Ear, Nose And Throat Infections Research Articles

#1271 Risk of primary infections in patients with IgA nephropathy: a Swedish population-based cohort study

Abstract Background and Aims IgA nephropathy (IgAN) is the most common global kidney disease with a highly variable clinical presentation. Diagnosis IgAN requires a biopsy, and the immunohistologic examination is dominated by depositions of aberrant IgA1 antibodies. Since IgA antibodies are mainly produced by the mucosal associated lymphoid tissue the relationship between the mucosal immune system and IgAN has long been considered. The current theories on the origin of the disease involve genetic and environmental factors, with mucosal infections potentially playing a role. In some IgAN patients gastrointestinal and/or upper respiratory infections can aggravate the disease with episodic macrohematuria and/or increased proteinuria. Coincidently, these infections are also more common among patients with selective IgA deficiency. The aim of this study was to investigate whether the presence of IgAN confers an increased risk of infections in general to the IgAN patient. Method IgAN was defined by a computerized biopsy record from 1997 to 2011 in Sweden. Each IgAN patient was matched with up to five reference individuals based on age, sex, calendar year, and county of residence. Exclusions included those with organ transplants, HIV, immunodeficiency, or end-stage kidney disease before study entry, and follow-up data were censored for subsequent occurrences. Linear and Cox regressions, adjusted for age, sex, and education, were performed to analyze total infections and antimicrobial treatments in both patient and reference groups. Sibling analyses were also performed, adjusted for baseline age, sex and educational attainment. Results The linear regression analysis revealed a significant association between IgA nephropathy (IgAN) and the overall frequency of infections compared to the general population (β = 0.45; 95% CI: 0.37–0.54), women (β = 0.35; 95% CI: 0.19–0.50), men (β = 0.50; 95% CI: 0.40–0.60), and siblings (β = 0.37; 95% CI: 0.25–0.49) for women (β = 0.24; 95% CI: 0.06–0.41) and men (β = 0.43; 95% CI: 0.27–0.60). Similarly, a significant association was found for the frequency of prescribed antimicrobial agents compared to the general population (β = 0.66; 95% CI: 0.51–0.82), women (β = 0.92; 95% CI: 0.56–1.27), men (β = 0.55; 95% CI: 0.39–0.71), with similar estimates in the sibling analyses. The subtypes with the strongest association were urinary tract infections (β = 0.09; 95% CI: 0.07–0.11), ENT (ear, nose, and throat) infections (β = 0.08; 95% CI: 0.04–0.12), muscular infections (β = 0.08; 95% CI: 0.05–0.12), and infections in the GI (gastrointestinal) tract (β = 0.06; 95% CI: 0.04–0.09). Infections in the lower respiratory tract, skin and mycoses also had a significant positive association, however, no associations to infections in the central nervous system or infections caused by helminths and protozoans were identified. Cox regression showed an elevated risk of any infection with an adjusted hazard ratio (HR) of 2.05 (95% CI: 1.88–2.23), especially for sepsis (aHR = 3.13; 95% CI: 2.14–4.59), and time to the first prescription of antimicrobials with an aHR of 1.37 (95% CI: 1.30–1.45). Linear regression of prescribed antimicrobial treatments showed an overall β = 0.67; 95% CI: 0.51–0.82, and specifically for antibiotics (β = 0.64; 95% CI: 0.49–0.78). Conclusion Our study demonstrates an increased prevalence of infections and antibiotic prescriptions in IgAN patients compared to the general population and their siblings. Further studies on the potential impact of IgAN and its immunological aberrations on overall infection susceptibility is warranted.

