Lupine as a potential agent against diet-induced obesity through adenosine monophosphate-activated protein kinase pathway: crude oil versus nanoemulsion formulations

Obesity represents a major challenge to the pharmaceutical community due to the minimal availability of anti-obesity drugs and the drawbacks of current weight-loss agents. The study described herein presents lupine oil, in two pharmaceutical formulations, as a potential anti-obesity agent via its effect on different physiological, biochemical, and hormonal parameters. Rats were divided into two groups; one group was continued on a standard commercial rodent diet and served as the non-obese control. The other group was fed a high-fat diet for 7 weeks to prepare an obese rat model. Then, the obese rats were divided into groups to receive 100 mg/kg of the crude lupine oil or nanoemulsion for 10 or 20 days. Lupine oil showed a potent body weight-reducing effect and improved insulin resistance. The oil altered obesity-induced hyperlipidemia and it enhanced the leptin/adiponectin/AMPK hormonal system in epididymal fat, serum, and liver, to which all the above physiological activities could be attributed. The nanoemulsion formulation of lupine oil significantly amplified the activity for all the above physiological and hormonal parameters when compared to the crude oil formulation. Lupine oil nanoemulsion could be used as a potential drug against diet-induced obesity.

Detection and characterization of carbapenem resistant Enterobacteriacea in Sohag University Hospitals

Background: The spread of carbapenem resistance among Enterobacteriaceae have become a problem for healthcare facilities worldwide. Community and hospital-acquired infections caused by these bacteria have been associated with significant morbidity and mortality with limited treatment options. Rapid detection of carbapenem resistant Enterobacteriaceae [CRE] is important for infection control

Objectives: To detect the prevalence of carbapenem resistant Enterobacteriaceae [CRE] species and determine their antimicrobial susceptibility profile using the Vitek 2 system and the presence of carbapenemases genes using Multiplex PCR

Methodology: Various clinical samples were collected from 469 patients from Sohag University Hospitals in the period between August 2016 and April 2018, CRE isolates were identified by conventional methods and antimicrobial susceptibility testing using disc diffusion method and also performed by Vitek 2 automated system, Multiplex PCR was used for detection of carbapenemases genes as blaKPC, blaVIM, blaIMP, blaNDM-1 and blaOXA-48

Results: The prevalence of carbapenem resistant Enterobacteriaceae [CRE] species was 19.9%, Klebsiella pneumoniae was the most common species [51.4%], Escherichia coli [28.6%], Enterobacter aerogenes[8.6%] and Acinetobacter baumannii [5.7%]. Vitek 2 system identified CRE isolates with 82.7% sensitivity, 98.6 % specificity and 90.6% diagnostic accuracy 25.7% of CRE strains were isolated from the internal ICU and 20 % from Chest Department, and mostly isolated from urine[40%] and from endotracheal tubes swabs[28.6 %] 77.1 % of CRE isolates contained carbapenemases genes, 62.1 % were blaKPC positive, 20.7 % were blaVIM-positive, 3.4 % were blaNDM-positive, 13.8 % were blaOXA-48-positive and none was blaIMP-positive

Conclusion: Conventional methods supported by Vitek 2 system is a valuable method for identification of CRE species, the detected carbapenemases genes in this study indicate that carbapenem resistance is spreading in Egypt and support the use of molecular methods for the rapid detection of CRE for successful implementation of infection control measures. We recommend routine testing to determine carbapenem resistance in Enterobacteriaceae in health facilities in Egypt

Species identification and antifungal susceptibility profile of candida isolates from ICU patients in Sohag University hospital, Upper Egypt

Background: Candida species are among the most common fungal pathogens in ICU patients. Candida albicans was the predominant species, but a shift toward non-albicans Candida species has been recently observed

Objectives: To detect the prevalence of different Candida species and determine their antifungal susceptibility profile in ICU patients using phenotypic methods, the Vitek 2 system compared with CHROMagar Candida agar and a genotypic method; PCR-RFLP

Methodology: Various clinical samples were collected from 248 ICU patients in Sohag University Hospital from the period between September 2014 and May 2015. Samples were cultured on CHROMagar Candida agar. Results were compared with those of Vitek 2 system and confirmed by PCR- RFLP method and antifungal susceptibility profiles were analyzed by disc diffusion and Vitek 2 antifungal susceptibility tests

Results: The study revealed an overall isolation rate of Candida species among ICU patients was 29% by PCR-RFLP. Candida albicans was the most frequent species isolated [40.3%]. Non- albicans Candida species including Candida tropicalis [22.2%], Candida glabrata [18%], Candida krusei [12.5%], C. parapsilosis [4.2%], C. dubliniensis [1.4%] and Candida guilliermondii [1.4%] were also isolated. The sensitivity of vitek 2 with regard to correct identification of Candida species was 96%; the specificity was 100%, also CHROMagar Candida agar enable the correct identification with sensitivity 89%, specificity 100%. Vitek 2 antifungal susceptibility tests results were found to be an accurate method as it was compared with the disc diffusion method for fluconazole, voriconazole and amphotracin B

Conclusion: CHROMagar Candida agar supported by Vitek 2 system is a valuable method for identification of common Candida species, these methods are easy to interpret and give rapid results in comparison with the expensive PCR-RFLP method. Although amphotericin B and fluconazole are widely used in clinical practice, there was no evidence of enhanced resistance. Moreover, voriconazole could be used in treatment of fluconazole-resistant Candida species

Occult Hepatitis B virus infection among Egyptian hepatitis C virus seropositive and seronegative hemodialysis patients in Sohag government, Upper Egypt

Background: Hepatitis B virus [HBV] and hepatitis C virus [HCV] Infections are important and common causes of liver disease in end-stage renal failure [ESRF] in patients on haemodialysis [HD]. HBV is less endemic than HCV in Egypt [ranges from 2%-7%]. Although, the prevalence of HBV in haemodialysis patients has decreased significantly due to HBV vaccine and screening of blood donors, the immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Haemodialysis patients are more risky to develop occult hepatitis B infection [OBI] due to an increased number of blood transfusions, frequent invasive procedures, difficulty in diagnosis of occult hepatitis B infection [OBI] and immunosuppression. Occult hepatitis B infection [OBI] is defined by the presence of HBV DNA in serum or liver tissue in the absence of HBsAg

Objective: to study the prevalence of occult HBV infection in HCV-positive and HCV negative patients on regular hemodialysis from Upper Egypt

Methodology: One Hundred hemodialysis patients with negative HBsAg were included in the study. These patients were divided into two groups: HCV positive and HCV negative, based on the results of anti-HCV by ELISA and HCV-RNA by PCR. HBV-DNA was studied using the real-time PCR method in both groups

Results: HBV DNA was detected in 7 of the 100 patients [7%] and HBcAb was detected in 22 patients [22%]. There were no statistically significant differences in the age, sex, duration of hemodialysis, biochemical parameters, HBcAb, or HBV DNA between patients with and without HCV infection

Conclusion: The prevalence of occult HBV infection [OBI] among Egyptian hemodialysis patients is 7% with no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV infection and we suggest screening of all HD patients for OBI by testing anti-HBc and HBV DNA

Chronic diseases and outcome in critically ill elderly admitted to ICU

Background: Elderly patients are a significant and increasing proportion of ICU patients. With advancing age, the comorbidities critically ill elderly patients have substantial mortality. The early recognition of patients at high risk of mortality is needed to plan care in advance and to control healthcare costs

Aim: To find out the relation between chronic diseases and outcome in critically ill elderly admitted to ICU

Study design: A prospective study

Participants: seventy elderly patients aged 60 years and above

Method: This study was performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill elderly patients admitted for 24 hours or more. Each patient was subjected to on admission clinical assessment including detailed history taking, in addition to laboratory investigations

Results: The results of our study showed that ischemic heart disease was the only chronic diseases that had significant statistical effect on mortality in critically ill elderly admitted to ICU with p. value= 0.002

Conclusion: In the current study we found that mortality was associated with history of ischemic heart disease

Novel GLRB gene mutation in a Saudi baby with hyperekplexia.

Aim: We aim to describe a case of hyperekplexia in a Saudi neonate due to Novel mutation in GLRB. Case Presentation: One month old Saudi neonate with hypertonicity, repetitive episodes of jitteriness and exaggerated startle reflex. Discussion: Hyperekplexia (OMIM:149400, 138492 & 604159) is considered a rare, autosomal dominant neurological disorder that presents early in life with hypertonicity, exaggerated startle response and life threatening neonatal apnea. It has been caused by mutation in the alpha-1subunit (GLRA1) on chromosome 5q32, Beta subunit (GLRB) gene on chromosome 4q31 of the inhibitory glycine receptor and GLYT2 gene (SLC6A5) on chromosome 11p15 which encodes a presynaptic glycine transporter. Conclusion: Raising awareness of the presence of this treatable disease may prevent unnecessary exposure to anti-epileptic medications, prevent life threatening apneas and improve long term outcome.

Health status and risk factors of street children in Beni-Suief city

The magnitude of street children problem is escalating, and this is related to increasing levels of poverty especially in developing countries. The aim of this study was to highlight the problem of street children in Beni-Sueif city, with emphasis on the health and social status of these children through assessing the health status of these children and identifying the most common risk factors influencing their physical, psychological, and social health. The study was conducted on 101 street children in Beni-Sueif city. Data collection tools included an interview questionnaire form, a physical assessment sheet, and a lab sheet for stool and urine analysis, hemoglobin level and viral Hepatitis B and C markers. The results revealed that their age ranged between 7 and 16 years. The majority were current smokers, used addictive substances, and all had aggressive behavior. The most common physical problems were underweight, angular stomatitis, and teeth decay. All had positive stool analysis, 86.1% were anemic, and 24.8% had positive viral hepatitis markers. The predictors of addiction were male sex, longer duration in the street, and smoking. Age was the predictor of being hepatitis B or C positive. Street children are mostly males who quit or never attended schools, and with untoward family circumstances. The majority are indulged in smoking, substance abuse, and violence. They suffer both physical and psychological problems. It is recommended to study the magnitude of the problem at a national level. The role of NGOs must be fostered. Screening programs are needed for these children

Mitomycin-C needle bleb revision in congenital glaucoma

This study was designed to evaluate the efficacy and safety of mitomycin-C [MMC] augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital. A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 +/- 3.4 years [range, 1-12 years]. Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC [0.04 mg/mL] and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous out flow. Follow-up ranged from 6 to 20 months [mean, 9.23 +/- 5.25 months]. One needling revision was performed in 22 eyes [73.3%] and eight eyes [26.7%] received two needle revisions. The mean intraocular pressure [IOP] decreased from 26.9 +/- 2.85 mmHg [range, 21-34 mmHg] before surgery to 15.63 +/- 3.15 mmHg [range, 10-24 mmHg] at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye. MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery

Salicylate induction of phenotypic resistance to ceftazidime in pseudomonas aeruginosa and serratia marcescens possessing AmpC gene, isolated form nosocomial wound infections

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