Features associated with severe disease in hospitalized children with 2009 influenza A [H1N1] infection at a university hospital in Riyadh, Saudi Arabia

In 2009, pandemic H1N1 influenza A caused significant morbidity and mortality worldwide; however, available data on disease characteristics and outcome of hospitalized children is limited. A prospective cohort study of children who required hospitalization because of the influenza A [H1N1] infection at King Khalid University Hospital in Riyadh, Saudi Arabia, over 6 months [July- December, 2009]. Data was collected using a predesigned form for all admitted pediatric cases [0-12 years] presenting with the influenza-like illness and who tested positive for the novel influenza [H1N1] using reverse transcriptase polymerase chain reaction assay. The clinical course and features associated with the severe disease among such children were described. Out of 1103 children with the influenza-like illness, 375 [34%] were confirmed pediatric cases of influenza A [H1N1], of whom 50 [13.3%] required hospitalization. The median age was 3 years [range, 1 month-12 years]. Fever was the most frequent symptom [94%] at admission, followed by cough [86%] and other symptoms including vomiting and diarrhea. The majority [70%] of children had at least one underlying medical condition, with bronchial asthma being the most common [40%]. All cases were treated with oseltamivir. Five children [10%] were admitted to the ICU, 4 required mechanical ventilation, and 2 died [4%].The majority of children with 2009 H1N1 influenza A-associated hospitalization in this series had an uncomplicated course. Respiratory complications and ICU admissions were more frequent in those with underlying disease, especially asthma and neuromuscular diseases. Efforts need to be focused prior to each influenza season and special emphasis needs to be given to children by immunizing them with H1N1 influenza A vaccination to avoid severe disease and minimize complications

Heavy metals removal from synthetic wastewater by a novel nano-size composite adsorbent

The effects of varying operating conditions on metals removal from aqueous solution using a novel nano-size composite adsorbent are reported in this paper. Characterization of the composite adsorbent material showed successful production of carbon nanotubes on granular activated carbon using 1% nickel as catalyst. In the laboratory adsorption experiment, initial mixed metals concentration of 2.0 mg/L Cu[2+], 1.5 mg/L Pb[2+] and 0.8 mg/L Ni[2+] were synthesized based on metals concentration from samples collected from a semiconductor industry effluent. The effects of operation conditions on metals removal using composite adsorbent were investigated. Experimental conditions resulting in optimal metals adsorption were observed at pH 5, 1 g/L dosage and 60 min contact time. It was noted that the percentage of metals removal at the equilibrium condition varied for each metal, with lead recording 99%, copper 61% and nickel 20%, giving metal affinity trend of Pb[2+] > Cu[2+] > Ni[2+] on the adsorbent. Langmuir's adsorption isotherm model gave a higher R[2] value of 0.93, 0.89 and 0.986 for copper, nickel and lead, respectively, over that of Freundlich model during the adsorption process of the three metals in matrix solution

place of transvaginal color and pulsed Doppler sonography in the diagnosis of benign and malignant endometrial pathology in patients with post menopausal bleeding

Transvaginal color Doppler ultrasound [TVCDUS] may play significant role in diagnosis of endometrial pathology particulary endometrial carcinoma in women with postmenopausal bleeding [PMB]. Increasing experience in this field may help many women to overcome long waiting lists for surgery. In [65] women with postmenopausal bleeding we measured endometrial thickness [ET] [double layer] considering [8] mm as cut-off point to differentiate between benign and malignant endometrial lesions. We also looked for homogenicity, regularity of endometrium and integrity of sub endometrialhalo. [TVCDUS] was used to asses the vascularity, and vascular density of endometrium, myometrium and endometrial tumor. Resistance index [RI] and peak systolic velocity [PS] were also measured for endometrial, myometrial and uterine arteries. Correlation between [TVCDUS] and results of histopathology of endometrial specimens [24 hysterectomy and 41 D and C] was done. [ET] of [8] mm was found to be predictive for endometrial carcinoma with sensitivity of 100% and visualization rate of endometrial flow was significantly higher in case of carcinoma versus benign conditions of endometrium. Vascular density was significantly higher in case of carcinoma. [RI] of [0.42] was considered as cut-off point to differentiate between benign and malignant lesions with sensitivity of [80%]. [PI/ ] for myometrial and uterine arteries were not significantly different between cancer and benign conditions. TVCDUS has an important role in diagnosis of endometrial carcinoma especially in high risk group of women. Intra-tumoral blood flow is more sensitive marker of carcinoma than uterine blood flow. Adopting this method with increasing experience may result with considerable saving of both potential and economic costs

Nosocomial diarrhoea in relation to sanitation state: a study in Tikrit, Iraq

A cross-sectional hospital-based study of 259 children aged < 5 years was carried out in Tikrit, Iraq, to identify the prevalence of nosocomial diarrhoea and sources of contamination in the ward environment. Nosocomial diarrhoea was diagnosed in 84 children [32.4%]. Children with diarrhoea were more likely than unaffected children to be bottle-fed, given unboiled water, to have unclean food containers and contaminated bed sheets. Three out of 5 brands of formula milk [unopened cans] were contaminated. Three-quarters of medical staff and employees had contaminated hands. Enterobacter spp., Pseudomonas aeruginosa and Citrobacter spp. were the most commonly identified microorganisms. A greater emphasis on personal hygiene, improved care practices and promotion of breastfeeding is recommended

