High prevalence of Klebsiella pneumoniae carbapenemase-mediated resistance in K. pneumoniae isolates from Egypt

The emergence and rapid spread of antibiotic-resistant Klebsiella pneumoniae isolates harbouring the bla[KPC] gene that encodes for carbapenemase production have complicated the management of patient infections. This study in a tertiary care hospital in Egypt used real-time PCR assay to test ertapenem-nonsusceptible isolates of K. pneumoniae for the presence of the bla[KPC] gene and compared the results with modified Hodge test. Antibiotic sensitivity was performed by standard methods, and interpreted following both the old CLSI breakpoints [M100-S19] for carbapenems and the revised breakpoints [M100-S22]. From the 45 non-duplicate isolates of K. pneumoniae recovered from different clinical specimens, a high prevalence of ertapenem-nonsusceptible isolates [44.4%] was reported using the new lower CLSI breakpoints. The bla[KPC] gene was confirmed in 14/20 [70.0%] of these isolates. The high prevalence of ertapenem nonsusceptibility at a tertiary care hospital in Egypt was predominantly attributed to K. pneumoniae carbapenemase-mediated resistance mechanisms in K. pneumoniae isolates

Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease?

To evaluate the association between autoimmune thrombocytopenia with other autoimmune disorders, to show if they are different autoimmune diseases or one disease with different presentations at the same time, and to study the effect of treatment on platelet count in different thyroid condition. In this retrospective study, we included 141 patients with thrombocytopenic purpura. The result of thyroid function test, thyroid autoantibodies, Coombs' reactivity, anti-nuclear antibody, and double-stranded DNA were analyzed. This study was conducted in the Clinical Hematology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2003 and August 2010. There were 51 [36.2%] patients with laboratory evidence of autoimmune disease, 13 [9.2%] with hypothyroidism, and 6 [4.3%] with hyperthyroidism. In addition, 5 [3.5%] patients showed laboratory evidence of Evan syndrome and 3 [2.1%] patients had isolated positive thyroid antibodies. There was non-significant difference [p=0.61] in platelets count after one month of treatment of patients with different thyroid condition. Immune thrombocytopenia is associated with evidence of different autoimmune disease or a combination of them, which may appear at presentation or during the course of disease giving evidence that they are different manifestations of a single disease. Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease

Identification and characterization of nuclear matrix protein[s] and assessment of its usefullness for early diagnosis of bladder cancer

The highest incidence rates of bladder cancer are generally found in industrially developed countries, particularly North America and Western Europe, and areas associated with endemic schistosomiasis, including parts of Africa and the Middle East. The appropriate treatment of patients with bladder cancer mandates early detection and regular follow up for recurrences. Currently, cystoscopy is the standard method for diagnosing and monitoring bladder cancer recurrence, but it is an invasive and relatively costly technique, and may sometimes be inconclusive, particularly in cases of cystitis. Western blot and specific immunoglobulin-G antibody were used to identify the urinary NMP marker. Urine samples from 123 patients with bladder cancer and 50 controls were evaluated using the developed SDS-PAGE, Western blot and ELISA. The NMP marker was identified in the urine of patients with bladder cancer at 52 kDa [NMP- 52] by SDS-PAGE, Western blot and ELISA. In addition, the NMP-52 tumor marker was not detected in the urine of patients. Detecting the urinary NMP-52 marker using SDS-PAGE, Western blot and ELISA, would be helpful in the rapid diagnosis of bladder cancer

Biochemical studies on fibronectin in patients with chronic liver diseases

The aim of this study was to assess the diagnostic value of fibronectin to discriminate between significant [F2-F4] and none significant fibrosis [F0-F1] in order to avoid liver biopsy. Fibronectin was identified using specific monoclonal antibody and Western blot at 90-kDa in serum of chronic HCV patients. Fibronectin was quantified in serum using ELISA technique. The Cut-off level of fibronectin was 400 micro g/ml. The mean +/- SD [micro g/ml] of serum fibronectin concentration in patients with none significant liver fibrosis were 317 +/- 184 and in patients with significant liver fibrosis were 587.8 +/- 322. There were significant differences among two groups of patients [P<0.0001]. The area under the receiver operating characteristic [ROC] curve of fibronectin for discriminating patients with none significant liver fibrosis from those with significant liver fibrosis were 0.78. The diagnostic values of the fibronectin in discriminating patients with none significant liver fibrosis from patients with significant liver fibrosis were high with 82% sensitivity, 68% specificity, 81% negative predictive value, 69% positive predictive value and 76% efficiency. In conclusion, serum fibronectin has a good diagnostic performance and can be used for discriminating patients with non significant liver fibrosis from patients with significant liver fibrosis

Lymphocytes DNA content, p53, C-MYC and BCL-2 as predictive markers in childhood with acute lymphoblastic leukemia

Cell cycle parameters as well as apoptotic and tumor markers directly control cell growth. DNA ploidy and S phase fraction, apoptosis fraction in addition to apoptotic inducer [p53, c-myc] and antiapoptotic marker [Bcl-2] were investigated in childhood with acute lymphoblastic leukemia [ALL] leukemia as a predictive markers represented in survival data. This study included 70 children with [ALL]; 38 males and 32 females; of median age 5 years. Event free survival [EFS] and overall survival [OS] were estimated for all studied cases. Cell cycle and apoptotic parameters as well as p53, c-myc and Bcl-2 were analyzed using FACS caliber flow cytometer in the lymphocyte cells of peripheral blood. Aneuploidy constituted 33% of studied cases. The median overall survival [OS] showed higher significant values when S% was <4.5%, and DNA index was >/= 0.94 and p53 was < 70.87, whereas it showed no significant difference related to G0/G1%, G2/M% and aneuploidy%. The median event free survival [EFS] showed significant higher value at Bcl-2 >/= 81.5 but with no significance related to other cell cycle parameters as well as p53 and c-myc. These data suggest that DNA index, S phase fraction, p53 and BcI-2 may be useful as a predictive markers that help patients' stratification and adjusting protocols of ALL therapy

Dysregulation of blood lymphocyte subsets and natural killer cells in schistosomal liver cirrhosis and hepatocellular carcinoma

Immunological factors are important in the pathogenesis of a wide spectrum of hepatobiliary diseases. Using flow cytometry, we determined the changes in lymphocyte subsets and natural killer cells in 123 individuals [81 patients with liver disease and 42 healthy volunteers]. The liver diseases included periportal fibrosis [PPF, 10 patients]. liver cirrhosis [LC, 31 patients], and hepatocellular carcinoma [HCC, 40 patients]. Schistosomiasis and viral hepatitis B and C were the putative etiological agents of liver diseases. Immunophenotyping by indirect immunofluorescence was conducted using monoclonal antibodies to CD3 [T-lymphocytes], CD4 [helper/inducer T-cells], CD8 [suppressor/cytotoxic T-cells] and CD 57 [natural killer cells] cell surface markers. Immunophenotyping of PPF patients showed no significant changes in all markers compared with the healthy controls. However, there was a significant decrease [P<0.01] in CD3 and CD4 T-cells, and a highly significant increase [P<0.001] in CD 57 T-cells in patients with LC or HCC. In addition, LC and HCC patients showed no significant change in CD8 T-cells compared with controls. The progression of liver diseases is associated with a dysregulation of cellular immune responses. T-lymphocytes and natural killer cells may play a role in the immunopathogenesis of LC and HCC

Fast-dot ELISA using urine, a rapid and dependable field assay for diagnosis of schistosomiasis

The fast dot-enzyme linked immunosorbent assay [FD-ELISA] was used as a field applicable tool for rapid diagnosis of schistosomiasis. 700 fecal specimens were parasitologically examined for detection of S. mansoni eggs and other parasitic infection. Egg count was done for 100 infected patients. Rectal biopsies [394] were taken from individuals with no S. mansoni egg in their stool where it was used as golden standard for diagnosis of schistosomiasis. Cross- reactivity with other parasites was studied. Serum samples were tested by ELISA technique for detection of human IgG anti-schistosomal antibodies. 700 urine samples [433 S. mansoni infected patients and 267 healthy individuals] were tested by FD-ELISA for detection of a schistosomal antigen excreted in urine using BRLF4 mouse monoclonal antibody. FD- ELISA results were compared with ELISA detecting antischistosomal IgG and stool analysis where it showed highest efficiency [91%] compared with 81% and 60% for ELISA and stool analysis, respectively. The sensitivity of FD-ELISA was high ranging from 90 to 94% in the 4 different clinical stages of schistosomiasis [simple intestinal, hepatosplenomegaly, shrunken liver and splenomegaly, and shrunken liver-splenomegaly and ascites]. FD-ELISA was highly sensitive, detecting infection cases with 20 eggs/g feces and its specificity was 89%. The antigen was characterized as a protein with a molecular weight of 74 KDa using Western Blot technique

Seroprevelance of H pylori infection in asymptomatic healthy individuals and in patients with upper gastrointestinal symptoms in relation to schistosoma mansoni infection

The seroprevalence of IgG antibodies to Helicobacter pylori and antischistosomal antibodies were determined by the ELISA technique in the sera of 140 healthy asymptomatic subjects and 22 patients who underwent endoscopy for upper gastrointestinal symptoms. The overall prevalence of H. pylori in the asymptomatic group was 82.9% and 95.45% in the patients group. The incidence increased by age reaching its peak in the third decade and 50% of the studied children below 10 years old were seropositive. The seroprevalence of H. pylori antibodies had no relation to sex, habit of smoking or infection with Schistosoma mansoni. These data suggest that the serological tests for diagnosis of H. pylori infection are not recommended for developing countries hyperendemic for parasitic and diarrheal diseases due to the early acquisition of infection during childhood

Comparative study between cytology and DOT eliza for early detection of bladder cancer

A newly developed monoclonal antibody CK1K10 to keratinized grade 1 squamous cell carcinoma was used in a dot enzyme linked immunosorbent assay [dot ELISA] to test urine samples of 118 patients with bladder carcinoma, 291 patients with genitourinary pathology other than bladder carcinoma, in addition to 550 healthy controls. The overall sensitivity of the dot ELISA was 90% among 118 patients with bladder carcinoma. 82% of the transitional cell carcinoma, 96% of the squamous cell carcinoma, 70% of the undifferentiated tumors and 100% of the adenocarcinoma were positive with this assay. The specificity was 90% in the sample population [negative predictive value = 98%]. A comparative study of diagnosis by cytology and dot ELISA was carried out in 57 patients with bladder carcinoma. Dot ELISA was found to be superior as a screening tool for high risk groups [P value <0.001 using Chi square test]. Cytology detected 21% of transitional cell carcinoma, 68% of squamous cell carcinoma, 50% of adenocarcinoma and 86% of undifferentiated tumors. The dot ELISA assay should be useful for screening high risk groups since it does not require sophisticated equipment, is noninvasive, does not require highly trained staff and can be performed in less than 30 minutes

Aural polyps and cholesteatoma in children

A 9 years review of aural polyps in children treated surgically in King Abdel-Aziz University Hospital, revealed a total of 38 cases, 33 [86.84%] of them were found to have an underlying cholesteatoma. 7 [18.42%] cases have history of tympanoplasty, 11 [28.94%] cases have history of grommet insertion. These results showed that aural polyps in children are strongly associated with underlying cholesteatoma and a more exploratory operation should be performed as an initial treatment