Quality of care of Egyptian asthmatic children: Clinicians adherence to asthma guidelines

<p>Abstract</p> <p>Background</p> <p>Despite the development and dissemination of guidelines for the diagnosis and management of asthma, a gap remains between current recommendations and actual practice.</p> <p>Objectives</p> <p>To assess the physicians attitude towards asthma guidelines and their adherence to its recommendations.</p> <p>Methods</p> <p>Three hundred and fifty two clinicians (101 General practitioners, 131 pediatric specialists, 35 pediatric consultants and 85 doctors did not report the qualification) engaged in direct childhood asthma care in Cairo, Egypt were subjected to a self-administered questionnaire with 35 questions of which most were multiple choices, aiming at assessment of three important aspects about the involved physicians; physician's knowledge, practice and attitude. 165 of the clinicians were working in governmental hospitals, 68 clinicians work in private clinics and 119 clinicians work in both.</p> <p>Results</p> <p>Agreement with asthma guidelines was present in 76.2% of the studied physicians, however those who not in agreement with the guidelines claimed that this was mainly due to patient factors, firstly the poor socioeconomic standard of the patient (18.1%) and secondly due to poor patient compliance (16%). Poor knowledge was found in 28.5%, poor practice was found in 43.6% and poor attitude was found in 14.4% of the studied physicians. There was positive highly significant correlation between qualification and knowledge, (p < 0.01), positive highly significant correlation between qualification and practice, (p < 0.01), and positive highly significant correlation between qualification and attitude, (p < 0.01).</p> <p>Conclusion</p> <p>The attitude of the studied physicians revealed agreement of their majority with the guidelines, while the disagreement was mainly explained by the poor socioeconomic standard of the patients. The degree of poor practice is more marked than that of poor knowledge or poor attitude reflecting resources limitations and applications obstacles in the physician's practice.</p

Traditional knowledge of wild edible plants used in Palestine (Northern West Bank): A comparative study

<p>Abstract</p> <p>Background</p> <p>A comparative food ethnobotanical study was carried out in fifteen local communities distributed in five districts in the Palestinian Authority, PA (northern West Bank), six of which were located in Nablus, two in Jenin, two in Salfit, three in Qalqilia, and two in Tulkarm. These are among the areas in the PA whose rural inhabitants primarily subsisted on agriculture and therefore still preserve the traditional knowledge on wild edible plants.</p> <p>Methods</p> <p>Data on the use of wild edible plants were collected for one-year period, through informed consent semi-structured interviews with 190 local informants. A semi-quantitative approach was used to document use diversity, and relative importance of each species.</p> <p>Results and discussion</p> <p>The study recorded 100 wild edible plant species, seventy six of which were mentioned by three informants and above and were distributed across 70 genera and 26 families. The most significant species include <it>Majorana syriaca, Foeniculum vulgare, Malvasylvestris</it>, <it>Salvia fruticosa, Cyclamen persicum, Micromeria fruticosa, Arum palaestinum, Trigonella foenum-graecum</it>, <it>Gundelia tournefortii</it>, and <it>Matricaria aurea</it>. All the ten species with the highest mean cultural importance values (mCI), were cited in all five areas. Moreover, most were important in every region. A common cultural background may explain these similarities. One taxon (<it>Majoranasyriaca</it>) in particular was found to be among the most quoted species in almost all areas surveyed. CI values, as a measure of traditional botanical knowledge, for edible species in relatively remote and isolated areas (Qalqilia, and Salfit) were generally higher than for the same species in other areas. This can be attributed to the fact that local knowledge of wild edible plants and plant gathering are more spread in remote or isolated areas.</p> <p>Conclusion</p> <p>Gathering, processing and consuming wild edible plants are still practiced in all the studied Palestinian areas. About 26 % (26/100) of the recorded wild botanicals including the most quoted and with highest mCI values, are currently gathered and utilized in all the areas, demonstrating that there are ethnobotanical contact points among the various Palestinian regions. The habit of using wild edible plants is still alive in the PA, but is disappearing. Therefore, the recording, preserving, and infusing of this knowledge to future generations is pressing and fundamental.</p

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

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

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

Association of neutrophil to lymphocyte ratio with disease activity indices and musculoskeletal ultrasound findings in recent onset rheumatoid arthritis patients

Aim of the work: To study the relation between neutrophil-lymphocyte ratio (NLR) with disease activity indices and with musculoskeletal ultrasonographic findings in recent onset rheumatoid arthritis (RA) patients. Patients and methods: The study consisted of 40 recently diagnosed RA patients and 40 matched control. Patients’ disease activity was assessed clinically by the disease activity score (DAS-28). Musculoskeletal ultrasound was performed to detect synovitis by Power-Doppler ultrasound (PDUS). The association of NLR with the disease activity indices and the PDUS score were analyzed. Results: The mean age of the patients was 44.5 ± 2.7 years, disease duration 9.4 ± 4.5 months and the female:male ratio was 2.3:1. Their disease activity was 4.7 ± 1.33 and the PDUS score was 10.24 ± 4.56. The NLR was significantly increased in the RA patients (3.28 ± 0.59) compared to the control (1.7 ± 0.23) (p < 0.0002). There was a significant correlation between NLR with the disease duration (p < 0.015), tender joint count (p < 0.022), swollen joint count (p < 0.018), morning stiffness (p < 0.045), visual analogue scale (p < 0.026), DAS-28 (p < 0.049), erythrocyte sedimentation rate (p < 0.032), C-reactive protein (p < 0.017) and PDUS score (p < 0.037). NLR was significantly elevated in highly active RA patients compared to patients with moderate and low disease activity (p < 0.014). Conclusion: NLR significantly correlated with disease activity indices in recent onset RA patients thus reflecting systemic inflammation with its advantages of being available, easy and cost accessible being as reliable as the DAS-28 hence it could be used as a marker of disease activity

Impacted Application of Water-Hyacinth-Derived Biochar and Organic Manures on Soil Properties and Barley Growth

The biochar application can improve the physiochemical properties of both sandy and clayey loam soils and is considered a potential adaptation tool toward climate change. Therefore, the current study is novel in combining water-hyacinth-derived biochar with organic manures as a suggested effective way of treating the soil with biochar under arid and semiarid conditions. Water hyacinth weeds were slow pyrolyzed at a temperature of 300 &deg;C, which resulted in nonalkaline biochar with a pH value of 6.31, which is suitable for alkaline soils. A pot experiment was established to study the impact of the solo application of nonalkaline water-hyacinth-derived biochar (WHB) and its combined application with farmyard (WHB/FM) and poultry manure (WHB/PM) at a rate of 1.5 and 3%, respectively, on some chemical and physical properties of sandy and clay loam soils and some barley&rsquo;s growth parameters. WHB, WHB/FM, and WHB/PM significantly affected the soil pH at different application rates (1.5 and 3%) in sandy soil. A considerable alteration in water-stable aggregates (WSA), dispersion ratio (DR), available water content (AWC), and cation ratio of soil structural stability (CROSS) index resulted from combining manures (FM and PM) with biochar better than the solo application of biochar. WHB/PM treatments had a superior effect in improving barley&rsquo;s growth. Relative increases were by 37.3 and 11.0% in plant height and by 61.6 and 28.5% in the dry matter in sandy and clayey loam soils, respectively. Under the conditions of this study, we can conclude that treating the soil with WHB/PM at a rate of 1.5 and 3% is the most effective application. The current study may have a vital role in Egyptian agriculture sustainability by enhancing the soil characteristics of the old agricultural and the newly reclaimed lands

Impacted Application of Water-Hyacinth-Derived Biochar and Organic Manures on Soil Properties and Barley Growth

The biochar application can improve the physiochemical properties of both sandy and clayey loam soils and is considered a potential adaptation tool toward climate change. Therefore, the current study is novel in combining water-hyacinth-derived biochar with organic manures as a suggested effective way of treating the soil with biochar under arid and semiarid conditions. Water hyacinth weeds were slow pyrolyzed at a temperature of 300 °C, which resulted in nonalkaline biochar with a pH value of 6.31, which is suitable for alkaline soils. A pot experiment was established to study the impact of the solo application of nonalkaline water-hyacinth-derived biochar (WHB) and its combined application with farmyard (WHB/FM) and poultry manure (WHB/PM) at a rate of 1.5 and 3%, respectively, on some chemical and physical properties of sandy and clay loam soils and some barley’s growth parameters. WHB, WHB/FM, and WHB/PM significantly affected the soil pH at different application rates (1.5 and 3%) in sandy soil. A considerable alteration in water-stable aggregates (WSA), dispersion ratio (DR), available water content (AWC), and cation ratio of soil structural stability (CROSS) index resulted from combining manures (FM and PM) with biochar better than the solo application of biochar. WHB/PM treatments had a superior effect in improving barley’s growth. Relative increases were by 37.3 and 11.0% in plant height and by 61.6 and 28.5% in the dry matter in sandy and clayey loam soils, respectively. Under the conditions of this study, we can conclude that treating the soil with WHB/PM at a rate of 1.5 and 3% is the most effective application. The current study may have a vital role in Egyptian agriculture sustainability by enhancing the soil characteristics of the old agricultural and the newly reclaimed lands

Screening of Egyptian obese children and adolescents for insertion/deletion (I/D) polymorphism in angiotensin-converting enzyme gene

Background: /aims: The role of angiotensin-converting enzyme (ACE) gene polymorphism in the development of obesity and hypertension in children has not been widely studied. We aimed to screen Egyptian obese children and adolescents for insertion/deletion (I/D) polymorphism in the ACE gene. Methods: One hundred forty-two children and adolescents were included (70 with simple obesity and 72 controls). Blood pressure was measured, and anthropometric parameters were assessed in all included children and adolescents. Fasting lipid profile, fasting glucose, and insulin were measured. DNA extraction and ACE I/D polymorphism genotyping were also performed. Results: Obese children had a higher frequency of DD genotype (30% in obese versus 11.1% in controls, P = .01) and D alleles (61.8% in obese versus 48.6% in controls, P = .01). Obese children with hypertension and prehypertension had higher frequency of DD genotype than II genotype and higher D alleles than I alleles. DD genotype and D allele were independently associated with hypertension (OR: 9.86 and 11.57, respectively, P < .001), while dyslipidemia and insulin resistance were not associated with the ACE I/D gene polymorphism. Conclusion: DD genotype and D-allele of the ACE gene polymorphism were associated with obesity and with hypertension and pre-hypertension in Egyptian children. Keywords: Obesity, Hypertension, ACE, Polymorphis