Control of occupational exposure to phenol in industrial wastewater treatment plant of a petroleum refinery in Alexandria, Egypt: An intervention application case study.

Phenol exposure is one of the hazards in the industrial wastewater treatment basin of any refinery. It additively interacts with hydrogen sulfide emitted from the wastewater basin. Consequently, its concentration should be greatly lower than its threshold limit value. The present study aimed at controlling occupational exposure to phenol in the work environment of wastewater treatment plant in a refinery by reducing phenolic compounds in the industrial wastewater basin. This study was conducted on both laboratory and refinery scales. The first was completed by dividing each wastewater sample from the outlets of different refinery units into three portions; the first was analyzed for phenolic compounds. The second and third were for laboratory scale charcoal and bacterial treatments. The two methods were compared regarding their simplicities, design, and removal efficiencies. Accordingly, bacterial treatment by continuous flow of sewage water containing Pseudomonas Aeruginosa was used for refinery scale treatment. Laboratory scale treatment of phenolic compounds revealed higher removal efficiency of charcoal [100.0(0.0) %] than of bacteria [99.9(0.013) %]. The refinery scale bacterial treatment was [99.8(0.013) %] efficient. Consequently, level of phenol in the work environment after refinery-scale treatment [0.069(0.802) mg/m(3)] was much lower than that before [5.700(26.050) mg/m(3)], with removal efficiency of [99.125(2.335) %]. From the present study, we can conclude that bacterial treatment of phenolic compounds in industrial wastewater of the wastewater treatment plant using continuous flow of sewage water containing Pseudomonas Aeruginosa reduces the workers' exposure to phenol.

Effects of foliar application with compost tea and filtrate biogas slurry liquid on yield and fruit quality of washington navel orange (Citrus sinenesis Osbeck) trees.

Sixteen-year-old navel orange trees at a private orchard located in Kafer El-Sheikh Governorate, Egypt, were used in this study. Compost tea (CT) and filtrate biogas slurry liquid (FLB) were applied at two different concentrations (50% and 100%); control trees were sprayed with water Trees treated with CT at 100% were the highest in yield, fruit weight, and vitamin C, whereas the highest percentage of fruit set, fruit number and soluble solid content (SSC), lowest fruit drop, and highest reducing and total sugars were in trees treated with 100% FLB. Concentrations at 50% for both foliar application (CT and FLB) improved yield and fruit characteristics than control treatment. Generally, using a foliar application of compost tea and filtrate biogas slurry liquid at (100%) treatments as food nutrients could be recommended to improve the yield and fruit quality of navel orange fruits under the current study conditions.

Correlation between uroflowmetry, prostate volume, postvoid residue, and lower urinary tract symptoms as measured by the International Prostate Symptom Score.

OBJECTIVES: To evaluate the relation between lower urinary tract symptoms (LUTS) as measured by the International Prostate Symptom Score (IPSS) and noninvasive objective parameters of lower urinary tract dysfunction. METHODS: Eight hundred three consecutive patients with LUTS and/or benign prostatic hyperplasia were evaluated with IPSS, uroflowmetry, prostate volume estimation, and postvoiding residue measurement. The relations between these parameters were quantified by means of Spearman correlation coefficients. RESULTS: Statistically significant but weak correlations were found between the IPSS and results of uroflowmetry and postvoiding residual urine. There was no correlation between the IPSS and results of prostate volume measurements. CONCLUSIONS: The correlation between objective noninvasive parameters of lower urinary tract dysfunction and LUTS is weak.

An analysis of hospital-acquired bacteraemia in intensive care unit patients in a university hospital in Kuwait.

An analysis of hospital-acquired bacteraemia among ICU patients was carried out over a two-year period in order to determine the incidence, associated mortality rate and susceptibility pattern of causative pathogens. There was a high incidence of bacteraemia, occurring in 127 (18.4%) of 692 patients. Mortality attributable to nosocomial bacteraemia was 52% of the total 79 deaths from all causes. The highest mortality rate (58.5%) occurred in patients with fungal infections, whilst death from Gram-negative bacteraemia was only 17%. Over 98% of patients had underlying disease. Nearly half (46.8%) of 267 organisms isolated were Gram-positive. In comparison, Gram-negative bacteria accounted for 36.6% and the rest (17.6%) were fungi (mainly Candida albicans). The majority of the bactereamic episodes were monomicrobial (90.2%). Coagulase-negative staphylococci (CNS) were the commonest pathogens isolated, representing 32.6% of all organisms. Inducible beta-lactamase producing organism (Enterobacter spp. 9.7%, Serratia marcescens 6.7%, Klebsiella pneumoniae 6% and Pseudomonas aeruginosa 6%) formed the bulk of Gram-negative bacteria. In contrast, Escherichia coli (7.5%) and K. pneumoniae (4%) were the commonest Gram-negative bacteria from hospital-acquired bacteraemia in the general hospital population. The majority (80%) of CNS were resistant to methicillin (MRSE) but susceptible to vancomycin; they were relatively resistant to erythromycin, clindamycin and beta-lactams antibiotics. Whilst Gram-negative organisms were relatively susceptible to imipenem (85%), ciprofloxacin (88%) and amikacin (87%), they had unacceptably low levels of susceptibility to cefuroxime (59.3%), cefotaxime (71%), ceftazidime (60.9%), and piperacillin (51.1%). This study shows that hospital-acquired bacteraemia in ICU patients carries a poor prognosis. Information regarding the infective agents and their susceptibility in the ICU setting is valuable for the selection of empirical therapy before culture and susceptibility results are known.

Nasolabial cyst: a report of eight cases and a review of the literature.

Nasolabial cyst is a cystic ectodermal developmental swelling which occurs as a cyst on the lateral half of the floor of the nasal vestibule at the base of the alae of the nose. Although, it is a rare disease, this is a report of eight cases in a population of 500,000 in one year. Seven of the patients were female aged between 25-50 years. Seven cysts were left-sided and one was bilateral. The purpose of this paper is to present an additional example of patients with nasolabial cyst. It may be a more common disease than previously thought.

Formulation of aspirin-magaldrate double-layer tablets: in vitro evaluation and cytoprotective activity in rats.

Double layer 325 mg oral aspirin tablets buffered with magaldrate antacid, 100, 150, 175 and 200 mg (F1, F2, F3 and F4, respectively) were prepared by direct compression. The new formulae were of remarkable hardness and friability. The tablets complied with the requirements of the acid neutralizing capacity, uniformity of dosage units, disintegration and dissolution tests (USP XXIII) for buffered aspirin tablets. The in vitro release pattern of F1 and F1 followed first order kinetics (r = 0.999), while F3 and F4 were released according to a zero order model (r = 0.993). Formulations F2, F3 and F4 as well as the marketed preparations, pure Aspro tablets (Acetylsalicylic acid 320 mg per tablet), or Ascriptin tablets (aspirin 325 mg plus 150 mg Maalox per tablet) were administered to fasted rats by gavage at doses that provided 400 mg aspirin kg-1 and the extent of the induced gastric damage was quantified 6 h later. Ascriptin, F3 and F4 preparations produced significantly less gastric damage (p < 0.05, n = 6) when compared with pure Aspro tablets. There was a clear dose-dependent decrease in the gastric damage following treatment with F2, F3 and F4 preparations, but there was no significant difference between the effects of F3 and F4 which were equipotent with Ascriptin.

In vitro formation of the anthranoid scaffold by cell-free extracts from yeast-extract-treated Cassia bicapsularis cell cultures.

The anthranoid skeleton is believed to be formed by octaketide synthase (OKS), a member of the type III polyketide synthase (PKS) superfamily. Recombinant OKSs catalyze stepwise condensation of eight acetyl units to form a linear octaketide intermediate which, however, is incorrectly folded and cyclized to give the shunt products SEK4 and SEK4b. Here we report in vitro formation of the anthranoid scaffold by cell-free extracts from yeast-extract-treated Cassia bicapsularis cell cultures. Unlike field- and in vitro-grown shoots which accumulate anthraquinones, cell cultures mainly contained tetrahydroanthracenes, formation of which was increased 2.5-fold by the addition of yeast extract. The elicitor-stimulated accumulation of tetrahydroanthracenes was preceded by an approx. 35-fold increase in OKS activity. Incubation of cell-free extracts from yeast-extract-treated cell cultures with acetyl-CoA and [2-(14)C]malonyl-CoA led to formation of torosachrysone (tetrahydroanthracene) and emodin anthrone, beside two yet unidentified products. No product formation occurred in the absence of acetyl-CoA as starter substrate. To confirm the identities of the enzymatic products, cell-free extracts were incubated with acetyl-CoA and [U-(13)C(3)]malonyl-CoA and (13)C incorporation was analyzed by ESI-MS/MS. Detection of anthranoid biosynthesis in cell-free extracts indicates in vitro cooperation of OKS with a yet unidentified factor or enzyme for octaketide cyclization.

