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Background: An ear infection, can be classified into otitis externs and otitis media, this affects all age groups especially infants and young. This infection associate with pathogenic microorganism type, frequent antibiotic uses, health care and age. The most common pathogenic bacteria of the ear infection are Pseudomonas spp. Antibiotic resistance represents a serious threat to the health of humans. Methods: 48 ear swabs were collected through the use of wooden sticks in a sterile container for the identification of Pseudomonas, Serratiaand Klebsiella species by VITEK 2 system and biochemical tests. The antibiotic susceptibility against these bacterial species was detected through the method of standard disk diffusion on the Moller Hinton agar. Results: Among ear swabs, the positive growth percentage of the pathogenic gram-negative bacteria was 29.166%, and the percentage of Pseudomonas spp. was 57.142%. Males were found to be more susceptible than females with an infection percentage of 57.142%. Conclusion: The antibiotic susceptibility patterns show the azithromycin, gentamycin, piperacillin, ceftriaxone, cefepime, imipenem, ceftriazon, and gentamycin have activity against Pseudomonas spp.

Introduction: Bacterial and/ or fungal infection of the middle or external ear can be painful and sometimes the infection can be of mixed nature i.e. caused due to both bacteria and fungi. The combination of antibiotics and antifungals can be used for the treatment of mixed ear infections, along with it, anti-inflammatory agent and anaesthetics can be combined to relieve the discomfort caused by the infection. This study was conducted to test the efficacy and safety for the combination of Neomycin, Beclomethasone, Clotrimazole and Lignocaine for the treatment of middle or external ear infection. Method: Of enrolled 200, 177 patients completed the study. Efficacy was evaluated by symptom score (SS) scale which was an eleven-point scale ranging from 0 to 10 where 0 was no symptom to 10 was the maximum tolerated symptoms. All patients were asked to report SS on SS scale for ear pain, ear discharge and ear itching on day 1, 3 and 5. Safety assessment was made by analysing the adverse events reported by the patient. Results: SS of ear pain was reduced from 6.158 at baseline visit to 3.050 at day 3 to 0.468 at day 5. SS of ear discharge reduced from 6.175 at baseline to 2.768 at day 3 to 0.491 at day 5. SS of ear itching reduced from 4.694 at baseline to 1.604 at day 3 to 0.299 at day 5. Conclusion: The investigational product was found to be efficacious and safe for the treatment of otitis media and externa.

INTRODUCTION Subjective tinnitus, a perception of phantom sound, is a common otological condition that affects almost 15% of the general population. It is known that noise-induced hearing loss (NIHL) and tinnitus exhibit a high level of comorbidity in individuals exposed to intense noise and music. However, the influence of genetic variants associated with NIHL on tinnitus remains elusive. We hypothesized that young musicians carrying genetic variants associated with NIHL would exhibit a higher prevalence of tinnitus than their counterparts. METHODS To test this hypothesis, we analyzed the database by Bhatt et al. (2020) (originally developed by Phillips et al., 2015) that investigated the genetic links to NIHL in young college-aged musicians. The present study identified 186 participants (average age = 20.3 yrs, range = 18-25 yrs) with normal tympanometry and otoscopic findings and with no missing data. We included 19 single nucleotide polymorphisms in 13 cochlear genes that were previously associated with NIHL. The candidate genes include: KCNE1, KCNQ1, CDH23, GJB2, GJB4, KCNJ10, CAT, HSP70, PCDH70, MYH14, GRM7, PON2, and ESRRB. RESULTS We find that individuals with at least one minor allele of rs163171 (C > T) in KCNQ1 exhibit significantly higher odds of reporting tinnitus compared to individuals carrying the major allele of rs163171. KCNE1 rs2070358 revealed a suggestive association (p = 0.049) with tinnitus, but the FDR corrected p-value did not achieve statistical significance (p

Background and Objectives: Allergic rhinitis, a global health issue, if left untreated cause serious conditions like asthma, sinusitis or ear infections. Precise identification of allergens is worthwhile since it may lead to improvement in therapy. Therefore, this study was undertaken to determine the common inhalant allergens causing allergy in and around Saharanpur by skin prick test, serum IgE levels, nasal smear eosinphilia and AEC levels. Materials and Methods: 50 patients diagnosed clinically to have allergic rhinitis were included in the study. Absolute eosinophil count, nasal smear for eosinophils, and total IgE levels (wherever possible) were determined. Skin prick tests using 46 common inhalant allergens were done and results analysed. Results: Increased absolute eosinophil count, nasal smear positive for eosinophil and raised total IgE levels were found to be present in 56%, 22% and 97% of the patients respectively. Frequency of positive skin prick test response to various group of allergens were — Pollen (80%), Dust (70%), Mite (52%), Insects (50%), Fungi (48%) and Epithelial antigens (20%). Overall, pollen of Parthenium (in 70%) followed by House dust (in 64%) were found to be the most common offending allergens. Conclusion: It can be concluded that skin prick test along with serum IgE levels used to identify the causative allergens is useful in the patients of allergic rhinitis. Keywords: Allergic rhinitis, Skin prick test, Aeroallergens, Nasal smear eosinophils, IgE.

Extrahepatic portal venous obstruction (EHPVO) and temporomandibular joint (TMJ) ankylosisis are significant problems in Asian countries. Both EHPVO and bilateral TMJ ankylosis may have rare association due to protein C and S deficiency which may cause hypercoagulability as well as reduced fibrinolytic activity. Ankylosis arising in early childhood is associated with facial asymmetry, feeding difficulty and speech development alterations. It is also associated with great challenges of endoscopic management in extra hepatic portal vein obstruction (EHPVO) with variceal bleed as well as air way management during surgical management and post-operative recovery. Recently a case series had shown association of TMJ ankylosis with EHPVO due to protein C deficiency which might be an etiological factor for both EHPVO as well as TMJ ankylosis. This case report documents a case of 14 year young girl who had TMJ ankylosis due to ear infection and EHPVO with esophageal varices had multiple episodes of upper GI bleed with mild deficiency of protein C and S, successfully managed with proximal splenorenal shunt to prevent further episodes of upper GI bleed, as endoscopic management is not feasible due to TMJ ankylosis.

Middle ear infection occurs when fluid accumulate in middle ear as a result of inflammatory response to viral or bacterial infection. Infections may spread from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Luc abscess is a rare complication of otitis media. The difference of this complication with other extracranial abscesses relating to otitis media is, it may not be associated with mastoid bone involvement. Therefore, it is defined as benign complication of otitis media. Here, we report a case of 10-month-old baby boy diagnosed with Luc abscess with mastoid involvement.

The prevalence of overweight and obesity is increasing among reproductive-age women in sub-Saharan Africa. Whether maternal body mass index (BMI) influences the risk of infant infections in low- and middle-income countries (LMIC) is uncertain. We used data from a birth cohort of 5344 HIV-unexposed Zimbabwean infants with available data on maternal BMI, to calculate rates of sick clinic visits for infections during the first 12 months postpartum, and adjusted hazard ratios (aHR) for each maternal BMI group. Compared to infants of mothers with normal BMI, the rate of sick clinic visits for any infection progressively rose among infants of overweight (aHR 1.05; 95%CI 0.99, 1.11) and obese women (aHR 1.15; 95%CI 1.05, 1.25). Excess clinic attendances were particularly due to skin, respiratory and ear infections. Maternal obesity may therefore influence infant infectious morbidity in LMIC over the first year after birth.

Background Many studies have reported an inferred causal association of income poverty with physical health among children; but making causal inference is challenging due to multiple potential sources of systematic error. We quantified the short-run effect of changes in household poverty status on children’s health (asthma and ear infections) and service use (visits to the doctor and parent-reported hospital admissions), using a national longitudinal study of Australian children, with particular attention to potential residual confounding and selection bias due to study attrition. Methods We use four modelling approaches differing in their capacity to reduce residual confounding (generalized linear, random effects (RE), hybrid and fixed effects (FE) regression modelling) to model the effect of income poverty ( Results Of the 10 090 children included, 20% were in families in poverty at survey baseline (2004). Across subsequent years, ∼25% experienced intermittent and Conclusions While poverty has deleterious causal effects on children’s socio-behavioural and educational outcomes, we find little evidence of a short-run causal effect of poverty on asthma, ear infections and health service use in Australia.

Mollaret’s meningitis is an aseptic recurrent benign lymphocytic meningitis lasting 2-5 days and occurs over years with spontaneous complete resolution of symptoms between episodes. An 88 years-old-male presented with acute onset headache, lethargy and altered sensorium after a recent ear infection. He had multiple similar episodes in the past, each preceded by ear or sinus infection with cerebrospinal fluid finding consistent with aseptic meningitis. However, no specific causative agent was ever identified. He was confused, disoriented and lethargic with normal vitals and systemic examination. Blood tests showed leukocytosis with neutrophilia. Cerebrospinal fluid analysis revealed increased cell count with lymphocyte predominance, elevated protein and negative polymerase chain reaction. Magnetic resonance imaging of brain showed chronic small vessel ischemic changes. He fulfilled the Bruyn’s criteria for clinical diagnosis. He was empirically administered acyclovir during hospitalization and was discharged without prophylactic antiviraldue to negative cerebrospinal fluid analysis, culture, and multiplex polymerase chain reaction.

The Rohingyas fled from their home to escape ethnic persecution. Due to their status as refugees they have difficulties in accessing healthcare leading to avoidable mortality and morbidity. Infectious diseases are reported to be among the causes. To ease access to healthcare, IMAM Response and Relief Team (IMARET) provides a free monthly clinic for them. The objective of this study is to determine the proportion of infectious diseases and appropriateness of antimicrobial usage among its pediatrics patients. It was conducted in 2017, through universal sampling. Information retrieved were via interviews and medical records. The majority diagnosis were infectious diseases (57.1%), which include respiratory infections (77.3%), skin (13.6%), gastrointestinal (4.5%), eye and ear infection (both 1%). Albendazole (40.7%) was the most prescribed. Only 7.4% were appropriately prescribed antimicrobials. Age (p = 0.005) and BMI (p = 0.006) were significantly associated with infections.

Aspartylglucosaminuria (AGU) is a recessively inherited neurodegenerative lysosomal storage disease characterized by progressive intellectual disability, skeletal abnormalities, connective tissue overgrowth, gait disturbance, and seizures followed by premature death. AGU is caused by pathogenic variants in the aspartylglucosaminidase ( AGA) gene, leading to glycoasparagine accumulation and cellular dysfunction. Although more prevalent in the Finnish population, more than 30 AGA variants have been identified worldwide. Owing to its rarity, AGU may be largely underdiagnosed. Recognition of the following early clinical features may aid in AGU diagnosis: developmental delays, hyperactivity, early growth spurt, inguinal and abdominal hernias, clumsiness, characteristic facial features, recurring upper respiratory and ear infections, tonsillectomy, multiple sets of tympanostomy tube placement, and sleep problems. Although no curative therapies currently exist, early diagnosis may provide benefit through the provision of anticipatory guidance, management of expectations, early interventions, and prophylaxis; it will also be crucial for increased clinical benefits of future AGU disease-modifying therapies.

Background: Children living with smoker parents are exposed to high rates of mixtures of nicotine, toxic, and carcinogenic substances. Secondhand smoke causes more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome in infants and children. Thereby, this study aimed to investigate the behavior and attitude of parents in Al-Hasa region toward smoking and also to assess their knowledge and awareness about e-cigarette smoking, second-hand third-hand smoking. Methodology: This cross-sectional study was conducted with parents of children below 18 years of age in Al-Hasa region, Saudi Arabia. The study was conducted through an online questionnaire survey. The survey included the demographics, behavior, and attitude of parents toward smoking. Results: Among 150 parents in this study, there were 52.67% of smoker parents. A large proportion of parents (45.29%) reported that they would accept the decision of their children, if the children began to smoke. Most parents had heard about third-hand smoking; 12.65% believed it had no effect on health, whereas 55.28% believed it was harmful to the health. There were 29.3% who thought e-cigarettes were less harmful than regular tobacco smoking. Conclusion: The study showed a high prevalence of parental smoking and a high proportion of heavy smokers, although parents knew that exposure to parental smoking is harmful to their children. The attitude and behavior of parents seem to negatively impact their and their children’s health; so, raising awareness and knowledge is necessary and counseling the smokers to quit smoking is important.

The ENT pathologies are not well known to the populations of our developing countries. This lack of knowledge leads certain subjects to have attitudes and practices that favor their occurrence and/or their aggravation. The objective of this study was to assess the knowledge and describe the attitudes and practices of patients facing ENT pathologies at the Conakry Hospital and University Center (CHU). This was a prospective, descriptive study lasting six months (June-November 2018). Among the 1410 patients who had consulted in the department during the study period, 1102 had participated in the survey, or 78.16% of cases. The mean age of the patients was 39.3 ± 17.3 years, predominantly female, for a sex ratio of 0.75. The majority of patients were of university education (41.02%) and civil servants (38.66%) represented the dominant socio-professional layer. Rhino-sinusitis (30.85%) and ear infections (20.14%) were the most common pathologies. Almost a third (32.85%) of respondents had no knowledge of behaviors harmful to ENT health. More than half (52.45%) of the patients did not know of any factors favoring the occurrence of ENT pathologies. The therapeutic orientation had been made towards modern medicine in 63.52% against 4.54% for traditional medicine. The choice of self-medication concerned 31.94% of patients. This survey showed that patients have limited knowledge of ENT pathologies as well as the attitudes and practices likely to favor their occurrence. However, a multicenter study involving a larger proportion of patients will confirm these data.

Mastoid osteomas of the temporal bone are rare, benign, and usually asymptomatic tumors. However, depending on their size and extension, mastoid osteomas may cause facial palsy, a sensation of ear fullness, pressure-related pain, hearing loss, recurrent external ear infections, and chronic discharge. The etiology of mastoid osteomas is still unknown, but congenital, infectious, and traumatic factors have been proposed. Surgical treatment may be performed with minimal postoperative morbidity. In this article, the authors report a case of a 48-year-old woman seeking orthodontic treatment with an unusual retroauricular protruding mass, including the diagnostic process and differential diagnosis. This case supports the essential role of cone-beam computed tomography to analyze and identify the lesion as a mastoid osteoma.

Introduction Secondhand smoke (SHS) appears to be an insidious public health issue in Saudi Arabia, with a high percentage of people being reportedly exposed. In an attempt to raise awareness about this issue, we explored medical students’ level of knowledge about SHS risks, as well as their levels of exposure to SHS and the correlation between knowledge and exposure. Methods A cross-sectional study was conducted in February 2020 at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. An online, modified version of a validated questionnaire was distributed among 2nd to 6th year medical students. The questionnaire mainly explored the following items: 1) exposure level to SHS; 2) impact of SHS exposure; and 3) knowledge about SHS related health risks, with calculation of a knowledge score (range: 0–8). Adequate knowledge was defined as a score ≥5 (median = 5), and associations with sociodemographic and lifestyle factors and exposure to SHS were analyzed using chi-squared and independent t-test, as appropriate. Results Of a total 416 participants, 65.0% declared having one or more smoking persons among acquaintances, 26.4% being exposed to SHS at home, and 40.1% exposed to parental smoking during childhood. Further, 79.8% reported being regularly exposed to SHS in public places. Majority of participants reported significant discomfort (53.2%) and physical symptoms (98.3%) subsequent to SHS exposure. Among the list of 8 health risks, ear infection in children (28.1%), heart attack in children (37.5%), and cognitive deficit (47.8%) were the least frequently identified. Adequate knowledge was found among 57.5% of the participants, and was higher among females and lower among participants living with their friends, compared to their counterparts (p

