Chronic tonsillitis and biofilms: a brief overview of treatment modalities

Is There any Association between Vitamin D Deficiency and Recurrent Tonsillopharyngitis? An Updated Systematic Review

Introduction: It has been theorized that vitamin D deficiency is directly associated with the occurrence of recurrent tonsillopharyngitis. The purpose of this study was to investigate the potential association between vitamin D levels and recurrent tonsillopharyngitis. Methods:We searched the databases of PubMed, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) until the 15th of August 2023. Original articles of any study design assessing the correlation between recurrent tonsillopharyngitis and vitamin D levels in both pediatric and adult patients were considered. Serum 25-hydroxyvitamin D level was the measured outcome. Quality assessment was carried out by using the Newcastle-Ottawa scale (NOS) for observational studies. Results:Eleven observational studies with a total of 2 503 participants were included in this systematic review. The qualitative synthesis revealed a possible association between recurrent tonsillopharyngitis and vitamin D deficiency. All studies, except one study, demonstrated a statistically significant association between the two conditions. As per our quality appraisal, all papers were deemed to be of moderate or good quality. Conclusion:This study shows a potential association between vitamin D deficiency and the development of recurrent tonsillopharyngitis. Future studies should not only investigate this association in a more comprehensive manner but also assess the prevention potential of vitamin D supplementation on tonsillopharyngitis pathogenesis.

Modeling human immune responses to vaccination in vitro

The human immune system is a complex network of coordinated components that are crucial for health and disease. Animal models, commonly used to study immunomodulatory agents, are limited by species-specific differences, low throughput, and ethical concerns. In contrast, in vitro modeling of human immune responses can enable species- and population-specific mechanistic studies and translational development within the same study participant. Translational accuracy of in vitro models is enhanced by accounting for genetic, epigenetic, and demographic features such as age, sex, and comorbidity. This review explores various human in vitro immune models, considers evidence that they may resemble human in vivo responses, and assesses their potential to accelerate and de-risk vaccine discovery and development.

Evaluation of Guidelines For Tonsillectomy in Adults With Recurrent Acute Tonsillitis

OBJECTIVES

The criteria for selecting patients with recurrent acute tonsillitis (RT) for tonsillectomy remain unsettled and different guidelines are used internationally. We aimed to evaluate currently used guidelines for tonsillectomy in adults with RT and identify the best predictive parameters for improved throat-related quality of life (TR-QOL) after surgery.

METHODS

About 66 RT patients undergoing tonsillectomy was prospectively included and categorized into 3 groups based on which guideline(s) they met: Group 1: patients not meeting any of the Danish/Paradise/Scottish Intercollegiate Guideline Network (SIGN) guidelines. Group 2: patients meeting the Danish guidelines. Group 3: patients meeting the Paradise and/or the SIGN guidelines. TR-QOL was assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) before and 6 months after tonsillectomy as well as the Glasgow Benefit Inventory (GBI). Predictive parameters for improved TR-QOL were investigated using multiple linear regression.

RESULTS

About 61 (92%) patients completed the questionnaires. Patients in all groups had significant TR-QOL improvements (Group 1 (n = 20): ΔTOI-14 31.1; GBI 29.4; Group 2 (n = 31): ΔTOI-14 32.0; GBI 36.4; Group 3 (n = 10): ΔTOI-14 45.6; GBI 39.7) and satisfaction rates were high (94%-100%). Preoperative TOI-14 score was the best predictor for improved TR-QOL (P < .001, R2 = .80), followed by the number of tonsillitis episodes with physician verification within the previous 12 months (P = .002, R2 = .25).

CONCLUSIONS

Patients in all groups experienced massive TR-QOL improvements suggesting that currently used guidelines may be too restrictive. Preoperative TOI-14 score was the best parameter for predicting TR-QOL improvement, and this tool may be useful in the selection of adults with RT for tonsillectomy.

Effect of Body Mass Index on Post Tonsillectomy Hemorrhages

AIMS

Obesity affects adverse outcomes in patients undergoing various surgeries. The study was carried out to assess the clinical association between body mass index and post tonsillectomy hemorrhages.

MATERIALS AND METHODS

This prospective study was carried out on 60 patients, age between 5 and 40 years, admitted in Department of ENT with chronic tonsillitis. Body mass index and post tonsillectomy hemorrhage were evaluated in all patients who underwent surgery. Bleeding episode were categorized according to the Austrian tonsil study.

RESULTS

This prospective study was carried out on 60 patients (adults and children), between December 2021 and November 2022. All patients underwent tonsillectomy under general anaesthesia. It was seen that most of the patients did not have any significant bleeding i.e., Grade A1 (Dry, no clot), and A2 (Clot, but no active bleeding after clot removal) whereas 4 patients (6.7%) had Grade B1 post tonsillectomy hemorrhage (Minimal bleeding requiring minimal intervention by vasoconstriction using adrenaline swab). Post tonsillectomy hemorrhage was seen more in adults. Post tonsillectomy bleeding of Grade B1 was recored in 28.6% of underweight patients, 8% of normal weight patients and no significant bleeding occurred in any of the overweight and obese patients (p-value 0.256).

CONCLUSION

Overweight and obesity (higher BMI) did not increase the risk of post tonsillectomy hemorrhage in either children or adults.

IgG4 Positivity in Chronic Tonsillitis: A New Component of IgG4-Related Disease?

OBJECTIVE

Immunoglobulin G4-related disease (IgG4-RD) and chronic tonsillitis are both chronic fibroinflammatory diseases in which tissue atrophy is sometimes observed. In this study, the authors aimed to investigate the pathologic IgG4 positivity in tonsillectomy specimens and hypothesized to name it as a new clinical component of IgG4-RD if there is significant IgG4 positivity in chronic tonsillitis.

METHODS

A total of 73 patients who underwent tonsillectomy for chronic tonsillitis were included in this study. Of these, 31 patients had atrophic form chronic tonsillitis. Pathologic examinations and specific IgG4 immunohistochemical staining were performed by the same experienced pathologist in terms of IgG4-RD.

RESULTS

Sixty-three percent (n=46) of the cases were male, 37% (n=27) were female, their ages ranged from 3 to 51, and the mean age was 19.11±14.82. It was determined that 23.3% (n=17) of the cases participating in the study were IgG4-positive. When the pathologic grades of the cases were examined; it was observed that 13.7% (n=10) were Grade I, 65.8% (n=48) were Grade II, and 20.5% (n=15) were Grade III. A statistically significant difference was found between the pathology degrees of the cases according to the IgG4 groups ( P =0.001; P <0.01).

CONCLUSION

The authors concluded that as the histopathologic grades of chronic lymphoplasmacytic inflammation in tonsils specimen increase, IgG4 positivity rates also increase. Therefore, this clinical entity may be a new IgG4-related disease state in cases with chronic tonsillitis.

LEVEL OF EVIDENCE

Level II.

Recent Advances of Composite Nanomaterials for Antibiofilm Application

A biofilm is a microbial community formed by bacteria that adsorb on the surface of tissues or materials and is wrapped in extracellular polymeric substances (EPS) such as polysaccharides, proteins and nucleic acids. As a protective barrier, the EPS can not only prevent the penetration of antibiotics and other antibacterial agents into the biofilm, but also protect the bacteria in the biofilm from the attacks of the human immune system, making it difficult to eradicate biofilm-related infections and posing a serious threat to public health. Therefore, there is an urgent need to develop new and efficient antibiofilm drugs. Although natural enzymes (lysozyme, peroxidase, etc.) and antimicrobial peptides have excellent bactericidal activity, their low stability in the physiological environment and poor permeability in biofilms limit their application in antibiofilms. With the development of materials science, more and more nanomaterials are being designed to be utilized for antimicrobial and antibiofilm applications. Nanomaterials have great application prospects in antibiofilm because of their good biocompati-bility, unique physical and chemical properties, adjustable nanostructure, high permeability and non-proneness to induce bacterial resistance. In this review, with the application of composite nanomaterials in antibiofilms as the theme, we summarize the research progress of three types of composite nanomaterials, including organic composite materials, inorganic materials and organic-inorganic hybrid materials, used as antibiofilms with non-phototherapy and phototherapy modes of action. At the same time, the challenges and development directions of these composite nanomaterials in antibiofilm therapy are also discussed. It is expected we will provide new ideas for the design of safe and efficient antibiofilm materials.

Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery

Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.

