Effects of reduced crude protein diets while maintaining essential amino acid concentrations on growth performance, nitrogen output, ammonia production, and meat yield.

An experiment was conducted to determine the effect of feeding reduced crude protein (CP) diets to Ross × Ross 708 male broilers while providing adequate essential amino acid (AA) concentrations on growth performance, nitrogen (N) and ammonia output, and carcass characteristics from d 1 to 33 post hatch. Birds received 1 of 6 dietary treatments (10 replicate pens per treatment) varying in CP content. Diet 1 (control) was formulated with DL-Met, L-Lys, and L-Thr (23.2, 20.7, and 19.1% CP) in the starter (1-14 d of age), grower (15-25 d of age), and finisher (26-33 d of age) periods, respectively. Dietary L-Val, Gly (only in starter period), L-Ile, L-Arg, and L-Trp were sequentially supplemented in the order of limitation in Diets 2 through 6. Dietary CP was reduced gradually across the dietary treatments resulting in a CP reduction in Diets 1 to 6 by 3.4, 3.4, and 2.3% points in the starter, grower, and finisher periods, respectively. At d 14, 25, and 33 posthatch, feed conversion decreased (P < 0.05) with L-Val addition (Diet 2) and increased (P < 0.01) with L-Val to L-Trp addition (Diet 6) to the control. Dietary treatments did not alter weights and yields of carcass, breast, drum, or thighs. Dietary CP reduction with added L-Val (Diet 2), L-Val to L-Arg (Diet 5), or L-Val to L-Trp (Diet 6) increased abdominal fat (P < 0.01) compared with control. Nitrogen excretion (g/bird; P = 0.003) and equilibrium ammonia concentration (mg/kg; P = 0.041) at day 33 reduced by 16% and 48% respectively in birds fed reduced-CP diets with L-Val to L-Trp (Diet 6) compared with control-fed birds. This study indicated that sequential addition of supplemental AA in the order of limitation from DL-Met to L-Arg allowed reduction of dietary CP beyond 2%-point without depressing growth performance and meat yield of broilers from day 1 to 33 while reducing nitrogen excretion and ammonia emissions.

From the Breast to the Finger - A Case Report of Acrometastasis.

BACKGROUND: Acrometastasis is an unusual presentation that is associated with a poor prognosis. SUMMARY OF CASE: We report a case of an advanced breast cancer in a Nigerian woman, with clinical, radiological and histopathological features of lung, brain, and distal phalanx metastases. We report this case to highlight the need to have a high index of suspicion for acrometastasis as well as to emphasize the effect and challenges of managing metastatic breast cancer in a low-income country. CONCLUSION: Breast cancer metastasis to the bones of the hand is a rare condition and associated with poor prognosis.

CONTEXTE: L'acrométastase est une présentation inhabituelle associée à un pronostic défavorable. RÉSUMÉ DU CAS: Nous rapportons le cas d'un cancer du sein avancé chez une femme nigériane, présentant des caractéristiques cliniques, radiologiques et histopathologiques de métastases pulmonaires, cérébrales et de la phalange distale. Nous rapportons ce cas pour souligner la nécessité d'avoir un haut degré de suspicion pour l'acrométastase ainsi que pour souligner les effets et les défis de la prise en charge du cancer du sein métastatique dans un pays à faible revenu. CONCLUSION: La métastase du cancer du sein aux os de la main est une condition rare et associée à un pronostic défavorable. MOTS-CLÉS: Cancer du sein, Métastase, Acrométastase.

Challenges to Thrombolysis in A Resource-Poor Setting- A Case Report.

A major complication of acute ischemic stroke is death and disability. The emergence of reperfusion therapy in form of thrombolysis and endovascular thrombectomy has led to the reversal of this trend in high-income countries. Low- and middle-income countries are yet to benefit maximally from these time-bound treatment options due to some limitations. We intend to highlight some of these in this report. We report an 80-year-old male patient with hypertension and firstdegree AV block admitted 3 hours after the onset of stroke with National Institutes of Health Stroke Scale (NIHSS) score of 13 and Medical Research Council (MRC) muscle power grade 3 in both the left upper and lower limb. Urgent non-contrast brain CT revealed no evidence of hemorrhage. Intravenous tissue plasminogen activator (tPA) was administered at a dose of 0.6 mg/kg 9 hours after symptom onset. He made significant improvement afterward and was discharged. The challenges encountered in his management include prehospital and intrahospital delay, and unavailability of tissue plasminogen activator. There is a need for an improved healthcare delivery system in order to reduce the morbidity associated with acute ischemic stroke.

Une complication majeure de l'accident vasculaire cérébral ischémique aigu est le décès et l'invalidité. L'émergence de la thérapie de reperfusion sous forme de thrombolyse et de thrombectomie endovasculaire a conduit à l'inversion de cette tendance dans les pays à revenu élevé. Les pays à revenu faible et moyen n'ont pas encore pleinement bénéficié de ces options de traitement limitées dans le temps en raison de certaines limitations. Nous avons l'intention de mettre en lumière certaines de ces limitations dans ce rapport. Nous rapportons le cas d'un homme de 80 ans, connu pour son hypertension et un bloc auriculo-ventriculaire de premier degré, admis 3 heures après le début de l'accident vasculaire cérébral avec un score de 13 à l'échelle d'AVC des National Institutes of Health (NIHSS) et une force musculaire du Medical Research Council (MRC) de grade 3 dans les membres supérieurs et inférieurs gauches. Une tomodensitométrie cérébrale urgente sans produit de contraste n'a révélé aucune preuve d'hémorragie. De l'activateur tissulaire du plasminogène (tPA) par voie intraveineuse a été administré à une dose de 0,6 mg/kg 9 heures après le début des symptômes. Il a ensuite connu une amélioration significative et a été autorisé à quitter l'établissement. Les défis rencontrés dans sa prise en charge comprenaient des retards préhospitaliers et intrahospitaliers, ainsi que l'indisponibilité de l'activateur tissulaire du plasminogène. Il est nécessaire d'améliorer le système de prestation de soins de santé afin de réduire la morbidité associée à l'accident vasculaire cérébral ischémique aigu. MOTS-CLÉS: Ischémique, AVC, Thrombolyse, Tissu, Plasminogène, Thrombectomie.

Dietary phosphorus level regulates appetite through modulation of gut and hypothalamic expression of anorexigenic genes in broiler chickens.

Two experiments were designed to elucidate gut and hypothalamic molecular regulation of appetite by dietary phosphorus (P) concentration in broiler chickens. Birds (192 Cobb-500 broiler chickens) were randomly assigned to 3 experimental diets in experiment 1 (Exp. 1) and 24 broiler chickens were randomly assigned to 3 treatment groups in Exp. 2. Each diet comprised 8 replicate cages, with either 8 birds (Exp. 1) or 1 bird (Exp. 2) per replicate cage. In Exp. 1, diets contained 1.2 (P-deficient), 2.8 (P-marginal) or 4.4 (P-adequate) g/kg non-phytate P (nPP). In Exp. 2, birds fed the P-adequate diet were pair-fed (PF) to the feed consumption levels of birds fed the P-deficient diet. Feed intake and BW gain (P < 0.001) decreased in birds fed the P-deficient diet in Exp. 1. Birds fed the P-deficient diet had similar feed intake and BW gain with PF group fed the P-adequate diet (Exp. 2) but was significantly lower (P < 0.001) than birds fed the P-adequate diets. Sodium-phosphate cotransporter (NaPi-IIb) mRNA was upregulated (P < 0.05) in both experiments. Conversely, cholecystokinin (CCK) mRNA was downregulated (P < 0.01) in birds fed P-deficient diets. Anorexia-related hypothalamic cholecystokinin receptor (CCKAR) and melanocortin receptors (MC3R and MC4R) were upregulated (P < 0.05) in birds fed P-deficient diets, in both experiments. The current data show that dietary P deficiency decreases feed intake in broiler chickens by altering the expression of anorexigenic genes in the gut and hypothalamus of broiler chickens.

Contribution of purified soybean trypsin inhibitor and exogenous protease to endogenous amino acid losses and mineral digestibility.

The primary objective of the current study was to evaluate the impact of trypsin inhibitor (TI) and exogenous protease supplementation on endogenous loss of amino acids (AA) in broiler chickens. A total of 384 Cobb-500 broiler chicks were allocated to 4 nitrogen-free diets, each with 8 replicate cages and 12 birds per replicate. The diets were arranged as a 2 × 2 factorial with factors being dietary TI (0 or 8,000 TIU/g) and exogenous protease (0 or 15,000 PROT/kg). Desired dietary TI concentration was achieved by addition of commercially available, purified soybean TI. There was no effect of TI or exogenous protease or their interaction on growth performance of birds. However, the endogenous loss of nitrogen (N) and all AA increased (P < 0.05) due to dietary TI concentration except for Cys. The increase in endogenous AA due to TI ranged from 17% for Thr to 52.2% for Trp. Exogenous protease had no effect on endogenous loss of N and all AA. There was no effect of TI or exogenous protease or their interaction on the AID of P, however AID of Ca, Fe, Mg, Mn, and Cu was reduced (P < 0.05) due to dietary TI. The AID of Cu (P < 0.01) and K (P < 0.05) improved with exogenous protease supplementation. Significant interactions (P < 0.05) between exogenous protease and TI existed for Zn, Mg, Cu, and Na. The concentration (g/kg DM intake) of crude mucin and sialic acid increased (P < 0.05) with increased dietary TI. Decreased trypsin (P < 0.001) and increased chymotrypsin (P < 0.001) activity in the pancreas were observed as a result of exogenous protease supplementation. In conclusion, the current study showed that TI increases the endogenous loss of AA and reduced the digestibility of minerals in broiler chickens. Furthermore, exogenous protease did not affect endogenous AA flow, irrespective of added purified dietary TI.

Energy value of dry fat and stabilised rice bran for broiler chickens.

1. The ileal digestible energy (IDE), metabolisable energy (ME) and nitrogen-corrected ME (MEn) of dry fat (DF) and stabilised rice bran (SRB) were determined in two experiments with broiler chickens using the regression method.2. Chickens were fed a common broiler starter diet from d 0 to 17 and experimental diets from d 17 to 22 post hatching. Three diets were prepared; a maize-soybean meal reference diet (RD) and two test diets containing either DF at 50 or 100 g/kg replacement (Experiment 1) or SRB at 100 or 200 g/kg replacement (Experiment 2) of the energy-contributing ingredients in the RD. In each experiment, 192 chickens were randomly allocated to one of three dietary treatments in a randomised complete block design, comprising eight replicate cages with eight birds per cage.3. In Experiment 1, the IDE, ME and MEn linearly increased (P < 0.001) with increasing DF concentrations, while in Experiment 2, the IDE, ME and MEn of the diets were not affected by dietary supplemental SRB. The regression-derived IDE concentration for DF and SRB were 25.30 and 14.88 MJ/kg DM, respectively. The respective ME and MEn estimates (MJ/kg DM) were 25.32 and 24.78 for DF; 14.38 and 13.36 for SRB.4. In conclusion, the current data showed that broiler chickens utilised between 77% and 79% and 68% to 76% of the gross energy (GE) in DF and SRB, respectively, and this suggested a strong potential for these ingredients as dietary energy sources for broiler chickens.

Takayasu's Arteritis Presenting Atypically in a Female Nigerian.

Takayasu's arteritis (TA) is an idiopathic form of large vessel granulomatous vasculitis that mainly affects the aorta and its major branches, most frequently in young women under 50 years. While traditionally, it is a disease found commonly in Asia continent, it has also been reported from different parts of the world, albeit with a few reports from Sub-Sahara Africa. The clinical presentations are variable and are commonly from systemic inflammation, vascular occlusive diseases and aneurysm. Asymptomatic cases of TA have been documented and are usually discovered incidentally on physical examination. Common vascular symptoms from different series include vascular claudication, reduced or absent pulse, carotid bruit, hypertension and headache. Facial mononeuropathy and retinal ischaemic changes are rare findings in TA. However, occlusive disease of ulnar artery has not been reported in TA despite our extensive literature search. Here, we present a 48-year-old woman, who was admitted via the medical emergency with community acquired pneumonia but was incidentally diagnosed with Takayasu arteritis with lower motor neuron facial nerve palsy, unilateral blindness, and ulnar artery occlusion. Multidisciplinary management was instituted and patient was discharged after resolution of community acquired pneumonia, vascular claudication, and chronic headache. TA often presents asymptomatically and sometimes with atypical features and thus we suggest high index of suspicion and detailed cardio-vascular examination in young individuals with unexplained chronic headache, facial nerve palsy and visual symptoms.

Portal hypertension evolving from sickled hepatopathy: Could hepatic venous Doppler ultrasound be beneficial in its evaluation?

PURPOSE: Sickle cell intrahepatic cholestasis involves sickling within hepatic sinusoids leading to vascular stasis and localized hypoxia resulting in ballooning of the hepatocytes causing a direct back pressure effect with resultant intracanalicular cholestasis. Vascular stasis may ultimately lead to portal hypertension. We proposed to document findings suggestive of portal hypertension evolving from hepatopathy in steady-state sickle cell disease (SCD) patients using hepatic venous Doppler ultrasound. METHODS: This is a prospective case series of 6 SCD subjects in steady-state (median age, 30 years; range, 19-43), comprising of 3 males and 3 females, who underwent a routine Doppler ultrasound evaluation of their hepatic veins and were discovered to have an abnormal biphasic waveform pattern. Venous blood was obtained from all subjects to evaluate for P-selectin, homocysteine, foetal haemoglobin, haematocrit levels, white cell and platelet counts. Doppler ultrasound was also carried out on all subjects to evaluate for the hepatic waveform, right renal artery RI and PI along with the hepatic artery velocities. RESULTS: All the 6 subjects had reduced haematocrit (median value of 21.5%; range, 18-25%) and some degree of renal dysfunction (plasma cystatin-C ranged from 1.6 to 12.2 mg/L). Elevated white cell count, hyperhomocysteinemia, reduced SpO2(<94.0%) and reduced estimated GFR (eGFR < 90 ml/min) was also noted in 4 subjects (66.7%). Similarly, 4 subjects (66.7%) had elevated RI in the right kidneys while 3 subjects (50.0%) had elevated PI in the right kidney. CONCLUSION: Doppler ultrasound Hepatic vein waveform analysis may be a useful examination in the evaluation of patients with SCD as it may elicit feature of portal hypertension. Further studies are suggested to confirm this in a larger population of SCD patients using the gold standard.

Variations of renal vascular anatomy in a nigerian population: A computerized tomography studys.

BACKGROUND: A broad spectrum of renal vascular variations has been reported by anatomists and radiologists. The prevalence of these variations is extremely divergent in different populations. Therefore, radiologists and surgeons in different climes must be knowledgeable about the type and prevalence of the variants in their area of practice to avoid diagnostic pitfalls and for optimization of surgical techniques. OBJECTIVE: The objective of this study is to describe the types and prevalence of renal vascular variations among patients undergoing contrast-enhanced computerized tomography (CECT) of the abdomen in a Nigerian population, as well as provide a concise review of literature on the embryological basis and clinical significance of the identified variations. MATERIALS AND METHODS: This study was a retrospective review of 200 CECT of the abdomen to identify variations of arterial (accessory, early branching, and precaval) and venous (multiple, retroaortic, and circumaortic) anatomy of the kidneys. RESULTS: We studied 200 patients, 102 (51%) females and 98 (49%) males. Age range is 18-90 years (mean = 53.08 ± 17.01). Prevalence of any renal vascular variations was 50%, arterial variations were 37%, and venous variations were 13%. Variations were significantly more common in males, P = 0.000075. The most common arterial variant was the accessory renal artery (23%) seen in 10% (right) and 13.0% (left); early branching was seen in 4.0% (right) and 0.5% (left) as well as precaval right renal artery seen in 4.5%. Venous variants were late confluence 3.0% (right) and 2.5% (left); multiple veins was seen in 2.5% (right) and 2.5% (left) as well as retroaortic left renal vein seen in 2.0%. The inferior polar accessory artery was the most prevalent accessory artery. Early arterial bifurcation was significantly more common on the right (P = 0.016) while other vascular variants showed no statistically significant association with laterality. CONCLUSION: Variation of renal vascular anatomy is a frequent finding among Nigerians. Radiologists and surgeons must be aware of these variants for optimization of surgical techniques.