This study's purpose was to provide qualitative evidence to support the development of two observer‐reported outcome measures assessing the physical symptoms/complications of achondroplasia in children and impacts on children's quality of life. Individual/focus group concept elicitation interviews were conducted with parents of children aged 2 to

Ear infection or otitis media (OM) occurs in many Aboriginal and Torres Strait Islander children at a young age and tends to persist over a long period of time. Chronic OM is associated with conduc...

Development of intracranial complications from middle ear infections might be difficult to diagnose. We compared radiological and surgical findings of 26 patients affected by Otogenic Meningitis. Results of our analysis showed that surgery is more reliable than imaging in revealing bone defects. Therefore, suggest that surgery be performed for diagnosis and eventual management of all cases of suspected otogenic meningitis. Keywords: Computed Tomography, Magnetic Resonance Imaging, Middle Ear Infection, Otogenic Meningitis, Surgery.

Background: Otitis externa & otitis media are notorious ear infections and a major health problem in developing countries causing serious local damage and threatening complications. Early and effective treatment based on the knowledge of causative microorganisms and their antimicrobial sensitivity can ensure prompt clinical recovery and possible complications can thus be avoided. Aims & Objectives: To identify & characterize the microorganisms causing otological infections & to correlate the findings with the clinical profile of patients. Materials and Methods: Clinically suspected cases of otological infections were enrolled in the study and the ear discharge was obtained using two separate pre-sterilized swabs. They were processed for aerobic culture and sensitivity. Drug susceptibility testing was done using Kirby Bauer disc diffusion method. Results: Among 126 otological cases enrolled, mostly were males. Most affected age group was 51-60 years, Ear discharge, ear pain and feeling of fullness were the commonest presenting symptoms. Clinically 65% were classified into otitis media and 35% into otitis externa. Unsafe Chronic suppurative otitis media was the commonest type. Most common bacterial isolate on culture was Pseudomonas aeruginosa (47.1%). Gram positive bacteria were predominant isolates in otitis externa, while Gram negative bacteria were more common in Otitis media. Antimicrobial profile of Gram negative isolates revealed maximum sensitivity to piperacillin, piperacillin-tazobactum, imipenam and ciprofloxacin. All Gram positive isolates were sensitive to vancomycin, teicoplanin & linezolid. Conclusion: Continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates is necessary to decrease the potential risk of complications by early institution of appropriate treatment. Keywords: Otitis externa, Otitis media, Pseudomonas aeruginosa, Staphylococcus aureus.

يعد المرض واحدا من أقسى الابتلاءات التي قد تصيب الإنسان، ولقد عانى حکام الأندلس من بعض الأمراض سواء کانت في مرحلة الطفولة کالجدري مثلا بالإضافة إلى بعض الأمراض العارضة مثل التهابات الأذن والرمد، ولکنهم أيضا عانوا في بعض الأحيان من أمراض مستعصية مثل الشلل، ولذلک لجأ الحکام إلى الأطباء الذين کانوا يقيمون بترکيبة بعض المرکبات من الأدوية؛ وهي وصفات خاصة أو شرب بعض الأعشاب الطبيعية حينما يشعرون ببعض التعب أو الإجهاد، کما لجأوا في بعض الأحيان إلى القيام بعملية الفصد، وهي على ما يبدو کانت من الأمور المعتادة والمستخدمة بکثرة في ذلک الحين. وفي هذه الدراسة سوف أقوم بعرض للأمراض التي تعرض لها حکام الأندلس وطريقة علاجها، إلى جانب أثر هذا المرض فيما تم اتخاذه من قرارات؛ فمن المعروف ما يحدثه المرض في الإنسان من کسرة في النفس ورقة في المشاعر، بالإضافة إلى اتخاذ البعض فترة المرض فرصة لترتيب أوضاعه أو الرجوع إلى الله. Disease is one of the most severe afflictions that may afflict humans, and the rulers of Andalusia suffered from some diseases, whether in childhood, such as smallpox, for example, in addition to some occasional diseases such as ear infections and conjunctivitis, but they also sometimes suffered from incurable diseases such as paralysis, so the rulers resorted to the doctors who were evaluating the combination of some prescription of medicines; They are special recipes or drink some natural herbs when they feel some fatigue or stress, and they sometimes resorted to Venesection)phlebotomy(, which seemed to be one of the usual and widely used at that time. In this study, I will present the diseases that the rulers of Andalusia were exposed to and the method of their treatment, as well as the impact of this disease on the decisions that have been made. It is well known that illness causes a feeling of weakness into the soul and a piece of paper in feelings, in addition to some taking the sickness period as an opportunity to arrange their conditions or return to God.

Aim This systematic review evaluates the current evidence for the use of probiotics in the prevention of acute otitis media (AOM) in children. Methods This study is registered with PROSPERO prior to commencement. PubMed, MEDLINE, EMBASE and Cochrane database were searched using relating keywords. All literature was screened to determine relatability to the topic. Review articles were also screened for additional literature. Results Thirteen studies were found on probiotics and their role in preventing AOM in children. They ranged in quality from poor to moderate. Half (2/4) of the studies that used nasal probiotic formulations showed a significant difference in reducing otitis media, while only a third (3/9) of the studies using oral formulations suggest benefit in reducing AOM. None of the studies demonstrated significant adverse effects from probiotics. Conclusion The evidence for any effect of probiotics on the prevention of AOM is limited, and the overall low quality of studies makes it difficult to draw definitive conclusions. No serious adverse events were noted, and there is some evidence to suggest possible benefit with nasal probiotic administration.

Associations of household airborne fungi with allergies in childhood were inconsistent in the epidemiologic studies. During 2013–2014, we conducted a case-control study (phase two), which was nested in a cross-sectional study (phase one) during 2011–2012 in Shanghai, China. We inspected indoor air quality of 454 residences for 5–10 years old children. We defined cases as those children who were reported illnesses in the questionnaire of phase one or phase two and defined controls as those children who were not reported illnesses in both phases. A total of 436 living rooms and 445 bedrooms had valid data of household airborne fungi, and their mean concentrations were 301 cfu/m3 and 310 cfu/m3, respectively. In the multiple logistic regression analyses with adjusting for potential confounders, most associations of 16 studied illnesses with airborne fungi concentration were not statistically significant. Taking children in the 1st quartile that was stratified according to airborne fungi concentration in the living room as reference, only children in the 3rd quartile were significantly associated with a higher odd of lifetime-ever ear infections (adjusted OR, 95% CI 3.05, 1.29–7.21), and children in the 4th quartile were significantly associated with a higher odd of lifetime-ever wheeze (2.72, 1.28–5.75); but children in the 3rd quartile (0.33, 0.17–0.68) and in the 4th quartile (0.47, 0.23–0.97) were significantly associated with a lower odd of rhinitis in the past 12 months prior to the home inspection. Our results indicate that exposures to indoor airborne fungi in low concentrations seemingly have no significant impacts on the risks of most allergic and airway illnesses in childhood. Since families with sick participants might pay more attention to improve indoor air quality, effects of “avoidance behavior” on associations between indoor pollutants and childhood health should be considered in the data analysis and design of the nested case-control study.

Cleidocranial dysplasia (CCD) is a rare autosomal dominant disorder caused by mutations in the Runx2 gene. The CCD is characterized by frontal bossing, a patent anterior fontanelle, presence of Wormian bones, midface hypoplasia, multiple dental abnormalities, clavicular hypoplasia or aplasia, skeletal abnormalities, and short stature. The aims of this study are to report the phenotypic manifestations of all patients who presented with CCD and to review the multidisciplinary management of these patients. The longitudinal data of patients with a diagnosis of CCD treated at The Australian Craniofacial Unit from 1980 to 2019 were reviewed. Fourteen patients were identified for inclusion in this study. The age at referral to the unit ranged from 1 week old to 49 years old (mean 11.2 years old). All patients had clinical features of frontal bossing, a patent anterior fontanelle, multiple Wormian bones, midface hypoplasia, abnormal dentition, clavicular hypoplasia/aplasia, and normal intellect. Eleven patients had obstructive sleep apnea. Eight patients had positive family history. Speech issues were found in 6 patients and abnormal hearing was found in 4 patients. Seven patients who underwent skeletal survey were found to have skeletal abnormalities. All patients were evaluated and managed by the multidisciplinary team, which consisted of craniofacial surgeons, pediatric dentists, orthodontists, ENT surgeons, pediatricians, clinical geneticists, radiologists, orthopedic surgeons, and social workers. All patients were treated by dentists/orthodontists requiring multiple surgical interventions and orthodontic treatment. Seven patients who had recurrent ear infection underwent ventilation tube insertion. Seven of 11 patients who had obstructive sleep apnea underwent adenotonsillectomy. Four patients underwent orthognathic surgery to correct midface hypoplasia and malocclusion. Two patients had cranioplasty for correction of metopic depressions. The characteristic findings of patients with CCD involving multiple regions of the body should draw clinicians' attention to the need for multidisciplinary management of these patients.

To reduce antibiotic use, clinical guidelines recommend treating many pediatric ear infections with watchful waiting (WW), which entails parents managing children’s symptoms while waiting to see if the infection will resolve without antibiotics. This study examines providers’ WW advice in recorded medical visits ( n = 28), focusing on five communication elements specified by guidelines and consistent with advice response theory. Results suggest directions for improving providers’ delivery of WW advice and are discussed with regard to theory.

Objectives Diagnostic errors can harm critically ill children. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility of record review to identify patient, provider, and work system factors associated with diagnostic errors during the first 12 hours after PICU admission. Design Pilot retrospective cohort study with structured record review using a structured tool (Safer Dx instrument) to identify diagnostic error. Setting Academic tertiary referral PICU. Patients Patients 0-17 years old admitted nonelectively to the PICU. Interventions None. Measurements and main results Four of 50 patients (8%) had diagnostic errors in the first 12 hours after admission. The Safer Dx instrument helped identify delayed diagnoses of chronic ear infection, increased intracranial pressure (two cases), and Bartonella encephalitis. We calculated that 610 PICU admissions are needed to achieve 80% power (α = 0.05) to detect significant associations with error. Conclusions Our pilot study found four patients with diagnostic error out of 50 children admitted nonelectively to a PICU. Retrospective record review using a structured tool to identify diagnostic errors is feasible in this population. Pilot data are being used to inform a larger and more definitive multicenter study.

Objectives To reduce overprescribing, health campaigns urge physicians to provide people with information regarding appropriate antibiotic use and encourage the public to trust their physicians' prescribing decisions. We test (1) whether providing individuals with complete information about the viral aetiology of an illness and the ineffectiveness of antibiotics will reduce inappropriate antibiotic expectations, (2) whether individuals with greater trust in their physician will have lower expectations, and (3) whether individuals with greater trust in their physician will benefit more from the complete information provision and have lower expectations. Design Experiment 1 features a between-subjects design (information provision: baseline vs. complete information) with a general measure of participants' trust in their physician. Experiment 2 features a 2 (physician trustworthiness: low vs. high) × 2 (information provision: baseline vs. complete information) between-subjects design. Methods In Experiment 1, participants (n = 366) reported their trust in their physician, read a vignette describing a hypothetical consultation with a physician for a viral cold and then expressed their expectations for antibiotics. In Experiment 2, participants (n = 380) read a vignette of a consultation with a physician for a viral ear infection then expressed their expectations for antibiotics. Results In both experiments, the provision of complete information significantly reduced inappropriate expectations for antibiotics. Greater trust in physicians was associated with higher antibiotic expectations in Experiment 1, but lower expectations in Experiment 2. In both experiments, trust in physicians appeared to facilitate the effect of information provision, but this effect was weak and inconsistent. Conclusion Providing information about viral aetiology and the ineffectiveness and side effects of antibiotics reduces inappropriate antibiotic expectations. Further research into the effect of trust in physicians as a moderator of the effect information provision is required, particularly given the recent increase in trust-based antibiotic campaigns. Statement of contribution What is already known Inappropriate expectations for antibiotics encourage overprescribing in primary care. To reduce inappropriate expectations, interventions often aim to educate people about antibiotics and encourage them to trust their physician. What does this study add Causal evidence that clinical information provision reduces but does not eliminate inappropriate antibiotic expectations. We find that increased trust in physicians is not always associated with lower expectations for antibiotics. Although increased trust seemed to boost the effect of information provision, this effect was weak and inconsistent.

In whole, 56 patients were included. Amidst identified microorganisms were fungus (4,7%) and bacteria (95,3%) to which Gram negative bacilli represented 72,1% (n=44), Gram positive cocci 6,4% (n=10), Gram positive bacilli 8,2% (n=5) and Gram negative cocci 3,3% (n=2). Among these bacterias, Pseudomonas aeruginosa and Proteus sp were predominant, with respectively 41% (n=25), 23% (n=14). However, three cases of S. aureus reported, six with negative coagulase Staphylococcus, one with Escherichia coli, one with Klebsiella sp, one with Haemophilus sp, two cases with Neisseria sp and four cases with Corynebacterium sp. Two types of cultures were noticed, one of them monomorphic (91,1%, n=51) and the other polymorphic (8,9%, n=5) to which 3 associations of P. aeruginosa-Proteus sp, 1 association of P. aeruginosa- coagulase negative Staphylococcus and 1 association of P. aeruginosa- E. coli. No resistance to ciprofloxacin was observed with Pseudomonas, Neisseria sp, Haemophilus, and enterobacteria except for E. coli. No resistance to rifampicin was observed with S. aureus. However, the sensitivity of S. aureus to ciprofloxacin decreased (one bacterium out of three). The use of rifampicin or fluoroquinolones should be based on the type of ear infections

Micro-organisms use quorum sensing (QS), a cell density-dependent process, to communicate. This QS mode of interchange leads to the production of a variety of virulence factors, co-ordination of complex bacterial behaviours, such as swarming motility, degradation of host tissue and biofilm formation. QS is implicated in numerous human infections and consequently researchers have sought ways of effectively inhibiting the process in pathogenic bacteria. Two decades ago, furanones were the first class of chemical compounds identified as Pseudomonas aeruginosa QS inhibitors (QSIs). P. aeruginosa is a ubiquitous organism, capable of causing a wide range of infections in humans, including eye and ear infections, wound infections and potentially fatal bacteraemia and thus novel treatments against this organism are greatly needed. This review provides a brief background on QS and the use of furanones as QSIs. Based on the effectiveness of action, both in vivo and in vitro, we will explore the use of furanones as potential antimicrobial therapeutics and conclude with open questions.

Background and aims Brain abscess is a serious and dreadful disease presenting at tertiary centre. The objective of this study was to look into the clinical profile, predisposing conditions, microbiology and outcome of children suffering from brain abscess. Methods 30 children up to 18 years with clinical and imaging evidence of brain abscess were taken for study. Patients were stabilized as per unit protocol. Necessary investigations were carried out. Neuroimaging (CT or MRI) was used to confirm the diagnosis. All parameters (clinical, investigation, outcome) were recorded in predesigned performa. Neurosurgery consultation was sought in patients with multiple abscesses, posterior fossa abscesses, abscess with air-fluid level and causing midline shift. Results There were 16 males with 13 patients in age group (5-10 years). Mean duration of stay in hospital was 14.8 days. Most common predisposing factor was chronic suppurative otitis media (n-15). Typically, patients presented with fever, headache and seizures. On examination, motor deficits were the most common followed by signs of meningitis. Computerized tomography confirmed the diagnosis in most cases. Temporal lobe (n-11) was the commonest intracranial site for the abscess. Methicillin resistant staphylococcus and proteus mirabilis were the common pathogen isolated from blood and pus. Blood culture positivity rate was 16.7% and pus culture positivity rate was 25%. All cases were managed with intravenous antibiotics and aspiration (n-10) and excision (n-6). There were 5 deaths. There was complete immediate recovery in 13 cases with residual motor deficit in 12 cases. Conclusion Brain abscess is a rare but serious entity in children. Late diagnosis and improper management leads to poor outcome. Early surgical intervention is helpful. Threshold for diagnosis should be low in children with chronic ear infection and congenital heart diseases.

Childhood Apraxia of Speech (CAS) profile is examined in this article to reveal new insights. These insights might have big influence on the clinical aspect of the phenomenon. One of the interesting insights founded was the close relationship between the CAS population and Autism. Since Autism is such a high incidence phenomenon, it implicates to CAS as well. A retrospective research was conducted based on 277 entry level evaluations of children diagnosed with CAS or suspected CAS who visited a private clinic between the years 2006-2013. The analysis included speech variables along background and environmental variables. This article is dealing with the non-speech variables that enable us to observe other parts of this phenomenon. The main findings are within the areas of diagnosis, age group, educational frames, ear infections, gender, development at first year, babbling and age and speech skill. Some of the results were not as expected. Further discussion regarding every result and implication is included as well as regarding the interaction between CAS and Autism.

Background: Hearing is important for language development in children, especially during the first 2 years of life. Hearing loss (HL) during this critical period may have a negative impact on speech, language, academic, and socio-emotional development. Therefore, maternal knowledge of the risk factors associated with neonatal HL has a significant impact as most risk factors are preventable. The current review paper aimed at investigating the maternal knowledge and attitudes regarding the risk factors, early detection, and early intervention of neonatal HL in Saudi Arabia. Methodology: A cross-sectional study was carried out targeting mothers of infants between the ages of 18 and 50 years in the Maternity and Children Hospital in Al-Ahsa, Saudi Arabia. A questionnaire including 30 items was distributed to the targeted mothers. Results: A total of 384 mothers participated in the study. The majority of mothers were aware of head injuries/slaps on-ear (78%) and ear infections (ear discharge and pain) (74.30%) as risk factors contributing to infant HL. However, there was poor knowledge of other risk factors, including delayed crying at birth (17.50%), neonatal jaundice (12.60%), high-grade fever, and infections during pregnancy (17.80%), early and elderly pregnancy (13.40%), and premature birth, low birth weight (>1.75 kg) and neonatal intensive care unit admission (> 5 days) (15.80%).Conclusion: Actions must be taken to raise maternal awareness regarding HL risk factors, early identification,and possible interventions.

The majority of children will develop an ear infection at some point in their lives, but the majority will be self-limiting or respond promptly to antibiotic treatment. Once ear discharge develops and fails to settle following treatment, continuing discharge may represent underlying pathology of the tympanic membrane such as a perforation or indicate the need for modification of the initial antibiotic treatment. In cases of chronic ear discharge it is vitally important that the ear drum can be seen clearly in order not to miss pathology such as cholesteatoma. Referral to an ear nose and throat specialist is indicated in cases where the ear discharge continues for a number of weeks or becomes recurrent.

Background Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children Results Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to Conclusion In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.

Objective Today, antibiotic resistance is increasing and evolving into an important health problem. Therefore, it is important to research on alternative therapies to antibiotics. This study aimed to investigate the inhibitory effect of four garlic derivatives on microorganisms commonly isolated in ear infections. Methods The antimicrobial activities of allicin, s-allyl cysteine (SAC), diallyl disulfide (DADS), and s-allyl mercaptocysteine (SAMC) were investigated on standard strains of commonly isolated microorganisms using the broth microdilution method. The test strains were selected among the microorganisms responsible for chronic suppurative otitis media and otitis externa. These microorganisms were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, Candida albicans, and Candida tropicalis. Results Minimum inhibitory concentration (MIC) values of allicin and SAC ranged from 0.125 to 20 μg/mL for fermentative bacteria (E. coli and K. pneumoniae), 20 to 80 μg/mL for non-fermentative bacteria (P. aeruginosa and A. baumannii), 5 to 10 μg/mL for gram-positive cocci (S. aureus and E. faecium), and 40 to 80 μg/mL for yeasts (C. albicans and C. tropicalis). MIC values of DADS ranged from 40 to 80 μg/mL for fermentative bacteria, 40 to 160 μg/mL for non-fermentative bacteria, 40 to 80 μg/mL for gram-positive cocci, and 20 to 40 μg/mL for yeasts. The MICs of SAMC were >640 μg/mL for the tested bacteria and yeasts. Conclusion Both allicin and SAC showed antimicrobial activity against the tested microorganisms, even at low concentrations. These two derivatives may be used to treat infections in the future.

Successful implementation of lytic virulent bacteriophages in clinical practice requires convincing evidence of its safety and efficacy. Design : We searched in CENTRAL, MEDLINE, Embase, and Russian-language literature databases in May 2018. Original articles must fulfill the following eligibility criteria: randomized, controlled trials investigating the effects of phage therapy in people with bacterial infections; at least one patient outcome was reported. Three review authors independently selected, studies, extracted, data, and. assessed, risk of bias. We used, random-effects models for meta-analysis. Participants: adults and. children of both, sexes with bacterial infection, including multi-drug resistant variants, or individuals at risk of infection. Outcomes: recovery or resolution of infection; clinical improvement; change in number of exacerbations; recurrence of infection; quality of life; elimination or load, reduction of a pathogen in an anatomical compartment. Results : We included 13 trials (issued in 1965-2018) including 9 treatment studies and. 4 prevention studies. Overall, eight randomized, trials involved, adults. Five studies addressed skin and soft tissues infections, six studies concerned intestinal infections, one study addressed respiratory tract infection and. one study — ear infection. Across bias domains, 35-90% of trials scored, low risk of bias. Meta-analysis for adverse events attributable to phages and. for wound, healing provided us with pooled relative risks of 0.74 (95% CI 0.68;1.2) and 0.91 (95% CI0.68;1.2) respectively. Conclusions: Beneficial effect of bacteriophages can be demonstrated, and. not refuted. However, our study led. to tentative conclusions. The conduct of well-designed and sufficiently powered, trials would, facilitate registration and. wide accepting of bacteriophage treatment.

Background Neuroendocrine neoplasms (NENs) are a rare type of tumor that arise from neuroendocrine cells. Primary neuroendocrine tumors of the head and neck are exceedingly rare and range from benign-behaving neoplasms to aggressive neuroendocrine carcinomas (NEC). Objectives The main purpose of this article is to report a rare case of well-differentiated neuroendocrine carcinoma (WD-NEC) (Grade 1) of the jugular foramen with uncharacteristic high-grade features and aggressive pattern of spread reminiscent of poorly-differentiated neuroendocrine carcinoma (PD-NEC). In addition, we review the scientific literature and describe differences in current World Health Organization (WHO) classification system for various organ systems. Methods A 49-year-old man with right ear infections developed acute facial paralysis. Imaging showed otomastoiditis and incidental right jugular foramen (JF) tumor suspicious for meningioma. After facial nerve decompression, he developed right vocal cord paralysis and dysphagia. His facial nerve function recovered completely; however, repeat imaging showed rapid growth of the JF mass. The patient underwent transtemporal approach for definitive resection. Results Pathology showed Grade 1, WD-NEC with aggressive features: mitotic index up to 2, focal necrosis, Ki-67 > 20%. Nuclear medicine scans confirmed the jugular foramen was the primary site. Chemoradiation was initiated; however, the patient developed metastasis and passed away. Conclusion We present a rare case of WD-NEC of the jugular foramen with atypical presentation and aggressive features. We review diagnostic work-up, WHO classification systems for NEC, and highlight the potential role of Ki-67 in NECs of the head and neck.

ObjectivesTo report an extremely rare case of malleoincudal osteoma that led to conductive hearing loss despite an unusually normal otomicroscopic appearance, and to highlight the usefulness of costal cartilage for ossicular chain reconstruction after tumour removal.Case reportA 37-year-old woman presented with a 2-year history of progressive, right-sided hearing loss. Physical examination revealed a normal tympanic membrane. Pure tone audiometry showed a right-sided conductive hearing loss. High-resolution computed tomography revealed a right-sided epitympanic mass arising from the malleus head and contiguous with the incus. The patient underwent a closed mastoido-epitympanectomy. The malleus head and the incus with associated malleoincudal osteoma were removed. Ossicular chain reconstruction using costal cartilage was performed at the time of tumour removal.ConclusionThe possibility of a middle-ear osteoma must be considered in cases of unilateral and progressive conductive hearing loss with a normal otomicroscopic appearance in patients with no history of ear infection, trauma or prior surgery, and with no family history of hearing loss. Surgical treatment is indicated in cases of significant conductive hearing loss. To our knowledge, this is the first case report of malleoincudal osteoma in which the ossicular chain was reconstructed using costal cartilage.