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Background and Objectives: HIV infection is a global public health problem that can lead to the progression of AIDS. Nutritional status and biochemical markers can significantly contribute to the progression of AIDS in HIV/AIDS patients. The main objective of this study is to examine the association between the nutritional and biochemical markers as well as BMI in HIV/AIDS patients in the kingdom of Bahrain. Methods: A retrospective cohort study, including 300 patients (248 males and 52 females) with HIV/AIDS in Bahrain. Various biochemical markers were collected from patients’ medical records including CD4^+ T cells counts, albumin, Hb, HCT, MCV, WBC, and creatinine. A semi-structured questionnaire using of a standardized food frequency questionnaire (FFQ) was used from which total energy and total macronutrients were calculate. Results: the mean BMI of participants was 27.20 kg/m2 with none of the participants had a BMI lower than 18.5 kg/m2 (underweight). The majority of patients’ dietary intake of macronutrients and total calories intake were either within or above the recommended RDA levels. The results also showed that all mean values of the nutritional and biochemical markers (CD4^+ T cells counts, albumin, Hb, HCT, MCV, WBC, and creatinine) are within the referenced normal ranges. A significant positive correlation of CD4^+ T cells counts, Hb, HCT and albumin at

Background The coronavirus disease 2019 (COVID-19) pandemic presents a significant challenge to the medical profession, increasing in the presence of microbial co-infection. Bacterial and Fungal co-infections increase the risk of morbidity and mortality in patients with COVID-19. Aim To study the bacterial profile in patients with COVID-19 who needed admission to receive treatment in the main centres concerned with managing COVID-19 disease in the Kingdom of Bahrain. Methods The study was a retrospective observational analysis of the bacterial profile and the bacterial resistance in patients with confirmed COVID-19 disease who needed admission to receive treatment in the main centres assigned to manage patients with COVID-19 disease in the Kingdom of Bahrain from February to October 2020. We used the electronic patients' records and the microbiology laboratory data to identify patients' demographics, clinical data, microbial profile, hospital or community-acquired, and the outcomes. Results The study included 1380 patients admitted with confirmed COVID-19 disease during the study period. 51% were admitted from February to June, and 49% were admitted from July to October 2020, with a recurrence rate was 0.36%. There was a significant increase in bacterial and fungal co-infection in the second period compared to the first period. The most common isolated organisms were the gram-negative bacteria (mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, multi-drug resistant Acinetobacter baumannii, and Escherichia coli), the gram-positive bacteria (mainly coagulase negative Staphylococci, Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus) and fungaemia (Candida galabrata, Candida tropicalis, Candida albicans, Aspergillus fumigatus, Candida parapsilosis, Aspergillus niger). The hospital-acquired infection formed 73.8%, 61.6%, 100% gram-negative, gram-positive and fungaemia. Most of the hospital-acquired infection occurred in the second period with a higher death rate than community-acquired infections. Conclusion Bacterial and fungal co-infections in patients admitted with confirmed COVID-19 disease pose higher morbidity and mortality risks than those without co-infections. We should perform every effort to minimize these risks.

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 +/- 0.74. Sepsis (qSOFA >= 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 +/- 0.963) compared to upper-middle (0.17 +/- 0.482) and high-income (0.36 +/- 0.714) countries ( P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.

Background: Hospital acquired infections increase the morbidity and mortality of the inpatient population. Pathogens like Staphylococcus aureus and Enterococci are transmitted by direct contact or transmitted by fomites such as healthcare personnel’s attires. This is a cross-sectional study aimed to explore the prevalence ofcontamination of the attires of healthcare personnel working atSalmanyia Medical Complex. Method: We randomly selected 100 doctors and nurses working in different departmentsand swabbed their attire's sleeves and pockets. We then stored both swabs in their accompanying syringe that contains a bacterial transportation media, and sent them to the lab for culturing. SPSS 23 was used for data entry and analysis. After that, percentages and frequencies were computed for different categorical variables, and a cross-tabulation was computed between each two categorical variables. Chi-Squared test was used to determine whether there were significant relationships between each two categorical variables. Results:Of the total samples, 44 pocket and 45 cuff samples were contaminated with staphylococcus epidermidis (skin flora). Thirty eight participants were found to have contamination of both the cuff and pocket. Nurseshad slightly higher prevalence of cuff contamination than doctors (P=0.032). Amongst doctors, surgeons had the highest prevalence (P=0.006). Discussion:Compared to the data available in the literature, our data did not reveal contamination with significant pathogens such as staphylococcus aureus or MRSA.Nevertheless, contamination with staphylococcus epidermidis could be whether from autoinoculation or contamination from the hospital environment and could correlate to level of hygiene. Frequent washing of attire doesn’t reduce the level of contamination.

The threat of Antimicrobial Resistance (AMR) has attracted the highest level of attention after the United Nation (UN) General Assembly's High Level meeting on AMR in 2016. During that meeting a temporary committee, the inter agency coordination group (IACG) [1] was formulated, under the chairmanship of the Director General of the World Health Organization (DG-WHO) and the UN Deputy Secretary General. The IACG group was tasked to link, guide and advise on political steps needed to address and mitigate the emergence of AMR globally [2]. Efforts to combat AMR, however, have previously been developed prior to this initiative by several decades. Yet, the emergence of resistance continues to be on the rise. The Gulf Cooperation Council Center for Infection Control (GCC-IC) was been established in 2005 and has made major efforts to address all aspects related to human infection control in the member countries. Many of which have been reached. In 2015, the board was able to draft through its multidisciplinary meeting the first roadmap for the counties on this issue [3]. Two years later a follow-up meeting took place in Riyadh on April 2017. Regional and international experts joined in to share and contribute to the understanding of AMR and to advise on further steps needed for this initiative. We dedicated 3 papers on this meeting. The first paper is to provide an update on progress form the GCC countries and further steps that need to be taken, (in press). The second paper is part one out of two round table discussions. The first round table discussion paper, which is the current paper, addresses AMR and the "One Health" concept with a focus on leadership. The second round table discussion paper addresses AMR and the "One Health" concept with a focus on human health [4].

The objective of this study was to compare central line-associated bloodstream infection (CLABSI) rates in Gulf Cooperation Council (GCC) states with those of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) using pooled data from 6 hospitals in 3 GCC countries. The overall CLABSI rate was 3.1 per 1,000 central line days. After adjusting for differences in intensive care unit types, the risk of CLABSI in GCC hospitals was 146% higher than NHSN hospitals but 33% lower than INICC hospitals.

Background The true burden of catheter-associated urinary tract infections (CAUTIs) remains largely unknown because of a lack of national and regional surveillance reports in Gulf Cooperation Council (GCC) countries. The purpose of this study was to estimate location-specific CAUTI rates in the GCC region and to compare them with published reports from the U.S. National Healthcare Safety Network (NHSN) and the International Nosocomial Infection Control Consortium (INICC). Methods CAUTI rates and urinary catheter utilization between 2008 and 2013 were calculated using NHSN methodology pooled from 6 hospitals in 3 GCC countries: Saudi Arabia, Oman, and Bahrain. The standardized infection ratios of the CAUTIs were compared with published reports of the NHSN and INICC. Results A total of 286 CAUTI events were diagnosed during 6 years of surveillance, covering 89,254 catheter days and 113,807 patient days. The overall CAUTI rate was 3.2 per 1,000 catheter days (95% confidence interval, 2.8-3.6), with an overall urinary catheter utilization of 0.78. The CAUTI rates showed a wide variability between participating hospitals, with approximately 80% reduction during the study. The overall compliance with the urinary catheter bundle implementation during the second half of the study was 65%. The risk of CAUTI in GCC hospitals was 35% higher than the NHSN hospitals, but 37% lower than the INICC hospitals. Conclusions CAUTI rates pooled from a sample of GCC hospitals are quite different from rates in both developing and developed countries.

Background Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are very limited. The aim of this study was to estimate VAP rates in GCC hospitals and to compare rates with published reports of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC). Methods VAP rates and ventilator utilization between 2008 and 2013 were calculated from aggregate VAP surveillance data using NHSN methodology pooled from 6 hospitals in 3 GCC countries: Saudi Arabia, Oman, and Bahrain. The standardized infection ratios of VAP in GCC hospitals were compared with published reports of the NHSN and INICC. Results A total of 368 VAP events were diagnosed during a 6-year period covering 76,749 ventilator days and 134,994 patient days. The overall VAP rate was 4.8 per 1,000 ventilator days (95% confidence interval, 4.3-5.3), with an overall ventilator utilization of 0.57. The VAP rates showed a wide variability between different types of intensive care units (ICUs) and were decreasing over time. After adjusting for the differences in ICU type, the risk of VAP in GCC hospitals was 217% higher than NHSN hospitals and 69% lower than INICC hospitals. Conclusions The risk of VAP in ICU patients in GCC countries is higher than pooled U.S. VAP rates but lower than pooled rates from developing countries participating in the INICC.

Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are either limited in some countries or completely lacking in other countries.

Physicians may face difficulties treating patients who have hyponatremia.The risks of rapid correction, such as pontine myelinosis, are well known.Also, many and sometimes complex factors influence the serum sodiumconcentration. A 72-year-old woman from a nursing home presents to the emergencydepartment with a change in her mental state over the past few hours. She hasa medical history of coronary artery disease and hypertension. Her medicationsinclude hydrochlorothiazide. 25 mg a day, and aspirin, 81 mg a day. Onphysical examination, she has decreased skin turgor, orthostatic hypotension,and disorientation to time, place, and person without focal neurologicdeficits. Initial laboratory tests show a serum sodium level of 110 mmol/L;blood urea nitrogen, 23.2 mmol/L (65 mg/dL); creatinine, 318 μmol/L (3.6mg/dL); triglycerides, 2.75 mmol/L (244 mg/dl); and plasma osmolality, 278mmol/kg of water (278 mOsm/kg of water). Other laboratory findings are abicarbonate value of 29 mmol/L; hematocrit, 0.35 (35%); potassium, 4.0 mmol/L;uric acid, 0.42 mmol/L (7.0 mg/dL); urine osmolality, 450 mmol/kg of water;and urine specific gravity, 1.019. Her serum sodium level 2 months beforeadmission was 135 mmol/L, and her urine output was 400 mL a day. She isadmitted to the hospital, and a regimen of intravenous isotonic sodiumchloride solution is started at a rate of 84 mL per hour in the first 24hours.

Hand hygiene is an effective means of preventing hospital-associated infection (HAI). Compliance among health care workers( HCWs) is the main strategic goal for the infection control committee as per the Ministry of Health collaboration with World Health Organization's (WHO) Global Patient Safety Challenge since October 2005.

The outdated rules of older HIV genotypic resistance algorithms can affect virologic responses. This study was designed to determine how often these incorrect resistance interpretations affect analyses of long-term clinical trials, antiretroviral (ARV) choices, and HIV disease progression rates.Baseline VIRCO virtual phenotypes (VVP) from patients screened in 2001-2002 for OPTIMA were compared to 2005 Stanford HIV resistance database algorithm (HIVDB-10/05, version 4.1.4) interpretations of the HIV-1 pol sequences. Drugs were called discordant if resistant by one algorithm and sensitive by the other.Of 2,341 drug comparisons, 501 (21.4%) were discordant, affecting 140 (86.4%) of 162 screened patients. NRTI/NtRTIs were more discordant than NNRTIs and PIs (38.6% vs. 4.3% vs. 12.8%; p.0001). Sixty-nine (53%) patients were placed on 2 drugs reported as sensitive by VVP but resistant by HIVDB-10/05; they had higher than expected rates of disease progression and a similar time to first event or death as patients on ARVs classified as resistant by both algorithms (p = .61).Underestimation of drug resistance by older genotypic algorithms resulted in using ARVs incorrectly thought to be sensitive and in higher than expected rates of HIV disease progression. The use of older genotypes to interpret long-term clinical trials should account for this underestimation, because results may be different if viral sequences are interpreted with newer algorithms.

The clinical course of follicular lymphoma (FL) is well known. Although it is a chemosensitive disease, thereby allowing substantial palliation, recurrence is the rule; only a small subset who presents with limited stage disease is cured. Multiple attempts have been made over the past two decades to improve the survival of patients with FL, and a large number of phase III trials have been reported. These have included a variety of different therapeutic interventions, such as combination chemotherapy, recombinant interferons, new cytotoxic drugs, and immunologic agents. Most studies have not demonstrated that the use of a particular therapy convincingly prolongs survival. Follicular lymphoma cells express CD20 and are associated in most cases with the t(14:18) chromosomal translocation. Rituximab is a chimeric monoclonal antibody directed against the B-cell CD20 antigen, which has been utilized for the therapy of B-cell non-Hodgkin’s lymphoma. Rituximab was shown to be active in FL, and studies of its effectiveness in combination with cytotoxic chemotherapy to increase the response rate are forthcoming.

