Coronavirus disease 2019 pandemic related chondrodermatitis nodularis helicis: the role of masks

BACKGROUND

Chondrodermatitis nodularis helicis is a benign, but painful inflammatory condition of the ear, characterised by a tender nodule located on the helix or antihelix. This study aimed to investigate the occurrence of chondrodermatitis nodularis helicis associated with the use of coronavirus disease 2019 masks during the pandemic.

METHOD

A retrospective single-centre study was performed from February 2020 to February 2022 in the Maxillo-Facial Unit at the University Hospital of Siena, Italy.

RESULTS

During the indexed period, 11 patients were affected by chondrodermatitis nodularis helicis. All patients wore a mask for more than 8 hours a day, every day for several months.

CONCLUSION

Although there is no certain proof of the correlation between masks and chondrodermatitis nodularis helicis, an increase in the incidence of this condition was highlighted in our single-centre experience in the pandemic period. The prolonged use of coronavirus disease 2019 masks may explain this correlation.

What are the most common disorders in dogs?

Georgina Mills reports on research from VetCompass looking at the top reasons why dogs visit the vets.

Extended spectrum beta lactamase producing bacteria among outpatients with ear infection at FelegeHiwot Referral Hospital, North West Ethiopia

BACKGROUND

Antibiotic resistant bacteria particularly extended-spectrum beta lactamase (ESBL) producing are of major concern for management of outpatients. They can spread rapidly and are associated with poor patient outcome. However, there is scarcity of information on ear infection with ESBL producing bacteria in Ethiopia. Therefore, this study investigates the prevalence of ear infection with ESBL producing bacteria among outpatients attending Felegehiwot Referral Hospital, Northwest Ethiopia.

METHODS

A hospital based cross-sectional study was conducted from May, 2018 to January, 2019. Demographic and clinical data were collected with face to face interview and were complemented with patient card review. Ear discharge specimens were collected from study participants using swab technique. All ear swab specimens were cultured using standard microbiological techniques. The ESBL producing bacteria were detected by double disc synergy test and interpreted based on Clinical and laboratory Standards Institute Guidelines. Chi-square and fisher's exact tests were calculated to check association between variables.

RESULTS

A total of 236 patients (male = 138 and female = 98) with ear infection took part in the study. The median age of the participants was 20years. Overall, 10 (4.23%, 95%CI; 2.3-7.6%) of patients had ear infection with ESBL producing bacteria. Other chronic illnesses (p = 0.003), history of hospital visit and treatment (p = 0.006) and history of antibiotic use without physician's prescription (p<0.001) had significant association with prevalence of ESBL producing bacteria in ear infection. The proportion of ear infection with ESBL producing P.mirabilis, P.aeruginosa and K.pneumoniae were 4 (1.7%), 3 (1.3%) and 2 (0.8%), respectively. All ESBL producing isolates were MDR (100%). Overall, 58 (43%) species were MDR. P.aeruginosa was the leading MDR isolate 29 (53.7%).For all bacterial isolates of ear infection, ampicillin(93.3%) and amoxicillin-clavulanic acid (58.5%) revealed high level of resistance whereas low resistance rates were observed for ciprofloxacin (5.2%), third generation cephalosporin (11.9-20%) and aztreonam (16.3%).

CONCLUSIONS

Ear infection due to ESBL producing bacteria coupled with high levels of MDR is becoming a growing concern for outpatients in the study area. Regular detection of these bacteria and wise use of antibiotics are needed to stop the spread of this form of resistance.

Reduction in emergency department visits for children's asthma, ear infections, and respiratory infections after the introduction of state smoke-free legislation

Despite the benefits of smoke-free legislation on adult health, little is known about its impact on children's health. We examined the effects of tobacco control policies on the rate of emergency department (ED) visits for childhood asthma (N=128,807), ear infections (N=288,697), and respiratory infections (N=410,686) using outpatient ED visit data in Massachusetts (2001-2010), New Hampshire (2001-2009), and Vermont (2002-2010). We used negative binomial regression models to analyze the effect of state and local smoke-free legislation on ED visits for each health condition, controlling for cigarette taxes and health care reform legislation. We found no changes in the overall rate of ED visits for asthma, ear infections, and upper respiratory infections after the implementation of state or local smoke-free legislation or cigarette tax increases. However, an interaction with children's age revealed that among 10-17-year-olds state smoke-free legislation was associated with a 12% reduction in ED visits for asthma (adjusted incidence rate ratios (aIRR) 0.88; 95% CI 0.83, 0.95), an 8% reduction for ear infections (0.92; 0.88, 0.97), and a 9% reduction for upper respiratory infections (0.91; 0.87, 0.95). We found an overall 8% reduction in ED visits for lower respiratory infections after the implementation of state smoke-free legislation (0.92; 0.87, 0.96). The implementation of health care reform in Massachusetts was also associated with a 6-9% reduction in all children's ED visits for ear and upper respiratory infections. Our results suggest that state smoke-free legislation and health care reform may be effective interventions to improve children's health by reducing ED visits for asthma, ear infections, and respiratory infections.

Mycoplasma Otitis in California Calves

A retrospective study of Mycoplasma otitis in California calves submitted for necropsy between 1993 and 2002 was conducted to characterize the demographic features of the disease and the pathologic findings associated with infection. Sixty-one confirmed cases of Mycoplasma otitis were identified among 20,525 necropsied cattle. All affected animals were calves, ranging in age from 2 weeks to 4 months and with a median age of 1.5 months. Ninety-two percent of the cases were dairy breeds. A higher percent of necropsied calves with Mycoplasma otitis were males (0.45%) than females (0.23%). The proportion of cases that had Mycoplasma otitis increased from 1993 to 2002, and there was a significant ( P < 0.05) seasonal distribution, with the highest proportion in the spring and the lowest in the summer months. Infections involved both the middle and inner ear and were characterized by a suppurative inflammatory response with extensive bony involvement. Three species of Mycoplasma were isolated from the ears: M. bovis, M. bovirhinis, and M. alkalescens. Concurrent pneumonia occurred in 47 cases (77%), and Mycoplasma was isolated from the lungs of 30 of those cases. The increasing proportion of Mycoplasma otitis cases in the past 10 years emphasizes the importance of identifying risk factors that could be modified to lower the incidence of this disease in calves.

[CLINICAL AND EPIDEMIOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF VAC- CINATION OF CHILDREN AGAINST PNEUMOCOCCAL INFECTION IN THE AMUR REGION]

AIM

To study the effectiveness of anti-pneumococcal vaccination of children in the organiza- tion of anti-epidemic measures in the areas of the flood in the Amur region.

MATERIAL AND METHODS

The monitoring program included 4988 children aged 2 to 5 years who have risk factors for pneu- mococcal infection. Pneumococcal conjugate vaccine Prevenar- 13 was used for immunization. Data on the incidence of child with acute respiratory infection, acute otitis media, pneumonia, meningitis during the post-vaccination period were taken into account. To evaluate the effective- ness of vaccination we used indicators and specific criteria (coefficient prophylactic vaccination and infection index).

RESULTS

The level of total morbidity of children in post-immunization pe- riod decreased by 13.6%; the number of cases ofpneumonia in the population of observed children decreased by 2.3 times; the total duration of the illness in children decreased by 14.6%, the number of.courses of antibiotic therapy was reduced by 21.3%, the number of hospital admissions of children - 38.4%, the number of days of temporary disability ofparents - 11.1%. Direct dependence of the degree of effectiveness of vaccination against pneumococcal disease by the age of children is determined.

CONCLUSION

The findings suggest that implementation of the program of clinical and epidemiological monitoring and prevention of community-acquired pneumonia with use of a vaccine against pneumococcal infections in the territory of the Amur Region has a high level of medical and socio-economic efficiency.

Genotyping and antifungal susceptibility testing of multiple Malassezia pachydermatis isolates from otitis and dermatitis cases in pets: is it really worth the effort?

A total of 216 colonies of Malassezia pachydermatis from 28 cases of fungal otitis or dermatitis in pets were genotyped by M13 fingerprinting and tested for antifungal susceptibility. A huge genetic diversity was found (157 M13 types in total), with all animals having a polyclonal pattern of infection (5.4 ± 1.5 genotypes/sample). Furthermore, analysis of molecular variance (AMOVA) revealed that most genetic diversity (44%) was found at the within sample level. In contrast, variability in antifungal susceptibility among isolates from the same sample was less important, with different M13 types displaying in most cases identical or very similar MIC results. Most isolates displayed high in vitro susceptibility to amphotericin B, terbinafine and all azoles tested except fluconazole, for which MIC values were always ≥4 μg/ml and a 26.9% of isolates displayed values ≥32 μg/ml. We conclude that although characterization of multiple yeast isolates results in a considerable increase in laboratory workload and expenses, it may help to get a better understanding of the epidemiology of M. pachydermatis in a given patient population.

[Antibiotic Resistance and Serotype Pattern of Streptococcus pneumoniae Isolated from Children in St. Petersburg in 2010-2013]

The surveillance of the serotype pattern and antibiotic resistance of S. pneumoniae in various geographical regions is required for the validity of rational etiotrophic therapy of pneumococcal infections and the choice of the optimal vaccines for their prophylaxis. 250 S. pneumoniae isolates from children with acute otitis or pneumonia and healthy carriers in St. Petersburg in 2010-2013 were investigated. The analysis of the serotype pattern of the pneumococci showed that 13-valent conjugate vaccine was the most active (86.1% of pneumococci causing pneumonia and 86.4% of pneumococci causing acute otitis). The isolates were higly resistant to beta-lactams and macrolides. By the EUCAST criteria, the decrease in the susceptibility to penicillin, cefotaxime, erythromycin and ceftarolin was observed in 32.4%, 14%, 33.2 and 6% of the isolates respectively. 22.4% of the isolates showed associate resistance to penicillin and erythromycin.. No resistance to moxifloxacin was detected. The frequency of resistance to tetracycline, co-trimoxasole and chloramphenicol in various patients ranged within 30-50%. The prevalence of the antibiotic resistance was mainly characteristic of the isolates serotypes 19A, 19F, 14 and serogroup 6.

Swimming pool attendance, respiratory symptoms and infections in the first year of life

We evaluated the relationship between indoor and outdoor swimming pool attendance and respiratory symptoms and infections during the first year of life. A population-based mother-child cohort study was conducted in four Spanish areas (INMA project). Study subjects were recruited at pregnancy, followed to delivery and 14 months after birth. Information on swimming pool attendance and health manifestations during the first year of life was collected at 14 months: low respiratory tract infection (LRTI), persistent cough, wheezing, atopic eczema and otitis. Odds ratios and 95 % confidence interval (OR 95 %CI) were calculated by logistic regression adjusting for confounders. Among the 2,205 babies included, 37 % reported having LRTI, 37 % wheezing, 16 % persistent cough, 22 % atopic eczema, 33 % otitis and 50 % attended swimming pools during the first year of life. Around 40 % went to outdoor pools in summer with a median cumulative duration of 7.5 h/year, and 20 % attended indoor pools with a median cumulative duration of 18 h/year. Pool attendance differed by area, season of birth and sociodemographic characteristics, and was not associated with LRTI, wheezing, persistent cough, atopic eczema or otitis. Adjusted OR of wheezing and LRTI were, respectively, 1.06 (95 %CI, 0.88-1.28) and 1.09 (0.90-1.31) for babies attending vs. babies not attending pools. Stratification by type of swimming pool, cumulative duration or parental atopy did not modify the results.

CONCLUSION

No association was detected between pool attendance and LRTI, wheezing, persistent cough, atopic eczema or otitis during the first year of life in Spain.

Socioeconomic disparities in physical health among Aboriginal and Torres Strait Islander children in Western Australia

OBJECTIVE

Few empirical studies have specifically examined the relationship between socio-economic status (SES) and health in Indigenous populations of Australia. We sought to provide insights into the nature of this relationship by examining socio-economic disparities in physical health outcomes among Aboriginal and Torres Strait Islander children in Western Australia.

DESIGN

We used a diverse set of health and SES indicators from a representative survey conducted in 2000-2002 on the health and development of 5289 Indigenous children aged 0-17 years in Western Australia. Analysis was conducted using multivariate logistic regression within a multilevel framework.

RESULTS

After controlling for age and sex, we found statistically significant socio-economic disparities in health in almost half of the associations that were investigated, although the direction, shape and magnitude of associations differed. For ear infections, recurring chest infections and sensory function problems, the patterns were generally consistent with a positive socio-economic gradient - where better health was associated with higher SES. The reverse pattern was found for asthma, accidents and injuries, and oral health problems, although this was primarily observed for area-level SES indicators.

CONCLUSION

Conventional notions of social position and class have some influence on the physical health of Indigenous children, although the diversity of results implies that there are other ways of conceptualising and measuring SES that are important for Indigenous populations. We need to consider factors that relate specifically to Indigenous circumstances and culture in the past and present day, and give more thought to how we measure social position in the Indigenous community, to gain a better understanding of the pathways from SES to Indigenous child health.

Incidence of infectious diseases in infants fed follow-on formula containing synbiotics: an observational study

Aim

Infectious diseases in infants are a major public health issue. Synbiotic-enriched formulas (EF) are intended to mimic the beneficial effects of human milk on infectious diseases. We performed an observational study in infants switching to follow-on formula to determine the effects of synbiotic-enriched formula compared to standard formula (SF).

Methods

We recorded family characteristics, medical history and growth data, as well as the symptoms, severity and treatment of infectious diseases. Main outcome measures were compared after adjustments for baseline characteristics.

Results

Between January and June 2007, 771 healthy infants were included in the study; 35.4% experienced at least one infectious disease during the 3-month study period. The most common were upper respiratory tract (24.1%), otitis (6.6%) and gastrointestinal infectious diseases (5.0%). Infants fed synbiotic-enriched formula had fewer infectious diseases overall (EF: 31.0%; SF: 40.6%; p = 0.005) and significantly fewer gastrointestinal infectious diseases (EF: 3.5%; SF: 6.8%; p = 0.03). During follow-up, weight gain was significantly higher (p = 0.0467) in infants fed synbiotic-enriched formula (18.3 ± 8.7 g/day) versus SF (16.9 ± 7.5 g/day).

Conclusions

Supplementation with synbiotics may have beneficial effects on the incidence of infectious disease and growth in infants. Further studies are needed determine optimal doses and composition of synbiotics in infant formula.

[Value of the high gastroesophageal reflux registration in the diagnosis of extraesophageal manifestations of GERD]

INTRODUCTION

The 24-hours pH-monitoring is the "gold standard" to verify the presence of pathologic reflux and confirmation of GERD. But there is lack of data whether it is helpful to verify the link between extraesophageal manifestations with GERD.

AIM

To evaluate the utility of proximal 24-hours pH monitoring for diagnosing ENR manifestations of GERD.

METHODS

Ninety one GERD patients were enrolled to the study. The allergic, infectious and toxic etiology of comorbid diseases were exclusion criteria. Dual-probe 24-hours pH studies were performed to all of the patients. Distal probe was placed 5 cm above esophago-gastric junction, the proximal one--at the upper 1/3 of esophagus over upper esophageal sphincter. The presence of high gastroesophageal reflux (HGR) was diagnosed when at least one episode of drop of pH < 4 for 20 sec at proximal probe during the study occurred. The evaluation of sensitivity and specificity of the method was calculated by the standard protocol.

RESULTS

Comorbid ENR pathology (GERD + CP) was found in 59 patients. Presence of HGR was found in 76.27% of patients of GERD + CP group and in 43.75% of controls (p = 0.0026). Number of HGR was higher in GERD + CP group: M +/- s: 12.51 +/- 18.56 compared to 2.84 +/- 7.11 accordingly, p = 0.0003. Mean pH values were lower in the main group: 6.32 +/- 0.52 compared to 6.58 +/- 0.42 in controls, p = 0.011. Acid exposure time was greater in the main group: 3.19 +/- 6.76 min, compared to 2.42 +/- 10.02 min in controls, p = 0.003. The correlation was found between each of the studied pH-metric parameters and presence of ENR pathology in GERD patients. The results of calculated diagnostic efficacy of the 24-hrs pH monitoring for evaluating the link between GERD and comorbid pathology were as follows: Diagnostic sensitivity--76.27% (95% Confidence Interval's limits (CI): 0.6403-0.8531); Diagnostic specificity: 56.25% (95% CI [0.3933-0.7183]); likelihood ratio for a positive test result 1.743 (95% CI [1.148-2.648]); likelihood ratio for a negative test result 0.422 (95% CI [0.243-0.731]).

CONCLUSION

There is correlation between parameters of 24-hours pH-monitoring in the proximal esophagus and comorbid ENR pathology in GERD patients. High gastroesophageal reflux is more common in GERD patients with comorbid ENR pathology than in GERD patients without ENR diseases. Detection of high gastroesophageal reflux with placing the distal probe in the upper esophagus may be helpful for the diagnosing of extraesophageal manifestations of GERD.

Community-acquired bacterial meningitis in elderly patients: experience over 30 years

Clinical characteristics, etiologies, evolution, and prognostic factors of community-acquired bacterial meningitis in elderly patients are not well known. To improve this knowledge, all episodes of community-acquired bacterial meningitis were prospectively recorded and cases occurring in patients >or=65 years old were selected. During the period 1977-2006, 675 episodes in adults (aged >or=18 yr) were recorded, with 185 (27%) in patients aged >or=65 years old; 76 were male and 109 were female, with a mean age of 73 +/- 6 years (range, 65-93 yr). Causative microorganisms were Streptococcus pneumoniae 74, Neisseria meningitidis 49, Listeria monocytogenes 17, other streptococcal 9, Escherichia coli 6, Haemophilus influenzae 4, Klebsiella pneumoniae and Staphylococcus aureus 2 each, Capnocytophaga canimorsus and Enterococcus faecalis 1 each, and unknown in 20. On admission 91% had had fever, 32% were in a coma (Glasgow Coma Scale <or=8), 9% presented with seizures, and 8% with shock. Thirty patients (16%) presented with seizures during therapy. Mortality was 58/185 (31%). Compared with patients aged 18-65 years, there were significant differences among older patients (aged >or=65 yr), who showed a higher frequency of diabetes and malignancy as underlying disease; pneumonia, otitis, and pericranial fistula as predisposing factors; and S. pneumoniae and L. monocytogenes as etiology. There were also differences in clinical presentation, complications, sequelae, and mortality. Factors independently related with mortality were age, pneumonia as a predisposing factor, coma on admission, and heart failure and seizures after therapy. Dexamethasone therapy was a protective factor. In conclusion, bacterial meningitis in elderly patients is associated with greater diagnostic difficulties and neurologic severity and more complications, as well as with increased mortality. Antiseizure prophylaxis might be useful in these patients.

Local infection and septic conditions in otorhinolaryngological practice

For all the difference of the mechanisms underlying septic conditions encountered in otrohinolaryngological practice they have a common nature related to biological properties of the pathogen responsible for a given pathological process, primary localization of the lesioned structure, and anatomical characteristics of the affected region. These factors must be taken into consideration in planning surgical treatment,t antibacterial or pathogenetic therapy to manage septic processes in the ear, nose and/or throat. Such an approach may be instrumental in arresting the further extent of infection and thereby improving prognosis of the disease.

Impact of oseltamivir on the incidence of secondary complications of influenza in adolescent and adult patients: results from a retrospective population-based study

OBJECTIVE

To assess the effectiveness of oseltamivir in reducing the risks of influenza-related secondary complications in otherwise healthy adolescent and adult patients aged > or = 13 years.

RESEARCH DESIGN AND METHODS

Retrospective cohort analysis utilizing health insurance claims data in the USA (Thomson MarketScan Research Database) from six influenza seasons (October-March) between 2000 and 2006 to identify adults and adolescents (> or = 13 years) with influenza. Patients who received a prescription for oseltamivir within +/-1 day of diagnosis were compared with a propensity-matched control group receiving no antiviral treatment. The first claim evidence of influenza was used to establish the study index date. Differences in outcomes were determined using Cox proportional hazards regression and expressed in terms of hazard ratios (HR) with 95% confidence intervals (CI).

MAIN OUTCOME MEASURES

Diagnosis of pneumonia, any respiratory condition, otitis media and its complications, hospitalizations due to pneumonia, and hospitalization for any reason within 14 days of the index date. Healthcare expenditure within 30 days of the index date was also analyzed.

RESULTS

The oseltamivir and untreated control groups each included 36 751 eligible patients. Oseltamivir use reduced the risks of otitis media and its complications by 23% (HR=0.77; 95% CI: 0.65, 0.93), any respiratory disease by 18% (HR 0.82; 95% CI: 0.79, 0.86), and hospitalization for any reason by 22% (HR 0.78; 95% CI: 0.67, 0.91). There were no differences in any other clinical outcomes, including hospitalization for respiratory disease. Healthcare expenditure did not differ between the two groups.

LIMITATIONS

The retrospective nature of the study meant that the findings may be susceptible to missing or lost data. The results obtained here represent individuals enrolled in private healthcare plans and may not, therefore, be representative of the entire US population. The lack of a virologic diagnosis of influenza, and an index date based on the first diagnosis of influenza rather than first exposure or symptom onset, may have resulted in a conservative estimate of treatment effect.

CONCLUSIONS

Secondary complications of influenza, such as respiratory disease and otitis media, were reduced in patients treated with oseltamivir. The risk of hospitalization for respiratory diseases was not reduced, although there was a reduction in the risk of hospitalization for any reason. Clinical benefits observed with oseltamivir were not associated with a change in healthcare costs.

[Epidemiological analysis of the incidence of invasive and non-invasive pneumococcal infections in different population groups]

Despite modern achievements in diagnostics and treatment, invasive and non-invasive pneumococcal infections remain a topical public health problem. To a large extent, it is connected with the absence or inconsistence of evidence-based information on this kind of infection. In this paper, retrospective analysis of the incidence of pneumococcal infections was performed on the basis of medical records available today in every health institution; the peculiarities of their nosologic structure were revealed. Among invasive forms, pneumococcal pneumonias prevailed (50.06%); apparent hypodiagnostics of pneumococcal meningitis was noted (only 4.02%). Among non-invasive forms, acute otitis with various complications prevailed (47.5%), acute sinusitis was registered in 37.5% of cases, and other ENT diseases (sphenoiditis, frontitis, ethmoiditis, etc.) were registered in 15% of cases. The study found that the main risk factors in these patients had been different ENT diseases which the patients had suffered from during the previous three months before the actual illness. Thus, the necessity for the development and perfection of techniques of microbiological diagnostics and the development of epidemiological control methods on their basis are obvious.

[Presumption diagnosis: otomycosis. A 451 patients study]

Otomycosis is a common disease. We try to analyze the causative factors for otomycosis in our environment. Our study includes 451 patients with a presumed diagnosis of otomycosis. The patients were included by ear, nose and throat specialist and general doctors; the diagnosis was confirmed in 24.43% and 16.16% respectively. The most common fungal pathogen found was Aspergillus spp. and Candida sp. The high frecuency of Aspergillus Niger may be because of the diferent ways of gathering samples. The abundance of Candida parapsilosis in the samples that came from general doctors may be because the inadequate treatment with topic antibiotics contributes fungal proliferation. We conclude that the causative factors for otomycosis could be avoided or treated. Treatment with antifungal agents is not enought to ensure complete cure, an furthermore the treatment should be aimed to restore the physiology of the external auditory cannal.

[Brain abscess: analysis of prevalence and clinical course]

The aim of the study was the analysis of the patients with bacterial meningitis and brain abscess who were treated in the Department of Infection Disease and Hepatology of Medical University in Lodz in years 1996-2005. We reviewed their clinical presentation, bacteriology treatment and outcome retrospectively. Among 135 patients who were confirmed cases of bacterial meningitis 16 identified as having brain abscesses. The prevalence rate of brain abscesses significantly increased in years: 2004-2005. The common predisposing factors were otic and teeth infections, sinusitis, penetrating head trauma, and bacterial endocarditis. Solitary abscess was found in 56% of the cases while in 44% of the cases multiple abscess were found. The most common presentation: headache, fever and neurological deficit were present in 37% of the cases. 75% of patients were disqualified from early neurosurgical intervention and antibiotic therapy were recommended. The antibiotic therapy was effective only in 1 patient. The mortality rate was 38% and 56% of the survivors had late neurological defects. The prevalence rate of brain abscesses significantly increased in years 2004-2005. Over all mortality was very high and antibiotic therapy hasn't been effective treatment in brain abscess at the late stage of its evolution. The early neurosurgical intervention is recommended. Late neurosurgical intervention strongly influences poor outcome in patients with brain abscess.

Variabilidad de la prescripción antibiótica en las infecciones respiratorias en dos países de Europa

BACKGROUND

Treatment for respiratory tract infections (RTI) in the primary care setting is empirical. Antibiotic prescribing patterns differ among countries and are based on the prevalence of antibiotic resistance in the geographical area. The aim of this study was to compare the antibiotics prescribed by general practitioners (GPs) for RTIs between Spain and Denmark.

METHODS

Observational multicenter survey carried out in the primary healthcare setting. Two groups of GPs in Spain and Denmark recorded all contacts with RTI patients during a 3-week period between November 2001 and January 2002.

RESULTS

A total of 2833 RTI cases were registered. Broad-spectrum penicillins and combinations of these drugs plus beta-lactamase inhibitors were the antibiotics most frequently prescribed by Spanish GPs (62.3%), followed by macrolides (22.3%). In contrast, narrow-spectrum penicillins were most commonly prescribed by Danish GPs (58% of all prescriptions), followed by macrolides (29%) (P < .001). Antibiotics most frequently prescribed for ear, tonsillar, sinus and bronchopulmonary infections were broad-spectrum penicillins among Spanish GPs and narrow-spectrum penicillins in Denmark. Spanish GPs prescribed penicillin V only for tonsillitis, accounting for 5.1% of the antibiotics used for this condition, whereas this drug accounted for 91.7% of the prescriptions by their Danish colleagues for the same indication.

CONCLUSIONS

The substantial differences in RTI management between the participating GPs should make us reflect on the rational use of antibiotics. The discrepancies disclosed may indicate dissimilarities in recommendations, traditions, habits, or antibiotic pressures between the countries studied.

Asthma, ear problems, and dental anxiety among 6- to 8-yr-olds in Denmark: a population-based cross-sectional study

The aim of this study was to examine the association between asthma, ear problems, and dental anxiety in children in a population-based cross-sectional study. The population included four municipalities in the County of North Jutland, Denmark, in 2001. A total of 1235 children aged 6-8 yr, and their parents, were identified. Data were obtained from a prescription database, from parental-answered questionnaires, and from dental records. Children with asthma were defined as children that had received prescriptions for both inhaled beta2-agonists and corticosteroids during the past year. Data on ear problems and dental anxiety were obtained from the questionnaires. Dental anxiety was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Use of asthma-drugs was associated with dental anxiety (odds ratio = 1.70; 95% confidence interval 0.90-3.22). A history of often ear problems was also associated with dental anxiety (odds ratio = 1.83; 95% confidence interval 1.20-2.80). It is concluded that asthma and ear problems may be risk factors for dental anxiety in children.

Purulent rhinitis and otitis caused by Pseudomonas aeruginosa in sheep showered with contaminated 'shower wash'

Three crossbred lowland ewes developed a severe purulent rhinitis and another three ewes developed a severe purulent otitis externa/media after being showered with a wash that had been used 24 to 48 hours before on a separate group of Cheviot ewes with lesions of dermatitis. Pseudomonas aeruginosa was isolated in pure growth from the aural and nasal abscesses and also from the dermatitis lesions. Extended antibiotic susceptibility testing and the random amplification of polymorphic DNA indicated that a single clonal type was associated with the rhinitis and otitis and with the dermatitis, providing strong evidence of an epidemiological link between the lesions of dermatitis and the aural and nasal abscesses through the use of the contaminated 'shower wash'.

Factors associated with first molar dental enamel defects: a multivariate epidemiological approach

PURPOSE

The purpose of this study was to ascertain factors linked to developmental defects of tooth enamel (DDE) in first permanent molars.

METHODS

A retrospective epidemiological case-control study was conducted with 48 cases and 149 controls. Dental examinations were performed on 8-year-old children in accordance with World Health Organization (WHO) guidelines. DDE were defined according to FDI World Dental Federation criteria (DDE index). The various study variables were measured and compared during the first 3 years of life, using dental and health records. These variables included gender, pediatric care, hospital admission, certain specific diseases (urinary tract infections, upper and lower respiratory tract infections, varicella, gastroenteritis, otitis) and drug therapies. A multivariate analysis was performed using multiple logistic regression techniques.

RESULTS

The multivariate analysis indicated that: girls had at least a two-fold risk of DDE; frequent pediatric care showed a strong association with DDE, which had an odds ratio (OR) of 3.40 to 4.16 according to year of life; urinary tract infection (UTI) registered a strong association in the second and third years of life with DDE, showing an OR of 32.4 in the second year of life and 6.33 in the third year of life; and mucolytics acted as a protective factor for DDE with an OR range of 0.53 to 0.23 according to year of life.

CONCLUSIONS

Female gender, UTI, and high frequency of pediatric care registered a strong association with DDE. Treatment with mucolytics exerted a protective effect against DDE.

Oral administration of probiotic Escherichia coli after birth reduces frequency of allergies and repeated infections later in life (after 10 and 20 years)

BACKGROUND

The development of allergies is a complex in which both composition and influence of the intestinal flora play an important role. We observed in earlier studies that the presence of an orally administered probiotic Escherichia coli strain in the intestine stimulated both a serum and local antibody response, decreased the presence of pathogens, the number of infections and the need for antibiotics.

METHODS

The preventive effect of oral colonization after birth with a probiotic E. COLI strain was assessed by evaluating the results of a questionnaire both 20 years (150 full-term infants) and 10 years (77 preterm infants) after colonization.

RESULTS

Differences in occurrence of allergies in colonized and control subjects were statistically significant both after 10 and 20 years (p < 0.01). Specific serum IgE antibodies confirmed the presence of allergies in 100% of 10-year-old and 91% of 20-year-old patients with clinical symptoms of allergy. Ten years after colonization, the occurrence of repeated infections was significantly lower in colonized subjects than it was in controls (p < 0.01); 20 years later, no differences were found in these groups.

CONCLUSIONS

Intentional colonization of the intestine with E. coli after birth (offering the advantage of the first colonizer) was found to decrease the incidence of allergies and repeated infections in later life.

Duration of breastfeeding, daycare, and physician visits among infants 6 months and younger

PURPOSE

To describe the association between duration of breastfeeding and an illness requiring a visit to a health care provider within the past 30 days (IRHP) among infants </= 6 months.

METHODS

Participants were breastfeeding women who delivered at a birthing center in suburban Detroit, Michigan and women employed by a company in Omaha, Nebraska. Subjects were interviewed by telephone at 3,6,9, and 12 weeks postpartum and by mailed questionnaire at 6 months postpartum.

RESULTS

Of the 674 breastfeeding women, 233 (34.5%) reported an IRHP. An IRHP was more likely among infants attending daycare (RR = 1.60; 95% CI 1.30, 1.96). There was an interaction between duration of breastfeeding, the number of children in the household, and IRHP (p < 0.0001). For firstborn children, each additional week of breastfeeding decreased the likelihood of an IRHP by 4%. An increased duration of breastfeeding was not significantly protective against an IRHP for infants living with additional children in the household.

CONCLUSIONS

Breastfeeding offers protection against an IRHP among firstborn children. Having additional children in the household or attending daycare outside of the home may diminish these benefits.

[Sports injuries, sports damages and diseases of world class athletes practicing modern pentathlon]

108 world class athletes (54 males, 54 females) practicing modern pentathlon had been interviewed about their individual training and competition efforts as well as their sports related injuries, damages and diseases in the last world cup season using a standardized empirical questionnaire. The mean training extent was about 25 hours per week, the mean number of national and international competitions athletes made was 9, especially concerning swimming and running. Mean number of health threatening incidents of each athlete had been 2 with 41% diseases such as otitis and pharyngitis, 23% injuries such as contusions and distortions and 33% damages such as tendinitis, periostitis and strains. Head and neck involvement were more frequent than those of pelvis and the lower extremities. Training efforts were the most frequent reasons for health threatening events (84%), especially concerning diseases and damages, whereas most of the injuries happened during competitions (p<.01). Most of the injuries happened practicing horse riding during competitions (9%). Running was the most frequent reason for damages, whereas horse riding is the leading cause for injuries, furthermore damages and injuries are typical for fencing. Swimming is often associated with diseases. In contrary shooting did not show typically affiliated health threatening events. The incidence of health threatening incidents concerning world class athletes practicing modern pentathlon is quite low. Especially running and swimming combined with a high training extent empirically predisposed to suffer from damages and diseases. Horse riding with a quite low training extent and fencing show a higher incidence of injuries. From the training-methodological point of view the training extent should not be too extended. Due to a high number of diseases it may be profitable to be in attendance of an inner medicine physician.

The public health problem of acute respiratory illness in childcare

Acute respiratory illness continues to be a significant problem for children attending childcare. The problems for the child are in terms of prevalence, incidence, and quality of life. Additional costs relate to parental absence from work and loss of earnings. This paper reports on the literature, and notes that little research has been undertaken to determine whether there are long-term risks or benefits to experiencing acute respiratory illness in early childhood. Research to date is presented, and the role of public health nurses is discussed in relation to how they might assist in reducing the incidence/prevalence of acute respiratory illness in children attending childcare.

Adverse events associated with hepatitis B vaccine in U.S. children less than six years of age, 1993 and 1994

PURPOSE

This study evaluated infrequent adverse reactions to hepatitis B vaccine by investigating the association of this vaccine with adverse health outcomes for U.S. children less than six years of age. The evaluation of the association between hepatitis B vaccine and chronic arthritis provides needed data, relevant to the Institute of Medicine's Report that there are inadequate data available to assess the causal relationship of hepatitis B vaccine to arthritis risk.

METHODS

The 1993 (n = 5505 children) and 1994 (n = 6515 children) National Health Interview Survey (NHIS) datasets were analyzed to provide post-marketing surveillance data from probability samples of the U.S. population. Incident cases of adverse events were determined from the temporal association between the hepatitis B vaccination and the adverse events. Logistic regression modeling was used to adjust for potential confounding.

RESULTS

Controlling for age, race, and gender simultaneously in the 1994 NHIS, hepatitis B vaccine was found to be associated with prevalent arthritis [odds ratio (OR) = 5.91, 95% confidence interval (CI) = 1.05-33.14], incident acute ear infections (OR = 1.60, 95% CI = 1.00-2.58), and incident pharyngitis/nasopharyngitis (OR = 1.41, 95% CI = 0.95-2.09).

CONCLUSIONS

Evidence from this study suggests that hepatitis B vaccine is positively associated with adverse health outcomes in the general population of US children.

Morbidity among human immunodeficiency virus-1-infected and -uninfected African children

OBJECTIVE

To assess patterns of morbidity and associated factors in late infancy and early childhood among human immunodeficiency virus (HIV)-infected and -uninfected African children.

DESIGN

Prospective study.

SETTING

The Queen Elizabeth Central Hospital, Blantyre, Malawi.

PARTICIPANTS

Children with known HIV status from an earlier perinatal intervention trial were enrolled during the first year of life and followed to approximately 36 months of age.

OUTCOME MEASURES

Morbidity and mortality information was collected every 3 months by a questionnaire. A physical examination was conducted every 6 months. Blood to determine CD4(+) values was also collected. Age-adjusted and Kaplan-Meier analyses were performed to compare rates of morbidity and mortality among infected and uninfected children.

RESULTS

Overall, 808 children (190 HIV-infected, 499 HIV-uninfected but born to infected mothers, and 119 born to HIV-uninfected mothers) were included in this study. Of these, 109 died during a median follow-up of 18 months. Rates of childhood immunizations were high among all children (eg, lowest was measles vaccination [87%] among HIV-infected children). Age-adjusted morbidity rates were significantly higher among HIV-infected than among HIV-uninfected children. HIV-infected children were more immunosuppressed than were uninfected children. By 3 years of age, 89% of the infected children died, 10% were in HIV disease category B or C, and only approximately 1% were without HIV symptoms. Among HIV-infected children, median survival after the first occurrence of acquired immunodeficiency syndrome-related conditions, such as splenomegaly, oral thrush, and developmental delay, was <10 months. These same conditions, in addition to frequent bouts of fever, were the main morbidity predictors of mortality.

CONCLUSIONS

The frequency of diseases was high, and progression from asymptomatic or symptomatic HIV disease to death was rapid. Management strategies that effectively reduce morbidity for HIV-infected children are needed.

Predictive inference, causal reasoning, and model assessment in nonparametric Bayesian analysis: a case study

This paper continues our earlier analysis of a data set on acute ear infections in small children, presented in Andreev and Arjas (1998). The main goal here is to provide a method, based on the use of predictive distributions, for assessing the possible causal influence which the type of day care will have on the incidence of ear infections. A closely related technique is used for the assessment of the nonparametric Bayesian intensity model applied in the paper. Two graphical methods, supported by formal tests, are suggested for this purpose.

Agreement between clinical examination and parental morbidity histories for children in Nepal

Parental histories are often used to estimate the prevalence and the impact of interventions on child morbidity, but few studies have examined the agreement between parental histories and clinical examination. We compared clinical findings with a same-day parental morbidity history for pre-school-age children in rural Nepal. A 15 per cent sample of children from 40 wards in Sarlahi district, Nepal, was selected for participation and 814 same-day morbidity histories were obtained from parents. A clinician, masked to the parent's history, visited the household 2-4 h later and examined the child for signs of morbidity symptoms about which the parent had previously been questioned. Signs included measurement of temperature, respiratory rate, examination of stools, ear discharge, and presence of persistent cough. Agreement between the history and clinical examination was excellent for ear infection (kappa = 0.75) and history of measles rash (kappa = 0.74), moderate to poor for diarrhoea (kappa = 0.21) and fever (kappa = 0.31), and there was no evidence of agreement for dysentery (kappa = -0.01), rapid breathing (kappa = 0.06), and cough (kappa = 0.09). The prevalence of dysentery, fever, cough, and rapid breathing was lower if clinical signs rather than histories were used. The prevalence of diarrhoea was higher if the presence of a loose stool in a cup rather than a history was used. The prevalence of ear infections and measles was comparable with both methods. The agreement between histories and clinical examination varies by morbidity type, as does the prevalence of morbidity estimated by one or other method.

A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States

BACKGROUND

Studies on the health benefits of breastfeeding in developed countries have shown conflicting results. These studies often fail to account for confounding, reverse causality, and dose-response effects. We addressed these issues in analyzing longitudinal data to determine if breastfeeding protects US infants from developing diarrhea and ear infections.

METHODS

Mothers participating in a mail panel provided information on their infants at ages 2, 3, 4, 5, 6, and 7 months. Infants were classified as exclusively breastfed; high, middle, or low mixed breast- and formula-fed; or exclusively formula-fed. Diarrhea and ear infection diagnoses were based on mothers' reports. Infant age and gender; other liquid and solid intake; maternal education, occupation, and smoking; household size; family income; and day care use were adjusted for in the full models.

RESULTS

The risk of developing either diarrhea or ear infection increased as the amount of breast milk an infant received decreased. In the full models, the risk for diarrhea remained significant only in infants who received no breast milk compared with those who received only breast milk (odds ratio = 1.8); the risk for ear infection remained significant in the low mixed feeding group (odds ratio = 1.6) and among infants receiving no breast milk compared with those who received only breast milk (odds ratio = 1.7).

CONCLUSIONS

Breastfeeding protects US infants against the development of diarrhea and ear infection. Breastfeeding does not have to be exclusive to confer this benefit. In fact, protection is afforded in a dose-response manner. The more breast milk an infant receives in the first 6 months of life, the less likely that he or she

[Tuberculosis of the otorhinolaryngologic region: laryngeal and extra-laryngeal forms]

BACKGROUND

The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis.

METHODS

All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed. All cases of cervical adenitis were not included.

RESULTS

Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal). In the laryngeal forms, all patients were male except for one, and all were smokers. The duration of the symptoms was greater than 3 months in all the cases. Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord. Twenty-nine percent did not present with coincident pulmonary tuberculosis. None of the extra-laryngeal forms showed pulmonary involvement. All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis. The evolution with medical treatment was favorable in all cases. During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital.

CONCLUSIONS

Tuberculosis of the upper respiratory tract is infrequent. Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms. Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy. Response to medical treatment is usually good.

A longitudinal study of emergency room visits and air pollution for Prince George, British Columbia

A new method for regression analysis of longitudinal counts is applied to data from Prince George, British Columbia, previously analysed by Knight et al. The data consist of daily recordings of the number of emergency room visits for each of four categories of respiratory diseases, along with measurements of meteorological variables and air pollution. We use a state-space model assuming conditionally independent Poisson counts for the four categories given a latent morbidity process, the latent process being a gamma Markov process. The main objective of the investigation was to examine the relationship between air pollution and respiratory morbidity, taking into account seasonality and meteorological conditions. We found that total reduced sulphur significantly influences the expected number of emergency room visits for the four disease categories, in agreement with the conclusion by Knight et al. However, our final model is simpler than theirs; in particular we found no evidence of seasonal variation beyond that explained by the meteorological variables.

Revision tympanoplasty: surgical findings and results in Riyadh

A report on the surgical findings and long-term results of 68 revision tympanoplasties performed at King Abdul Aziz University Hospital over a period of 7 years is presented. Temporalis fascia was used in all operations, with an overall success rate of 85% of graft take up, with significant improvement of hearing in the majority of cases. The causes of immediate failure were found to be due to faulty surgical techniques, however most of the late reperforations were due to infections and in some to atrophy of the graft. It is concluded that better surgical technique and improvement of medical facilities in most rural areas are of utmost importance in Saudi Arabia.

Clinical observations on bovine parasitic otitis in Tanzania

Between January 1982 and December 1989 more than 5,000 clinical cases of bovine parasitic otitis were examined. Clinical signs were mild in early cases and were characterised by dullness, anorexia and occasional head shaking, but were severe in long standing cases where the major presenting clinical signs were dark brown aural discharges which soiled the hair below and in front of the ear, emaciation, central nervous signs, recumbency and death.

Parasitic otitis in sheep associated with psoroptes infestation: a clinical and epidemiological study

Parasitic otitis associated with psoroptes infestation was diagnosed in a small pedigree flock of sheep with aural haematomas, abscessation and cauliflower ears. Thirteen of the 15 lambs were affected but the clinical signs were mild; small, discrete, crusty lesions on the inner aspect of the ear at the junction of its anterior and posterior borders were typical. Nine of the 20 adults were affected but the lesions were more severe. Eighteen of the 64 members of the breed society who responded to a telephone survey reported sheep with similar clinical signs in their flocks. The proportion of animals affected ranged from 1 to 60 per cent with a median value of 16 per cent.

[Epidemiological features of hospital purulent-septic infections in otolaryngological wards]

Prospective epidemiological observation in an otorhinolaryngological hospital has made it possible to distinguish the specific features of pyoseptic nosocomial infections. Such infections, appearing as cross re- and superinfections, are most frequently induced by staphylococci, as well as by Proteus and Pseudomonas aeruginosa. High risk groups include patients with purulent otitis and sinusitis, who have contacted infection through instruments in examination and dressing rooms. The main sources of infection are patients with pyoseptic infections of the ear and sinuses.

Swimming and ear infection

Surface swimming in fresh or ocean water is not contraindicated in children with otitis media or in children with tympanostomy tubes. Diving should be prohibited in children with acute or chronic otitis media or in children with tympanostomy tubes. Hot tub water, bath water, chlorinated water, or water from stagnant ponds may pose a risk for either otitis media or otitis externa.

Fungal infections of ear with special reference to chronic suppurative otitis media

Fungus were found to take important role in ear infections of the 344 patients (CSOM 286, Otomycosis 44, Otitis externa 14), significant fungal infections (with positive smear and culture) were detected on 49%, 79.5%, 66.6% patients respectively. 84.8% patients were detected both by smear and culture, 14.1% patients by culture and 0.1% patients in smear preparation only. In CSOM patients, age predominated in 20-27 yrs group, sex in male below 30 yrs, and Aspergillus flavus, A. niger, Penicillium, A. fumigatus in mycelial fungus, Candida albicans, C. parapsillosis in yeast. But in 18 post antibiotic fungus infected patients Penicillium and A. niger were the important isolates. In otomycosis and otitis externa patients A. niger took the main role.

Health hazards associated with windsurfing on polluted water

We documented the risks associated with windsurfing on sewage polluted water. Seventy-nine windsurfers and 41 controls were studied over a nine-day period for occurrence of symptoms of gastroenteritis, otitis, conjunctivitis, and skin infection. Relative risks were 2.9 for occurrence of one or more of these symptoms and 5.5 for symptoms of gastroenteritis. Relative risk increased with the reported number of falls into the water.

Private medical insurance and elective surgery during early childhood

The relationship between private medical insurance coverage and rates of elective ENT surgery was studied in a birth cohort of seven-year-old children. This analysis suggested that private medical insurance coverage was associated with differences in patterns of elective surgery with children whose families were covered by insurance being more likely to receive elective ENT surgery by seven years and far more likely to receive this treatment at a private hospital. These trends persisted when the child's history of ear/throat infections and family social and economic background were taken into account statistically.

Septal manipulation in the neonate: method and results

The septal configuration at birth may be straight (type A) which occurs in 42% cases, bent to one side (type B), or deformed to both sides (type C). There is a close correlation of these types, immediately with nasal obstruction and feeding problems and later with the development of dental abnormalities and respiratory infections of the throat and ear. These symptoms occur most in type B cases and least in type A cases. A total of 284 babies was assessed at birth and then when aged about 5 years. A total of 105 babies, who had minimal trouble and were used as controls and not manipulated, were compared with 179 who had troublesome symptoms and were manipulated. Manipulation greatly reduced the incidence of these problems at a statistically significant level. The physiological reason why type B causes more ear disease than types A or C is described. This involves the normally occurring Bernouilli's phenomenon in the nose. The external nasal deformity which causes minimal physiological changes, and occurs in 4% of births, can be successfully straightened by manipulation.

Diphtheria in North America

The incidence of diphtheria has declined in North America during the last fifty years until it is now an uncommon disease. This general pattern is similar to that seen in other developed countries with well-organized immunization programmes, but certain noteworthy characteristics have been observed in recent years: foci of infection lingered in two population groups of low socio-economic status, in both of which the skin has been an important reservoir. In central areas of certain cities, endemic diphtheria, chiefly cutaneous, has occurred amongst indigent adult males living in unhygienic conditions; and in the native Indian population of Northern Canada diphtheria infection has been endemic in infants and children, many of the infections being of the skin or ear and toxic disease being uncommon. During the last few years, diphtheria outbreaks have not been reported in urban areas and possibly endemicity is now restricted to northern native populations. The number of infections detected in these northern endemic areas is steadily decreasing.

[Role of azlocillin in the treatment of Pseudomonas aeruginosa otitis in children]

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.