Trend of bacterial meningitis in Bahrain from 1990 to 2013 and effect of introduction of new vaccines

Meningitis is among the 10 commonest infectious causes of death worldwide. This retrospective analysis of reported cases of meningitis in Bahrain aimed to assess the trend in the incidence of bacterial meningitis from 1990 to 2013, before and after the introduction of new vaccines. Of 1455 reported cases of meningitis during the study period 73.1% were viral and 26.9% were bacterial etiology [tuberculous meningitis 8.3%; Streptococcus pneumoniae 4.9%, Haemophiius influenzoe 3.6% and Neisseria meningitidis 1.7%]. There was a peak of meningitis cases in 1995-1996. The incidence of meningitis due to H. influenzae and N. meningitidis showed a marked reduction after the introduction of the corresponding vaccines in 1998 and 2001 respectively, and S. pneumoniae became the predominant organism after Mycobacterium tuberculosis. The changing trend in the etiology of bacterial meningitis points to the need to study vaccination programme modifications, such as pneumococcal vaccine for the adult population, especially high-risk groups

Serum and erythrocyte magnesium levels in patients with myocardial infarction with or without heart failure

Magnesium [Mg] is a mineral that is involved in over 300 reactions in the body. Magnesium is a potent vasodilation, and plays an important role in muscle contraction. It has been early documented that Mg deficiency can precipitate ventricular arrhythmias and treatment with Mg has some anti arrythmic effect. Moreover there is an ample evidence that a significant percentage of patients with IHD suffer from Mg deficiency. The objective of the present study is to measure Mg levels in serum and RBCs of patients with some forms of IHD. The study was conducted in Baghdad hospital and Ibn - Al-Bitar Hospital. The 180 patients with IHD were divided into Two groups. Group one, 80 patients with Ischemic Heart Failure [IHF] [EF<30] aged 65.75 +/- 5.97 year [50 males and 30 females], group two, 100 patients with Muocardial Infarction [MI][EF<50] aged 50.34 +/- 6.36 year [58 males and 42 females]. Serum Mg and RBCs Mg were measured in all patient groups by Atomic Absorption Spectrophotometer. The [mean +/- SD] value of serum and RBCs Mg in patients with both groups Ischemic Heart Disease [IHD] was significantly lower when compared with that of controls [p<0.05].The serum Mg levels [0.81 +/- SD mmol/L] are significantly lower in the IHF group and in MI group [0.96 +/- 0.18 mmol/L] when compared with that of controls [1.00 +/- 0.17 mmol/L] [p<0.001]. The data obtained in present study revealed the decrease of Mg level in serum and RBCs in both patients groups, which affect the contractility of heart muscle and cardiac performance.

Traumatic foreign bodies in the paranasal sinuses

It is a retrospective study in which rare or unusual cases of traumatic foreign bodies in the paranasal sinuses, which exclusively resulted from explosions and violent acts over the last five years, were analyzed and studied. In the presence of security instability and violent acts with explosions and clashes in the unstable areas in Iraq, many casualties including civilians and military subjects are affected. In this review, eight cases of traumatic foreign bodies in the paranasal sinuses were collected and the majority was managed by the author. Six patients were civilians, while 2 were military personals. All patients were males except for one female casualty. The ethmoid sinuses were affected in the majority of cases [5 cases], while the maxillary sinus was affected in 2 patients, and the sphenoid sinus in one patient. Surgical intervention was done in 4 patients, while 4 patients were not operated. This study outlines the presentations, effects, and complications of the foreign bodies in the sinuses, together with a description of the surgical procedure adopted in the operated patients

Electrocardiograph and echocardiograph findings of patients with long standing rheumatoid arthritis in Baghdad teaching hospital

Rheumatoid arthritis [RA] is a systemic autoimmune disease with characteristic feature of persistant inflammatory synovitis in symmetrical distribution; it has a higher incidence of fatal and non-fatal cardiovascular events which account for half of all death in RA patients. To study the cardiac involvement in long standing rheumatoid arthritis patients in comparison to healthy persons by electrocardiograph and echocardiograph. A sample of 100 Iraqi patients with long standing rheumatoid arthritis and 100 healthy individuals who served as control group matched for sex and age were selected after exclusion of risk factors [hypertension, diabetes mellitus, smoking and previous cardiac problems], both groups were studied by electrocardiograph and echocardiograph under supervision of a cardiologist. There were a significant number of patients with rheumatoid arthritis having abnormal electrocardiographic findings 21[21%] in comparison to healthy persons 7[7%] [P-value 0.004], also there were significant number of rheumatoid arthritis patients with abnormal echocardiographic findings 36[36%] in comparison to healthy individuals 11[11%] [P-value 0.000].while there were no significant association between disease duration and type of medications with cardiac abnormalities reported in this study. There is an increase of asymptomatic cardiac structural abnormalities in chronic rheumatoid arthritis patients in comparison to normal healthy individuals as detected by electrocardiograph and echocardiograph

Extent of coronary arteries disease between angiographic findings and some atherogenic lipid in Dices

Modification of lipid subtypes improves the prognosis of ischemic heart disease. Correlating the coronary angiographic finding with the measurement of different plasma lipid parameters. [180] hundred eighty patients admitted in the study, [120] patients were male, [60] patient were female, their age range [29-72 years] were randomly assigned into four groups. Group [1]: Patient with myocardial infarction [STEMI]. Group [2]: Patient with non-STEMI myocardial infarction. Group [3]: Patient with unstable angina. Group [4]: Patient with ischemic cardiomyopathy. The angiographic findings, were classified according to the guidelines of [ACC/AHA] all patients had lipid parameters correlated to their angiographic finding [A, B, C, respectively]. This study showed that there was significantly correlated between the levels of HDL, LDL, triglyceride and the coronary angiographic findings in groups [A, B, C] [0.05, 0.001, 0.001] respective. However the use of Atherogesic index [TG/HDL-c] was highly significant and nave clinical evaluation the severity of extent of coronary artery disease [i.e. the Raton [5.9] in group A, [5.2] in group B, [4.8] croup C]. Using more than one lipid parameter can assess the severity of coronary artery disease

Across-sectional study of brucellosis in patients admitted to baquba to general hospital

Brucellosisls a very common disease in Iraq the manifestations of the disease are different from one persom to the other in which the clinical diagnosis needs a thorugh study and documented precise investigations. To describe selected possible for acquiring brucellosis in Diala governorate and compare the relative frequency of selected clinical features between pediatric and adult age groups. A cross sectional study was done on a sample of 108 patients with an established diagnosis of Brucellosis admitted to Baquba General Hospital during the period extending from May 2001 to June 2003. Males constituted about two thirds of the study sample [65.7%] About a fifty [20.4%] of the study sample were in the pediatric age group [<16 years of age]. Raw milk or unpasteurized cheese and raw liver was among the risky for acquiring the infection reported by 67% and 58% of the study sample respectively. Animal contact [Agricultural activities] was reported by 59.3%. Among pediatric age group, the most frequent clinical features were: Spinal tenderness, abdominal pain, arthralgia, sweating aches lack of energy and arthritis. While among adults: Arthralgia, headache, aches, sweating, lack of energy, spinal tenderness, chills, fever, loss of appetite and arthritis were among the most frequently reported symptoms. Hepatosplenomegally is rarely reported and epididymoorchitis is a frequent complication of brucellosis in children. This result showed a male preponderanc in comparison to female Patients and this probably due to occupational exposure

chlamydia pneumonia an independent risk factor in ischemic heart disease?

Immune system may interplay between Chlamydia pneumoniae infection and ischemic heart disease [IHD].Major histocompatibility genes regulate innate and adaptive immunity. This study was established to shed light on the possible association between ischemic heart disease [IHD] with Chlamydia pneumoniae infection and HLA antigens. Microlymphocytotoxicity assay has been applied for HLA-typing of 150 blood samples of 100 IHD patients and 50 healthy normal controls, In addition enzyme linked immunosorbant assay [ELISA] used to detedct C pnuminiae IgA and IgG. An increased frequency of HLA-A2, B35 alleland HLA-A2-B*35 haplotype was observed for patients group versus control group with P-value [0.0001, 0.05, and 0.001] respectively. This finding demonstrated that the HLA-B35 positive haplotypes confer the C.pneumoniae-related risk for IHD. HLA-DR3,DR4 and DR7 might play a role in AIH susceptibility

Inflammatory markers [interleukin-6 and C- reactive proteins] in patients with type 2 diabetes mellitus and positive family history of ischemic heart disease

Patients with family history of type-2 diabetes and ischemic heart disease [IHD] have an increased risk of developing these diseases in the future. It's currently believed that inflammatory mediators such as Interleukin-6 [IL-6] and C-reactive protein [CRP] play an important role in the pathogenesis of metabolic disorders. This study was conducted to assess the parameters of chronic inflammation in patients with newly diagnosed diabetes and positive family history of ischemic heart disease. The present study included 48 Iraqi patients with a diagnosis of diabetes established since 2003 using the 1999 WHO criteria, 20"of these patients had a family history of ischemic heart disease. The mean age of study participants was 49.4 +/- 10.2 years [ranging from 20 - 68]. Enzyme linked immunosorbant assay [ELISA] used to detect IL-6 and CRP,. while blood sugar and lipid profile were detected using commercially available kits which provided by [BioRad]. It was found that patients with a positive family history of IHD the concentration of IL 6 and CRP were found to be higher while HDL were found to be lower when compared with type 2 diabetic subjects with a negative family history for IHD. This finding demo nstrated that patients with newly diagnosed diabetes and a family history of IHD have increased risk of macroangiopathic complications related to the elevated concentrations of inflammatory markers

Psychiatric disorders in cardiac patients

Psychiatric disorders and coronary heart disease are not uncommonly seen together in the same patient especially in association with myocardial infarction these disorders vary from simple anxiety, depression, posttraumatic stress disorder, adjustment disorder. Studying the depressive disorders in the Iraqi cardiac patients and its prevalence after April 2003 and trying to ascertain any mispractice in management of such patients by ignoring the psychiatric cause. 260 patients admitted to Baghdad teaching hospital medical departments over the period December 2005- October 2007. Those patients were having either stable angina unstable angina and myocardial infraction. A uniform questionnaire was used for all patients to find out the prevalence any psychiatric disorders. This study showed the presence of depression during the pre and post cardiac events in 70 cases [27%] anxiety was also a very common problem in about 60 cases [23%], however the percentage of patients whom were had psychiatric disorders after an acute events due to unsettled security in the country since 2003 were as follow depression [21% cases 8%] from the total number of cases respectively. Psychiatric disorders are becoming a common problem in many Iraqi cardiac patients because of the difficulties of their daily life since 2003 and it represents about 50% of the cases of psychiatrics disorders. This may make it an important issue to use antidepressant drugs in many of those patients

value of using echocardiography in patients of advanced liver disease with cardio pulmonary complications

Patients with chronic liver disease are liable to get cardio - pulmonary complications, one of these complications is development of pulmonary hypertension ranging from mild to it's sever form - this complication could give some abnormal findings in chest x-ray, electrocardiography but more prominently by echocardiography. To clarify the benefit of using the echocardiogram is detecting pulmonary hypertension prior to the use of invasive methods [catheterization] in patients with advanced liver disease. A total of 50 patients with chronic liver diseases [cirrhosis, chronic active hepatitis] their age range is [25-70 years] [mean are 37.07 years], the fifty patients were free from any cardiac or respiratory diseases. The study extending from December 2007-August 2008. All patients went through full history and routine blood test: including complete blood picture, fasting blood sugar, blood urea and screatinne, lipid profile, liver function tests, clinical examination, and investigations included routine blood test, chest x-ray, and electrocardiography, echocardiography [Transthoracie and transoesphageal]. The child-Pugh score used for assessing the severity and prognosis of chronic liver disease and it classified into three groups [A, B, C] used in this study. Fifteen patients from the 50 cases [30%] only proved to have cardio-pulmonary changes [i.e. pulmonary hypertension right ventricular hypertrophy and dilatation with the mean value of >/= 25mm Hg at rest or >/= 30mm Hg during exertion] those patients were having fatigue in [70%] of them while dysponea, chest pain, cyanosis, syncope were detected in 30%, 10%, 1%, 2% respectively in those cases of pulmonary hypertension with chronic liver disease. The use of non invasive methods especially echocardiography were helpful in detecting the presence of pulmonary hypertension in patients with chronic liver disease

efficacy of the particle repositioning maneuver in treating unilateral benign paroxysmal positional vertigo [BPPV]

Epley maneuver is a common procedure in treating benign paroxysmal positional vertigo [BPPV]. This study is carried out to assess the effectiveness and the safety of a modified form of Epley maneuver [The Particle Repositioning Maneuver] in treating unilateral benign paroxysmal positional vertigo [BPPV]. This prospective study was done over one year period [from March 2006 until February 2007]. Fifty seven [57] patients, with age between [26-82] years, complaining of unilateral BPPV randomly allocated into two groups. The first group [28 patients] underwent The Particle Repositioning Maneuver. The second [control] group [29 patients] was treated conservatively with anti-vertigo medication without performing the maneuver. All patients were followed one week after the presentation. In the first group, 24 out of 28 patients had improvement of symptoms and disappearance of nystagmus on immediate post maneuver Dix-Hallpike one week later showed similar results. In the control group, only 11 patients out of 29 had symptoms improved and negative Dix-Hallpike test after one week, with improvement rate of 37.9%, p-value <0.001 which is highly significant in favor of the maneuver group. No complications were reported in the maneuver group. We conclude that this repositioning maneuver is an effective method to treat BPPV

Endoscopic sinus surgery of antrochoanal polyps: one year study of 17 patients

The aim of this prospective case series study is to assess the outcome of endoscopic sinus surgery on antrochoanal polyps in 17 patients over one year period. Seventeen patients with antrochoanal polyps were treated in the department of otorhinolaryngology in al-Jamhoree Mosul teaching Hospital from March 2006 up to February 2007. They had endoscopic transnasal surgery as the method of treatment, and all patients were followed one year postoperatively. Only one pediatric patient had recurrent polyp after 6 months and was subjected to another surgery which was complicated by temporary epiphora. Another patient had adhesions, otherwise all patients had improvement of symptoms, and frequent follow ups over one year showed no recurrence. No major complications were reported in any patient. The endoscopic transnasal surgery of antrochoanal polyp is a minimally invasive technique which is both effective and safe

Insight on the side effects of lipid lowering agents [Statin] in Iraqi patients with ischemic heart diseases

3-hydroxy-3 methyl glutaryl co enzyme inhibitor [MMG-COA] [statin] is a very common drug used in many medical conditions regardless of the presence or absence of dyslipidemia. One of these conditions is the cardiac disorders. Throwing a light on the prevalence of their side effects in Iraqi patients. Two hundred seventy patients with ischemic heart disease from the period of November 2006-November 2007 referred to Baghdad teaching hospital [the medical city]. Those cases were using statin and grouped into two groups. Group A: patients admitted with acute coronary syndrome [myocardial infarction and unstable angina] [230 patients 77%]. Group B: patients with associated risk factors [Hypertension, diabetes mellitus, smoking and secondary lipidemia] 40 cases 23%, have history of ischemic heart disease on treatment they use the drug in range of [10-40] daily with review monthly for the side effects. All 270 cases were free from other organic disorders [i.e. renal, thyroid, malignancy, or any longstanding disease]. All patients went through a questionnaire which includes: age, gender, risk factors [Hypertension, diabetes mellitus, smoking, and lipidemia], routine blood tests, lipid profile, liver function tests, C-reactive proteins, thyroid function tests, chest X-ray, electrocardiography and echocardiography done for all patients, all patients used to take drugs in the range of 10-40mg daily for at least one year. The side effects noticed in this study were gastric, musculoskeletal, elevated liver enzymes [40%, 28.9%, and 1% respectively from the total number of patients]. Other side effects in other systems like skin, respiratory, and cardiac were not encountered. This study showed that the side effects of statin were not involving all the body systems

Detection of TEM, SHV and PER type extended-spectrum B-Lactamase genes among clinical strains of pseudomonas aemginosa isolated from burnt patients at Shafa-Hospital, Kerman, Iran

This study was carried out to evaluate the existence of the TEM, SHY and PER ESBL genes in ESBL producing strains of Pseudomonas aeruginosa isolated from burnt patients at Shafa-hospital, Kennan, Iran. A total of 120 strains of P. aeruginosa were isolated from 245 patients in burn unit of Shafa-hospital during January 2006 to December 2007. MIC of antibiotics was measured using agar dilution test ESBL producing strains were detected by double-disc synergy method containing amoxicillin and amoxicillin+clavulanic acid and phenotypic confirmatory test. All the clinical isolates resistant to imipenem [IMP] were screened for the production of MBL by E-test with IMP/IMP+EDTA strips. PCR and multiplex-PCR performed for the detection of different types of ESBL producing genes in ESBL positive isolates. Of 120 the isolates, 3-5% showed MIC greater than 16 mg/ml to IMP and meropenem, 66% showed MIC greater than 32 mg/ml to ceftazidime, 42% to azteronam and 60% of the isolates showed MIC greater than 64 mg/ml to cefotaxime, 41 [34%] contlnned as ESBL producers. Not any isolate could produce MBL [pœ0.05]. The PCR assay of all ESBL producing isolates revealed that 6.6%, 4.1% and 2.5% of them were positive for SHY, PER and TEM genes, respectively. Many ESBL producing strains of P. aeruginosa isolated from patients in burn unit of Shafa-hospital. However, none could produce MBL enzyme. The genes among ESBL producing strains were SHY, PER as well as TEM type of b-lacatamases

Interpretation of clinical, radiological, electrocardiographic and echocanliographic findings in pulmonary hypertension

10 make correlation between clinical radiological electrocardiographic and echocardiographic finding in cases of Pulmonary Hypertension. 140 patients referred to the medical departments, Haghdad Teaching Hospital [90 of them admitted in this study were as follow]; [52 [47%] cases having Ischemic heart disease, 28 [25%] cases having C.O.P.D., 10 [9%] cases having connective tissue diseases, 9 [8%] eases of Rheumatoid Arthritis, 1 case S.L.E.]. The remaining 50 cases were excluded from the study because they have another chronic disorder like Diabetus mellitus, Renal failure, Malignancy, Skeletal deformity. Forty normal volunteers were admitted in this study both groups were assessed clinically, radiologically, electrocardiographically, echoeardiographically plus the routine blood tests including F.B.S, B. urea, lipid profile. 90 cases of patients admitted in this study showed variable findings the prominent finding was loud pulmonary sound "p2" in 100% of cases, 19.6% of cases showed cardiomegaly, 33% prominent pulmonary marking, 11.4% percardial effusion, 28% Right Ventricular Hypertrophy. It is not necessary to find all the clinical, radiological, electrocardiographic and the echocardiographic changes in any patient with pulmonary hypertention>30 mm Hg

echocardiographic abnormalities in 52 Iraqi patients with rheumatoid arithritis

To study the prevalence of echocardiographic findings in unselected population of patients with rheumatoid arthritis [RA] Fifty two RA patients and fifty two normal healthy people assessed clinically, Echo Cardiografically, ECG, pulmonary function tests and laboratory investigations. Two-dimensional echocardiography demonstrated significant cardiac disease in [59%] of patients in form of right ventricular dilatation [25%], left ventricular dilatation [11.5%], left atrial dilatation [3.8%], mitral valve abnormalities [11.5%] [M.V. regurgitation, M.V. thickening, M.V. prolapsed, M.V. stenosis], septal hypertrophy [5.8%], diastolic pressure dysfunction[5.8%], thick aortic calcified cusps [3.8%], aortic regurgitation[5.8%], mild pericardial effusion[13.5%], tricuspid Regurgitation [11.5%] and raised pulmonary artery pressure above 30 mmHg [3.8%].The normal healthy people had only two people one had M.V. regurgitation and the other had mild M.V. prolapse and there were no other abnormalities in [ECG] of [PFT]. Wide and frequent varieties of echocardiographic cardiac abnormalities were found in an unselected population of patients with RA, using Doppler echocardiography giving different grades of severity of cardiac manifestation

Titrated cyclocryopexy - a report on long term results

To determine the efficacy and safety of a titrated cyclocryopexy in advanced glaucomatous eyes in term of intraocular pressure control and complications. Retrospective Cohort analysis of a titrated cyclocryopexy in 30 eyes of 25 patients with uncontrolled glaucoma during July 1996 to July 2003 at Hayatabad Medical Complex, Peshawar. Inclusion criteria applied was; patients having uncontrolled IOP with maximum medical therapy, previous trabeculectomy and a minimum follow-up of 2 years. All patients were assessed for glaucoma. Numbers of cryoapplications were determined according to the IOP. Four to 12 applications in one sitting were used. Repeat cryoapplication were applied at least after six-weeks of previous therapy if IOP was not controlled. A total of 30 eyes of 25 patients were studied. IOP control of less than 21 mm Hg was achieved in 83% of the eyes. Mean IOP was reduced from 29 ' 4.96 pre-op to 17 ' 7.36 at two years follow-up. Forty percent of the eyes ne eded single session, 40% received 2 sessions and other 20% needed sessions. All the patients lost at least one line of Snellen chart at 2 years follow-up, 70% retained useful vision, 20% retained light perception and 10% lost perception of light. Serious complications included phthisis, persistent vitreous hemorrhage with retinal detachment, and total retinal detachment and persistent vitreous hemorrhage in 1 eye each. Cyclocryopexy appears to be an effective procedure in cases of advanced glaucoma with an acceptable risk / benefit ratio. If done in a titrated manner the number of complications are reduced in severity

Transurethral incision of prostate as treatment of benign prostatic hypertrophy

To evaluate efficacy of transurethral incision of prostate [TUIP] as a treatment modality for BPH. During the period between May 1999 and April 2004 all patients with LUTS and prostates of less than 30 grams underwent transurethral incision of prostate. The operative course, early and long term complications were recorded till six months of follow up. A total of 85 patients were operated during the study period with the mean age of 56 years and average operating time of 22.5 minutes. Most patients [n=84] were discharged within 2 to 5 postoperative days. Early postoperative complications included hemorrhage requiring blood transfusion in two patients, clot retention in two patients and failure to void after catheter removal in two patients, which needed transurethral resection of prostate in the same admission. Seventy-eight patients reported improvement in symptoms while two patients reported no relief in symptoms. None of the patients reported worsening of symptoms or incontinence. Out of 58 sexually active men, 42 reported retrograde ejaculation and 8 patients suffered decreased ejaculate. Two patients reported erectile dysfunction. TUIP in prostates of less than 30 grams causing lower urinary tract symptoms is an effective and reliable procedure for young, sexually active men