Figure 1 A schematic diagram illustrating a systematic multipronged approach to address penicillin allergy delabelling in lowincome, low-middle-income and upper middle-income countries.

Objective: To determine the frequency and risk factors of fungal keratitis (FK) and the value of direct microscopy and PCR techniques of corneal smears as appropriate diagnostic methods. Methods: The keratitis cases in Ophthalmology Department of Zagazig University Hospitals, between January and June 2012 were enrolled. Corneal samples were examined by direct microscopic examination of wet mount preparation with KOH (10%), PCR technique and cultured simultaneously. The corneal smear and PCR findings were compared to the culture results to analyze specificity, sensitivity and predictive values of these techniques. Results: A total of 350 patients diagnosed as keratitis and 60 of them were included in the study by a systemic random sampling method. The FK was proven in 33 (55%) cases with culture results. Ocular trauma (63.6%) was the most prevalent predisposing factor. The cultures revealed that the most frequent fungal pathogen were Penicillium spp. (24.2%) followed by Aspergillus fumigatus (21.2%). Direct microscopic examination had a sensitivity of 100%, specificity of 66.7%, a positive predictive value (PPV) of 78.6% and a negative predictive value (NPV) of 100%. PCR had a sensitivity of 100%, specificity of 88.9%, a PPV of 91.7% and a NPV of 100%. Conclusion: Although, PCR is able to detect fungi in a high proportion of culture negative cases, it is difficult to be used as a routine diagnostic test due to the economic reasons. Therefore, we strongly recommend the use of direct microscopy of corneal smear as a rapid, economic and sensitive method for screening of FK.

hospitals are regional tertiary hospital that serves more than six governors providing service to a population of more than nine million people living in the east of Egypt. Control group: number and characters of control group were selected to adapt with age and sex for each cancer group. Cases: Patients included in this study attended Medical Oncology department for the period of June 2013 to June 2015 and were confirmed to have cancer, clinically, laboratory and radiologically. Inclusion criteria: Patients suffering from solid tumors where association with oncogenic infectious agent were suspected HCC, Urinary bladder cancer, Gastric carcinoma, Head and neck and cancer cervix Exclusion criteria: Patient suffering from hematological malignancies or other solid tumors. Further investigations were done to identify the causing infectious agent, if present. These investigations include:

Background: Sepsis is a global, life-threatening health priority. Blood culture is the gold standard of diagnosis of sepsis, however, it requires several days, which delays the diagnosis of the sepsis. Biomarkers could play a pivotal role in diagnosis, grading and predicting the outcome of sepsis. Objectives: To assess the potential role of C-reactive protein (CRP), procalcitonin (PCT) and presepsin for diagnosis, grading and predicting the prognosis of sepsis. Methods: The study included 28 patients diagnosed with sepsis, and 28 intensive care unit (ICU) patients presented by different presentations but with no sepsis. For patients with sepsis, APACHE II score was calculated, blood culture was done using BacT/Alert system, and Vitek 2 to identify bacterial isolates. For all subjects included in the study, quantitative measurement of CRP, PCT and presepsin were done using PA54 Specific Protein Analyzer, VIDAS ® immune-analyzer, and PATHFAST fully automated immunoassay analyzer, respectively. Results: APACHE II score positively correlated with PCT (p=0.026) and presepsin (p=0.034), but not CRP (p=0.291). Differences between cases and control group for the three biomarkers' levels were statistically significant (P value <0.001). For sepsis severity, there were significant increase in PCT and presepsin on admission (P value <0.001) among septic shock compared to sepsis cases. Procalcitonin was slightly superior than presepsin. Procalcitonin and presepsin showed statistically significant increase (P <0.001 & p=0.02 respectively) among died compared to survived subgroups. Conclusion: PCT and presepsin are reliable biomarkers for early diagnosis, grading and predicting of the prognosis of sepsis.

Introduction: Arthritic pain and impairment are all too prevalent with osteoarthritis (OA), the most common form of the illness. Numeric scoring systems can be used to assess knee osteoarthritis (OA) patients' levels of pain. Objective: This study aimed to evaluate the possible factors that increase pain and functional impairment in knee OA leading to increased VAS and WOMAC score. Patients and Methods: On 58 osteoarthritis patients, at Zagazig University Hospitals' Rheumatology and Rehabilitation Department, we conducted this cross-sectional trial. An extensive physical examination, a set of lab tests, and a series of X-rays were all performed on each patient. We utilized the WOMAC index from the Western Ontario and McMasters Universities as well as Visual Analogue Scale (VAS "0-10 cm") to assess functions and pain. For determining the severity, we utilized grading scale of Kellgren and Lawrence. Results: BMI, deformity, ESR, radiological grading are indicators of functional impairment and pain index among cases who had knee osteoarthritis. Conclusion: Presence of knee deformities and advanced X-ray grading were associated with higher pain score and more functional impairment, so we should prevent their progression. BMI is a main risk factor for higher pain scores and functional impairments.

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Background: Brain and acute leukemia, cytoplasmic (BAALC) gene is identified on chromosome 8q22.3 and implicated in normal hematopoiesis. BAALC gene overexpression is associated with poor outcome. Methods: We aimed to evaluate BAALC expression in de novo Egyptian acute myeloid leukemia (AML) cases and determine its prognostic value. We recruited 70 patients with de novo AML diagnosed and treated at clinical pathology and medical oncology departments, fulfilling inclusion criteria in our prospective study and evaluated BAALC expression level. Patients received induction therapy. The Institutional Review Board approved our study. Results: The mean age was 39.2 years ± 11.87, (18–60) with a male/female ratio of 3/2. The cutoff value of BAALC as a prognostic factor was 2.11 with sensitivity (86.1%), specificity (80%), positive predictive value (88.6%), and negative predictive value (76.2%.) ( P < 0.001), 43 (61.4%) patients had high BAALC expression. Seventy-two percent of patients in the low BAALC group achieved complete remission (CR) compared to 42.1% in high BAALC expression group ( P = 0.03). Patients with low BAALC (123.1 ± 4.9) had longer mean survival time than high BAALC group (45.85 ± 5.1) ( P = 0.000). Conclusion: High-BAALC expression is an adverse prognostic factor, with a higher risk of relapse, lower CR rates, and lower survival in Egyptian de novo AML patients.