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Background: Tracheal intubation sometimes causes postoperative sore throat (POST) due to laryngeal damage. However, clinical observations suggest that the environment of the oral cavity may also affect POST. Objective: The purpose of this study was to investigate whether salivary pH in the oral cavity affects POST. Methods: After obtaining ethical approval, informed consent was obtained from all patients. Patients who underwent surgery in the supine position were enrolled as the control group. Patients who underwent laparoscopic surgery in the head‐down position were enrolled as the intervention group. Immediately before both groups of patients were anaesthetised, expelled saliva was collected, and salivary pH was measured. Immediately postoperatively, the same measurement was carried out before the patient regained consciousness. The primary outcome was the change in salivary pH. The secondary outcome was POST. In our study, POST was defined as pharyngeal and swallowing pain in the glossopharyngeal and superior laryngeal nerves. The normal distribution of pH was tested using the Shapiro–Wilk test followed by analysis using repeated‐measurements and one‐way analysis of variance. Statistical significance was set at p <.05. Results: A total of 62 patients were enrolled, of whom two were excluded based on the exclusion criteria. Salivary pH in the intervention group was significantly lower than that in the control group. Five patients had POST in the intervention group, whereas none had POST in the control group had POST. Conclusion: Acidotic‐shifted saliva is considered one of the causes of POST. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative Sore Throat (POST) is a known complication after general anaesthesia with an endotracheal tube (14.4% to 50%) and less so with Supraglottic Airway (SGA) devices (5.8% to 34%). Various modalities and drugs can decrease POST. Zinc possesses anti-inflammatory and antioxidant properties and is utilised in oral mucositis and xerostomia. Aim: To evaluate the effect of preoperative administration of a zinc lozenge on POST after the removal of the Proseal Laryngeal Mask Airway (PLMA). Materials and Methods: In this randomised, double-blinded controlled study was conducted at the Department of Anaesthesia at Pt. BD Sharma PGIMS, Rohtak, Haryana, India, over a period of five months from August 2020 to December 2020. 100 patients aged 18-60 years of either sex belonging to American Association of Anesthesiologists (ASA) I and II undergoing elective surgery under general anaesthesia with PLMA placement were randomly allocated into two groups to receive a 40 mg zinc lozenge (Group-I) or placebo (Group-II) and were asked to chew it 30 minutes preoperatively. Patients with upper respiratory tract infections, at risk of aspiration, or with anticipated difficult intubation were excluded from the study. The incidence and severity of POST were assessed on a 4-point scale (0-3) at 30 minutes, 2, 4, and 24 hours postoperatively. The primary outcome of the study was the incidence of POST at four hours postoperatively, and the secondary outcome was the severity of POST at 30 minutes, two hours, and 24 hours postoperatively. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software programme. The Chi-square test and unpaired t-test were used for statistical analysis. Results: The mean age in Group-I was 38.6±12.32 years and in Group-II was 37.90±14.84 years (p-value 0.79). Data regarding the distribution of patients according to sex were comparable with a p-value of 0.31. There was a significantly lower incidence of POST in Group-I (zinc group) than in Group-II (placebo group) at four hours with a p-value of 0.004. Conclusion: The present study has shown that the preoperative administration of a 40 mg zinc lozenge effectively reduces the incidence and severity of POST in the postoperative period, peaking at four hours after general anaesthesia. Zinc lozenges are easy, convenient, non invasive, and successfully prevent POST. [ABSTRACT FROM AUTHOR]

Objectives: Fusobacterium necrophorum is a common cause of pharyngotonsillitis. However, no guidelines exist on when to diagnose or treat it. We aimed to investigate associations between clinical criteria and F. necrophorum-positivity in pharyngotonsillitis and assess the predictive potential of a simple scoring system. Methods: Pharyngotonsillitis patients who were tested for F. necrophorum (PCR) and presented to hospitals in the Skåne Region, Sweden, between 2013–2020 were eligible. Data were retrieved from electronic chart reviews and registries. By logistic regression we investigated associations between F. necrophorum-positivity and pre-specified criteria: age 13–30 years, symptom duration ≤ 3 days, absence of viral symptoms (e.g. cough, coryza), fever, tonsillar swelling/exudate, lymphadenopathy and CRP ≥ 50 mg/L. In secondary analyses, associated variables were weighted by strength of association into a score and its predictive accuracy of F. necrophorum was assessed. Results: Among 561 cases included, 184 (33%) had F. necrophorum, which was associated with the following criteria: age 13–30, symptom duration ≤ 3 days, absence of viral symptoms, tonsillar swelling/exudate and CRP ≥ 50 mg/L. Age 13–30 had the strongest association (OR5.7 95%CI 3.7–8.8). After weighting, these five variables had a sensitivity and specificity of 68% and 71% respectively to predict F. necrophorum-positivity at the proposed cut-off. Conclusion: Our results suggest that F. necrophorum cases presenting to hospitals might be better distinguished from other pharyngotonsillitis cases by a simple scoring system presented, with age 13–30 being the strongest predictor for F. necrophorum. Prospective studies, involving primary care settings, are needed to evaluate generalisability of findings beyond cases presenting to hospitals. [ABSTRACT FROM AUTHOR]

Background Conflicting international guidelines exist on the management of sore throat by antibiotics. Objectives To assess with the Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument the quality of guidelines for uncomplicated acute group A beta-haemolytic streptococcal (GABHS) sore-throat. To make a sensitivity analysis restricted to guidelines with a rigour of development score higher than 60% and to describe their recommendations on scores, tests, and antibiotic therapy, including their justification. Methods A guideline literature review of acute GABHS sore throat, published between January 2000 and December 2019 in primary care and secondary care. The PubMed database, the Canadian Medical Association Infobase on Clinical Practice Guidelines and the International Network Guidelines were used. The quality of guidelines was assessed using the AGREE II instrument. The guidelines were classified into 2 categories: high-quality guidelines had to rate >60% for the rigour of development score, the others were classified as low-quality guidelines. Results Significant heterogeneity between the 15 guidelines concerned the scores of the 6 assessment domains. Among them, 6 guidelines presented a score above 60% with regards to the rigor of development domain and used a systematic literature search method, citing meta-analyses of recent randomised clinical trials. Most of the 6 high-quality guidelines no longer recommended the systematic use of diagnostic scores and tests, nor antibiotic therapy to prevent acute rheumatic fever or loco-regional complications, except for high-risk patients. Conclusion Major discrepancies emphasise the need for only high-quality guidelines, based on adequately assessed evidence. Restricted antibiotic prescriptions to severe cases or high-risk patients would avoid antibiotic resistance. [ABSTRACT FROM AUTHOR]

