BACKGROUND: Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries. METHODS: Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients. RESULTS: Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria. CONCLUSIONS: Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.

• Klíčová slova
• AID-Net, Autoinflammatory diseases, Eurofever, JIR-cohort, PFAPA, SURF,
• MeSH
• aftózní stomatitida * diagnóza   epidemiologie   MeSH
• dědičné zánětlivé autoimunitní nemoci * diagnóza   MeSH
• dítě MeSH
• faryngitida * diagnóza   MeSH
• horečka etiologie   diagnóza   MeSH
• kojenec MeSH
• lidé MeSH
• lymfadenitida * diagnóza   epidemiologie   MeSH
• mladiství MeSH
• předškolní dítě MeSH
• recidiva MeSH
• registrace * MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

INTRODUCTION: Deep neck infections represent severe inflammatory involvement of defined fascial spaces of the neck and are potentially life-threatening diseases. The etiology is most commonly odontogenic or tonsillogenic. The main complications are mediastinitis, septic shock and upper airway obstruction. Treatment is based on the administration of intravenous antibiotics and, in indicated cases, surgical drainage of abscess sites. Case report 1: A 7-year-old girl was treated by a general practitioner for acute tonsil-litis. CT scan with contrast medium was indicated due to worsening of the condition and neck movement. A large retropharyngeal abscess was not reliably found from the external approach, so the procedure was extended to tonsillectomy and transoral drain-age. The cause was probably a multilocular abscess with rigid membranous septa. Case report 2: A 65-year-old man with diabetes mellitus presents with odynophagia and infiltrate of the left side of the neck. CT scan showed a phlegmon in the left carotid space. Surgery was indicated after 24 hrs of ineffective conservative treatment. During the operation, extensive formed abscess lesions were found and drained. Case report 3: A 60-year-old woman was treated as an outpatient for tonsillitis, then at the regional ENT department with an incipient epiglottitis, and finally at a tertiary department with a diagnosis of deep neck infection extending from the epiglottis to the hyoid according to imaging examinations. Peroperative findings revealed even larger extent of abscess that extended down to the jugulum. Case report 4: A 57-year-old patient with peritonsillar abscess treated by incision and antibiotics in the regional ENT department. Despite the treatment instituted, the condition progressed and a parapharyngeal abscess developed, which had to be managed by tonsillectomy and external incision at a tertiary department, including postoperative intubation and several days of hospitalization in an ICU ward. CONCLUSION: Medical history, otorhinolaryngological examination and early head and neck contrast enhanced CT are essential in the diagnosis of deep cervical inflamma-tion. Modern therapeutic algorithms including a multidisciplinary approach, repeated CT scans and surgical revisions lead to reduced mortality, including patients with mediastinitis.

• Klíčová slova
• case report, deep neck infections, parapharyngeal abscess, retropharyngeal abscess,
• MeSH
• dítě MeSH
• krk * MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrofaryngeální absces * diagnóza   chirurgie   MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Pharmaceutical care for patients with sore throat not requiring medical attention Counsultancy in self-treatment of mild health problems is one of the dominant aspects of providing pharmaceutical care, especially in pharmacy practice. A sore throat is one of the most common reasons for visiting a pharmacy. According to current knowledge, the biggest pitfall of sore throat management is the systematic and reliable classification of patients into uncomplicated and potentially complicated cases, which should ideally take place at the level of pre-medical care, i.e. in a pharmacy. For this purpose, the practical use of the self-treatment algorithm in the therapy of sore throat was presented in the article. The introduction of a systematic algorithm into pharmacy practice could contribute to higher efficacy of the provided care and reduce the risk of overlooking warning symptoms (red flags). The article also provides an overview of over the counter therapeutic options for sore throat.

• Klíčová slova
• Pharyngitis, pharmaceutical care., self-treatment algorithm, sore throat,
• MeSH
• algoritmy MeSH
• farmaceutické služby MeSH
• faryngitida * farmakoterapie   terapie   MeSH
• léky bez předpisu terapeutické užití   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• léky bez předpisu MeSH

OBJECTIVE: Group A beta-haemolytic streptococci (GAS), which are responsible for most cases of acute bacterial tonsillopharyngitis, are transmitted from person to person and may rarely cause foodborne outbreaks. This study aims to report the epidemic caused by GAS in our hospital and to draw attention to the explosive outbreaks of the bacteria. METHODS: Acute tonsillopharyngitis was seen in 201 of 450 hospital employees who ate in the hospital cafeteria on 4-5 June 2015. RESULTS: GAS was detected in 106 (68%) of 157 cases and in 40 (63.5%) of 62 throat culture samples. The attack rate was 44.7%. The most suspected source of the outbreak was a food handler who had been showing signs of streptococcal tonsillopharyngitis for six days, and perhaps the food prepared by these staff. CONCLUSION: It should not be forgotten that GAS can cause explosive outbreaks by infecting food through hand lesions or mouth secretions of food service personnel.

