ABSTRACT
BACKGROUND: E-cigarette use, or vaping, is an alternative nicotine delivery system that is becoming increasingly prevalent in adolescents and young adults. There is currently a lack of comprehensive research on the adverse effects of vaping on the upper airway. Acute epiglottitis is a potentially life-threatening condition that can lead to airway obstruction. It is commonly caused by bacterial infections such as streptococci, staphylococcus, and Moraxella. Adult patients with acute epiglottitis mainly present with odynophagia, dysphagia, and respiratory difficulties. The diagnosis of epiglottitis is made by direct laryngoscopy, and the mainstay of treatment is antibiotics. Bozella et al. (2020) reported a case of subacute non-infectious epiglottitis associated with e-cigarette use in a pediatric patient (Pediatrics 145(3), 2020). Here we present a case of acute epiglottitis in a healthy young adult after vaping, with a negative infectious workup. To our knowledge, there has been no such reported case of epiglottitis associated with e-cigarette use in an adult patient. CASE DESCRIPTION: A previously healthy 29-year-old male with daily e-cigarette use presented to the emergency department with a severe sore throat, dysphagia, mild hoarseness, and shortness of breath, especially when lying supine. A lateral neck soft tissue radiograph revealed a thickened epiglottis with a thumb sign. Direct bedside laryngoscopy showed a swollen epiglottis, partially obstructing the supraglottic region confirming the diagnosis of acute epiglottitis. Throat and nasal swabs were negative for streptococcus and COVID-19 infection, respectively. The patient's condition improved significantly after receiving intravenous Dexamethasone and antibiotics for 2 days. Repeat laryngoscopy showed the resolution of epiglottis swelling, and subjective symptoms had resolved entirely 2 weeks following the start of the treatment. CONCLUSIONS: Although bacterial infections usually cause acute epiglottitis, this case presents the second report of this condition associated with vaping with negative microbiological investigations. Therefore, we recommend that physicians consider non-infectious causes such as vaping in their differential diagnosis for patients with acute and subacute epiglottitis. More research is warranted on the utility of antibiotics in treating vaping-induced epiglottitis.
ABSTRACT
In this paper, a novel terahertz (THz) plasmonic switch is designed and simulated. The device consists of a periodically corrugated n-type doped silicon wafer covered with a metallic layer. Surface plasmon propagation along the structure is controlled by applying a control voltage onto the metal. As will be presented, the applied voltage can effectively alter the width of the depletion layer appeared between the deposited metal and the semiconductor. In this manner, the conductivity of the silicon substrate can be successfully controlled due to the absence of free electrons at the depleted sections. Afterwards, the effectiveness of the proposed plasmonic switch is enhanced by implementing a p(++)-type doped well beneath the metallic indentation edges. Consequently, a P-Intrinsic-N diode is formed which can manipulate the plasmon propagation by modifying the electron and hole densities inside the intrinsic area. The simulation results are explained very concisely by the help of scattering matrix formalism. Such a representation is essential as employing the switches in the design of complex plasmonic systems with many interacting parts.
