Characterization of Contamination Around the Largest Lead Smelter in Egypt Carried Out Through a Cooperation Program between USA and Egypt

The Government of Egypt together USAID aimed to reduce the impact of lead smelters on the environment. The major site was in Shoubra El-Kheima, where the Awadulla Secondary Lead Smelter is situated.  The Awadulla Family Company owns about 70% of the lead smelters in Egypt. This work presents the results and conclusions of a detailed on-site and off-site contaminant characterization of the Awadulla Secondary Lead Smelter.    As part of the characterization of the smelter site, soil and dust samples were collected within and near the smelter using two methods. The first consisted of collecting bulk dust and soil samples from the floor and ground in the direct vicinity of the smelter. The second involved using wet wipes to collect dust samples from walls, smooth floors, duct work, window and ledges.  The results indicate that the most contaminated soils can be found in industrial areas and on public streets in Shoubra El-Kheima. The highest lead concentrations of more than 780,000 mg.kg-1 were found inside the smelter site. Concentrations at the El-Mahy Smelter nearby reached 302,275 mg.kg-1. Residential areas had considerably lower lead levels in soil and dust.  Samples of surface water and groundwater were collected and tested for lead contamination.  Only three samples had lead concentrations above detection limits, indicating water contamination is not a problem. The maximum area affected by deposition of lead from the Awadulla smelter appears to be no more than 500 m all around the smelter. The plan calls for moving the smelters to a new industrial area called Abu Zaabal.  This move will leave behind existing structures that are highly contaminated with lead dust.  El Gobierno egipcio, junto con USAID (Agencia Estadounidense Para el Desarrollo Internacional), pretendía reducir el impacto de los hornos de fundición de plomo sobre el medio ambiente. El emplazamiento principal está en Shoubra El-Kheima, donde se encuentra el horno de fundición de plomo secundario de Awadulla. La empresa de la familia Awadulla posee aproximadamente el 70% de los hornos de fundición de plomo en Egipto. Este trabajo presenta los resultados y las conclusiones de un detallado estudio de caracterización de contaminantes en el emplazamiento y fuera del emplazamiento del horno de fundición de plomo secundario de Awadulla. Como parte de la caracterización del emplazamiento del horno de fundición, se recogieron muestras de terreno y de polvo dentro de y cerca del horno de fundición usando dos métodos. Por una parte, se recogieron muestras de polvo y de terreno a granel del suelo y la tierra en las inmediaciones directas del horno de fundición y por otra, se recogieron muestras de polvo de paredes, suelos lisos, canalizaciones, ventanas y repisas utilizando toallitas húmedas. Los resultados indican que los terrenos más contaminados se encuentran en zonas industriales y en calles públicas en Shoubra El-Kheima. Las concentraciones más elevadas, de más de 780.000 mg/kg, están dentro del emplazamiento del horno de fundición. Las concentraciones en el cercano horno de fundición de El-Mahy eran de 302.275 mg/kg. Las zonas residenciales mostraron niveles de plomo considerablemente inferiores en terreno y polvo. Se recogieron muestras de agua superficial y agua subterránea y se les realizaron pruebas para detectar contaminación por plomo. Solamente tres muestras presentaban concentraciones de plomo por encima de los límites de detección, indicando que la contaminación del agua no supone un problema. El área máxima afectada por deposición de plomo procedente del horno de fundición de Awadulla parece no ser superior a 500 metros alrededor del horno de fundición. El plan requiere trasladar los hornos de fundición a una nueva zona industrial llamada Abu Zaabal. Este traslado dejará atrás estructuras existentes que están altamente contaminadas con polvo de plomo.En collaboration avec l'USAID, le Gouvernement égyptien a élaboré un projet visant à réduire l'impact des fonderies de plomb sur l'environnement. La principale fonderie concernée était l'Awadulla Secondary Lead Smelter située à Shoubra El-Kheima. L'Awadulla Family Company détient environ 70 % des fonderies de plomb en Egypte. Cet article présente les résultats et les conclusions d'une étude de caractérisation de contaminants sur site et hors site menée sur le site de l'Awadulla Secondary Lead Smelter. Dans le cadre de cette étude, des échantillons de terre et de poussière ont été recueillis dans et à proximité de la fonderie selon deux méthodes. La première méthode a consisté à recueillir des échantillons en vrac de poussière et de terre sur le sol de la fonderie et à proximité immédiate de celle-ci. La seconde méthode a consisté à recueillir des échantillons de poussière sur les murs, les sols lisses, les conduites, les fenêtres et les rebords de celles-ci, à l'aide de chiffons humides. Les résultats ont indiqué que les sols les plus contaminés étaient localisés dans les zones industrielles et les rues de Shoubra El-Kheima. Les plus fortes concentrations, supérieures à 780 000 mg/kg, ont été relevées sur le site même de la fonderie. Des concentrations de 302 275 mg/kg ont été constatées à la fonderie voisine d'El-Mahy. Les zones résidentielles ont affiché des taux de plomb nettement plus faibles dans le sol et la poussière. Des échantillons des eaux de surface et des eaux souterraines ont été recueillis et analysés afin de déterminer la contamination au plomb. Seuls trois échantillons ont présenté des concentrations en plomb supérieures aux limites de détection, indiquant que la contamination de l'eau n'était pas inquiétante. Le périmètre touché par des dépôts de plomb de la fonderie Awadulla semble être de 500 mètres autour de la fonderie maximum. Le programme préconise le déplacement des fonderies dans une nouvelle zone industrielle dénommée Abu Zaabal. Cela implique l'abandon des structures existantes fortement contaminées par de la poussière de plomb

Quality-of-life among women with breast cancer: application of the international classification of functioning, disability and health model

BackgroundThis study aimed to identify the factors that influence Breast Cancer (BC) women’s quality of life (QoL) based on the International Classification of Functioning, Disability and Health (ICF) framework.MethodA cross-sectional study was conducted among 188 women with BC. The dependent variable, QoL, was measured using the Quality of Life Index (QLI-c). The independent variables were measured using the following Arabic-validated questionnaires: Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ).ResultsThere was a significant positive correlation between monthly income (r = 0.17, p = 0.016) and QoL, and significant negative correlation between the stage of disease (r = −0.221, p = 0.002) and duration of first diagnosis (r = −0.280, p = 0.004) with QoL. Poor sleep quality, sexual dysfunction, fatigue, depression, and anxiety had significant negative correlations with QoL (p < 0.01). Multiple regression analysis revealed that among the various factors that might affect QoL, sexual dysfunction, poor sleep quality, depression, and anxiety were significant predictors of QoL (p ≤ 0.05).ConclusionThe ICF provided an excellent framework to explore the factors influencing QoL among women with BC. This study has given evidence for the relationship of demographic, clinical, and body functional factors with QoL among women with BC. Interestingly, sexual dysfunction, poor sleep quality, depression, and anxiety factors are predictors of QoL. Awareness of these factors that predict QoL will guide healthcare professionals to improve the health and QoL of BC women

Mpox: Risks and approaches to prevention

Since early May 2022, an outbreak due to Mpox virus (formerly called monkeypox) has occurred in many countries around the world. On July 23, the World Health Organization declared the outbreak ‘Public Health Emergency of International Concern’. In order to combat the outbreak, it is important to have effective infection prevention and control plans. The first step is to qualitatively and quantitatively determine the risks of infections, followed by the design and implementation of infection prevention and control measures. Mpox is transmitted through direct, indirect, and prolonged contact, through sexual transmission, and via the respiratory route. Men who have sex with men are identified as the most vulnerable population. Home pet-raisers, and health care workers are at risk of catching the disease. The outcome of infection is catastrophic among the elderly, immunocompromised individuals, pregnant female and children. The spillover to animals is of great concern. It is important to communicate the risks and have community engagement in the control of this outbreak. The availability of vaccines will add to the capability of containing the outbreak. It is critical to prevent the virus from spreading further. Hence, we review the recent findings on the risk management of Mpox along with the preventive strategies

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit