Over the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018.A repeated cross-sectional study using patient data from the IQVIA Medical Research Data (IMRD) database. The proportion (95% CI) of women prescribed non-barrier contraception per year was captured.A total of 2 705 638 women aged 15–49 years were included. Between 2000 and 2018, the proportion of women prescribed combined hormonal contraception (CHC) fell from 26.2% (26.0%–26.3%) to 14.3% (14.2%–14.3%). Prescriptions for progestogen-only pills (POPs) and long-acting reversible contraception (LARC) rose from 4.3% (4.3%–4.4%) to 10.8% (10.7%–10.9%) and 4.2% (4.1 %–4.2%) to 6.5% (6.5%–6.6%), respectively. Comparing 2018 data for most deprived versus least deprived areas, women from the most deprived areas were more likely to be prescribed LARC (7.7% (7.5%–7.9%) vs 5.6% (5.4%–5.8%)) while women from the least deprived areas were more likely to be prescribed contraceptive pills (20.8% (21.1%–21.5%) vs 26.2% (26.5%–26.9%)). In 2009, LARC prescriptions increased irrespective of age and social deprivation in line with a pay-for-performance incentive. However, following the incentive’s withdrawal in 2014, LARC prescriptions for adolescents aged 15–19 years fell from 6.8% (6.6%–7.0%) in 2013 to 5.6% (5.4%–5.8%) in 2018.CHC prescribing fell by 46% while POP prescribing more than doubled. The type of contraception prescribed was influenced by social deprivation. Withdrawal of a pay-for-performance incentive may have adversely affected adolescent LARC uptake, highlighting the need for further intervention to target this at-risk group. Additionally, the UK has seen a number of policy-related initiatives aimed at reducing unwanted pregnancy.3In the UK, approximately 26% of women aged 16–49 years use hormonal contraception.4 In 2009, a pay-for-performance Quality and Outcomes (QOF) incentive for LARC counselling was introduced. This incentive aimed to increase LARC uptake by paying general practitioners (GPs) a premium for providing information relating to LARC to women attending for contraception.3 Despite its success, the incentive was retired in 2014, and at the same time funding to sexual and reproductive health (SRH) services was reduced.5In 2005, the National Institute for Health and Care Excellence (NICE) published its first long-acting reversible contraception (LARC) guideline advising that all women requiring contraception should be given information about LARC.6 However, the majority of women seek contraception from primary care,7 with only 5% of females aged 13 to 54 years using SRH service for contraception between 1 April 2019 and 31 March 2020.6 Data on contraceptive prescriptions issued in primary care in England are reported in absolute numbers but they are not linked to individual patients nor is data available for the devolved nations of the UK.6Detailed data on trends in contraceptive provision from SRH services is published annually by NHS Digital.Describing trends in contraceptive prescribing and how they relate to demographic factors such as age and deprivation is an essential step in planning future service delivery as the model of contraceptive care undergoes change. We aimed to investigate sociodemographic and temporal trends in the prescribing of non-barrier contraception in primary care from 2000 to 2018.A repeated cross-sectional study using electronic UK general practice (GP) records from the IQVIA Medical Research Data (IMRD) database8 The GP practices included in IMRD are broadly representative of the UK in terms of practice size, age, gender, mortality and the prevalence of a number of chronic conditions such as diabetes, epilepsy and asthma.9 IMRD incorporates data from THIN, a Cegadim Database. Reference made to THIN is intended to be descriptive of the data asset licensed by IQVIA.In the UK National Health Service (NHS), GPs look after patients in the community and are often the first point of contact for anyone with a health problem. IMRD is a longitudinal database containing the anonymised medical records of 18.3 million patients across 797 UK GP practices. IMRD represents approximately 6% of the UK population and goes back to 1994. Data are recorded using the Read code hierarchical coding system.10 All data included were from time periods after the GP practices had met electronic data quality standards.12First, a source cohort of women was extracted from IMRD. All women aged 15–49 years who contributed data to IMRD for the period 1 January 2000 to 31 December 2018 were eligible for inclusion. This was a dynamic cohort, with women entering and exiting throughout the study period. The age range 15–49 years was selected as this is the World Health Organization (WHO) definition of ‘women of reproductive age’.Women were censored from the cohort at the first recording of any medical event which would usually preclude future use of contraception , the first recording of a prescription for hormone replacement therapy , the datSeparate cross-sections were then identified for each calendar year (2000–2018). To be included, each woman was required to contribute data to the source cohort for the entire year from 1 January to 31 December. A woman could contribute data to multiple cross-sections. In each cross-section, a woman’s age was defined as the age she would be on 1 July of that year .The main outcome of interest was the prescription of non-barrier contraceptives. Prescription code lists for the following contraceptives were developed and reviewed by a GP: combined hormonal contraception (CHC) , transdermal patches and intravaginal rings), POPs and LARC  and intrauterine devices (IUDs)). For LARC, Read codes were also used to search the medical records for documented evidence of administration/insertion . Due to μg was separated from other POPs as it works in a similar way to COCPs by inhibiting ovulation.COCPs were stratified by pill generation. Pill generation is the four-level UK classification system used for COCPs as they were rolled out chronologically. The majority of pills contain ethinylestradiol and the difference between the generations is the formulation of the progestogen. First-generation pills were not included in the study as they had all been discontinued in the UK by the early 1990s. Co-cyprindiol, a treatment for acne and also a contraceptive, was included separately. Desogestrel 75 13The following data were captured for each patient: age (in 5-year bands), country of GP practice, Townsend score (a postcode-linked quintile measurement of deprivation which was taken from the patient’s home address at GP registration. ‘Townsend 1’ is the least deprived and ‘Townsend 5’ is the most deprived).Stata Statistical Software: Release 15  was used for all analyses.Descriptive characteristics were summarised using numbers and percentages for categorical variables and medians and interquartile ranges (IQRs) for non-normally distributed continuous variables.The number of women who received each type of contraceptive was reported as a proportion ) of the total number of women in the cross-section for each year. Multiple prescriptions of the same method within a year were treated the same as a single prescription. Women could be prescribed multiple different types of contraception within 1 year. Proportions were stratified by age group, country and deprivation.Patients and the public were not involved in this study.IMRD data collection was approved by the NHS South-East Multicentre Research Ethics Committee in 2003. This study was approved by the Scientific Research Committee (SRC) on 11 May 2021 (SRC reference 18THIN082-A1).A total of 3 577 421 women were included in the source cohort. Nineteen cross-sections were identified, one for each calendar year. 2 705 638 women (15 251 805 person-years) contributed cross-sectional data . There wBetween 2000 and 2018, the proportion of women receiving a prescription for any contraceptive fell from 32.9% (32.7%–33.0%) to 29.2% (29.1%–29.3%). However, this was in the context of a rise in prescription of LARC from 4.2% (4.1%–4.2%) to 6.5% (6.5%–6.6%) and POPs from 4.3% (4.3%–4.4%) to 10.8 (10.7%–10.9%) and a fall in prescription of CHCs from 26.2% (26.0%–26.3%) to 14.3% (14.2%–14.3%) .Second-generation COCP, third-generation COCP and co-cyprindiol prescriptions fell from 20.9% (20.8%–21.0%) to 11.0% (11.0%–11.1%), 4.1% (4.0%–4.l%) to 1.7% (1.7%–1.7%) and 2.2% (2.2%–2.3%) to 0.5% (0.5%–0.5%), respectively. Fourth-generation COCP prescriptions increased from 0.0% to 2.7% (2.7%–2.8%) in 2010 and then declined to 1.4% (1.4%–1.5%) in 2018. Less than 0.1% were prescribed intravaginal rings and contraceptive patches throughout .Prescribing of CHCs fell in all countries. The largest fall was seen in England, falling from 26.5% (26.3%–26.6%) to 13.8% (13.6%–13.9%) and the smallest fall in Northern Ireland; 24.8% (24.1%–25.6%) to 16.8% (16.4%–17.1%) of women . CHCs weμg was introduced in 2002), whereas prescription of other POPs fell from 4.3% (4.3%–4.4%) to 1.0% (0.9%–1.0%). Prescribing of POPs rose in all countries, the most dramatically in Northern Ireland from 3.2% (2.9%–3.5%) to 11.6% (11.3%–11.9%) (Desogestrel prescriptions increased from 0.0% in 2000 to 10.0% (95% CI 9.9 to 10.1) in 2018 (desogestrel 75 %–11.9%) . A simil%–11.9%) .IUD/IUS prescribing increased from 1.2% (1.1%–1.2%) in 2000 to 1.9% (1.9%–1.9%) in 2018. Implant prescribing increased from 0.0% to 1.7% (1.7%–1.8%); the older levonorgestrel implants were discontinued and replaced by etonogestrel implants in 1999. IUD/IUS and implant uptake increased more rapidly in line with LARC linkage to QOF in 2009 and plateaued after this date . InjectaAll countries saw a rise in uptake of LARC over the study period; the largest in Scotland from 4.6% (4.4%–4.8%) to 8.0% (7.9%–8.2%) and the smallest in Northern Ireland from 3.6% (3.3%–3.9%) to 4.8% (4.6%–5.0%) . LARC waAdolescents aged 15–19 years and women aged 20–24 years saw the biggest increase in LARC prescribing between 2000 and 2013; from 3.9% (3.7%–4.1%) to 6.8% (6.6%–7.0%) and 6.1% (5.9%–6.3%) to 8.9% (8.7%–9.0%), respectively. The only age group to see a reduction in LARC prescription after linkage to QOF ended was adolescents, falling from 6.8% (6.6%–7.0%) in 2013 to 5.6% (5.4%–5.8%) in 2018 .Over a 19-year period, prescription of CHCs almost halved, but a 2.5-fold increase in POP prescription was found. LARC prescription increased in line with the introduction of the NICE guidance in 2005, with a further increase following the pay-for-performance QOF indicator in 2009. Adolescents were the only age group to see a fall in LARC uptake after the QOF indicator was withdrawn in 2014.Strengths of this study include the large sample size and the use of a database generalisable to the UK population. Unlike survey studies which rely on self-reporting of contraceptive use, our data are based on prospectively collected electronic prescribing records, thus avoiding recall bias.There are a number of limitations to this study. First, contraceptive prescriptions from SRH services were not included. Additionally, some GPs do not offer implant or IUD/IUS insertion and women will have to obtain these elsewhere. Therefore, results are an underestimate of actual contraceptive uptake, but still an accurate representation of prescribing in primary care. Second, it is acknowledged that a proportion of women will have been prescribed methods for non-contraceptive reasons . Third, although we captured LARC insertions, some of these devices can remain in situ for up to 10 years. Therefore, we are not able to provide reliable estimates of prevalent use for these methods. Finally, although IMRD has been shown to be generalisable to the UK population, when stratifying by country, contributing practices are not necessarily generalisable to the region.17 We observed comparable estimates of prescribing to a population-based Northern Irish study for the period 2010–2016 (20.2% vs 16.6% for COCPs and 9.4% vs 8.0% for POPs).18 The small difference could be explained by the fact that these researchers were unable to link 11% of dispensed contraceptives to individuals and these were not included. In comparison to a Clinical Practice Research Datalink study focusing on the impact of QOF on LARC uptake for the period 2004–2014, our estimates of LARC prescribing were higher (5.7% vs 3.0% for 2009 and 6.7% vs 3.9% for 2014).19 This could be because this research group classified LARC uptake as ‘a branded or generic prescription for LARC’ whereas we additionally included documentation of insertion in the medical records. We observed similar trends in LARC prescribing before and during the period that LARC was linked to QOF. However, our study provides new evidence that LARC prescribing has fallen in adolescents since the QOF indicator was withdrawn in 2014. An explanation could be the fact that young people are more likely to be new users of contraception; new users may be more likely to take up LARC when offered it than women already established on contraception that works for them. Young women are the most at risk of unplanned pregnancy,20 and if LARC uptake in adolescents has fallen then this is a concern. A study assessing rates of unplanned pregnancies in relation to withdrawal of the QOF indicator would a useful piece of work. This could guide decision-making regarding re-implementation of the incentive or the introduction of new interventions.Similarly to the USA, Ireland, Australia and Canada, oral contraception was the most commonly prescribed method.16 we found LARC to be more commonly prescribed in deprived areas and oral contraception to be more commonly prescribed in less deprived areas. These trends are likely to be influenced by social inequalities. Contraceptive failure rates have been shown to be higher across all methods in low-income groups.21 Additionally, in England and Wales, the rate of abortion in the most deprived decile is more than double the rate in the least deprived.22 These factors could generate prejudice among GPs when selecting appropriate contraception. Practitioners must be trained to provide informed contraceptive choices, including appropriate information and education to avoid prescribing inequalities.In keeping with data from Canada and Ireland,μg in 2002.23 POP prescribing may have also increased due to a shift towards administration of medications via patient group direction; non-medical prescribers may be more likely to supply medications with fewer risks and contraindications.24 This would account for the reduction in COCP prescribing mirroring the increase in POP prescription. Recently, desogestrel 75 μg became available over-the-counter.25 While this broadens contraceptive availability, desogestrel 75 μg is not as effective as LARC. We hope that pharmacists will use the opportunity to signpost women, particularly adolescents, to information on LARC and reverse the falling trend in this population.An increase in prescribing of POPs was expected since the introduction of desogestrel 75 Our study highlights temporal and sociodemographic trends in contraceptive prescribing across the UK. How contraceptive care is delivered is currently in a period of transition. Prescribers will need to be attuned to changes in demand for contraception, so that any evolving model responds to women’s choices and needs.Supplementary data


Escherichia coli infected pigs. Sixty weaned pigs were assigned to one of five treatments: negative control (CON−), positive control (CON+), dietary supplementation of 100 ppm BB1, 50 or 100 ppm BB2. All pigs, except CON−, were orally inoculated with 1010 CFU F18 ETEC/3-mL dose for 3 consecutive days after 7 d adaption. Feces, ileal digesta and cecal content were collected for 16S rRNA amplicon sequencing. Serum and ileal mucosa underwent primary metabolomics analysis. Supplementing 100 ppm BB1 increased (p < 0.05) relative abundances of Enterobacteriaceae and Escherichia–Shigella in ileum, and the relative abundances of Bacteroidota and Prevotellaceae in cecum than CON+ on d 5 post-inoculation (PI). Supplementing 100 ppm BB2 upregulated serum pinitol on d 4 PI and serum cholesterol and aminomalonic acids on d 21 PI, while supplementing 50 ppm BB2 reduced asparagine in ileal mucosa on d 5 PI than CON+. Supplementation with botanical blends modulated ileal and cecal microbiota and serum metabolomics profiles in weaned pigs under Escherichia coli challenge.The objective of this study was to investigate supplementation of botanical blends (BB) comprised of 0.3% capsicum oleoresin and 12% garlic oil on gut microbiota and metabolomic profiles in serum and ileal mucosa of  Escherichia coli (ETEC) when pigs are under weaning stress . Al. Al14]. 10 CFU per 3 mL in phosphate buffer saline. The ETEC inoculums were prepared by the Western Institute for Food Safety and Security at UC Davis. The F18 ETEC was isolated from a field disease outbreak by the University of Illinois Veterinary Diagnostic Lab (isolate number: U.IL-VDL #05-27242) and expresses heat-labile toxin, heat-stabile toxins, and Shiga-like toxins. The dosage has been shown to cause mild diarrhea in previous studies [After 7 days of adaptation, pigs in all treatment groups except the negative control were inoculated with 3 mL of F18 ETEC for three consecutive days starting d 0. Each dose was provided at 10 studies ,15,16. A studies .Tail samples were collected from all piglets to test for their susceptibility to F18 ETEC. Tails were genotyped using a method described in Kreuzer et al.  and confExcluding pigs in the 100 ppm BB1 group, blood samples were collected from 24 pigs (six pigs per treatment) on d 4 and 21 PI for untargeted metabolomic analysis. Ileal mucosa was collected on d 5 PI and immediately stored in liquid nitrogen for untargeted metabolomic analysis.The 16S rRNA amplicon sequencing was used to identify and quantify microbial communities in ileal digesta, cecal content, and fecal samples. Bacterial DNA was extracted from all samples using the Quick-DNA Fecal/Soil Microbe Kit  according to the manufacturer’s instructions. DNA samples were quantified and standardized prior to amplification. Duplicate DNA samples were amplified using PCR of the V4 hypervariable region of the 16S rRNA gene using primers 515F (5′-XXXXXXXXGTGTGCCAGCMGCCGCGGTAA-3′), including an 8 bp barcode (X) unique to each sample followed by a 2 nt Illumina adapter (bold), and 806R (5′-GGACTACHVGGGTWTCTAAT-3′) . Each PChttps://github.com/najoshi/sabre (accessed on 29 June 2021). Demultiplexed sequences were imported into Quantitative Insights Into Microbial Ecology 2  to remove primers and lower quality reads using the DADA2 plugin [Barcode sequences were removed and the raw fastq files were demultiplexed in sabre . Residues were then resuspended in 500 µL of 50% aqueous acetonitrile and centrifuged at 12,800× g for 2 min to separate complex lipids and waxes. Resultant supernatant was collected and concentrated in a vacuum compressor. Dried sample extracts were derivatized and mixed with internal retention index markers, fatty acid methyl esters with chain lengths of C8 to C30. Samples were injected for GC/TOF-MS analysis, and all samples were analyzed in a single batch. Data were acquired for MS and mass calibration using FC43 (perfluorotributylamine) prior to analysis sequencing. Metabolite identification was performed based on two parameters: (1) retention index window ± 2000 U (around ± 2 second retention time deviation), and (2) mass spectral similarity plus additional confidence criteria that were based on Fiehn et al. [Untargeted metabolomics analysis was performed using gas chromatography  coupled with time-of-flight mass spectrometry (GC/TOF-MS)  by the NIH West Coast Metabolomics Center. Metabolite extraction method was derived from a previous study . Approxin et al. .m/z) value of ions in MS was detected.Raw data were pre-processed directly in Leco ChromaTOF software (v.2.32) for automatic mass spectral deconvolution and peak detection at signal/noise levels of 5:1. The BinBase algorithm was then used to further annotate the peaks within the deconvoluted data . The Binp > 0.05. Statistical significance for beta diversity was then tested using PERMANOVA and the vegan package [p-values were adjusted for multiple comparisons using false discovery rate (FDR).Sequence files for gut microbiota analysis were exported from QIIME2 and imported into R 4.1.0 for data visualization and statistical analysis . Shannon and Chao1 indices were measured for alpha diversity by using the estimate_richness function in phyloseq . The Bra package . Statisthttps://www.metaboanalyst.ca; accessed on 15 April 2022) [Metabolomics data were analyzed using different modules of the web-based platform MetaboAnalyst 5.0 (il 2022) . Peaks wp < 0.05) in feces as pigs aged from d –7 to 21 PI (p < 0.05) Chao1 index than CON+, otherwise no difference was observed among treatments in both Shannon and Chao1 indices throughout the experiment. The principal coordinate analysis based on Bray–Curtis displayed that the fecal samples collected on d –7 were clustered tightly and away from fecal samples collected on d 0, 5, and 21 PI  through time in fecal samples of pigs. However, the relative abundance of Firmicutes, Lachnospiraceae, Streptococcaceae, and Veillonellaceae increased (p < 0.05) when pig age increased. ETEC infection did not affect the relative abundance of Bacteroidota, Firmicutes, and Proteobacteria on d 5 and 21 PI when CON+ was compared with CON−. Supplementation with 100 ppm BB1 or 50 ppm BB2 enhanced (p < 0.05) the relative abundance of Bacteroidota (14.96 or 14.04% vs. 7.73%) and Proteobacteria (1.93 or 5.60% vs. 0.34%) but reduced (p < 0.05) the relative abundance of Firmicutes (75.28 or 74.27% vs. 84.54%) on d 5 PI, compared with CON−. Supplementation was 100 ppm BB2 also enhanced (p < 0.05) the relative abundance of Proteobacteria (5.45% vs. 0.34%) but reduced (p < 0.05) the relative abundance of Firmicutes (74.39% vs. 84.54%) on d 5 PI, compared with CON−. At the family level, pigs fed with 50 ppm BB2 reduced (p < 0.05) the relative abundance of Lachnospiraceae (18.32 vs. 25.87%) on d 5, and pigs fed with 100 ppm BB1 reduced (p < 0.05) the relative abundance of Lachnospiraceae (9.88 vs. 20.12%) on 21 PI, compared with CON−.The three most abundant phyla in fecal samples were Firmicutes, Bacteroidota, and Proteobacteria from all treatments throughout the experiment . The relLactobacillus, Streptococcus, and Blautia were the three most abundant genera in fecal samples throughout the experiment , but the relative abundance of Clostridium sensu stricto and Lachnoclostridium decreased in feces through time. ETEC infection reduced (p < 0.05) the relative abundance of fecal Faecalibacterium (3.21% vs. 5.63%) on d 5 PI and fecal Prevotella (0.68% vs. 6.59%) on d 21 PI when CON+ was compared with CON−. Pigs supplemented with 100 ppm BB1 had lower (p < 0.05) relative abundance of Blautia in feces on d 5 (5.74% vs. 9.19%) and 21 PI (3.13% vs. 7.26%) and had higher (p < 0.05) relative abundance of Escherichia–Shigella on d 5 PI (1.01% vs. 0.07%), than pigs in CON−. Supplementation with 50 ppm BB2 reduced (p < 0.05) the relative abundance of Blautia (5.49% vs. 9.19%) and increased (p < 0.05) the relative abundance of Escherichia–Shigella (4.52% vs. 0.07%) on d 5 PI compared with CON−.At the genus level, periment . ThroughWithin ileal digesta and cecal contents of weaned pigs collected on d 5 PI, the mean sampling depth was 21,432 reads and the total number of identified taxa was 2061. In alpha diversity, no difference was observed in both Shannon and Chao1 diversities in cecal contents among treatments . HoweverPrevotellaceae, Lachnospiraceae, and Ruminococcaceae was lower (p < 0.05) in the ileum than in the cecum. In ileal digesta, the relative abundance of Bacteroidota and its families Muribaculaceae and Prevotellaceae, and the relative abundance of Firmicutes families Ruminococcaceae and Selemonadaceae and Proteobacteria family Succinivibrionaceae were lower (p < 0.05) in CON+ than in CON−. The relative abundance of Pasteurellaceae was greater (p < 0.05) in CON+ than in CON−. No difference was observed in cecal content between CON− and CON+. Pigs supplemented with 100 ppm BB1 increased (p < 0.05) the relative abundance of Enterobacteriaceae (16.25% vs. 0.30%) in the ileum compared with CON+. In cecal content, pigs fed with 100 ppm BB1 had greater (p < 0.05) relative abundance of Bacteroidota (15.21% vs. 6.46%) and Prevotellaceae (13.26% vs. 5.98%) than CON+, while the relative abundance of Veillonellaceae was greater (p < 0.05) in CON+ (11.36% vs. 4.32%) than in 100 ppm BB1. The relative abundance of Enterobacteriaceae was higher (p < 0.05) in cecum of pigs supplemented with 100 ppm BB1, or 50 or 100 ppm BB2 than CON+ . No difference was observed in ileal and cecal microbiota composition among BB treatments on d 5 PI.In ileal digesta and cecal contents, the three most abundance phyla were Firmicutes, Proteobacteria, and Bacteroidota . The relLactobacillus and Streptococcus were the two most abundant genera in ileal digesta and cecal contents (p < 0.05) relative abundance of Agathobacter, Blautia, and Faecalibacterium than ileal digesta. No difference was observed in the relative abundance of the most abundant genera in the ileum and cecum between CON− and CON+. In ileal digesta, the relative abundance of Escherichia–Shigella was greater (p < 0.05) in 100 ppm BB1 (16.25% vs. 0.30%) than in CON+. In cecal content, the relative abundance of Megasphaera was lower (p < 0.05) in 100 ppm BB1 (2.81% vs. 8.22%) than in CON+ and the relative abundance of Escherichia–Shigella was greater (p < 0.05) when pigs were supplemented with BBs than pigs in CON+.contents . Cecal cThe mean number of reads was 24,588 per sample and the total number of identified taxa was 1202 in intestinal digesta from pigs collected on d 21 PI. Supplementing with BB and challenged with F18 ETEC did not affect the Shannon and Chao1 indices in ileal digesta and cecal content . For betMuribaculaceae, Prevotellaceae, Lachnospiraceae, and Succinivibrionaceae was lower (p < 0.05) in the ileum than in the cecum. F18 ETEC inoculation increased (p < 0.05) relative abundance of Streptococcaceae (56.81% vs. 1.93%) and Pasteurellaceae (8.95% vs. 0.68%) in the ileum when comparing CON+ with CON–. Supplementation with 50 ppm BB2 reduced (p < 0.05) the relative abundance of Streptococcaceae (15.63% vs. 56.81%) in ileal digesta in comparison to CON+. In cecal content, supplementation with 100 ppm BB2 increased (p < 0.05) the relative abundance of Muribaculaceae (0.38% vs. 0.25%) when compared with CON+. Lactobacillus and Streptococcus were the most abundance genera in ileal digesta and cecal content on d 21 PI (Blautia was higher (p < 0.05), but the relative abundance of Clostridium sensu stricto and Turicibacter was lower (p < 0.05) in cecum than in ileum. The relative abundance of Strepptococcus (56.81% vs. 1.93%) in ileal digesta was greater (p < 0.05) in CON+ than in CON–.The three most abundant phyla were Firmicutes, Bacteroidota, and Proteobacteria in ileal digesta and cecal content samples from all pigs on d 21 PI . The rel d 21 PI . The relA total of 221 metabolites (117 identified and 104 unidentified) were detected in serum samples on d 4 and 21 PI. VIP scores were computed to assess discriminatory variables in the dataset. On d 4 PI, F18 ETEC infection downregulated methionine, malic acid, galactonic acid, and pinitol, and upregulated oleic acid, arachidonic acid, and lauric acid when CON+ was compared with CON– . SupplemA total of 291 metabolites, including 162 identified and 129 unidentified metabolites were detected in ileal mucosa samples collected on d 5 PI. Asparagine was upregulated in ileal mucosa by supplementing 50 ppm BB2 compared with CON+. No differential metabolites were identified in ileal mucosa when comparing CON– vs. CON+, 50 ppm BB2 vs. CON+, and 50 ppm vs. 100 ppm BB2.Newly weaned pigs are highly stressed due to sudden dietary and environmental changes, and are more susceptible to ETEC-induced post-weaning diarrhea . The aniIn the present study, fecal microbiota was shifted over time throughout the study. Decreased Shannon and Chao1 indices indicate that microbial diversity was reduced due to a decrease in microbial richness in fecal samples. Reduced microbial diversity in fecal microbiota was also reported during the early stage of weaning in pigs . Other sLachnoclostridium in feces on d 5 and 21 PI, compared with the positive control. Previous research reported that Lachnoclosridium could produce butyrate, which helps maintain energy homeostasis and stimulates immune responses in the small intestine of pigs [Lachnospiraceae that was greater in pigs fed with 100 ppm botanical blend 2 (21.94%) than botanical blend 1 (9.88%) on d 21 PI. Overall, fecal microbiota was mainly affected by age rather than botanical supplementations.Fecal microbiota was also modified by the presence of ETEC and dietary supplementation with botanical blends. Supplementation with 50 ppm botanical blend 2 increased the relative abundance of  of pigs ,50. The Ruminococcaceae and Prevotellaceeae, which are associated with producing butyrate and contributing to antimicrobial activity in the intestines [Pasteurellaceae was also more abundant in infected pigs than in sham pigs, which was also observed by Li et al. [Pasteurellaceae might be correlated with an increase in ETEC [Pasteurellaceae is an indicator of gut dysbiosis in humans with inflammatory bowel disease [The peak of ETEC infection in post-weaning pigs is approximately day 5 to 7 post-inoculation . In the testines ,54. Morei et al. . This ob in ETEC . This re disease . It was  disease . In addi disease .Enterobacteriaceae and Escherichia–Shigella in ileal digesta than pigs in the positive control. The performance and clinical data from these pigs reported that supplementation with botanical blends reduced diarrheal frequency in weaned pigs infected with ETEC, thus there might be other reasons for the increased abundance of Enterobacteriaceae in the ileal digesta of pigs in the botanical blend groups [Prevotellaceae was greater in the cecum when pigs were supplemented with 100 ppm botanical blend 1 than pigs in the positive control. Prevotella was likely responsible for the increase in Prevotellaceae. Similar results were also observed when growing pigs were supplemented with essential oil blends [Megasphaera in the cecum when pigs were supplemented with 100 ppm botanical blend 1. In consistency, Li et al. [Megasphaera in the cecal microbiota of weaned pigs when supplemented with 62.5 ppm carvacrol and 7.5 ppm thymol. Megasphaera can utilize dietary protein and aid in amino acid metabolism in the small intestine of pigs [Megasphaera in the large intestine is limited. In the present study, pigs supplemented with botanical blends had lower abundance of Veillonellaceae than control pigs, which was different from the observations in Li et al. [Supplementation with botanical blends modified the intestinal microbiota of weaned pigs during the peak of ETEC infection. Pigs supplemented with 100 ppm botanical blend 1 had greater abundances of d groups . The rell blends . The prei et al.  reportedi et al. . This isStreptococcaceae and Pasteurellaceae were more abundant in ileal digesta of pigs in the positive control than negative control. These results may imply that ETEC has a long-term effect on the ileal microbiota of weaned pigs. A high abundance of Streptococcaceae is correlated with the high abundance of Streptococcus. Other research also reported that pigs under ETEC challenge had high abundance of Streptococcus in their gut microbiota [Streptococcus spp. are known to disrupt immunoglobulins from eliminating pathogens that invade the intestines [Streptococcaceae in ileal digesta of weaned pigs challenged with ETEC, this result might suggest that 50 ppm BB2 may modify the intestinal environment to prevent other opportunistic pathogens from invading the gut. However, the present study did not characterize the gut microbiota to the species level, thus future studies are needed to quantify microbiota at the species level and confirm the potential pathogenicity of Streptococcus. In addition, supplementation with 100 ppm botanical blend 2 increased the relative abundance of Muribaculaceae in the cecum compared with the positive control. Muribaculaceae is often known to be one of the predominant families found in mouse cecal microbiota and their abundance can be altered by diets [Muribaculaceae in the intestine of pigs is not well understood.Weaned pigs were reported to fully recover from ETEC infection by d 21 PI, as indicated by the normal diarrhea scores . In the crobiota . Pathogetestines . Since 5by diets ,66. HoweUntargeted metabolomics was performed in serum samples collected on d 4 and 21 PI to identify metabolomic changes in weaned pigs infected with ETEC. During the acute response of ETEC (d 4 PI), ETEC challenge downregulated pinitol, malic acid, galactonic acid, and methionine. Pinitol, malic acid, and galactonic acid are reported to have anti-inflammatory effects via inhibiting the NF-κB activation pathway, thus, suppressing inflammatory cellular responses ,68,69. TDuring the recovery period of ETEC infection, ETEC challenged pigs had lower mannose and higher methionine and guanosine in serum samples. The high mannose concentration is associated with increased mannose glycosylation, which was reported to be negatively correlated with intestinal permeability . On d 21On d 4 PI, upregulation of pinitol was observed in pigs fed with 100 ppm botanical blend 2, compared with the positive control. This observation is consistent with the cytokine data published by Wong et al. , in whicLimited changes in the metabolomic profile were observed in the ileal mucosa of ETEC infected pigs on d 5 PI. The major finding was that supplementation with 50 ppm of botanical blend 2 reduced serum asparagine compared with the positive control. Asparagine is a metabolite from aspartate metabolism. Large amounts of evidence indicate that aspartate could promote a macrophage-mediated inflammatory response and attenuate intestinal damage caused by endotoxins in weaned pigs ,78. No dEnterobacteriaceae in ileum, and Prevotellaceae and Megasphaera in cecum on d 5 PI. Moreover, both ETEC challenge and 100 ppm botanical blend 2 induced some changes in serum metabolomic profile that might be related to the regulation of systemic inflammation in weaned pigs. Limited differences were observed in intestinal microbiota and metabolomics analysis between the two botanical blends. Taken altogether, the present study provided a wider insight on how botanical blends may have reduced inflammation by altering the serum metabolomic profile while minimally affecting the gut microbiota of weaned pigs infected with ETEC. Manipulation of gut microbiota has been considered as a strategy to alleviate post-weaning diarrhea of weaned pigs, but the botanical blends used in the present study could alleviate inflammatory response with limited modulation to the gut microbiota that was analyzed by 16S rRNA sequencing. The limits of 16S rRNA sequencing have been widely recognized. Thus, future studies are suggested to assess gut bacterial biomass and the functional genomes from the gut microbiota. In addition, future studies are also suggested to assess the metabolomic profiles of intestinal digesta to further investigate the impacts of botanical blends on pig gut microbiota.The present study observed that age was the major factor to shift fecal microbiota, indicated by the increased relative abundance of Firmicutes and decreased relative abundance of Bacteroidota throughout sampling time points. Although ETEC infection and botanical blend supplementation had limited impacts on fecal microbiota, they both affected ileal and cecal microbiota composition in weaned pigs during the peak of ETEC infection. Supplementation of botanical blends increased the relative abundance of


This study aims to assess drug use in Primary Health Centers (PHCs) in Lagos State, Nigeria using the World Health Organization in collaboration with the International Network of Rational Use of Drugs core drug use indicators.the study was conducted between February to October 2021 as a comparative observational survey of selected PHCs. It included a retrospective and prospective cross-sectional design for prescribing and patient care indicators assessing 2640 prescriptions and clients respectively. Data were analyzed and presented as frequency with percentage or mean with standard deviation, as applicable. The performances of the types of PHCs were compared using two-sample t-test. A 2-tailed p-value < 0.05 was considered statistically significant.average number of drugs per prescription, drugs prescribed by the generic name, percentage of encounters with prescribed antibiotics and injections were 3.6 ± 0.9%, 76.5 ± 18.5%, 63.3 ± 19.1% and 21.1 ± 24.1% respectively with no significance difference between the comprehensive and basic PHCs. For all the facilities, the average consultation and dispensing times were 10.5 ± 6.0 minutes, 244.9 ± 179.2 seconds respectively. In this study, the percentage of patients’ knowledge of the correct dosage was 72.4 ± 38.3%. There is statistically significant difference in availability of key drugs in stock between the comprehensive and basic PHCs .irrational drug use practices exist in comprehensive and basic PHCs. There is a need to implement interventions aimed at strengthening good prescribing and patient-care practices across the PHCs in Lagos State. A valuable resource that is an indicator of health care quality worldwide is drugs . An esseThe Nigerian National Drug Policy stipulates that essential medicines are selected based on the prevailing disease conditions and rational drug use is attained when there is rational prescribing of drugs in generic or non-proprietary names and from an Essential Drugs List (EDL) . The WorMany studies have investigated drug use practices in health facilities in Nigeria. Studies within Nigeria -16 have There is a need for comprehensive data on the current state of drug use practices at the primary level of healthcare in Lagos State. The design of the present study was to address these identified gaps. This study aimed to assess drug use in PHCs in Lagos State, Nigeria using the WHO/INRUD core drug use indicators and the index of rational drug use.Study area and period: the study was carried out in selected PHCs in Lagos State. Lagos State is made of five administrative divisions, namely: Ikeja, Badagry, Ikorodu, Lagos, and Epe [ and Epe . At the  and Epe . The stuStudy design: this study involved a comparative observational survey in selected PHCs in Lagos State, Nigeria. The observational study included a retrospective cross-sectional design for prescribing indicators; and a prospective cross-sectional design for patient care and facility specific indicators using WHO methodology.Inclusion criteria: i) basic primary health centers; ii) comprehensive primary health centers.Exclusion criteria: i) health posts.Sample size determination and sampling technique: WHO (1993) recommends a sample size of at least 600 encounters or with a greater number if possible for a cross sectional study. There should be a minimum of 30 encounters per facility [ue: WHO 193 recommSample size determination: the sample size was computed using the following formula [ formula :α= 1.96 ; S = 0.5 (standard deviation of the average drugs/encounter); and d = 0.15 (level of precision) [where Zecision) ,30.The effective sample size computed was 86 PHCs, after adjusting for a design effect of 2.0.eff= 42.6844 x 2.0 = 85.3688; n eff≌86n Health facility indicators: a total of 19 essential medicines (Annex 1) which are used to treat the most prevalent conditions were chosen to be assessed as key drugs for testing drug availability in the basic and comprehensive PHCs in line with the recommendations (minimum of 15 key medicines in each facility) [Patient care indicators: a minimum of 30 encounters per facility were observed when data was collected using the patient care indicator forms as recommended by WHO [d by WHO . A totalPrescribing indicators: as recommended by WHO, a minimum of 30 prescribing encounters were considered for assessment [sessment . A totalData collection instrument, measurements, and techniques: the drug use indicators , WHO/INRUD detailed indicators encounter form are standardized data collection tools used for the study. The drug labelling form and patient´s knowledge form were designed for the purpose of collecting additional data. The evaluation of the core drug use indicators was according to the WHO/ International Network of Rational Use of Drugs (INRUD) guidelines [idelines ,31.Health facility indicators measurement: the WHO health facility indicators were used in this research using the health facility indicator checklist to collect data relating to availability of essential medicines [edicines ,31. The edicines  drugs inPatient care indicators measurement: trained data collectors interviewed patients focusing on knowledge about dispensed medications  thus assessing the effectiveness of counselling the patients. Observation of the adequacy of labelling of medicine package or drug envelope was also noted. The data collectors ensured clinic flow was not disrupted and the same patients were followed through when observing the consultation and dispensing process. Patients were interviewed away from the main clinic to assess their knowledge base of medicines dispensed. Data was collected prospectively.Prescribing indicators measurement: data on prescribing indicators were collated retrospectively from randomly selected prescriptions and filled in prescribing indicator form in line with WHO methodology [hodology .Calculation of the measurement of the core drug use indicators: formula for measurement of drug use indicators were obtained using the WHO guidelines [idelines .Facility-specific indicators: availability of copy of EDL or formulary. This indicator is scored either 1 (yes) or 0 (no), for the facility as a whole.Data management and statistical analysis: data collected, reviewed and verified were entered in MS Excel (2016) and statistically analyzed in IBM SPSS (version 23). Data were summarized using frequency with percentage or mean with standard deviation, as applicable. The performances of PHCs on drug use indicators were compared across the type of functional PHCs in Lagos State for statistically significant difference using two-sample t-test. A 2-tailed p-value < 0.05 was considered statistically significant.Ethical considerations: ethical approval with health research assigned number ADM/DCST/HREC/APP/2257 was obtained from the Health Research Ethics Committee, Lagos University Teaching Hospital. The Lagos State Government through the Lagos State Primary Health Care Board also granted approval to carry out the study. Verbal consent from each patient to participate in the study was obtained before the interview.A total of 2640 prescriptions were encountered in the selected 88 PHCs in Lagos State.Drug prescribing indicators: average number of drugs prescribed per prescription were 3.6 ± 0.9%, 3.8 ± 0.9% and 3.5 ± 0.9% for all the PHCs, comprehensive PHCs and basic PHCs respectively. For all the PHCs, the drugs prescribed by the generic name was 76.5 ± 18.5%. The difference among the PHCs was not statistically significant for all prescribing indicators except the percentage of drugs prescribed in comprehensive and basic PHCs (<0.0001) (<0.0001) .Patient-care indicators: for all the PHCs, the average consultation time was 10.5 ± 6.0 minutes. The average dispensing time was 244.9 ± 179.2 seconds. The percentage of patients´ knowledge of the correct dosage in this study was 72.4 ± 38.3%. The difference among the PHCs were not statistically significant for all patient-care indicators (dicators .Facility-specific indicators: the percentage availability of the EDL copy was 98.6 ± 12% and of key drugs in the stock (Annex 1) as 89.8 ± 3.5%. Among the PHCs, there was a significant difference for percentage availability of key drugs in the stock between comprehensive and basic PHCs (0.0001) ((0.0001) . The val(0.0001) .Drug prescribing indicators: the average number of drugs prescribed at the selected PHCs were more than twice (3.6) the optimal range recommended by the WHO/INRUD (1.6-1.8) [1.6-1.8)  indicati1.6-1.8) , Africa 1.6-1.8)  and Nige1.6-1.8) . It is h1.6-1.8) . The med1.6-1.8) . Rationa1.6-1.8) .This present study showed no significant difference between the comprehensive and basic PHCs surveyed in terms of generic prescribing. It was found that the percentage of generic prescribing prescribed across all the PHCs was 76.5% ± 18.5 which is below the WHO recommended standard (100%). A range of 27-86% of the drugs were prescribed using their generic name in primary health centers in Bangladesh, Kenya and Tanzania -37. In NPercentage of prescription with antibiotic was 63.3% for all the centers with no significant difference in prescription pattern at the comprehensive and basic PHCs P > 0.7889). This is thrice the WHO standard 20-26.8%) [. This is0-26.8% . It was This study showed that the percentage of injections prescribed in all PHCs was found to be 21.1 ± 24.1% while 27.1 ± 28.1% was reported at the comprehensive PHCs and 19.3 ± 22.7% for the basic PHCs. The percentage of injections prescribed across all PHCs and at basic PHCs was within the optimal level (13.4-24.1) while the value reported at the comprehensive PHCs did not fall within the optimal range. It may be attributed to the fact that basic PHCs do not stock many injections and doctors are available only at the comprehensive PHCs. Similarly, a study in Kenya showed the injections prescribed were almost within the optimal range at 24.9% . Use of Regarding drugs prescribed from the Essential Medicine list (EDL), findings shows that 89.2% of all drugs prescribed was found in the EDL. This is lower than the optimal reference value of 100% and lower than previous studies carried out in regional Africa; Ethiopia (92%)  and locaPatient-care indicators: the results of the present study demonstrated that the average consultation time was optimal across the PHCs (10.5 ± 6.0min) and at basic PHCs (11 ± 6.6 min) while the consultation time within the comprehensive centers (9.1 ± 4.4min) was lower than the optimal limit. The reason some comprehensive PHCs reported a value below the optimal time limit may be attributed to high patients turn out. The optimal consultation time recommended is ≥ 10 mins [ 10 mins  and thiss 10.5 ± .0min and 10 mins ,37,49. A 10 mins . AdequacPrevious studies in Nigeria, Ethiopia and Kenya reported low values in labelling adequacy ranging from 0% ,17.5% and 22.6% ,37,50 onThe IRPCDU values shows better performance at the basic PHCs (4.0) when compared with the comprehensive PHCs (3.9). Both types of PHCs showed IRPCDU values lower than the ideal value of 5. The values were higher than that found in studies carried out in Egypt (2.82-3.19)  and PakiFacility-specific indicators: the study revealed that the percentage availability of EDL in all the PHCs was 98.6 ± 12%. Findings from previous studies in Ethiopia and Pakistan showed the availability was 93.75% and 100% respectively which was higher than findings from this study [is study . The stais study ,52. The is study .Limitations of the study: the study was not designed to investigate the reasons for the irrational prescribing and dispensing practices observed in the study. Future studies will be required to further investigate the reasons for the irrational drug use practices at the PHCs. It was a cross sectional study of primary health facilities which did not include the secondary and tertiary health facilities. The assessment was carried out across of a sample of selected PHCs in Lagos State.This study demonstrated irrational drug use practices for some indicators as shown by values reported for the non-polypharmacy index, rational antibiotic index, labelled drugs index and patients' knowledge index in both comprehensive and basic PHCs. There was no significant difference in most of the core drug use indicators between the comprehensive and basic PHCs. There is need to implement interventions aimed at strengthening good prescribing and patient-care practices to ensure rational drug use across the PHCs in Lagos State.Irrational prescribing, dispensing and drug use practices exists in many health facilities;This is very significant in developing countries;The consequence has led to irrational drug use and loss of confidence in health systems.There is irrational drug use practices in Primary Health Centres in Lagos State, Nigeria;Patients' knowledge of drugs dispensed is poor and not in line with WHO/INRUD recommendations;There is need to implement interventions aimed at strengthening good prescribing and patient-care practices across the PHCs in Lagos State.


Prolonged exposure to Video games may have several negative cognitive and emotional consequences.However, a few investigations have explored the effects of video games addiction on sleep.To study the effects of gaming addiction on sleep patterns in young adultsWe conducted a cross-sectional, descriptive and analytical study.Data were collected using a self-administered questionnaire on social networks targeting young adults between 18–40 years. We used the gaming addiction scale (GAS) in its validated Arabic short version. We also used the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) to assess the sleep quality of our participants.One hundred and nine participants were included. The mean age was 29.6 ± 10.3. Males accounted for 60.6% of the study population. The mean Gas score was 13.11± 6.08.According to the GAS,25.7% were addicted gamers. The mean PSQI score was 7.25± 3.15. A poor sleep quality pattern (score > 6) was found in 59.6% of the participants. We found that the GAS score was significantly correlated to the total score of PSQI( P=0.003). We also found that the group with poor sleep quality had higher GAS scores (p= 0.014). We found a correlation between the GAS score and the following components of the PSQI: subjective sleep quality ( p= 0.01), sleep disturbances (p=0.024) and the use of sleep-promoting medication ( p=0.046)Our study showed that video gaming behavior had a significant effect on sleep quality. This can have negative consequences on life quality, together with an impaired performance at awakening.No significant relationships.


We estimated the annual progression rate (APR) of HbA1c-defined prediabetes in adults 65 years or older from the Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR) study.5Data on progression to diabetes in older adults are essential to guide policy because lifestyle intervention programs may not be cost-effective when progression rates are low.5 Analyses were completed in October 2021. The Centers for Disease Control and Prevention institutional review board deemed the study exempt from review, with a waiver of informed consent because LEADR data are deidentified. Incident diabetes was ascertained using previously published criteria.6 This cohort study included patients 65 years or older with HbA1c level of 5.7% to 6.4% , with 3 months or more follow-up after HbA1c-based prediabetes diagnosis, and without kidney failure. The APR was estimated from mean 1-year cumulative incidence , and 95% CIs were derived from Poisson regression models. Estimates were stratified by baseline variables: age group, sex, race and ethnicity, social vulnerability index (SVI), body mass index (BMI), HbA1c level, family history of diabetes, and hypertension diagnosis. Analyses were performed using SAS, version 9.4. This study followed the STROBE reporting guideline.The LEADR study comprises longitudinal outpatient electronic health record (EHR) data on 2 045 999 adults between January 2010 and December 2018 across 10 geographically diverse US health care networks.1c level of 5.7% to 5.9%. The most pronounced differences in progression were for BMI and HbA1c. The APR among patients with BMI of 18.5 to 24.9 was 3.5% , whereas it was 7.6%  among those with BMI of 40 or greater. Patients with HbA1c levels of 5.7% to 5.9% had an APR of 2.8%  compared with 8.2%  among patients with HbA1c levels of 6.0% to 6.4%.A total of 50 152 patients were included in the study . Median 1c-defined prediabetes reported approximately half the APR in our study and substantial regression to normoglycemia, recommending against prediabetes screening and intervention in older adults.2 The results of that study may be attributed to an older, less diverse sample and self-selection bias from an observational design.2 Using HbA1c and fasting blood glucose levels to define prediabetes, a study of primary care patients reported an APR of 4.7% among individuals aged 65 to 75 years and 4.1% among those 75 years or older.3 Another study of a nationally representative population reported APRs of 4.5% among those aged 65 to 79 years and 1.8% among those 80 years or older, both with HbA1c-defined prediabetes.4The estimated APR to diabetes among older adults with prediabetes in this study was 5.3%, differing from previous US studies, likely owing to different study designs and populations. A study of community-dwelling Black and White adults 70 years or older with HbA1c testing in clinical settings.Strengths of this study include the large sample of diverse patients. Limitations include patients’ unknown duration of prediabetes, possible incomplete capture of health care utilization resulting in under-ascertainment of prediabetes or diabetes, and the inability to distinguish between type 1 and type 2 diabetes. Owing to inherent selection bias, the EHR-based sample was representative of patients comprising the health care organizations contributing data and may not be representative of the general US population. Our findings may provide important information to evaluate the cost-effectiveness of lifestyle interventions in older adults with prediabetes identified by HbA


The aetiological factors of dental fear include negative information, witnessing or having a bad experience, and negative conditions related to periodontal treatment. Modified Dental Anxiety Scale Nepali version, is one of the tools used in epidemiological studies to measure dental anxiety in adults. The objective was to find out the prevalence of anxiety among dental patients visiting for periodontal therapy in a tertiary care hospital.This descriptive cross-sectional study was conducted among patients visiting for periodontal therapy from November 2020 to January 2021 at a tertiary care dental hospital. Ethical clearance from Institutional Review Committee (Reference no. 0311202001) was taken before the study. Convenient sampling was done. A standard questionnaire for dental anxiety was used for data collection after receiving informed consent from the participants. Data were entered and analyzed in Microsoft Excel Sheet. Descriptive data are presented as means, standard deviations, frequencies, and percentages.Among a total of 311 participants visiting for periodontal therapy, 297 (95.49%)  were having anxiety. Among total patients, 113 (36.33%) were fairly anxious, 111 (35.69%) were slightly anxious, 62 (19.94%) very anxious and 11 (3.54%) were extremely anxious. Majority of males 54 (17.36%) were slightly anxious while most females 67 (21.54%) were fairly anxious. Mean Modified Dental Anxiety Scale-Nepali score of all the participants was 11.59±3.808. Extreme dental anxiety was observed in 11 (3.54%) participants 7 (2.25%) females; 4 (1.29%) males).The prevalence of anxiety among patients visiting for periodontal therapy in this study was found to be higher compared to other study done in similar setting. An informed consent was obtained from the participants before they were given the questionnaire. The questionnaire contained questions about all the possible dental procedures. Patients not willing for periodontal therapy and under psychiatric consultation or under psychiatric medication were excluded from the study. Convenient sampling was done. A sample size of 311 was calculated by using following formula:This descriptive cross-sectional study was conducted in the Kathmandu Medical College (KMC), Teaching Hospital, Nepal. The data were collected from outpatient dental departments of both Kathmandu and Bhaktapur hospitals of KMC from November 2020 to January 2021 after obtaining ethical clearance from institutional review committee of KMC (Ref. 0311202001). Patients visiting for periodontal therapy were requested to participate in the study by convenience sampling. A standard questionnaire was taken from Giri, et al.2 × p × q / e2n = Z2 × (0.74) × (1-0.74) / (0.05)2  = (1.96)  = 295.65Where,n = sample sizeZ = 1.96 at 95% Confidence Interval (CI)8p = prevalence of dental anxiety, 74%q = 1-pe = margin of error, 5%Adding 5% of non-response rate, total sample was 310.43 =311. Data were entered and analysed in Microsoft Excel sheet. Descriptive findings are presented as means, standard deviations, frequencies, and percentages.Among total 311 participants, 297 (95.49%)  were having anxiety. Among the total 311 participants, 113 (36.33%) were fairly anxious and 11 1 (35.69%) were slightly anxious .Among males, 54 (17.36%) were slightly anxious while 67 (21.54%) of females were fairly anxious .The mean MDAS-N score of all the participants was The mean MDAS-N score of all the participants was 11.59±3.808  was observed in 11 (3.54%) of the 311 participants  which ranged from nine years to 90 years and there were 143 (45.98%) males and 168 (54.02%) females. Since the study was conducted in Bagmati province, almost all the participants  were from Bagmati province and eight (2.57%) did not respond.5 Dental anxiety also varies with age, sex, and education.12 The MDAS is the modification of the Corah's Dental Anxiety Scale, which also includes question about local anaesthetic injection. Levin, et al. have reported that patients suffering from chronic periodontitis had higher anxiety compared to control group patients.13Dental anxiety can be predicted by cancellation of dental appointment(s), memorisation of poor dental practice, gender, and age.14 In this study, high dental anxiety (MDAS-N ≥19) was observed in 11 (3.54%) of the 311 participants. Other study showed 1 3% of patients in dental college and 20.90% of patients in dental clinics were severely anxious.3 One study reported that more than one third (36.9%) of the study population had DAS ≥15 .15 Another study done by telephone survey4 showed that 11.6% had high dental anxiety (DAS-N ≥19) while White, et al.16 reported 6.82% patients with high dental anxiety. In this study, females were more anxious than males. Though most studies,6 report females to be more anxious, a study in South India did not support for gender differences for anxiety.7The mean MDAS-N score of all participants was 11.59±3.808, this was similar to that reported by Faisal et al. (10.24±4.7).17 but Viinikangas, et al. study reported less score for older individuals.18 The prevalence of anxiety was seen mostly in the 20-30-year age group (37.3%).19 The anxiety level can be decreased by dental screening and education.17 Medical and dental students were less anxious than arts and computer science students suggesting role of dental education in reducing dental anxiety.21In the present study, 0-19 years age group had highest mean score of 12.43±3.830  similar 15 In this study, MDAS score had been found the highest with local anaesthesia and tooth drilling where similar study done on students reported that students were anxious about tooth drilling and local anaesthetic injection. While anticipating a dental treatment for the next day, 35.3% of participants were not anxious. There were various levels of anxiety among the remaining 65.7%. Total of 64% of these respondents were extremely anxious to slightly anxious. Anxiety levels increased further when participants were asked about getting their tooth drilled and 89% of the respondents were anxious about getting their tooth drilled.15 similarly, higher level of anxiety was found to be exhibited by participants for injection (55%), followed by scaling (45%) and tooth drilling (40%).22In current study, participants were more anxious on the day before appointment than on the day during waiting for an appointment where as in Inamdar, et al. study, the level of anxiety while waiting for a dental treatment, increased a little as compared to the anxious anticipation of dental treatment a day earlier, approximately 1 0% of the individuals were more anxious.23 High anxiety, younger age, and traumatic dental history were correlated with greater increases in heart rate during the administration of local dental anaesthesia.24 dental education, psychotherapy might be helpful in reducing anxiety regarding local anaesthesia.Local anaesthesia is given for other dental procedure and related to dental delayed dental visit.25 No significant difference result have been found between death-related occupations  and non-death related occupations  measured by death related anxiety scale.26 Limitations of the study include singlecentre study with small sample size.The mean MDAS-N score was highest (11.83±3.774) among bachelors and above education group, but the difference was minimal . This maThe prevalence of anxiety among patients visiting fot periodontal therapy in this study was found to be higher compared to other study done in similar setting. Further studies with other modifying variables are needed to conclude this finding regarding dental anxiety in periodontal therapy and its reduction for patient comfort.


Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options.Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media.A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years.p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008).According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy. Deep neck infections (DNI) were first described by Galen in the second century.11Streptococcus species and Staphylococcus aureus are often the causative pathogens, although most of the patients have aerobic and anaerobic bacteria, which are often found together. In most studies, aerobic bacteria are cultured more frequently. This may be due to the fact that anaerobic bacteria are more difficult to produce and to identify in cultures.24Symptoms and signs vary according to disease progression and site of involvement. The most common are pain, fever and swelling.Our aim was to detect anaerobic bacteria and compare efficacy of surgical-medical treatment in different age groups.This study was carried out with prospective evaluation of 74 patients who were hospitalized at the Department of Otorhinolaryngology, University of Mersin between 01.07.2016 and 01.07.2017 for deep neck infection. The study was approved by University of Mersin Clinical Research Ethics Committee dated 26/11/2015 and numbered 2015/360. Patients who were hospitalized for deep neck infection and underwent surgical and medical treatment were included in the study. Medical files, computed tomography scans and intraoperative photo images were recorded for each patient.Patients were categorized as pediatric (0 − 18 years) or adult (18-). In this study, patient’s age, sex, time from the onset of their complaints to admission to the hospital, history of antibiotic use before admission to hospital, radiological imaging studies, value of the long axis of abscesses in millimeter (mm), physical examination findings, symptoms, additional diseases, radiological and surgical placement of abscess. locations, localization of infections, treatment method, intraoperative findings, bacteriological culture results, pathologic results of specimens taken from surgical procedure, surgical operation method, penicillin allergy, empirical antibiotic treatment, need for change in antibiotic treatment, presence of complications, duration of hospitalization, total antibiotic usage time, need for intensive care and death, tracheotomy need, drugs, alcohol and smoking were recorded. Abscess locations were divided into 7 regions and defined. These regions; Level − 5 , parapharyngeal, peritonsillary, submandibular, SCM medial (Level 2 – 3 − 4), parotid area and submental area. Complaints and symptoms of the patients were grouped under 7 titles including pain, swelling, trismus, dysphagia, fever, neck movement limitation and dyspnea. Physical examination findings were classified as parotid swelling, bulging of the upper tonsillar pole, distorted uvula, submandibular swelling, swelling in the medial of SCM, swelling in the posterior cervical triangle, mandibular swelling (on mandibular corpus), and submental swelling. Surgical and medical therapy (intravenous antibiotics) were used in 61 of 74 patients treated for deep neck infection. Isolated medical therapy (i–v antibiotics) was preferred in 13 patients. All patients underwent surgery under general anesthesia. Endotracheal intubation was preferred in patients undergoing general anesthesia. One or more of the surgical methods, such as abscess drainage, tracheotomy, neck exploration, unilateral tonsillectomy and sialoendoscopy, were preferred in patients according to the location of their infections. All 74 patients were hospitalized and received iv antibiotic therapy. Among the selected antibiotics, ampicillin + sulbactam, clindamycin, meropenem, teicoplanin, ciprofloxacin, ertapenem, sultamicillin, cefazolin, anidulafungin, linezolid, piperacillin + tazobactam were employed. Antibiotic drug selection was decided by consulting the pediatric infectious diseases and adult infectious diseases departments according to the patient's age, additional diseases, and whether he had previously received antibiotic treatment. Antibiotic treatment was reviewed according to the results of the cultures and the response of the patients.Culture was obtained from 60 patients in order to produce aerobic and anaerobic agents in microbiology laboratory.1Oven at 37 °C 2Biosafety cabinet 3Autoclave (Hirayama HV-L Seies 50 L)4Anaerobic jar Devices used and used in microbiology laboratory1Anaerob media provider 2Anaerobic indicator 3Anaerob bacteria identification rapid ID-32A kit 4Vancomycin A disk (5 micrograms) − BOX 1 (50 DISC) 5Colistin A (10 micrograms) − one box (disk 50)) 6Kanamycin A disc (1000 micrograms) − 1 box (50 discs) 7SPS Disc −50 discs BBL taxo, For 1 liter of distilled water, 46 g of medium was added, sterilized by autoclaving at 121 °C for 15 min, after cooling to 50°−55 °C and sheep blood was added to sterile defibrin and poured into sterile petroleum.29.75 grams of powder medium was added to 1 liter of distilled water, sterilized by autoclaving at 121 °C for 15 min with stirring, and 5 mL was dispensed into sterile glass tubes.Media poured into ready to use petroleum40 g of blood agar base  powder medium is added for 1 liter of distilled water and it is sterilized by autoclave at 121 °C for 15 min after mixing. The medium was cooled to 70 °C and sheep blood was added to sterile defibrin and poured into sterile petroleum.Deep neck abscess samples taken during the operation were delivered to the laboratory in sterile tube and thioglycolated medium.Aerobic and anaerobic planting of the samples were performed without delay. Sheep blood agar, chocolate agar and anaerobic blood agar medium were planted. Sheep blood agar medium was incubated under aerobic conditions in the oven, chocolate agar desiccator (wax jar) and anaerobic blood agar were incubated under anaerobic conditions. In order to provide anaerobic media, jars of anaerobic media provider  and anaerobic indicator were placed, and the lid was closed, and the oven was removed. Two samples were prepared and Gram stained. All media were incubated at 35°−37 °C for 48 h.2 were evaluated as anaerobic bacteria. The colony structure was examined for identification and the hemolysis properties of the colonies were evaluated for pigment formation. Gram stained preparations and morphology of each colony were examined. Bacterial suspension was prepared for identification of anaerobic bacteria and spread over the whole area of the anaerobic blood agar medium by swab. Subsequently vancomycin to distinguish Gram-negative bacilli , colistin , kanamycin  discs were placed. To distinguish Peptostreptococcus anaerobius from other anaerobic Gram-positive cocci, sodium polyethanol sulphonate  disc was used. In addition, anaerobic bacteria identification was performed at species level using rapid ID-32A Strips  Rapid ID-32A is a system consisting of 29 enzymatic tests that identify anaerobic bacteria within 4 h. 4 MacFarland turbidity bacterial suspension is prepared, the suspension is distributed to 55 microliters of strips until 32 wells are added to the urea well, the lid is closed and incubated under aerobic conditions for 4 h. NIT1 + NIT2, IND well JAMES and PAL well and serA well were added to the NIT well and 10 min after the FB reagent was dropped, reactions were evaluated according to the evaluation table and the identification number was obtained. These numbers were obtained by entering the apiwebTM identification software. Species name was obtained. Gram positive cocci were evaluated by Gram staining, catalase, DNAase, esculin hydrolysis, bacitracin and optokin sensitivities.At the end of incubation, aerotolerance test was performed by making passages on chocolate agar medium from each colony grown on anaerobic media. Bacteria that grew in anaerobic medium and did not grow on chocolate agar in 5%−10% COt test and Bonferroni correction p-values were used. Median, first and third quartile values were given as descriptive statistics for categorical type variables and the nonparametric alternative Mann-Whitney U test was used in order to compare the mean of two groups in cases where appropriate conditions were not provided for independent samples t test. Kruskal Wallis statistic, a non-parametric alternative to one-way ANOVA, was used in cases where the data did not conform to the normal distribution in terms of a continuous variable with more than two groups. In order to determine which group was the difference, post hoc test was applied based on corrected p-values. Statistical significance level (p) was taken as 0.05 for all analyzes.Statistical analysis of the data was performed with SPSS 21.0 trial version statistical package program. Descriptive statistics were given for numbers and percentages for categorical variables and Chi-Square test was used to show the relationship between two categorical variables. Kolmogorov-Smirnov and Shapiro-Wilks tests were taken into consideration for the control of the normal distribution of continuous variables. If the difference between the groups was determined as a result of the Chi-Square evaluations, if the number of categories was more than two, the control of the difference was evaluated by two − rate The study was conducted on 74 patients 37 female (50%) and 37 males (50%). The ages of the patients ranged from 1 to 69 years. The mean age was 31.34. While the mean age for women was 30.57, the mean age for men was 32.97. The study included 13 pediatric (0–18 years) and 61 adults (18–69 years) patients. Seven (53.8%) of the pediatric patients were female and 6 (46.2%) were male. Thirty (49.2%) of the adult patients were female and 31 (50.8%) were male.The time period from the onset of complaints to the hospital admissions ranged from 0 days to 47 days. The average admission period was 7.32 days. Nineteen patients had comorbidities (25.7%) and 55 did not have comorbidities (74.3%).Additional diseases included hypothyroidism, hypertension (HT), celiac disease, pregnancy, coronary artery disease (CAD), rheumatoid arthritis (RA) + immunosuppressant use, chronic obstructive pulmonary disease (COPD), cirrhosis, diabetes mellitus (DM), chronic kidney disease (CKD), amputated lower extremity, penicillin allergy, esophageal squamous cell cancer  and ankylosing spondylitis.p = 0.137). There was a statistically significant relationship between the presence of comorbidities and treatment modalities. (p = 0.017). All patients with additional disease underwent surgical treatment.There was no statistically significant difference between the patients with comorbidities and those without comorbidities in terms of hospitalization time (p =  0.327). There was a statistically significant difference between the pediatric and adult groups in terms of hospitalization time in patients with a history of antibiotic use; it was concluded that pediatric patients were hospitalized for a longer period (p =  0.036).Fifty-six patients (75.6%) had a history of antibiotic use before admission. Antibiotics were prescribed by a family doctor or by secondary or tertiary health care facilities. Some patients had a history of self-antibiotic use without examination. Eighteen patients (24.4%) had no history of antibiotic use before admission. Of the 13 pediatric patients, 11 (84.6%) had a history of antibiotic use, and 2 (15.4) did not. 45 (73.8%) of the adult patients had a history of antibiotic use, while 16 (26.2%) had no history of antibiotic use. There was no statistically significant difference between the pediatric and adult groups in terms of hospitalization duration in patients without a history of antibiotic use (p =  0.051). There was no statistically significant difference between isolated smoking and treatment modality (p =  1.00).Twenty-five (33.8%) of the patients had a history of smoking and 7 (9.5%) had a history of both smoking and alcohol use. No patients had drug use or addiction. 42 patients (56.8%) were not using alcohol, smoking or drugs. There was no statistically significant difference between smokers and nonsmokers in terms of hospitalization time , swelling in 38 patients (51.4%), trismus in 16 patients (21.6%), dysphagia in 7 patients (9.5%), fever in 28 patients (37.8%), neck movement limitation in one patient (1.4%) and dyspnea in 2 patients (2.7%) were present. The most common complaint was pain.The most common physical examination was bulging in the upper pole of the tonsil and displacement of the uvula (41.9%) .Table 1Pp =  0.229). There was a statistically significant relationship between the value of the abscess long axis in mm and the treatment modality of all patients (p = 0.005) (p = 0.008). In pediatric patients, there was no statistically significant relationship between the value of the long axis of abscess in mm and the type of treatment (p = 0.318). While the value of the long axis of abscess in mm in surgical patients was larger than the group of isolated medical treatment, there was no such difference in the pediatric age group.Sixty-six patients (89.2%) underwent computed tomography (CT) and 5 patients (6.8%) underwent ultrasonography (USG). Three patients (4.1%) did not undergo CT. CT radiologic examination was the most common (85.2%). Three patients who were inappropriate for radiological examination were adults and their abscesses were peritonsillar and submandibular. The long axis of abscess was measured. The abscess long axis was found to be 5 mm minimum and 76 mm maximum. In pediatric patients, the minimum was 5 mm and the maximum was 45 mm. There was no statistically significant relationship between the abscess long axis value in mm and the age of the patients (pediatric − adult) (= 0.005) . There wWhen the abscess locations of the patients were examined, it was evident that 30 patients (40.5%) had peritonsillar abscess. The most common abscess area was the peritonsillar region. In pediatric patients, the most common abscess was seen in the medial SCM (30.8%), whereas peritonsillar abscess was the most common in adult patients (44.3%) .Table 3Ap =  0.063). The most common etiologic factor was tonsillopharyngitis (51.4%). Tonsil was the most common source of infection in 8 pediatric patients (61.5%) and 30 adult patients (49.2%)  .Table 4Ep =  0.006). The nasopharynx, which is the source of infection, is a statistically significantly more frequent source of infection in pediatric age group (p =  0.0018).There was a statistically significant difference between the locations of infections and patients' ages (p =  1.00). There was no statistically significant difference between the location of the abscess and the treatment modality (p =  0.343).All patients received iv antibiotics. In 61 patients (82.4%), surgical treatment was combined with medical treatment. Isolated medical treatment was selected in 13 patients (17.6%). Eleven pediatric patients (84.6%) underwent surgery and 2 pediatric patients (15.4%) underwent medical treatment. Fifty adult patients (82%) underwent surgery and 11 adult patients (18%) underwent medical treatment. There was no significant relationship between the treatment modality and the age of the patients (pediatric – adult) (Abscess drainage in 24 patients (32.4%), neck exploration in 24 patients (32.4%), abscess drainage plus unilateral tonsillectomy in 10 patients (13.5%), abscess drainage plus tracheotomy in 1 patient (1.4%), neck exploration plus sialoendoscopy in 1 patient (1.4%) and neck exploration plus tracheotomy in 1 patient (1.4%) was performed. The most common surgical procedures were abscess drainage and neck exploration (32.4%). Two patients underwent tracheotomy due to additional problems on the days following treatment. None of the patients underwent tracheotomy due to difficult intubation or complications during the first surgical procedure.p = 0.136). There was a statistically significant relationship between the presence of abscess, cellulitis and/or necrotic lymph nodes in the patients and the presence of bacteriological culture (p =  0.01) Bacteriological culture was more likely to occur in patients with intraoperative abscesses. There was no statistically significant relationship between the age (pediatric/adult) and the presence of abscess, cellulitis, and/or necrotic lymph nodes intraoperatively (p =  0.294).Of 61 patients who underwent surgical treatment, 55  had intraoperative abscess and 6 (9.8%) had cellulitis and/or necrotic lymph nodes. Intraoperative abscess, cellulitis and/or necrotic lymph nodes in patients had no statistically significant relationship with radiological abscess in one area and abscess in multiple areas  Empirical antibiotic therapy was changed in 7 patients (9.4%) due to lack of improvement in clinical status and culture results. Linezolid, piperacillin plus tazobactam, meropenem and teicoplanin were used in these patients according to culture results .Table 5EPatients were given iv antibiotic therapy during their hospitalization. Routine antibiotic treatment was continued to each patient for 10 days after discharge. The mean duration of antibiotic use was 17.99 days. Complications were observed in 3 patients (4.1%). Upper airway obstruction was seen in 1 patient (1.4%), premature birth in 1 patient (1.4%), mediastinitis plus pleural effusion and septic shock and upper airway obstruction in 1 patient (1.4%). One of the patients in the study (1.4%) died. Two patients (2.7%) needed observation in the intensive care unit. Two patients (2.7%) required tracheotomy during their hospitalization. Complications, requiring intensive care, tracheotomy and death were all in adult patients. Material was obtained for pathological examination from 36 patients (48.6%). Malignancy was detected in 1 (2.7%) of the patients with pathology . This patient was pregnant, and her abscess was medial to the SCM. Preterm birth occurred in this patient.Culture was obtained from 60 patients (81.1%). Bacterial growth was detected in 51 (85%) patients. Nine (90%) of 10 pediatric patients who had culture were found to have growth. Forty-two (84%) of the 50 adult patients who were cultured had positive growth. The most frequent bacterial growth was from the peritonsillar area. (39.2%) Isolated aerobic bacteria were isolated in 29 (48.3%), aerobic plus anaerobic bacteria  in 12 (20%), and isolated anaerobic bacteria in 10 (16.7%). No bacterial growth was observed in 9 patients (15%). Most often isolated aerobic bacteria were cultured. (48.3%) .Table 6BStreptococci were detected in 20 (48.7%) and staphylococci in 19 (46.3%) of 41 patients with aerobic bacterial growth. Of the 41 patients with aerobic bacterial growth, microbiological bacterial culture revealed 46 times aerobic bacterial growth. The most common bacteria (34.7%) were Streptococcus spp.  . There was single bacterial growth in 33 (64.7%) patients and more than one bacterial growth in 18 (35.3%) patients. Seven of 9 (77.8%) patients with no bacterial growth had a history of antibiotic use before admission. Of the 41 patients with aerobic bacterial growth, 32 (78%) were adult patients and 9 (22%) were pediatric. ococcus) .Peptostreptococcus spp., Prevotella spp., Prevotella oralis ; a oralis .Table 7Ap = 0.954). There was no statistically significant relationship between aerobic, anaerobic, mixed bacterial growth and abscess sites (p = 0.604). There was no statistically significant relationship between aerobic, anaerobic, mixed bacterial growth and age of patients (pediatric – adult) (p =  0.081). There was no statistically significant relationship between the history of antibiotic use before the admission to the hospital and the growth of aerobes, anaerobes and mixed bacteria (p =  0.753).There was no statistically significant relationship between aerobic, anaerobic, mixed bacterial growth and the sites where the infections originated (p =  0.017). Adult patients had less hospitalization time than pediatric patients. There was no statistically significant relationship between the duration of hospitalization and whether patients had comorbidities (p  = 0.137). There was no statistically significant relationship between hospitalization time and abscess in single or multiple areas. (p =  0.746). Patients were operated on a mean of 1.80 days after admission .The hospitalization time of the patients ranged from 2 to 22 days, with an average of 8.28 days. There was a statistically significant difference between pediatric and adult patient groups in terms of hospitalization time .Cordesmeyer reported 63, Shimizu 123, Pascual 330, Adovica 263, and Ban 97 patients.In Adovica's study, the most common etiologic cause was odontogenic infection; in 139 (70.6%) patients.In the Adovica study of 263 patients, in 95 (36.2%) patients, the most common site of abscess was the submandibular region.The most common clinical finding in Pascual's study was odynophagia with 98.2%, followed by trismus with 55.5%.In the Adovica study, 194 patients (58.8%) underwent CT examination.In the Kataria study, DM was detected in 8 (10.5%) patients, i-v drug use in 4 (5.2%) patients, and chronic kidney disease in 2 (2.6%) patients. While 16 (21%) patients had a history of smoking, 28 (36.8%) patients chewed tobacco.p = 0.316). Surgery was performed in 23 (76.6%) of 30 patients with isolated peritonsillar abscess and in 2 (100%) of 2 patients with peritonsillar plus parapharyngeal abscess. Abscess drainage was sufficient in 15 (60%) patients with peritonsillar abscess. 10 (40%) patients had to undergo tonsillectomy for abscess drainage.In the Kauffmann study, 62% of patients were administered amoxicillin/clavulanate potassium, 14.3% of patients 2nd and 3rd generation cephalosporin and 4.7% of patients clindamycin received empirical initial antibiotic treatment. In a series of 63 patients, these antibiotics and their combination were successful in 33 patients, while the spectrum was expanded in 21 patients. Nine patients developed total resistance to all of these antibiotics which resulted in prolonged hospital stay. All patients underwent surgery under general anesthesia. Seven (11.1%) patients required revision surgery. Multiple abscesses were seen in 6 (85.7%) patients who underwent revision surgery.In the Cordesmeyer study, pathology material was obtained from 49 (77.7%) patients, and malignancy was detected in 1 (2%) of these patients.Streptococcus viridans. Among anaerobic bacteria, the most common Bacteroides (8.3%) species were grown.Streptococcus pyogenes was the most commonly produced microorganism in Celakovsky's study, while coagulase negative staphylococci were the most commonly produced microorganisms in Rizzo's study.p = 0.02). In addition, staphylococcus growth was found to be significantly higher in the pediatric age group (p < 0.0001). However, there was no such difference in terms of streptococcal growthp = 0.05). In our study, culture was taken from 60 (81.1%) patients. Bacterial growth occurred in 51 (85%) patients. Twenty-nine (48.3%) patients had isolated aerobic bacteria, 10 (16.7%) patients isolated anaerobic bacteria, 12 (20%) patients aerobic plus anaerobic bacteria  growth. Among the aerobic bacteria, the most common growth rate was Streptococcus spp.  with 34.7%. The most common anaerobic bacteria were Peptostreptococcus spp., Prevotella spp., Prevotella oralis (18.5%). Klebsiella pneumoniae was detected in 2 (2.7%) patients, Brucella melitensis in 1 (1.4%) patient and Mycobacterium tuberculosis bacteria in 1 (1.4%) patient.In the Cordesmeyer study, 60 (95.2%) patients found bacterial growth as a result of bacterial culture. In 43 (71.7%) of 60 patients with culture growth, a single bacterium grew. Mixed growth (multiple pathogens and aerobic plus anaerobic bacteria) was detected in 17 (28.3%) patients. In total, 22 different bacteria were produced and the most common microorganism (26.7%) was Çetin tried isolated medical treatment in 12 pediatric patients; no complications and death were observed (101). In the Ban study, tracheotomy was performed in 32 (32.9%) patients.DNI is a disease group that seriously concerns public health with mortality and morbidity. Ensuring airway safety of patients should be the first intervention. If there is no contraindication, it is necessary to confirm the diagnosis with CT. Hospitalized patients should be examined in a multidisciplinary manner. Intubation without tracheotomy may depend on the experience of the anesthesiologist and the presence of appropriate equipment. Abscesses located lateral to the tonsil capsule may not properly drain without concomitant tonsillectomy.This thesis was supported by Mersin University Scientific Research Projects Unit with the number 2016-2-TP3-1825 .The authors declare no conflicts of interest.