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Streptococcus is a genus of spherical Gram-positive bacteria belonging to the phylum firmicutes and the lactic acid bacteria group. Members of the genus Streptococcus cause mild to severe bacterial illnesses in humans and animals. This work was designed to determine the biochemical, serological, and molecular characterization of Streptococci species isolated from cow`s milk, broilers chickens, and Nile tilapia. Bacteriological examination was carried out on 255 Samples (120 cow' milk, 65 broiler chickens, and 70 Nile tilapia) collected during the period from July 2010 to June 2013 from various localities in Beni-Suef Governorate, Egypt. Identification of the isolated strain revealed S. agalactiae, S. equi subsp. zooepidemicus, E. fecalis, S. iniae, E. avium and L. lactis subsp. Lactis were found in the isolated strains. Furthermore S. agalactiae (Lancefield group B), S. equi subsp. zooepidemicus (Lancefield group C) and E. faecalis (Lancefield group D) were found in the agglutination test for Lancefield groups. A multiplex PCR assay involves amplifying the multiple gene products in a single reaction using primers derived from 16S rRNA genes of S. agalacitae, S. equi subsp. zooepidemicus and lctO gene of S. iniae. The amplified products showed amplification of 220bp, 679bp and 870bp of amplification respectively. The sensitivity of streptococci species to antimicrobials exhibited that S. agalactiae, S equi subsp. zooepidemicus and S. iniae showed high sensitivity to both enrofloxacin, erythromycin followed by cephalexin. [ABSTRACT FROM AUTHOR]

Fish with bacterial septicemic syndrome (BSS) exhibit very similar clinical signs regardless of the etiological agents. Members of Aeromonas, Pseudomonas, Vibrio, Edwardsiella, Streptococcus and Lactococcus species are considered the most reported bacterial pathogens incriminated in such syndrome. Aeromonas hydrophila, Edwardsiella tarda and Streptococcus iniae are 3 major pathogens share in the BSS associated losses in aquaculture and considered problematic for growth of tilapia and catfish production in Egypt. Therefore, rapid and accurate diagnosis is highly needed for controlling their disease outbreaks, particularly, in mixed infections. In an attempt to elucidate the main causative pathogen, a novel multiplex PCR (m-PCR) was newly designed in this study. The developed m-PCR involves amplifying the three multiple genes in single reaction based upon primers deduced from the regions carrying 16S rRNA, etfA and 16S RNA genes of A. hydrophila (Aeromonas spp.), E. tarda and S. iniae, respectively. Prior to perform m-PCR, individual PCR assays were carried out to adapt suitable laboratory and m-PCR assays conditions. The specificity of the developed m-PCR was confirmed by the fact that only specific fragments were amplified equivalent for 953, 415 and 300 bp corresponding to A.hydrophila, E. tarda and S. iniae, respectively, and that was evident with both extracted DNAs and the bacterial cells. More specifically, these specific bands were obtained also when either the extracted DNAs or the bacterial cells of the three pathogens mixed together in the reaction. The developed m-PCR is accurate, sensitive, fast and simple technique for the simultaneous detection of A. hydrophila (Aeromonas spp.), E.tarda, and S. iniae, three major bacterial pathogens involved in BSS incidence in Egypt. [ABSTRACT FROM AUTHOR]

Background Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease, with the highest prevalence amongst Mediterranean countries including Egypt (where there is high carrier rate of MEFV gene), characterized by recurrent attacks of fever and polyserositis. Mutations in the MEFV gene encoding pyrin has been associated with the disease, which causes exaggeration of the inflammatory response through uncontrolled interleukin production. Issuing updated treatment recommendations are vital for the treating healthcare professionals to get well acquainted with its diagnosis & treatment. To produce consensus-based recommendations to guide the early diagnosis, management and follow-up of patients with FMF. Methods The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by the core team. A qualitative synthesis of scientific evidence based on systematic review and clinical experience was conducted to compile evidence for the diagnosis and management of FMF. A consensus process was conducted among the expert panel to generate the final recommendations and grade their strength. 3 rounds of Delphi process were carried out. Results Following 3 Delphi rounds, recommendations were developed for: early diagnosis, who to treat, treatment targets, genetic testing and its interpretation in association with clinical presentation, treatment of FMF and dealing with acute attacks, monitoring of management, identify treatment response, systemic affection, persistent attacks or inflammation, resistant cases, protracted symptoms, as well as remission status. Algorithm for patients' diagnosis and management is provided. The final document comprises 12 recommendations, each presented with its degree of agreement (0–10), Level of agreement, grade of recommendation and rationale. The degree of agreement was >7/10 in all instances. Conclusion This guideline provides comprehensive approach to the accurate diagnosis and effective management/monitoring of FMF. It also represents a model for the incorporation of medical genetics practice into the more traditional domains of general medicine. [ABSTRACT FROM AUTHOR]

