Spatial and temporal characteristics of cancer in the period from 2004 to 2013 in the Hashemite Kingdom of Jordan

Cancer in Jordan is a major public health problem and the second leading cause of death after heart disease. This study aimed at studying the spatial and temporal characteristics of cancer in Jordan and its 12 governorates for the period 2004-2013 to establish a baseline for future research and identification of cancer risk factors paving the way for developing a cancer control plan in the country. Numerical and graphical summaries, time-series additive seasonal decomposition, the method of least squares, and spacetime scan statistics were applied in a geographic information systems environment. Although the results indicate that the cancer incidence in Jordan is comparatively low, it is increasing over time. In the 10-year study period, a total of 44,741 cases was reported with a mean annual crude incidence rate of 68.4 cases/100,000, mean annual age-adjusted incidence rate of 111.9 cases/100,000, and a monthly rate increase of 1.2 (cases/100,000)/month. This study also revealed that the spatial and temporal characteristics of cancer vary among the governorates. Amman, which includes the capital city and hosts more than one-third of the population of the country, reported 61.0% of the total number of cases. Amman also reported the highest annual crude incidence rate (105.3 cases/100,000), the highest annual age-adjusted incidence rate (160.6 cases/100,000), and the highest rate of increase (0.7 (cases/100,000)/month) forming a high-rate cluster. Excluding the three governorates Amman, Balqa, and Ma’daba, low-rate clusters were found with regard to the remaining governorates. All governorates, except Irbid and Mafraq, showed significant rates of increase of cancer incidence. However, no clear seasonality pattern with respect to cancer incidence was discerned

Association of Lung CT Findings in Coronavirus Disease 2019 (COVID-19) With Patients' Age, Body Weight, Vital Signs, and Medical Regimen

Objective: This study aimed to detect possible associations between lung computed tomography (CT) findings in COVID-19 and patients' age, body weight, vital signs, and medical regimen in Jordan. Methods: The present cross-sectional study enrolled 230 patients who tested positive for COVID-19 in Prince Hamza Hospital in Jordan. Demographic data, as well as major lung CT scan findings, were obtained from the hospital records of the COVID-19 patients. Results: The main observed major lung changes among the enrolled COVID-19 patients included ground-glass opacification in 47 (20.4%) patients and consolidation in 22 (9.6%) patients. A higher percentage of patients with major lung changes (24%) was observed among patients above 60 years old, while (50%) of patients with no changes in their lung findings were in the age group of 18–29 years old. Results obtained from the present study showed that only patients with major CT lung changes (9.7%) were prescribed more than three antibiotics. Additionally, 41.6 % of patients with major lung CT scan changes had either dry (31.0%) or productive (10.6%) cough at admission. Conclusion: Several factors have been identified by this study for their ability to predict lung changes. Early assessment of these predictors could help provide a prompt intervention that may enhance health outcomes and reduce the risk for further lung changes

Studies on the in vitro cultivation and development of cryptosporidium species

In this study, Cryptosporidium was cultured successfully for the first time with the completion and long-term maintenance of the whole life cycle. The success of this study was due to modifications to the pH throughout the period of in vitro culturing and the inhibition of host cell overgrowth by subculturing and gamma irradiation. These appear to be critical factors that may have contributed to the failure in Cryptosporidium culturing and long-term maintenance in previous studies. The addition of growth supplements N-2 and B-27 also appeared to enhance the growth of Cryptosporidium and attempts to cryopreserve in vitro-derived oocysts resulted in the maintenance of viable sporozoites within these oocysts. The life cycle for three species of Cryprtosporidium (C. hominis, C. parvum and C. andersoni) was completed in vitro during this study from sporozoites to sporulated oocysts. Cryptosporidium hominis and C. parvum genotypes (cattle and pig) were successfully proliferated and maintained in HCT-8 cells. This is the first report of the successful culturing and maintenance of C. andersoni and C. hominis in cell culture. The culture derived oocysts of C. parvum (cattle genotype) were infective to 3-4 day old ARC/Swiss mice, however, culture derived oocysts of C. hominis failed to infect mice under the same experimental conditions supporting other in vivo results of the failure of this species to infect mice. Furthermore, oocysts of C. andersoni, C. hominis and C. parvum (pig genotype) isolated from the faeces of infected hosts failed to infect mice, a result consistent with previous results confirming the host specificity of the Cryptosporidium species and genotypes. The completion of the life cycle for C. hominis and C. parvwn (cattle genotype) was further confirmed using TEM microscopy. All the developmental stages (sexual and asexual) were detected in cross sections prepared from HCT-8 monolayers infected with C. hominis and C. parvum (cattle genotype). The presence of sporozoites in the sections prepared after 96 hours post-infection again confirmed their release from oocysts formed in culture. Comparing the endogenous development of different Cryptosporidium species and genotypes, it was found that they all followed the same pattern of development with some minor differences. Cryptosporidium andersoni endogenous stages were larger than those of C. hominis and C. parvum (cattle genotype) and easier to monitor at lower magnifications. Cryptosporidium hominis appeared to be more adapted to grow in HCT-8 cells and completed the life cycle earlier than the C. parvum (cattle genotype). This observation was made with both light and electron microscopy. During the present study, the modification of the culturing system facilitated the study of the complete life cycle of Cryptosporidium and allowed the description of new extracellular stages in its life cycle for the first time. The extracellular stages were first observed in culture of C. andersoni and subsequently in the faeces of cattle chronically infected with C. andersoni. The presence of this extracellular stage in the life cycle of C. andersoni was further confirmed following its isolation from the faeces of infected cattle using a laser microdissection technique. This stage was present in large numbers and some of them were seen undergoing syzgy. Extraction of DNA from the extracellular stage, followed by PCR-RFLP and sequencing of the 18S rDNA confirmed that this is a stage in the life cycle of C. andersoni. Comparative observations with C. parvum (cattle genotype) also confirmed the presence of extracellular stages. Extracellular stages were recovered from in vitro culture after 5 days post-infection with the cattle genotype of C. parvum and from infected mice. At least two morphologically different stages (stages 1 & 2) were purified from mice after 72 hours of infection. The presence and morphological characterisation of extracellular developmental stages in the life cycle of Cryptosporidium confirms its relationship to gregarines and provides important implications for our understanding of the taxonomic and phylogenetic affinities of the genus Cryptosporidium. The growth of Cryptosporidium in cell culture now provides a means of studying its development, metabolism, and behaviour as well as testing its response to different therapeutic agents

Seroprevalence of cystic echinococcosis in a high-risk area (Al-Mafraq Governorate) in Jordan, using indirect hemagglutination test

Hydatid disease (HD) is a zoonotic disease of humans and animals which is caused by infection with the larval stages of the taeniid cestodes of the genus Echinococcus. HD is endemic in many countries of the Middle East, including Jordan. The seroprevalence rate of HD in areas of elevated risk in Jordan has not previously been investigated using indirect haemagglutination (IHA) testing. In the present study, 512 blood samples were collected from recruited outpatients from an internal medicine clinic in Al-Mafraq Governmental Hospital in Jordan. Each participant signed a consent form and completed a questionnaire. The presence of antibodies specific for E. granulosus antigens was detected using an IHA test. Statistical analysis was performed by SPSS software using the Chi-square test. In all, 4.1% of the study participants were seropositive for E. granulosus IgG antibodies. There was a significant correlation between unexplained weight loss among seropositive patients (P = 0.018). Seropositivity was significantly higher in patients who slaughtered sheep inside their houses (P = 0.023). HD seroprevalence did not correlate with gender (P = 0.433), age (P = 0.880), residency status (P = 0.938), or educational level (P = 0.808). The vast majority (75.2%) of participants reported no prior knowledge about HD, and 99.8% were not aware about the etiology of the disease. Keywords: Cystic Echinococcosis (CE), Hydatid disease (HD), Echinococcus granulosus, Jordan, Indirect hemagglutination (IHA), Seroprevalenc

Exploring recent spatial patterns of cutaneous leishmaniasis and their associations with climate in some countries of the Middle East using geographical information systems

This study explores the spatial trends of cutaneous leishmaniasis (CL) and characterises the relationships between the observed spatial patterns and climate in Jordan, Syria, Iraq and Saudi Arabia in 2009. Areal interpolation revealed the presence of four major hotspots of relatively high incidence rates covering most parts of Syria, central parts of Iraq, and north-western, central, south-eastern and south-western parts of Saudi Arabia. The severity of these hotspots was seen to decrease from high to low latitudes. The spatial patterns could be partly linked to precipitation (the higher the precipitation, the higher the incidence rates) and to a lesser degree to temperature (the lower the temperature, the higher the incidence rates). No significant relationship was deduced between the observed spatial patterns of incidence rates and humidity. However, these three climatic factors could be used jointly as explanatory variables (ceteris paribus) to explain part of the spatial variations of the CL incidence rates in the study area by applying geographically weighted regression

Molecular Diagnosis and Identification of Leishmania Species in Jordan from Saved Dry Samples

Diagnosis of the endemic cutaneous leishmaniasis (CL) in Jordan relies on patient clinical presentation and microscopic identification. Studies toward improved identification of the causative Leishmania species, especially in regions where multiple species exist, and the introduction of these techniques into medical diagnosis is paramount. This study looked at the current epidemiology of CL in Jordan. Clinically diagnosed 41 patients with CL were tested for the presence of Leishmania parasite using both Giemsa staining from skin scraps on glass slides and ITS1-PCR from samples blotted onto storage cards (NucleoCards®). Microscopically, 28 out of the 41 (68.3%) collected samples were positive for amastigotes, whereas the molecular ITS1-PCR amplification successfully identified 30 of the 41 samples (73.2%). Furthermore, PCR-RFLP analysis allowed species identification which is impossible microscopically. Of the 30 PCR positive samples, 28 were Leishmania major positive and the other two samples were Leishmania tropica. This indicates that L. major is the most prevalent species in Jordan and the two L. tropica cases originated from Syria indicating possible future L. tropica outbreaks. Diagnosis of CL based on clinical presentation only may falsely increase its prevalence. Although PCR is more sensitive, it is still not available in our medical laboratories in Jordan

Cryptosporidiosis among Hemodialysis Patients in Jordan: First Preliminary Screening Surveillance

Few studies have reported the incidence of cryptosporidiosis among hemodialysis patients worldwide. Currently many molecular and immunological assays have been developed for the sensitive diagnosis of cryptosporidiosis, but still, the microscopic detection of the parasitic infective stage (oocysts) in stool specimens using modified acid stain is regarded as a reliable sensitive technique which is widely used in many clinical labs. In the present study, a total of 133 stool samples were collected from hemodialysis patients and were screened for Cryptosporidium oocyst using formalin-ether concentration and modified acid-fast staining technique. Clinical and demographic data were also collected and analyzed. Cryptosporidium oocysts were recovered in 15/133 (11%) of the investigated hemodialysis patients. The age of patients ranged from 25 to 80 years (mean: 57.84 ± 12.22). Most of the Cryptosporidium-positive cases were recovered from males (73.7%) residing in rural villages in Irbid city (86.6%). The most repeatedly reported symptoms in the Cryptosporidium-positive patients were gastrointestinal symptoms, including diarrhea (15%), nausea (24%), abdominal pain (23%) and bloating (17%), in addition to general fatigue (32%) and weight loss (19%). No statistically significant associations for certain clinical symptoms or risk factors were found. The present study is the first preliminary study in Jordan that provided a brief screening for the incidence of cryptosporidiosis among hemodialysis patients