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Bronchiolitis Obliterans After Severe Adenovirus Pneumonia:A Review of 46 Cases
Bronchiolitis obliterans after severe adenovirus pneumonia:a review of 46 cases Yuan-Mei Lan medical college of XiaMen University Yun-Gang Yang ( [email protected] ) Xiamen University and Fujian Medical University Aliated First Hospital Xiao-Liang Lin Xiamen University and Fujian Medical University Aliated First Hospital Qi-Hong Chen Fujian Medical University Research article Keywords: Bronchiolitis obliterans, Adenovirus, Pneumonia, Children Posted Date: October 26th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-93838/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/13 Abstract Background:This study aimed to investigate the risk factors of bronchiolitis obliterans caused by severe adenovirus pneumonia. Methods: The First Aliated Hospital of Xiamen University in January, 2019 was collected The clinical data of 229 children with severe adenovirus pneumonia from January to January 2020 were divided into obliterative bronchiolitis group (BO group) and non obstructive bronchiolitis group (non BO group) according to the follow-up clinical manifestations and imaging data. The clinical data, laboratory examination and imaging data of the children were retrospectively analyzed. Results: Among 229 children with severe adenovirus pneumonia, 46 cases were in BO group. The number of days of hospitalization, oxygen consumption time, LDH, IL-6, AST, D-dimer and hypoxemia in BO group were signicantly higher than those in non BO group; The difference was statistically signicant (P < 0.05). Univariate logistic regression analysis showed that there were signicant differences in the blood routine neutrophil ratio, platelet level, Oxygen supply time, hospitalization days, AST level, whether there was hypoxemia, timing of using hormone, more than two bacterial feelings were found in the two groups, levels of LDH, albumin and Scope of lung imaging (P < 0.05). -
Acute Bronchitis Treatment Without Antibiotics Owner: NCQA (AAB)
Measure Name: Acute Bronchitis Treatment without Antibiotics Owner: NCQA (AAB) Measure Code: BRN Lab Data: N Rule Description: The percentage of adults 18-64 years of age who had a diagnosis of acute bronchitis and were not dispensed an antibiotic prescription within three days of the encounter. General Criteria Summary 1. Continuous enrollment: One year prior to the date of the acute bronchitis index encounter through 7 days following that date (373 days) 2. Index Episode based: Yes 3. Anchor date: Episode date 4. Gaps in enrollment: One 45-day gap allowed in the period of continuous enrollment 5. Medical coverage: Yes 6. Drug coverage: Yes 7. Attribution time frame: Episode date 8. Exclusions apply: None 9. Age range: 18-64 10. Intake period: All but the last 7 days of the measurement year Summary of changes for 2013 1. No changes to this measure. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Denominator Description: All patients, aged 18 years as of the beginning of the year prior to the measurement year to 64 years as of the end of the measurement year, who had an outpatient or emergency department encounter with a diagnosis of acute bronchitis Inclusion Criteria: Patients as above with no comorbid condition during the twelve month period prior to the encounter, no prescription for an antibiotic medication filled 30 days prior to the encounter, and no competing diagnosis during the period from 30 days prior to the encounter to 7 days after the encounter. The intake period is from the beginning of the measurement year to 7 days prior to the end of the measurement year. -
Sore Throats: Causes and Cures
