Fighting Sexual Harassment on Campus: How Local Contexts of Different Universities Affect the Dynamics and Outcome of these Efforts

In a context where sexual harassment and assault against women is widespread, this article examines the approach taken by three Egyptian universities to the issue. The article argues that the outcome of the universities’ efforts in combating sexual harassment is influenced by their local context and it is this context that can hinder the route to accountability. It examines the interactive relationship between collective action and accountability in the context of fighting sexual harassment on campus. It applies the methodology of action research as a tool that is capable of producing more democratic relationships in knowledge production. The article concludes that there are many differences between the three universities in terms of defining the problem as well as with regard to their local contexts. Those differences question the notion of collective action and accordingly the concept of accountability.Foreign, Commonwealth and Development Office – FCD

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

Soluble Endoglin as a new marker for prediction of pre-eclampsia in early pregnancy

Objective: To evaluate the use of a new marker in the prediction of pre-eclampsia few months before the onset of manifestations. Materials and methods: Sixty-six women during early pregnancy were enrolled in the present study and were divided as follows: Thirty-three pregnant women: 15 developed gestational hypertension and 18 pregnant women who later developed pre-eclampsia and 33 normotensive pregnant women taken as controls. Exclusion was done to twin pregnancies, cases with fetal abnormalities, maternal renal disease and connective tissue diseases. Serum concentration of angiogenic markers (VEGF, PIGF) and anti-angiogenic marker: soluble Endoglin (sEng) was measured during 14–18weeks gestation using ELISA technique. All women were followed up till delivery. Results: A statistically significant difference was found in comparing the median level of VEGF and PIGF in cases of gestational hypertension and pre-eclampsia with controls (P<0.0005 and P<0.0005). A statistically significant difference was found in comparing the median level of VEGF in gestational hypertension group with pre-eclampsia (P=0.19). The median level of soluble Endoglin had a statistically significant difference in comparing gestational hypertension and pre-eclampsia group with controls (P<0.0005). A cut-off value of 31pg/ml VEGF yielded a sensitivity of 94.4%, specificity of 72.9% with accuracy 78.8%. PIGF at cut-off level of 49pg/ml had a sensitivity of 77.8, specificity of 89.6% with accuracy 86.6%. In case of sEng the sensitivity was 94.4%, specificity was 87.5% and accuracy was 89.5%. Conclusion: Pregnant women who are at risk of developing pre-eclampsia can be offered measuring these markers as a screening method to point out those who are more likely to develop pre-eclampsia and warrant close observation and intervention

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

Evaluation of 25-hydroxy vitamin d3 levels in patients with small uterine myomas

Background; Uterine fibroid are the most frequent benign pelvic tumors between women in reproductive period group that has multifactorial pathogenesis. Modern ideas of uterine fibroid pathogenesis have included vitamin D as a vital component. Aim and objectives; was to study the link between 25-hydroxy vitamin D3 levels in cases having small uterine myomas. Subjects and methods; This is a case-control study, was conducted at the Gynecology and Obstetrics department outpatient clinic at Al Zahraa University Hospitals, on 60 women divided into two groups: (Study group); included Thirty cases having fibroid uterus, (Control group); included Thirty women who had no fibroid uterus. Result; When compared to controls, vitamin D3 levels in cases were considerably lower. Conclusion; Vitamin D looks to be a promising and valuable anti-UF treatment. More large, well-designed randomized clinical trials are needed to look into the effectiveness of vitamin D in females with UFs of all ethnicities, especially those of color who are at higher risk of vitamin D deficiency. As a result, vitamin D may become a viable treatment choice for UF, with the added benefit of its pleiotropic impact

Resistin as a predictor for ovarian response to clomiphene citrate in obese PCOS women

