Antibiotics for Treatment of Acute Otitis Media

Antibiotics for Treatment of Acute Otitis Media The role of Antibiotics for Treatment of Acute Otitis Media in Prevention of Subsequent Development of Acute Mastoiditis in Children Introduction Acute otitis media (AOM) is considered to be one of the most common infections in children. Most of the time it is self-limiting disease without need for antibiotic therapy; however, some children have individual potential for serious complications such as mastoiditis. Acute mastoiditis is still the most common complication of acute Otitis media and is defined as an acute inflammation of the mastoid air cells which are contiguous with the middle ear cleft and arising as a result of spread of infection from acute otitis media beyond the middle ear. The incidence of acute mastoiditis was signià ¯Ã‚ ¬Ã‚ cantly reduced following the antibiotic era and the overall incidence of mastoiditis as a complication of acute otitis media dropped to less than 1%.1,3. But some recent literature indicated an increase of the disease incidence especially in countries with less antibiotic prescription [2], while others reported that no increased incidence despite the national restriction guidelines of antibiotics prescription [4]. Most recently published guidelines reported that acute otitis media should be treated initially with supportive therapy with discretionary clinical follow-up and antibiotic treatment is reserved for cases in children younger than 6 months, unresolving cases, or otherwise complicated cases. The aim of this study was to carry out a retrospective analysis of all children admitted with acute mastoiditis and to study the role of antibiotics prescribed for acute otitis media on development of acute mastoiditis. Patients and Methods The medical records of all children admitted, diagnosed and treated as acute mastoiditis in the Ear, Nose and Throat department in King Hussein Medical center, Amman- Jordan during the period 2002 to 2012 were studied retrospectively. Patients were divided into 2 groups: Group I: patients who received antibiotics for acute otitis media 2 weeks pre hospitalization. Group II: patients who did not receive antibiotics prior to hospitalization. The clinical criteria for the diagnosis of acute mastoiditis were based on the following: Clinical and Otomicroscopic evidence of acute otitis media on admission or recent episode of otitis media within 2 weeks before admission. Post-auricular inflammatory signs (swelling, erythema and tenderness). Anteroinferior displacement of the auricle. Exclusion criteria were: Patients with incomplete data or in which the diagnosis was not conclusive. Patients suspected to have cholesteatoma. Immune compromised patients. Patients with ventilation tubes in situ. Patients who had undergone prior ear surgeries. Data regarding the age, gender, and duration of pre hospitalization antibiotic therapy, the clinical and microbiological findings, treatment modality and the outcome of the disease were recorded. Results During the study period, a total number of 63 children were admitted with the diagnosis of acute mastoiditis (42 males and 21 females) aged from 7 months to 13 years with a mean age of 5.7 years. Out of 63 patients, 56 (88.9%) patients had post auricular inflammation only whereas the remainder 7 (11.1%) cases had a subperiosteal abscess. The preadmission history demonstrated that 52 (82.5%) patients had a history of antecedent acute otitis media within 2 weeks before admission. Before the development of acute mastoiditis, we recorded that 41(65.1%) children were taking oral antibiotics 2 weeks before admission prescribed for acute otitis media (Group I) with duration of therapy ranging between 1-13 days (mean duration 3.6 days). The most commonly prescribed antibiotic prior to hospitalization was amoxicillin–clavulanic acid (n=30) followed by amoxicillin (n = 6), and à ¯Ã‚ ¬Ã‚ rst or second-generation cephalosporin (n = 5). On other hand 11 patients did not use any type of antibiotics before admission which was confirmed by the Parents of patients (Group II). The duration of illness before admission of patient was ranging between 1-14 days (mean 3.5  ± 3.1 days). Acute otitis media in the left side was reported to be more common than the right side (25 cases vs. 20 cases, respectively), Whereas 7 children were reported to have bilateral acute otitis media. None of our patients reported to have bilateral mastoiditis. The Clinical features of children with acute mastoiditis on admission are shown in table I. Computerized tomography of the Temporal bone was performed on admission in all patients and cloudiness of the mastoid was demonstrated in all the patients. In 7 cases there was destruction of cortex with subperiosteal abscess. Data regarding microbiological culture findings was recorded in 48 patients, of whom 25 (52%) cultures were taken from middle ear aspirate during myringotomy; culture of pus from the external auditory canal was obtained in 11 patients (23%), from subperiosteal abscess in 7 patients (14.6%) and from the mastoid cavity during mastoidectomy in 5 patients (10.4%). The most commonly isolated organisms were Streptococcus pneumonia, Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeroginosa, Proteus mirabilis and Haemophilus inà ¯Ã‚ ¬Ã¢â‚¬Å¡uenzae. On admission, all of the patients were treated with intravenous antibiotics and the most commonly used antibiotics were ceftriaxone, cefuroxime, Ceftazidime and Metronidazole. In addition to Intravenous antibiotics, some patients were underwent tympanostomy tube insertion, abscess drainage and cortical mastoidectomy. All patients in our study were recovered uneventfully with these treatment modalities and none of them developed recurrences of mastoiditis within a period of at least one year of clinical follow up. Discussion Although, in the literature the incidence of acute mastoiditis decreased in the last decades, there is some evidence that in recent years, this entity is rising, as Papournas and Kudo [6,9] have reported. However, our series includes 63 cases of acute mastoiditis in 10 years period. The demographic data collected in this study with regard to gender and age was consistent with other series [3, 7, 1 2]. Acute mastoiditis has been reported to be more predominant in boys as has been noted previously [11—14]. The use of broad spectrum antibiotics as initial treatment for acute otitis media, a rather common practice in our country, might play a role in selecting resistant microorganisms. In our study, in which 65.1% children were taking oral antibiotics for otitis media before admission provides evidence for the assumption that widespread use of antimicrobials in treatment of acute otitis media does not provide complete protection against acute mastoiditis. Furthermore, the symptoms of acute mastoiditis may be abated, in consequence of the treatment, requiring a high degree of awareness by contemporary clinicians to watch for manifestations. Therefore, antimicrobials should be used judiciously in treatment of acute otitis media, avoiding the employment of broad-spectrum drugs as an initial regimen. Yet, complete abstention from use of antibiotics in treatment of suppurative otitis media is not advisable, as this seems to increase the risk of complications in general and of acute mastoiditi s in particular [15,16]. Recently, some authors observed that the number of children admitted to some hospitals with acute mastoiditis has risen [12-14]. However, Luntz et al [15] reported that the use of antibiotics is not a safe guard against acute mastoiditis and it may lead to a latent (masked) mastoiditis. Also, Kvaerner et al [4] In their registry based study on 399 Norwegian children proved that the incidence of acute mastoiditis has not been increased in Norway despite the national restricted use of antibiotics in primary care. Findings in children with acute mastoiditis are well described in clinical studies. In agreement with our à ¯Ã‚ ¬Ã‚ ndings the children are young, and present with retroauricular oedema, protrusion of the ear and abnormal tympanic membranes in addition to various degrees of general discomfort [1,5 – 9]. The most frequent symptom in our study was abnormal tympanic membrane with retroauricular erythema. During the last decade several reports show a decreasing rate of cortical mastoidectomy as the treatment of choice for acute mastoiditis. The rate of surgery varies greatly from 12 – 98% in different studies [1,4 – 8]. This may be due to different criteria for the diagnosis and may also reà ¯Ã‚ ¬Ã¢â‚¬Å¡ect the fact that an increasing portion of children are treated in pediatric wards. The increasing tendency for conservative treatment during the recent years may also reà ¯Ã‚ ¬Ã¢â‚¬Å¡ect an increasing availability of CT or MR scans to exclude complications. Microbiological culture findings were recorded in 48 patients in this study and Streptococcus pneumonia was the most commonly isolated organism. Similar results have been reported by other authors [2,6,12,15,16]. Other identià ¯Ã‚ ¬Ã‚ ed organisms were Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeroginosa, Proteus mirabilis and Haemophilus inà ¯Ã‚ ¬Ã¢â‚¬Å¡uenzae. Our data do not support that general use of antibiotics in acute otitis media will prevent the subsequent development of acute mastoiditis. Neurological complications was reported in 5 – 20% in the literature [2,3,15], although recent publications show a lower rate of complications [6,12]. In our material none of the patients developed neurological complications. Conclusion References Table I Clinical features on admission of 63 children with Acute Mastoiditis

