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

Characteristics of Dissolved Organic Nitrogen in Municipal and Biological Nitrogen Removal Wastewater Treatment Plants in Jordan

The investigation is conducted on the biochemical form and characteristics of wastewater-derived DON in three different WWTPs in Jordan. The main eliminations of DON and biodegradable dissolved organic nitrogen (BDON) noticed along the treatment course are in the Irbid (ITP). Dissolved combined amino acids (DCAA) and dissolved free amino acids (DFAA) in the outlet accounted for less than 4% of the outlet DON of all plants. The DON from the outlet was composed of 90% hydrophilic compounds which stimulate algal growth. The study provided information for future improvement of WWTPs of Jordan and for adjusting the assortment of DON elimination systems to comply with stricter limits

Karyotypes of Bats (Chiroptera: Rhinolophidae, Vespertilionidae) from Jordan

WOS: 000268698500004The karyotypes of four bat species of two families (Rhinolophidae and Vespertilionidae) were examined from Jordan. Bat specimens were captured by use of mist-nets and hand-nets from three localities in Jordan in June 2006. Chromosomes were obtained from femoral bone marrow cells and about 20-30 metaphase cells of each animal were examined. The diploid number of chromosomes (2n) and the fundamental numbers of chromosomal arms (NFa) were determined to be 2n=58 and NFa=60 for Rhinolophus ferrumequinum, Rh. euryale and Rh. blasii, and 2n=44, NFa=50 for Pipistrellus kuhlii. Karyology of Rh. euryale and P. kuhlii is investigated from Jordan for the first time. The karyotypes of Jordanian bats show similarity to other populations in other countries with respect to the diploid chromosome number, however, the fundamental chromosome number and the number of autosomal arms are quite different.Deanship of Academic Research; Al-Hussein Bin Talal University, Ma'an, JordanThis work was supported by a grant from the Deanship of Academic Research, Al-Hussein Bin Talal University, Ma'an, Jordan. The authors wish to thank Prof. Dr. Ratib Al-Oran, President of Al Hussein Bin Talal University for his continuous support. We also wish to thank Mr. Hazim Talfha for his help in laboratory and staffs from The Royal Society for the Conservation of Nature for help in the field, especially Mr. Nashat Hamidan

Formononetin suppresses hyperglycaemia through activation of GLUT4-AMPK pathway

Background: Formononetin (FMN) is a flavonoid that has different pharmacological effects. Thus, the anti-diabetic effects of FMN has been investigated in a high-fat diet/Streptozotocin-(HFD/STZ)-induced diabetes mice model. Methods: Mice were fed with HFD followed by STZ. Diabetic mice were treated orally with FMN or metformin for 28 days before collecting plasma and soleus muscle for further analysis. Results: FMN reduced serum glucose (p>0.001) and increased serum insulin in diabetic group compared to the vehicle control. Additionally, FMN decreased homeostasis model assessment of insulin resistance (HOMA-IR). Fasting glucose level was also reduced with FMN during the intraperitoneal glucose tolerance test (IPGTT). GLUT4 and p-AMPK-α1 were upregulated following treatment with FMN. LDL, triglyceride, and cholesterol were reduced in diabetic mice treated with FMN. FMN reduced MDA, increased GSH levels , and reduced GSSG levels in diabetic mice. Conclusion: FMN could represent a promising therapeutic agent to treat T2D

2ʹ,3,3,5ʹ-Tetramethyl-4ʹ-nitro-2ʹH-1,3ʹ-bipyrazole exerts antinociceptive effect using various nociception models

Background: 2ʹ,3,3,5ʹ-Tetramethyl-4ʹ-nitro-2ʹH-1,3ʹ-bipyrazole (TMNB) is a novel bipyrazole compound that exhibited antidiabetic and anti-inflammatory properties. However, its analgesic effect has not been investigated. This study aimed to assess the antinociceptive activity of TMNB using different nociception mouse models. Methods: TMNB doses (50, 100, 150, and 200 µg/kg) were assessed in mice using the acetic acid-induced writhing test, hot plate test, and formalin-induced paw licking assay. The effects were compared to those of mice treated with acetylsalicylic acid or morphine in the presence or absence of naloxone. Capsaicin- and glutamate-induced paw-licking tests were also used to evaluate the involvement of the vanilloid and glutamatergic systems, respectively. Results: TMNB produced significant dose-dependent inhibition of nociceptive behavior in the acetic acid-induced writhing test, showing 66% inhibition at a dose of 200 µg/kg. TMNB also caused a significant increase in the latency period in response to the hot plate test (68.2% at 200 µg/kg), and significantly inhibited both the neurogenic and inflammatory phases in the formalin-induced paw-licking test. Naloxone significantly reverses the effect of TMNB in both the hot plate test and formalin-induced paw-licking test. Moreover, TMNB significantly inhibited the neurogenic nociception induced by intraplantar injections of glutamate and capsaicin (53% and 77.1%, respectively at a dose of 200 µg/kg). Conclusion: TMNB possesses antinociceptive activity in mice that is mediated through both central and peripheral pathways

Cirsimaritin alleviates dextran sodium sulfate-induced acute colitis in experimental animals: a therapeutic approach for inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic disease that affects the entire digestive tract. IBD can be classified as ulcerative colitis or Crohn’s disease. The key symptoms of IBD include the emergence of abscesses or pustules, pronounced abdominal discomfort, diarrhea, fistulas, and intestinal narrowing, all of which can greatly affect a patient’s daily well-being. Several factors, including bacterial infections, immune response irregularities, and changes in the intestinal milieu, can contribute to the onset of IBD. The aim of this study was investigating the role of cirsimaritin in reducing the severity of colitis in animal model. To induce colitis in laboratory Swiss albino mice, a 4% dextran sulfate sodium (DSS) concoction was provided in their hydration source for a duration of six days. Before the onset of colitis, mice were treated with cirsimaritin (10 mg/kg) once daily to evaluate its potential treatment effects against DSS-induced inflammation. The results showed that 10 mg/kg of cirsimaritin decreased colitis severity (P&lt;0.05). Moreover, cirsimaritin successfully reversed the detrimental effects induced by DSS, including weight reduction, colon truncation, tissue-related damage, increased levels of inflammatory cells in the affected region, and secretion of proinflammatory cytokines. Our findings suggest that cirsimaritin can effectively alleviate acute colitis triggered by DSS

In Situ Hydrothermal Synthesis of Ni1&minus;xMnxWO4 Nanoheterostructure for Enhanced Photodegradation of Methyl Orange

The monoclinic nanocrystalline Ni1&minus;xMnxWO4 heterostructure has been successfully synthesized by the hydrothermal technique for achieving better sensitive and photocatalytic performances. Different characterization techniques such as X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), ultraviolet-visible (UV&ndash;Vis), and photoluminescence (PL) spectroscopy have been employed to investigate their structural, microstructural, and optical properties. Mn-ion incorporation in the NiWO4 lattice reduces the particle size of the sample compared with the pure undoped NiWO4 sample, which has been confirmed from the transmission electron microscope image. The Tauc plot of the Ni1&minus;xMnxWO4 sample exhibits a significant decrease in bandgap energy compared with the pure undoped NiWO4 sample due to the quantum confinement effect. Finally, the material was explored as a photocatalyst for the degradation of methyl orange (MO) dye from wastewater under visible light irradiation. Various reaction parameters such as pH, catalyst dose, reaction time, and kinetics of the photodegradation were studied using the batch method. The results showed that the Ni1&minus;xMnxWO4 is highly efficient (94.51%) compared with undoped NiWO4 (65.45%). The rate of photodegradation by Ni1&ndash;xMnxWO4 (0.067) was found to be 1.06 times higher than the undoped NiWO4 (0.062)

The Safety, Cosmetic Outcome, and Patient Satisfaction after Inferior Pedicle Reduction Mammaplasty for Significant Macromastia

Background:. Significant macromastia is socially and physically debilitating. Reduction mammaplasty in these cases carries significant morbidity. Methods:. Cases of inferior pedicle reduction mammaplasty performed at the breast unit, King Fahd Hospital, Jeddah, Saudi Arabia, over the last 10 years were reviewed. Inclusion criteria were cases with significant macromastia in which the distance from the supra-sternal notch to the nipple was ≥ 40 cm. Results:. There were 26 cases of inferior pedicle reduction mammaplasty done for significant macromastia. The average age was 34.56 years (range, 16–56 years). The average sternal notch to the nipple distance was 43.08 cm (range, 40–49 cm). The average amount of breast tissue removed from the right breast was 1,057.6 g (range, 495–2,450) and from the left breast was 959.4 g (range, 445–2,100). Postoperatively, 4/26 (15.4%) had ecchymosis, 9/26 (34.6%) developed T-junction sloughing, 2/26 (7.7%) had wound infection, and 1/26 (3.8%) had unilateral partial nipple-areola complex ischemia. In 7/26 (26.9%), scars were evident and revision was performed in 4/26 (15.4%) cases. Variable degrees of upper breast flattening and bottoming were seen in most cases; however, these variations were more profound in fatty breasts and longer pedicles. The average follow-up period was 26.04 months (range, 3–68 months). All patients were satisfied with the reduced breast heaviness, but only 19/26 (73.1%) were highly satisfied with the breast shape and scars. Conclusions:. In cases of significant macromastia, inferior pedicle reduction mammaplasty is a safe procedure. Evident scars, upper breast flattening, and bottoming adversely affect the level of satisfaction

In Situ Hydrothermal Synthesis of Ni_1−xMn_xWO₄ Nanoheterostructure for Enhanced Photodegradation of Methyl Orange

The monoclinic nanocrystalline Ni1−xMnxWO4 heterostructure has been successfully synthesized by the hydrothermal technique for achieving better sensitive and photocatalytic performances. Different characterization techniques such as X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), ultraviolet-visible (UV–Vis), and photoluminescence (PL) spectroscopy have been employed to investigate their structural, microstructural, and optical properties. Mn-ion incorporation in the NiWO4 lattice reduces the particle size of the sample compared with the pure undoped NiWO4 sample, which has been confirmed from the transmission electron microscope image. The Tauc plot of the Ni1−xMnxWO4 sample exhibits a significant decrease in bandgap energy compared with the pure undoped NiWO4 sample due to the quantum confinement effect. Finally, the material was explored as a photocatalyst for the degradation of methyl orange (MO) dye from wastewater under visible light irradiation. Various reaction parameters such as pH, catalyst dose, reaction time, and kinetics of the photodegradation were studied using the batch method. The results showed that the Ni1−xMnxWO4 is highly efficient (94.51%) compared with undoped NiWO4 (65.45%). The rate of photodegradation by Ni1–xMnxWO4 (0.067) was found to be 1.06 times higher than the undoped NiWO4 (0.062)