What are the risk factors for acute otitis media treatment failure?

OBJECTIVE: To identify risk factors associated with acute otitis media treatment failure (AOMTF) among 13-valent pneumococcal conjugate vaccine (PCV) immunized children. METHODS: In this retrospective study, we identified children <12 years who were admitted to our hospital November 2017-October 2020. Children were categorized either as acute otitis media treatment failure (AOMTF), if they received adequate pre-admission antibiotics, or as AOM without treatment failure (AOMwTF), if they did not receive any pre-admission antibiotics. We collected demographics, clinical behavior, laboratory results, length and hospitalization course. Hospitalization was justified if previously treated properly. RESULTS: The AOMTF group included 84 children (43 boys, mean age: 1.30 ± 0.83 years), whereas the AOMwTF group included 251 children (132 boys, mean age: 1.20 ± 0.89 years). AOMTF accounted for 25% of all AOM admissions. Among the AOMTF group, 46 (54.8%) were treated with amoxicillin and 24 (28.6%) with amoxicillin/clavulanic acid. Risk factors for AOMTF included recurrent AOM episodes history (30.9% vs 5.5%, OR 7.6, 95%CI 3.5-15.4, p < 0.001), otorrhea (29.4% vs 9.5%, OR 4, 95%CI 2.1-7.5, p < 0.001), tympanic membrane perforation (14.2% vs 4.3%, OR 3.6, 95%CI 1.5-8.6, p < 0.0019). Children with AOMTF were treated more with 2nd- or 3rd-line antibiotics (90.2% vs 65.9%, OR 4, 95%CI 2.2-10.4, p < 0.001), and underwent more myringotomy/ventilation tube insertions (14.4% vs 6.9%, OR 2.3, 95%CI 1.0-5.0, p = 0.037). Mean admission durations were similar: 3.83 ± 1.6 days in the AOMTF group vs 3.37 ± 2.77 days in the AOMwTF group (p = 0.15). CONCLUSION: Risk factors associated with AOMTF should be identified early during the AOM course to reduce complication rates and surgery referral.

[CLINIC BLOOD PRESSURE MONITORING AS A PREDICTOR OF MASKED HYPERTENSION].

INTRODUCTION: Masked hypertension is strongly linked to morbidity and mortality. The phenomenon poses a challenge to physicians due to the difficult diagnosis. Recent studies have shown that the incidence may occur in 8.8% -16.6% of the population and up to 30.4% among people with borderline blood pressure. OBJECTIVES: To examine the prevalence of masked hypertension in the Israeli population and the clinic blood pressure status as a predictor of masked hypertension. METHODS: Interviewees were randomly recruited from among passers-by at Assuta Hospital in Ashdod. Those who were found to have normal and normal-high blood pressure ranges were included in the study. Ambulatory blood pressure monitoring was performed, and anthropometric measures were assessed. A statistical analysis compared groups according to their blood pressure clinical and ambulatory blood pressure categories. RESULTS: A total of 35 participants were included in this research. Masked hypertension was found among 35.3% of patients with normal range blood pressure and 27.7% of those in the borderline range. Significant differences were found between the normotensive group and the masked hypertension group in BMI, waist circumference, and clinical category of clinic diastolic blood pressure. CONCLUSIONS: A third of those with in-clinic normal blood pressure suffer from masked hypertension. Borderline in-clinic diastolic blood pressure is significantly associated with masked hypertension. DISCUSSION: This study presents higher masked hypertension rates than previously reported, the difference may be explained by differences in the nature and the lifestyle of the study population. The high incidence of the phenomenon indicates the need for further investigation of patients with in-clinic normal and borderline blood pressure.

[RESISTIVE INDEX - A POSSIBLE SUBTLE INDEX OF KIDNEY DYSFUNCTION IN PRE-HYPERTENSIVE PATIENTS].

INTRODUCTION: The phenomenon of "masked hypertension" is a diagnostic challenge for physicians. The renal resistance index is a radiological index that expresses damage to the renal blood vessels. The literature regarding the relationship between the renal resistance index and primary kidney disease (as a cause of hypertension) or kidney disease as a result of hypertension is low and limited. OBJECTIVES: The aim of this study is to examine the reliability of the renal resistive index as a means of detecting masked hypertension. METHODS: Respondents were recruited at random, those who were found within normal and normal-high blood pressure ranges were included in the study. A renal ultrasound and ambulatory blood pressure monitoring were performed, and anthropometric measures were assessed. A statistical analysis compared groups according to their blood pressure clinical category and the presence of masked hypertension versus normal. RESULTS: No significant difference was found between the study groups in the renal resistance indices. CONCLUSIONS: The renal resistive index is not an appropriate tool for assessing the presence of masked hypertension in patients with in-clinic pre-hypertension. DISCUSSION: The results of the study were consistent with previous studies that question the clinical use of the renal resistive index. There is no room for using the renal resistive index as a tool to assess the likelihood of masked hypertension in patients with in-clinic pre-hypertension.

Ehd3, a regulator of vesicular trafficking, is silenced in gliomas and functions as a tumor suppressor by controlling cell cycle arrest and apoptosis.

EHD3 [Eps15 homology (EH) domain-containing protein 3] is a protein that resides in tubular and vesicular membrane structures and participates in endocytic recycling, although all its functions are unknown. Since Ehd3 is most abundantly expressed in brain tissues, we examined its role in brain cancer progression. Using immunohistochemistry, we report loss of EHD3 expression in gliomas, including low-grade astrocytomas, suggesting that this is an early event in gliomagenesis. EHD3 expression is also very low in most of glioma cell lines tested. In two cell lines, a bisulfite sequencing method identifies promoter hypermethylation as a mechanism of Ehd3 silencing, and its expression was restored by the demethylating agent 5-Azacytidine. Doxycycline-inducible restoration of EHD3 expression to glioma cells decreases their growth and invasiveness and induces cell cycle arrest and apoptosis. Furthermore, shRNA-mediated Ehd3 silencing increases cell growth. Using a xenograft model, we demonstrate Ehd3 growth inhibitory functions in glioma cells in vivo. We suggest that Ehd3 functions as a tumor suppressor gene and loss of its expression is a very common event in gliomas. This is the first study to highlight the importance of a member of the C-terminal EHD proteins in cancer and to link their functions to the cell cycle and apoptosis.