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Peritonsillar abscess Emily Macassey, Patrick J D Dawes In this issue of the NZMJ, Love et al1 report interesting observations about patterns of epidemiology and microbiology of peritonsillar abscess (PTA) in Canterbury and make comparisons with previous studies performed at Christchurch Hospital. The report contains some valuable observations when it comes to the treatment of the condition. Peritonsillar abscess (also known as quinsy) is a potentially life-threatening infection of the potential space adjacent to the tonsillar capsule in the oropharynx. It can be difficult for doctors unfamiliar with PTA to differentiate it from severe tonsillitis but unilaterality of symptoms and inability to swallow saliva are good indicators. The main differentiating signs seen are trismus, swelling or bulging of the soft palate, medialisation of the tonsil and deviation of the uvula.2 PTA is life-threatening because of both its potential for airway obstruction and spread to the parapharyngeal and retropharyngeal spaces. It is reported that George Washington probably died from quinsy in 1799.3 It is reassuring that 97.3% of isolates are reported as penicillin sensitive. Penicillin remains the first-line antibiotic for all tonsillar infections and this is the sole agent used in many New Zealand hospitals. In other countries resistance rates vary from 10– 50%.4 In a survey of UK consultants, 28% had a preference for penicillin monotherapy, whilst penicillin combined with metronidazole was the choice of 44%.3 Research has shown that even when patients have penicillin resistant organisms, treatment with aspiration and parenteral penicillin still achieves clinical resolution.5 This is in accordance with principles of abscess management where drainage is paramount.
H ypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects. Objective: Search for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis. Method: A prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils). Results: The patients’ ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (≥ 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (≤ 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I. Conclusion: This study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups.
Fact Sheet for Medicaid and CHIP Providers Influenza A (H1N1) Flu Vaccination Coverage • The H1N1 vaccine will not be part of the Vaccines for Children (VFC) program. • Children up to the age of 21 in the Medicaid program are entitled under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit to receive vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). The 2009 H1N1 vaccine is on the ACIP list of recommended vaccines. • Children up to the age of 19 in the CHIP program are covered for vaccines recommended by ACIP, which includes the 2009 H1N1 vaccine. • States may not impose cost sharing on children or pregnant women in Medicaid or CHIP for the administration of the vaccine. • For adults in the Medicaid program, 2009 H1N1 vaccine administration is a covered service when furnished by a participating provider under the mandatory section 1905(a) Medicaid benefit. Since hospital, physician and federally qualified health center/rural health clinic (FQHC/RHC) services are mandatory Medicaid benefits, 2009 H1N1 vaccine administration would be a covered service when provided by these participating providers. Vaccine Reimbursement • The H1N1 vaccine will be free to providers, and the distribution system being used to deliver the vaccine is the same as VFC program. However, because the H1N1 was purchased outside of the VFC program, the vaccine administration fee will be reimbursed outside of the VFC program. • Medicaid and CHIP will cover the vaccine administration fee for children and pregnant women. Most States also reimburse administration fees for adult vaccines. • Providers will be reimbursed for the administration of the vaccine according to the vaccine reimbursement rate stated in their State’s Medicaid plan or CHIP plan. Because the H1N1 vaccine will be purchased and distributed outside of the VFC program, States may set the rates for the administration of the H1N1 vaccine without regard to the reimbursement limitations in the VFC program. CMS has encouraged States to review the vaccine administration fees outside of their VFC programs to ensure they are adequate to provide broad access to the 2009 H1N1 vaccine.
Should you get a prostate cancer screening? Talk with your doctor. You can also learn more at cancer.org/cancer/prostatecancer/index. Symptoms When the prostate gets bigger because of cancer, it can squeeze the urethra. This stops or slows down the flow of urine. This may be a sign of prostate cancer. But other health conditions can cause the same problem, so check with your doctor if this happens to you. The same is true for these prostate cancer symptoms: Frequent urination (especially at night) }} Difficulty urinating }} Pain or burning during urination }} Blood in the urine or semen }} Nagging pain in the back, hips or pelvis }} Painful ejaculation }} Screening for prostate cancer Not all men have symptoms when they have prostate cancer. Routine screenings can be done to find it, but the decision to get a prostate cancer screening is yours. Not all health and medical organizations agree on whether screenings are right for everyone. Talk to your doctor about the risks and benefits. Sources: Centers for Disease Control and Prevention website: CDC Features: Prostate Cancer (accessed February 2013): cdc.gov. National Cancer Institute website: What You Need to Know about Prostate Cancer (accessed February 2013): cancer.org. American Cancer Society website: Prostate Cancer (accessed February 2013): cancer.gov. This information is meant to be educational. It should not be interpreted as medical advice. Please talk to your doctor about changes that may affect your health. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO
About this booklet This booklet is for you if you have prostate cancer that has spread to other parts of the body and are experiencing symptoms such as bone pain. This is called advanced prostate cancer. If you are a partner or relative of a man with advanced prostate cancer, you may also ﬁnd it helpful. We describe the possible symptoms you might experience, and treatments for advanced prostate cancer. You can also ﬁnd information about emotional, practical and spiritual support. This booklet is a general guide but everybody’s experience of advanced prostate cancer is different. You may ﬁnd it helpful to dip into this booklet for the information that is relevant to you. If you would like more detailed information you can speak to your doctor or nurse at the hospital or your GP. You can also speak to our Specialist Nurses by calling our conﬁdential helpline. The following symbols appear throughout the booklet to guide you to sources of further information: Prostate Cancer UK Specialist Nurse helpline Prostate Cancer UK publications If you would like to know more about anything you read in this booklet, you can call our Specialist Nurses on our conﬁdential helpline. Helpline 0800 074 8383 prostatecanceruk.org What is palliative care? If you have advanced prostate cancer, you may hear the term palliative care. Palliative care aims to relieve pain and other symptoms. It also provides men with emotional, physical, practical and spiritual support to help deal with advanced prostate cancer. Palliative care can be provided at any stage of advanced prostate cancer. It is not just for men in the ﬁnal stages of life. Men with advanced prostate cancer might have palliative care for many months or years. The photos in this booklet are of people personally affected by prostate cancer. The personal experience quotations we use are not always attributed to the photos they accompany.
Flexible power options are critical when you’re constantly on the move. The AC or DC Power Adapter gives EMS responders the ability to charge their LIFEPAK 15 device from power outlets within a vehicle, streamlining ongoing power maintenance and ensuring their 15 is always ready to respond. With the ability to rapidly disconnect, no additional time is needed to transport the 15 to the site of the emergency. Managing device readiness is an ongoing task in the hospital environment. Physio-Control can help streamline these activities by allowing each 15 to constantly charge from any standard AC power outlet through a power adapter securely mounted to the crash cart, wall or other hard surface. By reducing the need to swap-out batteries, this both simplifies protocols and gives you the confidence that your LIFEPAK 15 device will be ready when you need it. In the event of a Code, the monitor/defibrillator easily disconnects from the power cable to reduce steps during a time-sensitive emergency. The AC power adapter can be easily mounted to your LIFEPAK 15 monitor/defibrillator with its attachment kit. The power adapter kit is intended for indoor use only and not intended for use in a vehicle.
Studies indicate that between 75-90% of the medical symptoms that people describe to their family practice physicians are due either to self-limiting conditions (colds, flu, other infections) or to stress. Stress can create medical symptoms directly—headaches, palpitations, body pains, fatigue, rashes and high blood pressure, to name a few—and can also make symptoms due to other causes worse. Learning to reduce your stress can impact dramatically on how you feel and on the quality of your life. In fact, reducing your stress can mean the difference between feeling fully alive and functioning at your peak, versus feeling ill and functionally compromised. The following medical symptom checklist was created by my colleagues Jane Leserman, Ph.D. and Claudia Dorrington when I was director of the Mind/Body Clinic at what was then Boston's Beth Israel Hospital, and is now the Beth Israel/Deaconess Medical Center. We asked our patients—most of whom came to us with symptoms either caused by or made worse by stress-for letters of referral from their physicians so that we could be sure that their medical symptoms had been properly assessed and treated insofar as possible. For that reason, it is important for you to make sure that any physical or mental symptoms that you might be experiencing have been properly evaluated before trying any self-help approaches. Then you can rest assured that no helpful medical treatment has been overlooked. That said, researchers in the field of wisdom rate self-reflection as the most important kind of wisdom. If you don't know where you are, it's hard to tell which way you're going. For that reason, continuing self-reflection is a cornerstone of stress management, and integral to minding the body, and mending the mind. (By the way, you can get information on how to manage your stress in my book Minding the Body, Mending the Mind which is based on the program I developed at a Harvard Medical School teaching hospital. As you fill out the following medical and psychological symptoms checklists, hopefully you'll learn some valuable things about yourself. Should you feel that you need help, based on completing these questionnaires, make sure to ...
Rupal Hospital for Women is a premiere leader in women's healthcare since 45 long years. The doctors at Rupal Hospital are committed to provide highest quality of healthcare to its patients in all stages of their lives from pregnancy to menopause. We are one stop place for all gynaec problems and our expertise lies in providing affordable Laparoscopic surgeries and difficult cases of infertility like IVF, ICSI, IUI, TESA/MESA, Egg, Sperm and embryo freezing, Egg /sperm/Embryo Donation, Surrogacy. We also provide to our patients information regarding pre care and post care of pregnancy related issues. Dr. Malti Shah believes that preventive interventions are equally important as curative medicine, and prevention always requires awareness and educations. She monitors the patients and gives them advise and educates them on changing seasons and its implications from time to time on their health and baby’s health. You can contact the team of doctors in Rupal Hospital at http://www.rupalhospital.com
http://www.creative-diagnostics.com/ Creative Diagnostics manufactures and markets worldwide the highest quality; innovative; specialty immunoassays. Fully-automated and semi-automated system options are available utilizing advanced direct label technology to meet the throughput needs of both large and small independent and hospital laboratories