Insulin sensitivity and plasma glucose response to aerobic exercise in pregnant women at risk for gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is one of the common complications that occur during pregnancy. Early intervention is essential to prevent the development of the disease in the non-pregnant state but also helpful in preventing the occurrence of GDM. The aim of the study was to assess the effect of aerobic exercises on insulin sensitivity and fasting plasma glucose level in pregnant women with risk for gestational diabetes mellitus.Materials and methods: Forty multigravidae women between 20-24 weeks of gestation with risk for GDM were randomly selected (age range was 25-35 years), body mass index ranged from 30-35 kg/m². Women were divided into two equal groups: intervention group (A), which followed an aerobic exercise program in the form of walking on treadmill, three times weekly until the end of 37 weeks of gestation in addition to diet control. Control group (B) which received diet control with usual care given by obstetricians and midwives. Evaluation of the women in both groups was carried out before and after treatment program through assessment of fasting blood glucose and insulin levels.Results: There was a highly statistically significance decrease in fasting blood glucose level, fasting insulin level in both groups where the p value was 0.0001 favoring group (A).Conclusion: Moderate intensity of aerobic exercises were effective in reducing fasting blood glucose level and fasting insulin level in pregnant women with risk for gestational diabetes mellitus.Keywords: Aerobic exercise, Blood glucose level, Insulin level, Pregnancy, Maternal diabete

Diffusion-weighted images and its application in the clinical diagnostic testing of endometrial focal lesions

Background: Numerous endometrial disorders can create several difficulties for the radiologist due to the overlapping of imaging characteristics and diverse endometrial pathologies. The most frequently utilized imaging tool for diagnosing and characterizing endometrial focal lesions is magnetic resonance imaging (MRI) with diffusion weighted images (DWI).Objective: We conducted this study to determine the efficacy of MRI with DWI in improving the diagnostic accuracy of endometrial focal lesions, especially in the differential diagnosis of benign and malignant focal endometrial masses.Patients and Methods: This study recruited 36 women (21 postmenopausal and 15 premenopausal) who experienced vaginal bleeding and had endometrial thickness and focal endometrial lesions with a distinct echo pattern on ultrasound (US) examination. The age of patients was between 27 to 85 years, with an average of 45.2 years. Ethics Committee approval was obtained in addition to written informed consent from all included patients.Results: The 36 patients included in this study, were classified according to their lesions histopathological results; Benign group (15 lesions; 41.67%) and malignant group (21 lesions; 58.33%). The most common benign lesion was endometrial polyp (9/15) while the most common malignant lesion was endometrial carcinoma (21/21). In the current study MRI with diffusion could correctly diagnose 33 lesions out of 36 lesions, achieving (91.6%) sensitivity, (100%) specificity, (100%) positive predictive value (PPV), (95.6%) negative predictive value (NPV) and accuracy (97.05 %).Conclusion: Integrating DWI and ADC mapping at a high b value in pelvic MRI examination improves the sensitivity, specificity, and precision of diagnosing endometrial focal lesions

Toxoplasma gondii Suppresses Th2-Induced by Trichinella spiralis Infection and Downregulates Serine Protease Genes Expression: A Critical Role in Vaccine Development

Background: Toxoplasma gondii coinfection can modify host immune responses and the severity and spread of other parasites. We investigated how T. gondii and Trichinella spiralis infections counter-regulate each other's immune responses. Methods: The parasite burden, the expression of T. gondii rhoptry kinase ROP18 and T. spiralis putative serine protease (TsSP), the IgG1 and IgG2a responses, besides histopathological and immunohistochemical staining with iNOS and arginase were used to evaluate the dynamics of coinfection. Results: Through their effects on host immune responsiveness, coinfection with T. gondii modified the virulence of T. spiralis infection. Coinfected animals with high and low doses of T. gondii demonstrated significant reductions in the T. spiralis burden of 75.2% and 68.2%, respectively. TsSP expression was downregulated in both groups by 96.2% and 86.7%, whereasROP18 expression was downregulated by only 6% and10.6%, respectively. In coinfected mice, elevated levels of T. gondii-specific IgG2a antibodies were detected. Th1 induced by T. gondii inhibits the Th2 response to T. spiralis in coinfected animals with high iNOS expression andlow-arginine1 expression. Conclusion: T. gondii infection induces a shift toward a Th1-type immune response while suppressing a helminth-specific Th2 immune response, paving the way for developing novel vaccines and more efficient control strategies

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of sleep related breathing disorders on ocular function

