Does a simple educational exercise influence practice in acute tonsillitis in children?

Aim: To assess the concordance of treatment of children attending with tonsillitis in Paediatric Accident and Emergency with established guidelines, and subsequent review of the management of this condition after a simple educational exercise. Methods: An audit on children with tonsillitis was carried out amongst doctors working in the Paediatric Accident and Emergency Department during a three month period in 2009. Eleven doctors completed an anonymous questionnaire requesting details on presentation, symptoms, investigations and treatment of children presenting with acute tonsillitis. The results obtained from this questionnaire were compared to NICE guidelines and modified Centor (McIsaac) criteria, and fed back to the participating doctors together with copies of these guidelines via a simple, structured educational exercise. Three months later, a second identical questionnaire was again completed by the same cohort of doctors. Results: The first questionnaire showed that there was a tendency towards unnecessary prescription of antibiotics and investigations in children with acute tonsillitis, when compared to recommendations in the guidelines. Following educational feedback, the second questionnaire showed a reduction in antibiotic prescriptions by 9% (p=0.5) and investigations by 37% (p=0.1). Compliance with guidelines had improved significantly with regard to non-prescribing of antibiotics with a fever of 1cm and presence of underlying disease although these changes were not statistically significant. Conclusion: Although doctors were initially only partly compliant with established guidelines for children with acute tonsillitis, compliance improved significantly after a simple educational exercise.peer-reviewe

Clinicians’ adherence to local antibiotic guidelines for upper respiratory tract infections in the ear, nose & throat casualty department of a public general hospital

Background: In Malta, resistance to antibiotics constitutes a major threat to public health. This study aims to assess clinicians’ adherence to local antibiotic guidelines when treating cases of acute otitis media, acute tonsillitis and rhinosinusitis, that present to the ear, nose and throat (ENT) casualty department in Malta’s public general hospital, as well as to recommend methods for improving adherence and minimising overprescribing. Methodology: Data on first line antibiotic prescribing regimens was retrieved from ENT casualty sheets between February and March 2015 for adult patients (>12years) diagnosed with acute otitis media, acute tonsillitis and persistent rhinosinusitis. On an audit form, aspects of the prescribed antibiotic were benchmarked to local infection control antibiotic guidelines of 2011 to evaluate adherence. Results: From 1010 casualty records, 188 were antibiotic prescriptions, of which 93 (49.4%) were correctly indicated as per guidelines. From the indicated prescriptions 81 (87%) were assessable, out of which full adherence was only observed in 6 (7%) of prescriptions. All of these were for rhinosinusitis. Full adherence in rhinosinusitis was found to be 43%, whilst no adherence was found in the other infections. The most prescribed antibacterial for all three infections was co-amoxiclav. Conclusion: The current antibiotic guidelines have not been adequately implemented as adherence to antibiotic choice alone was low in all infections. This may have an impact on antibiotic-resistant rates and infection incident rates. Hence to improve adherence to local antibiotic guidelines, it is recommended that these should be clear, regularly updated, well disseminated and reinforced. The addition of a care pathway may further improve appropriate antibiotic use.peer-reviewe

Perbedaan Prestasi Belajar Antara Siswa Tonsilitis Kronis Dengan Siswa Tidak Tonsilitis Kronis

Background : Upper respiratory tract infection (URI) in Indonesia is a common cause of morbidity and mortality in children. Epidemiological data in seven province in Indonesia, prevalence of chronic tonsillitis 3,8% in the highest after acute nasopharyngitis which is a problem that is commonly found in children, given the high incidence and impact that can affect the quality of life of children, one of them is academic achievement. From the past studies there is a difference between farokah (2007) and khargoshae (2009) where farokah get a significant association in academic achievement suffering from chronic tonsillitis student below the average of the calss 76,6%, wheares non chronic tonsillitis by 23,4%. The research conducted by khargoshae only get a small sample size so it does not have a significant relationship between the size of the tonsils and academic achievement. Objective : To determine The Different Of Academic Achievment Between Student With Chronic Tonsillitis and Student Without Chronic Tonsillitis Methods : This study used cross sectional study. This study was conductd in January 2015 in SD Negeri 1 karangasem Surakarta with the sample of children in grade 1 to grade 6 as many as 230 children and devided in 2 groups, the cases are student with chronic tonsillitis and other groups are student without chronic tonsillitis as a control. Data were analyzed with chi-square Result : there were 70 student involved, consisting of 35 student with chronic tonsillitis and 35 student without chronic tonsillitis. From the result showed that the value of p= <0,001 for, where p<0,05. Conclusion : there is The Different Of Academic Achievment Between Student With Chronic Tonsillitis and Student Without Chronic Tonsilliti

Prevalence, pattern and management of tonsilitis in students-an online survey

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat-one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. The objective of the study is to study the prevalence of tonsillitis in adults, to evaluate which triggering factors contributes to tonsillitis and to evaluate the treatment strategy for tonsillitis. A Prospective survey will be carried out in 49 peoples using the information's gathered from students in Pharmacy colleges in Trivandrum. This study provides the prevalence of tonsillitis. Past history, medication usage, diagnosis, treatment and triggering factors was collected and analyzed properly. Also response is recorded. In the current research, a survey on prevalence of tonsillitis in adults was formulated .Approximately, 77% female are affected with tonsillitis than 22.9% of male. Among the responders, 75% have tonsillitis and remaining 25% not. About 13% of patients taken self medication, 47.8% consulting physician and 41% are taken home remedies. From this study, most of the responders were satisfied with OTC medicines and home remedies and recurrent attack of tonsillitis are increasing day by day to abolish Tonsillitis, to reduce the frequency and severity of recurrent throat infections to improve general well-being, behavior, and educational achievement with minimal adverse effects.&nbsp; &nbsp; &nbsp

Gonococcal Tonsillar Infection—ACase Report and Literature Review

Abstract. : Oral gonococcal infection is an uncommon but well-described manifestation of gonococcal infection, usually described as pharyngitis in the literature. Tonsillitis is much rarer and its role in the clinical presentation in oral gonorrhea is less clear. We describe a case of oral gonorrhea presenting with tonsillitis and a discrete cervical lymphadenopathy and present a review of the literature from 1961 to 2002. Of the 512 reported cases of oral gonococcal infection, only 61 have been described to be tonsillitis. The tonsils were invariably enlarged and infected. A whitish-yellow exudate in the cryptae was described in 12 cases (20.6%). Fever and cervical lymphadenopathy appear to be rather uncommon, since they have been described in only five (8.2%) and six (9.3%) of the 61 patients with tonsillitis, respectively. Gonococcal tonsillitis should be included in the differential diagnosis of tonsillitis in sexually active patient

Overview of the clinical features of cefixime

Third-generation cephalosporins in oral formulations have become an increasingly important first-line choice against common bacterial infections. Cefixime is one such agent, which possesses excellent efficacy against a broad spectrum of pathogens, including Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Clinical success rates are similar to cefaclor, clarithromycin, and other cephalosporins. Importantly, cefixime also possesses excellent activity against beta-lactamase-producing strains. The pharmacodynamic features of the drug include a half-life of 3-4 h and a C-max of 4.4 mu g/ml, well above the MIC90 for susceptible pathogens, permitting once-daily dosing. In this brief overview, the bacteriological and clinical efficacy of cefixime is discussed, as well as its indications

Changing indications and socio-demographic determinants of (adeno)tonsillectomy among children in England--are they linked? A retrospective analysis of hospital data.

OBJECTIVE: To assess whether increased awareness and diagnosis of obstructive sleep apnoea syndrome (OSAS) and national guidance on tonsillectomy for recurrent tonsillitis have influenced the socio-demographic profile of children who underwent tonsillectomy over the last decade. METHOD: Retrospective time-trends study of Hospital Episodes Statistics data. We examined the age, sex and deprivation level, alongside OSAS diagnoses, among children aged <16 years who underwent (adeno)tonsillectomy in England between 2001/2 and 2011/12. RESULTS: Among children aged <16 years, there were 29,697 and 27,732 (adeno)tonsillectomies performed in 2001/2 and 2011/12, respectively. The median age at (adeno)tonsillectomy decreased from 7 (IQR: 5-11) to 5 (IQR: 4-9) years over the decade. (Adeno)tonsillectomy rates among children aged 4-15 years decreased by 14% from 350 (95%CI: 346-354) in 2001/2 to 300 (95%CI: 296-303) per 100,000 children in 2011/12. However, (adeno)tonsillectomy rates among children aged <4 years increased by 58% from 135 (95%CI: 131-140) to 213 (95%CI 208-219) per 100,000 children in 2001/2 and 2011/2, respectively. OSAS diagnoses among children aged <4 years who underwent surgery increased from 18% to 39% between these study years and the proportion of children aged <4 years with OSAS from the most deprived areas increased from 5% to 12%, respectively. CONCLUSIONS: (Adeno)tonsillectomy rates declined among children aged 4-15 years, which reflects national guidelines recommending the restriction of the operation to children with more severe recurrent throat infections. However, (adeno)tonsillectomy rates among pre-school children substantially increased over the past decade and one in five children undergoing the operation was aged <4 years in 2011/12.The increase in surgery rates in younger children is likely to have been driven by increased awareness and detection of OSAS, particularly among children from the most deprived areas

The content of general practice in Malta : a pilot study comparing health centre and private practice in Malta with each other and with general practice (as reported for other countries)

The effective planning of a system and the training of personnel to run it requires accurate data regarding the use to be made of the system. For a health care system such data, apart from actual numbers of patients, will include age/sex distribution, patient requests and expectations, and common presenting symptoms and diagnoses. Studies have been conducted in various countries to collect such data and while they have demonstrated general similarities among countries, they have also shown important regional differences. The present study arose as a result of discussions during a course on Family Medicine held by the University of Malta attended by ten doctors working in Government Health Centres, as it was noted that no such information has been published for Malta. The main objectives of the study were to determine the content of general practice in Malta; compare general practice experience in Government Health Centres and in private practice; determine and compare referral rates in Government Health Centres and in private practice.peer-reviewe

Evaluation of iron and zinc levels in recurrent tonsillitis and tonsillar hypertrophy

WOS: 000372213200012PubMed ID: 26954864Objectives: The aim of this study is to look into the roles of iron and zinc metals in etiopathogenesis of recurrent tonsillitis and tonsillar hypertrophy by evaluating the levels of iron and zinc elements in the palatine tonsillar tissue. Methods: In total, 40 patients who underwent a tonsillectomy to treat recurrent tonsillitis and tonsillar hypertrophy were included in the study. Patients were classified into two groups, recurrent tonsillitis and tonsillar hypertrophy, determined by the results of clinical and histopathological examination. The levels of iron and zinc elements were determined for each tonsillar tissue sample. Results: There was a significant difference in the iron and zinc concentrations (p < 0.001) between the tonsillar hypertrophy and recurrent tonsillitis groups. The levels of iron and zinc were significantly lower in the recurrent tonsillitis group. Conclusions: This study suggests that low tissue concentrations of iron and zinc may lead to recurrent tonsillitis. (C) 2016 Elsevier Inc. All rights reserved

Diagnostic Value of Histological and Microbiological Screening in Etiopathogenesis of Recurrent and Hypertrophic Tonsillitis

Interest in the mechanisms and causes of recurrent tonsillitis is considerable. CD4+CD25+ T-lymphocytes have an important role in the maintenance of immunological tolerance. The aim of our research was to compare the diagnostic value of palatine tonsils histological and microbiological screening in patients with hypertrophic and recurrent tonsillitis. 14 patients with hypertrophic and 10 patients with chronic tonsillitis undergoing tonsillectomy were enrolled in the study. Rapid diagnosis of adenovirus, parainfluenza, influenza A and B, and respiratory syncytial virus infection was made before tonsillectomy by viral antigen detection using the immunofluorescence procedure from tonsils. Herpes simplex and cytomegaloviruses DNA were detected by the polymerase chain reaction. Samples for bacteriological studies were collected using a cotton swab. Immunohistochemical methods were used to evaluate S-100 and TGF-beta1 expression. The obtained results showed that patients with recurrent tonsillitis had less S-100 and TGF-beta1 positive cells in parafollicular regions compared to patients with hypertrophic tonsillitis. In both groups, tonsils were colonized predominantly by gram-positive microorganisms and adenovirus (36% of cases). However, in patients with recurrent tonsillitis, associations of gram-positive, gram-negative bacteria and viruses (40% of cases) were observed. To conclude, recurrent tonsillitis is characterized by the breakdown of the immunological tolerance to oral microflora