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Article
PSEUDOMONAS AERUGINOSA: UNCOMMON CAUSE OF BACTERIAL MENINGITIS

Author: Yasser W. Al-Mula Abed ياسر وليد عبد الله شريف
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2016 Volume: 14 Issue: 1 Pages: 93-95
Publisher: Al-Nahrain University جامعة النهرين

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Introduction:Gram negative bacillary meningitis is uncommon disease that needs proper diagnosis and urgent treatment to avoid serious complications. Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa are the most frequent gram negative bacilli. Use of third generation cephalosporins has made a significant therapeutic change with significant reduction in mortality. Ceftriaxone should always be the drug of choice until the full sensitivity report is available. Here, we report a case of bacterial meningitis caused by Pseudomonas aeruginosa which is thought to be secondary to previous ear infections. The diagnosis was confirmed by gram stain and culture of the cerebrospinal fluid. The patient was successfully treated with intravenous antibiotic for total of three weeks.Key words: Pseduomonas aeruginosa, meningitis, ear, infection.


Article
Causes of Meningitis in children in Diyala government / Iraq
أسباب التهاب سحايا الدماغ في محافظة ديالى /العراق

Authors: Halah Qasim Raheem هاله قاسم --- Kareem Assi Obaid كريم عاصي --- falah Mukheber فلاح مخيبر --- Mustafa Alzobaidi مصطفى
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2019 Volume: 32 Issue: 1 Pages: 22-27
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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ABSTRACTBackground: Differentiating bacterial from nonbacterial meningitis is very important in deciding treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis, which carries relatively better outcome.Aim of study: To identify the causes of meningitis in children aged ≤ 14 years’ old in Diyala, Iraq.Subjects and Methods: A descriptive study conducted in Al-Batool Teaching Hospital,Diyala, Iraq during a period from October 2017 to February 2018. It included all patients aged ≤ 14 years’ old who admitted with primary diagnosis of meningitis, presented with clinical signs of meningitis. Patients were subjected to a detailed history, clinical examination and a laboratory and radiological investigation. Results:The main cause of meningitis detected by cerebrospinal fluid was viral cause (74.3%), Coxsackie virus A16 IgM antibody was detected in 70% of cases. Age and duration of fever were significantly associated factors with cause of meningitis (P= 0.024 and P= 0.017 respectively). 45.7% of study patients were presented with fit, most of these fits were generalized in type (93.8%) and 56.3% of these fits lasted for less than 15 minutes. Conclusion:Meningitis was caused mostly by mostly viral infection and Coxsackie virus A16 IgM antibody was the most common virus detected. Viral meningitis was associated with young age and short duration of fever. Cerebrospinal fluid protein was significantly higher in bacterial than in viral meningitis.

الخلاصةالخلفية: تمييز التهاب السحايا البكتيري من غير البكتيري مهم جدا في تحديد العلاج. الالتهاب السحائي البكتيري هو حالة عصبية تهدد الحياة ويحتاج إلى مضادات حيوية فورية بالحقن، مقارنة بالتهاب السحايا الفيروسي والغير ملوث، والذي يحمل نتائج أفضل نسبياً.الهدف من الدراسة: لتحديد الأسباب الشائعة لالتهاب السحايا عند الأطفال.طرق البحث: دراسة مقطعية أجريت في مستشفى البتول التعليمي، ديالى، العراق خلال الفترة من تشرين الأول / أكتوبر 2017 إلى شباط / فبراير 2018، شملت جميع المرضى الذين تقل أعمارهم عن 14 سنة والذين أقروا بالتشخيص الأولي للالتهاب السحائي، مع ظهور علامات سريرية على التهاب السحايا، كان العدد الإجمالي للمرضى المسجلين 70. تم استبعاد المرضى الذين تتجاوز أعمارهم 14 سنة، المصابين باستسقاء الرأس، والذين تم تشخيصهم على أنهم التهاب السحايا بعد الصدمة من هذه الدراسة. خضع جميع المرضى إلى تاريخ مفصل وفحص السريري وتحاليل مختبرية وشعاعية.النتائج:كان السبب الأكثر شيوعًا للإصابة بالتهاب السحايا الذي تم اكتشافه من خلال نتيجةتحليل سائل النخاع الشوكيهو السبب الفيروسي (74.3٪) وتم اكتشاف فيروس Coxsackie A16 IgM في 70٪ من الحالات. كان العمر ومدة الحمى عوامل مرتبطة بشكل كبير مع سبب التهاب السحايا ((P <0.05. تم ملاحظة اختلاجات عصبية في 45.7٪ من المرضى الذين أجريت عليهم الدراسة، معظم هذه النوبات تم تعميمها في النوع (93.8٪) و56.3٪ منهم استغرقت أقل من 15 دقيقة. الاستنتاج:كانت معظم حالات التهاب السحايا في العراق ناتجة عن عدوى فيروسية وكان فيروس كوكساكي A16 IgM هو أكثر الفيروسات انتشارا. ارتبط التهاب السحايا الفيروسي مع سن مبكرة ومدة قصيرة من الحمى. كان البروتينلسائل النخاع الشوكي أعلى بكثير في البكتيريا منه في التهاب السحايا الفيروسي.

Keywords

: Meningitis --- viral --- bacterial --- Diyala --- Iraq.


Article
Diagnosis of Enteroviral-associated-Meningitis by RT-PCR for the First Time in Iraq

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Abstract

Introduction: A protocol for testing cerebrospinal fluid specimens using RT-PCR for the diagnosis of central nervous system infections was developed 2 and used totest 20 CSF specimens.Objectives: A-Evaluation of efficiency of In-house prepared Extraction reagent. BAmplified of Enteroviral-RNA genome by single-step RT-PCR. Methods: 20cerebrospinal fluid specimens were included. RNA was extracted from 250μl by method Chomcynki, 1993. EV-RT-PCR was performed for all specimens studied.Results: We successfully isolated total RNA from 20 CSF specimens of AM cases.Ten of 20 specimens were positive by RT-PCR.Conclusions: Single-step extraction method was allowed isolation of RNA in 4hr.and provided both high yield and purity of un-degraded RNA preparation. EV-RTPCR detection test is suitable for clinical diagnosis of EV-related meningitis andmay improve the management of EV-related neurologic syndromes.

لتشخیص إصابات الجھاز العصبي RT-PCR◌ٌٌ مقدمة : لفحص نماذج سائل النخاع الشوكي, استخدم تقنیةالمركزي وقد تم فحصعشرین نموذج من سائل النخاع الشوكي.الھدف :في استخلاص الحامض النووي المنقوص (TRI-Reagent) أ- تقییم كفاءة الخلیط الثلاثي للموادRNA الأوكسجین.Single step-RT-PCRٌ باستخدام تقنیة Enteroviral-RNA-genome ب - إمكانیة مضاعفةطریقة العمل: تضمن البحث ( 20 ) نموذج سائل النخاع الشوكي (حجم 250 مایكرولیتر من سائل النخاعوحضرت Chomcynki, تبعا لطریقة 1993 RNA الشوكي) واستخدم في استخلاص الحامض النوويلفحصجمیع نماذج الدراسة. EV-RT-PCR تقنیةمن عشرین نموذج سائل نخاع شوكي من حالات RNA النتائج: لقد نجحنا باستخلاص الحامض النووي. EV-RT-PCR عشرة منھا كانت موجبة في فحص ,aseptic meningitis التھاب السحایاخلال أربع RNA الاستنتاج: أظھرت طریقة الاستخلاصذات الخطوة المنفردة قابلیتھا على استخلاصوأعطتنا منتوج جید والحامض النووي (TRI-Reagent) ساعات فقط باستخدام الخلیط الثلاثي للموادفحص ملائم للتشخیص الطبي لالتھاب السحایا EV-RT-PCR المستخلص ذا نقاوة عالیة. یعتبرالمتسبب من الإصابة بالفیروسات المعویة وباستخدامھ یطور ویحسن معالجة المتلازمات العصبیة المتسببةعن الفیروسات المعویة.


