Background: Faecal carriage of ESBL-producing bacteria is a potential risk for transmission and infection. Antibiotic resistance in diarrheal children is considered a risk factor for these young aged ones and limit treatment options. This study aimed to investigate the frequency of ESBL-producing Gram negative bacilli (GNB) phenotypically by Vitek and genotypically by PCR. Method: Seventy-three diarrheal isolates from outpatient children at of age range from less than 6 months to 18 months were isolated. Bacterial strains were identified and subjected to antimicrobial susceptibility testing by using the automated Vitek 2 compact system. All isolates were screened for ESBL phenotypically by Vitek and genotypically by PCR for blaCTXM, blaTEM and blaSHV. Results: Seventy three different GNB identified by Vitek system. The frequency of Escherichia coli was 68.5%, Acinetobacter haemolytica was 7 /73 (9.6%), Pseudomonas species (sp.) 4/73 (5.5%), Proteus mirabilis was (2.7%), Salmonella sp. was (1.4%), Enterobacter sp. was (6.8%), Aeromonas salmonicida was (1.4%), and Klebsiella was (4.1%). ESBL carriage was significantly high among isolated strains (64.4 %). High frequency of multidrug resistance (MDR) (90.4%) was found. High resistance was detected to ampicillin (98.6%), followed by cefazolin (93.2%) and ceftazidime (82.2%), trimethoprim-sulphamethoxazol (76.7%). Resistance to carbapenems was detected as (16.4%). blaCTX-M positive was (78.1%), blaTEM positive (53.4%), blaSHV positive (31.5%). Conclusions: The current study reported a high rate of faecal carriage of ESBL-producing and MDR GNB and children below 2 years of age. Resistance was observed to the available antimicrobials that are used for children in treatment. This leaves few treatment options for infections caused by these bacteria.

Background and Objectives: Enterococci causes many serious and life-threatening infections. Enterococci may be the cause of diarrhea in children. Multidrug-resistant (MDR) Enterococci limits treatment options. So, the aim of our study was to detect the frequency and the antibiotic resistance profile, both phenotypically and genotypically, of MDR Enterococci isolated from the stools of children suffering from gastroenteritis who needed hospitalization. Materials and Methods: Enterococci were isolated from stool samples from children. One hundred ten (110) infants (in patients) with typical signs of gastroenteritis (nausea, vomiting, abdominal pain, diarrhea). The Vitek 2 Compact System is used for identification and antimicrobial susceptibility testing. Drug resistance genes (ermB, aph(3′)IIIa, and tetM) and virulence genes (esp) were identified using molecular techniques. Results: Thirty-six isolates of Enterococci were diagnosed phenotypically by routine lab examination and Vitek2 followed by genotypic characterization by multiplex PCR for three resistant genes: ermB (100%), aph(3′)IIIa (63.9%) and tetM (91.7%) and one virulence gene (esp (25%)). The frequency of Enterococci among studied patients was 32.7% (36/110). Most of the Enterococci isolated from stool were Enterococcus faecuim (86.1%). MDR Enterococci was found to be 94.4% (34/36) in total isolates. Conclusion: MDR Enterococci was isolated in community acquired diarrhea in young aged (less than 24 months) children. More than one resistance gene: ermB, aph(3′)IIIa, tetM and virulence gene (esp) were detected in isolates. The presence of MDR strains is risky at a young age as it limits treatment options. Drug-resistant genes may be transmitted to a child through a carrier mother or cross infection from the hospital.

Background: Coronavirus disease-2019 (COVID-19) mortality rates are increasing globally. Protection is especially important for those who are at risk for serious and fatal disease. Furthermore, factors increasing these risks are of interest in the search of potential treatments. The study's goal is to improve our understanding of how risk factors affect COVID-19 fatality rates. Methods: Data was collected for all 100 COVID- 19 adult patients who admitted to Chest Hospital, Assiut University Hospitals and other quarantine hospitals in Assiut, Egypt with confirmed COVID-19 by RT-PCR from January 2022 to August2022.The patient cohort was classified into severe group (n=32) cases developed as severe symptoms and needed critical care support (ICU). A total of 68 patients did not require intensive care (ICU) and were thus classified as non-severe. Follow-up was completed on October, 2022, at which time all patients either were discharged from the hospital as “cured” or had a fatal outcome of the disease. Results: 56.0% of patients were ≥60 years, 65 patients (65%) were of the male gender. The most prevalent symptoms among patients were dyspnea (98%), cough (93%) followed by fever (74%). The most prevalent comorbidities hypertension (37%), diabetes mellitus (34%), and followed by chronic obstructive pulmonary disease (19%).32.0% of patients with COVID-19 infection admitted ICU, and 18.0% of patients were died. Conclusion: In this study, the most common risk factors associated with COVID-19 among the studied population were age ≥60 years, male gender (65%) and comorbidities (hypertension (37.0%), diabetes mellitus (34.0%) and COPD (19.0%)). Also, age and comorbidities were significantly higher in died patients when compared with cured patients.

Background: Coronavirus disease-2019 (COVID-19) mortality rates are increasing globally. Protection is especially important for those who are at risk for serious and fatal disease. Furthermore, factors increasing these risks are of interest in the search of potential treatments. The study's goal is to improve our understanding of how risk factors affect COVID-19 fatality rates. Methods: Data was collected for all 100 COVID- 19 adult patients who admitted to Chest Hospital, Assiut University Hospitals and other quarantine hospitals in Assiut, Egypt with confirmed COVID-19 by RT-PCR from January 2022 to August2022.The patient cohort was classified into severe group (n=32) cases developed as severe symptoms and needed critical care support (ICU). A total of 68 patients did not require intensive care (ICU) and were thus classified as non-severe. Follow-up was completed on October, 2022, at which time all patients either were discharged from the hospital as “cured” or had a fatal outcome of the disease. Results: 56.0% of patients were ≥60 years, 65 patients (65%) were of the male gender. The most prevalent symptoms among patients were dyspnea (98%), cough (93%) followed by fever (74%). The most prevalent comorbidities hypertension (37%), diabetes mellitus (34%), and followed by chronic obstructive pulmonary disease (19%).32.0% of patients with COVID-19 infection admitted ICU, and 18.0% of patients were died. Conclusion: In this study, the most common risk factors associated with COVID-19 among the studied population were age ≥60 years, male gender (65%) and comorbidities (hypertension (37.0%), diabetes mellitus (34.0%) and COPD (19.0%)). Also, age and comorbidities were significantly higher in died patients when compared with cured patients.

Background: The emergence of colistin-resistant strains is considered a great threat for the children suffering from diarrhea. This study aimed to screen for the presence of mcr-1 in Escherichia coli (E. coli) isolates collected from children with diarrhea and to compare between genotypic and phenotypic methods for detection of colisitin resistant E.coli carrying mcr-1gene. Methods: Isolation of E.coli was done followed by antimicrobial susceptibility test. Kirby-Baur disc diffusion was used to determine antimicrobial susceptibility, whereas broth microdilution (BMD) and the double disc synergy test (DDST) were used to determine colistin resistance. The screening for mcr-1 was used to investigate one probable mechanism of colistin resistance by PCR. Results: All mcr-1 E.coli isolates were resistant to ampicillin, while resistance to ampicillin/sulbactam, cefazolin, cefoxitin, ceftazidime and trimethoprim-sulphamethoxazol was 94.1% (32/34), 94.1% (32/34), 94.1% (32/34), 85.3% (29/34) and 70.6% (24/34) respectively. All mcr-1carrying E. coli strains were sensitive to tobramycin, amikacin and imipenem. Moderate resistance was noticed to piperacillin/ tazobactam(23/34) 67.6%, gentamycin 47.1% (16/34), and ciprofloxacin 44.1% (15/34). Thirty-one (91.2 %) mcr-1 positive E. coli strains were multidrug resistant (MDR). Forty five out of 95 (47.4%) of E.coli isolates were positive for mcr-1 by DDST and 34 /95 (35.78%) of E. coli isolates were positive for mcr-1 by PCR. Conclusions: This study reported a high prevalence of colistin resistant E. coli harboring mcr-1 gene in young children in Pediatric Hospital of Assiut University. Broth microdilution is more accurate than DDST in detection of colistin resistance.

A minimally invasive approach has become standard for mitral valve surgery. The periareolar approach has grown in popularity regarding the cosmesis for patients. We have adopted a new modification to the periareolar approach: the periareolar minimally invasive (PAMI) technique. The objectives of the current study are to test the hypothesis that the PAMI approach is more feasible and safer than the inframammary approach in addition to identify risk factors and assess outcomes of both periareolar and inframammary approach.