Partially treated bacterial meningitis among children in Al-Anbar governorate

Partially treated bacterial meningitis is an important clinical entity to be aware of particularly in an environment of empirical prescription of antibiotics, as it may delay the child's presentation to hospital and alter the cerebrospinal fluid findings. To find out the effect of partial antibiotic treatment on the clinical presentation and laboratory findings among children with bacterial meningitis in Al-Anbar governorate. The medical records of fifty children with bacterial meningitis that were admitted to Al-Ramadi Maternity and Children hospital during the period 1[st] February 2000 till 31[st] January 2002, were reviewed retrospectively the patients were divided into untreated group and partially treated group. Partial antibiotic treatment in children with bacterial meningitis had no significant effect on the presenting signs and symptoms, cerebrospinal fluid cell count, protein, and glucose, when compared to the untreated group, while cerebrospinal fluid culture showed significant difference between untreated group 24/24 [100%] and partially treated group 11/26 [42.3%]. P<0.05. Among the different available diagnostic tests, cerebrospinal fluid enzyme linked immunosorbent assay had the best yield in both untreated group [90.9%] and the partially treated group [95.8%]. Partial antibiotic treatment in bacterial meningitis among children does not mask the clinical features nor significantly changes the cerebrospinal fluid cell count, protein, glucose, and bacterial antigen detection by immunoassay, however, it has a significant effect on the positive yield of cerebrospinal fluid culture

Iron deficiency anemia: the utility of upper gastrointestinal endoscopy and histopathohgy

Occult blood loss must be considered as a possible cause in every case of iron deficiency anemia. To evaluate upper gastrointestinal endoscopy in finding a potential cause for iron deficiency anemia among children in Al-Anbar governorate. Twenty five children aged 2-14 years, referred to the gastroenterology unit in Al-Ramadi General Hospital for upper gastrointestinal endoscopy had iron deficiency anemia. Fiberoptic endoscopy was used under general anesthesia and endoscopic tissue biopsies were taken from 22 patients for histopathological examination. The main presenting signs and symptoms were pallor, abdominal pain, and stunting. The upper gastrointestinal endoscopy showed thinning of duodenal folds and serrated mucosa in 8 [32%], duodenal ulcer in 3 [12%], esophageal varices in 1 [4%], nodular gastritis in 1 [4%], and reflux esophagitis in 1 [4%], with a yield rate of 56%. While tissue biopsies revealed histopathological findings suggestive of celiac disease in 12 [48%], Giardia lamblia in 2 [8%], Helicobacter pylori gastritis in 1 [4%], and esophagitis in 1 [4%]. There was a significant association between the endoscopic finding of thinning of duodenal folds and serrated mucosa and the histopathological finding suggestive of celiac disease, P<0.05. Iron deficiency anemia in children 2-14 years of age warrants upper gastrointestinal endoscopy to find potentially treatable causes for the iron deficiency anemia