Hepatitis C-Associated Chronic Lymphoproliferative Disorders: A Single Center Experience

Hepatitis C virus (HCV) infection is a major public health concern in Egypt with its unique genotype. Besides liver disease, HCV is a lymphotropic virus involved in the pathogenesis of various extrahepatic diseases. A causative role of HCV in the generation of chronic lymphoproliferative diseases as well as its impact on disease behavior in HCV chronic carriers are not fully understood. We investigated the prevalence of HCV among cohort of Egyptian patients (n:84) with chronic lymphoproliferative diseases, the relation between HCV infection and the immunological state of this opulation and also their clinical and laboratory characteristics. High prevalence of HCV (40%) among Egyptian patients with chronic lymphoproliferative diseases with following subtype frequency was revealed; CLL (38.2%) followed by DLBCL (20.6%), and LPL (17.6%). We found significant correlation between HCV and platelet count (P=0.014), Albumin (P=0.02), LDH (P=0.014) and B2M (P=0.05). Otherwise, there were no significant correlations with other parameters especially the immunological assessment; serum immunoglobulins, Coombs test, and cryoglobulinemia. HCV prevalence among patients with chronic lymphoproliferative diseases is higher than that estimated in the general population. Those patients should be tested for HCV during the assessment. Our observations suggest that HCV may have an oncogenic role in Egyptian patients with chronic lymphoproliferative diseases and it may affect the prognostic markers in those populations

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

The TREAT-NMD DMD Global Database: analysis of more than 7,000 Duchenne muscular dystrophy mutations.

Analyzing the type and frequency of patient-specific mutations that give rise to Duchenne muscular dystrophy (DMD) is an invaluable tool for diagnostics, basic scientific research, trial planning, and improved clinical care. Locus-specific databases allow for the collection, organization, storage, and analysis of genetic variants of disease. Here, we describe the development and analysis of the TREAT-NMD DMD Global database (http://umd.be/TREAT_DMD/). We analyzed genetic data for 7,149 DMD mutations held within the database. A total of 5,682 large mutations were observed (80% of total mutations), of which 4,894 (86%) were deletions (1 exon or larger) and 784 (14%) were duplications (1 exon or larger). There were 1,445 small mutations (smaller than 1 exon, 20% of all mutations), of which 358 (25%) were small deletions and 132 (9%) small insertions and 199 (14%) affected the splice sites. Point mutations totalled 756 (52% of small mutations) with 726 (50%) nonsense mutations and 30 (2%) missense mutations. Finally, 22 (0.3%) mid-intronic mutations were observed. In addition, mutations were identified within the database that would potentially benefit from novel genetic therapies for DMD including stop codon read-through therapies (10% of total mutations) and exon skipping therapy (80% of deletions and 55% of total mutations)

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

Utilization of Various Industrial Wastes in Ordinary Concrete Under Normal Manufacturing Conditions

Abstract The main objective of the present work is to evaluate using alkaline wastewater from pot factories (recycled NaOH solutions with variant concentrations and pH values) along with waste powders possessing pozzolanic properties, such as supplementary cementitious materials and stone waste dust in concrete under normal manufacturing conditions. An extensive analysis of the chemical components and the physical properties of the used materials was achieved. Both supplementary cementitious materials and stone waste dust materials were used as 0%, 10%, 20%, or 30% partial cement replacements using either tap water or alkaline wastewater to make samples for physical, mechanical, and microstructure testing. Thermodynamic modeling was used to evaluate the effect of the flushed alkaline industrial water and the powders on the hydration products. The results showed an increase in the workability of the mixes made with alkaline wastewater, an increase in water absorption for samples made with alkaline wastewater at the age of 28 days, and a relative decrease in compressive strength at 3 and 28 days, respectively. Despite the reduction in mechanical strength, most samples made with alkaline wastewater and 10%, 20% supplementary cementitious materials, or stone waste dust materials gave an accepted concrete grade. The microstructure analysis showed a slight change in pores distribution, pores values, and hydration products at 3 and 28 days. The thermodynamic analysis provided insight into data on the effect of supplementary cementitious materials, stone waste dust materials, and alkaline wastewater on hydration products. Finally, the combination of these wastes in concrete production showed satisfactory conclusions

Role of diffusion weighted imaging and dynamic contrast enhanced MR mammography to detect recurrence in breast cancer patients after sur

Objective: To assess role of Diffusion weighted imaging (DWI) in addition to dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM) in detection of breast cancer recurrence after surgery. Patients and methods: Sixty female patients who underwent breast surgery were included in this prospective study. Patients were examined by sonomammography followed by DCE-MRI to exclude recurrence. DWI was performed using b values of 0, 50, and 850 s/mm2. Patients with suspected recurrence were subjected to histopathological confirmation. Results: Twenty seven patients had pathologically proven recurrence and thirty three patients showed spectrum of post operative changes. DCE-MRI was superior to DWI with 2 false positive (FP) cases and no false negative (FN) cases, while DWI showed 3 (FN) cases and 4 (FP) cases. DCE-MRI & DWI showed sensitivity (100%, 88.9%), specificity (93.9%, 87.9%), positive predictive value (PPV) (93.1%, 88.9%), negative predictive value (NPV) (100%, 90.6%) & accuracy (96.7%, 88.3%) respectively. Conclusion: Our study showed better diagnostic performance for DCE-MRI compared to DWI in post operative breast assessment. However, DWI can provide an alternative diagnostic tool to contrast administration “if interpreted in association with conventional MR sequences” thus can be used when contrast media is contraindicated