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

The Role of L- and T-type Ca2+ Channels in Rat Cerebral Arteries

The overall goal of this thesis was to identify which voltage-gated Ca2+ channels are expressed in rat cerebral arterial smooth muscle and to determine their contributions to myogenic tone regulation. We began by exploring which voltage-gated Ca2+ channels are expressed in cerebral arterial smooth muscle. A combination of molecular, electrophysiological and functional measurements revealed the presence of L- (CaV1.2) and T-type (CaV3.1 and CaV3.2) Ca2+ channel subtypes in rat cerebral arteries. Both types contribute to arterial tone development, although the contribution of the L-type channels to tone development is greater. We then investigated the role of a specific T-type Ca2+ channel subtype, CaV3.2, in cerebral arterial smooth muscle by functional assessment and a structural approach using immunohistochemistry, proximity ligation assay, electron-tomography, and immunogold labeling, combined with computational modeling and electrophysiological measurements. Results indicate that Ca2+ influx through CaV3.2 channels elicits dilation by activating ryanodine receptors and inducing Ca2+ sparks, localized events that activate BKCa channels. In conclusion this work provided evidence for the presence of different types of voltage-gated Ca2+ channels and provided evidence of their diverse functional roles in regulating myogenic tone in rat cerebral arteries. Overall, the conclusions indicate the importance of the different functional roles of voltage-gated Ca2+ channels, which have substantial physiological relevance to the function of the cerebral vasculature

The Palliative and Antioxidant Effects of Hesperidin against Lead-Acetate-Induced Testicular Injury in Male Wistar Rats

Lead (Pb)-induced reprotoxicity is a detrimental consequence of Pb exposure, which results in abnormal spermatogenesis, testicular degeneration, and pathogenic sperm changes. The association between impaired male reproductive function and Pb-induced oxidative stress (OS) has been demonstrated, with consequent testicular antioxidant deficiency. The current study investigated the protective role of the natural antioxidant hesperidin (HSD) against lead-acetate (PbAc)-induced testicular toxicity. Male Wistar rats (n = 40) were randomly divided into four experimental groups: Group I (negative control) received 2.0 mL/kg BW 0.9% saline; Group II received 100 mg/kg BW PbAc; Group III received 100 mg/kg BW HSD; and Group IV received HSD two hours before PbAc using the abovementioned doses. The treatments were administered daily for 30 consecutive days. The results showed that HSD treatment significantly restored PbAc-induced decrease in body, epididymal, and testicular weights as well as in semen parameters, reproductive hormones, and testicular markers of OS. Reduced MDA levels and improved testicular histopathological findings were also observed. Collectively, this study sheds light on the preventive role of HSD against PbAc-induced testicular injury, which is mediated via the suppression of OS and the modulation of reproductive hormones as well as the plausibility of HSD being used as a supplementary therapeutic option for recovery

Rho-kinase-mediated suppression of KDR current in cerebral arteries requires an intact actin cytoskeleton

This study examined the role of the actin cytoskeleton in Rho-kinase-mediated suppression of the delayed-rectifier K+ (KDR) current in cerebral arteries. Myocytes from rat cerebral arteries were enzymatically isolated, and whole cell KDR currents were monitored using conventional patch-clamp electrophysiology. At +40 mV, the KDR current averaged 19.8 ± 1.6 pA/pF (mean ± SE) and was potently inhibited by UTP (3 × 10−5 M). This suppression was observed to depend on Rho signaling and was abolished by the Rho-kinase inhibitors H-1152 (3 × 10−7 M) and Y-27632 (3 × 10−5 M). Rho-kinase was also found to concomitantly facilitate actin polymerization in response to UTP. We therefore examined whether actin dynamics played a role in the ability of Rho-kinase to suppress KDR current and found that actin disruption using either cytochalasin D (1 × 10−5 M) or latrunculin A (1 × 10−8 M) prevented current modulation. Consistent with our electrophysiological observations, both Rho-kinase inhibition and actin disruption significantly attenuated UTP-induced depolarization and constriction of cerebral arteries. We propose that UTP initiates Rho-kinase-mediated remodeling of the actin cytoskeleton and consequently suppresses the KDR current, thereby facilitating the depolarization and constriction of cerebral arteries

Synbiotic Tarhana as a functional food

Abstract: In the present study formulated synbiotic tarhana (Turkish fermented cereal food) was produced as a functional food from the fermentation of wheat flour, some spices [salt, pepper, dill and sweet marjoram (Organum majorana)], some vegetables [tomato (Lycoprsicum esculentum), pepper (Capsicum annum) and onion (Allium cepa)], and synbiotic yoghurt which prepared with prebiotic (inulin and lactose each 3%) and different concentrations of the probiotic culture (0.5, 1.5, 3, 4.5% DVS-ABT2 containing Streptococcus thermophilus, Lactobacillus acidophilus and Bifidobacterium bifidum). After fermentation (3 days), tarhana dough was dried in the sun. The effect of the fermentation (0, 1, 2 and 3 days) and the probiotic culture concentration on the chemical composition and the probiotic population of the wet tarhana were evaluated. The effect of the probiotic culture concentration on the chemical composition, the probiotic population and the sensory attribute of dried tarhana were evaluated. Also the effect of dried tarhana (prepared from yoghurt which was fermented by 4.5% probiotic culture) on the plasma lipid profile of human subjects was studied. The results showed that the pH value decreased while the acidity increased, acetaldehyde and diacetyl values increased during the fermentation period and by increasing the probiotic culture concentration of the wet and the dried tarhana. Neither the fermentation nor the concentration of the probiotic culture of wet and dried tarhana affected the crude protein, ether extract, crude fibre, and ash values. The numbers of probiotic bacteria increased until the second day of fermentation. However, in the following day, with an increase of the acid content their number decreased. Generally the increasing of the probiotic culture concentration increased the numbers of probiotic bacteria of the wet and dried tarhana. Also the concentration of the probiotic culture didn&apos;t affect the sensory attributes of dried tarhana. Subjects supplemented with dried tarhana showed significant reduction in total plasma cholesterol, low density lipoproteins (LDL-C) and triglycerides, while high density lipoprotein (HDL-C) increased