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Background: In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging. Objectives: We aimed to investigate clinical associations of hemogram-derived indices, namely: red cell distribution width (RDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) with disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS). Methods: In 250 patients with rheumatological disease and 100 healthy age-matched controls, we investigated disease activity scores and indicators and evaluated their association with hemogram-derived indices values. Results: Compared with the control group, RDW, MPV, and PLR significantly increased ( P < .001) in the three studied disorders (RA, SLE, and AS), but LMR dramatically decreased. SII was considerably higher in RA and AS patients compared with controls but not in SLE patients. On the other hand, NLR rose dramatically in SLE patients compared with controls ( P = .043), but did not change much in RA and AS patients ( P > .05). RDW and MPV showed significant changes ( P < .001) in the three studied diseases (RA, SLE, and AS) according to disease activity. They significantly increased across worsening activity scores. Only in the SLE group, PLR was significantly increased with disease activity ( P < .001), while LMR showed a significant decrease ( P = .016). Conclusions: Clinicians must pay close attention to complete blood count (CBC) analysis and its various derived ratios to better characterize the activity of rheumatological disorders and anticipate the disease course and prognosis.

Background: Candida albicans has emerged as an important nosocomial pathogen. The morbidity and mortality associated with this pathogen are related to the presence of virulence genes and antifungal resistance. The objective of the present study was to investigate the prevalence of antifungal resistance, biofilm formation and some virulence genes such as ALS1, PLB1, INT1, SAP1 and HWP1, among clinical isolates of Candida albicans recovered from immunocompromised patients. Methods: The study included one hundred C. albicans isolates identified phenotypically and by a molecular technique using Polymerase Chain Reaction (PCR). The identified C. albicans was further subjected to antifungal study by the microdilution method, biofilm study and molecular study for virulence genes by PCR. Results: The resistance to antifungal drugs, fluconazole, caspofungin and itraconazole was 8% for each of them and for amphotericin B, it was 9%. The prevalence of the studied virulence genes was HWP1 77%, INT1 72%, ALS1 65%, SAP1 65% and PLB1 52%. The biofilm capacity was identified by the microplate method in 58% of C. albicans. The OD was intense in 20 isolates, moderate in 21 isolates and mild in 17 isolates. There was a statistically significant increase in the prevalence of the studied virulence genes INT1, ALS1, HWP1, SAP1 and PLB1 among biofilm forming C. albicans as compared to non-biofilm forming isolates (P=0.0001). Additionally, the resistance to fluconazole, itraconazole and caspofungin was statistically, significantly higher in C. albicans with the capacity to form biofilm as compared to non-biofilm forming C. albicans. Conclusion: The present study highlights the prevalence of resistance to antifungal drugs among C. albicans which are not uncommon. Moreover, there was a high prevalence of INT1, ALS1, HWP1, SAP1 and PLB1 genes in C. albicans. The resistance to antifungal drugs was common among isolates with the capacity to form the biofilm. There was an association between the biofilm formation and virulence genes.

Introduction Patients with burn wounds are more susceptible to develop healthcare associated (HA) infection. Bacterial isolates from HA burn wound infection vary from one place to the other and also differ in terms of antimicrobial susceptibility pattern. The aim of our study was to assess the incidence of HA burn wound infection, risk factors and to determine the microbiological profile and antimicrobial susceptibility pattern of isolated pathogens. Methods This was a one-year retrospective descriptive study conducted between January 2017 and December 2017, in Al-Babtain Burn and Plastic Surgery center, Kuwait. The identification of bacterial isolates was conducted by conventional biochemical methods according to standard microbiological techniques and commercially available kits using analytical profile index procedure. Results Total body surface area >35% affected and length of stay more than 14 days were statistically significant risk factors for HA burn infection (RR of 10.057 and 5.912, respectively). Analysis of microbiological profile of these positive cultures indicated that the most common isolated organism was Acinetobacter baumannii followed by Klebsiella pneumoniae. Multidrug resistant organisms composed 65.85% of the positive isolates. Vancomycin, tigecycline, teicoplanin and linezolid showed 100% effectiveness for all Gram positive isolates. For Gram negative organisms, imipenem and meropenem showed 38.71% and 41.93% efficacy, respectively. Conclusion Identification of antimicrobial susceptibility patterns helps to tailor the required antibiotic policy to minimize the acquired infections among these vulnerable patients.

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