Clinical, biochemical and inflammatory predictors of mortality in patients with spontaneous bacterial peritonitis

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis. It contributes to high morbidity and mortality in this population. In-hospital mortality of SBP ranges between 20% and 40%, suggesting that further refinements are essential in managing SBP. Early recognition of high-risk patients would enable us to reduce the short-term mortality.Objective: The current study aimed to evaluate the value of clinical, biochemical and inflammatory markers in the prediction of 1-month and 3-month cumulative mortality in patients with SBP.Patients and methods: Two hundred patients with a confirmed diagnosis of SBP were enrolled. They were admitted and received the proper treatment at the National Liver Institute Hospital-Menoufia University, Egypt. Patients were prospectively followed up for mortality over a period of three months. Predictors of mortality were assessed and analyzed.Results: Mortality rates were 20% and 41% at 1 month and 3 month respectively. Our findings showed that low blood pressure, abdominal pain, fever, higher Child-Pugh score, MELD score, serum bilirubin, INR, serum creatinine, C-reactive protein to albumin (CRP/Albumin) ratio, neutrophil–lymphocyte ratio (NLR), massive splenomegaly and large ascites have been demonstrated as risk factors associated with short-term mortality.Conclusion: SBP carries a high risk of mortality among cirrhotic patients. Clinical parameters (low blood pressure, abdominal pain, fever, massive splenomegaly and large ascites), prognostic scores (Child-Pugh and MELD) and inflammatory markers (CRP, CRP/albumin ratio, and NLR) seem to be accurate and reliable tools that could independently predict short-term mortality in patients with SBP

Analysis of NPHS2 Gene Mutations in Egyptian Children with Nephrotic Syndrome

BACKGROUND: Mutations in the NPHS2 genes are the main aetiology of early-onset and familial steroid-resistant nephrotic syndrome (SRNS). The pathogenic NPHS2 mutation together with the p.R229Q variant has been less described among Egyptian children. AIM: This study aims to determine the mutation of NPHS2 in children with NS and discover the role of p.R229Q variant in SRNS METHODS: The study included 53 children with NS, and 53 healthy volunteers matched in age and sex controls. The median age at disease onset was 7.3 years. Among NS cases, 31 cases had steroid-sensitive nephrotic syndrome (SSNS) and 22 children with steroid-resistant nephrotic syndrome (SRNS). Polymerase chain reaction amplification of the whole coding region of NPHS2 gene was carried out for its mutational analysis. Restriction digestion testing was carried out after PCR to determine the presence of R229Q polymorphism. Randomly selected samples were re-genotyped by two independent technicians for assessment of Quality control RESULTS: NS patients showed a significant higher frequency of heterozygous genotype GA (89.5%) compared to control group (10.5%) with increased risk of NS (OR, 12.04; 95% CI, 2.61 to55.38; p < 0.0001). Moreover, SRNS showed a significant higher frequency of GA genotype (68.2%) than the SSNS group (6.5%). The GA genotype was associated with increased risk of SRNS (OR, 31.1; 95% CI, 5.73 to 168.48; P < 0.001) and the A allele was associated with increased risk of SRNS (OR, 15.52; 95% CI, 3.325 to 72.422; P < .001). CONCLUSION: R229Q polymorphisms are associated with SRNS, and any child with SRNS should be searched for mutations in the NPHS2 gene

Melatonin abrogates liver, ovarian, and uterine toxicities induced by tamoxifen in a breast cancer mouse model

Melatonin is known for its efficacy in breast cancer treatment. However, the safety profile of melatonin, particularly its effect on liver, uterus and ovaries is largely unknown. Here, we explored the safety profile of melatonin using virgin female mice of the Swiss albino strain. Further, we investigated whether melatonin can overcome liver, ovaries and uterine toxicities which are induced by tamoxifen using N,N-dimethylbenzylamine (DMBA) induced breast cancer mouse model? Treatment of tamoxifen after breast cancer induction in mice resulted in reduction of breast masses but severe pathological abnormalities like liver steatosis, hyper ovulation, ovarian cysts, uterine glands dilatations and endometriosis were observed in treated animals. Whereas, melatonin when used in combination with tamoxifen helped to reduce the mouse mammary tumor volume and significantly decreases liver enzymes, steroid hormones and oxidative stress. Melatonin also reverted the liver, ovarian and uterus toxicity induced by tamoxifen. The results have demonstrated that tamoxifen when used as combination therapy with melatonin serve as an effective anti-breast cancer molecule with minimum liver, ovarian and uterus toxicities

Melatonin abrogates liver, ovarian, and uterine toxicities induced by tamoxifen in a breast cancer mouse model

33-43Melatonin is known for its efficacy in breast cancer treatment. However, the safety profile of melatonin, particularly its effect on liver, uterus and ovaries is largely unknown. Here, we explored the safety profile of melatonin using virgin female mice of the Swiss albino strain. Further, we investigated whether melatonin can overcome liver, ovaries and uterine toxicities which are induced by tamoxifen using N,N-dimethylbenzylamine (DMBA) induced breast cancer mouse model? Treatment of tamoxifen after breast cancer induction in mice resulted in reduction of breast masses but severe pathological abnormalities like liver steatosis, hyper ovulation, ovarian cysts, uterine glands dilatations and endometriosis were observed in treated animals. Whereas, melatonin when used in combination with tamoxifen helped to reduce the mouse mammary tumor volume and significantly decreases liver enzymes, steroid hormones and oxidative stress. Melatonin also reverted the liver, ovarian and uterus toxicity induced by tamoxifen. The results have demonstrated that tamoxifen when used as combination therapy with melatonin serve as an effective anti-breast cancer molecule with minimum liver, ovarian and uterus toxicities

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

Active compounds and biological activity of in vitro cultures of some Echinacea purpurea varieties

Abstract Background Plant cell cultures have developed rapidly in recent years for the synthesis of selected natural products. This study was conducted to evaluate the effect of yeast extract, jasmonic acid, phenylalanine, and tyrosine on total caffeic acid and polysaccharide production in callus cultures of two Echinacea varieties, namely Double Decker and Rubinstern. The biological activities (antioxidant, antimicrobial and cytotoxic activities) of different Echinacea extracts were also evaluated. Results Data revealed the effect of yeast extract on calli of the two varieties. Double Decker calli recorded maximum caffeic acid derivatives and total hydrolysable sugars after 30 days of cultivation using 1.5 g/l and 1.0 g/l yeast extract respectively whereas, in Rubinstern calli, the maximum caffeic acid derivatives and total hydrolysable sugars were recorded at 1.0 g/l after 30 days. Using 50 mM jasmonic acid, Double Decker calli recorded maximum values of caffeic acid derivatives and total hydrolysable sugars after 15 days. In Rubinstern calli, caffeic acid derivatives and total hydrolysable sugar recorded maximum values after 30 days at 200 mM jasmonic acid and after 15 days at 50 mM jasmonic acid, respectively. In Double Decker variety, caffeic acid derivatives and total hydrolysable sugars recorded maximum values at 100 mg/l phenylalanine. Rubinstern calli recorded maximum value of caffeic acid derivatives at 100 mg/l phenylalanine and total hydrolysable sugars at 50 mg/l phenylalanine. As for tyrosine, maximum values of caffeic acid derivatives and total hydrolysable sugars recorded at 150 mg/l with Double Decker calli. Rubinstern calli recorded maximum value of caffeic acid derivatives and total hydrolysable sugars at 150 and 50 mg/l tyrosine, respectively. The biological activities of the different Echinacea extracts showed that maximum antioxidant activity (89.2%) was recorded with Rubinstern calli. Also, the maximum value of cell death (78.2%) was observed with the extract of Rubinstern calli. For antibacterial activity, most extracts showed inhibitory effect against Bacillus subtilis and Staphylococcus aureus growth. Conclusion Both elicitors (yeast extract and jasmonic acid) and precursors (phenylalanine and tyrosine) have a clear effect on natural products of the two Echinacea varieties. The investigated Echinacea extracts (in vitro and in vivo plants and calli of the two varieties) showed moderate activity against tested microbial strains

Detection of simulated vertical root fractures; which is better multi-detector computed tomography or cone beam computed tomography?

Objectives: Multi-detector computed tomography (MDCT) and cone beam computed tomography (CBCT) were compared regarding their ability to detect vertical root fractures. Methods: Sixty four extracted posterior teeth were included in this study. Using a diamond disc, thirty six teeth were cut vertically to simulate a VRF. Twenty eight teeth were used as control. Fractured and non-fractured teeth were randomly positioned in 4 skulls and mandibles. Scanning was performed first on a 16 slice Siemens MDCT, then by i-CAT Next Generation CBCT. Two observers assessed the multiplanar images for vertical root fractures using a 3-point scale. The first observer repeated the assessment after 1 week. Later, the 2 observers re-assessed the images together to reach a consensus score. Results: CBCT showed higher sensitivity, accuracy as well as negative predictive value compared to MDCT. The mean area under the curve was 0.917 for MDCT and 0.972 for CBCT. The difference in diagnostic accuracy between the 2 modalities was statistically significant P = .036. Inter-observer agreement was 0.971 for MDCT and 0.994 for CBCT, whereas intra-observer agreement was 0.981 for MDCT and 0.985 for CBCT. Conclusion: Using the specified scanners at the specified exposure parameters, the diagnostic accuracy of CBCT in detecting vertical root fractures was significantly higher than MDCT. Keywords: Multi-detector computed tomography, Cone-beam computed tomography, Root fractur

Fault Detection and Classification of CIGS Thin-Film PV Modules Using an Adaptive Neuro-Fuzzy Inference Scheme

The use of artificial intelligence to automate PV module fault detection, diagnosis, and classification processes has gained interest for PV solar plants maintenance planning and reduction in expensive inspection and shutdown periods. The present article reports on the development of an adaptive neuro-fuzzy inference system (ANFIS) for PV fault classification based on statistical and mathematical features extracted from outdoor infrared thermography (IRT) and I-V measurements of thin-film PV modules. The selection of the membership function is shown to be essential to obtain a high classifier performance. Principal components analysis (PCA) is used to reduce the dimensions to speed up the classification process. For each type of fault, effective features that are highly correlated to the PV module’s operating power ratio are identified. Evaluation of the proposed methodology, based on datasets gathered from a typical PV plant, reveals that features extraction methods based on mathematical parameters and I-V measurements provide a 100% classification accuracy. On the other hand, features extraction based on statistical factors provides 83.33% accuracy. A novel technique is proposed for developing a correlation matrix between the PV operating power ratio and the effective features extracted online from infrared thermal images. This eliminates the need for offline I-V measurements to estimate the operating power ratio of PV modules