Antibiogram and molecular characterization of extended-spectrum ß-lactamase-producing pathogens implicated in chronic suppurative otitis media.

Introduction: beta-lactamase-producing bacteria, especially extended-spectrum beta-lactamase (ESBL) producers have strong clinical relevance and have been implicated in chronic suppurative otitis media (CSOM) treatment failures. This study aimed to determine the frequency, antibiogram, and molecular characteristics of ESBL-producing gram-negative bacterial (GNB) pathogens isolated from patients with CSOM. Methods: three hundred (300) ear swab samples collected from patients with active CSOM were analysed using standard microbiological techniques. Antibiogram of pathogens was determined by Kirby-Bauer disk diffusion technique. Phenotypic detection and molecular characterization of ESBL-producing GNB pathogens were performed by double disk synergy test (DDST) and polymerase chain reaction (PCR). Results: Escherichia coli and P. aeruginosa were more prevalent among CSOM patients with a duration of discharge >2 weeks. The frequency of ESBL producers among the GNB pathogens was 18.3%. Isolates were generally multidrug-resistant but very susceptible (100% - 70.4%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance values of the isolates ranged from 0.7-0.8. Polymerase chain reaction showed that blaSHV (47.6%) was the most predominant ESBL genotype. This was followed by blaTEM (25.2%) and blaCTX-M (10.7%) as the least predominant ESBL gene. Concomitant expression of ESBL gene was observed in 13.6% of the isolates. Conclusion: this study reported the occurrence and spread of ß-lactamase-producing bacteria in patients with CSOM infections. It is therefore very crucial to screen for antibiotic-resistant pathogens at early stages of CSOM infections, for proper antimicrobial therapy and to curb the increasing spread of antimicrobial resistance.

Obstructive Sleep Apnea Awareness among Primary Care Physicians in Africa.

Rationale: Obstructive sleep apnea (OSA) is a significant health problem among adults and children globally, resulting in decreased quality of life and increased costs of healthcare. For optimal clinical care, primary care physicians should be familiar with OSA and confident in their ability to screen, diagnose, and manage this condition.Objectives: To assess the knowledge, attitudes, and practices of primary care physicians in Kenya, Nigeria, and South Africa regarding OSA in adults and children.Methods: We conducted a multicenter cross-sectional survey in Kenya (Nairobi), Nigeria (Edo State), and South Africa (Cape Town) between April 2016 and July 2017. At least 40 participants were randomly selected from a register of primary care physicians at each site. Potential participants were contacted to receive online/paper-based, validated OSA Knowledge and Attitudes (OSAKA) and OSAKA in Children (OSAKA-KIDS) questionnaires related to adults and children, respectively. The median percentage knowledge scores and proportions of favorable attitude were computed and current diagnostic and referral practices were documented.Results: The median OSAKA knowledge scores were 83.3% (interquartile range [IQR], 77.8-88.9), 66.7% (IQR, 55.6-77.8), and 61.1% (IQR, 55.6-77.8) among South African, Kenyan, and Nigerian physicians, respectively. For OSAKA-KIDS, the median knowledge scores were 61.1% (IQR, 50.0-72.2), 64.2% (IQR, 35.3-93.2), and 58.3% (IQR, 44.4-66.7) among South African, Kenyan, and Nigerian physicians, respectively. Most physicians (90-94%) considered adult and pediatric OSA very/extremely important. Fewer physicians agreed/strongly agreed that they were confident about OSA diagnosis (55%), management (25%), and continuous positive airway pressure (18%) use in adults. Even fewer physicians agreed/strongly agreed that they were confident about pediatric OSA diagnosis (35%), management (21%), and continuous positive airway pressure use (18%). South African physicians mainly prescribed polysomnography (51%) and overnight oximetry (22%), whereas 49% of Nigerian physicians and 65% of Kenyan physicians commonly requested lateral cervical radiography.Conclusions: Primary care physicians in South Africa, Nigeria, and Kenya considered OSA to be important but had modest knowledge about OSA in adults and children, and had a low perceived confidence in adult and pediatric management. Focused educational interventions during undergraduate training and continuing professional development programs may improve primary physicians' knowledge about OSA and its diagnosis and management.

Tonsillectomy: Vasoconstrictive hydrolytic cold dissection method.

BACKGROUND: Tonsillectomy, a common paediatric otolaryngology procedure, has undergone several evolutionary trends in the surgical techniques aimed at minimizing complications and improving patients' satisfaction. Despite the technological advancements in this respect, search for an ideal method is still ongoing, and some authorities are reverting back to the conventional methods. We wish to introduce the "Vasoconstrictive hydrolytic cold dissection" (VHCD) method. PATIENTS AND METHODS: The VHCD method was described, and the outcome measures in one hundred and thirty-five patients who had the procedures were presented in . Data entrance was done with SPSS 14. RESULTS: A total 135 patients comprising of 107 children aged 1-12 years and 28 adolescents/adults aged 14-52 years were operated upon using the VHCD between March 2009 and July 2012 by the same teams of Surgeons and Anaesthetists. The average surgical time and blood volume losses were 15 minutes and 5 mls for children and 12 mins and 10 mls for adults/adolescents, respectively. There was a single case (0.7%) of post-tonsillar bleed (reactionary haemorrhage). The rest (99.3%) recorded nil haemorrhage within and beyond first 2 weeks post-surgery. CONCLUSIONS: Surgeons used to other techniques of tonsillectomies may not revert to the cold steel; however, those practicing CSM will benefit from VHCD. We hereby recommend this simple, cost-effective modification of the cold steel tonsillectomy, which appears to have made dissection easier and also minimizes haemorrhage, a common complication of tonsillectomy surgery. It is timely in the advent of increased advocacy towards reversal to the conventional method of tonsillectomy. A randomized control trial is required for further evaluation of this method.

Migraine and Meniere's disease: two different phenomena with frequently observed concomitant occurrences.

BACKGROUND: Some variants of migraine could be indistinguishable from Meniere's disease, and this has prompted suggestions of possible association between the two disease entities. AIM AND OBJECTIVES: This study aims at determining the prevalence of migraine among Meniere's patients and a possible linkage between the two diseases in our environment. METHODOLOGY: A 10-year retrospective study of patients diagnosed with Meniere's disease using American Academy of Otorhinolaryngology criteria, including those that had associated migranous symptoms in accordance with the International Headache Society (IHS) diagnostic criteria for migraine, between 1996 and 2005. The prevalence of migraine in the Meniere's patients was also compared with lifetime prevalence recorded from a previous population-based study within the same setting. The statistical difference was tested with a Z nonparametric test (significance at P < 0.05). Epicalc2000 and SPSS 11 were used for the statistical analysis. RESULT: A total of 25 patients representing 0.22% of the 11,463 ear, nose and throat outpatients seen within the study period met the diagnostic criteria for Meniere's disease. There were nine (36%) males and 16 (94%) females. Their ages ranged 27-65 years, mean 45.25 years +/- 11.05. Eight (32%) met IHS criteria for migraine. There is a statistically significant difference between the prevalence of migraine in Meniere's patients and migraine in the overall population (32% vs. 5.3%, P = 0.000). CONCLUSION: The significant preponderance in the prevalence of migraine in Meniere's disease suggests a link between the two diseases. However, more molecular or genetic studies are needed to unveil this phenomenon.