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PubMed1996

Community outbreak of acute respiratory infection by Mycoplasma pneumoniae.

We present the results of the investigation of an epidemic outbreak of Mycoplasma pneumoniae infection which affected 95 schoolchildren from certain village in Catalonia. The investigation took an epidemiological, clinical and microbiological approach, detecting by capture enzyme-immunoassay technique the presence of IgM antibodies against M. pneumoniae. All cases occurred over a 9 week period. The attack rate in children under five was 18% and 8.2% in those from 5-14 years. The age mean and standard deviation of the cases was 5.2 +/- 3.5 years, the range being from 9 months to 14 years. Cough was the most common clinical manifestation (87.4%), followed by fever (67.4%), asthenia (21.1%), abdominal pain (18.9%), vomiting (13.7%), earache (8.4%) and sore throat (6.3%). There was no significant difference in the distribution of symptoms according to age groups. IgM anti M. pneumoniae was positive in 36 (37.9%) of the samples analysed. Treatment chosen in most cases (90) was eritromicin and there was a correct evolution in all cases except for two clinical and radiological recurrences. Hospitalization was only necessary in 5 cases. The present findings are important to emphasize the high incidence of M. pneumoniae respiratory disease in children under 5, and suggests that with respiratory processes affecting very young children, a possible Mycoplasma pneumoniae infection should also be considered and the necessary action taken in the form of early and appropriate treatment.

Adolescent↗
PubMed1976

Preventive and episodic health care of inner-city children.

Children in low-income, inner-city households who used different sources of ambulatory care were analyzed with regard to their experiences in securing preventive and episodic illness care. This analysis is derived from a larger study that investigated the utilization of health care systems by groups within an inner-city community; it focused on the Outpatient Department of a large teaching hospital and on the impact of a new Health Maintenance Organization (HMO). Data were obtained through household interviews of three sample populations: enrollees in an HMO, residents of a public housing project, and persons from the general community. When preventive health care was examined, our findings showed that, while the majority of children of school age were immunized, only about half of the children under age 6 were. Among children aged 3 through 5, those attending day care centers were more likely to be immunized than those not in such programs. There were indications that children using the HMO were more frequently receiving preventive services, particularly general physical examinations. There was no relationship between the usual source of care, or day care participation, and whether a child received care for an episode of illness. There were differences by age and usual source of care in seeking care for earaches and in receiving regular care for asthma. The patterns of health care utilization found in this study promote interest in the influence of the source of ambulatory care for children in other socioeconomic groups.

Adolescent↗
PubMed2005

Evaluation of the clinical efficacy of Qingqiao capsule in treating patients with secretory otitis media.

OBJECTIVE: To observe the clinical efficacy of Qingqiao Capsule (QQC) in treating patients with secretory otitis media (SOM). METHODS: A total of 90 patients were randomly assigned into the treated group (n = 45) and the control group (n = 45). Patients in the treated group were administrated with QQC, 5 capsules each time, 3 times a day for totally 10-14 days, and those in the control group were given per os cefaclor capsules 0.5 g each time for adult, 3 times a day, or 20 mg/(kg.d) for children, for 10-14 days. The therapeutic efficacy of treatment on the patients was observed and compared after treatment and followed up for 3-6 months. RESULTS: (1) The clinical efficacy in the treated group was superior to that in the control group with significant statistical difference (P < 0.01); (2) Comparison of the efficacies in patients of three different TCM syndrome types (the external pathogenic wind invasion caused auditory orifice stuffiness type, the Gan-Dan damp-heat steaming up auditory orifice type and the Pi-deficiency dysfunction induced dirty dampness blocking ear type) showed no statistically significant difference (P > 0.05); (3) The vanishing rate and time needed of the main symptoms and signs in the treated group were superior to those in the control group on ear muffle, tinnitus, hearing impairment, hydrotypanum, pure tone threshold and abnormal tongue figure, and the difference was statistically significant (P < 0.05 or P < 0.01), only those of earache, otopiesis and abnormal pulse figure were insignificantly different between the two groups (P > 0.05). CONCLUSION: QQC is an effective Chinese composite medicine on patients with SOM, and shows no obvious adverse reaction.

Adolescent↗
PubMed2005

After-hours paediatric telephone triage and advice: the Neuchâtel experience.

UNLABELLED: Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice (TTA) system. To determine whether other Swiss public paediatric departments practiced formal TTA, we conducted a nation-wide postal survey. To delineate who used our call centre and for what reasons, we embarked on a retrospective study of all the 1997/2000 calls. Most of the units run a TTA (27/35) but few specifically train their staff (14/27). A 43% increase in call numbers was seen between 1997 (3242) and 2000 (4628). During week-days, most of the calls were between 6 and 11 pm and at weekends, a mid morning activity peak was seen. Some 75% of calls were for children aged 5 years or less. Fever, earache and cough accounted for 42% of the main complaints. Of all calls, 27% were dealt by nurses' advice only. About 15% of the calls were transferred to the on-call resident. About 50% led to a same day ED appointment. CONCLUSION: Nurse-led paediatric telephone triage and advice is common in Switzerland where training seems to be irregular. Our data can help units to better plan an eventual paediatric telephone triage and advice service.

After-Hours Care↗
PubMed1979

Pain of first-trimester abortion: its quantification and relations with other variables.

Among 2,299 patients on whom first-trimester abortions were performed after administration of local anesthesia, 97 per cent reported experiencing some degree of pain. Independent ratings of the pain severity were obtained from the patients and also from the doctors and counselors who observed them. Although the rating procedures used by patients from those used by doctors and counselors, the three sources agreed significantly in evaluating pain levels of individual patients. Data from all three sources indicated that pain produced during the abortion procedure tended to be minor in severity. The ranking of relative painfulness of the eight stages of the aborton procedure based on average ratings obtained from doctors was nearly identical to that based on average ratings obtained from counselors. (Patients did not rate the separate stages.) On average, the patients rated the pain as being less than earache or toothache, but more than headache or bachache. The youngest patients experienced the most pain, and the oldest experienced the least. Both gestational age and cervical dilatation were related to pain in a curvilinear fashion, i.e., for both variables, patients in extreme categories experienced more pain than those in intermediate categories. Preprocedure fearfulness was positively related to intraoperative pain. No support was found for the expectation that oral administration of 5 mg. of diazepam reduces pain during this procedure.

Abortion, Induced↗
PubMed1993

Presenting signs and symptoms of nasopharyngeal carcinoma.

Pain in the head and neck may be due to multiple causes and difficult to localize. A definitive diagnosis can be difficult to make. The literature reports several cases of nasopharyngeal carcinoma presenting as temporomandibular disorders (TMD). The records of 52 patients with a diagnosis of nasopharyngeal carcinoma were reviewed to determine the frequency of symptoms that may be similar to TMD. In 13.5% of the patients common TMD signs and symptoms were present, such as clicking in the joint, pain while chewing, and limited opening. Of the patients reviewed, 44.2% described the location of their pain as headache, earache, or as jaw, midface, or neck pain. The most common description of pain was aching, dull, or pressing. Symptoms identified that may assist in differentiation of nasopharyngeal carcinoma from TMD include nosebleed, nasal stuffiness, altered hearing, and cervical lymph node enlargement. A patient with carcinoma of the nasopharynx may have symptoms that must be differentiated from TMD.

Adult↗
PubMed1982

Phase II trial of 13-cis-retinoic acid in metastatic breast cancer.

Studies have suggested that both natural and synthetic retinoids have extensive chemopreventive activity against a variety of carcinogens in vivo and in vitro. We have previously shown that growth of human breast cancer cells can be inhibited by retinoids, and retinoic acid-binding proteins have been demonstrated in these cell lines and tumor biopsies. We studied the activity of 13-cis-retinoic acid in the treatment of 18 patients with advanced breast cancer refractory to standard cytotoxic and/or endocrine therapy. Patients began on 0.5 mg/kg and escalated to 8 mg/kg over a one-month period unless toxicity (dry skin, dry mucosa, cheilitis, conjunctivitis) forced dose reduction. All these toxicities responded promptly to dose reduction. Four patients exhibited drug related hypercalcemia, 2 complained of severe earache and several had nausea, vomiting and abdominal cramping. There were no objective responses as defined by standard criteria. One patient with thrombocytopenia secondary to documented marrow involvement demonstrated a recovery of platelet count from 9000 to 110,000. 13-cis-Retinoic acid is not of apparent value in women with heavily pretreated breast cancer.

Breast Neoplasms↗
PubMed1986

The inter-relationship of folk, traditional and Western medicine within an Asian community in Britain.

A community-based interview study of Asians and a questionnaire study of health professionals were performed to ascertain the role of traditional medicine in the context of health care within the Asian community. Among Asians, knowledge of herbal remedies, the Asian healer and cultural concepts such as the 'hot/cold' theory was high. They frequently used culinary ingredients to treat common diseases such as abdominal discomfort, earache and toothache. The use of metal-based medications was rare, application of the 'hot/cold' concept was not of nutritional significance and Asian healers were infrequently consulted except during visits to India and Pakistan. Among health professionals awareness of Asian medicine was low. None had encountered morbidity resulting from its remedies while 50% felt that such remedies should be encouraged unless shown to be harmful. Traditional medicine was found to play a modest but not insignificant role within the context of total health care. There was little evidence that is use comprises a significant health threat. Opportunities for further research and a prediction of the future of Asian medicine in Britain is presented.

Adult↗
PubMed1982

Geaster mammosum: a bactericidal fungus used in Himalayan folklore.

The discovery is described of the high bactericidal and healing properties of basidiospores of a "star fungus" identified as Geaster mammosum Chev. (family: Geastraceae) growing saprophytically in pine forests. It is used in folk medicine for burns by the inhabitants of Kumaon. This drug was clinically tried on 25 patients with karnasrava (otorrhoea), 8 with karnasula (earache), 7 with vrana (wounds) and 2 with nabhipaka (umbilical sepsis) showing an improvement/cure in almost all cases. The drug offers potential for development as a therapeutic agent.

Adolescent↗
PubMed2004

Leaf extract of Crinum bulbispermum has antinociceptive activity in rats.

In Sri Lankan folk medicine, the leaves of Crinum bulbispermum Burm. (Family: Amaryllidaceae) are claimed to be useful for earache, which is suggestive of antinociceptive activity. The aim of this study was to examine scientifically the antinociceptive activity of Crinum bulbispermum leaves. One of three doses (1000, 1500 and 3000 mg/kg, N=6/group) of aqueous leaf extract (ALE) or 1 ml of distilled water (DW) (vehicle) (N=6) was orally administered to male rats and antinociceptive activity was determined using three models of nociception (tail flick, hot plate and formalin tests). In the hot plate test, slight (18-42%) but significant (P<0.05) overall prolongation of reaction time was evident up to 4h. In the hot plate test, reaction time was markedly (84-121%) and significantly increased by the high dose up to 3h. In contrast, in the formalin test, the high and mid doses significantly impaired the number of lickings and time spent on licking at both phases, whilst the lower dose impaired only the time spent on licking at the late phase. Collectively these results suggest that the antinociception is mediated both spinally and supraspinally and is effective against phasic and continuous non-inflammatory/inflammatory pain. Additionally, the ALE had antihyperalgesic activity. The antinociception of the ALE appear to results from opioid mechanisms, sedation and antioxidant activities. Unfortunately, ALE is mild to moderately toxic.

Administration, Oral↗
PubMed2006

Middle and posterior fossa aspergilloma.

BACKGROUND: Aspergilloma of the brain is a rare disease. Among its varied presentations, a solitary intracranial mass is very uncommon. A preoperative diagnosis of it is very difficult, but a perioperative squash smear/frozen section can identify the pathology. Because of its rarity in immunocompetent patients and the difficulty in preoperative diagnosis, we have illustrated this case and its presentation and management. METHODS: A 27-year-old man presented with an h/o right-sided weakness along with headache and ear discharge. A computed tomographic (CT) scan showed a large irregular, space-occupying lesion in the middle and posterior cranial fossa. He had a mastoidectomy done 3 years before for chronic suppurative otitis media. After a symptom-free interval of 1 year, he was investigated for severe earache on the same side. A CT scan at that time showed a space occupying mass in the right temporal bone and right inferior temporal lobe. A biopsy and histopathology of the lesion revealed a chronic granulomatous mass. He was started on antituberculous drugs and was on it for 7 months at the time of presentation. RESULTS: He underwent a suboccipital craniectomy and total excision of the mass. Postoperatively, his consciousness improved but began to deteriorate on the third postoperative day. A repeat CT scan showed hydrocephalus and total removal of the mass. An external ventricular drain was put and he was ventilated, but he died on the fourth postoperative day. Histopathology report came as aspergilloma. CONCLUSION: This report highlights the rare presentation of aspergilloma in an immunocompetent patient. It emphasizes the importance of suspecting this disease in such patients and the role of intraoperative squash smear preparations or frozen section in the diagnosis as routine diagnostic procedures that will help in early pharmacotherapeutic interventions in adjunct to surgery.

Adult↗
PubMed2006

Pain complaint as the first symptom of oral cancer: a descriptive study.

OBJECTIVE: To identify pain as the initial symptom of oral cancer patients. STUDY DESIGN: Hospital charts of 1412 patients (1977 to 1998) with oral cancer were reviewed (238 female and 1174 male). RESULTS: Pain was the initial complaint in 19.2% of the sample. Oral cancer (ratio 4:1) and initial pain (ratio 9:1; P= .001) was prevalent in men. There were 12 different complaints of pain: sore throat (37.6%), tongue pain (14.0%), mouth pain (12.9%); pain when swallowing (11.1%), dental pain (5.9%); earache (5.9%); pain in the palate (4.1%); burning mouth (3.3%); gingival pain (2.2%); pain when chewing (1.1%); neck pain (1.1%), and facial pain (0.7%). Pain was associated with advanced TNM staging and location of tumor in the tongue (P= .004) and the tongue/mouth floor (P< .006). CONCLUSION: There were 12 different descriptions of pain; pain was related to TNM staging in the tongue and the tongue/mouth floor. The data presented reinforce the suggestion that patients with orofacial pain need systematized evaluation and sometimes require an interdisciplinary approach.

Adolescent↗
PubMed2004

Efficacy of ofloxacin otic solution once daily for 7 days in the treatment of otitis externa: a multicenter, open-label, phase III trial.

BACKGROUND: Otitis externa (OE) is an infection of the external auditory canal that is typically treated with topically applied broad-spectrum antibiotics. Twice-daily topical treatment with ofloxacin otic 0.3% solution for 10 days has been reported to be as effective and well tolerated as the standard of care, neomycin sulfate/polymyxin B sulfate/hydrocortisone solution administered 4 times daily for 10 days. OBJECTIVE: This study evaluated the efficacy and safety profile of 7 days of a once-daily regimen of ofloxacin otic 0.3% solution in the treatment of OE. METHODS: This multicenter, open-label, Phase III study was conducted from June 12, 2002, to October 14, 2002. Eligible patients were aged > or = 6 months and had OE of <2 weeks' duration with moderate to severe edema and tenderness involving 1 or both ears and sufficient exudate for microbiologic culture. Ofloxacin otic solution was instilled once daily for 7 days (5 drops for children aged 6 months to <13 years, 10 drops for adolescents/adults aged > or = 13 years). Assessments were conducted at the end-of-treatment visit and 7 to 10 days later (the test-of-cure visit). Medication was supplied free of charge to study participants who incurred no costs for physician visits. RESULTS: Of 489 patients enrolled at 58 sites in 3 countries, 439 were clinically evaluable (173 children, 266 adolescents/adults; 52 % males, 48% females; 47% Hispanic, 45% white; 5% black, and 3% other). The cure rate among clinically evaluable patients was 91% (95% of children, 88% of adolescents/adults); 68% of patients were cured within 7 days. Forty-three potentially pathogenic strains were isolated from 253 microbiologically evaluable patients. Pseudomonas aeruginosa was isolated from 158 (62%) microbiologically evaluable patients and Staphylococcus aureus from 32 (13%). Eradication rates were 96% overall. No serious adverse events were observed. Minor adverse events were experienced by 15 (3%) of 489 patients included in the safety population. The most common adverse events were pruritus (5 patients), increased earache (4 patients), and application-site reactions (3 patients). Overall mean (SD) adherence to therapy was 98% (11.9). CONCLUSIONS: Ofloxacin otic 0.3% solution administered once daily for 7 days was well tolerated and effective in achieving clinical and microbiologic cure of OE. The compliance rates in this study suggests that this regimen may be better accepted by patients than longer, more repetitive regimens.

Adolescent↗
PubMed1986

Nasal septal deviation: effective intervention and long term follow-up.

Nasal septal deviation (DNS) occurs more frequently during childhood although it occurs at any age due to trauma. Recently, it has been increasingly recognized that nasal septal deviation is seen also at birth and a number of explanations for this occurrence is forwarded. Awareness of such occurrence and its recognition at birth both by pediatricians and obstetricians is essential for early interventional management of this condition in close collaboration with the otorhinolaryngologists. Closed surgical intervention of this defect carried out early after it was detected at birth benefitted the afflicted in terms of nasal airway improvement and its maintenance resulting in normalization of its anatomy and physiology in long term follow-up. Septal deviation detected at birth if left alone without interventional procedure continues to persist. It is furthermore accompanied by statistically valied symptoms like upper respiratory infections, cough, earache, ear discharge, fever, mouth breathing and at times feeding difficulty during infancy and childhood. Long term follow-up of children who underwent closed surgical correction of DNS at birth, revealed no untoward effects such as nasofacial disproportion or retardation of facial growth. Early interventional management of DNS detected at birth therefore appears to be a safe procedure. It can even be performed by neonatologists or an obstetrician. Such an intervention procedure early in life can prevent septoplasty surgery at a latter date besides preventing a number of nasal airway-related conditions.

Child, Preschool↗
PubMed2004

Disputes over coverage of emergency department services: a study of two health maintenance organizations.

STUDY OBJECTIVE: We describe the characteristics and outcomes of enrollee-health plan disputes over insurance coverage for emergency department (ED) services at 2 large health maintenance organizations (HMOs) that apply the prudent layperson standard. METHODS: We abstracted information from a stratified random sample of approximately 3,500 appeals of coverage denials lodged by privately insured enrollees between 1998 and 2000 at 2 of the nation's largest HMOs (hereafter referred to as Plan 1 and Plan 2). We describe appeals involving ED services in terms of the timing of visits, patient age, costs of services, primary reason the patient sought care, and appeal outcome. RESULTS: Disputes over ED services accounted for approximately one half (52%) of postservice appeals at Plan 1 and one third (34%) at Plan 2. Nearly one half (46%) of ED appeals involved weekend, nighttime, or holiday visits to the ED; 22% were children's visits. The average cost of services in dispute was US$1,107. The most common general reasons for the ED visits in dispute were symptoms of illness (64%), injuries (22%), and services related to disease (8%). The most common presenting symptoms were abdominal pain, cramps, or spasms (7.6%); earaches or ear infections (3.4%); and lacerations/cuts (2.9%). Enrollees won more than 90% of appeals. CONCLUSION: The prevalence of ED cases among all appeals reflects disagreement between lay and expert judgments about what constitutes emergency care under the prudent layperson standard. The high rate at which enrollees win these appeals highlights significant disagreement in interpretation of the standard among different adjudicators within managed care organizations (medical groups and health plans). When enrollees fail to challenge denials that would be reversed on appeal, they bear the financial brunt of ambiguities in interpretation of the prudent layperson standard.

Adult↗
PubMed1990

Indigent children who are denied care in the emergency department.

We conducted a six-month prospective study of the diagnoses and outcomes of 588 children who were denied care in our emergency department under a new primary-care case management health system for 100,000 indigent patients. The mean patient age was 4.7 years (39% were less than 2 years old). The most common presenting complaints were colds, earaches, rash, vomiting, and diarrhea. Nine percent of children presented for trauma, and 10% had fever of more than 38.2 C. Follow-up was available from the primary care physician for 388 children (66%). Of the 60% of patients who kept their arranged appointment, 42% received antibiotics, 3% were referred for further evaluation, and two children were hospitalized. Follow-up was available from the parents for 125 children (21%). No follow-up information of any kind was available for 111 children (19%), and no follow-up regarding the health of the child was available for 265 children (45%). This last group included 10% with a chief complaint of trauma and 6% with temperature of more than 39 C. Forty-nine percent of patients in this group were less than 2 years old.

Appointments and Schedules↗
PubMed2000

Amoxicillin for fever and sore throat due to non-exudative pharyngotonsillitis: beneficial or harmful?

OBJECTIVES: To determine duration of signs and symptoms and adverse reactions after treatment with amoxicillin of patients with fever and sore throat due to non-exudative pharyngotonsillitis. DESIGN: This was a randomized, double-blinded, placebo-controlled trial. Outpatients at four medical centers were enrolled. Patients over 5 years of age presented with fever and sore throat for less than 10 days due to non-exudative pharyngotonsillitis. Cases with any of the following symptoms or illness were excluded: earache, nasal discharge with foul smell, rheumatic fever, valvular heart disease, renal disease, and penicillin hypersensitivity. Amoxicillin or identical placebo at the dosage of 50 mg/ kg per day was given three or four times daily for 7 days. RESULTS: There were 1217 patients enrolled in this study. Some were lost to follow-up, which is the reason for the variability in number of cases in these analyses. After therapy, duration of fever was 2.46 and 2.48 days (P = 0.78) and of sore throat 3.01 and 3.04 days (P = 0.80) in amoxicillin (n = 431) and placebo (n = 436) groups, respectively. Complications were clinically documented in 13 (2.5%) and 16 (3.0%) cases in amoxicillin (n = 527) and placebo (n = 524) groups (P = 0.56). Two cases (0.46% and 0.46%) from each group (n= 433 and 431) were positive by antistreptolysin O antibody determination. The history of carditis and abnormal urinalysis after treatment were not obtained. CONCLUSIONS: Amoxicillin therapy for non-exudative pharyngotonsillitis conferred no beneficial or harmful effect.

Adenoids↗
PubMed1975

Otology in the Bible and Talmud.

The present paper is an English translation of the chapter of Otology in Preuss's classic book Biblisch-Talmudische Medizin. Described in the Talmud are a variety of anatomical ear abnormalities such as double ear, pierced ears, small ears, cut off ears, and pendulous ears. A slave whose ear was wounded had to be freed. Compensation for injury to the ear and to hearing is clearly noted. Remedies for earache are mentioned. The legal status of a deaf-mute, and the relationship of deafness to muteness are also discussed in the Talmud.

Animals↗