Can montelukast correct immune dysregulation in preschool children with mild persistent asthma?

Background: Asthma is the most common inflammatory disorder among preschool and school-age children. Regulation of immune cells and their cytokines is essential to control asthma. Montelukast is a leukotriene receptor antagonist that suppresses inflammatory cell proliferation, and reduces cytokines and mediator secretion. Objective: The research team's goal was to study the immunological parameters among mild  asthmatic patients before and after the treatment with Montelukast. Methods: Forty preschool children with mild persistent asthma and twenty healthy, non-allergic children were included in the study. Blood eosinophil count, total IgE, serum IL-4, IL-10, and IL-13 levels were  assessed. T helper (CD3+CD4+) and T regulatory (CD4+CD25+) cell counts were measured using flow cytometry; for mild asthmatics before and after six weeks of treatment with Montelukast and for the control group. Results: Asthmatic children have shown a significant elevation of serum levels of IgE, IL4 and IL13, and also an increase of eosinophils, total lymphocyte T cells and T helper cell count. However; serum levels of IL10 and Treg cell count was lower in asthmatics compared to control. Following six weeks of Montelukast treatment, all immunological parameters improved. There was a significant elevation of serum levels of IL10 and Treg cell count, with a decrease in serum levels of IgE, IL4 and IL13; eosinophil counts, and helper T cells. Conclusion: Montelukast treatment improves the impaired immunological balance of mild asthmatic children through the increase of serum IL-10, T regulatory cell counts that have anti-inflammatory and immunoregulatory effects. It also decreases T helper cells and their proinflammatory cytokines

The Effect of Cinnamon versus Atorvastatin on the Submandibular Salivary Gland of Hypercholesterolemic Albino Rats (Histological, Immunohistochemical and Ultrastructural study)

Hypercholesterolemia refers to elevated cholesterol levels in the blood, and statin family compounds are essential synthetic medications for treating this condition. Plant extracts, such as cinnamon, were used to treat various diseases, researchs showing that cinnamon significantly reduces blood triglycerides and total cholesterol while increasing HDL cholesterol levels. Objectives: The present study's goal was to compare the effect of Cinnamon versus Atorvastatin on the submandibular salivary gland of hypercholesterolemic albino rats. Materials and Methods: There were two groups of twenty-eight male albino rats. (1) Control group: rats were kept on a normal diet, (2) Experimental groups: Hypercholesterolemic group: rats fed with hypercholesterolemic rich diet for 4 months, Atorvastatin and Cinnamon groups: rats were given Atorvastatin tablets and Cinnamon powder at the beginning of the third month with a dose of 10 mg/kg BW. and 6mg \ Kg. B.W. respectively. Sections 5 mm thick of the submandibular salivary glands were examined histologically, ultra-structurally, and immunologically through assessment of anti-Caspase Ⅲ immune antibody. Results: The group with high cholesterol showed marked degenerative changes in parenchymal elements of the submandibular salivary gland, while the Atorvastatin and Cinnamon groups showed a marked enhancing effect in the histological structure of the rat’s submandibular gland. Conclusion: Administration of Atorvastatin as a synthetic line of treatment for hypercholesterolemia positively affected submandibular gland tissue and the cholesterol level in the blood. As a natural herbal line of treatment Cinnamon enhanced the histological and ultrastructure picture of the submandibular gland, level of caspase III in addition to blood cholesterol levels in hypercholesteraemic rat

The Effects of Atorvastatin, Ginger, and Cinnamon on the Structure of Rats' Submandibular Salivary Gland Fed on Cholesterol-Rich Diet

Hypercholesterolemia is a term used to describe high amounts of cholesterol in the blood. The statin family of substances, a heterogeneous collection of molecules that impede the action of HMG CoA reductase, is one of the most important synthetic pharmaceuticals used to address such disorders. Plant extracts are increasingly being utilized to treat a variety of diseases. According to studies, Cinnamon and ginger lowers blood triglycerides and total cholesterol while increasing HDL cholesterol, or high-density lipoprotein. Aim of the Study: The present study's goal was to compare the effect of statin (Atorvastatin) and Herbals (Ginger+ Cinnamon) on the submandibular salivary gland of hypercholesterolemic albino rats. Materials and Methods: There were two groups of 40 mature male albino rats. (1) Control group: rats were kept on a normal diet, (2) Experimental groups: Hypercholesterolemic group:  rats fed with hypercholesterolemic rich diet for 4 months, Atorvastatin and Cinnamon+ Ginger groups: rats were given Atorvastatin tablets and Cinnamon+ Ginger powder at the beginning of the third month with a dose of 10 mg/kg BW. and 6 gm \Kg. BW+ 100 mg\ Kg. BW respectively. Sections 5 mm thick of the parotid gland were examined histologically, ultra-structurally, and immunologically by anti-Caspase Ⅲ immune antibody. Results: The high cholesterol group had significant degenerative alterations in the parenchymal parts of the submandibular salivary gland, whereas the Atorvastatin and Cinnamon+ Ginger groups demonstrated significant enhancing effects in the histological structure of the rat's submandibular gland. Conclusion: To varying degrees, hypercholesterolemia wreaks havoc on the anatomy of the parotid gland. The use of Atorvastatin as a synthetic line of treatment for hypercholesterolemia improved submandibular gland tissue and blood cholesterol levels. Cinnamon+ Ginger administration improved submandibular gland tissue as a natural herbal remedy for high cholesterol levels in the blood

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Concept of Abstract as Approach for Applying the Method of Formal Criticism in the Field of Painting

The current research aims at employing the concept of abstraction in formal criticism, in order to develop the application aspect of it, within curricula of criticism and artistic appreciation. The importance such process is to realize the concept of abstraction as a main axis that isolates the artistic work from its surroundings. Thus, the formal criticism can be applied on various works of art in the field of painting to analyze and extract artistic formulations in plastic works. The artistic criticism reveals the structure and understanding of the artwork, which enriches the aesthetic experience and makes it more satisfaction and pleasure to the viewer. Accordingly, the study is considered as analytical study of the abstraction concept in field of painting through the ages, and to identify its philosophy, objectives and types. Results of the research showed that the concept of abstraction is related to the work of art, in line with the formal criticism because the relationship between extracted forms from abstraction concept is the fundamental aspect, which represents symmetrical relation with application of the formal criticism method. The study has presented several recommendations, the most important are: The study recommends with the necessity to apply innovative methods through organizing critic workshops as interactive teaching methods which enrich field of criticism and artistic appreciation

Liver elasticity assessment after biliary drainage in patients with extrahepatic cholestasis by shear wave sono-elastography (SWE)

Abstract Background Extrahepatic cholestasis that is caused by benign and malignant diseases has been reported to influence liver elasticity, independent of liver fibrosis. Shear wave sono-elastography is a novel noninvasive ultrasound-based tool to assess liver stiffness that is indirectly measured by the propagation velocity of ultrasound waves within the liver parenchyma. The aim of our study is to explore the impact of extrahepatic cholestasis on liver elasticity assessed by sono-elastography. Methods This is the prospective cohort study of 80 patients with obstructive jaundice. Liver elasticity was measured before biliary drainage (day 0), with measures repeated 2 days (day 2) and seven days (day 7) after biliary drainage. Then, correlation with serum bilirubin and serum liver enzymes values was done. Results The studied patients with extrahepatic cholestasis (38 males and 42 females with mean age ± SD of 45.8 ± 14.6 years) referred to our department for biliary drainage. All underwent liver elasticity measurement by real-time shear wave sono-elastography before biliary drainage with the highest value of mean elasticity (± SD) 8.44 kPa (± 3.02) and then repeated on day 2 with mean elasticity 6.82 kPa (± 2.77), followed by maximum improvement of liver stiffness on day 7 with mean elasticity 4.8 kPa (± 1.80), coincided with improvement of cholestatic laboratory levels. Conclusions This study confirmed improvement of liver stiffness, measured by sono-elastography, after biliary drainage in patients with extrahepatic biliary obstruction

Evaluation of diaphragm in patients with chronic obstructive pulmonary disease using ultrasonography in relation to disease severity in Fayoum University Hospital

Background Diaphragmatic evaluation is crucial in the diagnosis of patients with chronic obstructive pulmonary disease (COPD). Diaphragmatic ultrasound is a simple, noninvasive, and bedside method. Ultrasound can analyze the diaphragm’s location, structure, and motility, as well as excursion and thickness.The study’s goal is to assess the diaphragm by ultrasonography in patients with COPD and relationship to disease severity. During their follow-up at the outpatient chest clinic, 40 patients with stable COPD and 40 healthy controls were studied for a year. Results The diaphragmatic measurements (thickening at total lung capacity and residual volume, excursion, and diaphragm thickness percentage) detected by ultrasonography were observed to decrease with increasing COPD severity.Furthermore, in comparison with the control group, these parameters were shown to be considerably lower in patients with COPD. Conclusion Ultrasonography is a safe, noninvasive, and straightforward approach for determining diaphragmatic thickness and excursion.The thickness and excursion of the diaphragmatic function were found to have a negative relationship with COPD severity