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Background: Extensively drug resistant (XDR) organisms like Acinetobacter baumannii, pseudomonas aeruginosa XDR, Klebsiella pneumoniae XDR and Carbapenem-resistant Enterobacterales (CRE) leading to pneumonia and blood stream infections (BSI) are associated with high mortality rates and therapeutic modalities became restricted. Objective: Our clinical trial assessed whether combination therapy with Colistin and meropenem was superior to colistin alone for treatment of the extensively drug resistant Enterobacterals. Patients and methods: Our study was a randomized, prospective trial, we randomly selected the participants to receive Colistin loading dose of 5 mg/kg once followed by a maintenance dose of 1.67 mg/kg every 8 hours in Combination with either meropenem at a dose of 2 gm every 8 hours or Colistin alone, for treatment of pneumonia and/or Blood stream infection (BSI) caused by extensively resistant (XDR) Acientobacter baumannii, pseudomonas aeruginosa XDR, Klebsiella pneumoniae XDR and Carbapenem resistant Enterobacterals. Results: Two hundred participants were randomly assigned to treatment by either Colistin as monotherapy or by combination of Colistin and meropenem. Acinetobacter baumannii and Klebsiella pneumoniae were the predominant organisms in our study (67%) and (16%) respectively followed by carbapenem-resistant Enterobacterals (15%) and pneumonia the most common infection (80%). All patients were in the intensive care unit at the time of enrollment (100%). There was a statistical difference in mortality between both groups (79% in colistin group and in combination therapy group was 48%; p < 0.001), clinical improvement (vasopressor requirement, mechanical ventilation settings, inflammatory markers, leucocytic count and radiology) were all in favor of the Combination therapy of Colistin and meropenem. Conclusion: Colistin and meropenem Combination therapy was more beneficial than monotherapy only for the treatment of pneumonia and/or blood stream infection caused by the XDR Entrobacterals including mortality. [ABSTRACT FROM AUTHOR]

Introduction: Real‐time reverse‐transcriptase polymerase chain reaction (RT‐PCR) assays were established to detect severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2). However, due to the high rate of false negative results, additional tests as computed tomography (CT) scans of the chest and blood chemistry are required to properly diagnose COVID‐19 infection. Abnormal morphological changes of peripheral blood cells as granulocytic dysmorphism and abnormal reactive lymphocytes have been described in some cases. The aim of the present study was to investigate the morphological changes affecting all peripheral blood cells of COVID‐19 patients, in order to find any specific abnormalities that could help in the early diagnosis and/or prognosis. Methods: Peripheral blood smears of 113 COVID‐19 patients and 50 non‐COVID‐19 controls were examined for morphological changes in the period between October 2020 and January 2021 (second wave). We set a score value in which every morphological abnormality was given one point in each examined blood smear. Score, neurophil/lymphocyte (N/L) ratio, and blood chemistry were compared to the severity and outcome of the disease. Results: Significant morphological changes were found when compared to control blood smears. Various abnormalities as pyknotic cells, broken cells, pseudo Pelger‐Huët, abnormal lymphocytes, abnormal monocytes, and leukoerythroblastic reaction were found. Cases with higher scores had unfavorable outcomes (p =.005). High interleukin‐6 (IL‐6) levels were correlated to pyknotic cells (p =.003). Conclusion: The blood picture of COVID‐19 patients revealed various morphological changes that are not detected with the same frequency and variability in other viral infections. The prominent morphological changes can be predictive of an undesirable outcome of the disease. [ABSTRACT FROM AUTHOR]

Severe respiratory involvement that follows a process of immune dysregulation and intense cytokine production remains to be the most dreaded complication of Coronavirus Disease-2019 (COVID-19) infection. The aim of this study was to analyze T lymphocyte subsets and natural killer (NK) lymphocytes in moderate and severe cases of COVID-19 infection and assess their significance in disease severity and prognosis. Twenty moderate cases and 20 severe cases of COVID-19 were studied and compared regarding blood picture, biochemical markers, T lymphocyte population subsets, and NK lymphocytes, which were determined by flow cytometric analysis. On analyzing the flow cytometric data of T lymphocyte cells and their subsets and NK cells in two groups of COVID-19 infection (one group moderate and the other severe cases), some immature NK lymphocyte relative and absolute counts were higher in the severe patients with worse outcome and death, while some mature NK lymphocyte relative and absolute counts were depressed in both groups. Also, interleukin (IL)-6 was significantly higher in severe cases when compared to moderate cases, and there was a positive significant correlation between immature NK lymphocyte relative and absolute counts and IL-6. There was no statistically significant difference between T lymphocyte subsets (T helper and T cytotoxic) with disease severity or outcome. Some immature NK lymphocyte subsets contribute to the widespread inflammatory response that complicates severe cases of COVID-19; therapeutic approaches directed to enhancing NK maturation or drugs that block NK cell inhibitory receptors have a potential role in controlling COVID-19 induced cytokine storm. [ABSTRACT FROM AUTHOR]

Background: Malnutrition including undernutrition, overnutrition, and micronutrient deficiencies are considerable problems worldwide, with variable burdens among different communities. Its complications include physical and cognitive impairment, with the probability of irreversible lifelong consequences. We aimed to assess the prevalence of undernutrition, overweight, obesity, and anemia in preschoolers, being a risk group for developmental adverse events. Methods: We recruited 505 healthy preschool children, with a male: female ratio of 1.05:1. Children with chronic diseases were excluded. We used anthropometry and complete blood count to screen for malnutrition and anemia. Results: The mean age of the study group was 3.8 ± 1.4 years (1.02–7). The screening results were average in 228 (45.1%) children, while 277 (54.9%) children had either abnormal anthropometry, anemia, or both. We observed undernutrition in 48 (9.5%) children; among them, 33 (6.6%) were underweight, 33 (6.6%) wasted, and 15 (3%) were stunted, with no significant difference between children aged below or above five. We identified overnutrition in 125 (24.8%); 43 (8.5%) were overweight, 12 (2.4%) were obese, and 70 (13.9%) had a high body mass index Z score, not qualifying the definition of overweight. Anemia was diagnosed in 141 (27.9%) children and was significantly more frequent among older children without gender discrimination. About 10% (50 children) had both anemia and abnormal anthropometry. The frequency of abnormal anthropometry was comparable between children with anemia and those with normal hemoglobin. Conclusion: Malnutrition and anemia in preschoolers are still a heavy burden affecting about half of our study group, with an upward trend towards the overnutrition side. Anemia is still a moderate public health problem in preschoolers. [ABSTRACT FROM AUTHOR]

Introduction: Regulatory T cells (Treg) deficits, both quantitative and qualitative, are known to be possible triggers for the development of autoimmune disorders by causing T and B cells dysfunction. The contribution of Treg deficiency in the etiology of systemic lupus erythematosus (SLE) is still being debated. The aim of the present study is to evaluate the percentage of circulating CD4+CD25+Foxp3+ Treg cells in a cohort of Egyptian SLE patients and to correlate this value with the activity and damage index of these patients. Methods: 50 female patients with SLE together with an equal number of age- and sex-matched healthy controls were enrolled in the study. Flow cytometric determination of peripheral Treg cells was carried out for all participants by detecting the percentage of CD4+CD25+Foxp3+ cells to compare cases with the control group. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), while disease damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI). Both indices were correlated with the percentage of CD4+CD25+Foxp3 T regulatory cells. Results: CD4+CD25+Foxp3+ Treg cells percentage was significantly decreased in patients with SLE as compared to healthy controls. On correlating CD4+CD25+Foxp3+ Treg percentage with SLEDAI-2K, a significantly negative correlation was found. Also, there was a negative significant correlation between CD4+CD25+Foxp3+ Treg cells percentage and SLICC/ACR DI. On correlating SLEDAI-2K with damage index (SLICC/ACR DI), we found highly significant positive correlation. Conclusion: Our study showed impaired production of CD4+CD25+Foxp3+ Tregs in SLE patients, which can play a reciprocal role with some cytokines to affect the activity of the disease and organ damage. CD4+CD25+Foxp3+ Tregs cells should be the target to determine the clinical effectiveness of new therapy to modulate Tregs besides the traditional treatments. [ABSTRACT FROM AUTHOR]