[Acute purulent otitis media in children]

OBJECTIVE

Improving the effectiveness of inpatient care for children with acute purulent otitis media.

MATERIAL AND METHODS

100 children at the age from 0 to 18 years were inspected from January to August 2021. The main diagnostic methods included otoscopy, pharyngoscopy, rhinoscopy. Bacteriological examination of the pus from the ear was done for all patients.

RESULTS

Acute purulent otitis media is a common cause of hospitalization in children aged 0 to 3 years. The main causative agents of the disease in toddlers are Staphylococcus aureus and pneumococcus (38%), in preschoolers and primary school children - pyogenic streptococcus and pneumococcus (30%), in high school students - Staphylococcus aureus.

[Effectiveness of baloon dilation of Eustachian tube in children with otitis media with effusion]

Otitis media with effusion is one of the most common ENT diseases in childhood. Absence of acute symptoms, prevalence of pathology among preschoolers, who often cannot complain on discomfort in the ears and hearing loss, lead to late diagnosis and treatment. Standard surgery is highly effective, but it is not able to help all patients. A new, minimally invasive technique of surgical treatment of otitis media with effusion - balloon dilation of the Eustachian tube provides additional opportunities in solving these problems.

OBJECTIVE

To evaluate the effectiveness and possibilities of its increasing in balloon dilation of the auditory tube in children with chronic otitis media with effusion. 34 children with chronic otitis media with effusion were under observation, who underwent 54 operations using a balloon catheter for the auditory tubes. The mismatch between the pressure value and the baloon diameter has been experimentally shown, and therefore a technique for intraoperative control of the effectiveness of the procedure has been developed. The effectiveness of balloon dilation in the study was 30.8-64.3%, depending on the following factors: the stage of otitis media at which the treatment was carried out, the combination of balloon dilation with tympanostomy, the use of intraoperative efficiency control technique. The high safety of the operation and the possibility of its effective implementation in patients with an operated cleft-palate are shown.

[The cochlear implantation in patients with syndromic deafness. Clinical examples]

OBJECTIVE

To describe clinical observations of patients with syndromic deafness.

RESULTS

Deaf patients with CHARGE, Crouzon, and Wildervanck syndromes were monitored at the Russian Research Clinical Center for Audiology and Hearing Rehabilitation (Moscow) in different years. All of them were diagnosed having bilateral congenital deafness. After collecting anamnesis, evaluating the results of computed tomography of the temporal bones, and audiological examination, it was decided to conduct the cochlear implantation.

CONCLUSION

The only method that allows patients with bilateral congenital deafness to gain hearing is the cochlear implantation. The malformations of the tympanic cavity structures, an abnormal course of the facial nerve canal lead to technical difficulties during the surgical stage of cochlear implantation. The navigation equipment, monitoring of the facial nerve makes it easier to find anatomical structures, as well as to avoid injuries.

[Peculiarities of preparing a patient with a cochlear implant for a magnetic resonance imaging]

OBJECTIVE

To develop an algorithm of actions aimed at preparing a patient with a cochlear implant for magnetic resonance imaging (MRI).

MATERIAL AND METHODS

A deaf patient after bilateral cochlear implantation (CI) came to St. Vladimir Children's City Clinical Hospital (Moscow) with symptoms of the demyelinating disease for MRI of the brain and spinal cord. Magnet were removed for MRI, then new magnets were installed.

CONCLUSION

The temporary removing magnet for MRI of the brain and spinal cord allows to significantly reduce artifacts of MRI images.

[The main steps in treatment of the children with otitis media with effusion]

MATERIAL AND METHODS

361 children at age from 11 months to 18 years with otitis media with effusion (OME) were inspected after tympanostomy during 2013-2018 years. Treatment was carried out in accordance with the stages of OME: secretory, mucous, fibrous. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, computed tomography. Surgical treatment may be required already at the secretory stage of the disease, as well as in all cases with mucous and fibrous stages of OME.

