Multi-drug resistant uropathogenic isolates of proteus at Assiut university hospitals

Background: proteus bacilli are more commonly associated with UTIs in those individuals with structural or functional abnormalities, especially ascending infections in patients undergoing urinary catheterization

Aim of the study: to estimate the frequency of proteus infection in patients with I urinary tract infections, detection of sensitivity profile to antibiotics and detection of ESBL

Material and methods: one hundred and fifty five patients with symptoms of urinary tract infection were recruited and urine sample from each patient was collected as well as demographic data and associated I risk factors were recorded. Urine culture, antimicrobial susceptibility test, screening and confirmatory tests for detection of ESBL were done

Results and conclusion: the mean age +/- SD was 45 +/- 17 years, 139 were males and 16 were females. Sixty eight patients were catheterized and 87 patients were non-catheterized. E coli was the highest bacterial organism [35%] detected by urine culture among catheterized patients, while Kpneumoniae was the highest among non-catheterized patients. There was a significantly higher percent of proteus among non-catheterized patients than catheterized patients. Proteus alone or proteus with other bacterial infection was detected in 14.8% in catheterized versus 6.1% in non-catheterized patients. Only 13 cases out of 155 cases [8.4%] had positive culture for proteus organism. All are males and most of them were catheterized and had benign enlarged prostate [8 cases; 61%]. Out of 13 Proteus isolates, nine Proteus isolates showed reduced susceptibility to the Ceftazidime, Cefotaxime, Ceftriaxone, and Cefuroxime and gave the same zone diameter range as adapted by CLSI [2014] document M100 S24 and nine considered potential ESBL producers

Prevalence of hospital-acquired enterococci infections in the intensive care units of Assiut University Hospitals

Enterococci is an emerging multidrug-resistant global opportunistic pathogen and is acquiring increasing importance as a nosocomial pathogen. This study aimed to determine the prevalence of nosocomial enterococci infections in the intensive care units of Assiut University Hospitals. This study included 285 patients who developed hospital acquired infections. They were admitted to different intensive care units [ICU] from March 2013 to March 2014. Appropriate clinical samples were collected from the patients after consent and were cultured for isolation and biochemical identification. A total of 30 strains of enterococci were isolated from 285 patients [10.5%]. The commonest clinical manifestation were lower respiratory tract infections [86.6%], wound infections [6. 7%] and urinary tract infections [6. 7%]. The chest ICU showed the highest percentage of isolation [66. 7%]. We conclude that nosocomial enterococci infections are significant in Assiut University Hospitals. High prevalence of enterococci in the lower respiratory tract infections

Nosocomial acinetobacter infection in Assiut University Hospital

This study aimed to isolation of Acinetobacter spp, detect resistance patterns of isolated strains, phenotypic and genotypic detection of Metallo-beta-lactamase and typing of isolated strains from clinical and environmental respectively. this study includes 440 different clinical specimens, 672 environmental samples, inoculated on different culture media, confirmation of isolates by API20NE, PCR to detect 16SrRNA-23SrRNA gene, determine susceptibility pattern of isolates to different antibiotics and phenotypic and Genotypic detection of bla -OXA 51-like gene. 24 strains of Acinetobacter [5.45%] were isolated from 440 clinical samples, 27 strains of Acinetobacter were isolated from 672 environmental samples [4.017%]. Tetracycline was the most active drug against multi-drug resistant A.baumannii. [48/51 or 94%] of Acinetobacter isolates showed increase in zone of inhibition around IPM/EDTA disc compared with IPM disc alone. [49/51 or 96%] of Acinetobacter isolates were detected by presence of 16srRNA - 23 srRNA gene [universal gene present in all Acinetobacter species]. [49/51 or 96%] of isolated Acinetobacter spp showed band with blaOXA-51-like" genes. [37/51 or 72.5%] Acinetobacter isolates showed positive bands for class I integrase gene [gene responsible for multi drug resistance and outbreaks in hospitals]

Mitochondrial cytochrome C and ultrastructural changes in hepatic steatosis induced by hepatitis C virus

