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The present study was designed to investigate the prevalence of herpes simplex virus type-2 (HSV-2) in Egyptian patients with bladder cancer or cystitis and to evaluate the performance of different diagnostic HSV-2 assays. The study included 50 patients: 27 with bladder cancer (group I), 23 with cystitis (group II) and 20 subjects as controls (group III). HSV-2 DNA was detected using polymerase chain reaction (PCR) on bladder tissue and buffy coat cells (BCC). Electron microscopic studies (EMS) on BCC and ELISAs for IgM, IgG and specific glycoprotein G-2 (gG-2) IgG were performed. HSV-2 DNA was detected by PCR on bladder tissue biopsies in 29.6% and 21.7% of group I and II respectively and it was also detected by PCR on BCC in 22.2% and 21.7% of group I and II respectively. EMS revealed HSV like particles in 16.6% of cases. IgG, specific gG-2 IgG and IgM were detected in 30%, 16% and 6% of cases respectively. The different assays were evaluated in relation to PCR on bladder tissue biopsies. The gG-2-based ELISA and EMS on BCC were found to be highly specific (97.3% and 100% respectively), with similar low sensitivity of approximately 54%. PCR on BCC was the most sensitive assay. The association of HSV-2 with bladder cancer is suggested especially in schistosomal patients.

The infection control unit at the Theodor Bilharz Research Institute in Egypt describes how it responded to the challenge of changing a culture of infection control practice in the workplace. Improved disposal of healthcare waste, the introduction of hand hygiene facilities and the design of a central sterilisation unit are some of the measures being introduced to raise awareness of infection control in the institute. The team also found that mupirocin nasal applications on healthcare workers with Methicillin Resistant Staphylococcus aureus (MRSA) colonisation resulted in nasal carriage clearance.

Candida species resistant to fluconazole and voriconazole were screened for the presence of ERG11gene by polymerase chain reaction (PCR). Also, the association of this gene with the demonstration of Candida virulence factors; biofilm formation, phospholipase and proteinases activities were studied. A total of 61 Candida isolates were collected from urine specimens. Candida species were identified by API 20 C Aux test. Extracellular phospholipase, secretory aspartyl proteinase and biofilm formation were determined. ERG11 gene was detected by PCR. C. albicans was identified in 34.5%, C. glabrata in 29.5% and C. tropicalis and C. krusei in 18% each. Candida species was resistant to fluconazole and voriconazole in 55.7% and 27.9%, respectively. Seventeen (50%) of fluconazole resistant Candida isolates were sensitive to voriconazole. The most frequently Candida species revealed fluconazole resistance were C. glabrata (47.1%), C. krusei (29.4%), and C. tropicalis and C. albicans (11.8% each). Biofilm formation, phospholipase and proteinase activity were determined in 41.2%, 67.6% and 35.3% of fluconazole resistant Candida isolates, respectively. Erg 11 gene was determined in 82.4% of fluconazole resistant Candida isolates and prominent in C. glabrata (93.75%), followed by C. krusei (90%), C. tropicalis (75%) and C. albicans (25%). Erg 11 gene was detected in 64.7% (11/17) of fluconazole resistant-voriconazole sensitive Candida isolates. Regarding, correlation of Erg11 gene positivity and virulence factors among fluconazole resistant Candida isolates, 34.5% exhibited biofilm formation and 62.1% and 31% showed phospholipase and proteinase activities, respectively. There were statistically significant difference concerning the association of proteinase activities and Erg 11 gene expression among fluconazole resistance Candida isolates (P=0.04). The study emphasizes the high prevalence of Erg11 gene among fluconazole resistant Candida species. There was association between the proteinase activity, fluconazole resistance and the presence of Erg11 among Candida species. Voriconazole maintains better activity towards Candida species and represent an alternative therapy.

EDITORIAL SYNOPSIS Thirty-six patients with bilharzial hepatic fibrosis were investigated, and five other patients were studied before and after portacaval shunt operation. The liver parenchyma is well preserved in bilharzial hepatic fibrosis and this is reflected in the almost normal results of liver function tests. In 40% of the patients bromsulphalein was retained to an abnormal degree and retention was increased post-operatively in the patients studied before and after portacaval shunt operations. The increased retention of bromsulphalein was found to be the result of prehepatic factors, namely, diminished hepatic blood flow and increased systemic portal collateral circulation either singly or in combination.In schistosomal hepatic fibrosis the various liver function tests give normal or only slightly abnormal results, particularly in tests depending on alterations in the serum proteins; these are not specific for liver diseases. Most other liver function tests yield normal results except the bromsulphalein retention test. This fact stimulated us to search for factors other than liver cell dysfunction which might modify the results. PROCEDUREThirty-six patients with confirmed bilharzial hepatic fibrosis were studied. In addition to routine investigations, the icterus index, thymol turbidity, plasma proteins, and prothrombin activity were estimated.Bromsulphalein was injected intravenously in a dose of 2 mg./kg. body weight (Kolmer, Spaulding, and Robinson, 1952), and a sample of blood from the opposite arm was collected half an hour after the injection. Blood was then left to coagulate and serum was separated by centrifuging and 2 drops of a 10% solution of sodium hydroxide were added to the serum to bring out the colour. The amount of the dye retained in the serum was estimated by direct comparison with prepared standards. Retention of more than 10% of the dye was considered abnormal.The portal pressure was measured by the intrasplenic technique in all the patients, the hepatic vein was catheterized in 26, the pressures were recorded in all, and the hepatic blood flow was estimated in 15 of them by the bromsulphalein clearance technique.Liver biopsy specimens were obtained and examined in 28 patients.Various tests were carried out to prove and assess the degree of systemic portal collateral circulation. These included radiological examination of the oesophagus for oesophageal varices. Portal collateral veins on the anterior abdominal wall were sought and demonstrated in some patients by infra-red photography. Splenoportography was carried out in 34 patients to study the intra-abdominal portal collateral veins, and haemorrhoids were detected by proctoscopy.We also studied the results of bromsulphalein retention and other liver function tests in five patients with bilharzial hepatic fibrosis before and after portacaval shunt operations. RESULTSResults of bromsulphalein retention tests ranged from 2 to 36% of the injected dye. Normal values (up to 10%) were observed in 21 patients, while abnormal results rangi...

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