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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

Application of biodegradable collagen matrix (Ologen™) implants in Dacryocystorhinostomy surgeries, a randomized clinical study

Abstract Background To introduce and evaluate the application of Ologen implants in external Dacryocystorhinostomy (DCR) Surgeries. Methods Prospective comparative randomized study was carried out on 60 patients coming to ophthalmology department, Menoufia University Hospitals. Patients included were suffering from primary acquired nasolacrimal duct obstruction with positive regurge test. Patients were randomly enrolled into two groups using alternating choice technique. Group A included 30 patients who had DCR surgery to treat the obstruction with Silicone tubes. Group B included 30 patients had a Dacryocystorhinostomy with Silicone tubes and Ologen implants. Results Success rates as regard to relief of symptomatic epiphora were 86.7% in group A and 96.7% in group B and time of dye clearance test was 4.5 ± 0.6 min in group A and 3.9 ± 0.4 min in group B with p value 0.353 &0.001 consecutively. Apart from immediate mild post operative hemorrhage that was encountered in 2 cases in group B and 1 case in group A, there were no significant complications in both groups. Conclusion The current study shows that application of Ologen implants in external DCR surgeries may improve symptomatic epiphora without exposing the patients to more intra-operative or post-operative complications. To the best of our knowledge, the current study is the first one to use Ologen implants in external DCR surgeries. However, the follow-up period was relatively short and the sample size is relatively small and further work is required to verify the effect of Ologen in external DCR surgeries. Trial registration Current Controlled Trials PACTR201711002809215, and the date of registration is 29 November 2017. The trial is Retrospectively registered

Effect of loading rate and source of energy on the drying parameters of the basil during drying

Abstract The basil leaves were dried different sources of energy at different loading rates. Using hybrid solar drying compared to the conventional source of energy such as fossil and propane. Drying parameters were studied. Also, product quality was assessed under study treatments. The results indicated that the higher accumulated weight loss of basil leaves (75.56%) were obtained at 25 kg m−2 loading rate and solar drying system. The highest rate of the decrease in moisture content of basil leaves was happened at the 45 kg m−2 loading rates. Meanwhile, the lowest rate of the decrease in moisture content of basil leaves was found at 15 kg m−2 loading rates. The highest drying rate of basil leaves (219.54 gwater kg−1 h−1) was obtained at the loading rate of 15 kg m−2. The highest values of total chlorophyll and color of basil leaves 745.9 and 36.35 were found for solar dryer. The lowest values of total chlorophyll and color of basil leaves 703.5 and 31.66 were found for diesel dryer. The drying efficiency ranged from 33.98 to 40.33% for all batch loads. The highest essential oil yield obtained for solar dryer, the lowest essential oil yield occurred for diesel dryer. The highest value of volatile compounds with found for solar dryer. The total costs for basil drying were 19.73, 26.70 and 23.93 LE h−1 for solar, diesel and propane dryers, respectively. Also, the total costs of basil drying were 8.77, 13.15 and 12.27 LE kg−1 dried for solar, diesel and propane dryers, respectively

Microstructural, Physicochemical, Microbiological, and Organoleptic Characteristics of Sugar- and Fat-Free Ice Cream from Buffalo Milk

Ice cream is a popular dessert product across the world. Structure, body, taste, and odor properties are created by adding non-milk ingredients and milk ingredients. The main aim of the study is to decrease the caloric value of ice cream by using sugar and fat replacements. Ice cream treatments were investigated based on microstructural, chemical, physical, microbiological, sensory, and calorific values. Four different ice creams were used (control ice cream (SC1), ice cream with stevia (SC2), ice cream with sucralose (SC3), and ice cream with sorbitol (SC4)). The chemical properties in all treatments of ice cream were significantly recorded (p p p p p p < 0.05). On the other hand, the lowest calorific value was calculated in SC2, followed by the SC3 and SC4 treatments. In scanning electron microscopy (SEM), the gel exhibited a homogeneous structure with a fine network within the SC2, SC3, and SC4 treatments, as it contained a cohesive structure with small-sized pores

Biochar production under different pyrolysis temperatures with different types of agricultural wastes

