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Background Following a global shortage of piperacillin/tazobactam in 2017, a formulary decision was taken at a large District General Hospital in the East of England to partly replace piperacillin/tazobactam with either temocillin as monotherapy or as part of a combination regimen. A retrospective audit was then conducted to assess the clinical effectiveness of temocillin therapy. Methods Data from patients admitted to Watford General Hospital between May and August 2017 and treated with temocillin were reviewed retrospectively. Clinical characteristics of patients, data related to the episode of infection, clinical success, tolerance and mortality were analysed. Results Temocillin was used in 126 patients with median age of 73 years. Infection episodes mostly originated from the abdomen (n = 46), the lung (n = 40) and the urinary tract (n = 21). Seventy-seven patients received temocillin as first-line therapy and 106 received it empirically, with temocillin prescribed in combination with another antibiotic in 82% of the empirically treated cases. Clinical success was observed in 88.9% of cases with no difference between patients treated empirically and others (89.6% versus 85%) or in efficacy among abdominal (91%), pulmonary (87.5%) and urinary (81%) infections. One case of Clostridioides difficile infection was reported in a patient treated with four different antibiotics. During the shortage period, the hospital’s standardized mortality ratio was significantly lower when compared with the same period of the preceding year (85 versus 96). Conclusions Using temocillin as part of an empirical strategy is feasible and safe as long as appropriate antibiotic combination is recommended based upon the indication and the likely bacterial pathogen.

ObjectivesTo assess the real-world diagnostic accuracy of the Livzon point-of-care rapid test for antibodies to SARS-COV-2DesignProspective cohort studySettingDistrict general hospital in EnglandParticipants173 Patients and 224 hospital staff with a history of COVID-19 symptoms, and who underwent PCR and/or reference antibody testing for COVID-19.InterventionsThe Livzon point-of-care (POC) lateral flow immunoassay rapid antibody test (IgM and IgG) was conducted at least 7 days after onset of symptoms and compared to the composite reference standard of PCR for SARS-COV-2 plus reference laboratory testing for antibodies to SARS-COV-2. The SARS-CoV-2 RT-PCR was tested using the available molecular technology during the study time (PHE laboratories, GeneXpert®system Xpert, Xpress SARS-CoV-2 and Source bioscience laboratory). All molecular platforms/assays were PHE/NHSE approved. The reference antibody test was the Elecsys Anti-SARS-CoV-2 assay (Roche diagnostics GmBH).Main outcome measuresSensitivity and specificity of the rapid antibody testResultsThe reference antibody test was positive in 190/268 (70.9%) of participants with a history of symptoms suggestive of COVID-19; in the majority (n=312) the POC test was taken 35 days or more after onset of symptoms. The POC antibody test had an overall sensitivity of 90.1% (292/328, 95% CI 86.3 – 93.1) and specificity of 100% (68/68, 95% CI 94.7 - 100) for confirming prior SARS-CoV-2 infection when compared to the composite reference standard. Sensitivity was 97.8% (89/92, 95% CI 92.3% to 99.7%) in participants who had been admitted to hospital and 84.4% (124/147, 95% CI 77.5% to 89.8%) in those with milder illness who had never been seen in hospital.ConclusionsThe Livzon point-of-care antibody test had comparable sensitivity and specificity to the reference laboratory antibody test, so could be used in clinical settings to support decision-making about patients presenting with more than 10 days of symptoms of COVID-19.What is already known on this topic-Presence of IgG and IgM antibodies to SARS-COV-2 indicates that the person was infected at least 7 days previously and is usually no longer infectious.-Rapid point-of-care tests for antibodies to SARS-COV-2 are widely available, cheap and easy to use-Preliminary evaluations suggested that rapid antibody tests may have insufficient accuracy to be useful for testing individual patients.What this study adds-The rapid point-of-care test for antibodies to SARS-COV-2 was 90.1% sensitive and 100% specific compared to reference standards for prior infection with COVID-19.-This is comparable to reference antibody tests-The point-of-care test evaluated in this study could be used to support clinical decision-making in real time, for patients presenting with symptoms of possible COVID-19 with at least 10 days of symptoms.

IntroductionSeveral viral respiratory infections - notably influenza - are associated with secondary bacterial infection and additional pathology. The extent to which this applies for COVID-19 is unknown. Accordingly, we aimed to define the bacteria causing secondary pneumonias in COVID-19 ICU patients using the FilmArray Pneumonia Panel, and to determine this test’s potential in COVID-19 management.MethodsCOVID-19 ICU patients with clinically-suspected secondary infection at 5 UK hospitals were tested with the FilmArray at point of care. We collected patient demographic data and compared FilmArray results with routine culture.ResultsWe report results of 110 FilmArray tests on 94 patients (16 had 2 tests): 69 patients (73%) were male, the median age was 59 yrs; 92 were ventilated. Median hospital stay before testing was 14 days (range 1-38). Fifty-nine (54%) tests were positive, with 141 bacteria detected. Most were Enterobacterales (n=55, includingKlebsiellaspp. [n= 35]) orStaphylococcus aureus(n=13), as is typical of hospital and ventilator pneumonia. Community pathogens, includingHaemophilus influenzae(n=8) andStreptococcus pneumoniae(n=1), were rarer. FilmArray detected one additional virus (Rhinovirus/Enterovirus) and no atypical bacteria. Fewer samples (28 % vs. 54%) were positive by routine culture, and fewer species were reported per sample;Klebsiellaspecies remained the most prevalent pathogens.ConclusionFilmArray had a higher diagnostic yield than culture for ICU COVID-19 patients with suspected secondary pneumonias. The bacteria found mostly were Enterobacterales,S. aureusandP. aeruginosa, as in typical HAP/VAP, but withKlebsiellaspp. more prominent. We found almost no viral co-infection. Turnaround from sample to results is around 1h 15 min compared with the usual 72h for culture, giving prescribers earlier data to inform antimicrobial decisions.

Introduction Meropenem is a broad spectrum antibiotic used to treat a variety of bacterial infections. There are no clear standards nationally for the use of meropenem. The purpose of this study is to audit the appropriateness of Meropenem prescription at West Hertfordshire NHS trust METHODOLOGY Patients started on meropenem were identified via the hospital pharmacy in the period from 1st January 2019 to 31st March 2019. Patients’ clinical notes, drug charts and blood tests were reviewed. Appropriateness of meropenem prescription was judged based on the following: indication, penicillin allergy and its nature, pathogen antibiogram, microbiologists approval, indications for escalation and duration of treatment RESULTS forty-eight patients were identified during the study period. The main indications were hospital-acquired/community-acquired pneumonia and UTI. Penicillin allergy was documented in 31%, the nature of allergy was intolerance in 13% and not known in 20%. Of note, in 42% of these, treatment was not pathogen guided. In 45.5% of non-penicillin allergic patients, escalation to meropenem were neither supported by antibiogram nor by microbiologists. The main driver was raised inflammatory markers (62.5%). Of the 37 patients who completed their treatment during the study period, 21.6% had > 7 days with only 50% recommended by Microbiologists. CONCLUSION: In third of the patients, meropenem use was driven by penicillin allergy, however the nature of allergy did not justify its use in many of these cases. Lack of microbiology approval, failure to de-escalate and long courses of meropenem were additional areas identified to target in our antimicrobial stewardship programme

Since the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), millions have been diagnosed with COVID-19. The major clinical manifestations of SARS-CoV-2 infection are pulmonary, however reports of COVID-19-associated central nervous system complications emerged.1 2 We report a case of encephalitis in a pulmonologically asymptomatic patient with COVID-19. A 66-year-old female presented in mid-March 2020, with a few hours history of confusion. She was completely well until the day of admission. There was no medical, infectious or behavioural prodrome. There was no alcohol or nutritional history. She had travelled to Spain, the USA and Mexico in the 3 months prior, but had been home for 19 days. She suddenly complained that her head ‘felt funny’. She carried on normal tasks but, within an hour, became confused, amnestic and was unaware of why social distancing measures were being observed. On admission, her temperature was 37.9°C. Other observations were normal. She was lymphopaenic at 0.4×109/L (0.8–3.1). Full blood count was otherwise normal. C-reactive protein (CRP) was 14.5 mg/L (0–5). Routine blood tests, including renal function, liver function and clotting, were normal. A brain CT was unremarkable. Six hours after admission, she had a single, spontaneously resolving, generalised tonic-clonic seizure. Her postictal Glasgow Coma Scale (GCS) was 6/15 (E1/V1/M4). This remained unchanged for 48 hours. Postictal neurological examination showed equal, reactive pupils, no response to visual menace, no vestibulo-ocular reflex, normal tone bilaterally, symmetrical brisk reflexes and extensor plantars. She remained febrile (37.9°C) for 48 hours. Oxygen saturation dropped to 93% on air only once during her 4-week admission. She never developed breathlessness, cough or tachypnoea. An MRI of the brain on day 2 showed non-enhancing, symmetrical T2 and FLAIR …

Context The significant global upsurge in antimicrobial resistance, particularly among Enterobacteriaceae, represents a serious threat to health care systems. The implications for urologic practice are of particular concern. Objective To review trends in antibiotic resistance in urologic practice. Evidence acquisition We report current European trends of resistance in Gram-negative uropathogens. Evidence synthesis In addition to β-lactam resistance, Gram-negative pathogens are often resistant to multiple drug classes, including aminoglycosides, fluoroquinolones, and carbapenems, commonly used to treat urologic infections. Interest is renewed in old antibiotics, and several new antibiotics are in the pipeline to meet the challenge of treating these infections. In this review, we summarise emerging trends in antimicrobial resistance and its impact on urologic practice. We also review current guidelines on the treatment and prevention of urologic infections with these organisms, and some key antibiotics in the era of resistance. Conclusions Increasing antimicrobial resistance represents a challenge to urologic practice for both treatment and prophylaxis. Antibiotic choice should be determined according to risk factors for multidrug resistance. Good knowledge of the local microbial prevalence and resistance profile is required to guide antimicrobial therapy. Patient summary Antimicrobial resistance represents a challenge in urology. We summarise emerging trends in antimicrobial resistance and review current guidelines on the treatment and prevention of urologic infections, as well as some key antibiotics in the era of resistance.

Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of "blunt" fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re-education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH. There were 31 Staphylococcus aureus bacteremias (SABs); 14 (45.2%) dialyzing with CVCs, 12 (38.7%) BH and five (16.1%) AVF. The 30 day mortality rate for SAB was 7.5% with a complication rate of 22.6%. The hazard ratio for first SAB was significantly greater for both CVC and BH access compared to AVF (5.3 (95% CI -1.9-18.6), P

Introduction: This winter has seen the worst flu epidemic in 7 years and exacerbated pressure on hospitals. Early diagnosis in the emergency department (ED) should prevent transmission to other patients in hospitals, help avoid bed closures for infection control (IC) purposes, and allow rapid treatment to be delivered. Aims & Objectives: To determine whether POCT alters the following, in patients with possible influenza: 1. Time to diagnosis (rule in/out of influenza) 2. Proportion of patients admitted from outset to a bed with appropriate level of isolation (by rapid POCT confirmation) thereby avoiding subsequent bed moves. Methods: All patients presenting with possible influenza underwent POCT (Filmarray Biofire) as part of their initial assessment. We present findings from the first 2 weeks after implementation of this novel service. Results: Of 130 patients tested, 57 cases of influenza were identified, of the following strains: 41 B, 14 A H3 and 2 A H1 2009. The average time from receipt of sample to test result was 12 hours for n = 25 samples sent to the microbiology lab via the traditional method. In contrast, POCT results were available in 43 minutes. 29 of 57 influenza patients underwent POCT whilst in ED prior to admission, of whom 22 could be appropriately admitted as per infection control (IC) measures and 7 safely discharged. Of the 50 admitted, 32 were discharged home without any bed/ward moves as they had been correctly placed in the appropriate IC cohort bay from the outset. None required ITU. Discussion: We have demonstrated that POCT leads to rapid confirmation of influenza and allows informed early decision making, reducing flu contacts and bed closures.

This experiment was conducted to study the influence of different sources and rates of some organic manure on growth and heavy metals concentration in spinach plants grown on two different soils. Resultsshowed that values of dry weight (DW) of roots, shoots and total plant of spinach grown on Abou-Rawash and El-Nobaria soils significantly increased by using all the organic manure sources (sewage sludge(SS), banana and cotton composts (BC and CC)) and rates (11, 22, and 44 t/fed)) as compared with control treatment. Thehighest dry weight of roots, shoots and total spinach plants grown on both soils were obtained by using cotton compost (CC) followed by banana compost (BC) and sewage sludge (SS) in decreasing order (CC > BC > SS). The obtained results revealed that DW of spinach plants grown on sandy calcareous soil of El- Nobaria was higher under all the organic manure treatments than those obtained from sandy soil of Abou-Rawash. Moreover, dry weight of spinach plants grown on Abou-Rawash and El-Nobaria soils significantly increased by increasing the application rate from all the used organic manures up to 44 t/fed. Organic manures (SS, BC and CC) led to more significantly increases in the concentration of Zn, Cu, Pb, Cd and Ni in both roots and shoots of spinach plants grown on Abou-Rawash and El-Nobaria soils as compared with control treatment. Theconcentration of Zn, Cu, Pb, Cd and Ni in roots and shoots of spinach plants grown on sandy and calcareous soils were higher when SS was applied to the tested soils in comparison with the addition of the other organic composts (BC and CC). The tested sources of organic manures could be arranged due to their inducing effect on Zn, Cu, Pb, Cd and Ni concentrations in roots and shoots of spinach plants grown on both soils in the following decreasing order: SS > CC > BC. The efficiency of studied materials on heavy metal concentrations was varied in accordance to sources and rates of application and / or the part of the grown plant. All the concentrations of Zn, Cu, Pb, Cd and Ni in spinach plants grown on Abou-Rawash and El-Nobaria soils werewithin the normal ranges of heavy metal in plants and did not reach the phytotoxic levels obtained in the literature. The highest values of extractable and total heavy metals in the two tested soils after spinach plantation were attained by using sewage sludge (SS) following by BC and CC in decreasing order (SS > BC >CC). The values of extractable and total of studied heavy metals in the used soils after spinach plantation follow the order: Zn > Cu > Pb > Ni > Cd. It could be concluded that all the obtained values of DTPA-heavy metals in the used soils are in the normal range and less than tolerable levels of all studied heavy metals, and could be used as the background level of the heavy metals in uncontaminated soils of Egypt.

This experiment was conducted to study the influence of different sources and rates of some organic manure on growth and heavy metals concentration in spinach plants grown on two different soils. The important results could be summarized in the following: results show that values of dry weight (DW) of roots, shoots and total plant of corn grown on Abou-Rawash and El-Nobaria soils significantly increased by using all the organic manure sources (sewage sludge(SS), banana and cotton composts (BC and CC) and rates (11, 22, and 44 t/fed)) as compared with control treatment. There is no significant effect between all the used organic manures (SS, BC, and CC) on dry weight production of roots, shoots and total plant of corn grown on Abou-Rawash sandy soil, but in El-Nobaria sandy calcareous soil, the SS and BC treatments significantly increased dry weight of roots, shoots and total plant of corn in comparison with those obtained by using CC treatment. Furthermore, there is no any significant effect between sewage sludge (SS) and (BC) on the production of the dry weight of different organs of corn plant grown on El-Nobaria soil. Dry weight of corn plants grown on both soils significantly increased by increasing the application rate from all the used organic manures up to 44 t/fed. The highest DW of corn plants grown on both soils were obtained by using BC and rate of 44 t/fed, while the lowest values were attained by using CC and rate of 11 t/fed. All the organic manures (SS, BC and CC) led to more significantly increases in the concentration of Zn, Cu, Pb,Cd and Ni in both roots and shoots of corn plants grown on both soils as compared with control. The concentrations of Zn, Cu, Pb, Cd and Ni in corn plants grown on Abou-Rawash significantly increased when BC was applied as compared with CC. Moreover, there is no clear difference could be found between BC and CC used in sandy calcareous soil of El-Nobaria, and the concentration of all the heavy metals in corn plants followed the order of SS > BC > CC in decreasing order. All the concentration of Zn, Cu, Pb, Cd and Ni in corn plants grown on both soils were within the normal range of heavy metals in plants and did not reach phytotoxic studies in the literature. Application of organic manures (SS, BC and CC) resulted in significantly increases of the extractable DTPA and the total metals of Zn, Cu, Pb, Cd and Ni in both used soils after corn plantation as compared with untreated control. Application of SS significantly increased both extractable and total heavy metals (Zn, Cu, Pb, Cd and Ni) in Abou-Rawash and El-Nobaria soils after plantation of corn as compared with CC and BC. Also, the addition of banana compost to Abou-Rawash and El-Nobaria soils significantly increased the extractable as well as the total heavy metals (Zn, Cu, Pb, Cd and Ni) after corn plantation when compared with addition of cotton compost. Generally, the highest values of extractable and total heavy metals in the two tested soils after corn plantation were attained by using sewage sludge (SS) following by BC and CC in decreasing order (SS > BC > CC). The values of extractable and total of content of heavy metals took the following order: Zn > Cu > Pb > Ni > Cd after corn plantation. The extractable heavy metals in Abou-Rawash sandy soil were higher than those obtained in El-Nobaria sandy calcareous soil under all the organic manure treatments and the tested soils. The obtained values of DTPAheavy metals in the used soils are in the normal range and less than tolerable levels of all studied heavy metals, and could be used as the background level of the heavy metals in uncontaminated soil of Egypt.

A pot experiment was conducted to study the effect of elemental sulfur(E.S) rates (300 and 600 ppm) and/or sulfur oxidizing bacteria (S.O.B. ATCC 8158) on growth and nutrients content of sorghum plants grown on different soils (sandy soils(I & II) and clay loam soil).The obtained results could be summarized in the followings:Sorghum plants:Significant increases over the control were observed in fresh and dry weights of sorghum plant as well as its content of SO4=, N, P, K, Fe, Mn, Zn and Cu by using all the sulfur and/or the oxidizing bacteria treatments. Addition of E.S (300 & 600 ppm) in combination with S.O.B. ATCC 8158 significantly increased both fresh and dry weights as well as SO4=, N, P, K, Fe, Mn, Zn and Cu contents of sorghum plants grown on the used soils as compared with either of them alone.E.S rates (300 & 600 ppm) significantly increased the fresh and dry weights as well as all the studied nutrients content (SO4=, N, P, K, Fe, Mn, Zn and Cu) of sorghum plants grown on the different soils as compared with S.O.B. ATCC 8158 treatment alone. The highest rate of E.S (600 ppm) significantly increased all the previous parameters under study as compared with the lower rate (300 ppm). The highest values of fresh and dry weights as well as nutrients content (SO4=, N, P, K, Fe, Mn, Zn and Cu) of sorghum plants grown on the used soils were obtained by 600 ppm E.S + S.O.B. ATCC 8158 treatment followed by 600 ppm E.S; 300 ppm E.S + S.O.B. ATCC 8158; 300 ppm E.S; S.O.B. ATCC 8158 and control treatments in decreasing order.The used soils:E.S rates (300 & 600 ppm) and/or S.O.B. ATCC 8158 decreased pH values of the used soils after 3, 6 and 9 weeks from sowing as compared with their corresponding control treatments. The values of pH of sand soil (I) and clay loam soil slightly decreased by time i.e they decreased from 3 weeks to 9 weeks from plantation. E.S rates (300 & 600 ppm) with or without inoculation the used soils with S.O.B. ATCC 8158 significantly increased SO4=, N, P, K, Fe, Mn, Zn and Cu content of all the used soils as compared with the control and sole S.O.B. ATCC 8158 treatments each alone. The highest values of SO4=, N, P, K, Fe, Mn, Zn and Cu contents of sandy soils (I & II) and clay loam soil took the same trend of these nutrient in sorghum plants. The highest rate of E.S (600 ppm) significantly increased SO4=, N, P, K, Fe, Mn, Zn and Cu contents in all the used soils as compared with the lower rates (300 ppm). All the values of fresh and dry weights as well as all the determined elements in sorghum plants and the used soils were higher when the clay loam soil was used than when the other two sandy soils (I & II) were used. This may be due to the fertility levels of these soils.

A pot experiment was conducted to study the effect of elemental sulfur (E.S) rate (2.5 g/kg soil) and sulfur oxidizing bacteria on pepper plant and some chemical properties of two representative soil samples varying in their texture and CaCO3 content. Pepper was grown in Shobrakheet clay loam and Nobaria sandy loam soils for 50 days. Each soil was treated with elemental sulfur (2.5 g kg-1 soil) and inoculated with two sulfur oxidizing bacteria (S.O.B. No.8 and S.O.B. ATCC 8158). Elemental sulfur with or without sulfur oxidizing bacteria increased shoot dry weights of pepper plants as compared with control. The highest effect was observed with E.S + ATCC 8158 treatment which resulted in increasing the pepper shoot dry weights from 1.36 to 2.08 g pot-1 with the clay loam soil and from 0.77 to 1.37 g pot-1 with the sandy loam soil. The same treatment resulted in the highest plant content of S, N, P, K and micronutrients.

A field experiment was carried out at the Abis Experimental Farm, Faculty of Agriculture, Alexandria University. The soil (clay loam) was treated with sulfur oxidizing bacteria (S.O.B.), municipal refuse compost (O.M), elemental sulfur (E.S) and Cabronite, each alone or in combination. Seeds of cowpea were inoculated with the specific root nodule bacteria (Okadin) before planting.According to the obtained results the following results could be concluded:All the used treatments i.e E.S; O.M; Cabronite and S.O.B. each alone or in combination significantly increased the dry weights of cowpea plants and also increased the roots, shoots and seeds as well the used soil content of S, P, K, N, Fe, Mn, Zn and Cu.The application of elemental sulfur with S.O.B. to the soil improved the availability and plant uptake of macro and micro nutrients by cowpea plants as well nutrients content of the used soil.Application of O.M maximized the role of sulfur and S.O.B.It could be concluded that the best treatment which clearly affected growth, nodulation, seed yield and nutrients content of cowpea plants as well as the elemental content of the used soil was elemental sulfur (E.S) + organic matter (O.M) and sulfur oxidizing bacteria (S.O.B.) treatment.

A field experiment was carried out in the Research and Production Station, National Research Center, El-Nobaria during the season, 2009 to evaluate the effect of cobalt and different sources of phosphorus fertilizers on the growth, yield quantity and quality of tomato. Treatments can be arranged in descending order as follows: Mono super phosphate (MSP) > Triple super phosphate (TSP) > Rock phosphate (RP). Mono super phosphate (MSP) had superior effect on all growth parameters of tomato shoots and roots yield quantity and quality as well as mineral nutrient constituents of tomato fruits compared with other phosphorus sources. Rock phosphate (RP) treatment gave the lowest values of tomato growth, yield, chemical constituents and mineral composition of tomato fruits. Cobalt addition enhanced all parameters of tomato growth and yield with all sources of phosphorus fertilizers especially with mono super phosphate.

A field experiment was conducted in research and production station, El- Nubaria location, National Research Centre, Egypt during winter season, 2008, to study the effect of different solution fertilizers formula and organic manure on vegetative growth, heads yield quantity and quality as well as nutrient composition of broccoli (Brassica oleracea var. italica).The obtained results showed that all mineral solution fertilizers gave a significant synergistic effect for broccoli growth, yield quantity and quality as well as nutrients composition compared the control (mineral N, P, K recommended fertilizers). The mineral formula 19: 19: 19 recorded the highest growth heads, yield and quality along with mineral content in broccoli. Using farmyard manure plus inorganic fertilizers enhanced all growth and yield parameters. Applying farmyard manure plus the mineral solution fertilizer formula 19: 19: 19 caused the superior and optimum figures of broccoli growth, mineral composition as well as heads yield quantity and quality. Organic manure alone recorded the lowest one.

A pot experiment was conducted to study the effect of two levels of cobalt (0 & 7.5 ppm) and peanut compost rates (0, 5, 10, 15 and 20 ton/fed.) on growth, nodules formation, yield and nutrients status of cowpea plants were grown in Nobaria farm as a newly reclaimed soil. The obtained results revealed that addition of cobalt (7.5 ppm) significantly increased plant growth, nodules number, fresh and dry weights of shoots and roots contents of (N, P, K, Co and Mn) in the different parts of cowpea plants, yield parameter, as well as protein percentage of grains as compared to the plants which untreated with cobalt. Iron content had another trend, where it decreased by cobalt addition. Peanut compost rates significantly increased all the growth, yield parameters and nutrients content as compared to control treatment. The highest values were obtained by addition of 15 ton/fed peanut compost except iron content, followed by 20, 10 and 5 ton/fed in decreasing order. The interaction between cobalt and peanut compost rate significantly affected all the mentioned parameters. The highest values of all the studied parameters except iron content were obtained by cobalt addition (7.5 ppm) in combination with rate of 15 ton/fed.

Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of "blunt" fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re-education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH. There were 31 Staphylococcus aureus bacteremias (SABs); 14 (45.2%) dialyzing with CVCs, 12 (38.7%) BH and five (16.1%) AVF. The 30 day mortality rate for SAB was 7.5% with a complication rate of 22.6%. The hazard ratio for first SAB was significantly greater for both CVC and BH access compared to AVF (5.3 (95% CI -1.9-18.6), P 0.001 and 3.6 (1.3-96), P = 0.011, respectively). During the study SAB rates per 1000 CVC days were 0.21, compared to 0.15 for BH. After major re-education and asepsis technique campaigns the SAB rate for BH fell to 0.06, but quickly returned to 0.17. Extending BH needling to all our dialysis centers, SAB infection rates increased to those not dissimilar to CVC access. Despite re-education programs coupled with a strict asepsis policy and active SA eradication, followed by audit cycles, the increased infection risk with BH remained, such that we have limited BH to self-care patients.

Xenogeneic anti-lymphocyte serum (ALS) remains a major reagent for immunosuppression in clinical practice, but mechanisms of action and risks of opportunistic infection have not been considered in the context of innate immunity and its role in immune responsiveness. Rabbit anti rat ALS was administered intraperitoneally. Blood was taken for flow cytometry to establish absolute counts of leucocyte subsets. Tissues were harvested for immunohistology to evaluate interstitial dendritic cells and tissue macrophages. At day 2 of ALS therapy, T cells are completely depleted, as anticipated. B cells are undiminished and form approximately 90% of blood leucocytes. Monocytes and natural killer (NK) cells are substantially (approximately 80%), but not completely, depleted, and there is a trend for diminished numbers of putative dendritic cells. Neither interstitial dendritic cells nor tissue macrophages in heart are affected. The results at day 7 were very similar to day 2. Substantial depletion of blood monocytes and NK cells might attenuate the innate immune system, and represent a possible supplementary mechanism (in addition to T cell depletion) for suppression of rejection. It might be of particular importance in reducing defences against infections. Monitoring these parameters could be of clinical value.

Buttonhole needling for arteriovenous fistulae (AVF) has increased in popularity among dialysis centers. Concerns have been raised about the risks of infection, so we reviewed our experience of buttonhole needling in 227 adult patients on hemodialysis. The mean buttonhole AVF survival was 27.0 months, in 227 patients, 61.1% male, mean age 63.8 ± 15.5 years, 45.8% with diabetes mellitus, median dialysis vintage 19 months (6.5-42.8). Ninety-six patients transferred to rope ladder AVF cannulation, because of cannulation failure in 25%, persistent bleeding at the needling site in 24%, fistula thrombosis in 14%, and infections in 15%. Because of persistent methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant S. aureus (MRSA) colonization, 18.8% discontinued buttonhole needling. Transfer from buttonhole needling was more common for people with diabetes (X = 6.57; p = 0.035), older patients (odds ratio, 0.985; p = 0.007), and persistent MSSA/MRSA colonization (odds ratio, 0.88; p = 0.037). Eleven episodes of suspected buttonhole S. aureus bacteremia occurred giving a bacteremia rate of 2.94 per 100 patient years, and 15 local infections giving an infection rate of 4.01 per 100 patient years. In this large series of buttonhole AVF access, although infection rates were increased, more patients discontinued buttonhole needling because of technical cannulation problems and persistent bleeding from needle tracks.

Angiogenesis is thought to play a major role in the development of Kaposi's sarcoma (KS), considered by many to be a hyperplastic disorder caused in part by local production of inflammatory cytokines. The antiangiogenic effects of protease inhibitors, in particular ritonavir, have been suggested in laboratory work to lead to regression of KS, and recent data have shown the importance of ritonavir as a model of pharmaceutical development. As our clinical cohort data has shown that non-nucleoside reverse transcriptase inhibitor-based regimens are not inferior to protease inhibitor-based therapy in the prevention of KS, we investigated the specific contribution of ritonavir to chemoprevention of this AIDS-defining illness. In a logistic regression analysis, we found that ritonavir-based therapy confers no advantages compared to other regimens in the prevention of KS. This is consistent with data suggesting that regression of KS is mediated by an overall improvement in immune function and not by the effects of specific antiretrovirals.

Pasteurella multocida is a rare cause of infective endocarditis with only a few cases described. This report involves a 38-year-old penicillin-allergic patient in an immunocompromised state with several co-morbidities. Two molecular microbiological techniques, 16S rRNA sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry were used to confirm the species identification as P. multocida. Previous reports in the literature are also reviewed.

The human immunodeficiency virus is notorious for its ability to evade the immune system. As well as its ability to escape from cell-mediated and humoral immune responses, new insights are detailing its subversive, pernicious interactions with the innate immune system. The molecular mechanisms underlying these processes highlight potential therapeutic and vaccination strategies.

Two field experiments were conducted in Research and Production Station, National Research Centre, Nobaria Location, Beheara Governorate, Delta Egypt. Experiments were carried out to study the effect of cobalt concentrations (0.0, 5.0, 7.5, 10.0, 12.5 and 15.0 ppm) on Rosemary herb yield, essential oil content and its composition under drip irrigation system during 2012 and 2013 seasons. The obtained results indicate that:- All cobalt concentrations significantly increased all Rosemary growth and herb yield parameters compared with untreated plants. Cobalt at 10 ppm gave the maximum values of fresh herb and its biomass, essential oil and its composition. Increasing cobalt levels above 10 ppm in plant growing media cobalt promotive effect reduced.

Two field experiments were conducted in Research and Production Station, National Research Centre, Nobaria Location, Beheara Governorate, Delta Egypt under drip irrigation system. Experiments were conducted to evaluate the effect of cobalt levels (0.0, 5.0, 7.5, 10.0, 12.5 and 15.0 ppm) on Rosemary endogenous hormons, chemical constituents and nutritional status during 2012 and 2013 seasons. The obtained results are summarized in the following: Cobalt significantly increase Rosemary herb endogenous hormons such as Auxins, Gibberllins, Cytokinens and Abscisic acid as well as chemical and nutritional contents compared with control. Cobalt at 10 ppm gave the greatest figures. Increasing cobalt levels more than 10 ppm reduces the positive effect. Finally, Cobalt enhancement Rosemary – oil- quality.

A 43-year-old previously healthy solicitor presented with a 9-day history of cough productive of yellow sputum with a prodrome of sore throat and myalgia. The cough was paroxysmal in nature and severe enough to cause extensive bilateral subconjunctival haemorrhages and cough syncopes multiple times a day, with one bout of associated haematemesis on the day of admission. He was isolated, treated for a presumed atypical chest infection with tazocin and clarithromycin, and monitored carefully until the hyponatraemia on presentation was resolved. Atypical screen and blood cultures were sent off, though unexciting at first, eventually confirmed the unlikely; Bordetella pertussis, much to the surprise of many who had Legionella as the top differential.