Immunochemical and PCR analysis of Staphylococcus aureus Enterotoxin B (SEB) in milk and fruit juices collected in Lahore, Pakistan

Enterotoxins secreted by S. aureus are known as a food-poisoning agent that is associated with various gastro-intestinal pathological conditions. In this study, a one-step immunodetection method was devised for routine checking of SEB in milk and fruit juices available locally. Antibodies against recombinant SEB were raised, purified, and cross reactivity was checked against clinically important bacteria (Shigella flexneri, Streptococci, Salmonella typhi, Klebsiella and Bacillus subtilis). Purified anti-SEB antibodies were conjugated with gold nanoparticles (Ab-GNPs) for direct detection of SEB in samples. SEB (33%, 4.76% and 15%) was found in non-sterilized milk (118), sterilized milk (42) and juices (60), respectively. Coagulase, MSA tests and PCR amplification of 725 bp of the SEB gene confirmed the presence of S. aureus in the collected samples positive for SEB. Immunoassay is easy, reliable and less time consuming and will be helpful to detect the SEB in food samples at local level

Predictors of Mortality of COVID-19 cases In Benazir Bhutto Hospital Rawalpindi

Background: There has been a global epidemic of COVID-19 caused by novel corona virus (SARS-2). Current research aims to study the demographic, clinical characteristics and co-morbidities in COVID-19 related deaths. Methodology: This observational (descriptive) study was conducted at BBH Rawalpindi based on data from 1st March-15th June 2020 after ethical approval. Inclusion criteria was the deceased COVID PCR positive cases (>18 years age) of both the genders. Exclusion criteria was negative PCR, doubtful diagnosis and expiry outside the hospital setting. Data was collected from hospital record and family members. Demographic details, symptoms, duration of hospital stay, co-morbidities, type of ventilatory support were documented. Data analysed by SPSS, significant p<0.05. Results: There were 54 expiries from1st March to 13th June, 42(78%) males & 12(22%) females. Mean age was 54.24+12.78 years. 76% had various comorbidities, i.e., diabetes (57%), hypertension (54%), ischemic heart disease (20%); stroke, cancer, COPD and hypothyroidism (<10% each). Most frequent cause of death was acute respiratory distress syndrome due to Covid-19. Two patients died of sepsis and multiorgan failure. 64% of patients received mechanical ventilation and 35% oxygen via non-rebreather mask. There was average 4 days on invasive mechanical ventilator. 51-60 years had longest duration of illness and hospitalization till death, while 20-30 years had the shortest.  The average mortality climbed up (25% to 57%) from April to May 2020. Conclusion: COVID-19 claims significant mortality. The risk factors for mortality being age above 50 years, male gender, co-morbidities like diabetes, hypertension, ischemic heart disease, need for mechanical ventilation upon admission and longer duration of illness. There is need to intensify the vaccination and prevention in the community keeping in mind these high-risk groups. The high-risk cases, need to be aggressively managed to reduced mortality and improve outcome. &nbsp

PLASMA DONATION AND PERCEPTION, ATTITUDE, BEHAVIOR OF COVID-19 PATIENTS: A CROSS SECTIONAL STUDY

BACKGROUND: Current study aims to identify the perception, attitude and behavior about Covid and plasma donation in the Covid cases. METHODOLOGY: This descriptive cross-sectional study was conducted ---removed for blind review---Adult COVID-19/post-Covid patients were included by consecutive sampling. The critically ill, mechanically ventilated cases were excluded. Special questionnaire was developed including the demographic variables, mode of transmission, personal hygiene, prevention, post covid immunity, re-infection, psychosocial factors, financial reservations and post covid life. Willingness for plasma donation, laboratory diagnostics and blood groups inquired. Data was collected by direct interview by researcher and analyzed by SPSS V.20. RESULTS: Mean age was 39.8+15 years; 122(54%) females and 104(46%) males. Total 163(73%) participants said Covid has impact on health, economy, social, mental and psychological state. 188(83%) considered Covid a threat to human life. 142(63%) had a close Covid contact and 15(6.6%) had recently travelled. 131(58%) said they could have prevented getting infected. 171(75.7%) considered handwashing and 208(92%) cleanliness and158(77%) considered natural, herbal remedies as preventive. 191(84.5%) wore mask for most/all of the time. 130(57.5%) said they will be immune to Covid post-recovery. 179(79.2%) were aware of re-infection. 169(74.8%) considered smoking as a risk for Covid and137(60.6%) aimed to quit smoking. 204(93%) committed to hand washing and 210(92.9%) to wearing masks post-Covid. 127(56%) were concerned about their food, 78(34.5%) about finances, 103(45.6%) about their family getting infected. 213(94%) expected life to normalize post-Covid. Most frequent blood group was B+ 67(29.6%) followed by A+ 42(18.6%) and O+ 41(18.1%). 128(66.6%) participants showed willingness to donate their plasma after recovery. 24(10.6%) refused the donation. 134(59.3%) agreed that plasma donation won’t reduce their immunity. 186(82.3%) were clinically recovered at the time of interview. CONCLUSION: Our Covid patients had a positive approach towards plasma donation. They expected normalization of life post Covid and showed commitment toward continuation of preventive habits and smoking cessation. However, there were significant concerns about finances, safety of loved ones and mental health.

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

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

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

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Development of Diagnostic Dip Strip Immunoassay Using Antibodies of PreS 2 Region of Hepatitis B Surface Antigen

Abstract.-An immunoassay based on immunochromatographic lateral flow is developed for qualitative determination of HBsAg in serum samples using anti-preS 2 antibodies. The diagnostic test strip consists of four components i) sample application pad ii) conjugate pad iii) nitrocellulose membrane and iv) absorbent pad. Affinity purified anti-HBsAg antibodies and goat anti-rabbit IgG antibodies were coated onto nitrocellulose membrane as a test line and control line, respectively. The affinity purified anti-Pre-S 2 antibodies conjugated to colloidal gold particles (20 nm) were coated on polyester conjugate pad. The conjugate pad was attached to nitrocellulose membrane and the sample application pad was attached to conjugate pad. The absorbent pad comprising 3mm Whatman paper was attached to the nitrocellulose strip opposite to the sample pad. Purified HBsAg (1.4µg/µl in PBS), 100 µl, was loaded on sample pad and allowed to flow over the strip for 10 minutes. Pink colour test line indicates the correct binding of gold labeled antibodies to antigen. The staining of control line confirms the accuracy of the strip. The sensitivity and specificity of dip strip was measured by using serum samples of one hundred clinically confirmed HBV positive individuals and twenty HBV negative individuals. The test line appeared colored in the case of HBV positive individuals and remained blank in the case of negative individuals. The results of indigenous dipstrip were compared with the results of imported dipstrips. The results indicated that indigenous dipstrip is as good as the imported one, therefore, recommended for use in clinical trials