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.

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.

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.

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.

Potential Association between Subclinical Hypothyroidism and Childhood Migraine.

Background and Objectives: Migraine is caused by genetic susceptibility that is triggered by environmental as well as biological factors, and it is also linked to many somatic comorbidities, including clinical and subclinical hypothyroidism. We aimed to estimate the potential association between subclinical hypothyroidism (ScH) and migraine in children at our tertiary hospital. Materials and Methods: Using a case−control strategy, 200 children and adolescents were assigned to two equal groups: a case group (patients with migraine) of 100 patients and a control group of 100 patients without migraine. Clinical and biochemical parameters (TSH, FT4) were compared between the groups using statistical analysis. Results: Thyroid function comparison between the groups showed higher TSH but normal FT4 among children with migraine headache compared to the control group, which means more frequent ScH cases among the migraine group relative to the control (17% vs. 2%, p < 0.001). Obesity and overweight were more frequent among patients with migraine than the control group (8 and 5% vs. 2 and 1%, respectively). The (overweight/obese) patients with migraine had about 77% ScH and 15.4% overt hypothyroidism compared to 8% ScH and no overt hypothyroidism among normal body weight migraine patients (p < 0.001). No significant difference in the prevalence of nodular goiter between patients with migraine and controls was found. Conclusions: Based on our results, subclinical hypothyroidism is significantly linked to childhood migraine. Obesity and being overweight are more frequent among patients with migraine. Therefore, it may be logical to test the thyroid function in migraineur children, especially those with high BMI. Further studies are recommended to discover the mechanism of this association in children.

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.

Occurrence, Pathogenic Potential and Antimicrobial Resistance of Escherichia coli Isolated from Raw Milk Cheese Commercialized in Banat Region, Romania.

The aim of the present study was to investigate the presence, pathogenic potential and antimicrobial susceptibility profile of Escherichia coli isolated from raw milk cheese, traditionally produced by farmers and marketed directly to the consumer in Banat region, Romania. A total of 81.1% (43/53) of the processed samples expressed positive results for E. coli, with a distribution of 83.8% (31/37), and 75.0% (12/16) in the cow- and sheep-milk-origin assortments, respectively. Overall, 69.8% (30/43) of the specimens had a contamination level ≤10 CFU/g. Molecular tests showed that, from the total number of E. coli isolates, 9.3% (4/43) harbored the stx2, and 2.3% (1/43), the stx1 virulence genes. The E. coli O157 (including H7) biovariety was identified in 7% (3/43) of the samples by the Vidas equipment. From the 27 antimicrobials tested with the Vitek2 automated system, the E. coli isolates displayed resistance to enrofloxacin (100%, 15 out of 15 tested isolates), ampicillin (39.5%, 17/43), norfloxacin (28.6%, 8/28), fosfomycin (25%, 7/28), amoxicillin/clavulanic acid (23.3%, 10/43), cefalexin (20%, 3/15), cefalotin (13.3%, 2/15), tetracycline (13.3%, 2/15), trimethoprim-sulfamethoxazole (9.3%, 4/43), piperacillin-tazobactam (7.1%, 2/28), cefotaxime (7.1%, 2/28), cefepime (7.1%, 2/28), ticarcillin/clavulanic acid (6.7%, 1/15), florfenicol (6.7%, 1/15), ceftazidime (3.6%, 1/28), and ertapenem (3.6%, 1/28). Ten (23.3%) strains were multidrug-resistant. The obtained preliminary results indicated hygienic-sanitary deficiencies throughout the cheese production process, and demonstrated that these products can harbor virulent and multidrug-resistant E. coli strains, which constitute a public health risk. However, future investigations, processing a higher number of samples, are still necessary to draw comprehensive conclusions.

The physicochemical and microbiological quality of meat produced in a traditional slaughterhouse in Mansoura City, Egypt.

INTRODUCTION: In several developing countries the slaughter of meat producing animals is still practiced in traditional slaughterhouses. In the Mansoura slaughterhouse, animals are subjected to various stressors and treated with cruelty, in addition to unhygienic treatment and handling of animal carcasses. Hence, this study was designed to investigate the meat quality from cattle, buffalo, and sheep carcasses processed in an old-fashioned slaughterhouse from Mansoura city, Egypt, in the context of pre-slaughter stress. METHODOLOGY: The bleeding efficiency and the ultimate pH (pHu) of carcasses were tested, along with the effect of post-slaughter handling practice on the microbiological properties of meat. RESULTS: From the 351 examined animals, the ultimate pH (pHu) was less than 5.8 in 81 cases (23.1%) and higher than 6.0 in 165 cases (47%). Furthermore, 45 (12.8%), 270 (76.9%), and 36 (10.3%) of the tested carcasses were well-, moderate- and imperfectly-bled, respectively. Cultivation using the wet-dry triple swab technique sampled from the outer surfaces of cattle, buffalo, and sheep carcasses revealed that about 47.9% of the tested carcasses were contaminated, with total viable count levels exceeding 7 log10 cfu/cm2, and 42.7% were contaminated with Enterobacteriaceae, with levels > 3 log10 cfu/cm2. The molds and yeasts from the tested carcasses had lower counts (< 2 log10 cfu/cm2). CONCLUSIONS: Results indicated neglect in terms of sanitary measures during slaughtering and dressing of carcasses, with subsequent higher microbial contamination and impaired meat quality. Therefore, the traditional slaughtering facilities should be modernized to increase their meat producing efficiency, subsequently leading to exportation possibilities.

Protocol for systematic review and meta-analysis of randomized controlled trials, cost-benefit analysis and interrupted time-series interventions on pharmacist's prescribing.

Background: Shortening the process of prescribing via permitting the pharmacist to select the most appropriate pharmaceuticals for each particular patient may provide great opportunities for pharmacists to develop suitable pharmaceutical care plan, monitor and follow up prescribed medications, communicate and consult physicians for more confirmations. Objective: The objective of the current protocol for the systematic review and meta-analysis of pharmacists prescribing interventions was to explore, investigate the evidence, assess and compare PICO in patients with medical conditions (population), receiving pharmacist's prescribing care services (interventions) versus non-pharmacist's prescribing (comparators), and identify how it will impact the clinical, humanistic, and economic patient's outcomes (outcomes). Methods: The necessary elements of PRISMA will be strictly followed to report the systematic review. The meta-analysis will be reported in line with the Cochrane guidelines for synthesis of trials and all forms will be based on quality measures as per the validated Cochrane templates. We will present the results of the systematic review and the meta-analysis based on PICO comparison between the included trials. Results: We have identified four models of pharmacist prescribing interventions (independent, dependent [collaborative], supplementary, and emergency prescribing). The results will contain a systematic critical evaluation of the included trials in terms of the sample number of the population (characteristics), the type of interventions and the comparators, and the main outcome measures. Conclusion: This protocol will report the evidence and explore the magnitude of impact of pharmacist prescribing interventions, on clinical, humanistic, and economic outcomes. .

Multidrug Resistant Coagulase-Positive Staphylococcus aureus and Their Enterotoxins Detection in Traditional Cheeses Marketed in Banat Region, Romania.

