This review examines the clinical diagnosis of acute purulent sinusitis in primary care settings based on 4 studies. The review found that purulent nasal secretions as a symptom or sign, pain in the teeth, and a two-phase illness history were associated with acute purulent sinusitis. An elevated erythrocyte sedimentation rate and C-reactive protein level also contributed to the diagnosis when evaluated in the studies.
Idiopathic Subglottic and Tracheal Stenosis - A Survey of the Patient ExperienceCatherine Anderson
This document describes a survey of 160 patients with either acquired subglottic stenosis (AS, n=28) or idiopathic subglottic and tracheal stenosis (ISTS, n=132). The key findings were:
1) ISTS patients experienced longer delays in diagnosis compared to AS patients, with 58% of ISTS patients not receiving a diagnosis for over 18 months.
2) The most common treatments for both groups were balloon dilation and laser dilation, while tracheal resection was performed in 36% of both groups.
3) Patient satisfaction was significantly higher after tracheal resection (76% satisfaction) compared to other treatment modalities (39% satisfaction).
Ochsner Sherren regimen Vs Appendectomy in Adults with Acute Appendicitis.QUESTJOURNAL
ABSTRACT: The main Objective of this study is to examine whether Ochsner Sherren regimen in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 480 patients who underwent an appendectomy for acute appendicitis between November2012 and October 2015 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12>71 hours group compared with total interval<12 hours. Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays . Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant , guarding , rebound , and CT scan findings of peritoneal fluid , fecalith , dilation of the appendix , and perforation . Increased length of hospital stay and antibiotic treatment as well as postoperative complications also correlated with progressive pathology. In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity
REG IPF/ILD Working Group Meeting 25/09/15Zoe Mitchell
The document outlines plans for two diagnostic studies in interstitial lung disease (ILD). [1] Phase I will characterize ILD diagnostic practices globally, especially in underrepresented regions, to inform the design of [2] Phase II which will evaluate agreement and accuracy of ILD multidisciplinary team diagnoses across sites. The studies aim to establish best practice recommendations for optimizing the pathway to accurate ILD diagnosis.
This meta-analysis examined whether the long-acting anticholinergic drug tiotropium reduces exacerbations and hospitalizations in COPD patients compared to placebo, ipratropium, and salmeterol. The analysis found that tiotropium significantly reduced exacerbations compared to placebo and ipratropium, and reduced exacerbations compared to salmeterol. It also found a reduction in hospitalizations compared to placebo and ipratropium. However, the results should be interpreted cautiously given variability across the included trials, the possibility of inappropriate data pooling, and the generally poor quality of the trials.
An audit was conducted of ward nurses' knowledge of sepsis definitions and management guidelines. A questionnaire was administered to 73 ward nurses which assessed their understanding of the signs and symptoms of sepsis, as well as case studies depicting potential sepsis patients. The results showed that some nurses had a poor understanding of the standard definitions of sepsis, severe sepsis/septic shock and recommended initial management. In response, targeted educational initiatives were implemented to improve nurses' knowledge of sepsis definitions and management guidelines put forth by the Surviving Sepsis Campaign. The study concluded that focused education for ward nurses is needed if the goal of reducing sepsis mortality by 25% is to be achieved.
Chronic Rhinosinusitis and Its Impact on PregnancyAI Publications
Nasal congestion is the most common symptom of pregnancy rhinitis, which disappears once the baby is born. Pregnant patients with rhinitis report symptoms in 18 to 30 percent of cases. As a result, pregnant rhinitis may have a negative impact on the pregnancy and may result in obstructive sleep apnea, which may have an adverse effect on the outcome of the pregnancy. Previous studies on the prevalence of pregnant rhinitis at various stages of pregnancy have come up with conflicting results. The purpose of this study was to investigate the prevalence of rhinosinusitis during various stages of pregnancy. At a private hospital in the Kurdistan area of Iraq, a cross-sectional observation study of patients in the second and third trimesters of pregnancy was undertaken using the 22-item Sino-Nasal Outcome Test (SNOT-22). The participants were women in their second and third trimesters of pregnancy. The study comprised 76 patients who were considered to be at low risk of becoming pregnant. Thirty-two patients were in their second trimester of pregnancy and 44 patients were in their third trimester of pregnancy when the study was conducted. When comparing the third trimester to the second trimester, the average item scores for the complete questionnaire were considerably higher (P value =0.041), indicating a more severe deterioration of cognitive function. In both the second and third trimesters, a comparison between women with and without preexisting allergic rhinitis reveals that the allergic group has significantly higher SNOT-22 scores (P value =0.007). In individuals with rhinosinusitis, the risk of miscarriage was reduced in the third trimester (P value =0.011). Rhinosinusitis is less common in the third trimester of pregnancy when compared to the second trimester, as well as when compared to patients who do not have rhinosinusitis in the first place.
This document summarizes a study analyzing data from 14 countries that participated in the Burden of Obstructive Lung Disease (BOLD) study to describe characteristics of COPD in never smokers and identify possible risk factors. The study found that among 4,291 never smokers, 6.6% had mild COPD and 5.6% had moderate to severe COPD. Never smokers comprised 23.3% of those with moderate to severe COPD. Predictors of COPD in never smokers included older age, lower education levels, occupational exposures, childhood respiratory diseases, and abnormal BMI. The study confirms that never smokers represent a substantial proportion of COPD cases and suggests additional risk factors beyond smoking.
Idiopathic Subglottic and Tracheal Stenosis - A Survey of the Patient ExperienceCatherine Anderson
This document describes a survey of 160 patients with either acquired subglottic stenosis (AS, n=28) or idiopathic subglottic and tracheal stenosis (ISTS, n=132). The key findings were:
1) ISTS patients experienced longer delays in diagnosis compared to AS patients, with 58% of ISTS patients not receiving a diagnosis for over 18 months.
2) The most common treatments for both groups were balloon dilation and laser dilation, while tracheal resection was performed in 36% of both groups.
3) Patient satisfaction was significantly higher after tracheal resection (76% satisfaction) compared to other treatment modalities (39% satisfaction).
Ochsner Sherren regimen Vs Appendectomy in Adults with Acute Appendicitis.QUESTJOURNAL
ABSTRACT: The main Objective of this study is to examine whether Ochsner Sherren regimen in adult patients with acute appendicitis is safe by correlating the interval from onset of symptoms to operation (total interval) with the degree of pathology and incidence of postoperative complications. Prompt appendectomy has long been the standard of care for acute appendicitis because of the risk of progression to advanced pathology. This time-honored practice has been recently challenged by studies in pediatric patients, which suggested that acute appendicitis can be managed in an elective manner once antibiotic therapy is initiated. No such data are available in adult patients with acute appendicitis. A retrospective review of 480 patients who underwent an appendectomy for acute appendicitis between November2012 and October 2015 was conducted. The following parameters were monitored and correlated: demographics, time from onset of symptoms to arrival at the emergency room (patient interval) and from arrival to the emergency room to the operating room (hospital interval), physical, computed tomography (CT scan) and pathologic findings, complications, length of stay, and length of antibiotic treatment. Pathologic state was graded 1 (G1) for acute appendicitis, 2 (G2) for gangrenous acute appendicitis, 3 (G3) for perforation or phlegmon, and 4 (G4) for a periappendicular abscess. The risk of advanced pathology, defined as a higher pathology grade, increased with the total interval. When this interval was <12>71 hours group compared with total interval<12 hours. Although both prolonged patient and hospital intervals were associated with advanced pathology, prehospital delays were more profoundly related to worsening pathology compared with in-hospital delays . Advanced pathology was associated with tenderness to palpation beyond the right lower quadrant , guarding , rebound , and CT scan findings of peritoneal fluid , fecalith , dilation of the appendix , and perforation . Increased length of hospital stay and antibiotic treatment as well as postoperative complications also correlated with progressive pathology. In adult patients with acute appendicitis, the risk of developing advanced pathology and postoperative complications increases with time; therefore, delayed appendectomy is unsafe. As delays in seeking medical help are difficult to control, prompt appendectomy is mandatory. Because these conclusions are derived from retrospective data, a prospective study is required to confirm their validity
REG IPF/ILD Working Group Meeting 25/09/15Zoe Mitchell
The document outlines plans for two diagnostic studies in interstitial lung disease (ILD). [1] Phase I will characterize ILD diagnostic practices globally, especially in underrepresented regions, to inform the design of [2] Phase II which will evaluate agreement and accuracy of ILD multidisciplinary team diagnoses across sites. The studies aim to establish best practice recommendations for optimizing the pathway to accurate ILD diagnosis.
This meta-analysis examined whether the long-acting anticholinergic drug tiotropium reduces exacerbations and hospitalizations in COPD patients compared to placebo, ipratropium, and salmeterol. The analysis found that tiotropium significantly reduced exacerbations compared to placebo and ipratropium, and reduced exacerbations compared to salmeterol. It also found a reduction in hospitalizations compared to placebo and ipratropium. However, the results should be interpreted cautiously given variability across the included trials, the possibility of inappropriate data pooling, and the generally poor quality of the trials.
An audit was conducted of ward nurses' knowledge of sepsis definitions and management guidelines. A questionnaire was administered to 73 ward nurses which assessed their understanding of the signs and symptoms of sepsis, as well as case studies depicting potential sepsis patients. The results showed that some nurses had a poor understanding of the standard definitions of sepsis, severe sepsis/septic shock and recommended initial management. In response, targeted educational initiatives were implemented to improve nurses' knowledge of sepsis definitions and management guidelines put forth by the Surviving Sepsis Campaign. The study concluded that focused education for ward nurses is needed if the goal of reducing sepsis mortality by 25% is to be achieved.
Chronic Rhinosinusitis and Its Impact on PregnancyAI Publications
Nasal congestion is the most common symptom of pregnancy rhinitis, which disappears once the baby is born. Pregnant patients with rhinitis report symptoms in 18 to 30 percent of cases. As a result, pregnant rhinitis may have a negative impact on the pregnancy and may result in obstructive sleep apnea, which may have an adverse effect on the outcome of the pregnancy. Previous studies on the prevalence of pregnant rhinitis at various stages of pregnancy have come up with conflicting results. The purpose of this study was to investigate the prevalence of rhinosinusitis during various stages of pregnancy. At a private hospital in the Kurdistan area of Iraq, a cross-sectional observation study of patients in the second and third trimesters of pregnancy was undertaken using the 22-item Sino-Nasal Outcome Test (SNOT-22). The participants were women in their second and third trimesters of pregnancy. The study comprised 76 patients who were considered to be at low risk of becoming pregnant. Thirty-two patients were in their second trimester of pregnancy and 44 patients were in their third trimester of pregnancy when the study was conducted. When comparing the third trimester to the second trimester, the average item scores for the complete questionnaire were considerably higher (P value =0.041), indicating a more severe deterioration of cognitive function. In both the second and third trimesters, a comparison between women with and without preexisting allergic rhinitis reveals that the allergic group has significantly higher SNOT-22 scores (P value =0.007). In individuals with rhinosinusitis, the risk of miscarriage was reduced in the third trimester (P value =0.011). Rhinosinusitis is less common in the third trimester of pregnancy when compared to the second trimester, as well as when compared to patients who do not have rhinosinusitis in the first place.
This document summarizes a study analyzing data from 14 countries that participated in the Burden of Obstructive Lung Disease (BOLD) study to describe characteristics of COPD in never smokers and identify possible risk factors. The study found that among 4,291 never smokers, 6.6% had mild COPD and 5.6% had moderate to severe COPD. Never smokers comprised 23.3% of those with moderate to severe COPD. Predictors of COPD in never smokers included older age, lower education levels, occupational exposures, childhood respiratory diseases, and abnormal BMI. The study confirms that never smokers represent a substantial proportion of COPD cases and suggests additional risk factors beyond smoking.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
Morbidity and Mortality in Patients with Difficult Tracheal Intubation: An Analysis of the PeDIR Registry
This study analyzed 900 cases of difficult direct laryngoscopy (DDL) in children from the Pediatric Difficult Intubation registry (PeDIR) to identify risk factors associated with complications. The overall complication rate was 22.7% and the severe complication rate was 2.6%. Multiple intubation attempts, intubation outside the operating room, and unanticipated difficult airways were associated with severe complications on multivariate analysis. The results indicate there is significant morbidity and mortality in pediatric patients with difficult direct laryngoscopy, and certain risk factors can help identify those at higher risk of severe complications.
CLINICAL FEATURES, DIFFERENCES IN COVID FIRST, SECOND, THIRD WAVES- A DATA BA...DrHeena tiwari
This study compared the clinical features of COVID-19 in children and youth across the first three waves in multiple countries. A total of 397 patients aged 18 or younger were included. More patients were asymptomatic in the second and third waves compared to the first wave. Most illnesses were mild in all waves. A few patients presented with unusual manifestations like chilblains or multisystem inflammatory syndrome. The study found differences in symptoms and hospital length of stay across the three waves.
Evaluation of Signs and Symptoms Post Recovery in COVID Patients: A Questionn...DrHeena tiwari
This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
This study evaluated the prevalence of allergic rhinitis symptoms in children and adolescents in Kurdistan Province, Iran. A total of 3,890 students aged 6-7 and 13-14 years old completed questionnaires based on the International Study of Asthma and Allergies in Childhood. The results found that 29.7% reported sneezing or a runny nose in the past 12 months, with a higher prevalence in boys aged 13-14 years. Based on physician diagnosis, 9.37% had allergic rhinitis, which was more common in boys at both school levels and significantly higher in boys aged 13-14 years. The study concluded the prevalence of allergic rhinitis symptoms in this region
Role of Budesonide in Corona Virus Disease: Systematic Review DrHeena tiwari
Inhaled budesonide has been shown to significantly reduce the likelihood of Covid-19 patients requiring urgent or emergency care or hospitalization when given early to patients with mild symptoms. A systematic review of studies found inhaled budesonide reduced the risk of these adverse outcomes by 91% in one study. It also reduced the median time to recovery by 3 days in another study of patients with risk factors who were not hospitalized. The studies support the potential for inhaled budesonide to control the excessive inflammatory response to Covid-19 and prevent disease progression when administered early in mild cases.
This document provides guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in adults. Some of the key recommendations include:
1) Using noninvasive sampling with semiquantitative cultures rather than invasive sampling with quantitative cultures to diagnose VAP.
2) If invasive quantitative cultures are performed for a patient with suspected VAP and results are below the diagnostic threshold, antibiotics should be withheld rather than continued.
3) For patients with suspected HAP (non-VAP), treatment should be guided by microbiologic studies of respiratory samples rather than being empirically treated.
4) For patients with suspected HAP/V
James Fingleton PhD thesis amended FINAL version 14th NovemberJames Fingleton
This thesis explores phenotypes of obstructive airways disease through cluster analysis of data from the New Zealand Respiratory Health Survey (NZRHS). The NZRHS involved over 1,000 participants and examined clinical characteristics, lung function, biomarkers and responses to bronchodilators and inhaled corticosteroids to identify phenotypes. Cluster analysis identified five distinct phenotypes that differ in pathophysiology and treatment response. The thesis aims to characterize the identified phenotypes and develop rules to allocate patients to the appropriate phenotype, in order to enable personalized treatment of obstructive airway diseases.
