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Trials Mar 2021Acute pharyngitis and tonsillitis are common respiratory diseases for which children seek medical care. Their main clinical manifestation is sore throat which interferes...
Evaluation on immediate analgesic efficacy and safety of Kai-Hou-Jian spray (children's type) in treating sore throat caused by acute pharyngitis and tonsillitis in children: study protocol for a randomized controlled trial.
BACKGROUND
Acute pharyngitis and tonsillitis are common respiratory diseases for which children seek medical care. Their main clinical manifestation is sore throat which interferes with patients' quality of life. However, there is no proven effective or safe method to treat it. It is necessary to find an excellent strategy to reduce sore throat and reduce the burden of acute illness. We designed the randomized controlled trial with the characteristics of traditional Chinese medicine (TCM) to determine the clinical positioning of Kai-Hou-Jian spray (children's type) (KHJS) through evidence-based research. This trial aims to evaluate the immediate analgesic efficacy of KHJS on sore throat caused by acute pharyngitis and tonsillitis (wind-heat syndrome/heat exuberance in lung and stomach syndrome) in children and to observe its safety.
METHODS/DESIGN
This is a prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled trial. It will include 240 children with acute pharyngitis/tonsillitis from 7 study sites across China. All participants are randomly assigned to two parallel treatment groups, one with KHJS and the other with placebo sprays, for 5 consecutive days. The primary outcome is the time of analgesic onset. Secondary outcomes include duration of analgesic effect, area under time curve of 0-3 h Wong-Baker FACES Pain Rating Scale (WBS) score (AUC0-3 h), rate of analgesic onset, rate of disappearance of sore throat, changes of WBS score (in days), effective rate of pharyngeal signs, and effective rate of TCM syndrome. The incidence of adverse events during the trial is the primary safety outcome. In addition, vital signs and laboratory tests before and after medication are monitored.
DISCUSSION
To our knowledge, this will be the first clinical trial to explore the immediate analgesic efficacy of a Chinese patent medicine spray for acute pharyngitis/tonsillitis induced sore throat in children in a multicenter, randomized, double-blinded, parallel-group, placebo-controlled manner. Not only might it prove the efficacy and safety of KHJS in the treatment of sore throat caused by acute pharyngitis/tonsillitis in children, but it might also provide evidence for the treatment of acute sore throat with Chinese herbal medicine.
TRIAL REGISTRATION
A multicenter, randomized, double-blind, very low-dose, parallel controlled trial for the immediate analgesic effect and safety of Kai-Hou- Jian spray (children's type) in the treatment of sore throat caused by acute pharyngitis and tonsillitis in children. Chinese Clinical Trial Registry ChiCTR2000031599 . Registered on 5 April 2020.
Topics: Analgesics; Child; China; Double-Blind Method; Humans; Multicenter Studies as Topic; Pharyngitis; Prospective Studies; Quality of Life; Randomized Controlled Trials as Topic; Tonsillitis; Treatment Outcome
PubMed: 33736674
DOI: 10.1186/s13063-021-05148-1 -
International Journal of Medical... 2022Post-anaesthetic sore throat (PAST) is a well-recognized consequence of tracheal intubation; however, quantitative morphometric measurements remain challenging. This...
Post-anaesthetic sore throat (PAST) is a well-recognized consequence of tracheal intubation; however, quantitative morphometric measurements remain challenging. This study aimed to introduce a special laser projection device that can facilitate computer-assisted, digitalized analysis and provide important information on laryngeal mucosa change, pre and post-surgery under general anesthesia with intubation. The laryngeal images were captured and divided into the control group and the intubation group. Image processing techniques were used to quantify the post-extubation laryngeal variation, with its distinct color space and texture features. Meanwhile, the maximum length of the vocal fold, vocal width at the midpoint, and maximum cross-sectional area of the glottic space were determined and calculated. These parameters were analyzed and compared pre and post-surgery. A total of 69 subjects were enrolled in this study, comprising 32 subjects in the healthy group and 37 subjects in the intubation group. The color space and texture analysis with contrast and correlation profiles all shows trend toward higher measures in the intubation group than in the healthy group, with statistical significance and outstanding discrimination ability, especially in the interarytenoid region. The incidence of PAST was approximately 46% (17 patients). The gender difference, type of surgery, and the fixation position of the tube were not significantly related to the PAST occurrence. All the eigenvalues showed significant differences pre and post-surgery in the interarytenoid region and a significant trend toward red and increased contrast texture profiles was revealed. Furthermore, the glottic area showed a significant decrease of 25.29%, while the vocal width showed a significant increase post extubation. Our equipment and processing can measure subtle laryngeal changes that would allow a clinician to diagnose postoperative laryngeal inflammation in a simpler and less invasive way. The trend toward red, the increased contrast texture and vocal width, and the reduced glottic space were all compatible with post-intubation inflammatory response, especially in the interarytenoid region. This is important to know so that one can take appropriate steps to alleviate PAST in the future.
Topics: Adult; Anesthesia, General; Humans; Intubation, Intratracheal; Larynx; Pharyngitis; Postoperative Period
PubMed: 35370474
DOI: 10.7150/ijms.69425 -
BMC Anesthesiology Oct 2023Postoperative sore throat and sleep disturbance are prevalent among patients undergoing spinal surgery, and these conditions can substantially impact their postoperative... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial.
BACKGROUND
Postoperative sore throat and sleep disturbance are prevalent among patients undergoing spinal surgery, and these conditions can substantially impact their postoperative satisfaction and quality of life. The present study aimed to examine the impact of ultrasound-guided stellate ganglion block (SGB) on the occurrence of postoperative sore throat (POST) and postoperative sleep disturbance (PSD) in patients who undergo lumbar spine surgery under general anesthesia.
METHODS
Sixty patients were randomly assigned to either the experimental group (SGB group) or the control group (CG). Both groups received the same induction and maintenance drugs. However, the SGB group received a right SGB under ultrasound guidance 15 min before anesthesia induction, while the CG did not receive any block anesthesia intervention before anesthesia induction. We monitored the incidence and severity of POST at 1, 6, 24, and 48 h after surgery in both groups. Additionally, we evaluated the deep sleep quality score on the first, second, and fifth days after surgery in both groups.
RESULTS
The incidence of POST at 1 h and 6 h after surgery was significantly lower in the SGB group (10.0% and 13.3%) than in the CG (43.3% and 36.7%) (P < 0.05). The postoperative sore throat scores of the SGB group (0.10 ± 0.31 and 0.17 ± 0.46) at 1 h and 6 h after surgery were lower than those of the CG (0.57 ± 0.73 and 0.50 ± 0.77) (P < 0.05). Moreover, the deep sleep quality score on the first, second, and fifth days after surgery were significantly higher in the CG (5.40 ± 3.37, 4.70 ± 3.19, 4.53 ± 3.44) than in the SGB group (3.87 ± 2.30, 3.13 ± 1.77, 3.03 ± 1.84) (P < 0.05).
CONCLUSION
Ultrasound-guided SGB can reduce the incidence and severity of POST and improve PSD in patients undergoing lumbar spine surgery.
TRIAL REGISTRATION
This study was registered on Chinese Clinical Trial Registry, (ChiCTR2200065279) on 01/11/2022.
Topics: Humans; Stellate Ganglion; Quality of Life; Pain; Pharyngitis; Ultrasonography, Interventional; Sleep
PubMed: 37838663
DOI: 10.1186/s12871-023-02301-y -
Vestnik Otorinolaringologii 2020According to WHO almost half of the population undergoing infectious diseases of the upper respiratory tract one third of which is inflammatory diseases of the pharynx.... (Observational Study)
Observational Study
According to WHO almost half of the population undergoing infectious diseases of the upper respiratory tract one third of which is inflammatory diseases of the pharynx. This article presents the therapy issue of patients with sore throat due to acute pharyngitis and/or acute tonsillitis of non-streptococcal etiology based on our own experience and literature data. Observational study was carried out at the Otorhinolaryngology department of MSUMD n.a. A.I. Evdokimov in order to evaluate efficacy and tolerability of complex local drug Doritricin. The study involved 52 patients, objective and subjective manifestations of the disease were evaluated. Obtained data indicate the effectiveness and safety of Doritricin, as well as the possibility of reducing the number of drugs used during treatment.
Topics: Humans; Larynx; Nose; Peritonsillar Abscess; Pharyngitis; Pharynx; Streptococcal Infections
PubMed: 32885634
DOI: 10.17116/otorino20208504135 -
Pediatrics Jul 2016Identifying symptomatic patients who are at low risk for group A streptococcal (GAS) pharyngitis could reduce unnecessary visits and antibiotic use. The accuracy with...
BACKGROUND AND OBJECTIVES
Identifying symptomatic patients who are at low risk for group A streptococcal (GAS) pharyngitis could reduce unnecessary visits and antibiotic use. The accuracy with which patients and parents report signs and symptoms of GAS has not been studied. Our objectives were to measure agreement between patient or parent and physician-reported signs and symptoms of GAS and to evaluate the performance of a modified Centor score, based on patient or parent and physician reports, for identifying patients at low risk for GAS pharyngitis.
METHODS
Children 3 to 21 years old presenting to a single tertiary care emergency department between October 2013 and January 2015 were included if they complained of a sore throat and were tested for GAS. Patients or parents and physicians completed surveys assessing signs and symptoms to determine a modified age-adjusted Centor score for GAS. We evaluated the overall agreement and κ between patient or parent and physician-reported signs and symptoms and compared the performance of the scores based on assessments by patients or parents and physicians and the risk of GAS.
RESULTS
Of 320 patients enrolled, 107 (33%) tested GAS positive. Agreement was higher for symptoms (fever [agreement = 82%, κ = 0.64] and cough [72%, 0.45]) than for signs (exudate [80%, 0.41] and tender cervical nodes [73%, 0.18]). Agreement was highest when no signs and symptoms contained in the Centor score were present (94%, κ = 0.61). The proportion of patients testing GAS positive rose as the modified Centor score increased.
CONCLUSIONS
For identifying GAS pharyngitis, patients or parents and physicians showed moderate to substantial agreement for 3 of 4 key pharyngitis signs and symptoms.
Topics: Adolescent; Child; Child, Preschool; Diagnostic Self Evaluation; Female; Humans; Male; Parents; Pharyngitis; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Symptom Assessment; Young Adult
PubMed: 27279649
DOI: 10.1542/peds.2016-0317 -
Journal of the Pediatric Infectious... Apr 2024The most common cause of bacterial pharyngitis is Group A Streptococcus (GAS). Accurate diagnosis of GAS pharyngitis is crucial to identify children who would benefit... (Review)
Review
The most common cause of bacterial pharyngitis is Group A Streptococcus (GAS). Accurate diagnosis of GAS pharyngitis is crucial to identify children who would benefit from antibiotic treatment. Rapid diagnosis has the potential to reduce antibiotic overuse. Current national guidelines differ in their recommendations for GAS testing. While rapid antigen detection tests (RADTs) are widely used, their sensitivity is considered too low for stand-alone testing by several expert bodies. Newer molecular tests using nucleic acid amplification show higher accuracy and fast results, but their cost, complexity, and very high sensitivity may limit widespread adoption. This review provides up-to-date evidence regarding rapid diagnostic testing and antimicrobial stewardship in children with sore throat. We discuss discrepancies across GAS testing guidelines at the international level, patient selection for testing for GAS, rapid test accuracy, and the potential role of rapid GAS tests to promote antibiotic stewardship, with emphasis on emerging rapid molecular tests.
Topics: Humans; Pharyngitis; Antimicrobial Stewardship; Streptococcal Infections; Streptococcus pyogenes; Child; Anti-Bacterial Agents; Practice Guidelines as Topic; Nucleic Acid Amplification Techniques
PubMed: 38456797
DOI: 10.1093/jpids/piae022 -
Laryngo- Rhino- Otologie Oct 2022
Topics: Humans; Pharyngitis; Placebos
PubMed: 36174563
DOI: 10.1055/a-1873-5695 -
Laryngo- Rhino- Otologie Sep 2022
Topics: Humans; Nasopharyngitis; Pharyngitis
PubMed: 36041444
DOI: 10.1055/a-1851-3791 -
Clinical Infectious Diseases : An... Jul 2021Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in...
Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States.
BACKGROUND
Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development.
METHODS
We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules.
RESULTS
GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented.
CONCLUSIONS
An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Humans; Incidence; Infant; Otitis Media; Outpatients; Pharyngitis; Respiratory Tract Infections; Sinusitis; Streptococcus pyogenes; United States; Vaccination
PubMed: 32374829
DOI: 10.1093/cid/ciaa529 -
Pediatrics Jul 2018Acute pharyngitis is a common diagnosis in ambulatory pediatrics. The Infectious Diseases Society of America (IDSA) clinical practice guideline for group A streptococcal...
BACKGROUND AND OBJECTIVES
Acute pharyngitis is a common diagnosis in ambulatory pediatrics. The Infectious Diseases Society of America (IDSA) clinical practice guideline for group A streptococcal (GAS) pharyngitis recommends strict criteria for GAS testing to avoid misdiagnosis and unnecessary treatment of children who are colonized with group A . We sought to improve adherence to the IDSA guideline for testing and treatment of GAS pharyngitis in a large community pediatrics practice.
METHODS
The Model for Improvement was used, and iterative Plan-Do-Study-Act cycles were completed. The quality improvement project was approved for American Board of Pediatrics Part 4 Maintenance of Certification credit. Interventions included provider education, modification of existing office procedure, communication strategies, and patient and family education. Outcomes were assessed by using statistical process control charts.
RESULTS
An absolute reduction in unnecessary GAS testing of 23.5% (from 64% to 40.5%) was observed during the project. Presence of viral symptoms was the primary reason for unnecessary testing. Appropriate antibiotic use for GAS pharyngitis did not significantly change during the project; although, inappropriate use was primarily related to unnecessary testing. At the end of the intervention period, the majority of providers perceived an improvement in their ability to communicate with families about the need for GAS pharyngitis testing and about antibiotic use.
CONCLUSIONS
The majority of GAS pharyngitis testing in this practice before intervention was inconsistent with IDSA guideline recommendations. A quality improvement initiative, which was approved for Part 4 Maintenance of Certification credit, led to improvement in guideline-based testing for GAS pharyngitis.
Topics: Anti-Bacterial Agents; Guideline Adherence; Humans; Pharyngitis; Practice Guidelines as Topic; Practice Patterns, Physicians'; Quality Improvement; Streptococcal Infections; Streptococcus pyogenes
PubMed: 29925574
DOI: 10.1542/peds.2017-2033