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Zaidi S, Das JK, Jamal W, Ali A, Siddiqui F, Thabet A, Salah H, Mataria A. Government purchasing initiatives involving private providers in the Eastern Mediterranean Region: a systematic review of impact on health service utilisation. BMJ Open 2023; 13:e063327. [PMID: 36813492 PMCID: PMC9950888 DOI: 10.1136/bmjopen-2022-063327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE This paper provides a systematic review of evidence of government purchase of health services from private providers through stand-alone contracting-out (CO) initiatives and CO insurance schemes (CO-I) on health service utilisation in Eastern Mediterranean Region (EMR) to inform universal health coverage 2030 strategies. DESIGN Systematic review. DATA SOURCES Electronic search of published and grey literature on Cochrane Central Register of Controlled Trials, PubMed, CINHAL, Google Scholar and web, including websites of ministries of health from January 2010 to November 2021. ELIGIBILITY CRITERIA Randomised controlled trials, quasi-experimental studies, time series, before-after and endline with comparison group reporting quantitative utilisation of data across 16 low-income and middle-income states of EMR. Search was limited to publications in English or English translation. DATA EXTRACTION AND SYNTHESIS We planned for meta-analysis, but due to limited data and heterogeneous outcomes, descriptive analysis was performed. RESULTS Several initiatives were identified but only 128 studies were eligible for full-text screening and 17 met the inclusion criteria. These included CO (n=9), CO-I (n=3) and a combination of both (n=5) across seven countries. Eight studies assessed interventions at national level and nine at subnational level. Seven studies reported on purchasing arrangements with non-governmental organisations, 10 on private hospitals and clinics. Impact on outpatient curative care utilisation was seen in both CO and CO-I, positive evidence of improved maternity care service volumes was seen mainly from CO interventions and less reported from CO-I, whereas data on child health service volume was only available for CO and indicated negative impact on service volumes. The studies also suggest pro-poor effect for CO initiatives, whereas there was scarce data for CO-I. CONCLUSION Purchasing involving stand-alone CO and CO-I interventions in EMR positively impact general curative care utilisation, but lacks conclusive evidence for other services. Policy attention is needed for embedded evaluations within programmes, standardised outcome metrics and disaggregated utilisation data.
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Affiliation(s)
- Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Aga Khan University (International), AKU-UK, London, UK
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Wafa Jamal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Ammarah Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Faareha Siddiqui
- Faculty of Health Sciences, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aya Thabet
- Department of Universal Health Coverage/ Health Systems, WHO-EMRO, Cairo, Egypt
| | - Hassan Salah
- Department of Universal Health Coverage/ Health Systems, WHO-EMRO, Cairo, Egypt
| | - Awad Mataria
- Department of Universal Health Coverage/ Health Systems, WHO-EMRO, Cairo, Egypt
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Mourad A, Jamal W, Kadoch I, Antaki R, Helou ME, Grosfils V, Phillips S, Hemmings R. P-106 Total motile sperm count and oral ovulation induction protocols are not predictors of success in donor insemination cycles: Results from a large retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
to investigate the effect of total motile sperm (TMS) count, and ovulation induction on clinical pregnancy rate in artificial insemination with donor (AID) cycles.
Summary answer
TMS count is not a predictor of sucess, and natural cycles are as effective as oral ovulation induction in donor inseminations
What is known already
There are inconsistent results regarding the effect of sperm parameters on success rates of artificial insemination with donor (AID). Besides, the use of gonadotropin stimulation for ovulation induction in this category of patients is questionable, and its effectiveness over natural cycles is not yet confirmed in the literature.
Study design, size, duration
Patients who underwent AID cycles at the university-affiliated fertility center-OVO clinic in Montreal, Canada between 2011 and 2015 were retrospectively selected. A total of 4333 AID cycles were performed on 1179 patients, resulting in 744 pregnancies.
Participants/materials, setting, methods
Cycles were divided into 8 groups based on TMS count: <0.5, [0.5-1[, [1-5[, [5-10[, [10-20[, [20-40[, [40-80[, and ≥80. A TMS of 10 to 20 million was selected as a reference level. Ovulation induction was divided into oral stimulation, combined oral and gonadotropin stimulation and gonadotropin-only stimulation, and compared to natural cycles. Regression analysis and a predictive model of clinical pregnancy in AID cycles were generated from patient demographic and cycle characteristics.
Main results and the role of chance
There was no significant difference in positive β-hCG result, clinical pregnancy, multiple pregnancy and miscarriage rates when comparing all ranges of TMS count to a reference of 10 to 20 million. When dividing patients based on the protocol for ovulation induction, clinical pregnancy rate was significantly higher in the gonadotropin-only stimulation group (OR 4.116,[1.379,12.287]) but not in other types of stimulation, as compared to natural cycles. hCG triggering resulted in a similar clinical pregnancy and miscarriage rates, but a higher multiple pregnancy rate when compared to urinary LH testing (7.7% versus 1.3%, p = 0.045). A multivariate logistic regression analysis for predictors of clinical pregnancy accounting for relevant demographic and cycle characteristics was conducted. No significant difference was noted in different ranges of TMS and the groups of ovulation induction. In this model, age was found to be a significant predictor. In particular, with every one-year increase in age, the odds of clinical pregnancy decreases by 6.4% (Adjusted OR 0.936; 95%CI [0.914, 0.958]).
Limitations, reasons for caution
In our study, cycles with TMS count below 1 million are limited. Thus, results should be viewed with caution in this group, without cycle cancellation, since clinical pregnancy can be achieved. Moreover, our results cannot be generalized on infertile couples given the characteristics of our population of interest.
Wider implications of the findings
Minimal or maximal cut-off values for TMS in AID cycles should not be used as indicators for cycle cancellation. Natural cycles are as successful as oral ovulation induction. hCG trigger, unless indicated, should not be used as it is associated with higher risk of multiple pregnancy without increasing clinical pregnancy.
Trial registration number
not applicable
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Affiliation(s)
- A Mourad
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - W Jamal
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - I.J Kadoch
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - R Antaki
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - M.O. El Helou
- American University of Beirut, Scholars in health research program , Beirut, Lebanon
| | - V Grosfils
- University of Montreal, Faculty of medicine , Montreal, Canada
| | - S Phillips
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
| | - R Hemmings
- University of Montreal, Department of Obstetrics and Gynecology , Montreal, Canada
- OVO fertility center, Reproductive endocrinology and infertility , Montreal, Canada
- McGill University, Department of Obstetrics and Gynecology , Montreal, Canada
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Alazemi AM, Jamal W, Al Khabbaz A, Rotimi VO. Prevalence of target anaerobes associated with chronic periodontitis. Access Microbiol 2020; 2:acmi000177. [PMID: 33490872 PMCID: PMC7818240 DOI: 10.1099/acmi.0.000177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Periodontal diseases are a group of chronic infections that destroy tissues surrounding and supporting the teeth. Data on the anaerobes associated with periodontal infections in Kuwait is lacking. Aim To investigate the target anaerobes associated with chronic periodontitis (CP) in patients admitted to Dental Clinics in Kuwait University Health Sciences Center, Kuwait. Methodology Patients with CP (severe and moderate) were recruited into this study during a period of 15 months. Samples were collected directly from inside the gingival pockets and subjected to semi-quantitative PCR assays. Results A total of 30 patients, stratified into moderate and severe CP and 31 healthy individuals, used as controls, were studied. Nine (30 %) of the 30 patients were in the 50–59-year age group. The detection rate of Aggregatibacter actinomycetemcomitans between the patients (9 : 30 %) versus the controls (5 : 16.1 %) was non-significant (P >0.05). Fusobacterium spp., were detected in all patients versus 29 (93.1 %) controls, (P >0.05). However, four target anaerobes were significantly associated with CP patients; Porphyromonas gingivalis was detected in ten (33.3 %) patients versus two (6.4 %) controls (P <0.0001); Tannerella forsythia 25 (83.3 %) versus 16 (51.6 %) controls (P <0.0001); Parvimonas micra 27 (90 %) versus 16 (51.6 %) controls (P <0.0001) and Treponema denticola, 18 (60 %) versus nine (29 %) controls (P <0.0001), respectively. Prevotella spp. were detected in 27 (90 %) patients and 30 (96.7 %) controls (P>0.5). There was no significant difference in the burden of Prevotella spp. between patients and controls determined by semi-quantitative PCR assays. Conclusion Some (4/7) of the target anaerobes were significantly associated with CP in our study. P. gingivalis was the most strongly associated anaerobe with CP, although not the keystone bacteria, while Prevotella spp. was similar to the healthy controls.
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Affiliation(s)
| | - W. Jamal
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - A. Al Khabbaz
- Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Kuwait
| | - V. O. Rotimi
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
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Cavinato L, Cardinaux A, Jain K, Jamal W, Kjelgaard M, Sinha P, Barbieri R. Characterizing autonomic response to arousing visual-auditory multi-modal task in Autism Spectrum Disorder (ASD). Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4942-4945. [PMID: 31946969 DOI: 10.1109/embc.2019.8856641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sensory abnormalities are widespread in Autism Spectrum Disorder (ASD). However, their definition is still quite subjective and vague. Here we propose a novel approach for characterization of Autonomic Nervous System responses to sensory stimulation based on electrocardiogram (ECG) assessment. In particular, we develop a preliminary study where autonomic responses of both autistic (ASD = 5) and neurotypical (NT = 5) participants have been evaluated in terms of changes in responsiveness to repeated stimuli. Autonomic control has been estimated via high-frequency heart rate variability (HF-HRV) and low-frequency HRV (LF-HRV). Results show significant differences among groups for the HRV measures (p value = 0.0158), supported by expected changes of HF (p value = 0.0079) and LF (p value = 0.0079) trends over stimulations. We thus conclude that an overall decrease in autonomic arousal can give important insights for devising new habituation metrics in NT and ASD individuals.
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McGuire D, Zinman B, Inzucchi SE, Anker SD, Wanner C, Kaspers S, Von Eynatten M, Johansen OE, Elsasser U, Pocock S, Fitchett D, Jamal W, Hantel S, Lund SS. P6270Empagliflozin reduces the total burden of first and recurrent hospitalisations in patients with type 2 diabetes and established cardiovascular disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
The EMPA-REG OUTCOME trial included patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular (CV) disease. Empagliflozin reduced the risk of 3-point major adverse CV events (MACE; composite of CV death, myocardial infarction [MI], or stroke) by 14%, CV death by 38% and hospitalisation for heart failure (HF) by 35% vs placebo in analyses of time to first event. We assessed the effect of empagliflozin on all-cause hospitalisation in post-hoc analyses of all (first and recurrent) events.
Materials and methods
Patients were randomised to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo in addition to standard of care. We assessed the effects of empagliflozin pooled vs placebo on first event of all-cause hospitalisation using Cox regression and all (first and recurrent) events of all-cause hospitalisation using a negative binomial model.
Results
A total of 7020 patients were treated (4687 empagliflozin; 2333 placebo, mean [SD] age 63 [9] years, 71% male, 47% with history of MI, 23% with history of stroke, 10% with HF). In this analysis, 1725/4687 (36.8%) empagliflozin patients and 925/2333 (39.6%) placebo patients experienced an event leading to hospitalisation. The adjusted hazard ratio (HR; 95% CI) vs placebo for first all-cause hospitalisation using the Cox regression model was 0.89 (0.82, 0.96; p=0.0033; Figure); In analyses of all (first and recurrent) hospitalisation events, there were 3168 events in the empagliflozin group and 1863 in the placebo group. The adjusted event rate ratio (95% CI) vs placebo was 0.83 (0.76, 0.91; p<0.0001; Figure).