Embedded esophageal foreign body. A diagnostic challenge

Esophageal foreign body [EFB] ingestion is of ubiquitous occurrence in pediatric population. Diagnosis and precise localization of non-radio opaque FB poses considerable challenge. Delayed presentation, poor history, and inconclusive esophagoscopic findings often lead to diagnostic delay. Multidetector computed tomography [MDCT] could be a great option in these situations. We present a case of EFB in a child who presented with failure to thrive, had negative fibreoptic endoscopy, ultimately diagnosed conclusively on MDCT examination

Prevalence and correlates of conduct disorder among inmates of juvenile detention centres, United Arab Emirates

The prevalence of conduct disorder was assessed in 77 young people in 4 juvenile detention centres in the United Arab Emirates [UAE]. The prevalence of conduct disorder was 24.7%, and recidivism, as indicated by repeat admissions to the centres, was found to be associated with conduct disorder. Having a diagnosis of conduct disorder was associated with a lower educational and occupational level of the father, as well as living with a single parent or relatives. Among UAE nationals, conduct disorder was also associated with having a mother who was a non-UAE national

Value of tissue Doppler echocardiography in assessing left ventricular diastolic dysfunction

Objective: to assess the value of the tissue Doppler echocardiography [TDE] in diagnosing left ventricular diastolic dysfunction [LVDD], especially in the existence of pseudo normalization of the A/E ratio and isovolumic relaxation time [IVRT]

Methods: fifty-two patients from the outpatient cardiology clinic of A1 Mouassat Hospital were studied by echocardiography between February and July 2003. They were divided into two groups. The first, Group A, contained 28 patients with a history of uncontrolled systemic hypertension for more than six months, aortic valve stenosis, or ischemic heart disease proven by angiography. All these patients had at least one of the following echocardiographic signs suggesting LVDD: ME L 2, IVRT>90 ms, concentric left ventricular hypertrophy, or enlargement of the AC reversed wave of the pulmonary vein flow spectrum. The second, Group B, contained 24 patients [less than 40 years old]. None of this group had any sign of LVDD either by echocardiography or clinically. All the patients had echocardiography with the following measurements: LA diameter, Aortic root diameter [AoD], E wave, A wave, ME ratio. The E wave of the mitral valve annulus [Ea] and the A wave of the mitral valve annulus [Aa] were both measured by TDE, and AdEa ratio was calculate in all patients

Results: the AdEa ratio was higher than one in all patients of Group A, even in those cases with pseudo normalization of the ME ratio measured by traditional Doppler. The Aa/Ea ratio was less than one in all patients of Group B

Conclusion: these results strongly support the usefulness of TDE of the mitral valve annulus in diagnosing LVDD even when there is pseudo normalization of the ME ratio measured by traditional Doppler

Neonatal and childhood bacterial meningitis at Saddam general hospital in Tikrit

A prospective study of the infants and children bacterial meningitis cases admitted to Saddam General Hospital [SGH] during the Spring of 1995 covering 87 patients where analyzed. Data were collected by a researcher filled, 23 relevant variables questionnaire, in addition to clinical findings and laboratory investigations. The peak incidence was in the 3 months to two years of age group, comprising 50% of the total cases. These patients were admitted to the hospital after showing signs and symptoms at times from one day to one month. The majority of cases [48%] were admitted within 1-5 days. The main etiological agents were H. influenzae, Streptococci, N. meningitidis, E. Coli, and Pneumococci. There were 28% of non responsive patients and four mortality cases and five cases with neurological sequalae. The factors influencing the disease and the treatment outcome are discussed

Pulmonary function of smokers in an air polluted environment

The relation of smoking and air pollution impact on pulmonary function was studied in a cohort of 158 persons. Subjects from three different departments in the Baiji oil refinery complex were examined. A control group from the staff members of the medical college of Tikrit university were also selected randomly. Anthropometric, health status, and environmental information were collected about each subject. A researcher filled, twenty two relevant variable questionnaire was designed to obtain maximum necessary data. The results indicated that statistically significant changes in PEFR readings were among smokers in the air polluted area. However, there might be synergistic effect of cigarette smoking and industrial air pollution. Non measurable obstructive changes might be present in the exposed nonsmokers, but are detectable by PEFR

Appendicitis at Saddam General Hospital in Tikrit

Fourty one cases of appendectomy were studied. The cross-sectional study used an interviewer questionnaire which was precoded and designed to obtain relevant data; in addition to bacteriological and histopathological examinations. Appendicitis was common among age group [15-20] years of age. Abdominal pain was the chief complain of all cases. Other associated symptoms, were in decreased order of frequency, general malaise, nausea, loss of appetite, low fever, vomiting, high fever, diarrhea, and constipation. Acutely inflamed appendix was the commonest gross pathological observation and was commonly of the obstructive type. Histopathological findings included: Acute inflammation, lymphoid hyperplasia, gangrene, or chronic inflammation. The microbiological findings were in order of frequency of isolation: E. coli, Kelbsiella, Staphylococci, and Bacteroids

Respiratory affections among employees of two industrial plants

In an attempt to evaluate the effect of air pollution on the prevalence of respiratory disease this study was conducted. The health records of the employees of two Iraqi factories was reviewed for the years 1992 and 1993 for respiratory affections. A total of 685 records were selected randomly from the health records of Baiji oil refinery employees. In addition to 471 health records of the plastic sacks factory. The respiratory affections were classified into 11 disease categories. The results shows that the respiratory affections of Baiji production employees were 22% and 14% during 1992 and 1993 respectively. Compared to 21% and 20% during the same years of the plastic sacks factory employees. The management employees respiratory affections of Baiji refinery were 36% and 32% during the same period of time. While the same affections for the plastic sacks factory employees were 7% and 8% for 1992 and 1993 respectively

Granulosa cell tumour a clinico pathologic study

19 granulosa cell tumour [GCT] were reviewed and re-evaluated clinically and histologically. The age range between 18-53 years. Patients were divided into two age groups. They young age group [younger than 40 years] which Consisted of eight patients, and the old age group [older than 40] which consisted of eleven patients. The usual clinical presentation of those patients was generally vaginal bleeding in the older age group, or-post-menopausal bleeding, and/or abdominal mass. while the young age group presented with amenorrhea, vaginal bleeding and abdominal mass in order of frequency. Juvenile G C T. has distinctive clinical and pathological subtype and is associated with better prognosis. The operative and histologica findings are of great importance in the assessment of the outcome. Patients with juvenile G.C.T. carry better outcome even with the presence of cytological atypia and mitotic divisions. The operative finding of a tumour that invades the surface of the ovary with Local and omental metastasis needs more aggressive treatment. Since a large group of our patients are of the child bearing age, the critical decision of treatment for young women with stage la disease [whether conservative or to chose more radical treatment] is the responsibility of both the pathologist and the clinician

Long-term cytologic follow-up studies of copper intrauterine contraceptive device users

Cytologic evaluation in the form of multiple follow-up studies was carried out in [210] women using Copper IUCD for a period ranging from 18-72 months. Age of those women ranged from 21-42 years. Pre-insertion smears were available for nearly half of them. The main encountered cytologic abnormalities included squamous metaplasia [70.5%] endocervial cell proliferation and repair [59%], abnormal endometrial cell shedding [24%] and dysplais: [9.5%]. While the former two lesions showed a significant association with loop insertion, the rate of dysplasia did not reveal any significant change during the six-month period of follow up. The results of the present work, therefore, support the observation noted by other major studies that there is no significant enhancement of cervical cytologic neoplasia from up to six years of using IUCD

Comparative study: laparoscopic hormonal and cytological assessment of ovulation

To assess ovarian function in forty nine infertile women seen and managed at Saddam Medical City Teaching Hospital where laproscopy, hormonal and cytological studies were performed. Serial vaginal sears and 24-hours urine collection were arranged weekly for 4-8 weeks for cytological and hormonal study regarding ovarian function. Results revealed; congenital adrenogenital syndrome was noted in 4%. Stein-Leventhal syndrome in 25%, ovarian hypofunction with apparently normal looking ovarian in 18%, ovarian failure 14%, and groups leuteum insufficiency in 8% while the rest of 31% had normal ovulation

Prevalence of acne amony secondary school students

This is a cross-sectional, case-control study of the secondary school students in Tikrit in 1994. A random sample of 630 students were studied. The results have revealed a prevalence rate of 14% with female to male ratio of 2:1. Most of the students with acne were in the 15-18 years age group. More than one half of the cases were from the middle class families. Fat rich and spicy diet preference among cases were 35% and 29% respectively. Students with emotional stress formed 33% of the cases while 67% of cases reported positive family history. Most of the cases have greasy skin while 51% of the female cases suffered, in addition, of menstrual irregularity. The lesion in 62% of cases were located on the face, the rest of them were located on the face in addition to other body localities

Parasitic infection among primary school children in Tikrit city

A survey of the prevalent parasitic infection in school children in Tikrit city was conducted in 1992. A cross-section, multistage, random sample size of 440 primary school children was selected. The prevalence of infection was 19.8%. Seven different species of parasites were diagnosed. Hymenolipes nana ranked first [35.3%], then followed by Entamoeba histolytica [23.3%], and Giardia lamblia [16.8%]. The relationship between sex, age group, socioeconomic status, parents educational level and other factors were also studied

importance of cytological study of cervical smears

Cervical smears stained by papanicolou technique were examined in 1000 patients referred from the Gynaecology outpatient Department in the Medical City Teaching Hospital Inflammatory cells were found in 615[61.5%] patients, different grades of dysplasis in 169 [16.9%] patients, malignant cells in 11 [1.1%] patients; whereas no abnormal cells were found in 205 [20.5%] patients. Routine pap smear can be performed to detect high risk group of patients for further detailed diagnostic means of cervical cancer