27 research outputs found

    Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

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    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

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    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

    Green process intensification techniques for bio-refinery

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    International audienceBio-refinery could be a new concept to meet the challenges of the 21st century, to stop the commonly used one cultivation–one product paradigm, and, therefore, permits valorization of majority of secondary and primary metabolites of a plant matrix. This article presents innovative food processing techniques (such as microwave, ultrasound, pulse electric field, Instant controlled pressure drop, and supercritical fluid processing) and their role in promoting bio-refinery. We will pay special attention to strategies and tools available to make extraction greener and present them as success stories for research, education, and at industrial scale

    Les potentialités offertes par la vectorisation d'un agent antiangiogénique, le thalidomide et d'agents anti-cancéreux, le chlorambucil et la doxorubicine

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    Le travail présenté dans cette thèse concerne la préparation de nouveaux vecteurs amphiphiles dotés soit d'un agent anti-angiogénique, le thalidomide soit d'un agent anti-cancéreux, le chlorambucil ou la doxorubicine.Le premier chapitre, après une synthèse bibliographique sur le sinistre passé du thalidomide et un bref rappel sur l'intérêt des télomères dérivés du (THAM) Tris(hydroxyméthyl)acrylamidométhane, concerne les potentialités offertes par la vectorisation de cet inhibiteur d'angiogenèse, en le greffant sur des structures amphiphiles adaptées. Afin de réaliser ce greffage, la synthèse de deux analogues a été réalisée. Les résultats acquis ont montré que ces composés sont de très bons candidats pour accroître l'activité inhibitrice de l'angiogenèse du principe actif étudié. Le second chapitre concerne la biodistribution in vivo de ces composés et l'intérêt du glucose dans le ciblage des cellules cancéreuses. Les tests biologiques semblent montrer que les cellules tumorales possèdent des récepteurs spécifiques du thalidomide et que le greffage du glucose sur un vecteur télomère apparaît comme un moyen intéressant de cibler les sites tumoraux. La préparation de structures moléculaires amphiphiles a ensuite été réalisée selon la même technique que pour les télomères, afin de vérifier après analyse de leur biodistribution, si elles possèdent les mêmes avantages pour la vectorisation de principes biologiquement actifs.Le troisième chapitre concerne l'étude des structures macromoléculaires pour la vectorisation de médicaments anti-cancéreux tels que le chlorambucil et la doxorubicine. Les premiers tests in vitro sur le télomère porteur de chlorambucil n'ont révélé aucune activité. Dès lors, la synthèse de motifs vectoriels simples a été envisagée sur lesquels le médicament est lié soit par une liaison amide soit par une liaison esterThe work presented in this manuscrit deals with the preparation of new amphiphilic vectors endowed with thalidomide, chlorambucil or doxorubicin moities.The first chapter reminds the last disasters of thalidomide and relates the potentialities of the vectorization of this drug by telomers derived from Tham (Trishydroxymethyl) acrylamidomethane for the inhibition of angiogenesis.In this field differents derivates of thalidomide were prepared and the macromolecular prodrugs obtained were tested in vivo.The second chapter deals with the potentialities of the introduction of glucosidic units on telomeric carriers for the targeting of cancerous cells.The last chapter describes the synthesis and biological evaluations of molecular amphiphilic/ and telomeric carriers endowed with chlorambucil or doxorubicin.AVIGNON-BU Centrale (840072102) / SudocSudocFranceF

    Portable microwave assisted extraction: An original concept for green analytical chemistry

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    International audienceThis paper describes a portable microwave assisted extraction apparatus (PMAE) for extraction of bioac-tive compounds especially essential oils and aromas directly in a crop or in a forest. The developed procedure, based on the concept of green analytical chemistry, is appropriate to obtain direct in-field information about the level of essential oils in natural samples and to illustrate green chemical lesson and research. The efficiency of this experiment was validated for the extraction of essential oil of rosemary directly in a crop and allows obtaining a quantitative information on the content of essential oil, which was similar to that obtained by conventional methods in the laboratory

    Laboratory to pilot scale: Microwave extraction for polyphenols lettuce

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    International audienceMicrowave hydrodiffusion and gravity (MHG) technique has been applied to pilot-scale solvent-free microwave extraction (SFME) of polyphenols from Lettuce sativa. Following the dictates of green extraction and with the aim to save time and energy, the lab-scale knowledge on SFME was exploited for the development of a pilot-scale process. The investigation entailed the optimization of all main parameters (temperature, time, extracted water volume, etc.) and we showed that the polyphenols composition profile under SFME was similar to the classic methods though a bit lower in total content. The energy consumption in the optimized procedure (30 min) was 1W/g of fresh matrix

    Downscaling of Industrial Turbo-Distillation to Laboratory Turbo-Clevenger for Extraction of Essential Oils. Application of Concepts of Green Analytical Chemistry

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    In the effort of innovation towards green analytical chemistry concepts and considering the six principles of green extraction, the industrial turbodistillation process was downscaled into a laboratory apparatus turbo-Clevenger (TC) for the extraction of essential oils. Turbodistillation is used as an industrial purpose for the extraction of essential oils from hard matrixes such as wood, barks, seeds. In this work, a TC and the conventional technique of hydrodistillation (HD, Clevenger apparatus) are used for the extraction of essential oils from three spices with hard structures(Illicium verum, Schinus terebinthifolius, and Cinnamomum cassia) and are compared. This study shows that the essential oils extracted by TC in 30 min were quantitatively (yield and kinetics profile) and qualitatively (aromatic profile) similar to those obtained using conventional hydrodistillation in 3 h. This process, which gave a reduced extraction time, was perfectly adapted to the extraction of hard matrixes
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