This study aimed to determine the incidence of E. coli in raw milk and
cheese, in addition to isolate and identify Enterotoxigenic E. coli. The
existence of heat stable toxin (STh) and heat labile toxin (LT) genes were
determined in the isolated strains. This study included 350 samples of raw
milk and cheese samples. Different media were used to isolate E. coli and
different biochemical tests were used for identification. E. coli was detected
in 61.4% of samples. They were tested for the presence of STh and LT
genes by PCR. ETEC was detected in 3.7% of E. coli isolates. Only one
strain from milk of street samples that found to harbor STh gene. Seven
strains were detected in Kareish cheese including two strains harbor LT
gene and five strains harbor STh gene.

Chronic granulomatous disease (CGD) is a rare inherited primary
immunodeficiency disorder that affects phagocytes and is characterized
by a marked increased susceptibility to severe bacterial and
fungal infections. We aimed to describe the clinical presentations of
pediatric patients with CGD in Upper Egypt and to identify the
defective component of NADPH oxidase. Pediatric patients diagnosed
with CGD within one year from January 2018 to
January 2019 were enrolled in the study. Patient history, clinical
and laboratory investigations were carried out, including nitroblue
tetrazolium test and flow cytometry DHR analysis. Infectious microorganisms
were isolated from infected sites to identify the causative
agents and their resistance profile. A total of 15 patients were
diagnosed with CGD. Failure to thrive and lymphadenopathy were
the most common presentations. The median age of clinical onset
was 1.17 years of age. The most common gene mutations were
observed in the CYBA gene. All cases showed pulmonary infections
followed by abscesses. Staphylococcus aureus and Klebsiella pneumoniae
were the most frequently isolated bacterial pathogens,
Aspergillus spp and Candida spp were isolated from fungal infections.
4/15 (26.7%) children died due to severe serious infections.
We concluded that CGD is common in Upper Egypt, and we recommend
raising the awareness and testing for CGD in pediatric
patients with recurrent or persistent infections, especially those
with a familiar history of similar manifestations to avoid delays in
proper diagnosis and deterioration of cases.

The monocyte/macrophage lineage cells were found involved in the pathogenesis of systemic sclerosis
(SSc) disease. The naïve macrophages are activated either to M1 cells with proinflammatory roles or to
M2 cells that function to resolve inflammation with tissue repair. Recently, cells with dual phenotypes
were detected in SSc disease. So, we aimed in this study to demonstrate different monocyte/macrophage
phenotypes in peripheral cells from a group of Egyptian SSc patients, correlating percentages of these
cells with the clinical findings in patients.
The study participants comprised 41 patients with diffuse cutaneous SSc disease and 25 healthy individuals
as controls. Clinical, radiological, and laboratory tests were conducted for SSc patients. Different
phenotypes of the monocyte/macrophage subsets were identified in peripheral blood of patients and controls
by flow cytometry for characteristic M1 (CD80, CD86, and TLR4) and M2 (CD204, CD163 and CD206)
markers.
SSc patients showed higher percentages of peripheral cells of the M1, M2, and mixed M1/M2 phenotypes
within the monocyte/macrophage lineage compared to controls. Different cell phenotypes were
associated significantly with the disease duration, modified Rodnan’s score, the Medsger skin score,
and the Medsger lung in SSc patients. Some cells with the M1/M2 phenotypes were higher in SSc patients
with pitting scars, arthritis, and myalgia.

RORc2 is the master transcription factor of T helper 17 cells. We aimed to evaluate whether RORc2 genetic polymorphism and serum levels have association with the risk and activity of rheumatoid arthritis (RA). RORC genetic polymorphisms were investigated by real time PCR. Serum RORc2 protein levels were determined by enzyme-linked immunosorbent assay. Protective effects of rs370515 CT, rs370515 CT + TT, rs3828057 CT, rs3828057 CT+TT and rs9826 GG genotypes were detected. The genotype-phenotype analysis showed no significant differences in the disease activity score 28 (DAS 28) under the recessive versus dominant genotypes. RORc2 protein serum levels were significantly higher in RA patients than controls (P= 0.001) and had a positive correlation with DAS-28. In conclusions, RORC genetic polymorphisms correlate with the risk but not activity of RA, whereas RORc2 serum levels have a positive correlation with both risk and activity of RA.

Background: Heart failure is the most common cause of hospitalization in elderly
patients. It is likely that many of the mechanisms that contribute to reductions in
systolic and diastolic function, seen in diabetic patients, place them at an increased
risk of heart failure. Diuretic therapy, especially loop diuretics, is the usual way of
managing congestion, particularly in volume-overloaded patients. Little is known about
the beneficial effect of dapagliflozin when added to loop diuretics in managing patients
with decompensated heart failure.
Aim: To assess the effect of the addition of dapagliflozin to furosemide in managing
decompensated patient with heart failure and reduced left ventricular ejection fraction in
terms of weight loss and dyspnea improvement.
Patients and Methods: The study included 100 type 2 diabetic patients who were
admitted with decompensated heart failure. The study population was randomly divided
into two arms. Serum electrolytes and kidney functions were followed up during their
hospital stay.
Results: With dapagliflozin, there was a statistically significant difference between the
two groups regarding the change in body weight and body mass index. The diuresis
parameters including urine output, total fluid loss, and fluid balance also showed a
statistically significant difference in favor of the use of dapagliflozin, with no significant
change in serum potassium or kidney functions. There was significant improvement in
patient-reported dyspnea scores with the use of dapagliflozin.
Conclusions: Dapagliflozin may provide a new drug option in the
treatment of heart failure especially among vulnerable group of diabetics.

Aims: We aimed in this study to detect the prevalence of carbapenem-hydrolyzing oxacillinase
genes among Acinetobacter baumannii clinical isolates recovered from Assiut University Hospitals,
Egypt.
Methods: The antimicrobial susceptibilities of 23 non-repetitive Acinetobacter baumannii clinical
isolates collected from patients with multiple types of infections were determined. Amplification of
blaOXA-23, blaOXA-51, and blaOXA-58 genes was performed by PCR.
Results: Acinetobacter baumannii isolates showed high resistance to carbapenems and other
antibiotics. Eleven (48%) isolates were extensively drug resistant and 12 (52%) isolates showedpandrug resistance. Among 23 Acinetobacter baumannii strains; oxacillinase genes were detected
in 19 (83%) strains, none of the examined genes were found in 4 (17%) strains. Twelve (52%), 9
(39%), and 4 (17%) isolates harbored blaOXA-51, blaOXA-23, and blaOXA-58 genes, respectively,
either in single form (12 isolates; 52%) or combined (7 isolates; 30%). blaOXA-producers associated
with longer hospital stay and poor outcome. A. baumannii isolates expressed blaOXA-23 and
blaOXA-58 genes, had higher MIC for carbapenems than blaOXA-51 gene.
Conclusion: We concluded that, the presence of oxacillinase genes, especially blaOXA-23 and
blaOXA-58, may convey resistance to carbapenems in Acinetobacter baumannii isolates and are
associated with high comorbidities and poor outcome in patients.

Background: Fungi represent an interesting candidate for the synthesis of nanoparticles. The biosynthesis of silver
nanoparticles (AgNPs) has many industrial and biomedical indications. We aimed in this work to biologically
synthesize silver nanoparticles using Aspergillus niger and to evaluate its effect against the newly identified
Allovahlkampfia spelaea that causes resistant human keratitis.
Material and methods: Aspergillus niger (soil isolate) was treated with silver nitrate to produce silver nanoparticles.
AgNPs were characterized by Ultraviolet–Visible Spectroscopy, Transmission Electron Microscopy, and Fourier
Transform Infrared Spectroscopy. The effect of the synthesized nanoparticles against Allovahlkampfia spelaea
growth, encystation, excystation, and toxicity in host cells was evaluated.
Results: AgNPs exhibited significant inhibition of Allovahlkampfia spelaea viability and growth of both trophozoites
and cysts, with a reduction of amoebic cytotoxic activity in host cells.
Conclusion: AgNPs may give a promising future to the treatment of Allovahlkampfia spelaea infections in humans.

Rheumatoid arthritis (RA) is an inflammatory autoimmune polyarthritis with progressive destruction of the synovial joints
associated with systemic manifestations. RA is characterized by infiltration of the synovial joints with inflammatory immune
cells with premature immunosenescence. Shorter telomere length in the peripheral blood cells and increase in the oxidative stress
have been detected in patients with RA. The aim of the present study was to study the association of markers of telomere
shortening and oxidative stress with RA disease activity. Sixty-one RA patients and 15 healthy controls were enrolled in the
study. Demographic data, clinical examination, and disease activity status were evaluated for the RA patients. Serum levels of
chitinase and NAG (telomere markers) were determined by biochemical reactions using colloidal chitin and NAG as substrates,
respectively. Nitric oxide and superoxide dismutase (oxidative stress markers) were determined colometrically and spectrophotometrically,
respectively, in the sera of RA patients and controls. Results were correlated with disease activity. Indices of
telomere shortening and oxidative markers were significantly higher in RA patients compared to controls. These indices were
correlated with signs of disease activity (including number of swollen and tender joints, DAS-28, and inflammatory markers).
Rheumatoid arthritis is a disease in which markers of telomere shortening and elevated oxidant stress correlate with disease activity.

Study objectives: Sleep disorders are significant problems in patients with rheumatoid arthritis (RA) and
are associated with poor quality of life. Irisin is myokine which may have anti-inflammatory and energy
regulatory roles. This study assessed the association of serum irisin levels with the quality of sleep and
disease activity in RA patients.
Methods: In sum, 58 RA patients and 30 matched healthy controls were included. Disease activity score
in 28 joints (DAS28-ESR) and the patients’ global score were calculated. RA patients were grouped according
to the Pittsburgh Sleep Quality Index score (PSQI) into good-sleepers (group 1) defined as a PQSI
score
5 and poor sleepers (group 2) with a PSQI > 5. Serum irisin levels were measured for both patients
and controls by commercially available enzyme-linked immunosorbent assay kits.
Results: Poor sleep quality was found in 26 (45%) of the RA patients. Irisin levels were significantly lower
in RA patients with poor sleep compared to those with good sleep and healthy controls (p < 0.001).
Serum irisin levels correlated inversely with disease duration, morning stiffness duration, DAS28-ESR,
global score, and total PSQI score (r ¼ 0.722 to 0.263 & p values
0.001e0.04) indicating a possible
anti-inflammatory role of irisin in RA patients. The analysis employed Student's t-test, ANOVA, and
Pearson correlation.
Conclusions: Irisin levels were decreased in RA patients with poor sleep quality compared to RA patients
with good sleep quality and healthy controls, indicating a possible association of decreased serum irisin
with sleep impairment in RA patients.

Objective: we aimed to study systemic sclerosis patients in order to
assess osteoprotegerin/Receptor activator of nuclear factor-kB ligand
(OPG/RANKL) system and find the relation of these biomarkers with
the clinical features of the disease, the carotid intima thickness,
markers of inflammation, lipid profile, and other laboratory
characteristics.
Methods: both the level of (RANKL), (OPG) in sera of participants, in
30 (SSc) patients and the atherosclerotic changes affecting the common
carotid artery were measured and, were compared to 30 healthy
controls matched for age and sex. All participants were assessed
clinically and subjected to the Revised Medsger SSc severity scale
and underwent carotid Doppler ultrasound examination.
Results: OPG, RANKL, and RANKL/OPG were 1.9 ± 0.4 ng/ml,
24.3 ± 17.25 ng/ml, and 13.5 ±9.8 versus 0.77 ± 0.25 ng/ml,
7.13 ± 3.02 ng/ml, and 9.6 ± 3.1 in the SSc patients and the controls
with significance (P = 0.001, P = 0.001, P = 0.045) respectively. The
OPG- RANKL axis in the SSc patients correlated significantly with
carotid intima thickness, arthritis, arthralgia, inflammatory markers,
Medsger joint, Medsger vascular, Medsger skin, and dyslipidemia.
Conclusion: In cardiovascular risks, OPG serum level might increase
as a preventive compensatory mechanism to neutralize the RANKL
level increment. The determination of the OPG-RANKL system is a
diagnostic indicator for the intensity of vascular calcification and
atherosclerosis in SSc patients.