profile of non-fermentative gram negative bacilli from lower respiratory tract infections in Iraqi patients

1- Identify the non-fermentative Gram negative bacilli [NFGNB]. 2- To compare between bacteria causing RT infections in immunocompromised and immunocompetent patients. 3- To determine the utility of sputum, saliva, and bronchial wash [B.wash] in the identification of bacteria causing RT infections. 4- To determine the antibacterial sensitivity profiles of the isolated microorganisms for diagnostic and therapeutic purposes. This study included 295 patients suffering from LRT infections, attending Ibn Sina Teaching Hospital, and Oncology and Nuclear Medicine Hospital. The patients were subdivided into two groups. The first one consisted of 173 immunocompromised patients complaining of LRT infections accompanied by cancer, diabetes mellitus, or other chronic diseases. The second group, comprised 122 immunocompetent patients suffering from LRT infections only. Collectively these RT infections were of three clinical entities namely bronchitis [99/295; 33.6%], pneumonia [156/295; 52.9%], and bronchiectasis [40/295; 13.5%]. Also, three clinical specimens including sputum [216 samples], saliva [216 samples], and bronchial wash [79 samples] were examined. The identification of the isolated bacteria was carried out by direct examination, culture on specific selective and standard media, and biochemical tests. Moreover, the isolates of NFGNB were tested for sensitivity to various antibacterial agents. A total of 358 bacterial isolates were detected among the sputum and B. wash specimens from the 295 patients. The bacterial isolates were encountered from both immunocompromised [225/358; 62. 8%] and immunocompetent [133/358; 37.2%] patients. Out of these 358 isolates, 47 [13.1%] were NFGNB. Among these 47 isolates 20 [61.7%] were detected from immunocompromised patients, while 18 [38.3%] were encountered in immunocompetent ones. Besides, a total of 294 common bacterial pathogens including 153 [42.7%] Gram positive, 104 [29.1%] Gram negative, 37 [10.3%] anaerobes were isolated. However, the best agents for the NFGNB isolates were amikacin [93.8%] and ciprofloxacin [85.8%]. The NFGNB are important uncommon pathogens in LRT infections. Sputum and B. wash are reproducible clinical specimens for the detection of various microorganisms causing LRT infections. Amikacin and ciprofloxacin are the proper drugs for the NFGNB

Antiphospholipid syndrome as a cause of recurrent pregnancy loss

[1] To Study the effect of antiphospholipid syndrome [APS] on recurrent pregnancy loss [RPL] in relation to the trimester of gestation and pregnancy outcome. [2] To identify auto antibodies related to the APS, namely anticardiolipin [ACA], antiphoshatidyl serine [APA], lupus anticoagulant [LAC] and false positive- Venereal Diseases Research Laboratory test [FP-VDRL] response. This study included 72 patients with RPL and 30 apparently healthy multiparous women as a control. It was found that 21 [29 percent] patients had APS who were all AC A positive. Of these patients only one was also positive for LAC antibodies and three for APA. The FP-VDRL test was found to be significantly associated with APS, especially with the IgG group. The ACA concentrations [both of IgG and IgM] were significantly higher [P> 0.05] in patients than in the control. The ACA concentrations and prevalence were significantly higher in the primary losers than in the control, while total APA prevalence was higher [P>0.046] in the primary losers than the secondary one. Both ACA and LAC did not show significant differences in any of the three trimesters of pregnancy loss. It was found that APA was significantly effective on RPL during the first trimester [P>0.046]. Also, the FP-VDRL was significantly different when comparing first trimester losers with the third trimester pregnancy losers. The APS with ACA and/or LAC may carry risk of RPL. The presence of APA alone has no risk of RPL, but when associated with ACA may indicate a more complicated condition