Salinization of groundwater during 20 years of agricultural irrigation, Luxor, Egypt.

Groundwater salinization is a global problem accounting for 11-30% of the world's irrigated areas. Luxor region in Upper Egypt is one of such areas affected by salinity. Multivariate statistics indicate that groundwater is affected by intermixed processes; mineralization (salinization), fertilization, domestic wastes, and meteoric recharge. Temporal change in salinity and hydrochemical facies during 1997-2017 revealed aquifer salinization, due to the dissolution of salts from overlain saline soil and marine deposits underneath as well as up-coning of deep saline water. Increasing salinity over time was statistically documented, exhibited temporally high significant differences (P < 0.05), where salinization consumed a quarter of the aquifer during 20 years. Evolution of water facies from less mineralized Ca-Cl, Mg-Cl to highly mineralized Na-Cl species explains the salinization process over time. Elevated content of Na and Cl is associated with the dissolution of marine sediments and saltwater intrusion. The shift from silicate weathering into evaporation dominance confirmed the saltwater intrusion. As a result, groundwater has a high degree of salinity, is not suitable for domestic and other uses. On other hand, fertilization and domestic sewage are probably responsible for the high NO3- and Cd content. Over 80% of Cd exists in mobile species facilitates Cd-plant uptake indicating an alarming environmental situation. Cd mobility is closely related to elevated salinity and chlorinity, allowing competition with major ions and forming of soluble complexes. The present approach will improve the uncertainties of environmental interpretation, as an initial step for aquifers management in reclaimed lands.

Multivariate statistics explaining groundwater chemistry, Asyut, Egypt.

Groundwater is an important source for domestic and irrigation purposes in Asyut area. Water quality varied widely due to complex geochemical processes and pollution sources. Understanding the processes controlling groundwater chemistry is necessary to overcome related problems. Multivariate statistics revealed that groundwater is affected by anthropogenic recharge (agricultural/organic pollution), mineralization, and redox processes. Contributions from natural vs. anthropogenic sources explain the variance in hydrochemical data. Shallow wells are relatively higher in bicarbonate content due to oxidation of organic pollutants. Shallow wells anomaly high with iron and organically polluted are most probably owing to pipe corrosion in residential areas. N fertilization impact on natural weathering has been demonstrated. Groundwater is getting more mineralized toward desert fringes due to lithological and hydrogeological characteristics under unconfined conditions. Evaporation factor enhances groundwater salinity under aridity. Fe and Mn contents are relatively higher as the redox potential is getting more reducing. The current study will help in building suitable management plan to protect the aquifer.

Siwa Oasis groundwater quality: factors controlling spatial and temporal changes.

Siwa Oasis is of great historical, environmental, and scientific importance, as it contains unique archeological and geological features. Groundwater is the main source of freshwater in that oasis. The carbonate aquifer groundwater, used for irrigation, was sampled to evaluate factors controlling quality changes spatially and temporally by applying hydrochemical and statistical analyses. The salinity of the aquifer varied spatially from 1367 to 8645 mg/l based on one hydrogeological condition, with the highest TDS (> 5432.5 mg/l, 25% of samples) at the central part of the study area. Temporally, the salinity changed slightly from 3754.3 mg/l (in 2014) to 4222.4 mg/l (in 2020). The cession of illegal wells, pumping control, and excavation of formed salts have a noticeable impact on salinity (mediate the increase in salinity) and ions. However, about 61% of the studied samples can be considered unsuitable for irrigation owing to salinity and can harm plant yield. The heavy metals studied (Fe, Mn, Cu, Pb), except Cd, were within the permissible limit for irrigation water. Finally, it is proposed to construct desalination stations to enhance water quality for irrigation in the study area and set up many companies for salt extraction.

Polyethylene Glycol 3350 Changes Stool Consistency and the Microbiome but not Behavior of CD1 Mice.

OBJECTIVES: Polyethylene Glycol 3350 (PEG3350) is a laxative commonly used to treat constipation in children. The Food and Drug Administration has received reports of increased anxiety, aggression, and obsessive--compulsive behaviors in children administered PEG3350. Thus, we assessed whether daily administration of PEG3350 leads to anxiety-like behavior in mice. METHODS: Outbred CD-1 IGS mice were administered either a high or a low dose of PEG3350 via daily oral gavage for 2 weeks. As a laxative comparison and control, additional mice were given a high or low dose of magnesium citrate or vehicle (water). Weight and stool consistency were assessed after each gavage to determine laxative effectiveness. Anxiety-like behaviors were assessed using light/dark, open field, and elevated plus maze (EPM) tests at baseline, after 2 weeks of daily gavage, and after a 2 week washout in experiment 1, and after 2 weeks of daily gavage in experiment 2. Stool samples were collected for microbiome analysis in experiment 2 at baseline, after 2 weeks of daily gavage, and after 2 weeks washout. RESULTS: PEG3350 and magnesium citrate significantly changed stool consistency, as well as microbiome alpha and beta diversity. Anxiety-like behaviors were not, however, different in mice administered low or high doses of PEG3350 or magnesium citrate. CONCLUSIONS: Although changes in stool consistency and the gut microbiome occurred, administration of PEG3350 did not alter anxiety-like behaviors.

Chemical and bacterial quality monitoring of the Nile River water and associated health risks in Qena-Sohag sector, Egypt.

The River Nile is the primary source of freshwater for drinking, irrigation, and industrial purposes in Egypt. Thus, the water quality in this river concerns the health of local inhabitants. The present study reveals seasonal variations of various physicochemical and heavy metals parameters and microbial load of water at 15 sites from Qena to Sohag cities, Egypt. The water is fresh with TDS ≤ 270 and 410 mg L-1 in summer and winter, respectively. Fe, Mn, Cd, Cr, Cu, Ni, and Zn concentrations were within drinking water specification in both seasons except Cr and Cd in summer. Viable numbers of total coliform, fecal coliform, and fecal streptococci were recorded in both seasons with fecal streptococci's disappearing in winter. The concentrations of salts and ions in winter were higher than summer due to decreased water quantity and flow rate in this season. On the other hand, heavy metals and bacteria were higher in summer owing to the rain and weathering of upstream rocks and increasing of human activities during the summer. The calculated water quality index (WQI) depicted that the chemical quality of water was poor for drinking and treatment, especially biological treatment, which is required before the water is supplied for drinking. Human health risk assessment factors such as probable daily intake, hazard quotient, and carcinogenic risk indicated high risks of Cr, Cd, and Ni for adults and children in both seasons. The non-carcinogenic and carcinogenic risks are mainly posed by Cr. The WQI values for the other water uses indicated the marginal quality for aquatic life, fair for irrigation, and fair in summer to good in winter for livestock consumption. The irrigation water quality parameters indicated that the water could be used to irrigate all soils and crops except the hazard of biological contamination. The water-rock interaction controls water chemistry besides the contribution of human activities. The agricultural, industrial, and municipal wastewaters were the main contributors to water pollution and should be treated before discharge into the Nile River. Source and drinking water should be monitored continuously to prevent related human waterborne diseases.

Shallow groundwater environmental investigation at northeastern Cairo, Egypt: quality and photo-treatment evaluation.

