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Resistance to carbapenems has been increasingly reported from the Enterobacteriaceae family, with different mechanisms in different geographic parts of the world. This study investigated the mechanisms of carbapenem resistance in Escherichia coli, Klebsiella pneumoniae and Enterobacter spp. carried out as a multicentre study (n = 10). All third-generation cephalosporin-resistant E. coli, K. pneumoniae and Enterobacter spp. that had been recovered from the selected provinces were included. Modified Hodge test and Carba NP test were done as a phenotypical method for detection of carbapenemase; the most common carbapenemase was detected by PCR. We evaluated the presence of an active efflux pump by using cyanide 3-chlorophenylhydrazone. Overexpression of AcrA/B and presence of OqxAB was detected by real-time PCR and conventional PCR respectively. Microorganisms in this study included 58 E. coli, 95 K. pneumoniae and 60 Enterobacter spp. Modified Hodge test showed a sensitivity of 41% and a specificity of 83%, and the Carba NP test showed a sensitivity of 26% and a specificity of 92% for detection of carbapenemase. OXA-48 was the most frequently detected carbapenemase, followed by NDM-1. Thirty-nine percent and 27% of positive cyanide 3-chlorophenylhydrazone test organisms included active AcrA/B and OqxAB efflux pumps respectively. The result showed the Carba NP test was more specific than MHT. Data confirmed the involvement of AcrA/B and OqxAB efflux pump as a carbapenem resistance mechanism in selected bacteria. Similar to other reports from the Middle East, we found OXA-48 and NDM-1 to be the most frequent carbapenemase.Throughout the year 2019, Nigeria had sporadic outbreaks of yellow fever (YF), which began in the northern region of the country. Indeed, controlling the bites and population of Aedes mosquitoes and vaccination are the only effective means of preventing YF. Vectorial migration, sylvan-to-urban spillover, immunization failure and, perhaps, genetic modification of YFV could be reasons for the re-emergence of YF at the community, state and national levels. This article offers a critical review of the vector biology, YF vaccine immunodynamics and environmental drivers of YFV infections, with the aim of understanding the interplay of these factors in the re-emergence of YF and risk assessment of living in or travelling to areas where YF is endemic.Pulmonary carcinoids originate from neuroendocrine cells of the lung and comprise 0.5%-5% of all lung malignancies. Endobronchial carcinoids are rare, low-grade malignant tumors that occasionally coexist with other infectious diseases, including tuberculosis and nontuberculous mycobacterial infection. We treated a 63-year-old woman who presented with a right middle lobe obstruction. A chest computed tomography scan demonstrated a mass-like lesion in the right middle lobe with mediastinal lymphadenopathy. She underwent an exploratory operation after 2 weeks of antibiotic treatment. The pathology revealed a right middle lobe bronchial carcinoid tumor and aspergillosis. Chest computed tomography scans have revealed no recurrence of the carcinoid or aspergillosis during the 5-year follow-up.

Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients.

Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Patients were followed up for outcome until 30 September 2020. None of the patients received prophylactic anti-tubercular drugs. Proven diagnosis of active TB was considered if

(MTB) was cultured from clinical samples or acid-fast bacilli (AFB) or MTB demonstrated on Ziehl-Neelsen (ZN) staining or histopathology or XPERT MTB, while probable diagnosis of TB was considered if histopathology findings were suggestive of caseation necrosis/epithelioid cell granulomas without any evidence of malignancy or lymphocyte rich exudative effusions (pleural/pericardial) without an alternative cause.

Among 381 alloSCT recipients, 15 patieneatment of TB is the key in AlloSCT recipients, especially in endemic TB populations.Angiolipoma are benign tumors composed of mature adipocytes ad mixed with abnormal vascular elements. It reportedly accounts for 0.1-0.5% of all spinal axis tumors in adults and is extremely rare in children. This article describes a case of spinal extradural angiolipoma in a 35-year-old man, who presented with paraplegia and sphincter disorders, the MRI showed extradural spinal lesions at the level of T7 to T10, that squeezed the spinal cord. We attained total resection without any further neurological complication. The diagnosis of SEALs initially can be challenging radiologically since they may imitate other spinal lesions. The gold standard treatment modality should always be surgery, however in some cases, total resection can not be done.

Superior mesenteric artery syndrome is a rare entity, caused by compression of the duodenum between the superior mesenteric artery and the aorta.

A 16-year-old male in the inpatient service of our hospital complained of vomiting for two weeks. The patient had a long hospital stay in our center for the management of trauma-related complications, which resulted in significant weight loss despite the parenteral nutrition as he was unable for taking the enteral nutrition due to severe facial traumatic injury. In oral contrast study, the proximal duodenal segments were dilated. The contrast media could not reach the duodenojejunal junction in the supine position, though a small amount of the contras passed the distal duodenal part on repositioning the patient to prone. Bafilomycin A1 cost On abdominal CT images, the angle and distance between the superior mesenteric artery and the abdominal aorta were decreased to 20. 8

, and 7.3 mm respectively. The findings were consistent with the superior mesenteric artery compression syndrome are nonspecific, which may underestimate the diagnosis. However, clinical suspicion supported by imaging study may help the accurate diagnosis. Superior mesenteric artery syndrome should be considered in all polytrauma and longstanding immobile patients present with rapid weight loss and vomiting.

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