Molecular characterization of Enterococcus spp. clinical isolates from Cairo, Egypt.

Purpose: Enterococci are responsible for serious diseases such as bacteraemia, endocarditis and urinary tract infections. The ability of enterococci to cause such diseases is due to acquisition of certain virulence factors such as haemolysin, gelatinase and enterococcus surface protein. This study has been conducted to investigate the occurrence of virulence factors and resistance to various antibiotics with emphasis on vancomycin in the Enterococcus spp. Materials and Methods: Clinical specimens were collected and isolates were identifi ed by proper microscopic, culture and biochemical tests. Susceptibility and degree of resistance of the isolates to various antibiotics were determined. Virulence factors were examined by phenotypic tests followed by molecular methods. Bioinformatics analysis was used to detect regions in the genomes that might have originated from horizontal gene transfer. Result: The presence or absence of virulence genes did not affect the pattern of antimicrobial resistance in Enterococcus isolates; consequently, no relationship was found between virulence factors and resistance to different antibiotics used. Bioinformatics analysis showed that the virulence genes were mainly transferred by transposons. Conclusion: Among the enterococci, environmental factors may interfere in the expression of virulence factors. Horizontal gene transfer plays an important role in the spread of resistance and virulence genes.

Antimicrobial Profile of Selected Snake Venoms and Their Associated Enzymatic Activities.

Aims: To investigate the antiviral and antibacterial profile of several crude snake venoms and to assess some of their enzymatic activities. Methodology: The antiviral activities of Naja haje, Bitis arietans, Naja nigricollis and Echis carinatus snake venoms were investigated against Herpes simplex virus type1, Rift valley fever virus and Vesicular stomatitis virus using the end point of cytopathic effect method. Antibacterial activities of Bitis arietans, Cerastes cerastes, Echis carinatus, Vipera lebetina, Naja naja, Pseudechis australis, Naja nigricollis and Naja haje venoms were examined against Staphylococcus aureus, Escherichia coli, Salmonella typhimurium and Pseudomonas aeruginosa using disc diffusion method. Microdilution method was used to determine the venom's minimum inhibitory concentration. L-amino acid oxidase and phospholipase A2 activities of crude venoms were evaluated using enzymatic assays. Results: Naja nigricollis, Bitis arietans and Echis carinatus snake venoms exhibited significant antiviral activities against all test viruses, except for N. haje treated cells. The mean depletion of viral infectivity titer of venom pretreated cells was higher than its depletion post viral infection for all three venoms showing antiviral activities. Naja nigricollis exhibited the highest antiviral activity against test viruses and recorded a mean depletion of viral infectivity titer in venom pretreated cells of 3.8 log (10) / ml , 3.2 log (10) / ml and 2.5 log (10) / ml for HSV-1, RVFV and VSV, respectively. Pseudechis australis, followed by Naja naja and Naja nigricollis venoms, showed the highest inhibitory activity against test bacteria with inhibition zones ranging from 11-17 mm, 8-14 mm and 8-13 mm, respectively. Minimum inhibitory concentrations of test venoms against different bacterial strains ranged from 156 μg / ml to 1.25 mg / ml. Maximum L- amino oxidase activity was detected in Naja naja, Cerastes cerastes and Pseudechis australis. The highest Phospholipase A2 activity was identified in Bitis arietans, Pseudechis australis, Naja naja and Naja nigricollis. Conclusion: It can be concluded that snake venoms or their bioactive derivatives can be promising therapeutic agents against some microbial infections. Further investigations will be carried out for purification and more characterization of the biologically active components in snake venoms.

management of parotid hemangioma in neonates and infants

The aim of this study was to present the experience of treatment of six neonates and infants with parotid hemangiomas. Four cases were treated with external carotid artery ligation, three cases of them have shown a marked reduction of the hemangioma size, [two complete reduction> 90%, one substantial reduction 80% and the last case showed no response or <10%]. It has been concluded that interferon alfa-2a therapy is by far superior to external carotid artery ligation for the treatment of life threatening or cosmetically deforming parotid hemangiomas in neonates and infants

Treatment of osteomyelitis by closed continuous saline suction-irrigation

A total of 110 patients, aged 4 to 65 years, mean 22.4 years, 82 males and 28 females, were treated. The osteomyelitis was post-traumatic in 26 and haematogenous in 84. Of the traumatic cases, 20 followed operations on closed fractures. The disease had started 6 months to 27 years, mean 5.4 years, before treatment. The surgical technique included thorough debridement of soft tissues and excision of sinus tracks and fibrous tissue. The osteomyelitic cavity was treated by one of three procedures: either a] deroofing, saucerisation and sequestrectomy, b] large bored drilling of its walls, or c] packing with cancellous pelvic bone graft after saucerisation and sequestrectomy. This was followed by continuous suction-irrigation by saline circulating hi plastic tubes inserted at the end of the operation. The wound was tightly closed in layers. The irrigation was continued for 7 to 52 days, mean 22.7 days. Antibiotics were started from the first day of the operation. They were chosen properly according to the sensitivity of the microorganisms cultured aerobically and obtained by swabs from discharging sinuses and from the depth of the osteomyelitic cavity. They grew mostly Staphylococcus aureus [101 cases], either alone [79 cases], or with Staphylococcus epidermidis, Gram positive cocci, diphtheroid bacilli, Escherichia coil, Pseudomonas, haemolytic Bacillus subtilis. The results were: clinical cure of the bony and soft tissue disease in 82 cases [74.5%] for all the period of follow-up of 7 to 11 years. Ten more cases [9.1%] were also cured for 7 to 11 years, but had delayed soft tissue healing up to 6 weeks. Of the remaining 18 cases [16.4%] considered as failed, 9 recurred in the first 2 months due to failure of the irrigation system. The other nine cases recurred later within 2 years. Of these 18 cases, 9 could be reoperated, using the same techniques and remained cured. The other 9 refused treatment or vanished

Treatment of carpal scaphoid nonunion by scapho-capitate fusion

Fifty patients with non-united fracture of the carpal seaphoid were studied. All were young adult males, operated upon by a modified Sutro technique. The contiguous cartilaginous surfaces between the scaphoid and capitate bone, were cleared from their articular cartilage. The small gap between the two bones was packed with cancellous bone obtained from the lower end of the radius. Plaster of Paris was applied for three months. In all cases radiological union occurred after three months. A good grip followed, with disappearance of pain and tenderness. Some degree of limitation of movement developed in both dorsiflexion and palmar flexion, mainly affecting the midcarpal joint. It was not disabling and markedly improved by time within a year