Background: Water is essential for supporting public health and life without water is impossible. Microbial guidelines seek to ensure that drinking water is free of microorganisms that can cause disease. Objectives: This study focused on examination of drinking water (100 samples) from different community water supplies in Tanta city, Egypt for bacterial contamination and relationship between drinking water and gastrointestinal manifestations. Methodology: Drinking water samples were collected from different sources and places and subjected to three tests: a) measurement of physical characters of water pH, turbidity and free residual chlorine b) heterotrophic bacterial count technique c) multiple tube fermentation technique for identification of E.Coli and Strept faecalis. Results: Samples conformed to standard specifications bacteriologically and physically were 80% and 90% respectively. Samples with abnormal pH, turbidity and free residual chlorine were 2%, 8% and 14% of respectively. The incidence of total coliforms, E.Coli and Strept faecalis was 17%, 5% and 2% respectively. Attacks of GIT manifestations were present in people in 20% of places. Abnormal turbidity >1 NTU was significant with total coliforms. Total coliforms ≥2.2, abnormal turbidity >1 NTU and heterotrophic bacterial count >500 at 37ºC were significant with attacks of gastrointestinal manifestations. Conclusion: Ground water better than filtered water and less liable to microbial contamination. Turbidity is a good indicator for total coliforms and is significant with attacks of GIT manifestations. Use of water filters (7 stages) in all houses is recommended for improvement of water criteria.

Hyperammonemia is a rare cause of encephalopathy in multiple myeloma in the absence of hepatic involvement. This is the only reported case of a 74-year-old man who presented with multiple myeloma and achieved complete remission but developed hyperammonemia afterward. He was aggressively treated with a combination of chemotherapy and immunotherapy, with a resolution of his encephalopathy; however, within one month, he relapsed with encephalopathy. He ultimately decided to pursue comfort-care measures. The authors conclude that hyperammonemia in multiple myeloma is a rare but important differential in patients with encephalopathy of unknown causes. Aggressive treatment is of the utmost importance due to the high mortality associated with the condition.

Androgen usage has widely increased in recent times via prescribed and unprescribed means. Testosterone is a popular androgen taken by both athletes and the general population. While there is some evidence of androgens being thrombogenic, we report on a 19-year-old male who presented to the hospital after the usage of testosterone for one month, leading to the development of multiple pulmonary emboli and deep vein thrombosis. The authors hope to elucidate the relationship between testosterone usage and thrombosis formation.

Methemoglobinemia is an acute medical emergency that requires prompt correction. Physicians should have a high degree of suspicion of methemoglobinemia in cases that present with hypoxemia that does not resolve with supplemental oxygenation, and they should confirm this suspicion with a positive methemoglobin concentration on arterial blood gas. There are multiple medications that can induce methemoglobinemia, such as local anesthetics, antimalarials, and dapsone. Phenazopyridine is an azo dye used over-the-counter as a urinary analgesic for women with urinary tract infections, and it has also been implicated in causing methemoglobinemia. The preferred treatment of methemoglobinemia is methylene blue, but its use is contraindicated for patients with glucose-6-phosphatase deficiency or those who take serotonergic drugs. Alternative treatments include high-dose ascorbic acid, exchange transfusion therapy, and hyperbaric oxygenation. The authors report a case of a 39-year-old female who took phenazopyridine for 2 weeks to treat dysuria from a urinary tract infection and subsequently developed methemoglobinemia. The patient had contraindications for the use of methylene blue and was therefore treated with high-dose ascorbic acid. The authors hope that this interesting case promotes further research into the utilization of high-dose ascorbic acid for managing methemoglobinemia in patients who are unable to receive methylene blue.