Speech is produced by a nonlinear, dynamical Vocal Tract (VT) system, and is transmitted through multiple (air, bone and skin conduction) modes, as captured by the air, bone and throat microphones respectively. Speaker specific characteristics that capture this nonlinearity are rarely used as stand-alone features for speaker modeling, and at best have been used in tandem with well known linear spectral features to produce tangible results. This paper proposes Recurrent Plot (RP) embeddings as stand-alone, non-linear speaker-discriminating features. Two datasets, the continuous multimodal TIMIT speech corpus and the consonant-vowel unimodal syllable dataset, are used in this study for conducting closed-set speaker identification experiments. Experiments with unimodal speaker recognition systems show that RP embeddings capture the nonlinear dynamics of the VT system which are unique to every speaker, in all the modes of speech. The Air (A), Bone (B) and Throat (T) microphone systems, trained purely on RP embeddings perform with an accuracy of 95.81%, 98.18% and 99.74%, respectively. Experiments using the joint feature space of combined RP embeddings for bimodal (A–T, A–B, B–T) and trimodal (A–B–T) systems show that the best trimodal system (99.84% accuracy) performs on par with trimodal systems using spectrogram (99.45%) and MFCC (99.98%). The 98.84% performance of the B–T bimodal system shows the efficacy of a speaker recognition system based entirely on alternate (bone and throat) speech, in the absence of the standard (air) speech. The results underscore the significance of the RP embedding, as a nonlinear feature representation of the dynamical VT system that can act independently for speaker recognition. It is envisaged that speech recognition too will benefit from this nonlinear feature. [ABSTRACT FROM AUTHOR]

The throat is an organ that includes the larynx, esophagus, and bronchi. Vocalization or deglutition triggers micro‐movements of muscles around the throat. In this study, based on machine learning using a flexible patch, pronunciation is identified by analyzing the vibration and movement of the laryngeal muscles, and the type of food consumed is determined through peristalsis analysis. Previously, voices are recognized through cochlea hair cells, and the type of food intake is identified through taste receptors. However, this study converted auditory or gustatory senses to tactile stage through sensory transition and finally visualized. Using a customized throat patch with segmented nodes, the pronunciation of [a], [e], [i], [o], and [u], representative vowels of languages worldwide, are distinguished with an accuracy of 85.9% based on the polynomial kernel algorithm. In addition, cookies, water, gummies, and chocolate are distinguished with 91.1% accuracy by detecting differences in the esophagus's peristalsis. Transformation of auditory or gustatory sensations to tactile information and visualization is expected to be used for communication in noisy environments or soundless environments such as outer space. This approach can also provide significant potential for determining the type of ingestion for users who have lost their sense of taste. [ABSTRACT FROM AUTHOR]

This paper focuses on the Einstein–Cartan theory, an extension of general relativity that incorporates a torsion tensor into spacetime. The differential form technique is employed to analyze the Einstein–Cartan theory, which replaces tensors with tetrads. A tetrad formalism, specifically the Newman–Penrose–Jogia–Griffiths formalism, is used to study the field equations. Also, the energy–momentum tensor is determined, considering a Weyssenhoff fluid with anisotropic matter. The spin density is derived in terms of the redshift function. Additionally, our findings demonstrate that the radial sound speed within the wormhole throat exceeds the speed of light, suggesting the existence of superluminal matter, while the tangential sound speed indicates near-light-speed propagation, particularly within the throat, emphasizing the significance of exotic matter in comprehending wormhole properties. The results also extend to examining the energy conditions at the throat of a Morris–Thorne wormhole, shedding light on the properties of wormholes within the context of the Einstein–Cartan theory, including the energy conditions at the throat. [ABSTRACT FROM AUTHOR]

A new species of Boesenbergia, B. ashihoi Suparna, Sameer Patil & V.Deepu is described from Lumdiengsai, Meghalaya, India. Boesenbergia ashihoi resembles B. siphonantha (King ex Baker) M.Sabu, Prasanthk. & Škornick. and B. tillandsiodes (Baker) Kuntze in bearing a small globular rhizome, long‐petioled leaves, horn‐like spike and anther connectives without crest, but differs in having elliptic leaves (versus oblong‐lanceolate), bracteoles much shorter than bracts (versus almost equalling bracts), labellum orbicular with orangish throat (versus ovate to obovate or cuneate with reddish or yellowish throat), and corolla tube 9–10 cm long (versus 1–6 cm long). The new species is described and illustrated in detail. A key to species of Boesenbergia in India is provided. [ABSTRACT FROM AUTHOR]

Background: Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. Methods: We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0–3). Results: POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. Conclusion: Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. Trial registration: CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India). [ABSTRACT FROM AUTHOR]

Outpatient health care facilities are essential for quickly diagnosing common infectious diseases such as bacterial and viral pharyngitis. The only form of pharyngitis requiring antibiotics is strep throat (ST); however, antibiotic prescription rates are much higher than ST prevalence, suggesting antibiotics are being inappropriately prescribed. Current rapid ST diagnostics may be contributing to this problem due to the low sensitivity and variable specificity of these tests. It is best practice to verify a negative ST diagnosis with a group A Streptococcus (GAS) culture, but many clinics do not perform this test due to the additional cost and 24–72 h required to obtain results. This indicates there is great need for more accurate rapid diagnostic tools in outpatient facilities. We hypothesized that next generation qPCR technology could be adapted to detect GAS DNA from saliva samples (instead of the traditional throat swab) by creating a simple, fast, and inexpensive protocol. Saliva specimens collected from patients at James Madison University Health Center were used to test the effectiveness of our Chelex 100-based rapid DNA extraction method, followed by a fast protocol developed for the Open qPCR machine to accurately detect ST. Our final saliva processing and qPCR protocol required no specialized training to perform and was able to detect ST with 100 % sensitivity and 100 % specificity (n=102) in 22–26 min, costing only $1.12 per sample. Saliva can be rapidly analyzed via qPCR for the accurate and inexpensive detection of ST. [ABSTRACT FROM AUTHOR]

We analyse traversable wormholes defined by the dynamic line elements that asymptotically approach Friedmann–Robertson–Walker (FRW) universe. These dynamical wormholes is supported by the galactic dark matter as well as perfect isotropic fluid. We will discuss several evolving Lorentzian wormholes comprising with different perfect isotropic fluids in addition to various scale factors. We will speculate the various significance, features and throat energy conditions for these evolving traversable Lorentzian wormholes. [ABSTRACT FROM AUTHOR]

Background: Reducing antibiotic use in Australia, and the subsequent impact on antimicrobial resistance, requires multiple, sustained approaches with appropriate resources and support. Additional strategies to reduce antibiotic prescribing include effective vaccines, against pathogens such as Streptococcus pyogenes, the most common bacterial cause of sore throat. As part of efforts towards assessing the benefits of introducing new strategies to reduce antimicrobial prescribing, we aimed to determine the burden of antimicrobial prescribing for sore throat in general practice. Methods: General practice activity data from 2013 – 2017 derived from the first 8 practices participating in the 'Primary Care Audit, Teaching and Research Open Network' (Patron) program were analysed according to reason for visit (upper respiratory tract infection, URTI, or sore throat) and antibiotic prescription. The main outcome measures were percentage of sore throat or URTI presentations with antibiotic prescription by age. Results: A total of 722,339 visits to general practice were made by 65,449 patients; 5.7% of visits were for URTI with 0.8% meeting the more specific criteria for sore throat. 66.1% of sore throat visits and 36.2% of URTI visits resulted in antibiotic prescription. Penicillin, the recommended antibiotic for sore throat when indicated, was the antibiotic of choice in only 52.9% of sore throat cases prescribed antibiotics. Broader spectrum antibiotics were prescribed more frequently in older age groups. Conclusions: Frequency of antibiotic prescribing for sore throat is high and broad, despite Australian Therapeutic guideline recommendations. Multiple, sustained interventions to reduce prescribing, including availability of effective S. pyogenes vaccines that could reduce the incidence of streptococcal pharyngitis, could obviate the need to prescribe antibiotics and support ongoing efforts to promote antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Objectives: A globus and thick mucus in the throat are common reasons for referral to an ear, nose, and throat (ENT) specialist. ENT outpatient appointments focus on nasolaryngoscopy examinations, patient education, and reassurance. An endoscopic outpatient clinic (EOC) was established to efficiently manage patients with benign laryngeal symptoms. Methods: Patients referred between February 2022 and June 2023 due to a globus and/or thick mucus in the throat were immediately contacted via post. The contact letter included patient education about the potential underlying reasons for their symptoms and self‐care instructions. A 15‐min outpatient visit was scheduled for an ENT examination and nasolaryngoscopy. Patients completed a questionnaire about their current symptoms and whether they had followed the self‐care instructions just before visiting the EOC and 1‐month following their appointment. Results: In total, 203 patients examined in the EOC were included in the study. Before the EOC visit, most patients (89.2%) considered the information letter useful, it relieved concerns in 44.2% of patients, and 73.2% patients had already followed the self‐care instructions. After the 1‐month follow‐up period, symptoms diminished significantly (p <.001). Conclusions: Instructions for self‐care and encouragement relieved concerns among patients with benign laryngeal symptoms. Moreover, symptoms improved significantly after a 1‐month follow‐up period. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Introduction Postoperative sore throat (POST) is a fairly common side effect of general anesthesia. The K-Y jelly is a well-known lubricant used in many medical procedures. Objective In this randomized study, we evaluated the use of throat packs soaked with K-Y jelly for POST outcomes in patients submitted to nasal surgery. Methods The present double-blinded, randomized, controlled study included 140 ASA I–II patients undergoing nasal surgery under general anesthesia. Patients received either or K-Y jelly or water-soaked X-ray detectable throat packs fully inserted into the mouth to occlude the oropharynx. Results Comparison between the studied groups regarding the severity of POST assessed by visual analog scale revealed significantly lower POST levels in the K-Y jelly group on recovery from anesthesia, and at 2, 4, and 6 hours postoperatively. Conclusions The use of K-Y jelly-soaked throat packs was associated with less severe POST after nasal surgery. [ABSTRACT FROM AUTHOR]

An investigation of the total pressure gain (TPG) in rotating detonation combustors (RDCs) with dilution holes is conducted by the experimental method in this study. The effects of pressure ratios (PR = 4.2–7.2) and equivalence ratios (ER = 0.5–1.5) on the total pressure gain are analyzed in four models, i.e., models A–D, of different throat areas A 3.1 and dilution hole area A 3.5 . When the PR is small, the lowest ER causes the highest TPG, and when the PR is high, the highest ER leads to the highest TPG in Model A. While in models B–D, as ER increases, the TPG increases gradually in all the cases. Comparing the level of TPG between the four models, it is found that the increment of A 3.1 and A 3.5 results in the enhancement of the TPG. The present study's TPG shows superiority when compared with that of traditional RDC, which indicates that the RDC with dilution holes is more promising for achieving positive TPG in specific configurations. An empirical model considering the throat area A 3.1 , dilution hole area A 3.5 , outlet area A 8 , and heat (released by the fuel combustion) release rate Q v is proposed to better predict the performance of different RDC configurations. Positive total pressure gain is inferred to be promisingly attained at a high A 3.1 / A 8 , low A 8 / A 3.5 , and a high Q v . Total pressure measured by total pressure rake is verified by comparing with the data calculated by Mach-corrected-static-pressure and mass flow function methods, with relative errors in ±4% and ±15%, respectively. [ABSTRACT FROM AUTHOR]

Background: Mesalamine produces many side effects through oral route such as stomach cramps, throat irritation, back ache and muscle pain. Furthermore, it failed to yield maximum drug release and also not able to produce the drug release for over a period of time at the target site. To overcome these disadvantages, the current research proposed to develop microspheres with pH-dependent bio-resorbable polymers to obtain site-specific controlled drug release at the target site. Materials and Methods: Microspheres were prepared by two methods as ionic gelation and solvent evaporation methods using copolymers such as Eudragit S 100 and PLGA. Results: The prepared formulations were characterized for multiple parameters and the particle size ranges were found in between 5.52 to12.56 µm whereas percentage entrapment efficiency was found in the range of 32 to 98% respectively. Apart from other formulations, PLGA microspheres showed the maximum cumulative percentage drug release through in vitro and ex vivo and the results were found as 96±0.1% and 90.8±0.8% respectively. As compared to Pentasa®, PLGA microspheres showed two folds increase in drug release. The PLGA biodegradability was observed as maximum in the caecal content than other formulations. Conclusion: Compared to Pentasa®, the prepared PLGA microspheres showed the best results and the obtained result was verified with a p-value which is shown <0.005. Based on the results, it was concluded that the prepared PLGA microspheres showed better-controlled drug release than other test formulations. [ABSTRACT FROM AUTHOR]

Introduction: Evidence regarding throat packing for head and neck surgeries is limited. A video laryngoscope, an airway adjunct used for various diagnostic and therapeutic purposes, can also effectively pack the throat. Aim: To compare the Time Taken for Throat Packing (TTTP) using a non-channeled video laryngoscope BPL™ versus the conventional Macintosh larynogoscope direct laryngoscope. Materials and Methods: In this non-inferiority, randomised controlled, single-blind study, 72 patients undergoing head and neck surgeries requiring throat packing were recruited. The non-inferiority margin was set at 10 seconds between the two groups (n=36 each). Throat packing in Group-M and Group-V was performed using the Macintosh and video laryngoscopes with the assistance of Magill's forceps. The TTTP was recorded from the blade insertion to complete blade removal. A one-sided two-sample unpaired t-test was used to test non-inferiority hypothesis considered in this study. Results: The mean age of patients in Group-M was 37.39 years and in Group-V was 33.65 years, with mean weights of 60.89 kg and 56.32 kg, respectively. The mean TTTP difference between Group-M and Group-V was found to be -12.6 seconds with a lower limit of the one-sided 95% Confidence Interval (CI) of -20.6s. The null hypothesis was accepted, concluding that video laryngoscope-guided throat packing took a longer duration. The ease of throat packing, haemodynamic stress response, and Postoperative Sore Throat (POST) were comparable between both groups. Conclusion: Video laryngoscope-guided throat packing is inferior to conventional Macintosh throat packing in terms of TTTP. However, it is equivocal regarding the ease of throat packing and the stress response induced. POST was the same whether throat packing was performed using a video laryngoscope or a Macintosh laryngoscope. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Care must be taken to mitigate the effect of cognitive bias in times of frequent common presentations. The etiology of bicytopenias and pancytopenias must always be carefully investigated. Blast cells in low count B ALL may not be seen on a peripheral smear and diagnosis often requires confirmational bone marrow aspirate with flow cytometry and molecular typing. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Acute onset of vertigo and hearing loss is rare in leukemic disorders. MRI can diagnose intracochlear hemorrhage as the underlying cause. The hearing can improve but if severe hearing loss preserves, cochlear implantation can be considered. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The occurrence of papillary and follicular thyroid carcinoma as a collision tumor is rare. We report on a case of a collision tumor consisting of papillary and follicular thyroid carcinoma treated successfully with surgery and radioiodine ablation. [ABSTRACT FROM AUTHOR]

