Background: To compare clinical outcomes and technical success when direct versus indirect revascularization was achieved after endovascular technique for critical limb ischemia patients with isolated below-the-knee lesions. Fifty patients were included, 34 male and 16 female, their age from 49 to 77 years (mean 63 ±16). All patients were subjected to infra-genicular angioplasty and divided into direct 28 (31 limbs) and indirect groups 22 (24 limbs). Antegrade approach through ipsilateral CFA was used in 48 patients, while retrograde approach through tibiopedal access was used in 2 patients. Diagnostic angiography was done for all cases and duplex ultrasound was used for follow-up. Results: One hundred thirty-two lesions were encountered, 46 in the ATA, 43 in PTA, 29 in peroneal artery, and 19 in dorsalis pedis artery. Transluminal approach was done in 47 limbs while subintimal cross was used in 8 limbs. After 1 year follow-up, AFS was 75% in the direct group and 67% in the indirect group. Freedom from MALE was 65% in the direct group and 55% in the indirect group. Freedom from MA was 86% in the direct group and 75% in the indirect group. Conclusion: When there is a choice of target artery for revascularization, preference should be given to the artery directly feeding the wound's angiosome.

Proteus spp. are widely distributed opportunistic pathogens that can cause various human infections. A total of 361 clinical specimens were obtained from patients who were attending to different hospitals in El-Minia governorate, Egypt. Approximately 23 % of the samples belong to Proteus spp. isolates which were obtained from various clinical sources. After biochemical identification, 42.1 % of isolates were found to belong to Proteus vulgaris and 57.8 % to P. mirabilis. The urine samples collected from catheterized patients represented 32.6 % of all the clinical specimens, and the majority of the recorded isolates were Proteus spp. The antibacterial sensitivity of the Proteus spp. was examined using 16 different antibiotics from various families. The most effective antibiotics were Amikacin; Levofloxacin, and Meropenem, recording 68.6 %, 66.2 %, and 62.2 % of the isolates sensitivity to each of these antibiotics, respectively. Using the ureR-based PCR, 48 % of the isolates were identified as P. mirabilis. Moreover, the Qnr genes (i.e., qnrA, qnrB, qnrS, qnrD, and qnrC) and the aac (6')-Ib-cr gene had been identified in 40 % of P. mirabilis isolates. The aims of the study were to investigate the prevalence of Proteus spp. in El-Minia, Egypt; determine the antibacterial susceptibility pattern of these isolates, and characterize the PMQR genes in Proteus spp. Quinolone resistance in P. mirabilis isolates might have been brought on by mechanisms other than qnr and aac (6')-Ib genes. Finally, since Proteus spp. are widespread in the environment; healthcare facilities must uphold stringent sanitation standards to reduce the incidence of the nosocomial infections.