Recurrent Sore Throat Research Articles

P59 Multicentric osteolysis nodulosis and arthropathy syndrome: a case report in Erbil - Iraq

Abstract Introduction Multicentric osteolysis nodulosis and arthropathy (MONA) is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once the MMP2 pathogenic variants have been identified in an affected family member, it is a skeletal dysplasia characterized by progressive osteolysis (particularly of the carpal and tarsal bones), osteoporosis, subcutaneous nodules on the palms and soles, and progressive arthropathy (joint contractures, pain, swelling, and stiffness). Case description The patient is a 15-year-old female living in Erbil, Kurdistan. Her condition started when she was 10 months old, as she began walking and experienced recurrent sore throat. At age 4 year, she had a history of falling, developed stiffness and contracture in her elbow that made it difficult to move. A few months later, she developed a painful swelling/mass in her left foot that interfered with her walking. She had delayed tooth eruption, with only 2 teeth appearing per 2 years, her fontanelle did not close until age 3 years. At age 4, she had a fall that caused stiffness in her right hand. Over the next few years, she developed masses/swelling and pain/stiffness in her feet, hands, elbows, knees, and ankles, leading to deformities. She did not have any hearing problems but missed 3 years of school due to her condition. Back pain started 3 years ago and has been decreasing Family History: Her sister, at age 4, had pain and mild swelling in her hands and feet, along with facial abnormalities. Another 4-year-old child in the family was admitted to the ICU with similar symptoms. Complete blood count, serum biochemistry, rheumatoid profile was normal. Ultrasound of abdomen and ECHO was normal. On radiological imaging done for hands, feet, spine, in which in hands has diffuse generalized osteopenia, decrease joint spaces, resorptions of the phalanges, or cortical thinning and expansion of the phalangeal, metacarpal and metatarsal bone with deformity, and in x-ray of spine shows osteopenia with scoliosis. Dexa scan done for hip and spine which reveals (-6) severe osteoporosis. The results of genetic testing on 26th of October, led to the diagnosis of MONA syndrome. The patient was started on supportive treatment (alendronate tablet 70 mg per week, Vit D tablet 5000 IU per day, NSAID for pain and physiotherapy). Discussion The existing literature on MONA syndrome has broadly characterized the skeletal manifestations in the hands and feet. However, more detailed information is needed regarding specific skeletal involvement, ray involvement (which fingers/toes are affected), type and number of joints affected, laterality (whether the involvement is symmetrical or asymmetrical), type and severity of deformities, characteristic sparing of individual joints, if any longitudinal studies could help track the chronological order of joint involvement, especially in the larger or proximal joint Research on MONA syndrome has described the skeletal manifestations in the hands and feet, but further study is needed to understand the specifics of ray involvement, joint involvement, laterality, and severity of deformity. Longitudinal studies can help track the progression of joint involvement, particularly in larger joints. The recurrence of symptoms after orthopedic surgery in one patient highlights the progressive nature of the syndrome and suggests that early surgical intervention may not be effective. Due to the rarity of MONA syndrome, it is difficult to fully understand the pattern of the syndrome’s phenotype. Furthermore, reported correlations between the syndrome’s genetic and phenotypic characteristics have been inconsistent and inconclusive The treatment for MONA syndrome is primarily supportive and includes physical therapy to slow the development of contractures and prolong mobility. Pain relief may not be achieved through medication unless the pain is caused by secondary osteoarthritis or contractures. Additionally, daily recommended supplementation of vitamin D and calcium; standard management of congenital heart defects; management of scoliosis and kyphosis per orthopedist. Key learning points • The complicated diagnostic process for MONA syndrome necessitates a re-review of the reported phenotype-genotype correlations. By expanding the understanding of the phenotype, including the detailed skeletal manifestations, the goal is to reach a consensus on the diagnostic criteria for MONA syndrome. The aim of this case report was to systematically describe the clinical manifestations, with a focus on the skeletal features, in children with molecularly confirmed MONA syndrome, and to establish relevant phenotype-genotype correlations.

A Rare Case of Giant Epignathus (Teratoma) of Left Palatine Tonsil: A Case Report.

Teratomas are rare tumors that originate from all three primary germinal layers and can develop anywhere along the body's midline, most commonly in the sacrococcygeal area. Within the head-and-neck region, they are infrequent, especially in the oropharyngeal area, and predominantly occur in infants. This case report presents an unusual instance of a teratoma in the left palatine tonsil, also known as giant epignathus, of a 25-year-old female. The patient experienced a progressively enlarging mass over six to seven months without recurrent sore throat, fever, respiratory difficulties, or weight loss. Clinical and imaging assessments revealed a 2cm x 3cm irregular mass in the left palatine tonsil, which was surgically excised. Histopathology confirmed a mature teratoma. The patient was followed up for six months without evidence of recurrence. This case underlines the importance of considering teratomas in the differential diagnosis of tonsillar masses, even in adults, and highlights complete surgical excision as the treatment of choice to minimize recurrence risks and achieve optimal patient outcomes.

Early provision of clinical information with an ‘opt in’ approach improves patient experience in tonsillectomy referrals

Patients referred by their general practitioner (GP) with a definite diagnosis, for example, recurrent sore throat for consideration of tonsillectomy in adults, may wait for months without receiving any further...

Comparing The Efficacy of Ibuprofen alone with Ibuprofen and Paracetamol in Combination in Relieving Post Tonsillectomy Pain in Children: A Prospective Comparative Study

Background: Tonsillectomy is a frequent surgical intervention for recurrent tonsillitis in both adults and children, employing predominantly the cold steel method. Pain management post-surgery primarily involves NSAIDs and opioids, with varying degrees of effectiveness and side effects. Objective: The study aimed to evaluate the pain relief efficacy of combining ibuprofen with paracetamol compared to the use of ibuprofen alone in children post-tonsillectomy. Methods: Following ethical approval, 278 children with recurrent sore throat and quinsy were enrolled in an inpatient study at the Department of ENT, A unit of Hayatabad Medical Complex, Peshawar, from May 06 to August 30, 2023. This analytic cross-sectional study utilized a comparative prospective data collection approach and non-probability convenience sampling. Participants included 142 boys and 136 girls, aged 6 to 12 years. Results: Of the total 278 children, 142 (51.1%) were male and 136 (48.9%) female. Ibuprofen alone was prescribed to 136 children, while 134 received a combination of ibuprofen and paracetamol. Among those treated with the combination therapy, 65 (23.4%) reported no pain (VAS scores 1-3). In contrast, those receiving ibuprofen alone reported moderate pain (VAS scores 4-7) as follows: 2.2% (N=6), 11.2% (N=31), 19.4% (N=54), and 9.4% (N=26); and severe pain (VAS scores 8-10) was reported by 6.5% (N=18) and 0.4% (N=1). Conclusion: The combination of ibuprofen and paracetamol is significantly more effective in managing post-tonsillectomy pain in children compared to ibuprofen alone.

Demographic Study to Evaluate the Morbidity Status of Children in Jodhpur City

Every nation's foundation is its children, and that nation's top priority is to ensure their health. Their early years of life are characterized by their development and growth. The first few years of life are the most important time because of the fast growth and development that is common at this age and necessitates ongoing observation. During this time, roughly 40% of physical growth and 80% of mental development take place. Any obstacle they face at this age could severely restrict their ability to develop and grow. A child who lacks access to health care during these formative years is denied the chance to develop into a healthy adult, and the harm caused in the early years may be permanent or in the long run. Children under the age of five continue to die from ailments that are treatable or preventable. Despite the significant progress in immunization to strengthen the immune system, medical research has not yet developed a fully effective defense against virulent organisms, and occasionally we fail in the struggle for survival. To understand the primary causes of death and the carers' patterns of seeking medical attention before the deaths of such children, a cross-section study encompassing the area of Jodhpur, Rajasthan, was done. The survey was conducted on 1000 children living in the surroundings of the Post Graduate Institute of Ayurved, Dr. S. R. Rajasthan Ayurved University, Jodhpur. Demographic studies show that Respiratory tract Infection is the main cause of morbidity in children. In Respiratory tract Infection recurrent cough, recurrent running nose, recurrent nasal obstruction, recurrent sore throat, and breathlessness are included. Out of which maximum number of children suffered from recurrent running nose.

Effectiveness, perceptions and environmental benefits of remote consultation for adults referred with recurrent tonsillitis.

We evaluate remote consultation for adult patients referred with recurrent sore throat, measuring the effectiveness of the consultation, satisfaction and environmental impact. Eligible patients were invited to telephone clinics, undertaking a satisfaction survey after consultation, focusing on perceived convenience, satisfaction, cost and travel arrangements (used to calculate potential environmental benefit). Provider opinion was also captured. Forty-eight of 60 patients attended, with 38 (63%) eligible for inclusion. Thirty-six of these 38 patients (95%) had a definitive outcome of tonsillectomy (27/38) or discharge (9/38). Thirty-three of the 38 patients (87%) responded to the survey and reported high satisfaction in all arms of questioning (mean Likert ranking = 4.7/5). A mean of 3.76 hours of missed work and 5.17kg carbon dioxide emission equivalents were saved per patient. Provider responses were positive towards ongoing remote consultation use. Telephone consultation for adult patients considered for tonsillectomy is convenient to patients in terms of cost and time, reduces environmental harm and is associated with high patient and provider satisfaction.

A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient's condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren's syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient's autoimmune reactions.

Upper and Lower Respiratory Mucous Membrane Plasmacytosis with a Cobblestone Appearance: a Case Report.

A 53-year-old woman with a recurrent sore throat, xerostomia, nasal obstruction, and nasal discharge came to our hospital. At the first visit, she did not have a fever, but a blood test showed an intense inflammatory response. She had oral mucosal erosion. She developed dyspnea 2months later. Nasendoscopy, laryngoscopy, and bronchoscopy showed upper and lower respiratory mucosa cobblestone appearance. Microscopy of the nasal and pharyngeal mucosa biopsy found regular mononuclear inflammatory cell dense submucosal infiltrate, mainly plasma cells. A mucous membrane plasmacytosis diagnosis was made. Prednisolone 1mg/kg/day rapidly improved bronchial symptoms and cobblestone appearance.

A Case of 31-Year-Old Female With Recurrent Tonsillitis due to Poor Differentiation of Naïve T Cells to Memory T Cells

We report a case of a 31-year-old female presented with recurrent sore throat and dyspnea even after tonsillectomy and repeated adenoidectomy. Hypertrophic lingual tonsil was removed via transoral robotic surgery and was confirmed as lymphoid follicular hyperplasia by pathological examination. The analysis of the distribution and the mean fluorescence intensity of T cells after stimulation with relevant cytokines showed impaired differentiation of naïve T cells into memory T cells. As such, defective T cell immunity had made the patient susceptible to repetitive upper respiratory infection.

Efficacy of Sublingual Therapeutic Bacterial Vaccine in Patients with Recurrent Sore Throat: A Randomized Controlled Trial

Introduction: Recurrent sore throat is a significant burden on the healthcare system. It is associated with significant morbidity and antimicrobial resistance due to frequent antibiotic use. The sublingual live-attenuated polyvalent bacterial vaccine has been used as an adjunct treatment in these patients for its immunomodulatory properties, increasing immune responses, and boosting the innate immune system. Objective: To determine the efficacy of the sublingual live-attenuated polyvalent bacterial vaccine in patients with recurrent sore throats. Materials and Methods: This randomized control trial was conducted at the Department of ENT, Services Institute of Medical Sciences, Lahore from July, 2019 to January 2020 A Total of 60 patients full filling the inclusion criteria were included in the study and were equally divided into two groups. Each group had 30 patients to compare the mean number of sore throat episodes in the treatment and control groups. After approval from the hospital ethical review committee (No. Estt/ 20980/S.H), informed consent was obtained from each patient. Group A patients received a sublingual live-attenuated polyvalent bacterial vaccine and whereas group B were given placebo (normal saline 0.9%). Treatment response was noted for a period of 3 months. Results: The mean number of sore throat episodes was 0.53 ± 0.63 in the sublingual polyvalent live-attenuated bacterial vaccine group compared to 1.67 ± 0.92 in the placebo group (p-value =0.0001). The mean duration of disease in Group A was 3.20 ± 1.56 years compared to 3.40 ± 1.63 years in Group B. Conclusion: Sublingual live-attenuated polyvalent bacterial vaccine is effective in reducing the number of recurrent sore throat episodes and need for frequent antibiotic use and/or tonsillectomies

Subaortic stenosis and Wolff-Parkinson-White syndrome: Clinical case and literature review

The association of a subaortic stenosis with a WPW syndrome is very rare yet so challenging due to the difficulty of the treatment. In order to describe this association, we report the case of a young man. A 39 yo Moroccan man with a history of recurrent sore throat, was referred to our care after a heart murmur was discovered during a pre-employment medical checkup. He beneficed from a physical examination, an EKG and a transthoracic cardiac ultrasound. The patient did not have any symptoms: no dyspnea or palpitations or fatigue or syncope. There was no family history of cardiac disease or murmur. Physical examination found a well-developed male in no distress, blood pressure at 140/80 mmHg, heart rate at 91 bpm, BMI = 21 kg/m 2 . Cardiac auscultation revealed a systolic murmur in the aortic area increased by the Valsalva maneuver. With no sign of heart failure. The results of the remaining physical examination were within normal ranges. The electrocardiogram revealed an intermittent WPW. Echocardiography was performed while the patient was in ventricular pre-excitation conduction revealed a subaortic stenosis diaphragm with an average gradient of 51 mmHg, a hypertrophic left ventricular wall, with good systolic function with an ejection fraction of 68%, the LV filling pressures were highs. A left atrium surface of 18.3 cm 2 , the aortic valve was tricuspide with a small regurgitation, the ascending aorta was dilated. Mitral valve was thin with normal opening. Right cavities were not dilated with normal function, we noted a small tricuspide regurgitation with systolic pulmomanary artery pression at 44 mmHg. Inferior vena cava was thin, and no pericardium effusion was found. Labs results came normal. The patient was put under small dose of beta-blockers and diuretics and a surgical treatment was discussed. The necessity to explore the WPW patients before treatment.

P087 Polyarteritis nodosa: a case report

Abstract Background Polyarteritis nodosa is a necrotizing vasculitis of small and medium caliber arteries. Rarely described in children, its pathophysiology is complex and remains poorly elucidated. Two main forms were described in the literature: cutaneous and visceral. Material and results We report the cases of two boys, aged of 7 and 11 years old. They had a history of recurrent sore throat with a recurrent aphthosis in the 11-year-old child. Both boys presented with polyarthralgias, myalgias, polymorphous skin lesions made of livedo reticularis with subcutaneous nodosa on the lower limbs in the first child and distal necrosis of the toes with oedema of the lower limbs in the second. Patients suffered also of cough evolving in a context of alteration of the general state made of fever and asthenia. A biological inflammatory syndrome was present in both children and the skin histology confirmed periarteritis nodosa. The evolution was marked by the disappearance of arthralgias and myalgias after a corticosteroid-based treatment with progressive dose reduction until minimal effective dose. Conclusion The diagnosis of Polyarteritis nodosa should be made in any child presenting with the following signs: fever, altered general condition, myalgias, arthralgias and skin manifestations. The prognosis is usually benign but long-term surveillance is necessary.

