DOCSLIB.ORG

International Sore Throat Guidelines and International Medical Graduates: a Mixed Methods Systematic Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
International Sore Throat Guidelines and International Medical Graduates: a Mixed Methods Systematic Review ORIGINAL SCIENTIFIC PAPER SYSTEMATIC REVIEW International sore throat guidelines and international medical graduates: a mixed methods systematic review Karen J Hoare PhD, NP;1 Erin Ward BSc;2 Bruce Arroll MBChB, PhD, FNZCPHM, FRNZCGP3 1 Senior Lecturer/Nurse Practitioner for Children and Young People, ABSTRACT School of Nursing and Department of General AIM: To examine national and international guidelines on sore throat management and Practice and Primary Health Care University of subsequently, to explore the phenomenon of international medical graduates working in Auckland, Private Bag general and rural practice in New Zealand. 92 019, Auckland 1142, New Zealand METHOD: Two separate systematic reviews were conducted that resulted in a c ontingent 2 School of Nursing, methodology. Contingent methodologies involve syntheses of data that are derived University of Auckland, Private Bag 92 019, sequentially. The initial review for this study examined international sore throat guidelines Auckland 1142, and their key points. The results of this initial review resulted in the theory that international New Zealand medical graduates may be unaware of the New Zealand specific sore throat guidelines and 3 Elaine Gurr Chair the problem of acute rheumatic fever in this country. The subsequent review examined the of General Practice phenomenon of international medical graduates working in general or rural practice in New and Primary Health Care, Director of the Zealand. Data sources were Medline, Google Scholar, Trip Database, and NHS Evidence, Goodfellow Unit, Embase and Scopus. Electronic databases were searched for relevant data published Department of General January 2000–December 2013. Additional hand searches found key references from Practice and Primary Health Care, University articles and websites. of Auckland, Private Bag 92019, Auckland 1142, RESULTS: International guidelines for the management of sore throats differ from New Zealand; Physical New Z ealand guidelines. Of resource rich countries, New Zealand has the second highest Address: Tamaki Campus, 261 Morrin Road, Glen number of international medical graduates: they may not use New Zealand specific sore Innes, New Zealand throat guidelines. DISCUSSION: Acute rheumatic fever is virtually eradicated in most resource rich countries. Rheumatic fever rates of among indigenous Māori and Pacifika people in New Zealand have failed to reduce over the last three decades. Knowledge and actions of international medical graduates in relation to sore throat management needs investigating. KEYWORDS: Sore throats; acute rheumatic fever; clinical guidelines; international medical graduates; mixed methods review J PRIM HEALTH CARE 2016;8(1):20–29. Introduction group A beta-haemolytic streptococcal (GABHS) 10.1071/HC15032 infection.4 Acute rheumatic fever (ARF) is an Sore throats are common and one of the top ten auto immune multi-system disease that occurs reasons for seeing a doctor in New Zealand 1 as sequela to GABHS. Throughout the developed C ORRESPONDENCE TO: (NZ). In the NZ European population, most sore Karen J Hoare throats have viral aetiology, are self-limiting, and world ARF has all but disappeared. For example, a University of Auckland, resolve without the need for medical interven- recent study reported in the British Medical Jour- Private Bag 92 019, Auckland 2,3 1142, New Zealand tion. In an estimated 10% of adult and 15–30% nal examined 14 610 adults for complications fol- [email protected] of paediatric cases, sore throats are a result of lowing an acute sore throat and failed to mention 20 Journal Compilation © Royal New Zealand College of General Practitioners 2016 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License ORIGINAL SCIENTIFIC PAPER SYSTEMATIC REVIEW ARF.5 However in NZ, ARF remains a serious illness with high rates among Māori and Pasifika WHAT GAP THIS FILLS children compared with other children.6 Most cases of ARF are seen in the North Island, in poor What we already know: Rates of acute rheumatic fever in Māori and socioeconomic areas. The rates of ARF in Māori Pacifika people in New Zealand are high compared to other devel- and Pasifika have failed to reduce since the 1980s.7 oped world countries. These rates have failed to reduce over three decades. NZ has the highest number of overseas trained doctors in the Organisation for Economic Devel- What this study adds: International guidelines regarding sore throat opment and Co-operation (OECD) countries, at management vary considerably between countries. At 41% of the 41%, nearly double the level of Australia.8,9 These medical workforce, New Zealand has the second largest number international medical graduates (IMGs), who of international medical graduates of 14 resource rich countries. often hail from countries where ARF has been virtually eradicated such as the UK, may not be aware of the continuing problem of ARF in NZ. segregated and integrated mixed method system- Additionally there is a plethora of international atic reviews. A contingent methodology involves guidelines that have been developed to inform two or more systematic reviews that are conduct- sore throat management, many of which aim to ed sequentially and based on the results of the decrease antibiotics use in settings of low ARF initial synthesis (see Figure 1). They can use data prevalence, unlike NZ. Some IMGs who work from qualitative, quantitative or mixed methods in primary health care or rural practice may be studies. In our review the initial data collected unaware of the NZ specific guidelines developed pertained to the number of international sore by the Heart Foundation for sore throat manage- throat guidelines and their key points. The ment in Māori and Pacifika people. subsequent review focused on a content analysis of studies referring to IMGs working in primary This article is guided by a mixed methods sys- health care in NZ. tematic review using a contingent methodology and starts with a review of international sore The review commenced with searching and throat guidelines. Our thesis is that guidelines appraising international guidelines written are country specific and many IMGs may be in English for sore throat management. After unaware of the problem of ARF in Māori and reviewing and synthesising guidelines published Pacifika people in NZ. There are no bridging between November 2012 and February 2013, it programmes available for IMGs coming to work became apparent that there were inconsistencies in primary care here. IMGs may be unaware that in guideline recommendations. These incon- access to primary health care, and thus treatment sistencies led us to theorise that IMGs may be of sore throats, is limited for many Māori and unaware of the specific problem of ARF in NZ Pacifika people and that this may contribute to and may refer to guidelines from their home the failure of ARF reduction over the past three countries when practising medicine in NZ. decades. The persistence of high rates of ARF in NZ is now receiving attention from policy Determining the search strategy makers. It is timely to explore the preparation for IMGs coming to work in NZ, particularly for A systematic search of the literature pertaining IMGs working in general and rural practice. to guidelines for sore throats was conducted. The databases accessed were Medline, Google Methods Scholar, Trip Database, and NHS Evidence. Relevant references were retrieved from the We conducted a mixed methods review using a reference lists of the guidelines. The search was contingent methodology.10 Contingent meth- limited to full text articles published in English odologies were described by Sandelowski et al. January 2000 – D ecember 2012. English lan- as being one of three frameworks to conduct a guage is mainly used in the NZ health system mixed methods review.11 The other two ways are and therefore it was considered unnecessary to VOLUME 8 • NUMBER 1 • MARCH 2016 JOURNAL OF PRIMARY HEALTH CARE 21 ORIGINAL SCIENTIFIC PAPER SYSTEMATIC REVIEW Figure 1. Mixed-method systematic review using a contingent methodology10 documents and literature from medical profes- sional bodies. The New Zealand Ministry of /ŶŝƟĂůƐĞĂƌĐŚ Health and Medical Council of websites were ŶLJŐƵŝĚĞůŝŶĞ explored for information on IMGs. Only eight articles were identified following this search and so ‘Australia’ was added as a search ZĞƐĞĂƌĐŚƋƵĞƐƟŽŶϭ͘ term due to its close ties with NZ’s medical system via the Trans-Tasman agreement. Adding ‘Australia’ as an additional search term elicited a further four articles. ^ƚƵĚLJƐĞůĞĐƟŽŶ͘ ĂƚĂĂŶĂůLJƐŝƐ͘ Quality appraisal and data KH and EW appraised all of the guidelines and used the AGREE Collaboration’s criteria for high quality clinical practice guidelines12 (Box 1). YƵĂŶƟƚĂƟǀĞ͕ ZĞƐĞĂƌĐŚƋƵĞƐƟŽŶϮ͘ Twenty guidelines met these criteria. The data ƋƵĂůŝƚĂƟǀĞŽƌŵŝdžĞĚͲ were subject to content analysis and then organ- ŵĞƚŚŽĚƐƐLJŶƚŚĞƐŝƐ͘ ised by EW and KH into key themes. Quality reporting standards are increasingly ^ƚƵĚLJƐĞůĞĐƟŽŶ͘ expected in health services research. The recently ĂƚĂĂŶĂůLJƐŝƐ͘ developed RAMESES (Realist and Meta-review Evidence Synthesis: Evolving Standards) publica- tion standard was followed.13 The authors of this standard emphasise the importance of trans- YƵĂŶƟƚĂƟǀĞ͕ parency in reporting the results of a realist or ƋƵĂůŝƚĂƟǀĞŽƌŵŝdžĞĚͲ meta-review evidence synthesis. The authors con- ŵĞƚŚŽĚƐƐLJŶƚŚĞƐŝƐ͘ sidered the RAMESES standard an appropriate guide to convey
Load more

Recommended publications
  • Supplementary File 1
    Supplementary File Table S1 Checklist for Documentation of Google Trends research. a) Initial list of pain locations and factors related to pain Name Matched as topic related to pain (not disease diagnosis) Head & Neck Headache / Head Pain Yes, „Headache” Eye pain Yes „Eye pain” Nose pain No Ear pain Yes, „Ear pain” Toothache Yes, „Toothache” Tongue pain No Lip pain No Sore Throat Yes, „Sore Throat” Neck pain Yes, „Neck pain” Trunk Chest pain / Heart pain Yes, „Chest pain” Breast pain Yes, „Breast pain” Abdominal pain / Stomache Yes, „Abdominal pain” Epigastric pain Yes, „Epigastric pain” Umbilical pain No Flank pain Yes, „Abdominal pain” Hypogastrium pain No Groin pain Yes, „Groin pain” Back pain Yes, „Back pain” Low back pain / Lumbar pain Yes, „Low back pain” Pelvic region Pelvic pain Yes, „Pelvic pain” Penis pain Yes, „Penile pain” Testicular pain / Pain of balls Yes, „Testicular pain” Rectum pain / Anal pain Yes, „Rectum pain” Limbs Shoulder pain Yes, „Shoulder pain” Clavicle pain No Arm pain No Forearm pain No Wrist pain Yes, „Wrist pain” Hand pain / Palm pain No Thigh pain No Buttock pain No Knee pain Yes, „Knee pain” Calf pain / Calf cramps No Podalgia / Feet pain Yes, „Podalgia” Factors Dysmennorhea / Painful Yes, „Dysmenorrhea” mennorhea Dyspareunia / Sex during Yes, „Dyspareunia” intercourse Odynophagia / Pain during Yes, „Odynophagia” swallowing Pain during breathing No Pain during walking No b) Search details Section/Topic Checklist item Search Variables Access Date 22 July 2019 Time Period From January 2004 to date of the
    [Show full text]
  • The Pfizer/Biontech COVID-19 Vaccine: What You Need to Know
    Vaccine Information Statement • Pfizer/BioNTech COVID-19 Vaccine • When administering vaccine use EUA Fact Sheet date for VIS date in Plummer Chart • Created and distributed by Mayo Clinic VACCINE INFORMATION STATEMENT Mayo Clinic created this Vaccine The Pfizer/BioNTech COVID-19 Information Statement for use temporarily until the official CDC Vaccine: What You Need to Know versions are available. Why get vaccinated The Pfizer/BioNTech 1 against COVID-19? 2 COVID-19 vaccine This COVID-19 vaccine can prevent COVID-19 The Pfizer/BioNTech COVID-19 vaccine provides infection. protection against COVID-19 infection. It is one of several vaccines developed to protect against The COVID-19 infection (also called coronavirus COVID-19 infection. disease 2019) is caused by the SARS-CoV-2 virus. Symptoms can range from no symptoms at all to In a randomized, controlled trial involving severe acute respiratory syndrome. Most common over 40,000 volunteers, the vaccine prevented symptoms include fever, cough, loss of smell or COVID-19 in 95% of people vaccinated. The 95% taste and fatigue. prevention rate was about the same no matter the age, sex, ethnicity or race of the people who Symptoms usually appear 2 to 14 days after received it. infection. Early symptoms may include a loss of taste or smell. Other symptoms include shortness The Pfizer/BioNTech COVID-19 vaccine is of breath or difficulty breathing, muscle aches, recommended for people 12 years of age and chills, sore throat, runny nose, headache and older. The vaccine is given in two doses. The chest pain. Some people have experienced rash, second dose is given 21 days after the first.
    [Show full text]
  • PHARYNGITIS- Management Considerations
    PHARYNGITIS: Management Considerations NICE’18, BMJ’17, IDSA’12 www.RxFiles.ca © Aug 2021 PEARLS for the MANAGEMENT of PHARYNGITIS SHOULD ANTIBIOTICS BE USED TO TREAT PHARYNGITIS? The majority of pharyngitis cases do NOT require antibiotics as they are viral infections 80-90% of adults (>70% of children) do NOT require antibiotics as infection likely viral. (80-90% in adults, >70% in children). Patients with a positive throat swab should receive an antibiotic to the risk of Pharyngitis is typically self-limiting (often 3-7 days; up to 10 days). complications. See modified Centor score on left column, & antibiotic table below. A validated clinical decision rule e.g. modified Centor score can help identify low risk patients The turn-around-time for throat swab results can take a few days. However, antibiotics who do not require diagnostic testing (see below) or antibiotics. started within 9 days of symptom onset in confirmed GAS will prevent rheumatic fever. For confirmed Group A Streptococcus (GAS) pharyngitis, penicillin for 10 days is the drug Some possible strategies: watchful waiting, or empiric antibiotic (stop if throat swab negative). of choice. There is no documented GAS resistance to penicillin. MOST COMMON BACTERIAL PATHOGEN Advise on treatments that will provide symptomatic relief: NSAIDs, acetaminophen, Group A Streptococcus (GAS) medicated throat lozenges, topical anesthetics, warm liquids. EMPIRIC DRUG REGIMENS OF CHOICE & SUSCEPTIBILITY CONCERNS Patients should see their prescriber if: ❶ symptoms worsen, ❷ symptoms take longer FIRST LINE than 3 to 5 days to resolve, &/or ❸ unilateral neck swelling develops. - Majority of cases are viral. - See Symptom Management PRE-TREATMENT CONSIDERATIONS No antibiotic - Only use antibiotics in confirmed following page.
    [Show full text]
  • Sore Throats
    Sore Throats Insight into relief for a sore throat • What causes a sore throat? • What are my treatment options? • How can I prevent a sore throat? • and more... Infections from viruses or bacteria are the main cause of sore throats and can make it difficult to talk and breathe. Allergies and sinus infections can also contribute to a sore throat. If you have a sore throat that lasts for more than five to seven days, you should see your doctor. While increasing your liquid intake, gargling with warm salt water, or taking over-the-counter pain relievers may help, if appropriate, your doctor may write you a prescription for an antibiotic. What are the causes and symptoms of a sore throat? Infections by contagious viruses or bacteria are the source of the majority of sore throats. Viruses: Sore throats often accompany viral infections, including the flu, colds, measles, chicken pox, whooping cough, and croup. One viral infection, infectious mononucleosis, or “mono,” takes much longer than a week to be cured. This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface. Other symptoms include swollen glands in the neck, armpits, and groin; fever, chills, and headache. If you are suffering from mono, you will likely experience a severe sore throat that may last for one to four weeks and, sometimes, serious breathing difficulties. Mono causes extreme fatigue that can last six weeks or more, and can also affect the liver, leading to jaundice-yellow skin and eyes. Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria.
    [Show full text]
  • Reactive Arthritis Following Tonsillitis
    Grand Rounds Vol 5 pages 8–9 Speciality: Otolaryngology; rheumatology; general medicine Article Type: Case Report DOI: 10.1102/1470-5206.2005.0004 c 2005 e-MED Ltd GR Reactive arthritis following tonsillitis Urmi Bapat and Antony Narula St. Mary’s Hospital, London, UK Corresponding address: Mrs Urmi Bapat, 123 Tumey Road, London SE21 7JB, UK Tel.: +44-7788-453148; Fax: c/o +44-20-7886-1847; E-mail: [email protected] Date accepted for publication 10 December 2004 Abstract Reactive arthritis following upper respiratory tract infections is well known. The usual age group is young adults and management of the arthritis with anti-inflammatory medication is the mainstay of treatment. We present a case of reactive arthritis following tonsillitis, which was successfully treated by tonsillectomy. Keywords Reactive arthritis; tonsillitis; tonsillectomy. Case report A 35-year-old man was referred to the ENT Department from the rheumatologists with a history of recurrent sore throats for the last 5–6 years. He had been suffering from reactive large and small joint polyarthritis (especially his wrists, the small joints of his hands, knees and feet) but no spondyloarthropathy for the last 2 years following each sore throat. His arthritis improved following antibiotics for the sore throat. ENT examination revealed chronically inflamed tonsils. Investigations included throat swabs and various blood tests. The throat swabs were always negative; liver function tests were slightly deranged, erythroctye sedimentation rate (ESR) and C-reactive protein (CRP) levels were high on two occasions (11 mm, 16 mg/ml and 18 mm, 27 mg/ml, respectively) and anti-streptococcal antibody titre (ASOT) was positive on three separate occasions, rising each time (400 IU/ml, 800 IU/ml and 1000 IU/ml).
    [Show full text]
  • Streptococcal Pharyngitis (Strep Throat)
    Streptococcal Pharyngitis (Strep Throat) Maria Pitaro, MD ore throat is a very common reason for a visit to a health care provider. While the major treatable pathogen is group A beta hemolytic Streptococcus (GAS), Sthis organism is responsible for only 15-30% of sore throat cases in children and 5-10% of cases in adults. Other pathogens that cause sore throat are viruses (about 50%), other bacteria (including Group C beta hemolytic Streptococci and Neisseria gonorrhea), Chlamydia, and Mycoplasma. In this era of increasing microbiologic resistance to antibiotics, the public health goal of all clinicians should be to avoid the inappropriate use of antibiotics and to target treatment to patients most likely to have infection due to GAS. Clinical Manifestations and chest and in the folds of the skin and usually Pharyngitis due to GAS varies in severity. The spares the face, palms, and soles. Flushing of the Streptococcal Pharyngitis most common presentation is an acute illness with cheeks and pallor around the mouth is common, (Strep Throat). sore throat, fever (often >101°F/38.3°C), tonsillar and the tongue becomes swollen, red, and mottled Inflammation of the exudates (pus on the tonsils), and tender cervical (“strawberry tongue”). Both skin and tongue may oropharynx with adenopathy (swollen glands). Patients may also have peel during recovery. petechiae, or small headache, malaise, and anorexia. Additional physical Pharyngitis due to GAS is usually a self-limited red spots, on the soft palate. examination findings may include petechiae of the condition with symptoms resolving in 2-5 days even Photo courtesy soft palate and a red, swollen uvula.
    [Show full text]
  • VIRAL MENINGITIS (Nonbacterial Meningitis, Aseptic Meningitis)
    VIRAL MENINGITIS (Nonbacterial Meningitis, Aseptic Meningitis) What is VIRAL MENINGITIS? Viral meningitis is an infection of the meninges (a thin lining covering the brain and spinal cord) by any one of a number of different viruses. It is a fairly common disease. Almost all of the cases occur as single, isolated events. Outbreaks are rare. Anyone can get viral meningitis but it occurs most often in children. This type of meningitis should not be confused with the more serious form of Meningococcal meningitis which requires prompt public health intervention to identify and assure treatment of close contacts at risk for contracting the disease. What causes viral meningitis? Approximately half of the cases in the United States are due to common entero (intestinal) viruses. Occasionally, children will have viral meningitis associated with mumps or herpes virus infection. Most people who are infected with enteroviruses either have no symptoms or only get a fever, cold, rash or mouth sores. Only a small number of people with enterovirus infections go on to develop meningitis. What are the symptoms? The symptoms may include fever, headache, stiff neck and fatigue. Rash, sore throat and intestinal symptoms may also occur. Symptoms generally appear within one week of exposure. Symptoms common in infants include fever, irritability and poor feeding. How are the viruses that cause viral meningitis spread? Because a number of different viruses are capable of causing viral meningitis, the manner in which the virus is spread depends upon the type of virus involved. Most cases are due to enteroviruses that may be passed in the stool.
    [Show full text]
  • Pertinent Negatives and Positives for Common Chief Complaints New Scribes Sometimes Have Difficulty Determining What Is Relevant
    Pertinent Negatives and Positives for Common Chief Complaints New Scribes sometimes have difficulty determining what is relevant for the HPI versus ROS This can be helpful for them to do better charting Remember: If you are going to mark any of these symptoms positive, your ​ physician better know! Headache: fevers, chills, neck stiffness or pain, localized weakness, worst headache of life, thunderclap ​ headache, slurred speech, carbon monoxide exposure, sinus congestion/pain, paresthesias, diplopia (double vision), blurred vision, recent trauma, change in mentation. Chest Pain: shortness of breath, leg pain or swelling, palpitations, nausea, diaphoresis, arm pain, cough, ​ fevers. Also address personal history of diabetes, hypertension, high cholesterol, and blood clotting disorders, and family history of heart disease, recent travel, recent surgery, prior DVT/PE. Shortness of Breath: chest pain, palpitations, leg swelling, weight gain, cough (productive?), hemoptysis ​ (coughing up blood), wheezing, fevers, chills. Abdominal Pain: nausea/vomiting, diarrhea, hematochezia (red bloody stool), melanotic stools (black ​ tarry stool), urinary symptoms (dysuria, hematuria, frequency, urgency), flank pain, fevers, chills, chance of pregnancy, chest pain (epigastric). Back Pain: lower extremity weakness, bowel or bladder concerns (urinary incontinence), paresthesias, ​ trauma/injury to the back, family history of AAA (abdominal aortic aneurysm). Syncope: headache (secondary to head trauma), confusion, localized weakness, seizure activity, slurred ​ speech, diplopia, chest pain, palpitations, lightheadedness, DM (diabetes mellitus) history. Weakness: chest pain, palpitations, shortness of breath, nausea, emesis, syncope, localized weakness, ​ gait instability, facial droop, slurred speech, tremors, diplopia, seizure activity, dysphagia, Dizziness: chest pain, palpitations, shortness of breath, nausea, emesis, syncope, localized weakness, ​ gait instability, facial droop, slurred speech, tremors, diplopia, seizure activity, dysphagia.
    [Show full text]
  • Soothing Your Sore Throat
    Soothing Your Sore Throat Developed by the American Pharmacists Association. Improving medication use. Advancing patient care. Do you have a sore throat? Well, you’re certainly not alone. Sore throats are common for both adults and children. Know the Facts Some sore throats are caused by irritation. Smoking, loud talking or yelling, drinking alcohol, or breathing air that is too dry and too cold (or hot) can make your throat sore. If you have allergies, your throat often may be painful. But most sore throats are caused by an infection. The back of your throat is warm and wet. It’s the perfect spot to grow viruses and bacteria. Viruses cause about 85% to 90% of all infectious sore throats, while bacteria cause the remaining 10% to 15% of infec- tious sore throats. One type of bacterial infection in the throat is called “strep throat.” Your doctor can swab your throat to find out if you have strep and can prescribe medicine—an antibiotic—to treat it. How can you decide if your sore throat might be strep? Here are some clues. Caring for Your Sore Throat Is it most Could it How you feel? likely a be strep Although antibiotic medications work magic on strep throats, virus? throat? they do nothing for sore throats that come from viruses or gen- eral irritations. But there are things you can do to feel better. Your sore throat came on • Here are some tips: fast, and you had no other symptoms. • Drink more. Water, fruit juices, and caffeine-free liquids are best.
    [Show full text]
  • Arthritis and Arthralgia in Infection with Mycoplasma Pneumoniae
    Thorax: first published as 10.1136/thx.25.6.748 on 1 November 1970. Downloaded from Tlhorax (1970), 25, 748. Arthritis and arthralgia in infection with Mycoplasma pneumoniae M. C. JONES Brompton Hospital, London, S.W.3 Joint involvement following infection with Mycoplasma pneumoniae is extreinely uncommon. Four patients are presented in whom joint symptoms occurred, giving rise to diagnostic difficulties in three. It is suggested that these manifestations were due to M. pneumoniae. Mycoplasma pneumoniae, first identified as the were painful on movement but otherwise appeared cause of Eaton agent pneumonia in 1962 by normal. The chest was clear. Chanock, Hayflick, and Barile, remains the only Investigations Haemoglobin 12-6 g./100 ml., WBC species of mycoplasma proven to be a human 6,200/cu. mm., ESR 37 mm. (Westergren). Sputum pathogen (Griffin and Crawford, 1969). It attacks sterile on culture; blood cultures negative; antistrepto- mainly the respiratory system but is also a recog- lysin 0 (ASO) titre less than 200 units/ml. A chest nized cause of acute haemolytic anaemia (Peterson, radiograph showed consolidation involving the anterior Ham, and Finland, 1943) and erythema multi- segment of the left upper lobe. Initial complement forme (Gordon and Lyell, 1969). Involvement of fixation test (CFT) to M. pneumoniae showed a titre the ear, heart and central nervous system has also of less than 1 in 5 together with a cold agglutinincopyright. been described (Lambert, 1 968a), and recently titre (CAT) of I in 16 at 4° C. involvement Treatment with ampicillin was ineffective, the tem- three cases with joint have been perature remaining at 102' F.
    [Show full text]
  • TMJ Screening Consultation Symptoms
    TMJ Screening Consultation OFFICE USE Version: TMDQV1 TMJ Screening Consultation Patient ID:_____ NAME: CURRENT DATE: ____/____/_______ ____________________ __ ____________________ DATE OF BIRTH:___/___/______ MALE FEMALE Referring Physician: Contact ID: WHAT ARE THE CHIEF COMPLAINTS FOR WHICH YOU ARE SEEKING TREATMENT? Please number your complaints with #1 being the most severe, #2 the next most severe, etc. Number Number #1 = the most severe symptom #1 = the most severe symptom Jaw pain Morning head pain Jaw clicking Ringing in the ears Jaw locking Dizziness Limited mouth opening Nocturnal teeth grinding Facial pain Frequent Heavy Snoring Neck pain Pain when chewing Headaches Migraines Other: Write In Symptoms HEAD PAIN Jaw pain - at rest Unsupported Control JAW SYMPTOMS Unsupported Control Unsupported Control Jaw popping Unsupported Control Jaw clicking Unsupported Control Jaw locks closed JAW PAIN Jaw locks open Jaw pain - on opening Teeth grinding Jaw pain - while chewing MOUTH AND NOSE RELATED CONDITION Patient Signature: Date: TMJ Screening Consultation Symptoms MOUTH AND NOSE RELATED CONDITION THROAT, NECK & BACK RELATED CONDITIONS Burning tongue CONTINUED Frequent biting of cheek Back pain - lower Frequent snoring Back pain - middle Broken teeth Back pain - upper Teeth clenching Chronic sore throat Dry mouth Constant feeling of a foreign object in throat EAR RELATED CONDITIONS Difficulty in swallowing Buzzing in the ears Limited movement of neck Tinnitus (ringing in the ears) Neck pain Ear pain Numbness in the hands or fingers
    [Show full text]
  • Just a Sore Throat?
    CLINICAL Just a sore throat? Kam Cheong Wong distress apart from a moderate sore throat. Keywords: diagnosis, differential; electrocardiography; case reports; heart diseases He is afebrile. His heart rate is 66 bpm, regular and his blood pressure is 122/80 mmHg. His tonsils and uvula are neither inflamed nor swollen. He has no cervical Case study lymphadenopathy. His lungs are clear on auscultation and his heart sounds are dual A man, 43 years of age, presents to his with no murmur. His electrocardiogram is general practitioner with a 6 day history of shown in Figure 1. sore throat. There are no other symptoms of an upper respiratory tract infection. In Question 1 passing, the patient mentions that 6 days ago he experienced an episode of exertional Describe any clinically important findings shown in chest pain. On further questioning it is the electrocardiogram (ECG) in Figure 1. found the chest pain was central with no radiation, it lasted 30 minutes, resolved Question 2 spontaneously and was associated with What is the likely pathology in this case? nausea. He did not seek medical assessment at the time and has no cardiac history. Question 3 He takes no regular medication and has How many patients with this problem present no allergies. He is an exsmoker with a 15 atypically? pack-year history (he quit 7 years ago) but has no other known cardiac risk factors. He Question 4 does not drink alcohol or take illicit drugs. On examination, he appears well built What are some of the atypical presentations of with a body mass index of 27.
    [Show full text]