Hospital-acquired Clostridium difficile infection amongst ICU and burn patients in Kuwait.

OBJECTIVES: To prospectively study the prevalence of nosocomially acquired Clostridium difficile, a major cause of diarrhoea in hospitalized patients, in the intensive care units (ICUs) and burn unit (BUs) of three teaching hospitals in Kuwait. METHODS: During a 1-year prospective study, stool/rectal swabs were obtained from 344 patients admitted into the ICUs of Mubarak Hospital (ICU-1), the Kuwait Cancer Control Centre (ICU-2), and the BU of Ibn Sina Hospital. The presence of C. difficile and/or its toxin was detected by serially culturing the specimens on differential, selective and enriched media and the use of TOX-A/B test, on admission and at subsequent 1-weekly interval until discharge. RESULTS: Out of the 344 patients admitted into these units, over a study period of 1 year, only 263 (77%) were evaluable. All of them had negative stool culture/toxin on admission. Overall, 25 (9.5%) of these 263 patients acquired C. difficile during their hospitalization. Thirteen (7%) of 187 patients acquired C. difficile in ICU-1, 9 (36%) of 25 on ICU-2 and 3 (5.9%) of 51 patients in BU. Eight (32%) developed diarrhoea attributable only to C. difficile and/or toxin, and the remaining 17 (68%) were asymptomatic: none had pseudomembranous colitis. The diarrhoea in these patients was associated with antibiotic use, the main trigger-antibiotics being the third-generation cephalosporins. Acquisition occurred within 4-53 days of admission, with the majority occurring in the first 15 days. CONCLUSION: Overall, the prevalence of hospital-acquired C. difficile infection/colonization was less than 10%. The use of third-generation cephalosporins was high and was related to the development of diarrhoea. Once acquired, diarrhoea developed in about one third of C. difficile-positive cases, an indication that C. difficile infection/colonization endemic in the hospital ICUs studied is usually transmitted among the hospitalized patients.

The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints.

PURPOSE: We evaluated the urethrocystoscopic findings and results of urodynamic studies in elderly men with voiding complaints. MATERIALS AND METHODS: A total of 492 consecutive patients with voiding complaints underwent a standardized screening program, including transrectal ultrasonography of the prostate, urodynamic investigations with pressure-flow study analysis and flexible urethrocystoscopy. RESULTS: A significant correlation was found between bladder trabeculation and grade of bladder outlet obstruction. Detrusor instability correlated significantly with grade of trabeculation. Grade of obstruction showed a clear correlation with prostatic occlusion of the urethra and the presence of a middle lobe at cystoscopy. CONCLUSIONS: The findings at urethrocystoscopy correlate well with those of urodynamic investigations.

The outcome of renal ultrasound in the assessment of 556 consecutive patients with benign prostatic hyperplasia.

PURPOSE: We determined the additional value of renal ultrasonography in the assessment of patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Renal ultrasound was performed in 556 consecutive patients with benign prostatic hyperplasia and the results were correlated with other clinical parameters. RESULTS: Of the patients 14 (2.5%) had dilatation of the renal pelvis, 65 (11.7%) had renal cysts and 1 (0.18%) had renal cell carcinoma. The serum creatinine level appeared to be correlated with dilatation of the renal pelvis. To predict dilatation additional information can be obtained by including the results of the post-void residual measurements. CONCLUSIONS: Renal ultrasound is indicated only in patients with a specific serum creatinine level and/or post-void residual volume.

Reliability of the International Prostate Symptom Score in the assessment of patients with lower urinary tract symptoms and/or benign prostatic hyperplasia.

PURPOSE: The reliability of the International Prostate Symptom Score (I-PSS) was tested in patients with lower urinary tract symptoms and/or benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 71 consecutive men with benign prostatic hyperplasia and/or lower urinary tract symptoms was asked to complete the I-PSS at baseline and 8 weeks later. At the second visit the physician also completed the I-PSS according to the complaints of the patient. Variability between both scores was evaluated by calculation of duplo errors and results were compared to the clinical data. RESULTS: A considerable variability existed between the I-PSS results obtained at baseline and 8 weeks. The duplo error was 4.3. In a regression analysis of I-PSS, including all clinical parameters, only free flow had some predictive value for I-PSS outcomes. CONCLUSIONS: It is important to consider the variability of the I-PSS score when making decisions concerning treatment.

The predictive value of microscopic haematuria in patients with lower urinary tract symptoms and benign prostatic hyperplasia.

OBJECTIVE: To determine the additional value of the presence of microscopic haematuria in patients with benign prostatic hyperplasia (BPH). METHODS: In 750 consecutive patients with BPH urinalysis was performed and the grade of microhaematuria was correlated with other clinical findings. RESULTS: Microscopic haematuria was found in one third of the patients. Only 3 had a bladder tumour and 49 patients had urinary calculi for which only one patient required treatment. There was no correlations between any clinical parameter and the finding of microscopic haematuria. CONCLUSION: Microscopic haematuria is a frequent finding in assessment of BPH patients and additional tests should only be performed if indicated.

The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment.

INTRODUCTION: There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a randomized trial was performed. METHODS: Patients were randomized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime or ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (immediately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain. RESULTS: After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no statistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the prophylaxis and placebo group) had clinical and bacteriological signs of a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no beneficial effect of antibiotic prophylaxis, in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at the site of treatment. CONCLUSION: We conclude that in patients with urine proven sterile prior to ESWL there is no need for antibiotic prophylaxis.

The correlation between bladder outlet obstruction and lower urinary tract symptoms as measured by the international prostate symptom score.

PURPOSE: We studied the relationship between lower urinary tract symptoms as measured by the international prostate symptom score (I-PSS) and urodynamic findings in elderly men. MATERIALS AND METHODS: We evaluated 803 consecutive patients with lower urinary tract symptoms via the I-PSS and urodynamics with pressure-flow studies. RESULTS: A statistically significant correlation was found between all I-PSS questions (except intermittency) and objective parameters of obstruction. However, the clinical significance of this finding is minimal because a large overlap of symptom scores exists among patients with different grades of bladder outlet obstruction. The filling component of the I-PSS correlated somewhat better with obstruction than did the voiding component. CONCLUSIONS: It seems impossible to diagnosis bladder outlet obstruction from symptoms alone. It does not even seem possible to define subgroups in which further urodynamic examination is indicated.

The correlation between prostate volume, transition zone volume, transition zone index and clinical and urodynamic investigations in patients with lower urinary tract symptoms.

OBJECTIVE: To determine if, in patients with lower urinary tract symptoms (LUTS), measurement of the transition zone (TZ) of the prostate by transrectal ultrasonography (TRUS) and the ratio between the TZ volume and total prostate volume (TZ index) correlates better with clinical and urodynamic investigations than total prostate volume alone. PATIENTS AND METHODS: In total, 150 consecutive patients with LUTS underwent a standardized screening programme including the International Prostate Symptom Sore (IPSS), a physical examination, TRUS of the prostate and urodynamic investigations with pressure-flow studies. The total prostate volume and TZ volume were assessed from TRUS using the ellipsoid formula. Spearman's rank correlation coefficients were calculated between different prostate volume measurements and specific symptomatic and urodynamic variables. RESULTS: The relationships between specific IPSS symptoms, symptom scores and the prostate volume measurements were not statistically significant except for one domain, nocturia, that appeared to be statistically significantly correlated with the TZ index (r = 0.25). The correlations for free flow, pressure-flow variables and prostate volume measurements were stronger, but only moderate at best. The highest correlations were between TZ volume and the linear passive urethral resistance obstruction category, urethral resistance factor and detrusor pressure at maximum flow (r = 0.43, 0.44 and 0.40, respectively). The differences between the correlations of prostate volume and TZ index and these variables were small (r = 0.39, 0.38 and 0.37, respectively for prostate volume and r = 0.38, 0.40 and 0.33 respectively for TZ index). CONCLUSIONS: There were very small differences between the correlations of total prostate volume, TZ volume and TZ index, and clinical and pressure-flow variables. In the assessment of the last two, the estimation of the total prostate volume by TRUS was a reasonable way to obtain the required information about prostate size and measuring TZ volume and calculating TZ index was of limited additional value. Symptoms and bladder outlet obstruction were mainly determined by other factors than the prostate and, specifically, TZ volume. As earlier studies have indicated that including pressure-flow data in the pre-operative evaluation and selection of patients for interventional therapies may improve the overall clinical results, we think that prostate volume, TZ volume or symptoms alone should not be used as the main indication for deciding on the appropriate invasive treatment options.