Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis.

Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

Learning from defects using a comprehensive management system for incident reports in critical care.

Incident reporting systems are often used without a structured review process, limiting their utility to learn from defects and compromising their impact on improving the healthcare system. The objective of this study is to describe the experience of implementing a Comprehensive Management System (CMS) for incident reports in the ICU. A physician-led multidisciplinary Incident Report Committee was created to review, analyse and manage the department incident reports. New protocols, policies and procedures, and other patient safety interventions were developed as a result. Information was disseminated to staff through multiple avenues. We compared the pre- and post-intervention periods for the impact on the number of incident reports, level of harm, time needed to close reports and reporting individuals. A total of 1719 incidents were studied. ICU-related incident reports increased from 20 to 36 incidents per 1000 patient days (P=0.01). After implementing the CMS, there was an increase in reporting 'no harm' from 14.2 to 28.1 incidents per 1000 patient days (P<0.001). There was a significant decrease in the time needed to close incident report after implementing the CMS (median of 70 days [Q1-Q3: 26-212] versus 13 days [Q1-Q3: 6-25, P<0.001]). A physician-led multidisciplinary CMS resulted in significant improvement in the output of the incident reporting system. This may be important to enhance the effectiveness of incident reporting systems in highlighting system defects, increasing learning opportunities and improving patient safety.

Knowledge about the Scottish Mental Health Act in a general hospital setting.

BACKGROUND: Clinical experience suggests that non-psychiatrists' knowledge of mental health legislation in relation to emergency detention is inadequate. However, most non-psychiatrists will use this legislation at some point in their career. METHODOLOGY: A questionnaire about emergency detention legislation was circulated to non-psychiatric medical staff to test their knowledge of the provisions relevant to the general hospital. RESULTS: Two hundred and seventy four medical staff replied (a response rate of 82%). Results showed that an understanding of detention procedures and applicability were markedly deficient, irrespective of grade, specialty or experience. CONCLUSION: The results indicate a need for increased education and awareness about emergency detention legislation especially in view of the implementation of the Mental Health (Scotland) Act (2003).

External quality control of Mycobacterium tuberculosis drug susceptibility testing: results of two rounds in endemic countries.

SETTING: Quality assurance for the World Health Organization (WHO)/International Union Against Tuberculosis and Lung Disease (The Union) global tuberculosis (TB) drug resistance surveillance programme. OBJECTIVE: To monitor the quality of drug susceptibility testing (DST) in different countries. METHODS: In 2002-2003 and 2005-2006, 20 Mycobacterium tuberculosis strains were sent by the WHO/Union Supranational Reference Laboratory of Rome to TB reference laboratories in Albania, Bahrain, Kosovo, Mozambique, Oman, Qatar and Turkey for external quality control (EQC). RESULTS: In 2002-2003, the specificity, sensitivity, efficiency, reproducibility and predictive values for resistance/susceptibility were >or=90% for streptomycin (SM), isoniazid (INH) and ethambutol (EMB). In 2005-2006, all statistical values were >or=96% for SM, INH, rifampicin and EMB. CONCLUSION: EQC improved the quality of M. tuberculosis DST in the participating countries.

The effects of a neuregulin 1 variant on white matter density and integrity.

Theories of abnormal anatomical and functional connectivity in schizophrenia and bipolar disorder are supported by evidence from functional magnetic resonance imaging (MRI), structural MRI and diffusion tensor imaging (DTI). The presence of similar abnormalities in unaffected relatives suggests such disconnectivity is genetically mediated, albeit through unspecified loci. Neuregulin 1 (NRG1) is a psychosis susceptibility gene with effects on neuronal migration, axon guidance and myelination that could potentially explain these findings. In the current study, unaffected subjects were genotyped at the NRG1 single nucleotide polymorphism (SNP) rs6994992 (SNP8NRG243177) locus, previously associated with increased risk for psychosis, and the effect of genetic variation at this locus on white matter density (T(1)-weighted MRI) and integrity (DTI) was ascertained. Subjects with the risk-associated TT genotype had reduced white matter density in the anterior limb of the internal capsule and evidence of reduced structural connectivity in the same region using DTI. We therefore provide the first imaging evidence that genetic variation in NRG1 is associated with reduced white matter density and integrity in human subjects. This finding is discussed in the context of NRG1 effects on neuronal migration, axon guidance and myelination.

National study on the prevalence of iodine deficiency disorders among schoolchildren 8-12 years of age in Bahrain.

A cross-sectional survey of primary-school children in Bahrain was conducted to estimate the prevalence of goitre and iodine deficiency according to age, sex and area of residence. During January-May 1999, 1600 children were randomly chosen from all government schools. Children were examined for goitre and of those, 50% were randomly selected for urinary iodine level assessment. Only 26 children (1.7%) had goitre. Although median urinary iodine was above 100 microg/L, 121 of 749 children (16.2%) had low urinary iodine levels. Although iodine deficiency does not pose a significant public health problem in Bahrain, education about the nutritional value of iodized salts in the prevention of this disorder could increase public awareness.

Rapid diagnosis of Mycobacterium tuberculosis by multiplex polymerase chain reaction from clinical specimens.

An essential element in the control of tuberculosis is the rapid, sensitive and specific identification of the causative agent. Until now, screening and diagnosis are largely based on clinical signs, radiological examination, tuberculin tests, sputum examination under the microscope, or culture for mycobacteria. Tuberculin tests lack specificity and only give an indication of previous exposure to mycobacteria. Direct microscopic examination of sputum is neither specific nor sensitive enough, and mycobacterial isolation is time-consuming. As an alternative to these classical methods, new nucleic acid-based technologies show promise as a more rapid, sensitive, and specific means of identification of mycobacteria. Two commercial standardized nucleic acid-based amplification techniques have been reported to yield reliable results within 5 to 7 hrs. Roche Amplicor MTB (Roche Diagnostic System, Somerville, N.J.) and Gen-Probe AMTB (Gen-Probe Inc., San Diego, Calif.). The amplified target is part of the 16S rRNA gene which is common to all the mycobacteria. An attempt has been made to describe the use of the target DNA, SenX3-RegX3, in a multiplex PCR to detect and differentiate M. tuberculosis from other mycobacteria directly from clinical specimens.

National study on the prevalence of iodine deficiency disorders among schoolchildren 8-12 years of age in Bahrain

A cross-sectional survey of primary-school children in Bahrain was conducted to estimate the prevalence of goitre and iodine deficiency according to age, sex and area of residence. During January-May 1999, 1600 children were randomly chosen from all government schools. Children were examined for goitre and of those, 50% were randomly selected for urinary iodine level assessment. Only 26 children [1.7%] had goitre. Although median urinary iodine was above 100 microg/L, 121 of 749 children [16.2%] had low urinary iodine levels. Although iodine deficiency does not pose a significant public health problem in Bahrain, education about the nutritional value of iodized salts in the prevention of this disorder could increase public awareness

Epidemics of aseptic meningitis due to enteroviruses following national immunization days in Bahrain.

We report two successive epidemics of aseptic meningitis due to enteroviruses (EV) observed after national immunization days against polio. Meningitis due to echovirus 30 occurred from July 1995 to the end of January 1996, mostly among children aged 0-12 years (95.1% of cases), and meningitis due to echovirus 4 occurred from May 1996 to the end of September 1996 in the same age group. There were 286 and 169 cases, respectively. Specimens from several representative cases were sent to the WHO Collaborating Center for Virus Reference and Research Laboratory for serological testing and virus detection, including polymerase chain reaction (PCR) studies. Using those tests, evidence of echovirus 30 infection was found in 44% of the children who were sampled during the first epidemic and 45.5% during the second. During echovirus 30 and echovirus 4 epidemics, a similar decline in the age-specific attack rate from 19.1/10,000 and 10.1/10,000 population aged 12 years to 2.4/10,000 and 3.6/10,000 population aged 13 years was observed, respectively.

Epidemiology of HIV and AIDS in Bahrain.

Between 1986 and 1996, 378 HIV cases were identified in Bahrain, of whom 51% were foreign nationals. Intravenous drug abuse was a major risk factor (38.8%) among Bahraini nationals, while transmission through sexual contact was more common (45.7%) among foreigners. Other well known risk factors were also represented in the two communities. The male to female ratio for the two communities were very different with 10:1 for nationals compared to 1:1.4 for foreigners. Among the AIDS defining manifestations, Pneumocystis carinii pneumonia was the commonest (50%), followed by tuberculosis (21%), oro-esophageal candidiasis, cryptosporidiosis and toxoplasmosis. Transmission through sex and maternal-foetus route could emerge as significant contributors in the spread of AIDS in Bahrain unless appropriate preventive steps are taken.

HIV antibodies among intravenous drug users in Bahrain.

A 12-month study was conducted to identify risk factors for human immunodeficiency virus (HIV) infections among intravenous drug users (IDU) attending drug rehabilitation clinic of the Psychiatric Hospital, Manama, Bahrain. Patients provided demographic and behavioural information based on a questionnaire. Two hundred and forty male IDUs participated in the study on voluntary basis. The seroprevalence of HIV was 21.1 per cent. The presence of HIV antibody was associated with educational status, frequency of injecting drugs and needle sharing.

PIP: During January 1st to December 31st, 1991, a total of 242 male intravenous drug users (IDUs) attending the drug rehabilitation clinic of the Psychiatric Hospital, Manama, Bahrain, for treatment were interviewed by trained interviewers using a structured questionnaire to gather information on age, sex, marital status, nationality, religion, income, educational status, history of drug use, sexual practices, and blood and blood product transfusions. The sera were tested for antibodies to HIV-1 and HIV-2 using a second generation enzyme linked immunoassay (ELISA) and confirmed by Western Blot. 51 (21.1%) IDUs were positive for anti-HIV-1 by ELISA as confirmed by Western blot. 5 of 62 (8.1%) cases with college education were positive for HIV compared with 35 of 138 (25.4%) with secondary level of education and 11 of 42 (26.2%) with primary or lower level of education (p 0.01). Among the behavioral characteristics, only needle sharing showed an association of borderline statistical significance (p = 0.06). Frequency of intravenous drug use and sexual practice showed 95% confidence limits close to 1.0 (the null value) and higher limits of 4.61 and 2.71, respectively. Only educational status showed a significantly lower risk of HIV positivity in persons with college education with an odds ratio of 0.25. Stepdown logistic regression analysis was performed on 219 IDUs using the five potential predictor variables: age, education, intravenous drug use, needle sharing, and sexual practice. This showed that sexual practice was not an independent predictor variable of HIV positivity. Hence a second logistic regression analysis was carried out using age as a continuous variable and education, intravenous drug use, and needle sharing as dichotomous variables. Data on all 242 drug users were available for this analysis. Only education and needle sharing emerged as significant predictor variables. The odds ratios were: education 0.250 and needle sharing 2.46.

Prenatal serologic screening in Bahrain.

Between 1988 and 1990, serological surveys designed to study local disease prevalence and assess the clinical value of various prenatal screening tests were undertaken at Salmaniya Medical Center in Bahrain. High maternal antibody prevalence (greater than 85%) to cytomegalovirus (CMV), herpes simplex virus (HSV) and rubella was demonstrated, and 28% showed antibodies to Toxoplasma gondii. The lowest seroprevalence values were found for HBsAg (1.2%) and Treponema pallidum (0.9%). Routine testing for rubella, syphilis, and hepatitis B are advocated for all pregnancies in Bahrain. In contrast, CMV and HSV serologies are not recommended. Toxoplasma antibody testing remains controversial, but the lack of a proven agent to prevent congenital toxoplasmosis coupled with the high cost of serial testing mitigates against its routine use at this time.

Epidemiology of rotavirus diarrhoea in children under five years in Bahrain.

A case-control study in children under five years of age was undertaken in Bahrain between February 1984 to March 1986 to study the aetiology of diarrhoea with special reference to rotavirus. During this period fecal samples were collected from 698 hospitalized and non-hospitalized diarrhoea cases and 532 from non-diarrhoea controls. Rotavirus was the enteropathogen most commonly detected (20.8%) and represented 68.7% of the total positives from the cases. Percentage rotavirus infection detected in the hospitalized patients was significantly higher than in non-hospitalized cases. Rotavirus was most frequently detected in the age group 6-11 months (26.6%). Rotavirus was not detected at all above 24 months of age. A higher percentage of rotavirus infection was noticed in males up to 11 months. Children of mothers with university education showed a higher level of rotavirus infection (39.3%) in comparison to children of mothers with school level education (20.4%) or no education (19.6%). Rotavirus was detected more often in patients from higher income homes (25.6%) compared to a lower income group (18.2%). No significant difference in rotavirus positivity was noticed between the children of working and non-working mothers. Rotavirus detection in relation to different feeding habits showed no difference. Rotavirus could be detected throughout the year from diarrhoea cases in Bahrain and showed no seasonal trend. It did not show any correlation with mean monthly temperature and mean monthly relative humidity.

Utilization of exogenous siderophores by Campylobacter species.

The availability of iron to potentially pathogenic bacterial strains is restricted by the iron-binding proteins of the host. In this study, we examined 40 strains of Campylobacter species grown under iron-limiting conditions. While the strains produced no detectable siderophores, all the isolates freely utilized exogenous siderophores produced by other organisms as iron carriers. These data suggest that the use of an exogenous siderophore (either purified or present in a coinfecting microorganism) may be important in developing a suitable laboratory model for campylobacteriosis.