Study of red blood cell alloimmunization risk factors in multiply transfused thalassemia patients: role in improving thalassemia transfusion practice in Fayoum, Egypt.

BACKGROUND: ß-Thalassemia is considered the most common chronic hemolytic anemia in Egypt. Alloimmunization can lead to serious clinical complications in transfusion-dependent patients. The objective of this study was to determine the frequency and types of alloantibodies, and, in addition, to study the risk factors that might influence alloimmunization in multiply transfused thalassemia patients in Fayoum, Egypt, with the goal that this study could help minimize some of the transfusion-associated risks in those patients. STUDY DESIGN AND METHODS: A total of 188 multiply transfused thalassemia patients attending Fayoum University Hospital were analyzed. Alloantibody identification was performed by DiaMed-ID microtyping system. RESULTS: Alloimmunization prevalence was 7.98%. The most common alloantibody was D-related; anti-D was the most frequent alloantibody found in eight of the 188 patients (4.25 %), followed by anti-C in two patients (1.1%), anti- E in two (1.1 %), anti-c in two (1.1 %), anti-Fya in two (1.1%), anti-K in one (0.53 %), and an unknown antibody in one patient (0.53%). Higher rates of alloimmunization were found in female patients, in patients with ß-thalassemia intermedia, in splenectomized patients, in D- patients, and in patients who started blood transfusion after 3 years of age. CONCLUSION: The study reemphasizes the need for cost-effective strategy for thalassemia transfusion practice in developing countries. Red blood cell antigen typing before transfusion and issue of antigen-matched or antigen-negative blood can be made available to alloimmunized multiply transfused patients. Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.

The impact of fetal and maternal physiologic factors on umbilical cord blood quality as a source of stem cells in Egyptian population.

BACKGROUND: Umbilical cord blood (UCB) has rapidly become a clinically useful alternative stem cell source. Many variables have been used to evaluate a UCB unit and predict transplant outcomes. The objective of this study was to measure the expression of hematopoietic stem cells in UCB and its relation to certain maternal and neonatal physiologic factors to establish optimum criteria for UCB donor selection. STUDY DESIGN AND METHODS: Two hundred UCB units were collected from normal uncomplicated vaginal and cesarean deliveries. Total volume was noted and immediately assessed for total nucleated cell (TNC) count and CD34+ cell concentration. Assessment of maternal and neonatal variables such as mode of delivery, placental weight, baby's birthweight, and sex was made. RESULTS: The volume of the donations ranged from 42.0 to 126 mL, the TNC count ranged from 5 × 10(9) to 28.7 × 10(9) cells/L, and CD34+ cells ranged from 0.03% to 0.62%. There was a significant positive correlation between cord blood volume and cesarean section (p = 0.01) and placental weight (p = 0.02). There was a significant positive correlation with a p value of less than 0.05 between the number of CD34+ cells and UCB volume and TNC. There was no significant difference between the variables and the TNC count. CONCLUSION: Our study concludes that cord units collected for banking should be obtained by selecting units of larger volumes, of higher TNCs, from female babies with heavy placenta, and from babies delivered via cesarean section.

Insight on the hepatitis B virus and host immune mechanisms in the context of occult hepatitis.

Hepatitis B virus infection is the 10th leading cause of death around the world. Occult HBV infection (OBI) represents those with a viral load of < 104 IU/ml. Among permanent blood recipients, OBI appears to be the most common cause of posttransfusion hepatitis. Moreover, OBI may reduce hepatitis C virus (HCV) treatment responsiveness in people with chronic HCV infection, and OBI may become acutely reactivated when on immunosuppression or potentially contribute to chronic liver disease. Since most previous studies used either small sample sizes, diverse populations, or were cross-sectional in design, it is possible that using multiple techniques with varying sensitivity for HBV DNA measurement in the liver or serum will shed light on discrepancies in the impact of OBI in cases with chronic liver disease. The purpose of this research is to review many elements of OBI, such as its prevalence, the hepatitis B virus and host immune mechanisms, diagnostic procedures, clinical implications, therapy, and prevention strategies.