Conclusion
In the EMPA-REG OUTCOME trial, risk reductions with empagliflozin were seen in both first and all hospitalisation events and were numerically more favourable in analyses of all events vs analyses of first events. These analyses expand on the favourable CV effects of empagliflozin by also showing a reduction in the total burden of hospitalisation events in patients with T2D and established CV disease.
Acknowledgement/Funding
Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance
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Affiliation(s)
- D McGuire
- University of Texas Southwestern Medical Center, Dallas, United States of America
| | - B Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - S E Inzucchi
- Yale University School of Medicine, Section of Endocrinology, New Haven, United States of America
| | - S D Anker
- Charité - Universitätsmedizin, Department of Cardiology (Campus CVK) & BRCT, Berlin, Germany
| | - C Wanner
- Würzburg University Clinic, Würzburg, Germany
| | - S Kaspers
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M Von Eynatten
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - O.-E Johansen
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - U Elsasser
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - S Pocock
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom
| | - D Fitchett
- St. Michael's Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - W Jamal
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S Hantel
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - S S Lund
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
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Habib S, Zaidi SMA, Jamal W, Zafar I, Kazmi T, Yasir M. Predictors of treatment failure among pulmonary tuberculosis patients in Pakistan. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Habib S, Azeemi K, Zaidi SMA, Jamal W, Kazmi T, Waqar M. Utilizing chest X-ray based active case finding approach for early tuberculosis case detection in Pakistan. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jamal W, Azeemi K, Waqar M, Ikram K, Zaidi SMA, Habib S. Active case finding for tuberculosis among prisoners in Karachi, Pakistan. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.pa2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sonnevend Á, Ghazawi A, Alqahtani M, Shibl A, Jamal W, Hashmey R, Pal T. Plasmid-mediated colistin resistance in Escherichia coli from the Arabian Peninsula. Int J Infect Dis 2016; 50:85-90. [DOI: 10.1016/j.ijid.2016.07.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022] Open
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Al Sweih N, Mokaddas E, Jamal W, Phillips OA, Rotimi VO. In VitroActivity of Linezolid and Other Antibiotics Against Gram-Positive Bacteria from the Major Teaching Hospitals in Kuwait. J Chemother 2013; 17:607-13. [PMID: 16433190 DOI: 10.1179/joc.2005.17.6.607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/31/2022]
Abstract
Multidrug-resistant Gram-positive bacteria are an increasingly pressing problem in the clinic. Consequently, linezolid, a recently introduced oxazolidinone with Gram-positive activity, was tested in comparison with 10 other antibiotics against 8103 clinically significant Gram-positive cocci by Etest, disk diffusion and Vitek methods. Linezolid demonstrated excellent activities against all isolates. Vancomycin and teicoplanin demonstrated equally excellent activity against almost all isolates. The methicillin-resistant Staphylococcus aureus (MRSA) strains were all susceptible to the glycopeptides and linezolid, but resistant to erythromycin (96%), fusidic acid (91.5%), gentamicin (84%) and clindamycin (73%). Forty one and 39% of the Streptococcus pneumoniae isolates were resistant to penicillin (MIC >0.5 microg/ml) and erythromycin (MIC >1 microg/ml), respectively. S. agalactiae susceptibility was 9% and 10% resistant to clindamycin and erythromycin, respectively. In conclusion, all the Gram-positive isolates tested were susceptible to linezolid. With its oral bioavailability profiles, it obviously holds great promise. Our data should be a useful addition to the literature from the Middle East.
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Affiliation(s)
- N Al Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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Zaninovic N, Rosenwaks Z, Iager AE, Kocabas AM, Otu HH, Ruppel P, Langerveld A, Schnarr P, Suarez M, Jarrett JC, Conaghan J, Rosa GJM, Fernandez E, Rawlins RG, Cibelli JB, Crosby J, Kirkegaard K, Hindkjaer J, Ingerslev HJ, Lykke-Hartmann K, Himaya E, Jamal W, Phillips S, Delrieu D, Hamamah S, Kadoch IJ, Cortezzi SS, Cabral EC, Ferreira CR, Trevisan MG, Figueira RCS, Eberlin MN, Iaconelli A, Borges E, Chimote NM, Chimote NN, Nath NM, Chimote MN, Mehta BN. SESSION 02: EMBRYOLOGY - BIOMARKERS. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.2] [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: 11/12/2022] Open
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Jamal W, Rotimi V, Albert MJ, Khodakhast F, Udo E, Poirel L. Emergence of nosocomial New Delhi metallo-β-lactamase-1 (NDM-1)-producing Klebsiella pneumoniae in patients admitted to a tertiary care hospital in Kuwait. Int J Antimicrob Agents 2012; 39:183-4. [DOI: 10.1016/j.ijantimicag.2011.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/04/2011] [Accepted: 10/07/2011] [Indexed: 11/24/2022]
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Vélez M, Jamal W, Phillips S, Zini A, Kadoch J. Surgically retrieved sperm versus ejaculated sperm in modified natural in vitro fertilization-intracytoplasmic sperm injection (MNIVF-ICSI) cycles. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Al Sweih N, Salama MF, Jamal W, Al Hashem G, Rotimi VO. An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait. Indian J Med Microbiol 2011; 29:130-5. [DOI: 10.4103/0255-0857.81791] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Al Hashem G, Al Sweih N, Jamal W, Rotimi VO. Sequence analysis of bla(CTX-M) genes carried by clinically significant Escherichia coli isolates in Kuwait hospitals. Med Princ Pract 2011; 20:213-9. [PMID: 21454989 DOI: 10.1159/000321242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 06/13/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the extent, distribution and sequence analysis of bla(CTX-M) genes carried by Escherichia coli isolated from patients admitted to all government hospitals in Kuwait. METHODS Extended-spectrum β-lactamase (ESBL)-producing E. coli isolates were collected from the 8 major hospitals in Kuwait. CTX-M ESBLs were analyzed by PCR and sequenced. Clonality of the positive isolates was determined for genetic relatedness using pulsed-field gel electrophoresis (PFGE) with XbaI digestion of the genomic DNA. RESULTS Of the 136 ESBL-positive isolates, 106 (77.9%) harbored bla(CTX-M) genes. Among these, bla(CTX-M-15) was the most frequent with a prevalence rate of 84.1%, followed by bla(CTX-M-14) (6.8%), bla(CTX-M-14b) (5.7%) and bla(TOHO-1) (3.4%). Ninety-three (87.7%) were isolated from Kuwaiti (35.9%), Egyptian (31.1%) and Indian (20.8%) nationals; the majority of isolates positive for bla(CTX-M-15) were mainly from these 3 nationalities. PFGE analysis did not demonstrate any clustering of positive isolates in any particular hospital. CONCLUSION This study confirms an explosive emergence of CTX-M-15 β-lactamase among E. coli isolates in Kuwait and shows that the strains were clonally heterogeneous with no evidence of inter- or intra-hospital spread. Thus Kuwait may represent an important source of CTX-M-15-positive E. coli.
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Affiliation(s)
- G Al Hashem
- Department of Microbiology, Faculty of Medicine, Health Sciences Centre, Kuwait University, Jabriya, Kuwait
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Al Sweih N, Al Hashem G, Jamal W, Rotimi V. National surveillance of antimicrobial susceptibility of CTX-M-positive and -negative clinical isolates of Escherichia coli from Kuwait government hospitals. J Chemother 2010; 22:254-8. [PMID: 20685629 DOI: 10.1179/joc.2010.22.4.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Antibiotic resistance in Escherichia coli is becoming a complex therapeutic problem. Surveillance programs are valuable tools and offer important information on bacterial resistance trends. This study was undertaken to determine the susceptibility of clinically significant isolates of E. coli obtained from patients admitted to 8 Kuwait government hospitals and to examine how this was influenced by the production of CTX-M extended-spectrum beta-lactamases (ESBLs). The susceptibility of 876 consecutive clinically significant strains of E. coli to 13 antibiotics was determined by Etest. ESBL production was assessed by ESBL-Etest method and the presence of CTX-M beta-lactamases was confirmed by PCR technique. Of the 876 isolates, 604 (69%) were highly non-susceptible to ampicillin with MIC(90 )of >256 microg/ml. Resistance to the 3(rd)-generation cephalosporins ranged from 7.5% in the Maternity hospital to 29% in the Ibn Sina hospital; ciprofloxacin resistance rates ranged from 14% and 40%, respectively. Carbapenems and amikacin demonstrated excellent activity. The minimum inhibitory concentrations (MIC(90)) of cefotaxime, ceftazidime, cefepime and ciprofloxacin were >256, 64, >256 and >32 microg/ml, respectively for CTX-M-positive isolates versus 0.5, 1, 025 and 0.125 microg/ml for CTX-M-negative strains. Frequencies of CTX-M-positive isolates within the cefotaxime MIC ranges of 1-2, 3-8, 9-16 and >16 microg/ml were 0, 4, 15 and 81%, respectively. In conclusion, the susceptibility of E. coli to the 3(rd )generation cephalosporins and ciprofloxacin was influenced by the presence of CTX-M ESBL and a high proportion of the CTX-M-producing isolates were in the susceptibility ranges of cefotaxime.
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Affiliation(s)
- N Al Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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Jamal W, Shahin M, Rotimi V. P21.02 Detection of ESBL, MBL and AmpC in Enterobacteriaceae and Acinetobacter spp. using Cica Beta tests in a routine diagnostic laboratory. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jamal W, Rotimi VO, Brazier J, Duerden BI. Analysis of prevalence, risk factors and molecular epidemiology of Clostridium difficile infection in Kuwait over a 3-year period. Anaerobe 2010; 16:560-5. [PMID: 20887795 DOI: 10.1016/j.anaerobe.2010.09.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 01/22/2023]
Abstract
We conducted a prospective study to evaluate the prevalence and epidemiology of CDI in Kuwait government hospitals over a 3-year period, January 2003 to December 2005, to determine the ribotypes responsible for CDI and to estimate the prevalence of ribotype 027. We also conducted a case-control study to identify the risk factors in our patient population. A total of 697 stool samples from patients with suspected CDI were obtained and sent to Anaerobe Reference Laboratory, Faculty of Medicine, Kuwait University for Clostridium difficile toxin detection, culture and PCR ribotyping. During the period, 73 (10.5%) out of 697 patients met the case definition of CDI. Of these, 56 (76.7%) were hospital-acquired and 17 (23.3%) were from outpatient clinics. Thus, the prevalence of hospital-acquired CDI amongst patients with diarrhoea was 8% over the study period; the prevalence in 2003, 2004 and 2005 was 9.7%, 7.8% and 7.2%, respectively. Our data showed that 42.9% of the CDI patients were above 60 years, of which >79% were aged 71 years and above. Patients with CDI were more likely than the controls to have been exposed to immunosuppressive drugs and feeding via nasogastric tube. The most common ribotypes isolated during this study were 002, 001, 126 and 140 and they represent 55.1% of all isolates. PCR ribotype 027 was not isolated.
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Affiliation(s)
- W Jamal
- Department of Microbiology, Kuwait University, Safat, Kuwait.
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Badia A, Le Pimpec-Barthes F, Bagan P, Jamal W, Riquet M. [Late-onset postpneumonectomy empyema]. Rev Pneumol Clin 2010; 66:120-126. [PMID: 20413047 DOI: 10.1016/j.pneumo.2009.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 09/16/2009] [Accepted: 09/20/2009] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Empyema occurring after pneumonectomy is a major complication usually diagnosed during the same hospitalization. However, late-onset empyemas are not infrequent and may be difficult to diagnose and manage. PATIENTS AND METHODS From 1995 to 2008, 15 patients were referred to our department for an empyema that occurred between four months and 16years following a pneumonectomy (mean is equal to four years). We more particularly reviewed the mode of occurrence, the possible causes and the management of those late infections. RESULTS Presentation and characteristics were miscellaneous and delay in diagnosis was generally the rule. Two tendencies were emerging according to the delay of occurrence. During the first year following the pneumonectomy, the patients (n=8) had often received an adjuvant treatment (radiation therapy: n=2; radiation and chemotherapy: n=1; chemotherapy: n=2), often presented a bronchial fistula (n=5), and post-management morbidity (two deaths). After the first year, the patients (n=7) were without bronchial fistula, had rarely received an adjuvant therapy (n=1), and were rather suffering multiple associated diseases (n=3), or a bacteremia (n=3), and the treatments were more rapidly efficient. CONCLUSION Empyema is among the first diagnoses to think about in case of fever occurring late after pneumonectomy. Early diagnosis may permit more rapid management and hence, easier and better recovery.
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Affiliation(s)
- A Badia
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
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Al Kandari M, Jamal W, Udo EE, El Sayed A, Al Shammri S, Rotimi VO. A case of community-onset meningitis caused by hospital methicillin-resistant Staphylococcus aureus successfully treated with linezolid and rifampicin. Med Princ Pract 2010; 19:235-9. [PMID: 20357511 DOI: 10.1159/000285301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 06/11/2009] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a relatively rare presentation of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in a previously healthy boy in Kuwait. CLINICAL PRESENTATION AND INTERVENTION A 14-year-old boy presented with a 2 weeks' history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trauma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on culture grew MRSA. Staphylococcal chromosome cassette mec (SCCmec) typing revealed that it belonged to SCCmec type III and sequence type 238 (ST238-SCCmec-III). Polymerase chain reaction screening for the presence of Panton-Valentine leukocidin (PVL) genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well. CONCLUSION Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor.
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Affiliation(s)
- M Al Kandari
- Division of Microbiology, Mubarak Al-Kabir Hospital, and Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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Jamal W, Salama M, Dehrab N, Al Hashem G, Shahin M, Rotimi VO. Role of tigecycline in the control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Hosp Infect 2009; 72:234-42. [PMID: 19493588 DOI: 10.1016/j.jhin.2009.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 03/16/2009] [Indexed: 11/18/2022]
Abstract
The incidence of Acinetobacter baumannii infection has greatly increased over recent decades with infections occurring more in critically ill hospitalised patients. Hospital outbreaks of multiple antibiotic-resistant strains are posing an increasing threat to public health. Three different outbreaks of multidrug-resistant A. baumannii (MRAB) infections involving 24 patients, aged 16-75 years occurred in the intensive care unit in the course of one year. The isolates were cultured from clinical samples and identified using automated Vitek II ID system and the API 20NE system. Susceptibility testing was done by the E-test method. Molecular typing of the isolates was determined by pulsed-field electrophoresis. Screening of both patients and the environment was carried out. The acquisition time, i.e. the time of admission to time of acquiring infection, ranged from 3 to 31 days. All isolates were multiply resistant (MRAB), including resistance to carbapenems (MRAB-C) in the majority of cases but susceptible to tigecycline, with a minimum inhibitory concentration (MIC(90)) of 2 microg/mL. The overall mortality rate was 16.7%. Time-to-clearance of the MRAB-C was 8.3 days in the first outbreak, when tigecycline was not used, and 2.8 and 3.1 days during the second and third outbreaks, respectively, when tigecycline was used, and all but one patient survived. Environmental screening revealed gross contamination of many surfaces and equipment within the unit. The outbreak strains belonged to two distinct clones (D and E) whereas the 14 environmental strains belonged to three distinct groups (A-C). The outbreak of infections treated with tigecycline was successfully eliminated in conjunction with an aggressive infection control strategy.
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Affiliation(s)
- W Jamal
- Department of Microbiology, Mubarak Al Kabir Hospital and Faculty of Medicine, Kuwait University, Safat, Kuwait
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Ensor VM, Jamal W, Rotimi VO, Evans JT, Hawkey PM. Predominance of CTX-M-15 extended spectrum beta-lactamases in diverse Escherichia coli and Klebsiella pneumoniae from hospital and community patients in Kuwait. Int J Antimicrob Agents 2008; 33:487-9. [PMID: 19097760 DOI: 10.1016/j.ijantimicag.2008.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 10/02/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
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Poirel L, Rotimi V, Bernabeu S, Jamal W, Nordmann P. P1029 Explosive emergence of CTX-M-15 extended-spectrum β-lactamase in Enterobacteriaceae in Kuwait. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pai M, Jamal W, Mosse A, Bishop C, Bown S, McEwan J. Inhibition of in-stent restenosis in rabbit iliac arteries with photodynamic therapy. Eur J Vasc Endovasc Surg 2005; 30:573-81. [PMID: 16125418 DOI: 10.1016/j.ejvs.2005.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 07/05/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Photodynamic therapy (PDT, the combination of light with a photosensitising drug in the presence of oxygen) inhibits restenosis after angioplasty without stenting. This study assesses the potential of PDT for prevention of in-stent re-stenosis. DESIGN AND METHODS Normal rabbits were given the photosensitising agent 5-aminolaevulinic acid (ALA) 60 mg/kg, 3 h prior to endovascular illumination of the iliac artery (635 nm at 50 J/cm(2)) either immediately before or after deployment of an oversized (3 mm diameter) stent. PDT treated arteries were retrieved 3 or 28 days later and assessed for cell counts and vascular morphometry. Control arteries (stent but no PDT) were examined at 28 days. RESULTS There were no adverse events and all vessels were patent at the end of the study. At 3 days there was almost complete medial cell ablation when light was delivered before stent deployment (17+/-1 cells/hpf), with little effect when illumination followed stent deployment (184+/-17 cells/hpf, p<0.0001). Twenty-eight days after PDT, the neointimal areas were 1.41+/-0.52 mm(2) (stent with no PDT), 1.24+/-0.54 mm(2) (light after stent) and 0.60+/-0.21 mm(2) (light before stent) (p=0.004). CONCLUSIONS PDT before stent deployment caused almost complete medial cell ablation at 3 days with inhibition of in-stent restenosis at 28 days. PDT is worthy of further study as an adjuvant to percutaneous intervention in patients with vascular disease.
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MESH Headings
- Aminolevulinic Acid/administration & dosage
- Aminolevulinic Acid/therapeutic use
- Animals
- Arterial Occlusive Diseases/surgery
- Blood Vessel Prosthesis Implantation/instrumentation
- Disease Models, Animal
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/pathology
- Graft Occlusion, Vascular/drug therapy
- Graft Occlusion, Vascular/pathology
- Iliac Artery
- Injections, Intra-Arterial
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/pathology
- Photochemotherapy/methods
- Photosensitizing Agents/administration & dosage
- Photosensitizing Agents/therapeutic use
- Prosthesis Failure
- Rabbits
- Stents
- Treatment Outcome
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Affiliation(s)
- M Pai
- The Royal Free and University College London Medical School, London, UK
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Abstract
Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30-40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed.
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Affiliation(s)
- W Jamal
- Department of Thoracic Surgery and Pathology, Royal Brompton Hospital, London, UK
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