Determinants of coronavirus disease 2019 vaccine acceptance, hesitancy, and barriers among healthcare workers in Ismailia, Egypt: a mixed methods study.

BACKGROUND: Coronavirus disease 2019 vaccine acceptance among healthcare workers (HCWs) plays a fundamental role in combating the COVID-19 pandemic. Vaccination acceptance depends on perceptions of competence and motives of the providers, producers, health professionals, and policymakers. This study aimed to identify the frequency and determinants of COVID-19 vaccine uptake acceptance, hesitancy, and barriers among HCWs. METHODS: A total of 500 HCWs from 3 different hospital affiliations in Ismailia Governorate, Egypt, were included in this mixed methods study. The study was conducted between March and April 2021 through two phases. Phase 1 included a cross-sectional study using a self-administered questionnaire with inquiries about different determinants of vaccine acceptance, hesitancy, and barriers, which was completed either electronically in a Google form or a hard printed copy. Phase 2 included four focus group discussions to explore the determinants in depth. RESULTS: The mean age of participants was 33.9 ± 7.9 years, 70% were females, 51.2% were nurses, and 28.6% were physicians. Of the 500 HCWs, only 27.8% accepted taking the vaccine immediately, 49.2% refused, and 23% were hesitant. Vaccine safety was the highest associated factor with vaccine acceptance (odds ratio (OR) = 6.3, 95% confidence interval (CI) 3.132-12.619), followed by previous uptake of influenza vaccine (OR = 3.3, 95% CI 2.048-5.217) and vaccine effectiveness (OR = 2.6, 95% CI 1.282-5.262). The main barriers to vaccine acceptance were mistrust in governmental policies during the pandemic or in the healthcare facility they work in. Hesitancy was common among females and nurses and was attributed to three prominent factors, including safety concerns, negative stories, and personal knowledge. CONCLUSIONS: The vaccine acceptance frequency among HCWs was considered low, as the majority either refused or was hesitant about taking the vaccine. Concerns about vaccine safety and effectiveness were significant determinants of vaccine acceptance. Factors related to trust were the main barriers to vaccine uptake. The health authority should establish a surveillance system for side effects of the COVID-19 vaccine and communicate this information between HCWs to decrease their worries about safety and increase vaccine uptake.

Molecular Insights into Human Transmembrane Protease Serine-2 (TMPS2) Inhibitors against SARS-CoV2: Homology Modelling, Molecular Dynamics, and Docking Studies.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), which caused novel corona virus disease-2019 (COVID-19) pandemic, necessitated a global demand for studies related to genes and enzymes of SARS-CoV2. SARS-CoV2 infection depends on the host cell Angiotensin-Converting Enzyme-2 (ACE2) and Transmembrane Serine Protease-2 (TMPRSS2), where the virus uses ACE2 for entry and TMPRSS2 for S protein priming. The TMPRSS2 gene encodes a Transmembrane Protease Serine-2 protein (TMPS2) that belongs to the serine protease family. There is no crystal structure available for TMPS2, therefore, a homology model was required to establish a putative 3D structure for the enzyme. A homology model was constructed using SWISS-MODEL and evaluations were performed through Ramachandran plots, Verify 3D and Protein Statistical Analysis (ProSA). Molecular dynamics simulations were employed to investigate the stability of the constructed model. Docking of TMPS2 inhibitors, camostat, nafamostat, gabexate, and sivelestat, using Molecular Operating Environment (MOE) software, into the constructed model was performed and the protein-ligand complexes were subjected to MD simulations and computational binding affinity calculations. These in silico studies determined the tertiary structure of TMPS2 amino acid sequence and predicted how ligands bind to the model, which is important for drug development for the prevention and treatment of COVID-19.

Homocysteine, insulin-like growth factor one and oestrogen levels in patients with erectile dysfunction-associated chronic hepatitis C virus infection.

