Prevalence and Incidence of Drug-Resistant Temporal Lobe Epilepsy in Qatar.

BACKGROUND: Information on the epidemiology of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) from Qatar and the developing countries is scarce. To acquire knowledge on the incidence and prevalence of drug-resistant TLE-HS in Qatar, we designed this analytical and extrapolative systematic review of the existing literature. MATERIAL AND METHODS: We searched the electronic database PubMed from 1947 until April, 2018, using the following search terms in the title: "epilepsy" OR "temporal lobe" OR "hippocampal sclerosis" AND "epidemiology" OR "incidence" OR "prevalence." Relevant original studies, reviews, and their references, were included. We extrapolated from the previous international literature to estimate the epidemiology of drug-resistant TLE-HS in Qatar. RESULTS: The estimated Qatar incidence of epilepsy varies from 50 to 61 per 100 000 persons per year, and the estimated prevalence of epilepsy is 6.54 per 1000 population; the estimated incidence of TLE varies from 9.5 to 11.6 patients per 100 000 population per year and the estimated prevalence of TLE is 1.76 patients per 1000 people, with 4721 patients having TLE in Qatar. Finally, the reviewed studies also helped in making an estimate of the Qatar prevalence of drug-resistant TLE-HS to be between 0.3 and 0.6 cases per 1000 people (804-1609 current patients) and the Qatar incidence of drug-resistant TLE-HS (2.3-4.3 cases per 100 000 people, per year) with 62 to 116 new patients per year. CONCLUSION: Our study suggests that 804 to 1609 current patients (with 62-116 additional patients per year) in Qatar are suffering from drug-resistant TLE-HS; emphasis should be placed on the surgical aspect of the current Qatar Comprehensive Epilepsy Program.

ant(6)-I Genes Encoding Aminoglycoside O-Nucleotidyltransferases Are Widely Spread Among Streptomycin Resistant Strains of Campylobacter jejuni and Campylobacter coli.

Thermotolerant Campylobacter species C. jejuni and C. coli are actually recognized as the major bacterial agent responsible for food-transmitted gastroenteritis. The most effective antimicrobials against Campylobacter are macrolides and some, but not all aminoglycosides. Among these, susceptibility to streptomycin is reduced by mutations in the ribosomal RPSL protein or by expression of ANT(6)-I aminoglycoside O-nucleotidyltransferases. The presence of streptomycin resistance genes was evaluated among streptomycin-resistant Campylobacter isolated from humans and animals by using PCR with degenerated primers devised to distinguish ant(6)-Ia, ant(6)-Ib and other ant-like genes. Genes encoding ANT(6)-I enzymes were found in all possible combinations with a major fraction of the isolates carrying a previously described ant-like gene, distantly related and belonging to the new ant(6)-I sub-family ant(6)-Ie. Among Campylobacter isolates, ant(6)-Ie was uniquely found functional in C. coli, as shown by gene transfer and phenotype expression in Escherichia coli, unlike detected coding sequences in C. jejuni that were truncated by an internal frame shift associated to RPSL mutations in streptomycin resistant strains. The genetic relationships of C. coli isolates with ANT(6)-Ie revealed one cluster of strains presented in bovine and humans, suggesting a circulation pathway of Campylobacter strains by consuming contaminated calf meat by bacteria expressing this streptomycin resistance element.

Characteristics of patients with confirmed epilepsy and psychogenic nonepileptic seizures in Qatar.

OBJECTIVE: The Middle Eastern country of Qatar opened its first epilepsy monitoring unit (EMU) in late 2015. This study compared demographic and clinical characteristics of patients with confirmed epilepsy to those of patients with confirmed psychogenic nonepileptic seizures (PNES). METHODS: Data were collected via retrospective chart review on 113 patients admitted for evaluation to the Qatar national health system EMU between November 2015 and May 2017. RESULTS: Seventy-one patients had a confirmed diagnosis (20 had PNES, 46 had epilepsy, 5 had both PNES and epilepsy). Evaluation in 33 patients was inconclusive, and 9 had other medical conditions. Patients with PNES were significantly more likely to be primary Arabic speakers (p = 0.003), and this difference was not explained by education or employment status. The most common referral request in patients with PNES was for recurrent/refractory seizures (p = 0.011), and there was a trend for patients with PNES to have more frequent seizures compared with patients with epilepsy (daily to several per week versus several times a month or less, p = 0.051). Depression was identified in 47% of patients with epilepsy and 65% of patients with PNES, and patients with PNES had higher mean depression scores on the PHQ-9 than patients with epilepsy (p = 0.014). Patients with PNES experienced significantly more fatigue (p = 0.021). Seventy percent of patients with PNES and 50% of patients with epilepsy reported sleep problems. CONCLUSIONS: The characteristics of patients with epilepsy and PNES at the EMU in Qatar were generally similar to those found worldwide. Patients with PNES more often suffered from frequent depression, sleep problems, and fatigue than those with epilepsy, but these were significant concerns for both groups.

Identification of the main quinolone resistance determinant in Campylobacter jejuni and Campylobacter coli by MAMA-DEG PCR.

Among zoonotic diseases, campylobacteriosis stands out as the major bacterial infection producing human gastroenteritis. Antimicrobial therapy, only recommended in critical cases, is challenged by resistance mechanisms that should be unambiguously detected for achievement of effective treatments. Quinolone (ciprofloxacin) resistance of Campylobacter jejuni and Campylobacter coli, the 2 main Campylobacter detected in humans, is conferred by the mutation gyrA C-257-T, which can be genotyped by several methods that require a previous identification of the pathogen species to circumvent the sequence polymorphism of the gene. A multiplex PCR, based on degenerated oligonucleotides, has been designed for unambiguous identification of the quinolone resistance determinant in Campylobacter spp. isolates. The method was verified with 249 Campylobacter strains isolated from humans (141 isolates) and from the 3 most important animal sources for this zoonosis: poultry (34 isolates), swine (38 isolates), and cattle (36 isolates). High resistance to ciprofloxacin, MIC above 4µg/mL, linked to the mutated genotype predicted by MAMA-DEG PCR (mismatch amplification mutation assay PCR with degenerated primers) was found frequently among isolates from the different hosts.

Polymorphism of genes encoding PmrAB in colistin-resistant strains of Escherichia coli and Salmonella enterica isolated from poultry and swine.

OBJECTIVES: To detect the occurrence of low susceptibility to colistin (polymyxin E), a last-resort antimicrobial, among enterobacteria isolated from samples of animal origin (poultry and swine) and to find out the molecular basis of colistin resistance. METHODS: Salmonella enterica and Escherichia coli were isolated from eggs and swine samples. Bacterial strains were screened for colistin resistance by using MIC determinations interpreted according to EUCAST recommendations. pmrAB genes were amplified by PCR from bacterial isolates and their sequences were characterized. RESULTS: Nine colistin-resistant strains were detected in a collection of 739 enterobacteria (S. enterica and E. coli) isolated from animal samples taken in different environments. Sequences encoding the PmrAB two-component sensor-regulator from two colistin-resistant E. coli strains isolated from swine faeces presented three non-synonymous polymorphisms, producing the variants 39S → I and 81R → S of PmrA and 161V → G of PmrB, among which the involvement of mutations in PmrA-81 and PmrB-161 in resistance to the antimicrobial had been previously shown. No variation at the protein level was detected after analysis of PmrAB sequences from seven colistin-resistant S. enterica strains. CONCLUSIONS: E. coli strains carrying mutations in PmrAB that confer resistance to polymyxins, which might have evolved in vivo and have been rarely detected, are described for the first time in enterobacteria isolated from animals.

Cirugía de salvamento de extremidades para paciente con tumor maligno de la cintura escapular. A propósito de un caso / Limb salvage surgery for patient withMalignant tumor of the shoulder girdle. A case report

Previo a los años 70, la amputación interescapulotorácica era el principal tratamiento para los tumores óseos malignos de la cintura escapular. Con la mejor comprensión del comportamiento biológico de éstos y aplicación de terapia adyuvante, 80-90% pueden ser resecados con seguridad, empleando procedimientos de salvamento de extremidades. Se trata de paciente masculino de 34 años de edad quien cursa con aumento de volumen en región escapular derecha, de un año de evolución, acompañado de dolor en articulación acromio-clavicular y limitación para movimientos de abducción y flexión. Radiológicamente, se observó área osteolítica en fosa supraespinosa de escápula derecha; la tomografía reveló lesión destructiva de acromio, cabeza humeral y tercio externo de clavícula, en gammagrama óseo: lesión única en escápula derecha; TAC de tórax sin evidencia de lesiones secundarias. Biopsia incisional reportó sarcoma de alto grado clasificado como estadío IIB de Enneking. Posterior a estudio de Angioresonancia, se decidió y realizó la cirugía de salvamento de extremidad denominada Thikoff Lindbergh tipo IVB, consistente en la resección oncológica de margen amplio de escápula, articulación glenohumeral, 2/3 externos de clavícula y 1/3 proximal de húmero derecho. La histopatología determinó bordes libres de enfermedad y el diagnóstico final fue Osteosarcoma de alto grado. Postoperatorio con excelentes resultados; es referido a oncología clínica y a fisioterapia. Aunque los osteosarcomas de huesos planos son relativamente raros, su aparición en huesos como escapula condicionan situaciones de difícil manejo, ya que la resección adecuada está sujeta a un correcto proceso de estadificación y a una técnica depurada y experimentada(AU)

