Factors influencing pain and functional impairment in patients with knee osteoarthritis

Introduction: Arthritic pain and impairment are all too prevalent with osteoarthritis (OA), the most common form of the illness. Numeric scoring systems can be used to assess knee osteoarthritis (OA) patients' levels of pain. Objective: This study aimed to evaluate the possible factors that increase pain and functional impairment in knee OA leading to increased VAS and WOMAC score.Patients and Methods: On 58 osteoarthritis patients, at Zagazig University Hospitals' Rheumatology and Rehabilitation Department, we conducted this cross-sectional trial. An extensive physical examination, a set of lab tests, and a series of X-rays were all performed on each patient. We utilized the WOMAC index from the Western Ontario and McMasters Universities as well as Visual Analogue Scale (VAS "0-10 cm") to assess functions and pain. For determining the severity, we utilized grading scale of Kellgren and Lawrence.Results: BMI, deformity, ESR, radiological grading are indicators of functional impairment and pain index among cases who had knee osteoarthritis.Conclusion: Presence of knee deformities and advanced X-ray grading were associated with higher pain score and more functional impairment, so we should prevent their progression. BMI is a main risk factor for higher pain scores and functional impairments

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

دراسة مستوى الحمض الميني الهموسيستين بين مرضى السكري النوع الثاني في محافظة غزة

Background: Diabetes mellitus is prevalent in The Gaza Strip. Recently, hyperhomocysteinemia has been linked to the pathophysiology of type 2 diabetic patients. Objective: To assess homocysteine and some biochemical parameters in type 2 diabetic patients from Gaza Governorate, Gaza Strip. Materials and Methods: This case control study comprised 84 diabetic patients taken from Al Rimal diabetic clinic and Al-Shifa hospital in Gaza Governorate. And 84 healthy controls were included. Cases and controls were matched with age and gender. A questionnaire interview was applied. Serum homocysteine, glucose, urea, creatinine, cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and whole blood HbA1c were determined. Data were analyzed using SPSS version 18.0. Results: The mean ages of controls and cases were 49.2±7.6and 50.1±5.8 years. Diabetes mellitus was more prevalent among unemployment individuals as well as among individuals with family history of diabetes. Two thirds of patients were not on diet. In addition, the prevalence of diabetes was higher among individuals who frequently eat meat. The self-reported complications among diabetic patients were retinopathy, cardiovascular disease, neuropathy, nephropathy, recurrent infections, skin lesions and oral cavity lesions. The prevalence of retinopathy and neuropathy showed positive significant association with the duration of diabetes. The t-test showed significant increase in BMI of diabetic patients compared to controls (30.1±5.6 vs. 25.7±3.7, p= 0.000). The mean level of serum homocysteine was significantly higher in diabetic patients compared to controls (20.8±5.4 vs.13.4±3.7 µmol/l, P=0.000). Higher levels of homocysteine were found in unemployed cases and those with family history of diabetes as well as individuals who ate meat daily. The mean levels HbA1c and glucose were significantly higher in patients than in controls (7.5±1.4% and 252.9±119.5 mg/dl Vs. 4.7±0.6% and 108.7±13.7 mg/dl, P=0.000). The average levels of cholesterol, triglycerides and LDL-C were higher in cases (240.3±84.7, 215±89.7 and 154.1±84.4 mg/dl, respectively) compared to controls (180.2±28.6, 123.3±60.1 and 107.0±23.9 mg/dl, respectively) with P=0.000, P=0.000 and P=0.001, respectively. On the other hand, HDL-C was significantly lower in cases (41.3±11.3 Vs. 46.9±7.1 mg/dl, P=0.015). Urea and creatinine concentrations were significantly elevated in cases compared to controls (59.4±52.3 and 1.4±1.6 mg/dl Vs. 26.0±7.5 and 0.72±0.16 mg/dl, p=0.000 and p=0.005, respectively). The Pearson correlation test showed positive significant correlations of homocysteine with BMI, HbA1c, glucose, triglyceride, urea and creatinine ( r=0.214, P=0.045; r= 0.473, P=0.000; r=0.508, P=0.000; r=0.422, P=0.000; r=0.647, P=0.000 and r=0.601, P=0.000, respectively). On the other hand, there was a negative significant correlation between homocysteine and HDL-C level (r=-0.443, P=0.000). Conclusions: The significant increase of homocysteine in diabetic patients and its positive significant correlations with BMI, HbA1c, glucose, triglyceride, urea and creatinine and negative significant correlation with HDL-C makes it a possible biomarker for diabetes and may indicate its pathophysiological role in the disease

Microbiological, Nutritional and Sensorial Changes in Fresh Carrot Juice Preserved by Irradiation

Fresh carrot juice has perishable nature and very limited shelf life, and may pose a microbiological hazard. Gamma irradiation (1.5, 3.0 and 4.0 kGy) as non-thermal processing was performed to improve microbial quality, ensure safety and extending the refrigerated shelf life of fresh carrot juice. Irradiation dose of 3.0 kGy greatly reduced total aerobic bacterial counts, lactic acid bacteria and total molds and yeasts. While, it completely eliminated coliform bacteria, Escherishia coli and Enterococcus faecalis. Irradiation dose of 1.5 kGy had no significant effect on ascorbic acid content of the juice, while irradiation doses of 3.0 and 4.0 kGy significantly decreased ascorbic acid content. However, there was no significant difference in total carotene content between all irradiated samples and non-irradiated control. It was found that immediately after irradiation the sensory scores of irradiated (1.5 and 3.0 kGy) and non-irradiated samples were not significantly different. Irradiation dose of 4.0 kGy significantly reduced the sensory quality attributes of the juice. Thus, irradiation dose of 3.0 kGy can be successfully used to improve the microbial quality and extend the refrigerated shelf-life of fresh carrot juice, where it extended the shelf-life to 8 days against only 2 day for non-irradiated control. Key words: Fresh carrot juice, Gamma irradiation, Microbial quality, Nutritional quality

Isolation and characterization of coliphages from different water sources and their biocontrol application combined with electron beam irradiation for elimination of E. coli in domestic wastewater

Abstract Background Antibiotic-resistant bacteria, including Escherichia coli (E. coli), are high-risk waterborne pathogens that pose a vital threat to the general public’s health. Therefore, this study aims to develop alternative and affordable treatment approaches. Coliphage treatment is an economically and environmentally sustainable method for eliminating pathogenic bacteria. A significant step toward improving germicidal effectiveness might be to combine coliphage with electron beam treatment. Results Twelve isolated E. coli were used as host bacteria. In addition, eleven coliphages were isolated and characterized to determine their suitable host range and lytic activities. Antibiotic resistance was tested to detect the most antimicrobial-resistant E. coli isolates. Results indicated that E. coli-2 and E. coli-10 were the most resistant bacterial isolates. Both somatic coliphage-3 (S3) and F-specific coliphage-3 (F3) were the most active lytic coliphages. Based on transmission electron microscope analysis, S3 was classified as a member of the Myoviridae family, while F3 belonged to the Leviviridae family. Genome types were detected; the S3 genome was a linear double-stranded DNA virus, while the F3 genome was a single-strand RNA virus. The adjustment of pH to 7 and temperature to 38 °C increased coliphage activity by 32.2% for S3 and 14% for F3. The optimum multiplicity of infection (MOI) for S3 was 1:1 and 2:1 for F3. From the one-step growth curve, both the latent periods of S3 and F3 were estimated to be 30 and 20 min, and the burst sizes showed 5.8 and 4.6 (PFU)/infected cells, respectively. The D10 values of the most two antimicrobial-resistant strains (E. coli-2 and E. coli-10) were calculated, showing nearly identical values (0.37 and 0.38 kGy), respectively. Both coliphages were used, either alone or in combination with electron beam irradiation (EBI), to eradicate the most multidrug-resistant E. coli in domestic wastewater. EBI reduced the counts of E. coli-2 and -10 by 59% and 65%, respectively. While the combination of coliphages and EBI completely eradicated these microbes. Conclusions Combination of each individual coliphage and EBI decreased the growth of E. coli in domestic wastewater to an undetectable level. Graphical Abstrac

Urokinase plasminogen activator receptor, plasminogen activator inhibitor- 1,extracellular matrix metalloproteinase protein inducer and CA 15-3 as potential biomarkers for diagnosis and prognosis of primary breast cancer

Breast cancer is one of the most important leading causes of cancer deathin the less developed countries.The identification of markers that could assist in diagnosis, evaluation of therapeutic response, detection of recurrence and metastasis is a useful tool. The present study is undertaken to provide insights about the role of urokinase plasminogen activator receptor (uPAR), plasminogen activator inhibitor-1 (PAI-1), extracellular matrix metalloproteinase protein inducer (EMMPRIN), cancer antigen (CA) 15-3 in diagnosis and/or prognosis of breast cancer, evaluate the possible correlations between these biomarkers and the clinico-pathological status of breast cancer and compare between validity of these biomarkers with tumor marker (CA 15-3). A total of 75 women whose ages ranged between 30 to70 years and 10 healthy controls with matched age and sex were included. The patients were divided into 4 groups, group I: Included 39 female patients with breast cancer before operation, group II: Included 17 women from group I followed for 6 months after operation, group III: Included 9 women from group I followed for 12 months after operation, group IV: Included 10 female patients with benign breast diseases. Estimation of serum uPAR, PAI-1, EMMPRIN and CA 15-3 by ELISA and related clinico-pathological features were assessed. The results revealed higher mean serum levels of uPAR, PAI-1, EMMPRIN and CA 15-3 in breast cancer women before operation when compared to other 4 groups. Patients after 6 and 12 months follow up showed a decrement of uPAR, EMMPRIN, PAI-1 and CA 15-3 levels.There was significant relationbetween uPAR, PAI-1, EMMPRIN, CA 15-3 and clinicopathological characteristic of breast cancer patients. There was a significant positive correlation between serum uPAR, PAI-1 and EMMPRIN (p&lt;0.001).In conclusion, High circulating uPAR, PAI-1 andEMMPRIN were significantly associated with breast carcinogenesis and metastasis. Accordingly, estimation of these biomarkers may predict the breast disease behavior and its prognosis.Key words:Breast cancer,CA 15-3,EMMPRIN, PAI-1, uPA