Antimicrobial susceptibility patterns of bacterial isolates at the American University Medical Center in Lebanon.

In Lebanon, knowledge of the prevailing pattern of bacterial resistance to antimicrobial agents has been limited, particularly because of 15 years of civil strife. Thus, the current study was conducted to determine the antimicrobial susceptibility patterns of nonselected bacterial isolates recovered from recent clinical specimens, using the standardized disk agar diffusion technique. A total of 5216 isolates (1443 Gram positive and 3773 Gram negative) were examined. Over 92% of Staphylococcus aureus and coagulase-negative staphylococci (CNS) were resistant to penicillins. Methicillin resistance was more frequently noted among CNS (28%) compared with S. aureus (18%). For the pneumococci, 27% of the isolates were resistant to penicillin G. High but variable rates of multidrug resistance were encountered among Acinetobacter spp., Pseudomonas spp., Serratia spp., Citrobacter spp., and Enterobacter spp. Ampicillin resistance was detected in 65% of Escherichia coli and in 20% of Haemophilus influenzae isolates. Although one resistant Salmonella typhi strain was observed, 17% of other Salmonella spp. and 60% of Shigella spp. proved to be resistant to ampicillin, chloramphenicol, and cotrimoxazole. Among Vibrio cholerae isolates, high resistance to tetracycline (71%) and trimethoprim-sulfamethoxazole (94%) was observed. The overall antimicrobial resistance rates in Lebanon seem to fall between figures reported from the Arabian Gulf countries (higher) and those from medical centers in the United States (lower).

Serum immunoglobulin levels in normal children and adults in the Lebanese and other Arab Middle Eastern populations.

Serum immunoglobulin levels were determined in 1000 serum samples of normal middle easterners. Ig levels in mothers at delivery were normal except for a depressed IgG level. In cord blood the level of IgG was higher than its level in mothers, but no IgA or IgD was found. IgD was formed in some instances in the sera of infants in the first week of life. IgG showed a pattern similar to that described by others with the lowest values at 1-2 months, increasing gradually so that by 1-3 years the normal adult blood level is reached. IgA levels continued to increase with age and although no definite explanation is available, it is interesting to speculate on the possible relationship to the increased incidence of intestinal parasitism. IgM showed significant differences between males and females being higher in the latter. IgD levels reached maximum levels by 3-5 years, and mean levels ere lower after the 14th year.

Gonorrhea in the male: some aspects of treatment in Lebanon.

One hundred male patients with acute gonococcal urethritis were treated with various antibiotic and chemotherapeutic regimens. Pivampicillin, 1400 mg orally in two divided does at 5 hours' interval gave 100% cure in 60 patients. Gentamicin, 280 mg IM in one dose was equally efficaceous in 15 patients. Ampicillin and Trimethoprim-sulfamethoxazole gave cure rates of around 70%. While the results of the first two groups were in agreement with data published in different parts of the world, our results with the later two groups were contrary to those of other authors. The need for periodic evaluation of various antibiotic regimens in the treatment of gonorrhea is indicated.

Serum lipids and lipoprotein profile in a selected group of normal Lebanese subjects.

Serum triglycerides, total cholesterol, LDL, VLDL and HDL cholesterol levels were determined in a group of 442 apparently healthy Lebanese subjects after a 12 hr fast. Age-dependent increase was noted for total cholesterol, LDL cholesterol and triglycerides. On the other hand, VLDL and HDL cholesterol levels were age-independent. In addition, sex differences were noted for HDL cholesterol only. Our findings for total cholesterol and triglycerides are comparable with values reported by other authors, while values for LDL and VLDL are significantly different.

Hepatitis C virus : prevalence in Lebanese blood donors and brief overview of the disease.

Hepatitis C virus (HCV) is recognized as the major cause of non-A, non-B hepatitis. Its prevalence in different patient populations and blood donors has been reported worldwide but not yet from Lebanon. This study was performed to determine the prevalence of HCV antibodies in 536 random Lebanese blood donors using three enzyme immunoassay kits: ETI-AB-HCVK (Sorin, Biomedica, Italy), UBI HCV EIA (Organon Teknika, Netherlands) and ORTHO HCV 2.0 ELISA (Ortho Diagnostic Systems, USA). The latter was also used as an arbitrator test. Though ETI-AB-HCVK and UBI HCV EIA kits gave higher initial positive results (5.8% and 3.7%, respectively) than ORTHO HCV 2.0 ELISA (1.1%), the over all prevalence of HCV antibody in these blood donors was 0.7%. A brief review of the HCV virus, its epidemiology, clinical features and diagnostic aspects is also presented. A similar testing approach was carried out on additional 3643 blood donors. Confirmatory testing based on CHIRON*RIBA*HCV 2.0 strip immunoblot assay (Ortho) revealed that the HCV antibody seroprevalence in random Lebanese blood donors is 0.11% and not 0.7% as found by ELISAs alone.

Prevalence and etiology of intestinal parasites in Lebanon.

As there are no studies done on the prevalence of intestinal parasites in Lebanon since 1967, this study was undertaken to reveal the current patterns of intestinal parasitic infestations in Lebanese patients from two geographic regions: Beirut and Tripoli. Analysis was based on 33,253 stool specimens examined at the American University of Beirut Medical Center (AUH) and 11,611 specimens examined at the Islamic Hospital (IH) in Tripoli over five and three years, respectively. The prevalence of intestinal parasites at AUH and IH were 8.47% and 45.35%, respectively (overall 18%). The prevalence in males vs females was almost the same; being 8.23% vs 8.74%, and 44.67% vs 45.88%, at AUH and IH, respectively. Multiple infections were noted in 8.8% and 3.5% of stool specimens at AUH and IH, respectively. Although 18 different types of parasites were encountered, the most common pathogenic parasites found at AUH vs IH were: Giardia lamblia (20.7% vs 10.5% of parasites found), Entamoeba histolytica (19.41% vs 1.25%), Taenia spp. (6.03% vs 4.08%) and Ascaris lumbricoides (2.09% vs 46.97%). The overall yearly or monthly prevalence of parasites recovered from both hospitals did not show clear seasonal patterns. Compared to developed countries, Lebanon still suffers from a high prevalence and a wide spectrum of intestinal parasites.

Experience of the blood bank at the American University Hospital during the war in Lebanon.

The difficulties of switching from a community hospital blood bank type of practice to a field hospital blood bank operation with all the associated problems, are presented. Whole blood consumption markedly increased during the war while components use dropped and the voluntary benevolent donorship became the only source of blood supply. Guidelines of blood bank practice are derived from this experience.

Antibody response in marasmic children during recovery.

The I, II and III antibody responses to tetanus and diphtheria were assessed in marasmic and moderate protein-calorie malnourished children and compared to that of controls. The results suggest that during recovery marasmic children are capable of responding adequately to tetanus and diphtheria vaccines.

The prevalence of hepatitis B surface antigen (HBsAg) among students and blood donors at the American University of Beirut (AUB).

HBsAg testing by CEP was performed on 2359 students and 6153 blood donors at the American University of Beirut. No significant difference existed in the prevalanece rates among the various socioeconmic groups of the Arab Asians tested. There was, however, a definite difference among the various geographic groups. The findings suggest that socioecomic factors do not satisfactorily explain the differences in the prevalence rates among various nationals.

Primary intestinal lymphoma with paraproteinemia.

Five cases of primary intestinal lymphoma are described. The main clinical features included abdominal pain, diarrhea, and marked weight loss, together with radiologic and some laboratory findings suggestive of malabsorption. Laparatomy perfomed in four cases revealed dilatation of the small intestine, with mesenteric node enlargement. In these four instances there was a definite histologic evidence of malignant lymphoma, either initially or later in the course of the disease. A characteristic feature here was the diffuse infiltration of the intestinal mucosa with plasma cells, which in the deeper layers became progressively atypical and were mixed with histiocytes and giant cells. A similar infiltrate was seen in the mesenteric nodes. Immunoelectrophoresis showed the pattern of IgA heavy chain disease. It is suggested that the latter is a variant of primary intestinal lymphoma and not a separate disease entity.