Carotid Intima-Media Thickness in Children with Overweight/Obesity: A Single-center Study

Our study aimed to assess Carotid artery Intima-Media Thickness (CIMT) in a group of children with overweight/obesity as a good predictor for atherosclerosis.We included 39 prepubertal children with Body Mass Indexes (BMI) above 85% for age and sex; 23% overweight, and 77% obese. Twenty matched non-obese healthy children were enrolled to compare CIMT results. About 44% of the cases had abnormal blood pressure, ~39% had dyslipidemia, and ~74% had an unhealthy metabolic state.We observed higher CIMT in cases than controls, with no significant difference between overweight and obese status (at a confidence interval of 95% and P < 0.05). CIMT was positively associated with the BMI of the whole study group, and with HC and triglyceride in the children with obesity. CIMT was significantly higher among children with overweight/obesity than in average weight children, regardless of their metabolic status or blood pressure stage

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

A New Mixed Signal Platform to Study the Accuracy/Complexity Trade-Off of DPD Algorithms

International audienceThe increase in bandwidth of Power Amplifier (PA) input signals has led to the development of more complex behavioral PA models. Most recent models such as the Generalized Memory Polynomial (1) or the Polyharmonic distortion modeling (2) can be used to design very performant but complex and thus very consuming Digital Predistortion algorithms (DPDs). On the other hand, with earlier simpler models, the precision of the DPD may not be enough. The model order is also the major factor influencing the requirements in terms of bandwidth and dynamic range of the digitized signal in the feedback loop of a typical Power amplification system architecture: the higher the order, the more information is needed for identification. This paper describes a new mixed signal simulation platform developed to study the complexity vs. accuracy trade-off from the DPD point of view. The platform estimates the accuracy of the DPD and the power consumption (including the consumption of the DPD itself) of the whole feedback loop, by comparing various PA models with various DPDs algorithms. Contrary to older works, measuring the accuracy on the open loop without DPD and estimating the complexity in theoretical number of operations, our goal is to be able to estimate with precision the performances and the power consumption of the whole amplification system (PA + DPD + DAC + feedback loop) for optimization of DPD algorithms

The Impact of Educational Sessions on Anxiety Levels among Women Undergoing Caesarean Section: A Quasi-Experimental Study

Although the Caesarean section (CS) is considered a harmless surgery, it has various complications. Women scheduled for elective CSs often have high levels of anxiety due to a lack of knowledge. The aim of this quantitative quasi-experimental study was to determine the relationship between preoperative educational sessions and anxiety levels among women undergoing CSs. The study was conducted at the antenatal unit in the King Faisal Medical Complex (KFMC) in Taif, Saudi Arabia, using a structured interview questionnaire, the State–Trait Anxiety Inventory (STAI), and satisfaction interviews. A total of 50 pregnant women participated in this study, who were divided into two groups: 25 participants in the intervention group and 25 in the control group. Most participants (92%) in the intervention group had low anxiety levels following educational sessions, and 96% of the participants were very satisfied with the preoperative information they had been given. Women in the control group (again, 92%) had high anxiety levels, and there was a significant difference in the anxiety levels of the intervention and control groups (p ≤ 0.5) after the educational sessions. Providing proper preoperative education about CSs can reduce preoperative anxiety, improve patient outcomes, and enhance patients’ involvement in their care and decision-making

Neurophysiological evaluation of juvenile systemic lupus erythematosus

Abstract Background Peripheral nervous system and the central nervous system involvement in systemic lupus erythematosus (SLE) patients are one of the major causes of morbidity and mortality. The aim of this work was to study the nervous system clinically and electrophysiologically in children with systemic lupus erythematosus. Results The study was carried out on thirty-eight children with SLE. Their age ranged from 5 to 16 years. The most encountered neurologic manifestations were tremors. It was observed in 47.4% of children, followed by headache in 39.5%, sensory manifestation as numbness in 23.7%, cerebrovascular stroke in 5.3%, and chorea in 2.6%, which was unilateral mostly in the upper limb, tics, and convulsion had the same percentage. Around 16% of children had positive findings in MRI, such as cerebrovascular disease, minimal hematoma, pseudotumorcerebri, vasculitis, and ectatic ventricles. Subclinical peripheral neuropathy was reported in nearly 52.6% of children, and clinical peripheral neuropathy was reported in 23.6%. Pure sensory subclinical peripheral neuropathy was detected in 13.1% of children, but mixed subclinical peripheral neuropathy was detected in 39.4%. Nearly 53% of studied children had an abnormal somatosensory-evoked potential study of posterior tibial and median nerves. Conclusion The current study reported that the clinical neurological manifestations in juvenile SLE is common. Peripheral neuropathy is commonly detected, which could be either clinical or sub-clinical. Somatosensory evoked potential study is of value for early detection of central affection. So, we recommend more studies to determine the guidelines when to order these informative investigations for children with JSLE

Effect of Comprehensive Nursing Interventions on Quality of life among Women with Stress Urinary Incontinence

Stress Urinary Incontinence (SUI) is called a silent epidemic which is not a life threatening condition, but a worldwide problem at the same time which contributes to poor quality of life. Aim: Design, implement comprehensive nursing interventions for adult women with stress urinary incontinence and evaluate the effect of these interventions on improving their quality of life. Quazi experimental research design was utilized to conduct this study. This study was carried out in the Urology and Nephrology Assuit University Hospital and its affiliate Clinic. A sample of 50 adult women, the mean age of studied patients was (42.22±11.84). Two tools were used by the researcher namely: Tool I: A structured interview questionnaire sheet it included two parts, part i: demographic data of patient and part ii: medical&amp; urological data assessment. Tool II: Kings Health Questionnaire (KHQ), it is a standardized questionnaire used to assess the impact of stress urinary incontinence on quality of life. The results showed that the quality of life among adult women with stress urinary incontinence were improved after the implementation of comprehensive nursing interventions with a statistically significance difference (p&gt;0.05) in all quality of life domains. . We conclude that provided comprehensive nursing interventions are effective in improving QOL in adult women with SUI. Given the study results, it is recommended that expand of public education efforts through various methods about importance of health educational interventions for appropriate management of stress urinary incontinence among women

Atherosclerosis in Egyptian patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a systemic inflammatory disorder with extra-articular features including cardiovascular diseases. Objective The objective of this study was to assess the presence of atherosclerosis in Egyptian patients with AS and its relation to disease activity. Patients and methods Thirty patients with AS of at least 18 years of age and 30 age-matched and sex-matched controls were included. Assessment of medical history, clinical examinations, and assessment of AS disease activity using BASDAI, BASMI, and BASFI as well as dobutamine echocardiography were performed only for patients. Complete blood count, ESR, C-reactive protein, lipid profile, serum von Willebrand factor (vWF) Ag level by ELISA, ECG, and carotid duplex were performed for all participants. Results In patients, 11 had active disease and 19 were in remission. A hypertensive response (HTNR) appeared in eight patients; six of them had active disease. There was a significant increase in the level of vWF in actively diseased patients than inactive patients and controls. Carotid intima-media thickness (IMT) was significantly increased in AS patients than controls. Levels of low-density lipoprotein were significantly higher in AS patients than the controls and in AS patients receiving biologics than those not receiving biologics. In the inactive group, vWF and IMT were significantly increased in patients receiving biologics. vWF correlated positively with BASDI, BASMI, BASFI scores, ESR, and carotid IMT and negatively with high-density lipoprotein. Conclusion Patients with AS are more susceptible to atherosclerosis, which is related to disease activity, and receiving biologics may place them at a higher risk. vWF, as a useful marker of atherosclerosis in AS patients, was correlated positively with disease activity scores and IMT

Effectiveness of probiotics and clove essential oils in improving growth performance, immuno-antioxidant status, ileum morphometric, and microbial community structure for heat-stressed broilers

Abstract Recently, interest has increased in using bio-additives, herbs, and their extracts as feed additives because of their potential role in improving chick's health and productivity, especially during stress. Thus, our aim in this study is to examine whether nutritional supplementation (probiotics and clove essential oils) will help mitigate the negative effect of heat stress on the bird by modifying the microbial content, boosting immunity, oxidative status, metabolic, and growth. In this study, three hundred one-day-old broiler chicks (Ross 308) were fed the following experimental diet: (CON) basal diet (control diet); (CEO) CON with clove essential oils (300 mg/kg); (PRO) CON with probiotics (2 g/kg); (PC) CON with probiotics and clove essential oils. Our results showed a significant improvement (P < 0.05) in body weight gain, feed conversion ratio, nutrient digestibility, and digestive enzymes activities in broilers fed on PC, CEO, and PRO compared to the control group. Moreover, a significant decrease was recorded in the abdominal fat content and an increase in the relative weight of bursa of Fabricius, and higher antibody levels against Newcastle disease virus, as well as, there was an increase (P < 0.05) in interleukin 10 (IL-10) in all treated groups. Meanwhile, there was a decrease in tumor necrosis factor-α (TNF-α) in all supplemented groups compared with the control group. Serum triglycerides, cholesterol, low-density lipoprotein concentrations, and alanine aminotransferase activities were significantly lower in the treated groups. Superoxide dismutase and glutathione peroxidase levels were elevated (P < 0.05) and the malondialdehyde level value significantly decreased in all supplemented groups. The treated groups enhanced the ileum structure by increasing Lactobacillus, decreasing E. coli, and improving the morphometrically (P < 0.05). This study strongly suggests that clove essential oil and probiotic mixture can be used as a feed supplement to reduce the effects of heat stress by improving the growth performance and enhancing immuno-antioxidant status, ileum morphometric, as well as modifying the microbial community structure of the ileum of broilers