Institutional and production characteristics among smallholder pig producers in Enugu State, Nigeria.

A study on the institutional and production characteristics of pig farming in Enugu State, Nigeria, was conducted using 80 randomly selected smallholder pig producers. Data were collected by using an interview schedule. Descriptive statistics were used to analyze data. The mean number of pigs owned by smallholder producer was 18. Only 20.0 and 6.3 % of the producers had access to credit and to extension services, respectively. Ninety percent of the respondents practiced intensive management system. The major housing type used by producers was cement brick walls with aluminum roofing sheets (97.6 %). The majority (80 %) of producers reared mostly crossbred pigs and family labor (68.7 %) was most prevalent. Fourteen (50 %) of the 28 routine management practices were always performed by the pig producers. Extension service providers should intensify efforts to provide producers with appropriate management practices and training for effective disease control and improve productivity.

A study of clinician adherence to treatment guidelines for otitis media with effusion.

OBJECTIVES: This study evaluated clinician compliance with recommendations in the 2004 American Academy of Pediatrics (AAP) guidelines on otitis media with effusion (OME) related to documentation of presence, laterality, resolution, persistence, and surveillance for hearing loss or speech delay. METHODS: Retrospective chart review of 363 children aged 2 months to 12 years diagnosed with OME was performed. An electronic survey was used to measure physician awareness and knowledge of specific recommendations in the 2004 AAP clinical practice guidelines on OME. RESULTS: We found a high level of documentation practices at the initial diagnosis of OME (laterality 95%) but poor documentation of follow-up factors (duration 14.9%). Documentation was not found to improve after release of the 2004 AAP guidelines. The survey found physician knowledge lacking in terms of the decibel hearing level stratification of management and antibiotic use, although better for the use of pneumatic otoscopy as a primary diagnostic method and adenoidectomy and myringotomy as accepted treatments. CONCLUSION: Documentation practices of clinicians studied remained unchanged after release of the 2004 guidelines. More research is needed to delineate reasons for poor adherence of pediatric health care professionals to the 2004 OME guidelines, and ways to enhance communication of guideline changes to practicing health care professionals.

Designing a Care Pathway Model - A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway.

INTRODUCTION: Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. THEORY: The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. METHODS: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. RESULTS: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. CONCLUSION: The design addressed existing problems and is an optimisation of the case hospital's pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

Mould and mycotoxin exposure assessment of melon and bush mango seeds, two common soup thickeners consumed in Nigeria.

An examination of the mould and fungal metabolite pattern in melon and bush mango seeds locally produced in Nigeria was undertaken in order to understand the mycotoxicological risk posed to consumers of both of these important and commonly consumed soup thickeners. The variation in mycotoxin levels in graded categories of both foodstuffs were also determined. Aspergillus, Fusarium, Penicillium, Mucorales and Trichoderma were the recovered fungi from the foodstuffs with Aspergillus species dominating (melon=97.8%; bush mango=89.9%). Among the Aspergillus species identified Aspergillus section Flavi dominated (melon: 72%; bush mango: 57%) and A. flavus, A. parasiticus, A. parvisclerotigenus and A. tamarii were the recovered species. About 56% and 73% of the A. flavus isolates from melon and bush mango seed samples, respectively were aflatoxigenic. Thirty-four and 59 metabolites including notable mycotoxins were found in the melon and bush mango seeds respectively. Mean aflatoxin levels (µg/kg) in melon (aflatoxin B1 (AFB1)=37.5 and total aflatoxins=142) and bush mango seeds (AFB1=68.1 and total aflatoxins=61.7) were higher than other mycotoxins, suggesting potential higher exposure for consumer populations. Significantly (p<0.05) higher levels of mycotoxins were found in hand-peeled melon and discoloured bush mango seeds than in machine-peeled melon and non-discoloured seeds except for HT-2 and T-2 toxins which occurred conversely. All melon and bush mango seeds exceeded the 2µg/kg AFB1 limit whereas all melon and 55% of bush mango seeds exceeded the 4µg/kg total aflatoxin EU limit adopted in Nigeria. This is the first report of (1) mycotoxin co-occurrence in bush mango seeds, (2) cyclopiazonic acid, HT-2 toxin, moniliformin, mycophenolic acid, T-2 toxin and tenuazonic acid occurrence, and (3) mycotoxin exposure assessment of both foodstuffs.

[Prognostic value of stress echocardiography by dobutamine combined with atropine]. / Valor prognóstico da ecocardiografia com estresse pela dobutamina associada à atropina.

PURPOSE: To determine the prognostic value of dobutamine-atropine stress echocardiography (DASE). METHODS: We studied 452 consecutive patients at high risk for coronary artery disease, using DASE. They were followed during a mean period of 23 months. RESULTS: There were 9 cardiac deaths and 2 acute myocardial infarctions in the group of patients with positive tests, and there were 2 myocardial infarctions and 1 cardiac death in patients with negative DASE. CONCLUSION: We conclude that DASE reliably identifies patients at high risk for hard cardiac events.

Clinical spectrum of acute otitis media complicating upper respiratory tract viral infection.

BACKGROUND: acute otitis media (AOM) often occurs as a complication of upper respiratory tract infection (URI). OBJECTIVE: to describe otoscopic findings during URI, the full clinical spectrum of AOM, and outcome of cases managed with watchful waiting. METHODS: : In a prospective study of 294 healthy children (6 months-3 years), characteristics of AOM complicating URI were studied. Otoscopic findings were categorized by tympanic membrane (TM) position, color, translucency, and mobility. Otoscopic score was assigned based on McCormick otoscopy scale (OS)-8 scale. RESULTS: during days 1 to 7 of URI, otoscopic findings at 1114 visits were consistent with AOM in 22%; myringitis (inflamed TM, no fluid) was diagnosed in 7%. In AOM episodes diagnosed within 28 days of URI onset, TM position was described as: nonbulging (19%), mild bulging (45%), bulging (29%), and TM perforation occurred in (6%). OS-8 scale showed mild TM inflammation (OS, 2-3) in 6%, moderate (OS, 4-5) in 59%, and severe (OS, 6-8) in 35%. In 54% of 126 bilateral AOM episodes, inflammation of both TMs was at different stages. Of 28 cases of nonsevere AOM managed with watchful waiting, 4 progressed and 3 later required an antibiotic. CONCLUSIONS: AOM is a spectrum of infection that may present at various stages, even in the same child with bilateral disease. During URI, otoscopic changes are observed from the first day of onset. Understanding the wide clinical spectrum of AOM is needed to help with future clinical trial design and development of a scoring system to establish treatment criteria that will minimize antibiotic use.

Persistence of adenovirus nucleic acids in nasopharyngeal secretions: a diagnostic conundrum.

BACKGROUND: Polymerase chain reaction (PCR) assays increase the rate of viral detection in clinical specimens, compared with conventional virologic methods. Studies suggest that PCR may detect virus nucleic acid (NA) that persists in the respiratory tract. METHODS: We analyzed virologic data from children having frequent upper respiratory infections (URI), who were followed up in a longitudinal study. Nasopharyngeal secretions were collected at URI onset and when acute otitis media was diagnosed; virus studies were performed using conventional diagnostics and PCR. Repeated presence of adenovirus by PCR was further studied by sequencing and phylogenetic analysis. RESULTS: Of 581 URI episodes in 76 children, 510 viruses were detected. Of the viruses detected by PCR, 15% were those detected previously; repeated positives occurred most frequently with adenovirus. Sequencing results were available in 13 children with repeated adenovirus detection; the following 4 patterns of infection were identified (16 instances): (1) adenovirus of the same serotype and strain detected continuously (n = 8 instances), (2) adenovirus of different serotypes detected during sequential URI episodes (n = 3), (3) adenovirus of the same serotype but different strains detected during sequential URI episodes (n = 3), and (4) adenovirus of the same serotype and strain detected intermittently (n = 2). CONCLUSIONS: Among children with frequent URIs, repeated positive PCR results for adenovirus NA may represent a new serotype/strain, or persistence of viral NA. Results must be interpreted with caution; clinical correlation and presence of other viruses are important. Further longitudinal studies of children during and after infection are required for better understanding of the clinical significance of positive PCR tests for adenovirus NA in the respiratory tract.

Twin preterm neonates with cardiac toxicity related to lopinavir/ritonavir therapy.

We report twin neonates who were born prematurely at 32 weeks of gestation to a mother with human immunodeficiency virus infection. One of the twins developed complete heart block and dilated cardiomyopathy related to lopinavir/ritonavir therapy, a boosted protease-inhibitor agent, while the other twin developed mild bradycardia. We recommend caution in the use of lopinavir/ritonavir in the immediate neonatal period.

An oncogenic isoform of HER2 associated with locally disseminated breast cancer and trastuzumab resistance.

The HER2-targeted therapy trastuzumab is widely used for the treatment of patients with metastatic breast tumors overexpressing HER2. However, an objective response is observed in only 12% to 24% of patients treated with trastuzumab as a single agent and initial responders regress in <6 months (1-3). The reason for the clinical failure of trastuzumab in this setting remains unclear. Here we show that local lymph node-positive disease progression in 89% of breast cancer patients with HER2-positive tumors involves the HER2 oncogenic variant HER2Delta16. We further show that ectopic expression of HER2Delta16, but not wild-type HER2, promotes receptor dimerization, cell invasion, and trastuzumab resistance of NIH3T3 and MCF-7 tumor cell lines. The potentiated metastatic and oncogenic properties of HER2Delta16 were mediated through direct coupling of HER2Delta16 to Src kinase. Cotargeting of HER2Delta16 and Src kinase with the single-agent tyrosine kinase inhibitor dasatinib resulted in Src inactivation, destabilization of HER2Delta16, and suppressed tumorigenicity. Activated Src kinase was also observed in 44% of HER2Delta16-expressing breast carcinomas underscoring the potential clinical implications of coupled HER2Delta16 and Src signaling. Our results suggest that HER2Delta16 expression is an important genetic event driving trastuzumab-refractory breast cancer. We propose that successful targeted therapeutics for intervention of aggressive HER2-positive breast cancers will require a strategy to suppress HER2Delta16 oncogenic signaling. One possibility involves a therapeutic strategy employing single-agent tyrosine kinase inhibitors to disengage the functionally coupled oncogenic HER2Delta16 and Src tyrosine kinase pathways.

PHARMACOGNOSTIC STUDIES ON Gisekia Pharnaceoides Linn.

Gisekia Pharnaceoides Linn is a diffuse subsucculent, glabrous herb. It is aromatic, aperient and act as powerful anthelmintic in cases of taenia. The plant possesses antibacterial, CNS depressant and anthelmintic activity. The present communication deals with the morphology, anatomy, microscopic constants, Physicochemical constants preliminary phytochemical studies and fluorescence Linn.

Valor prognóstico da ecocardiografia com estresse pela dobutamina associada à atropina / Prognostic value of dobutamine-atropine stress echocardiography

OBJETIVO - Avaliar o valor prognóstico para eventos cardíacos maiores da ecocardiografia com estresse pela dobutamina associada à atropina (EEDA). MÉTODOS - Estudados 452 pacientes consecutivos, com alto risco para presença de doença arterial coronária, acompanhados por um período médio de 23 meses. RESULTADOS - Houve 9 mortes cardíacas e 2 infartos agudos do miocárdio em pacientes com EEDA positiva e 2 infartos e 1 morte cardíaca em pacientes com EEDA negativa. CONCLUSÄO - A EEDA é capaz de identificar pacientes de alto risco para eventos maiores.