Background: Candida is the most common cause of fungal infections. Candida species are identified by different phenotypic methods. Accurate identification of Candida species enables appropriate selection of antifungal agents by clinicians. Azoles are the most frequently used antifungal drugs to treat Candida infections. However, resistance among previously susceptible Candida species has emerged which made antifungal susceptibility testing crucial. Aim: This study aimed to phenotypically identify the different Candida species isolated from various clinical specimens in Suez Canal University Hospitals (SCUHs), and to assess their antifungal susceptibility patterns. Method: One hundred and five clinical specimens were collected from different departments in SCUHs. Isolates were identified as Candida by colony morphology on Sabouraud dextrose agar and Gram staining. Candida species were phenotypically identified using germ tube test, hypertonic Sabouraud broth, corn meal agar, chromogenic Candida agar, KB006 HiCandida Identification Kit and Vitek 2 YST-ID system. Antifungal susceptibility to fluconazole, voriconazole and amphotericin B was done by disk diffusion method. Results: Prevalence of Candida was 54.3%. C. tropicalis was the most common species followed by C. albicans, C. dubliniensis, C. glabrata, C. parapsilosis and lastly C. kefyr. Only one strain was resistant to amphotericin B. Eight strains were susceptible dose dependent, and 2 were resistant to fluconazole. No resistance was detected to voriconazole. Conclusions: The prevalence of candidiasis is remarkable. Non-albicans Candida species (NACs) cause most of these infections. Fluconazole and amphotericin B showed low resistance rates. No resistance to voriconazole was reported in this study. Therefore, voriconazole could be more effective as empirical therapy than fluconazole and amphotericin B. Accurate identification of Candida species is essential for therapeutic and prognostic impact, appropriate selection of antifungal agents by clinicians and controlling the increase of resistant Candida strains.

Coronavirus disease 2019 (COVID-19) pandemic has urged the scientific community internationally to find answers in terms of therapeutics and vaccines to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The post vaccination immune response differs between individuals especially health care workers who are the first line of defense to combat this disease. Our aim was to measure levels of anti-IgG antibodies titer post COVID-19 vaccination among health care workers in Suez Canal University Hospital. The study included 141 healthcare workers. Of these, 54 were physicians, 80 nurses, 6 health service workers, and one security guard. We used the Roche Elecsys Anti-SARS-CoV-2 assay for serological detection of IgG. Seropositive was found in 96.5% of the participants, and 43.3% of them had evidence of the prior history of COVID-19 infection. The highest titers of IgG in sera were found in the youngest age groups (20 - <35) years with a mean of 335.1 U/ ml. Participants who received the Sinovac vaccine had the highest mean IgG titer, 354.6U/ml; followed by Sinopharm (mean 352.15 U/ml) then Pfizer and Moderna (311.7U/ml) and AstraZeneca vaccine had the least mean level (267.31U/ml). Fatigue was the most significant short side effect occurring with 34% of the participants. In conclusion, there was a significant rising in serum IgG titer post-vaccine, and better antibody response in those previously infected with COVID-19. The post-COVID-19 vaccine serum IgG titers were affected by age, prior history of COVID-19 infection, and type of vaccine while short side effects post-vaccination may be affected by age and type of the vaccine.

Background Coronavirus disease 2019 is an emerging respiratory disease caused by a novel coronavirus effect on 10-20% of total healthcare workers and was first detected in December 2019 in Wuhan, China. This study was designed to assess effect of COVID-19 stressors on healthcare workers’ performance and attitude. A descriptive cross sectional research design was used. A convenient sample (all available healthcare workers) physicians “112,”, nurses “183,” pharmacists “31,” and laboratory technicians “38” was participated to conduct aim of the study. Utilize the study with two tools; online self-administrated questionnaire to assess level of knowledge, attitude, and infection control measures regarding coronavirus disease 2019 and COVID-19 stress scales to assess the varied stressors among healthcare workers. Results More than three quarter of the studied participants had satisfactory level of knowledge and infection control measures. Approximately all of the studied participants had positive attitude regarding COVID-19. A total of 57.4% of the studied medical participants had moderate COVID-19 psychological stress levels, while 49.1% of the studied paramedical participants had moderate COVID-19 psychological stress levels. But less than one quarter had severe COVID-19 psychological stress levels. There is a significant correlation between COVID-19 psychological stressor levels and satisfactory level of knowledge among medical participants. Conclusion/implications for practice Most of healthcare workers had satisfactory level of knowledge, infection control measures, and positive attitude regarding COVID-19. Most of them had moderate COVID-19 psychological stress levels.

Aim: The present study aimed to compare between apical bacterial leakage of obturating systems such as EndoRez, ActiV GP and AH Plus sealers using gutta-percha, with two different irrigating materials Biopure MTAD (mixture of doxycycline, acetic acid and detergent) and 2.25% sodium hypochlorite (NaOCl). Methods: Seventy extracted human mandibular premolars with single canal were divided into two equal groups of 30 samples each according to the irrigating solution used either Biopure MTAD or 2.25% NaOCL. The other 10 teeth (5 roots positive group and 5 roots negative group) were used as control. The main groups were subdivided into 3 subgroups according to the obturation system used, EndoRez, ActiV GP or AH Plus with gutta percha. Sealing ability was assessed using Enterococcus faecalis (E. faecalis) in a double chamber leakage model. Samples were monitored weekly for periods of 1, 4 and 8 weeks to assess the turbidity of the medium in contact with the lower coronal portion of the root segment. Results: Showed statistically significant increase in the mean apical leakage with specimens irrigated with 2.25% NaOCL than Biopure MTAD in all periods, while roots obturated with EndoRez showed less statistically significant leakage than the rest of the experimental materials at 1 and 4 weeks periods while, at 8 weeks period all the experimental materials showed leakage with no statistically significance difference. Conclusion: EndoRez when used after Biopure MTAD irrigation provides better sealing with root canal dentin.

BACKGROUND:Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The aetiological agents of the disease may show geographic variation.AIM:The aim of the present study was to isolate the causative pathogens and to correlate the various clinical patterns of onychomycosis with causative pathogens.MATERIALS AND METHODS:The study population comprised 170 patients with clinical suspicion of onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens.RESULTS:Out of total 170 cases included in the study, 140 (82.4%) were positive by microscopy and 77 (45.3%) showed positive mycological findings by both microscopy and culture. The male: female ratio was 1:2.5 and the mean age was 35.29 ± 16.47 years. Fingernails were involved in 51.9%, toenails in 28.6% and both fingernails and toenails in 19.5% of the 77 patients. The clinical types noted were distal lateral subungual onychomycosis (71.4%), proximal subungual onychomycosis (10.4%), total dystrophic onychomycosis (10.4%), superficial white onychomycosis (3.9%) and mixed pattern onychomycosis (3.9%). Yeasts were the most common pathogens isolated, being found in 36 patients (46.8%) followed by nondermatophyte molds which were isolated from 28 patients (36.4%) followed by dermatophytes which were isolated from 13 patients (16.9%).CONCLUSION:Distal lateral subungual onychomycosis was the most common clinical presentation. Candida albicans, Aspergillus species and Tricophyton rubrum were the major pathogens. A single pathogen can give rise to more than one clinical type.

Background: Ventilator associated pneumonia (VAP) is an important source of morbidity and mortality in patients receiving mechanical ventilation. VAP is associated with prolongation of mechanical ventilation, ICU and hospital stay and increases in costs.Methods: Quality improvement project. Mechanically ventilated patients received oral care every 8 h with chlorhexidine 2%. A formal process was developed to evaluate compliance with the following ventilator bundle initiatives: head of the bed elevation to 30-45 degrees, daily sedation vacation and assess the readiness to extubate, providing peptic ulcer disease prophylaxis and providing deep vein thrombosis prophylaxis (unless contraindicated).Results: The rate of VAP before starting the project, in the first 6 months of year 1431H, was 16.2 cases/1000 ventilator days. Six month after inception of the quality improvement project, the VAP rates decreased to 5.6 cases/1000 ventilator days at the end of 1431H, and at the end of 1432H, it was 5.5 cases/1000 ventilator days. This leads to significant reduction in mortality (adjusted according to APACHE II) from 23.4% to 19.1% (p value 0.024) and the length of stay in ICU from 9.7 to 6.5 days (p value 0.00002).Conclusion: The combination of regular oral hygiene with chlorhexidine 2% and rigorous implementation of ventilator care bundle was associated with significant reduction in VAP rate in mechanically ventilated patients. This has led to reduction in length of stay in ICU from 9.7 to 6.5 days and reduction in mortality from 23.4% to 19.1%. (C) 2013 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V. Open access under CC BY-NC-ND license.

Purpose: The purpose of this study was to compare between two copings materials covering natural teeth abutments supporting overdentures including Cobalt-Chromium and zirconia as regard to bacterial adherence and biofilm mass formation. Material & methods: Sixteen completely edentulous patients with remaining lower canines of age ranged (50-65years) were selected according to bacterial sample inclusion criteria. The patients were divided into two equal groups( n=8):First group had received complete maxillary dentures and tooth supported mandibular overdentures constructed with primary and secondary metal copings (Cobalt Chromium) .Second group had received complete maxillary dentures and tooth supported mandibular overdentures constructed with primary and secondary zirconia copings. First in vitro study (Quantitative assessment study): Microbiological swabs were collected from buccal, lingual, mesial and distal surfaces of the canines by using sterile endodontic paper points, Then the paper points were put immediately in vials containing sterile nutrient Broth Typicase Soy Broth (TSB). After incubation, bacterial colonies specially (Streptococcus sanguinus) counted in Colonial Forming Units( CFU/Ml). Second in vitro study (Bacterial adhesion assay): After incubation of bacterial colonies, an inoculums were then transferred to another fresh TSB broth, then bacteria were allowed to adhere to the prepared discs (12x12 x2mm) of Cobalt Chromium and Zirconium Oxide which finished and gradually polished like mirror surfaces, the tested biofilm mass adherence between the two materials was analyzed using microplate reader (Bio-Rad Laboratories, CA, USA). The data were collected and statistically analyzed.Results: The quantitative bacterial culture from each group of patients ( n=8) had revealed higher percentage of bacterial count in (group1) of patients that were wearing overdentures with metal copings compared to the other group of patients (group 2) of zirconium copings with statistical significant difference( p<.0.001), The second in vitro study of both materials (Cobalt Chromium and Zirconium ) according to the absorbent value that were investigated as regard to bacterial biofilm adherence revealed that, there was biofilm adherence for both materials, but that of Cobalt Chromium 0.400±0.08 was higher than of Zirconium material 0.100±0.03 with statistical significant difference (p<.0.001). Conclusion: Zirconium copings as regard to biological and bacterial adherence is much better for oral hygiene maintenance than metal Cobalt Chromium copings. Further studies are recommended by other experimental means like Electron Microscopy, other bacterial species to support this research. [Mohamed E. Elsayed, Khaled O. Sultan, Hala M. Abd EL hameed, and Abeer E. Elsayed, Detection of Bacterial Colonization around Cobalt Chromium versus Zirconium Copings on Natural Teeth Supporting Overdenture. Two different In Vitro Studies. J Am Sci 2012;8(7):799-803].(ISSN: 1545-1003). http://www.americanscience.org.117

Background: We investigated the cytokine response during coronary artery bypass grafting (CABG) surgery with and without cardiopulmonary bypass (off-pump) and the effect on patient's outcome in the early postoperative period.Methods: Eighteen patients were studied, 9 patients undergoing off- pump surgery (group 1) and 9 patients with CPB (group 2). Demographic and preoperative characteristics were comparable in both groups. Plasma levels of TNF-alpha, IL- 6, IL- 8, IL- 10, IL- 4, tumour necrosis soluble receptors-1 (TNFsr-1) and tumour necrosis soluble receptors-2 (TNFsr-2) were measured before skin incision (T0), before revascularization (T1), after revascularization (T2), 2 h (T3) and 24 (T4) hours after skin closure. Levels of myocardial enzymes were also measured in the first postoperative morning.Results: Serum levels of TNF-a and IL- 8 increased in group 2 at T3 and T4 more than at T0 (p < 0.05). IL- 6 increased in both groups with higher levels in group 2 than in group 1 at T3 (773 +/- 331 vs 315 +/- 189 pg/ml; p < 0.05). IL- 10 was higher in group 2 than in group 1 at T2 (115 +/- 119 vs 13 +/- 4 pg/ml; p < 0.001) and at T3 (212 +/- 171 vs 31 +/- 29 pg/ml; p < 0.05). At T3 levels of TNFsr-1 and TNFsr-2 were higher in group 2 than in group 1 (TNFsr-1 4858 +/- 1325 vs 2089 +/- 584 pg/ ml; p < 0.01 and TNFsr-2 4971 +/- 63 vs 3801 +/- 738 pg/ ml; p < 0.05). Production of IL-4 did not increase in neither group. The length of ICU stay was less in group 1 than in group 2 (52 +/- 33 vs 26 +/- 11 h; p < 0.05) as well as was the length of hospital stay (7.1 +/- 0.4 vs 5.3 +/- 0.5 days; p < 0.001).Conclusion: Off-pump procedure evoked a lower cytokine response than CABG with CPB. This minimised myocardial damage and shorten the stay in the ICU and the hospital. (C) 2010 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V.

Psychiatric morbidity is common in rheumatoid arthritis (RA) patients and may affect disease activity and immunological markers. We studied the relationship of the psychiatric morbidity and immunological factors; the serum levels of Interleukin-1beta (IL-1beta), Tumor Necrosis Factor Alpha (TNF-alpha), Interleukin-18 (IL-18) and its inducer interleukin-12 (IL-12), and their impact on RA disease activity. Forty-two RA patients and 20 apparently healthy individuals as a control group were included in this study. Psychiatric morbidity was identified according to the International Classification of Disease, tenth version criteria (ICD-10). The Hospital Anxiety and Depression Scale (HADS) and the mental health Short Form 36 (SF-36) were applied for further analysis. Serum IL-1beta, IL-12, IL-18 and the TNF-a were measured using Enzyme-Amplified Sensitivity Immunoassays (EASIA) and were correlated with psychiatric morbidity and disease activity as measured by Health Assessment Questionnaire and Overall Status. Psychiatric morbidity was found in 40.48% of the studied patients, the most common psychiatric disorders among RA patients were depressive disorders and anxiety disorders. The SF-36 score was closely correlated to the anxiety and depression score (P < 0.001). RA patients showed high levels of IL-1beta, IL-12, IL-18 and TNF-alpha than the control group. There was a significant correlation between psychiatric morbidity, serum levels of IL-1beta, IL-12, IL-18, TNF-alpha and disease activity measurements. We have to view rheumatoid arthritis as a psycho-immumological disorder rather than an autoimmune disease. Furthermore, the studied cytokines may be a novel target for therapeutic intervention of rheumatoid arthritis and its psychiatric morbidity.

The exact pathophysiology of chronic idiopathic urticaria (CIU) is not well understood. The concept of autoreactivity has evolved to explain the disease in up to 50% of cases, while the search for other mechanisms is still needed to explain the disease, at least among the remaining subpopulation of non-autoreactive CIU. Therefore, we thought to investigate some aspects of the IgE-dependent, lymphocyte-mediated late-phase response (LPR) of anaphylaxis. We searched for percentages of FcepsilonRII-bearing (CD23+) B and T lymphocytes and correlated this with total IgE serum levels, IL-4 serum levels and the disease severity scores. Twenty-five patients with non-autoreactive CIU and ten healthy control subjects participated in this study. CD23+ B- and T-cells were assessed by flow cytometry, total IgE serum levels were estimated by enzyme linked fluorescent assay (ELFA), IL-4 serum levels were estimated by Enzyme Amplified Sensitivity Immunoassay (EASIA), while disease severity was determined by a daily self-assessment urticaria activity and itching score. Our results showed that the mean values for percentages of CD23+ B-cells (6.7 +/- 2.3%), total IgE serum levels (139.6 +/- 103.9 microg/dl) and IL-4 serum levels (18.3 +/- 14.7 ng/ml) for patients were statistically significant (p = 0.002, 0.013 and 0.008, respectively), when compared with the corresponding values for controls (4.0 +/- 1.7%, 51.5 +/- 25.1 microg/dl, and 5.1 +/- 4.1 ng/ml, respectively), while the difference between the mean percentage of CD23+ T-cells for patients (2.8 +/- 2%) and that for controls (2.1 +/- 0.6%) was non-significant (p = 0.267). Strong positive correlations were detected between percentages of CD23+ B-cells and severity scores (r = 0.678, p = 0.0001), total IgE serum levels (r = 0.756, p = 0.0001) and IL-4 serum levels (r = 0.709, p = 0.0001), while no correlation was detected between CD23+ B-cells and CD23+ T-cells (r= 0.188, p= 0.368). It is concluded, that CD23+ B-cells, regulated by IL-4, may contribute in the pathogenesis of non-autoreactive CIU, by producing high levels of IgE and possibly lymphokines, while CD23+ T-cells may be involved in early antigen recognition. This may have a future therapeutic ramification in this distinct subset of CIU by targeting low-affinity IgE receptors.