Suppurative Complications Research Articles

Risk Factors for Severe Outcomes in Bacterial Meningitis

Objectives: This study aimed to define risk factors associated with suppurative complications, short-term sequelae, and death in pediatric patients with bacterial meningitis. Methods: A retrospective cohort study was conducted on children with bacterial meningitis, aged 0 months to 18 years, who were admitted to the Hospital Infantil João Paulo II, reference in infectious diseases, from 2005 to 2018. Results: In 178 cases, meningococcal meningitis was the most prevalent disease form (51%), followed by pneumococcal meningitis (31%) and Haemophilus influenzae type B meningitis (10%). The main clinical findings at admission were fever (93.1%), vomiting (67.9%), drowsiness (47.8%), headache (36.5%), irritability (28.3%), and seizures (26.4%). Suppurative complications were recorded in 19% of the patients. The prevalence of neurological sequelae during hospital discharge was 12.4%. Hearing (41%; n = 9) and cognitive (9%) impairments were prominent among the diagnosed sequelae. Incidences of epileptic crises, vestibular disorders, or hydrocephalus were noted in one case each (4.5%), and 12.4% of the patients died. Conclusions: Streptococcus pneumoniae and H. influenzae type B were associated with the diagnosis of sequelae during hospital discharge, seizures were considered a risk factor for suppurative complications, and gastrointestinal symptoms or signs of clinical severity were associated with death.

MODERN PRINCIPLES FOR LOCAL MANAGEMENT OF PURULENT WOUNDS

At present, surgical infection is one of the most thorny, difficult and urgent issues in clinical practice and is a great social and ecological importance globally. Growing number of suppurative and necrotizing lesions, postoperative suppurative complications, cases of generalized infection and various toxic and allergic reactions are among the challenges the surgeons have to encounter in daily practice. Patients with suppurative inflammatory lesions, which occurrence rate is reaching out 35 – 40% of soft tissue inflammatory cases, constitute a considerable share of all surgical patients. And sometimes the treatment outcomes of such conditions are unsatisfactory. Under the body immune response, the number of postoperative suppurative complications is demonstrates a tendency toward the growth. The clinical course of such suppurative processes is usually acute and often causes systemic infection, sepsis, and even lethal outcomes. In the total number of the lethal cases in surgical inpatient departments, the number of acute surgical infection ranges from 40 to 60%. Moreover, there has been an increase in a number of chronic cases resulted from acute ones that require more time and expenses to manage them. Long hospital staying, insufficient treatment efficacy of existing techniques, considerable economic losses for rehabilitation evidence the range of questions unsolved. The literary review has shown that early detection and proper management of purulent foci is among the leading factors of successful management of surgical wounds. Despite the active implementation of new approaches and techniques for the treatment of purulent wounds, so called "under the bandage" wound management is of considerable clinical importance, therefore the right selection of wound dressing materials, different by their chemical nature, dressings techniques, medications is one of the most promising ways on local treatment of suppurative wounds that can significantly increase the effectiveness of the treatment outcomes.

RARE INTRAOPERATIVE FIND — ADENOCARCINOMA OF THE APPENDIX: CLINICAL CASE

Relevance: Neoplasms of the large bowel are one of the most common diseases among all malignant neoplasms of the gastrointestinal tract. The predominant localization is the rectosigmoid junction. The rarest disease is a neoplasm of the appendix. Purpose: Diagnosis of the neoplasm of the appendix with extension into cecum cupula and into the anterior abdominal wall and description of the results on the example of a clinical case. Materials: We present a case of patient I., male, 34 years old. He is a hypersthenic overweight person, essential hypertension stage I, rate III, risk 3. Results: Patient I. was first admitted in a private clinic (Tver, Russia) in September 2020 after the 1 day of onset. A clinical presentation complies with appendicitis. He was sent to the emergency surgery department after the examination by the surgeon. There he underwent a diagnostic laparoscopy, conversion, laparotomy with preservation of the appendix, and draining of the abdominal cavity. The second visit to a private clinic was in May 2021. The CT scan of the abdominal organs was performed and an infiltrate was detected in the cecum cupula with a small area of suppurative complication. Then the patient was hospitalized in the surgery department, where he was prescribed antibiotic therapy for periappendiceal mass and recommended a planned appendectomy. In September 2021, the patient turned to the surgery department at the place of residence due to the deterioration. He underwent a laparotomy in the right iliac region, viscerolysis, median laparotomy, rightsided hemicolectomy for adenocarcinoma of the appendix, ileotransverse anastomosis by the side-to-side method, drainage of the abdominal cavity. Conclusion: Acute appendicitis remains a challenge for practicing surgeons despite being common and well-studied. Acute appendicitis is characterized by pronounced clinical symptoms. But it also has many hidden forms that mimicked other diseases. That’s why the establishment of this diagnosis is difficult even for experienced clinicians. This clinical case demonstrates certain difficulties in the timely diagnosis of the appendix neoplasm. This is because the development of most appendix tumors is asymptomatic or resembles the clinic of acute appendicitis. The tumors are detected by chance, or during visualization, or during appendectomy. Only early diagnosis of the disease, knowledge of the treatment strategy and timely initiation of appropriate therapy can improve the prognosis of patients, reduce the risk of disability and death. It is undoubtedly important in clinical practice.

Some aspects in the treatment of patients with a suppurative process after joint implanting

Attention is concentrated on the basically varying nature of early and late suppurative complications after implanting and hence on different approaches to treating deep suppurative processes. In early deep suppurations, timely intensive care permitted the authors to eliminate suppurative complications in 67.8%, by preserving the implant. In late suppurations associated with metallosis, the implant cannot be preserved, it is necessary to treat not only a deep suppuration, but also metallosis.

Suppurative complications following BCG vaccine in 2 Nepalese children

BackgroundThe Bacillus Calmette–Guérin (BCG) vaccine is one of the most common vaccines administered worldwide and awareness regarding its usual and adverse reactions is important. Local and systemic complications require accurate identification for timely therapy. We hereby report two patients with rare suppurative local complications of BCG. Case presentationCase 1: A nine-month-old boy presented with swelling over the right deltoid for one month with low-grade fever and purulent discharge for two days. The active discharge occurred from the same site of previous BCG inoculation, the regression of which was achieved conservatively. Case 2: The second case was a 14-month-old boy who presented with a swelling over the lower part of the right axilla for one year, later diagnosed as a tuberculous lymph nodal abscess. Needle aspiration was done and anti-tubercular therapy was started based on positive Gene Xpert reports. Both the cases resolved completely without complications. ConclusionPharmacovigilance surveillance of BCG scar reactions and occurrence of suppurative complications should be known by clinicians for correct identification and management.

Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children

ObjectiveIntracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. MethodsA retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. Results65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. ConclusionIntracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.

Damage to the connective tissue system in patients with post-traumatic osteomyelitis

In 63 patients with suppurative bone process the activity of N-acetyl-fi-D-glucosaminidaze lysosomal enzyme in urine as well as oxyproline and hexuronic acids excretion were evaluated. Significant changes in metabolism of collagen and proteoglycans of osseous organic matrix were detected and it was confirmed by high excretion of their structural components. The more active and vaster the suppurative process was the more quantitative excretion of collagen and glu- cosaminoglycans and higher enzyme activity were. The suggestion was formulated that high excretion of N-acetyl-fl-D-glucosaminidaze in urine noted in the patients with suppurative inflammatory complications was the indicator of pathologic changes in tubular apparatus of kidney. The detection of excretion of the connective tissue metabolites (oxyproline and hexuronic acids) could be used for the diagnostic and prognostic evaluation of the disease severity and for the choice of method for the treatment of suppurative process.

Метаболизм соединительной ткани у больных с гнойными осложнениями после остеосинтеза отломков длинных костей

Остеосинтез (osteosynthesis; греч. osteon (кость) + synthesis (соединение)) — это хирургическое соединение отломков костей в правильном положении с целью стабильной фиксации до полной их консолидации (костного сращения) и восстановления целости и функции кости. Обследовано 34 больных в возрасте 17–58 лет с гнойными осложнениями после остеосинтеза при переломах длинных костей, в том числе у 29 мужчин и 5 женщин. В сыворотке кpови больных определяли следующие биохимические показатели: активность коллагеназы, фpакции гидpоксипpолина, гликозаминогликаны, кальций, фосфор и электролиты (Na+, K+, Ca++).Результаты исследования показывают, что у больных с гнойными осложнениями после остеосинтеза длинных костей при рецидиве воспалительного процесса усиливается катаболическая фаза метаболизма основных компонентов органической основы костной ткани. Об этом свидетельствуют показатели, отражающие синтетическую и катаболическую фазы метаболизма основных компонентов соединительной ткани — коллагена и гликозаминогликанов. Данные, полученные при исследовании минерального обмена, отражают нарушения минерализации костной ткани, что подтверждается показателями содержания общего кальция, ионизированного кальция, фосфора и электролитов.

Аналіз оперативного лікування осіб літнього та старечого віку з переломами проксимального відділу стегнової кістки методом накісткового остеосинтезу пластиною

Актуальність. Переломи проксимального відділу стегнової кістки (ПВСК) в осіб похилого та старечого віку продовжують залишатися актуальною проблемою клінічної медицини. Мета: оцінити віддалені результати оперативного лікування методом накісткового остеосинтезу пластиною пацієнтів похилого та старечого віку з переломами проксимального відділу стегнової кістки. Матеріали та методи. Проаналізовано 744 історії хвороби пацієнтів, які знаходилися на стаціонарному лікуванні в травматологічному відділенні Харківської міської клінічної багатопрофільної лікарні № 17 у період 2008–2016 рр. До групи дослідження ввійшли пацієнти літнього та старечого віку з низькоенергетичними переломами ПВСК. Для подальшого дослідження за віковими критеріями та типом перелому сформована група з 24 пацієнтів, середній вік яких становив 71–74 роки: 10 пацієнтів чоловічої та 14 пацієнтів жіночої статі. У всіх пацієнтів виявлена супутня патологія з переважанням захворювань серцево-судинної системи. Усім хворим виконано остеосинтез проксимальною стегновою пластиною з кутовою стабільністю. Оцінка больового синдрому, статико-динамічної активності пацієнтів, деформації та амплітуди рухів оперованої нижньої кінцівки проводилася з використанням оцінної шкали Харріса. Результати. Віддалені результати лікування переломів ПВСК методом остеосинтезу накістковою пластиною вивчалися на прикладі 24 пацієнтів, термін спостереження становив від 9 років до 1 року. Залежність від сторонньої допомоги при виписці спостерігалася у 16 пацієнтів, 15 хворих використовували ходунки. У 14 випадках пацієнти частково навантажували оперовану нижню кінцівку, 3 пацієнта пересувалися з повним навантаженням, 7 пацієнтів — без опори на оперовану нижню кінцівку. Термін користування зовнішніми опорами становив від 4 місяців дотепер. При анкетуванні 91,6 % хворих суб’єктивно відзначили погіршення якості життя після хірургічного лікування перенесеної травми. Після остеосинтезу накістковою пластиною хороший результат (12,5 %) виявлено лише у однієї пацієнтки, задовільні результати у анкетованих пацієнтів не виявлено, незадовільні результати (87,5 %) відзначені у 7 анкетованих пацієнтів. Слід сказати, що хороший результат (88 балів за шкалою Харріса) відзначено у однієї пацієнтки з 2-м типом перелому, вік якої на момент операції становив 66 років. Причинами незадовільних результатів стало вторинне зміщення кісткових уламків (25 %), присутність помірного або слабкого болю (87,5 %). Висновки. Хірургічне лікування переломів проксимального відділу стегнової кістки у осіб похилого та старечого віку супроводжується високою летальністю (66,6 %). Віддалені результати після остеосинтезу переломів цієї ділянки у 87,5 % були поганими, причинами чого були вторинне зміщення кісткових уламків (25 %), присутність помірного або слабкого болю (87,5 %). Лікування хворих літнього та старечого віку накістковим остеосинтезом із переломами проксимального відділу стегнової кістки часто не дозволяє активізувати хворих у ранні терміни, що згодом призводить до загострення хронічних супутніх захворювань. Застосування накісткового остеосинтезу при лікуванні переломів проксимального відділу стегна в осіб похилого та старечого віку є малоефективним методом, який би дозволив досягти хороших і задовільних результатів. Потрібна розробка методів хірургічного лікування пацієнтів похилого та старечого віку з переломами проксимального відділу стегнової кістки, що дозволяють здійснити ранню активізацію хворого з повним навантаженням на оперовану нижню кінцівку.

РАНЕВЫЕ ГНОЙНО-ВОСПАЛИТЕЛЬНЫЕ ОСЛОЖНЕНИЯ ПОСЛЕ НЕНАТЯЖНОЙ ГЕРНИОПЛАСТИКИ

Objective: Analysis of surgical site suppurative complications after correction of large and giant ventral hernias. Methods: Various types of hernioplasty were performed on 220 patients with large and giant ventral hernias. Among the total number of patients, tension-free hernioplasty was performed in 123 patients, which accounted for 56% of the total number of patients. Various types of mesh implants were used, as well as different techniques of mesh placement in the area of the hernia ring. Results: Surgical site suppuration in the postoperative period occurred in 7 patients, which amounted to 5.6%. Partial removal of the mesh polymer implant was carried out only in one case. Timely diagnosis of the complications and adequate sanitation of the surgical site in 6 cases showed a good effect, and the implants did not necessitate removal. In one observation with necrosis of the edges of the wound and suppuration of the surgical site, after partial removal of the implant, a hernia recurrence was noted in the area of the removed mesh. In 6 other cases, there was no recurrence of the pathology during the long-term follow-up. Conclusion: Surgical site suppurative inflammation in the postoperative period, negatively affecting the outcome of the operation, can contribute to hernia recurrence. Timely diagnosis of complications and adequate sanitation of surgical site in most cases give satisfactory results. Keywords: Large and giant ventral hernias, hernia recurrence, tension-free hernioplasty, suppurative inflammation.

Antibiotics for treatment of sore throat in children and adults.

Antibiotics for treatment of sore throat in children and adults.

P115 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR IN DECOMPENSATED CIRRHOSIS

Abstract Aim To evaluate the possibilities, benefits and safety of laparoscopic treatment of inguinal hernias in patients with cirrhosis of the liver and ascites, in particular to evaluate the TAPP approach for the treatment of inguinal hernias in patients with cirrhosis of the liver and ascites. Material and Methods Group I - TAPP repair in 16 patients with liver cirrhosis and ascites. Group II - Lichtenstein type hernioplasty in 15 patients with liver cirrhosis and ascites. All patients underwent planned surgery after dosing preoperative laparocentesis and correction of liver function indices. Results In the first group of patients no complications developed, no suppurative complications were observed, no edema, no leakage of ascites fluid. Postoperatively, all patients recovered well, noticed less pain. Only 25 percent of patients required analgesics. Patients were discharged at home 3-5 days postoperatively. In group II - minor complications were observed: 1 local hematoma, 1 seroma. Postoperative pain syndrome was more pronounced. All patients required analgesics. Duration of hospitalization 4-6 days. During a 10-month follow-up, no patients had recurrence and chronic pain. Conclusions TAPP repair provided the opportunity to assess macroscopic changes in the liver and possibly to perform liver biopsies, if necessary. TAPP repair reduces days of hospitalization and postoperative recovery by reducing pain syndrome with a low percentage of analgesics. TAPP repair can be a useful treatment option for patients with liver cirrhosis accompanied by ascites.

Migrated Foreign Body of Upper Digestive Tract-A Ten-Year Institutional Experience.

The ingested foreign body is one of the commonest emergencies encountered by otolaryngologists Depending on the shape and duration of impaction, a small number of foreign bodies (1-2%) can perforate the wall of the gastrointestinal Tract. A migrated foreign body may remain quiescent or cause life-threatening suppurative and vascular complications. Data were collected retrospectively from the hospital records in a tertiary care hospital in South India from 2010 to 2020. Fifteen patients diagnosed with migrated foreign body and who underwent neck exploration were included in the study. Demographic details, mode of presentation, clinical and radiological findings, rigid esophagoscopy findings, neck exploration techniques employed were noted. The mean age of the patients was 37.66years. All patients had a history of dysphagia, odynophagia, and point tenderness. All the patients underwent a lateral neck radiograph, and it was positive in 12 patients (80%), while in 3 patients (20%), it was negative. All the patients had a positive finding in Contrast-Enhanced Computed Tomography. Esophagoscopy was done prior to neck exploration to identify the site of injury and the probable site of migration. All the patients underwent lateral neck exploration, and foreign body was removed. Migrated foreign body can cause significant morbidity and mortality if not diagnosed and managed early. Strong suspicion and a systematic approach are needed for the diagnosis and management.

302 Migratory Foreign Body in The Neck- How A Fishbone Morphed into A Piece of Glass In 18 Months

Abstract Background Foreign body (FB) ingestion is a common presentation to ear, nose, and throat (ENT) surgeons. Usual culprits include fish or chicken bones, steak, or non-organic items. FBs can be categorised into batteries, hard objects, and soft boluses. Hard objects that have not passed beyond the post-cricoid region require removal to minimise perforation risk. In rare cases FBs are reported to migrate extra-luminally into surrounding tissues of the neck necessitating cross-sectional imaging ahead of neck exploration. Case Report A 70-year-old lady presented to A&E with a sensation of FBs in her throat. She was aphagic without dyspnoea. Home-cooked fish ingestion was the precursor. Panendoscopy was clear. The patient was discharged once tolerating fluids and soft diet. She presented 14 months later to the ENT clinic with a persistent FB sensation in her throat. A computed-tomography scan of neck showed a right sided, radio-opaque, 3 cm foreign body sitting just anterior to the carotid sheath, behind the right superior thyroid lobe. An elective external neck exploration revealed a 3 cm shard of glass which was successfully removed without complications. Conclusions Extra-luminal migration of FBs is extremely rare. They may present with life-threatening suppurative or vascular complications. A literature review revealed that migratory FBs tend to be sharp and long such as needles, wires, or fishbones. To allow prompt diagnosis and management, we propose a low threshold for CT imaging in instances with a clear history and persistent symptoms even when panendoscopy is negative.

Infectious complications of hip arthroplasty

The objective of the research is to study the causes and outcomes of infectious complications after total hip arthroplasty. The background of the research is the analysis of outcomes of 364 patients with complications after total hip arthroplasty; 369 cases, from 2005 to 2018. The infectious complications accounted for 21.7% (80 cases). The work involves clinical, radiological, microbiological, and statistical research methods. As a result of research causes of suppurative complications after total hip arthroplasty were: chronic infectious diseases of internal organs (t=3.37, p=0.001), instability of prosthetic components (t=3.14, p=0.002), over two previous surgical interventions involving the affected joint (t=2.43, p=0.005). In the treatment of periprosthetic infections, sanitizing interventions without the prosthetic components’ removal appeared efficient within only up to 3 weeks. If the sanitizing interventions were inconclusive, the double-stage revision prosthetics appeared adequate in a reliable number of cases (t = 11.2, p = 0.0028), namely 24, which amounted to 92.3%. In conclusion, it was concluded that the causes of periprosthetic infections were: diseases of the internal organs, instability of the components, over two surgical operations involving the same joint. The development of various complications after total hip replacements demands surgical revision procedures.

Пролежні м’яких тканин у хворих на цукровий діабет 2-го типу: клінічні стратегії, показники інсулінорезистентності та аспекти комплексного лікування

Вступ. Причинами виникнення пролежневих трофічних виразок є ішемія та нейротрофічні зміни тканин, викликані їх тривалою хронічною компресією, постійним патологічним зволоженням та зсувом тканин, що детермінує виникнення локальної ішемії. Мета роботи: дослідити клінічні варіанти та гнійні ускладнення пролежнів у хворих на цукровий діабет (ЦД) 2-го типу з позицій наявності інсулінорезистентності (ІР) у контексті оптимізації комплексного лікування. Матеріали і методи. Загальну вибірку ретро- та проспективного аналізу становили результати комплексного лікування 112 пацієнтів. Наявність ЦД 2-го типу пiдтверджено в 37 пацієнтів, 27 пацієнтів iз пролежнями без ускладнень (І–ІІІ стадії) та ЦД становили І групу порівняння, iз пролежнями IV стадії — ІІ групу порівняння, інші 75 осiб — групу контролю. Результати. У хворих на ЦД 2-го типу (І група порівняння) спостерігалося вірогідно значуще зменшення НОМА-індексу функції β-клітин та збільшення НОМА-індексу ІР (8,31 ± 0,02, р < 0,01). У хворих на ЦД 2-го типу з наявністю ускладнених пролежнів (ІІ група порівняння) зареєстровано більш значне підвищення показників циркулюючого інсуліну (p2 < 0,01), НОМА-індексу ІР (p2 < 0,05) та значне зменшення НОМА-індексу функції β-клітин (р < 0,05). При проведенні кореляційного аналізу показникiв НОМА-ІР та концентрації елементів у крові кореляційний зв’язок був встановлений тільки у хворих на ЦД 2-го типу (І та ІІ групи порівняння): між показником НОМА-ІР та вмістом Mg2+ в еритроцитах виявлено негативний сильний кореляційний зв’язок (r = –0,72; Р < 0,01), між НОМА-ІР та концентрацією Zn2+ у сироватці крові — негативний зв’язок середньої сили (r = –0,66; p < 0,01) та між НОМА-ІР й рівнем Cr3+ у сироватці крові — негативний кореляційний (r = –0,69; p < 0,01). Висновки. Перевагою запропонованої класифікації пролежнів м’яких тканин та послідовності комплексного лікування є врахування особливостей патогенезу, морфогенезу та клінічного перебігу пролежнів з ускладненнями, які мають вплив на перебіг загоєння та потребують адекватних стратегій лікування гнійних ран — TIME і DOMINATE, що, на нашу думку, детермінує можливість впровадження в клінічну практику відділень паліативної допомоги, інших стаціонарних та амбулаторних закладів охорони здоров’я.

Remedial Effects of Homeopathic Medicine in Chronic Suppurative Otitis Media-Related Complications

Chronic Suppurative Otitis Media (CSOM) is characterized by persistent otorrhoea from the middle ear through a perforated tympanic membrane. It is regarded as one of the most important causes of hearing impairment in developing countries. In many cases, treating CSOM with antibiotics generates fears of resistance. Unlike conventional antibiotics, homeopathic remedies are mostly free from side effects. Therefore, this study was performed to evaluate the effects of homeopathic medicines to treat CSOM patients. A total of 90 subjects were included in this study; among them, 60 were suffering from CSOM, and 30 were healthy controls. The CSOM patients were randomly assigned for the daily administration of homeopathic medicines such as tellurium metallicum in 6C potency (n=17), mercurius solubilis in 200C potency (n=13), and calcarea sulphurica in 30C potency (n=10) for 8 weeks. Ear suppuration was prevented in all of the patients treated with the medicines. More than 50% of the patients’ tympanic membrane perforation were healed by tellurium metallicum and calcarea sulphurica, however, no membrane healing was observed by mercuris solubilis. It was next examined whether the patients underwent hearing impairment compared to healthy control subjects. The average hearing thresholds of the control subjects (n=30) at 1, 4, 8, and 12 kHz frequencies were 13.55 ± 1.57, 15.58 ± 1.12, 27.58 ± 2.00, and 32.57 ± 2.45 dB SPL, respectively. When the average hearing thresholds of the CSOM patients (n=40) were measured at all of the above frequencies, the values became 30.25 ± 1.75, 36.80 ± 3.25, 50.75 ± 2.35, and 59.50 ± 2.96 dB SPL, respectively. This result indicated the loss of hearing in CSOM patients as the average hearing thresholds of the patients were significantly higher (p<0.05) than that of the control subjects. Treatment for 8 weeks with all three homeopathic medicines significantly reduced (p<0.05) hearing thresholds of the patients at all the frequencies. This result demonstrated dramatic improvement in patients’ hearing by the homeopathic medicines. This study, therefore, provides conclusive evidence that homeopathic medicines prevent ear suppuration in CSOM patients as well as heal perforated membrane, and improve hearing.
 Bioresearch Commu. 7(2): 982-989, 2021 (June)

Immediate and postponed results of surgery of tuberculosis in patients with HIV infection

The objective: to evaluate immediate and postponed results of surgical treatment of tuberculosis (TB) in patients with TB/HIV co-infection.Subjects and methods. 106 patients underwent surgery: 64 patients suffering from pulmonary tuberculosis (81.2% had resections, and 18.8% – thoracoplasty), 36 patients – tuberculous spondylitis (vertebral body resection in combination with anterior spondylodesis), and 6 patients – cerebral TB (removal of tuberculous lesions under neuronavigation). Development of complications in the postoperative period and tuberculosis relapses in the long-term period was assessed.Results. No severe and suppurative complications were observed in the postoperative period in patients with HIV/pulmonary TB and HIV/cerebral TB. In patients with HIV/TB spondylitis, complications were registered in 4/36 (11.1%) cases: in 2/4 – postoperative wound suppuration and in 2/4 – ligature fistulas. No relapse of tuberculosis was reported after lung resection in 45 out of 45 patients availabe for follow-up, after thoracoplasty in 10 out of 12 patients, after surgery due to tuberculous spondylitis – in 25 out of 27 patients, and cerebral tuberculosis – in 5 out of 6.

Pediatric subperiosteal orbital abscess characterization and prediction of size, location, and management

IntroductionSubperiosteal orbital abscess (SPOA) is a serious suppurative complication of pediatric sinusitis. The objective of this study is to stratify patient selection into those best treated medically versus surgically based on clinical outcomes. MethodsThis is a retrospective review of patients diagnosed with SPOA complicating sinusitis treated at a tertiary care pediatric hospital from 2002 through 2016. SPOA was diagnosed by CT scan. Characteristics evaluated include demographics, abscess size, location, and measurements, length of hospital stay, medical and surgical interventions, presenting symptoms, and complications. ResultsA total of 108 total SPOA secondary to sinusitis patients were included. A majority, 72.2%, were male with an average age at presentation of 6.8 years. The mean ± standard deviation abscess cubic volume was 0.98 ± 1.27 cm3 (median(range) = 0.44(0.01–7.34 cmcm3)). With an abscess volume of 0.510 cm3, there was a sensitivity of 71.2% and a specificity of 84.4% for needing surgical drainage. Those with large abscesses at our volume threshold were 13 times more likely to require surgery than those with small abscesses, OR: 13.41, 95%CI: 5.02–35.86, p < .001. Patients that required surgery had an abscess closer to the orbital apex with the majority, 25 (61.0%), being the most proximal to the apex, p = .004. The likelihood of surgery decreased with increased distance from the orbital apex in medial abscesses (OR:.92, 95%CI: 0.86-0.98, p = .009). ConclusionIn the pediatric population, SPOA is a serious consequence of sinusitis. This study provides evidence supporting that larger abscess size is a significant risk factor for requiring surgery. The appeal of our study is that it provides evidence and support that employ clinical parameters already assessed as standard practice in evaluating these patients. In summarizing the clinical translational relevance of our study, when determining whether to treat a patient with surgery and antimicrobial/medical therapy vs. non-surgical medical therapy alone, the clinician should focus on size of 0.510 cm3 or larger for abscesses in any location as a relative indication for surgery.

Different antibiotic treatments for group A streptococcal pharyngitis.

Different antibiotic treatments for group A streptococcal pharyngitis.