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Fusaro M, Giannini S, Miozzo D, Noale M, Tripepi G, Plebani M, Zaninotto M, Piccoli A, Vilei MT, Cristofaro R, Gallieni M, Hamamoto K, Inaba M, Okuno S, Imanishi Y, Ishimura E, Yamakawa T, Shoji S, Rothe HM, Eller P, Mayer G, Ketteler M, Kramar R, Shaheen F, Al Rukhaimi M, Alsahow A, Al-Ali F, Al Salmi I, Al Ghareeb S, Wang M, Bieber B, Robinson BM, Pisoni RL, Waniewski J, Debowska M, Wojcik-Zaluska A, Ksiazek A, Zaluska W, De Broe ME, Wilson RJ, Copley JB, Hiramtasu R, Ubara Y, Hoshino J, Takaichi K, Ghalli FG, Ghalli FG, Ibakkanavar R, Chess J, Roberts G, Riley S, Oliveira ASA, Carvalho CJB, Oliveira CBL, Pessoa CTBC, Leao RAS, Gueiros JEB, Gueiros APS, Okano K, Tsuruta Y, Hibi A, Tsukada M, Miwa N, Kimata N, Tsuchiya K, Akiba T, Nitta K, Mizobuchi M, Ogata H, Hosaka N, Sanada D, Arai N, Koiwa F, Kinugasa E, Shibata T, Akizawa T, Delanaye P, Krzesinski JM, Warling X, Moonen M, Smelten N, Medart L, Pottel H, Cavalier E, Delanaye P, Souberbielle JC, Gadisseur R, Dubois BE, Krzesinski JM, Cavalier E, Matias P, Jorge C, Mendes M, Azevedo A, Navarro D, Ferreira C, Amaral T, Aires I, Gil C, Ferreira A, Kikuchi H, Shimada H, Karasawa R, Suzuki M, An WS, Lee SM, Oh YJ, Son YK, De Paola L, Lombardi G, Panzino MT, Lombardi L, Reichel H, Hahn KM, Kohnle M, Guggenberger C, Delanna F, Sasaki N, Tsunoda M, Ikee R, Hashimoto N, Sola L, Leyun MN, Diaz JC, Sehabiague C, Gonzalez S, Alallon W, Bourbeau K, Lajoie C, Macway F, Fujii T, Suzuki S, Shinozaki M, Tanaka H, Klingele M, Seiler S, Poppleton A, Lepper P, Fliser D, Seidel R, Lun L, Liu D, Li X, Wei X, Miao J, Gao Z, Hu R, De Paola L, Lombardi G, Panzino MT, Lombardi L, Gros B, Galan A, Gonzalez-Parra E, Herrero JA, Echave M, Vegter S, Tolley K, Oyaguez I, Gutzwiller FS, Braunhofer PG, Szucs TD, Schwenkglenks M, Yilmaz VT, Ozdem S, Donmez L, Kocak H, Dinckan A, Cetinkaya R, Suleymanlar G, Ersoy FF. DIALYSIS BONE DISEASE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Al-Ali F, Cree T, Duan L, Hall S, Jefferson A, Louis S, Major K, Smoker S, Walker S. How effective is endovascular intracranial revascularization in stroke prevention? Results from Borgess Medical Center Intracranial Revascularization Registry. AJNR Am J Neuroradiol 2011; 32:1227-31. [PMID: 21778241 DOI: 10.3174/ajnr.a2670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%-99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes. MATERIALS AND METHODS We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%-99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first. RESULTS We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%-99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS. CONCLUSIONS Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stent-placement arm compared favorably with the WASID results.
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Affiliation(s)
- F Al-Ali
- Neurosurgery of Kalamazoo, Kalamazoo, Michigan, USA.
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Al-Ali F, Cree T, Hall S, Louis S, Major K, Smoker S, Walker S. Predictors of unfavorable outcome in intracranial angioplasty and stenting in a single-center comparison: results from the Borgess Medical Center-Intracranial Revascularization Registry. AJNR Am J Neuroradiol 2011; 32:1221-6. [PMID: 21546459 DOI: 10.3174/ajnr.a2530] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared. MATERIALS AND METHODS This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked. RESULTS From April 2002 to January 2009, 140 subjects with 159 lesions (50%-100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; P = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days (P = .0439) and restenosis (P = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days (P = .008). Eccentric lesions were more likely to have stroke than concentric lesions (P = .0726). CONCLUSIONS In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.
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Affiliation(s)
- F Al-Ali
- Borgess Medical Center, Borgess Research Institute, Kalamazoo, Michigan, USA.
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Hira PR, Al-Ali F, Shweiki HM, Abdella NA, Johny M, Francis I, Iqbal J, Thompson R, Nevar F. Strongyloidiasis: challenges in diagnosis and management in non-endemic Kuwait. Ann Trop Med Parasitol 2004; 98:261-70. [PMID: 15119971 DOI: 10.1179/000349804225003299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Among immunocompromised individuals, hyper-infection with Strongyloides stercoralis may occur and lead to fatal strongyloidiasis. To clinicians and laboratory diagnosticians in non-endemic countries such as Kuwait, this severe infection poses a particular problem. The clinical histories and signs and symptoms of four Kuwaiti cases of S. stercoralis hyper-infection were reviewed. Each of the four was found not only to have lived in an area where S. stercoralis was endemic but also to have been treated with immunosuppressive steroids (for medical problems unrelated to the nematode infection). When they presented with undiagnosed hyper-infections their clinical features were confusing. Three of the cases, all with low eosinophil counts, died but the other, who was treated with thiabendazole, survived. In the light of these observations, healthy medical examinees who had recently moved from endemic zones were checked for asymptomatic S. stercoralis infection, both by stool examination and ELISA-based serology. Of 381 stool samples investigated over a 3-month period, 183 (48%) were found positive for helminths, 7% for S. stercoralis. Of 198 individuals from endemic zones who were screened after another medical examination, 71 (35.8%) were found positive for intestinal helminth parasites, including one (1.45%) infected with S. stercoralis. Although ELISA appear reliable in making a presumptive diagnosis of strongylodiasis, the results of such assays are not very specific and are best interpreted in conjunction with the patient's clinical status. The concurrent administration of anthelminthics to patients prescribed steroids who, because they live or have lived in an area where S. stercoralis is endemic, are at risk of infection with the nematode, should be considered.
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Affiliation(s)
- P R Hira
- Department of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
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Hira PR, Iqbal J, Al-Ali F, Philip R, Grover S, D'Almeida E, Al-Eneizi AA. Invasive amebiasis: challenges in diagnosis in a non-endemic country (Kuwait). Am J Trop Med Hyg 2001; 65:341-5. [PMID: 11693881 DOI: 10.4269/ajtmh.2001.65.341] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Invasive zymodemes of the enteric protozoan Entamoeba histolytica infect the large intestine and cause extra-intestinal lesions such as amebic liver abscess (ALA). The clinical manifestations of ALA are protean, particularly in patients presenting in a non-endemic, desert country such as Kuwait, and diagnosis becomes problematic. In this study, we present cases of ALA to illustrate the clinical and diagnostic challenges. For serodiagnosis of ALA, we compared the sensitivity and specificity of the indirect hemagglutination assay (IHA) with the ImmunoTab assay and an enzyme-linked immunosorbent assay (ELISA) for this geographic region. We tested sera of 110 patients with ALA, 1,224 patients suspected of having invasive amebic infection, and 50 Europeans with no travel history to an amebic-endemic area. The IHA was simple, rapid, easy to perform, and reliable (sensitivity = 99%, specificity > 95%). The performance of the IHA in detecting ALA in suspected cases was significantly better than that of the ELISA and the ImmunoTab test. Compared with the IHA, both the ELISA and ImmunoTab assay detected relatively higher numbers of false-positive cases (4.7% and 3.6%, respectively). With the availability of ultrasound and computed tomography scans, the serology correlates excellently with the clinical presentation. In chronic cases where fibrosis may be present around the abscess, the IHA has limitations, as in the follow-up of treated patients. Pitfalls in diagnosis are highlighted by discussing the differential diagnosis of ALA from bacterial hepatic abscesses and infected hydatid cysts. Most importantly, the IHA in such cases was invariably at a titer that is considered not significant.
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Affiliation(s)
- P R Hira
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City
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Abstract
OBJECTIVE To detect the incidence of cryptosporidial infection in children presenting with gastrointestinal symptoms at the local hospital in Kuwait. METHODS Over a period of 3 years, September 1995 to August 1997, a single fecal sample from 3549 children was analyzed by modified saframin-methylene blue (SM-B) staining and a direct immunofluorescence test for the presence of Cryptosporidium oocysts. RESULTS Cryptosporidium oocysts were detected in 51 (10%) children with diarrhea. Prevalence was highest (73%) in children > 2 years of age compared with children < 2 years of age. The maximum number of cases, 38 of 51 (75%), was seen during the months January to April, indicating a marked seasonal variation. Polyparasitism was common in children with diarrhea; however, 43 of the 51 (84%) children with cryptosporidiosis had cryptosporidium infection only. Blastocystis hominis and Endolimax nana were the most common parasites detected (38% and 15%, respectively). Forty-seven of the 51 (90%) children with cryptosporidiosis were Kuwaiti and gave no history of travel abroad, suggesting that the infection was acquired indigenously. Sociodemographic information on children with cryptosporidiosis suggests three possible modes of transmission of infection: drinking contaminated water stored in overhead water tanks, person to person, or contact with infected animals. CONCLUSION In this study, we observed water-borne transmission of cryptosporidium infection in children with diarrhea. The infection is seasonal and endemic.
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Affiliation(s)
- J Iqbal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Farwaniya District Hospital, Farwaniya, Kuwait.
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Abstract
Methods which measure masticatory performance include gravimetric, volumetric and direct observation which depend on the weight, volume and size, respectively, of a test food once chewing is completed. Almonds, one of the most common test foods used, have a convenient size and texture. However, due to their oily content and mixing with saliva, washing and drying is required to overcome the clumping of chewed particles. A method has been developed using bagged almonds to exclude saliva and preventing loss of almond particles in the mouth. In addition, microwaving the whole almond reduces the oil content of the almond, reducing clumping, and potentially eliminating the need for washing and drying the particles. A dentate volunteer was asked to chew seven blanched almonds and seven microwaved almonds. The chewed particles were separated using two sieves, weighed and optically scanned to measure the number and area of the particles. Results were obtained both before and after washing and drying of the chewed particles. The overall results for the test of masticatory performance is very similar whether or not a washing stage is used for microwaved almonds. For untreated almonds washing has a more noticeable effect and may still be considered necessary.
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Affiliation(s)
- F Al-Ali
- Department of Prosthetic Dentistry, St. Bartholomew's and the Royal London School of Medicine and Dentistry, University of London, U.K
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Hira PR, Al-Ali F, Soriano EB, Behbehani K. Aspects of imported malaria at a district general hospital in non-endemic Kuwait, Arabian Gulf. Eur J Epidemiol 1988; 4:200-5. [PMID: 3042448 DOI: 10.1007/bf00144752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is no indigenous mosquito-borne transmission of malaria in Kuwait. However, in a five year period at a district general hospital, the number of laboratory-diagnosed cases of malaria increased annually from 25 to 84, a rise of 336%. Except for two induced infections, all were imported, mainly from the Indian subcontinent. Plasmodium vivax was responsible for 87.29% of the cases; P.falciparum (12.05%), a mixed infection of P.vivax and P.falciparum (0.33%) and a case of P.ovale (0.33%) were also identified. Rapid preparation of acetone-fixed, Giemsa-stained thick blood films, a heightened awareness of the infection, examination of multiple samples of blood from patients and the general resurgence of malaria in endemic areas were some of the factors responsible for the high number of cases diagnosed. Most patients were young males and presented with clinical malaria due to P.vivax between May and October each year, an apparent seasonal peak. However, many were already resident in the country for a variable period. Patients with P.falciparum though, presented clinically within two weeks of arrival in the country. Parasite densities were calculated to monitor the progress of treatment and identify quickly any possible chloroquine-resistant P.falciparum strains. A policy of active prophylaxis is suggested to stem the tide of imported malaria.
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Affiliation(s)
- P R Hira
- Department of Microbiology, Faculty of Medicine, Kuwait University, Arabian Gulf
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