Search

Background: Complement is a crucial branch of both non-specific and specific immune system. C3 is the third complement component which plays a protective role in viral infections. There are two co-dominant inherited variants or allotypes for C3: C3 fast (C3F) and C3 slow (C3S). C3F variant has been linked to multiple diseases production including infections among liver transplantation recipients. Objectives: To investigate the most common risk factors for post-liver transplantation infections especially preoperative colonization. To identify types and rates of post-liver transplantation infections and their causing organisms. To identify C3 allotypes for both liver transplantation donors and recipients, and to correlate recipients’ allotypes with post-transplantation infections. Methodology: This study is a prospective study; it was conducted from January 2017 to August 2019 on 64 chronic cirrhotic patients, experienced liver transplantation in the National Liver Institute ICU, Menoufia, Egypt, and their donors. Blood cultures and other samples were collected according to site of infection using standard Microbiological sample collection methods and bacterial isolated were identified by standard microbiological methods using VITEK2 Compact automated ID/AST instrument. CMV IgG and IgM were detected by ELISA method. DNA was extracted and the extract was used for detection of C3S and C3F alleles by using Amplification Refractory Mutation System (ARMS). Results: The most common cause for liver transplantation was HCV related liver cirrhosis (26.56%). Risk factors for postliver transplantation were Pre-operative microbial colonization (100%) and long operative time (9.875±2.45 h). 39.8% of post-transplantation infections occurred during second week post-operatively and the commonest infections were drain infections (29.5%) and urinary tract infection (27.3%). 51.7% of liver transplantation recipients were C3FF, 32.8% were C3FS and 15.6% were C3SS. C3FF recipients showed increased relative risk to develop CMV (5.2) and bacterial & fungal infections (2.2) than other recipients’ allotypes. Conclusion: A comprehensive infectious diseases workup including detection of C3 allotype of the candidate for liver transplantation should be done pre-operatively to early detect and treat infections which can improve the outcome of the operation dramatically and improve patients’ life style. More studies should be done to find out if there is relation between donors’ and recipients’ C3 allotypes as currently no clear data still present.

Background: Infections with carbapenem resistant Enterobacteriaceae (CRE) cause significant morbidity and mortality in Liver transplant recipients. Accurate detection of CRE is the first step in combating this problem. Objectives: to study the distribution of pathogens and CRE causing infections in liver allograft recipients with special reference to the impact of pre-operative intestinal colonization with CRE on post-operative infections, and to investigate the phenotypic tests and to detect the frequency of blaOXA48 and blaNDM-1 genes by duplex PCR. Methodology: A total of 23 CRE isolates were investigated for carbapenemase production by phenotypic methods such as the modified Hodge test (MHT), douple disc synergy test (DDST), E test and Rabidec Carba NP (RCNP) test. Production of blaOXA 48 and blaNDM-1genes was investigated by duplex PCR. Results: Frequency of CRE that harbored blaOXA-48 and blaNDM-1 genes, as obtained by PCR, was 47.8% for blaOXA-48, 20.1% for blaNDM-1 and 8.7% of CRE isolates co-produced the two genes. RCNP test exhibited Sensitivity of 90.9% and 100% versus 81.1% and 66.6% sensitivities by MHT in detecting blaOXA-48 and blaNDM1genes respectively. E-test had a much higher sensitivity in identifying NDM-1 carpabenemase compared to DDST (100% versus 66.6% respectively).Conclusion: RCNP test can be done instead of MHT in detecting CRE, as it is more accurate, rapid and having excellent sensitivity in detecting blaNDM-1 and blaOXA-48 producing isolates. E-test is more reliable than DDST and can be a valid alternative to PCR in detecting MBL especially NDM-1 type.

Background As physicians in a referral hospital, we observed the association between history of enteric fever and somatic disorders associated with low mood. At the Al-Hussein University Hospital, Cairo and the National Liver Institute Hospital, Menoufia, we receive patients from all over Egypt, including rural areas where enteric fever is endemic. Aim Here in, 60 Egyptian patients referred to us for evaluation of different somatic disorders are reported. Methods After extensive evaluations, the patients' symptoms were function-related. Also, their typhoid carrier states were documented, and the severity of depression using Hamilton-D (HAM-D) questionnaire was evaluated and recorded. All patients were treated with ceftriaxone, 2 gm, IV, daily for 15 days. The clinical evaluation and Hamilton score were reassessed at the end of the treatment and 6 weeks thereafter. The patients did not receive any anti-depressant nor anti-anxiety treatment during their course. Typhoid carrier was defined by documenting the history of typhoid fever that was diagnosed by culturing the Salmonella species, and not by serology, isolated from stool culture along with febrile condition, plus the absence of fever in the past 3 weeks. The Widal test was not accepted as a criterion for enrollment. Results Patients showed clinically significant improvement in the somatic complaints, and their HAM-D score immediately post-treatment that was consolidated for 6 weeks post-treatment completion. Conclusion In this study, the typhoid carrier was associated with the psychosomatic depression that improved by antibiotic therapy.

Ahmed Morad Asaad,1 Shamshul Ansari,2 Soma Elsayed Ajlan,3 Samah Mohammed Awad4 1Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 2Department of Microbiology and Immunology, Chitwan Medical College School of Medicine, Bharatpur, 44200, Nepal; 3Department of Medical Microbiology and Immunology, Faculty of Medicine, Menoufia University, Menoufia, Egypt; 4Department of Clinical Microbiology and Immunology, Molecular Microbiology in Liver and GIT, National Liver Institute, Menoufia, EgyptCorrespondence: Shamshul AnsariDepartment of Microbiology, Chitwan Medical College School of Medicine, Bharatpur, 44200, Chitwan, NepalTel +977-9840656933Email shamshulansari483@yahoo.comObjective: This cross-sectional study aims to determine the prevalence and associated risk factors of biofilm-producing A. baumannii nosocomial isolates from a tertiary care hospital, as well as to investigate any possible association of biofilm formation with the distribution of biofilm-related genotypes and antibiotic resistance phenotypes.Methods: A total of 94 non-duplicate A. baumannii nosocomial isolates were identified, their biofilm formation was quantitatively detected using the modified microtiter plate assay, and their susceptibilities to different antibiotics were determined using the breakpoint method. Isolates were then subjected to PCR assays targeting bap, ompA and blaPER-1 genes.Results: The majority (70.1%) of isolates were biofilm producers. The most prevalent biofilm gene was ompA (63.8%), followed by bap (13.8%) and blaPER-1 (10.6%). The presence of multi- and extensive-drug resistance (MDR and XDR) was significantly associated with biofilm producers (p = 0.017 and 0.002, respectively). The length of hospital stay (aOR= 0.023), the presence of ompA gene (aOR = 0.286) or bap gene (aOR = 0.346), ampicillin/sulbactam resistance (aOR = 1), and the presence of MDR (aOR = − 0.329) or XDR (aOR = − 0.252) were considered significant risk factors associated with biofilm-producing isolates.Conclusion: The high prevalence of biofilm-producing MDR and XDR nosocomial isolates in this study is worrisome and alarming. Characterization of risk factors could help control the continuous selection and transfer of this serious A. baumannii phenotype inside hospitals and improve the quality of patients’ care.Keywords: Acinetobacter, biofilm, MDR, XDR, nosocomial infection

IntroductionEpidemiological and genetic studies have recorded the association between proinflammatory cytokines and the development of insulin resistance, diabetes, and cardiovascular disease. The role of interleukin 6 (IL-6), NH2-terminal portion pro-brain natriuretic peptide (NT-proBNP) and resistin in the pathogenesis of heart disease in type 2 diabetes mellitus (T2DM) is still a matter of controversy. The current study aimed to evaluate the role of these biomarkers in the development of left ventricular systolic dysfunction and the ability to use them as non-invasive test in the prediction of left ventricular hypertrophy and systolic dysfunction in T2DM.Research design and methods150 participants were included in this case–control study. Patients were divided into two subgroups according to echocardiographic findings: group 1a included 46 patients with type 2 diabetes mellitus and echocardiographic evidence of abnormal systolic function; group 1b included 54 patients with type 2 diabetes mellitus and with normal echocardiogenic study; and group 2 included 50 apparently healthy controls. Routine laboratory investigations such as complete blood count, liver and renal function tests, and lipid profile, serum IL-6, NT-proBNP, and resistin were measured in all participants. Conventional echocardiography was done with special concern on the assessment of left ventricular systolic function (ejection fraction).ResultsThere was a significant increase in the level of resistin, NT-proBNP and IL-6 in group 1a patients compared with group 1b and in healthy controls. Echocardiographic parameters showed a significant increase in left ventricular mass index, left ventricle posterior wall thickness, interventricular septum thickness, and left ventricle mass in group 1a compared with group 1b and the control group. The increased left ventricular mass index was associated with higher levels of IL-6, NT-proBNP and resistin.ConclusionsProinflammatory cytokines had a clear relation with left ventricular systolic dysfunction and hypertrophy and can be used as early non-invasive markers for detection of left ventricular remodeling and systolic dysfunction in patients with T2DM.

Background Duodenoscope-emerging infection especially drug-resistant bacteria is considered a major concern nowadays. Different approaches were attempted to overcome this problem, like double high-level disinfection procedure. We performed a systematic review and meta-analysis to evaluate risk difference for positive cultures from duodenoscopes between double high-level disinfection (dHLD) and single (standard) high-level disinfection (sHLD). Main body A thorough literature search (in October and November 2019) for studies comparing dHLD and sHLD for duodenoscopes was performed by 3 researchers in the Web of Science, Scopus, PubMed, and Cochran databases. The search terms were “duodenoscope,” “ERCP endoscope,” “disinfection,” “sterilization,” and “reprocessing,” and only randomized clinical trials with the English language were accepted. Four trials were identified studying dHLD, and only 2 clinical trials comparing dHLD with standard sHLD were found reporting 6193 duodenoscope cultures. Overall sHLD cultures were 2972, and dHLD cultures were 3221; overall positive cultures were 140 in sHLD and 161 in dHLD. The results of a meta-analysis using the random-effect model showed no significant risk difference (RD) between the 2 procedures for duodenoscope positive cultures (p = 0.53, RD 0.003, 95% CI “− 0.007–0.013”). Conclusions Double HLD offered no significant difference over single HLD for duodenoscope disinfection. An alternative strategy to overcome duodenoscope-transmitted infection is a big issue to be resolved.

Objective This cross-sectional study aims to determine the prevalence and associated risk factors of biofilm-producing A. baumannii nosocomial isolates from a tertiary care hospital, as well as to investigate any possible association of biofilm formation with the distribution of biofilm-related genotypes and antibiotic resistance phenotypes. Methods A total of 94 non-duplicate A. baumannii nosocomial isolates were identified, their biofilm formation was quantitatively detected using the modified microtiter plate assay, and their susceptibilities to different antibiotics were determined using the breakpoint method. Isolates were then subjected to PCR assays targeting bap, ompA and blaPER-1 genes. Results The majority (70.1%) of isolates were biofilm producers. The most prevalent biofilm gene was ompA (63.8%), followed by bap (13.8%) and blaPER-1 (10.6%). The presence of multi- and extensive-drug resistance (MDR and XDR) was significantly associated with biofilm producers (p = 0.017 and 0.002, respectively). The length of hospital stay (aOR= 0.023), the presence of ompA gene (aOR = 0.286) or bap gene (aOR = 0.346), ampicillin/sulbactam resistance (aOR = 1), and the presence of MDR (aOR = −0.329) or XDR (aOR = −0.252) were considered significant risk factors associated with biofilm-producing isolates. Conclusion The high prevalence of biofilm-producing MDR and XDR nosocomial isolates in this study is worrisome and alarming. Characterization of risk factors could help control the continuous selection and transfer of this serious A. baumannii phenotype inside hospitals and improve the quality of patients’ care.

