Influence of Mobile Application Based Brain Training Program on Cognitive Function and Quality of Life in Patients Post Stroke

Background: Stroke often leads to cognitive impairment, which can significantly reduce one's independence as well as quality of life. Cognitive rehabilitation is a treatment strategy for restoring cognitive abilities following brain injuries. Cognitive functioning can be improved through the use of multimedia as well as informatics in computerized cognitive rehabilitation (CCR). Purpose: to investigate the influence of a mobile application-based brain training program on cognitive functions as well as quality of life in post stroke patients. Methodology: forty referred medically and radiologically diagnosed stroke patients from both genders experienced post stroke cognitive impairment (PSCI), aged from 45 to 60 years old, were randomized into two groups of the same number: a study group and a control group. The Study group received mobile application-based brain training program (Lumosity training application) as well as aerobic training on a bicycle ergometer, and the control group received only the aerobic training on a bicycle ergometer for 18 sessions every other day for 6 weeks, 3 sessions/week, each session for 60 minutes. All patients were evaluated with Computer-based cognitive device RehaCom, Addenbrooke’s Cognitive Examination Revised (ACE-R) test, Montreal Cognitive Assessment (MoCA) in addition to Stroke specific quality of life scale (SS-QoL) pre and post treatment. Results: a significant difference has been detected among the two groups as the (p-value = 0.001) indicating that the study group reported enhancement in the cognitive functions as well as the quality of life more than the control group and there was a correlation between RehaCom, MoCA, ACE-R and SS-QoL. Conclusion: This study showed that six weeks of mobile application-based brain training program (Lumosity training application) as well as aerobic training on a bicycle ergometer was a beneficial approach and is a successful treatment for patients suffering from (PSCI)

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

Two-dimensional and four-dimensional ultrasound in the diagnosis of non-cardiac fetal congenital anomalies in high risk pregnancies: a comparative study

Abstract Background The high incidence of non-cardiac congenital anomalies in high-risk pregnancies is a major worldwide health problem. Congenital deformities represent 20–25% of perinatal deaths. The best non-invasive screening method for diagnosing congenital abnormalities is ultrasound. Four-dimensional ultrasound added additional diagnostic value to two-dimensional ultrasound in evaluating fetal prenatal conditions. Our study's goal was to compare the roles of two-dimensional and four-dimensional ultrasound in the diagnosis of non-cardiac fetal congenital anomalies in high-risk pregnancies. Results Out of the 100 pregnant women who underwent examinations, all had high-risk pregnancies and were expected to give birth to babies with deformities, a total of 25 cases (or 25%) of fetal abnormalities were found. The two-dimensional ultrasound diagnosis's accuracy sensitivity, and specificity were 84%, 76%, and 86.67%, respectively, while they were 87%, 80%, and 89.33%, respectively, for four-dimensional ultrasound. The accuracy, sensitivity, and specificity of two-dimensional ultrasound combined with four-dimensional ultrasound were significantly higher (94%, 88%, and 96%, respectively) than those of two-dimensional ultrasound or four-dimensional ultrasound alone. This study also analyzed the risk factors leading to fetal malformations. The results showed that consanguinity, increased maternal age, past history or family history of congenital anomalies, history of medication during pregnancy, and maternal diabetes were major risk factors statistically significant for congenital anomalies. Conclusion The diagnosis rate of fetal abnormalities can be significantly increased by combining two-dimensional ultrasound with four-dimensional ultrasound. Avoiding risk factors that raise the likelihood of fetal abnormalities should take priority for pregnant women with high risk factors. To lower the incidence of fetal abnormalities, prenatal screening and diagnosis should be standardized

Invasion of the Land of Samurai: Potential Spread of Old-World Screwworm to Japan under Climate Change

Temperatures have fluctuated dramatically throughout our planet&rsquo;s long history, and in recent decades, global warming has become a more visible indicator of climate change. Climate change has several effects on different economic sectors, especially the livestock industry. The Old-world screwworm (OWS), Chrysomya bezziana (Villeneuve, 1914), is one of the most destructive insect pests which is invading new regions as a result of climate change. The economic loss in livestock business due to invasion of OWS was previously assessed by FAO in Iraq to be USD 8,555,000. Other areas at risk of invasion with OWS in the future include Japan. Therefore, maximum entropy implemented in MaxEnt was used to model predictive risk maps of OWS invasion to Japan based on two representative concentration pathways (RCPs), 2.6 and 8.5, for 2050 and 2070. The Area Under Curve (AUC) indicates high model performance, with a value equal to 0.89 (&plusmn;0.001). In addition, the True Skill Statistics (TSS) value was equal to 0.7. The resulting models indicate the unsuitability of the northern territory of Japan for invasion by OWS. The main island&rsquo;s southern costs show high and very high invasion suitability, respectively, and both Kyushu and Okinawa are at high risk of invasion with OWS. The predicted risk maps can be considered a warning sign for the Japanese quarantine authority to hasten a control program in order to protect the livestock industry from this devastating pest

Invasion of the Land of Samurai: Potential Spread of Old-World Screwworm to Japan under Climate Change

Temperatures have fluctuated dramatically throughout our planet’s long history, and in recent decades, global warming has become a more visible indicator of climate change. Climate change has several effects on different economic sectors, especially the livestock industry. The Old-world screwworm (OWS), Chrysomya bezziana (Villeneuve, 1914), is one of the most destructive insect pests which is invading new regions as a result of climate change. The economic loss in livestock business due to invasion of OWS was previously assessed by FAO in Iraq to be USD 8,555,000. Other areas at risk of invasion with OWS in the future include Japan. Therefore, maximum entropy implemented in MaxEnt was used to model predictive risk maps of OWS invasion to Japan based on two representative concentration pathways (RCPs), 2.6 and 8.5, for 2050 and 2070. The Area Under Curve (AUC) indicates high model performance, with a value equal to 0.89 (±0.001). In addition, the True Skill Statistics (TSS) value was equal to 0.7. The resulting models indicate the unsuitability of the northern territory of Japan for invasion by OWS. The main island’s southern costs show high and very high invasion suitability, respectively, and both Kyushu and Okinawa are at high risk of invasion with OWS. The predicted risk maps can be considered a warning sign for the Japanese quarantine authority to hasten a control program in order to protect the livestock industry from this devastating pest

The Binary Mixtures of Lambda-Cyhalothrin, Chlorfenapyr, and Abamectin, against the House Fly Larvae, Musca domestica L.

The house fly Musca domestica L. is one of the medical and veterinary pests that can develop resistance to different insecticides. Mixing insecticides is a new strategy for accelerating pest control; furthermore, it can overcome insect resistance to insecticides. This study aims to evaluate three insecticides, chlorfenapyr, abamectin, and lambda-cyhalothrin, individually and their binary mixtures against 2nd instar larvae of M. domestica laboratory strain. Chlorfenapyr exhibited the most toxic effect on larvae, followed by abamectin then the lambda-cyhalothrin. The half-lethal concentrations (LC50) values were 3.65, 30.6, and 94.89 ppm, respectively. These results revealed that the high potentiation effect was the mixture of abamectin/chlorfenapyr in all the mixing ratios. In contrast, the tested combination of lambda-cyhalothrin/abamectin showed an antagonism effect at all mixing ratios against house fly larvae. The total protein, esterases, glutathione-S-transferase (GST), and cytochrome P-450 activity were also measured in the current investigation in the larvae treated with chlorfenapyr. Our results indicate that GST may play a role in detoxifying chlorfenapyr in M. domestica larvae. The highest activity of glutathione-S-transferase was achieved in treated larvae with chlorfenapyr, and an increase in cytochrome P-450 activity in the larvae was observed post-treatment with Abamectin/chlorfenapyr

Multi-Omics Analysis Revealed a Significant Alteration of Critical Metabolic Pathways Due to Sorafenib-Resistance in Hep3B Cell Lines

Hepatocellular carcinoma (HCC) is the second prominent cause of cancer-associated death worldwide. Usually, HCC is diagnosed in advanced stages, wherein sorafenib, a multiple target tyrosine kinase inhibitor, is used as the first line of treatment. Unfortunately, resistance to sorafenib is usually encountered within six months of treatment. Therefore, there is a critical need to identify the underlying reasons for drug resistance. In the present study, we investigated the proteomic and metabolomics alterations accompanying sorafenib resistance in hepatocellular carcinoma Hep3B cells by employing ultra-high-performance liquid chromatography quadrupole time of flight mass spectrometry (UHPLC-QTOF-MS). The Bruker Human Metabolome Database (HMDB) library was used to identify the differentially abundant metabolites through MetaboScape 4.0 software (Bruker). For protein annotation and identification, the Uniprot proteome for Homo sapiens (Human) database was utilized through MaxQuant. The results revealed that 27 metabolites and 18 proteins were significantly dysregulated due to sorafenib resistance in Hep3B cells compared to the parental phenotype. D-alanine, L-proline, o-tyrosine, succinic acid and phosphatidylcholine (PC, 16:0/16:0) were among the significantly altered metabolites. Ubiquitin carboxyl-terminal hydrolase isozyme L1, mitochondrial superoxide dismutase, UDP-glucose-6-dehydrogenase, sorbitol dehydrogenase and calpain small subunit 1 were among the significantly altered proteins. The findings revealed that resistant Hep3B cells demonstrated significant alterations in amino acid and nucleotide metabolic pathways, energy production pathways and other pathways related to cancer aggressiveness, such as migration, proliferation and drug-resistance. Joint pathway enrichment analysis unveiled unique pathways, including the antifolate resistance pathway and other important pathways that maintain cancer cells’ survival, growth, and proliferation. Collectively, the results identified potential biomarkers for sorafenib-resistant HCC and gave insights into their role in chemotherapeutic drug resistance, cancer initiation, progression and aggressiveness, which may contribute to better prognosis and chemotherapeutic outcomes

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe