Background:The polymyxins including colistin are the "last resort" antibiotics for treatment of infections with carbapenem resistant Enterobacteriaceae. Recently, transferable colistin resistance mediated by the mcr-genes has been described in Enterobacteriaceae. The testing of colistin susceptibility is challenging. The aim of the work is to detect the occurence of mcr-1 and mcr-2 genes in phenotypically colistin-resistant carbapenem resistant Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates using conventional polymerse chain reaction (PCR). Methods: One hundred and sixteen carbapenem-resistant E.coli and K.pneumoniae isolates were collected from patients admitted to different wards of Suez Canal University Hospitals (SCUHs) in Ismailia. Urine, endotracheal aspirates, blood, pus and sputum specimens were collected from different patients. Minimal inhibitory concentration (MIC) by broth microdiluton method was done to assess phenotypic colistin resistance. The colistin resistant E.coli and K.pneumoniae isolates were tested by conventional PCR to detect plasmid mediated mcr-1 and mcr-2 genes. Chi-square test was applied and p-value < 0.05 was considered statistically significant. Results: Forty three isolates out of 116 carbapenem resistant isolates (37.1%) were colistin resistant as shown by MIC by broth microdiluton method. The 43 colistin resistant E.coli and K.pneumoniae isolates were tested by conventional PCR to detect plasmid mediated mcr-1 and mcr-2 genes. Two mcr-2 genes and one mcr-1 gene were detected. Conclusion: Results revealed that the prevalence of colistin resistance among carbapenem-resistant E.coli and K.pneumoniae in SCUHs is concerning; further limiting potential therapeutic options. Plasmid mediated colistin resistance genes mcr-1 and mcr-2 is emerging in SCUHs which refer to a problem in the hospital as by horizontal transfer of this plasmid, the resistance can spread to many isolates in the hospital.

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Nasal carriage of Staphylococcus aureus (NCSA) is frequent in patients with allergic rhinitis (AR). Allergen immunotherapy is safe and effective in the treatment of AR. Objective: The present work aims to assess the effect of NCSA on the clinical response to immunotherapy (IT) in AR patients. Methodology: Assessment of symptom severity was done by visual analogue scale in 25 NCSA-positive and 25 NCSA-negative AR patients. Patients were treated by cluster IT for 8 weeks after which symptom severity was reassessed. Results: Before IT, NCSA-positive patients showed significant increase in rhinorrhea, sneezing, and nasal blockage than NCSA-negative patients. No significant difference was observed in non-nasal symptoms or total symptom severity scores. After IT, there was no difference in the severity of nasal and non-nasal symptoms between the two groups. Clinical improvement was more noticeable in NCSA-positive than NCSAnegative patients; however, the difference is non-significant. Conclusion: NCSA does not affect the clinical response to immunotherapy in AR patients.

Introduction: Fluoride varnish is quickly and easily applied without the need for bulky mouth trays or suctioning of saliva. This is especially helpful for infants and toddlers. Aim: The aim of this study was to evaluate and compare the effect of three different fluoride varnishes (Durashield, Flour Protector and Bifluoride 10) on streptococcus mutans and lactobacillus count (in vitro study). Materials and methods: Total of 144 acrylic discs were divided into two main equal groups of 72 discs in each (group A: for examination of Streptococcus mutans and group B: for examination of Lactobacillus); each group was further subdivided into four equal subgroups based on the type of varnish applied to the disc surface (A1, B1: Durashield; A2, B2: Fl protector; A3, B3: Biflouride; A4, B4: untreated discs served as control). Saliva collected from single volunteer was poured into tubes until the discs were completely immersed and incubated for 24h, 48h and 5 days. Six discs from each subgroup were taken out from tubes every time and sonicated in saline. Suspensions were been plated on selective media for Streptococcus mutans and Lactobacillus. The numbers of colony-forming units (CFU/mL) on suitably diluted plates were been determined. Results: For all tested subgroups, the lowest amount bacterial count of Streptococcus mutans and Lactobacilluswas observed during the first 24 h, followed by a significant increase over the following 4 days. Biflouride subgroups had the lowest values of viable Streptocoocusmutans and Lactobacilluscounts during all test periods. In comparison Durashield with Flour protector subgroup difference of viable counts of streptocoocusmutans and lactobacillus was observed but statistically nonsignificant. Conclusions: Biflouridevarnish exhibited the greatest antibacterial effect (Streptococcus mutans and Lactobacillus) compared to Durashield and flour protector. Fluor protector varnish showed the same inhibitory effect of Durashildvarnish despite Flour protector had lower fluoride concentration than Durashield.

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