Adjacent thoracic lymph node metastases originating from two separate primary cancers: case report

Reported is an unusual case of adjacent thoracic lymph nodes demonstrating metastases from two different primary malignancies. A 51 year-old woman with a previous history of bilateral breast cancer underwent a radical gastro-oesophagectomy for adenocarcinoma of the lower third of the oesophagus. The resection specimen demonstrated breast and oesophageal metastases in adjacent thoracic lymph nodes. Mechanisms for this phenomenon, including the known local immune suppression on lymphoid cells by oesophageal carcinoma cells, are discussed

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

Exploring the Antimicrobial and Hepatoprotective Effects of Kefir; A Probiotic Fermented Milk

Fermented milk is considered as a good source of nutrition for many people. One of the most important substances that could be used in the fermentation of milk is kefir grains. Kefir fermented milk is very important in many health conditions such as bacterial infections, high blood pressure and some hepatic conditions. The aim of this study was to determine the antibacterial activity of fermented milk of kefir against certain pathogenic microorganisms such as Salmonella sp., Escherichia coli, Staphylococcus sp. and Candida albicans using agar diffusion method. The effectiveness of fermented milk of kefir has been studied as hepatoprotective against CCl4 inducing liver toxicity and as a protective agent against kidney and spleen damage using laboratory animal models. The results revealed that the fermented milk of kefir had a potent antibacterial activity against many pathogenic microorganisms and it also showed significant high protection in mice against the toxicity of CCl4. In conclusion, kefir milk can be used as an antibacterial supplement and as a protective agent against liver toxicity

Essential Oil of <i>Ipomoea carnea</i>: Chemical Profile, Chemometric Analysis, Free Radical Scavenging, and Antibacterial Activities

Essential oils (EOs) have been reported as a promising group of naturally extracted compounds due to their various reported biological activities. Ipomoea carnea is a widely distributed plant with many traditional uses worldwide. However, although the EOs of various Ipomea species have been reported, I. carnea remains poorly studied. Therefore, the present investigation aimed to characterize the chemical profile of the EO of I. carnea growing in Egypt via gas chromatography/mass spectroscopy (GC-MS) and correlate its profile with other reported species via chemometric analysis using agglomerative hierarchical clustering (AHC) and principal component analysis (PCA). In addition, the aim was to determine the antioxidant and antibacterial activities of the extracted EO. Depending on the GC-MS analysis, 31 compounds were identified, mainly terpenes (94.82), with traces of carotenoid and apocarotenoid-derived compounds. The major compounds were tau-cadinol (35.68%), α-cadinol (26.76%), spathulenol (8.11%), and caryophyllene oxide (6.56%), which were assigned as major compounds. The chemometric studies showed that the Egyptian ecospecies of I. carnea differs in chemical profile from those growing in Brazil, as well as those reported for other Ipomea species. The EO showed significant DPPH and ABTS radical scavenging abilities, with IC50 values of 33.69 and 40.86 mg L−1, respectively. Additionally, the I. carnea EO displayed significant inhibition against the growth of all tested bacterial strains, where it showed an MIC range of 82–1442 mg mL−1. Based on the current results, the I. carnea EO, particularly the major identified compounds, could be used as a potential eco-friendly green resource for antioxidant and antimicrobial activities. Therefore, further study is recommended to evaluate the biological significance of the main compounds, either individually or in combination, as well as assess their modes of action and safety

Essential Oil of Ipomoea carnea: Chemical Profile, Chemometric Analysis, Free Radical Scavenging, and Antibacterial Activities

Essential oils (EOs) have been reported as a promising group of naturally extracted compounds due to their various reported biological activities. Ipomoea carnea is a widely distributed plant with many traditional uses worldwide. However, although the EOs of various Ipomea species have been reported, I. carnea remains poorly studied. Therefore, the present investigation aimed to characterize the chemical profile of the EO of I. carnea growing in Egypt via gas chromatography/mass spectroscopy (GC-MS) and correlate its profile with other reported species via chemometric analysis using agglomerative hierarchical clustering (AHC) and principal component analysis (PCA). In addition, the aim was to determine the antioxidant and antibacterial activities of the extracted EO. Depending on the GC-MS analysis, 31 compounds were identified, mainly terpenes (94.82), with traces of carotenoid and apocarotenoid-derived compounds. The major compounds were tau-cadinol (35.68%), &alpha;-cadinol (26.76%), spathulenol (8.11%), and caryophyllene oxide (6.56%), which were assigned as major compounds. The chemometric studies showed that the Egyptian ecospecies of I. carnea differs in chemical profile from those growing in Brazil, as well as those reported for other Ipomea species. The EO showed significant DPPH and ABTS radical scavenging abilities, with IC50 values of 33.69 and 40.86 mg L&minus;1, respectively. Additionally, the I. carnea EO displayed significant inhibition against the growth of all tested bacterial strains, where it showed an MIC range of 82&ndash;1442 mg mL&minus;1. Based on the current results, the I. carnea EO, particularly the major identified compounds, could be used as a potential eco-friendly green resource for antioxidant and antimicrobial activities. Therefore, further study is recommended to evaluate the biological significance of the main compounds, either individually or in combination, as well as assess their modes of action and safety

Antibacterial and Antifugal Mono- and Di-substituted Symmetrical and Unsymmetrical Triazine-derived Schiff-bases and their Transition Metal Complexes

A new series of antibacterial and antifungal triazine-derived mono- and di-substituted (symmetrical and unsymmetrical) Schiff-bases and their cobalt(II), copper(II), nickel(II) and zinc(II) metal complexes have been synthesized and characterized by their elemental analyses, molar conductances, magnetic moments and IR and electronic spectral measurements. IR spectra indicated the ligands to act as tridentate towards divalent metal ions via a trazine-N, the azomethine-N and, indole-NH and deprotonated-O of salicylaldehyde. The magnetic moments and electronic spectral data suggest octahedral geometry for the Co(II), Ni(II) and Zn(II)complexes and square-pyramid for Cu(II) complexes. NMR spectral data of the ligands and their diamagnetic zinc(II) complexes well-define their proposed structures/geometries. Elemental analyses data of the ligands and metal complexes agree with their proposed structures/geometries. The synthesized ligands, along with their metal complexes were screened for their antibacterial activity against Escherichia coli, Bacillus subtillis, Shigella flexneri, Staphylococcus aureus, Pseudomonas aeruginosa and Salmonella typhi and for antifungal activity against Trichophyton longifusus, Candida albicans, Aspergillus flavus, Microsporum canis, Fusarium solani and Candida glaberata. The results of these studies show the metal complexes to be more antibacterial/ antifungal against two or more species as compared to the uncomplexed Schiff-base ligands