Serum Amyloid A Level in Egyptian Children with Familial Mediterranean Fever

Background and Objectives. SAA is an acute-phase reactant detected during an FMF attack or other inflammatory conditions. High SAA levels may increase the risk of amyloidosis. The aim of the study is to measure the serum amyloid A (SAA) level in a group of Egyptian children with familial Mediterranean fever (FMF) and study its various correlates, if any. Methods. The study enrolled seventy-one children with FMF. Results. SAA level was high in 78.9% of the studied patients with a mean of 81.62±31.6 mg/L, and CRP was positive in 31% of patients. There was no significant releation between SAA level and any demographic or clinical manifestation. High SAA was more frequent in V726A allele (16.9%) followed by M694V allele (12.3%). Elevated SAA levels were more frequent in patients on low colchicine doses. Forty-five percent (45%) of patients have low adherence to colchicine therapy. Interpretation and Conclusion. High SAA levels were detected two weeks after last FMF attack in a large percentage of Egyptian FMF children. This indicates that subclinical inflammation continues during attack-free periods, and SAA could be used as a marker of it

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

Mean Platelet Volume and Splenomegaly as Useful Markers of Subclinical Activity in Egyptian Children with Familial Mediterranean Fever: A Cross-Sectional Study

Objective. To study whether mean platelet volume (MPV) and splenomegaly could be used as subclinical inflammatory markers in children with familial Mediterranean fever (FMF) at the attack-free period. Patients and Methods. The study included ninety-seven children with FMF. MPV was carried out within 4 hours of blood sampling according to standard laboratory practice. Splenomegaly was determined by abdominal ultrasound (USG). Results. High MPV was detected in 84.45% of our studied patients and was significantly higher in FMF patients with splenomegaly than in patients without splenomegaly. There was a statistically significant correlation between MPV and splenic span (P=0.045). Conclusion. Elevated MPV and its significant correlation with splenic span in FMF children during the attack-free periods support the use of MPV and splenomegaly as useful markers of the subclinical inflammation in FMF patients at the attack-free period

Evaluation of hearing in familial Mediterranean fever children

Aim of the work: Familial Mediterranean fever (FMF) is the most prevalent monogenic auto-inflammatory illness worldwide. It is characterised by periods of self-limiting fever and polyserositis, including pleuritis as well as peritonitis. This study attempted to assess hearing in paediatric FMF patients on colchicine treatment. Patients and methods: A hundred children with FMF (7–18 years old) (male/female: 43/57) were recruited. Audiological assessments were performed for all patients, including transient-evoked otoacoustic emission (TEOAE), tympanometry, as well as pure-tone audiometry (PTA) tests. Severity score, response to treatment and type of MEFV gene mutation were assessed. Results: The mean age of patients was 11 ± 3 years and disease duration 7.1 ± 2.7 years. Fourteen patients were normal in all audiological tests, whereas 86 patients had impaired hearing (Sensorineural hearing loss (SNHL) in one or both ears). PTA results were normal in 23 patients and bilaterally impaired in 50 patients and unilaterally impaired in 27 patients. TEOAE results showed that 37 patients had a bilateral pass test, nine patients had a unilateral pass test, 11 patients had a bilateral partial pass test, eight patients had a unilateral partial pass test, and 40 patients had a bilateral fail test, and seven patients had a unilateral fail test. The patients were 22 % homozygous, 52 % heterozygous, and 26 % compound heterozygous. M694I was the most prevalent allele (32 %) in the current study. There were no statistically substantial correlations between audiological parameters and other variables. Conclusions: Children with FMF seem to have an increased risk of hearing impairment due to the affection of cochlear functions

Evaluating Galectin-3 (LGALS3) +191 gene variant and serum Galectin-3 levels in Egyptian children with familial mediterranean fever

Background: The most important and devastating complications of Familial Mediterranean fever (FMF) is renal amyloidosis, usually affecting the kidneys leading to end stage renal failure. FMF- related renal amyloidosis needed to be diagnosed early. Optimal colchicine dose is effective in prevention and reversing renal amyloidosis. Aim of the work: to evaluate serum galectin-3 level and its gene polymorphism (LGALS3 191 C&gt;A) as a marker of proteinuria and subclinical inflammation in Egyptian children and adolescents with FMF. Methods: Fifty FMF patients in attack free period and 40 healthy children were included as a control group. Serum levels of galectin-3 were measured, Galectin-3 (LGALS3) c.191 C&gt;A (rs4644) gene variant was investigated and morning spot urine was collected for determination of albumin / creatinine ratio (ACR). Results: Serum Galectin-3 levels were significantly higher in FMF patients than control group, P &lt; 0.03. Regarding genotype and allele distribution of (LGALS3) c. 191 C&gt;A polymorphism there was statistical significant difference between cases and control, 13 patients (42%) had CC and the remaining 37 patients (63%) were CA. The control had 18 child (58%) with CC compared to 22 child with CA (37%) and BUN level was higher among CC type of Galectin-3 (LGALS3) c.191 C&gt;A

Evaluating galectin-3 (LGALS3) +191 gene variant and serum galectin-3 levels in Egyptian children with familial Mediterranean fever

Background: The most important and devastating complications of Familial Mediterranean fever (FMF) is renal amyloidosis, usually affecting the kidneys leading to end stage renal failure. FMF- related renal amyloidosis needed to be diagnosed early. Optimal colchicine dose is effective in prevention and reversing renal amyloidosis. Aim of the work: to evaluate serum galectin-3 level and its gene polymorphism (LGALS3 191 C&gt;A) as a marker of proteinuria and subclinical inflammation in Egyptian children and adolescents with FMF. Methods: Fifty FMF patients in attack free period and 40 healthy children were included as a control group. Serum levels of galectin-3 were measured, Galectin-3 (LGALS3) c.191 C&gt;A (rs4644) gene variant was investigated and morning spot urine was collected for determination of albumin / creatinine ratio (ACR). Results: Serum Galectin-3 levels were significantly higher in FMF patients than control group, P &lt; 0.03. Regarding genotype and allele distribution of (LGALS3) c. 191 C&gt;A polymorphism there was statistical significant difference between cases and control, 13 patients (42%) had CC and the remaining 37 patients (63%) were CA. The control had 18 child (58%) with CC compared to 22 child with CA (37%) and BUN level was higher among CC type of Galectin-3 (LGALS3) c.191 C&gt;A.&nbsp

Demographic data of Egyptian juvenile systemic lupus erythematosus during COVID-19 pandemic: A single centre study

Background: Juvenile Systemic lupus erythematous is a chronic autoimmune inflammatory disease that causes damage to various organs such as kidneys, blood, musculoskeletal and nervous system. SLE is variable ranging From mild to severe with unpredictable course of the disease and periods of remission and flares. Methods : The study included 67 patients diagnosed as having jSLE according to the&nbsp; Systemic Lupus International Collaborating Clinics(SLICC) for whom demographic data , full history and laboratory investigations were collected. Results: Among our study population were&nbsp; 13.4%males&nbsp; and&nbsp; 86.6% females&nbsp; with male to female ratio (1:6.4 ). Their mean age was 10.94±3&nbsp; years. Most of our patients were from Giza (43.3%) followed by Cairo (22.4%). C3 and C4 were consumed in&nbsp; 74.6%&nbsp; of patients, proteinuria was present in 73.1% of patients , hematuria was present in 25.4% of patients. ANA was positive in 98.5%&nbsp; of patients at the time of diagnosis&nbsp; while antiDNA was positive in 85.1%. Conclusion: Juvenile systemic lupus erythematosus is not uncommon in Egypt with female predominance as known worldwide but younger age of onset of the disease. During COVID 19 pandemic follow up was limited due to fear of infection

NuCLS: A scalable crowdsourcing, deep learning approach and dataset for nucleus classification, localization and segmentation

High-resolution mapping of cells and tissue structures provides a foundation for developing interpretable machine-learning models for computational pathology. Deep learning algorithms can provide accurate mappings given large numbers of labeled instances for training and validation. Generating adequate volume of quality labels has emerged as a critical barrier in computational pathology given the time and effort required from pathologists. In this paper we describe an approach for engaging crowds of medical students and pathologists that was used to produce a dataset of over 220,000 annotations of cell nuclei in breast cancers. We show how suggested annotations generated by a weak algorithm can improve the accuracy of annotations generated by non-experts and can yield useful data for training segmentation algorithms without laborious manual tracing. We systematically examine interrater agreement and describe modifications to the MaskRCNN model to improve cell mapping. We also describe a technique we call Decision Tree Approximation of Learned Embeddings (DTALE) that leverages nucleus segmentations and morphologic features to improve the transparency of nucleus classification models. The annotation data produced in this study are freely available for algorithm development and benchmarking at: https://sites.google.com/view/nucls

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe