Peritonsillar Abscess Research Articles

Peritonsillar abscess caused by hypervirulent Klebsiella pneumoniae: A case report and literature review

Peritonsillar abscess caused by hypervirulent Klebsiella pneumoniae: A case report and literature review

Recurrent peritonsillar abscess in adults: Incidence and risk factors in a prospective longitudinal cohort

Recurrent peritonsillar abscess in adults: Incidence and risk factors in a prospective longitudinal cohort

Seasonal variation and demographic characteristics of acute tonsillitis and peritonsillar abscess in ENT practices in Germany (2019-2023).

Peritonsillar abscess (PTA) is a common soft tissue infection of the head and neck. It remains unclear to what extent inflammatory diseases of the palatine tonsils or other infections contribute to the development of PTA. This study examines the demographic characteristics and seasonal variations of acute tonsillitis (aT) and PTA in ENT practices in Germany using a practice database. Retrospective analysis based on data from the German-wide IQVIA™ Disease Analyzer database for the period 2019 to 2023. Data include diagnoses of aT (ICD-10: J03) and PTA (ICD-10: J36) as well as patient demographics (age, sex). Seasonal variations were identified by analysing the monthly diagnosis rates. The Pearson correlation between the monthly case numbers of aT and PTA was determined. 59,934 cases of aT and 5,024 cases of PTA were recorded. The mean age was 30.3 years (aT) and 39.4 years (PTA). The proportion of female patients was 60% (aT) and 49% (PTA). Both diagnoses showed seasonal variations with peaks in winter and spring and a decline in summer, although the decline was less pronounced for PTA. The monthly case numbers of aT and PTA showed high correlations between r = 0.75 (2019) and r = 0.94 (2020). The average correlation for the period 2019-2023 was r = 0.81. During the coronavirus pandemic, a significant decrease in the case numbers of both diseases was observed, while the typical seasonal variations disappeared. After the pandemic, the case numbers increased to higher levels than before the pandemic. aT and PTA both show seasonal variations with peaks in winter and spring and a decline in summer. The correlation between the variations of aT and PTA could be related to a partly common aetiology or to the specific sample of the practice database. The attenuation of seasonal variation during the coronavirus pandemic illustrates the impact of COVID-19 on the incidence of other diseases and on the use of healthcare pathways by patients.

6575 From Tonsils to the Thyroid: A Rare Case of Acute Suppurative Thyroiditis in an Immunocompetent Adult

Abstract Disclosure: F. Sajid: None. A. Mubashir: None. F. Mohsin: None. M. Sattar: None. Introduction: Acute suppurative thyroiditis (AST) is a rare infection of the thyroid gland due to its high vascularity, protective encapsulation, and high iodine content. Most AST cases occur in children with anatomical aberrations or in immunosuppressed adults. Here, we describe a case of AST in an immunocompetent woman. Case: A 54-year-old woman with no medical history presented to the emergency department due to dyspnea, dysphagia, and odynophagia for two days. She reported a four-day history of sore throat, fever, and chills. She was saturating well on room air but was sitting in a tripod position. She had erythema, swelling, tenderness to palpation in the anterior neck with a hoarse voice, and moderate trismus. Nasopharyngoscopy revealed no mass, but the scope could not pass beyond the velum due to edema. The patient’s condition quickly deteriorated, necessitating emergent intubation for acute hypoxic respiratory failure. After intubation, the patient had cardiac arrest with asystole requiring resuscitation and successful ROSC. The initial CT scan showed extensive soft tissue abnormalities in the nasopharynx and parapharyngeal tissues, extending to the thyroid gland and mediastinum with the possibility of developing abscesses. A thyroid ultrasound showed a heterogeneous thyroid gland without nodules or increased vascularity. Treatment commenced with ampicillin-sulbactam. Laboratory results showed Free T4 of 4.74 ng/dL (0.58-1.64), TSH 0.03 MCIU/mL (0.39-4.08), Total T3 1.56 ng/dL (0.72-1.35), WBC 19.3 K/UL (4.8-10.8), and elevated ESR and CRP levels. Thyroid-stimulating Immunoglobulin (TSI), Thyroid Peroxidase (TPO) Antibody, and Thyrotropin Binding Inhibitory Immunoglobulin (TBII) were negative, making AST the top differential. Methimazole was initiated due to concerns of thyroid storm, but it was quickly tapered due to a significant decrease in Free T4 levels and suspicion of AST. A repeat CT scan revealed more defined abscesses along the bilateral pharyngeal walls extending to the thyroid bed. The patient underwent bilateral tonsillectomy and drainage of the abscesses. She was extubated the following day. Cultures from the abscesses grew rare Klebsiella pneumoniae, susceptible to Ampicillin-sulbactam. A barium swallow on day 14 showed no evidence of a pyriform sinus fistula. She was discharged on day 15 with Augmentin for 7 days. On discharge, free T4 decreased to half (2.39 ng/dL), and Total T3 normalized (1.08ng/dL). Conclusion: This case presents a rare instance of AST in an immunocompetent patient without anatomical anomalies, stemming from the spread of peritonsillar and parapharyngeal abscesses into the thyroid bed. AST should be considered in cases of deep neck infections, as it is a potentially life-threatening disease. It is crucial to identify and treat AST early to prevent complications. The primary treatment involves antibiotics, incision, and drainage. Presentation: 6/1/2024

Comprehensive evaluation of deep neck infections: A retrospective analysis of 111 cases.

Our study will analyze patients' clinical characteristics, treatment strategies, and complications with deep neck infection (DNI) using their medical records for five years. The present study included 111 patients diagnosed with DNI in our clinic between January 2018 and March 2023. The patients' complaints at admission, sociodemographic characteristics, season of diagnosis, findings from laboratory tests, radiological imaging performed at the time of first diagnosis, abscess localization, medical and surgical treatment methods used, and complications developing during follow-up were retrospectively examined. The mean age of the patients included in the study was 38.51 ± 16.92 (6-87 years). There was a significant correlation between chronic disease, smoking behaviours, oral hygiene, and DNI among patients based on their sociodemographic characteristics and medical history (p < .005). DNI development did not differ by season (p > .005). Physical examination findings predominantly revealed neck masses (39.6%) and peritonsillar abscesses (32.4%), and patients with peritonsillar abscesses had a shorter length of hospital stay than those with other localizations. No severe complications occurred during the clinical follow-up. Chronic diseases, smoking, and poor oral hygiene are the primary risk factors for developing DNIs. If an abscess is located in a critical area, it may require extended hospitalization and surgery under general anesthesia. Therefore, addressing these risk factors and encouraging good oral hygiene practices are crucial to preventing DNIs and reducing the need for intensive treatment.

Peritonsillar Abscess: An Update on Diagnosis and Medical-Surgical Management. A Review of the Literature and Case Report

Introduction: Peritonsillar abscess is an acute pharyngeal infection located between the tonsillar capsule and the aponeurosis of the superior constrictor muscle of the pharynx, being an important cause of consultation in emergency services. Its management includes antibiotic treatments and/or emptying of the abscess. Objective: To describe the diagnosis and medical-surgical management of a 47-year-old male patient with peritonsillar abscess; Regarding the case, a review of the updated literature on the topic was carried out. Method: Presentation of the case report: 47-year-old male patient, who attended the Libertador Bernardo O'Higgins Regional Hospital due to increased tonsillar volume. Sudden onset. Clinically, guttural voice, odynophagia, dysphagia, trismus and intermittent fever were notable. Discussion: After the clinical, imaging and laboratory study, a diagnosis of peritonsillar abscess was reached, which underwent medical-surgical management, presenting satisfactory evolution of this case, a review of the literature was carried out in the last 10 years in Spanish. English in the search engines PubMed and Science Direct. Conclusions: Surgical management of peritonsillar abscess continues to be the treatment of choice; however, based on the review of the literature that was carried out, medical management can also be chosen in some cases.

Peritonsillar abscess in a nine-week-old patient

In this case report, a nine-week-old girl was referred to the ear-, nose- and throat department because of decreased oral intake, swelling of the left tonsil and the left side of the neck. An MRI was performed due to the atypical presentation, which revealed a massive peritonsillar abscess communicating with the swelling on the neck. Treatment consisted of an incision, drainage and intravenous antibiotics. Re-dilation and rinsing were performed on the first post-operative day before extubation. Finally, the patient was discharged after two days with oral antibiotics.

Seasonality Disrupted: Post-Pandemic Trends in Otorhinolaryngological Infections.

Background: The COVID-19 pandemic has notably affected the epidemiology of various infectious diseases. The imposed public health measures and disruptions in vaccination programs have potentially altered the patterns of these diseases post pandemic. Objective: To investigate the change in epidemiology of otorhinolaryngological infectious diseases in adult and pediatric patients after the COVID-19 pandemic and the relaxation of public health measures. Methods: A retrospective cohort study was conducted at a large tertiary university otolaryngology department in the south of Germany, examining admissions with specific ICD-10 diagnoses from 2019 to 2023. Data were seasonally categorized and statistically analyzed. Results: A total of 1728 inpatient cases were analyzed. There was a significant increase in otorhinolaryngological infections in the post-pandemic winter of 2022, particularly of peritonsillar abscesses, acute tonsillitis and acute mastoiditis. No significant post-pandemic spike in mononucleosis was observed. The duration of hospitalization was shorter in 2022, and the median age of patients did not change significantly pre- versus post-pandemic. Conclusions: The study indicates a significant post-pandemic rise in otorhinolaryngological infections. Remarkably, the typical "dip" in infections during the summer months was not observed in the post pandemic years, possibly reflecting the impact of the termination of non-pharmaceutical interventions. Mononucleosis was the only infection not following this pattern.

Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

&lt;b&gt;Introduction:&lt;/b&gt; Lemierre’s syndrome, first described by André Lemierre in 1936, is a rare but life-threatening condition. It is characterized by a triad of symptoms: pharyngeal infection, internal jugular vein thrombosis, and sepsis with distant abscesses, usually in the lungs. The primary pathogen is the anaerobic Gram-negative bacterium &lt;i&gt;Fusobacterium necrophorum&lt;/i&gt; (&lt;i&gt;F. necrophorum&lt;/i&gt;). In recent years, there has been an increase in the incidence of Lemierre’s syndrome.&lt;b&gt;Case report:&lt;/b&gt; A 20-year-old male was admitted to the Emergency Department (ED) with jaundice, dyspnea, sore throat, fever up to 39C, neck pain, and left lower limb weakness. Examination revealed enlarged palatine tonsils with purulent exudates and a right-sided peritonsillar abscess. Laboratory tests showed elevated inflammatory markers, thrombocytopenia, and leukocytosis. Computed topography (CT) confirmed internal jugular vein thrombosis, abscesses in the right sternocleidomastoid muscle, and bilateral pleural effusions. The patient received oxygen therapy, antibiotics, anticoagulation, and pleural drainage. After 26 days of hospitalization, he was discharged with a recommendation to continue antibiotic therapy and low-molecular-weight heparin, as well as planned removal of the palatine tonsils (tonsillectomy).&lt;b&gt;Discussion:&lt;/b&gt; Lemierre’s syndrome is a severe complication of upper respiratory tract infections, mainly affecting young individuals. Symptoms include pharyngeal infection, sepsis, and internal jugular vein thrombosis. Early diagnosis and appropriate treatment, including prolonged antibiotics and sometimes anticoagulation, are crucial. The rise in incidence may be linked to the irrational use of antibiotics. Educating clinicians is vital to improve outcomes and reduce complications.&lt;b&gt;Conclusions:&lt;/b&gt; Initial symptoms of Lemierre’s syndrome are nonspecific, complicating early diagnosis. Neck imaging and/or positive blood cultures are key for diagnosis. The incidence is 1–2.5 cases per million annually, making it rare but potentially fatal. Mortality before antibiotics was around 90%; currently, it is 5–18%, but higher without proper diagnosis. Early imaging significantly improves prognosis.

National survey on peritonsillar abscess treatment and attitudes toward quinsy tonsillectomy

ABSTRACT Objectives Peritonsillar abscess (PTA) is a common deep neck infection traditionally managed with conservative measures. Quinsy Tonsillectomy (QT) is recognized as a definitive treatment but remains variably utilized. We aimed to investigate PTA management strategies and attitudes toward QT among otolaryngologists. Methods An anonymous questionnaire was distributed to members of the local national Society of Otolaryngology, evaluating treatment strategies based on patient characteristics and clinical scenario. Results A total of 108 otolaryngologists responded (response rate: 30.8%). Participants preferred to treat PTA patients as inpatients (89%) and predominantly offered incision and drainage (I&D) as the first (90.7%) and subsequent (98.1%) treatment plan. QT was favored as a primary treatment only in 1.9% of responders. QT adoption increased with multiple I&D failures, reaching 95.3% after four attempts. In patients with recurrent PTA or tonsillitis, 84.2% preferred I&D follows by interval elective tonsillectomy, while 15% considered QT. The most common reason (72.2%) to avoid QT was the perception of a high perioperative risk. Conclusion I&D was favored for initial PTA treatment. QT is considered after multiple failed I&D attempts, and its use is limited as a primary treatment, mainly due to concerns regarding perioperative risk.

Recurrent peritonsillar abscess in adults: Incidence and risk factors in a prospective longitudinal cohort

ObjectiveThe incidence of recurrent peritonsillar abscess (7.4–22%) was estimated in retrospective studies. The aim of this prospective study was to estimate the cumulative incidence of recurrent peritonsillar abscess and related risk factors. MethodsWe performed a prospective longitudinal cohort study. The study included adult patients (≥18 years old) of both sexes who were attended in the emergency facilities of our tertiary hospital, without peritonsillar abscess background, diagnosed of a first episode of peritonsillar abscess and treated with standard of care (abscess drainage and antibiotics). Patients were followed for 24 months. Cumulative incidence of peritonsillar abscess recurrence was estimated and its 95% confidence interval was calculated; and predictive risk factors were assessed. ResultsBetween January 1st, 2019 and March 9th, 2020, a total of 181 consecutive patients were included. The cumulative incidence of recurrent peritonsillar abscess at 2 years of the diagnosis was 9.9% (18 out of 181, 95% CI: 6.4–15.2%). The only risk factor associated with recurrent peritonsillar abscess in multivariate analysis was low plasma glucose level at the time of emergency room attendance (HR: 0.46, 95% CI: 0.24–0.91, p-value: 0.026). ConclusionPeritonsillar abscess is an incident medical issue, with an established recurrence rate, but with unclear predictive risk factors of recurrence. Further studies are needed to assess the risk factor associated with recurrent peritonsillar abscess.

Importance of biomarkers in streptococcal acute tonsillitis & peritonsillar abscess.

Background & objectives Acute tonsillitis is a disease that can often be cured with medical treatment. However, complications may occur during this disease process. One of these complications is peritonsillar abscess. In recent years, biomarkers have been frequently used in the diagnosis of diseases. The aim of the study was to reveal whether peritonsillar abscess develops after acute tonsillitis, and acute tonsillitis can be differentiated using biomarkers and which biomarker has higher predictive value for this differentiation. Methods The control group consisted of individuals who were operated for septoplasty in the otolaryngology clinic, and the acute tonsillitis group consisted of individuals diagnosed with acute tonsillitis in the same clinic. Both groups were statistically compared in terms of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII), infection discrimination index (IDI), plateletcrit (PCT) and lymphocyte to monocyte ratio (LMR) biomarkers. Statistically, significant biomarker values were compared between the subgroups in the tonsillitis group of those who had only acute tonsillitis and those who had peritonsillar abscess due to acute tonsillitis. Receiver operating characteristics (ROC) curve analysis was performed on biomarkers for their ability to predict the presence of peritonsillar abscess. Results When the individuals who had only acute tonsillitis and those who had acute tonsillitis with peritonsillar abscess were compared in terms of biomarkers, there was a statistically significant difference between the mean MPV, SII and PCT (P=0.010, 0.021, 0.023, respectively). ROC analysis was performed to calculate the sensitivity and specificity of MPV, PCT and SII for the diagnosis of acute tonsillitis with peritonsillar abscess (sensitivity-specificity for MPV 51.9-72.7%, for SII 94.2-32.7%, for PCT 71.2-50.9%, respectively). Interpretation & conclusions MPV, SII and PCT biomarkers may be useful to help clinicians predict peritonsillar abscess due to acute tonsillitis.

Increase of pyogenic bacterial infections after relaxation of social distancing measures linked to COVID-19 pandemic.

After the relaxation of COVID-19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear-nose-throat (ENT) infections, in the period from 1 August to 31 March from the years 2018-2019 to 2022-2023. The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). In 2022-2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018-2019, 2019-2020, 2020-2021, 2021-2022 and 2022-2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022-2023 in respect of 2021-2022. We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID-19 social distancing measures.

Extensive deep neck infection associated with acupuncture

Deep neck infections are rare but potentially lethal conditions that require prompt identification and management. They can occur in the peritonsillar, submandibular, parapharyngeal and retropharyngeal spaces. The most affected areas tend to differ by age, with tonsillitis being more common in children and odontogenic in older adults. Predisposing factors to infection can also influence location. Early treatment is paramount as airway compromise, septic shock and extension to adjacent structures can lead to morbidity and mortality. Here we report a case of extensive deep neck infection in an elderly diabetic patient with multiple abscesses involving the paraspinal space and extending anteriorly close to the carotid sheet, yet without airway compromise or hemodynamic instability. After further questioning, the likely mode of infection was identified as acupuncture in the affected region. We present a review of the presentations, differential diagnoses, treatments, and clinical course of adults with deep neck infections to highlight the importance of expeditious diagnosis and treatment.

The Role of Ultrasound in Pediatric Peritonsillar Infection: A Descriptive Analysis.

In this study, we describe the role of ultrasound in diagnosing pediatric peritonsillar abscesses (PTAs). A retrospective chart review was conducted on 54 children aged 4 to 17 years who had an ultrasound performed for suspected PTA. Based on ultrasound imaging, the patients were classified into 2 groups: PTA-positive (8, 14.8%) and PTA-negative (46, 85.2 %). Trismus was significantly associated with PTA (50% vs. 13%, P = .03). PTA-positive patients were more likely to be given steroids, be admitted, and have extended hospital stays (P = .04, .004, and .002, respectively). The 2 groups had no significant difference in computed tomography (CT) acquisition, surgical intervention, and return visits (P = .92, .17, and .97, respectively). Larger abscesses trended toward surgical treatment (P = .087). Ultrasound is an efficient diagnostic modality for suspected peritonsillar infections in children, with similar clinical outcomes for PTA-positive and PTA-negative groups.

Conscious sedation for the management of peritonsillar abscess in pediatric patients: A prospective case series and literature review

ObjectivePeritonsillar abscess (PTA) is a common pediatric infection requiring drainage. Conscious Sedation (CS) can facilitate drainage in uncooperative children. However, it carries risks, especially if the airway is compromised. Moreover, evidence on its safety and efficacy is limited. This study examined the safety, pain reduction, and anxiety management of hospitalized pediatric patients treated for PTA under CS. Materials and methodsWe performed a prospective observational case series of 118 children aged 2–15 years with 155 PTA episodes, managed from 2016 to 2023. Conscious sedation was used in 42 episodes. Outcomes were compared among CS and non-CS (local anesthesia only). Complications assessed safety. Efficacy was evaluated by the amount of pus, hospitalization parameters, pain scores, and recurrence. ResultsNo significant differences were found regarding the demographic and presentation parameters except for younger age among the CS group (9 vs 11 years p = 0.001). One minor oxygen desaturation (2 %) event occurred with CS. Abscess drainage amount was greater with CS than non-CS, 4.9±4 mL vs. 3.2±2 mL, respectively (p = 0.03). Hospitalization stays were similar among groups. Maximum pain scores were lower with CS than non-CS, 1.4 ± 2 vs 4.2 ± 3 (p < 0.001); similarly, IV pain medication was used less frequently, 0.9 ± 1 vs. 1.6 ± 3 (p = 0.045), and the need for re-aspiration was less common 14 % vs. 28 % (p = 0.04), with CS than non-CS, respectively. The three-month recurrence rate was numerically lower with CS (5 % vs. 14 % non-CS). ConclusionsConscious sedation facilitates PTA drainage with excellent safety and improved efficacy compared to local anesthesia in children. Pain scores are reduced both during drainage and hospitalization. Our prospective data add to the limited evidence supporting CS as a viable option for abscess drainage in uncooperative pediatric patients. Further study is warranted to confirm potential long-term reductions in recurrence.

Peritonsillar Abscess Outcomes with and Without Computed Tomography: A Retrospective Cohort Study.

Peritonsillar abscess (PTA) is a common deep space head and neck infection, which can be diagnosed with or without computed tomography (CT). CT poses a risk for false positives, leading to unnecessary abscess drainage attempts without benefit, whereas needle or open aspiration without imaging could potentially lead to missed abscess in need of treatment. This study considered the utility and impact of obtaining CT scans in patients with suspected PTA by comparing outcomes between CT and non-CT usage. Retrospective cohort analysis using TriNetX datasets compared the outcomes of two cohorts: PTA without CT and PTA with CT. Measured outcomes included incision and drainage; quinsy adenotonsillectomy; recurrent PTA; airway emergency/obstruction; repeat emergency department (ED) visits; and need for antibiotics, opiates, or steroids. Odds ratios (OR) were calculated using a cohort analysis. The CT usage group had increased odds of receiving antibiotics (OR 3.043, [2.043-4.531]), opiates (OR 1.614, [1.138-1.289]), and steroids (OR 1.373, [1.108-1.702]), as well as a higher likelihood of returning to the ED (OR 5.900, [3.534-9.849]) and developing a recurrent PTA (OR 1.943, [1.410-2.677]). No significant differences were observed in the incidence of incision and drainage, quinsy adenotonsillectomy, or airway emergency/obstruction. Our study indicated that CT scans for PTA diagnosis were associated with increased prescription of antibiotics, opioids, steroids, return ED visits, and recurrent PTA. Future prospective trials are needed to determine if the use of CT scans indicates higher patient acuity that explains the potential negative outcomes. Level II Laryngoscope, 2024.

Therapeutic management of peritonsillar abscess during COVID-19.

The purpose of this study is to examine the effects of the Covid-19 pandemic and lockdown policies in Germany on frequency and treatment of peritonsillar abscess at a tertiary referral center in Germany. This retrospective case-control study analyzed all cases of peritonsillar abscess treated from 03/01/2018 until 08/30/2022 at Augsburg ENT University Hospital, Germany, through abscess tonsillectomy and/ or incisional drainage. Data was collected and correlated to Covid-19 Stringency Index using codes based on the Institute for Hospital Remuneration System in Germany. After excluding 303 cases, 975 abscess tonsillectomy and incisional drainage cases were studied, with the first German lockdown serving as cutoff date. Treatment algorithm was maintained regardless of co-infection with Covid-19. A total of 174 patients received abscess tonsillectomy as therapy, while 801 patients underwent incisional drainage. Before the first German lockdown, 452 patients received incisional drainage. Since the pandemic, 349 cases of incisional drainage were registered (OR = 0.54, 95%-CI [0.27-0.86], p = 0.04), despite no significant change in the percentage of peritonsillar abscess of all ENT emergencies. The mean age at presentation with PTA was 39.8 years, and the rate of relapse was 4.0%. The study found no association between the scale of policy measures and treatment (OR = 1.00, 95%-CI [0.99-1.01], p = 0.52). The results indicate that, despite the reduction in capacities due to Covid-19, the proportion of patients with peritonsillar abscess treated through abscess tonsillectomy increased at Augsburg ENT University Hospital since the first German lockdown. Hospitalization times could still be reduced with comparable relapse rates.

Efficient In Vitro Propagation of Turpinia arguta and Quantitative Analysis of Its Ligustroflavone and Rhoifolin Content

Turpinia arguta is an excellent medicinal plant mainly used for the treatment of pharyngitis, tonsillitis, and tonsillar abscesses. However, an efficient regeneration protocol using tissue cultures for T. arguta does not exist. Its main medicinal constituents are flavonoids, particularly ligustroflavone and rhoifolin. Here, we aimed to establish a tissue culture system for T. arguta for the first time using annual stem segments with axillary buds harvested from the field of the Jiangxi Academy of Forestry as explants by dynamically determining the accumulation of effective functional components in the tissue culture plantlets. Orthogonal tests were conducted to compare the effects of different explant disinfection times, media, and exogenous hormone ratios on the induction of the axillary bud growth, successional proliferation, and rooting of T. arguta stem segments. The best explant disinfection effect was achieved by disinfecting the T. arguta explant with 75% ethanol for 50 s, followed by 0.1% mercuric chloride (HgCl2) for 6 min, and the optimal media for successional proliferation and rooting were Murashige and Skoog (MS) + 0.2 mg/L of 6-benzyladenine (6-BA), + 0.03 mg/L of naphthaleneacetic acid (NAA), and ½ MS + 2.5 mg/L of indole-3-butyric acid + 0.5 mg/L of NAA, respectively. The detection of ligustroflavone and rhoifolin in tissue culture plantlets 0, 3, and 5 months after transplanting showed a significant increasing trend and eventually exceeded the content requirements of the 2020 Edition ofChinese Pharmacopoeia for T. arguta. Our findings provide, for the first time, an effective tissue culture system for T. arguta, thereby providing important information to support the germplasm preservation, innovation, and application of T. arguta in the future.

Low-cost otolaryngology simulation models for early-stage trainees: a scoping review.

Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature. This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents. Of the 1706 studies screened, 17 met inclusion criteria. Most studies were conducted in HICs. Most models were low-fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation. Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models.