This news section is written by a medical journalist and offers
Cancer Cytopathology
readers timely information on events, issues, and personalities of interest to the subspecialty. In this issue, ...the recent surge of oropharyngeal squamous cell carcinoma has been blamed almost entirely on the human papillomavirus (HPV). Otolaryngologists are now sensing an opening for increasing vaccination rates and decreasing the incidence of HPV‐associated oropharyngeal cancer.
Sore throat is a common reason for people to present for medical care and to be prescribed antibiotics. Overuse of antibiotics in primary medicine is a concern, hence it is important to establish ...their efficacy in treating sore throat and preventing secondary complications. OBJECTIVES: To assess the effects of antibiotics for reducing symptoms of sore throat for child and adult patients.
We searched CENTRAL 2021, Issue 2, MEDLINE (January 1966 to April week 1, 2021), Embase (January 1990 to April 2021), and two trial registries (searched 6 April 2021).
Randomised controlled trials (RCTs) or quasi-RCTs of antibiotics versus control assessing typical sore throat symptoms or complications amongst children and adults seeking medical care for sore throat symptoms.
We used standard methodological procedures as recommended by Cochrane. Two review authors independently screened studies for inclusion and extracted data, resolving any differences in opinion by discussion. We contacted the trial authors from three studies for additional information. We used GRADE to assess the certainty of the evidence for the efficacy of antibiotics on our primary outcomes (sore throat at day three and one week) and secondary outcomes (fever and headache symptoms and incidence of acute rheumatic fever, acute glomerulonephritis, acute otitis media, acute sinusitis, and quinsy).
We included 29 trials with 15,337 cases of sore throat. The majority of included studies were conducted in the 1950s, during which time the rates of serious complications (especially acute rheumatic fever) were much higher than today. Although clinical antibiotic trials for sore throat and respiratory symptoms are still being conducted, it is unusual for them to include placebo or 'no treatment' control arms, which is a requirement for inclusion in the review. The age of participants ranged from younger than one year to older than 50 years, but most participants across all studies were adults. Although all studies recruited patients presenting with symptoms of sore throat, few of them distinguished between bacterial and viral aetiology. Bias may have been introduced through non-clarity in treatment allocation procedures and lack of blinding in some studies. Harms from antibiotics were poorly or inconsistently reported, and were thus not quantified for this review. 1. Symptoms Throat soreness and headache at day three were reduced by using antibiotics, although 82% of participants in the placebo or no treatment group were symptom-free by one week. The reduction in sore throat symptoms at day three (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.60 to 0.80; 16 studies, 3730 participants; moderate-certainty evidence) was greater than at one week in absolute numbers (RR 0.50, 95% CI 0.34 to 0.75; 14 studies, 3083 participants; moderate-certainty evidence) due to many cases in both treatment groups having resolved by this time. The number needed to treat for an additional beneficial outcome (NNTB) to prevent one sore throat at day three was less than six; at week one it was 18. Compared with placebo or no treatment, antibiotics did not significantly reduce fever at day three (RR 0.75, 95% CI 0.53 to 1.07; 8 studies, 1443 participants; high-certainty evidence), but did reduce headache at day three (RR 0.49, 95% CI 0.34 to 0.70; 4 studies, 1020 participants; high-certainty evidence). 2. Suppurative complications Whilst the prevalence of suppurative complications was low, antibiotics reduced the incidence of acute otitis media within 14 days (Peto odds ratio (OR) 0.21, 95% CI 0.11 to 0.40; 10 studies, 3646 participants; high-certainty evidence) and quinsy within two months (Peto OR 0.16, 95% CI 0.07 to 0.35; 8 studies, 2433 participants; high-certainty evidence) compared to those receiving placebo or no treatment, but not acute sinusitis within 14 days (Peto OR 0.46, 95% CI 0.10 to 2.05; 8 studies, 2387 participants; high-certainty evidence). 3. Non-suppurative complications There were too few cases of acute glomerulonephritis to determine whether there was a protective effect of antibiotics compared with placebo against this complication (Peto OR 0.07, 95% CI 0.00 to 1.32; 10 studies, 5147 participants; low-certainty evidence). Antibiotics reduced acute rheumatic fever within two months when compared to the control group (Peto OR 0.36, 95% CI 0.26 to 0.50; 18 studies, 12,249 participants; moderate-certainty evidence). It should be noted that the overall prevalence of acute rheumatic fever was very low, particularly in the later studies.
