Evaluation of community pharmacists' awareness towards Middle East respiratory syndrome: a simulated client method.

Middle East Respiratory Syndrome (MERS) is a viral respiratory disease caused by a coronavirus variant in the Arabian Peninsula. There is a lack of information regarding awareness and practices of community pharmacists in Qatar for this contagious disease. To determine the quality of the MERS-related information, recommendations, and counselling practices provided by Qatar's community pharmacists by using Simulated Client Method (SCM). An observational cross-sectional study using a non traditional SCM was conducted in community pharmacies of Qatar from February 2017 to April 2017. A total of 30 community pharmacies were visited twice by two independent simulated clients and data regarding, provision of evidence -based information, recommendations and counselling practices were collected to assess the competency of pharmacists in managing MERS as a primary care problem. Both descriptive and inferential statistical methods were used for data analysis. In present study, majority of pharmacists encountered were male and younger than 45 -year -old with 44 (73.3%) each. The average number of pharmacists who did not ask about the patient's current medical conditions 56 (93.3), medications 58 (97.5%), allergies, and smoking status in both scenarios were not asked by any of the pharmacist. Most of the pharmacists gave an incorrect explanation of MERS 43 (71.7%). The overall quality counselling score for the pharmacists (mean +/- SD; median (IQR)) was {27.5 +/- 4.5; 28.5 (25.3-30.0)}. Quality counselling was significantly related to the type of pharmacy (p=0.0478). Qatar community pharmacist's MERS related information, recommendations, and counselling practices were below expectations and inconsistent, thus urging the need for continuous professional development

Association between Serum Adiponectin and Insulin Resistance in Children and Adolescents with Type 1 Diabetes: A Cross-Sectional, Single Center Study from Egypt

Objective: To determine the serum level of adiponectin and its relation to insulin resistance (IR) in children andadolescents with type 1 diabetes (T1D). Materials and methods: Over a 3-month period, 65 children diagnosed with T1D who were followed up at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU) at Cairo University Children’s Hospital. Demographics, clinical data, investigations, and management details were collected from the patient’s medical records and evaluated for the serum level of adiponectin. Results: Mean age of the study population was 12.6 ± 2 years. About 40% of participants had low serum adiponectin, with a mean value of 2.4 ± 3.6. Sixty-one (93.8%) of participants had dyslipidemia. The mean estimated glucose disposal rate (eGDR) was 6.9 ± 2.1. Multivariate linear regression was performed to adjust for possible confounders in correlation between serum adiponectin and eGDR; it wasn’t significant asp-value = 0.875. There was a statistically significant difference between patients with normal and low adiponectin regarding the age of diagnosis of diabetes, body mass index, the occurrence of microalbuminuria, and LDL level, with p-values of 0.04, 0.015, 0.022, and 0.011, respectively. Conclusions: There was also an association between lower adiponectin levels in children with type 1 diabetes and the occurrence of microalbuminuria and dyslipidemia. However, there is no reported association between its level and IR

Intervention Study to Upgrade Patient Safety Practices in Pediatric Intensive Care Units of Cairo University Children Hospital

BACKGROUND: The World Health Organization calls patient safety “an endemic concern.†Keeping patients safe is viewed as a global public health problem and a human rights issue. An environment where safety culture prevails is considered the biggest obstacle to improve patient safety. Proactive efforts to identify, prevent, and eliminate errors have the potential to significantly improve safety. Pediatric intensive care unit (PICU) is high-hazard and -risk environments. AIM: The aim of this study is to enhance compliance to patient safety practices within the general PICUs in Cairo University Children’s Hospital. METHODS: This is a pretest-posttest interventional study. A tailored intervention after the baseline assessment was designed and implemented followed by reassessment. All physicians and nurses present in the general PICUs who were available and consented participated in the study. A questionnaire for knowledge and attitude and a checklist for practice assessment of the participants were used. RESULTS: The median age of the participants was 30 years and interquartile range (28–40). There was a statistically significant difference between those who received patient safety training and those who did not in patient safety knowledge. The median knowledge score increased significantly after the intervention. Regarding the attitude of the studied personnel toward their perception of patient safety culture’s dimensions before and after the intervention, there was no statistically significant difference in some dimensions and a statistically significant improvement in some others. CONCLUSION: The strategies based on patient safety awareness-raising among health-care providers together with commitment and enthusiasm among senior leadership in the hospital can potentially improve compliance with practice and consequently lead to better patient safety

Distribution pattern of antibiotic resistance genes in Escherichia coli isolated from colibacillosis cases in broiler farms of Egypt

Background and Aim: Multidrug resistance (MDR) of Escherichia coli has become an increasing concern in poultry farming worldwide. However, E. coli can accumulate resistance genes through gene transfer. The most problematic resistance mechanism in E. coli is the acquisition of genes encoding broad-spectrum β-lactamases, known as extended-spectrum β-lactamases, that confer resistance to broad-spectrum cephalosporins. Plasmid-mediated quinolone resistance genes (conferring resistance to quinolones) and mcr-1 genes (conferring resistance to colistin) also contribute to antimicrobial resistance. This study aimed to investigate the prevalence of antimicrobial susceptibility and to detect β-lactamase and colistin resistance genes of E. coli isolated from broiler farms in Egypt. Materials and Methods: Samples from 938 broiler farms were bacteriologically examined for E. coli isolation. The antimicrobial resistance profile was evaluated using disk diffusion, and several resistance genes were investigated through polymerase chain reaction amplification. Results: Escherichia coli was isolated and identified from 675/938 farms (72%) from the pooled internal organs (liver, heart, lung, spleen, and yolk) of broilers. Escherichia coli isolates from the most recent 3 years (2018–2020) were serotyped into 13 serotypes; the most prevalent serotype was O125 (n = 8). The highest phenotypic antibiotic resistance profiles during this period were against ampicillin, penicillin, tetracycline, and nalidixic acid. Escherichia coli was sensitive to clinically relevant antibiotics. Twenty-eight selected isolates from the most recent 3 years (2018–2020) were found to have MDR, where the prevalence of the antibiotic resistance genes ctx, tem, and shv was 46% and that of mcr-1 was 64%. Integrons were found in 93% of the isolates. Conclusion: The study showed a high prevalence of E. coli infection in broiler farms associated with MDR, which has a high public health significance because of its zoonotic relevance. These results strengthen the application of continuous surveillance programs

Genomic characterization of SARS-CoV-2 in Egypt: insights into spike protein thermodynamic stability

The overall pattern of the SARS-CoV-2 pandemic so far has been a series of waves; surges in new cases followed by declines. The appearance of novel mutations and variants underlie the rises in infections, making surveillance of SARS-CoV-2 mutations and prediction of variant evolution of utmost importance. In this study, we sequenced 320 SARS-CoV-2 viral genomes isolated from patients from the outpatient COVID-19 clinic in the Children’s Cancer Hospital Egypt 57357 (CCHE 57357) and the Egypt Center for Research and Regenerative Medicine (ECRRM). The samples were collected between March and December 2021, covering the third and fourth waves of the pandemic. The third wave was found to be dominated by Nextclade 20D in our samples, with a small number of alpha variants. The delta variant was found to dominate the fourth wave samples, with the appearance of omicron variants late in 2021. Phylogenetic analysis reveals that the omicron variants are closest genetically to early pandemic variants. Mutation analysis shows SNPs, stop codon mutation gain, and deletion/insertion mutations, with distinct patterns of mutations governed by Nextclade or WHO variant. Finally, we observed a large number of highly correlated mutations, and some negatively correlated mutations, and identified a general inclination toward mutations that lead to enhanced thermodynamic stability of the spike protein. Overall, this study contributes genetic and phylogenetic data, as well as provides insights into SARS-CoV-2 viral evolution that may eventually help in the prediction of evolving mutations for better vaccine development and drug targets

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

Feminizing adrenal tumor in a 6-year-old boy

A 6-year-old boy presented with bilateral gynecomastia and breast tenderness. The condition started since 1 year before medical consultation with gradual onset and progressive course of breast enlargement and accelerated growth with no history of any nipple discharge. There was no history of drug intake or chronic diseases. Investigations showed picture of pseudo precocious puberty with advanced bone age, suppressed LH, FSH and high estradiol (E2). Adrenal precursors (17 OHP, Δ4 A, DHEA, DHEAS) were normal with normal testosterone, cortisol, ACTH. Scrotal U/S was normal while, abdominal U/S revealed right sided hypo echoic supra renal rounded solid mass. Abdominal multi-slice CT with contrast was done and revealed a well-defined hypo dense right adrenal mass with heterogeneous enhancement in the post contrast study showing attenuation of about 25 HU in precontrast and 111 HU in post contrast which makes the mass suspicious of malignancy. Chest X-ray was normal with no lymphadenopathy or pulmonary infiltrates. The diagnosis of feminizing adrenal neoplasm was confirmed and laparoscopic right adrenalectomy was done. Microscopic examination was done after excision and revealed a picture of adrenocortical adenoma with distinct cell borders with no vascular or capsular invasion. The hormonal profile was repeated after 2 weeks of adrenalectomy and revealed normal levels of estradiol (E2), adrenal precursors, FSH and LH. Adrenal tumors can be functional presenting with virilization, Feminization, or Cushing’s syndrome. Feminizing adrenal tumors are rare tumors especially in pediatrics, but should be excluded in cases presented with gynecomastia. The differentiation between benign and malignant tumors may be difficult

Effect of insulin glargine on glycemic control in adolescents with type 1-diabetes

AbstractBackgroundAdolescence is a transitional phase characterized by multiple physiological and psychosocial factors that make glycemic control more difficult, and often results in hyperglycemia and/or hypoglycemia-related emergencies, and increases the risk of chronic complications. Insulin analogs were introduced with the aim of overcoming such difficulties.ObjectiveTo study the role of long acting insulin analog (insulin glargine) in glycemic control of adolescents with poorly controlled type 1 diabetes who suffer from frequent hypoglycemic attacks and marked glucose variability, and to compare its effectiveness and cost versus intermediate acting insulin (NPH) in a country with limited resources like Egypt.Subject and methodA non-randomized open label treat to target trial that included twenty-nine adolescents (10–18years), with T1DM. They were on MDI regimen. All had unsatisfactory glycemic control with frequent hypoglycemia and/or recurrent glucose excursions. All were shifted from twice daily NPH to single bedtime injection of insulin glargine (Lantus), and followed up for a minimum period of 6months.ResultsSwitching to insulin glargine was associated with a statistically significant reduction in attacks of hypoglycemia and DKA (p<0.001), but with insignificant reduction in HbA1c (p=0.9). BMI showed a significant increase (p=0.004), as well as the cost of basal insulin as glargine compared to NPH.ConclusionThe present study encourages the use of insulin glargine in the presence of significant hypoglycemia and glucose variability, with close monitoring of diet and weight. Cost effectiveness and effect on HbA1c and quality of life need further longitudinal studies with larger numbers

The effect of receiving thyroid hormone replacement on the dysphonia severity index for congenital hypothyroid children

Abstract Objectives Dysphonia is a common compliant in hypothyroid patients. Subjective voice changes could be clearly found in congenital hypothyroid children (CHC); however, the early treated children with thyroid hormone replacement (THR) may not experience dysphonia. The objective of this study is to determine if the CHC who were receiving early THR would have objectively measurable changes on vocal function as assessed by the dysphonia severity index (DSI). Methods Participants were 29 children aged from 6 to 12 years. Fifteen children had congenital hypothyroidism on eltroxin therapy started before the age of 1 year and 14 were typically developing children (TDC). All children did not have voice compliant. DSI was calculated for all children through the measure of maximum phonation time (MPT), highest frequency (F0-high), lowest intensity (I-low), and jitter percent (j %). Results CHC receiving early THR were not significantly different from TDC on DSI value; however, both groups showed significant difference on MPT and F0-high. Degree of voice changes by DSI in males was significantly higher than females in CHC on eltroxin therapy while no significant difference regarding gender has been found on DSI in TDC. Conclusions The results suggested that there is no evidence of DSI objective voice changes in CHC receiving THR compared to TDC, yet separate objective voice measures alternations had been found in CHC. This highlights the importance of achieving efficient neonatal screening programs for CHC and providing strong support to initiate early THR to avoid any alternation of laryngeal function