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Article
Assessment of Nurses' Knowledge Towards Child with Bacterial Meningitis at Pediatric Teaching Hospitals in Baghdad City

Author: Khamees Bandar Al-Sa'idi
Journal: nursing national Iraqi specility المجلة العراقية الوطنية للعلوم التمريضية ISSN: 18122388 Year: 2007 Volume: 20 Issue: 1,2 Pages: 1-11
Publisher: Baghdad University جامعة بغداد

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Abstract

AbstractObjective: The study aims to assess nurses' knowledge toward the child having bacterial meningitis and to find the relationship between nurses' knowledge and their demographic variables. Methodology: A descriptive study was carried out at the pediatric teaching hospitals in Baghdad from the 1 st November 2005 to the 1 st August, 2006.Non probability (purposive) sample of (60) nurses were selected from pediatric teaching hospitals in Baghdad, these nurses are working at medical, pediatric emergency wards and premature units and they have at least one year of experience in pediatric hospital.The data were collected through using specially constructed questionnaire, which comprises (107) items and filled by using interview technique.The reliability of the questionnaire was determined through a pilot study and the validity through a oanel of experts.The data were analyzed through the application of descriptive statistic frequency, percentage, and the application of inferential statistical procedures, which include Pearson correlation coefficient and chi-square.Results: The results of the study indicated that nurses have inadequate knowledge about general information (35 %), diagnosis (38.3 %), and medical treatment (40 %).While they have accepted level of knowledge (38.3 %), in nursing management toward the child with bacterial meningitis.In conclusion the results indicated that one third of the sample (33. 3 %) has poor knowledge toward all aspects of bacterial meningitis.Moreover, there is no significant association between nurse's knowledge and their age, sex, and marital status. However, significant relationship is found between their knowledge and their level of education, years of experience in pediatric unite, and years of employment.Recommendation: The study recommended that education and training programs in bacterial meningitis should be presented to the nurses. Key wards : Bacterial Meningitis


Article
The Significance of Serum C-Reactive Protein in Childhood Acute Meningitis

Author: Russul Feihan Mussa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 3 Pages: 730-738
Publisher: Babylon University جامعة بابل

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Abstract

Serum concentrations ofC-reactive protein is considered an important diagnostic test for sepsis because itincreases several folds in response to bacterial infection. All over the worldbacterial meningitis is asignificant cause of childhood morbidity and mortality, so early diagnosis and treatment are the most important ways in prevention of the complications.The aim of this study was toestimate the usefulness of serum CRP level in differentiation between septic and aseptic meningitis.We measured the serum CRP level in patients who were diagnosed by clinical and laboratory findings as pyogenic and aseptic meningitis. It was found that partially treated meningitis was most common in all age group,and there is significant correlation between high serum CRP titer and positive CSF culture p.value0.004. Serum CRP was of high titer in 23 (82%) patients with pyogenic meningitis, while its negative in70% of patients with viral meningitis. Fever was the most common presenting symptom in all age group 99(90%) of patients. Patients with Meningeal sign (neck stiffness) were 29(87.8%) in those more than one year from total 33 patients and headache 19(82.6%) from total 21 patients.There is a good sensitivity for serum–CRP, while there is a high specificity for CSF culture and a good specificity for CSF gram stain in pyogenic meningitis. CSF leukocyte polymorphs significantly increased in pyogenic meningitis ,p.value 0.008. while lymphocytes significantly increased in viral meningitis, p.value 0.002. CSF protein: Increase >100mg/dl in 86% of patients with pyogenic meningitis.CSF glucose was significantly decreased in pyogenic meningitis p.value 0.004.We conclude from this studythatserum CRP can helptodistinguish betweenpyogenicand aseptic meningitis. Children who present with clinical feature of meningitis in whom serum CRP values are determined at 12 hour after the onset of fever and are < 6 mg/L are less likely to have pyogenic meningitis. Serum CRP detection is not expensive, simple and dependable diagnostic indicator in meningitis.


Article
Acute Bacterial Meningitis Among Children under Five Years of Age in Baghdad.

