ABSTRACT
Multi-drug resistant bacteria have become a major global healthcare problem in the twenty-first century thus an urgent need for products that act on novel molecular targets that circumvent resistance mechanisms, garlic is one of hundreds of plants that are used in traditional medicine as treatment for bacterial infections, In this study, we tried to uncover the effect of different concentrations of local Aqueous Garlic Extract [AGE] on Multi-drug organisms including Escheichia coli [ESBL],Klebsiella pneumonia [ESBL],Pseudomona aeruginosa,Acinitobacter spp, MRSA, by disk diffusion and agar well diffusion assay. All tested organisms were inhibited by AGE up to 25% concentration and the activity was a linear function of concentration. At 100%, the maximum zone of inhibition was observed against MRSA, a Gram positive organism and the minimum was against Klebsiella pneumonia [ESBL], a Gram-negative organism. This indicates that AGE has the potential of a broad spectrum of activity against both Gram-positive and Gram-negative bacteria. In conclusion, the results of this study have provided scientific Justification for the use of local garlic extract in health products and herbal remedies against multidrug-resistant bacterial infections in Kingdom of Saudi Arabia
ABSTRACT
Allogeneic stem cell transplantation [SCT] offers the best chance of cure and long-term survival for children with myelodysplastic syndromes [MDS]. Retrospective analysis of pediatric patients with primary MDS treated with allogeneic SCT at a single institution treated between January 1993 and December 2008. Of 16 consecutive children who received allogeneic SCT for treatment of MDS in our center, 14 patients met the criteria of MDS according WHO I and II criteria. The median age was 4.8 years [range, 1-14 years] and 64% were male. The median time from diagnosis to transplant was 6 months. MDS stage was refractory cytopenia [RC] in 9, refractory anemia with excess blasts [RAEB] in 5. Monosomy 7 was present in 35% of the patients. The majority of patients [11/14] were conditioned with a busulfan-based myeloablative [MA] regimen with addition of low-dose of etoposide [30 mg/kg]. All but one received a bone marrow graft. Nine patients achieved complete remission [CR], and seven remain alive. At a median follow-up of 3 years [range, 2-14 years] the OS and EFS was 57% [95%CI, 0.28-0.78]. Cumulative EFS at 10 years was 43% [95% CI: 0.14-0.70]. Relapse-related mortality was 21.4%; nonrelapse mortality [NRM] was 28.57%. All the survivors had etoposide in their conditioning regimen. Patients younger than 10 years had better survival [P=.001]. Children with MDS achieve encouraging OS and EFS following allogeneic SCT. A busulfan-based regimen with a lower dose of etoposide is an effective and less toxic regimen. The outcomes are best in younger patients
ABSTRACT
Stem cells from umbilical cord blood [CB] have increasingly become a viable alternate source of progenitor cells for hematopoietic cell transplantation [HSCT] Cytomegalovirus [CMV] is thought to contribute significantly to HSCT morbidity and mortality. Retrospective case-control study in patients at tertiary care center. We determined the incidence, risk factors and outcomes for CMV infection and disease after unrelated cord blood transplantation [UCBT] in children. Between 2003 and 2007, 73 pediatric patients underwent UCBT and 68% of recipients were CMV seropositive. The overall incidence of CMV infection, early and late CMV infection was 58.9% [43/73], 62.8% [27/43], and 37.4% [1 6/43], respectively. In patients with early CMV infection, 6 of 27 [22%] patients progressed to develop CMV end-organ disease including pneumonitis and retinitis. High levels CMV antigenemia >70 infected cells by pp65 antigenemia assay + PMNs, P-.237 were associated with a higher risk of progression to CMV disease. The development of CMV infections was higher in CMV-seropositive recipients [P<.001] and in those who developed graft-versus-host-diseases [GVHD] [P<.001]. Other risk factors for CMV infection include the use of high-dose corticosteroids [P<.001] and older age of the recipient at the time of transplant [P<.002]. Late CMV infection was strongly associated with a previous history of early CMV infection [P<.001]. CMV infection is a significant complication in UCBT recipients in pediatric patients and is associated with an increase in transplant-related morbidity and mortality. Risk factors for CMV infections after UCBT include GVHD, use of corticosteroids, underlying diseases [hematologic malignancies] and older age. Late CMV infection was strongly associated with a previous history of CMV infection
Subject(s)
Humans , Infant , Male , Female , Child , Cord Blood Stem Cell Transplantation , Incidence , Risk Factors , Retrospective Studies , Case-Control StudiesABSTRACT
The Eastern Mediterranean Bone Marrow Transplantation [EMBMT] Group has accumulated over 25 years of data and experience in hematopoietic stem cell transplantation [HSCT], most particularly in he-moglobinopathies, severe aplastic anemia [SAA], and inherited metabolic and immune disorders, in addition to hematologic malignancies peculiar to the region and where recent updates in trends in activities are warranted. To study trends in HSCT activities in the World Health Organization-Eastern Mediterranean [EM] region surveyed by EMBMT between 2008 and 2009. STUDY DESIGN: Retrospective analysis of the survey data, mainly of the cumulative number of transplants, types of transplants [autologous vs. allogeneic], types of conditioning as myeloablative [MAC] vs. reduced intensity conditioning [RIC] and trends in leukemias, hemo-globinopathies, SAA, inherited bone marrow failure syndromes amongst others. Fourteen teams from ten Eastern Mediterranean Region Organization [EMRO] countries reported their data [100% return rate] to the EMBMT for the years 2008-2009 with a total of 2608 first HSCT [1286 in 2008; 1322 in 2009]. Allogeneic HSCT represented the majority [63%] in both years. The main indications for allogeneic HSCT were acute leukemias [732; 44%], bone marrow failure syndromes [331, 20%], hemoglobinopathies [255; 15%] and immune deficiencies [90; 5%]. There was a progressive increase in the proportions of chronic myeloid leukemia [CML] cases transplanted beyond the first chronic phase [3; 7% of all CML cases in 2008 vs 13; 29% in 2009]. The main indications for autologous transplants were plasma cell disorders [345; 36%] Hodgkin disease [256; 27%], non-Hodgkin lymphoma [207; 22%] and solid tumors [83; 9%]. RIC continued to show a progressive increase over the years [7% in 2007, 11% in 2008 and 13% in 2009], yet remained relatively low compared to contemporary practices in Europe published by EBMT. The vast majority [95%] of allo-HSCT sources were from sibling donors with a continued dominance of peripheral blood [PB] [1076; 63%], while cord blood transplant [CBT] increased to 83 [5% of allo-HSCT], matched unrelated donor [MUD] remained underutilized [1; 0%] and there were no haploidentical transplants reported. Large centers with >50 HSCT/year showed a plateau of the total number of allo-HSCT over the last 5 years that may be related to capacity issues and needs further study. There is an overall increased rate of HSCT in the EMRO region with a significant increase in utilization of CBT and allogeneic PB-HSCT as a valuable source. However, further research on outcome data and development of regional donor banks [CB and MUD] may help facilitate future planning to satisfy the regional needs and increase collaboration within the group and globally
Subject(s)
Humans , Retrospective Studies , Health Surveys , Transplantation, Homologous , Transplantation, AutologousABSTRACT
The study included 36 cases with congenital heart disease [CHD] all of them had left to right shunt [17 cases of them had pulmonary hypertension [PHT], 30 cases with valvular rheumatic heart disease [RHD] [15 of whom had PHT]. Ten healthy normal age-matched children were taken as control for each group. Full history and physical examination, pulse oximetry, standard 13-lead ECG and detailed echocardiographic examination were done for every patient and control case. Chest radiograph posterantrior view in erect position was done for all patients. Erythrocytic sedimentation rate, C-reactive rotein and antistreptolysin-O titer were done for patients with RHD. All cases and controls had the following done: plasma level of endothelin-1 [ET-1], angiotesin-II [ANG-II], nitric oxide [NO] and serum level of angiotesin-converting enzyme [ACE] activity. The mean peak pulmonary pressure [PP] in patients having CHD and PHT was 54.35 +/- 9.69 mm Hg, while it was 61.73 +/- 11.55 mm Hg in those with RHD and RHT. The mean peak PP in the group of patients having CHD without PHT was 22.64 +/- 4.11 mm Hg. It was significantly higher than in those with RHD without PHT [9.41 +/- 1.98 mm Hg, P<0.05] and than controls [4.12 +/- 1.25, P<0.01]. It was observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in all cases with CHD [3.42 +/- 0.77, 77.21 +/- 29.14, 81.27 +/- 37.3, 107.2 +/- 47.65, P<0.001], cases with PHT [3.76 +/- 0.81, 94.1 +/- 21.1, 101.4 +/- 33.8, 136.2 +/- 37.9, P<0.001] OR without PHT [2.92 +/- 0.6,61.36 +/- 27.5, 63.28 +/- 16.5, 85.36 +/- 22.6, P<0.5 and 0.01] than in their controls [1.86 +/- 0.6, 34.07 +/- 10.7, 19.15 +/- 10.9, 54.1 +/- 32.1]. It was observed that the mean level of ET-1, NO, ANG-II and ACE were significantly higher in cases with CHD with PHT than in those without PHT [p<0.05 for each]. In the group of patients with RHD, it was observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in all cases [3.89 +/- 1.4, 78.46 +/- 59, 70.35 +/- 37.4, P<0.01 and 0.001] and cases with PHT [4.9 +/- 1.0, 100.5 +/- 32, 95.7 +/- 36.8, 121 +/- 40.9, P <0.001] than in controls [1.55 +/- 0.5, 33.47 +/- 13.0, 22.68 +/- 11.1, 53.27 +/- 32.4]. It was also observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in cases with than in those without PHT [2.6 +/- 0.8, 56.5 +/- 18.0, 44.96 +/- 12.7, 63.3 +/- 37] [P<0.01]. It was observed that the mean levels of ET-1, ANG-II and ACE were significantly higher in cases with CHD having heart failure [3.8 +/- 0.73, 106.8 +/- 50.37, 155.3 +/- 65.66] than those without heart failure [3.26 +/- 0.7, 69.88 +/- 25.1, 91.85 +/- 32.8], P<0.05 and 0.001. There was statistically significant positive correlation between PP in all the studied patients and serum level of ET-1, NO, ANG-II and ACE [P<0.001]. A significant positive corrlation was found between serum level of ET-1 and NO in all the studied cases [P<0.05]. A significant positive correlation was also found between serum level of ANG-II and ACE in all the studied cases [P<0.03]. ET-1 and NO production is increased in cases with PHT secondary to CHD with left to right shunt and to RHD and its production correlates with the level of PP. It could be also concluded that the level of ANG-II and ACE activity is increased in cases with PHT secondary to CHD with left to right shunt and to RHD and its production correlates with the level of PP. The use of NO, NO donors, prostacyclin and ET-1 antagonists should be considered in the management of pulmonary hypertension secondary to hyperkinetic arterial PHT due to CHD with left to right shunt and in the management of venous pulmonary hypertension secondary to RHD. The long-term effect of such drugs on the pathological process in such cases should be studied. Still early intervention in cases with hyperkinetic arterial PHT due to CHD with left to right shunt before the end of the first year of life is highly recommended. It may be also suggested that the use of ACE inhibitors could be useful to prevent the effects of ANG-II on the pulmonary vascular pathology
Subject(s)
Humans , Male , Female , Rheumatic Heart Disease , Hypertension, Pulmonary , Echocardiography , Blood Sedimentation , C-Reactive Protein , Antistreptolysin , Endothelin-1 , Nitric Oxide , Angiotensin II , Peptidyl-Dipeptidase A , ChildABSTRACT
Therapy for patients with congenital sideroblastic anemia has been limited to blood transfusions and chelation. Five patients with Congenital Sideroblastic anemia [CSA] who were blood transfusion dependent underwent stem cell transplantation [SCT] from matched sibling donors. Their ages at SCT were 1,2,3,5 and 8 years. Conditioning consisted of cyclophasphamide 50 mg/kg/day for 4 days, busulfan 4 mg/kg/day for days and antithymocyte globulin [ATG] 30 mg/kg/for 4 doses pretransplant. For Graft vs. Host disease [GVHD] prophylaxis, cyclosporin A and methotrexate were used. All patient engrafted, and are alive with sustained engraftment and are transfusion independent. Two patients developed acute GVHD, and none of the patients developed chronic GVHD. In conclusion SCT can be curative for patients with CSA
Subject(s)
Humans , Male , Female , Anemia, Sideroblastic/congenital , Follow-Up Studies , Treatment Outcome , Blood TransfusionABSTRACT
Kasabach-Merritt syndrome is an infrequent combination of Kaposiform hemangio-endothelioma and severe thrombocytopenia, which may be life- threatening with an overall mortality rate of 20-30% and for which there are no definitive methods of treatment. A retrospective data collection of a single institute [KFSHRC]* reporting three cases of Kasabach-Merritt syndrome, showing a very good response to tranexamic acid with the reversal of the hematological disorder, decrease in steroid requirement and diminution of the size of the lesion in few months duration. The early use of tranexamic acid in the treatment of Kasabach-Merritt syndrome, especially the non-resectable vascular tumors, was recommended to be combined with interferon-alpha or steroid therapy for children