role of ica operon and biofilm formation in coagulase negative staphylococcal infection

Coagulase negative staphylococci are normal skin commensals and are frequently isolated from clinical specimens. CoNS are a major cause of sepsis in the neonatal intensive care unit. The virulence of these bacteria is mainly due to their ability to form biofilms on indwelling medical devices. One important element in this process is the ica operon [intercellular adhesion operon], a gene cluster encoding the production of polysaccharide intercellular adhesion [PIA], which mediates the intercellular adherence of bacteria and the accumulation of multilayer biofilm . This work aimed to evaluate that pathogenic CoNS isolates are more likely to be positive for the ica operon and to produce biofilm than isolates isolated randomly from healthy individuals. Also to compare between antibiotic sensitivity of biofilm producing CoNS isolates and non-biofilm producing CoNS isolates. Finally to detect source of infection in neonatal intensive care unit using biotyping, antibiogram and plasmid profile as epidemiological markers. This study was conducted from April 2010 to April 2011, at Medical Microbiology and Immunology Department, Faculty of Medicine Zagazig University. The study included 40 neonates admitted to NICU, with picture of bacteremia with the mean age 17.43+/- 7.2 days. From them 40 blood samples were taken from peripheral sites and 40 skin swabs were taken from axilla for culture on blood culture bottles and blood agar respectively. 40 age matched healthy neonates as control group and 25 health care workers from NICU to detect source of infection were enrolled in the study. The biofilm production was examined using congo red agar and the presence of genes icaA, icaD were determined by PCR. Biotyping, antibiogram and plasmid profiles were used as epidemiological markers to detect source of infection in NICU. The isolated CoNS were [32.5%, 37.5%, 20% and 24 from blood samples, skin swabs, control and health care workers respectively and the most common isolated organism was S. epidermidis followed by S. haemolyticus then S. hominis. Also the results of qualitative detection of biofilm formation were 69.2%, 33.3% and 33.3% from the studied specimens respectively but all control were non-biofilm forming. The icaA and icaD genes were 76.9%, 40% and 33.3% from studied specimens respectively but both genes were not found in any control isolates. We conclude that the isolates of CONS infections are more likely to be positive for ica operon and health care workers play a role in dissemination of CONS infection in hospital

Plasma transforming growth factor beta-1 level in asthmatic children

Airway remodeling is a characteristic feature of asthma. The mechanism of this remodeling is thought to involve Transforming growth factor - beta1 [TGF-beta1]. We compare plasma level of TGF-beta1 among asthmatic patients and healthy children and to evaluate these levels with atopic status. 50 asthmatic patients divided into: 30 asthmatics in between attack and 20 during attack . As regard to atopy they were subdivided into: atopic during and in between attack and non-atopic during and in between attack. Group II [Control group]: this group included 20 healthy volunteers. All subjects were subjected to history taking, chest X-ray, CBC, intra-dermal skin tests, serum level of total IgE and determination of plasma TGF-beta1. There was statistical significant difference between asthmatics and control group, also between asthmatics inbetween attack and control group as regard the mean total leucocytic count. Regarding the mean eosinophilic count, there was extremely statistical significant difference between asthmatics [during and in between attack] with control group, there was statistical significant difference between asthmatic patients inbetween attack and during attack. Regarding the mean neutrophil count there was statistical significant difference in asthmatics compared to the control group, there was no statistical significant difference between asthmatics in between attack and asthmatics during attack. Regarding to serum level of total IgE, there was statistical significant difference between both asthmatic group and the control group. But no statistical significant difference between asthmatic patients in between attack and during attack. Regarding plasma level of TGF beta1, there was significant difference between asthmatic group and the control group, also between asthmatics during and in between attack. The most risky offending allergen was mixed pollens [71.4%], followed by hay dust [61.9%], smoke [57.1%], house dust [47.6%], mixed fungi [38%], cotton [28.5%], wool [19%] and lastly, human hair [9.5%]. There was statistical significant difference as regard the mean total leucocytic and neutrophil count in non- atopic patients compared to atopic patient. Statistical significant difference as regard the mean serum level of total IgE in atopic patients in between attack compared to the other groups. There was also statistical significant difference between both groups of atopic patient, also both groups of non-atopic as regard to serum total IgE. As regard the mean level of plasma TGF beta1, there was statistical significant difference in non-atopic asthmatic patients inbetween attack compared to other groups. There was also statistical significant difference between both groups of atopic and both group of non-atopic patients. This study concludes that patients with non atopic asthma have elevated plasma TGFbeta1 levels that may reflect a post-infective phenomenon that serves to down-regulate the host immune response

Candida colonization in very low birth weight neonates with early-onset neutropenia

Candida species are the leading cause of invasive fungal infections in hospitalized children. Colonization by Candida spp. is' almost always the first step in the development of invasive candidiasis. Preterm neonates in NICUs are at high risk for severe fungal infections. Early-onset neutropenia is a well-known risk factor for bacterial sepsis in preterm neonates. The aim of this case control study was evaluation of the role of early onset neutropenia as a risk factor for Candida colonization in preterm very low_ birth weight neonates in NICU, the current role of granulocyte colony-stimulating factor in treatment of these conditions and to screen the antifungal susceptibility of the isolated Candida spp to help management of emerging fungal infections. Forty four very low birth weight" [VLBW] neonates were enrolled in this study. ·They were classified into two groups. Group I: twenty two VLBW neonates [<1500gm] with early onset neutropenia [EON] in the 1st week of life and group II: twenty two matched VLBW neonates without EON as a control group. Group I was further divided into: group IA: Eleven neonates received recombinant granulocyte colony stimulating factor [G CSF] for 3 consecutive days plus routine therapy and group IB: Eleven neonates received routine therapy. Surveillance microbiological swabs from ear canal, oropharyngeal secretions, perianal area and rectum, urine and blood in the 1st and 2nd weeks were collected and cultured according to standard methods. Colonies identified as Candida by colonial morphology on sabouraud dextrose agar and CHRO Magar candida media. All isolated strains were subjected to broth microdilution assays to detect MIC for voriconazole, fluconazole, Iitraconazole, and amphotericin B with calculation of MIC50 and MIC90 for the isolated strains. The study revealed a significant difference of colonization by Candida spp in neutropenic group I as 9 cases out of 22 patient in group I were colonized while only 3 cases out of 22 patient in group II were colonized by Candida spp. [P value 0. 04]. Out of 220 samples cultured from each group, Candida spp were significantly isolated from group I [26] in comparison to group II [JO] [P value 0.05]. C. albicans was the most commonly isolated Candida species followed by C. tropicalis, then C. glabrata. There was a good therapeutic effect of rhG-CSF on intensity of colonization as three cases with high grade colonization in the 1st week improved to low grade colonization in the second week. Treatment with rhGCSF significantly improved absolute neutrophilic count in group IA receiving rhGCSF than group IB [conventional treatment]. Among all isolates of Candida spp, the highest MIC 50 and MIC 90 were for fluconazole [4 and 64 microglml respectively]. The lowest MIC50 and MIC90 were for voriconazole [0.06and0.5 microg/ml]. C. albicans was the most susceptible species to voriconazole [MIC50, 0.03 microg/ml while MIC90, 0.06 microg/ml]. C. tropical is the least susceptible to voriconazole [[MIC50, 0.5 microg/ml while MIC90, 2 microg/ml]. Amphotericin B MICs show a very narrow range [0.25-1 microglml]. Isolated strains were all susceptible to amphotrocinB. As regards to azoles tested, isolated strains were most sensitive to voriconazole [97.2%], followed by Iitraconazole [88.9%] and fluconazole [83.3%] respectively. This study concludes that early onset neutropenia is an independent risk factor for Candida colonization and treatment with rhGCSF corrects ANC sooner and decreases the intensity but fails to completely clear Candida colonization so it recommends proper antenatal and post-natal care to decrease other risk factors of pre-maturity and Candida colonization. This study also concludes that Candida spp isolated is still sensitive to amphotericin B. But resistance to azole antifungal drugs is an emerging problem so it recommends further studies to evaluate the antifungal resistance

role of apoptosis of lymphocytes in pediatric patients with chronic renal failure and end stage renal disease

Apoptosis is an essential form of physiological cell suicide in which the cell itself initiates, regulates and executes cell death pathway using a highly structured arsenal of specific proteins. Patients with chronic kidney disease [CKD] have an impairment of the immune response. Apoptosis of lymphocytes can contribute to this immune defect. The aim of this study is to study the effect of apoptosis on lymphocytes of chronic renal failure and end stage renal disease pediatric patients. This study was conducted on 7 pediatric patients with chronic renal failure under conservative treatment, 7 pediatric cases with end stage renal disease [ESRD] under hemodialysis and 8 healthy control subjects. Lymphocytes were isolated by ficoll-Hypaque method. Apoptosis of lymphocytes was assessed by Annexin V: FITC assay kit. Percentage of apoptotic lymphocytes [annexin V: FITC +ve and propidium iodide -ve] was determined by flow cytometer. Extraction of DNA from lymphocytes was done using DNeasy prep-kit. DNA electrophoresis was done on 2% agarose gel and stained with ethidium bromide. The bands are seen through UV trans-illuminator. Mean positive apoptotic lymphocytes were 35%, 27%, and 4% in end stage renal disease, chronic renal failure patients and control personnel respectively. Apoptosis was significantly higher in end stage renal disease patients in comparison to control personnel [Chi Square and p value, 28. 7 and <0.0001 respectively]. Apoptosis was significantly higher in chronic renal failure patients in comparison to control personnel [Chi Square and p value, 18.5 and <0.0001 respectively]. Apoptosis was more in lymphocytes of end stage renal disease patients than chronic renal failure patients but this difference is not significant [Chi Square and p value, 1.145 and 0.2845 respectively]. By DNA electrophoresis, 7 cases of ESRD and 6 out of 7 CRF cases give the DNA ladder characteristic to apoptosis while no control gives this ladder pattern. This study concludes -that apoptosis significantly affects lymphocytes in chronic renal failure and end stage disease renal disease pediatric patients so it can contribute to immune deficiency seen in these patients

Nosocomial infections with extended spectrum beta lactamase producing enterobacteriaceae in pediatric intensive care unit of Zagazig university hospitals

Enterobacteriaceae are of great concern because antimicrobial therapy of infections due to these resistant pathogens remains a clinical dilemma in hospitalized patients. It is also noted that there is an increase in the antibiotic resistance among Gram negative bacilli to third generation cephalosporins which is caused by expression of ESBL enzymes. Therefore, infections due to ESBL producing isolates continue to pose a challenge to infection management worldwide. The present study was conducted to highlight ESBL production among Eenterobacteriaceae isolated from nosocomial infections [NI] acquired in PICU of Zagazig University hospital by phenotypic and molecular method. The study was done on 604 PICU patients. Specimens for cultures were obtained according to site of NI: blood, urine, CSF, endotracheal tube [ET] aspirates and tips. isolates were confirmed by API 20E and subjected to double disc diffusion test for Phenotypic detection of the extended spectrum beta lactamases. The SHV genes were amplified by PCR, each on a 930 bp fragment. Resulting amplicons were subjected to restriction enzyme digestion for genotypic detection of SHV ESBL. From positive 96 specimens, 68 Enterobacteriaceae were isolated. The most numerous isolated enterobacteria were klebsiella spp [40.6 %], followed by E.coli [9.4%], Enterobacter Spp and Proteus spp [6.3% each], Serratia spp[5.2%], and Citrobacter spp [3.1%].66.2% of Enterobacteriaceae were ESBL producing isolates. Klebsiella pneumonia showed the highest percentage of ESBL producing strains [84.6%], followed by Citrobacter spp [66.7%], Serratia [60%], Enterobacter [50%], Porteus [33.3 %], and the least ESBL producer was E.coli [22.2%]. There is high significant difference between ESBL and Non ESBL producing organisms as regarding the presence of SHV ESBL type gene. 41 Out of 45 isolates [91.1%] of phenotypically ESBL producing Enterobacteriaceae carried the SHV ESBL type gene as indicated by presence of 2 bands of 768 and 162 by RFLP. This study concludes that extended spectrum beta lactamase [ESBL] producing Enterobacteriaciaeae should be put in mind while dealing with specimens of PICU. Double disc diffusion test is a simple and sensitive confirmatory test for ESBL detection. Also, PCR-RFLP is a rapid test for genotypic ESBL detection but needs molecular equipments and facilities

Effect of vision problems on health status of primary school children

The aim of this study was to assess the effect of vision problems on health status of primary school children. The sample included 250 primary school children at primary schools and ophthalmic clinic affiliated to students health insurance in El-Khosous district. Their age ranged between 9-12 years. For data collection, four tools were used: the first tool was an interviewing questionnaire for assessing the socio-demographic characteristic of the primary school children, their medical history, Parent's awareness about health needs and problems of primary school children, the dangerous effect of vision problems on health status and scholastic achievement of their children and Assessment sheet for life style, e.g., [nutritional habits, hygiene, sleep].Second tool was Physical assessment sheet for Monitoring growth and development, Physical observation from head to toes for child.. Third tool was medical record review.. Fourth tool was an observational check list for learning environment at school. The study reflected that more than half [58.4%]of the studied sample had poor vision. There were no statistically association between the vision problem and children' scholastic achievement, there is a significant statistically association between the children' life style and the vision problem occurrence. This study recommended the needs to increase public and family awareness through mass media to provide more explanations about vision problems and their effects on health status of the children

