Background Hepatocellular carcinoma (HCC) remains a major health problem despite the emergence of several preventive and therapeutic modalities. HCC has heterogeneous and wide morpho-molecular patterns, resulting in unique clinical and prognostic criteria. Therefore, we aimed to study the clinical and pathological criteria of HCC to update the morpho-molecular classifications and provide a guide to the diagnosis of this disease. Methods Five hundred thirty pathologically analyzed HCC cases were included in this study. The clinical and survival data of these cases were collected. Results Hepatitis C virus is still the dominant cause of HCC in Egypt. Post-direct-acting antiviral agent HCC showed an aggressive course compared to interferon-related HCC. Old age, male gender, elevated alpha-fetoprotein level, tumor size, and background liver were important prognostic parameters. Special HCC variants have characteristic clinical, laboratory, radiological, prognostic, and survival data. Tumor-infiltrating lymphocytes rather than neutrophil-rich HCC have an excellent prognosis. Conclusions HCC is a heterogenous tumor with diverse clinical, pathological, and prognostic parameters. Incorporating the clinicopathological profile per specific subtype is essential in the treatment decision of patients with HCC. Trial registration This was a retrospective study that included 530 HCC cases eligible for analysis. The cases were obtained from the archives of the Pathology Department, during the period between January 2010 and December 2019. Clinical and survival data were collected from the patients’ medical records after approval by the institutional review board (IRB No. 246/2021) of Liver National Institute, Menoufia University. The research followed the guidelines outlined in the Declaration of Helsinki and registered on ClinicalTrials.gov (NCT05047146).

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Conflicting reports are available about the association between human parvovirus B19 (B19) infection and RA. Most studies were done in European and Asian countries, but only few studies were performed in Africa. Objectives: This study aimed to investigate the seroprevalence of parvovirus B19 infection in RA patients compared with healthy controls and to search for possible association of B19 viremia with disease activity and severity. Methodology: This case-control study was conducted on 50 RA patients who fulfilled the 2010 American College of Rheumatology/European League against Rheumatism classification criteria for rheumatoid arthritis and 30 matched healthy controls. All participants were examined for parvovirus B19 infection by serological detection of anti-B19 IgM and IgG by ELISA and B19 DNA by nested PCR. Results: Parvovirus B19 DNA was detected in 17 (34%) of patients While controls were (6.7%) with a significant difference (0.005). There was significant difference between patients and controls (P=0.007) regarding IgG anti-B19 antibody but not anti-B19 IgM (P =0.59). There was a significant association between B19 viremia and all activity parameters. B19 positive patients had higher levels of ESR and CRP, higher DAS28 scores and more affected joints than B19 negative patients with statistically significant differences. B19 positive patients had significantly higher levels of RF and anti-CCP. Furthermore, B19 positive patients were more likely to have joint erosion. Conclusion: This study revealed that parvovirus B19 infection may play a role in the aetiopathogenesis of RA.

Emerging of tigecycline resistant Acinetobacter baumannii (A. baumannii) is a critical global health problem as tigecycline is considered the last-line antibiotic for treatment of carbapenem resistant A. baumannii infections. Overexpression of efflux pumps is a leading mechanism of antibiotic resistance in A. baumannii. Objectives:Detection of the presence of three efflux pump genes; adeB, adeJ and adeG and determination of their expression level in Tigecycline Resistant A. baumannii collected from Benha University Hospital. Methodology: Thirty A. baumannii strains were collected and tested for antibiotic susceptibility. Presence of adeB, adeJ and adeG genes was detected by conventional PCR and their expression levels were assessed by RT-PCR. Results: Tigecycline susceptibility showed 60% (18/30) resistance and 40% (12/30) sensitivity. In tigecycline resistant strains, adeB gene was identified in 13/18 (72.2%) and adeJ gene in 12/18 (66.7%) with statistically significant association (P= 0.023). In tigecycline sensitive isolates adeB and adeJ genes were identified in 7/12 (58.3%) and 2/12 (16.7%) strains respectively. The adeG gene was not identified in any of the isolated strains. Combined adeB and adeJ genes were identified in 50% of tigecycline resistant isolates and only in 8.3% of (tigecycline sensitive) isolates with statistical significance difference (P= 0.018). Comparing adeB and adeJ gene expression revealed that transcription level was increased significantly and associated with tigecycline resistance. Conclusion: This study revealed wide spread of tigecycline resistant A. baumannii strains in Benha University Hospital and elucidated the significant role of (adeB and adeJ) genes in their emergence.

Background: Ascites is a recognized problem in patients with decompensated liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is a massive problem in patients who suffer from cirrhosis with ascites. Early bacterial detection allows great intervention to stop SBP. 16S ribosomal RNA (rRNA) is a universal gene used to detect different bacteria present within a sample. Objectives: This study aimed to evaluate the efficacy of broad range 16S rRNA gene polymerase chain reaction (PCR) in diagnosis of ascitic fluid (AF) infection. Methodology: Fifty cirrhotic ascitic patients were undergone to full history, clinical examination, laboratory tests including, AF specimens analysis for polymorph nuclear leucocytic (PMN) count, culture for bacteria and PCR-for DNA detection of bacteria. Results: Bacteria were separated from 21 (42%) of samples of ascitic fluid, and they were mainly Gram-negative bacteria. The sensitivities of culture for bacteria and PCR in diagnosing AF infection were 53% and 86% respectively, while the accuracies were 62% and 74% respectively relation with PMNL. Conclusions: Bacterial DNA in AF samples may be another method for diagnosis AF infection rather than bacterial culture and PMN count for early detection and treatment of AF infection. METHODOLOGY Patients:This cross-sectional study was conducted in Benha University and National Liver Institute, Menoufia University over the duration from April 2018 to October 2018 and included fifty patients with cirrhosis of liver and ascites. The study was confirmed by the Research Ethical Committee Menoufia University and an informed consent was obtained from each participant before enrollment in the research. The patients in that study with cirrhosis as detected by clinical methods and by laboratory investigations. Exclusion criteria included the presence of any clinical sign of infection and antibiotic intake within the preceding 2 weeks.Patients were classified into 2 groups depending on PMN count into:Group 1(SBP group): it included all cases with ascitic PMN ≥ 250 cells/mm 3 with +ve and -ve culture.Group 2 (Non SBP group): it included all cases with ascitic PMN < 250 cells/mm 3 .

Background: Acinetobacter baumannii (A. baumannii) is one of the most important nosocomial pathogen. With the introduction of colistin as a last resort in treatment of A. baumannii, resistant strains. Using combined antibiotics could increase the success of treatment and reduce resistance. Objectives: To assess potential in-vitro synergistic activity of colistin when combined with (vancomycin, teicoplanin, rifampicin, tigecycline, meropenem, amikacin, and ceftazidime) against colistin resistant A. baumannii (CRAB). Also, to screen the prevalence of plasmid mediated colistin resistance (mcr) genes (mcr-1 to mcr-5) in colistin resistant isolates. Methodology: A. baumannii strains were isolated from different microbial specimens. Antibiotic susceptibility testing was done for all isolates by disk diffusion method while broth micro dilution (BMD) was performed to determine colistin minimum inhibitory concentration (MIC). Genotypic detection of mcr genes was done using multiplex PCR. Checkerboard method was done to detect potential synergistic activities between colistin and other tested antibiotics against CRAB. Results: A total of 94 A. baumannii strains were isolated from 373 different clinical samples. Colistin resistance was detected in 44/94 (46.8%) of isolated A. baumannii. Only 2 out of 44 CRAB (4.5%) carried mcr-1 gene and neither of other mcr genes could be detected. All isolated CRAB were resistant to 7 tested antibiotics by BMD. But when colistin was included in a checkerboard pattern, colistin-based combinations with vancomycin, meropenem, rifampicin, teicoplanin and ceftazidime showed synergy in 93. 2%, 90.9%, 88.7%, 86.4% and 79.5% of isolated CRAB respectively. For both tigecyclin and amikacin more than 90% of CRAB showed indifference in combination with colistin. Conclusion: Further studies are needed to determine the ability of colistin based antimicrobial combinations as an alternative therapy to treat CRAB infections and confirm that synergy.