Production and Quantification of Virulence Factors in Malassezia Species

A total of 77 strains of Malassezia were included in this study. Biofilm production and hydrolytic enzymes were studied by using specific solid media. Real-time Reverse Transcriptase qPCR method was applied to determine overexpression of genes encoding extracellular enzyme. All included Malassezia species produced biofilms. No statistical significant difference was observed between biofilm formation of the Malassezia species (P = 0.567) . All Malassezia species produced lipase and 95% of M. globosa showed a strong enzymatic activity (Pz=0.55 ± 0.02). Statistical significant difference was observed between the mean keratinase indices of M. slooffiae and the others Malassezia species ( P = 0.005). The overexpression of one or more genes was observed in 100% of strains isolated from patients with folliculitis, in 87.5% for pityriasis versicolor isolates and in 57.14% for the control group isolates. A statistical significant difference of the lipase gene expression ( P = 0.072) was associated with the strains collected from patients with folliculitis vs group control. This investigation provides more information about the frequency of the production of the major enzymes considered to be virulence factors of Malassezia species. Interestingly, the overexpression of one or more genes was observed in strains isolated from patients with Malassezia disorder.

Evaluation of the Role of Hyaluronic Acid as a Potential Marker for Diagnosis of Non-Alcoholic Fatty Liver Disease

Background Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, ranging from simple steatosis and nonalcoholic steatohepatitis (NASH) to liver cirrhosis, with its complications including hepatocellular carcinoma (HCC). Aim of the Work to evaluate the efficacy and reliability of Hyaluronic Acid as a potential noninvasive biomarker for diagnosis and prognosis of NAFLD and to compare it with the traditional noninvasive techniques and if it can replace liver biopsy. Patients and Methods This cross-sectional study was conducted on 63 subjects from the Gastroenterology and Hepatology Department of Ain Shams University Hospital. They were divided into three different groups as following: a healthy control group, fatty liver and nonalcoholic steatohepatitis (NASH). All patients and controls were subjected to routine laboratory tests and serum Hyaluronic acid test. Results There were high statistical significant differences between groups as regard INR. Regarding to liver functions, there was a high statistical significant difference between groups as regard AST and ALT ,Bilirubin and Albumin.. Comparison between groups regarding to RBS, there was high statistical significant difference between groups as regard RBS. Comparison between groups regarding to lipid profile, there was high statistical significant difference between groups as regard LDL and cholesterol. Regarding to APRI and Fib4, there was high statistical significant difference between groups as regard APRI and Fib4. Regarding to H.A, there was high statistical significant difference between groups as regard H.A. The study shows that there is non-significant correlation between either APRI or Fib4 and H.A in fatty liver, and there is also nonsignificant correlation either APRI or Fib4 and H.A in NASH. Conclusion Hyaluronic Acid can be reliably used as an accurate and specific noninvasive biomarker for the diagnosis of Nonalcoholic fatty Liver Disease and staging of the severity of disease compared with the traditional known noninvasive scores

The Effect of Hemodiafiltration on Inflammatory Biomarkers in Comparison to High Flux Dialyzers in Prevalent Hemodialysis Patients

