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

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Optimization of carvedilol solid lipid nanoparticles: An approach to control the release and enhance the oral bioavailability on rabbits.

Solid lipid nanoparticles (SLNs) are prospective carriers for oral delivery of poorly soluble drugs with low bioavailability. Therefore, the study aimed at developing carvedilol (CVD) in SLNs to control its release and enhance its bioavailability in the management of hypertension, and cardiac diseases. Box-Behnken design (BBD) was applied to optimize the variables affecting the quality of CVD-SLNs which prepared by homogenization-ultrasonication technique. The concentrations of Percirol (X1), Gelucire (X2), and stearylamine (X3) were chosen as the crucial independent variables. The dependent variables were estimated and analyzed by Statgraphics software to achieve the optimum characteristics of the developed SLNs. The optimized SLNs was evaluated in vitro and in vivo for pharmacokinetic parameters on male New Zealand white rabbits. The results of this study revealed that the CVD-SLNs have a colloidal size of 31.3 nm with zeta potential of 24.25 mV indicating good stability and 91.43% entrapment efficiency. The in vitro release of CVD from the SLNs was best fitted to Hixon-Crowell model that describes the release from the particles with uniform size. The in vivo pharmacokinetics results indicated the prolongation in the mean residence time of CVD to 23 h when delivered in SLNs and its oral bioavailability enhanced by more than 2-folds

An Algorithm for Fast Computation of 3D Zernike Moments for Volumetric Images

An algorithm was proposed for very fast and low-complexity computation of three-dimensional Zernike moments. The 3D Zernike moments were expressed in terms of exact 3D geometric moments where the later are computed exactly through the mathematical integration of the monomial terms over the digital image/object voxels. A new symmetry-based method was proposed to compute 3D Zernike moments with 87% reduction in the computational complexity. A fast 1D cascade algorithm was also employed to add more complexity reduction. The comparison with existing methods was performed, where the numerical experiments and the complexity analysis ensured the efficiency of the proposed method especially with image and objects of large sizes

Classification of skin lesions using transfer learning and augmentation with Alex-net.

Skin cancer is one of most deadly diseases in humans. According to the high similarity between melanoma and nevus lesions, physicians take much more time to investigate these lesions. The automated classification of skin lesions will save effort, time and human life. The purpose of this paper is to present an automatic skin lesions classification system with higher classification rate using the theory of transfer learning and the pre-trained deep neural network. The transfer learning has been applied to the Alex-net in different ways, including fine-tuning the weights of the architecture, replacing the classification layer with a softmax layer that works with two or three kinds of skin lesions, and augmenting dataset by fixed and random rotation angles. The new softmax layer has the ability to classify the segmented color image lesions into melanoma and nevus or into melanoma, seborrheic keratosis, and nevus. The three well-known datasets, MED-NODE, Derm (IS & Quest) and ISIC, are used in testing and verifying the proposed method. The proposed DCNN weights have been fine-tuned using the training and testing dataset from ISIC in addition to 10-fold cross validation for MED-NODE and DermIS-DermQuest. The accuracy, sensitivity, specificity, and precision measures are used to evaluate the performance of the proposed method and the existing methods. For the datasets, MED-NODE, Derm (IS & Quest) and ISIC, the proposed method has achieved accuracy percentages of 96.86%, 97.70%, and 95.91% respectively. The performance of the proposed method has outperformed the performance of the existing classification methods of skin cancer

Machine Learning and Deep Learning Methods for Skin Lesion Classification and Diagnosis: A Systematic Review

Computer-aided systems for skin lesion diagnosis is a growing area of research. Recently, researchers have shown an increasing interest in developing computer-aided diagnosis systems. This paper aims to review, synthesize and evaluate the quality of evidence for the diagnostic accuracy of computer-aided systems. This study discusses the papers published in the last five years in ScienceDirect, IEEE, and SpringerLink databases. It includes 53 articles using traditional machine learning methods and 49 articles using deep learning methods. The studies are compared based on their contributions, the methods used and the achieved results. The work identified the main challenges of evaluating skin lesion segmentation and classification methods such as small datasets, ad hoc image selection and racial bias

Robust Zero-Watermarking of Color Medical Images Using Multi-Channel Gaussian-Hermite Moments and 1D Chebyshev Chaotic Map

Copyright protection of medical images is a vital goal in the era of smart healthcare systems. In recent telemedicine applications, medical images are sensed using medical imaging devices and transmitted to remote places for screening by physicians and specialists. During their transmission, the medical images could be tampered with by intruders. Traditional watermarking methods embed the information in the host images to protect the copyright of medical images. The embedding destroys the original image and cannot be applied efficiently to images used in medicine that require high integrity. Robust zero-watermarking methods are preferable over other watermarking algorithms in medical image security due to their outstanding performance. Most existing methods are presented based on moments and moment invariants, which have become a prominent method for zero-watermarking due to their favorable image description capabilities and geometric invariance. Although moment-based zero-watermarking can be an effective approach to image copyright protection, several present approaches cannot effectively resist geometric attacks, and others have a low resistance to large-scale attacks. Besides these issues, most of these algorithms rely on traditional moment computation, which suffers from numerical error accumulation, leading to numerical instabilities, and time consumption and affecting the performance of these moment-based zero-watermarking techniques. In this paper, we derived multi-channel Gaussian–Hermite moments of fractional-order (MFrGHMs) to solve the problems. Then we used a kernel-based method for the highly accurate computation of MFrGHMs to solve the computation issue. Then, we constructed image features that are accurate and robust. Finally, we presented a new zero-watermarking scheme for color medical images using accurate MFrGHMs and 1D Chebyshev chaotic features to achieve lossless copyright protection of the color medical images. We performed experiments where their outcomes ensure the robustness of the proposed zero-watermarking algorithms against various attacks. The proposed zero-watermarking algorithm achieves a good balance between robustness and imperceptibility. Compared with similar existing algorithms, the proposed algorithm has superior robustness, security, and time computation

Skin-Net: a novel deep residual network for skin lesions classification using multilevel feature extraction and cross-channel correlation with detection of outlier

Abstract Human Skin cancer is commonly detected visually through clinical screening followed by a dermoscopic examination. However, automated skin lesion classification remains challenging due to the visual similarities between benign and melanoma lesions. In this work, the authors proposed a new Artificial Intelligence-Based method to classify skin lesions. In this method, we used Residual Deep Convolution Neural Network. We implemented several convolution filters for multi-layer feature extraction and cross-channel correlation by sliding dot product filters instead of sliding filters along the horizontal axis. The proposed method overcomes the imbalanced dataset problem by converting the dataset from image and label to vector of image and weight. The proposed method is tested and evaluated using the challenging datasets ISIC-2019 & ISIC-2020. It outperformed the existing deep convolutional networks in the multiclass classification of skin lesions. Graphical Abstrac

COVID-19 diagnosis from CT scans and chest X-ray images using low-cost Raspberry Pi.

The diagnosis of COVID-19 is of vital demand. Several studies have been conducted to decide whether the chest X-ray and computed tomography (CT) scans of patients indicate COVID-19. While these efforts resulted in successful classification systems, the design of a portable and cost-effective COVID-19 diagnosis system has not been addressed yet. The memory requirements of the current state-of-the-art COVID-19 diagnosis systems are not suitable for embedded systems due to the required large memory size of these systems (e.g., hundreds of megabytes). Thus, the current work is motivated to design a similar system with minimal memory requirements. In this paper, we propose a diagnosis system using a Raspberry Pi Linux embedded system. First, local features are extracted using local binary pattern (LBP) algorithm. Second, the global features are extracted from the chest X-ray or CT scans using multi-channel fractional-order Legendre-Fourier moments (MFrLFMs). Finally, the most significant features (local and global) are selected. The proposed system steps are integrated to fit the low computational and memory capacities of the embedded system. The proposed method has the smallest computational and memory resources,less than the state-of-the-art methods by two to three orders of magnitude, among existing state-of-the-art deep learning (DL)-based methods