Introduction/objectives: systemic sclerosis (SSc) is an autoimmune disorder with multiple organs destruction. This study aimed to identify the ultrasonographic changes of major salivary glands in Egyptian scleroderma patients and to detect their association to different disease manifestations., Methods: Forty-seven SSc patients and 43 apparent healthy volunteers were enrolled. Demographics, inflammatory markers, and autoimmune status were recorded. Ultrasound evaluation of salivary glands was performed. Salivary gland changes' associations were statistically examined with SSc susceptibility and disease manifestations., Results: Thirty-one SSc patients exhibited glandular pathology (p < 0.0001), compared to controls. Of these abnormalities, SSc patients showed a total parotid gray scale of 2, total submandibular gray scale of 2, total glandular gray scale of 4, and total glandular Doppler signal of 1 at p < 0.0001, compared to the control group. Patients with SSc and glandular pathology had a higher prevalence of arthritis (p = 0.029) and ESR (p = 0.002) than those with normal glandular ultrasound. Significant associations were reported between gray scale ultrasound (GSUS) of total parotid (odds ratio "OR" = 0.4), total submandibular (OR = 0.36), and total glandular (OR = 0.53) with susceptibility to SSc at p < 0.0001. Total glandular GSUS (p = 0.039) and total submandibular power Doppler (p = 0.044) correlated with the SSc duration. Total parotid GSUS (p = 0.008) and total glandular GSUS (p < 0.0001) correlated with Schirmer's test., Conclusions: Major salivary glands are affected in SSc. Hence, scanning these glands with ultrasound is an additive tool besides the current practice. Key Points • Major salivary gland changes, observed by ultrasonography, are new findings in Egyptian SSc patients. • Ultrasound changes of major salivary glands are associated with inflammatory markers and clinical manifestations of SSc. • Scleroderma ultrasonography scans of the main salivary glands could be added to the routine work., (© 2023. The Author(s).)

Purpose: Since the declaration of COVID-19 as a pandemic, a wide between-country variation was observed regarding in-hospital mortality and its predictors. Given the scarcity of local research and the need to prioritize the provision of care, this study was conducted aiming to measure the incidence of in-hospital COVID-19 mortality and to develop a simple and clinically applicable model for its prediction., Methods: COVID-19-confirmed patients admitted to the designated isolation areas of Ain-Shams University Hospitals (April 2020-February 2021) were included in this retrospective cohort study (n = 3663). Data were retrieved from patients' records. Kaplan-Meier survival and Cox proportional hazard regression were used. Binary logistic regression was used for creating mortality prediction models., Results: Patients were 53.6% males, 4.6% current smokers, and their median age was 58 (IQR 41-68) years. Admission to intensive care units was 41.1% and mortality was 26.5% (972/3663, 95% CI 25.1-28.0%). Independent mortality predictors-with rapid mortality onset-were age ≥ 75 years, patients' admission in critical condition, and being symptomatic. Current smoking and presence of comorbidities particularly, obesity, malignancy, and chronic haematological disorders predicted mortality too. Some biomarkers were also recognized. Two prediction models exhibited the best performance: a basic model including age, presence/absence of comorbidities, and the severity level of the condition on admission (Area Under Receiver Operating Characteristic Curve (AUC) = 0.832, 95% CI 0.816-0.847) and another model with added International Normalized Ratio (INR) value (AUC = 0.842, 95% CI 0.812-0.873)., Conclusion: Patients with the identified mortality risk factors are to be prioritized for preventive and rapid treatment measures. With the provided prediction models, clinicians can calculate mortality probability for their patients. Presenting multiple and very generic models can enable clinicians to choose the one containing the parameters available in their specific clinical setting, and also to test the applicability of such models in a non-COVID-19 respiratory infection., (© 2023. The Author(s).)

Objectives: Recently, direct acting antivirals (DAAs), sofosbuvir (SOF) combined with ledipasvir (LED), were approved for treatment of hepatitis C virus (HCV)-infected children 12 years of age and older or weighting at least 35 kg for all HCV genotypes. The aim of this study was to assess the safety and efficacy of SOF/LED in genotype 4 HCV-infected Egyptian children and adolescents., Methods: This observational study included 40 consecutive HCV-infected children of age 12 to <18 years old or weighing >35 kg, both treatment-naive and treatment-experienced. All of the children were hepatitis B virus-negative and had normal renal functions and heart rate. Patients received oral, fixed-dose combination tablet of SOF/LED (400 mg SOF, 90 mg LED [Harvoni]) once daily for 12 weeks. Potential side effects were recorded at weeks 4, 8, and 12 weeks of treatment. The study primary outcome was sustained virological response 12 weeks (SVR12) after end-of-treatment., Results: The study included 40 children and adolescents, 24 were boys (60%); their age ranged between 11.5 and 17.5 years (mean 13.9 ± 1.5). Baseline viral load ranged between 9630 and 24,600,000 IU/mL. HCV RNA became negative in 39 patients (97.5%) at 4 weeks and in all patients (100%) at weeks 8, 12, and SVR12. Asthenia was the commonest side effect, reported in 52.5% followed by headache in 47.5%., Conclusions: Treatment with all-oral DAAs (SOF/LED) for 12 weeks was well tolerated in Egyptian children and adolescents infected with genotype 4 HCV, with 100% SVR12 and negligible side effects.

Background and Aim: Extrahepatic portal vein obstruction (EHPVO) is an important cause of portal hypertension in children. The aim of this study was to describe the clinical presentation, possible risk factors, upper gastrointestinal endoscopic findings, and treatment modalities of children with EHPVO., Methods: After ethical approval of our study protocol by our institution review board, we analyzed available data from medical records of patients with EHPVO presenting to the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Egypt, for a period of 15 years from January 1996 to December 2010., Results: The study included 169 patients. Their ages at presentation ranged from 1 month to 12 years (median 2.5 years, interquartile range 5); 101 were boys. Hematemesis was a presenting symptom in 58%, splenomegaly was present in 87%, esophageal varices were present in 94%, and fundal varices were present in 23%. Possible risk factors, in the form of umbilical catheterization, umbilical sepsis, and exchange transfusion, were elicited in 18%. Propranolol was associated with reduction in bleeding episodes (P < 0.001), but was associated with increased chest symptoms (P < 0.01). Both injection sclerotherapy and band ligation were effective in the management of bleeding varices and for primary and secondary prophylaxis; however, injection sclerotherapy was associated with the development of secondary gastric varices (P = 0.03)., Conclusions: This large study of children with EHPVO demonstrates the efficacy of propranolol in the reduction of gastrointestinal bleeding in children with EHPVO. Both injection sclerotherapy and band ligation were effective in the management of esophageal varices, although the former was associated with the development of secondary gastric varices. Randomized clinical trials to choose the best modalities for the management of portal hypertension in children are still lacking.

Background/aims: In Egypt, the liver transplantation (LTx) program that became available since 2001 is a living donor program. We aimed to assess the obstacles to pediatric LTx., Methods: Over a six-month-period, 41 pediatric patients were indicated for LTx; their ages ranged between 1.5 months to 17 years. Patients and potential donors were evaluated according to the program protocol., Results: The obstacles for performing LTx were classified into recipient, donor and program obstacles or limitations. Each patient may have more than one limitation. Late presentation and co-morbid conditions were on the top of the recipient list of obstacles. Refusal of potential donors to donate was the commonest limitation on the donor side (33%). The commonest program limitations were young age and small size of the recipient., Conclusions: Limitations in recipient characteristics as well as donor shortage are still the main obstacles for living donor liver transplantation (LDLT) in our pediatric liver disease patients. Small weight and young age of potential LDLT candidates are the principle causes for delaying this life saving procedure. Increasing community awareness about living organ donation and nutritional support for end stage liver disease (ESLD) babies is pivotal, given our limitation to a living donor program.

Background and Study Aims: Most paediatric patients with Wilson's disease (WD) present with hepatic manifestations, but some may have neurologic or psychiatric features. Our aim was to define the clinical, biochemical features and the outcome of therapy of a group of Egyptian children diagnosed with WD., Patients and Methods: The study was carried out at the Paediatric Hepatology Unit at Cairo University Children's Hospital, Egypt; 54 patients were diagnosed with WD from 1996 to 2009. The diagnosis was based on low serum ceruloplasmin levels, increased urinary copper concentrations before or after D-penicillamine challenge and/or the presence of Kayser-Fleischer (K-F) rings., Results: The clinical presentation was as follows: hepatic presentation in 33 patients (61%), hepato-neurologic 3 (5.5%), neurologic 5 (9.3%) and presymptomatic 13 (24%). Twelve couples had more than one affected sib. Increased urinary copper concentrations before or after D-penicillamine challenge was found in all patients, low serum ceruloplasmin in 97% and K-F rings in 31.5%. All patients were treated with penicillamine and zinc sulphate except one presymptomatic case who was treated with zinc sulphate only. Three patients underwent liver transplantation and eight patients died after a median duration of treatment of 6 months (1-36). The hepatic symptoms improved with treatment but the neurological symptoms remained stationary., Conclusions: Clinical and biochemical assays remain the standard for diagnosis of WD. Penicillamine and zinc therapy can effectively treat WD with hepatic symptoms. Liver transplantation remains life saving for those with fulminant and end stage WD. Screening for presymptomatic sibs is of utmost importance., (Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.)

Objectives: Celiac disease (CD) is increasingly reported from North Africa, including Egypt. Autoimmune hepatitis (AIH) is considered a high risk factor for CD. We aimed to investigate the frequency of CD diagnosis in AIH., Methods: We prospectively enrolled 26 AIH patients aged 3.5-21 (mean 9.98 ± 3.94) years and 20 healthy age- and sex-matched controls. Serodiagnosis of CD was based on the most sensitive tests namely immunoglobulin A (IgA) human tissue transglutaminase antibody (IgA-tTGA) by enzyme-linked immunosorbent assay and/or IgA endomysial antibody (IgA-EMA) by immunofluoresence and confirmed the diagnosis by upper gastrointestinal endoscopy and histo-pathological findings in jejunal biopsy., Results: IgA-EMA was positive in four patients (15.4%), whereas IgA-tTGA was positive in two of them (7.7%). Histopathology was confirmatory in three (11.5%) seropositive patients., Conclusion: The high prevalence (11.5%) of CD among Egyptian children with AIH indicates that CD exists in high-risk groups in our region and must be carefully looked into.

Background: Glycogen storage disease type III (GSD III) is caused by mutations in AGL which encodes for a single protein with two enzyme activities: oligo-1, 4-1, 4-glucantransferase (transferase) and amylo-1, 6-glucosidase. Activity of both enzymes is lost in most patients with GSD III, but in the very rare subtype IIId, transferase activity is deficient. Since the spectrum of AGL mutations is dependent on the ethnic group, we investigated the clinical and molecular characteristics in Egyptian patients with GSD III., Methods: Clinical features were examined in five Egyptian patients. AGL was sequenced and AGL haplotypes were determined., Results: Six novel AGL mutations were identified: a large deletion (c.3481-3588+1417del1525 bp), two insertions (c.1389insG and c.2368insA), two small deletions (c.2223-2224delGT and c.4041delT), and a missense mutation (p.L620P). p.L620P was found in a patient with IIId. Each mutation was located on a different AGL haplotype., Conclusions: Our results suggest that there is allelic and phenotypic heterogeneity of GSD III in Egypt. This is the second description of a large deletion in AGL. p.L620P is the second mutation found in GSD IIId.

