Severe Sore Throat Research Articles

6472 Methimazole Induced Agranulocytosis: Uncommon Complication of a Common Medication

Abstract Disclosure: R. Kaur: None. L. Kaur: None. A. Sridhar: None. T. Chaudhary: None. N. Patel: None. Methimazole (MMI) induced agranulocytosis is a rare and life threatening adverse effect that usually occurs within 3 months of drug initiation and can rapidly lead to overwhelming infection. It is reported in 0.1 to 0.5 % of patients on treatment with methimazole. MMI is a standard drug used in graves disease and toxic multinodular goiter. We report a case of MMI induced agranulocytosis in an elderly female with recently diagnosed toxic multinodular goiter. A 66 year old female with past medical history of recently diagnosed toxic multinodular goiter for which she was started on methimazole 80mg/day two months ago presented to the emergency department with chief complaint of severe sore throat associated with rapidly increasing pharyngeal pain and fever over the past 24 hours. She was lethargic, febrile with temperature of 102 F, tachycardic with heart rate of 115/minute and hypotensive with blood pressure of 108/64 mm Hg. Physical examination revealed diffuse pharyngeal and tonsillar erythema with bilateral purulent exudate with tender anterior cervical lymphadenopathy. Thyroid was enlarged, firm, irregular and nontender. Pulmonary, cardiac and abdominal exam was unremarkable. Lab work showed severe leukopenia with WBC count of 1,600/mm3, neutropenia with absolute neutrophil count of 0.0 x 1000/ul (normal range 1.8-7.3 x 1000/ul) and erythrocyte sedimentation rate and C reactive protein were both elevated. Blood cultures and fungal cultures showed no growth. Urinalysis and urine culture were both unremarkable. She had an extensive haematological, rheumatological and infectious disease workup for neutropenia, which was largely unrevealing. Rapid streptococcal testing was negative but throat cultures grew beta haemolytic streptococci. Treatment included suspending methimazole, administering antimicrobial therapy with piperacillin - tazobactam, acyclovir and fluconazole. She was also started on a granulocyte colony stimulating factor. Patient presented satisfactory evolution with progressive increase in leukocyte count and remission of symptoms by day 5 of treatment, rendering further bone marrow testing unnecessary. Antibiotics were changed to oral amoxicillin-clavulanic acid after throat culture results were available and the patient was discharged in stable condition. One month after discharge she underwent total thyroidectomy for definitive cure and is currently followed up as an outpatient by endocrinology. The objective of this case report is to present an uncommon case of agranulocytosis secondary to use of methimazole and to increase awareness among the physicians about the need to consider this diagnosis in patients on this medication. It is also advised that these patients be educated about the drugs side effects, a practice that may avert suffering and unnecessary costs. Presentation: 6/3/2024

Topical larynx lidocaine Spraying reduces cardiovascular stress response caused by suspension laryngoscopic surgery

ObjectiveThis study aimed to investigate the potential reduction of cardiovascular stress response caused by suspension laryngoscopic surgery through the application of lidocaine spray on the larynx and trachea. MethodsA total of 68 patients scheduled for elective suspension laryngoscopic surgery were randomly assigned to either the lidocaine group (Group L, n = 34) or the control group (Group C, n = 33). In Group L, patients received a sprayed lidocaine dose of 2 mg/kg on the larynx and trachea after anesthesia induction, prior to intubation. In Group C, equal volumes of saline solution were administered. MAP and HR were recorded at various time points: before anesthesia (T0), 1-minute after intubation (T1), 1 and 3 min after suspension laryngoscopy (T2 and T3), at the end of the operation (T4), and at 1, 5, and 30 min after extubation (T5, T6, and T7). Arterial blood glucose, epinephrine, and norepinephrine levels were measured at T0, T2, T5, and T7. The occurrence of severe cough and sore throat at T6 and T7 after extubation was compared between the two groups. ResultsAt T0 and T1, there were no statistically significant differences in mean arterial pressures, heart rate, and blood catecholamine levels between the two groups. However, from T2 to T7, the blood pressure and heart rate in Group L were lower compared to Group C, with significant differences observed at T2‒T6 (p < 0.05). Group L also showed less elevation in blood glucose at T2, T5, and T7 (p < 0.05). The changes in epinephrine and norepinephrine levels between the two groups were statistically significant at T2 and T5 (p < 0.05). ConclusionsAdministering lidocaine spray on the larynx and trachea during intubation for suspension laryngoscopic surgery can effectively alleviate the stress response. Level 1 evidencePatients in this study are randomly assigned to the treatment or control group and are followed prospectively.

Diagnosis Gangguan Pernapasan Pada Anak (Balita) Menggunakan Metode Forward Chaining dan Naïve Bayes

Respiratory system disorders often occur in humans and can be transmitted at any time from human to human. Respiratory disorders occur more often than disorders or infections of other body organ systems. Starting from the common cold with relatively mild to severe symptoms, coughing, fever, sore throat and shortness of breath. This disease is very dangerous, especially if it infects toddlers. To solve existing problems, researchers are trying to build an expert system to help people recognize respiratory diseases such as common cold, flu, bronchitis, pneumonia, asthma, allergies (rhinitis), sinusitis, tuberculosis, bronchopneumonia. Based on the symptoms entered into the system later, the system will use forward chaining and naïve Bayes methods as its inference engine which will produce a disease diagnosis. Based on 9 types of disease data with 30 types of symptom data for respiratory system diseases, the system has an accuracy of 87.6%. With these results, researchers hope to help the public as a medium for initial consultation in diagnosing respiratory diseases.

Peritonsillar Abscess and Post-aspiration Bleed Identified with Point-of-care Ultrasound Using Endocavitary Probe: A Case Report.

Peritonsillar abscesses form between the tonsillar capsule, the superior constrictor, and palatopharyngeus muscles. Physicians traditionally make this diagnosis clinically; however, ultrasound allows clinicians to further identify and differentiate between peritonsillitis, peritonsillar abscess, and phlegmon formation. By increasing both the sensitivity and specificity, ultrasound improves the diagnostic accuracy for patients with peritonsillar abscesses. This case demonstrates the utilization of ultrasound in peritonsillar abscesses and the application of point-of-care ultrasound (POCUS) in identifying complications of procedures used for treatment in the emergency department (ED). A 19-year-old male presented to the ED with complaints of severe sore throat and fever for the prior five days. A POCUS using an endocavitary probe with sterile cover demonstrated hypoechoic debris with a "swirl sign." Ultrasound was used to successfully guide needle aspiration by using in-plane needle guidance. The patient had significant bleeding after needle aspiration, and repeat POCUS clearly identified a new pocket of blood that had formed and was contained in the soft tissue. We monitored the size of the hematoma in real time with ultrasound to ensure the hematoma had no rapid expansion and was stable. Among the differential diagnoses for sore throat, the diagnosis of peritonsillar abscess is particularly concerning as it is both common and generally requires swift intervention. Presentations can range from a mild infection to a life-threatening emergency with potential airway compromise. The two primary avenues for treatment include either needle aspiration or incision and drainage. Ultrasound can successfully identify the abscess and other landmarks for safe and successful drainage, as well as early identification of complications.

Superior Laryngeal Nerve Block for Microlaryngoscopic Surgery: A Systematic Review and Meta-Analysis.

To assess the safety and efficacy of superior laryngeal nerve block (SLNB) for microlaryngoscopic surgery (MLS). PubMed, Embase, Web of Science, Ovid Medline, Cochrane Library, CNKI database, VIP database, Wanfang database, and trial registry databases. PICOS principles were performed: adults undergoing MLS receiving SLNB compared with no-SLNB in randomized controlled trials were included. Primary outcome included the incidence of severe postoperative sore throat (POST). Secondary outcomes included perioperative mean arterial pressure (MAP) and heart rate (HR), incidence of severe postoperative cough, and anesthesia recovery time. Eleven articles with 728 patients were included. Results indicated that SLNB provides lower incidence of severe POST in post-extubation 30 min (relative ratio [RR] = 0.13; 95% confidence intervals [CIs]: 0.05 ~ 0.34), 2 h (RR = 0.09; 95% CI: 0.02 ~ 0.36), 4-6 h (RR = 0.11; 95% CI: 0.03 ~ 0.41), and 24 h (RR = 0.15; 95% CI: 0.03 ~ 0.83); lower MAP (tracheal intubation: standardized mean difference [SMD] = -1.59; 95% CI: -1.69 to -0.42); suspension laryngoscope insertion: (SMD = -0.98; 95% CI: -1.49 to -0.46); tracheal extubation: (SMD = -0.78; 95% CI:-1.24 to -0.31); post-extubation 5 min: (SMD = -0.95; 95% CI: -1.41 to -0.49); lower HR (tracheal intubation: mean difference [MD] = -9.71; 95% CI: -17.16 to -2.27); suspension laryngoscope insertion: (MD = -8.64; 95% CI: -16.79 to -0.49); tracheal extubation: (MD = -10.13; 95% CI: -17.86 to -2.39); post-extubation 5 min: (MD = -13.44; 95% CI: -22.53 to -4.35); lower incidence of severe postoperative cough in post-extubation 30 min (RR = 0.18; 95% CI: 0.06 ~ 0.57) and 2 h (RR = 0.13; 95% CI: 0.02 ~ 0.69); and shorter anesthesia recovery time (MD = -5.34; 95% CI: -8.81 to -1.86) compared to controls. SLNB could provide lower incidence of severe POST, more stable perioperative MAP and HR, lower incidence of severe postoperative cough, and shorter anesthesia recovery time for MLS. I Laryngoscope, 134:3437-3446, 2024.

Клинико-анамнестические факторы риска развития преэклампсии как осложнения гестационного сахарного диабета

Aim. To identify the clinical and anamnestic risk factors of preeclampsia (PE) in gestational diabetes mellitus (GDM). Design. Open-label observational prospective study. Materials and methods. The study enrolled 204 pregnant women with GDM, 70 of which had their pregnancy complicated with PE (study group) and 134 patients did not have PE (controls). In the study group, clinical and anamnestic risk factors were searched for by tracing data from primary medical records. The age of participants was 21 to 46 years old. Extragenital conditions were studied as possible risk factors of PE in GDM. Results. It has been established that GDM with PE was more likely to be associated with chronic arterial hypertension (CAH) (χ2 = 7.72, р = 0.006, odds ratio (OR) = 8.52, 95% confidence interval (CI): 1.76–41.29); a history of respiratory diseases — severe sore throat (χ2 = 6.2, р = 0.01, OR = 3.98, 95% CI: 1.40–11.27), chronic tonsillitis (χ2 = 12.84, р &lt; 0.001, OR = 4.81, 95% CI: 2.03–11.40), acute bronchitis (χ2 = 6.0, р = 0.02, OR = 7.33, 95% CI: 1.48–36.32) than GDM without PE. Conclusion. Clinical and anamnestic risk factors of PE in women with GDM are CAH, a history of respiratory diseases (acute bronchitis, severe sore throat, chronic tonsillitis). Keywords: gestational diabetes mellitus, preeclampsia, risk factors.

SELF-PRESCRIPTION, DRUG MISUSE AND UNRECOGNISED SIDE EFFECTS : – A CASE REPORT.

It is well known that virtually all medications have side effects and the manufacturing companies document such in the leaflets attached with the packed medications. All packages of medicines whether capsules, eye drops, tablets or injections contain these leaflets that clearly outline the potential side effects amongst many other pieces of information. The use of the medication lies in its safety, usefulness and efficacy weighed against those side effects. We report a case of a side effect of an oral medication which we strongly consider was the cause of the severe sore throat and pharyngitis of a 59-year-old male who had been on the over-the-counter self-prescribed medication. This report seeks to raise awareness by drawing the attention of physicians in resource-constrained settings where regulations over prescribed drugs are often un-adhered to be conversant with the side effects of prescription drugs, take a comprehensive drug history and properly educate their patients accordingly.

The Indications of Tonsillectomy Among Pediatric Patients: Our Nine-Year Retrospective Review.

Tonsillectomy is a surgical procedure that involves removing the tonsils, often performed alongside adenoidectomy. Dating back to ancient times, it improves quality of life and can belife-savingwhen done for appropriate reasons. Common indications in children include recurrent tonsillitis and sleep-disordered breathing (SDB).Evidence suggests it reduces how often and how severe sore throats are in highly affected children. Symptoms such as lymphadenopathy, tonsillar pus, fever, or signs of streptococcal infection shouldbe present for diagnosis of tonsillitis. Polysomnography (PSG) is essential to diagnoseobstructive sleep apnea (OSA) and confirm airway obstruction. Our aim in this study is to determine the reasons for tonsillectomy in Taif, Saudi Arabia, since it is not well established before in this city. A nine-year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy performed in a tertiary hospital. Data was analyzed using SPSS (IBM Corp., Armonk, NY, USA). The research study involved analyzing data from361 participants. Among the participants, 16.9%(n = 61)underwent tonsillectomy alone, while the majority (83.1%; n = 300)underwent tonsillectomy in combination with other procedures. The most common combined procedure was adenotonsillectomy (71.7%; n = 259). Additionally, adenotonsillectomy and insertion of grommets in other combinations was observed andwas equal to 11.4% (n = 41) of the totalpercentage of oursample.The primary indications for tonsillectomy alone were chronic tonsillitis (42.6%; n = 26) and recurrent tonsillitis (49.2%; n = 30). Conclusion:This research study provides valuable information on the types of procedures performed and the indications for surgery in pediatric patients. The results highlight the prevalence of chronic and recurrent tonsillitis andadenotonsillitisas primary indications for tonsillectomy, either alone or in combination with other procedures. These findings contribute to our understanding of the clinical decision-making process and can aid healthcare professionals in providing optimal care for pediatric patients with tonsillar andadenotonsillarpathologies.

A randomised, double-blind, comparative study of preoperative magnesium sulphate versus zinc sulphate gargle for prevention of postoperative sore throat following endotracheal intubation.

Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h. After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data. The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5-23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2-37.7) in contrast to 13.6% (95% CI 3.5-23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively. Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle.

Vaping-induced acute epiglottitis: a case report

BackgroundE-cigarette use, or vaping, is an alternative nicotine delivery system that is becoming increasingly prevalent in adolescents and young adults. There is currently a lack of comprehensive research on the adverse effects of vaping on the upper airway.Acute epiglottitis is a potentially life-threatening condition that can lead to airway obstruction. It is commonly caused by bacterial infections such as streptococci, staphylococcus, and Moraxella. Adult patients with acute epiglottitis mainly present with odynophagia, dysphagia, and respiratory difficulties. The diagnosis of epiglottitis is made by direct laryngoscopy, and the mainstay of treatment is antibiotics.Bozella et al. (2020) reported a case of subacute non-infectious epiglottitis associated with e-cigarette use in a pediatric patient (Pediatrics 145(3), 2020). Here we present a case of acute epiglottitis in a healthy young adult after vaping, with a negative infectious workup. To our knowledge, there has been no such reported case of epiglottitis associated with e-cigarette use in an adult patient.Case descriptionA previously healthy 29-year-old male with daily e-cigarette use presented to the emergency department with a severe sore throat, dysphagia, mild hoarseness, and shortness of breath, especially when lying supine. A lateral neck soft tissue radiograph revealed a thickened epiglottis with a thumb sign. Direct bedside laryngoscopy showed a swollen epiglottis, partially obstructing the supraglottic region confirming the diagnosis of acute epiglottitis. Throat and nasal swabs were negative for streptococcus and COVID-19 infection, respectively. The patient’s condition improved significantly after receiving intravenous Dexamethasone and antibiotics for 2 days. Repeat laryngoscopy showed the resolution of epiglottis swelling, and subjective symptoms had resolved entirely 2 weeks following the start of the treatment.ConclusionsAlthough bacterial infections usually cause acute epiglottitis, this case presents the second report of this condition associated with vaping with negative microbiological investigations. Therefore, we recommend that physicians consider non-infectious causes such as vaping in their differential diagnosis for patients with acute and subacute epiglottitis. More research is warranted on the utility of antibiotics in treating vaping-induced epiglottitis.

Reducing Antibiotic Misuse through the Use of Point-of-Care Tests in Germany: A Survey of 1257 Medical Practices.

Though more than 80% of acute pharyngitis (AP) cases have a viral etiology, it remains one of the most common causes for the unnecessary prescription of antibiotics (ABs). Half of patients receive antibiotics in general practice. Point-of-Care Tests (POCTs) distinguish between bacterial and viral pharyngitis. The objective of this study was to evaluate the use of POCTs using throat swabs to detect β-Streptococcus pyogenes Group A (strep A) infection among patients with sore throat/acute pharyngitis in primary care practices across Germany. A study was conducted in 1257 primary care practices. Two questionnaires were administered concerning frequency, POCT results and whether antibiotics were prescribed. Of the 1257 physicians, 60% used POCTs. Of these, 25% used a POCT before prescribing an antibiotic, 39% in cases of severe sore throat, 40% in cases of long-lasting pharyngitis and 25% in other cases. In total, 83% considered the adoption of POCTs in everyday practice to be important or very important for the diagnosis of strep A, 90% considered it important or very important for achieving a more sensible use of antibiotics and the prevention of bacterial resistance and 80% considered it important or very important for justifying to patients whether or not an antibiotic is needed. POCT results and information on AB prescriptions were available for 583 patients. Of these, 22.5% tested positive for strep A, and 21.8% were prescribed antibiotics. Our study shows that the use of swab tests in patients with sore throat in primary care practices results in high levels of physician satisfaction and can strongly reduce the misuse of antibiotics in clinical practice.

A Neural Integrity Monitor Electromyography Endotracheal Tube Causes More Severe Postoperative Sore Throat Than a Standard Endotracheal Tube in Adults: A Prospective Cohort Study.

This study aimed at figuring out the different effects of a neural integrity monitor electromyography endotracheal tube (NIM-EMG-ETT) and a standard endotracheal tube (ETT) on postoperative sore throat (POST). This prospective cohort study enrolled 143 patients scheduled to undergo general anesthesia with endotracheal intubation. Patients were allocated into three groups: Group A, non-thyroid surgery with a standard ETT; Group B, thyroid surgery with a standard ETT; Group C, thyroid surgery with a NIM-EMG-ETT. The incidence, the severity and visual analog scale (VAS) of POST were recorded. The incidence and the severity of POST were tested by χ2 test or Fisher's exact test. And VAS of POST was tested by Kruskal-Wallis test. The incidences of POST in Group B and Group C were significantly higher than that of Group A at all the time points after extubation (P < 0.001). The incidences of POST in Group C was significantly higher than that in Group B at 8h, 24h and 48h after extubation (89.4% vs. 68.8%, P = 0.014, relative risk (RR) 1.30, 95% confidence interval (CI) 1.05-1.61; 89.4% vs. 58.3%, P = 0.001, RR 1.53, 95% CI 1.18-1.98; 76.6% vs. 45.8%, P = 0.002, RR 1.67, 95% CI 1.18-2.36). Moreover, there was a significant higher VAS of POST and more serious POST with Group C than with Group B. A NIM-EMG-ETT may induce higher incidence of POST and more serious POST than a standard ETT. Chinese Clinical Trail Registry ( http://www.chictr.org.cn/index.aspx , ChiCTR2200058896, 2022-4-18).

Web-Based Expert System For Respiratory Disorders In Human Using Backward Chaining Method

Respiratory disorders are various types of diseases or disorders that inhibit lung function. This disease can affect the ability to breathe. Respiratory disorders can be transmitted anytime and anywhere. Respiratory disorders are more common than other organ system disorders or infections. They start from the common cold with relatively mild to severe pneumonia, cough, fever, sore throat, and shortness of breath. Inadequate medical equipment also triggers the difficulty of treating and diagnosing a disorder. This study aims to help the community diagnose respiratory disorders and determine how to deal with them effectively and efficiently. This website-based expert system for diagnosing human respiratory disorders uses the Backward Chaining inference method. The results of this study will produce a website for diagnosing respiratory disorders in humans.

The Case Files

The Case Files

Slow advancement of the endotracheal tube during fiberoptic-guided tracheal intubation reduces the severity of postoperative sore throat

Although fiberoptic-guided tracheal intubation is a gentler method than using a direct laryngoscope, injury may occur owing to impingement between the distal edge of the endotracheal tube and the glottis. This study aimed to investigate the effects of endotracheal tube advancement speed during fiberoptic-guided intubation on airway symptoms postoperatively. We randomized patients scheduled for laparoscopic gynecological surgery to either Group C or S. When advancing the tube over the bronchoscope, the operator advanced the tube at a normal speed in Group C and at a slower speed in Group S. The speed in Group S was approximately half that in Group C. The target outcomes were the severity of postoperative sore throat, hoarseness, and cough. Patients in Group C experienced a more severe sore throat than those in Group S at 3 and 24 h postoperatively (p = 0.001 and p = 0.012, respectively). However, the severity of hoarseness and cough postoperatively were not significantly different between the groups. In conclusion, the slow advancement of the endotracheal tube during fiberoptic-guided intubation can reduce sore throat severity.

Extubation by supraglottic airway after lobectomy prevents cough-associated air leaks and prolonged coughing or sore throat.

Double-lumen endobronchial tubes (DLTs) are essential for differential lung ventilation during pulmonary lobectomy, but they are more rigid, longer, larger in diameter and irritable. Coughing at extubation sometimes causes airway and lung injury, which causes severe air leaks, prolonged cough and sore throat. We examined the prevalence of cough-associated air leaks at extubation and postoperative cough or sore throat after lobectomy and evaluated the efficacy of supraglottic airway (SGA) in preventing these complications. Patient characteristics and operative and postoperative factors data were collected from patients who underwent pulmonary lobectomy between January 2013 and March 2022. After propensity score matching, these data were compared between the SGA and DLT groups. A total of 1069 patients with lung cancer (SGA, 641; DLTs, 428) were enrolled and coughing at extubation occurred in 100 (23.4%) patients in the DLT group, 65 (65.0%) showed increased cough-associated air leaks at extubation and 20 (30.8%) showed prolonged air leaks. Coughing at extubation occurred in 6 (0.9%) in the SGA group. In 193 patients from each group after propensity score matching, coughing at extubation and the associated air leak increase were significantly lower in the SGA group. Visual analogue scale of postoperative cough and sore throat on postoperative days 2, 7 and 30 were significantly lower in the SGA group. SGA is effective and safe for preventing cough-associated air leaks and prolonged postoperative cough or sore throat at extubation following pulmonary lobectomy.

Алгоритм топической терапии в лечении тонзиллофарингитов

Acute tonsillopharyngitis (OTP) is an acute infectious inflammation of the mucous membrane and lymphadenoid structures of the oropharynx of viral, bacterial, fungal etiology, is one of the most common diseases in the outpatient practice of a doctor. Due to the frequent irrational use of systemic antibacterial drugs along with the growth of resistance of bacterial pathogens to them, drugs for local therapy attract special attention. In accordance with the clinical guidelines for the treatment of OTP with severe sore throat, taking into account the need, tolerability and age of the patient, the use of topical drugs, in particular, hexetidine and benzydamine, is recommended. Hexetidine (Gelangin®) should be used as a local therapy for OTP of mixed etiology, characterized by mild sore throat, perspiration, unexpressed infiltration and redness of the mucous membrane of the pharynx and tonsils. The action of hexetidine is most effective in the initial disease before the development of a pronounced inflammatory reaction of tissues (the first 3–5 days of treatment). Benzydamine (Angidac®) as a drug of complex anti-inflammatory, analgesic and antimicrobial action has advantages in the stage of expanded inflammation after the penetration of microorganisms into tissues, it is advisable to use it for any etiology of acute OTP, especially with severe sore throat, accompanied by phenomena of severe infiltration and hyperemia of the tissues of the affected area. The combined use of drugs should be justified by the need to obtain a summation of effects.

Comparing the Effectiveness of Betamethasone Gel with Lidocaine Gel Application on Endotracheal Tube in Preventing Post Operating Sore Throat

Objective: To compare the effectiveness of betamethasone gel and lidocaine gel application in reduction of post-operative sore throat. Study Design: Randomized controlled trial Place and Duration: Study was conducted at anesthesia department of Dow University of Health Sciences, Karachi with duration from May 2022 to October 2022. Methodology: A total of 54 patients were enrolled and divided into two groups Betamethasone and Lidocaine (Lignocaine) by lottery method. In one group betamethasone gel 0.05% was applied over endotracheal tube (ETT) and in other group lignocaine gel 4% was applied over the ETTT. SPSS version 23 was used for data analysis. Mean ± SD and frequency (percentage) were calculated for numerical and categorical data respectively. Results: Majority of the patients in betamethasone group, 15 (55.6%) patients, had not developed sore throat whereas mild and moderate sore throat was most common in lidocaine group. Further, 5 (18.5%) patients in lidocaine group and only 2 (7.4%) patients in betamethasone group was severe sore throat. (p=0.015). Practical implication: Sore throat is a common post-operative complication having potential to lead poor surgical results. This study will help the clinicians/anesthesiologists to overcome the problem and reduce the incidence of sore throat in routine practice. Conclusion: Application of betamethasone gel over endotracheal tube just before insertion is associated with reduced risk of sore throat as compare to lignocaine gel. Keywords: Lidocaine gel, Betamethasone gel, Post-operative sore throat, Laryngoscopy, Endotracheal tube.

New SARS-CoV-2 Omicron variant — clinical picture, treatment, prevention (literature review)

Despite the decrease in the incidence rate, today the problem of a coronavirus disease 2019 (COVID-19) remains relevant on a global scale. Among the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) variants, the Omicron is currently dominant. The differentiating properties of the Omicron variant are a shorter incubation period (1-5 days), high contagiousness, and a relatively mild course of the disease, which is associated with the highest number of genome mutations among all SARS-CoV-2 variants. The new variant is characterized by upper respiratory tract symptoms: rhinorrhea, severe sore throat, sneezing, less commonly cough, headache, and weakness. Oral antiviral drugs Paxlovid and Molnupiravir are effective for treating mild to moderate COVID-19, including in outpatients. While corticosteroids and interleukin-6 receptor antagonists are still effective in treating patients with moderate to severe COVID-19, the effectiveness of anti-SARS-CoV-2 monoclonal antibodies has not yet been fully proven. Vaccination, especially booster doses, against SARS-CoV-2 is the most effective method of preventing COVID-19. The review purpose was to analyze the literature to determine the key aspects of prevention, clinical picture and treatment of a new SARSCoV-2 Omicron variant. The work used publications for the period from November 2021 to February 25, 2022, dedicated to the prevention, diagnosis and treatment of COVID-19 caused by the Omicron variant from the following databases: PubMed, eLibrary, MedRxiv, Google Scholar. The following key words were used: “Omicron”, “SARS CoV-2”, “COVID-19”, “Omicron treatment”. The analysis showed that COVID-19 caused by the Omicron variant is characterized by a relatively mild course. However, due to high contagiousness, this variant poses a significant problem due to the excessive load on outpatient and inpatient healthcare, including intensive care units.

Retropharyngeal abscess as an example of a deep neck infection in children

Deep neck infections are severe complications of the inflammatory processes in the upper respiratory tract. They can be divided into retropharyngeal, parapharyngeal, peritonsillar and submandibular abscesses, depending on the affected region. Deep neck infections are considered as acute bacterial complications with a progressive course and life-threatening character and that’s why they require immediate wide-range, intravenous antibiotic therapy. A 7-year-old female patient presented to her general practitioner with persistent, recurrent fever lasting for 3 days. Fever subsided after 2 days of antibiotic therapy, but she developed trismus, severe sore throat, especially on the right side, radiating to the right ear and dysphagia. The patient was referred to the Pediatric Otolaryngology Department as a matter of urgency. On examination she had enlarged lymph nodes on the right side of the neck with limited head and neck movements to the right side and posteriorly. There was also an asymmetry of the pharynx behind the right palatopharyngeal arch observed. Laboratory blood tests showed high CRP level (3.84 mg/dl, n &lt; 0.5). CT scan was performed and showed multiloculated abscess in right retropharyngeal space. Our patient was qualified for the surgical procedure – drainage of the abscess under general anaesthesia together with wide spectrum antibiotic therapy in a form of cefuroxime and clindamycin. During procedure a large amount of pus was evacuated, and a sample was sent for microbiological results. It showed growth of Staphylococcus hominis, probably multiplication of local physiological colonization. She also received anti-inflammatory drugs and has had physiotherapy throughout the hospitalization period to prevent torticollis. We observed gradual local and general improvement, together with normalization of the inflammatory markers. She was discharged from the hospital after 7 days of intravenous treatment. Accurate diagnosis and immediate proper treatment of deep neck infections are essential in prevention of further local (to the surrounding regions) and general expansion (like thrombosis, sepsis, meningitis) of the inflammatory process and of persistent changes (like stenosis of the respiratory tract). Fortunately, in the post-antibiotic era most patients are fully healed, further complications are almost unseen and mortality rates are low.