Polycyclic aromatic hydrocarbons in citrus fruit irrigated with fresh water under arid conditions: Concentrations, sources, and risk assessment

In Jordan, as well as in all the world countries, consumption of citrus fruits is an essential part of the daily diet, so it is important to assess the potential risk of the persistent organic pollutants such as polyaromatic hydrocarbons (PAHs) in these fruits to the human health and identify their sources in order to eliminate or reduce them. This study reports 16 priority PAHs content in four types of peeled citrus fruits grown in Jordan valley. PAHs were detected in all the studied samples in variable quantities depending on the type of citrus fruits. The results showed that the highest PAH level corresponded to acenaphthene (35.018 µg/kg) in grapefruit. Among the carcinogenic PAHs, benzo[a]anthracene (BaA) and benzo(a)pyrene (BaP) were the most representative and found in all the analyzed fruit, soil, and water samples, whereas anthracene (ANT) was not detected at all. The mean ∑16 PAHs for the different fruits were found to be 62.593 µg kg−1 in grapefruit, 24.840 µg kg−1 in lemon, 22.901 µg kg−1 in mandarin, and 5.082 µg kg−1 in orange. The dominance of naphthalene (NAP) and acenaphthene (ACE) in soil under hot climatic conditions indicates the recent and continuous input of these types in the investigated area. The bioconcentration factor (BCF) for ∑16 PAHs was observed in the order of grapefruit > lemon > mandarin > orange. Based on the results of the principal component analysis (PCA), the primary sources of PAHs in agricultural soils mainly originated from biomass burning and vehicular emissions. The incremental lifetime cancer risk (ILCR) indicated that consumption of these four citrus fruits may expose human health to potential cancer risk. The findings of this study call the policymakers and public administrations to the formulation of stringent policies and actions to control biomass burning and vehicular emissions

Dose verification of intensity modulated radiotherapy in head and neck tumors

Purpose: To evaluate the agreement between measured and calculated doses for head and neck tumors using different gamma criteria and to establish quality assurance protocol for the delivery of IMRT in The National Cancer Institute in Cairo. Methods: The dose is calculated for 30 patients using CMS Treatment Planning System. The ionization chamber (0.6 cm3 Farmer type) is used for point dose measurements. The 2D-array (PTW 729) and GafChromic films (EBT2) are used for 2D graphical dose distribution. Four different gamma criteria of dose difference (DD) and distance to agreement (DTA) (3%/3 mm, 3%/5 mm, 4%/4 mm and 5%/5 mm DD / DTA) are selected. These criteria are evaluated while suppressing the dose of 10%, 20% or 30% from dose distribution. Results: Point dose evaluations using the ion chamber ranged from -2.6% to 3.7% (mean and standard deviation of 0.46 ± 1.7). Significant differences are observed between the films and 2D-array for all criteria except the 3%/5 mm criteria (96.89 ± 2.2% vs. 94.81 ± 4.2% (p < 0.01)). Conclusion: Differences may exceed about 3% when the ionization chamber is present in steep dose gradient regions. The present results suggest the gamma criteria of 3%/5 mm as the most suitable criteria for IMRT quality assurance. This gamma criterion of 3%/5 mm favorably exceeds 95% in case of maximum dose while suppressing the dose of 20%.The use of 2D-array can reduce the IMRT QA workload.------------------------------Cite this article as: Elawady RA, Attalla EM, Elshemey WM, Shouman T, Alsayed AA. Dose verification of intensity modulated radiotherapy in head and neck tumors. Int J Cancer Ther Oncol 2014; 2(3):02037. DOI: 10.14319/ijcto.0203.

Molecular Characterization of Escherichia coli O157:H7 and non-O157 Shiga Toxin Producing E. coli from Retail Meat and Humans

A total of 550 meat samples (300 minced beef and 250 chicken meat) marketed in Zagazig City, Sharkia Governorate, Egypt, as well as 150 human stool samples were examined for Shiga toxin producing E. coli. Results revealed that the isolation rates of E. coli O157:H7 versus non- O157 were 1.7% versus 2.3% in minced beef, 0.8% versus 2% in chicken meat and 0.7% versus 2.7% in human stools. Other identified serotypes were including O111:H8 (25%), O26:H11 (20.8%), O55:H7 (16.7%) and O113:H21 (4.2%). Virulence associated genes were identified in E. coli serotypes, stx1 and stx2 were characterized in 16.7% and 62.5% of the isolates, while, eaeA and hlyA genes were identified in 50% and 70.8% of the examined serotypes, respectively. Genotyping of E. coli O157:H7 serotype from different sources using Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) fingerprinting revealed heterogenicity of the isolates, however, human and minced beef isolates were grouped in the same cluster indicating potential transmission of infection from contaminated beef to human consumers. In conclusion, ERIC-PCR is a highly discriminatory, reliable and cost-effective tool for tracing sources of infection with bacteria. Public health education and application of strict hygienic measures during slaughtering, transportation and preparation of meat are essential to minimize the risk of contamination and transmission of infection to consumer

Accumulation, Source Identification, and Cancer Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in Different Jordanian Vegetables

The accumulation of polyaromatic hydrocarbons in plants is considered one of the most serious threats faced by mankind because of their persistence in the environment and their carcinogenic and teratogenic effect on human health. The concentrations of sixteen priority polycyclic aromatic hydrocarbons (16 PAHs) were determined in four types of edible vegetables (tomatoes, zucchini, eggplants, and cucumbers), irrigation water, and agriculture soil, where samples were collected from the Jordan Valley, Jordan. The mean total concentration of 16 PAHs (∑16PAHs) ranged from 10.649 to 21.774 µg kg−1 in vegetables, 28.72 µg kg−1 in soil, and 0.218 µg L−1 in the water samples. The tomato samples posed the highest ∑16PAH concentration level in the vegetables, whereas the zucchini samples had the lowest. Generally, the PAHs with a high molecular weight and four or more benzene rings prevailed among the studied samples. The diagnostic ratios and the principal component analysis (PCA) revealed that the PAH contamination sources in soil and vegetables mainly originated from a pyrogenic origin, traffic emission sources, and biomass combustion. The bioconcentration factors (BCF) for ∑16PAHs have been observed in the order of tomatoes > cucumbers and eggplants > zucchini. A potential cancer risk related to lifetime consumption was revealed based on calculating the incremental lifetime cancer risk of PAHs (ILCR). Therefore, sustainable agricultural practices and avoiding biomass combusting would greatly help in minimizing the potential health risk from dietary exposure to PAHs

Squint Among Adult Population in Hail City, Saudi Arabia

Background: Strabismus, also known as crossed eyes, is a condition in which the eyes do not properly align with each other when looking at an object. If present during a large part of childhood, it may result in amblyopia. If onset is during adulthood, it is more likely to result in double vision. Objective: The aim of the study was to estimate the prevalence of squint, types and treatment characteristics in the studied adults in Hail city, Saudi Arabia. Methods: A cross-sectional study conducted in Hail city, Saudi Arabia. The study included 294 participants; 95 male and 199 female adults aged >20 years. The study period was from 1 January to 30 April 2018. Data collected by personal interview using a pre-designed questionnaire, which distributed among the participants to be self-reported. Results: The prevalence of squint among the studied population was 9.9%. it was more common in females than males. Squint was right sided in 24.1% of the cases, left sided in 51.7% and in both eyes in 24.1% of the studied cases. About half (44.8%) of cases had inward squint (esotropia) and 10.3% outward squint (exsotropia), 24.1% of the cases had Intermittent squint and 6.9% had permanent squint. Most (55.2%) of squint cases use glasses and 34.5% of cases squint affected their visual acuity. In 6.9%, squint causes psychological troubles. As regards treatment, 20.7% received medical treatment and 17.2% received surgical treatment but 62.1% do not seek medical care. Only 10.3% of cases completely cured and 13.8% had recurrence. There was insignificant relation with age, sex, education, squint in parents, chronic diseases, consanguinity or hereditary diseases (P>0.05). Conclusion: in this study, the prevalence of squint in the adult participants in Hail city, Saudi Arabia was 9.9% but 62.1% do not seek medical care. After treatment, only 10.3% of cases completely cured and 13.8% had recurrence. Health education of the public about importance of early treatment is highly recommended. Keywords: Squint; strabismus; adult population; prevalence; types; Hail; Saudi Arabia

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

الانفتاح الاقتصادي وأثره على النمو الاقتصادي:دراسة تحليلية على المملكة الأردنية الهاشمية للسنوات 1995-2015

تعتبر الأردن من الدول التي اهتمت بتنمية قطاع التجارة الخارجية كمؤشر للانفتاح الاقتصادي، وكأداة مهمة لرفع معدل النمو الاقتصادي وتحقيق مستويات معقولة من الرفاهية للمواطنين الأردنيين خصوصا في العقدين الأخيرين, حيث تكتسب التجارة الخارجية أهمية من الناحية الاقتصادية كونها دافعاً رئيسياً وقاطرة للنمو الاقتصادي. تستمد الدراسة أهميتها من راهنيتها كونها درست وحللت الآثار الاقتصادية المترتبة على توجه الاقتصاد الأردني لسياسات الانفتاح الاقتصادي مع العالم الخارجي مع اتساع دائرة العولمة والخصخصة على الصعيد العالمي. هدفت الدراسة إلى ضرورة التعرف على مفهوم الانفتاح الاقتصادي ومراحل نموه وواقع الميزان التجاري وأثره على النمو الاقتصادي في الأردن للسنوات 2015-1995م, إضافة لقياس الأثر الاقتصادي والتنموي لقطاع التجارة الخارجية . استخدم الباحثان المنهج الوصفي التحليلي لجهة تناسبه وموضوع الدراسة من خلال تحليل واقع الاقتصاد الأردني وتم تعزيز ذلك بلغة الأرقام الصادرة عن مصادرها الرسمية. وتوصلت الدراسة إلى محدودية اسهام الانفتاح الاقتصادي في نمو الاقتصاد الأردني وإلى انكشافه مع العالم الخارجي وتأثره المباشر بالأزمات الاقتصادية العالمية والتي عكست هشاشة الميزان التجاري الأردني التي أظهرت استدامة العجز في الميزان التجاري وتفاقمه مع الوقت , واعتباره مشكلة ليست مؤقتة أو عابرة, وإلى ثبات نسبي لمعدلات البطالة في السوق الأردني. أوصت الدراسة بضرورة الاهتمام بالسوق المحلي في الأردن عبر زيادة الإنفاق العام وتحفيز الطلب الكلي الفعال وذلك لتقليل عجز الميزان التجاري وتحقيق معدلات معقولة من النمو الاقتصادي. وضرورة اتباع الأردن سياسات اقتصادية متوازنة قائمة على تعظيم الموارد المحلية والاستثمار في قطاعات الاقتصاد المنتج وعدم الاعتماد على برامج الخصخصة