Context Previous data on etiologic bacteria in acute
exacerbations of chronic obstructive pulmonary disease
(AECOPD) in Upper Egypt are limited.
Aim The aim of this study was to identify the causative
bacteria in AECOPD and to determine the antibiotic
resistance patterns for AECOPD in Upper Egypt.
Settings and design The study design was a prospective
one and was conducted in a University Hospital.
Materials and methods Patients who were admitted in
Assiut University Hospital with AECOPD were prospectively
enrolled. Sputum specimens were investigated using culture.
Susceptibilities of the isolated bacterial strains to different
antibiotics were determined using the disk diffusion method.
Results During 18 months, 156 patients who experienced
218 AECOPD were enrolled. A significant bacterial growth
was found in 77% of patients during 81% of exacerbations.
The most commonly detected bacteria were Haemophilus
influenzae (18%), Streptococcus pneumoniae (15%), and
Klebsiella pneumoniae (14%). The majority of the isolated
strains showed high resistance rates to most groups of
antibiotics; 63% of the isolated strains were multidrug
resistant, 29% were extensively drug resistant, and 5% were
pandrug resistant. High resistance rates were observed
against penicillins and cephalosporins, moderate rates
against fluoroquinolones, and lowest rates against the
carbapenems. All gram-positive bacteria were sensitive to
linezolid. Increased severity of chronic obstructive pulmonary
disease was related to increased prevalence of antibiotic
resistance.
Conclusion The predominant bacterial pathogens for
AECOPD in Upper Egypt are H. influenzae, S. pneumoniae,
and K. pneumoniae. Bacterial resistance rates were the
highest against penicillins and cephalosporins, moderate
against fluoroquinolones, and least against carbapenems.
Increased severity of chronic obstructive pulmonary disease
is related to an increased prevalence of antibiotic resistance.

Thyroid nodules are common pathologies detected in thyroid gland. A thyroid nodule is the manifestation of a wide range of thyroid diseases, some benign and others malignant. Currently, the use of imaging methods has increased the diagnosis of asymptomatic nodules. Ultrasound studies of the population have reported a nodular thyroid disease rate of nearly 67% in elderly women. Most of these nodules are benign, and the incidence of malignancy is low (3–7%). Purpose To evaluate the role of vascular pattern and spectral wave forms and resistivity and pulsatility indices to differentiate between malignant and benign features. Patients and methods A total of 40 patients who were presented with thyroid nodules scheduled for surgery and preoperative fine-needle aspiration cytology were examined in a prospective way. G?ray-scale and color Doppler patterns were used to rank each thyroid nodule on a scale from 0 to 4 as follows: none, solely perinodular, accompanied by per-nodular prominence, accompanied by intranodular prominence, and only intranodular, respectively. Final diagnosis (benign or malignant) was confirmed by pathological correlations. Results Value of malignancy in thyroid nodules with a mean resistivity index of 0.72±0.13 is found to be significantly higher than with benignity (0.60.0.08). Conclusion Duplex Doppler parameters are helpful in distinguishing malignant from benign thyroid nodules.

Background: The introduction of biosimilar medicines has paved the way for the NHS to make substantial savings. Etanercept biosimilar was launched in February 2016 and provided an opportunity for huge savings to be made for the overall health economy. The drug cost was 30% cheaper than etanercept originator. Methods: Croydon Health Services had 193 rheumatoid arthritis patients eligible for the switch. To date, 25 patients (13%) have not switched for various reasons and 168 patients were switched to the biosimilar. The total saving was over£ 200,000 for Croydon CCG. A monitoring database was set up to follow these patients to ensure safety and efficacy of the new treatment. Results: Of the 168 patients switched, 18 (11%) have switched back to the originator product. The reasons for switchback were lack of efficacy in 11 patients (7%) and intolerance in 7 (4%). The most common intolerances were

The aim of this prospective study was to compare scrotal ultrasonographic findings in obese and normal weight infertile men and correlate these findings with semen parameters and hormonal profile

Asymmetric breast density is a potentially perplexing finding; it may be due to normal hormonal variation of the parenchymal pattern and summation artifact or it may indicate an underlying true pathology. The current study aimed to identify the role of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values in the assessment of breast asymmetries. Fifty breast lesions were detected corresponding to the mammographic asymmetry. There were 35 (70%) benign lesions and 15 (30%) malignant lesions. The mean ADC value was 1.59 ± 0.4 × 10–3 mm2/s for benign lesions and 0.82 ± 0.3 × 10–3 mm2/s for malignant lesions. The ADC cutoff value to differentiate between benign and malignant lesions was 1.10 × 10–3 mm2/s with sensitivity 80%, specificity 88.6%, positive predictive value 75%, negative predictive value 91%, and accuracy 86%. Best results were achieved by implementation of the combined DCE-MRI and DWI protocol, with sensitivity 93.3%, specificity 94.3%, positive predictive value 87.5%, negative predictive value 97.1%, and accuracy 94%. Dynamic contrast-enhanced MRI (DCE-MRI) was the most sensitive method for the detection of the underlying malignant pathology of breast asymmetries. However, it provided a limited specificity that may cause improper final BIRADS classification and may increase the unnecessary invasive procedures. DWI was used as an adjunctive method to DCE-MRI that maintained high sensitivity and increased specificity and the overall diagnostic accuracy of breast MRI examination. Best results can be achieved by the combined protocol of DCE-MRI and DWI

Systemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought. Seventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger’s severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done. SSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P < 0.05). Significant positive correlations existed between CCA-IMT and Medsger vascular (r = 0.7, P = 0.02). The FLAIR-MRI showed multiple hyperintense lesions in 24 patients (33%), ranging 0–36 lesions. SSc patients with more lesions (positive MRI) had longer disease duration (P = 0.001) and left and right carotid artery atheromata (P = 0.001, and 0.013, respectively) than SSc patients with negative MRIs; Medsger vascular score did not separate the SSc groups (P = 0.08). In systemic sclerosis patients without central nervous system symptoms, MRI lesion numbers correlated with CCA-IMT. MRI abnormalities were found more frequently if CRP

Myiasis is the infestation of human tissues by dipterous fly larvae of the class Insecta. Clogmia albipunctatus, family Psychodidae, is one of the most medically important insects that cause human myiasis. The aim of the present study is the morphological identification and the molecular characterization of moth flies causing many cases of urinary myiasis in Egypt, based on sequencing of the mitochondrial DNA of the larvae. Seven urinary samples of patients complaining of urinary symptoms and giving a history of low socioeconomic level were examined. Recovered larvae were identified using light microscopy and SEM. For molecular identification, the mitochondrial genes Cytochrome B (cytB), NADH1, NADH1, and 16S were sequenced and phylogenetically analyzed. The morphological and molecular characterization could accurately diagnose our patients to have C. albipunctatus infestation. Such results provided the initial set of data on the molecular identification and phylogenetic analysis of moth flies based on DNA barcoding in Egypt.