We assessed the change of homocysteine (Hcy), insulin-like growth factor one (IGF-Ι) and oestrogen (E2) levels in patients with erectile dysfunction (ED) associated with chronic hepatitis C virus (HCV) infection. Eighty-five male patients with chronic HCV and/or ED were enrolled in this study. Seventy-five men were assigned to three equal groups (n = 25/each); Group A: patients who had chronic HCV and ED. Group B: patients who had chronic HCV and had no ED complaint. Group C: patients who had ED with no chronic HCV. In addition to 10 control patients with no ED or chronic HCV (Group D). All patients were subjected to: detailed medical and sexual history, complete physical examination, laboratory assessment including measurement of serum Hcy, IGF-1 and E2. The means of international index of erectile function scores were 8 and 16 in groups A and C respectively. There were significant differences in Hcy, IGF-I and E2 among study groups (p < 0.05 for each). There were significant differences in Hcy between patients with Child B and Child C. A strong association between severity of ED and chronic HCV was demonstrated. There was statistically significant increase of Hcy and E2 levels and reduction in IGF-I level in patients with ED associated with chronic HCV infection.

Stemness-related transcriptional factors and homing gene expression profiles in hepatic differentiation and cancer.

Stem cell transcriptional signature activation is an essential event in the development of cancer. This study aimed to investigate the differential expression profile of three pluripotency-associated genes (OCT4, NANOG, and SOX2), G-protein-coupled chemokine receptor 4 (CXCR4) and the ligand (CXCL2), and alpha feto-protein (AFP) in hepatogenic differentiated stem cells and in sera of hepatitis C virus (HCV) and HCV-induced hepatocellular carcinoma (HCC) patients. Mesenchymal stem cells derived from umbilical cord blood were differentiated using hepatogenic differentiation media. Serum specimens were collected from 96 patients (32 cirrhotic HCV, 32 early HCC, and 32 late HCC) and 96 controls. Real-time quantitative reverse transcription polymerase chain reaction was performed for relative quantification of the 6 target genes using LIVAC method. In silico network analysis was also executed to explore the pluripotency and tumorigenic regulatory circuits in liver cancer. The expression levels of all genes declined gradually during the stages of stem cell differentiation. On univariate and multivariate analyses, NANOG, CXCR4 and AFP were significantly up-regulated in HCC patients with late clinical stage. In contrast, SOX2 and CXCL2 were markedly over-expressed in cirrhotic patients and could be used for clear demarcation between cirrhotic and HCC patients in our cases. In conclusion, our data highlight the potential role of SOX2 stem cell marker and CXCL2 chemokine in liver cell degeneration and fibrogenesis in HCV-induced hepatic cirrhosis in our sample of the Egyptian population. In addition, the significant association of NANOG and CXCR4 high-expression with late HCC, could contribute to the acquisition of stem cell-like properties in hepatic cancer and dissemination in late stages, respectively. Taken together, our results could have a potential application in HCC prognosis and treatment.

Predominance of Giardia lamblia assemblage A among iron deficiency anaemic pre-school Egyptian children.

Intestinal parasites and nutritional deficiency can coexist and influence each other. This study aimed to clarify the association between Giardia genotypes and presence of iron deficiency anaemia (IDA) among pre-school Egyptian children. Two groups (IDA and non-anaemic) of giardiasis children (44/group) were selected according to their recovery response after treatment of giardiasis. Each group included 24 and 20 gastrointestinal symptomatic and asymptomatic, respectively. Giardia human genotypes were performed by intergenic spacer (IGS) gene based polymerase chain reaction (PCR) with high-resolution melting curve (HRM). PCR/HRM proved that Tms of assemblage A and B ranged from 79.31 ± 0.29 to 84.77 ± 0.31. In IDA patients, assemblages A and B were found among 40/44 (90.9 %) and 4/44 (9.1 %), respectively, while in non-anaemic patients, assemblages A and B were found in 10/44 (22.7 %) and 32/44 (72.7 %), respectively, beside two (4.6 %) cases had mixed infection. The difference was statistically significant. No significant relation was found between symptomatic or asymptomatic assemblages and IDA as assemblage A was found in 21/24 (87.5 %) and 19/20 (95 %) of symptomatic and asymptomatic, respectively, while 3/24 (12.5 %) and 1/20 (5 %) of assemblage B were symptomatic was asymptomatic, respectively. A significant relation was found between assemblage A subtypes distribution among IDA patients as AI and AII were detected on 23 (52.3 %) and 16 (36.4 %) of patients, respectively, while one case (2.3 %) had mixed infection. In conclusion, assemblage A is predominant among IDA giardiasis children suggesting its role in enhancing the occurrence of IDA while B has a protective role.

Hepatitis B surface gene variants isolated from blood donors with overt and occult HBV infection in north eastern Egypt.

BACKGROUND: Major hydrophilic region in genomic HBV extending from aa99 to aa169, clustered with a highly conformational epitope, is critical to the antigenicity of hepatitis B surface antigen (HBsAg) and may affect the diagnosis of HBV in HBV screening test. So, this study aimed to characterize variants of S gene product of hepatitis B virus (HBV) isolated from patients with overt or occult HBV infection in north-eastern Egypt. METHODS: The study included sera of two different groups of volunteer blood donors (VBDs), 82 with overt HBV that were positive for HBsAg and anti-HBc and 343 donors negative for HBsAg eligible for donation. Of the latter group, only 44 were positive for anti-HBc. All anti-HBc positive sera were subjected to HBV DNA detection and partial sequence analysis targeting the HBV S gene. RESULTS: HBV DNA was detected in 22.7 % of HBsAg-/anti-HBc + (10/44 patients) and in 90 % of HBsAg + donors (74/82 patients) with significant statistical difference (P = 0.0001). Phylogenetic analysis showed that HBV strains retrieved from both groups were of genotype D. Amino acid escape mutation T125M was detected in only 2 samples of the occult infection group and in none of the overt group (P = 0.01). Different amino acid substitutions were identified in overt infection group: S143L/T (16.2 %, 12/74) and P120T/S (2.7 %, 2/74). Q129R was significantly more frequent in cases with occult HBV infection (40 %, 4/10) than overt group (6.8 %, 5/74) (P = 0.01). CONCLUSIONS: HBV genotype D predominated both in patients with overt and occult HBV infection. Different profiles of amino acid substitutions in the major hydrophilic region were seen in these two groups in Egypt.

Strong prediction of virological response to combination therapy by IL28B gene variants rs12979860 and rs8099917 in chronic hepatitis C genotype 4.

BACKGROUND: A strong association between single nucleotide polymorphisms (SNPs) of IL28B and treatment outcomes of pegylated interferon-α (PEG IFNα) and ribavirin (RBV) has been shown in chronic hepatitis C (CHC) patients with genotype 1. AIM: This study aimed to assess two SNPs of IL28B, rs12979860 and rs8099917, in predicting sustained virological responses (SVR) to treatment of CHC patients with genotype 4 (HCV-4). The value of rs8099917 was investigated in carriers of unfavourable genotypes of rs12979860. METHODS: This study included 119 CHC patients with HCV-4 receiving combination therapy. Both SNPs of IL28B were determined by real-time detection polymerase chain reaction. RESULTS: Genotypes CC/CT/TT of rs12979860 were found in 42 (35.3%), 56 (47.1%) and 21 (17.6%) and rs8099917 TT/TG/GG were found in 74 (62.2%), 40 (33.6%) and 5 (4.2%). In carriers of rs12979860 CC and rs8099917 TT, the rate of SVR was 87.5 and 65.7% respectively. In 54 patients heterozygous for the C allele of rs12979860, testing of rs8099917 revealed SVR in 42.3% of carriers of the TT genotype but no such responses in carriers of TG or GG (P < 0.0001, OR = 47.3, 95% CI: 2.33-767.2). By multivariate analysis, predictors of SVR were baseline ALT (P = 0.014, OR = 6.3, 95% CI: 1.45-27.33), rs12979860 CC (P = 0.001, OR = 13.48, 95% CI: 2.95-61.69) and rs8099917 TT (P = 0.027, OR = 7.5, 95% CI: 1.25-44.88). CONCLUSION: In CHC genotype 4 patients, favourable genotypes of both SNPs of IL28B are valuable for predicting SVR. Additional genotyping of rs8099917 in carriers of the heterozygous C allele of rs12979860 can improve the prediction of SVR.

Association of IL-10-592 C > A /-1082 A > G and the TNFα -308 G > A with susceptibility to COVID-19 and clinical outcomes.

BACKGROUND: Variation in host immune responses to SARS-CoV-2 is regulated by multiple genes involved in innate viral response and cytokine storm emergence like IL-10 and TNFa gene polymorphisms. We hypothesize that IL-10; -592 C > A and - 1082 A > G and TNFa-308 G > A are associated with the risk of SARS-COV2 infections and clinical outcome. METHODS: Genotyping, laboratory and radiological investigations were done to 110 COVID-19 patients and 110 healthy subjects, in Ismailia, Egypt. RESULTS: A significant association between the - 592 A allele, A containing genotypes under all models (p < 0.0001), and TNFa A allele with risk to infection was observed but not with the G allele of the - 1082. The - 592 /-1082 CG and the - 592 /-1082/ -308 CGG haplotypes showed higher odds in COVID-19 patients. Severe lung affection was negatively associated with - 592, while positive association was observed with - 1082. Higher D-dimer levels were strongly associated with the - 1082 GG genotype. Survival outcomes were strongly associated with the GA genotype of TNFa. -308 as well as AGG and AAA haplotypes. CONCLUSION: IL-10 and TNFa polymorphisms should be considered for clinical and epidemiological evaluation of COVID-19 patients.

Vitamin D receptor gene polymorphism and its relation to cancer colon occurrence.

Cancer colon is the second most prevalent cancer for females and the third for males. Vitamin D's cellular impacts are achieved by 1,25 (OH) 2D binding to the Vitamin D receptor (VDR). This study aimed at assessing the relation between vitamin D receptor gene polymorphism and cancer colon. This case-control study included 50 colorectal cancer (CRC) cases which were candidates for colonoscopy and 50 controls with normal colonoscopy. The study was conducted in Suez Canal University hospitals. All cases were diagnosed with colonoscopy and confirmed with histopathology. Blood samples from study subjects were used for detection of vitamin D receptor FokI polymorphism. We found that more than two thirds of patients were males. Around half of the cases were over 60 years old. Most of the study participants were overweight (26%), obese (53%), non-alcoholics (99%), and non-smokers (72%). However, about one third of the patients were diabetic (31%). Noticeably, none of these factors was significantly variant among CRC group and normal colonoscopy group (p < 0.05). The most common presentation among cases with colon cancer was constipation (80%). Of the 100 studied cases, 74% had left-sided colon cancer, with a 66% of them were resectable. The odds ratio of VDR polymorphism between the cases and control groups was high (3 with 95% CI (0.3-31)), however it did not reach statistical significance (p= 0.3). Most of the cases with VDR polymorphism had colon cancer (75%). In conclusion, based on our findings, there was no correlation between colorectal cancer and vitamin D receptor gene polymorphism.

Knowledge, attitude, and practice (KAP) of antimicrobial prescription and its resistance among health care providers in the COVID-19 era: A cross sectional study.

Antimicrobial resistance (AMR) is considered as a global health and development threat. During COVID-19 pandemic, there has been an increase in antimicrobial resistance. Health care providers (HCPs) play the main role in facing antibiotic resistance because they have the authority to prescribe antibiotics during clinical practice as well as in promoting patients' compliance with therapies and avoid self-medication. So, this study will serve as an important source of information in context with Covid19 pandemic in Egypt. The data was collected using a validated standardized self-administered online questionnaire compromised of four sections: socio-demographic data of the HCPs, the general knowledge on antibiotics and AMR, the HCP attitude towards antibiotic prescription and AMR and the practice in applying the appropriate antibiotic prescription. Most of HCPs (93.7%) recorded good knowledge level about antibiotic prescription and antimicrobial resistance with mean score of knowledge13.21 ± 1.83. About 79% of HCPs recorded a positive attitude towards proper antibiotic prescription with mean score of attitudes 63.02 ± 7.68. Fifty four percent of HCPs demonstrated a good level of practice with mean score of practice 9.75 ± 2.17. In conclusion, HCPs in our study have a good level of knowledge and attitude about antibiotics. However lower level of proper practice towards the problem of AMR in COVID19 era was noticed. Implementation of effective policies and guidelines is crucial to evaluate the antimicrobial use especially in the COVID-19 era to reduce the unintended consequences of the misuse of antibiotics and its impact on AMR.

Screening for SARS-CoV-2 IgM and IgG antibodies among healthcare workers: A single-center study in Egypt.

Coronavirus disease 2019 (COVID-19) pandemic has become a global public health disaster, spreading throughout the world. In order to accurately determine the extent of the pandemic, it is important to accurately identify the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers (HCWs). This study intended to determine the prevalence of SARS-CoV-2 infection among HCWs and examine its correlation with the demographic characteristics of the study participants prior to the implementation of the vaccination campaign. In this cross-sectional study included 431 HCWs from Suez Canal University Hospital in Ismailia, Egypt. Their sera were screened for SARS-CoV-2 antibodies using a one-step novel coronavirus (COVID-19) IgM/IgG antibody test from Artron, Canada. Positive cases were then confirmed using nasal swab real-time reverse transcriptase PCR from Viasure, Spain. Of the 431 study participants, 254 (58.9%) were males and 177 (41.1%) females. The majority of participants, 262 (60.8%), were younger than 30 years old, 150 (34.8%) between 30 and 40 years old, and only 19 (4.4%) older than 40 years old. Out of the total samples, 26 (6%) tested positive for SARS-CoV-2 IgM, while 19 (4.4%) tested positive for both IgM and IgG. The majority of the samples, 386 (89.6%), tested negative for both IgG and IgM. There was no association between the prevalence of SARS-CoV-2 and either sex or age of study participants. In conclusion, during the study period, the prevalence of SARS-CoV-2 infection among healthcare workers at Suez Canal University Hospital in Egypt was relatively low. Additionally, there was no significant correlation observed between the prevalence of positive cases and either age or sex.

COVID-19 anti immunoglobulin G antibodies serum levels among health care workers post COVID -19 vaccination: A single center study.

Coronavirus disease 2019 (COVID-19) pandemic has urged the scientific community internationally to find answers in terms of therapeutics and vaccines to control the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The post vaccination immune response differs between individuals especially health care workers who are the first line of defense to combat this disease. Our aim was to measure levels of anti-IgG antibodies titer post COVID-19 vaccination among health care workers in Suez Canal University Hospital. The study included 141 healthcare workers. Of these, 54 were physicians, 80 nurses, 6 health service workers, and one security guard. We used the Roche Elecsys Anti-SARS-CoV-2 assay for serological detection of IgG. Seropositive was found in 96.5% of the participants, and 43.3% of them had evidence of the prior history of COVID-19 infection. The highest titers of IgG in sera were found in the youngest age groups (20 - <35) years with a mean of 335.1 U/ ml. Participants who received the Sinovac vaccine had the highest mean IgG titer, 354.6U/ml; followed by Sinopharm (mean 352.15 U/ml) then Pfizer and Moderna (311.7U/ml) and AstraZeneca vaccine had the least mean level (267.31U/ml). Fatigue was the most significant short side effect occurring with 34% of the participants. In conclusion, there was a significant rising in serum IgG titer post-vaccine, and better antibody response in those previously infected with COVID-19. The post-COVID-19 vaccine serum IgG titers were affected by age, prior history of COVID-19 infection, and type of vaccine while short side effects post-vaccination may be affected by age and type of the vaccine.

Perception of COVID-19 and Vaccine Acceptance among Healthcare Workers.

