inflammation in eRA patients with negative/low response against CCP. Here, we demonstrate the complex nature of the interplay of RA with specific infections. Conclusions: For the first time, differences in the patterns of annual trivial infections and their links with RA indices were found in cohorts of familial and sporadic cases of the disease. Additionally, for the first time, we identified a remarkable relationship between early RA and exacerbations of chronic tonsillitis, as well as tuberculosis in the patient's history. Altogether, this study supports the existence of a complex interplay between infections and RA at onset driven by familial status and the presence of anti-CCP Ab at elevated levels.

Primary care medical brigades in the Parish of San Mateo in the province of Esmeraldas: a strategy for corporate social responsibility

Introduction: the medical health care brigades are a strategy to address the health problems of communities from a perspective of social construction, in which people are recognized as subjects of rights and key actors in the process of building with solid foundations through the establishment of strategic alliances with companies committed to corporate social responsibility that allow the strengthening of governance processes to develop a culture of quality that promotes the sustained improvement of the provision of health services. Method: this study has a cross-sectional and descriptive approach, from the registration of a database in Excel with the total number of attendances and anonymized data of the direct beneficiaries of the project. Results: a total of 915 residents of the communities of Tabete, La Victoria, Timbre Commune, Tatica and Cantonal Seat of the San Mateo parish of the city and province of Esmeraldas benefited, achieving a total of 1059 visits in general or family medicine, obstetrics and dentistry, from which the 10 main morbidities of the beneficiaries were obtained, the most prevalent being intestinal parasitosis without other specification with 60 %. atopic dermatitis with 25 % and acute vaginitis with 21 %. Primary essential hypertension, acute rhinopharyngitis, type 2 diabetes mellitus with other specified complications, urinary tract infection of unspecified site, acute tonsillitis and other gastroenteritis and colitis of infectious origin account for less than 10 % each. Conclusions: corporate social responsibility strategies through medical brigades are a mechanism to highlight and reaffirm the concept of improving health care gaps, which allows the participation of the community in health promotion and prevention and minimizes the occurrence of chronic non-communicable and communicable diseases and their sequelae