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Australian Journal of General Practice Mar 2024
Topics: Humans; Pharyngitis
PubMed: 38437659
DOI: 10.31128/AJGP-08-23-6917 -
Complementary Therapies in Medicine May 2024Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic...
BACKGROUND
Medical guidelines are an important basis for qualitative and cost-effective patient care. However, there is a lack of clinical recommendations in anthroposophic medicine (AM), an integrative medicine approach frequently practised in Europe. Acute tonsillitis, which includes tonsillopharyngitis, is a common childhood disease. that is mostly caused by a viral infection. Symptomatic treatment is therefore of high importance, and AM can offer several therapy options.
METHODS
53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprises five survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel.
RESULTS
Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%).
CONCLUSION
The clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.
Topics: Child; Humans; Consensus; Anthroposophy; Integrative Medicine; Physicians; Tonsillitis; Delphi Technique
PubMed: 38432580
DOI: 10.1016/j.ctim.2024.103031 -
Infection Mar 2024The massive increase of infections with Group A Streptococcus (GAS) in 2022-2023 coincided in Switzerland with a change of the recommendations for the management of GAS...
PURPOSE
The massive increase of infections with Group A Streptococcus (GAS) in 2022-2023 coincided in Switzerland with a change of the recommendations for the management of GAS pharyngitis. Therefore, the objective of the present study was to investigate whether the clinical manifestations and management before hospitalization for GAS infection differed in 2022-2023 compared with 2013-2022.
METHODS
Retrospective study of GAS infections requiring hospitalization in patients below 16 years. Preadmission illness (modified McIsaac score), oral antibiotic use, and outcome in 2022-2023 were compared with 2013-2022. Time series were compared with surveillance data for respiratory viruses.
RESULTS
In 2022-2023, the median modified McIsaac score was lower (2 [IQR 2-3] vs. 3 [IQR 2-4], p = < 0.0001) and the duration of preadmission illness was longer (4 days [3-7] vs. 3 [2-6], p = 0.004) than in 2013-2022. In both periods, withholding of preadmission oral antibiotics despite a modified McIsaac score ≥ 3 (12% vs. 18%, n.s.) or ≥ 4 (2.4% vs. 10.0%, p = 0.027) was rare. Respiratory disease, skeletal/muscle infection, and invasive GAS disease were significantly more frequent in 2022-2023, but there were no differences in clinical outcome. The time course of GAS cases in 2022-2023 coincided with the activity of influenza A/B.
CONCLUSION
We found no evidence supporting the hypothesis that the 2022-2023 GAS outbreak was associated with a change in preadmission management possibly induced by the new recommendation for GAS pharyngitis. However, clinical manifestations before admission and comparative examination of time-series strongly suggest that viral co-circulation played an important role in this outbreak.
PubMed: 38427206
DOI: 10.1007/s15010-024-02198-w -
International Wound Journal Mar 2024At present, it is still controversial whether patients in intensive care unit (ICU) use tracheal intubation with or without cuff. This paper evaluates the effect of... (Meta-Analysis)
Meta-Analysis
At present, it is still controversial whether patients in intensive care unit (ICU) use tracheal intubation with or without cuff. This paper evaluates the effect of tracheal intubation with and without cuff on overall complication rate of patients with intubation in ICU. The database of PubMed, Embase, Conchrane Library and Web of Science was searched by computer, and the clinical research on intubation with and without cuff in ICU was collected. The time range was from the database establishment to November 2023. Literature was independently screened, information was extracted, and quality was assessed by two researchers. Finally, there were nine studies included, with 11 068 patients (7391 in cuff group and 3677 in non-cuff group). The results showed that the overall complication rate of cuff group was significantly lower than that of non-cuff group, and that of cuff group (RR = 0.53, p < 0.01). In addition, compared with the non-cuff group, the cuff group had a lower number of tracheal intubation changes [RR = 0.05, p < 0.01] and a lower incidence of aspiration pneumonia (RR = 0.45, p = 0.01). Compared with the non-cuff group, the cuff group had a higher incidence of oral mucosal ulcers and pharyngitis (RR = 1.99, p = 0.04), while the cuff group had a lower incidence of laryngeal edema (RR = 0.39, p < 0.01). In ICU intubation patients, the use of cuffs reduces overall complication rate in comparison to patients without cuffs. Therefore, patients with intubation in ICU can recommend tracheal intubation with cuff.
Topics: Humans; Incidence; Intubation, Intratracheal; Critical Care; Intensive Care Units
PubMed: 38414304
DOI: 10.1111/iwj.14741 -
Aging Feb 2024Clinical studies have confirmed that Qingfei Dayuan (QFDY) granules are effective in the treatment of influenza and upper respiratory tract infections (URTIs) caused by... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Clinical studies have confirmed that Qingfei Dayuan (QFDY) granules are effective in the treatment of influenza and upper respiratory tract infections (URTIs) caused by pulmonary heat-toxin syndrome (PHTS). Granules of Chinese medicine formulations have become a widely used dosage form in clinical practice. With the continuous optimization of extraction technology, the advantages of Chinese medicine granules have been gradually demonstrated, but the price of Chinese medicine granules is generally higher than that of traditional dosage forms of Chinese medicine, and we support the rational use of the appropriate dosage of QFDY for patients with these conditions. Therefore, we set up half of the conventional dose as the low dose group, and designed the three-arm study to rigorously compare the efficacy difference of low-dose QFDY, QFDY and the placebo group, with the expectation of providing scientific support for the rational selection of the dose and the safe and effective use of the medicine in clinical practice.
METHODS
We recruited 108 patients with clinical diagnoses of influenza and URTIs caused by PHTS to receive treatment at six hospitals in Hubei, China. Using a centralized randomization system, patients were randomly assigned at a 1:1:1 ratio to the QFDY, low-dose QFDY, or placebo control groups to receive the corresponding drug, and the study physicians, subjects, outcome assessors, and statisticians were unaware of group assignments. The primary outcome was the time to complete fever relief. Secondary outcomes included the efficacy of Chinese medicine in alleviating signs and symptoms and the disappearance rate of individual symptoms. Adverse events were monitored throughout the trial.
RESULTS
A total of 108 patients were recruited. A total of 106 patients were included in the full analysis set (FAS). In the FAS analysis, there was no statistically significant difference in baseline of the three groups before treatment (P > 0.05). 1. Regarding the median time to complete fever relief, the QFDY, low-dose QFDY and placebo groups had median times of 26 h, 40 h and 48 h, respectively. The QFDY group had a shorter time to complete fever relief than the placebo group, and the difference was statistically significant (P < 0.05), while the low-dose QFDY group had a shorter time than the placebo group, but the difference was not statistically significant (P > 0.05). 2. In terms of the total efficacy of Chinese medicine in alleviating symptoms at the end of three full days of treatment, as well as the cure rate of red and sore throat, stuffy and runny nose, and sneezing, QFDY and low-dose QFDY were superior to the placebo, and the differences were statistically significant (P < 0.01). There was no statistical significance in the comparison between the QFDY group and the low-dose QFDY group (P > 0.05). 3. In terms of the headache cure rate after three full days of treatment, QFDY was superior to the placebo, with a statistically significant difference (P < 0.05), and there was no significant efficacy of low-dose QFDY. 4. Safety comparisons showed no serious adverse events and 30 minor adverse events, which were not clinically considered to be related to the drug and were not statistically significant.
CONCLUSIONS
In the treatment of patients with influenza and URTIs caused by PHTS, which are mainly characterized by clinical symptoms such as red and sore throat, stuffy and runny nose, and sneezing, when fever is not obvious or low-grade fever is present, the use of low-dose QFDY to simply alleviate the clinical symptoms is recommended and preferred. Moreover, with its good safety profile, QFDY can be used in the treatment of patients with influenza and URTIs caused by PHTS, which can effectively shorten the duration of fever, significantly increase the total efficacy of Chinese medicine in alleviating symptoms after 3 days of treatment, and accelerate the recovery of symptoms such as red and sore throat, stuffy and runny nose, sneezing, and headache, etc. Clinical Trial Registration: http://www.chictr.org.cn.
TRIAL NUMBER
ChiCTR2100043449. Registered on 18 February 2021.
Topics: Humans; Influenza, Human; Sneezing; Fever; Respiratory Tract Infections; Pharyngitis; Headache; Rhinorrhea; Treatment Outcome; Drugs, Chinese Herbal
PubMed: 38412322
DOI: 10.18632/aging.205601 -
JNMA; Journal of the Nepal Medical... Jan 2024Postoperative sore throat is the second most common minor adverse event after general anaesthesia with endotracheal intubation. It is an uncomfortable and stressful...
INTRODUCTION
Postoperative sore throat is the second most common minor adverse event after general anaesthesia with endotracheal intubation. It is an uncomfortable and stressful sequel of tracheal intubation. The incidence of postoperative sore throat varies across different studies and type of anesthesia technique used. The aim of the study was to find out the prevalence of postoperative sore throat following general anaesthesia with endotracheal intubation in a tertiary care centre.
METHODS
A descriptive cross-sectional study was conducted among the patients who underwent surgery under general anaesthesia with endotracheal intubation from 1 December 2022 to 31 October 2023 after receiving ethical approval from the Institutional Review Committee. The anaesthesia technique was standardized in all the patients. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.
RESULTS
Among 200 patients, postoperative sore throat was seen in 86 (43%) (36.14-49.86, 95% Confidence Interval) patients. The maximum reported time of sore throat was at a fourth postoperative hour 80 (93.02%).
CONCLUSIONS
The prevalence of postoperative sore throat among patients undergoing surgery under general anaesthesia with endotracheal intubation was similar to the studies conducted in similar settings.
KEYWORDS
endotracheal intubation; general anaesthesia; prevalence.
Topics: Humans; Tertiary Care Centers; Postoperative Complications; Cross-Sectional Studies; Anesthesia, General; Pharyngitis; Intubation, Intratracheal
PubMed: 38410011
DOI: 10.31729/jnma.8399 -
BMC Oral Health Feb 2024There is a blooming trend in the application of robotic surgery in oral and maxillofacial care, and different studies had evaluated the quality of life (QoL) outcomes... (Review)
Review
BACKGROUND
There is a blooming trend in the application of robotic surgery in oral and maxillofacial care, and different studies had evaluated the quality of life (QoL) outcomes among patients who underwent robotic surgery in the oral and maxillofacial region. However, empirical evidence on the QoL outcomes from these procedures is yet to be mapped. Thus, this study was conducted to evaluate the available scientific evidence and gaps concerning the QoL outcomes of patients treated with robotic surgery in the oral and maxillofacial region.
METHODS
This study adopted a scoping review design, and it was conducted and reported based on the Arksey and O'Malley, PRISMA-ScR, and AMSTAR-2 guidelines. SCOPUS, PubMed, CINAHL Complete, and APA PsycINFO were searched to retrieve relevant literature. Using Rayyan software, the retrieved literature were deduplicated, and screened based on the review's eligibility criteria. Only the eligible articles were included in the review. From the included articles, relevant data were charted, collated, and summarized.
RESULTS
A total of 123 literature were retrieved from the literature search. After deduplication and screening, only 18 heterogeneous original articles were included in the review. A total of 771 transoral robotic surgeries (TORSs) were reported in these articles, and the TORSs were conducted on patients with oropharyngeal carcinomas (OPC), recurrent tonsillitis, and obstructive sleep apnoea (OSA). In total, 20 different QoL instruments were used in these articles to assess patients' QoL outcomes, and the most used instrument was the MD Anderson Dysphagia Inventory Questionnaire (MDADI). Physical functions related to swallowing, speech and salivary functions were the most assessed QoL aspects. TORS was reported to result in improved QOL in patients with OPC, OSA, and recurrent tonsillitis, most significantly within the first postoperative year. Notably, the site of the lesion, involvement of neck dissections and the characteristics of the adjuvant therapy seemed to affect the QOL outcome in patients with OPC.
CONCLUSION
Compared to the conventional treatment modalities, TORS has demonstrated better QoL, mostly in the domains related to oral functions such as swallowing and speech, among patients treated with such. This improvement was most evident within the initial post-operative year.
Topics: Humans; Quality of Life; Robotic Surgical Procedures; Oropharyngeal Neoplasms; Tonsillitis; Sleep Apnea, Obstructive
PubMed: 38408988
DOI: 10.1186/s12903-024-04035-w -
Journal of Ayub Medical College,... 2023Indiscriminate use of antibiotics is a well-known reason for increasing antimicrobial resistance. Upper respiratory tract infection presents with similar symptoms and...
Relationship Between Upper Respiratory Tract Symptoms And Treatment-Seeking Behaviour In Healthy Attendants Of Patients Presenting To Opd Clinics Of Bbs Teaching Hospital Abbottabad.
BACKGROUND
Indiscriminate use of antibiotics is a well-known reason for increasing antimicrobial resistance. Upper respiratory tract infection presents with similar symptoms and signs irrespective of its bacterial or viral causes and is either ignored or managed aggressively by the primary care physicians. The objective was to determine the relationship between upper respiratory tract infections and treatment-seeking behaviour in healthy individuals attending the OPD clinics of BBS Teaching Hospital with their sick family members.
METHODS
Six hundred and eighty-five healthy individuals who accompanied patients to the OPD clinics of BBS Teaching Hospital, Abbottabad were enrolled in this cross-sectional survey. They were given a modified questionnaire to respond to and their replies were analyzed for assessment.
RESULTS
In a survey of 685 individuals, 98.2% were aware of antibiotics, but only 28.6% correctly understood their use against infections. Misconceptions about antibiotic resistance were common, with 54.5% believing it arises from human immunity. Only 31.53% consulted a doctor for upper respiratory symptoms and 72.6% of those expected antibiotics. Women showed higher antibiotic knowledge than men, but education level was a stronger predictor of both knowledge and attitudes.
CONCLUSION
This study highlights a critical gap in public understanding and responsible usage of antibiotics, particularly in the context of upper respiratory tract infections. This study reveals that increased awareness and more informed attitudes about antibiotic resistance correlate with a decreased likelihood of inappropriate antibiotic prescription.
Topics: Male; Humans; Female; Cross-Sectional Studies; Respiratory Tract Infections; Hospitals, Teaching; Anti-Bacterial Agents; Nose Diseases; Respiratory System; Practice Patterns, Physicians'
PubMed: 38406897
DOI: 10.55519/JAMC-S4-12816 -
Anales de Pediatria Mar 2024
Topics: Humans; Streptococcus pyogenes; Pharyngitis; Syndrome; Streptococcal Infections
PubMed: 38403535
DOI: 10.1016/j.anpede.2024.01.016 -
European Journal of Epidemiology Mar 2024The burden of respiratory tract infections (RTIs) is high in childhood. Several residential exposures may affect relative rates.
Residential exposure to mold, dampness, and indoor air pollution and risk of respiratory tract infections: a study among children ages 11 and 12 in the Danish National Birth Cohort.
BACKGROUND
The burden of respiratory tract infections (RTIs) is high in childhood. Several residential exposures may affect relative rates.
OBJECTIVES
To determine risk of RTIs in children ages 11 and 12 by residential exposures.
METHODS
We included children in the Danish National Birth Cohort (DNBC) at ages 11 and 12. We estimated incidence risk ratios (IRR) and 95% confidence intervals (CI) for counts of RTIs within the last year by exposure to mold/dampness, gas stove usage, summer and winter candle-burning, fireplace usage, cats and dogs indoors, and farmhouse living. We also estimated IRR and 95% CI for RTIs for predicted scores of four extracted factors ('owned house', 'mold and dampness', 'candles', and 'density') from exploratory factor analyses (EFA).
RESULTS
We included 42 720 children with complete data. Mold/dampness was associated with all RTIs (common cold: IRR 1.09[1.07, 1.12]; influenza: IRR 1.10 [1.05, 1.15]; tonsillitis: IRR 1.19 [1.10, 1.28]; conjunctivitis: IRR 1.16 [1.02, 1.32]; and doctor-diagnosed pneumonia: IRR 1.05 [0.90, 1.21]), as was the EFA factor 'mold/dampness' for several outcomes. Gas stove usage was associated with conjunctivitis (IRR 1.25 [1.05, 1.49]) and with doctor-diagnosed pneumonia (IRR 1.14 [0.93, 1.39]). Candle-burning during summer, but not winter, was associated with several RTIs, for tonsillitis in a dose-dependent fashion (increasing weekly frequencies vs. none: [IRR 1.06 [0.98, 1.14], IRR 1.16 [1.04, 1.30], IRR 1.23 [1.06, 1.43], IRR 1.29 [1.00, 1.67], and IRR 1.41 [1.12, 1.78]).
CONCLUSION
Residential exposures, in particular to mold and dampness and to a lesser degree to indoor combustion sources, are related to the occurrence of RTIs in children.
Topics: Child; Humans; Animals; Cats; Dogs; Air Pollution, Indoor; Birth Cohort; Respiratory Tract Infections; Pneumonia; Fungi; Tonsillitis; Conjunctivitis; Denmark
PubMed: 38393605
DOI: 10.1007/s10654-024-01101-z