RESUMEN
BACKGROUND: Milk and.milk products from cattle in tuberculosis endemic countries like Nigeria where pasteurization is not enforced could be a source of health concerns to the consumers. METHODS: We assessed randomly selected fresh milk from pastoral cattle, cheese samples and sour milk (nono) for the presence of Mycobacterium species through cultural isolation, Multiplex Polymerase Chain Reaction (PCR) and PCR-restriction enzyme analysis (PRA)-hsp65. RESULTS: Out of 269 fresh milk, 295 cheese and 150 sour milk samples screened; 8.30%, 0.34% and 0.00%, respectively were positive for Mycobacterium species. Molecular characterization revealed three M. africanum (fresh milk = 2; cheese = 1) and a high prevalence of Non-tuberculous Mycobacterium (NTM; 89.29%) from fresh milk comprising M. gordonae (n = 12), M. fortuitum (n = 4), M. senegalense (n = 7) and M. avium (n = 1). CONCLUSION: The isolation of M. africanum and NTM species from this study is a matter of public health concern considering the practice of pooling milk from different animals and the consumption of unpasteurized milk which characterize most pastoral communities in Nigeria. Given the predominance of NTM in this study, their potential to cause disease in humans should not be ignored. Urgent measures should also be taken to integrate molecular techniques that will differentiate NTM from members of the M. tuberculosis complex in the epidemiology of tuberculosis in order to avoid misdiagnosis in humans and thereby protect public health.
Asunto(s)
Queso/microbiología , Leche/microbiología , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Micobacterias no Tuberculosas/aislamiento & purificación , Salud Pública , Animales , Bovinos , ADN Bacteriano/análisis , Errores Diagnósticos , Humanos , Incidencia , Infecciones por Mycobacterium no Tuberculosas/microbiología , Nigeria/epidemiología , Micobacterias no Tuberculosas/genética , Reacción en Cadena de la Polimerasa , Estudios RetrospectivosRESUMEN
BACKGROUND: The molecular biological techniques of polymerase chain reaction (PCR) are accurate and rapid diagnostic methods in the epidemiology of Mycobacterium species in humans and animals, especially in developing countries. METHODS: In this study, positive cultures from suspected tuberculous lesions of slaughtered cattle from two abattoirs in north-central Nigeria were subjected to a two-step multiplex PCR technique, based on genus typing and genomic regions of difference (RD). RESULTS: Out of 50 suspected tuberculous lesions cultured, 40 isolates were obtained. Based on genus typing, 32 of the isolates were identified as Mycobacterium tuberculosis complex (MTC), one as non-tuberculous Mycobacterium (NTM) and the remaining seven were unclassified. Using genomic RD multiplex PCR, all the 32 isolates initially identified as MTC were further characterized as M. bovis. CONCLUSION: Our findings show that 80% of positive cultures from suspected tuberculous lesions were identified as M. bovis; hence, re-confirming M. bovis as the main cause of bovine tuberculosis in Nigeria. These results give further credence to the use of PCR-based molecular techniques as excellent complementary epidemiological tools in the tracking of bovine tuberculosis, a zoonotic disease of major public health importance in Nigeria.
Asunto(s)
ADN Bacteriano/análisis , Mycobacterium bovis/genética , Salud Pública , Tuberculosis Bovina/microbiología , Animales , Bovinos , Humanos , Incidencia , Mycobacterium bovis/aislamiento & purificación , Nigeria/epidemiología , Tuberculosis Bovina/epidemiologíaRESUMEN
Two pathogens were employed, Streptococcus faecalis and Candida albicans for the study of the antimicrobial effects of Piper guineense and Phyllantus amarus using agar-well diffusion and disc-diffusion methods. Phytochemical screening of ethanol, cold and hot water extracts detected the presence of tannins, saponins, flavonoids, terpenoids and phlobatannins. Antimicrobial effect of the plant extracts showed that the organic solvent and aqueous solvents of P. amarus were inhibitory to S. faecalis while the extracts of Phyllantus amarus were not inhibitory to Candida albicans. Agar-well determined Minimum Inhibitory Concentration (MIC) values ranged between 3.125 mg/ml and 6.25 mg/ml while the disc diffusion determined MIC values ranged between 6.25 mg/ml and 25.0 mg/ml. The agar-well determined MIC values for the ethanolic P. amarus extracts (3.12 mg/ml) were lower than the corresponding disc-diffusion MIC determined values (6.25 mg/ml-25.00 mg/ml). Bacteriocidal and bacteriostatic effect varied with, solvent type of extract, concentration of the plant extract and the method of the test adopted. The active components of the plant have no antifungal effect on the tested yeast (Candida albicans). These findings are discussed in relation to plant chemicals as a means of disease control and also to the problem of microbial resistance to synthetic drugs.
Asunto(s)
Candida albicans/efectos de los fármacos , Enterococcus faecalis/efectos de los fármacos , Phyllanthus , Piper , Extractos Vegetales/farmacología , Pruebas de Sensibilidad MicrobianaRESUMEN
BACKGROUND: No bariatric operation has been documented to effect adequate weight loss in all patients. Patients with inadequate weight loss or significant weight regain with an anatomically intact short-limb gastric bypass, of which the Fobi pouch operation (FPO) for obesity is a modification, are usually revised to a distal Roux-en-Y gastric bypass (DRYGBP) to enhance weight loss. METHOD: A retrospective review of the charts of all patients who had a revision to a DRYGBP at our Center during an 8-year period was carried out and the findings analyzed. RESULTS: 65 patients who had the FPO had a revision to the DRYGBP. Most were super obese patients who, even though they had lost significant weight, were still morbidly obese. Some were patients who had not lost adequate weight or <40% excess weight, and a small number were patients who requested more weight loss even though they had a BMI of < 35. 15 patients developed protein malnutrition requiring supplemental feeding. 6 required rerevision to short-limb gastric bypass. CONCLUSION: Revision of short-limb gastric bypass to DRYGBP usually enhances weight loss but at a cost of an increased incidence of protein malnutrition.
Asunto(s)
Derivación Gástrica/métodos , Adulto , Anastomosis en-Y de Roux , Femenino , Derivación Gástrica/efectos adversos , Humanos , Masculino , Obesidad Mórbida/cirugía , Desnutrición Proteico-Calórica/etiología , Reoperación , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
BACKGROUND: The effect of transecting vs. stapling the stomach in continuity in the banded gastric bypass (GBP) operation was studied. METHOD: 50 patients, 25 in each group, were enrolled into a prospective study to determine if transecting the stomach vs. stapling it in continuity in performing GBP for obesity decreases the incidence of gastro-gastric fistula formation without increased morbidity. RESULTS: The patient profiles in the 2 groups were very similar. The peri-operative complications included 1 splenic capsular injury in each group, controlled without a splenectomy. There was 1 anastomotic leak in the stapled and 1 bleeding from the cut edge of the bypassed stomach in the transected group, both requiring re-operations in the immediate postoperative period. There was no peri-operative mortality. The percent follow-up after 6 years was 80% and 88% in the stapled and transected groups respectively. The incidence of late complications of solid food intolerance, ventral incisional hernia, cholelithiasis and small bowel obstruction was similar in both groups. There were 8 gastro-gastric fistulas in the stapled group and 1 in the transected group. The reduction in body mass index and percent excess weight loss (66%) were similar in both groups. CONCLUSION: The incidence of gastro-gastric fistula may be reduced in GBP procedures by transecting the stomach as opposed to stapling it in continuity, without an increase in morbidity or mortality or any loss in the effectiveness of the operation.
Asunto(s)
Materiales Biocompatibles Revestidos/normas , Dimetilpolisiloxanos/normas , Derivación Gástrica/instrumentación , Siliconas/normas , Engrapadoras Quirúrgicas/normas , Adulto , Índice de Masa Corporal , Colelitiasis/epidemiología , Colelitiasis/etiología , Materiales Biocompatibles Revestidos/efectos adversos , Dimetilpolisiloxanos/efectos adversos , Femenino , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Fístula Gástrica/etiología , Humanos , Incidencia , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/etiología , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Prospectivos , Reoperación , Siliconas/efectos adversos , Engrapadoras Quirúrgicas/efectos adversos , Resultado del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND: Prosthetic devices have been used in bariatric operations to control the outlet of the gastric pouch and thus maintain weight loss. A complication of these prostheses is erosion or migration into the gastric lumen. The transected banded vertical gastric bypass (TBVGBP) is one of the modifications of gastric bypass. This modification has a silastic ring placed around the pouch to form the stoma. METHOD: The records of patients with band erosion (BE) after this operation were reviewed, to determine the incidence, etiology, management and outcome during a 9-year period. RESULTS: From May 1992 through May 2001, 2,949 primary and secondary TBVGBP were performed through the Center for Surgical Treatment of Obesity, utilizing 3 hospitals. 48 patients (1.63%) were documented to have BE: 40 documented by us and 8 by subsequent treating surgeons or at other facilities. Presenting symptoms were weight regain (18), stenosis or obstruction (17), pain (9), bleeding (7), and 5 were incidental findings. Some patients presented with more than one symptom. 8 were treated expectantly with spontaneous extrusion of the band. 16 bands have been removed endoscopically in 14 patients. 26 patients had open surgical revision, with 12 having band removal only and 14 band removal and revision of either the gastroenterostomy with or without band replacement or conversion to a distal Roux-en-Y gastric bypass (DRYGBP). Two patients who had revision to DRYGBP were re-revised to a longer common limb because of protein malnutrition. Three patients who had revision of the gastroenterostomy with band removal and replacement developed leaks that were managed non-surgically. Two of these re-eroded and the band was removed endoscopically with a subsequent revision to a DRYGBP. There was no death due to BE. CONCLUSION: BE is an uncommon complication of TBVGBP. Infection, previous bariatric operations and surgical technique play a role in BE. BE is best managed by endoscopic removal but can be treated expectantly or by open surgical intervention. Band removal without replacement or revision to DRYGBP may result in weight regain.
Asunto(s)
Derivación Gástrica/instrumentación , Falla de Prótesis , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Humanos , Obesidad Mórbida/cirugía , Prótesis e Implantes , ReoperaciónRESUMEN
BACKGROUND: Many patients who qualify for obesity surgery have a moderate to large panniculus (grade 1-5). They can benefit from panniculectomy done concurrently with gastric bypass (GBP) or subsequently after significant weight reduction, usually 18 months after the GBP. METHOD: Over the last 8 years, 2,231 bariatric operations were performed at the Center. 577 panniculectomies were done, with 428 (74.2%) concurrent with the GBP and 149 (25.8%) subsequent to the GBP. RESULTS: The redundant pannus weighed from 5 to 54.5 kg. Wound problems occured in 15.1% of panniculectomies. Transfusion was necessary in 1.9%. Hospital stay was 4 to 5 days, and was no greater than in patients that underwent the GBP alone. Those with grades 3-5 suffer more back-pain and problems of hygiene resulting from panniculitis. CONCLUSION: A very redundant panniculus compounds the patient's physical, social and emotional problems. Where cardiopulmonary and other medical status are satisfactory, a panniculectomy may be offered to patients with a symptomatic panniculus at the time of bariatric surgery, as a physically beneficial and cost-effective adjuvant.