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

Deep Learning-Based Meniscus Tear Detection From Accelerated MRI

Magnetic Resonance Imaging (MRI) is an exceptional diagnostic tool known for its ability to provide superior soft tissue contrast. Despite its proven efficacy, traditional MRI methods have some inherent limitations, including relatively longer scan times and the requirement for specialized expertise in data analysis. These factors can, at times, create challenges in the widespread adoption of MRI in certain research and clinical scenarios. Deep learning (DL) methods for MRI reconstruction and analysis offer a promising solution to address this issue. While these DL techniques have been validated using standard image quality metrics, they fall short in assessing clinically relevant details. This hinders their clinical reliability and practical application. Although radiologists have previously compared the diagnostic equivalence of accelerated DL-reconstructed images to conventional ones for evaluating knee internal derangement, it remains uncertain whether DL detectors can accurately identify clinically important details when reconstruction models are used. Furthermore, the artifacts or hallucinations generated by DL reconstructions in knee MRI have not been examined in a clinical setting. Thus, this study aims to determine the performance of DL detectors on retrospectively accelerated DL-reconstructed knee MRI, comparing them to conventional imaging and expert evaluations for detecting meniscal tears. Our investigation yields three significant contributions. First, an in-depth analysis of DL reconstruction highlights the presence of hallucinations in the femur, tibia, and false positive artifacts, indicating that the overall reconstruction quality does not directly affect pathological features. Second, the results of DL detectors demonstrate that their performance aligns well with image quality assessment metrics and expert scores. This finding validates the reliability of the detection outcomes. Finally, we propose an integrated (i.e. reconstruction &#x002B; detection) process for meniscal tears on fastMRI&#x002B; data and achieved state-of-the-art results with average precision scores of 0.69 and 0.67 at 4&#x2013; and 8-fold accelerations, respectively

Intestinal perforation due to ingestion of fish bone

Perforation of the gastrointestinal tract by accidently ingested foreign bodies is rare, occurring in less than 1% of the patients. Fish bones are the most common foreign bodies leading gastrointestinal tract perforation due to their elongated shape end sharp ends. Preoperative diagnosis of the gastrointestinal tract perforation by foreign body is challenging since the patients present with a wide and nonspecific spectrum of symptoms and usually don't recall ingestion of the foreign body. It should always be kept in mind in cases with acute abdominal complaint. Herein, we present multidetector computed tomography findings of a case with bowel perforation due to fish bone. Thus, computed tomography scan revealed the foreign body with perforated intestinal segment, led prompt diagnosis and optimal surgical treatment even in a patient with no preoperative history of foreign body ingestion. [Cukurova Med J 2016; 41(0.100): 1-4

Evaluation of ocular pulse amplitude in patients with carotid artery stenosis using the Pascal dynamic contour tonometer.

Background To evaluate ocular pulse amplitude (OPA) in patients with carotid artery stenosis (CAS) using the Pascal dynamic contour tonometer (DCT). Methods Consecutive patients who underwent ultrasound Doppler examination of the carotid artery for the suspicion of CAS were prospectively enrolled in the study. Each patient underwent a complete ocular examination. OPA was measured using Pascal DCT. The participants were divided into four groups according to the degree of CAS: Group 1 (no occlusion, control group), Group 2 (mild occlusion: = 70 per cent). Results A total of 161 eyes of 81 patients were included in the study. Of the 81 patients, 50 (61.7 per cent) were male, and 31 (38.3 per cent) were female. The mean age was 66.6 +/- 12.3 years (range, 20-91 years). Mean OPA values were found to be 2.68 +/- 0.97 mmHg in Group 1 (n = 64 eyes), 2.62 +/- 0.83 mmHg in Group 2 (n = 49 eyes), 2.30 +/- 0.97 mmHg in Group 3 (n = 27 eyes) and 1.66 +/- 0.59 mmHg in Group 4 (n = 21 eyes). There was no statistically significant difference in mean OPA levels between Group 1 and Group 2 (p = 0.73). However, statistically significant differences were found between the other groups when they were compared with each other (Groups 1 and 3, p = 0.02; Groups 1 and 4, p < 0.001; Groups 2 and 3, p = 0.02; Groups 2 and 4, p < 0.001; Groups 3 and 4, p = 0.002). Conclusion OPA decreases in patients with moderate to severe CAS. OPA measurement with Pascal DCT can be used as a screening test for CAS

Unusual case of spinal epidermoid cyst and a concomitant spinal arachnoid cyst

A 38-year-old woman presented with a 12-month history of subjective weakness and pain in her legs. Thoracolumbar MRI revealed two spinal intradural cystic lesions at T5–6 and T11 levels, respectively. The lesion located at the T5–6 level was heterogeneously hyperintense on T2-weighted images and heterogeneously hypointense on T1-weighted images. This lesion showed high signal intensity on diffusion weighted MRI (DWI) and low signal intensity on apparent diffusion coefficient images (ADC). According to the MRI findings, we reported this tumour as a spinal epidermoid cyst. The pathology result suggested that the lesion was an epidermoid cyst. The second intradural lesion, at the T11 level, showed a hypointense signal on T1 and hyperintense signal on T2 images. However, in contrast to the superior lesion, this lesion was hypointense on DWI and hyperintense on ADC. We evaluated the second lesion as an arachnoid cyst according to the MRI findings

Interference in ACTH immunoassay negatively impacts the management of subclinical hypercortisolism

WOS: 000399738100012PubMed ID: 28247312Purpose Low plasma corticotropin is considered a useful parameter for the diagnosis of subclinical hypercortisolism in patients with an adrenal incidentaloma. However, immunoassays are vulnerable to interference from endogenous antibodies. In this study, subjects who underwent Hypothalamus-pituitary-adrenal axis evaluation for the assessment of subclinical hypercortisolism were evaluated. The objective of the study was to ascertain whether antibody interference in corticotropin immunoassay affected the diagnostic work-up and clinical decisions. Methods The 437 consecutive patients with incidentally discovered adrenal adenomas were included in this single centre study. Patients who had a combination of a nonsuppressed corticotropin concentration (> 4.4 pmol/L) and a non-suppressed cortisol concentration after 1 mg overnight dexamethasone suppression test (> 50 nmol/L) were selected. Eight eligible subjects without specific features of Cushing's syndrome were identified and recruited for interference studies and follow-up. Nine controls including one patient with unilateral adrenalectomy and one patient with Cushing's disease were recruited as well. Measurements Eligible subjects and controls were subjected to hormonal tests and investigations for suspected interference. Interference studies included measurement of corticotropin on a different analytical platform, serial dilutions, polyethylene glycol precipitation and heterophilic antibody analysis. Patients were followed with clinical and laboratory parameters for a median duration of 30 (12-90) months. Results Antibody interference was identified in four patients. Rheumatoid factor was responsible for the interference in one patient. Clinical management of the patients was affected by the erroneous results. Interference tests were negative in control subjects. Conclusion Erroneous results associated with analytical interference negatively impacted on clinical decision making in this patient group. This should be considered particularly in conditions such as subclinical hypercortisolism which decisions depend on laboratory investigations mainly. Analytical interference could explain the high variability observed both in field measurements from patients who were expected to have lower corticotropin concentrations and in subclinical hypercortisolism prevalence reported by different studies. Many problems can be resolved by ensuring good communication between clinical and laboratory staff

Reversible 3D compression of segmented medical volumes: usability analysis for teleradiology and storage

Background DICOM standard does not have modules that provide the possibilities of two-dimensional Presentation States to three-dimensional (3D). Once the final 3D rendering is obtained, only video/image exporting or snapshots can be used. To increase the utility of 3D Presentation States in clinical practice and teleradiology, the storing and transferring the segmentation results, obtained after tedious procedures, can be very effective

Effect of bivalirudin on neointimal hyperplasia and endothelial proliferation in rabbit

Background The aim of this study was to investigate the effects of bivalirudin on endothelial cell proliferation and neointimal hyperplasia in a rabbit carotid artery model. Methods "New Zealand rabbits (n = 12)" weighing 2-3 kg were randomly divided into two groups. Arteriotomy was performed to the rabbit carotid artery and closed with continuous suture technique. Group B (n = 6) as a control group received 150 U/kg heparin sodium; however, group A (n = 6) was given 0.75 mg/kg bivalirudin i.v. bolus and infusion 1.75 mg/kg/hour (B01AE06-Bivalirudin 250 mg) during perioperation period. At the end of the 28th day, the carotid artery segment was excised and evaluated histologically. Results All histological and immune staining analyzes were performed by two blind researchers in the treatment of rabbits. In the control group rabbit carotid artery sections, tunica intima was observed to thicken. In the bivalirudin group, intimal hyperplasia was less observed compared to the control group. No significant difference was observed between groups in tunica media thickness. Lumen diameter and lumen area were found to be wider in the experimental group.Pvalue was found to be less than 0.05. Conclusion Our study demonstrates that bivalirudin significantly affects and prevents neointimal hyperplasia and endothelial cell proliferation