Transcriptional responses in jejunum of two layer chicken strains following variations in dietary calcium and phosphorus levels.

BACKGROUND: Calcium (Ca) and phosphorus (P) are essential nutrients that are linked to a large array of biological processes. Disturbances in Ca and P homeostasis in chickens are associated with a decline in growth and egg laying performance and environmental burden due to excessive P excretion rates. Improved utilization of minerals in particular of P sources contributes to healthy growth while preserving the finite resource of mineral P and mitigating environmental pollution. In the current study, high performance Lohmann Selected Leghorn (LSL) and Lohmann Brown (LB) hens at peak laying performance were examined to approximate the consequences of variable dietary Ca and P supply. The experimental design comprised four dietary groups with standard or reduced levels of either Ca or P or both (n = 10 birds per treatment group and strain) in order to stimulate intrinsic mechanisms to maintain homeostasis. Jejunal transcriptome profiles and the systemic endocrine regulation of mineral homeostasis were assessed (n = 80). RESULTS: Endogenous mechanisms to maintain mineral homeostasis in response to variations in the supply of Ca and P were effective in both laying hen strains. However, the LSL and LB appeared to adopt different molecular pathways, as shown by circulating vitamin D levels and strain-specific transcriptome patterns. Responses in LSL indicated altered proliferation rates of intestinal cells as well as adaptive responses at the level of paracellular transport and immunocompetence. Endogenous mechanisms in LB appeared to involve a restructuring of the epithelium, which may allow adaptation of absorption capacity via improved micro-anatomical characteristics. CONCLUSIONS: The results suggest that LSL and LB hens may exhibit different Ca, P, and vitamin D requirements, which have so far been neglected in the supply recommendations. There is a demand for trial data showing the mechanisms of endogenous factors of Ca and P homeostasis, such as vitamin D, at local and systemic levels in laying hens.

Jejunal microbiota of broilers fed varying levels of mineral phosphorus.

Efforts to achieve sustainable phosphorus (P) inputs in broiler farming which meet the physiological demand of animals include nutritional intervention strategies that have the potential to modulate and utilize endogenous and microbiota-associated capacities. A temporal P conditioning strategy in broiler nutrition is promising as it induces endocrinal and transcriptional responses to maintain mineral homeostasis. In this context, the current study aims to evaluate the composition of the jejunal microbiota as a functional entity located at the main absorption site involved in nutrient metabolism. Starting from a medium or high P supply in the first weeks of life of broilers, a depletion strategy was applied at growth intervals from d 17 to 24 and d 25 to 37 to investigate the consequences on the composition of the jejunal microbiota. The results on fecal mineral P, calcium (Ca), and phytate contents showed that the diets applied to the depleted and non-depleted cohorts were effective. Microbial diversity in jejunum was represented by alpha diversity indices which appeared unaffected between dietary groups. However, chickens assigned to the dietary P depletion groups showed significantly higher abundances of Facklamia, Lachnospiraceae, and Ruminococcaceae compared to non-depleted control groups. Based on current knowledge of microbial function, these microorganisms make only a minor contribution to the birds' adaptive mechanism in the jejunum following P depletion. Microbial taxa such as Brevibacterium, Brachybacterium, and genera of the Staphylococcaceae family proliferated in a P-enriched environment and might be considered biomarkers for excessive P supply in commercial broiler chickens.

Broiler physiological response to low phosphorus diets at different stages of production.

Phosphorus (P) inclusion in broiler diets needs to meet the physiological demands at a specific developmental stage to ensure the performance, health, and welfare of the birds and minimize nutrient losses. Toward a more efficient utilization of P in broiler husbandry, a timed nutritional conditioning strategy might enhance the endogenous mechanisms of mineral homeostasis and thus reduce dietary P supply of mineral sources. In this study, following a variable P supply in the starter phase, the effects of a dietary P depletion of broiler chickens were investigated at different developmental stages. Physiological adaptation mechanisms were elucidated based on zootechnical performance, endocrine parameters, regulation of intestinal P transport, bone characteristics, and health aspects. The results revealed a marked response to P depletion at the earliest developmental phase, after which indications of effective compensatory mechanism were detectable with advancing ages. Potential mechanisms that enable broilers to maintain mineral homeostasis primarily include endocrine control mediated by calcitriol actions, as well as intestinal P uptake and mineral mobilization from the bone. Conclusively, the precise timing, duration, and extent of a P depletion strategy in the broiler chicken might be considered for optimized nutrient utilization.

Discussing sudden unexpected death in epilepsy: Are we empowering our patients? A questionnaire survey.

OBJECTIVE: To examine patient knowledge about sudden unexpected death in epilepsy (SUDEP) compared to other risks in epilepsy. To explore patients' experiences surrounding SUDEP disclosure and opinions on how information should be delivered. DESIGN: A cross-sectional questionnaire. SETTING: Royal Free Hospital, London outpatient epilepsy clinics. PARTICIPANTS: New and follow-up patients attending epilepsy clinics at a London teaching hospital over six months. Patients identified as being at risk of suffering negative emotional or psychological consequences of SUDEP discussions were excluded. MAIN OUTCOME MEASURES: Patient knowledge about epilepsy risks; patient opinion regarding source, timing and delivery of SUDEP information; impact on health seeking behaviour. RESULTS: Ninety-eight per cent of patients were aware of medication adherence, 84% of factors influencing seizure frequency, 78% of driving regulations, 50% of SUDEP and 38% of status epilepticus; 72% of patients felt that SUDEP information should be given to all patients. Preferences for timing of SUDEP discussions varied between those wanting information at diagnosis (40%) and those preferring to receive it after three clinic appointments (18%) to avoid information overload at the first consultation. Emotional responses (48% positive, 38% negative) predominated over measurable behavioural change following SUDEP discussions. CONCLUSIONS: Less than half the patients knew about SUDEP and status epilepticus. Although the majority of patients with epilepsy wish to be informed about SUDEP early on in their diagnosis, information must be delivered in a way that promotes patient knowledge and empowerment.

Clinical observations of malignant trophoblastic disease.

We studied the clinical records of 64 women with malignant trophoblastic disease. Fifty-five patients (68%) were aged 25-50 years. The current pregnancy was preceded by abortion in 24 cases, by molar pregnancy in 23 cases and by normal pregnancy in 17 cases. The most common presenting symptoms were vaginal bleeding, abdominal mass and abdominal pain. Pulmonary lesions were mostly silent, but hemoptysis occurred in seven patients. Metastases were found in 39 patients. Treatment was mainly chemotherapy. Remission for over 12 months occurred in 40 patients, and 21 patients died.

Cesarean section for twin pregnancy in Ibadan, Nigeria.

During an 11-year period, 23,524 deliveries were conducted at the University College Hospital, Ibadan; 4,360 (18.5%) were delivered by cesarean section, 49 of which were associated with twin pregnancy. The main indications for this operation in twin pregnancy were prolapsed umbilical cord, previous cesarean section scar and malpresentation of the second twin with the membranes already ruptured. The perinatal mortality of 18.2% was mainly attributable to prematurity. Obstetricians in this community have adopted a conservative attitude towards cesarean section because of the general aversion to this operation by our patients and the risk of subsequent rupture of the uterine scar in women who wish to deliver themselves at home in subsequent pregnancies. Cesarean section is therefore performed in twin pregnancy for the same absolute indications as for single pregnancy.

Socio-psychological factors affecting emergency obstetric deliveries at the University College Hospital, Ibadan, Nigeria.

