The impact of metabolic syndrome on the clinical profile and tumor characteristics of endometrial carcinoma

Background: The objective is to study the influence of different components of metabolic syndrome on clinical behavior and tumor characteristics of endometrial cancer cases and to evaluate if metformin usage affects the stage and grade of endometrial cancer.Methods: 60 women attending the gynecological oncology clinic at El Shatby Maternity University Hospital, after being diagnosed as endometrial carcinoma, were recruited in the study. Serum samples were collected to detect insulin level and lipid profile, and then allocated into two groups according to metabolic syndrome existence. After the recommended surgery, and the routine histopathological diagnosis followed by histopathological chemilumeniscence technique to detect staining intensity, percentage of estrogen receptors ER, and score out of 8 according to Allred score.Results: Endometrial cancer EC patients with metabolic syndrome had a significantly higher age, higher FIGO stages, and higher grade compared to EC without metabolic syndrome (p˂0.05). There was no statically significant difference between both groups in estrogen receptors scoring. HDL was an important factor affecting grade of EC patients, as when HDL decreased by one mg/dl, the grade increased by 0.033% (P=0.030, OR=0.899, OR adjusted=0.826), Insulin level was found to be an important factor affecting stage as when insulin level increased by one Uiu/ml, the stage increased by1.091% (p=<0.001, OR=1.064, OR adjusted=1.091).Conclusions: Hyperinsulinemia was the most important factor affecting aggressiveness of the tumor as regards stage and risk group classification. Metformin failed to show a protective effect against endometrial cancer progression

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

Waist height ratio and waist circumference in relation to hypertension, Framingham risk score in hospitalized elderly Egyptians

Background: Hypertension is a public health problem and obesity is becoming an epidemic, increasing the risk of hypertension. Both are risk factors for cardiovascular diseases (CVD). Methods: A case control study recruiting 102 patients aged ≥60 years, divided into 55 cases with hypertension and 47 controls without. Body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) were measured as well as lipid profile then Framingham risk score (FRS) was calculated. Results: Odds ratio (OR) for hypertension and medium to high risk cardiovascular events was the same in female patients using WC and WHtR. In male patients, only WHtR increased the risk for hypertension and for cardiovascular events, OR significantly increased with higher WHtR compared to WC. Conclusion: WHtR and WC are strong risk factors for hypertension and cardiovascular events in Egyptian elderly female patients. WHtR is the best anthropometric predictor for hypertension and cardiovascular events in male patients. Keywords: Hypertension, Waist to height ratio, Waist circumference, Framingham risk, Egyptian

Helicobacter pylori associated to unexplained or refractory iron deficiency anemia: an Egyptian single-center experience

Background: Refractory or unexplained iron deficiency anemia accounts for about 15% of all cases. The endoscopic gastrointestinal workup sometimes fails to establish the cause of iron deficiency anemia and a considerable proportion of patients regardless of risk category fail to respond to oral iron supplementation. The aim of the present study was to assess the etiological role of Helicobacter pylori infection in adult Egyptian patients with unexplained or refractory iron deficiency anemia. Methods: A case controlled study was composed of 104 iron deficiency anemia cases and 70 age- and gender-matched healthy controls. Patients were diagnosed with iron deficiency anemia according to hemoglobin, mean corpuscular volume, serum ferritin, and transferrin saturation. Upper and lower endoscopies were performed and active H. pylori infection was investigated by testing for the H. pylori antigen in stool specimens. Hematological response to H. pylori treatment with triple therapy together with iron therapy (n = 32) or only iron therapy (n = 32) were assessed in patients with H. pylori infection. Results: H. pylori infection was more prevalent in patients with unexplained or refractory iron deficiency anemia (61.5%). Of the different hematological parameters investigated, there was a significant correlation only between H. pylori infection and mean corpuscular volume (p-value 0.046). Moreover, there was a significant correlation between receiving triple therapy together with iron supplementation and improvements in the hematological parameters [hemoglobin (p-value < 0.001), mean corpuscular volume (p-value < 0.001), iron (p-value < 0.001) and serum ferritin (p-value < 0.001)] compared to receiving iron supplementation alone. Conclusions: Failing to test for H. pylori infection could lead to a failure to identify a treatable cause of anemia and could lead to additional and potentially unnecessary investigations. Furthermore, treatment of H. pylori infection together with iron supplementation gives a more rapid and satisfactory response. Keywords: Helicobacter pylori, Iron deficiency anemia, Refractory iron deficiency, Unexplained iron deficiency, Microcytic anemi

The impact of metabolic syndrome on the clinical profile and tumor characteristics of endometrial carcinoma

Background: The objective is to study the influence of different components of metabolic syndrome on clinical behavior and tumor characteristics of endometrial cancer cases and to evaluate if metformin usage affects the stage and grade of endometrial cancer.Methods: 60 women attending the gynecological oncology clinic at El Shatby Maternity University Hospital, after being diagnosed as endometrial carcinoma, were recruited in the study. Serum samples were collected to detect insulin level and lipid profile, and then allocated into two groups according to metabolic syndrome existence. After the recommended surgery, and the routine histopathological diagnosis followed by histopathological chemilumeniscence technique to detect staining intensity, percentage of estrogen receptors ER, and score out of 8 according to Allred score.Results: Endometrial cancer EC patients with metabolic syndrome had a significantly higher age, higher FIGO stages, and higher grade compared to EC without metabolic syndrome (p˂0.05). There was no statically significant difference between both groups in estrogen receptors scoring. HDL was an important factor affecting grade of EC patients, as when HDL decreased by one mg/dl, the grade increased by 0.033% (P=0.030, OR=0.899, OR adjusted=0.826), Insulin level was found to be an important factor affecting stage as when insulin level increased by one Uiu/ml, the stage increased by1.091% (p=&lt;0.001, OR=1.064, OR adjusted=1.091).Conclusions: Hyperinsulinemia was the most important factor affecting aggressiveness of the tumor as regards stage and risk group classification. Metformin failed to show a protective effect against endometrial cancer progression

Barriers to breast cancer screening among a sample of Egyptian females

Background: Breast cancer (BC) is usually diagnosed in late stages in countries with limited resources. Early detection of BC is likely to improve the outcome of the disease for women in these areas. Objective: The aim of this study was to understand the possible personal, economic, and systems barriers to BC screening in a sample of Egyptian women. Materials and Methods: A cross-sectional study was conducted in family health centers representing the seven districts of Alexandria governorate, Egypt. A total of 612 women were randomly selected from the chosen centers. Results: In this sample of Egyptian women, the most frequently identified potential barriers to BC screening were the following: 81.8% would not seek care until they were ill, 77% were unwilling to have a mammogram until it was recommended by the doctor, 71.4% blamed the, lack of privacy, 69.2% thought that medical checkups were not worthwhile, and 64.6% blamed the cost of services. The study further revealed that women of lower education, women in the lower income category, women who did not do paid work, those who had poor knowledge of the risks of BC, and women with no family history of BC were more likely to perceive different screening barriers compared with their counterparts. Conclusion: Many potential personal, economic, and health system barriers were identified. Addressing these barriers by increasing the awareness of BC and dealing with the misconceptions that the women have can help the policy makers to design more culturally relevant strategies to motivate women to utilize screening services