Molecular and serological techniques for the diagnosis of culture negative infective endocarditis in Alexandria Main University Hospital

AbstractBackground and aimCulture-negative infective endocarditis (CNIE) is a diagnostic dilemma. The study was carried out to estimate the prevalence of CNIE among definite IE cases, to describe the epidemiologic and clinical characteristics of CNIE patients and to diagnose the microbial etiology of CNIE using molecular and serological techniques.Subjects and methodsSixty-five definite IE cases were enrolled in a prospective observational study between January and December 2010. CNIE cases were tested by 16SrRNA and seminested PCR for 35 blood samples, serological tests and the study of ten valve tissue specimens.ResultsCNIE constituted 39 (60%) cases. The mean age of CNIE patients was 31years. Male to female ratio was 2.9:1. Healthcare associated IE accounted for 15.4%, native valve IE for 66.7% and intravenous drug abuse for 20.5% of cases. The mitral valve was the most frequently involved (56.4%). Out of 39 CNIE cases, seminested blood PCR detected 12 cases (ten Staphylococci, two Streptococci). Five cases were reactive by serology (three Bartonella, one Coxiella, and one Brucella). Six cases were positive by analysis of valve tissue (three Staphylococci, three Streptococci). The combined results of all diagnostic tools decreased the percentage of non-identified causes of CNIE from 60% to 24.6%.ConclusionsOur data underlined the role of collecting blood culture before starting antibiotics and the role of seminested PCR in the diagnosis of conventional causes of CNIE. The importance of serology to identify non conventional causes was also highlighted

Biodegradation of Organophosphorus Pesticide (Malathion) by Bacillus sp. FYM31 Isolated from Agriculture Drainage Water

Organophosphorus pesticides (OP) are used extensively in many arenas including agriculture and industry leading to humans and agroecosystems disorders. Malathion is one of the OP that are used in agriculture to control pest and protect crops. Also, they harm non-target organisms and affect cruelly water sources, air, and soil quality. The present study aimed to isolate and identify a potent bacterial isolate capable of degrading malathion. Bacterial strain that isolated from Al Fayoum governorate, Egypt exhibited high efficiency for malathion biodegradation. Biodegradation process using minimal salt medium (MSM) supplemented with different malathion concentrations indicated that the bacterium was able to degrade and use malathion as a sole carbon source up to 700 mg/l at 37°C.The potent strain that exhibited biodegradation potential was identified as Bacillus sp. FYM31 and deposited into GenBank with the accession number OK325597. HPLC proved the effectiveness of malathion removal by Bacillus sp. FYM31 after 12 days of incubation to the level of 70.1% malathion (700 mg/l) degradation. Organophosphorus hydrolase (opd) gene was detected in the potent Bacillus sp. FYM31 strain. Due to the widespread usage of malathion in Egypt's agricultural areas, Bacillus sp. FYM31 can help bio-remediate the polluted areas

International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Bridging the Cultural Divide: A Study of the Published English Versions of Some of Gamal Al-Ghitani Literary Works

This research paper is an attempt to evaluate Peter Newmark's semantic and communicative approaches that are commonly adopted by translators to impart the flavor of the Egyptian culture to the Anglophone readers. The two approaches are diametrically opposed: the semantic approach involves the transfer of the text literally without any alteration: it preserves the length of sentences, position and integrity of clauses and words. It is author-oriented in the sense that it closely pursues the author's thought process and disregards the response of the target readers. This approach does not pay heed to the message of the writer and the target readers may find it difficult to digest the target text. The communicative approach, on the other hand, sets great store on the target reader and the response of the receptor. It attempts to generate a meaning that will elicit a response from the target recipients that approximates the response of the SL readers. It also advocates the equivalent-effect principle of translation which tends to rule out the predominance of words and structure.   This paper attempts to address the vexed question of choosing an optimal translation approach and whether to represent the source culture in Target Text by highlighting the importance of the functional approach to translation which is based on the Skopostheorie, for it strikes a balance between Newmark's approaches by according priority to the function the translated text is intended to fulfill. Although this Skopostheorie has drawn many criticisms, some of them have been refuted; it is practically useful to adopt it provided the translator voices his/her opinion which is soundly based on his/her expertise and does not follow blindly what the commissioner/client dictates to him/her. Translation is not all about linguistic transcoding, or cultural transference, rather it is a communicative action determined by a purpose. Translators can safely produce skopos-based translation provided that they observe the principles of coherence and culture. Some of Gamal Al-Ghitani's literary works are selected to put theories into practice since they are replete with expressions that reflect the Egyptian culture hence pose a challenge to the translator

In vitro and in vivo antimicrobial activity of combined therapy of silver nanoparticles and visible blue light against Pseudomonas aeruginosa

Suzanne Nour El Din,1 Tarek A El-Tayeb,2 Khaled Abou-Aisha,1 Mohamed El-Azizi1 1Department of Microbiology, Immunology and Biotechnology, Faculty of Pharmacy and Biotechnology, German University in Cairo, 2National Institute for Laser Enhanced Sciences, Cairo University, Cairo, Egypt Abstract: Silver nanoparticles (AgNPs) have been used as potential antimicrobial agents against resistant pathogens. We investigated the possible therapeutic use of AgNPs in combination with visible blue light against a multidrug resistant clinical isolate of Pseudomonas aeruginosa in vitro and in vivo. The antibacterial activity of AgNPs against P. aeruginosa (1×105 colony forming unit/mL) was investigated at its minimal inhibitory concentration (MIC) and sub-MIC, alone and in combination with blue light at 460 nm and 250 mW for 2 hours. The effect of this combined therapy on the treated bacteria was then visualized using transmission electron microscope. The therapy was also assessed in the prevention of biofilm formation by P. aeruginosa on AgNP-impregnated gelatin biopolymer discs. Further, in vivo investigations were performed to evaluate the efficacy of the combined therapy to prevent burn-wound colonization and sepsis in mice and, finally, to treat a real infected horse with antibiotic-unresponsive chronic wound. The antimicrobial activity of AgNPs and visible blue light was significantly enhanced (P<0.001) when both agents were combined compared to each agent alone when AgNPs were tested at MIC, 1/2, or 1/4 MIC. Transmission electron microscope showed significant damage to the cells that were treated with the combined therapy compared to other cells that received either the AgNPs or blue light. In addition, the combined treatment significantly (P<0.001) inhibited biofilm formation by P. aeruginosa on gelatin discs compared to each agent individually. Finally, the combined therapy effectively treated a horse suffering from a chronic wound caused by mixed infection, where signs of improvement were observed after 1 week, and the wound completely healed after 4 weeks. To our knowledge, this combinatorial therapy has not been investigated before. It was proved efficient and promising in managing infections caused by multidrug resistant bacteria and could be used as an alternative to conventional antibiotic therapy. Keywords: biofilm, invasive sepsis, wound colonization, murine model, bioplastic disc, nonconventional therap

The use of colposcopy versus colposcopy and optical detection system in diagnosis of squamous intraepithelial lesions of the cervix: A clinical comparative study

Objective: To assess whether the use of optical detection system (ODS) as an adjunct to colposcopy increases the detection of biopsy confirmed CIN 2, 3 in women being evaluated for an abnormal cervical cytology. Methods: This is a comparative study comparing the use of colposcopy alone with the use of colposcopy plus ODS system. Three hundred and six women were recruited from the out patient clinic of Suzan Mobark hospital, Minia University, referred to the Early Cancer Detection Unit for colposcopical evaluation. The main study outcomes were differences in true-positive rates (biopsy confirmed CIN 2, 3) and false-positive rates between the two methods. Results: The true-positive (TP) rates were 17.8% versus 13.9% (P = 0.001) for the combined colposcopy and ODS compared to colposcopy-only, respectively, in women with either an atypical squamous cell (ASC) or low-grade squamous intraepithelial lesion (LGSIL) cytology result. TP rates were 53.6% versus 50% for the combined colposcopy and ODS compared to colposcopy-only, respectively, among women referred for the evaluation of HGSIL. The 28.1% gain in true-positives observed with the use of ODS and colposcopy among women referred for an ASC or LSIL cytology was achieved with only a fractional increase in a number of biopsies obtained per patient (0.21). In the combined colposcopy and ODS among women with ASC or LSIL, the PPV of biopsies indicated by ODS was 24.3% and the PPV of biopsies indicated by colposcopy was 23.3%. All tests indicate that ODS and colposcopy provide benefit compared to colposcopy alone among women with ASC or LGSIL. Conclusions: Combining ODS with colposcopy provides a clinically meaningful increase in the detection of CIN 2, 3 in women referred for the evaluation of abnormal cytology results