Emergence of plasmid-encoded VIM-2-producing Pseudomonas aeruginosa isolated from clinical samples in Lebanon.

The present study aimed to describe the emergence of carbapenem-resistant Pseudomonas aeruginosa isolated from clinical Lebanese patients. The resistance of these isolates is due to the presence of the plasmid-encoded bla VIM-2 gene. We provide its first description in Lebanon, as well as a description of disruption of the oprD gene by mutations.

Extended spectrum beta-lactamase carriage state among elderly nursing home residents in Beirut.

INTRODUCTION: ESBL-producing Enterobacteriaceae can cause severe infections, but they are also isolated from the stool of asymptomatic subjects. Faecal carriage of such organism is poorly understood. METHODS: First phase of the study was cross-sectional with prevalence and epidemiology of ESBL faecal carriage in two nursing homes in Beirut: 57 residents in the first (NH1) and 151 residents in the second (NH2). In second phase, faecal swabs from cohort of NH1 residents were examined for carriage at six-week intervals over three-month period. Residents' charts were reviewed to assess carriage risk factors. RESULTS: Over 3 consecutive samplings at NH1, 81% of residents were at least one-time carriers with 50% at the first round, 60.4% at the second, and 74.5% at the last one. At NH2, 68.2% of residents were carriers. Constipation (in NH1) and antibiotic intake (in NH2) were significantly associated with higher ESBL faecal carriage while the length of stay at the nursing home (in NH2) was associated with less carriage. CONCLUSION: Faecal carriage of ESBL-producing Enterobacteriaceae is high among nursing home patients in Beirut. The rate of carriage changes rapidly and significantly over time either with multiple factors playing a possible role like outbreak spreading, antibiotic, and health care system exposure.

Home-based versus center-based care in children with cerebral palsy: a cost-effectiveness analysis.

The rehabilitation services for children with cerebral palsy are provided in two forms: home-based care and center-based care. The aim of this research was to evaluate the cost-effectiveness of the home-based accordance with the center-based care for kids with cerebral palsy. In this cost-effectiveness research, 56 children under 12 years old were assigned randomly to two rehabilitation programs: (1) clinic-based rehabilitation services (CBRS); and (2) home-based rehabilitation services (HBRS). Data were collected by two questionnaires: a strong life quality survey of children with cerebral palsy (CP QOL-Child) and medical and non-medical costs' checklists. Finally, the incremental expense-efficacy rate (ICER) was used to determine the further expenses of one unit of the quality of life gained by CBRS compared with HBRS. The mean costs per patients for the home-based care group were less than the ones for the clinic-based care unit (US$ 660.3 vs. US$ 933.8). The costs of the rehabilitation services and transportation were the main costs in the two patients' groups. The quality of life for cases in the home-based care group was better than the one of the clinic-based care team. The results showed that the home-based care method was more cost-effective than the centre-based care approach in children with cerebral palsy. The incremental cost-effectiveness ratio was calculated at about US$ 2.6. The conclusion was that home-based care centers were more cost-effective than the centre-based care centers for children with cerebral palsy. Therefore, it was suggested that the health policy makers pay more attention to developing home-based care strategy in physically challenged children.

Methimazole-induced myositis: a case report and review of the literature.

UNLABELLED: Methimazole is an anti-thyroid drug commonly used to treat hyperthyroidism and is a relatively safe medication. Several side effects have been reported and usually develop within 3 months of therapy. Well-known adverse reactions include agranulocytosis, hepatitis, skin eruptions, and musculoskeletal complaints such as myalgia, arthralgia, and arthritis. So far, myositis secondary to carbimazole was described in the context of a lupus-like syndrome or other rare cases of anti-neutrophil cytoplasmic antibodies-associated vasculitis. Methimazole-induced myositis occurring independently of such reactions was rarely stated. We report a patient with hyperthyroidism who, early after therapy with methimazole, developed hepatitis, eosinophilia, and fever that resolved completely after stopping the medication as well as a delayed onset of biopsy-proven eosinophilic myositis and fasciitis of gluteal muscles that resolved eventually without any additional therapy. Therefore, we raise the awareness regarding a rare side effect of methimazole: myositis. LEARNING POINTS: Several differential diagnoses arise when managing a hyperthyroid patient with muscle complaints.Both hyperthyroidism and methimazole are associated with myositis.Methimazole-induced myositis is a rare clinical entity.Resolution of symptoms may occur after stopping methimazole.

Implantable electrophysiologic cardiac device infections: a risk factor analysis.

The risk of cardiac device infection (CDI) is rising significantly, with several risk factors identified. The purpose of this study is to determine the rate of CDI at our center and to assess the associated risk factors, in order to define appropriate measures to prevent this complication. We retrospectively reviewed all cases of patients with CDI at St. George Hospital between February 1999 and July 2010. Each case was matched with three controls. We performed a descriptive and bivariate analysis to identify significant risk factors. Eighteen case patients and 54 control subjects met the inclusion criteria. An organism was recovered in 58 % of the cases. Significant risk factors included previous history of CDI (p < 0.001), recent manipulation (p < 0.001), trauma to the site of implant (p = 0.003), having a dual chamber/dual lead pacemaker (p = 0.002), and development of post-procedural hematoma (p = 0.012). Our findings complement the results of previous studies. We recommend a pre-procedural risk assessment and a thorough post-implantation follow-up to prevent the development of infective complications.

Estudio comparativo entre el 18-FDG PET/CT y la técnica de ganglio centinela para la detección de metástasis axilares en cáncer de mama. Resultados preliminares del protocolo Roffo PET/CT 1 / Comparative study between 18-FDG PET/CT and centinela node technique for the detection of axillary metastases in breast cancer. Preliminary results of Roffo PET/CT 1 protocol

Objetivo: comparar al capacidad del PET y del ganglio centinela (GC) para la detección de metástasis (MTS) axilares. Evaluar la sensibilidad, especificidad, valor de predicción positivo y negativo del PET/CT. Criterios de inclusión: cáncer de mama T1 T2 N0. Pacientes con axilas clínicamente dudosas. Criterios de exclusión: carcinoma ductal in situ, carcinoma inflamatorio, biopsia reciente de mama o axila, embarazo o lactancia, diabetes. Método: el 18-FDG PET/CT se realizó 15 días antes de la cirugía. La técnica de ganglio centinela se efectuó con el método combinado (radiosótopos y azul patente). Material: fueron evaluadas 44 pacientes. Edad promedio 58 años (37-79). T1: 29 pacientes (66%); T2: 15 pacientes (34%). Tamaño tumoral entre 5 y 40mm (promedio 19mm). Axila clínicamente negativa: 38 (86%); axila dudosa 6 (14%). Estadio I: 27 pacientes (61%); estadio II: 17 pacientes (39%). Once pacientes tuvieron tumores no palpables (25%). Nueve pacientes (20%) tuvieron biopsias previas. Resultados: treinta y siete (84%) tumores fueron carcinomas ductales infiltrantes; 5 (11%) lobulillares; y 2 (5%) ductolobulillares. Doce pacientes tuvieron MTS en el GC (27%), de éstas 2 casos eran micrometástasis (17%). En 2 pacientes el PET/CT cambió la estadificación, ya que fue positivo para metástasis óseas y pulmonares. Resultados PET en mama: once negativos (FN: 20%). Tres (33%) eran carcinomas lobulillares infiltrantes; 3 eran T1a (33%). Sensibilidad 79% VPP=100%. Resultados PET en axila: en 36 pacientes el PET fue negativo (82%); 4 de éstas presentaron MTS en el ganglio centinela; 2 de ellas eran micrometástasis. Falso negativo: 33%. Sensibilidad: 66%. En 8 pacientes el PET fue positivo (18%) y el ganglio centinela presentaba MTS en todos los casos. Especificidad: 100%. VPP=100%. En 6 pacientes la axila era dudosa, de éstas sólo en una paciente el PET y el GC fueron positivos.(AU)

Estudio comparativo entre el 18-FDG PET/CT y la técnica de ganglio centinela para la detección de metástasis axilares en cáncer de mama. Resultados preliminares del protocolo Roffo PET/CT 1 / Comparative study between 18-FDG PET/CT and centinela node technique for the detection of axillary metastases in breast cancer. Preliminary results of Roffo PET/CT 1 protocol

Objetivo: comparar al capacidad del PET y del ganglio centinela (GC) para la detección de metástasis (MTS) axilares. Evaluar la sensibilidad, especificidad, valor de predicción positivo y negativo del PET/CT. Criterios de inclusión: cáncer de mama T1 T2 N0. Pacientes con axilas clínicamente dudosas. Criterios de exclusión: carcinoma ductal in situ, carcinoma inflamatorio, biopsia reciente de mama o axila, embarazo o lactancia, diabetes. Método: el 18-FDG PET/CT se realizó 15 días antes de la cirugía. La técnica de ganglio centinela se efectuó con el método combinado (radiosótopos y azul patente). Material: fueron evaluadas 44 pacientes. Edad promedio 58 años (37-79). T1: 29 pacientes (66%); T2: 15 pacientes (34%). Tamaño tumoral entre 5 y 40mm (promedio 19mm). Axila clínicamente negativa: 38 (86%); axila dudosa 6 (14%). Estadio I: 27 pacientes (61%); estadio II: 17 pacientes (39%). Once pacientes tuvieron tumores no palpables (25%). Nueve pacientes (20%) tuvieron biopsias previas. Resultados: treinta y siete (84%) tumores fueron carcinomas ductales infiltrantes; 5 (11%) lobulillares; y 2 (5%) ductolobulillares. Doce pacientes tuvieron MTS en el GC (27%), de éstas 2 casos eran micrometástasis (17%). En 2 pacientes el PET/CT cambió la estadificación, ya que fue positivo para metástasis óseas y pulmonares. Resultados PET en mama: once negativos (FN: 20%). Tres (33%) eran carcinomas lobulillares infiltrantes; 3 eran T1a (33%). Sensibilidad 79% VPP=100%. Resultados PET en axila: en 36 pacientes el PET fue negativo (82%); 4 de éstas presentaron MTS en el ganglio centinela; 2 de ellas eran micrometástasis. Falso negativo: 33%. Sensibilidad: 66%. En 8 pacientes el PET fue positivo (18%) y el ganglio centinela presentaba MTS en todos los casos. Especificidad: 100%. VPP=100%. En 6 pacientes la axila era dudosa, de éstas sólo en una paciente el PET y el GC fueron positivos.

Symptoms of ovarian cancer in young patients 2 years before diagnosis, a case-control study.

Ovarian cancer is usually diagnosed after it has spread and is difficult to cure. Most of attempts to identify early symptoms have lacked control group or have been based on interviews. We examined early symptoms of ovarian cancer in young women and compared with a matched control group. Symptoms recorded in medical files of 100 women aged 15-35 years with ovarian cancer who were referred to Vali-Asr hospital between 1995 and 2005. Symptoms of cases were compared with 100 matched controls during 2 years before diagnosis. More cases (95%) than controls (28%) complained of at least one symptom up to 2 years before diagnosis, most of these symptoms were abdominal. Others included urinary symptoms, infertility and abnormal vaginal bleeding. The most common symptoms among cases were: unusual abdominal or lower back pain 52%, unusual bloating, fullness and pressure in the abdomen 37%, gastro-intestinal problems 36%. In total, 11%, 3% and 12% of controls reported these symptoms respectively, resulting in odds ratios of 8.7, 18.9 and 4.1 respectively for these symptoms. Unusual abdominal or lower back pain, fullness and pressure, gastrointestinal, urinary problems and infertility should make women and physicians more aware of changes associated with ovarian cancer.

Middle East and North Africa consensus on osteoporosis.

