Twenty-year observational study of paediatric tonsillitis and tonsillectomy

Introduction: Tonsillectomy is now only indicated in the UK when specific criteria are met, as outlined by the Scottish Intercollegiate Guidelines Network (SIGN) and The National Institute for Health and Care Excellence (NICE). As a result, fewer numbers of tonsillectomy are being performed. Tonsillectomy is the primary treatment for recurrent tonsillitis; therefore, we hypothesise that acute admissions to hospital with tonsillitis and infective complications will have risen since criteria were introduced. Our aim was to assess the rates of acute hospital admissions with tonsillitis in children and the factors associated with this. Methods: Data were provided by Information Service Division for all under 16s in Scotland between 1996/1997 and 2016/2017. Socioeconomic background was determined from the Scottish Index of Multiple Deprivation (SIMD) score. Poisson regression analysis was used to model predictors of surgery and correlation analysis to study the relationship between tonsillitis and other factors. Results: 60 456 tonsillectomies were performed. The number of tonsillectomies dropped significantly following the introduction of SIGN guidelines, and the rates of tonsillitis increased; however, admissions with tonsillitis were already on an upward trajectory. Children from the most deprived areas were 72.0% (95% CI 60% to 85%, p<0.001) more likely to receive tonsillectomy and were also more likely to be admitted with tonsillitis than the least deprived areas. Conclusion: Tonsillectomy and tonsillitis rates are highest in the most deprived; postulated reasons include antibiotic stewardship and difficulty accessing primary care. Current guidelines on tonsillectomy may be disproportionately harmful in children from deprived households

Multimodal optical mesoscopy reveals the quantity and spatial distribution of gram-positive biofilms in ex vivo tonsils

Biofilms are known to be present in tonsils, but little is known about their spatial location and size distribution throughout the tonsil. Studies of the location and distribution of biofilms in tonsil specimens have thus far been limited to either high-magnification methods such as electron microscopy, which enables high resolution imaging but only from a tiny tissue volume, or lower magnification techniques such as light microscopy, which allow imaging of larger specimens but with poor spatial resolution. To overcome these limitations, we report the use of multimodal optical mesoscopy to visualize and quantify the number and spatial distribution of gram-positive biofilms in fresh, excised paediatric tonsils. This methodology supports simultaneous imaging of both the tonsil host and biofilms in whole mounts of tissue up to 5 mm x 5 mm x 3 mm with subcellular resolution throughout. A quantitative assessment of thirty-six tonsil specimens revealed no statistically significant difference between biofilm presence on the tonsil surface and the interior of the tonsil. This new quantitative mesoscale imaging approach may prove useful in understanding the role of biofilms in tonsillar diseases and other infections

Spectroscopy and photochemistry of arylazonaphtol dyes

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Reverse flow of brain interstitial fluid through venular blood-brain barrier

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN013947 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Paediatric maxillary antrolith: A case report

Objective: To report a case of maxillary antrolith in a paediatric patient. Method: Here we present a case report of a maxillary antrolith in a 15-year-old male and a review of literature regarding unilateral opaque paranasal sinus lesions including maxillary antroliths. Results: A 15-year-old male presented with a 5-month history of left sided facial swelling, nasal obstruction and anosmia. He was managed as a chronic sinusitis with topical decongestant and steroids to little effect. MRI demonstrated an enlarged right maxillary sinus and a T2 enhancing 12 × 12mm calcified lesion in the left maxillary sinus with sinusitic change. Conclusion: Maxillary antroliths are often incidental findings on imaging but can present as chronic sinusitis. This case highlights a rare differential of unilateral radiopaque paranasal sinus lesions in the paediatric population

Is It Time to FONA Friend? A Novel Mixed Reality Front of Neck Access Simulator

Emergency cricothyroidotomy is a life-saving but infrequently performed procedure for emergency airway difficulty. This is performed as the final “rescue” step, after all non-invasive intubation techniques have failed. This time critical procedure must be performed with efficiency and proficiency. Such expertise is developed through experience; however as this procedure is rarely encountered, these skills are taught through simulation. Hence this research sought to develop a simulation for practice of front of neck access that is easily accessible, cheap and ethically sustainable that offers moderate realism. Hence a mixed reality cricothyroidotomy simulation was created, whereby a mobile application demonstrates the technical steps in CCT using augmented reality and then later records the participant performing the procedure on a 3D anatomically correct larynx model. Though the technology is still experimental, the protype and pilot test have demonstrated positive results, with the majority of the participants agree that there should be increased frequency in training CCT and that this simulator is adequate for this task. There is still scope for further development; the model can be modified to demonstrate the anatomical variations of gender and age as well as developing a new semi-rigid material for 3D printing that has greater similarity to cartilage. The application can be further enhanced by making the AR animation more streamline, the educational information more detailed and the feedback more intuitive. The advancement of technology will bring with it an abundance of new directions for this application and for medical education