Effect of esomeprazole on maternal serum soluble fms-like tyrosine kinase-1 and endoglin in patients with early-onset preeclampsia

Objective: This study evaluates the effect of esomeprazole on the maternal serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) in patients with early-onset preeclampsia.Methods: A randomized, double-blind, placebo-controlled trial was carried out in a tertiary University hospital between March 2018, and September 2019 (Clinical Trials.Gov: NCT03213639). The study included women between 28 and 31+6 weeks gestational age who had been diagnosed as preeclampsia without severe features. They were randomly assigned in a 1:1 ratio into an esomeprazole group, which received esomeprazole 40 mg orally once a day, and a placebo group, which received one placebo tablet daily. Blood samples were obtained to assess levels of serum sFlt-1and sEng using ELISA testing. The primary outcome was the difference between the mean serum level of sFlt-1 and sEng at the start of treatment and at the termination of pregnancy in both groups.Results: Eighty-eight patients were randomly assigned into both groups (44 in each). No statistically significant difference was found in the levels of sFlt-1 between both groups at admission and termination of pregnancy. The number of days of treatment for the esomeprazole group was slightly longer than the placebo group (11.4±9.4 vs. 10.3±6.3 days, P=0.515). No statistically significant difference in the rate of maternal and fetal complications occurred between the two groups. No side effects from the study medications were reported.Conclusions: Esomeprazole, at the dosage used in this study did not effectively lower the serum levels of sFlt-1 and sEng in patients with early-onset preeclampsia. Furthermore, it did not prolong the duration of pregnancy, nor did it decrease maternal or fetal complications

BLOOD LIPID DISORDER IN MEN WITH INCREASED WAIST CIRCUMFERENCE COMPARED TO MEN HAVING NORMAL WAIST CIRCUMFERENCE WITHIN THE SAME CATEGORY OF BMI

Background: No local studies have been performed yet to investigate the influence of central or abdominal obesity on serum lipids in men having increased Waist Circumference (WC) compared to men with normal Waist Circumference values within the same BMI (Body Mass Index) category. Objective:To examine whether the prevalence of dyslipidemia, (defined as Hypercholesterolemia (Total Cholesterol level ≥240 mg/dl), high LDL-C level (≥160 mg/dl), low HDL-C level (<35 mg/dl), or Hypertriglyceridemia (TG level ≥200 mg/dl)), is higher in men having high Waist Circumference compared to others with normal WC values within the same BMI category. Methods: The study was conducted between September 2013 and July 2014. Eighty-eight overweight men (BMI = 25-29.9) were grouped by WC as follows: 28 with high values (>102 cm) and 60 with normal values (≤ 102cm). Blood samples were drawn and assayed for total cholesterol, triglyceride, HDL-C, and LDL-C,at the department of Laboratory in the Faculty of Public Health, Lebanese University. All assays were performed by enzymatic colorimetric methods using Hitachi-704. Results: Overweight men with high WC values (according to cutoff points internationally adopted) were the most likely to have dyslipidemia with its subsequent increased health risk compared with those having normal WC values. Conclusion: we showed in this study that the prevalence of dyslipidemia in men with high WC values is greater compared to those with normal WC values within the same BMI category. This finding leads us to the importance of the incorporated evaluation of WC in addition to the BMI in clinical practice

BLOOD LIPID DISORDER IN MEN WITH INCREASED WAIST CIRCUMFERENCE COMPARED TO MEN HAVING NORMAL WAIST CIRCUMFERENCE WITHIN THE SAME CATEGORY OF BMI

Background: No local studies have been performed yet to investigate the influence of central or abdominal obesity on serum lipids in men having increased Waist Circumference (WC) compared to men with normal Waist Circumference values within the same BMI (Body Mass Index) category. Objective:To examine whether the prevalence of dyslipidemia, (defined as Hypercholesterolemia (Total Cholesterol level ≥240 mg/dl), high LDL-C level (≥160 mg/dl), low HDL-C level (<35 mg/dl), or Hypertriglyceridemia (TG level ≥200 mg/dl)), is higher in men having high Waist Circumference compared to others with normal WC values within the same BMI category. Methods: The study was conducted between September 2013 and July 2014. Eighty-eight overweight men (BMI = 25-29.9) were grouped by WC as follows: 28 with high values (>102 cm) and 60 with normal values (≤ 102cm). Blood samples were drawn and assayed for total cholesterol, triglyceride, HDL-C, and LDL-C,at the department of Laboratory in the Faculty of Public Health, Lebanese University. All assays were performed by enzymatic colorimetric methods using Hitachi-704. Results: Overweight men with high WC values (according to cutoff points internationally adopted) were the most likely to have dyslipidemia with its subsequent increased health risk compared with those having normal WC values. Conclusion: we showed in this study that the prevalence of dyslipidemia in men with high WC values is greater compared to those with normal WC values within the same BMI category. This finding leads us to the importance of the incorporated evaluation of WC in addition to the BMI in clinical practice

Optimization of a PID Controller within a Dynamic Model of a Steam Rankine Cycle with Coupled Energy Storage

Fusion energy is an appealing option for future energy generation, but also presents unique design challenges. The UK Atomic Energy Authority is leading the Spherical Tokamak for Energy Production (STEP) programme to build a fusion power plant capable of net electricity generation. This work addresses the use of dynamic models in an optimization framework for the design of the thermal power generation cycle for STEP. The optimization of a proportional-integral-derivative controller regulating the power output of a steam Rankine cycle with a coupled thermal energy storage system is presented. A lumped-parameter dynamic model of the system has been implemented. The effectiveness of a controller design is evaluated by simulating the system under a perturbation to the power demand on the system. By minimizing the mean absolute power deviation, there is a reduction of 97 % compared to the initial controller design, as well as a reduction of 95 % in the maximum absolute power deviation and a faster return to setpoint. The optimized design does introduce more oscillations in the system, which are undesirable for control systems and are challenging for the optimization procedure

Modified plastic optical fiber coated graphene/polyaniline nanocompositefor ammonia sensing

In this paper, a side polished multimode plastic optical fiber gas sensor coated with graphene/polyaniline nanocomposite is developed for ammonia gas sensing application. Graphene/polyaniline nanocomposite is deposited onto side polished plastic optical fiber by drop-casting method. The proposed sensor is exposed to different concentration of ammonia varies from 1% to 0.25 % at room temperature. Absorbance response of the gas sensor is monitored and recorded using spectrophotometer system. The absorbance increase linearly with the increase in the ammonia concentrations. The response and recovery time are 24 s and 71.8 s, respectively

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Public health utility of cause of death data : applying empirical algorithms to improve data quality

Background: Accurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. Incorrectly or vaguely assigned deaths, defined as garbage-coded deaths, mask the true cause distribution. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. We identify the pattern of garbage-coded deaths in the world and present the methods used to determine their redistribution to generate more plausible cause of death assignments. Methods: We describe the methods developed for the GBD 2019 study and subsequent iterations to redistribute garbage-coded deaths in vital registration data to plausible underlying causes. These methods include analysis of multiple cause data, negative correlation, impairment, and proportional redistribution. We classify garbage codes into classes according to the level of specificity of the reported cause of death (CoD) and capture trends in the global pattern of proportion of garbage-coded deaths, disaggregated by these classes, and the relationship between this proportion and the Socio-Demographic Index. We examine the relative importance of the top four garbage codes by age and sex and demonstrate the impact of redistribution on the annual GBD CoD rankings. Results: The proportion of least-specific (class 1 and 2) garbage-coded deaths ranged from 3.7% of all vital registration deaths to 67.3% in 2015, and the age-standardized proportion had an overall negative association with the Socio Demographic Index. When broken down by age and sex, the category for unspecified lower respiratory infections was responsible for nearly 30% of garbage-coded deaths in those under 1 year of age for both sexes, representing the largest proportion of garbage codes for that age group. We show how the cause distribution by number of deaths changes before and after redistribution for four countries: Brazil, the United States, Japan, and France, highlighting the necessity of accounting for garbage-coded deaths in the GBD

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The burden of unintentional drowning: Global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

__Background:__ Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. __Methods:__ Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. __Results:__ Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. __Conclusions:__ There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low-and middle-income countries

Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015 : findings from the Global Burden of Disease 2015 study

To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. A total of 1.4 million CVD deaths (95% UI: 1.3-1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.Peer reviewe