Real World Evidence (RWE, Real World Data), of the Effectiveness of Amoxicillin-Clavulanate in the Treatment of Children with Upper Respiratory Tract Infections (Tonsillitis, Otitis, Sinusitis)

Real-world evidence (RWE) is clinical evidence on a medical product’s safety and efficacy that is generated using real-world data (RWD) resulting from routine healthcare delivery. This study evaluates the clinical efficacy of amoxicillin + clavulanic acid in children with pharyngitis, acute otitis, or acute rhinosinusitis with suspected bacterial origin under normal office and home conditions. Methods: This was a real-life, prospective, observational, pharmacovigilance study. It included children of both sexes between 2 and 12 years old, with a diagnosis of Rhinopharyngitis (tonsillitis), Acute Otitis Media and Rhinosinusitis. The main effectiveness variable evaluated was reduction and time to resolution of symptoms. All patients received Amoxicillin/Clavulanic Acid suspension 600 mg/42.9 mg/5 mL at a dose of 90 mg/Kg/day in two doses, every 12 hours for 7 days. The evaluations were carried out at the beginning, at 72 hours (3rd day) and at 7 days. All patients underwent culture and antibiogram. Results: The majority of cultures were negative for pathogenic germs, suspecting unidentifiable germs, or viral etiology despite the rigorous selection of subjects following validated scores. The most frequently isolated germ was Staphylococcus aureus;growth of gram-negative bacteria was reported in 33.33% of the cultures. There was a significant improvement in symptoms in children with tonsillitis and rhinosinusitis from the first 72 hours of treatment, persisting until the 7 days. In the otitis media group, returning to normal by the tenth day. During the conduction of this investigation, no adverse effects associated with the prescribed therapy were reported.

A Preliminary Study on Effects of Zhuang Medicine Clerodendrum japonicum(Thunb.)Sweet on Acute Tonsillitis

[Objectives]To study the effect of Zhuang medicine Clerodendrum japonicum(Thunb.)Sweet on acute tonsillitis.[Methods]The antibacterial,antipyretic,anti-inflammatory and analgesic effects of the extract of Zhuang medicine C.japonicum(Thunb.)Sweet were observed.[Results]Zhuang medicine C.japonicum(Thunb.)Sweet showed a good inhibitory effect onα-hemolytic streptococcus,β-hemolytic streptococcs,Staphylococcus citreus,Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa,Proteus and Escherichia coli;it showed a good inhibitory effect on the infection of Staphylococcus aureus andβ-hemolytic streptococcs in vivo;it could significantly reduce the elevated body temperature of rabbits injected with the triple vaccine and significantly increase the pain threshold of thermally stimulated mice.[Conclusions]Zhuang Medicine C.japonicum(Thunb.)Sweet has positive significance in the treatment of acute tonsillitis instead of antibiotics.

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Tonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome.Postoperative hemorrhage of tonsillectomy is a lifethreatening complication.AIM To identify the risk factors that may contribute to primary and secondary postoperative hemorrhage in pediatric tonsillectomy.METHODS The clinical data from 5015 children,3443 males and 1572 females,aged 1.92-17.08 years,with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected.The variables including sex,age,time of onset,diagnosis,method of tonsillectomy,experience of surgeon,time when the surgery started and monthly average air temperature were abstracted.The patients with postoperative hemorrhage were classied into two groups,the primary bleeding group and the secondary bleeding group,and their characteristics were compared with those of the nonbleeding group separately.Statistical analysis was performed by chi-square test with SPSS 20.RESULTS Ninety-two patients had post-tonsillectomy hemorrhage,and the incidence rate of post-tonsillectomy hemorrhage was 1.83%.The mean age was 5.75 years.Cases of primary hemorrhage accounted for approximately 33.70%(31/92),and cases of secondary hemorrhage occurred in 66.30%(61/92).The rate of reoperation for bleeding was 0.92%,and the rate of rehospitalization for bleeding was 0.88%in all patients.Multiple hemostasis surgery was performed in 6.52%(3/46)of patients.The method of tonsillectomy(coblation tonsillectomy)and experience of the surgeon(junior surgeon with less than 5 years of experience)were significantly associated with primary hemorrhage(χ^(2)=5.830,P=0.016,χ^(2)=6.621,P=0.010,respectively).Age(over 6 years old)and time of onset(more than a 1-year history)were significantly associated with secondary hemorrhage(χ^(2)=15.242,P=0.000,χ^(2)=4.293,P=0.038,respectively).There was no signicant difference in sex,diagnosis,time when the surgery started or monthly average air temperature.There was a signicant difference in the intervention measures between the primary bleeding group and the secondary bleeding group(χ^(2)=10.947,P=0.001).The lower pole and middle portion were the common bleeding sites,followed by the upper pole and palatoglossal arch.CONCLUSION The incidence rate of post-tonsillectomy hemorrhage is low.Coblation tonsillectomy and less than 5 years’experience of surgeon contribute to the tendency for primary hemorrhage.Age and time of onset are responsible for secondary hemorrhage.

Specific Gravity of the Tonsil and the Adenoid

Purpose: When considering about adeno-tonsillar hypertrophies it is important to know their weights as well as their specific gravities. Subjects and methods: Specific gravities of 344 tonsils and 117 adenoids were measured. Results: Average specific gravities of tonsils and adenoids were 1.08 (SD: 0.0411), 1.12 (SD: 0.574) respectively. Significant difference was observed between two (p 0.002). Discussion: The palatine tonsils and pharyngeal tonsil or adenoid are in a Waldeyer’s ring. They are thought that they work for lymphatic immune systems. However, there are several differences between tonsil and adenoid. The former has capsule, and increases their weight by growth;on the contrary the latter has no capsule, shrinks by growth. Tonsils are relatively hard mass but adenoids are very soft and easily bleed by touching with cotton swabs via nose. Conclusion: At this study, specific gravity of the adenoid was heavier than that of tonsils. These results suggest that tonsil and adenoid are physiologically different.

Incidence of Malignancy in Asymmetrical Tonsillar Enlargement

Objective: To determine the incidence of carcinoma in patients with asymmetrical tonsillar enlargement. Study Design: A clinical retrospective case series based on medical records of our medical complex. Results: During a two-year period, 990 patients underwent tonsillectomy at Salmaniya Medical Complex (SMC). 59 (5.9%) of those patients had asymmetrical enlargement of their tonsils, three of whom had suspicious clinical findings at presentation. The latter were found to have tonsillar malignancy on histopathological testing. Malignancy was excluded in all other specimen. Conclusions: Since the incidence of malignancy in asymmetrical tonsils is negligible in the absence of other associated risk factors, watchful waiting may be appropriate prior to any surgical intervention. Diagnostic tonsillectomy is indicated in patients with asymmetrical tonsillar enlargement with associated suspicious clinical findings, including cervical lymphadenopathy and rapid tonsillar enlargement.

Rectal tonsil:A case report and literature review

The rectal tonsil,a reactive proliferation of lymphoidtissue located in the rectum,is rare.Histologically,benign lymphoid hyperplasia of the rectum is usuallycharacterized by large lymphoid follicles with activegerminal centers and a narrow surrounding mantlezone and marginal zone.This lesion is benign,but must be differentiated from the polypoid type of mucosaassociated lymphoid tissue lymphomas.In the current paper,we present a case of rectal tonsil in a 59-yearold woman.We describe the endoscopic ultrasound imaging findings with literature review.

Clinical and Pathological Implications of Increases in Tonsillar CD19+CD5+B Cells,CD208+Dendritic Cells,and IgA1-positive Cells of Immunoglobulin A Nephropathy

Objective:Several studies indicated that tonsillectomy can improve the prognosis of patients with immunoglobulin A nephropathy(IgAN).However,the relationship between tonsillar immunity and IgAN is still unclear.Methods:A total of 14 IgAN patients were recruited in the current study from May 2015 to April 2016 in Tongji Hospital.B cells,dendritic cells(DCs),and IgAl positive cells in human tonsils were detected using immunofluorescence and immunohistochemistry.Correlations between these cells and clinicopathologic features were evaluated.

Herpes simplex induced necrotizing tonsillitis in an immunocompromised patient with ulcerative colitis

We here present the case of a 22-year-old female of Suriname ethnicity with ulcerative colitis who received treatment with mercaptopurine and infliximab.She presented herself with a severe necrotizing tonsillitis due to herpes simplex virus type-1(HSV-1).Combination therapy consisting of immunomodulators and anti-tumor necrosis factor(TNF) agents is increasingly being used.Anti-TNF therapy is associated with an increased risk of developing serious infections,and especially patients receiving combination treatment with thiopurines are at an increased risk.We here show that HSV infections can cause a severe tonsillitis in immunocompromised patients.Early recognition is essential when there is no improvement with initial antibiotic therapy within the first 24 to 72 h.HSV infections should be in the differential diagnosis of immunocompromised patients presenting with a necrotizing tonsillitis and can be confirmed by polymerase chain reaction.Early treatment with antiviral agents should be considered especially if antibiotic treatment fails in such patients.

Ascending colon adenocarcinoma with tonsillar metastasis:A case report and review of the literature

Metastatic palatine tonsil cancer is extremely rare, with nearly 100 such tumors reported in the English literature. The prognosis of metastatic palatine tonsil cancer is poor. A 53-year-old man presented with painless left palatine tonsillar swelling and a cervical mass following right hemicolectomy for an ascending colon adenocarcinoma. Physical examination showed an ulcerated mass located on the upper pole of the left palatine tonsil. A punch biopsy was taken for histological examination which showed a moderately- differentiated adenocarcinoma. The patient was treated with palliative radiotherapy and chemotherapy. He was still alive when we wrote this paper. Our case shows that immunohistochemical diagnosis of metastatic palatine tonsil cancer is essential.

Tonsil-derived stem cells as a new source of adult stem cells

Located near the oropharynx, the tonsils are the primary mucosal immune organ. Tonsil tissue is a promising alternative source for the high-yield isolation of adult stem cells, and recent studies have reported the identification and isolation of tonsil-derived stem cells (T-SCs) from waste surgical tissue following tonsillectomies in relatively young donors (i.e., under 10 years old). As such, TSCs offer several advantages, including superior proliferation and a shorter doubling time compared to bone marrow-derived mesenchymal stem cells (MSCs). T-SCs also exhibit multi-lineage differentiation, including mesodermal, endodermal (e.g., hepatocytes and parathyroid-like cells), and even ectodermal cells (e.g., Schwann cells). To this end, numbers of researchers have evaluated the practical use of T-SCs as an alternative source of autologous or allogenic MSCs. In this review, we summarize the details of T-SC isolation and identification and provide an overview of their application in cell therapy and regenerative medicine.

Ultrasound features of primary non-Hodgkin’s lymphoma of the palatine tonsil:A case report

BACKGROUND Lymphomas are the second most common malignancy of the head and neck.In this region,the vast majority of extranodal lymphomas are located in the palatine tonsil,accounting for about 51%.Tonsillar lymphomas are aggressive tumors with intermediate-or high-grade histology.We here report a case of primary non-Hodgkin’s lymphoma of the palatine tonsil and analyze its ultrasound features.CASE SUMMARY A 40-year-old man presented with right palatine tonsil swelling for 2 mo after a cold,accompanied by dysphagia,snoring,and suffocation.He had no sore throat,fever,or history of upper respiratory tract infection or tuberculosis.The patient was generally in good health and denied other diseases.He was diagnosed with acute tonsillitis initially and treated with antibiotics for 7 d.However,there was no improvement with the treatment.Tonsil biopsy and ultrasound-guided biopsy of the biggest lymph node of the right neck showed the typical pathology of non-Hodgkin lymphoma.CONCLUSION Primary lymphoma of the tonsils is rare,and its diagnosis is challenging.Ul-trasound is a useful modality in diagnosing oropharyngeal diseases,and can clearly show the features of this tumor,but the final diagnosis should be estab-lished by histology.

Systematic Evaluation (Meta-analysis) of the Efficacy and Safety of Pudilan Xiaoyan Oral Liquid (蒲地蓝消炎口服液) in the Treatment of Suppurutive Tonsillitis in Children

