ABSTRACT
Background: Interferon alpha [IFN-q is widely used as a therapeutic agent for Hepatitis C [HCV] infections. Chemokines (including CXCLIO, CCL5 and CCLll] have been identified to play an important role in endocrine autoimmune diseases and particular attention has been raised by studies demonstrating CXC chemokines over expression in Hashimoto thyroiditis. Objective: Study serum levels of CXCLIO, CCL5, and CCLll chemokines as predictors for interfer on-induced thyroiditis in HCV patients submitted for antiviral therapy. Patients and Methods: Seventy two patients with HCV Infection selected from 100 patients submitted for INF-alpha and ribavirin therapy were recruited into; group 1 comprised 59 patients with negative anti-thyroid peroxidase antibodies [ATPO], group 2 comprised 13 patients with positive ATPO, Twenty healthy adults were included as control Thyroid function, auto-antibodies and serum chemokines [CXCLIO, CCL5, and CCLll, assayed by a quantitative sandwich immunoassay] were performed before therapy, after 12 and 24 weeks of treatment. Results: In comparison to group 1, group 2 patients had significantly higher ANA [P=0.03S], ATPO, CXCLIO and CCL5 [all P= 0.000] and significantly lower TSH [P=0.30] before therapy; higher ATPO, CCL5 [all P= 0.001] and lower TSH [P= 0.034] after 12 weeks; higher ATPO and lower TSH [all P= 0.001] after 24 weeks of therapy. Thyroiditis occurred in 10.2 % of group 1 and 38.5 % of group 2 patients after 12 weeks of therapy without significant difference between the two groups. After 24 weeks of therapy, group 2 patients had significantly higher number of thyroiditis [53.8 %] than group 1 [11.9 %] [P=0.001]. Significant increase of CXCLIO was found in patients with thyroiditis [P<0.05] at the end of therapy. Conclusion: As HCV infection might contributes to the initiation of thyroid autoimmunity and interferon induced thyroiditis is a frequent complication of IFN-a therapy, HCV infected patients could be subjected to thyroid screening by utilizing some chemokines as CXCLIO, CCL5 in addition to ATPO for identification of those who are prone to thyroiditis during IFN-a therapy?
ABSTRACT
Background: the persistence of hepatitis B virus [HBV] DNA in liver tissue or serum in the absence of detectable hepatitis B surface antigen [HBsAg] is called occult hepatitis B infection [OBJ]. Both HBV and hepatitis C virus [HCV] are transmitted parenterally, and coinfection is not uncommon, particularly in countries with a high prevalence of one or both viruses
Aim: this study was conducted to assess OBI prevalence in Egyptian patients with HCV related liver diseases, see if anti-HBc alone can. consider a good marker for detection of OBI, to record the serological profile of occult HB V infected patients, and to detect the clinical impact of this coinfection
Methods: after exclusion of HBsAg positive patients, serum samples from 128 Egyptian patients with HCV related liver diseases were included in our study. All the patients were positive for anti-HCV and HCV RNA, and negative for HBsAg. Serum samples were collected and subjected to fiver function tests and virological assays for HBsAg,
Results: occult HBV infection was detected in 21% of our patients with the highest prevalence found in patients with hepatocellular carcinoma [HCC] [44.4%] followed by patients with cirrhosis [22.2%] then chronic hepatitis C patients [16.3%]. Occult HBV infection can be found in both patients who show previous hepatitis B infection, [22%], and in those who were negative for anti-HBc, [19%]. Occult HBV infection was detected with the highest prevalence in patients with anti-HBc only [51.8%], followed by patients with negative all serological markers [29.6%], then [11.1%] were anti-HBc and anti-HBs, and finally [7.4%] were anti-HBc and anti. HBe. Patients co-infected with occult hepatitis B had significantly a higher prevalence of sever fibrosis [12/27 OBJ versus 13/101 HCV only infected patient, P<0.01] and significantly higher prevalence of decompensated liver disease [3/4 OBJ versus 3/14 HCV only infected patient, P<0.05]
Conclusion: OBJ is highly prevalent in Egypt. It is frequently associated with HCV-related chronic liver diseases and it may play a major role as an etiological agent for hepatocellular carcinoma in these patients. Occult HBV infection may have a clinical significance as it may increase the liver fibrosis and worsen the liver disease in HCV patients but we think that it doesn't affect the HCV response to combination therapy
ABSTRACT
Staphylococcus aureus, a major cause of potentially life threatening infections acquired in health care and community settings, has developed resistance to most classes of antimicrobial agents with dramatic increase in the number of health care associated infections due to methicillin resistant S. aureus [MRSA]. During the period of our study 974 S. aureus strains were isolated from different types of infections in different wards of Mansoura University Hospitals [MUH], 530 [54.4%] isolates were methicillin sensitive S. aureus [MSSA] and 444 [45.6%] isolates were MRSA. Simplified population analysis of MRSA strains revealed, 27 [6.08%] heterogeneous vancomycin intermediate sensitive S. aureus [hVISA], 12 [2.70%] vancomycin intermediate sensitive S. aureus [VISA], while 2 [0.45%] isolates were vancomycin resistant S. aureus [VRSA]. hVISA strains were isolated from different infections, mainly from blood stream infections [29.63%] and infected skin ulcers and bedsores [29.63%], where the 12 VISA strains were isolated from infected skin ulcers and bedsores [41.66%], infected surgical wounds [41.66%] and lower respiratory tract infections [16.67]. The 2 VRSA isolates were isolated from blood stream infection [one case] and an infected bedsore [the other case]. One of the 2 VRSA cases was isolated from children hospital and the other one was isolated from medical wards. Minimal inhibitory concentration [MIC] of different antimicrobial agents for S. aureus with diminished sensitivity to vancomycin was done by microdilution method revealing a significant difference in resistance among VISA, hVISA and VRSA with vancomycin, linzolide, meropenem. Time kill study of different antibiotics for VRSA isolates showed that, vancomycin exhibited no kill activity at 1X MIC, but killing activity was achieved only at 2X and 4X. Other tested antibiotics were significantly had killing activity more than vancomycin at concentration of 1X MIC. Daptomycin, quinipristin/dalfopristin, tigecyclin, meropenem, ciprofloxacin, and erythromycin were significantly had killing activity more than linezolide at concentration of 1X MIC. In conclusion, the first two identified VRSA isolates from children hospital and medical wards still susceptible to some antibiotics which are not used widely such as, daptomycin, quinipristin/dalfopristin and tigecyclin, also hVISA and VISA had antimicrobial susceptibility pattern similar to VRSA isolates
ABSTRACT
Extended spectrum beta- Lactamase producing klebsiella [ESbetaL-KP] is an important cause of nosocomial infections in neonatal intensive care units [NICUs]. We conducted a prospective cohort study in the NICU, Mansoura University Children's Hospital, over a period of twelve months starting from June 2005 to May 2006, to assess the incidence of ESbetaL-KP, identify the frequency of SHV-1 and SHV-2 gene acquisition among ESbetaL-KP isolates, and the risk factors associated with ESbetaL-KP infection. Antimicrobial susceptibility was determined by, phenotypic confirmation of ESbetaL production was done by the double-disk synergy test [DDST] and Etest. Genetic detection of SHV-1 and SHV-2 genes in ESbetaL-KP isolates was done by polymerase chain reaction [PCR] and restriction fragment length polymorphisms [RFLP]. Risk factors associated with ESbetaL-KP infection were analyzed by both univariate and multiple logistic regression methods. Three hundred and ninety-eight neonates were enrolled in the study cohort. The overall nosocomial infection incidence rate was 36.6%. Klebsiella species was the commonest organism [27 among 138 bacterial isolates [19.6%]]. Eighteen klebsiella isolates [66.7%] exhibited phenotypic ESbetaL- resistance patterns. PCR amplicons from the 18 ESbetaL-KP isolates were subjected to RFLP analysis which revealed the presence of SHV-2 in all 18 isolates [100%], SHV-1 gene in 8 strains [44.4%]. Independent risk factors for ESbetaL-KP infection were: mechanical ventilation [odds ratio [OR]: 4.18, 95% confidence intervals [CI]: 1.57 -11.00]; birth weight < 1500 g [OR: 3.19, CI: 1.22 - 8.30]; duration of hospitalization > 15 days [OR: 4.09, CI: 1.17-14.40]; total parenteral nutrition [TPN] [OR: 4.93, CI: 1.12 - 21.70]; and prior use of oxyimino-antibiotics [OR: 4.87, CI: 1.10 -21.50]. Neonates infected with ESbetaL-KP higher mortality [27.8%] compared to other neonates [11%] [P=0.04]
Conclusion: This study confirms the high incidence of ESbetaL-KP in our NICU and further demonstrates the role of genes coding for SHV-1 and SHV-2 enzymes in clinical and environmental isolates. Independent risk factors for acquisition of ESbetaL-KP were mechanical ventilation; birth weight 15 days; and prior exposure to oxyimino antibiotics. Neonates infected with ESbetaL-KP experienced increased mortality compared to other neonates
ABSTRACT
Infection with human papillomavirus [HPV] and Chlamydia trachomatis are associated with cervical intraepithelial neoplasia. The recognition of HPV infection as a factor that is necessary, but not sufficient, for the development of cervical cancer has resulted in the initiation of several longitudinal studies and randomized clinical trials designed to examine the predictive value of HPV DNA testing. Forty two women were enrolled in this study [patients group] together with 20 apparently normal women [control]. For all patients and control groups, cervical swabs were taken, examined for HPV, HPV 16, HPV 18 DNA by 2 sequential PCR reactions, Chlamydia antigen and TNF-alpha by ELISA. Among 42 cases diagnosed pathologically as cervical carcinoma, HPV DNA was detected in 37 cases [88.09%]. HPV16 DNA was more common than HPV18 DNA as it was detected in 28 cases [66.7%] while HPV18 DNA was detected in 4 cases [9.5%]. There is a statistically significant difference between HPV and control cases, also HPV16 and control cases. Regarding Chlamydia antigen, 10 cases were detected out of 42 cases [23.8%] while, only 3 cases were detected in control group [15%] indicating that there is non statistically significant difference between the two groups. Regarding the pathological types of cervical carcinoma, in adenocarcinoma, HPV DNA was detected in 4 cases [80%], while in Squamous cell carcinoma [SCC], it was detected in 33 cases [89.19%]. In adenocarcinoma, HPV 16 DNA was detected in 2 cases [40%], while in SCC, it was detected in 26 cases [70.27%]. In adenocarcinoma, HPV 18 DNA was detected in 1 case [20%], while in SCC, it was detected in 3 cases [8.11%]. Regarding Chlamydia antigen, in adenocarcinoma, the antigen was detected in 1 case [20%] and in SCC, it was detected in 9 cases [24.32%]. Our results emphasized that HPV 16 was more predominant in squamous cell carcinoma, whereas type 18 was relatively high in adenocarcinoma. The level of TNF-alpha [pg/ml] was 33.81 +/-9.38 in cancer cervix cases, which was statistically significant compared to control cases [1.33 +/-0.74 [P<0.001]]. There is none statistically significant difference between adenocarcinoma [34.12 +/-12.31] and SCC [33.76 +/-9.13 [P=0.970]]. There was no significant difference regarding TNF-alpha level between HPV positive cases [34.23 +/-9.39] and HPV negative [30.66 +/-9.68 [P = 0.342]]. There was a significant difference between HPV16 [32.88 +/-8.84] and HPV18 [41.98 +/-4.32]. Also, there was no significant difference between Chlamydiae positive cases [36.62 +/-8.79] and Chlamydiae negative cases [32.93 +/-9.52 [P=0.260]]. We conclude that cervical infection with HPV but not with Chlamydia may be an important risk factor for the development of cervical cancer and TNF-alpha levels increased significantly in cervical carcinoma without special reference to the pathological type of the tumor
ABSTRACT
Pseudomonas aeruginosa and Serratia marcescens is prevalent opportunistic pathogens in humans, causing many nosocomial infections including burn and surgical wounds that difficult to treat because of high resistance to a wide variety of antibiotics including cephalosporins, quinolones, aztreonam and imipenem. For many gram-negative bacteria, including Enterobacteriaceae and Pseudomonas spp., the production of the Chromosomally encoded, class C beta-lactamase, or the AmpC enzyme, represents the intrinsic mechanism of resistance to beta-lactam antibiotics. AmpC expression is under the control of a regulatory gene system. Many inducers cause constitutive overproduction of the enzyme and an increased resistance to agents, such as oxyiminocephalosporins including ceftazidime. AmpC is a group I, class C beta-lactamase present in most Enterobacteriaceae and in P. aeruginosa and other non-fermenting gram-negative bacilli. Salicylate and antibiotics are often administrated simultaneously, and subsequent high levels of both drugs can compromise their effectiveness. In this study, we aim to detect the effect of concomitant administration of salicylate and ceftazidime, on the sensitivity patterns of S. aeruginosa and S. marcescens. 20 [54.05%] out of 37 pseudomonas aeruginosa isolates are possessing the gene, where only 2 [30.00%] Serratia marcescens isolates out of 6 were positive for AmpC ACC-1 gene. Efficiency of plating and time kill study showed a decrease in the susceptibility to ceftazidime in the presence of salicylate concentration of 100 micro g/ml and 150 micro g/ml but not with 50 micro g/ml concentration with no significant difference to concentration higher than 100 micro g/ml. After subculturing in the absence of salicylate only 10 [62.5%] pseudomonas strains out of 16 recover their original susceptibility patterns, where the 2 tested Serratia strains recover their original susceptibility patterns. Also we test the same original 16 strains after exposure to ceftazidime alone without salicylate, on their resubculturing, also 11 strains only regain their original susceptibility pattern
In conclusion: salicylate with concentration concomitant to that of serum concentration reached with therapeutic dose may affect the MIC of ceftazidime for Pseudomonas and Serratia. The original sensitivity pattern may not be resumed, we claim that the irreversibility occur from exposure to ceftazidime alone but not to salicylate
ABSTRACT
The study objective was to find if serum specific suppressive activities on Lymphocyte transformation in response to Schistosoma mansoni [S. mansoni] antigens, usually present in serum of chronic S. mansoni infected patients, are permeable through the placenta from S. mansoni infected mothers to their newborns. Also, to find if such transferred activities are maintained during breast feeding and after weaning. Control group of 8 normal mothers and their offspring and 3 study groups of 13, 11, 11 S. mansoni infected mothers and their newborns, breast-fed infants and weaned children were included in the study. Proliferative response of Lymphocytes, from S. mansoni donors, to S. mansoni soluble egg antigen [SEA] and adult worm antigen [AWA], in presence of serum from each infected mothers groups, showed significantly higher suppressive activity than when the same lymphocytes were incubated with the same antigens in presence of serum from normal mothers group. This suppressive activity was transferred from S. mansoni infected mothers to their newborns' serum and maintained in their barest-fed infants' serum as donors' lymphocytes showed significantly higher suppressive activity in presence of serum from these two groups than in presence of serum from offspring of normal mothers. Serum from weaned children of S. mansoni infected mothers still showed suppressive activity significantly higher than serum from offspring of normal mothers but significantly lower than suppressive activity of serum from newborns and breast-fed infants of S. mansoni infected mothers. No significant difference in suppressive activity in presence of serum from different groups when donors' lymphocytes were stimulated by PHA indicating that this transferred suppressive activity is specific to S. mansoni antigens. Interleukin-10 [IL-10] production by donors' lymphocytes when stimulated by different stimulants showed results parallel to suppressive activity. Also, IL-10 production by donors' lymphocytes when stimulated by SEA and AWA in presence of serum from offspring of S. mansoni infected mothers showed highly significant positive correlation with suppressive activity of donors' lymphocytes when stimulated by the same antigens in presence of the same serum [P = 0.001 and < 0.001 respectively]. The parallelism and correlation between effect of serum on suppressive activity and IL-10 production suggest that IL-10 production is one of the main mechanisms by which serum affect lymphocytes transformation. These results suggest that the antischistosomal immunological status of S. mansoni infected mothers affects the future of their offspring when infected with S. mansoni and encourage studying the use of effective pathology modulating vaccines with mothers during pregnancy and lactation