Author: Huda S. Al-Rawazq
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 3 Pages: 312-315
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The periodic review conducted of acute bacterial meningitis in children younger than 5 years of age in Baghdad to reflect changes in the epidemiological pattern of this infection. Patients and Methods: Sixty patients with signs and symptoms suggestive of meningitis who were admitted to Central Teaching Hospital in Baghdad City were included in a prospective study started from the 1st October till the 30th of December 2009. By bacteriological study, biochemical and cytological study in the laboratory, WBCs in the blood with differential count was done to support the diagnosis of bacterial meningitis.
Results: Present study revealed that from (60) patients (6) cases (10.0 %) showed positive and (54) cases (90.0 %) negative cultures to CSF patients.
Conclusions: The administration of antibiotic before lumber puncture associated with false negative CSF culture. Most cases of meningitis were under one year of age occurred in male more than female with bottle feeding. Fever was the most common presenting symptom followed by vomiting and convulsion.


Article
The Role of Lactate Dehydrogenase in Differentiating Between Bacterial and Non -Bacterial Meningitis in children Under Five Years in Ramadi Maternity and Children Hospital
دور انزيم اللاكتيت ديهايدروجينيز في التشخيص التفريقي بين التهاب السحايا الجرثومي وغير الجرثومي في الأطفال تحت سن الخامسة في مستشفى النسائية والأطفال في الرمادي

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Abstract

The present study was designed to find out the usefulness of lactate dehydrogenase (LDH) level in cerebrospinal fluid (CSF) in differentiating bacterial from non-bacterial meningitis in children below 5 year of age . A total of 177 patients who were admitted to the AL-Ramadi Maternity and children hospital, AL-Anbar, Iraq During a period of one year ( from 1st.November / 2007 to 1st.November 2008), for diagnosis and treatment of meningitis were included in the study. Cerebrospinal fluid samples were collected from patients by lumbar puncture(LP) for diagnosis. Levels of LDH were measured spectrophotometrically in Randox commercially prepared kits and compared in bacterial , non-bacterial meningitis and controls.The study revealed that only 24 cases have meningitis. Bacterial meningitis present in 19(79%) . Of them 11(46%) with positive culture and 8(33%) with negative culture (partially treated), while the remaining 5(21%) were found to be non-bacterial cases. The study concluded that measurement of LDH levels in CSF is beneficial in differentiating bacterial from non-bacterial meningitis since it was significantly increased in bacterial meningitis.

صممت الدراسة الحالية بهدف معرفة أهمية تركيز إنزيم اللاكتيت ديهايدروجينيزفي السائل المخي ألشوكي في التفريق بين التهاب السحاياالجرثومي وغير الجرثومي في الأطفال تحت خمس سنوات في مستشفى النسائية والأطفال في الرمادي .شملت الدراسة 177 طفلا دون سنالخامسة من العمر يعانون من أعراض وعلامات التهاب السحايا وادخلو إلى المستشفى لغرض التشخيص والعلاج للفترة من 1 تشرين الثاني2007 إلى 1 تشرين الثاني 2008 حيث تم جمع السائل المخي الشوكي من هؤلاء الأطفال بطريقة البزل القطني لغرض التشخيص كما تم قياستركيز إنزيم اللاكتيت ديهاديدروجينيز بطريقة المطياف الضوئي.من خلال الطرق المختبرية المتعددة للتشخيص ،تبين أن 24 حالة يعانون فعلا منالتهاب السحايا .بينت النتائج أن 19 حالة ( 79 % ) يعانون من التهاب االسحايا البكتيري وينقسمون إلى 11 حالة ( 46 % ) كانت نتيجة الزرعالبكتيري موجبة وأن 8 حالات ( 33 % ) كانت نتيجة الزرع البكتيري سالبة بينما عد العدد المتبقي 5 حالات ( 21 %) هو التهاب سحايا غيربكتيري.استنتجت الدراسة أن بالإمكان الاستفادة من قياس تركيز إنزيم اللاكتيت ديهايدروجينيز في السائل المخي ألشوكي للتفريق بين نوعي التهابالسحايا إذ انه يرتفع معنويا في حالة التهاب السحايا البكتيري


Article
Causative Organisms and Risk Factors In Bacterial Meningitis in Al-Elwia Childhood Hospital - Baghdad

