Retroperitoneal duodenal perforation during endoscopic sphincterotomy: sonographic findings

We present the sonographic findings in 5 cases of retroperitoneal duodenal perforation during endoscopic sphincterotomy. In each case, sonography showed hyperechoic areas associated with shadowing and ring-down artifacts between the liver and the right kidney correlating with the retroperitoneal air seen on plain x-ray films. This brightly echogenic area with shadowing surrounded and obscured the kidney. In 4 patients, resolution was documented on follow-up sonographic examinations in agreement with other radiologic findings; the other patient died.     

Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study

Background

The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world’s poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services.

Methods

A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center.

Results

Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services.

Conclusion

There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published global trends regarding surgical access in Sub-Saharan Africa. As the global health community must develop innovative solutions to address the rising burden of musculoskeletal disease and support the advancement of universal health coverage, increasing access to orthopaedic surgical services will play a central role in improving health care in the world’s developing regions.

     

Endoscopic ultrasonography in the evaluation of dilated common bile duct

Abdominal ultrasonography (US) is the procedure of first choice in the evaluation of a dilated common bile duct (CBD). Dilated bile ducts and the level of obstruction can be reliably demonstrated with US, but the cause can be determined in only two thirds of patients. The aim of this prospective study was to assess the value of endoscopic ultrasonography (EUS) in detecting the cause of CBD dilatation in patients in whom US could not demonstrate the cause of dilation or in whom US revealed equivocal results. This 13-month study included the evaluation of 985 patients. Ninety consecutive patients found to have an enlarged CBD (diameter, > or =7 mm) of unexplained origin during US examination were included in this study. All patients were evaluated by EUS. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography with or without sphincterotomy ( n = 72) and surgical exploration ( n = 17). The following diagnoses were made by EUS: choledocholithiasis in 40 patients, benign distal stricture in 8, choledochal cyst in 2, and ova of Ascaris in 1. The dilatation of CBD was found by EUS examination to be caused by a tumor in 13 cases. These included tumor of the papilla of the Vater in six patients, distal cholangiocarcinoma in five, and pancreatic head cancer in two. Endoscopic ultrasonography provided an accurate explanation for CBD dilatation in 70 of the 76 patients (92%). We conclude that the diagnostic strategy for cholestasis should include US as a first choice. When the diagnosis of biliary obstruction remains probable, EUS should be carried out. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be reserved for therapeutic use rather than diagnostic.     

Myriocin treatment of CF lung infection and inflammation: complex analyses for enigmatic lipids

Naunyn-Schmiedeberg's Archives of Pharmacology - Our aim was to use quantitative and qualitative analyses to gain further insight into the role of ceramide in cystic fibrosis (CF). Sphingolipid...     

Polymorphism of variable-number tandem repeats at multiple loci in Mycobacterium tuberculosis

Genotyping based on variable-number tandem repeats (VNTR) is currently a very promising tool for studying the molecular epidemiology and phylogeny of Mycobacterium tuberculosis. Here we investigate the polymorphisms of 48 loci of direct or tandem repeats in M. tuberculosis previously identified by our group. Thirty-nine loci, including nine novel ones, were polymorphic. Ten VNTR loci had high allelic diversity (Nei's diversity indices >or= 0.6) and subsequently were used as the representative VNTR typing set for comparison to IS 6110-based restriction fragment length polymorphism (RFLP) typing. The 10-locus VNTR set, potentially providing >2 x 10(9) allele combinations, obviously showed discriminating capacity over the IS 6110 RFLP method for M. tuberculosis isolates with fewer than six IS 6110-hybridized bands, whereas it had a slightly better resolution than IS 6110 RFLP for the isolates having more than five IS 6110-hybridized bands. Allelic diversity of many VNTR loci varied in each IS 6110 RFLP type. Genetic relationships inferred from the 10-VNTR set supported the notion that M. tuberculosis may have evolved from two different lineages (high and low IS 6110 copy number). In addition, we found that the lengths of many VNTR loci had statistically significant relationships to each other. These relationships could cause a restriction of the VNTR typing discriminating capability to some extent. Our results suggest that VNTR-PCR typing is practically useful for application to molecular epidemiological and phylogenetic studies of M. tuberculosis. The discriminating power of the VNTR typing system can still be enhanced by the supplementation of more VNTR loci.     

Obesity and risk for hypertension and diabetes among Kenyan adults: Results from a national survey

Despite the anticipated growth in the global burden of obesity especially in low-income countries, limited data exist on the contribution of obesity to cardiometabolic diseases in Africa.We examined population-based samples of Kenyan adults who participated in the 2015 national chronic disease risk factor surveillance survey. Weight and height were measured, and body mass index (BMI) was calculated and used as a measure for general obesity. Waist circumference (WC), a clinical measure of central obesity was also measured. Logistic regression was used to assess the association between obesity with hypertension, diabetes, and dyslipidemia risk.Of the 4276 participants, the median (IQR) age was 36 (27–47) years, 41% were men. One-third (37%) of the participants were centrally obese, whereas 10% were generally obese. The odds for overweight and general obesity were highest among females, adults >40 years, and those in the highest wealth quartile. Central and general obesity, assessed by WC and BMI, were associated with hypertension and dyslipidemia but not diabetes for both sexes. Compared with adults of normal weight, individuals with a BMI of ≥30 kg/m² had an odds ratio of 2.39 (95% confidence interval [CI], 1.82–3.12) for hypertension and 2.24 (95% CI, 1.70–2.96) for dyslipidemia.Obesity prevalence is high in Kenya and is associated with hypertension and dyslipidemia but not diabetes. Our findings indicate an urgent need to develop public health interventions to address obesity and prevent the development of comorbid conditions.     

Intake of alcoholic beverages is a predictor of iron status and hemoglobin in adult Tanzanians

Iron deficiency is widespread in sub-Saharan Africa, but its predictors are not fully understood. We conducted a cross-sectional study among adults around Lake Victoria to describe iron status and asses the role of dietary and infectious predictors. Linear regression analyses were used to assess the role of infections and intake of meat, fish, fruit/vegetables, alcoholic beverages, and soil on hemoglobin and serum ferritin, while controlling for elevated serum alpha(1)-antichymotrypsin (ACT). Among 1498 participants, the mean age was 33.3 (14-87) y with 53.9% females. More than one-half ate fish daily, 6% ate fruit/vegetables daily, and only 11% ate meat weekly. One-third consumed alcoholic beverages and one-fifth of females consumed soil. Hookworm (80.3%), Schistosoma mansoni (64.7%), and HIV (7.3%) infection were common. Anemia was found in 48.2% of females (<120 g/L hemoglobin) and 40.1% of males (<130 g/L hemoglobin), and 22.3% of females and 7.0% of males had depleted iron stores (serum ferritin <12 microg/L). In multivariate analyses, alcoholic beverage consumption and HIV were positive, whereas soil eating and hookworm infection were negative predictors of serum ferritin. Alcoholic beverage consumption was a positive predictor of hemoglobin, and soil eating, HIV, and hookworm infection were negative predictors. Intakes of meat, fish, and fruit or vegetables were not predictors. Elevated serum ACT was a predictor of both hemoglobin and serum ferritin. Anemia and depleted iron stores were common, whereas iron overload was rare. In conclusion, the associations between alcoholic beverage intake and hemoglobin and iron status suggest that alcoholic beverages may contain micronutrients essential to erythropoiesis. The role of alcoholic beverage intake and other determinants of hemoglobin and iron status in low-income populations needs to be better elucidated.     

AFM1 in Milk: Physical,Biological, and Prophylactic Methods to Mitigate Contamination

Aflatoxins (AFs) are toxic, carcinogenic, immunosuppressive secondary metabolites produced by some Aspergillus species which colonize crops, including many dietary staple foods and feed components. AFB₁ is the prevalent and most toxic among AFs. In the liver, it is biotransformed into AFM₁, which is then excreted into the milk of lactating mammals, including dairy animals. AFM₁ has been shown to be cause of both acute and chronic toxicoses. The presence of AFM₁ in milk and dairy products represents a worldwide concern since even small amounts of this metabolite may be of importance as long-term exposure is concerned. Contamination of milk may be mitigated either directly, decreasing the AFM₁ content in contaminated milk, or indirectly, decreasing AFB₁ contamination in the feed of dairy animals. Current strategies for AFM₁ mitigation include good agricultural practices in pre-harvest and post-harvest management of feed crops (including storage) and physical or chemical decontamination of feed and milk. However, no single strategy offers a complete solution to the issue.