To systematically evaluate the efficacy and safety of Pudilan Xiaoyan Oral in Liquid(蒲地蓝消炎口服液)in the treatment of suppurative tonsillitis in children.In WanFang,CNKI,VIP,CBM,PubMed,Embase and Corchrane and other databases,relevant literatures about Pudilan Xiaoyan Oral Liquid(蒲地蓝消炎口服液)in the treatment of pediatric suppurative tonsillitis were searched.The retrieval time was from the establishment of the database to April 2019.Relevant randomized controlled trials were extracted.The control group was treated with conventional antibiotics,and the observation group was treated with Pudilan Xiaoyan Oral Liquid(蒲地蓝消炎口服液)based on the control group.After they were summarized and analyzed,Cochrane Handbook 5.1 evaluation standard and RevMan 5.3 software were used to determine the quality of literature.A total of 172 literatures were retrieved and 23 randomized controlled trials were included.A total of 1188 children were in the experimental group while 1175 children were in the control group,involving 2363 children with suppurative tonsillitis.Meta-analysis showed that the total effective rate of Pudilan Xiaoyan Oral Liquid(蒲地蓝消炎口服液)combined with routine treatment was better than that of routine treatment(RR=0.88,95%CI(0.86,0.91),P<0.00001);Pudilan Xiaoyan Oral Liquid(蒲地蓝消炎口服液)combined with routine treatment in children was better than that of routine treatment alone in term of temperature recovery,sore throat time,the reduction of tonsil purulent secretion.There were few reports of adverse reactions and no serious adverse reactions.To sum up,Pudilan Xiaoyan Oral Liquid(蒲地蓝消炎口服液)combined with routine treatment can significantly improve the efficacy of children with suppurative tonsillitis,but due to the low quality of the included literature,it should be used cautiously.It is suggested that clinical randomized controlled trials should be designed with large sample size,multi-centers and conforming to international standards to improve the quality of evidence.

Histiocytic sarcoma of tonsil:a case report

In this article,a case of histiocytic sarcoma(HS) arising from tonsil in a 60 year-old male patient was reported.Consideried a local disease,a regime consisting of 4 cycles of(CHOP) associated with radiotherapy was used.A positive result was gained after treatment.But HS is a rare hematopoietic neoplasm derived from hematopoietic monoblasts with aggressive characteristic and poor outcome.Stage of disease and tumor size are possibly associated with the prognosis.

Carcinosarcoma of the Palatine Tonsil—Diagnostic and Treatment Approach. Literature Review: Clinical Case

Introduction: Carcinosarcoma of the head and neck is a very rare pathology < 1%. This is a mixed tumor with epithelial and mesenchymal components. It is characterized by high recurrence, metastasis, and mortality rates. Aim: The sporadic nature of carcinosarcomas of the oral cavity, sinonasal tract, larynx, and hypopharynx causes difficulties with the diagnostic and therapeutic approach. Our clinical case is an example of a rare localization of carcinosarcoma, which allows for a detailed examination thereof. Materials and methods: We present a clinical case of a 67-year-old male, admitted to the Otorhinolaryngology Clinic of University Hospital “Sv. Georgi”—Plovdiv, presenting with difficulty swallowing and a lump on the right side of the neck for several months. Computed tomography was performed and a tumor involving the right palatine tonsil was found. The tonsil was surgically removed. The histopathological findings showed a biphasic tumor with epithelial and mesenchymal components—carcinosarcoma. Results: Following monotonsillectomy, the patient was referred to radiotherapy. The local status does not indicate any progression and infiltration into soft tissue. Conclusion: Carcinosarcoma is a malignant mixed tumor with high recurrence, metastasis, and mortality rates. It is difficult to diagnose due to its non-typical location and the need for immunohistochemistry testing, which is not always possible. The therapy for carcinosarcoma of the head and neck is delivered as per protocol for treatment of squamous cell carcinoma due to the absence of a specific one.

Squamous Inclusion Cyst in the Palatine Tonsil Mimicking a Tumor

Squamous inclusion cyst is a rare benign cystic lesion most commonly affecting the floor of mouth in the oral cavity. Its presence in the palatine tonsil of the oropharynx is an extremely rare occurrence. We highlight a case of an elderly female who was histopathologically diagnosed as squamous inclusion cyst of the palatine tonsil. We shall discuss the presentation, diagnosis, management and postoperative follow-up of the case.

Primary Tuberculosis of Tonsil in a Diabetic Patient—A Case Report

Though Tuberculosis is one of the most common causes of ill health and death worldwide, people with diabetes have 2 - 3 times higher risk of tuberculosis when compared with people without diabetes. Though tuberculosis can affect any part of the body, oral and oropharyngeal tuberculosis is rare, but reported. And it’s association with diabetes mellitus because of the decreased host mechanism, is still rare, but reported. A 50-year-old female diabetic who was on insulin therapy came to OPD of MGM hospital, Kakatiya Medical College, Warangal with complaints of severe pain in throat for the last 6 months. On examination, right tonsil was enlarged with granular surface. Left tonsil and rest of the oropharynx were normal. Examination of chest was normal and there was no evidence of pulmonary tuberculosis. Punch biopsy revealed tuberculosis of tonsil. Isolated cases of primary tuberculosis of tonsil without evidence of pulmonary tuberculosis are rare. Presence of diabetes mellitus makes patients 2 - 3 times more vulnerable for tubercular infection.

