Risk assessment of some toxic metals in canned fish products retailed in Mansoura, Egypt.

Background: Canned fish products are widely consumed in Egypt, particularly for protein-rich meals that are quick to prepare and low in calories. Canned fish products are contaminated with toxic metals from the fish itself or from canning materials during processing. Aim: To determine the residual levels of cadmium (Cd), lead (Pb), arsenic (As), mercury (Hg), aluminum (Al), and Tin (Sn) in some canned fish products obtained from retail shops in Mansoura, Egypt. Furthermore, noncarcinogenic health risks evaluation for the Egyptian population due to hazardous metal oral intake. Methods: One hundred canned fish products (20 each of herring, mackerel, salmon, sardine, and tuna) were collected from May to September 2023, and canned fish products were obtained from Mansoura city markets in Egypt. Samples were digested in a solution composed of 60% nitric acid and 40% perchloric acid, and then an atomic absorption spectrophotometer was used for the detection of selected toxic metals. Results: It was found that the residual level of hazardous metals exceeded the acceptability level established in the European Union for Pb, Cd, and Hg by 20%, 10%, and 10%, 15%, 5%, and 20%, 35%, 30%, and 45%, 25%, 25%, and 40%, in examined herring, mackerel, sardine, and tuna, respectively. In contrast, all salmon samples were accepted for Pb and Hg, and only 5% were not accepted due to a higher Cd level than the maximum permissible limit. The average estimated daily intake of (EDI) is below the tolerable daily intakes (TDIs) for all metals. Comparatively, the EDI of Hg was 0.265 µg/kg body weight (B.W) exceeded TDIs 0.228 µg/kg B.W. The hazard index for canned tuna and sardines is more than one. Conclusion: Canned fish products are contaminated with a variety of toxic metals, especially sardine and tuna. Therefore, it is advised to decrease the consumption rate of such fish products.

Comparative study of two techniques of laparoscopic burch colposuspension using sutures versus mesh in women with genuine stress urinary incontinence.

Background: To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence. Methods: This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire. Results: The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31-304] to 3 [0-300] at 1 year, p < 0.001), stress test scores (from 82 [11-153] to 1 [0-124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration. Conclusion: LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.

Association of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims-based cohort study.

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the mainstays of multimodal pain management. While effective for acute pain control, recent pre-clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. Our objective was to explore the association between peri-operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90-180 days in previously opioid-naïve patients undergoing total knee arthroplasty. A database of health claims in the USA was used to identify all opioid-naïve adult patients who underwent primary knee arthroplasty between January 2010 and October 2021. We evaluated the magnitude of association between peri-operative prescription NSAID claims and claims for opioids at 90 days postoperatively using multivariable logistic regression models. Secondary outcomes included: the magnitude of association between peri-operative NSAID prescription and claims for opioids at 180 days postoperatively; and identifying other potential factors associated with opioid claims at 90 days postoperatively. After risk adjustment using multivariable logistic regression models in the 789,736-patient cohort, the adjusted odds ratio (95%CI) for a continuous claim of opioids at 90 and 180 days postoperatively among patients with a peri-operative NSAID prescription within 30 days was 1.32 (1.30-1.35), p < 0.001; and 1.12 (1.10-1.15), p < 0.001, respectively. This estimate of effect remained robust at 90 days after accounting for known potential confounders, including pre-existing knee pain and acute postoperative pain severity. Similar analysis of other pain medications (e.g. paracetamol) did not detect such an association. This population-based cohort study suggests that peri-operative prescription NSAID use may be associated with continued opioid prescription claims at 90 and 180 days after knee arthroplasty, even after adjusting for other observed covariates for continuous opioid claims. These novel findings can inform clinical decision-making for post-surgical pain management, risk-benefit discussions with patients and future research.

[Level of knowledge on occupational asthma and asthmagens: Assessment among healthcare workers by a validated questionnaire]. / Niveau de connaissance sur l'asthme professionnel et les agents asthmogènes : évaluation auprès du personnel de santé par un questionnaire validé.

INTRODUCTION: The health system is one of the professional sectors perhaps most at risk of occupational asthma. The aims of this study were to evaluate the level of knowledge of health care workers (HCWs) on occupational asthma and asthmogenic agents and to pave the way to effective educational action on the subject. METHODS: A multicenter transversal study including 180 HCWs was carried out between July and December 2020. A validated questionnaire addressed four dimensions: knowledge of asthmatic disease, knowledge of occupational asthma, knowledge of prognosis of occupational asthma and knowledge on the prevention of occupational asthma. RESULTS: The average total score was 13.71/18 (76.17%). There was no correlation between average total score and age, educational level, seniority or status of paramedical staff. Mean total scores were significantly higher for participants with no fixed work schedule and those practicing in non-university structures. The difficulty indexes for the four aforementioned dimensions were 82.22%, 77.56%, 53.52% and 66.67% respectively. CONCLUSIONS: Knowledge gaps affect all professional categories but to different degrees. A review of the level of knowledge of persons in each category would be the first step on the road to planned educational action.

Risk assessment of toxic residues among some freshwater and marine water fish species.

Egypt has several beaches, as well as the Nile River and a few lakes; therefore, it could compensate for the lack of protein in red meat with fish. Fish, however, may become a source of heavy metal exposure in humans. The current study was to assess the level of five toxic metals, lead (Pb), cadmium (Cd), mercury (Hg), arsenic (As), and aluminum (Al), in six species, namely, Oreochromis niloticus (O. niloticus), Mugil cephalus (M. cephalus), Lates niloticus (L. niloticus), Plectropomus leopardus (P. leopardus), Epinephelus tauvina (E. tauvina), and Lethrinus nebulosus (L. nebulosus), collected from the El-Obour fish market in Egypt. The residual concentrations of the tested toxic metals in the examined O. niloticus, M. cephalus, L. niloticus, E. tauvina, P. leopardus, and L. nebulosus species were found to be higher than the European Commission's maximum permissible limits (MPL) for Pb and Cd by 10 and 20%, 15 and 65%, 75 and 15%, 20 and 65%, 15 and 40%, and 25 and 5%. In contrast, 30% of L. niloticus exceeded the MPL for Hg. It was shown that the average estimated daily intake (EDI) and the target hazard quotient (THQ) in fish samples are below safety levels for human consumption and hazard index (HI < 1). From the human health point of view, this study showed that there was no possible health risk to people due to the intake of any studied species under the current consumption rate in the country.

Non-resectable pulmonary alveolar echinococcosis with multi-stage vertebral location.

Alveolar echinococcosis (also known as Hydatid cyst or Hydatydosis) is a zoonosis with a high degree of disability and morbidity. Bone echinococcosis is a rare presentation. Authors are always defending a personalized approach taking account of the particularities of the cyst location. Recognition of this syndrome is crucial because advances in medical and surgical management strategies have controlled and relieved symptoms in numerous cases. We report, hereby, a case of a patient with a thoracic spine alveolar echinococcosis of an unusual extension. We discussed the outcome of the treatment after fifteen years of follow-up.

Irradiation as a Promising Technology to Improve Bacteriological and Physicochemical Quality of Fish.

Fish is an excellent source of protein and other essential minerals and vitamins; nevertheless, several food-borne disease outbreaks have been linked to the consumption of different types of fish. Therefore, we aimed to overcome these health threats by evaluating gamma radiation as a good fish preservation method. The aerobic plate count (APC), identification of most common pathogenic bacteria, organoleptic properties, proximate composition, and other chemical evaluations were detected in both untreated and gamma-treated fish. The overall grades of organoleptic evaluations ranged from good to very good. Fortunately, the overall chemical analysis of all examined fish samples was accepted. For the untreated fish samples, the APC was within and above the permissible limit (5 × 107 CFU/g). Pathogenic bacteria were detected with a high prevalence rate, especially S. aureus, which was found in high percentages among examined untreated fish samples. Regarding the treated fish samples, APC and pathogenic bacterial counts were reduced in a dose-dependent manner, and the irradiation at dose 5 KGy resulted in complete eradication of the aerobic plate count (not detectable) with a mean reduction percentage equal to 100%. However, gamma irradiation has no significant effect on proximate composition; particularly, carbohydrates, proteins, and lipids were not significantly affected by low and medium doses of radiation. Therefore, gamma irradiation is a highly effective fish preservation method without any effect on fish quality. Additionally, gamma irradiation as a cold process is an attractive technology for solving the problem arising from fish-borne pathogens, and it has been purposed in this study as a cheap and safe method for reducing microbial contamination of fish.

Fabrication of nitrogen doped TiO2/Fe2O3 nanostructures for photocatalytic oxidation of methanol based wastewater.

An important industrial process that often occurs on the surface of a heterogeneous catalyst using thermochemical or photochemical could help in the oxidation of methanol-based wastewater to formaldehyde. Titania-based photocatalysts have drawn a lot of interest from scientists because they are a reliable and affordable catalyst material for photocatalytic oxidation processes in the presence of light energy. In this study, a straight-forward hydrothermal method for producing n-TiO2@α-Fe2O3 composite photocatalysts and hematite (α-Fe2O3) nanocubes has been done. By adjusting the ratio of n-TiO2 in the prepared composite photocatalysts, the enhancing influence of the nitrogen-doped titania on the photocatalytic characteristics of the prepared materials was investigated. The prepared materials were thoroughly characterized using common physiochemical methods, such as transmission electron microscope (TEM), scanning electron microscope (SEM), X-ray diffraction (XRD), energy dispersive X-ray (EDX), X-ray photoelectrons spectroscopy (XPS), physisorption (BET), and others, in order to learn more about the structure The results obtained showed that nitrogen-doped titania outperforms non-doped titania for methanol photooxidation. The addition of nitrogen-doped titania to their surfaces resulted in an even greater improvement in the photooxidation rates of the methanol coupled with hematite. The photooxidation of methanol in the aqueous solution to simulate its concentration in the wastewater has been occurred. After 3 h, the four weight percent of n-TiO2@α-Fe2O3 photocatalyst showed the highest rate of HCHO production.

Ion Channels in Gliomas-From Molecular Basis to Treatment.

Ion channels provide the basis for the nervous system's intrinsic electrical activity. Neuronal excitability is a characteristic property of neurons and is critical for all functions of the nervous system. Glia cells fulfill essential supportive roles, but unlike neurons, they also retain the ability to divide. This can lead to uncontrolled growth and the formation of gliomas. Ion channels are involved in the unique biology of gliomas pertaining to peritumoral pathology and seizures, diffuse invasion, and treatment resistance. The emerging picture shows ion channels in the brain at the crossroads of neurophysiology and fundamental pathophysiological processes of specific cancer behaviors as reflected by uncontrolled proliferation, infiltration, resistance to apoptosis, metabolism, and angiogenesis. Ion channels are highly druggable, making them an enticing therapeutic target. Targeting ion channels in difficult-to-treat brain tumors such as gliomas requires an understanding of their extremely heterogenous tumor microenvironment and highly diverse molecular profiles, both representing major causes of recurrence and treatment resistance. In this review, we survey the current knowledge on ion channels with oncogenic behavior within the heterogeneous group of gliomas, review ion channel gene expression as genomic biomarkers for glioma prognosis and provide an update on therapeutic perspectives for repurposed and novel ion channel inhibitors and electrotherapy.

Exposure of aquatic organisms to natural radionuclides in irrigation drains, Qena, Egypt.

Natural radioactivity in irrigation drains was measured by gamma spectrometry, and the resulting dose rates received by aquatic organisms were estimated. Irrigation water and sediment samples were collected from 5 irrigation drains located in Qena governorate, south of Egypt. The average activity concentrations (Bq L-1) of 226Ra, 232Th, and 40 K in irrigation water were 0.76 ± 0.06, 0.27 ± 0.02, and 8.14 ± 0.71, while in sediment (Bq kg-1) were 24.46 ± 1.84, 20.72 ± 1.45, and 453.00 ± 28.14, respectively. The total dose rate per aquatic organism ranged from 1.94 × 10-04 µGy h-1 in Mollusc to 7.15 × 10-04 µGy h-1 in phytoplankton. These values are far from the international recommended limit 400 µGy h-1 for chronic exposure to aquatic organisms, and the dose rate screening value of 10 µGy h-1 suggested by ERICA tool. Based on these results, it is unlikely that harmful effects will appear on the considered aquatic organisms due to exposure to natural radioactivity in the studied environment.

Network meta-analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta-analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid-related adverse effects and functional recovery. Network meta-analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft-donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single-injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid-related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single-injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction.

Facile Microwave Synthesis of Hierarchical Porous Copper Oxide and Its Catalytic Activity and Kinetics for Carbon Monoxide Oxidation.

The synthesis of copper oxide (CuO)-based nanomaterials has received a tremendous deal of interest in recent years. Particularly, the design and development of novel CuO structures with improved physical and chemical properties have attracted immense attention, especially for catalysis applications. We report on a rational, rapid, and surfactant-free microwave synthesis (MWS) of hierarchical porous copper oxide (HP-CuO) with a three-dimensional (3D) sponge-like topology using an MWS reactor. The activity of the microwave (MW)-synthesized HP-CuO catalysts for carbon monoxide (CO) oxidation was studied and compared to CuO prepared by the conventional heating method (CHM). Results showed that HP-CuO catalysts prepared by MWS for 10 and 30 min surpassed the CuO catalyst prepared by CHM, exhibiting T 80 of 98 and 115 °C, respectively, as compared to 185 °C of CuO prepared by CHM (T80 is the temperature corresponding to 80% CO conversion). In addition, the MW-synthesized HP-CuO catalysts outperformed the CHM-synthesized CuO, achieving a 100% CO conversion at 150 °C compared to 240 °C in the case of CuO prepared by CHM. Interestingly, the HP-CuO catalyst expressed workable CO conversion kinetics with a reaction rate of c.a.35 µmol s-1 g-1 at 150 °C and apparent activation energy (E a) of 82 kJ mol-1. The HP-CuO catalyst showed excellent cycling and long-term stabilities for CO oxidation up to 4 cycles and 72 h on the stream, respectively. The enhanced catalytic activity and stability of the HP-CuO catalyst appear to result from the unique topological and structural features of HP-CuO, which were revealed by SEM, XRD, Raman, BET, TGA, XPS, and TPR techniques.

Evaluation of immunogenicity and reactogenicity of COVID-19 vaccines in pregnant women.

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with increased risk of adverse maternal and perinatal outcomes. Vaccines are highly effective at preventing severe coronavirus disease 2019 (COVID-19), but there are limited data on COVID-19 vaccines in pregnancy. This study aimed to investigate the reactogenicity and immunogenicity of COVID-19 vaccines in pregnant women when administered according to the 12-week-interval dosing schedule recommended in the UK. METHODS: This was a cohort study of pregnant women receiving COVID-19 vaccination between April and September 2021. The outcomes were immunogenicity and reactogenicity after COVID-19 vaccination. Pregnant women were recruited by phone, e-mail and/or text and were vaccinated according to vaccine availability at their local vaccination center. For immunogenicity assessment, blood samples were taken at specific timepoints after each dose to evaluate nucleocapsid protein (N) and spike protein (S) antibody titers. The comparator group comprised non-pregnant female healthcare workers in the same age group who were vaccinated as part of the national immunization program in a contemporaneous longitudinal cohort study. Longitudinal changes in serum antibody titers and association with pregnancy status were assessed using a two-step regression approach. Reactogenicity assessment in pregnant women was undertaken using an online questionnaire. The comparator group comprised non-pregnant women aged 18-49 years who had received two vaccine doses in primary care. The association of pregnancy status with reactogenicity was assessed using logistic regression analysis. RESULTS: Overall, 67 pregnant women, of whom 66 had received a mRNA vaccine, and 79 non-pregnant women, of whom 50 had received a mRNA vaccine, were included in the immunogenicity study. Most (61.2%) pregnant women received their first vaccine dose in the third trimester, while 3.0% received it in the first trimester and 35.8% in the second trimester. SARS-CoV-2 S-antibody geometric mean concentrations after mRNA vaccination were not significantly different at 2-6 weeks after the first dose but were significantly lower at 2-6 weeks after the second dose in infection-naïve pregnant compared with non-pregnant women. In pregnant women, prior infection was associated with higher antibody levels at 2-6 weeks after the second vaccine dose. Reactogenicity analysis included 108 pregnant women and 116 non-pregnant women. After the first dose, tiredness and chills were reported less commonly in pregnant compared with non-pregnant women (P = 0.043 and P = 0.029, respectively). After the second dose, feeling generally unwell was reported less commonly (P = 0.046) in pregnant compared with non-pregnant women. CONCLUSIONS: Using an extended 12-week interval between vaccine doses, antibody responses after two doses of mRNA COVID-19 vaccine were found to be lower in pregnant compared with non-pregnant women. Strong antibody responses were achieved after one dose in previously infected women, regardless of pregnancy status. Pregnant women reported fewer adverse events after both the first and second dose of vaccine. These findings should now be addressed in larger controlled studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ensuring equity: Pharmacogenetic implementation in rural and tribal communities.

Implementation strategies for pharmacogenetic testing have been largely limited to major academic medical centers and large health systems, threatening to exacerbate healthcare disparities for rural and tribal populations. There exists a need in Montana (United States)-a state where two-thirds of the population live in rural areas and with a large proportion of tribal residents-to develop novel strategies to make pharmacogenetic testing more broadly available. We established partnerships between University of Montana (UM) and three early adopter sites providing patient-centered care to historically neglected populations. We conducted 45 semi-structured interviews with key stakeholders at each site and solicited participant feedback on the utility of a centralized pharmacogenetic service at UM offering consultations to patients and providers statewide via telehealth. For settings serving rural patients-tribal and non-tribal-participants described healthcare facilities without adequate infrastructure, personnel, and funding to implement pharmacogenetic services. Participants serving tribal communities stressed the need for ethical practices for collecting biospecimens and returning genetic results to patients, largely due to historical and contemporary traumas experienced by tribal populations with regard to genetic research. Participants expressed that pharmacogenetic testing could benefit patients by achieving therapeutic benefit sooner, reducing the risk of side effects, and improving adherence outcomes for patients with limited access to follow-up services in remote areas. Others expressed concern that financial barriers to pharmacogenetic testing for patients of lower socioeconomic status would further exacerbate inequities in care. Participants valued the role of telehealth to deliver pharmacogenetic consults from a centralized service at UM, describing the ability to connect providers and patients to resources and expertise as imperative to driving successful pharmacogenetic implementation. Our results support strategies to improve access to pharmacogenetic testing for neglected patient populations and create opportunities to reduce existing healthcare inequities. By exploring critical challenges for pharmacogenetic implementation focused on serving underserved communities, this work can help guide equitable frameworks to serve as a model for other resource-limited settings looking to initiate pharmacogenetic testing.

Analgesic benefits of the quadratus lumborum block in total hip arthroplasty: a systematic review and meta-analysis.

The quadratus lumborum block (QLB) is reported to reduce pain and improve function following total hip arthroplasty; however, randomised controlled trials evaluating the benefits of adding this block to general or spinal anaesthesia in this population are conflicting. We performed a systematic review seeking randomised controlled trials investigating QLB benefits for total hip arthroplasty, stratifying comparisons regarding the addition of QLB to either general or spinal anaesthesia. The primary outcome was 24-h area under the curve (AUC) pain score. Pain scores were interpreted in the context of a population-specific minimal clinically important difference of 1.86 cm on a 10-cm visual analogue scale, or an AUC pain score of 5.58 cm.h. Secondary outcomes included analgesic consumption, functional recovery and opioid-related side-effects. In all, 18 trials (1318 patients) were included. Adding QLB to general or spinal anaesthesia improved 24-h AUC rest pain scores by a mean difference (95%CI) of -3.56 cm.h (-6.70 to -0.42; p = 0.034) and - 4.19 cm.h (-7.20 to -1.18; p = 0.014), respectively. These improvements failed to reach the pre-determined minimal clinically important difference, as did the reduction in analgesic consumption. Quadratus lumborum block improved functional recovery for general, but not spinal, anaesthesia. Opioid-related side-effects were reduced with QLB regardless of anaesthetic modality. Low-to-moderate quality evidence suggests that the extent to which adding QLB to either general or spinal anaesthesia reduces postoperative pain and opioid consumption after total hip arthroplasty is statistically significant but may be clinically unimportant for most patients. However, adding QLB to general anaesthesia might enhance functional recovery. Taken together, our findings do not support the routine use of QLB as part of multimodal analgesic regimens for total hip arthroplasty.

Prevalence of extended-spectrum ß-lactamase-producing Enterobacterales in retail sheep meat from Zagazig city, Egypt.

BACKGROUND: The goal of this study was to investigate the prevalence of extended-spectrum ß-lactamase production in Enterobacterales isolated from retail sheep meat in Zagazig, Egypt. METHODS: One hundred random samples of sheep meat were collected from different retail butcher shops (n = 5) in the city of Zagazig, Egypt. Bacterial isolates were identified by MALDI-TOF MS and screened for antibiotic susceptibility by disk diffusion; further genotypic characterization of ß-lactamase-encoding genes was performed with Real-Time PCR. E. coli strains were phylotyped with the Clermont triplex PCR method. RESULTS: Of the total of 101 bacterial isolates recovered from retail sheep meat samples, 93 were E. coli, six were Enterobacter cloacae and two were Proteus mirabilis. As many as 17% of these 100 samples showed ESBL phenotypes, all were E. coli. The blaCTX-M genes were detected in seven isolates (six were blaCTX-M-15 and one was blaCTX-M-14), three isolates harboured blaTEM (all were blaTEM-one), and two carried genes of the blaSHV family (both were blaSHV-12). Eight E. coli isolates expressed ESBL phenotype but no blaTEM, blaSHV or blaCTX-M genes were detected by PCR. ESBL- positive E. coli isolates were nearly equally distributed over the commensal groups A/B1 and the virulent group D. CONCLUSION: Nearly one in five sheep meat samples was contaminated with ESBL-E. coli. This further corroborates the potential role played by contaminated meat in the increasing resistance rates that have been reported worldwide.

Isolated Persistent Left Superior Vena Cava Revealed by an Associated Asthma.

BACKGROUND: Persistent left superior vena cava (PLSVC) is a rare anomaly of the thoracic venous system. Case Report. We present a case of a patient with isolated asymptomatic PLSVC, who was diagnosed because of dyspnea revealing an associated asthma. An 18-year-old male patient complained of paroxystic sibilant dyspnea. He did not have any anomaly in physical examination. The chest X-ray revealed cardiomegaly with a widening of lower mediastinum. The electrocardiogram does not show any anomaly. Echocardiography showed the PLSVC. The thoracic contrast computed tomography of the chest showed ecstasies of the right cardiac cavities and a double superior vena cava. The patient did not have similar family cases. Respiratory functional explorations led to the diagnosis of an associated asthma. Currently, he is followed up periodically. Asthma was improved with inhaled corticosteroid treatment. CONCLUSION: PLSVC is rare but can have important clinical implications. Associated severe cardiac malformations must be systematically sought.

A Delicate Surgical Resection to Treat a Proximal Pulmonary Adenoid Cystic Carcinoma.

Pulmonary adenoid cystic carcinoma (PACC) is an exceedingly rare tumor of low-grade malignancy. Diagnosis is often late, so the tumoral process may be huge at presentation. Surgical resection could be challenging, and the recurrence rate would be greater. We report, hereby, a case of proximal PACC with involvement of the carina in a young male adult, without respiratory distress. Surgical resection was performed through a left pneumonectomy followed by a complex trachea-bronchoplastic procedure. During the operative time, the assisted ventilatory mode was carefully chosen. No adjuvant treatment was needed. Our patient is still under clinicoradiological surveillance and remains disease-free.