Résumé
Backgrounds and Objectives: Neck deep infections are potentially threatening life conditions which can occur while using broad spectrum antibiotics. Early diagnostic and therapeutic interventions are essential in approaching these infections. As these infections are prevalent and there are difficulties in diagnosis and curing these infections and threatening morbidities they have, we decided to study the results of culture and anti-bio gram in these patients, for determination of these parameters, sensitivity, resistance of antibiotic used for these organisms and selection of appropriate antibiotic
Materials and Methods: In 100 patients admitted with a diagnosis of deep neck spaces infection between July 2008 and November 2012, pus was aspirated and sent to microbiology lab for gram staining, culture and anti-bio gram. Types of isolated bacteria and the sensitivity and resistance rate were defined
Results: In our study 100 patients with a diagnosis of deep neck spaces infection were studied. Average age was 33.8 +/- 13.43 years old. 65% were male, 4% had diabetes, 3% had the history of abscess/cellulitis, 3% had liver disease, 2% had the history of opiate addiction and 6% had the history of alcohol consumption. In 71% culture was negative and in 29% it was positive. 68.9% were gram positive cocci and 31.1% were gram negative bacilli. From 29 positive cultures, 13[44.8%] were Streptococcus Viridans, 5[17.2%] were Staphylococcus, 5[17.2%] were Klebsiella Pneumoniae, 2[6.9%] were beta hemolytic Streptococcus, 2 [6.9%] were Haemophilus Influenzae and 2[6.9%] were Entrobacter. Final diagnosis was peritonsillar abscess and cellulitis. In 22% the etiology was pharyngitis, in 18% was Odontogenic, in 5% were upper respiratory tract infections, in 2% was dermatologic infection and in 1% was foreign body. Etiology was unknown in 51% of the patients. The most sensitivity was to Vancomycin [100%], Imipenem [100%], Erythromycin [80%] and Levofloxacin [80%]. The less sensitivity was to Gentamycin [50%] and Penicillin G [28.6%]. There was no statistically significant relation between the culture results and demographic variants or patient's medical history
Conclusion: Deep neck infection is a life threatening disease. Antibiotics should be started after blood sampling for culture and antibiogram and continued according to antibiogram results. Beginning antibiotics before blood sampling will result in wrong findings in culture and antibiogram
Résumé
Management of pain in children is often inadequate and numerous clinical practice guidelines and policy statements have been published on the subject of pediatric pain. Tonsillectomy is among the most frequent otorhinolaryngologic surgeries, especially in the pediatric age group and after tonsillectomy the patients usually suffer from mild to severe pain for three postoperative days which may limit activity level and intake, leading to dehydration and a prolonged hospital stay. In this study acetaminophen, acetaminophen codeine and ibuprofen have been compared in a single study. A randomized, prospective, double-blind study was conducted at the Tabriz pediatric hospital. Patients were selected randomly from the hospitalized patients undergoing tonsillectomy suffering from recurrent tonsillitis or adenotonsillar hypertrophy and assigned to one of three groups [acetaminophen [ACT]-acetaminophen codeine [ACT/C]-ibuprofen [IBU] according to a predetermined randomization code. All the operations were taken place under same conditions by the same surgeon. Objective pain score used for pain assessment and adverse drug reactions were collected on checklists and analyzed using SPSS software. Chi square test results revealed a significant difference between ACT ACT/C IBU groups. Neither acetaminophen nor Ibuprofen at the doses given was able to provide sufficient analgesia. The rate of bleeding in all groups did not show any significant difference according to Pearson-chi-square test [P=0.22]. The incidence of anorexia in ACT, ACT/C and IBU groups was 15.7, 7.8 and 25.8 percent, respectively, which showed a significant difference by chi-square test [P=0.045]. According to our study it can be concluded that acetaminophen codeine posses more analgesic effect than acetaminophen and ibuprofen in post tonsillectomy pain management in pediatric patients