To the editor, Hyponatremia is the most common electrolyte abnormality observed in a general hospital population and is associated with many disease states.1 We report a case of acute hyponatremic encephalopathy that developed after 2 doses of a thiazide. A 69-year-old woman presented to the emergency department with uncontrolled hypertension. She had longstanding hypertension, for which she was taking perindopril erbumine. Her serum electrolyte levels at presentation were sodium, 131 mmol/L; potassium, 3.8 mmol/L; chloride, 94 mmol/L; and bicarbonate, 33 mmol/L. She was given 2 doses of hydrochlorothiazide, each 25 mg. After several hours of observation, her blood pressure returned to normal, and she was discharged to home. The patient's family brought her to the hospital the next day because she was found unconscious on the floor. She was confused and did not respond to questions. She had no history of any seizure activity, nor had she had blurred vision, headache, numbness, or weakness since her discharge from the emergency department. On physical examination, the patient was confused, disoriented, and agitated. A neurologic examination was difficult to perform. Her serum electrolyte levels were sodium, 115 mmol/L; potassium, 3.2 mmol/L; chloride, 88 mmol/L; and bicarbonate, 21 mmol/L; and her blood glucose level was 10.0 mmol/L (181 mg/dL). Her serum osmolality was 270 mOsm/kg, her urine osmolality was 295 mOsm/kg, and urine sodium concentration was 82 mmol/L. Her thyroidstimulating hormone level was normal. A computed tomographic scan of the brain showed no acute bleeding and changes consistent with small vessel ischemia. Magnetic resonance imaging of the brain was normal. Electroencephalography showed diffuse slow waves. We diagnosed hyponatremic encephalopathy due to hydrochlorothiazide, and treatment with an intravenous 3% saline solution was started. In 3 days, the patient's serum sodium level rose to 136 mmol/L. She made a full clinical recovery. Prescribing diuretic medications for elderly patients requires special precautions.2 Thiazides and their analogues are particularly likely to cause hyponatremia,2 which is usually asymptomatic if it is chronic or mild. Symptoms develop when the serum sodium level falls below 120 mmol/L. Severe hyponatremia is a disorder with a high mortality.3,4,5 Aggressive treatment of hyponatremia with hypertonic saline solution can be associated with central myelinolysis. Therefore, both hyponatremia and its treatment may lead to permanent brain damage.1 In a review of 129 patients taking thiazides, hyponatremia developed within 5 days in 25 patients (31%) and in an additional 25 patients (31%) within 14 days.2 In our patient, the hyponatremia developed after 2 doses of thiazide, which to our knowledge has not been reported previously in the literature. There is also no previous documentation of hyponatremia being caused by an interaction between thiazides and perindopril. Various mechanisms for thiazide-induced hyponatremia have been proposed. The principal mechanism is thought to be through the blockage of sodium chloride cotransport in the proximal part of the distal tubule, leading to excess sodium excretion.3 An ongoing loss of sodium without adequate replacement and potassium loss in the urine are other contributory causes. Hyponatremia due to thiazide use is thought to be an idiosyncratic reaction.

After 2 weeks of therapy with rosiglitazone, 4 g/d, a 61-year-old man developed severe hepatocellular injury. Liver function rapidly improved and symptoms resolved after discontinuation of rosiglit...

Summary: The Gulf Cooperation Council Center for Infection Control (GCC-IC) has placed the emergence of antimicrobial resistance (AMR) on the top of its agenda for the past four years. The board members have developed the initial draft for the GCC strategic plan for combating AMR in 2014. The strategic plan stems from the WHO mandate to combat AMR at all levels. The need for engaging a large number of stakeholders has prompted the GCC-IC to engage a wider core of professionals in finalizing the plan. A multi-disciplinary group of more than 40 experts were then identified. And a workshop was conducted in Riyadh January 2015 and included, for the first time, representation of relevant ministries and agencies as well as international experts in the field. Participants worked over a period of two and a half days in different groups. International experts shared the global experiences and challenges in addressing human, food, animal, and environmental aspects of controlling AMR. Participants were then divided into 4 groups each to address the human, animal, microbiological and diagnostic, or the environmental aspect of AMR. At the end of the workshop, the strategic plan was revised and endorsed by all participants. The GCC-IC board members then approved it as the strategic plan for AMR. The document produced here is the first GCC strategic plan addressing AMR, which shall be adopted by GCC countries to develop country-based plans and related key performance indicators (KPIs). It is now the role of each country to identify the body that will be accountable for implementing the plan at the country level. Keywords: Strategic plan, Antimicrobial resistance, AMR, GCC, Saudi Arabia, United Arab Emirates, Qatar, Bahrain, Oman, Kuwait