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Since the detection of antigenically atypical very virulent Infectious bursal disease viruses (vvIBDV) in Egypt in 1999, the country has been experiencing recurrent outbreaks with high mortality rates and typical gross lesions associated with typical vvIBDV. However, a significant change occurred in 2023, marked by a notable increase in reported subclinical IBDV cases. To evaluate the field situation, samples from 21 farms in 2023 and 18 farms from 2021 and 2022, all of which had experienced IBD outbreaks based on clinical diagnosis, were collected, and subjected to VP2-HVR sequencing. Phylogenetic analysis revealed that all samples collected in 2021 and 2022 clustered with classical virulent strains and vvIBDV. In 2023, one sample clustered with the Egyptian vvIBDV, another with classical virulent IBDV, and the rest with the novel variant IBDV (nVarIBDV) circulating in China. The alignment of deduced amino acid sequences for VP2 showed that all Egyptian classic virulent strains were identical to the Winterfield or Lukert strains, while vvIBDV strains exhibited two out of the three typical residues found in Egyptian vvIBDV, namely Y220F and G254S, but not A321T. Meanwhile, all Egyptian variant strains exhibited typical residues found in nVarIBDV. However, all Egyptian variants showed a mutation at position 321 (321V), which represents the most exposed part of the capsid and is known to have a massive impact on IBDV antigenicity, except for one sample that had 318G instead. This report highlights the emergence of a new variant IBDV in Egypt, clustered with the Chinese new variants, spreading subclinically in broiler farms across a wide geographic area.RESEARCH HIGHLIGHTS New variant IBDV which emerged in Egypt clustered with Chinese nVarIBDV.nVarIBDV spread subclinically across a wide geographic area.Mutation at 321 represents capsid's most exposed part, a defining feature.Antigenically modified vvIBDV still circulating in Egypt with typical lesions.
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Infecções por Birnaviridae , Galinhas , Vírus da Doença Infecciosa da Bursa , Filogenia , Doenças das Aves Domésticas , Vírus da Doença Infecciosa da Bursa/genética , Vírus da Doença Infecciosa da Bursa/patogenicidade , Vírus da Doença Infecciosa da Bursa/isolamento & purificação , Animais , Egito/epidemiologia , Infecções por Birnaviridae/veterinária , Infecções por Birnaviridae/virologia , Infecções por Birnaviridae/epidemiologia , Doenças das Aves Domésticas/virologia , Doenças das Aves Domésticas/epidemiologia , Galinhas/virologia , Surtos de Doenças/veterinária , Sequência de Aminoácidos , Vacinas Virais/imunologia , Vacinação/veterinária , Proteínas Estruturais Virais/genética , Virulência , Variação GenéticaRESUMO
BACKGROUND: Kienböck's disease is idiopathic lunate avascular necrosis, which may lead to lunate collapse, abnormal carpal motion and wrist arthritis. The current study aimed to assess the outcomes of treating stage IIIA Kienböck's disease by a novel technique of limited carpal fusion via partial lunate excision with preservation of the proximal lunate surface and scapho-luno-capitate (SLC) fusion. MATERIALS AND METHODS: We conducted a prospective study of patients with grade IIIA Kienböck's disease managed with a novel technique of limited carpal fusion comprising SLC fusion with preservation of the proximal lunate articular cartilage. Autologous iliac crest bone grafting and K-wires fixation were used to enhance the osteosynthesis of the SLC fusion. The minimum follow-up period was 1 year. A visual analog scale (VAS) and the Mayo Wrist Score were utilized for the evaluation of patient residual pain and functional assessment, respectively. A digital Smedley dynamometer was used to measure the grip strength. The modified carpal height ratio (MCHR) was used for monitoring carpal collapse. The radioscaphoid angle, scapholunate angle, and the modified carpal-ulnar distance ratio were used for the assessment of carpal bones alignment and ulnar translocation of carpal bones. RESULTS: This study included 20 patients with a mean age of 27.9 ± 5.5 years. At the last follow-up, the mean range of flexion/extension range of motion (% of normal side) improved from 52.8 ± 5.4% to 65.7 ± 11.1%, P = 0.002, the mean grip strength (% of normal side) improved from 54.6 ± 11.8% to 88.3 ± 12.4%, P = 0.001, the mean Mayo Wrist Score improved from 41.5 ± 8.2 to 81 ± 9.2, P = 0.002, and the mean VAS score reduced from 6.1 ± 1.6 to 0.6 ± 0.4, P = 0.004. The mean follow-up MCHR improved from 1.46 ± 0.11 to 1.59 ± 0.34, P = 0.112. The mean radioscaphoid angle improved from 63 ± 10º to 49 ± 6º, P = 0.011. The mean scapholunate angle increased from 32 ± 6º to 47 ± 8º, P = 0.004. The mean modified carpal-ulnar distance ratio was preserved and none of the patients developed ulnar translocation of the carpal bones. Radiological union was achieved in all patients. CONCLUSIONS: Scapho-luno-capitate fusion with partial lunate excision and preservation of the proximal lunate surface is a valuable option for treating stage IIIA Kienböck's disease, with satisfactory outcomes. Level of evidence Level IV. Trial registration Not applicable.
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Capitato , Ossos do Carpo , Osso Semilunar , Osteonecrose , Humanos , Adulto Jovem , Adulto , Estudos Prospectivos , Capitato/cirurgia , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osso Semilunar/irrigação sanguínea , Articulação do Punho/cirurgia , Osteonecrose/cirurgia , Amplitude de Movimento ArticularRESUMO
OBJECTIVES: Coronary chronic total occlusion (CTO) is a frequent condition encountered in cardiac catheterization laboratory with a prevalence of about 20%. Through literature, data are scarcely reported regarding the left ventricular (LV) function recovery post CTO percutaneous coronary intervention (PCI) in patients with low (<40%) and mid-range (40%-49%) LV ejection fraction (LVEF). The aim of this study was to assess the echocardiographic outcomes of CTO patients with low and mid-range LVEF successfully revascularized at 6-month follow-up. METHODS: This prospective study included 75 patients with at least one CTO of an epicardial coronary artery proved by previous diagnostic coronary angiography with PCI attempt indication, and successfully revascularized. They were equally divided according to LVEF into three groups, and echocardiographic remodeling indices were assessed at baseline and 6 months post PCI. RESULTS: Our study showed significant improvement of LVEF, S-wave velocity by tissue doppler imaging (TDI), LV wall-motion score (LVWMS), and LV systolic sphericity index (LVSIS) 6 months post CTO PCI in low LVEF group, and a significant improvement in LVEF, S-wave velocity, and LVWMS in mid-range LVEF group (P < .05). The delta change in LVEF was significantly more in low LVEF group, compared to the other two groups (F = 4.739, P < .05). CONCLUSION: Successful CTO PCI in patients with low and mid-range LVEF is associated with significant improvement of LVEF and other indices of myocardial remodeling after 6 months of follow-up.
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Oclusão Coronária , Intervenção Coronária Percutânea , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Ecocardiografia , Humanos , Estudos Prospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
We isolated highly pathogenic avian influenza virus (H5N8) of clade 2.3.4.4 from the common coot (Fulica atra) in Egypt, documenting its introduction into Africa through migratory birds. This virus has a close genetic relationship with subtype H5N8 viruses circulating in Europe. Enhanced surveillance to detect newly emerging viruses is warranted.
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Migração Animal/fisiologia , Glicoproteínas de Hemaglutininação de Vírus da Influenza/genética , Vírus da Influenza A Subtipo H5N8/genética , Influenza Aviária/epidemiologia , Vírus Reordenados/genética , Sequência de Aminoácidos , Animais , Animais Selvagens , Aves , Egito/epidemiologia , Expressão Gênica , Glicoproteínas de Hemaglutininação de Vírus da Influenza/química , Glicoproteínas de Hemaglutininação de Vírus da Influenza/metabolismo , Vírus da Influenza A Subtipo H5N8/classificação , Vírus da Influenza A Subtipo H5N8/isolamento & purificação , Vírus da Influenza A Subtipo H5N8/patogenicidade , Influenza Aviária/transmissão , Influenza Aviária/virologia , Modelos Moleculares , Mutação , Filogenia , Conformação Proteica em alfa-Hélice , Conformação Proteica em Folha beta , Vírus Reordenados/classificação , Vírus Reordenados/isolamento & purificação , Vírus Reordenados/patogenicidadeRESUMO
The aim of this study was to evaluate the clinical and radiological results of fixation of clavicle alone in floating shoulder injury. From 2007to 2011 thirteen patients with floating shoulder injury (ipsilateral clavicle and scapular neck fracture ) were treated by isolated fixation of the clavicle by plate osteosynthesis. Assessment of the shoulder function was performed using the university of California at Los Angeles (UCLA) shoulder rating scale .The mean duration of follow up period was 24.3 months .All the fractures were united , fractures of the clavicle united from 11to 16 weeks after surgery and that of scapula from 12to16 weeks . The overall UCLA shoulder rating scale was 32.3 (range from 30-34) . Isolated plate fixation of clavicle fracture in floating shoulder injuries results in high rates of both clavicular and scapular fracture healing provided the integrity of coracocla-vicular ligament and involvement of the coracoids process with the distal scapular fragment .
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Clavícula/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Escápula/lesões , Adulto , Placas Ósseas , Clavícula/diagnóstico por imagem , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Recuperação de Função Fisiológica/fisiologia , Escápula/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
The effectiveness of recombinant turkey herpesvirus avian influenza (A/swan/Hungary/4999/2006(H5N1)) clade 2.2 virus (rHVT-H5) vaccine was evaluated in two layer chicken breeds (White Bovans [WB] and Brown Shaver [BS]). One dose of rHVT-H5 vaccine was administered at day 1 and birds were monitored serologically (haemagglutination inhibition test) and virologically for 19 weeks. Maternally-derived antibody and post-vaccination H5 antibody titres were measured using the Chinese (A/Goose/Guangdong/1/96(H5N1)) HA and the Egyptian (A/chicken/Egypt/128s/2012(H5N1)) HA as antigens. The challenge was conducted at 19 weeks of age and on six experimental groups: Groups I (WB) and II (BS), both vaccinated and challenged; Groups III (WB) and IV (BS), both vaccinated but not challenged; Groups V and VI, unvaccinated specific pathogen free chickens, serving respectively as positive and negative controls. The challenge virus was the clade 2.2.1 highly pathogenic avian influenza H5N1 A/chicken/Egypt/128s/2012 at a dose of 10(6) median embryo infective dose. For both breeds, complete maternally-derived antibody waning occurred at the age of 4 weeks. The immune response to rHVT-H5 vaccination was detected from the sixth week. The seroconversion rates for both breeds reached 85.7 to 100% in the eighth week of age. Protection levels of 73.3%, 60% and 0% were respectively recorded in Groups I, II and V. No mortalities occurred in the unchallenged groups. Group I showed superior results for all measured post-challenge parameters. In conclusion, a single rHVT-H5 hatchery vaccination conferred a high level of protection for a relatively extended period. This vaccine could be an important tool for future A/H5N1 prevention/control in endemic countries. Further studies on persistence of immunity beyond 19 weeks, need for booster with inactivated vaccines, breed susceptibility and vaccinal response, and transmissibility are recommended.
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Galinhas/imunologia , Herpesvirus Meleagrídeo 1/imunologia , Virus da Influenza A Subtipo H5N1/imunologia , Influenza Aviária/prevenção & controle , Doenças das Aves Domésticas/prevenção & controle , Vacinação/veterinária , Animais , Egito , Feminino , Vacinas contra Influenza/imunologia , Influenza Aviária/imunologia , Influenza Aviária/virologia , Doenças das Aves Domésticas/imunologia , Doenças das Aves Domésticas/virologia , Organismos Livres de Patógenos Específicos , Vacinas de Produtos Inativados/imunologia , Vacinas SintéticasRESUMO
BACKGROUND: Severely calcified coronary bifurcations complicate percutaneous coronary interventions (PCI) and often necessitate dedicated lesion preparation. We compared the outcomes of single- versus two-stent techniques for treating heavily calcified true bifurcation lesions following rotational atherectomy (RA). METHODS: Among patients receiving RA for severely calcified true bifurcations at a single center, 59 were treated with a single stent, and another 59 received two stents. We analyzed in-hospital adverse outcomes and 1-year rates of the bifurcation-oriented composite endpoint (BOCE), defined as cardiac death, target bifurcation myocardial infarction (TB-MI), or target bifurcation revascularization (TBR). RESULTS: The single-stent arm was associated with more in-hospital adverse outcomes (adj. OR, 6.13; 95% CI, 1.34-28.0; p = 0.019), driven by higher peri-procedural MI rates (18.6% vs. 5.1%, p = 0.043) and more side branch compromise (13.6% vs. 0%, p = 0.006). After 1 year, both techniques had comparable 1-year BOCE (adj. HR, 0.38; 95% CI, 0.12-1.23; p = 0.106). We observed a significant interaction between the treatment technique and the presence of LM bifurcation (p interaction = 0.012), favoring single-stent technique in patients with non-LM bifurcations (HR 0.14, 95% CI 0.03-0.68; p = 0.015). Notably, the single-stent technique had lower rates of TBR (2% vs. 15%, p log-rank = 0.026) after 1 year. CONCLUSION: Patients with severely calcified true bifurcation lesions, treated with RA followed by a single stent implantation, had more in-hospital adverse outcomes compared to those treated with two stents. However, the superior outcomes of the two-stent technique did not translate into improved long-term results. In fact, the two-stent technique was even associated with higher rates of revascularization after 1 year.
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Aterectomia Coronária , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Índice de Gravidade de Doença , Stents , Calcificação Vascular , Humanos , Aterectomia Coronária/métodos , Masculino , Feminino , Idoso , Resultado do Tratamento , Calcificação Vascular/diagnóstico , Calcificação Vascular/cirurgia , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/diagnóstico , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Angiografia Coronária , Fatores de Tempo , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Fatores de Risco , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , SeguimentosRESUMO
INTRODUCTION: Patients at high bleeding risk (HBR patients) represent an important subset of patients undergoing percutaneous coronary intervention (PCI). It remains unclear whether a shortened duration of dual antiplatelet therapy (DAPT) confers benefits compared with prolonged duration of DAPT in this patient population. The aim of this study was to investigate and compare bleeding and ischemic outcomes among HBR patients receiving short- versus long-term DAPT after PCI. METHODS: A meta-analysis of studies comparing short-term (1-3 months) and long-term (6-12 months) DAPT after PCI with second-generation drug-eluting stents in HBR patients was performed. RESULTS: Six studies [1 randomized controlled trial (RCT), 2 RCT subanalyses, and 3 prospective propensity-matched studies] involving 15,908 patients were included in the meta-analysis. During a follow-up of 12 months, short-term DAPT was associated with a reduction in major bleeding events [odds ratio (OR) 0.63, 95% confidence interval (CI) 0.42-0.95; p = 0.03, I2 = 71] and comparable definite/probable stent thrombosis, all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and ischemic stroke, compared with long-DAPT. Single antiplatelet therapy (SAPT) with aspirin was comparable to SAPT with P2Y12 inhibitor, with no treatment-by-subgroup interaction for major bleeding events (p-interaction = 0.27). In studies including patients presenting with MI, a trend of more frequent MI was noted in the short-DAPT arm (OR 1.25, 95% CI 0.98-1.59; p = 0.07; I2 = 0). In a sensitivity analysis comparing 3- and 12-month DAPT, the 3-month DAPT strategy was associated with a higher risk of ischemic stroke (OR 2.37, 95% CI 1.15-4.87; p = 0.02, I2 = 0%). CONCLUSION: Short-term DAPT after PCI in HBR patients was associated a reduction in major bleeding events and similar ischemic outcomes. However, a higher risk of ischemic stroke and MI at 1 year of follow-up was seen in some subsets.
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BACKGROUND: Rotational atherectomy (RA) is a complex procedure often associated with high contrast load. Known risk scores do not predict contrast-induced acute kidney injury (CI-AKI) before RA. We aim to investigate pre-procedural predictors of CI-AKI after RA, and the role of the target vessel SYNTAX score (tvSS). METHODS: Among 295 patients who underwent RA between 01.2010 and 02.2019 at a single center, 49 developed CI-AKI. Those who were on chronic hemodialysis or with no available 48-h' kidney function tests were excluded. Predictors of CI-AKI were assessed in the whole cohort and those with no basal renal impairment. RESULTS: The rate of CI-AKI was 16.6 %. The tvSS was 18 [14-23] vs. 12 [9-18] in patients with vs. without CI-AKI (p < 0.001). The tvSS cut-off value of 15 provided 75 % sensitivity and 60 % specificity for predicting CI-AKI. Consequently, a tvSS ≥15 emerged as an independent pre-procedural predictor for CI-AKI (adjusted OR: 4.94, 95 % CI: 2.38-10.20, p < 0.001), along with left ventricular ejection fraction (LVEF) ≤35 % (p = 0.016) and glomerular filtration rate (GFR) <45 ml/min (p = 0.004). TvSS was the only independent pre-procedural predictor for CI-AKI in patients with GFR ≥60 ml/min (p < 0.001). The contrast volume/GFR ratio and peri-procedural myocardial infarction (MI) were independent procedural predictors for CI-AKI in the whole cohort and in patients with basal GFR ≥60 ml/min. CONCLUSION: CI-AKI after RA is frequent. The tvSS is an efficient pre-procedural predictor for CI-AKI after RA, along with LVEF ≤35 % and GFR <45 ml/min. Contrast volume/GFR ratio and peri-procedural MI emerged as procedural predictors for CI-AKI.
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Injúria Renal Aguda , Aterectomia Coronária , Infarto do Miocárdio , Humanos , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Meios de Contraste/efeitos adversos , Aterectomia Coronária/efeitos adversos , Volume Sistólico , Função Ventricular Esquerda , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Fatores de RiscoRESUMO
OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) has shown great safety and efficacy in the management of post-living-donor liver transplantation (LDLT) biliary complications. Pancreatitis is the most commonest and the most feared complication after ERCP. METHODS: We reviewed the data of liver transplant recipients who underwent ERCP for biliary complications after LDLT between 2011 and 2022. RESULTS: In total 63 patients underwent ERCP after LDLT. They were targeted to 134 set of ERCP. Pancreatitis occurred in 52 sets (38.8%). We subclassified the patients into two groups, without pancreatitis: 31 patients (49.2%) and with pancreatitis 32 patients (50.8%). A higher incidence of pancreatitis was noticed with the first ERCP set (P = 0.04). Biliary strictures were more noted in the pancreatitis group (P = 0.025). Difficult cannulation requiring precut was more observed in the pancreatitis group (P = 0.007). Also, more frequent sphincterotomy was observed in the pancreatitis group (P = 0.003). Longer hospital stay, more fever, abdominal pain and vomiting were noted in the pancreatitis group (P = 0.001). Higher post-ERCP serum amylase (P = 0.001) and creatinine (P = 0.021), while lower serum calcium (P = 0.21) were noticed in the pancreatitis group. On multivariate analysis, preoperative diabetes, number of biliary anastomoses (single/multiple) and difficult cannulation requiring precut were significant predictors of post-ERCP pancreatitis. CONCLUSION: Patient-related risk factors and bedside procedure-related risk factors play an essential role in the development of pancreatitis after ERCP for LDLT recipients. Endoscopists should be mindful by those high-risk patients during ERCP to apply appropriate techniques to prevent the development of this serious complication.
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Transplante de Fígado , Pancreatite , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Pancreatite/etiologia , Estudos Retrospectivos , Esfinterotomia Endoscópica/efeitos adversosRESUMO
Wild migratory birds have the capability to spread avian influenza virus (AIV) over long distances as well as transmit the virus to domestic birds. In this study, swab and tissue samples were obtained from 190 migratory birds during close surveillance in Egypt in response to the recent outbreaks of the highly pathogenic avian influenza (HPAI) H5N1 virus. The collected samples were tested for a variety of AIV subtypes (H5N1, H9N2, H5N8, and H6N2) as well as other pathogens such as NDV, IBV, ILT, IBDV, and WNV. Among all of the tested samples, the HPAI H5N1 virus was found in six samples; the other samples were found to be negative for all of the tested pathogens. The Egyptian HPAI H5N1 strains shared genetic traits with the HPAI H5N1 strains that are currently being reported in Europe, North America, Asia, and Africa in 2021-2022. Whole genome sequencing revealed markers associated with mammalian adaption and virulence traits among different gene segments, similar to those found in HPAI H5N1 strains detected in Europe and Africa. The detection of the HPAI H5N1 strain of clade 2.3.4.4b in wild birds in Egypt underlines the risk of the introduction of this strain into the local poultry population. Hence, there is reason to be vigilant and continue epidemiological and molecular monitoring of the AIV in close proximity to the domestic-wild bird interface.
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BACKGROUND: Competent lateral and posterolateral valves showed proximal tortuosity that might hinder left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT). CASE SUMMARY: A 57-year-old woman was diagnosed as non-ischaemic cardiomyopathy, no other comorbidities, complaining of dyspnoea [New York Heart Association (NYHA) class III], and on optimal medical therapy. Electrocardiogram showed left bundle branch block with QRS duration 150 ms. The patient was candidate for CRT. However, during LV lead implantation, a competent posterolateral vein valve and proximal tortuosity hindered LV lead implantation that was overcome by balloon-assisted tracking technique. At 9 months of follow-up, the patient had NYHA class II, ejection fraction improved to 38%, and all implanted leads were still in place. DISCUSSION: Balloon-assisted tracking technique can be used to cross coronary sinus and smaller veins with competent valves and coronary veins tortuosity.
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BACKGROUND: Intertrochanteric fractures are a public health concern, especially in geriatric patients. Early surgical management is crucial to allow early mobilization, which helps reduce the disability and increase patients' survival. In this article, we report the outcomes of minimally invasive osteosynthesis of intertrochanteric fractures with dynamic hip screw (DHS). METHODS: The present study was a prospective case series of patients who had intertrochanteric fractures treated with minimally invasive DHS technique. Postoperative patient satisfaction rate was evaluated using the visual analog scale (VAS) of pain. Functional outcomes were evaluated using the Harris hip score (HHS) and the Merle-d'Aubigne-Postel (MDP) scoring system at 12 months of follow-up. Satisfactory results were considered with HHS of ≥80 points and MDP scores of ≥15. Postoperative complications were noted. RESULTS: In this study, 70 patients were included, 41 (58.6%) males and 29 (41.4%) females, with an average age of 69.3 ± 8.3 years. The mean length of hospital stay was 2.1 ± 0.9 days. The average follow-up period was 23.9 ± 7.1 months. The mean time to radiological union was 16.8 ± 1.9 weeks. The mean postoperative VAS score for pain was 2.5 ± 1.1. The mean HHS was 87.1 ± 4.7 points and the mean MDP score was 15.6 ± 2.3 at 12 months follow-up. An average of 10.6 ± 2.9 weeks was required for full weight bearing. CONCLUSION: The minimally invasive DHS technique effectively treats intertrochanteric fractures with minimal incision, less bleeding, shorter operative time, early discharge from hospital, faster rehabilitation, and favorable functional outcomes.
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Drug combinations may have a crucial role in treating infections due to multidrug resistant Acinetobacter spp. One suggested combination is colistin with teicoplanin. The effect of colistin on Acinetobacter spp. outer membrane can permit teicoplanin to its target in the cell wall. The aim of this study was to evaluate the synergistic activity of colistin and teicoplanin combination against 29 multidrug resistant isolates of Acinetobacter spp. The antimicrobial activity of colistin alone and in combination with teicoplanin was assessed using MIC and time-kill assays. The combination of 1 mg/l colistin and 10 mg/l teicoplanin showed in vitro synergism against all tested Acinetobacter isolates except one (Acinetobacter lowffii). The combination of 1 mg/l colistin and 10 mg/l teicoplanin was bactericidal at 6 h against 100% of Acinetobacter baumannii isolates with no bacterial regrowth at 24 h. The same combination was bactericidal against three out of seven non-baumannii Acinetobacter isolates. The increased concentration of teicoplanin (20 mg/l) was synergistic but still not bactericidal against the four remaining isolates. The combination of colistin and teicoplanin was synergistic against all tested Acinetobacter spp It is therefore recommended that clinical trials are conducted to clarify the therapeutic potential of the combination.
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Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/efeitos dos fármacos , Colistina/farmacologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Teicoplanina/farmacologia , Antibacterianos/farmacologia , Combinação de Medicamentos , Sinergismo Farmacológico , Humanos , Testes de Sensibilidade Microbiana/métodosRESUMO
The highly pathogenic avian influenza (HPAI) H5N8 virus was first detected in Egypt in late 2016. Since then, the virus has spread rapidly among different poultry sectors, becoming the dominant HPAI H5 subtype reported in Egypt. Different genotypes of the HPAI H5N8 virus were reported in Egypt; however, the geographic patterns and molecular evolution of the Egyptian HPAI H5N8 viruses are still unclear. Here, extensive epidemiological surveillance was conducted, including more than half a million samples collected from different poultry sectors (farms/backyards/live bird markets) from all governorates in Egypt during 2019-2021. In addition, genetic characterization and evolutionary analyses were performed using 47 selected positive H5N8 isolates obtained during the same period. The result of the conducted surveillance showed that HPAI H5N8 viruses of clade 2.3.4.4b continue to circulate in different locations in Egypt, with an obvious seasonal pattern, and no further detection of the HPAI H5N1 virus of clade 2.2.1.2 was observed in the poultry population during 2019-2021. In addition, phylogenetic and Bayesian analyses revealed that two major genotypes (G5 and G6) of HPAI H5N8 viruses were continually expanding among the poultry sectors in Egypt. Notably, molecular dating analysis suggested that the Egyptian HPAI H5N8 virus is the potential ancestral viruses of the European H5N8 viruses of 2020-2021. In summary, the data of this study highlight the current epidemiology, diversity, and evolution of HPAI H5N8 viruses in Egypt and call for continuous monitoring of the genetic features of the avian influenza viruses in Egypt.
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Virus da Influenza A Subtipo H5N1 , Vírus da Influenza A , Influenza Aviária , Influenza Humana , Animais , Teorema de Bayes , Egito/epidemiologia , Humanos , Vírus da Influenza A/genética , Influenza Aviária/epidemiologia , Epidemiologia Molecular , Filogenia , Aves DomésticasRESUMO
OBJECTIVE: To compare choroidal thickness in pregnant women with and without diabetes mellitus (DM). METHODS: Sixty pregnant females (60 eyes) were enrolled in this cross-sectional controlled study. They were divided into two groups: Group A (30 patients; 30 eyes) were pregestational diabetic pregnant females, while Group B (30 patients; 30 eyes) were non-diabetic pregnant females. Exclusion criteria were high-risk pregnancy, diabetic retinopathy in Group A subjects, systemic or ophthalmological pathology, drug intake other than vitamin supplements and diabetic medications, and large errors of refraction. All patients underwent full ophthalmological examination and enhanced depth imaging optical coherence tomography (EDI-OCT) to measure the choroidal thickness in the nine zones of the Early Treatment Diabetic Retinopathy Study (ETDRS) map. RESULTS: Our results show that Group A eyes (of pregnant diabetic females) had a highly significant greater choroidal thickness than Group B eyes (of pregnant non-diabetic females) in all nine zones of the ETDRS map (p-value <0.01). Moreover, we found a positive linear correlation between the duration of DM and the degree of choroidal thickening. CONCLUSION: Pregnant diabetic females have a thicker choroid than that of pregnant non-diabetic females.
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Despite the low pathogenicity of the H9N2 avian influenza viruses, they can induce severe economic losses in various poultry sectors in conjunction with other factors. In Egypt, low-pathogenic avian influenza (LPAI) H9N2 became endemic in 2011 and has undergone continuous genetic evolution since then. The regular monitoring of the evolution of the virus is necessary to control its spread. During 2017-2020, there were 44 positive samples isolated, and these viruses were genetically sequenced to determine the hemagglutinin (HA) gene circulating in Egypt. The molecular analysis revealed at least nine changes in amino acid residues in comparison with the reference Egyptian strain from the original introduction in 2011 (A/qu/Egypt/113413v/2011), with a similarity of 95%-96%. Amino acid residues 180 and 216 are the most important residues in terms of positive selection pressure. Phylogenetically, the new Egyptian H9N2 viruses in 2017-2020 belonged to a new subcluster related to the strains that had been circulating since 2015. Comparative analysis of the HA gene of LPAI H9N2 viruses in Egypt from 2011 to 2020 supports a continuous evolution through the years with persistent markers.
Assuntos
Galinhas/virologia , Evolução Molecular , Glicoproteínas de Hemaglutininação de Vírus da Influenza/genética , Vírus da Influenza A Subtipo H9N2/genética , Influenza Aviária/virologia , Doenças das Aves Domésticas/virologia , Animais , Egito/epidemiologia , Influenza Aviária/epidemiologia , FilogeniaRESUMO
BACKGROUND: De novo malignancies are a major reason of long-term mortalities after liver transplantation. However, they usually receive minimal attention from most health care specialists. The current study aims to evaluate our experience of de novo malignancies after living-donor liver transplantation (LDLT). METHODS: We reviewed the data of patients who underwent LDLT at our center during the period between May 2004 and December 2018. RESULTS: During the study period, 640 patients underwent LDLT. After a mean follow-up period of 41.2 ± 25.8 months, 15 patients (2.3%) with de novo malignancies were diagnosed. The most common de novo malignancies were cutaneous cancers (40%), post-transplantation lymphoproliferative disorders (13.3%), colon cancers (13.3%), and breast cancers (13.3%). Acute cellular rejection (ACR) episodes occurred in 10 patients (66.7%). Mild ACR occurred in 8 patients (53.3%), and moderate ACR occurred in 2 patients (13.3%). All patients were managed with aggressive cancer treatment. The mean survival after therapy was 40.8 ± 26.4 months. The mean overall survival after LDLT was 83.9 ± 52.9 months. Twelve patients (80%) were still alive, and 3 mortalities (20%) occurred. The 1-, 5-, and 10-year overall survival rates after LDLT were 91.7%, 91.7%, and 61.1%, respectively. On multivariate regression analysis, smoking history, operation time, and development of ACR episodes were significant predictors of de novo malignancy development. CONCLUSIONS: Liver transplant recipients are at high risk for the development of de novo malignancies. Early detection and aggressive management strategies are essential to improving the recipients' survival.
Assuntos
Transplante de Fígado/efeitos adversos , Neoplasias , Complicações Pós-Operatórias , Adulto , Feminino , Humanos , Hospedeiro Imunocomprometido , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/imunologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/imunologia , Estudos Retrospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
Most recently, the whole world is struggling against the virulent pandemic COVID-19. Due to the unbounded global spread of the disease, having biosensors with high performance such as high sensitivity and accuracy is of utmost importance. In this paper, the effects of various parameters on the behaviors of micro-biosensors are investigated in order to enhance their performance. These parameters are related to the geometry and material, and they are assumed to be gradually changing in the longitudinal direction of the biosensor according to a power law. Therefore, they are called functionally graded geometrical and material parameters. Another aspect is when considering microcantilever-based biosensors, the main behavior parameter is the deflection at the free end. In the analyses, the influences of the surface stress and van der Waals intermolecular forces are taken into account. Also, the total energy of the beam, which is the combination of the van der Waals energy and the elastic strain energy, is accomplished. In addition, the equivalent force causing the deflection is also evaluated using Castigliano method for two cases. These cases account for a concentrated force at the free end and a distributed load along the biosensor, respectively. Since the governing equations account for the size dependency and the considered parameters are functions of the position, the solution is too complex to be achieved analytically, and therefore, numerical methods are applied. For uniform biosensors made of homogeneous materials, or in other words when all parameters are not varying with the position, the obtained results are compared with those in the literature, and good agreement is obtained. On the other hand, the performance, which include sensitivity and limit of detection, of functionally graded biosensors can be enhanced by proper choices of the considered parameters and the corresponding exponent of the gradation function.
RESUMO
Highly pathogenic avian influenza (HPAI) viruses continue to circulate worldwide, causing numerous outbreaks among bird species and severe public health concerns. H5N1 and H5N8 are the two most fundamental HPAI subtypes detected in birds in the last two decades. The two viruses may compete with each other while sharing the same host population and, thus, suppress the spread of one of the viruses. In this study, we performed a statistical analysis to investigate the temporal correlation of the HPAI H5N1 and HPAI H5N8 subtypes using globally reported data in 2015-2020. This was joined with an in-depth analysis using data generated via our national surveillance program in Egypt. A total of 6412 outbreaks were reported worldwide during this period, with 39% (2529) as H5N1 and 61% (3883) as H5N8. In Egypt, 65% of positive cases were found in backyards, while only 12% were found in farms and 23% in live bird markets. Overall, our findings depict a trade-off between the number of positive H5N1 and H5N8 samples around early 2017, which is suggestive of the potential replacement between the two subtypes. Further research is still required to elucidate the underpinning mechanisms of this competitive dynamic. This, in turn, will implicate the design of effective strategies for disease control.