In the current article, we discuss the wormhole geometries in two different gravity theories, namely F (Q , T) gravity and F (R , T) gravity. In these theories, Q is called a non-metricity scalar, R stands for the Ricci scalar, and T denotes the trace of the energy–momentum tensor (EMT). The main goal of this study is to comprehensively compare the properties of wormhole solutions within these two modified gravity frameworks by taking a particular shape function. The conducted analysis shows that the energy density is consistently positive for wormhole models in both gravity theories, while the radial pressure is positive for F (Q , T) gravity and negative in F (R , T) gravity. Furthermore, the tangential pressure shows reverse behavior in comparison to the radial pressure. By using the Tolman-Oppenheimer-Volkov (TOV) equation, the equilibrium aspect is also described, which indicates that hydrostatic force dominates anisotropic force in the case of F (Q , T) gravity theory, while the reverse situation occurs in F (R , T) gravity, i.e., anisotropic force dominates hydrostatic force. Moreover, using the concept of the exoticity parameter, we observed the presence of exotic matter at or near the throat in the case of F (Q , T) gravity while matter distribution is exotic near the throat but normal matter far from the throat in F (R , T) gravity case. In conclusion, precise wormhole models can be created with a potential NEC and DEC violation at the throat of both wormholes while having a positive energy density, i.e., ρ > 0 . [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults. Methods: One hundred and fourteen ASA I-III patients of either gender, aged 18–65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough. Results: One hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0–0), which was significantly lower than those in group C (1 (0–2) at 2 h, p < 0.001 ; 1 (0–1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0–1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0–2) was superior to that in group C (2 (0–2), p = 0.006) at 2 h postoperatively. Conclusions: In conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness. Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021. [ABSTRACT FROM AUTHOR]

Superficial infections with Streptococcus pyogenes (Strep A), pharyngitis and impetigo can induce acute rheumatic fever, an autoimmune sequela manifesting mostly with arthritis and rheumatic carditis. Valvular heart damage can persist or advance following repeated episodes of acute rheumatic fever, causing rheumatic heart disease. Acute rheumatic fever and rheumatic heart disease disproportionately affect children and young adults in developing countries and disadvantaged communities in developed countries. People living with rheumatic heart disease are at risk of experiencing potentially fatal complications such as heart failure, bacterial endocarditis or stroke. Transthoracic echocardiography plays a central role in diagnosing both rheumatic carditis and rheumatic heart disease. Despite the obvious medical need, no licensed Strep A vaccines are currently available, as their clinical development process faces several challenges, including concerns for cardiac safety. However, the development of Strep A vaccines has been recently relaunched by many vaccine developers. In this context, a reliable and consistent safety evaluation of Strep A vaccine candidates, including the use of transthoracic echocardiography for detecting cardiac adverse events, could greatly contribute to developing a safe and efficacious product in the near future. Here, we propose a framework for the consistent use of transthoracic echocardiography to proactively detect cardiac safety events in clinical trials of Strep A vaccine candidates. Plain Language Summary: Throat and skin infections caused by certain types of bacteria, named Streptococcus pyogenes, are frequent worldwide; however, in many children from less developed countries and disadvantaged communities, infections with S. pyogenes lead to a condition called acute rheumatic fever, which usually affects the joints and the heart. Damage to the heart valves may evolve to rheumatic heart disease, a permanent condition with often life-threatening complications. Rheumatic heart disease is an important health problem in places and communities where S. pyogenes infections occur frequently. A vaccine against these bacteria would help lower the number of people with valvular heart disease; however, no such vaccine exists yet. Research on vaccines against S. pyogenes was on hold for almost 30 years because of initial concerns that vaccinated children might develop acute rheumatic fever more frequently. Recently, researchers started working again on vaccines against S. pyogenes, but concerns about the safety of such vaccines persist. Doctors can reliably use echocardiography to diagnose cases of rheumatic carditis (as a sign of acute rheumatic fever) and rheumatic heart disease. Here, we propose a simple approach for the consistent use of echocardiography in clinical research of vaccines against S. pyogenes that will allow the detection of any potential heart-related side effects of the vaccine. [ABSTRACT FROM AUTHOR]

Sore throat is a common presentation in pediatric office settings and emergency departments. Bacterial infection due to Streptococcus pyogenes represented about 25% of sore throat in children. The study aimed to find a relationship between interleukin-37 and vitamin D levels in children with sore throat infection by S. pyogenes bacteria from Salah Al-din General Hospital and Samarra General Hospital in Salah al-Din Governorate, Iraq. The number of sore throat patients in the present study was 317, aged between 5 and 17 years old. The control group included 80 healthy individuals. Throat swabs from children were collected and aseptically inoculated on Petri plate media. Blood samples were collected from patients and control children for determination of Vitamin D and IL-37 by ELISA. The study showed that 30.28% (96 of 317) of the children studied were infected with S. pyogenes bacteria. The results revealed a significant elevation in the mean IL-37 level among children with S. pyogenes infection (96.9±12.2 pg/ml) compared to the control group (62.5±11.3 pg/ml) (p-value = 0.0001). Furthermore, children with S. pyogenes infection had a significantly lower mean vitamin D level (22.3±6.1 pg/ml) compared to the control group (52.8±3.08 pg/ml) (p-value = 0.0001). In conclusion, this study provides evidence of significant alterations in immune markers, including IL-37, and vitamin D levels, in children with S. pyogenes infection compared to the control group. These findings suggest the involvement of these immune markers in the pathogenesis of S. pyogenes infection. [ABSTRACT FROM AUTHOR]

This article explores the different manifestations of leishmaniasis, a parasitic infection caused by the Leishmania genus. It focuses on cases that presented with symptoms in the ear, nose, and throat, including the skin, nasal mucosa, and oral mucosa. The article highlights the importance of collaboration between medical departments in managing the disease and emphasizes the need for thorough examination and awareness of leishmaniasis in individuals who have traveled to endemic areas. Treatment options vary depending on the case and may involve systemic therapy. [Extracted from the article]

Background and Aims: Postoperative sore throat (POST) is a common complication following general anesthesia with tracheal intubation that increases patient morbidity. We evaluated the effect of preoperative administration of IV paracetamol and a combination of paracetamol with nebulized or IV dexamethasone on the incidence of POST (primary objective), hoarseness of voice and cough (secondary objectives) in adult patients. Methods: In a randomized, double‑blind study in a tertiary care hospital, 150 patients undergoing laparoscopic cholecystectomy under general anesthesia with tracheal intubation were divided into three groups (n = 50): Group P received IV paracetamol 1 g infusion; Group I received IV dexamethasone 8 mg and IV paracetamol 1 g infusion; and Group N received nebulized dexamethasone 8 mg and IV Paracetamol 1 g infusion. The incidence and severity of POST, hoarseness and cough were assessed at various time‑points for 24 hours after surgery. Results: The overall incidence of POST was 72%, 18%, and 24% in groups P, I, and N, respectively; P < .0001. The severity of POST was significantly less in groups I and N compared with group P; both P < .0001. The incidence of postoperative hoarseness was comparable between the three groups; P = 0.216. The incidence and severity of postoperative cough were significantly higher in group P compared with group I; P = 0.016. Statistical calculations were done using SPSS 21 version program for Windows. Conclusions: Prophylactic administration of both nebulized and IV dexamethasone 8 mg in combination with IV paracetamol was effective in decreasing the incidence and severity of POST in adult patients undergoing laparoscopic cholecystectomy under general anesthesia with tracheal intubation. [ABSTRACT FROM AUTHOR]

This article from the Journal of Cardiovascular Disease Research examines the incidence of post-operative sore throat in patients with different methods of monitoring endotracheal tube cuff pressure. The study, conducted at a tertiary care hospital with 100 patients, aimed to determine the relationship between cuff pressure and sore throat, as well as other factors. The results showed no significant differences between the two groups in terms of age, gender, BMI, and other factors. However, there was a statistically significant correlation between post-operative grade and the monitoring method used. The article also discusses the causes of post-operative sore throat and suggests that monitoring cuff pressure can help prevent airway difficulties. The study has some limitations, such as variations in intubation technique and multiple operators. Overall, the article highlights the importance of monitoring and adjusting cuff pressure to reduce post-operative complications. [Extracted from the article]

• Validation and CO2 ejector simulation using HEM. • The only cross-sectional area parameter that affects the primary flow rate of a CO2 ejector is the nozzle throat cross-sectional area. • The nozzle throat and mixing chamber cross-sectional area have a significant effect on the secondary flow rate and entrainment ratio of the CO2 ejector. • The inlet cross-sectional area of the nozzle almost does not affect the secondary flow rate and entrainment ratio. • The pre-mixing chamber and the diffusion chamber outlet cross-sectional area do not have a significant effect within a certain range. In this paper, based on the homogeneous equilibrium model, the effects of nozzle inlet cross-sectional area, nozzle throat cross-sectional area, pre-mixing chamber cross-sectional area, mixing chamber cross-sectional area, and diffusion chamber outlet cross-sectional area on the performance of the ejector of a CO 2 transcritical refrigeration system are analyzed by using Ansys Fluent. The simulation results show that the primary flow rate of the ejector is sensitive only to the nozzle throat cross-sectional area, while the entrainment ratio is strongly influenced by the nozzle throat and the mixing chamber cross-sectional area, and there is an optimum value. The nozzle inlet cross-sectional area has no significant effect on the performance of the ejector. The pre-mixing and diffusion chamber outlet cross-sectional areas do not have a significant effect on the performance within a limited range, but deviating too much from the optimum value can also lead to degradation of ejector performance. [ABSTRACT FROM AUTHOR]

A fundamental understanding of the CaCO3 precipitation process in the pore network of geomaterials is important to uncover the mechanism behind the evolution of the engineering properties of geomaterials during the microbially induced carbonate precipitation (MICP) treatment. However, the details about the CaCO3 precipitation process and its interaction with the flow field at the pore scale are not well understood. In the current work, the CaCO3 precipitation process and flow field in a heterogeneous chip composed of two pore bodies, four pore throats of different sizes, and two dead-end pores are presented. The test results show that solutions can percolate through all four pore throats and diffuse into the dead-end pores at the beginning of the tests. As a result, CaCO3 can be precipitated across the chip with some difference in the number, shape, and size of crystals. Fine pore throats are more likely to be clogged, leading to solution percolating through coarse channels, thereby increasing the amount of CaCO3 in coarse channels. Precipitation in coarse channels is also ceased after a certain duration despite the continued injection of the solution. Our work provides insight into the CaCO3 precipitation process in a representative pore element, which can help to understand the mechanism behind the evolution of engineering properties and establish simulation models to predict the engineering properties of geomaterials treated by the MICP method. [ABSTRACT FROM AUTHOR]

In recent years, there has been a notable rise in the number of patients afflicted with laryngeal diseases, including cancer, trauma, and other ailments leading to voice loss. Currently, the market is witnessing a pressing demand for medical and healthcare products designed to assist individuals with voice defects, prompting the invention of the artificial throat (AT). This user-friendly device eliminates the need for complex procedures like phonation reconstruction surgery. Therefore, in this review, we will initially give a careful introduction to the intelligent AT, which can act not only as a sound sensor but also as a thin-film sound emitter. Then, the sensing principle to detect sound will be discussed carefully, including capacitive, piezoelectric, electromagnetic, and piezoresistive components employed in the realm of sound sensing. Following this, the development of thermoacoustic theory and different materials made of sound emitters will also be analyzed. After that, various algorithms utilized by the intelligent AT for speech pattern recognition will be reviewed, including some classical algorithms and neural network algorithms. Finally, the outlook, challenge, and conclusion of the intelligent AT will be stated. The intelligent AT presents clear advantages for patients with voice impairments, demonstrating significant social values. [ABSTRACT FROM AUTHOR]

Gentiana mopanshanensis, a new species of the family Gentianaceae is here described and illustrated. This species is presently known only from the Mopanshan Mountain, Yunnan Province, southwest China. Phylogenetic analysis based on ITS sequence data has shown that this new species is a member of the series Fimbriatae of the section Chondrophyllae. Morphologically, it mostly resembles G. mairei and G. panthaica, but differs clearly from the latter two species in the shape and size of the leaves, and the characters of the corolla throat and plicae. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health‐related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Methods: Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC‐scale), and Euro‐QoL‐5D‐3L questionnaires. Results: A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non‐dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non‐dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Conclusion: Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. Level of evidence: 2b. [ABSTRACT FROM AUTHOR]

The release of trapped bubbles from dead-end pore throats filled with nonvolatile liquid has widespread applications in gas–liquid reactors, radiators, foam flooding, ceramic sintering, and droplet microcarriers. As conventional pressure-driven flow cannot induce the transport of bubbles in dead-end pores, this paper explores the possibility of using heating to control the release of bubbles from dead-end pore throats. Visualization experiments of the microfluidics within a dead-end pore throat structure are conducted to address the release process of bubbles during heating. An increase in temperature causes dissolved gas in the solution to be transferred to the bubble, which enhances the bubble pressure and enables the bubble to pass through the pore throat. We analyze the effects of the initial bubble radius and initial temperature on the critical temperature Tcr at which the bubble passes through the pore throat. A larger initial radius does not necessarily make it more difficult for the bubble to pass through the throat, but there is a critical radius above which any increase in radius produces a lower value of Tcr. A theoretical model considering diffusion mass transfer, capillary forces, and corner film flows is developed, and this model is found to be in good agreement with the experimental results. Finally, we obtain three dimensionless numbers that can be used to predict Tcr. Our work provides guidance for the effective regulation of diffusive growth and the heating-induced release of bubbles from dead-end pore throats. [ABSTRACT FROM AUTHOR]