Article
The Vallue off Pollymerase Chaiin Reacttiion iin tthe Diiagnosiis off Tubercullous Meniingiittiis iin a Samplle off Iraqii Pattiient

Authors: Akram M. Al-Mahdawi --- Kareem M.Al-Tameemi --- Eman Sh. Al-Obeidy --- ***,Laith Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 382-391
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Tuberculous meningitis (TBM) is a medical emergency. Early diagnosis is of utmost importance to minimize morbidity and mortality. Polymerase chain reaction (PCR) seems to be a promising test for rapid and early diagnosis of TBM.OBJECTIVE:To investigate whether PCR detects tubercle bacilli in CSF specimens that are missed by direct microscopy and culture, and if so whether PCR has significant diagnostic value compared to conventional methods.METHODS:PCR, culture and acid- fast bacilli (AFB) were performed on CSF samples taken from 43 patients with TBM (based on clinical features and cytochemical parameters of the CSF) and 15 with non- TBM as control group.RESULTS:Of the 43 CSF specimens from highly probable TBM patients, 33 were positive by PCR (76.7%), whereas only 5 was acid-fast microscopy (AFM) positive (11.6%) and 22 were culture positive (55.2%). No positive results were found by AFM, culture or PCR in the non-tuberculous control group.CONCLUSION:The results of this study indicate that application of PCR is extremely useful for the diagnosis of TBM.The PCR is superior to the currently available techniques for the diagnosis of tuberculous meningitis in terms of sensitivity, specificity and rapidity and can play a critical role in the diagnosis of suspected cases.


Article
Is Lumbar Puncture Mandatory for First Simple Febrile Seizures Among Children 6 to 18 Months of Age

Authors: Dalal Mohamed Ameen --- Faiq Abdul Hassan --- Abdulkadhim Imran Moosa
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2012 Volume: 5 no 1 Issue: 11 Pages: 1262-1267
Publisher: Kerbala University جامعة كربلاء

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background: Fever with seizure,is a common complaint with which a child may presented to the emergency department ,is mainly due to febrile seizure, but it may also be duo to central nervous system infection.Objective: This study was done to evaluate the utility of Lumbar puncture for first simple febrile seizures among children 6 to 18 months of age.Method: A prospective study was conducted in emergency department of Karbala teaching hospital for children. Patients who were presented with first simple febrile seizure in age group 6 to 18 months were included. Lumbar puncture was done and meningitis diagnosed on the bases of either cytological and biochemical criteria or Cerebrospinal Fluid culture.Results: Out of 105 patients with First simple febrile seizure, 41 patients (39.05%) were 6 to 12 months old, 41.5% of them had meningitis while 64 patients (60.95%) were 12 to 18 months old, and 17.2% of them had meningitis. Cerebrospinal Fluid, cultures were negative in all cases. meningitis was more in males than females for both age groups with a male:female ratio 3:1.Conclusion: First simple febrile seizure is a common pediatric emergency and high percent of patients with this sole presentation had meningitis.Key words: First simple febrile seizure, Lumbar puncture ,Meningitis.Abbreviations .FSFS:First simple febrile seizure,L.P: Lumbar puncture,CSF: Cerebrospinal Fluid, P value :Probability Value.


Article
Meningitis In Sulaimani Pediatric Teaching Hospital: A Retrospective Study

Authors: Seenaa Muhammed Ali --- Heersh Hma Raof Saeed --- Khalid Rashid Suliman
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 2 Pages: 13-20
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Meningitis in children is one of the life threatening condition in pediatric age group, which needs proper and early diagnosis in the emergency department. Meningitis morbidity and mortality depend on causative agent, time of diagnosis, proper and sufficient duration of therapy in the hospital. For diagnosis, many parameters can be used from history, physical examination and laboratory investigation, which needs sophisticated laboratory to perform.Objective: To analyze CSF findings in children admitted to hospital as meningitis (bacterial and non-bacterial). Also, assess frequency and percentage of the bacterial species isolated from positive CSF culture and determine the resistance patterns of the different bacterial pathogens. Method: A retrospective study carried out in Sulaimania, Iraq/pediatric teaching hospital from January to December 2014. lumber puncture done in 96 cases aged between 29 days to 15 years that have been diagnosed as meningitis CSF parameters; WBC total count, Sugar and protein level were examined, also culture done for all cases with CSF leukocytosis . Results: According to CSF findings and clinical diagnosis, 51% (49cases) considered bacterial while 49% (47 cases) considered non bacterial meningitis. Deaths recorded only among Bacterial meningitis patients with a percentage of 6.1%. Results of CSF culture determined a 24 % (22 cases) as positive for bacterial growth. Streptococcal pneumonia, was on the top of the isolated bacteria with a high resistance against penicillin and Azithromycin.Conclusion: Bacterial meningitis are still occupying large percentage of cases admitted to hospital, and if un-diagnosed promptly will have a high mortality. High index of suspicion for bacterial meningitis is recommended.


Article
Polymerase Chain Reaction Testing in Comparison to Culture of Cerebrospinal Fluid for Diagnosis of Bacterial Meningitis in Children

Authors: Zena Khalid Mahdi --- Hayder H Al-Momen --- Ali Abdulrazzaq Obed --- Essam J Al-Zwaini
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2018 Volume: 11 Issue: 1 Pages: 3903-3911
Publisher: Kerbala University جامعة كربلاء

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background: Childhood bacterial meningitis is a neurological exigency. Accurate, early, rapid diagnosis and treatment is essential to decrease its morbidity and mortality. Aim of study: This is a retrospective study comparing real-time polymerase chain reaction (RT-PCR), with standard bacterial culture for the diagnosis of bacterial meningitis during cerebrospinal fluid (CSF) examination.Materials and methods: RT-PCR was used for the detection of three most common causes of bacterial meningitis (Streptococcus pneumonia, Haemophilus influenza type b, and Neisseria meningitides) in 100 CSF samples from children aged 2 months to 12 years admitted to Al-Elwiya Pediatric Teaching Hospital during the period from January 2016 to January 2017 Results: Growth was detected in 6% CSF cultures of patients included in the study and Streptococcus pneumoniae was the most prominent isolated bacteria. RT-PCR was positive in 43% CSF samples from which S. pneumoniae was identified in all samples. PCR and culture showed concordance in 6% positive and 57% negative samples. Using culture as a reference method, the sensitivity, specificity, and positive and negative predictive values for PCR on CSF samples were 100 %, 60.64%, 13.93% and 100 %, respectively. RT-PCR was positive in 37% CSF samples whereas culture was negative.Conclusion: RT-PCR is a rapid and sensitive test for the diagnosis of bacterial meningitis. The findings of this retrospective study recommend the use of RT-PCR for the diagnosis of children with a clinical suspicion of bacterial meningitis and as a complement to culture, especially, those who received previous antibiotic treatment before lumbar puncture.

Keywords

Meningitis --- Children --- PCR --- CSF --- Bacteria --- Culture


Article
Meningitis in Baghdad 1993 – 1998Part 1: Acute Bacterial Meningitis

Authors: Saleh J. Al- Ethawy** PhD --- Abbas A. Al- Chaderchi** MSc --- Khulood J. Al- Kaisi* MSc
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2009 Volume: 51 Issue: 2 Pages: 159-161
Publisher: Baghdad University جامعة بغداد

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Background: There is a need for a periodic review of acute bacterial meningitis (ABM) since the pathogens responsible for infection vary with time, geography and patient's age. This study was carried out to describe the epidemiology of different types of meningitis and variables affecting the outcome (improvement, complication and death) Patients and Methods: All the cases of meningitis diagnosed and treated at Ibn- Al-Khateeb Teaching Hospital for the period Jan. 1993 to Dec. 1998 were included in this study. The collected data were age, sex, occupation, date of admission, date of discharge, type of meningitis and outcome of the disease.Results: Out of the total cases, 73.3% were ABM. High rate of ABM was among children < 5 years of age and a significant (p = 0.01) high rate was observed among male (60%) (p = 0.01). Predictors of outcome of meningitis were age, sex, residence, duration of hospitalization and type of meningitis.Conclusion: ABM was predominantly observed in children. The high case fatality rate reported in this study was attributed to the deterioration of health services due to wars and sanctions in 1990s.


Article
Occurrence of Pneumococcal Meningitis in Iraq
حدوث التهاب السحايا البكتيري في العراق

Authors: Kifah A. Al-Khurki ** كفاح احمد الكرخي --- Khalid A. Habib * * خالد عبد الرزاق حبيب ** --- Huda Z. Al-Banae هدى زهير البناء
Journal: Baghdad Science Journal مجلة بغداد للعلوم ISSN: 20788665 24117986 Year: 2012 Volume: 9 Issue: 3 Pages: 466-471
Publisher: Baghdad University جامعة بغداد

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This study focuses on the relative frequency of Streptococcus pneumoniae in children with culture-proven bacterial meningitis. The epidemiology has been investigated with clinical and laboratory findings in The Central Public Health Laboratory, Iraq from April to September, 2010. From (138) samples , (55) cases (39.85 %) were diagnosed by physician as bacterial meningitis, (23) cases (16.66 %) as viral menginitis , (18) cases (13.04 %) as different medical cases (e.g febrile convulsion , meningoencephalitis , epilepsy …etc) and (42) cases (30.43 %) as unidentified medical cases. For bacterial meningitis S.pneumoniae was isolated from (10) cases (18.18 %) only. The median age for bacterial meningitis was (130.75) month and the predominance was in the age group (1-20) months which appear as (42) cases (76.36 %) . Fever was the frequent presenting symptoms in (49) cases (89.09 %) , followed vomiting in (34) cases (61.81 %) , then irritability and seizures in (29 ,25) cases (52.72 , 45.45) % respectively . In bacterial meningitis , the mean for glucose and protein levels was (44 and 65) (mg/dl) respectively.

هذه الدراسه تركز على بكتريا Streptococcus pneumoniae في الاطفال الذين اظهروا نتائج زرعيه ايجابيه لحالات التهاب السحايا البكتيري. تم التحري عن الوبائيه ، النتائج المخبريه والطبيه في مختبر الصحه المركزي – العراق للفتره من نيسان الى ايلول 2010. تم جمع ( 138) عينه كان منها (55) حاله ( 39,85 %) مشخصه من قبل الطبيب المعالج كحاله التهاب سحايا بكتيري ،( 23) حاله (16,66 %) كحاله التهاب سحايا فايروسي ، (18) حاله (13,04%) كحالات طبيه مختلفه (مثل febrile convulsion ، ningoencephalitis ، الصرع ،....الخ) و (42) حاله (30,43 %) كحالات غير مشخصه طبيا. عزلت بكترياStreptococcus pneumoniae من ( 10) حالات فقط (18,18 %) من حالات التهاب السحايا البكتيري . كان متوسط اعمار المرضى لحالات التهاب السحايا البكتيري (130,75) شهر و كانت اعلى نسبه في الفئه العمريه (1-20) شهر والتي ظهرت بعدد (42) حاله (76,36 %). الحمى كانت من اكثر الاعراض تكرارا في (49) حاله (89,09 %) متبوعه بالغثيان في (34) حاله (61,81 %) ومن ثم الانفعاليه والصرع في (29 ، 25) حاله (52,72 و 45,45) % على التوالي.كان متوسط الكلوكوز والبروتين لحالات التهاب السحايا البكتيري (44 و65) (ملغم/ديسليتر) على التوالي.


Article
DETECTION OF AUTOLYSIN, PNEUMOLYSIN AND PNEUMOCOCCAL SURFACE ADHESION A GENES AMONG STREPTOCOCCUS PNEUMONIAE CAUSING BACTERIAL MENINGITIS IN CHILDREN
التحري عن جينات PNEUMOCOCCAL AUTOLYSIN, PNEUMOLYSIN, SURFACE ADHESION A في بكتريا STREPTOCOCCUS PNEUMONIAE المسببة لإلتهاب السحايا البكتيري في الأطفال

Author: Huda Z. Al-Banae
Journal: Iraqi Journal of Biotechnology المجلة العراقية للتقانات الحياتية ISSN: 18154794 Year: 2012 Volume: 11 Issue: 2 Pages: 519-528
Publisher: Baghdad University جامعة بغداد

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The aim of the present study is to assess the presence of autolysin, pneumolysin and pneumococcal surface adhesion A genes as virulence factors that may contribute in pathogenicity of Streptococcus pneumoniae causing bacterial meningitis in children. Non-culture tests such latex agglutination test and PCR for S.pneumoniae diagnosis should be considered for patients who need early identification of pathogens or have previously received antibiotics, or whose initial cerebrospinal fluid Gramʼs stain is negative with negative culture at(72)hrs incubation. There were (303) cases delivered their cerebrospinal fluids samples to the central public health laboratory distributed by (183) male (60.39%) and (120) female (39.60%). Seventy seven cases (25.41%) were diagnosed as bacterial meningitis; (36) cases (11.88%) as viral meningitis. S. pneumoniae was isolated from (16) cases (20.7%) of bacterial meningitis. DNA from S. pneumoniae was extracted then subjected to amplification by PCR leading to detection of autolysin and pneumolysin genes in (9) out from (16) isolate and presence of pneumococcal surface adhesion A gene in (8) out from (16) isolate.

هدفت الدراسة الحالية الى التحري عن جينات Autolysin, Pneumolysin, Pneumococcal surface adhesion A كعوامل ضراوة يمكن أن تساهم في إمراضية بكتريا Streptococcus pneumoniae المسببة لالتهاب السحايا البكتيري في الاطفال. الاختبارات غير المعتمدة على الزرع مثل إختبار التلازن وإختبار تضخيم الدنا التضاعفي المتسلسل لتشخيص بكتريا S. pneumoniae ذو أهمية خاصة بالنسبة للمرضى الذين يحتاجون الى تشخيص مبكر للممرضات المسببة أو المرضى الذين تنالوا علاجاً من المضادات الحيوية مسبقاً أو المرضى سالبي تصبيغ كرام لنماذجهم من سائل النخاع الشوكي مع نتيجة زرع سلبية بعد (72) ساعة من الحضن. تم تسليم (303) عينة من سائل النخاع الشوكي الى مختبر الصحة المركزي. توزعت العينات الى (183) ذكراً (60,39%) و(120) أنثى (39,60 %). (77) حالة (25,41%) شخصت كحالات التهاب سحايا بكتيري و(36) حالة (11,88%)كحالات التهاب سحايا فايروسي. بكتريا S. pneumoniae عزلت من (16) حالة (20,77 %) من حالات التهاب السحايا البكتيري. تم إستخلاص دنا بكترياS. pneumoniae ومن ثم تم تضخيمه بتقنية تضخيم الدنا التضاعفي المتسلسل ليتم إيجاد جيني Autolysin, Pneumolysin في (9) من أصل (16) عزلة وإيجاد جين Pneumococcal Surface Adhesion A في (8) من أصل (16) عزلة

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