PIP: This study was designed to determine the influence of socio- psychological characteristics on reproductive outcomes among emergency cases admitted into the Labor Ward of the University College Hospital in Ibadan City, Nigeria. The study took place between May 1, 1984 and February 28, 1985 and included all emergency cases admitted (EA) into the hospital. 144 matched pairs of patients (emergency and booked cases) were admitted into the study making a total of 228 patients. Results of the study showed no observed differences in the educational or occupational status of the spouses of booked patients compared with EA. However, there were more uneducated women among the EA than the booked. IN both groups younger patients (15-34) had format education compared with the older patients (35+), strengthening the hypothesis that education is the most influential factor in patient's acceptance of modern maternity care. Polygamy and Islam were more prevalent among the EA than the booked. It is believed that the economic affects of polygamy exercise more direct adverse effects on reproduction than religion. The purdah system, practiced by Moslems confines women to their homes, interfering with their ability to get pre-natal care. Fewer number of EA lived with their spouses compared with booked patients. Lower social class is associated with larger numbers of adverse factors in reproductive outcomes such as increased rates of low birth weight babies, multiple pregnancies and fetal abnormalities. (Author's modified).^ieng

Sinonasal paraganglioma: a case report.

OBJECTIVE: To highlight the importance of a high index of suspicion and meticulous evaluation of a patient with bleeding sinonasal mass in the diagnosis of sinonasal paraganglioma. METHOD: Case report of a 39-year-old female who presented with a bleeding lobulated left nasal mass necessitating multiple blood transfusions is presented. RESULT: Diagnostic investigations revealed that the patient was HIV-positive (ELISA and Western blot) and a tumour histology of paraganglioma. She had a CD4+ count of 487 cells/mm3. The urinary vanillylmandelic acid assay and echocardiography were normal. Subsequently, she had complete tumour excision through a medial maxillectomy and has remained without a recurrence 12 months after. CONCLUSION: To our knowledge, this is the first report in the world literature of sinonasal paraganglioma in a HIV-positive patient and the first reported case of sinonasal paraganglioma in Africa. It is, however, not clear from this report if the patient's HIV status preceded her development of the paraganglioma or not.

Dermoid cyst of the urinary bladder as a differential diagnosis of bladder calculus: a case report.

Dermoid cysts are extremely rare in the urinary bladder and can pose a diagnostic dilemma to both the Urologist and the Histopathologist. Only a few cases were found documented and cited in PubMed. We present a case of dermoid cyst in the urinary bladder presenting as a bladder stone with a brief review of the literature.

Funds squeezed and stretched: the predicament of health care.

Funding for health in Ogun State, Nigeria is reviewed in relation to the health-for-all targets. The author examines the ways in which money is spent, with particular reference to the impact of wages, salaries and allowances on budgeting in a manpower-intensive sector.

PIP: Nigeria's national health policy promotes primary health care as the means to achieve health for all. Local governments, state governments, and the federal government are responsible for primary, secondary, and tertiary levels of care, respectively. All government levels are receiving fewer and fewer public funds. For example, the federal health budget for 1988 was just 25% of that for 1981 in real terms. Expenditure on always-needed items (e.g,, maintenance, medical supplies, and drugs) is still decreasing, while personnel costs either stay the same or increase. Ogun State has 15 local government areas and 448 health care facilities. Its total fertility and maternal, infant, and child mortality rates are 6.2, 15/1000 births, 90-120/1000 live births, and about 25%, respectively. Malaria, diarrhea, respiratory and other infections, and accidents account for most deaths. In 1988 and 1989, the local governments spent 11% and 10% (range = 4-23%), respectively, on the health sector. Per capita health expenditure ranges were US$0.30-0.80 and US$0.16-0.80, respectively. In the five newly created local government areas, the inferior health funding goes mainly to infrastructural development. In 1988 and 1989, the health sector of the local governments in Ogun State secured just 60% and 54%, respectively, of promised funds. Wages, salaries, and allowances made up 56% and 61% of expenditures; yet, 48% and 49% were proposed. The mean capital expenditures was just 18.5% of total health expenditure. When one looks at real value, however, the money expended on human resources was less than proposed. Thus, if the governments had achieved funding targets, there would have been more funds for nonpersonnel and capital costs. Ogun State needs to control personnel costs. The author hopes that this review sparks other states to conduct similar studies and leads to a national reexamination of financing policy.