KNOWLEDGE AND MALPRACTICES IN PEDIATRICS DIARRHEA MANAGEMENT BY IRAQI MOTHERS

Objectives: In developing countries like Iraq, diarrhea was responsible for 70% of deaths among pediatrics. This study was designed to determine Iraqi mothers' knowledge and malpractices associated with diarrhea management in pediatrics.Methods: A cross-sectional pilot study was done on a convenient sample of mothers in Baghdad – Iraq. Data collection was done using a validated questionnaire specifically designed for this study.Result: Most participants preferred to consult physicians or pharmacists about pediatrics diarrhea management. Breastfeeding was stopped by 19% of participants, whereas 35% of mothers who depend on formulated milk discontinued it. Only 30% of participants use oral rehydration solution therapy always as a part of treatment. Although 54% of participated mothers certainly not used antibiotics for the diarrhea management before doctor consultation, however 52.5% of these mothers used antimotility suspensions without any consultation. 17% of participants used some herbal preparations in addition to 11% used some forms of traditional harmful preparations (Al-Sagwa) to manage diarrhea.Conclusions: This study indicates a good level of knowledge about diarrhea management for most participants, although there are some wrong concepts which followed by a small percentage of mothers, especially the most dangerous malpractices of using Al-Sagwa

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

Analgesic intake after pulpotomy and root canal treatment of permanent molars with carious exposure: A randomized clinical trial

To compare the patients’ analgesic intake after pulpotomy and root canal treatment and to compare the time span of both endodontic procedures. A total of thirty-four permanent mandibular molars with signs and symptoms of irreversible pulpitis were randomly assigned to a pulpotomy group (n=17) and root canal treatment (RCT) group (n=17). Endodontic procedure duration was recorded for both groups. Analgesic intake for each patient was recorded up to the fourth day post treatment. In management of mature permanent teeth with carious exposure, pulpotomy may be preferred because it is a simple technique requiring less time and patients requires significantly less analgesics postoperatively

Potential Egyptian bacterial consortium for oil spill treatment: A laboratory simulation

The purpose of the study was to reach high efficiency of an oil-degrading bacteria to be used in oil-spill treatment separately or with bacterial consortium. The consortium effect on crude oil was examined by GC-MS. The consortium degraded 99.2% of crude oil after 7 days, while Enterobacter sp. ASH, as individual culture, degraded 80% only. This isolate was identified based on 16S rRNA gene sequence analysis, morphological, physiological, and biochemical characterization. ANOVA analysis showed that medium volume and crude oil concentration are the significant factors. The results showed that the mixed consortium showed better biodegradation abilities than E. sp. ASH

Torque ripples reduction of electric vehicle synchronous reluctance motor drive using the strong action controller

Smart, Micro and Nano-grids are the future of electric power systems. In parallel with this future, electric vehicles (EVs) take a great deal of attention, as they are one of the important elements in these systems. Also, with the passage of time, the development continues in the technology of manufacturing EVs. Since the electric motor is the main component in these vehicles, research and development is continuing to find the most suitable motors that can work in such vehicles. The synchronous reluctance motor (SynRM) is the newest motor used in this industry. SynRMs faces different challenges, one of which is the torque ripples. Different trials were used to reduce or eliminate or minimize these ripples. Most of previous work focuses on the SynRM design parameters to reduce torque ripples. In this paper, the control methodology and the strong action controller (SAC) are used as a tool to reduce these ripples. The simulation results showed the effectiveness of the application of the proposed SAC in ripples factor reduction. This reduction represents a new contribution over the already existed techniques