Cigarette smoking as a risk factor for ischaemic stroke in young South Asian male migrants to Qatar: The BRAINS study.

BACKGROUND: The incidence of stroke in the Middle East is high, given its relatively young population. Smoking is a well-recognized risk factor for ischaemic stroke, and its high regional prevalence may partly account for this increased stroke risk. This research aims to determine whether young male South Asian migrants in Qatar were adversely affected by stroke depending on their smoking status. METHODS: Data from the ongoing international prospective BRAINS study was analysed. Male South Asian migrants to Qatar with a history of ischaemic stroke were recruited. Multivariate regression analysis was used to estimate the effects of comorbidities, such as BMI, hypertension, diabetes, hypercholesterolemia, alcohol consumption, and ischemic heart disease, on the association of age of stroke onset and smoking status. RESULTS: We identified 778 (mean age 49.5±10.2) migrant male workers of South Asian descent with ischaemic stroke in Qatar, of which 41.3% of the sample were current smokers. Compared to non-smokers, current smokers suffered a stroke 2.03 years earlier (95%CI: 0.60-3.46, P=0.005). Multivariate regression analysis demonstrated that only current smoking status was associated with an earlier age of stroke onset (ß=2.03, SE=0.74, P=0.006). CONCLUSION: Smoking is associated with at least a two-year earlier onset of ischaemic stroke in male South Asian migrants to the Middle East. Our study has important implications for the public health management of migrants in host countries.

Frequency of Acute Kidney Injury in Patient Receiving Piperacillin - Tazobactam: A Hospital-based Study from Qatar.

BACKGROUND: several studies have been reported piperacillin-tazobactam (TAZ / PIPC)-associated AKI with various frequencies. The aim of this study was to determine the frequency of TAZ/PIPC- associated AKI among our patients and to identify the risk factors for this clinical entity. METHODS: this retrospective cross-sectional study was conducted at Hamad General Hospital; it involved adult patients who were admitted from January 2017 to December 2017. RESULTS: we involved 917 patients, of whom 635 (69.25%) were males and 282 (30.75%) were females. The mean age of the patients was 52 (SD 19) years, and 98 (10.7%) patients were diagnosed with AKI. The patients with AKI were significantly older than without AKI [59.71 (SD 19.79) versus 51.06 (SD 18.67); P <0.001]. After TAZ/PIPC initiation, the mean creatinine level in the AKI group was higher than the mean creatinine level in the non-AKI group, [158.91 (SD 81.93) versus 66.78 (SD 21.42); P<001]. The mean time of onset of AKI after PIPC/TAZ initiation was 4.46 (SD 3.20) (1-12 days). AKI was significantly associated with low mean serum albumin (P<0.001), high mean fasting blood glucose (P<0.001), coronary artery diseases (P<0.001), heart failure (P<0.001), liver diseases (P=0.047), diabetes mellitus (P=0.021) and hypertension (P<0.001). The in-hospital mortality was significantly higher in the AKI group [38.78% versus 5.13% in the non-AKI group; P<0.001], and only advanced age and heart failure were found as independent risk factors for TAZ/PIPC-associated AKI. CONCLUSION: TAZ/PIPC was significantly associated with AKI. Advanced age and heart failure were identified as independent risk factors for TAZ/PIPC-associated AKI.

Acinetobacter Infections among Adult Patients in Qatar: A 2-Year Hospital-Based Study.

This retrospective study was conducted at Hamad General Hospital, Qatar, to describe the demographic data, clinical features underlying diseases, antimicrobial susceptibility, and outcome of A. baumannii infection. It involved all adult patients 15 years of age or older who were managed at Hamad General Hospital for A. baumannii infection from January 1, 2012, to December 31, 2013. We identified a total of 239 patients with A. baumannii infection, of which 182 (76.2%) were males. The mean age was 49.10 ± 19.57 years. The majority of the episodes (25.1%) occurred in elderly patients (≥65 years) and the most commonly identified site of A. baumannii infection was the respiratory tract, 117 (48.9%). Most episodes of infection, 231 (96.7%), were hospital-acquired and high rate of nosocomial infections occurred in the medical intensive care unit, 66 (28.6%). All patients had underlying medical conditions. Maximum resistance was seen to cefotaxime, 147 (58.3%), and minimum resistance was seen to colistin, 2 (1.4%). Of the 239 isolates, 102 (42.7%) were susceptible and 137 (57.3%) were multidrug-resistant. The in-hospital mortality in our study was 31%. Male gender, multidrug resistance, and septic shock were found to be independent mortality predictors.

Risk Factors, Clinical Presentation, Diagnosis, and Treatment Outcomes of Portal Vein Thrombosis: A Five-Year Hospital-Based Study From Qatar.

Background: There is a lack of robust epidemiological information on portal vein thrombosis (PVT) in Qatar. This study aimed to describe the risk factors, clinical presentation, diagnosis, and treatment outcomes of PVT in patients with and without liver cirrhosis admitted to Hamad General Hospital. Methods: This retrospective observational study was conducted at Hamad General Hospital, Doha, Qatar. Consecutive patients with PVT between January 1, 2015 and December 31, 2019 were included in this study. Results: We included 363 cases representing 0.05% of all inpatients admitted to our hospital during the study period. Their mean age was 47.79 ± 14.48 years. There were 258 (71.1%) males and 105 (28.9%) females. Abdominal pain was the most common presenting symptom (160 (44.1%)), while splenomegaly was the most common presenting sign (158 (43.5%)). Liver cirrhosis was the most frequent risk factor for PVT (147 (40.5%)), while no risk factors were identified in 49 (13.5%) patients. Anticoagulant therapy was given to 171/207 (82.6%) patients with acute PVT and 19/156 (12.2%) patients with chronic PVT. The options used for anticoagulation treatment were: low molecular weight heparin (LMWH) or unfractionated heparin alone, LMWH/unfractionated heparin followed by warfarin, and direct-acting oral anticoagulants (rivaroxaban). Out of the 262 patients in whom PVT recanalization was assessed, 43.8% of the cases had recanalization after anticoagulation treatment, while 12.6% of them had spontaneous recanalization without such therapy. A comparison between different anticoagulants used in this study showed no significant difference in the effectiveness of the three regimens used. The 30-day mortality was recorded for 71 patients (19.5%). The major risk factors for 30-day mortality were: age over 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L. Conclusion: PVT is a rare clinical entity in Qatar with liver cirrhosis being the most common risk factor. Early administration of anticoagulation therapy is associated with a significant recanalization, while age > 45 years, male sex, hepatic failure, malignancies, and bilirubin > 34 µmol/L are independent risk factors for 30-day mortality.

Adult Coagulase-Negative Staphylococcal Meningitis in Qatar: Clinical Characteristics and Therapeutic Outcomes.

BACKGROUND AND OBJECTIVES: Coagulase-negative staphylococci (CoNS) have emerged as a major pathogen in nosocomial meningitis. This study was designed to describe the clinical profile, laboratory parameters, treatment, and outcomes of CoNS meningitis in patients admitted to Hamad General Hospital, Qatar. MATERIALS AND METHODS: This retrospective hospital-based study described the patients with CoNS meningitis from 2009 to 2013. RESULTS: Twelve patients were recruited for the study, of which there were 10 (83.3%) males and 2 (16.7%) females with a median age of 39 years (interquartile range [IQR]: 29-46 years). Fever was the most common presenting symptom being present in all patients, followed by mental alterations 7 (58.3%). All CoNS meningitis cases in this study were nosocomially acquired after neurosurgery and in most cases after external ventricular drain (EVD) insertion. The median time between the procedure and acquisition of infection was 13 days (IQR: 10-15.7 days). The isolated species include 8 (66.7%) Staphylococcus epidermidis, 2 (16.7%) Staphylococcus capitis, and 2 (16.7%) Staphylococcus haemolyticus. All CoNS isolates were sensitive to vancomycin while 75% of them were oxacillin resistance. In the eight patients with EVDs, the infected EVDs were removed, while all patients received empirical antibiotics involving mainly vancomycin and ceftriaxone that were modified upon receipt of culture results. All patients were cured, and no mortality was reported. CONCLUSIONS: CoNS meningitis is a recognized complication related to the introduction of neurosurgical devices. Because of its nonspecific clinical presentation, treating physicians should have a high suspicion index. If CoNS meningitis is highly suspected, vancomycin is the empirical treatment of choice while awaiting results of sensitivity.

Anaphylaxis following rivaroxaban ingestion: report of an extremely rare case.

We reported an anaphylactic reaction following ingestion of rivaroxaban in a 48-years-old male, who was recently discharged from the hospital as a case of deep vein thrombosis. At home, the patient developed a diffuse itchy skin rash, shortness of breath, and vomiting 30 minutes after rivaroxaban ingestion. Emergency Medical Service found that the patient had severe dyspnea, low blood pressure, and decreased blood oxygen saturation. The patient was given oxygen, intramuscular epinephrine, intravenous hydrocortisone, diphenhydramine, salbutamol nebulizer, and was immediately transferred to the emergency department of Hamad General Hospital. Subcutaneous enoxaparin was initiated, while hydrocortisone and salbutamol nebulizer continued. On the next day, his vital signs had stabilized, and intravenous hydrocortisone was switched to prednisolone tablets, and salbutamol nebulizer was switched to budesonide/salmeterol inhaler, whereas enoxaparin was overlapped with warfarin. After achieving the target international normalized ratio (INR), enoxaparin was discontinued and the patient was discharged with significant clinical and laboratory improvement.

Role of Fiberoptic Bronchoscopy in the Rapid Diagnosis of Sputum Smear-negative Disseminated Tuberculosis with Pulmonary Miliary Infiltrates.

OBJECTIVES: We sought to evaluate the role of bronchoscopy-related procedures such as bronchoalveolar lavage (BAL), bronchial wash (BW), bronchial brush (B brush), transbronchial biopsy (TBB), and post-bronchoscopy sputum (PBS), alone or in combination, in the rapid diagnosis of negative sputum smear disseminated tuberculosis (TB). METHODS: We performed a secondary post hoc analysis of data collected from our previous study entitled "Disseminated tuberculosis among adult patients admitted to Hamad General Hospital, Qatar: A five-year hospital-based study" with a modified objective. RESULTS: We identified 27 patients. BAL fluid was positive for acid-fast bacilli (AFB) smear in 7/27 (25.9%) patients and were culture-positive for Myobacterium tuberculosis in 17/27 (63.0%) cases, while BW collections were smear-positive in 9/27 (33.3%) cases and culture-positive for M. tuberculosis in 18/27 (66.7%) cases. TBB showed caseating granulomas in 10/16 (62.5%) cases and one case of non-caseating granuloma (6.3%). PBS was positive for AFB in 4/8 (50.0%) patients. The combination of these procedures enabled us to diagnose disseminated TB rapidly in 22 (81.5%) cases. CONCLUSIONS: Bronchoscopy proved to be an effective method for the rapid diagnosis of disseminated TB in patients in whom sputum smear microscopy was negative.

Tuberculous Adenitis with Concurrent Hodgkin Lymphoma: A Case Report.

The concomitant occurrence of tuberculous adenitis and Hodgkin lymphoma is rare, posing a diagnostic dilemma since both have similar symptoms, such as lymphadenopathy, weight loss, fever, and night sweats. We reported such a case in a 15-year-old girl who presented with fever and neck swelling and was found to have lymphadenopathy. A biopsy of the right supraclavicular lymph node showed Reed-Sternberg cells and stained positive for acid-fast bacilli and tuberculosis culture. The patient was diagnosed with tuberculous adenitis with concurrent Hodgkin lymphoma in the same lymph node. She was started on anti-tubercular medications and chemotherapy and showed clinical improvement. This case highlights the need for suspicion in order to identify these two disorders in the same patient, since missing one of them is possible and may lead to fatal complications.

Imported malaria in Qatar: a one year hospital-based study in 2005.

A study was conducted to describe the clinical presentation, epidemiology and outcome of imported malaria in patients admitted to Hamad Medical Corporation, Qatar, between 1st January and 31st December 2005. During a one-year study, 81 patients [64 (79%) males and 17 (21%) females] were studied. The median age was 26 years. Most infections were caused by Plasmodium vivax, and Pakistan was the most common area of malaria acquisition. The median times between last arrival in Qatar and the onset of symptoms with Plasmodium falciparum, P. vivax and mixed infections were 14, 28 and 17 days respectively. The median times between onset of symptoms and diagnosis of P. falciparum, P. vivax and mixed infections were 3, 3 and 3.5 days respectively. The predominant symptoms were fever and chill in all patients. High bilirubin and thrombocytopenia were found in 51 (63%) and 47 (58%) of the patients respectively. None had been taking chemoprophylaxis against malaria infection. Six patients had severe falciparum malaria, which was more prevalent among Qatari than non-Qatari patients (p=0.02). No deaths occurred during the study period. The median time of stay in hospital was 3 days; it was longer in patients with P. falciparum infection than in patients with P. vivax (p=0.02). In conclusion, P. vivax is the most common cause of imported malaria, with the majority acquired from the Indian subcontinent. Only a few patients presented with severe malaria. Increased efforts are needed to educate travelers about the need for prophylaxis and other measures.

Incidence and epidemiological features of acute pancreatitis among adult inhabitants in Qatar.

BACKGROUND/AIMS: Acute pancreatitis (AP) is one of the most common gastrointestinal causes of hospital admission in Qatar. The aim of the present study was to investigate the epidemiological features and demographic characteristics of patients with AP and to estimate the annual incidence rates of this disease among adult inhabitants in Qatar. MATERIALS AND METHODS: This retrospective study was conducted using the data collected by reviewing records of patients with AP admitted to the medical and surgical wards of Hamad GeneralHospital and Alkhor Hospital, Qatar from January 2007 to December 2012. Diagnosis of AP was based on abdominal pain suggestive of AP, serum lipase and/or amylase at least three times the upper limit of normal, and/or characteristic findings of AP on abdominal ultrasound or computed tomography. RESULTS: A total of 382 AP events were reported in 334 patients. There were 250 (75%) males and 84 (25%) females. The mean age (±SD) of the patients was 56.8±18.7 years. Gallstone disease (40.6%) was the highest cause of AP, followed by alcohol consumption (28.5%) and idiopathic AP (20.7%). The mean annual incidence rate of AP was 5 per 100,000 adult inhabitants in Qatar from January 2007 to December 2012. The incidence rate among men was higher than that among women. Mortality rate was low (0.3%), and there were complications in 112 (29.3%) patients. CONCLUSION: The annual incidence rate of AP is relatively low in Qatar and tends to behave similar to many European countries in etiology, which can be explained by population structure. Gallstone and alcohol consumption are the main causes, and idiopathic AP is responsible for more cases than expected.

Stroke in Qatar: a first prospective hospital-based study of acute stroke.

BACKGROUND: Stroke is a major cause of morbidity and mortality in Qatar. OBJECTIVES: The aim of our study was to determine types of strokes, the associated risk factors, clinical presentation, outcome, and time to hospital admission among Qatari and non-Qatari patients as well as young and nonyoung patients. METHODS: We conducted a hospital-based prospective observational study including all patients admitted to Hamad Medical Corporation with first-ever stroke from September 15, 2004, to September 14, 2005. A stroke was defined according to World Health Organization criteria. RESULTS: Stroke was confirmed in 270 patients of whom 217 (80.4%) had ischemic stroke and 53 (19.6%) had hemorrhagic stroke. Male patients predominated in all types of stroke. The main risk factors for stroke were hypertension and diabetes, whereas lacunar infarct was the most common subtype of ischemic stroke. Risk factor profiles were similar between Qatari and non-Qatari patients except for hypercholesterolemia, which was observed with a higher frequency in Qatari compared with non-Qatari patients with ischemic stroke. There were significant differences between the young and nonyoung patients with ischemic stroke with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome. Most patients arrived at the hospital more than 3 hours from stroke onset because of unawareness of stroke symptoms. The overall in-hospital mortality was 9.3%. CONCLUSIONS: Hypertension and diabetes mellitus were the main risk factors for stroke in Qatar, whereas lacunar infarct was the most common subtype. Significant differences between the young and nonyoung patients were observed with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome.

Epidemiological and Clinical Features of Salmonella Typhi Infection Among Adult Patients in Qatar: A Hospital-based Study.

OBJECTIVES: We sought to describe the epidemiological and clinical features of typhoid fever in Qatar. METHODS: We conducted a retrospective study of adult patients treated for typhoid fever at Hamad General Hospital and Alkhor Hospital between 2005 and 2012. RESULTS: The mean age of the 354 patients enrolled in the study was 28.4±9.3 years; 296 (83.6%) were males. There were 42, 48, 39, 44, 46, 47, 52, and 36 cases of adults with typhoid fever in 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012, respectively. Overall, 343 (96.9%) patients had a history of travel to endemic areas. Among them, 93.0% acquired typhoid fever in the Indian subcontinent. Fever was observed in all cases, and the other predominant symptoms were abdominal pain (38.1%), diarrhea (35.6%), and headache (33.1%). Salmonella typhi, showed high resistance to ciprofloxacin (n = 163; 46.0%), and low resistance to ceftriaxone (n = 2; 0.6%). Four patients developed intestinal perforation, which was surgically repaired in two cases. Two patients (0.6%) died. CONCLUSIONS: Typhoid fever was frequent among immigrants to endemic areas. Travelers returning from endemic areas with suspected typhoid fever should be treated empirically with third-generation cephalosporin after obtaining appropriate cultures. Moreover, preventive measurements such as education on food and water hygiene, and effective vaccination of travelers should be practiced widely among travelers to endemic areas to reduce morbidity and mortality.

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase.

A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound (US) guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient's condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent (gemfibrozil) was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.

Risk factors of young ischemic stroke in Qatar.

OBJECTIVES: There is limited information about risk factors of young ischemic stroke in Qatar. The aim of this study was to describe the risk factors and subtypes of young ischemic stroke among Qatari and non-Qatari residents. PATIENTS AND METHODS: Hospital based prospective observational study involving all young adults (15-45 years of age) admitted to Hamad General Hospital with first-ever ischemic stroke from September 2004 to September 2005. A stroke was defined according to WHO criteria. RESULTS: Stroke was confirmed in 40 (32 males and 8 females). Their ages ranged from 17 to 44 years (mean 37.1+/-13.27). Thirty (75%) of the patients were non-Qatari. The most common risk factors were hypertension 16 (40%), diabetes mellitus 13 (32.5%), hypercholesterolemia 11 (27.5%), smoking 11 (27.5%), and alcohol intake 9 (22.5%). Regarding stroke subtypes, lacunar stroke syndrome (LACS) was diagnosed in 17 (42.5%), total anterior circulation stroke syndrome (TACS) in 16 (40%), partial anterior circulation stroke syndrome (PACS) in 5 (12.5%) and posterior circulation stroke syndrome (POCS) in 2 (5%). Partial anterior circulation stroke syndrome (PACS) was observed with a higher frequency in Qatari patients compared with non-Qataris (p=0.009), whereas total anterior circulation stroke syndrome (TACS) was observed more in non-Qatari than in Qatari patients (p=0.03). Average hospital stay was 18 days. In-hospital mortality was 2.5%. CONCLUSION: The risk factors of ischemic stroke in young adults are numerous. The most common were hypertension, diabetes mellitus, hypercholesterolemia, smoking and alcohol intake. Only one Indonesian male patient with POCS died in the hospital.

Guillain-Barré syndrome associated with Salmonella paratyphi A.

A 31-year-old Nepali man was admitted to the intensive care unit with a 3-day history of fever associated with four-limb weakness, followed by difficulty in swallowing. The patient came from Nepal 20 days before admission. On examination the patient was conscious and appeared ill, with a temperature of 38.0 degrees C. His four limbs were weak (grades 2-3) and he was areflexic with mild facial weakness and absent gag reflex. Brain CT and MRI were normal. Cerebrospinal fluid analysis showed high protein. A neurophysiologic study showed data consistent with motor axonal polyradiculopathy. The patient was diagnosed with Guillain-Barré syndrome (GBS), and intravenous immunoglobulin (0.4 g/kg day for 5 days) was administered. On the third hospitalization day, the patient developed respiratory failure for which he was intubated and mechanically ventilated. On the same day, blood samples grew Salmonella paratyphi A (S. paratyphi A), which was sensitive to ceftriaxone. The patient was then diagnosed with GBS associated with S. paratyphi A, and treated with ceftriaxon (2 g administered intravenously, daily for 10 days). On the eleventh hospitalization day the patient was weaned from ventilator and extubated successfully. Subsequently, the patient improved, his fever subsided, and he regained muscle power satisfactorily.

Nosocomial Pseudomonas putida Meningitis: A Case Report and Literature Review.

We report a case of Pseudomonas putida meningitis in a 26-year-old Nepalese man who was admitted to Hamad General Hospital with epidermoid cyst for drainage. Ommaya reservoir was placed into the cyst for drainage and externalventricular drainage (EVD) was performed. After four days, the patient was transferred to the ward in stable condition. His weakness resolved partially and headache severity decreased. After three days, the patient developed fever and headache severity increased with deterioration of consciousness level. Cerebrospinal fluid (CSF) through EVD showed 2 200 leucocytes/µL, protein level of 295 mg/dL, and glucose level of < 1.8 mg/dL. Meropenem was started on the patient. Aspirate from Ommaya reservoir and CSF showed gram-negative rods and cultures yielded P. putida sensitive to cefepime, gentamycin, ciprofloxacin, and amikacin, but resistant to meropenem and piperacillin-tazobactam. EVD was replaced and the patient received cefepime and ciprofloxacin for 21 days after which he improved and was discharged with right sided residual weakness.

