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Rehab H El-Sokkary,1 Raghdaa A Ramadan,1 Mohamed El-Shabrawy,2 Lobna A El-Korashi,1 Abeer Elhawary,2 Sameh Embarak,2 Rehab M Elsaid Tash,1 Neveen G Elantouny3 1Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 2Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 3Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt Background: Effective empirical antibiotic therapy for community acquired pneumonia (CAP), based on frequently updated data about the pattern of bacterial distribution and their antimicrobial susceptibilities, is mandatory. Aim: To identify the bacterial etiology of CAP in adults and their antibiotic susceptibility patterns and to evaluate the response to initial empirical antibiotic therapy in an Egyptian university hospital. Settings and design: A cross-sectional hospital-based study. Patients and methods: CAP cases were selected by systemic random sampling from those admitted to the chest department. All were evaluated at admission and 4 days after starting empiric therapy. Typical bacteria were isolated, identified and tested for their antibiotic susceptibility. An indirect IF assay was used to diagnose atypical bacteria. Clinical response to initial empiric antibiotic therapy was clinically, laboratory and radiologically evaluated. Results: Two hundred and seventy CAP patients were included. Bacteria represented 50.4% of them. Klebsiella pneumoniae was the most prevalent bacterium (10.37%) followed by Streptococcus pneumoniae and P. aeruginosa (7.78% each). Overall, 76.2% of isolates showed a multidrug resistant phenotype: 82.61% (19/23) S. pneumoniae, 89.66 % (26/29) K. pneumoniae, 65.22% (15/23) Pseudomonas aeruginosa, 87.50% (7/8) Escherichia coli and 81.25 % (13/16) Staphylococcus aureus. Broad spectrum β-lactams, especially carbapenems, and moxifloxacin showed in vitro efficacy on most of the tested isolates. Forty-three cases (15.9%) were nonresponders, 37 (86%) of them showed bacterial etiology. The highest rate of nonresponsiveness (30.43%) was observed in cases receiving antipseudomonal/antipneumococcal β-lactam plus a fluoroquinolone for suspected P. aeruginosa infection. Conclusion: Multidrug resistance in bacteria causing CAP and high frequency of isolation of hospital pathogens are prominent features of this study. Azithromycin containing regimens were associated with the lowest rates of nonresponsiveness. Development and implementation of an antibiotic stewardship program are highly recommended for CAP management. Keywords: pneumonia, atypical bacteria, respiratory infection, community, antibiotic stewardship, empirical therapy, infection control

Previous studies have shown that environmental exposure to heavy metals has been related to epigenetic changes, such as DNA methylation in receptors involved in pathogenesis of asthma. One of these receptors is beta-2 adrenergic receptor (ADRB2). We conducted this study to examine the association between blood aluminum concentration, blood ADRB2 5′ untranslated region (5′-UTR) methylation level, and childhood asthma control level. Our results showed a significant positive association between high blood aluminum concentration (odds ratio, 16, 95% confidence interval (CI) [3.57 to 71.76], p < 0.001) and high blood ADRB2 5′-UTR methylation level (odds ratio, 4.75, 95% CI [1.39 to 16.2], p = 0.013), and risk of uncontrolled asthma. Multivariable logistic regression revealed that higher blood aluminum concentration was independently associated with increased risk of uncontrolled bronchial asthma (odds ratio, 9.10, 95% CI [2.38 to 34.85], p = 0.0013], after controlling for age, sex, and blood ADRB2 5′-UTR methylation level. In addition, blood ADRB2 5′-UTR methylation level significantly correlated with whole blood aluminum concentration in asthmatic children (r = 0.480, p < 0.001). We concluded that increasing blood aluminum concentration is an important independent correlate of risk for uncontrolled bronchial asthma as well as increased blood aluminum concentration caused ADRB2 5′-UTR hyper-methylation with increasing risk of uncontrolled bronchial asthma. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is one of the most prevalent chronic inflammatory dermatological disorders in childhood. Assessment of AD severity is the initial step in designing the proper therapeutic plan. Moreover, it is imperative for evaluation of disease improvement during and following therapy. This study was designed to assess the prognostic role of miRNA-155 (miR-155) in the prediction of AD severity as the primary outcome. While the secondary outcome was to correlate the serum miR-155 expression levels with the scoring atopic dermatitis (SCORAD) severity index. This case-control study included 24 children with AD and 24 apparently healthy children as a control group. AD children were stratified according to the SCORAD severity index. Approximately 58% of children had mild AD, 25% moderate AD, and about 17% severe AD. Children with AD had statistically significantly higher miR-155 expression levels in comparison to the control children, (p < 0.001). Children with severe AD had statistically significantly higher miR-155 expression levels compared to mild AD children (p=0.001). The receiver operating characteristic curve analysis for miR-155 demonstrated that miR-155 can differentiate between children with mild AD and those with moderate-to-severe AD, with an area under the curve of 0.879, and an excellent discrimination power. A statistically strong significant positive correlation existed between miR-155 levels and SCORAD severity index (rs= 0.666, p < 0.001). In conclusion, MiR-155 could be considered as a non-invasive biomarker of AD severity in children. It is a promising prognostic tool in the prediction of AD severity., (Copyright© by the Egyptian Association of Immunologists.)

Coronavirus disease 2019 (COVID-19) is a multisystem disease affecting respiratory, cardiovascular, gastrointestinal, neurological, immunological and haematological systems. The most important indices that have been studied are platelet (PLT) indices in addition to the PLT count and red blood cell distribution width (RDW). This retrospective study included 95 patients with COVID-19 and was conducted at the Hospital Isolation, Scientific and Medical Research Centre and Clinical Pathology Department at Zagazig University Hospitals, Egypt over 6 months from March to August 2021. All patients on admission had a full blood count, which included white blood cell (WBC) count, haemoglobin, RDW, PLT count and its indices in addition to PLT-to-WBC ratio (PWR) and PLT-to-lymphocyte ratio (PLR), which were calculated for all the study patients. There were significant linear correlations for higher levels of the PLR, PWR and RDW and mortality rate (p = 0.03, p < 0.001 and p < 0.001 respectively). Moreover, on multivariable analysis the RDW, PLT count and PWR levels were independent prognostic predictors for mortality with a hazard ratio [HR] of 1.25 (95% confidence interval [CI] 1.09-1.44, p = 0.002), 1.00 (95% CI 0.99-1.00, p = 0.03) and 2.3 (95% CI 1.21-4.48, p = 0.01) respectively. The RDW and PLT indices are accessible predictors that can be valuable prognostic factors for survival assessment and risk stratification of COVID-19., (© 2022 British Society for Haematology and John Wiley & Sons Ltd.)

Background: Healthcare workers (HCWs) are at a high risk for disease exposure. Given the limited availability of nucleic acid testing by PCR in low resource settings, serological assays can provide useful data on the proportion of HCWs who have recently or previously been infected. Therefore, in this study, we conducted an immunologic study to determine the seroprevalence of anti-SARS-CoV-2 antibodies in two university hospitals in Egypt., Methods: in this cross sectional study, HCWs who were working in SARS-CoV-2 Isolation Hospitals were interviewed. Estimating specific antibodies (IgM and IgG) against SARS-CoV-2 was carried out using an enzyme-linked immunosorbent assay targeting the Spike antigen of SARS-CoV-2 virus., Results: Out of 111, 82 (74%) HCWs accepted to participate with a mean age of 31.5 ± 8.5 years. Anti-SARS-COV2 antibodies were detected in 38/82 (46.3%) of cases with a mean age of 31 years and female HCWs constituted 57.6% of cases. The highest rate of seropositivity was from the nurses (60.5%), and physicians (31.6%) with only (7.9%) technicians. Only 28/82 (34.1%) HCWs reported previous history of COVID19. We reported a statistically significant difference in the timing of exposure (p = 0.010) and the frequency of contact with COVID-19 cases (p = 0.040) between previously infected and on-infected HCWs. Longer time of recovery was reported from IgG positive HCWs (p = 0.036)., Conclusion: The high frequency of seropositive HCWs in investigated hospitals is alarming, especially among asymptomatic personnel. Confirmation of diseased HCWs (among seropositive ones) are warranted., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Although cumulative data strongly suggest an association between dyslipidemia and allergic disorders, especially asthma, evidence regarding allergic rhinitis (AR) is lacking. We aimed to assess frequency and associated risk factors of dyslipidemia among patients with AR., Methods: The current study is a cross-sectional study that recruited 150 AR patients by systematic randomization. Blood samples for serum lipid profile, total immunoglobulin E (IgE) and serum interleukin-17A (IL-17A) were withdrawn from all patients., Results: Dyslipidemia was prevalent in 84 AR patients (56%). Higher levels of total IgE, IL17-A, and sensitization to hay dust and mixed mites significantly increased the risk of dyslipidemia among AR patients by 1.004, 1.062, 4.057 and 3.652 respectively ( P  < 0.05)., Conclusion: High serum total IgE level, high serum IL-17A level, and sensitization to hay dust and mixed mites are independent risk factors for dyslipidemia among AR patients., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 The Author(s).)

Chronic spontaneous urticaria (CSU) is a popular disease, affects patients' life. Its etiologic agents are not well known so; treatment of the patients is difficult. CD203c is a marker that is only present on basophils. Statins are drugs used to lower cholesterol. Nowadays, it is well known that they have immunomodulatory effects. This study evaluated the efficacy of a statin, atorvastatin, in combination with antihistamines in treating CSU patients. Forty CSU patients were divided equally into two groups. The first group was treated with antihistamines and atorvastatin, while the second group was treated with antihistamines and placebo. Both groups received the treatment for three months. The effect of treatment on total severity score (TSS), autologous serum skin test (ASST), basophil histamine release (BHR) assay, in vivo basophil CD203c expression (%) and basophil activation test (BAT-CD203c) was assessed. We found statistically significant reduction in TSS, BHR assay, in vivo basophil CD203c expression (%) (P= 0.000 each), diameter of ASST and BAT-CD203c (P= 0.002, 0.017, respectively), in the patients that received the atorvastatin and antihistamines. In conclusion, atorvastatin is effective in treating CSU patients., (Copyright© by the Egyptian Association of Immunologists.)

H. pylori infection causes peptic ulcer, chronic gastritis, mucosa-associated lymphoid tissue lymphoma, and gastric carcinoma. It has several virulence factors such as cytotoxin-associated gene A( cagA ) and the induced by contact with epithelium antigen ( iceA ). We aimed to explore the relationship between cagA and iceA of H. pylori and gastrointestinal diseases. One hundred and eighteen patients who attended Gastrointestinal Endoscopy Unit at Zagazig University Hospitals, Egypt, were included in this study. Two gastric biopsies were collected and evaluated by rapid urease test (RUT) and PCR. cagA and iceA genes were amplified by PCR. We found that 54 patients (45.76%) were positive by both RUT and PCR. cagA and iceA genes were present in 57.4% and 46.29% of the studied patients, respectively. cagA was the most prevalent gene in gastritis (33.3%) and peptic ulcer (68.7%). iceA1/iceA2 positive genes were the most prevalent in gastric cancer (75%). iceA1 gene was present in 38.7% of cagA positive cases, but iceA2 gene was present in 45.2% of cagA positive cases. iceA1/iceA2 positive genes were present in 29% of cagA positive cases. In conclusion, cagA and iceA genes could be used as markers for severe gastrointestinal diseases. iceA gene was strongly related to cagA gene.