Colistin-, cefepime-, and levofloxacin-resistant Salmonella enterica serovars isolated from Egyptian chicken carcasses.

OBJECTIVES: The emergence of multidrug-resistant (MDR) Salmonella strains, especially resistant ones toward critically important antimicrobial classes such as fluoroquinolones and third- and fourth-generation cephalosporins, is a growing public health concern. The current study, therefore, aimed to determine the prevalence, and existence of virulence genes (invA, stn, and spvC genes), antimicrobial resistance profiles, and the presence of ß-lactamase resistance genes (blaOXA, blaCTX-M1, blaSHV, and blaTEM) in Salmonella strains isolated from native chicken carcasses in Egypt marketed in Mansoura, Egypt, as well as spotlight the risk of isolated MDR, colistin-, cefepime-, and levofloxacin-resistant Salmonella enterica serovars to public health. METHODS: One hundred fifty freshly dressed native chicken carcasses were collected from different poultry shops in Mansoura City, Egypt between July 2022 and November 2022. Salmonella isolation was performed using standard bacteriological techniques, including pre-enrichment in buffered peptone water (BPW), selective enrichment in Rappaport Vassiliadis broth (RVS), and cultivating on the surface of xylose-lysine-desoxycholate (XLD) agar. All suspected Salmonella colonies were subjected to biochemical tests, serological identification using slide agglutination test, and Polymerase Chain Reaction (PCR) targeting the invasion A gene (invA; Salmonella marker gene). Afterward, all molecularly verified isolates were screened for the presence of virulence genes (stn and spvC). The antimicrobial susceptibility testing for isolated Salmonella strains towards the 16 antimicrobial agents tested was analyzed by Kirby-Bauer disc diffusion method, except for colistin, in which the minimum inhibition concentration (MIC) was determined by broth microdilution technique. Furthermore, 82 cefotaxime-resistant Salmonella isolates were tested using multiplex PCR targeting the ß-lactamase resistance genes, including blaOXA, blaCTX-M1, blaSHV, and blaTEM genes. RESULTS: Salmonella enterica species were molecularly confirmed via the invA Salmonella marker gene in 18% (27/150) of the freshly dressed native chicken carcasses. Twelve Salmonella serotypes were identified among 129 confirmed Salmonella isolates with the most predominant serotypes were S. Kentucky, S. Enteritidis, S. Typhimurium, and S. Molade with an incidence of 19.4% (25/129), 17.1% (22/129), 17.1% (22/129), and 10.9% (14/129), respectively. All the identified Salmonella isolates (n = 129) were positive for both invA and stn genes, while only 31.8% (41/129) of isolates were positive for the spvC gene. One hundred twenty-one (93.8%) of the 129 Salmonella-verified isolates were resistant to at least three antibiotics. Interestingly, 3.9%, 14.7%, and 75.2% of isolates were categorized into pan-drug-resistant, extensively drug-resistant, and multidrug-resistant, respectively. The average MAR index for the 129 isolates tested was 0.505. Exactly, 82.2%, 82.2%, 63.6%, 51.9%, 50.4%, 48.8%, 11.6%, and 10.1% of isolated Salmonella strains were resistant to cefepime, colistin, cefotaxime, ceftazidime/clavulanic acid, levofloxacin, ciprofloxacin, azithromycin, and meropenem, respectively. Thirty-one out (37.8%) of the 82 cefotaxime-resistant Salmonella isolates were ß-lactamase producers with the blaTEM as the most predominant ß-lactamase resistance gene, followed by blaCTX-M1 and blaOXA genes, which were detected in 21, 16, and 14 isolates respectively). CONCLUSION: The high prevalence of MDR-, colistin-, cefepime-, and levofloxacin-resistant Salmonella serovars among Salmonella isolates from native chicken is alarming as these antimicrobials are critically important in treating severe salmonellosis cases and boost the urgent need for controlling antibiotic usage in veterinary and human medicine to protect public health.

Aged garlic extract preserves beta-cell functioning via modulation of nuclear factor kappa-B (NF-κB)/Toll-like receptor (TLR)-4 and sarco endoplasmic reticulum calcium ATPase (SERCA)/Ca2+ in diabetes mellitus.

BACKGROUND: Peripheral insulin resistance and compromised insulin secretion from pancreatic ß-cells are significant factors and pathogenic hallmarks of diabetes mellitus (DM). NF-κß/TLR-4 and SERCA/Ca2+ pathways have been identified as potential pathways regulating insulin synthesis by preserving pancreatic ß-cell functioning. The current study aimed to evaluate the therapeutic effect of aged garlic extract (AGE) against DM in a streptozotocin (STZ)-induced rat model with particular emphasis on pancreatic ß-cell functioning. METHODS: AGE was characterized by gas chromatography-mass spectrometry (GC-MS), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM) to evaluate its physio-chemical characteristics followed by in-vitro anti-diabetic and antioxidant potential. This was followed by the induction of DM in laboratory animals for investigating the therapeutic action of AGE by evaluating the role of NF-κß/TLR-4 and the SERCA/Ca2+ pathway. The parameters assessed in the present experimental setup encompassed antioxidant parameters, metabolic indicators, insulin concentration, intracellular calcium levels, apoptotic markers (CCK-8 and Caspase Glo-8), and protein expression (P-62 and APACHE-II). RESULTS: AGE characterization by SEM, GC-MS, and X-ray diffraction (XRD) revealed the presence of phenylalanine, alliin, S-allylmercaptocysteine (SAMC), tryptophan, 1-methyl-1,2,3,4-tetrahydro-ß-carboline-3-carboxylic acid as major bioactive constituents of AGE. Metabolic studies, including intraperitoneal glucose tolerance test (IPGTT), revealed significantly lower blood glucose levels in the AGE group compared to the disease control group. In contrast, the intraperitoneal insulin tolerance test (ITT) exhibited no significant difference in insulin sensitivity between the AGE supplementation group and the DM control group. Interestingly, AGE was found to have no significant effect on fasting glucose and serum insulin levels. In contrast, AGE supplementation was found to cause significant hypoglycaemia in postprandial blood glucose and insulin levels. Importantly, AGE causes restoration of intracellular Ca2+ levels by modulation of SERCA/Ca2 functioning and inhibition NF-κB/TLR-4 pathway. AGE was found to interact with and inhibit the DR-5/ caspase-8/3 apoptotic complex. Furthermore, microscopic studies revealed degeneration and apoptotic changes in pancreatic ß-cells of the DM control group, while supplementation of AGE resulted in inhibition of apoptotic pathway and regeneration of pancreatic ß-cells. CONCLUSION: The current study suggests that AGE enhance glucose homeostasis by exerting their effects on pancreatic ß-cells, without ameliorating peripheral sensitivity. Moreover, AGEs promote an increase in ß-cell mass by mitigating the apoptosis of pancreatic ß-cells. These findings suggest that AGE could aid in developing a viable alternative therapy for diabetes mellitus (DM).

Carcinogenic and non-carcinogenic health risks associated with the consumption of fishes contaminated with heavy metals from Manzala Lake, Egypt.

Manzala Lake was sampled to assess the concentrations and possible ecological risks of heavy metals. The mean heavy metal levels in the muscles of Nile tilapia, Flathead grey mullets and African catfish were 0.01, 0.15 and 0.29 mg/kg, respectively, for mercury; 3.16, 4.25 and 4.74 mg/kg for arsenic; 1.01, 0.87 and 0.95 mg/kg for lead; and 0.05, 0.12 and 0.06 mg/kg for cadmium. The levels of heavy metals exceeded their maximum permissible limits in most samples. The EDIs of some metals were higher than their PTDIs or BMDLs. The THQs and TTHQs from metal intake were >1 for Hg and Cd. In addition, the TCR values of As in all fish species were higher than 1.0 × 10-4 indicating a potential health risks from consumption of fish species which need strict hygienic procedures to prevent fish contamination with heavy metals and ensure that their levels did not exceed the maximum permissible limits.

Antimicrobial effect of garlic against foodborne pathogens in ground mutton.

The antimicrobial effect of fresh garlic (20, 30, and 50 g/kg) and the equivalent concentrations of garlic oil (80, 120, and 200 mg/kg) was investigated in ground mutton during storage at 4 °C. By day 6 and thereafter, mutton meatballs treated with 50 g/kg of fresh garlic and 200 mg/kg garlic oil exhibited a significant decline in psychrotrophic and Pseudomonas counts in comparison with control. Fresh garlic added at a concentration of 50 g/kg exhibited the highest antimicrobial effect, followed by garlic oil at 200 mg/kg, fresh garlic at 30 g/kg, and garlic oil at 120 mg/kg. By the 15th day of storage, the fresh garlic added at concentrations of 50 and 30 g/kg and garlic oil added at concentrations of 120, and 200 mg/kg inactivated the populations of foodborne pathogens artificially inoculated into ground mutton and exhibited significant (P < 0.01) lower counts in Salmonella Typhimurium, Escherichia coli O157:H7, Listeria monocytogenes, and Staphylococcus aureus by more than 3 logs CFU/g, in comparison to control. Therefore, fresh garlic and garlic oil can be used as natural antimicrobial food additives to extend the shelf life and inactivate the populations of foodborne pathogens in meat products.

Pulmonary edema: A complication of post-complete ingrown toenail excision. A case report.

A sympathetic crashing pulmonary edema (SCAPE) is an emergency medical situation necessitating early recognition and treatment. We present a case of a 15-years old male who underwent a toenail excision of his left big toe and who developed SCAPE postoperatively. The low incidence of SCAPE intraoperatively makes it challenging for anesthesiologists to diagnose it. It occurs unexpectedly and precipitously, and it may increase the risks of morbidity and mortality if it is not treated promptly. Our aim is to raise awareness of how to abruptly manage such cases.

Assessment of nursing knowledge and practice toward prevention of acquired infections in the emergency department of King Faisal Medical Complex in Taif.

Background: Hospital-acquired infections constitute a significant source of morbidity and mortality for both patients and healthcare professionals. Nursing professionals constitute an integral component of any quality-related program in a hospital, given their oversight and provision of nearly all healthcare services. Nurses' knowledge and attitudes play a significant role in healthcare delivery. Within Saudi Arabia, the prevalence of hospital-acquired infections in hospital settings has prompted a growing emphasis on evaluating nursing knowledge and adherence to practice standards aimed at hospital-acquired infection prevention. Methods: This single-center cross-sectional study was conducted at the emergency department of King Faisal Medical Complex, Taif, between October and December 2022, involving 168 nurses. The study utilized a pre-validated structured online questionnaire comprising three sections: demographics, knowledge assessment, and practice evaluation. Knowledge and practice levels were categorized as good, moderate, and poor using quartiles. Results: The study encompassed 168 nurses employed in the emergency department of the hospital, revealing their proficiency in standard practices for preventing hospital-acquired infections. Notably, 63.8% of participants demonstrated a commendable "Good" level of knowledge, while 10.6% exhibited a "Moderate" level and 25.5% manifested a "Poor" level in terms of knowledge. Similarly, concerning practice levels, 56.4% showcased a commendable "Good" practice level, 22.3% maintained a "Moderate" practice level, and 21.3% presented a "Poor" practice level. Chi-square analysis unveiled a significant association between age and knowledge levels (p = 0.000). In addition, age (p = 0.000) and years of clinical experience (p = 0.000) were significantly linked to nurses' practice levels The nurses aged 40-50 years (82%) and those with 10-15 years of clinical experience (83.3%) showed good levels of knowledge and practice, respectively. Overall, most of the nurses demonstrated effective knowledge and compliance with infection prevention practices. Conclusion: Sociodemographic factors such as age and clinical experience exert a notable impact on nurses' knowledge and practices regarding hospital-acquired infections.

The Impact of Economic Corridor and Tourism on Local Community's Quality of Life under One Belt One Road Context.

Economic corridors unlock new economic opportunities and tourism development in the region to achieve sustainable development goals. Green economic growth is conducive to environmental sustainability. Economic mega-projects of CPEC promote tourism that leads to communities' well-being and better quality of life. Modern infrastructure development contributes significantly to economic growth and tourism activities. This study's objectives emphasize exploring tourism and sustainable development pursuits under OBOR economic projects that open doors to improving residents' quality of life. The growing world is an eyewitness to a continuous rise in emissions and its severe consequences for humankind. It is necessary to show off the leading factors that result in tourism and economic activities causing environmental pollution rather than blame policymakers. Undoubtedly, many studies previously focused on demonstrating the influence of socio-economic factors that lead to better environmental quality. However, the empirical literature on tourism, social well-being, foreign direct investment, and the Environment in Belt and Road developed economies needed improvement. This research applied a series of advanced estimators that help demonstrate the study's probable results. This study explores the role of Social well-being (HDI), tourism development, FDI, renewable energy, information & communication technology (ICT), and urbanization on CO2 emissions in Belt and Road (BRI) developed economies.Estimated results exhibited the significant contribution of ICT and renewable energy to sustainability. Besides, FDI contributes to emissions reduction after its threshold level. Conversely, urbanization and tourism activities contribute to environmental pollution. The study outcomes stated inverted/EKC U-shaped hypotheses related to specified economies. Finally, the analysis based on the D-H panel causality test constructs exciting results.The present study concludes that economic corridor plays a vital role in tourism development, the community's well-being, and SDGs goals (sustainable development) impact on environmental safety. The findings suggest essential and applicable policies to attain the desired sustainability level. Findings contribute to the literature on tourism, well-being, and sustainability. Further studies can use insights using this methodology.

Extensively drug-, ciprofloxacin-, cefotaxime-, and azithromycin-resistant Salmonella enterica serovars isolated from camel meat in Egypt.

Given the great importance of Salmonella as a leading foodborne pathogen of global concern and the few available data regarding its prevalence in camel meat, the present study aimed to determine the prevalence, antimicrobial resistance (AMR) profile, virulence genes, ß-lactamase genes of Salmonella enterica serovars isolated from camel meat marketed in Egypt. Forty-five (29.6 %) of the 152 camel meat samples examined were positive for Salmonella spp. Among the 432 Salmonella presumptive colonies isolated, 128 were molecularly verified as Salmonella after confirmation by PCR targeting the Salmonella marker (invA) gene. Virulence genes, encompassing stn, spvC, and hilA genes, were detected in 91.4 % (117/128), 20.3 % (26/128), and 80.5 % (103/128) of the isolates, respectively. S. Enteritidis, S. Typhimurium, S. Cerro, and S. Montevideo were the most prevalent serovars with incidences of 25 % (32/128), 15.6 % (20/128), 15.6 % (20/128), and 12.5 % (16/128), respectively. Interestingly, 56.3 %, 53.1 %, 37.5 %, 28.1 %, 21.9 %, 18.8 %, 12.5 %, and 3.1 % of the isolates tested showed resistance to cefepime, ciprofloxacin, levofloxacin, cefotaxime, gentamicin, colistin, meropenem, and azithromycin, respectively. Salmonella isolates showed resistance to at least one antibiotic, with a mean multiple antibiotic resistance (MAR) index of 0.472. Interestingly, 59.4 %, 15.6 %, and 3.1 % of the isolates were categorized into multidrug-resistant, extensively drug-resistant, and pan-drug-resistant, respectively. Only 23 (25 %) of the 92 ampicillin-resistant isolates were proven to be Extended Spectrum Beta-Lactamase (ESBL)-producing Salmonella, in which ß-lactamase (bla) genes were detected. The blaOXA-2 was the most existing gene where it was detected lonely in 10 of the ampicillin-resistant isolates and coexisted with blaCMY-1 in 4 isolates and with blaCMY-2 in a single isolate. The blaCMY-1, however, existed in 11 isolates, whereas the blaCMY-2 gene was only detected in 3 isolates tested. The present findings affirm that camel meat could be a leading reservoir for multi- and extensively-drug-resistance ß-lactamase-producing Salmonella, representing a global public health challenge. Therefore, further research is necessary to detect the prevalence and AMR of Salmonella serovars from camel meat in Egypt and other countries to put camel meat as a source of Salmonella in foods of animal origin.

Hazard Analysis and Critical Control Point (HACCP) Application to Dry-Cured Pastrami in Egyptian Pastrami Factories.

The current study established a HACCP tactic for all hazards related to Egyptian dry-cured pastrami production. All types of hazards that could occur at each production step were depicted. The fabrication steps of pastrami were originally based on the processes and conclusions presented in two previous publications by members of the research team; thus, the current scientific paper is considered a completion of the two previous publications. All operations executed and products manufactured outside the pastrami factory were excluded. The HACCP system was only applied to dry-cured pastrami production stages from receiving frozen raw meat and non-meat ingredients until packaging and storing the final product. Four CCPs were detected and taken into account. The permissible critical limits of additives and non-meat ingredients were considered. Suitable corrective actions were arranged. Regular HACCP plan review, proper recording of detected CCPs and critical limits were necessary for validation processes. Following up with the supply chain by obtaining the certified suppliers, together with the importance of the verification procedures of the elaborated HACCP plan, were essential in order to ensure the production of safe food without defects.

Designing Of Occlusal Appliance Digital Protocol Using An Open Source 3D Modelling Software Program: a Technical Report.

Occlusal splint is a commonly prescribed dental appliance in the dental office for the management of bruxism or temporomandibular disorder. The use of digital dental technology facilitates fabrication of this therapeutic device. The digital technology improvement had helped in designing and producing occlusal splints that show better precision and accuracy, ease of manufacturing in terms of time-consuming and materials, in addition to the option of simple and straightforward duplication process. This technical report describes the digital workflow steps that need to be followed to design an occlusal device in a fully digital protocol. Maxillary and mandibular models' scans were acquired in centric relation, and a virtual 3D occlusal device was designed using a free, open-source 3D modelling software program.

Cefotaxime-, Ciprofloxacin-, and Extensively Drug-Resistant Escherichia coli O157:H7 and O55:H7 in Camel Meat.

The present study aimed to explore for the first time the occurrence and the antimicrobial resistance profiles of E. coli O157:H7 and O55:H7 isolates in camel meat in Egypt. Among the 110 camel meat samples examined using standardized microbiological techniques, 10 (9.1%) and 32 (29.1%) were positive for E. coli O157:H7 and E. coli O55:H7, respectively. In total, 24 isolates were verified as E. coli O157:H7, while 102 isolates were confirmed serologically as E. coli O55:H7. Multiplex PCR revealed the existence of eaeA, stx1, stx2, and EHEC-hlyA among E. coli O157:H7 and O55:H7 isolates (n = 126) at various percentages. According to their resistance against 14 antibiotics, 16.7% and 83.3% of O157:H7 isolates and 8.6% and 76.5% of O55:H7 isolates were classified into extensively drug-resistant and multi-drug-resistant, respectively, whereas 29.4% and 22.2% of E. coli isolates were resistant to cefotaxime and ciprofloxacin, respectively. The study results emphasize that camel meat may be a vehicle for multi- and extensively drug-resistant E. coli O157:H7 and O55:H7 strains, indicating a potential threat to public health. Further studies based on the molecular evidence of the antimicrobial resistance genes and enrolling a larger number of samples are recommended for a better understanding of the antimicrobial resistance phenomenon of camel-meat-originating pathogenic E. coli strains.

Diabetes mellitus is not associated with worse short term outcome in patients older than 65 years old post-liver transplantation.

BACKGROUND: Non-alcoholic fatty liver disease is a global health care challenge and a leading indication of liver transplantation (LT). Hence, more patients with diabetes mellitus (DM) are undergoing LT, especially, above the age of 65. AIM: To evaluate the impact of DM on short-term outcomes post-LT in patients over the age of 65. METHODS: We collected data of patients who underwent LT from January 2001 until December 2019 using our electronic medical record. We assessed the impact of DM on short-term outcomes, one-year, post-LT based on the following variables: Survival at one year; acute cellular rejection (ACR) rates; intensive care unit (ICU) and hospital length of stay; and readmissions. RESULTS: Total of 148 patients who are 65 year or older underwent LT during the study period. The mean age is 68.5 ± 3.3 years and 67.6% were male. The median Model for End-stage Liver Disease score at time of transplantation was 22 (6-39), 39% of patients had hepatocellular carcinoma and 77.7% underwent living donor LT. The one-year survival was similar between DM patients and others, 91%. ACR occurred in 13.5% of patients (P = 0.902). The median ICU stay is 4.5-day P = 0.023. The rates of ICU and 90-d readmission were similar (P = 0.821) and (P = 0.194), respectively. CONCLUSION: The short-term outcome of elderly diabetic patients undergoing LT is similar to others. The presence of DM in elderly LT candidates should not discourage physicians from transplant consideration in this cohort of patients.

Antimicrobial Effect of Moringa oleifera Leaves Extract on Foodborne Pathogens in Ground Beef.

Consumers nowadays are becoming more aware of the importance of using only meat products containing safe and natural additives. Hence, using natural food additives for extending the shelf life of meat along with delaying microbial growth has become an urgent issue. Given the increasingly popular view of Moringa oleifera leaves as a traditional remedy and also the scarcity of published data concerning its antimicrobial effect against foodborne pathogens in meat and meat products, we designed the present study to investigate the antimicrobial effect of Moringa oleifera leaves aqueous extract (0.5%, 1%, and 2%) on ground beef during refrigerated storage at 4 °C for 18 days. MLE revealed potent antimicrobial properties against spoilage bacteria, such as aerobic plate count and Enterobacteriaceae count. MLE 2% showed a significant (p < 0.01) reduction in the counts of E. coli O157:H7, Salmonella enterica serovar Typhimurium, and Staphylococcus aureus artificially inoculated to ground beef by 6.54, 5.35, and 5.40 log10 CFU/g, respectively, compared to control, by the 18th day of storage. Moringa leaves extract (MLE) had no adverse effect on the overall acceptability and other sensory attributes; moreover, it induced a slight improvement in the tenderness and juiciness of treated ground beef, compared to the control. Therefore, MLE can be used as a healthy, natural, and safe preservative to increase meat products' safety, quality, and shelf stability during cold storage. A promising approach for using natural food additives rather than chemical preservatives could begin new frontiers in the food industry, as they are more safe and do not constitute health risks to consumers.

ß-Lactamase Producing Escherichia coli Encoding blaCTX-M and blaCMY Genes in Chicken Carcasses from Egypt.

Escherichia coli with multidrug resistance and ß-lactamase genes may constitute a great public health hazard due to the potential for their transmission to humans through the food chain. This study determined the prevalence, antibiotic resistance profiles, phylogroups, and ß-lactamase genes of E. coli isolates from chicken carcasses marketed in Mansoura, Egypt. Interestingly, E. coli was detected in 98% (98/100) of the chicken carcasses examined, which seemed among the highest contamination rates by E. coli worldwide. From the 425 genetically verified uidA gene-positive E. coli, 85 isolates were further studied for antimicrobial resistance profiles, phylogroups, and ß-lactamase genes. Interestingly, 89.41% of E. coli (76/85) strains tested against 24 different antibiotics were multidrug-resistant. Of the examined 85 E. coli isolates, 22 (25.88%) isolates harbored blaCTX-M and were resistant to ampicillin, cefazoline, and ceftriaxone, while three of them were resistant to ceftazidime besides. Nine (10.59%) E. coli strains harbored AmpC- ß-lactamase blaCMY and were resistant to ampicillin. One isolate co-carried blaCMY and blaCTX-M genes, though it was negative for the blaTEM gene. Of the 35 isolates that harbored either extended-spectrum ß-lactamase (ESBL) and/or AmpC ß-lactamase genes, six strains (17.14%) were assigned to pathogenic phylogroup F and one to phylogroup E, whereas 28 (80%) isolates belonged to commensal phylogenetic groups.

Clarithromycin-, and metronidazole-resistant Helicobacter pylori isolated from raw and ready-to-eat meat in Mansoura, Egypt.

Helicobacter pylori (H. pylori), classified as a class-I carcinogen, is one of the leading medical pathogens of global concern associated mainly with the development of gastric adenocarcinomas and gastric mucosa-associated lymphoid tissue lymphomas; nevertheless, its prevalence in food especially meat and meat products is not fully covered. Additionally, the resistance of H. pylori towards clarithromycin is increasing worldwide and consider the leading cause of H. pylori treatment failure. Thus, the present study was designed to determine the prevalence, molecular characterization, and antimicrobial resistance profiles of clarithromycin-, and metronidazole-resistant H. pylori isolated from raw and ready-to-eat meat samples retailed in Mansoura city, Egypt. Among the 250 samples tested, H. pylori were molecularly confirmed in 40.8 % (49/120) of raw meat products and in 29.2 % (38/130) of ready-to-eat meat products. Precisely, 53.3 % (32/60), 56.7 % (17/30), 40 % (8/20), 55 % (11/20), 60 % (12/20), 13.3 % (4/30), and 15 % (3/20) of raw ground beef, beef burger, beef burger sandwiches, beef shawarma sandwiches, beef kofta sandwiches, beef luncheon, and beef sausage sandwiches, respectively were positive for H. pylori. Of the 204 biochemically-identified H. pylori isolates, 53.9 % (110/204) were molecularly confirmed by PCR through the detection of glmM, cagA, or vacA genes, which were detected at an incidence of 95.5 % (105/110), 77.3 % (85/110), and 20.9 % (23/110) among the isolates, respectively. The antimicrobial sensitivity testing revealed that all of the 110 (100 %) molecularly-confirmed H. pylori isolates were multidrug-resistant (MDR; resistant to four or more antibiotics). Interestingly, 100 % and 61.8 % of H. pylori isolated from raw and ready-to-eat meat were resistant to metronidazole and clarithromycin, respectively which consider alarming results as metronidazole and clarithromycin are the mainstay antibiotics in the treatment of H. pylori infections. Additionally, 94.5 %, 94.5 %, 24.5 %, 23.6 %, and 13.6 % of isolates were resistant to vancomycin, sulphamethoxazole-trimethoprim, imipenem, levofloxacin, and nitrofurantoin, respectively. The widespread contamination of examined raw and ready-to-eat meat product samples with MDR H. pylori isolates could constitute a tremendous public health hazard. Further studies concerning the prevalence and possible methods of elimination of H. pylori in different food categories distributed in the various provinces in Egypt as well as in other countries is required for a better understanding the H. pylori as an emerging foodborne pathogen.

Nisin and Organic Acid Salts Improved the Microbial Quality, Extended the Shelf Life, and Maintained the Sensory Attributes of Semidry Beef Luncheon Marketed at Adverse (35-40 °C) Ambient Summer Temperatures.

Semidry beef luncheon may undergo deteriorative changes during storage at ambient temperatures in tropical and subtropical regions including Egypt. This study was conducted in a meat plant in Egypt with the aim of overcoming the economic losses from the returns of spoiled unsold beef luncheon displayed in grocery stores at adverse summer temperatures of 37 °C or more. Ten approaches were applied using different preservatives, comprising sodium nitrite, nisin, potassium sorbate, and organic acid salts (a combination of sodium lactate, sodium acetate, and sodium diacetate). In addition, the product was cooked at different temperatures and was stored for 21 days at 37 °C, during which time the shelf life, microbial quality, pH, and sensory attributes were investigated. By Day 21 of storage, the luncheon contained 50 mg/kg sodium nitrite, 25 mg/kg nisin, and 1000 mg/kg organic acid salts and, when cooked at a final core temperature of 92 °C, exhibited reductions in aerobic plate count, anaerobic plate count, lactic acid bacterial count, and mold and yeast counts by 4.32, 3.54, 3.47, and 1.89 log10 CFU/g, respectively, when compared with the control. The sensory attributes and pH were also maintained in the final products of such treatment, with no product return and the avoidance of economic loss. This study presents a novel approach for solving the major problem of the deteriorative changes that occur in semidry luncheon sausage and similar meat products which require rejection with a huge economic loss, especially in tropical and semitropical areas of the world that have similar problems of high climatic temperatures and a low availability of energy or technological resources.

Characteristics of chest pain among children presenting to the pediatric emergency department.

Chest pain in pediatric patients is a common concern in pediatric emergency departments (ED). In most cases, benign conditions are related to noncardiac causes, and only a minority of the cases are caused by heart disease. This research aimed to evaluate the causes and characteristics of chest pain among children in a pediatric emergency department. This retrospective study evaluated children younger than 14 years of age who presented to the emergency department of a general pediatric hospital in the Eastern area of Saudi Arabia with non-traumatic chest pain between 2017 and 2022. The data included socioeconomic information, physical examination findings, and the results of basic investigations, such as chest X-ray and electrocardiogram. The Chi-square test was performed to compare various etiologies, with a 5% significant level. The study evaluated 310 patients with a mean age of 9.1±2.7 years. The majority of children presenting with chest pain had normal physical examinations, except 3.3% who showed respiratory and cardiac findings. The diagnostic tests indicated pneumonia in 2.9% and arrhythmia in 2.1% of children. Most patients were discharged with a diagnosis of idiopathic or muscular chest pain. The majority of patients (95%) were treated symptomatically in outpatient settings, with just one patient requiring hospitalization. The most common cause of chest pain prompting a child to visit the ED was idiopathic chest pain. Therefore, this study highlights the significance of obtaining a comprehensive medical history and physical examination to reveal important clues and help avoid unnecessary tests.

Occurrence of Campylobacter spp. and Phenotypic Antimicrobial Resistance Profiles of Campylobacter jejuni in Slaughtered Broiler Chickens in North-Western Romania

Campylobacteriosis is recognized as one of the most common food-borne zoonoses, with worldwide distribution, having undercooked poultry meat and other cross-contaminated foodstuffs as the main sources of human infections. The current study aimed to provide data on the occurrence of the thermophilic Campylobacter spp. in seven broiler chicken flocks, from three north-western Transylvanian counties of Romania, as well as to determine the antimicrobial resistance profile of the isolated C. jejuni strains. A total of 324 fresh cecal samples were collected during the slaughtering process, and screened for the presence of Campylobacter spp., using routine microbiological and molecular diagnostic tools. Overall, 85.2% (276/324; 95% CI 80.9-88.6) of the tested samples expressed positive results for Campylobacter spp., with dominant occurrence of C. coli towards C. jejuni (63.4% vs. 36.6%). From the six tested antimicrobials, the 101 isolated C. jejuni strains were resistant against ciprofloxacin (79.2%), nalidixic acid (78.2%), tetracycline (49.5%), and streptomycin (7.9%), but total susceptibility was noticed against erythromycin and gentamicin. Seven (6.9%) isolates exhibited multidrug resistance. The study results emphasize the role of broiler chicken as reservoir of Campylobacter infections for humans, as well as strengthen the necessity of the prudent using of antimicrobials in the poultry industry.

A 14-Year-Old Saudi Boy with Gynecomastia, Cushing Syndrome, Large-Cell Calcifying Sertoli Cell Tumor of the Testis, and Carney Complex.

BACKGROUND Carney complex (CNC) is a rare multiple neoplasia syndrome with autosomal dominant inheritance. CNC is frequently misdiagnosed owing to its diverse clinical characteristics. We reported the case of a 14-year-old Saudi boy with a history of gynecomastia, Cushing syndrome, large-cell calcifying Sertoli cell tumor of the testis, and CNC. CASE REPORT The patient was referred to the pediatric endocrine clinic for evaluation of bilateral slow progressing gynecomastia for 1-year duration. His clinical examination revealed lentigenes, bilateral diffuse breast enlargement (consistent with Tanner stage III), and asymmetrical testicular enlargement, more on the left side. Other systemic examinations were unremarkable. The initial blood workup showed elevated estradiol level with unsuppressed cortisol after an overnight 1-mg dexamethasone suppression test. Breast ultrasound (US) confirmed true gynecomastia. Testicular US revealed microcalcification and the testicular biopsy confirmed diagnoses of large-cell calcifying Sertoli cell tumor (LCCSCT). A 2-step dexamethasone suppression test showed a paradoxical rise in serum and urine cortisol levels, which are characteristic for PPNAD. LCCSCT and PPNAD are 2 major criteria fulfilling a diagnosis of CNC. The gene test showed heterozygous mutation in the PRKAR1A gene, which is diagnostic for CNC. The patient underwent bilateral mastoplasty and was planned for radical left orchiectomy. CONCLUSIONS Gynecomastia and LCCSCT can be presenting features of CNC, which mandates careful, thorough clinical examination and tailored investigation to reach a diagnosis.

Prevalence of Multidrug-Resistant Salmonella enterica Serovars in Buffalo Meat in Egypt.

The current study aimed to investigate the presence of Salmonella spp. prevalence in buffalo meat in Egypt, along with studying the antimicrobial susceptibility of the recovered isolates. Salmonella spp. was detected in 25% of tested buffalo meat. A total of 53 (100%) isolates were genetically verified by PCR as Salmonella, based on the detection of the invA gene. The stn and hilA genes were detected in 71.7% (38/53), and 83.0% (44/53) of the recovered isolates, respectively. Salmonella Enteritidis (11/53; 20.7%) was the most commonly isolated serovar, followed by S. Typhimurium (9/53; 17%), S. Montevideo (6/53; 11.3%), meanwhile, S. Chester, S. Derby, S. Papuana, and S. Saintpaul were the least commonly identified serovars (a single strain for each; 1.9%). Among the 16 antimicrobials tested, amikacin, imipenem, gentamicin, cefotaxime, meropenem, ciprofloxacin, and enrofloxacin were the most effective drugs, with bacterial susceptibility percentages of 98.1%, 94.3%, 92.5%, 86.8%, 83.0%, 73.6%, and 69.8%, respectively. Meanwhile, the least effective ones were erythromycin, streptomycin, clindamycin, cefepime, and nalidixic acid, with bacterial resistance percentages of 100%, 98.1%, 88.7%, 77.4%, and 66%, respectively. Interestingly, the high contamination level of Egyptian buffalo meat with multidrug-resistant Salmonella (79.2%; 42/53) can constitute a problem for public health. Therefore, programs to control Salmonella contamination are needed in Egypt.