Background: COVID-19 infection is more likely to be acquired and transmitted by healthcare workers (HCWs). Furthermore, they serve as role models for communities in terms of COVID-19 vaccination attitudes. As a result, HCWs' reluctance to vaccinate could have a significant impact on pandemic containment efforts. Aim: To characterize the current COVID-19 vaccine approval situation among healthcare workers and to determine the most likely reason for agreement or disagreement with COVID-19 vaccination. Methods: This cross-sectional design included 451 HCWs from COVID-19 treatment institutions, with COVID-19 exposure risk changing depending on job function and working location. Results: The study recruited 156 physicians and 295 nurses, of whom 58.1% were female and 41.9% were male. Physicians had a significantly higher rate of participation in COVID-19 pandemic prevention and control, with a rate of 69.9% versus 55.3% of nurses. Acceptance of COVID-19 vaccination was reported by 40.8% of HCWs. The rate of acceptance was significantly higher among physicians (55.1%) than among nurses (33.2%) (p < 0.001). Most HCWs (67.8%) believed the vaccine was not effective. Physicians showed more significant trust in the effectiveness of the vaccine than nurses (41% and 27.5, respectively) (p=0.003). Concerning vaccine safety, only 32.8% of HCWs believed it was safe. This was significantly higher in physicians (41.7%) than in nurses (28.1%) (p=0.004). Conclusion: Vaccination uncertainty is common among healthcare personnel in Egypt, and this could be a significant barrier to vaccine uptake among the public. Campaigns to raise vaccine knowledge are critically needed.

Genotypic detection of metronidazole and clarithromycin resistance in dyspeptic patients with helicobacter pylori.

In Egypt, antibiotic sensitivity analysis for Helicobacter pylori is not routinely performed. We aimed to identify the clarithromycin and metronidazole resistance directly from gastric biopsies for better guide treatment regimens. This cross-sectional descriptive study included 75 adult dyspeptic patients referred to the upper endoscopy unit in Suez Canal University Hospital, Ismailia, Egypt. Gastric biopsies were taken for rapid urease test (RUT) and cultured on brucella agar with antibiotic supplements. Genomic DNA was extracted directly from the specimen, and PCR was performed for direct detection of H. pylori. Also, to explore clarithromycin and metronidazole resistance, mutations in the 23S rRNA gene and the rdxA gene were investigated. We found that 60 samples were positive to RUT (80%), and only 4 samples were positive by culture. UreC gene was detected in 45 specimens. Meanwhile, 26 isolates were contained mutations at positions 2142 and 2143. Amplification of the metronidazole rdx gene was performed by conventional PCR. Out of 45 isolates, DNA sequence analysis of PCR product showed the wild type (ACA) in 9 isolates, while the mutant type (ATA) was detected in 28 isolates. We found a significant proportion of clarithromycin and metronidazole resistance among H. pylori infected patients in our region.

Genetic Variation in DEAD-Box Helicase 20 as a Putative Marker of Recurrence in Propensity-Matched Colon Cancer Patients.

Variants of the DEAD-Box Helicase 20 (DDX20), one of the microRNAs (miRNAs) machinery genes, can modulate miRNA/target gene expressions and, hence, influence cancer susceptibility and prognosis. Here, we aimed to unravel the association of DDX20 rs197412 T/C variant with colon cancer risk and/or prognosis in paired samples of 122 colon cancer and non-cancer tissue specimens by TaqMan allelic discrimination analysis. Structural/functional bioinformatic analyses were carried out, followed by a meta-analysis. We found that the T allele was more frequent in cancer tissues compared to control tissues (60.2% vs. 35.7%, p < 0.001). Furthermore, the T variant was highly frequent in primary tumors with evidence of recurrence (73% vs. 47.5%, p < 0.001). Genetic association models, adjusted by age and sex, revealed that the T allele was associated with a higher risk of developing colon cancer under heterozygote (T/C vs. C/C: OR = 2.35, 95%CI = 1.25−4.44, p < 0.001), homozygote (T/T vs. C/C: OR = 7.6, 95%CI = 3.5−16.8, p < 0.001), dominant (T/C-T/T vs. C/C: OR = 3.4, 95%CI = 1.87−8.5, p < 0.001), and recessive (T/T vs. C/C-T/C: OR = 4.42, 95%CI = 2.29−8.54, p = 0.001) models. Kaplan−Meier survival curves showed the shift in the C > T allele to be associated with poor disease-free survival. After adjusting covariates using a multivariate cox regression model, patients harboring C > T somatic mutation were 3.5 times more likely to develop a recurrence (p < 0.001). A meta-analysis of nine studies (including ours) showed a higher risk of CRC (81%) in subjects harboring the T/T genotype than in T/C + C/C genotypes, supporting the potential clinical utility of the specified study variant as a biomarker for risk stratification in CRC cases. However, results were not significant in non-colorectal cancers. In conclusion, the DDX20 rs197412 variant is associated with increased colon cancer risk and a higher likelihood of recurrence in the study population.

Stress, anxiety and depression among healthcare workers facing COVID-19 pandemic in Egypt: a cross-sectional online-based study.

OBJECTIVE: This study assessed perceived stress, anxiety and depression among healthcare workers facing the COVID-19 pandemic in Egypt. SETTING: This was an online study where a Google form was prepared including sociodemographic and occupational data as well as three validated questionnaires to assess perceived stress, anxiety and depression, respectively. The form was distributed online to all social media groups including healthcare workers all across the country, and responses were collected until the sample size of 262. PARTICIPANTS: Healthcare workers (physicians, dentists, pharmacists, physiotherapists, nurses, technicians and administrators) working in governmental or educational hospitals from all Egyptian governorates who are members of social media groups. The mean age of participants was 33.4±5.9 years, 70% were women, about 70% were married and 66% were physicians. OUTCOMES: The frequency of perceived stress, anxiety and depression observed among the study participants according to the results of their questionnaires. Then the frequencies were compared between different sociodemographic characteristics. RESULTS: Only 1.3% showed low perceived stress while 98.5% showed moderate to severe stress. About 9.5% did not experience generalised anxiety, while the remaining 90.5% had different degrees of anxiety as mild anxiety showed the highest per cent affecting about 40% of participants followed by moderate anxiety about 32% then severe anxiety, 18.5%. With regard to depression, 94% of participants showed mild to severe depression. CONCLUSION: This study showed a high prevalence of perceived stress, anxiety and depression among healthcare workers during the COVID-19 pandemic that affected all workers regardless of different sociodemographic characteristics.

Genotyping of Helicobacter pylori Virulence Genes cagA and vacA: Regional and National Study.

Helicobacter pylori (H. pylori) plays a crucial role in the pathogenesis of gastritis, peptic ulcer, and gastric cancer. The presence of pathogenicity islands (PAI) genes contributes to the pathogenesis of many gastrointestinal disorders. Cytotoxin-associated gene A (cagA) and vacuolating cytotoxin gene (vacA) are the most known virulence genes in H. pylori. So, our aim was to study H. pylori virulence genes' role in gastric disorders pathogenesis. Our study included 150 adult patients who suffered dyspeptic symptoms and were referred to the GIT endoscopy unit. Gastric biopsies were attained for rapid urease test (RUT) and histopathological examination, and multiplex PCR technique for detection of virulence genes was performed. It was found that 100 specimens were (RUT) positive, of which sixty samples (60%) were PCR positive for H. pylori ureC gene. The vacA and cagA genes were identified in 61.6% and 53% of H. pylori strains, respectively. Only 5 cases were vacA-positive and cagA-negative. The most virulent vacA s1 allele existed in 56.6% of cases. Out of the 60 H. pylori strains, 66% had at least one virulence gene and 34% did not show any virulence gene. H. pylori infection showed significant increase with age. H. pylori are prevalent amid dyspeptic patients in our region. The main genotype combinations were vacA+/cagA+ of s1m1 genotype and they were frequently associated with peptic ulcer diseases, gastritis, and gastroesophageal reflux disease.

Prevalence of Aminoglycoside Resistance and Aminoglycoside Modifying Enzymes in Acinetobacter baumannii Among Intensive Care Unit Patients, Ismailia, Egypt.

