Paradise Criteria for Tonsillectomy

The Paradise criteria for tonsillectomy was given by AAO-HNS for tonsillectomy in paediatric and adolscent age group.

Minimum number of sore throat in a year

            Atleast 7 in the previous year

            OR Atleast 5 in each of two previous years

            OR Atleast 3 in each of three previous years

With Clinical feature of Sore throat along with atleast one of the following

            Fever > 100.9^oF (38.3^oC )

            OR Tender Cervical Lympadenopathy of size > 2 cm

            OR Tonsillar exudate

            OR Culture positive for GABH (Group A β Hemolytic Streptococcus)

With Administration of adequate dosing of ANTIBIOTIC for proven or suspected GABH infection. 

Know the difference between membranous tonsillitis and diptheria.

What are the causes of membranes over the tonsils?

Difference between adenoid and Tonsils.

Do you know how your examiner wants to hear the examination of oral cavity during your OSCE and Clinical Skills. Follow link.

2017 WHO Recommendation for treatment of TB . Things you must know !!!

2017 WHO Recommendation for treatment of TB : Things you must know !!!

1.     Drug and Dosing

a.      The 2017 guideline from WHO strongly suggest the use of RIFAMPICIN based drug regimen ( 2HRZE + 4HR) for 6 months compared to 4 months course with FLUOROQUINOLONE group of drug.

b.     Always use fixed dose combination formulation for treating drug susceptible TB   than individual drug regimen.

c.      The WHO recommends use of DAILY DOSING of drugs compared to THRICE A WEEK regimen in both intensive and continuation phase.

2.      HIV and PTB

a.      ART should be started in all patient living with HIV irrespective of CD4 counts.

b.     TB treatment should be started first followed by ART within 8 weeks (as early as possible). If CD4 cell count is less than 50, it should be started with in 2 weeks.

c.      A 6 months regimen of ATT is enough for patient under ART and 8 months course is not needed.

3.     Steroid

a.      WHO strongly recommends the initial use of steroid (Dexamethasone / Prednisolone) tapered over a period of 6-8 weeks in TB MENINGITIS. While the use of steriod of pericarditis the conditionally recommended.

4.     Retreatment

a.      Category II (2HRZES+1HRZE+5HRE) should no longer be prescribed  

without Drug sensitivity and testing.

Know about various Focuses and Complexes seen in Tuberculosis

The recommendations that still holds valid from 2010 are:

 

1.     Drug and Dosing

a.      New patient with PTB must receive 6 months of ATT therapy (2HRZE + 4HR) that is a Rifampicin based therapy and NOT that contains 2HRZE + 4HE.

b.     The use of daily dosing regimen should be practiced as far as feasible and twice daily dose should never be  used. There were recommendation for use of thrice weekly dose however the newer recommdation strongly favors use of daily dosing regimen.

c.      In areas with high resistance for Isoniazid, the expert recommend the use of HRE in continuation phase rather than HR alone.

d.     The extension of intensive phase is NOT recommended strongly even if the patient is not sputum negative at the end of Intensive phase

2.     TB and HIV

a.      WHO strongly recommends use of Rifampicin based therapy for the patients living with TB and HIV or patient living in high TB prevalent area.

b.     The duration should be NO LESS THAN those with HIV NEGATIVE status that is 6 months.There was suspicion over need of prolonged therapy but the newer recommedation suggests 6 month is sufficient.

c.      The DAILY DOSE THERAPY is recommended.

3.     Re-treatment

a.      The specimen for culture and sensitivity must be obtained in any patient going for re-treatment and sensitivity testing must be done at least for ISONIAZID and RIFAMPICIN.

b.     If possible the therapy should be guided based upon Rapid Molecular susceptibility testing.

For other details and full text follow the link to http://apps.who.int/iris/bitstream/10665/255052/1/9789241550000-eng.pdf?ua=1

Modification in Acute Rheumatic Fever Diagnostic Jones Criteria

The previously recommended diagnostic criteria used in Acute Rheumatic Fever has been modified in 2014 by the WHO and American Heart Association. Segregartion of the risk group into High risk and low risk group is an important feature.Low risk population are those who have incidence of RHD (Rhematic Heart disease) less than or equal to 1/1000 population/year and incidence of ARF (Acute Rheumatic Fever ) less than or equal to two /100000 population.

The previously accepted Jones Criteria still holds true for the low risk population.

HOWEVER, in the high risk population just the presence of MONOARTHRITIS or POLYARTHALGIA is sufficient to diagnose the ARF as MAJOR CRITERIA unlike in previous system where polyarthritis was must. 

Similarly in Minor Criteria the presence of MONOARTHALGIA is sufficient to daignose the condition. The value of ESR measured on the 1st hour with a value >= 30mm/hr is sufficeint  in low reisk populationwhile that of >= 60mm/hr is needed in low risk population to consider acute  rheumatic fever.

Presence of Clinically evident Sydenham Chorea is enough to diagnose the ARF.

Similarly, Arthritis with Carditis is enough to diagnose the condition.

Presence of Subcutaneous nodule or Erythema Marginatum with one of the major criteria diagnoses the condition.

Revised Jones Criteria 2014
Screenshot taken from http://circ.ahajournals.org/content/early/2015/04/23/CIR.0000000000000205

Visit http://circ.ahajournals.org/content/early/2015/04/23/CIR.0000000000000205 the site and download the PDF file for full details.