Background: The emergence of antibiotic resistance pathogen is an important health risk, usually gram-negative bacteria acquire resistance to antibiotics by the production of beta-lactamase enzyme, CTX-M-type enzymes are a group of class A extended-spectrum B-lactamases (ESBLs) that are rapidly Spreading among gram-negative worldwide. CTX-M-type ESBLs exhibit powerful activity against cefotaxime and ceftriaxone antibiotics but generally not against ceftazidime, in some geographical areas, CTX-M is now the most prevalent ESBLs in Enterobacteriaceae. There are 172 known variants of CTX-M genes identified until August 25, 2016. Objectives: This present study aims to identify the gene, namely: CTX-M, Responsible for extended-spectrum beta-lactamase (ESBL) among Enterobacteriaceae isolated from different samples of Sudanese patients in Shendi city (urine, pus, and wound). Methodology: 200 samples were identified as gram-negative bacteria. Identification of the isolates was done by using conventional biochemical methods, and ESBLs were screened according to (CLSI) guidelines. ESBLs Positive strains were tested for the presence of ESBL encoding CTX-M, Gene by using PCR with specific primers for the detection of CTX-M. Results: ESBL found to be higher in P. aeruginosa n=18(78.3%) Klebsiella spp n=45 (64.2%). Escherichia coli n=51(57.3%) Proteus n=8(53.3%) the total of ESBL from all gram-negative isolate represent n=122 (61%). The presence of the CTX-M, the gene was confirmed in n=57(46.8%) in all isolates. The CTX-M gene were detected in n= 17 (37.8%) Klebsiella spp, n=28(55%) of Escherichia coli, n=3(37.5%) in Proteus and n=9 (50%) in P. aeruginosa isolates. Conclusion: P. aeruginosa isolates represent a high percentage of ESBL producers followed by Klebsiella spp, then Escherichia coli and proteus spp CTX-M gen detected commonly in Escherichia coli followed by P. aeruginosa then Klebsiella spp and Proteus spp. The study concludes that the ESBL production within gram-negative bacteria was high and the CTX-M gene was spread in Shendi city.

Background: Inflammatory response had a role in cancer progression, presence of noticeable inflammation within the tumor and its margin may play an important prognostic role in colorectal carcinoma. Objective: The goal of the study is to estimate the classical H&E lymphocytes infiltration pattern, CD3, CD8 cells percentage, and their relation with surgical staging TNM. Materials and Methods: Thirty cases of colorectal carcinoma were collected from a privet lab in Baghdad from May 2021 to August 2021. The clinicopathological data were taken from patient’s reports. The pathological samples were taken from tumor invasive margin as paraffin blocks, for each block one H&E slide and two slides for immune staining for CD3, CD8. Results: The tumor size ranged from≤ 3-5cm, twenty-three cases (79%) were moderately differentiated adenocarcinoma, nineteen cases (65%) diagnosed as stage III. Tumor infiltrating lymphocytes (K-M) grade shows grade 1 in seventeen cases (59%), grade 2 in ten cases (34%), and grade 3 in three (7%) cases. Sixteen cases (55%) show high intraepithelial CD3, five cases (17%) show high intraepithelial CD8, four cases (14%) with low lymphocytes/stromal ratio, eighteen cases (61%) show moderate lymphocyte/stromal infiltration, and seven cases (24%) with high lymphocytes/stromal infiltration. there were significant statistical relations between intraepithelial CD3 and stromal CD3/CD8 ratio (p=0.010); intraepithelial CD3 cells and stromal/tumor ratio (p=0.024); intraepithelial CD8 cells and patient age (p=0.019); and between tumor size and stromal /lymphocytes ratio(p=0.025); no significant relation between K-M grade, intraepithelial cells, stromal/tumor ratio and TNM staging nor tumor grade. Conclusions: The relation between classical TNM staging and tumor infiltrating lymphocytes are independent; each one of them measures different aspect of cancer cells behavior, and both of them are important for patient prognosis. There is variation in tumor infiltrating lymphocytes, intraepithelial lymphocyte (CD3, CD8) which clarified by immune histochemical method. Automated calculation method (immunoscore) is superior.