Chlorinated pesticide residues in human breast milk collected from southern Jordan in 2012/2013

Chlorinated pesticide residues in human breast milk from five southern Jordan districts were analyzed in 2012/2013. The total number of samples from all districts was 100. The number of samples gathered from each district was collected according to their population densities. The present study shows that 59% of the samples which contained pesticides’ residues were p,p’-DDE, 30% contained β-HCH, 10% contained p,p′-DDT, 6% contained α-HCH, 2% contained heptachlor and 1% contained endrin. These human milk samples were free of aldrin, dieldrin, α-endosulfan, β-endosulfan, HCB, γ-HCH, o,p′-DDD, o,p′-DDT and o,p′-DDE. The levels of the six mentioned compounds detected in all mother’s milk samples were higher in Ghor El-Safi district compared with the other four districts. In this study, it is recommended to continue the pesticides residues monitoring in all parts of Jordan, particularly in Ghor El-Safi district and other regions in the cultivated Jordan Valley.     

Managing the open abdomen in a district general hospital

Introduction

The need to manage an open abdomen is becoming more common in general surgical practice and a variety of methods of temporary abdominal closure (TAC) are available. The evidence for the efficacy of the various forms of TAC as well as the subsequent definitive fascial closure (DFC) rates and complications comes mainly from large trauma series in the US, which represent a different patient population to those in the UK in whom TAC is usually required.

Methods

All cases of open abdomen management in our hospital over a five-year period were reviewed to ascertain the methods of TAC used, our success in achieving DFC and the applicability of managing such cases in a district hospital environment.

Results

Nineteen patients underwent TAC, with two deaths (10.5%) and an overall DFC rate at hospital discharge of 12/17 (70.6%). The median lengths of critical care and hospital stays were 19.5 and 38.0 days respectively. Thirteen out of seventeen survivors had at least one significant complication.

Conclusions

The management of the open abdomen can be achieved safely in a district general hospital setting with acceptable outcomes for the non-trauma patients commonly seen in UK practice but it is a resource intensive and expensive undertaking.     

Genetic basis of neurodevelopmental disorders in 103 Jordanian families

We recruited 103 families from Jordan with neurodevelopmental disorders (NDD) and patterns of inheritance mostly suggestive of autosomal recessive inheritance. In each family, we investigated at least one affected individual using exome sequencing and an in-house diagnostic variant interpretation pipeline including a search for copy number variation. This approach led us to identify the likely molecular defect in established disease genes in 37 families. We could identify 25 pathogenic nonsense and 11 missense variants as well as 3 pathogenic copy number variants and 1 repeat expansion. Notably, 11 of the disease-causal variants occurred de novo. In addition, we prioritized a homozygous frameshift variant in PUS3 in two sisters with intellectual disability. To our knowledge, PUS3 has been postulated only recently as a candidate disease gene for intellectual disability in a single family with three affected siblings. Our findings provide additional evidence to establish loss of PUS3 function as a cause of intellectual disability.     

Subjective Quality of Life of Community Living Sudanese Psychiatric Patients: Comparison with Family Caregivers’ Impressions and Control Group

Background: Researchers have paid scant attention to comparative studies of quality of life (QOL) issues among psychiatric diagnostic groups; the studies of patient – caregiver concordance ratings had small sample sizes; and the reports are rare from the African and Arab worlds. Objectives: to assess the subjective QOL of stable Sudanese outpatients, using the WHOQOL – Bref, compared with a general population sample; examine the caregiver–patient concordance; and assess the variables that impact on domains of QOL. Method: The responses of outpatients with schizophrenia (99), major affective disorders (120) and neuroses (81) (mean age 33.8) were compared with 211 controls and the impression of their family caregivers. Results: Patients were dissatisfied with life circumstances; the schizophrenia group and those with co-morbidity had significantly lower QOL scores; while the control group had higher QOL scores. There was no significant impact on QOL domains, of socio-demographic factors, duration of illness and treatment side effects. The schizophrenia group had least concordance with caregivers, but eight items were judged to be satisfactorily concordant for all groups. Conclusions: Psychiatric patients in stable condition can make reliable judgments of QOL, with relatives providing additional information. Differences in QOL and concordance of ratings reflect disease severity.     

Matrix metalloproteinase-2, squamous cell carcinoma antigen, and tissue polypeptide-specific antigen expression in Egyptian patients with cervical carcinoma: Relationship with prognosis

Matrix metalloproteinases (MMPs), a family of proteolytic enzymes produced by both stromal and tumor cells, appear to have a key role in the events leading to local invasion and metastasis by malignant neoplasms. In the present study, we evaluated the role of MMP-2, squamous cell carcinoma antigen (SCCA), and tissue polypeptide - specific antigen (TPS) in cervical neoplasia. Using Western blotting and enzyme immunoassay (EIA), we analyzed 50 patients with cervical carcinoma (CC) and 25 normal controls for expression of MMP-2 in tissue cell lysates. We also quantified SCCA and TPS with microparticle immunoassay and EIA, respectively. The results were correlated with human papilloma virus (HPV) infection, clinicopathological findings, and disease outcome. The cutoff point for each marker was estimated from receiver operating characteristic curves. Logistic regression analysis was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) for each marker. MMP-2, SCCA, and TPS protein expression were significantly higher in patients with CC than in normal controls. While TPS was the best marker for discriminating between patients and controls, MMP-2 was associated with an advanced tumor stage (OR, 13.9 [95% CI, 1.4-133.9]) and poor histological grade (OR, 10.2 [95% CI, 1.7-60.5]). Moreover, independent of the effect of an advanced CC stage and grade, the patients' age, and the presence of HPV infection, MMP-2 was considered a strong predictor for CC recurrence (OR, 8.1 [95% CI, 1.3- 49.1]). Tissue markers may be used to select high-risk patients for early detection of and adjuvant therapy for recurrence. Our MMP-2 findings are particularly relevant to the development of protease inhibitors as a new cancer therapy approach.     

Application of the BSG guidelines to a colonoscopy waiting list

Objective  Currently priority for colonoscopy is given to diagnostic and therapeutic procedures. Surveillance colonoscopies place a significant demand on the service. These are held on a separate waiting list in our institution, which is currently several years behind. The purpose of this study was to apply the BSG guidelines to this waiting list in our institution in order to ascertain whether patients are appropriately listed.
Method  This was a retrospective review. The patients on the waiting list whose procedures were due in 2004 and 2005 formed the study group. Information on demographics, previous colonoscopies, and indication was taken from the case notes. Results were analysed using Microsoft Excel.
Results  A total of 172 patients were overdue their colonoscopies. If the BSG guidelines were strictly adhered to, 49% of these patients were inappropriately listed. If applied less rigidly, 42% of patients should not have been on the list. The reasons for removal from the list were as follows: Thirty-nine patients were older than the upper age limit, 23 had had clear colonoscopies after adenomatous polyp follow up, four were listed for diverticular disease follow up, four for metaplastic polyps, one for constipation and one for per rectum (PR) bleed follow up.
Conclusion  With strict application of the BSG guidelines to a surveillance colonoscopy waiting list, 49% of the patients on the list do not need the procedure. It is recommended that consultant led education and control of the waiting list be used to reduce unnecessary investigations.     

Cisplatin and 5-Fluorouracil for Metastatic Squamous Cell Carcinoma from Unknown Primary

Chemotherapy for squamous cell carcinoma with unknown primary (SCUP) has not been prospectively studied. To evaluate the efficacy of cis-diaminedichloroplatinum (cisplatin) and 5-fluorouracil (5-FU) in advanced SCUP, we treated 15 patients with measurable disease. A prospective trial was conducted of cisplatin and 5-FU in patients presenting with SCUP. All patients had evaluation in search for primary disease with computed tomographic scan of the head, neck, and chest and endoscopic evaluation of the nasopharynx, larynx, esophagus, and tracheobronchial passaes with negative blind biopsies. Chemotherapy consisted of cisplatin 100 mg/m²on day 1 and 5-FU 1000 mg/m²continuous infusion over 24 hr for 4 days. The regimen was repeated every 21 days. Responses were seen in 8 of 1.5 patients [1 complete response (CR) and 7 partial responses (PR)], for an overall response rate of 53%. These results suggest that cisplatin-5-FU combination has efficacy in advanced SCUP and deserves further trials both in advanced disease and in combined modality programs with surgery and radiation therapy.     

Workplace influenza vaccination in two major industries in saudi arabia: a cost benefit analysis

This study aimed at evaluating the effectiveness of mass Influenza vaccination on workers health and costs reductions. We compared 1396 Influenza vaccinated workers versus 1004 not vaccinated workers from same workplaces, regarding outcome of interests, like frequency of Influenza Like Illnesses (ILI), frequency of physician office visits due to ILI, sick leaves due to ILI, and cost benefit analysis and cost saving analysis in two major industries in Riyadh; food processing, and chemical industries. The goal of vaccination coverage was 80%, but the maximum coverage reached was 58%. Average sick-leave days reduction during the 4 months follow up period was from 1.27 days/worker in the no vaccine group to 0.31 days/worker in the vaccine group (p<0.001). Also, there is a reduction in the average number of physician office visits from 0.99/worker in the no vaccine group to 0.23 days/worker in the vaccine group (p<0.001); with relative risk reduction of ILI among vaccinated workers to 0.37 (0.31<95%CI< 0.44) compared to no vaccine group. Combined data from the two industries showed a net saving of about 28 US$ per each vaccinated worker.