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Nesemeier R, Jones S, Jacob K, Cash E, Goldman J. Trends in Emergency Department Computed Tomography Usage for Diagnosis of Peritonsillar Abscess. EAR, NOSE & THROAT JOURNAL 2023; 102:NP35-NP39. [PMID: 33433233 DOI: 10.1177/0145561320984996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Peritonsillar abscess (PTA) is the most common deep neck space infection and a frequent cause for otolaryngology consultation. Patients often undergo computed tomography (CT) scan for confirmation in addition to physical examination. Our aims were to determine whether patients unnecessarily undergo CT scans in the emergency department (ED) when presenting with sore throat and identify physical examination characteristics that predict PTA. METHODS The electronic medical records of all patients (>18 years) presenting to an ED between June 2014 and June 2015 with a primary diagnosis of acute pharyngitis, acute tonsillitis, or PTA were reviewed for presenting symptoms and diagnostic imaging use. RESULTS Four hundred eight patients met inclusion criteria; 21 were diagnosed with PTA, including 13 based on history and physical alone. A total of 21 CT scans were ordered, 11 (52.3%) of which did not demonstrate abscess. Soft palatal fullness, uvular deviation, drooling, and muffled voice were all significantly associated with increased CT usage (all P values <.02). Rising subjective pain scores were associated with increased use of CT imaging (P = .029). Multivariable analyses revealed that soft palatal fullness, uvular deviation, and drooling were all significant predictors of PTA (all P values <.001). CONCLUSIONS Patients with severe symptoms of PTA, including uvular deviation, drooling, and soft palatal fullness, were most likely to undergo CT imaging. Given the high likelihood of PTA, patients presenting with these symptoms could forego CT imaging, reducing exposure to ionizing radiation.
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Affiliation(s)
- Ryan Nesemeier
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shawn Jones
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kevin Jacob
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Julie Goldman
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Development and Application of AR-Based Assessment System for Infant Airway Obstruction First Aid Training. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111622. [PMID: 36360350 PMCID: PMC9688683 DOI: 10.3390/children9111622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
Airway obstruction refers to suffocation caused by blockage of the airway due to a foreign body and is a common cause of accidental death in infants below one year of age. However, the current infant CPR manikins used for training in first aid for foreign body airway obstruction can only be applied to one single scenario. Furthermore, trainees' first aid skills cannot be recorded and quantified with a digital system and, consequently, assessment of their skills is difficult to conduct. This study aims to overcome the technical limitations by developing an AR-based assessment system for training in first aid for infant airway obstruction. With this assessment system, trainees can learn first aid more efficiently and correctly and conduct a quantitative assessment of their skills digitally. For instructors, the time required for assessment, potential human error, and the cost of training can also be reduced. The system can be a practical learning tool that helps trainees assess emergencies and integrate their knowledge and skills.
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Jiang X, Lin A, Li S, Shi Y, Zhou F, Felix Gomez GG, Gregory RL, Zhang C, Chen S, Huang R. Effects of artificial honey and epigallocatechin-3-gallate on streptococcus pyogenes. BMC Microbiol 2022; 22:207. [PMID: 36028794 PMCID: PMC9419396 DOI: 10.1186/s12866-022-02611-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2022] Open
Abstract
Background Streptococcus pyogenes is an important global human pathogen that causes pharyngitis, and antibacterial therapy has become an important part of the overall therapy for pharyngitis. As natural derivatives, honey and green tea are often recommended for patients with pharyngitis in traditional Chinese medicine without experimental theoretical basis on wether the combined effect of honey and green tea on pharyngitis is better than they alone. The aims of this study were to explore the effects of artificial honey (AH) and epigallocatechin-3-gallate (EGCG) on S. pyogenes and elucidate the possible mechanisms, which were investigated using MIC (the minimum inhibitory concentration), FIC (fractional inhibitory concentration) index, growth pattern, biofilm formation and RT-qPCR. Results The MIC of AH on S. pyogenes was 12.5% (v/v) and the MIC of EGCG was 1250 μg/ml. The FIC index of AH and EGCG was 0.5. The planktonic cell growth, growth pattern and biofilm formation assays showed that AH and EGCG mixture had stronger inhibitory effect on S. pyogenes than they alone. RT-qPCR confirmed that the expression of hasA and luxS gene were inhibited by AH and EGCG mixture. Conclusions AH and EGCG mixture can inhibit the planktonic cell growth, biofilm formation and some virulence genes expression of S. pyogenes, better than they alone. The combination of honey and green tea have the potential to treat pharyngitis as natural derivatives, avoiding drug resistance and double infection.
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Affiliation(s)
- Xiaoge Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Orthodontics Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - An Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Shijia Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Orthodontics Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Yangyang Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Endodontic Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fangjie Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Endodontic Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | | | - Richard L Gregory
- Department of Oral Biology, School of Dentistry, Indiana University, Indianapolis, USA
| | - Chaoliang Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Song Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Orthodontics Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
| | - Ruijie Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Oral Biology, School of Dentistry, Indiana University, Indianapolis, USA.
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Shibata J, Osawa I, Ito H, Soeno S, Hara K, Sonoo T, Nakamura K, Goto T. Risk factors of sepsis among patients with qSOFA<2 in the emergency department. Am J Emerg Med 2021; 50:699-706. [PMID: 34879489 DOI: 10.1016/j.ajem.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Studies have suggested that qSOFA can be used for early detection of sepsis immediately upon arrival at the emergency department (ED). Despite this, little is known about the risk factors associated with the subsequent diagnosis of sepsis among patients with qSOFA<2 in the ED. METHODS This is a retrospective cohort study using ED data from a large tertiary medical center in Japan, 2018-2020. We included adult patients (aged ≥18 years) presenting to the ED with suspected infection (e.g., having a fever) and qSOFA<2. We identified patients who developed sepsis based on the Sepsis-3 criteria, and compared patient characteristics (e.g., demographics, vital signs upon the initial triage, chief complaint, and comorbidities) between patients who developed sepsis or not. Additionally, we identified the potential risk factors of sepsis among patients with qSOFA<2 using a multivariable logistic regression model. RESULTS We identified 151 (7%) patients who developed sepsis among 2025 adult patients with suspected infection and qSOFA<2. Compared with patients who did not develop sepsis, patients who developed sepsis were likely to be older and have vital signs suggestive of imminent sepsis (e.g., high respiratory rate). In the multivariable logistic regression model, the potential risk factors of sepsis among patients with qSOFA<2 were older age (adjusted OR, 1.92 [95%CI 1.19-3.19]), vital signs suggestive of imminent sepsis (e.g., adjusted OR of altered mental status, 3.50 [95%CI 2.25-5.50]), receipt of oxygen therapy upon arrival at the ED (adjusted OR, 1.91 [95%CI 1.38-2.26]), chief complaint of sore throat (adjusted OR, 2.15 [95%CI 1.08-4.13]), and the presence of comorbid diabetes mellitus, ischemic heart disease, and chronic kidney disease (e.g., adjusted OR of diabetes mellitus, 1.47 [95%CI 1.10-1.96]). On the contrary, chief complaint of abdominal and chest pain were associated with a lower risk of sepsis (e.g., adjusted OR of abdominal pain, 0.26 [95%CI 0.14-0.45]). CONCLUSIONS We found that older age, vital signs prognosticating sepsis, and the presence of some comorbidities were the potential risk factors of sepsis in patients with qSOFA<2. These potential risk factors could be useful to efficiently recognize patients who might develop sepsis in the ED.
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Affiliation(s)
| | - Itsuki Osawa
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Honoka Ito
- Nursing Course, College of Nursing, School of Medicine and Health Sciences, University of Tsukuba, Japan
| | - Shoko Soeno
- Department of Palliative Care, Southern Tohoku General Hospital, Fukushima, Japan
| | - Konan Hara
- Department of Economics, University of Arizona, AZ, United States; TXP Medical Co. Ltd., Tokyo, Japan
| | - Tomohiro Sonoo
- TXP Medical Co. Ltd., Tokyo, Japan; Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Tadahiro Goto
- TXP Medical Co. Ltd., Tokyo, Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Wijesundara NM, Lee SF, Cheng Z, Davidson R, Rupasinghe HPV. Carvacrol exhibits rapid bactericidal activity against Streptococcus pyogenes through cell membrane damage. Sci Rep 2021; 11:1487. [PMID: 33452275 PMCID: PMC7811018 DOI: 10.1038/s41598-020-79713-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022] Open
Abstract
Streptococcus pyogenes is an important human pathogen worldwide. The identification of natural antibacterial phytochemicals has renewed interest due to the current scarcity of antibiotic development. Carvacrol is a monoterpenoid found in herbs. We evaluated carvacrol alone and combined with selected antibiotics against four strains of S. pyogenes in vitro. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of carvacrol against S. pyogenes were 125 µg/mL (0.53 mM) and 250 µg/mL (1.05 mM), respectively. Kill curve results showed that carvacrol exhibits instantaneous bactericidal activity against S. pyogenes. We also demonstrated the potential mechanism of action of carvacrol through compromising the cell membrane integrity. Carvacrol induced membrane integrity changes leading to leakage of cytoplasmic content such as lactate dehydrogenase enzymes and nucleic acids. We further confirmed dose-dependent rupturing of cells and cell deaths using transmission electron microscopy. The chequerboard assay results showed that carvacrol possesses an additive-synergistic effect with clindamycin or penicillin. Carvacrol alone, combined with clindamycin or penicillin, can be used as a safe and efficacious natural health product for managing streptococcal pharyngitis.
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Affiliation(s)
- Niluni M Wijesundara
- Department of Plant, Food, and Environmental Sciences, Faculty of Agriculture, Dalhousie University, Truro, NS, Canada.,Department of Biology, Faculty of Science, Dalhousie University, Halifax, NS, Canada.,Department of Animal Science, Faculty of Animal Science and Export Agriculture, Uva Wellassa University, Badulla, Sri Lanka
| | - Song F Lee
- Department of Microbiology & Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Applied Oral Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada.,Canadian Center for Vaccinology, Nova Scotia Health Authority, and the Izaak Walton Killam Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Zhenyu Cheng
- Department of Microbiology & Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ross Davidson
- Department of Microbiology & Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Canadian Center for Vaccinology, Nova Scotia Health Authority, and the Izaak Walton Killam Health Centre, Dalhousie University, Halifax, NS, Canada.,Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Division of Microbiology at the Queen Elizabeth II Health Sciences Centre, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - H P Vasantha Rupasinghe
- Department of Plant, Food, and Environmental Sciences, Faculty of Agriculture, Dalhousie University, Truro, NS, Canada. .,Department of Biology, Faculty of Science, Dalhousie University, Halifax, NS, Canada. .,Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. .,National Institute of Fundamental Studies, Kandy, Sri Lanka.
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Wijesundara NM, Rupasinghe HPV. Herbal Tea for the Management of Pharyngitis: Inhibition of Streptococcus pyogenes Growth and Biofilm Formation by Herbal Infusions. Biomedicines 2019; 7:biomedicines7030063. [PMID: 31450579 PMCID: PMC6783935 DOI: 10.3390/biomedicines7030063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022] Open
Abstract
Herbal teas are becoming popular as functional beverages due to their various health promotional properties. This study aimed at assessing 13 hot water infusions (HWIs) from different herbs against streptococcal pharyngitis (strep throat). Licorice root exhibited the lowest minimum inhibitory concentrations (MIC) of 1.56 mg/mL, followed by barberry root, thyme, and oregano flowering shoots, with a MIC of 3.13 mg/mL. At their respective minimum bactericidal concentrations (MBC), licorice showed the bactericidal effect on S. pyogenes within 12 h after exposure while others need 24 h for a similar outcome. The HWIs exhibited inhibitory activity on biofilm formation, ranging from 1.56 to 6.25 mg/mL, which confirmed by ruptured cells or clusters of dead cell debris observed in scanning electron microscope (SEM). Overall, non-toxic concentrations of efficacious HWIs from licorice root, barberry root, thyme, and oregano flowering shoots may provide potential sources for developing herbal teas or biomedicine for the management of S. pyogenes infections.
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Affiliation(s)
- Niluni M Wijesundara
- Department of Biology, Faculty of Science, Dalhousie University, Halifax, NS 3H 4R2, Canada
- Department of Animal Science, Faculty of Animal Science and Export Agriculture, Uva Wellassa University, Badulla 90 000, Sri Lanka
| | - H P Vasantha Rupasinghe
- Department of Plant, Food, and Environmental Sciences, Faculty of Agriculture, Dalhousie University, Truro, NS B2N 5E3, Canada.
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada.
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Oropharyngeal and Tonsillar Infections. HEAD, NECK, AND OROFACIAL INFECTIONS 2016. [PMCID: PMC7151798 DOI: 10.1016/b978-0-323-28945-0.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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