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Z Memish

Publications and source records attributed to Z Memish.

At least 19 recordsLinked to original sources
PubMed2003

HIV-1 p24 antigen testing in blood banks: results from Saudi Arabia.

HIV-1 p24 antigen testing was introduced to increase sensitivity in the early detection of HIV infection in blood donors. Since the introduction of HIV-1 p24 antigen testing in Saudi Arabia, we have failed to detect a single positive case. Over a three-year period, only four indeterminates were detected out of 24,654 blood donors. All four proved negative by confirmatory testing. Based on this experience, we believe that resources would be better directed to pooled nucleic acid testing and that p24 serological testing should be abandoned.

AIDS Serodiagnosis↗
PubMed2001

Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia.

The incidence of drug resistance in Mycobacterium tuberculosis (MTB) isolated from our hospital between April 1996 and March 1998 was compared with an earlier study (1993-1995). Thirty (29.7%) of 101 MTB isolates were resistant to one or more anti-TB drugs and 21 (20%) of 101 were multi-drug resistant M. tuberculosis (MDR-TB). Resistance was most common to isoniazid (28.7%), followed by streptomycin (22.8%) and rifampicin (20.8%). Resistance to pyrazinamide and ethambutol was 7.9 and 6.9%, respectively. There was a three-fold increase in resistance compared with the earlier study.

Antitubercular Agents↗
PubMed2001

Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum.

BACKGROUND: Abdominal tuberculosis has varied presentation and can be confused with other conditions. METHODS: We report our experience with 46 patients. Charts of patients managed during 1984-97 were reviewed. RESULTS: Fifty-two percent were women and mean age was 46 years. Presenting symptoms were as follows: fever 70%; abdominal pain 70%; weight loss 68%; abdominal swelling 67%; change in bowel habit 39%; anorexia 30%; and sweating 30%. Common physical signs were as follows: fever 73%; ascites 61%; abdominal mass 13%; and doughy abdomen 9%. Thirty percent of patients either gave past history of TB or presented with active TB of other sites. TB skin test was positive in only 27% of patients. CT scans of abdomen were abnormal in 80%, showing ascites, peritoneal lesions or enlarged nodes. Ascitic fluid was diagnostic for TB on smear/culture in 33%. Peritoneal biopsy was performed by laparoscopy or laparotomy in 61%. It was positive for ganulomas in 97% and for smear/culture in 68%. Forty-two patients recovered after receiving anti-TB therapy for 9-12 months. Four patients died. One died within 1 month of initiation of therapy due to extensive TB, and death in the other 3 was due to unrelated causes. CONCLUSION: Abdominal TB should be suspected in patients with fever, abdominal pain and ascites. This condition carries good prognosis if promptly diagnosed and treated.

Adolescent↗
PubMed2001

Brucellosis control in Saudi Arabia: prospects and challenges.

Brucellosis is a zoonotic disease of worldwide distribution. Despite its control in many developed countries the disease remains endemic in Saudi Arabia where the national seroprevalence of the disease is 15%. In Saudi Arabia the disease is introduced through uncontrolled importation of animals that are poorly screened for the disease. Every year the Kingdom imports a few million heads of sheep and goats for sacrifice during Hajj from Africa, India, and Autstralia. Brucella melitensis remains the principle cause of human brucellosis in Saudi Arabia, causing 88-93% of the cases. Recent national statistics indicate that the disease incidence in humans is close to 40 cases per 100,000. The eradication of human brucellosis in Saudi Arabia will ultimately depend on the eradication of animal brucellosis. There is an urgent need for a national program for controlling brucellosis in the Kingdom. The components of this program will include recruitment and training of qualified veterinarians, development of an adequate number of animal quarantine centers and implementing legislation to control marketing and movement of animals.

Agriculture↗
PubMed2001

Community acquired pneumonia (CAP): an update.

Community-acquired pneumonia (CAP) remains a common and serious infectious disease worldwide. Recent investigations highlight the difficulties in making etiological diagnosis while emphasizing the importance of atypical pathogens in CAP. Prognostic tools such as the pneumonia severity index have been validated and widely endorsed as an aid in making site of care decisions in managing CAP patients. Empiric treatment guidelines for CAP have been developed and their use has been shown to simplify treatment regimens and improve outcome.

Administration, Oral↗
PubMed2001

Methicillin-resistant Staphylococcus aureus: profiles oceans apart--Canadian and Saudi Arabian experiences.

Methicillin-resistant Staphylococcus aureus (MRSA), a pathogen which has increased over the past three decades, is responsible for nosocomial infections and adverse patient outcomes. It is a pathogen of global importance. Rates of patient colonization or infection vary greatly internationally. Lower rates have been observed in Canada and Saudi Arabia compared to the United States and United Kingdom. Although these lower rates may appear reassuring, the trend in MRSA observed in two capital cities, Winnipeg, Canada and Riyadh, Saudi Arabia are consistent with a widespread global increase in MRSA.

Canada↗
PubMed2001

Bacterial meningitis in Saudi Arabia: the impact of Haemophilus influenzae type b vaccination.

Bacterial meningitis is one of the major causes of morbidity and mortality in children. A retrospective chart review of all cases of culture-proven bacterial meningitis in children was conducted in a tertiary care facility in the King Fahad National Guard Hospital (KFNGH), Riyadh. Sixty-seven patients with culture-proven meningitis were reviewed. Bacterial meningitis is more common in children under 2 years of age (85%). Haemophilus influenzae type b (Hib) was the most common organism causing meningitis in children (57%). Streptococcus pneumoniae was the second most common organism (31%) followed by group B streptococcus in (7.5%). Fever, lethargy and vomiting were the most common presenting symptoms, occurring in 95%, 72%, and 66% respectively. The calculated incidence of Hib in KFNGH is 40/100,000. This incidence decreased dramatically after the initiation of routine infant vaccination in KFNGH with the conjugate Hib vaccine in April 1998. Outcome of Hib meningitis was good in 85% while outcome of Streptococcus pneumoniae was good in (53%). 43% of S. pneumoniae were resistant to penicillin. There was no cephalosporin-resistant isolate identified during the study period. Mortality due to meningitis was 4 (6%), 3 patients died due to S. pneumoniae and one due to Hib. Since Hib is the most common organism causing meningitis in Saudi Arabian children, mass vaccination of all Saudi children should be mandatory.

Adolescent↗
PubMed2001

Antibiotic resistance in developing countries.

During the past decade there have been major changes in the susceptibility of bacteria that cause various infections. Resistance to anti-infective agents, including antibiotics, is worldwide, both in developed and developing countries. Almost all bacterial species can develop resistance to anti-infective agents and resistance can readily be transferred among bacteria by transmissible elements (plasmids). Measures to prevent the emergence of resistance must be implemented urgently. A multiplicity of factors drive antibiotic resistance and solutions require the collaboration of governmental agencies, pharmaceutical companies, healthcare providers and consumers. Knowledge of resistance patterns and of the ways by which resistance is overcome is vital to the future of antimicrobial chemotherapy.

Developing Countries↗
PubMed2001

Infection control practice: global preparedness for future challenges.

The modern infection control profession emerged in the 1960s in England and the US in response to a pandemic of infections in hospitalized patients from a virulent strain of Staphylococcus aureus. The need for better patient care practices to prevent infections in this setting was evident, and the nursing, medical and microbiology professions responded. Both governmental and non-governmental agencies and professional organizations supported their efforts. During the past 3 decades infection control programs and professionals have multiplied and flourished throughout the world. At first, each country worked primarily within its own borders. In recent years collaboration among countries has increased dramatically, especially as related to education and training, research, and publishing. This article describes two examples of these partnerships. In the US, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology, Inc (APIC) have joined with the King Fahad National Guard Hospital (KFNGH), a center-of-excellence for infection control in Riyadh, Saudi Arabia for educational meetings and infection control certification. The information exchanged and relationships developed through these activities will further efforts of both countries toward meeting infection prevention and control challenges of the future.

Disaster Planning↗
PubMed2001

Infectious diseases: career preparation.

The human resources for the discipline of Infectious Diseases are inadequate in many countries. There is no global definition of "Infectious Diseases" physicians and cover competency. Preparation for a career in this speciality varies greatly. In large populations in Asia and Africa, few individuals exist who have been trained to be Infectious Disease Clinicians. There is a great need by national and international societies to embrace this speciality and address the global deficiencies in this discipline by directing funding agencies as well as training institutions to redirect resources to strengthen the capacity of health professionals to deal with infectious diseases adequately throughout the world.

Africa↗
PubMed2001

Diagnostic value of Brucella ELISA IgG and IgM in bacteremic and non-bacteremic patients with brucellosis.

The diagnostic value of Brucella ELISA IgG and IgM has been evaluated in patients with brucellosis. Serum samples and blood cultures were collected from 83 patients with brucellosis. The sera were tested by Brucella ELISA for Brucella IgM and IgG antibodies. All 44 controls were negative for IgG and IgM. Brucella melitensis was isolated from blood cultures of 30/83 (36.1%) patients. Among the 30 bacteremic patients, 24 (80%) had an increased IgM titer of > or = 200. Of the 53 non-bacteremic patients, 41 had IgM titer > or = 200, while 22 had IgG titer of > or = 1,600. The ELISA IgM and IgG tests achieved a specificity and sensitivity of 100% and 96% respectively, while the positive and negative predictive values were 100% and 94% respectively. The Brucella ELISA is a reliable and sensitive test in the diagnosis of brucellosis. The test is rapid, easy to perform and can be automated.

Bacteremia↗
PubMed2001

The correlation of agglutination titer with positive blood cultures in brucellosis: A comparison of two study periods.

Brucellosis is an endemic zoonosis in Saudi Arabia. Correlation of Brucella agglutination antibody titer with positive blood culture was performed over 2 time periods (1986 and 1998). At the King Fahad National Guard Hospital we generally consider a titer value of 1:320 or greater as being diagnostic of Brucella. Using this cut-off, the positive predictive value of 39.3% (95% CI=31.5 to 47.6) in the 1986 study increased to 55.7% (95% CI=42.4 to 68.5) in the recent study (P=0.03). This improvement is probably due to parallel improvement in both methodologies.

Agglutination Tests↗
PubMed2001

The use of direct susceptibility tests from BACTEC 9240 to Microscan Walkaway.

Using a straight-from-the-bottle into-the-instrument technique, a series of direct susceptibility tests were performed with the BACTEC 9240 and Microscan Walkaway systems. Although rapid, unacceptably high error rates were obtained when compared with a standardized method. This procedure is not sufficiently accurate for clinical use.

Cell Culture Techniques↗
PubMed2001

Upper airway obstruction due to rhinoscleroma: case report.

Rhinoscleroma is a very rare cause of upper airway obstruction with only isolated reports in the literature of rhinoscleroma with isolated tracheal obstruction. The course is usually chronic with the presentation most often being non-specific. We report a 54-year-old woman with progressive shortness of breath and wheezing over 7 years' duration. She was diagnosed and treated as bronchial asthma without improvement in her symptoms. At the time of referral to our institution, her flow-volume loop revealed fixed upper airway obstruction. Her chest radiography and other laboratory tests were normal. Bronchoscopy revealed a 70-80% irregular concentric stenosis of the trachea beginning immediately below the vocal cords and extending 4 cm distally. Biopsy showed characteristic Mikulicz histiocytes containing numerous gram-negative intracellular coccobacilli consistent with a diagnosis of rhinoscleroma. The patient was treated with laser resection of the stenosis followed by a course of ciprofloxcin and trimethoprim-sulfamethoxazole. She has remained asymptomatic over a year follow-up period and repeated biopsies have shown no evidence of recurrence.