Groundwater represents the primary source of freshwater for more than 35% of world people, and its contamination became a worldwide challenge. Egypt is suffering from water quantity and quality, especially in desert areas. El Obour city and environs Northeast Cairo face waterlogging owing to the elevated-shallow groundwater table. In the present research work, the water quality of the shallow groundwater aquifer was studied. The remediation efficiency of polluted water using photocatalytic treatment technique in the presence of modified nano-titania and solar radiation has also been investigated. Twenty-eight representative samples have been collected from different locations, and their microbial, physical, and chemical characteristics were determined. The average contents of Pb (214.96 µg/L), As (1517 µg/L), Cd (8.79 µg/L), total bacterial count (2.22 × 105 CFU/ml), and bacterial indicators (MPN-index/100 ml): total coliform (497.4), fecal coliform (358.3), and fecal streptococci (115.9) were higher than WHO permissible limits for drinking water, possibly due to higher industrialization, agricultural, and urbanization rates. The organic pollutants reached critical concentrations (chemical oxygen demand up to 960.8 mg O2/L). Most of the studied samples contained acceptable concentrations of the major ions, (e.g., K+, Mg2+, HCO3-), for drinking and irrigation purposes. The statistical analyses (e.g., principal component analysis and cluster analysis) pointed out the control of water-rock interaction and anthropogenic activities in water composition. The hydrochemical data show that most of the water samples (96.4%) are Na2SO4 and NaHCO3 type, indicating its meteoric origin. The contamination with human and animal fecal substances, NO3¯, and NH4+ was identified in all samples, which pointed out the control of anthropogenic activities in water pollution. The photocatalytic technique efficiently eliminated more than 82-95% of organic contents and microbial pollutants, respectively, but it was inefficient in reducing heavy metal levels. According to the current results, shallow groundwater injection into the deep aquifer must be constrained and reusable after treatment. Finally, more studies are imperative to disseminate the applied treatment techniques to elude bacteria and organic pollutants from water at a pilot scale.

A Celiac Care Index Improves Care of Pediatric Patients Newly Diagnosed with Celiac Disease.

OBJECTIVES: To describe quality improvement efforts to reduce variability in the care of children diagnosed with celiac disease through use of an institutional patient registry and a chronic care index. STUDY DESIGN: An institutional patient registry tracked rates of follow-up visits and repeat serologic testing. A Celiac Care Index that included anthropometrics, biopsy expectations, dietician consultation, and baseline laboratory evaluation was developed to standardize evaluation at diagnosis. Provider education sessions communicated expectations for this standard of care and order sets within the electronic medical record simplified test collection. Data was recorded and reviewed weekly and structured communications with providers were provided biweekly. RESULTS: Adherence with follow-up expectations (77%-89% P = .03) and repeat serologic testing (50%-90% P < .0001) significantly increased during the study period. Adherence with completion of the Celiac Care Index resulted in significant improvement in obtaining complete blood count (80%-98% P < .0001), iron (25%-78% P < .0001), ferritin (34%-80% P < .0001), alanine aminotransferase/aspartate aminotransferase (74%-96% P < .0001), thyroid-stimulating hormone (64%-90% P < .0001), vitamin D (36%-83% P < .0001), and hepatitis B immune status (30%-80% P < .0001). Iron deficiency demonstrated by low ferritin levels was common (41%) and a high rate of nonimmunity to hepatitis B (70%) was detected. CONCLUSIONS: The Celiac Care Index improved adherence with published care recommendations and reduced variability in baseline evaluation at diagnosis. Laboratory test results indicate further studies are needed to evaluate these recommendations.

Environmental factors controlling potentially toxic element behaviour in urban soils, El Tebbin, Egypt.

This study focuses on the assessment of surface soils from industrially polluted region (El Tebbin) of southern Cairo, Egypt. The impact of agricultural, residential and industrial land use on soils developed from Nile river sediments has significantly compromised their function. Previous evidence has shown that the food chain is contaminated and enhances risk of contaminant exposure of the residential communities. This study investigates factors controlling potentially toxic element (PTE) distribution (Co, Ni, Pb, Cd, Zn, Cr and Cu) in El Tebbin soils and provide estimates of their mobility and bioavailability. The PTE concentrations are characterised by high variability as result of the variety of natural and anthropogenic influences. Highest spatial variability is found for Zn, Cd, Pb and Cu (C.V = 260.0%, 280.4%, 140.8% and 159.6% respectively) and enrichment factors indicate strong anthropogenic inputs. For Co and Ni, relatively low spatial variability (C.V = 65.8% and 45.0% respectively) with depletion in Ni suggests a relatively minor contribution from anthropogenic sources. For Cr, a more uniform distribution pattern showing depletion to minimal enrichment across the study area (C.V = 19.2%) reflects almost exclusive lithogenic control. Using principle component analysis (PCA) to explore concentration data reveals that the major inputs affecting PTE distribution are modified by primary soil properties (texture and pH). Their relative bioavailability (identified through sequential chemical extraction) relates strongly to local input sources. Those elements dominated by lithogenic input (Ni and Co) were found predominantly in soil residual fractions (95.6% and 90.5% respectively), while elements with stronger anthropogenic contributions (Cd, Zn, Pb and Cu) showed much higher portion in the more mobile and bioavailable fractions obtained from sequential chemical extraction, with average proportions of the totals being 62.6%, 57%, 40.7% and 39.2% respectively. Those PTEs with strong anthropogenic influence are potentially much more mobile for bioaccumulation in food chain with increased health risk for exposed residents and are confirmed by elevated concentrations of Cd, Zn, Pb and Cu recorded in local plant species. The main pollution sources were further highlighted by cluster analysis and showed vehicle traffic and specific industrial activities but which varied significantly from site to site. The identification of sources through the approach developed here allows prioritisation of monitoring and regulatory decisions by the local government to reduce further environmental exposure of the local population.

Dynamical System Modeling to Simulate Donor T Cell Response to Whole Exome Sequencing-Derived Recipient Peptides Demonstrates Different Alloreactivity Potential in HLA-Matched and -Mismatched Donor-Recipient Pairs.

Immune reconstitution kinetics and subsequent clinical outcomes in HLA-matched recipients of allogeneic stem cell transplantation (SCT) are variable and difficult to predict. Considering SCT as a dynamical system may allow sequence differences across the exomes of the transplant donors and recipients to be used to simulate an alloreactive T cell response, which may allow better clinical outcome prediction. To accomplish this, whole exome sequencing was performed on 34 HLA-matched SCT donor-recipient pairs (DRPs) and the nucleotide sequence differences translated to peptides. The binding affinity of the peptides to the relevant HLA in each DRP was determined. The resulting array of peptide-HLA binding affinity values in each patient was considered as an operator modifying a hypothetical T cell repertoire vector, in which each T cell clone proliferates in accordance with the logistic equation of growth. Using an iterating system of matrices, each simulated T cell clone's growth was calculated with the steady-state population being proportional to the magnitude of the binding affinity of the driving HLA-peptide complex. Incorporating competition between T cell clones responding to different HLA-peptide complexes reproduces a number of features of clinically observed T cell clonal repertoire in the simulated repertoire, including sigmoidal growth kinetics of individual T cell clones and overall repertoire, Power Law clonal frequency distribution, increase in repertoire complexity over time with increasing clonal diversity, and alteration of clonal dominance when a different antigen array is encountered, such as in SCT. The simulated, alloreactive T cell repertoire was markedly different in HLA-matched DRPs. The patterns were differentiated by rate of growth and steady-state magnitude of the simulated T cell repertoire and demonstrate a possible correlation with survival. In conclusion, exome wide sequence differences in DRPs may allow simulation of donor alloreactive T cell response to recipient antigens and may provide a quantitative basis for refining donor selection and titration of immunosuppression after SCT.

Dynamical System Modeling of Immune Reconstitution after Allogeneic Stem Cell Transplantation Identifies Patients at Risk for Adverse Outcomes.

