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

Intraoperative Corneal Thickness Changes during Pulsed Accelerated Corneal Cross-Linking Using Isotonic Riboflavin with HPMC.

Purpose. To evaluate corneal thickness changes during pulsed accelerated corneal cross-linking (CXL) for keratoconus using a new isotonic riboflavin formula. Methods. In this prospective, interventional, clinical study patients with grades 1-2 keratoconus (Amsler-Krumeich classification) underwent pulsed accelerated (30 mW/cm(2)) CXL after application of an isotonic riboflavin solution (0.1%) with HPMC for 10 minutes. Central corneal thickness (CCT) measurements were taken using ultrasound pachymetry before and after epithelial removal, after riboflavin soaking, and immediately after completion of UVA treatment. Results. Twenty eyes of 11 patients (4 males, 7 females) were enrolled. Mean patient age was 26 ± 3 (range from 18 to 30 years). No intraoperative or postoperative complications were observed in any of the patients. Mean CCT was 507 ± 35 μm (range: 559-459 μm) before and 475 ± 40 μm (range: 535-420 μm) after epithelial removal (P < 0.001). After 10 minutes of riboflavin instillation, there was a statistically significant decrease of CCT by 6.2% from 475 ± 40 μm (range: 535-420 μm) to 446 ± 31 μm (range: 508-400) (P < 0.005). There was no other statistically significant change of CCT during UVA irradiation. Conclusions. A significant decrease of corneal thickness was demonstrated during the isotonic riboflavin with HPMC application while there was no significant change during the pulsed accelerated UVA irradiation

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Formation and Reduction Processes of River Deltas ; Theory and Experiments

Beach erosion has recently been recognized as accelerating due to changes in sediment sources from rivers. This can be considered as reduction processes of river deltas. In this paper, the formation and reduction processes of river deltas are first investigated theoretically by introducing the non-uniformity of longshore sediment transport into the equation of continuity of shoreline change. Theoretical solutions to shoreline changes in the formation and reduction processes are derived from the simplified governing equations using the concept of one-line theory. By numerical results of the solutions, shoreline changes in the formation and reduction processes are well explained. Secondly, experiments both on the formation and reduction processes were carried out. The theoretical results of the processes compared favorably with the experimental ones, indicating that the processes can be well explained by specifying the predominant parameters

河口デルタの形成, 縮小過程と制御に関する研究

京都大学0048新制・課程博士工学博士甲第4640号工博第1145号新制||工||817(附属図書館)UT51-90-V113京都大学大学院工学研究科土木工学専攻(主査)教授 土屋 義人, 教授 村本 嘉雄, 教授 中川 博次学位規則第4条第1項該当Kyoto UniversityDFA

Study on the use of banana peels for oil spill removal

Nowadays, oil spill is one of the most serious pollutants that have negative effects on the ecosystem and marine life. Environmentalists face major challenges in the treatment of spills and in developing an alternative product with low cost. Among all different sorbents, agriculture waste is preferred as an oil cleanup technology due to its biodegradation and buoyancy. This study investigates the oil sorption capacity of crude and gas oils, using banana peel as a substitutional material from local fruit wastes. The research detected that the capacity of this sorbent to clean up crude oil from produced water toward different factors is associated with surface characteristics, oil type, oil film thickness, sorption time, temperature, in addition to the salinity of crude oil. Analytical techniques of banana peel, such as microstructure and morphology using FTIR spectrometry and scanning electron microscopy (SEM) are also studied. Banana peel is tested using gas oil, 1- and 7-day weathered Almein crude oil. The results explain that the best conditions were established at 0.3625 mm particle size and temperature at 25 °C for 15 min. Keywords: Banana peel, Oil spill, Adsorption, Sorption capacity, Sorben

Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review

The association between uric acid (UA) on one side and systemic hypertension (Htn), dyslipidemia, glucose intolerance, overweight, fatty liver, renal disease and cardiovascular disease (CVD) on the other side is well recognized. However, the causal relationship between UA and these different clinical problems is still debatable. The recent years have witnessed hundreds of experimental and clinical trials that favored the opinion that UA is a probable player in the pathogenesis of these disease entities. These studies disclosed the strong association between hyperuricemia and metabolic syndrome (MS), obesity, Htn, type 2 diabetes mellitus (DM), non-alcoholic fatty liver disease, hypertriglyceridemia, acute kidney injury, chronic kidney disease (CKD), coronary heart disease (CHD), heart failure and increased mortality among cardiac and CKD patients. The association between UA and nephrolithiasis or preeclampsia is a non-debatable association. Recent experimental trials have disclosed different changes in enzyme activities induced by UA. Nitric oxide (NO) synthase, adenosine monophosphate kinase (AMPK), adenosine monophosphate dehydrogenase (AMPD), and nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase are affected by UA. These changes in enzymatic activities can lead to the observed biochemical and pathological changes associated with UA. The recent experimental, clinical, interventional, and epidemiologic trials favor the concept of a causative role of UA in the pathogenesis of MS, renal, and CVDs

Is Fibroblast growth factor 23 the leading cause of increased mortality among chronic kidney disease patients? A narrative review

The death rate among chronic kidney disease patients is the highest compared to other chronic diseases. 60% of these fatalities are cardiovascular. Cardiovascular calcifications and chronic inflammation affect almost all chronic kidney disease patients and are associated with cardiovascular mortality. Fibroblast growth factor 23 is associated with vascular calcification. Systemic inflammation in chronic kidney disease patients is multifactorial. The role of systemic inflammation in the pathogenesis of vascular calcification was recently reappraised. Fibroblast growth factor 23 was accused as a direct stimulus of left ventricular hypertrophy, uremic inflammation, and impaired neutrophil function. This review will discuss the underlying mechanisms that underlie the link between Fibroblast growth factor 23 and increased mortality encountered among chronic kidney disease patients