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Background: Mortality due to infection with carbapenem-resistant Enterobacteriaceae (CRE) is reported globally and carbapenemase production is the main mechanism of resistance in these isolates. The detection and treatment of carbapenemase-producing Enterobacteriaceae (CPE) is a major challenge in health care facilities. Objectives: The aim of the current study was to evaluate the in-vitro effect of different single and combined antibiotic agents against CRE clinical isolates. Methodology: Fifty CRE isolates were detected using disk diffusion test as a screening test. Species identification and antibiotic susceptibility testing was done using Vitek 2 system. Carbapenemase enzyme production was confirmed by Carba NP test. Multiplex PCR was done to detect carbapenem resistance genes. Antibiotics were tested in the form of single agents (colistin and tigecycline) and combined (tigecycline/ colistin, doripenem/ colistin and dual carbapenem therapy (ertapenem and doripenem) against CRE isolates using E-test method. Results: Most of the CRE isolates were K. pneumoniae, 68%, followed by E. coli, 22%, S. marcescens, 4%, E. cloacae, 4% and C. freundii, 2%. CPE was confirmed in 46 isolates by multiplex PCR; blaNDM-like was the main carbapenem resistance gene in (84%) of the isolates, followed by blaOXA-48-like (6%) and blaKPC-like (2%). Carba NP test detected 90% of CPE isolates. Single use of colistin and tigecycline showed 100% sensitivity against all tested CRE isolates except in blaNDM-like (83%). Combination of colistin/tigecycline showed synergetic activity in 18% of CRE that was correlated to their carbapenemase R genes showing a significant increase in blaOXA-48-like and blaKPC-like positive isolates (100%) compared to blaNDM-like (7%). Other combinations showed indifferent effect whereas antagonism was not detected in any of the tested combinations. Conclusions: blaNDM-like is the main carbapenemase-producing gene detected among our CPE isolates followed by blaOXA-48-like. Colistin and tigecycline are still effective when used as single agents, and may offer effective treatment options when used in combination for CRE infections. Characterization of carbapenemases is crucial in determining treatment options. There is urgent demand for the development of novel therapeutic agents against NDM-producing CPE isolates.

Background: coronary artery bypass graft (CABG) is considered alone of the most critical surgeries in Egypt nowadays. Assessing bio psychosocial needs for patients post (CABG) is very important for facilitating their recovery and helping them cope with any health problems. Aim: This study aimed to assess bio psychosocial needs of patient post coronary artery bypass graft (CABG). Research design: Descriptive exploratory design was used to achieve the aim of this study. Setting: This study was conducted in the Cardio Thoracic Outpatient clinics at Cardio Thoracic Academy affiliated to Ain Shams University Hospital. Subject: A purposive sample of 60 adult patients' post CABG were taken to conduct this study randomly selected. Tools:1). Patient′ interviewing questionnaire, 2: Bio psychosocial needs of patients post Coronary Artery Bypass Graft assessment tool. Results:70%of patients under study had satisfactory level of knowledge regarding coronary artery bypass graft. As well as, there was higher mean score of the studied patients regarding their social needs 53.06± 13.63 rather than psychological needed 44.64±7.37 and physical need 40.74±12.53. Conclusion: The studied patients reported the social needs very much need more than the other needs, more than half of the studied patients reported psychological needs.regarding depression. Recommendations: further studies should be designed to encouraged Patients to participate in rehabilitation programs post coronary artery bypass graft surgeries to satisfy their physical, psychological and social needs.

Candida species resistant to fluconazole and voriconazole were screened for the presence of ERG11gene by polymerase chain reaction (PCR). Also, the association of this gene with the demonstration of Candida virulence factors; biofilm formation, phospholipase and proteinases activities were studied. A total of 61 Candida isolates were collected from urine specimens. Candida species were identified by API 20 C Aux test. Extracellular phospholipase, secretory aspartyl proteinase and biofilm formation were determined. ERG11 gene was detected by PCR. C. albicans was identified in 34.5%, C. glabrata in 29.5% and C. tropicalis and C. krusei in 18% each. Candida species was resistant to fluconazole and voriconazole in 55.7% and 27.9%, respectively. Seventeen (50%) of fluconazole resistant Candida isolates were sensitive to voriconazole. The most frequently Candida species revealed fluconazole resistance were C. glabrata (47.1%), C. krusei (29.4%), and C. tropicalis and C. albicans (11.8% each). Biofilm formation, phospholipase and proteinase activity were determined in 41.2%, 67.6% and 35.3% of fluconazole resistant Candida isolates, respectively. Erg 11 gene was determined in 82.4% of fluconazole resistant Candida isolates and prominent in C. glabrata (93.75%), followed by C. krusei (90%), C. tropicalis (75%) and C. albicans (25%). Erg 11 gene was detected in 64.7% (11/17) of fluconazole resistant-voriconazole sensitive Candida isolates. Regarding, correlation of Erg11 gene positivity and virulence factors among fluconazole resistant Candida isolates, 34.5% exhibited biofilm formation and 62.1% and 31% showed phospholipase and proteinase activities, respectively. There were statistically significant difference concerning the association of proteinase activities and Erg 11 gene expression among fluconazole resistance Candida isolates (P=0.04). The study emphasizes the high prevalence of Erg11 gene among fluconazole resistant Candida species. There was association between the proteinase activity, fluconazole resistance and the presence of Erg11 among Candida species. Voriconazole maintains better activity towards Candida species and represent an alternative therapy.

Purpose Higher education institutions (HEIs) should play a fundamental role in achieving the international 2030 sustainable development (SD) agenda. Quality education is the fourth of the sustainable development goals (SDGs), and one of the targets related to this is to ensure that by 2030 all learners acquire the knowledge and skills needed to promote SD. Therefore, the SDGs provide a motive for HEIs to integrate SD concepts into their day-to-day practices. This study aims to introduce a framework for HEIs’ sustainable development assessment. Such a framework guides HEIs and educational leaders to support their countries’ commitments to achieving the SDGs. Design/methodology/approach This paper presents the results of a case study analysis of the role and successful techniques of HEIs in achieving SD in three countries, namely, Germany, Japan and Egypt. Primary data was collected by semi-structured interviews with three Cairo University officials, while secondary data was collected by reviewing the universities' official websites, reports, publications and related papers. This study introduces a novel framework for HEIs' SD analysis and assessment, which guides HEIs and educational leaders to support SD to fulfill their countries' commitments to achieving the SDGs. This framework is based on the following five categories: strategic direction and institutional working practices, supporting students, supporting university staff competencies, supporting society's stakeholders and networking and sustainable campus. Consideration is given to the potential role of HEIs to support SD in each of these areas. Findings Cairo University could learn from the novel and pioneer practices of the Leuphana University of Lüneburg, and the University of Tokyo to fill in the gaps it has in different roles. It can also put more effort into adopting the suggested higher education programs of Egypt's Vision 2030. Research limitations/implications This paper is limited to a case analysis comparing three countries, Germany, Japan and Egypt. Second, this study has not considered school education, which is equally essential in countries' SD. Practical implications HEIs can use the framework and the findings in this paper to evaluate their current roles in supporting SD, identify the gaps and take actions accordingly to address their weaknesses. Originality/value The paper compares three universities, one in each of the case study countries. It draws conclusions that identify ways in which the paper's framework and findings can guide SD practice in HEIs internationally, especially those in the developing world.

Purpose The rise of carbapenem-resistant A. baumannii (CRAB) is considered a public health problem limiting the treatment options. Our current work studied the emergence and mechanisms of colistin-resistance among CRAB isolates in Egypt. Materials and methods Seventeen clinically recovered A. baumannii were identified and screened for their antimicrobial susceptibilities using VITEK-2 system. Colistin susceptibility was evaluated using broth microdilution, and characterization of carbapenem/colistin resistance determinants was performed using whole-genome sequencing (Illumina MiSeq). Results About 52.9% (9/17) were colistin-resistant. PCR results revealed that all isolates carried bla OXA-51-like genes, bla OXA-23-like was detected in 82.3% (14/17) and bla NDM in 23.5% (4/17). Two isolates harboured bla GES-35 and bla OXA-23. Furthermore, genome analysis of seven isolates revealed six belonged to international clone 2 (IC2) while the remaining isolate was a singleton (ST158), representing a clone circulating in Mediterranean/Middle Eastern countries. Conclusion The emergence and high incidence of colistin-resistance among CRAB clinical isolates in Egypt are alarming because it further limits therapy options and requires prudent antimicrobial stewardship and stringent infection control measures. Whole-genome sequence analyses suggest that the resistance to colistin was associated with multiple mutations in the pmrCAB genes. The high incidence of the high-risk lineage IC2 harbouring bla OXA-23-like as well as bla NDM is also of concern.

Introduction Acinetobacter baumannii is a challenging pathogen responsible for serious nosocomial infections. Colistin resistance in carbapenem-resistant A. baumannii strains is a critical health problem as it limits the available therapeutic options. The current work aimed to study the reliability of several phenotypic methods for the detection of colistin resistance among carbapenem-resistant A. baumannii isolates in Egypt. Methods A total of 22 carbapenem-resistant A. baumannii isolates were recovered. Colistin minimum inhibitory concentrations (MICs) were determined using broth microdilution (BMD) and compared to agar dilution (AD), automated system (VITEK-2) and gradient test (E-test) and were analyzed by statistical methods. Results Phenotypic testing showed that nine of 22 isolates (40.9%) were colistin-resistant by BMD and seven of them were also resistant by AD, with the categorical agreement (CA) of 72.7% and essential agreement (EA) of 90.9%. Colistin MIC results ranged from 1-8 µg/mL and 1-32 µg/mL by both AD and BMD respectively. Detection of colistin resistance by gradient test and automated system showed high very major error (VME) rates (40.9%) compared to BMD with a lack of CA between them. AD gave moderate agreement with BMD by 90.9% EA, 72.7% CA and only 9.1% VME. Conclusions In delineating colistin breakpoints BMD followed by AD method are defined as the only reliable phenotypic methods for colistin resistance evaluation. More rapid and reliable tests, other than BMD and AD, are required for the convenient detection of colistin resistance in the routine clinical microbiology laboratory daily workflow.

Lenticular galaxy NGC3 has been chosen to study the surface photometry using griz filter. The data where obtained from the seventh Sloan Digital Sky Survey (SDSS) Data Release seven (DR7), and main the image reduction was done by the pipeline of SDSS. The work was achieved by the ELLIPS task from the STSDAS ISOPHOTE package in the Image Reduction and Analysis Facility (IRAF).The overall structure of the galaxy (a bulge, a bar, isophotal contour maps, together with a bulge to disk decomposition of the galaxy images where achieved, Also, the photometric properties (the disk position angle, ellipticity, B4 and inclination of the galaxy) where estimated.

Resistance to quinolone has increased significantly and one of the most reasons is plasmid-mediated quinolone resistance (PMQR). The aim of this study is to detect the prevalence of PMQR in multidrug-resistant (MDR) Gram negative bacilli and to characterize these resistance genes. A total of 420 Gram negative bacilli clinical isolates were collected from patients attending Misr children hospital. Isolates were identified by biochemical reactions, while antimicrobial susceptibility testingwas done by Kirby-Bauer disk diffusion method. Minimum inhibitory concentrations (MIC) of ciprofloxacin were detected by E-test, whereas combined test method was used to detect extended-spectrum β-lactamase (ESBL) production. QnrA, qnrB, and qnrS genes were determined by multiplex polymerase chain reaction (PCR). MDRGram negative bacilli represented 68% (268/420); most of them were recovered from blood culture specimens (21%).Among these MDR isolates21%(60/268) were ciprofloxacin resistant; with MICs >32µg/ml in 95% of the isolates.ESBL production was detected in 11.7% of the studied isolates. The qnr genes were detected in 60%. QnrS and qnrB were the detected genes in 77.8% and 16.7% of the isolates respectively. Both qnrB and qnrS genes were determined simultaneously in 5.5%.QnrB gene was found alone in only one isolate (14.3%) that was ESBL-producer. The most MDR isolates were recovered from blood culture; this confirms the occurrence of these superbugs and their ability to cause life threatening infections. The prevalence of quinolone resistant Gram negative bacilli clinical isolates is high. The mostly prevalent PMQR gene is qnrS followed by qnrB.

Treatment of warts is considered as a big challenge for patients as well as doctors. Immunotherapy represents a promising and successful method of warts treatment. A great attention has been paid for various types of immunotherapeutic agents. One of the immunotherapeutic approaches is intralesional immunotherapy that showed a successful result in treatment of warts. Complete resolution of warts was achieved in many of studied patients, while some of them showed partial response and only few patients showed no response. Our study was based on the previous observations and reports of regression of several types of warts after administration of candida antigen and other new immunotherapeutic antigens. Candida antigen group showed complete clearance in 16 patients (69.6%), partial response in seven patients (30.4%). In VZV vaccine group, complete clearance was observed in 15 patients (65.2%), partial response in eight patients (34.8%). These results showed that the therapeutic response in two groups had a close statistical result and more chances must be given to VZV vaccine specially after its promising and successful results. In conclusion, we presented a novel approach for the treatment of recalcitrant wart using intralesional immunotherapy with Candida antigen and VZV vaccine. VZV vaccine seems to be promising, safe and effective remedy for any type warts mainly plantar warts.

Noncavitated caries lesion is a demineralized lesion without evidence of cavitation. As the lesion progresses, the outer surface, which is in contact with plaque and is protected by the salivary pellicle, is exposed to cycles of demineralization and remineralization, and it regains some minerals (including fluoride) and becomes less prone to further demineralization. At this stage, the demineralization process can be reversed or arrested via remineralization products. Moreover, tooth sensitivity should only be used when the patient describes a significant increase in their dentine sensitivity, that is, hypersensitive dentine is supersensitive with respect to the patient’s previous experience. Nanotechnologies have favored our understanding of dental tissues at the nanoscale. This allows for understanding the genesis of tooth complex tissue which probes the structure of the protein and mineral components of the developing enamel matrix at the nano level, to replicate this process as biomimetic remineralizations and regeneration.

Purpose The rise of carbapenem-resistant A. baumannii (CRAB) is considered a public health problem limiting the treatment options. Our current work studied the emergence and mechanisms of colistin-resistance among CRAB isolates in Egypt. Materials and Methods Seventeen clinically recovered A. baumannii were identified and screened for their antimicrobial susceptibilities using VITEK-2 system. Colistin susceptibility was evaluated using broth microdilution, and characterization of carbapenem/colistin resistance determinants was performed using whole-genome sequencing (Illumina MiSeq). Results About 52.9% (9/17) were colistin-resistant. PCR results revealed that all isolates carried blaOXA-51-like genes, blaOXA-23-like was detected in 82.3% (14/17) and blaNDM in 23.5% (4/17). Two isolates harboured blaGES-35 and blaOXA-23. Furthermore, genome analysis of seven isolates revealed six belonged to international clone 2 (IC2) while the remaining isolate was a singleton (ST158), representing a clone circulating in Mediterranean/Middle Eastern countries. Conclusion The emergence and high incidence of colistin-resistance among CRAB clinical isolates in Egypt are alarming because it further limits therapy options and requires prudent antimicrobial stewardship and stringent infection control measures. Whole-genome sequence analyses suggest that the resistance to colistin was associated with multiple mutations in the pmrCAB genes. The high incidence of the high-risk lineage IC2 harbouring blaOXA-23-like as well as blaNDM is also of concern.

INTRODUCTION: Acinetobacter baumannii is a challenging pathogen responsible for serious nosocomial infections. Colistin resistance in carbapenem-resistant A. baumannii strains is a critical health problem as it limits the available therapeutic options. The current work aimed to study the reliability of several phenotypic methods for the detection of colistin resistance among carbapenem-resistant A. baumannii isolates in Egypt. METHODS: A total of 22 carbapenem-resistant A. baumannii isolates were recovered. Colistin minimum inhibitory concentrations (MICs) were determined using broth microdilution (BMD) and compared to agar dilution (AD), automated system (VITEK-2) and gradient test (E-test) and were analyzed by statistical methods. RESULTS: Phenotypic testing showed that nine of 22 isolates (40.9%) were colistin-resistant by BMD and seven of them were also resistant by AD, with the categorical agreement (CA) of 72.7% and essential agreement (EA) of 90.9%. Colistin MIC results ranged from 1-8 µg/mL and 1-32 µg/mL by both AD and BMD respectively. Detection of colistin resistance by gradient test and automated system showed high very major error (VME) rates (40.9%) compared to BMD with a lack of CA between them. AD gave moderate agreement with BMD by 90.9% EA, 72.7% CA and only 9.1% VME. CONCLUSIONS: In delineating colistin breakpoints BMD followed by AD method are defined as the only reliable phenotypic methods for colistin resistance evaluation. More rapid and reliable tests, other than BMD and AD, are required for the convenient detection of colistin resistance in the routine clinical microbiology laboratory daily workflow.

Enterobacteria producing NDM carbapenemases represent a severe diagnostic and therapeutic challenge in healthcare settings. Infections caused by NDM-positive strains are usually associated with high mortality rates and very limited treatment options. A total number of 33 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates were included in this study, comprising 30 recovered from clinical diagnostic samples and 3 cultured from screening rectal swabs taken at patient admission. Bacterial identification was performed by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS) and antibiotic susceptibility testing was performed by reference broth microdilution and a commercial automated method. Isolates were investigated for carbapenemase production using the β-CARBA test, the modified carbapenem inactivation method (mCIM) and, for the 30 clinical isolates, by MALDI-TOF/MS, using the MBT STARⓇ-Carba IVD Kit. Carbapenem resistance genes were characterised by PCR and sequencing. Seven different blaNDM gene variants were identified in 94% of the isolates, whilst three variants of blaOXA-48-like were detected in 27% of the isolates. Most CRKP corresponded to high-risk clones (ST147, ST11 and ST15). Novel ST4497 is reported for the first time in this study as well as the first emergence of K. pneumoniae ST231 producing OXA-232 in Egypt. These results indicate an ongoing evolution of the blaNDM genes in our area and confirm the need for a maintained surveillance system in order to monitor the spread of these mobile blaNDM genes.

Background: Infection with Helicobacter pylori (H. pylori) causes persistent gastritis that may progress to fatal gastric cancer. The cytotoxin-associated gene A protein (CagA), encoded by the cytotoxin-associated gene A (cagA) is the main virulence factor associated with more severe clinical outcomes. It is further divided into Western-type CagA and East Asian-type CagA. The East Asian-type CagA induces more cytoskeleton changes and is more likely to be associated with gastric cancer. Aim of the study: In the current study we aimed to identify the most prevalent H. pylori cagA genotype among Egyptian patients suffering from dyspepsia and to examine its possible correlation with the associated clinical condition. Patients and methods: Four biopsies were obtained from the antrum and angularis from each of 113 adult patients, who underwent upper endoscopy at the Endoscopy Unit, Theodor Bilharz Research Institute (TBRI) Hospital for the analysis of H. pylori by rapid urease test and detection of 16S rRNA. Nested PCR assay was used to determine cagA genotype. Results: Sixty (53.1%) dyspeptic patients were found infected with H. pylori. Although Egypt has a high prevalence of H. pylori infection, low prevalence of cagA was detected (26.5%). Western type cagA is the predominant type (62.5%) while East Asian type was not detected and others (37.5%) remain uncharacterized. Western-genotype cagA genotype was found in 80% of patients with peptic ulcer disease and 40% of patients with gastritis. Conclusion: Absence of the more virulent East Asian cagA genotype, which is the strongest risk factor for gastric carcinogenesis, may explain the very low gastric cancer rate among Egyptian population compared to other parts of the world. This finding demands further molecular studies using whole genome sequencing and more samples to determine the exact uncharacterized cagA genotype to identify the actual risk in developing gastroduodenal diseases in Egypt. Keywords: Helicobacter pylori, Endoscopic findings, Western type cagA, East-Asian cagA, Peptic ulcer, Gastritis

Implementing sustainability can enhance quality of our life and thus granting us a healthy life and promote economic, social, and environmental circumstances. The appropriate use of building materials helps in reducing negative environmental impact and life-cycle cost of buildings. This paper proposes a set of parameters that affects selecting sustainable building materials. These parameters are derived from rating systems, previous studies and experts' opinion. Then, a questionnaire survey is prepared to solicit the opinion of construction practitioners on the importance of these parameters. Accordingly, buildings materials are evaluated according to the amount of waste, the quantity of waste delivered to landfill, the amount of recyclable waste, life-cycle cost, and health and safety index. Because of the complex interrelations among these parameters, a system dynamics model is created to simulate these interactions to enable evaluating building materials. Then, the Analytical Hierarch Process (AHP) is used to select the most sustainable building material depending on the evaluation parameters. The main benefit of the developed model is its ability to evaluate building materials based on the identified parameters, along their life cycle and then selecting the most appropriate one. A case study to appreciate the performance of common building materials like wood, concrete and steel is presented to prove the main features of the suggested model. The simulation results show that concrete is healthier and safer than wood and steel. However, steel has the highest life cycle cost with the lowest amount of waste on landfill because of its high recyclable rate. This development will help decision-makers to select suitable building materials for construction projects.

Background: Ventilator associated pneumonia (VAP) accounts for 7-70% of infections in intensive care units (ICUs) leading to increase in hospitalization, mortality and cost. Endotracheal tube (ETT) is a risk factor for developing VAP caused by biofilm producing organisms resistant to antimicrobial agents. This study aimed to determine guidelines for ETT extubation through detection of biofilm formation and development of VAP. Objectives: Our aim was to assess biofilm formation on the luminal surface of ETTs in intubated patients in ICU in relation to duration of intubation bacteriologically and morphologically using Scanning Electron Microscope (SEM). Antimicrobial resistance and VAP development were also studied. Methodology: Our work was conducted on 20 ETTs divided into two groups: Group (1); 8 patients with ETTs

Helicobactor pylori (H. pylori) has been strongly associated with gastritis, peptic ulcer and is linked to an increased risk of gastric cancer. The cytotoxin-associated gene product (cagA) and the vacuolating cytotoxin (vacA) have been implicated as two major virulence factors of H. pylori. Since there is an increasing evidence that genetic variability of H. pylori may have clinical importance, we aimed to evaluate different vacA genotypes and reveal its relationship with endoscopic and transmission electron microscopy (TEM) findings among H. pylori infected Egyptian patients. Forty H. pylori infected patients possessing vacA gene who underwent upper endoscopic examination were considered to be infected with H. pylori when rapid urease test and detection of 16S rRNA in gastric biopsy recorded positive. Both vacA and cagA genotypes were detected by polymerase chain reaction (PCR). The TEM was performed to assess the ultra-structure of the gastric mucosa. Four vacA genotypes were identified, the most prominent was the s2/m2 allele combination (52.5%) followed by s1/m1 (27.5%), s1/m2 (17.5%) and s2/m1 genotype was found just in one H. pylori strain (2.5%). There were significant correlations between vacA s2/m2 and gastritis (65.2%), and vacA s1/m1 and peptic ulceration (57%). The cagA gene was associated with 38% of vacA genotypes and 60% of which were significantly associated with vacA s1/m1 genotype with the development of severe gastritis reaching up to gastric ulcer. The TEM revealed H. pylori spiral and coccoid forms, cytoplasmic vacuolar degeneration caused by vacA, swollen mitochondria and dilated rough endoplasmic reticulum. In Egypt where prevalence of H. pylori infection is high, genotyping of H. pylori virulence factors can help to predict patients who are at a high risk of related gastroduodenal diseases. Although H. pylori with vacA s2/m2 genotype is mostly related to low level of virulent strains yet, significant crosstalk between H. pylori strains harboring both vacA s1/m1 and cagA gene provides crucial insights into virulence of high level. Key words: Helicobactor pylori, vacA genotyping, cagA, gastritis, peptic ulcer.

Summary Objectives The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates recovered from clinical specimens at a tertiary care hospital in Egypt over a period of 15 months. Methods Eight CRKP isolates were included in this study. The minimum inhibitory concentrations of different antibiotics were determined by broth microdilution and Etest methods. Multilocus sequence typing was performed. Antibiotic resistance genes were assessed by PCR and DNA sequencing. Plasmid analysis was done by S1 nuclease digestion of whole genomic DNA followed by pulsed-field gel electrophoresis (S1-PFGE). Result Eight carbapenem-resistant NDM-1-producing K. pneumoniae isolates of three different sequence types (ST) were identified (ST147, ST11, and ST17), in which bla NDM-1 was carried by either IncR or untypeable plasmids. Seven out of the eight isolates also contained the rmtF methylase gene. Conclusion This study describes the occurrence of IncR plasmids carrying bla NDM-1 and rmtF in Egypt, raising concerns regarding this type of replicon and its role in the transmission of these resistance determinants.

Emerging Microbes and Infections (2016) 5, e30; doi:10.1038/emi.2016.24; published online 6 April 2016

Higher Education Institutions are a crucial player in achieving the international 2030 sustainable development agenda on the national levels. This study examines the role that Cairo University plays in promoting sustainable development competencies (a vital goal identified by the United Nations) through its formal and non-formal educational practices. This investigation represents the initial empirical effort that explores the promotion of sustainable development competencies in the Middle East. Specifically, it contributes to the literature by investigating factors that affect sustainable development competencies and by utilizing a Middle Eastern context. Finding reveals that there is a significant difference in the level of sustainable development competencies between students in different majors and colleges.

Objectives To describe the management and costs associated with G-CSF therapy in hematological cancer patients in multiple institutes in Egypt. Methods This study analyzed a random population sample from the Egyptian national healthcare database, focusing on 145 patients with hematological malignancies who were reimbursed in 2012 to 2019 for at least one G-CSF treatment dispensed in pharmacy. Patient characteristics and treatment costs were analyzed accordingly. Then the costs and characteristics of patients associated with the use of different G-CSF products were analyzed. Results The most frequent hematological malignancies in the database population were Hodgkin disease (22%), non-Hodgkin lymphoma (38 %), and leukemias, either acute or chronic (40%). The reimbursed G-CSF was pegfilgrastim in 31% of cases, and filgrastim in 69%. More than one G-CSF product was reimbursed to 39% of patients. The total annual reimbursed health expenses per patient, according to the type of G-CSF, were around 52000 L.E, and 47000 L.E for patients treated with filgrastim, and pegfilgrastim, respectively. In patients with DLBCL, ambulatory care cost was 87000 L.E with filgrastim, and 92000 L.E with pegfilgrastim, and the respective cost of G-CSF was 14000 and 17000 L.E per patient. Conclusion Febrile neutropenia is considered a serious toxicity of cancer chemotherapy that has to be treated in hospital. Both daily G-CSFs and pegylated G-CSF are recommended in international guidelines and effective in hematological cancer. The choice of G-CSF product can affect the total cost of ambulatory care. Therapy with these factors has not been associated with improvements in survival, and hence an examination of the effects of myeloid growth factors, G-CSF and GM-CSF, on economic outcomes is pivotal than its effect on survival. The available data on the economic outcomes associated with the use of these factors in oncology practice have to be reviewed worldwide. The myeloid growth factors have an effect on the cancer patients supportive care, which facilitate decision-making utilizing chemotherapy dose intensification.

Sparse Code Multiple Access (SCMA) is a non-orthogonal multiple access (NOMA) scheme which allows multi-user communication with massive connectivity. In this paper, we consider an uplink SCMA network of limited resources (time/frequency/power). We seek to answer the following question: what is the maximum number of users that can be admitted in uplink SCMA subject to user-rate constraints? This is termed “user capacity” in communication network. We first obtain a closed form for the lower bound of user capacity which is the first contribution of this work. We then study the general problem of optimizing the resource allocation in terms of codebook assignment and power allocation to maximize the number of users, as well as the total sum rate subject to power, codebook and user-rate constraints. This optimization problem turns out to be non-convex and NP-hard; therefore, we propose an iterative algorithm that provides sub-optimal codebook assignment and power allocation which can efficiently solve this problem. Specifically, another contribution of this work is showing that using swap matching for codebook assignment and Difference of two Convex functions (DC) programming for power allocation efficiently solve the problem yielding better results compared with, e.g., cooperative co-evolutionary particle swarm optimization (CCPSO) algorithm or simple equal power and conventional codebook allocation. Finally, we verify our analytical bound on the user capacity via Monte Carlo simulations and show that the proposed resource allocation algorithm provides significant gains in the number of scheduled users in the system with higher sum rate compared with other schemes. The proposed algorithm can achieve an increment in the number of scheduled users of 45%, and 80% compared with CCPSO and simple equal power and regular codebook allocation, respectively. We also compare our proposed swap matching criterion based on sum rate maximization with the two-sided exchange stable swap matching and simulation results show the effectiveness of the proposed criterion for our problem.

Background: Extended spectrum β-lactamases (ESBLs) and AmpC β-lactamases are enzymes produced by a variety of Gram-negative bacteria which confer an increased resistance to commonly used antibiotics and represent a substantial clinical threat. Several phenotypic tests have been recommended for screening and confirmation of ESBL- and AmpC-producing organisms. However, a comprehensive diagnostic algorithm integrating both screening and confirmation has not been established. Objectives:This study aimed to detect ESBL and/or AmpC production by using MastD68C ESBL and AmpC detection set as a single phenotypic method and to study its sensitivity and specificity comparing to other methods. Evaluate the effect of novel antibiotics namely tigecycline and doripenem, as well as the efficacy of old reviving antibiotics as colistin and temocillinagainst ESBL- and AmpC-producing Enterobacteriaecae. Methodology:Hundred Enterobacteriaceae isolates were screened for ESBL production using disc diffusion method and confirmed by combination disc diffusion test. Screening of AmpC production was done by cefoxitin disc test, disc approximation test and confirmation was done byAmpC disc test. Isolates screened positive for ESBL were investigated for their susceptibility to temocillin, tigecycline, colistin and doripenem by E-test.Results:Among the 100 Enterobacteriaceae isolates, 45 were screened positive for ESBL-production using the disc diffusion test and 36 were confirmed by the combination disc test. Nine isolates were screened for AmpCproduction using the cefoxitin disc test and 5 isolates were confirmed as AmpC producers by AmpC disc test. Using MAST D68C set, 35 isolates were ESBL producers, 2 were AmpC producers, one isolate was both ESBL and AmpC producer. All isolates were sensitive to tigecycline and doripenem. Forty-three isolates were sensitive to colistin, while, thirty-seven isolates were sensitive to temocillin. Conclusion:MAST D68C test appears to be a promising way to detect isolates producing ESBL and/or AmpC. Tigecycline, doripenem, temocillin and colistinrevealed excellent activity against ESBL- and AmpC- producing Enterobacteriaceae.