Abstract The main aim of this study is to determine the physical and chemical properties of biochar synthesized from different materials (straw rice, sawdust, sugar cane, and tree leaves) at different pyrolysis temperatures (400, 600, and 800 °C). The physical and chemical properties such as moisture content, water holding capacity, bulk density, and porosity; and pH, electrical conductivity (EC), organic matter, organic carbon, total nitrogen, potassium, phosphorus, calcium, magnesium, sodium, and sulfur were determined, respectively. The results show that the biochar yield decreased with increasing pyrolysis temperature, and the values of the analyzed properties varied depending on the type of biochar and pyrolysis temperature. The moisture content ranged from 1.11 to 4.18%, and the water holding capacity ranged from 12.9 to 27.6 g water g−1 dry sample. The highest value of bulk density (211.9 kg m−3) was obtained from sawdust at a pyrolysis temperature of 800 °C. The porosity values ranged from 45.9 to 63.7%. The highest values of pH and EC (10.4 and 3.46 dS m−1) were obtained from tree leaves at a pyrolysis temperature of 800 °C. Total organic matter ranged from 66.0 to 98.1%, total organic carbon ranged from 38.3 to 56.9%, and total nitrogen ranged from 0.4 to 1.9%. The highest values of phosphorus and calcium content (134.6 and 649.0 mg kg−1) were obtained from sugar cane at a pyrolysis temperature of 800 °C. The magnesium, sodium and sulfur content had ranges of 10.9–51.7, 1124–1703 and 3568–12,060 mg kg−1, respectively

Equilibrium and kinetic modelling of aqueous cadmium ion and activated carbon adsorption system

Despite their extensive and decade long application in wastewater treatment, activated carbon remains one of the most viable adsorbents, with substantive practical application, due to their high pollutant binding capacity. In this study, commercially available activated charcoal was applied in the uptake of aqueous cadmium [Cd(II)] ion. The effect of some process variables on the Cd (II) uptake was investigated via batch mode. Furthermore, the adsorbents’ surface charge (pHPZC), surface morphology (using SEM) and available surface functional groups (using FTIR) were explained. The pH dependence of the present adsorption system was revealed, with the optimum pH was recorded at pH 5.0. Similarly, the Cd (II) uptake (mg/g) decreased with increasing adsorbent dosage due to possible active sites clogging, overcrowding and interference Furthermore, the isothermal and kinetics analyses of the experimental data, that were aptly validated using the hybrid error model, respectively depicted the Langmuir isotherm and pseudo-second-order kinetic model as the best fit. A Langmuir adsorption capacity of 682.5 mg g-1 was also recorded in the study. Consequently, the present adsorption system was characterized by an equilibrium timeframe of industrial practicability, hence the adsorbent was successfully applied for the aqueous Cd (II) uptake

Potential health risk assessment for heavy metals in Tilapia fish of different spatiotemporal monitoring patterns in Kafr El-Shaikh and El-Faiyum Governorates of Egypt

Heavy metal (HMs) levels were evaluated in aquacultured tilapia fish collected from two highly producing districts in Egypt (Kafr El-Sheikh and El-Faiyum Governorates) during two seasons (autumn 2021 and spring 2022). As well, health risk assessment of exposure to HMs in tilapia fish was studied. The results revealed that six HMs: As, Cu, Fe, Mn, Cr and Zn were predominant in fish samples of the first season (autumn 2021), while most of HMs were existed in samples of the second season. All samples of the two seasons were free of Hg. Notably, autumn season’s fish samples showed higher concentrations of HMs than those of the spring season. As well, Kafr El-Sheikh farms were highly contaminated with HMs than those of El-Faiyum governorate. Risk assessment results indicated that the THQ values of As substantially exceeded 1 either for Kafr El-Shaikh samples (3.15 ± 0.5) or for El-Faiyum samples (2.39 ± 0.8) of autumn season. Meanwhile, THQ values for all HMs, in spring season 2021, were less than one whole. These results indicated a potential health risk arising from the exposure to HMs, As in particular, in fish samples of autumn season as compared to those of spring season. Therefore, there is a need for remedial applications, in such polluted aquacultures in autumn season, which are currently under investigation as an integral part of the research project that funded the current study