Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt

Introduction: the prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to  quantify the incidence, risk factors and outcome of patients harboring XDR-GNB. Methods: a one year prospective study was done by collecting all the bacteriological reports  for cultures sent from the surgical intensive care unit, Cairo university teaching hospital.  XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of  antimicrobial agents .Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance. Results: during one-year study period, a total of 152 samples (65%) out of 234 gram negative  bacilli samples developed extensively drug resistant infection. XDR strains were significantly  higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%),  Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%).Relaparotomy was the only significant risk factor for acquisition of XDR infection. Conclusion: extensively drug-resistant gram negative infections are frequent in our ICU. This  is an alarming health care issue in Egypt which emphasizes the need to rigorously implement  infection control practices

Asymptomatic SARS-CoV-2 infection among healthcare workers in a non-COVID-19 teaching university hospital

Background: During the COVID-19 pandemic, most of the published reports on COVID-19 emphasized that health care workers (HCWs) get infected more than the general population representing one of the most vulnerable groups. However, that the real percentage of HCWs infected by SARS-CoV-2 in Egypt remains unknown. The researchers conducted the current study to assess seroprevalence of SARS-CoV-2 IgG among HCWs working in a hospital with no SARS-CoV-2 patients, and to identify the potential factors associated with SARS-CoV-2 IgG seropositivity.Design and Methods: The current study is a cross-sectional study carried out among 455 HCWs at Cairo University Hospital. The researchers administered a questionnaire shortly before the SARS-CoV-2 rapid test is performed using closed-ended question format to obtain information on demographic data of the study participants including age, sex, specialty, clinical information including questions about medical conditions, and. history of previous exposure with a confirmed or suspected case of COVID-19, and history of COVID-19- compatible symptoms during the previous 14 days (cough, sore throat, runny nose, fatigue, shortness of breath, fever, headache, vomiting, diarrhea, anosmia, ageusia, and chills). Results: We screened 455 HCWs for SARS-CoV-2 antibodies, 31.4% were in the high-risk group, and 68.6% in the low-risk group. The overall IgG seroprevalence was 36 (7.9%) (95% CI 5.8 to 10.8). The IgG seroprevalence was significantly higher in low-risk group 11% (35/312) versus high-risk group 0.7% (1/143), p<0.001. Conclusions: Low seropositivity rates for SARS-CoV-2 among HCWs is suggestive of lack of immunity and we are still far from herd immunity

Allelic Discrimination of Vitamin D Receptor Polymorphisms and Risk of Type 2 Diabetes Mellitus: A Case-Controlled Study

(1) Background: Type 2 diabetes mellitus (T2DM) is one of the rapidly growing healthcare problems, and several vitamin D receptor (VDR) polymorphisms seem to modulate the risk of T2DM. Our research was designed to investigate the allelic discrimination of VDR polymorphisms and T2DM occurrence risk. (2) Methods: This case-control research included 156 patients with T2DM and 145 healthy control subjects. Most of the study population were males 56.6% vs. 62.8% in the case and control groups, respectively. Genotyping for VDR single nucleotide polymorphisms (SNPs), rs228570 (Fok1), rs7975232 (Apa1), and rs1544410 (Bsm1) was compared between both groups. (3) Results: There was a negative link between vitamin D levels and insulin sensitivity. A significant difference was noted in the allelic discrimination of VDR polymorphism rs228570 and rs1544410 between the study groups (p \u3c 0.001). No difference was observed in the allelic discrimination of VDR polymorphism rs7975232 between the groups (p = 0.063). Moreover, T2DM patients had significantly higher levels of fasting blood sugar (FBS), glycated hemoglobin HbA1c, 2-h post-prandial blood sugar (PP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), total cholesterol, and triglycerides (p \u3c 0.001), while High-Density Lipoprotein (HDL) Cholesterol (HDL-C) was significantly decreased (p = 0.006). (4) Conclusions: VDR polymorphisms had a positive association with T2DM risk among the Egyptian population. Further large-scale research using deep sequencing of samples is strongly urged to investigate different vitamin D gene variants and interactions, as well as the influence of vitamin D on T2DM

Evaluating the Feasibility of Pro-Neurotensin and 25-Hydroxyvitamin D3 as Possible Indicators for Type 2 Diabetes Mellitus and Its Complications

(1) Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome are associated with decreased vitamin D. In contrast, high pro-neurotensin (pro-NT) levels are linked with an increased risk of T2DM and cardiovascular disease. We aimed to determine the validity of pro-NT and 25-dihydroxy vitamin D3 levels as predictors for T2DM complications; (2) Methods: One hundred T2DM, and one hundred healthy volunteers participated in this case-control study. Their Pro-NT and 25-hydroxyvitamin D3 levels were evaluated using the ELISA technique; (3) Results: Pro-NT and 25 (OH) vitamin D3 have significant validity and accuracy in T2DM prediction, 84.5%, and 90.5%, respectively (p = 0.001). At a value of \u3c29.5, 25-Hydroxy vitamin D3 showed 88% sensitivity and 93% specificity in predicting T2DM. At a value of \u3e124 Pmol/L, Pro-NT showed 81% sensitivity and 88% specificity in predicting T2DM. At a value of 16.5, 25-Hydroxy vitamin D3 had 78.4% sensitivity and 68.3% specificity in predicting T2DM complications. At a value of \u3e158 pmol/L, Pro-NT predicted T2DM complications with 67.6% sensitivity and 56.0% specificity; (4) Conclusions: 25 (OH) Vit D3 and Pro-NT could identify T2DM patients and predict T2DM complications. More extensive research is required to adequately validate this novel perspective with a large population study

Carbapenem- and colistin-resistant Enterobacterales in intensive care unit patients in Mediterranean countries, 2019

IntroductionThe colonization of patients by carbapenemase-producing Enterobacterales (CPE) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units (ICUs). Our study aimed to comprehensively assess CPE prevalence among ICU patients across the Mediterranean region pre-COVID-19, conducting a multicenter prevalence study in the first quarter of 2019.MethodsWe collected clinical data and rectal or fecal samples from 256 ICU patients for CPE testing. Additionally, we performed whole-genome sequencing on 40 representative CPE strains to document their molecular characteristics.ResultsAmong the 256 patients, CPE was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant CPE strains, affecting three ICUs. Genetic analysis revealed highly diverse E. coli and K. pneumoniae strains, predominantly from international high-risk clones. Notably, blaOXA-48 and blaNDM-1 were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased CPE carriage (p < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated.DiscussionOur study provides CPE prevalence in Mediterranean ICUs and reaffirms established CPE presence in this setting but also provides updates on the molecular diversity of CPE strains. These findings highlight the imperative of reinforcing infection control measures in the participating ICUs to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions