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Tahir MA, Khan MA, Ikram A, Chaudhry TH, Amir A, Tahir M, Haq IU, Zaki SA, Salam A, Wali S, Munir W, Salman M. Coordination strategies and concept of operations implemented during activation of public health emergency operations center for COVID-19 response in Pakistan. Sci Rep 2023; 13:18831. [PMID: 37914904 PMCID: PMC10620167 DOI: 10.1038/s41598-023-46234-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies/departments in Pakistan. Health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to emergencies. We conducted an assessment of public health emergency response coordination implemented during the COVID-19 at strategic level. This was mix-method qualitative study. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment. The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies. Effective public health emergency response is based on multi-departmental coordination, resource mobilization, and clear roles for each agency. Pakistan must proactively address these challenges for pandemic response in future.
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Affiliation(s)
- Majid Ali Tahir
- CDC, National Institutes of Health, Islamabad, Pakistan.
- Department of Public Health and Nutrition, University of Haripur, Haripur, KP, Pakistan.
| | - Mumtaz Ali Khan
- Center for Disease Control, National Institutes of Health, Islamabad, Pakistan
| | - Aamer Ikram
- Center for Disease Control, National Institutes of Health, Islamabad, Pakistan
| | | | - Afreenish Amir
- Center for Disease Control, National Institutes of Health, Islamabad, Pakistan
| | | | - Ijaz Ul Haq
- Department of Public Health and Nutrition, University of Haripur, Haripur, KP, Pakistan.
| | - Shahbaz Ahmed Zaki
- Department of Public Health and Nutrition, University of Haripur, Haripur, KP, Pakistan
| | - Arslan Salam
- Center for Disease Control, National Institutes of Health, Islamabad, Pakistan
| | - Sidra Wali
- Center for Disease Control, National Institutes of Health, Islamabad, Pakistan
| | | | - Muhammad Salman
- Center for Disease Control, National Institutes of Health, Islamabad, Pakistan
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Carey ME, Dyson ZA, Ingle DJ, Amir A, Aworh MK, Chattaway MA, Chew KL, Crump JA, Feasey NA, Howden BP, Keddy KH, Maes M, Parry CM, Van Puyvelde S, Webb HE, Afolayan AO, Alexander AP, Anandan S, Andrews JR, Ashton PM, Basnyat B, Bavdekar A, Bogoch II, Clemens JD, da Silva KE, De A, de Ligt J, Diaz Guevara PL, Dolecek C, Dutta S, Ehlers MM, Francois Watkins L, Garrett DO, Godbole G, Gordon MA, Greenhill AR, Griffin C, Gupta M, Hendriksen RS, Heyderman RS, Hooda Y, Hormazabal JC, Ikhimiukor OO, Iqbal J, Jacob JJ, Jenkins C, Jinka DR, John J, Kang G, Kanteh A, Kapil A, Karkey A, Kariuki S, Kingsley RA, Koshy RM, Lauer AC, Levine MM, Lingegowda RK, Luby SP, Mackenzie GA, Mashe T, Msefula C, Mutreja A, Nagaraj G, Nagaraj S, Nair S, Naseri TK, Nimarota-Brown S, Njamkepo E, Okeke IN, Perumal SPB, Pollard AJ, Pragasam AK, Qadri F, Qamar FN, Rahman SIA, Rambocus SD, Rasko DA, Ray P, Robins-Browne R, Rongsen-Chandola T, Rutanga JP, Saha SK, Saha S, Saigal K, Sajib MSI, Seidman JC, Shakya J, Shamanna V, Shastri J, Shrestha R, Sia S, Sikorski MJ, Singh A, Smith AM, Tagg KA, Tamrakar D, Tanmoy AM, Thomas M, Thomas MS, Thomsen R, Thomson NR, Tupua S, Vaidya K, Valcanis M, Veeraraghavan B, Weill FX, Wright J, Dougan G, Argimón S, Keane JA, Aanensen DM, Baker S, Holt KE. Global diversity and antimicrobial resistance of typhoid fever pathogens: Insights from a meta-analysis of 13,000 Salmonella Typhi genomes. eLife 2023; 12:e85867. [PMID: 37697804 PMCID: PMC10506625 DOI: 10.7554/elife.85867] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 08/02/2023] [Indexed: 09/13/2023] Open
Abstract
Background The Global Typhoid Genomics Consortium was established to bring together the typhoid research community to aggregate and analyse Salmonella enterica serovar Typhi (Typhi) genomic data to inform public health action. This analysis, which marks 22 years since the publication of the first Typhi genome, represents the largest Typhi genome sequence collection to date (n=13,000). Methods This is a meta-analysis of global genotype and antimicrobial resistance (AMR) determinants extracted from previously sequenced genome data and analysed using consistent methods implemented in open analysis platforms GenoTyphi and Pathogenwatch. Results Compared with previous global snapshots, the data highlight that genotype 4.3.1 (H58) has not spread beyond Asia and Eastern/Southern Africa; in other regions, distinct genotypes dominate and have independently evolved AMR. Data gaps remain in many parts of the world, and we show the potential of travel-associated sequences to provide informal 'sentinel' surveillance for such locations. The data indicate that ciprofloxacin non-susceptibility (>1 resistance determinant) is widespread across geographies and genotypes, with high-level ciprofloxacin resistance (≥3 determinants) reaching 20% prevalence in South Asia. Extensively drug-resistant (XDR) typhoid has become dominant in Pakistan (70% in 2020) but has not yet become established elsewhere. Ceftriaxone resistance has emerged in eight non-XDR genotypes, including a ciprofloxacin-resistant lineage (4.3.1.2.1) in India. Azithromycin resistance mutations were detected at low prevalence in South Asia, including in two common ciprofloxacin-resistant genotypes. Conclusions The consortium's aim is to encourage continued data sharing and collaboration to monitor the emergence and global spread of AMR Typhi, and to inform decision-making around the introduction of typhoid conjugate vaccines (TCVs) and other prevention and control strategies. Funding No specific funding was awarded for this meta-analysis. Coordinators were supported by fellowships from the European Union (ZAD received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 845681), the Wellcome Trust (SB, Wellcome Trust Senior Fellowship), and the National Health and Medical Research Council (DJI is supported by an NHMRC Investigator Grant [GNT1195210]).
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Affiliation(s)
- Megan E Carey
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- IAVI, Chelsea & Westminster HospitalLondonUnited Kingdom
| | - Zoe A Dyson
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, Central Clinical School, Monash UniversityMelbourneAustralia
- Wellcome Sanger Institute, Wellcome Genome CampusHinxtonUnited Kingdom
| | - Danielle J Ingle
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of MelbourneMelbourneAustralia
| | | | - Mabel K Aworh
- Nigeria Field Epidemiology and Laboratory Training ProgrammeAbujaNigeria
- College of Veterinary Medicine, North Carolina State UniversityRaleighUnited States
| | | | - Ka Lip Chew
- National University HospitalSingaporeSingapore
| | - John A Crump
- Centre for International Health, University of OtagoDunedinNew Zealand
| | - Nicholas A Feasey
- Department of Clinical Sciences, Liverpool School of Tropical MedicineLiverpoolUnited Kingdom
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health SciencesBlantyreMalawi
| | - Benjamin P Howden
- Centre for Pathogen Genomics, Department of Microbiology and Immunology, University of Melbourne at Doherty Institute for Infection and ImmunityMelbourneAustralia
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | | | - Mailis Maes
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Christopher M Parry
- Department of Clinical Sciences, Liverpool School of Tropical MedicineLiverpoolUnited Kingdom
| | - Sandra Van Puyvelde
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
- University of AntwerpAntwerpBelgium
| | - Hattie E Webb
- Centers for Disease Control and PreventionAtlantaUnited States
| | - Ayorinde Oluwatobiloba Afolayan
- Global Health Research Unit (GHRU) for the Genomic Surveillance of Antimicrobial Resistance, Faculty of Pharmacy, University of IbadanIbadanNigeria
| | | | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical CollegeVelloreIndia
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford UniversityStanfordUnited States
| | - Philip M Ashton
- Malawi-Liverpool Wellcome ProgrammeBlantyreMalawi
- Institute of Infection, Veterinary and Ecological Sciences, University of LiverpoolLiverpoolUnited Kingdom
| | - Buddha Basnyat
- Oxford University Clinical Research Unit NepalKathmanduNepal
| | | | - Isaac I Bogoch
- Department of Medicine, Division of Infectious Diseases, University of TorontoTorontoCanada
| | - John D Clemens
- International Vaccine InstituteSeoulRepublic of Korea
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
- UCLA Fielding School of Public HealthLos AngelesUnited States
- Korea UniversitySeoulRepublic of Korea
| | - Kesia Esther da Silva
- Division of Infectious Diseases and Geographic Medicine, Stanford UniversityStanfordUnited States
| | - Anuradha De
- Topiwala National Medical CollegeMumbaiIndia
| | - Joep de Ligt
- ESR, Institute of Environmental Science and Research Ltd., PoriruaWellingtonNew Zealand
| | | | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Shanta Dutta
- ICMR - National Institute of Cholera & Enteric DiseasesKolkataIndia
| | - Marthie M Ehlers
- Department of Medical Microbiology, Faculty of Health Sciences, University of PretoriaPretoriaSouth Africa
- Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory ServicePretoriaSouth Africa
| | | | | | - Gauri Godbole
- United Kingdom Health Security AgencyLondonUnited Kingdom
| | - Melita A Gordon
- Institute of Infection, Veterinary and Ecological Sciences, University of LiverpoolLiverpoolUnited Kingdom
| | - Andrew R Greenhill
- Federation University AustraliaChurchillAustralia
- Papua New Guinea Institute of Medical ResearchGorokaPapua New Guinea
| | - Chelsey Griffin
- Centers for Disease Control and PreventionAtlantaUnited States
| | - Madhu Gupta
- Post Graduate Institute of Medical Education and ResearchChandigarhIndia
| | | | - Robert S Heyderman
- Research Department of Infection, Division of Infection and Immunity, University College LondonLondonUnited Kingdom
| | | | - Juan Carlos Hormazabal
- Bacteriologia, Subdepartamento de Enfermedades Infecciosas, Departamento de Laboratorio Biomedico, Instituto de Salud Publica de Chile (ISP)SantiagoChile
| | - Odion O Ikhimiukor
- Global Health Research Unit (GHRU) for the Genomic Surveillance of Antimicrobial Resistance, Faculty of Pharmacy, University of IbadanIbadanNigeria
| | - Junaid Iqbal
- Department of Pediatrics and Child Health, Aga Khan UniversityKarachiPakistan
| | - Jobin John Jacob
- Department of Clinical Microbiology, Christian Medical CollegeVelloreIndia
| | - Claire Jenkins
- United Kingdom Health Security AgencyLondonUnited Kingdom
| | | | - Jacob John
- Department of Community Health, Christian Medical CollegeVelloreIndia
| | - Gagandeep Kang
- Department of Community Health, Christian Medical CollegeVelloreIndia
| | - Abdoulie Kanteh
- Medical Research Council Unit The Gambia at London School Hygiene & Tropical MedicineFajaraGambia
| | - Arti Kapil
- All India Institute of Medical SciencesDelhiIndia
| | | | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research InstituteNairobiKenya
| | | | | | - AC Lauer
- Centers for Disease Control and PreventionAtlantaUnited States
| | - Myron M Levine
- Center for Vaccine Development and Global Health (CVD), University of Maryland School of Medicine, Baltimore, Maryland, USABaltimoreUnited States
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford UniversityStanfordUnited States
| | - Grant Austin Mackenzie
- Medical Research Council Unit The Gambia at London School Hygiene & Tropical MedicineFajaraGambia
| | - Tapfumanei Mashe
- National Microbiology Reference LaboratoryHarareZimbabwe
- World Health OrganizationHarareZimbabwe
| | | | - Ankur Mutreja
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Geetha Nagaraj
- Central Research Laboratory, Kempegowda Institute of Medical SciencesBengaluruIndia
| | | | - Satheesh Nair
- United Kingdom Health Security AgencyLondonUnited Kingdom
| | | | | | | | - Iruka N Okeke
- Global Health Research Unit (GHRU) for the Genomic Surveillance of Antimicrobial Resistance, Faculty of Pharmacy, University of IbadanIbadanNigeria
| | | | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of OxfordOxfordUnited Kingdom
- The NIHR Oxford Biomedical Research CentreOxfordUnited Kingdom
| | | | - Firdausi Qadri
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan UniversityKarachiPakistan
| | | | - Savitra Devi Rambocus
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - David A Rasko
- Department of Microbiology and Immunology, University of Maryland School of MedicineBaltimoreUnited States
- Institute for Genome Sciences, University of Maryland School of MedicineBaltimoreUnited States
| | - Pallab Ray
- Post Graduate Institute of Medical Education and ResearchChandigarhIndia
| | - Roy Robins-Browne
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of MelbourneMelbourneAustralia
- Murdoch Children’s Research Institute, Royal Children’s HospitalParkvilleAustralia
| | | | | | | | | | | | - Mohammad Saiful Islam Sajib
- Child Health Research FoundationDhakaBangladesh
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of GlasgowGlasgowUnited Kingdom
| | | | - Jivan Shakya
- Dhulikhel HospitalDhulikhelNepal
- Institute for Research in Science and TechnologyKathmanduNepal
| | - Varun Shamanna
- Central Research Laboratory, Kempegowda Institute of Medical SciencesBengaluruIndia
| | - Jayanthi Shastri
- Topiwala National Medical CollegeMumbaiIndia
- Kasturba Hospital for Infectious DiseasesMumbaiIndia
| | - Rajeev Shrestha
- Center for Infectious Disease Research & Surveillance, Dhulikhel Hospital, Kathmandu University HospitalDhulikhelNepal
| | - Sonia Sia
- Research Institute for Tropical Medicine, Department of HealthMuntinlupa CityPhilippines
| | - Michael J Sikorski
- Center for Vaccine Development and Global Health (CVD), University of Maryland School of Medicine, Baltimore, Maryland, USABaltimoreUnited States
- Department of Microbiology and Immunology, University of Maryland School of MedicineBaltimoreUnited States
- Institute for Genome Sciences, University of Maryland School of MedicineBaltimoreUnited States
| | | | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Kaitlin A Tagg
- Centers for Disease Control and PreventionAtlantaUnited States
| | - Dipesh Tamrakar
- Center for Infectious Disease Research & Surveillance, Dhulikhel Hospital, Kathmandu University HospitalDhulikhelNepal
| | | | - Maria Thomas
- Christian Medical College, LudhianaLudhianaIndia
| | | | | | | | - Siaosi Tupua
- Ministry of Health, Government of SamoaApiaSamoa
| | | | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | | | | | - Jackie Wright
- ESR, Institute of Environmental Science and Research Ltd., PoriruaWellingtonNew Zealand
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - Silvia Argimón
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of OxfordOxfordUnited Kingdom
| | - Jacqueline A Keane
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
| | - David M Aanensen
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of OxfordOxfordUnited Kingdom
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge School of Clinical Medicine, Cambridge Biomedical CampusCambridgeUnited Kingdom
- IAVI, Chelsea & Westminster HospitalLondonUnited Kingdom
| | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, Central Clinical School, Monash UniversityMelbourneAustralia
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Saleem Z, Haseeb A, Abuhussain SSA, Moore CE, Kamran SH, Qamar MU, Azmat A, Pichierri G, Raees F, Asghar S, Saeed A, Amir A, Hashmi FK, Meyer JC, Sefah IA, Rehman IU, Nadeem MU, Godman B. Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications. Medicina (Kaunas) 2023; 59:1215. [PMID: 37512028 PMCID: PMC10383515 DOI: 10.3390/medicina59071215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah 21955, Saudi Arabia
| | | | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Sairah Hafeez Kamran
- Institute of Pharmacy, Lahore College for Women University, Lahore 54000, Pakistan
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Aisha Azmat
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Giuseppe Pichierri
- Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK
| | - Fahad Raees
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Shahzad Asghar
- Department of Pharmacy, University of South Asia, Lahore 54000, Pakistan
| | - Amna Saeed
- Department of Pharmaceutical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur 22620, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
- National Institute of Health, Park Road, Islamabad 45501, Pakistan
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
| | - Inaam Ur Rehman
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Umer Nadeem
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Ambreen S, Safdar N, Ikram A, Baig MZI, Farooq A, Amir A, Saeed A, Sabih F, Ahsan Q, Zafar A, Mahipala PG, Saleem Z, Salman M. Point Prevalence Survey of Antimicrobial Use in Selected Tertiary Care Hospitals of Pakistan Using WHO Methodology: Results and Inferences. Medicina (Kaunas) 2023; 59:1102. [PMID: 37374306 PMCID: PMC10303015 DOI: 10.3390/medicina59061102] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and objectives: The inappropriate use of antibiotics in hospitals can potentially lead to the development and spread of antibiotic resistance, increased mortality, and high economic burden. The objective of the study was to assess current patterns of antibiotic use in leading hospitals of Pakistan. Moreover, the information collected can support in policy-making and hospital interventions aiming to improve antibiotic prescription and use. Methodology and materials: A point prevalence survey was carried out with data abstracted principally from patient medical records from 14 tertiary care hospitals. Data were collected through the standardized online tool KOBO application for smart phones and laptops. For data analysis, SPSS Software was used. The association of risk factors with antimicrobial use was calculated using inferential statistics. Results: Among the surveyed patients, the prevalence of antibiotic use was 75% on average in the selected hospitals. The most common classes of antibiotics prescribed were third-generation cephalosporin (38.5%). Furthermore, 59% of the patients were prescribed one while 32% of the patients were prescribed two antibiotics. Whereas the most common indication for antibiotic use was surgical prophylaxis (33%). There is no antimicrobial guideline or policy for 61.9% of antimicrobials in the respected hospitals. Conclusions: It was observed in the survey that there is an urgent need to review the excessive use of empiric antimicrobials and surgical prophylaxis. Programs should be initiated to address this issue, which includes developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities.
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Affiliation(s)
- Saadia Ambreen
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Numrah Safdar
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Aamer Ikram
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | | | - Ayesha Farooq
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Afreenish Amir
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Asim Saeed
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
| | - Farah Sabih
- World Health Organization, Country Office, Park Road, Islamabad 45501, Pakistan (P.G.M.)
| | - Qadeer Ahsan
- The Fleming Fund Country Grant, DAI Office, Beverly Centre, F-6/1, Blue Area, Islamabad 04403, Pakistan
| | - Alia Zafar
- World Health Organization, Country Office, Park Road, Islamabad 45501, Pakistan (P.G.M.)
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakaria University, Multan 60800, Pakistan;
| | - Muhammad Salman
- National Institute of Health, Park Road, Islamabad 45501, Pakistan (A.I.); (A.A.); (M.S.)
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Saleem Z, Ahsan U, Haseeb A, Altaf U, Batool N, Rani H, Jaffer J, Shahid F, Hussain M, Amir A, Rehman IU, Saleh U, Shabbir S, Qamar MU, Altowayan WM, Raees F, Azmat A, Imam MT, Skosana PP, Godman B. Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications. Antibiotics (Basel) 2023; 12:678. [PMID: 37107040 PMCID: PMC10135394 DOI: 10.3390/antibiotics12040678] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahuddin Zakaria University, Multan 60800, Pakistan
| | - Umar Ahsan
- Department of Infection Prevention and Control, Alnoor Specialist Hospital, Ministry of Health, Makkah 24241, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Ummara Altaf
- Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore 54000, Pakistan
| | - Narjis Batool
- Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
| | - Hira Rani
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Javeria Jaffer
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Fatima Shahid
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Mujahid Hussain
- Department of Pharmacy, Indus Hospital and Health Network, Karachi 75190, Pakistan
| | - Afreenish Amir
- Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
| | - Inaam Ur Rehman
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Umar Saleh
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Sana Shabbir
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Waleed Mohammad Altowayan
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Aisha Azmat
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al Kharj 11942, Saudi Arabia
| | - Phumzile P. Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Haseeb M, Amir A, Ikram A. In Silico Analysis of SARS-CoV-2 Spike Proteins of Different Field Variants. Vaccines (Basel) 2023; 11:vaccines11040736. [PMID: 37112648 PMCID: PMC10145761 DOI: 10.3390/vaccines11040736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Coronaviruses belong to the group of RNA family of viruses that trigger diseases in birds, humans, and mammals, which can cause respiratory tract infections. The COVID-19 pandemic has badly affected every part of the world. Our study aimed to explore the genome of SARS-CoV-2, followed by in silico analysis of its proteins. Different nucleotide and protein variants of SARS-CoV-2 were retrieved from NCBI. Contigs and consensus sequences were developed to identify these variants using SnapGene. Data of the variants that significantly differed from each other was run through Predict Protein software to understand the changes produced in the protein structure. The SOPMA web server was used to predict the secondary structure of the proteins. Tertiary structure details of the selected proteins were analyzed using the web server SWISS-MODEL. Sequencing results showed numerous single nucleotide polymorphisms in the surface glycoprotein, nucleocapsid, ORF1a, and ORF1ab polyprotein while the envelope, membrane, ORF3a, ORF6, ORF7a, ORF8, and ORF10 genes had no or few SNPs. Contigs were used to identify variations in the Alpha and Delta variants of SARS-CoV-2 with the reference strain (Wuhan). Some of the secondary structures of the SARS-CoV-2 proteins were predicted by using Sopma software and were further compared with reference strains of SARS-CoV-2 (Wuhan) proteins. The tertiary structure details of only spike proteins were analyzed through the SWISS-MODEL and Ramachandran plots. Through the Swiss-model, a comparison of the tertiary structure model of the SARS-CoV-2 spike protein of the Alpha and Delta variants was made with the reference strain (Wuhan). Alpha and Delta variants of the SARS-CoV-2 isolates submitted in GISAID from Pakistan with changes in structural and nonstructural proteins were compared with the reference strain, and 3D structure mapping of the spike glycoprotein and mutations in the amino acids were seen. The surprisingly increased rate of SARS-CoV-2 transmission has forced numerous countries to impose a total lockdown due to an unusual occurrence. In this research, we employed in silico computational tools to analyze the SARS-CoV-2 genomes worldwide to detect vital variations in structural proteins and dynamic changes in all SARS-CoV-2 proteins, mainly spike proteins, produced due to many mutations. Our analysis revealed substantial differences in the functionality, immunological, physicochemical, and structural variations in the SARS-CoV-2 isolates. However, the real impact of these SNPs can only be determined further by experiments. Our results can aid in vivo and in vitro experiments in the future.
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Haseeb A, Saleem Z, Altaf U, Batool N, Godman B, Ahsan U, Ashiq M, Razzaq M, Hanif R, E-Huma Z, Amir A, Hossain MA, Raafat M, Radwan RM, Iqbal MS, Kamran SH. Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications. Infect Drug Resist 2023; 16:77-86. [PMID: 36636371 PMCID: PMC9831081 DOI: 10.2147/idr.s391295] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Background Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. Methods This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Results Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Conclusion Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan,Correspondence: Zikria Saleem, Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan, Email
| | - Ummara Altaf
- Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Narjis Batool
- Australian Institute of Health Innovation, Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Umar Ahsan
- Department of Infection Prevention and Control, Al Noor Specialist Hospital, Ministry of health, Makkah, Kingdom of Saudi Arabia
| | - Mehreen Ashiq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Mutiba Razzaq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Rabia Hanif
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zill E-Huma
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mohammad Akbar Hossain
- Department of Pharmacology and Toxicology, Faculty of Medicine in Al-Qunfudah, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohamed Raafat
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Al Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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Aslam B, Siddique MH, Siddique AB, Shafique M, Muzammil S, Khurshid M, Rasool MH, Ahmad M, Chaudhry TH, Amir A, Salman M, Baloch Z, Alturki NA, Alzamami A. Distribution of mcr-1 Harboring Hypervirulent Klebsiella pneumoniae in Clinical Specimens and Lytic Activity of Bacteriophage KpnM Against Isolates. Infect Drug Resist 2022; 15:5795-5811. [PMID: 36213765 PMCID: PMC9534162 DOI: 10.2147/idr.s374503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/25/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022] Open
Abstract
Background The World Health Organization (WHO) has declared the multi-drug resistant (MDR) Klebsiella pneumoniae as one of the critical bacterial pathogens. The dearth of new antibiotics and inadequate therapeutic options necessitate finding alternative options. Bacteriophages are known as enemies of bacteria and are well-recognized to fight MDR pathogens. Methods A total of 150 samples were collected from different clinical specimens through a convenient sampling technique. Isolation, identification, and antibiotic susceptibility testing (AST) of K. pneumoniae were done by standard and validated microbiological procedures. Molecular identification of virulence factors and antibiotic resistance genes (ARGs) was carried out through polymerase chain reaction (PCR) by using specific primers. For bacteriophage isolation, hospital sewage samples were processed for phage enrichment, purification, and further characterization ie, transmission electron microscopy (TEM) and stability testing, etc. followed by evaluation of the lytic potential of the phage. Results Overall, a total of 41% of isolates of K. pneumoniae were observed as hypervirulent K. pneumoniae (hvKp). Among hvKp, a total of 12 (42%) were detected as MDR hvKp. A total of 37% of all MDR isolates were found resistant to colistin, and 66% of the colistin resistance isolates were recorded as mcr-1 positive. Isolated phage KpnM had shown lytic activity against 53 (79%) K. pneumoniae isolates. Remarkably, all 8 mcr-1 harboring MDR hvKp and non-hvKp isolates were susceptible to KpnM phage. Conclusion Significant distribution of mcr-1 harboring hypervirulent Klebsiella pneumoniae was observed in clinical specimens, which is worrisome for the health system of the country. Characterized phage KpnM exhibited encouraging results and showed the lytic activity against the mcr-1 harboring hvKp isolates, which may be used as a prospective alternative control strategy to fight this ominous bacterium.
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Affiliation(s)
- Bilal Aslam
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
- Correspondence: Bilal Aslam, Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan, Email
| | - Muhammad Hussnain Siddique
- Department of Bioinformatics & Biotechnology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Abu Baker Siddique
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Shafique
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Saima Muzammil
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Mohsin Khurshid
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | | | - Moeed Ahmad
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Tamoor Hamid Chaudhry
- Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Afreenish Amir
- Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Muhammad Salman
- Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Zulqarnain Baloch
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, People’s Republic of China
| | - Norah A Alturki
- Clinical Laboratory Science Department, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alzamami
- Clinical Laboratory Science Department, College of Applied Medical Science, Shaqra University, AlQuwayiyah, Saudi Arabia
- Ahmad Alzamami, Clinical Laboratory Science Department, College of Applied Medical Science, Shaqra University, AlQuwayiyah, Saudi Arabia, Email
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Aslam B, Chaudhry TH, Arshad MI, Muzammil S, Siddique AB, Yasmeen N, Khurshid M, Amir A, Salman M, Rasool MH, Xia X, Baloch Z. Distribution and genetic diversity of multi-drug-resistant Klebsiella pneumoniae at the human–animal–environment interface in Pakistan. Front Microbiol 2022; 13:898248. [PMID: 36147844 PMCID: PMC9486001 DOI: 10.3389/fmicb.2022.898248] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Klebsiella pneumoniae is ubiquitous and known to be a notorious pathogen of humans, animals, and plant-based foods. K. pneumoniae is a recognized trafficker of antibiotic resistance genes (ARGs) between and from different ecological niches. A total of 775 samples (n = 775) were collected from September 2017 to August 2019 from humans, animals, and environmental sources by applying the random convenient sampling technique. A total of 120 (15.7%) samples were confirmed as K. pneumoniae. The distribution of K. pneumoniae among humans, the environment, and animals was 17.1, 12.38, and 10%, respectively. Isolates have shown significant resistance against all the subjected antibiotics agents except colistin. ARGs profiling revealed that the highest percentage prevalence (67.5%) of blaCTX–M was estimated in the isolates, and various carbapenem resistance genes that were found in the study were blaNDM–1 (43.3%), blaOXA–48 (38%), and (1.67%) blaKPC–2. Overall, 21 distinct sequence types (ST) and 13 clonal complexes (CCs) were found through the multi-locus sequence typing (MLST) analysis. Taking together, the distribution of multi-drug resistance (MDR) K. pneumoniae clones in the community and associated environment is alarming for the health care system of the country. Health policymakers should consider the role of all the integral parts of humans, animals, and the associated environment intently to cope with this serious public and animal health concern.
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Affiliation(s)
- Bilal Aslam
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Tamoor Hamid Chaudhry
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
- National Institute of Health, Islamabad, Pakistan
| | - Muhammad Imran Arshad
- Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Saima Muzammil
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Abu Baker Siddique
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Nafeesa Yasmeen
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, South China Agricultural University, Guangzhou, China
| | - Mohsin Khurshid
- Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | | | | | | | - Xueshan Xia
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- *Correspondence: Xueshan Xia,
| | - Zulqarnain Baloch
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Zulqarnain Baloch,
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Tusabe F, Kesande M, Amir A, Iannone O, Ayebare RR, Nanyondo J. Bacterial contamination of healthcare worker’s mobile phones: a case study at two referral hospitals in Uganda. Global Security: Health, Science and Policy 2022. [DOI: 10.1080/23779497.2021.2023321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Fred Tusabe
- Global Health Security Department, Infectious Diseases Institute Uganda, Kampala, Uganda
| | - Maureen Kesande
- Global Health Security Department, Infectious Diseases Institute Uganda, Kampala, Uganda
| | - Afreenish Amir
- Microbiology Department, National Institute of Health Pakistan, Islamabad, Pakistan
| | - Olivia Iannone
- Policy Department, Barbaricum LLC Washington, Washington, DC, USA
| | | | - Judith Nanyondo
- Global Health Security Department, Infectious Diseases Institute Uganda, Kampala, Uganda
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Nabhan AF, Mburu G, Elshafeey F, Magdi R, Kamel M, Elshebiny M, Abuelnaga YG, Ghonim M, Abdelhamid MH, Ghonim M, Eid P, Morsy A, Nasser M, Abdelwahab N, Elhayatmy F, Hussein AA, Elgabaly N, Sawires E, Tarkhan Y, Doas Y, Farrag N, Amir A, Gobran MF, Maged M, Abdulhady M, Sherif Y, Dyab M, Kiarie J. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac005. [PMID: 35280216 PMCID: PMC8907405 DOI: 10.1093/hropen/hoac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/31/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the scope of literature regarding women’s reproductive span in terms of definitions, trends and determinants? SUMMARY ANSWER The scoping review found a wide variation in definitions, trends and determinants of biological, social and effective women’s reproductive span. WHAT IS KNOWN ALREADY A woman’s reproductive span refers to her childbearing years. Its span influences a woman’s reproductive decisions. STUDY DESIGN, SIZE, DURATION A systematic scoping review was conducted. We searched MEDLINE, PubMed, JSTOR, CINAHL, Web of Science and Scopus electronic databases from inception to January 2021 without imposing language or date restrictions. We searched unpublished sources including the Global Burden of Disease, Demographic and Health Surveys, and National Health and Nutrition Examination Surveys. The list of relevant references was searched by hand. Sixty-seven reports on women’s reproductive span were included in this review. PARTICIPANTS/MATERIALS, SETTING, METHODS This scoping systematic review followed an established framework. The reporting of this scoping review followed the reporting requirements provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Extension for Scoping Reviews. Identified records were independently screened and data were extracted. We performed conceptual synthesis by grouping the studies by available concepts of reproductive span and then summarized definitions, measures used, temporal trends, determinants, and broad findings of implications on population demographics and assisted reproduction. Structured tabulation and graphical synthesis were used to show patterns in the data and convey detailed information efficiently, along with a narrative commentary. MAIN RESULTS AND THE ROLE OF CHANCE A total of 67 relevant reports on women’s reproductive span were published between 1980 and 2020 from 74 countries. Most reports (42/67) were cross-sectional in design. Literature on reproductive span was conceptually grouped as biological (the interval between age at menarche and age at menopause), effective (when a woman is both fertile and engaging in sexual activity) and social (period of exposure to sexual activity). We summarized the working definitions, trends and determinants of each concept. Few articles addressed implications on demographics and assisted reproduction. LIMITATIONS, REASONS FOR CAUTION A formal assessment of methodological quality of the included studies was not performed because the aim of this review was to provide an overview of the existing evidence base regardless of quality. WIDER IMPLICATIONS OF THE FINDINGS The review produced a comprehensive set of possible definitions of women’s reproductive span, trends, and potential determinants. Further advancement of these findings will involve collaboration with relevant stakeholders to rate the importance of each definition in relation to demography and fertility care, outline a set of core definitions, identify implications for policy, practice or research and define future research opportunities to explore linkages between reproductive spans, their determinants, and the need for assisted reproduction. STUDY FUNDING/COMPETING INTEREST(S) This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors had no competing interests. STUDY REGISTRATION NUMBER N/A.
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Affiliation(s)
- A F Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, El-Khalifa El-Maamoun Street, Cairo 11341, Egypt. E-mail: https://orcid.org/0000-0003-4572-2210
| | - G Mburu
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
| | - F Elshafeey
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - R Magdi
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Kamel
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Elshebiny
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Y G Abuelnaga
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Ghonim
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M H Abdelhamid
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Mo Ghonim
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - P Eid
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - A Morsy
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Nasser
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - N Abdelwahab
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - F Elhayatmy
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - A A Hussein
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - N Elgabaly
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - E Sawires
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Y Tarkhan
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Y Doas
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - N Farrag
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - A Amir
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M F Gobran
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Maged
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Abdulhady
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Y Sherif
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - M Dyab
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - J Kiarie
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
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Saleem Z, Faller EM, Godman B, Malik MSA, Iftikhar A, Iqbal S, Akbar A, Hashim M, Amin A, Javeed S, Amir A, Zafar A, Sabih F, Hashmi FK, Hassali MA. Antibiotic consumption at community pharmacies: A multicenter repeated prevalence surveillance using WHO methodology. Medicine Access @ Point of Care 2021; 5:23992026211064714. [PMID: 36204499 PMCID: PMC9413637 DOI: 10.1177/23992026211064714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Antibiotics are losing their effectiveness because of the rapid emergence of
resistant bacteria. Unnecessary antimicrobial use increases antimicrobial
resistance (AMR). There are currently no published data on antibiotic
consumption in Pakistan at the community level. This is a concern given high
levels of self-purchasing of antibiotics in Pakistan and variable knowledge
regarding antibiotics and AMR among physicians and pharmacists. Objective: The objective of this repeated prevalence survey was to assess the pattern of
antibiotic consumption data among different community pharmacies to provide
a baseline for developing future pertinent initiatives. Methods: A multicenter repeated prevalence survey conducted among community pharmacies
in Lahore, a metropolitan city with a population of approximately 10 million
people, from October to December 2017 using the World Health Organization
(WHO) methodology for a global program on surveillance of antimicrobial
consumption. Results: The total number of defined daily doses (DDDs) dispensed per patient ranged
from 0.1 to 50.0. In most cases, two DDDs per patient were dispensed from
pharmacies. Co-amoxiclav was the most commonly dispensed antibiotic with a
total number of DDDs at 1018.15. Co-amoxiclav was followed by ciprofloxacin
with a total number of 486.6 DDDs and azithromycin with a total number of
472.66 DDDs. The least consumed antibiotics were cefadroxil, cefotaxime,
amikacin, and ofloxacin, with overall consumption highest in December. Conclusion: The study indicated high antibiotic usage among community pharmacies in
Lahore, Pakistan particularly broad-spectrum antibiotics, which were mostly
dispensed inappropriately. The National action plan of Pakistan on AMR
should be implemented by policymakers including restrictions on the
dispensing of antimicrobials.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | | | - Aqsa Iftikhar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sonia Iqbal
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aroosa Akbar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Mahnoor Hashim
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aneeqa Amin
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sidra Javeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Afreenish Amir
- National University of Medical Sciences, Rawalpindi, Pakistan
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14
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Zohra T, Ikram A, Salman M, Amir A, Saeed A, Ashraf Z, Ahad A. Wastewater based environmental surveillance of toxigenic Vibrio cholerae in Pakistan. PLoS One 2021; 16:e0257414. [PMID: 34591885 PMCID: PMC8483414 DOI: 10.1371/journal.pone.0257414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pakistan has been experiencing intervals of sporadic cases and localized outbreaks in the last two decades. No proper study has been carried out in order to find out the environmental burden of toxigenic V. cholerae as well as how temporal and environmental factors associated in driving cholera across the country. METHODS We tested waste water samples from designated national environment surveillance sites in Pakistan with RT-PCR assay. Multistage sampling technique were utilized for samples collection and for effective sample processing Bag-Mediated Filtration system, were employed. Results were analysed by district and month wise to understand the geographic distribution and identify the seasonal pattern of V. cholera detection in Pakistan. RESULTS Between May 2019, and February 2020, we obtained and screened 160 samples in 12 districts across Pakistan. Out of 16 sentinel environmental surveillance sites, 15 sites showed positive results against cholera toxigenic gene with mostly lower CT value (mean, 34±2) and have significant difference (p < 0.05). The highest number of positive samples were collected from Sindh in month of November, then in June it is circulating in different districts of Pakistan including four Provinces respectively. CONCLUSION V. cholera detection do not follow a clear seasonal pattern. However, the poor sanitation problems or temperature and rainfall may potentially influence the frequency and duration of cholera across the country. Occurrence of toxigenic V. cholerae in the environment samples showed that cholera is endemic, which is an alarming for a potential future cholera outbreaks in the country.
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Affiliation(s)
- Tanzeel Zohra
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
| | - Aamer Ikram
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
| | - Muhammad Salman
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
| | - Afreenish Amir
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
| | - Asim Saeed
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
| | - Zurva Ashraf
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
| | - Abdul Ahad
- Public Health Laboratories Division, Department of Microbiology, National Institute of Health, Islamabad, Pakistan
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15
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Saleem Z, Godman B, Azhar F, Kalungia AC, Fadare J, Opanga S, Markovic-Pekovic V, Hoxha I, Saeed A, Al-Gethamy M, Haseeb A, Salman M, Khan AA, Nadeem MU, Rehman IU, Qamar MU, Amir A, Ikram A, Hassali MA. Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications. Expert Rev Anti Infect Ther 2021; 20:71-93. [PMID: 34038294 DOI: 10.1080/14787210.2021.1935238] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: The emergence of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in the World Health Assembly. Pakistan's national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan.Areas covered: This narrative review of the five components of the Pakistan NAP has been undertaken to discuss some of the challenges in implementation of the NAP for AMR in Pakistan including different opinions and views of key stakeholders, combined with suggestions on potential ways to reduce the burden of the AMR.Expert opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town Malaysia
| | - Faiza Azhar
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Amna Saeed
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Manal Al-Gethamy
- Alnoor Specialist Hospital Makkah, Department of Infection Prevention & Control Program, Makkah, Kingdom of Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Kingdom of Saudi Arabia
| | - Muhammad Salman
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ayaz Ali Khan
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Muhammad Umer Nadeem
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inaam Ur Rehman
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Muhammad Usman Qamar
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National Institute of Health Islamabad, Pakistan
| | - Aamer Ikram
- Department of Microbiology, National Institute of Health Islamabad, Pakistan
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16
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Adil S, Paracha RZ, Tariq S, Nisar M, Ijaz S, Siddiqa A, Hussain Z, Amir A. A Computational Systems Analyses to Identify Biomarkers and Mechanistic Link in Psoriasis and Cutaneous Squamous Cell Carcinoma. Front Immunol 2021; 12:662528. [PMID: 34267747 PMCID: PMC8276676 DOI: 10.3389/fimmu.2021.662528] [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] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Psoriasis is the most common and chronic skin disease that affects individuals from every age group. The rate of psoriasis is increasing over the time in both developed and developing countries. Studies have revealed the possibility of association of psoriasis with skin cancers, particularly non-melanoma skin cancers (NMSC), which, include basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). There is a need to analyze the disease at molecular level to propose potential biomarkers and therapeutic targets in comparison to cSCC. Therefore, the second analyzed disease of this study is cSCC. It is the second most common prevalent skin cancer all over the world with the potential to metastasize and recur. There is an urge to validate the proposed biomarkers and discover new potential biomarkers as well. In order to achieve the goals and objectives of the study, microarray and RNA-sequencing data analyses were performed followed by network analysis. Afterwards, quantitative systems biology was implemented to analyze the results at a holistic level. The aim was to predict the molecular patterns that can lead psoriasis to cancer. The current study proposed potential biomarkers and therapeutic targets for psoriasis and cSCC. IL-17 signaling pathway is also identified as significant pathway in both diseases. Moreover, the current study proposed that autoimmune pathology, neutrophil recruitment, and immunity to extracellular pathogens are sensitive towards MAPKs (MAPK13 and MAPK14) and genes for AP-1 (FOSL1 and FOS). Therefore, these genes should be further studied in gene knock down based studies as they may play significant role in leading psoriasis towards cancer.
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Affiliation(s)
- Sidra Adil
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan
| | - Rehan Zafar Paracha
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan
| | - Salma Tariq
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan
| | - Maryum Nisar
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan
| | - Sadaf Ijaz
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan
| | - Amnah Siddiqa
- Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - Zamir Hussain
- Research Center for Modeling and Simulation, National University of Sciences and Technology, Islamabad, Pakistan
| | - Afreenish Amir
- National Institute of Health (Pakistan), Islamabad, Pakistan
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17
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Raza HK, Chansysouphanthong T, Singh S, Amir A, Raza MW, Zhang Z, Cui G, Chen H. Polycythemia vera complicated by chorea: A case report and the review of Chinese and international literature. Rev Neurol (Paris) 2021; 177:1025-1030. [PMID: 33781561 DOI: 10.1016/j.neurol.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- H K Raza
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China; School of International Education, Xuzhou Medical University, 221002 Xuzhou, China
| | - T Chansysouphanthong
- School of International Education, Xuzhou Medical University, 221002 Xuzhou, China
| | - S Singh
- School of International Education, Xuzhou Medical University, 221002 Xuzhou, China
| | - A Amir
- Central Park Medical College, Lahore, Pakistan
| | - M W Raza
- Hainan University, Haikou, Hainan, China
| | - Z Zhang
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China
| | - G Cui
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China.
| | - H Chen
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, 221002 Xuzhou, China.
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18
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Amir A, Lai MY, Sarip F, Omar H, Wan Ismail WH, Grover CS, Lau YL, Mahmud R. Enteral myiasis causing acute dysentery: A case report. Trop Biomed 2021; 38:142-144. [PMID: 33797537 DOI: 10.47665/tb.38.1.024] [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: 11/21/2022]
Abstract
Enteral myiasis or intestinal myiasis is acquired by ingesting food or water contaminated with dipteran fly eggs or larvae. Here, we describe a patient with intestinal myiasis presenting with acute dysentery caused by the larva of Hermetia illucens. The larva was identified morphologically, and its species confirmed through molecular analysis using polymerase chain reaction and sequencing based on mitochondrial cytochrome c oxidase subunit I gene (COI).
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Affiliation(s)
- A Amir
- Department of Parasitology, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia.,Parasitology Diagnostic Unit, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - M Y Lai
- Department of Parasitology, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - F Sarip
- Parasitology Diagnostic Unit, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - H Omar
- Parasitology Diagnostic Unit, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - W H Wan Ismail
- Parasitology Diagnostic Unit, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - C S Grover
- Columbia Asia Hospital - Miri, Lot 1035 - 1039, Jalan Bulan Sabit, CDT 155, Jalan Bulan Sabit, 98009 Miri, Sarawak, Malaysia
| | - Y L Lau
- Department of Parasitology, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - R Mahmud
- Parasitology Diagnostic Unit, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
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19
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Mat Salleh NH, Abdul Rahman MF, Samsusah S, De Silva JR, Tan JH, Amir A, Lau YL. Complications of Sub-microscopic Plasmodium vivax Malaria among Orang Asli in Pos Lenjang, Kuala Lipis. Trop Biomed 2021; 38:33-35. [PMID: 33797521 DOI: 10.47665/tb.38.1.006] [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: 11/21/2022]
Abstract
In recent years, increasing cases of Plasmodium vivax complications had been reported all over the world. This former benign Plasmodium species is now recognized to be one of the human malaria parasites that can produce severe disease. In this article, we report two cases of sub-microscopic P. vivax malaria confirmed by PCR. Both patients were asymptomatic before treatment. They showed unusual presentations few days after initiation of antimalarial treatment. Both patients had subsequently completed antimalarial treatment and recovered completely.
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Affiliation(s)
- N H Mat Salleh
- Lipis District Health Office, 27200 Kuala Lipis, Pahang, Malaysia
| | - M F Abdul Rahman
- Lipis District Health Office, 27200 Kuala Lipis, Pahang, Malaysia
| | - S Samsusah
- Lipis District Health Office, 27200 Kuala Lipis, Pahang, Malaysia
| | - J R De Silva
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - J H Tan
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - A Amir
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Y L Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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20
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Amir A, Umur N. Meningococcal pneumonia, a case report. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.404] [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: 10/22/2022] Open
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21
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Ahad A, Salman M, Ikram A, Ashraf Z, Amir A, Saeed A, Ahmad A. Prevalence and molecular Characterization of ESBL-producing Escherichia coli in waste water samples from Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.119] [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: 11/25/2022] Open
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22
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Amir A, Ikram A, Ali Z, Rizwan M, Saeed A, Salman M. Pangenome analysis and reverse vaccinology of XDR Salmonella typhi strain from Pakistan identified novel vaccine targets. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1242] [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: 10/22/2022] Open
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23
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Amir A, Lai M, Sarip F, Omar H, Ismail WW, Grover CS, Lau Y, Mahmud R. A case of intestinal myiasis causing acute dysentery. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.456] [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: 10/22/2022] Open
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24
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Lapidot Y, Amir A, Ben-Simon S, Veitsman E, Cohen-Ezra O, Davidov Y, Weiss P, Bradichevski T, Segev S, Koren O, Ben-Ari Z, Safran M. Alterations of the salivary and fecal microbiome in patients with primary sclerosing cholangitis. Hepatol Int 2020; 15:191-201. [PMID: 32949377 DOI: 10.1007/s12072-020-10089-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a chronic, progressive liver disease known for its frequent concurrence with inflammatory bowel disease. PSC can progress to cirrhosis, end-stage liver disease, hepatobiliary cancer, and/or colorectal cancer. The etiopathogenesis of PSC remains poorly understood, and, as such, pharmacotherapy has yet to be definitively established. Little is known about the salivary microbiome in PSC and PSC-IBD. This study aimed to evaluate the oral microbiome of patients with PSC, with association to these patient's fecal microbial composition. METHODS Saliva, fecal samples and Food Frequency Questionnaires were collected from 35 PSC patients with or without concomitant inflammatory bowel disease and 30 age- and BMI-matched healthy volunteers. 16S rRNA gene sequencing was performed using Illumina MiSeq platform. RESULTS The salivary microbial signature of PSC was significantly altered as compared to healthy controls, independent of concomitant IBD, and was comprised of 19 significantly altered species, of which, eight species were consistently overrepresented in both fecal and saliva of patients with PSC, including Veillonella, Scardovia and Streptococcus. CONCLUSIONS PSC is characterized by microbial dysbiosis in the gut and the salivary microbiome, independently from IBD. The PSC dysbiotic signature includes a reduction in autochthonous bacteria and an increased relative abundance of pathogenic bacteria, including an invasion of oral bacteria to the gut. PSC is a strong modulator of the microbial profile, in the gut and the oral microbiome. These results may lead to the development of biomarkers for screening and early diagnosis or the development of personalized medicine in PSC.
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Affiliation(s)
- Y Lapidot
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel. .,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel. .,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - A Amir
- Cancer Research Center, Sheba Medical Center, Ramat-Gan, Israel
| | - S Ben-Simon
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - E Veitsman
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel.,The Liver Unit, Rambam Health Care Campus, Haifa, Israel
| | - O Cohen-Ezra
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Y Davidov
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - P Weiss
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - T Bradichevski
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Medical Screening Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - O Koren
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Z Ben-Ari
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel.,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Safran
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel.,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
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25
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Woliner-van der Weg W, Peppelman M, Elshot YS, Visch MB, Crijns MB, Alkemade HAC, Bronkhorst EM, Adang E, Amir A, Gerritsen MJP, van Erp PEJ, Lubeek SFK. Biopsy outperforms reflectance confocal microscopy in diagnosing and subtyping basal cell carcinoma: results and experiences from a randomized controlled multicentre trial. Br J Dermatol 2020; 184:663-671. [PMID: 32628771 PMCID: PMC8246942 DOI: 10.1111/bjd.19381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/14/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022]
Abstract
Background Reflectance confocal microscopy (RCM) is a noninvasive method for skin assessment, allowing entire lesion evaluation up to the papillary dermis. RCM is a potentially attractive alternative to punch biopsy (PB) in basal cell carcinoma (BCC). Objectives To determine the diagnostic accuracy of RCM vs. PB in diagnosing and subtyping BCC, and to study patient satisfaction and preferences. Methods Patients with a clinically suspected primary BCC were randomized between RCM and biopsy. Conventional surgical excision or follow‐up were used as reference. Sensitivity and specificity for BCC diagnosis and subtyping were calculated for both methods. BCC subtype was stratified based on clinical relevance: aggressive (infiltrative/micronodular) vs. nonaggressive (superficial/nodular) histopathological subtype and superficial vs. nonsuperficial BCC. Data on patient satisfaction and preferences were collected using a questionnaire and a contingent valuation method. Results Sensitivity for BCC diagnosis was high and similar for both methods (RCM 99·0% vs. biopsy 99·0%; P = 1·0). Specificity for BCC diagnosis was lower for RCM (59·1% vs. 100·0%; P < 0·001). Sensitivity for aggressive BCC subtypes was lower for RCM (33·3% vs. 77·3%; P = 0·003). Sensitivity for nonsuperficial BCC was not significantly different (RCM 88·9% vs. biopsy 91·0%; P = 0·724). Patient satisfaction and preferences were good and highly comparable for both methods. Conclusions Biopsy outperforms RCM in diagnosing and subtyping clinically suspected primary BCC. This outcome does not support routine clinical implementation of RCM, as a replacement for PBs in this patient group.
What is already known about this topic?
Expert groups have demonstrated the potency of in vivo diagnosing and subtyping of basal cell carcinoma (BCC) using confocal imaging. However, the diagnostic accuracy and financial consequences remain unclear, especially regarding correct subtyping.
What does this study add?
Confocal imaging was tested on performance in a real‐world clinical setting, as an alternative to diagnostic punch biopsies (PBs). In this setting, we concluded that for clinically suspicious primary BCC in daily practice, a PB remains preferred above confocal imaging, as it provides a superior accuracy for diagnosing and subtyping.
Linked Comment: Patalay. Br J Dermatol 2021; 184:590.
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Affiliation(s)
- W Woliner-van der Weg
- Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M Peppelman
- Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Y S Elshot
- Department of Dermatology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - M B Visch
- Department of Dermatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - M B Crijns
- Department of Dermatology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H A C Alkemade
- Department of Dermatology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - E M Bronkhorst
- Department of, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - E Adang
- Department of, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - A Amir
- Department of, Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M J P Gerritsen
- Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - P E J van Erp
- Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S F K Lubeek
- Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Ponnampalavanar S, Kukreja A, Amir A, Mahmud R. First case report of paragonimiasis in a Malaysian man. Trop Biomed 2020; 37:24-28. [PMID: 33612715] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Paragonimiasis is an infection caused by Paragonimus, a lung fluke and is acquired by eating raw or undercooked crustaceans containing the infective metacercariae. Herein, we report a case of paragonimiasis in a Malaysian man who presented with incidental findings from chest radiographs. Examination of his biopsied lung tissue and sputum specimen revealed Paragonimus sp. eggs, whereas stool examination showed the presence of Giardia cysts. Patient was succesfully treated with praziquantel and metronidazole respectively.
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Affiliation(s)
- S Ponnampalavanar
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia
| | - A Kukreja
- Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia
| | - A Amir
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - R Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Saeed M, Rasool MH, Rasheed F, Saqalein M, Nisar MA, Imran AA, Tariq S, Amir A, Ikram A, Khurshid M. Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan. J Infect Dev Ctries 2020; 14:169-176. [PMID: 32146451 DOI: 10.3855/jidc.12049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/31/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The multidrug-resistant (MDR) Salmonella enterica serovar Typhi isolates have been increasingly reported from the Asian and African countries. The emergence of isolates with decreased susceptibility to fluoroquinolones and cephalosporins has worsened the situation. Recently, an outbreak from Sindh, Pakistan was reported caused by extensively drug-resistant (XDR) S. Typhi strains. METHODOLOGY In the present study, a total of 82 cases of typhoid have been investigated during 2018 from the febrile children referred to a tertiary care hospital in the population-wise largest province (Punjab) of Pakistan. S. Typhi was identified by standard microbiological techniques and isolates were characterized for antimicrobial resistance profiling and minimum inhibitory concentrations were determined. The presence of various ESBL genes in S. Typhi was confirmed by the PCR. RESULTS Out of the 82 isolates tested, 35 (43%) were found to be XDR; resistant to the first-line drugs. The resistance to third-generation cephalosporins was mainly mediated by extended-spectrum beta-lactamases i.e. blaTEM and blaCTX-M genes. CONCLUSIONS The higher prevalence of ESBL producing Salmonella typhi clinical strains raises the concern about transmission prevention and infection management in the community as well as clinical settings. Moreover, the study highlights the problem concerning the declining antibiotic arsenal for the therapeutic management of typhoid fever and the emergence and spread of XDR strains in Pakistan.
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Affiliation(s)
- Muhammad Saeed
- Department of Microbiology, Government College University Faisalabad, Pakistan.
| | | | - Farhan Rasheed
- Department of Pathology, Allama Iqbal Medical College, Lahore, Pakistan.
| | - Muhammad Saqalein
- Department of Microbiology, Government College University Faisalabad, Pakistan.
| | - Muhammad Atif Nisar
- Department of Microbiology, Government College University Faisalabad, Pakistan.
| | | | - Saba Tariq
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan.
| | | | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan.
| | - Mohsin Khurshid
- Department of Microbiology, Government College University Faisalabad, Pakistan.
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Abd Rahim N, Amir A, Amir A, Hang Seng Che, ElKhateb A. Hill Climbing Maximum Power Point Tracking on Four Stage Switch Capacitor Based Boost Converter. 5th IET International Conference on Clean Energy and Technology (CEAT2018) 2018. [DOI: 10.1049/cp.2018.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abd Rahim N, Amir A, Amir A, Selvaraj J. Maximum Energy Extraction for PV System Using Closed Bracket Technique. 5th IET International Conference on Clean Energy and Technology (CEAT2018) 2018. [DOI: 10.1049/cp.2018.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Hussain SM, Sheikh H, Amir A, Hassan AA. Oral health: Treating refugees. Br Dent J 2017; 223:463. [DOI: 10.1038/sj.bdj.2017.843] [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: 11/09/2022]
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Alterman M, Shuster A, Amir A, Reiser V. Delayed maxillofacial reconstruction — thinking inside and outside of the box. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.597] [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: 11/26/2022]
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Rahman MZA, Yaakob N, Amir A, Ahmad RB, Yoon S, Abd Halim A. Performance Analysis of Congestion Control Mechanism in Software Defined Network (SDN). MATEC Web Conf 2017; 140:01033. [DOI: 10.1051/matecconf/201714001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Eisenbach A, Havdala T, Delahaye J, Grenet T, Amir A, Frydman A. Publisher's Note: Glassy Dynamics in Disordered Electronic Systems Reveal Striking Thermal Memory Effects [Phys. Rev. Lett. 117, 116601 (2016)]. Phys Rev Lett 2016; 117:139901. [PMID: 27715108 DOI: 10.1103/physrevlett.117.139901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 06/06/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.117.116601.
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Eisenbach A, Havdala T, Delahaye J, Grenet T, Amir A, Frydman A. Glassy Dynamics in Disordered Electronic Systems Reveal Striking Thermal Memory Effects. Phys Rev Lett 2016; 117:116601. [PMID: 27661707 DOI: 10.1103/physrevlett.117.116601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 06/06/2023]
Abstract
Memory is one of the unique qualities of a glassy system. The relaxation of a glass to equilibrium contains information on the sample's excitation history, an effect often refer to as "aging." We demonstrate that under the right conditions a glass can also possess a different type of memory. We study the conductance relaxation of electron glasses that are fabricated at low temperatures. Remarkably, the dynamics are found to depend not only on the ambient measurement temperature but also on the maximum temperature to which the system was exposed. Hence the system "remembers" its highest temperature. This effect may be qualitatively understood in terms of energy barriers and local minima in configuration space and therefore may be a general property of the glass state.
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Affiliation(s)
- A Eisenbach
- The Department of Physics, Bar Ilan University, Ramat Gan 52900, Israel
| | - T Havdala
- The Department of Physics, Bar Ilan University, Ramat Gan 52900, Israel
| | - J Delahaye
- Institut Néel, CNRS, BP 166, 38042 Grenoble Cedex 9, France
| | - T Grenet
- Institut Néel, CNRS, BP 166, 38042 Grenoble Cedex 9, France
| | - A Amir
- School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA
| | - A Frydman
- The Department of Physics, Bar Ilan University, Ramat Gan 52900, Israel
- Institut Néel, CNRS, BP 166, 38042 Grenoble Cedex 9, France
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Rai V, Amir A, Muniandy RK, Vijayan R. Abstract PR454. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492841.90403.c7] [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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Yen Sarn Y, Hasan M, Jamaluddin MFH, Pui San L, Amir A, Rai V. Abstract PR120. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492526.56714.ce] [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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Angal L, Lim YA, Yap NJ, Ngui R, Amir A, Kamarulzaman A, Rohela M. Toxoplasmosis in HIV and non HIV prisoners in Malaysia. Trop Biomed 2016; 33:159-169. [PMID: 33579153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This is the first Malaysian study to determine the trend and risk factors of Toxoplasma gondii infection in HIV and non-HIV among prisoners in terms of socio-demographic and behavioural characteristics, clinical presentations and haematological distributions. Blood samples from 303 participants, comprising 133 HIV positive and 170 HIV negative inmates were collected in EDTA and plain tubes. Two mls of each blood sample in plain tubes were centrifuged at 1500 rpm for 10 minutes and the sera obtained were subjected to ELISA for detection of Toxoplasma IgM and IgG antibody towards Toxoplasma antigen. Seropositive samples for Toxoplasma IgM or both Toxoplasma IgM and IgG were further tested with Novalisa Toxoplasma gondii IgG avidity test to rule out acute from latent infections. Blood in EDTA tubes were sent to Clinical Diagnostic Lab (CDL), University Malaya Medical Centre (UMMC), Kuala Lumpur for complete blood count and differential count analysis. Overall seroprevalence of anti-T. gondii antibodies was detected in 41.9% (127 out of 303) of the participants. Anti-T. gondii antibodies was detected in 63.2% (84 out of 133) of HIV positive subjects and in 25.3% (43 out of 170) of HIV negative subjects. Seroprevalence of anti-T. gondii antibodies was significantly higher in HIV positive than in HIV negative subjects (OR = 5.06; 95% CI = 3.09-8.30; p < 0.001). The rate of T. gondii seropositivity increased significantly in those aged 40 years and above, HIV positive individuals and those with history of drug abuse. White blood cells (WBCs), neutrophils and basophils counts decreased significantly in those infected with Toxoplasma. Creating awareness about T. gondii infection and follow-up of their status is recommended. Moreover, screening of T. gondii infection in HIV-infected individuals should be considered for better treatment and management, including control and prevention.
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Affiliation(s)
- L Angal
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Y A Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N J Yap
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Amir
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M Rohela
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Amir A, Teomy S, Kalir A. The effect of phencyclidine on noradrenaline uptake by bovine chromaffin granules. Monogr Neural Sci 2015; 7:129-37. [PMID: 7231434 DOI: 10.1159/000388820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The effects of the psychotomimetic drug, phencyclidine, on the reserpine sensitive uptake of (-)noradrenaline, on the reserpine resistant uptake of tryptamine, and on catecholamine release were studied in vitro using bovine chromaffin granules. Phencyclidine inhibited the uptake of (-)noradrenaline and tryptamine in a concentration-dependent manner. It caused 50% inhibition of (-)noradrenaline uptake at 2 X 10(-4)M and of tryptamine uptake at 7 X 10(-4)M. Release of catecholamines was not affected by phencyclidine at 0 degree C and pH 6--8 in concentrations up to 8 X 10(-3)M, whereas at 37 degrees C the drug (4 X 10(-3)M) caused a release that was increased when the pH was raised from 6 to 8. Since the effects of phencyclidine on chromaffin granule uptake and release are observed at high concentrations of the drug only, there is no evidence that these effects are relevant to the in vivo effects of the drug.
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Amir A, Lee YL. A case of acute kidney injury by near-drowning. Malays Fam Physician 2013; 8:34-36. [PMID: 25893056 PMCID: PMC4400688] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute kidney injury following immersion or near-drowning is rarely described and no data from Malaysia have been found. We report a case of acute kidney injury following a near-drowning event. A 20-year-old man who recovered from near-drowning in a swimming pool 5 days earlier presented to our clinic with abdominal pain, anorexia, nausea and polyuria. Dipstick urinalysis showed a trace of blood. The serum creatinine level was 10-fold higher than the normal range. A bedside ultrasound showed features suggestive of acute tubular necrosis. He is then referred to the hospital with the diagnosis of acute kidney injury with the possibility of acute tubular necrosis secondary to near-drowning. We suggest that any patient presenting after immersion or near-drowning to be should assessed for potential acute kidney injury.
