Infection among renal transplant patients in the Kingdom of Bahrain: A ten year retrospective study ( 2004-2014)

Introduction:  Kidney transplantation is the process of transplanting the organ to a patient with end stage renal disease. Complications with transplant can be encountered during or for a varying period post operatively. As graft survival and immunosuppressant regimens have improved, infection of grafts have become a leading concern. The diagnosis of infection in such patients is challenging too due to the lack of the typical infection indicators like fever as the patients are immunocompromised. The focus of our study is to study the extent of infection on the transplanted patients. The research will look into the type of microorganisms encountered, their management and outcome. Methods  & Materials: A retrospective study was carried out between the periods of 1st of January 2004 to 31st of December of the same year 2014. All renal transplant patients admitted during this period were segregated according to the reason of admission. Only those with impression of infection were enrolled.   Results: A total of 108 patients admitted between the period of 1st of January 2004 and 31st of December 2014 with impression of infection post renal transplant. Some of the patients had recurrent history during those ten years for infectious purposes. From the 108 patients, 74 of them received transplant from living donors (68.52%). The diagnosis on admission was limited to certain differentials. 35.19% patients were admitted with the impression of urinary tract infection. Pneumonia was diagnosed in 10.19%.  patients.  Majority of patient (89.96%) were on maintenance dose of steroids. That was followed by MMF, Tacrolimus and cyclosporine with a percentage of 81.48%, 46.3% and 25.93% respectively. Regarding the antibiotics, 86.11% of the admitted patient were started on single antibiotic on admission including those with recurrent admission. Conclusion: Fever is a common presenting symptom in our population of transplant recipients which reflects the possibility of infection. The majority responded to a single antibiotic use.  The limitation of our study is the small number of the transplanted patients. &nbsp

An audit of primary care referrals to the Ophthalmic Accident and Emergency Department of the Royal Victoria Eye and Ear Hospital, Dublin.

Aims: The objective of this audit was to determine the pattern of general practitioner referrals to the ophthalmic casualty department and to make recommendations to improve the service. Methods: Clinical data were collected from the Accident and Emergency Department (A&E) case notes regarding patient demographics, reason for referral by GP, triage group, diagnosis and course of management. Results: A total of 2,015 patients attended the A&E during the one-month study period, of whom 335 (16.6%) were GP referred. A total of 271 (80.9%) of these patients were non-urgent referrals. Non-painful and non-sight threatening conditions accounted for 172 (51.3%) referrals. The consistency of ocular examinations in the GP letters was poor, with only 16.4% recording visual acuity and 49.9% recording any examination findings. Conclusion: There is a high rate of non-emergency referrals to the ophthalmic A&E. There is a need for better ophthalmic training for GPs, either as part of the existing training scheme or as part of continued education programmes. The introduction of a standard GP referral form with focused questions would allow better triage of these patients on arrival in the A&E department. The expansion of the role of the casualty nurse specialist would also help to alleviate pressure on this overburdened system.</p