Objectives: To identify and test the antibiotic susceptibility of nosocomial coliform bacilli and investigate the presence of oqxA and oqxB genes among the multidrug-resistant (MDR) phenotypes. Methods: One hundred and twenty different healthcare-associated infection samples were collected. Coliform bacilli were isolated, identified by conventional methods, and then antibiotic susceptibility tests were done using the VITEK2 system and disk diffusion methods. OqxAB operon was identified using a conventional PCR-based technique. oqxA and oqxB genes were compared between MDR Klebsiella pneumonia (K. pneumonia) phenotypes and MDR Escherichia coli (E. coli) phenotypes. Besides, oqxAB operons were compared between phenotypes of K. pneumonia and E. coli isolates. Results: Seventy coliform bacilli were isolated with the predominance of K. pneumonia and E. coli. Besides, 82.1% of K. pneumonia strains and 53.3% of E. coli isolates were MDR phenotypes. Significant more oqxB genes alone were found in MDR E. coli than that in MDR K. pneumoniae phenotypes (χ²=10.160, P=0.003). OqxAB operon was significantly more in MDR phenotypes of E. coli than that in the susceptible phenotypes (P<0.001). There was significantly less of this operon in susceptible E. coli isolates than that in susceptible K. pneumoniae isolates (P<0.001). OqxAB positive isolates that were also resistant to fluoroquinolones, tetracycline, trimethoprim, and chloramphenicol, most probably suggested functional pumps. Conclusions: MDR coliform bacilli are strongly implicated in healthcare-associated infection. Attention should be paid to the presence of oqxAB pump, as an important mechanism in the development of resistance against many antimicrobials because it contributes to co-resistance with other categories; therefore, this pump could be a good target for efflux pump inhibitors.

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Sandfly fever is a febrile emerging arboviral illness which is a huge threat posed to public health. Sandfly fever viruses (Sicilian, Naples, and Toscana) are endemic to the Mediterranean region. Evidence suggests an increase in the activity of sandfly-borne phleboviruses and their extension to other places. The infection is relatively benign but may cause severe clinical manifestations and complications. Sandfly fever viruses belongs to the genus Phlebovirus (family Bunyaviridae), and the four main serotypes include sandfly fever Sicilian virus, sandfly fever Naples virus, sandfly fever Cyprus virus, and Toscana virus. Sandfly fever has flu-like symptoms such as fever, headache, photophobia, malaise, myalgia, and retro-orbital pain. The incubation period of the disease is 4-8 days, and the patient usually recovers within a week. The first infection provides the host with immunity. Sandfly fever viruses are transmitted through the bites of infected female sandflies, thus, the epidemiology of sandfly fever is closely related to the presence and activity of sandfly species that act as the vectors for transmission. Cases and outbreaks of the disease have been reported worldwide for more than 100 years. All in all, this disease is important for non-endemic countries because it is a travel-related and/or imported illness.

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Rationale: Diffuse unilateral subacute neuroretinitis is a form of posterior uveitis and has a few clinical presentations according to the onset of presentation. Patients’ concern: A girl (5-year-old) and 2 boys (both 12-year-old) were included in this report. Upon presentation, the visual acuity ranges from 6/12 to 6/60. All three cases had different symptoms (case 1: floaters; case 2: eye redness and pain; case 3: central scotoma). All of them had variable posterior uveitis features (case 1: vitritis and focal retinitis; case 2: subretinal larva track; case 3: choroiditis). Diagnosis: Diffuse unilateral subacute neuroretinitis. Intervention: All 3 patients were treated with oral albendazole. Outcome: All patients showed remarkable resolution of inflammatory reactions of the eye and also improvement of vision. Lesson: High index of suspicion should be made for children and young adults who are previously healthy but presented with suddenly onset of reduced vision with clinical features of posterior uveitis of variable degree. Clinical features together with a full blood picture can help to diagnose the problem when other parameters are negative.

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Rationale: Clinicians encounter multiple alcohol-related illnesses in practice, and Marchiafava-Bignami disease is a rare and devastating entity among them. It is a toxic-demyelinating disease and seen in chronic alcoholics, although it may be occasionally observed in chronically malnourished teetotalers. The clinical presentations are diverse. The symptoms and signs are non-specific, and the onset can be acute or chronic. Patient’s concerns: A 45-year-old right-handed patient suffered from alcohol use disorder with multiple non-specific neuropsychiatric manifestations. Diagnosis: Marchiafava-Bignami disease. Interventions: Thiamine, folate, vitamin B12, and steroid therapy. Outcome: The patient’s behaviour was significantly improved but dysarthria and pyramidal signs persisted. He was left with permanent cognitive impairment. Lessons: Though prompt therapy may halt the demyelinating process in this disease, the treatment remains a challenge in clinical practice. The recognition of the neuro-radiologic features is crucial to establish an early diagnosis.

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Rationale: Chronic myeloid leukaemia is a myeloproliferative disorder due to clonal hyperproliferation of myeloid cells within the bone marrow. It can present both pro- and anti-thrombotic states. CML has different presentations within the gastrointestinal tract. Patient’s concern: A 40-year-old non-diabetic and non-hypertensive male complained of abdominal pain with nausea and emesis for 1 day. Besides, he had a history of abdominal distension and fever for 1 day. Diagnosis: Acute small bowel gangrene due to chronic myeloid leukaemia. Intervention: A limited resection of small intestine with ileostomy and mucus fistula. Outcome: After 3 months following surgery the patient underwent stoma closure. The patient was followed up for more than 3 years postoperatively. During the follow-up, the patient was asymptomatic without any recurrence of the disease. Lesson: Chronic myeloid leukaemia should be considered as one of the causes for small intestine gangrene when there is increased leukocyte count, splenomegaly without evidence of atherosclerotic occlusion or systemic emboli from the heart.

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Objectives: To determine the predictive value of lactate dehydrogenase (LDH) in diagnosis of septic shock and its association with other prognostic scores in critical pediatric patients. Methods: A cross-sectional study was performed at Children’s Hospital of Cairo University between June 2019 and December 2019. A total of 200 pediatric patients were divided into the septic shock group [100 critically ill patients with septic shock from the pediatric intensive care unit (PICU)] and the control group (100 patients with only sepsis). LDH was determined in the first 24 hours of admission. The sensitivity and specificity of LDH in diagnosis of septic shock were assessed; the levels of related indicators of patients with different etiologies were compared; correlations between LDH, Paediatric Index of Mortality Π, and Pediatric Sequential Organ Failure Assessment (PSOFA) were analyzed. Results: LDH was 512 μL (406.50-663.00) in the septic shock group and was significantly higher than that (190 μL, range 160.00-264.50) in the control group (P<0.001). Besides, median LDH in children with chest infecion was higher than that in children with other diagnoses (P=0.047). A good positive correlation was found between PSOFA and LDH (r=0.503, P<0.001). Conclusions: LDH could be a potential inflammatory marker in diagnosis of septic shock and is valuable for PICU admission decisions.

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Objective: To determine if there was any difference in SpO₂ readings during exchange blood transfusion (EBT). Methods: A prospective cross-sectional study of neonates with severe neonatal jaundice requiring EBT was conducted. Oxygen saturation was recorded before, immediately and 15 minutes after EBT by using a pulse oximeter. Results: This study included 30 neonates with 20 males and 10 females. The age ranged from 1 to 12 days with a mean of (5.4 ±2.9) days. Pre-EBT SpO2 ranged from 90% to 98% with a mean value of (94.3 ± 2.2)%; SpO₂ in the end of EBT ranged from 85% to 99% with a mean value of (94.1 ± 3.2)%; SpO₂ at 15 minutes after EBT ranged from 77% to 99% with a mean value of (94.8 ± 4.1)%. There was no significant difference between SpO₂ values at onset of EBT and either immediately or 15 minutes after EBT (P=0.770 and 0.422, respectively). SpO₂ showed no significant difference between neonates who were infused with blood of different storage times (<24 h or ≥24 h) at the onset of EBT (P=0.584), immediately (P>0.999) and 15 minutes after EBT (P=0.887). Besides, SpO₂ values were compariable in neonates with hematocrit <45% or ≥45% at the onset of EBT (P=0.284), immediately (P=0.118) and 15 minutes after EBT (P=0.868). Conclusions: EBT does not affect SpO₂ in neonates.

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Heart diseases are common life-threatening acute diseases. They are leading causes of mortality worldwide, especially significant in developed countries. Other than medications for therapies and prophylaxis, special treatment considerations with implantable cardiac devices are important to reduce mortality and medical disability. This paper aims to review indications, contraindications, efficacy, complications, and generic considerations of several commonly implanted cardiac devices including pacemakers, cardiac resynchronization devices, implantable cardiac defibrillators, left atrial appendage occlusion watchman devices, and ventricular assist devices. As various implantable therapeutic cardiac devices are sometimes carried in the bodies of patients with cardiac disease, practitioners of various specialties should be familiar with different cardiac devices on the management of different cardiac conditions while providing holistic care.

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