The main objectives of the present study were to determine the occurrence of coagulase positive staphylococci (CPS) and to assess the presence and antimicrobial susceptibility profile of Staphylococcus aureus isolates in different raw milk origin (cow and sheep) traditional cheeses marketed in Banat region, Romania. Additionally, the presence of mecA gene in S. aureus isolates and the staphylococcal enterotoxins (SEs) in cheese samples were evaluated. A total of 81.6% (138/169) of the screened samples were positive for CPS. Furthermore, 35.5% (49/138) of the investigated CPS positive cheese samples were contaminated with S. aureus, with an isolation frequency of 46.6% (14/30) in caș, 33.3% (32/96) in telemea, 25% (2/8) in burduf, and 25% (1/4) in urda assortments, respectively. From the total number of S. aureus isolates, 6.1% (3/49) harbored the mecA gene. Detectable levels of SEs were identified in 4.3% (4/94) of cheese samples with a CPS contamination level higher than 105 log CFU g-1. The expressed antimicrobial susceptibility profile of the tested cheese-origin S. aureus isolates, with the automated Vitek 2 equipment, showed resistance towards amikacin (90.1%, 10 out from 11 tested), enrofloxacin (86.2%, 25/29), ceftiofur (72.7%, 8/11), neomycin (63.6%, 7/11), benzylpenicillin (53.1%, 26/49), kanamycin (41.4%, 12/29), rifampicin (39.5%, 15/38), tetracycline (38.8%, 19/49), tilmicosin (36.4%, 4/11), clindamycin (30.6%, 15/49), ciprofloxacin (30%, 6/20), erythromycin (22.4%, 11/49), tylosin (18.2%, 2/11), oxacillin (16.3%, 8/49), linezolid (15%, 3/20), teicoplanin (15%, 3/20), fusidic acid (13.1%), imipenem (10.5%, 4/38), vancomycin (7.9%, 3/38), ampicillin (5.5%, 1/18), mupirocin (5.5%, 1/18), fosfomycin (5%, 1/20), and gentamicin (4.1%, 2/49). Twenty-four (49%) S. aureus isolates exhibited multidrug resistance. The investigation highlighted a common occurrence of multidrug-resistant S. aureus strains in the monitored cheese assortments, which can constitute a potential risk for consumers' health.

Ensuring safety and improving keeping quality of meatballs by addition of sesame oil and sesamol as natural antimicrobial and antioxidant agents.

The antioxidant and antimicrobial effect of sesame oil (10, 30, and 50 g/kg) and sesamol (0.1, 0.3, and 0.5 g/kg) in meatballs during cold storage for 18 days at 3 ± 1 °C was investigated. Sesame oil and sesamol did not alter the sensory attributes of meatballs. Addition of either sesame oil or sesamol significantly delayed lipid oxidation when compared with control. Sesamol exhibited more potent antioxidant activities more than sesame oil. During storage, the aerobic plate counts (APCs) and Enterobacteriaceae counts (EBCs) were markedly (P < 0.01) decreased in meatballs treated with sesame oil or sesamol in comparison with untreated control samples. Control meatballs showed signs of quality deterioration at day 7 of storage, while treated meatballs exhibited longer shelf lifes ranged from 9-18 days according to sesame oil or sesamol concentrations. Both sesame oil and sesamol induced marked (P < 0.01) decline in the counts of E. coli O157:H7, Salmonella enterica serovar Typhimurium, Staphylococcus aureus and Listeria monocytogenes that artificially inoculated to meatballs. Sesamol was more effective than sesame oil in the reduction of APCs, EBCs as well as foodborne pathogens. The results suggest that both sesame oil and sesamol are potentially useful natural additives to fresh meat products for improving its microbial quality and extending its shelf life during cold storage.

Multidrug-, methicillin-, and vancomycin-resistant Staphylococcus aureus isolated from ready-to-eat meat sandwiches: An ongoing food and public health concern.

Methicillin-resistant S. aureus (MRSA) and their antimicrobial resistance pose exacerbating global health threats and endangering everyone. Thus, the prevalence, molecular characterization of virulence genes, and antimicrobial resistance patterns of strains isolated from 225 beef burger and hot dog sandwiches vended in Mansoura city, Egypt were determined. 83.1% of the sandwiches tested were contaminated with coagulase-positive S. aureus, with a mean count of 4 × 103 CFU/g. Genes encoding mecA, α-hemolysin, staphylococcal enterotoxins, and toxic shock syndrome toxin-1 were detected in 22.6%, 96.3%, 61.1%, and 0% of the strains isolated, respectively. Of the 190 coagulase-positive strains, 43 (22.6%) were confirmed as MRSA. Among them, 4 strains (2.1%) were vancomycin-resistant S. aureus (VRSA) and resistant to all antimicrobials tested. Interestingly, all isolates were resistant to at least one of the antimicrobials tested, with 75.2% being multi-drug resistant (MDR) and an average multiple antimicrobial resistance (MAR) index of 0.503. Not less important, 100%, 96.3%, 90.5%, 79.5%, 73.7%, 62.6%, and 48.9% of isolates were resistant to Kanamycin, Nalidixic acid, Cefotaxime, Sulphamethoxazole-Trimethoprim, Penicillin G, Tetracycline, and Cephalothin, respectively. The potential hazard of MDR-, MRSA-, and VRSA-contaminated sandwiches may be an indication of the presence of what is more dangerous. Hence, strict hygienic measures and good standards of food handler's personal hygiene to prevent transmission of these pathogens to consumers are imperative.

Evaluation of the use of NGage® Nitinol stone extractor for intraocular foreign body removal.

PURPOSE: To describe a novel technique to use the NGage® Nitinol Stone Extractor for large IOFB extraction. METHODS: We conducted a retrospective case series study by reviewing the data of 4 eyes with retained large IOFB extracted with the use of the NGage® Nitinol Stone Extractor. The study was conducted in a single tertiary referral center on four eyes of four patients with large retained IOFB. Studied eyes were treated by pars plana vitrectomy (PPV) and IOFB extraction by using the NGage® Nitinol Stone Extractor through a limbal incision. RESULTS: Four eyes of four male patients with large Retained IOFB were included in the study. The nature of the IOFB was metallic in 2 eyes, glass in 1 eye or ceramic 1 eye. All the IOFB were removed from a limbal wound. Silicone oil tamponade was required in 3 eyes. Two eyes required reoperation. At 6 months postoperative, the final visual acuity using Snellen chart ranged between PL and 0.1. CONCLUSION: The NGage® Nitinol Stone Extractor can be a useful tool for the extraction of the large retained IOFB.

Trimanual vitrectomy for severe proliferative diabetic retinopathy.

PURPOSE: To describe and evaluate a novel technique of pars plana vitrectomy (PPV) under chandelier illumination which is aided with the vital dyes and perfluorocarbon liquids for the management of the complex diabetic vitrectomy cases. METHODS: We conducted a prospective interventional comparative study on 40 eyes of 36 patients with advanced diabetic eye disease requiring PPV. The study was conducted in a single tertiary referral center. Eyes were divided on 1:1 basis by stratified randomization into two groups. Group 1 had trimanual vitrectomy done assisted with chandelier illumination, perfluorocarbon liquid (PFCL) and vital dyes. Group 2 had the conventional bimanual vitrectomy done assisted with chandelier illumination only. All patients were followed up for a minimum of 6 months after the surgery. RESULTS: Forty eyes of 36 patients with the mean age of 51.42 years (range 28-69) were evaluated. The anatomical success at 6 months could be achieved in all the eyes in both groups. The complete removal of the pre-retinal proliferations could be accomplished in all the eyes in the trimanual PPV group, and only in 85% of the eyes in the bimanual PPV group. Operative time was significantly shorter in the trimanual PPV group (p < 0.001). More eyes in the trimanual PPV group (55.0%) could achieve better vision (> 6/60) 6 months after the operation compared to the bimanual PPV group (50.0%), but this difference was not statistically significant. CONCLUSION: Trimanual PPV is a novel, safe and effective technique that can improve the results of the complex diabetic PPV.

Microbial Decontamination of Beef Carcass Surfaces by Lactic Acid, Acetic Acid, and Trisodium Phosphate Sprays.

The present study was undertaken to investigate the effect of lactic acid (LA), acetic acid, (AA) and trisodium phosphate (TSP) spray on the microbiological population of beef carcass surfaces slaughtered in a traditional abattoir in Zagazig, Egypt. Higher microbial populations were determined on the shoulder than on the thigh surfaces, and meat sampling by tissue excision technique yielded significantly higher (P < 0.01) microbial count than swabbing method. The application of LA (2%), AA (2%), and TSP (12%) sprays for 30 seconds significantly (P < 0.01) reduced the microbial population counts on the beef surfaces by 0.9 to 2.2 logs. A complete inhibition of enterococci growth was achieved by LA and AA sprays. In general, LA and AA sprays were more efficient as antimicrobial agents than the TSP spray. Among the studied organisms, enterococci were the most reducible bacteria by LA and AA, followed by Enterobacteriaceae and coliforms, while Staphylococcus aureus being the least. This study also indicated that microbial populations determined on the shoulder were higher than on the thigh surfaces, and meat sampling by tissue excision technique yielded significantly higher (P < 0.01) microbial count than swabbing method.

Acute myelitis as a neurological complication of Covid-19: A case report and MRI findings.

During the recent outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 coronavirus, there is rising concerns about neurological complications of COVID-19. Fever, headache, and anosmia may occur early during the disease course. Other neurological sequalae such as encephalitis may occur in later phases. We report a case of acute myelitis in a 32-year old male COVID-19 positive patient who presented with a 2-day history of flu-like symptoms then sudden onset paraplegia and urinary retention. The incidence is not known and the pathogenesis of the disease behind this manifestation is still not fully understood. Nevertheless considering the broad differential diagnosis of acute myelitis, prompt clinical, and diagnostic work up was crucial to exclude other causes. Patients presenting with neurological symptoms such as loss of consciousness, ataxia, convulsions, status epilepticus, encephalitis, myelitis or neuritis should raise concerns for COVID-19 infection during this pandemic prompting early diagnosis and initiation of proper management.

Retrograde fiberoptic endoscopy evaluation for patients with laryngeal edema.

BACKGROUND: Airway and swallowing evaluation is a crucial step before weaning the patient from a tracheostomy tube. Different evaluation procedures can be used successfully in many patients, but sometimes, this can be difficult or impossible for patients who have laryngeal edema as the existence of edema tends to block the view of true vocal folds. Thus, a new approach using retrograde fiberoptic endoscopy evaluation of swallowing (FEES) has been suggested to help visualize the vocal folds clearly. This study was performed to evaluate the impact of such a modification to the standard FEES. METHODOLOGY: Thirty-six patients were referred for swallowing and airway evaluation. They were examined via nasopharyngolaryngobronchoscopy and FEES; nine of them had laryngeal edema and fit the inclusion criteria. RESULTS: Four out of the nine patients who had laryngeal edema could immediately swallow after evaluation with retrograde FEES. CONCLUSIONS: Retrograde FEES is suggested to be an effective way to evaluate swallowing and is a valuable tool for research in this area. LEVEL OF EVIDENCE: Level 4 (case series).

Symptomatic Internal Carotid Agenesis in Children.

Carotid artery agenesis is a rare congenital anomaly, and there are controversies in the leading cause for it. We present a 6-year-old girl with resolved focal neurological ischemic stroke that showed bilateral internal carotid artery (ICA) agenesis. Through this paper, we highlight the carotid canal congenital obliteration hypothesis as it may be a risk for such finding.

Health Risk Assessment of Exposure to Heavy Metals from Sheep Meat and Offal in Kuwait.

ABSTRACT: A total of 600 sheep samples (200 each of muscle, liver, and kidney) collected from 200 sheep carcasses slaughtered at abattoirs in Kuwait were analyzed by atomic absorption spectrophotometry for concentrations of mercury (Hg), arsenic (As), lead (Pb), cadmium (Cd), and chromium (Cr). These metals were detected in all (100%) examined samples; higher concentrations occurred in kidney followed by liver and muscle. The mean (±standard error of the mean) values of the metals detected in sheep muscle, liver, and kidney samples were 0.320 ± 0.061, 0.488 ± 0.042, and 0.791 ± 0.152 µg/g, respectively for Hg; 349 ± 0.074, 0.504 ± 0.049, and 0.642 ± 0.113 µg/g, respectively, for As; 0.482 ± 0.098, 0.567 ± 0.042, and 0.706 ± 0.098 µg/g, respectively, for Pb; 0.301 ± 0.344, 0.433 ± 0.032, and 0.586 ± 0.064 µg/g, respectively, for Cd; and 0.362 ± 0.064, 0.585 ± 0.044, and 0.738 ± 0.111 µg/g, respectively, for Cr. The concentrations of all heavy metals except Cr exceeded the maximum permissible limits set by various international food agencies. The estimated daily intake of each metal was lower than its provisional tolerable daily intake. The target hazard quotient and hazard index values for Hg were >1.0 in all examined sheep samples, suggesting significant health risks to the public from the consumption of sheep meat and offal marketed in Kuwait.