Effect of Marginal-Quality Irrigation on Accumulation of some Heavy Metals (Mn, Pb, and Zn) in TypicTorripsamment Soils and Food Crops

Lack of active sorption sites in sandy soils renders metals added by irrigation water more labile and increases their soil-to-plant transfer. Thus, this study investigated the long-term impacts of irrigation using sewage effluents and contaminated groundwater on metal accumulations in TypicTorripsamment soils, and edible parts of food crops. Nine sites in El-Gabal El-Asfar farm, south-eastern to the Nile Delta of Egypt, were selected. At each site, irrigation water, soil (0-30 cm), and the crop's edible part were sampled in triplicates and analyzed for Mn, Pb, and Zn. Results revealed significant (p < 0.05) differences in metal concentrations among water sources. Thus, constant irrigation caused significant spatial variations in total and available metal contents in soils. Total contents of Pb (in four sites) and Zn (in all sites) exceed the lithosphere range, while the available contents of the three metals exceeded the safe limits in all soils. The index of geo-accumulation indicated no Mn pollution but showed elevated pollution risks for Pb and Zn. The three metals showed high availability ratios, proving the effect of light soil texture. The multivariate statistical analysis indicated that Mn and Zn had similar geochemical behaviors in soils. Metal contents in all crop's edible parts surpassed the safe limits. The bioaccumulation factor (BAF) was less than 1.0 for Mn and Zn but higher than 1.0 for Pb. The highest BAFs occurred in cabbage leaves, indicating the phytoextraction potential of this species. Sufficient water treatment and proper remediation techniques are recommended to alleviate metal accumulation in food crops and their transfer via the food chain

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

Correlative study between C-reactive protein, clinical severity, and nerve conduction studies in Guillain-Barrè syndrome

Abstract Background Guillain-Barre' syndrome (GBS) is a serious autoimmune disorder in which the immune system attacks healthy nerve cells of the peripheral nervous system causing polyradiculoneuropathy which leads to weakness, numbness, and tingling, and can eventually cause paralysis. Autoimmune conditions like GBS can induce a high level of inflammation resulting in an increase in the C-reactive protein( CRP) production. The aim of this study is to assess the relationship between CRP level and the clinical severity as well as the electrophysiological findings of nerve conduction studies in patients with GBS. Methods Twenty- four patients (10 males &14 females) with ages ranged from 14 to 50 years and a mean age of 33.46 ±12.25 years who fulfilled the clinical criteria for diagnosing GBS were recruited within the first 2 weeks of onset of illness, in a cross- section study. They underwent general and neurological examination. Nerve conduction studies as well as assessment of serum CRP level were done. Results There was a statistically significant positive correlation between clinical severity assessed by (Hughes disability scale) and serum CRP level in GBS patients. Multivariate logistic regression analysis showed that both gastroenteritis, cranio-bulbar affection, need for mechanical ventilation (MV), disability score >4, and absent motor and sensory responses were significantly associated with high serum CRP level >6mg/dl. Conclusions The results of this study support the hypothesis that in GBS patients, gastroenteritis, craniobulbar affection, need for MV, disability score >4, and absent motor and sensory nerve responses were significantly related to high serum CRP level. This reflects the negative impact of the inflammatory response elicited by high CRP level on clinical severity in GBS patients, and so it may be used as a prognostic marker of clinical severity of GBS and this can help in therapeutic decision making

Assessment of mycoplasma vaccine efficacy in reducing infection with Newcastle disease virus

The present work recorded the impact of using Mycoplasma gallisepticum vaccines on post-vaccinal response and protection against challenge with Newcastle disease virus. Specific pathogen-free chickens were divided into eight groups of forty chickens each. Group G1 was vaccinated with Mycoplasma gallisepticum live attenuated and Mycoplasma gallisepticum inactivated vaccines. Group G2 was vaccinated with Mycoplasma gallisepticum live attenuated, Mycoplasma gallisepticum inactivated and Newcastle disease inactivated vaccines. Group G3 was vaccinated with Mycoplasma gallisepticum live attenuated vaccine. Group G4 was vaccinated with Mycoplasma gallisepticum live attenuated and Newcastle disease inactivated vaccines. Group G5 was vaccinated with Mycoplasma gallisepticum inactivated vaccine. Group G6 was vaccinated with Mycoplasma gallisepticum inactivated and Newcastle disease inactivated vaccines. Group G7 was vaccinated with Newcastle disease inactivated vaccine. Group G8 was kept as non-vaccinated control. The Newcastle disease hemagglutination inhibition antibodies and mortality percentages were measured. Group G7 recorded the best protective Newcastle disease hemagglutination inhibition antibody titer (7 log2). Group G2 recorded a marginal satisfactory antibody titer (6 log2) after vaccination by the three tested vaccines. The remaining groups revealed unsatisfactory titers ranged from 0-5. The protection levels for G2, G4, G6 and G7 ranged from 70% to 100%, but only G2 and G7 were considered protected. G1, G3, G5 and G8 showed typical clinical signs of Newcastle disease. The Mycoplasma gallisepticum vaccines couldn’t improve the response to Newcastle disease inactivated vaccine. The results suggest that Mycoplasma gallisepticum vaccination is immunosuppressive rather than immunomodulatory in Newcastle disease vaccination

