Background: Early detection and start of antibiotic therapy neonatal sepsis (N.S) dramatically improves outcomes, so it is important to perform fast, reliable and specific early laboratory biomarkers. Aim: This study aimed to detect the prevelance, the risk factors, hematology profile, microbial profile of neonatal sepsis patients and also investigate the value of PCT and CRP, in comparison to presepsin in establishing the early diagnosis of neonatal sepsis. Methods: A cross sectional study was performed from March to September 2019 in Al Quwayiyah General hospital involving 120 neonates who were classified into 3 groups. The patients groups Khater and Al-Hosiny; JAMB, 20(1): 80-90, 2020; Article no.JAMB.54569 81 were: Proved N.S, suspected N.S and control healthy neonates, classified depending on Tollner score. Haematology profile and blood culture for each neonate were done. CRP, PCT and presepsin values were analyzed, compared, and their effectiveness as diagnostic markers was determined. Sensitivity, specificity, positive, and negative predictive values of the markers were calculated. Results: The prevelance of neonatal sepsis was 20.8%. 75 neonates were males and 45 neonates were females. 74 neonates were preterm, while 46 were full term. Gestational age in weeks was 31.1±5.9w for neonates with proved sepsis, 32.4±6.7w for neonates with suspected sepsis and 36.4±4.4w for control group. The mean birth weight was 1740±105.3 g for neonates with proved sepsis, 32.4±6.7 g for neonates with suspected sepsis, 2.650±205.2 g for control group. 36 babies suffered from respiratory distress syndrome, 10 had jaundice, 8 had cough, 28 had fever and 8 complained of other symptoms. Blood cultures were positive for all patients of proved sepsis. The identified bacteria included Gram positive bacteria 22(55%) which were Coagulase negative staph. 13(32.5%) followed by Staphylococcus aureus 4(10%) while Gram negative bacteria 15(37.5%) which were E. coli 5(12.5%) followed by Klebsiella peumoniae and also fungal infection (Candida species) detected in 3(7.5%) cases. There was significant difference between the mean and standared deviation of CRP, PCT and presepsin levels in proved and suspected N.S. groups when compared with healthy controls (P< 0.05). CRP sensitivity and specificity (72%, 61% respectively) which were less useful in diagnosis of neonatal sepsis compared to presepsin which has the highest sensitivity and specificity (95%, 81% respectively) followed by procalcitonin with sensitivity and specificity (90%, 69% respectively). Conclusion: The prevalence of neonatal sepsis among all admitted neonates in Al-Quwayiyah general hospital was 20.8%. Our results also detected higher sensitivity, specificity and positive and negative predictive values for presepsin more than and PCT CRP in the diagnosis of NS. Original Research Article

Background: An increase in extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) has been observed. Aims: Of this study was done to detect the prevelance of ESBL, AmpC producing and ESBL and AmpC co-producing strains of Escherichia coli (E. coli) in urinary tract infections patients in Benha University Hospital and to evaluate the performance of CHROMagar™ ESBL media for rapid screening of ESBL producing E. coli. Place and Duration of Study: This is a Six-months Cross sectional study conducted in Urology and Microbiology & Immunology departments, Benha University, Egypt. Methodology: All patients under study were subjected to: Full history taking and clinical examination. Bacteriological study included; urine sample collection from each patient and subjected to urine analysis, urine culture on cysteine lactose electrolyte deficient agar (CLED) agar, CHROMagar™ ESBL media and MacConkey agar supplemented with 2 mg/liter ceftazidime (MCKC). ESBL detection in E. coli isolated on CLED agar by phenotypic screening by clinical and laboratory standards institute (CLSI) method then Original Research Article Results: In this study out of 45 E. coli strains 24 (53.3%) ESBL producers were detected by E. test (golden method for confirmation of ESBL according to CLSI) and 21(46.7%) strains were non ESBL producers. There was no significant difference between ESBL isolation from community acquired and health care associated UTI patients; out of the 24 isolated ESBL producing E.coli strains 9 (37.5%) were detected in community acquired UTI patients while 15 (62.5%) were detected in health care associated UTI patients. The sensitivity of both MCKC and CHROMagar™ ESBL media were 100% (95%CL: 85.6% to 100%).While specificity were 87.5% (95%CL:67.6% to 97.2%) and 80.8% (95%CL: 60.6% to 93.4%) respectively. In our study out of 45 isolated E. coli strains 14 (31.1%) were AmpC producers by AmpC test, 4 (8.9%) were AmpC and ESBL co-producers by cefepime/ cefepime clavulanic E.test. Conclusion: It is important to know the prevalence of ESBL, AmpC producing and ESBL&AmpC co-producing organisms so that judicious use of antibiotics could be done and increase awareness about the need for routine detection of AmpC and ESBL in clinical isolates. CHROMagar™ ESBL media detect ESBL producers from clinical specimen and give rapid presumptive identification by means of colony colour after 24h with good sensitivity and specificity.

Background: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis. Methods: The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination. Results: Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty. Conclusion: Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.

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This work was carried out in collaboration between both authors. Author ESK planned and designed the study, wrote the protocol, collected the samples, performed the practical laboratory activities, participated in the interpretation of the results and analysis, drafted and critically revised the manuscript. Author MHAN participated in planning and designing the study, sample collection, participated in the interpretation of the results. Both authors read and approved the final manuscript.