Background: Patients with primary refractory Hodgkin's disease (PR-HD) have a dismal pro... more Background: Patients with primary refractory Hodgkin's disease (PR-HD) have a dismal prognosis when treated with conventional salvage chemotherapy. We analyzed time to treatment failure (TTF), overall survival (OS) and clinical variables influencing the outcome ...
In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobactera... more In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobacterales (CRE) acquisition in inpatients with 3rd generation cephalosporin-resistant (3GCR) Enterobacterales at a tertiary-care hospital in Lebanon, and suggested a risk prediction score for it. This is a retrospective matched case–control study of inpatients with 3GCR Enterobacterales that are carbapenem resistant (cases) versus those with carbapenem-sensitive isolates (controls). Data analysis was performed on IBM SPSS program, version 23.0 (Armonk, NY, USA: IBM Corp.). Categorical variables were compared between cases and controls through bivariate analysis and those with statistical significance (P
Background Sexually transmitted infections (STIs) cause a major public health problem that affect... more Background Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed. Methods A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Urealplasma parvum, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma girerdii, Gardnerella vaginalis, Candida albicans and Human Papillomavirus (HPV). Positive HPV samples underwent genotypin...
Introduction: Bacterial infections are frequent complications occurring after autologous hematopo... more Introduction: Bacterial infections are frequent complications occurring after autologous hematopoietic stem-cell transplantation (AHSCT). Herein, we identified the bacterial ecology and its antibiogram in AHSCT patients. We assessed the incidence, contributing factors and outcome of prolonged neutropenia and bacteremia post-AHSCT in the absence of antibacterial prophylaxis. Methodology: This is a retrospective chart review of 190 adult patients who underwent AHSCT for lymphoma and multiple myeloma, between 2005 and 2015 at a Lebanese hospital. Results: Most of the isolated bacteria originated from urine (49%) followed by blood (30%) and were mainly Gram-negative (70%). Fluoroquinolone susceptibility was 57% among Gram-negative and Gram-positive isolates. Bacteremia was documented in 12.6% of the patients, with a predominant gram-negative etiology having 95% susceptibility to fluoroquinolones. The duration of neutropenia, < or > 7 days, did not affect the incidence of bacteremi...
Introduction: Streptococcus pneumoniae causes a wide range of infections classified as invasive a... more Introduction: Streptococcus pneumoniae causes a wide range of infections classified as invasive and non-invasive pneumococcal disease (non-IPD). Methodology: We retrospectively reviewed over a decade the clinical course and outcome of 103 adult subjects infected with S. pneumoniae. Results: The majority of the subjects (92%) were eligible for pneumococcal vaccination, however none were vaccinated. Most of the infective strains caused non-IPD (64%), with CAP being the leading primary infection (49%). Clinical success was achieved in 71% of the cases and microbiological success in 94% of the cases with available documented follow-up cultures. Yet, 19% of the subjects developed superinfections caused by extensive-drug resistant bacteria with the predominance of ventilator-associated pneumonia (13%). Total in-hospital mortality reached 27% and S. pneumoniae infection attributed mortality was 20%. Using multivariate logistic regression, kidney disease and septic shock were independent ri...
In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropen... more In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropenia above 7 days and of bacteraemia in patients with lymphoma and multiple myeloma who underwent autologous haematopoietic stem cell transplantation (AHSCT) without antibacterial prophylaxis. This is a retrospective chart review of 190 adult patients who underwent AHSCT between 2005 and 2015 at a Lebanese hospital. Neutropenia of 7 days duration and longer was documented in 66% of the patient population. Through univariate analysis, patients with lymphoma were significantly more likely to have prolonged neutropenia (≥ 7 days) compared to those with myeloma. Mucositis above grade 3, diarrhoea and fever were more likely to occur in patients with prolonged neutropenia. Bacteraemia was documented in 12.6% of the patients. Total mortality rate was 3.7%, and that attributed to bacteraemia was 12.5% in the bacteraemia subgroup. Among bacterial isolates recovered from clinical specimens (89 isola...
Acute respiratory tract viral infections occur worldwide and are one of the major global burdens ... more Acute respiratory tract viral infections occur worldwide and are one of the major global burdens of diseases in children. The aim of this study was to determine the viral etiology of respiratory infections in hospitalized children, to understand the viral seasonality in a major Lebanese hospital and to correlate disease severity and the presence of virus. Over a one year period, nasal and throat swabs were collected from 236 pediatric patients, aged 16 years old or less and hospitalized for acute respiratory illness. Samples collected were tested for the presence of 17 respiratory viruses using multiplex real-time RT-PCR. Pathogens were identified in 165 children (70%) and were frequently observed during fall and winter seasons. Co-infection was found in 37% of positive samples. The most frequently detected pathogens were human Rhinovirus (hRV, 23%), Respiratory Syncytial Virus (RSV, 19%), human Bocavirus (hBov, 15%), human Metapneumovirus (hMPV, 10%) and human Adenovirus (hAdV, 10%). A total of 48% of children were diagnosed with bronchiolitis and 25% with pneumonia. While bronchiolitis was often caused by RSV single virus infection and hAdV/hBoV coinfection, pneumonia was significantly associated with hBoV and HP1V1 infections. No significant correlation was observed between a single viral etiology infection and a specific clinical symptom. This study provides relevant facts on the circulatory pattern of respiratory viruses in Lebanon and the importance of using PCR as a useful tool for virus detection. Early diagnosis at the initial time of hospitalization may reduce the spread of the viruses in pediatric units. This article is protected by copyright. All rights reserved.
Background: Patients with primary refractory Hodgkin&#x27;s disease (PR-HD) have a dismal pro... more Background: Patients with primary refractory Hodgkin&#x27;s disease (PR-HD) have a dismal prognosis when treated with conventional salvage chemotherapy. We analyzed time to treatment failure (TTF), overall survival (OS) and clinical variables influencing the outcome ...
In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobactera... more In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobacterales (CRE) acquisition in inpatients with 3rd generation cephalosporin-resistant (3GCR) Enterobacterales at a tertiary-care hospital in Lebanon, and suggested a risk prediction score for it. This is a retrospective matched case–control study of inpatients with 3GCR Enterobacterales that are carbapenem resistant (cases) versus those with carbapenem-sensitive isolates (controls). Data analysis was performed on IBM SPSS program, version 23.0 (Armonk, NY, USA: IBM Corp.). Categorical variables were compared between cases and controls through bivariate analysis and those with statistical significance (P
Background Sexually transmitted infections (STIs) cause a major public health problem that affect... more Background Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed. Methods A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Urealplasma parvum, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma girerdii, Gardnerella vaginalis, Candida albicans and Human Papillomavirus (HPV). Positive HPV samples underwent genotypin...
Introduction: Bacterial infections are frequent complications occurring after autologous hematopo... more Introduction: Bacterial infections are frequent complications occurring after autologous hematopoietic stem-cell transplantation (AHSCT). Herein, we identified the bacterial ecology and its antibiogram in AHSCT patients. We assessed the incidence, contributing factors and outcome of prolonged neutropenia and bacteremia post-AHSCT in the absence of antibacterial prophylaxis. Methodology: This is a retrospective chart review of 190 adult patients who underwent AHSCT for lymphoma and multiple myeloma, between 2005 and 2015 at a Lebanese hospital. Results: Most of the isolated bacteria originated from urine (49%) followed by blood (30%) and were mainly Gram-negative (70%). Fluoroquinolone susceptibility was 57% among Gram-negative and Gram-positive isolates. Bacteremia was documented in 12.6% of the patients, with a predominant gram-negative etiology having 95% susceptibility to fluoroquinolones. The duration of neutropenia, < or > 7 days, did not affect the incidence of bacteremi...
Introduction: Streptococcus pneumoniae causes a wide range of infections classified as invasive a... more Introduction: Streptococcus pneumoniae causes a wide range of infections classified as invasive and non-invasive pneumococcal disease (non-IPD). Methodology: We retrospectively reviewed over a decade the clinical course and outcome of 103 adult subjects infected with S. pneumoniae. Results: The majority of the subjects (92%) were eligible for pneumococcal vaccination, however none were vaccinated. Most of the infective strains caused non-IPD (64%), with CAP being the leading primary infection (49%). Clinical success was achieved in 71% of the cases and microbiological success in 94% of the cases with available documented follow-up cultures. Yet, 19% of the subjects developed superinfections caused by extensive-drug resistant bacteria with the predominance of ventilator-associated pneumonia (13%). Total in-hospital mortality reached 27% and S. pneumoniae infection attributed mortality was 20%. Using multivariate logistic regression, kidney disease and septic shock were independent ri...