Experience :: Essays Papers

Experience Plane tickets in hand, my possible girlfriend and I embark on our first vacation to Cozumel, Mexico during the summer of 2000. I had known her for about 7 months and during that time i had grown very fond of her. Our relationship began to blossom and that in the near future we would begin to grow even closer. Boy, was I wrong. We both needed a break from our stress filled lives and i was hoping I could help her overcome whatever tragedy happened in her life because i didn't understand why she was depressed most of the time. She had told me about a few things that had transpired between her and her parents but it just didn't explain all of her emotional problems. Most of the plane ride there was spent bartering with the flight attendants for tasty beverages. She looked out the window with longing eyes. Her eyes seem to say so much and yet, so very little. I didn't quite understand what was missing from her life, but I would soon grasp the emense pain. The plane soon arrived in Cozumel. We were ushered like cattle through customs. Our baggage was taken by Miguel, a three-foot Mexican. We arrived at hotel Paradisus. Paradise, what more could you ask for. Truth be known, I don't think that there is such a place or thing. It's jsut a simple concept we all hope for,but never achieve. We spent that night walking along the beach and talking. She said very little, but I still enjoyed her being my my side. I never in my wildest dreams imagined myself with such a beautiful girl in such a perfect place. I couldn't have been happier, but all good things must come to an end. The next day was spent with fun-filled activites. She of course had located the many bars at our hotel. We had purchases the all-inclusive package. She received alcohol, and I received activities.

Causes of Variation

Variation is a result that leads to a difference or deviation (for example, structure, form, function) from the recognised norm or standard. It is a modification in structure, form or function in an organism, deviating from other organisms of the same species or group. There are two types of variation: interspecific variation and intraspecific variation. Interspecific variation is when one species differs from another like mammals differ from fish. These differences are explained through differing ancestries explained by the difference of genetics perhaps due to natural selection. However, intraspecific variation is when members of the same species differ from each other like how there are many different types of cats. This can be mainly explained through mutations.Variation is the result of two main factors: genetic differences and environmental influences. In most cases it is a combination of both factors. Additionally, in asexual reproduction, variety can only occur through mutati ons whereas off springs that have been produced sexually the variety will be more apparent due to the probabilities being higher due to more factors contributing to the cause of variation such as meiosis and fusion of gametes, as well as mutation.Genetic differences are due to the different genes that each individual organism possesses. The differences occur arise in living organisms and change from generation to generation. Genetic variation arises as a result of mutations, meiosis and fusion of gametes. Mutations are changes in DNA that result in the offspring containing different characteristics by the changing of quantity or structure of the DNA.The end result of the process of altering the DNA structure is a different amino acid sequence that leads to a formation of a different polypeptide, and hence a different protein, or no protein being produced at all. So, as proteins are responsible for the characteristics of an organism, it follows that changes to DNA are likely to alter an organisms characteristics. These sudden changes to genes and chromosomes may, or may not be passed onto the next generation.Genetic differences are also explained through meiosis. Meiosis is the process in which four daughter nuclei’s are produced, each with half the number of chromosomes as the parent cell. It allows the offspring to adapt and survive in the changing world by allowing genetic variation through the independent segregation of homologous chromosomes due to the homologous pairs of chromosomes arranging in a new, random order. Also, the recombination of homologous chromosomes crossing over causes variation. Overall, meiosis mixes up the genetic material before it is passed into the gametes, all of which are therefore different.Lastly, genetic differences are also explained through the fusion of gametes. In sexual reproduction the offspring inherit some characteristics of each parents and are therefore different from both of them. Which gamete fuses with at fe rtilisation is a completely random process that emphasises the variation occurring in the offspring.On the other hand, environmental influences also have a massive input in variation. The environment influences the way in which the genes are expressed. The genes allow certain things to happen whereas the environment determines where each characteristic is utilised. For example, a plant may contain genes that allow it to grow tall however, it is the environment that allow this stage to progress so if the seed germinates for example, the plant will not be able to utilise it’s beneficial characteristics to the highest extent. Examples of environmental influences are: climatic conditions (such as rainfall, temperature and sunlight), soil conditions, food availability and pH.Overall, variation is caused due to a combination of environmental influences and genetic differences. However, it is hard to distinguish between the effects of environmental and genetic so is difficult to dra w conclusions about the causes of variation.

Overview of Federal Elections in Canada

Canada is a federal parliamentary democracy within a constitutional monarchy. While the monarch (the head of state) is determined by heredity, Canadians elect members of parliament, and the leader of the party that gets the most seats in parliament becomes prime minister. The prime minister serves as the head of executive power and, therefore, the head of the government. All adult citizens of Canada are eligible to vote but must show positive identification at their polling place.   Elections Canada Elections Canada is a nonpartisan agency that is responsible for the conduct of federal elections, by-elections, and referendums. Elections Canada is headed by the chief electoral officer of Canada, who  is appointed by a resolution of the House of Commons. When Are Federal Elections Held in Canada? Canadian federal elections are usually held every four years. There is fixed-date legislation on the books that sets a fixed date for federal elections to be held every four years on the first Thursday of October. Exceptions can be made, however, especially if the government loses the confidence of the House of Commons. Citizens have several ways to vote. These include: Vote at the polls on election dayVote at a local advance pollVote at the local Elections Canada officeVote by mail Ridings and Members of Parliament The census determines Canadas electoral districts or ridings. For the 2015 Canadian federal election, the number of ridings increased from 308 to 338. Voters in each riding elect one member of parliament (MP) to send to the House of Commons. The Senate in Canada is not an elected body. Federal Political Parties Canada maintains a registry of political parties. While 24 parties fielded candidates and received votes in the 2015 election, the Canadian elections website listed 16 registered parties in 2017. Each party can nominate one candidate for each riding. Often, representatives of only a handful of federal political parties win seats in the House of Commons. For example, in the 2015 election, only the Conservative Party, the New Democratic Party, the Liberal Party, the Bloc Quà ©bà ©cois, and the Green Party saw candidates elected to the House of Commons. Forming the Government The party that wins the most ridings in a general federal election is asked by the governor-general to form the government. The leader of that party becomes the Prime Minister of Canada. If the party wins more than half the ridings—thats 170 seats in the 2015 election—then it will have a majority government, which makes it much easier to get legislation passed in the House of Commons. If the winning party wins 169 seats or fewer, it will form a minority government. In order to get legislation through the House, a minority government usually has to adjust policies to get enough votes from MPs of other parties. A minority government must constantly work to maintain the confidence of the House of Commons in order to stay in power. The Official Opposition The political party that wins the second-highest number of seats in the House of Commons becomes the Official Opposition.