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Background: The assessment of quality of life (QoL) has become increasingly important in the process of monitoring quality of care and improving services for people with skin diseases. Objective: This study aimed to translate the Skindex-16, a skin-disease-specific, brief QoL questionnaire into Arabic and culturally adapt it to Egyptians and to evaluate its reliability and validity. Methods: Translation and cultural adaption were performed following guidelines for cross-cultural adaption of health-related quality of life measures. Subsequently, the Egyptian Arabic version of Skindex-16 was administered to 500 consecutive dermatological patients and 500 healthy persons for verification of its reliability and validity. Results: Three items of Skindex-16 required a second translation and back-translation to achieve satisfactory agreement with the original instrument. The instrument showed high internal consistency (Cronbach’s alpha range for the scales 0.79-0.95), indicating good reliability. Construct validity was indicated by higher scores for all patients than those for healthy persons (41.3±20.3 vs. 1.0±3.4 respectively, P 0.001), indicating a poorer QoL. In addition, patients with skin color change/ difficult concealment had significantly poorer QoL than those without skin color change (42.9±20.8 vs. 36.2±17.9 respectively; P = 0.003) or without difficult concealment (45.5±20.7 vs. 34.6±17.7 respectively; P 0.001). The majority (90%) of the patients’ responses to an open-ended question about their skin disease were addressed in Skindex-16, indicating content validity. Hyperpigmentation was the most frequently mentioned response that was not directly addressed by the items of the instrument. Conclusion: The adapted and translated Egyptian Arabic version of Skindex-16 provides valid and reliable assessments of QoL in Egyptian patients with skin disease. We recommend adding questions, in the Arabic version of Skindex-16, addressing hyperpigmentation that was frequently mentioned by our patients.

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Background: The enterococci may be considered as opportunistic agents particularly in immunocompromised patients. It is one of the top three pathogens causing many healthcare associated infections (HAIs). Resistance to several commonly used antimicrobial agents is a remarkable characteristic of most species which may carry various genes contributing to virulence. Objectives: to determine the prevalence of enterococci species in different intensive care units (ICUs) causing health care associated infections (HAIs), intestinal carriage and environmental contamination. Also, to study the antimicrobial susceptibility pattern of the isolates with special reference to vancomycin resistance. In addition to phenotypic and genotypic detection of gelatinase, cytolysin and biofilm formation among isolates. Patients and methods: This study was carried out in the infection control laboratory at Assiut University Hospitals over a period of one year. Clinical samples were collected from 285 patients with various (HAIs) acquired after admission to different ICUs. Rectal swabs were taken from 14 cases for detection of enterococci carriage. In addition, 1377 environmental samples were collected from the surroundings of the patients. Identification was done by conventional bacteriological methods and confirmed by analytical profile index (API). Antimicrobial sensitivity testing was performed by Kirby Bauer disc diffusion method and detection of vancomycin resistance was done by agar screen method. For the isolates, phenotypic detection of cytolysin, gelatinase production and detection of biofilm by tube method, Congo red method and microtiter plate. We performed polymerase chain reaction (PCR) for detection of some virulence genes (gelE, cylA, vanA, vanB and esp). Results: Enterococci caused 10.5% of the HAIs. Respiratory tract infection was the predominant type (86.7%). The commonest species were E.gallinarum (36.7%), E.casseliflavus (30%), E.faecalis (30%), and E.durans (3.4 %). Vancomycin resistance was detected in a total of 40% (12/30) of those isolates. The risk factors associated with acquiring vancomycin resistant enterococci (VRE) were immune suppression (P= 0.031) and artificial feeding (P= 0.008). For the rectal swabs, enterococci species were detected in 71.4% of samples with the predominance of E.casseliflavus (50%). Most of the isolates were vancomycin resistant (70%). Out of a total 1377 environmental samples, 577 (42%) samples were contaminated with different microorganisms. Enterococci were detected in 1.7% (10/577) of total contaminated samples, 50% of which were vancomycin resistant. All isolates were resistant to penicillin, ampicillin, oxacillin, ciprofloxacin, amikacin, erythromycin, clindamycin and trimethoprim-sulfamethaxazole. For the remaining antibiotics, variable percentages of resistance were reported. Cytolysin and gelatinase were detected phenotypically in 16% and 48 % of the isolates respectively. The microtiter plate method showed the highest percentages of detection of biofilm among all isolated species (100%). The studied virulence genes gelE , esp, vanA and vanB were detected in 62%, 12%, 2% and 12% respectively, while cylA gene was not detected in any isolates. Conclusions: A significant percentage of enterococci was isolated from patients and environments in the ICUs. Many virulence factors were detected phenotypically and genotypically among isolates. The high percentage of resistance, coupled with the risk of cross transmission to other patients make enterococci infections a significant infection control issue in hospitals Keywords— Antimicrobial resistance , enterococci, ICUs, virulence factors

Background: The enterococci may be considered as opportunistic agents particularly in immunocompromised patients. It is one of the top three pathogens causing many healthcare associated infections (HAIs). Resistance to several commonly used antimicrobial agents is a remarkable characteristic of most species which may carry various genes contributing to virulence. Objectives: to determine the prevalence of enterococci species in different intensive care units (ICUs) causing health care associated infections (HAIs), intestinal carriage and environmental contamination. Also, to study the antimicrobial susceptibility pattern of the isolates with special reference to vancomycin resistance. In addition to phenotypic and genotypic detection of gelatinase, cytolysin and biofilm formation among isolates. Patients and methods: This study was carried out in the infection control laboratory at Assiut University Hospitals over a period of one year. Clinical samples were collected from 285 patients with various (HAIs) acquired after admission to different ICUs. Rectal swabs were taken from 14 cases for detection of enterococci carriage. In addition, 1377 environmental samples were collected from the surroundings of the patients. Identification was done by conventional bacteriological methods and confirmed by analytical profile index (API). Antimicrobial sensitivity testing was performed by Kirby Bauer disc diffusion method and detection of vancomycin resistance was done by agar screen method. For the isolates, phenotypic detection of cytolysin, gelatinase production and detection of biofilm by tube method, Congo red method and microtiter plate. We performed polymerase chain reaction (PCR) for detection of some virulence genes (gelE, cylA, vanA, vanB and esp). Results: Enterococci caused 10.5% of the HAIs. Respiratory tract infection was the predominant type (86.7%). The commonest species were E.gallinarum (36.7%), E.casseliflavus (30%), E.faecalis (30%), and E.durans (3.4 %). Vancomycin resistance was detected in a total of 40% (12/30) of those isolates. The risk factors associated with acquiring vancomycin resistant enterococci (VRE) were immune suppression (P= 0.031) and artificial feeding (P= 0.008). For the rectal swabs, enterococci species were detected in 71.4% of samples with the predominance of E.casseliflavus (50%). Most of the isolates were vancomycin resistant (70%). Out of a total 1377 environmental samples, 577 (42%) samples were contaminated with different microorganisms. Enterococci were detected in 1.7% (10/577) of total contaminated samples, 50% of which were vancomycin resistant. All isolates were resistant to penicillin, ampicillin, oxacillin, ciprofloxacin, amikacin, erythromycin, clindamycin and trimethoprim-sulfamethaxazole. For the remaining antibiotics, variable percentages of resistance were reported. Cytolysin and gelatinase were detected phenotypically in 16% and 48 % of the isolates respectively. The microtiter plate method showed the highest percentages of detection of biofilm among all isolated species (100%). The studied virulence genes gelE , esp, vanA and vanB were detected in 62%, 12%, 2% and 12% respectively, while cylA gene was not detected in any isolates. Conclusions: A significant percentage of enterococci was isolated from patients and environments in the ICUs. Many virulence factors were detected phenotypically and genotypically among isolates. The high percentage of resistance, coupled with the risk of cross transmission to other patients make enterococci infections a significant infection control issue in hospitals Keywords— Antimicrobial resistance , enterococci, ICUs, virulence factors

Background: Pyospermia is a common finding in infertile men with controversial issues about its significance Objective: To evaluate effect of pyospermia on computerized semen (CASA) parameters, sperm DNA integrity and chromosomal aneuploidy in infertile men. Subjects: The study included 50 infertile men with oligoasthenoteratozoospermia divided into 2 groups according to presence or absence of pyospermia. Methods: The study included clinical evaluation, peroxidase stain, CASA, sperm DNA evaluation with acridine orange test and sperm FISH analysis of 18, x and Y chromosomes. Main outcome measure: Comparison between the infertile men with and without pyospermia CASA, sperm DNA fragmentation with acridine orange test and sperm FISH parameters. Also, to correlate between the number of pus cells and these parameters. Results: Infertile men with pyospermia had significantly lower sperm progressive and total motility percentages. Also, motility parameters by CASA including curvilinear, straight line and average pathway velocities, straightness, and amplitude of lateral head displacement were significantly lower with pyospermia. Sperm DNA fragmentation index by AOT was significantly higher with pyospermia. Percentages of sperms with disomy XY and 18 by FISH were higher with pyospermia. These changes in sperm motility parameters and DNA integrity correlated with the number of peroxidase positive leukocytes. Conclusions: Pyospermia has a negative impact on sperm motility parameters and DNA integrity regardless infertility as a cofactor.