Spontaneous Transethmoidal Meningoceles in Adults: Case Series with Emphasis on Surgical Management.

BACKGROUND: Spontaneous onset transethmoidal meningocele is a rare entity among the adult population. METHODS: A retrospective chart review was performed and cases of adults diagnosed with spontaneous transethmoidal meningoceles from November 2000 till February 2014 were reported. Data collected included demographics, clinical presentation, diagnostic modalities, and results. Intraoperative findings, the type of surgical reconstruction performed, and the percentage of recurrence, if present, were also reported. RESULTS: Ten cases of spontaneous transethmoidal meningoceles in adults were diagnosed. Eight were females and two males with a mean age of 47.5 years. All patients presented with CSF leakage with or without meningitis. They underwent a reconstruction of the base of skull defect using the temporalis fascia graft in addition to fibrin glue (Tissucol) and Surgicel (Ethicon). In two cases with a larger defect, a piece of septal bone and turbinate mucosa were applied achieving a watertight seal in all cases. CONCLUSION: Spontaneous transethmoidal meningocele in adults is a rare condition. It usually presents with clear rhinorrhea with or without meningitis and an endoscopic multilayer reconstruction is advocated for treatment of such conditions.

A tool to assess knowledge, attitude and behavior of Indonesian health care workers regarding infection control.

AIM: to investigate knowledge, attitude and behaviour toward infection control in two teaching hospitals on the island of Java by means of a questionnaire and to evaluate the use of the questionnaire as a tool. METHODS: we investigated knowledge, attitude and behaviour toward infection control in two teaching hospitals on the island of Java by means of a questionnaire to identify problem areas, barriers and facilitators. The target was to include at least 50% of all health care workers (physicians, nurses, assistant nurses and infection control nurses) in each hospital, department and profession. Differences between demographic variables and scores for individual questions and groups of questions were compared using the chi-square statistic and analysis of variance and Spearman's rho was used to test for correlations between knowledge, attitude, self-reported behaviour and perceived obstacles. RESULTS: more than half of the health care workers of the participating departments completed the questionnaire. Of the 1036 respondents (44% nurses, 37% physicians and 19% assistant nurses), 34% were vaccinated against hepatitis B, 77% had experienced needle stick accidents and 93% had been instructed about infection control. The mean of the correct answers to the knowledge questions was 44%; of the answers to the attitude questions 67% were in agreement with the correct attitude; obstacles to compliance with infection control guidelines were perceived in 30% of the questions and the mean self-reported compliance was 63%. Safe handling of sharps, hand hygiene and the use of personal protective equipment were identified as the most important aspects for interventions. Significant positive correlations were found between knowledge, attitude, self-reported behaviour and perceived obstacles. CONCLUSION: the questionnaire in conjunction with site visits and interviews was a valuable strategy to identify trouble spots in the hospitals and to determine barriers to facilitators of change that should be taken into account when planning interventions. Successful interventions should cover hospital management, the infection control team, as well as the health care workers on the wards.

Distribution modelling of Aedes aegypti in three dengue-endemic areas in Sumatera, Indonesia.

Ae. aegypti is a dengue virus vector and a public health threat in Indonesia. Furthermore, the Dengue Haemoragic Fever (DHF) has spread to all cities in the country, including Bandar Lampung. A species distribution model, Maximum Entropy (MaxEnt), was used to predict the geographic distribution of this vector in three dengue-endemic areas, namely Sukarame, Kemiling, and Tanjung Seneng. Previously, surveillance was conducted to determine the presence of Ae. aegypti. Therefore, this study suggested that environmental variables such as rainfall, temperature, land cover, and population density have influenced the widespread of Ae. aegypti and facilitate its proliferation in the study areas. The influence of the environmental variables was analyzed using a response curve. The model performance was measured by percent contribution, the importance of permutations, and the jackknife test. This study's evaluation indicates that the certainty models for the presence of Ae. aegypti in Sukarame, Kemiling, and Tanjung Seneng were developed extremely well, with respective values of 0.989, 0.993, and 0.969. The results showed that Ae. aegypti is widespread in the three endemic areas. The high population density and land conversion into settlements are influential environmental variables essential in determining the distribution of the vector in three areas of Bandar Lampung. Climatic factors such as rainfall and temperature are supporting aspects in maintaining the habitat of Ae. aegypti in the area. Mapping areas at risk of this dengue vector can aid in planning disease management strategies and identifying priority locations for entomological surveys to control epidemics.

Nasal carriage of methicillin-resistant and methicillin-sensitive strains of Staphylococcus sciuri in the Indonesian population.

