The myth of the subclinical rejection: Is it real?

Introduction: Subclinical rejection (SCAR) of renalallografts refers to graft lymphocytic infiltrationtaking acute rejection histologic pattern despitestable renal function. There are no data to suggestthat subclinical tubulointerstitial inflammation isregulatory or in any way beneficial to the graft. Wehave investigated whether C57BL/6 CD8 T cellshome to long term engrafted (LTE) DBA/2 skinallografts and if it is protecting or rejecting.Methods and results: We transplanted two groupsof B6 CD4 KO mice, 6 mice each, with MHCmismatched DBA/2 skin. Only the 1st group wastreated with Rapamycin (RPM) as reported. After100 days of LTE, we challenged RPM treated hostswith a 2nd DBA/2 skin graft. The 2nd but not the 1stgraft was rejected. Then we investigated thefunctional effects of graft inflitrating CD8 T cells.DBA/2 skin grafts were harvested 100 daysposttransplantation from (i) RPM treated B6 CD4ko mice (N=5) and (ii) skin autografts (N=5) inDBA/2 recipients. LTE DBA/2 allografts or controlDBA/2 autografts were then transplanted ontoC57BL/6-Rag KO hosts, and peripheral bloodlymphocytes (PBL) samples were collected 30 dayspost skin transplantation. CD8T cells can not bedetected in PBL of nae RAG-/- mice. 4.6 % CD8T cells are detected in PBL of RAG-/- recipients ofLTE allografts, but not in recipients of syngeneicgrafts. To test the protective function of the grafthoming CD8 T cells (from LTE RPM mice) thatexpanded by homeostatic proliferation and arepresent in PBL of the RAG-/-, 0.2 x 106 CD8 Tcells from naive CD4KO mice were adoptivelytransferred into the RAG-/- hosts bearing the LTEDBA/2 allografts or DBA/2 autografts 30 daysfollowing skin transplantation. Survival of LTEDBA/2 skin allografts transplanted onto RAG-/-mice were significantly prolonged.Conclusion: Graft infiltrating CD8 T cells areregulatory and functionally active to protectallograft from rejection

Aquaponics as a sustainable alternative to new land reclamation and conventional agriculture in Egypt

Agriculture in Egypt is facing dramatic changes that affect its productivity, and accordingly the Egyptian economy. Egypt started in the 1930s, expanding agricultural land through land reclamation projects. Many of these projects did not perform as expected or planned due to lack of water and other challenges. While land reclamation and conventional agriculture techniques have a lot of technical, social, and economical problems in Egypt; soilless agriculture and aquaponics are being successfully used in other regions for urban food production as a sustainable solution. Aquaponics is a technique that integrates fish and crop productions by bringing aquaculture with hydroponics (soilless planting) together into one system. Although aquaponics has shown promising results in different regions worldwide, there are questions that need answering about the most suitable type of aquaponics for food production in Egypt. Aquaponics have been investigated in this work in order to identify its potentials, hence recommend the suitable aquaponics systems for Egypt. The thesis shows that aquaponics is an ally or alternative to conventional agriculture and land reclamation in Egypt. In this thesis, two different Aquaponics systems were tested in an experiment, in the American University in Cairo, to determine which system design will be more efficient and productive for use in Egypt on a larger scale. The production and crops variety were more promising in the Integrated Aqua Aegaculture System than the Deep Water Culture aquaponics system. The elemental analysis results of water and plants samples, from both aquaponics systems, show that the Integrated Aqua Vegaculture system has more potential than the Deep Water Culture system, especially in Egypt under certain boundary conditions

Targeting Immunity in End-Stage Renal Disease

Background: Despite the stable incidence of end-stage renal disease (ESRD), it continues to be associated with an unacceptably high cardiovascular risk. Summary: ESRD is characterized by enhanced oxidative stress and severe inflammation, which boost cardiovascular risk, thus increasing cardiovascular-associated mortality rate. While substantial effort has been made in the technological innovation of dialytic techniques, few significant advances have been made to reduce inflammation in patients with ESRD. Indeed, this contrasts with the extensive scientific breakthroughs made in the basic field of science in targeting inflammation. There is thus a pressing need for clinical trials to test the effect of reducing inflammation in patients with ESRD. Here, we will revisit the negative effect of ESRD on inflammation and explore the impact of enhanced inflammation on cardiovascular outcomes and survival in patients with ESRD. Finally, we will discuss the need for clinical trials that target inflammation in ESRD, as well as weigh potential disadvantages and offer novel innovative approaches. Key Message: We will try to understand why the issue of inflammation has not been successfully addressed thus far in patients with ESRD, while at the same time weighing the potential disadvantages and offering novel innovative approaches for targeting inflammation in patients with ESRD

Detection and molecular characterization of vancomycin resistant Staphylococcus aureus from clinical isolates

Until now, few strains of vancomycin resistant Staphylococcus aureus (VRSA) have been reported worldwide. The disk diffusion method for determination of vancomycin sensitivity frequently misclassifies intermediately susceptible isolates to fully susceptible. However, non-automated minimum inhibitory concentration (MIC) detection methods are the gold standards. In the present study, 439 Gram positive clinical isolates were collected. Among them, 220 Staphylococcus aureus were identified. Multiplex polymerase chain reaction (PCR) detection method for vancomycin resistant S. aureus (VRSA) was developed for detection of both vanA gene (for vancomycin resistance) and nuc gene (specific for S. aureus) in a single step PCR compared to conventional non-automated disc diffusion and MIC detection methods. Molecular typing of VRSA isolates was performed using randomly amplified polymorphic (RAPD) DNA assay technique. The results show 10 VRSA isolates detected by disc diffusion method and MIC determination. Five out of them harbored vanA gene that were detected by multiplex PCR and most of them showed low clonal diversity.Key words: Molecular characterization, multiplex polymerase chain reaction (PCR), vancomycin resistant Staphylococcus aureus (VRSA), vanA gene, nuc gene, randomly amplified polymorphic DNA (RAPD) assay technique

Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates

Background: Invasive fungal diseases (IFDs) are opportunistic infections associated with significant mortality in paediatric patients, especially in those with compromised immune system and neonates with very low birth weight (VLBW). The objectives of this study are to determine the prevalence, clinical features and fungi isolates of neonatal sepsis in three hospitals in Egypt. Methodology: The study is a cross sectional survey of 176 neonates with clinical sepsis admitted to the neonatal intensive care units (NICU) of the three hospitals over a period of one year (February 2015 to January 2016). A minimum of two blood samples (collected within 24 hours) from each neonate were cultured for bacteria in automated BacT/AlerT and conventional culture bottles, while Saboraud-Brain Heart Infusion broth was inoculated for fungi culture. Positive growths from the broth were sub-cultured on Sabouraud Dextrose Agar (SDA) plates for aerobic incubation at 25oC and 37oC for 2 weeks. Identification of fungi colonies on SDA was by conventional morphology and confirmation on chromogenic agar media. Phylogenetic analysis of representative fungi isolates was done by partial nucleotide sequencing of D1-D2 domain of the large subunit rRNA gene. Results: Of the 176 neonates, blood culture was positive for pathogens in 55 (31.3 %) samples and fungi were isolated in 26 (14.8 %); yeast (25) and mould (1). The commonly isolated yeasts were Candida albicans, Candida tropicalis, and Candida krusei representing 34.6%, 30.8% and 23.1%, respectively of the total fungi isolated. The phylogenetic analysis in comparison to Genbank data showed defined clades for Candida tropicalis, Candida parapsilosis, Candida albicans and Pichia kudriavzevii Conclusion: This current study highlights the changing pattern of neonatal infections in Egypt caused by Candida, with increasing incidence of infections caused by non-albicans Candida species. Key words: fungal infection, neonatal, risk factors, PCR, yeas

