Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan.

The epidemiology of Rift Valley fever virus (RVFV) and Crimean-Congo hemorrhagic fever virus (CCHFV) in Jordan is unknown. Our investigation showed 3% of 989 tested dairy cattle, sheep, and goats were RVFV seropositive and 14% were CCHFV seropositive. Ongoing surveillance is needed to assess risk to humans and protect public health.

First nationwide seroepidemiology and risk factors report of Helicobater pylori in Jordan.

BACKGROUND AND AIM: Helicobacter pylori inhabits the gastric mucosa of humans and causes 89% of all gastric cancers. This is the first study of the seroprevalence, spatial distribution, and risk factors for H pylori in Jordan. MATERIALS AND METHODS: This is a cross-sectional study of 460 healthy participants (aged between 15 and 81 years) proportionately sampled across each region of Jordan. Sera samples were tested for H pylori using Enzygnost® anti-H pylori immunoglobulin G enzyme-linked immunosorbent assay. Participants completed a validated questionnaire about potential risk factors including food consumption habits and environmental and animal exposure. Multivariate generalized linear models identified risk factors for infection. RESULTS: The results showed a high seroprevalence (88.6%; 95% confidence interval [CI]: 85.3-91.2) of H pylori in the study population. After adjusting for possible confounders, age, consumption of raw milk, and location of residence were significantly associated with seropositivity. Older participants aged 30-49 years had an 11% greater risk of seropositivity compared to participants aged 15-29 years. Participants who consume raw milk and dairy products have a 9% decreased risk in seropositivity (prevalence ratio = 0.92; 95% CI: 0.84-0.99) compared to those who do not consume these products. CONCLUSION: This study reports a negative association between consumption of raw milk and seropositivity, and this is in line with several studies that report consumption of raw milk may be protective against H pylori. However, because of the risk of other serious pathogens associated with the consumption of raw dairy products, this study recommends pasteurization of raw milk. Future studies on the effect of fermented dairy products on H pylori colorization in gastric mucosa are recommended.

Prevalence, molecular characterization, and antimicrobial resistance profiles of Listeria monocytogenes, Salmonella enterica, and Escherichia coli O157:H7 on dairy cattle farms in Jordan.

This study determined the prevalence, pulsed-field gel electrophoresis profiles, and antimicrobial resistance profile of Listeria monocytogenes, Salmonella enterica, and Escherichia coli O157:H7 isolates from dairy cattle farms in Jordan. Samples from bulk tank milk (n = 305), cattle feces (n = 610), and rectoanal mucosal swabs (n = 610) were collected from 61 dairy cattle farms. We confirmed 32 L. monocytogenes, 28 S. enterica, and 24 E. coli O157:H7 isolates from the samples. The farm-level prevalence (at least 1 positive sample per farm) of L. monocytogenes, S. enterica, and E. coli O157:H7 was 27.9, 19.7, and 23.0%, respectively. The prevalence of L. monocytogenes, S. enterica, and E. coli O157:H7 in bulk tank milk was 7.5, 1.6, and 3.3%, respectively. The prevalence of L. monocytogenes and S. enterica in fecal samples was 1.5 and 3.8%, respectively, and the prevalence of E. coli O157:H7 in rectoanal mucosal swabs was 2.3%. Based on disk diffusion testing, all L. monocytogenes, S. enterica, and E. coli O157:H7 isolates exhibited resistance to at least 1 antimicrobial class. Multidrug resistance (resistance to 3 or more classes of antimicrobials) was exhibited by 96.9% of L. monocytogenes, 91.7% of E. coli O157:H7, and 82.1% of S. enterica isolates. Moreover, 93.8, 79.2, and 57.1% of the L. monocytogenes, E. coli O157:H7, and S. enterica isolates, respectively, were resistant to 5 or more antimicrobial classes. More than 50% of L. monocytogenes isolates were resistant to ampicillin, clindamycin, penicillin, erythromycin, quinupristin-dalfopristin, streptomycin, teicoplanin, linezolid, vancomycin, kanamycin, and tetracycline. More than 50% of S. enterica and E. coli O157:H7 isolates were resistant to ampicillin, cephalothin, nalidixic acid, kanamycin, streptomycin, amoxicillin-clavulanic acid, and tetracycline. The prevalence of the studied pathogens this study was comparable to reports from other countries. The isolated pathogens exhibited a high degree of antimicrobial resistance, suggesting that the bacterial flora of dairy cattle in Jordan are under intense antimicrobial selection pressure. Additional research is required to determine the causes and drivers of resistance, and to develop approaches to mitigating antimicrobial resistance.

Zoonotic Anaplasma phagocytophilum, Ehrlichia canis, Dirofilaria immitis, Borrelia burgdorferi, and spotted fever group rickettsiae (SFGR) in different types of dogs.

Dogs can carry and share zoonotic pathogens with humans. This problem is understudied in different parts of the world, including Jordan. This study determined the prevalence of Anaplasma phagocytophilum, Ehrlichia canis, Dirofilaria immitis, and Borrelia burgdorferi using the SNAP 4Dx Plus test and spotted fever group rickettsiae (SFGR) using enzyme immunoassay IgG test in different types of dogs (farm/breeding, police, and stray) in Jordan. The results showed a very high seroprevalence (87%) of SFGR in dogs all over Jordan. Specifically, the seroprevalence was 97.0, 90.5 and 71.2% in farm, stray, and police dogs, respectively. Overall, 9.9% of dogs were seropositive for A. phagocytophilum. Specifically, 14.9% of farm, 14.3% of stray, and 0% of police dogs were seropositive. None of the studied dogs had D. immitis, E. canis, or B. burgdorferi. It can be concluded that SFGR and A. phagocytophilum are endemic in Jordan. This study suggests that controlling stray dogs and monitoring dog breeding farms should be considered as control measures to limit the transmission of SFGR and A. phagocytophilum and to limit their public health impact in Jordan. Moreover, further follow-up studies are needed to study these pathogens in the human population in Jordan.

Major diseases, extensive misuse, and high antimicrobial resistance of Escherichia coli in large- and small-scale dairy cattle farms in Jordan.

This study aimed to determine the major diseases, antimicrobial use, and resistance in commensal Escherichia coli in dairy cattle in Jordan. Forty-three (large, n = 21; small, n = 22) farms were surveyed. A validated questionnaire was administered to the herdsmen to elicit information about disease prevalence, antimicrobial knowledge, and antimicrobial use. In addition, fecal samples were collected from 5 lactating animals on each farm. A total of 520 E. coli isolates were tested for resistance to 12 antimicrobials. From the herdsmen's perspective, the diseases that require use of veterinary services in large and small production systems were mastitis (51.2%), metritis (51.2%), and enteritis (39.5%), and the most commonly used antimicrobials were oxytetracycline and streptomycin. Dairy herdsmen (83.7%) reported that it is easy to purchase antimicrobials without a veterinary prescription and 97.7% of them more frequently changed the antimicrobial drug rather than increasing the dose when presented with nonresponse to treatment. Escherichia coli isolates exhibited high resistance to streptomycin (47.5%), tetracycline (45.4%), and ampicillin (34.2%). Less than 10% of isolates were resistant to chloramphenicol, kanamycin, gentamicin, ciprofloxacin, and ceftriaxone. Overall, 64.6 and 37.1% of the E. coli isolates exhibited resistance to ≥1 antimicrobial and multidrug resistance (resistance to ≥3 antimicrobial classes), respectively. The isolates exhibited 107 antimicrobial resistance profiles. This study indicates that antimicrobials are frequently misused in dairies in Jordan and that resistance among commensal E. coli toward antimicrobials of human and veterinary importance is high. Therefore, educational programs for herdsmen and enacting regulations and guidelines are necessary to promote the judicious use of antimicrobials in dairy animals in Jordan.

High prevalence and antimicrobial resistance of mecA Staphylococcus aureus in dairy cattle, sheep, and goat bulk tank milk in Jordan.

The aim of this study was to determine the prevalence and antimicrobial resistance of mecA and mecC methicillin-resistant Staphylococcus aureus (MRSA) in cattle, sheep, and goat dairy farms in Jordan. Milk samples were collected from bulk tanks at 117 dairy farms (44 cattle, 47 sheep, and 26 goat dairy farms) in each region of the country. MRSA were isolated on mecA and mecC chromogenic media and confirmed by PCR. The confirmed isolates were tested for resistance toward 15 antimicrobials by the disc diffusion method. None of the tested bulk milk samples were positive for mecC and 26% (95% CI 20-32%) were positive for mecA MRSA. Specifically, mecA MRSA was detected in 31.8% (95% CI 17.5-46.1) of cattle, 29.8% (95% CI 16.2-43.4) of sheep, and 11.5% (95% CI - 1.6-24.7%) of goat dairy farms. All isolates (n = 86) exhibited resistance to penicillin, oxacillin, cefoxitin; meanwhile, most isolates (70-85%) exhibited resistance toward gentamicin, clindamycin, rifampicin, neomycin, fusidic acid, erythromycin, tetracycline, and ciprofloxacin. All mecA MRSA isolates were resistant to at least one class of antimicrobials. Isolates from all goat milk, 88% of cattle milk, and 87% of sheep milk samples exhibited resistance to three classes of antimicrobials and were considered multidrug resistant (MDR). These data demonstrate widespread MDR MRSA in dairy ruminants in Jordan, and these rates are higher than those reported in other countries. Such high prevalence of MDR MRSA and mecA MRSA could lead to economic losses in the dairy industry in Jordan and poses a possible public health risk.

Design and Analysis of an Enhanced Patient-Server Mutual Authentication Protocol for Telecare Medical Information System.

In order to access remote medical server, generally the patients utilize smart card to login to the server. It has been observed that most of the user (patient) authentication protocols suffer from smart card stolen attack that means the attacker can mount several common attacks after extracting smart card information. Recently, Lu et al.'s proposes a session key agreement protocol between the patient and remote medical server and claims that the same protocol is secure against relevant security attacks. However, this paper presents several security attacks on Lu et al.'s protocol such as identity trace attack, new smart card issue attack, patient impersonation attack and medical server impersonation attack. In order to fix the mentioned security pitfalls including smart card stolen attack, this paper proposes an efficient remote mutual authentication protocol using smart card. We have then simulated the proposed protocol using widely-accepted AVISPA simulation tool whose results make certain that the same protocol is secure against active and passive attacks including replay and man-in-the-middle attacks. Moreover, the rigorous security analysis proves that the proposed protocol provides strong security protection on the relevant security attacks including smart card stolen attack. We compare the proposed scheme with several related schemes in terms of computation cost and communication cost as well as security functionalities. It has been observed that the proposed scheme is comparatively better than related existing schemes.

Heavy metals in fish from the Red Sea, Arabian Sea, and Indian Ocean: effect of origin, fish species and size and correlation among the metals.

This study determined the levels of As, Cu, Pb, and Cd in fish from Red Sea, Arabian Sea, and Indian Ocean by graphite furnace atomic absorption spectrophotometry. Metal levels were compared with international standards. The levels among fish types and origin, the relationship among metals, and the correlation between the levels and fish size were statistically tested. Fish type and origin significantly affected the levels. None of the fish contained As, Cu, and Pb above the FAO and EU codes. However, Cd exceeded the Jordanian, FAO, and EC codes from the three origins. As and Cd positively correlated with each other in Arabian Sea fish. As and Pb correlated negatively, but Cu and Cd did not correlate with fish size. This study indicates that Cd is common in fish from the three origins regardless the fish size. This warrants continuous monitoring for heavy metals, especially Cd, in internationally traded fish.

High multidrug resistance of Listeria monocytogenes and association with water sources in sheep and goat dairy flocks in Jordan.

Listeria monocytogenes is a significant pathogen that causes listeriosis in humans and small ruminants. This study aimed to estimate the prevalence, antimicrobial resistance and risk factors of L. monocytogenes in small dairy ruminants in Jordan. A total of 948 milk samples were collected from 155 sheep and goat flocks across Jordan. L. monocytogenes was isolated from the samples, confirmed and tested for 13 clinically important antimicrobials. Data were also collected on the husbandry practices to identify risk factors for the presence of L. monocytogenes. The results showed that the flock-level prevalence of L. monocytogenes was 20.0% (95% CI; 14.46%-26.99%) and the prevalence in the individual milk samples was 6.43% (95% CI; 4.92%-8.36%). The univariable (UOR=2.65, p = 0.021) and multivariable (AOR=2.49, p = 0.028) analyses showed that using water from municipality pipelines as a water source in the flock reduced L. monocytogenes prevalence. All L. monocytogenes isolates were resistant to at least one antimicrobial. High percentages of the isolates were resistant to ampicillin (83.6%), streptomycin (79.3%), kanamycin (75.0%), quinupristin/dalfopristin (63.8%) and clindamycin (61.2%). About 83.6% of the isolates (94.2% and 75% of the sheep and goat isolates) exhibited multidrug resistance (resistance to ≥3 antimicrobial classes). In addition, the isolates exhibited fifty unique antimicrobial resistance profiles. Thus, it's recommended to restrict the misuse of clinically important antimicrobials and to chlorinate and monitor the water sources in sheep and goat flocks.

Traceable Attribute-Based Encryption With Equality Test for Cloud Enabled E-Health System.

The emerging Internet of Things (IoTs) and cloud technologies spark dramatic growth in efficiency and productivity for the conventional e-health sector. However, the extensive applications of the communication network also expose the sensitive medical data to the unprecedented cyber threats. To protect the data privacy in IoTs-based e-health cloud environments, we propose an adaptively secure data sharing scheme with traceability and equality test (T-ABEET). The T-ABEET not only allows flexible access control to the massive data but also provides the functionality of traitor tracing to identity the users who leak their decryption keys. Meanwhile, through carrying out the equality test, the target ciphertext can be retrieved efficiently without revealing anything about the plaintext. Particularly, distinct from previous traceable ABE works, the tracing cost in our T-ABEET scheme keeps constant even with the increasing number of users. Also, by introducing the multi-authority mechanism, our T-ABEET can avoid the inherent key escrow problem of ABE. Furthermore, our T-ABEET is demonstrated adaptively secure under subgroup decision assumption. Finally, performance comparison reveals that our T-ABEET has superior practicality, efficiency, and security in cloud-enabled e-health systems.

A COVID-19 X-ray image classification model based on an enhanced convolutional neural network and hill climbing algorithms.

The classification of medical images is significant among researchers and physicians for the early identification and clinical treatment of many disorders. Though, traditional classifiers require more time and effort for feature extraction and reduction from images. To overcome this problem, there is a need for a new deep learning method known as Convolution Neural Network (CNN), which shows the high performance and self-learning capabilities. In this paper,to classify whether a chest X-ray (CXR) image shows pneumonia (Normal) or COVID-19 illness, a test-bed analysis has been carried out between pre-trained CNN models like Visual Geometry Group (VGG-16), VGG-19, Inception version 3 (INV3), Caps Net, DenseNet121, Residual Neural Network with 50 deep layers (ResNet50), Mobile-Net and proposed CNN classifier. It has been observed that, in terms of accuracy, the proposed CNN model appears to be potentially superior to others. Additionally, in order to increase the performance of the CNN classifier, a nature-inspired optimization method known as Hill-Climbing Algorithm based CNN (CNN-HCA) model has been proposed to enhance the CNN model's parameters. The proposed CNN-HCA model performance is tested using a simulation study and contrasted to existing hybridized classifiers like as Particle Swarm Optimization (CNN-PSO) and CNN-Jaya. The proposed CNN-HCA model is compared with peer reviewed works in the same domain. The CXR dataset, which is freely available on the Kaggle repository, was used for all experimental validations. In terms of Receiver Operating Characteristic Curve (ROC), Area Under the ROC Curve (AUC), sensitivity, specificity, F-score, and accuracy, the simulation findings show that the CNN-HCA is possibly superior than existing hybrid approaches. Each method employs a k-fold stratified cross-validation strategy to reduce over-fitting.

Sheep and goat milk in Jordan is a reservoir of multidrug resistant extended spectrum and AmpC beta-lactamases Escherichia coli.

Limited data is available on the prevalence and antimicrobial resistance of extended spectrum (ESBL) and AmpC ß-lactamases Escherichia coli in sheep and goats in Jordan. This study determined the molecular prevalence and antimicrobial-resistance of ESBL and AmpC ß-lactamases E. coli in 155 sheep and goat flocks across Jordan by testing 948 milk samples. The samples were enriched in MacConkey broth, and then plated on MacConkey agar with cefotaxime. The presence of ESBL and AmpC genes in the E. coli isolates was determined by PCR and the resistance toward critically important antimicrobials was tested by disc diffusion. In total, 1016 E. coli isolates were isolated from the cefotaxime supplemented MacConkey, 382 isolates harbored ESBL genes and 54 harbored blaCMY. The prevalence of blaCTX-M, blaTEM, blaCMY and blaSHVE. coli in the milk samples were 33.5 %, 31.7 %, 5.7 %. and 1.1 %, respectively. At the flock level, 30.3 % flocks had ß-lactamase E. coli, specifically 25.2 %, 20.7 %, 5.2 % and 2.6 % had blaCTX-M, blaTEM, blaCMY and blaSHV E. coli, respectively. About 52.2 % of the isolates harbored both blaCTX-M and blaTEM. A high percentage (>59 %) of ESBL and AmpC ß-lactamases E. coli resisted sulfamethoxazole/trimethoprim, tetracycline and nalidixic acid. Overall, 93.5 % and 96.3 % of ESBL and AmpC E. coli were resistant to ≥1 another antimicrobial class and 44.5 % and 44.4 % were resistant to ≥3 another antimicrobial class, respectively. This study shows that sheep and goat milk is a reservoir of multidrug resistant ESBL and AmpC ß-lactamases E. coli, thus good hygienic practices and judicious antimicrobials use are important in small ruminants' farming.

Urinary tract virulence genes in extended-spectrum beta-lactamase E. coli from dairy cows, beef cattle, and small ruminants.

Extended-spectrum ß-lactamase Escherichia coli is an important cause of urinary tract infections in humans. ESBL producers E. coli were reported in food-producing animals, but no previous study reported the virulence potential of these isolates. Thus, this study determined the virulence potential of ESBL producers E. coli isolates from 518 beef feces, 610 dairy cow feces, 305 dairy cow milk, 503 sheep milk and 445 goat milk samples. A total of 278 isolates; specifically, 130 from beef feces, 39 from the cow's feces, 42 from cow's milk, 44 from sheep milk and 23 from goats' milk were isolated and then tested for 14 virulence genes by polymerase chain reaction. After that, the correlation of virulence genes presence among the isolates was determined statistically. Overall, 97% of the isolates carried fimH, 39% carried iroN E. coli and 32% carried papC. The kpsMT K1, cnf1, papAH, papG allele II & III, papG allele II, and kpsMT II were carried by 6 to 23% of the isolates, while less than 6% of the isolates carried papG allele III, papG allele I, Univcnf, iutA and hlyA. About 68.2% of the isolates carried two or more virulence genes and 41.8% carried three or more. Moreover, the isolates had 71 different profiles of virulence genes, where the most common profiles were fimH alone (86 isolate), fimH + iroN E. coli (35 isolate), fimH + papC (20 isolate), and fimH + papC + iroN E. coli (13 isolate). The adhesion, capsule synthesis and toxins secretion genes were significantly associated (p Ë‚ 0.01) with each other. These results call for awareness about the risk of food animals as reservoirs of ESBL uropathogenic E. coli that would threaten public health and limits the treatment options for urinary tract infections.

The Role of Internet of Things to Control the Outbreak of COVID-19 Pandemic.

Currently, COVID-19 pandemic is the major cause of disease burden globally. So, there is a need for an urgent solution to fight against this pandemic. Internet of Things (IoT) has the ability of data transmission without human interaction. This technology enables devices to connect in the hospitals and other planned locations to combat this situation. This article provides a road map by highlighting the IoT applications that can help to control it. This study also proposes a real-time identification and monitoring of COVID-19 patients. The proposed framework consists of four components using the cloud architecture: 1) data collection of disease symptoms (using IoT-based devices); 2) health center or quarantine center (data collected using IoT devices); 3) data warehouse (analysis using machine learning models); and 4) health professionals (provide treatment). To predict the severity level of COVID-19 patients on the basis of IoT-based real-time data, we experimented with five machine learning models. The results reveal that random forest outperformed among all other models. IoT applications will help management, health professionals, and patients to investigate the symptoms of contagious disease and manage COVID-19 +ve patients worldwide.

Contact Tracing Incentive for COVID-19 and Other Pandemic Diseases From a Crowdsourcing Perspective.

Governments of the world have invested a lot of manpower and material resources to combat COVID-19 this year. At this moment, the most efficient way that could stop the epidemic is to leverage the contact tracing system to monitor people's daily contact information and isolate the close contacts of COVID-19. However, the contact tracing data usually contains people's sensitive information that they do not want to share with the contact tracing system and government. Conversely, the contact tracing system could perform better when it obtains more detailed contact tracing data. In this article, we treat the process of collecting contact tracing data from a crowdsourcing perspective in order to motivate users to contribute more contact tracing data and propose the incentive algorithm named CovidCrowd. Different from previous works where they ask users to contribute their data voluntarily, the government offers some reward to users who upload their contact tracing data to reimburse the privacy and data processing cost. We formulate the problem as a Stackelberg game and show there exists a Nash equilibrium for any user given the fixed reward value. Then, CovidCrowd computes the optimal reward value which could maximize the utility of the system. Finally, we conduct a large-scale simulation with thousands of users and evaluation with real-world data set. Both results show that CovidCrowd outperforms the benchmarks, e.g., the user participating level is improved by at least 13.2% for all evaluation scenarios.

Prevalence and antimicrobial resistance of Listeria monocytogenes, Salmonella enterica and Escherichia coli O157:H7 in imported beef cattle in Jordan.

This study characterized Listeria monocytogenes, Salmonella enterica, and E. coli O157:H7 by collecting rectoanal mucosal swabs and fecal samples from 518 imported beef cattle at Jordan's major abattoir. A unique 53 L. monocytogenes, 287 S. enterica, and 17 E. coli O157:H7 were isolated from 37, 120 and 9 different animals; respectively. The prevalence of S. enterica, L. monocytogenes and E. coli O157:H7 were 23.2 % (95 % CI, 19.7-27.0 %), 7.1 % (95 % CI, 5.2-9.7 %) and 1.7 % (95 % CI, 0.9-3.3 %); respectively. All L. monocytogenes, all E. coli O157:H7 and 93.0 % of S. enterica isolates resisted at least one antimicrobial class. All L. monocytogenes, 94.1 % of E. coli O157:H7 and 69.7 % of S. enterica isolates exhibited multidrug resistance (resistant to ≥3 antimicrobials classes). Moreover, high percentages of L. monocytogenes (98.1 %), E. coli O157:H7 (64.7 %) and S. enterica (45.3 %) isolates resisted ≥5 antimicrobial classes. More than 90 % of the L. monocytogenes isolates resisted ampicillin, penicillin and erythromycin and more than 75 % resisted vancomycin. S. enterica isolates resisted several treatment-of-choice antimicrobials such as nalidixic acid (85.4 %), ciprofloxacin (26.8 %) and ceftriaxone (19.5 %). Furthermore, greater than 50 % of the E. coli O157:H7 isolates resisted streptomycin, nalidixic acid, tetracycline, ampicillin, sulfamethoxazole-trimethoprim, kanamycin, chloramphenicol and ciprofloxacin. The high prevalence and the high resistance percentages of the studied pathogens toward clinically important antimicrobials is alarming. Thus, applying strict sanitation procedures at the abattoirs in Jordan is crucial to lower the risk of carcasses contamination.

Individual animal and herd level seroprevalence and risk factors of Hepatitis E in ruminants in Jordan.

OBJECTIVES: Hepatitis E virus (HEV) is zoonotic and endemic in several countries. There are no data on the farm level-prevalence and risk factors of HEV in ruminant farms in Jordan or elsewhere. This study aimed to estimate the seroprevalence and risk factors of HEV in ruminant farms in all regions of Jordan. MATERIAL AND METHODS: A total of 460 apparently healthy ruminants from 115 (31 cow, 51 sheep and 33 goat) farms were tested for HEV antibodies using a double antigen sandwich enzyme linked immunosorbent test. A validated questionnaire was used to collect data on animal health and husbandry practices. RESULTS: The results showed that 37.4% of the dairy farms under study (51.6%, 37.2% and 24.2% of dairy cow, sheep and goat farms; respectively) had at least one HEV seropositive animal. At the individual animal level, 12.1% of the tested animals were HEV positive; 14.5% (n = 18), 12.7% (n = 26) and 8.3% (n = 11) of cows, sheep and goats; respectively. Infrequent cleaning of feeders was associated with a significantly greater odds of HEV seropositivity in both large and small dairy ruminant farms (AOR = 16.0, p-val = 0.03, AOR = 3.4, p-val = 0.02, respectively). Farms which reported that small ruminants (sheep and goats) were mixed together had a greater odds of farm-level HEV seroprevalence (AOR = 3.1, p-val = 0.04). CONCLUSIONS: This study shows widespread and high farm-level HEV seroprevalence in dairy farms in Jordan. Husbandry practices and off-abattoir carcass processing in Jordan could amplify emergence and transmission of zoonotic HEV. Future studies should include HEV genotyping in ruminants, their products and humans to better understand HEV epidemiology in Jordan.

Effect of Low-dose ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart Surgery Patients: END-AF Low Dose Trial.

BACKGROUND: Studies using 1 mg of colchicine to prevent postoperative atrial fibrillation (POAF) reported conflicting results. Moreover, colchicine was associated with significant gastrointestinal (GI) side effects. This study examined whether low-dose colchicine effectively prevents POAF and whether low-dose therapy is associated with lower rates of colchicine-induced GI side effects. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, consecutive adult patients admitted for elective cardiac surgeries randomly received a 1-mg dose of colchicine (n = 81) or placebo (n = 71) orally 12 to 24 hours before surgery followed by a daily dose of 0.5 mg until hospital discharge. The primary efficacy endpoint was the development of at least one episode of POAF of ≥5 minutes. The primary safety endpoint was the development of adverse events, especially diarrhea. RESULTS: The in-hospital mortality rate was 3.9%. POAF occurred in 13 patients (16.1%) in the colchicine group and 13 patients (18.3%) in the placebo group (odds ratio 0.85 [95% Confidence Interval = 0.37-1.99]). Diarrhea occurred in two patients in each group and necessitated treatment discontinuation in one patient in each group. CONCLUSION: Low-dose colchicine did not prevent POAF in patients undergoing cardiac surgery. These results should be interpreted cautiously because of the small sample size and early study termination.ClinicalTrials.gov Unique Identifier number: NCT03015831.

Seroepidemiology, Spatial Distribution, and Risk Factors of Francisella tularensis in Jordan.

There is a paucity of data on Francisella tularensis in the Middle East and North Africa. This is the first countrywide study to determine the seroprevalence, spatial distribution, and risk factors for F. tularensis in Jordan. A total of 828 Jordanians were serologically tested for F. tularensis by ELISA. These individuals filled out a self-administered questionnaire to collect demographic and risk factor information. Bivariate and multivariate logistic regressions were performed to determine which variables are associated with seropositivity. The overall seroprevalence of F. tularensis was 7.7% (95% CI: 6.10-9.75). The bivariate analyses showed that age, region of residence, small ruminant ownership, and practicing horticulture were significantly associated with seropositivity, and these variables were controlled for in the multivariate analysis. The multivariate analysis showed an increased odds of seropositivity among individuals living in northern desert, middle, and northern highland areas, compared with individuals living in the drier southern area, as 7.27 (95% CI: 2.49-21.19), 3.79 (95% CI: 1.53-9.39), and 3.52 (95% CI: 1.45-388.55), respectively. Individuals owning a small ruminant had 1.86 (95% CI: 1.02-3.40) greater odds for seropositivity than individuals who do not own a small ruminant. Individuals practicing horticulture had 2.10 (95% CI: 1.20-3.66) greater odds for seropositivity than individuals who do not practice horticulture. This is the first study to address the seroprevalence of F. tularensis in Jordan and the Middle East. Further research is needed to identify clinical cases of tularemia in Jordan and to determine the circulating F. tularensis subspecies.

Inactivation of Escherichia coli O157:H7 on the intact and damaged portions of lettuce and spinach leaves by using allyl isothiocyanate, carvacrol, and cinnamaldehyde in vapor phase.

Antimicrobials in the vapor phase might be more effective in inactivating Escherichia coli O157:H7 cells attached to leafy greens than aqueous antimicrobials. We determined the activity of allyl isothiocyanate (AIT), cinnamaldehyde, and carvacrol against E. coli O157:H7 on intact and damaged lettuce and spinach tissue. Samples were treated with various concentrations of antimicrobial in the vapor phase at 0, 4, and 10 degrees C in an enclosed container. On intact lettuce surface, the vapor of the lowest concentration of these antimicrobials inactivated >4 log of E. coli O157:H7 at 0 and 4 degrees C in 4 days and at 10 degrees C in 2 days. However, at the tissue damaged by cutting, the highest concentration reduced the population by 4 log at 0 degrees C and 2 to 4 log at 4 degrees C in 4 days. These concentrations also reduced the population of the pathogen by 1 to 3 log at 10 degrees C in 2 days. The pathogen population on spinach surface was reduced by 1 log less than on lettuce surface. However, reduction of the pathogen within spinach tissue was 2 and 3 log less than within lettuce tissue at 0 and 4 degrees C, respectively. Overall, greater inactivation occurred on lettuce than spinach leaves and on the leaf surfaces than at the damaged area. Using antimicrobials in the vapor phase may improve the safety of refrigerated leafy greens marketed in sealed packages.