Spatial congruency or discrepancy? Exploring the spatiotemporal dynamics of built-up expansion patterns and flood risk

Most coastal cities have been experiencing unprecedented urbanization-induced flood risk, climatic events, and haphazard anthropogenic activities, jeopardizing residents' lives and building environments. Despite mounting flood-related studies, analyzing the correlation between the spatiotemporal dynamics of Built-up Expansion patterns (BE) and flood risk remains unknown and holds divergent perspectives. In this context, the coastal city of Alexandria, Egypt, characterized by multiple urban patterns and experiencing heavy rainfall annually, was selected as a testbed. Our method defined the spatiotemporal rates of BE from 1995 to 2023, quantified flood risk spatially, and finally investigated the correlation between BE and flood risk through spatial and statistical analysis. Our results show the built-up area occupied 30.32 % of the total city area till 2023, and the infilling pattern dominated the BE growth by 45.21 % of the total built-up area, followed by leapfrogging and edge expansion by 33.25 % and 21.55 %, respectively. The unplanned-infilling pattern is predominantly highly correlated with the flood-vulnerable peaks (correlation coefficient (rk) = 0.975, p-value < 0.05) and lowers dramatically towards planned-infilling regions with flood protections. Meanwhile, a spatial mismatch exists between high-risk peaks and leapfrogging and edge expansion (rk = 0.118 and 0.662, respectively, with a p-value < 0.01), indicating that controlling the built-up amount is inadequate for mitigating flood risk. Porosity-based urban configuration and spatial distribution of built-up patches in harmony with nature-based solutions are recommended for shaping flood-resilient and effective urban planning.

Assessing the effectiveness of nature-based solutions-strengthened urban planning mechanisms in forming flood-resilient cities

Cities have experienced rapid urbanization-induced harsh climatic events, especially flooding, inevitably resulting in negative and irreversible consequences for urban resilience and endangering residents' lives. Numerous studies have analyzed the effects of anthropogenic practices (land use changes and urbanization) on flood forecasting. However, non-structural mitigation's effectiveness, like Nature-Based Solutions (NBS), has yet to receive adequate attention, particularly in the Middle East and North Africa (MENA) region, which have become increasingly significant and indispensable for operationalizing cities efficiently. Therefore, our study investigated the predictive influence of incorporating one of the most common NBS strategies called low-impact development tools (LID) (such as rain gardens, bio-retention cells, green roofs, infiltration trenches, permeable pavement, and vegetative swale) during the urban planning of Alexandria, Egypt, which experiences the harshest rainfall annually and includes various urban patterns. City characteristics-dependent 14 LID scenarios were simulated with recurrence intervals ranging from 2 to 100 years using the LID Treatment Train Tool (LID TTT), depending on calibrated data from 2015 to 2020, by the Nash-Sutcliffe efficiency index and deterministic coefficient, and root-mean-square error with values of 0.97, 0.91, and 0.31, respectively. Our findings confirmed the significant effectiveness of combined LID tools on total flood runoff volume reduction by 73.7%, revealing that different urban patterns can be used in flood-prone cities, provided LID tools are considered in city planning besides grey infrastructure to achieve optimal mitigation. These results, which combined multiple disciplines and were not explicitly mentioned in similar studies in developing countries, may assist municipalities' policymakers in planning flood-resistant, sustainable cities.

Are Coastal Hotels Ready for Climate Change? The Case of Alexandria, Egypt

Climate change casts a shadow on the tourism industry in Egypt in general, and on coastal hotels in particular, as the coastal areas of Egypt have been classified as the most vulnerable to climate change in the Middle East. As such, mitigating the negative impacts and threats of climate change requires an assessment of the vulnerability of coastal hotels and the extent to which adaptation measures are applied. Accordingly, this study applied a hybrid methodology to achieve three main objectives. First, to evaluate Alexandria's vulnerability to future climate change (at the destination level) by analyzing the recent climatic trends and expected scenarios. Second, to assess the vulnerability of Alexandria's coastal hotels to climate change (sector level) using satellite images, aerial mapping, remote sensing, and geographic information systems (GIS). Third, to explore how coastal hotels are adapting to the risks of climate change using the four business-focused adaptation measures (i.e., technical, managerial, policies, and awareness-raising). The findings of the study revealed and confirmed that the hotel sector in Alexandria is threatened by sea level rise (SLR). Four hotels are at risk of inundation, and the extent of hotels at risk will increase with future scenarios of SLR. On the other hand, the results of examining the adaptation measures of 36 hotels indicated that the scope of the adaptation measures differed significantly between hotels due to factors such as hotel category, size, duration of operation, and EMS status, but overall, the scope of application was more comprehensive and varied than expected. Technical adaptation measures were the most common and applied by the majority of hotels in Alexandria. The results of this study should help figure out what adaptation measures coastal hotels should take and show policymakers where they should focus their adaptation efforts.