Staphylococcus sciuri strains were unexpectedly cultured from healthy persons and patients from Indonesia during a population-based survey on nasal Staphylococcus aureus carriage. Fifty-one S. sciuri isolates were further characterized. The S. aureus mecA gene was detected by PCR in 22 isolates (43.1%), whereas S. sciuri mecA was found in 33 isolates (64.7%). The staphylococcal cassette chromosome mec (SCCmec) regions of S. aureus mecA-positive isolates contained elements of classical S. aureus SCCmec types II and/or III.

Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital.

Standard precautions can prevent transmission of micro-organisms. This study investigated hand hygiene, handling of needles and use of personal protective equipment in an Indonesian teaching hospital, and performed a multi-faceted intervention study to improve compliance. An intervention was performed in an internal medicine ward and a paediatric ward, consisting of development of a protocol for standard precautions, installation of washstands, educational activities and performance feedback. Before, during and after the intervention, observers monitored compliance with hand hygiene, safe handling of needles and use of gloves, gowns and masks. A gynaecology ward served as the control. Unobtrusive observations were performed to check for an influence of the observers on the overt observations. In total, 7,160 activities were observed. Compliance with hand hygiene increased from 46% to 77% in the internal medicine ward and from 22% to 62% in the paediatric ward. Before the intervention, no safe recapping of needles was recorded in either ward. After the intervention, 20% of needles were recapped safely. Inappropriate gown use decreased in the internal medicine ward. There were no significant changes in use of gloves and masks. There may have been an effect of the overt observations in the paediatric ward, but there was no effect in the internal medicine ward. There were no significant changes in the control ward, except for a decrease in the use of gloves. In conclusion, compliance with hand hygiene procedures improved significantly due to an intervention project focused on education and improved facilities. Compliance with safe handling of needles improved slightly due to introduction of the one-handed method for safe recapping of used needles.

Surveillance of healthcare-associated infections in Indonesian hospitals.

A cross-sectional surveillance of healthcare-associated infections (HAIs) and exposure to risk factors was undertaken in two Indonesian teaching hospitals (Hospitals A and B). Patients from internal medicine, surgery, obstetrics and gynaecology, paediatrics, a class department and intensive care were included. Patient demographics, antibiotic use, culture results, presence of HAI [phlebitis, surgical site infection (SSI), urinary tract infection (UTI) and septicaemia] and risk factors were recorded. To check for interobserver variation, a validation study was performed in Hospital B. In Hospitals A and B, 1,334 and 888 patients were included, respectively. Exposure to invasive devices and surgery was 59%. In Hospital A, 2.8% of all patients had phlebitis, 1.7% had SSI, 0.9% had UTI and 0.8% had septicaemia. In Hospital B, 3.8% had phlebitis, 1.8% had SSI, 1.1% had UTI and 0.8% had septicaemia. In the validation study, the prevalence as recorded by the first team was 2.6% phlebitis, 1.8% SSI, 0.9% UTI and no septicaemia, and that recorded by the second team was 2.2% phlebitis, 2.6% SSI, 3.5% UTI and 0.9% septicaemia. This study is the first to report on HAI in Indonesia. Prevalence rates are comparable to those in other countries. The reliability of the surveillance was insufficient as a considerable difference in prevalence rates was found in the validation study. The surveillance method used is a feasible tool for hospitals in countries with limited healthcare resources to estimate their level of HAI and make improvements in infection control. Efficiency can be improved by restricting the surveillance to include only those patients with invasive procedures. This can help to detect 90% of all infections while screening only 60% of patients.

Effects of constant temperatures on oviposition and immature development of Simulium bidentatum (Diptera: Simuliidae), a vector of bovine Onchocerca (Nematoda: Onchocercidae) in central Kyushu, Japan.

Laboratory developmental studies were carried out on Simulium bidentatum (Shiraki) under constant air and water temperatures (7, 10, 13, 16, 19, 22, 25, and 28 degrees C). The median time required for female flies to complete oocyte maturation after blood feeding decreased from 8 to 1.5 d and the median time from blood feeding to oviposition decreased from 16 to 3 d as air temperature increased from 7 to 28 degrees C. Air temperatures from 16 to 22 degrees C were most suitable for oviposition. An average of 61.4% of eggs hatched. Egg developmental period decreased from 17 to 4.5 d when water temperature increased from 7 to 19 degrees C and decreased to 3.5 d when water temperature was between 22 and 28 degrees C. Larval and pupal development occurred at water temperatures > or = 13 degrees C, but was most successful from 16 to 22 degrees C. Seven (in 16 lots) or 6 instars (in 1 lot) were indicated by using the Dyar rule. We conclude that S. bidentatum is adapted to moderate weather conditions in spring and autumn and that approximately 7 generations of this species occur per year in Oita, Japan.

Black flies (Diptera: Simuliidae) of the Special Province of Aceh, Indonesia.

The black fly fauna of the Special Province of Aceh, Indonesia, was surveyed in 24 streams in 5 regencies, from 7 to 13 June 1998. Ten species were identified, Simulium (Nevermannia) aureohirtum Brunetti, S. (Gomphostilbia) duolongum Takaoka & Davies, S. (G.) sheilae Takaoka & Davies, S. (G.) sundaicum Edwards, S. (S.) nobile de Meijere, S. (S.) fenestratum Edwards, S. (S.) argyrocinctum de Meijere, S. (S.) nebulicola Edwards, S. (S.) iridescens de Meijere, and S. (S.) minangkabaum Takaoka & Sigit. These species are essentially oriental in distribution, because they belong to the 3 subgenera that are dominant groups in oriental or Palaearctic regions, or both.

Maxillary sinus cavernous hemangioma: a rare entity.

Vascular lesions of the sinonasal tract are rare. These lesions do not have typical signs or symptoms. They may present insidiously with minimal symptoms. A high index of suspicion and a good preoperative evaluation are needed for diagnosis. No standard surgical approach is indicated. We report a case of cavernous hemangioma of the maxillary sinus in an adult male. We present the diagnostic work-up and discuss the differential diagnosis and potential therapeutic approaches.

Post-adenoidectomy inflammatory pseudotumor.

PROBLEM: Inflammatory pseudotumor is a rare pathology in the head and neck area. Multiple post-adenoidectomy complications have been described in the literature without alluding to such an entity. METHOD: A case report of an inflammatory pseudotumor following an adenoidectomy. MAIN RESULTS: Pseudotumor of the nasopharynx should be added to the list of possible complications of adenoidectomy. CONCLUSION: Inflammatory pseudotumor of the nasopharynx is a rare complication that confronts the otolaryngologist and the pathologist with a diagnostic challenge. Surgical excision remains the best therapeutic option.

An unusual complication following tracheo-esophageal puncture for alaryngeal voice restoration.

A laryngectomized patient who developed massive subcutaneous emphysema, pneumothorax, pneumomediastinum, and esophageal fistula with a retroesophageal collection following the creation of a tracheo-esophageal fistula for alaryngeal voice restoration is presented, together with its management. A review of the literature is made, and possible causes of the three complications are discussed.

Median palatine cyst: an unusual presentation of a rare entity.

Median palatine cyst is rare. Mostly, it is asymptomatic and usually is discovered incidentally during routine dental or radiological examination. The case that we report has the following unusual features: Firstly, it is the largest cyst to be reported, measuring 5 cm in diameter. Secondly, there was no swelling on the oral surface of the hard palate contrary to other reports. Rather, it caused elevation of the nasal floor and nasal obstruction. Thirdly, it pushed the inferior and caudal end of the septum into the left nasal chamber. The median palatine cyst was surgically removed by a sublabial degloving approach. The cyst was removed in toto and the palatal bone curetted to ensure adequate removal of any nesting cells that could lead to recurrence in the future.

Endoscopic removal of an ectopic third molar obstructing the osteomeatal complex.

We report a rare case of an ectopic third molar at the level of the osteomeatal complex. A 21-year-old man came to us with a left-sided nasal obstruction of 2 years' duration. Computed tomography of the paranasal sinuses revealed that an aberrant tooth was obstructing the osteomeatal complex and bulging into the ethmoid infundibulum. Opacity of the entire left maxillary sinus indicated the presence of an associated cystic formation. A transnasal endoscopic sinus technique was employed to create a large middle meatal antrostomy and to remove the tooth as well as the cystic contents and cyst wall. Pathologic analysis revealed that the cyst was dentigerous. After recovery from surgery, the patient resumed nasal breathing. The endoscopic surgical approach used in this case caused less morbidity than do the more common methods (e.g., the Caldwell-Luc procedure) of removing ectopic teeth from the sinus.

Mycobacterial cervical lymphadenitis.