Hepatic steatosis is an important hallmark of hepatitis C virus [HCV] infection. There is substantial body of evidence to implicate steatosis in the development of hepatic fibrosis. The underlying mechanisms of HCV-related steatosis however are not yet clarified. This study was performed to evaluate ultrastructural mitochondrial changes in patients with HCV-induced hepatic steatosis and correlate these findings with serum cytochrome c and apolipoproteins. Thirty-seven HCV-positive patients admitted to Theodore-Bilharz Research Institute were selected. They did not have other confounding prosteatogenic variables: diabetes, overweight, alcohol consumption and prosteatogenic drugs as amiodarone; corticosteroids. In addition, 10 apparently age- matched subjects were selected as a reference group. All subjects were initially subjected to full history, thorough clinical examination, liver function tests; lipid profile, HCV-IgG antibody and hepatitis-B surface antigen. All patients were subjected to ultrasound-guided liver biopsy. Biopsy specimen was processed for light and electron microscopic histopathological examination. According to histopathological findings, patients were divided into 4 groups according to the stage of fibrosis[I, II, III and IV]into :-Group 1 [n=7]; Group 2 [n=9]; Group:3 [n=9] and Group 4 [n=12]or cirrhotic group respectively. Measurement of apolipoproteins A, B and II and specific estimation of serum cytochrome-C was performed. Interpretation of the results revealed accumulated fat droplets by ultrastructure identification in the hepatocytes together with hypobetalipoproteinemia and hypotriglyceridemia. This was accompanied with mitochondrial ultrastructural alterations in all the studied groups ranging from complete dissolution to loss of outer mitochondria] membrane. In addition, it is noteworthy that ultrastructural changes of the rough endoplasmic reticulum [RER] detected in this study may be a contributing factor to abnormal fat metabolism in HCV. Concomittantly, serum cytochrome c was significantly lowered in all the studied groups as compared to the reference mean value. Depletion of mitochondria] cytochrme c might result in accumulation of reactive oxygen species and further accentuation of steatosis. There was significant correlation between serum cytochrome c, apolipoprotein B and serum triglycerides in the patients' group, ushering that it might have its role in HCV-induced lipid changes. In the cirrhotic group, ultrastructural elucidation of homogenous unlocalized intracytoplasmic fat and evident intracytoplasmic collagen fibrils was reported in this study. This was associated with significantly lowered serum ApoAl, ApoB and triglycerides as compared to all other groups. The afore-mentioned data solidifies the evidence that hepatic steatosis and fibrosis are important sequence of HCV infection and confirm the ability of hepatocyte to synthesize collagen. Moreover, the discerned intracytoplasmic unsaturated fat droplets might mirror the inability of the HCV-dysfunctioning hepatocyte to cope with the excessive dietary intake of fat and hence accentuation of steatosis results. In conclusion, ultrastructural. mitochondrial and RER changes seems to confirm their relation- to the associated intracytoplasmic fatty acids accumulation, the decreased serum cytochrome c and apolipoproteins Al and B Moreover it confirms the cytopathic effect of HCV

Effect of denervation on rat soleus muscle: light morphometric and electron microscopic study

This study described the light, morphometric and ultrastructure of denervated rat soleus muscle, with a particular emphasis on understanding the ultrastructural changes and cellular basis for the reduced restorative capacity of denervated muscle. The right hind limbs of adult male Wister rats were denervated for periods of one, two, three and four weeks and the samples were processed for light and electron microscopy. Atrophy of muscle fibers was prominent from the first week. At further periods of denervation, atrophy of all muscle fibers was seen most clear with morphometry. As denervation progressed, the morphology of individual muscle fibers varied. Most of muscle fibers contained well-organized myofilaments; whereas in others, local areas of sarcomeric disorganization were evident. Mitochondria became smaller and rounded, the elements of the sarcoplasmic reticulum proliferated and became more disorganized, the autophagic vesicles were well present in the cytoplasm of atrophic muscle fibers. The satellite cells did not show signs of activation at four weeks after denervation

use of cervical insulin-like growth factor-binding protein-1 assay for prediction of preterm labor in high risk women

The objective of this study was to determine the value of cervical insulin-like growth factor- binding protein-1 assay for the prediction of preterm labor in high-risk women. Thirty pregnant women at high risk for preterm labor were studied by serial cervical insulin-like growth factor - binding protein -1 assay between 26-36 weeks of gestation. The presence of cervical insulin-like growth factor-binding protein -1 in cervical secretions was compared to preterm labor. The preterm delivery rate was 40%. Cervical insulin-like growth factor- binding protein-1 was positive in 10/12 of women delivering preterm and in 7/18 of women delivering at term. As a prediction for preterm birth before 37 weeks, the presence of cervical insulin-like growth factor-binding protein- 1 showed a sensitivity of 83.3%, a specificity of 61.1%, a positive predictive value of 58.8% and a negative predictive value of 84.6%

Expression of intercellular adhesion molecule ICAM-1 and cytokeratin as Potential markcrs of disease activity in the Egyptian pattern of chronic hepatitis C

Chronic hepatitis C [ch.HCV] and schistosomal hepatic fibrosis or both as a mixed hepatic lesion [MHL] are among the most common causes of endemic chronic hepatic disease in Egypt. Adhesion molecules especially ICAM-1 play an important role in inflammatory and immunological responses of chronic liver disease. Cytokeratin 18 [CK-18], although normally expressed in hepatic tissue, yet it is altered during chronic inflammatory hepatic lesions. This work was planned to study ICAM-1 as expressed in hepatic tissue in the different grades of the disease activity, in relation to its circulating levels in patients sera, and to evaluate the level of CK-18 expression in relation to the different grades of chronic inflammation and stages of fibrosis in the examined liver biopsies. The material for this study comprised 33 patients [17 ch.HCV and 16 MHL]. Seven cases, that proved to have nearly normal serological data and insignificant histopathological hepatic features, were considered as controls. All patients were assessed for HCV serological markers as well as serum levels of soluble ICAM-1 [sICAM-1] by the Enzyme Linked Immunosorbent. Assay [ELISA]. Liver needle biopsy specimens were processed and assessed for the histopathological grade of the disease activity and stage of fibrosis of the hepatic lesion. Tissue expression of ICAM-1 and CK-18 was detected using immunohistochemical techniques. Our results revealed significantly higher levels of serum sICAM-1 in both ch.HCV and MHL groups compared to controls [p<0.01]. Meanwhile, higher levels of sICAM-1 were recorded in the MHL cases relative to ch.HCV cases. ICAM-1 expression was not detected in any of the control cases, while it was positively expressed in all ch. HCV and MHL cases, with a higher score recorded in the later group [P>0.001 compared to the control group]. ICAM-1 expression was detected mainly within the sinusoidal cells [endothelial and Kupffer cells], hepatocytes, mononuclear inflammatory cells and vascular endothehail cells in portal areas. On classifying patients according to their grades of active inflammation and stages of fibrosis, higher scores of ICAM-1 expression within the hepatic tissue were recorded in cases with more active inflammatory grades and higher fibrotic stages. On the other hand, serum of ICAM-1 levels though were significantly elevated in patients with higher grades of inflammatory activity yet, they were decreased in patients with higher fibrotic stages. CK18 expression was mainly detected within hepatocytes of the periportal areas [in a combined membranous and intracytoplasmic pattern], as well as within the bile ducts epithelium in the portal areas. Over expression of CKI 8 was detected in both the ch.HCV and MHL groups [p<0.001 relative to controls], but the expression scores were higher in the MHL group. From these results we may conclude that MHL is a more aggressive and active chronic inflammatory hepatic disease than ch.HCV alone. Also, serum levels of sICAM-1 as well as hepatic expression of both ICAM-1 and CK-18 are related to the degree of disease activity, which may point out to the possibility of using serum sICAM-1 levels as well as the expression scores of hepalic ICAM-1 and CK-18 as efficient tools for monitoring the disease activity in ch. HCV and MHL patients. While ICAM-1 expression in tissue could be used as indicator for the stage of fibrosis in those patients also recommend that both ICAM-1 in serum andhepatic tissue could be used for monitoring the effect of therapy on the studied pattern of chronic hepatitis C

Morphology of the apical surface of endometrium on 1st, 6th and 22nd days of pregnancy in rats [Transmission and scanning electron microscopic study]

Morphology of the apical surface of the luminal epithelial cells of the endometrium of the rats on the 1st, 6th and 22nd days of pregnancy was examined by transmission and scanning electron microscopes. Twenty adult female and five adult male rats were used in this study. The animals were subsequently euthanized on either the 1st, 6th and 22nd days of pregnancy [term=23 days]. Using transmission electron microscope, the microvilli covering the apical surface of the luminal epithelial cells were long and irregularly spaced on the 1st day of pregnancy. They became shorter in length, numerous fewer in number and showed pinopods on the 6th day of pregnancy. Finally, they became numerous, long and slender on the 22nd day of pregnancy. Using the scanning electron microscope, it was observed that the uterine luminal epithelium was covered with long and slender microvilli on the 1st day of pregnancy. As pregnancy advanced, they became shorter and sparsely distributed with the presence of membranous protrusions on the 6th day of pregnancy. Late in pregnancy, on the 22nd day, the microvilli became longer and more numerous but no membranous protrusions could be observed

After scherotherapy bacteraemia and bacterial peritonitis

This study included 120 patients with liver cirrhosis divided into 3 groups: Group I [46 patients], who were subjected to repeated esophageal sclerotherapy, group II [20 patients], who received antibiotics before, during and after sclerotherapy, and group III [54 patients], who were not subjected to sclerotherapy. Patients, who received prophylactic chemotherapy during sclerotherapy developed neither fever nor peritonitis, while some of those, who did not receive chemotherapy, developed fever [10 patients, 21.7%] with positive ascitic fluid [6 patients, 13%] and bacteremia [4 patients, 9.1%]. This rate was much less in patients with liver cirrhosis, who were not subjected to sclerotherapy [3 patients, 5.6%]. Therefore, it may be concluded that prophylactic chemotherapy may be recommended before sclerotherapy to minimize the risk of developing bacteremia or peritonitis

Evaluation of four serological tests for the detection of brucella antibodies in man and animals

Blood samples were collected from 197 different animal species, as well as 101 human contacts. Detection of brucella antibodies was carried out by RBT, SAT, MET and CFT. The study revealed that the S.A.T. could act as an efficient and reliable diagnostic test for brucellosis in Egypt, from the economic point of view

Combined reconstruction of the anterior cruciate ligament using semitendinosos tendon and leeds-keio ligament prosthesis

Thirty four patients had a combined reconstruction of the anterior cruciate ligament with use of semitendinosus tendon and Leeds-Keio Ligament Prosthesis. The tendon was augmented by Leeds-Keio Ligament Prosthesis aiming at a stronger and a more durable reconstruction. Results were assessed via two methods; score of the American Medical Association System for stability and Lysholm Scoring System for functional assessment. Results were encouraging as eighteen patients [52.9%] had a rating of excellent; twelve [35.3%] were good; two [5.9%] were fair and two [5.9%] were poor. Our findings confirm the efficacy of combined reconstruction of the anterior cruciate ligament for chronic injuries