Systems that evolve over time and follow mathematical laws as they evolve are called dynamical systems. Lymphocyte recovery and clinical outcomes in 41 allograft recipients conditioned using antithymocyte globulin (ATG) and 4.5-Gy total body irradiation were studied to determine if immune reconstitution could be described as a dynamical system. Survival, relapse, and graft-versus-host disease (GVHD) were not significantly different in 2 cohorts of patients receiving different doses of ATG. However, donor-derived CD3(+) cell reconstitution was superior in the lower ATG dose cohort, and there were fewer instances of donor lymphocyte infusion (DLI). Lymphoid recovery was plotted in each individual over time and demonstrated 1 of 3 sigmoid growth patterns: Pattern A (n = 15) had rapid growth with high lymphocyte counts, pattern B (n = 14) had slower growth with intermediate recovery, and pattern C (n = 10) had poor lymphocyte reconstitution. There was a significant association between lymphocyte recovery patterns and both the rate of change of donor-derived CD3(+) at day 30 after stem cell transplantation (SCT) and clinical outcomes. GVHD was observed more frequently with pattern A, relapse and DLI more so with pattern C, with a consequent survival advantage in patients with patterns A and B. We conclude that evaluating immune reconstitution after SCT as a dynamical system may differentiate patients at risk of adverse outcomes and allow early intervention to modulate that risk.

Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become part of the arsenal to temporize patients in shock from severe hemorrhage. REBOA is used in trauma to prevent cardiovascular collapse by preserving heart and brain perfusion and minimizing distal hemorrhage until definitive hemorrhage control can be achieved. Significant side effects, including death, ischemia and reperfusion injuries, severe renal and lung damage, limb ischemia and amputations have all been reported. The aim of this article is to provide an update on complications related to REBOA. REBOA has emerged as a critical intervention for managing severe hemorrhagic shock, aiming to temporize patients and prevent cardiovascular collapse until definitive hemorrhage control can be achieved. However, this life-saving procedure is not without its challenges, with significant reported side effects. This review provides an updated overview of complications associated with REBOA. The most prevalent procedure-related complication is distal embolization and lower limb ischemia, with an incidence of 16% (range: 4-52.6%). Vascular and access site complications are also noteworthy, documented in studies with incidence rates varying from 1.2% to 11.1%. Conversely, bleeding-related complications exhibit lower documentation, with incidence rates ranging from 1.4% to 28.6%. Pseudoaneurysms are less likely, with rates ranging from 2% to 14%. A notable incidence of complications arises from lower limb compartment syndrome and lower limb amputation associated with the REBOA procedure. Systemic complications include acute kidney failure, consistently reported across various studies, with incidence rates ranging from 5.6% to 46%, representing one of the most frequently documented systemic complications. Infection and sepsis are also described, with rates ranging from 2% to 36%. Pulmonary-related complications, including acute respiratory distress syndrome and multisystem organ failure, occur in this population at rates ranging from 7.1% to 17.5%. This comprehensive overview underscores the diverse spectrum of complications associated with REBOA.

Prevalence and Awareness of Anterior Cruciate Ligament Injuries Among Full-Contact, Semi-contact, and Non-contact Sports Athletes in the Kingdom of Bahrain.

Background The anterior cruciate ligament (ACL) is a crucial connective tissue that links the femur to the tibia, playing a vital role in stabilizing the knee by resisting forward and rotational movements. ACL tears can occur due to both contact and non-contact sports injuries. Diagnosis and assessment typically involve the Lachman test and magnetic resonance imaging. Initial treatment focuses on reducing swelling, followed by physical therapy or surgery to restore long-term knee functionality. Objective This study aimed to assess the injury prevalence and awareness of ACL and the engagement of preventing training programs among Bahraini athletes across diverse sports. Methods A cross-sectional survey was utilized to evaluate injury prevalence and awareness of ACL and engagement in preventing training among 161 Bahraini athletes from different sports. Data were collected through a detailed questionnaire addressing demographics, sports involvement, ACL injury history, and preventive training. The analysis involved descriptive statistics, one-way ANOVA, and independent t-tests to compare knowledge across sports types. A chi-square test was performed to examine correlations between injury history and training. Results The results showed that athletes in full-contact sports exhibited significantly higher ACL injury awareness compared to those in semi-contact and non-contact sports. Furthermore, a higher percentage of athletes in semi-contact and non-contact sports reported a history of ACL injuries when compared to those in full-contact sports. However, there was no significant difference in the engagement of preventive exercise training across different sports categories. Conclusion A notable gap in ACL injury awareness exists among Bahraini athletes, varying significantly across sport types. The data highlight the need for customized educational programs catering to different sports.

The preparedness and knowledge of pharmacists and general practitioners in managing human monkeypox: a highly spreading infectious disease.

BACKGROUND: After the era of the COVID-19 pandemic, the role of pharmacists was emphasized in the battle against highly spreading and infectious diseases like human Monkeypox (hMPV). AIM: Assess the hMPV knowledge of the community, clinical pharmacists, and general practitioners (GPs) and raise their awareness about hMPV. METHODS: A web-based questionnaire was distributed randomly to Egyptian community pharmacists, clinical pharmacists, and GPs from all governorates. The questionnaire was divided into two sections: one for demographic information and the other for hMPV knowledge (nature of the disease, incubation period, transmission, symptoms, Prophylaxis, Prevention, and management). The evidence-based answers were provided after completing the submission. Data were descriptively analyzed using IBM SPSS software. RESULTS: From a total of 753 respondents, only 710 participants were included in the final data analysis. The % of respondents who presented good total knowledge scores about hMPV was comparable between study groups (P = 0.826). There were no differences between groups identifying different disease clinical characteristics (P = 0.689) and hMPV management (P = 0.324). Community pharmacists had better knowledge scores than GPs in the prevention and prophylaxis domain (P = 0.037). CONCLUSION: Pharmacists and GPs have good and similar knowledge levels of hMPV. However, a gap exists in recognizing the right hMPV incubation period, prophylaxis, and omitting antibiotics from hMPV management. Pharmacists and GPs are the frontline health care providers (HCPs), so they would require more knowledge enhancement about such contagious diseases to offer the best possible patient care.

COVID-19 Presenting With Acute Anicteric Hepatitis in Pediatric Patient: A Case Report.

The impact that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has on the hepatobiliary system is poorly described in the pediatric population compared with the adult population. In adults, gastrointestinal symptoms and marked elevation in liver enzymes in the setting of coronavirus disease 2019 (COVID-19) has been directly correlated with disease severity. This case is a unique presentation of a pediatric patient with a relatively mild disease course despite the presence of gastrointestinal symptoms and marked elevation in transaminases, suggesting that SARS-CoV-2 virus may cause isolated acute hepatitis in pediatric patients.

Septic arthritis of the knee joint secondary to Prevotella bivia.

Prevotella bivia is an obligatory anaerobic, gram-negative rod, which often produces a detectable beta-lactamase. To date, there has been only 3 descriptions of septic arthritis secondary to this microorganism in a patients pre-existing sever joint disease like rheumatoid arthritis and osteoarthritis or after joint prosthesis. We are reporting the first case of septic arthritis due to Prevotella bivia in a patient with no pre-existing joint symptoms.

Stem cell transplantation as a dynamical system: are clinical outcomes deterministic?

Outcomes in stem cell transplantation (SCT) are modeled using probability theory. However, the clinical course following SCT appears to demonstrate many characteristics of dynamical systems, especially when outcomes are considered in the context of immune reconstitution. Dynamical systems tend to evolve over time according to mathematically determined rules. Characteristically, the future states of the system are predicated on the states preceding them, and there is sensitivity to initial conditions. In SCT, the interaction between donor T cells and the recipient may be considered as such a system in which, graft source, conditioning, and early immunosuppression profoundly influence immune reconstitution over time. This eventually determines clinical outcomes, either the emergence of tolerance or the development of graft versus host disease. In this paper, parallels between SCT and dynamical systems are explored and a conceptual framework for developing mathematical models to understand disparate transplant outcomes is proposed.