With the increasing life expectancy, osteoporosis is becoming a major worldwide health problem. The magnitude of the disease may become larger in developing countries, more particularly in the Middle East region where the prevalence of low bone mass is higher than in western countries. Although several local organizations and countries have developed guidelines for osteoporosis, no previous regional guidelines have been developed encompassing all Middle-Eastern and North African countries. The present document reviews all the regional published data on bone mineral density, risk factors, fracture prevalence and vitamin D status. It also gives simple recommendations applicable to all these countries. This document was endorsed by leading members of all the different regional countries including, Iran, Egypt, Tunisia, Jordan, Palestine, Syria, Iraq, Libya, Oman, Kuwait, Saudi Arabia and Bahrain.

Right congenital diaphragmatic hernia a well-known pathology?

In right congenital diaphragmatic hernia (RCDH), several clinical diagnostic pitfalls are possible and should be known to those caring for infants and children with this disorder. The records of the 18 patients at Hotel Dieu de France Hospital with a history of CDH between 1990 and 1999 were collected; those of the ten who had a RCDH were reviewed retrospectively. The mean age at diagnosis was 6 months; the male-to-female ratio was 2:3. The delay between the first symptom and the diagnosis ranged between 0 and 10.5 months (mean 4.5 months). An acute presentation was observed in four cases, consisting of respiratory distress in three; the 4th presented with gastric volvulus and intestinal obstruction. The presenting symptoms were mild in four cases; recurrent respiratory infections in three and failure to thrive in one. The diagnosis was incidental in two cases during the evaluation of respiratory symptoms attributed to an atrial septal defect. The radiologic findings provided by a chest radiograph (CxR) were sufficient to make an accurate diagnosis in eight cases and peritoneography was useful in one. In six cases, the presenting CxR had been misinterpreted as normal or acute lobar pneumonia. Pathologic findings at surgery consisted of lateral and posterior right diaphragmatic defects in nine cases; the defect was lateral and anterior in one. A hernia sac was found in seven cases; malrotation was present in three. Surgical correction was done by an abdominal approach in nine cases and a thoracic approach in one. The diaphragmatic defect was repaired by transverse closure in six cases, diaphragm plication in three and prosthetic closure in one. The postoperative outcome was uneventful in eight cases. Two patients died. Thus, RCDH seems to cause less severe symptoms than left-sided LCDH. It usually manifests beyond the neonatal period as respiratory or gastrointestinal symptoms. The diagnosis should be made easily by a CxR. The presence of a hernia sac correlated with a mild presentation. An abdominal surgical approach is preferred.

Double-blind placebo-controlled trial of terazosin effect on blood pressure and urinary output of dopamine in hypertensive patients.

In a parallel, double-blind study, 12 untreated hypertensive patients received terazosin (2-4 mg/day for 4 weeks), and 12 received placebo during the same period. Systolic and diastolic blood pressure decreased significantly in the terazosin group, from 150 +/- 5.0 mmHg systolic and 99.6 +/- 2.0 diastolic before treatment, to 134.0 +/- 7.0 systolic and 85.6 +/- 3.0 mmHg diastolic at week 4 of treatment. No significant blood pressure changes occurred in the placebo group. Blood pressure decrease showed a positive correlation (r = .62 and r = .52 for systolic and diastolic blood pressure, respectively) with the patient's age (P less than .05). Total plasma cholesterol decreased 18% in the terazosin group (P less than .05) and 9% in the placebo group (P greater than .05). Urinary dopamine excretion decreased significantly from 692.8 +/- 180.0 to 330.5 +/- 52.0 micrograms/24 hours in the terazosin group (P less than .05) and showed a nonsignificant increase in the placebo group. Compared with 22 age- and sex-matched healthy volunteers, urinary dopamine excretion in the hypertensive group before treatment was not statistically different (779.3 +/- 83.1 micrograms/24 hours). Dopamine excretion was higher in untreated hypertensive men and in male healthy volunteers compared with women. The decrease of urinary dopamine excretion observed under terazosin treatment could be due to a decrease of kidney dopamine synthesis or release induced by blood pressure reduction, or secondarily to the blockade of kidney alpha 1-receptors, modulating dopamine excretion. No significant changes were observed in urinary excretion of noradrenaline and adrenaline.

Tritiated water exchange in the human uterine cavity.

Measurements with the use of tritiated water (3H2O) in human volunteers indicate that the mean tritiated water half life (t1/2 3H2O) in the uterine cavity is 1.3 minutes. This figure is very close to that previously measured in subhuman primates. By extrapolation from various prior studies the volume of the human uterine cavity (aVc) may be assumed to approximate 0.4 to 0.6 ml. According to the formula aVc divided by 2 x 1,440 divided by (t1/2 3H2O) water turnover in the human endometrial canal is calculated to range from 222 to 332 ml/24 hours.

3H2O volume and exchange in uterine cavity of monkeys.

A technique was developed to measure water exchange in the endometrical canal (uterine cavity). This type of determination should provide information necessary to understanding intrauterine pharmacokinetics. In the study described, measurements were performed on one cynomologus and four rhesus monkeys. Endometrial fluid in the uterine cavity was replaced with a 3H2O solution of known specific radioactivity (dpm/ml). Radioactivity remaining in the cavity at measured intervals of approximately 0.5, 1, 2, and 3 min following replacement was determined by flushing out the cavity. By extrapolating the 3H2O disappearance curve versus time to t = 0 (zero time), the apparent cavity volume (aVc) was derived. Values for aVc and t 1/2 3H2O were used to calculate endometrial fluid-water turnover rate. Mean values determined in four rhesus monkeys were as follows: aVc, 0.032 ml; t 1/2 H2O, 1.17 min; 24-h H2O turnover, 19.5 ml. In general, this value for H2O turnover was considerably higher than values of endometrial fluid production quantitated by other techniques. Water measurements in human uteri similar to those reported here appear feasible and are anticipated in future work.

Effective body water half-life and total body water in rhesus and cynomolgus monkeys.

Although body water content and effective water half-life have been determined in several mammalian species, including man, these measurements are not available for sub-human primates to our knowledge. Values were therefore determined in a group of rhesus and cynomolgus monkeys. A fairly wide range of water half-life values was found in each of the two species between animals, but there was little variation within animals who had more than one determination over the course of 1 year. Mean values for effective water half-life were 7.2 days and 3.7 days for naturally menstruating females of the cynomolgus and rhesus species, respectively. Water half-life in female rhesus monkeys with artificial menstrual cycles averaged 6.2 days. Females of both species had a similar percentage of body water content of 64%. Water half-life measured 7.1 and 8.5 days in two male rhesus; and water content was 62% of body weight in one of these animals.

Cervicectomy with uterovaginal anastomosis in the rhesus monkey: a new surgical model for reproductive studies.

Cervicectomy with uterovaginal anastomosis in the rhesus monkey allows easy and non-traumatic access to the uterine cavity through the vagina for such purposes as biopsy, flushing, aspiration of fluid, and placement of IUDs. Endometrial and tissue samples cannot be contaminated by cervical mucus. The surgical procedure and results on eleven animals are described. Neither uterine nor ovarian function appeared to be significantly altered. The surgical model seems well suited to long-term studies on IUDs.

PIP: A surgical model for gaining access into the uterine cavity while avoiding the cervical canal in the rhesus monkey was developed. The procedure, which was carried out on 11 rhesus monkeys, employs the removal of the cervix with uterovaginal anastomosis. The monkeys were operated on over the span of 1 year, and at this time the uterine cavities of 9 of the monkeys can still be probed. Menstrual blood loss was measured both pre- and postoperation; there were no signigicant differences. Spontaneous postoperative expulsion of an IUD resulted in blockage or distortion of the anastomosis in 1 monkey; and in another the anastomosis was patent for a least 5 months, but later became impenetrable. It is concluded that the surgical model is well suited to long-term studies on IUDs.