HER2/neu expression status of post BCG recurrent non-muscle-invasive bladder urothelial carcinomas in relation to their primary ones

Background: Transurethral resection (TUR) followed by adjuvant therapy is still the treatment of choice of Non-Muscle-Invasive Bladder Urothelial Carcinoma (NMIBUC). However, recurrence is one of the most troublesome features of these lesions. Early second resection and adjuvant BCG therapy has been shown to improve the outcome. Objective: To evaluate the prognostic value of C-erbB-2 (HER2/neu) expression status in Non-Muscle-Invasive Bladder Urothelial Carcinoma cases, before and after intravesical Bacillus Calmette Guerin (BCG immunotherapy). Materials and methods: HER2/neu expression was studied in 120 (Ta-T1) Non-Muscle-Invasive Urothelial Carcinoma cases. The expression was evaluated and compared to the expression after Bacillus Calmette Guerin (BCG) immunotherapy. Results: HER2/neu expression in low and high grade of the Non- Muscle-Invasive Urothelial Carcinoma was (38%) and (83%) respectively. The difference of the expression rates by tumor grade was statistically significant. In recurring lesions post BCG therapy, C-erbB-2 expression was markedly decreased (31.6%) when compared to its expression before therapy (65%). Conclusions: The HER2/neu expression increased as the tumor grade rose. The reduction in expression following BCG treatment in Non-Invasive transitional cell carcinoma cases could reflect a reduction of the potential malignancy of the tumor

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Diagnostic value of immunopathology in malignant pleural tumors

Background Immunohistochemistry (IHC) plays a basic role in the diagnosis and differentiation of malignant pleural tumors (MPT). Objective To recognize histological types of MPT to enhance selection of IHC markers for final diagnosis and to simplify the panel of antibodies required. Patients and methods This study was conducted on 30 patients with histopathologically confirmed MPT of 73 patients having clinical and/or radiological evidences of pleural effusion with or without pleural-based masses. Pleural fluid cytology and histopathological examinations for pleural biopsy were done. IHC was performed for histopathologically confirmed MPT. Two mesothelial positive markers and two carcinoma positive markers were used to differentiate malignant mesothelioma (MM) from metastatic carcinoma. Results Histopathological examination demonstrated that MM with mixed pattern was suspected in 16.7%, metastatic adenocarcinoma with malignant glandular component was suspected in 50%, and undifferentiated carcinoma in 33.3%, with no sarcoma or sarcoma-like pattern. By IHC, MM was proved in 26.7% and metastatic carcinoma was proved in 73.3% of cases. Calretinin had 90.9% specificity and 87.5% sensitivity for MM. Hector Battifora mesothelial-1 had 100% sensitivity for MM, but it was also positive in 54.5% of metastatic carcinoma. Carcinoembryonic antigen had 100% specificity for metastatic adenocarcinoma. Ber-EP4 has no significant value to differentiate metastatic carcinoma from mesothelioma. Conclusion Although there was a difference in the sensitivity and specificity of IHC markers in differentiating MM and metastatic carcinoma, the panel of three markers can identify tumor type with epithelioid cell pattern with a high degree of confidence. Accurate clinical history and radiological examination provide guidance

Bronchoalveolar lavage in lung cancer: does it increase the positive yield of bronchoscopy?

Background Cells obtained from bronchoalveolar space can give a definite diagnosis in malignancies. The present study aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in lung cancer and to assess the relationship of its yield with radiology, endoscopy, and pathological subtypes. Patients and methods A retrospective study with re-revision of saved bronchoscopic video, computed tomography (CT) films, and pathology slides was conducted on 101 patients with definite bronchogenic carcinoma diagnosed over 4 years. Results BAL positive yield was found in 42.4% of cases, and its yield coincided with other bronchoscopic sampling methods in 43.6% of cases. Regarding CT findings, the BAL positive yield was significantly higher in peripheral lesions (79.1%), mass size more than or equal to 3 cm (62.8%), CT bronchus sign (46.5%), hilar and/or mediastinal adenopathy (86.0%), and consolidation (51.2%). The most common bronchoscopic abnormality in patients with BAL positive yield was submucosal lesions (83.3%). The adenocarcinoma (48.8%) and bronchoalveolar carcinoma (11.6%) were the histopathological types having significant BAL positive yield. The most significant predictive factors for BAL positive yield were mediastinal adenopathy, endobronchial lesions, nonvisible lesions, adenocarcinoma type, submucosal lesions, CT bronchus sign, mass size more than or equal to 3 cm, peripheral lesions, and concomitant use of bronchial brushing. BAL had 40.3% sensitivity, 51.7% specificity, 67.4% positive predictive value, 25.9% negative predictive value, and 43.6% diagnostic accuracy in bronchogenic carcinoma. Conclusion BAL increases the positive yield of bronchoscopy by 13.9% with fair diagnostic performance, especially in peripherally locating nonvisible lesions. Although tissue biopsy remains the gold standard sampling, clinicians might rely on BAL cytology for diagnosis of lung cancer in some patients

Green Synthesis of Zinc Oxide Nanoparticles (ZnO-NPs) Using Arthrospira platensis (Class: Cyanophyceae) and Evaluation of their Biomedical Activities

In this study, zinc oxide nanoparticles (ZnO-NPs) were successfully fabricated through the harnessing of metabolites present in the cell filtrate of a newly isolated and identified microalga Arthrospira platensis (Class: Cyanophyceae). The formed ZnO-NPs were characterized by UV&ndash;Vis spectroscopy, Fourier transform infrared (FT-IR), transmission electron microscopy (TEM), energy-dispersive spectroscopy (EDX), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). Data showed the efficacy of cyanobacterial metabolites in fabricating spherical, crystallographic ZnO-NPs with a size &asymp;30.0 to 55.0 nm at a wavelength of 370 nm. Moreover, FT-IR analysis showed varied absorption peaks related to nanoparticle formation. XPS analysis confirms the presence of Zn(II)O at different varied bending energies. Data analyses exhibit that the activities of biosynthesized ZnO-NPs were dose-dependent. Their application as an antimicrobial agent was examined and formed clear zones, 24.1 &plusmn; 0.3, 21.1 &plusmn; 0.06, 19.1 &plusmn; 0.3, 19.9 &plusmn; 0.1, and 21.6 &plusmn; 0.6 mm, at 200 ppm against Bacillus subtilis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans, respectively, and these activities were reduced as the NPs concentration decreased. The minimum inhibitory concentration (MIC) values were determined as 50 ppm for S. aureus, 25 ppm for P. aeruginosa, and 12.5 ppm for B. subtilis, E. coli, and C. albicans. More interestingly, ZnO-NPs exhibit high in vitro cytotoxic efficacy against cancerous (Caco-2) (IC50 = 9.95 ppm) as compared with normal (WI38) cell line (IC50 = 53.34 ppm)

Synergistic Influence of <i>Arbuscular mycorrhizal</i> Fungi Inoculation with Nanoparticle Foliar Application Enhances Chili (<i>Capsicum annuum</i> L.) Antioxidant Enzymes, Anatomical Characteristics, and Productivity under Cold-Stress Conditions

In this study, we aimed to evaluate the effects of Arbuscular mycorrhiza fungus (AMF) inoculation, foliar application of zinc oxide and selenium nanoparticles (ZnO-NPs and Se-NPs), and their combined interactions on the growth and productivity of chili pepper under cold-stress conditions. Two field experiments were successfully conducted during the winter seasons of 2021 and 2022 in an experimental field at the Faculty of Agriculture, Cairo University, Giza, Egypt. The results showed that, under cold stress, the combination of AMF inoculation and ZnO-NPs + Se-NPs as a foliar spray increased the average fruit weight by 92.4% and 98.7%, and the number of fruits by 34.6% and 54.8 compared to control treatment in the 2021 and 2022 seasons, respectively. Additionally, the combination of AMF and a mixture of nanoparticles (ZnO-NPs + Se-NPs) significantly increased the total marketable yield by 95.8% and 94.7% compared to the control, which recorded values of 2.4 and 1.9 kg m−2 in the 2021 and 2022 seasons, respectively. Furthermore, the combination of AMF and a mixture of nanoparticles (ZnO-NPs + Se-NPs) showed the highest total content of ascorbic acid and capsaicin in chili fruits compared to the other treatments. The combination of AMF and a mixture of nanoparticles (ZnO-NPs + Se-NPs) stimulated the accumulation of peroxidase (POD) and nitrogen glutamate dehydrogenase (GDH) while decreasing hydrogen peroxide (H2O2) and lipid peroxidation (MDA) contents. SDS analysis revealed that the application of ZnO-NPs, Se-NPs, AMF + ZnO-NPs, and AMF + ZnO-NPs + Se-NPs induced the emergence of new protein bands and reconstitution of those damaged by cold stress. Regarding histological structure, the combination of AMF inoculation and ZnO-NPs + Se-NPs as a foliar spray showed an enhancement in the thickness of grana thylakoids and increased the number of chloroplasts. Intriguingly, the findings showed that AMF and a mixture of nanoparticles (ZnO-NPs + Se-NPs) could offer guidance for increasing plant development and productivity under cold-stress conditions