Extra-long treatment of MDR-TB osteomyelitis of humerus due to neurotoxicity from the 2nd-line drugs: a case report.

Infection with tuberculosis (TB) still considered a leading infectious cause of death, osteomyelitis TB rare entity, and being extraspinal MDR-TB make it very rare case; most of experience in treating osteomyelitis TB was derived from pulmonary TB experience, and we present a case of humerus MDR-TB that was treated for 5 years, with several interruption due to side effect and other causes.

Intrapleural Tenecteplase for Complicated Parapneumonic Pleural Effusion.

Intrapleural thrombolytics have shown promising results in complicated parapneumonic pleural effusions reducing the need for surgical interventions. Until now, studies have evaluated primarily streptokinase, urokinase, and recently, alteplase. In this case series, we share our experience with tenecteplase-a tissue-specific plasminogen activator in 15 patients. We observed that tenecteplase is effective in 14/15 (93.3%) of our patients, and none of them had any bleeding episodes.

Hodgkin's Lymphoma as an Unusual Cause of Eosinophilic Pleural Effusion.

Eosinophilic pleural effusion can be the first presenting feature of a wide range of diseases, with malignancy being the commonest cause. Elevated levels of eosinophils could be an indicator of a favourable prognosis. In clinical practice, malignant lymphomas have been rarely associated with eosinophilic pleural effusions. In this report, we present the case of a 37-year-old otherwise healthy woman, who initially presented with a cough of five months' duration. Diagnostic workups including pleural and lymph node biopsies confirmed the diagnosis of nodular lymphocyte-predominant Hodgkin's lymphoma.

First Case of Dendriform Pulmonary Ossification in Bahrain.

Dendriform pulmonary ossification (DPO) is a rare interstitial lung disease characterised by the presence of mature bone with marrow elements in the lung parenchyma with typical radiologic findings of diffuse and numerous calcified nodules. In this case study, we are presenting a case of asymptomatic primary DPO discovered during routine screening chest X-ray. To our best knowledge, this is the first case of DPO reported in Bahrain.

Effect of Long-Term Moderate Physical Exercise on Irisin between Normal Weight and Obese Men.

BACKGROUND: Irisin is a myokine that has a beneficial effect on obesity and glucose metabolism by increasing energy expenditure. This study aims to investigate the effect of long-term moderate physical exercise on irisin levels and its correlations with body mass index (BMI), waist circumferences (WC), and metabolic parameters in normal weight and obese males. Material and method. A follow-up case-control study of sixty male participants, comprised of thirty normal weight and thirty obese, who had undergone supervised long-term moderate physical exercises for six months. Serum irisin levels, fasting blood glucose, serum insulin, homeostatic model assessment of the insulin resistance index (HOMA-IR), and ß-cell function (HOMA-B2) were assessed. RESULTS: Long-term moderate exercise induced elevation of the irisin level significantly (P < 0.0001) with significant reduction of the BMI, WC, fasting blood glucose, insulin, HOMA-IR, and HOMA-B2 levels (P < 0.0001) in comparison between obese and normal weight groups. There are significant differences for each parameter in each obese and normal weight group before and after physical exercise with exception of the BMI and WC in the normal group. Significant negative correlations were shown between irisin and blood glucose and insulin and HOMA-IR levels in the obese group and normal weight group. CONCLUSION: Irisin improves glucose homeostasis after long-term moderate physical exercises, suggesting that irisin could have regulatory effect on glucose, insulin resistance, and obesity and it could be used as a potential therapy for obesity and insulin resistance.

Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain.

Background Kidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality. Methods This retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI. Results The mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma. Conclusions The rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.

Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates.

BACKGROUND: Bronchoalveolar lavage (BAL) is utilized for diagnosing lung infiltrates in immunocompromised. There is heterogeneity in the data and reported diagnostic yields range from 26 to 69%. Therefore, selection criteria for BAL to maximize yield and minimize complications are unclear. Objectives of this study were to determine the diagnostic yield and complication rate of BAL in immunocompromised patients presenting with lung infiltrates, and identify factors impacting these outcomes. Exploratory aims included characterization of pathogens, rate of treatment modification and mortality. METHODS: Retrospective study from January 2012 to December 2016. Patients on mechanical ventilation were excluded. Positive diagnostic yield was defined as confirmed microbiological or cytological diagnosis. RESULTS: A total of 217 patients were recruited (70.1% male and mean age: 51.7 ± 14.6 years). Diagnostic yield was 60.8% and complication rate 14.7%. Complications (hypoxemia and endobronchial bleeding) were all sell-limiting. Treatment modification based on BAL results was 63.3%. In 97.0% an infectious aetiology was identified. HIV infection (OR 5.304, 95% CI 1.611-17.458, p = 0.006) and severe neutropenia (OR 4.253, 95% CI 1.288-14.045, p = 0.018) were associated with positive yield. Leukemia (OR 0.317, 95% CI 0.102-0.982, p = 0.047) was associated with lower yield. No factors impacted complication rate. Overall mortality (90-day) was 17.5% and in those with hematologic malignancy, it was 28.3%. CONCLUSION: BAL retains utility in diagnosis of immunocompromised patients with lung infiltrates. However, patients with hematologic malignancy have a high mortality and alternative sampling should be considered because of poor results with BAL. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01374542 . Registered June 16, 2011.

New approach for determination of sulfadiazine in pharmaceutical preparations using 4(4-sulphophenylazo)pyrogallol: Kinetic spectrophotometric method.

A new trend describes the development and validation of a simple, sensitive and selective kinetic spectrophotometric methods for the determination of sulfadiazine in pharmaceutical formulations has been conducted. In this paper, sulfadiazine was derivatized as a new organic compound 4(4-sulphophenylazo) pyrogallol, 4-SPAP, by coupling pyrogallol with diazotized sulfadiazine in medium of controlled pH. 4-SPAP was characterized by techniques of FT-IR, H-NMR, GC-Mass, TG and DSC thermal analysis methods. Solvatochromic behavior in solvents of various polarities was also investigated. The determination of sulfadiazine was accomplished by initial rate and fixed time methods. These methods were based on the reaction of the compound containing sulfadiazine, 4-SPAP, with Ca(II) to form colored product with a maximum absorbance at 520 nm. The two methods were adopted for constructing the calibration curves and examined for their suitability for the quantitation of sulfadiazine in pharmaceuticals. The limit of detection (LOD) and limit of quantification (LOQ) were found to be, by initial rate method, 0.35 and 1.05 µg·mL-1and that by fixed time method were found to be 0.69 and 2.07 µg·mL-1, respectively. The percent relative standard deviations (%RSD) for the results ranged from 1.04% to 1.76% and 0.85% to 1.42% for the initial rate and fixed time methods of the proposed kinetic spectrophotometric method, respectively. The existence of common excipients in the pharmaceutical formulation did not produce any significant interference. Statistical comparison was reported as indicated from the F- and t-test data of the proposed methods with that of reference method showing excellent agreement and indicating no significant difference in their accuracy and precision.

Physical and physiological demands of futsal.

Futsal, the 5-a-side version of soccer (i.e. 1 goalkeeper and 4 outfield players), was introduced in 1930 and continues to grow in popularity around the world. Competitive games comprise of two 20-min periods of high-intensity and intermittent activities requiring substantial physical, tactical, and technical efforts from the players. A greater understanding of the physical and skill requirements will aid the development of futsal and enable practitioners to undertake appropriate training regimes for the demands of the sport. The objective of this review is to examine key aspects of futsal such as match analysis, physiological demands, energy requirements, fitness measurements, and skill requirements. Futsal players experience fatigue as the game progresses due to the high-intensity nature of the game and the repeated maximal sprint efforts required. The intermittent nature of the sport necessitates the use of aerobic and anaerobic energy pathways throughout exercise. Therefore, a futsal player needs to have a great capacity of intermittent endurance, repeated sprint ability, and leg power, while technical aspects include the ability of high level shooting and passing skills, agility and coordination. Future research is warranted to help practitioners develop more specific tests into futsal performance, especially with regards skill.

A descriptive-comparative study of performance characteristics in futsal players of different levels.

Despite the increasing popularity of futsal, there is little information on performance characteristics of players. We aimed to determine the validity and reliability of a futsal shooting test and to evaluate and compare performance characteristics of three futsal playing levels. Twenty-four males (n = 8 elite, n = 8 semi-elite, n = 8 social) completed two trials to examine the reliability of the Massey Futsal Shooting Test (MFST) and to compare various fitness characteristics between groups. MFST time taken (P = 0.010), shot speed (P < 0.001) and points scored per shot (P < 0.001) were better for elite relative to social players. Test-retest reliability was acceptable for all groups, but it was most repeatable in elite players. Loughborough Soccer Passing Test performance was better in elite relative to social players (P = 0.004). There were no differences in countermovement-jump height between groups. Elite players ran faster over 5 m than both semi-elite (P = 0.043) and social (P = 0.002) and faster than the social players through 10 m (P = 0.028) and 20 m (P = 0.026). Distance covered in the Futsal Intermittent Endurance Test was higher in elite relative to semi-elite (P = 0.005) and social (P < 0.001) groups. The MFST is a valid and reliable protocol to assess futsal shooting-skill performance; elite players have superior shooting and passing skill and have greater sprinting and intermittent-running ability.