BACKGROUND:Helicobacter pylori infection is highly prevalent in Egypt and plays a central role in peptic ulcer disease, gastric cancer, and several extra-gastrointestinal disorders. Growing antibiotic resistance and emerging treatment options necessitate an updated national consensus to guide diagnosis and management strategies. AIM:To develop updated, evidence-based consensus recommendations for the management of H. pylori infection in Egypt, reflecting current international guidelines and regional clinical realities. METHODS:A multidisciplinary expert panel reviewed studies on H. pylori published since 2018, including Egyptian data and updated global guidelines. Statements were developed across five domains: epidemiology, diagnosis, treatment, gastric cancer, and extra-gastroduodenal associations. Each statement was discussed and voted upon; consensus was defined as ≥70% agreement. CONCLUSION:This 2026 Egyptian consensus provides practical guidance on optimizing H. pylori diagnosis and eradication. Key updates include support for high-dose PPIs and vonoprazan-based therapy, expanded use of bismuth regimens, and validation of high-dose dual therapy as an effective option. Adoption of these recommendations aims to improve eradication success, reduce complications, and guide future public health strategies in Egypt.

INTRODUCTION:Toxoplasma infection is highly prevalent among patients with different autoimmune diseases, including psoriasis patients. Pyrimethamine is an antiparasitic medication that has a variable treatment response in Toxoplasma-infected patients. This study investigates the demographic, biochemical, and genetic factors influencing the response to pyrimethamine treatment in Toxoplasma gondii-infected psoriasis patients. METHODS:We conducted a comprehensive analysis of 73 patients diagnosed with toxoplasmosis. Demographic characteristics, biochemical lab results, and the serum levels of TNF-α detected by ELISA, and MicroRNA-155 expression were analyzed using real-time PCR with the 2ΔΔCt method. RESULTS AND DISCUSSION:Total cholesterol and bilirubin levels were higher in patients with good responses compared to those in the poor response group, while other biochemical parameters did not exhibit any statistically significant differences. Neither MicroRNA-155 expression nor serum TNF-α levels were found to be significantly associated with treatment response. Univariate and multivariate logistic regression analyses were conducted to assess predictors of treatment response to pyrimethamine. CONCLUSION:Biochemical markers play a role in determining the response to pyrimethamine treatment; however, other factors may also contribute. Future research should focus on larger longitudinal studies to validate these findings and explore additional biomarkers.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) was identified as the aetiological agent of coronavirus disease 2019 (COVID-19). The SARS-COV-2 genome encodes four structural proteins include spike (S) protein, envelope (E) protein, membrane (M) protein, and nucleocapsid (N) protein. nucleocapsid protein is one of the predominantly expressed structural proteins and has been confirmed as an ideal target for early diagnostic detection in SARS-COV-2 infection. In the current study, the diagnostic performance of Nucleocapsid antigen in severe acute respiratory syndrome Coronavirus 2 infected individuals is evaluated in Egypt. Patients and Methods: All human individuals' samples (n= 106) were collected from El Sahel teaching hospital, Cairo, Egypt, after informed consent of the patients. Clinical samples (n=86) (nasopharyngeal and blood specimens) were collected from every patient after confirmed infection (range from 0- 55 days from beginning of symptoms) using RT-PCR. In addition, 25 healthy volunteers with no signs of clinical impairment and normal chest radiographs were included as controls. Results: significant differences in liver enzymes, alanine aminotransferase (ALT) (P < 0.0001), aspartate aminotransferase (AST) (P < 0.0001); also, creatinine (P < 0.0001), RBCs (P < 0.001), hemoglobin (P < 0.0001), lactate dehydrogenase (LDH) (P < 0.0001), WBCs (P = 0.029), and ferritin (P=0.01); neutrophils (P < 0.0001), and lymphocytes, HbA1C, D-dimer, C reactive protein (CRP), and lactate dehydrogenase (LDH). LDH was the most effective biomarker in distinguishing COVID from heathy individuals (AUC= 0.98, sensitivity= 97%, specificity= 95%). Followed by lymphocytes (AUC=0.95), D-Dimer (AUC=0.89), and CRP (AUC=0.85), then nucleocapsid antigen (AUC=0.75) with sensitivity= 50% and specificity= 100%, finally ferritin (AUC=0.61). Conclusion and Summary: SARS-COV-2 nucleocapsid antigen showed a comparable diagnostic performance to the severity of COVID-19.

AbstractLinezolid resistance has become a focal point worldwide, particularly as linezolid stands as one of the last resort antibiotics against multiple-drug resistant bacterial strains. Despite its critical importance, the situation in Egypt remains relatively unexplored. As various linezolid resistance mechanisms have been identified in staphylococci, our investigation aims to uncover the molecular characteristics of staphylococci showing reduced susceptibility to Linezolid at Kasr-El-Eini Teaching Hospital. Thirty isolates were investigated in this study. The selected samples, identified by Vitek 2 system and confirmed by 16S rRNA, were examined by disc diffusion method. Of the 30 isolates, two were confirmed as linezolid resistant and screened for the presence of cfr gene and mutations in the Domain V of the 23S rRNA gene. Both of the studied strains, identified asStaphylococcus haemolyticus, SZ-2 and SZ-7 harbored two point mutations G2576T and G2602T in the Domain V of the 23S rRNA gene. A novel G2694C mutation reported for the first time was detected in strain SZ-7. The presence of cfr gene was confirmed in both isolates. Linezolid-resistantStaphylococcus haemolyticushad emerged in ICU patients with prior antibiotic exposure. The exact role of the novel G2694C mutation in linezolid resistance needs further investigations. The study underscores the importance of proper surveillance ofcfr-carrying strains in the healthcare settings in Egypt.

BackgroundSome anthropometric, laboratory, and genetic variations, such as patatin-like phospholipase domain-containing protein 3 (PNPLA3) genetic variants, have been associated with nonalcoholic fatty liver disease (NAFLD). Liver biopsy is the most accurate NAFLD diagnostic method, but it is invasive; hence, noninvasive diagnostics are required for the early diagnosis and assessment of NAFLD.Patient and MethodsThis prospective case-control study included 107 NAFLD patients and 107 healthy controls. All individuals underwent anthropometric measurements, abdominal ultrasonography, laboratory tests, and evaluation for PNPLA3 polymorphisms.ResultsPatients with NAFLD had higher levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) than healthy individuals (p = 0.03, p < 0.0001). Additionally, patients with NAFLD had substantially lower albumin (P = 0.01) and leptin (P < 0.0001) levels than healthy individuals. BMI leptin and CRP levels were independent indicators of NAFLD severity (p = 0.05–0.004). GG is the most prevalent genotype in patients with moderate to severe NAFLD. A novel model based on four markers (leptin, CRP, BMI, and PNPLA3 polymorphism) was developed. The AUC values for distinguishing between the healthy subjects and those with varying degrees of NAFLD severity (mild, moderate, and severe) were 0.99, 0.99, and 1.0, respectively.ConclusionAnthropometric measurements, such as BMI and laboratory results, including liver enzymes, CRP, inflammatory markers, lipid parameters, and genetic markers, especially PNPLA3 polymorphisms, can provide an accurate, sensitive, and specific noninvasive approach for the early identification and assessment of NAFLD and can guide its management. This may minimize the need for liver biopsy to assess NAFLD. Further large-scale studies are needed to confirm these findings and verify the model in larger studies.

IntroductionThe colonization of patients by carbapenemase-producing Enterobacterales (CPE) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units (ICUs). Our study aimed to comprehensively assess CPE prevalence among ICU patients across the Mediterranean region pre-COVID-19, conducting a multicenter prevalence study in the first quarter of 2019.MethodsWe collected clinical data and rectal or fecal samples from 256 ICU patients for CPE testing. Additionally, we performed whole-genome sequencing on 40 representative CPE strains to document their molecular characteristics.ResultsAmong the 256 patients, CPE was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant CPE strains, affecting three ICUs. Genetic analysis revealed highly diverse E. coli and K. pneumoniae strains, predominantly from international high-risk clones. Notably, blaOXA-48 and blaNDM-1 were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased CPE carriage (p < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated.DiscussionOur study provides CPE prevalence in Mediterranean ICUs and reaffirms established CPE presence in this setting but also provides updates on the molecular diversity of CPE strains. These findings highlight the imperative of reinforcing infection control measures in the participating ICUs to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions.

