We compare conditional logistic regression and the missing-parents approach under several risk scenarios.
Results We show that the missing-parents approach improves power when some families have more than one unaffected sibling and that under weak assumptions the approach permits
the incorporation of supplemental cases who have no sibling available and supplemental click here controls whose case sibling is unavailable (e.g., due to disability or death).
Conclusion The missing-parents approach offers both improved statistical efficiency and asymptotically unbiased estimation for genotype relative risks and genotype-by-exposure interaction parameters.”
“Objective: The aim of this study is to define the clinical and bacteriological characteristics of acute mastoiditis (AM) in children in order to optimize diagnostic work-up and treatment.
Methods: In this retrospective study, 188 children between 3 months and 15 years of age (15 +/- 24 months; median +/- SD) were referred to our pediatric ENT emergency center for AM during a 7-year period (December 2001-January 2008).
seven percent were male and 43% were female. Clinical follow-up duration was 3.9 +/- 0.7 months (mean +/- SEM). The incidence of AM remained stable during the whole study period. Microbiological samples (n = 236) were negative in 33% of cases. The most frequently isolated germs were Streptococcus pneumoniae (51%). Streptococcus pyogenes (11.5%), Anaerobes (6.5%), and coagulase-negative Staphylococcus (6.5%). Paracentesis, puncture of retro auricular abscess under local anesthesia, and peroperative samples all contributed selleck to isolate the involved germ(s). All the patients were hospitalized and received CP358774 intravenous antibiotics, and 36.2% (n = 68) underwent surgery. Several surgical procedures were necessary in 4 cases (2.1%). AM recurrences requiring a second hospitalization were observed in 8 patients (4.3%). The only observed complication was lateral sinus thrombosis (n = 6; 3.2%). Surgical failures, requiring more than one surgical procedure, were more frequent in case of: (i) presence of Anaerobes (p <= 0.001) or Gram-negative
bacteria (p <= 0.05) in microbiological samples; (ii) surgical drainage without mastoidectomy (p <= 0.001). Recurrences were more frequent in AM due to Streptococcus pneumoniae.
Conclusions: Based on our findings and on literature data, a protocol was established in order to standardize the management of pediatric AM in our center. The mains points are: no systematic surgery; if surgery is indicated, it must encompass a mastoidectomy; broad-spectrum intravenous antibiotic treatment covering the most commonly involved germs (3rd generation cephalosporin) and secondarily adapted to the results of microbiological samples. If the infection is not controlled after 48 h of intravenous antibiotherapy, a mastoidectomy had to be performed. (C) 2010 Elsevier Ireland Ltd. All rights reserved.