Pattern of upper respiratory tract infections and physicians' antibiotic prescribing practices in Bahrain

To evaluate the pattern of antibiotic prescriptions for paediatric upper respiratory tract infections [URTI] and determine the associated predictors for such antibiotic use in the Kingdom of Bahrain. From March 2005 to March 2006, demographic data, clinical presentation, investigations and antibiotic prescription for children with URTI [n = 184] at the Bahrain Defence Force Hospital was recorded. To assess the factors which influence physician antibiotic prescription for URTI, a cross-sectional survey of doctors was carried out using a pre-tested questionnaire which was administered to paediatricians, general practitioners and emergency room physicians. Antibiotics were given to 95 of the 184 [51.6%] patients, mainly children <3 years [40/95]. Significant association was demonstrated for antibiotic prescription, age and diagnosis of tonsillitis or acute otitis media [p < 0.05]. Amoxicillin [37/95] was the most frequently prescribed antibiotic, followed by -lactam/-lactamase combination and second-generation cephalosporins. Fever, younger age, sore throat and presence of earache increased the likelihood of antibiotic prescription. Data from the cross-sectional survey of doctors revealed that lack of national guidelines, parental pressure and diagnostic uncertainty contributed to antibiotic overuse. Antibiotic overuse for the treatment of paediatric URTI remains a problem in our setting. We suggest the development of national guidelines which are integrated with structured continuing medical education courses, public awareness campaigns and the introduction of rapid streptococcal antigen tests in the outpatient clinic

Relapsing polychondritis in an elderly male.

A 65 years patient presented with left ear swelling, swelling of the nasal bridge with congestion of the eyes. Clinically there was evidence of left auricular chondritis, nasal chondritis and conjunctivitis with a history of multiple similar episodes in the past, features suggestive of relapsing polychondritis. The patient improved with oral prednisolone.

Study of a possible role of neutrophil chemotactic cytokine [IL-8] in the development of diabetic nephropathy

Aim: The aim of the study was to evaluate the role of interleukin-8 in the development of diabetic nephropathy and its correlation with metabolic contol and pathological stages of diabetic nephropathy. Subjects and Twenty patients with diabetic nephropathy [group I] and twenty control subjects [group II] were included. Of the subjects with diabetic nephropathy, 7 had grade I nephropathy [mild mesangial proliferation]. 5 had grade II [moderate mesangial proliferation] and 8 had grade III [severe mesangial proliferation]. Serum and urinary IL-8 were measured by enzyme-linked immunosorbant assay. Detectable levels of IL-8 were found in the urine and serum of subjects with vairous stages of diabetic nephropathy. In the control subjects, neither serum nor urine IL-8 were detectd. The serum concentrations of IL-8 were higher in subjects with severe than those with mild or moderate mesangial proliferation, i.e. it increases with the progression of diabetic renal disease. Urinary IL-8 concentrations were significantly higher in diabetic subjects with moderate mesangial proliferation than in those with mild or severe mesangial proliferation. There was a positive correlation between serum IL-8 and the urinary IL-8 and proteinuria. Conclusions: These data suggest that the elevated serum and urinary IL-8 in diabetic nephropathy patients offers an additional explanation for the long sought role of several cytokines in the development of diabetic renal disease. Also, IL-8 in the urine could be used as a predictor of diabetic nephropathy

The foam mattress-back syndrome.

BACKGROUND: Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms. OBJECTIVE: To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital. METHODS: One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed. RESULTS: Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattresses, only to recur after sleeping again on the foam mattress in the hospital/hostel. CONCLUSION: Sleeping on foam mattress is associated with the appearance of backache in medical residents which is reproducible and gets relieved after using regular cotton mattresses.

Hypocomplementemic urticarial vasculitis and lower cranial nerve palsies.

A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.

Mepacrine therapy in niclosamide resistant taeniasis.

OBJECTIVE: To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. METHODS: Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. RESULTS: Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. CONCLUSION: We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated drug for the treatment of niclosamide resistant Taenia saginata infestations.

Assessment of anti-inflamatory and analgesic activities on the co-administration of acetyl salicytic acid and diclofenac sodium [voltaren] in adjuvent-arthritic rats

The effects of interaction between acetyl salicylic acid [300 mg/ kgm/day orally for 2 weeks] and diclofenac [25 mg/kgm/day orally for 2 weeks] were studied in albino rate rendered arthritic by intradermal injection of mycobacterium butyricum. The fluorimetric estimation of plasma cortisol level showed significant elevation following acetyl salicylic acid administration and also following combined diclofenac and acetyl salicylic acid administration but to a less extent, while ibuprofen alone failed to produce any significant change. Analgesic activity was assessed by analgesymeter test. Acetyl salicylic acid and Diclofenac given separately or concurrently produced a highly significant analgesic action which did not differ statistically in various groups. Anti-inflammatory activity was assessed by the paw oedema test, the anti-inflammatory action of diclofenac was statistically more marked than that of acetyl salicylic acid, but was more or less similar to the effect of concurrent drug administration. It could be concluded that the analgesic action of combined acetyl salicylic acid and diclofenac administration was not superior to either drug when given alone, and the anti-inflammatory action of combined aministration did not differ from that of diclofenac alone, thus one could suggest that, this form of combined drug therapy has no advantage over ibuprofen alone