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

Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey

Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

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

Large-scale genome-wide analysis identifies genetic variants associated with cardiac structure and function

BACKGROUND: Understanding the genetic architecture of cardiac structure and function may help to prevent and treat heart disease. This investigation sought to identify common genetic variations associated with inter-individual variability in cardiac structure and function. METHODS: A GWAS meta-analysis of echocardiographic traits was performed, including 46,533 individuals from 30 studies (EchoGen consortium). The analysis included 16 traits of left ventricular (LV) structure, and systolic and diastolic function. RESULTS: The discovery analysis included 21 cohorts for structural and systolic function traits (n = 32,212) and 17 cohorts for diastolic function traits (n = 21,852). Replication was performed in 5 cohorts (n = 14,321) and 6 cohorts (n = 16,308), respectively. Besides 5 previously reported loci, the combined meta-analysis identified 10 additional genome-wide significant SNPs: rs12541595 near MTSS1 and rs10774625 in ATXN2 for LV end-diastolic internal dimension; rs806322 near KCNRG, rs4765663 in CACNA1C, rs6702619 near PALMD, rs7127129 in TMEM16A, rs11207426 near FGGY, rs17608766 in GOSR2, and rs17696696 in CFDP1 for aortic root diameter; and rs12440869 in IQCH for Doppler transmitral A-wave peak velocity. Findings were in part validated in other cohorts and in GWAS of related disease traits. The genetic loci showed associations with putative signaling pathways, and with gene expression in whole blood, monocytes, and myocardial tissue. CONCLUSION: The additional genetic loci identified in this large meta-analysis of cardiac structure and function provide insights into the underlying genetic architecture of cardiac structure and warrant follow-up in future functional studies. FUNDING: For detailed information per study, see Acknowledgments.This work was supported by a grant from the US National Heart, Lung, and Blood Institute (N01-HL-25195; R01HL 093328 to RSV), a MAIFOR grant from the University Medical Center Mainz, Germany (to PSW), the Center for Translational Vascular Biology (CTVB) of the Johannes Gutenberg-University of Mainz, and the Federal Ministry of Research and Education, Germany (BMBF 01EO1003 to PSW). This work was also supported by the research project Greifswald Approach to Individualized Medicine (GANI_MED). GANI_MED was funded by the Federal Ministry of Education and Research and the Ministry of Cultural Affairs of the Federal State of Mecklenburg, West Pomerania (contract 03IS2061A). We thank all study participants, and the colleagues and coworkers from all cohorts and sites who were involved in the generation of data or in the analysis. We especially thank Andrew Johnson (FHS) for generation of the gene annotation database used for analysis. We thank the German Center for Cardiovascular Research (DZHK e.V.) for supporting the analysis and publication of this project. RSV is a member of the Scientific Advisory Board of the DZHK. Data on CAD and MI were contributed by CARDIoGRAMplusC4D investigators. See Supplemental Acknowledgments for consortium details. PSW, JFF, AS, AT, TZ, RSV, and MD had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis

Distribuzione, ecologia e demografia di Calystegia soldanella (L.) R.Br. sul litorale del Parco di Migliarino, San Rossore, Massaciuccoli

Nel presente lavoro è stata studiata la popolazione di Calystegia soldanella presente nel litorale del Parco di San Rossore, Migliarino, Massaciuccoli. Calystegia soldanella è una specie dunale costiera che colonizza le dune embrionali e mobili. Questa pianta trattiene la sabbia con i suoi lunghi rizomi e contrasta pertanto il fenomeno erosivo che colpisce attualmente le nostre coste. Il lavoro si è composto di più parti: Analisi della distribuzione della popolazione nell'area di studio, tramite GPS. I punti rilevati sono stati riportati sulla cartografia per ricavare l'areale di distribuzione e i fattori di disturbo che influenzano tale distribuzione. Analisi demografica di una stazione di Calystegia soldanella all'interno della Tenuta di San Rossore, tramite rilevamenti demografici in 20 aree di un m² ciascuna, ogni 10-15 giorni durante il periodo maggio-ottobre 2009. I dati ottenuti sono stati elaborati per ricavare l'andamento, durante la stagione vegetativa, del diametro degli individui, della fioritura, produzione di semi, ricrescita vegetativa, cause di morte e di danneggiamento. Sono stati confrontati i dati con le informazioni climatiche locali e si è tentato di creare un modello matematico per spiegare i fenomeni demografici. Studio dell'auto-impollinazione tramite applicazione di garze su 19 bocci di C. soldanella. Raccolta dei semi di C. soldanella, su cui sono state effettuate le misurazioni delle dimensioni e del peso, la prova di vitalità, le prove di germinazione, di imbibizione, di longevità e di rimozione della dormienza fisica tramite utilizzo di temperature estreme. Studio della banca dei semi del suolo, effettuata tramite carotaggi nella spiaggia di San Rossore, da cui sono stati estratti i semi presenti, contati, misurati, fotografati e divisi per specie. Si è tentato di determinarne la specie di appartenenza. Si sono confrontati i dati con quelli di precendenti studi sulla banca dei semi del suolo e infine sono state effettuate prove di germinazione su questi semi. Risultati e discussione: Dall'analisi della distribuzione è emersa una discontinuità dell'areale della specie, che non si trova affatto nella zona di Marina di Pisa, e in parte nella zona di Tirrenia a causa della forte antropizzazione del litorale. La pianta è rara in tutto il litorale di San Rossore a causa del forte fenomeno erosivo in corso. A nord del Serchio la distribuzione è ampia e continua. Dai rilevi demografici è emerso un calo nel numero di individui e nella taglia media durante i mesi aridi estivi, con ripresa in quelli autunnali. La fioritura avviene in maggio-giugno, la capacità riproduttiva è proporzionale alla taglia dell'individuo, ma la produzione di frutti è scarsa soprattutto a causa del fenomeno predatorio. La causa di morte più frequente è l'essiccamento. La ricrescita vegetativa è proporzionale alla piovosità. Non sembra possibile per la pianta effettuare l'auto-impollinazione, in accordo con la bibliografia. Le prove sui semi hanno dimostrato: lunghezza media 6,39 ± 0,36 mm, larghezza media 5,02 ± 0,42 mm e spessore medio 4,90 ± 0,45 mm; peso 69 mg; contenuto idrico 5,7%; contenuto in olii 0,32%; vitalità 96%. La prova dell'imbibizione ha confermato che i semi possiedono dormienza fisica, la germinazione è avvenuta con successo al 100%. La prova di longevità ha fornito un valore di p50 = 60,41 giorni. Dalle prove con uso della temperatura si ricava che il trattamento in cui si immergono alternativamente i semi per 10 secondi in acqua bollente e 10 secondi in acqua ghiacciata per 20 volte, ripetendo il trattamento una seconda volta sui semi rimasti duri, rimuove la dormienza dal 73% dei semi, che successivamente germinano. Dai carotaggi sono stati estratti 887 semi appartenenti a 37 specie. La densità dei semi diminuisce con la profondità. Lo studio della loro varianza ha portato a risultati concordi con la letteratura (Thompson et al., 1993). Non sono stati trovati all'interno dei carotaggi semi di C. soldanella. Nelle prove di germinazione solamente 2 semi di Ammophila littoralis e 4 semi di Otanthus maritimus sono germinati

Demography and reproductive performance of Calystegia soldanella on a sandy seashore in Tuscany, Italy

Calystegia soldanella (L.) R.Br. is a psammophyte growing in the coastal foredunes of temperate areas. We investigated its demography and reproductive performance, to improve the in situ and ex situ management of the species as an essential element in planning the stabilization of the shoreline. The studied population is located in northwestern Tuscany, Italy. Demographic data were recorded in 20 quadrats from May to October 2009. Self-pollination ability has been tested by wrapping flower buds in cotton lint. Seeds traits (length, width, depth, shape index, mass, and water content), flotation ability, and germination percentage have been determined on seeds collected from the study site. The presence of C. soldanella seeds in the soil seed bank has been investigated by sifting the sand of 30 soil core samples. Our results showed that ramet density decreases during summer, mainly owing to drought. Predation reduces ramet size especially in spring and autumn, but rarely fatally, having the greatest impact on flower removal and, therefore, in decreasing the population’s genetic variability. Self-pollination does not occur and the percentage of reproductive ramets increases with their size. Tested seeds were able to float on water and germinated to 100%. No C. soldanella seeds were observed in the soil core samples. While suggesting useful indications for the management of the investigated population, our results provide a guideline for a more comprehensive study about the management of C. soldanella.</jats:p

A Rolling-Horizon Approach for Predictive Maintenance Planning to Reduce the Risk of Rail Service Disruptions

This article proposes a model for the risk-based scheduling of predictive maintenance activities on a railway line to intervene when a track segment has reached a certain state of degradation, thus preventing faults and possible failures. With the aim of taking into account the stochastic nature of real environments, the rail-track degradation process is represented as a stochastic process, and the failure probability is evaluated as the probability of reaching a degradation threshold. Moreover, a rolling-horizon framework is introduced to manage newly available real-time information and unpredicted faults or maintenance activity delays. Whereas the traditional scheduling models are offline models that cover the long-term horizon but neglect operational disturbances, the presented model allows for dynamic day-to-day planning and adaptation of the maintenance plan to real-time information, thereby responding to the increasing understanding of real-world processes. The optimization problem on maintenance scheduling is formulated as a mixed-integer linear programming problem based on risk minimization, in adherence to ISO 55 000 guidelines. Finally, the application of the approach to a real rail network is reported and discussed, with a focus on the planning of tamping activities at the operational level