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Kikuchi histiocytic necrotizing lymphadenitis: clinicopathological and immunohistochemical study.

Clinical, morphological and immunohistochemical features of 10 cases having the lymphnodal histological pattern of Kikuchi disease were examined. Two of these were diagnosed as systemic lupus erythematosus (SLE). Morphologically, Kikuchi disease and SLE were nearly indistinguishable. Plasma cells, neutrophilic infiltration, haematoxyphilic bodies and vasculitis were not useful in differentiating the conditions. Kikuchi lymphadenitis and malignant lymphoma however could be differentiated histologically. Morphological features that exclude malignancy included: polymorphous nature of cellular infiltrate, absence of abnormal mitosis, preservation of sinusoidal pattern on intervening areas and presence of extracellular and intracellular karyorrhectic debris.

Adolescent↗

Microbiological infections in HIV positive Bahraini patients with low CD4+ T-lymphocyte count.

The correlation of CD4+ T-lymphocyte count and the distribution of pathogenic or opportunistic microbial infection most commonly found in HIV positive individuals differ from one area to the other. The present study reports such findings in 67 HIV positive Bahraini patients in the period May 1997 to Nov. 1998. CD4+ T-lymphocyte count was measured using flow cytometry. Bacterial and fungal cultures were performed. Serological diagnosis was performed when indicated. Viral study was done serologically. The distribution of CD4+ T-lymphocyte count in the studied group was: 21 patients (31.3%) less than 100 cells/microl, 5 patients (7.5%) 100-200 cells/microl, 25 patients (37.3%) 201-500 cells/microl and 16 patients (23.9%) with count more than 500 cells/microl. Among patients with low CD4 count (less than 100 cells/microl) (n=21), microbial infections varied from fungal infections 66%, bacterial infections 57% and viral infections 4.8%. Bacterial infections included Salmonellosis (14.3%), Staphylococcus epidermidis (14.3%), Pseudomonas aeruginosa (9.5%), H. influenzae (9.5%), Legionellosis (4.8%) and E. coli (4.8%). Fungal infection included Candida albicans (52.4%), Pneumocystis carinii (9.5%), Cryptococcus neoformans (4.8%). Viral infection included H. simplex to (4.8%). Fungal infections were the highest common infection in thus study. The most common microbial infection was Candida albicans. P. carinii and Cryptococcus neoformans were less common than found in other studies world wide.

AIDS-Related Opportunistic Infections↗

Sickle cell disease in pregnancy. Obstetric and anesthetic management perspectives.

Recent advances in the pathophysiology, clinical investigations, and management of sickle hemoglobinopathies enables all physicians to better manage these disease states and their sequelae. Patients with sickle cell disease SCD are living longer and are thus more likely to contract unrelated diseases that require surgery and anesthesia. Patients with SCD continue to be a challenge to all branches of medicine particularly in obstetrics, surgery and anesthesia; however, the armamentarium of new knowledge and practice places a different perspective on the care of this old disease. In general, the literature to date suggests that neither prophylactic transfusion of pregnant sicklers nor the selection of an anesthetic in labor have a major impact on patient outcome; however, perioperative management can greatly affect the consequences. A thorough knowledge of the impact of the disease on clinical status can determine how, when, and why to manage parturients with SCD.

Anemia, Sickle Cell↗

The clinical skills laboratory as a learning tool for medical students and health professionals.

Clinical skill laboratories CSL have become one of the essential facilities in an undergraduate medical curriculum. A wide range of training skills were recently introduced which includes clinical examination, diagnostic and therapeutic skills as well as communication skills. Although the educational value of the CSL is very well recognized, very little is written about it in the literature. The purpose of this paper is to provide an overview of the skills laboratory integrated in an undergraduate medical curriculum, highlight the nature of this trend, look at the advantages and disadvantages and suggest some guidelines for implementation.

Bahrain↗

Cardiac echinococcosis: echocardiographic diagnosis with a fatal clinical outcome.

Hydatid disease HD is an endemic disease found in various regions of the world. The organs mostly affected are the liver and lung. Cardiac involvement in HD is rare. The symptoms are mainly due to the mass effect of the calcific hydatid cyst obstructing the blood or the lymphatic vessels. Other manifestations are secondary infection or cyst rupture in the involved organ. Here, we report a middle aged female patient with no history of medical illness who presented to the emergency room with an unrecordable blood pressure. Echocardiogram showed multiple calcific cysts of echinococcosis granulosa in the left ventricle cavity. In the clinical setting, where there is detection of HD elsewhere in the body, an echocardiogram is mandatory as cardiac involvement is serious and may be fatal.

Adult↗

Nurses and doctors ... and patients.

A Forum discussion group hosted by Dr Eilif Liisberg was formed from a few of the participants at a WHO nursing conference in Geneva. Subjects discussed were the status of nursing and changing attitudes to patients.

Attitude of Health Personnel↗

Group purchasing of pharmaceuticals and medical supplies by the Gulf Cooperation Council states.

An important issue in health care today is the cost of essential pharmaceuticals and medical supplies. To control the increase of health care expenses, in 1976 the Gulf Cooperation Council states began to study the idea of establishing a group purchasing programme for pharmaceuticals and medical supplies. This paper demonstrates the elements of the programme, how it works, what obstacles it faces and how other countries can profit from this experience. It also discusses the future of the group purchasing programme in the light of globalization and how the international changes under the World Trade Organization agreements will affect the programme in future.

Bahrain↗

Etiology of mild mental retardation among Bahraini children: a community-based case control study.

The etiology of and suspected risk factors leading to mild mental retardation were analyzed in unselected series of 109 Bahraini school children with this condition born between 1967 and 1982. The cause was considered to be prenatal in 38.5% of the children; perinatal (asphyxia and prematurity), in 11.9%; and postnatal, in 7.4%. In 42% the cause was untraceable. Predisposing background factors associated with mild mental retardation were compared with characteristics of a matched control group from community schools. An illiterate father, consanguinity, and a relative with mental retardation were significantly more common among the sample with mild mental retardation. These results are not consistent with the view that mild retardation is predominantly cultural-familial and not pathological in nature.

Bahrain↗