The microorganisms responsible for the contamination of watering water and market garden products are generally Enterobacteriaceae. Indeed, K. pneumoniae and Pseudomonas spp. are components of the commensal flora of the mucous membranes and upper respiratory tract. They are widely found in the environment . Strains of K. pneumoniae are some important pathogens, and they are often the cause of nosocomial pneumonia , septicaemia , urinary infections , infections of wounds , infections in the intensive care unit  and neonatal septicemia. They are also major opportunistic pathogens, especially in immune-suppressed individuals. Meanwhile, Pseudomonas spp. are opportunistic pathogens that often invade host tissues and cause infection and bacteremia in immune-suppressed hosts. However, there are some antibiotics that destroy these Enterobacteriaceae. Only Enterobacteriaceae microorganisms have generally developed various strategies to change the potential for action of these molecules. Resistance to extended-spectrum cephalosporins in the family of Enterobacteriaceae has commonly been associated with the expression of extended-spectrum TEM and SHV β-lactamases . Ten  variants of the CTX-M-type β-lactamases have been described in various enterobacterial species. It therefore appears necessary to evaluate the risks of microbial pollution from watering water in vegetable products and horticultural products and consider the importance and ever-growing place of these products in the diet of the population of Benin. This study was undertaken in this light and is designed to characterize the strains of K. pneumoniae and fluorescent Pseudomonas spp. producing β-lactamase inhibitors and identify contaminated market garden products and watering water. The results show that most of these products are consumed directly at Cotonou in Benin; this study was also conducted to assess and to limit the health risks associated with consumption of these products and restrict non-antibiotic prescription.In the rainy season, the four types of market garden products sampled are contaminated. Thus, for fluorescent Pseudomonas spp., great nightshade is the most contaminated, at a rate of 28%. It is followed by lettuce , cabbage  and finally carrots that are contaminated by fluorescent Pseudomonas spp. .

Lettuce is the most contaminated with K. pneumoniae ; it is followed by great nightshade  and cabbage ; carrots are not contaminated with K. pneumoniae. The difference of contamination proportions is significant. Among the different studied market garden products,flood and drain table and according to the two seasons, carrots are less contaminated than four leafy vegetables  and Figure 1. This result can be explained by the fact that the carrot is a root vegetable in which the edible part is underground. So, it is less exposed to the watering water. Allydice-Francis and Brown showed that lettuce and carrots are the two vegetables mainly associated with P. aeruginosa contamination. Only K. pneumoniae and fluorescent Pseudomonas spp. contamination can be through already-contaminated soils and dirty irrigation water infiltration, because it is recognized that wastewater transports almost all pathogens  contained in the feces . It is also established that excreta containing pathogens can survive for a long time in the water, soil and plants. Bacterial and viral pathogens can survive on cantaloupe, lettuce and pepper. However, it has been found that, although this contamination occurs by direct contamination of food, the accumulation rates of the strains varies. This observation was made because the variability of the rate of contamination is comparable with the rate from the work of. Considering the three types of water surveyed, well and drilling water are the ones most contaminated by fluorescent Pseudomonas spp., at a rate of 25%; drawing water is not contaminated by fluorescent Pseudomonas spp. However, pool water is the one most contaminated by K. pneumoniae, at a rate of 17%, followed by well and drilling water that is contaminated by K. pneumoniae at a rate of 13%. The difference of contamination proportions is not significant. In the rainy season, lettuce is the most contaminated by K. pneumoniae and fluorescent Pseudomonas spp. strains ; it is followed by great nightshade and cabbage. In the dry season, great nightshade is the most contaminated by K. pneumoniae and fluorescent Pseudomonas spp. strains; it is followed by cabbage and lettuce. These observations may find explanation in the morphology of these products and the type of crop. Indeed, asserted that the contamination would be staining direct food at the level of vegetable leaf , taking into account the large contact surface, and in the cabbage andcarrot at the same time. The root of vegetables that is in the leaves that close forming a crown, would be a conducive environment for the development of bacteria such as K. pneumoniae and fluorescent Pseudomonas spp. With regard to great nightshade and lettuce, they have broader leaves, providing a larger surface area for increased contamination by K. pneumoniae and fluorescent Pseudomonas spp.

In general, vegetables are more contaminated in the rainy season than in the dry season. This observation can explain the presence of water runoff in the rainy season that will drain, directly or indirectly, the feces and all microbes that contain garbage to garden products as supported by. Similar observations were made by in their study on lettuce contamination by E. coli. During the dry season, a variation of rate of contamination is observed depending on the site. Thus, the site in Cadjehoun is the most contaminated one, whereas the site in Akpakpa is the least contaminated one. On the site in Cadjehoun, analyzed vegetable products are contaminated at 4% and 67%, respectively, with K. pneumoniae and fluorescent Pseudomonas spp. at the same site, watering water analyzed is contaminated with K. pneumoniae at 17% and 33% by fluorescent Pseudomonas spp. As for the site in Akpakpa, all watering water is not contaminated, while the vegetable products are contaminated at 6% by fluorescent Pseudomonas spp. The difference of contamination proportions is significant. During the rainy season, the results are based on the analysis of the vegetable products. Thus, on the site in Cadjehoun, the contamination rate is 11% for each of the two types of strains. The Site of Akpakpa seems to be the most contaminated one this season, with a rate of contamination of 4% and 25%, respectively, for K. pneumoniae and fluorescent Pseudomonas spp. Meanwhile, the site of Houéyiho-Barrier is contaminated by fluorescent Pseudomonas spp. at a rate of 13%. The difference in proportions is significant.The susceptibility results of fluorescent Pseudomonas spp. strains to antibiotics show that they are resistant to the vast majority of the tested antibiotics. The rates of resistance to the trimethoprim/sulfamethoxazol and ciprofloxacin are, respectively, 82% and 8%. This result is comparable to the 83% and 7% rates observed by. Tobramycin resistance is 47%; this rate is higher than the one found by , who found a rate of resistance to tobramycin of 34.4%. In this study, all of the strains of K. pneumoniae and fluorescent Pseudomonas spp. were not resistant to imipenem. The fluorescent Pseudomonas spp. isolated from fresh vegetables by are not resistant to imipenem . This result demonstrates that imipenem would remain the most active molecule on K. pneumoniae and fluorescent Pseudomonas spp. This rate is lower than the one found by in Tunisia who have found 19.6% resistance to imipenem. Indeed,studied the emergency risk of resistance associated with piperacillin, ceftazidime, ciprofloxacin and imipenem observed by a variable emergency risk, with maximum resistance to imipenem . For K. pneumoniae, this rate is comparable to the 0.4% observed by in the food sector and confirmed by the 0% to 2% rate of resistance observed by in their study of some patients hospitalized in Europe and in the United States of America. However, this rate is different from the 16% observed by in Cameroon on clinical strains and the 10% observed by in America in the same field. Thus, the difference can be explained by the origin of the involved strains, although the strains have acquired resistance against antibiotics. This resistance is due to improper and uncontrolled use of antibiotics.

This high rate of resistance in this study could be explained by the misuse of the antibiotics by the population in our country.On the other hand, the strains come from the food raw materials that have not yet faced the misuse of antibiotics.Intracranial tumors of a certain size range  are often treated with single-fraction stereotactic radiosurgery , in which a rapid dose fall-off to spare normal tissues is achieved by using multiple beam directions and a high degree of collimation. The Leksell Gamma Knife Perfexion system , for example, has 192 high-activity Cobalt-60 sources that can be collimated to a single focus, capable of delivering a highly focal and conformal ablative radiation dose with a rapid dose fall-off toward surrounding healthy tissue. With spatial uncertainties of about 0.35 mm, the Perfexion system has an average agreement of 0.1 – 1.6 mm for substantial isodose lines and uncertainties in target localization of up to 1.3 mm for cases involving multiple brain metastases. For maximum accuracy, SRS delivered with this system requires use of a minimally invasive frame that is rigidly mounted onto the patient’s skull. In contrast to single-session SRS, fractionated stereotactic radiosurgery , in which radiation is delivered in 3 – 5 large fractions, is an attractive option for larger intracranial tumors or skull base tumors because the single-fraction dose required for tumor control often exceeds the tolerance of adjacent critical neuro-optic structures. Delivery of FSRS with the GK is facilitated by the use of an alternative to the head frame, in which the patient’s head position is fixed by means of a customized vacuum-assisted mouthpiece . Another means of delivering FSRS is with advanced linear accelerators , such as the TrueBeam STx . LINACs have the advantages of sub-millimeter precision, a fully integratedvolumetric imaging system, rolling bench high-dose-rate delivery, motion management techniques, and high-definition  multi-leaf collimation. Use of volumetric modulated arc therapy  on LINACs also permits continuous delivery of radiation, which can significantly reduce treatment time. A third means of delivering FSRS is by proton beam therapy. The unique dosimetric characteristic of protons can minimize the dose to normal tissue distal to the tumor relative to that from high-energy photons and can be used for FSRS of head and neck tumors. Recent advances in proton radiation delivery involving spot scanning or intensity-modulated proton therapy enable sufficiently conformal plans to treat head and neck tumors. For this purpose, IMPT has the potential to capture the “best of both worlds” by limiting the high-dose region beyond the tumor while also limiting the low dose bath, i.e. exposure of surrounding tissues to low-dose radiation. Treatment for a subset of head and neck tumors, i.e. those at the skull base, or larger intracranial tumors is uniquely challenging because of the strict constraints on nearby critical structures. Here, we extracted treatment plans from patients with skull-base or intracranial tumors treated with FSRS, used them to generate plans for VMAT and IMPT, and compared the quality of the three sets of treatment plans.We first identified 9 patients who had received FSRS with GKE  from February 2013 to January 2015 at a single institution .

Treatment in all cases had been directed to a single isocenter/target, and the median prescription dose was 24 Gy delivered in 3 daily fractions. The GK treatment plans were generated under magnetic resonance imaging  or computerized tomography  guidance and were obtained within a week before the first treatment session. Plans for GK therapy with the Extend system  had been generated by a combination of inverse planning and forward planning by a team of radiation oncologists, neurosurgeons, and physicists using the Leksell Gamma Plan 10.1.1 . After the mouth piece assisted frame was placed, the patient was transported to the simulation CT scanner and a setup verification CT scan was acquired. That scan was then fused to the treatment-planning image to verify the consistency of setup by using the Extend system’s repositioning tools. GKE treatment plans included a 2-mm margin around the tumor to form the planning target volume .From each GKE plan, a VMAT plan was generated using a Pinnacle treatment planning system  on a TrueBeam STx LINAC using 6-MV photons and high-definition multi-leaf collimators. PTVs and organs at risk  were defined on the GKE plan and digitally transferred to Pinnacle using the DICOM-RT protocol for VMAT planning.