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Carbapenem resistance is now a public health concern worldwide. Carbapenem is considered the last resort antimicrobial drug used for treatment of hospital care associated infection and community acquired infection that resistant to all other β-lactam drugs. There are a different mechanisms by which bacteria become resistant to carbapenem drug including efflux pump, porin mutation and production of carbapenemase enzyme that hydrolyze the drug. Carbapenemase enzymes were identified largely in different members of Enterobacteriaceae family which is a gram negative bacteria responsible for a variety of infectious diseases and this was associated with increased morbidity and mortality rate worldwide. Many Risk factors were found to be associated with increased susceptibility to develop carbapenem resiatance that should be searched for to prevent further spread of resistance.Various phenotypic and genotypic tests are used to detect carbapenemase production with different sensitivity and specificity. The current state of carbapenem resistance is well identified in many parts of the world while in other places such as sub-Saharan Africa, this is not well known.

Background Vitamin D has multiple effects on the innate and adaptive immune system. Vitamin D has immunomodulation effects that are able to decrease the inflammatory reaction included in the bronchial asthma; thus, it plays an important effect in the asthma pathogenesis. Low serum magnesium level is associated with impaired lung function and bronchial hyperreactivity. Study design This is a prospective hospital-based study. Objective To evaluate serum levels of vitamin D, magnesium, and calcium in patients with stable bronchial asthma and their relation to asthma severity. Patients and methods A total of 65 adult patients with stable bronchial asthma and 30 healthy controls were included in the study. After clinical history taking and examination, pulmonary function tests were performed. Serum levels of 25-hydroxy vitamin D [25(OH)D], ionized calcium, and magnesium were measured in all participants. Results The mean serum levels of 25(OH)D, magnesium, and ionized calcium were significantly lower in patients with stable asthma than control participants (P

Introduction: Neonatal sepsis is defined as a clinical syndrome in an infant 28 days of life or younger, manifested by systemic signs of infection and isolation of a bacterial pathogen from the bloodstream[EmanShehab El-Din et al, 2015]. Positive blood culture and sensitivity of the isolate is the best guide to antimicrobial therapy and once started should be modified according to the culture sensitivity reports[Aggarwalet al, 2001]. Aim of the work: To determine clinical and microbiological pattern of neonatal sepsis in Sohag university hospital with special focus on causative pathogens and their response to used antimicrobials. Patient and methods: Our study conducted over a period of 18 months between October 2015 and April 2017 at Sohag university hospital and included 75 neonates with suspected sepsis and positive blood culture using Egyptian neonatal network (EGNN) guidelines, subjected to full clinical examination, septic screen(CBC, ESR and CRP) and blood culture and sensitivity tests. Results: All studied neonates presented with late onset sepsis with higher incidence in infants born via CS especially with low and very low birth weight.The incidence of neonatal sepsis was predominantly due gram negative bacteria mainly Klepseillapneumonae followed by staphylococcus haemolyticusandstaphylococcus epidermidis. Klebseilla isolates showed high sensitivity for aminoglycosides and quinolones antibiotics with resistance to penicillin's group, Staphylococcus isolates showed resistance to penicillin's and aminoglycosides while sensitive to quinolones and nitrofurantions. E.coli and Pseudomonas species showed moderate sensitivity to 3rd generation cephalosporins, aminoglycosides, quinolones and nitrofurantoins with resistance to classic penicillin's. Conclusion: In our study gram negative bacteria mainly Klepseillapneumonae was the most causative agent of neonatal sepsis. Most isolated organisms showed resistance to classic penicillins.Klepseillapneumonaeshowed high sensitivity for aminoglycosides and quinolones, Staphylococcus isolates showed high sensitivity to quinolones and nitrofurantions while E.coli and Pseudomonas species showed moderate sensitivity to 3rd generation cephalosporins, aminoglycosides, quinolones and nitrofurantoins.

Resistance of Streptococcus pneumoniae to multiple antibacterial agents, including β-lactams, macrolides, tetracyclines, and co-trimoxazole, has emerged worldwide in the 1980s and 1990s and has emphasized the need for new therapeutic alternatives, such as newer fluoroquinolones. Older fluoroquinolones, such as ciprofloxacin and ofloxacin, have been widely used in the last 2 decades, but their activity against gram-positive pathogens is limited. Newer fluoroquinolones, such as levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin, have enhanced activity against most respiratory pathogens, and some are being more widely used to treat respiratory tract infections. Therefore, the emergence of fluoroquinolone-resistant S. pneumoniae strains, although worldwide prevalence is low, is a concern to clinicians who manage respiratory tract infections. Aim of the work: The aim of this study was to determine the prevalence of fluoroquinolone resistance Streptococcus pneumoniae (FQRSP) and to examine the genetic relatedness of pneumococcal isolates with parC and gyrB genes mutations in different specimens. Patients and Methods: In this study, Biometra Thermal Cyclar-T Gradient Software PCR system version 4 together with DNASIS 2.6 Sequence Analysis Programs were used to investigate the presence of mutations at quinolone resistance-determining regions of topoisomerase IV and DNA gyrase on 78 S. pneumoniae strains, Among 78 isolates 37 (47.4%) of S. pneumonia isolates were Fluroquinolones susceptible, 12 (15.4%) were with variable susceptibility and 29 (37.2%) were Fluroquinolones resistant. Results: Our study illustrate the role of mutation in the parC & gyrB genes and the effect of mutations in the both genes in fluoroquinolone resistance among S. pneumoniae isolates. Conclusion: Results indicated that there is a significant correlation between quinolone resistance development and mutations in the parC gene and in less significance in the gyrB genes .

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by progressively destructive joint inflammation and destruction of articular cartilage, bone and synovial hyperplasia. Cytokines play a fundamental role in the processes that cause inflammation, articular destruction and extra-articular manifestations associated with RA.The preferential production of interleukin22 (IL22) by T cells suggests that elevated levels of this cytokine exist in chronic, T cell-mediated diseases, such as psoriasis and RA and that IL-22 plays an important role in the pathogenesis of these disorders. Objective: To study the role of IL-22 in RA. Methods:IL-22 serum levelswere measuredin55 female patients with RA, 28 of them on medical treatment and the other 27 were newly diagnosed patients and in 18 healthy controls. Patients are assessed for clinical and laboratory variables. Correlations of IL-22 serum levels with disease activity markers as disease activity score for 28 joints (DAS28), serological markers, bone erosions were assessed. Results: IL-22 levels were increased in patients with RA compared with controls (mean 34.6 pg/ml and 3.2pg/ml, respectively; P < 0.001). Levels of IL-22 correlated positively with DAS28 score (P

Introduction: Streptococcus pneumoniae is a major Gram-positive pathogen responsible for pneumonia, bactermia, otitis media, and meningitis leading to considerable morbidity and mortality among children and elderly individuals. The primary goals of antibiotic treatment of respiratory tract infections are clinical efficacy of treatment, pathogen eradication, and prevention of resistance development. Resistance to fluoroquinolones in S. pneumoniae arises in a stepwise fashion and results from alterations in the target binding site due to the acquisition of spontaneous mutations in the quinolone resistance-determining regions (QRDRs) of the topoisomerase IV and DNA gyrase genes. Although mutations usually occur in the QRDRs of parC and gyrA, a role for mutations in the parE subunit in low-level resistance has been reported. Aim of the work: The aim of this study was to determine the prevalence of fluoroquinolone resistance Streptococcus pneumoniae (FQRSP) and to examine the genetic relatedness of pneumococcal isolates with parE and gyrA genes mutations in different specimens in Sohag University Hospital. Patients and Methods: This study was prospectively conducted over a period of 24 months between October 2015 and September 2017, at Sohag university hospital. During the study period, 78 patients hospitalized for a syndrome consistent with a diagnosis of community acquired pneumonia (CAP ) included in this study with a mean age of 34.5 years (range, 2 to 67), 60% of whom were males. A CAP syndrome was defined as a newly recognized pulmonary infiltrate together with 2 of the following findings: subjective fever or documented temperature 37.4 °C, increased cough, sputum production, or shortness of breath, pleuritic chest pain, confusion, rales, leukocytosis, (according to age) (1). Patients who had taken antibiotic treatment within 3 days prior to initial visit were excluded from this study. Results: Our study illustrate the role of mutation in the gyrA&parE genes and the effect of mutations in the both genes in fluoroquinolone resistance among S. pneumoniae isolates. Conclusion: The present study provide an opportunity to view the predominant mutations conferring reduced susceptibility to FQs in clinical pneumococcal isolates. There is a strong relationship between these mutations and decrese susceptibility to the most fameous FQs to some extent, although this varies between strains and for each drug.

Introduction: The commonest bacterial agent involved in causation of UTIs is Escherichia coli. The emergence of FQ resistant uropathogenic E. coli is of great concern. Aim of the work: to study resistance towards urinary E. coli with various generations of fluoroquinolones. Patients & Methods:: our study was carried out in the Clinical Pathology Department, Sohag University Hospital during the period from June 2016 to May 2017. Our study included 140 participants. Isolates from the specimens were obtained and identified using; Gram staining, colony characteristics on different culture medias. VITEC 2 Compact 15 identification kits were be used to confirm the identification of the isolates Results: E.coli was isolated from 100 patients (71%) of all patients complaining of UTI with positive urinary culture (study or case group). By studying prevalence of Antibiotic resistance of E.coli isolates reveals that fluoroquinolones show sensitivities of 42-46%. Also Nitrofurantoin has the highest sensitivity of 87%. This is followed by meropenem (67%). Ampicillin shows sensitivity in only 6% of cases. Regarding drug sensitivity in out & inpatients, we find that all generations of fluoroquinolones show highly significant resistance ratios among inpatients compared to outpatients. Meropenem show resistance more in inpatients than outpatients, with significant difference, Ampicillin and Nitrofuratoin show non-significant difference. Conclusion: our study show an increased fluoroquinolone resistance among uropathogenic E. coli isolates mainly in hospital admitted patients.

Chronic HCV with its longstanding complications of cirrhosis and HCC is a highly prevalent and challenging problem in Egypt. Recently, microRNAs are ranked as potential biomarkers for early diagnosis of HCV related complications. The aim of the present study was to evaluate the role of miRNA-122 and miRNA-155 for prediction of progression of HCV infection and for diagnosis of HCC. A total of 92 chronic HCV patients [chronic HCV (group 1, n =32); chronic HCV with cirrhosis (group 2, n=31); chronic HCV with HCC (group 3, n=29)] were enrolled into the study. Expression of serum miRNA-122 and miRNA-155 was assayed by real-time PCR in all participants. The serum level of miR-122 was significantly higher in chronic HCV patients than in healthy controls and both of cirrhotic and HCC patients (P0.001). Serum miR-155 was significantly elevated in HCC than in controls and non-HCC patients (P0.001). MiR-155 at the cut-off value of6.11 for HCC diagnosis, had sensitivity and specificity of 72.4% and 95.2%, respectively. In conclusion; microRNA-122 is a potential marker of progression of hepatocytes injury in patients infected with HCV but not a reliable marker for diagnosis of HCC. MicroRNA-155 is a relatively reliable marker for HCC detection.

Introduction Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening complication of cirrhosis. Several large studies have identified additional risk factors for the development of SBP. Zinc deficiency has been found to be frequent in cirrhotic patients. Aim of the work The aim of the present study was to evaluate the frequency, possible risk factors and the role of zinc in the development of first-time and recurrent SBP. Methodology A total of 176 cirrhotic ascetic patients admitted to the Hepatology Department in Sohag University Hospital were enroled in the study. SBP peritonitis was diagnosed through history-taking and through examination and laboratory investigations, including ascetic fluid study and the detection of serum zinc level. Results Of the 176 cirrhotic patients, SBP was diagnosed in 54 (31%); in total, 40 patients (23%) had single and 14 (8%) had recurrent episodes of SBP. Out of the 23 studied clinical and laboratory variables, we found that the prolonged use of proton pump inhibitor (PPI) (P = 0.001), lower prothrombin concentration (P = 0.03), ascetic protein level less than or equal to 1 g/dl (P < 0.0001) and zinc deficiency (P = 0.001) were independent risk factors for the development of SBP in cirrhotic patients; using multivariate analysis, only low protein in ascites less than or equal to 1 and low zinc status were predictors of SBP. Conclusion In our study, the frequency of SBP was 31%; overall, 23% of the patients had first-episode and 8% had recurrent SBP. The use of PPI, low platelet count, ascetic protein content and zinc deficiency were the predictors for the development of SBP; only low protein in ascites less than or equal to 1 and low zinc status were independent predictors of SBP.

Introduction: Hepatitis C virus (HCV) genotype 4 is the most prevalent in Egypt. Vis-ceral adiposity index (VAI) and (TyG) index are newly developed indices for assess-ment of metabolic syndrome (MS) and insulin resistance (IR). We aimed at comparing their levels in HCV-patients with healthy controls and validate their use for prediction of hepatic histopathological changes. Patient and Methods: 78 chronic HCV-infected patients proven by PCR, viral genotyping and hepatic histopathology, and 67 healthy controls were enrolled. Presence of MS, Homeostasis Model Assessment for IR esti-mation (HOMA-IR), TyG index, and VAI were assessed. Results: HOMA-IR, TyG and frequency of MS were significantly higher in patients’ group (p < 0.0001 for each) in comparison to controls. In HCV patients, increased fasting blood glucose (FBG) was the only strong predictor of severe hepatic necro-inflammation. High FBG, older age, female sex, high AST, TyG, VAI, serum lipids abnormalities and presence of MS were all associated with severe fibrosis on univariate regression analysis. Only high AST, TyG, VAI and LDL were independent predictors of severe fibrosis. A model using the 4 parameters showed a strong validity in predicting advanced hepatic fibrosis (AUC 0.801; CI: 0.705 - 0.897, p < 0001). Female sex, high BMI, VAI, LDL and TG values are all significantly associated with moderate/severe steatosis on univariate analysis. Among them, high BMI and LDL are the strong predictors (AUC 0.738; CI 0.625 - 0.851, p = 0.002). Conclusion: HCV genotype 4 is significantly associated with MS and increased values of HOMA IR and TyG index. TyG index and VAI are valuable simple indices that could predict the histopathological changes in Egyptian CHC pa-tients.

Approximately 60 - 85% of HCV infections cannot eradicate the virus and progress to chronic hepatitis, this may be explained by failure in host immune responses or by the ability of HCV to defeat host defense mechanisms. Mannose-binding lectin (MBL) may play an immunomodulatory role. This work intended to evaluate the relationship of MBL concentration to chronic HCV infection. Two groups, a patient group (n=50) with chronic hepatitis C, and a control group, (n=35) apparently healthy non-infected subjects were studied. MBL was measured by ELISA in both patients and controls. MBL was higher in chronic HCV patients (1159.86 ± 710.29) than in controls (329.7 ± 68.0) (p0.001). There was a negative correlation with the level of vireamia, and a positive correlation with the alpha-fetoprotein level. We conclude that MBL may play a role in modulating host immunity, persistence of HCV infection and the disease progression.

Tuberculosis is a major health problem worldwide. Genetic factors are considered important determinants of the host susceptibility to Mycobacterium tuberculosis. The aim of the current study was to evaluate the association between pentraxin 3 genetic variants and the susceptibility and severity of active pulmonary tuberculosis. The study included 100 patients with newly diagnosed pulmonary TB and 50 healthy controls. PTX3 plasma level was assayed using ELISA and PTX3 genotypes (rs2305619, rs3816527, rs1840680) were detected by real time PCR in all participants. PTX3 rs1840680 genotype (AA) and allele (A) were significantly higher in the study group while the genotype (GG) was higher in the control group. The plasma level of PTX3 was higher in the patients than controls (P0.0001). There is a strong association between PTX3 plasma level and the activity and severity of pulmonary TB. PTX3 rs1840680 genotype AA is associated with increased risk of active pulmonary TB.

Background In this study, we aimed to examine the association of adiponectin (ADIPOQ) rs2241766 (+45T/G) and rs266729 (−11377C/G) gene polymorphisms with serum ADIPOQ in non-alcoholic fatty liver disease (NAFLD). Methods ADIPOQ rs2241766 and rs266729gene polymorphisms were genotyped by using TaqMan 5′-nuclease assay and serum ADIPOQ level was measured in 100 NAFLD patients and 100 healthy controls. Results The study revealed an association of G- allele of ADIPOQ rs2241766 gene polymorphism with NAFLD; X2 (P-value); 3.95 (0.047). Moreover, G-allele of ADIPOQ rs266729 gene polymorphism increased significantly in the patients compared to controls, X2 (P-value): 3.9 (0.046). The study also revealed lower serum ADIPOQ levels in NAFLD patients compared to controls (P Conclusion G-alleles of rs2241766 (+45 T/G) and rs266729 (−11377C/G) gene polymorphisms of ADIPOQ gene were associated with NAFLD, but not with serum ADIPOQ levels.

SETTING: Little is known on the occurrence of pulmonary fungal diseases in patients with fungal rhino-sinusitis. OBJECTIVE: To investigate the presence of pulmonary fungal diseases in patients with FS. Patients and Methods: A prospective study was done for 44 patients who fulfilled inclusion criteria (sinus CT, microbiological and histopathologically). All patients were assessed for pulmonary symptoms, chest X- ray, CT scan, routine lab study, and Broncho-alveolar lavage. Detection of fungal hyphae, fungal culture, skin prick tests, total and specific IgE were done to all cases. RESULTS: The mean age of patients were 32.5±13.2 with 21 (48%) male and 23 (52%) female. Categorization of FS into allergic FS 24 (54.5%), fungus ball 16 (36.4%), acute fulminant FS 3 cases (6.8%) and chronic invasive sinusitis 1 (2.3%). Asthma was present in 11 cases 6 (25%) in AFS, 4 (25%) in fungal ball, and 1 (33%) in AFFS. Eleven cases (25%) had chest symptoms as cough and wheeze in all cases, malaise 7 cases (16%), dyspnea in 6 cases (14%), weight loss in 3 cases (7%) and expectoration of golden brown cast in 2 cases (5%). Six patients (14%) had radiological involvement. Three cases (6%) in allergic FS category only had the diagnostic criteria for SAM one case of them had ABPA plus AFS and pulmonary fungus ball. One patient was in acute stage I, second was in stage III corticosteroid dependant state, and third was in stage 1V of exacerbation with high total, specific IgE for aspergillus fumigates. CONCLUSION: Evaluation for pulmonary fungal infection especially in patients with fungal rhino sinusitis is highly recommended. There is an urgent need to treat it early to decrease morbidity and mortality of the diseases.

Background: Tuberculosis (TB) in elderly is a worldwide problem. Objective: To evaluate differences in clinical, radiological, laboratory features, adverse antituberculosis drug reactions and TB-related mortality in elderly and young pulmonary TB patients. Results: The study included analysis of the medical history, chest radiographic and laboratory findings in 124 elderly and 124 young pulmonary TB patients, with mean age of 60.5 ± 9.1 and 31.6 ± 10.8 years, respectively (p

Background and Aim: Interleukin-28B (IL-28B) polymorphism is a predictor of sustained virologic response (SVR), spontaneous clearance and personalizing therapy of hepatitis C virus (HCV). This study aimed to determine IL28B rs12979860 polymorphism among chronic hepatitis C (CHC) Egyptian patients as a step in personalized HCV therapy and pharmacogenomics. Methods: CHC Egyptian patients were received sofosbuvir (SOF) plus pegylated interferon (PEG-IFN) and ribavirin (RBV) for 12 weeks. A total of 82 HCV infected Egyptian patients and 27 healthy individuals were included in the present study. CHC Patients were classified as achieving SVR if plasma HCV-RNA was undetectable (group A) and non-responders if plasma HCV-RNA was detectable (group B). IL28B genotypes were analyzed and their associations with SVR were selected. Results: The end of treatment response (ETR) rate was 100%. However, SVR12 was 76.8% (group A) and 23.2% relapsed (group B). Among studied CHC patients, 50% were IL-28B TT, 40.2% CT, and 9.8% CC. while the percentage of their frequencies in the healthy persons were 18.5%, 51.8%, and 29.6%, respectively. These results showed that the frequencies of TT genotypes were more prevalent in HCV patients. The genotype CC (n=8) achieved higher rates of SVR in group A (87.5%) than relapsed patients in group B (12.5%) and it had the least prevalence in group B compared with the frequencies of CT (21.2%) and TT (26.9%) genotypes. These results showed that CC genotype was associated with SVR. Conclusions: It can be concluded that the individuals with IL28B TT genotype are more susceptible to HCV infection in Egyptian patients and relapse. Moreover, IL-28B CC is useful for pretreatment prediction of the outcome of HCV treatment. Hence, IL28B polymorphism could be considered as a pharmacogenetic predictor in personalized HCV therapy and pharmacogenomics during SOF plus PEG-IFN and RBV therapy for chronic hepatitis C Egyptian patients.

Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with advance liver cirrhosis and is associated with significant mortality. Multidrug resistance is an evolving problem in management of SBP. Therefore, early diagnosis and proper selection of antimicrobial therapy are warranted. Objective: Assessment of the accuracy of conventional culture compared to blood culture in diagnosis of SBP and evaluation the role of blood culture in selection of antimicrobial therapy for treatment of SBP. Methods: One hundred unselected consecutive cirrhotic patients with moderate or severe ascitis who were admitted to Internal Medicine Department during the period from October 2016 to April 2017 were included. Diagnostic aspiration of the ascetic fluid was made for each patient. The aspirated samples underwent chemical and cytological analysis as well as inoculation on conventional culture and on blood culture. Positive growths were tested for antibiotic sensitivity. Results: 47 patients (47%) among the 100 cirrhotic patients had spontaneous bacterial peritonitis. Positive growths were detected in 11 patients (23.4%) and in 32(68.1%) patients by using conventional culture and blood culture respectively. By using blood culture as gold stander, the sensitivity, specificity, positive predictive value and negative predictive value of conventional culture were 34.38%, 100%, 100% and 41.67% respectively. All isolated growths were sensitive to meropenem. Resistance to cefotaxime was detected in 20 cases (62.5%). Other tested drugs showed variable degrees of sensitivity. Conclusion: Conventional culture is of low sensitivity in diagnosis of SBP among cirrhotic patients and blood culture should be considered the gold standard for diagnosis of SBP. Multidrug resistance in SBP is common and antibiotic selection should be based on culture and sensitivity tests.