Selected SNPs of FCN2 Associated with Chronic Tonsillitis in the Polish Adult Population

Chronic tonsillitis is a problem related to bacterial and viral infections. Ficolins play a key role in the defence against various pathogens. In the present study, we investigated the associations between the selected single nucleotide polymorphisms (SNPs) of the FCN2 gene and chronic tonsillitis in the Polish population. The study included 101 patients with chronic tonsillitis and 101 healthy individuals. The selected SNPs of FCN2 (rs3124953, rs17514136 and rs3124954) were genotyped using TaqMan SNP Genotyping Assays (Applied Biosystem, Foster City, CA, USA). The analysis of rs17514136 and rs3124953 showed no significant differences in genotype frequencies between the chronic tonsillitis patients and controls (p > 0.01). The CT genotype of rs3124954 was significantly more frequent, while the CC genotype was less frequent in chronic tonsillitis patients (p = 0.003 and p = 0.001, respectively). The frequency of the A/G/T haplotype (rs17514136/rs3124953/rs3124954) was significantly more common in chronic tonsillitis patients (p = 0.0011). Moreover, the FCN2 CT genotype of rs3124954 was associated with a higher risk of chronic tonsillitis, while the CC genotype of rs3124954 decreased this risk. Our findings demonstrate that FCN2 rs3124954 may be associated with chronic tonsillitis in the Polish adult population.

The role of nanocomposites against biofilm infections in humans

The use of nanomaterials in several fields of science has undergone a revolution in the last few decades. It has been reported by the National Institutes of Health (NIH) that 65% and 80% of infections are accountable for at least 65% of human bacterial infections. One of their important applications in healthcare is the use of nanoparticles (NPs) to eradicate free-floating bacteria and those that form biofilms. A nanocomposite (NC) is a multiphase stable fabric with one or three dimensions that are much smaller than 100 nm, or systems with nanoscale repeat distances between the unique phases that make up the material. Using NC materials to get rid of germs is a more sophisticated and effective technique to destroy bacterial biofilms. These biofilms are refractory to standard antibiotics, mainly to chronic infections and non-healing wounds. Materials like graphene and chitosan can be utilized to make several forms of NCs, in addition to different metal oxides. The ability of NCs to address the issue of bacterial resistance is its main advantage over antibiotics. This review highlights the synthesis, characterization, and mechanism through which NCs disrupt Gram-positive and Gram-negative bacterial biofilms, and their relative benefits and drawbacks. There is an urgent need to develop materials like NCs with a larger spectrum of action due to the rising prevalence of human bacterial diseases that are multidrug-resistant and form biofilms.

Analysis of Tonsil Tissues from Patients Diagnosed with Chronic Tonsillitis-Microbiological Profile, Biofilm-Forming Capacity and Histology

Chronic tonsillitis (CT) is a global health issue which can impair patient's quality of life and has an important socioeconomic impact due to the nonrational use of antibiotics, increased antimicrobial resistance and frequent need for surgical treatment. In order to isolate and identify the causing agents of CT, a total of 79 postoperative palatine and adenoid tissue samples were obtained from the ENT Clinic, KBC Zvezdara, Belgrade, Serbia. Culture identification was performed by MALDI-TOF MS and the Staphylococcus aureus isolates were tested for biofilm forming capability and antibiotic susceptibility. Additionally, a histological examination of palatine and adenoid tissue was performed in order to detect the presence of CT-causing bacteria. The slight majority of participants were females with median age of 28 years for adult patients (group I) and 6 years for children (group II). Analysis of the incidence of bacteria isolated from tissue samples in both groups showed the highest prevalence of S. aureus, Streptococcus oralis and Streptococcus parasanquinis. In addition to interfollicular hyperplasia, colonies of species S. aureus were detected in histological material. The presence of biofilm might be the reason for the recurrence of infection. Therefore, searching for a new treatment of CT is of great importance.

Analysis of Microorganism Colonization, Biofilm Production, and Antibacterial Susceptibility in Recurrent Tonsillitis and Peritonsillar Abscess Patients

Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are complicated by peritonsillar abscesses (PTAs). The treatment of RT and PTAs remains surgical, and tonsillectomies are still relevant. Materials and methods: In a prospective, controlled study, we analyzed the bacteria of the tonsillar crypts of 99 patients with RT and 29 patients with a PTA. We performed the biofilm formation and antibacterial susceptibility testing of strains isolated from study patients. We compared the results obtained between patient groups with the aim to identify any differences that may contribute to ongoing symptoms of RT or that may play a role in developing PTAs. Results: The greatest diversity of microorganisms was found in patients with RT. Gram-positive bacteria were predominant in both groups. Candida species were predominant in patients with a PTA (48.3% of cases). Irrespective of patient group, the most commonly isolated pathogenic bacterium was S. aureus (in 33.3% of RT cases and in 24.14% of PTA cases). The most prevalent Gram-negative bacterium was K. pneumoniae (in 10.1% of RT cases and in 13.4% of PTA cases). At least one biofilm-producing strain was found in 37.4% of RT cases and in 27.6% of PTA cases. Moderate or strong biofilm producers were detected in 16 out of 37 cases of RT and in 2 out of 8 PTA cases. There was a statistically significant association found between the presence of Gram-positive bacteria and a biofilm-formation phenotype in the RT group and PTA group (Pearson χ2 test, p < 0.001). S. aureus and K. pneumoniae strains were sensitive to commonly used antibiotics. One S. aureus isolate was identified as MRSA. Conclusions: S. aureus is the most common pathogen isolated from patients with RT, and Candida spp. are the most common pathogens isolated from patients with a PTA. S. aureus isolates are susceptible to most antibiotics. Patients with RT more commonly have biofilm-producing strains, but patients with a PTA more commonly have biofilm non-producer strains. K. pneumoniae does not play a major role in biofilm production.

Is Helicobacter pylori colonization associated with chronic tonsillitis? - A meta-analysis and systematic review

PURPOSE

The aim of this study was to investigate the correlation between Helicobacter pylori colonization of tonsillar tissue in chronic tonsillitis and in noninfectious hyperplastic tonsils.

MATERIALS AND METHODS

All included studies investigated the presence of Helicobacter pylori in tonsillar tissue removed for infectious or noninfectious factors. Included studies must have used an accepted method of testing for Helicobacter pylori. We pooled six eligible studies to perform a traditional meta-analysis.

RESULTS

Six studies were included, including 462 patients. Helicobacter pylori does have a significant role in chronic tonsillitis compared with noninfectious indications for tonsillectomy for children population. Detection methods had effects on results.

CONCLUSION

The positive rate of Helicobacter pylori in chronic tonsillitis group was significantly higher than that in simple noninfectious group for the pediatric population, but not for adults. We suspected that chronic tonsillitis is likely to be relevant to Helicobacter pylori.

Antibiotic use and resistance in a tertiary care hospital: knowledge and attitude among patients of orthopaedic and surgical wards in Malaysia

Objectives

The prevalence of antimicrobial resistance (AMR) is rising globally as well as in Malaysia. AMR can lead to difficulty in the treatment of chronic infection if being neglected. This study aimed to assess the level of knowledge and attitude about antibiotic usage and AMR.

Methods

A cross-sectional study design was carried out at the Hospital Kuala Lumpur (HKL), Malaysia, where participants were recruited by using the non-probability convenience sampling from the six orthopaedic and four surgical wards. A self-administered questionnaire was used to collect the required data which were then analysed by using SPSS.

Key findings

A total number of 390 adult Malaysians (286 from orthopaedic wards and 104 from surgical wards) were involved in the study. This study showed that the level of knowledge and attitude about antibiotics among the majority of respondents were moderate. However, their knowledge regarding AMR was very low (i.e. lack of knowledge). In contrast, the majority of them (69.8%) showed a positive attitude towards antibiotics. Statistical analysis of data revealed that the level of knowledge of AMR was significantly associated with gender, age, race, marital status, educational level and knowledge about antibiotic resistance terms (P &lt; 0.05) while respondents’ attitude towards antibiotic usage was significantly associated with gender, race, marital status and education level (P &lt; 0.05).

Conclusions

It was necessary to formulate and develop strategies to improve the knowledge and awareness about antibiotics and AMR among health professionals. These might help them to improve their skills in delivering health information to the patients through a proper counselling technique.

Strategies for Antimicrobial Peptides Immobilization on Surfaces to Prevent Biofilm Growth on Biomedical Devices

Nosocomial and medical device-induced biofilm infections affect millions of lives and urgently require innovative preventive approaches. These pathologies have led to the development of numerous antimicrobial strategies, an emergent topic involving both natural and synthetic routes, among which some are currently under testing for clinical approval and use. Antimicrobial peptides (AMPs) are ideal candidates for this fight. Therefore, the strategies involving surface functionalization with AMPs to prevent bacterial attachment/biofilms formation have experienced a tremendous development over the last decade. In this review, we describe the different mechanisms of action by which AMPs prevent bacterial adhesion and/or biofilm formation to better address their potential as anti-infective agents. We additionally analyze AMP immobilization techniques on a variety of materials, with a focus on biomedical applications. Furthermore, we summarize the advances made to date regarding the immobilization strategies of AMPs on various surfaces and their ability to prevent the adhesion of various microorganisms. Progress toward the clinical approval of AMPs in antibiotherapy is also reviewed.

Plant-derived nanotherapeutic systems to counter the overgrowing threat of resistant microbes and biofilms

Since antiquity, the survival of human civilization has always been threatened by the microbial infections. An alarming surge in the resistant microbial strains against the conventional drugs is quite evident in the preceding years. Furthermore, failure of currently available regimens of antibiotics has been highlighted by the emerging threat of biofilms in the community and hospital settings. Biofilms are complex dynamic composites rich in extracellular polysaccharides and DNA, supporting plethora of symbiotic microbial life forms, that can grow on both living and non-living surfaces. These enforced structures are impervious to the drugs and lead to spread of recurrent and non-treatable infections. There is a strong realization among the scientists and healthcare providers to work out alternative strategies to combat the issue of drug resistance and biofilms. Plants are a traditional but rich source of effective antimicrobials with wider spectrum due to presence of multiple constituents in perfect synergy. Other than the biocompatibility and the safety profile, these phytochemicals have been repeatedly proven to overcome the non-responsiveness of resistant microbes and films via multiple pathways such as blocking the efflux pumps, better penetration across the cell membranes or biofilms, and anti-adhesive properties. However, the unfavorable physicochemical attributes and stability issues of these phytochemicals have hampered their commercialization. These issues of the phytochemicals can be solved by designing suitably constructed nanoscaled structures. Nanosized systems can not only improve the physicochemical features of the encapsulated payloads but can also enhance their pharmacokinetic and therapeutic profile. This review encompasses why and how various types of phytochemicals and their nanosized preparations counter the microbial resistance and the biofouling. We believe that phytochemical in tandem with nanotechnological innovations can be employed to defeat the microbial resistance and biofilms. This review will help in better understanding of the challenges associated with developing such platforms and their future prospects.

The Prevalence of High- and Low-Risk Types of HPV in Patients with Squamous Cell Carcinoma of the Head and Neck, Patients with Chronic Tonsillitis, and Healthy Individuals Living in Poland

Human papillomavirus (HPV) is a virus with the potential to infect human epithelial cells and an etiological agent of many types of cancer, including head and neck cancer. The aim of the study was to determine the prevalence of HPV infection in patients with head and neck squamous cell carcinoma (HNSCC), patients with chronic tonsillitis, and healthy individuals, and to establish high- and low-risk HPV genotypes in these groups. The objectives also comprised the delineation of the relationship between the infection with high- or low-risk HPV subtypes and clinicopathological and demographic characteristics of the study groups. This study was composed of 76 patients diagnosed with HNSCC, 71 patients with chronic tonsillitis, and 168 cases without either of these conditions (the control group). HPV detection and identification of subtypes were performed on isolated DNA using a test which allowed detection of 33 common high-risk and low-risk HPV subtypes. The prevalence of HPV infection was 42.1%, 25.4%, and 37.5% in HNSCC, chronic tonsillitis, and control groups, respectively. HPV 16 was the most prevalent genotype in all groups and the non-oncogenic HPV 43/44 was frequent in HNSCC patients. This analysis provides insight into the prevalence of oral oncogenic and non-oncogenic HPVs in patients with head and neck cancer, patients with chronic tonsillitis and healthy individuals, and leads to the conclusion that further investigations are warranted to examine a larger cohort of patients focusing on high- and low-risk HPV genotypes. Efforts should be focused on screening and prevention strategies, and therefore, it is important to introduce tools for effective detection of HPV genotypes. Furthermore, given the role of vaccines against oral HPV infection, our observations lead to the suggestion that HPV vaccination should be of considerable importance in public health strategies.

S. aureus and K. pneumoniae on the Surface and within Core of Tonsils in Adults with Recurrent Tonsillitis

Background and Objectives: Recurrent tonsillitis is an infection of the palatine tonsils. Samples for microbiological testing are usually obtained from the inflamed surface of the tonsils. Colonizing the surface bacteria does not always correlate with pathogens causing recurrent tonsillitis and there is no consensus or this in research studies. The aim of the study was to compare whether Staphylococcus aureus (S. aureus) and Klebsiella pneumoniae (K. pneumoniae) differ when isolated from the tonsillar surface or tonsillar crypts in patients with recurrent tonsillitis. Materials and Methods: a case series study was conducted at a tertiary referral center among 25 patients diagnosed with recurrent tonsillitis. An evaluation of S. aureus and K. pneumoniae incidence, biofilm formation and antibacterial susceptibility was performed. Results: There was a statistically significant association between surface and punch biopsy samples for S. aureus (Fisher’s Exact test p = 0.004) and K. pneumoniae (Fisher’s Exact test p < 0.001). A McNemar test did not reveal a statistically significant association. Although the antibacterial resistance profile was not broad, five out of nine S. aureus isolates were biofilm producers and four out of five K. pneumoniae isolates were biofilm producers. Conclusions: Surface and core cultures of tonsils are comparable with a differing incidence between the surface and the punch biopsy cultures for S. aureus and K. pneumoniae. A larger quantity of bacteria exist in surface samples suggesting that a biopsy sample may be less challenging in evaluating recurrent tonsillitis. We recommend that antibacterial susceptibility results are considered alongside the biofilm-forming potential of isolated bacteria.

The investigation of bacterial adhesion of palatine tonsils epithelial cells in patient with infectious mononucleosis

Aim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms by using the pharynx palatine tonsils epithelium electron microscopic examination of the patients with infectious mononucleosis and acute streptococcal tonsillitis. Materials and methods. Two patients – patient P., 12 years old with a confirmed diagnosis of infectious mononucleosis and patient A., 8 years old with confirmed acute streptococcal tonsillitis. The patients were taken a bacteriological examination of the mucus and epithelium scraping from the surface of the pharyngeal tonsils. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University. Results and discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria: Diphtheroides sp., Neisseria sp., Corynebacterium spp. were identified as result of the patient P. bacteriological examination of mucus from the surface of the pharyngeal tonsils. Staph. aureus, Str. viridans, Str. pneumoniae were identified during a bacteriological examination of patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient’s tonsils with acute tonsillitis. Research showed that bacteria were accumulated not only in the structure of extracellular detritus. Numerous bacteria accumulations were also found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis. The cell's shape looked like a bunch of grapes. Conclusions. The electron microscopic examination showed differences in the coccal flora localization: the extracellular localization of bacteria in the patient with acute bacterial tonsillitis and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found.

Efficacy of topical application of autologous platelet-rich plasma in adult tonsillectomy patients: a randomised control study

OBJECTIVE

Tonsillectomy is a painful surgery performed in cases of recurrent tonsillitis. Application of platelet-rich plasma to diminish the pain and morbidity post-tonsillectomy is gaining importance. This study evaluated post-operative pain and morbidity after autologous platelet-rich plasma application on the tonsil beds during tonsillectomy.

METHOD

Participants were randomised into group 1 (n = 28, peri-operative platelet-rich plasma intervention) and group 2 (n = 28, control). Post-tonsillectomy, patients were assessed (day 0, 1, 2, 3, 7 and 14) for pain, healing and time taken to return to normal activity. Data were analysed by independent t-test and chi-square test with p ≤ 0.05 as the significance level.

RESULTS

A significant decrease in the mean pain score up to day 7 (p < 0.05) and tonsillar fossae healing on days 2 and 3 (p < 0.05) post-tonsillectomy was noted. The majority of the patients returned to their routine activities after a week post-tonsillectomy.

CONCLUSION

Platelet-rich plasma application was effective in accentuating healing and reducing post-tonsillectomy pain and morbidity.

Effect of a low temperature plasma knife on the treatment of chronic tonsillitis and its effect on T lymphocyte subsets

OBJECTIVE

To investigate the effect of a low temperature plasma knife on the treatment of chronic tonsillitis and its effect on T lymphocyte subsets.

METHODS

A total of 70 patients diagnosed with tonsillitis from March 2017 to October 2018 were selected as research subjects. Among them, patients treated by routine surgery were placed into the control group (33 cases), and patients treated by low temperature plasma knife were placed in the observation group (37 cases). The clinical efficacy, intraoperative blood loss, operative time, time of complete white membrane coverage, time of complete white membrane shedding, pain scoring, adverse reactions and the influence on T cell subsets between the two groups were compared.

RESULTS

The clinical treatment efficacy of the observation group was significantly higher than that of the control group (P<0.05). The operative time, intraoperative blood loss, time of complete white membrane coverage and time of complete white membrane shedding in the observation group were significantly lower than those in the control group. The pain score of patients in the observation group was significantly lower than in the control group on 1 d, 3 d and 5 d after surgery (P<0.05), while there was no significant difference in pain score between the two groups 7 d after surgery (P>0.05). There was no significant difference between the observation group and the control group in postoperative blood loss, torus tubarius injury and adverse nasal adhesion (P>0.05). The total curative effective rate of the control group was significantly lower than that of the observation group (P<0.05).

CONCLUSION

To sum up, a low temperature plasma knife has good effects in the treatment of chronic tonsillitis, which can alleviate the pain response of patients without increasing the incidence of adverse reactions, and as such it is worthy of clinical promotion.

An Up-to-Date Review on Bio-Resource Therapeutics Effective against Bacterial Species Frequently Associated with Chronic Sinusitis and Tonsillitis

Upper respiratory tract infections include inflammations of the nose, sinuses (sinusitis), pharynx (tonsillitis, pharyngitis) and larynx (laryngitis) with bacteria or viruses as the main cause of these conditions. Due to their repetitive nature, chronic respiratory infections represent a global problem which is often a result of improper treatment. If not treated adequately, these conditions may have serious consequences. On the other hand, mis - and overuse of antibiotics has reduced their efficiency and accelerated the development of resistant bacterial strains, which further complicates the treatment of infections. This literature review will focus on current knowledge regarding medicinal plants and mushrooms which have been traditionally used in the treatment of infections caused by chronic sinusitis and tonsillitis commonly linked to bacteria - Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Fusobacterium nucleatum, Haemophilus influenzae and Moraxella catarrhalis. The present literature overview might be considered as a starting point for the development of novel, natural antimicrobial products with potential practical use in the treatment of chronic tonsillitis and sinusitis.

The effects of radiofrequency on the bacteriological and histological characteristics of tonsils in patients with chronic and persistent tonsillitis

OBJECTIVES

Tonsillotomy with radiofrequency (RF) is one of the newest treatments for chronic tonsillitis, but the mechanism of RF effects and complications are still pending. The aim of this study was to evaluate the effects of RF on the histological and bacteriological characteristics of the tonsils (Case-control study).

MATERIALS AND METHODS

In fifty-two patients with chronic tonsillitis in 2017-2018, immediately after tonsillectomy, the tonsils were divided into 2sections; one sample treated with RF, and the other one considered as control, without intervention. All tonsil samples sent for histological and bacteriological study: morphometric assays made by Digitizer software, and type of bacterial colonies identified by microbiological and biochemical tests. Willcoxon and McNemar tests were used for statistical analysis and level of significance was p ≤ .05.

RESULTS

Tonsil mucosal thickness (2202.98 ± 323.09 vs. 2463.94 ± 357.61 μm) and size of the tonsil nodule (28,000.42 ± 9608.75 vs. 36,692.81 ± 7040.74 μm²) were significantly lower in the RF+ group than other group (p = .001 and p = .01, respectively). There was no significant differences in thickness of the tonsil epithelium (p = .075), number of lymphoid nodules (p = .860), and the number of reticular tonsil epithelium (p = .813) between the two groups. Bacterial growth in RF- and RF+ groups had no statistically significant difference (p = .06), however, the average colony count of S. aureus in RF+ tonsils were significantly lower, and total number of bacterial colonies were significantly lower in RF+ group(1405 ± 156 vs. 2471 ± 156), (p = .001).

CONCLUSION

RF surgery has significant effects on size of the nodules, thickness of the mucous layer and bacteriological characteristics of tonsil tissue. Especially S. aureus seems to be more sensitive to RF effects.

Effectiveness of TCM cauterization in recurrent tonsillitis: A protocol for systematic review and meta-analysis

INTRODUCTION

Recurrent tonsillitis (RT) is often treated with antibiotic therapy and surgery. Although these treatments have advantages, they are also controversial. The purpose of this study is to analyze the safety and effectiveness of traditional Chinese medicine (TCM) cauterization in the treatment of RT, so as to provide an alternative for the clinicians and to cover the shortage of therapeutic methods.

METHODS AND ANALYSIS

This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. We will formulate strict inclusion and exclusion criteria in English databases (PubMed, EMBASE, and Web of Science), Chinese databases (CNKI, Wanfang databases, CBM, and VIP), and search literatures in different clinical registration platforms (Cochrane Library, Chinese Cochrane Centre's Clinical Trial Registry Platform). The included articles will be evaluated using Cochrane RCT evaluation criteria. Stata 15.0 will be used for data analysis. Subgroup analysis, sensitivity analysis, and meta-regression will detect sources of heterogeneity. Egger's Test or Begg's Test will detect publication bias quantitatively.

CONCLUSION

Cauterization can effectively control the recurrence of tonsillitis through clinical trials, but evidence-based medicine needs to be adopted to provide strong evidence for its effectiveness. The purpose of our research is to provide the evidence.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/PZ69Q.

Fractionation of Biomolecules in Withania coagulans Extract for Bioreductive Nanoparticle Synthesis, Antifungal and Biofilm Activity

Withania coagulans contains a complex mixture of various bioactive compounds. In order to reduce the complexity of the plant extract to purify its phytochemical biomolecules, a novel fractionation strategy using different solvent combination ratios was applied to isolate twelve bioactive fractions. These fractions were tested for activity in the biogenic synthesis of cobalt oxide nanoparticles, biofilm and antifungal activities. The results revealed that plant extract with bioactive fractions in 30% ratio for all solvent combinations showed more potent bioreducing power, according to the observed color changes and the appearance of representative absorption peaks at 500-510 nm in the UV-visible spectra which confirm the synthesis of cobalt oxide nanoparticles (Co3O4 NPs). XRD diffraction was used to define the crystal structure, size and phase composition of the products. The fractions obtained using 90% methanol/hexane and 30% methanol/hexane showed more effectiveness against biofilm formation by Pseudomonas aeruginosa and Staphylococcus aureus so these fractions could potentially be used to treat bacterial infections. The 90% hexane/H2O fraction showed excellent antifungal activity against Aspergillus niger and Candida albicans, while the 70% methanol/hexane fraction showed good antifungal activity for C. albicans, so these fractions are potentially useful for the treatment of various fungal infections. On the whole it was concluded that fractionation based on effective combinations of methanol/hexane was useful to investigate and study bioactive compounds, and the active compounds from these fractions may be further purified and tested in various clinical trials.

Analysis of Biochemical Parameters in Children with Chronic Tonsillitis

Chronic tonsillitis are frequent in pediatric pathology with numerous involved risk factors and pathogenic mechanisms. In this study, epidemiological data and biochemical values addressed to inflammation and mineral, lipid and hepatic metabolism were analyzed for 37 children of school age with chronic tonsillitis. We found that in the majority of cases, chronic tonsillitis was associated with increasing number of blood circulating inflammatory cells, high values of transaminases, cholesterol, triglycerides and low values of procalcitonin, C-reactive protein, calcium, vitamin D and serum iron. The results indicated relations of the biochemical profile analyzed with risk factors and systemic mechanisms for initiation and maintenance of chronic tonsillitis, aspects that can be used to optimize the prognosis of chronic tonsillitis in children.

Cellular senescence in recurrent tonsillitis and tonsillar hypertrophy in children

OBJECTIVE

To observe the difference in cellular senescence patterns between recurrent tonsillitis and tonsillar hypertrophy.

METHODS AND MATERIALS

Forty-three patients diagnosed with recurrent tonsillitis or tonsillar hypertrophy, based on medical history and symptoms, underwent tonsillectomy. The specimens were collected and examined using senescence β-galactosidase staining for cellular senescence. Macrophages were detected by immunochemistry.

RESULTS

Cellular senescence was found in both recurrent tonsillitis and tonsillar hypertrophy groups. The comparison of cellular senescence in microcompartments of tonsil tissue (germinal centre, mantle zone, subepithelial and intraepithelial) revealed a significant increase of senescent cells in germinal centres in tonsillar hypertrophy compared with that in tonsillar hypertrophy. The majority of senescent cells in both groups were CD68-positive.

CONCLUSIONS

Different cellular senescence patterns were found between the two studied paediatric tonsillar diseases. Macrophage senescence may play a role in the pathogenesis of these diseases.

Short-term effect of adenotonsillectomy on growth and nutritional anthropometric parameters of children with obstructive adenotonsillar enlargement

Background

Obstructive adenotonsillar enlargement is known to cause failure to thrive in children. The effect of adenotonsillectomy is not well documented on the growth of affected children. The study was carried out to investigate the effect of adenotonsillectomy on growth of children with obstructive adenotonsillar enlargement. It was a quasi-experimental study consisting of 62 children (≤ 12 years) with obstructive adenotonsillar enlargement and 62 healthy controls. Variables measured at baseline, sixth week and 13th week post adenotonsillectomy, were weight, height, mid-upper arm circumference, and triceps skinfold thickness. The percent of weight-for-age and height-for-age were, respectively, calculated by dividing the child’s weight and height by the median expected weight and height (i.e., the 50th percentile) based on the child’s chronological age. The obtained weight-for-age and height-for-age values were used to determine the presence of failure to thrive and stunting, respectively.

Results

Majority (70.6%) of the patients with malnutrition were from a low socioeconomic class. At baseline, failure to thrive and stunting were found among 17 (26.4%) cases and 11 (17.7%) controls, but the proportion reduced to six (9.7%) and three (4.8%), respectively, at the 13th week post adenotonsillectomy. There was a steady increase in weight-for-age, height-for-age, mid-upper arm circumference, and triceps skinfold thickness in both cases and controls from baseline to the 13th week. However, there was a significant difference in percentage variation of these variables between the two groups.

Conclusions

Adenotonsillectomy improved the growth of children with obstructive adenotonsillar enlargement and hence recommended in cases with failure to thrive and stunting.