The current study examined bidirectional relations between anxious symptoms and two forms of peer victimization  within an underrepresented sample of urban adolescents during key transition periods  and the following 2 years. A predominantly African American sample (91%) of 358 adolescents  living in low-income urban areas were assessed annually across 4 years. Using self-report measures, adolescents reported on their past year experiences of anxiety and peer victimization. Longitudinal path analyses tested progressively complex models for each type of victimization. Anxious symptoms predicted both overt and relational victimization at the time of transition (Wave 1 to Wave 2) and the following year (Wave 2 to Wave 3). Furthermore, whereas previous levels of victimization and future anxious symptoms were positively correlated over time, only relational victimization at Wave 1 predicted anxious symptoms at Wave 2. Prior levels of each construct were the strongest predictor of future outcomes . Overall, there was little support for bidirectional relations between anxiety symptoms and peer victimization. Intervention and prevention programs seeking to reduce peer victimization or anxiety should start by targeting the symptom/behavior of interest. Interventions that target anxious thoughts and feelings during these key transition times in adolescence should be assessed as areas of priority. Bully , defined as being maltreated by one’s peers, including being exposed to such behaviors as hitting, name-calling, and being purposefully excluded from groups, is a common problem among adolescents that has been shown to have serious consequences. Student reports from nationally representative samples indicate that 16% to 20% of youth in the United States experience some form of PV, though these rates vary by age, sex, ethnicity/race, and disability status . For exaBully . These aResearchers have distinguished between several types of PV, with two key subtypes being overt and relational victimization. Overt victimization involves both openly aggressive nonphysical and physical person-to-person acts such as name-calling or pushing, shoving, or hitting, respectively. Alternatively, relational victimization includes more covert behaviors such as being excluded from a group, deliberately ignored, or the target of rumors or lies that damage the victim’s reputation and social relationships . ExperieThe negative consequences of PV can be severe and can have long-term impacts on victims’ well-being, even into adulthood . ResearcAlthough researchers have explored relations between victimization and a variety of adjustment problems, there has been increasing focus on its association with internalizing symptoms. Some researchers have theorized that although internalizing symptoms may exist before a youth’s exposure to PV, the frequency of symptoms may escalate as a result of the PV . VictimiThe majority of research examining relations between PV and internalizing symptoms has focused on depressive symptoms e.g., . A meta-Prior research examining the bidirectional relations between PV and anxiety, including internalizing symptoms more broadly, has had a variety of limitations. Contradictory results may be the result of samples drawn from populations that differ based on age and culture , or because the length of time between data collections of the studies varies. Researchers also have been inconsistent in their definitions of PV and have not always investigated the unique constructs that comprise these domains . Furthermore, researchers have tended to combined anxious and depressive symptoms .In addition, the majority of samples examined in these studies have been limited to those in sixth grade or younger, and most consist of primarily Caucasian youth. Also, almost all the research completed so far gathered data at only two time points across a timeframe of 2 years or less. This can be problematic as certain sensitive periods may be missed. For example, naturally occurring transition times, such as the transition from elementary school to middle school, or middle school to high school, may offer youth opportunities to either remove themselves from environments that included PV and establish new healthier peer relationships or enter new environments where PV is more prevalent and/or supportive peer relationships have been discontinued. Furthermore, there has yet to be a study that analyzes anxiety symptoms broadly in relation to overt and relational PV over time.We designed this study to contribute to the literature on PV by addressing several of the limitations of past work. First, we considered general anxious symptoms as a unique construct, going beyond work that has focused solely on social phobia symptoms. Second, we examined overt and relational victimization separately. Third, we investigated the relation between anxious symptoms and victimization across 3 years using four time points encompassing youth in fifth through 11th grade. This captured a broader range of development than past studies and allowed for a more detailed investigation of the timing of these relations. Fourth, we investigated the potential bidirectional nature of the relations between anxious symptoms and PV with path analyses using cross-lagged path models, which allow for a more comprehensive examination of this phenomenon. Finally, the community-based sample consisted of poor, mostly African American youth who are underrepresented in the literature on PV. This gap in the literature reflects a general trend in psychological research to understudy ethnic minority populations . Based oM age in years = 12.10, SD = 1.63; 56% female) from a larger longitudinal study focusing on youth violence exposure, physiology, and drug use  or eighth grade  at Wave 1 of the study (2005). Most (91%) identified themselves as African American, 3% as European American, 3% as American Indian, and 3% endorsed other racial/ethnic groups. The most common family structure consisted of maternal caregivers who never married (40%), followed by those who were married or cohabitating (32%), separated or divorced (26%), and widowed (2%). The median household income for the sample was between US$300 and US$400 per week, with 34% of the sample earning US$300 or less per week and 29% earning a weekly income of US$500 or more. Caregivers’ level of education varied with 23% who did not complete high school, 31% holding a high school or general education diploma, 24% who pursued but did not complete some form of education beyond high school, 13% holding an associate’s degree or completed vocational training, and 9% holding a bachelor’s or advanced degree. Participants in the current study lived in neighborhoods in a midsized city in the Southeastern United States that was characterized by high violence and/or poverty rates .The sample consisted of 358 urban youth . We used a modified scoring recommended by The RCMAS  is a 37-never, 1 = once, 2 = twice, 3 = 3 or 4 times, 4 = 5 or 6 times, 5 = 7 or 8 times, 6 = at least once a month, 7 = at least once a week, and 8 = almost every day. For Waves 2 to 4, the original rating scale of the PBFS-R was used such that respondents were asked how frequently they experience different forms of victimization  in the past 30 days on a 6-point scale: 0 = never, 1 = 1–2 times, 2 = 3–5 times, 3 = 6–9 times, 4 = 10–19 times, and 5 = 20 times or more. The relational victimization items  were partially based on the Social Experiences Questionnaire (SEQ-S) developed by The PBFS-R is a self-report measure that consists of seven subscales that assess the frequency of problem behaviors in youth . The sixps > .10. Interviews with the caregiver and youth lasted approximately 90 min, included assistance with self-report measures, and participants received US$50 in gift cards per family at each wave. At the end of the study, names of families who finished all four interviews were put in a drawing for US$300, US$200, and US$100 prizes. Sixty-nine percent of the original sample was retained across the entire four-wave study. These retention rates are better than many community-based studies for recruiting participants from high-risk neighborhoods  to protect families’ responses. The interviewers hired to conduct these sessions were of various racial/ethnic backgrounds and sexes. Tests for interviewer race and sex effects revealed no systematic biases, borhoods . The pret tests on baseline data to see whether youth who completed all four waves of data differed from those who dropped out of the study. We also conducted a test to determine whether the missing data were missing completely at random (MCAR). Then, correlations between anxious symptoms, overt victimization, and relational victimization were calculated to examine the relations within each of the four waves of data using MPlus Version 6.1  estimator used to accurately conduct chi-square difference testing. The models were (a) an autoregressive model in which each variable was regressed the prior level of that variable (Model 1); (b) an anxiety prediction model in which previous waves of anxiety were added to the autoregressive model to predict future waves of victimization (Model 2); (c) a victimization prediction model in which previous waves of victimization were added to the autoregressive model to predict future waves of anxiety (Model 3); and (d) a full bidirectional model in which both previous waves of victimization and anxiety were added to the autoregressive model to predict future waves of each construct  chi-square to degrees of freedom ratio less than 2.0; (b) the comparative fit index (CFI) of more than .95 ; and (c)z-score of 3.29 to a score equivalent to a z-score of 3.29. We used the winsorized data in all analyses. In addition, we conducted the path analysis using an estimator robust to nonnormality . r = .10, ns). Our attrition analyses did not identify any significant differences between participants who completed all of the study measures at all waves and those who did not on any demographics or study variables. Furthermore, according to 2 = 161.82, df = 139, p = .090.We followed procedures recommended by 2Δ(3) = 4.52, p = .21, or of Model 2 model, χ2Δ(3) = 4.43, p = .22. Thus, our findings supported the notion that anxiety predicted subsequent changes in overt PV but did not support reciprocal relations such that overt PV predicted changes in anxiety. Standardized path coefficients indicated that anxiety predicted changes in overt PV across Waves 1 and 2 and across Waves 2 and 3, but not across Waves 3 and 4  within a community sample of predominantly African American adolescents living in low-income urban areas across four waves of data collected annually during key transition periods  and the following 2 years. We expected to find bidirectional, longitudinal relations between anxious symptoms and PV over time.Anxious symptoms predicted both overt and relational PV, but only at the time of transition (Wave 1 to Wave 2) and the following year (Wave 2 to Wave 3). This expands on our current knowledge that has found varying levels of support for the notion that anxiety “drives” risk for PV. This extends findings from studies that showed social phobia symptoms predicted overt PV in certain populations  consistently predicted the following year’s levels of the construct across all models tested. Researchers who have included analogous paths in their investigations also have found that previous levels of internalizing symptoms and PV significantly and consistently predicted future levels of each construct, respectively . TherefoGiven this study’s findings, it is important to consider what current PV programs tend to offer to youth and if this is sufficient for reducing instances of PV. Programs that focus on reducing PV, as well as bullying, typically reduce PV by 17% to 20% on average . AccordiHowever, although most programs used in the United States include assertiveness and social skills training , ethnic/racial backgrounds, or socioeconomic status (SES) levels, as the sample for this study was predominately African American urban adolescents from low-income families. In addition, most of the data collected in this study occurred before there was widespread usage of smartphones and social media by youth, which has changed the patterns of adolescent communication and the PV landscape to include more instances of PV by indirect means, especially through cyberbullying .This study contributed to our understanding of the prospective relations between anxiety symptoms and overt and relational PV in a commonly underrepresented population in the current research. Similar to past research which has included analogous paths in their investigations , this st


P = 0.007) and 83.4% of patients were satisfied with the surgical results and the average satisfaction score was 4.2 out of a possible 5.0. Multiple regression analysis showed that patient satisfaction was significantly associated with the postoperative SHS , the postoperative PSQI  and the presence of a posterior subcapsular cataract (PSC) . This study clarified that cataract surgery may improve both visual function and patient happiness and that patient satisfaction was affected by postoperative sleep quality and the disappearance of a PSC.The purpose of this study was to investigate the changes in patient subjective happiness and satisfaction with cataract surgery and evaluate the association between satisfaction and types of cataract. This study surveyed 247 participants  and they completed questionnaires on their satisfaction with the surgery, the subjective happiness scale (SHS) and the Pittsburgh Sleep Quality Index (PSQI) before and after surgery. The SHS increased postoperatively from 4.6 ± 0.7 to 4.8 ± 0.7 ( Another study reported improvements in the QOL, cognition, and depression after cataract surgery6. We evaluated changes in the sleep quality and gait speed before and after cataract surgery and reported that surgery effectively improved sleep quality and slow gaid speed7. Therefore, cataract surgery can improve the patients’ lives.Cataracts are common in elderly individuals, and surgery is indicated in most cases. Several studies have reported that cataract surgery improves not only the visual function but also the patients’ quality of life (QOL). Previous studies have reported that the risk of falls decreased after cataract surgery8, and positive emotions are highly beneficial for physical and mental health13. In Ophthalmology, Kawashima et al. reported an association between subjective happiness and dry eye disease14. Matsuguma et al. evaluated the relationship between subjective happiness and laser-assisted in situ keratomileusis15 and visual impairment16. A recent review reported that positive affective states, including happiness, may contribute to sleep17. As mentioned previously, using the Pittsburgh Sleep Quality Index (PSQI), we found that cataract surgery effectively improved sleep quality and that the PSQI improved significantly in patients with a posterior subcapsular cataract (PSC)18. Considering these findings, we assumed that the patient subjective happiness and sleep quality also may be better postoperatively. Feeny et al. showed that in Vietnam cataract surgery provided benefits that included significant improvements in earnings, mobility, self-care, ability to undertake daily activities, self-assessed health and mental health, life satisfaction, hope, and self-efficacy19.Recent psychology research has indicated that happiness has become an important goal for many peopleIn the current study, we investigated the changes in the patient subjective happiness before and after cataract surgery and surgical satisfaction in Japan and the association between subjective happiness, satisfaction, and cataract-related factors by evaluating the types and severity of cataracts.During the study, 261 patients underwent cataract surgery and 14 were excluded. The 247 remaining patients  were evaluated. Seventy-four patients underwent unilateral surgery and 173 underwent bilateral surgeries. Fifty-six patients of undergoing unilateral surgery were the first-eye surgery and 18 patients were second-eye surgery. There were not any complications including posterior capsule rupture.P = 0.007) from 4.6 ± 0.7 to 4.8 ± 0.7. The average satisfaction score was 4.2 ± 0.9; 83.4% of patients were satisfied with the surgery . The postoperative CDVA, UDVA, and PSQI were significantly better than the preoperative values .The preoperative and postoperative results of ocular examinations and questionnaires are summarized in Table There are not significant differences between first-eye surgery group and second-eye surgery group in unilateral surgery patients about satisfaction score, change in SHS and PSQI Table .Table 2CP = 0.035) more prevalent in women than men (P = 0.035), and their refractive error was significantly (P < 0.01) more myopic than the patients without nuclear opalescence .The numbers of patients with nuclear opalescence (≥ grade 3), cortical cataract, and PSC were 54, 71, and 54, respectively. The presence of nuclear opalescence was significantly (P = 0.017) and the preoperative CDVA  significantly affected the patient happiness before cataract surgery. Table P < 0.001) with the preoperative SHS. The satisfaction score was significantly  associated with the changes in the SHS (Table Table P < 0.001)   , the postoperative PSQI  and the presence of a PSC  significantly affected the patient surgical satisfaction (Table P = 0.004) than without a PSC   type implanted. The current study confirmed that sleep quality improved significantly after cataract surgery and further confirmed the association between the improvement and patient satisfaction.Many previous studies have evaluated sleep quality before and after cataract surgery; two meta-analyses21. The current results agree with those of previous studies. In addition, refractive error of the patients with nuclear opalescence in this study was more myopic than the patients without nuclear opalescence. We speculated that better near vision in myopic patients with nuclear opalescence may account for their higher SHS score compared with patients without nuclear opalescence.Interestingly, we also found that the preoperative SHS score was associated with poor VA and the presence of nuclear opalescence. The patients with poor VA had a lower SHS score, and those with nuclear opalescence had a higher SHS score. More women than men were among those with nuclear opalescence. Shimai et al. reported that the SHS scores of women were higher than those of men29. We should follow these patients for longer periods, such as 6 months or 1 year. Finally, this study was conducted in a mixed sample that included two types of IOLs (a clear ultraviolet light-filtering IOL and a yellow blue light-filtering IOL) and unilateral/bilateral cataracts.The current study had some limitations. First, we could not collect additional data that might have affected subjective happiness, such as income or marital status. We inferred that the patients with nuclear opalescence may have elements that made them happier than those without nuclear opalescence. Second, we did not evaluate the improvement of symptoms such as glare or haloes. We should have assessed these points with questionnaire, glare testing and low contrast visual acuity testing, because these factors possibly affected the patient’s daily life. Third, the study included some biases because it was conducted in one hospital and two clinics in an urban area. Fourth, the patients’ happiness may change over time, considering the set-point theory of happinessThe study participants were patients who underwent cataract surgery at Todoroki Eye Clinic, Tokyo, Japan, Minatomirai Eye Clinic, Kanagawa, Japan, and Keio University Hospital, Tokyo, Japan, between June 2016 and June 2018. The subjects completed questionnaires that measured their subjective happiness within 1 month before and after surgery and their satisfaction 1 month with surgery.Patients were excluded who were younger than 20 years, did not answer all questions, and Took a psychotropic drug. The Institutional Review Board of Keio University School of Medicine approved the research protocol, and the study was conducted in accordance with the tenets of the 1995 Declaration of Helsinki. All participants were provided informed consent.30 as nuclear opalescence grade 3 or higher, cortical cataracts disrupting the visual axis, and PSCs. Nuclear opalescence was graded by comparing the color slit-lamp image to be graded with the standard nuclear images (standards 1–6)30. A cortical cataract is visualized in retroillumination images focused either anteriorly or posteriorly30. Only posteriorly focused retroillumination images are used in grading PSC30.All participants underwent preoperative and postoperative ocular examinations that included measurement of the uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), and spherical equivalent (SE) by an orthoptist. The SE is a commonly used to express the refractive error by algebraically adding half the cylindrical power to the spherical power. Three experienced ophthalmologists who performed the cataract surgeries evaluated the types and severity of the cataracts by slit-lamp biomicroscopy under maximal pupillary dilation. The types of cataracts were classified according to the Lens Opacities Classification System IIIAll surgeons underwent phacoemulsification and aspiration. The selection of anesthesia during surgery, two of them underwent with only topical anesthesia (oxybuprocaine hydrochloride and lidocaine hydrochloride 4.0%) and another clinic underwent both topical anesthesia and intracameral anesthesia (lidocaine hydrochloride 0.5%). After the surgery, two medical institutions prescribed three ophthalmic solutions  for postoperative medication. Another clinic prescribed two ophthalmic solutions (moxifloxacin hydrochloride 0.5% and bromfenac sodium hydrate 0.1%) and add a corticosteroid ophthalmic solution (betamethasone sodium phosphate fradiomycin sulfate) in case the patient has severe inflammation after the surgery.20 originally developed by Lyubomirsky  and test–retest reliability (r = 0.86) over 5 weeks were scientifically sound31.Regarding the outcome measures, subjective happiness was measured using the validated Japanese version of the Subjective Happiness Scale (SHS)y eTable 31. The sWe also evaluated the patient postoperative satisfaction using the original questionnaire. The questionnaire used a 5-point Likert scale ranging from 1 (least satisfied) to 5 (very satisfied).32, a self-administered questionnaire, is comprised of seven subscales that evaluate sleep quality, including subjective sleep quality, daytime dysfunction, sleep latency, sleep duration, habitual sleep efficacy, sleep disturbances, and use of sleep medications; the score was calculated according to separate algorithms and analyzed. Each component was scored on a scale of 0–3, with 3 indicating the worst score. The highest possible global score is 21, and the normal range on the PSQI is less than 632. We used the validated Japanese version of the PSQI33.The PSQIJournal of Cataract & Refractive Surgery.If the patient underwent bilateral surgeries, the data from the eye with the better VA were used for all statistical analyses. The VA was converted to the logarithm of the minimum angle of resolution (logMAR). For the statistical analysis of the CDVA and UDCA, counting fingers was categorized as logMAR 2.00 and hand motions as logMAR 3.00, according to the VA conversion chart of the The differences between the preoperative and postoperative CDVA, UDVA, SE, SHS, and PSQI were analyzed using the Wilcoxon signed-rank test. The differences between first-eye surgery group and second-eye surgery group in unilateral surgery patients were also analyzed using the Wilcoxon signed-rank test.P < 0.20) in simple correlation to identify the factors affecting the patient satisfaction and happiness with the results of cataract surgery. Multiple regression analysis then was performed to determine the predictors of the SHS score and satisfaction, and possible predictors . P < 0.05 was considered significant. All statistical analyses were performed using SPSS version 25 .The correlations were evaluated using the Spearman’s rank correlation test. Multiple regression analysis was performed for potential variables with statistical significance (In summary, the current study showed that cataract surgery may improve not only the visual function but also the patient happiness with surgery. The study also showed that the patient postoperative subjective happiness was associated with surgical satisfaction, and the satisfaction was affected by postoperative sleep quality and the disappearance of a PSC.Supplementary Table.


Vitamin D has been playing an important role in the treatment of lung diseases. The non-calcemic effects of this vitamin and its role in chronic obstructive pulmonary disease (COPD) has drawn significant attention recently. Many studies have been conducted to explore the relationship between the two. We tested the hypothesis that vitamin D can act as an effective therapeutic agent for COPD by reviewing the correlation between the two and effectiveness along with the safety of supplemental vitamin D when used to treat chronic bronchitis and emphysema through clinical trials. An electronic search was conducted using combinations of keywords “vitamin D” and “COPD” from PubMed and Google scholar. Only relevant, human studies of all types were included from the last decade. A total of 36 articles were selected for review. Observational studies indicate a correlation between low serum 25(OH)D levels and obstructive lung disease pathology as well as clinical outcomes. Moreover, clinical trials were aimed to understand the impact of the use of vitamin D in improving disease indexes. These clinical trials used different drug regimes, mode of administration, and intervention duration with contrasting outcomes.Hypovitaminosis D is a common and harmful variant of this group of obstructive lung diseases, and correcting this deficiency can improve exacerbations, inflammation, lung functions, symptoms, and quality of life. These benefits are more prevalent in patients with low baseline serum 25 hydroxyvitamin D(25(OH)D) levels. Peroral is the most frequently used route of drug administration, however, further work is required to explore the pharmacological properties of vitamin D. There was not enough literature available about the safety of the drug of intervention. Smoking and other air pollutants are a leading cause of the systemic inflammatory response. Host factors like genetic abnormalities, abnormal lung development, and accelerated aging also play an important role in developing the disease . TobaccoErgocalciferol (D2) and cholecalciferol (D3) are two forms of fat-soluble vitamin D. It can be obtained from diets such as fortified food, fish, and dietary supplements. Still, more than 80% of it is produced in the skin under UV radiation. In the liver, vitamin D3 is then hydroxylated to 25(OH)D, a marker for serum vitamin D levels because of its long half-life . 1,25 to see potential effects of low serum25(OH)D levels on COPD and Clinical trials, in particular, to concentrate more on the supplemental use of vitamin D in treating COPD. Our areas of interest would be efficacy, dosing regimes, duration of therapy, and safety profile of vitamin D and how baseline serum vitamin D levels in the intervention group play with the results.Study selection and data extraction were performed by first scanning through the titles and then by applying Inclusion exclusion criteria Table  and readQuality CheckThe entire method was performed ethically and scientifically. Quality appraisal for individual studies and statistical analysis was not done.ResultsSearch results from PubMed showed 211 articles in the last 10 years. Twenty articles were collected from other sources like google scholar, gray literature, and a web page VitaminDwiki. After removing duplicates, 220 articles were screened through the titles or abstract. One hundred and fifty-five studies were excluded, and out of 65 retrieved articles, some more studies were removed based on an animal model, cellular, or molecular levels .DiscussionVitamin D and its role in extraskeletal diseases have gained enormous popularity in the last decade. Few autoimmune, respiratory, neurodegenerative, and mental health problems are among those extra skeletal problems . Like itRelationship Between Vitamin D and COPD Serum 25(OH)D levels below 20 ng/mL (50 nmol/L) is defined as vitamin D deficiency between 21-29 ng/mL (52.5-72.5 nmol/L) as insufficiency and 30 ng/mL as normal levels by US endocrinology society . The preA negative correlation has been reported between disease severity and vitamin D levels ,18. Kim Clinical Trials Demonstrating the Role of Supplemental Vitamin D in the Treatment of COPDDue to the increasing desire to explore the role of vitamin D2/D3 in treating lung diseases like asthma, COPD, and cystic fibrosis, many studies have been conducted so far with inconsistent results either due to a small sample size or some other limitations. A meta-analysis of 25 randomized controlled trials (RCTs) was recently performed to see the efficacy of using this vitamin to treat emphysema and chronic bronchitis with positive results regarding acute exacerbations, lung functions, six-minute walk distance, COPD assessment score, and sputum . Data exSome of the common primary outcomes of those clinical trials are exacerbations, lung functions , quality of life, physical exercise, and muscle strength. Lehouck’s study could not find any significant effects on the first onset of exacerbation or its frequency, quality of life, hospitalizations, and mortality after giving high dose calcitriol . In compLung functions like FEV1 and FVC showed significant improvement by receiving 100,000IU of vitamin D monthly for six months, but baseline 25(OH)D levels were not recorded in this study . Gharaba Both single high dose intramuscular and oral supplemental vitamin D seems to have beneficial effects on health-related quality of life ,38. We cAs we reviewed earlier observational studies demonstrating the role of hypovitaminosis D in disease severity, progression, poor outcome, increased inflammation, and symptoms of emphysema or chronic bronchitis, little is known from experimental studies in this field. More clinical trials are required to explore these parameters of disease in detail. Dastan et al. documented the effect of vitamin D supplements on inflammation resolution by measuring serum levels of inflammatory markers . GhodratPharmacologic Perspective of Supplemental Vitamin DIn RCTs, mostly the oral route of drug administration was used; only two experimented with high dose intramuscular bolus vitamin D with significant improvement in the quality of life, symptoms of acute exacerbation of COPD, and inflammation resolution ,43. ThesAn animal trial performed on mice has put forward a new hypothesis that vitamin D, when used topically/intrapulmonary, can exert a healing effect on lung alveolar cells. This can provide a future subject to explore that inhalational can be an effective mode of administration with less systemic side effects. The healing or curative effect of this vitamin needs further human trials . TransieLow dose intervention performed for a shorter duration of time often failed to demonstrate beneficial effects of vitamin D on patients with emphysema or chronic bronchitis ,37. But Effect of baseline 25(OH)D levels on results of the clinical trials: A subgroup analysis performed on 30 severely vitamin D deficient patients (serum 25(OH)D levels <10 ng/mL) raised a concern about the relationship between low baseline 25(OH)D levels and its beneficial effects on calcitriol supplementation . In contLimitationsThere were only a limited number of clinical trials available that satisfied the full selection criteria. The outcomes discussed in the studies were usually widespread and only few were in the desired spectrum of interest. Side effects related to supplemental use of vitamin D were reported by only handful of studies.We reviewed the relationship between vitamin D and COPD. The efficacy, safety, and pharmacological properties of calcitriol supplements used in treating obstructive lung diseases remained our focus areas. The reviewed studies show that hypovitaminosis D is more prevalent in COPD patients, and it affects the disease symptoms, severity, progression, exacerbations, prognosis, mortality, lung functions, inflammation, and quality of life. This supplementation can reduce the number of disease exacerbations, inflammation resolution, improving physical exercise, muscle strength, and lung functions . In general COPD patients with vitamin D deficiency or insufficiency and smokers, benefit more from calcitriol supplementation.Oral supplements were used most commonly, but the parenteral route also gave successful results. Some of our studies reflect that using higher doses of vitamin D for a longer duration of time gave relatively more significant results than lower doses. Still, overall results were inconclusive, and very few studies commented on the safety profile of these supplements. In the future, pharmacologic aspects and the safety of calcitriol supplements should be explored in detail. More studies are needed to talk about the alveolar healing and repairing properties of vitamin D as seen in animal models. Inhalational formulations might be the best way to administer it with the least systemic side effects however human trials are required to provide evidence. Conclusively, with the correct amount of evidence vitamin D could act as a novel curative agent for treating COPD in the future.


Vibrio parahaemolyticus, hepatitis E virus (HEV), and antimicrobial residues are the emerging hazards that are considered most imminent and severe and that could cause safety problems of the highest scale in the bivalve value chain by the majority of the experts consulted (75%). Finally, in a preliminary way, an exploratory study carried out in the Galician Rías highlighted the presence of HEV in mussels cultivated in class B production areas.Emerging risk identification is a priority for the European Food Safety Authority (EFSA). The goal of the Galician Emerging Food Safety Risks Network (RISEGAL) is the identification of emerging risks in foods produced and commercialized in Galicia (northwest Spain) in order to propose prevention plans and mitigation strategies. In this work, RISEGAL applied a systematic approach for the identification of emerging food safety risks potentially affecting bivalve shellfish. First, a comprehensive review of scientific databases was carried out to identify hazards most quoted as emerging in bivalves in the period 2016–2018. Then, identified hazards were semiquantitatively assessed by a panel of food safety experts, who scored them accordingly with the five evaluation criteria proposed by EFSA: novelty, soundness, imminence, scale, and severity. Scores determined that perfluorinated compounds, antimicrobial resistance,  Identification of risks at early appearance (emerging) is a matter of public health, as it can be a major preventive instrument for foodborne diseases . That isThe Galician Food Safety Emerging Risks Network (RISEGAL) was born in 2018 with the mission of contributing to the identification of food safety emerging hazards and their driving factors in foods produced or commercialized in Galicia.Galicia is a small region located in the northwest corner of the Iberian Peninsula. The food industry is one of the main economic sectors of the region. In fact, Galicia leads in seafood production and processing in the EU, and local industries constitute half of the national industry of the sector . In partBivalve mollusks are recognized as vectors in the transmission of viral and bacterial diseases . TherefoEmerging risks in food safety are promoted by socioeconomic and environmental driving factors, such as consumption habits, migration, increasing ageing, and climate change. Climate change is a recognized challenge to food safety. Changes in temperature, humidity, rainfall patterns, and increases in weather events affect all productive systems. These impacts will affect the persistence and occurrence of germs and toxin production microorganisms  and the patterns of foodborne diseases, thus increasing the risk of emerging zoonosis. Additionally, indirect effects derived from the application of mitigation strategies are expected .Most driving factors can be considered nonglobal but dependent on each specific geographical location. In Galicia, for example, ageing is considered an important driving factor for the appearance of emerging hazards. Also, traditional habits of shellfish consumption, raw or undercooked, undoubtedly increase foodborne illness risks . Most biConsequently, the aim of this work was to identify and prioritize emerging hazards potentially associated with bivalve shellfish produced in Galicia. Additionally, an exploratory study of such hazards was subsequently performed to find out whether they could be already detected in mussels cultured in Galician Rías from harvesting areas approved for human consumption.www.typeform.com domain name (the “site”) is provided by TYPEFORM SL, Barcelona, Spain. The inquiry was addressed to public health inspectors, consumers, and stakeholders of the food industry, and responses were automatically collected by the program in an optional anonymous manner.A short (six questions) online inquiry was designed by using the free software Typeform  Core Collection database. Two consecutive searching steps  were carried out by using the keywords included in To gather data from the different stakeholders concerned with the mollusk bivalve chain, data collection was carried out by these three complementary approaches.Members of RISEGAL and 10–15 additional external experts carried out a blind scoring (0–5) of novelty, severity, imminence, soundness, and scale, all criteria considered by EFSA for the initial qualitative description of emerging issues .In each sampling time, mussels were obtained from three sites located in different zones in Galician Rías  .Escherichia coli per 100 g shellfish) according to European legislation. Mussels were transported alive on ice to the laboratory and distributed in groups of 15–20 individuals for further analysis.They were collected monthly from May to July 2019. The sampling points  were locVibrio parahaemolyticus and Vibrio vulnificus were detected following the ISO 21872-1:2017 method. Mussels were washed, scrubbed, and opened aseptically. Flesh and intravalvar fluids were collected and homogenized for 120 s in a sterile bag using a Stomacher . Enrichment was carried out in two subsequent steps. First, 25 g of the homogenized sample was homogenized in 225 mL of alkaline saline peptone water (ASPW) and incubated at 37 °C for 6 h. Second, 1 mL was reinoculated into 10 mL of ASPW and incubated at 37 and 45 °C for 18 h. At the end of the incubation period, an inoculating loop of the culture broth was streaked onto thiosulfate citrate bile salt sucrose  and Vibrio ChromoSelect agar . After incubation at 37 °C for 24 h, five typical colonies were subcultured on saline nutrient agar (3% NaCl) plates. Presumptive isolates were confirmed as V. parahaemolyticus by PCR amplification of the toxR and enteropathogenicity-associated genes (tdh and trh) or the vvh gene in the case of V. vulnificus.Twenty-five grams of bivalve flesh obtained from 15–20 mussels were homogenized in 225 mL of 0.1% peptone water  for 60 s. Serial dilutions were streaked on marine agar plates  and incubated at 25 °C for 5 days . ResultsTwenty-five grams of bivalve flesh obtained from 15–20 mussels was homogenized for 2–3 min in a Stomacher  in 100 mL of TSB  supplemented with cicloproxacin (4 mg/L) and 1% sodium chloride. This fluoroquinolone was selected because of the widespread distribution of resistance against this antibiotic [Identification of colonies with low susceptibility to ciprofloxacin was based on 16S rRNA gene sequence and analysis following the procedure described by Rodríguez-López et al. .TEM–bla, CTX-Mbla (beta-lactams), qnrS (quinolones), sul1 (sulphonamides), and aac6 (aminoglycosides). In addition, we screened the gene intI1, which encodes for an integrase enzyme associated with class 1 integrons, recognized as a proxy of anthropogenic microbial sources [Antibiotic resistance gene detection was carried out by conventional PCR as described before . The set sources . 3 PFU) of Mengovirus (clone vMC0) were spiked into each homogenate as RNA extraction efficiency control. One volume of 0.1% peptone water pH 7.5 (1:1 w/v) was added to each homogenate, which was then shaken for 1 h at 4 °C and centrifuged at 1000× g for 5 min, recovering the supernatant. Viral RNA was extracted from the supernatants (150 μL sample volume) using the NucleoSpin® RNA Virus Kit  in duplicate, following the manufacturer’s instructions.Viral recovery from shellfish homogenates (2 g) was performed according to ISO 15216-1:2017, with slight modifications . Briefly® probe containing a 5′ 6-carboxy fluorescein fluorophore and 3′ Black Hole Quencher. Reverse transcription was carried out at 50 °C for 15 min, followed by denaturation at 95 °C for 5 min. cDNA was then amplified with 45 PCR cycles at 95 °C (15 s) and 55 °C (20 s). Extraction and amplification efficiencies were calculated using Mengovirus and appropriate external controls  as indicated in the ISO 15216-1:2017 protocol.RT-qPCR targeting the ORF3 region of HEV  was emplViral genome copies were quantified accordingly to the ISO 15216-1:2017. Briefly, serial dilutions of HEV RNA purified from a clinical sample  were employed to construct standard curves, plotting the number of genome copies against the Cq values. Results were expressed as number of RNA viral genome copies per gram of digestive tissue.2HPO4·2H2O, citric acid, and EDTA) were added, mixed in vortex, and placed in an ultrasonic bath for 20 min. Samples were centrifuged  for 10 min, and supernatant was transferred to another polypropylene tube. After adding 3 mL of hexane, the mixture was stirred and centrifuged for 5 min. Following centrifugation at 2500× g and 4 °C for 5 min, supernatant was taken to a PTFE tube for defatting with hexane twice. Following centrifugation as before, hexane was removed, and the extract was cleaned up by Oasis HLB solid-phase extraction under smooth vacuum. An 85% phosphoric acid solution  was added to the resulting extract, which was eluted through a solid-phase extraction (SPE) cartridge , previously conditioned with 3 × 5 mL of methanol and 2 × 5 mL of water. After elution of the sample, the cartridge was washed with 3 × 5 mL of 5% methanol in water and dried for 1 min under vacuum. Elution was carried out with 6 mL of methanol with 2% formic acid in a 15 mL polypropylene tube. Finally, sample was concentrated to almost dryness in a vacuum evaporation system . The resulting residue was redissolved in 1 mL of water with 0.1% formic acid in an analytical vial.It was carried out following the method of Chiesa et al. . MusselsThe analysis of the presence of the different antibiotics was performed by high-efficiency chromatography  coupled with a triple quadrupole mass spectrometer . The injection volume was set at 10 μL, and the injector and column were maintained at 10 and 40 °C, respectively. Chromatographic separation was carried out on a Phenomenex Kinetex Biphenyl 1.7 μm column (50 × 2.1 mm), using mobile phase wate with 0.1% formic acid (A) and methanol with 0.1% formic acid (B). Elution was performed at a flux of 300 µL/min through the following gradient: from 5% B to 100% B in 10 min, and 2 min at 100% B, and then 0.2 min to recover initial conditions and keep it stable for 5.8 min. The mass spectrometer used an electrospray source (ESI), working in positive or negative mode depending on the compound to be determined. The ESI parameters were as follows: curtain gas, 30 L/min; collision gas, 8 L/min; ion source gas, 50 L/min; temperature, 400 °C; and ion spray voltage, 5.5 kV for ESI+ and −4.2 kV for ESI. Detection in the mass spectrometer was performed in MRM (multiple reaction monitoring) mode considering two transitions for each analyte  higher than 10 in the two chromatograms of the transitions would be reported as present.N2a cell assay is based on toxicity associated with the VGSCs (voltage-gated sodium channels) resulting from the use of veratridine and ouabain. The assay enables the semiquantitation of tetrodotoxin TTX based on the percentage of living cells remaining.The conditions used in this assay were proposed by Manger et al. ,17 with The same conditions described by Turner et al. , with slCell viability was measured by a colorimetric method using tetrazolium (MTT) metabolism .The extraction method conditions described by Turner et al.  and the An Agilent 1290 Infinity LC system  was used for the liquid chromatographic separation. This separation is described in Leão et al. . The chrA 6460A Triple Quadrupole mass/massMS/MS (QQQ) equipped with a Jet Stream ESI source  was used for the analysis of TTX in MRM (multiple reaction monitoring) mode by detecting m/z transitions in tandem mass spectrometry, which are included in The optimized conditions are summarized in The procedure followed by RISEGAL for the identification of emerging hazards in bivalves is schematized in A short online inquiry (six questions) was designed in order to gather information related to which emerging issues/problems could be identified by different actors associated with the production and marketing of bivalves in Galicia. RISEGAL invited professionals of the industrial sector as well as health professionals, veterinary inspectors, and consumers. Questions and answer options are included in Metrics data are included in Vibrio spp. in clams or mussels, presence of persistent organic contaminants (POPs) and heavy metals in mussels, and increase of problems associated with red tides. Most of the respondents (~30%) identified virus as the principal causative agent, followed by bacteria, chemical contaminants, and biotoxins.Veterinary inspectors, researchers, and professionals of health surveillance answered theaccounted for 56% of the responses. Workers associated with the sector of food industry provided 20% of the responses, being the rest of responses answered by citizensand the rest of the responses were completed by citizens. From those 50 different answers collected since august 2018, 35 reported possible emerging food safety problems in bivalve mollusks , and 54% of them were associated with mussels (Q3). Some of the most frequently reported emergent problems were related to the presence of HEV in mussels, norovirus in oysters, increase of A nonscientific literature survey was performed by using FoodRiskScan as described in Materials and Methods . The scaThe general and specific scientific searches rendered a total of 251 and 751 articles, respectively. After several subsequent filtering steps, 126 articles were selected by the experts as directly related to emerging risks associated with bivalves. Those 126 articles were grouped by RISEGAL per type of hazard for further evaluation: biotoxins (17), parasites (14), virus (15), chemical contaminants (28), bacteria (38), and antimicrobials (14). A comparison between the outputs rendered by the three search strategies used for data collection demonstrated that information obtained through the scientific survey already included those obtained from both the online inquiry and the nonscientific survey. Consequently, only those outputs from the scientific survey were considered in further steps. This was in agreement with EFSA panels that have already pointed out the lack of efficiency of the nonscientific (grey) literature for the identification of signals related to emerging risks .The scientific groups of articles selected were sent to the experts of RISEGAL for them to select a maximum of 3 emerging hazards according to a brief form previously designed . AdditioVibrio parahaemolyticus, HEV, and antimicrobial residues are the emerging hazards that are considered most imminent and severe and that could cause safety problems of the highest scale in the bivalve value chain.Outputs were gathered, grouped in two intervals (0–2 and 3–5), and analyzed by using the relative frequency of responses . By consPerfluorinated compounds (PFCs) are toxic persistent environmental pollutants. They are mainly used as flame retardants in many commercial products and, for this reason, are easily found in aquatic life  and wateAntimicrobial resistance (AMR) is one of the greatest challenges of the 21st century . AccordiV. parahaemolyticus is a typical warm-water bacterial pathogen and a worldwide leading cause of bacterial illness associated with seafood consumption [V. parahaemolyticus have been described since 1990 [Vibrio infections in the world [V. parahaemolyticus as an emerging hazard becomes even higher when considering that some authors attribute the biosynthesis of TTX to Vibrio [sumption . Althougnce 1990 . Moreovehe world . The impo Vibrio .Orthopevirus, which includes five genotypes that infect humans  [HEV belongs to the family Hepeviridae within the genus , and 7) . Of thes, and 7) . On the , and 7) . HEV is , and 7) .V. parahaemolyticus, V. vulnificus, antibiotic-resistant bacteria (ARB), and TTX was determined in mussels collected at class B production areas in the Rías of Galicia. Obtained results demonstrated the absence of V. parahaemolyticus, V. vulnificus, and TTX in the mussels collected in the different zones of production. No antibiotic residues were detected in mussel samples. HEV and some ciprofloxacin-resistant bacteria were detected.The presence of antibiotic residues, HEV, Hepatitis E virus3 copies/g of digestive tissue versus 15 copies/g in June) in both zones. HEV was not detected in samples collected in July The abundance of culturable heterotrophic bacteria (CHB) and ciprofloxacin-resistant bacteria (CRB) obtained in mussel samples collected at different B production zones are shown in A. rivipollensis was first isolated from biofilm and sediment samples of the Ter River in the framework of an antibiotic-resistant bacteria study [Aeromonas autochthonous in aquatic environments [A. rivipollensis and E. coli revealed the presence of the gene intI1, which has been considered a good proxy for pollution [These results are in agreement with previous works, in which ia study  and furtronments . Also, Aollution . It shouVibrio parahaemolyticus, and HEV antimicrobial residues are the emerging hazards that are considered most imminent and severe and that could cause safety problems of the highest scale. An exploratory phase showed the presence of hepatitis E in mussels collected in different production zones of Galician Rías, whereas TTX, V. parahaemolyticus, V. vulnificus, and antibiotic residues were not detected. Future research should be directed towards the risk assessment of identified hazards too. RISEGAL’s mission will proceed to focus also on other value food chains in order to identify new emerging hazards that could compromise food safety in our region.Emerging hazards in food safety should be foreseen to implement effective mitigation strategies on time. It is the only way to be prepared against oncoming changes, such as those associated with climate change. This work constitutes an example of an initial approach to emerging hazard identification in the bivalve shellfish value chain, which was selected for its socioeconomic impact in Galicia. Although further exploratory studies will be carried out in future research, the present results permitted the study to conclude that perfluorinated compounds, antimicrobial resistance,


Despite different regional anesthesia techniques used to provide intraoperative and postoperative analgesia in pediatric patients, the analgesic effectiveness of peripheral nerve blockades with minimal side effect profiles have not yet been fully determined.We aimed to compare the efficacy of ultrasound-guided transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, and caudal epidural block on perioperative analgesia in pediatric patients aged between 6 months and 14 years who underwent elective unilateral lower abdominal wall surgery.Ninety-four patients classified under the American Society of Anesthesiologists physical status classification system as ASA I or ASA II were randomly divided into 3 equal groups to perform TAP, QL or Caudal epidural block using 0.25% of bupivacaine solution (0.5 ml kg−1).Postoperative analgesic consumption was highest in the TAP block group (P < 0.05). In the QL block group, Pediatric Objective Pain Scale (POAS) scores were statistically significantly lower after 2 and 4 h (P < 0.05). The length of hospital stay was significantly longer in the caudal block group than the QL block group (P < 0.05).We suggest that analgesia with ultrasound-guided QL block should be considered as an option for perioperative analgesia in pediatric patients undergoing lower abdominal surgery if the expertise and equipment are available. Recently, regional anesthesia techniques have been replaced by peripheral nerve blocks in the management of perioperative pain. Because of the widespread use of ultrasonography, it has been reported that peripheral nerve blocks showed similar analgesic efficacy with favorable rates of side effects when compared to central blocks.Central nerve blocks are often used in combination with general anesthesia for pediatric surgery in order to reduce general anesthetic requirements, opioid use, postoperative pain, nausea and vomiting, and risk of anesthetic neurotoxicity, particularly in young patients [1–4]. Caudal epidural block (CEB) is a well-established and commonly performed neuraxial technique for providing intraoperative and postoperative analgesia in pediatric patients scheduled for lower abdominal perineal surgical interventions [5–6]. Although the efficacy and safety of CEB are fairly high [7], the associated complications such as inadvertent dural puncture, unwarranted motor blockade of lower limbs, and disturbance of bladder function [8] might limit its use.Undoubtedly, introduction of ultrasonography into anesthesia practice has led to an increase in practice of peripheral nerve blocks. Ultrasonography guidance has significantly facilitated the practice of regional nerve blockades [9]. There has been a growing interest in ultrasound-guided transversus abdominis plane (TAP) block as an alternative and valid postoperative analgesic method in pediatric patients undergoing lower abdominal surgery [10].Quadratus lumborum block (QL block) is a new abdominal and truncal block used for providing somatic analgesia of both upper and lower abdominal pain which was described by Blanco as a posterior variant of the TAP block [11].As the effectiveness and minimal adverse effect profiles of perineural blockade in pediatric surgery were not yet fully determined, we conducted this randomized controlled trial to investigate the efficacy and safety of ultrasound-guided TAP block, QL block, and CEB for perioperative analgesia on pediatric patients during the first 24 h following unilateral lower abdominal surgery.After obtaining approval of the Ethical Board of the Bezmialem Vakıf University , we found 94 pediatric patients aged 6 months to 14 years, with American Society of Anesthesiologists (ASA) physical status of I or II, who were scheduled for elective unilateral lower abdominal surgery under general anesthesia to include in our study. Informed consent was obtained from the family of each patient. Parents and a second anesthetist were blinded to group assignment in the recovery room and the surgical ward.Patients with known allergies to local anesthetics, infection of injection sites, coagulation disorders, liver–kidney diseases, or unwillingness to participate were excluded from the study.Patients were premedicated with oral midazolam 0.5 mg kg−1 30 min before surgery. After standard anesthesia monitorization including electrocardiogram, heart rate, noninvasive blood pressure, peripheral oxygen saturation (SpO2), end-tidal carbon dioxide, temperature, and Bispectral index (BIS), anesthesia was induced with inhalation of 8% sevoflurane in 50% air in oxygen under spontaneous ventilation. Afterwards, peripheral venous access was established to administer propofol 2 mg kg−1 and fentanyl citrate 1 μg kg−1. Laryngeal mask airway was used to secure the upper airway. Anesthesia was maintained with sevoflurane in 50% air in oxygen by targeting BIS scores of 50–60 in all groups. During the operation, a fentanyl infusion of 0.5 μg kg−1 was administered if the blood pressure and heart rate increased to 20% higher than the baseline value. An isotonic balanced electrolyte solution of 10 ml kg−1 h−1 was administered intravenously throughout the surgery.All the blocks were performed by the same anesthesiologist after the placement of laryngeal mask airway before onset of surgery under ultrasound guidance .After induction of anesthesia at the supine position, a 14-5 MHz linear ultrasound probe was placed between the anterolateral abdominal wall and iliac crest. The external abdominal oblique, internal abdominal oblique, and transversus abdominis muscles were identified using the probe. A 22-gauge, 50-mm needle was inserted using the in-plane technique. The needle was advanced until it reached the neurofascial plane between the internal oblique and transversus abdominis muscles. After careful aspiration to exclude vascular puncture, 0.5 ml kg−1 of 0.25% bupivacaine solution was injected .After induction of anesthesia in the supine position, a 14-5 MHz linear ultrasonography probe was placed between the iliac crest and costal margin. The external oblique, internal oblique, and transversus abdominis muscles were identified, the probe was moved posteriorly and the QL muscle was visualized, and the midline of the thoracolumbar fascia was visible as a bright hyperechogenic line. The probe was attached to the area of the triangle of Petit until the QL was confirmed. A 22-gauge, 50-mm needle tip was placed at the anterolateral border of the QL following a negative aspiration of blood, then 0.5 ml kg−1 of 0.25% bupivacaine was injected between the QL muscle and the thoracolumbar fascia  .After induction of anesthesia, each patient was placed in the left lateral decubitus position. Under aseptic precautions, a 14-5 MHz linear ultrasound probe was placed on to the sacrococcygeal region. Dura mater, epidural space, conus medullaris, sacral cornua, and sacrococcygeal ligament were identified. Using the in-plane technique, a 25-gauge, 30-mm bevelled needle  was introduced to reach the sacral epidural space and 0.5 ml kg−1 of 0.25% bupivacaine solution was injected carefully after negative aspiration .After administration of the nerve blocks, heart rate, blood pressure, SpO2, and BIS levels were monitored every 5 min until surgical incision, followed by monitoring at 10-min intervals until recovery from anesthesia. End-tidal sevoflurane concentration and additional opioid requirements were also recorded.After the operations, duration of surgery was noted and the patients were transferred to the recovery room. Patients were observed for 30 min in the recovery room, and then sent to the ward. When the children were awake, Pediatric Objective Pain Scale (POAS), ventilatory frequency, arterial pressure, and heart rate were documented by a blinded investigator.Pain assessments were made by using POAS at 0.5, 1, 2, 4, 8, 12, and 24 h after recovery from anesthesia (Table 1). If the POAS was greater than 5 in the recovery room and the surgical ward, IV paracetamol 10 mg kg−1 was administered. The same dose was repeated if needed after 30 min. Nursing staff that were to administer rescue analgesia on the surgical ward were blind to the group allocation of patients. Parents were informed about pain assessment and were instructed to give 10 mg kg−1 of ibuprofen syrup to their children if they experienced pain at home.Further records compiled 24 h after the operation included time of first analgesic requirement; total analgesics consumption; length of hospital stay; adverse effects including nausea, vomiting, hypotension, motor weakness, and urinary retention; and satisfaction levels of the patients’ parents and of the surgeons.Statistical analyses were performed by using IBM SPSS Statistics 22 . Conformance of the variables with normal distribution was measured by using the Shapiro–Wilks test. In addition to descriptive statistics , normally distributed variables were compared using a one-way ANOVA analysis of variance test. In the comparison of quantitative findings among groups, Tukey’s Honest Significant Difference test was used to determine the group causing the difference. Intergroup variables without normal distribution were compared using the Kruskal–Wallis test, and the group causing the difference was identified via the Mann–Whitney U test. The comparison of the normally distributed quantitative data within the groups was performed using the Paired-Sample t-test, and intragroup variables without normal distribution were compared using the Wilcoxon Signed Rank test. Qualitative data were tested using the chi-square and Fisher–Freeman–Halton test. P < 0.05 was considered statistically significant.Sample size was calculated based on data from the study by Sahin et al. [12]. Twenty-five subjects were required to detect differences in total rescue analgesia requirement doses; that is 0.373 (140), power: 0.80 and 0.05. Due to the possibility of some subjects being excluded, the study was planned to include 35 patients in each group.Six patients from the TAP block group and 5 patients from the CEB group were excluded as their parents requested circumcision for their children. The study included a total of 94 patients. The groups were comparable based on age, sex, weight, ASA scores, and operation type (Table 2).The time required to perform CEB was longer than that required for TAP or QL block (P < 0.05). Duration of anesthesia did not prolong duration of surgery (Table 3). There were no statistically significant differences among the groups with regard to heart rate, blood pressure, SpO2, and BIS levels during the intraoperative periods (P > 0.05). Fentanyl requirements and end-tidal sevoflurane concentration did not differ among the groups during intraoperative periods (P > 0.05). The need for additional analgesia was significantly higher in the TAP block group than in the other groups (P < 0.05). Additional mean paracetamol requirements were 300 mg, 225 mg, and 150 mg in the TAP block, QL block, and CEB groups, respectively (P < 0.05).The POAS scores from the second and fourth hour in the QL block group were significantly lower than those in the other groups (P < 0.05) . . Postoperative urinary retention was also noted in 3 patients in the caudal block group. There was a statistically significant difference in length of hospital stay in the caudal block group compared to the QL block group (P < 0.05). There was no statistically significant difference among the groups in terms of parent and surgeon satisfaction levels (P > 0.05).No postoperative difference in vital signs was observed in the groups. There was no statistically difference in initial analgesic requirement, total analgesics consumption, and adverse effects among the groups (P > 0.05) (Table 4). Two postoperative patients in the caudal block group were unable to stand during the first 2.5 h (2.57 ± 0.99)We concluded that, while the amount of opioid consumed during intraoperative periods of perineural and caudal epidural (TAP and QLB) blocks is similar, in the postoperative period QLB is more beneficial to the recovery profile of pediatric patients.The result of the present study confirm that ultrasonography has become an additional routine guide, especially in perineural blocks, and that minimally invasive analgesic methods have begun to replace central blocks in the perioperative periods [13].Caudal block is the preferred regional anesthesia technique in pediatric patients [14]. Although the caudal block provides perfect analgesia, there is a risk of neurological complications. For this reason, practitioners are exploring other analgesic methods [15]. In our study, these results were supported by the initial dose of analgesic being administered at the fifth hour following surgery in the caudal block group and a score of less than 3 on the Pediatric Objective Pain Scale during 24 h postoperative period. However, 2 patients in the caudal block group suffered an average of 2.5 h of motor weakness and 3 events of urinary retention, which prolonged the discharge time. We think that this result does not change parent and surgeon satisfaction levels because of the small sample size. The caudal blocks were also associated with longer blockade and anesthesia periods than the other 2 groups. TAP and QL block were performed in the supine position, while caudal block was applied in lateral decubitus position. Image adjustment with USG and use of a different needle from other applications may also cause the caudal block to take longer.Studies indicate that the analgesic quality of the TAP block renders it a viable alternative to the central nerve block [16]. In a recently published study, the TAP block and caudal block were compared in children undergoing lower abdominal surgery. It showed that firstly, the median duration of postoperative analgesia was significantly greater (3.5 h vs 6 h) in children who received CEB; secondly, there was no difference in the rescue analgesia requirements between the groups; thirdly, children who received CEB experienced greater incidence of pain in the 6 to 24 h postoperative interval; and finally, the number of children requiring rescue analgesia in the first 24 h postoperatively was significantly lower in the TAP group [16]. In another study, Sahin et al. compared the efficacies of the caudal block, ultrasound-guided TAP block, and ilioinguinal/iliohypogastric (II/IH) blocks for postoperative analgesia in children undergoing lower abdominal surgery. Caudal and TAP blocks were found to provide comparable postoperative analgesia, total analgesic consumption, and time to first analgesic requirement [12]. In our study, we found that TAP block was not as effective as caudal block or QL block. In 4 patients from the TAP group, effective analgesia was achieved only after additional paracetamol. The same patients were given oral ibuprofen at home. In a cadaver study by Elsharkawy et al., it is stated that the mechanism of analgesia may not solely involve blockade of distal sensory efferents, but may be due to a more proximal effect, perhaps at the level of the paravertebral space [17]. Therefore, it remains unclear whether TAP techniques result in LA spread into the PVS.QL block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen [14]. QL block has an excellent analgesic effect on pain reduction, with patients reporting a reduction of 1–2/10 on the pain scale, usually lasting more than 24 h. Aksu et al. initiated ultrasound-guided QL block to provide postoperative analgesia for ambulatory surgeries in pediatric anesthesia practice. They presented results from their first 10 patients. The patients were observed as relaxed and calm in the postoperative care unit. None of the patients required additional analgesics. Patients were discharged from hospital at postoperative fourth and fifth hour. They admit that controlled studies involving a sufficient number of patients are required in order to detect the distribution of the local anesthetics and the field of coverage [18].In a recent study, Oksuz et al. compared the efficacy of the TAP and QL block for postoperative analgesia in lower abdominal surgeries. It was reported that the number of patients who required analgesia in the first 24 h following surgery was significantly lower in the QL block group than in the TAP block group. In the QL block group, the postoperative 30 min and 1, 2, 4, 6, 12, and 24 h FLACC  scores were lower compared to those of the TAP block group. The first analgesic request time was 15 h in the QL block group and 10 h in the TAP group [19]. In our study, it was observed that QL block provided lower postoperative pain scores and shorter periods of hospital stay. However, the first analgesic request time and number of patients who required analgesia in the first 24 h postoperatively was not significantly different between the groups. The true mechanism of analgesia provided by QL block has not yet been fully clarified. It is believed that the local anesthetics spread in a segmental longitudinal pattern, and the endothoracic fascia into the paravertebral space. Therefore, the assumption is that visceral analgesia results from the spread of anesthetics to the celiac ganglion or sympathetic trunk via splanchnic nerves, as is the case with the paravertebral block [20].In a small number of pediatric studies with QL block and TAP block, duration of postoperative analgesia, the rescue analgesia requirements, and the number of patients requiring analgesia during the first 24 h were reported differently . These results are each different from each other and can only be explained by only the distal sensory efferents distribution or by the paravertebral space distributions of the local anesthetics.In conclusion, in our study of pediatric patients who underwent lower abdominal surgery, we have found that TAP block caused higher additional analgesic consumption, caudal block led to prolonged hospital stays, and QL block provided lower postoperative pain scores. We suggest that ultrasound-guided QL block could be considered as an option for perioperative analgesia methods in pediatric patients undergoing lower abdominal surgery if the expertise and equipment are available.


A renogastric fistula is a rare complication defined by abnormal communication between the kidney and the stomach. We report the case of a patient admitted to the intensive care unit for hemorrhagic shock following upper gastrointestinal bleeding whose radiological investigations revealed a fistulated renal hematoma in the stomach. A renogastric fistula is an extremely rare complication, always affecting the left kidney, and it is among the rarest fistulas between the urinary and digestive tracts .A 53-year-old patient followed for chronic renal failure  and also followed for bladder tumor (urothelium grade 2) was admitted to the intensive care unit for the management of hemorrhagic shock following upper digestive bleeding.The clinical examination found the patient with GSC 13/15, with arterial hypotension at 85/46 mmHg, tachycardic at 115, with diuresis at 0.3 ml/kg/h, and with macroscopic hematuria. The respiratory examination found the patient polypneic at 26 and with ambient air saturation at 85%. The abdominal examination found an epigastric sensitivity with touch and rectal absence of melena.3, TP at 60%, renal failure with creatinemia at 85 mg/l and urea level at 1.1 g/l, hyponatremia at 132 mEq/l, and hyperkalemia at 5.9 mEq/l.The biological assessment had objectified hemoglobin level at 5.9 g/dl, platelets at 195,000/mmOur management was to transfuse the patient with 2 units of red blood cells, administer norepinephrine on a central venous catheter, and make hypokalemic measurements.After stabilization, the patient had an abdominal CT scan that objectified a large hematoma of the left kidney fistulated in the stomach .Unfortunately, the patient died after the second episode of haematemesis of great abundance and complicated refractory hemorrhagic shock, before a hemostasis procedure was performed.A fistula is an abnormal communication between 2 epithelium-lined cavities. Urointestinal fistulas can occur between any part of the urinary system and the digestive tract. They are rare and renogastric fistulas are the least common fistula between the urinary and digestive tracts. They are most often of chronic inflammatory origin, secondary to kidney stones or traumatic origin . NormallA renogastric fistula is a rare complication with a variety of etiologies and clinical signs, and diagnosis is based on CT scan and treatment is often surgical.


Engraulis encrasicolus (European anchovy), Brachydeuterus auritus (bigeye grunt), Sardinella aurita (round sardinella), Selene dorsalis (African moonfish), Sierrathrissa leonensis (West African (WA) pygmy herring) and Tilapia spp. (tilapia) were collected from five different regions in Ghana. Samples were analyzed for nutrients , microbiological quality , and contaminants . Except for tilapia, the processed small fish species had the potential to significantly contribute to the nutrient intakes of vitamins, minerals, and essential fatty acids. High levels of iron, mercury and lead were detected in certain fish samples, which calls for further research and identification of anthropogenic sources along the value chains. The total cell counts in all samples were acceptable; Salmonella was not detected in any sample and E. coli only in one sample. However, high numbers of coliform bacteria were found. PAH4 in smoked samples reached high concentrations up to 1,300 μg/kg, but in contrast salted tilapia samples had a range of PAH4 concentration of 1 μg/kg to 24 μg/kg. This endpoint oriented study provides data for the nutritional value of small processed fish as food in Ghana and also provides information about potential food safety hazards. Future research is needed to determine potential sources of contamination along the value chains in different regions, identify critical points, and develop applicable mitigation strategies to improve the quality and safety of processed small fish in Ghana.The triple burden of malnutrition is an incessant issue in low- and middle-income countries, and fish has the potential to mitigate this burden. In Ghana fish is a central part of the diet, but data on nutrients and contaminants in processed indigenous fish species, that are often eaten whole, are missing. Samples of smoked, dried or salted  The sigand zinc , 18. In and zinc .Different processing techniques, such as smoking, drying and salting enables the availability of marine and freshwater fish throughout the country . To prevhttps://smallfishfood.org/), an international consortium collaborating to understand how socio-cultural, economic and institutional transformations of the fish food and value chain—from ecosystem to consumer—can contribute to improved, sustainable utilization of small fish resources for Africa’s low-income population. Access to local, reliable and up-to-date food composition data (FCD), particularly on foods that are essential to vulnerable population groups, is scares but imperative to improve FNS. Although the main body of FCD comprises nutrients, data on potentially harmful food components such as heavy metals, polycyclic aromatic hydrocarbons (PAHs) and pathogenic microorganisms are also important for nutritional recommendations, as it provides the basis for the estimation of exposure, risk assessments and risk-benefit analysis [The current study is part of the SmallFishFood project , Brachydeuterus auritus (bigeye grunt), Sardinella aurita (round sardinella), Selene dorsalis (African moonfish) and small freshwater species Sierrathrissa leonensis (West African (WA) pygmy herring), and Tilapia spp. (tilapia) were sampled at selected fish markets throughout Ghana. The identification details of the sampled species, including scientific and Ghanaian names, are presented in Selection of fish species sampled from Ghana were based on a market survey conducted in February 2018, where open markets in Accra, Techiman and Kumasi were visited to determine the most frequent fish species, fish sizes and the most common processing method used for each species. During November 2018, samples of processed small marine fish species The sampling was conducted according to Greenfield and Southgate’s requirements for retail sampling . Sample nd and 24th of November 2018. In Accra, the batches of each sampled fish species were pooled into composite samples for analysis of nutrients, heavy metals and PAHs, with each composite sample representing one species from one location. Subsequently, the pooled samples were shipped in boxes containing cooling elements via express airmail to Norway on November 29th, 2018. Un-pooled batch samples for microbial analysis were shipped via express airmail to Germany on December 17th, 2018.Upon arrival at the fish markets, the sampling was started in one section of the market and the selected fish species were sampled from every third market stall. The selected species were identified by a taxonomist, and two separate batches of approximately 100 g of fish was weighed and collected in zip lock plastic bags. Depending on availability of the selected fish species at each fish market, which was influenced by the unpredictable nature of fish supply from small-scale fishermen and fishmongers, between 1–5 batches of each processed fish species were collected from different market stalls at each location. After sampling, the samples were stored in Styrofoam boxes and kept at room temperature along the sampling route from Bolgatanga to Accra. The sampling was conducted between the 21 and A2) and D3, calcium and trace elements iodine, selenium, zinc, and iron were analyzed. The concentration of heavy metals arsenic , mercury , lead, and cadmium was analyzed in all composite samples in addition to levels of PAHs. All analyses were performed in singular parallels at the IMR laboratories using accredited methods with NS-EN ISO/IEC 17025 standards, except for iron. The analytical methods including corresponding limits of quantification (LOQ) and measurement uncertainties are described in detail elsewhere [Depending on the fish species, the tissue for analysis was prepared according to Ghanaian food customs, and may or may not include head, viscera, bones, scales or other parts . The comlsewhere .The crude protein content was determined by burning the material in a combustion tube containing pure oxygen at 830°C. Nitrogen (N) was detected with a thermal conductivity detector (TCD), and the content of N was calculated from an estimated average of 16% N per 100 g protein using the following formulaThe method is accredited according to AOAC Official Methods of Analysis .For determination of crude fat, the fat content was extracted with ethyl acetate and filtered before the solvent was evaporated and the residual fat was weighed. The method is accredited in accordance with ISO-EN 17025 and standardized as a Norwegian Standard, NS 9402 .The fatty acid content was determined using gas liquid chromatography (GLC). Lipids in the samples were extracted according to Folch, Lees , and the1  and A2  content, the samples were saponified and the unsaponifiable material was extracted. Vitamin A1 and A2 was determined by high-performance liquid chromatography (HPLC)  using a PDA detector (Photo Diode Array) and the retinol content was calculated by external calibration (standard curve) [To determine vitamin Ad curve) .3, the samples were saponified, and the unsaponifiable material was extracted and subsequently purified in a preparative HPLC column. The fractions containing D2  and D3  were pooled  and injected on an analytic HPLC column (reverse phase). Vitamin D3 and D2 was determined by an ultraviolet (UV) detector and the content of vitamin D3 was calculated using vitamin D2 as an internal standard [For determination of vitamin Dstandard .12  was released from the sample by extraction (autoclaving in acetate buffer) and mixed with growth medium before the microorganism (Lactobacillus delbruecki -ATCC 4797) was added and subsequently incubated at 37°C for 22 hours. The concentration of vitamin B12 was calculated by comparing the growth of the organism in the unknown samples with the growth of the organism in known standard concentrations by turbidimetric reading  [Vitamin B 575 nm) .The concentration of calcium, heavy metals cadmium, arsenic , mercury , and lead as well as trace elements selenium, zinc, and iron was determined by Inductively Coupled Plasma-Mass Spectrometry  equipped with an autosampler  after wet digestion in a microwave oven as previously described by Julshamn, Maage . For detThe concentration of the PAHs benz(a)anthracene (BaA), benzo(a)pyrene (BaP), benzo(b)fluoranthene (BbF) and Chrysene (Chr), collectively referred to as PAH4, were determined by Gas Chromatography Mass Spectrometry (GC-MS/MS) after extraction with dichloridemethane (DCM): cyclohexane (1:3) using an US EPA 16 PAH cocktail (CIL ES-4087) internal standard. The extract was evaporated and rinsed on an SPA column (Envichrom) before adding recovery standard and analyzing the samples by GC-MS/MS , 58.After arrival at the German Federal Institute for Risk Assessment, the samples were stored at 4°C until further processing. Samples were homogenized batchwise using a GRINDOMIX GM200  for 20 seconds at 4.000 rpm and stored in plastic cups with a screw-on lid  at 4°C until microbiological analysis.The batchwise samples were processed as described in ISO 6887–3:2003. A batch sample aliquot of 11 g was mixed with 22 g buffered peptone water  in a peristaltic lab blender  for 10 seconds and rehydrated at room temperature for 1 h. The batchwise initial suspensions were prepared as a tenfold dilution of the rehydrated fish by addition of 297 g of buffered peptone water and mixing it for 90 seconds. For microbial analysis, initial suspensions of batch samples were pooled per species and market, as described for the analysis of nutrients and minerals.™ sachets . The limit of detection (LOD) based on the detection of one colony per plate was calculated as 2.5 log CFU/g of processed fish.The total colony count (TCC) analysis was based on ISO 4833:2015, however, instead of plate count agar, Columbia blood agar plates  were used. The pooled initial suspension was further diluted 1:10 in maximum recovery dilution  and 100 μL per dilution step were spread on agar plates. One set of plates were incubated at 30°C for 72 h aerobically, and an additional set of plates were incubated at 30°C for 72 h under anaerobic conditions in anaerobic jars with AnaeroGenE. coli and coliform bacteria, Brilliance™E. coli/coliform agar plates  were inoculated with 100 μL of the pooled initial suspension and their further dilutions. In addition, 1 mL of the pooled initial suspension was spread on three plates to increase the level of detection 10-fold (LOD 1.5 log CFU/g). The plates were incubated at 37°C for 24 h, aerobically.For quantification of Salmonella spp. was performed according to ISO 6579–1:2017. The 300 mL initial suspensions per batch were incubated at 37°C for 18 h, aerobically. After incubation, enriched batch samples were pooled as described above. An aliquot of 1 mL of the pooled enrichment culture was added to 10 mL Mueller Kauffman Tetrathionate Novobiocin broth  and incubated at 37°C for 24 h, aerobically. Further, 100 μL was dripped as three droplets on modified semi-solid Rappaport Vassiliadis agar  and incubated at 41.5°C for 24 h, aerobically. After incubation, 10 μL of MKTTn selective culture or a loop full of spreading growth from MSRV were spread to Xylose Lysine Deoxycholate agar plates  and Gassner agar plates  both incubated at 37°C for 24 h aerobically to achieve single colonies. After incubation, plates were checked for presumptive colonies.The detection of The analytical data was exported from Laboratory Information Management Systems (LIMS) and processed using Microsoft Excel 2013. When calculating mean and standard deviation, analyses below LOQ were included in the calculations as the respective LOQ value divided by two. Statistical analyses was performed using IBM SPSS version 26  and for all tests a significance level of α = 0.05 was used. Normal distribution was tested using Shapiro-Wilk test. For normally distributed data, the homogeneity of variances was tested using Levene-test. If homogeneity of variances was given, the differences between the fish species was analyzed using one-way analysis of variance (ANOVA). As a post hoc test to discriminate different pairs, a Tukey-test was performed. If the homogeneity of variances was not given, a Welch-ANOVA was used to determine the differences between the fish species, followed by a Dunnet-T3-test. If the values were not normally distributed, a Kruskal-Wallis-test was performed to determine differences between the species followed by pairwise comparison of the fish species with a Bonferroni correction.In the present study, analytical data on 24 composite samples of processed, small fish  from several fish markets covering a large geographic range in Ghana are reported . Based oSardinella spp.) from Ghana reported minimal variation in protein content between fresh and smoked specimens [The content of protein and fat as well as fatty acid composition of the processed fish species are presented in pecimens . Furtherpecimens  found thpecimens . Despitepecimens .Fat content in fish is more variable than other proximate components and may reflect a natural variance in different fish species along with seasonal variations in feed sources and availability for the given species . A consiScomber scombrus) and smoking of sardines (Sardinella spp.) and tilapia (Tilapia spp.) in a Ghanaian chorkor oven did not produce significant changes in fatty acid composition [The marine products smoked bigeye grunt and smoked round sardinella had the highest mean values of the n-3 fatty acids EPA and DHA, while smoked European anchovy had the highest content of EPA and DHA in terms of percentage. Salted tilapia and dried/smoked WA pygmy herring had the lowest content of EPA and DHA, which was expected given their freshwater origin. However, the difference to most marine water species was only significant for DHA. Interestingly, African moonfish had a similar content of EPA and DHA to the freshwater species WA pygmy herring. Further, the freshwater species WA pygmy herring showed high levels of PUFAs being more comparable to the sampled marine species and significantly higher than the levels of the freshwater species tilapia. Fatty acids are highly susceptible to oxidation; however, previous studies have documented that automated smoking of Atlantic mackerel  than for A1 [2 were only detected in smoked marine fish species bigeye grunt (8.9 μg/100 g), round sardinella (5.2 μg/100 g) and African moonfish (3.4 μg/100 g). The ratio of vitamin A2 to total vitamin A content was low for bigeye grunt and African moonfish but constituted a considerable share (> 30%) in round sardinella, thus indicating that some processed marine fish species are also a potential source of vitamin A2. Collectively, our results suggest that including smoked bigeye grunt or smoked African moonfish in the diet may contribute towards alleviating the persistent burden of vitamin A deficiency in Ghana [Vitamin Ap to 90% . Vitaminos, Leth  documentn for A1  and thatn for A1 . In the in Ghana .12, ranging from 8.9 μg/100 g in processed bigeye grunt to 23.0 μg/100 g in round sardinella. Animal source foods are known as the major dietary source of vitamin B12 [12 is up to three times higher in the viscera of fish compared to fillet [(Etrumeus teres) demonstrated that heating processes may decrease vitamin B12 levels by up to 62% [12 in smoked, dried or salted fish could nevertheless be higher than in fresh fish. Still, the cumulative effects of high temperatures during both processing and cooking on vitamin levels are yet to be thoroughly investigated.All fish species contained considerable amounts of vitamin Bamin B12  and prevo fillet . This inp to 62% , but theOf the analyzed processed fish species, tilapia was the least mineral dense, containing the lowest concentrations of selenium (33 μg/100 g), iodine 49 μg/100 g) and iron (10 mg/100 g) compared with all other analyzed species, and significantly lower levels of selenium and iodine than the marine species. Round sardinella had the highest levels of selenium (242 μg/100 g) while African moonfish contained significantly higher concentrations of calcium (5467 mg/100 g) and iodine (233 μg/100 g). The smallest fish analyzed, WA pygmy herring, had the highest concentrations of both iron (78 mg/100 g) and zinc (15 mg/100 g). Even though mean iron values of WA pygmy herring were not significantly higher than for other species , high le μg/100 gardinella spp) from Ghana [Zinc is essential for optimal growth, and is closely interlinked with aggravated symptoms of iron deficiency anemia with its role as a catalyst in iron metabolism . Althougom Ghana  and notaom Ghana . These fom Ghana , 86. IncSprattus sprattus) have yielded high average levels of iodine (148 μg/100 g) and iodine retention ranged from 48–93% in a study on different cooking methods [Adequate iodine intake is essential for synthesis of thyroid hormones and neurodevelopment, however, the magnitude of iodine deficiency among children and other vulnerable population groups in Ghana is not thoroughly mapped. Marine fish are regarded as the superior dietary source to iodine . However methods , thus unSprattus sprattus) reported a selenium content of 20 μg/100 g [Selenium plays a key role in ameliorating the toxic effects of mercury  which isμg/100 g , which iμg/100 g , processE. coli were used as indicator bacteria for fecal contamination along the value chain and Salmonella was analyzed as their presence is associated with food-borne disease. The microbial quality parameters of the processed fish species are presented in A total of 24 pooled samples were analyzed for bacteria related to microbiological quality. Total colony count (TCC) was used to describe the general bacterial load which can be used as an indicator for poor hygiene conditions and control along the value chain. Coliform bacteria and Sardinella eba) samples from three different markets and found aerobic TCC ranging from 6.36 log CFU/g to 7.47 log CFU/g, thus being more than one log-cycle higher than in the here presented samples in general. Another study from Nigeria by Akinwumi and Adegbehingbe [As shown in behingbe  reportedbehingbe , who comIn the sampled fish products, anaerobic TCC were showing low levels being one order of magnitude below the levels of aerobic TCC . ConsequE. coli in sampled processed fish from Ghana revealed that only one composite sample (WA pygmy herring from Techiman) was positive for E. coli with a concentration of 2.51 log CFU/g). Higher levels were found for coliforms in 70.8% of the fish samples. There was a strong variance in contamination of single fish species with coliforms between market samples, where the highest coliform counts were found in tilapia from Bolgatanga  in tilapia to 0.31 mg/kg in processed European anchovy , which w species , 109; th species –113, the species  reported species  reported species , 117. Fo species , which wLead content in the analyzed processed fish ranged from levels below quantification in tilapia (<LOQ) to 0.64 mg/kg in WA pygmy herring. No statistically significant difference was detected between the different fish species, and consequently, no difference was detected between marine or freshwater habitats. However, WA pygmy herring from Accra were contaminated with lead at 1.3 mg/kg  and alsoThe mean concentration of mercury in most processed small fish was low, ranging from below quantification levels (<LOQ) in processed tilapia to 0.065 mg/kg in processed bigeye grunt. WA pygmy herring was an exception with a comparably high concentration of 0.223 mg/kg in all market samples see . It has Chrysichthys nigrodigitatus) at one landing site and found arsenic concentrations of 0.21 mg/kg in the fillet. The WA pygmy herring analyzed in the current study displayed similar arsenic concentrations , while the sampled whole tilapia contained markedly lower arsenic levels. The low levels of arsenic in processed whole tilapia could not be explained with the current study-design, as it is unknown whether the tilapia were harvested from a freshwater system or if they originated from aquaculture. In this study, only total arsenic was analyzed, but it can be assumed that the less toxic organic arsenic is the dominant compound [The concentration of total arsenic in all processed fish species had the highest variation in metal concentration with means ranging from 0.1 mg/kg in tilapia to 9.8 mg/kg in round sardinella. The sampled freshwater species, WA pygmy herring and tilapia, had significantly lower concentrations of arsenic compared with all marine species except African moonfish. To our knowledge, arsenic concentrations in whole fish have not been reported for Ghana thus far. Arsenic levels of 0.37 mg/kg have been reported in fillet of bigeye grunt, however, the samples were collected from only one landing site . The curcompound . In Ghancompound . The expNti  have repThe results provide novel data from Ghana on food quality and food safety including nutrient composition, heavy metal concentration, polycyclic aromatic hydrocarbon content and microbiological hygienic indicators in processed, i.e. smoked or dried whole small fish. As small fish are often consumed whole, the here presented data are highly valuable for future risk benefit analyses, given that existing data on fish is mostly limited to the content in the fillets of fresh fish. Still, some limitations are recognized. In the present study only pooled samples were analyzed, which would to some degree mask the presence of variance between the separate batches from the same sampling location. Further, the market sampling did not enable to trace the source and location of contamination as it was not known where and when the single fish batches were harvested, processed and stored. However, the advantage of this approach is that it gives a cross sectional outline on the nutrient composition, microbial concentration, and contamination with heavy metals and PAHs in Ghana. Origin and source distribution of the different contaminants, especially heavy metals, in the processed fish are relevant topics for future research. Especially heavy metal concentration is influenced by geographical origin of the unprocessed fish, but it might also be influenced by the location of processing, storage and marketing. Another aspect is the nutrient composition of processed fish which can vary and is affected by a multitude of pre-harvest and post-harvest factors. Pre-harvest factors include species, habitat, feed resources, life stage, seasonality, and changes in climatic patterns, while post-harvest factors include processing methods, storage conditions and shelf-life. Since this study gives an insight into the differences of the sampled processed fish, it is necessary to further investigate the aforementioned factors to display differences in nutrient composition and food safety issues throughout the year including different regions. Future research would need to take bioaccessibility of contaminants into consideration. Based on the here presented data, conclusions on the critical points along the value chains and geographical origin of the different contaminants cannot be drawn directly and need further investigation.Salmonella was found. The cause of contamination with coliform bacteria cannot be determined by this study and should be further investigated. Data from this study contributes to building reliable food composition data for Ghana on processed small fish. Further research is needed to analyze composition of prepared meals including preparation methods of small fish on consumer level. Having local consumption data is necessary to perform any risk benefit analysis and risk assessments and should be advocated in future studies.Processed fish eaten whole are rich in vitamins, minerals and essential fatty acids and can therefore contribute with high-quality proteins and essential micronutrients in order achieve a balanced Ghanaian diet, which consists of mostly starchy staples. Of the analyzed fish species, tilapia stood out as markedly less nutrient dense. As tilapia is one of the species that could increase availability of fish through farming, the present results demonstrate that tilapia cannot substitute wild species in terms of micronutrient content. On the other side, the freshwater fish WA pygmy herring showed several nutritional characteristics of marine fishes. High concentrations of mercury and lead were detected in some fish samples, while elevated levels of PAHs were detected in all smoked samples. Heavy metal concentrations determined in this study call for further analyses and identification of geographical origin and contamination sources along the value chains to mitigate the health hazards associated with heavy metals. The high levels of PAHs in smoked fish in all regions necessitate the improvement of the smoking process by implementing best practices and improved kilns (e.g. FTT-kiln and Ahonto oven). Based on microbiological analysis, the overall quality of processed fish samples was acceptable. Nonetheless, the majority of sampled processed fish showed elevated coliform counts, but no S1 Table(PDF)Click here for additional data file.S2 Table(PDF)Click here for additional data file.S3 Table(XLSX)Click here for additional data file.