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1.
J Healthc Qual Res ; 39(2): 126-134, 2024.
Article in Spanish | MEDLINE | ID: mdl-38302372

ABSTRACT

BACKGROUND AND OBJECTIVE: People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions. MATERIALS AND METHODS: A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase). RESULTS: Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings. CONCLUSIONS: The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization.


Subject(s)
Disabled Persons , Humans , Health Facilities , Health Services Accessibility , Hospitals , Quality of Health Care
2.
Acta pediatr. esp ; 66(10): 510-512, nov. 2008. ilus
Article in Spanish | IBECS | ID: ibc-59591

ABSTRACT

Los linfangiomas son tumores raros y benignos producidos por el desarrollo anómalo de los vasos linfáticos. Presentamos un caso de linfangioma quístico asintomático localizado en paladar duro; se trata de una localización atípica, puesto que la mayoría de esas lesiones se localizan en la lengua a nivel de cavidad oral. Se realizó una resección con láser de CO2, sin que se evidenciase recidiva tras dos años de seguimiento. Actualmente se acepta adoptar una actitud expectante o el tratamiento con agentes esclerosantes que reduzcan su tamaño o los eliminen (AU)


Lymphangiomas are rare, benign tumors produced by the abnormal development of the lymphatic vessels. We present a case of asymptomatic cystic lymphangioma localized in the hard palate. This is an uncommon location since most of these lesions are found in the tongue at the level of the oral cavity. Resection was performed with CO laser, and there was no evidence of recurrence after two years of follow-up. At the present time, the approaches most widely accepted are expectant treatment or administration of sclerosing agents that reduce the size of the lesions or eliminate them (AU)


Subject(s)
Humans , Female , Child , Lymphangioma/diagnosis , Lymphangioma/radiotherapy , Lymphatic Vessel Tumors/diagnosis , Lymphatic Vessel Tumors/therapy , Lasers, Gas/therapeutic use , Lymphangioma, Cystic/diagnosis , Lymphangioma, Cystic/radiotherapy , Diagnosis, Differential , Mouth/injuries , Mouth/pathology , Cyclophosphamide/therapeutic use , Infusions, Intralesional
3.
An Otorrinolaringol Ibero Am ; 34(5): 433-8, 2007.
Article in Spanish | MEDLINE | ID: mdl-18030849

ABSTRACT

The complexity of the embriologic development of the neck and the possible abnomarlies in this process, with the consequent posterior manifestations make necessary the knowledge of the embriologic anatomy of the neck. In the possible manifestations that can be of the anomalies of the development of the branchial archs are the abnomarlies of the first branchial archs. They are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects.


Subject(s)
Branchial Region/abnormalities , Branchial Region/surgery , Fistula/congenital , Child , Fistula/surgery , Humans , Male
4.
An. otorrinolaringol. Ibero-Am ; 34(5): 433-438, sept.-oct. 2007. ilus
Article in Es | IBECS | ID: ibc-64558

ABSTRACT

La complejidad del desarrollo embriológico del cuello y las posibles del cuello y las posibles anomalías en este proceso, con las consiguientes manifestaciones posteriores hacen necesario el conocimiento de la anatomía embriológica del cuello. Dentro de las posibles manifestaciones que pueden darse de las anomlías del desarrollo de los arcos branquiales se encuentran las anomalías del primer arco branquial. Son dentro de las anomalías del desarrollo de los arcos branquiales, infrecuentes y están íntimamente relacionadas con el nervio facial. Presentamos el caso clínico correspondiente a un niño de 7 años con esta patología y repasamos los aspectos más importantes de la misma


The complexity of the embryologic development of the neck and the possible abnormalies in thi process, with the consequent posterior manifestations make necessary the knowledge of the embryologic anatomy of the neck. In the possible manifestations that can be of the abnormalies of the development of the branchial archs are the abnormalies of the first branchial archs. The are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects


Subject(s)
Humans , Male , Child , Branchial Region/abnormalities , Branchial Region/pathology , Branchial Region/surgery , Fistula/complications , Fistula/diagnosis , Fistula/surgery , Facial Nerve/abnormalities , Facial Nerve/surgery , Embryonic and Fetal Development/genetics , Embryonic and Fetal Development/physiology , Neck/abnormalities , Neck/pathology , Neck/surgery , Branchial Region/physiopathology
5.
An Otorrinolaringol Ibero Am ; 34(6): 557-64, 2007.
Article in Spanish | MEDLINE | ID: mdl-18293775

ABSTRACT

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy.


Subject(s)
Arteriovenous Malformations/epidemiology , Otorhinolaryngologic Diseases/epidemiology , Adult , Aged , Aged, 80 and over , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/surgery , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/surgery
6.
An. otorrinolaringol. Ibero-Am ; 33(6): 557-564, nov.-dic. 2006. ilus
Article in Es | IBECS | ID: ibc-049765

ABSTRACT

La cirugía endoscópica nasosinusal ha posibilitado un cambio en el diagnóstico, tratamiento y manejo postquirúrgico de múltiples patologías nasales y sinusales. Los mucoceles de los senos paranasales pueden constituir una de las indicaciones ideales para la realización de esta técnica siempre que reúnan condiciones suficientes de accesibilidad. En estos casos, se lograría evitar tratamiento quirúrgico por vía externa con las secuelas y morbilidad consiguientes. Presentamos un mucocele de gran tamaño y extensión maxiloetmoidal tratado endoscópicamente y analizamos los puntos clave para sentar la indicación de tratamiento endoscópico en esta patología


The Functional Endoscopic Sinus Surgery has posibilitated a change in the diagnosis, treatment and postsurgical management of many nasosinusal diseases. Mucoceles of the paranasal sinuses are an ideal indication for performing these surgical procedures when good accesibility conditions are presented under these circumstances, external approach, with the subsequent impairments and morbility, could be avoided. An endoscopically treated extensive maxilloethmoydal mucocele is presented and key points to endoscopic treatment indication are provided


Subject(s)
Male , Adult , Humans , Mucocele/surgery , Paranasal Sinus Diseases/surgery , Ethmoid Sinusitis , Ethmoid Sinusitis/surgery , Magnetic Resonance Imaging , Maxillary Sinusitis , Maxillary Sinusitis/surgery , Mucocele/diagnosis , Otorhinolaryngologic Surgical Procedures , Paranasal Sinus Diseases/diagnosis , Tomography, X-Ray Computed , Treatment Outcome
7.
An Otorrinolaringol Ibero Am ; 33(5): 481-7, 2006.
Article in Spanish | MEDLINE | ID: mdl-17091861

ABSTRACT

Unilateral vocal fold paralysis is frequently encountered during ENT practise. It may result from many different conditions and it always should be regarded as a sign revealingan underlaying disease that can be located anywhere along the traject of the tenth cranial nerve or at the cricoarytenoidjoint being malignancies and trauma the leading causes. Etiology, glottal characteristics and compensative maneuvers, and individual factors such as comorbility or age must be considered when treatment options are proposed to the patient. A case of an uncommon etiology for unilateral vocal fold paralysis, an aortic aneurysm, is presented and considerations about the management of this condition are provided.


Subject(s)
Aortic Aneurysm, Thoracic/complications , Vocal Cord Paralysis/etiology , Aged, 80 and over , Aortic Aneurysm, Thoracic/diagnostic imaging , Humans , Male , Radiography, Thoracic , Tomography, X-Ray Computed
8.
An. otorrinolaringol. Ibero-Am ; 33(5): 481-487, sept.-oct. 2006. ilus
Article in Es | IBECS | ID: ibc-049059

ABSTRACT

La parálisis unilateral de una cuerda vocal es un hallazgo común durante el ejercicio de la otorrinolaringología que puede deberse a múltiples patologías y que siempre debe considerarse como un signo revelador de una patología subyacente que puede ubicarse a cualquier nivel del trayecto del X par craneal o en la articulación cricoaritenoidea, siendo tumores malignos y traumatismos las principales causas. A la hora de proponer las diferentes opciones terapéuticas factibles, se debe valorar y considerar la etiología de la parálisis, las características exploratorias del la laringe y las maniobras compensatorias que ésta realiza, y factores individuales del paciente tales como comorbilidad, edad, autopercepción de la enfermedad por el paciente y sus deseos. Presentamos un caso de parálisis recurrencial unilateral de una etiología poco frecuente, un aneurisma de aorta, realizando una serie de consideraciones que a nuestro juicio son importantes en estos caso


Unilateral vocal fold paralysis is frequently encountered during ENT practise. It may result from many different conditions and it always should be regarded as a sign revealingan underlaying disease that can be located anywhere along the traject ofthe tenth cranial nerve or at the cricoarytenoid joint being malignancies and trauma the leading causes. Etiology, glottal characteristics and compensative maneuvers, and individual factors such as comorbility or age must be considered when treatment options are proposed to the patient. A case of an uncommon etiology for unilateral vocal fold paralysis, an aortic aneurysm, is presented and considerations about the management of this condition are provided


Subject(s)
Male , Aged, 80 and over , Humans , Aortic Aneurysm, Thoracic/complications , Vocal Cord Paralysis/etiology , Aortic Aneurysm, Thoracic , Radiography, Thoracic
9.
An Otorrinolaringol Ibero Am ; 33(6): 557-64, 2006.
Article in Spanish | MEDLINE | ID: mdl-17233270

ABSTRACT

The Functional Endoscopic Sinus Surgery has posibilitated a change in the diagnosis, treatment and postsurgical management of many nasosinusal diseases. Mucoceles of the paranasal sinuses are an ideal indication for performing these surgical procedures when good accesibility conditions are present. Under these circumstances, external approach, with the subsequent impairments and morbility, could be avoided. An endoscopically treated extensive maxilloethmoydal mucocele is presented and key points to endoscopic treatment indication are provided.


Subject(s)
Mucocele/surgery , Paranasal Sinus Diseases/surgery , Adult , Ethmoid Sinus/diagnostic imaging , Ethmoid Sinus/surgery , Humans , Magnetic Resonance Imaging , Male , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Mucocele/diagnosis , Otorhinolaryngologic Surgical Procedures , Paranasal Sinus Diseases/diagnosis , Tomography, X-Ray Computed , Treatment Outcome
10.
Acta Otorrinolaringol Esp ; 56(5): 215-8, 2005 May.
Article in Spanish | MEDLINE | ID: mdl-15960125

ABSTRACT

OBJECTIVES: Non Hodgkin's lymphoma (NHL) is a frecuent tumor in the ENT field althougt there are not too many publications with a large number of patients. PATIENTS AND METHODS: We have studied 300 patiens with NHL and analysed the head and neck affectation, the presence in Waldeyer's ring, the first symptoms and the stage of the disease. RESULTS: Over 50% had head and neck manifestation. Of them, the most frequent one were adenopathies. In the Waldeyer's ring, the tonsil was the most frecuently affected structure. CONCLUSION: There is an evident relationship between NHL and the Oto-Rhino-laringology area and it is necessary consider it in the differential diagnosis of head and neck adenopathies.


Subject(s)
Lymphoma, Non-Hodgkin , Otorhinolaryngologic Neoplasms , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Lymphoma, Non-Hodgkin/diagnosis , Male , Middle Aged , Otorhinolaryngologic Neoplasms/diagnosis
11.
Acta Otorrinolaringol Esp ; 55(3): 148-51, 2004 Mar.
Article in Spanish | MEDLINE | ID: mdl-15253343

ABSTRACT

Angiomyolipoma is an uncommon hamartomatous renal tumor very prone to spontaneous bleeding. However it is possible to find it in extrarenal sites, being the liver the most frequent one. The rest of sites recorded in literature are exceptional. In fact, to our knowledge, this is the first case reported of cervicothoracic settlement of an angiomyolipoma. This rare location, together with its marked tendency to bleed bleeding determinate a complicated diagnoses a difficult surgical approach.


Subject(s)
Angiomyolipoma/surgery , Head and Neck Neoplasms/surgery , Adult , Humans , Male , Surgical Procedures, Operative/methods
12.
An Otorrinolaringol Ibero Am ; 30(1): 47-59, 2003.
Article in Spanish | MEDLINE | ID: mdl-12680299

ABSTRACT

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.


Subject(s)
Otitis Media/cerebrospinal fluid , Tuberculosis/cerebrospinal fluid , Adult , Aged , Amoxicillin/therapeutic use , Antitubercular Agents/therapeutic use , Cerebrospinal Fluid Otorrhea/cerebrospinal fluid , Cerebrospinal Fluid Otorrhea/microbiology , Drug Combinations , Ear Diseases/cerebrospinal fluid , Ear Diseases/drug therapy , Ear Diseases/microbiology , Female , Humans , Isoniazid/therapeutic use , Male , Mycobacterium Infections/drug therapy , Mycobacterium Infections/microbiology , Mycobacterium tuberculosis/isolation & purification , Otitis Media/drug therapy , Otitis Media/microbiology , Penicillins/therapeutic use , Proteus Infections/drug therapy , Proteus Infections/microbiology , Proteus mirabilis/isolation & purification , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Tuberculosis/drug therapy , Tuberculosis/microbiology
13.
Acta Otorrinolaringol Esp ; 53(7): 473-80, 2002.
Article in Spanish | MEDLINE | ID: mdl-12487069

ABSTRACT

The nasopharyngeal carcinoma in Spain, low risk geographical area, is a rare tumor. This is the cause why there few papers about it in our country. We have carried out a muestral descriptive statistical study. We have selected among all the patients diagnosed of nasopharyngeal carcinoma a big group who, have been treated with induction chemotherapy followed by radiotherapy with or without surgery, they presented very complete clinical histories in the Departments of E.N.T., Oncology and Radiotherapy that allowed us to compare all the picked up data and this increased, without doubt, the reliability of them. The results obtained in the different examined variables of our patients are the same that those we found in literature. The nasopharyngeal carcinoma is a tumor that usually affects young patients, of both sexes, without previous consumption of alcohol and tobacco and they are diagnosed in advanced stages. The rhinologic symptoms are the most frequent ones but the cervical nodes are the usual cause for consulting a doctor with a long diagnostic interval. There is a prevalence in the undifferentiated tumors showed by histology.


Subject(s)
Carcinoma , Nasopharyngeal Neoplasms , Adult , Age Factors , Aged , Alcohol Drinking/adverse effects , Carcinoma/diagnosis , Carcinoma/epidemiology , Carcinoma/mortality , Carcinoma/pathology , Carcinoma/therapy , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Data Interpretation, Statistical , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Nasopharyngeal Neoplasms/diagnosis , Nasopharyngeal Neoplasms/epidemiology , Nasopharyngeal Neoplasms/mortality , Nasopharyngeal Neoplasms/pathology , Nasopharyngeal Neoplasms/therapy , Nasopharynx/pathology , Risk Factors , Sex Factors , Smoking/adverse effects , Spain/epidemiology , Time Factors
14.
An Otorrinolaringol Ibero Am ; 29(6): 593-603, 2002.
Article in Spanish | MEDLINE | ID: mdl-12596351

ABSTRACT

Computer nuclear morphometry and stereology are attractive methods because its objectivity and cheapness allowing histologic diagnosis when identifying minimal variations respectively the normality and also detect negligible disparities between anormal cells which could escape to the assessment of the pathologist. We present the data gained from several morphogenic and stereologic parameters resulting of measurements of tumoral cells procured from 40 patients with nasopharyngeal carcinomata. Middle values have been: nuclear area 27.70 microns 2; nuclear perimeter 20.80 microns; nuclear factor of form 0.81 microns; nuclear outline index 4.01; nuclear orientation angle 87.29 degrees; nuclear ellipsiticity 704.14; nuclear regularity 61.83; middle lineal length 4.30, middle linear distance 107.94; and nuclear volume 118.80 microns 3. Our series is the largest studied till now of all found in the literature. Comparison our data with those of previous publications.


Subject(s)
Carcinoma, Squamous Cell/pathology , Nasopharyngeal Neoplasms/pathology , Photogrammetry/instrumentation , Humans , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging
15.
Acta Otorrinolaringol Esp ; 52(5): 381-6, 2001.
Article in Spanish | MEDLINE | ID: mdl-11526644

ABSTRACT

The present study aims to analyse the survival of 94 patients with squamous cell carcinoma of the oral cavity. They were 86 men and 8 women with a mean age of 61. Seventy four percent were smokers and 70% consumed alcohol regularly. Eighty three percent had unhealthy teeth. A great majority of patients (76) were in the advanced stages (III-IV) and 61% showed neck nodules. The overall survival at 5 years was the following: 70% for patients in stage I, 85% in stage II, 58% stage III and only 17% for the patients in stage IV. The most significant prognostic factor that affected the survival was the N stage. For the patients in N0 and N1 we only found significant differences when the lymph nodes were histologically affected by the tumor.


Subject(s)
Carcinoma, Squamous Cell/mortality , Mouth Neoplasms/mortality , Female , Humans , Male , Middle Aged , Neoplasm Staging , Prevalence , Survival Rate
16.
An Otorrinolaringol Ibero Am ; 28(6): 553-61, 2001.
Article in Spanish | MEDLINE | ID: mdl-11859617

ABSTRACT

Adenocarcinomata of the nose are scanty growths. They included primary adenocarcinomata not derived from salivary glands and these in its turn not share histological, pathogenical and prognostic characteristic, being the latter those of high degree or intestinal type and the other the lower degree. We report an unusual clinical case which should be classified among those of high degree, but because of its behavior showed totally benign.


Subject(s)
Adenocarcinoma/pathology , Intestinal Neoplasms/pathology , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/surgery , Humans , Intestinal Neoplasms/diagnostic imaging , Intestinal Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Radiography
17.
An Otorrinolaringol Ibero Am ; 27(3): 265-83, 2000.
Article in Spanish | MEDLINE | ID: mdl-11075476

ABSTRACT

In this essay we deal with different aspects of the techniques described by Pearson and cols. in 1980, carrying out an analysis of objectives, indications and contraindications, physiological fundamentals, description of the surgical technique, aftercare and exposition of the results achieved in patients operated from September 1996-97.


Subject(s)
Laryngectomy/methods , Larynx/surgery , Pharyngectomy/methods , Pharynx/surgery , Trachea/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , Deglutition , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Lymph Node Excision/methods , Male , Middle Aged , Neoplasm Staging , Pharyngeal Neoplasms/pathology , Pharyngeal Neoplasms/surgery , Phonation
18.
An Otorrinolaringol Ibero Am ; 27(1): 5-15, 2000.
Article in Spanish | MEDLINE | ID: mdl-10829480

ABSTRACT

We report a clinical case of vagal chemodectoma with cell atypies, which was presented as slowly growing neck mass without any other symptoms. At the beginning and due to the histologic report of the needle biopsy, which morphologic study based on cellular atypia was misinterpreted as a malignant tumor and with the images obtained by computed tomography (CT) suggesting a malignant neoplasia, we proceeded to approach the case as a metastatic tumor of unknown origin. We made a revision of the epidemiologic factors, and diagnostic and therapeutic management of this type of growths.


Subject(s)
Cranial Nerve Neoplasms/diagnosis , Paraganglioma, Extra-Adrenal/diagnosis , Vagus Nerve/diagnostic imaging , Vagus Nerve/pathology , Adult , Cerebral Angiography , Cranial Nerve Neoplasms/surgery , Humans , Magnetic Resonance Imaging , Male , Paraganglioma, Extra-Adrenal/surgery , Vagus Nerve/surgery
19.
An Otorrinolaringol Ibero Am ; 27(1): 17-23, 2000.
Article in Spanish | MEDLINE | ID: mdl-10829481

ABSTRACT

Tumors of the nasal cavity and sinuses are rather infrequent, being squamous carcinoma the predominant type, which accounts for the 80 percent of the totality of them. Maxillary sinus is the most affected, followed by nose cavity. Half of cases are originated on turbinates. We present the clinical case of a woman patient diagnosed of microcytic carcinoma of the right nasal cavity originated at the level of middle turbinate. The mass filled the width of the fossa getting in touch with the nasal septum, without encroaching it. According its extent the tumor was classified as T2, N0, M0 and treated with radiotherapy only. Microcytic carcinoma is an exceptional histological type in nasal cavity and next to its numeric meagerness in this location makes this case a very peculiar one.


Subject(s)
Carcinoma/diagnosis , Nasal Cavity/diagnostic imaging , Nasal Cavity/pathology , Nose Neoplasms/diagnosis , Aged , Carcinoma/radiotherapy , Female , Humans , Neoplasm Staging , Nose Neoplasms/radiotherapy , Tomography, X-Ray Computed
20.
An Otorrinolaringol Ibero Am ; 26(5): 495-504, 1999.
Article in Spanish | MEDLINE | ID: mdl-10568306

ABSTRACT

The incidence of acute mastoiditis accounts for 0.004% of acute middle otitis. Nowadays there is a decrease of number of mastoiditis and its complications, but from time to time are seen outbreaks without logical explanation of facts. We report 4 clinical cases of acute mastoiditis complicated with subperiosteal abscess, in children between 8 and 23 month old, seen at our department during the last 3 years, three of them diagnosed in a 4-month term.


Subject(s)
Abscess/etiology , Enterococcus , Gram-Positive Bacterial Infections/complications , Mastoiditis/complications , Peptostreptococcus , Pneumococcal Infections/complications , Abscess/diagnosis , Acute Disease , Female , Gram-Positive Bacterial Infections/diagnosis , Humans , Infant , Male , Mastoiditis/diagnosis , Pneumococcal Infections/diagnosis
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