Assessment of patient safety culture among the staff of the University Hospital for Gynecology and Obstetrics in Alexandria, Egypt

Background

Patient safety (PS) is a fundamental component of healthcare quality. Patient Safety Culture (PSC) assessment provides an organization with insight of perceptions and attitudes of its staff related to patient safety. In addition, it is meant to improve performance rather than blaming individuals. This study aimed to assess patient safety culture from the health care staff perspective in El-Shatby University Hospital for Gynecology and Obstetrics.

Methods

A descriptive cross-sectional study was conducted. The study was conducted at El-Shatby University Hospital for Gynecology and Obstetrics from November 2020 to January 2021. The target participants were assistant lecturers, residents, and head nurses in charge during the field study period. The number of potential participants who fulfilled the inclusion criteria (in charge during the period of data collection and working in the hospital for more than 3 months) was 83; the twelve participants who participated in the pilot study were excluded. The total number of participants who agreed to participate in the study was 66 participants (38 residents, 18 assistant lecturers, and 10 head nurses) out of 71 potential participants representing a 92.9% response rate. A structured self-administered questionnaire format adapted from Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was distributed anonymously to the participants. The questionnaire has 42 items measuring twelve patient safety culture dimensions: teamwork within the unit, supervisors’ expectations and actions to promote patient safety, feedback and communication about error, organizational learning, communication openness, overall perception of patient safety, hands-off and transitions, teamwork across units, frequency of events reported, management support for patient safety, staffing, and management support for patient safety. Except for two items that are responded on a five-point frequency scale (never, rarely, sometimes, most of the time, and always) the majority of patient safety culture questions are answered on a five-point agreement scale (strongly disagree, disagree, neutral, agree, and strongly agree), with a higher score indicating a more favorable attitude toward patient safety.

Results

The overall average positive percent score was 45.4%. Average positive response percentages to individual items ranged from 28.8 to 81.8%. No domain had an average positive percent score of more than 75%. Out of the twelve dimensions of patient safety culture included in the HSOPSC questionnaire, “the teamwork within unit” domain had the highest average positive percent score (62.1%) among all participants. On the other hand, the “Non-punitive response to error” domain had the lowest score (18.9%). More than half (57.6%) of the participants rated patient’s safety at the hospital as acceptable.

Conclusion

Investing in practices that strengthen patient safety is crucial if the hospital is to improve overall performance and quality of services. The present study displays a frail patient safety culture (PSC) in the majority of the domains. All the domains should be considered of high priority focused areas for remark and reformative tasks. Continuous training programs of the staff on patient safety to improve their perception of safety culture are necessary. All PSC composites need improvement starting with regular assessment of PSC along with continuous monitoring and increasing the healthcare providers’ awareness of demanded PSC.

Thermal comfort optimization through bioclimatic design in Mediterranean cities

Background: Bioclimatic design is an approach based on local climate which improves thermal qualities and indoor comfort. Buildings follow this process to minimize negative effects on the environment. However, this approach is still not suitable in developed countries. This study aims to investigate Mediterranean local bioclimatic strategies' impact on thermal comfort efficiency in housing, by examining architectural elements and treatments. Methods: We adopted a descriptive, analytical, and comparative methodology, complemented with a software simulation, within a qualitative and quantitative approach. Investigation and methodological tools were based on technical information including plans, elevations, photos, and documentation. The approach consisted of multiple stages: a literature review interpreting the concept of bioclimatic design, as well as thermal comfort variables and common Mediterranean building features. Moreover, the paper showcases three examples of successful Mediterranean passive houses. Furthermore, the paper presents a case- studyhouse in Alex West, Alexandria, designed in the Mediterranean Revival style. Results: The results showed that the most influencing building features on thermal comfort were the low-pitched roofs and the top chimney, which achieved 12.6% and 5% improvement in the summer and 13% and 6.8% in winter, respectively. The pergola and porch elements barely had an effect when placed on the northern façade. However, on the southern façade, a positive contribution in the summer by 1.4% and 3.4% respectively were reported, but a slight negative impact in winter by 0.5% and 2% respectively. Conclusions :  We examined the impact of common Mediterranean building features , and compared thermal comfort results between case-study houses. Features focusing on passive design for cooling rather than heating, allowing wind flow for maximized natural ventilation, using ventilated pitched roof spaces, using sun shading elements in the proper facades and angles, help passive thermal regulation. The study proposes recommendations for optimizing thermal comfort in residential buildings in Alexandria, Egypt.

Pattern of Urban Flora in Intra-City Railway Habitats (Alexandria, Egypt): A Conservation Perspective

Intra-city railway areas are deemed large greenspaces and are believed to be key in enhancing the diversity and dynamics of urban flora. In the current study, the floristic composition and diversity along intra-city railway and tram tracks in Alexandria were surveyed. The floristic composition of the plant communities in relation to environmental factors, ecological indicators, and level of human impact was analyzed using multivariate analysis (two-way indicator species analysis (TWINSPAN) for classification and detrended correspondence analysis (DECORANA) for ordination. The multivariate ordination techniques (CCA) revealed differences in the environmental factors and climatic factors influencing the floristic composition of the railway and tram track habitats. Tram tracks suffered higher human impact while maintaining higher vitality and cover compared to train tracks. Species recorded were mainly therophytes, followed by phanerophytes and hemicryptophytes dominated by native species; however, invasive species' contribution was higher compared to surrounding regions. The number of invasive species was greater in railway areas compared to tram track areas (19 and 15, respectively). The occurrence of two endemic species (Sinapis allionii and Sonchus macrocarpus) with limited national distribution highlights the importance of these habitats as valuable refuge areas for rare and endangered species worthy of conservation action.

Human Health Implication of Major and Trace Elements Present in Commercial Crustaceans of a Traditional Seafood Marketing Region, Egypt

The present study focused on the distribution of some major and trace elements (S (as SO₄^2-), Na, K, B, Ca, Mg, F, Li, Al, Fe, Zn, Cu, Mn, Ni, Co, Cd, and Pb) in both flesh (Fl) and total cephalon/exoskeleton (C/E) tissues of selected crustacean species obtained from an Egyptian traditional seafood marketing region. The sequence of studied elements in (Fl) and (C/E) tissues in descending orders was S (as SO₄^2-) > Na > K > B > Mg > Ca > Li > F > Al > Zn > Fe > Cu > Pb > Ni > Mn > Co > Cd, and S (as SO₄^2-) > Na > B > K > Mg > Ca > F > Li > Al > Fe > Cu > Zn > Mn > Pb > Ni > Co > Cd, respectively. Both length-weight relationship and Fulton's condition factor showed the physical and biological statuses of the crustaceans. Ion quotient calculations of the studied tissues pointed to their importance in decreasing hypertension, preeclampsia, and heart disease. Human health risk due to the consumption of the crustacean species was determined using some guideline limits, metal pollution index (MPI), estimated daily intake (EDI), health comparison values (CVs), dietary intake (DRI-ULs), target hazard quotient (THQ), total target hazard quotient (TTHQ), and provisional tolerable weekly intake (%PTWI). MPI values of cephalon/exoskeleton tissues were greater than those of the flesh with ranges between 11.4-24.0 and 4.6-14.3, respectively. Interestingly, the calculations of TTHQ of toddler and adult were lesser than one and not expected to pose any risk concern to human from crustaceans' consumption.

Pattern of Uveitis Associated with Behçet's Disease in an Egyptian Cohort

Purpose

To report the clinical experience of uveitis associated with Behçet's disease in a cohort of Egyptian patients.

Methods

The present study is a retrospective analysis of the medical charts of patients with Behçet's disease, who were referred to a tertiary eye care center in Egypt between June 2010 and June 2018.

Results

The current study included 1301 eyes of 681 patients with Behçet's disease. The mean age of the patients at the time of referral was 27.2 ± 3.9 years. Panuveitis was the most common presentation. About 28% of all involved eyes had a final visual acuity <20/200, by the last follow-up visit.

Conclusion

Behçet's disease is an important cause of uveitis in Egypt, and despite the fact that the prognosis of Behçet's uveitis has globally improved in recent years, the visual outcome in Egypt is still not favorable especially in case of delayed referral to tertiary centers.

Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization

BACKGROUND

Maternal neonatal tetanus is a substantial public health problem in many developing countries. In 2017, nearly, 30,848 newborns died of neonatal tetanus; thus, high immunization coverage remains a necessity. This study aims to assess knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization.

METHODS

A cross-section survey of 700 females attending health offices in Alexandria was done using an interview questionnaire to collect data regarding women's knowledge and beliefs about tetanus toxoid vaccine (TTV) and maternal and neonatal tetanus (MNT). Nine health offices were selected using multi-stage random sampling.

RESULTS

Most of studied women (83.6%) had poor knowledge of MNT and TTV. The highest percentage of women had low perception of susceptibility to MNT (48.0%), moderate perception of severity of MNT (57.4%) and barriers to TTV (58.9%), high perception of benefits of TTV (86.6%), and high self-efficacy in taking the vaccine (76.2%). Less than one-third of the sampled women (27.7%) were immune by (TT2+). Logistic regression models showed that the place of antenatal care, level of knowledge, perceived barriers, and socio-economic level were significant predictors of immunity status (p = 0.008, p = 0.032, p = 0.011, and p = 0.001, respectively).

CONCLUSION

Women lacked information about MNT/TTV and may even have been discouraged by their private obstetricians from taking the vaccine. Perceived barriers to receiving tetanus toxoid vaccination were shown to be an important predictor of immunization behavior.

Prevalence of Chronic Diabetic Complications in Newly Diagnosed versus Known Type 2 Diabetic Subjects in a Sample of Alexandria Population, Egypt

BACKGROUND

In Egypt, data on the prevalence of chronic diabetic complications, which are essential for the adjustment of policies and practices related to diabetes care, are scarce. Therefore, the aim of this study was to determine the frequency of chronic complications of diabetes; namely neuropathy, Diabetic Kidney Disease (DKD), retinopathy and Peripheral Arterial Disease (PAD) in newly-diagnosed versus known type 2 diabetic patients.

SUBJECTS & METHODS

This is a cross-sectional study that is based on a previous household survey conducted on a representative sample of the population of Alexandria, Egypt. This study included 506 consecutive subjects with type 2 diabetes; 323 patients with previously known T2DM and 183 patients with newly diagnosed T2DM (discovered during the survey). For each participant, a focused history was taken. Comprehensive clinical examination was done including fundus examination, foot examination and assessment of ankle brachial index. Laboratory tests included HbAlc, lipids profile, serum creatinine and Urinary Albumin Creatinine Ratio (UACR).

RESULTS

Peripheral neuropathy was detected in 20% of the studied patients; 29.4% of known patients and 3.3% of newly diagnosed patients (p<0.001). Diabetic kidney disease was detected in 33.2% of the studied patients; 46.1% of known patients and 10.4% of newly diagnosed patients (p<0.001). Diabetic retinopathy was detected in 34.6% of the studied patients; 48.3% of known patients and 10.4% of newly diagnosed patients (p<0.001). Peripheral arterial disease was detected in 32.6% of the studied patients; 45.5% of known patients and 9.8% of newly diagnosed patients (p<0.001). In patients with known diabetes, the presence of any of the studied complications (neuropathy, diabetic kidney disease, retinopathy or PAD) was significantly associated with the presence of all other complications (p< 0.001). In patients with newly-diagnosed diabetes, the presence of diabetic kidney disease was significantly associated with the presence of retinopathy (p<0.001), with no significant association with PAD (p=0.357).

CONCLUSION

The present study confirms that a considerable proportion of people with T2DM have microvascular complications and/or PAD at the time of, and possibly years before, diagnosis. Having shown that, it is strongly recommended to apply appropriate screening strategies for subjects with diabetes at the time of diagnosis. Finally, these results should be considered as a call for action for the health care planners and providers in our region to plan for early screening for diabetes and its complications to reduce the disease burden in our community.

Early contribution of Alexandria medical school to the anatomy, physiology and pathology of the nervous system

Alexandria's famous medical school was established about 300 BC. It was the seat of learning for many Greco-Roman physicians. The physiologist Erasistratus, the anatomist Herophilus - named the Father of Anatomy were outstanding pioneers. Their work and discoveries of the nervous system, its structure and function, are described. In the 2nd century AD they were succeeded by Rufus of Ephesus - the medical link between Hippocrates and Galen, - and Aretaeus a leading anatomist and physician in this period.

Uveitis Referral Pattern in Upper and Lower Egypt

Purpose: To report the pattern of uveitis in two referral eye hospitals, one in Upper Egypt and another in Lower Egypt Methods: Retrospective chart review of all uveitis cases visiting the uveitis clinic in Alexandria and Sohag University Hospitals between May 2010 and March 2017. Results: A total of 1315 patients (683 in Upper Egypt and 632 in Lower Egypt) were identified. Uveitis was bilateral in 56.6% of patients in Upper Egypt and in 43.6% of patients in Lower Egypt. Anterior uveitis was the most common in both regions, accounting for 34.7% and 38.2% of cases in Upper Egypt and Lower Egypt respectively. Pediatric cases constituted 18.7% of the cases in Upper Egypt and 18.1% of the cases in Lower Egypt. Specific diagnosis was established in 71.3% and 67.7% of Upper and Lower Egypt cases respectively. Conclusions: Patterns of uveitis differ according to the geographical area in Egypt.

Seroprevalence of Toxoplasma gondii infection among patients with non-schizophrenic neurodevelopmental disorders in Alexandria, Egypt

Toxoplasma gondii is an opportunistic parasite with neurotropic characteristics that can mediate neurodevelopmental disorders, including mental, behavioral and personality aspects of their hosts. Therefore, the seroprevalence of anti-Toxoplasma antibodies has been studied in patients with different neurological disorders from different localities. On searching online databases, however, we could not find published studies on the seroprevalence of anti-Toxoplasma antibodies among patients with neurodevelopmental disorders in Egypt. Therefore, the present preliminary study was conducted to determine the serological profile of T. gondii infection among patients with non-schizophrenic neurodevelopmental disorders in Alexandria, Egypt. Data and blood samples were collected from 188 patients recruited for the study from four mental rehabilitation centers in the period from July 2014 to March 2015. The overall seropositivity rates of IgM and IgG among patients were 16.5% (31/188) and 50.0% (94/188), respectively. Of the studied patients' characteristics, only age was significantly associated with anti-Toxoplasma IgG seropositivity, with older patients being about twice more likely exposed to infection. However, no statistically significant association was found with IgM. In addition, seropositivity of anti-Toxoplasma IgG, but not IgM, was significantly associated with non-schizophrenic neurodevelopmental disorders; however, neither IgG nor IgM showed a significant association with cognitive impairment as indicated by the intelligence quotient scores.

Association of some virulence genes with antibiotic resistance among uropathogenic Escherichia coli isolated from urinary tract infection patients in Alexandria, Egypt: A hospital-based study

Uropathogenic Escherichia coli (UPEC) is the infecting agent most frequently involved in urinary tract infections (UTIs) worldwide. UPEC resistance to commonly used antibiotics represents a major health problem all over the world. Several factors have been associated with UPEC resistance to antibiotics. The present study deployed a molecular approach to explore the association between some UPEC virulence genes and antibiotic resistance among patients with UTI in Alexandria, Egypt. The study revealed a significant association between presence of the pap gene and resistance to gentamicin; however, it was not significantly associated with resistance to β-lactam antibiotics, quinolones, aminoglycosides, nitrofurantoin and trimethoprim/sulfamethoxazole. The genes sfa, aer and cnf1 were not significantly associated with UPEC resistance to any of the tested antibiotics. In conclusion, resistance of UPEC isolates in the present study could be attributed to other virulence factors.

Contamination of irrigation systems of dental units with Cryptosporidium species in Alexandria, Egypt: a neglected disinfection pitfall

PURPOSE

To investigate the contamination of the dental irrigation systems with Cryptosporidium species in Alexandria, Egypt.

METHODS

Forty water samples from all 20 working dental irrigation machines in a dental center in Alexandria were included in the study. Water samples were taken from the handpieces of dental irrigation machines in all studied units. After filtration through a membrane filter, water sample residues were stained using modified Ziehl-Neelsen staining and examined microscopically for Cryptosporidium spp.

RESULTS

Cryptosporidium spp. was found as a contaminant in 27.5% of water samples taken from dental irrigation machines.

CONCLUSION

This indicates a contamination by the public water supplies to which these dental irrigation machines are connected. This disinfection pitfall may pose an infection risk to those seeking dental care.

Description and SEM Observations of a New Species of Cyst Nematode Heterodera goldeni (Nematoda: Heteroderidae) Attacking Panicum coloratum in Egypt

A cyst nematode, Heterodera goldeni n. sp., is photographed and described from Qasabagrass roots (Panicum coloratum L.) in Alexandria, Egypt. It is characterized in having second-stage juveniles with body length of 546 microm (450-612), stylet length of 22.6 microm (22-23.5) with anchor-shaped knobs, lateral field with 3 lines, tail 60-75 microm, hyaline tail terminus 38.4 microm (33-43); cysts are lemon-shaped, dark to light brown with an extensive sub-crystalline layer covering the entire cyst, cuticular midbody pattern zig-zag, cysts ambifenestrate, well-developed underbridge with finger-like projections, bullae present, vulva slit measuring 44-48 microm long. Males are absent, and females have heavy punctations on the cuticle. Its relationship to H. graminophila described from Florida and Louisiana and H. leuceilyma described from Florida are discussed. The present known distribution is restricted to Alexandria, Egypt. Its economic importance in rangeland grasses and cultivated crops such as rice is not known.