Incidental Finding of Isolated Rosai-Dorfman Disease in the Tonsils of a 4-Year-Old Girl: A Case Report and a Brief Review of Current Practice in Tonsillectomy Specimen Handling

We report herein a case of isolated Rosai-Dorfman disease (Sinus Histiocytosis with Massive Lymphadenopathy) diagnosed upon routine microscopic examination of tonsils in a child. The patient is a 4 year old girl who had a history of sleep apnea, but no other significant medical history or other findings on physical examination. In this report, we discuss the various approaches to handling of tonsillectomy specimens. We also discuss the value of routine microscopic examination, providing a list of case examples of incidental, clinically important, findings that can be missed if a microscopic examination of tonsils was not performed. We finally discuss the clinical significance of finding histologic evidence of Rosai-Dorfman disease in a child.

A Pedunculated Fibrolipomatous Polyp of Tonsil: A Rare Case Report

Lipoma being the most common mesenchymal tumour of the body is rare in head and neck region. Fibrolipoma is a rare benign tumour of palatine tonsil which may present a pedunculated lesion in oropharynx and can cause dysphagia, foreign body sensation in throat, sleep disturbance and voice change. Our patient presented with foreign body sensation in throat. Examination showed pedunculated polypoidal mass arising from right palatine tonsil, treated with tonsillectomy under general anaesthesia. Histopathological examination confirmed as fibrolipoma of tonsil. Malignant transformation in fibrolipoma is very rare but some cases have been reported. Hence patient was followed up for two years and no recurrence noted.

Tuberculous Peritonsillar Abscess: A Case Report in Malaysia

Tonsillitis is one of the most common presentations to the primary care clinic. Majority of the tonsillitis is viral etiology and occasionally is caused by bacteria such as streptococcal pharyngo-tonsillitis. However, if tonsillitis lasts longer than a week and associated with cervical lymph nodes, other differential diagnoses should be considered. This case report illustrated a patient who presented with fever, sore throat and odynophagia which lasted for one week then developed trismus. Examination revealed a left tonsillar hypertrophy with soft palate swelling and pus aspirated from the tonsil revealed positive smear to Acid-fast Bacilli and he responded to anti-tuberculosis treatment.

Tonsillitis and Their Complications: Epidemiological, Clinical and Therapeutic Profiles

Tonsillitis or angina, is considered as an inflammation of the palatine tonsils most often of infectious origin. It can be acute or chronic. The germs in question are mostly viruses and bacteria. Objectives: The objective of this work was to study the epidemiological and therapeutic profile of tonsillitis and their complications in the ENT Department and Head and Neck Surgery of the Mother-Child University Hospital in Luxembourg. Patients and Methods: This is a prospective study over a 12-month period from January 2018 to December 2018, including all patients who presented with tonsillitis and/or their complications. Results: Three hundred and fifteen (315) patients were collected during this period. The average age in our study was 14.25 years with extremes ranging from 2 years to 61 years. The sex ratio was 0.65 in favor of the female sex. During this period we recorded 80.95% of cases of uncomplicated tonsillitis including 60.50% for acute tonsillitis, 24.5% for chronic tonsillitis 5% for adenoid tonsillitis and 19.05% for complications. Complications included peritonsillar phlegmon 42.22%, heart disease 33.33%, cervical cellulitis 8.89%, adeno-phlegmon 6.67%, para-pharyngeal abscess 4.44%, and sepsis 4.44%. The exclusive medical treatment was performed in 44.31%. Surgical treatment (drainage incision and tonsillectomy) was performed in 55.69%. Conclusion: Tonsillitis and its complications represent an important pathology in ENT. Feynophagy febrile is the pair-origin symptom that can lead to the diagnosis. The prevention of complications is the guarantor of the reduction of its morbidity. We recommend that in the absence of RDT (Rapid Diagnostic Test), it is necessary to systematize antibiotic therapy to prevent serious complications.