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

Evaluation of the microbial community, acidity and proximate composition of akamu, a fermented maize food

Abstract BACKGROUND Akamu is a lactic acid-fermented cereal-based food that constitutes a major infant complementary food in most West African countries. The identities of LAB populations from DGGE analysis and conventionally isolated LAB and yeasts from traditionally fermented akamu were confirmed by PCR sequencing analysis. The relationships between pH, acidity and lactic acid levels and proximate composition of the akamu samples were investigated. RESULTS The LAB communities in the akamu samples comprised mainly Lactobacillus species, including Lb. fermentum, Lb. plantarum, Lb. delbrueckii ssp. bulgaricus and Lb. helveticus, as well as Lactococcus lactis ssp. cremoris. Identified yeasts were Candida tropicalis, Candida albicans, Clavispora lusitaniae and Saccharomyces paradoxus. Low pH (3.22–3.95) was accompanied by high lactic acid concentrations (43.10–84.29 mmol kg−1). Protein (31.88–74.32 g kg−1) and lipid (17.74–36.83 g kg−1) contents were negatively correlated with carbohydrate content (897.48–926.20 g kg−1, of which ≤1 g kg−1 was sugars). Ash was either not detected or present only in trace amounts (≤4 g kg−1). Energy levels ranged from 17.29 to 18.37 kJ g−1. CONCLUSION The akamu samples were predominantly starchy foods and had pH < 4.0 owing to the activities of fermentative LAB. © 2013 Society of Chemical Industr

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

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Tip 1 Diabetes Mellitus Tanılı Hastalarda Kas Gücü Ve Mimarisinin Değerlendirilmesi

Bu çalışma T1D hastalarında kas kuvveti ve mimarisini değerlendirmek amacıyla yapıldı. lt grup analizlerinde ise T1D süresi, Hb 1C düzeyi, mikrovasküler komplikasyonların ve insülin kullanma yönteminin kas kuvveti ve mimarisi üzerine olan etkisi araştırıldı. Çalışmaya T1D tanısı olan 32 hasta (23 kadın, 9 erkek) ile yaş, cinsiyet, boy, kilo, fiziksel aktivite düzeyi yönünden eşleştirilmiş 31 sağlıklı gönüllü (22 kadın, 9 erkek) dahil edildi. Her iki grupta ayrıntılı lökomotor ve nörolojik sistem muayeneleri yapıldı, IP Q kullanılarak fiziksel aktivite düzeyi belirlendi. T1D ve kontrol grubunda ultrasonografik olarak dominant ekstremite kuadriseps femoris kas kalınlıkları (RF, VI, VM, VL) ile pennat açı (VI, VM, VL) ölçümleri yapıldı. Daha sonra her iki grupta 60 /sn ve 180 /sn açısal hızlarda izokinetik dinamometre sistemi kullanarak kas kuvveti değerleri ölçüldü. T1D grubunda cinsiyet, yaş, boy, kilo, fiziksel aktivite düzeyi yönünden benzer kontrol grubuna kıyasla 60º/sn açısal hızda fleksiyon ve ekstansiyon pik tork ölçümlerinde istatistiksel olarak anlamlı fark saptandı (p0,05). T1D grubu insülin alınma yöntemine göre alt gruplara ayrıldığında insülin pompası kullanan grupta, subkutan insülin kullanan gruba göre RF, VI, VM kas kalınlıkları istatistiksel olarak anlamlı derecede daha büyüktü (p<0,05). T1D hasta 120 grubunda mikrovasküler komplikasyonu olan hastaları çıkarıp kontrol grubu ile kıyasladığımızda elde edilen izokinetik ve ultrasonografik parametreler yine aynı şekilde T1D grubunda anlamlı derecede daha düşüktü (p<0,05). Bu sonuçlar T1D hasta grubunda kas kuvveti ve mimarisinin olumsuz yönde etkilendiğini, insülin eksikliğinin sarkopeni için bir risk faktörü olduğunu ve bunun ultrasonografik olarak gösterilebileceğini desteklemektedir. yrıca bu sonuçlara göre insülin pompası kullanımının subkutan insülin kullanımına göre diabetik miyopati açısından daha olumlu etkilerinin olduğu ve diabetik miyopatinin, diğer diabetik komplikasyonlardan bağımsız olarak geliştiği söylenebilir.This study was performed to evaluate muscle strength and architecture in T1D patients. In subgroup analyzes, the effects of T1D duration, HbA1C level, microvascular complications and insulin use method on muscle strength and architecture were investigated. 32 T1D patients (23 females, 9 males) and 31 healthy volunteers (22 females, 9 males) matched for age, sex, height, weight, and physical activity level were included in the study. Detailed leukomotor and neurological system examinations were performed in both groups and physical activity level was determined using IPAQ. The dominant extremity quadriceps femoris muscle thickness (RF, VI, VM, VL) and pennate angle (VI, VM, VL) were measured ultrasonographically in T1D and control groups. Then, muscle strength values were measured in both groups at 60/sec and 180/sec angular velocities using isokinetic dynamometer system. In T1D group, statistically significant difference was found in flexion and extension peak torque measurements at 60º/sec angular velocity compared to similar control group in terms of gender, age, height, weight, physical activity level (p 0.05). When T1D group was subdivided according to insulin uptake method, RF, VI, VM muscle thickness was significantly higher in the insulin pump group compared to the subcutaneous insulin group (p <0.05). When we compared patients without 122 microvascular complications in T1D group with control group, isokinetic and ultrasonographic parameters likewise were significantly lower in T1D group (p <0.05). These results support that muscle strength and architecture are negatively affected in T1D patients, insulin deficiency is a risk factor for sarcopenia and this can be demonstrated by ultrasonography. Also according to these results, it can be said that insulin pump use has more positive effects in terms of diabetic myopathy than subcutaneous insulin use and that diabetic myopathy develops independently from other diabetic complications

John F. Kennedy Caddesi tarihi ve önemi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2014.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Öztürk, İbrahim Mert

Hypermobility Frequency in School Children: Relationship With Idiopathic Scoliosis, Age, Sex and Musculoskeletal Problems.

This study aims to assess the prevalence of generalized joint hypermobility (GJH) in school children in relation to scoliosis and to identify musculoskeletal problems

Hypermobility Frequency in School Children: Relationship With Idiopathic Scoliosis, Age, Sex, and Musculoskeletal Problems

Objectives: This study aims to assess the prevalence of generalized joint hypermobility (GJH) in school children in relation to scoliosis and to identify musculoskeletal problems. Patients and methods: This cross-sectional study included 822 school children (413 males, 409 females; mean age 12.2 +/- 1.3 years; range, 10 and 15 years). Demographic characteristics of all children were recorded. The presence of GJH was assessed by the Beighton score (>= 4 was considered joint hypermobility). Scoliosis screening consisted of forward bend test (FBT) and measurement of angle of trunk rotation (ATR). Positive FBT or ATR was >= 5 degrees referred to a portable X-ray device. The presence of musculoskeletal complaints was determined by a questionnaire. Results: Children's body mass index (BMI) was 19.6 +/- 4.1. GJH was diagnosed in 151 subjects (18.4\%). No significant association was detected between sex and hypermobility. Joint hypermobility was inversely correlated with age and BMI. Scoliosis was found in 43 subjects (5.2\%) and all of them except one girl had mild scoliosis. The most common scoliosis pattern was a single left thoracolumbar curve. Seventy-three subjects (8.9\%) had Cobb angle under 10 degrees, with a potential for progression. Among subjects having GJH, the most common clinical finding was pes planus (34.3\%) and the most common clinical symptom was ankle sprain 31.3\%). Conclusion: Similar to that found in children from many countries, GJH is a common clinical condition in Turkish children. GJH should be assessed in the differential diagnosis of adolescents with musculoskeletal complaints for effective treatment and reducing morbidity. GJH should be considered in adolescents with scoliosis, which may be an important aspect treatment