Background: Surgery of the brain tumors near eloquent areas carries the risk of either disabling neurological deficit or inadequate resection with bad prognosis in both situations. Awake surgery is the gold standard procedure for such lesions. However, it requires certain anesthetic drugs, advanced techniques, and trained teams that are not available in every neurosurgical institute. This work aims to evaluate safety, feasibility, and outcome of operating on patients with space occupying lesions near eloquent areas under scalp block being continuously examined by a neurologist through retrospective study of 20 cases with supratentorial lesions related to language or sensorimotor cortex. Results: There were 12 males and 8 females with mean age 36.8 years. Forty percent of patients were presented by motor weakness. Tumors were related to motor cortex in 11 patients and to language areas in 9 patients. Mean operative time was 210 min. Gross or near total resection was achieved in 15cases, four cases had subtotal resection and biopsy only was done in 1 case. Two patients suffered from intraoperative seizures and conversion to general anesthesia was required in one patient. Conclusion: Operating on tumors near eloquent brain areas under scalp block and continuous neurological examination during tumor resection proved to be effective in early detection and prevention of permanent major deficits especially in the developing countries with limited resources.

Hypervirulent Klebsiella pneumoniae is a highly pathogenic variant of Klebsiella pneumonae, which represents a global public health issue because it is very virulent and spreads easily. The objectives of this study were to assess the predominance of hvKp among health care-associated infections in intensive care units of Tanta University Hospital and to compare hvKp with classical K. pneumoniae (cKp) in terms of antibiotic resistance, virulence, and molecular features. The study included 300 patients suffering from HAIs from different ICUs of Tanta University Hospitals. K. pneumoniae isolates were identified and subjected to string testing and antibiotic susceptibility testing, and the tissue culture assay for biofilm formation and polymerase chain reaction (PCR) tests were performed for the identification of capsular genes (K1, K2, K57) and virulence genes (rmpA, rmpA2, iuc A). Fifty-seven K. pneumonaie isolates were isolated. A total of 21 (36.8%) of them were hvKp and 36 (63.15%) were cKp. Significantly higher antibiotic resistance was detected in the cKp group. There was a significant difference between biofilm formation between cKp and hvKp isolates (p < 0.004*). iucA, rmpA2, and K1 genes were significantly associated with hvKp. The string test shows 100% sensitivity and negative predictive value for the detection of hvKp. Consequently, using the string test alone for the screening of hvKp is required. However, combining aerobactin-positive with hypermucoviscous isolates while screening for hvKp is crucial.

It is crucial to identify Enterobacterales that produce carbapenemase to treat and manage hospital infections. The suggested techniques for their identification need a lengthy wait, technical knowledge, and training. Lateral flow immunoassays (LFIAs) provide a solution to these requirements. Thus, this study compared LFIA with phenotypic and genotypic tests for carbapenemase-producing bacteria. Fifty clinical isolates of carbapenem-resistant superbugs were examined. KPC, VIM, NDM, IMP, and OXA-48-like enzymes were evaluated and compared with phenotypic tests and LFIA. Regarding the phenotypic characteristics, the mCIM was positive in 37/50 (74%), and the eCIM was positive in 21/50 (42%). Regarding using LFIA, 41 out of the total isolates (82%) gave a positive red line with one or more of the tested genes. The most frequently detected gene was bla_NDM (27/50 (54%)), and the least detected one was bla_IMP (14/50 (28%)), which was in accordance with the PCR results. While investigating the accuracy of LFIA vs. PCR, it was found that LFIA had 100% sensitivity in the detection of the bla_NDM and bla_OXA genes, with 85.2% and 91.4% specificity, respectively, while for the bla_IMP, bla_KPC, and bla_VIM genes, the values were 91.7% and 92.1%, 94.1% and 90.9%, and 95.5% and 89.3%, respectively. The overall accuracy of LFIA ranged from 92 to 94%. Our comparison with molecular assays revealed remarkable agreement, so we propose that this test might be utilized as a supplementary tool.

Background Data: Posterior atlantoaxial fixation is indicated for C1-C2 instability or painful osteoarthritis. Different techniques were designed for atlantoaxial fixation as sublaminar wiring, transarticular screw fixation, and, recently, C1 lateral mass and C2 pedicle polyaxial screws and rod system. Purpose: To investigate the safety, advantages, and complications of posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws in C1-C2 instability. Study Design: A retrospective clinical case series. Patients and Methods: Fourteen consecutive patients, ten males and four females, with a mean age of 40.8±9.6 years were reported. All had traumatic C1-2 instability due to type II odontoid fractures and underwent posterior fixation with polyaxial C1 lateral mass and C2 pedicle screws. Nine patients suffered from motor vehicle accident (MVA) and 5 suffered from falls. All patients were neurologically intact except four patients who had neurological deficits. We used Japanese Orthopedic Association Score (JOA) for their functional evaluation. The average follow-up was 17±1.96 (range, 12–20 months). Operative time, operative blood loss, screw trajectory, screw length, and injury of neurovascular structures were reported. Fusion and construct stability were evaluated by plain radiography and/or CT. Visual Analogue Scale (VAS) of neck pain and JOA were used to evaluate the functional outcome. Results: The mean duration of surgery was 175.3±12.3 min. The mean blood loss was 553.6±106.5 ml and two patients required transfusion of one unit of blood. The mean length of C1 lateral mass and C2 pedicle screws were 30±1.6 mm and 16.4±1.8 mm, respectively. Correct screw placement and good stability were reported in all patients (100%) at the last follow-up. Mean neck pain on VAS was 2.8±0.8 and 2.3±0.5 at 6 and 12 months, respectively. The complications included moderate pain at iliac graft site for 3 months in 2 patients, pain and dysesthesia in C2 dermatome for 4 months in 3 patients, and superficial wound infection in 2 patients. Conclusion: Posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws is a safe and effective method in the treatment of traumatic atlantoaxial subluxation due to type II odontoid fractures. (2019ESJ176)