Introduction Inflammation in patients with ESRD undergoing HD is an increasing concern for physicians and has been related to increase the rates of morbidity and mortality. Interestingly, patients with ESRD in conventional HD have frequent infections and a suboptimal response to vaccines; this is probably related to an immune inflammatory disorder associated either with uremia and/or nutritional status. In addition to CRP, which seems to be the most important marker for the identification and control of inflammation in clinical practice, many other markers are also available for the evaluation of inflammatory state. Decreased renal clearance clearly accounts for higher levels of circulating cytokines, although increased production has also been described. Hemodiafiltration has been shown to improve cardio-protection and the immunologic system and reduces infection and mortality compared with conventional HD. A recent study showed that hemodiafiltration compared with conventional HD reduced the risk of mortality in ESRD patients. Analysis of pooled individual participant data from randomized controlled trials has shown survival benefits of high volume-HDF on all-cause mortality and especially cardiovascular mortality rate. The mechanisms that lead to improved outcomes are not clear, but it is thought that HDF may reduce the production of inflammatory mediators through the use of biocompatible dialysers and ultrapure dialysate and also improve clearance of larger molecular weight substances, many of which are associated with oxidative stress, inflammation and endothelial dysfunction. Objective The aim of this study is to detect, prospectively, the effect of 3 months dialysis with Hemodiafiltration on inflammatory and nutritional biomarkers in comparison to conventional dialysis with high flux dialyzer in stable HD patients. Patients and methods 30 adults aged 20-75 years who were selected from Dialysis Unit, Kobary El-Kobba Military Hospital. 30 male patients known to have chronic kidney disease and are on dialysis with high flux dialyzer more than 3 months were divided into 2 groups:15 Patients are shifted to be on dialysis with HDF and 15 Patients are continued to be on Regular Hemodialysis with high flux dialyzer. Full medical history and clinical examination. Anthropometric measurements and Laboratory investigations including Complete Blood Picture (WBCs, platelets, Hb), Coagulation profile PT, PTT&INR, Liver function tests (ALT, AST, T. Bilirubin and S. Albumin), Lipid profile (Triglycerides, total cholesterol, VLDL), S. creatinine, BUN, Na, K, Uric acid, Total Proteins, Serum Calcium, Serum Phosphorus, PTH, Serum ferritin, High sensitivity CRP (Enzyme- Linked Immunosorbent Assay (ELISA)) and IL6 (ELISA). Results The current study was conducted on 30 patients with chronic kidney disease on regular dialysis. The patients were divided into two groups A representing patients on hemodiafiltration (n = 15) and group B representing patients on dialysis with high flux dialyzer (n = 15). A high statistical significant difference (P < 0.01) was found regarding K 4.3±0.6 meq/l in group A while it is 5.2±0.5 meq/l in group B, a high statistical significant difference (P < 0.01) was found regarding phosphorus 4.6±1.0 mg/dl in group A while it is 6.1±0.9 mg/dl in group B and no statistical significant difference (P > 0.05) was found as regard the uric acid. A statistical significant difference (P < 0.05) was found regarding CRP 63.5±40.9 mg/dl in group A while it is 73.4±33.2 mg/dl in group B, a statistical significant difference (P < 0.01) was found regarding IL6 85.3±37.6 mg/dl in group A while it is 156.7±151.9 mg/dl in group B after 3 months and no statistical significant difference (P > 0.05) was found as regard those inflammatory markers before 3 months. A statistical significant difference (P < 0.05) was found regarding CRP. A statistical significant difference (P < 0.05) was found regarding IL6. Conclusion The present study revealed that there was no significant change in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer before 3 months but there was a significant decrease in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer after 3 months.

Comparison between Early Results of Laparoscopic Mini Gastric Bypass and Sleeve Gastrectomy regarding Weight Loss, Remission of Type II Diabetes Mellitus and Hypertension

Background Bariatric Surgery leads to a dramatic improvement in morbid obesity and associated type 2 Diabetes Mellitus (T2DM) and hypertension. Objectives The aim of the study was to compare between early results of Laparoscopic Mini Gastric Bypass and Sleeve gastrectomy regarding excess weight loss, remission of Type II diabetes mellitus and hypertension. Patients and Methods Type of the study, retrospective study. study setting, Our study was carried out at The General Surgery Department Ain Shams University Hospitals. study period,. All cases were operated during the period February and march 2019. Follow up of patients 6 months after operation was done (retrospective study). Last follow up was done on September 2019. The study included 50 patients aged 18-60 years with Type II Diabetes Mellitus and hypertension of at least 6 months duration, BMI 35 65 kg/m2 for at least 5 years. Results In this study There was no statistical significant difference between studied groups as regard age,gender,and baseline clinical data. there was a statistical significant difference between patients in LMGB group as well as between patients in LGS group before and six months after surgery as regard weight in kg, BMI and HbA1C and.remission of hypertention (P value 0.000). there was high statistical significant difference between studied groups as regard percentage of change of weight and BMI(P value 0.000) However, there was no statistical significant difference between studied groups as regard percent of change of HbA1C. (P value 0.613),remission of T2DM.(p value 0.123 ) and control of hypertension. (p value 0.136 ). Further results and data could be reached on long-term follow up of patients involved in this study. Conclusion Patients receiving mini-gastric bypass had more advantageous indexes than patients receiving sleeve gastrectomy, such as higher six months EWL% (excess weight loss), higher T2DM remission rate and higher hypertension remission rate. Especially on long term follow up and that was proved by meta analysis of previous studies but on short term follow up there is no statistical singnificant difference between both studied groups except in percentage of change of weight and BMI. Mini-gastric bypass is simple, safe and more effective bariatric procedure than laparoscopic sleeve gastrectomy.

Assessment of Hepatic Steatosis Before and After Treatment In Egyptian HCV Patients Treated With DAAs Using Non Invasive Parameters

Background Hepatitis C virus (HCV) is a major health problem worldwide. More than one million people die each year from hepatitis C virus (HCV) related diseases. Aim of the Work to evaluate the effect of direct acting antiviral drugs on hepatic steatosis in naïve HCV chronically infected Egyptian patients after reaching SVR12. Patients and Methods study was carried out on 100 treatment naive patients with chronic infection of HCV attending the out-patient clinic. The patients were diagnosed having HCV by detecting HCV antibodies by ELISA & PCR for HCV RNA at The Gastro-enterolgy and Hepatology Department, Ain Shams University and Kobry El Koba Military Hospital between August 2017 till February 2019. Results The mean TG, mean s. cholesterol and APRI Score decreased significantly showing a high statistical significant difference between baseline and SVR12. The mean HDL and LDL significantly increased showing a high statistical significant difference between baseline and SVR12. NAFLD Score increased from baseline to SVR12 showing a statistical significant difference in NAFLD Score between baseline and SVR12. Fibroscan median mean decreased showing a highly statistical difference in Fibroscan Median between baseline and SVR12. Out of 100 patients, cirrhosis regressed to F3 in 33 patients, F2 in 3 patients and didn’t regress to F1 in any patient, while the majority (43 patients) remained as F4 at SVR12. Conclusion APRI Score mean and Fibroscan median mean were significantly decreased, while NAFLD Score was increased among the studied groups from baseline and SVR12.

Anti-Mullerian Hormone (AMH) Level in Presence of Ovarian Endometrioma

Background: The effect of endometriomas itself on the ovarian responsiveness that relate to ovarian reserve had been reported with several inconsistent results. In one study evaluated women with unilateral endometriomas, ovaries with disease showed lower response to ovarian stimulation than contralateral healthy ovaries .However, recent study on infertile women with un-operated unilateral small endometriomas did not support difference in ovarian responsiveness. The aim was to evaluate the impact of presence of endometriomas on ovarian reserve as measured by circulating AMH. Methods: This retrospective study was carried out on 80 female patients in childbearing period attending outpatient clinic and/or inpatient department of obstetrics and gynecology at Tanat University Hospital and the study was conducted directly after approval in the period from Apri, 2019 till April 2020. Group (A): Study group: 60 female patients aged between 20 to 30 years old GROUP (B): Control group: 20 age matched female with healthy ovaries. Results: there is no statistical significant difference between groups as regard Menarche (years), Regularity and Amount of menstrual blood flow. There is statistical significant difference between groups as regard fixed tender Right Ventricular Failure. But there are no statistical significant differences between groups as regard nodule in rectovaginal septum, fixed tender adnexal masses, association with adenomyosis and infertility. There is highly statistical significant difference between case and control groups as regard AMH levels. there are highly statistical significant positive correlation between duration of endometriosis and each of presence of pelvic pain, cyst diameter and Visual Analogue Scale. Conclusions: Women with endometrioma have significantly lower serum AMH levels and seem to experience a more rapid decline in serum AMH levels than age matched counterparts, suggesting a harmful effect of endometrioma per se on ovarian reserve.

The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study

Primary nocturnal enuresis (PNE) affects children’s physical and mental health with a high rate. However, its neural mechanism is still unclear. Studies have found that the paraventricular thalamus (PVT) is among the key brain regions implicated with awakening regulation and its control of the transition between sleep and wakening is dependent on signaling through the PVT-nucleus accumbens (NAc) pathway. So this study analyzed the function of brain regions and their connectivity of PVT and NAc. A total of twenty-six PNE and typically developing (TD) children were involved in the study and the methods of amplitude of low frequency fluctuation (ALFF), degree centrality (DC) and functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI) were used to analyze the brain functions. Results showed that there was no statistical significant difference in ALFF and DC between PNE and TD children in bilateral PVT and NAc. And there was statistical significant difference of the comparison of the FC of left PVT (lPVT) and left NAc (lNAc) between PNE and TD children. Meanwhile, there was negative correlation between awakening score and the FC of rPVT and lNAc, and no obvious correlation between awakening score and the FC of lPVT and lNAc in PNE children. Meanwhile, there was both negative correlation between awakening score and the FC of lPVT, rPTV and lNAc in TD children. Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children. This finding could help establish the evaluation index of PNE.

Study of serum albumin as a marker of severity in COVID-19 positive SARI and COVID-19 negative SARI patients

Background: COVID-19 a pandemic caused by SARS CoV-2 has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Hypoalbuminemia in COVID-19 indicates severe disease. The aim of the study was to determine incidence of hypoalbuminemia and correlation of severity of hypoalbuminemia with COVID-19 positive SARI and COVID negative SARI patients.Methods: A study was conducted on 265 SARI patients who were admitted in hospitals attached to BMCRI. History was taken, general physical examination and a detailed systemic examination was done. Patients were categorized into mild, moderate and severe illness. RT-PCR for COVID-19 patients done using throat and nasal swab. Total WBC counts and differential counts, platelet counts were estimated. Serum albumin levels were correlated with pneumonia severity and compared between COVID-19 positive and Negative SARI. And also, correlation with comorbities was done.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. Patients categorized into moderate and severe SARI. Mean age of subjects with COVID-19 positive (severe) was higher- 58.70±15.598 followed by COVID-19 positive (moderate)- 55.13±14.480. About 30% (N=90) were belong to severe SARI group, Chi-square test showed statistical significant association with respect to age. Chi-square test showed no statistical significant association with respect to gender. Independent sample t test showed statistical difference with respect to S. albumin levels between COVID positive and COVID negative subjects. In COVID positive subjects, S. albumin levels showed statistical significant difference between moderate and severe sub groups whereas there was no statistical significant difference seen in COVID negative sub groups.Conclusions: The relationship between hypoalbuminemia and reduced survival in COVID-19 may have several explanations. First, acting as an anti-inflammatory and antioxidant protein, albumin may protect against cytokine storm. Second, albumin encompasses anticoagulant properties and inhibits oxidative stress-related clotting and platelet activation that occurs in severe COVID-19. Third, albumin is an inverse acute phase reactant. In our present study hypoalbuminemia was more significant in severe COVID-19 positive SARI patients compared to COVID-19 negative SARI patients hence, we could say that hypoalbuminemia is inversely related with COVID-19 severity and also more significant hypoalbuminemia in COVID-19 positive SARI.

MMP-2, MMP-9, TNF-α Levels in Relation to Sub types of Attention Deficit Hyperactivity Disorder

Many authors have suggested the association between Attention Deficit Hyperactivity Disorder (ADHD) and inflammation through various mechanisms among which increased serum cytokines.30 newly diagnosed ADHD children, aged 6-12and of both sexes were collected from outpatient clinic, Psychiatry Department, Al Zahraa University Hospital and a matched control group of 30 children. They were subjected to Clinical assessment, Whechsler Intelligence Scale for children (WISC), Conners' Parent Rating Scale-Revised & serum MMP-2, MMP-9, TNF-α levels were determined. There was statistical significant difference between patient and control groups regarding MMP-2 level (648.50 ± 81.94 vs 344.13 ± 32.02), MMP-9 level (143.00±16.98 vs 102.90 ± 4.13) & TNF-α level (345 ± 7.1.vs 202 ± 22.3). Hyperactive/impulsive subtype represented 16(53.3%), Inattentive subtype represented 6(20%), Combined subtype represented 8(26.7%) of the ADHD group. MMP-2, MMP-9, TNF-α levels were all higher among the Hyperactive/impulsive subtype, followed by thecombined subtype then the Inattentive subtype with high statistical significant difference. A high statistical significant difference was found in all subscales of Conners' scale among the 3 subtypes of ADHD. A positive correlation was found between TNF-α level and age, whereas, a negative correlation exists between MMP-2, MMP-9, TNF-α level and IQ. In addition, correlation was found between MMP-2, MMP-9 levels and cognitive problems, TNF-α level and inattention.Our study illustrates the co-occurrence of inflammatory process and ADHD, but further studies on larger sample are needed.

MO987IMPACT OF POST-TRANSPLANT TUBERCULOSIS ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENTS: RISK FACTORS AND OUTCOME

Background and Aims TB is encountered worldwide more frequently among renal transplant recipients due to of the state of immunosuppression. Antituberculosis drugs cause CYP-450 enzyme induction that increase the metabolism of CNI and mTORi So, decreasing the plasma trough level which in turn expose the transplant recipient to the risk of rejection. Our study concerned with the impact of post-transplant TB on live donor kidney transplant recipients outcome. Method This is retrospective cohort study held in Urology and Nephrology Center, Mansoura University, Egypt. The study included 210 patients out of 3200 kidney transplant recipients (KTRs) who underwent renal transplantation at Mansoura urology and Nephrology Centre between March 1976 and December 2019. The patients were divided into 2 main groups according to history of post-transplant tuberculosis, a group of 70 kidney transplant recipients who developed tuberculosis after transplantation served as a study group and a matched group of 140 kidney transplant recipients who did not develop tuberculosis after transplantation served as control group. Study group was then subdivided into pulmonary and urinary TB groups. Results We found that patients with Low BMI are associated with higher incidence of post-transplant TB (p value: 0.023). While, post-transplant TB was associated with increased incidence of post-transplant DM, bacterial infection, CMV infection and surgical wound infection. Exposure to rejection episodes (either acute or chronic) is comparable among both groups. Post-transplant diabetes incidence was higher among TB group with statistical significant difference (p value: 0.01). Bacterial infection incidence including pneumonia, urinary tract infection and gastroenteritis were associated with higher incidence of TB with statistically significant difference (p value: 0.012). CMV infection incidence was significantly higher among TB group (p value: 0.02). Incidence of wound infection post-transplantation was higher among TB group with statistically significant difference (p value: 0.014). Both groups were comparable regarding creatinine and creatinine clearance at last follow-up (p value: 0.61, 0.51 respectively). Overall, there was no statistically significant difference among both groups regarding 5, 10 and 15 years graft and patient survival (p value: 0.54, 0.15 respectively). During treatment of TB in the study group, there was statistical significant difference regarding liver enzymes and CNI doses either before or during anti-tuberculous treatment as liver enzymes were elevated (p value: 0.023) and higher doses of CNI were required to achieve satisfactory trough level during antituberculus treatment (p value: 0.037). Liver enzymes dropped significantly and lower doses of CNI were used after cessation of anti-tuberculous treatment (p value: 0.041, 0.03 respectively). Study group was then subdivided into 2 main groups: pulmonary TB (42 KTRs) and Urinary TB (28 KTRs). There was no statistical significant difference among both groups regarding baseline data, transplantation data, post-transplant medical complication except that CMV infection incidence was higher among pulmonary TB group (p value: 0.012). Patient and graft survival were comparable. Conclusion Among renal transplant recipients, tuberculosis is a serious problem for both the disease itself and its treatment with anti-tuberculous medications. In our series the rejection was comparable in both groups (with or without tuberculosis) this may be explained by frequent monitoring of the immunosuppressive drug level.