Identification of the Bacterial Gene in Patients Who Repeatedly Develop Streptococcal Pharyngitis

Background: We aimed at determining whether the pathogenic bacteria at the onset of disease are genetically different and whether this affects future choice of the therapeutic methods against group A β-hemolytic streptococcal acute pharyngitis/tonsillitis. Methods: A pharynx swab was collected from pediatric patients who visited our hospital. The swab was cultured, and hemolytic streptococcus was detected 230 times. We isolated pathogenic bacteria of patients infected more than once and examined the bacteria using pulse-field gel electrophoresis. Results: Based on gene search results, we found that if the period of developing relapse was within 1 month from the first infection, all patients had the same gene. However, all patients in whom reinfection occurred after 6 months or later had different pertinent genes. Conclusions: The number of relapse/reinfection is significant for this disease, and considerably caution is essential for its treatment. No changes to antibacterial drug administration may be necessary for the second administration unless more than 6 months have passed since the first infection.

Molecular Identification of Streptococcus pyogenes in Isolates from Children with Pharyngitis, Gezira State, Sudan 2022

Background: Streptococcus pyogenes (Group A streptococcus) is an important Gram-positive human pathogen affected the upper respiratory tract, such as the tonsils and pharynx, and is also induces post-infection diseases such as rheumatic fever and glomerulonephritis. This study aim to isolate Streptococcus pyogenes from children with pharyngitis and to evaluate the molecular identification of S. pyogenes compared with conventional methods. Methods: A cross sectional study was conducted on total of 200 throat swab samples which were collected from children with pharyngitis referred to Wad medani Pediatric Teaching Hospital and Wad medani ENT hospital from January to November 2021. Demographic and clinical data were collected by questionnaire. Throat swabs were tested with the standard microbiological techniques to isolated Group A streptococcus (GAS). Antimicrobial susceptibility testing was performed to all GAS isolates using the Kirby Bauer disk diffusion method according to clinical laboratory standard institute (CLSI) guidelines. Additionally, PCR was used to identify Spy 1258 gene of isolated bacteria. Results: From all throat swab samples screened, 51 isolates (25.5%) were identified as GAS. Antibiotic susceptibility testing revealed that all the GAS isolates were sensitive to Penicillin and Azithromycin. Sensitivity to Erythromycin, Gentamicin, Clarithromycin, Amoxicillin and Cephalexin were 88.2%, 86.3%, 45.1%, 41.2%, 13.7%, respectively. Based on PCR identification of Spy 1258 gene the percentage of isolated bacteria was 21%. Conclusion: The rate of isolated Streptococcus pyogenes was 25.5% by conventional methods and 21% by PCR. The bacteria were sensitive to Penicillin and Azithromycin. The Spy 1258 gene was specific for detection of Streptococcus pyogenes.

Efficacy and safety of atomized inhalation for Shuanghuanglian on chronic pharyngitis:a Meta-analysis of the randomized controlled trials

Objective: As a Chinese drugs preparation to clear heat and remove toxicity, Shuanghuanglian (SHL) has been widely used, but the clinical efficacy and safety of SHL on chronic pharyngitis remain unclear, especially the application of atomized inhalation of SHL need to be verified. The aim of this study was to evaluate its clinical efficacy and safety for chronic pharyngitis. Methods: From the Cochrane Library, Pubmed, EMbase, Wanfang Datebase, CNKI (China National Knowledge Infrastructure), VIP (Chinese Scientifc Journals Database), CBM (Chinese Biomedicine Database), We got the qualified randomized controlled trials(RCTs) and adopted RevMan5.3 software and the risk of bias tool according to the Cochrane to perform a metaanalysis. Results: Ten RCTs, a total of 950 cases (involving 472 cases in SHL group and 478 in control group) were included. The results showed that the clinical efficacy in SHL group was superior to control group [Chi2=5.61, 95%CI (4.29, 11.43), P<0.05], and four literatures reported no obvious adverse reactions in SHL group. Conclusion: Application of atomized inhalation of SHL may have a potential advantage in treating chronic pharyngitis. However, due to the limitation of the quality and sample size of those studies, the accuracy of the result should be treated with caution, higher standardized researches are required to justify the conclusion.

Study on the mechanism of Fructus Forsythiae and Folium Nelumbinis on acute pharyngitis based on network pharmacology

Objective:To explore the mechanism of Lianqiao-Heye(Fructus Forsythiae and Folium Nelumbinis,FF-FN)drug pair in treating acute pharyngitis(AP)by network pharmacology.Methods:The chemical components and potential therapeutic targets of FF-FN drug pair were obtained from TCMSP firstly,and databases GeneCards,DrugBank,OMIM and PharmGKB were utilized to get the genes related to AP and the intersection of the results was obtained.Then Cytoscape software was used to construct drug-component-target network diagram to screen out the key compounds.Protein interaction network(PPI)was established using String database,and the core targets were screened by CytoNCA topology analysis.R language software was used for GO biological function analysis and KEGG pathway analysis.Finally,the docking verification of key compounds and core target molecules was carried out by AutoDock software.Results:A total of 38 active compounds and 917 potential therapeutic targets were obtained from FF-FN drug pair,while a total of 1534 targets were screened out for AP,among which,the number of intersection targets was 117.7 core targets were screened out from PPI core network,with JUN,TP53,CXCL8 and RELA included.A total of 2487 biological processes were involved in GO enrichment analysis,and 157 related pathways were screened out by KEGG.Based on results of molecular docking verification,the key compounds such as quercetin,luteolin and wogonin in FF-FN drug pair were proved capable of binding to the core targets and a good affinity was shown.Conclusion:FF-FN pair can intervene AP through multiple targets and multiple pathways,including PI3KAkts signaling pathway,AGE-RAGE signaling pathway and IL-17 signaling pathway.The combination of quercetin,luteolin,wogonin,kaempferol andβ-sitosterol with JUN,RELA,MAPK1,TNF and MYC can possibly be one of the mechanisms regarding to the therapeutic effect.

rapid strep testing in children with recently treated streptococcal pharyngitis

Importance:The use of the rapid antigen-detection test(RADT)has become the standard of care in the early diagnosis of group A beta-hemolytic Streptococcus(GAS)pharyngitis.Concern has been expressed over increased false positives when the child had been treated recently for GAS pharyngitis,resulting in over use of antibiotics.Objective:To determine if the false positive rate for RADT is increased in children recently treated for GAS pharyngitis.Methods:We conducted a prospective study to evaluate 300 children from a private practice with acute pharyngitis who were treated for GAS pharyngitis within the preceding 28 days(study group)compared to 306 children of comparable age who had not been previously treated(control group).RADT and throat culture were performed on all children presenting with signs and symptoms of acute pharyngitis.The false positive and false negative rates were determined and compared in both groups.results:The false positive rate of 11.5%(23/200)in the study group was significantly higher than the false positive rate of 0 in the control group.False positives were more likely to occur in younger children.Interpretation:These data would indicate that while RADT is reliable in most children,it can lead to over treatment in children who have been recently treated for GAS.In children treated in the preceding 28 days for GAS pharyngitis,the presence of infection should be determined with a throat culture only.Treatment based on a positive RADT should be reserved for children not recently treated for GAS pharyngitis.

The treatment of streptococcal tonsillitis/ pharyngitis in young children

Pharyngitis is common in children,accounting for nearly 12 million visits annually in the United States.Streptococcus pyogenes or group A streptococcus(GAS)is the most common bacterial cause of pharyngitis for which antibiotics are indicated.Antibiotic treatment of streptococcal pharyngitis virtually eliminates the presence of bacteria from the pharynx and thus removes the risk of subsequent rheumatic fever.GAS is spread from person to person via respiratory droplets with a short incubation period of 2~5 days.GAS pharyngitis peaks in the late winter and early spring months when children are predominately indoors for school and sports.Colonization is also higher in winter months,and while up to 20%of school age children are colonized with GAS in their throat during this time,colonization has not been shown to contribute to the spread of disease.In low-and middle-income countries and other situations in which crowding is common(e.g.,schools),outbreaks of pharyngitis are common.GAS pharyngitis can occur at all ages and it is most common in school-aged children with a peak at 7~8 years of age.Pharyngitis caused by GAS is rare in children<3 years of age and becomes much less common in late adolescence through adulthood.

局灶性真皮发育不全伴咽喉部乳头状增生1例

1临床资料患者,男,17岁,因“咽部异物感1个月”就诊于浙江省台州医院。患者1个月前无明显诱因下出现咽部异物感,偶有咽阻塞感,无咽痛、发热,无咳嗽、咳痰,无呼吸困难,进食无梗阻,遂就诊我院。既往史:5年前患者经基因检测确诊为PORCN基因突变导致的局灶性真皮发育不全。专科查体:咽部黏膜稍充血,左扁桃体Ⅱ度肿大,表面散在乳头状瘤样增生,右扁桃体Ⅰ度肿大。间接喉镜下见左扁桃体下级、舌根部广泛乳头状新生物隆起,遮挡部分会厌,声门暴露不佳。

成人慢性咽部炎症患者咽部细菌学特点

我院于2000年以来对142例成人慢性扁桃体炎、慢性咽炎患者咽部细菌微生物学特点进行分析,报道如下。 1资料与方法 1．1一般资料。慢性咽炎、慢性扁桃体炎患者142例，男69例，女73例；年龄18～70岁，平均42岁。其中合并腺样体肥大者45例，男38例，女7例；平均39岁。依腺样体肥大与否分组，无腺样体肥大组（Ⅰ组）97例，腺样体肥大组（Ⅱ组）45例。

Fishbone-Type Pharyngeal Foreign Body with Cutaneous Migration in the ENT Department of the Mamou Regional Hospital: A Case Report

We report a case of pharyngeal foreign body with cutaneous migration in the form of a fishbone in a 24-year-old rural resident, presented with odynophagia, dysphagia, pain and left antero-latero-cervical swelling fistulated to the skin following ingestion of a fishbone during a meal that had been evolving for 2 weeks. Vital parameters were normal, with an unremarkable psychological examination. Clinical examination revealed a left antero-latero-cervical swelling that was painful to palpation, fistulous to the skin and draining frank pus, revealing a sharp fishbone. A standard X-ray showed that the foreign body had exited the pharynx and was located in the soft tissues of the lower neck. An exploratory cervicotomy was performed, allowing extraction of a serrated fishbone. The post-operative course was favorable.

Association between the nutritional status and radiation pharyngeal mucositis in patients with head and neck cancer during radiotherapy:A longitudinal study

Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.

儿童扁桃体摘除术治疗复发性咽喉炎的临床研究

复发性咽喉炎是一种极易复发、难根治的咽喉部疾病,临床上表现出咽部肿痛、干燥、发痒等症状。部分患者误认为复发性咽喉炎就是慢性扁桃体炎,因此欲通过扁桃体的切除来求得根治。在英国,大约有75%的扁桃体切除术被用于复发性喉痛的临床治疗[1]。而在过去的20年中,英国的扁桃体切除率显著下降,这源于人们对扁桃体切除治疗复发性喉痛疗效、结果有了更清醒的认识。

颈咽综合征误诊误治分析

颈咽综合征是指由于颈椎病变引起咽部感觉异常的病症,一般以骨质增生型最为多见[1]。近年来随着颈椎增生症的低龄化和颈肌劳损患者的不断增加,该疾病的发生率明显提高,但是临床常常误诊[2]。

原发性咽旁间隙肿瘤的诊断及治疗

咽旁间隙是一上起颅底下至舌骨、位置深在、解剖关系复杂的潜在间隙。原发性咽旁间隙的肿瘤少见，病理类型复杂，熟悉咽旁间隙解剖结构、正确进行术前评估、选择适当的手术入路，是成功切除肿瘤并减少并发症的关键。我们对收治的162例患者进行回顾性总结分析，报道如下。

咽部多形性腺瘤1例

多形性腺瘤又称混合瘤，多发于腮腺，颌下腺次之，腭部占第3位，咽部少见．我科于2006-03-01收入1例，报道如下。

Therapeutic effect of Liyan Baidu decoction combined with oxygen spray on radioactive stomatitis in patients with nasopharyngeal carcinoma

Objective: To observe the efficacy of Liyan Baidu Decoction combined with Oxygen Spray in the treatment of radiation oropharyngeal cancer in patients with nasopharyngeal carcinoma. Methods: Forty patients with radionomephicitis of nasopharyngeal carcinoma from 2015.03-2017.05 were randomly divided into treatment group (27 cases) and control group (23 cases). The treatment group was treated with Liyan Baidu Decoction combined with oxygen spray;the control group was treated with rehabilitation fluid. Results: Compared with the control group, the time of oral mucosal reaction was delayed (P < 0.05), the cumulative radiation of oral mucosal reaction increased (P < 0.05), and the oral mucosal reaction index decreased (P < 0.05). The degree of salivary gland damage was decreased (P < 0.05), and most of the KPS scores were improved compared with before treatment. However, the quality of life of Liyan Baidu Decoction group was higher than that of the control group (P < 0.05). Conclusion: Liyan Baidu decoction combined with oxygen spray may effectively delay the time of acute radioactive oral mucosal reaction in patients with nasopharyngeal carcinoma, and effectively reduce the radiation oral mucosal damage and salivary gland damage in patients with nasopharyngeal carcinoma. This study provides a clinical basis for the application of Liyan Baidu Decoction.

An Herbal Formula (GPC) Suppresses the Releases of Pro-Inflammatory Effectors in Lipopolysaccharide/Peptidoglycan-Activated RAW264.7 Macrophages and Reduces the Extent of Chemical-Induced Acute/Chronic Inflammation in Rodents

Pharyngitis (an inflammation in the pharynx) is a commonly occurring symptom of upper respiratory tract infection in patients suffering from common cold. The high prevalence of upper respiratory tract infection necessitates a safe and effective antiinflammatory agent for pharyngitis. Chinese herbal medicine, which has been clinically prescribed for thousands of years, may offer a basis for the treatment of common cold as well as the amelioration of pharyngitis. In the present study, we investigated the in vitro and in vivo anti-inflammatory activities of a Chinese herbal formula, namely GPC, which is comprised of Glycyrrhiza Radix, Platycodonis Radix, Citri Reticulatae Pericarpium, Phyllanthi Fructus and Taraxaci Herba. Incubation with GPC (30, 100 and 300 μg/mL) suppressed the releases of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6) and nitric oxide in lipopolysaccharide/peptidoglycanactivated RAW264.7 macrophages. In addition to the cell-based study, long-term treatment with GPC (0.35, 1.05 and 2.10 mL/kg/day × 30 doses) was found to reduce the extent of inflammation in animal models of carrageenan-induced paw edema (acute inflammation) as well as cotton pellet-induced granuloma formation (chronic inflammation) in mice. The ability of GPC to enhance the tracheobronchial expectorant action suggested its immunomodulatory activity in the respiratory tract. This postulation was supported by the observation that GPC reduced the degree of pharyngitis and reversed the changes in plasma TNF-α and IL-6 levels in capsaicininduced pharyngitis in rats. The ensemble of results suggests that GPC may offer a promising prospect for alleviating the extent of pharyngitis by virtue of antiinflammatory activities.

Preliminary Study on the Antibacterial Activity of Six Medicinal Plants against Two Naso-Pharyngeal Pathogens—Streptococccus pyogenes and Pseudomonas aeruginosa

Objective: The objective is to study the antibacterial activity of six medicinal plants against two naso-pharyngeal pathogens and determination of total phenol contents in ethanol extracts of those plants. Methods: Different serial concentrations (0.05 g/mL, 0.1 g/mL, 0.2 g/mL, 0.4 g/mL) of ethanolic and acetone extracts of Piper nigrum L. (Piperaceae), Ocimum sanctum Linn., Plectranthus amboinicus L. (Lamiaceae), Ayapana triplinervis M.Vahl. (Asteraceae), Cinnamomum zeylanicum L. (Lauraceae), Allium schoenoprasum Linn. (Liliaceace) were evaluated for the antibacterial activity using disc diffusion method against gram positive Streptococcus pyogenes and gram negative Pseudomonas aeruginosa. The extracts were prepared from different parts of the plants. The total phenol content was estimated using folin-ciocaltau reagent in catechol equivalents. Results: Majority of the extracts had inhibitory effect against the tested bacteria at different concentrations. In ethanol extracts, Plectranthus amboinicus exhibited the maximum zone of inhibition (14 mm) at 0.05 g/mL concentration against Streptococcus pyogenes, and Ocimum sanctum showed highest zone of bacterial inhibition (19 mm) at 0.05 g concentration against Pseudomonas aeruginosa. In acetone extracts, Piper nigrum had the maximum zone of bacterial inhibition (17 mm) in 0.4 g/mL concentration against Streptococcus pyogenes and Cinnamomum zeylanicum and Allium schoenoprasum exhibited the highest zone of bacterial inhibition (0.4 g/mL) against Pseudomonas aeruginosa. The ethanol extract of Plectranthus amboinicus contained the highest amount of phenol (0.8 mg/mL) and Allium schoenoprasum contained the lowest amount (0.62 mg/mL). In acetone, Cinnamomum zeylanicum contained highest phenol content (0.78 mg/mL). Conclusion: All these investigations pave way to the molecular modeling of the lead phyto compounds present in the studied plants, and also in finding out their biochemical action in various metabolic pathways and reactions of infection.

Antimicrobial Efficacy of Curcumin Formulations byPhotodynamic Therapy

URTI （upper respiratory tract infections） are caused by acute, chronic or recurrent infections including pharyngitis andtonsillitis. The etiologic agents involved are bacteria, virus, and fungi. The standard treatment for bacterial infections is the use ofantibiotics. The antibiotic resistance, side effects of drugs and URTI complications indicate the importance of new therapies. PDT（photodynamic therapy） is a treatment option with a fast onset of action, low side effects, and easy administration of PS（photosensitizer） based on this study. The main aim of this study was to develop a new modality for the treatment of infectiouspharyngotonsillitis by photodynamic therapy. In addition, this study aims to evaluate components of the therapy as the PS, curcumin,in two formulations and irradiation conditions in the effectiveness of treatment. The procedure consists of two steps： oraladministration of CFs （curcumin formulations） containing a PS and illumination （450 nm and 0-60 J/cm2）. Bacterial isolates wereobtained from patients in a routine clinical pratice. The new methodology has been developed from the principle ofPI （photodynamicinactivation）. The strain identification number of colony forming units determined the efficacy of PI using each component, lightingand PS. The use of curcumin formulations in PI presented microbial reduction of 5 log.

Recent traction methods for endoscopic submucosal dissection

Endoscopic mucosal resection(EMR) is problematic with regard to en bloc and curable resection rates.Advancements in endoscopic techniques have enabled novel endoscopic approaches such as endoscopic submucosal dissection(ESD), which has overcome some EMR problems, and has become the standard treatment for gastrointestinal tumors. However, ESD is technically difficult. Procedure time is longer and complications such as intraoperative perforation and bleeding occur more frequently than in EMR. Recently various traction methods have been introduced to facilitate ESD procedures, such as clip with line, external forceps, clip and snare, internal traction, double scope, and magnetic anchor. Each method must be used appropriately according to the anatomical characteristics. In this review we discuss recently proposed traction methods for ESD based on the characteristics of various anatomical sites.

鼻咽癌放疗后颈内动脉闭塞1例

随着放疗及化放疗技术的发展,鼻咽癌生存期逐渐提高,而放疗相关晚期并发症已成为影响此类患者生活质量的严重问题。现报道1例鼻咽癌放疗后12年,经磁共振血管成像（magnetic resonance angiography,MRA）及数字减影血管造影（digital subtraction angiography,DSA）确诊的颈内动脉闭塞病例,患者经气管切开及胃造瘘后,随访至今。1临床资料患者,男,69岁,因鼻咽癌放疗后12年。