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

A Comparative Study of Al and Bi Addition in the Transparent Conductive ZnO Thin Films Prepared by Spray Ultrasonic Method

Zinc oxide (ZnO) is a binary semiconductor material with direct band gap (3,3 eV) because of their good optoelectronics properties. ZnO thin films find several applications such as: solar cells, gas sensors, piezoelectric sensors, waves guides. ZnO thin films can be prepared by several techniques: spray paralysis, thermal evaporation, reactive sputtering, sol gel, laser ablation. In this present work and in order to obtain conducting transparent layers, ZnO thin films were deposited by ultrasonic spray technique on glass and silicon substrates. The investigate is focused on the doping level influence of the structural, optical and electrical properties of ZnO thin films. Two dopants were used Bismuth and Aluminium. In the starting solution Bismuth and Aluminium where used with a variation of the doping rate from 0 to 5 % mol . X-ray diffraction patterns confirm that all films are crystalline and the preferred orientation depends on the dopant nature and concentration. The optical characterization of deposited films was carried out using UV-Vis spectrometry in the spectral range 200-800 nm. The analysis of the transmittance spectra allows us to deduce the film thicknesses optical band gaps, and Urbach energy. Hence, the values of the gap were found to be between 3.19 to 3.31 eV. The electrical measurements were made using the two points technique. From the results, we concluded that the electrical conductivity of doped ZnO layers is higher than that of undoped layers and the effect of Bismuth was more pronounced on the evolution of the conductivity than Aluminium

Spatial and temporal assessment of metals contamination in the surface sediments of biogenic intertidal reefs of Sabellaria alveolata (Annelida: Polychaeta) from Essaouira protected coastal area (Atlantic coast of Morocco)

In the present study, we assessed the spatial and temporal distributions of metal contents and their environmental risks in the surface sediments from Essaouira protected coastal area (Atlantic coast of Morocco). Surface sediment samples of the biogenic reefs of Sabellaria alveolata (Annelida: Polychaeta) were collected seasonally, and the fine fraction ( Fe > Zn > Cr > Cu > Pb > Cd. Concentrations were lower than mean Earth crustal contents and world average background levels except for Cd. Spatial and temporal variations of metals were highly significant, and largely determined by geochemical background properties and inputs of terrigenous material except for Cd which was associated with upwelling phenomena. Comparison with sediment quality guidelines (SQGs) and ecotoxicological values indicated few exceedances with regard to most metals except for Cd, Cr and Cu. Consequently, the dredged sediment may be dumped at sea with little likelihood of adverse biological effects. However, some sediments had a moderately high Cd content, especially during summer and warrant more detailed assessment

Combination of partial situs inversus, polysplenia and annular pancreas with duodenal obstruction and intestinal malrotation

Situs inversus is a challenge to the physician, both for the diagnostic and for the therapeutic. A combination of partial situs inversus, annular pancreas and polysplenia with bowel malrotation has been reported in a newborn who presented as duodenal obstruction. Situs inversus is rare especially without heart malformation. All the abnor - malities in this combination can be explained on the basis of multiple organ malrotation. It also demonstrates the necessity of meticulous investigation and precise description of the anomaly as far as the management of this case is concerned