Throat Symptoms Research Articles

Impact of COVID-19 infection among indian sickle cell disease patients.

Sickle cell disease (SCD) is one of the most common hemoglobinopathy disorders and is widely prevalent in India, especially in the tribal population. SCD patients are prone to develop recurrent respiratory infections and related complications owing to the microvascular occlusion and impaired immunological response. We aimed to determine the prevalence and impact of COVID-19 in SCD patients from India. We conducted a cross-sectional study in Chandrapur district of Maharashtra, India, between August and October 2021. After taking informed consent, details of 300 SCD patients' demographic data, history of COVID-19 testing, infection, symptoms related to COVID-19 in the past 1 year, hospitalization, complications, mortality, COVID-19 vaccination, and side effects were recorded. We found that 93 (31%) of SCD patients had influenza-like symptoms during the COVID-19 pandemic with symptoms of fever (81.72%), cough (35.48%), sore throat (18.27%), headache (15.05%), and breathlessness (7.52%). A total of 13 (4.33%) SCD among 300 SCD were tested as COVID positive. Majority of them were mild cases and the 1st dose of COVID-19 vaccine was received by 47 (29.37%) of SCD patients and 10 (6.02%) of the patient had received second dose of vaccine. Low incidence of COVID-19 and milder disease spectrum in our study cohort suggests that there is no increased risk of COVID-19 mortality and morbidity in SCD patients compared to general population. However, the reason for low COVID vaccination in our study could be due to the fear of complications of COVID vaccine.

Clinical and upper airway characteristics of 3715 patients with the Omicron variant of SARS-Cov-2 in Changchun, China

ObjectiveThe spread of the novel SARS-Cov-2 variant Omicron created a challenging public health situation in a number of countries. In March 2022, Omicron emerged in Changchun, China, and the number of patients infected rapidly increased. The prevalence of Omicron infection symptoms differs from that of Delta, with more upper airway clinical symptoms apparent. This study aimed to investigate the clinical and upper airway characteristics of the Omicron variant. Materials and methodsIn this retrospective study, we collected data from participants in Changchun who had tested positive for Omicron with quantitative polymerase chain reaction between 10 March and 30 May 2022 using telephone interviews. The questionnaire was designed by the research team based on the number of upper airway symptoms using the visual analogue scale. We also considered age, sex, vaccination status, general symptoms, and cure period. ResultsA total of 3715 patients (2056 males and 1659 females) with mild COVID-19 from the Omicron variant were included. The patients had a mean age of 38.63 ( ± 13.97) years (range 2–86 years). The vaccine uptake rate was 91.33 % (8.66 %, 4.58 %, 65.33 %, and 21.43 % had received zero, one, two, and three doses, respectively). The incidence of upper airway symptoms, including throat and nasal symptoms, was 54.21 %. Throat symptoms were the most common during Omicron infection (49.12 %). Nasal symptoms were also common (20.08 %). The incidence of lower airway symptoms was 25.60 %, and gastrointestinal symptoms was 10.87 %. The incidence of general symptoms was 55.26 %. The cure period ranged from three to 37 days, with a mean of 10.24 ± 4.69 days. We compared the upper airway symptom severity for Omicron among different vaccination statuses and found no differences. ConclusionsThe main clinical characteristics of the SARS-Cov-2 Omicron variant are upper airway symptoms and general symptoms. Fever remains the most common symptom, followed by mild dry cough. There was no association between Omicron infection and COVID-19 vaccines, and the vaccination status might have been ineffective against upper airway symptom severity by Omicron.

A Siddha Management of Chronic Tonsillitis - A Case Report

Aim and objective: In the present scenario the medicine system from the west has started acknowledging the importance and wisdom of the ancient medicine system such as Siddha, Ayurvedha, Unani. There are many diseases that need surgical procedures till date, so in order to find a probable cure now a paradigm shift is really important. Tonsillitis is an infection of the tonsils associated with a sore throat, difficulty in swallowing, fever, etc. Still, surgical removal of tonsils is one of the most frequent procedures during childhood. In the Siddha system of medicine tonsillitis can be compared with Virana silatham. To evaluate the effect of Siddha medicine in the management of tonsillitis. Materials and Methods: The subject approached Out Patient Department of Siddha Clinical Research Unit(SCRU),under Central Council for Research in Siddha(CCRS), Safdarjung Hospital Campus, New Delhi with symptoms of sore throat, ear pain, difficulty in swallowing, sleep apnoea, which involved problems of breathing at night and foul smell from the mouth for past four months systemically. Discussion: The manifestation of symptoms and their severity depends on the extent of involvement of Uyir thathukkal (Vali,Azhal, Iyyam). Though the disease is Iyyam and Azhal predominant, there is derangement of Iyyam and Azhal Dosham in Virana silatham. Results: In this case, the subject showed a marked improvement as depicted in the photographs taken at different levels of treatment, also there was a significant improvement noted in both subjective and objective parameters. By adopting the Siddha treatment approach with an external treatment modality an attempt is made to bring about satisfactory results.

Agreement between rapid antigen detection test and culture for group A streptococcus in patients recently treated for pharyngotonsillitis - a prospective observational study in primary care

Objective The aim was to compare rapid antigen detection test (RADT) and throat culture for group A streptococci (GAS) among patients recently treated with penicillin V for GAS pharyngotonsillitis. Design and setting The study was a secondary analysis within a randomized controlled trial comparing 5 versus 10 days of penicillin V for GAS pharyngotonsillitis. Patients were recruited at 17 primary health care centres in Sweden. Subjects We included 316 patients ≥ 6 years of age, having 3–4 Centor criteria, a positive RADT and a positive throat culture for GAS at inclusion, and also having a RADT and throat culture for GAS taken at a follow-up visit within 21 days. Main outcome measures RADT and conventional throat culture for GAS. Results This prospective study showed 91% agreement between RADT and culture at follow-up within 21 days. Only 3/316 participants had negative RADT with a positive throat culture for GAS at follow-up, and 27/316 patients with positive RADT had a negative culture for GAS. Log rank test did not reveal any difference in the decline over time of positive tests between RADT and throat culture (p = 0.24). Agreement between RADT and throat culture for GAS at the follow-up was not associated with treatment duration, number of days from inclusion until follow-up, throat symptoms at follow-up, gender, or age. Conclusion RADT and culture for GAS agreed to a high extent also after recent penicillin V treatment. RADT for GAS means a low risk for missing the presence of GAS. KEY POINTS Testing for group A streptococci (GAS) before antibiotic treatment can reduce antibiotic prescription for pharyngotonsillitis. It has been proposed that rapid antigen detection tests (RADT) for group A streptococci after recent penicillin V treatment may be falsely positive due to possible persisting antigens from non-viable bacteria. The decline of the presence of GAS was similar between RADT and conventional throat culture in patients who had recently completed penicillin V treatment for GAS pharyngotonsillitis RADT for GAS is useful in identifying the presence of GAS after recent penicillin V treatment

Causal inference between indoor dampness and adverse health effects

Indoor dampness can promote the establishment of microbes in indoor environments, and as such, controlling dampness is important for maintaining a healthy indoor environment. Here, an index is proposed for evaluating indoor dampness based on checking for visible condensation, mold in living rooms and bedrooms, and moldy odors indoors. In this evaluation method, eight items related to visible condensation, presence of mold, and moldy odors are assigned a maximum score of 3 points; the total score (a maximum of 24 points) is then used as an index for the degree of dampness. We classified the total score into four rankings based on quartiles. Rank 4 represents the lowest rank and was assigned to houses that had the most severe levels of indoor dampness. We hypothesized that the lower the rank, the higher the incidence of sick housing syndrome (SHS) would be among young children. To clarify whether there was an association between child SHS and indoor dampness, we conducted an Internet-based cross-sectional survey on children aged 4–12 years. This study first identified potential confounding variables for exposure to indoor dampness using a directed acyclic graph. The results indicated that the higher the degree of dampness, the higher the health risk was for ocular, nasal, and throat symptoms. Dose-response relationships between indoor dampness and SHS were presented using the dampness index proposed in this study.

The Diagnostic Value of the Patient's Reason for Encounter in Primary Care: A Retrospective Cohort Study.

Context Knowledge of incidence, prevalence and trends in morbidity support the diagnostic process of general practitioners (GPs). GPs use estimated probabilities of probable diagnoses to guide their policy on testing and referral. However, GPs estimations often are implicit and imprecise. The International Classification of Primary Care (ICPC) has the potential to incorporate the doctor and patient's perspective within a clinical encounter. The patient perspective is reflected in the Reason for encounter (RFE) which is the 'literal uttered reason' of the patient to contact the GP and comprises the patient's priority for seeking care. Previous research showed the predictive value of some RFEs in diagnosing cancer. Objective Our aim is to analyze the predictive value of the RFE for the final diagnosis, taking into account patient's age and sex. Study Design and Analysis In this cohort study, we determined the relationship between RFE, age, sex and the final diagnosis with multilevel analysis and distribution analysis. We focused on the top 10 most common RFEs. Dataset FaMe-Net database, containing coded routine health data from GP registration network (7 GP practices; 40.000 patients). GPs code the RFE and diagnosis of all contacts with patients, using the ICPC-2 within an episode of care (EoC) structure. An EoC is defined as a health problem in an individual from the first encounter until completion in the last encounter. Population Studied We used data from 1989-2020 and selected all patients with a RFE in the top 10 most common RFEs and the corresponding final diagnoses. Outcome Measures The predictive value is shown in odds risk and frequencies. Results We included 162,315 contacts from 37,194 patients. Multilevel analysis showed significant impact of the additional RFE on the final diagnosis (p<0.05). For example, patients presenting with RFE cough had a 5.6% chance of pneumonia, while it rose to 16.4%, when cough and fever were mentioned as RFE. Age and sex were also of significant impact on the final diagnosis(p<0.05), except for sex in case of fever(p 0.332) and throat symptoms(p 0.616). Conclusions Additional RFE, age and sex are of significant impact on the final diagnosis. Other patient factors might also have relevant predictive value. Artificial intelligence can be beneficial to add more variables to build a diagnostic prediction model. This model can support GPs in the diagnostic process and can help students and residents in training.

Participants reported COVID-19 knowledge and prevalence of symptoms of COVID-19 among hospital pharmacists in a tertiary hospitals in Bayelsa state

Purpose: This study investigated participants reported COVID-19 knowledge and prevalence of symptoms of COVID-19 among hospital pharmacists in Bayelsa State, Nigeria. Method: A random simple sampling techniques was employed with 136 questionnaires were distributed among the hospital pharmacists. Results: A total of 120 out of 136 questionnaires were retrieved from the participants cutting across all the pharmacists. Participants reported that they had adequate knowledge of COVID-19 signs and symptoms. The male participants were more. Those with age range of 36-45 years were most common. Participants most reported signs and symptoms of COVID-19 during the peak, last one month and in the last week were loss of taste, loss of appetite, and loss of smell. The majority of the participants reported adequate knowledge of COVID-19, origin as China, and causative agent as a virus with incubation period from 3 -14 days, often treated with antibiotics. Participants revealed that cancer patients and those above 50 years were most affected. Also, participants had adequate knowledge of COVID-19 as contagious, worst in patients with weak immune system. Participants reported that they had adequate knowledge of COVID -19 signs and symptoms. Most reported were symptoms of fever, cough, and sore throat among the participants. Discussion: Most of the participants reported adequate knowledge of COVID-19, means of transmission of COVID-19, side effect with COVID-19. Also, the clearly identify adequate knowledge means of COVI D-19 transmission sign and symptom. There was no statistically significant difference (P = 0.085) on knowledge of COVID-19 among the pharmacist’s population.

The Use of Tai Chi and Qigong to Mediate Long-Haul COVID-19 Symptoms: Case Report

Introduction: Although new COVID-19 cases have been decreasing globally, long-haul COVID-19 continues to present a challenge. Long-haul COVID-19 symptoms, such as dyspnea, fatigue, cognitive impairments, gastrointestinal distress, and mood changes, can remain for months after initial infection in 10-30% of individuals infected with COVID-19. These symptoms can limit daily function and decrease quality of life. Given the recency of the disease, very little literature exists on the causes of long-haul COVID-19 and few treatment options are available for afflicted individuals. This case report describes the use of the Eastern medicine practices of Tai Chi and Qigong as a possible technique to increase lung function and thus daily function in those with long-haul COVID. Both Tai Chi and Qigong were developed thousands of years ago in China and utilized as part of traditional Chinese medicine. They are forms of gentle, low-intensity exercise involving slow, continuous movements and stretches that focus on alignment, coordination, and breathing control. Previous studies have shown that Tai Chi and Qigong provide beneficial effects in those experiencing mood disorders, chronic pain, cardiovascular issues, fibromyalgia, and chronic obstructive pulmonary disease. Although practitioners have proposed the use of Tai Chi and Qigong in patients with COVID-19, no data exists on the outcomes. Materials and Methods: This case report presents a patient with pre-existing conditions of obesity, gastroesophageal reflux disease, cervical cancer, cataract surgery, and sinus surgery initially diagnosed with COVID-19 with symptoms of acute dyspnea, dizziness, cough, headache, chills, fever, rhinorrhea, and sore throat. She was later diagnosed with long-haul COVID-19 with symptoms of dyspnea, fatigue, and dizziness on exertion and gastrointestinal distress. The patient practiced Tai Chi and Qigong three to four times weekly for about 30 min on average. Results: The patient experienced decreases in resting heart rate and weight and an increase in oxygen saturation level (SpO2) from 83% to 96%, indicating that Tai Chi and Qigong may have the potential to restore lung function. Conclusion: Thus, we propose that Tai Chi and Qigong can be an easily accessible, low-intensity, and cost-effective technique to increase lung function and quality of life in patients with long-haul COVID-19.

Gender-based incidence, recovery period, and mortality rate of COVID-19 among the population of district Attock, Pakistan.

COVID-19 is reported as an extremely contagious disease with common symptoms of fever, dry cough, sore throat, and tiredness. The published literature on incidence and gender-wise prevalence of COVID-19 is scarce in Pakistan. Therefore, the present study was designed to compare the distribution, incubation period and mortality rate of COVID-19 among the male and female population of district Attock. The data were collected between 01 April 2020 and 07 December 2020 from the population of district Attock, Pakistan. A total of 22,962 individuals were screened and 843 were found positive for RT-qPCR for SARS-CoV-2. The confirmed positive cases were monitored carefully. Among the positive cases, the incidence of COVID-19 was 61.7% among males and 38.2% among females. The average recovery period of males was 18.89±7.75 days and females were 19±8.40 days from SARS-CoV-2. The overall mortality rate was 8.06%. The death rate of male patients was significantly higher (P<0.05) compared to female patients. Also, the mortality rate was higher (P<0.05) in male patients of 40-60 years of age compared to female patients of the same age group. Moreover, the mortality rate significantly increased (P<0.05) with the increase of age irrespective of gender. In conclusion, the incidence and mortality rate of COVID-19 is higher in males compared to the female population. Moreover, irrespective of gender the mortality rate was significantly lower among patients aged <40 years.

Perfil clínico e epidemiológico de pacientes pediátricos diagnosticados com COVID-19 em um hospital público de referência na Amazônia brasileira

INTRODUCTION: The disease caused by SARS-CoV-2 called COVID-19 has high transmissibility and broad clinical spectrum. OBJECTIVE: To describe the epidemiological profile and clinical manifestations of children infected with the SARS-CoV-2 virus in a referral pediatric hospital. METHODS: This is a descriptive retrospective study, approved by the Research Ethics Council. RESULTS: 139 medical records of children diagnosed with COVID-19 were analyzed. By correlating the clinical outcome of the disease with its classification, the result was that 13% of patients who died had the severe form of COVID-19. 20% of children with mild clinical form and 19% of moderate clinical form were discharged home. When analyzing each of the symptoms with the clinical outcome, there was a statistically significant relationship between myalgia and dry cough symptoms and the discharge home outcome. And when the complications were analyzed: acute respiratory distress syndrome, multiple organ dysfunction and sepsis, they presented significant statistics with the clinical outcome of death and with the severe and critical clinical forms. When symptoms and complications were related to the clinical classification, they found a significant association between symptoms of productive cough and sore throat and the clinical forms: mild and moderate. CONCLUSION: It is necessary to encourage research in order to characterize the various clinical manifestations of this pathology, which may have different forms of presentation and spread knowledge about it, to establish measures for early diagnosis and adequate treatment, with restoration of health. of affected children.

Distinguishing Swine Flu (H1N1) from COVID-19: Clinical, Virological, and Immunological Perspectives.

This article provides an in-depth examination on the differences between the influenza A strain, H1N1 (also called Swine Flu) and Covid-19 focusing on the immune response and clinical symptoms. Flu symptoms due to influenza A strain, H1N1, were initially discovered in 2009. This variant of influenza A is believed to have emerged through reassortment, a process where the resulting virus inherits gene segments from each of its parental viruses. This reassortment event has resulted in a variant with altered characteristics, potentially affecting the level of immunity in humans. The symptoms of this strain typically manifest 1-4 days after exposure and include fever, cough, sore throat, runny/stuffy nose, body aches, fatigue, and gastrointestinal symptoms such as diarrhea. The transmission dynamics of this new variant, including human-to-human transmission, are still under investigation by health authorities. Individuals with weakened immune systems are generally more susceptible to severe illness. Risk factors associated with swine flu can include older adults, young children, pregnant women, and individuals with obesity. Historical variants of swine flu, such as the 2015 variant in India, have been associated with significant case numbers and deaths, often due to respiratory failure. Since the epidemic of Covid-19 due to SARS-CoV2 in early 2020, several symptoms of COVID-19 and swine flu overlap. In this article, we critically reviewed the differences and similarities in the immune response and clinical symptoms due to H1N1 virus and SARS-CoV2 in human.

1056. Correlates of Omicron SARS-CoV-2 viral load: diagnostic and clinical implications

Abstract Background Omicron SARS-CoV-2 infections are associated with less frequent olfactory sensory loss and a predominance of pharyngitis symptoms compared to prior variants, with proposed diagnostic implications. We examined whether such symptomology predicts a higher RNA abundance in the oropharynx. We further investigated how age, symptom-day, vaccination history and clinical severity correlate with viral load to inform clinical prognostication and transmission modeling. Methods The EPICC study is a longitudinal cohort of COVID-19 cases enrolled through U.S military medical treatment facilities. Demographic and clinical characteristics were measured with interviews and surveys. Nasopharyngeal (NP), oropharyngeal (OP) and nasal swabs (NS) were collected for SARS-CoV-2 qPCR and sequence genotyping. Multivariable linear regression models were fit to estimate the effect of anatomical site on SARS-CoV-2 RNA abundance (a proxy for viral load), adjusting for sampling time, vaccine history and host age. Results We analyzed 77 sequence-confirmed Omicron cases; no BA.2 cases were detected. The median age was 38.8 years. 81.8% were vaccinated and 15.6% cases were hospitalized. 80.0%, 21.8%, and 65.5% reported nasal congestion, loss of smell or taste, and sore throat, respectively. The median RNA abundance was lowest in OP swabs (p &amp;lt; 0.001) (Fig 1). Linear regression confirmed that OP sampling was associated with lower viral load (p &amp;lt; 0.001). We further noted that greater age and symptom-day were independent correlates of viral load (Table 1). By bivariate analysis there was a trend toward lower RNA abundance in vaccinated subjects (p = 0.35). RNA abundance (at any site) was substantially higher in hospitalized (10634 N2 genome equivalents [GE]/reaction) versus outpatient cases (1419 N1 GE/reaction) but this was not statistically significant (p = 0.26). Fig 1.RNA abundance by upper respiratory swab anatomical location of collection (n = 142 swabs from n = 77 subjects) Conclusion We noted prevalent sore throat symptoms and infrequent sensory loss in Omicron cases. Despite this, viral load was highest in NP/NS collected swabs as has been noted in prior variants. We note an age correlation with RNA abundance, and provide a viral load decay rate which may be useful for transmission modeling. Vaccination and clinical severity may also correlate with Omicron viral load, as noted with prior SARS-CoV-2 variants. Disclosures Simon Pollett, MBBS, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Julia S. Rozman, n/a, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response David Tribble, MD, DrPH, Astra Zeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Mark P. Simons, PhD, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response Timothy Burgess, MD, MPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.

Comparative Study between Caspar Cervical Retractor System and Traditional S Retractor in Application on Anterior Cervical Decompression and Fixation

Although Caspar cervical retractor system (CCRS) is commonly utilized in anterior cervical decompression and fixation (ACDF), most urban hospitals still use both traditional S retractor and CCRS in conventional anterior cervical surgeries. Related data to evaluate the effect are required to be reported. The aim of this study is to compare the efficacy between using the traditional cervical S retractor and CCRS in anterior cervical decompression and fixation ACDF. The retrospective study that total 360 patients received ACDF using different retractors (traditional S retractor or CCRS) were enrolled in this study from January 2010 to January 2020. Width change rate of cervical prevertebral soft tissue, throat symptoms, and subjective experiences of the operating surgeons were evaluated by t-test or analysis of variance (ANOVA) respectively. The width change rate of prevertebral soft tissue was significantly higher in the S retractor group than that of the CCRS group both in single segment group (40.9% vs 20.8%, P < 0.05) and double segments group (45.8% vs 25.2%; p < 0.05). In the three segments group, the width change rate of prevertebral soft tissue was higher in the S retractor group than that of the CCRS group, but with no statistical significance (27.3% vs 23.6%; P> 0.05). The incidence rates of dysphagia, dyspnea, and throat discomfort in the traditional S retractor group were significantly higher compared to the CCRS group (P < 0.05), while satisfactory rate of surgeon was higher in the CCRS group (P < 0.05). However, there was no correlation between anterior soft tissue rate and operative time (P > 0.05), as well as the width change rate of anterior soft tissue and the DNRS score (P > 0.05). CCRS was superior compared to the traditional S retractor in reducing the postoperative complications and the postoperative fatigue of surgeon. Meanwhile, the width change rate of prevertebral soft tissue was not related to operative time and DNRS score.

International Delphi-based consensus on the appropriate use and effect of Benzydamine hydrochloride in the treatment of sore throat

BackgroundBenzydamine hydrochloride is a locally-acting Non-Steroidal Anti-Inflammatory Drug (NSAID) with combined local anesthetic and analgesic properties, indicated for the symptomatic relief of pain in acute sore throat. The aim of this study was to obtain an European Consensus among pharmacists, general practitioners and pediatricians on the appropriate use of benzydamine hydrochloride in the treatment of sore throat.MethodsThe authors developed a Delphi questionnaire organized into 15 statements focused on 4 topics: the mechanism of action of benzydamine, the benzydamine treatment in an adult patient and in a pediatric patient, and the advantages of benzydamine over other topical treatments. The survey was administered to a panel of to 320 participants including general practitioners, pediatricians, and pharmacists from 6 European countries (Italy, Germany, Portugal, Romania, Russia, and Spain), who rated their level of agreement or disagreement with each statement on a 6-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with each statement.ResultsPanelists’ agreement on statements was very high. Consensus was reached for all 15 statements in the Delphi survey, with more than 98% positive agreement on topic 4, suggesting a shared view among European healthcare professionals (HCPs) about the advantages of benzydamine over other topical treatments. A strong consensus (> 99%) was reached for all the statements of topic 1 regarding the mechanism of action of benzydamine, except for its anesthetic properties (79%). Strong agreement was reached for all statements in topics 2 and 3 regarding the treatment of acute sore throat symptoms in the adult and pediatric patient, except for one on the efficacy of benzydamine in preventing post-operative sore throat, for which it was 67%.ConclusionBecause all relevant publications on benzydamine are dated and there are no recommendations on its use for the symptomatic treatment of sore throat in European guidelines, this Delphi-based international consensus may be important in reinforcing the appropriate use and effect of benzydamine in the treatment of sore throat among health care professionals.

COVID-19 treated with oral Nirmatrelvir-Ritonavir in 3 children

Objective: To summarize the application experience and the therapeutic effect of Nirmatrelvir-Ritonavir (trade name: Paxlovid) for COVID-19 in children. Methods: A retrospective analysis was performed on the clinical data, including collecting the clinical manifestations and clinical outcomes, dynamically monitoring the blood routine, hepatic and renal function and SARS-CoV-2 nucleic acid results, and observing the related side effects during the treatment, etc, of 3 cases with COVID-19 treated with Paxlovid admitted to Shanghai Children's Hospital (designated referral hospital for SARS-CoV-2 infection in Shanghai) from May 1st to June 1st, 2022. Results: The 3 cases were 12, 14, 17 years of age, among which 2 cases were males, 1 case was female. All 3 cases were mild cases with underlying diseases and risk of developing into severe COVID-19, with symptoms of high fever, sore throat and dry cough. The treatment of Paxlovid at 3rd day of symptom onset contributed to the symptom-free after 1-2 days and negative results of SARS-CoV-2 nucleic acid after 2-4 days. All patients had no adverse manifestations of gastrointestinal tract and nervous system but a case had little skin rashes, which recovered after the withdrawal of Paxlovid. Three cases had normal hepatic and renal function during the Paxlovid treatment. At 3 months after discharge, no clinical manifestations of post-COVID syndrome were found in all 3 cases. Conclusion: Paxlovid was effective and relatively safe in the treatment of 3 children with COVID-19.

ADVERSE REACTION TO TIXAGEVIMAB AND CILGAVIMAB (EVUSHELD): ANAPHYLAXIS OR NOT?

<h3>Introduction</h3> Tixagevimab and cilgavimab (Evusheld) are long-acting monoclonal antibodies indicated for COVID-19 pre-exposure prophylaxis. Although multiple endotypes of hypersensitivity reactions to monoclonal antibodies have been described, including type I (IgE and non-IgE-mediated) reactions, cytokine release, mixed reactions, and type IV delayed reactions, serious hypersensitivity reactions to Evusheld are rare. We present a case of Evusheld adverse reaction, potentially consistent with anaphylaxis. <h3>Case Description</h3> 72-year-old female with Sjogren's syndrome, rheumatoid arthritis, secondary hypogammaglobulinemia from rituximab, interstitial lung disease, and laryngospasm received intramuscular Evusheld in clinic. Forty minutes later, the patient developed throat pain, throat fullness, difficulty swallowing, and dyspnea without wheezing or hypoxia. Documentation noted an unspecified rash. Vitals were stable. The patient was administered epinephrine, diphenhydramine, and steroids and transferred to the emergency department where symptoms resolved. However, five hours later, she developed recurrent throat fullness and difficulty swallowing, resulting in repeat Epinephrine. Flexible laryngoscopy was unremarkable. She had two additional self-resolving episodes of throat tightness at 12 and 24 hours. Labs drawn 24 hours after the initial reaction demonstrated IgE <2 kU/L, tryptase <2 ug/L, and IL-6 <2 pg/mL. The patient was discharged with 5-days of antihistamines and steroids. <h3>Discussion</h3> This case highlights the difficulty in diagnosing anaphylaxis. While certain features of the patient's clinical symptoms were suggestive of anaphylaxis (rash, dyspnea, and throat symptoms), her long-standing history of laryngospasm, unremarkable laryngoscopy, undetectable serum IgE, and non-elevated tryptase suggest against an immediate IgE-mediated type I hypersensitivity reaction to Evusheld. A detailed risk-benefit discussion with the patient is warranted before consideration of future Evusheld doses.

Analyzing the Clinical Efficacy of a Type 5 Phosphodiesterase Inhibitor Combined With Ziyin Baihuo Granules in the Treatment of Erectile Dysfunction.

The study explored the clinical efficacy of a type 5 phosphodiesterase inhibitor (PDE5i) combined with Ziyin Baihuo granules in the treatment of patients suffering from erectile dysfunction (ED) with yin deficiency and fire-hyperactivity syndrome. A total of 163 patients with erectile dysfunction were divided into observation and control groups. The observation group took tadalafil (Cialis) and Ziyin Baihuo granules orally, and the control group took only tadalafil orally, for 12 weeks. An additional 40 healthy people were selected as a normal group for comparison of the sex hormone levels before and after treatment of the participants in the erectile dysfunction group. After treatment, the symptoms of dry throat and tongue, tidal fever and night sweats, liking cold and avoiding heat, and waist pain showed significant improvement in the observation group (p < .05). Compared with before treatment, the clinical indexes of erectile function in the control group and the observation group were improved after treatment (p < .05). After treatment, Ziyin Baihuo granules combined with tadalafil restored the abnormal indexes of blood (p < .05) in the observation group. Our research shows that PDE5i combined with Ziyin Baihuo granules could effectively improve erectile function.

ODP165 Atypical DKA? Think Cannabis!

Abstract Diabetic ketoacidosis (DKA) can be life threatening if not recognized and treated promptly. DKA is characterized by hyperglycemia, acidosis, ketosis and elevated anion gap. The presence of these metabolic derangements is essential to make the diagnosis. The use of cannabis has been associated with atypical acid-base profile in DKA which may contribute to confusion in diagnosis and treatment. Case A 20-year-old man with type 1 diabetes since age 10 presented to the emergency department with 4 days of nausea, vomiting and elevated blood glucose (BG). Emesis occurred up to 6 times daily and started 2 days prior to hyperglycemia. He was unable to correct BG with rapid acting insulin. Moderate urine ketones were present. He denied symptoms of diarrhea, fever, sore throat, runny nose or cough and reported adherence to insulin regimen. Physical exam was remarkable for dry mucous membranes and mild epigastric tenderness. Lab evaluation showed BG of 268 (70-110mg/dL), sodium 133 (135-145 mmol/L), potassium 3.6 (3.5- 5.1 mmol/L), chloride 95 (98-107 mmol/L), bicarbonate 22 (22-32 mmol/L), creatinine 0.8 (0.6–1.2 mg/dL), Anion gap 16, beta-hydroxybutyrate 3.38 (&amp;lt;0.27 mmol/L). He had normal white blood cell count and infectious work up was unremarkable. The patient was started on continuous IV fluids and was managed with intermittent subcutaneous rapid acting insulin in addition to basal insulin. After anion gap closure he was transitioned to his home doses of insulin. Prior to discharge, the patient discretely asked about the effects of smoking marijuana on BG and subsequently disclosed he had increased his use of marijuana recently. Discussion Diabetic keto-alkalosis may present as a result of recurrent vomiting that leads to gastric acid loss. Cannabis use has been linked to an increased risk of diabetic keto-alkalosis. The underlying mechanism is hypothesized to be related to cannabis effects on the stomach causing delayed gastric emptying and leading to cyclic nausea and vomiting. One study conducted to investigate acid-base parameters seen in atypical DKA in Type 1 Diabetes referred to this as "Hyperglycemic Ketosis due to Cannabis Hyperemesis Syndrome" (HK-CHS) recommending obtaining urine drug screen in patients with atypical DKA 1 . Attention should be drawn to this phenomenon as cannabis use has grown with its legalization in many states. Individuals with T1D presenting with ketosis but normal or elevated pH and/or serum bicarbonate may confuse clinicians and delay proper diagnosis. When the patient does not disclose cannabis use voluntarily, taking a thorough social history is critical to making the correct diagnosis. Reference: 1. Akturk HK, Snell-Bergeon J, Kinney GL, Champakanath A, Monte A, Shah VN. Differentiating diabetic ketoacidosis and hyperglycemic ketosis due to cannabis hyperemesis syndrome in adults with type 1 diabetes. Diabetes Care 2021 December 8,: dc211730 Presentation: No date and time listed

Psychological Distress, Adaptation, And Well-Being in COVID-19 Recovered Patients: A Correlational Descriptive Study

The novel SARS-CoV-2 virus was reported in the province of Wuhan china and spread to more than 220 countries in no time. The patient who diagnosed corona virus has symptoms of flu, fever, sore throat and respiratory tract infection. In Pakistan the cases of covid-19 were also higher (305,671) and deaths (6416) due to six biggest populations in the world. Objective: The aim of the study was to explore the psychological distress, adaptation and well-being of patients diagnosed with covid-19 in Pakistan. Methods: A descriptive correlational study was conducted from May 2021 to September 2021 having a sample size of 173 having a consecutive sampling technique in Khyber teaching hospital and Hayat Abad medical complex Peshawar. Data was collected through valid and reliable instruments that are: Kessler Psychological Distress Scale (k-10), psychological adaptation scale (PSA), and The Warwick-Edinburgh mental well-being scale (WEMWBS) were used for data collection. Microsoft Excel and SPSS were used for analysis of mean, standard deviation, independent t-test and Pearson correlation. Results: In this study the number of male participants was higher (56.6%) than female participants (43.4%). The k-10 means score were (34.42), PSA (80.86) and Well-being was (59). Independent t-test findings were (k-10) p-value=0.713, (PSA) p-value= 1.501 and well-being p-value (0,795). The Pearson correlation shows that psychological distress was strongly correlated with PSA (p-value=0.002), and well-being (p-value=0.001). Conclusions: The study concluded that patient were physically, psychological, and emotionally affected after covid-19, so hospitalized patients received only physical treatment regimens and the other aspects of holistic care, especially psychological care, were ignored by the healthcare professionals.

Severity predictors of COVID-19 in SARS-CoV-2 variant, delta and omicron period; single center study.

The outcomes of coronavirus disease 2019 (COVID-19) treatment have improved due to vaccination and the establishment of better treatment regimens. However, the emergence of variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, and the corresponding changes in the characteristics of the disease present new challenges in patient management. This study aimed to analyze predictors of COVID-19 severity caused by the delta and omicron variants of SARS-CoV-2. We retrospectively analyzed the data of patients who were admitted for COVID-19 at Yokohama City University Hospital from August 2021 to March 2022. A total of 141 patients were included in this study. Of these, 91 had moderate COVID-19, whereas 50 had severe COVID-19. There were significant differences in sex, vaccination status, dyspnea, sore throat symptoms, and body mass index (BMI) (p <0.0001, p <0.001, p <0.001, p = 0.02, p< 0.0001, respectively) between the moderate and severe COVID-19 groups. Regarding comorbidities, smoking habit and renal dysfunction were significantly different between the two groups (p = 0.007 and p = 0.01, respectively). Regarding laboratory data, only LDH level on the first day of hospitalization was significantly different between the two groups (p<0.001). Multiple logistic regression analysis revealed that time from the onset of COVID-19 to hospitalization, BMI, smoking habit, and LDH level were significantly different between the two groups (p<0.03, p = 0.039, p = 0.008, p<0.001, respectively). The cut-off value for the time from onset of COVID-19 to hospitalization was four days (sensitivity, 0.73; specificity, 0.70). Time from the onset of COVID-19 to hospitalization is the most important factor in the prevention of the aggravation of COVID-19 caused by the delta and omicron SARS-CoV-2 variants. Appropriate medical management within four days after the onset of COVID-19 is essential for preventing the progression of COVID-19, especially in patients with smoking habits.