BACKGROUND: Acinetobacter baumannii is an opportunistic pathogen that rapidly develops antibiotic resistance against commonly prescribed antimicrobial agents in hospitalized patients worldwide. Aminoglycosides are commonly used in the treatment of A. baumannii health care-associated infections (HAIs). Aminoglycosides resistance mechanisms are varied and commonly involve production of aminoglycoside-modifying enzymes (AME) and efflux systems. AIM: This study aimed to provide an insight into the frequency of genes encoding AME in A. baumannii strains isolated from different clinical specimens in intensive care units (ICU). METHODOLOGY: A total of 52 multidrug-resistant (MDR) A. baumannii strains were isolated from ICU, Suez Canal University Hospitals. Species identification and antibiotics susceptibility testing were done by the automated system VITEK 2. The genes encoding AME were detected by PCR. RESULTS: Aminoglycosides resistance (amikacin, gentamicin and tobramycin) was observed in 35 isolates (67.3%). We found that aacC1 gene was the predominant AME resistance gene among A. baumannii isolates, detected in 14 isolates (40%), aphA6 in 11 isolates (31.4%) and addA1 in 5 isolates (14.2%). We found 5 isolates containing 2 AME genes, 3 of them with aacC1 and aphA6 and the remaining 2 with both aacC1 and aadA1 genes. Nearly, 5 isolates (14.2%) were negative for all AME resistance genes. CONCLUSION: Our study indicated that AME encoding genes are predominant in A. baumannii strains in our region which stressed on the importance of preventive measures to control spreading of resistance genes.

Antibiotic Use and Resistance Among Prescribers: Current Status of Knowledge, Attitude, and Practice in Egypt.

INTRODUCTION: The problem of antimicrobial resistance (AMR) is rising worldwide. One of the most significant factors influencing antimicrobial resistance in low- and middle-income countries is the lack of the skills and knowledge of health care providers for proper antimicrobial use. AIM: To identify knowledge, characterize practices and describe the attitude of Egyptian prescribers towards antibiotic use. METHODS: A self-administered validated questionnaire was distributed among Egyptian prescribers. RESULTS: Five hundred Egyptian physicians responded to the questionnaire, 113 (22.6%) reported having Antibiotic Stewardship Program (ASP) at their workplace, 99 (19.8%) use international antibiotic guidelines as the main source for prescribing activity, 358 (71.6%) recorded adequate knowledge. Elder prescribers and those who work in private or university hospitals were significantly more knowledgeable (p=0.031 and 0.001, respectively). Forty-seven (9.4%) showed a positive attitude towards proper antibiotic prescription. The type of work institution; primary health clinics and private, or university hospital and the specialty are significantly associated with a positive attitude (p=0.009 and 0.015, respectively). Seventy-eight (15.6%) expressed a proper antibiotic prescription practice. Elder age, more experienced and trained prescribers showed more proper practice. The implementation of ASP and using proper sources of information were significantly associated with proper practice (p=0.012 and 0.008, respectively). CONCLUSION: Egyptian prescribers have a good level of knowledge about antibiotics. However, low rates of positive attitude and proper practice towards the problem of AMR and ASP are recorded.

Assessment of potential risk factors for coronavirus disease-19 (COVID-19) among health care workers.

BACKGROUND: Understanding COVID-19 infection among health workers and the risk factors for adverse outcomes is important not only for characterizing virus transmission patterns and risk factors for infection, but also for preventing the future infection of health workers and other patients and reducing secondary COVID-19 transmission within health care settings. Our aim was to identify risk factors for infection among health care workers to limit adverse events in health care facilities. SUBJECTS AND METHODS: A total of 336 HCWs from COVID-19 treatment hospitals took part in the study with varying COVID-19 exposure risk depending on job function and working site. All participants were asked about risk factors for COVID-19 infection. RESULTS: Among our participants, 42.6% were medical doctors, 28.6% nurses and 7.4% assistant nurses and 21.4% were others. Forty four percent of participants had work experience 5-10 years. More than half of participants received training in Infection Prevention and Control (IPC) (56.8%) about COVID 19; 91% have hand hygiene facilities and 69% admitted availability of PPE. More than half of participants admitted that they always follow IPC measures. Two thirds of participants (66.7%) had close contact with a patient since admission; 42.3% were present in aerosolizing procedures for patients. Forty two percent of participants had respiratory symptom; the most common was sore throat representing (32.4%). The highest frequency of respiratory symptoms was among of nurses and assistant nurses 51%. Frequency of respiratory symptoms was higher among those who contacted the patient directly or for prolonged period compared to those who do not admitted these contacts. CONCLUSIONS: Risk factors for COVID-19 represented by those who were smokers, nurses and assistant nurses were more liable to catch COVID-19 than doctors as they contacted the patient directly for prolonged period or his/her body fluids, materials or surfaces around him.