Antimicrobial Susceptibility Pattern of Bacterial Pathogens in Our Setup: Ear, Nose and Throat Perspective

With a high prevalence of infections involving the ear, nose, and throat, and the occurrence of drug resistance the antimicrobial susceptibility pattern of bacterial pathogens is of immense importance. Objective: To determine the antimicrobial sensitivity profile of pathogenic bacteria isolated from representative infected areas of patients with ear, nose, and throat infections. Methods: This cross-sectional observational study was conducted at Ear, Nose and Throat (ENT) Outpatient Department (OPD), Capital Hospital Islamabad, over two years. The sample included 639 pathogenic bacterial culture specimens, grown from the representative infected ear, nose, or throat of patients who attended ENT outpatients of the hospital. The bacterial cultures were subjected to the standard disc agar diffusion method to know the antimicrobial susceptibility profile. Data collected included the patient’s age, gender, area/ site of infection, bacterial pathogen isolated, and sensitivity to antibiotics. Results: The sample included 49.30% males and 50.70% females and mean age of 30.13±19.24 years. Gram-positive organisms were predominant [n=441, (69.01%)] with Staphylococcus aureus being the commonest isolate (67.92%) followed by Pseudomonas spp. (26.13%). Gram-positive isolates were sensitive to Cefoperazone+Sulbactam, Ceftazidime, Cefoperazone, Amikacin, Pipercillin+Tazobactam, Vancomycin, Gentamycin, Linezolid, Amoxicillin + Clavulanate, and Ceftriaxone with resistance to Cefixime, while the Gram-negative isolates were sensitive to Vancomycin and Meropenum, Ciprofloxacin, Levofloxacin, Ceftriaxone and Ceftazidime and highly resistant to Cefixime, Cefuroxime, Amoxicillin+Clavulanate and Co-trimoxazole. Conclusions: Since ENT infections are predominated by Staphylococcus aureus and Pseudomonas spp. When unavoidable the empirical therapy should cover these pathogens, however culture and sensitivity studies are justified keeping in view the growing resistance to antimicrobials.

Comparative analysis of diagnostic accuracy between MRI and CT scans in detecting skull base ENT pathologies

Skull base ENT (Ear, Nose, and Throat) pathologies present a diagnostic challenge due to their intricate location. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans are commonly used diagnostic tools for detecting these pathologies. This study aims to associate the diagnostic exactness of MRI and CT scans in detecting skull base ENT pathologies. Aim: The primary objective of our current research is to assess and associate the diagnostic accuracy of MRI and CT scans in detecting skull base ENT pathologies, including tumors, infections, and congenital anomalies. Methods: Researchers led the retrospective study of medical records from the cohort of patients with suspected skull base ENT pathologies who underwent both MRI and CT scans. Imaging reports were reviewed by experienced radiologists blinded to the clinical outcomes. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for each modality. McNemar's test was utilized to assess statistical significance of differences in diagnostic accuracy between MRI and CT. Results: An overall of 150 individuals were involved in our research. MRI demonstrated a sensitivity of 87%, specificity of 92%, PPV of 85%, and NPV of 93% in detecting skull base ENT pathologies. CT scans showed a sensitivity of 72%, specificity of 78%, PPV of 70%, and NPV of 80%. The diagnostic accuracy of MRI was significantly higher than that of CT for detecting these pathologies (p < 0.05). Subgroup analyses were performed for different types of pathologies, providing valuable insights into the strengths and limitations of each imaging modality. Conclusion: This comparative analysis highlights the superior diagnostic accuracy of MRI over CT scans in detecting skull base ENT pathologies. MRI offers higher sensitivity and specificity, making it a valuable tool for clinicians in the evaluation and management of individuals with these conditions. However, CT may still have a role in specific cases where MRI is contraindicated or for initial screening. Clinicians should consider these findings when selecting the most appropriate imaging modality for patients with suspected skull base ENT pathologies.

Molecular Characterization and Antibiogram of Staphylococcus and Pseudomonas Species Isolated from Patients Attending Rivers State Teaching Hospital, Nigeria