Vinod K. Anand, MD, FACS Nose and Sinus Clinic Sore Throats: Causes and Cures What Causes A Sore Throat? Sore throat is one symptom of an array of different medical disorders. Infections cause the majority of sore throats, and these are the sore throats that are contagious (can be passed from one person to another). Infections are caused by either viruses (such as the "flu," the "common cold" or mononucleosis) or bacteria (such as "strep," mycoplasma or hemophilus). The most important difference between viruses and bacteria is that bacteria respond well to antibiotic treatment, but viruses do not. Viruses Most viral sore throats accompany the "flu" or a "cold." when a stuff-runny nose, sneezing, and generalized aches and pains accompany the sore throat, it is probably caused by one of the hundreds of known viruses. These are highly contagious and cause epidemics in a community, especially in the winter. The body cures itself of a viral infection by building antibodies that destroy the virus, a process that takes about a week. Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful. One special viral infection takes much longer than a week to be cured: infectious mononucleosis or "mono." This virus lodges in the lymph system, causing massive enlargement of the tonsils (with white patches on their surface) and swollen glands in the neck, armpits and groin. it creates a severely sore throat, sometimes causes serious difficulties breathing, and can affect the liver, leading to jaundice (yellow skin and eyes). -
New Jersey Chapter American College of Physicians
NEW JERSEY CHAPTER AMERICAN COLLEGE OF PHYSICIANS ASSOCIATES ABSTRACT COMPETITION 2015 SUBMISSIONS 2015 Resident/Fellow Abstracts 1 1. ID CATEGORY NAME ADDITIONAL PROGRAM ABSTRACT AUTHORS 2. 295 Clinical Abed, Kareem Viren Vankawala MD Atlanticare Intrapulmonary Arteriovenous Malformation causing Recurrent Cerebral Emboli Vignette FACC; Qi Sun MD Regional Medical Ischemic strokes are mainly due to cardioembolic occlusion of small vessels, as well as large vessel thromboemboli. We describe a Center case of intrapulmonary A-V shunt as the etiology of an acute ischemic event. A 63 year old male with a past history of (Dominik supraventricular tachycardia and recurrent deep vein thrombosis; who has been non-compliant on Rivaroxaban, presents with Zampino) pleuritic chest pain and was found to have a right lower lobe pulmonary embolus. The deep vein thrombosis and pulmonary embolus were not significant enough to warrant ultrasound-enhanced thrombolysis by Ekosonic EndoWave Infusion Catheter System, and the patient was subsequently restarted on Rivaroxaban and discharged. The patient presented five days later with left arm tightness and was found to have multiple areas of punctuate infarction of both cerebellar hemispheres, more confluent within the right frontal lobe. Of note he was compliant at this time with Rivaroxaban. The patient was started on unfractionated heparin drip and subsequently admitted. On admission, his vital signs showed a blood pressure of 138/93, heart rate 65 bpm, and respiratory rate 16. Cardiopulmonary examination revealed regular rate and rhythm, without murmurs, rubs or gallops and his lungs were clear to auscultation. Neurologic examination revealed intact cranial nerves, preserved strength in all extremities, mild dysmetria in the left upper extremity and an NIH score of 1. -
SINUSITIS AS a CAUSE of TONSILLITIS. by BEDFORD RUSSELL, F.R.C.S., Surgeon-In-Charge, Throat Departmentt, St
Postgrad Med J: first published as 10.1136/pgmj.9.89.80 on 1 March 1933. Downloaded from 80 POST-GRADUATE MEDICAL JOURNAL March, 1933 Plastic Surgery: A short course of lecture-demonstrations is being arranged, to be given at the Hammersmith Hospitar, by Sir Harold Gillies, Mr. MacIndoe and Mr. Kilner. Details will be circulated shortly. Technique of Operations: A series of demonstrations is being arranged. Details will be circulated shortly. Demonstrations in (Advanced) Medicine and Surgeryi A series of weekly demonstrations is being arranged. Details will be circulated shortly. A Guide Book, giving details of how to reach the various London Hospitals by tube, tram, or bus, can be obtained from the Fellowship. Price 6d. (Members and Associates, 3d.). SINUSITIS AS A CAUSE OF TONSILLITIS. BY BEDFORD RUSSELL, F.R.C.S., Surgeon-in-Charge, Throat Departmentt, St. Bart's Hospital. ALTHOUGH the existence of sinus-infection has long since been recognized, medical men whose work lies chiefly in the treatment of disease in the nose, throat and ear are frequently struck with the number of cases of sinusitis which have escaped recognition,copyright. even in the presence of symptoms and signs which should have given rise at least to suspicion of such disease. The explanation of the failure to recognize any but the most mlianifest cases of sinusitis lies, 1 think, in the extreme youth of this branch of medicine; for although operations upon the nose were undoubtedly performed thousands of years ago, it was not uintil the adoption of cocaine about forty years ago that it was even to examine the nasal cavities really critically. -
Differentiated from the Rare Congenital Lues. Catarrhal Pharyngitis Produces Attacks of Hacking Cough with Frothy Mucus Appearing in the Mouth and on the Lips
Sir,-Your editorial in the February Research Newsletter has asked for sug- gestions on the classification and elucidation of minor maladies seen in general practice. I would like to recall the catarrhal diathesis of the older physicians. Perhaps it should be called a catarrhal state. It is extremely common especially in under fives and over fifties. It is conceived as an imperfect state of health or an incomplete defence against infection. Indeed, saprophytic organisms are encouraged to become virulent and inflammatory in the milieu of catarrh. In the newly born it is manifested as a sticky eye and a nasal snuffle which must be differentiated from the rare congenital lues. Catarrhal pharyngitis produces attacks of hacking cough with frothy mucus appearing in the mouth and on the lips. Catarrhal gastritis causes anorexia and irregular vomiting of curdy milk, sour fluid and mucus. Catarrhal bronchitis requires no description except to state that in its non-toxic afebrile form it can be associated with bronchospasm or bronchial relaxation. Deeper still within the young baby is the manifestation of catarrh called infantile gastro-enteritis which is a disease of uncertain etiology. At about four or five the child with the catarrhal diathesis develops tonsillar and adenoidal hypertrophy and hyperaemia, catarrhal otitis media (no pus formation), sinusitis and more active bronchitis with fever and secondary infections. Between seven and ten seems to be the favourite age for short attacks of mucous colitis. I have also seen two cases which clinicallv resembled ulcerative colitis but were of short duration. Stool cultures were negative for any pathogens and the disease occurred in isolated instances when no dysentery was observed in the vicinity. -
Diagnosis and Treatment of Acute Pharyngitis/Tonsillitis: a Preliminary Observational Study in General Medicine
Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2016; 20: 4950-4954 Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine F. DI MUZIO, M. BARUCCO, F. GUERRIERO Azienda Sanitaria Locale Roma 4, Rome, Italy Abstract. – OBJECTIVE : According to re - pharmaceutical expenditure, without neglecting cent observations, the insufficiently targeted the more important and correct application of use of antibiotics is creating increasingly resis - the Guidelines with performing of a clinically val - tant bacterial strains. In this context, it seems idated test that carries advantages for reducing increasingly clear the need to resort to extreme the use of unnecessary and potentially harmful and prudent rationalization of antibiotic thera - antibiotics and the consequent lower prevalence py, especially by the physicians working in pri - and incidence of antibiotic-resistant bacterial mary care units. In clinical practice, actually the strains. general practitioner often treats multiple dis - eases without having the proper equipment. In Key Words: particular, the use of a dedicated, easy to use Acute pharyngitis, Tonsillitis, Strep throat, Beta-he - diagnostic test would be one more weapon for molytic streptococcus Group A (GABHS), Rapid anti - the correct diagnosis and treatment of acute gen detection test, Appropriateness use of antibiotics, pharyngo-tonsillitis. The disease is a condition Cost savings in pharmaceutical spending. frequently encountered in clinical practice but -
Problem Based Review: Pleuritic Chest Pain
172 Acute Medicine 2012; 11(3): 172-182 Trainee Section 172 Problem based review: Pleuritic Chest Pain RW Lee, LE Hodgson, MB Jackson & N Adams Abstract Pleuritic pain, a sharp discomfort near the chest wall exacerbated by inspiration is associated with a number of pathologies. Pulmonary embolus and infection are two common causes but diagnosis can often be challenging, both for experienced physicians and trainees. The underlying anatomy and pathophysiology of such pain and the most common aetiologies are presented. Clinical symptoms and signs that may arise alongside pleuritic pain are then discussed, followed by an introduction to the diagnostic tools such as the Wells’ score and current guidelines that can help to select the most appropriate investigation(s). Management of pulmonary embolism and other common causes of pleuritic pain are also discussed and highlighted by a clinical vignette. Keywords Pleuritic pain, pulmonary embolus, pleurisy, chest pain Key Points 1. Pleuritic chest pain is a common reason for presentation to hospital. 2. Pulmonary embolism is a common, potentially life-threatening cause but can be difficult to diagnose, with clear overlap Richard William Lee between typical presentations. MBBS, MRCP, MA 3. Excluding other differential diagnoses can be difficult without definitive investigation e.g. CT Pulmonary Angiography (Cantab.) (CTPA). Respiratory Registrar, 4. Clinical probability and scoring systems (e.g. Wells’ score) can assist the physician in further management. Darent Valley Hospital 5. Several key guidelines from the thoracic and cardiological societies provide useful algorithms for investigation and further reading. Luke Eliot Hodgson MBBS, MRCP, MSc Respiratory Registrar, Introduction Brighton & Sussex Case History University Hospitals NHS Pleuritic pain is a sharp, ‘catching’ pain perceived A 37 year-old male smoker, with no previous medical Trust. -
Systemic Pulmonary Events Associated with Myelodysplastic Syndromes: a Retrospective Multicentre Study
Journal of Clinical Medicine Article Systemic Pulmonary Events Associated with Myelodysplastic Syndromes: A Retrospective Multicentre Study Quentin Scanvion 1 , Laurent Pascal 2, Thierno Sy 3, Lidwine Stervinou-Wémeau 4, Anne-Laure Lejeune 5, Valérie Deken 6, Éric Hachulla 1, Bruno Quesnel 2 , Arsène Mékinian 7, David Launay 1,8,9 and Louis Terriou 1,2,* 1 Department of Internal Medicine and Clinical Immunology, National Reference Centre for Rare Systemic Autoimmune Disease North and North-West of France, University of Lille, CHU Lille, F-59000 Lille, France; [email protected] (Q.S.); [email protected] (É.H.); [email protected] (D.L.) 2 Department of Haematology, Hôpital Saint-Vincent de Lille, Catholic University of Lille, F-59000 Lille, France; [email protected] (L.P.); [email protected] (B.Q.) 3 Internal Medicine Department, Armentières Hospital, F-59280 Armentières, France; [email protected] 4 Service de Pneumologie et ImmunoAllergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, CHU Lille, F-59000 Lille, France; [email protected] 5 Department of Thoracic Imagining, University of Lille, CHU Lille, F-59000 Lille, France; [email protected] 6 ULR 2694—METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, CHU Lille, F-59000 Lille, France; [email protected] 7 Department of Internal Medicine, AP-HP, Saint-Antoine Hospital, F-75012 Paris, France; [email protected] 8 INFINITE—Institute for Translational Research in Inflammation, University of Lille, F-59000 Lille, France 9 Inserm, U1286, F-59000 Lille, France * Correspondence: [email protected] Citation: Scanvion, Q.; Pascal, L.; Sy, T.; Stervinou-Wémeau, L.; Lejeune, A.-L.; Deken, V.; Hachulla, É.; Abstract: Although pulmonary events are considered to be frequently associated with malignant Quesnel, B.; Mékinian, A.; Launay, D.; haemopathies, they have been sparsely studied in the specific context of myelodysplastic syndromes et al. -
Allergic Rhinitis Adults and Adolescents 12 Years and Over Cambridgeshire and Peterborough Joint Pathway
Allergic Rhinitis Adults and Adolescents 12 years and over Cambridgeshire and Peterborough Joint Pathway Diagnosis from symptoms (nasal congestion, rhinorrhoea, itching, sneezing) Allergen/irritant avoidance advice with/without douching. Encourage Self-Care. Full patient history and nasal examination is essential MILD SYMPTOMS MODERATE – SEVERE SYMPTOMS Encourage Self-Care Encourage Self-Care • No troublesome symptoms • Abnormal sleep, sleep disturbance • Completes normal daily symptoms • Impairment of daily activities, sport, leisure • Normal work and school • Troublesome symptoms • Normal sleep disturbance • Problems caused at work or school ORAL/INTRANASAL NON-SEDATING H1 INTRANASAL CORTICOSTEROID* ANTIHISTAMINE ‘as needed’ 1° Care Responsibility Treatment Failure** 2° Care Responsibility Encourage Self-Care* 2° Care advice to 1° Care Check use, concordance dose COMBINATION OF AN ‘AS-NEEDED’ ORAL/INTRANASAL ANTIHISTAMINE AND REGULAR INTRANASAL CORTICOSTEROID* Treatment Failure** Check use, concordance dose olicy Itch/sneeze/extra Catarrh: add Watery Blockage: add short nasal itch/rash: add Montelukast if Rhinorrhoea: -term intranasal non-sedating H1 asthmatic (review Add decongestant (5 – 7 oral antihistamine after 28 days for Ipratropium days’ maximum) regularly. effect) Routine GP Treatment follow up Failure** ENT/ surgical Allergy specialist Referral Inflammatory rhinitis Referral (Skin prick test or blood test to confirm allergy if appropriate) Course of oral Potential Consider combination preparation of intranasal corticosteroids, -
1 Pathology Week 13: the Lung Ver.2
Pathology week 13: the Lung ver.2 Atelectasis - either incomplete expansion of the lungs (neonatal) or collapse of previously inflated lung, producing areas of relatively airless pulmonary parenchyma - reduces oxygenation, predisposes to infection - reversible except if caused by contraction o acquired either: resorption atelectasis (obstruction airway, resorption trapped oxygen) • mucus plugging eg asthma, bronchitis, bronchiectasis, post op, FBs • mediastinum shifts towards affected lung compression atelectasis • effusion, pneumothorax, haemothorax, peritonitis – basal atelectasis • mediastinum shift away from affected lung contraction atelectasis • when local or general fibrotic changes in lung prevent full expansion Acute Lung Injury - a spectrum of pulmonary lesions (endothelial and epithelial) - initiated by many factors - susceptibility my be heritable - mediators include cytokines, oxidants, growth factors (incl TNF, IL1, IL6, IL10, TGFβ) - may manifest as congestion, oedema, surfactant disruption, atelectasis - may progress to ARDS or acute interstitial pneumonia Pulmonary Oedema - most common haemodynamic mechanism: ↑ hydrostatic pressure in LVF - heavy, wet lungs – initially basal due to greater hydrostatic pressure - alveolar capillaries engorged, intra-alveolar granular pink precipitate, alveolar microhaemorrhages and haemosiderin-laden macrophages (“heart failure” cells ) - longstanding LVF – many haemosiderin-laden macrophages, fibrosis, thickening alveolar walls – lungs firm and brown (brown induration) Oedema caused -
Acute Pleurisy in Sarcoidosis
Thorax: first published as 10.1136/thx.33.1.124 on 1 February 1978. Downloaded from Thorax, 1978, 33, 124-127 Acute pleurisy in sarcoidosis I. T. GARDINER AND J. S. UFF From the Departments of Medicine and Histopathology, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London W12 OHS, UK Gardiner, I. T., and Uff, J. S. (1978). Thorax, 33, 124-127. Acute pleurisy in sarcoidosis. A 47-year-old white man with sarcoidosis presented with a six-week history of acute painful pleurisy. On auscultation a loud pleural rub was heard at the left base together with bilateral basal crepitations. The chest radiograph showed hilar enlargement as well as diffuse lung shadowing. A lung biopsy showed the presence of numerous epithelioid and giant-cell granulomata, particularly subpleurally. A patchy interstitial pneumonia was also present. He was given a six-month course of prednisolone, and lung function returned to normal. Pleural involvement by sarcoid was thought to be were unhelpful, an open lung biopsy was per- very infrequent (Chusid and Siltzbach, 1974) until formed on 19 July 1974. Small white nodules, one recent report which gave an incidence of 1 mm across, were scattered over the visceral nearly 18% (Wilen et al., 1974). However, histo- pleura, and the lung felt firmer than normal. The logically confirmed cases remain small in number, hilar lymph nodes were enlarged and a biopsy even from very large series. Beekman et al. (1976) specimen was taken from one. have stressed that it is so unusual that pleural Two weeks later he was started on prednisolone, disease in a patient with sarcoidosis is very likely 30 mg per day.