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.

Spirometry is the most widely used lung function test both in the diagnosis and stratification of severity of lung disease. The Forced Expiratory Flow between 25 and 75% of the FVC (FEF25_75) is one of the most commonly cited measures of small airways pathology. This study aimed at evaluation of early effect of smoking on small airways. It included: 50 asymptomatic smokers (Group 1) and 50 non smokers (Group 2) as a control. The result revealed: The subjects age was ranged from 18 to 75 years with mean age 43.12 ± 13.231SD in smokers, and range from 15-62 with mean age 41.74 years with ± 14.512SD in non-smokers. 62 % of the a symptomatic smokers were Manual workers which are the majority of the smokers, and 38 % for Mental worker while the majority of non-smokers were Mental worker 64 %, with 36 % for Manual worker. Smoking cigarette was most common (54 %), then marijuana (46 %). The mean values of all the pulmonary function tests are significantly reduced in smokers compared to non smokers, although, they are within the normal range. The association of impaired PFTs in smokers was found to be statistically highly significant to FEF 25-75 (small airway). Otherwise; there were no significance to other values applying unpaired T test. The most affected age group in significant FEF25-75 reduction was found in 36-55years old, females were more affected than males. The duration of smoking was the most independent risk factor that affects the small airways, than the type of smoking and number of cigarettes or stones per day.

Spirometry is the most widely used lung function test both in the diagnosis and stratification of severity of lung disease. The Forced Expiratory Flow between 25 and 75% of the FVC (FEF25_75) is one of the most commonly cited measures of small airways pathology. This study aimed at evaluation of early effect of smoking on small airways. It included: 50 asymptomatic smokers (Group 1) and 50 non smokers (Group 2) as a control. The result revealed: The subjects age was ranged from 18 to 75 years with mean age 43.12 ± 13.231SD in smokers, and range from 15-62 with mean age 41.74 years with ± 14.512SD in non-smokers. 62 % of the a symptomatic smokers were Manual workers which are the majority of the smokers, and 38 % for Mental worker while the majority of non-smokers were Mental worker 64 %, with 36 % for Manual worker. Smoking cigarette was most common (54 %), then marijuana (46 %). The mean values of all the pulmonary function tests are significantly reduced in smokers compared to non smokers, although, they are within the normal range. The association of impaired PFTs in smokers was found to be statistically highly significant to FEF 25-75 (small airway). Otherwise; there were no significance to other values applying unpaired T test. The most affected age group in significant FEF25-75 reduction was found in 36-55years old, females were more affected than males. The duration of smoking was the most independent risk factor that affects the small airways, than the type of smoking and number of cigarettes or stones per day.

Background: Gaucher Disease (GD) is the most prevalent lysosomal storage disease. GD is associated with remarkable alterations in the immune system, and GD patients are more susceptible to infections and are at a higher risk of developing autoimmune disorders and malignancies. Aim: to determine the changes in lymphocyte subpopulations and activated T lymphocytes (CD3+ HLA-DR+) in children with GD under enzyme replacement therapy (ERT) managed in Assiut Children university hospitals. Methods: This prospective case-control study was conducted among 18 children aged from 2-14 years (10 males and 8 females) with GD type 1 under enzyme replacement therapy (ERT) admitted to Assiut children university hospitals. Three-color flow cytometric immunophenotyping was used for determining the frequency of lymphocyte subpopulations and activated T lymphocytes in these patients. Results: A significant increases was found in the frequencies of total lymphocytes, CD19+, CD3+, CD4+ and CD8+ in children with GD1 when compared to healthy control. The frequencies of activated T-Lymphocytes (CD3+ HLA-DR+), activated CD4 (CD4+ HLA-DR+) and activated CD8 (CD8+ HLA-DR+) were significantly higher in GD1 as compared to healthy children. Conclusion: The increased proportion of activated T-lymphocytes in children with GD1 raises the issue of their involvement in the pathogenesis of the immune dysfunction seen in these patients. Activated T-lymphocytes could play a role in the clinical course of GD1.

Background: Gaucher Disease (GD) is the most prevalent lysosomal storage disease. GD is associated with remarkable alterations in the immune system, and GD patients are more susceptible to infections and are at a higher risk of developing autoimmune disorders and malignancies. Aim: to determine the changes in lymphocyte subpopulations and activated T lymphocytes (CD3+ HLA-DR+) in children with GD under enzyme replacement therapy (ERT) managed in Assiut Children university hospitals. Methods: This prospective case-control study was conducted among 18 children aged from 2-14 years (10 males and 8 females) with GD type 1 under enzyme replacement therapy (ERT) admitted to Assiut children university hospitals. Three-color flow cytometric immunophenotyping was used for determining the frequency of lymphocyte subpopulations and activated T lymphocytes in these patients. Results: A significant increases was found in the frequencies of total lymphocytes, CD19+, CD3+, CD4+ and CD8+ in children with GD1 when compared to healthy control. The frequencies of activated T-Lymphocytes (CD3+ HLA-DR+), activated CD4 (CD4+ HLA-DR+) and activated CD8 (CD8+ HLA-DR+) were significantly higher in GD1 as compared to healthy children. Conclusion: The increased proportion of activated T-lymphocytes in children with GD1 raises the issue of their involvement in the pathogenesis of the immune dysfunction seen in these patients. Activated T-lymphocytes could play a role in the clinical course of GD1.

Background: Gaucher Disease (GD) is the most prevalent lysosomal storage disease. GD is associated with remarkable alterations in the immune system, and GD patients are more susceptible to infections and are at a higher risk of developing autoimmune disorders and malignancies. Aim: to determine the changes in lymphocyte subpopulations and activated T lymphocytes (CD3+ HLA-DR+) in children with GD under enzyme replacement therapy (ERT) managed in Assiut Children university hospitals. Methods: This prospective case-control study was conducted among 18 children aged from 2-14 years (10 males and 8 females) with GD type 1 under enzyme replacement therapy (ERT) admitted to Assiut children university hospitals. Three-color flow cytometric immunophenotyping was used for determining the frequency of lymphocyte subpopulations and activated T lymphocytes in these patients. Results: A significant increases was found in the frequencies of total lymphocytes, CD19+, CD3+, CD4+ and CD8+ in children with GD1 when compared to healthy control. The frequencies of activated T-Lymphocytes (CD3+ HLA-DR+), activated CD4 (CD4+ HLA-DR+) and activated CD8 (CD8+ HLA-DR+) were significantly higher in GD1 as compared to healthy children. Conclusion: The increased proportion of activated T-lymphocytes in children with GD1 raises the issue of their involvement in the pathogenesis of the immune dysfunction seen in these patients. Activated T-lymphocytes could play a role in the clinical course of GD1.

Background: Egypt is the highest affected country with Chronic hepatitis C with a prevalence of 22%. . Seroprevalence of HCV is 0.2% in children 11 years and 0.4% in children ≥11 years of age. Aim : To evaluate the use of 1H MRS and DW-MRI in early detection of liver fibrosis by measuring some metabolic components (Glx/lipid, PME/lipid and Glyu/lipid ratios) and ADC in liver tissues in relation to histopathological changes. Methods: A cross-sectional study was conducted from 2012-2014, included thirty children (25 ♂ & 5♀ ) with asymptomatic chronic hepatitis C infection matched to twenty healthy children as controls . Anti HCV antibodies, HCV RNA PCR, liver function tests , abdominal ultrasonography, percutaneous liver biopsy and IH MRS (Glx/lipid, PME/lipid, Glyu/lipid ratios) and DW-MRI were done. Results: METAVIR grades showed 29 cases (96.6%) had activity while 17 cases (56.7 %) had fibrosis and +ve TGF-β1 in liver tissues in 19 cases (63.3%). Significant positive correlations between the results of 1H MRS and liver biopsy (METAVIR Grades, Stages and TGF-β1). Multivariant regression analysis showed that DW-MRI (reflected by ADC) was the good predictor for activity and Glyu/lipid ratio of MRS was the good predictor of fibrosis. Conclusion:Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay liver fibrosis. TGF-β1 in liver tissue may be considered a useful better tool in the assessment of hepatic fibrosis. 1H MRS may be a non-invasive helpful diagnostic tool in assessing asymptomatic chronic hepatitis C children

Background: Egypt is the highest affected country with Chronic hepatitis C with a prevalence of 22%. . Seroprevalence of HCV is 0.2% in children 11 years and 0.4% in children ≥11 years of age. Aim : To evaluate the use of 1H MRS and DW-MRI in early detection of liver fibrosis by measuring some metabolic components (Glx/lipid, PME/lipid and Glyu/lipid ratios) and ADC in liver tissues in relation to histopathological changes. Methods: A cross-sectional study was conducted from 2012-2014, included thirty children (25 ♂ & 5♀ ) with asymptomatic chronic hepatitis C infection matched to twenty healthy children as controls . Anti HCV antibodies, HCV RNA PCR, liver function tests , abdominal ultrasonography, percutaneous liver biopsy and IH MRS (Glx/lipid, PME/lipid, Glyu/lipid ratios) and DW-MRI were done. Results: METAVIR grades showed 29 cases (96.6%) had activity while 17 cases (56.7 %) had fibrosis and +ve TGF-β1 in liver tissues in 19 cases (63.3%). Significant positive correlations between the results of 1H MRS and liver biopsy (METAVIR Grades, Stages and TGF-β1). Multivariant regression analysis showed that DW-MRI (reflected by ADC) was the good predictor for activity and Glyu/lipid ratio of MRS was the good predictor of fibrosis. Conclusion:Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay liver fibrosis. TGF-β1 in liver tissue may be considered a useful better tool in the assessment of hepatic fibrosis. 1H MRS may be a non-invasive helpful diagnostic tool in assessing asymptomatic chronic hepatitis C children