Mycobacterial cervical lymphadenitis remains a diagnostic challenge for many clinicians despite current advances in diagnostic laboratory techniques. Although much has been done to prevent tuberculosis, cases of mycobacterial disease in endemic form still occur. Six hundred and forty-five patients with tuberculosis were diagnosed and treated at the American University of Beirut Medical Center during the period from 1970 to 1985. Twenty-nine (4.5%) of these patients had proven mycobacterial cervical lymphadenitis. We stress histopathologic examination as the single most important means for diagnosing mycobacterial cervical lymphadenitis. Operation in combination with antituberculous chemotherapy remain the treatments of choice.

Hemangioma of the nasal septum: A clinicopathological profile.

Septal hemangioma is a rare cause of epistaxis and nasal obstruction. Ten cases were seen in our center over 25 years and constitute 31% of all cases of nasal hemangioma. The male to female ration was 2.4:1; patient age ranged between 14 and 63 years (average, 39 years). The main presenting symptom was epistaxis with progressive nasal obstruction. There was a positive history of trauma in 7 cases. Symptoms varied between 1.5 months to 4 years (average, 13 months). All tumors but one were located anteriorly in the septum and measured between 0.5 and 2 cm in diameter. Histologically they were well-defined benign neoplasms covered with stratified squamous epithelium and showed varying degrees of ulceration. In eight cases the core was composed of proliferating capillary-type vessels, and two were cavernous. Operative intervention is the treatment of choice, with recurrences likely in the event of incomplete excision (two of the ten cases recurred).

Bacterial etiology of otitis media with effusion in a group of Lebanese children.

Identification of the main bacteria causing otitis media with effusion (OME) in a given population is essential. It indicates the degree of involvement of a given bacterium in a particular disease of that population. Knowledge of the most prevalent bacteria would initiate the search for the mode of acquisition of such bacteria and may aid in establishing appropriate control and prevention programs, which may decrease the incidence of OME. The rapid response of most OME to a variety of broad-spectrum antimicrobials deprives the clinician from knowing the particular bacteriologic agent prevailing in a community. With the emergence of resistant strains and the change over time of the relative distribution of bacteriologic agents known to cause OME, the identification of the bacterial etiology of OME in Lebanese children was initiated.

The etiologic role of the osteo-meatal complex in the pathogenesis of sinusitis: a retrospective study of clinical, CT and endoscopic findings in 143 patients.

UNLABELLED: The etiological role of the osteo-meatal complex (OMC) in the pathogenesis of sinus disease is a debatable issue. The charts of 143 patients who underwent endoscopic sinus surgery at the American University of Beirut Medical Center between 1992 and 1995 were reviewed. Clinical symptoms included facial pain, nasal obstruction, headache, and postnasal drip. CT scan and endoscopic findings were reviewed. The presence of OMC disease radiologically was correlated with all the clinical, nasal endoscopic and other radiologic findings (disease in the rest of paranasal sinuses, or presence of concha bullosa). Its etiological role in patients with sinusitis is discussed. RESULTS: No endoscopic findings could be statistically correlated with the OMC disease. Facial pain and postnasal drip were the only clinical symptoms that statistically correlated with the OMC disease (p-value = 0.009 and 0.008, respectively). The OMC disease correlated with the radiological evidence of sinusitis in any of the sinuses.

Distribution modelling of Aedes aegypti in three dengue-endemic areas in Sumatera, Indonesia

@#Ae. aegypti is a dengue virus vector and a public health threat in Indonesia. Furthermore, the Dengue Haemoragic Fever (DHF) has spread to all cities in the country, including Bandar Lampung. A species distribution model, Maximum Entropy (MaxEnt), was used to predict the geographic distribution of this vector in three dengue-endemic areas, namely Sukarame, Kemiling, and Tanjung Seneng. Previously, surveillance was conducted to determine the presence of Ae. aegypti. Therefore, this study suggested that environmental variables such as rainfall, temperature, land cover, and population density have influenced the widespread of Ae. aegypti and facilitate its proliferation in the study areas. The influence of the environmental variables was analyzed using a response curve. The model performance was measured by percent contribution, the importance of permutations, and the jackknife test. This study’s evaluation indicates that the certainty models for the presence of Ae. aegypti in Sukarame, Kemiling, and Tanjung Seneng were developed extremely well, with respective values of 0.989, 0.993, and 0.969. The results showed that Ae. aegypti is widespread in the three endemic areas. The high population density and land conversion into settlements are influential environmental variables essential in determining the distribution of the vector in three areas of Bandar Lampung. Climatic factors such as rainfall and temperature are supporting aspects in maintaining the habitat of Ae. aegypti in the area. Mapping areas at risk of this dengue vector can aid in planning disease management strategies and identifying priority locations for entomological surveys to control epidemics.