Immunological problems have been identified as a potential cause of recurrent pregnancy loss (RPL). The aim of this study was to investigate the effect of Th-1 cell cytokines, leukemia inhibitory factor and hoxA genes in women with RPL. Materials & methods: A prospective, case-control study conducted in Assiut Women Health Hospital, Egypt included 37 women presented with a history of RPL. Samples of uterine flush and endometrial biopsy were taken during the implantation window from those confirmed as not pregnant. Cytokine (LIF and Th1 induced) levels were measured by ELISA, while hoxA10 and hoxA11 gene expression was evaluated by Taq-man Real Time PCR. Results: Higher cytokine mean levels were seen in the RPL group when compared to the control group (TNF-a and LIF cytokines, p
0.001; INF-c and IL2 cytokines, p
0.01). The opposite was true with regards to gene expression, with lower means in both sets found in the RPL group (hoxA11, p
0.000). A statistically significant positive correlation between INF-c and TNF-a, hoxA10 and hoxA11, as well as between LIF and hoxA11 was demonstrated. Conclusion: This study suggests that women with a history of RPL can have abnormal cytokine and gene expression even when not pregnant. Our findings can be a basis for providing of future successful immunological therapy for women with RPL.

Streptococcus pneumoniae is the most common cause of acute communityacquired pneumonia and accounts for 30-40% of lower respiratory tract infections. It accounts also for about 50% of hospital-acquired pneumonia. Macrolides remain the primary antibiotic of choice for physicians treating such infections. Macrolide resistance in Strept. pneumoniae is primarily due to two mechanisms; target site modification (encoded by the erm (B) gene) and efflux pump expulsion (encoded by the mef gene). Objectives: The aim of this study was to identify the incidence of Strept. pneumoniae among acute and chronic otitis media cases; to perform the antimicrobial sensitivity tests for such isolates, to determine the percentage of Strept. pneumoniae resistant to erythromycin, clarithromycin and azithromycin, to assess the antibiotic susceptibility profile of macrolide-resistant Strept. pneumoniae and lastly to detect the frequency of common macrolide resistant genes (The mefE and ermB genes) among erythromycin resistant Strept. pneumoniae by PCR technique. Methodology: 317 patients suffering from acute or chronic otitis media, attended to pediatric and ENT- Outpatient Clinics at Al- Azhar University Hospital of Assiut, were isolated and tested for Strept. pneumoniae and for antibiotics sensitivity pattern. Resistant strains for erythromycin, clarithromycin and azithromycin were assayed for MIC using E test. PCR for erm(B) and mef(E) resistant determinant genes by multiplex PCR was applied. Results: 78 (24.6%) isolates of Strept. pneumoniae were isolated. Of them 66 and 12 isolates from acute and chronic otitis media respectively. Cefoperazone was the most sensitive drug, followed by Cefotaxime, Azithromycin and Amoxacillin-clavulanate. Tetracyclin was the most resistant drug followed by Clindamycin and Apramycin. The E- test confirmed the results of disc diffusion test. By PCR, 10 (41.7%) isolates have both erm B and mef E genes, while 8 (33.3%) isolates have mef E gene only and 2 (8.3%) isolates showed erm B gene only. Conclusion: There is a high prevalence of erythromycin resistant Strept. pneumoniae. So macrolides cannot be recommended for the treatment of pneumococcal infections without susceptibility testing. Results point to the importance of detection of erm B and mef E genes for epidemiological aspects and to track possible presence of macrolide resistance.

Streptococcus pneumoniae is the most common cause of acute communityacquired pneumonia and accounts for 30-40% of lower respiratory tract infections. It accounts also for about 50% of hospital-acquired pneumonia. Macrolides remain the primary antibiotic of choice for physicians treating such infections. Macrolide resistance in Strept. pneumoniae is primarily due to two mechanisms; target site modification (encoded by the erm (B) gene) and efflux pump expulsion (encoded by the mef gene). Objectives: The aim of this study was to identify the incidence of Strept. pneumoniae among acute and chronic otitis media cases; to perform the antimicrobial sensitivity tests for such isolates, to determine the percentage of Strept. pneumoniae resistant to erythromycin, clarithromycin and azithromycin, to assess the antibiotic susceptibility profile of macrolide-resistant Strept. pneumoniae and lastly to detect the frequency of common macrolide resistant genes (The mefE and ermB genes) among erythromycin resistant Strept. pneumoniae by PCR technique. Methodology: 317 patients suffering from acute or chronic otitis media, attended to pediatric and ENT- Outpatient Clinics at Al- Azhar University Hospital of Assiut, were isolated and tested for Strept. pneumoniae and for antibiotics sensitivity pattern. Resistant strains for erythromycin, clarithromycin and azithromycin were assayed for MIC using E test. PCR for erm(B) and mef(E) resistant determinant genes by multiplex PCR was applied. Results: 78 (24.6%) isolates of Strept. pneumoniae were isolated. Of them 66 and 12 isolates from acute and chronic otitis media respectively. Cefoperazone was the most sensitive drug, followed by Cefotaxime, Azithromycin and Amoxacillin-clavulanate. Tetracyclin was the most resistant drug followed by Clindamycin and Apramycin. The E- test confirmed the results of disc diffusion test. By PCR, 10 (41.7%) isolates have both erm B and mef E genes, while 8 (33.3%) isolates have mef E gene only and 2 (8.3%) isolates showed erm B gene only. Conclusion: There is a high prevalence of erythromycin resistant Strept. pneumoniae. So macrolides cannot be recommended for the treatment of pneumococcal infections without susceptibility testing. Results point to the importance of detection of erm B and mef E genes for epidemiological aspects and to track possible presence of macrolide resistance.

Streptococcus pneumoniae is the most common cause of acute communityacquired pneumonia and accounts for 30-40% of lower respiratory tract infections. It accounts also for about 50% of hospital-acquired pneumonia. Macrolides remain the primary antibiotic of choice for physicians treating such infections. Macrolide resistance in Strept. pneumoniae is primarily due to two mechanisms; target site modification (encoded by the erm (B) gene) and efflux pump expulsion (encoded by the mef gene). Objectives: The aim of this study was to identify the incidence of Strept. pneumoniae among acute and chronic otitis media cases; to perform the antimicrobial sensitivity tests for such isolates, to determine the percentage of Strept. pneumoniae resistant to erythromycin, clarithromycin and azithromycin, to assess the antibiotic susceptibility profile of macrolide-resistant Strept. pneumoniae and lastly to detect the frequency of common macrolide resistant genes (The mefE and ermB genes) among erythromycin resistant Strept. pneumoniae by PCR technique. Methodology: 317 patients suffering from acute or chronic otitis media, attended to pediatric and ENT- Outpatient Clinics at Al- Azhar University Hospital of Assiut, were isolated and tested for Strept. pneumoniae and for antibiotics sensitivity pattern. Resistant strains for erythromycin, clarithromycin and azithromycin were assayed for MIC using E test. PCR for erm(B) and mef(E) resistant determinant genes by multiplex PCR was applied. Results: 78 (24.6%) isolates of Strept. pneumoniae were isolated. Of them 66 and 12 isolates from acute and chronic otitis media respectively. Cefoperazone was the most sensitive drug, followed by Cefotaxime, Azithromycin and Amoxacillin-clavulanate. Tetracyclin was the most resistant drug followed by Clindamycin and Apramycin. The E- test confirmed the results of disc diffusion test. By PCR, 10 (41.7%) isolates have both erm B and mef E genes, while 8 (33.3%) isolates have mef E gene only and 2 (8.3%) isolates showed erm B gene only. Conclusion: There is a high prevalence of erythromycin resistant Strept. pneumoniae. So macrolides cannot be recommended for the treatment of pneumococcal infections without susceptibility testing. Results point to the importance of detection of erm B and mef E genes for epidemiological aspects and to track possible presence of macrolide resistance.

Streptococcus pneumoniae is the most common cause of acute communityacquired pneumonia and accounts for 30-40% of lower respiratory tract infections. It accounts also for about 50% of hospital-acquired pneumonia. Macrolides remain the primary antibiotic of choice for physicians treating such infections. Macrolide resistance in Strept. pneumoniae is primarily due to two mechanisms; target site modification (encoded by the erm (B) gene) and efflux pump expulsion (encoded by the mef gene). Objectives: The aim of this study was to identify the incidence of Strept. pneumoniae among acute and chronic otitis media cases; to perform the antimicrobial sensitivity tests for such isolates, to determine the percentage of Strept. pneumoniae resistant to erythromycin, clarithromycin and azithromycin, to assess the antibiotic susceptibility profile of macrolide-resistant Strept. pneumoniae and lastly to detect the frequency of common macrolide resistant genes (The mefE and ermB genes) among erythromycin resistant Strept. pneumoniae by PCR technique. Methodology: 317 patients suffering from acute or chronic otitis media, attended to pediatric and ENT- Outpatient Clinics at Al- Azhar University Hospital of Assiut, were isolated and tested for Strept. pneumoniae and for antibiotics sensitivity pattern. Resistant strains for erythromycin, clarithromycin and azithromycin were assayed for MIC using E test. PCR for erm(B) and mef(E) resistant determinant genes by multiplex PCR was applied. Results: 78 (24.6%) isolates of Strept. pneumoniae were isolated. Of them 66 and 12 isolates from acute and chronic otitis media respectively. Cefoperazone was the most sensitive drug, followed by Cefotaxime, Azithromycin and Amoxacillin-clavulanate. Tetracyclin was the most resistant drug followed by Clindamycin and Apramycin. The E- test confirmed the results of disc diffusion test. By PCR, 10 (41.7%) isolates have both erm B and mef E genes, while 8 (33.3%) isolates have mef E gene only and 2 (8.3%) isolates showed erm B gene only. Conclusion: There is a high prevalence of erythromycin resistant Strept. pneumoniae. So macrolides cannot be recommended for the treatment of pneumococcal infections without susceptibility testing. Results point to the importance of detection of erm B and mef E genes for epidemiological aspects and to track possible presence of macrolide resistance.

The hospital environment may contribute with the dissemination of pathogens. There are no meaningful standards for permissible levels of microbial contamination of inanimate surfaces in hospital environment, but an increased microbial load on surfaces may imply the possibility of finding a pathogen. During a 18 months study, 1153 bacterial isolates were recovered from 1063 enviromental samples(beds, door handle, trash basket , door surface, floors, and medial equipments) in trauma and chest ICUs of Assuit University Hospital and trauma ICU of Sohag university hospital. In vitro susceptibility of environmental bacterial isolates to 12 antimicrobial agents Ampicilin; Amikacin, Ciprofloxacin, Tetracycline, Bacitracin, Amoxclav, Gentamicin, Cefotaxime, Ceftazidime, Imipenem, Meropenem and Chloramphenicol (as commercial antimicrobial agents). Proteus mirabilis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp, Staphylococcus aureus, Streptococcus pneumoniae, Entercoccus spp, Acinetobacter baumannii, Serratia marcescens and Coagulase negative Staphylococcus were identified in three intensive care units. The most prevalent organism was Klebsiella pneumonia and Staphylococcus aureus in trauma and chest ICUs of Assuit University Hospital, Escherichia coli in trauma ICU of Sohag University Hospital. Vancomycin, linezolid, gentamicin and ciperofloxcin were highly effective to gram positives while imipenem and meropenem to gram negatives

Nosocomial infections are the most common complications affecting hospitalized patients. The main purpose of this study was to determinate the frequency of nosocomial microorganisms obtained from intensive care unit patients admitted throughout 48 h and to detect the most common organisms and their susceptibility patterns to commercial antimicrobial agents and natural products (essential oils). Resistance gene was determinate. During 18 months study, 894 bacterial isolates were recovered from 682 clinical samples(urine, blood, sputum, wound) in trauma and chest ICUs of Assuit University Hospital and trauma ICU of Sohag University Hospital. API 20E test was performed for Klebsiella pneumoniae isolates (as the commonest organisms). In vitro susceptibility of Klebsiella pneumoniae isolates to 12 antimicrobial agents Ampicilin; Amikacin, Ciprofloxacin, Tetracycline, Bacitracin, Amoxclav, Gentamicin, Cefotaxime, Ceftazidime, Imipenem, Meropenem and Chloramphenicol (as commercial antimicrobial agents) and to Rosmarinus officinalis and Cymbopogen citrates essential oils was performed using the Kirby-Bauer’s disk diffusion method. PCR Testing for resistance gene for Klebsiella pneumoniae to carbapenems (imipenem and meropenem). Out of 894 bacterial isolates 210 Klebsiella pneumoniae isolates were detected and confirmed by API 20E. Lowest resistance of Klebsiella pneumoniae to imipenem and meropenem (1%, 1% in trauma ICU of Assiut university hospital) (17.6%, 11.8%in chest ICU of Assiut university hospital) (3.1%, 4.1% in trauma ICU of Sohag university hospital). cymbopogen citrates essential oils had the positive effect on carbapenem resistant Klebsiella pneumoniae isolates rather than Rosmarinus officinalis essential oil. bla CTX-M gene, bla TEM gene and bla SHV gene were detected as resistance gene for imipenem and meropenem.

The diagnosis of blood steam infections (BSIs) in febrile neutropenic pediatric cancer patients (FNPCP) remains a challenge. Although blood culture is the most accurate method; yet the delay in results has urged the need for reliable biomarkers for early diagnosis. The objectives of this study were to identify the bacterial causes of BSIs in FNPCP at SECI and their antimicrobial susceptibility patterns. Also, to assess the value of procalcitonin (PCT), interleukin 6 (IL6), and interleukin 10 (IL 10) for early diagnosis of BSIs. This study included 68 FNPCP with a total of 85 fever episodes. Blood cultures were done at the onset of fever. Identification of the organisms was carried by Vitek 2 system and the antimicrobial susceptibility testing by disc diffusion. The levels of PCT, IL-6 and IL-10 serum levels were measured by ELISA. Blood stream bacterial infection was detected in 29.4% (25/85). Most were Gram positive cocci in 53.6 % (15/28). There were high percentages of multidrug resistant organism (MDRO) (73.3% and 92.3% among Gram positive and negative bacteria, respectively). The least percentage of resistance was to linezolid (0%) and amikacin (15.4%). The levels of the biomarkers were significantly higher in patients with positive bacterial cultures compared to those with negative cultures (P 0.001). IL -6 had the best sensitivity (96%) (AUC 0.975, cut off 0.925ng/L) with considerable specificity (88.3%). Combined PCT & IL-6 had the highest sensitivity (96%) and specificity (98.3%). We conclude that the percentage of BSIs among FNPCP was considerable. Gram positive bacteria were the commonest causes. High percentages of MDRO were reported. The most efficient antimicrobials were linezolid and amikacin. IL-6 alone had the best sensitivity for early diagnosis of BSIs. The combination of PCT and IL 6 showed the best performance.

The diagnosis of blood steam infections (BSIs) in febrile neutropenic pediatric cancer patients (FNPCP) remains a challenge. Although blood culture is the most accurate method; yet the delay in results has urged the need for reliable biomarkers for early diagnosis. The objectives of this study were to identify the bacterial causes of BSIs in FNPCP at SECI and their antimicrobial susceptibility patterns. Also, to assess the value of procalcitonin (PCT), interleukin 6 (IL6), and interleukin 10 (IL 10) for early diagnosis of BSIs. This study included 68 FNPCP with a total of 85 fever episodes. Blood cultures were done at the onset of fever. Identification of the organisms was carried by Vitek 2 system and the antimicrobial susceptibility testing by disc diffusion. The levels of PCT, IL-6 and IL-10 serum levels were measured by ELISA. Blood stream bacterial infection was detected in 29.4% (25/85). Most were Gram positive cocci in 53.6 % (15/28). There were high percentages of multidrug resistant organism (MDRO) (73.3% and 92.3% among Gram positive and negative bacteria, respectively). The least percentage of resistance was to linezolid (0%) and amikacin (15.4%). The levels of the biomarkers were significantly higher in patients with positive bacterial cultures compared to those with negative cultures (P 0.001). IL -6 had the best sensitivity (96%) (AUC 0.975, cut off 0.925ng/L) with considerable specificity (88.3%). Combined PCT & IL-6 had the highest sensitivity (96%) and specificity (98.3%). We conclude that the percentage of BSIs among FNPCP was considerable. Gram positive bacteria were the commonest causes. High percentages of MDRO were reported. The most efficient antimicrobials were linezolid and amikacin. IL-6 alone had the best sensitivity for early diagnosis of BSIs. The combination of PCT and IL 6 showed the best performance.

The diagnosis of blood steam infections (BSIs) in febrile neutropenic pediatric cancer patients (FNPCP) remains a challenge. Although blood culture is the most accurate method; yet the delay in results has urged the need for reliable biomarkers for early diagnosis. The objectives of this study were to identify the bacterial causes of BSIs in FNPCP at SECI and their antimicrobial susceptibility patterns. Also, to assess the value of procalcitonin (PCT), interleukin 6 (IL6), and interleukin 10 (IL 10) for early diagnosis of BSIs. This study included 68 FNPCP with a total of 85 fever episodes. Blood cultures were done at the onset of fever. Identification of the organisms was carried by Vitek 2 system and the antimicrobial susceptibility testing by disc diffusion. The levels of PCT, IL-6 and IL-10 serum levels were measured by ELISA. Blood stream bacterial infection was detected in 29.4% (25/85). Most were Gram positive cocci in 53.6 % (15/28). There were high percentages of multidrug resistant organism (MDRO) (73.3% and 92.3% among Gram positive and negative bacteria, respectively). The least percentage of resistance was to linezolid (0%) and amikacin (15.4%). The levels of the biomarkers were significantly higher in patients with positive bacterial cultures compared to those with negative cultures (P 0.001). IL -6 had the best sensitivity (96%) (AUC 0.975, cut off 0.925ng/L) with considerable specificity (88.3%). Combined PCT & IL-6 had the highest sensitivity (96%) and specificity (98.3%). We conclude that the percentage of BSIs among FNPCP was considerable. Gram positive bacteria were the commonest causes. High percentages of MDRO were reported. The most efficient antimicrobials were linezolid and amikacin. IL-6 alone had the best sensitivity for early diagnosis of BSIs. The combination of PCT and IL 6 showed the best performance.