The aim of this study was identifying bacterial pathogens involved in meningitis, studying their antibiotic resistance profiles, investigating the antibiotic resistance genes as well as evaluating the use of various antibiotic combinations. Antibiotic susceptibility tests were evaluated according to CLSI guidelines. Antibiotic combinations were evaluated by calculating the Fractional Inhibitory Concentration (FIC) index. A total of 71 bacterial isolates were recovered from 68 culture positive CSF specimens. Sixty five of these isolates (91.5%) were recovered from single infection specimens, while 6 isolates (8.4%) were recovered from mixed infection specimens. Out of the 71 recovered isolates, 48 (67.6%) were Gram-positive, and 23 (32.4%) were Gram-negative. Thirty one of the Gram positive isolates were S. pneumoniae (64.6%, n = 48). Out of the recovered 71 isolates; 26 (36.6%) were multidrug-resistant (MDR) isolates of which, 18 (69.2%) were Gram-negative and 8 (30.8%) were Gram-positive. All MDR isolates (100%) showed resistance to penicillin and ampicillin, however, they showed lower resistance to meropenem (50%), levofloxacin (50%), amikacin (48%), pipercillin-tazobactam (45.8%). Most common antibiotic resistance genes were investigated including: tem (21.1%), shv (15.8%), ctx-m (15.8%) coding for TEM-, SHV, CTX-M extended-spectrum beta-lactamases (ESBLs), respectively; aac(6')-I b(26.3%) coding for aminoglycoside 6’-N-acetyltransferase type Ib ciprofloxacin resistant variant; and qnrA (5.3%) gene coding for quinolone resistance. The DNA sequences of the respective resistance genes of some selected isolates were PCR amplified, analyzed and submitted to the GenBank database under the accession numbers, KX214665, KX214664, KX214663, KX214662, respectively. The FIC values for ampicillin/sulbactam plus cefepime showed either additive or synergistic effect against ten tested Gram-negative MDR isolates, while doxycycline plus levofloxacin combination revealed synergism against two MDR Gram-positive isolates. The results indicate high prevalence of antibiotic resistance among MDR isolates. Therefore, new guidelines should be implemented in Egypt to rationalize the use and avoid the misuse and abuse of antimicrobial agents.

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BackgroundCardiovascular diseases (CVDs) are a major cause of morbidity and mortality in patients with end stage renal disease (ESRD). Circulating endotoxins may have toxic effect on myocardial functions and are speculated as pathogens of accelerated atherosclerosis and hemodialysis (HD) patients.ObjectiveWe aimed to assess the possible relation between circulating endotoxin levels and left ventricular functions parameters, common carotid artery intimal media thickness (CIMT) in prevalent HD patients.Patients and MethodsForty stable prevalent HD patients with mean age (47.97 ± 14.42) year using regular conventional hemodialysis sessions in Ain shams university hemodialysis unit, Cairo, Egypt were randomly selected. Diabetics, congestive heart failure and those with history of myocardial infarction or coronary artery disease were excluded from the study. All patients were studied by CBC and routine chemistry, as well as hs CRP, Intact PTH, lipid profile and endotoxin level by ELISA before and after the HD session, Delta change of endotoxin (pre dialysis endotoxin-post dialysis endotoxin) was calculated, resting Doppler echocardiographic and carotid duplex.ResultsMean of Pre-HD session serum endotoxin level was (0.356 ± 0.090) EU/mL and the mean of post -HD endotoxin levels was (0.367 ± 0.110) EU/mL. Significant positive correlation between post dialysis endotoxin, MV E/A ratio and grades of left ventricular diastolic dysfunction (P < 0.05) and significant correlation between delta change in endotoxin and EF% (r = −0.36,P = 0.02). By stepwise linear regression analysis for determinants of MVE/A post –HD endotoxin level independently associated with MV E/A ratio (ß = 0.350, P = 0.027). We did not detect any significant correlation between CCA atherosclerosis and neither pre nor post- HD endotoxin level nor with delta change of pre and post HD endotoxin levels.ConclusionAcute increase in post dialytic circulating endotoxin level in prevalent HD patients may be associated with both left ventricular systolic and diastolic dysfunction and that attempts to reduce endotoxin level may have a positive impact on cardiovascular complications in HD Patients.

Background Several SARS-CoV-2 variants with increased transmissibility and/or potential immune escape have emerged and rapidly spread worldwide. Ongoing surveillance analyses are performed worldwide to designate new variants of concern (VOC) of coronavirus. Main text This report identifies the first Egyptian patient with a confirmed SARS-CoV-2 omicron variant. The patient showed positivity on reverse transcriptase-polymerase chain reaction and full genome sequencing was performed to confirm the variant. The mutations found in the variant were compared with the GISAID reference strain hCoV-19/Wuhan/WIV04/2019. Genome BLAST showed the highest similarity to omicron variants isolated in South Africa. Phylogenetic analysis revealed that the variant belongs to the 21K clade. Conclusions The study indicates the importance of information-sharing among global public health partners. Moreover the importance of implementation of full genome sequencing to rapidly identify and track the new SARS-CoV-2 variants.

Three mature male ruminally canulated sheep were fed at 90% of their ad libitum intake. The three control rations, one from each tested roughage were formulated along with concentrate feed mixture CFM at the commonly practiced ratio being: 30% rice straw RS + 70 CFM 30% maize stalks MS + 70 CFM 40% clover straw CS + 60 CFM With the objective of increasing the use of roughage, six tested diets were formulated two from each roughage by almost doubling their ratio as in the respective control diets and reducing the traditional CFM as a protein supplement to less than one half by either quality soybean meal SBM ,10% or equivalent urea U, 1.2% as follows: 1. 60 % RS + 30% CFM + 10% SBM 2. 60 % RS + 38.8% CFM + 1.2% U 3. 60 % MS + 30% CFM + 10% SBM 4. 60 % MS + 38.8% CFM + 1.2% U 5. 75 % CS + 17% CFM + 8% SBM 6. 75 % CS + 24 % CFM + 1.0% U These proportions were chosen to achieve iso-nitrogenous diets containing about 12% CP necessary for optimal utilization and fermentation of roughages in the rumen rskov et al., 1972.The in situ dry matter disappearance DMD values increased significantly P<0.01 when feeding on CS than MS or RS 50.63, 40.24 and 34.17%, respectively and the neutral detergent fiber disappearance NDFD% increased significantly P<0.01 when feeding on CS than MS or RS 29.81, 28.48 and 27.49%, respectively. The acid detergent fiber disappearance ADFD% followed the same trend of NDF disappearance %. The potential degradability a+b of DM for CS and MS were higher P<0.01 than RS 56.72, 56.37 and 54.08, respectively. The potential degradability a+b of NDF for MS was higher significantly P<0.01 than RS and CS (53.32, 48.32 and 37.91%, respectively). The potential degradability (a+b) of Mehrez, A.Z. et al. 6760ADF for MS and RS were higher (P<0.01) than CS (55.64, 55.08 and 47.05, respectively).The mean rumen volatile fatty acids (VFA) values increased significantly (P<0.01) when feeding on MS than CS or RS (9.30, 8.68 and 8.5 ml Eql/100 ml RL, respectively), and the concentration of NH3 was higher (P<0.01) when feeding on MS than CS or RS (18.86, 16.4 and 15.71 mg/100 ml RL, respectively).The DMD% increased significantly when added CFM+U than CFM+SBM or CFM (42.85, 41.93 and 40.26, respectively). The NDFD and ADFD% followed the same trend in DMD (29.74, 28.36 and 27.69, respectively), and (35.97, 35.08 and 34.91, respectively). The potential degradability (a+b) of DM increased significantly (P<0.01) when added CFM+U or CFM+SBM than CFM (56.83, 56.65 and 53.69%, respectively). The potential degradability (a+b) of NDF increased significantly when added CFM+SBM than CFM+U or CFM (48.4, 46.59 and 44.63%, respectively). The potential degradability (a+b) of ADF increased significantly when added CFM+SBM than CFM or CFM+U (56.75, 51.65 and 49.37%, respectively). The buffering capacity (BC) values increased significantly (P<0.01) when added CFM+U than CFM or CFM+SBM (11.03, 10.26 and 9.64 ml Eq./100ml RL, respectively). The VFA values were increased significantly (P<0.01) when ...