Morphological and imaging evaluation of the metacarpophalangeal and metatarsophalangeal joints in healthy and lame donkeys

The donkey is of socio-economic value yet imaging techniques in both healthy and abnormal limbs are a limiting factor in research and medicine. The objective was to determine anatomical features of both healthy and clinically abnormal donkey metacarpophalangeal and metatarsophalangeal joints (n=13) using anatomical dissection, casting, x-ray and computed tomography. The joint capsule contained two palmar/plantar and two dorsal recesses. The proximal-palmar or plantar recess was larger than the distodorsal recess and potential sites of approaches to the recesses were determined. Soft tissue structures were distinguished using computed tomography at 300mA which was superior to 120mA. This methodology gave better assessments of the synovial tendon sheath, joint recesses and cruciate, collateral and short sesamoidean ligaments. Computed tomography provided outstanding discrimination between the cortex and medulla of the third metacarpal, the proximal sesamoid bones, the proximal phalanx and excellent details of the osseous structures. Although the joints appeared free from exostosis using x-ray; the position and extension of exostosis in pathologically affected donkeys (a novel finding) was revealed using computed tomography with 300mA in comparison to 120mA. The study also provided an anatomical record of the metacarpophalangeal and metatarsophalangeal joints using the latest technology which could impact on clinical situations including anesthesia injection sites

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

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 years; 78.2% included were male with a median age of 37 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

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

Transvaginal Ultrasound is a Valuable Investigation in Female Stress Incontinence

Objectives: To evaluate the role of transvaginal ultrasound (TVUS) in studying the anatomical bases of genuine stress urinary incontinence (SUI) and understanding the causes of success and failure of operations aiming at the treatment of incontinence. Patients and Methods: This study included 15 continent females (Group I, healthy control) and 46 patients complaining of SUI (Group II). All cases were subjected to full history, physical examination, urodynamic evaluation and TVUS examination. In 42 patients of Group II, TVUS was repeated one year after treatment of incontinence, while four patients were lost to follow-up. In 36 of these 42 cases (85.7%), treatment was successful (Group IIIa), while treatment had failed and SUI had persisted or recurred within one year in six cases (Group IIIb, 14.3%). We used TVUS to measure the bladder-symphysis distance (BS), the rotational angle (RA), the bladder neck motility (BNM) and the vertical bladder neck descent. Results: While the mean BS was insignificantly shorter in Group II compared to Group I (2.24 ± 0.7cm versus 2.4 ± 0.5 cm, p = 0.08), the mean RA, BNM and vertical bladder neck descent were significantly larter in Group II (115 ± 17o 29 ± 16o 1.4 ± 0.4 cm for Group II versus 94 ± 15o 20 ± 5o 0.34 ± 0.4 cm for Group I). The comparison between Groups I and II showed that the TVUS-measured parameters correlated well with the clinical condition. A comparison between Group IIIa (BS = 2.2 ± 1 cm, RA = 100 ± 19o BNM = 22 ± 4o and vertical bladder neck descent = 0.38 ± 0.5 cm) and Group IIIb (BS = 2.2 ± 0.5 cm, RA = 117 ± 16o, BNM = 30 ± 9o and vertical bladder neck descent = 1.4 ± 0.3 cm) showed that the TVUS-measured parameters correlated well with the surgical outcome. Conclusions: TVUS is a valuable tool for the diagnosis and postoperative evaluation of SUI and may help in understanding the causes of success and failure of surgical treatment of SUI. L'échographie endovaginale est une exploration précieuse dans l'incontinence d'effort de la femme Objectifs: Evaluer l'apport de l'échographie endo-vaginale dans l'étude des bases anatomiques de l'incontinence urinaire d'effort avérée de la femme et comprendre les causes du succès et de l'échec de la chirurgie de l'incontinence. Patientes et Méthodes: Cette étude avait inclus 15 femmes continentes constituant le Groupe I ou groupe contrôle et 46 patients se plaignant d'incontinence urinaire d'effort le groupe II ou groupe cas. Pour tous les cas l'histoire de la maladie a été notée et une exploration clinique, urodynamique et par échographie endo vaginale a été réalisée. Chez 36 patientes du Groupe II (85,7%) le traitement était efficace (Groupe IIIa), tandis qu'il y'a eu échec du traitement avec persistance de l'incontinence urinaire d'effort dans une proportion de 14.3% (Groupe IIIb). Nous avions utilisé l'échographie endo vaginale pour mesurer la distance vessie-symphyse pubienne, l'angle de rotation, la mobilité du col vésical et la descente verticale du col vésical. Résultats: Tandis que la distance moyenne vessie-symphyse était significativement plus courte dans le groupe II compare au groupe I (2.24 ± 0.7cm contre 2.4 ± 0.5 cm, p = 0.08), la moyenne d'angle de rotation, de mobilité du col vésical et de descente du col vésical était significativement plus large dans le Groupe II (115 ± 17o 29 ± 16o 1.4 ± 0.4 cm pour le Groupe II contre 94 ± 15o 20 ± 5o 0.34 ± 0.4 cm pour le Groupe I). La comparaison entre les deux groupes avait montré que les paramètres mesurés par échographie endo vaginale étaient corrélés avec le tableau clinique. Une comparaison entre le groupe IIIa (distance pubis-symphyse = 2.2 ± 1 cm, angle de rotation = 100 ± 19o, mobilité du col vésical = 22 ± 4o et desente du col vésical = 0.38 ± 0.5 cm) et le Groupe IIIb (distance vessie-pubis = 2.2 ± 0.5 cm, angle de rotation = 117 ± 16o, mobilité du col vésical = 30 ± 9o et descente verticale du col vésical = 1.4 ± 0.3 cm) avait montré que les paramètres mesurés par l'échographie endo vaginale avaient une bonne corrélation avec les résultats de la chirurgie. Conclusions: L'échographie endo vaginale est une exploration précieuse dans le diagnostic et l'évaluation post opératoire de l'incontinence urinaire d'effort. Elle peut aider à la compréhension des causes de réussite et d'échec dans le traitement de l'incontinence urinaire d'effort. African Journal of Urology Vol.10(1) 2004: 30-3

Regular consumption of green tea improves pulse pressure and induces regression of left ventricular hypertrophy in hypertensive patients

Abstract This study characterized the effects of regular green tea (GT) and hot water (HW) ingestion on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and left ventricular hypertrophy (LVH) in two equal, sex‐ and age‐matched groups; Grp1 and Grp2 (n = 100 each; age 53 ± 4 years) of hypertensive patients. Grp1 had regular GT treatment, followed by HW ingestion, whereas Grp2 had HW ingestion followed by GT treatment for periods of 4 months each. Electrocardiographic (ECG) and echocardiographic assessments of LVH were made before and at the end of both periods. SBP was lowered significantly by 6.6%; DBP by 5.1%, and PP by 9.1% by the end of month 4 of GT treatment in Grp1. Upon GT cessation and HW ingestion, SBP, DBP, and PP returned to pretreatment levels over 4 months. In Grp2, SBP, DBP, and PP were reduced insignificantly by 1.5%, 1.0%, and 2.3% by the end of the 4th month of HW ingestion. Conversely, over 4 months of GT treatment, SBP, DBP, and PP were significantly lowered by 5.4%, 4.1%, and 7.7% from the baseline values, respectively. ECG and echocardiographic evidence of LVH was shown in 20% of Grp1 and 24% of Grp2 patients before intervention. This was significantly lowered to 8% and 10% in Grp1 and Grp2 by GT treatment. However, this increased to 16% following HW ingestion in Grp1. HW ingestion did mot induce regression of LVH in Grp2. Thus, regular GT ingestion has cardiovascular protective effects

Relationship between gestational age, birth weight and deciduous tooth eruption

Background: Teething is a normal part of child growth and development. Growth parameters and feeding pattern may be determinants of the timing of teeth eruption in healthy infant. Primary tooth eruption may be affected by gestational age, postnatal nutrition, degree of prematurity as well as severity of neonatal illness. Objectives: The aim of this study was to evaluate the relation between gestational age, weight and neonatal illness to the time of eruption of the first deciduous tooth. Materials and methods: This study was a follow up prospective study carried out at the Bab El Sharia University hospital from October 2010 to October 2012. The study included 250 newborn from the obstetric department, from the NICU and from the outpatient clinics at the hospital. The babies were stratified according to gestational age to preterm (37 weeks): 178 cases. The babies were followed from birth till the eruption of the first deciduous tooth. Results: There was a negative linear correlation between the time of the first deciduous tooth eruption and birth weight. The eruption of the first deciduous tooth was delayed in babies admitted to NICU specially if there was major interference such as intubation, mechanical ventilation. Conclusion: Delayed tooth eruption was related to lower birth weight and prematurity. The delayed eruption in preterm babies may be related to premature birth and not to a delay in dental development