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International Journal of Pediatric... Jan 2024This study aimed to compare the tonsillar microbiota between post tonsillectomy patients with bleeding and without bleeding, and to investigate the potential role of...
OBJECTIVE
This study aimed to compare the tonsillar microbiota between post tonsillectomy patients with bleeding and without bleeding, and to investigate the potential role of tonsillar microbiota in the development of post-tonsillectomy hemorrhage (PTH).
METHODS
Nineteen tonsillar tissues from PTH patients and 21 tissues from control patients were collected. Metagenomic sequencing was used to compare the microbiota in PTH and control groups. Alpha diversity indices were used to compare the richness and evenness of the microbiota between the two groups. PCoA and NMDS analyses were used to evaluate beta diversity. LDA analysis was conducted to identify significantly abundant genera.
RESULTS
No significant difference in alpha diversity indices was found between PTH and control patients. The dominant bacteria in the tonsillar microbiota were Haemophilus, Streptococcus, and Fusobacterium. PCoA and NMDS analyses showed significant differences in beta diversity between PTH and control patients. PTH patients had a significantly higher relative abundance of Neisseria, Capnocytophaga, and Veillonella. Capnocytophaga was also identified as a significantly abundant genus by LDA analysis.
CONCLUSION
This study demonstrates that there is a difference in the tonsillar microbiota between PTH and control patients. The results suggest that Neisseria, Capnocytophaga, and Veillonella may be associated with the development of PTH. These findings provide new insights into the potential role of the tonsillar microbiota in the development of PTH, and may help to develop new strategies for preventing and treating this potentially life-threatening complication.
Topics: Child; Humans; Palatine Tonsil; Tonsillectomy; Hemorrhage; Microbiota; Hypertrophy; Neisseria
PubMed: 38039804
DOI: 10.1016/j.ijporl.2023.111788 -
Journal of Medical Cases Nov 2023Abrupt loss of focal brain function is the main characteristic of the beginning of ischemic stroke. However, individuals with disorders other than stroke can also...
Abrupt loss of focal brain function is the main characteristic of the beginning of ischemic stroke. However, individuals with disorders other than stroke can also present with similar features. These conditions include seizure disorders, migraine, central nervous system abscess or tumor, head trauma, subdural hematoma, cerebral venous thrombosis, viral encephalitis, conversion reaction, hypertensive encephalopathy, multiple sclerosis, and spinal cord disorder. An 82-year-old man presented with a sudden onset of numbness in his left forearm in the distribution of C6 and C7 spinal nerves, 2 days after undergoing endarterectomy and stent placement in his right carotid artery because of stenosis. He was diagnosed with hypo-pharyngeal squamous cell carcinoma (T1, L0, M0) 17 years earlier (2006) which was treated with 70 Gy intensity-modulated radiotherapy (IMRT). The patient underwent stent insertion into his left carotid artery 3.5 years earlier because of 80% carotid artery stenosis. He was initially suspected to have an ischemic stroke. However, computed tomography angiography of the head and neck did not show stenosis or occlusion of the major intracranial arteries and no aneurysms were identified. It showed interval stenting of the cervical portion of the right carotid artery and stable appearance of left carotid artery stent. Both carotid artery stents and the vertebral arteries were patent. The cervical spine showed bilateral moderate to severe foramen stenosis in C3-C4 and C5-C6, and moderate to severe stenosis in the right C2-C3 and left C4-C5. His symptoms subsided after performing neck extension exercises. This is the first report of a patient whose cervical radiculopathy symptoms were suspected to be caused by ischemic stroke. The recent angioplasty and stent placement in the right carotid artery made the association more likely and had to be excluded. Clinicians should be aware that cervical radiculopathy could present as ischemic stroke. It is therefore important that disorders that cause symptoms similar to ischemic stroke are also considered in these individuals.
PubMed: 38029053
DOI: 10.14740/jmc4162 -
Health Science Reports Nov 2023The use of lidocaine aerosol for pediatric tonsil and adenoidectomy has been reported less frequently. We hope to improve the perioperative comfort of pediatric patients...
Lidocaine aerosol preoperative application for improving the comfort of pediatric patients undergoing tonsillectomy and adenoidectomy: A prospective randomized controlled trial.
BACKGROUND AND AIMS
The use of lidocaine aerosol for pediatric tonsil and adenoidectomy has been reported less frequently. We hope to improve the perioperative comfort of pediatric patients undergoing these procedures by applying lidocaine aerosol.
METHODS
A total of 122 pediatric patients receiving tonsil and adenoidectomy were randomly divided into a lidocaine aerosol group (Group L) and a saline group (Group C), with 61 patients in each group; 2.4% alkaline lidocaine aerosol and saline were sprayed in the pharynx before induction. Our primary outcome were the incidence and rate ratio (RR) of postoperative pharyngeal complications (oropharyngeal dryness, dysphagia, hoarseness, and sore throat) and the pharyngeal comfort score, the latter of which was assessed by the occurrence of the above complications (yes = 0 point, none = 1 point). The secondary outcomes included preoperative and intraoperative blood pressure and heart rate, the incidence of choking during the induction period, the intraoperative opioid dosage, and the pain level and depth of sedation at 2, 6, and 24 h postoperatively. Statistical software used in this study included PASS15.0, SPSS 26.0, and GraphPad Prism 9.3.1, and statistical methods used included the -test, the ² test, the Mann-Whitney test, and the repeated measures analysis of variance.
RESULTS
The incidence and RR of postoperative pharyngeal complications such as oropharyngeal dryness (RR: 0.667, 95% confidence interval [CI]: 0.458-0.970, = 0.03), dysphagia (RR: 0.333, 95% CI: 0.114-0.976, = 0.03), hoarseness (RR: 0.647, 95% CI: 0.433-0.967, = 0.03), and sore throat (RR: 0.727, 95% CI: 0.547-0.967, = 0.03) were significantly lower in Group L than in Group C at 2 h postoperatively, and the incidence and RR of postoperative sore throat was significantly lower in Group L than in Group C at 6 h postoperatively (RR: 0.717, 95% CI: 0.547-0.942, = 0.01). The postoperative pharyngeal comfort scores were significantly higher in Group L than in Group C at all postoperative time points ( < 0.05). The Ramsay sedation score was significantly higher ( < 0.01) and FLACC (face, legs, activity, crying, and consolability) score was significantly lower ( < 0.01) in Group L than in Group C at 2 h postoperatively. In Group C, the blood pressure and heart rate significantly faster at all time points immediately after intubation and afterward, except at the end of surgery ( < 0.05).
CONCLUSIONS
In pediatric tonsil and adenoidectomy, the application of lidocaine aerosol before induction can reduce the incidence of postoperative pharyngeal complications, improve the child's postoperative pharyngeal comfort, and better realize perioperative "comfort medical treatment."
PubMed: 38028678
DOI: 10.1002/hsr2.1688 -
Cureus Oct 2023Anomalous external carotid artery (ECA)-internal carotid artery (ICA) anastomosis is a rare variant of cervical carotid artery formation that forms an arterial ring in...
Anomalous external carotid artery (ECA)-internal carotid artery (ICA) anastomosis is a rare variant of cervical carotid artery formation that forms an arterial ring in the cervical segment, and its embryological mechanism is still unknown. We report a case of a 41-year-old woman who was incidentally diagnosed with this arterial variation using digital subtraction angiography. The angiography revealed the occipital artery arising from the anastomotic vessel and the ascending pharyngeal artery arising from the ICA near the anastomosis. The proximal ICA was smaller in diameter than the proximal ECA, but it was not stenotic and had sufficient caliber for the distal blood flow. It is commonly believed that the persistence of primitive vessels is the result of agenesis or hypoplasia of the proximal artery. In our case, the anomalous vessel was considered to be the remnant of a primitive anastomosis between the ECA and the ICA via the pharyngo-occipital system, and the narrowing of the proximal ICA may be the result of the remaining ECA-ICA anastomosis.
PubMed: 38021755
DOI: 10.7759/cureus.47878 -
Acta Veterinaria Scandinavica Nov 2023Early diagnosis of disease in calves is crucial for fast recovery and prudent use of antibiotics. The serum concentration of acute phase proteins (APPs) is up- or...
BACKGROUND
Early diagnosis of disease in calves is crucial for fast recovery and prudent use of antibiotics. The serum concentration of acute phase proteins (APPs) is up- or downregulated in response to tissue injury and has been studied widely in human medicine. There is growing interest in using APPs as biomarkers for different diseases and as a tool to initiate and monitor treatment in veterinary medicine as well. The concentration of APPs in saliva in healthy calves has not been established and the use of pharyngeal swabs offers a non-invasive alternative to blood sampling. Pharyngeal swabs, tracheal aspirate (TA) and blood samples were collected from 84 clinically healthy commercial dairy calves and analyzed for the APPs serum amyloid A (SAA), haptoglobin (Hp) and lipopolysaccharide binding protein (LBP).
RESULTS
We found detectable concentrations of SAA, Hp and LBP in pharyngeal swabs from calves, as well as in TA and serum. There were no biologically interesting correlations between the SAA concentrations in serum and TA or pharyngeal swabs. This also applied to Hp and LBP concentrations in serum and TA or pharyngeal swabs.
CONCLUSIONS
SAA, Hp and LBP can be measured in saliva and TA from calves, but there was no correlation between the specific APP concentration in serum and pharyngeal swab or TA. There was a considerable technical variation in the sampling method for both pharyngeal swab and TA, and further validation of the methods is needed.
Topics: Humans; Animals; Cattle; Acute-Phase Proteins; Serum Amyloid A Protein; Haptoglobins; Biomarkers; Cattle Diseases
PubMed: 38007540
DOI: 10.1186/s13028-023-00714-w -
Tidsskrift For Den Norske Laegeforening... Nov 2023Acute haematoma on the neck can cause potentially life-threatening compression of the upper airways. Such patients must therefore be examined quickly and carefully...
BACKGROUND
Acute haematoma on the neck can cause potentially life-threatening compression of the upper airways. Such patients must therefore be examined quickly and carefully observed with regard to compromised airways.
CASE PRESENTATION
An elderly male patient with obesity, known obstructive sleep apnoea and heart failure, non-severe chronic renal failure, and anticoagulation treatment presented with an acute subcutaneous haematoma of the neck. The patient had recently started an NSAID therapy regime for acute back pain. As part of the ENT examination endoscopy was performed. The airways were open and the patient had no respiratory distress. A CT scan confirmed open airways but revealed an additional circumferential haematoma in the pharynx of the patient. Blood work showed no anaemia or obvious infectious process.
INTERPRETATION
The unfortunate combination of the patient's regular medications and recent acute analgesic therapy with simultaneous renal failure was likely to have contributed to the development of an acute haematoma. Acute pharyngeal haematoma has been described in the literature in patients receiving anticoagulation therapy and one or more of the above-mentioned conditions that this patient had. The haematoma was controlled and resolved without further intervention.
Topics: Humans; Male; Aged; Neck; Sleep Apnea, Obstructive; Hematoma
PubMed: 37987073
DOI: 10.4045/tidsskr.23.0141 -
Medicine Nov 2023Cervical longus tendonitis is a type of disease with neck pain as the main clinical manifestation. Because the front of the cervical longus muscle is adjacent to the...
INTRODUCTION
Cervical longus tendonitis is a type of disease with neck pain as the main clinical manifestation. Because the front of the cervical longus muscle is adjacent to the esophagus and pharynx, this disease is often accompanied by pharyngeal pain and pain when swallowing. Clinical and imaging doctors often have an incomplete understanding of it, and this disease is often confused with other diseases that cause neck pain.
PATIENT CONCERNS
A 33-year-old Chinese woman was the patient. Suffering from severe neck pain and significantly limited activity, accompanied by left shoulder pain, occasionally dizziness, headache and other symptoms, the pain is significantly aggravated when doing swallowing action.
DIAGNOSIS
Tendonitis of the long neck muscle.
INTERVENTIONS
Given the patient's condition, we used acupuncture combined with massage therapy as a symptomatic treatment.
OUTCOMES
After 10 days of treatment, the symptoms were better than before, and no pain was seen in the swallowing movements such as drinking water (Fig. 2C and D).
LESSONS
Because the clinical reports of diseases are rare, the treatment methods are limited, and acupuncture combined with massage is an effective method for the treatment of tendonitis of the cervical long muscle, to dredge the meridians, promoting blood circulation, removing blood stasis and relieving pain.
Topics: Adult; Female; Humans; Acupuncture Therapy; Neck; Neck Muscles; Neck Pain; Tendinopathy
PubMed: 37986360
DOI: 10.1097/MD.0000000000035980 -
Wellcome Open Research 2023(StrepA) causes a significant burden of disease globally from superficial infections to invasive disease. It is responsible for over 500,000 deaths each year,...
BACKGROUND
(StrepA) causes a significant burden of disease globally from superficial infections to invasive disease. It is responsible for over 500,000 deaths each year, predominantly in low- and middle-income countries (LMIC). Superficial StrepA infections of the skin and pharynx can lead to rheumatic heart disease, the largest cause of StrepA-related deaths in LMIC. StrepA can also asymptomatically colonise normal skin and the pharynx (carriage), potentially increasing infection risk. (SDSE) carriage is also common in LMIC and may interact with StrepA. This study aims to investigate StrepA and SDSE carriage and infection epidemiology, transmission dynamics and naturally acquired immunity within households in The Gambia.
METHODS
A longitudinal household observational cohort study will be conducted over one year. 45 households will be recruited from the urban area of Sukuta, The Gambia, resulting in approximately 450 participants. Households will be visited monthly, and available participants will undergo oropharyngeal and normal skin swabbing. Incident cases of pharyngitis and pyoderma will be captured via active case reporting, with swabs taken from disease sites. Swabs will be cultured for the presence of group A, C and G beta-haemolytic streptococci. Isolates will undergo whole genome sequencing. At each visit, clinical, socio-demographic and social mixing data will be collected. Blood serum will be collected at baseline and final visit. Oral fluid and dried blood spot samples will be collected at each visit. Mucosal and serum anti-StrepA antibody responses will be measured.
OUTCOME
This study will report StrepA and SDSE clinical epidemiology, risk factors, transmission dynamics, and serological responses to carriage and infection. Detailed social mixing behaviour will be combined with phylogenetic relatedness to model the extent of transmission occurring withing and between households. The study will provide data to help meet global strategic StrepA research goals.
PubMed: 37954923
DOI: 10.12688/wellcomeopenres.18716.2 -
JMA Journal Oct 2023The internal carotid artery (ICA) typically runs posterolaterally to the external carotid artery (ECA) at the level of the common carotid artery (CCA) bifurcation in the...
The internal carotid artery (ICA) typically runs posterolaterally to the external carotid artery (ECA) at the level of the common carotid artery (CCA) bifurcation in the neck. The "twisted ICA" is an anatomical variation, wherein the ICA is medial to the ECA. Several studies on the twisted ICA have discussed its anatomical definition, incidence, clinical features, and surgical results in patients with luminal stenosis. Computed tomography angiography (CTA)-based analyses of surgically treated cohorts documented a twist angle, reaching up to 95°. Carotid endarterectomy (CEA) was successfully performed for these patients. This study reports a case of a significantly twisted ICA with severe luminal stenosis that was successfully treated with CEA. An 81-year-old male was incidentally diagnosed with asymptomatic right ICA stenosis based on magnetic resonance (MR) angiography. Three-dimensional (3D)-CTA showed that the ICA revealed 74% stenosis of the ICA, based on the North American Symptomatic Carotid Endarterectomy Trial criteria. The 3D-CTA showed the ICA medial to the ipsilateral ECA at the level of the CCA bifurcation in the neck. It extended proximally to the pharynx, and the twist angle was 102°. Black-blood MR of the carotid plaque exhibited a high intensity on T1-weighted imaging, indicating vulnerability. Intraoperatively, the position of the ICA was corrected using multiple hooks instead of a surgical retractor. He showed no permanent deficits, such as an ipsilateral cerebral infarction, although transient postoperative hoarseness was observed. This case report documented a significantly twisted ICA with luminal stenosis, successfully treated via CEA, by correcting the carotid position using multiple hooks with gentle manipulation.
PubMed: 37941708
DOI: 10.31662/jmaj.2023-0033 -
Tanaffos Jan 2023One of the most common reasons for mortality in patients with cystic fibrosis (CF) is lung infections, among which () infection has the largest share. Diagnosis of can...
BACKGROUND
One of the most common reasons for mortality in patients with cystic fibrosis (CF) is lung infections, among which () infection has the largest share. Diagnosis of can be assessed by various methods such as sputum culture results and IgG antibody level via measuring the specific anti- antibodies. This study aimed to select the best predictive technique in the diagnosis of in CF patients through spirometry, sputum culture, and serum IgG antibody levels.
MATERIALS AND METHODS
In this cross-sectional study, blood and sputum or pharyngeal samples were taken from 68 patients with cystic fibrosis. Because spirometry was not possible in all patients, 34 patients could do the spirometry. The samples were studied concerning infection. The data including variables such as age, sex, and spirometry results were obtained. Then, in the serologic method, 3 serum-specific antibody levels were determined by enzyme-linked immune sorbent assay (ELISA).
RESULTS
The average age of children was 7.4 ± 5.6 (ranging from 0.5 to 23) years. Generally, the percentage of infection increased in CF patients with higher ages. A statistically direct significant relationship was observed between the concentration of serum IgG antibodies in patients with CF and -positive sputum culture results (p<0.05).
CONCLUSION
Serum IgG antibodies against specific antigens could be a diagnostic method against infection, especially in patients who cannot expectorate. However, because of the positive and negative predictive value of both serum IgG antibody levels and the results of the sputum culture, we suggested that utilizing the combination of these methods could be beneficial in earlier diagnosis of .
PubMed: 37920326
DOI: No ID Found