BackgroundDevice-associated infections (DAIs) are a significant cause of morbidity following living donor liver transplantation (LDLT). We aimed to assess the impact of bundled care on reducing rates of device-associated infections.MethodsWe performed a before-and-after comparative study at a liver transplantation facility over a three-year period, spanning from January 2016 to December 2018. The study included a total of 57 patients who underwent LDLT. We investigated the implementation of a care bundle, which consists of multiple evidence-based procedures that are consistently performed as a unified unit. We divided our study into three phases and implemented a bundled care approach in the second phase. Rates of pneumonia related to ventilators [VAP], bloodstream infections associated with central line [CLABSI], and urinary tract infections associated with catheters [CAUTI] were assessed throughout the study period. Bacterial identification and antibiotic susceptibility testing were performed using the automated Vitek-2 system. The comparison between different phases was assessed using the chi-square test or the Fisher exact test for qualitative values and the Kruskal-Wallis H test for quantitative values with non-normal distribution.ResultsIn the baseline phase, the VAP rates were 73.5, the CAUTI rates were 47.2, and the CLABSI rates were 7.4 per one thousand device days (PDD). During the bundle care phase, the rates decreased to 33.3, 18.18, and 4.78. In the follow-up phase, the rates further decreased to 35.7%, 16.8%, and 2.7% PDD. The prevalence of Klebsiella pneumonia (37.5%) and Methicillin resistance Staph aureus (37.5%) in VAP were noted. The primary causative agent of CAUTI was Candida albicans, accounting for 33.3% of cases, whereas Coagulase-negative Staph was the predominant organism responsible for CLABSI, with a prevalence of 40%.ConclusionThis study demonstrates the effectiveness of utilizing the care bundle approach to reduce DAI in LDLT, especially in low socioeconomic countries with limited resources. By implementing a comprehensive set of evidence-based interventions, healthcare systems can effectively reduce the burden of DAI, enhance infection prevention strategies and improve patient outcomes in resource-constrained settings.

Linezolid resistance has become a focal point worldwide, particularly as linezolid stands as one of the last resort antibiotics against multiple-drug resistant bacterial strains. Despite its critical importance, the situation in Egypt remains relatively unexplored. As various linezolid resistance mechanisms have been identified in staphylococci, our investigation aims to uncover the molecular characteristics of staphylococci showing reduced susceptibility to Linezolid at Kasr-El-Eini Teaching Hospital. Thirty isolates were investigated in this study. The selected samples, identified by Vitek 2 system and confirmed by 16S rRNA, were examined by disc diffusion method. Of the 30 isolates, two were confirmed as linezolid resistant and screened for the presence of cfr gene and mutations in the Domain V of the 23S rRNA gene. Both of the studied strains, identified as Staphylococcus haemolyticus , SZ-2 and SZ-7 harbored two point mutations G2576T and G2602T in the Domain V of the 23S rRNA gene. A novel G2694C mutation reported for the first time was detected in strain SZ-7. The presence of cfr gene was confirmed in both isolates. Linezolid-resistant Staphylococcus haemolyticus had emerged in ICU patients with prior antibiotic exposure. The exact role of the novel G2694C mutation in linezolid resistance needs further investigations. The study underscores the importance of proper surveillance of cfr -carrying strains in the healthcare settings in Egypt. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Review Board of the Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Egypt gave ethical approval for this work prior to the beginning of the study with a waiver of informed consents. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at NCBI.

Antibiotics are used to both prevent and treat bacterial infections. When bacteria adapt to the use of antibiotics, antibiotic resistance develops. Antibiotic resistance develops in bacteria, not in people or other animals. Both people and animals are susceptible to infection from these germs, and their illnesses are more difficult to treat than those caused by non-resistant bacteria. Antibiotic resistance causes greater mortality, longer hospital stays and higher medical expenses. The way antibiotics are prescribed and used worldwide has to alter immediately. Antibiotic resistance will continue to pose a serious hazard even if new medications are created. Additionally, behavioral changes must focus on improving food cleanliness, hand washing, practicing safer sex and being vaccinated in order to stop the spread of diseases. This chapter discusses the history, evolution and epidemiology of antibiotic resistance, antibiotic resistance mechanisms and their methods of detection, prevention of antibiotic-resistant organisms in healthcare settings and the role of artificial intelligence in prevention of antimicrobial resistance and drug discovery.

Background and Aim: Helicobacter pylori CagA gene is a major virulence factor that undergoes tyrosine phosphorylation in a region holding differing numbers of repeat sequences (EPIYAs) resulting in modulation of the inflammatory response. The aim of this cross-sectional study is to determine the correlation between CagA EPIYA motifs with diverse gastroduodenal outcomes. Methods: Gastric biopsies were collected from 54 Egyptian patients (11 patients with PUD and 43 chronic non atrophic gastritis). Molecular detection of H. pylori, CagA gene with determination of the EPIYA motifs in CagA positive cases were done. Results: Out of the 54 H. pylori positive cases, CagA gene was detected in 31 patients. EPIYA-ABC was the most presented pattern in 22 cases (71 %) and the least common pattern was EPIYA-ABCCC, which was positive only in one case (3.2%). Both EPIYA-AB and EPIYA-ABCC were presented in 4 cases for each (12.9% for each). Conclusion: There was a significant statistical correlation between the presence of CagA gene and both PUD and GU. Furthermore, the structure of the variable region of the CagA gene in Egyptian strains was Western type with a variable number of EPIYA‑C.

Background Immune paralysis can be defined as a hypoinflammatory state associated with the incapacity of the immune system to release proinflammatory mediators despite the clearance of pathogens by antimicrobials. Persistent immune paralysis leads to failure to eradicate primary infections with a substantial increase in the risk of multiorgan dysfunction and mortality. The state of immune paralysis is caused mainly by the diminished ability of monocytes to release proinflammatory cytokines in response to endotoxin. This phenomenon is known as endotoxin tolerance. This study aimed to assess the role of dexmedetomidine in modifying immune paralysis in septic shock patients. Methods Twenty-four patients with septic shock were randomized into two groups of 12 patients. A continuous intravenous infusion of dexmedetomidine started at 0.15 µg kg −1 hr −1 and adjusted by 0.15 µg kg −1 h −1 to a maximum of 0.75 µg kg −1 h −1 (10 ml h −1 ), while midazolam was started at 1 mg h −1 (2 mL hr −1 ) and adjusted by 1 mg h −1 to a maximum of 5 mg h −1 (10 mL h −1 ). All infusions were adjusted by increments of 2 mL/hr −1 to maintain blinding. Serum levels of CD42a+/CD14+, HLADR+/CD14+, CRP, IL-6, IL-10 and TNF-α were measured at baseline (T1), 12 h (T2), and 24 h (T3). Results Treatment with dexmedetomidine yielded no significant difference in CD42a+/CD14+, HLADR+/CD14, CD24b-MFI, HLADR-MFI, IL6 and TREM1 at all time points when compared with midazolam treatment. There was no significant difference in TLR levels between the two groups. Cardiac output in the dexmedetomidine group showed a significant decrease at 6, 12 and 24 h (P = 0.033, 0.021, and 0.005, respectively) compared with that in the midazolam group. Conclusion Our results indicated that dexmedetomidine did not affect CD42a+/CD14+ and HLA-DR+/CD14+ expression in septic patients. Furthermore, cytokine production and inflammatory biomarkers did not change with dexmedetomidine infusion. Trial registration Clinical trial.gov registry (NCT03989609) on June 14, 2019, https://register.clinicaltrials.gov .

BACKGROUND & AIMS:Coronavirus disease - 2019 (COVID-19) is a major pandemic that causes high morbidity and mortality rates. AIM OF THIS STUDY:to detect the relations between many risk factors, ACE-2, MCP-1, Micro RNA 146 gene expression, and COVID-19 infection and disease severity. METHODS:This study was carried out on 165 cases of COVID-19 and 138 controls. ACE2 and MCP1 levels were measured in COVID-19 cases and control by ELISA and micro-RNA-146 expression by PCR. RESULTS:We found an increased blood level of ACE2 and MCP1 in COVID- 19 patients than in healthy persons and a significant down-regulation of micro-RNA 146 gene expression in cases than in controls. There was a significant correlation between increased blood level of ACE2, regulation of micro-RNA 146 gene expression and severity of lung affection, a significant correlation was found between increased blood level of MCP1 and thrombosis in COVID-19 patients. Neurological complications were significantly correlated with more viral load, more ACE2 blood level, and down regulation of micro RNA146 expression. CONCLUSION:High viral load, increased blood level of ACE2, and down-regulation of micro-RNA 146 expression are associated with more severe lung injury and the presence of neurologic complications like convulsions and coma in COVID-19 Egyptian patients.

(1) Background: Type 2 diabetes mellitus (T2DM) is one of the rapidly growing healthcare problems, and several vitamin D receptor (VDR) polymorphisms seem to modulate the risk of T2DM. Our research was designed to investigate the allelic discrimination of VDR polymorphisms and T2DM occurrence risk. (2) Methods: This case-control research included 156 patients with T2DM and 145 healthy control subjects. Most of the study population were males 56.6% vs. 62.8% in the case and control groups, respectively. Genotyping for VDR single nucleotide polymorphisms (SNPs), rs228570 (Fok1), rs7975232 (Apa1), and rs1544410 (Bsm1) was compared between both groups. (3) Results: There was a negative link between vitamin D levels and insulin sensitivity. A significant difference was noted in the allelic discrimination of VDR polymorphism rs228570 and rs1544410 between the study groups (p < 0.001). No difference was observed in the allelic discrimination of VDR polymorphism rs7975232 between the groups (p = 0.063). Moreover, T2DM patients had significantly higher levels of fasting blood sugar (FBS), glycated hemoglobin HbA1c, 2-h post-prandial blood sugar (PP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), total cholesterol, and triglycerides (p < 0.001), while High-Density Lipoprotein (HDL) Cholesterol (HDL-C) was significantly decreased (p = 0.006). (4) Conclusions: VDR polymorphisms had a positive association with T2DM risk among the Egyptian population. Further large-scale research using deep sequencing of samples is strongly urged to investigate different vitamin D gene variants and interactions, as well as the influence of vitamin D on T2DM.

Background Carbapenem-resistant Gram-negative organisms (CRGNO) are a growing threat. We aimed in our study to determine the genotype of carbapenemases at Beni-Suef University Hospital by using newly introduced lateral flow assays in comparison with molecular techniques and test the effectiveness of ceftazidime/avibactam against them. Methods Screening for carbapenemase production was done by mSuperCARBA (CHROMagar™ company). Genotypic characterization was done using 3 different kits of lateral flow assays: the NG-Test CARBA5 assay (NG Biotech, Guipry, France), RESIST-3 O.K.N. (Coris BioConcept, Belgium) and Carbapenem-resistant K.N.I.V.O Detection K-Set (Beijing Gold Mountain river Tech Development Co, China), whereas genotypic characterization was done for blaVIM blaIMP, blaKPC, blaOXA-48, and blaNDM by PCR. Results The high prevalence of CRGNO in Beni-Suef University Hospital (29%) was dominated by Klebsiella pneumonia (83.3%) harboring OXA-48 (92%). Lateral flow immunoassays showed high sensitivity and specificity for each type of carbapenemases in comparison with PCR. Conclusion The coexistence of multiple carbapenemases genes in the same isolate increased resistance to new therapeutic options, e.g., CZA/AVI. Proper implementation of isolation measures in health care facilities can render the spread of CRGNO.

BACKGROUND:Leptin (LEP) is an anti-obesity hormone that regulates food intake, energy expenditure, and glucose metabolism. The genetic variants in LEP and the LEP receptor (LEPR) gene may play an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and obesity. The current study aimed to investigate the association of serum LEP levels, and LEP polymorphisms in LEP (rs7799039, 2548 G/A) with T2DM in Egyptian patients. METHODS:A total of 205 subjects were included in the present case-control study, consisting of 100 T2DM patients and 105 healthy controls. The anthropometric, psychometric, and biochemical measurements were taken from all the subjects. The genotyping of LEP gene variants was carried out by polymerase chain reaction TaqMan technology. Serum LEP levels were measured by the ELISA technique. RESULTS:T2DM patients had significantly elevated levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), international normalisation ratio (INR), creatinine, urea, cholesterol, triglyceride (TG), and low-density lipoproteins (LDL) and significantly decreased high-density lipoprotein (HDL) compared to healthy subjects. serum LEP levels were significantly decreased p (<0.001) as compared to the control group. LEP gene SNP rs7799039 was associated with an increased diabetic risk with A allele being more frequent in T2DM patients than control subjects. The distribution of the AA genotype and GA genotype of LEP SNP rs7799039 was higher in the diabetic group than control one. In addition, AA + GA genotype carriers had significantly elevated HbA1c, FBS, PPBS, TG, and LDL levels and on the contrary, decreased serum LEP levels compared to GG homozygotes. CONCLUSION:The genetic polymorphism rs7799039 showed a highly significant correlation with blood LEP. The co-dominant and dominant models of the LEP genetic polymorphism (rs7799039, 2548 G/A) were shown to have a significant correlation with complicated and uncomplicated diabetes individuals, but we have found that serum LEP levels were inversely related with control and diabetes patients. A positive significant association was found between LEP genetic polymorphism (rs7799039, 2548 G/A) and serum LEP in patients and controls. LEP levels and its rs7799039 genetic variant may play a vital role in increasing T2DM susceptibility.

Background: Carbapenem-resistant organisms (CRO) have been disseminated worldwide.Ceftazidime-avibactam (CZA/AVI) has been suggested as an alternative option.Objectives: This study aims to assess the prevalence of CRO among clinical isolates and to investigate the in vitro antimicrobial activity of CZA/AVI.Design: Our observational experimental in vitro study was conducted over one year.Settings: Pediatric specialized teaching hospital.Material and Methods: Identification was done by MALDI-TOF-MS.CZA/AVI susceptibility testing was done by disk diffusion.The presence of carbapenemases was detected by modified carbapenem inactivation method and multiplex PCR tests.Main Outcome Measures: Prevalence of CRO was 72.6%; (80.0%) of our isolates were Klebsiella pneumoniae.The most frequently detected carbapenamase genes were blaNDM (70.0%), followed by blaOXA-48 (68.24%) and blaKPC (16.47%).Sample size: 170 clinical isolates of Enterobacterales and Pseudomonas aeruginosa.Result: CZA/AVI in vitro efficacy was 30.0%.Conclusion: Due to the high prevalence of metallo B lactamases in our hospital CZA/AVI may not be a good therapeutic option for CRO infections, emphasizing the importance of improving infection prevention and control.Limitations: larger sample size is needed and studying the in vivo response in correlation with the invitro results will be of great benefit.

(1) Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome are associated with decreased vitamin D. In contrast, high pro-neurotensin (pro-NT) levels are linked with an increased risk of T2DM and cardiovascular disease. We aimed to determine the validity of pro-NT and 25-dihydroxy vitamin D3 levels as predictors for T2DM complications; (2) Methods: One hundred T2DM, and one hundred healthy volunteers participated in this case-control study. Their Pro-NT and 25-hydroxyvitamin D3 levels were evaluated using the ELISA technique; (3) Results: Pro-NT and 25 (OH) vitamin D3 have significant validity and accuracy in T2DM prediction, 84.5%, and 90.5%, respectively (p = 0.001). At a value of <29.5, 25-Hydroxy vitamin D3 showed 88% sensitivity and 93% specificity in predicting T2DM. At a value of >124 Pmol/L, Pro-NT showed 81% sensitivity and 88% specificity in predicting T2DM. At a value of 16.5, 25-Hydroxy vitamin D3 had 78.4% sensitivity and 68.3% specificity in predicting T2DM complications. At a value of >158 pmol/L, Pro-NT predicted T2DM complications with 67.6% sensitivity and 56.0% specificity; (4) Conclusions: 25 (OH) Vit D3 and Pro-NT could identify T2DM patients and predict T2DM complications. More extensive research is required to adequately validate this novel perspective with a large population study.

Searching for a non-antibiotic therapeutic option such as probiotics is gaining momentum nowadays. We aimed to evaluate the in vitro antibacterial ability of cell-free supernatant (CFS) of selected Lactobacillus strains (with probiotic properties) against clinical isolates of OXA-48-producing multidrug-resistant (MDR) Klebsiella pneumoniae separately and in combination with cefoperazone antibiotic. Over a period of 8 months, a cross-sectional experimental study involving 590 Klebsiella pneumoniae isolates was done. Our study took place at The Specialized Pediatric Teaching Hospital of Cairo University. Of the 590 Klebsiella pneumoniae isolates collected from blood cultures, pus, endotracheal aspirates, and pleural fluid, only 50 unrepeated clinical isolates of MDR Klebsiella pneumoniae-producing OXA-48-like detected by CHROMID® OXA-48 (bioMérieux, France) were selected for our study. After determining the minimal inhibitory concentration of CFS of ten Lactobacillus strains and cefoperazone each, the synergistic effect of both was tested. Among ten tested Lactobacillus spp., a significant increase in the mean value of inhibition zone diameter with CFS of L. helveticus (14.32 mm) and L. rhamnosus (13.3 mm) was detected separately. On the contrary, an antagonistic activity against all tested isolates was detected upon combination of Lactobacilli with cefoperazone (512 μg/ml). The mean value of inhibition zone diameter of L. helveticus CFS+ cefoperazone was (11.0 mm) and for L. rhamnosus CFS+ cefoperazone was (10.88 mm) (p value <0.001). The antimicrobial efficiency of using CFS of Lactobacillus species separately indicates that these therapies may be a substitute treatment strategy against MDR Klebsiella pneumoniae.

The coronavirus disease 2019 (COVID-19) poses a significant threat to achieving the Sustainable Development Goals (SDGs). To address this challenge, a thorough examination of the pandemic's influence on four SDGs in Egypt is presented in a system dynamic model. The addressed goals are related to no poverty (SDG 1), zero hunger (SDG 2), decent work and economic growth (SDG 8), and climate action (SDG 13). The model is simulated over 35 years extending from 2015 to 2050. Furthermore, a web-based interactive learning environment is developed to analyze the interdependencies among public health activities and study the impacts of possible intervention countermeasures or prevention policies. Indicators including poverty line, food insecurity, gross domestic product (GDP) growth rate, and greenhouse gas (GHG) emissions are evaluated to track Egypt's performance in relation to SDGs 1, 2, 8, and 13. According to the simulation model, the poverty line will continue to decline until it reaches around 16% by 2050. According to the significant governmental efforts to follow its vision of 2030, Egypt can achieve a decreasing percentage of food insecurity, reaching 3% in 2030, and this percentage will continue to decrease until it reaches full sufficiency by 2050. The GDP growth rate will rise every year until it reaches 13.71% in 2050. With respect to climate, GHG emissions are predicted to fall to roughly 97 Mt CO2-equivalents by 2050. This approach revitalizes debates about the achievement of SDGs amid the crisis and acts as a powerful tool that aids decision-makers in identifying leverage points to avoid the long-term negative repercussions of the crisis on the economy, people, and environment.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen associated with severe morbidity and mortality and poses a significant threat to public health worldwide. The genetic diversity based on sequence types of MRSA strains was illustrated in previous studies; meanwhile, the diversity along with the predominant sequence type, especially in Egypt, remains unknown. The purpose of the current study was to determine the diversity of the predominant MRSA clone ST239-MRSA (n = 50) isolated from different hosts and clinical samples and to illustrate the correlation between the resistance patterns, toxin genes, and the genetic background in Port-said and El-Sharkia Governorates, Egypt. The ST239-MRSA clone was analyzed by phenotypic antibiotyping and various genotypic assays comprising SCCmec, agr, spa, coa, and coa-RFLP in addition to toxin gene profiles. Most of the analyzed strains (40/50, 80%) were multidrug resistant (MDR), belonged to SCCmec-III, agr-I, and coa genotype I, and harbored sea and pvl genes. A negative correlation between the toxin gene profiles and antimicrobial resistance was recorded. Meanwhile, the correlation between the toxin gene profiles and the genetic background was not observed in this study. Although ST239-MRSA strains belonged to a single sequence type, they exhibited a high degree of phenotypic and genotypic diversity, indicating weak clonality and adaptability. With such diversity, it is assumed that these strains may have undergone different evolutionary processes during transmission events among and/or within a single host or tissue niche.