This document provides guidelines from the Infectious Diseases Society of America (IDSA) for the diagnosis and management of aspergillosis. It summarizes recommendations for protecting high-risk patients from aspergillosis exposure, establishing a diagnosis using tests such as galactomannan and PCR, treating invasive aspergillosis with antifungal agents like voriconazole, and managing specific forms of invasive aspergillosis including invasive pulmonary aspergillosis. The guidelines are based on reviews of current evidence and are intended to assist clinical decision making while allowing flexibility based on individual patient circumstances.
A systematic review of the association between ptb and the development of chr...EArl Copina
This systematic review examined evidence for an association between pulmonary tuberculosis (PTB) and the development of chronic airflow obstruction (CAO). The review included 19 studies comprising 1 case series, 3 case-control studies, 4 cohort studies, and 8 cross-sectional studies involving over 10,000 subjects total. The majority of studies, including 3 large population-based surveys, found a significant positive association between PTB and CAO, with odds ratios ranging from 1.37 to 2.94. While causality cannot be proven, the evidence confirms that a history of PTB is independently associated with CAO.
ASTHMA CORRELATES AMONG ADOLESCENCE IN COUNTRY: AN ORIGINAL RESEARCHDrHeena tiwari
The document summarizes a study on asthma correlates among adolescents in a country. The study involved a cross-sectional survey of 1200 children to examine health risks and lifestyle factors. The results found that the prevalence of self-reported asthma was 8.2%. Asthmatic adolescents were more likely to be male, overweight or obese, consume soft drinks and energy drinks more frequently, and less likely to consume milk compared to non-asthmatic adolescents. The study aims to establish how lifestyle factors are associated with increased asthma incidence among adolescents.
This document reports on a study that assessed the prevalence of asthma symptoms among elementary and middle school students in Kurdistan Province, Iran. A questionnaire was distributed to 4,000 students aged 6-7 and 13-14 years, with a 97% response rate. The prevalence of wheezing in the past 12 months was found to be 26.5% overall. The prevalence of physician-diagnosed asthma was 3.9%. There were statistically significant differences in prevalence rates between different cities in the province. The study found a relatively high prevalence of wheezing and asthma among students in Kurdistan province compared to other similar studies.
This document summarizes guidelines for the treatment of community acquired pneumonia from the Infectious Diseases Society of America and American Thoracic Society from 2007. It discusses recommendations for hospital admission criteria using CURB-65 and PSI scores, diagnostic testing including the types of specimens that should be collected from patients with severe CAP. It also provides guidance on appropriate antibiotic regimens for outpatient, non-ICU inpatient, and ICU inpatient settings.
REG Child Health Working Group Meeting 26/09/15Zoe Mitchell
This document provides details of a child health working group meeting, including the agenda, completed work, publication status, and a presentation on a comparative effectiveness study of extra-fine particle inhaled corticosteroids and alternative guideline-recommended step-up options in preschool children with asthma. The meeting will take place on September 26th in Amsterdam, chaired by Steve Turner, and will discuss a real-life MASCOT study, abstracts previously presented, the publication status of three papers, and a proposed comparative effectiveness study using the Optimum Patient Care Research Database to compare outcomes of different treatment approaches for preschool wheeze/asthma.
This study was performed Department of Otor hinolaryngology, Jubilee Mission Medical College, thrissur, Kerala for a period of 2 years commencing from December 2012 to November 2014. To review our experience with deep neck space infections and to study changing trends. The objectives were to study clinical presentation, etiology, associated systemic diseases, bacteriology, radiology, management and outcome of deep neck space infections.40 Patients coming from both urban and rural areas irrespective of age and sex admitted in department of ENT with deep neck space infections which was confirmed either clinically or radiologically. Superficial skin abscesses and abscesses due to infections of external neck injuries were excluded from the study \r\n.
Evaluation of Empirical Usage of Respiratory Medications in Treatment of Pati...DR. SUJOY MUKHERJEE
1) The study evaluated the empirical use of respiratory medications in 550 patients presenting with chronic lower respiratory symptoms who were referred for spirometric screening.
2) It was found that empirical usage of medications without spirometry was widespread, with the potential for future adverse outcomes from misdiagnoses.
3) The study concluded that all patients with chronic lower respiratory symptoms should have their diagnoses confirmed with spirometry testing before receiving medications to avoid incorrect diagnoses and unwanted side effects from unnecessary treatments.
This study evaluated a nurse-led telephone intervention to support patients with chronic obstructive pulmonary disease (COPD) in managing their condition. 73 patients were randomly assigned to either receive standard care including a self-management plan, or to receive the self-management plan plus two telephone calls from a nurse over six weeks. The telephone calls provided education on using their self-management plan and managing exacerbations. The primary outcome was COPD symptom severity assessed before and after with the COPD Assessment Tool (CAT). Secondary outcomes included self-reported exacerbations and healthcare utilization. CAT scores significantly improved in the intervention group but not the control group. There were no significant differences in exacerbations between groups. Patient satisfaction did not differ significantly between groups
This document describes a study that developed and validated a treatment algorithm and patient information toolkit for managing uremic pruritus (UP) in patients with chronic kidney disease and end-stage kidney disease. The algorithm and tools were created through a literature review and expert input from clinicians. The algorithm and tools then underwent three rounds of validation where clinicians rated their content validity and face validity. The results found high content validity (average CVI of 0.89) and face validity (over 78% of clinicians agreeing or strongly agreeing) for the algorithm. A similar validation process for the patient information tools also found high content validity and face validity. This validation establishes that the developed treatment algorithm and patient information toolkit are relevant and useful according to expert
This document summarizes a study investigating the health-related quality of life and functional status of individuals who have been cured of pulmonary tuberculosis in the Breede Valley District of South Africa. A total of 45 individuals participated in lung function tests, six-minute walk tests, and quality of life questionnaires. The results found that about half had normal lung function, while 25% had restrictive lung function and 21% had obstructive lung function. Six-minute walk distances were reduced compared to references. Quality of life scores also suggested negative impacts in both physical and mental health domains. Challenges in patient recruitment and accessibility were discussed, with recommendations for future research.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
Morbidity and Mortality in Patients with Difficult Tracheal Intubation: An Analysis of the PeDIR Registry
This study analyzed 900 cases of difficult direct laryngoscopy (DDL) in children from the Pediatric Difficult Intubation registry (PeDIR) to identify risk factors associated with complications. The overall complication rate was 22.7% and the severe complication rate was 2.6%. Multiple intubation attempts, intubation outside the operating room, and unanticipated difficult airways were associated with severe complications on multivariate analysis. The results indicate there is significant morbidity and mortality in pediatric patients with difficult direct laryngoscopy, and certain risk factors can help identify those at higher risk of severe complications.
CLINICAL FEATURES, DIFFERENCES IN COVID FIRST, SECOND, THIRD WAVES- A DATA BA...DrHeena tiwari
This study compared the clinical features of COVID-19 in children and youth across the first three waves in multiple countries. A total of 397 patients aged 18 or younger were included. More patients were asymptomatic in the second and third waves compared to the first wave. Most illnesses were mild in all waves. A few patients presented with unusual manifestations like chilblains or multisystem inflammatory syndrome. The study found differences in symptoms and hospital length of stay across the three waves.
Evaluation of Signs and Symptoms Post Recovery in COVID Patients: A Questionn...DrHeena tiwari
This document describes a questionnaire survey of 287 individuals who recovered from COVID-19. The survey found that only 10.8% reported no ongoing symptoms, while most reported fatigue (72.8%), anxiety (38%), joint pain (31.4%), or other symptoms. Symptom severity was related to severity of initial COVID-19 infection and presence of pre-existing conditions. The study aims to evaluate ongoing signs and symptoms in post-recovery COVID patients.
This study evaluated the prevalence of allergic rhinitis symptoms in children and adolescents in Kurdistan Province, Iran. A total of 3,890 students aged 6-7 and 13-14 years old completed questionnaires based on the International Study of Asthma and Allergies in Childhood. The results found that 29.7% reported sneezing or a runny nose in the past 12 months, with a higher prevalence in boys aged 13-14 years. Based on physician diagnosis, 9.37% had allergic rhinitis, which was more common in boys at both school levels and significantly higher in boys aged 13-14 years. The study concluded the prevalence of allergic rhinitis symptoms in this region
Role of Budesonide in Corona Virus Disease: Systematic Review DrHeena tiwari
Inhaled budesonide has been shown to significantly reduce the likelihood of Covid-19 patients requiring urgent or emergency care or hospitalization when given early to patients with mild symptoms. A systematic review of studies found inhaled budesonide reduced the risk of these adverse outcomes by 91% in one study. It also reduced the median time to recovery by 3 days in another study of patients with risk factors who were not hospitalized. The studies support the potential for inhaled budesonide to control the excessive inflammatory response to Covid-19 and prevent disease progression when administered early in mild cases.
This document provides guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in adults. Some of the key recommendations include:
1) Using noninvasive sampling with semiquantitative cultures rather than invasive sampling with quantitative cultures to diagnose VAP.
2) If invasive quantitative cultures are performed for a patient with suspected VAP and results are below the diagnostic threshold, antibiotics should be withheld rather than continued.
3) For patients with suspected HAP (non-VAP), treatment should be guided by microbiologic studies of respiratory samples rather than being empirically treated.
4) For patients with suspected HAP/V
James Fingleton PhD thesis amended FINAL version 14th NovemberJames Fingleton
This thesis explores phenotypes of obstructive airways disease through cluster analysis of data from the New Zealand Respiratory Health Survey (NZRHS). The NZRHS involved over 1,000 participants and examined clinical characteristics, lung function, biomarkers and responses to bronchodilators and inhaled corticosteroids to identify phenotypes. Cluster analysis identified five distinct phenotypes that differ in pathophysiology and treatment response. The thesis aims to characterize the identified phenotypes and develop rules to allocate patients to the appropriate phenotype, in order to enable personalized treatment of obstructive airway diseases.
This document provides guidelines from the Infectious Diseases Society of America (IDSA) for the diagnosis and management of aspergillosis. It summarizes recommendations for protecting high-risk patients from aspergillosis exposure, establishing a diagnosis using tests such as galactomannan and PCR, treating invasive aspergillosis with antifungal agents like voriconazole, and managing specific forms of invasive aspergillosis including invasive pulmonary aspergillosis. The guidelines are based on reviews of current evidence and are intended to assist clinical decision making while allowing flexibility based on individual patient circumstances.
A systematic review of the association between ptb and the development of chr...EArl Copina
This systematic review examined evidence for an association between pulmonary tuberculosis (PTB) and the development of chronic airflow obstruction (CAO). The review included 19 studies comprising 1 case series, 3 case-control studies, 4 cohort studies, and 8 cross-sectional studies involving over 10,000 subjects total. The majority of studies, including 3 large population-based surveys, found a significant positive association between PTB and CAO, with odds ratios ranging from 1.37 to 2.94. While causality cannot be proven, the evidence confirms that a history of PTB is independently associated with CAO.
ASTHMA CORRELATES AMONG ADOLESCENCE IN COUNTRY: AN ORIGINAL RESEARCHDrHeena tiwari
The document summarizes a study on asthma correlates among adolescents in a country. The study involved a cross-sectional survey of 1200 children to examine health risks and lifestyle factors. The results found that the prevalence of self-reported asthma was 8.2%. Asthmatic adolescents were more likely to be male, overweight or obese, consume soft drinks and energy drinks more frequently, and less likely to consume milk compared to non-asthmatic adolescents. The study aims to establish how lifestyle factors are associated with increased asthma incidence among adolescents.
This document reports on a study that assessed the prevalence of asthma symptoms among elementary and middle school students in Kurdistan Province, Iran. A questionnaire was distributed to 4,000 students aged 6-7 and 13-14 years, with a 97% response rate. The prevalence of wheezing in the past 12 months was found to be 26.5% overall. The prevalence of physician-diagnosed asthma was 3.9%. There were statistically significant differences in prevalence rates between different cities in the province. The study found a relatively high prevalence of wheezing and asthma among students in Kurdistan province compared to other similar studies.
This document summarizes guidelines for the treatment of community acquired pneumonia from the Infectious Diseases Society of America and American Thoracic Society from 2007. It discusses recommendations for hospital admission criteria using CURB-65 and PSI scores, diagnostic testing including the types of specimens that should be collected from patients with severe CAP. It also provides guidance on appropriate antibiotic regimens for outpatient, non-ICU inpatient, and ICU inpatient settings.
REG Child Health Working Group Meeting 26/09/15Zoe Mitchell
This document provides details of a child health working group meeting, including the agenda, completed work, publication status, and a presentation on a comparative effectiveness study of extra-fine particle inhaled corticosteroids and alternative guideline-recommended step-up options in preschool children with asthma. The meeting will take place on September 26th in Amsterdam, chaired by Steve Turner, and will discuss a real-life MASCOT study, abstracts previously presented, the publication status of three papers, and a proposed comparative effectiveness study using the Optimum Patient Care Research Database to compare outcomes of different treatment approaches for preschool wheeze/asthma.
This study was performed Department of Otor hinolaryngology, Jubilee Mission Medical College, thrissur, Kerala for a period of 2 years commencing from December 2012 to November 2014. To review our experience with deep neck space infections and to study changing trends. The objectives were to study clinical presentation, etiology, associated systemic diseases, bacteriology, radiology, management and outcome of deep neck space infections.40 Patients coming from both urban and rural areas irrespective of age and sex admitted in department of ENT with deep neck space infections which was confirmed either clinically or radiologically. Superficial skin abscesses and abscesses due to infections of external neck injuries were excluded from the study \r\n.
Evaluation of Empirical Usage of Respiratory Medications in Treatment of Pati...DR. SUJOY MUKHERJEE
1) The study evaluated the empirical use of respiratory medications in 550 patients presenting with chronic lower respiratory symptoms who were referred for spirometric screening.
2) It was found that empirical usage of medications without spirometry was widespread, with the potential for future adverse outcomes from misdiagnoses.
3) The study concluded that all patients with chronic lower respiratory symptoms should have their diagnoses confirmed with spirometry testing before receiving medications to avoid incorrect diagnoses and unwanted side effects from unnecessary treatments.
This study evaluated a nurse-led telephone intervention to support patients with chronic obstructive pulmonary disease (COPD) in managing their condition. 73 patients were randomly assigned to either receive standard care including a self-management plan, or to receive the self-management plan plus two telephone calls from a nurse over six weeks. The telephone calls provided education on using their self-management plan and managing exacerbations. The primary outcome was COPD symptom severity assessed before and after with the COPD Assessment Tool (CAT). Secondary outcomes included self-reported exacerbations and healthcare utilization. CAT scores significantly improved in the intervention group but not the control group. There were no significant differences in exacerbations between groups. Patient satisfaction did not differ significantly between groups
This document describes a study that developed and validated a treatment algorithm and patient information toolkit for managing uremic pruritus (UP) in patients with chronic kidney disease and end-stage kidney disease. The algorithm and tools were created through a literature review and expert input from clinicians. The algorithm and tools then underwent three rounds of validation where clinicians rated their content validity and face validity. The results found high content validity (average CVI of 0.89) and face validity (over 78% of clinicians agreeing or strongly agreeing) for the algorithm. A similar validation process for the patient information tools also found high content validity and face validity. This validation establishes that the developed treatment algorithm and patient information toolkit are relevant and useful according to expert
This document summarizes a study investigating the health-related quality of life and functional status of individuals who have been cured of pulmonary tuberculosis in the Breede Valley District of South Africa. A total of 45 individuals participated in lung function tests, six-minute walk tests, and quality of life questionnaires. The results found that about half had normal lung function, while 25% had restrictive lung function and 21% had obstructive lung function. Six-minute walk distances were reduced compared to references. Quality of life scores also suggested negative impacts in both physical and mental health domains. Challenges in patient recruitment and accessibility were discussed, with recommendations for future research.
This document summarizes an article from the journal Asthma in General Practice. The article investigates the underpresentation of shortness of breath symptoms to general practitioners in the general population without a confirmed diagnosis of obstructive airways disease. Of 285 people who experienced shortness of breath in the past year, only 93 (33%) had ever consulted their GP for this. Neither perception of symptoms nor psychological factors could explain the underpresentation. A random sample of over 1,000 people was screened for respiratory symptoms, and those reporting shortness of breath were studied further. While shortness of breath was common, most people did not seek medical help for it. This suggests that underpresentation, not underdiagnosis, contributes significantly to the
This document provides an overview of analytical epidemiology studies, specifically case-control studies and cohort studies. It defines epidemiology and describes the two main types of analytical studies - case-control studies which are retrospective and look backward from the effect to the cause, and cohort studies which are prospective and look forward from cause to effect. The key steps of each study type are outlined, including selection of cases/controls, measurement of exposure, and analysis. Potential sources of bias are also discussed.
The international survey on the management of allergic rhinitis by physicians...Georgi Daskalov
ORIGINAL RESEARCH Open Access
The international survey on the management of
allergic rhinitis by physicians and patients
(ISMAR)
Carlos E Baena-Cagnani
1
†
ˆ
, Giorgio W Canonica
2*
, Mohamed Zaky Helal
3
†
, René Maximiliano Gómez
4
†
,
Enrico Compalati
2
†
, Mario E Zernotti
5
†
, Mario Sanchez-Borges
6
†
, Fabio F Morato Castro
7
†
,
Margarita Murrieta Aguttes
8
†
, Aida López-Garcia
9
†
, Faheem A Tadros
10
†
and ISMAR Study Group
Corticosteroids for sore throat sr ma bmj 2018Mayra Serrano
This systematic review and meta-analysis found that a single low dose of corticosteroids, such as oral dexamethasone up to 10 mg, provides moderate to high quality evidence of pain relief for patients with sore throat. Patients who received corticosteroids were twice as likely to experience pain relief after 24 hours and 1.5 times more likely to have no pain at 48 hours, with no increase in serious adverse effects. The mean time to complete pain resolution was about 11 hours shorter with corticosteroids. Included trials enrolled over 1400 individuals and assessed outcomes up to 48 hours, but did not evaluate risks of repeated corticosteroid use for recurrent sore throats.
Assessing the quality of the management skills required for lower respiratory...Ben Mbwele
1) The study assessed the quality of care for lower respiratory tract infections (LRTI) provided by clinicians in Tanzania by analyzing patient files and interviewing clinicians.
2) It found that medications prescribed for LRTI varied greatly between patient files and clinicians' responses. No files showed attempts to assess the severity of pneumonia.
3) Only a small minority of clinicians could correctly identify atypical causes of pneumonia like Q-fever or mention appropriate treatment guidelines. Monitoring of patient progress was not consistent across different levels of care facilities.
This document summarizes a review of literature on patient-related risk factors for dental implant therapy. The review identified 43 relevant studies based on inclusion criteria. The studies contained confounding variables and small sample sizes in subgroups. Consistent evidence showed increased implant failure rates in smokers, patients with a history of radiotherapy, and those with poor local bone quality or quantity. Weaker evidence linked a history of periodontitis to higher peri-implant disease. A lack of evidence precluded guidelines for patients with autoimmune disorders. Emerging evidence suggests a correlation between genetic traits and disrupted osseointegration.
This document provides an updated 2016 global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD). It summarizes the membership and roles of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) board of directors and science committee. The strategy is intended as a tool for healthcare professionals to implement effective COPD management programs based on available resources. It emphasizes an assessment of symptoms and exacerbation risk to determine treatment.
This document discusses evidence for preventing ventilator-associated pneumonia (VAP) through appropriate oral care for mechanically ventilated patients in intensive care units. It reviews literature showing that VAP increases mortality and hospital stay. Chlorhexidine oral care is shown to be more effective at preventing VAP than tooth brushing alone, as it has bactericidal properties, while brushing only reduces bacteria. Studies also find developing VAP is associated with changes in oral health for intubated neuroscience ICU patients. The best practice for VAP prevention is a combined approach including chlorhexidine oral care along with other measures like head elevation and limiting hospital stay.
CRITIQUE ON Effect of 0.12% Chlorhexidine Oral Rinse on Preventing Hospital-A...manjunathbeth1
This study examined the effect of 0.12% chlorhexidine oral rinse on preventing hospital-acquired pneumonia in non-ventilated inpatients. A randomized, double-blind, triple-arm clinical trial was conducted with 103 patients aged 50 or older who were randomly assigned to one of three groups: 0.12% chlorhexidine rinse, Listerine rinse, or saline rinse. Outcome measures including incidence of hospital-acquired pneumonia, oral health, bacterial load, and clinical pneumonia index scale were evaluated and compared between the groups at various timepoints. The results suggested that the chlorhexidine rinse was more effective at reducing risk of hospital-acquired pneumonia and improving oral health compared to
This study examined the attitudes and treatment of 3,415 asthma patients in 11 countries who were prescribed regular maintenance therapy of inhaled corticosteroids. The study found that 74% used short-acting beta-agonists daily and 51% had uncontrolled asthma according to a questionnaire. Even patients with well-controlled asthma reported an average of 6 worsening episodes per year. While patients recognized the early signs of worsening, the most common response was to increase short-acting beta-agonist use rather than inhaled corticosteroids. This represents a missed opportunity to properly manage worsening asthma.
This document describes a study that investigated symptoms, diagnosis, management, and complications of treatment in 110 patients with pulmonary bullae. The main findings were:
1) The majority of patients were male smokers who presented with respiratory distress.
2) Surgical resection via bullectomy was effective for managing respiratory distress and had no recurrence after 8 months.
3) Post-operative air leaks occurred in 20 patients but were managed with chest tubes or Heimlich valves with full recovery after 1 month.
4) Smoking was identified as a major risk factor for bullae formation. Surgical treatment was concluded to be important for managing severe respiratory symptoms.
Measuring quality of life in nasal surgerySurbhi narayan
This document discusses measuring quality of life in nasal surgery. It covers using questionnaires to assess patient outcomes, both general quality of life measures like the SF-36 and disease-specific measures like the SNOT-20 for chronic rhinosinusitis. Quality of life is important to evaluate in clinical research, for insurance reimbursement, and in patient care. The document also discusses measuring quality of life outcomes for procedures like septoplasty and rhinoplasty and the importance of considering psychological factors for some patients seeking cosmetic nasal surgery.
This document summarizes an 11-year retrospective cross-sectional study on pulmonary alveolar proteinosis (PAP) conducted in Iran. 45 PAP patients underwent whole lung lavage (WLL), which showed significant improvement in symptoms and lung function. WLL had never been used before to treat Iranian PAP patients. Diagnosis was made using bronchoalveolar lavage or lung biopsy. 20% had a history of dust exposure. 24.4% had an underlying condition like active tuberculosis. Hemoptysis was found to predict treatment failure, so properly treating tuberculosis may improve outcomes for PAP patients in Iran where tuberculosis is endemic. WLL was found to be an effective treatment for PAP.
This journal club presentation summarizes an article from Arthritis & Rheumatology that examined the association between asthma, chronic obstructive pulmonary disease (COPD), and subsequent risk of rheumatoid arthritis (RA) using two large prospective cohorts. The study found that both asthma and COPD were associated with increased risk of incident RA, independent of smoking status and other potential confounding factors. Asthma remained associated with higher RA risk among never-smokers. COPD showed the strongest association with later RA among ever-smokers aged over 55 years. The results provide support for the hypothesis that chronic airway inflammation may contribute to RA pathogenesis.
Newer diagnostic methods in tuberculosis detectionApollo Hospitals
One-third of the world's population has been infected with Mycobacterium tuberculosis, with new infections occurring in about 1% of the population each year. However 90–95% of infections remain asymptomatic. Thus early diagnosis of tuberculosis and drug resistance improves survival and helps to promote contact tracing, implementation of institutional cross-infection procedures, and other public-health actions. There have been many advances and modifications to the methodology for tuberculosis diagnosis some of which are very promising. But these advances have not kept pace with the explosion of tuberculosis or the outbreak of drug resistant tuberculosis. This review describes some of the newer advances in tuberculosis diagnostics and the challenges they face.
The 2019 Diagnostic Summit brought together diagnostic developers in academia and industry as well as end-users in the pharmaceutical and healthcare sector to gain a comprehensive picture of diagnostics in prenatal, oncology, infectious disease, point-of-care, and liquid biopsy.
This important Summit enabled delegates to learn what novel technologies, platforms and applications are emerging that will impact future healthcare delivery and pharmaceutical research.
Bringing together European leading experts via presentations, workshops and case studies the Summit was a must attend event! We explored:
Current diagnostic testing in GP surgeries and Pharmacies
How Diagnostics can be funded and funding barriers
Advances in Prenatal Molecular Diagnostics
Diagnostic Regulations
Point of care testing
Advanced Diagnostics for infectious diseases
Adapting and evaluating Innovation
Education on testing and accuracy
Patient and Clinical pathways
Key health areas examined in the Summit included:
Sexual Health
Diabetes
Cancer
Antibiotic Resistance
Sepsis
Obesity
Urinary Infections
Similar to Tìm hiểu viêm xoang cấp mủ | Venus Global (20)
Kính chào tất cả mọi người. Tổng hợp 23 loại trái cây giảm cân, giữ dáng, dưỡng da hiệu quả, cung cấp dưỡng chất cho cơ thể. Truy cập vào bài viết để biết thông tin chi tiết!
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Kính chào tất cả mọi người. Gợi ý 6 cách nhịn ăn giảm cân không hại đến sức khỏe. Những lưu ý quan trọng khi nhịn ăn giảm cân mà bạn cần nắm rõ
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Kính chào tất cả mọi người. Bí quyết giảm cân thông dụng nhất. Những thói quen hàng ngày cũng có thể giúp bạn giảm cân. Nhấn vào bài viết để tìm hiểu ngay.
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Kính chào tất cả mọi người. Uống thuốc giảm cân có hiệu quả? Thuốc giảm mỡ bụng nào tốt nhất trên thị trường. Cùng Venus tìm hiểu qua bài viết dưới đây.
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Tập gym giảm cân
Kính chào tất cả mọi người. Tập gym giảm cân như thế nào cho đúng cách và hiệu quả tốt nhất? Giáo án tập gym giúp giảm cân hiệu quả chỉ trong 7 ngày.
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Kính chào tất cả mọi người. Tổng hợp 9 phương pháp giảm cân trong 1 tuần đơn giản - hiệu quả - an toàn nhất. Truy cập vào bài viết để biết thêm thông tin chi tiết
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Kính chào tất cả mọi người. Hướng dẫn 11 cách làm ngũ cốc giảm cân đơn giản tại nhà giúp bổ sung đủ dinh dưỡng mà vẫn giảm cân hiệu quả
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Kính chào tất cả mọi người. Nhập môn cùng các bài tập yoga giảm cân đơn giản, lấy lại thân hình thon gọn, vóc dáng chuẩn nhanh chóng. Tìm hiểu ngay bài viết để biết cụ thể hơn.
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Detox giảm cân
Kính chào tất cả mọi người. Bạn muốn giảm cân? Lưu ngay 21 loại nước detox đào thải mỡ thừa, làm đẹp da an toàn và hiệu quả tại nhà.
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Kính chào tất cả mọi người. Thực phẩm giàu chất xơ giảm cân được nhiều gymer ưa chuộng. Bạn đang muốn lên kế hoạch ăn kiêng? Xem ngay bài viết để giải quyết vấn đề này.
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Kính chào tất cả mọi người. Bạn đang cần tìm một giải pháp giảm cân an toàn nhưng vẫn đảm bảo dưỡng chất cho cơ thể? Cùng Venus tìm hiểu ngay một số loại sinh tố giảm cân
ngon- bổ- rẻ.
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Kính chào tất cả mọi người. Uống nước cũng có thể giảm cân? Những loại nước uống giảm cân thần thánh mà bạn không biết sẽ được Venus tổng hợp và chia sẻ trong bài viết.
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Giảm cân hiệu quả bằng mật ong
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The clinical diagnosis of acute purulent sinusitis in general practice - A review
Article in British Journal of General Practice · July 2002
Source: PubMed
CITATIONS
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Drug Utilization in the Botswana Primary Health Care View project
Outcome of primary health care rehabilitation of older disabled people in two different settings - an open, prospective, comparative observational study. Faculty of
Medicine University of Oslo 2013 View project
Morten Lindbæk
University of Oslo
211 PUBLICATIONS 2,891 CITATIONS
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3. Methods Working Group on Diagnosis and Screening.9
The
following criteria for validity were sought:
• Were the clinical findings compared with a valid refer-
ence standard?
• Were the findings and reference standard measured
blind against each other?
• Was the choice of patients assessed by the reference
standard independent of the results of the clinical find-
ings?
• Was the reference standard measured before any inter-
ventions were started with knowledge of the results?
• Were the clinical findings reported in a valid design?
Reference standard diagnostic criteria
Sinus puncture was regarded as positive if the puncture
revealed purulent or mucopurulent secretion. In accordance
with established criteria,10 ultrasound findings were consid-
ered positive if there were:
• scans showing a back wall echo greater than 3.5 cm
from the initial echo;
• sinus radiographs findings with air–fluid level, complete
opacity or mucosal thickening greater than 5 mm;4 or,
• sinus CTs with air–fluid levels, or complete opacity in
any sinus.11
Results
Search results
The searches yielded 87 references. Of these, 29 were
review articles, 21 were articles about treatment only, five
looked at sinusitis in childhood, and ten were not eligible for
other reasons (editorials, questionnaires, etc), leaving 22 eli-
gible studies. Table 1 gives the reasons for further evaluation
of these studies. Seven articles met the primary inclusion cri-
teria, of which one was a double publication12,13 and one a
triple publication,4,14,15 leaving four articles for final evalua-
tion.
Methodological quality of included studies
Table 2 gives the evaluation of the methodological quality of
the four included studies. The methodological approaches
used were variable. Several types of categories and tabula-
tions were used. Sensitivity and specificity were reported in
most cases and likelihood ratios in all four. One of the stud-
ies recruited only male patients;4 the other three had similar
sex distribution — two-thirds female and one-third male. All
four studies met the main methodological demands and
used logistic regression analysis, enabling the evaluation of
symptoms and signs, individually and grouped.
In Table 3 the symptoms, signs and blood tests have been
analysed and found to be independently associated with
acute purulent sinusitis. To assess the strength of each of
the associations, the likelihood ratio (LR) and frequency of
each variable have been included. As there was no access
to the original data, it was not possible to combine and
analyse the aggregated data.