• Klíčová slova
• GAS, Streptococcus pyogenes, foodborne, outbreak, streptococcal tonsillopharyngitis,
• MeSH
• epidemický výskyt choroby MeSH
• faryngitida * epidemiologie   diagnóza   mikrobiologie   MeSH
• lidé MeSH
• nemocnice MeSH
• Streptococcus pyogenes MeSH
• streptokokové infekce * epidemiologie   diagnóza   mikrobiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The origin of metal elements in tonsillar tissues of children patients was investigated in order to establish the link between environmental pollution and tonsilitis diagnosis. The children lived either in a polluted, industrial region (Moravian-Silesian Region, North-East Czechia) or a clean, predominantly agricultural region (South Bohemian Region, South-East Czechia). Simultaneously, the distance of the address of the patients to the closest main road was assessed. The elemental content of the present particulate matter in the tonsil samples, coming from indicated tonsillectomies, was analysed using scanning electron microscopy equipped with an X-ray microprobe. No significant association of the elemental composition and the region was found using both bivariate and multivariate methods; however, an association with the distance to the closest main road was found. The study presents a novel assessment of the tonsillar tissues and supports the link between environmental factors (traffic-related particulate pollution) and the onset of chronic, idiopathic diseases in children, which has been debated recently.

• Klíčová slova
• Children, Chronic tonsillitis, Idiopathic diseases, Industrial pollution, Metal-based particles, Traffic pollution,
• MeSH
• chronická nemoc MeSH
• dítě MeSH
• látky znečišťující vzduch * analýza   MeSH
• lidé MeSH
• lymfatický systém chemie   MeSH
• monitorování životního prostředí MeSH
• pevné částice analýza   MeSH
• pilotní projekty MeSH
• tonzilitida * MeSH
• znečištění ovzduší * analýza   MeSH
• znečištění spojené s dopravou * analýza   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• látky znečišťující vzduch * MeSH
• pevné částice MeSH

Tonsillectomy is a routine surgery in otorhinolaryngology and the occurrence of postoperative bleeding is not a rare complication. The aim of this retrospective, observational, analytic, cohort study is to compare the incidence of this complication for the most common indications. A group of patients indicated for tonsillectomies for peritonsillar abscess (group I) was compared to a group of patients indicated for chronic and recurrent tonsillitis (group II). There are a lot of pathophysiological differences in patients indicated for acute tonsillectomy for peritonsillar abscess and in patients indicated for elective tonsillectomy for chronic or recurrent tonsillitis. No technique to minimize the risk of bleeding after tonsillectomy has been found and a large part of postoperative bleeding occurs in postoperative home-care, which makes this issue topical. In total, 2842 unilateral tonsillectomies from the years 2014-2019 were included in the study. Bleeding occurred in 10.03% and, surprisingly, despite completely different conditions in the field of surgery (oedema, acute inflammation in peritonsillar abscess), there was no statistically significant difference between incidence of postoperative bleeding in the studied groups (p = 0.9920). The highest incidence of bleeding was found in the patients of group I on the eighth postoperative day, with those aged 20-24 years (p = 0.0235) being the most at risk, and in group II, on the sixth postoperative day, with those aged 25-29 years (p = 0.0128) and 45-49 years (p = 0.0249) being the most at risk.

• Klíčová slova
• chronic tonsillitis, peritonsillar abscess, personalized treatment, postoperative bleeding, recurrent tonsillitis,
• MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé MeSH
• mladý dospělý MeSH
• peritonzilární absces * epidemiologie   chirurgie   MeSH
• retrospektivní studie MeSH
• tonzilektomie * škodlivé účinky   MeSH
• tonzilitida * epidemiologie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Tonsillitis is a relatively well treatable disease. Complications of untreated tonsillitis can even today result in life-threatening complications. The aim of this study is to present a case of a 47-year-old man without previous history of health problems, who suffocated after a brief episode of breathing difficulties. At the forensic autopsy, left-side necrotising tonsillitis with adjacent soft tissue, uvula, and epiglottis swelling and inflammation and significant airway narrowing were found.

• Klíčová slova
• asphyxia, autopsy, sudden death, tonsillitis,
• MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhlá smrt etiologie   MeSH
• pitva MeSH
• soudní patologie MeSH
• tonzilitida * etiologie   MeSH
• zánět MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Peritonsillar abscess (PTA) is the most common complication of tonsillitis. Cultivation usually reveals a wide spectrum of aerobic and anaerobic microbiota. This retrospective study compared PTA incidence and the spectrum of individual microbial findings in groups of patients divided by gender, age, and season. Of the 966 samples cultivated, a positive cultivation finding was detected in 606 patients (62.73%). Cultivation findings were negative in 360 (37.27%), meaning no pathogen was present or only common microbiota was cultivated. The highest incidence of PTA was found in group I patients (19-50 years) (p ≤ 0.0001) and the most frequently cultured pathogens was Streptococcus pyogenes (36.23%). Gender seemed to have an influence on the results, with higher incidence found in males (p ≤ 0.0001). The analysis of correlation between PTA incidence and season did not yield statistically significant results (p = 0.4396) and no statistically significant differences were observed in individual pathogen frequency. PTA had a higher incidence in adult males and a slightly higher incidence in girls in childhood. The following findings are clinically significant and have implications for antibiotic treatment strategy: (1) the most frequently cultivated pathogen was Streptococcus pyogenes; (2) an increased incidence of anaerobes was proven in the oldest group (>50 years).

• Klíčová slova
• bacteriology, incidence, patient stratification, peritonsillar abscess, personalized treatment, primary prevention,
• MeSH
• antibakteriální látky MeSH
• dítě MeSH
• dospělí MeSH
• incidence MeSH
• lidé MeSH
• peritonzilární absces epidemiologie   mikrobiologie   MeSH
• retrospektivní studie MeSH
• Streptococcus pyogenes MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antibakteriální látky MeSH

OBJECTIVES: The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases. MATERIALS AND METHODS: Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured. RESULTS: The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47). CONCLUSION: Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.

• Klíčová slova
• GSTA1, GSTP1, glutathione S-transferase, idiopathic tonsillar hypertrophy, recurrent tonsillitis,
• MeSH
• dítě MeSH
• glutathiontransferasa metabolismus   MeSH
• hypertrofie enzymologie   patofyziologie   MeSH
• krční mandle enzymologie   patologie   MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• proteiny metabolismus   MeSH
• tonzilitida enzymologie   patofyziologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• glutathiontransferasa MeSH
• proteiny MeSH

BACKGROUND: ABP 501 was evaluated in a phase 3 single-arm, open-label extension (OLE) study to collect additional safety and efficacy data in patients with rheumatoid arthritis (RA). METHODS: Subjects completing the final visit in the parent phase 3 randomized, double-blind, controlled equivalence study comparing the efficacy and safety of the biosimilar ABP 501 with adalimumab reference product (RP) were enrolled in this open-label extension (OLE) study. All subjects received 40 mg ABP 501 every other week for 68 weeks. Key safety endpoints included treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), and anti-drug antibody (ADA) incidences. Efficacy endpoints included ACR20 (at least 20% improvement in American College of Rheumatology core set measurements from baseline) and Disease Activity Score 28-joint count C-reactive protein (DAS28-CRP) change from baseline. RESULTS: Among 466/467 patients treated with ABP 501, 229 transitioned from the ABP 501 arm of the parent study (ABP 501/ABP 501) and 237 from the adalimumab RP arm (RP/ABP 501); 412/467 (88.2%) patients completed the study. The overall TEAE incidence was 63.7% (297/466); grade ≥ 3 TEAE incidence was 9.0% (42/466). The incidence of TEAEs leading to discontinuation of investigational product was 3.6% (17/466). The SAE incidence was 9.9% (46/466). Overall, 18.2% (85/466) of subjects developed binding ADAs and 6.9% (32/466) developed neutralizing ADAs in the OLE study. The ACR20 response rate was 73.3% (340/464 subjects) at OLE baseline, and 78.8% (327/415 subjects) at week 70 of the OLE study. The overall mean DAS28-CRP change from the parent study baseline was - 2.25 at the OLE study baseline (n = 440), - 2.36 at week 4 (n = 463), - 2.41 at week 24 (n = 450), - 2.55 at week 48 (n = 433), and - 2.60 at week 70 (n = 412). Efficacy was maintained throughout the study. CONCLUSIONS: Efficacy previously demonstrated in the parent study was maintained in this OLE study with no new safety findings. Long-term safety, immunogenicity, and efficacy were similar in the ABP 501/ABP 501 and RP/ABP 501 groups. The single switch from RP to ABP 501 did not impact immunogenicity. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02114931.

• Klíčová slova
• ABP 501, Adalimumab, Biosimilar, Efficacy, Long-term safety, Rheumatoid arthritis,
• MeSH
• adalimumab škodlivé účinky   terapeutické užití   MeSH
• antirevmatika škodlivé účinky   terapeutické užití   MeSH
• biosimilární léčivé přípravky škodlivé účinky   terapeutické užití   MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• lidé středního věku MeSH
• lidé MeSH
• nazofaryngitida chemicky indukované   MeSH
• revmatoidní artritida farmakoterapie   MeSH
• rozvrh dávkování léků MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• ABP 501 MeSH Prohlížeč
• adalimumab MeSH
• antirevmatika MeSH
• biosimilární léčivé přípravky MeSH