Introduction: Sleep disorders are common and obstructive sleep apnea hypopnea syndrome (OSAHS) is the commonest. OSAHS is not commonly diagnosed by the ophthalmologist, but it has many systemic and ocular complications. Aim of the work: The aim of this study was to detect the effect of sleep related breathing disorders on ocular function. Patients and methods: Thirty patients with OSAHS were enrolled after obtaining informed consents. Patients were subjected to full history taking, Epworth sleepiness scale, anthropometric data, Mallampati score, clinical apnea score, sleep study and complete ocular examination. Results: 4 patients had mild OSAHS (13.33%), 12 patients had moderate OSAHS (40%) and 14 patients had severe OSAHS (46.67%) two of them had sleep hypoventilation. 4 patients were free from any ocular manifestations. In 26 patients one or more of the following ocular findings were found: floppy eyelid syndrome (FES) was detected in 3 (10%) patients, glaucoma was diagnosed in 5 (16.67%) patients, senile cataract was found in 3 (10%) patients, nonarteritic anterior ischemic optic neuropathy (NAION) was detected in 4 (13.33%) patients, papilledema was diagnosed in 3 (10%) patients and 18 (60%) patients had dry eye manifestations. In conclusion: The increased prevalence of ocular symptoms and signs in patients with OSAHS indicates a need to increase awareness and establish close collaboration with the sleep physicians with clear pathways for review of OSAHS patients by the ophthalmic services. We should study the effect of treatment of OSAHS on the ocular manifestations

EFFICACY OF NEURAL MOBILIZATION ON LOW BACK PAIN WITH S1 RADICULOPATHY

Background: A definite conclusion about the effectiveness of neural mobilization on patients with radiculopathy can’t be reached because of the lacks of well designed randomized controlled trials. The purpose of the study to investigate the effects of neural mobilization on low back pain subjects with S1 radiculopathy. Methods: Sixty chronic low back pain subjects with S1 radiculopathy participated in this study. The participants were suffering from varying degrees of unilateral pain and paresthesia in the lumbosacral region and lower limb. The causes of radiculopathy were bulged disc, herniated disc or neuroforaminal stenosis at L5-S1 level.The participants were randomly assigned into two equal groups with 30 participants in each group. The experimental group received neural mobilization and conventional rehabilitation program in the form of infrared, ultrasonic and general exercises that involved stretching and strengthening exercises for the back muscles for 6 weeks. The control group received the same conventional rehabilitation program only for 6 weeks. The outcome measures were H-reflex latency, amplitude, and H/M ratio for assessing S1 nerve root function, visual analog scale (VAS) for assessing pain level, and Oswestry Disability Index (ODI) for assessing functional disability. All the participants were evaluated pre and post 6 weeks of treatment. Results: Both groups showed significant improvements in all measured variables after 6 weeks, but neural mobilization showed more beneficial and statistically significant effect in all measured variables than the control group. Conclusion: Neural mobilization technique is an effective intervention for reduction of pain, functional disability and enhancing physiological function of the nerve root in low back pain with lumbosacral radiculopathy

Voice changes in patients with chronic obstructive pulmonary disease

Introduction: Voice changes are not a direct symptom of chronic obstructive pulmonary disease (COPD), but many COPD patients experience voice changes. Aim of the work: The aim of this work was to establish the voice changes in patients with chronic obstructive pulmonary disease. Patients and methods: Fifty COPD patients were conducted in this study. Patients were enrolled after obtaining informed consents. All patients were subjected to clinical diagnostic aids which include history taking (age, sex, smoking index and drug history), general and chest examinations, spirometry, arterial blood gases, chest X-ray, endoscopic examination of the larynx, auditory perceptual assessment and acoustic analysis of voice. Results: The age of the patients ranged from 32 to 76 years, all patients were current or former smokers and the pack year index ranged from 20 to 66 with a mean ± SD value of 41.16 ± 13.80. Dysphonia was perceived in 25 (50%) patients. There was significant positive correlation between the smoking index with Jitter%, Shimmer% and the grade of dysphonia. There was significant positive correlation between Jitter%, Shimmer% and the grade of dysphonia with the large doses of ICSs usage and with pMDIs usage. Moreover, there was significant inverse correlation between Jitter%, Shimmer% and the grade of dysphonia with DPIs usage and with FVC, FEV1 and MMEF% of predicted values. In conclusion: Dysphonia (hoarseness) in COPD patients is multifactorial. Successful analysis should depend on cooperation between pulmonologists, voice specialists, and laryngologists

Thoracoscopic pleurodesis using iodopovidone versus pleural abrasions in management of recurrent pneumothorax

Introduction: Spontaneous pneumothorax is classified as either primary or secondary, recurrent pneumothorax may require further corrective and/or preventive measures such as pleurodesis. Aim of the work: The aim of this work was to compare the effectiveness of chemical pleurodesis using iodopovidone and mechanical pleurodesis by thoracoscopic pleural abrasions in management of recurrent spontaneous pneumothorax. Patients and methods: Thirty patients with documented recurrent spontaneous pneumothorax were enrolled in this study after obtaining informed consents. The patients were divided into two groups each contains 15 patients. All patients were subjected to the following: full history taking, thorough clinical examination, laboratory investigations including prothrombin activity and INR, radiological evaluation and thoracoscopic intervention was done using rigid thoracoscope and videoscopy unit. Results: The success rate of iodopovidone pleurodesis in this study ranged from 88.7% after 1 week to 92.3% after 1 month. Whereas, the success rate of mechanical pleurodesis ranged from 73.3% after 1 week to 90.9% after 1 month. There was no significant statistical difference between the results of the follow up between the 2 groups after 1, 7, 30 and 90 days. Conclusion: Chemical pleurodesis using iodopovidone was as effective as mechanical pleurodesis by thoracoscopic pleural abrasions in management of recurrent spontaneous pneumothorax