Purulent rhinorrhoea as a symptom was found to be asso-
ciated with purulent sinusitis in three of the four studies. Pain
in the teeth was found to be associated with the diagnoses
in two of the studies, though not in the remaining two. Illness
starting with upper respiratory tract infection was an associ-
ation found in only one of the studies. The other two symp-
toms — two phases in the illness history and ineffectiveness
of decongestants — were associated with one study each,
but were not investigated in the others. Purulent secretion in
the nasal cavity was associated with two of the studies,
whereas pain at bending forward was associated with only
one of the four studies. Transillumination of the maxillary
sinuses was associated with one study, but not investigated
in the others. An erythrocyte sedimentation rate (ESR)
greater than 10 mm/h for males and greater than 20 mm/h
for females was associated with purulent sinusitis in the two
studies where it was investigated, while C-reactive protein
(CRP) greater than 10 mg/l was associated with only one of
the studies where it was investigated.
Table 4 shows the sensitivity and specificity of the three
reference standards (ultrasonography, X-rays or CT) as com-
pared with sinus puncture as the optimal reference stan-
dard.16 X-rays has been used in a number of studies but, as
demonstrated in the table, there is a major difference if only
patients with fluid level or total opacification are included,
compared with when patients with mucosal thickening
greater than 5 mm are also included.16 The result also varies
for ultrasonography; a recent study demonstrated low sen-
sitivity compared with sinus puncture.17 Sinus CT may have
a high specificity when using fluid level and total opacifica-
tion as the criteria for acute sinusitis; however, data are lack-
ing. Data from previous studies show that the positive pre-
dictive value with these criteria is 0.90.3 CT also has the
advantage of giving an adequate view of the smaller sinus-
es (frontal, sphenoidal and ethmoid sinuses), which fre-
quently can be affected in sinusitis.11
Two studies have been performed in ear, nose and throat
(ENT) practice. Berg studied patients with illness duration of
less than three months using puncture as the reference
standard.18 He found four symptoms and signs to be asso-
ciated with purulent sinusitis: history of purulent nasal dis-
charge with unilateral predominance; history of bilateral
purulent nasal discharge; history of facial pain with unilater-
al predominance; and pus in the nasal cavity on physical
492 British Journal of General Practice, June 2002
M Lindbæk and P Hjortdahl
HOW THIS FITS IN
What do we know?
Acute sinusitis is a common diagnosis that
often leads to prescription of an antibiotic. The
clinical diagnosis of acute purulent sinusitis is uncertain and
there is conflicting evidence about the value of the clinical
symptoms and signs.
What does this paper add?
This systematic review demonstrates clinical symptoms and
signs and blood tests that have been associated with the con-
firmed diagnosis in a primary care setting. By use of these, the
GP can increase the probability of diagnosing an acute puru-
lent sinusitis.
Table 1. Results of the literature searches.
Reasons for exclusion Number of reports
Selected patient population 3
No clinical data given 6
Lack of reference standard 5
Retrospective study 1
Eligible reports 7
Total 22
4. examination. Axelsson used sinus X-ray as the reference
standard and found purulent rhinorrhoea, preceding upper
respiratory infection, cough, hyposmia, and malaise to be
predictors of bacterial sinusitis.19
Discussion
The literature search revealed only four studies eligible for
inclusion in this review. The two main reasons for exclusion
of studies were the lack of an acceptable reference standard
or a lack of relevant clinical information. Searches were not
conducted for studies in languages other than English; how-
ever, previous reviews relevant to other aspects of acute
sinusitis did not reveal further studies from general practice
populations.7,8
British Journal of General Practice, June 2002 493
Review article
Table 2. Characteristics of diagnostic studies of acute sinusitis in general practice identified by use of defined MeSH terms.
Study
Patient characteristics characteristics Fraction of
patients
Study Country/ Setting/ Symptoms Age % Symptom Blinded Clearly with Logistic
year specialty on entry years male duration defined sinusitis regression
Hansen2
— Denmark, PHC Doctor 15–79 30 <30 days Yes Yes 89/168 +
Clinical 1995 suspected
examination
compared with
puncture
Lindbæk3
— Norway, PHC Doctor 16–69 32 <30 days Yes Yes 123/201 +
Clinical 1995 suspected
examination
compared
with CT
Williams4 — USA, PHC Headache, >17 100 <90 days Yes Yes 88/247 +
Clinical 1992 nasal
examination symptoms,
compared patient
with X-ray suspected
Van Duijn5
— Holland, PHC Doctor 16–70 31 <30 days Yes Yes 212/400 +
Clinical 1992 suspected
examination
compared with
ultrasonography
Table 3. Symptoms, signs and blood tests independently associated with a confirmed diagnosis of acute sinusitis in four studies from gen-
eral practice.a
Study
Hansen2
Lindbæk3
Williams4
van Duijn5
Total
Reference standard Puncture CT sinus X-ray Ultrasound
Number of patients n = 174 n = 201 n = 247 n = 441
Association LR (frequency) LR (frequency) LR (frequency) LR (frequency)
Symptomsa
Purulent rhinorrohoea – 1.5 (78) 1.5 (59) 1.9 (47) 3+ 1–
Pain in teeth – – 2.5 (11) 2.1 (26) 2+ 2–
Beginning with common cold – – – 1.4 (78) 1+ 3–
Unilateral maxillary pain – – – 1.8 (27) 1+ 3–
Two phases in history 0 2.1 (59) 0 0 1+
Lack of response to nasal decongestants 0 0 2.1 (28) 0 1+
Signsa
Purulent secretion in nasal cavity – 5.5 (42) 2.1 (34) – 2+ 2–
Pain in bending forward – – – 1.6 (52) 1+ 3–
Transillumination of sinus 0 0 1.6 (56) 0 1+
Blood testsa
ESR>10/20 2.9 (39) 1.7 (61) 0 0 2+
CPR>10 1.8 (57) – 0 0 1+ 1–
Predictive values
Positive (numbers of factors) 0.68 (2 of 2) 0.86 (3 of 4) 0.80 (4 of 5) Not stated
Negative (numbers of factors) 0.74 (2 of 2) 0.53 (3 of 4) 0.66 (4 of 5) Not stated
aAssociation given by likelihood ratio (frequency of trial in percentage)
– = no association; 0 = not investigated.
5. In this review the focus was on symptoms, signs, and test-
ing of patient (blood tests) that are independently associat-
ed with the diagnosis of purulent sinusitis. The review was
based on studies from general practice with an unselected
patient population. Four factors were found that were con-
firmed in at least two of the four studies: purulent secretion
as a symptom and as a finding, pain in the teeth, and an ele-
vated ESR. Among these four predictors, purulent secretion
in the nasal cavity as a symptom was the strongest predic-
tor in three of the four studies. In addition, two phases in the
illness history — ineffectiveness of decongestants and tran-
sillumination of sinuses — may be of value. An ESR greater
than 10 mm/h for males or greater than 20 mm/h for females
and a CRP greater than 10 mg/l can also be of diagnostic
value. The evaluation of the strength of each of the factors
was based on the LRs and the frequencies of the each
symptom and sign.
In this review four different reference standards were
accepted. Table 4 shows the properties of three of these
compared with sinus puncture, indicating that they all have
individual weaknesses. Ultrasonography is the least accu-
rate, X-rays have a low specificity when using mucosal thick-
ening as part of the inclusion criteria, and sinus CT has an
uncertain sensitivity with the criteria used.
Although four different reference methods were used in
the included studies, the four factors found were associated
with the diagnosis of acute purulent sinusitis in two or three
of the four studies, indicating that they are of clinical value.
Two of the factors had only been investigated in one study
each, but were found to be associated with the diagnosis.
Three factors were confirmed in one study, but not con-
firmed in the remaining three, indicating that they are of
questionable value. It has not been possible to pool the data
into one larger meta-analysis. By using the four strongest
predictors and, in addition, taking into consideration the two
other predictors that have been confirmed in one study, GPs
can increase the accuracy of their clinical diagnosis of acute
purulent sinusitis. The findings of studies carried out among
ENT patients18,19 were much the same as were found in this
review, indicating the same predictors of acute purulent
sinusitis.
Of equal importance, a number of clinical signs and symp-
toms that frequently have been presented in clinical guide-
lines, were not demonstrated to be of value in this review. In
addition to the three that were not confirmed in three out of
four studies identified (beginning with the common cold,
unilateral maxillary pain, pain at bending forward), the fol-
lowing factors have been suggested, but not demonstrated
to be of differential diagnostic value: bilateral pain over max-
illary sinus; pain over frontal sinuses; headache; allergy;
malaise; cough; anosmia and cacosmia; nasal congestion;
fever with temperature greater than 38oC; tenderness over
maxillary and frontal sinuses; purulent pharyngeal dis-
charge; and oedema over maxillary sinuses. Although many
of these factors are frequent in patients with acute sinusitis,
they are not specific enough to help in sorting out patients
with acute purulent sinusitis.
The use of seven days’ illness duration as a lower time
limit to develop a bacterial sinusitis has been raised in some
reviews, based on reasoning related to bacteriology and
physiology.20
Some of the data in this review indicate that a
symptom duration of seven days or more may be of diag-
nostic value,1,3
but these data have not been analysed in a
multivariate logistic regression.
In placebo-controlled treatment studies it was demon-
strated that at least half of the patients with confirmed sinusi-
tis recovered without antibiotic treatment.21 This indicates
that only sinusitis patients with a high probability of having
purulent sinusitis should receive antibiotic treatment. In
many cases of an illness duration under seven days, an
expectative attitude should be used. The signs and symp-
toms found in this review to be valid indicators of purulent
sinusitis can also be helpful when considering antibiotic
treatment. By use of these indicators, it should be possible
to reduce the use of antibiotic treatment for patients with
sinusitis. On the other hand, our review has demonstrated
that the clinical differential diagnosis of purulent sinusitis is
at best uncertain, with a moderate sensitivity. In cases with
an uncertain diagnosis, GPs should thus choose to share
the decision making with the patients, taking their context
and their values into account when deciding on antibiotic
treatment.
References
1. Lindbaek M, Hjortdahl P
, Johnsen UL. Randomised, double blind,
placebo controlled trial of penicillin V and amoxycillin in treatment
of acute sinus infections in adults. BMJ 1996; 313(7053): 325-
329.
2. Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute max-
illary sinusitis in a general practice population. BMJ 1995;
311(6999): 233-236.
3. Lindbaek M, Hjortdahl P
, Johnsen UL. Use of symptoms, signs,
and blood tests to diagnose acute sinus infections in primary
care: comparison with computed tomography. Fam Med 1996;
28(3): 183-188.
4. Williams JW Jr, Simel DL, Roberts L, Samsa GP
. Clinical evalua-
tion for sinusitis. Making the diagnosis by history and physical
examination. Ann Int Med 1992; 117(9): 705-710.
5. van Duijn NP
, Brouwer HJ, Lamberts H. Use of symptoms and
signs to diagnose maxillary sinusitis in general practice: compari-
son with ultrasonography. BMJ 1992; 305(6855): 684-687.
6. Lindbaek M, Berild D, Straand J, Hjortdahl P
. Influence of prescrip-
tion patterns in general practice on anti-microbial resistance in
Norway. Br J Gen Pract 1999; 49: 436-440.
7. Engels EA, Terrin N, Barza M, Lau J. Meta-analysis of diagnostic
tests for acute sinusitis. J Clin Epidemiol 2000; 53(8): 852-862.
8. Varonen H, Makela M, Savolainen S, et al. Comparison of ultra-
sound, radiography, and clinical examination in the diagnosis of
acute maxillary sinusitis: a systematic review. J Clin Epidemiol
494 British Journal of General Practice, June 2002
M Lindbæk and P Hjortdahl
Table 4. Sensitivity and specificity of tests for sinusitis in adults.
Test Sensitivity (%) (95% CI) Specificity (%) (95% CI)
X-ray (air–fluid level or total opacity)a
0.73 (0.60–0.83) 0.80 (0.20–0.91)
X-ray (air–fluid level or total opacity or mucous thickening)a
0.90 (0.68–0.97) 0.61 (0.20–0.91)
Ultrasonographyb
0.76 (range = 0.44–0.92) 0.76 (range = 0.52–0.91)
CT (air–fluid level or total opacity or mucous thickening)b
Unknown 0.76 (range = 0.58–0.84)
CT (air–fluid level or total opacity)c
Unknown Unknown (PPV = 0.90)
aData from Lau J, Zucker D, Engels EA, et al. Diagnosis and treatment of acute bacterial rhinosinusitis. Evidence Report/Technology Assessment No.
9. Rockville, MD: Agency for Health Care Policy and Research, March 1999. bData from Willett LR, Carson JL, Williams JW. Current diagnosis and
management of sinusitis. J Gen Intern Med 1994; 9: 38-45. cPersonal communication, Dr Jens G Hansen, Denmark, 1996.
6. British Journal of General Practice, June 2002 495
Review article
2000; 53(9): 940-948.
9. Anonymous. Cochrane Methods Working Group on Systematic
Review of Screening and Diagnostic Tests: Recommended
Methods. http://som.flinders.edu.au/cochrane/, 1997.
10. Revonta M. Ultrasound in the diagnosis of maxillary and frontalsi-
nusitis. Acta Oto-Laryngologica 1980 [supplement]; 370: 1-55.
11. Lindbaek M, Johnsen UL, Kaastad E, et al. CT findings in general
practice patients with suspected acute sinusitis. Acta Radiologica
1996; 37(5): 708-713.
12. Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute max-
illary sinusitis in a general practice population. BMJ 1995;
311(6999): 233-236.
13. Hansen JG, Schmidt H, Rosborg J, Lund EB. Klinisk kriterium for
sinuitis maxillaris acuta i almen praksis. Ugeskrift for Laeger 1996;
158(22): 3156-3159.
14. Williams JW Jr, Roberts L Jr, Distell B, Simel DL. Diagnosing
sinusitis by X-ray: is a single Waters view adequate? J Gen Int
Med 1992; 7(5): 481-485.
15. Williams JW Jr, Simel DL. Does this patient have sinusitis?
Diagnosing acute sinusitis by history and physical examination.
JAMA 1993; 270(10): 1242-1246.
16. Willett LR, Carson JL, Williams JW Jr. Current diagnosis and man-
agement of sinusitis. J Gen Int Med 1994; 9(1): 38-45.
17. Laine K, Maatta T, Varonen H, Makela M. Diagnosing acute maxil-
lary sinusitis in primary care: a comparison of ultrasound, clinical
examination and radiography. Rhinology 1998; 36(1): 2-6.
18. Berg O, Bergstedt H, Carenfelt C, et al. Discrimination of purulent
from non-purulent maxillary sinusitis. Clinical and radiographic
diagnosis. Ann Otol Rhinol Laryngol 1981; 90(3 Part 1): 272-275.
19. Axelsson A, Runze U. Comparison of subjective and radiological
findings during the course of acute maxillary sinusitis. Ann Otol
Rhinol Laryngol 1983; 92(1 Part 1): 75-77.
20. Gwaltney JM, Jr. Acute community acquired bacterial sinusitis: To
treat or not to treat. Can Respir J 1999; 6(A): 46A-50A.
21. de Ferranti SD, Ioannidis JP
, Lau J, et al. Are amoxycillin and
folate inhibitors as effective as other antibiotics for acute sinusitis?
A meta-analysis. BMJ 1998; 317(7159): 632-637.
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