Pertussis seroimmunity in mother-neonate pairs and other pediatric age groups from Egypt

Background: Despite the widespread availability of 2 classes of effective vaccines, whole cell and acellular, pertussis has resurged as a serious public health problem. We sought to investigate the pertussis immune status of mother-neonate pairs and children in our country where pertussis vaccination is obligatory. Methods: This cross-sectional study included 75 healthy full-term neonates and their mothers, 100 infants (2-24 months), 170 children (2-12 years) and 80 adolescents (12-18 years). Serum pertussis IgG was measured in all enrolled subjects. A positive titre was defined as >24 U/ml. Results: Positive pertussis IgG levels were detected in 69 of the mothers (92%), in 63 of their newborns (84%). Seroimmunity to pertussis was positively noted in 55% of infants, 82.2% of preschool children, 77.5% of school-aged children and 75% in adolescents. Serum pertussis IgG titers among the neonates showed a significant positive correlation with the maternal titers (P=0.00001). Higher rates of pertussis seroimmunity was observed among residents in urban and suburban areas as compared to those living in rural areas (P<0.05) . Conclusion: This pilot study may suggest the presence of sufficient pertussis seroimmunity rates in the studied age groups. Still, there were some failures in immune acquisition probably due to inefficient vaccination in some localities or waning of immunity with age. Wider scale studies would allow better insight into the pertussis immune status in our country and hence the need for booster immunization

A Secure and Lightweight Three-Factor Remote User Authentication Protocol for Future IoT Applications

With the booming integration of IoT technology in our daily life applications such as smart industrial, smart city, smart home, smart grid, and healthcare, it is essential to ensure the security and privacy challenges of these systems. Furthermore, time-critical IoT applications in healthcare require access from external parties (users) to their real-time private information via wireless communication devices. Therefore, challenges such as user authentication must be addressed in IoT wireless sensor networks (WSNs). In this paper, we propose a secure and lightweight three-factor (3FA) user authentication protocol based on feature extraction of user biometrics for future IoT WSN applications. The proposed protocol is based on the hash and XOR operations, including (i) a 3-factor authentication (i.e., smart device, biometrics, and user password); (ii) shared session key; (iii) mutual authentication; and (iv) key freshness. We demonstrate the proposed protocol’s security using the widely accepted Burrows–Abadi–Needham (BAN) logic, Automated Validation of Internet Security Protocols and Applications (AVISPA) simulation tool, and the informal security analysis that demonstrates its other features. In addition, our simulations prove that the proposed protocol is superior to the existing related authentication protocols, in terms of security and functionality features, along with communication and computation overheads. Moreover, the proposed protocol can be utilized efficiently in most of IoT’s WSN applications, such as wireless healthcare sensor networks

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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<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<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. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit