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Search Results: 1 - 10 of 154881 matches for " George F Araj "
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First Report of Nocardia asiatica Presenting as an Anterior Mediastinal Mass in a Patient with Myasthenia Gravis: A Case Report and Review of the Literature
Rima I. El-Herte,Souha S. Kanj,George F. Araj,Hassan Chami,Walid Gharzuddine
Case Reports in Infectious Diseases , 2012, DOI: 10.1155/2012/325767
Abstract: The spectrum of infections with Nocardia spp. is heterogeneous. It has classically been associated with lung, brain, or skin involvement. We describe an unusual presentation of Nocardia asiatica (N. asiatica) in an Iraqi patient with myasthenia gravis suffering from a disseminated infection and presenting with an anterior mediastinal cystic mass. N. asiatica has only been three times described outside Japan and Thailand, and the rarity of this entity deserves this communication.
Frequency of conjugative transfer of plasmid-encoded ISEcp1 - blaCTX-M-15 and aac(6')-lb-cr genes in Enterobacteriaceae at a tertiary care center in Lebanon - role of transferases
Mohamad Harajly, Marie-Therese Khairallah, John E Corkill, George F Araj, Ghassan M Matar
Annals of Clinical Microbiology and Antimicrobials , 2010, DOI: 10.1186/1476-0711-9-19
Abstract: Conjugation experiments were done on 53 ESBL-producing and/or fluoroquinolone resistant E. coli and K. pneumoniae and ESBL-producing S. sonnei isolates. Antimicrobial susceptibility testing on parent and transconjugant isolates, and PCR amplifications on plasmid extracts of the resistance-encoding genes: blaCTX-M-15 with the ISEcp1 insertion sequence, the aac(6')-lb-cr and qnrS genes, as well as tra encoding transferases genes were done. Random amplified polymorphic DNA (RAPD) analysis was performed to demonstrate whether conjugative isolates are clonal and whether they are linked epidemiologically to a particular source.Antimicrobial susceptibility testing on transconjugants revealed that 26 out of 53 (49%) ESBL-producing Enterobacteriaceae were able to transfer antimicrobial resistance to the recipients. Transfer of high-level resistance to the transconjugants encoded by the blaCTX-M-15 gene downstream the ISEcp1 insertion sequence against 3rd generation cephalosporins, and of low-level resistance against ciprofloxacin, and variable levels of resistance against aminoglycosides encoded by aac(6')-lb-cr gene, were observed in transconjugants. tra encoding transferase genes were detected exclusively in conjugative isolates.In conclusion, the frequency of transfer of antimicrobial resistance in non clonal Enterobacteriaceae at the tertiary care center by conjugation was 49%. Conjugation occurred in isolates expressing the tra encoding transferase genes. Multiple conjugative strains harboring the plasmid encoded antimicrobial resistant genes were circulating in the medical center. Molecular epidemiology analysis showed that conjugative isolates are neither clonal nor linked to a particular site and transfer of antimicrobial resistance is by horizontal transfer of plasmids.Plasmid-encoded Extended-spectrum β-lactamases (ESBL) are increasingly spreading among Enterobacteriaceae clinical isolates throughout the world due mostly to their presence on highly conjugative plas
Detection of a highly prevalent and potentially virulent strain of Pseudomonas aeruginosa from nosocomial infections in a medical center
Ghassan M Matar, Mira H Chaar, George F Araj, Zaher Srour, Ghassan Jamaleddine, Usamah Hadi
BMC Microbiology , 2005, DOI: 10.1186/1471-2180-5-29
Abstract: Data showed that most of the clinical and environmental isolates were susceptible to tested antimicrobial agents. RAPD analysis determined the presence of 31 genotypes, with genotype 1 detected in 42% of the clinical isolates and 43% of the environmental isolates. Enzymatic activity testing showed that genotype 1 produced all virulence factors tested for.In conclusion, our data demonstrated the predominant prevalence of a potentially virulent P. aeruginosa genotype, circulating in a number of units of the medical center and emphasize the need to reinforce infection control measures.Despite the advances in hospital care and the introduction of a wide variety of antimicrobial agents, Pseudomonas aeruginosa continues to be a major nosocomial pathogen particularly in patients who suffer from immunosuppression [1]. P. aeruginosa is a ubiquitous pathogen prevalent in the hospital environments, and can cause severe nosocomial infections [2]. The latter involve a broad spectrum of infections including the respiratory, gastrointestinal, and urinary tracts as well as wound infections, sepsis and others [3]. Various possible sources of P. aeruginosa infection in hospitals have been identified; such as tap water, medical equipment, hospital personnel and other patients [2,4]. P. aeruginosa accounts for 10% of all hospital acquired infections, a site specific prevalence which may vary from one unit to another and from study to study [5]. Among data on site-specific infections, P. aeruginosa appears to be the major cause of ventilator-associated pneumonia with a high rate of attributable mortality [6]. Moreover this organism can contaminate a number of other medical equipment such as respirators, endoscopes, bronchoscopes, transvenous pacemakers, urinary catheters, and dialysis equipment, leading to site-related infections [7,8]. During the last year, the average prevalence of P. aeruginosa nosocomial infections in our medical center was 18%. Such a high rate prompted us to study
First Report of Nocardia asiatica Presenting as an Anterior Mediastinal Mass in a Patient with Myasthenia Gravis: A Case Report and Review of the Literature
Rima I. El-Herte,Souha S. Kanj,George F. Araj,Hassan Chami,Walid Gharzuddine
Case Reports in Infectious Diseases , 2012, DOI: 10.1155/2012/325767
Abstract: The spectrum of infections with Nocardia spp. is heterogeneous. It has classically been associated with lung, brain, or skin involvement. We describe an unusual presentation of Nocardia asiatica (N. asiatica) in an Iraqi patient with myasthenia gravis suffering from a disseminated infection and presenting with an anterior mediastinal cystic mass. N. asiatica has only been three times described outside Japan and Thailand, and the rarity of this entity deserves this communication. 1. Case A 49-year-old Iraqi male presented in February 2011 to the American University of Beirut Medical Center (AUB-MC) with fever, chills, chest pain, anorexia, and weight loss after being operated on for a presumed malignant thymoma in India. His initial history goes back to May 2010 when he was diagnosed with myasthenia gravis in Iraq and was started on prednisone 60?mg orally and mestinon 60?mg orally three times per day. A computed tomography (CT) of the chest done in Iraq showed a cystic mediastinal mass abutting the right ventricle described as thymoma (images not available) but very similar to the CT done at our institution later. No interventions were undertaken in Iraq. He was then referred for right lateral thoracotomy in India in November 2010. Pathology revealed malignant thymoma. The patient remained hospitalized in India for 3 weeks where he reported chills, weight loss, and sweating without any documented fever. He was started on chemotherapy (unknown regimen) and was discharged home on levofloxacin 500?mg orally daily for ten days. No microbiological work-up was initiated in India to try to detect an underlying infectious process. The period from December 2010 until February 2011 in Iraq was characterized by recurrent chest pain, fever, chills, sweating, cough, and greenish sputum production. Blood tests at that time showed a WBC of 26,000/μL. Repeated CT of the chest showed multiple cystic masses impinging on the right ventricle and left atrium described as metastasis in concordance with his history of malignant thymoma (Figure 1). At a local hospital, he received blood transfusion, fluconazole, and cefotaxime both at unknown frequency and dosage without improvement. He then had a PET scan in Lebanon showing cystic masses in the chest with necrosis and invasion of the pericardium described as metastasis. He presented to our institution where echocardiography showed two large anterior fluid collections one of which was compressing the right ventricle with a third cyst behind the left atrium (Figure 2). Pericardiocentesis was performed and yielded 90?mL of
Correlation between Group B Streptococcal Genotypes, Their Antimicrobial Resistance Profiles, and Virulence Genes among Pregnant Women in Lebanon
Antoine Hannoun,Marwa Shehab,Marie-Therese Khairallah,Ahmad Sabra,Roland Abi-Rached,Tony Bazi,Khalid A. Yunis,George F. Araj,Ghassan M. Matar
International Journal of Microbiology , 2009, DOI: 10.1155/2009/796512
Abstract: The antimicrobial susceptibility profiles of 76 Streptococcus agalactiae (Group B Streptococci [GBS]) isolates from vaginal specimens of pregnant women near term were correlated to their genotypes generated by Random Amplified Polymorphic DNA analysis and their virulence factors encoding genes cylE, lmb, scpB, rib, and bca by PCR. Based on the distribution of the susceptibility patterns, six profiles were generated. RAPD analysis detected 7 clusters of genotypes. The cylE gene was present in 99% of the isolates, the lmb in 96%, scpB in 94.7%, rib in 33%, and bca in 56.5% of isolates. The isolates demonstrated a significant correlation between antimicrobial resistance and genotype clusters denoting the distribution of particular clones with different antimicrobial resistance profiles, entailing the practice of caution in therapeutic options. All virulence factors encoding genes were detected in all seven genotypic clusters with rib and bca not coexisting in the same genome.
Genotypes and serotype distribution of macrolide resistant invasive and non- invasive Streptococcus pneumoniae isolates from Lebanon
Nedal Taha, George F Araj, Rima H Wakim, Souha S Kanj, Zeina A Kanafani, Ahmad Sabra, Marie-Therese Khairallah, Farah J Nassar, Marwa Shehab, Maysa Baroud, Ghassan Dbaibo, Ghassan M Matar
Annals of Clinical Microbiology and Antimicrobials , 2012, DOI: 10.1186/1476-0711-11-2
Abstract: Forty four macrolide resistant and 21 macrolide susceptible S. pneumoniae clinical isolates were tested for antimicrobial susceptibility according to CLSI guidelines (2008) and underwent molecular characterization. Serotyping of these isolates was performed by Multiplex PCR-based serotype deduction using CDC protocols. PCR amplification of macrolide resistant erm (encoding methylase) and mef (encoding macrolide efflux pump protein) genes was carried out.Among 44 isolates resistant to erythromycin, 35 were resistant to penicillin and 18 to ceftriaxone. Examination of 44 macrolide resistant isolates by PCR showed that 16 isolates harbored the erm(B) gene, 8 isolates harbored the mef gene, and 14 isolates harbored both the erm(B) and mef genes. There was no amplification by PCR of the erm(B) or mef genes in 6 isolates. Seven different capsular serotypes 2, 9V/9A,12F, 14,19A, 19F, and 23, were detected by multiplex PCR serotype deduction in 35 of 44 macrolide resistant isolates, with 19F being the most prevalent serotype. With the exception of serotype 2, all serotypes were invasive. Isolates belonging to the invasive serotypes 14 and 19F harbored both erm(B) and mef genes. Nine of the 44 macrolide resistant isolates were non-serotypable by our protocols.Macrolide resistance in S. pneumoniae in Lebanon is mainly through target site modification but is also mediated through efflux pumps, with serotype 19F having dual resistance and being the most prevalent and invasive.Streptococcus pneumoniae continues to be a major cause of morbidity and mortality in humans. It is one of the most significant bacterial pathogens causing community acquired infections, most notably pneumonia, otitis media, bacteremia, and meningitis [1,2]. Treatment of pneumococcal infections is becoming difficult due to the high prevalence of penicillin-resistant strains and to the rapid development of resistance to other antimicrobials including macrolides. These drugs are extensively used for the treat
Effect of Mobile Credit on Operational Efficiency in Commercial Banks in Kenya  [PDF]
Koki F. Kinyanzui, George Achoki, Peter Kiriri
Open Journal of Business and Management (OJBM) , 2018, DOI: 10.4236/ojbm.2018.64062
Abstract:
This study sought to establish the effect of mobile credit on operational efficiency in commercial banks in Kenya. The study utilized primary as well as secondary data on access to mobile credit and its effects on the performance of the organization. A questionnaire was the primary data collection tool and composed of open ended and closed ended questions. Data collected was analyzed using multiple linear regression analysis at a 95% confidence interval. Analyzed data was presented using tables and figures for ease of interpretation. Operational efficiency is the goal of any manager in a customer service driven sector. Some of the strategies to achieve operational efficiency include managerial behavior change, promoting operational optimization and use of technology. Mobile credit introduction improved operational efficiency in commercial banks. Mobile credit introduction enhanced operational efficiency in loans collection, returns on shareholders. The operational efficiency performance indicators utilized in this study were: return on assets, earnings per share and proportion of non-performing loans. On the other hand, proportion of non-performing loans declined after the introduction of mobile credit indicating increased operational efficiency in debt collection. The introduction of mobile credit significantly enhanced organization efficiency as measured by metrics such by brand image building, ability to adapt to market changes and perceptions of reliability in the customer’s mind. Mobile credit introduction improved operational efficiency in commercial banks. Mobile credit introduction enhanced operational efficiency in loans collection, returns on shareholders. Overall, it has been accepted that the use of technology is one of the major strategies used to enhance operational efficiency. The findings of this study propose that the use of mobile credit has enhanced debt collection efficiency and revenue generation efficiency.
Long term dynamic of real exchange rate, trade liberalization and financial integration: The case of south-east Mediterranean countries
Amor Hadj Thouraya,El Araj Rita
Panoeconomicus , 2009, DOI: 10.2298/pan0901073a
Abstract: The purpose of this paper is to estimate the effects of the trade liberalization and of the international financial integration on the long-term behavior of Real Exchange Rate (RER) for the South East Mediterranean countries. So the following question: how does the new trade and financial context affect the Equilibrium RER? We refer to the econometric technique of time series analysis, (the unit root tests of Dickey-Fuller (1979) and we apply the cointegration test of Engle and Granger (1987) of single equation for six South East Mediterranean countries (Algeria, Egypt, Lebanon, Morocco, Tunisia and Turkey) over the period of 1979-2004. Our estimates suggest that, for the six countries, long-term RER behavior depends essentially on economic specificity of each country and in particular on their degree of financial integration and trade opening. Our results also show that the evolution of the RER misalignment during our sample period, seem to be for some countries persistant and recurrent, but with decrease.
Improving Child survival through enhancing Prevention of Mother to Child Transmission of HIV
George F. Mkoma
Dar Es Salaam Medical Students' Journal , 2012,
Abstract: Background: Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. Effective strategies are needed for the Prevention of Mother-To-Child Transmission of HIV (PMTCT). The complete PMTCT package includes comprehensive antenatal (ANC) care, modified obstetric practices, antiretroviral therapy and infant feeding counseling and support. Aim: This article presents syntheses of evidence on the cost-effectiveness of HIV MTCT strategies for LMICs, investigates whether a maternal triple-antiretroviral regimen that was designed to maximally suppress viral load in late pregnancy and the first 6 months of lactation was safe and well-tolerated, investigates acceptability of the PMTCT programme components, and identifies structural and cultural challenges to male involvement in the reduction of MTCT. Methods: I identified articles on the use of ARVs to prevent MTCT of HIV through a comprehensive database search including PubMed and Embase. I screened the titles and abstracts from the individual database search results from year 2002-2011, pooled the potentially eligible studies, retrieved full-text articles, and then assessed whether they met the inclusion criteria. I extracted the data based on publication date, demographic characteristics and HIV transmission rates to babies. Results: The articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMICs. HIV-transmission rates among subgroups defined by maternal risk factors, including baseline CD4 cell count and viral load was 15% after 24 months, while transmission rates for those who have received ARVs was 7% for the same period. This reveals that triple-antiretroviral regimen for pregnant-women was safe and feasible. Routine testing for HIV of women at the antenatal clinic was found to be highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. The vision, goal, objectives and targets noted by Global Partners Forum will serve as a framework for WHO to support countries to focus on and prioritize the accelerated scale-up of effective and comprehensive PMTCT services. Conclusion and recommendations: Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritized for the PMTCT programme to achieve its potential. Increased community sensitization, counseling and testing, treatment and support of women identified as HIV infected should improve acceptance of PMTCT servi
The Use of Two Doors in a Trap-Door Spider's Nest
George F. Atkinson
Psyche , 1888, DOI: 10.1155/1888/49547
Abstract:
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