Association between occupational lead exposure and plasma levels of selected oxidative stress related parameters in Jordanian automobile workers

Objectives: To study any possible correlation between blood lead levels and some oxidative stress parameters of selected groups of lead-exposed automobile occupational Jordanian workers. Material and Methods: Blood lead levels were determined for a total of 90 male automobile workers aged within the range of 25–45 years old along with the group of 20 agematched healthy males control. To get an idea about the antioxidant status of controls and lead-exposed workers, and to estimate the oxidative stress caused by exposure to lead, we measured the hydrogen peroxide (H2O2) concentration, superoxide dismutase (SOD) activity, lipid peroxidation as malondialdehyde (MDA) and total antioxidant capacity of controls and workers. Results: The study showed that lead levels in the case of workers were approximately 4–5 times as high as in controls 14.5–21 μg×dl–1 vs. 4.3 μg×dl–1, respectively. There was a significant decrease (16–25%) in the level of plasma reduced glutathione and 21–33% decrease in total antioxidant capacity (TAOC) in all worker groups, as compared to controls. The results showed that the concentration of malondialdehyde (MDA) in plasma was higher (120–333%) in the case of workers than controls being the highest in automobile electronics and the lowest – in mechanics. Furthermore, there was 149–221% increase in hydrogen peroxide (H2O2) concentration, and 26–38% increase in SOD activity in the case of workers compared to the control group. Conclusions: There is a strong evidence for the associations between occupational lead exposure and various markers of oxidative stress in Jordanian automobile occupational workers. Thus, there is an urgent need to raise awareness and to initiate suitable protection guidelines for workers. Int J Occup Med Environ Health 2018;31(4):517–52

Non-Dexamethasone Corticosteroid Therapy’s Effect on COVID-19 Prognosis in Cancer Patients: A Retrospective Study

Background: Anti-inflammatory corticosteroids are used in cancer treatment and COVID-19 infections. Data on the impact of non-dexamethasone corticosteroids on COVID-19 infection severity in cancer patients are minimal. This study investigates if corticosteroid treatment affects the disease severity in adult cancer patients. Methods: A total of 116 COVID-19-infected cancer patients on hydrocortisone (H) or prednisone (P) were compared to 343 untreated patients. The study included patients who received corticosteroids before (B), after (A), or both before and after (B and A) COVID-19 infections. Ventilation support, hospitalization and mortality were investigated. Results: Our data showed that a significantly greater number of patients taking H or P required ventilation support and hospitalization and that mortality rates were higher than the control group. Patients who received H or P after COVID-19 infection had a significantly worse prognosis than the other sub-groups and the control group. Conclusion: Corticosteroids impacted cancer patients’ COVID-19 prognosis. Despite the limited sample size, H- and P-treated patients’ corticosteroids performed worse than the control, especially if treatments were received after COVID-19 infection. Hence, when a cancer patient already on H or P treatment is diagnosed with COVID-19, we recommend switching to a steroid treatment as suggested by international guidelines

Occupational exposure to pesticides and occurrence of the chromosomal translocation t(14;18) among farmers in Jordan

Background: An increased incidence of non-Hodgkin’s lymphoma (NHL) has been reported in farmers and other occupational groups working with pesticides. In these individuals, an increased prevalence of the chromosomal translocation t(14;18)(q32;q21), one of the most common chromosomal abnormalities in NHL, has been detected in peripheral blood lymphocytes. This translocation juxtaposes the antiapoptotic BCL2 protein to the immunoglobulin heavy chain gene locus (IGH) leading to overexpression of BCL2. This causes an increase in cell survival, paving the way for malignant transformation. Aim of the study: The present study aimed to evaluate the association between the occurrence of the chromosomal translocation t(14;18) and occupational exposure to pesticides among a group of Jordanian farmers. Methods: A total of 192 male subjects including 96 agricultural workers and 96 control subjects participated in this study. BCL2-IGH t(14;18) fusions were detected by a nested polymerase chain reaction (PCR) assay targeting the major breakpoint region (MBR). Results: We found that occupational exposure to pesticides in open-field farming and insecticide used on animals increased the frequency of the chromosomal translocation t(14;18). Farmers occupationally exposed to pesticides and insecticide were 13.5 times more likely to harbor t(14;18). 63.5% (61 of 96) of farmers compared to 11.5% (11 of 96) of controls carried the translocation (odds ratio: 13.5; 95% confidence interval (CI) = 6.3–28.6). We ruled out the influence of possible confounding factors such as age, duration of sun exposure, alcohol intake, smoking, and use of personal protective equipment. Conclusion: Our results indicate that pesticides increased the frequency of chromosomal translocation in the 14q32 region. Accordingly, the presented data agrees with previous suggestions from the literature that pesticides might be involved in the development of NHL through the t(14;18) pathway. Keywords: Pesticides, Translocation t(14;, 18), Follicular lymphom

The Effect of Dexamethasone Treatment on COVID-19 Prognosis in Cancer Patients

Background: Dexamethasone is used to treat cancer, relieve chemotherapy-induced nausea and vomiting, enhance cancer patients’ appetites, and treat COVID-19 patients. There is little evidence of the impact of a dexamethasone treatment plan on the severity of COVID-19 infections in cancer patients. This study explores whether dexamethasone treatment plan influences the severity of COVID-19 in dexamethasone-treated cancer patients. Methods: The medical records of 108 cancer patients receiving dexamethasone at King Hussein Cancer Center with a COVID-19 infection and 343 without corticosteroid treatment were reviewed. Patients on dexamethasone within seven days before infection, after infection, or both were included. Ventilation support, hospitalization, and mortality within 28 days of a COVID-19 diagnosis were key severity factors. Results: We found that dexamethasone before a COVID-19 infection increased the risk of requiring ventilation assistance and mortality within 28 days by a factor of 5.8 (2.8–12.0) relative to control (p < 0.005). Continuing dexamethasone treatment after a COVID-19 infection, or starting it after infection, had a risk factor equivalent to control. Conclusion: Our data showed that dexamethasone therapy protocol affected COVID-19 prognoses in cancer patients, and it is preferable to not discontinue therapy after infection. A rigorous prospective comparison between early and late dexamethasone dosing is needed to determine the best protocol for treatment

Investigating the Utility of the SOFA Score and Creating a Modified SOFA Score for Predicting Mortality in the Intensive Care Units in a Tertiary Hospital in Jordan

Background. The utility of the Sequential Organ Failure Assessment (SOFA) score in predicting mortality in the intensive care unit (ICU) has been demonstrated before, but serial testing in various settings is required to validate and improve the score. This study examined the utility of the SOFA score in predicting mortality in Jordanian ICU patients and aimed to find a modified score that required fewer laboratory tests. Methods. A prospective observational study was conducted at Jordan University Hospital (JUH). All adult patients admitted to JUH ICUs between June and December 2020 were included in the study. SOFA scores were measured daily during the whole ICU stay. A modified SOFA score (mSOFA) was constructed from the available laboratory, clinical, and demographic data. The performance of the SOFA, mSOFA, qSOFA, and SIRS in predicting ICU mortality was assessed using the area under the receiver operating characteristic curve (AUROC). Results. 194 patients were followed up. SOFA score (mean ± SD) at admission was significantly higher in non-survivors (7.5 ± 3.9) compared to survivors (2.4 ± 2.2) and performed the best in predicting ICU mortality (AUROC = 0.8756, 95% CI: 0.8117–0.9395) compared to qSOFA (AUROC = 0.746, 95% CI: 0.655–0.836) and SIRS (AUROC = 0.533, 95% CI: 0.425–0.641). The constructed mSOFA included points for the hepatic and CNS SOFA scores, in addition to one point each for the presence of chronic kidney disease or the use of breathing support; it performed as well as the SOFA score in this cohort or better than the SOFA score in a subgroup of patients with heart disease. Conclusion. SOFA score was a good predictor of mortality in a Jordanian ICU population and better than qSOFA, while SIRS could not predict mortality. Furthermore, the proposed mSOFA score which employed fewer laboratory tests could be used after validation from larger studies