Antibiotics probably reduce the number of people experiencing sore throat, and reduce the likelihood of headache, and some sore throat complications. As the effect on symptoms can be small, clinicians must judge on an individual basis whether it is clinically justifiable to use antibiotics to produce this effect, and whether the underlying cause of the sore throat is likely to be of bacterial origin. Furthermore, the balance between modest symptom reduction and the potential hazards of antimicrobial resistance must be recognised. Few trials have attempted to measure symptom severity. If antibiotics reduce the severity as well as the duration of symptoms, their benefit will have been underestimated in this meta-analysis. Additionally, more trials are needed in low-income countries, in socio-economically deprived sections of high-income countries, as well as in children.
Antibiotics for sore throat Spinks, Anneliese; Glasziou, Paul P; Del Mar, Chris B
Cochrane database of systematic reviews,
11/2013
11
Journal Article
Recenzirano
Odprti dostop
Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it.
To assess the benefits of ...antibiotics for sore throat for patients in primary care settings.
We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to July week 1, 2013) and EMBASE (January 1990 to July 2013).
Randomised controlled trials (RCTs) or quasi-RCTs of antibiotics versus control assessing typical sore throat symptoms or complications.
Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. We contacted trial authors from three studies for additional information.
We included 27 trials with 12,835 cases of sore throat. We did not identify any new trials in this 2013 update. 1. Symptoms Throat soreness and fever were reduced by about half by using antibiotics. The greatest difference was seen at day three. The number needed to treat to benefit (NNTB) to prevent one sore throat at day three was less than six; at week one it was 21. 2. Non-suppurative complications The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two-thirds within one month (risk ratio (RR) 0.27; 95% confidence interval (CI) 0.12 to 0.60). 3. Suppurative complications Antibiotics reduced the incidence of acute otitis media within 14 days (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis within 14 days (RR 0.48; 95% CI 0.08 to 2.76); and quinsy within two months (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo. 4. Subgroup analyses of symptom reduction Antibiotics were more effective against symptoms at day three (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week one the RR was 0.29 (95% CI 0.12 to 0.70) for positive and 0.73 (95% CI 0.50 to 1.07) for negative Streptococcus swabs.
Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in high-income countries requires treating many with antibiotics for one to benefit. This NNTB may be lower in low-income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.
Introduction: Evidence regarding throat packing for head and neck surgeries is limited. A video laryngoscope, an airway adjunct used for various diagnostic and therapeutic purposes, can also ...effectively pack the throat. Aim: To compare the Time Taken for Throat Packing (TTTP) using a non-channeled video laryngoscope BPL™ versus the conventional Macintosh larynogoscope direct laryngoscope. Materials and Methods: In this non-inferiority, randomised controlled, single-blind study, 72 patients undergoing head and neck surgeries requiring throat packing were recruited. The non-inferiority margin was set at 10 seconds between the two groups (n=36 each). Throat packing in Group-M and Group-V was performed using the Macintosh and video laryngoscopes with the assistance of Magill’s forceps. The TTTP was recorded from the blade insertion to complete blade removal. A one-sided two-sample unpaired t-test was used to test non-inferiority hypothesis considered in this study. Results: The mean age of patients in Group-M was 37.39 years and in Group-V was 33.65 years, with mean weights of 60.89 kg and 56.32 kg, respectively. The mean TTTP difference between Group-M and Group-V was found to be -12.6 seconds with a lower limit of the one-sided 95% Confidence Interval (CI) of −20.6s. The null hypothesis was accepted, concluding that video laryngoscope-guided throat packing took a longer duration. The ease of throat packing, haemodynamic stress response, and Postoperative Sore Throat (POST) were comparable between both groups. Conclusion: Video laryngoscope-guided throat packing is inferior to conventional Macintosh throat packing in terms of TTTP. However, it is equivocal regarding the ease of throat packing and the stress response induced. POST was the same whether throat packing was performed using a video laryngoscope or a Macintosh laryngoscope.
