Tumor necrosis factor alpha (TNF-α) is a proinflammatory cytokine with an important role in the pathogenesis of several diseases. Its encoding gene is located in the short arm of chromosome 6 in the major histocompatibility complex class III region. Most of the TNF-α gene polymorphisms are located in its promoter region and they are thought to affect the susceptibility and/or severity of different human diseases. This review summarizes the data related to the association between TNF-α gene and its receptor polymorphisms, and the development of autoimmune diseases. Among these polymorphisms the −308G/A TNF-α promotor polymorphism has been associated several times with the the development of autoimmune diseases, however some discrepant results have been recorded. The other TNF-α gene polymorphisms had little or no association with autoimmune diseases. Current results about the molecules controlling TNF-α expression are also presented. The discrepancy between different records could be related partly to either the differences in the ethnic origin or number of the studied individuals, or the abundance and activation of other molecules that interact with the TNF-α promotor region or other elements.

Patients infected with schistosoma frequently show a high seroprevalence of anti‐hepatitis C virus (anti‐HCV) antibodies. The aim of this study was to find the underlying reason for this phenomenon, and to examine a possible involvement of autoantibodies. Out of 2,400 Egyptian blood donors, 192 (8%) were anti‐HCV positive by ELISA. They were 133 males and 59 females with age ranging from 27 to 48 years. According to optical density ratio (ODR) of anti‐HCV antibodies, 96 cases were low positive (LP) with ODR (1–2) designated as group I, and 96 were high positive (HP) with ODR (≥2) (group II). Both groups were examined for quantitative HCV core antigen (HCVcAg), liver function (Albumin, ALT, AST) and anti‐Schistosoma mansoni (anti‐Sm) IgG. Group I cases were HCVcAg negative with normal liver function tests, and 44 of them were anti‐Sm positive. Ninety cases (93.75%) of group II were HCVcAg positive with markedly affected liver function tests and 72 cases were anti‐Sm positive. All group I cases were examined for autoimmune markers (ANA, AMA, SMA and LKM). In group I, 33 (75%) of anti‐Sm positive cases were positive for one or more of the autoimmune markers examined, while none of anti‐Sm negative was positive for any marker with significant difference between the two groups (P<0.0001). Our results primarily on blood donors indicate that LP anti‐HCV frequently represents false‐positive reactivity with a possible role of Sm‐induced autoantibodies in this phenomenon.

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Summary Background Healthcare-associated infection (HAI) is a major problem in healthcare facilities and is associated with increased morbidity and mortality and prolonged hospital stay. This study aims to determine the incidence rate, risk factors, and bacterial aetiology of HAI in a tertiary care hospital in Mansoura, Egypt. Methods This is a prospective observational study carried out over 12 months in different departments of Mansoura New General Hospital (MNGH). Data were collected from patient's records and laboratory results of the ongoing HAI surveillance program. Results The incidence of HAI was 3.7% among 6912 patients studied. The independent predictors of HAI were multiple devices (AOR=88.1), central venous catheter (CVC) (AOR=34), urinary catheter (AOR=28.9) and length of stay >20 days (AOR=3.1). Surgical site infections (SSI) were the most frequent (24%) followed by catheter associated urinary tract infections (CAUTI) (20%). The most frequently isolated pathogens were Klebsiella spp . (27.2%), and E. coli (18%). Conclusions HAI is a significant problem in MNGH. Klebsiella spp. were the predominant causative organisms of HAI, as has been described in other studies from developing countries.

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Candida albicans frequently cause oropharyngeal candidiasis in immunocompromised patients. As some of these isolates show resistance against azoles, the clinician is wary of initiating therapy with fluconazole (FZ) until a final susceptibility report is generated. We aimed to evaluate the efficacy of rapid flow cytometry (FCM) and disc diffusion (DD) methods in comparison to reference microdilution (MD) of Clinical and Laboratory Standards Institute (CLSI) method for FZ. Thirty seven Candida albicans isolates were tested by the three methods. By both MD and FCM, 26/37 (70.3%) were sensitive with minimal inhibitory concentration (MIC) ≤ 8μg/ml, 5/37 (13.5%) were susceptible dose dependant (S-DD) with MIC 16-32 μg/ml and 6/37 (16.2%) were resistant with MIC ≥64μg/ml. More than 92% of isolates susceptible to FZ by the MD were susceptible by the DD methods with good agreement (81.08%, P = 0.000). However, 4/5 isolates diagnosed as S-DD by MD were resistant by DD. Interestingly, the MIC by FCM at 4 h showed excellent agreement (95.59%, P = 0.000) to that obtained by MD method at 24 h. Overall, FCM antifungal susceptibility testing provided rapid, reproducible results that are valuable alternative to MD. The DD test is recommended as a simple and reliable screening test for the detection of susceptible Candida albicans isolates to FZ

Background:The frequency of nosocomial yeast infections has increased dramatically in the recent years. They are considered an important cause of morbidity and mortality in immunocompromised cancer patients. The majority of yeast infections are caused by Candida species. However, species like Trichosporon and Rhodotorula should be considered as possible infectious agents as well.Objectives: This study aimed at determining the prevalence of yeast species, their distribution among patients and the antifungal susceptibility profile at Oncology Center, Mansoura, Egypt.Methods: From December 2016 till November 2017, cancer patients who developed infective episodes two days or more following hospital admission were included in the study. Clinical samples were collected according to the site of infection using standard sterile procedures. Blood samples were cultured using the BACT-ALERT system. Fungal identification and susceptibility testing were performed by Vitek 2 system. Results:Eighty-seven fungal strains were obtained from our patients. A higher isolation rate was observed in urine samples (47.1%) followed by oropharyngeal (24.1%) and blood (21.8%) samples. The majority of the yeast species were Candida albicans (40.2%), C. tropicalis (14.9%), C. parapsilosis (9.2%), C. famata (6.9%) and C. guilliermondii (6.9%). Out of the 87 samples, 8 (9.2%) were resistant to fluconazole, 7 (8.0%) were resistant to flucytosine, 5 (5.7%) were resistant to voriconazole and amphotericin B, and no sample was resistant to caspofungin or micafungin. Conclusions:Vitek 2 system offers a novel method for the early identification and susceptibility testing of different yeast species. It helps to minimize the risk for emergence of resistant species and reduce mortality rates, particularly in cancer patients.

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