Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial

Background Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. Objectives This study aims to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. Methods A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing versus no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. Results The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the two groups diminished by POD 2. Patients having received throat packs also demonstrated a higher usage of opioids in post anesthesia care unit (PACU). The incidence of PONV was not significantly different between the two cohorts at any point of observations. Conclusions This study demonstrates results that largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering this data, we do not recommend routine use of throat packing during elective septorhinoplasty.

Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19

Background Long-COVID refers to a variety of symptoms affecting different organs reported by people following Coronavirus Disease 2019 (COVID-19) infection. To date, there have been no robust estimates of the incidence and co-occurrence of long-COVID features, their relationship to age, sex, or severity of infection, and the extent to which they are specific to COVID-19. The aim of this study is to address these issues. Methods and findings We conducted a retrospective cohort study based on linked electronic health records (EHRs) data from 81 million patients including 273,618 COVID-19 survivors. The incidence and co-occurrence within 6 months and in the 3 to 6 months after COVID-19 diagnosis were calculated for 9 core features of long-COVID (breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression). Their co-occurrence network was also analyzed. Comparison with a propensity score–matched cohort of patients diagnosed with influenza during the same time period was achieved using Kaplan–Meier analysis and the Cox proportional hazard model. The incidence of atopic dermatitis was used as a negative control. Among COVID-19 survivors (mean [SD] age: 46.3 [19.8], 55.6% female), 57.00% had one or more long-COVID feature recorded during the whole 6-month period (i.e., including the acute phase), and 36.55% between 3 and 6 months. The incidence of each feature was: abnormal breathing (18.71% in the 1- to 180-day period; 7.94% in the 90- to180-day period), fatigue/malaise (12.82%; 5.87%), chest/throat pain (12.60%; 5.71%), headache (8.67%; 4.63%), other pain (11.60%; 7.19%), abdominal symptoms (15.58%; 8.29%), myalgia (3.24%; 1.54%), cognitive symptoms (7.88%; 3.95%), and anxiety/depression (22.82%; 15.49%). All 9 features were more frequently reported after COVID-19 than after influenza (with an overall excess incidence of 16.60% and hazard ratios between 1.44 and 2.04, all p < 0.001), co-occurred more commonly, and formed a more interconnected network. Significant differences in incidence and co-occurrence were associated with sex, age, and illness severity. Besides the limitations inherent to EHR data, limitations of this study include that (i) the findings do not generalize to patients who have had COVID-19 but were not diagnosed, nor to patients who do not seek or receive medical attention when experiencing symptoms of long-COVID; (ii) the findings say nothing about the persistence of the clinical features; and (iii) the difference between cohorts might be affected by one cohort seeking or receiving more medical attention for their symptoms. Conclusions Long-COVID clinical features occurred and co-occurred frequently and showed some specificity to COVID-19, though they were also observed after influenza. Different long-COVID clinical profiles were observed based on demographics and illness severity.

Current treatment of post-tonsillectomy pain: a review

<p class="abstract">Tonsillectomy is one of the most common surgical procedures performed by an otorhinolaryngologist. This surgery is done more in the pediatric age group. Although tonsillectomy is safe and effective surgery, it is usually associated with significant post-operative pain. Analgesics used for post-tonsillectomy pain is often inadequate. Severe throat pain following tonsillectomy has been documented for decades. Patients or parents/caretakers often worry about such severe pain in the home. The pain following tonsillectomy is usually intense and long-lasting. The severe post-tonsillectomy pain often overstrains the patient, family, and hospital staff. Regular changes in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more challenging. Pain following the tonsillectomy period continues to be a highly debated issue and an area of active research. Throat pain in the post-tonsillectomy period can result in significant morbidity among patients. There are different analgesics available; each one has its risk profile and side effects when used for controlling post-tonsillectomy pain. This review article discusses on recent management of post-tonsillectomy pain. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain, and details of medications used for controlling post-tonsillectomy pain.</p>

Evidence of the Efficacy of Flurbiprofen 8.75 mg Lozenges for Patients Receiving Antibiotics for Laboratory-Confirmed Streptococcal Pharyngitis

Objectives: To determine the efficacy of flurbiprofen 8.75 mg lozenges for patients with laboratory-confirmed streptococcal pharyngitis both before and concomitant with antibiotics. Methods: This post hoc analysis comprised adult participants from 2 earlier randomized, double-blind, placebo-controlled studies evaluating the analgesic efficacy of flurbiprofen 8.75 mg lozenges in acute pharyngitis. Throat swabs were obtained to diagnose streptococcal infection. Prior to and 2 hours after each dose of study medication (flurbiprofen or placebo lozenges), patients rated 3 symptoms of acute pharyngitis (sore throat pain, difficulty swallowing, and swollen throat) using visual analogue scales. Appropriate antibiotic treatment was initiated when culture results were reported. Mean changes in each pharyngeal symptom were compared over the immediate 24 hours before and during the initial 24 hours of antibiotic treatment. Results: Twenty-four patients provided both preantibiotic and concomitant antibiotic efficacy outcomes. Relief of throat pain was 93% greater in the flurbiprofen group than in the placebo group before antibiotic coadministration and 84% greater than placebo during antibiotic administration (both P < .05). Relief of difficulty swallowing was 71% greater in the flurbiprofen group than in the placebo before antibiotic administration (P = .16) and 107% greater during concomitant antibiotic administration (P = .04). Relief of the sensation of throat swelling was 295% greater with flurbiprofen than placebo before antibiotic administration (P = .008) and 70% greater during concomitant antibiotic administration (P = .06). For placebo-treated patients, relief from throat pain and difficulty swallowing were similar before and during antibiotic treatment (P > .05), indicating no benefit with antibiotic administration for these symptoms. No treatment-related discontinuations or serious adverse events were reported. Conclusions: Irrespective of antibiotic use, flurbiprofen 8.75 mg lozenges provide well-tolerated, effective relief of pharyngeal symptoms in patients with streptococcal infection. In the 24 hours after administration, antibiotics provide no relief of throat pain or difficulty swallowing beyond the topical demulcent effects of placebo lozenges.

Detection Coronavirus using Cased-Based Reasoning with Extended Jaccard Coefficient

Coronavirus Disease 2019 or known as COVID-19 is a new disease that can cause respiratory problems and pneumonia. This disease is caused by infection with Severe Acute Respiratory Syndrome Me Coronavirus 2 (SARS-CoV-2). Some of the clinical symptoms that appear vary, ranging from symptoms such as influenza, cough, cold, throat pain, muscle aches, headaches to those with serious complications such as pneumonia or sepsis. This research to build case-based reasoning for early detection of COVID-19 by looking at the characteristics of clinical symptoms seen in a person using the Extended Jaccard Coefficient method. The results show case-based reasoning for early detection of COVID-19 using the Extended Jaccard Coefficient method can model the level of similarity of a new case to an old case.

Comparison Between the Efficacy of Saline, Alkalinised Lignocaine 2% and Alkalinised Lignocaine 4% in the Cuff of Endotracheal Tube to Reduce the Incidence of Cough and Sorethroat During Extubation

Background: To compare the efficacy of saline, lignocaine 2% and Lignocaine 4% in the endotracheal tube cuff to decrease the incidence of post operative cough and sore throat. A unique, efficient and easy method designed to decrease cough and sore throat during emergence. Hence there was a need for the study. Methods: After approval from institutional Ethical Committee, Kasturba Medical college, Mangaluru and written informed consent from 120 patients of A.S.A class I & II, aged between 18-60 years posted for various surgeries were included. Randomization was done into three groups of 40 patients each. Group 1 – Normal saline, group 2 - 2% Lignocaine and group 3 - 4% Lignocaine. Postoperatively patients were assessed for incidence of cough and sore throat pain based on visual analogue scale (VAS) Results: 65% of patients in group 2 and 72% of patients in group 3 were extubated smoothly, whereas only 20% of patients in group 1 had smooth extubation, p<0.001. There was significant difference in sore throat pain and cough in group 2 and 3 when compared to group 1. Conclusion: The incidence of sore throat and cough was significantly reduced with Lignocaine in the endotracheal tube cuff when compared to saline. Lignocaine 4% was found to be far more better than 2% in reducing sore throat.

An observational study of clinical sequelae in COVID-19 at ESIC MCH Hyderabad

ABSTRACTBackground: covid 19 a deadly pandemic affecting people in 2020 not going to leave them without sequelae.This study is aimed at studying the sequelae in patients affected with covid 19.Methods: This Prospective Observational study was done from July 2020 to October 2020 in ESIC MCH Hyderabad.The patients admitted with covid 19 symptoms were treated and discharged.The patients on their follow up in OPD were asked about the symptoms persisting. Results: A total of 100 patients 60 males and 40 females presented during the study period.Most of the patients had fatigue 75[75%],myalgia 70[70%],dyspnea50[50%],throat pain 30[30%],edema 15[15%],dvt 10[10%],abdominal pain5[5%].Some of them developed DM due to use of steroids. Conclusions: It was observed from the study that this deadly pandemic could have everlasting effect on the affected people.though people recovered from the illness patients had complaints of fatigue,myalgias,dyspnea etc.Patients having lung complications aggravated leading to fibrosis.it was observed that patients with covid infection had predilection for kidney failure,heart failure.

Reduction of Viral Load in Patients With Acute Sore Throats: Results From an Observational Clinical Trial With Echinacea and Salvia Lozenges

Background: Acute tonsillopharyngitis or sore throat is an initial and frequent sign of viral respiratory tract infection (RTI) and represents an optimal occasion for early and effective treatment. Most sore throats are caused by a multiplicity of viruses that are highly contagious (e.g., rhinoviruses or coronaviruses). Thus, therapeutic intervention should not only aim to reduce symptoms (anti-inflammatory and anesthetic), but also the viral load and transmission (anti-viral). Both of these actions have been attributed to Echinacea purpurea and Salvia officinalis. The goal of this clinical study was to assess the safety and acute treatment effects of the Echinacea/Salvia lozenges for the treatment of early symptoms of sore throat, associated common cold symptoms, and viral shedding from the very beginning.Methods: A total of 74 patients (age 13-69 years) with acute sore throat symptoms (<48 h) were treated with five Echinacea/Salvia lozenges per day (4000 mg Echinacea purpurea extract [Echinaforce®] and 1893 mg Salvia officinalis extract [A. Vogel Switzerland] daily) for 4 days. Patients recorded throat pain, tonsillopharyngitis, and common cold symptoms and provided throat swab samples to assess the viral load before, during and after therapy.Results: The lozenges had 99% (very) good ratings and were exceptionally well-tolerated according to the physician and patients. A single lozenge significantly reduced viral load by 62% (p<0.03), and a 4-day treatment by 96% (p<0.02). Ninety minutes after the first dose, throat pain was reduced by 48% (p<0.001) and tonsillopharyngitis symptoms, such as difficulty of swallowing, salivation, and reddening, by 34% (p<0.001). At the end of treatment, pain, sore throat, and additional common cold symptoms, such as nasal and systemic complaints, were reduced by more than 83% (p<0.001). The physician’s assessment of throat status ultimately confirmed the patient-reported positive treatment outcome. Finally, no complicated RTI developed during therapy, and no antibiotic treatment was required (0%).Conclusions: Echinacea/Salvia lozenges represent an effective option for the early treatment of acute sore throats with a wide safety margin. Importantly, antiviral effects immediately reduce viral shedding and potentially the transmission of RTIs from the very start of treatment.

INTRANASAL APPLICATION OF LACTOCOCCUS LACTIS W 136 BACTERIA EARLY IN SARS-Cov-2 INFECTION MAY HAVE A BENEFICIAL IMMUNOMODULATORY EFFECT: A PROOF-OF-CONCEPT STUDY

ABSTRACTJustificationStimulation of early innate anti-viral responses during the early phase of SARS-COV-2 infection oxygen may improve evolution of illness and late pulmonary complications. This may be possible using a TLR agonist such as a probiotic bacterium possessing desirable immunomodulatory properties.MethodWe performed a non-contact, open-label, prospective randomized clinical trial comparing intranasally applied Lactococcus lactis W136 with saline irrigation alone in patients within 96 hours of diagnosis of SARS-COV-2 infection not requiring supplemental oxygen.ResultsTwenty-three of a planned forty participants aged 18-59 without comorbidities were recruited. Irrigation with intranasal L lactis W136 twice-daily for fourteen days of was associated with a nasal response characterised by increase in the symptom of Facial and Throat pain/discomfort, and with a lesser severity in symptoms of i) Fatigue ii) Olfactory dysfunction and iii) Breathlessness. Safety and tolerability were good, with no acute infections or severe deteriorations.InterpretationFacial and throat pain may correspond to postulated mechanism of action corresponding to activation of innate defences with antiviral effects and may explain the potentially protective effects seen. Intranasal L lactis W136 irrigations may thus represent a potentially inexpensive, safe, and easily scalable non-antigen based therapeutic for the continuing global SARS-COV-2 pandemic.Data availability statementData is available on request from the senior author, Dr Desrosiers: [email protected] work was supported with internal funds from the Desrosiers laboratory at the Centre de Recherche du Centre Hospitaller de l’Université de Montreal (CRCHUM).Competing InterestsDr Desrosiers holds equity in Probionase Therapies inc., Which commercialises Lactococcus lactis W136 for chronic rhinosinusitis.