Background: The novel corona virus is a high contagious disease, ‎declared by World Health Organization (WHO) as a global pandemic in 2020 with profound ‎impact on morbidity and mortality, assessment of outcomes in infected patients and ‎knowledge of prediction of mortality and morbidity are important. We aimed to assess ‎the clinical and laboratory findings in predicting COVID-19 severity and outcome in ‎patients admitted to Suez Canal University Teaching Hospital.‎ Methodology: This cross-sectional prospective study included 500 ‎confirmed PCR COVID-19 infected patients, selected through random sampling‎. A ‎structured checklist was used to collect patient data.‎ Results: Mean age was 61.8 years, 56.2% were males, 74.8% had ‎comorbidities. Lung involvement was evident in more than 75% on CT, 17.2% had ‎leukopenia, 42.2% had lymphocytopenia between 5 – 10% and 93% of the patients ‎had elevated neutrophil- lymphocyte ratio. 65.8% had elevated D-dimer, and elevated ‎liver and kidney functions were found in 40.6% and 25% respectively. The mortality ‎rate in studied population was 30.2% and it was significantly associated with old age, ‎hypoxemia, having high involvement of the lungs on CT. Decreased WBC count, ‎high D-dimer level and high NLR associated with severity and increased death rate of ‎the disease.‎ Conclusion: The study revealed many findings with impact on the patient's severity and outcome old age, laboratory findings, CT imaging and need to antiviral therapy the most predicting factors of the ‎severity and prognosis of the patients.

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: Worldwide, the prevalence of hepatitis B virus (HBV) infection is decreasing particularly in the vaccinated population. However, there are foci of increased transmission particularly in localized communities and within families. Objective: This study aimed at identifying HBV infection status among family members (FMs) of a cohort of HBsAg positive index cases (ICs) living in a village near Ismailia City, North-East Egypt. Design and participants: The study targeted ICs with chronic hepatitis B and their FMs. All were inquired for socio-demographic data, previous vaccination, kinship, and risk factors. All were tested for hepatitis markers and in HBcAb positive sera, HBV DNA and ALT were added. Results: The study included 96 participants including 14 ICs, 51 (53.1%) were females and 73 (76%) self-reported receiving hepatitis B vaccine after birth. Among 82 FMs, HBcAb was found in 49 (59.76%) of whom overt and occult HBV were diagnosed in 24 (49%) and 18 (36.7%). HBs Ag and HBcAb were more frequent in unvaccinated compared to vaccinated FMs; being 60.9% vs. 32.9% for HBsAg (p < /em>=0.017) and 91.3% vs. 57.5% for HBcAb (p < /em>=0.003). Among the FMs, active HBV were more related to male than female ICs (54.9% vs. 45.2%, p < /em>=0.73) while among children, it is more related to females more than male ICs (38.9% vs. 25%, p < /em>=0.33). In all HBsAg positive participants, HBeAg was negative and HBV DNA load was higher among female than male ICs (median 3500 vs. 2594.5 IU/mL, p < /em>=0.82). Conclusion: The study shows a high rate of HBV transmission among FMs of HBsAg carriers living in a remote area in North-East Egypt. Both overt and occult HBV infections were frequent despite previous vaccination

Amoebiasis is caused by Entamoeba histolytica infection.In African countries amoebiasis is endemic and one of the top 10 causative agents of diarrhea in children.The common diagnostic method for Entamoeba spp. in Egypt is microscopic observation and identification of cysts/trophozoites in fecal samples.It is known that metronidazole (MTZ) is the choice of treatment for amoebiasis.However, drug resistance and side effects are considered to be disadvantages.In this study children and adolescents infected with E. histolytica complex (Eco) have been divided into two groups.As a control treatment, one group received MTZ capsules.The other group (intervention) received herbal medicinal capsules of Nigella sativa (N.sativa) powder to test for its effectiveness against Eco infection and compare its results with the control group.Socio-demographic data, cure rate, recession of symptoms and residual side effects of treatment were evaluated for the patients.In the intervention group, N. sativa showed a cure rate of 78.8% compared to 91.2% in MTZ-control group with no significant difference.Eco infected patients complained about diarrhea, bloody stool and abdominal pain with significant reduction in N. sativa-control group symptoms (from 93.9 to 15.2 %) compared to MTZ.Treatment with MTZ caused several symptomatic residual side effects of metallic taste, anorexia, abdominal pain and diarrhea.After N. sativa treatment, however, no residual symptoms were noted, an indicator of its safety.N. sativa was safe, cost-effective, herb with potential promising effectiveness against Eco infection.

Background: Hospital acquired pneumonia occurs more than 48 h after hospital admission and was not present at the time of admission, while ventilator associated pneumonia occurs after 48-72 h of endotracheal intubation or within 48 h of extubation. HAP is the second most common nosocomial infection and accounts for approximately 25% of all infections in the Intensive Care Unit worldwide.Purposes: To identify the etiology, initial evaluation, prevention, and treatment of adult patients with ICU HAP, and VAP in Suez Canal University hospital and their management strategies.Methods: This study was conducted in the department of ICU, Suez Canal University Hospital; Ismailia, Egypt in the period from May to August 2013. All the patients were subjected to clinical and radiological assessment, Endotracheal aspirate samples for culture, and sensitivity to determine the causative organisms, Clinical Pulmonary Infection Score was done in order to determine the severity of HAP.Results: 89% of patients were suffering from VAP, while 11% were suffering from HAP, with mean age of 63.8 +/- 10.47 years. Methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae represented the most common isolated organisms that accounted about 65% of the studied population. The isolated microorganisms were resistant to Amoxicillin, MRSA showed highest sensitivity (44.4%) to Vancomycin and (27.8%) to Imipenem. K. pneumoniae were sensitive mainly to Imipenem (75.9%) and to Levofloxacin (44.8%).Conclusion: Gram-negative organisms were isolated in 46% of cases, gram-positive organisms in 41% and the isolated organisms showed high resistance to most of the tested antibiotics. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest Diseases and Tuberculosis.

Background: Acute pharyngitis is one of the most common illnesses. Most acute cases are caused by viral infections. To enhance the appropriate prescribing of antibiotics a number of clinical prediction rules have been developed to distinguish streptococcal pharyngitis from pharyngitis by other causes Aim: To assess the appropriateness of antibiotic prescribed to cases of acute pharyngitis and the diagnostic accuracy of the McIsaac modified Centor score for predicting group A beta hemolytic streptococcal pharyngitis. Patients and Methods: A cross-sectional study; was conducted in Port Said fever hospital, Ismailia fever hospital and Suez fever hospital, within the area of Suez Canal, including. The study included 196 patients who presented to these hospitals between the age of 3 and 65 years. Results: Antibiotics were prescribed to 86% of patients while the prevalence of group A beta hemolytic streptococcus (GABHS) pharyngitis was 12.8%. A broad spectrum third-line agents or a non recommended antibiotics were prescribed to 62% of patients. McIsaac score was found to be 100% sensitive and 63.16% specific giving 28.41% a positive predictive value and a negative predictive value of 100%. Conclusion: Antibiotics are prescribed inappropriatly to patients with acute pharyngitis and McIsaac score is a useful clinical to for diagnosis of GABHS pharyngitis and its use decreases antibiotic prescription.

BackgroundDientamoeba fragilis was considered as a commensal amoeba that inhabits the large intestine. Later, its association with irritable bowel syndrome drew attention to its pathogenicity. Metronidazole (MTZ) is the most recommended drug for treatment of D. fragilis and other pathogenic intestinal protozoa. Many studies reported that it is not suitable for children because of its mutagenicity and carcinogenic potential. However, still more work is needed to establish new, effective, and safe therapeutic agents against D. fragilis.Aim of the workThe present study aimed at evaluating the effect of different doses of the aqueous extract of Nigella sativa on D. fragilis in experimentally infected mice in comparison with MTZ as a standard drug.Materials and methodsIsolates of D. fragilis were obtained from patients complaining of acute/chronic intermittent diarrhea or diarrhea alternating with constipation with/without abdominal pain. Histopathological examination of cecal tissue of experimentally infected and treated mice with three different doses of N. sativa (125, 250, and 500 mg/kg/day) was compared with that of mice infected and treated by two doses of MTZ (62.5 and 125 mg/kg/day) as the standard treatment. Infected untreated mice were used as the control group.ResultsHistopathological examination of cecal tissue of the infected untreated group showed different degrees of pathological changes, which completely disappeared with the highest N. sativa dose (500 mg/kg). Concentrations below 500 mg/kg produced less severe pathological changes than in untreated animals. N. sativa in high dose significantly prevented cytopathic effect in mice 1 day after infection and for five consecutive days.ConclusionN. sativa has a potential therapeutic effect against D. fragilis infection in an experimental in vivo study. We recommend double-blind controlled clinical trials in humans to assess the use of N. sativa in management of human D. fragilis infection.

Background and study aims: Giardiasis may present with dyspeptic symptoms that may mimic other gastrointestinal and/or biliary disorders. The objective of this study was to determine the prevalence of giardiasis in stool and duodenal aspirate of patients with NUD, assess symptomatic benefit of therapy, and compare the diagnostic tools for giardiasis utilizing stool and duodenal aspirates microscopic evaluation versus ELISA testing.Patients and methods: 109 Patients with endoscopic diagnosis of NUD out of 278 consecutive patients with dyspepsia were included. The severity of dyspepsia and the quality of life were assessed utilizing Rome II criteria and SF-36 for Quality of Life and concomitant stool and/or duodenal aspirate samples were submitted for ELISA antigen test for Giardia intestinalis. Those who tested positive for giardiasis (Group 1) were assigned to receive Tinidazole 2.0 g. single dose plus omeprazole for 4 weeks and the remaining patients (Group 2) omeprazole alone for 4 weeks. One month after therapy, both groups were reassessed and Stool ELISA antigen test for G. intestinalis for Group 1, was performed.Results: ELISA testing of stool (19%) and duodenal aspirates (19%) had significantly better results than microscopic ones in stool (11%) or duodenal aspirates (7%). The two groups were well matched with respect to age, sex, initial results on the Glasgow Dyspepsia Severity Score, prevalence of previously prescribed antisecretory-drug therapy, prevalence of smoking, predominant symptom at presentation, and quality of life. The outcome of patients at 1 month, on an intention-to-treat basis, showed that the symptoms were resolved (defined as a score of 0 or 1) in 17 of 21 patients (81%) in Group 1 as compared with 31 of 88 patients (35%) in Group 2 P < 0.001. The scores in both groups were lower than those at base line and there was a highly statistically significant difference between both groups.Conclusion: G. intestinalis as a cause of dyspepsia should be considered in patients with negative endoscopy and in those who remain symptomatic in spite of adequate treatment for known upper G. I. disorders. NUD associated with the presence of Giardia, had better symptomatic benefit (81%) with specific treatment than controls (35%). ELISA testing of stool (19%) and duodenal aspirates (19%) had significantly better results than microscopic ones in stool (11%) or duodenal aspirates (7%). (C) 2013 Arab Journal of Gastroenterology. Published by Elsevier B.V.

The necessity to treat patients with chronic hepatitis C virus infection (HCV) prior to renal transplantation is evident, particularly in young non-cirrhotic patients. In this study our aim was to asses the virological response to pegylated interferon alone and in combination with ribavirin 200 mg three times weekly in chronic hepatitis C patients with chronic renal failure on haemodialysis, awaiting kidney transplantation. In a retrospective study, data of patients from King Saud Medical Complex in Saudi Arabia were collected. Three groups were included: Group1 included 18 chronic hepatitis C patients with chronic renal failure on haemodialysis who received pegylated interferon alfa2a. Group 2 included 19 chroinc hepatitis C patients who received pegylated interferon alfa2a with ribavirin 200 mg three times weekly. The control group included 17 chronic hepatitis C patients on haemodialysis who did not receive treatment. Sixteen patients in each Groups 1 (89%) and 2 (84%) tolerated treatment and continued therapy. Out of these, 56% of Group 1 patients showed a sustained virological response (SVR), whereas in Group 2 75% had a SVR. Non of Group 3 patients had negative HCV RNA. There is a statistically non-significant difference on adding ribavirin 200 mg three times weekly to pegylated interferon alfa2a. Treatment of chronic hepatitis C in haemodialysis patients is generally safe and well tolerated. A significant SVR can be obtained either in the pegylated interferon alone or in combination with low dose ribavirin. We recommend larger prospective controlled clinical trials especially in haemodialysis patients eligible for kidney transplantation and a follow-up on patients after kidney transplantation to assess outcome.

Natural killer cells can be divided into five subpopulations based on the relative expression of CD16 and CD56 markers. The majority of natural killer cells are CD56(dim), which are considered to be the main cytotoxic effectors. A minority of the natural killer cells are CD56(bright), and function as an important source of immune-regulatory cytokines. Shifts of these subsets have been reported in patients with chronic hepatitis C virus infection. We sought to investigate the shift of natural killer subsets among Egyptian patients with chronic HCV and to analyze the influence of interferon therapy on this shift. We applied a flow cytometric analysis of peripheral blood natural killer subsets for 12 interferon-untreated and 12 interferon-treated patients with chronic HCV, in comparison to 10 control subjects. Among interferon-untreated patients, there was a significant reduction of CD56(-)16(+) ( immature natural killer) cells. Among interferon-treated patients, the absolute count of natural killer cells was reduced, with expansion of the CD56bright subset and reduction of the CD56(dim)16(+) subset. Natural killer subset counts were not significantly correlated to HCV viral load and were not significantly different among interferon responders and non-responders. In conclusion, HCV infection in Egyptian patients has been observed to be statistically and significantly associated with reduction of the CD56(-)16(+) NK subset, while a statistically significant expansion of CD56bright and reduction of CD56(dim)16(+) subsets were observed after interferon therapy. Further studies are required to delineate the molecular basis of interferon-induced shift of natural killer subsets among patients with HCV.

Natural killer cells (NK) as components of the innate immunity substantially contribute to anti-tumor immune responses, NK cell subpopulations can be defined on the basis of the relative expression of CD16 and CD56 markers. Earlier research demonstrated a dramatic reduction in the frequency of peripheral blood CD56dimCD16+ NK subsets in hepatocellular carcinoma (HCC) patients compared with healthy subjects. We aim to assess the relative and absolute counts of natural killer cells subsets in hepatitis C-related HCC among Egyptian patients. Flowcytometric analysis of peripheral blood NK subsets was performed for HCV with HCC patients (n=20) and HCV without HCC patients (n=14) as compared to healthy control subjects (n=152). We found that HCC patients displayed a marked reduction in the relative frequency of peripheral CD56im subsets compared with healthy subjects. Moreover, there was a significant reduction in the absolute counts of CD56dim16+, CD56dim16- and CD56bright. In conclusion, this study demonstrated that the absolute counts of dim and bright NK cell subsets were decreased in different proportions in patients with HCV-related HCC that refers to a possible role for these cells, particularly CD 56 bright cells, in the immune response to HCC. This might aid in developing new therapeutic strategies targeting both NK subsets for HCC.

The genotyping of cryptosporidium clinical isolates obtained from 36 gastrointestinal symptomatic patients were identified by nested PCR for amplification of 18S rRNA followed by RFLP analysis using Ssp1 and Vsp1, and then pathological changes between different cryptosporidium genotypes were evaluated in experimentally infected mice. Cryptosporidium genotypes (C. parvum, C. hominis & C. melegridies) were detected (66.7%, 27.7% & 5.6%) respectively in human isolates. Different degrees of pathological changes were found among infected mice by different Cryptosporidium genotypes. Moderate and severe degrees of pathological changes with infection score ranging from 2 to 4 were found in all infected mice with C. parvum (except one isolate), while mild degree of pathological changes with infection score of 2 was found in all mice with C. melegridies. The results showed statistically significant relation between genotype and pathological degrees. There were no differences in the average number of oocysts per smear in Group II and Group III while in Group I, there was no oocysts shedding.

The present study assessed sensitivity and specificity of PCR targeting P30 gene in diagnosis of congenital toxoplasmosis using amniotic fluid samples. A total of 358 pregnant women in their first trimester of pregnancy, most of them were asymptomatic while the others suffered lymphadenopathy, fever and/or malaise. The serum sample from each woman was screened for Toxoplasma-specific ELISA IgM & IgG. Sero-negative females were then screened in 2nd & 3rd trimesters for sero-conversion. Amniocentesis was performed to seropositive and sero-converted women. Detection of Toxoplasma DNA in AF was done by animal inoculation and PCR targeting P30 gene. 85/358 women were sero-positive for Toxoplasma. Congenital infection was detected in 14/85 fetuses by MI. One mouse had tachyzoite in peritoneal exudate while other 13 showed cysts in histpathological sections of mice. PCR test targeting P30 gene was positive in 13 with additional four fetuses, only PCR gave positive results, and serologic follow-up of suspected fetuses (17) by IgM ELISA confirmed congenital toxoplasmosis. Sixteen cases of congenitally infected newborn were a symptomatic. One was clinically diagnosed (ventricular dilatation) by the ultrasound. The PCR drastically changed the diagnostic repertoire for prenatal diagnosis. The sensitivity and specificity of PCR targeting P30 gene on AF samples were 92.9% & 94.4% respectively while positive predictive value (PPV) was 76.5%, and negative predictive value (NPV) was 98.5%. Its disadvantages were in fact that negative result cannot exclude acute infection, and thus must be confirmed by MI and it is also an expensive technique.

The genotyping of Blastocystis hominis clinical isolates obtained from 28 gastrointestinal symptomatic patients and 16 asymptomatic individuals were identified by polymerase chain reaction using sequenced-tagged site (STS) primers. Then, pathophysiological variability between different B. hominis genotypes was evaluated in experimentally infected rats. Only four B. hominis subtypes (1, 2, 3, and 4) were detected (18.2%, 9.1%, 54.5%, and 18.2%, respectively) in human isolates. In symptomatic isolates, subtypes 1, 3, and 4 were detected in 8 (28.6%), 16 (57.1%), and 4 (14.3%) patients, respectively. In asymptomatic isolates, subtypes 2, 3, and 4 were identified in 4 (25%), 8 (50%), and 4 (25%), respectively. Subtype 3 was the commonest in humans. Different degrees of pathological changes were found among infected rats by symptomatic subtypes compared with asymptomatic subtypes. The moderate and severe degrees of pathological changes were found only in symptomatic subtypes infected rats while mild degree was found only in asymptomatic subtypes infected rats. Only subtype 1 induced mortality rate with 25% among infected rats. On evaluation of the intestinal cell permeability in the Ussing chamber, a prominent increase in short circuit current (ΔIsc) was found in symptomatic subtype 1 compared to symptomatic subtypes 3 and 4 infected rats. Minimal effects were found in the asymptomatic and control groups. The results proved that subtype 1 was clinically and statistically highly relevant to the pathogenicity of B. hominis while subtype 2 was irrelevant. Also, the results suggest the presence of pathogenic and nonpathogenic strains among subtypes 3 and 4.