Objective: to evaluate the value of resistin as a predictor of ovulation induction by clomiphene citrate in cases of PCOS. Design: prospective, controlled clinical study Setting: kasr Al-Aini Hospital Materials and Methods: obese subfertile women with PCOS (BMI>30 kg/m2) received clomiphene citrate 50mg / 8hours from the third day of the cycle and for five days. Based on success of ovulation induction, women were divided into two groups: Group I who responded to CC and Group II: those who failed to respond to CC. Blood samples were collected on day 3 of the cycle and resistin, insulin and sugar were assayed . Results: There was no significant difference between both groups regarding background characteristics, however, there was a significant difference regarding both BMI and resistin between both groups. Multiple linear regression showed a statistically significant value of resistin independent of that of BMI. The ROC curve showed a cut-off value of 4.78 for resistin with area under curve more than 78.9% and sensitivity 66.67% and specificity 82.4% to predict response to clomiphene citrate in obese PCOS women Conclusion: in obese women, resistin may be of value in prediction of ovarian response to clomiphene citrate. This needs to be confirmed in further trials

Association of interleukin-23 receptor (IL-23R) gene polymorphisms (rs11209026, rs2201841 and rs10889677) with Egyptian rheumatoid arthritis patients

AbstractAim of the workTo analyse interleukin 23 receptors (IL23R) single-nucleotide polymorphism (SNPs) (rs11209026, rs2201841, and rs10889677) and to detect their association with Egyptian rheumatoid arthritis (RA) patients.Patients and methodsThe study included 120 Egyptian RA patients and 120 healthy controls that were genotyped for the three SNPs by real time/polymerase chain reaction for the first SNP and restriction fragment length polymorphism/PCR (RFLP/PCR) in the last two SNPs. The disease activity score (DAS28) was assessed in the patients.ResultsThe studied patients had a mean age of 42.5±13.4years, a disease duration of 5.2±3.5years and consisted of 22 males and 98 females. Joint deformities were present in 35 and 66 patients had swollen joints. The rheumatoid factor (RF) was positive in 78.3% and the DAS28 was 3.2±1.2. Our data emphasize that the AA genotype of rs11209026 was significantly associated with RA patients compared to the controls (p=0.001). We did not find any significant association between either rs2201841 or rs10889677 and the development of RA (p=1, p=0.56 respectively). The AA allele in the 3 SNPs were remarkable frequent in those with deformities and positive RF.ConclusionOur results suggest that IL23 receptor AA genotype variant of rs11209026 contributes to the aetiology of RA and may be considered a genetic marker and shared the susceptibility gene. We need to address the subgroup of patients who will benefit from the selective suppression of the IL-23 signalling which would represent new perspectives towards a personalized therapy of RA patients by further studies

Evaluation of risk factors of ventilator associated pneumonia on outcome of acute exacerbation of chronic obstructive pulmonary disease

Background: Ventilator associated pneumonia (VAP) remains an area of active clinical research with little data about effect of (VAP) on outcome among patients with acute exacerbation of chronic obstructive pulmonary disease. Materials and methods: A prospective study included patients with COPD exacerbation requiring endotracheal intubation for more than 48 h. Clinical assessment and Quantitative culture done for all patients for the occurrence of VAP. Results: Out of one hundred fifty two patients 92 patients (60.5%) were with VAP diagnosis. Their mean age was 56.1 ± 15.02 (38 cases developed early while 54 cases developed late VAP). Forty eight cases were discharged (54%) while 44 cases (46%) died. In comparing mean age of both groups 45.08 ± 15.52 and 57.41 ± 16.34 with P value 0.003. Prolonged use of antibiotics, re-intubation and steroid use are possible risk factors for VAP with significant P values 0.03, 0.001, 0.05 respectively. Age above vs. below 60 showed adjusted odds ratio 5.33; 95% confidence interval 1.59–7.83 with P value 0.007. Early vs. late VAP, and prolonged use of antibiotics vs. none showed significant odds ratio 0.32; 95% CI 0.13–0.76, odds ratio 2.85; 95% CI 1.07–7.59 with P values 0.01, 0.04 respectively. Conclusions: Old age, late onset VAP, re-intubation and prolonged use of antibiotics were predictors of mortality in VAP patients with AECOPD