Reference values for the erythrocytic profile of Anak 2000 broilers and Lohmann brown pullets in Nsukka,Eastern Nigeria

Reference values for the erythrocytic indices are vital for the diagnosis of anaemia and polycythemia and also for the assessment of efficacy of therapy instituted to correct these abnormalities. This study determined the reference values for the packed cell volume (PCV), haemoglobin concentration (HbC), red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) of Anak 2000 broilers (A2B) at 14-day intervals for 84 days and Lohmann brown pullets (LBP) at 21-day intervals for 147 days. A total of 120 chickens were used for the study (60 A2B and 60 LBP), and all haematological determinations followed standard procedures. Results of the determinations on the A2B showed that PCV and HbC did not significantly vary (p > 0.05) with age and had a low correlation with age (r = −0.22 and r = 0.15, respectively), but RBC counts increased with and positively correlated with age (r = 0.78), while MCV and MCH decreased with and were strongly inversely correlated with age (r = −0.80 and r = −0.84, respectively), and MCHC did not follow a definite pattern. For the LBP, there were no significant variations (p > 0.05) associated with age in the PCV, RBC counts, MCV, MCH and MCHC up to 105 days of age; the significant variations (p < 0.05) obtained after day 105 were associated with pre-lay and egg-laying. The HbC of the LBP did not significantly vary (p > 0.05) all through the study. When compared with findings in similar studies as reported by other investigators, some of the values obtained in this study and the patterns of change in relation to age were in agreement while some others contrasted, probably because of differences between the strains and the climatic/environmental conditions under which the chickens were raised.     

Pathogenesis of infectious bursal disease in embryonally bursectomised chickens

Embryonally bursectomised and nonbursectomised chickens were infected with infectious bursal disease virus (IBDV) at 36 days of age. Neither clinical signs nor gross lesions were observed in the infected, bursectomised (IB) chickens. No significant changes were observed in carcass, thymus or spleen weights of IB and noninfected bursectomised chickens. A mild lymphocytic necrosis and depletion were found in the spleen, thymus and caecal tonsil of the IB chickens. Neither precipitating nor serum neutralising antibodies were detected in the sera but IBDV was reisolated from the spleen and thymus. Infected, nonbursectomised (IN) chickens developed severe depression with diarrhoea and high mortalities. Haemorrhages were found in the muscles of the breast and thigh, proventriculus and intestines. Significant changes were observed between the carcass, thymus and bursa weights of the IN and noninfected, nonbursectomised chickens. There was severe lymphatic necrosis of the bursa, thymus, spleen and caecal tonsil. Both precipitating and neutralising antibodies were detected in the sera and the virus was reisolated from the bursa, thymus and spleen. It is concluded that the bursa of Fabricius is not essential for the establishment of an IBDV infection but is required for the clinical infection.     

Robotic kidney transplantation in the obese patient: 10‐year experience from a single center

Despite increasing obesity rates in the dialysis population, obese kidney transplant candidates are still denied transplantation by many centers. We performed a single‐center retrospective analysis of a robotic‐assisted kidney transplant (RAKT) cohort from January 2009 to December 2018. A total of 239 patients were included in this analysis. The median BMI was 41.4 kg/m², with the majority (53.1%) of patients being African American and 69.4% of organs sourced from living donors. The median surgery duration and warm ischemia times were 4.8 hours and 45 minutes respectively. Wound complications (mostly seromas and hematomas) occurred in 3.8% of patients, with 1 patient developing a surgical site infection (SSI). Seventeen (7.1%) graft failures, mostly due to acute rejection, were reported during follow‐up. Patient survival was 98% and 95%, whereas graft survival was 98% and 93%, at 1 and 3 years respectively. Similar survival statistics were obtained from patients undergoing open transplant over the same time period from the UNOS database. In conclusion, RAKT can be safely performed in obese patients with minimal SSI risk, excellent graft function, and patient outcomes comparable to national data. RAKT could improve access to kidney transplantation in obese patients due to the low surgical complication rate.     

Transmediastinal gunshot wounds in a mature trauma centre: Changing perspectives

Background

Transmediastinal gunshot wounds are associated with a high mortality and frequently require operative intervention. The purpose of this study was to identify the diagnostic and therapeutic challenges of these injuries in a mature trauma system with decreasing prehospital time intervals.

Methods

Patients admitted to a large urban Level 1 trauma centre between 1/2006 and 12/2010 sustaining a firearm injury to the torso were identified. Transmediastinal gunshot wounds were defined as missile tracts traversing the mediastinum identified on CT images, operative notes or autopsy reports.

Results

Overall, 133 patients met study criteria. A total of 116 patients (87.2%) were haemodynamically unstable or had no vital signs on arrival to the Emergency Department. Ninety-seven (83.6%) of these patients required a resuscitative thoracotomy resulting in 8 survivors (6.0%). There were 17 haemodynamically stable patients (12.8%) identified, 14 of whom underwent CT scan evaluation. Six patients subsequently required operative intervention. Only 11 patients (8.3%) in the study population were successfully managed nonoperatively. The overall mortality was 78.9%, and for those who reached the hospital with vital signs, the mortality was 24.3%.

Conclusions

Transmediastinal gunshot wounds encountered in a mature trauma centre are highly lethal injuries requiring resuscitative thoracotomy in most instances. Changing perspectives in these injuries may reflect the effects of an evolving prehospital care.     

Risk factors for post-traumatic pneumonia in patients with retained haemothorax: Results of a prospective,observational AAST study

Introduction

Retained haemothorax (RH) is a problematic sequela of thoracic trauma, reported in up to 20% of patients following chest injury. RH is associated with a higher severity of thoracic trauma and may portend the onset of other serious post-traumatic complications, including pneumonia. The development of pneumonia has previously been reported to be as high as 19.5% in the setting of traumatic RH. The purpose of this study was to identify risk factors for the development of pneumonia as a complication in RH.

Methods

We utilized the American Association for the Surgery of Trauma Post-Traumatic Retained Haemothorax database. Patients with post-traumatic RH were prospectively enrolled from 2009 to 2011. Inclusion criteria were placement of a thoracostomy tube within 24 h of admission for the evacuation of pneumothorax or haemothorax and subsequent chest computed tomography scan chest showing RH. Patients treated with thoracotomy before placement of tube thoracostomy were excluded. For univariate analysis, the Chi-square test with Yates correction was used for comparison of categorical risk factors and the Student's t-test or the Mann–Whitney test for comparison of continuous risk factors. To identify independent risk factors for the development of pneumonia, variables from the univariate analysis significant at p < 0.2 were entered into a forward logistic regression model. Adjusted odds ratio and 95% confidence intervals (CI) were derived.

Results

328 patients with post-traumatic RH from 20 United States centres were enrolled. After stepwise regression analysis, ISS > 25 (adjusted OR: 7.1; 95% CI: 3.1, 16.4; p < 0.001), blunt mechanism of injury (adjusted OR: 3.5; 95% CI: 1.7, 7.2; p = 0.001), and failure to administer peri-procedural antibiotics on the initial thoracostomy tube placement (adjusted OR: 2.6; 95% CI: 1.30, 5.4; p = 0.01) were found to be independent predictors of the pneumonia in patients with post-traumatic RH.

Conclusions

To our knowledge, our current study is the largest attempt to identify the independent predictors for pneumonia in this population. Our data show that elevated ISS, blunt thoracic trauma, and failure to administer peri-procedural antibiotics on tube thoracostomy placement are the statistically significant independent risk factors.     

Caregiver–proxy reliability of the Igbo-culture adapted Maleka Stroke Community Reintegration Measure: a validation study

Objectives: This study was designed to determine the caregiver–proxy reliability of the Igbo-culture adapted urban version of the Maleka Stroke Community Reintegration Measure (I-MSCRIM).

Methods: This was a validation study involving 74 consenting stroke survivors and their 74 primary informal caregivers consecutively recruited from selected tertiary hospitals in South-East Nigeria (Igboland). The I-MSCRIM was researcher-administered to the participants. Obtained data was analyzed using frequency counts, percentages, range, mean, standard deviation, Spearman rank order correlation, Mann–Whitney U test, Kruskal–Wallis test and Intra-class Correlation Coefficient. Alpha level was set at 0.05.

Results: The mean ages of the stroke survivors (55.4% males) and their primary informal caregivers (41.9% males) were 50.14 ± 12.24 and 31.93 ± 10.9 years respectively. There was no significant difference in the community reintegration (CR) scores as rated by stroke survivors and their primary informal caregivers (p > 0.05). The correlations between stroke survivors’ and primary informal caregivers’ rated CR scores were all adequate and acceptable (ICC = 0.602–0.917). The discrepancy in the total CR scores between the two ratings was significantly influenced by primary informal caregivers’ educational attainment (k = 13.15; p < 0.01).

Conclusion: The I-MSCRIM has acceptable caregiver–proxy reliability among Igbo stroke survivors in South-East Nigeria. This suggests that primary informal caregivers of stroke survivors can reliably estimate the CR of their care recipients when I-MSCRIM is administered to them. This will be useful when a stroke survivor cannot respond to I-MSCRIM.     

Postinflammatory ossicular fixation: CT analysis with surgical correlation

Postinflammatory ossicular fixation is a common problem encountered by the otologic surgeon upon exploration because of conductive hearing loss in patients with chronic otitis media. These nonotosclerotic noncongenital lesions take three pathologic forms: fibrous tissue fixation (chronic adhesive otitis media), hyalinization of collagen (tympanosclerosis), and new bone formation (fibro-osseous sclerosis). Fibrous tissue fixation appears on CT as nonbony, noncalcific soft-tissue debris encasing some or all of the ossicular chain. Tympanosclerosis appears as unifocal or multifocal punctate or weblike calcifications in the middle ear cavity or on the tympanic membrane. This debris may be in direct apposition to the ossicular chain or may replace the suspensory ligaments in symptomatic patients. New bone formation has been identified only in the attic and is the least common manifestation. Thick bony webs or generalized bony encasement may be present at CT. More than 300 patients with the clinical diagnosis of chronic otitis media have been examined. This study encompasses 23 proved cases.     

Fat-to-glucose interconversion by hydrodynamic transfer of two glyoxylate cycle enzyme genes

The glyoxylate cycle, which is well characterized in higher plants and some microorganisms but not in vertebrates, is able to bypass the citric acid cycle to achieve fat-to-carbohydrate interconversion. In this context, the hydrodynamic transfer of two glyoxylate cycle enzymes, such as isocytrate lyase (ICL) and malate synthase (MS), could accomplish the shift of using fat for the synthesis of glucose. Therefore, 20 mice weighing 23.37 ± 0.96 g were hydrodinamically gene transferred by administering into the tail vein a bolus with ICL and MS. After 36 hours, body weight, plasma glucose, respiratory quotient and energy expenditure were measured. The respiratory quotient was increased by gene transfer, which suggests that a higher carbohydrate/lipid ratio is oxidized in such animals. This application could help, if adequate protocols are designed, to induce fat utilization for glucose synthesis, which might be eventually useful to reduce body fat depots in situations of obesity and diabetes.     

Chirurgische Behandlung infizierter Knochendefekte

Zusammenfassung Die unhappy triad der Knochenchirurgie, Infekt, Defekt und Instabilität stellt uns auch heute noch vor schwer zu lösende Probleme. Das Vorgehen der Wahl scheint uns die Stabilisierung der Fragmente mittels einer internen (Osteosynthese) oder externen (äußere Spanner) Fixation, die radikale Ausräumung des Herdes, die vorübergehende Spüldrainage nach Willenegger [26, 27, 28] und schließlich das Auffüllen des Defektes mit autologer Spongiosa zu sein. Bei allen unseren in dieser Studie erfaßten 25 Patienten kam es zum knöcherner Einbau des Transplantates und Abheilung des Haut- und Weichteildefektes, bei vier Patienten be schleunigte eine Spalthautverpflanzung die Heilung. 23 Fälle sind 1 bis 6 Jahre nach der Behandlung vom Infekt her rezidivfrei geblieben, bei sämtlichen Patienten konnte die Belastungsstabilität erreicht werden.Durch das beschriebene Vorgehen konnte in allen Fällen die Gelenkfunktion erhalten oder verbessert werden. Das aktive Eingreifen gestattet zudem Achsen- und Längenkorrekturen.Klinische, szintigraphische und histologische Untersuchungen zeigen, daß der Einbau des spongiösen Transplantates unmittelbar nach der Verpflanzung einsetzt und nach 3 Monaten soweit fortgeschritten ist, daß die Belastungsstabilität erreicht wird.

---

Autogenous cancellous bone in osteomyelitis with defects of bone, soft tissue and skin

Summary Surgeons are still confronted with the grave problem of the unhappy triad of bone surgery, i.e. infection, osseous defect and instability. To us the stabilisation of fragments by means of internal or external fixation, the radical saucerization and packing of the cavity with autogenous cancellous bone with preceding irrigation drainage seems to be the procedure best suitable. 25 patients with infected defects of bone, soft tissue and skin were treated accordingly and followed up 1 to 6 years later: In all cases the graft had been integrated and the skin- and soft tissue defects had healed. In 23 cases osteomyelitis had not re-occured, weight bearing stability had been achieved in all 25 cases.The described procedure had either maintained or even improved articular function. Additionally the active intervention allowes correction of axis and length.It is demonstrated by radiological, scintigraphical and histological examinations, that the integration of the cancellous bone transplant begins immediately after transplantation and is advanced within three months to such a point that weight bearing becomes possible.

     

Anti-inflammatory effects of crude methanolic extract and fractions of Alchornea cordifolia leaves

The leaves of Alchornea cordifolia were collected, identified, dried, and reduced to coarse powder and extracted with aqueous methanol. Using various solvent treatments, the powdered dried leaf was fractionated into five fractions, A1, A2, B, C, D and E. The fractions were subjected to phytochemical analysis to identify the biologically active constituents. The anti-inflammatory effects of crude methanolic extract (ME) of Alchornea cordifolia leaves and the five fractions were evaluated using egg-albumen-induced rat hind paw oedema as a model of inflammation. The crude extract was also subjected to acute toxicity test. Fraction A2, which exhibited the most promising anti-inflammatory effect, was also subjected to analgesic and ulcerogenic tests. Phytochemical analysis of the extracts showed the presence of terpenes, sterols, flavonoids, tannins, carbohydrates, glycosides, saponins and traces of alkaloids. The LD(50) of the aqueous ME was found to be 1131.4 mg/kg. The crude ME (50 mg/kg) gave anti-inflammatory activity which was significant (P<0.05) at all the observation times (1-3h). The different solvent fractions exhibited varying degrees of anti-inflammatory activities, with terpenoid fraction (A2) and the tannin-containing multi-component fraction (D) showing very high and significant (P<0.01) activity at 100mg/kg, with percentage inhibition of oedema value of 87.69 each. In conclusion, the aqueous ME of Alchornea cordifolia leaves could be beneficial in the management of different inflammatory disease states. Its anti-inflammatory activity may not be attributed only to the terpenoid content.