6 research outputs found
Odontogenic Cutaneous Fistula: A Cause of Persistent Cervical Discharge
Odontogenic cutaneous fistulas often lead to intense levels of patient discomfort and suffering. Due to its rarity and the absence of dental symptoms, a considerable number of patients are usually misdiagnosed which results in inappropriate management. This case report presents a 16-year-old patient with a 2-year history of a nonhealing, persistently discharging lesion in the left submandibular region of the neck. The patient underwent exploration of the left submandibular region, and a fistulous tract directed superomedially to the ipsilateral lower molar teeth was excised. A subsequent panoramic orthopantomogram performed one week postoperatively demonstrated radiolucency is the distal root of tooth 37. A final diagnosis of odontogenic cutaneous fistula was made, and the patient was referred to the Maxillofacial Department for treatment of the offending tooth
Associations between climate variables and asthma visits to accident and emergency facilities in Trinidad, West Indies
Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America
Hypothesis: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America.
Background: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low-and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness.
Methods: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3.
Results: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21).
Conclusion: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study
Achado de bactérias selecionadas em crianças de Trinidad com doença amigdaliana crÎnica Selected bacterial recovery in Trinidadian children with chronic tonsillar disease
Faringoamigdalite na população pediĂĄtrica Ă© largamente tratada com antibiĂłticos. OBJETIVO: Estudar a microflora presente na superfĂcie e no nĂșcleo de amĂgdalas apĂłs adenoamigdalectomia eletiva em crianças. MĂTODO: AmĂgdalas de 102 crianças de Trinidad foram prospectivamente estudadas por meio de culturas e identificaçÔes bacteriolĂłgicas feitas a partir de amostras das superfĂcies e nĂșcleos de suas amĂgdalas entre 2005-2006. RESULTADOS: A partir de 360 amĂgdalas, foram isolados Streptococcus spp. (51,3%), Staphylococcus spp. (42,3%) e Gram-Negativos (6,4%). A identificação de estafilococos e estreptococos tanto na superfĂcie quanto no nĂșcleo foi semelhante (p>0,05). Encontramos mais (p<0,001) Streptococcus spp. nas superfĂcies (82,2%) do que nos nĂșcleos (63,3%); a prevalĂȘncia de estreptococos alfa-hemolĂticos foi maior (p<0,001) do que aquela de estreptococos beta-hemolĂticos nas superfĂcies (74,4% vs. 18,6%) do que nos nĂșcleos (58,9% vs. 13,7%). NĂŁo houve concordĂąncia entre superfĂcies e nĂșcleos com relação a estreptococos (p<0,0004) e estreptococos alfa-hemolĂticos (p<0,007). Estreptococos beta-hemolĂticos foram mais identificados (p<0,05) em crianças dentre 6-16 anos do que naquelas entre 1-5 anos de idade (31% e 23,8% vs 12,5% e 8%). A prevalĂȘncia de S. pyogenes na superfĂcie e no nĂșcleo foi de (84,6% vs 70%) e (50,0% vs 25,0%) em crianças de maior faixa etĂĄria e crianças mais novas, respectivamente. Klebsiella spp. (6,6%, 2,2%), Proteus (4,4%, 4,4%) e Pseudomonas (4,4 %, 1,1%) cresceram nas superfĂcies e nĂșcleos, respectivamente. CONCLUSĂO: As superfĂcies amigdalianas tinham mais estreptococos e estreptococos hemolĂticos do que seus nĂșcleos. Crianças mais velhas tiveram mais estreptococos beta-hemolĂticos, e sĂŁo altamente colonizadoras de S. pyogenes. Sugerimos estudos que investiguem os mecanismos de aderĂȘncia estreptocĂłcica em crianças de Trinidad.<br>Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3%), Staphylococcus spp. (42.3%) and Gram-negative genera (6.4%). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2%) than cores (63.3%) grew Streptococcus spp.; α-haemolytic Streptococcus prevalence was higher (p<0.001) than Ă-haemolytic Streptococcus on surfaces (74.4% vs. 18.6%) than cores (58.9% vs. 13.7%). Surfaces and cores were not concordant for streptococci (p<0.0004) and α-haemolytic Streptococcus (p<0.007). Surface and core Ă-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31% and 23.8% vs 12.5% and 8%). S. pyogenes surface and core prevalence was (84.6% vs 70%) and (50.0% vs 25.0%) in older and younger children respectively. Klebsiella spp. (6.6 %, 2.2%), Proteus (4.4%, 4.4%) and Pseudomonas (4.4 %, 1.1%) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for streptococci overall and for α haemolytic streptococci. Older children grow more β-haemolytic streptococci and are high colonizers of S. pyogenes. Studies probing the mechanisms of streptococcal adhesions in Trinidadian children are suggested