RESULTS

In children with recurrences of OME and in patients with congenital cleft lip and palate, it is preferable to use long-wearing ventilation tubes and balloning of the auditory tubes. The effectiveness of surgical treatment of OME was 97.6%.

CONCLUSION

The authors recommend dispensary observation of patients with OME for 12-24 months.

[The main steps in treatment of the children with otitis media with effusion]

THE AIM

Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT.

MATERIAL AND METHODS

Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant.

RESULTS

In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable.

CONCLUSION

Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.

Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up

SETTING

Patients who initiated treatment for multidrug-resistant tuberculosis (MDR-TB) at 15 Programmatic Management of Drug-resistant Tuberculosis (PMDT) health facilities in the Philippines between July and December 2012.

OBJECTIVES

To describe patients' views of current interventions, and suggest changes likely to reduce MDR-TB loss to follow-up.

METHODS

In-depth interviews were conducted between April and July 2014 with MDR-TB patients who were undergoing treatment, had finished treatment at the time of the interview (controls), or had been lost to follow-up (LTFU). Responses were thematically analyzed.

RESULTS

Interviews were conducted with 182 patients who were undergoing or had completed treatment and 91 LTFU patients. Views and suggestions could be thematically categorized as approaches to facilitate adherence or address barriers to adherence. The top themes were the need for transportation assistance or improvements to the current transportation assistance program, food assistance, and difficulties patients encountered related to their medications. These themes were addressed by respectively 63%, 60%, and 32% of the participants.

CONCLUSIONS

A more patient-centered approach is needed to improve MDR-TB treatment adherence. Programs should strive to provide assistance that considers patient preferences, is adequate to cover actual costs or needs, and is delivered in a timely, uninterrupted manner.

[The role of computer and magnetic resonance imaging in patients with deafness]

The objective of the present study was to evaluate the potential of CT and MRI for diagnostics of congenital and acquired pathology of the inner ear in the deaf patients. Two groups of the patients were examined. The first group consisted of 75 patients with congenital or acquired deafness etiology. The second group was comprised of 75 patients with deafness associated with acute bacterial meningitis suffered in the preceding period. All the patients were examined by CT and MRI of temporal bones. The results of the study provided a basis for the development of indications for the application of CT and MRI to examine the patients presenting with hearing loss and deafness.

CONCLUSION

CT and MRI make it possible to identify individual features of the temporal bone structure significant for the surgical treatment. MRI appears to have an advantage over CT for diagnostics of early obliteration of the cochlea. Both CT and MRI are the optional methods for the examination of the patients with deafness developing after meningitis.

Multidrug-resistant tuberculosis patients lost to follow-up: self-reported readiness to restart treatment

SETTING

Multidrug-resistant tuberculosis (MDR-TB) patients lost to follow-up (LTFU) from Programmatic Management of Drug-resistant Tuberculosis facilities in the Philippines.

OBJECTIVES

To gain insight into patients' readiness to return to treatment.

METHODS

MDR-TB patients who initiated treatment and were categorized as LTFU were identified using TB registers, contacted, and asked to consent to an interview and medical record review. At the conclusion of the interview, patients' readiness to restart treatment was assessed and examined in relation to demographic, clinical, and interview data. Odds ratios were calculated.

RESULTS

When asked if they would consider restarting MDR-TB treatment, 3% of the 89 participating patients reported that they had already restarted, 34% indicated that they wanted to restart, 33% had not considered restarting, 28% were undecided, and 2% had decided against restarting. Patients who wanted to restart treatment were more likely to report having borrowed money for TB-related expenses (OR 5.97, 95%CI 1.27-28.18), and were less likely to report being self-employed (OR 0.08, 95%CI 0.01-0.67), or perceive themselves at low or no risk for TB relapse (OR 0.30, 95%CI 0.08-0.96) than patients who did not indicate an interest in restarting treatment.

CONCLUSIONS

Efforts to re-engage LTFU patients in care should consider financial barriers, knowledge gaps, and personal adherence challenges in patients.

[Cholesteatoma of the external and middle ear in the childhood]

The objective of the present work was to enhance the effectiveness of diagnostics of cholesteatoma of the external and middle ear in the children. The study included 66 patients presenting with chronic suppurative otitis media and one child having cholesteatoma of the external auditory meatus. All the patients were examined with the use of otoendoscopy and CT of the temporal bones. It was shown that the frequent occurrence of acute suppurative otitis media, exudative suppurative otitis media, and adhesive otitis media is the risk factor of the development of cholesteatoma of the external and middle ear in the children. The following CT features of cholesteatoma of the external ear were revealed: the sclerotic or mixed type of the mastoid process, the presence of pathological contents in the epitympanic space, homogeneous character of pathological contents in the antrum, widened aditus, caries of antrum walls, the presence of soft tissues around the auditory ossicles, destruction of the long process of the anval bone, and a soft-tissue structure in the external auditory meatus.

[Peculiarities of the treatment of the patients presenting with exudative otitis media]

The objective of the present study was to enhance the effectiveness of provision of medical assistance and to standardize the approaches to its realization for the patients presenting with exudative otitis media (EOM). A total of 67 children (103 cases) at the age varying from 11 months and 17 years were available for the examination after the surgical treatment. The secretory phase of exudative otitis media was diagnosed in 23.5% of the children, mucous phase in 68%, and fibrous phase in 8.5%. The results of the study indicate that diagnostics of EOM requires the application of such methods as otomicroscopy, endoscopy, and tympanometry. Computed tomography of temporal bones may be helpful to distinguish between the complicated cases of exudative otitis media and other diseases of the middle ear. Tympanostomy is possible to perform in the secretory phase of the disease and in all the patients at the mucous and fibrous stages. The preferred localization of tympanostomy is thea ntero-inferior quadrant of the tympanic membrane. It is recommended to place long-term ventilation tubes in the children presenting with recurrent EOM and labial or palatal cleft. The authors managed to achieve the 97.6% effectiveness of the surgical treatment of exudative otitis media. The 12-24 month long follow-up period is recommended.

Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis

OBJECTIVE

To identify predictors of initial sputum culture conversion, estimate the usefulness of persistent positive cultures at different time points in predicting treatment failure, and evaluate different definitions of culture conversion for predicting failure among patients with multidrug-resistant tuberculosis (MDR-TB) in five countries, 2000-2004.

METHODS

Predictors of time to conversion were identified using multivariate Cox proportional hazards regression modeling. Receiver operating characteristic curves were plotted to visualize the effect of using different definitions of 'culture conversion' on the balance between sensitivity and specificity.

RESULTS

Overall, 1209/1416 (85%) of patients with baseline positive cultures converted in a median of 3.0 months (interquartile range 2.0-5.0). Independent predictors of less likely conversion included baseline positive smear (hazard ratio [HR] 0.60, 95%CI 0.53-0.68), resistance to pyrazinamide (HR 0.82, 95%CI 0.70-0.96), fluoroquinolones (FQs; HR 0.65, 95%CI 0.51-0.83) or thioamide (HR 0.83, 95%CI 0.71-0.96), previous use of FQs (HR 0.71, 95%CI 0.60-0.83), poor outcome of previous anti-tuberculosis treatment (HR 0.69, 95%CI 0.54-0.88) and alcoholism (HR 0.74, 95%CI 0.63-0.87). The maximum combined sensitivity (84%) and specificity (94%) in predicting treatment failure was based on lack of culture conversion at month 9 of treatment, assuming conversion is defined as five consecutive negative cultures.

CONCLUSION

Patients with identified risk factors were less likely to achieve sputum culture conversion during MDR-TB treatment.

