Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study.

Background: Monkeypox (Mpox) is a re-emerging infectious disease representing a new global challenge. It poses a substantial threat to countries, particularly those with a low number of cases. Due to its popularity as a tourist destination and its proximity to many African refugees, Egypt is potentially at risk of Mpox importation. Therefore, effective disease management necessitates healthcare workers (HCWs) to possess adept knowledge, along with a positive attitude and behavior. The study aimed to assess the knowledge, attitude, and perception of Egyptian HCWs and medical students towards human Mpox. Methods: The present cross-sectional study data was collected from participants between October and December 2022 via a questionnaire. The questionnaire comprised 31 questions in the knowledge section, 11 questions in the attitude section, and 14 in the perception section. Results: The present study involved a total of 1,034 HCWs and medical students. It was found that 55.3% of the participants demonstrated adequate knowledge about Mpox, whereas 44.5% and 39.8% of the respondents exhibited favorable attitudes and perceptions towards the disease, respectively. Binary logistic regression analysis revealed that adequate knowledge was significantly observed in ages older than 40 years (p < 0.001), married participants (p < 0.001), and doctors (p < 0.001). The positive attitude was significantly observed among the male sex (p = 0.045), urban residents (p = 0.002), and nurses (p = 0.002). Conversely, married participants (p = 0.013), doctors (p < 0.001), and individuals employed in pharmacy and laboratory departments (p < 0.001) experienced an increase in positive perception. Conclusion: Knowledge, attitude, and perception towards Mpox among Egyptian HCWs and medical students exhibit suboptimal levels. Addressing these gaps is crucial to controlling and effectively preventing disease transmission.

Evaluation of the antibacterial activity of Weissella confusa K3 cell-free supernatant against extended-spectrum ßeta lactamase (ESBL) producing uropathogenic Escherichia coli U60.

Different strategies have been approved for controlling extended-spectrum ßeta lactamase (ESBL) producing uropathogenic bacteria. The antibacterial activity of Lactic acid bacteria (LAB) is an effective strategy due to its probiotic characteristics and beneficial effects on human health. The antibiotic susceptibility test, disk diffusion method, and double disc synergy test indicated that five enteric uropathogenic isolates were ESBL producers during the present study. They recorded diameters of inhibition zones as ≤ 18, ≤ 8, ≤ 19, and ≤ 8 mm against cefotaxime (CTX), ceftazidime (CAZ), aztreonam (ATM), and ceftriaxone (CRO). Genotypically, blaTEM genes are the most common, with (100 %) occurrence in all the five enteric tested uropathogens, followed by blaSHV and blaCTX genes (60 %). In addition, out of 10 LAB isolates from dairy products, the CFS of isolate no. K3 had high antibacterial activity against the tested ESBLs, especially no. U60, with a MIC of 600 µl. Additionally, the MIC and sub-MIC of K3 CFS inhibited the production of antibiotic-resistant bla TEM genes of U60. Analyzing the 16S rRNA sequence confirmed that the most potent ESBL-producing bacteria (U60) and LAB (K3) isolates were identified as Escherichia coli U60.1 and Weissella confuse K3 with accession numbers MW173246 and MW173299.1, respectively, in GenBank.

Study on pyoverdine and biofilm production with detection of LasR gene in MDR Pseudomonas aeruginosa.

In cystic fibrosis individuals, chronic lung infections and hospital-acquired pneumonia are caused by Pseudomonas aeruginosa. P. aeruginosa generates siderophores such as pyoverdine (PVD) as iron uptake systems to cover its needs of iron ions for growth and infection. lasR quorum sensing (QS) gene has a crucial function in PVD production and biofilm generation in P. aeruginosa. Fifty isolates of P. aeruginosa were obtained from clinical specimens of sputum (collected from individuals suffering from pulmonary infections). Antibiotic sensitivity test was performed for 50P. aeruginosa isolates by using 10 different types of antibiotics. All isolates of P. aeruginosa showed resistance for all 10 using antibiotics in this study. Ten multidrug resistant isoloates of P. aeruginosa were selected for next tests. Virulence factors of ten multidrug resistant isolates of P. aeruginosa, such as biofilm generation, PVD production, and lasR gene were detected. From results, all 10P. aeruginosa isolates can produce biofilm, PVD, and contain lasR gene. The produced amplicon for the lasR gene was 725 bp. After mice injection by fresh and heated PVD produced by P. aeruginosa PS10 LC619328.2, the fresh PVD caused 100 % mortality within five days using 0.3 ml of its concentration (37.4 µM), while (15.3 µM) of heated PVD (toxoid) caused 50 % mortality.

Edible Xanthan/Propolis Coating and Its Effect on Physicochemical, Microbial, and Sensory Quality Indices in Mackerel Tuna (Euthynnus affinis) Fillets during Chilled Storage.

Worldwide aquaculture production is increasing, but with this increase comes quality and safety related problems. Hence, there is an urgent need to develop potent technologies to extend the shelf life of fish. Xanthan gum is commonly used in the food industry because of its high-water solubility, stability of its aqueous solutions in a wide pH range, and high viscosity. One of its modern food applications is its use as a gelling agent in edible coatings building. Therefore, in this study, the effect of xanthan coating containing various concentrations (0, 1, 2%; w/v) of ethanolic extract of propolis (EEP) on physicochemical, microbial, and sensory quality indices in mackerel fillets stored at 2 °C for 20 days was evaluated. The pH, peroxide value, K-value, TVB-N, TBARS, microbiological and sensory characteristics were determined every 5 days over the storage period (20 days). Samples treated with xanthan (XAN) coatings containing 1 and 2% of EEP were shown to have the highest level of physicochemical protection and maximum level of microbial inhibition (p < 0.05) compared to uncoated samples (control) over the storage period. Furthermore, the addition of EEP to XAN was more effective in notably preserving (p < 0.05) the taste and odor of coated samples compared to control.

Characterization of Volatile Flavor Compounds in Supercritical Fluid Separated and Identified in Gurum (Citrulluslanatus Var. colocynthoide) Seed Oil Using HSME and GC-MS.

In this study, the volatile compound profiles of gurum seed oil were determined using two methods: supercritical CO2 extraction (SFE) and the screw press process (SPP). For volatile compounds extraction and identification, headspace solid-phase micro-extraction (HS-SPME) and GC-MS were used, respectively. A total number of 56 volatile compounds were revealed and identified in oil extracted by SFE, while only 40 compounds were detected in extracted oil by SPP. Acids, aldehydes, esters, ketones, furans, and other components were present in the highest ratio in oil extracted by SFE. In contrast, alcohols and alkenes were found in the highest proportion in oil extracted by SPP. In this study, it was observed that SFE showed an increase in the amounts of volatile compounds and favorably impacted the aroma of gurum seed oil. The results reveal that different extraction methods significantly impact the volatile components of gurum seed oil, and this study can help evaluate the quality of the oil extracted from gurum seeds.

Bioactive Compound, Antioxidant, and Radical Scavenging Activity of Some Plant Aqueous Extracts for Enhancing Shelf Life of Cold-Stored Rabbit Meat.

The potential radical scavenging, antioxidant activities (DPPH and ABTS) and bioactive constituents of several plant aqueous extracts (Curcuma longa, CL; Myristica fragrans, MF; Zingiber officinale, ZO; Cymbopogon citratus, CC and Thymus vulgaris, TV as well as their mixture) were investigated. The effect of these extracts on quality aspects (sensory characteristic, color traits, and Thiobarbituric acid) of rabbit meat during a 16-day cold (4 ± 2 °C) storage were investigated. Total phenolics and flavonoid contents of all extracts ranged from 13.27 ± 0.57 to 25.23 ± 0.49 mg GAE/g and 6.57 ± 0.22 to 13.24 ± 0.19 mg quercetin/g, respectively. The aqueous extract of MF had the highest (p ≤ 0.05) ABTS scavenging activity (4.55 µ mol Te/g dry extract), whereas the highest (p < 0.05) DPPH scavenging activity was detected in ZO extract (9.32 µ mol Te/g dry extract). Identification of extracts' bioactive compounds by GC-MS revealed that Eugenol (34.51%), Cinnamaldehyde (44.71%), Carvacrol (40.49%), Eicosane aldehyde (31.73%), and thymol (50.04%) are the first abundant bioactive compounds of CL, MF, ZO, CC, and TV aqueous extracts, respectively. Generally, the thiobarbituric acid reactive substances (TBARS) of all cold stored rabbit meat increased (p < 0.05) by increasing the storage time. The lowest TBARS values were detected for the samples treated with 0.2% of plant extracts mixture, which increased the shelf life of cold-stored rabbits by 50%. Significant (p < 0.05) increases in both L* and b* were observed with extended storage time. Meanwhile, the redness of the cold stored rabbit meat had an opposite trend. Treating the cold stored rabbit meat with 0.2% of the extract's mixture doubled the storage time with acceptable odor and taste. The results indicated that the studied plant extracts may be effective against rancidity and may be used as a natural antioxidant to prolong the shelf life of cold-stored rabbit meat.

Impact of a Carboxymethyl Cellulose Coating Incorporated with an Ethanolic Propolis Extract on the Quality Criteria of Chicken Breast Meat.

Recently, the demand for composite edible coatings has increased significantly as a new trend to confront the serious processing and storage problems that always arise regarding chicken meat. We aim to develop a carboxymethyl cellulose (CMC) coating containing various concentrations (0, 1, 2, 3, and 4%) of an ethanolic propolis extract (EPE) to maintain the quality and extend the shelf life of chicken breast meat stored at 2 °C for 16 days. The influence of the CMC and EPE coating on the physicochemical and microbiological quality parameters of chicken breast meat, e.g., pH, color, metmyoglobin (MetMb), lipid oxidation (thiobarbituric acid reactive substance, TBARS), and microbiological and sensory analyses, was studied. Significantly lower weight loss and pH (p ≤ 0.05) were noted in the coated samples compared with the uncoated samples (control) over the storage period. MetMb content was significantly reduced (p ≤ 0.05) in the coated samples compared to the control. Additionally, the addition of EPE to CMC was more effective in inhibiting microbial growth, preventing lipid oxidation, and keeping the overall acceptability of coated chicken breast meat compared to the control. This work presents CMC and EPE as alternative preservatives to produce active packaging coatings.

Forkhead Box P3 (Foxp3) serum level and Foxp3 Gene-Promoter polymorphisms in Egyptian rheumatoid arthritis patients: A case-control study.

Regulatory T (Treg) cells are the chief player in induction of autotolerance and the transcription factor, Forkhead Box P3 (Foxp3), is the master regulator of their development and function. Polymorphisms in Foxp3 locus affect Foxp3 expression and can influence Treg cell function. This study aimed to determine the frequency of -3279C/A and -924A/G polymorphisms in the promoter region of the Foxp3 gene in Egyptian rheumatoid arthritis (RA) patients in comparison to apparently healthy controls, to test their association with Foxp3 serum levels as well as with patients' clinical and laboratory features. Also, to evaluate Foxp3 serum level as a putative measure of Foxp3+ Treg cells-mediated immune regulation and disease activity. A total of 136 subjects (68 RA patients and 68 controls) were studied for determining the frequency of both -3279 C/A and -924 A/G polymorphisms in the Foxp3 promoter region by PCR-RFLP and measuring their Foxp3 protein serum levels by ELISA. Our results indicated that; -3279 Foxp3 CA and AA genotypes were significantly higher in patients than controls (OR (95% CI) = 2.86 (1.31-6.26) and 2.79 (1.11-7.07), P= 0.008 and p = 0.03, respectively). Similarly, -924 AG genotype was significantly higher in patients than controls (OR (95% CI) = 2.92 (1.35-6.34); P=0.006). A significantly higher risk of RA was associated with the Foxp3 polymorphic variants -3279 A and -924 G. There was a statistically significant elevation in Foxp3 serum levels among patients, which was positively correlated to disease activity score and disease grade. In conclusion, Foxp3 polymorphisms influenced the risk of developing RA, but did not influence disease severity or activity. Serum level of Foxp3 is not a reliable indicator of Treg-mediated immune regulation in RA patients.

Accuracy of contrast swallow study in assessment of caustic esophageal stricture length in children: Agreement study.

BACKGROUND: Caustic esophageal stricture length assessment is essential for planning endoscopic management and predicting its prognosis. We aimed to assess the accuracy of contrast swallow study (CSS) in measuring stricture length in comparison to endoscopy (definitive investigation for actual length measurement). METHOD: Medical records of caustic esophageal strictures between 2010 and 2020 were retrospectively reviewed. Reliability study was done to compare between radiological and endoscopic measurement of stricture length. RESULT: 124 CSSs for 91 patients were analyzed. Six studies showed no stricture, single stricture was reported in 101 studies, double strictures were reported in 16 studies, triple strictures were reported in one study (136 radiological stricture). Endoscopy revealed 133 true strictures. Number of the strictures was consistent between CSS and endoscopy in 112 studies (90.3%) and different in 12 studies (9.7%). Eight endoscopies revealed strictures not reported in CSS (5.5% false negative strictures), while 10 CSSs reported 11 strictures that were not detected during the endoscopy (7.6% false positive strictures). Reliability analysis revealed interclass correlation coefficient = 0.6 (95% CI 0.5 to 0.7) indicating moderate reliability. CONCLUSION: CSS is not accurate in assessing caustic esophageal stricture length. Combination of CSS and endoscopic investigation is better for proper evaluation of these patients. Level III of evidence.

Predictors of successful endoscopic management of caustic esophageal strictures in children: When to stop the dilatations?

BACKGROUND: Caustic esophageal strictures are mainly managed by endoscopic dilatations. Cases that do not respond to the dilatations eventually require an esophageal replacement. The aim of our study was to identify factors that could allow us to predict if the dilatations will be successful or not. METHODS: We retrospectively reviewed the chart of 100 patients with caustic esophageal injuries treated at our center between 2012 and 2019. Collected data included age, gender, type of caustic substance, duration of the dilatations, length and extent of the strictures, number and time interval between dilatations, presence of gastroesophageal reflux, occurrence of esophageal perforation, and outcome of the dilatation program. RESULTS: The patient ages ranged from 1 to 8 years old. The overall success rate was 98.2% for patients with short strictures and 81.8% for patients with long strictures (>3 cm). A long stricture, a pharyngeal extension of the stricture, the occurrence of an esophageal perforation, and the presence of gastroesophageal reflux were strong predictors of the failure of the dilatation program. The median treatment time for the patients to achieve a cure was 5 months in cases of short strictures and 17 months in cases of long strictures. Within the subgroup of patients with long strictures, a dysphagia-free period within the first year of management of 8 weeks was associated with the success of the dilatation program. CONCLUSION: A length of more than 3 cm, pharyngeal involvement, the occurrence of esophageal perforation, and the presence of gastroesophageal reflux are predictors of failure of dilatations for the management of caustic esophageal strictures. A dysphagia-free period of 8 weeks or more within the first year of dilatations is considered a predictor of success of dilatations in patients with long strictures. LEVEL OF EVIDENCE: Level II.

Iatrogenic esophageal perforation caused by endoscopic dilatation of caustic stricture: Current management and possibility of esophageal salvage.

BACKGROUND: Iatrogenic esophageal perforation (EP) is an undesirable complication of endoscopic dilatation of caustic esophageal stricture. We reported our current management protocol with possibility of continuing the dilatation program. PATIENTS AND METHODS: From January 2009 to January 2020 medical records were reviewed for patients presented with iatrogenic EP. Management according to each case condition was reported. RESULTS: 24 patients were enrolled, aged from 1.5 to 6 years old. Perforation was cervical in one case, abdominal in two cases, and thoracic in 21 cases. Immediate surgical repair was performed in the abdominal cases. Conservative management was chosen in 22 cases; two cases didn't respond and underwent esophageal diversion, and one of them died owing to severe sepsis. Three patients refused another trial of dilatation. Two cases failed to be redilated. 17 patients continued a dilatation program. Time passed between perforation and redilatation ranged from 35 days to 7 months. 15 patients were cured completely from dysphagia, one patient had marked improvement of his dysphagia, and one case with a resistant stricture was referred for esophageal replacement. CONCLUSION: Preserving the native esophagus is possible after iatrogenic EP of caustic esophageal stricture. A conservative approach should be attempted with caution not to endanger patient's life. Level IV of evidence.

Addressing Cancer Treatment Shortages in Saudi Arabia: Results of a National Survey and Expert Panel Recommendations.

PURPOSE: Cancer treatment shortages are complex and a persistent problem worldwide. Patients with cancer are most vulnerable to drug shortages, which provides opportunities to examine the extent of the challenge(s) facing Saudi Arabia and to provide recommendations toward mitigating the impact of cancer treatment shortages on patient outcomes. MATERIALS AND METHODS: A qualitative methodologic approach was conducted in April 2019 using a validated questionnaire and structured panel discussion for data generation. RESULTS: Overall, 55 responses were received from practicing oncology health care professionals (26 pharmacists and 29 physicians). The annual average number of treated patients with cancer per institution was 640 (adults [n = 400] and pediatric [n = 240]). All respondents (100%) reported that cancer treatment shortages constitute a current problem in their center, with an average of 5 (range, 1-9) per month. The panelists recognized 2 fundamental points. First, the definition of cancer drug shortages should be standardized and recognized at the national level. Second, the current system must be improved to ensure proper and efficient use of the current resources. On that basis, the panelists developed 9 recommendations for action. CONCLUSION: Cancer drug shortage is a significant problem in all health centers in Saudi Arabia. This study presents challenges that should be addressed at the national level and essential consensus recommendations for a coordinated action developed by a panel of experts to tackle the current national problem of cancer treatment shortages. Implementing these recommendations will provide a blueprint for management of national drug shortages in general and cancer treatment shortages in particular.

Assessment of The Role of Serum Neutrophil Gelatinase-Associated Lipocalin in Egyptian Childhood Bronchial Asthma: One Centre Study.

Neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a potential biomarker in many medical conditions including asthma. The aim of this study was to assess the role of serum NGAL in Egyptian childhood bronchial asthma. The study included 156 patients and 39 apparently healthy control children. Full clinical examination, pulmonary function tests; CBC, CRP, IgE, liver function tests, and renal function tests, and serum NGAL level were performed. The difference between the studied groups was statistically significant regarding IgE, eosinophils and NGAL (P= 0.001 for each). In addition, the difference between the subgroup with severe persistent asthma and the subgroup with mild intermittent asthma was significant (P=0.001). ROC curve analysis showed that at a cut-off value of 0.884 the sensitivity and specificity of differentiating severe bronchial asthma patients from controls was 82 % and 76 %, respectively. In conclusion, NGAL may represent a potential marker of bronchial asthma in children with severe disease.

Colonic replacement of the esophagus: towards standardization of the technique.

Since we have started colonic replacement of the esophagus in children, several successive modifications have led to evolution of the surgical technique aiming to decrease complications and achieve the best functional outcome. Currently, our surgical group has reached a single standardized technique that has been applied to all cases included in this report. A colonic flap (including the transverse colon) is prepared based on the left colic vessels. The proximal end of the colonic flap is transferred upwards passing at first behind the stomach and then anteriorly through the lesser omentum to traverse the thoracic cavity via a previously prepared retrosternal tunnel. The proximal end of the colonic flap is anastomosed to the proximal esophagus in the neck (end to end anastomosis). Most specifically, the distal end of the colonic flap is anastomosed to the posterior wall of the body of the stomach in order to prevent regurgitation of gastric contents into the colonic flap. The retro-sternal colon bypass is among the successful options to replace the esophagus in children. Adding a posterior cologastric anastomosis to the procedure greatly prevents gastric regurgitation that can be responsible for short- and long-term complications. LEVEL OF EVIDENCE: This is a case series with no comparison group (level IV evidence).

Causality analysis and prediction of 2-methylisoborneol production in a reservoir using empirical dynamic modeling.

2-Methylisobornel (MIB) is one of the most widespread and problematic biogenic compounds causing taste-and-odor problems in freshwater. To investigate the causes of MIB production and develop models to predict the MIB concentration, we have applied empirical dynamic modeling (EDM), a nonlinear approach based on Chaos theory, to the long-term water quality dataset of Kamafusa Reservoir in Japan. The study revealed the dynamic nature of MIB production in the reservoir, and determined causal variables for MIB production, including water temperature, pH, transparency, light intensity, and Green Phormidium. Moreover, EDM established that the system is three-dimensional, and the approach found elevated nonlinearity (from 1.5 to 3) across the whole study period (1996-2015). By taking only one or two candidate predictors with varying time lags, multivariate models for predicting MIB production (best model: r = 0.83, p < 0.001, root mean squared error = 3.1 ng/L) were successfully established. The modeling approach used in this study is a powerful tool for causality identification and odor prediction, thus making important contributions to reservoir management.

Surgical management of corrosive-induced gastric injury in children: 10years' experience.

AIM: The purpose of this study was to report surgical management and outcome of corrosive-induced gastric injuries in children at our institute over the last decade. PATIENTS & METHOD: Medical records of patients admitted for corrosive-induced gastric injury at the Pediatric Surgery Department of Ain Shams University between January 2007 and January 2017 were retrospectively reviewed. RESULTS: Twenty six cases (17 boys and 9 girls) were enrolled. Mean age was 3.61±1.29. Ingested agent was acid in all the patients. Main presenting symptom was gastric output obstruction in 22 cases. The interval between corrosive ingestion and presentation ranged from one to 135days (mean=43.9±34). Surgical procedure included total gastrectomy (n=2), partial gastrectomy (n=2), augmentation gastroplasty (n=1), Billroth I (n=2), antrectomy (n=2), antroplasty (n=3), gastrojejunostomy (n=2), Heineke-Mikulicz pyloroplasty (n=9), Finney pyloroplasty (n=5), and feeding jejunostomy (n=4). Anastomotic stricture requiring a second operation developed in one patient. There were three mortalities related to the associated esophageal strictures. The mean follow-up period is 3.5years. All patients are free of symptoms and gained adequate weight. CONCLUSION: Surgery is the mainstay of management for corrosive-induced gastric injuries with good long-term results. Surgical procedure should be tailored according to the patient's general condition and extent of gastric injury. LEVEL OF EVIDENCE: This is a case series with no comparison group (level IV).

Multi-objective models of waste load allocation toward a sustainable reuse of drainage water in irrigation.

The present study proposes a waste load allocation (WLA) framework for a sustainable quality management of agricultural drainage water (ADW). Two multi-objective models, namely, abatement-performance and abatement-equity-performance, were developed through the integration of a water quality model (QAUL2Kw) and a genetic algorithm, by considering (1) the total waste load abatement, and (2) the inequity among waste dischargers. For successfully accomplishing modeling tasks, we developed a comprehensive overall performance measure (E wla ) reflecting possible violations of Egyptian standards for ADW reuse in irrigation. This methodology was applied to the Gharbia drain in the Nile Delta, Egypt, during both summer and winter seasons of 2012. Abatement-performance modeling results for a target of E wla = 100 % corresponded to the abatement ratio of the dischargers ranging from 20.7 to 75.6 % and 29.5 to 78.5 % in summer and in winter, respectively, alongside highly shifting inequity values. Abatement-equity-performance modeling results for a target of E wla = 90 % unraveled the necessity of increasing treatment efforts in three out of five dischargers during summer, and four out of five in winter. The trade-off curves obtained from WLA models proved their reliability in selecting appropriate WLA procedures as a function of budget constraints, principles of social equity, and desired overall performance level. Hence, the proposed framework of methodologies is of great importance to decision makers working toward a sustainable reuse of the ADW in irrigation.

Trends in the Aggressiveness of End-of-Life Cancer Care in the State of Qatar.

PURPOSE: Quality of end-of-life (EOL) care is a key component of excellence in cancer care, and monitoring indicators for quality of EOL cancer care is crucial to providing excellent care. The aim of the current study is to describe the relative aggressiveness of EOL cancer care in the state of Qatar and to compare it with international figures. METHODS: We analyzed all deaths from cancer in Qatar between January 1, 2009 and December 31, 2013. A total of 784 eligible patients were studied to assess aggressiveness of cancer care at EOL. RESULTS: The average number of intensive care unit admissions per person decreased from 0.44 to 0.22 (P < .001) over the period of study. In addition, patients spent fewer days in the intensive care unit (2.79 to 1.82 days; P = .006) and made fewer visits to the emergency department (1.00 to 0.52 visits; P < .001) in the last 30 days of life. Fewer patients had at least one aggressive treatment measure at EOL during the 5-year period (82.3% to 71.0%; P = .038). The mean composite score for aggressiveness of EOL care decreased from 2.24 to 1.92 (P < .01). CONCLUSION: The aggressiveness of EOL cancer care has significantly decreased over time in Qatar; however, despite this decrease, the rate is still higher than that reported internationally. The integration of community palliative care services in Qatar may further decrease the aggressiveness of cancer care at EOL.

A simulation-based suitability index of the quality and quantity of agricultural drainage water for reuse in irrigation.

The suitability of agricultural drainage water (ADW) for reuse in irrigation was indexed based on a simulation of quality and quantity. The ADW reuse index (DWRI) has two components; the first one indicates the suitability of water quality (QLT) for reuse in irrigation based on the mixing ratio of ADW to canal irrigation water without violating the standards of using mixed water in irrigation, while the second indicates the available water quantity (QNT) based on the ratio of the available ADW to the required reuse discharge to meet the irrigation requirements alongside the drain. The QLT and QNT values ranged from 0 to ≥3 and from 0 to ≥0.40, respectively. Correspondingly, five classes from excellent to poor and from high scarcity to no scarcity were proposed to classify the QLT and QNT values, respectively. This approach was then applied to the Gharbia drain in the Nile Delta, Egypt, combined with QUAL2Kw simulations in the summer and winter of 2012. The QLT values along the drain ranged from 1.11 to 2.91 and 0.68 to 1.73 for summer and winter, respectively. Correspondingly, the QLT classes ranged from good to very good and from fair to good, respectively. In regard to QNT, values ranged from 0.10 to 0.62 and from 0.10 to 0.88 for summer and winter, respectively. Correspondingly, the QNT classes ranged from medium scarcity to no scarcity for both seasons. The demonstration of DWRI in the Gharbia drain suggests that the proposed index presents a simple tool for spatially evaluating the suitability of ADW for reuse in irrigation.

Occurrence of classes I and II integrons in Enterobacteriaceae collected from Zagazig University Hospitals, Egypt.

Integrons are genetic units characterized by the ability to capture and incorporate gene cassettes, thus can contribute to the emergence and transfer of antibiotic resistance. The objectives of this study were: (1) to investigate the presence and distribution of class I and class II integrons and the characteristics of the gene cassettes they carry in Enterobacteriaceae isolated from nosocomial infections at Zagzig University Hospital in Egypt, (2) to determine their impact on resistance, and (3) to identify risk factors for the existence of integrons. Relevant samples and full clinical history were collected from 118 inpatients. Samples were processed; isolated microbes were identified and tested for antibiotic susceptibilities. Integrons were detected by polymerase chain reaction (PCR) and were characterized into class I or II by restriction fragment length polymorphism (RFLP). Integron-positive isolates were subjected to another PCR to detect gene cassette, followed by gene cassette sequencing. Risk factors were analyzed by logistic regression analysis. Seventy-six Enterobacteriaceae isolates were recognized, 41 of them (53.9%) were integron-positive; 39 strains carried class I and 2 strains carried class II integrons. Integrons had gene cassettes encoding different combinations and types of resistance determinants. Interestingly, blaOXA129 gene was found and ereA gene was carried on class I integrons. The same determinants were carried within isolates of the same species as well as isolates of different species. The presence of integrons was significantly associated with multidrug resistance (MDR). No risk factors were associated for integron carriage. We conclude that integrons carrying gene cassettes encoding antibiotic resistance are significantly present among Enterobacteriaceae causing nosocomial infection in our hospital. Risk factors for acquisition remain to be identified.