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Affiliation(s)
- A Amir
- Department of Parasitology, Faculty of Medicine, University Malaya
| | - YL Lee
- Klinik dan surgeri semenyih
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Oosterhuis JW, Verstegen N, Van Der Elst A, Mollema R, Van Tets W, Joosten J, Amir A, Senan S. B-001PROPENSITY SCORE-MATCHED ANALYSIS OF STAGE I-II NON-SMALL CELL LUNG CANCER TREATED BY VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY OR STEREOTACTIC ABLATIVE RADIOTHERAPY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.1] [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: 11/14/2022] Open
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Amri M, Elhani I, Doussari S, Amir A. [Atopic dermatitis and prolonged exclusive breast-feeding]. Ann Dermatol Venereol 2012; 139:257-60. [PMID: 22482478 DOI: 10.1016/j.annder.2011.10.396] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/21/2011] [Accepted: 10/17/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to compare the prevalence of exclusive breastfeeding throughout at least the first 6 months of life in patients presenting atopic dermatitis (AD) with a control group, and to check for a correlation between the duration of exclusive breastfeeding and the severity of AD. PATIENTS AND METHODS We conducted a case-control study with prospective inclusion over a period of 3 years. The study group consisted of 114 patients aged less than 15 years, from an urban area, presenting AD but with no personal or family history of atopy. Each patient was compared with two controls from the same town, matched for age and gender, with no personal or family history of atopy, and free of AD. Data analysis was performed using the SPSS software package, version 15.0. A P-value of less than 0.05 was considered as statistically significant. RESULTS The prevalence of exclusive breastfeeding for at least the first 6 months of life in the patient group was significantly lower than in the control group (P=0.0413). On the other hand, AD was significantly less severe in patients exclusively breastfed for longer than 9 months (P=0.0079). CONCLUSION The correlations recorded in our study do not allow us to draw any definite conclusions about a protective effect of exclusive breastfeeding with regard to AD. However, other benefits of extended exclusive breastfeeding justify supporting breastfeeding in a community with an existing sociocultural predisposition for this feeding method.
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Affiliation(s)
- M Amri
- King Faisal University, Al Ahsa, Qatar Street, Al-Hafouf, Saudi Arabia.
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Shkalim V, Amir A, Samra Z, Amir J. Characteristics of non-typhi Salmonella gastroenteritis associated with bacteremia in infants and young children. Infection 2011; 40:285-9. [PMID: 22161258 DOI: 10.1007/s15010-011-0231-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 11/28/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the clinical and laboratory manifestations of non-typhi Salmonella gastroenteritis associated with bacteremia in children less than 36 months old. METHODS The study group included 17 patients, aged 2-34 months, with non-typhi Salmonella gastroenteritis and bacteremia, hospitalized in a tertiary pediatric medical center during the period 1995-2010. Clinical data were collected by medical chart review. Culture-related data were taken from the microbiology laboratory files. The results were compared with an assigned, age-matched, control group of 17 infants hospitalized with non-typhi Salmonella gastroenteritis without bacteremia. RESULTS Eleven cases (65%) occurred during the summer season. All patients presented with diarrhea, usually mixed with blood or mucus (clinical dysentery 65%). All but one had a high-grade fever (average 39.5°C). Three patients (19%) experienced convulsions during the acute episode of gastroenteritis. None of the patients had been previously treated with antibiotics. The most prevalent Salmonella serotype identified in the stool and blood was group C. Toxic appearance and convulsions on admission were more common among children with non-typhi Salmonella bacteremia, as opposed to those with non-typhi Salmonella gastroenteritis alone. No other epidemiological or laboratory differences were found. CONCLUSIONS Non-typhi Salmonella gastroenteritis poses a risk of bacteremia not only in infants younger than 3 months of age, but also in children younger than 36 months of age.
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Affiliation(s)
- V Shkalim
- Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petah Tikva, 49202, Israel.
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Abedi AJ, Khan Z, Ansari A, Amir A. SP5-23 Is knowledge and attitude correlating with practices? A KAP study on dengue fever. J Epidemiol Community Health 2011. [DOI: 10.1136/jech.2011.142976p.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Infant mortality rate is regarded as an important and sensitive indicator of the health status of a community. It also reflects the living standard of the people and the effectiveness of interventions for improving maternal and child health. Multiple factors related to social and economic conditions, health care and environment have a significant role to play on childhood mortality and improving childhood mortality is a national priority. The present study was planned to 1) determine the mortality rate among neonates and infants. 2) identification of pattern of various factors in relation to infant mortality and 3) to identify the causes of death in this age group. METHOD All the deaths in children under 12 months during July 2005 to June 2006 in Jawan block of district Aligarh, India were recorded. The cause of death was ascertained using the standard verbal autopsy procedure. RESULTS In the study period, 446 live births and 37 deaths in children under one year of age were reported. The neonatal and infant mortality rates were 49.4 and 83.0 per thousand live births respectively. The main causes of infant deaths were birth asphyxia, diarrhoea, pneumonia, prematurity (including Low birth weight and malnutrition). CONCLUSION Most of the death among infants are preventable, though promotion of institutional deliveries, strengthening of referral system, early recognition of danger signs and periodic retraining of health workers.
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Affiliation(s)
- Ms Shah
- Department of Community Medicine, J.N. Medical College, A.M.U., Aligarh (UP). India
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Kapoor N, Tyagi M, Kumar H, Arya A, Siddiqui M, Amir A, Malik A. Production of Cellulase Enzyme by Chaetomium sp. using Wheat Straw in Solid State Fermentation. ACTA ACUST UNITED AC 2010. [DOI: 10.3923/jm.2010.1199.1206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yusof S, Takriff M, Amir A, Kadhum H, Mohammad A, Jahim J. The Effect of Initial Butyric Acid Addition on ABE Fermentation by C. acetobutylicum NCIMB 619. ACTA ACUST UNITED AC 2010. [DOI: 10.3923/jas.2010.2709.2712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zaidi SHN, Khan Z, Khalique N, Amir A. A population based study on injuries in rural and urban areas of Aligarh. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.544] [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: 11/04/2022]
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Syeda-Mahmood T, Turaga P, Beymer D, Wang F, Amir A, Greenspan H, Pohl K. Shape-based Similarity Retrieval of Doppler Images for Clinical Decision Support. Proc IEEE Comput Soc Conf Comput Vis Pattern Recognit 2010; 2010:855-862. [PMID: 28626350 PMCID: PMC5470634 DOI: 10.1109/cvpr.2010.5540126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Flow Doppler imaging has become an integral part of an echocardiographic exam. Automated interpretation of flow doppler imaging has so far been restricted to obtaining hemodynamic information from velocity-time profiles depicted in these images. In this paper we exploit the shape patterns in Doppler images to infer the similarity in valvular disease labels for purposes of automated clinical decision support. Specifically, we model the similarity in appearance of Doppler images from the same disease class as a constrained non-rigid translation transform of the velocity envelopes embedded in these images. The shape similarity between two Doppler images is then judged by recovering the alignment transform using a variant of dynamic shape warping. Results of similarity retrieval of doppler images for cardiac decision support on a large database of images are presented.
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Affiliation(s)
| | - P Turaga
- University of Maryland, College Park
| | - D Beymer
- IBM Almaden Research Center, 650 Harry Road
| | - F Wang
- IBM Almaden Research Center, 650 Harry Road
| | - A Amir
- IBM Almaden Research Center, 650 Harry Road
| | | | - K Pohl
- IBM Almaden Research Center, 650 Harry Road
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Bohlega S, Alsaadi T, Amir A, Hosny H, Karawagh AM, Moulin D, Riachi N, Salti A, Shelbaya S. Guidelines for the Pharmacological Treatment of Peripheral Neuropathic Pain: Expert Panel Recommendations for the Middle East Region. J Int Med Res 2010; 38:295-317. [DOI: 10.1177/147323001003800201] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Neuropathic pain (NeP) has been the focus of extensive basic and clinical research over the past 20 years. This has led to an increased understanding of underlying pathophysiological mechanisms and the development of new therapeutic agents, as well as a clearer definition of the role of established medications. To date there are no published treatment guidelines for NeP in the Middle East. A multidisciplinary panel of Middle East and international experts met to review critically and reach a consensus on how best to apply evidence-based guidelines for the treatment of NeP (mainly peripheral NeP) in the Middle East. The expert panel recommended pregabalin, gabapentin and secondary amine tricyclic antidepressants (nortriptyline and desipramine) as first-line treatments for peripheral NeP. Serotonin-norepinephrine reuptake inhibitor antidepressants, tramadol and controlled-release opioid analgesics were recommended as second-line treatments. There is a need to increase diagnostic awareness of NeP, use validated screening questionnaires and undertake more treatment research in the Middle East region.
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Affiliation(s)
- S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - T Alsaadi
- Sheikh Kalifa Medical City, Abu Dhabi, United Arab Emirates
| | - A Amir
- International Medical Centre, Jeddah, Kingdom of Saudi Arabia
| | - H Hosny
- Cairo University, Cairo, Egypt
| | - AM Karawagh
- King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - D Moulin
- University of Western Ontario, London, Ontario, Canada
| | - N Riachi
- University Medical Centre, Rizk Hospital and the Lebanese American University, Beirut, Lebanon
| | - A Salti
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
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