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Introduction: Pseudomonas aeruginosa is a common nosocomial pathogen with multidrug resistance (MDR) and virulence factors (VFs). This study assessed the VFs and their associations with MDR and non-MDR isolates. Methodology: One hundred clinical isolates were analyzed for 12 VFs, encoding genes, and phenotypic traits. Antibiotic resistance patterns and correlations between VFs and MDR were investigated. Results: Aztreonam showed the highest resistance rate among MDR (94.7%) and ceftazidime showed the highest resistance rate among non-MDR isolates (44.2%). Carbapenems demonstrated the greatest susceptibility. VF positivity rates included 91% for algD, 90% for lasB, 86% for toxA, 82% for exoS, 19% for exoU, 78% for aprA, 75% for plcH, 94% for pigment production, 93% for biofilm formation, 72% for hemolysin, 65% for lipase, and 36% for DNase. Strong biofilm formation correlated with algD and lasB (93%). Pigment production was linked with lasB and toxA (94%). Strong biofilm formation was significantly higher in MDR isolates and resistant strains, than non-MDR isolates. No significant differences in VFs were observed between susceptible and resistant strains for lasB, algD, toxA, plcH, exoU, or general biofilm production; except for strong biofilm formation. Certain VFs correlated with susceptible isolates: exoS with tobramycin, aprA with aztreonam and piperacillin-tazobactam, pigment production with imipenem, DNase with aztreonam and norfloxacin, and lipase with tobramycin and ceftazidime. Conclusions: P. aeruginosa isolates displayed diverse VFs, biofilm-forming abilities, and MDR profiles; with strong biofilm formation closely linked to MDR. Targeting biofilm-related genes (algD, lasB) could offer effective therapeutic interventions, helping mitigate MDR infections and improve clinical outcomes.

Introduction: Nowadays, treating serious infections caused by multi-drug resistant Gram-negative bacteria is best left to the antiquated medication \"colistin.\". There have been reports of colistin-resistant (Col-R) and heteroresistant (hR) MDR and XDR-GNB strains worldwide. Therefore, we aimed to ascertain the rate of colistin resistance, certain potential resistance mechanisms, and heteroresistance in colistin-susceptible (Col-S) clinical isolates. Methodology: Identification and Antibiotic susceptibility test (AST) for all isolates were determined by Vitek-2 automated system. The Col-S strains were evaluated for heteroresistance using the population analysis profiling (PAP) method, while the Col-R strains were tested for mcr-1 gene activity by combined disk test (CDT) and colistin minimum inhibitory concentration reduction (CMR) test. The efflux pump mechanism was identified using cyanide 3-chlorophenylhydrazone (CCCP). Results: Out of 60 isolates enrolled in the study, AST revealed that 60% were MDR-GNB and 40% were XDR-GNB. Ten isolates were colistin resistant (16.6%). The mcr-1 gene was detected in five (5/10) Col-R isolates by PCR. CDT test detected mcr-1 gene activity in four (4/5) of mcr-1 gene positive isolates, while CMR test detected all. Efflux pump inhibition by CCCP showed a reduction of MICs by ≥ 8-folds in four Coli-R isolates. The frequency of carbapenem resistance (CR) within Col-hR strains was 75%, while ESBL was 25%. Conclusions: The alarmingly high occurrence of colistin resistance and heteroresistance in hospital care settings is of major concern and necessitates a reassessment of recommended AST methods since it can result in colistin therapy failure.

One of the most intricate parts of the human body is the spine. It serves multiple purposes. It supports and helps the movement of the body. It carries the weight of the entire abdomen, the upper limbs, and the head. The aim of this study is to establish a feasible 3D finite element model of the lumbar spine using the finite element method route and validate it by comparing the simulation results with data from in vitro experiments. A lumbar spine (L1–L5) finite element (FE) model was developed, and it included posterior fixation of pedicle screws (PS) at the L3–L4 segment level. This FE study investigated the impact of the posterior PS fixation system on the lumbar spine’s biomechanics using different materials for the screw-rod fixation system. Using titanium and CFR-PEEK materials, the impact of a posterior PS fixation system on lumbar spine biomechanics was examined for all physiological motions. The CFR-PEEK fixation system showed a reduction in von Misses stress at all physiological motions and an increase in the range of motion, which will increase the patient’s daily life performance rate and decrease the possibility of screw loosening and adjacent segment degeneration. The study concludes that CFR-PEEK rods are an alternate rod material to prevent the drawbacks of rigid-type rod fixation. CFR-PEEK implants have excellent mechanical stability and load-bearing capacity, reducing the likelihood of implant failure and promoting effective fusion. Results demonstrate how CFR-PEEK rods may lessen implant-related issues such as adjacent segment degeneration and screw loosening. Clinically, this could result in better long-term results for patients having lumbar fusion, decreased rates of revision surgery, and increased postoperative mobility. 

Rheumatoid arthritis (RA) is a chronic inflammatory condition that impacts not only the musculoskeletal system but also various other systems in the body, including the cutaneous, ocular, respiratory, cardiovascular, and circulatory systems. MicroRNAs (miRNAs) are a class of naturally occurring and highly conserved transcripts that primarily function in the regulation of gene expression. They accomplish this by facilitating the degradation of messenger RNA (mRNA) or by repressing mRNA translation. miRNAs are well-known regulators of a variety of cellular processes. Therefore, we aimed to detect the impact of miR-155 rs767649 polymorphism on RA activity. This case-control study included 66 Egyptian patients with RA who visited Al-Zhraa University Hospital, Internal Medicine Department, Cairo, Egypt, and 50 apparently healthy control subjects matched for age and sex. The participants were subjected to full clinical evaluation, including assessments of the disease activity score (DAS), erythrocyte sedimentation rate (ESR), liver and kidney function, anti-cyclic citrullinated peptide antibody (anti-CCP), and miR-155 polymorphism using real-time polymerase chain reaction (PCR). In the RA group, the majority (98.5%) were female, with a mean age of 43 years, while in the control group, 94% were female, with a mean age of 43.4 years. Comparison of laboratory parameters indicated significantly lower hemoglobin levels, higher ESR, and higher serum creatinine and anti-CCP levels in the RA group than in the control group. The RA group had a significantly higher frequency of TT genotypes and significantly lower frequencies of TA and TT genotypes than the control group. Considering the TT genotype and T allele as references, TA, AA, and TA/AA genotypes in the dominant model; AA in the recessive model; and A allele were significantly associated with protective effects against RA development (p<0.05, odds ratio<1). rs767649, the functional variant of miR-155, plays an important role in susceptibility to the increased risk of RA, suggesting that miR-155 can be used as a therapeutic target for the treatment of Egyptian patients with RA.

Background To study the utility of interferon gamma (IFN-γ) as a differentiating biomarker by assessing the aqueous humour and serum of patients with infectious and noninfectious uveitis. Methods A total of 40 patients with acute uveitis were divided into 2 groups (18 patients with infectious uveitis and 22 patients with noninfectious uveitis). All the subjects underwent a full ophthalmological examination. Aqueous humour (AqH) and serum samples were collected from uveitis patients. The quantitative levels of IFN-γ in aqueous medium and serum were measured by means of an enzyme-linked immunosorbent assay (ELISA). Results The quantitative level of IFN-γ in the aqueous humour was significantly greater (87.5 ± 81) (pg/ml) in infectious uveitis patients than in noninfectious uveitis patients (37.3 ± 9.9) (pg/ml) ( p  value = 0.006). However, the serum IFN-γ level (pg/ml) did not significantly differ between these groups ( p  value = 0.279). Thus, the IFN-γ level in the aqueous humour can be used to discriminate between infectious and noninfectious uveitis with 33.3% sensitivity and 100% specificity. Conclusion Aqueous IFN-γ can be used as a biomarker for differentiating between infectious and noninfectious uveitis.

Objective A cohort study was conducted with the support of the WHO, where a standardized WHO protocol was followed to assess vaccine effectiveness (VE) against symptomatic RT‒PCR confirmed SARS‒CoV-2 infection among hospital health workers (HWs) eligible for vaccination at Al-Azhar University hospitals. Methods A WHO-supported cohort study was conducted from July 2022 through September 2023 and included 1249 HWs who were randomly selected and followed up biweekly for one year. At enrollment, nasopharyngeal (NP) and blood samples were collected from each participant and evaluated to detect SARS-CoV-2 RNA via a real-time PCR assay (QIAGEN) and for the quantitative detection of SARS-CoV-2 binding antibodies via the Roche Elecsys Anti-SARS-CoV-2 S immunoassay (Roche Diagnostics, GmbH, Germany). During follow-up, NP samples were collected from anyone who developed symptoms consistent with the WHO definition of suspected cases of SARS-CoV-2 infection. Results At enrollment, SARS-CoV-2 RNA was detected in 119/1235 (9.6%) HWs and 89% of the participants with positive RNA were asymptomatic. COVID-19-binding antibodies were detected among 1245/1248 (99.8%) HWs, and 53.2% of them had titers > 2500 U/mL, regardless of vaccination status. During follow-up, 232 participants had COVID-19 symptoms, but only 108 provided NP samples, and 18 (16.7%) of them were positive for SARS-CoV-2 RNA. No hospitalization or mortality was recordedat enrollment or during the follow-up period. The cumulative incidence of COVID-19 infection was higher among HWs with incomplete vaccination compared to unvaccinated, fully vaccinated, or those who received booster doses ( P  = 0.025). There was no significant difference in VE among HWs who were fully vaccinated or had booster doses compared with unvaccinated HWs, with adjusted VE values of 68% (95% CI -28–92%) and 64% (95% CI -170–95%), respectively ( P  = 0.106 and 0.318 respectively). The adjusted VE increased to 89% (95% CI -33–99%) among HWs with hybrid immunity compared with those who were unvaccinated with a previous COVID-19 infection ( P  = 0.082). Conclusion This study indicates that VE against symptomatic lab-confirmed SARS-CoV-2 infection was quite high with over 60% protection and was higher among HWs with hybrid immunity (immunity due to a combination of previous infection and vaccination) compared to unvaccinated HWs with previous COVID-19 infection. The findings also highlight the importance of completing the primary vaccination series against COVID-19. This study reveals a high rate of asymptomatic COVID-19, a lower rate of confirmed cases, who showed marked decrease in hospitalization and fatality rates. Real-world VE studies are essential to address several unresolved issues, such as the appropriate number of booster doses and the longevity of protection.