Author: Ban Abdul Hameed بان عبد الحميد
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 59-68
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Childhood meningitis is a major cause of morbidity and mortality, Hemophilus influenza b (Hib) is the most common cause in many countries, especially below 5 years and before the development of conjugated Hib vaccine, it is followed by Streptococcus Pneumonia, and then N. meningitides, in addition to other microorganisms. Objective: To identify the causative organisms of bacterial meningitis and to identify the factors predisposing significantly to the incidence of bacterial meningitis. Method: This cross sectional , study was done in Al-Elwia Pediatric Hospital during the period 1st of January 2007 to 30th of June 2007.Eighty four patients with presumptive diagnosis of meningitis were included in this study, from the age of 2 months -12 years, History about some risk factors were taken in details. Analysis of cerebrospinal Fluid (CSF) with Gram stains & cultures were done in all cases. Results: The number of cases of meningitis was 50 (20 proved meningitis & 30 partially treated meningitis), while 34 patients are found to have no meningitis. Streptococcus pneumoniae was identified in 45%, Hemophilus Influenza b in 20%, while Nisseria meningitides 5%, other organisms include Escherichia coli, Staphylococcus aureus, Klebsiella, & salmonella. Many factors affecting the occurrence of bacterial meningitis & these include: age, sex, residence, body weight and home overcrowding. Conclusions: Streptococcus pneumoniae was found to be the predominant microorganism causing bacterial meningitis in children aged 2 months-12 years, followed by Hemophilus influenza b, while N. meningitides were one of the rare bacteria which had been identified. E. coli was found to be the major cause in cases of ventriculo-peritoneal (VP) shunt meningitis.


Article
Iraqi Children with Acute Bacterial Meningitis... Who May Need Ventilatory Support?

Author: Muhi Kadhem Al-Janabi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 2 Pages: 100-105
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Acute bacterial meningitis (ABM) is one of the most potentially serious infections occurring in infants and older children. Indications for PICU admission are shock, markedly elevated intracranial pressure (ICP), coma, and refractory seizures (1).METHODS:This cross sectional study enrolled children 2 months-12 years of age presented with (ABM) who were admitted to Children Welfare Teaching Hospital (CWTH) -Medical City- Baghdad, including those who needed Pediatric Intensive Care Units (PICUs) admission in CWTH Unit and Surgical Specialty Hospital (SSH) Unit in the period from the 1st of Feb 2004 to the 1st of Feb 2006. The diagnostic inclusion criteria of (ABM) were clinical symptoms and signs of meningitis plus a CSF neutrophilic pleocytosis with a CSF cells count of more than 5 cells/mm3 (1). Data included history, clinical examination, investigations, complications, PICU management, and outcome. Statistical analysis was done by using SPSS version 13.0 computer facility, Chi-square test and T test were used when needed and a P.value < 0.05 was considered significant.RESULTS:In the present study (ABM) in children 2 months -12 years constituted 7% of cases admitted to PICUs. The majority of cases (77.2%) were below 2 years of age. The mean age of children with (ABM) was 18.3+6.80 months. The PICU cases of (ABM) differed from the neurological ward cases in their more acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium and longer duration of stay and all these characteristics showed highly significant differences The case fatality rate of children with (ABM) is 13.3%.CONCLUSION:The study concluded the need for PICU admission in children with (ABM) with acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium, and recommended laboratory and PICU service expansion

Keywords

meningitis --- children --- picu --- Iraq.


Article
Evaluation of IMCI Indicators of Acute Bacterial Meningitis in Central Teaching Hospital for Child

