Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study.

Background: Monkeypox (Mpox) is a re-emerging infectious disease representing a new global challenge. It poses a substantial threat to countries, particularly those with a low number of cases. Due to its popularity as a tourist destination and its proximity to many African refugees, Egypt is potentially at risk of Mpox importation. Therefore, effective disease management necessitates healthcare workers (HCWs) to possess adept knowledge, along with a positive attitude and behavior. The study aimed to assess the knowledge, attitude, and perception of Egyptian HCWs and medical students towards human Mpox. Methods: The present cross-sectional study data was collected from participants between October and December 2022 via a questionnaire. The questionnaire comprised 31 questions in the knowledge section, 11 questions in the attitude section, and 14 in the perception section. Results: The present study involved a total of 1,034 HCWs and medical students. It was found that 55.3% of the participants demonstrated adequate knowledge about Mpox, whereas 44.5% and 39.8% of the respondents exhibited favorable attitudes and perceptions towards the disease, respectively. Binary logistic regression analysis revealed that adequate knowledge was significantly observed in ages older than 40 years (p < 0.001), married participants (p < 0.001), and doctors (p < 0.001). The positive attitude was significantly observed among the male sex (p = 0.045), urban residents (p = 0.002), and nurses (p = 0.002). Conversely, married participants (p = 0.013), doctors (p < 0.001), and individuals employed in pharmacy and laboratory departments (p < 0.001) experienced an increase in positive perception. Conclusion: Knowledge, attitude, and perception towards Mpox among Egyptian HCWs and medical students exhibit suboptimal levels. Addressing these gaps is crucial to controlling and effectively preventing disease transmission.

Fungal Aeroallergen Sensitization Patterns among Airway-Allergic Patients in Zagazig, Egypt.

BACKGROUND: Airway allergies such as asthma and allergic rhinitis, as well as their comorbidities, are increasing worldwide, causing significant socioeconomic health burdens to societies. It is estimated that between 3% and 10% of the population is allergic to fungi. The type of fungal sensitization varies from one geographical region to another. The present study aimed to identify the common fungal aeroallergen sensitization patterns among airway-allergic patients residing in the Zagazig locality, Egypt, in order to obtain a better understanding of fungal allergy, in addition to improving the awareness and management strategies for those patients. METHODS: The present cross-sectional study included 200 allergic rhinitis and asthma patients. Sensitization to fungal aeroallergens was evaluated by skin prick testing and in vitro measurement of total and specific immunoglobulin E. RESULTS: As determined by a skin prick test, 58% of the patients studied were allergic to mixed molds. Alternaria alternata was the predominant fungal aeroallergen among the studied patients (72.2%), which was followed by Aspergillus fumigatus (53.45%), Penicillium notatum (52.6%), Candida albicans (34.5%), and Aspergillus niger (25%). CONCLUSION: Mixed mold sensitization ranked fourth among the most frequent aeroallergens in airway-allergic patients, and Alternaria alternata was the most frequently encountered fungal aeroallergen in the Zagazig locality.

Altered Profile of Fecal Microbiota in Newly Diagnosed Systemic Lupus Erythematosus Egyptian Patients.

BACKGROUND: Dysbiosis of gut microbiota could promote autoimmune disorders including systemic lupus erythematosus (SLE). Clarifying this point would be of great importance in understanding the pathogenesis and hence the development of new strategies for SLE treatment. AIM: This study aimed to determine the fecal microbiota profile in newly diagnosed SLE patients compared to healthy subjects and to investigate the correlation of this profile with disease activity. METHODS: Newly diagnosed SLE patients who fulfilled at least four of the American College of Rheumatology (ACR) criteria were enrolled during the study period. Patients with lupus were matched to healthy subjects. SLE activity was evaluated using the Systemic Lupus Disease Activity Index (SLEDAI-2K). Fresh fecal samples were collected from each subject. Genomic DNA was extracted from fecal samples. Quantitative real-time PCR was applied for quantitation of Firmicutes phylum, Bacteroidetes phylum, and Lactobacillus genus in comparison to the total fecal microbiota. Results of patients' samples were compared to those of healthy subjects and were correlated to patients' SLEDAI-2K score. RESULTS: Twenty SLE patients' samples were compared with 20 control samples. There was a significant alteration in SLE patients' gut microbiota. A significantly lower (p ≤ 0.001) Firmicutes/Bacteroidetes (F/B) ratio in SLE patients (mean ratio: 0.66%) compared to healthy subjects (mean ratio: 1.79%) was found. Lactobacillus showed a significant decrease in SLE patients (p=0.006) in comparison to healthy controls. An inverse significant correlation between SLEDAI-2K scores for disease activity and F/B ratio (r = -0.451; p=0.04) was found. However, an inverse nonsignificant correlation between SLEDAI-2K scores for disease activity and Lactobacillus (r = -0.155; p=0.51) was detected. CONCLUSION: Compared to healthy controls, recently diagnosed SLE Egyptian patients have an altered fecal microbiota profile with significant lowering of both F/B ratio and Lactobacillus abundance, which is weakly correlated with disease activity.

Expression of Immune Checkpoint Regulators, Cytotoxic T-Lymphocyte Antigen-4, and Programmed Death-Ligand 1 in Epstein-Barr Virus-associated Nasopharyngeal Carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is the most common cancer arising from the nasopharynx with a poor prognosis. Targeting immune checkpoint is one of the new promising lines in cancer treatment. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed death-ligand 1 (PD-L1) are immune checkpoints that regulate T-cell immune function. AIM: This work aimed to assess the immunohistochemical expression of PD-L1 and CTLA-4 in NPC and their ability to predict survival and response therapy and to check their validity as immunotherapy targets. Twenty-six cases of NPC were studied by immunohistochemistry for PD-L1 and CTLA-4 and by nested polymerase chain reaction followed by DNA sequencing for the presence of EBNA-1 gene of Epstein-Barr virus (EBV). All investigated cases were diagnosed and treated in the Zagazig University Hospital in the period from August 2015 to July 2018. EBNA-1 gene was identified in 84.6% of the cases. Whereas the expression of PD-L1 was noted in 46.2% of all cases studied, 54.6% of EBV-associated NPCs were found to express PD-L1. There was a significant association between PD-L1 expression and the advanced stage of the tumor (P<0.001). CTLA-4 expression was observed in 88.4% of all NPC cases as cytoplasmic staining in both tumor cells and tumor-infiltrating lymphocytes. CTLA-4 expression in lymphocytes was associated with the presence of EBV. A significant association was detected between CTLA-4 and tumor-infiltrating lymphocyte expression on one side and the stage of the tumor on the other. High expression of CTLA-4 was significantly associated with disease progression and worse overall survival. CONCLUSION: PD-L1 and CTLA-4 are adverse prognostic markers in NPC. The authors propose that targeted therapy against PD-L1 and CTLA-4 will be a hopeful therapy for cases of NPC with resistance to concurrent chemoradiation treatment in Egypt, especially EBV-associated cases.

Mannose-Binding Lectin Serum Level and Gene Polymorphism in Systemic Lupus Erythematosus Egyptian Patients.

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the complement system plays a role in its pathogenesis. Mannose-binding lectin (MBL) is a serum protein, being a component of innate immune system, it is responsible for lectin pathway of complement activation. The presence of several polymorphisms at the coding regions of the MBL-2 gene, especially single point mutation at codon 54, leads to decreased level and /or functional deficits of MBL, which seems to be a risk factor for occurrence of autoimmune diseases, such as in SLE. So, this study was carried out to determine the role of the serum MBL concentration and the genetic polymorphisms of MBL-2 gene exon 1 codon 54 in Egyptian patients with SLE. Forty-eight SLE patients and 48 matched healthy controls were investigated. MBL serum level was measured by ELISA technique. MBL-2 polymorphism at exon 1 codon 54 was determined by PCR-RFLP. Our results revealed a significant reduction in MBL serum level among SLE patient group in comparison to the control group (P < 0.001). MBL-2 genotyping among SLE patients, revealed the wild type (A/A) in 52.1% and mutant types (A/B, B/B) in 47.9%. While among healthy controls, the wild type was detected in 81.2% and the mutant types in 18.8% with a statistically significant association between this polymorphism and SLE susceptibility (P=0.008). Comparison of MBL serum level among different genotypes within the patient group showed that the mutant allele had a suppressive effect on MBL serum level. In conclusion, carrying MBL-2 exon-1 codon 54 variant allele B was shown to be a risk factor for SLE.

Evaluation of Procalcitonin, C-Reactive Protein, and Interleukin-6 as Early Markers for Diagnosis of Neonatal Sepsis.

BACKGROUND: Neonatal sepsis diagnosis is a challenge because of its nonspecific presentation together with low sensitivity of the time-consuming bacterial cultures. So, many sepsis markers, like C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6), are emerging to improve its diagnosis. AIM: This study was done to investigate the role of CRP, PCT, and IL-6 in promoting the early diagnosis of neonatal sepsis in an attempt to decrease morbidity and mortality. METHODS: This cross-sectional study was conducted on 50 neonates suspected with sepsis enrolled from the neonatal intensive care unit (NICU) of Zagazig University Hospitals, Egypt. Blood cultures for these neonates were done before starting antibiotics. Also, bacterial DNA was revealed from the blood by broad-range 16S rDNA polymerase chain reaction (PCR). Measurements of CRP using the immunoturbidimetry method, PCT using fluorescence immunoassay quantitative method, and IL-6 using commercially available ELISA kit were done to all enrolled neonates. RESULTS: Forty-one neonates with proved sepsis were found to be positive in blood culture and/or PCR for bacterial 16S rDNA. The most common isolated organisms were Klebsiella (61.3%), followed by E. coli (9.7%) and CONS (9.7%). We detected much significant higher levels of PCT, CRP, and IL-6 in the proved sepsis group than the suspected neonatal sepsis cases (p ≤ 0.001, 0.001, and 0.004, respectively). Serum PCT levels showed the highest sensitivity, specificity, PPV, NPV, and accuracy of 97.6%, 89%, 97%, 88.9%, and 96% than other studied sepsis markers. CONCLUSION: PCT has satisfactory characteristics as a good marker than IL-6 and CRP for the diagnosis of neonatal sepsis.

Detection of Chromosomal and Plasmid-Mediated Quinolone Resistance Among Escherichia coli Isolated from Urinary Tract Infection Cases; Zagazig University Hospitals, Egypt.

INTRODUCTION: Resistance to fluoroquinolones (FQ) in uropathogenic Escherichia coli (UPEC) has emerged as a growing problem. Chromosomal mutations and plasmid-mediated quinolone resistance (PMQR) determinants have been implicated. Data concerning the prevalence of these determinants in UPEC in our hospital are quite limited. PURPOSE: To investigate the occurrence and genetic determinants of FQ resistance in UPEC isolated from urinary tract infection (UTI) cases in Zagazig University Hospitals. PATIENTS AND METHODS: Following their isolation, the identification and susceptibility of UPEC isolates were performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometer (MALDI-TOF MS). FQ resistance was detected by the disc diffusion method. Ciprofloxacin minimal inhibitory concentration (MIC) was determined using E-test. Chromosomal mutations in the gyrA gene were detected using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and for detection of PMQR, a couple of multiplex PCR reactions were used. RESULTS: Among a total of 192 UPEC isolates, 46.9% (n=90) were FQ resistant. More than half of the isolates (57.8%) exhibited high-level ciprofloxacin resistance (MIC > 32 µg/mL). Mutations in gyrA were detected in 76.7% of isolates, with 34.4% having mutations at more than one site. PMQR determinants were detected in 80.1% of UPEC isolates, with aac(6')-Ib-cr gene being the most frequent found in 61.1% of isolates. CONCLUSION: There is a high prevalence of both gyrA mutations and PMQR determinants among UPEC isolates in our hospital which contribute to high-level ciprofloxacin resistance, a finding that may require the revision of the antibiotics used for empirical treatment of UTI.

Microalgae in modern cancer therapy: Current knowledge.

Cancer is an everyday medical concern which requires an appropriate treatment strategy. The malfunction of cell cycle is a well-established cause for cancer induction. Chemotherapy and radiation are the standard available therapeutic approach for cancer treatment; however severe side effects were reported in association to such treatments, for instance, the efficacy of patients' immune system is adversely affected in apart by radiation. These side effects may be minimized by providing novel remedial preparations. Complementary and alternative medicinal compounds, which were obtained from fresh or marine flora particularly micro and macro algae, were reported to its anti-cancerous activities. Several types of bioactive molecules are also present in microalgae, such as carotenoids, various forms of polysaccharides, vitamins, sterol, fibres, minerals…ect; the great unused biomass of microalgae and their excellent diversity of chemical constituents may introduce a major step in developing of anti-malignant drugs. Previously, such characteristic of microalgal bio-diversity was commercially exploited to make food supplements and gelling substances. However, recently, several investigations were designed to study the potential anti-carcinogenic effect of microalgal extracts, where they mostly concluded their ability to induce apoptotic cancer cell death via caspase dependent or independent pathways. In this review paper, we reported the various species of microalgae that possessed anti-tumor activity, the tumor cell lines altered through using microalgal extracts along with the levels of such extracts that reported to its inhibitor effect against cell cycle and proliferation.

Carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: characterization of carbapenemase genes and E-test evaluation of colistin-based combinations.

BACKGROUND: Carbapenamase producing Acinetobacter baumannii and Pseudomonas aeruginosa are emerging worldwide limiting the use of carbapenems as effective and safe drugs. PURPOSE: To characterize different carbapenemase genes carried by carbapenem-resistant (CR) A. baumannii and P. aeruginosa isolates and to evaluate the in vitro effect of some colistin-based combinations by E-test method in Zagazig University Hospitals ICU isolates. METHODS: CR A. baumannii and P. aeruginosa isolated from the surgical intensive care unit (ICU) were tested for carbapenemase genes by polymerase chain reaction and the effect of colistin/meropenem and colistin/tigecycline combinations was evaluated by E-test. RESULTS: Genes coding for OXA-23, NDM and GES were detected in 90, 66.7 and 50% of CR A. baumannii, respectively, while genes coding for VIM, GES, NDM and IMP were detected in 50, 40.9, 27.3 and 18.2% of CR P. aeruginosa, respectively. Colistin/tigecycline combination showed synergistic and additive effect in 20% and 60% of A. baumannii isolates, respectively, while colistin/meropenem combination showed synergistic and additive effect in 63.6% and 36.4% of P. aeruginosa, respectively. CONCLUSION: Carbapenemase genes carriage accounts for high level carbapenem resistance in our isolates. Colistin/tigecycline and colistin/meropenem combinations can be considered for treatment of severe infections by CR A. baumannii and P. aeruginosa, respectively.

Multidrug-resistant bacteria among patients with ventilatorassociated pneumonia in an emergency intensive care unit, Egypt.

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection among mechanically ventilated patients. Our objectives were to determine the incidence of VAP, isolate multidrug-resistant bacteria, identify the most prevalent resistant strains and identify their antibiotic susceptibility pattern. The VAP rate was calculated. The isolated microbes were identified and tested for antibiotic susceptibilities. The minimum inhibitory concentrations were determined of imipenem, meropenem and ertapenem for Klebsiella isolates. Klebsiella isolates resistant to carbapenems were tested for the presence of the blaKPC gene. The VAP incidence density rate was 48.8 incidences/1 000 ventilator days. The most common Gram-positive organism was Staphylococcus aureus, of which 86.6% of isolates were resistant to cefoxitin , but 100% were sensitive to teicoplanin, linezolid and tigecycline. The most common Gram-negative bacillus was Klebsiella, of which 94.6% of isolates were resistant to cefotaxime, 70.2% to imipenem, and 64.9% to ertapenem, but 100% were sensitive to colistin and 94.6% were sensitive to tigecycline. Of the carbapenem-resistant Klebsiella strains, 23.1% had the blaKPC gene. The high rates of VAP and the high rates of resistance among isolated organisms point to improper implementation of infection control programmes.