Spatially visualized single-cell pathology of highly multiplexed protein profiles in health and disease.

Deep molecular profiling of biological tissues is an indicator of health and disease. We used imaging mass cytometry (IMC) to acquire spatially resolved 20-plex protein data in tissue sections from normal and chronic tonsillitis cases. We present SpatialViz, a suite of algorithms to explore spatial relationships in multiplexed tissue images by visualizing and quantifying single-cell granularity and anatomical complexity in diverse multiplexed tissue imaging data. Single-cell and spatial maps confirmed that CD68+ cells were correlated with the enhanced Granzyme B expression and CD3+ cells exhibited enrichment of CD4+ phenotype in chronic tonsillitis. SpatialViz revealed morphological distributions of cellular organizations in distinct anatomical areas, spatially resolved single-cell associations across anatomical categories, and distance maps between the markers. Spatial topographic maps showed the unique organization of different tissue layers. The spatial reference framework generated network-based comparisons of multiplex data from healthy and diseased tonsils. SpatialViz is broadly applicable to multiplexed tissue biology.

Geographical differences in tonsillar carriage rates of Fusobacterium necrophorum - A cross-sectional study in Sweden and Zambia.

While Fusobacterium necrophorum historically has been considered normal tonsillar flora, recent studies from Europe and the US have suggested that carriage occur transiently in adolescence and young adulthood. However, no studies originating from Africa exist. In this cross-sectional study of tonsillar carriage of F. necrophorum, we aimed to investigate geographical differences in tonsillar carriage rates of F. necrophorum in healthy participants aged 15-25 years in Sweden and Zambia and further investigate the age distribution of tonsillar carriage in Zambia. Specimens were obtained by tonsillar swabs and analyzed with real-time PCR for F. necrophorum. In participants aged 15-25 years, tonsillar carriage was more common in Sweden 21/100 (21%) than in Zambia 6/192 (3%), p < 0.001. In Zambian participants aged above 25 years tonsillar carriage was rare 1/76 (1%). In conclusion, the high rate of tonsillar carriage in participants aged 15-25 years in Sweden has implications on the interpretation of tonsillar findings in patients with pharyngotonsillitis. Interestingly, a geographical difference was found with tonsillar carriage rarely identified in Zambia.

Weight change before and after adenotonsillectomy in children: An analysis based upon pre-surgery body mass category.

OBJECTIVES: To determine the standardised body mass index (BMIz) trajectory before and after adenotonsillectomy/tonsillectomy between children in different weight classifications in a larger sample than has been studied previously, and to identify which patient factors would explain the difference in these outcomes. DESIGN: We used a retrospective chart review and leveraged data of weight status pre- and post-adenotonsillectomy/tonsillectomy from a cohort of paediatric patients seen between May 2004 and April 2017. SETTING: Data were collected from an electronic medical record at a single Midwest paediatric health system. PARTICIPANTS: The study population included a convenience sample of 1,751 paediatric patients who underwent adenotonsillectomy or tonsillectomy and had at least two height and weight measurements recorded on the same date both before and after surgery. MAIN OUTCOME MEASURES: Change in BMIz trajectories before and after surgery. RESULTS: Of 1751 paediatric patients (ages 3-11) underwent adenotonsillectomy/tonsillectomy procedures. Age at time of surgery and gender were not significant predictors. Children in different weight classifications demonstrated differences in BMIz trajectory after surgery. Children with overweight/obesity experience a decrease in BMIz, whereas children with underweight or normal weight experience an increase in BMIz. CONCLUSIONS: Improvement in weight status is seen after surgery: increased BMI for those underweight and decreased BMI for those with overweight/obesity. We advocate for behavioural strategies as a first-line treatment in children with underweight or overweight/obesity, and results suggest that coordinating these efforts alongside adenotonsillectomy/tonsillectomy when indicated for medical reasons may be warranted. However, further research is needed to confirm these findings due to the observational nature of this study.

The effect of bleeding on children's haemodynamic indices: an analysis of previous post-tonsillectomy bleeding cases.

OBJECTIVE: Post-surgical bleeding after tonsillectomy occurs in 2-7 per cent of cases. This study examined whether heart rate and haematocrit changes are associated with the amount of bleeding. METHOD: In this retrospective analytical study, data were collected from the medical charts of patients admitted with post-surgical bleeding. RESULTS: Over the course of 10 years, there were 218 cases of post-operative bleeding in children aged under 18 years. There was a significant increase in heart rate after the bleeding had started, and a significant decrease in both haemoglobin and haematocrit levels (p < 0.05). There was no significant correlation between the differences in haemoglobin and haematocrit and changes in heart rate. CONCLUSION: No correlation was found between the differences in haemoglobin and haematocrit levels and the changes in heart rate from before the surgery to after the bleeding had started. The monitoring of paediatric patients' heart rate after tonsillectomy surgery solely for the purpose of predicting acute blood loss is therefore discouraged.

Assessment of Tonsil Volume With Transcervical Ultrasonography in Both Children and Adults.

OBJECTIVES: To investigate the success of ultrasonography (USG) in the objective measurement of palatin tonsil volume in both children and adults and to compare those results with clinical findings. METHODS: Eighty-five patients, who were scheduled to undergo tonsillectomy with the indications of recurrent tonsillitis and obstructive sleep apnea syndrome, were included in the study. The tonsil grades of the patients were recorded according to the Friedman tonsil grading. The tonsil size and volume were measured with transcervical USG. After tonsillectomy, the volumes of the tonsils were calculated by the displacement method. The correlation between the obtained data was evaluated. In all analyses, P < .05 was accepted as a statistical level of significance. RESULTS: Fifty children and 35 adults were included in the study. In children, the mean actual volume ± SD of 100 tonsils was measured as 3.5 ± 1.45 mL, and the USG volume was 3.67 ± 1.59 mL; a high correlation was found between both methods (r = 0.842; P < .05). In adults, the mean actual volume of 70 tonsils was measured as 5.15 ± 2.25 mL, and the USG volume was 5.71 ± 2.98 mL; a moderate correlation was found between the methods (r = 0.589; P < .05). In children, a moderate correlation was found between the Friedman grading and the USG (r = 0.532; P < .05), and actual (r = 0.549; P < .05) tonsil volumes. In adults, a low correlation was found between the Friedman grading and the USG (r = 0.363; P < .05) and actual (r = 0.384; P < .05) tonsil volumes. CONCLUSIONS: Ultrasonography is a useful, accessible, and noninvasive imaging method for objective measurement of tonsil volume in adults and children.

Sore Throat Assessment Tool-10 for patients with acute pharyngo-tonsillitis.

INTRODUCTION: The aim of this study was to develop and validate a patient-based questionnaire for the assessment of sore throat symptoms. The questionnaire can be used to quantify the effects of different treatments in patients with acute pharyngo-tonsillitis (APT). METHODS: A 13-item questionnaire was constructed using a five-point Likert scale. Adult patients with APT consulting one of the participating general practitioners answered the survey. Healthy students served as controls. RESULTS: A total of 77 sore throat patients and 103 healthy controls were included. Ten items had moderate to high (> 0.25) inter-item correlations and high mean scores (> 3.0) among patients and were included in the final tool, the Sore Throat Assessment Tool (STAT)-10. The patients' mean STAT-10 score was 36.5 (95% confidence interval (CI): 34.8-38.2) at the time of inclusion compared with 10.4 (95% CI: 10.2-10.6) for controls (p < 0.001). Cronbach´s alpha coefficient for the questionnaire was 0.87. The standard error of measurement was 2.99, the intraclass correlation 0.92 and the Spearman correlation test-retest reliability 0.87. The STAT-10 scores increased with Centor scores (p = 0.018). CONCLUSIONS: The reliability and validity of the STAT-10 were very high. The STAT-10 is the first validated tool for measuring the intensity and duration of symptoms from the perspective of sore throat patients and for quantifying and comparing different treatment modalities in APT patients. FUNDING: This study received funding from The Lundbeck Foundation (Grant #R185-2014-2482), Fonden for Lægevidenskabens Fremme, and Hans Skouby´s Fond. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (2015-57-0002).

Antibiotic prescribing for tonsillopharyngitis in a general practice setting: Can the use of Modified Centor Criteria reduce antibiotic prescribing?

BACKGROUND AND OBJECTIVES: Empirical treatment of sore throat with antibiotics has historically been aimed at preventing complications of group A ß-haemolytic streptococcus infection. Threats posed by multi-resistant organisms mean that antimicrobial stewardship is important. The aim of this study was to investigate antibiotic prescribing for tonsillopharyngitis in relation to components of the Modified Centor Criteria (MCC) documented in consultation records. METHOD: Analysis of two rural Australian general practices was performed using clinic management software. A keyword search for 'tonsillopharyngitis/tonsillitis/pharyngitis' identified consultations. RESULTS: Antibiotic prescribing was frequent and congruent with existing studies; however, documented evidence of history and examination covering MCC components was associated with lower antibiotic prescribing (77.7% versus 85.5%, P <0.001; odds ratio: 2.4; 95% confidence interval: 1.8, 3.3, P <0.0001). DISCUSSION: We believe this is the first study that assesses the correlation between documentation and prescribing. Adopting and documenting MCC may improve appropriate prescription and patient safety and significantly reduce antibiotic prescription rates.

Glutathione S-transferase enzyme activity and protein expression in patients with recurrent tonsillitis and idiopathic tonsillar hypertrophy.

OBJECTIVES: The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases. MATERIALS AND METHODS: Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured. RESULTS: The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47). CONCLUSION: Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.

[The comparative evaluation of the effectiveness of the treatment of the patients presenting with the sub-compensated form of chronic tonsillitis making use of the antiseptic herbal medicinal product in the combination with the standard conservative therapy: the results of the open randomized study]. / Sravnitel'naia otsenka éffektivnosti lecheniia patsientov s subkompensirovannoi formoi khronicheskogo tonzillita antisepticheskim sredstvom rastitel'nogo proiskhozhdeniia v komplekse so standartnoi konservativnoi terapiei: rezul'taty otkrytogo randomizirovannogo issledovaniia.

The objective of the present study was the comparison of the effectiveness of the application of tonsilgon-N in the combination with the physical methods for sanitization of the palatine tonsil lagunes with that of the standard conservative treatment. A total of 60 patients having the confirmed diagnosis of sub-compensated form of chronic tonsillitis were recruited to participate in the study. All the patients were divided into two groups. Group 1 was comprised of 30 patients to whom tonsilgon-N was prescribed for the oral administration (25 droplets thrice daily for 30 days) in the combination with lagune cleansing with the use of the Tonsillor apparatus during 30 days (a total of 10 procedures). Group 2 consisted of 30 patients to whom only 10 sessions of rinsing the palatine tonsil lagunes were prescribed. The inoculums taken from the tonsils of the patients of group 1 contained no Klebsiella oxytoca, Escherichia coli, Enterobacter cloacae, and Moraxella catarhalis on the 15th day after the initiation of the treatment whereas the presence of the persisting pathogenic bacterial species was documented in 23.3% of the patients of this group. 10% of the patients in group 2 were found to retain Klebsiella oxytoca, Enterobacter cloacae, and Moraxella catarhalis in their tonsils whereas the rate of isolation of the pathogenic biotope amounted to 36,6%.

[The specific pathogenetic features of the development of chronic tonsillar pathology]. / Patogeneticheskie osobennosti formirovaniia khronicheskoi tonzilliarnoi patologii.

The authors discuss the mechanisms underlying the development of chronic tonsillar pathology confirmed by the methods of histological, autoradiographic, and bacteriological diagnostics. The new aspects of vital activity of microorganisms in the parenchymal tissue of the palatine tonsils are highlighted that account for the low effectiveness of the conservative therapy of chronic tonsillitis and give evidence of the necessity of the surgical treatment of this condition.

Resolution of recurrent tonsillitis in a non-smoker who became a vaper. A case study and new hypothesis.

BACKGROUND: Evidence concerning the impact of vaping on respiratory infections remains contradictory. Cell and animal studies suggested that vaping may increase vulnerability to respiratory infections, but human data do not confirm this concern. CASE PRESENTATION: We present a case of a never-smoker who became a vaper and after a few months of e-cigarette use experienced a complete resolution of chronic tonsillitis and a marked improvement in tonsilloliths. CONCLUSIONS: As this is a never-smoker, the improvements cannot be attributed to smoking cessation. One possible explanation is that the improvement was due to antimicrobial properties of propylene glycol. The hypothesis could be tested by a trial of zero-nicotine e-cigarettes in patients with recurrent bacterial throat infection.

A comparison of tonsillar surface swabbing, fine-needle aspiration core sampling, and dissected tonsillar core biopsy culture in children with recurrent tonsillitis.

In recurrent tonsillitis, the pathogenic bacteria are harbored in the tonsil core, and therefore cultures of superficial swab samples are not particularly accurate in identifying specific types of core bacteria. On the other hand, the results of fine-needle aspiration (FNA) cultures of core samples have been closely correlated with the findings of core cultures in excised tonsils, and both methods are far superior to surface swabbing. We conducted a prospective study to compare the accuracy of culture findings from tonsillar tissue obtained by surface swabbing, FNA sampling of the tonsil core in situ, and core sampling of the excised tonsil in children with recurrent tonsillitis. Our patient population was made up of 54 children-22 boys and 32 girls, aged 4 to 14 years (mean: 10.7)-who were undergoing elective tonsillectomy during a 1-year period. On the day of surgery, a surface swab, core FNA sample, and dissected core sample were obtained from each patient and sent for culture. Culture showed that the three methods were in agreement in 34 cases (63.0%). In 9 cases (16.7%) the surface swab culture grew different pathogens from those of the two core cultures, and in 3 other cases (5.6%) the surface swab culture was negative while the two core cultures were positive for the same pathogens. In all, the results of core FNA culture and dissected core culture were in agreement in 46 cases (85.2%); in only 4 cases (7.4%) did the core FNA culture fail to accurately identify the causative pathogens. Overall, the sensitivity and specificity of core FNA sampling were 100 and 50% respectively, compared with 82.9 and 30.8% for the superficial tonsillar swab. We conclude that routine culture of surface swab specimens in patients with chronic or recurrent tonsillitis is neither reliable nor valid. We recommend that core FNA sampling be considered the diagnostic method of choice since it can be done on an outpatient basis, it would reliably allow for culture-directed antibiotic therapy, and it could obviate the need for elective tonsillectomy in many cases. However, its feasibility as an office procedure in children remains to be determined.

Hyperplasia and the degree and activity of inflammation in chronic recurrent tonsillitis: a histopathological study.

Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p < 0.002), but did not reach statistical significance in the cranial and caudal sections (p = 0.107 and p = 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.

A Retrospective Cohort Study of Glossopharyngeal Nerve Taste in Children with Recurrent Acute Tonsillitis.

Objective To compare glossopharyngeal taste between healthy children and those with recurrent acute tonsillitis. Study Design Retrospective cohort study. Setting Pediatric clinics in a tertiary care medical center and satellite location. Subjects and Methods Smell and taste testing was administered to 80 well children and 64 children with recurrent acute tonsillitis (age range, 6-17 years). Smell testing was performed with the NIH Toolbox Odor Identification Test, with scores based on national averages for age and sex. Validated Taste Strips were placed on the midline of the tongue at the circumvallate papillae in random tastant order and in increasing concentrations to test sweet, salty, sour, and bitter. Ordinal logistic regression was used for multivariate analysis. Results The healthy and tonsillitis groups were similar, with mean ages of 11.3 and 10.8 years ( P = .34), respectively. The tonsillitis group had fewer boys (n = 18 vs 43, P = .002), higher mean body mass index (BMI) percentile (n = 72.2 vs 59.8, P = .01), and more subjects with public or no insurance (n = 24 vs 13, P = .004). Univariate analysis revealed no statistically significant differences in rate of normal overall taste (67.2% vs 60%, P = .39) and in sweet (79.7% vs 82.5%, P = .67), salty (85.9% vs 82.8%, P = .82), sour (64.1% vs 70%, P = .48), and bitter (90.6% vs 86.3%, P = .45). In multivariate analysis, smell ability, sex, BMI percentile, parent BMI, and insurance type did not affect overall taste or sweet, salty, sour, or bitter alone. Conclusion Despite controlling for potential intrinsic (sex, smell, BMI) and extrinsic (parent BMI, insurance type) confounders, there was no statistically significant difference in taste among children with recurrent acute tonsillitis as compared with healthy children.

[The rationale for the conservative treatment of chronic tonsillitis in the patients of the older age groups by the «soft¼ therapy methods]. / Obosnovanie konservativnogo lecheniya khronicheskogo tonzillita u lits starshikh vozrastnykh grupp metodami «myagkoi¼ terapii.

The objective of the present study was to develop an efficient system for the treatment of chronic tonsillitis in the patients of advanced and middle age based on the application of polyvalent bacteriophages in the combination with the physical factors and herbal medicines. The study involved 65 patients (39 women and 276 men) at the age from 65 to 73 years presenting with chronic tonsillitis. The treatment included washing the tonsillar lacunae with herbal infusion consisting of a tetterwort (Choledoniummajus) extract. This procedure was followed by phonophoresiswith the use of the combined polyvalent bacteriophage preparation in the non-liquid formulation during 7-10 days. The effectiveness of such treatment was evaluated based on the results of clinical examination and the analysis of the subjective feelings reported by the patients. In addition, the rosette-forming function of lymphocytes was estimated and palatine tonsil microbiotas in different patients were compared. The effectiveness of therapy was estimated at 89.2%. The positive outcome of the proposed treatment was documented in 78.6% of the cases within 6 months after the onset of therapy. It is concluded that the treatment of chronic tonsillitis with bacteriophagal preparations and herbal infusions in combination with thetraditionallow-frequency ultrasound treatment is highly efficacious (favourable outcome in 78.6% of the patients of middle and advanced age) without the use of antibiotic medications.

[The use of the enzymes for the enhancement of the effectiveness of antimicrobial photodynamic treatment of the patients presenting with chronic tonsillitis].

The objective of the present study was to enhance the effectiveness of the treatment of the patients presenting with various forms of chronic tonsillitis (CT) by means of antimicrobial photodynamic therapy (APDT). The study included 48 patients at the age from 18 to 55 years divided into three groups; all of them suffered from various forms of CT. Group 1 was comprised of 12 patients given a course of traditional conservative therapy. Group 2 consisted of 17 patients treated by APDT while group 3 included 19 patients in whom a course of antimicrobial photodynamic therapy was preceded by the treatment of the mucous membrane of the palatine amygdalae with a lidase solution. The microbiological testing was performed on days 5, 12, and 24 after APDT and also within the next 6-9 months. The results of the microbiological and clinical studies give evidence of the possibility to improve the effectiveness of the treatment of chronic tonsillitis by means of antimicrobial photodynamic therapy with the use of the preventive treatment of palatine tonsillar mucosa with a lidase solution. Such treatment was found to facilitate degradation of theintercellular matrix of the biofilm and reduced its resistance to the photodynamic impact.

Changes in body composition and growth pattern after adenotonsillectomy in prepubertal children.

OBJECTIVE: Adenotonsillar hypertrophy and chronic tonsillitis are associated with growth interruption during childhood, while adenotonsillectomy has been associated with growth improvement and increased body mass index (BMI). However, no reported study has investigated the effect of adenotonsillectomy on the proportion of body muscle and fat mass. The aim of this prospective study was to evaluate the effect of adenoidectomy and adenotonsillectomy on body muscle and fat composition in prepubertal children. METHODS: Thirty prepubertal children (22 boys, 8 girls; 3-9 years of age) were followed up for 6 months after adenoidectomy or adenotonsillectomy. Twenty-eight age-matched healthy children (12 boys, 16 girls) were followed for the same period, as controls. Data on dietary habits and physical activity were obtained from parent-completed questionnaires at baseline and 6 months. Height and weight z-scores, the amount and percentage of body fat and muscle mass, BMI z-scores, relative BMI and basal metabolic rate were evaluated before and 6 months after surgery with bioelectrical impedance analysis. RESULTS: After 6 months, body muscle mass and basal metabolic rate scores were significantly higher than at baseline in both groups (P<0.05). The rate of increase was not different between the groups. In the study group, the relative BMI scores improved significantly (P<0.05). Increases in body fat mass, body fat percentage, height z-scores, weight z-scores and BMI z-scores were not significantly different between the groups at 6 months (P>0.05). The number of overweight and obese children did not change significantly in either group (P<0.05). CONCLUSIONS: Adenotonsillectomy led to improvement in relative BMI and promoted healthy weight gain without increased body fat percentage in prepubertal children.

Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management.

More than 120,000 patients are treated annually in Germany to resolve repeated episodes of acute tonsillitis. Therapy is aiming at symptom regression, avoidance of complications, reduction in the number of disease-related absences in school or at work, increased cost-effectiveness and improved quality of life. The purpose of this part of the guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through different conservative treatment options in order to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical management in terms of intracapsular as well as extracapsular tonsillectomy (i.e. tonsillotomy) is the subject of part II of this guideline. To estimate the probability of tonsillitis caused by ß-hemolytic streptococci, a diagnostic scoring system according to Centor or McIsaac is suggested. If therapy is considered, a positive score of ≥3 should lead to pharyngeal swab or rapid test or culture in order to identify ß-hemolytic streptococci. Routinely performed blood tests for acute tonsillitis are not indicated. After acute streptococcal tonsillitis, there is no need to repeat a pharyngeal swab or any other routine blood tests, urine examinations or cardiological diagnostics such as ECG. The determination of the antistreptolysin O-titer (ASLO titer) and other antistreptococcal antibody titers do not have any value in relation to acute tonsillitis with or without pharyngitis and should not be performed. First-line therapy of ß-hemolytic streptococci consists of oral penicillin. Instead of phenoxymethylpenicillin-potassium (penicillin V potassium), also phenoxymethlpenicillin-benzathine with a clearly longer half-life can be used. Oral intake for 7 days of one of both the drugs is recommended. Alternative treatment with oral cephalosporins (e.g. cefadroxil, cefalexin) is indicated only in cases of penicillin failure, frequent recurrences, and whenever a more reliable eradication of ß-hemolytic streptococci is desirable. In cases of allergy or incompatibility of penicillin, cephalosporins or macrolides (e.g. Erythromycin-estolate) are valuable alternatives.

Does the quality of life impact of tonsillitis correlate with SIGN guideline compliance? An assessment of range and normality.

OBJECTIVES: To assess the scores of those who are eligible to be listed for tonsillectomy through compliance with the SIGN guidelines for any trends or range. DESIGN: A prospective study of all patients (aged 16 or above) listed for elective tonsillectomy from a nurse led tonsil clinic. Patients were given a TOI-14 questionnaire to complete after they had been added to the waiting list for surgery, but before undergoing tonsillectomy. Scores were assessed using SPSS. SETTING: Outpatient clinic. PARTICIPANTS: Patients aged over 16 listed for Tonsillectomy via SIGN Guideline 117. MAIN OUTCOME MEASURE: Scores from TOI-14, completed pre-operatively. RESULTS: 155 patients were listed from the nurse led clinic from October 2012 to August 2014; 5 questionnaires were excluded for being incomplete. The score range was 55 (15-70), with a calculated mean score of 45.62 and standard deviation of 9.701. Over 95% of results were within 2 standard deviations of the mean. A calculated negative skew also confirms that most patients who have clinical indications for tonsillectomy compliant with the SIGN guidelines show a higher score on the TOI-14. CONCLUSION: This analysis indicates a trend of pre-intervention scores on the TOI-14 questionnaire for those patients who have a SIGN guideline compliant clinical indication for a tonsillectomy. We therefore propose that this suggests correlation between 'clinically strong' indication for tonsillitis and patient perceived Quality of Life impact.

Recomendaciones para el manejo de la faringoamigdalitis aguda del adulto / Recommendations for management of acute pharyngitis in adults

La faringoamigdalitis aguda (FAA) en el adulto es una de las enfermedades infecciosas más comunes en la consulta del médico de familia. La etiología más frecuente es viral. Dentro de la etiología bacteriana, el principal agente responsable es Streptococcus pyogenes o estreptococo β-hemolítico del grupo A (EBHGA), causante del 5-30% de los casos. En el manejo diagnóstico, las escalas de valoración clínica para predecir la posible etiología bacteriana, son una buena ayuda para seleccionar a qué pacientes se deben practicar las técnicas de detección rápida de antígeno estreptocócico. Es conocido que, en general, sin estas técnicas se tiende al sobrediagnóstico de FAA estreptocócica, con la consiguiente prescripción innecesaria de antibióticos, muchas veces de amplio espectro. Así, con el manejo de las escalas y la técnica de diagnóstico rápido, elaboramos los algoritmos de manejo de la FAA. Los objetivos del tratamiento son acelerar la resolución de los síntomas, reducir el tiempo de contagio y prevenir las complicaciones supurativas locales y no supurativas. Los antibióticos de elección para el tratamiento de la FAA estreptocócica son penicilina y amoxicilina. La asociación de amoxicilina y clavulánico no está indicada en el tratamiento inicial en la infección aguda. Los macrólidos tampoco son un tratamiento de primera elección; su uso debe reservarse para pacientes con alergia a la penicilina. Es importante en nuestro país adecuar tanto el diagnóstico de la FAA bacteriana y la prescripción de antibióticos a la evidencia científica disponible. La implantación de protocolos de actuación en las farmacias comunitarias puede ser de utilidad para identificar y cribar los casos que no requieran tratamiento antibiótico (AU)

Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners’ consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%-30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy (AU)