Bone Mineral Density in Egyptian Children with Familial Mediterranean Fever

Background: Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The objective of this study was to assess BMD in Egyptian children with FMF on genetic basis. Methods: A cross sectional study included 45 FMF patients and 25 control children of both sexes in the age range between 3-16 years old. The patients were reclassified into two groups, namely group I(A) with 23 cases using colchicine for 1 month or less, and group I(B) with 22 cases using colchicine for more than 6 months. For both the patients and control groups, MEFV mutations were defined using molecular genetics technique and BMD was measured by DXA at the proximal femur and lumbar spines. Results: Four frequent gene mutations were found in the patient group E148Q (35.6%), V726A (33.3%), M680I (28.9%), and M694V (2.2%). There were also four heterozygous gene mutations in 40% of the control children. Patients receiving colchicine treatment for less than 1 month had highly significant lower values of BMD at the femur and lumbar spines than the control children (P=0.007, P<0.001). Patients receiving colchicine treatment for more than 6 months had improved values of BMD at femur compared with the control, but there were still significant differences between them in lumbar spine (P=0.036). There were insignificant effect of gene mutation type on BMD and the risk of osteopenia among the patients. Conclusion: FMF had a significant effect on BMD. However, regular use of colchicine treatment improves this effect mainly at the femur

Assessment of cognitive dysfunction, depression, and anxiety in patients with stable chronic obstructive pulmonary disease in relation to serum interleukin-6

Background Chronic obstructive pulmonary disease (COPD) is a well-recognized multicomponent disease, but its influences on cognitive function and other associated psychological disorders were poorly identified. Systemic inflammation is considered as a key link between these diseases. Aim To assess the cognitive impairment, anxiety, and depression among stable COPD patients using different neuropsychological tests, in relation with serum interleukin-6 (IL-6). Patients and methods A study was conducted upon 100 stable COPD patients and 25 controls. All the participants were subjected to neurological and psychiatric assessment, such as The Generalized Anxiety Disorder-7 scale, Beck Depression Inventory-II scale, and Montreal Cognitive Assessment scale. Serum IL-6 was measured for all participants. Results COPD patients had more frequent anxiety disorders, depression, cognitive dysfunction, and higher serum IL-6 than control group. Visual-spatial/executive and delayed recall domains of cognitive dysfunction were significantly affected in COPD than controls (P<0.001), whereas other domains (Naming, Attention, Language, Abstraction, and Orientation) did not reach a significant level of statistical difference. Generalized Anxiety Disorder-7 anxiety score showed a significant positive correlation with modified medical research council and serum IL-6 and a significant negative correlation with forced expiratory volume in the first second%. Beck Depression Inventory-II score showed a significant positive correlation with BMI. Montreal Cognitive Assessment score showed a significant positive correlation with forced expiratory volume in the first second% and a significant negative correlation with serum IL-6. A cut-off value of serum IL-6 more than 2.6 pg/ml had sensitivity and specificity for prediction of cognitive dysfunction in COPD patients (86.1 and 66.7%, respectively; P<0.001). Conclusion Anxiety, depression, and cognitive impairment were significantly more prevalent between COPD patients. Serum IL-6 was a valid predictor for cognitive dysfunction in COPD patients

Potential Effect of Biochar on Soil Properties, Microbial Activity and <i>Vicia faba</i> Properties Affected by Microplastics Contamination

Microplastics (MPs) contamination is an emerging issue globally; however, adverse impacts of MPs on soil, plants and microbial activity have not been intensively studied. In this study, the potential effect of different levels of MPs (1.5, 7.5, 15%) has been investigated on soil properties, plant properties (Vicia Faba) and microbial activities through a pot experiment. The effect of biochar (BC: 2%) to mitigate the adverse effects of MP has also been examined. Soil properties (pH, EC, OM, CaCO3 and some elements) have significantly differed due to contamination of soil by MPs as well as by adding BC to the soil. The pH and CaCO3 were significantly increased more than in the control, while EC, TDS, available P, Mn and Fe were significantly decreased lower than the control, which implies adsorption on microplastic. Plant properties, such as enzymes, chlorophyll and fresh and dry weight in roots, were adversely affected by MPs contamination; however, BC mitigated this effect, especially with low contamination levels of MPs. The fresh and dry weight of the shoot was not significantly affected by MPs. The cytogenetic analysis showed that the mitotic index was significantly reduced compared to the control (9.39%), while BC increased the mitotic index at 1.5% MPs (7.11%) although it was less than the control. The percentage of abnormalities of V. faba root tip cells under different levels of MPs was significantly increased more than the control; however, BC mitigated this effect, especially at 7.5% MPs. The total count of bacteria and fungi even in soil or in the rhizosphere area did not follow a clear trend; however, the effect of BC was clear in increasing their activities. Microbial biomass carbon and nitrogen were also significantly affected by MPs and BC. In this study, the BC level was low, however, it mitigated some adverse effects of MPs, especially at 1.5 and 7.5% of MPs. Thus, the BC could be promising in mitigating the negative impacts of MPs when applied with suitable levels that need more future studies