Coexistence of Helicobacter pylori and Giardia duodenalis causes severe iron deficiency anaemia in an adult male: a case report.

INTRODUCTION: Iron deficiency anaemia (IDA), the most prevalent type of anaemia, is recognised as a significant global health concern that affects individuals of all ages. CASE PRESENTATION: Herein, we present a case involving an adult male coinfected with Helicobacter pylori and Giardia duodenalis, which precipitated severe IDA. RESULTS: A 24-year-old male presented with symptoms including fatigue, dizziness, headache, abdominal pain, and diarrhoea persisting for four weeks. Thorough blood tests, including complete blood counts, blood film, and iron studies, conclusively established the presence of severe IDA. Furthermore, his faecal sample was collected and subjected to analysis of common bacterial and parasitic gastrointestinal infections. Examination of upper and lower gastrointestinal pathogens indicated that the severe IDA was most likely a result of coinfection with H. pylori and G. duodenalis. The patient received treatment involving antibiotics and iron replacement therapy, which resulted in an improvement in both his symptoms and laboratory results. CONCLUSIONS: The present report provides crucial insights into the synergistic effect of concurrent H. pylori and G. duodenalis infections, highlighting their potential to induce severe IDA in infected patients.

An overview of qualitative and quantitative platelet abnormalities in schistosomiasis.

Schistosomiasis is a neglected tropical disease referring to the infection with blood parasitic trematodes of the genus Schistosoma. It impacts millions of people worldwide, primarily in low-to-middle-income countries. Patients infected with schistosomiasis often exhibit a distinct hematological profile, including anemia, eosinophilia, thrombocytopenia, and coagulopathy. Platelets, essential components of the hemostatic system, play a crucial role in the pathogenesis of schistosomiasis. Schistosomes secrete serine proteases and express ectoenzymes, such as calpain protease, alkaline phosphatase (SmAP), phosphodiesterase (SmNPP5), ATP diphosphohydrolase (SmATPDase1), serine protease Sk1, SmSP2, and Sm22.6, which can interfere with platelet normal functioning. This report provides comprehensive, up-to-date information on platelet abnormalities observed in patients with schistosomiasis, highlighting their importance in the disease progression and complications. It delves into the interactions between platelets and schistosomes, including the impact of platelet dysfunction on hemostasis and immune responses, immune-mediated platelet destruction, and the potential mechanisms by which schistosome tegumental ectoenzymes affect platelets. Furthermore, the report clarifies the relationship between platelet abnormalities and clinical manifestations such as thrombocytopenia, coagulation disorders, and the emergence of portal hypertension and gastrointestinal bleeding. Understanding the complex interplay between platelets and schistosomes is crucial for improving patient management and outcomes in schistosomiasis, particularly for those with platelet alterations. This knowledge contributes to improved diagnostic methods, innovative treatment strategies, and global efforts to control and eliminate schistosomiasis.

Cryptosporidiosis among Hemodialysis Patients in Jordan: First Preliminary Screening Surveillance.

Few studies have reported the incidence of cryptosporidiosis among hemodialysis patients worldwide. Currently many molecular and immunological assays have been developed for the sensitive diagnosis of cryptosporidiosis, but still, the microscopic detection of the parasitic infective stage (oocysts) in stool specimens using modified acid stain is regarded as a reliable sensitive technique which is widely used in many clinical labs. In the present study, a total of 133 stool samples were collected from hemodialysis patients and were screened for Cryptosporidium oocyst using formalin-ether concentration and modified acid-fast staining technique. Clinical and demographic data were also collected and analyzed. Cryptosporidium oocysts were recovered in 15/133 (11%) of the investigated hemodialysis patients. The age of patients ranged from 25 to 80 years (mean: 57.84 ± 12.22). Most of the Cryptosporidium-positive cases were recovered from males (73.7%) residing in rural villages in Irbid city (86.6%). The most repeatedly reported symptoms in the Cryptosporidium-positive patients were gastrointestinal symptoms, including diarrhea (15%), nausea (24%), abdominal pain (23%) and bloating (17%), in addition to general fatigue (32%) and weight loss (19%). No statistically significant associations for certain clinical symptoms or risk factors were found. The present study is the first preliminary study in Jordan that provided a brief screening for the incidence of cryptosporidiosis among hemodialysis patients.

Association of Breastfeeding Duration with Susceptibility to Allergy, Influenza, and Methylation Status of TLR1 Gene.

Background and Objectives: This study aimed to investigate the possible association between exclusive breastfeeding duration during early infancy and susceptibility to allergy and influenza in adulthood. Furthermore, we also investigated the association of breastfeeding duration with DNA methylation at two sites in the promoter of the toll-like receptor-1 (TLR1) gene, as well as the association between DNA methylation of the toll-like receptor-1 (TLR1) gene and susceptibility to different diseases. Materials and Methods: Blood samples were collected from 100 adults and classified into two groups according to breastfeeding duration (<6 months and ≥6 months) during infancy. Subjects were asked to complete a questionnaire on their susceptibilities to different diseases and sign a consent form separately. Fifty-three samples underwent DNA extraction, and the DNA samples were divided into two aliquots, one of which was treated with bisulfite reagent. The promoter region of the TLR1 gene was then amplified by polymerase chain reaction (PCR) and sequenced. Results: We found a significant association between increased breastfeeding duration and a reduction in susceptibility to influenza and allergy, as well asa significant reduction in DNA methylation within the promoter of the TLR1 gene. No association was found between DNA methylation and susceptibility to different diseases. Conclusions: The findings demonstrate the significance of increased breastfeeding duration for improved health outcomes at the gene level.

Subcutaneous and visceral fat volumes measured by MRI and their relationships with nutrient intakes among adults.

BACKGROUND AND OBJECTIVES: Types and amounts of nutrients may influence the volume of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). This study targeted to investigate the relationship between SAT and VAT volumes and macro- and micronutrients intake among adults. METHODS AND STUDY DESIGN: Data were collected via a private face-to-face interview, in which diet history was obtained using validated quantitative food frequency questionnaire. The different fat volumes were assessed using magnetic resonance imaging (MRI) scanning. RESULTS: Participants with the lowest VAT volume had the highest intake of saturated fats, monounsaturated fatty acids and omega-3 and omega-6 fatty acids (p<0.05). VAT volume was significantly associated with the highest level of total energy and energy from carbohydrate consumption among participants while significantly associated with the lowest energy intake from fat among participants (p=0.013). There was a significant relationship with the highest consumption of total carbohydrate, soluble fiber, and insoluble fiber and VAT volume (p<0.05). Participants in the highest VAT volume had significantly the highest intake of vitamin A, ß- carotene, and copper. CONCLUSIONS: This study underscores the importance of quantifying depot-specific body fat and highlights the unique responsiveness of various fat depots to dietary intake.

Detection, genotyping, and phylogenetic analysis of Leishmania isolates collected from infected Jordanian residents and Syrian refugees who suffered from cutaneous leishmaniasis.

Leishmania is a parasitic protozoan which is transmitted to humans through the bite of an infected female Phlebotomus and Lutzomyia sand flies. Cutaneous leishmaniasis (CL), caused by Leishmania major and L. tropica, is an endemic disease in many areas of Jordan and considered as a major public health problem. The political instability in the Syrian Arab Republic has resulted in the immigration of large number of refugees into Jordan where most of them resided in camps near the Syrian borders. Therefore, the main objective of the present study was to inspect Leishmania species/genotypes which are responsible for CL infections among Syrian refugees and compare them with the recovered species/genotypes isolated from Jordanian patients. Three molecular-based assays (ITS1-PCR-RFLP, Nested ITS1-5.8S rDNA PCR, and Kinetoplast DNA PCR) followed by sequencing and phylogenetic analysis were undertaken and compared for their efficiency to confirm CL diagnosis and genotype the infecting Leishmania species. Thereafter, the evolutionary relationships among various Leishmania isolates from Syrian and Jordanian CL patients were elucidated. Results from the present study indicated that 20 and 9 out of the inspected 66 patients (39 Jordanian and 27 Syrian) were infected with L. major and L. tropica respectively. ITS1-PCR RFLP typing proved to be more sensitive in the detection of Leishmania species (positive in 44% of the isolates) compared to both ITS1-5.8S rDNA gene and Kinetoplast DNA PCR which were successful in identifying Leishmania species only in 23% and 33% of the isolates respectively. Sequencing and phylogenetic analysis of ITS1 and ITS1-5.8S rDNA genes revealed high levels of heterogeneity among the sequenced isolates. One sample typed as L. tropica from Jordanian patient showed high similarity with L. tropica sample isolated from a Syrian patient in a Lebanon refugee camp; therefore, the need for comprehensive studies to confirm if any new L. tropica strains might be introduced to Jordan by Syrian refugees is urgently indicated. These observations highlighted the need for further studies to clarify the risk status of species and strains which might be introduced from Syria to Jordan.

Spatial and temporal characteristics of cancer in the period from 2004 to 2013 in the Hashemite Kingdom of Jordan.

Cancer in Jordan is a major public health problem and the second leading cause of death after heart disease. This study aimed at studying the spatial and temporal characteristics of cancer in Jordan and its 12 governorates for the period 2004-2013 to establish a baseline for future research and identification of cancer risk factors paving the way for developing a cancer control plan in the country. Numerical and graphical summaries, time-series additive seasonal decomposition, the method of least squares, and spacetime scan statistics were applied in a geographic information systems environment. Although the results indicate that the cancer incidence in Jordan is comparatively low, it is increasing over time. In the 10-year study period, a total of 44,741 cases was reported with a mean annual crude incidence rate of 68.4 cases/100,000, mean annual age-adjusted incidence rate of 111.9 cases/100,000, and a monthly rate increase of 1.2 (cases/100,000)/month. This study also revealed that the spatial and temporal characteristics of cancer vary among the governorates. Amman, which includes the capital city and hosts more than one-third of the population of the country, reported 61.0% of the total number of cases. Amman also reported the highest annual crude incidence rate (105.3 cases/100,000), the highest annual age-adjusted incidence rate (160.6 cases/100,000), and the highest rate of increase (0.7 (cases/100,000)/month) forming a high-rate cluster. Excluding the three governorates Amman, Balqa, and Ma'daba, low-rate clusters were found with regard to the remaining governorates. All governorates, except Irbid and Mafraq, showed significant rates of increase of cancer incidence. However, no clear seasonality pattern with respect to cancer incidence was discerned.

Relationship of serum leptin with some biochemical, anthropometric parameters and abdominal fat volumes as measured by magnetic resonance imaging.

AIMS: To measure the level of leptin in volunteers and correlate it with several anthropometric, biochemical variables and abdominal fat volumes. METHODS: The level of leptin was investigated in 167 disease-free volunteers. Serum levels of IL-6, adiponectin, and resistin, blood lipid profile (cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) were determined. Waist circumference (WC) was measured using tape and magnetic resonance imaging (MRI) images. RESULTS: All measured anthropometric (BMI, WC measured by tape and MRI) and biochemical variables (adiponectin, resistin, cholesterol, HDL, LDL and TG); and abdominal fats showed a significant (p<0.05) difference between participants with abnormal serum leptin levels and those with normal leptin levels. A higher percentage of participants with abnormal serum leptin were obese males while participants with normal leptin levels were either overweight or normal weight females. A significant (p <0.05) positive correlation was detected between serum leptin concentration and WC, BMI, subcutaneous fat, visceral fat, total abdominal fat, and resistin. A moderate association was found between serum leptin concentration and the inflammatory cytokine IL-6. CONCLUSION: Abnormal serum leptin, was detected in obese male individuals which may be considered as an important indicator for the development of cardiovascular diseases and type 2 diabetes.

Cystic echinococcosis in Jordan: A review of causative species, previous studies, serological and radiological diagnosis.

Cystic echinococcosis (CE)/hydatidosis is a zoonotic disease which occur in human and herbivore animals as a result of infection with the larval stage of the taeniid cestode Echinococcus granulosus sensu lato (s. l.). In human, CE is a serious public health concern in many parts of the world including Jordan. The present review will cover CE causative agent: E. granulosus species/genotypes; life cycle of E. granulosus parasite, all published previous studies on CE in Jordan (humans, intermediate hosts, definitive host) as well as its diagnostic methods in human.

Human immune response to salivary proteins of wild-caught Phlebotomus papatasi.

Phlebotomine sand flies are the known vectors of Leishmania parasites. New approaches in vaccination against Leishmania have investigated the possibility of integrating Phlebotomus papatasi salivary proteins to enhance the immune response and protect against the transmission of the infection. The aim of the present study was to screen human immune responses to wild sand fly saliva and evaluate immunogenic salivary proteins. Blood samples were collected from donors in control and sand fly infested areas. Antibodies specific for sand fly antigens in donor plasma were probed using immunoblotting. In addition, recall proliferation capability of peripheral blood mononuclear cells (PBMC) was tested after sand fly salivary homogenates stimulation. The significant immunogenic salivary proteins (SPs) identified by immunoblotting were SP28, SP32, and SP36. A specific proliferative response of PBMC after stimulation with sand fly salivary homogenates was evident in donors that have antibody responses against sand fly salivary proteins. Individuals with antibody recognition to a higher number of salivary proteins (i.e., 3 or more SP bands) showed lower PBMC proliferative responses after in vitro stimulation with salivary gland homogenates (SGH) only in the sand fly infested, leishmaniasis free area. Interestingly, the presence of a humoral immune response to many SP antigens inversely correlates with a strong cell-mediated immune response (CMI). It was also noticed that some other heavily expressed antigens, in sand fly salivary homogenate, lack or have weak humoral immune reactivity in exposed individuals. Therefore, considering these antigens alone as CMI activators, without including the immunodominant humoral immune response proteins, needs future investigation.

Exploring recent spatial patterns of cutaneous leishmaniasis and their associations with climate in some countries of the Middle East using geographical information systems.

This study explores the spatial trends of cutaneous leishmaniasis (CL) and characterises the relationships between the observed spatial patterns and climate in Jordan, Syria, Iraq and Saudi Arabia in 2009. Areal interpolation revealed the presence of four major hotspots of relatively high incidence rates covering most parts of Syria, central parts of Iraq, and north-western, central, south-eastern and south-western parts of Saudi Arabia. The severity of these hotspots was seen to decrease from high to low latitudes. The spatial patterns could be partly linked to precipitation (the higher the precipitation, the higher the incidence rates) and to a lesser degree to temperature (the lower the temperature, the higher the incidence rates). No significant relationship was deduced between the observed spatial patterns of incidence rates and humidity. However, these three climatic factors could be used jointly as explanatory variables (ceteris paribus) to explain part of the spatial variations of the CL incidence rates in the study area by applying geographically weighted regression.