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Biomedical subjects

George F Araj

Publications and source records attributed to George F Araj.

At least 19 recordsLinked to original sources
PubMed2006

Polymerase chain reaction identification of coagulase-negative Staphylococci and of strain diversity and spread of Staphylococcus epidermidis in a major medical center in Lebanon.

A 2-step polymerase chain reaction (PCR) assay and random amplification of polymorphic DNA (RAPD) analysis, respectively, were assessed to identify coagulase-negative staphylococci organisms to the species level and to determine the strain diversity and spread of Staphylococcus epidermidis, the most frequently isolated species, in a medical center in Beirut, Lebanon. Our data indicated that PCR was faster and was more efficient in identifying S. epidermidis isolates than is conventional biochemical testing. RAPD analysis have shown that S. epidermidis strains were scattered across the different clinical services, demonstrating various clusters of infection in the medical center.

Base Sequence↗
PubMed2006

Efficacy and safety of rabeprazole, amoxicillin, and gatifloxacin after treatment failure of initial Helicobacter pylori eradication.

OBJECTIVES: To evaluate the efficacy of a 7-day regimen of gatifloxacin (400 mg daily), amoxicillin (1 g twice a day), and rabeprazole (20 mg twice a day) in the secondary eradication of Helicobacter pylori infection. METHODS: Eligible patients with persistent infection following one or more conventional clarithromycin-containing triple therapies were enrolled in this open-label trial. Eradication of infection was documented by (14)C-urea breath test a minimum of 4 weeks after therapy and 2 weeks off any acid suppressive therapy. Culture of H. pylori and in vitro susceptibility testing to amoxicillin, clarithromycin, and gatifloxacin was done in cases of failed eradication. RESULTS: A total of 45 patients (22 females:23 males; mean age 44.5 +/- 13 years) were enrolled. Eradication occurred in 38 patients [both per-protocol (PP) and intention-to-treat analysis: 84.4%; 95% CI: 74-95%]. No significant adverse effects were reported. In vitro susceptibility testing showed no secondary resistance to gatifloxacin or amoxicillin in any of the seven nonresponders. Smoking, age, and sex were not predictors of potential eradication failure. CONCLUSIONS: A 7-day regimen of gatifloxacin, rabeprazole, and amoxicillin is effective after failed eradication therapy for H. pylori and does not appear to result in secondary resistance. This combination is simple, well tolerated, and may lead to higher compliance and lower costs.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

Detection of a highly prevalent and potentially virulent strain of Pseudomonas aeruginosa from nosocomial infections in a medical center.

BACKGROUND: We correlated genotypes, virulence factors and antimicrobial susceptibility patterns of nosocomially identified Pseudomonas aeruginosa isolates from clinical specimens to those of environmental isolates encountered in the same units of a medical center. Antibiotic susceptibility testing, RAPD analysis and detection of enzymatic activities of extracellular virulence factors, were done on these isolates. RESULTS: Data showed that most of the clinical and environmental isolates were susceptible to tested antimicrobial agents. RAPD analysis determined the presence of 31 genotypes, with genotype 1 detected in 42% of the clinical isolates and 43% of the environmental isolates. Enzymatic activity testing showed that genotype 1 produced all virulence factors tested for. CONCLUSION: In conclusion, our data demonstrated the predominant prevalence of a potentially virulent P. aeruginosa genotype, circulating in a number of units of the medical center and emphasize the need to reinforce infection control measures.

Adolescent↗
PubMed2005

Antibiotic use in acute cholecystitis: practice patterns in the absence of evidence-based guidelines.

OBJECTIVES: Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear. METHODS: We conducted a retrospective review of all cases of acute cholecystitis between 1996 and 2001 at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis. A MEDLINE search for guidelines for antibiotic use in acute cholecystitis was conducted. RESULTS: The number of cases of acute cholecystitis was 79. The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively. Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days. Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis. CONCLUSIONS: The use of antibiotics in patients with acute cholecystitis is erratic and costly. Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.

Adult↗
PubMed2005

In vitro activity of antimicrobial agents against extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care center in Lebanon.

Looking for therapeutic options, we assessed the minimum inhibitory concentrations (MICs) of 7 antimicrobial agents against extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (n = 58) and Escherichia coli (n = 84) isolates. High rates of susceptibility were shown for both E coli and K pneumoniae against ertapenem (100% for both), piperacillin/tazobactam (83% and 91%, respectively) and amikacin (96% and 82%, respectively). In addition, most K pneumoniae isolates were susceptible to quinolones (72%-75%) and cefepime (88%). However, clinical correlation is warranted.

Adolescent↗
PubMed2005

Epidemiology and risk factors for extended-spectrum beta-lactamase-producing organisms: a case control study at a tertiary care center in Lebanon.

BACKGROUND: Infections caused by extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli constitute a growing problem worldwide. At the American University of Beirut Medical Center (AUBMC), we have observed a significant rise in the rates of ESBL-producing organisms over the past 5 years. METHODS: Using a case control study design, we compared 99 patients with infections caused by ESBL-producing Escherichia coli and Klebsiella species and 99 frequency-matched controls from which ESBL-nonproducing isolates were recovered at AUBMC. RESULTS: The most notable risk factor for acquiring infections with ESBL-producing organisms was antibiotic consumption within 30 days of the infection (OR, 7.06; 95% CI: 3.27-15.24), with third-generation cephalosporins being associated with the highest risk (OR, 28.4; 95% CI: 3.7-215.8). Other risk factors included recent surgery, presence of a urinary catheter, and need for mechanical ventilation. Moreover, cases had a longer mean duration of hospitalization and were more likely to have relapse of their infection than controls. CONCLUSIONS: Recent antibiotic use is by far the most important predisposing factor to infection with ESBL-producing organisms. Such infections are associated with prolonged hospital stay and increased morbidity. Attention should be redirected toward the unjustified liberal use of broad-spectrum antibiotics both in the hospital and in the community.

Anti-Bacterial Agents↗
PubMed2005

Evaluation of the PANBIO Brucella immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays for diagnosis of human brucellosis.

PANBIO Brucella immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) were assessed against Brucella standard agglutination tube and Coombs tests. The sensitivities of ELISA IgG and IgM were 91% and 100%, respectively, while the specificity was 100% for both. These ELISAs are simple, rapid, and reliable for the diagnosis of human brucellosis.

Brucella↗
PubMed2004

Efficacy of two rabeprazole/gatifloxacin-based triple therapies for Helicobacter pylori infection.

OBJECTIVES: To evaluate the efficacy of two novel treatment regimens consisting of gatifloxacin (400 mg daily), amoxicillin (1 g twice daily), and rabeprazole 20 mg once (RAG20) or twice daily (RAG40) given for 7 days in the eradication of Helicobacter pylori. METHODS: Eligible patients undergoing endoscopy and having a positive rapid urease assay for H. pylori were enrolled in this open-label trial. Gastric biopsies from a random cohort of patients were cultured for H. pylori and in vitro susceptibility to gatifloxacin and amoxicillin was performed using the E-test. Compliance and side-effects were evaluated by phone calls. (14)C-urea breath tests were performed a minimum of 4 weeks after therapy and 3 weeks after any acid suppressive therapy. RESULTS: A total of 104 patients, 52 in each group (40 females and 64 males; mean age 45.7 years) were enrolled sequentially. Eradication occurred in 43 out of 52 patients in RAG20 group (both per-protocol and intention-to-treat analysis: 83%; 95% CI: 72-93%) and in 48 of 52 patients in the RAG40 group (both per-protocol and intention-to-treat analysis: 92%; 95% CI: 85-99%). Seven patients in the RAG40 group who had previously failed one or more treatment regimens for H. pylori were cured. No significant adverse effects were reported. All 50 recovered H. pylori strains were susceptible to amoxicillin and gatifloxacin in vitro. CONCLUSIONS: A 7-day regimen of gatifloxacin-rabeprazole-amoxicillin is effective eradication therapy for H. pylori. The use of rabeprazole twice daily results in superior eradication rates including cases of failed primary therapy. This new regimen is simple, well-tolerated, and may lead to higher compliance and lower costs.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Intestinal parasites among presumably healthy individuals in Lebanon.

OBJECTIVE: To determine the prevalence period of intestinal parasites among presumably healthy subjects in Lebanon. METHODS: One stool specimen from 2634 presumably healthy Lebanese subjects, mean age 32.1 years with a range of 14-71 years, resident of different areas in Lebanon was examined for the presence of parasites. The analysis took place in the Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon, over 25-months between 1995-1997. RESULTS: The prevalence of intestinal parasites was 12.4%. The most common parasites identified were Entamoeba coli (38%), Giardia lamblia (3.1%) and Entamoeba histolytica (2.3%) [corrected]. CONCLUSION: The data presented shows the need to improve hygienic conditions to contain the problem of intestinal infections with parasites in Lebanon.

Adolescent↗
PubMed2003

Brucella pelvic tubo-ovarian abscess mimicking a pelvic malignancy.

A 57-y-old woman presented with recurrent abdominal and pelvic pain of 6 months' duration with low-grade fever. A computed tomographic scan indicated an ovarian tumor. Laparotomy revealed a pelvic abscess. Her symptoms resolved following surgery and antibiotic therapy. Pathology revealed an extensive inflammatory process. Tissue culture grew Brucella sp. The diagnosis and management of this previously undescribed pelvic tubo-ovarian abscess present a particular challenge.

Abdominal Pain↗
PubMed2003

Rapid MRSA detection by a latex kit.

Methicillin resistant strains of Staphylococcus aureus (MRSA) are implicated in serious infections and nosocomial outbreaks, and show resistance to a wide range of antibiotics, thus limiting the treatment options. Therefore, rapid detection is clinically crucial for both treatment and infection control measures. This study assessed the performance of a rapid latex agglutination kit marketed to detect MRSA clinical isolates (MRSA-Screen test Denka Seiken Co Ltd, Tokyo, Japan) based on detecting a specific penicillin binding protein 2a (PBP2a) in comparison to the NCCLS oxacillin salt agar screen plate, the 1 microg oxacillin disk diffusion test, and the oxacillin MIC by E-test. Testing was carried out on 133 isolates consisting of 99 MRSA and 34 methicillin sensitive strains of S. aureus (MSSA). Concordant results were observed between the latex kit and all the other tests for the 99 MRSA isolates. Only 1 of the 34 MSSA isolates gave a positive agglutination reaction in the latex kit. The kit sensitivity and specificity were determined to be 100% and 97%, respectively. This reliable performance indicates that the MRSA-Screen latex test is very useful test for the rapid detection of MRSA isolates in the clinical microbiology laboratory.

Agglutination↗
PubMed2002

Prevalence of Helicobacter pylori resistance to metronidazole, clarithromycin, amoxycillin and tetracycline in Lebanon.

The aim of this study was to determine the prevalence of antimicrobial resistance amongst Helicobacter pylori isolates cultured from gastric biopsies taken during routine endoscopies at the American University of Beirut Medical Center in Lebanon. Fifty-four consecutively recovered H. pylori isolates were tested against metronidazole, clarithromycin, tetracycline and amoxycillin using the epsilometer test. Resistance to metronidazole (MIC > 8 mg/l) was found in 29.5% of the isolates while resistance to clarithromycin (MIC > or =0.25 mg/l) and tetracycline (MIC > or =4 mg/l) was low (4 and 2%, respectively). All isolates were susceptible to amoxycillin (MIC < or =8 mg/l). These findings are comparable with those reported from Europe and the United States. The prevalence of metronidazole resistance in our study was lower than that from other parts of the Middle East and the developing world.

Amoxicillin↗
PubMed2002

Buttock abscess brucellosis.

Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations, and its complications can affect almost all organs and systems with varying incidence. Soft-tissue infection due to Brucella species is a rare complication of brucellosis. This report presents a case of a 30-y-old previously healthy woman whose right buttock abscess culture grew Brucella spp. The patient was treated successfully with abscess drainage and antibiotic therapy.

Abscess↗
PubMed2002

Tuberculosis of the knee.

Tuberculosis is a worldwide problem that has persisted in developing countries and is re-emerging in developed ones. Infectious complications with Mycobacterium tuberculosis have also been reported with increasing frequency. Among these, skeletal and intra-articular infections continue to affect patients and pose a difficult diagnostic problem to physicians and orthopedic surgeons. This is so, as the non-specific clinical presentation which, overlaps with several infectious and non-infectious diseases, and the latency period of this bacteria that can persist up to several years after the initial infection, contribute to diagnosis and management delay. Thus due to the paucity of the disease, physicians should heighten their index of suspicion for diagnosing tuberculosis of the joints especially when faced with recurrent symptoms of what they think is a common problem. In this context, we present a case of a protracted recurrent illness of a knee joint, which was proved by culture to be due to M. tuberculosis. Moreover, the aspects of this disease entity that poses a diagnostic challenge to the treating physician are highlighted together with those that differentiate it from other overlapping diseases such as brucellosis, especially in endemic areas.

Adult↗
PubMedDate not supplied

Tuberculous epididymo-orchitis following intravesical BCG for superficial bladder cancer.

A seventy-two-year-old man with transitional cell carcinoma of the bladder received intravesical Bacillus Calmette-Guérin (BCG) following which he developed left testicular pain and swelling that partially resolved with conservative treatment. Six months later a second course of BCG was given for recurrent disease. Ten months later, he developed left testicular swelling and severe induration along with a draining scrotal sinus. Tuberculous orchitis was suspected and a left orchiectomy was performed. Pathology showed caseating granulomatous orchitis and epididymitis with numerous acid fast bacilli on Ziehl-Neelson stain. The patient received a six-month course of antituberculous therapy. This case highlights a rare but serious complication of intravesical BCG.

Administration, Intravesical↗
PubMedDate not supplied

Molecular fingerprinting of multidrug-resistant Mycobacterium tuberculosis strains in Beirut reveals genetic diversity and father to daughter transmission.

The typing of six consecutive multidrug-resistant Mycobacterium tuberculosis strains isolated from patients with tuberculosis (TB) at the American University of Beirut Medical Center, was performed by touchdown double-repetitive-element (DRE)-PCR. The isolates exhibited four distinct patterns in DRE-PCR with three isolates exhibiting unique patterns and three isolates yielded similar DNA fragment patterns (cluster pattern). Only two of the three cluster isolates exhibited identical patterns as revealed by restriction fragment length polymorphism (RFLP) targeting specific mutations in the rpoB and katG genes that confer resistance to rifampin and isoniazid, respectively. A direct epidemiological linkage for the two isolates exhibiting genotypic relatedness was also established as the isolates were recovered from a 33-year-old man and his 8-year-old daughter. The data show that transmission of multidrug-resistant M. tuberculosis strains is contributing to the emergence of drug-resistant TB in Beirut. Combining DRE-PCR with RFLP at the rpoB and katG genes could provide a powerful means for investigating the spread of multidrug-resistant M. tuberculosis strains in Lebanon.

Adult↗