This article is the first to review published reports on the prevalence of multidrugresistant (MDR) gram-negative infections in Egypt and gain insights into antimicrobial resistance (AMR) surveillance and susceptibility testing capabilities of Egyptian medical centers. Materials and Methods: A literature review and online survey were conducted. Results: The online survey and literature review reported high prevalence of extendedspectrum β-lactamase (ESBL)-producing Enterobacteriaceae (19-85.24% of E. coli, and 10-87% of K. pneumoniae), carbapenem-resistant Enterobacteriaceae (35-100% of K. pneumoniae and 13.8-100% of E. coli), carbapenem-resistant Acinetobacter baumannii (10-100%), and carbapenem-resistant Pseudomonas aeruginosa (15-70%) in Egypt. Risk factors for MDR Gram-negative infections were ventilated patients (67.4%), prolonged hospitalization (53.5%) and chronic disease (34.9%). Although antimicrobial surveillance capabilities were deemed at least moderate in most centers, lack of access to rapid AMR diagnostics, lack of use of local epidemiological data in treatment decision-making, lack of antimicrobial stewardship (AMS) programs, and lack of risk prediction tools were commonly reported by respondents. Conclusion:This survey has highlighted the presence of knowledge gaps as well as limitations in the surveillance and monitoring capabilities of AMR in Egypt, with most laboratories lacking rapid diagnostics and molecular testing. Future efforts in Egypt should focus on tackling these issues via nationwide initiatives, including understanding the AMR trends in the country, capacity building of laboratories and their staff to correctly and timely identify AMR, and introducing newer antimicrobials for targeting emerging resistance mechanisms in Gram-negative species.

To compare the efficacy, cost effect and safety of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for distal ureteric calculi by evaluating stone-free rates, retreatment rates, need for auxiliary procedures, associated complications and technical consideration with respect to patient satisfaction. Patient and method: 70 patients with single unilateral radiopaque distal ureteric stone ranges from 0.8 cm to 1.2 cm in diameter and ≥1.5 cm in length were enrolled in a prospective randomized trial. Patients were randomized to undergo URS (35) or ESWL (35). The electromagnetic Dornier lithotripter S was used for ESWL and a semi-rigid Olympus ureteroscope, 7° direction of view, angled ocular,8.6/9.8 Fr. x 43 cm, 6.4 Fr. channel was used for URS. Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. Results: Patients in the ESWL group achieved a 77.1% overall stone-free rate (SFR) with a 74.3% retreatment rate and no auxiliary procedure was done. Complications occurred in 11.4% of patients treated with ESWL. Patients in the URS group achieved a 97.1% overall SFR with a retreatment rate of 8.6% and an auxiliary procedure rate of 100%. Complications occurred in 31.4% of patients treated with URS. Patient satisfaction was high for both groups, including 94.3% for URS and 77.1% for ESWL. ESWL were already at outpatient clinic so there were no admission or hospital stay. While in URS group patients admitted with mean hospital stay 1.6±0.5 day. Conclusions: In the treatment of large distal ureteral calculi ≥ 1.5 cm, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone-free rate and it provides immediate stone clearance with lower retreatment rates and higher patient satisfaction.

Background: Diagnosis of hepatic focal lesions could be done by magnetic resonance imaging (MRI) study especially when diffusion-weighted magnetic resonance imaging (DWI) is included in the imaging protocol with apparent diffusion coefficient (ADC) quantification. Several studies have demonstrated that combining DWI with ADC measurement plays an important role in the detection and characterization of hepatic focal lesions and differentiating hemangioma from hepatic deposits. Objective: The current study aimed at evaluation of the role of diffusion weighted imaging differentiating between hepatic hemangioma and metastasis (1-4 lesions in number) by diffusion weighted MRI in patient pathologically proved to have primary malignancy. Patient and methods: Fifty cases were included; patients referred to Radiology Department of Mansoura University Hospital. There were 33 females and 17 male patients with age ranged from 26 to 82 years. All patients were subjected to proper history taking and DWI MRI. This study was using a 1.5 T Philips Ingenia MRI scanner. Results: ADC had significantly lower values in patients with metastatic hepatic lesions with mean ADC 0.93 (SD 0.21) x10 -3 mm 2 /sec. ADC had significantly higher values in patients with hemangioma with mean ADC 1.96 (SD 0.31) x10 -3 mm 2 /sec. The mean ADC value in the metastatic group was statistically significantly lower compared to the hemangioma group. ADC had sensitivity and specificity of 100 % and 95.8% respectively, and an accuracy of 97.4% in differentiating between hemangioma and metastasis cases, when a cut-off value of 1.55 x 10-3mm2/s was applied. Conclusion: Combined qualitative and quantitative analysis of DWI and ADC values respectively can help in differentiation between hepatic hemangioma and metastatic deposits. Using DWI and ADC in conjunction with conventional imaging found to be a simple and non-invasive tool that aid in differentiation between hepatic hemangioma and metastatic deposits.