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Introduction: Nasal irrigation is a common treatment used for symptomatic relief during a viral upper raspatory tract infection. It is currently unknown if the regular use of nasal rinses contributes to a reduction in viral load and transmissibility in patients with upper respiratory tract infections, including COVID-19. Method(s): A systematic review was completed in April 2022 with predefined search criteria using keywords related to nasal irrigation and viral illnesses. Common nasal solutions used for irrigation, including saline, corticosteroid and providineiodine were included. Databases included MEDLINE, Embase, Web of Science, Cochrane, ClinicalTrials.gov. Data related to the type of nasal rinse, virus studied, effects on symptoms, viral load, and transmission were gathered in a standardized data extraction tool. Result(s): Title and screening was performed for 1267 unique results, where 65 studies received full-text review and 12 were included in data extraction. Eight of these 12 studies looked specifically at COVID-19. Six out of 10 randomized controlled trials (RCTs) used saline, 3 used providine- iodine, and 1 used an intranasal corticosteroid. Eight out of 10 RCTs showed that nasal irrigation reduced upper respiratory tract symptoms. Three trials showed a reduction in viral load. Four studies demonstrated a reduction of viral load in the nasopharynx. Four studies reported data on side effects. The most common was mild nasal irritation. Study methods were heterogeneous. Data on transmission were reported in only 1 study. Conclusion(s): Nasal irrigation is well tolerated in patients with viral upper respiratory tract infections with minimal risk. The data for nasal rinses for the prevention and treatment of viral infection are limited, and there are conflicting results. Saline and providine-iodine rinses may have some efficacy in reducing viral titres. While nasal rinses appear to be beneficial in reducing nasal symptoms of an upper respiratory tract infection, a larger scale study is needed to identify if these rinses impact the viral load, illness severity, and transmissibility in patients with COVID-19.
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CASE: A 24-year-old male without past medical history aside from high-risk sexual activity (multiple female sexual partners complicated by a distant history of chlamydia) however with frequent negative testing (recent negative HIV, syphilis RPR, and urinary gonorrhea/chlamydia RNA tests) and consistent condom use presents to an urgent care visit for 1 week history of sore throat with difficulty swallowing. The symptoms presented gradually with reported lymph node swelling of upper neck without associated cough, congestion, or fever. He denies sick contacts however there is high local transmission of COVID-19. Exam shows bilateral tonsillar swelling with right-sided white exudate and midline uvula;bilateral tender anterior cervical lymphadenopathy is present. COVID-19 PCR and Strep antigen/culture tests are negative. Patient is advised to treat symptomatically with ibuprofen and saltwater gargles for a likely viral upper respiratory tract infection. Symptoms persist without improvement;he presents again 1 week later. He now reveals that prior to this sore throat he had receptive oral intercourse with a female partner of unknown sexual history. Exam is unchanged. Repeat COVID-19 PCR test is negative. Monospot and HIV RNA tests are negative but gonorrhea RNA pharyngeal swab results positive. Patient is given IM ceftriaxone and symptoms resolve;patient tests negative on repeat swab 10 days later. IMPACT/DISCUSSION: This case demonstrates the difficulty in expeditious diagnosis of gonococcal pharyngitis without high index of suspicion. Spread primarily through receptive oral intercourse, most oropharyngeal infections with N. gonorrhoeae are asymptomatic, although symptoms shared with other common upper respiratory infections like sore throat, exudate, and cervical lymphadenopathy as well as fever may occur. Management is a single 500mg IM injection of ceftriaxone, notification of relevant partners, as well as a test of cure 7-14 days after initial treatment due to challenges of effective treatment when at this site. Expeditious diagnosis and eradication are important as pharyngeal gonococcal infections can contribute to high level of gonococcal transmission, uneradicated gonococcal infection could disseminate, and the pharynx is thought to be where horizontal transfer of gonococcal antimicrobial resistance genes commonly occurs. Given the increasing prevalence of gonococcal infections nationally and increasing rates of antimicrobial-resistant gonococcal infections, which were estimated to be 550,000 infections in 2019 and increasing when studied from 2000-2017 as per the CDC's 2019 Antibiotic Resistance Threats Report, this concern becomes increasingly urgent with time. CONCLUSION: -A high index of suspicion is required for expeditious diagnosis of gonococcal pharyngitis -A test of cure is recommended after treatment given the challenge of eradication at the pharynx -Eradication is important to decrease gonorrhea transmission and horizontal transfer of antimicrobial resistance genes.
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Objective: To report on the post-approval safety profile of subcutaneous interferon beta-1a (sc IFNβ-1a) in patients with relapsing multiple sclerosis (RMS), including COVID-19 and other respiratory viral infections. Background: sc IFNβ-1a is a well-established disease-modifying therapy for RMS, with an estimated cumulative exposure of 1,831,698 patient-years (to 30 April 2021). Design/Methods: Serious and non-serious adverse events (AEs)/adverse drug reactions (ADRs) from post-approval spontaneous individual case safety reports are presented cumulative to May 2021. AE rates are shown as total number of patients. Current COVID-19 findings are summarized. Results: A total of 527,833 ADRs have been reported;6.6% of events were serious. Analysis of the most common respiratory viral infection ADRs reported spontaneously (influenza [2374 cases, constituting 0.45% of all ADRs], viral infection [319], H1N1 influenza [15], viral bronchitis [6], and viral upper respiratory tract infection [5]) did not reveal any abnormal trend outside the known safety profile of sc IFNβ-1a;cases were typically non-serious. There was no suggestion of an increased risk of more severe respiratory viral infection or other ADRs in RMS patients who experienced such infection while being treated with sc IFNβ-1a. As of 17 August 2021, the Merck KGaA safety database included 1256 suspected or confirmed cases of COVID-19 in sc IFNβ-1a treated RMS patients;the majority were non-serious events. Among confirmed cases (n=1029), 110 patients were hospitalized with 5 requiring mechanical ventilation. There were 24 fatalities (18 fatal COVID-19 events and 6 other fatalities unconfirmed for COVID-19 involvement). At time of reporting, around half of COVID-19 confirmed AEs were recovered or resolving. Conclusions: Cumulative to 17 August 2021, there was no increased risk of COVID-19 in sc IFNβ-1a treated RMS patients and the majority of cases were non-serious, consistent with previously reported registries. No new safety concern was identified from post-approval cases in scope of this review.
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Upper respiratory tract infections (URI) are prevalent in the United States. URIs can also be debilitating and costly. The most common etiology for an URI is viral, and there are currently no antiviral medications for the common cold. Therefore, cost-effective preventative measures are essential in the prevention of URIs. This literature review intends to compare the few studies evaluating the effectiveness of saltwater gargle for preventing URIs. The goals of this review include commenting on the potential for a saltwater gargle in preventing URIs, shortcomings of the few studies performed and recommendations for further research in evaluating saltwater gargle as an effective prevention method. This review looks explicitly at three studies evaluating the effectiveness of saltwater gargling and the prevention of URIs. Conclusions derived from this review include both physiological and clinical evidence of the potential for saltwater gargling in URI prevention. The first two studies demonstrate patient-derived evidence for saltwater gargling, potentially providing a decreased risk of URI when used preventatively. The third study demonstrates the potential for polymerase chain reaction (PCR) in evaluating the effectiveness of saltwater gargling in reducing the duration of illness. Additionally, in the wake of the COVID-19 pandemic, cost-effective treatment options targeting viral URIs, such as SARS-CoV-2, warrant further evaluation and discussion.
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A great number of patients with Coronavirus Disease 2019 (COVID-19) experience olfactory dysfunction, typically of a short duration and with a high incidence rate, during the early stages of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This kind of olfactory dysfunction appears more likely in young people and women. This study presents a review of the clinical features and pathogenic mechanism of the olfactory dysfunction related to SARS-CoV-2 infection, aiming to provide a clinical reference for the diagnosis, differential diagnosis, treatment, and prevention of olfactory dysfunction in COVID-19 patients.
Subject(s)
COVID-19 , Olfaction Disorders , Adolescent , Female , Humans , Olfaction Disorders/etiology , SARS-CoV-2 , SmellABSTRACT
Background. The majority of human antimicrobial utilization occurs in the outpatient setting. Despite being mainly viral in etiology, upper respiratory tract infections (URIs) were the most common indication for outpatient antimicrobial prescriptions at our institution. Methods. Through our electronic health record (EHR), we were able to determine our rate of antibiotic prescriptions for inappropriate URI diagnosis at our primary care practice sites. We selected staff volunteers from each our primary care practice sites to serve as stewardship champions. They were given training in stewardship best practices, and an URI stewardship toolkit which included viral URI prescription pad, EHR order panel, and patient education signage. They were tasked with providing education and feedback to their practice sites. We meet with them on a monthly basis to disseminate prescribing data and education. They also provided feedback from practice sites to the stewardship committee. Results. Our decentralized model was put in place in November 2020. In the 6 months prior to the intervention, the average prescribing rate was 29.1%. In the 6 months after the intervention, the average prescribing rate decreased by 15% to 24.8%. During the intervention phase, there was an increase in number of non-COVID URIs diagnosed at our primary care sites. Temporal Trend in Inappropriate Antibiotics Prescribing Rates for Viral URIs Preand Post- Intervention Inappropriate antibiotic prescribing rate for viral upper respiratory tract infections from May 2020 until May 2021. Intervention started in December 2021 (arrow). Preintervention average was 29.1%. Post-intervention age was 24.8% which is a 15% decline in prescribing rate. Viral Upper Respiratory Infections Visits The total number of visits for presumed viral upper respiratory infections to primary care sites from May 2020 until May 2021. The majority of COVID-19 precautions in the area expired at the end of March 2021. Conclusion. We have been able to lower our inappropriate prescriptions for URIs utilizing a decentralized model of stewardship champions. This result was especially notable as the intervention phase corresponded with the end of COVID-19 precautions and an increase in non-COVID URIs diagnosed. The advantage of this approach includes an advocate embedded at each practice site who is familiar with the opportunities and challenges of the site, and a two-way flow of information from practice sites to the stewardship committee. This model provided additional benefit during the COVID-19 pandemic as the ability of centralized staff to travel to off campus clinic sites was curtailed.