Incidence and economic burden of acute otitis media in children aged up to 5 years in three Middle Eastern countries and Pakistan: a multinational, retrospective, observational study

Epidemiological data on acute otitis media [AOM], an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children 5 years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children [Saudi Arabia = 1023, Oman = 998, Pakistan = 1022, Turkey = 1000] were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars [USD]]. The overall incidence of AOM episodes per 1000 person-years was: Saudi Arabia, 207 [95% confidence interval [CI]: 178-238]; Oman, 105 [95% CI: 85-127]; Pakistan, 138 [95% CI: 116-163]; and Turkey, 99 [95% CI: 79-123]. The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation [SD] = 93.0], Oman USD16.1 [SD = 16.4], Pakistan USD22.1 [SD = 20.5], and Turkey USD33.6 [SD = 44.9]. The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies

General anaesthesia combined with bilateral paravertebral blockade [T11-T12-L1] vs general anaesthesia for bilateral varicocelectomy a randomized double-blind clinical trial

Varicocelectomy is a common operation in urology associated with considerable postoperative pain. The aim of this prospective, randomized, double-blind study was to investigate whether a combination of general anesthesia and bilateral nerve stimulator guided paravertebral nerve blocks could provide better postoperative pain relief compared to general anesthesia in combination with placebo paravertebral nerve block. Sixty patients scheduled for varicocelectomy were randomized prospectively. Thirty patients each in either the active group [general anaesthesia combined with nerve stimulator guided bilateral paravertebral block] or the control group [general anaesthesia combined with normal saline nerve stimulator guided bilateral paravertebral block]. Postoperative pain was assessed by visual analogue scale scores at predetermined time intervals. The active group was found to have better postoperative pain-relief [p < 0.005], reduced need for analgesics [p < 0.05], and also a more rapid return to normal activities [p < 0.001] compared to control group. Higher surgeon and patient satisfaction [p < 0.001] were noted in the active group compared to the control group. Preoperative paravertebral blockade combined with general anesthesia showed significantly reduced postoperative pain scores and analgesic consumption, earlier return to normal activity and was associated with better patient and surgeon satisfaction during varicocelectomy surgery

Fecoprevalence and determinants of helicobacter pylori infection among asymptomatic children in lebanon

Helicobacter pylori plays a major etiologic factor in the pathogenesis of chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa associated lym-phoid tissue lymphoma. However, most of the infected subjects remain asymptomatic. The aim of this study is to establish fecoprevalence of Helicobacter pylori infection in a convenient non-probabilistic sample of asymptomatic Lebanese children. Four-hundred fourteen children aged between one month and 17 years of different socio-economic standards were selected for Helicobacter pylori antigen testing in stool. Demographic characteristics, health and nutritional status were obtained through a questionnaire. Fecoprevalence of Helicobacter pylori infection was 0.21 of whom 28.7% were between 0-3 years, 34.5% between 4-9 years and 36.8% between 10-17 years. Seventy-five [86.2%] of the feco-positive children were from low socioeconomic standards and 12 [13.8%] were from middle to high socioeconomic standards [p < 0.0001]. Environmental variables demonstrated higher frequency of fecopositivity in children living in overcrowded houses, lower family income and poor parental education [p<0.05]. Helicobacter pylori is prevalent in asymptomatic Lebanese children. Prevention is worthy by improving the levels of education and the standards of hygiene