Background: The role of interleukin-6 (IL-6), Nt-pro BNP and resistin in the pathogenesis of heart disease in type 2 diabetic is still a matter of controversy. The current study aimed to declare the association between circulating levels of resistin, Nt-pro BNP and IL-6 and cardiac dysfunction in type 2 diabetes (T2DM) and to evaluate them as non invasive markers of Echocardiogenic changes. Methods: 150 participants shared in this study, 100 patients with T2DM and 50 healthy controls. According to echocardiographic findings, the patients were subdivided into 2 subgroups: Group 1a, includes 46 patients with T2DM and evidence of cardiac remolding and systolic dysfunction, and 54 patients were without Echocardiogenic changes as group 1b. Routine laboratory investigations were performed such as complete blood count, liver and renal function tests and lipid profile. Echocardiography was done to assess cardiac systolic function. Serum IL- 6, Nt-pro BNP and resistin were measured for all participants. Results: There was a significant increase in the levels of resistin, Nt-pro BNP and IL-6 in group 1a patients compared to 1b group and healthy controls. Echocardiograpgic parameters showed a significant increase of left ventricular mass index (LVMI), left ventricle posterior wall thickness (LVPW), inter-ventricular septum (IVS), left ventricle mass (LVM) in group 1a compared to group 1b and control group. The increased LVMI was associated with higher levels of IL-6, Nt-pro BNP and resistin. Conclusions: Pro-inflammatory cytokines play an important role in the diabetogensis and cardiac outcome in T2DM. They could be used as early non-invasive markers for cardiac remolding and systolic dysfunction in T2DM patients. Large scale future studies could be done to investigate the role of genetic polymorphism of these cytokines in development of cardiac stroke in DM. Funding Statement: The authors stated that they did not receive any funding. Declaration of Interests: The authors declare that there is no conflict of interest regarding the publication of this paper. Ethics Approval Statement: An informed written consent was obtained from all individual participants included in the study. The study was reviewed and approved by the ethical committee at the National Liver Institute.

Background Myocardial infarction (MI) is the major cause of death and disability worldwide. Many recent studies revealed the relationship between circulating irisin levels, endothelial dysfunctions and subclinical atherosclerosis in adult patients. Objectives The aim of this study was to investigate the distribution of Irisin gene single nucleotide polymorphism in patients with MI and its association with other clinical and laboratory variables in these patients. Patients and methods This study was carried out in 100 patients with MI, and 100 healthy subjects served as controls. All studied subjects underwent laboratory investigations, including measurement of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c) high-density lipoprotein cholesterol (HDL-c), creatinine kinase-MB (CK-MB), troponin I (TnI) and genotyping of rs 3480 and rs726344 of Irisin genes using the TaqMan Allelic Discrimination assay technique. Results There was a significant difference of Irisin genotypes in patients when compared to controls. By estimating odd ratio (OR) an association was found between G allele of rs 3480 and A allele of rs726344with increase the risk of developing myocardial infarction by 4.03 and 3.47 fold respectively. GG of rs 3480 carriers had significantly increased Troponin I and triglyceride levels, while GA carriers of rs726344 had significantly increased CKMB, Total cholesterol, LDLc, HDLc, troponin I and triglyceride levels compared with other genotypes. Conclusion G allele of rs 3480 and A allele of rs726344can considered as genetic risk factors for MI; these findings could have an impact on preventive strategy for myocardial infarction., Highlights • Irisin gene SNP GG genotype and G allele of rs3480 and GA genotype and A allele of rs 726,344 may confer susceptibility to MI. • Patients carrying GG genotype of rs3480 and GA genotype and A allele of rs 726,344 are associated with criteria of hypertension, diabetes, hyperlipidaemia. • Irisin gene expression are necessary to explain its role in pathology of MI and to evaluate the role in management.