Molecular study of Helicobacter pylori virulence genes CagA, Hpa and BabA2 in Egyptian patients

Objective: The objective of this study was to detect virulence genes of Helicobacter pylori (H.pylori) cagA, babA2 and hpa in gastric biopsies from patients with different stages of gastritis by polymerase chain reaction to correlate the presence of genes with the severity of the diseases.Method: A total of 80 non repetitive gastric biopsies from antrum of the stomach were obtained from the patients and subjected to study for histological examination, unease activity, culture for H.pylori, and polymerase chain reaction studies of virulence genes cagA, babA2 and hpa.Results: The most frequent detected gene by PCR was hpa (66.7%) and followed by cagA and babA2 (61.6%) for each. There was significant association between the three genes (P=0.0001). The study of the association between the virulence gene of H.pylori and different clinical symptoms revealed significant association of dyspepsia with cagA(P=0.001) babA2 and hpa (P=0.0001), regurgitation with cagA and babA2( P=0.002),vomiting with cagA and babA2 (P=0.01, P=0.002, respectively) and nausea with cagA and babA2 (P=0.0001, P=0.03, respectively). The virulence genes were detected in gastric ulcer. The degree of inflammation in histopathological examination was also statistically significant associated with the presence of virulences genes cagA (P=0.01), babA2 (p=0.0001) and hpa (P=0.0001)The present study highlights the presence of virulence genes in H.pylori associated with gastric ulcer. The genes cagA, babA2 and hpa are prevalent among the strains affecting the patients. Moreover, these genes are associated with marked clinical and pathological severity. The genes are significantly associated with each other. Further studies are recommended to validate these findings.Keywords: Gastritis, Genotypes, H.pylori, cagA, babA2, hpa, PC

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Correlation of clinical, laboratory, ventilation, and outcome parameters in hospitalized Coronavirus Disease 2019-infected patients with computed tomography severity score

Context Widespread prevalence of Coronavirus Disease 2019 (COVID-19) infection with high rates of morbidity and mortality necessitates early case definition and severity grading to predict prognosis and improve disease outcome parameters. Purpose To correlate computed tomography severity score (CTSS) in COVID-19-infected patients with their clinical, laboratory, method of ventilation, and disease outcome parameters. Patients and methods A retrospective analysis was performed on 139 COVID-19-infected patients with typical or indeterminate COVID radiological patterns with a correlation between CTSS and their clinical, laboratory, ventilation, hospital stay, and survival data. Results A total of 139 cases were included, with a mean age of 59.81 ± 12.29 years, 63.3% males, 28.77% were noncomorbid, and oxygen saturation of 82.53 ± 6.58 SD. They were subgrouped based on CTSS. A significant correlation was found between high CTSS and oxygen saturation, C-reactive protein, ferritin, D-dimer, lymphopenia, diabetes comorbid patients, need for high-flow oxygen therapy, need for noninvasive or invasive ventilation, mortality, and number of hospital stay in days. Conclusion Different parameters are correlated with high CTSS, especially low oxygen saturation, high C-reactive protein or ferritin values, diabetes, and long hospital stay

Enterotoxigenicity And Typing Of Clostridium perfringens Isolates From Some Poultry Products In Egypt

Abstract: Nearly 113 non outbreak raw and processed chicken meat products were collected from grocery stores and supermarkets namely chicken quarter, chicken fillet, drum stick, chicken paneé, and luncheon and nagets. C.perfringens were isolated in percentage of 27.43, typing of C.perfringens isolates by I/D injection in guinea pig revealad types A,D and non-toxigenic strains. The incidence of toxigenic strains were 83.9% while 16.1% were non-toxigenic strains. 70.8% of the toxigenic isolates classified as C.perfringens type A while 12.9% of the isolates classified as C.perfringens type D. Studying the enterotoxigenicity of C.perfringens type A by using suckling mouse bioassay revealed that 45.5% of the isolates were enterotoxigenic (produce enterotoxin). Using PCR for confirmation the presence of á and enterotoxin gene in enterotoxigenic type A isolates yielded cpa and enterotoxin genes in the predicted 1167bp and 233bp fragments respectively

Could pleural fluid lactate level have an added diagnostic value in para pneumonic effusion?

Background Pleural effusion is the accumulation of fluid in the pleural space, can be classified into transudative and exudative effusion. A parapneumonic effusion is a pleural effusion that forms adjacent to pneumonia. Para pneumonic effusion can be sub-typed into uncomplicated and complicated effusion. The aim of our work was to identify accuracy of pleural fluid lactate level to discriminate transudative from exudative effusion and uncomplicated from complicated parapneumonic effusion. Methods Thoracocentesis was done with subsequent evaluation of pleural fluid PH, protein, LDH, glucose and lactate. Also, gram stain, microbiological cultures, cytological examination was performed. Medical thoracoscopy was done whenever indicated. Results Our study included 52 males and 38 females with mean age 57.14 ± 11.69 years. Transudative effusions were detected in 22 patients (24.4%). Parapneumonic effusions accounted for 39 cases (43.3%), of these 23 cases were uncomplicated and 16 cases were complicated. The median pleural fluid lactate level in exudative effusion was significantly higher than transudative effusion (P value<0.001), in complicated parapneumonic effusion was significantly higher than uncomplicated parapneumonic effusion (P value<0.001). Pleural fluid lactate cut-off value of 2.68 mmol/l or more yielded 97% sensitivity, 90.9% specificity for detection of exudative effusion (Auc 0.968). A cut of value of 6.22 mmol/l had 87.5% sensitivity, 91.3% specificity for detection of complicated parapneumonic effusion. (Auc 0.971). Conclusion The pleural fluid lactate level has a high accuracy to discriminate transudative from exudative pleural effusion and uncomplicated from complicated parapneumonic effusion

Geochemistry of an Alaskan-type mafic-ultramafic complex in Eastern Desert, Egypt: New insights and constraints on the Neoproterozoic island arc magmatism

Mikbi intrusion (MI) is a part of the Neoproterozoic Nubian Shield located along the NE–SW trending major fracture zones prevailing southern Eastern Desert of Egypt. In this study, we present for the first time detailed mineralogical and bulk-rock geochemical data to infer some constraints on the parental magma genesis and to understand the tectonic processes contributed to MI formation. Lithologically, it is composed of fresh peridotite, clinopyroxenite, hornblendite, anorthosite, gabbronorite, pyroxene amphibole gabbro, amphibole gabbro and diorite. All rocks have low Th/La ratios (mostly <0.2) and lack positive Zr and Th anomalies excluding significant crustal contamination. They show very low concentrations of Nb, Ta, Zr and Hf together with sub-chondritic ratios of Nb/Ta (2–15) and Zr/Hf (19–35), suggesting that their mantle source was depleted by earlier melting extraction event. The oxygen fugacity (logƒO2) estimated from diorite biotite is around the nickel-nickel oxide buffer (NNO) indicating crystallization from a relatively oxidized magma. Amphiboles in the studied mafic-ultramafic rocks indicate relative oxygen fugacity (i.e. ΔNNO; nickel-nickel oxide) of 0.28–3 and were in equilibrium mostly with 3.77–8.24 wt.% H2Omelt (i.e. water content in the melt), consistent with the typical values of subduction-related magmas. Moreover, pressure estimates (0.53–6.79 kbar) indicate polybaric crystallization and suggest that the magma chamber(s) was located at relatively shallow crustal levels. The enrichment in LILE (e.g., Cs, Ba, K and Sr) and the depletion in HFSE (e.g., Th and Nb) relative to primitive mantle are consistent with island arc signature. The olivine, pyroxene and amphibole compositions also reflect arc affinity. These inferences suggest that their primary magma was derived from partial melting of a mantle source that formerly metasomatized in a subduction zone setting. Clinopyroxene and bulk-rock data are consistent with orogenic tholeiitic affinity. Consequently, the mineral and bulk-rock chemistry strongly indicate crystallization from hydrous tholeiitic magma. Moreover, their trace element patterns are subparallel indicating that the various rock types possibly result from differentiation of the same primary magma. These petrological, mineralogical and geochemical characteristics show that the MI is a typical Alaskan-type complex. Keywords: Alaskan-type complex, Neoproterozoic, Arc magmatism, Eastern desert, Egyp