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Biomedical subjects

K Khalil

Publications and source records attributed to K Khalil.

At least 19 recordsLinked to original sources
PubMed2005

Conversion of stable kidney transplant recipients from a twice daily Prograf-based regimen to a once daily modified release tacrolimus-based regimen.

UNLABELLED: Modified release (MR) tacrolimus is an extended release formulation administered once daily (qD). The purpose of this pharmacokinetic (PK) study was to evaluate tacrolimus exposure in stable kidney transplant recipients converted from Prograf twice a day to MR tacrolimus qD. METHODS: This was an open-label, multicenter study with a crossover design. Eligible patients were 18 to 65 years of age, more than 6 months posttransplant with stable renal function, and received stable Prograf doses more than 2 weeks prior to enrollment. Patients received Prograf twice a day through day 7; 24-hour PK profiles were obtained on days 1 and 7. Patients were converted to the same milligram-for-milligram daily dose of MR tacrolimus qD in the morning on day 8; 24-hour PK profiles were obtained for MR tacrolimus on days 8, 14, and 21. Laboratory and safety parameters were also evaluated. RESULTS: Most patients (67 of 70) completed all 5 PK profiles. The 90% confidence intervals (CI) for the MR tacrolimus vs Prograf comparison at steady state (days 14 and 21 vs days 1 and 7) were 90.7 and 99.4 for AUC0-24 and 82.7 and 91.9 for Cmin. MR tacrolimus was well tolerated with a safety profile comparable to that of Prograf. AUC0-24 was highly correlated to Cmin for Prograf (day 1, r = 0.80; day 7, r = 0.84) and MR tacrolimus (day 14, r = 0.92; day 21, r = 0.86). Renal function remained stable after conversion to MR tacrolimus. CONCLUSION: The steady state PK of MR tacrolimus are equivalent to Prograf after a milligram-for-milligram conversion in stable kidney transplant recipients. The results provide evidence to support a safe 1:1 conversion from Prograf twice a day to MR tacrolimus.

Adult↗
PubMed2004

Management of the third stage of labor in an Egyptian teaching hospital.

OBJECTIVES: The study describes normal labor practices in an Egyptian teaching hospital for the first time, where postpartum hemorrhage is the leading cause of maternal mortality. Third-stage management patterns are described and compared to evidence-based medicine. Reasons for third-stage practices observed are explored. STUDY DESIGN: 176 normal births were directly observed. Women were interviewed postpartum and study findings were shared with providers. RESULTS: Third-stage active management was correctly done for 15% of women observed. Most common deviations for the remaining 85% were: giving uterotonic drugs after placental delivery (65%) and without cord traction (49%). Passive management was not done for any observed delivery. CONCLUSIONS: The preventive role actively managing the third stage can provide against postpartum hemorrhage was lost to the majority of the deliveries observed. Obstacles to adopting protocols shown to reduce hemorrhage should be explored, given the contribution of postpartum hemorrhage to maternal deaths in Egypt.

Egypt↗
PubMed2004

Labor augmentation in an Egyptian teaching hospital.

OBJECTIVES: The study documented facility-based obstetric practices for normal labor in Egypt for the first time, to determine their relationship to evidence-based medicine. This paper describes the labor augmentation pattern observed. METHODS: 176 cases of normal labor were observed by medically-trained observers using a checklist. Ward activities were also documented. Observed women were interviewed postpartum and all findings were shared with the providers for their feedback. RESULTS: Labor was augmented in 91% (165) of the labors observed; this was inappropriate for 93% or 154 women. Reasons for inappropriateness were: oxytocin ordered at the first vaginal exam (41%); in spite of intact membranes (36%), at the time of membrane rupture (42%), in spite of good progress (24%), or a combination of these. The monitoring of oxytocin-receiving women and their babies was inadequate. CONCLUSIONS: Labor augmentation and monitoring deviated from evidence-based guidelines. Obstacles to implementing protocols need to be explored.

Egypt↗
PubMed2003

Atmospheric perfluorocarbons.

Collectively, man-made emissions of a few greenhouse gases may cause about the same amount of global warming as increasing carbon dioxide. Among the most potent of these non-CO2 greenhouse gases are the perfluorocarbons that have extraordinarily long atmospheric lifetimes of 10,000 to more than 50,000 yr. We report atmospheric concentrations over two decades, between 1978 and 1997, of the three most abundant perfluorocarbons--CF4, C2F6, and C3F8--and delineate the sources that account for the present abundances and trends. We show that C2F6 and C3F8 are present at only 2.9 and 0.2 pptv, respectively. CF4 is the most abundant perfluorocarbon at 74 pptv (in 1997) of which about 40 pptv are from natural emissions, 33 pptv from aluminum manufacturing, and 1 pptv from the semiconductor industry. The increasing trend of CF4 has slowed in recent years due to the major reductions in the emission rate per ton of aluminum produced. The effect of the falling emission factor is partially offset by increased production and increasing use by the semiconductor industry.

Air Pollutants↗
PubMed2003

Ethnobotanical knowledge of local Arab practitioners in the Middle Eastern region.

An ethnobotanical survey was conducted among 31 local Arab practitioners living in Galilee, Negev, Golan Heights and West Bank. Seeing that the Arabic traditional medicine is in danger of disappearing, a multilevel program is required, involving the training of local practitioners, an establishment of a regional medicinal plant botanical garden and a field gene bank for plant preservation.

Ethnobotany↗
PubMed2002

Ethnopharmacological survey of medicinal herbs in Israel, the Golan Heights and the West Bank region.

An extensive ethnopharmacological survey was conducted among the most well known Arabic indigenous herbal practitioners in Israel, the Golan Heights and the West Bank in order to evaluate the potential of local plants used in treating different diseases and illnesses. Thirty-one indigenous practitioners' of Arabic traditional medicine ranging in age from 40 to 116 years, were interviewed using a previously prepared questionnaire. The current survey revealed that 129 plant species are still in use in Arabic traditional medicine for the treatments of various diseases. Among these plants, there are 40 species used for treating skin diseases, 27 species for treating kidney and urinary system, 26 species for treating diabetes, 23 species for treating digestive system including stomach and intestinal pain and inflammation, 22 species for treating liver diseases, 16 species for treating respiratory system and coughing, 13 species for treating forms of cancer and nine species for treating weight loss and cholesterol reduction. Additional findings and implications of this current survey including preparation methods and route of use are discussed in this report.

Humans↗
PubMed1998

P fimbriae and other adhesins enhance intestinal persistence of Escherichia coli in early infancy.

Resident and transient Escherichia coli strains were identified in the rectal flora of 22 Pakistani infants followed from birth to 6 months of age. All strains were tested for O-antigen expression, adhesin specificity (P fimbriae, other mannose-resistant adhesins or type 1 fimbriae) and adherence to the colonic cell line HT-29. Resident strains displayed higher mannose-resistant adherence to HT-29 cells, and expressed P fimbriae (P = 0.0036) as well as other mannose-resistant adhesins (P = 0.012) more often than transient strains. In strains acquired during the first month of life, P fimbriae were 12 times more frequent in resident than in transient strains (P = 0.0006). The O-antigen distribution did not differ between resident and transient strains, and none of the resident P-fimbriated strains belonged to previously recognized uropathogenic clones. The results suggest that adhesins mediating adherence to intestinal epithelial cells, especially P fimbriae, enhance the persistence of E. coli in the large intestine of infants.

Adhesins, Escherichia coli↗
PubMed1998

High turnover rate of Escherichia coli strains in the intestinal flora of infants in Pakistan.

The Escherichia coli flora of infants in developed countries is dominated by one or a few strains which persist for prolonged periods of time, but no longitudinal studies have been performed in developing countries. To this end, we studied the rectal enterobacterial flora in 22 home-delivered Pakistani infants during their first 6 months of life. Three colonies were isolated and species typed on each of 11 sampling occasions. E. coli isolates were strain typed using electromorphic typing of cytoplasmic enzymes, and their O serogroups were determined. There was a very rapid turnover of enterobacterial strains in the rectal flora of individual infants. On average, 8.5 different E. coli strains were found per infant, and several biotypes of other enterobacteria. Less than 50% of the infants were colonized with E. coli from their mothers, but strains of maternal origin were four times more likely to persists in the infants' flora than other E. coli strains. Enterobacteria other than E. coli were always of non-maternal origin, and Enterobacter cloacae and Klebsiella pneumoniae biotypes recovered from contaminated feeds were later identified in the infants' rectal flora. An early colonization with klebsiella or enterobacter was significantly associated with diarrhoea during the neonatal period, although these bacteria were not likely to be the cause of the disease. The results suggest that poor hygienic conditions result in an unstable and diverse enterobacterial flora, which may influence infant health.

Diarrhea↗
PubMed1998

Occurrence and susceptibility to antibiotics of Shigella species in stools of hospitalized children with bloody diarrhea in Pakistan.

The aim of the present investigation was to study the frequency of Shigella spp. in patients with bloody diarrhea in Pakistan and the susceptibility of isolated Shigella to three antibiotics: ampicillin, cotrimoxazole and nalidixic acid. In addition, the frequency of Campylobacter and Salmonella was also determined. Stool samples (n = 152) were collected from 152 diarrheic children less than six years of age passing blood and mucus in their stools who were admitted to Paediatric Department of Mayo Hospital in Lahore, Pakistan from June to September 1990. The samples were cultivated on standard media for Shigella, Campylobacter, and Salmonella. Susceptibility of Shigella isolates was tested by disk diffusion method. The frequency of isolation was 19.1% for Shigella spp., 7.9% for Campylobacter, and 4.6% for Salmonella. Shigella flexneri (7.9%) was the most frequently isolated species, followed by S. dysenteriae (6.6%), S. boydii, (3.3%) and S. sonnei (1.3%). All Shigella isolates were susceptible to nalidixic acid (100%), while only a few were susceptible to cotrimoxazole (7.0%) and ampicillin (3.5%). In Pakistan, self-medication and purchases of drugs without a prescription are commonly practiced. Thus, there is a greater possibility of development of resistant strains due to over use of antibiotics.

Age Factors↗
PubMed1994

Flies and water as reservoirs for bacterial enteropathogens in urban and rural areas in and around Lahore, Pakistan.

The study was conducted to isolate and characterize campylobacter, enterotoxigenic Escherichia coli-labile toxin (ETEC-LT), shigella and salmonella in flies and water. The material for the study, flies (n = 300) and water samples (n = 148), was collected from different localities in and around Lahore, Pakistan. Cultivation of the samples was performed on conventional standard media. Membrane filtration technique was used for water prior to culture. Determination of ETEC-LT was done by GM1 ELISA. Results of our study showed that flies and water were reservoirs for all the four pathogens, campylobacter, ETEC-LT, shigella and salmonella. Flies from the village were carrying fewer enteropathogens, while water from the village was found to be more contaminated as compared to the city. Campylobacter and ETEC-LT were the most frequently isolated pathogens in both flies and water. Thus the incidence of diarrhoeal disease in children of developing countries may be decreased by providing plenty of safe drinking water, improving excreta disposal, toilet facilities and giving education in personal hygiene.

Animals↗
PubMed1994

Tracheal compression caused by traumatic thoracic duct leak.

A man with traumatic thoracic duct injury developed a lymphocele causing upper airway obstruction. Despite drainage of the chylothorax, tracheal compression persisted due to a thoracic duct tear. Operative repair of the tear resulted in resolution of the airway obstruction.

Accidents, Traffic↗
PubMed1993

Early child health in Lahore, Pakistan: VIII. Microbiology.

The causative agents of acute diarrhoea were investigated in children under the age of five years from 1985-1991 in three socio-economically different areas in Lahore, Pakistan. The aim was to determine the frequencies of the most common enteropathogens in faeces. The total isolation rate was 73.4%; two thirds (53.5%) were of bacterial and one third (19.9%) of viral origin. ETEC-LT (23.4%), Rota virus (19.9%), EPEC (15%) and Campylobacter (12%) were the single most frequent pathogens in all age groups and areas of living. The positivity of Campylobacter increased from 1.6% to 12% after the change of isolation technique. Shigella was isolated significantly (p > 0.001) more in children over than under one year of age. The incidence of bacterial infections was high during all seasons, while in certain years Rota virus was relatively low in the summer compared to the cooler months. The prevalence of ETEC-LT diarrhoea was higher in the periurban slum as compared to the village and the urban slum. The study is the first of its kind in Pakistan, and the results are similar to other comparable studies. It is thus possible to establish a well functioning and reliable microbiological laboratory in developing countries in a setting with restricted trained personnel and material resources.

Age Factors↗
PubMed1993

Frequency and enterotoxigenicity of Campylobacter jejuni and C. coli in domestic animals in Pakistan as compared to Sweden.

Domestic and wild animals have been considered to be the most common reservoirs of Campylobacter for human infections. This study has been conducted to establish the frequency and enterotoxigenicity of C. jejuni and C. coli in the stools of domestic animals in a developing versus a developed country. Faecal samples of 300 chickens and laying hens, 102 horses, 180 cows, 92 goats and sheep were collected from Pakistan and Sweden. The hippurate hydrolysis test and CHO-cell test were performed for species differentiation and enterotoxigenicity determination respectively. The pattern and sequence of frequency distribution of Campylobacter in animals in Pakistan and Sweden were similar, the main difference being a significantly higher frequency in Pakistani samples. C. jejuni was the dominant species from both countries and Pakistani strains were more enterotoxigenic than Swedish strains. We conclude that the spread of Campylobacter infection in developing countries originates from different sources in the neighbourhood, for example animals, and unless hygienic conditions improve no change can be expected.

Animals↗
PubMed1992

Post-operative return of head malposition in congenital null point nystagmus.

We present two patients with congenital null point nystagmus with head malposition and orthotopic eyes who underwent a modified Kestenbaum-Anderson operation. The face malposition returned in both patients about one year post operatively despite marked reduction of gaze toward the side of the original null point. We do not believe it is the reduced adduction of the fixating eye that eliminates the face turn or prevents its recurrence. Surgical normalization of an abnormal proprioception eliminates the face turn whereas the head malposition return is due to a faulty development of the brain, irreversible and deeply adopted to the abnormal proprioception.

Child, Preschool↗
PubMed1990

Enterotoxigenicity and frequency of Campylobacter jejuni, C. coli and C. laridis in human and animal stool isolates from different countries.

Campylobacter jejuni and C. coli strains were collected during three different years from adult patients with enterocolitis in Sweden (n = 372) from 49 patients in Kuwait, and Campylobacter strains from hens from Mexico, Pakistan and Sweden (n = 107) and Swedish pigs (n = 47). C. jejuni was the predominant species in human and hen isolates, and C. coli in pigs C. coli was significantly more common in human isolates from Sweden, and more common in hen isolates from Pakistan, than in hens from Sweden and Mexico. C. laridis was only isolated from pigs (17%) and was in no case enterotoxigenic. Both in human and hen isolates, C. jejuni strains were more enterotoxigenic than C. coli strains. C. jejuni strains from Swedish hens were less enterotoxigenic than those from Pakistan and Mexico (P less than 0.001), and strains from pigs were less enterotoxigenic than those from hens (P less than 0.001). We conclude that C. jejuni are more often enterotoxigenic and possibly more virulent than c. coli and C. laridis. The relative frequency of C. jejuni and C. coli in humans and animals differs from one country to another.

Adolescent↗
PubMed1989

Colonic interposition after esophagogastrectomy in a child with Zollinger-Ellison syndrome.

Zollinger-Ellison syndrome is a rare childhood entity that usually presents with peptic ulcer disease and is resistant to medical management. In contrast to the treatment of the disease in adults, total gastrectomy is the procedure of choice for pediatric patients. We report on a child with Zollinger-Ellison syndrome complicated by esophageal stricture in whom we performed a new operative procedure using a colonic interposition. The use of the procedure has obviated the side effects commonly associated with gastrectomy.

Child↗