Pattern and outcome of traumatic gastro- intestinal injuries in ile-ife.

AIMS AND OBJECTIVES: Trauma continues to assume a prominent role in the cause of disease in the developing world with increased westernization. This study highlights the pattern, management and outcome of gastrointestinal injuries following abdominal trauma in our hospital. PATIENTS AND METHODS: A descriptive retrospective study of all patients who had laparotomy following abdominal trauma at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and April 2013. RESULTS: A total of 120 patients had laparotomy following abdominal trauma. Forty- five patients comprising 41 males and 4 females whose ages ranged between 14 and 65 years had gastrointestinal injuries. Majority (68.9%) were in the third and fourth decades with penetrating injury occurring in 55.6% .Causes of injury included gunshots (44.4%), road traffic accidents (37.8%), stabs (8.9%), falls (6.7%) and impalement (2.2%). The small intestine was the commonest site of injury (57.8 %) irrespective of the mechanism. Gut perforations accounted for 71.1% of all injuries. Two-thirds of patients had other associated injuries with retroperitoneal trauma being the commonest associated intra-abdominal injury. Majority (44.4%) had bowel resection and anastomosis with surgical site infection recorded in 35.6%. Overall mortality was 6.7% and this was significantly associated with pre-operative blood transfusion (p<0.05). CONCLUSION: Gut perforations from gunshot especially of the small intestine are the commonest gastro-intestinal injury in our setting. Pre-operative blood transfusion, perhaps indicating severity of injury, implies poor prognosis.

Torsion of wandering spleen, an unusual cause of acute abdomen; a report of two cases.

BACKGROUND: Wandering spleen is an uncommon entity that is rarely considered in the evaluation of patients with acute abdominal conditions. OBJECTIVE: To report two cases of wandering spleen presenting with acute abdominal pain. METHODS: The clinical records of the patients including preoperative evaluation, intra-operative findings and postoperative care were reviewed RESULT: A 6 year old boy presented with right lumbar pain which worsened over a 36 hour period with findings of a tender right lumbar mass. Abdominal ultrasound showed a mass with echogenicity consistent with that of the spleen with no blood flow and an empty splenic bed. The pre-operative diagnosis was torsion of a wandering spleen. The second case was that of a 42 year old woman who presented with severe colicky lower abdominal pain which worsened over three days with a background history of progressively increasing lower abdominal mass which was tender and about 26 week gestational size at presentation. The initial diagnosis was torsion of an ovarian cyst. Abdomino-pelvic Ultrasound scan showed a heterogeneously hypo-echoic mass overlying the uterus and the left ovary with no blood flow. The presence of wandering spleen with torsion of the vascular pedicle was confirmed at laparotomy in both instances. Splenectomy was performed in both cases with good recovery. CONCLUSION: Torsion of a wandering spleen poses a diagnostic challenge. A high level of suspicion is required to make a diagnosis and institute appropriate treatment.

Angiosarcoma of the cervix: a case and literature review.

BACKGROUND: Generally, sarcomas of the female genital tract are rare and angiosarcomas are extremely rare. They usually have poor prognosis and pose serious diagnostic challenges requiring special techniques namely special stains and immunohistochemistry for proper elucidation. METHOD: A case report of a 65 old para 8 (4 alive) widow, 17 years postmenopusal, who presented with history of foul smelling brownish vaginal discharge, progressive weight loss and cervical lesion. She had examination under anaesthesia and biopsy. RESULT: Histopathological result showed features in keeping with angiosarcoma of the uterine cervix. CONCLUSION: Although angiosarcoma of the cervix is very rare, it is occasionally seen in black women in Nigeria.