Performance of Cepheid ® Xpert MTB/RIF ® and TB-Biochip ® MDR in two regions of Russia with a high prevalence of drug-resistant tuberculosis

The purpose of this study was to assess the performance of Cepheid® Xpert MTB/RIF® ("Xpert") and TB-Biochip® MDR ("TB-Biochip"). Sputum specimens from adults with presumptive tuberculosis (TB) were homogenized and split for: (1) direct Xpert and microscopy, and (2) concentration for Xpert, microscopy, culture [Lowenstein-Jensen (LJ) solid media and Mycobacteria Growth Indicator Tube® (MGIT)], indirect drug susceptibility testing (DST) using the absolute concentration method and MGIT, and TB-Biochip. In total, 109 of 238 (45.8 %) specimens were culture-positive for Mycobacterium tuberculosis complex (MTBC), and, of these, 67 isolates were rifampicin resistant (RIF-R) by phenotypic DST and 64/67 (95.5 %) were isoniazid resistant (INH-R). Compared to culture of the same specimen, a single direct Xpert was more sensitive for detecting MTBC [95.3 %, 95 % confidence interval (CI), 90.0-98.3 %] than direct (59.6 %, 95 % CI, 50.2-68.5 %) or concentrated smear (85.3 %, 95 % CI, 77.7-91.1 %) or LJ culture (80.8 %, 95 % CI, 72.4-87.5 %); the specificity was 86.0 % (95 % CI, 78.9-91.3 %). Compared with MGIT DST, Xpert correctly identified 98.2 % (95 % CI, 91.5-99.9 %) of RIF-R and 95.5 % (95 % CI, 85.8-99.2 %) of RIF-susceptible (RIF-S) specimens. In a subset of 104 specimens, the sensitivity of TB-Biochip for MTBC detection compared to culture was 97.3 % (95 % CI, 91.0-99.5 %); the specificity was 78.1 % (95 % CI, 61.5-89.9 %). TB-Biochip correctly identified 100 % (95 % CI, 94.2-100 %) of RIF-R, 94.7 % (95 % CI, 76.7-99.7 %) of RIF-S, 98.2 % (95 % CI, 91.4-99.9 %) of INH-R, and 78.6 % (95 % CI, 52.1-94.2 %) of INH-S specimens compared to MGIT DST. Xpert and Biochip were similar in accuracy for detecting MTBC and RIF resistance compared to conventional culture methods.

Rifampicin-resistant Mycobacterium tuberculosis: susceptibility to isoniazid and other anti-tuberculosis drugs

Based on data from 14 Supranational Tuberculosis (TB) Reference Laboratories worldwide, the proportion of rifampicin (RMP) resistant isolates that were isoniazid (INH) susceptible by phenotypic drug susceptibility testing varied widely (0.5-11.6%). RMP-resistant isolates that were INH-susceptible had significantly lower rates of resistance to other first- and second-line anti-tuberculosis drugs (except rifabutin) compared to multidrug-resistant isolates. RMP resistance is not always a good proxy for a presumptive diagnosis of multidrug-resistant TB, which has implications for use of molecular assays that identify only RMP resistance-associated DNA mutations.

Global isoniazid resistance patterns in rifampin-resistant and rifampin-susceptible tuberculosis

Following the World Health Organization's endorsement of the Xpert® MTB/RIF assay, which rapidly and simultaneously diagnoses tuberculosis (TB) and detects resistance to rifampin (RMP), the question arises to what extent RMP resistance is an adequate marker for multidrug-resistant TB (MDR-TB). A retrospective analysis of data from >81 countries and subnational settings demonstrated that >40% of RMP-resistant isolates from new TB cases did not display resistance to isoniazid (INH) in settings with relatively low MDR-TB prevalence (one third of all countries and subnational settings). Results indicated the need for INH susceptibility testing in addition to RMP susceptibility testing.

Frequency and type of microbiological monitoring of multidrug-resistant tuberculosis treatment

Monthly culture is usually recommended to monitor treatment of multidrug-resistant tuberculosis (MDR-TB). As mycobacterial laboratory capacity is limited in many settings, TB programs need evidence to decide whether monthly cultures are necessary compared to other approaches. We simulated three alternative monitoring strategies (culture every 2 or 3 months, and monthly smears alone) in a cohort of MDR-TB patients in Estonia, Latvia, Philippines, Russia and Peru from 2000 to 2004. This retrospective analysis illustrated that less frequent testing delays confirmation of bacteriological conversion. This would prolong intensive treatment, hospitalization and respiratory isolation, increasing cost and toxicity. After conversion, less frequent testing could delay diagnosis of possible treatment failure.

[A social backing program and motivation provision in patients with tuberculosis]

The purpose of the study was to obtain information on tuberculosis patients' needs, perception, and expectations from health care as a whole and social backing in order to improve the implementation of a program for enhancing tuberculosis patients' motivation for recovery and treatment. Anonymous voluntary questioning using the standard questionnaire was carried out among new tuberculosis cases registered to be treated in 4 subjects of the Russian Federation (the Oryol, Vladimir, and Belgorod Regions, and the Republic of Mariy-El). Eighty-seven patients who had stopped being treated before the appointed time and 1302 patients who were receiving chemotherapy at the time of questioning were interviewed using the questionnaire. The main reasons for treatment discontinuance in those who stopped treatment before the appointed time were the necessity of earning their living (30%), alcohol consumption (30%), inadequate health education of the patients who considered themselves to be healthy (25%). Most patients (67%) preferred rewards as social backing, products/hot food (41%), and fare (32%). Among the proposed social backing schemes, the most popular ones were those that envisaged small daily rewards (23%) or a large final bonus (21%). The majority (67%) of patients preferred outpatient treatment. Thus, patients with tuberculosis face a great deal of problems that affect their motivation for treatment. To satisfy some of these problems is not the direct duties of an antituberculosis service due to the fact that the manning table lacks appropriate posts and an item of expenses. Therefore additional funds should be allocated from the budgets of a subject of the Russian Federation and/or municipal entities for adequate organization of social backing of patients with tuberculosis to enhance the efficiency of their treatment. Collaboration of antituberculosis services of the Russian Federation's subjects with social organizations and an addiction service along the availability of psychological and legal consultations to patients is the most optimum variant of social backing organization to improve the patients' motivation for treatment.

[The clinical and epidemic characteristics of new-onset tuberculosis in relation to the procedure of detection]

The outpatient cards and case histories of 456 patients with tuberculosis detected in Samara in the period from January 1, 1999 to December 31, 2003 were examined. Tuberculosis was identified in 58.3% of the patients when they were asking for medical aid; among them 54.2% were treated at general hospital where caseous pneumonia, disseminated tuberculosis, and tuberculous pleurisy were more frequently diagnosed. The unemployed able-bodied persons amounted to 43% of the detected patients with tuberculosis, of whom 81% being identified on recourse to a doctor. Primary drug resistance does not depend on the procedure of tuberculosis detection. Early detection and the initiation of treatment will improve a clinical prognosis in patients with new-onset tuberculosis.

[Specific features of detection of caseous pneumonia and its course in Samara]

A hundred and sixty-three cases of caseous pneumonia were analyzed in Samara. Males aged 35 to 60 years were most frequently ill with the pneumonia; the unemployed and those who had not undergone CC-fluorography for more than 2 years were more frequently ill. The lesion was more commonly bilateral, involving 3 lobes or more with multiple lung tissue destruction. Primary drug resistance was identified in 30.8% of cases. The classical onset of caseous pneumonia with well-defined clinical picture was observed in 75.5% of cases. The average time of diagnosis establishment was I month. One-year death was 34.6%. Progression into chronic forms creates a reservoir of tuberculous infection.