Prior to the 70s, the forequarter amputation was the primary treatment for malignant bone tumors of the shoulder girdle. With better understanding of the biological behavior of these and application of adjuvant therapy, 80-90% can be safely resected using limb salvage procedures. Male patient is 34-year- old who was studying with increased volume in the right scapular region, a year of evolution, accompanied by pain in acromioclavicular joint and limitation of abduction and flexion movements. Radiologically, there was osteolytic area in right supraspinous fossa of scapula; tomography revealed destructive lesion of acromion, humeral head and the outer third of clavicle, in ganmagrama bone: single lesion in right scapula, CT scan without evidence of secondary lesions. Incisional biopsy reported high grade sarcoma classified as Enneking stage IIB. Angiography after study, it was decided and performed limb salvage surgery called Thikoff Lindbergh type IVB, consisting of oncological resection of scapula wide margin, glenohumeral joint, two thirds collarbone external third right proximal humerus. The histopathology determined disease-free edges and the final diagnosis was highgrade osteosarcoma. Postoperative with excellent results, is referred to physiotherapy and clinical oncology. Although osteosarcoma of flat bones are relatively rare, their occurrence in bone and scapula condition unwieldy situations as adequate resection is subject to proper staging process and a refined technique and experienced(AU)

Prevalence of quinolone resistance determinants in non-typhoidal Salmonella isolates from human origin in Extremadura, Spain.

Resistance to the quinolones nalidixic acid (NAL) and ciprofloxacin (CIP) and the occurrence of quinolone resistance determinants have been investigated in 300 non-typhoidal Salmonella from human origin, isolated in the years between 2004 and 2008, in 6 hospitals within Extremadura (Spain). Salmonella Enteritidis was the major serotype found among quinolone-resistant isolates, most of which were clustered by clonal analysis to a single clone, which presented D87 or S83 substitutions in GyrA. Eleven isolates presented the non-classical quinolone resistance phenotype (resistance to CIP and susceptibility to NAL), lacking mutations in the quinolone resistance determinant region of topoisomerase genes. Among them, one Salmonella Typhimurium isolate carried a qnrS1 gene in a low-molecular-weight plasmid, pQnrS1-HLR25, identical to plasmids previously found in the UK, Taiwan, and USA. The occurrence of this genetic element could represent a risk for the horizontal transmission of quinolone resistance among Enterobacteriaceae in the Iberian Peninsula.

Co-occurrence of ACSSuT and cephalosporin resistance phenotypes is mediated by int1-associated elements in nontyphoidal Salmonella enterica from human infections in Spain.

A screening of antimicrobial resistance and its genetic determinants has been performed on 300 Salmonella enterica isolates collected during 2004-2008 from human infections in Spain. Salmonella Typhimurium and Salmonella Enteritidis were the major serotypes, which were found with similar frequencies covering 80% of the bacterial collection. Salmonella Typhimurium isolates frequently shared low susceptibility to antimicrobials of the penta-resistance phenotype (ACSSuT) and/or cephalosporin resistance. The ACSSuT profile was found closely linked to int1-associated gene cassettes, with major elements carrying DNA fragments of 1.0 Kb (aadA2 gene) plus 1.2 Kb (blaPSE-1 gene) or 2.0 Kb (aadA1 and blaOXA-1 genes). Among these, ACSSuT and cephalosporin resistances were associated in Salmonella Typhimurium isolates expressing the blaOXA gene. ß-lactamase activities were also detected from isolates carrying blaTEM, blaCMY, or blaSHV, although only the two last genes expressed extended-spectrum ß-lactamases. The clonal analysis of S. enterica strains suggests that both horizontal and vertical transfer mechanisms are involved in the wide dissemination of their antimicrobial resistance.

Dissemination of antimicrobial-resistant clones of Salmonella enterica among domestic animals, wild animals, and humans.

Non-typhoidal salmonellosis is an important zoonotic disease caused by Salmonella enterica. This work focuses on the identification of Salmonella enterica clonal strains which, presenting a wide distribution potential, express resistance determinants that compromise effectiveness of the antimicrobial therapy. The screening was performed on 506 Salmonella enterica isolates from animals and humans, which were characterized by serovar and phage typing, genome macrorestriction and pulsed-field gel electrophoresis, and detection of phenotypic and genotypic traits for antimicrobial resistance. A Salmonella Enteritidis strain with strong quinolone resistance is spread on three host environments carrying one of the four variants found for the GyrA protein: (1) Asp87Tyr, the major polymorphism found in 39 Salmonella isolates from human origin and six from poultry; (2) Ser83Phe, with four isolates from human origin and one from white stork (Ciconia ciconia); and (3) Asp87Asn or (4) Asp87Gly, with two isolates each from human origins. Several Salmonella Typhimurium strains that presented int1 elements and the classically associated pentaresistance (ACSSuT) phenotype were found distributed between two host environments: domestic animals and humans, domestics and wild animals, or wild fauna plus humans. This study points out the importance of monitoring gut microbiota and its antimicrobial resistance from wildlife, in parallel to livestock animals and humans, especially for animal species that are in close contact with people.

Cambios metafisiarios de los miembros inferiores originados por osteocondromatosis múltiple hereditaria / Mataphyseal changes of the lower limb caused by multiple hereditary osteochondromatosis

Se realizó un estudio de población, de tipo prospectivo, descriptivo y observacional en pacientes que acudieron a la Unidad de Tumores Óseos y Partes Blandas (UTOPB) del Hospital Universitario “Dr. Manuel Núñez Tovar” entre enero de 2008 y julio de 2010, con el diagnóstico de Osteocondromatosis Múltiple Hereditaria (OMH) que afectaba las articulaciones de las extremidades inferiores; se estudiaron 26 pacientes, equivalentes a 52 extremidades inferiores, con predominio del sexo masculino 1,2:1, las edades de los pacientes comprendían entre los 6 y 15 años, con mayor registro de casos a los 12 años (19,2%). Se cuantificó el número de osteocondromas periarticulares en las articulaciones de cadera, rodilla y tobillo, observando un predominio en la rodilla (48,7%) a expensas de la metáfisis distal del fémur. Se clasificó la afectación funcional de las articulaciones en tres grados (leve, moderada y severa), tomando como referencia el movimiento de flexoextensión, siendo el tobillo la articulación que presento el mayor grado de limitación y la cadera la menos afectada a la presencia de osteocondromas

We conducted a prospective, descriptive and observational population-based study, in patients attending the Unit of Bone and Soft Tissue Tumors (UTOPB) at the Hospital "Dr. Manuel Núñez Tovar" between January 2008 and July 2010, with the diagnosis of Multiple Hereditary Osteochondromatosis (MHO), which affected the joints of the lower extremities, were studied 26 patients, equivalent to 52 lower extremities; with a male predominance 1,2:1, the age of the patients ranged between 6 and 15 years, with highest number of cases at 12 years (19.2%). We quantified the number of periarticular osteochondromas at the hip, knee and ankle, having predominance in the knee (48.7%) at the expense of the distal femur metaphysis. We scored the functional range of the joints in three grades (mild, moderate and severe), with reference to the movement of flexion-extension, the ankle joint had the highest degree of limitation and, the hip was less affected to the presence of osteochondromas

Condrosarcoma de alto grado: extirpación y reconstrucción con prótesis total del fémur primer caso realizado en Venezuela / High-grade chondrosarcoma: removal and reconstruction of the total femur prosthesis first case in Venezuela

En el presente caso clínico se muestra, la historia de un paciente quien era portador de un condrosarcoma en fémur derecho, el cual fue diagnósticado en el año 2000, en el Hospital "Padre Machado", mediante la aplicación de una estricto protocolo diagnóstico para tumores óseos, el cual evidenció una lesión extracompartamental que requirió para su tratamiento la extirpación de todo el hueso, con posterior reconstrucción con mega prótesis hecha a la medida con articulaciones de cadera y rodilla incluidas, con evidencias, luego de dos años de seguimiento, de execelentes resultados oncológicos y funcionales.

Condrosarcomas: experiencia diagnóstica y terapéutica en el Hospital Oncológico "Padre Machado" desde 1988 hasta 1999 / Chondrosarcomas: diagnostic and therapeutic experience to the Oncological

A 31 casos de condrosarcomas de huesos que acudieron y se trataron en el Hospital "Padre Machado" de 1988 a 1999, se revisaron los aspectos demográficos diagnósticos y terapéuticos. El 60 por ciento era masculino, la edad promedio era de 39.35 años. El hueso más afectado fue el fémur seguido por el húmero. Del análisis histológico se obtuvo un predominio de grado I. Se evidenció una relación directa entre grado histológico y capacidad metastásica y una relación inversa entre grado histológico y sobrevida del paciente. Los esquemas terapéuticos más utilizados fueron quirúrgicos. De estos predominó el de tipo ablativo (hemipelvectomía y amputaciones)

Tumor de células gigantes del hueso: estudio clínico, radiológico y morfológico / Giant cell tumors of bone: clinical, radiologic and morphological study

En un estudio realizado, durante el período 1976 - 1995, se encontraron 39 casos de tumores de células gigantes del hueso. El sexo femenino predominó sobre el masculino. La edad promedio de aparición de esta neoplasia fue de 26 años. Histológicamente el 94,9 por ciento fueron grado I, según la clasificación de Jaffé. No se encontró relación estadísticamente significativa entre el grado histológico y la evolución de los pacientes. Radiológicamente en el 41,7 por ciento de los casos se observaron grado II, según la clasificación de Campanacci, encontrándose asociación significativa entre esta variable y la aparición de recividas y metástasis. El tratamiento empleado fue quirúrgico, siendo la resección en bloque la modalidad más utilizada

Lesiones tumorales óseas benignas y pesudotumorales en niños y adolescentes. 1980-1995 / Bone pseudo tumoral lesions benign bone tomors

Realizamos un estudio retrospectivo de patología tumoral ósea benigna y lesiones pseudotumorales en pacientes en edades infantiles y juveniles que asistieron a nuestro hospital, durante los años 1980 a 1995; encontramos, en 127 pacientes estudiados, que el osteocondroma fue el tumor óseo benigno de mayor consulta con un 57 por ciento, seguido por el condroblastoma con un 13,5 por ciento. De las lesiones pseudotumorales se observó mayor frecuencia en el quiste óseo solitario con un 30,4 por ciento, seguido de la displasia fibrosa con un 26,4 por ciento. La mayoría de los resultados se corresponden con los estudios de series de otros autores

Experiencia quirúrgica en la cadera espástica / Surgical experience of patients with spastic hip

Se refiere la experiencia en el tratamiento de pacientes afectados por cadera espástica, en el Hospital San Juan de Dios de Caracas, Venezuela, durante el período 1980-1995. Se trataron 57 caderas de 48 pacientes con parálisis cerebral. La afección fue más frecuente en hombres que en mujeres. El compromiso unilateral resultó más frecuente. La subluxación se presentó en 35 caderas y la luxación en 22. El tratamiento quirúrgico fue clasificado como procedimientos en tejidos blandos y osteotomías. El procedimiento más frecuentemente implementado en tejidos blandos fue la miotomía de los aductores, combinada o no con la tenotomía del psoas. El procedimiento más utilizado en tejido óseo fue la osteotomía varizante y desrotatoria. En la pelvis se empleó más frecuentemente la osteotomía de Salter

Experiencia quirúrgica en la cadera espástica / Surgical experience of patients with spastic hip

Se refiere la experiencia en el tratamiento de pacientes afectados por cadera espástica, en el Hospital San Juan de Dios de Caracas, Venezuela, durante el período 1980-1995. Se trataron 57 caderas de 48 pacientes con parálisis cerebral. La afección fue más frecuente en hombres que en mujeres. El compromiso unilateral resultó más frecuente. La subluxación se presentó en 35 caderas y la luxación en 22. El tratamiento quirúrgico fue clasificado como procedimientos en tejidos blandos y osteotomías. El procedimiento más frecuentemente implementado en tejidos blandos fue la miotomía de los aductores, combinada o no con la tenotomía del psoas. El procedimiento más utilizado en tejido óseo fue la osteotomía varizante y desrotatoria. En la pelvis se empleó más frecuentemente la osteotomía de Salter