A regional virtual case discussion forum in pediatric oncology: Experience of the Pediatric Oncology East and Mediterranean Group

BACKGROUND

The Pediatric Oncology East and Mediterranean (POEM) group that aims to share expertise among pediatric oncology providers across the Middle East, North Africa, and East Asia region initiated a virtual Case Discussion Forum (CDF) in 2013.

METHODS

Meeting records from September 2013 till June 2021 were reviewed. Detailed minutes were available starting August 2016; case data were analyzed including diagnoses, purpose of presentation and recommendations. A 38-item survey assessing perception of benefits, challenges, and opportunities of the forum was distributed to members of the POEM group and results analyzed.

RESULTS

A total of 140 cases were presented from 14 countries. After August 2016, 67 cases were presented, and those were analyzed regarding reasons for discussion, barriers, and recommendations. Details are presented in this report, and the most common challenges identified were related to histopathologic/molecular diagnosis (24%), imaging interpretation (18%), resource limitations (12%), and surgical difficulties (9%). A survey was distributed to all POEM members in 28 countries, and 76 responded. The main benefit reported was the provision of recommendations regarding treatment and evaluation, while the main challenges reported were time zone difference and workload. Recognized opportunities included conducting regionally relevant research studies based on clinical problems identified during discussions, and setting guidelines for resource-adapted treatment regimens.

CONCLUSIONS

The POEM CDF identified areas for multi-institutional regional studies and led to a twinning project between two centers in the region for improving diagnostic infrastructure. Such forums can identify specific resource limitations in pediatric cancer and direct efforts for targeted capacity building.

Occurrence and ecotoxicological risk assessment of pesticides in sediments of the Rosetta branch, Nile River, Egypt

This study aimed to (1) monitor the occurrence and spatiotemporal variations of 100 pesticides in sediments collected monthly from July 2018 to June 2019 from sampling sites in El-Rahawy, Sabal, and Tala, along the Rosetta branch of the Nile River, Egypt, and (2) perform an ecological risk assessment for aquatic organisms upon exposure to the detected sediment pesticides based on the risk quotient (RQ) method. Out of the 100 pesticides monitored, 16 pesticides belonging to seven chemical families were detected, and 55% of the sediment samples were contaminated with one or more pesticide residues. The mean concentration (mg/kg dry weight (dw)) and detection frequency (%) of the four most frequently detected pesticides in the sediment samples were as follows: chlorpyrifos (0.18 mg/kg dw and 34%), p,p'-DDE (0.018 mg/kg dw and 30%), cypermethrin (0.03 mg/kg dw and 14%), and deltamethrin (0.026 mg/kg dw and 13%). The spatial distribution exhibited that El-Rahawy had the highest pesticide load (2.86 mg/kg dw) among the studied sites, whereas the temporal variations revealed that the highest total pesticide concentrations were detected in winter season (1.73 mg/kg dw). Meanwhile, 12 pesticides showed high RQs (>1), posing a potential ecological risk to aquatic species that live and feed on such sediments.

Occurrence, human health, and ecotoxicological risk assessment of pesticides in surface waters of the River Nile's Rosetta Branch, Egypt

In Egypt, the shortage of freshwater resources and their pollution constitutes a growing concern. Therefore, the objectives of this study were to (i) monitor the occurrence and spatiotemporal variations of 100 pesticides in surface water samples collected monthly (from July 2018 to June 2019) from El-Rahawy, Sabal, and Tala sampling sites along the Rosetta branch of the River Nile in Egypt, (ii) identify potential non-carcinogenic health risks for the local people through the lifetime consumption of contaminated drinking water, and (iii) perform an ecological risk assessment of aquatic organisms upon exposure to pesticides detected in surface waters based on the risk quotients (RQs) method. Of the 100 pesticides analyzed, 22 belonging to 11 chemical families were detected, and 75.5% of surface water samples were contaminated with one or more pesticide residues. The most frequently detected pesticide was malathion (57%), followed by chlorpyrifos (54%), atrazine (23%), and carbendazim (20%). Spatial distribution showed that the El-Rahawy site had the highest pesticide load (38.47 μg/L), and Sabal had the lowest (16.29 μg/L). Temporal variations revealed that the highest total pesticide concentrations were detected in summer (27.98 μg/L) compared to spring (23.16 μg/L), winter (19.18 μg/L), and autumn (11.85 μg/L). For non-carcinogenic risks of pesticides detected in surface water, the target hazard quotient (THQ) values were less than one. This implies that there is no potential human risk from exposure to drinking water at the sites under study. However, 13 pesticides presented high-risk quotients (RQ > 1), posing potential ecological risks to aquatic organisms.

Occurrence and human health risks of pesticides and antibiotics in Nile tilapia along the Rosetta Nile branch, Egypt

Nile tilapia (Oreochromis niloticus) samples were collected at monthly intervals between July 2018 and June 2019 from 3 sampling sites (El-Rahawy, Sabal and Tala) situated along the Rosetta branch of the Nile, Egypt, to monitor the presence of 100 pesticides and 5 antibiotics using different extraction procedures followed by GC-MS/MS and LC-MS/MS. Potential human health risks via the consumption of contaminated fish was also assessed. Of the 72 analyzed fish muscle samples; 86% and 21% were contaminated with pesticides and antibiotics, respectively. Chlorpyrifos (ranging from < LOQ to 0.08 mg/kg) was the most frequently detected pesticide followed by p,p'-DDE (ranging from < LOQ to 0.04 mg/kg) in 83 and 45% of the fish muscle samples, respectively. Nitrofurazone (ranging from 8.6 to 52 μg/kg) was the most frequently detected antibiotic, followed by nitrofurantoin (ranging from 1.1 to 2 μg/kg) and chloramphenicol (ranging from < LOQ to 0.17 μg/kg). These antibiotics were found in 12, 6 and 5% of the fish muscle samples, respectively. The spatial distribution of the detected pesticides and antibiotics in fish samples along the Rosetta branch showed that the highest mean concentrations were found in the Sabal area, followed by samples from Tala and El-Rahawy. An investigation into seasonal variations revealed that the highest mean concentrations of pesticides and antibiotics in fish samples were detected in winter and spring, respectively. According to target hazard quotient (THQ) calculations for the detected pollutants in Nile tilapia muscle, all pollutants gave THQ values lower than 1, indicating that the consumption of this fish from the study sites is unlikely to cause any detrimental effects to consumers.

Establishment of a formal program for retinoblastoma: Feasibility of clinical coordination across borders and impact on outcome

Retinoblastoma is an ocular tumor that occurs in young children, in either heritable or sporadic manner. The relative rarity of retinoblastoma, and the need for expensive equipment, anesthesia, and pediatric ophthalmologic expertise, are barriers for effective treatment in developing countries. Also, with an average age-adjusted incidence of two to five cases per million children, patient number limits development of local expertise in countries with small populations. Lebanon is a small country with a population of approximately 4.5 million. In 2012, a comprehensive retinoblastoma program was formalized at the Children's Cancer Institute (CCI) at the American University of Beirut Medical Center, and resources were allocated for efficient interdisciplinary coordination to attract patients from neighboring countries such as Syria and Iraq, where such specialized therapy is also lacking. Through this program, care was coordinated across hospitals and borders such that patients would receive scheduled chemotherapy at their institution, and monthly retinal examinations and focal laser therapy at the CCI in Lebanon. Our results show the feasibility of successful collaboration across borders, with excellent patient and physician adherence to treatment plans. This was accompanied by an increase in patient referrals, which enables continued expertise development. However, the majority of patients presented with advanced intraocular disease, necessitating enucleation in 90% of eyes in unilateral cases, and more than 50% of eyes in bilateral cases. Future efforts need to focus on expanding the program that reaches to additional hospitals in both countries, and promoting early diagnosis, for further improvement of globe salvage rates.

Phenotypic characterization of microbes in the rhizosphere of Alyssum murale

Metal hyperaccumulator plants like Alyssum murale are used for phytoremediation of Ni contaminated soils. Soil microorganisms are known to play an important role in nutrient acquisition for plants, however, little is known about the rhizosphere microorganisms of hyperaccumulators. Fresh and dry weight, and Ni and Fe concentrations in plant shoots were higher when A. murale was grown in non-sterilized compared to sterilized soils. The analysis of microbial populations in the rhizosphere of A. murale and in bulk soils demonstrated that microbial numbers were affected by the presence of the plant. Significantly higher numbers of culturable actinomycetes, bacteria and fungi were found in the rhizosphere compared to bulk soil. A higher percent of Ni-resistant bacteria were also found in the rhizosphere compared to bulk soil. Percentage of acid producing bacteria was higher among the rhizosphere isolates compared to isolates from bulk soil. However, proportions of siderophore producing and phosphate solubilizing bacteria were not affected by the presence of the plant. We hypothesize that microbes in the rhizosphere of A. murale were capable of reducing soil pH leading to an increase in metal uptake by this hyperaccumulator.