Author: Mayada Mohamed Ali Alansari
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 358-361
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute bacterial meningitis [ABM] remains an important cause of death and neurological sequel in children, the clinical feature of meningitis is often nonspecific may overlap with those of other infection. Early diagnosis and appropriate treatment are perhaps the most important steps in management, but published data suggested that fewer than half of the cases of meningitis are identified at first assessment [1,2] .OBJECTIVE:Was to evaluate the clinical indicators of ABM of IMCI [integrated management of childhood illness] referral criteria of meningitis include [lethargy, unconsciousness, in ability to feed, neck stiffness, seizures] and other symptoms and sign.PATIENT AND METHODS:By prospective study done at central teaching hospital for child for one year from 1st of September 2006-31 0f August 2007,all admission were included, L p was done for 110 cases who got one or more of meningial signs and IMCI indicators and other symptoms and sign.RESULTS:From 110 cases who have one or more of IMCI indicators and other signs,75 got meningitis including 68 only who meet all referral criteria for meningitis sensitivity 90%, specifity 60%,other 13 cases got one or more of in dependent indicators of meningitis which include, lethargy , impaired consciousness, in ability to feed, neck stiffness, seizures, anterior fontanel bulging, cyanosis, others, while in dependent indicators of absence of meningitis were the absence of high fever. .CONCLUSION:Not all cases of meningitis meet all IMCI criteria but may have one or more of them and other criteria as seizure outside febril convulsion age, repeated short fit, diarrhea, and dehydration; however careful observation and assessment may be the practical way to identify most cases of meningitis

Keywords

ABM --- IMCI of meningitis


Article
Cerebrospinal fluid cholinesterase activity in children with meningitis

Authors: Aldeen Alnoori --- Mohammed Khalid Jamal محمد خالد جمال
Journal: Iraqi Journal of Pharmacy المجلة العراقية للصيدلة ISSN: 16802594 Year: 2011 Volume: 11 Issue: 2 Pages: 70-76
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To assess the changes of cerebrospinal fluid (CSF) acetyl cholinesterase(AChE) activity in children with acute bacterial meningitis in comparison to healthyage and sex matched controls.Patients and methods: Out of 41 cases admitted to Alkhansaa pediatric and diliveryhospital (Mosul city) between January 2010 and July 2010, 28 cases proved to be acase of Haemophilus influenzae meningitis, 13 child proved lack from any type ofmeningitis with age and sex matched subjects taken as a control group. Initially fromall of the studied children (patients and controls) about 5 ml CSF samples were takenand assayed for appearance, leucocytes, red blood cells, sugar, protein and AChEactivities by spectrophotometric method.Results: There were a significant increase in CSF WBCs count, RBCs count, proteinlevels, AChE activity with a decrease in CSF glucose level for children with acutebacterial meningitis in comparison to the control group.Conclusion: There is an important value for measurement of CSF AChE activity forconfidential diagnosis of children with acute bacterial meningitis specially for thosewith equivocal decision by using the traditional parameters.

أهداف البحث: لتحديد أهمية قياس مستوى التغيير لنشاط خميرة الكولين استراز في سائل النخاع ألشوكي للمرضى المصابين بالتهاب السحايا البكتيري الحاد من الاطفال وبالمقارنة مع مجموعة ضبط من اصحاء ذوي اجناس و اعمار مقاربة لمجوعة المرضى.المرضى وطرق العمل: من أصل 41 مريضا ادخلوا الى مستشفى الخنساء للأطفال و التوليد في مدينة الموصل للفترة مابين كانون الثاني 2010 وتموز 2010 ، كان هناك 28 حالة شخصت على انها التهاب سحايا بكتيري بجرثومة Haemophilus influenzae. كذلك انتخب 13طفلا من أعمار و أجناس مقاربة من الاصحاء اتخذت كمجموعة ضبط. في البداية تم سحب 5 مل من سائل النخاع ألشوكي من المجموعتين ( مجموعة المرضى والضبط) وتم معاينة النماذج و فحص كريات الدم البيض, كريات الدم الحمر ,مستوى السكر,مستوى البروتين و قياس مستوى نشاط خميرة الكولين استراز في سائل النخاع ألشوكي باستخدام طريقة امتصاص الطيف الضوئي.النتائج: هنالك زيادة معنوية في كريات الدم البيض, كريات الدم الحمر, مستوى البروتين و مستوى نشاط خميرة الكولين استراز في سائل النخاع ألشوكي مع نقص معنوي في مستوى السكر للأطفال الذين لديهم التهاب السحايا الحاد بالمقارنة مع مجموعة الضبط.الاستنتاج: كان هنالك فائدة مهمة من قياس مستوى نشاط خميرة الكولين استراز في سائل النخاع الشوكي للتأكد من صحة تشخيص التهاب السحايا البكتيري الحاد عند الأطفال الذين لم يكتمل تشخيصهم للمرض باستخدام طرق الكشف الاعتيادية .


Article
Subdural Effusion in Bacterial Meningitis Experience in Children Welfare Teaching Hospital

Authors: Mahjoob N. Al-Naddawi --- Hula Raoof abdul Rasool --- Nameer Mahdi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 1 Pages: 1-10
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Subdural effusions occur in (10 - 33 %) of children with acute bacterial meningitis. Usually occur bilateral over frontoparietal region, although localized collections can develop over occipital region. Effusions are most common when meningitis results from H.influenzae .(45% of all effusions).OBJECTIVE:To find out the incidence , age distribution and type of bacteria involved in occurrence of subdural effusion in bacterial meningitis, to know the risk factors that might associated with subdural effusion .PATIENTS AND METHODS:from march 2010 – feb.2011 a Prospective study was done on 50 patients diagnosed and treated as meningitis, information's obtained from patients include (patient name, date of birth, sex, residency, duration of illness before admission, clinical presentation, and if antibiotics used prior to admission. Diagnostic inclusion criteria clinical and laboratory based. daily follow up of them .Brain CT was done to all of patients with meningitis after 7 days of treatment to roll out subdural effusion because some of the patients were asymptomatic.RESULTS:The study shows that incidence of subdural effusion in bacterial meningitis was (22.0%).It is most commonly occur in children below the age of (1) year, there was no significant difference between male and female . Regarding CSF analysis, there were no specific findings that indicate presence of subdural effusion. The majority of the patients show no growth of bacteria on CSF culture, blood culture and gram stain, the others show equal growth of (streptococcus pneumonia, H.influenzae and N.meningitidis). Regarding outcome the majority of the patients discharged well, only one patient had focal deficit and one patient died.CONCLUSION:There were no significant risk factors associated with development of subdural effusion. The majority of patients was discharged without any intervention and required follow up only. It's important for physician to maintain a high index of suspicion for diagnosis of subdural effusion .It is important to follow-up patients with meningitis by imaging study, because majority of patients with subdural effusion are asymptomatic.


Article
Neurobrucellosis: Antimicrobial Treatment of Six Complicated Cases of Brucellosis

Author: Abdulridha Al-Abbasi
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 1 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Brucellosis is a classical zoonosis; it is a common disease in the Middle East countries. Involvement of the Central Nervous System by Brucella microorganisms might be not uncommon and is parallel to the prevalence rate of the disease among population. The work reported here is for six cases with brucella meningoencephalitis diagnosed by isolation of Brucella microorganisms from their blood and spinal fluid together, with high anti-brucella antibodies in their blood and Cerebro Spinal Fluid (CSF). Cases of PUO admitted to Fever Hospital and Neurological unit in the Medical City Teaching Hospital were evaluated clinically and neurologically. Six cases (three males and three females) suspected of neurological involvement by the disease all had fever, sweating +/- joint pains, all had meningeal irritation signs, abnormal CSF findings and all had history of raw milk &/or cheese consumption. They all were treated by different courses of many antibiotics for different times with skeptical responses. The general complaint was varying between fever, vomiting, weight loss, severe depression, headache and sweating, one case had change of sensorium, and hearing loss, one had cranial nerve palsy and three had peripheral weakness. All the cases had pleocytic CSF changes and Br. melitensis types 2 and 3 and Br. abortus type 4 isolated from their blood and all but one had same Brucellae isolated from their CSF. All cases had high titers of anti-brucella antibodies raised both in the serum and CSF though the Rose Bengal and ELISA tests. The treatment given was different of two or three combinations of Rifampin, Tetracycline, Cefotaxim, and Streptomycin for eight weeks up to four months for those with lumber osteomyelitis and epidural abscess cases. The outcome of cases was satisfying; four cases were cured without sequale, one case with cerebral abscesses was died and one case developed hearing loss and peripheral nerve weakness. It can be concluded neurobrucellosis is a treatable disease with a favorable outcomeexcept when there is a myelopathy or deafness and careful awareness of the disease as it is not an uncommon complication of common and treatable disease in our community is required.

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