Professional voice users depend on their voice for optimal performance of their profession. The aim of this study was to find out to what extent sucking a placebo and thyme represent an improvement ...of the voice in professional voice users after vocal loading.OBJECTIVESProfessional voice users depend on their voice for optimal performance of their profession. The aim of this study was to find out to what extent sucking a placebo and thyme represent an improvement of the voice in professional voice users after vocal loading.A randomized placebo-controlled clinical double-blind study was conducted with four measurement moments: a premeasurement, immediately after the vocal loading, after the subsequent ingestion of the "thymepearl" (TP) in the experimental group and in the control group the placebo, and after a half-hour break. Finally, 18 subjects were considered, 9 participants in each group.METHODSA randomized placebo-controlled clinical double-blind study was conducted with four measurement moments: a premeasurement, immediately after the vocal loading, after the subsequent ingestion of the "thymepearl" (TP) in the experimental group and in the control group the placebo, and after a half-hour break. Finally, 18 subjects were considered, 9 participants in each group.No significant differences in the objective measurements of both groups could be observed. However, significant improvements in subjective measures (perceptions of dry mouth and feeling of hoarseness) could be observed after vocal loading by sucking the thymepearls in direct comparison to the placebo.RESULTSNo significant differences in the objective measurements of both groups could be observed. However, significant improvements in subjective measures (perceptions of dry mouth and feeling of hoarseness) could be observed after vocal loading by sucking the thymepearls in direct comparison to the placebo.Sucking the TP can improve subjective sensation after vocal loading compared with placebo, but no differences are seen on objective vocal measures.CONCLUSIONSSucking the TP can improve subjective sensation after vocal loading compared with placebo, but no differences are seen on objective vocal measures.
Pore-throat characteristics of porous media play important roles in various flow processes. However, pore size distribution (PSD) and throat size distribution (TSD) of various porous media have ...rarely been reported. Watershed-segmentation (WS) is a promising pore-throat identification method. To avoid over- and under-segmentations, a trial-and-error method was devised and validated using artificially ordered packings. Afterwards, we analyzed porous media with various characteristics, and comparisons with artificially ordered packing were made. More angular particles generated larger pores and throats. TSD of spherical particles was bimodal, whereas other particles resembled a normal distribution. Pore surface area and volume relation demonstrated a fractal behavior. Compared with medial axis (MA) method, PSD and TSD from WS method were larger but exhibited similar distribution trends. Normalizing the PSD with the median pore size yielded a single Gaussian model, demonstrating a possible PSD model. However, normalization to TSD data does not produce a single Gaussian model.
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•Watershed method to identify pore−throat of various unconsolidated porous media•Spherical particles generate smaller throat but larger pore than angular particles.•Comparison to medial axis method shows similar trend but larger pore and throat.•Relationship of pore volume and surface area demonstrated a fractal behavior.•Normalized pore size distribution demonstrated a single Gaussian function.
Tracheal stenosis following brief intubation is a relatively rare but serious problem. However, some degree of airway injury is common following intubation, regardless of the duration. We herein ...report a rare case of a female patient in her late sixties, who developed severe tracheal stenosis following just a weeklong intubation. The tracheal stenosis was successfully treated via dilation and stenting using a self-expanding metal stent.
A Sore Throat that can Kill a Patient Ameri, Fatima Mohammed Al; Ali, Mohammed Abdulwahab; Eid, Mustafa Mahmood
Visual journal of emergency medicine,
October 2022, 2022-10-00, Letnik:
29
Journal Article
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