Sore Throat Pain Research Articles

Treatment and Management of Peritonsillar Abscess-A Review

Aim: To review the treatment and management of Peritonsillar abscess. Objective: To find out the various treatment procedures, precautions taken during the management peritonsillar abscess. Background: Peritonsillar abscess also known as quinsy is a complication of tonsillitis. It consists of pus formation is the supratonsillar space. It is very common in children as their intake of chocolate and sticky substances is high, hence more prone to infection .Also it can be caused due an infection caused in the loose connective tissue present in this area. Its early symptoms include sore throat and severe pain during swallowing and as the case progresses the pain increase and a distortion of vowels called as the “hot potato voice “may appear. Reason: I have interest in this area of research as every member in my family has had tonsillitis except me and it makes me curious about its occurrence and its management.

Changes in Sore Throat Symptoms throughout the Day and Night: A Questionnaire-Based Survey of Five Countries

Objective: Night-time symptoms of upper respiratory tract infection often feel more severe, but it is not known how sore throat symptoms might vary over 24 hours. The aim of the current analysis was to determine any effect of time of day on sore throat symptoms and treatment practices across five countries. Methods: Adults who had used a sore throat remedy at least once in the preceding 12 months answered a 30-minute questionnaire and then undertook a 7-week diary to document sore throat pain and treatment episodes. Analyses were conducted to investigate effect of time of day on sore throat symptoms, severity, and the use of throat products, as well as differences in functional and emotional needs. Results: A total of 5000 participants (1000 in each of the UK, Italy, Russia, USA, and Thailand) took part. Sore throat was reported more frequently in the morning and the evening/night-time, while fewer participants reported sore throat in the afternoon; similarly, sore throat products were reported to be taken more frequently in the morning and the evening/night-time. Conclusion: This survey shows an increased frequency of people reporting sore throat symptoms in the morning and the evening compared with other times of the day. Research is warranted to investigate the potential of a long-acting product such as flurbiprofen for alleviating night-time sore throat (and hence minimising sleep disruption and the impact on next-day functioning).

Efficacy of disintegrating aspirin in two different models for acute mild-to-moderate pain: sore throat pain and dental pain

A recently developed fast-release aspirin tablet formulation has been evaluated in two different pain models. The dental impaction pain model and the sore throat pain model are widely used for assessing analgesia, including acute mild-to-moderate pain. Both studies were double-blind, randomized, parallel group and compared a single dose of 1000 mg aspirin with 1000 mg paracetamol and with placebo and investigated the onset and overall time course of pain relief. Speed of onset was measured by the double-stopwatch method for time to meaningful pain relief and time to first perceptible pain relief. Pain intensity and pain relief were rated subjectively over a 6-h (dental pain) and 2-h (sore throat pain) time period. In both models fast-release aspirin and commercial paracetamol were statistically significantly different from placebo for onset of action, summed pain intensity differences and total pain relief. Meaningful pain relief was achieved within a median of 42.3 and 42.9 min for aspirin and paracetamol, respectively, in the dental pain model. The corresponding numbers in sore throat pain were 48.0 and 40.4 min. All treatments in both studies were safe and well tolerated. No serious adverse events were reported and no subject was discontinued due to an adverse event. Overall the two studies clearly demonstrated efficacy over placebo in the two pain models and a comparable efficacy and safety profile between aspirin and an equivalent dose of paracetamol under the conditions of acute dental pain and acute sore throat pain.Trial registration These trials were registered with ClinicalTrials.gov, registration number: NCT01420094, registration date: July 27, 2011 and registration number: NCT01453400, registration date: October 13, 2011.

Ear Acupuncture for Acute Sore Throat: A Randomized Controlled Trial

Sore throat is a common cause of pain in outpatient encounters. Battlefield auricular acupuncture (the placing of needles in specific points in the ear) is a modality used to treat acute pain associated with a variety of ailments. The aim of our study was to determine whether auricular acupuncture reduces pain, medication usage, and missed work hours when added to standard therapy in adult patients with acute sore throat. We conducted an unblinded, pragmatic, randomized controlled trial among adult, nonpregnant patients presenting to an Air Force family medicine clinic with pain from acute sore throat. A total of 54 patients were followed for 48 hours after treatment. Patients receiving auricular acupuncture reported lower pain scores than those who did not at 15 minutes (6.0 [95% confidence interval (CI), 5.4-6.6] vs 2.6 [95% CI, 1.7-3.5]; P < .0001), 6 hours (4.8 [95% CI, 4.0-5.6] vs 2.5 [95% CI, 1.6-3.4]; P = .0005), and 24 hours (4.1 [95% CI, 3.3-4.9] vs 1.3 [95% CI, 1.0-2.8]; P = .0006). They also reported taking fewer cumulative doses of pain medication at 6 hours (1.07 [95% CI, 0.69-1.45] vs 0.39 [95% CI, 0.2-0.58]; P = .003), 24 hours (2.63 [95% CI, 1.95-3.31] vs 1.37 [95% CI, 0.92-1.82]; P = .004), and 48 hours (4.07 [95% CI, 2.9-5.24] vs 2.19 [95% CI, 1.44-2.94]; P = .009). There was no difference in time missed from work between the auricular acupuncture and standard therapy groups. Compared with usual treatment, battlefield auricular acupuncture was associated with reduced sore throat pain for 24 hours and decreased use of pain medication for up to 48 hours. There was no apparent effect on hours missed from work.

Mevalonate kinase somatic mosaicism and bigenic genotypes may explain heterogeneity in mevalonate kinase deficiency

Results Case 1 A pediatric case with splenomegaly, cervical lymphoadenopathy, failure to thrive and anemia, was found to have two pathogenic MVK variants, p.V250I and p. L315G*51, and the Q705K variant on the NLRP3 gene, considered a functional polymorphism. Typical symptoms and a high level of urinal mevalonic acid allowed closure on MKD diagnosis this case. Case 2 A pediatric case with recurrent and vaccination triggered attacks of high fever, sore throat, cervical lymphadenopathy and abdominal pain since infancy was a carrier of the MEFV p.V726A variant. The patient was diagnosed with PFAPA and treated with steroids. In the last, 10 days long attack the patient developed arthritis, a maculopapular rash and high blood pressure. MKD genetic testing revealed two pathogenic MVK variants, p.V377I and p.G202R, confirming the diagnosis of MKD. Case 3 A patient with adult onset Still’s disease symptoms including fever attacks, arthralgia, urticaria, pericarditis, and partial response to NSAIDs was shown to have a rare MVK variant, p.R121W, and the NLRP3 p.Q705K functional polymorphism. The diagnosis is yet unresolved. Case 4 An adult patient developed high fever and abdominal pain lasting 2-3 and HLA-B51 positive aphthous stomatitis. We identified somatic mosaicism (22%) for a novel, p.Ala161Thr MVK variant. The patient’s attacks resolved with anti TNF treatment and the current diagnosis is Behcet’s disease.

Magnesium and Ketamine Gargle and Postoperative Sore Throat.

Background:Postoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia.Objectives:To compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat.Patients and Methods:A total of 100 patients candidate for emergency acute appendicitis surgery were enrolled in the study. Patients in ketamine group received ketamine gargle (0.5 mg/kg) and magnesium group received magnesium sulfate gargle (20 mg/kg up to 30 mL dextrose water 20%) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured by visual analogue scale (VAS) were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation.Results:There were no significant differences between age, sex, and body mass index (BMI) between two groups of patients. Hemodynamics of patients, including blood pressure, respiratory rate, oxygen saturation %, and conscious state were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group compared to ketamine group at 2 (P = 0.032), 4 (P = 0.02), and 24 hours (P = 0.01) after the operation. Sore throat pain score (VAS) was significantly lower in magnesium group compared to ketamine group at 2 (P = 0.019), 4 (P = 0.028), and 24 hours (P = 0.014) after the operation.Conclusions:Magnesium at low dose decreases sore throat and pain severity more effectively compared to ketamine gargle.

A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome complicated by IgA nephropathy with nephrotic syndrome.

A 62-year-old man visited our hospital with a mild sore throat, high-grade fever, and clavicular pain. Seven years earlier, he had been diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. His clavicles were tender and remarkably swollen. Also noted was marked pitting edema in the lower extremities and pustulosis on the palms and soles of the feet. Laboratory studies on admission showed an elevated white cell count (23,400/μl) and serum C-reactive protein level (24.4mg/dl). Urinalysis revealed proteinuria (2+) and occult blood (3+) with numerous dysmorphic red blood cells and hyalin casts. The patient was diagnosed with recurrence of his SAPHO syndrome and started on oral glucocorticoid therapy. By day 9 after admission, he had gained 16kg in body weight, and his proteinuria (6.4g/day) and serum creatinine level (2.3mg/dl) were elevated. Renal biopsy revealed mesangial proliferative glomerulonephritis with deposition of IgA and C3 in the mesangial area and along the capillary walls. The patient was diagnosed with IgA nephropathy accompanied by nephrotic syndrome. With oral prednisolone therapy, his fever, clavicular pain, and proteinuria were gradually relieved. The clinical course in this case suggests the onset of nephrotic syndrome with IgA nephropathy was associated with the recurrence of the patient's SAPHO. To our knowledge, this is the first reported case of SAPHO-associated IgA nephropathy.

Abstract 144: Lung Parenchymal Consolidation during typical Kawasaki Disease

Introduction: Kawasaki disease (KD) is a systemic vasculitis of childhood throughout the body. We report a patient who complicated by severe pneumonia of lung parenchymal consolidation (LPC) during typical KD clinical course. Case reports: A 7-yr-old male who had a past history of KD at 3-yr-old, visited a general practitioner with fever, sore throat and neck pain. Three days later, after being treated with CTRX/TBPMPI, he was transferred to our hospital because of bilateral lymph nodes swelling and a generalized erythema and rash. On admission he was still febrile and had bilateral conjunctival injections, cervical and axillary lymphadenopathy and markedly reddened pharynx, without edema. We diagnosed him as KD and treated him with aspirin and IVIG at a dose of 2.0g/kg, but the condition worsened; he developed dyspnea and dry cough. Crackles were noted on rt-lung auscultation, along with rt-basal dullness to percussion of the thorax. Chest radiography and a subsequent computed tomography scan revealed disseminated patchy infiltrates and ground-glass alterations with massive pleural effusions on rt-lung, and enlarged axillary and mediastinal lymph nodes. Some kinds of microbiology (including Mycoplasma) and virology (Epstein-Barr virus, cytomegalovirus, parvovirus B19), from all sampled sites (pleural effusion, blood, pharyngeal swab and cerebrospinal fluid), were negative for pathogenic specimens. So we treated him as intractable KD with second-IVIG and m-PSL, which led to the quick resolution of fever and progressive amelioration of pneumonia. Echocardiography showed normal ventricular size and function without coronary artery lesion (CAL). Thereafter, he was finally afebrile. At the first follow-up visit, 1 month after discharge, he had fully recovered. Clinically, echocardiographically and radiographically, no residues were noted. Conclusion: Several manifestations of broncho-pulmonary involvement in KD have been described. But there are very few case of LPC. We should consider the possibility that LPC were secondary to pulmonary arteritis.

(363) Demonstration of clinically important relief and the percent change in pain intensity at the time of meaningful relief by flurbiprofen 8.75 mg lozenge

A lozenge containing 8.75 mg of the non-steroidal anti-inflammatory drug flurbiprofen has been developed for the treatment of sore throat. We used the double-stopwatch method to evaluate the onset of its pharmacologic activity. To determine the % pain intensity difference (PID) at the time of meaningful relief (tMR) and whether it was clinically important, we included measurements at tMR on a 100-mm linear scale, the Sore Throat Pain Intensity Scale (STPIS). At baseline, adults with recent-onset moderate/severe sore throat and tonsillo-pharyngitis rated pain on the STPIS and an 11-point numerical rating scale, the Sore Throat Scale (STS), and were randomized under double-blind conditions to one flurbiprofen or placebo lozenge. Two stopwatches were started: patients depressed one stopwatch when they first perceived any relief and the second when they experienced meaningful relief (tMR). Patients rated pain on the STS every 5 minutes and on the STPIS at tMR. For the flurbiprofen group (n=101), median tMR was 43 minutes. (For the placebo group, median tMR could not be calculated because >50% of placebo-treated patients did not report meaningful relief.) Mean reduction in STS for flurbiprofen-treated patients at 45 minutes (closest time-point to the median tMR) was 2.2, corresponding to 30% PID, consistent with a “clinically important” change on an 11-point numerical rating scale.1 Mean % PID on the STPIS at the tMR was 42%, consistent with acute pain patients’ achieving “definite improvement”2 and “much improvement”.3 These findings not only demonstrate the onset of clinically significant pharmacologic activity of flurbiprofen lozenge but also provide a framework for interpreting changes on linear and numerical rating scales that can be applied to other pain trials. (1. Farrar, J Pain Symptom Manage, 2003; 2. Schachtel, J Pain, 2013; 3. Cepeda, Pain, 2003.) Supported by a grant from Reckitt Benckiser. A lozenge containing 8.75 mg of the non-steroidal anti-inflammatory drug flurbiprofen has been developed for the treatment of sore throat. We used the double-stopwatch method to evaluate the onset of its pharmacologic activity. To determine the % pain intensity difference (PID) at the time of meaningful relief (tMR) and whether it was clinically important, we included measurements at tMR on a 100-mm linear scale, the Sore Throat Pain Intensity Scale (STPIS). At baseline, adults with recent-onset moderate/severe sore throat and tonsillo-pharyngitis rated pain on the STPIS and an 11-point numerical rating scale, the Sore Throat Scale (STS), and were randomized under double-blind conditions to one flurbiprofen or placebo lozenge. Two stopwatches were started: patients depressed one stopwatch when they first perceived any relief and the second when they experienced meaningful relief (tMR). Patients rated pain on the STS every 5 minutes and on the STPIS at tMR. For the flurbiprofen group (n=101), median tMR was 43 minutes. (For the placebo group, median tMR could not be calculated because >50% of placebo-treated patients did not report meaningful relief.) Mean reduction in STS for flurbiprofen-treated patients at 45 minutes (closest time-point to the median tMR) was 2.2, corresponding to 30% PID, consistent with a “clinically important” change on an 11-point numerical rating scale.1 Mean % PID on the STPIS at the tMR was 42%, consistent with acute pain patients’ achieving “definite improvement”2 and “much improvement”.3 These findings not only demonstrate the onset of clinically significant pharmacologic activity of flurbiprofen lozenge but also provide a framework for interpreting changes on linear and numerical rating scales that can be applied to other pain trials. (1. Farrar, J Pain Symptom Manage, 2003; 2. Schachtel, J Pain, 2013; 3. Cepeda, Pain, 2003.) Supported by a grant from Reckitt Benckiser.

Uncommon Association of Pulmonary Infiltrates

Mitesh Kumar*, Prabhu Radhan and Bhawna Dev Department of Radiology, Sri Ramachandra Medical College and Hospital, Chennai, India *Corresponding author: Mitesh Kumar, MD, Senior Resident, Department of Radiology, Sri Ramachandra Medical College and Hospital, Chennai, India, Tel: 9003215202; E-mail: kumarmitesh@yahoo.com Received date: Feb 09, 2015, Accepted date: Feb 12, 2015, Published date: Feb 16, 2015 Copyright: © 2015 Kumar M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. History A 24 year old male patient presented with fever, chills, sore throat and neck pain since 2 weeks. He was tachycardiac and tachypneic on arrival. On auscultation, decreased entry in both lower lobes and crepitations were noted. Laboratory investigations showed elevated C-Reactive protein (CRP) and increased white blood cells (WBC) counts of 14,200/cm3. Chest radiograph supine AP view (Figure 1) was done initially on admission. As the patient’s condition worsened, a Computed Tomography (CT) scan of neck and chest (Figures 2-4) with intravenous contrast medium was done.

Enfermedad por el virus del Ébola

Ebola virus disease (EVD) is a contagious condition with high mortality. It is characterized by the presence of fever, weakness,sore throat, abdominal and muscle pain, headache, vomiting, diarrhea, bleeding and multiple organ failure. Its early recognitionis critical to controlling the spread of the virus. Treatment is based on supportive measures to control the complications causedby the virus. There is no specific treatment for EVD and no vaccine to prevent it. The prevention of disease transmission isbased on prioritizing environmental and contact care during the development of outbreaks.

Randomised, double-blind, placebo-controlled studies on flurbiprofen 8.75 mg lozenges in patients with/without group A or C streptococcal throat infection, with an assessment of clinicians' prediction of 'strep throat'.

Diagnosing group A streptococcus (Strep A) throat infection by clinical examination is difficult, and misdiagnosis may lead to inappropriate antibiotic use. Most patients with sore throat seek symptom relief rather than antibiotics, therefore, therapies that relieve symptoms should be recommended to patients. We report two clinical trials on the efficacy and safety of flurbiprofen 8.75 mg lozenge in patients with and without streptococcal sore throat. The studies enrolled adults with moderate-to-severe throat symptoms (sore throat pain, difficulty swallowing and swollen throat) and a diagnosis of pharyngitis. The practitioner assessed the likelihood of Strep A infection based on historical and clinical findings. Patients were randomised to flurbiprofen 8.75 mg or placebo lozenges under double-blind conditions and reported the three throat symptoms at baseline and at regular intervals over 24 h. A total of 402 patients received study medication (n = 203 flurbiprofen, n = 199 placebo). Throat culture identified Strep A in 10.0% of patients and group C streptococcus (Strep C) in a further 14.0%. The practitioners' assessments correctly diagnosed Strep A in 11/40 cases (sensitivity 27.5%, and specificity 79.7%). A single flurbiprofen lozenge provided significantly greater relief than placebo for all three throat symptoms, lasting 3-4 h for patients with and without Strep A/C. Multiple doses of flurbiprofen lozenges over 24 h also led to symptom relief, although not statistically significant in the Strep A/C group. There were no serious adverse events. The results highlight the challenge of identifying Strep A based on clinical features. With the growing problem of antibiotic resistance, non-antibiotic treatments should be considered. As demonstrated here, flurbiprofen 8.75 mg lozenges are an effective therapeutic option, providing immediate and long-lasting symptom relief in patients with and without Strep A/C infection.

Lemierre's syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection presenting with cardiac tamponade, a rare disease with a life-threatening presentation: a case report.

BackgroundLemierre's syndrome is a rare condition characterized by thrombophlebitis of internal jugular vein, septicemia and septic metastatic infection of different organs. It is preceded by an oropharyngeal infection by anaerobic organisms. Community-acquired methicillin-resistant Staphylococcus aureus is now emerging as a causative organism in Lemierre's syndrome. Clinical manifestations vary depending on the organ system affected by the infection. Although rare, patients may present with life-threatening conditions such as cardiac tamponade.Case presentationWe report the first case, to our knowledge, of Lemierre's syndrome presenting with cardiac tamponade secondary to community-acquired methicillin-resistant S. aureus in a previously well 45-year-old Sri Lankan lady. Fever, sore throat and left-sided neck pain complicated with facial and left upper limb swelling were followed by severe shortness of breath for 24 h. There was tachycardia with pulsus paradoxus, low blood pressure and soft heart sounds. Pericardial effusion with cardiac tamponade was detected on echocardiogram and methicillin-resistant S. aureus species were isolated in both blood and pericardial fluid cultures. Venous duplex of neck veins and computed tomography scan of the neck showed thrombosis of left-sided internal jugular, external jugular, subclavian and axillary veins. Diagnosis of Lemierre's syndrome was made, and patient had a satisfactory recovery following emergency pericardiocentesis and a prolonged course of antibiotics.ConclusionsAlthough uncommon, Lemierre's syndrome is a life-threatening condition. Patients may present with cardiac tamponade secondary to purulent pericarditis in Lemierre's syndrome, where emergency pericardiocentesis is lifesaving. Community-acquired methicillin-resistant S. aureus is emerging as a causative agent in Lemierre's syndrome, and awareness is required amongst physicians for prompt diagnosis and appropriate empirical treatment to prevent mortality and morbidity associated with the disease.

Utility of the sore throat pain model in a multiple-dose assessment of the acute analgesic flurbiprofen: a randomized controlled study.

BackgroundThe sore throat pain model has been conducted by different clinical investigators to demonstrate the efficacy of acute analgesic drugs in single-dose randomized clinical trials. The model used here was designed to study the multiple-dose safety and efficacy of lozenges containing flurbiprofen at 8.75 mg.MethodsAdults (n = 198) with moderate or severe acute sore throat and findings of pharyngitis on a Tonsillo-Pharyngitis Assessment (TPA) were randomly assigned to use either flurbiprofen 8.75 mg lozenges (n = 101) or matching placebo lozenges (n = 97) under double-blind conditions. Patients sucked one lozenge every three to six hours as needed, up to five lozenges per day, and rated symptoms on 100-mm scales: the Sore Throat Pain Intensity Scale (STPIS), the Difficulty Swallowing Scale (DSS), and the Swollen Throat Scale (SwoTS).ResultsReductions in pain (lasting for three hours) and in difficulty swallowing and throat swelling (for four hours) were observed after a single dose of the flurbiprofen 8.75 mg lozenge (P <0.05 compared with placebo). After using multiple doses over 24 hours, flurbiprofen-treated patients experienced a 59% greater reduction in throat pain, 45% less difficulty swallowing, and 44% less throat swelling than placebo-treated patients (all P <0.01). There were no serious adverse events.ConclusionsUtilizing the sore throat pain model with multiple doses over 24 hours, flurbiprofen 8.75 mg lozenges were shown to be an effective, well-tolerated treatment for sore throat pain. Other pharmacologic actions (reduced difficulty swallowing and reduced throat swelling) and overall patient satisfaction from the flurbiprofen lozenges were also demonstrated in this multiple-dose implementation of the sore throat pain model.Trial registrationThis trial was registered with ClinicalTrials.gov, registration number: NCT01048866, registration date: January 13, 2010.

An Incidental Nasopharyngeal Carcinoma Coexistent with Primary Nasopharyngeal Tuberculosis

Objective: To describe a case of nasopharyngeal carcinoma coexistent with primary nasopharyngeal tuberculosis and review the literature.&#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Public University Hospital&#x0D; Patient: One&#x0D; Results: A 28-year-old man presented with recurrent sore throat and neck pain with clinically enlarged tonsils. He underwent a routine adenotonsilectomy. Histopathologic examination revealed non-keratinizing squamous cell carcinoma with caseating granulomatous inflammation typical for tuberculosis in the same adenoid specimen. Nasopharyngeal carcinoma was staged T2bN2M0. He was treated with concurrent chemoradiotherapy and a 9-month course of anti tuberculosis treatment. He recovered and remained symptom free 1 year after treatment.&#x0D; Conclusion: Nasopharyngeal carcinoma (NPC) and tuberculosis (TB) are both very common diseases in Sabah, East Malaysia. However, it is very rare that both diseases present at the same time and same anatomical area in a patient. Diagnosis can be very challenging and confusing. Multidisciplinary consultations are warranted for appropriate treatment. Combined anti-tuberculosis treatment and concurrent chemoradiotherapy may be appropriate and effective.&#x0D; &#x0D; Keywords: Nasopharyngeal carcinoma, Primary Nasopharyngeal Tuberculosis, adenotonsillectomy &#x0D;

Differential diagnosis of strep A and C

Background: Sore throat caused by Streptococcus pyogenes group A (Strep A) may warrant antibiotic treatment due to risk of complications. Other Streptococci (group C) have been associated with sore throat but there is insufficient evidence that they cause complications.Weevaluateddisease severity inpatientswith streptococcal and non-streptococcal sore throat, and the effect of flurbiprofen 8.75mg lozenge on symptoms prior to any antibiotic administration. Methods & Materials: Adults with sore throat <4 days were evaluated for findings of pharyngitis using the Tonsillo-Pharyngitis Assessment (TPA) and pharyngeal inflammation using the Practitioner’s Assessment of Inflammation and randomly assigned flurbiprofen or placebo lozenges under double-blind conditions. They rated their sore throat pain on the Throat Pain Scale and pain on swallowing (odynophagia) on the Sore Throat Pain Intensity Scale (STPIS) at baseline and over 7 days. Antibiotics could be administrated at the investigator’s discretion once a diagnosis was made by throat culture (at ∼48hours). Results: Of 204 patients, 32 (16%) had Strep A and 52 (25%) had Strep C. Both types of Strep patients had similar physical features, although pharyngeal inflammation was slightly more severe for Strep A (18.8%) than Strep C and non-Strep patients (11.5% and 11.7%, respectively, bothp=NS). 62.5%of StrepApatients described relativelymore severeodynophagia comparedwith34.6%of StrepC (p<0.05) and 44.2% of non-Strep patients (p =0.064). Themean TPA scores were similar irrespective of cause, indicating the difficulty in making a diagnosis based on physical findings. Irrespective of cause, patients taking flurbiprofen lozenges reported -473.7 mm*h decrease in STPIS scores over the first (pre-antibiotic) 24hours compared with -322.3 mm*h on placebo (i.e. 47% more relief with flurbiprofen versus placebo, p <0.05). By 48hours, mean lozenge consumption per day had decreased in both treatment groups regardless of etiology, indicating the natural resolution of symptoms with time. Conclusion: Patients with Strep A appear to have more severe pain and inflammation than those with Strep C or nonstreptococcal infection, although their clinical features are not distinct on physical examination. Sore throat, irrespective of cause, is a self-limiting condition but symptoms benefit from treatment with flurbiprofen lozenge.

Chromobacterium violaceum: a fatal case in the northeast of the Brazil

Chromobacterium violaceum is a rare pathogen that can potentially cause fatal infections in humans. An 8-year-old child from Natal, northeast of Brazil, presented history of fever, sore throat, and abdominal pain, during 5 days before admission, and died 4 hours after hospitalization. Chromobacterium violaceum was isolated from oropharynx scrapings and was resistant to ampicillin, cefotaxime, cefalotin, ceftazidime, and ceftriaxone.

Health: Cognition and Threshold among the Oraon Tea Garden Labourers of Jalpaiguri District, West Bengal

There is scarcity of health information in many subpopulations in India, which needs to be explored for formulating effective public health policy. Studies on the tea garden population revealed that poor socioeconomic conditions, ignorance due to illiteracy, culture and food habit, overcrowding, and unhygienic living conditions make the population vulnerable to various communicable and noncommunicable diseases and malnutrition. Data were collected from the labourers of Birpara and Dalgaon tea gardens of Jalpaiguri district, West Bengal. The objective was to identify the primary health care available vis-à-vis the health problems. The results were based on mortality data, subjective well-being, frequency of ailment symptoms, perceived health status, and selected health practices as well as some observations, which indicate their cognition and threshold regarding health problems, presented as case studies. Mortality rates were high in the population; comparative mortality data shows no considerable change in mortality rate over time and space. A very high frequency of anaemia was prevalent among females along with sore throat and abdominal pain. Perceived health status of most of the people was good, although that was not always true, because the perception of the people often depends on their threshold and cognition about health and disease.

Onset of action of a lozenge containing flurbiprofen 8.75 mg: A randomized, double-blind, placebo-controlled trial with a new method for measuring onset of analgesic activity

A new onset-of-action model was utilized to distinguish the pharmacologic activity of flurbiprofen 8.75mg delivered in a lozenge from the demulcent effect of the lozenge base. In a randomized, double-blind, placebo-controlled trial, patients with sore throat rated pain on a Sore Throat Pain Intensity Scale before taking one flurbiprofen or placebo lozenge and at frequent (2-minute) intervals over the first hour after treatment. Further ratings of the Sore Throat Pain Intensity Scale and other patient-reported outcomes (difficulty swallowing, swollen throat, pain relief) were obtained at varying intervals over 6hours. Onset of pharmacologic activity was defined as the median time of first perceived pain reduction if a patient reported clinically meaningful (at least moderate) relief. The conventional method of comparing mean treatment responses at each time point was also implemented. Demulcent action was detected at the first 2-minute assessment. By the new method, 102 flurbiprofen-treated patients were identified as first perceiving pain relief at 12minutes, compared with >120minutes by 102 patients using placebo (P<0.001). By the conventional method, mean percentage pain reduction for flurbiprofen 8.75mg was first significantly differentiated from placebo at 26minutes (P<0.05). Efficacy of flurbiprofen lozenge was demonstrated for 3.5-4hours on the 4 patient-reported outcomes (all P<0.05 compared with placebo). There were no serious adverse events. This patient-centered onset-of-action model identifies the initiation of pain relief in patients who are definite drug responders, here demonstrating that a flurbiprofen 8.75-mg lozenge provides early relief of sore throat.

An 80-Year-Old Woman With Left-Sided Headache and Diplopia

An 80-year-old white woman with a history of hyperthyroidism treated with radioactive iodine ablation, gastroesophageal reflux disease complicated by Barrett esophagus, osteoarthritis, breast cancer status post-bilateral mastectomy, and diverticulosis presented with severe left-sided headache and diplopia. Three weeks prior to presentation, she developed a sharp pain located over the left temporal, parietal, and occipital regions. It was associated with exquisite scalp tenderness. Over the next few days, the pain progressed, involving the left side of the face, including the periorbital region. There was no radiation of the pain, and she had little relief with over-the-counter acetaminophen. She also experienced earache, sore throat, and left jaw pain with mastication. The patient saw a dentist for these symptoms, and she was diagnosed with temporomandibular joint disorder. She was prescribed a mouth guard; however, despite its use, her symptoms progressed to a point where she was unable to open her mouth at times, and her jaw felt swollen. Diplopia started 4 days prior to presentation. She experienced this intermittently for 24 hours before it became constant. She saw an ophthalmologist who diagnosed her with a right eye abduction deficit presumed to be a cranial nerve 6 (CN6) palsy. The patient then went to the emergency department for further evaluation. Review of systems was notable for fatigue, recent 10-pound weight loss, and intermittent myalgias, but there were no fevers, chills, dizziness, dysphagia, dysarthria, weakness, or numbness. Family history included coronary artery disease, diabetes, and various cancers. She was a 40-pack-year smoker, but quit 12 years ago. Her general physical examination was only notable for a blood pressure of 164/77 mm Hg. Neurological examination was notable for the inability to fully abduct the right eye. Fundoscopic examination was negative for papilledema. Strength was 5/5 throughout with normal tone. Serum laboratory analysis showed mild leukocytosis (12 200/mm3), normocytic anemia (hematocrit of 32.9% and mean corpuscular volume of 80.6 fL compared to hematocrit 40.2% 2 months prior), and thrombocytosis (675 000/mm3). Erythrocyte sedimentation rate (ESR) was 76 mm/h (reference range 0-30) and C-reactive protein (CRP) was 73.65 mg/L (reference range 0.30-8.00). A lumbar puncture (LP) was performed with a normal opening pressure of 15 cm H2O. The white blood cell count was 1 in tube 1 and 2 in tube 4. The red blood cell count was 9 in tube 1 and 1 in tube 4. The glucose was slightly elevated at 79 mg/dL (reference range 40-70), and the protein was normal at 41 mg/dL. The viral and bacterial studies of the cerebrospinal fluid (CSF) were unremarkable. Magnetic resonance imaging (MRI) of the brain and orbits with and without contrast was unremarkable except for moderate supratentorial white matter changes. Magnetic resonance angiogram of the head and neck with and without contrast was normal.