Influence of climate change on emerging pathogens and human immunity.

Global warming can be defined as the detectable increase in average global temperature in the last ten years regarding frequency and intensity. Climate change represents a long-term detectable climatic variability. The climatic system of the earth is disrupted because of the continuous production of greenhouse gases, which raises the risk of the emergence and re-emergence of human pathogens. In this review, we aimed to present the different mechanisms of climate change that increase human/pathogen exposure, introduce the recent concept of disaster microbiology, and discuss the effects of climate change on zoonoses as well as the effects of climate change on antibiotic resistance and human health.

Detection of ERG11 gene in fluconazole resistant urinary candida isolates.

Candida species resistant to fluconazole and voriconazole were screened for the presence of ERG11gene by polymerase chain reaction (PCR). Also, the association of this gene with the demonstration of Candida virulence factors; biofilm formation, phospholipase and proteinases activities were studied. A total of 61 Candida isolates were collected from urine specimens. Candida species were identified by API 20 C Aux test. Extracellular phospholipase, secretory aspartyl proteinase and biofilm formation were determined. ERG11 gene was detected by PCR. C. albicans was identified in 34.5%, C. glabrata in 29.5% and C. tropicalis and C. krusei in 18% each. Candida species was resistant to fluconazole and voriconazole in 55.7% and 27.9%, respectively. Seventeen (50%) of fluconazole resistant Candida isolates were sensitive to voriconazole. The most frequently Candida species revealed fluconazole resistance were C. glabrata (47.1%), C. krusei (29.4%), and C. tropicalis and C. albicans (11.8% each). Biofilm formation, phospholipase and proteinase activity were determined in 41.2%, 67.6% and 35.3% of fluconazole resistant Candida isolates, respectively. Erg 11 gene was determined in 82.4% of fluconazole resistant Candida isolates and prominent in C. glabrata (93.75%), followed by C. krusei (90%), C. tropicalis (75%) and C. albicans (25%). Erg 11 gene was detected in 64.7% (11/17) of fluconazole resistant-voriconazole sensitive Candida isolates. Regarding, correlation of Erg11 gene positivity and virulence factors among fluconazole resistant Candida isolates, 34.5% exhibited biofilm formation and 62.1% and 31% showed phospholipase and proteinase activities, respectively. There were statistically significant difference concerning the association of proteinase activities and Erg 11 gene expression among fluconazole resistance Candida isolates (P=0.04). The study emphasizes the high prevalence of Erg11 gene among fluconazole resistant Candida species. There was association between the proteinase activity, fluconazole resistance and the presence of Erg11 among Candida species. Voriconazole maintains better activity towards Candida species and represent an alternative therapy.

Trend of social media use by undergraduate medical students; a comparison between medical students and educators.

Purpose: Social media (SM) is one of the most powerful tools of communication and learning in the recent era. Different types of information can be shared through these social networking sites in the form of texts, videos, pictures, audios, and references (contacts). Due to the constant increase in the use of these social networking sites in our daily routine life especially during the COVID 19 pandemic, their use in teaching and learning has become inevitable. Social media has immense potential to enhance its role in educational settings. Both the students and educators use it for communication, education, sharing and expressing knowledge, and recreation. Therefore, the present study aims to find out the most frequently used social network sites for learning and easy communication between medical students and educators. Objective: This study sought to explore the most frequently used social networking sites by the medical students and educators at Batterjee Medical College. Methods: A cross-sectional study was carried out to assess the trends of usage of SM as an extracurricular way of enhancing learning and teaching experience among medical students and educators in Batterjee Medical College; Saudi Arabia from November 2020 to March 2021.A pre-validated self-administrated questionnaire was built using Google Drive forms and distributed to medical students and educators via emails and WhatsApp. Convenient sampling was used to collect the data. Conclusion: Social media has immense potential to enhance its role in educational settings. Students in our study preferred YouTube and WhatsApp for their learning and communication especially, during COVID 19 pandemic. However, to further enhance their utility choosing the right platform, the amount and quality of the information shared to ensure optimal benefit, providing ethical guides, and professional standards for SM use at institutional levels are the few challenges that need to address.

Endometrial thickness and serum beta-hCG as predictors of the effectiveness of oral misoprostol in early pregnancy failure.

OBJECTIVE: To evaluate ultrasonographic measurement of endometrial thickness and serum levels of chorionic gonadotropin (beta-hCG) as predictors of failure to abort completely in patients designated for uterine evacuation using oral misoprostol. METHODS: Women attending an obstetric outpatient clinic who complained of residual vaginal bleeding 15 days or more after taking oral misoprostol for medical induction of abortion for early pregnancy failure were evaluated by transvaginal ultrasound scan and assay of serum beta-hCG. They subsequently underwent dilatation and curettage under general anaesthesia. According to the results of histopathological examination of uterine contents, the study cohort was divided into women with incomplete abortion (19 cases, 19.6%) and cases with complete abortion (78 cases, 80.4%). The results of the ultrasound scan and the assay of serum beta-hCG were correlated with the histopathological results to determine the accuracy of these markers in predicting complete abortion. RESULTS: Baseline characteristics for both groups were similar. The endometrial thickness in the two groups ranged from 11.2 +/- 3.9 mm in the complete abortion group to 14.6 +/- 6.1 mm in the incomplete abortion group, a statistically significant difference (P = 0.003). Serum beta-hCG levels were statistically different in the two groups (complete abortion 73.9 +/- 23.9 IU/L vs. incomplete abortion 109.4 +/- 68.4 IU/L, P < 0.001). Measured endometrial thickness > or = 12 mm predicted incomplete abortion with a sensitivity of 88.5%, a specificity of 73.7%, a positive predictive value (PPV) of 93.2%, and a positive likelihood ratio (LR+ve) of 85.6. A serum beta-hCG > or = 100 IU/L predicted incomplete abortion with a sensitivity of 87.2%, a specificity of 78.9%, a PPV of 94.4%, and a LR+ve of 85.6. CONCLUSION: Quantitative assay of serum beta-hCG and ultrasound measurement of endometrial thickness are clinically useful measures for predicting late failure of medical abortion, but should be used as supplements to clinical assessments.

EFFECT OF LINEZOLID ALONE AND IN COMBINATION WITH OTHER ANTIBIOTICS, ON METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS.

The prevalence of methicillin-resistant Staphyloccoccus aureus (MRSA) strains has presented a new challenge in antimicrobial medication. Linezolid is a new drug with potent activity on Gram-positive pathogens such as MRSA. The aim of the study was to investigate the in vitro activity of linezolid alone and in combination with imipenem, vancomycin or rifampicin to determine the most active therapy against MRSA strains. Twenty clinical MRSA strains were isolated from patients admitted to inpatient departments and outpatient clinics of Theodor Bilharz Research Institute. Standard strain MRSA ATCC 43300 was included as a control. The MICs of MRSA strains to linezolid, vancomycin, imipenem and rifampicin were evaluated using E test. Time-kill curve were used to assess the in vitro activity of linezolid (at 8x MIC) alone and in combination with imipenem (at 32x MIC), vancomycin or rifampicin (at 8x MIC). Scanning and transmission electron microscopy were performed to compare bacterial morphological alterations owing to the different combi- nations. Time-kill studies showed synergistic effect when linezolid combined with imipenem was tested against all the MRSA strains. Linezolid plus vancomycin or rifampicin combinations did not display any synergism or antagonism. Scanning and transmission electron microscopy observations confirmed the interactions observed in time kill experiments. Linezolid in combination with subinhibitory concentrations of imipenem can be bactericidal against MRSA strains and appears to be a promising combination for the treatment of MRSA infections. No synergistic activity was seen when the linezolid and vancomycin or rifampicin were combined. Linezolid could prevent the emergence of mutants resistant to rifampicin