Influence of Platelets Rich Plasma on Repair of Superficial Digital Flexor Tendon Rupture in Donkeys (An Experimental Study)

This study was planned to prospectively evaluate the influence of platelets rich plasma (PRP) on the restoration of superficial digital flexor tendon (SDFT) in donkeys. Eighteen apparently clinically healthy male donkeys of 3-6 years old, weighing 150-200 kg, were used. The animals were classified into two equal groups; control group and PRP group. One cm transection of the full thickness of middle portion of the SDFT was made in all animals. First, all animals were subjected to sedation via xylazine HCl injection in a dose of 1 mg/kg body weight then the animals were deeply narcotized with chloral hydrate 10% in a dose of 5 gm/50 kg body weight. A linear skin incision in the palmar aspect of the right fore limb at the mid cannon region was performed in all operated animals. The animals in PRP group were subjected to intratendinous injections of 4 mL PRP with weekly interval (day 0, w1, w2, w3) under the guidance of ultrasonography. Representative tendon specimens from all animals were collected 30, 60, and 90 days post operation (PO) for histopathological examination. The obtained clinical and histopathological results reveled that PRP application improved the healing of SDFT compared to the control group, through increasing and acceleration of angiogenesis, fibrogenesis, collagen deposition and remodeling in the injured tendon matrices

The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

Lumbar stenosis is frequently observed and treated by spine surgeons. The extent of neurological decompression and the potential spinal fixation are the basic concerns when surgery is planned. But this segmented approach to the problem is sometimes insufficient due to the complex functional situations induced by a sagittal imbalance of the patient and the combination of pathologies known as hip-spine or knee-spine syndromes. A total of 373 consecutive patients included from our EOS and clinical data base. Patients were divided in two groups. Group A included patients presenting exclusive spinal issues (172 cases) out of whom 117 (68 %) had sagittal imbalance. Among 201 patients with associated lower limbs issues (group B), 122 (61 %) had sagittal imbalance. The perception of imbalance was noticed in 54 % (93 cases) in group A and 57 % (115 cases) in group B. In the global series of 239 imbalanced cases, the key point was a spine issue for 165 patients (the 117 patients with only spine problems and 48/122 cases with combined spine and lower limbs problems). But in the patients with combined spine and lower limbs problems, we individualized hipspine syndromes (24/122 patients) and knee-spine syndromes (13/122 patients). In some cases, (37/122 patients) the anatomical and functional situations were more complex to characterize a spine-hip or a hip-spine problem. The EOS full-body images provide new information regarding the global spinal and lower limbs alignment to improve the understanding of the patient functional posture. This study highlights the importance of the lower limb evaluation not only as compensatory mechanism of the spinal problems but also as an individualized parameter with its own influence on the global balance analysis. Level of evidence IV diagnostic case series

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

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&lt;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&lt;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

The superior performance of silica gel supported nano zero-valent iron for simultaneous removal of Cr (VI)

Abstract Pure nano zero-valent iron (NZVI) was fabricated under optimum conditions based on material production yield and its efficiency toward acid blue dye-25 decolorization. The optimum prepared bare NZVI was immobilized with two different supports of silica and starch to fabricate their composites nanomaterials. The three different prepared zero-valent iron-based nanomaterials were evaluated for removal of hexavalent chromium (Cr(VI)). The silica-modified NZVI recorded the most outstanding removal efficiency for Cr(VI) compared to pristine NZVI and starch-modified NZVI. The removal efficiency of Cr(VI) was improved under acidic conditions and decreased with raising the initial concentration of Cr(VI). The co-existence of cations, anions, and humic acid reduced Cr(VI) removal efficiency. The removal efficiency was ameliorated from 96.8% to 100% after adding 0.75 mM of H2O2. The reusability of silica-modified NZVI for six cycles of Cr(VI) removal was investigated and the removal mechanism was suggested as the physicochemical process. Based on Langmuir isotherm, the maximal Cr(VI) removal capacity attained 149.25 mg/g. Kinetic and equilibrium data were efficiently fitted using the pseudo-second-order and Langmuir models, respectively confirming the proposed mechanism. Diffusion models affirmed that the adsorption rate was governed by intraparticle diffusion. Adsorption thermodynamic study suggested the spontaneity and exothermic nature of the adsorption process. This study sheds light on the technology that has potential for magnetic separation and long-term use for effective removal of emerging water pollutants

Impact of Green Chitosan Nanoparticles Fabricated from Shrimp Processing Waste as a Source of Nano Nitrogen Fertilizers on the Yield Quantity and Quality of Wheat (Triticum aestivum L.) Cultivars

Waste from crustaceans has adverse effects on the environment. In this respect, shrimp waste was valorized for producing chitosan nanoparticles as a source for eco-friendly nano-nitrogen fertilizer. The application of nano-nitrogen fertilizers is a valuable alternative approach in agriculture due to its potential for reducing the application of mineral nitrogen fertilizers and increasing yield quality and quantity, thereby helping to reduce the worldwide food shortage. Chitosan nanoparticles were foliar sprayed at three volumes (0, 7, and 14 L/ha) and compared with mineral nitrogen fertilizer (M-N) sprayed at three volumes (0, 120, and 240 kg N/ha) and their combination on two wheat cultivars (Misr-1 and Gemaiza-11) during two consecutive seasons (2019/2020 and 2020/2021) in order to evaluate the agronomic response. The synthesized chitosan nanoparticles displayed characteristic bands of both Nan-N and urea/chitosan from 500&ndash;4000 cm&minus;1. They are stable and have a huge surface area of 73.21 m2 g&minus;1. The results revealed significant differences among wheat cultivars, fertilization applications, individual or combined, and their interactions for yield-contributing traits. Foliar application of nano-nitrogen fertilizer at 14 L/ha combined with mineral fertilizer at 240 kg/ha significantly increased total chlorophyll content by 41 and 31% compared to control; concerning plant height, the two cultivars recorded the tallest plants (86.2 and 86.5 cm) compared to control. On the other hand, the heaviest 1000-grain weight (55.8 and 57.4 g) was recorded with treatment of 120 kg Mn-N and 14 L Nan-N/ha compared to the control (47.6 and 45.5 g). The Misr-1 cultivar achieved the highest values for grain yield and nitrogen (1.30 and 1.91 mg/L) and potassium (9.87 and 9.81 mg/L) in the two studied seasons when foliarly sprayed with the combination of 120 kg Mn-N/ha + 14 L Nan-N/ha compared to the Gemaiza-11 cultivar. It can be concluded that Misr-1 exhibited higher levels of total chlorophyll content, spike length, 100-grain weight, grain yield in kg/ha, and nitrogen and potassium. However, Gemaiza-11 displayed higher biomass and straw yield values, plant height, and sodium concentration values. It could be economically recommended to use the application of 120 kg Mn-N/ha + 14 L Nan-N/ha on the Misr-1 cultivar to achieve the highest crop yield