To assess and compare the diagnostic performance of Clinical Prediction Rules (CPRs) developed to detect group A Beta-haemolytic streptococci in people with acute pharyngitis (or sore throat). A systematic review. We searched PubMed, Embase and Web of Science (inception–September 2022) for studies deriving and/or validating CPRs comprised of ≥2 predictors from an individual's history or physical examination. Two authors independently screened articles, extracted data and assessed risk of bias in included studies. A meta-analysis was not possible due to heterogeneity. Instead we compared the performance of CPRs when they were validated in the same study population (head-to-head comparisons). We used a modified grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess certainty of the evidence. We included 63 studies, all judged at high risk of bias. Of 24 derived CPRs, 7 were externally validated (in 46 external validations). Five validation studies provided data for head-to-head comparison of four pairs of CPRs. Very low certainty evidence favoured the Centor CPR over the McIsaac (2 studies) and FeverPain CPRs (1 study) and found the Centor CPR was equivalent to the Walsh CPR (1 study). The AbuReesh and Steinhoff 2005 CPRs had a similar poor discriminative ability (1 study). Within and between study comparisons suggested the performance of the Centor CPR may be better in adults (>18 years). Very low certainty evidence suggests a better performance of the Centor CPR. When deciding about antibiotic prescribing for pharyngitis patients, involving patients in a shared decision making discussion about the likely benefits and harms, including antibiotic resistance, is recommended. Further research of higher rigour, which compares CPRs across multiple settings, is needed. [ABSTRACT FROM AUTHOR]

Introduction Oral nicotine pouches (ONPs) contain a crystalized nicotine powder instead of tobacco leaves. ONPs come in a variety of flavors and are often marketed as "tobacco-free," but research on ONP use-motivations and related experiences is limited. Aims and Methods This cross-sectional web-based survey collected self-report data on ONP use-characteristics (eg, frequency), brands and flavors used, use-motivations, dependence (Fagerström Test for Nicotine Dependence-Smokeless Tobacco [FTND-ST]), and ONP-related adverse events (AEs) experienced. Results The sample included 118 adults who reported current (past 30-day) ONP use. On average (SD), participants reported ONP use on 13 (6) days during the past month. Most participants (% of the sample) also reported the use of tobacco cigarettes (74%) and/or electronic cigarettes (53%) during the past month. Zyn (27%) and Lucy (19%) were the most currently used ONP brands with mint (23%) and tobacco (16%) as the most currently used flavors. The availability of preferred flavors was the most frequently reported (31%) ONP use-motivation. The sample demonstrated significant dependence levels (FTND-ST = 7, SD = 2). Reported AEs included mouth lesions (48%), upset stomach (39%), sore mouth (37%), sore throat (21%), and nausea (9%). Results should be interpreted in the context of study limitations, including using a relatively small and homogeneous online convenience sample. Acknowledging the limitations, this sample was deemed appropriate to include considering the novelty of the findings, the dearth of related research, and the necessity of examining foundational ONP use-characteristics (eg, topography, AEs); however, future research should consider recruiting larger and more generalizable samples. Conclusions The availability of preferred flavors was a key ONP use-motivation in this sample. Mint and tobacco were the most currently used flavors, with Zyn and Lucy being the most currently used ONP brands. Participants reported dependence and a substantial number of ONP-related AEs. Nationally representative surveys should investigate ONP use along with outcomes included in the current study (eg, AEs) to inform ONP surveillance and policy development efforts. Implications This study is among the first to assess reasons for initiating/maintaining ONP use as well as other relevant use-experiences (eg, AEs, dependence). These results highlight the role of flavors and nicotine dependence in ONP use, which are important considerations for informing ONP regulations. [ABSTRACT FROM AUTHOR]

Background Community pharmacies in Wales delivered an NHS-funded sore throat test and treat (STTT) service during the period of increased invasive Group A Streptococcus (iGAS) incidents in winter 2022–23. Service users were screened using FeverPAIN/CENTOR scores, offered GAS rapid antigen detection tests (RADT) if appropriate, and antibiotics if indicated. Objectives To evaluate the service's response to a substantial rise in sore throat presentations during a period of heightened public anxiety. Methods Cross-sectional study with anonymized individual-level data from electronic pharmacy records of all eligible STTT service users, between January 2022 and March 2023. Results Antibiotics were supplied to 24% (95% CI: 23–24) of people who used the STTT service and 31% (95% CI: 31–32) of those who met the threshold for an RADT. Of 27 441 STTT consultations, 9308 (33.9%) occurred during December 2022. In the week commencing 2 December 2022, following the announcements of increased iGAS incidents, we observed a statistically significant increase of 1700 consultations (95% CI: 924–2476) and a statistically significant decrease in supply rate of 13.9 antibiotics per 100 RADT (95% CI: −18.40 to −9.40). Antibiotic supply rates increased thereafter to those observed before the announcements of iGAS incidents. Referral rates to other primary care or emergency settings remained below 10% throughout the study period. Conclusions Our findings suggest that, despite a dramatic increase in sore throat consultation rates in response to media reports, the pre-specified pathway followed by pharmacists ensured appropriate use of antibiotics, and absorbed a substantial workload that would otherwise end up in other healthcare settings. [ABSTRACT FROM AUTHOR]

Background In patients without ethnicity risk factors for acute rheumatic fever (ARF), our local guidelines recommend limiting antibiotic use following a positive throat swab culture (TSC). If symptoms are severe, a 5–7 day course is recommended. Despite this, most local patients with a positive TSC for group A Streptococcus (GAS) or Streptococcus dysgalactiae subsp. equisimilis (SDSE) were being prescribed 10 days of antibiotics. In response, we added comments to positive TSC reports recommending shorter treatment durations in those without ARF risk factors. No other antimicrobial stewardship initiatives were implemented. Objectives To assess the effect of these comments on antibiotic course duration after positive TSC. Methods All community TSC results from 1 October 2021 to 31 March 2023 (1 year pre- to 6 months post-change) were matched to antibiotic dispensing data. Patients who had been empirically dispensed an antibiotic prior to the culture report were excluded. The outcome of interest was the antibiotic duration dispensed in the 5 day period after the TSC report. Results Following introduction of the comments, median course duration reduced from 10 (IQR 5–10) to 7 days (IQR 0–10; P < 0.01) and from 7 (IQR 0–10) to 0 days (IQR 0–5; P < 0.01) following GAS- and SDSE-positive TSC, respectively, in those without ARF risk factors. The percentage of people receiving 10 days of antibiotics decreased from 63.0% to 37.0% (P < 0.01) and 41.2% to 14.6% (P < 0.01) for GAS and SDSE, respectively. Conclusions The introduction of comments providing direct prescribing advice to requestors appears to have been highly effective at improving guideline-compliant prescribing following positive TSC report. [ABSTRACT FROM AUTHOR]

This study reveals the heterogeneity, anisotropy, and formation mechanism of nanostructures (pores and throats) for the storage and seepage of tight oil by comprehensively unifying the following techniques: FE–SEM, gas adsorption, EDS, HPMI, MICP, and umbrella deconstruction. The results show that for tight oil reservoirs, 82.8% of the nanoscale pore contributes to oil storage, 50.2% of the nanoscale pore contributes to oil seepage, 76.5% of the nanoscale throat contributes to oil storage, and 38.9% of the nanoscale throat contributes to oil seepage. The nanopores were mainly formed in kaolinite, chlorite, K-feldspar, and illite, with 57%, 21%, 14%, and 7% of the contents, respectively. Among them, 85% are clay minerals. The weathering and dissolution of feldspar contributes a great deal to the formation of nanopores, accounting for about 78%, which a follow-up study should target. The relatively large pores can easily form a relatively large throat, and compaction and diagenesis later have little influence on the density of the nanoscale pores. Simultaneously, the pore radius and throat peak radius are the most robust parameters reflecting the reservoir's storage capacity and infiltration difficulty. The conclusion will provide a crucial scientific basis for tight oil storage and underground flow. • Nanostructures for the storage and seepage of tight oil are revealed comprehensively. • Compaction and diagenesis have little influence on the density of nanopores. • The peak radius could reflect the storage capacity. [ABSTRACT FROM AUTHOR]

In polymer flooding, the primary attentions focused on the influence of polymer concentration and the elasticity on fluid breakup. However, the shear-thinning characteristic can also significantly affect the apparent viscosity of the fluid. We simulated the breakup process of the dispersed phase in both shear-thinning and Newtonian fluids by using volume of fluid method, encompassing various viscosity ratios, capillary numbers, and rheological parameters. The critical conditions of capillary number and viscosity ratio for breakup of the dispersed phase were obtained, indicating that the dispersed phase was more prone to breakup in shear-thinning fluids. The mechanism of fluid breakup induced by shear-thinning was examined through the analysis of viscosity, pressure, and the magnitude of vorticity. Attributed to heightened destabilization in the radial direction and diminished viscous forces, fluid breakup processes were enhanced by lower zero-shear viscosity and reduced power-law index. The fluid breakup caused by the radial instability of shear-thinning fluids is distinguishing from the classical Roof snap-off theory. Inspiring by these results, enhancing rheological parameters such as power-law index and zero-shear viscosity in designing polymer flooding technique can accelerate the occurrence of the breakup process, thereby achieving control over the oil recovery process. [Display omitted] • Volume of fluid method is utilized to simulate fluid breakup in pore-throat. • The fluid breakup is more susceptible to occur in surrounding shear-thinning fluids. • Breakup processes are enhanced in lower zero-shear-viscosity and power-law index. • Delaying effect of rheological parameters on breakup follows: power-law index > zero-shear-viscosity > relaxation time. [ABSTRACT FROM AUTHOR]

Background & Aims: Post-operative sore throat is one of the minor complications after general anaesthesia with endo tracheal intubation. Although short lasting and selflimiting, it creates an uncomfortable situation for patient. Diffusion of Nitrous Oxide (N20) into endotracheal tube (ETT) cuffs and increase intra cuff pressure causes this. Different inflating agents have been studied to see the incidence of intra cuff pressure changes. This study was performed to see the post extubation tracheal mucosal changes and post-operative sore throat after using N20 in Oxygen as ETT cuff with direct visualization of the tracheal mucosa just after tracheal extubation. Methods: Institutional ethical committee approval and informed written consent were obtained, 50 patients, undergoing elective surgery under general anaesthesia, were enrolled. Patients were randomly allocated in two groups of 25. In Group A, the ETT cuff was inflated with air, in Group B, cuff was inflated with 67% N, 0 in oxygen. The cuff pressure was kept around 30 cm H, 0 and was measured every 10 minutes. The condition of the trachea was seen using fibreoptic bronchoscope and a grading was done. All the data was collected & statistical analysis performed. Results: The frequencies of pain, difficulty in swallowing, and hoarseness of voice at the recovery room within the first two hours after anaesthesia were lowest in Group B than Group A and significantly reduced within 24 hours. Perioperatively cuff pressure change in group A was significantly high and in group B it was minimum. Bronchoscopic view of larynx and trachea showed 64 % normal. 22% was erythematous, 10% was oedematous in group B. In group A it was 28%, 46% and 24%. Conclusions: It is evident, that N, 0 in 0, filled ETT cuff reduces the incidence of postoperative sore throat. It is proposed that the difference was produced due to no or minimum diffusion of N, 0 in N, 0 with 0, filled ETT cuff, subsequently no significant intra cuff pressure changes per operatively. [ABSTRACT FROM AUTHOR]

Background: Postoperative sore throat (POST) is a common postoperative complication. Complication: Chewing gum can inhibit the growth of oral bacteria, cleanse, and lubricate the oral cavity, which can help reduce postoperative sore throat. We hypothesize that chewing gum before surgery could relieve POST. Methods: Patients planned to undergo total thyroidectomy under general anesthesia with tracheal intubation were randomized to swallow saliva twice or chew 1.4 g/2.8 g of gum for 2 minutes before surgery. A standard anesthesia protocol was performed. The numerical rating scale scores of POST at 1, 24, and 48 h after surgery were collected. The primary outcome was the incidence of moderate/severe POST (numerical rating scale score >3) within 48 h. Results: Data from 148 patients (control group, n = 50; 1.4 g group, n = 48; and 2.8 g group, n = 50) were included in the analysis. Within 48 h, there was a significant difference among the three groups in the incidence of moderate/severe POST (control group: 74% vs. 1.4 g group: 65% vs. 2.8 g group: 50%. P = 0.04). The 2.8 g group had less incidence of moderate/severe POST than the control group (Odds Ratio = 0.351 95% Confidence Interval: (0.152 and 0.814) P = 0.02). Conclusion: Chewing 2.8 g gum before total thyroidectomy can reduce the incidence of moderate/severe POST within 48 h after surgery. [ABSTRACT FROM AUTHOR]

We review a new traversable-wormhole solution of the gravitational field equation of general relativity without exotic matter. Instead of having exotic matter to keep the wormhole throat open, the solution relies on a 3-dimensional "spacetime defect," which is characterized by a locally vanishing metric determinant. We also discuss the corresponding multiple-vacuumdefect- wormhole solution and possible experimental signatures from a "gas" of vacuum-defect wormholes. Multiple vacuum-defect wormholes appear to allow for backward time travel. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine and compare nonpharmacologic methods for the management of postoperative sore throat in adult patients undergoing endotracheal intubation. This study used a systematic review of clinical trials. Articles published between 2010 and 2022 in PubMed, Scopus, Web of Science, MEDLINE, EBSCOHost databases were included. The review was organized according to Cochrane Collaboration guidelines and reported using Preferred Reporting Items for Systematic Reviewsand Meta-Analyses. A total of 857 articles were retrieved in the initial search. After reviewing the articles according to the inclusion and exclusion criteria, a final set of seven articles was evaluated. It was observed that ASA I-II patients in whom elective surgery was planned were mostly included in the studies. It was determined that cold vapor, ice cube, licorice gargle, luo han guo (Monk fruit) herbal tea and tube warming were used as non-pharmacological methods. Interventions were performed preoperatively in five of the studies and postoperatively in two. Numeric pain scale was frequently used to assess sore throat. Patients’ sore throat was most commonly evaluated in the second, fourth and 24th hours after extubation. Cold vapor, licorice gargle, luo han guo herbal tea and tube warming were found to be effective in reducing sore throat. Several reliable non-pharmacological methods are available for managing a sore throat in patients undergoing endotracheal intubation. However, more research is needed to determine the most effective non-pharmacological approach. [ABSTRACT FROM AUTHOR]

Background: Post operative sore throat (POST) is a common issue encountered in patients undergoing surgery under general anaesthesia with endotracheal tube. Our study aimed to evaluate efficiency of Zn lozenges on post operative sore throat by comparing it with placebo. Method: Total 80, ASA I and ASA II, patients of age group 20 to 60 years, posted for surgery lasting for 1 to 4 hours under general anaesthesia with endotracheal intubation were randomly allocated in two groups, group Zn (patients receive Zn lozenges in preoperative period) and group P (received placebo preoperatively). Incidence rate and severity score of POST at 0, 2, 4 and 24 hr postoperatively were observed. SPSS17.0 version used. Student's T test and Mann Whitney U test used for continuous variables. Nominal categorical data compared using Chi-square and Fisher's exact test. P<0.05 considered statistically significant. Result: The overall incidence of POST in group Zn and group P was 15% and 37.5%, respectively (p <0.05). We found statistically significant difference in incidence of mild POST between groups at 0, 2, 4 hours postoperative. The incidence of moderate POST, at different interval of time, was found to be more in group P but the difference was statistically insignificant. No incidence of severe POST reported in both the groups. Conclusion: Zn lozenges helps to alleviate POST. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway. Methods: In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat. Results: A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001). Conclusion: Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo. [ABSTRACT FROM AUTHOR]

BACKGROUND Postoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia. The study was conducted to compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat. MATERIAL AND METHODS A total of 120 patients' candidate for surgery were enrolled in the study. Patients in ketamine group (K, n=40) received ketamine gargle (30mg in 30 mL of 25% dextrose in saline), Magnesium group (M, n=40) received magnesium sulfate gargle (1.5mg in 30 mL of 25% dextrose in saline) and Dextrose group (D, n=40) received dextrose gargle (30 mL of 25% dextrose) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured post operatively were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation using on a 4-point scale (0-3). RESULTS There were no significant differences between age, sex, body mass index (BMI), the Modified Mallampati class distribution and ASA grade between three groups of patients. Hemodynamics of patients, including blood pressure, mean arterial pressure and pulse rate were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group and ketamine group compared to Dextrose group. Dextrose group had significantly higher incidence of sore throat at 2 hr (P = 0.023) and at 4 hr (P = 0,031) compared to Magnesium group after the operation. No patient had severe sore throat in group M and group K. CONCLUSIONS Magnesium at even a low dose decreases incidence of sore throat and pain severity more effectively when compared to ketamine gargles. [ABSTRACT FROM AUTHOR]

General anaesthesia with endotracheal intubation results in postoperative sore throat. We studied the effectiveness of nebulization with ketamine which is a NMDA receptor antagonist, on the incidence and severity of sore throat in patients undergoing surgery under general anaesthesia. Institutional ethical committee approval obtained. 100 consenting patients scheduled for middle ear surgeries were randomly allocated to two groups of 50 each to receive 50mg of Ketamine or saline nebulization 15 minutes before the induction. Sore throat was less in 0, 2, 4, and 6hrs (p<0.02). Ketamine nebulization before intubation reduces incidence and severity of sore throat. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a prevalent inflammatory skin disease characterized by epidermal barrier dysfunction and Th2-skewed inflammation. Campanula takesimana (C. takesimana), a Korean endemic plant grown on Ulleng Island, has long been associated with a traditional alternative medicine for asthma, tonsillitis, and sore throat. In this study, we reported the effect of C. takesimana callus extract on upregulating epidermal barrier-related proteins dysregulated by Th2 cytokines. C. takesimana callus extract induced the expression of skin barrier proteins, such as filaggrin, claudin-1, and zonula occludens-1, in both human primary keratinocytes and Th2-induced AD-like skin-equivalent models. Additionally, RNA sequencing analysis demonstrated that C. takesimana callus extract partially restored Th2 cytokine-induced dysregulation of the epidermal development and lipid metabolic pathways. Considering the advantages of callus as a sustainable eco-friendly source of bioactive substances, and its effect on skin barrier proteins and lipid metabolic pathways, C. takesimana callus extracts can possibly be utilized to improve the integrity of the skin barrier. [ABSTRACT FROM AUTHOR]

Background: The incidence of postoperative sore throat (POST) after tracheal intubation using double-lumen endobronchial tubes (DLTs) is higher in patients with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than in the general population. This prospective trial was conducted to determine whether thermal softening of DLTs could decrease the incidence of POST or other airway injuries in patients with prior SARS-CoV-2 infection. Methods: A total of 120 patients with prior SARS-CoV-2 infection undergoing thoracoscopic surgery were randomly assigned to two groups (n = 60 each). In the thermal softening group, the distal portion of the DLT was placed in thermostatic saline (50 °C) for 10 min before endotracheal intubation. In the control group, the distal portion of the DLT was placed in room temperature saline for 10 min before endotracheal intubation. The incidence and severity of POST and hoarseness were assessed at 1, 6 and 24 h postoperatively. The primary outcomes were the incidence and severity of POST at 6 h postoperatively. The secondary outcomes were the incidence and severity of hoarseness, vocal cord and tracheal injuries, and hemodynamic changes in patients at intubation. Results: The incidence of POST at 6 h postoperatively was greater in the control group than in the thermal softening group [41 (68%) vs. 22 (37%), P = 0.001]. The overall incidence of POST at 24 h postoperatively was greater in the control group than in the thermal softening group [46 (76%) vs. 24 (40%), P < 0.001]. The overall incidence of tracheal injuries was also greater in the control group than in the thermal softening group (P = 0.016). Vocal cord injuries occurred more frequently in the control group than in the thermal softening group (P = 0.006). Conclusion: Thermal softening of DLTs before intubation can reduce the incidence of POST and airway injuries in patients with prior SARS-CoV-2 infection undergoing DLT insertion. Trial registration: This trial has been registered at www.chictr.org.cn (registration number: ChiCTR2200066821; registration date: December 19, 2022). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]