Introduction/Objective Warm autoantibodies are usually IgG-class and/or IgA-class immunoglobulins. may be classified as agglutinins or hemolysins, which may be incomplete or complete, depending on in vitro serology; they almost always bind complement. Autoimmune hemolytic anemia with only warm IgM autoantibodies is extremely rare. Methods A 91-year-old Caucasian male with hypertension presented with non-productive cough for two weeks, associated with shortness of breath and fatigue. He has a paste history of medical history of high degree AV block with sick sinus syndrome and bradycardia. Results He had blood pressure of 111/53 and heart rate of 50. Laboratory investigations showed leukocytes count of 7, Hemoglobin level of 5.6 g/dl, hematocrit level of 15.5%, platelets count of 267, total bilirubin of 5.6 mg/dL, direct bilirubin of 0.7 mg/dL, and lactate dehydrogenase (LDH) of 372 U/L and IgM titer for Mycoplasma pneumoniae was 1493 units/mL (Ref < 770). He was transfused four units of packed red blood cells as emergency release due to a positive antibody screen. His hemoglobin level increased from 5.6 g/dL to 7.2 g/dL then it decreased from 8.2 g/dL to 5.6 g/dL the next two days. Direct antiglobulin test was 3+ positive for C3d and Negative for IgG. He finished a 7-day course of antibiotic treatment. The results the Cold-agglutinin titer and thermal amplitude test were suggestive of an IgM warm autoantibody and a cold agglutinin of a moderate titer. The results exclude a diagnosis of cold agglutinin syndrome. Conclusion Mycoplasma pneumonia is mainly associated with cold agglutinin syndrome but it is very rare to be associated with WAIHA. WAIHA with a DAT positive for C3 only is relatively rare with an incidence ranging between 6% and 13% and can have a clinical picture ranging from mild to severe anemia. Severe symptomatic hemolysis can be treated with Rituximab, cytotoxic agents or plasmapheresis.
Introduction/Objective Bacterial adaptation to antibiotics has been very successful. Over the past decade, the increase in antibiotic resistance has generated considerable medical problems. UTIs are one of the most common community-onset infections. The emergence of resistance to all classes of antibiotics in previously susceptible bacterial pathogens is a major challenge to infectious disease medicine. Thus, it is important that we forcefully implement strategies to reduce the rate of appearance and spread of resistant bacteria to allow new drug discovery to catch up with bacterial resistance development. Objectives: Methods The aim of this study is to predict the percentage of urine cultures antibiotic resistance in patients with UTIs in Egypt. Subjects and methods: A total of 200 subjects were enrolled in this study from The Delta region in Egypt; 38% males and 62% females with a median age of 39 years and 35 years respectively. Identification of the isolated organisms was identified by the cultural characters (Morphological characters of the purified bacterial isolates were carried out according to the colony characters, Gram stain reaction and biochemical tests for each organism using a standard semi-automated technique Results 98 cultures (49%) were observed to have resistance to 3- 5 classes of antibiotics including, 98% Cephalosporins, 85% β-lactam inhibitors and 71% fluoroquinolones; 66 females (57 gram -ve stain and 9 gram +ve stain) and 33 males (27gm -ve stain, 6gm +ve stain). 82 cultures (41%) were not resistant to any classes.; 32 males (28 gram -ve stain and 3 gram +ve stain) and 50 females (45 gram -ve stain and 5 gram +ve stain). 19 cultures (9.5%) were observed to be resistant to all antibiotics.; 12 males (11 gram -ve stain and 1 gram +ve stain) and 7 females (2 gram -ve stain and 5 gram +ve stain). Conclusion This study highlights the highest antibiotic resistance associated with urinary tract infection in Egypt as well as the classification of the organisms. The high resistance percentage is due to the overuse of antibiotics by public and inappropriate antibiotic prescribing. Antibiotics are unregulated and available over the counter without a prescription in Egypt which makes it easily accessible. We recommend regulating the use of antibiotics and lunch antimicrobial stewardship programs in Egypt.
Introduction/Objective Women with diabetes mellitus (DM) are more susceptible to vulvovaginal candidiasis (VVC) than non-diabetics. This could be due to higher glucose levels predisposing VVC by damaging basic host defense mechanisms and stimulating Candida adhesion to vaginal cells. Objectives Investigating the prevalence of Candida albicans and biofilm formation in diabetic and nondiabetic IUD users. Methods/Case Report A total of 325 vaginal swabs and IUDs were enrolled in this study from the Delta region in Egypt. Females with a median age of 17 to 45 years were divided into two groups; diabetic (29.8%) and nondiabetic (70.1%). They were all vaginitis having one of these symptoms; irritation on the surface of the genital tract, uterine cervix ulcer, vaginal bleeding, and acute vaginal exudates. C. albicans were isolated and identified using cultural characters. Biofilm formation by Candida on removed IUDs and swabs was examined by XTT-reduction assay, scanning electron microscope (SEM), and transmission electron microscope (TEM). Antifungal susceptibility to fluconazole and amphotericin B (AMB) to isolated strains and in vitro experimental biofilm formation was performed. Results (if a Case Study enter NA) In diabetic cases, the highest percentage (91.1%) of isolated C.albicans was found among patients with irritation on the surface of the genital tract, whereas the lowest one (83.3%) was in the symptoms of acute vaginal exudates. In nondiabetic cases, the highest percentage of isolated C.albicans (51.7%) was found among patients with symptoms of acute vaginal exudates. In contrast, the lowest one (32.5%) was in the symptoms of irritation on the surface of the genital tract. XTT method illustrated the biofilm formation; SEM revealed a heterogeneous thick biofilm. Biofilm MIC to strains with AMB >1μg\ml was considered resistant, while those for which AMB concentration were ≤1μg\ml were deemed sensitive. Strains with Fluconazol 64 μg\ml were considered resistant, while those for which Fluconazol concentration was ≤8 μg\ml were deemed sensitive. Conclusion There was a significant direct relationship between diabetic cases and C.albicans prevalence in the current study. Furthermore, the ability to form biofilm was found to be the same in diabetic and nondiabetic patients.
Introduction/Objective Employee engagement is one of the most critical elements for the success of any organization. Proper engagement of the employees often leads to the success of an organization, while poor employee engagement often leads to the failure of an organization. Diversity is the presence of differences within an organization, such as differences in race, ethnicity, gender, sexual orientation, disability, or any other number of things. Inclusion is the practice of ensuring that people feel a sense of belonging and support from the organization. Methods/Case Report A retrospective study was performed at a mid-size hospital in California. The overall employee engagement score was recorded twelve months before and after founding a diversity and inclusion council. The diversity and inclusion council consisted of 12 members from all different races and gender, sexual orientations, disabilities, and socioeconomic status includes clinicians, administrators, and employees from all different hospital departments. On top of the 12 councils, nine Employee Resources Groups (ERG) represent minorities and underrepresented groups. Results (if a Case Study enter NA) The employee engagement score for 12 months (January 2019 to December 2019) for fully engaged employees was 29.5%, while the employee engagement score for 12 months (January 2020 to December 2020) for fully engaged employees was 49.3. The diversity and inclusion council was founded at the end of 2019. The data was obtained from the annual employee engagement survey. Conclusion There was a significant improvement (59.8%) in employee engagement score after launching the diversity and inclusion council. Diversity and inclusion promote the development and advancement of underrepresented groups in the laboratory through professional development courses and training. It actively creates a productive work environment within the laboratory that is free of harassment and bullying. Diversity and inclusion are vital for the laboratory to improve employee engagement scores, production, employees retentions, and laboratory financial performance.
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