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American Journal of Otolaryngology 2023MPOX has numerous otolaryngologic presentations that have been recognized as clinically important, especially with the onset of the 2022 outbreak. However, how these... (Meta-Analysis)
Meta-Analysis
PURPOSE
MPOX has numerous otolaryngologic presentations that have been recognized as clinically important, especially with the onset of the 2022 outbreak. However, how these features vary across region and outbreak have yet to be elucidated or supported by meta-analysis. The objective of this study is to identify the otolaryngologic manifestations of MPOX across previous and current outbreaks and among endemic and non-endemic regions.
BASIC PROCEDURES
Data sources of MEDLINE (PubMed), the Cochrane Library, Scopus, Embase, Web of Science, Google Scholar, and OpenGrey were searched through August 2022. All observational studies reporting data on laboratory-confirmed MPOX patients with otolaryngologic symptoms were included. Two authors independently performed the screening process while a third resolved disagreements. Data were extracted into a structured form by two authors independently. We performed a meta-analysis of the prevalence of otorhinolaryngologic symptoms using MetaXL software (version 5.3) under a random-effects model.
MAIN FINDINGS
38 studies with 5952 patients were included. The four most prevalent manifestations were headache at 31 % (95 % CI [0.16-0.49], I = 99 %), sore throat at 22 % (95 % CI [0.09-0.37], I = 99 %), cough at 16 % (95 % CI [0.05-0.30], I = 99 %), and cervical lymphadenopathy at 10 % (95 % CI [0.01-0.26], I = 100 %). Otolaryngologic features were more prevalent in previous outbreaks as compared to the 2022 outbreak including 37 % prevalence of headache (95 % CI [0.11-0.66], I = 100 %), 33 % prevalence of cough (95 % CI [0.21-0.47], I = 98 %), 27 % prevalence of sore throat (95 % CI [0.07-0.53], I = 99 %), 15 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.428], I = 100 %), 13 % prevalence of oral ulcers (95 % CI [0.02-0.30], I = 99 %), 6 % prevalence of oral exanthem (95 % CI [0.00-0.17], I = 99 %), 5 % prevalence of dysphagia (95 % CI [0.00-0.18], I = 99 %), and 5 % prevalence of tonsillar signs (95 % CI [0.00-0.13], I = 99 %). Features that were more prevalent in endemic areas versus non-endemic areas include 27 % prevalence of cough (95 % CI [0.14-0.41], I = 99 %), 15 % prevalence of oral ulcers (95 % CI [0.02-0.36], I = 99 %), 6 % prevalence of tonsillar signs (95 % CI [0.00-0.18], I = 99 %), and 19 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.48], I = 100 %), while the only feature more prevalent in non-endemic areas was headache with a prevalence of 36 % (95 % CI [0.24-0.47], I = 96 %).
PRINCIPAL CONCLUSIONS
In this systematic review and meta-analysis, four symptoms - headache, sore throat, cough, and cervical lymphadenopathy - were found to be the most prevalent otolaryngologic features of MPOX. Otolaryngologic manifestations of MPOX were more pronounced in prior outbreaks and in endemic areas as compared to the 2022 outbreak and non-endemic areas. These findings may aid MPOX recognition in an otolaryngology setting.
Topics: Humans; Cough; Headache; Lymphadenopathy; Oral Ulcer; Otolaryngology; Pain; Pharyngitis; Mpox (monkeypox)
PubMed: 37487464
DOI: 10.1016/j.amjoto.2023.103991 -
Paediatric Anaesthesia Nov 2023Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The performance of supraglottic devices versus tracheal tubes in children undergoing laparoscopic surgery is uncertain.
METHODS
A systematic review and meta-analysis of randomized controlled trials that compared supraglottic devices versus tracheal tubes in patients ≤18 years undergoing laparoscopic surgery under general anesthesia was conducted. The outcomes were peak airway pressures (cm H O), end-tidal carbon dioxide during pneumoperitoneum (mm Hg), recovery time (min), postoperative sore throat and adverse events. Mean difference and odds ratio, with 95% confidence intervals were reported using a random effect model.
RESULTS
Eight trials (n = 591) were included in the final meta-analysis. There was no statistically significant difference in the peak airway pressures (MD 0.58, 95% CI: -0.65 to 1.8; p = .36) and end-tidal carbon dioxide (MD -0.60, 95% CI: -2.00 to 0.80; p = .40) during pneumoperitoneum in the supraglottic device and the tracheal tube group. The tracheal tube group had higher odds of sore throat (OR 3.30, 95% CI: 1.69-6.45; p = .0005) and the supraglottic airway group had faster recovery time (MD 4.21, 95% CI: 3.12-5.31; p < .0001), which were statistically significant. The certainty of evidence is graded low.
CONCLUSION
There is low quality evidence to suggest that for pediatric laparoscopic surgeries of short duration, supraglottic devices could provide comparable intraoperative ventilation in terms of peak airway pressures and end tidal carbon dioxide, with lower odds of postoperative sore throat and faster recovery time when compared to tracheal tubes.
Topics: Humans; Child; Intubation, Intratracheal; Carbon Dioxide; Pneumoperitoneum; Laparoscopy; Pharyngitis; Laryngeal Masks
PubMed: 37386873
DOI: 10.1111/pan.14725 -
Medicine Jun 2023Several clinical reports have focused on acupuncture for the treatment of acute pharyngeal infections. However, the efficacy and safety of acupuncture for the treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several clinical reports have focused on acupuncture for the treatment of acute pharyngeal infections. However, the efficacy and safety of acupuncture for the treatment of acute pharyngeal infections are controversial. To systematically assess the efficacy and safety of acupuncture in treating acute pharynx infections, thus providing a reference for clinical decision-making.
METHODS
We searched PubMed, CENTRAL, Embase, Web of Science, China National Knowledge Infrastructure, China Biomedical, clinical research registration platforms, gray literature, and reference lists of the selected studies from inception to October 30, 2022. The risk of bias assessment was performed using RevMan. The meta-analysis was performed using STATA with the Hedges' g value. We also performed a subgroup analysis, meta-regression, and publication bias detection using Harbord's and Egger's tests.
RESULTS
We included 19 randomized controlled trials comprising 1701 patients, of which only one study had a high risk of bias. The primary outcome, i.e., the response rate, revealed that acupuncture was more effective than antibiotics. The secondary results revealed that the differences in the reduction of VAS scores, sore throat duration, and white blood cell counts were statistically significant in the acupuncture group compared with the antibiotic group. However, the difference in the modulation of the neutrophil percentage and C-reactive protein levels was insignificant. Moreover, the acupuncture treatment resulted in a lower incidence of adverse events than the antibiotic treatment.
CONCLUSIONS
Thus, acupuncture therapy for acute pharyngeal infections is safe and its response rate is superior to that of antibiotics. Acupuncture showed positive outcomes for alleviating the sore throat symptoms, shortening the sore throat duration, and improving the immune inflammation index. Nevertheless, owing to the limitations of this study, our conclusions should be interpreted with caution. More high-quality trials are warranted in the future for improving the methodology and reporting quality.
Topics: Humans; Pharynx; Acupuncture Therapy; Pain; Pharyngitis; Anti-Bacterial Agents; Randomized Controlled Trials as Topic
PubMed: 37352021
DOI: 10.1097/MD.0000000000034124 -
Asian Journal of Surgery Nov 2023
Meta-Analysis
The efficacy of ultrasound-guided superior laryngeal nerve block on postoperative sore throat after endotracheal intubation under general anesthesia: A systematic review and meta-analysis.
Topics: Humans; Intubation, Intratracheal; Postoperative Complications; Pain; Ultrasonography, Interventional; Pharyngitis; Anesthesia, General; Laryngeal Nerves
PubMed: 37211437
DOI: 10.1016/j.asjsur.2023.05.008 -
The Journal of Laryngology and Otology Sep 2023Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in... (Review)
Review
BACKGROUND
Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess.
METHODS
A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole.
RESULTS
Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects.
CONCLUSION
Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.
Topics: Humans; Peritonsillar Abscess; Metronidazole; Penicillins; Penicillin V; Drainage; Anti-Bacterial Agents
PubMed: 37194922
DOI: 10.1017/S0022215123000804 -
Reviews in Medical Virology Jul 2023Little is known about the ongoing monkeypox (mpox) outbreak, and the clinical features of mpox in patients worldwide have not been rigorously analysed. Thus, we aimed to... (Meta-Analysis)
Meta-Analysis Review
Little is known about the ongoing monkeypox (mpox) outbreak, and the clinical features of mpox in patients worldwide have not been rigorously analysed. Thus, we aimed to investigate the clinical features associated with mpox infection and understand the pathophysiology and characteristics of the disease. For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and the Cochrane Database of Systematic Reviews for articles published till 16 September 2022. We used a random effects model to calculate the pooled prevalence and 95% confidence interval (CI). We used the I statistic to assess heterogeneity, Egger's test to assess publication bias, 95% prediction interval to determine the level of uncertainty, and the Newcastle-Ottawa Scale and Joanna Briggs Institute quality assessment tool to assess the risk of bias. Twenty-six relevant articles from 19 countries across 5 continents were included, and data on 5472 mpox patients with 18 unique features were analysed. The pooled prevalence of clinical features of mpox were rash (85.7%, 95% CI: 68.3-94.3; k = 21), chills (77.8%, 95% CI: 70.5-83.7; k = 3), and fever (62.3%, 95% CI: 51.3-71.6; k = 25), lymphadenopathy (58.6%, 95% CI: 47.2-69.2; k = 21), lethargy or exhaustion (46.8%, 95% CI: 30.7-63.5; k = 14), pruritus (40.6%, 95% CI: 28.5-54.0; k = 5), myalgia (36.0%, 95% CI: 24.3-49.7; k = 16), headache (34.6%, 95% CI: 23.4-47.8; k = 17), skin ulcer (31.1%, 95% CI: 18.6-47.1; k = 7), abdomen symptom (24.2%, 95% CI: 17.9-31.9; k = 11), pharyngitis (23.0%, 95% CI: 12.7-37.9; k = 14), respiratory symptom (19.5%, 95% CI: 6.8-44.6; k = 6), nausea or vomiting (13.0%, 95% CI: 4.6-31.9; k = 3), scrotal or penile oedema (10.7%, 95% CI: 6.3-17.7; k = 4), conjunctivitis (7.1%, 95% CI: 2.4-18.9; k = 6), and death (0.9%, 95% CI: 0.4-2.0; k = 26). This is the first international and comprehensive study to examine all clinical presentations of human mpox infection. Our systematic review proposes a comprehensive understanding of the current mpox outbreak and may serve as key data for future studies on the pathological mechanisms and epidemiology of mpox infections.
Topics: Humans; Mpox (monkeypox); Pharyngitis; Prevalence; Exanthema; Fever
PubMed: 37056203
DOI: 10.1002/rmv.2446 -
Euro Surveillance : Bulletin Europeen... Apr 2023BackgroundPublic health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12-24 h from antibiotic initiation to... (Meta-Analysis)
Meta-Analysis
Time to negative throat culture following initiation of antibiotics for pharyngeal group A : a systematic review and meta-analysis up to October 2021 to inform public health control measures.
BackgroundPublic health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12-24 h from antibiotic initiation to prevent onward transmission requires a strong evidence base.AimTo estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics through a systematic literature review (PROSPERO CRD42021290364) and meta-analysis.MethodsWe searched Ovid MEDLINE (1946-), EMBASE (1974-) and Cochrane library. We included interventional or observational studies with ≥ 10 participants reporting rates of GAS throat culture positivity during antibiotic treatment for culture-confirmed GAS pharyngitis, scarlet fever and asymptomatic pharyngeal GAS carriage. We did not apply age, language or geographical restrictions.ResultsOf 5,058 unique records, 43 were included (37 randomised controlled studies, three non-randomised controlled trials and three before-and-after studies). The proportion of individuals remaining culture-positive on day 1, day 2 and days 3-9 were 6.9% (95% CI: 2.7-16.8%), 5.4% (95% CI: 2.1-13.3%) and 2.6% (95% CI: 1.6-4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI: 2.5-16.1%) and 1.6% (95% CI: 0.04-42.9%), respectively. Overall, for 9.1% (95% CI: 7.3-11.3), throat swabs collected after completion of therapy were GAS culture-positive. Only six studies had low risk of bias.ConclusionsOur review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 h but highlights the need for further research given methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and asymptomatic individuals.
Topics: Humans; Anti-Bacterial Agents; Pharynx; Public Health; Streptococcus pyogenes; Streptococcal Infections; Pharyngitis
PubMed: 37052678
DOI: 10.2807/1560-7917.ES.2023.28.15.2200573 -
Otolaryngology--head and Neck Surgery :... Oct 2023To investigate the impact of the surgical indication on posttonsillectomy bleed rates. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the impact of the surgical indication on posttonsillectomy bleed rates.
DATA SOURCES
PubMed, Scopus, CINAHL.
REVIEW METHODS
A systematic review was performed searching for articles published from the date of inception to July 6, 2022. English language articles describing posttonsillectomy hemorrhage rates in pediatric patients (age ≤ 18) stratified by indication were selected for inclusion. A meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted. All studies were assessed for risk of bias.
RESULTS
A total of 72 articles with 173,970 patients were selected for inclusion. The most common indications were chronic/recurrent tonsillitis (CT/RT), obstructive sleep apnea/sleep-disordered breathing (OSA/SDB), and adenotonsillar hypertrophy (ATH). Posttonsillectomy hemorrhage rates for CT/RT, OSA/SDB, and ATH were 3.57%, 3.69%, and 2.72%, respectively. Patients operated on for a combination of CT/RT and OSA/SDB had a bleed rate of 5.99% which was significantly higher than those operated on for CT/RT alone (Δ2.42%, p = .0006), OSA/SDB alone (Δ2.30%, p = .0016), and ATH alone (Δ3.27%, p < .0001). Additionally, those operated on for a combination of ATH and CT/RT had a hemorrhage rate of 6.93%, significantly higher than those operated on for CT/RT alone (Δ3.36%, p = .0003), OSA/SDB alone (Δ3.01%, p = .0014), and ATH alone (Δ3.98%, p < .0001).
CONCLUSION
Patients operated on for multiple indications had significantly higher rates of posttonsillectomy hemorrhage than those operated on for a single surgical indication. Better documentation of patients with multiple indications would help further characterize the magnitude of the compounding effect described here.
Topics: Child; Humans; Tonsillectomy; Sleep Apnea, Obstructive; Palatine Tonsil; Adenoidectomy; Tonsillitis; Hemorrhage; Hypertrophy
PubMed: 37003296
DOI: 10.1002/ohn.339 -
Complementary Therapies in Medicine May 2023Acute tonsillitis (including tonsillopharyngitis) in childhood is a common disease with a peak of illness in school-age. Most of these cases have a viral origin and... (Review)
Review
BACKGROUND
Acute tonsillitis (including tonsillopharyngitis) in childhood is a common disease with a peak of illness in school-age. Most of these cases have a viral origin and antibiotic therapy is not indicated, therefore, effective symptomatic therapy is required. For this reason, complementary, alternative and integrative medicine therapies might be a solution.
OBJECTIVE
The aim of this review is to demonstrate study status of such therapies.
METHODS
The databases PubMed, Cochrane Library, OVID, CAMbase, CAM-QUEST® and Anthromedics were systematically screened for studies investigating complementary, alternative and integrative therapy approaches in paediatric cohorts. Studies were analyzed by therapy approach, study design, cohort and outcome, using the PRISMA 2020 checklist.
RESULTS
The systematic literature search resulted in 321 articles. Five publications corresponded to the search criteria and were assigned to the following specific therapeutic categories: herbal medicine (3), homeopathy (1) and ayurvedic medicine (1). Clinical trials were found for the herbal compounds BNO 1030 (Impupret®) and EPs® 7630 (Umckaloabo), the homeopathic complex Tonzolyt® and the ayurvedic medicine Kanchnara-Guggulu and Pratisarana of Tankana‑Madhu. Antimicrobial effects of essential oils and carvacrol as single agents as well as in combination with erythromycin were analysed in an in vitro study.
CONCLUSION
Clinical studies indicate an improvement of symptoms and a good tolerability of all investigated remedies of complementary, alternative and integrative medicine in the treatment of tonsillitis in childhood. Nevertheless, quality and quantity of the studies were insufficient to make a reliable conclusion regarding effectiveness. Therefore, more clinical trials are urgently needed to achieve a meaningful result.
Topics: Child; Humans; Complementary Therapies; Tonsillitis; Homeopathy
PubMed: 36868289
DOI: 10.1016/j.ctim.2023.102940 -
Journal of Ethnopharmacology May 2023Arctium lappa L., is a biennial plant that grows around the Eurasia. Many parts of Arctium lappa L. (roots, leaves and fruits, etc.) are medically used in different... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
Arctium lappa L., is a biennial plant that grows around the Eurasia. Many parts of Arctium lappa L. (roots, leaves and fruits, etc.) are medically used in different countries. Arctium lappa L. fruit, also called Arctii Fructus, is traditionally applied to dispel wind-heat, ventilate lung to promote eruption, remove toxicity substance and relieve sore throat.
THE AIM OF THE REVIEW
The review aims to integrate the botany, ethnopharmacology, quality control, phytochemistry, pharmacology, derivatives and toxicity information of Arctii Fructus, so as to facilitate future research and explore the potential of Arctii Fructus as an agent for treating diseases.
MATERIALS AND METHODS
Related knowledge about Arctii Fructus were acquired from Science Direct, GeenMedical, PubMed, China National Knowledge Infrastructure (CNKI), Web of Science, Pharmacopoeia of the People's Republic of China, Doctoral and Master's thesis, ancient books, etc. RESULTS: Arctii Fructus as an herb used for medicine and food was pervasively distributed and applicated around the world. It was traditionally used to treat anemopyretic cold, dyspnea and cough, sore throat, etc. To date, more than 200 compounds have been isolated and identified from Arctii Fructus. It contained lignans, phenolic acids and fatty acids, terpenoids, volatile oils and others. Lignans, especially arctigenin and arctiin, had the extensive pharmacological effects such as anti-cancer, antiviral, anti-inflammatory activities. The ester derivatives of arctigenin had the anti-cancer, anti-Alzheimer's disease and immunity enhancing effects. Although Arctii Fructus extract had no toxicity, arctigenin was toxic at a certain dose. The alleviating effects of Arctii Fructus on chronic inflammation and ageing have been demonstrated by clinical studies.
CONCLUSION
Arctii Fructus is regarded as a worthy herb with many chemical components and various pharmacological effects. Several traditional applications have been supported by modern pharmacological research. However, their action mechanisms need to be further studied. Although many chemical components were isolated from Arctii Fructus, the current research mainly focused on lignans, especially arctiin and arctigenin. Therefore, it is very important to deeply clarify the pharmacological activities and action mechanism of the compounds and make full medicinal use of the resources of Arctii Fructus.
Topics: Humans; Ethnopharmacology; Fruit; Arctium; Lignans; Botany; Quality Control; Pharyngitis; Phytochemicals
PubMed: 36781057
DOI: 10.1016/j.jep.2023.116223