AbstractContinuouspositiveairwaypressure(CPAP)isastandardtreatmentofmoderateandsevereobstructive sleepapnea syndrome.However, itseffect inpatients with coexistingobstructiveandcentralapneasiscontroversial. Objectives:TodeterminetheimmediateresponsetoCPAPincombinedobstructiveandcentralsleepapneapatientswithoutheartfailure. Methods:Thirty sevenconsecutivepatients with moderateandsevere coexisting obstructive andcentralapneas(combinedgroup)wereprospectivelyenrolledinthiscrosssectionalanalyticstudy.Allpatientsunderwentafullnight-attendedandafullnightCPAPtitrationpolysomnography.TitrationwasconsideredsuccessfulifAHI 10andthetitrationstudyincludedatleast15 min inREMstage. Results:OnCPAPtitration,thecombinedgroupshowedsignificantimprovementinsleepandrespiratorypolysomnographicparameters.MeanAHIwasreducedfrom71.9±30.3to 8.39±5.15(P=0.000).WhereasCPAPsignificantlyreducedthecentralapneaindexfrom 12.8±6.67to3.1±2.86(P=0.000),theresponsetocentraleventswasvariable(rangedfrom20%to100%).Overallresults,25(67.6%)hadsuccessfultitrationwithsignificantbetterresponseinfemalesthanmalestoCPAPthanmales(88.9%vs.60.7%,P=0.019). Conclusion:CPAPcanbeeffectiveincombinedobstructiveandcentralapneapatientswithoutheartfailurewithconsiderationofindividualvariability.AtrialofCPAPtitrationshouldbedoneinthosepatients. 2016TheEgyptianSocietyof ChestDiseasesandTuberculosis.Productionandhostingby ElsevierB.V.Thisisanopenaccessarticle under theCCBY-NC-ND license (http://creativecommons.org/licenses/by-nc-

Theimmunomodulatory effectsofantibioticscouldinfluencethedegreeofsystemicandlocalresponsestoinfection,soinvestigationoftheirintrinsicinfluenceonthehost’sinflammatoryresponseappearstobeessential.Fluoroquinolonesareknowntoexertmodulatoryactivityonimmuneresponsestomicrobialinfection.Howeverthemechanismofthisimmunmodulationhasnotbeenwellelucidated.Theaimofthework,istoassesstheimmunomodulatoryeffectsofalevofloxacin,throughexaminingitseffectontheconcentrationsoftumornecrosisfactorα(TNF-α)andInterleukin–10(IL-10)inserumofpneumonicpatients.Afterfollowinglocalresearchethicscommitteeapprovalandinformedconsent.Thisstudyincluded 40patientswithdifferenttypesofpneumonia,admittedtodepartmentofChestDiseases,FacultyofMedicine,AssiutUniversityHospitals,Egypt.Also,10healthyvolunteersservedasrandomizedcontrols.Bothpatientsandcontrolsreceivedlevofloxacin(750mgoncedailyfor10days).SerumlevelsofTNF-αandIL-10weremeasuredinpatientsandcontrolbeforeandafterlevofloxacinadministration(750mgoncedailyfor10days)usinghumanTNF–αandIL-10ELISAkitsrespectively.LevofloxacincausedastatisticallysignificantdecreaseinthemeanlevelofTNF-αinbothpatients(20.82±1.31pg/ml)(P0.009)andcontrolgroup(17.12±0.84pg/ml)(P0.004).Incontrast,therewasstatisticallysignificantincrease(P0.000)inthemeanlevelofIL-10inpatients (61.75±2.85pg/ml)whilestatisticallysignificantdecrease(P0.005)incontrolgroup(28.57±1.37pg/ml).Inconclusion,ourstudydemonstratesthattreatmentwithlevofloxacinaffectsproductionofTNF-αasapro-inflammatorycytokineandIL-10asananti-inflammatorycytokineswhichmayprovide additionalbenefitsintreatmentof respiratorytract infectionsthatare independentofitsantibacterialproperties.

Theimmunomodulatory effectsofantibioticscouldinfluencethedegreeofsystemicandlocalresponsestoinfection,soinvestigationoftheirintrinsicinfluenceonthehost’sinflammatoryresponseappearstobeessential.Fluoroquinolonesareknowntoexertmodulatoryactivityonimmuneresponsestomicrobialinfection.Howeverthemechanismofthisimmunmodulationhasnotbeenwellelucidated.Theaimofthework,istoassesstheimmunomodulatoryeffectsofalevofloxacin,throughexaminingitseffectontheconcentrationsoftumornecrosisfactorα(TNF-α)andInterleukin–10(IL-10)inserumofpneumonicpatients.Afterfollowinglocalresearchethicscommitteeapprovalandinformedconsent.Thisstudyincluded 40patientswithdifferenttypesofpneumonia,admittedtodepartmentofChestDiseases,FacultyofMedicine,AssiutUniversityHospitals,Egypt.Also,10healthyvolunteersservedasrandomizedcontrols.Bothpatientsandcontrolsreceivedlevofloxacin(750mgoncedailyfor10days).SerumlevelsofTNF-αandIL-10weremeasuredinpatientsandcontrolbeforeandafterlevofloxacinadministration(750mgoncedailyfor10days)usinghumanTNF–αandIL-10ELISAkitsrespectively.LevofloxacincausedastatisticallysignificantdecreaseinthemeanlevelofTNF-αinbothpatients(20.82±1.31pg/ml)(P0.009)andcontrolgroup(17.12±0.84pg/ml)(P0.004).Incontrast,therewasstatisticallysignificantincrease(P0.000)inthemeanlevelofIL-10inpatients (61.75±2.85pg/ml)whilestatisticallysignificantdecrease(P0.005)incontrolgroup(28.57±1.37pg/ml).Inconclusion,ourstudydemonstratesthattreatmentwithlevofloxacinaffectsproductionofTNF-αasapro-inflammatorycytokineandIL-10asananti-inflammatorycytokineswhichmayprovide additionalbenefitsintreatmentof respiratorytract infectionsthatare independentofitsantibacterialproperties.

Theimmunomodulatory effectsofantibioticscouldinfluencethedegreeofsystemicandlocalresponsestoinfection,soinvestigationoftheirintrinsicinfluenceonthehost’sinflammatoryresponseappearstobeessential.Fluoroquinolonesareknowntoexertmodulatoryactivityonimmuneresponsestomicrobialinfection.Howeverthemechanismofthisimmunmodulationhasnotbeenwellelucidated.Theaimofthework,istoassesstheimmunomodulatoryeffectsofalevofloxacin,throughexaminingitseffectontheconcentrationsoftumornecrosisfactorα(TNF-α)andInterleukin–10(IL-10)inserumofpneumonicpatients.Afterfollowinglocalresearchethicscommitteeapprovalandinformedconsent.Thisstudyincluded 40patientswithdifferenttypesofpneumonia,admittedtodepartmentofChestDiseases,FacultyofMedicine,AssiutUniversityHospitals,Egypt.Also,10healthyvolunteersservedasrandomizedcontrols.Bothpatientsandcontrolsreceivedlevofloxacin(750mgoncedailyfor10days).SerumlevelsofTNF-αandIL-10weremeasuredinpatientsandcontrolbeforeandafterlevofloxacinadministration(750mgoncedailyfor10days)usinghumanTNF–αandIL-10ELISAkitsrespectively.LevofloxacincausedastatisticallysignificantdecreaseinthemeanlevelofTNF-αinbothpatients(20.82±1.31pg/ml)(P0.009)andcontrolgroup(17.12±0.84pg/ml)(P0.004).Incontrast,therewasstatisticallysignificantincrease(P0.000)inthemeanlevelofIL-10inpatients (61.75±2.85pg/ml)whilestatisticallysignificantdecrease(P0.005)incontrolgroup(28.57±1.37pg/ml).Inconclusion,ourstudydemonstratesthattreatmentwithlevofloxacinaffectsproductionofTNF-αasapro-inflammatorycytokineandIL-10asananti-inflammatorycytokineswhichmayprovide additionalbenefitsintreatmentof respiratorytract infectionsthatare independentofitsantibacterialproperties.

Theimmunomodulatory effectsofantibioticscouldinfluencethedegreeofsystemicandlocalresponsestoinfection,soinvestigationoftheirintrinsicinfluenceonthehost’sinflammatoryresponseappearstobeessential.Fluoroquinolonesareknowntoexertmodulatoryactivityonimmuneresponsestomicrobialinfection.Howeverthemechanismofthisimmunmodulationhasnotbeenwellelucidated.Theaimofthework,istoassesstheimmunomodulatoryeffectsofalevofloxacin,throughexaminingitseffectontheconcentrationsoftumornecrosisfactorα(TNF-α)andInterleukin–10(IL-10)inserumofpneumonicpatients.Afterfollowinglocalresearchethicscommitteeapprovalandinformedconsent.Thisstudyincluded 40patientswithdifferenttypesofpneumonia,admittedtodepartmentofChestDiseases,FacultyofMedicine,AssiutUniversityHospitals,Egypt.Also,10healthyvolunteersservedasrandomizedcontrols.Bothpatientsandcontrolsreceivedlevofloxacin(750mgoncedailyfor10days).SerumlevelsofTNF-αandIL-10weremeasuredinpatientsandcontrolbeforeandafterlevofloxacinadministration(750mgoncedailyfor10days)usinghumanTNF–αandIL-10ELISAkitsrespectively.LevofloxacincausedastatisticallysignificantdecreaseinthemeanlevelofTNF-αinbothpatients(20.82±1.31pg/ml)(P0.009)andcontrolgroup(17.12±0.84pg/ml)(P0.004).Incontrast,therewasstatisticallysignificantincrease(P0.000)inthemeanlevelofIL-10inpatients (61.75±2.85pg/ml)whilestatisticallysignificantdecrease(P0.005)incontrolgroup(28.57±1.37pg/ml).Inconclusion,ourstudydemonstratesthattreatmentwithlevofloxacinaffectsproductionofTNF-αasapro-inflammatorycytokineandIL-10asananti-inflammatorycytokineswhichmayprovide additionalbenefitsintreatmentof respiratorytract infectionsthatare independentofitsantibacterialproperties.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.HaemophilusinfluenzaeisaleadingcauseofCAP.ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofHaemophilusinfluenzaeisolatedfromunvaccinatedadultpatientswithCAPatAssiutUniversityHospitals.MaterialsandMethods:FromSeptember2013toaugust2014,sputumsamplesfrom132adultpatientswithCAPwereanalyzedforthedetectionofHaemophilusinfluenzausingconventionalmethods.AntimicrobialsusceptibilityandserotypingofHaemophilusinfluenzaewasperformed.Results:Haemophilusinfluenzaeweredetectedin21(16%)CAP-patients.Non-typeableHinfluenzaewerethemostfrequentlyisolatedserotypethatfoundin15(71%)ofHinfluenzae-cases.Hinfluenzaetypebwasfoundin5(24%)cases.WhileHinfluenzaetypefwasfoundinone(5%)case.CasesweredetectedmainlyduringJanuary,February,andMarch.ResistancewashighestfortheB-lactamgroupofantibiotics.Conclusion:CAPhasadiseaseburdeninadultpatientsatAssiutUniversityHospitals,Egypt.HinfluenzaeisaleadingcauseofCAPwhichwasassociatedmostlywithnon-typeableserotypes.ResistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongH influenzaestrains. Keywords:Haemophilusinfluenzae,community-acquiredpneumonia,serotyping, antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.HaemophilusinfluenzaeisaleadingcauseofCAP.ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofHaemophilusinfluenzaeisolatedfromunvaccinatedadultpatientswithCAPatAssiutUniversityHospitals.MaterialsandMethods:FromSeptember2013toaugust2014,sputumsamplesfrom132adultpatientswithCAPwereanalyzedforthedetectionofHaemophilusinfluenzausingconventionalmethods.AntimicrobialsusceptibilityandserotypingofHaemophilusinfluenzaewasperformed.Results:Haemophilusinfluenzaeweredetectedin21(16%)CAP-patients.Non-typeableHinfluenzaewerethemostfrequentlyisolatedserotypethatfoundin15(71%)ofHinfluenzae-cases.Hinfluenzaetypebwasfoundin5(24%)cases.WhileHinfluenzaetypefwasfoundinone(5%)case.CasesweredetectedmainlyduringJanuary,February,andMarch.ResistancewashighestfortheB-lactamgroupofantibiotics.Conclusion:CAPhasadiseaseburdeninadultpatientsatAssiutUniversityHospitals,Egypt.HinfluenzaeisaleadingcauseofCAPwhichwasassociatedmostlywithnon-typeableserotypes.ResistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongH influenzaestrains. Keywords:Haemophilusinfluenzae,community-acquiredpneumonia,serotyping, antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.HaemophilusinfluenzaeisaleadingcauseofCAP.ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofHaemophilusinfluenzaeisolatedfromunvaccinatedadultpatientswithCAPatAssiutUniversityHospitals.MaterialsandMethods:FromSeptember2013toaugust2014,sputumsamplesfrom132adultpatientswithCAPwereanalyzedforthedetectionofHaemophilusinfluenzausingconventionalmethods.AntimicrobialsusceptibilityandserotypingofHaemophilusinfluenzaewasperformed.Results:Haemophilusinfluenzaeweredetectedin21(16%)CAP-patients.Non-typeableHinfluenzaewerethemostfrequentlyisolatedserotypethatfoundin15(71%)ofHinfluenzae-cases.Hinfluenzaetypebwasfoundin5(24%)cases.WhileHinfluenzaetypefwasfoundinone(5%)case.CasesweredetectedmainlyduringJanuary,February,andMarch.ResistancewashighestfortheB-lactamgroupofantibiotics.Conclusion:CAPhasadiseaseburdeninadultpatientsatAssiutUniversityHospitals,Egypt.HinfluenzaeisaleadingcauseofCAPwhichwasassociatedmostlywithnon-typeableserotypes.ResistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongH influenzaestrains. Keywords:Haemophilusinfluenzae,community-acquiredpneumonia,serotyping, antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.Streptococcuspneumoniaeisthemostcommoncauseofcommunity-acquiredpneumonia. ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofStreptococcuspneumoniaeisolatedfrompatientswithcommunity-acquiredpneumoniaatAssiutUniversityHospitals.FromFebruary2013toMay2013,sputumsamplesfrom60adultpatientswithcommunity-acquiredpneumoniawereanalyzedforbacterialetiologyusingconventionalmethods.Antimicrobialsusceptibility and serotyping of Streptococcuspneumoniae wasperformed. bacterialagentsweredetectedin53patients(88%).Streptococcuspneumoniaewasthemostcommon(30%)isolatedbacteria.Eightco-infectionswereidentified.Thedetectedpneumococcal-serotypeswereindecreasingorder;1,9V,6B,19F,23F,14,and19A.Pneumococcal-antibioticresistancewashighestforpenicillinandampicillinantibiotics.Streptococcuspneumoniaeisthemostcommonisolatedbacteriaincasesofcommunity-acquiredpneumoniawhichisassociatedwithcertainserotypes.Resistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongpneumococcalstrainsworldwide. Keywords:Streptococcuspneumoniae,community-acquiredpneumonia,serotyping,antimicrobialresistance.

ABSTRACT Community-acquiredpneumoniaisacommondiseaseandafrequentcauseofmorbidityandmortalityworldwide.Streptococcuspneumoniaeisthemostcommoncauseofcommunity-acquiredpneumonia. ThecurrentstudywasconductedtodeterminetheserotypedistributionandantimicrobialsusceptibilitypatternsofStreptococcuspneumoniaeisolatedfrompatientswithcommunity-acquiredpneumoniaatAssiutUniversityHospitals.FromFebruary2013toMay2013,sputumsamplesfrom60adultpatientswithcommunity-acquiredpneumoniawereanalyzedforbacterialetiologyusingconventionalmethods.Antimicrobialsusceptibility and serotyping of Streptococcuspneumoniae wasperformed. bacterialagentsweredetectedin53patients(88%).Streptococcuspneumoniaewasthemostcommon(30%)isolatedbacteria.Eightco-infectionswereidentified.Thedetectedpneumococcal-serotypeswereindecreasingorder;1,9V,6B,19F,23F,14,and19A.Pneumococcal-antibioticresistancewashighestforpenicillinandampicillinantibiotics.Streptococcuspneumoniaeisthemostcommonisolatedbacteriaincasesofcommunity-acquiredpneumoniawhichisassociatedwithcertainserotypes.Resistancetopenicillinandotherantimicrobialagentsincreasedrapidlyduringthelastyearsamongpneumococcalstrainsworldwide. Keywords:Streptococcuspneumoniae,community-acquiredpneumonia,serotyping,antimicrobialresistance.