No identifiable cause can be found in more than half of the cases of portal vein thrombosis (PVT). Our aim was to assess the prevalence of factor V Leiden mutation and other thrombophilic factors as risk factors in the development of PVT in the pediatric age group. From March 2001 to January 2002, 40 children with PVT were enrolled in the study, in addition to 20 age-matched and sex-matched controls. Protein C, protein S, antithrombin III, and activated protein C resistance (APCR) were assayed. Molecular study of factor II and factor V mutations was carried out. Of the patients, 25 had detectable hereditary thrombophilia (62.5%), 12 had factor V Leiden mutation (30%), 11 had protein C deficiency (27.5%), 6 had factor II mutation (15%), 1 had antithrombin III deficiency (2.5%), and none had protein S deficiency. Five children had concurrence of more than one defect. Factor V Leiden mutation is the most common hereditary thrombophilia associated with PVT and the relative risk of factor V Leiden mutation, as a cause of PVT, was six times more than in controls (odds ratio=6). Concurrence of more than one hereditary thrombophilic factor was seen in 12.5% of our patients. Circumstantial risk factors (neonatal sepsis, umbilical sepsis, umbilical catheterization) were not more significantly prevalent among patients with hereditary thrombophilia than among those with no detectable abnormalities in anticoagulation.

The relationship between outdoor air pollution and acute respiratory infections (ARI) was previously documented. There are recent indications for connection between indoor air pollution and ARI in infants and young children. The aim of this study was to identify the relationship of indoor air pollutants to acute lower respiratory infection (ALRI) in children (< 2 years). The indoor air pollutants concentrations were measured in the homes of the sample. The sample consisted of 115 children (< 2 years) representing the control group (24), ALRI but no pneumonia (24), pneumonia (30), severe pneumonia or very severe disease (37). Air sampling was performed to measure the concentration of total suspended particulates (TSP), SO2 and CO. These pollutants were found in higher concentrations in cases' homes (52.46 +/- 19.68 microg/m3, 298.15 +/- 669.37 microg/m3, and 1.92 +/- 3.60 ppm) than in controls' homes (31.92 +/- 8.76 microg/m3, not detected, and 0.33 +/- 1.63 ppm respectively). Whereas SO2 was detected only in houses using kerosene, TSP and CO were detected with the different types of cooking fuels. Their mean concentrations were highest for biomass (88.86 +/- 13.30 microg/m3 and 9.29 +/- 2.50 ppm) and lowest for gas (40.78 +/- 15.25 microg/m3 and 0.76 +/- 2.19 ppm). Measures to improve indoor air quality are highly required.

The present work was planned to study morbidity pattern and nutritional status of a group of healthy new borns in a rural area near Alexandria (Abbis II, VIII villages) through a prospective follow up approach. Eighty two infants were followed up for 12 months. Each infant was subjected to 15 visits within the first year of life. Morbidity was recorded either from mother's history, records from rural health centres or detected by the researcher and expressed as morbidity risk exposures based on a tested scoring system. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age and weight for length in terms of a cut off point of 2 SD below the median of that of the reference. Gomez classification was used to diagnose undernutrition and Waterlow system was used to diagnose growth stunting. Socioeconomic status of infants' families was also assessed. Results indicated a high prevalence of morbidity risk exposure, growth retardation and under nutrition with a tendency for gradual increase towards the end of the follow up. The results also proved that diarrheal diseases were still the most common illness among infants followed by respiratory tract infections. Investigation of the effects of socioeconomic status on morbidity risk exposure proved its significance at the end of the follow up. The results also illustrated a significant effect of morbidity risk exposure on the nutritional status at the end of the first year.

The aim of the present study was to construct standard symphysis fundal height percentile curves to be used as a reference chart in monitoring fetal growth. The construction was based on 1185 observations (symphysis fundal height measured to the nearest 0.5 cm by a malleable elastic tape) obtained from follow up of 105 cases of healthy pregnant women who were: sure of date of their last menstrual period, confirmed by early dating scan "before 20th gestational week", experienced a very strict normal course of pregnancy, giving birth to normal term newborn with appropriate weight for gestational age and sex. The selection of the study sample went through several screening levels starting by 4088 cases and ending by 105 cases. The measurements were taken biweekly from the 18th week of gestation to delivery "37-42 weeks of gestation." Tenth, 25th, 50th, 75th, 90th and 95th percentiles were calculated and represented graphically. Mean, mean-1 SD, mean-2 SD, mean +1 SD, mean + 2 SD were also calculated and represented graphically. The curve of best fit was determined by polynominal regression. The resulted percentile curves and mean values were found to be comparable to those in both developed and developing countries. It was recommended to incorporate the reference charts of symphysis fundal height into the maternity services after using it in routine antenatal examination for large number of cases and establishing its sensitivity and specificity.

A cross-sectional nutritional survey of children aged 6-24 months (weaning period) attending MCH centres in Alexandria governorate through the year 1988-1989 was conducted with the aim of determining the prevalence of protein calorie malnutrition. The sample size was 1000 children chosen from 6 MCH centres in Alexandria (one centre for each zone). The sample was distributed along the six centres in proportion to the total number of infants recorded to have attended those centres through 1985. The centres were visited during the period starting November 1988 through June 1989. Each centre continued to be visited until the number decided to be included was completed. The study included the determination of age and the measurement of height and weight. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age, and weight for length in terms of a cut off point of 2 SD below the median of that of reference (Waterlow system). Gomez classification using weight/age as a parameter was used to diagnose undernutrition. The results of the study revealed a prevalence rate of undernutrition of 25.6% which was mostly of the first degree as expressed by Gomez categories. When expressed using waterlow system a prevalence of stunting of 29.7% was observed while wasting was observed in only 0.7% and concurrent wasting and stunting constituted 0.1%. These results were considered to be relatively lower in comparison to earlier similar studies. It was thus recommended that similar surveys for preschool age children in Alexandria and other regions of Egypt would be valuable.

A cross-sectional study was carried out on a sample of 900 pregnant women attending MCH centers in Alexandria to determine the incidence of high risk pregnancy and to demonstrate the common risk factors among them. The simplified scoring system developed by Morrison and Olsen (1979) was used. Mothers with scores 0-2 were considered at low risk those with score 3 and more were categorised as high risk. Results revealed that high risk women constituted 27.78% of the sample. Twenty three risk factors were identified among all pregnant women screened. The most frequently encountered were anaemia (37.33%), age 35+ (15.66%), parity 5+ (16.66%), previous gynecological surgery (8.88%) and history of previous stillbirth or neonatal death (6.11%). The mean number of risk factors in the low risk group was 0.95 compared to 3.03 in the high risk group. Stepwise regression analysis indicated that the reproductive history score was the best one variable predictor of total risk score explaining about 74% of the variation in the total score while the present history score explained a further 16% of the variation and the associated conditions score explained 9% only of the variation. The use of scoring technique is recommended to be used in identification of high risk pregnant women in MCH centers.

The present study was conducted to illustrate the range of normal blood pressure among pregnant mothers attending MCH centres and its biological and socioeconomic determinants. A total sample of 630 pregnant mothers were selected from 6 centres representing the 6 zones of Alexandria. Mothers of blood pressure above 140/90 mm Hg were excluded. The results showed that the mean systolic blood pressure in the first trimester was 112.16 mm Hg, decreased to 109.42. mm Hg for mothers in the 2nd trimester and raised again to 114.41 mm Hg in the 3rd trimester. A variety of socioeconomic and biological factors were involved in changing the range of blood pressure within normal limits specially during specific trimesters of pregnancy. It is recommended to record blood pressure for pregnant mothers from the first antenatal visit at any trimester. Single value can be used as potential marker. Those with higher trends of normal pressure values should be systemically followed.