Multiplex PCR assay: comparison with culture for detection of genital mycoplasma

Urea plasma, spp, Mycoplasma genitalia and Mycoplasma hominis are associated with infection of genitourinary tract and reproductive failure. The aim of this work was to determine the sensitivity, specificity and predictive values of multiplex PCR versus culture for detection of genital Mycoplasmas in clinical samples. 95 patients [60 males and 35 females] seen at Gynecology and Urology clinics aged from 20 to 50 years. They were complaining from urinary, gynecological, sexual or infertility problems. The studied specimens were distributed as 40 urine samples, 36 urethral swabs and 19 endocervical swabs.. The specimens were cultured on PPLO media, the remaining material were frozen at -70 for multiplex PCR. The results of this study showed that: 45.3% and 51.6% of studied samples were positive for genital mycoplasmas by culture and PCR. Respectively. Recovery of genital mycoplasmas by biochemical reactions [i.e., pH change in PPLO broth] was significantly higher than that by culture and staining. There was statistically significant agreement between culture and multiplex PCR in: Recovery of genital mycoplasmas from urine samples and urethral swabs. Recovery of Mycoplasma spp from urine samples and endocervical swabs. Recovery of Urea plasma urealyticum from urine samples and urethral swabs. Recovery of Mycoplasma hominis from cases of cystitis and female infertility. Recovery of Urea plasma urealyticum from cases of cystitis, vaginal discharge and male infertility. Multiplex PCR assay was found to have the following values regarding sensitivity, specificity, PPV and NPV of compared with culture: 81.4% , 73.1% , 71.4% and 82.6% in detection of genital mycoplasmas in urogenital specimens. 73.1% , 89.9% , 73.1% and 89.9% respectively in detection of M. hominis in urogenital specimens. 80.6% , 84.4% , 71.4% and 90.0% respectively in detection of U. urealyticum in urogenital specimens. In conclusion, Multiplex PCR assay is a rapid and accurate alternative of culture for detection of genital Mycoplasma species in clinical samples. We recommended that further studies should be done to identify M. genitalium, an extremely fastidious organism that could not be detected in the present study while it is reported to be implicated in several infections especially non-gonococcal urethritis and cervicitis

Violence against women and the role of the governmental institutes to prevent it

1- The results show that about half of the ladies that had been married and in the reproductive age were subject to violence since they were 15 years old and that one of five ladies were subjected to violence during the last year of survey and their husbands are the main cause of this violence and with a less rate for mothers, fathers and brothers. 2- Body violence is considered the most spreading where one third of the ladies that had been married and were subject to body violence at least once from current marriage or the last, also 18% of the ladies were subject to violence during the last year of survey. 3- The result shows that about 18% of the ladies that had been married and subject to physically violence, also 10% of them had been subject to violence lately, 7% of the ladies stated that their husbands has forced them to have sex and that 4% of them were forced lately to it even. 4- The result shows that half of the ladies agreed that their husbands has all the reasons and right to hit his wife in any cause of this following: If she burnet the food, if she argued with him, if she went out without his permission, if she were careless to the kids or if she refused to have sex, also 17% of the ladies believe that there is a good reason for beating due to the five reasons above. 5- The percentage of acceptance of beating the ladies increases in the rural areas compared to the urban areas, especially ladies living in rural Upper Egypt. 6- Also, Women in the lowest wealth quintile were more than three times as likely to consider wife beating to be justified for at last one of the reasons as women in the highest wealth quintile [74%, 23% respectively]

Study of the possible antinociceptive and anti-inflammatory activities of curcuma longa

Purpose: the aqueous extract of cur cumin, was evaluated for antinociceptive activity using writhing, formalin, and hot-plate tests in mice. Also, the extract was analyzed for anti-inflammatory activity with the carrageenan-induced paw edema in rats

Methodology. 84 female Swiss mice divided into three main groups [A, B and C]. Groups A and B were divided into five sub-groups [1, 2, 3, 4, 5]. Group 1 was injected i.p. with saline and groups 2, 3, 4, and 5 were given either acetic acid [l0mI/kg], i.p., or formalin [20ul of 2.5% solution of formalin] injected in the dorsal surface of the left hind paw of the mice. Groups 3, 4, and 5 were pretreated with aqueous extract of curcumin [150, 300, and 600 mgkg] before acetic acid or formalin injection. In group C, 24 female Swiss mice divided into four subgroups [1, 2, 3, and 4]. The first one act as a control and the others pretreated with aqueous extract of cur cumin [150, 300, and 600 mglkg] before hot plate test. 30 female Albino rats were used for carrageenan- induced paw edema

Results. in acetic acid induced abdominal writhing, the maximal inhibition of the nociceptive response was achieved at the dose of 600 mgkg of aqueous cur cumin. Intraplanter injection of 2.5% formalin evoked a characteristic biphasic licking response. Pretreatment [60 min] with different doses of aqueous extract of cur cumin had no significant effect against the duration of licking activity in the early phase, whereas doses of 300 and 600 mg/ kg produced marked reduction of the licking time in the late phase. Non significant effect was obtained in the hot plate test. The extract showed significant anti-inflammatory activity in the dose of 300,600 mg/kg i.p in the carrageenan test

Conclusions. the results obtained indicate that cur cumin can be used as analgesic anti-inflammatory agent which supports the folk medicinal use of the plant

Study of the possible cardio protective effect of curcuma longa in doxorubicin-induced cardiotoxicity in the rat

Purpose: doxorubicin [DOX] is an anthracycline antibiotic, with a broad-spectnun antitumor activity against a variety of he- matological and solid tumor. However, cardiomyopathy is the major limiting complication of its use. It affects 30-40% of pa- tients who receive a cumulative dose more than 500 mg/ml

Evaluation of hospitalized patients needs as perceived by patients, nurse interns and preceptors

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence. Each of the randomly sampled 50 nurse interns and their corresponding preceptors [9 preceptors] assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients [n=50] were interviewed about their perceived need by the researcher. Nurse interns and their preceptor's assessments were compared with the individual patient's opinion. Both nurse interns and their preceptors assessments showed close similarities with the patients' own estimations, although certain under and over estimations fir both physical and emotional needs were found. Nurse interns and their preceptors also showed uncertainty in some of their assessments concerning physical and emotional needs. Nurse interns and their preceptors nurses' assessments were closer than nurse inter/patients or preceptors/patients. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care

Some pharmacological studies of ropivacaine in comparison with bupivacaine

The effect of ropivacaine as a recent amino-amide local anaesthetic compared with bupivacaine on analgesic activities, cardiac contractility, blood pressure, heart rate, Electrocardiogram [ECG] and toxicity was studied. The result of our study revealed that ropivacaine Exhibited a less degree of analgesic potency than bupivacain, it increase the reaction time by 20.6 and up to 167.6% while bupivacaine increased it by 37.32 up to 197.1%. On isolated rabbits heart, ropivacaine and bupivacaine induced a significant dose dependent -ve inotropic effect. The cardiodepressant action of ropivacaine was lesser than that of bupivacaine. IV injection of ropivacaine [0.35-2.8mg/kg] produced slight increase in arterial blood pressure but in the last dose produce decrease in arterial blood pressure. Bupivacaine 0.5-1mg/kg produce no significant change in arterial blood pressure but in the subsequent doses it produces hypotension up to death, this hypotension may be the beginning effect of high toxic blood level of the drug. Ropivacaine showed no alterations in ECG apart from significant decrease in heart rate only in high doses, but on the other hand bradycardia started earlier with bupivacaine [1mg/kg] and ECG changes were seen after 5 minutes from injecting 2mg/kg which ended by cardiac arrest. In respect to toxicity, intra peritoneal LD50 of ropivacaine was found to be 115mg/kg compared to 90mg/kg of bupivacaine. We concluded that ropivacaine nearly resembles bupivacaine in its local analgesic effect but has a great margin of safety with less cardiodepressant action

Tissue response to a kaltostat wound dressing in tooth extraction in diabetes

The purpose of the present work was to study the effect of kaltostat on the healing process after tooth extraction in guinea pigs with induced diabetes. Nine guinea pigs were used after induction of diabetes by a single subcutaneous injection of a freshly prepared Alloxan mono-hydrate in saline solution. The animals were considered definitely diabetic only when the non-fasting blood sugar level was above 180 mg%. So, it was recommended to use the kaltostat in diabetic patients after teeth extraction in combination with any systemic prophylactic antibiotics to avoid the development of fibrinolytic alveolitis and to accelerate the healing process without expecting any harmful side effects