Protein substitution to produce a processed cheese with high branched-chain amino acids of medical and genetic importance

Background: The most important metabolic impairment in patients with advanced liver disease is characterized by low levels of circulating branched chain amino acids (BCAAs). The etiology of such abnormal amino acid metabolism is multifactorial including protein restricted diet or inadequatenutritional intake as in protein energy malnutrition. Multiple studies report the beneficial effects of BCAAs supplementation to improve plasma amino acids imbalance, several neurologic diseases, protein energy malnutrition, and subsequently the survival rate of cirrhotic patients.Methods: In the present study we used a protein substitution technique to synthesize a new processed cheese as a dairy source rich in BCAAs, with low phenylalanine content manufactured from Ras cheese, kariesh cheese, butter oil and phenylalanine-free milk. Chemical composition, aminoacids analysis, rheological properties and sensory evaluation were done to all of the cheese samples. L-Phenylalanine was selected to induce hepatic and brain affections in Begg Albino strain c (BALB/c) mice model. Effect of 2.5%, 5% and 10% protein-replacement cheese formulas was evaluated among mice groups including histopathological sections of the liver and brain; colorimetric determinationfor liver enzymes; serum total and differential cholesterol profile, serum albumin, globulin and totalprotein along with phenylalanine levels determinations.Results: Analysis of the processed cheese sample with 10% protein substitution revealed that the protein content was 7.42 mg/g (about 50% of the content in the standard processed cheese) while fat content,acidity and moisture were nearly the same. The sensory score for all the formulas ranged from 79–88. Highest content of BCAAs along with least phenylalanine content was attained in the processed cheese with 10% protein substitution. Weight of mice fed on different substitution formulasranged from 22.8 ± 2.2–24.66 ± 2.5 g compared with 17.8 ± 1.9 g in the untreated diseased mice (P< 0.05). Serum phenylalanine was 1.822 ± 0.42 mg/dl in the mice fed on 10% protein substitution formula compared to 6.2± 1.32 mg/dl in the untreated mice (P < 0.01). There was a highly significant difference (

Bacterial translocation markers in type 2 diabetes mellitus: their association with glycemic control and diabetic kidney disease in Egyptian patients

Background. The involvement of bacterial translocation in the pathogenesis of type 2 diabetes mellitus (T2DM) has been highlighted in recent years. The objective of the current study was to evaluate the potential impact of lipopolysaccaride-binding protein (LBP) and DNA translocation on glycemic control and progression to diabetic kidney disease in T2DM patients. Material and methods. A total of 30 T2DM patients as well as 30 controls were included in a cross-sectional observational study. Plasma LBP levels were deter­mined using an enzyme linked immunoassay. DNA translocation was assessed using polymerase chain reaction targeting 16SrNA gene. Results. Plasma levels of LBP were significantly elevated in T2DM patients than in controls (p = 0.02). LBP level was significantly and positively correlated with fasting glucose level, glycated hemoglobin, C-reactive protein, albumin-creatinine ratio and negatively correlated with glomerular filtration rate. Receiver operating curve revealed that LBP with a cut off of 15.17 μg/mL succeeded to predict both glycemic control and dia­betic kidney disease in T2DM patients. The bacterial 16SrRNA was detected in almost all blood samples of T2DM patients (28/30) and in about half (16/30) of the control group (p &lt; 0.001). Conclusion. Translocation products could trigger diabe­tes related complications. Future interventional work should target these products to reverse their effects

HYPERPHOSPHATEMIA IN END STAGE RENAL DISEASE: PREVALENCE AND PATIENTS CHARACTERISTICS OF MULTIETHNIC POPULATION OF UNITED ARAB EMIRATES

Objective: Hyperphosphatemia is significantly associated with increased mortality among end stage renal disease (ESRD) patients on hemodialysis. There is paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis.Methods: Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, hemoglobin, serum calcium, and hypertensive nephropathy as cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, hemoglobin and PTH independently correlated with hyperphosphatemia.Conclusion: We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia