Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

Background: The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. Objectives: To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. Methods: Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. Results: Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). Conclusion: Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.  Keywords: Screening test, diabetes mellitus, tuberculosis

Multicenter screening of diabetic patients for detecting new cases of tuberculosis: An approach to intensify the case detection rate of tuberculosis in developing countries with high prevalence of diabetes

Introduction: Tuberculosis (TB) is a major public health problem in most of developing countries. Meanwhile, the prevalence of type 2 diabetes mellitus (DM) is also increasing rapidly. Objectives: To describe the feasibility of implementing screening test for tuberculosis among diabetic patients and identifying factors associated with high detection rate. Methods: Study Design: Multi-center cross-sectional study. This study was implemented in the governmental healthcare settings. To diagnose TB among diabetics, we used a symptom-based questionnaire that included the symptoms of suspected TB according to the guidelines of National Tuberculosis Program in Egypt. Results: Among 4283 adult diabetics, 14 TB cases were diagnosed; 9 known TB cases and 5 newly detected cases. The number needed to detect one new case of TB was 855. Male diabetics and those suffered from liver disease experienced a significantly higher prevalence of TB and a higher detection rate of new active cases. Conclusions: Screening for TB among diabetics in routine governmental healthcare services was successfully implemented. Screening DM patients in countries with a high prevalence of DM will reveal a significant number of active TB cases, which will in turn improve the case detection rate of TB.

Hemodialysis associated dysautonomia; Effect of optimization of dialysis and nutrition: A prospective study

Background: Autonomic neuropathy is common among hemodialysis patients, even if they are asymptomatic. The aim of this study is to assess the effect of optimization of patients' dialysis and nutrition on the presence of autonomic dysfunction in these patients guided by sympathetic skin response (SSR) test. Methods: Fifteen patients on maintenance hemodialysis (12 males and 3 females) their age ranged from 24 to 67 years, most of them were on bicarbonate dialysis were included in our study. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling. Their nutrition was assessed by laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Their autonomic functions were assessed by clinical examination, hand grip and SSR test. Dialysis dose was readjusted to achieve a target kt/v value of 1.3/session thrice weekly. Also, their nutrition was reviewed to achieve nPCR of 1.2 gm/kg/day and caloric intake of 30-40 KCal/kg/day through diet manipulation and support. They were reassessed after 3 months. Results: Analysis of the data showed a statistically significant improvement of the observed subclinical autonomic neuropathy evidenced by a significant change in the hand grip (p = 0.044), and a high statistically significant improvement in the sympathetic skin response test parameters (both amplitude and latency) (p=0.001) after optimization of both hemodialysis and nutrition status. Conclusion: Improving dialysis and patients nutrition by using urea kinetic modeling is valuable in improving their autonomic functions as assessed by SSR test

Plasma O2modifies the structure of synthetic zeolite-A to improve the removalof cadmium ions from aqueous solutions

International audienceThe present study addresses the removal of cadmium ions (Cd(II)) from aqueous solutions at a pH of 7.5 using zeolite-A activated by exposure to oxygen plasma. The activation process was performed over a wide range of plasma powers (10, 20, 30, and 40 W) and exposure times (30 to 360 s). Oxygen plasma cannot chemically modify zeolite to a considerable extent, but it can clean the surface, open blocked pores, and induce the formation of additional OH groups via exposure to humidity in ambient air. Therefore, Cd +2 ion removal is increased by approximately 10% with the plasma treatments. Infrared-attenuated total reflectance spectroscopy, X-ray diffraction, scanning electron microscopy, and energy dispersive spectroscopy were applied to analyze the changes in the surface structure and properties of thesamples

IDENTIFICATION OF MYCOSPORINE-LIKE AMINO ACIDS AND EXPRESSION OF 3-DEHYDROQUINATE SYNTHASE GENE IN UV RADIATIONS-INDUCED Deinococcus radiodurans R1

Mycosporine-like amino acids (MAAs) are a group of more than 40 metabolites originated from 4-deoxygadusol featuring antioxidants, growth stimulation, and UV protective properties in many microorganisms. In D. radiodurans R1, 3-dehydroquinate synthase (DHQS) gene annotated in chromosome 1 encodes the precursor for all MAAs. In this study, a significant amount of MAAs were identified in D. radiodurans R1 after treatment with a different type of UV radiations, namely; the low energy UVA (360 nm) 6W and 100 W, and high energy UVC (254 nm) 6W at a period of 12 to 48 hours. The total RNA and MAAs were isolated from the UV-treated D. radiodurans R1. RT-qPCR experiment of the DHQS gene resulted in a significant increase of expression. Consequently, specific MAAs were identified using time-of-flight mass spectrometry (TOF-MS). They are mycosporine-taurine, mycosporine-glutamine, mycosporine-glutaminol, mycosporine-glutaminol-glucoside, mycosoprine-glycine, mycosporine-2-glycine, mycosporine-glycine:glutamic acid, shinorine, mycosporine-methylamine:serine, palythine-serine, and palythinol. The results suggested that these compounds play essential roles in D. radiodurans R1 radio-tolerance especially mycosporine-methylamine:serine and palythine-serine. This study can help to further understand the mechanism of radiation resistance in D. radiodurans R1, and its potential to be utilized as protective compound against radiation risk

The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

Background : Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. Objectives : To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. Methods : This retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV) non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB) approval was obtained. This study was limited to 88 patients who received fentanyl 1 µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Results : Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001). Tracheal intubation was 100% successful in the three groups of patients. Conclusion : Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes

Phenotypic and Molecular Detection of Antiseptic Resistance Genes among Clinical Staphylococcus aureus Isolates During COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic has expanded the use of chlorhexidine digluconate, a biocide frequently used in hospitals, to inhibit the spread of infection. Genes responsible for resistance against the quaternary ammonium compound qac in Staphylococcus aureus isolates have been shown to confer tolerance to a number of biocidal chemicals, including chlorhexidine. The aim of this study was to determine the occurrence of antiseptic resistance genes (qacA/B and qacC) in clinical isolates of methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA). The study also aimed to investigate the association between the presence of the mecA, qacA/B, and qacC genes in MRSA isolates and the susceptibility of the isolates to chlorhexidine to evaluate its future use in the Theodor Bilharz Research Institute (TBRI) hospital, following the Centers for Disease Control and Prevention recommendations for patients with MRSA. S. aureus isolates (n = 100) were collected from inpatients and outpatients at TBRI. A minimal inhibitory concentration of chlorhexidine was also detected. Polymerase chain reaction was used to detect the mecA, qacA/B, and qacC genes. The results revealed that 84% of S. aureus isolates were MRSA. MRSA (61.9%) and MSSA (68.8%) isolates were susceptible to chlorhexidine. The qacA/B gene was more dominant, being detected in 34%, while qacC was detected in only 5% of S. aureus isolates. All S. aureus isolates with reduced susceptibility to chlorhexidine harbored either the qacA/B or qacC genes. The clinical use of chlorhexidine may continue to increase, emphasizing the significance of continuous caution underlining the emergence of new clones with reduced susceptibility and avoiding antiseptic misuse

Impact of Anisakis pegreffi Infection on Gonadal Health and Gonadosomatic Index of European Hake (Merluccius merluccius)

Parameters belonging to the physical status and gonadal size of certain fish provide crucial information for assessing both the productivity and fecundity of declining fish populations. These parameters are vulnerable to the negative impacts of disease agents such as internal or systemic parasites. Although parasitic diseases might influence these parameters, the literature investigating these pathophysiological alterations is scanty. Therefore, the current study represents one of the scarcest studies that document the possible link between parasitism, gonadal health, and the growth of European hake (Merluccius merluccius). Screening of imported European halves indicated a relatively high prevalence of Anisakis pegreffi Larvae 3 infestation, with an 80% prevalence rate, a mean intensity of 24.4, and a mean abundance of 19.5. However, the prevalence of Anisakid larvae infection in native fish was 36% with a mean intensity of 7.36 and mean abundance of 2.65.The current research revealed remarkable ovarian pathology that involved several forms of degenerative changes in ovarian tissues. Such gonadal pathologies were attributed to the damaging effect of the retrieved Anisakis pegreffi Larvae 3. Gonadosomatic index of both heavily infected imported / native hakes was relatively impacted by the progressive gonadal pathology resulting from Anisakis pegreffi L3 infection. Morphometric measurements of the gonads and body have revealed that, gonadosomatic index of both heavily infected imported / native hakes was relatively impacted by the progressive gonadal pathology resulting from Anisakis pegreffi L3 infection

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