Economic Analysis of Stand-Alone Hybrid Wind/PV/Diesel Water Pumping System: A Case Study in Egypt

The design and evaluation of a stand-alone hybrid renewable energy system for pumping underground water for small farm irrigation is presented. Given environmental conditions, system specifications and daily load demand data, the optimal size of main system components is obtained using a sizing algorithm. Different renewable energy systems are compared using yearly simulations, on hourly base via specialized commercial software simulation packages PVSYST and HOMER, to simulate the system performance and to reach the optimum configurations based on the objective criteria. The criteria used in economic optimization are the net present cost and the cost of energy, with the percent of the capacity shortage. The following systems can be compared: PV only, PV with horizontal axis wind turbine, PV with vertical axis wind turbine, and PV with horizontal axis wind turbine and diesel generator and diesel generator only. The simulation also was carried out for different load patterns for optimum operation. The study was illustrated for climatic conditions of an isolated area in El-Tour City, Sinai, Egypt. The installed 3.42 kW PV water pumping system for irrigation purposes in the same site was also described

Phytochemical characterization and utilization of dried red beetroot (Beta vulgaris) peel extract in maintaining the quality of Nile Tilapia fish fillet

Phytochemicals derived from agro-industrial waste materials could be employed as functional food additives and natural antioxidants to replace their synthetic counterparts, which are increasingly being rejected. The current study aims to assess total phenolic compound (TPC), flavonoids, betalain contents, and antiradical scavenging using DPPH and IC50% of dried red beetroot peel (DRBP) extract at different concentrations of 50, 80, 100, 150, and 200 mg/100 mL t. In addition, a characterization of phenols and flavonoids was conducted using HPLC. The second part of this study aims to utilize aqueous DRBP extract in preserving Nile Talipia fish fillet at two concentrations of 80 and 100 mg/100 mL water, compared with 200 ppm of BHT (butylated hydroxytoluene) and control at 5 °C for 10 days. The DRBP aqueous extract was found to have a high concentration of TPC (832 mg/100 g), flavonoids (234 mg/100 g) and betalains (535 mg/100 g) compounds, resulting in a potential antioxidant activity. The IC50% for the extract was detected at 80 mg/100 mL extract. DRBP aqueous extract showed an excellent preservative effect on the fish fillet. Fish fillet samples treated with DRBP extract at a concentration of 100 mg/100 mL were superior in reducing TBA (thiobarbituric acid) increase compared with other treatments at the end of cold storage. Overall, the study showed that red beetroot extracts can act as a natural preservative agent due to their significant antioxidant activity, providing healthy and safe food to consumers

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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Validated Spectrophotometric Assay of Cefepime Hydrochloride and Cefuroxime Sodium Using a Tetrazolium Salt

A simple, rapid and sensitive spectrophotometric method for the determination of micro amounts of cefepime hydrochloride and cefuroxime sodium is described. The method is based on reduction of 2,3,5-triphenyltetrazolium chloride (TTC) by the cited drugs in slightly alkaline medium leading to formation of a highly colored formazan derivative. Different variables affecting the color development were investigated and optimized. Absorbance measurements were made at 483 nm. Under the proposed conditions, this method is applicable over concentration range of 4–50 µg ml-1 with molar absorpitivities ranging from 5.208 x 103–1.217 x 104 L.mol-1.cm-1 and Sandell's sensitivities ranging from 1.007 x 10-3–2.727 x10-3 µg cm-2. The proposed method was successfully applied for analysis of the cited drugs in formulations and the recovery percentages ranged from 99.47 to 99.8%. The results obtained demonstrated that the proposed method is equally accurate, precise and reproducible as the reported methods thus it is recommended for quality control and routine analysis where time, cost effectiveness and high specificity of analytical techniques are of great importance

Optimization of Integrated Forward – Reverse Osmosis Desalination Processes for Brackish Water

