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IntroductionThe prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB.MethodsA one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance.ResultsDuring one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection.ConclusionExtensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.

Background This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO 2 ) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19). Methods In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO 2 and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate‑oxygenation (ROX) index by dividing the SpO 2 by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO 2 , CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC). Results We included 72 critically ill patients who tested COVID-19-positive. SpO 2 on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8–0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73–0.94, P < 0.0001). Conclusions A baseline SpO 2 ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.

Introduction Focal adhesion kinase (FAK) is a nonreceptor tyrosine kinase protein frequently overexpressed in cancer and has been linked to an increase in the stem cell population of tumors, resistance to therapy, and metastatic spread. Pharmacological FAK inhibition in pancreatic cancer has received increased attention over the last few years, either alone or in combination with other therapeutics including chemotherapy and immunotherapy. However, its prognostic value and its role in radioresistance of pancreatic ducal adenocarcinoma (PDAC) is unknown. Methods and materials Using the TCGA and GTEx databases, we investigated the genetic alterations and mRNA expression levels of PTK2 (the encoding-gene for FAK) in normal pancreatic tissue and pancreatic cancer and its impact on patient survival. Furthermore, we evaluated the expression of FAK and its tyrosine domain Ty-397 in three pancreatic cancer cell lines. We went further and evaluated the role of a commercial FAK tyrosine kinase inhibitor VS-4718 on the viability and radiosensitization of the pancreatic cell lines as well as its effect on the extracellular matrix (ECM) production from the pancreatic stellate cells. Furthermore, we tested the effect of combining radiation with VS-4718 in a three-dimensional (3D) multicellular pancreatic tumor spheroid model. Results A database analysis revealed a relevant increase in genetic alterations and mRNA expression of the PTK2 in PDAC, which were associated with lower progression-free survival. In vitro, there was only variation in the basal phosphorylation level of FAK in cell lines. VS-4718 radiosensitized pancreatic cell lines only in the presence of ECM-producing pancreatic stellate cells and markedly reduced the ECM production in the stromal cells. Finally, using a 3D multicellular tumor model, the combination of VS-4718 and radiotherapy significantly reduced the growth of tumor aggregates. Conclusion Pharmacological inhibition of FAK in pancreatic cancer could be a novel therapeutic strategy as our results show a radiosensitization effect of VS-4718 in vitro in a multicellular 2D-and in a 3D-model of pancreatic cancer.

Introduction Child sexual abuse (CSA) is a serious violation of human well-being and of the law. It is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races and socioeconomic classes. CSA is outlawed nearly everywhere in the world, generally with severe criminal penalties, including, in some jurisdictions, life imprisonment or capital punishment Aim of the study to examine the incidence, risk factors and pattern of sexual assault in children to provide grounds for effective preventive measures and to heighten awareness of the health professionals. Methods This is both retrospective and prospective study evaluating sexual assault against children that were referred to Medico-legal Office and violence against women and children clinic in the Medico-legal department of Ministry of Justice, Cairo, Egypt from 2012 to 2016. Results The total number of CSA cases was 740 in the age range from 1 to18 years, females 391 (52.8%) were more predominant than males 349 (47.2%). The age group from 11 to 18 years accounted for the highest rate (56%), mostly in females (62.6%). El-Salaam was the most common district of reporting cases of child sexual abuse (9.7%). Most CSA cases were committed by single perpetrator (87 %) and most perpetrators were non-relative (89.1%).The most frequently reported type of child sexual abuse was anal assault (55%). Physical violence (27.7%) was the most common threat used against child cases. Majority of cases were examined after the sexual assault by more than one week (40.4%). Ecchymosis (6.1%) was the most frequent wound seen upon examination of CSA cases. Head and neck were the most common site of traumatic lesions (5.1%). Conclusions Family doctors and other health professionals should be minded with suspecting signs of CSA and its short and long-term deleterious consequences to refer them to specialized authorities to overcome the delay of reporting and loss of forensic evidence.