-
Cureus Dec 2023Adult epiglottitis, once primarily associated with pediatric populations, has emerged as a distinctive clinical entity with potentially life-threatening implications....
Adult epiglottitis, once primarily associated with pediatric populations, has emerged as a distinctive clinical entity with potentially life-threatening implications. This condition is characterized by inflammation and swelling of the epiglottis, presenting initially as a seemingly benign sore throat and dysphagia but progressing rapidly to more severe symptoms such as drooling, severe odynophagia, hoarse voice, and acute upper airway obstruction. Timely diagnosis and intervention are paramount, as delayed presentation can result in fatal outcomes even in adults. The cornerstone of treatment involves securing the airway, providing supplemental oxygen, and administering intravenous antibiotics. In this report, we present a case of adult epiglottitis in a 20-year-old individual, discussing the clinical presentation, diagnostic considerations, and the essential components of its management. Recognition of adult epiglottitis as a distinct clinical entity is crucial for healthcare practitioners to ensure prompt intervention and optimize patient outcomes.
PubMed: 38179346
DOI: 10.7759/cureus.49984 -
BMC Pharmacology & Toxicology Oct 2023Botulinum toxin (BoNT) injection is an important adjunctive method to treat sialorrhea. The purpose of this systematic review was to analyze the effect and safety of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Botulinum toxin (BoNT) injection is an important adjunctive method to treat sialorrhea. The purpose of this systematic review was to analyze the effect and safety of BoNT injections in the intervention of sialorrhea with Parkinson's disease (PD).
METHODS
We searched PubMed, Web Of Science (WOS), Scopus, Cochrane CENTRAL, and Embase from inception until April 2022. Randomized controlled trials or randomized crossover trials comparing BoNT with placebo in sialorrhea with PD were eligible. PRISMA guidelines were used to carry out the meta-analysis. The Drooling Severity Frequency Scale (DSFS) score and the number of adverse events (AEs) were the primary and secondary outcomes, respectively. Standardized mean differences (SMDs) and risk differences (RDs) are used to express continuous and categorical outcomes, respectively. Heterogeneity among these studies was evaluated using I tests. We used the GRADE tool to assess the certainty of evidence (COE).
RESULTS
Eight articles involving 259 patients compared BoNT injections with a placebo for PD with sialorrhea. This meta-analysis showed a significant reduction in DSFS scores between BoNT injections and placebo (SMD=-0.98; 95% CI, -1.27 to 0.70, p<0.001; COE: high). This meta-analysis showed a significant difference in AEs between BoNT injections and placebo (RD=0.15; 95% CI, 0.05 to 0.24, p=0.002; COE: low).
CONCLUSIONS
The pooled results suggest that BoNT injections have some effect on DSFS scores with sialorrhea caused by PD. There are also mild adverse events, which generally recover within a week or so. The results indicate that BoNT injection is one of the treatments for sialorrhea caused by PD, but we need to pay attention to adverse events. In addition, the follow-up time was extended to observe oral hygiene, ulceration or dental caries, and digestive function.
TRIAL REGISTRATION
Our review protocol was registered on PROSPERO (42021288334).
Topics: Humans; Botulinum Toxins, Type A; Sialorrhea; Parkinson Disease; Dental Caries; Treatment Outcome
PubMed: 37828600
DOI: 10.1186/s40360-023-00694-7 -
Clinical Chemistry Apr 2024SARS-CoV-2 variants continue to circulate globally, even within highly vaccinated populations. The first-generation SARS-CoV-2 vaccines elicit neutralizing immunoglobin... (Review)
Review
BACKGROUND
SARS-CoV-2 variants continue to circulate globally, even within highly vaccinated populations. The first-generation SARS-CoV-2 vaccines elicit neutralizing immunoglobin G (IgG) antibodies that prevent severe COVID-19 but induce only weak antibody responses in mucosal tissues. There is increasing recognition that secretory immunoglobin A (SIgA) antibodies in the upper respiratory tract and oral cavity are critical in interrupting virus shedding, transmission, and progression of disease. To fully understand the immune-related factors that influence SARS-CoV-2 dynamics at the population level, it will be necessary to monitor virus-specific IgG and SIgA in systemic and mucosal compartments.
CONTENT
Oral fluids and saliva, with appropriate standardized collection methods, constitute a readily accessible biospecimen type from which both systemic and mucosal antibodies can be measured. Serum-derived IgG and immunoglobin A (IgA) are found in gingival crevicular fluids and saliva as the result of transudation, while SIgA, which is produced in response to mucosal infection and vaccination, is actively transported across salivary gland epithelia and present in saliva and passive drool. In this mini-review, we summarize the need for the implementation of standards, highly qualified reagents, and best practices to ensure that clinical science is both rigorous and comparable across laboratories and institutions. We discuss the need for a better understanding of sample stability, collection methods, and other factors that affect measurement outcomes and interlaboratory variability.
SUMMARY
The establishment of best practices and clinical laboratory standards for the assessment of SARS-CoV-2 serum and mucosal antibodies in oral fluids is integral to understanding immune-related factors that influence COVID-19 transmission and persistence within populations.
Topics: Humans; COVID-19 Vaccines; SARS-CoV-2; COVID-19; Antibodies, Viral; Vaccination; Immunoglobulin A, Secretory; Immunoglobulin G; Immunoglobulin A; Antibodies, Neutralizing
PubMed: 38039096
DOI: 10.1093/clinchem/hvad169 -
Turkish Journal of Emergency Medicine 2023Esophagogastroduodenoscopy is considered the gold standard in assessing the severity of injury to the gastrointestinal tract following corrosive ingestion. Zargar's...
OBJECTIVES
Esophagogastroduodenoscopy is considered the gold standard in assessing the severity of injury to the gastrointestinal tract following corrosive ingestion. Zargar's endoscopic grading of injury helps in prognostication as well as guiding management. Since the major burden of cases lies in resource-limited settings, the availability of endoscopic evaluation is a limiting factor. Hence, it is prudent to develop bedside tools that can be used as screening tools to identify patients at high risk of mortality and complications so that timely referrals and judicious utilization of resources can be made. Literature in this regard is limited and published studies have shown that clinical features fail to predict the severity of injury. We aimed our study to find the role of Drooling, Reluctance, Oropharynx, Others, and Leukocytosis (DROOL) score as a predictor of mortality and complications following acute corrosive ingestion.
METHODS
This was a diagnostic accuracy study conducted in the emergency department (ED) of a tertiary care hospital in North India. We screened all cases of acute corrosive ingestion presented to our ED. We collected the data on demographic profile, clinical features, investigations, endoscopy findings, treatment, and DROOL score. We followed patients for up to 12 weeks for outcomes including mortality and complications.
RESULTS
We studied 79 patients of acute corrosive ingestion. The median age was 26 years with a female predominance. Nausea, vomiting, and pain abdomen were the common symptoms. The median DROOL score was 4. The majority of our patients had normal to Zargar grade 1 injury to the stomach and esophagus. Out of 79 patients, 27 patients developed some complications. The overall mortality up to 12 weeks was 10%. The receiver operating characteristics (ROC) analysis was performed, and the area under the ROC (AUROC) curve of Zargar classification in predicting overall complications was 0.909 (96% confidence interval [CI]: 0.842-0.975) and it was 0.775 (95% CI: 0.553-1.000) in predicting mortality. The AUROC of DROOL score in predicting overall complications was 0.932 (95% CI: 0.877-0.987) and the AUROC of DROOL score in predicting mortality was 0.864 (95% CI: 0.758-0.970). The ROC analysis showed that a DROOL score ≤4 has a sensitivity of 96.2% and a specificity of 77.8% in predicting overall complications. Similarly, DROOL score ≤5 has a sensitivity of 81.7% and a specificity of 62.5% in predicting the development of mortality. Delong test showed that there was no statistically significant difference in Zargar versus DROOL score in terms of prediction of mortality and overall complications ( > 0.05).
CONCLUSION
DROOL score is comparable to Zargar score in identifying patients at high risk of mortality and complications. Hence, DROOL score can be used for risk stratification of patients presenting with corrosive ingestion.
PubMed: 38024188
DOI: 10.4103/tjem.tjem_128_23 -
Journal of Medical Internet Research Dec 2023Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of...
BACKGROUND
Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics.
OBJECTIVE
We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats.
METHODS
We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients' throat photographs.
RESULTS
A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples.
CONCLUSIONS
Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples.
Topics: Child; Adult; Humans; Feasibility Studies; Self-Assessment; Pharyngitis; Inflammation; Anti-Bacterial Agents; Social Media; Suppuration
PubMed: 38064265
DOI: 10.2196/39791 -
Frontiers in Neurology 2023Sialorrhea is defined as a chronic excessive flow of saliva from the mouth, often with adverse consequences for health and quality of life of patients. In addition to... (Review)
Review
Sialorrhea is defined as a chronic excessive flow of saliva from the mouth, often with adverse consequences for health and quality of life of patients. In addition to currently used non-drug treatment and systemic drugs, intraglandular Botulinum Neurotoxin A (BoNT/A) injections have been examined in case studies, controlled trials and clinical practice. Two pivotal Phase III trials recently led to market approval in the USA and EU for IncobotulinumtoxinA [Xeomin®, IncoBoNT/A, neurotoxin type A (150 kD), free from complexing proteins, Merz Pharmaceuticals GmbH] for treatment of chronic sialorrhea in adults and pediatric patients. This review provides a multidisciplinary approach to discuss the current state of sialorrhea therapy as well as benefits and current limitations of BoNT/A injections. A consensus regarding treatment recommendations made available to physicians in Germany in 2022 has now been updated here for presentation to an international audience. This review provides a framework including a flow chart for patient selection, recommendations for dosing and the injection process, as well as a discussion of therapeutic goals, long-term benefits and safety aspects. This review is aimed at supporting physicians in developing multidisciplinary and individualized treatment approaches to achieve optimal benefits for patients.
PubMed: 38162447
DOI: 10.3389/fneur.2023.1275807 -
Parkinsonism & Related Disorders May 2024Gastrointestinal (GI) dysfunction is a common non-motor feature of Parkinson disease (PD). GI symptoms may start years before the onset of motor symptoms and impair... (Review)
Review
BACKGROUND
Gastrointestinal (GI) dysfunction is a common non-motor feature of Parkinson disease (PD). GI symptoms may start years before the onset of motor symptoms and impair quality of life. Robust clinical trial data is lacking to guide screening, diagnosis and treatment of GI dysfunction in PD.
OBJECTIVE
To develop consensus statements on screening, diagnosis, and treatment of GI dysfunction in PD.
METHODS
The application of a modified Delphi panel allowed for the synthesis of expert opinions into clinical statements. Consensus was predefined as a level of agreement of 100 % for each item. Five virtual Delphi rounds were held. Two movement disorders neurologists reviewed the literature on GI dysfunction in PD and developed draft statements based on the literature review. Draft statements were distributed among the panel that included five movement disorder neurologists and two gastroenterologists, both experts in GI dysmotility and its impact on PD symptoms. All members reviewed the statements and references in advance of the virtual meetings. In the virtual meetings, each statement was discussed, edited, and a vote was conducted. If there was not 100 % consensus, further discussions and modifications ensued until there was consensus.
RESULTS
Statements were developed for screening, diagnosis, and treatment of common GI symptoms in PD and were organized by anatomic segments: oral cavity and esophagus, stomach, small intestine, and colon and anorectum.
CONCLUSIONS
These consensus recommendations offer a practical framework for the diagnosis and treatment of GI dysfunction in PD.
PubMed: 38729797
DOI: 10.1016/j.parkreldis.2024.106982 -
European Journal of Pediatrics Jan 2024Paediatric anterior drooling has a major impact on the daily lives of children and caregivers. Intraglandular botulinum neurotoxin type-A (BoNT-A) injections are... (Review)
Review
Paediatric anterior drooling has a major impact on the daily lives of children and caregivers. Intraglandular botulinum neurotoxin type-A (BoNT-A) injections are considered an effective treatment to diminish drooling. However, there is no international consensus on which major salivary glands should be injected to obtain optimal treatment effect while minimizing the risk of side effects. This scoping review aimed to explore the evidence for submandibular BoNT-A injections and concurrent submandibular and parotid (i.e. four-gland) injections, respectively, and assess whether outcomes could be compared across studies to improve decision making regarding the optimal initial BoNT-A treatment approach for paediatric anterior drooling. PubMed, Embase, and Web of Science were searched to identify relevant studies (until October 1, 2023) on submandibular or four-gland BoNT-A injections for the treatment of anterior drooling in children with neurodevelopmental disabilities. Similarities and differences in treatment, patient, outcome, and follow-up characteristics were assessed. Twenty-eight papers were identified; 7 reporting on submandibular injections and 21 on four-gland injections. No major differences in treatment procedures or timing of follow-up were found. However, patient characteristics were poorly reported, there was great variety in outcome measurement, and the assessment of side effects was not clearly described. Conclusion: This review highlights heterogeneity in outcome measures and patient population descriptors among studies on paediatric BoNT-A injections, limiting the ability to compare treatment effectiveness between submandibular and four-gland injections. These findings emphasize the need for more extensive and uniform reporting of patient characteristics and the implementation of a core outcome measurement set to allow for comparison of results between studies and facilitate the optimization of clinical practice guidelines. What is Known: • There is no international consensus on which salivary glands to initially inject with BoNT-A to treat paediatric drooling. What is New: • Concluding on the optimal initial BoNT-A treatment based on literature is currently infeasible. There is considerable heterogeneity in outcome measures used to quantify anterior drooling.and clinical characteristics of children treated with intraglandular BoNT-A are generally insufficiently reported. • Consensus-based sets of outcome measures and patient characteristics should be developed and implemented.
Topics: Humans; Child; Sialorrhea; Neurotoxins; Submandibular Gland; Botulinum Toxins, Type A; Treatment Outcome
PubMed: 37924348
DOI: 10.1007/s00431-023-05309-1 -
Cureus Sep 2023Background Transgender individuals in India experience immense psychosocial stressors, stigma, and violence. In response to stress, the body exhibits adaptive responses...
Background Transgender individuals in India experience immense psychosocial stressors, stigma, and violence. In response to stress, the body exhibits adaptive responses that necessitate the production of organic chemicals ensuing in the detection of blood serum and saliva. There are currently no laboratory tests that are confirmatory for the diagnosis of stress and facilitate necessary treatment to be carried out in a timely manner. Thus, potential salivary biomarkers could be a helpful tool in overseeing the efficacy of pharmacological treatment prescribed by a psychiatrist. Aim This study aimed to assess the correlation between perceived stress and salivary stress biomarker levels in transgender and gender nonconforming (TGNC) individuals in Chennai, India. Methodology Twenty-two TGNC individuals and 22 age-matched controls in Chennai were administered the Perceived Stress Scale-10 questionnaire. Following this, their saliva samples were collected using the passive drool technique and subjected to sandwich enzyme-linked immunosorbent assay (ELISA) technique for measuring salivary cortisol, salivary tumor necrosis factor-alpha (TNF-alpha), and salivary C-reactive protein (CRP). Independent t-test was used to compare salivary stress biomarker levels between the TGNC and age-matched control groups. Pearson's correlation test was done to correlate perceived stress and salivary stress biomarker levels in the TGNC group. Results Significant difference was seen between the TGNC and control groups with respect to salivary cortisol and salivary TNF-alpha levels, with the levels being higher in the TGNC group. A significant positive correlation was seen between perceived stress and salivary cortisol and between perceived stress and salivary TNF-alpha levels. Conclusion There is a significant correlation between perceived stress and salivary biomarkers of stress among TGNC people in Chennai.
PubMed: 37900445
DOI: 10.7759/cureus.46065 -
Clinical Parkinsonism & Related... 2023Sialorrhea, or drooling, is defined as excessive saliva accumulation and unwanted loss of saliva from the mouth or over the tongue and into the pharynx. It constitutes... (Review)
Review
Sialorrhea, or drooling, is defined as excessive saliva accumulation and unwanted loss of saliva from the mouth or over the tongue and into the pharynx. It constitutes one of the most frequent and bothersome complaints of patients with Parkinson's disease (PD), affecting up to 84% of them. Sialorrhea is a distressing and challenging condition that may result in social isolation, embarrassment, depression, skin infections, poor oral health, and aspiration pneumonia. To better understand the burden of sialorrhea on patients with PD, Parkinson's Europe carried out a worldwide patient survey which showed that sialorrhea remains an underrecognized and undertreated issue in patients with PD. This is especially problematic because effective therapeutic options are available. This article presents the results of the Parkinson's Europe Sialorrhea Survey, which were considered by a multidisciplinary panel of experts to provide recommendations for improving the awareness, diagnosis, management, and treatment of sialorrhea in patients with PD. A shift in the treatment paradigm for sialorrhea in patients with PD is emerging. It is essential to better educate patients, family members, caregivers, and healthcare professionals about sialorrhea; to engage all those involved to actively discuss sialorrhea and measure its impact on quality of life; and to recognize the role of botulinum toxin and speech and language therapy as first-line therapies.
PubMed: 38021341
DOI: 10.1016/j.prdoa.2023.100223