well as salt water soaks considerably decreases the minimal erythema dose. 9,10 So, if enhanced UV gain is the mode of action in BPT, one may question whether broadband UVB following bathing might yield a better synergistic effect than NB-UVB.To date, the BPT studies conducted by Dawe et al. 1 and Léauté-Labrèze et al. 2 have been the most useful clinical approaches in order to estimate whether there is any additional effect of salt water soaks prior to phototherapy. The results obtained from these observations will put the data of numerous previous retrospective and prospective uncontrolled investigations into perspective and may 'downregulate' the enthusiasm of many BPT followers, particularly in Germany. Nevertheless, the conclusion of the previously published controlled trials on BPT suggest a small beneficial effect of using salt water soaks prior to phototherapy. 1,2,5-7 Beyond pure efficacy rates, we have also to take into account the high acceptance of BPT by patients with psoriasis, possibly indicating a holistic approach including time for relaxation and psychological effects that may contribute significantly to the clearance of psoriasis. 1 Disregarding the slight therapeutic benefit from bathing prior to phototherapy, we have to consider the economical and practical drawbacks of BPT. 3,4 Conclusively, in special medical settings (e.g. rehabilitation clinics), particularly where natural resources (e.g. spas) can be used, it is certainly justified to employ BPT for routine use. However, there is no good reason to recommend the general replacement of phototherapy with BPT.
Postoperative fever following endoscopic endonasal surgery is a rare occurrence of concern to surgeons. To elucidate preoperative and operative predictors of postoperative fever, we analyzed the characteristics of patients and their perioperative background in association with postoperative fever. A retrospective review of 371 patients who had undergone endoscopic endonasal surgery was conducted. Predictors, including intake of antibiotics, steroids, history of asthma, preoperative nasal bacterial culture, duration of operation, duration of packing and intraoperative intravenous antibiotics on the occurrence of postoperative fever, and bacterial colonization on the packing material, were analyzed retrospectively. Fever (≥38 °C) occurred in 63 (17 %) patients. Most incidences of fever occurred on postoperative day one. In majority of these cases, the fever subsided after removal of the packing material without further antibiotic administration. However, one patient who experienced persistent fever after the removal of packing material developed meningitis. History of asthma, prolonged operation time (≥108 min), and intravenous cefazolin administration instead of cefmetazole were associated with postoperative fever. Odds ratios (ORs) for each were 2.3, 4.6, and 2.0, respectively. Positive preoperative bacterial colonization was associated with postoperative bacterial colonization on the packing material (OR 2.3). Postoperative fever subsided in most patients after removal of the packing material. When this postoperative fever persists, its underlying cause should be examined.
Rationale:Since late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly spread worldwide, resulting in a pandemic. Patients with coronavirus disease 2019 (COVID-19) have difficulty in visiting clinics in person during pandemic because they might be encouraged to quarantine at home with supportive care. Peritonsillar abscess rarely coexists with COVID-19; however, patients with SARS-CoV-2 infection could get co-infections or become superinfected with other microorganisms which could cause peritonsillar abscess. We herein describe a case of peritonsillar abscess caused by Prevotella bivia that occurred as a co-infection with COVID-19 during home quarantine.Patient concerns:A 32-year-old Asian woman who was diagnosed with COVID-19 was instructed to stay home for quarantine. Her pharyngeal discomfort worsened, and she experienced trismus and dysphagia. An emergent visiting doctor referred her to our hospital. Contrast-enhanced computed tomography showed peritonsillar abscess findings, following which we referred her to an ear, nose, throat specialist. Prevotella bivia was identified on needle aspiration pus culture; however, two sets of blood and throat cultures were negative.Diagnosis:A definitive diagnosis of acute COVID-19 and peritonsillar abscess due to Prevotella bivia was made.Interventions:An antibiotic drug, antiviral drug, and adjunctive steroid were administered intravenously.Outcomes:Her symptoms improved without the need for incision and drainage, and she was discharged on day 7.Conclusion:Patients with suspected peritonsillar abscess should be triaged and referred to ear, nose, throat specialists appropriately. Scoring systems, such as modified Liverpool peritonsillar abscess score or the guidelines criteria might be useful tools to triage patients. During the early phase of SARS-CoV-2 infection, administration of corticosteroids is not recommended. When adjunctive steroids are considered for peritonsillar abscess, prior to or simultaneous use of the antiviral agent remdesivir for COVID-19 might be recommended.
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