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

Impact of Genetic Polymorphism of Myeloid Differentiation Primary Response Gene 88, Enhancer of Zeste Homolog 2, and B-cell Lymphoma 2 like 11 in Patients with Diffuse Large B Cell Lymphoma Treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristin

BACKGROUND: Despite the growing landscape of genetic drivers in Diffuse Large B-cell Lymphoma, yet their clinical implication is still unclear and R-CHOP regimen remains a “one size fits all” therapy. We aimed in this study to examine the prevalence of EZH2, BCL211 and MYD 88 genetic polymorphisms in DLBCL patients and correlate the results with various clinical and survival outcomes. METHODS: Genotyping of MYD88 (rs387907272 T/C), EZH2 (rs3757441 C/T), and BCL2L11 (rs3789068 A/G) polymorphisms were conducted using real time polymerase chain reaction analysis in a total of 75 DLBCL patients. RESULTS: Most of our cases carried the wild TT genotype of MYD88 gene (64%), the mutant TT genotype of EZH2 gene (52%) and the wild AA genotype of BCL2L11 gene (48%). Regarding cell of origin, Germinal Centre (GC) phenotype was present in 56% of cases while 44% expressed the Post-GC (PGC) phenotype. Poor response outcome to first line R-CHOP was significantly correlated with the mutated CC genotype of MYD 88 (p=0.02), while better response to R-CHOP was significantly associated with younger age &lt;50 years (p &lt;0.0001), good PS (p=0.046), normal LDH level (p=0.003), earlier stage (p &lt;0.0001), good IPI score (p=0.009), absence of extranodal disease (p &lt;0.0001) and absence of bulky disease (p=0.004). The median PFS and the 2 year OS were significantly higher in younger age, earlier stage, good IPI score, absence of extranodal disease, absence of bulky disease and in GC phenotype. CONCLUSIONS: Our results emphasized that the mutated genotype of MYD 88 gene polymorphism is significantly associated with poor response to R-CHOP therapy

Oxidative Stress in Hemodialysis Pediatric Patients

BACKGROUND: Oxidative stress may play a role in complications of hemodialysis patients as atherosclerosis, thrombosis, and inflammation. AIM: The aim of the study was to evaluate the oxidative stress in hemodialysis pediatric patients through measurement of oxidative stress enzymes as paraoxanase activity (PON), arylesterase activity (ASA), superoxide dismutase (SOD) and also non-enzymatic antioxidant vitamins as vitamins A, C and E levels. METHODS: The study included 50 hemodialysis pediatric patients with mean age 11.4 ± 5.4 years and 30 normal children of matched sex and age as a control group. Assessment of oxidative stresses was done using ELIZA technique. RESULTS: SOD, ASA, and vitamin C were significantly lower among hemodialysis patients in comparison to control group (p = 0.004, 0.004, &gt; 0.001 respectively). CONCLUSION: The study concluded that oxidative stress was common finding in hemodialysis pediatric patients which may play a role in complications encountered among these patients

The Determinant of Subjective Well-Being among the adult individuals in the UAE

Background: Enhancing individual wellbeing is a national priority in the United Arab Emirates. Up to date, wellbeing at the country level was measured through the national wellbeing survey that is sector specific comprising of 122 questions. The “World Health Organization 5 items (WHO-5) Well-being Index” is a reliable instrument to assess Subjective Well-Being, yet was never tested at national level in the UAE. Aim: This study examined the association of socio-economic determinants of health with the subjective well-being (SWB) using WHO-5 Well-being Index to inform public health policy in the UAE. Method: A cross-sectional survey from adults (aged 18+ and above) was conducted. About 10,000 individuals were randomly selected across all the seven Emirates. A total of 7367 adults (18 years and above) took part in the survey (response rate was 74%). The WHO-5 instrument is a valid screening measure as it includes only 5 items, is freely available in at least thirty-one languages, and is tremendously easy to complete, interpret and score. The social support of the respondents was evaluated by using the Multidimensional Scale of Perceived Social Support. Results: The results of the study demonstrate that majority of the participants (79.27%) reported moderate - high (≥50) well-being scores showing the good quality of life/well-being, whereas, only 20.72% of the individual reported ill-being/likely depression in the future. Respondent’s age, gender, marital status, monthly income (AED- UAE dirham), employment status and reporting at least one or more morbidity were found to be significantly associated with the SWB variables (p &lt; 0.05). A significant association was found between the comprehensive/emotional and /mental well-being and perceived social support. Conclusion: The WHO-5 index can be used as a reliable screening tool to identify wellbeing inequalities among adult individuals based on socio-economic determinants of health in the UAE. Addressing the socio- Hira Abdul Razzak1, Dr. Alya Harbi2, Ms. Mubarkah Jaber AlKarbi3, Dr. Amin Mohamed ElShamy4 , Dr. Lubna Al Shaali5, Dr. Rasha E Salama6 , Ms. Malaz Bakri7, Dr. Ahmed Alosi8, Ms. Amna AlDhmanie9 1678 © 2021 JPPW. All rights reserved economic determinants of health in the UAE can enhance subjective well-being (SWB) and help the UAE to achieve its strategic aspiration to make the UAE among the world leaders in quality of life

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

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Hepato and neuro-protective influences of biopropolis on thioacetamide-induced acute hepatic encephalopathy in rats

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome ultimately occurs as a complication of acute or chronic liver failure; accompanied by hyperammonemia. This study aimed to evaluate the potential of biopropolis as a hepato and neuroprotective agent using thioacetamide (TAA)-induced acute HE in rats as a model. Sixty Wistar rats were divided into five groups: Group 1 (normal control) received only saline and paraffin oil. Group 2 (hepatotoxic control) received TAA (300 mg/kg, once). Groups 3, 4 and 5 received TAA followed by vitamin E (100 mg/kg) and biopropolis (100 and 200 mg/kg), respectively, daily for 30 days. Evidences of hepatic encephalopathy were clearly detected in TAA-hepatotoxic group including significant elevation in the serum level of ammonia, liver functions, increased oxidative stress in liver and brain, apoptotic DNA fragmentation and overexpression of iNOS gene in brain tissue. The findings for groups administered biopropolis, highlighted its efficacy as a hepato and neuro-protectant through improving the liver functions, oxidative status and DNA fragmentation as well as suppressing the brain expression of iNOS gene. In conclusion, bioproplois, at a dose of 200 mg/kg/day protected against TAA-induced HE through its antioxidant and antiapoptotic influence; therefore, it can be used as a protective natural product.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Perceptions and practice of physicians and pharmacists regarding antibiotic misuse at primary health centres in Qatar: A cross-sectional study

Objectives: The inappropriate use of antibiotics is a critical global health issue. The lack of antimicrobial stewardship exposes the community to unwarranted medication and contributes to the development of antimicrobial resistance. This study evaluated the perceptions and practice of physicians and pharmacists at primary healthcare centres of Qatar with respect to antibiotic misuse. Methods: In this cross-sectional study, we recruited 226 physicians and 82 pharmacists in primary health care centres. A multistage cluster sampling technique was used for data collection. Separate self-administered questionnaires were administered to physicians and pharmacists. Results: Response rates for physicians and pharmacists were 97.8% and 100%, respectively. Both physicians (90.7%) and pharmacists (87.8%) perceived antibiotic misuse as a major public health issue. To prevent antibiotic misuse, most physicians and pharmacists reported a focus on patient education as well as good practices in their work. Conclusion: This study provides novel evidence on the perceptions and practices of health professionals concerning antibiotic prescription in primary healthcare settings of Qatar