Reverse Osmosis (RO) is a membrane desalination process which considered to be an efficient technology for desalination. However, the performance of RO process is facing some challenges; the most important of them are the energy consumption and fouling problem due to external concentration polarization (ECP). Forward osmosis (FO) is an osmotic-driven membrane desalination process, it exhibits lower energy consumption than pressure driven process like RO. It has been suggested to be coupled with RO in order to reduce salinity and the energy consumption. For this objective, a mathematical model has been designed to optimize the operational conditions for FO, RO and FO-RO hybrid system. Firstly, an individual FO experiment has been conducted using urea and sodium chloride as draw solutions to evaluate the FO performance in both agriculture waste treatment and desalination. Then, a modeling approach of an individual FO process has been investigated with considering water flux, solute flux and concentration polarization. In addition, the performance of FO-RO integrated system was compared with conventional RO process in terms of energy consumption, permeate quantity, quality and solute flux. The results of modeling calculations showed that the feed solution concentration, draw solution concentration and concentration polarization are very important factors that affect the overall performance. In addition, it indicated a good performance of individual FO process. Moreover, it revealed increase in both water productivity and permeate quality and a significant decline in energy consumption upon using the efficient FO-RO hybrid system to about 0.9 kWh/m3. Consequently, it offered high energy saving ranged between 87.57% and 87.81%, which confirmed that FO/RO integrated system is more energy efficient than the RO process only

Spectrophotometric Determination of Aciclovir, Cefepirne Hydrochloride, Etamsylate and Metoclopramide Hydrochloride Usina 1,10 Phenanttrroline—Fe(lll) Reaqent

A simple, rapid, sensitive and accurate method for the determination of aciclovir, cefepime HCI, etamsylate and metoclopramide HCI in pure form and in pharmaceutical formulations is developed.The method is based on the fomabon of tris(o-phenanthroline) iron(ll) complex (Ferroin) upon the reaction of the ated drugs wrth iron(lll )-o- phenanthroline mixture. The ferroin complex is colorimetncally measured at λmax 510 nm against a reagent blank. 0ptimization of the experimental conditions is described. Beer\u27s law is obeyed in the concentration range from 0.25–30 µg ml−1 with molar absorpitivities (ε) ranging from 4.796 x 103–9.51 2 x 104 L.mol−1.cm−1 and Sandell sensitivities (S) of 2.129 x 10−3–34.5 x 10−3 µg cm−2. The developed method is applied successfully for the determination of the cited drugs in pure forms and in the corresponding pharmaceutical formulations without any interferences from common excipients

Genotypic Characterization of Carbapenem-Resistant <i>Klebsiella pneumoniae</i> Isolated from an Egyptian University Hospital

Globally, Klebsiella pneumoniae (K. pneumoniae) has been identified as a serious source of infections. The objectives of our study were to investigate the prevalence of multidrug-resistant (MDR) K. pneumoniae in Tanta University Hospitals, Gharbia Governorate, Egypt; characterize their carbapenem resistance profiles; and identify their different capsular serotypes. We identified and isolated 160 (32%) K. pneumoniae from 500 different clinical samples, performed antimicrobial susceptibility testing, and then used multiplex PCR to detect carbapenemase genes and capsular serotypes K1, K2, K3, K5, K20, K54, and K57. We detected phenotypic carbapenem resistance in 31.3% (50/160) of the isolates; however, molecular assays revealed that 38.75% (62/160) of isolates were carrying carbapenemase-encoding genes. Generally, blaOXA-48 was the prevalent gene (15.5%), followed by blaVIM (15%), blaIMP (7.5%), blaKPC (4%), and blaNDM (3.8%). BlaVIM and blaOXA-48 correlated with phenotypic resistance in 91.67% and 88% of the isolates that harbored them, respectively. Capsular typing showed that the most prevalent pathotype was K1 (30.6%), followed by K57 (24.2%), K54 (19.35%), K20 (9.67%), and K2 (6.45%). A critical risk to community health is posed by the high incidence of multidrug-resistant (MDR) virulent K. pneumoniae isolates from our hospital, and our study examines this pathogen’s public health and epidemiological risks