Clinical and microbiological spectrum of meningococcal disease in adults during Hajj 2000: an implication of quadrivalent vaccination policy

To describe the epidemiological, clinical and laboratory features of meningococcal disease and explore the factors responsible for its morbidity and mortality among the pilgrims during Hajj 2000. Setting: This study was conducted at King Faisal Hospital, Makkah, Saudi Arabia. Any patient suspected of meningococcal disease during the period of pilgrimage presenting with fever, head ache, signs of meningeal irritation and turbid CSF, confirmed on gram stain smears, Latex agglutination test and culture was included in this study. Their clinical features, management and outcome was recorded and analysed. Of 105 confirmed cases of meningococcal disease, 64% had predominantly meningitis, 36% meningococcaemia and meningitis. Meningococcal rash was found in 2% and co-morbidity in 18% of cases. Antibiotics used empirically were benzylpenicillin or ceftriaxone along or in combination. Overall case fatility rate was 34%. Delay in diagnosis, delay of antibiotic administration, older patients and patients with serious concurrent medical problems, were the factors leading to higher than expected mortality rate. Maximum number of patients were Pakistanis [18%] followed by Indians [15%] and Indonesians [12%]. Overall serogrouping was as follows: group A [44], W135 [19], B [1] and untypable [1]. Serogroup W135 appeared more invasive and more fatal. Quadrivalent vaccine ACYW135 is recommended for pilgrims to enter Saudi Arabia and for mass vaccination in local population

Effects of Beta 2 adrenergic agonist [terbutaline], in dogs with acute hyperkalemia

This work was carried out to study the effects of gradually increasing doses of terbutaline [B2 agonist] on canine model of acute hyperkalemia to evaluate the possible use of B2 agonists in the management of acute hyperkalemia. The latter was induced by IV. infusion of Kcl during the whole period of the experiment, 4 hours. Potassium chloride infusion leads to a gradual increase in plasma K+ and no significant change in plasma glucose or arterial Bp. Hyperkalemic ECG changes depend on plasma K+ level ending in marked widening of QRS and large undulated pattern and lastly asystole. Administration of terbutaline IV in gradually increasing doses, and increasing by the same for 5 doses, resulted in dose related decrease of plasma K+ and increase in glucose levels. Also, terbutaline converted ECG changes induced by Kcl loading to sinus rhythm and prevented the ECG changes resulting from continuous Kcl infusion. The effect of terbutaline is mediated through stimulation of B2 receptors, since it is blocked by non selective blockade B1 and B2 [propranolol] and not by selective B1 blockade [atenolol]. So, correction of hyperkalemic ECG changes following terbutaline is a result of a decreased plasma K+ level, which is blocked by propranolol and is not affected by atenolol

Renal changes after co-administration of verapamil with acetyl salicylic acid or diclofenac

The effect of chronic co-administration of verapamil with either acetyl salicylic acid [ASA] or diclofenac were investigated on renal function parameters [serum urea and creatinine] and histopathologic changes that occur in the kidney. Also, urinary prostaglandin PGE2 changes were studied to uncover the possible protective effect of calcium channel blocker upon untoward renal effects of NSAIDs. Although chronic oral administration of verapamil alone increased, PGE2 level in urine of rats, yet, it did not induce any significant change on serum urea, creatinine or renal histopathology