Cláudia Scherber Giugno

Daily dose of clindamycin versus standard divided doses in obstetrical and gynecological infections: a retrospective cohort study.

To compare the rates of cure of septic abortion and pelvic inflammatory disease using a daily dose of clindamycin with gentamicin versus divided doses, we conducted a retrospective cohort study, where the electronic records of 661 patients who used clindamycin 1 × , 3 × or 4 ×/day (groups 1, 3 and 4, respectively) between September 2002 and August 2010 were analysed. Major outcomes included rates of cure and failure according to the clinical records. Secondary endpoints were percentage of adverse effects related to medication regimen and the prevalence of positive VDRL and HIV. Similar conditions were observed in all groups − septic abortion: 167/116/123; pelvic inflammatory disease: 73/95/87 (groups 1, 3 and 4, respectively). No significant difference was found among groups for age or for rate of cure. Rates of cure (cure/total [rate (95%CI)]) in groups 1, 3 and 4 were 236/240 [0.983 (0.957−0.993)], 205/211 [0.971 (0.939−0.986)], 203/210 [0.966 (0.932−0.983)], respectively. Days of use of clindamycin was significantly reduced in group 1, compared to groups 3 and 4 (2.6 ± 1.3 vs. 3.5 ± 2.5 vs. 3.3 ± 1.9−mean ± SD; p < 0.0001 – ANOVA), but this may be due to differences in how length of therapy was measured and not the effect on clinical cure.

Original articleAssessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjectsAvaliação da função da tuba de Eustáquio em pacientes com retração de membrana timpânica e em indivíduos normais

Introduction The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results.INTRODUCTION The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. OBJECTIVE To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. METHODS An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. RESULTS Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p=0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p≥0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. CONCLUSION In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects

Introduction The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results.INTRODUCTION The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. OBJECTIVE To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. METHODS An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. RESULTS Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p=0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p≥0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. CONCLUSION In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Cholesteatoma Growth Patterns: Are There Audiometric Differences between Posterior Epitympanics and Mesotympanics?

Objectives: Verify if there are differences in hearing impairment between posterior epitympanic and posterior mesotympanic cholesteatomas. Methods: This cross-sectional study evaluated 278 ears with cholesteatoma and no previous surgery between August 2000 and January 2013. Otoendoscopy and pure tone audiometry were performed at the first evaluation. The video-otoscopys were later analyzed and classified between the two main possible routes involved in cholesteatoma formation (posterior epitympanic and posterior mesotympanic). To compare the audiometric thresholds, we employed the Student t test. Results: The mean age was 33.7 years old, and 51.1% were male. The posterior epitympanic cholesteatoma was found in 51.4%. There were no differences in air and bone conduction thresholds between the two groups (P > 0.05). When the air-bone gaps were compared, however, the posterior mesotympanics had greater thresholds in 500 Hz, 2000Hz, and tritonal mean (P = 0.003, P = 0.03, and P = 0.02, respectively) Conclusions: The posterior mesotympanic cholesteatomas had greater air-bone gap thresholds in the speech frequencies when compared with posterior epitympanic cholesteatomas. However, the two growth patterns were very similar in the other audiometric parameters.

Eustachian Tube Function in Children with Normal Middle Ear and with Tympanic Membrane Retraction

Objectives: Identify the variation in middle ear pressure (MEP) after tubal function tests performed in normal children and in ears with retraction disease. Variability over time was analyzed. Methods: Observational cross-sectional study. A total of 38 subjects were studied between March and November of 2012. Subjects were classified into three groups: group1-normal ears (36 ears); group2-mild tympanic membrane (TM) retractions (23 ears); group3-moderate/severe TM retractions (17 ears). All patients had Valsalva maneuver, sniff test and Toynbee maneuver done sequentially in both ears twice with 15 days interval. MEP was measured with an Interacoustics AT235h tympanometer before and after the maneuvers. For analysis, MEP mixed effects models was used. For evaluation over time, Bland and Altman and intra-class correlation (ICC) were used. Significance of the study was ± = 0.05. Results: The mean ± SD age was 11 ± 2.72 years (8-17 years). At first time of the Valsalva maneuver, there was a trend of increasing pressures in the three groups (P = 0.012), and the mean pressures of the groups were different (P <0.001). For the sniff test and Toynbee there was no statistically significant difference between basal pressure and pressure after the maneuvers in three groups of ears (P >0.05) at the two times. We found a moderate degree of replicability over the two times of measurement. Conclusions: The average MEP increased in the Valsalva maneuver in the three groups. Pressure had more variability in ears with moderate/severe retraction.