Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a ubiquitous pathogen that is increasing in Gulf Cooperation Council (GCC) countries. It is implicated in a wide range of infections, from superficial skin infections to lifethreatening syndromes. MRSA has moved beyond healthcare facilities, affecting individuals in the community without substantial risk factors. Aims: To review the prevalence and molecular characterization of MRSA in GCC countries during 2011–2021. Methods: We comprehensively searched PubMed using the following keywords: MRSA, Staphylococcus aureus, GCC, Kuwait, Saudi Arabia, Bahrain, Oman, Qatar, UAE, prevalence, and molecular characterization for articles published after 2011. Results: Thirty-nine of 111 articles examined, fulfilled the purpose of this review. Most studies were in Kuwait (44%), Saudi Arabia (28%) and United Arab Emirates (10%). Studies from other GCC countries were sporadic. Several studies demonstrated a clear emergence in antibiotic resistance especially against fusidic acid, ciprofloxacin and clindamycin. Regional prevalence of MRSA is reported as 25–35%, with clear dominance of community-acquired (CA)-MRSA. Panton– Valentine leucocidin (PVL)-producing strains accounted for 35–45%, with clear association with CA-MRSA emergence, but there were some sporadic reports of incorporation of PVL in healthcare-associated (HA)-MRSA. The reported dominant strains included EUST80, USA1100 and WA-MRSA-51. Novel strains are more likely to produce PVL and show fusidic acid resistance. Conclusion: There is a need for national and regional MRSA surveillance programmes, especially with the emergence of strains that require no underlying risk factors to cause illness, as well as the propagation of chimeric resistance elements in both HA-MRSA and CA-MRSA.

Allelic differences of chemokine (C-C motif ) receptor 5 (CCR5) and CCR2, as well as the ligand for the chemokine receptor CXCR4, stromal-derived factor (SDF-1), are known to suppress HIV-1 transmission and to be involved in delay in HIV-1 disease progression. The aim of our study was to investigate the frequencies of four mutations that confer resistance to HIV-1: CCR5-Delta32, CCR5-m303, CCR2-64I, and SDF1-3'A among Bahrainis. We have studied the DNA polymorphisms in 304 unrelated healthy Bahraini individuals without any known history of HIV-1 infection or AIDS symptoms. The CCR5-Delta32 mutation was detected by PCR analysis, while the CCR5-m303, CCR2-64I, and SDF1-3'A mutations were detected by PCR-restriction fragment length polymorphism (PCR-RFLP) tests. Allele frequencies and the fit to the Hardy-Weinberg equilibrium were evaluated using the Arlequin population genetics application. The frequencies of the CCR5-Delta32, CCR2-64I, and SDF1-3'A alleles were 2.8%, 8.9%, and 26.5%, respectively. No mutant alleles were detected for the CCR5-m303 mutation in 304 individuals. We estimated the risk of AIDS onset (relative hazard), computed from the three-locus genotype data. This is the first report of these four mutations conferring resistance to HIV-1 in the Bahraini population. The presence of the CCR5-Delta32 allele among Bahrainis may be attributed to the admixture with people of European descent. The CCR2-64I allele and especially the SDF1-3'A allele are predominant in the Bahraini population and may be associated with resistance to fast HIV-1 infection in Bahrainis, and thus their genotyping can be used for prognosis in HIV-infected individuals.

The severity of OSA as indicated by clinical score was positively correlated with degree of elevation of 8-Isoprostane and IL-6 in breath condensate of children with OSA and also with degree of cardiac dysfunction. Echocardiography and tissue Doppler modality are advised to examine these children.

Introduction: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. Methodology: This retrospective cohort study used laboratory records (January 2009 -May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. Results: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. Conclusions: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians' awareness to improve care of HIV-infected patients.

Bahrain has one of the highest incidence rates of type 2 diabetes mellitus (T2DM). Development of diabetic nephropathy (DN) as a complication was noticed in some patients while absent in others. This interesting observation raises the role of certain genetic risk factors for the development of DN. Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism was found to be associated with T2DM. While some patients have predisposition to DN in the population, others have negative association. The present case-control association study was designed to investigate the association of ACE I/D polymorphism in T2DM patients in Bahrain especially in those who developed DN. A total of 360 T2DM patients (110 with DN and 250 without DN) and 360 healthy (non-diabetic) age-matched subjects were recruited for this study for comparison. The presence (insertion)/absence (deletion) (I/D) polymorphism of a 287-bp Alu1 element inside intron 16 of the ACE gene was investigated using PCR-gel electrophoresis. The results show that the distribution of the homozygote DD genotype of the ACE gene was high among Bahraini T2DM patients compared to the healthy non-diabetic subjects. In addition, the distribution of the deletion (D) allele was high among Bahraini T2DM patients with DN when compared to the healthy non-diabetic subjects. However, there was no significant difference in the distribution of ACE I/D allele and genotypes between DN patients when compared to those T2DM patients without DN. The results obtained in this study are in closely agreement with some previous reports which show a strong association of ACE polymorphism with T2DM patients, yet not a risk factor for development of DN.

Insertion/deletion (I/D) polymorphism, of a 287-bp Alu repetitive sequence in intron 16 of the angiotensin-converting enzyme (ACE) gene has been shown to be associated with different types of diseases and has been widely investigated in different populations with different ethnic origins. Various reports were published suggesting inter-ethnic variations in the frequency of allelic forms of the ACE gene. The goal of this study was to test the distribution of alleles and the different genotypes of ACE (I/D) polymorphism in Bahraini subjects and compare the results with those obtained from other population studies. The Bahraini population is an Arabic peninsula population with a high prevalence of T2DM and hypertension. A total of 560 unrelated Bahraini individuals were recruited in this study and the presence (insertion)/absence (deletion) (I/D) polymorphism of a 287-bp Alu1 element inside intron 16 of the ACE gene was done by PCR-based assays and the presence or absence of the genotypes were analyzed by the gel electrophoresis. The distribution of II, ID, and DD genotypes showed differences among Bahraini subjects, and the frequency of the D allele was significantly (P < 0.05) higher in the studied group. The results obtained for the D allele are consistent with those obtained from previous studies among Arabs, Africans, and Caucasians, but differs significantly (P < 0.05) from those in Japanese and Chinese, thus proving the ethnic variation in the distribution of the ACE alleles in different populations.

Aim: COVID-19 pandemic continues and dearth of information remains considering the utility of various inflammatory biomarkers. We carried out the present study to delineate the roles of these biomarkers in various strata of patients with coronavirus infection. Materials & methods: A retrospective study was carried out after obtaining approval from the relevant Ethics Committee. Patients established with COVID-19 infection as shown by positive real-time quantitative PCR test were included. Details on their demographics, diagnosis, whether they received tocilizumab, and the values of the following biomarkers were obtained: IL-6, C-reactive protein (CRP), serum ferritin, D-dimer, procalcitonin, fibrinogen, lactate dehydrogenase and creatinine kinase. Receiver operating characteristic curves were plotted and correlation of biomarkers with IL-6 were estimated. Results: One-hundred and three patients were recruited. We observed that serum ferritin followed by D-dimer had better predictive accuracy in identifying patients with pneumonia compared with asymptomatic; and CRP in addition to the earlier markers had better accuracy for predicting severe illness compared with mild–moderate. Serum IL-6 levels were significantly higher in patients with severe illness admitted in intensive care unit. Significantly, higher levels of IL-6 and serum ferritin were observed in patients receiving tocilizumab. A trend of increased IL-6 levels was observed immediately following the initiation of tocilizumab therapy followed by a drop thereafter. Conclusion: We observed serum ferritin, D-dimer and CRP to accurately predict patients developing severe COVID-19 infections as well as those at risk of developing COVID pneumonia. A trend in IL-6 levels was observed in patients on tocilizumab therapy.

ProblemPregnancy remains an immune challenge for the uterus that has to adapt to a semi‐allogeneic fetus using various regulatory mechanisms. Both HLA‐G and regulatory T cells (CD4+ CD25+ FOXP3+ Tregs) are upregulated in successful pregnancy, but not in abortion. It is unclear if HLA‐G plays a role in the upregulation of regulatory cells.Method of StudyWe measured the level of both sHLA‐G and Treg cells in the blood of healthy pregnant multigravida, unexplained recurrent spontaneous abortions (URSA) and healthy non‐pregnant and nulliparous females. We cultured peripheral blood lymphocytes of healthy non‐pregnant multigravida females who never had an abortion with lymphocytes of their partners at ratio of 1:1, with and without sHLA‐G to detect changes in number of Treg cells, or relevant cytokines.ResultsSoluble HLA‐G concentrations and Treg cells percentage were significantly lower in women with URSA as compared to healthy pregnant multigravida women and were comparable to healthy non‐pregnant nulliparous women. Percentage of Tregs increased between zero time and mixed lymphocyte cultures (MLC) in both cultures with and without recombinant sHLA‐G but no significant difference between the two cultures. When stimulated with sHLA‐G the mean extracellular IL‐10 concentration was unchanged, while the mean INF‐γ concentration was slightly higher with no significant difference. Intracellular TGF‐β was higher in CD4+ cells after incubation with sHLA‐G.ConclusionThe results of this study are consistent with previous studies on the role of sHLA‐G and Treg cells in inducing immune‐tolerance in pregnancy. The results also suggest a possible role for HLA‐G in the enrichment of Treg cells.