Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage were associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin converting enzyme 2 (ACE2). As a result of SARS‐Cov‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT 1 R) axis associated with oxidative stress. This leads to insulin resistanceas well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block the AT 1 R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are given: Kimchi in Korea, westernized foods and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects helpful in mitigating COVID‐19 severity.
Objective: To determine whether Psidium guajava leaves mouthwash is effective in the management of patients with aphthous ulcers Methods: Study Design: Randomized prospective open label clinical study Setting: Tertiary Government Training Hospital Subjects: Thirty two patients diagnosed with aphthous ulcers were randomly divided into two groups, a treatment group using prepared guava leaves mouthwash, and a control group using isotonic sodium chloride solution mouthwash, given thrice a day for seven days. Patients were evaluated using a 10 point Visual Analog Scale. The sizes of the aphthous ulcers were measured using a caliper, and compared on day 1 and day 7 for both treatment and control groups. Results were subjected to statistical analysis using T-test, Mann-Whitney U test, and Fisher Exact test. Results: Comparison of VAS scores of guava treatment and NSS control groups showed that there were no differences in pain experienced on days 1 and 2. However, the VAS scores from day 3 to 7 had p values ranging from 0.02 - 0.0001 which showed significant differences in resolution of pain. There was statistically significant marked improvement of pain symptoms as early as three days post-treatment among patients who were administered guava leaves mouthwash. Complete resolution of aphthous ulcers in 75% of the study group was observed on day 7. Mean ulcer size post-treatment with guava gargle was 0.25mm compared to 0.75mm for NSS gargle. The mean size difference at day 7 was 1.44mm for the guava treatment group and 0.88mm for the NSS control group. There was a statistically significant faster resolution of ulcer size on day 7 in 16/16 or 100 % of patients in the treatment group compared with only 10/16 or 62.5% of patients in the control group. Patients who were administered guava leaves mouthwash generally fared better than those administered isotonic sodium chloride solution. Conclusion: Guava leaves mouthwash was effective for aphthous ulcers in terms of reduction of symptoms of pain and faster reduction of ulcer size. Further clinical trials comparing this mouthwash against other treatment options are recommended. Keywords: Guava leaves (Psidium guajava), aphthous ulcers, mouthwash
Objective: To describe the clinical profile of patients with laryngotracheal stenosis over a 7-year period and discuss strategies for its prevention. Methods: Study Design: Retrospective Case Series Setting: Tertiary Government Hospital Participants: Patients with laryngotracheal stenosis confirmed by laryngoscopy and/or bronchoscopy Results: Twenty-one patients were evaluated for laryngotracheal stenosis from January 2008 to June 2015, but only 13 with complete data were included in this study. Of the 13 patients, nine (69.2%) belonged to the pediatric age group. Ten (77%) were males and three (23%) were females. Laryngotracheal stenosis following endotracheal tube (ET) intubation was seen in 11 (84.6%) while 2 had thyroid masses and no history of prior ET intubation. Presenting symptoms or reasons for referral were wheezing (n=4), stridor (n=4), failure to decannulate the tracheostomy tube (n=3), and dyspnea (n=2). Duration of ET intubation was four to 60 days. The highest frequency of ET re-intubation was 5 times. Among those intubated, stenosis was glottic in one, subglottic in five and tracheal in five patients. Three had Cotton-Myer grade I stenosis, two had grade II, three had grade III and three had grade IV stenosis. Those with thyroid masses had tracheal stenosis. Conclusion: Strategies for prevention of laryngotracheal stenosis should include routine airway endoscopy for patients with longstanding neck masses and for those with prolonged ET intubation, for whom the option of early prophylactic tracheostomy is worth considering. Otherwise, immediate post-extubation endoscopy may facilitate documentation and appropriate intervention. Keywords: acquired laryngeal stenosis; tracheal stenosis; endoscopy; intubation, intratracheal; tracheostomy
Objective: To report a case of foreign body lodged within the sphenoid sinus and its extraction. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache, without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized, probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopic-guided removal of the foreign body (a glass marble) were performed with no intra – operative and post – operative complications. Conclusion: Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction. Keywords: Sphenoid sinus foreign body, Computed Tomography (CT), Endoscopic-guided, transorbital approach
INTRODUCTION Upper respiratory tract infection (URTI) is an illness caused by an acute infection by viruses or bacteria of the nose, sinuses, pharynx, and larynx. Most URTIs are short, mild, and self-limiting, but some can lead to serious complications, resulting in heavy social and economic burden on individuals and society.AREAS COVERED This article presents the management guidelines and consensus established through the Delphi method during an expert roundtable conducted in November 2020 and results of a targeted literature review.EXPERT OPINION There is currently no available cure for acute URTI and management strategies aim towards symptom alleviation and prevention of URTI virus transmission. The effectiveness of these strategies is highly increased with early intervention, administered prior to the peaking of viral shedding. This reduces the chances of developing a full-blown acute URTI, decreases symptom severity, and reduces viral transmission. Mucoadhesive gel nasal sprays have shown promising results for early intervention of acute URTI. They act by creating a barrier that can trap virus particles, thereby preventing invasion of the mucosa by the virus. Additionally, they deliver broad spectrum activity that is effective against a wide variety of pathogens that cause acute URTI. Acute URTI warrants greater attention and proactive management in reducing its burden.
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