Acute Bacterial Meningitis in Qatar: A Hospital-Based Study from 2009 to 2013.

BACKGROUND AND OBJECTIVES: Bacterial meningitis is a common medical condition in Qatar. The aim of this study was to describe the clinical characteristics of bacterial meningitis, the frequency of each pathogen, and its sensitivity to antibiotics and risk factors for death. PATIENTS AND METHODS: This retrospective study was conducted at Hamad General Hospital between January 1, 2009, and December 31, 2013. RESULTS: We identified 117 episodes of acute bacterial meningitis in 110 patients. Their mean age was 26.4 ± 22.3 years (range: 2-74) and 81 (69.2%) of them were male patients. Fifty-nine episodes (50.4%) were community-acquired infection and fever was the most frequent symptom (94%), whereas neurosurgery is the most common underlying condition. Coagulase-negative staphylococci were the most common causative agent, of which 95% were oxacillin-resistant, while 63.3% of Acinetobacter spp. showed resistance to meropenem. The in-hospital mortality was 14 (12%). Only the presence of underlying diseases, hypotension, and inappropriate treatment were found to be independent predictors of mortality. CONCLUSION: Acute bacterial meningitis predominantly affected adults and coagulase-negative staphylococci species were the common causative agent in Qatar with majority of infections occurring nosocomially. More than 90% of all implicated coagulase-negative staphylococci strains were oxacillin-resistant.

Fulminant hepatic failure caused by Salmonella paratyphi A infection.

We report a case of fulminant hepatic failure associated with Salmonella paratyphi A infection, in a 29-year-old patient who was admitted to the intensive care unit (ICU) with fever of two days, headache and vomiting followed by behavioural changes and disorientation. On examination, the patient appeared acutely ill, agitated, confused, and deeply jaundiced. Temperature 38.5 degrees of C, pulse 92/min, blood pressure 130/89 mmHg. Both samples of blood grew S. paratyphi A, which was sensitive to ceftriaxone and ciprofloxacin. Ceftriaxon was administered with high-dose dexamethasone. Two weeks after treatment with ceftriaxon, the patient was discharged in satisfactory condition.

Streptococcus agalactiae Meningitis in Adult Patient: A Case Report and Literature Review.

We report a case of group B streptococcus meningitis in a 72-year-old female patient who was admitted in our hospital with a 21-day history of bilateral lower thigh pain and swelling associated with fever, headache, and vomiting. Her past medical history was remarkable for DM type 2, hypertension, and hypothyroidism. Upon admission, examination showed bilateral warmth and tender soft tissue swelling around the knees and MRI showed cellulitis of distal thirds of both thighs. The next day, the patient became drowsy. Neurologic examination showed neck rigidity and right sided hemiparesis. Cerebrospinal fluid and blood cultures yielded group B streptococcus sensitive to ceftriaxone, penicillin G, and vancomycin. The patient received ceftriaxone for a total of 14 days after which she improved and was discharged from the hospital with right sided weakness.

Epidemiology and Outcome of Ventilator-Associated Pneumonia in a Heterogeneous ICU Population in Qatar.

Objective. The purpose of this study is to collect data on epidemiology, microbiology, and outcome of VAP in our ICUs for reevaluation of the therapeutic strategies. Methods. This retrospective study involved all adult patients, 15 years of age or older, diagnosed with VAP in multidisciplinary ICUs at Hamad General Hospital between January 2010 and December 2012. Results. A total of 106 patients were enrolled. The mean incidence of VAP was 5.0 per 1000 ventilator-days. It was predominant among younger age group (<60 years), male patients (80.2%), and trauma ICU admissions (49.0%). The most common comorbidity was hypertension (34%) and polytrauma (36.8%) was the most frequent admission diagnosis. 30-day mortality was 23.6% and it was significantly higher in ≥60 years age group, female gender, patients with diabetes mellitus, hypertension, chronic respiratory disease, ≥1 comorbidity, and poor functional status, smokers, medical and surgical ICU admissions, and patients with previous stay in medical/surgical wards, inappropriate empirical therapy, and admission diagnosis of respiratory failure. Gram-negative bacilli were the most frequent respiratory specimen isolates, Pseudomonas spp. being the most common. Majority of our Acinetobacter isolates were multidrug resistant. Conclusion. The incidence of VAP in our ICUs was low. Higher mortality rates were observed in certain subgroup of patients. Resistance to commonly used antimicrobials is likely to require reevaluation of the therapeutic strategies at our institution.