Rheumatic heart disease in The Gambia: clinical and valvular aspects at presentation and evolution under penicillin prophylaxis

BackgroundRheumatic heart disease (RHD) remains the leading cause of cardiac-related deaths and disability in children and young adults worldwide. In The Gambia, the RHD burden is thought to be high although no data are available and no control programme is yet implemented. We conducted a pilot study to generate baseline data on the clinical and valvular characteristics of RHD patients at first presentation, adherence to penicillin prophylaxis and the evolution of lesions over time.MethodsAll patients registered with acute rheumatic fever (ARF) or RHD at two Gambian referral hospitals were invited for a clinical review that included echocardiography. In addition, patients were interviewed about potential risk factors, disease history, and treatment adherence. All clinical and echocardiography information at first presentation and during follow-up was retrieved from medical records.ResultsAmong 255 registered RHD patients, 35 had died, 127 were examined, and 111 confirmed RHD patients were enrolled, 64% of them females. The case fatality rate in 2017 was estimated at 19.6%. At first presentation, median age was 13 years (IQR [9; 18]), 57% patients had late stage heart failure, and 84.1% a pathological heart murmur. Although 53.2% of them reported history of recurrent sore throat, only 32.2% of them had sought medical treatment. A history suggestive of ARF was reported by 48.7% patients out of whom only 15.8% were adequately treated. Two third of the patients (65.5%) to whom it was prescribed were fully adherent to penicillin prophylaxis. Progressive worsening and repeated hospitalisation was experienced by 46.8% of the patients. 17 patients had cardiac surgery, but they represented only 18.1% of the 94 patients estimated eligible for cardiac surgery.ConclusionThis study highlights for the first time in The Gambia the devastating consequences of RHD on the health of adolescents and young adults. Our findings suggest a high burden of disease that remains largely undetected and without appropriate secondary prophylaxis. There is a need for the urgent implementation of an effective national RHD control programto decrease the unacceptably high mortality rate, improve case detection and management, and increase community awareness of this disease.

Abstract 628: Ophtalmological manifestations of acute leukemias at university hospital center Yalgado Ouedrago

Abstract Acute leukaemias constitute 9.04% of malignant hemopathies (Burkina Faso, 2015). Their manifestations are mainly haematological, however other less frequent attacks are possible. We report here for the first time in Burkina Faso, three cases of ocular localizations in young adults. Observation 1: S.I, male, 17-year-old patient, student living in Ouagadougou with a history of recurrent sore throat and ear infections. He was admitted for asthenia and pallor in the context of polytransfusion. The myelogram showed a rich marrow marked by the presence of 15% blast cells. Ophthalmologic examination reported visual acuity of 1/10, stage II proptosis and lower chemosis, and massive retinal and macular hemorrhage. Chemotherapy could not be performed. he died a week later. Observation 2: TB, male, 23-year-old patient, welder, suffering from acute lymphoblastic leukemia diagnosed in front of a severe recurrent anemia and confirmed by a myelogram, showing a rich marrow infiltrated by lymphoblasts representing 47% of the medullary cells. The ophthalmologic examination revealed conjunctival-palpebral infiltration by acute leukemia with myogenic ptosis. The evolution was marked by an improvement in symptoms after a cure according to the Vincristine-Prednisone protocol and he was discharged from hospital weeks later. He was subsequently lost to follow-up. Observation 3: KK male, 25-year-old patient, artisanal miner residing in Ouagadougou with a history of peptic ulcer disease, carrier of acute myeloid leukemia (AML) confirmed by a myelogram. The ophthalmologic examination concludes with a bilateral inflammatory orthopathy with an exposure keratitis on site of AML. He received transfusion of concentrates of red blood cells and platelets, as well as corticosteroid therapy for 04 days. The following was marked by a rapid worsening of the symptoms and the death of the patient a week later. Conclusion: The extra-haematological manifestations of acute leukemia are rare. They are associated with a pejorative prognosis. This series of 03 cases that we report is the first described to date in our context. Citation Format: Kalo Roland Millogo, Delphine Kabore, Solo Traore. Ophtalmological manifestations of acute leukemias at university hospital center Yalgado Ouedrago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 628.

Tonsillolith.

Small tonsilloliths are usually asymptomatic, whereas large tonsilloliths are sometimes associated with recurrent sore throat and odynophagia.

Outcome of tonsillectomy in children without the use of postoperative antibiotics at two tertiary care hospitals of Peshawar

Introduction: Overuse of antibiotics can lead to antimicrobial resistance and unnecessary costs. Although early studies reported improved outcomes following use of perioperative antibiotics for tonsillectomy, more recent studies have not been able to demonstrate a significant benefit on post tonsillectomy morbidity.
 Objective: To determine the need for postoperative antibiotics in children undergoing tonsillectomy under aseptic conditions at two tertiary care hospitals of Peshawar.
 Materials & Methods: Children aged 5-14 years admitted to the departments of Otorhinolaryngology-A unit of Hayatabad Medical Complex and Rehman Medical Institute, Peshawar from March 01, 2018 to September 30, 2018 for recurrent sore throat and recurrent quinsy were included in this quasi-experimental study based on prospective data collection and convenience sampling. Children with blood dyscrasias, upper and lower respiratory tract infections, and cardiopulmonary diseases were excluded. Routine preoperative investigations were done, and all were given postoperative analgesics. The patients were divided into two consecutive groups of 60 each; Group-A was given Co-amoxiclav 20mg/5mg/kg/day for 10 days and Group-B was not given any antibiotic. During their stay in the hospital and on follow up they were asked about pain via Visual Analogue Scale, and presence of fever and/or bleeding were documented.
 Results: Of 120 children, 50 (41.6%) were males and 70 (58.4%) were females, of ages 05-14 years; 01(1.6%) from Group-A and 01(1.6%) from Group-B presented with reactionary hemorrhage. However, 01(1.6%) from Group-A and 25(40%) from Group-B presented with secondary hemorrhage for which they were readmitted and put on injectable antibiotics. Similarly, 05(8.3%) from Group-A and 14(23.3%) from Group-B presented with pain for which pain killers were prescribed.
 Conclusion: Post tonsillectomy antibiotics may have a role in reducing the morbidities associated with the procedure in our setup.
 Keywords: Tonsillectomy; Postoperative Infections; Antibiotic Resistance; Hemorrhage.

A rare association of tonsillar tuberculosis and lichen scrofulosorum

BackgroundBoth tonsillar tuberculosis and lichen scrofulosorum are sporadic presentations of extrapulmonary tuberculosis. Lichen scrofulosorum commonly presents in children and young adults as lichenoid eruptions over the skin. Granulomatous inflammation of the tonsils, however, presents as non-specific sore throat and foreign body sensation in the throat. The concomitant presentation of the abovementioned tubercular manifestations has not been reported in the literature.Case presentationHerein, we report a case of an 11-year-old male patient who presented with a history of recurrent sore throat and ulcerative lesion over the tonsil. Systemic examination revealed multiple perifollicular eruptions over the trunk and back. The diagnosis was confirmed on histopathological findings of epithelioid cell granulomas with Langerhans giant cells following biopsy from the tonsil and skin lesions. Antitubercular therapy was initiated soon after. The patient responded to treatment as early as 6 weeks and was completely asymptomatic at 1 year of follow-up.ConclusionA diagnosis of granulomatous tonsillitis should alert the physician to the possibility of underlying systemic tuberculosis. In our case, coexistence of lichen scrofulosorum helped us to substantiate the diagnosis based on the biopsy report. Response to antitubercular agents is excellent and should be started at the earliest.

Study on presentation and predisposing factors for pediatric deep neck space infection

<p class="abstract"><strong>Background:</strong> Aim were to study the clinical presentation and predisposing factors in children with deep neck space infections and to study the effective mode of management of pediatric deep neck space infections and its complications. </p><p class="abstract"><strong>Methods:</strong> This prospective study was done in a tertiary care hospital on 163 pediatric patients with deep neck space infections who were thoroughly examined to know the source of the infection. Ultrasonography of neck and Radiological investigations were done to determine the location and extent of the abscesses. All patients were started on empirical antibiotic therapy of amoxicillin and clavulanic acid and metronidazole. Patients with small abscess were blindly aspirated with wide bore needle, while incision and drainage were done for large abscess. The pus samples from both were sent for culture and sensitivity. Patients presenting with complications, underwent incision and drainage. Patients, who failed empirical antibiotic therapy and needle aspiration, then underwent incision and drainage. </p><p class="abstract"><strong>Results:</strong> The most common symptom and sign was neck swelling (85%). The next most common symptom was neck pain (70%). Most of the patients had unknown source of infection and others had history of recurrent sore throat, dental infections, acute cervical lymphadenopathy, parotitis and furuncle over neck. </p><p class="abstract"><strong>Conclusions:</strong> Deep neck space infections (DNI’s) in pediatric population constitutes of medical emergency as it could lead to life threatening complications in a short time. Though with changing times of new diagnostic and therapeutic tools have drastically reduced the incidence of complications.</p>

A Case Report: Management of Granular Pharyngitis with Ayurveda

Background: Granular pharyngitis is an acute or subacute form of throat disease which is extremely common in autumn and spring. It is characterized by marked swelling of the follicular tissue of the pharynx, which has a granular glazed appearance. Symptomatically it can be correlated with Kaphaja Rohini or Kanthashalooka. Methods: A 20-year-old patient presented with complaint of recurrent dry cough, rhinorrhea, dysphagia, dry and sore throat, tiredness of voice since last 4 months. Management done with OPD based treatment. here in this case report treatment chosen was i.e. Yashtimadhu Ghanavati, Shitopaladi Churna, Naradiya Laxmi Vilasa Rasa Orally, Dashamoola Kwatha (Kavala), Yashtimadhu Churna (Pratisarana). Result: There was marked improvement in symptoms like recurrent dry cough, rhinorrhea, dysphagia, dry and sore throat tiredness of voice with the treatment of 1 month. Conclusion: Significant result was observed with this treatment protocol in the management of granular pharyngitis.

Epidemiologic profiles of subclinical rheumatic heart disease in children

Background Rheumatic heart disease (RHD) causes premature deaths every year worldwide. Low socioeconomic level is considered to be a risk factor facilitating the transmission of airway infections due to Streptococcus pyogenes. Subclinical RHD is a stage of RHD in which heart valve abnormalities have occurred according to the WHO or WHF classification but without any complaints to the subject. Echocardiography is used to screen subclinical RHD in several countries.
 Objective To estimate the prevalence, risk factors, and echocardiographic features of subclinical RHD in children.
 Methods This cross-sectional study was conducted on 250 elementary school children in Palembang, South Sumatera. We interviewed subject's parents about family characteristics, environment, and history of recurrent sore throat. Subjects underwent anthropometric examination, auscultation, and echocardiography. Diagnosis of RHD was based on World Health Organization (WHO) and World Heart Federation (WHF) criteria.
 Results Of 250 subjects, 132 (53.8%) were girls. Subjects’ age range was 5-14 years. The prevalence of subclinical RHD was 8% (95%CI 4.8 to 11.6). Of the 20 subclinical RHD subjects, 15 (75%) met the possible RHD criteria, 5 (25%) met the probable RHD criteria, and none met the definite RHD criteria. Multivariate analysis showed that household crowding (OR 8.135; 95%CI 1.048 TO 63.143; P=0.045), history of recurrent sore throat within the previous 6 months (OR 6,476; 95%CI 1.79 to 23.427; P=0.004) and age > 10 years (OR 3.167, 95%CI 1.184 to 8.471; P=0.022) significantly increased the risk of subclinical RHD.
 Conclusion The prevalence of subclinical RHD in elementary school children in Palembang was 8%. For echocardiographic features, most cases met the WHO/WHF possible RHD criteria. Factors significantly associated with the incidence of subclinical RHD are age > 10 years, household crowding, and history of recurrent sore throat in the previous 6 months.