Disease of ear, nose and throat (ENT) affect the functioning of adults as well as children, often with significant challenge to of the daily life of affected patients. Staphylococcus and Pseudomonas species are the most prevalent etiologic agent of ENT infections. Therefore the aim of this study was to determine the antibiogram of molecularly Characterized the Staphylococcus and Pseudomonas species in the Ear and Throat among Patients Attending Rivers State Teaching Hospital. Total number of eighty samples of throat swab, and aural (ear) swab were collected aseptically using sterile Evepon swab sticks and the sample collected were properly labelled with patients' number, date and the side. The swabs were immediately transported with a transportation medium in sterile cotton plugged test tube to the microbiology laboratory for further analysis. Qquestionnaires were administered for degraphic data collections. Each throat and aural swab sample was inoculated onto Mannitol salt agar and Cetrimide agar plates for isolation of Staphylococcus and Pseudomonas species respectively. The plates were incubated at 37°C and examined for growth after 24-48 hours. Pure culture of the isolates were primarily identified biochemically and confirmed using molecular approaches. Antibiogram of the isolates was performed by the Kirby-Bauer disk diffusion method on Mueller-Hinton agar according to Clinical and Laboratory Standards Institute guideline. Results shows that out of the 50 ear swabs and 30 throat swab samples, 17 (34%) and 8 (26.7%) of the throat swabs ear swabs were positive of Pseudomonas spp. While for the Staphylococcus spp. 8 (16%) out of the 50 ear swabs and 4 (13.7%) out of 30 throat swabs were positive. The molecular results of the isolates shows that Pseudomonas fluorescens NR_115715.1, Pseudomonas aeruginosa NR_113599.1.
 Staphylococcus aureus NR_113956.1. were the predominates species isolated from both ear and throat swabs. The results of antibiogram of the Staphylococcus and Pseudomonas species isolated revealed that commonly uses antibiotics especially Ceftazidime, Cefuroxime, Cloxacillin Gentamicin and Augmentin were 100% resistant to the isolates only Ofloxacin, Ceftriaxone and Nitrofurantoin were susceptible to the isolates with a percentage of 80.2%, 85.7% and 90%. The findings of this study points to the high level of frequent and indescrimate uses of antibiotics among patient suffering from symptoms of ENT resulting to difficulty in the treatment of infections using common antibiotics. It is strongly recommended that ccontinuous monitoring of patients is required for preparing antibiograms. These susceptibility results will help the physician for deciding the empirical regime for the patients.

Drug Utilization Pattern and Adverse Drug Reaction Monitoring of Antibiotics use in Ear, Nose and Throat Infection at Tertiary Care Hospital, Lucknow, India

Objective: To investigate the ENT department's (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods: A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result: In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin's (amoxicillin with clavulanic acid) and cephalosporin's (cefixime) being the most commonly used. Combination therapy was used in 100 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions: To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines.

Drug Utilization Pattern and Adverse Drug Reaction Monitoring of Antibiotics use in Ear, Nose and Throat Infection at Tertiary Care Hospital, Lucknow, India

Objective: To investigate the ENT department's (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods: A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result: In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin's (amoxicillin with clavulanic acid) and cephalosporin's (cefixime) being the most commonly used. Combination therapy was used in 100 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions: To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines.

Drug Utilization Pattern and Adverse Drug Reaction Monitoring of Antibiotics use in Ear, Nose and Throat Infection at Tertiary Care Hospital, Lucknow, India

Objective: To investigate the ENT department's (OPD, IPD) antibiotic prescribing practices at a tertiary care hospital in Lucknow, India. Material and Methods: A prospective, cross-sectional, non-experimental (observational) study was performed in (OPD, IPD) department of Ear, Nose and Throat (ENT) over a period of 6 months. Result: In this study, 100 ENT patients (51 male, 49 female) were selected based on inclusion and exclusion criteria. Ear infections were the most common reason for visits (86 patients), followed by nose (7 patients) and throat infections (5 patients). The most commonly prescribed antibiotics were β-lactam antibiotics, with penicillin's (amoxicillin with clavulanic acid) and cephalosporin's (cefixime) being the most commonly used. Combination therapy was used in 100 patients, with an average of 1.9 antibiotics per patient per course. A total of 40 antibiotics were prescribed, with oral being the most common route of administration. Only one adverse drug reaction was reported, with a suspected link to cefixime causing an increase in rashes in one patient. The study population had comorbid conditions of anxiety, epilepsy, and anaemia. Conclusions: To conclude, our study in the university teaching hospital (IIMSR) highlighted lesser utilization of antibiotics in ENT infections, as some of the ENT infections are not due to bacteria. The majority of ENT patients admitted to the hospital appear to have bacterial infections, and most of them reacted favourably to antibiotic treatment. Majority of the patients used the regimen in accordance with the current guidelines.

Ten-year prevalence of acute hospital ENT infections and the impact of COVID: A large population study.

BackgroundAcute ear, nose and throat (ENT) infections were the commonest referrals from accident and emergency to ENT services. The referral rate changed dramatically with season, year, national outbreaks and during the COVID pandemic.MethodRetrospective longitudinal study of the epidemiology of seven acute ENT infections in secondary care over 10 years. A mixed city and rural population of over 650 000 in central England was studied. The risk factors for each wave of infection during the surge of infection were sought. A statistical analysis of their significance was undertaken. This included analysis and correlation of group A‐beta haemolytic streptococcus (GABHS) in hospital and community. Seasonal variations, hospital admissions and the impact of the COVID were analysed.ResultsThere were 16 883 reported cases of the seven index ENT infections during the 10‐year period. Great seasonal and year‐to‐year variations were recorded. There was an incremental rise in 2018. Spring had the highest season of acute ENT infections. An outbreak of GABHS was noted in the community in 2014. The mean duration of hospital admission was 1.5 days. There was no statistical ethnic or gender predominance. A dramatically lower number of acute ENT infections were recorded during the COVID‐19 pandemic, and this continued after lifting of lockdown restrictions.ConclusionA resurgence in scarlet fever directly and indirectly contributed to an incremental rise in acute ENT infections in the following years. Both hospital and community B‐haemolytic cultures have declined during the COVID‐19 pandemic due to a reduction in infections as opposed to reduced case ascertainment.

Recent trends in bacteriological and antibiogram profile of isolates from ear, nose and throat in a tertiary care hospital in coastal Karnataka

<p class="abstract"><strong>Background:</strong> The objectives were to study the bacterial pathogens of ear, nose and throat (ENT), to determine the culture and sensitivity pattern of ENT infections in coastal Karnataka.</p><p class="abstract"><strong>Methods:</strong> A retrospective culture and sensitivity profiling study of 109 samples from September 2018 to September 2019 was done in Department of ENT in KVG Medical College and Hospital. </p><p class="abstract"><strong>Results:</strong> Among the pure growth, <em>Pseudomonas aeruginosa</em> was isolated in majority of samples (27.77%) followed by <em>Staphylococcus aureus</em> (22.9%). <em>Klebsiella </em>sp<em>.,</em> <em>Acinetobacter </em>sp., <em>Citrobacter</em>, <em>Non enterococcus</em>, <em>Escherichia coli</em>, <em>Proteus </em>sp. and <em>Streptococcus pneumoniae</em> were responsible for remaining samples. Among <em>S. aureus</em> majority was MRSA accounting for 18.51%. <em>P. aeruginosa</em> was most sensitive to amikacin, ceftazidime, meropenem and piperacillin- tazobactam and least sensitive to cotrimoxazole and colistin and most resistant to sparfloxacin, cefaperazone-sulbactam, ceftriaxone-tazobactam and clindamycin. MRSA was most sensitive to gentamicin, amikacin and clindamycin and most resistant to cephalexin, ampicillin and ciprofloxacin. <em>Klebsiella </em>sp<em>.</em> was most sensitive to amikacin and cotrimoxazole and most resistant to sparfloxacin and ceftriaxone<em>. E. coli</em> was most sensitive to gentamicin and cotrimoxazole and most resistant to sparfloxacin.</p><p><strong>Conclusions:</strong> <em>P. aeruginosa, S. aureus</em> and <em>Klebsiella </em>sp<em>. </em>represent majority of culture samples. With ever changing culture & sensitivity pattern and rising antibiotic resistance, a simple step of sending pus samples for the same will help in personalizing the treatment, thereby reducing the disease burden. </p>

Antibacterial susceptible pattern of ear, nose and throat in paediatric patient infections

Background: To study the bacterial pathogens of ear, nose and throat (ENT) to determine the frequency and sensitivity pattern of ENT infections in paediatric patients.Methods: The study was conducted during the period of June 2016 to May 2017 in Kerala Medical College Hospital. A total 225 samples were collected and evaluated for microbiological investigations. Antimicrobial susceptibility profile was determined by modified Kirby Bauer disc diffusion method.Results: Out of 225 samples, 140 (62.22%) were found positive growth and 85 (37.77%) of samples were found negative culture. The frequency of different organisms isolated was as follows: Pseudomonas 43 (30.71%), Staphylococcus aureus 32 (22.85%), Proteus spp. 18 (12.85%) Klebsiella spp. 17 (12.14%) etc., Antibiotic susceptibility pattern gram positive bacteria were vancomycin (100%) followed by amikacin (97.14%), and in gram negative bacteria; sulbactam/ cefoperazone (97.14%), piperacillin/tazobactam (95.23%) and meropenem (94.28%) were the most effective drugs.Conclusions: Pseudomonas aeruginosa, Staphylococcus aureus, Proteus spp. and Klebsiella spp. are the leading ENT pathogens in paediatric patients. Most of the isolates showed high resistance to cephalosporins. Showed high effectiveness to sulbactam/ cefoperazone, piperacillin/tazobactam.

Antimicrobial susceptibility of bacterial isolates from patients presenting with ear, nose and throat (ENT) infections in the German community healthcare setting.

Empiric initial antibiotic therapy of bacterial infections is based primarily upon the susceptibility of the most common causative pathogens. The purpose of this study was to provide susceptibility data on six bacterial species known to cause ear, nose and throat (ENT) infections. A total of 1066 isolates collected during a nationwide laboratory-based surveillance study were analysed. All Streptococcus pyogenes isolates were penicillin (PEN)-susceptible, indicating that natural penicillins can still be recommended as the first-line treatment for group A streptococcal tonsillopharyngitis. Of the S. pneumoniae isolates, 92.9% were PEN-susceptible and of the Haemophilus influenzae isolates, 89.7% were amoxicillin-susceptible, retaining aminopenicillins as the first-line treatment for acute otitis media (AOM) and acute rhinosinusitis (ARS), in case antibiotic therapy is considered. In contrast, cefuroxime axetil seems less likely to be suitable for the treatment of AOM or ARS, as all Moraxella catarrhalis and >99% of the H. influenzae isolates were categorised as intermediate or resistant. The susceptibility rates of Pseudomonas aeruginosa were 97-100% for the drugs tested, except for the fluoroquinolones (87.6%). Overall, bacterial isolates from outpatients presenting with ENT infections showed low frequencies of resistance in Germany. However, given the emergence of multidrug resistance to standard antibiotics in Escherichia coli and other pathogens, inappropriate use of broad-spectrum antibiotics for the treatment of ENT infections has to be avoided.

Drug utilization pattern of antimicrobial agents in an outpatient department of otorhinolaryngology in a tertiary care hospital: a prospective, cross-sectional study

Background: Study based on antimicrobial drug utilization pattern and focus on factors related to prescribing, administering and its associated events. The aim of this study is to assess the prescribing patterns of antimicrobials, to assess the appropriateness of prescribed antimicrobials in an ear, nose and throat (ENT) infections. Methods: A prospective observational drug utilization study was carried out in otorhinolaryngology department for a period of 4 months. Patients who attended the ENT outpatient department (OPD) with ENT infections were included in the study and patients who were not willing to participate in the study were excluded and the data were analyzed. Results: Out of 155 patients, the average number of drugs per patient was 1.2. The percentage of drugs prescribed with the generic name was 26.32%. During this study, it was found that the most commonly prescribed groups of antimicrobials were penicillins (34.87%) followed by fluroqinolones (26.32%) and nitroimidazole (25%). During the study, it was observed that 46.71% patients visited for treating ear infections, 12.5% for nasal infections and 40.79% for throat infections. The routes of administration were oral (74.23%) and topical (20.10%). Conclusions: Our study shows some rational prescription patterns like less utilization of antimicrobials in ENT infections and were according to standard treatment guideline. The results of this study will be useful in future for making standard treatment guidelines. It also promotes the rational prescription and rational use of drugs.

An ethnobotanical study of plants used for the treatment of ear, nose and throat (ENT) infections in Nkonkobe Municipality, South Africa

The use of medicinal plants in the treatment of infectious diseases has been used by the majority of the world’s population for thousands of years. South Africa has a rich heritage of indigenous knowledge on the use of traditional medicinal plants. The Eastern Cape Province of South Africa is particularly known for its richness in plant species. The indigenous people of this province have a long history of traditional plant usage for the treatment of various diseases and ailments. An ethnobotanical survey of medicinal plants used for the treatment of ear, nose and throat (ENT) infections in Nkonkobe Municipality of the Eastern Cape Province, South Africa, was conducted through the use of structured questionnaires. Respondents included traditional healers and herbalists. The information collected revealed 27 plant species belonging to 21 families were used to treat ENT infections. Members of the Asteraceae family were reported to be the most prominent followed by Lamiaceae, Alliaceae and Rutaceae, respectively. The leaves were reported to be the most used part of the plants, constituting about 59% of the herbal preparations, followed by the bark and roots (11% each), bulb, rhizome and stem (5% each), and twigs and fruits (2% each). Methods of herbal administration involved drinking the extracts, snuffing the powdered leaves and squeezing the warm leaf sap directly into the ear, for healing the throat, nose and ear infections respectively. Plants reported in this survey are important candidates for phytochemical and pharmacological tests. Key words: Ear, nose and throat infections, herbal medicine, traditional healers.

Drug utilization pattern of antibacterials used in ear, nose and throat outpatient and inpatient departments of a university hospital at New Delhi, India.

Objective:We explored the antibacterial prescribing patterns of physicians in ear, nose and throat (ENT) outpatient and inpatient departments (OPD, IPD) of a University Hospital, New Delhi, India.Materials and Methods:A prospective study was conducted, with a sample size of 276 patients, who visited the ENT OPD and IPD over a period of 4 months.Results:It was found that 62.68% were males, 26% patients were in the age group 26-35 years, followed by 22.8% belonging to the age group 26–35 years. Maximum number of patients were diagnosed with ear (37.3%) and throat (36.2%) infections. The most frequently prescribed antibacterials were β-lactams (45.52%) followed by quinolones (26.31%). The most commonly used agent in penicillins was amoxicillin and clavulanic acid (21.74%), in cepahalosporins was cefpodoxime proxetil (5.49%) and in quinolones was gemifloxacin (14.41%). Further, 66.67% of the patients received single antibacterial drug and the average number of antibacterial agents prescribed per patient per course was found to be 1.58. It was also observed that 70.71% of the antibacterials were prescribed by oral route. The most concomitant conditions were found to be diabetes (10.5%), hypertension (6.16%) and coronary heart disease (5.07%). All the drugs were prescribed by their brand names and 48.91% patients showed good adherence with the prescribed therapy.Conclusions:The present work is the maiden drug utilization study conducted in ENT department at our university hospital. It highlighted some rational prescription patterns including less utilization of antibiotics in ENT infections, good adherence by patients and prescription by brand names. The data presented here will be useful in future, long-term and more extensive drug utilization studies in the hospital and in promotion of rational prescribing and drug use in hospitals.

Intelligent Bayes Classifier (IBC) for ENT infection classification in hospital environment

Electronic Nose based ENT bacteria identification in hospital environment is a classical and challenging problem of classification. In this paper an electronic nose (e-nose), comprising a hybrid array of 12 tin oxide sensors (SnO2) and 6 conducting polymer sensors has been used to identify three species of bacteria, Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and Pseudomonas aeruginosa (P. aeruginosa) responsible for ear nose and throat (ENT) infections when collected as swab sample from infected patients and kept in ISO agar solution in the hospital environment. In the next stage a sub-classification technique has been developed for the classification of two different species of S. aureus, namely Methicillin-Resistant S. aureus (MRSA) and Methicillin Susceptible S. aureus (MSSA). An innovative Intelligent Bayes Classifier (IBC) based on "Baye's theorem" and "maximum probability rule" was developed and investigated for these three main groups of ENT bacteria. Along with the IBC three other supervised classifiers (namely, Multilayer Perceptron (MLP), Probabilistic neural network (PNN), and Radial Basis Function Network (RBFN)) were used to classify the three main bacteria classes. A comparative evaluation of the classifiers was conducted for this application. IBC outperformed MLP, PNN and RBFN. The best results suggest that we are able to identify and classify three bacteria main classes with up to 100% accuracy rate using IBC. We have also achieved 100% classification accuracy for the classification of MRSA and MSSA samples with IBC. We can conclude that this study proves that IBC based e-nose can provide very strong and rapid solution for the identification of ENT infections in hospital environment.

Clinical evaluation of the electronic nose in the diagnosis of ear, nose and throat infection: a preliminary study

The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.

Allergy: a global problem. Quality of life.

Allergy: a global problem. Quality of life.

Parental quality of life and recurrent ENT infections in their children: development of a questionnaire. Rhinitis Survey Group.

During the first 4 years of life, children develop ear, nose and throat (ENT) infections because their immune system is not fully mature. Some of them will develop a recurrence and repetition of these episodes might have impact on the parents' quality of life. Based on a literature review, face to face interviews with parents and meetings with a paediatrician, a 17 item French questionnaire has been devised in order to evaluate the specific impairment of parents' quality of life during a winter season. Cultural adaptations were made for Italy, Germany, Portugal and the Czech Republic. This questionnaire was completed by 1,214 parents in a longitudinal survey. The questionnaire was reduced to 14 items and three scores were identified through principal component analysis: an emotional score (eight items), a daily disturbance score (six items) and a global score (14 items). Construct validity was confirmed through multitrait analysis and internal consistency reliability confirmed using Cronbach's alpha. The emotional score was found to be linked to the number and type of ENT episodes while the daily disturbance score was linked to social consequences. The global score was linked to both aspects, demonstrating the clinical validity. This questionnaire is therefore able to measure the cumulative effect of recurrence of children's ENT infections on their parents' quality of life in France, Italy, Germany, Portugal and the Czech Republic.

Economic Evaluation of Ribosomal Immunotherapy in Patients with Chronic Ear, Nose and Throat and Respiratory Tract Infections

This study analyses the economic value of ribosomal immunotherapy in patients with chronic ear, nose and throat (ENT) infections and respiratory tract infections (RTI) as compared with patients not receiving prophylaxis. Specifically, the objective was to determine whether the incremental costs of ribosomal immunotherapy could be offset by healthcare savings through a reduction in recurrent episodes of acute infection. The study was conducted from the payer perspective in the Italian healthcare setting. A 6-month time-frame was used in the decision analysis model, and costs reflect 1995 values. The model incorporated international clinical trial data and Italian resource use data for adult patients with chronic sinusitis and bronchitis and children with recurrent ENT infections. The findings indicate that ribosomal immunotherapy is capable of generating net direct cost savings over 6 months ranging between 280 000 and 1 100 000 Italian lire (L) per patient (L1700 approximately $US1) depending on the type of chronic disease studied (otitis media or rhinopharyngitis in children, sinusitis or bronchitis in adults). Threshold incremental efficacy of immunoprophylaxis required to achieve cost equivalence compared with no prophylaxis ranged between 2 and 20%, depending on the indication and the magnitude of treatment cost associated with an acute infectious episode (low/best/high estimate) considered. In view of the incremental efficacy rates observed in clinical trials ranging between 40 and 65% for patients with ribosomal immunoprophylaxis, prevention of recurrent ENT infections and RTI appears to be an economically meaningful therapeutic strategy, even when assuming that efficacy rates achievable in real clinical practice may be lower than those reported in clinical trials. On the basis of these findings for Italy, physicians should give increased attention to ribosomal immunoprophylaxis of chronic respiratory diseases in children and adults.

Epidemiology of infections in the adult medical intensive care unit of a cancer hospital.

A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.