Laparoscopic ovarian drilling-plus: a one-stop management approach for PCO-associated infertility

Background: The current study aims to estimate additional values of laparoscopic intervention for diagnosis and treatment of concomitant pelvic pathologies among infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS) subjected to laparoscopic ovarian drilling (LOD) in comparison to non-PCOS infertile women subjected to diagnostic/therapeutic laparoscopy.Methods: A prospective cross sectional observational study was carried out in the Endoscopic unit of a tertiary care university hospital.  The study included 232 infertile women planned for laparoscopy were divided into a study group A (116 cases) with clomiphene-resistant PCOS and a control group B (116 cases) without PCOS. Each group was further subdivided into two subgroups according to the presence and absence of risk factors (RF) for adhesion formation. Diagnostic/operative laparoscopy was done. The main study outcome was the prevalence of any pelvic abnormalities seen during laparoscopy.Results: Both groups showed insignificant difference regarding socio-demographic history and basic data. Laparoscopy detected pelvic pathologies in 44 cases (37.9%) and 86 cases (74.1%) in both groups respectively. In group A, we diagnosed pelvic pathologies in 29 (32.6%) and 15 (55.6%) cases with and without RF respectively while in group B they were diagnosed in 76 (84.4%) and 10 (38.5%) cases with and without RF respectively. If compared to women with unexplained infertility, PCO patients without risk factors have an insignificant but higher prevalence of pelvic abnormalities. All concomitant pelvic pathologies in both groups were treated on a one-stop (see and treat) basis.Conclusions: Detection and proper management of associated pelvic pathologies at laparoscopy is a valuable additional advantage of LOD particularly in women with positive risk factors. LOD plus see and treat associated pathologies is a time saving and prompt management approach for women with PCO–associated infertility

Coxiella burnetii, the causative agent of Q fever in Saudi Arabia: molecular detection from camel and other domestic livestock

AbstractObjectiveTo detect Coxiella burnetii (C. burnetii) DNA in clinical specimens from camel, goats, cattle and sheep in the Kingdom of Saudi Arabia.MethodsA total of 367 clinical samples including blood, milk, faeces and urine were collected from different livestock and subjected to PCR amplification using primers which amplify transposon-like region and transposase gene.ResultsPositive amplification from both regions was obtained from camel, goats and cattle but not from sheep. A percentage of 10.8% samples yielded positive PCR amplification from both blood and milk, where 15 of 139 blood and 16 of 148 milk samples were positive. Faeces and urine showed higher percentages of positive samples reaching 40.8% and 23.8% respectively.ConclusionsThe preferred route of shedding in camel appeared to be the faeces followed by urine, while that of goats appeared to be the faeces and that of the cattle appeared to be the milk

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

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially