Methicillin resistance in staphylococcus aureus (MRSA) and in Coagulase – negative staphylococci (MRCNS) is wide spread and continues to increase in prevalence particularly in health care settings. MRSA is among the most important causes of nosocomial infections. It possesses a particular ability to spread in hospitals worldwide. Objectives: In this study we aimed to measure the frequency of clinical MRSA infection in Assiut University Hospital among patients and health care workers, and to compare different methicillin susceptibility methods with mecA gene detection by PCR as a gold standard test. In one year duration study, 660 patients admitted to different ICUs in Assiut University Hospital were included, 20% (132/660) of them developed nosocomial infection. Staphylococci accounted for 58.3% (77/132) of these cases, and 94 staphylococcal isolates were detected. MRSA represented 64.9% (61/94). Also health care workers (HCW) and the patient's environment were screened for MRSA nasal carriage and MRSA contamination respectively. It was found that 20.25% of HCW were colonized with MRSA and 12.3% of patient's environment was contaminated with MRSA. The MRSA screen latex agglutination test (Denk Seiken Co, Niiga Ta, Japan) and oxacillin resistance screening agar base (ORSAB) medium were compared with MIC determination and mec A gene detection by PCR assay, the "gold standard test". In an analysis of 61 mec A positive and 11 mecA negative S. aureus patient isolates, both latex agglutination test and ORSAB medium were reliable in detection of oxacillin resistance with 100% sensitivity and specificity for each. Antimicrobial susceptibility pattern of nosocomial MRSA isolates showed high resistance to ampicillin (95.1%), erythromycin (93.4%) and penicillin (93.4%), while low resistance to amikacin (37.7%), imipenen (29.5%) and vancomycin (18%). We concluded that MRSA-Screen test and ORSAB medium are reliable methods for detection of MRSA. Screening for colonization of MRSA is a key aspect of infection control to limit the nosocomial spread of this organism.

SENV is a blood- borne, circular ss DNA virus and possessing nine genotypes (A to I). Among nine genotypes, SENV-D and SENV-H genotypes have the strong link with patients with non (A-E) hepatitis infections. Recently, the identification of SEN virus (SENV) as a possible etiologic agent of parenteral transmission hepatitis let to the study of the prevalence of such agent. This study compared SENV prevalence and its two important genotypes (D&H) which might be pathogenic in high risk subjects including blood transfused patients and hemodialysed patients and low risk subjects as healthy blood donors. Subjects and methods: This study included 75 multitransfused patients, 60 of them were hemodialysed and the remaining were blood diseased including haemophilics, anaemics and leukemics. The study included also 25 healthy blood donors as a control. They were enrolled consecutively at the department of Internal Medicine, Assiut University Hospital. The sera were separated and SENV DNA was detected by polymerase chain reaction. Results: A higher prevalence of SENV infection was detected in patients groups than in blood donors (46.7% versus 20%).No significant relation was found between SENV infection and age, duration of haemodialysis or liver enzymes. However, there was significant difference between SENV positive and negative patients as regards gender and number of blood transfusions. Conclusions: SENV is commonly present in blood transfused and haemodialysed patients attended to Assiut University Hospitals as well as in blood donors at comparable rates. SENV infection has been found in only 20% of blood donors but in 46.7% of patients. The results also indicated that other possible routes of SENV infection other than blood transfusion may be included. Its pathogenic role in causing hepatitis is not documented, so far it can be considered as simple guest till further studies have been done.

Extended spectrum β lactamases producing Klebssiella pneumoniae (ESBL-KP) are an important cause of nosocomial infections in Intensive Care Units (ICUs). We conducted a prospective study on 650 patients who were admitted to different adult ICUs at Assiut University Hospital to determine the incidence of ESBL-KP by phenotypic and genotypic methods. Phenotypic tests for ESBL were combined disc method, double disc synergy test (DDST) and E-test. Genotypic detection of ESBL bla TEM and bla SHV genes was carried out by polymerase chain reaction amplification (PCR). The overall nosocomial infection incidence rate was 20% (130 patients). Klebsiella pneumonia was isolated from 44 patients (34%), in which 23 isolates were found to be phenotypically ESBL producers. ESBL-KP was most frequently isolated from chest ICU (47.8%) and blood was the most frequent site of infection (8 isolates, 34%). Based on Clinical and Laboratory Standards Institute (CLSI) screening test for ESBL, the combined disc method was the most sensitive (23/23, 100%) followed by the E-test (95.6%) and lastly the DDST (91.3 %). SHV gene was present in 8 isolates, TEM gene in 2 isolates, both SHV and TEM in 11 isolates and none of TEM or SHV in 2 isolates. Out of 950 environmental samples, Klebsiella pneumoniae was isolated from 48 samples (16.4%) in which 7 isolates (14.5 %) were ESBL and genotyping revealed SHV in 4 strains, and both SHV and TEM in 3 strains. Conclusion: This study revealed the high incidence of ESBL-KP in adult ICUs. SHV genotype was more prevalent than TEM type. Strict implementation of basic infection control measures seems to be the most effective means for controlling the spread of ESBL organisms.

Auto-immune hepatitis (AIH) in children is a rare chronic progressive liver disorder. It is characterised serologically by high aminotransferase levels, elevated immunoglobulin G (IgG) and the presence of autoantibodies. AIH is divided into two types according to the autoantibody profile. This study aims to assess frequency, clinical manifestations, biochemical features and outcome of AIH in children attending Assuit University Hospitals in Upper Egypt with acute icteric hepatitis and seronegative viral markers (anti-hepatitis A virus (HAV) IgM, HbsAg, anti-hepatitis C virus (anti-HCV) Ab). Patients and methods The study includes 34 children with AIH, diagnosed on the basis of the International Scoring Criteria of Auto-immune Hepatitis, recruited from Assuit University Hospitals, during the period from January 2005 to December 2009. All patients received prednisolone 2 mg kg–1 day–1. Follow-up was done for 1 year. Results Among 34 children diagnosed as AIH, 24 were females (70.5%) and 10 were males (29.5%). Jaundice represented the most consistent finding in all patients. According to the autoantibody profile, 25 children were classified as type 1 and nine children were classified as type 2. Corticosteroid therapy was started. Complete remission was observed in 67.6% of patients and partial remission in 17.6%. There was no significant statistical difference in clinical and biochemical features of AIH in patients regarding the response to treatment. Mild side effects of steroid therapy were encountered in 48.2% of patients. After complete withdrawal of corticosteroids, six patients (20.7%) developed relapse. Conclusion AIH type 1 was the main form of AIH in children referred to Assiut University Hospitals. Girls were more affected than boys. AIH type 1 exhibited a more active, ongoing immunologic process. Steroid alone can be used successfully in most cases. Children with AIH type 2 had a higher frequency of relapse after corticosteroid withdrawal. Further studies on a larger number of cases and long-term follow-up are recommended.

Objectives: to determine the prevalence of hypovitaminosis D, its association with bone density and to evaluate related determinants among admitted patients to Trauma Unit in Assiut University Hospitals. Materials and methods: A cross sectional study was carried out on patients with proximal femoral fractures aged 50 years and older admitted to Trauma Unit of Assiut University Hospitals, a level-I trauma center in Upper Egypt, from 1st January to end of December 2014. A randomized sample of 133 participants was included. Patients with polytrauma, major accidents and conditions known to affect bone density were excluded. Two well trained nurses filled a structured questionnaire by personal interview. Weight and height measurement, assessment of 25-hydroxy-vitamin D (25OHD) serum and bone mineral density measurement by DXA were done for all participants. A formal consent was taken from all participants prior to the study. Results: Participants aged 50-99 years with mean 69 ± 11.3 years, 48.1% were males and 51.9% were females. 50.4% and 22.6% of them were housewives and farmers respectively. Osteoporosis (T score of neck fe-mur -2.5) prevalence was 72.2%. Prevalence of (25OHD) deficiency (20 ng/ml) and inadequacy (between 20-30 ng/ml) were 60.9% and 15.8% respectively, and 23.3% were normal (> 30 ng/ml). Vitamin D level was positively correlated with T score of greater trochanter, neck femur, L4, L3 and L2 (r=0.23& p= 0.012, r= 0.28& p=0.001, r= 0.196& p=0.023, r= 0.18&p= 0.036 and r= 0.21 &p=0.02). Vitamin D deficiency was significantly associated with age and increase in BMI (p=0.04&0.012). Lack of milk and yoghurt intake had sig-nificant higher prevalence of vitamin D deficiency than others (p=0.02 and 0.01 respectively). No significant relation was found with sex or edu-cation level. Multiple regression analysis was done. Conclusions: Prevalence of vitamin D deficiency is high among hip fracture patients and is associated with low BMD. Vitamin D supplementation is strongly recommended for prevention of hip fractures in those aged >50 years.