Background: Neonatal sepsis is a nuisance to clinicians and medical microbiologists, particularly those cases caused by Klebsiella pneumoniae. Thus, we aimed at investigating the profile and mechanisms of antibiotic resistance and the clonal relationships between K. pneumoniae isolated from neonates at the largest tertiary care hospital's neonatal intensive care units (NICUs) in Minia, Egypt. Methods: This study comprised 156 neonates diagnosed with culture-proven sepsis from February 2019 to September 2019, at a major NICU of Minia City. All K. pneumoniae isolates were collected and characterized by antimicrobial profile, resistance genotype, and pulsed-field gel electrophoresis typing. Results: Twenty-four K. pneumoniae isolates (15.3%) were collected out of the 156 sepsis diagnosed neonates. These samples showed extensive drug resistance (XDR) to most of the tested antimicrobials, except fluoroquinolones. All the K. pneumoniae isolates possessed bla VIM and bla NDM carbapenemase genes, while bla KPC gene was detected in 95.8%. Considering extended-spectrum β-lactamases genes, bla CTX−M was found in all the isolates and bla OXA−1 gene in 75% of them. The plasmid-mediated quinolone resistance gene qnrS, was predominantly found among our isolates in comparison to qnrB or qnrA. A moderate degree of clonal relatedness was observed between the isolates. Conclusion: To the best of our knowledge, this the first report of an alarming occurrence of XDR among K. penumoniae isolates recovered from neonatal sepsis in Egypt. Our data necessitate proper antimicrobial stewardship as the choices will be very limited.

Coronavirus disease 2019 (COVID-19) continues to spread rapidly all over the world challenging nearly all governments. The exact nature of COVID-19’s spread and risk factors for such a rapid spread are still imprecise as available data depend on confirmed cases only. This may result in an asymmetrically distributed burden among countries. There is an urgent need for developing a new technique or model to identify and analyze risk factors affecting such a spread. Fuzzy logic appears to be suitable for dealing with multi-risk groups with undefined data. The main purpose of this research was to develop a risk analysis model for COVID-19’s spread evaluation. Other objectives included identifying such risk factors aiming to find out reasons for such a fast spread. Nine risk groups were identified and 46 risk factors were categorized under these groups. The methodology in this study depended on identifying each risk factor by its probability of occurrence and its impact on viruses spreading. Many logical rules were used to support the proposed risk analysis model and represented the relation between probabilities and impacts as well as to connect other risk factors. The model was verified and applied in Saudi Arabia with further probable use in similar conditions. Based on the model results, it was found that (daily activities) and (home isolation) are considered groups with highest risk. On the other hand, many risk factors were categorized with high severity such as (poor social distance), (crowdedness) and (poor personal hygiene practices). It was demonstrated that the impact of COVID-19’s spread was found with a positive correlation with the risk factors’ impact, while there was no association between probability of occurrence and impact of the risk factors on COVID-19’s spread. Saudi Arabia’s quick actions have greatly reduced the impact of the risks affecting COVID-19’s spread. Finally, the new model can be applied easily in most countries to help decision makers in evaluating and controlling COVID-19’s spread.

Objective: The purpose of this study was to investigate the clinical significance of the platelet to lymphocyte ratio (PLR) and the neutrophil to lymphocyte ratio (NLR) in term neonates and its impact on management of Early-Onset Neonatal Sepsis (EOS).Materials and Methods: This prospective cross-sectional observational study was conducted with 40 term neonates diagnosed with EOS compared with 40 healthy controls. Exclusion criteria were prematurity, post- maturity, small or large for gestational age according to week of pregnancy, preeclampsia, gestational diabetes mellitus, chorioamnionitis, congenital major anomalies, and cyanotic congenital heart disease. Results: A total of 80 term neonates were included in the study. Of these, 40 were diagnosed with EOS and 40 were healthy controls. NLR and PLR as predictors of early-onset neonatal sepsis, sensitivity of NLR was 67% and PLR was 70% and specificity of NLR was 99% and PLR was 73% and PPV of NLR was 98%, PLR was 72%. There is a significant weak positive correlation between platelets and sepsis, significant fair positive correlation between WBCs and PLR with sepsis, significant moderate positive correlation between immature neutrophils, I.T and NLR with sepsis, finally a significant negative fair correlation between lymphocytes and sepsis.Conclusions: NLRs and PLRs were positively correlated with EOS in term neonates, and these ratios can be used as diagnostic adjunct tests for neonate EOS workups.

Liquorice is one of the commonly used herbs in the field of medicine due to its pharmacological activities. Among these activities, the anti-inflammatory and antiallergic activities that support its use in asthma. This study included 80 asthmatic patients who were classified into two groups, group 1 (Placebo group) maintained on inhaled corticosteroids (ICs in moderate to high doses) and long-acting beta agonist (LABA) and received starch capsule (500 mg starch) twice daily as placebo and group 2 (active treatment group) maintained on ICs (in moderate to high doses) and LABA and received liquorice extract capsule (500 mg equivalent to 100mg glycyrrhizin) taken twice daily. The efficacy of liquorice was measured by estimation of pulmonary function and blood eosinophils %. On the other hand, safety was assessed by blood pressure measurement and determination of serum potassium level. The results revealed that addition of liquorice capsules to ICs and LABA resulted in a non-significant improvement in blood eosinophils (P-value 0.754). However, it resulted in a highly significant improvement in Forced Vital Capacity (FVC) % and Forced Expiratory Volume1 (FEV1) % when compared to group 1 (P-value 0.031.and 0.040 respectively). Regarding liquorice safety, neither Blood pressure (systolic and Diastolic) (SBP and DBP), nor serum K level showed any significant change in patients received liquorice capsules. Conclusion: liquorice in the used dose significantly improved FVC % and FEV1 % but did not affect blood eosinophils. There was no significant effect on blood pressure and serum K level, so, this dose is safe with no observed side effects.

Background:Shoulder pain is the third most common musculoskeletal reason for seeking medical care. The diagnosis of Rotator Cuff Tendinopathy (RCT), with supraspinatus partial thickness tendon tears and tendonosis, constitutes more than 50% of adult cases presenting with shoulder pains at any time. Platelet rich plasma (PRP) injections are nowadays being used as an alternative for treating the tendinopathies, who have failed to be managed by conservative management.Objectives:This work aimed to asses the effect of PRP injection under musculoskeletal ultrasound (MSUS) guidance in patients with rotator cuff tendinopathy, and partial thickness tear in comparison with those who received a rehabilitation program only. Baseline assessment and after three months was done using clinical, functional and ultrasonographic evaluation.Methods:Our study included 60 patients with RCT diagnosed both clinically and by MSUS. Patients were divided into two groups (gI, gII); group I included 30 patients who received a Supervised Rehabilitation Program and group II included 30 patients who received PRP injection. Patients in both groups were assessed clinically, functionally [(VAS), (WORC) and (SPADI)] and sonographically at baseline and after 3 months. Rehabilitation Program included: hot packs, (TENS), and (therapeutic ultrasound). The Exercise Programs (supervised and home-based) were applied, including: (ROM, stretching and strengthening exercises of the rotator cuff and scapular muscles). PRP injection was prepared under complete sterile conditions by whole blood centrifugation with specific protocol; blood was centrifuged firstly at 1000 rpm for 10 minutes. The plasma was then transferred to a new glass tube and centrifuged at 3000 rpm for 15 minutes. Platelets will form a pellet at the bottom of the tube. Finally, a pure platelet rich plasma was obtained with a concentration 4 times greater than baseline. Ca gluconate was mixed with PRP (in a ratio of 0.3 ml ca gluconate/ml PRP) immediately before the injection. Under ultrasound guidance, 3ml PRP was injected slowly into the bursa without usage of local anesthetics prior to injection. Post injection, patients were advised to rest, use cold packs and were allowed to do light range of motion exercises 2–5 days post injection. Acetaminophen was allowed for intolerable post injection pain.Results:Statistical analysis was made to 60 patients. Intragroup analysis showed statistical significant difference in both groups at follow up compared to baseline regarding clinical, functional and radiological data. Intergroup analysis showed more significant results in PRP group regarding clinical assessment (p <0.0001), functional assessment (SPADI (PS, DS and total) and WORC scores (p <0.0001) and sonographic assessment in (subscapularis tendinopathy, supraspinatus tendinopathy, supraspinatus fibrillar tendon disruption and supraspinatus tendon thickness) (p <0.0001) and sonographic subacromial subdeltoid bursitis (p= 0.001).Conclusion:Single PRP injection is an effective mean of treatment o...