Assessment of Sanitary Conditions in the Main Swimming Pools in Gaza Strip (2010 -2013): Palestine

Abstract. Approximately 1.7 million inhabitants of 378 km 2 areaofGazaStripdon'thaveenoughrecreationalareas,except Gaza beach which suffers from sewage pollution as well as some public and private swimming pools which considered as merely recreational places. The main objective of this study is to assess the microbiological quality of swimming pools water in Gaza Strip to assure its health safety for swimmers. Sampling and analysis were conducted by the Ministry of Health over a period of about four years (2010)(2011)(2012)(2013). Samples were collected from seven central swimming pools in Gaza Strip periodically and examined for Total Coliforms and Faecal Coliforms. In addition, Staphylococcus aureus, Faecal Streptococcus and Pseudomonas aeruginosa were isolated from the swimming pools samples with different percentages. Percentages of microbial contamination, concentration of free chlorine and pH level were examined in the studied swimming pools and compared with the international standards and the annual trends were demonstrated. The results show that, about 75% of the recorded data regarding pH level are unacceptable, while 100% of the recorded data about the concentration of free chlorine within the swimming pools are unacceptable. About 57% of the collected samples were contaminated by Total Coliforms, 39% were contaminated by Faecal Coliforms, 46% were contaminated by Staphylococcus aureus, 21% were contaminated by Pseudomonas aeruginosa and 18% were contaminated by Faecal streptococci. The annual trends show increase in percentage of contamination to be the worst during the year 2013. Therefore, proper intensive surveillance and water chlorination is needed periodically

Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.info:eu-repo/semantics/publishedVersio

Is Gaza Sandy Shoreline Region Contaminated with Human Gastrointestinal Parasites?

The study was implemented to test if the sandy shoreline of Gaza city is contaminated with human gastrointestinal parasites or not and to determine the types of intestinal parasites and the extent of contamination. A total of 104 s and samples ( 52 dry sand and 52 wet sand were analyzed during the summer season period. Samples were collected from the study area of about 12km along the seashore region of Gaza City. Dry samples and wet sand samples were analyzed using water-sedimentation technique and a light microscope. The results showed that the percentage of the parasitic contamination was 40.4% of the wet sand samples and 34.6% of the dry sand samples along the shoreline region of the Gaza City. The human gastrointestinal parasites detected were the following: Ascaris lumbricoides, S. stercoralis, E. vermicularis, E. histolytica/dispar, G. lamblia, E. coli and Taenia. spp. The findings showed that there was no statistically significant difference in the concentration of parasitic contamination between the dry and wet sand samples at confidence level of p-value < 0.05. It is recommended to conduct a periodical routine sampling of sand at the swash zone because the results of this study showed that the wet and the dry sand may pose a high level of health risk. Residents should be informed clearly by posting signs indicating polluted areas to keep them safe

Is Gaza Sandy Shoreline Region Contaminated with Human Gastrointestinal Parasites?

The study was implemented to test if the sandy shoreline of Gaza city is contaminated with human gastrointestinal parasites or not and to determine the types of intestinal parasites and the extent of contamination. A total of 104 s and samples (52 dry sand and 52 wet sand) were analyzed during the summer season period. Samples were collected from the study area of about 12km along the seashore region of Gaza City. Dry samples and wet sand samples were analyzed using water-sedimentation technique and a light microscope. The results showed that the percentage of the parasitic contamination was 40.4% of the wet sand samples and 34.6% of the dry sand samples along the shoreline region of the Gaza City. The human gastrointestinal parasites detected were the following: Ascaris lumbricoides, S. stercoralis, E. vermicularis, E. histolytica/dispar, G. lamblia, E. coli and Taenia. spp. The findings showed that there was no statistically significant difference in the concentration of parasitic contamination between the dry and wet sand samples at confidence level of p-value < 0.05. It is recommended to conduct a periodical routine sampling of sand at the swash zone because the results of this study showed that the wet and the dry sand may pose a high level of health risk. Residents should be informed clearly by posting signs indicating polluted areas to keep them safe

The effect of persulfate oxidation on the biodegradability of concentrated anaerobic stabilized leachate

Anaerobic stabilized landfill leachate was treated by persulfate (S2O82−) oxidation. The effect of three factors namely; persulfate dosage, pH and reaction time on COD and NH3-N removals; was studied. The results of analysis of variance (ANOVA) showed that the selected factors significantly affected the percentage of COD and NH3-N removals. Furthermore, the maximum removal was achieved at 60 min of persulfate oxidation, a COD/S2O82− ratio (1 g/4.2 g), and pH7, the percentage of removals for COD and NH3-N were 45% and 55%, respectively. The effect of persulfate oxidation on the biodegradability of leachate was also investigated. The results showed that the BOD5/COD ratio improved from 0.09 to 0.1. The oxidation enhanced the biodegradable (CODbi) from 36% to 57%. Hence, persulfate is suitable to pre-treat highly-concentrated stabilized leachate. This process should follow the organic degradation and ammonia removal followed by biological treatment processes

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years : a prospective multicentre cohort study

Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged >= 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Purpose The number of patients >= 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (+/- 2 years), Sequential Organ Failure Assessment (SOFA) score (+/- 2 points), clinical frailty scale (+/- 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear

Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

Background!#!The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe.!##!Methods!#!This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265).!##!Results!#!In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p &amp;lt; 0.0001). The PaO!##!Conclusion!#!An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients.!##!Trial registration number!#!NCT04321265 , registered March 19th, 2020