In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropen... more In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropenia above 7 days and of bacteraemia in patients with lymphoma and multiple myeloma who underwent autologous haematopoietic stem cell transplantation (AHSCT) without antibacterial prophylaxis. This is a retrospective chart review of 190 adult patients who underwent AHSCT between 2005 and 2015 at a Lebanese hospital. Neutropenia of 7 days duration and longer was documented in 66% of the patient population. Through univariate analysis, patients with lymphoma were significantly more likely to have prolonged neutropenia (≥ 7 days) compared to those with myeloma. Mucositis above grade 3, diarrhoea and fever were more likely to occur in patients with prolonged neutropenia. Bacteraemia was documented in 12.6% of the patients. Total mortality rate was 3.7%, and that attributed to bacteraemia was 12.5% in the bacteraemia subgroup. Among bacterial isolates recovered from clinical specimens (89 isola...
Acute respiratory tract viral infections occur worldwide and are one of the major global burdens ... more Acute respiratory tract viral infections occur worldwide and are one of the major global burdens of diseases in children. The aim of this study was to determine the viral etiology of respiratory infections in hospitalized children, to understand the viral seasonality in a major Lebanese hospital and to correlate disease severity and the presence of virus. Over a one year period, nasal and throat swabs were collected from 236 pediatric patients, aged 16 years old or less and hospitalized for acute respiratory illness. Samples collected were tested for the presence of 17 respiratory viruses using multiplex real-time RT-PCR. Pathogens were identified in 165 children (70%) and were frequently observed during fall and winter seasons. Co-infection was found in 37% of positive samples. The most frequently detected pathogens were human Rhinovirus (hRV, 23%), Respiratory Syncytial Virus (RSV, 19%), human Bocavirus (hBov, 15%), human Metapneumovirus (hMPV, 10%) and human Adenovirus (hAdV, 10%). A total of 48% of children were diagnosed with bronchiolitis and 25% with pneumonia. While bronchiolitis was often caused by RSV single virus infection and hAdV/hBoV coinfection, pneumonia was significantly associated with hBoV and HP1V1 infections. No significant correlation was observed between a single viral etiology infection and a specific clinical symptom. This study provides relevant facts on the circulatory pattern of respiratory viruses in Lebanon and the importance of using PCR as a useful tool for virus detection. Early diagnosis at the initial time of hospitalization may reduce the spread of the viruses in pediatric units. This article is protected by copyright. All rights reserved.
Between January, 2000 and December, 2011, 53 consecutive patients (pts) with Hodgkin's lymphoma (... more Between January, 2000 and December, 2011, 53 consecutive patients (pts) with Hodgkin's lymphoma (HL) sensitive to salvage therapy after a primary refractory status (18pts) or after relapse (35 pts) underwent high-dose chemotherapy (HDCT) BEAM (carmustine, etoposide, cytarabine, melphalan) and autologous stem cell transplantation (ASCT). Median age at ASCT was 33 years (y) (18-57). There were 35 males and 18 females. Among the 18 primary refractory pts, 14 received ABVD alone and 4 pts ABVD combined to radiation therapy (RP), as primary therapy. Fourteen pts responded after one line and 4 pts needed ≥ 2 lines of salvage therapy to respond. Ten of the 18 pts were autotransplanted in complete remission (CR) and 8 pts in partial remission (PR). Among the 35 pts autotransplanted in sensitive relapse, 20 pts received, as primary therapy, chemotherapy alone (ABVD: 19 pts, BEACOPP: 1 pt), and 15pts received chemotherapy (ABVD: 14 pts, MOPP: 1pt) combined to RP. Of these 35 pts, 21 were autotransplanted in CR and 14 pts in PR. Among the all 53 pts, 31 underwent ASCT in CR and 22 pts in PR. Evaluation of response to salvage therapy before ASCT was performed by PET scan in 32 pts. Source of stem cells were peripheral blood in 51 pts and bone marrow in 2 pts. With a median follow-up of 36 months (m) (4-147), overall survival (OS) and disease-free survival (DFS) rates at 10y were 62% and 58%, respectively, for the 53 pts. Concerning the 18 pts with primary refractory disease, OS and DFS rates at 10y were 60% and 59%, respectively. Concerning the 35 pts with sensitive relapse, OS and DFS rates at 10y were 60% and 57%, respectively. There was a significant difference in long-term outcome between the two groups of pts autotransplanted in CR and those autotransplanted in PR. Overall survival rates at 10y for the pts autotransplanted in CR versus in PR were 86% and 31%, respectively (p< 0.001). Disease-free survival rates at 10y for the pts autotransplanted in CR versus in PR were 76.5% and 28%, respectively (p< 0.001). S 434
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