Evaluation of seasonal and spatial variations of air quality index and ambient air pollutants in Isfahan using geographic information system

Introduction: Due to more than 1.7 million population, many vehicles and large industries around Isfahan, it has become one of the most polluted cities in Iran. The aim of this study was a spatial analysis of the concentrations of air pollutants and the air quality index [AQI]

Materials and Methods: In this descriptive and evaluative study, the air quality data of 7 monitoring stations in 2012 were taken from the Isfahan Department of Environment. The calculation of AQI was done as per the EPA guidelines. The zoning pollutant concentrations and AQI in the study area was determined with the use of the Arc map software, version 10.1

Results: The results showed that the highest concentrations of pollutants and the AQI were related to the Ahmadabad station. Moreover, the air quality in Isfahan in 2012 was 4.38% [4 days] in good conditions, 12.7% [47 days] in moderate conditions, 42.56% [156 days] in unhealthy conditions for sensitive groups, 39.49% [144 day] in unhealthy conditions, 2.8% [10 days] in a very unhealthy and 1.2% [4 days] in dangerous conditions, respectively

Conclusion: It was found that particulate matter was the main cause of Isfahan air pollution while Ahmadabad is the most polluted point in Isfahan. According to the calculations, during 314 days of the year 2012, the air quality of Isfahan was in unhealthy conditions and only 4 days was in good conditions. This is one of the biggest health challenges in this city

Zika virus: no cases in the Eastern Mediterranean Region but concerns remain

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern [PHEIC] with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat

Contribution of laboratories in the WHO Eastern Mediterranean Region to the selection of candidate seasonal influenza vaccine, 2010-2015

The World Health Organization [WHO] formulates recommendations for viruses to be included in vaccines for the influenza seasons in the northern and southern hemispheres on the basis of analyses by its collaborating centres [CCs]. This report describes the contribution of influenza laboratories and national influenza centres in countries in the WHO Region for the Eastern Mediterranean to the selection process of seasonal and pre-pandemic influenza virus subtypes. Data submitted by 22 countries to FluNet and FluID between September 2010 and June 2015 were analysed. National Influenza Centres [NICs] in 12 countries [55%] reported data, 5 [23%] to both FluNet and FluID and 7 [32%] only to FluNet. The WHO CC in London characterized 78% of the samples, and the CC in Atlanta, characterized 21%. The contribution of influenza laboratories and NICs from this Region to global influenza surveillance is appreciable. However, enhancing the contribution through initiatives such as the Pandemic Influenza Preparedness Framework is still needed

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries [Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen] in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region

Molecular characterization of methicillin-resistant Staphylococcus aureus isolated from tertiary care hospitals

Methicillin-resistant S. aureus [MRSA] tends to be resistant to multiple antibiotics. Methicillin resistance is conferred by the acquisition of the mecA gene, which is carried by a mobile genetic element called the staphylococcal cassette chromosome mec [SCCmec]. There are five major types of SCCmec elements [I-V]. The majority of hospital-acquired MRSA [HA-MRSA] strains carry SCCmec types I, II, or III, whereas community-acquired MRSA [CA-MRSA] strains carry SCCmec types IV or V. In addition, Panton-Valentine Leucocidin [PVL] is a gene encoding a powerful cytotoxin that is strongly associated with CA-MRSA strains. The present study was aimed to identify the types of SCCmec and PVL genes among clinical MRSA isolates. This study was conducted in 5 tertiary care hospitals in Makkah city from March to September of 2012. A total of 206 S. aureus clinical isolates were analysed using standard microbiological methods. Multiplex PCR was performed on genomic DNA from MRSA isolates in order to identify the types of SCCmec. In addition, PCR was performed to detect the PVL gene among the isolates. Of the 206 S. aureus isolates, 114 [55.3%] were MRSA, and 100 of the MRSA isolates carried the mecA gene. Results from SCCmec typing revealed that 3% were type I; 9% were type II; 47% were type III, and 29% were type IV. Nineteen per cent of the isolates harboured the PVL gene. Furthermore, there was a statistically significant correlation between the presence of the PVL gene and SCCmec type IV. The virulence of MRSA strains is increasing in both hospital and community settings in Makkah, highlighting the importance of their rapid identification in order to appropriately control infection

Antimicrobial susceptibility and metallo-beta-lactamase production among Pseudomonas aeruginosa isolated from Makkah Hospitals

