Diagnostic performance and predictive value of rheumatoid factor, anti-cyclic-citrullinated peptide antibodies and HLA-DRB1 locus genes in rheumatoid arthritis

<p>Abstract</p> <p>Background</p> <p>We evaluated the significance of the genes, defined as <it>DRB1*04 </it>or <it>DRB1*01</it>, in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints.</p> <p>Methods</p> <p>Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA-<it>DRB1 </it>alleles typed by PCR.</p> <p>Results</p> <p>In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA-<it>DRB1</it>*01 was found in 45% of patients and 35% of them had one or two HLA-<it>DRB1*04 </it>alleles. According to <it>DRB1*04 </it>subtypes, (<it>DRB1* 0405</it>) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti-CCP (OR 19.6), and <it>DRB1*04 </it>positive allele (OR 5.1). The combination of <it>DRB1*04 </it>+ anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLA-<it>DRB1*04</it>, HLA-<it>DRB1*01</it>, RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively).</p> <p>Conclusion</p> <p>Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.</p

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

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Phenotypic and Genotypic Characteristics of Antimicrobial Resistance of Gram-negative Bacteria isolated From Pet Animal

Most animal feeds are set from protein-rich raw materials. These protein constituents may possess various hazards, particularly highly drug-resistant pathogens, causing a bad impact not only on the pet's health, but also on their owners. In the current study, a total of 2100 pet food and 100 pets’ fecal swabs were collected and bacteriologically examined from 2017 to 2020. It was revealed that the percentage of Gram-negative bacteria isolated from pet food and fecal swabs was 49% and 56% respectively. E. coli, Proteus sp., and K. pneumoniae were the most isolated bacteria in percentages of 12.4%, 8.4%, and 4.9% respectively from Pet food and 25%, 7%, 12% respectively from pet fecal swabs. In addition, Enterobacter cloacae, P. aeruginosa, Aeromonas hydrophila, Citrobacter sp., P. fluorecens, and Y. enterocolitica were isolated from pet food in order to 3.8%, 3.5%, 3.2%, 2.6%, 2.6% and 2.1% respectively. Salmonella sp. isolated from pet food was 0.6% while it was 5% from pet fecal swabs. The most predominant salmonella serotype isolated from pet food and pet fecal swabs was S. Typhimurium. Furthermore, S. Virchow, S. Anatum, S. Kentucky, S. Kedougou and S. Infantis were isolated serotypes from Pet food in percentages of 15.7%, 23.1%, 15.4%, 7.7%, and 7.7% respectively. While S. Nitra, S. Ibargi, S. Enteritidis and S. Boecker were isolated from pet fecal swabs at a percentage of 20% for each. On the other hand, O158 was the most predominant E. coli serogroup isolated from pet food and pet fecal swabs in percentages of 30.4% and 30.8% respectively followed by O157 in percentages of 21.7% and 26.9% respectively. O26 was isolated from pet food and pet fecal swabs in percentages of 13% and 7.7% for each. O119 was isolated from pet food and pet fecal swabs in percentages of 4.3% and 3.8% respectively. O86, O27, O44, O55, and O78 were isolated from pet food in the percentage of 4.3%, 8.7%, 4.3%, 4.3%, and 8.7%respectively. While O114, O111, and O125 were isolated serotypes from pet fecal swabs in percentages of 15.4%, 3.8%, and 11.5% respectively. This study revealed that the antimicrobial sensitivity test of 80% of Salmonellae were resistant to Cefotaxime and Colistin sulphate while 50%, 30, and 20% of isolates were resistant to Gentamicin, Tetracycline, and Cefepime respectively, while 40% of Salmonellae were resistant to Chloramphenicol, Enrofloxacin, and Amoxicillin-clavulanate. Also 60% of Salmonellae showed resistance to Trimethoprim sulfamethoxazole and Ciprofloxacin. Detection of Extended-spectrum ß-lactamase resistance genes (blaTEM, blaSHV, and blaCTX-M) in Pets using Polymerase chain reaction (PCR) showed the presence of blaTEM and blaSHV genes in all tested isolates in 12 samples out of 12 (100%) and has shown that the ratio of blaCTX-M is 5 out of 12samples (41.6 %)

Silent hyperlipidaemia modulated vascular endothelial markers

The aetiology of ischemic heart diseases is mainly based on atherosclerosis of coronary artery. Inflammation and oxidative reactions are initiating and aggravating the illness resulting in pathological remodelling of vasculaturze at site of injury. Endothelium lining of blood vessels participated in the reaction biochemically through releasing some proteins into circulatory system which further complicate the condition. The aim of this study was to determine early diagnosed hyperlipidaemia-associated changes of the plasma level of some of these endothelial biomolecules. Compared to healthy control, hyperlipidaemic patients have significantly increased arginase, metalloendopeptidase, peroxidase, myeloperoxidase, and peroxynitrite with concomitant reduction in arylesterase and nitric oxide. The present study concluded that hyperlipidaemia play a great role in modulation of certain plasma protein markers which might be directly related to patient pathological condition or could be used as a tool for diagnosis or patient follow up indicating the stage of vasculature remodelling, healing, inflammation or resolution

Transcriptomic marker screening for evaluating the mortality rate of pediatric sepsis based on Henry gas solubility optimization

Sepsis is a potentially life-threatening medical condition that increases mortality in pediatric populations admitted in the intensive care unit (ICU). Due to the unpredictable nature of the disease course, it was challenging to find the informative genetic biomarkers at the earliest stages. Consequently, a considerable attention has been paid for the early prediction of pediatric sepsis based on genetic biomarkers analysis that would promote the early medical intervention. Therefore, the proposed study attempted to demonstrate the feasibility of Henry Gas Solubility Optimization (HGSO) in differential gene selection to train supervised machine learning algorithms for the early prediction of pediatric sepsis and survival rate evaluation. 26 nonoverlapping informative genes have been nominated using the gene expression profile of peripheral blood cells. After 20 runs of 5-fold cross-validation, the selected genes revealed its effectiveness in the early identification of sepsis subtypes with an estimated average accuracy of 98.03 ± 0.30 % evaluated using 20 runs of fivefold cross-validation and an average accuracy of 98.83 ± 0.57 % for evaluating the survival rate. Based on the experimental results, the present study using the novel metaheuristic algorithm HGSO determined the highest accuracy, the most predictive and informative genes for pediatric sepsis, thus allowing determination of the appropriate treatment plan

Serum selenium level in acute myocardial infarction

Introduction Although remarkable developments have been made in the management of cardiovascular disease, myocardial infarction (MI) remains the most common cause of death worldwide. MI is an acute condition of myocardial cell death that occurs as a result of imbalance between the coronary blood supply and myocardial requirements. Lipid peroxidation and excessive production of reactive oxygen species (ROS), such as superoxide anions (O2•−) and hydrogen peroxide, play a major role in the mechanism of MI. ROS directly damage the cell membrane and cause cell necrosis. However, ROS also stimulate signal transfer to upregulate inflammatory cytokines, for example, tumor necrosis factor-α in the ischemic area and the neighboring myocardium. Aim The aims of this article were: (a) to determine serum selenium (Se) and the cut-off value in acute MI patients and the correlation between serum Se and other cardiac biomarkers such as troponin, creatine kinase (CK), creatine kinase myocardial brand (CK-MB), C-reactive protein, and lipogram; and (b) to determine the most predictor risk factor of MI. Materials and methods The study was carried out on 120 individuals (60 patients and 60 controls). The patients presented to the Internal Medicine Department and Coronary Care Unit at Assiut University Hospital. The healthy controls were selected and matched for age and sex, and only those who were found to be in good health and free from any signs of chronic diseases or disorders were included. Results The main finding of this analysis that there is a statistical difference between patients and controls in serum Se as the mean Se level in patients was 80.3±20.5 and in controls it was 97.2±14.0 and P value of less than 0.001, Thus, serum Se is significantly low in MI patients. Also, there was no statistical difference in serum Se in terms of sex, smoking, accompanying diseases (diabetes or hypertension), or type of infarction. Conclusion This study supports a significant association between deficient serum Se concentration with cut-off value of up to 84 ng/ml and MI. Strikingly, the most predictor of MI is serum Se, followed by total cholesterol, diabetes mellitus, low-density lipoprotein, and hypertension