INVESTIGATION OF THE CLINICAL SIGNIFICANCE OF ESCITALOPRAM-INDUCED ELECTROCARDIOGRAPHIC CHANGES IN MEN: A PILOT OBSERVATIONAL STUDY

Objective: We sought to investigate the clinical significance of secondary electrocardiographic (ECG) changes in men after using escitalopram. Methods: This pilot observational cohort study recruited male patients taking escitalopram for at least 6 mo in Mental Hospital of Qassim. All patients underwent a 12-lead ECG examination. We also measured the heart rate (HR), QTc, and QRS interval. Data on all related medical conditions and medications were recorded. Results: Fifty-three men were recruited, with a mean age of 37.39±8.39 y: 34.4% and 31.1% of these patients were taking escitalopram for depression and anxiety, respectively. The mean dose of escitalopram was 14.35 mg. Observations showed that 20.9% of the patients taking escitalopram had a fast HR (>100 beats/min [bpm]), indicative of sinus tachycardia, whereas 11.4% of patients had a slow HR (<60 bpm). The mean QT and QTc in patients taking escitalopram were 366.62±28.69 and 398.92±16.15 ms, respectively. Conclusion: Low doses of escitalopram resulted in minimal clinically significant changes. Thus, patients should be monitored when doses are escalated further

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

Impact of CMMI-based process maturity levels on effort, productivity and diseconomy of scale

The Software Capability Maturity Model Integration (CMMI) has become a popular Software Process Improvement (SPI) model for enhancing software development processes with the goal of developing high-quality software within budget and schedule. Since software development effort can be greatly affected by the organizational process maturity level, this study examines the impact of different CMMI-based process maturity levels on effort, productivity development team and diseconomy of scale for a standard project sizes. The COnstructive COst MOdel (COCOMO) is employed to compute the software development effort. The percentage of change (increase or decrease) in software development effort, productivity and diseconomy of scale is employed as a measure of effectiveness for this study. The results of this work demonstrate that each higher CMMI maturity level has a considerable impact in decreasing the development effort, increasing the productivity rate and reducing the diseconomy of scale. The results also indicate that the impact of CMMI-based maturity levels significantly increases with project sizes

Lightweight and Secure Elliptical Curve Cryptography (ECC) Key Exchange for Mobile Phones

Open networks enable data communication between different types of mobile devices that showcase the need to enforce elevated security measures. Securing sensitive or confidential data in mobile phones is accomplished by implementing a diverse range of cryptographic techniques. While encryption algorithms, such as Rivest–Shamir–Adleman (RSA) may offer secure solutions that are often difficult to compromise, these in turn prerequisite high speed computational resources for effective operation. Elliptical curve cryptography (ECC) is well thought-out standard that offers a workable and feasible methods of encryption/decryption, whilst being applicable to resource constraint devices. This paper implements a novel key exchange mechanism that helps to secure exchange of data between the communicating mobile devices. The study aims to address the limitation of Elliptic Curve Deffie Hellman, which is susceptible to Man-in-the-Middle attack and proposes an enhanced Elliptic Curve Deffie Hellman (ECDH) technique for secure data communication in open networks. The study results reveal, how the implementation of ECDH allows exchange of keys between the two communicating devices with limited resources

Strategic human resource management practices and human capital development: The role of employee commitment

This paper studied the influence of strategic human resource management on human capital development through the mediation of employee commitment. A descriptive cross-sectional study design was used to collect data from 514 participants (medical staff) from five hospitals in northern Jordan. The hospitals involved were from different sectors, including governmental, private, and university hospitals. Several analysis methods were used in the study: Confirmatory Factor Analysis (CFA), discriminant validity, and composite reliability. Direct and indirect hypothesis testing was also utilized using Structural Equation Modeling (SEM). The study showed that the practice of strategic human resource management had a direct positive impact on employee commitment; the practice of strategic human resource management had a direct positive impact on human capital development; the impact of employee commitment on human capital development was positive and direct; employee commitment has a partial mediating effect between both of them. Accordingly, HR managers in hospitals should move from “softer” responsibilities and traditional HR activities to a more strategic level (i.e., developmental strategy), where HR strategies are aligned and reinforce the hospital’s vision and mission and link organizational strategy to HR strategies. Healthcare managers should invest more in human capital through formal education and training. AcknowledgmentsThe Deanship of Research at Jordan University of Science and Technology (JUST) in Jordan is acknowledged by authors for providing facilities through the research No. 488/2020 and research environment to accomplish the goals of this work. The authors thank Professor Fareed Nusair at the Department of Health Management &amp; Policy, the Faculty of Medicine

The Combined Effect of the Trapezius Muscle Strengthening and Pectoralis Minor Muscle Stretching on Correcting the Rounded Shoulder Posture and Shoulder Flexion Range of Motion among Young Saudi Females: A Randomized Comparative Study

Background: The shortening of the pectoralis minor muscle (PMi-M) and weakening of the lower trapezius muscle (LTr-M) affect scapular movement, resulting in the development of a rounded shoulder posture and reduction in the shoulder flexion range of motion (SFROM). Objective: This study evaluated the combined effect of LTr-M strengthening and PMi-M stretching on correcting the rounded shoulder postures and SFROM among young Saudi females. Methods: This study was based on a two-arm parallel-group repeated measures randomized comparative design. A total of sixty female participants with rounded shoulder postures were recruited and randomly allocated into groups 1 and 2 (n = 30/group). Each group performed supervised PMi-M stretching; however, group 2 performed a combination of LTr-M strengthening and PMi-M stretching. The outcomes, including rounded shoulder posture and SFROM, were assessed using the pectoralis minor length test (PMLT) and universal goniometer. A repeated measure ANOVA was used to compare the differences within-group and between-group for the outcomes measures at one-week (baseline) pre-intervention, two weeks, and three -weeks post-intervention. The significance level was set at q > 2.00 and p 2.00) in the outcomes of PMLT and SFROM when comparing their post-intervention scores to the baseline scores. The between-group comparison revealed a significant and an insignificant (q < 2.00) difference in the outcomes of PMLT and SFROM, respectively when comparing their scores at the second- and third-week post-intervention. Furthermore, the effect size of the intervention suggests an advantage of group 2 over group 1 in increasing the resting length of the PMi-M only among young Saudi females. Conclusions: The combined effect of LTr-M strengthening and PMi-M stretching was more beneficial than PMi-M stretching alone in correcting the rounded shoulder posture among young Saudi females by increasing PMi-M resting length. However, it could not yield a differential improvement in the SFROM outcome among them

Biogenic Gold Nanoparticles as Potent Antibacterial and Antibiofilm Nano-Antibiotics against Pseudomonas aeruginosa

Abstract: Plant-based synthesis of eco-friendly nanoparticles has widespread applications in many fields, including medicine. Biofilm&mdash;a shield for pathogenic microorganisms&mdash;once formed, is difficult to destroy with antibiotics, making the pathogen resistant. Here, we synthesized gold nanoparticles (AuNPs) using the stem of an Ayurvedic medicinal plant, Tinospora cordifolia, and studied the action of AuNPs against Pseudomonas aeruginosa PAO1 biofilm. The synthesized AuNPs were characterized by techniques such as ultraviolet-visible spectroscopy, Fourier-transform infrared (FTIR) spectroscopy, energy-dispersive X-ray diffraction, X-ray diffraction, scanning electron microscopy (SEM), and transmission electron microscopy. The AuNPs were spherically shaped with an average size of 16.1 nm. Further, the subminimum inhibitory concentrations (MICs) of AuNPs (50, 100, and 150 &micro;g/mL) greatly affected the biofilm-forming ability of P. aeruginosa, as observed by crystal violet assay and SEM, which showed a decrease in the number of biofilm-forming cells with increasing AuNP concentration. This was further justified by confocal laser scanning microscopy (CLSM), which showed irregularities in the structure of the biofilm at the sub-MIC of AuNPs. Further, the interaction of AuNPs with PAO1 at the highest sub-MIC (150 &micro;g/mL) showed the internalization of the nanoparticles, probably affecting the tendency of PAO1 to colonize on the surface of the nanoparticles. This study suggests that green-synthesized AuNPs can be used as effective nano-antibiotics against biofilm-related infections caused by P. aeruginosa