Pseudomonas aeruginosa is the most prevalent pathogen in nosocomial infections it produces metallo-beta-lactamases [MBLs] that reduce antibiotic effectiveness. This study aimed to determine the frequency, antimicrobial-susceptibility patterns, and MBL types of P. aeruginosa infections in clinical specimens obtained from patients in Makkah hospitals. Clinical isolates [478] were collected during a 6-month period, from September 2009 [Ramadan 1430 AH], from various clinical wards of Al-Noor Specialist, Hera General, and King Abdul-Aziz Hospitals. All isolates were subjected to routine microbiological investigations and automated antibiotic-susceptibility testing. MBL production was assessed using double-disk synergy test by comparing the zone of inhibition given by disks containing imipenem with and without ethylene diaminetetraacetic acid [EDTA] and MBL types distinguished by polymerase chain reaction. Most P. aeruginosa strains [31%] were isolated from intensive care units [ICUs] and male medical wards [15.9%]. P. aeruginosa mostly caused respiratory tract [52%], wound [26%], and urinary tract [12%] infections. P. aeruginosa was most susceptible to imipenem [65.9%], amikacin [62.7%], meropenem [58.7%], and piperacillin/tazobactam [57.2%]. MBL-producing P.aeruginosa were identified in 76 [15.9%] isolates. The rate of MBLs types were 21% and 18.4% for IMP and VIM, respectively. These results can be used as guidelines for treatment of bacterial infections in Saudi Arabia. Multidrug-resistant and MBL-producing P. aeruginosa is a serious public health concern, which must be tackled.

Frequency and antibiotic susceptibility of gram-positive bacteria in Makkah hospitals

Gram-positive bacteria are important nosocomial pathogens. The objective of this study was to estimate the frequencies and resistance rates of gram-positive pathogens isolated from hospitals in Makkah, Saudi Arabia. Prospective study at three Makkah hospitals from May 2008 to April 2009. Clinical isolates were collected and demographic and laboratory data were recorded. Standard microbiological methods were used to identify the organisms and test for antimicrobial susceptibility. The results were interpreted according to the Clinical Laboratory Standards Institute [CLSI] guidelines. Clinical isolates were collected from 1087 patients. Gram-positive pathogens infected all age groups, but had no gender predominance. Staphylococcus aureus was the most common cause of wound infection and accounted for more than half of the clinical isolates [688 cases]. Coagulase-negative Staphylococcus [CONS] was a common isolate from blood cultures. Wounds were the most common site of infection [37.6%]. Enterococcus spp. and Streptococcus agalactiae were the second most common bacteria [26%]. The resistance rates of 5 aureus and CONS isolates were 39.4% and 82.4% for oxacillin, respectively. Among the streptococci, the resistance rates of Streptococcus pneumoniae were 21.1% and 16.7% for ampicillin and erythromycin, respectively. S aureus infections were found to be very common in the Makkah hospitals. Infection prevention, control measures and continuous monitoring for antibiotic susceptibility are necessary to reduce these and other nosocomial infections

Aneurysmal bone cyst of the occipital bone

A 13 years boy presented with a painless hard and fixed swelling in occipital region for the last three months. Plain X-ray, CT scan and MRI showed an expansile multi loculated cystic lesion in occipital bone. Histopathological examination revealed it to be an aneurysmal bone cyst. Treatment of choice is surgery. However, radiotherapy may be helpful in incompletely excised lesions

Legionella infection; an environmental and clinical study during hajj season

Respiratory system is most commonly affected during Hajj season. [1] to determine the prevalence of Legionella in drinking water, cooling sprinklers and other sources of water consumed in pilgrimage area of the holy city, Makkah; [2] to study the prevalence of pneumonia caused by Legionella species from clinically suspected cases; and [3] to determine whether there is any relationship disease incidence and water supply system. The clinical samples were received from in-patients of the following five Ministry of Health [MOH] Hospitals; Hera General Hospital, Al-Noor Specialist Hospital, King Faisal Hospital, King Abdul-Aziz Hospital, and Ajyad Hospital during Hajj 2003. The patients included in the study were those who fulfilled the following criteria; clinically diagnosed as pneumonia, negative on routine cultures and found negative for acid fast bacilli [AFB] from sputum/bronchial aspirate [BAL]. Serological tests was done by Enzyme linked Immunosorbent assay [ELISA] for Legionella antibodies total lgG and IgM. Out of total 133 patients suspected for Legionella, 83 [62.4%] were male and 50 [37.6%] female. The male versus female ratio was 1:0.6. The major age group affected was between 50-70 years [63.2%]. There were 4 [3.0%] cases of Legionella species isolated from microbiological cultures. The overall seropositive rate among clinically suspected cases was 4.51%. A total of 560 water samples were collected from Arafat, Muzdalifa, Mena, and areas around the Holy Mosque and found negative for Legionella species. Pneumonia was one of the most common illnesses among pilgrims. The water supplied to all areas of the pilgrimage was free from the Legionella and no link has been established among the patients with water supply systems. Both clinicians' awareness and availability of specialized laboratory tests for atypical pneumonia such as Legionella is necessary. Although, all water samples found negative for Legionella but it is recommended to screen all water reservoirs for Legionella annually before Hajj season

Omental caking: a rare manifestation of malignant peripheral nerve sheath tumour

Malignant peripheral nerve sheath tumour [MPNST] is a very rare tumour with an incidence of one per 100,000 and constitutes between 3 to 10% of all soft tissue sarcomas. Most of the sarcoma involve the extremities and retroperitoneal regions. However, this case presented with mass in left inguinal region and then spread rapidly to omentum, assuming the appearance of an omental cake. Mass responded well to chemotherapy comprising of Ifosfamide and Doxorubicin

Frequency and antimicrobial susceptibility of Gram-negative bacteria isolated from 2 hospitals in Makkah, Saudi Arabia

To estimate the prevalence and antibiotic susceptibility of the Gram-negative bacteria isolated from 2 hospitals in Makkah. This study was undertaken in 2 main tertiary care hospitals namely; Al-Noor Specialist Hospital, and Hera Hospital in Makkah, Kingdom of Saudi Arabia from October 2005 to March 2006. A total of 1137 Gram-negative bacteria were identified in non-duplicate clinical specimens obtained from 965 patients of various body sites infections. Demographic data, identity of microorganisms, and antimicrobial susceptibilities were obtained from medical and laboratory records. The most prevalent Gram-negative bacteria were Escherichia coli [31.6%], and Pseudomonas aeruginosa [31.2%], followed by Acinetobacter baumannii [10.8%], Klebsiella pneumoniae [8.3%], Klebsiella sp. [6.2%], Haemophilus influenzae [3.7%], Proteus sp. [3.3%], and Enterobacter sp. [1.9%]. Results demonstrated that Gram-negative bacteria have a high rate of resistance to commonly used antibiotics. Furthermore, multi-drug resistance was also common in this study. Our data showed a high rate of resistance among Gram-negative pathogens in comparison with other countries in the world. The implementation of monitoring programs is an important part of the prevention strategy against the development of antibiotic resistance in hospitals

[ in-vitro study of canal configuration in the mandibular first and second molars]

The human teeth have a lot of anatomical variations, and treatment of each tooth is under the influence of its configuration. Therefore, recognizing canal configuration is necessary for proper endodontic therapy, and lack of knowledge about it leads to failure in therapy. Since one of the most effective factors in canal configuration is race, we planned an in vitro investigation in canal configuration of the mandibular first and second molars. This descriptive-analytic study was conducted on 160 extracted mandibular first and second molars, collected from a number of clinics and private offices in Isfahan. Access cavities were made and canal systems were stained with India ink. The teeth were decalcified with 10% nitric acid, dehydrated and cleared with methyl salicylate. Then, they were studied to determine the number of roots and type of canal configuration in each root using Weine classification. Mandibular first molars were additionally cut in cross-sections in three points of the root and then canal configurations of the teeth were evaluated. For statistical analysis, Chi-square test was used. In this study, using the clearing method, out of 80 mandibular first molars, 98.75% had two roots and 1.25% had three roots. The mesial roots had type II and III [50.63%, 31.65%] configuration. The distal root had I and II [84.82%, 10.12%] configuration. Out of 80 mandibular second molars, 90% had two roots, and 10% had single root, 6.25% of which had C-shaped root. In the two- rooted molars, the mesial roots had type I and II [31.95%, 42.22%] and distal roots had type I and II [88.88%, 6.95%] configuration. Out of 80 mandibular first molars in the sectional method, the mesial roots had type II and III [51.90%, 46.83%] configuration. The distal roots had type I and II [56.49%, 31.65%] configuration. The difference between clearing and sectional methods was statistically significant [p<0.05]. In other countries, many researches have been done using different methods about internal anatomy of teeth; their results are different form those of this study. It appears that these differences are due to genetic or race factors and the methods used. Additionally, the results of different studies indicate that more attention should be paid to new studies on canal configuration of these teeth

Porocarcinoma: a rare sweat gland malignancy

Eccrine Porocarcinoma [ECP] is a malignant tumour arising from the intraepithelial ductal parts of the sweat gland. It has also been described as malignant hidroacanthoma simplex, sweat gland carcinoma, malignant intra-epidermal eccrine poroma, eccrine poroepithelioma, dysplastic poroma, malignant syringo acanthoma and porocarcinoma. Treatment with wide local excision but metastatic lesions can be treated with chemotherapy. Here, we present a case report of 52 years old male who presented with a fungating growth on left pre-auricular region that came out to be a case of ECP on histopathological examination

Hepatic and skeletal metastases from primary intracranial atypical meningioma

Meningioma constitutes 27% of primary CNS tumours. It rarely metastasizes to distant sites [< 0.1%]. Here, we present a case report of primary atypical intracranial meningioma metastasizing to liver and bone after 4 years of surgery and postoperative radiotherapy presenting with multiple episodes of hypoglycemia

Prevalence and antibiotic resistance among helicobacter pylori clinical isolates from main hospitals in the western region of Saudi Arabia

The aim of this study was to evaluate the antimicrobial susceptibility patterns amongst H. pylori clinical strains isolated from the main hospitals in the western region of Saudi Arabia. Antimicrobial susceptibility testing was performed for 137 clinical isolates of H. pylori recovered from 368 Saudi patients undergoing endoscopic examination. The antibiotics used were amoxicillin, tetracycline, clarithromycin and metronidazole. A high percentage of resistance were observed against metronidazole [48.2%] followed by clarithromycin [27.7%], amoxicillin [14.6%] and tetracycline [9.5%]. A total of 12 [8.8%] multidrug-resistant H. pylori isolates were observed in this study. Moreover, a warning sign of emerging resistance to amoxicillin, tetracycline and clarithromycin were noted. The clinician need to be aware about resistance pattern in their region when they select empiric antibiotics regimen for H. pylori

Efficacy of air sampler sartorious MD8 and settle plate method for quantitative estimation of air microorganisms

The main aim of the study was to identify pathogenic strains floating in the environment of Makkah city during Hajj 1424-H and to compare the efficacy of air filter device Sartorious MD8 to the traditional method called exposing settle plate method for the quantitative estimation of microorganisms. Air samples for identification of bacteria and fungi were taken from three different environments; outdoor, indoor, and microbiology department. Seven outdoor locations were selected; Muna, Arafat, Jamarat, slaughter areas, tunnels, grounds and toilet surrounding. For the in-door environment, the following clinical units of Hera General Hospital were selected; intensive care unit, nursery, emergency room, operation room, medical ward, and surgical ward, microbiology environment three places were selected microbiology departments of Hera General Hospital, Al-Noor Specialist Hospital, and Umm Al-Qura University. Mean bacterial and fungal colony count was calculated in each area by both methods. The four major potential human pathogens Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Aspergillus fumigatus were isolated. Mean bacterial and fungal colony count was significantly found higher in air filter method. The air pier [MD8] was found more effective for monitoring the viable bacteria and fungi in hospital environment outdoor environment as compared to the exposing settle plate method

Frequency and antimicrobial susceptibility patterns of bacterial pathogens isolated from septicemic patients in Makkah hospitals

To determine the frequency of septicemic cases in Makkah hospitals, the main pathogens causing septicemia, and to describe the prevalence of antibiotic resistance among septicemia clinical isolates. We performed a prospective study of 1626 septicemic cases in the 4 main hospitals in Makkah City during April 2004 to March 2005. Blood culture, isolation of organism and susceptibility to antibiotics were assessed using a routine microbiological methods. Out of the 1626 septicemic cases identified, gram-positive organisms were involved in 56.6% of these episodes with coagulase-negative Staphylococci and Staphylococcus aureus being the most frequent. While Escherichia coli and Pseudomonas species were the most common among gram-negative organisms. Candida species was involved in 5.9% of all encountered organisms. Most septicemic cases were reported in male patients over 50 years, the intensive care units, Saudi patients and during Hajj season. Results also showed the frequency and antimicrobial susceptibility patterns of bacterial pathogens isolated from septicemic patients in Makkah hospitals. The rates of antibiotic resistance among pathogens in this study,are much higher than what has been reported elsewhere in the Kingdom as well as in many of international studies

Methicillin resistance among Staphylococcus aureus isolates from Saudi hospitals

To determine the prevalence of methicillin-resistant Staphylococcus aureus [MRSA] strains among clinical isolates collected from the 4 tertiary hospitals in Makkah, Saudi Arabia, and to test the antimicrobial susceptibility patterns of S. aureus isolates against 9 antimicrobial agents. A total of 512 S. aureus clinical isolates were collected during a period of 1 year starting in April 2003 in AI-Noor, King Abdul-Aziz, Hera and King Faisal Hospitals, Makkah, Saudi Arabia. The sensitivity patterns of these isolates were determined using the Kirby-Bauer disk diffusion method. The prevalence of MRSA among S. aureus isolates was 38.9% [199/512]. Among 199 MRSA isolates, 78.8% showed multidrug resistance to erythromycin, gentamicin and oxytetracycline. The rate of MRSA resistance in this study was much higher than what had been reported in other areas of Saudi Arabia emphasizing the need for local or country-based surveillance to characterize and monitor MRSA and to develop strategies that will improve MRSA treatment and control