Screening for M[beta]L production of multidrug-resistant Pseudomonas aerugjnosa strains isolated from different clinical samples at Assiut University Hospitals

P.aeruginosa is an important cause of morbidity and mortality in immune-compromised patients. There is no single drug active against 100% of P. aeruginosa clinical isolates. Carbapenems are [beta]lactam antibiotics, presently considered as the most potent agents for treatment of MDR P. aeruginosa. During this study 90 pseudomonas strains were isolated from different sources 52 [57.78%] urine specimens 28 [31.11%] blood specimens and I 0 [11.11%] sputum specimens. All strains were subjected to microscopic examination, culture on selective medium and were tested biochemically for Catalase activity, Oxidase test, Citrate utilization test, and Gelatin liquefaction test. Antimicrobial susceptibility testing was performed using the disc diffusion method [modified Kirby-Bauer] on MH agar. MDR P. aeruginosa strains were stereotyped by standard slide agglutination test as recommended by the manufacturer's instructions. Screening for M[beta]L production of MD R P. aeruginosa was detected by Combined-disc synergy and E-test. Prevalence of both bla [IMP-1] 1 and bla [VIM-1] gene among M[beta]L producing P. aeruginosa isolates were detected by PCR. Ninety pseudomonas strains were subjected to antimicrobial susceptibility profile toward different antibiotic classes. Most P. aeruginosa isolates were sensitive in a descending order to Carbapenem; Imipenem [75.55%] and Meropenem [73.33%]> 4[th] generations Cephalosporins; Cefepime [66.6%] > Flouroquinolones; Levofloxacin [66.6%] and Ciprofloxacin [60%] >3[rd] generations Cephalosporins; Cefatriaxone [51.1%] and ceftazidime [44.44%]>Aminoglycosides; Tobramycin [37.77%] and Amikacin [24.44%]. Out of 90 isolated strains 47 [52.22%] were MDRS. MDR P. aeruginosa isolates [47 strains] were stereotyped as follow: serotype O:11 [12 [25.53%]], followed by serotype 0:5 [7[14.9%]], both O:9 and O:1 [6[12.7%]], both O:2 and O3 [4[8.51%]], O:6 [2[4.25%]] and both O:4 and O:7 [1[2.13%]], and four strains [8.52%] were cross-reacted with both serotypes O: 5 and O: 11 antibodies. Screening for M[beta]Ls production by Both Combined-disc IMP-EDT A and E test methods were positive in 19 and 20 isolates respectively, while prevalence of both bla [IMP-1] and bla[VIM1] gene among M[beta]L producing P. aeruginosa isolates were 17 [77.27%] and 14 [63.63%] positive to bla[IMP-1] and bla[VIM-1] gene respectively. In conclusion, Combined disk test [IMP-EDTA] and M[beta]L E test, were found to be very sensitive for detection of M[beta]L in P. aeruginosa isolates. Phenotypic methods for screening of M[beta]L production in P. aeruginosa strains correlate with genotypic methods [PCR]

Cardiovascular diseases among Egyptian patients with rheumatoid arthritis and its relation to traditional risk factors

Rheumatoid arthritis [RA] is associated with increased mortality which is due to accelerated coronary artery and cerebrovascular atherosclerosis and researchers have not been able to clearly identify specific aspects of RA or its treatment that might higher the risk for cardiovascular [CV] disease. Prevalence of CV events in patients with rheumatoid arthritis. Effects of rheumatoid arthritis as a risk factor in developing CV diseases as well as influence of early and proper treatment on such risk. Association between RA as a risk factor and other traditional risk factors on CV diseases. 300 patients with RA and 150 controls matched with age and sex were subjected to full clinical assessment, laboratory investigations especially for rheumatoid factor [RF], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], electrocardiography [ECG], conventional radiographs of both hands and feet to detect joint erosions and Doppler echocardiography. 13.5% of patients with RA has CV events, 7% for myocardial infarction and 2% for stroke. RA-related risk factors [extra articular disease, joints erosions and presence of RF were associated with CV events, the use of disease modifying antirheumatic drugs [DMARDs] were associated with lower risk for CV events. Our study confirm the role of traditional risk factors and their interplay with RA-retated risk factors in development of CV events. It also supports the beneficial effects of some DMARDs in lowering such risks

Subclinical atherosclerosis in patients with early rheumatoid arthritis

Rheumatoid arthritis [RA] patients have increased mortality and morbidity as a result of cardiovascular [CV] and cerebrovascular diseases. Surprisingly the extent of atherosclerosis [AS] in RA is not known, nor have standard CVD risk factors have been fully evaluated. Study of these changes in early RA and early diagnosis of AS in this population might trigger more aggressive prophylaxis. To demonstrate subclinical atherosclerosis in early RA and possible underlying mechanism. 60 patients with early RA and 40 controls matched for age, sex and traditional risk factors for AS were selected. All patients and controls were subjected to a complete history and full clinical examination, laboratory assessment and carotid ultrasonography. Patients with early RA had average greater cIMT than controls and an increased prevalence of atherosclerotic plaques. Positive association between cIMT and age, joint count, disease activity score [DAS], smoking, serum cholesterol and c-reactive protein [CRP] were observed. Age and CRP were independently associated with atherosclerosis. Patients with early RA developed accelerated atherosclerosis compared with controls. Age and CRP are strong predictors for occurrence of CV disease before onset of symptoms