Literature Review on Patient Demographics, Risk Factors and Causative Agents of Otomycosis

Background: Otomycosis can be defined as a fungal infection of the external auditory canal, frequentlyencountered in the general otolaryngology department. Otomycosis is more commonly reported in hot andhumid climates and various individual as well as environmental factors predispose to this infection. Otomycosisis not only a prevalent condition but also follows a set patterns in patient demographics, predisposing factorsand, causative pathogens, which we aim to explore in this review. Objectives: In this review, we intend to shedlight on the prevalence of otomycosis, along with the characteristics of patients that are most commonlypresented with this condition including age, gender, occupation, socioeconomic class, as well as complains. Wealso aim to elucidate the various predisposing risk factors that increase the likelihood of contracting otomycosisand explore the usually encountered pathogenic causes. Materials and Methods: A review of relevant articlespublished between the years of 1975 to 2019 in English language was done using the databases of PubMed Pico,Google Scholar and Google, using the predetermined keywords. Conclusion: Otomycosis is a prevalent fungalear infection mostly seen in young patients between the ages of 21-30 years. Otomycosis mostly involves oneear, and bilateral involvement is mostly observed in immunodeficient patients. The most frequently reported riskfactors include self-cleaning of ears with objects such as Q-tips, wooden sticks, metal pickers, instillation ofmustard oil in ears, undue use of antibiotic ear drops, and swimming. Otomycosis causative organism isespecially Aspergillus and Candida while concomitant bacterial infection can be seen in several cases ofotomycosis, the most common implicated bacteria being staphylococcus aureus. This literature reviewhighlights the need for education to eradicate the aforementioned predisposing risk factors to reduce theincidence of otomycosis.

Bacterial etiology of early onset and late onset sepsis in menoufia university hospital: trends in antimicrobial susceptibility patterns

Neonatal sepsis is responsible for 30 - 50% of total neonatal deaths each_year in developing countries. Our study aimed to determine the bacterial etiology of early onset sepsis [EOS] and late onset sepsis [LOS] and their antibiotic resistance patterns

This study was conducted at the Microbiology and Immunology department, and Neonatal Intensive Care Unit [NICU], Menoufia University Hospitals. 35 suspected cases of sepsis were included in our study [14 females and 21 males] aged from 1-28 days. They were screened for sepsis by modified clinical sepsis score and hematological sepsis scoring system [total score 7, score > 3 suggestive of sepsis ]

Cases within the first week of life were considered EOS and considered LOS if occurring after the first week. CBC, semi quantitative CRP, blood culture were done for all neonates

Antimicrobial susceptibility and ESfiLs detection were carried out for all isolates. Our results revealed that premature and low birth weight cases were more than full term and normal birth weight cases. Early onset sepsis group included 12 [34.3%] cases while late onset sepsis group included 23 [65.7%]

Total number of isolates were 26, Gram-negative bacteria were more frequent than Gram-positive with a frequency of 57.7% and 42.3% respectively. The most prevalent organism isolated from EOS cases was Klebsiella spp. [26.9%] . Gram negative organisms were seen mainly in early onset sepsis while gram positive organisms were seen in late onset sepsis with predominance of S. aureus. Klebsiella spp. and E. coli were highly sensitive to imipenem [100% each], however, high resistance was observed to penicillin, ampicillin and erythromycin [100% for each] . One out of 5 [20%] E. coli isolates and 2 out of 7 [28.6%] Klebsiella isolates were extended spectrum beta lactamase [ESfiL] producers . S. aureus showed high sensitivity to imipenem [100%], 100% resistant to amoxicillin-davulinic acid . Coagulase -ve staphylococci were highly sensitive to vancomycin [100%] 100% resistant to ampicillin, erythromycin, pipracillin, and penicillin. Gram-positive and negative bacteria have demonstrated high resistance against 3rd generation cephalosporins [more than 60%]. In conclusions, Gram negative bacteria [K. pneumoniae and E. coli] were the main cause of EOS in our study, while S. aureus and CoNS were most common in LOS cases. Emergence of multi-drug resistant strains especially for commonly used antibiotics is an important issue especially in NICU. Most isolates are highly resistant against commonly used antibiotics and are relatively more sensitive to less commonly used drugs like imipenem . Continuous surveillance should be carried out at regular intervals to find out the changing antibiotic susceptibility patterns and advice empirical therapy

Random amplification polymorphic DNA is a good epidemiologic screening method of pseudomonas aeruginosa nosocomial isolates from menoufyia university hospital burn unit

Burned patients are at increased risk for hospital-acquired infections. Pseudomonas aeruginosa is the most common bacterial pathogen involved in these infections. Epidemiologic typing is needed to discover the source of infection. Phenotypic characteristics of Pseudomonas aeruginosa could be used for this purpose. However, the genomic fingerprinting methods are now regarded as more accurate typing methods. Random amplified polymorphic DNA is thought to be an efficient genetic typing method. In the Burn Unit of Menoufyia University Hospital this study was carried out in order to overview the problem of hospital acquired infections in this unit, to identify the most common pathogen and to find out probable sources of infections. Fifty-three cases of nosocomial burn wound infections, ten medical personnels and thirty-one environmental samples were screened, bacterial isolates were identified. Epidemiologic study for the most common isolate [Pseudomonas aeruginosa] was done using antibiogram and pyocin production in addition to some genetic studies as plasmid profile and random amplification polymorphic DNA [RAPD] typing. Total number of Pseudomonas aeurginosa strains isolated from burn wound infections, medical staff and Burn Unit environment and equipments was 36. These P. aeurginosa strains were mostly sensitive to imipinem [69.5%] followed by amikin [61.2%]. Antibiogram typing classified these isolates into 9 groups. beta lactamase prduction was proved in 58% of strains. Pyocin typing revealed 5 types. Sixteen strains had plasmids with 7 different profiles. According to RAPD 24 different patterns were distinguished. Identical clones of Pseudomonas aeurginosa were identified: two clones were related to environmental sources [Hydrotherapy tub and stretcher of hydrotherapy]. Horizontal acquisition through health care worker [finger tips] was proved.Endogenous colonization was also found in two cases. The RAPD method is simple, fast and has high discriminatory power suitable for application in epidemiologic studies. Stringent infection control policies and education campaign are urgently needed

Role of interleukin-18 in allergic rhinitis

The role of IL-18 has not been well studied in allergic rhinitis. Few studies demonstrated up- regulation of IL-18 in nasal discharge of allergic rhinitis patients. The persistence of elevated IL-18 concentrations until after the season suggests a role for this cytokine in persistent allergic inflammation. In this study, we tried to through light on this role in patients with allergic rhinitis by investigating whether polymorphism is present in the coding regions of the IL-18 gene and, if so, to further analyze the association between polymorphism and allergic rhinitis in a case-control study. Blood samples were collected from 32 patients and 8 healthy controls matched by age and sex. Every patient was subjected to skin prick test [SPT] to confirm the clinical diagnosis and to detect the causative allergen[s]. Sera from the patients and controls were analyzed by using PCR single-nucleotide polymorphisms [SNPs]. There was a significant difference of IL-18 gene polymorphism at position -137 among allergic rhinitis patients and controls. The frequency of the -137C allele was significantly higher among allergic rhinitis patients as compared to the controls. We concluded that IL-18 gene polymorphism may represent an important susceptibility biomarker for the increased susceptibility to allergic rhinitis. This study reinforced the need for in-depth analysis of immune dysregulation of patients with allergic rhinitis arid point to the potential usefulness of cytokine-based therapy

Does the distressed fetus always need the pediatrician's attendance?

There is still a debate to whether pediatricians should attend all cesarean deliveries. This issue is even more complicated in developing countries. Little published data exist regarding the differences in resuscitative needs of infants delivered by cesarean section for fetal distress versus those without this diagnosis. The Objective of this study was to describe the differences in resuscitative and immediate Postnatal intervention needs for neonates with and without fetal distress delivered by cesarean section. Another aim was to devise an evaluation tool to assess and compare levels of neonatal resuscitation. The delivery records of 9687 deliveries in El-Shatby Hospital, University of Alexandria were reviewed. Apgar scores and resuscitative needs were assigned to a newly devised scoring system. Resuscitation subscores and total resuscitation scores were compared using non-parametric methods. The results proved that fetal distress group [n= 104] had a significantly greater resuscitative needs mean scores and subscores [p < 0.001] than did the non-fetal distress group [n= 545]. Of the non-fetal distress group, 48.6% still received some active form of intervention

Conclusion: The presence of a skilled pediatrician in all cesarean deliveries is highly recommended