Airway Obstruction↗
PubMed2000

Brucella bacteraemia: clinical and laboratory observations in 160 patients.

OBJECTIVES: To describe the clinical, serological, and prognostic features of bacteraemic brucellosis in an endemic region. METHODS: Retrospective case series of 160 patients admitted from 1983 to 1995 to a hospital providing secondary and tertiary level medical care in Saudi Arabia. All patients had positive blood cultures for Brucella species, predominantly Brucella melitensis. RESULTS: Bacteraemia was documented in 38% of 545 cases of brucellosis admitted to our institution during the study period. The main clinical syndromes were febrile illness alone (44%) or fever with arthritis (42%). Of 68 isolates that were speciated, 93% were Brucella melitensis. Initial agglutinating antibody titre was > or =1:320 in 96% of the patients. Antimicrobial resistance of B.melitensis isolates was: co-trimoxazole, 29%; rifampicin, 3.5%; streptomycin, 0.6%; and tetracycline, 0.6%. No increase in resistance was noted over the 13-year study period. Commonly used antimicrobial regimens consisted of streptomycin plus tetracycline or rifampicin plus doxycycline given for 6 weeks. Seven patients (5%) had relapse of their symptoms after antimicrobial therapy. Three of these had infective endocarditis with repeated bacteraemia. These patients required aortic valve replacement and recovered after surgery. The remaining four patients responded to a second course of therapy. CONCLUSIONS: Brucella bacteraemia is an acute febrile disease often associated with rheumatologic complaints. Most patients have an agglutinating antibody titre > or =1:320 and respond well to standard chemotherapy regimens with low mortality.

Adult↗
PubMed2000

The changing spectrum of Group B streptococcal (GBS) infection in infants of Saudi Arabia.

This study describes the incidence, clinical presentation and outcome of neonatal Group B streptococcal (GBS) infection in a Saudi Arabian Hospital. Charts of all neonates with GBS infection admitted to our hospital during a 5-year period (1990-1994) were reviewed retrospectively. Of the 29,601 live births, 23 neonates had GBS infection, giving an overall incidence rate of 0.8 per 1000 live births. The incidence rate appeared to increase from 0.2 per 1000 live births in 1990 to 1.2 per 1000 live births in 1994 (not statistically significant (P=0.07)). Of the 23 neonates with GBS infection, 16 (70%) were full term infants (gestation > or = 37 weeks). In contrast, 7 (30%) were preterm infants (gestation < 37 weeks). Ten (44%) mothers had premature rupture of membrane. Intrapartum fever and/or urinary tract infection was observed in 9% of the mothers. Nineteen (82%) of the neonates had early onset GBS infection, whereas only 4 infants (18%) had late-onset infection. Blood and CSF cultures were positive in 21 (91%) and 5 (21%), respectively. Complications of GBS infection were as follows: sepsis without focus of infection 15 (65%); meningitis 5 (22%); pneumonia 3 (13%); urinary tract infection 2 (9%). None of these complications had any significant association with the onset of infection (P>0.1). The overall case-fatality rate was 9%. The incidence of GBS infection appears to be increasing in Saudi neonates and measures to prevent perinatal transmission need to emphasized and implemented.

Adult↗
PubMed2000

Candida meningitis in children: report of two cases.

Candida meningitis is rare in children. However reports have been increasing recently. We report two cases of meningitis caused by Candida species. The first case was a term male infant who was admitted at 14 days of age with the diagnosis of possible sepsis. He had received multiple courses of antibiotics without improvement. Later his cerebrospinal fluid (CSF) culture grew Candida tropicalis. The damage done by the infection was severe and the patient died. The second case was a 2-month old girl who was born at 34 weeks of gestation. She was admitted to the Neonatal Intensive Care Unit (NICU) and given antibiotics as prophylaxis. Despite this she developed recurrent episodes of fever that required multiple courses of antibiotics. After discharging her, she continued to have fever. Upon investigation, her blood and CSF grew Candida albicans. She was treated and responded to therapy.

Antifungal Agents↗