Friday, February 26, 2021

Iris Publishers- Open access Journal of Archives of Clinical Case Studies | ABCD…Airway, Breathing, Circulation (and don’t forget Differentials)

 


authored by Ashok Handa*

Abstract

Male patients over the age of 65, presenting with acute abdominal pain should be managed as a potential ruptured abdominal aortic aneurysm (AAA), until proven otherwise. Ruptured AAA is a commonly missed life-threatening diagnosis. This paper aims to recap over the diagnosis and management to aid doctors in training in their decision making.

Keywords:AAA; Aneurysm; Rupture; Epigastric pain; Collapse

Main Text

History

A 69-year old man presented to the emergency department with a three-week history of general malaise and diarrhoea, on a background of chronic kidney disease (baseline creatinine 250 μmol/L) and an abdominal aortic aneurysm (AAA;5cm). He was admitted with acute kidney injury (creatinine 1500 μmol/L) presumed to be secondary to severe hypovolemia, and commenced emergently on hemofiltration requiring heparinization, as well as aggressive fluid resuscitation. A few days later, he developed sudden onset of epigastric pain and syncope, with increasing abdominal girth and decreasing haemoglobin. Surgical review found a tender abdomen with a pulsatile epigastric mass, however he continued to be hydrated and anti-coagulated, as definitive diagnostic imaging and vascular referral was delayed until the following morning, some 5 hours later.

Computed tomography angiography (CTA) of the abdomen showed a large infrarenal AAA, measuring 7.5 cm in maximal anterior-posterior diameter (Figures 1 & 2). Typical features of an aortic aneurysm include the calcified intimal layer of the arterial wall and the eccentric thrombus lining of the arterial lumen..

Of greater concern is the presence of an apparent contained rupture indicated by the presence of a significant retroperitoneal swelling due to a large contained haematoma, in this case unusually bilaterally and anteriorly displacing the posterior peritoneum; this can be verified by indicative Hounsfield’s units [1]. Quite remarkably, contrast can also be seen jetting from the intraluminal space into the haematoma anteriorly. The former is sufficient to demonstrate a ruptured aneurysm that has subsequently tamponaded, however the latter suggests ongoing bleeding into the retroperitoneal space.

Key Points

This case demonstrates that a high index of suspicion must always be exercised when patients over 65-years present with a history of epigastric pain and collapse. Certainly, a ruptured aneurysm constitutes one of several important differentials that must always be suspected and rapidly excluded (Table 1). In this case, a ruptured AAA could have been seen using a bedside ultrasound, including a FAST (focused assessment with sonography for trauma) scan [2]. Otherwise, in the setting of such severe acute renal failure, even a non-contrast CT would have sufficient features to suggest the diagnosis.

Management

Management of ruptured aneurysms includes early assessment and management with subsequent rapid access to definitive treatment (Table 2). If suspected or confirmed, all patients should have adequate vascular access, and “permissive hypotension” is key, such that low systolic blood pressures (>90mmHg) are tolerated as long as the Glasgow Coma Scale remains 15 and ST-T segment remains unchanged on electrocardiography. If the patient becomes haemodynamically unstable, volume resuscitation should be implemented cautiously with packed red blood cells, either previously cross-matched or O-negative if a crossmatch is not available. Simultaneously, early referral and rapid transfer to the nearest Vascular Unit should be facilitated [3].

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Iris Publishers- Open access Journal of Archives of Clinical Case Studies | Assessment of Umbilical Cord Milking on the Outcome of Term and Preterm Infants, Controlled Clinical Trial

 



authored by Omima T Taha*

Abstract

Background: Early cord clamping and cutting of the umbilical cord at birth may contribute to anemia in infancy thus it can deprive the infant of 60 to 100 ml of whole blood representing 30-50 mg/kg of iron. The umbilical cord milking is a safe technique.

Aim of the study:b> The aim of the study to assess the effects of umbilical cord milking as compared with early cord clamping on hematological parameters (hemoglobin, packed cell volume, bilirubin and ferritin) among term and near term neonates.

Materials & methods:b> This study was carried out as randomized, controlled clinical trial. The subjects were divided randomly into two groups (200 neonates who the cord was milked after cutting and clamping at 25 cm from the umbilicus as a study group and 200 neonates who were received early cord clamping without milking as a control group) in term and near term infants.

Results:b> the hemoglobin level significantly increased in study group at 12, 48 hours and 6 weeks of birth (16.9, 16.9 &15.5 gm/dl) as compared with control group (16.2, 16.2 &15.0 gm/dl) and serum ferritin level significantly increased in study group at 6 weeks of birth (135.4 μg/ml) as compared with control group (128.8 μg/ml). The hematocrit level at 12 and 48 hours after birth was significantly higher in study group (p= 0.016). Serum bilirubin was slightly elevated in study group but there were not any infants of them needed phototherapy.

Conclusions: Umbilical cord milking improved hemoglobin and iron status in term and near term neonates.

Keywords: Delayed cord clamping; Term and preterm; early cord clamping; Umbilical cord milking

Introduction

Current evidences suggest that the practice of immediate clamping and cutting of the umbilical cord at birth may contribute to anemia in infancy [1]. Immediate clamping can deprive a full term infant of 60 to 100 ml of whole blood representing 30-60 mg/ kg of iron [2]. The low tech-low cost” intervention of delayed cord clamping can reduce anemia in infancy by enhancing placentalinfant transfusion at birth. Delayed cord clamping (DCC), in which the cord is clamped after a short delay after birth, and umbilical cord milking (UCM), in which cord blood is stripped or milked toward the baby, have been shown to prevent anemia in infants [3].

These procedures allow the transfer of additional blood volume and hemoglobin (Hb %) from the placenta to the neonate. This process can improve the infant’s iron stores, which may be of particular value in settings in which nutrition is poor [4]. However, a recent meta-analysis reported that delayed cord clamping is only marginally beneficial in reducing anemia in term neonates [5]. Moreover, there are concerns about delayed initiation of resuscitation and increased incidence of hypothermia among preterm neonates undergoing these procedures [6]. Also, the risk of maternal bleeding makes a delay in cord clamping at the time of cesarean section challenging [3].

One clinical trial and a secondary analysis from the same trial have compared milking of a 20 cm segment of the umbilical cord versus immediate umbilical cord clamping on preterm singleton infants born (> 34 weeks ) of gestation. Significant findings in the clinical study included higher initial Hb concentration, mean systemic blood pressure, reduced need for blood transfusion and higher urine output during the first 72 hours in the group that underwent umbilical cord milking compared with the group that underwent umbilical cord clamping. Also the group that underwent umbilical cord milking required a shorter duration of supplemental oxygen and mechanical ventilation [7].

Recent studies have demonstrated that UCM and DCC result in comparable increases in Hb in premature neonates. However, there are insufficient data about the effect of UCM in full-term neonates. The aim of the present will be to investigate the effects of umbilical cord milking in term (gestational age ≥37 - 40+6 weeks) and near term infants (gestational age >34- 36+6 weeks) as regard hematological values, incidence of anemia and hemodynamics [8].

Patients and methods

This is randomized, controlled clinical trial study conducted at Obstetrics and Gynecology department of Suez Canal University hospitals among all pregnant women of fetal age > 34 weeks for cesarean delivery and randomly divided into two groups:

1) Study group: enrolled neonates were allocated to umbilical cord milking technique.

2) Control group: enrolled neonates were allocated to early umbilical cord clamping without milking technique.

Exclusion criteria include had Infants with congenital anomalies, intrauterine growth restriction, Infants with short umbilical cord length (<25 cm) , Delivery by cesarean section for fetal distress, Rhesus factor negative mothers, Cord prolapsed, Hydropesfetalis, Placenta previa, Placental abruption, Cord abnormalities as true knots, multiple gestation and Women with chronic medical illness (diabetes mellitus, Hypertension, cardiac diseases) or pregnancy related illness (gestational diabetes mellitus, preeclampsia). And this study estimated sample size was: n=400 (200 patients for each group).

Study procedure

An informed written consent was obtained from each participant before enrollment in the study. All enrolled women before lower uterine segment cesarean section delivery, were subjected to the following:

1) Full history (age, LMP, socioeconomic status)

2) Maternal weight

3) Maternal high and then BMI

4) Maternal hemoglobin

5) History of medical disorders, history of anemia, and history of antenatal iron supplementation and

6) Gestational age based on date of last menstrual period and documented and proved by first trimester ultrasonographic examination.

In all cases after birth, the neonates were held on the thighs of mother in cesarean section while the umbilical cord was cut and clamped.

In the study group

The cord was cut at approximately 25 cm of length from umbilical stump within 30 seconds of birth (early clamping). Then the neonate was placed under the radiant warmer. The umbilical cord was raised and milked from the cut end toward infant 3 times with speed at 10 cm/ sec, and then clamped 2-3 cm from the umbilical stump.

In the control group

The umbilical cord was clamped early (within 30 seconds) near the umbilicus and was cut without doing cord milking [3].

After clamping the cord, the neonates of both groups were received the routine care by the attending pediatrician according to standard protocols of neonatal post-delivery newborn care [9].

All neonates of both groups were evaluated for the following:

a) Before discharge of mother and infant hemoglobin and packed cell volume was measured at first 12 hours and 48 hours of postnatal life.

b) Serum bilirubin was measured at 48 hours of postnatal life.

c) Assessment of hemodynamic parameters of heart rate, respiratory rate and blood pressure in the first 48 hours of postnatal life (30 min, 12 hours and 48 hours).

d) All neonates were followed up till age of six weeks and a follow up visit was scheduled for all infants with evaluation of hemoglobin, and serum ferritin at that visit for assessment of incidence of anemia.

Statistical analysis

Gathered data was processed using SPSS version 15 (SPSS Inc., Chicago, IL, USA) 21st edition (2013). Quantitative data was expressed as mean±SD while qualitative data was expressed as numbers and percentages (%). Student t test and ANOVA test was used to test significance of difference for quantitative variables and Chi Square were used to test significance of difference for qualitative variables. A probability value of p-value < 0.05 was considered statistically significant.

Results

As shown in (Table1) there were not significant differences in the baseline demographic characteristics of two groups. Most of maternal age was < 35 years (64% in study group & 56% in control group), were house wife (93.5 % in study group &89.5% in control group) and lived in Urban (66%in study group & 56% in control group). Most of the mothers in this study their socioeconomic status were moderate 53% of mothers in early cord clamping group and 48% of mothers milking group and it was no significant difference in both groups..

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Wednesday, February 24, 2021

Iris Publishers- Open access Journal of Annals of Urology & Nephrology | Albuminuria in the Elderly More than a Marker of Renal or Cardiovascular Disease

 



authored by Joshua I Barzilay*

Background

Albuminuria - the presence of more than 30 mg of alumin per one gram of creatinine in the urine - is highly prevalent in older adults. Based on data from the NHANES III study, more than 20% of adults over the age of 70 years have albuminuria, while among similarly aged adults with diabetes the prevalence reaches 40% [1,2]. To date, most studies have examined albuminuria as a risk factor for cardiovascular disease. We too have found albuminuria to be associated with a 70-80% increased prevalence of cardiovascular disease [3] and a doubling of mortality risk (mostly cardiovascular in nature) [4] as compared to older people without microalbuminuria.

More recently, we and others have shown that albuminuria is associated with other diseases of older age. The two most outstanding diseases of older age associated with albuminuria are hip fractures and dementia. In one study of ours [5], a doubling of albuminuria was significantly associated with hip fracture risk in women (hazard ratio, 1.12, 95 % CI, 1.001-1.25), but not in men. In two other studies, we found a borderline lower bone mineral density in association with albuminuria in men [5, 6]. We also reported that participants with baseline albuminuria had a significantly increased risk of hip fracture compared with participants without albuminuria (adjusted hazard ratio=1.36 [1.01, 1.84], P=0.05) [7]. Last, it is known that up to 40-50% of people with hip fractures have cognitive impairment (such as dementia or mild cognitive impairment [a possible precursor of dementia). In our analyses we found that the association of cognitive impairment with hip fracture risk was attenuated with adjustment for the presence of albuminuria [8]. Stated differently, albuminuria played a role in mediating the association of hip fracture risk with cognitive impairment. Given the above findings, it would appear that albuminuria is more than a disorder of the glomerulus or a cardio-renal risk factor.

Several studies have shown albuminuria to be related to other disorders of aging. These include reduced physical performance, as measured by gait speed and grip strength [9]; dementia [10]; reduced lung function, as measured by one second forced expiratory volume [11]; microvascular cardiomyopathy [12]; abnormal reactivity of small [13] and large blood vessels [14]; and abnormal retinal findings in people with diabetes [15]. Taken together, these findings suggest that albuminuria may be an indicator of enhanced physiological aging beyond its known association with cardiovascular risk, and a possible marker of a systemic functional disorder of the microvasculature [16].

Present Study

We reasoned that if albuminuria is indeed a marker of aging or of enhanced susceptibility to illness, then hospitalization rates would be higher in people with albuminuria as compared to people without albuminuria. In addition, we hypothesized that rates of hospitalization would be increased as well for a wide variety of disorders, especially in certain domains of aging—for example, heart failure, injury, cancer and infection. Finally, given the adverse association of diabetes on health, we hypothesized that people with albuminuria and diabetes would have a higher rate of hospitalization than people with albuminuria but without diabetes. To do such an analysis, we examined the Cardiovascular Health Study (CHS) data set. CHS is a follow up study of nearly 6000 Caucasian and African American adults (age >65 years at baseline) from four US research centers who have been passively followed for health outcomes over several decades. The cohort is well characterized and has served as a source for more than 1500 academic papers. Using incident hospitalization rates as a measure of outcome, we found albuminuria to have a pervasive and deleterious association on the health of older adults across a broad range of diagnoses. Hospitalization rates were 39% higher among people with albuminuria compared to people without albuminuria, even after adjustment for hypertension and diabetes (the main determinants of albuminuria), and adjustment for concomitant estimated glomerular filtration rate. The number of hospital days was increased by ~60% as well. Circulatory disorders (e.g., heart failure) accounted for the largest number of hospitalizations (~30%). Most hospitalizations, however, were not for circulatory disorders. Infectious, endocrine (e.g., diabetes), injury and respiratory (e.g., pneumonia) hospitalizations were increased 40- 90%. Cancer risks were also increased, but not significantly so. Genitourinary disorders, in particular, were increased by ~40% in men and ~75% in women. Diseases of the male genital organs (ICD 9 codes 600.0-608.0) were increased. Of interest, the presence of diabetes did not enhance the risk of being hospitalized for any of these disorders. From this latter finding it may be deduced that the effect of diabetes on hospitalization risk is mediated in large part through its association with albuminuria, not from diabetes per se. Also, of interest, was the fact that albuminuria did not significantly increase the risk of hospitalization for chronic kidney disease, though it did have a statistically significant association with acute kidney injury. For more specifics, the reader is referred to our article (see reference 1).

Conclusion

In conclusion, there are two take away messages from our study for the urologist and the nephrologist. One, albuminuria is most likely a manifestation of a systemic disorder that impacts the health of older adults. It is not just a renal microvascular disorder. Second, albuminuria is a risk factor for hospitalization. Additional attention to people with albuminuria, to optimize their health, may lead to cost savings.

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Iris Publishers- Open access Journal of Annals of Urology & Nephrology | Invasive Mole with Nephrotic Syndrome: A Case Report with Literature Review

 


authored by Yu Zhao*

Abstract

Nephrotic syndrome(NS)associated with invasive mole (IM) is uncommon. In this report, we present a case of NS that developed from IM. A 22-year-old woman was admitted to our hospital because of left lower slightly abdominal pain with sparing vaginal bleeding and NS. Transabdominal ultrasound examination confirmed a regular shape, border clearance component with a typical honeycomb pattern in the left side of the uterus. The curettage was performed for her two times. A renal biopsy was performed and suggested minimal change disease (MCD). Interestingly, when the IM was removed, her NS was complete remission. We report the rare case to highlight the importance of considering that NS associated with IM should be kept in mind during management of a woman of childbearing age with renal involvement.

Keywords: Invasive mole; Nephrotic syndrome; Gestational trophoblastic neoplasia; hydatidiform mole

Introduction

Invasive mole (IM), a malignant tumor, is a form of gestational trophoblastic neoplasia (GTN), which are characterized by invasive hydatid tissue into the myometrium or distant metastasis [1]. The most common transfer locations for IM are the vagina, lungs and brain. The most common symptom of IM is irregular vaginal bleeding, but further symptoms caused by bleeding in the metastases may also be detected, such as hemoptysis and neurological symptoms [2]. Myometrial invasion, swollen villi and hyperplastic trophoblast are often considered to be the pathological features of IM. IM′s clinical diagnosis mainly depends on medical history, clinical symptoms, laboratory tests and examination using imaging. Pathological results are the most essential basis for diagnosis. Good prognosis based on timely and comprehensive chemotherapy [3]. In this report, we describe a patient presenting with NS in which the underlying diagnosis of IM was made by a combination of chance and a high level of clinical suspicion, and to improve patient care amongst internists by heightening awareness of this uncommon condition.

Case Report

A 22-year-old woman was admitted to our hospital because of slight left lower abdominal pain with sporadic vaginal bleeding. She reported amenorrhea for 37 days and had a positive urine β-hCG test. She had no obstetric history, with menarche at 13 years of age, regular menstruation and no pregnancy history. She was admitted to the department of nephrology because of NS and was treated with hydrochlorothiazide, but her oedema was aggravated. Her urine output decreased to 500 ml/day. She had no fever, erythema, joint pain or alopecia. Physical examination at admission revealed mucocutaneous pallor and generalized oedema. A soft elastic, non-tender palpable mass, approximately 10 cm in diameter, was identified in the lower left part of the abdomen. A vaginal examination showed a normal vulva and vagina. Laboratory examination showed the following: haemoglobin 93 g/L, total protein 50 g/L, albumin 28 g/L, serum β-hCG 15400 mIU/mL, urine β-hCG 34140 mIU/mL, and urine protein 3.5 g/24 h. Screening tests for hepatitis A, B, and C were negative. Testing for antinuclear antibodies, dsDNA antibodies, anticardiolipin antibodies and antineutrophil cytoplasmic antibodies were negative. Due to increased abdominal pain and oedema in the patient, haemoglobin was decreased to 81 g/L. Ectopic pregnancy was highly suspected and she was urgently transferred to the gynaecology department. A trans-abdominal ultrasound examination confirmed a regularshaped, clear-border mass with a typical honeycomb pattern on the left side of the uterus. An abdominopelvic computed tomography scan confirmed a substantial mass; ovarian cystadenocarcinoma and trophoblastic neoplasia of the uterus were considered. Suction curettage was performed twice. Gross suction curettage specimens showed placental tissue with different-sized vesicles that resembled a cluster of grapes, with the absence of a foetus. A light micrograph showed complete hydatidiform mole (III), and hydatidiform mole with myometrial invasion was confirmed by ultrasonography. A renal biopsy was performed. Light microscopy showed that the glomeruli were normal, without mesangial widening. The capillary loops were open and had normal in appearance. Immunofluorescence staining revealed that immunoglobulin G (IgG), IgA, IgM, C3, fibrinogen and C1q were all negative. Electron microscopy revealed that the thickness of the basement membrane was within the normal range, and diffuse foot process fusion was observed. The pathological findings suggested minimal change disease (MCD). After suction curettage, facial oedema and pretibial pitting oedema significantly subsided. Her urine output increased to 1000 ml/day, and she lost weight. Her abdominal pain was obviously eased, and the vaginal bleeding was clearly lessened. Serum β-hCG levels declined to 2068 mIU/mL. Blood chemistry tests revealed a total protein level of 54.3 g/L and albumin level of 32.6 g/L. 5-FU single chamber chemotherapy was administered. One month later, her serum β-hCG declined to 7.7 mIU/mL, her urine β-hCG decreased to 5 mIU/mL, her total protein was 57.7 g/L, her albumin was 41.9 g/L, and her urine protein was 0.56 g/24 h. She has been regularly followed for the last twenty-six months and has remained free of clinical symptoms.

IM is responsible for the most cases of localized GTN1, which is one style of Gestational trophoblastic disease (GTD). IM occur in approximately 15% of patients with complete hydatidiform moles, while in other types of pregnancies it occurs less frequently [4]. In China, the incidence rate of IM following pregnancy is 0.94- 1.30% [5]. IM, sometimes, which are penetration of the peritoneum or adjacent parametria or the vaginal vault, are distinguished by excessive trophoblastic overgrowth and extensive penetration by trophoblastic elements, including whole villi, deep into the myometrium. As a result of the improved economy and the decline in overall birth rate, the prevalence of IM has declined over the past 30 years. However, IM has malignant tumor behavior and can undergo extensive metastasis. If not treated in time, it can be converted into choriocarcinoma with poor prognosis, which can lead to significant morbidity and mortality. The common causes of secondary adult female NS are systemic lupus erythematosus, hepatitis B, and Henoch-Schonlein purpura, etc. We report additionally the rare case about NS associated with IM in a 22-year-old unmarried woman. Myometrial invasion, swollen villi and hyperplastic trophoblasts are frequently considered to be pathological features of IM; however, the majority of IM cases are diagnosed clinically rather than pathologically [6]. Based on the clinical manifestation and correlation examination, we diagnosed NS associated with IM. From the treatment situation, with a nearly recover in laboratory test results after a week of the suction curettage. Our patient was consistent with the above references in clinical manifestation and prognosis. We thought the NS associated with IM, probably is the paraneoplastic phenomenon. Because when the suction curettage was administered, the NS secondary to the IM was general remission. It is not clear that the precise pathogenesis of relationship between the IM and NS. Rong YJ [7] showed that the pathogenesis may be due to maternal and trophoblast cells had abnormal immune response with immune complex deposition in glomeruli, causing increased permeability of the glomerular filtration membrane, which led to a series of pathophysiological changes. The placenta releases trophoblastic cells with cytotoxic characteristics and the capacity to cause secondary glomerular endothelial damage by Brown DW reported [8]. The NS associated with IM, probably is the paraneoplastic phenomenon. IM has malignant potential for local invasion and distant metastasis [8] and is probably capable of causing a paraneoplastic phenomenon, which is noted prior to the diagnosis of the malignancy. It is possible that the placenta releases trophoblastic cells with cytotoxic characteristics and the capacity to cause secondary glomerular endothelial damage. A review of the literature reveals that only 7 cases on NS accompanied by hydatidiform moles are shown in Table 1 [9-14].

Pathologic finding suggested respectively, pre-eclamptic nephropathy 9, 12, membrano proliferative glomerulonephritis10, focal segmental glomerulosclerosis [12] and MCD [13]. NS was the prominently manifestation, endothelial cell swelling or swollen epithelial cells with diffuse foot process fusion were the renal pathological presentation. Interestingly, when the IM was removed, the IM was complete remission. According the literatures, we did not find a tendency about pathology of NS associated with hydatidiform moles. Pathologic finding of our patient was MCD. We can actively infer that IM had a tendency to be associated with MCD. Recently, although MCD may occur in association with haematologic malignancies, lymphoma or leukaemias [15], rare cases of MCD associated with solid tumors have been reported. We report additionally the rare case to highlight the importance of considering that NS associated with GTD should be kept in mind during management of a woman of childbearing age with renal involvement, pregnancy history and menstrual history should be considered as an indispensable inquiry for the choice of correct treatment measures.

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Tuesday, February 23, 2021

Iris Publishers- Open access Journal of Nutrition & Food Science | Survey of Mycotoxin in Brazilian Corn by NIR Spectroscopy-Year 2019

 


authored by Carlos Augusto Mallmann1*

Abstract

Corn is commonly attacked by fungi and mycotoxins. The negative impacts caused by these toxic metabolites justify the use tools that enable constant monitoring and provide a quick feedback. The natural occurrence of mycotoxins, fumonisins B1+B2 (FUM), Aflatoxin B1 (AFB1), Deoxynivalenol (DON) and Zearalenone (ZEN) was investigated through Near Infrared Spectroscopy (NIR) in 3,069 spectra of corn samples from several Brazilian states throughout 2019. FUM was the most prevalent (98.2%) mycotoxin found in this study, followed by AFB1 (20.3%), DON (9.6%) and ZEN (5.9%). The annual average of FUM (B1+B2) was 2,092 μg kg-1 and the average in positive samples was 2,130 μg kg-1, with variations in some periods of the year. The annual mean of AFB1 was low, 1.8 μg kg-1, and the average in positive samples was 8.9 μg kg-1. As well as the prevalence, the concentrations of DON and ZEN were relatively low: 39 and 6 μg kg-1, respectively. These findings show the importance of mycotoxicological monitoring to avoid economic losses and to spare animal health. The use of rapid diagnostic tools, such as NIR, allows decision making in an agile and efficient way.

Keywords: Zea mays L; Aflatoxins; Fumonisins; Online; Monitoring; Risk

Introduction

Corn (Zea mays L.) is one of the most cultivated cereals around the world. It has a relevant role in economy and society due to its high nutritional value and productive potential [1,2]. Brazil is the third major producer of corn, after the United States and China [3]. Most Brazilian states are corn producers, but the largest volume of the cereal is harvested in the mid-west, the southeast and the south regions. Considering the 2018/2019 corn harvest, the leading state was Mato Grosso (31.3%), followed by Paraná (16.7%) and Goiás (11.5%) [4]. The main destination of this commodity is the domestic market, with the animal feed sector being its largest consumer [5].

Brazilian climatic conditions in association with harvest, storage and transport issues, can cause fungal growth and mycotoxin production [6-8]. Corn is widely attacked by fungi and mycotoxins because it is a highly nutritious substrate for their development [9-11]. The main mycotoxins found in Brazilian corn are those of the Aspergillus genus that produce aflatoxins (AFBs), and those of the Fusarium genus which produce fumonisins (FUM), zearalenone (ZEN) and deoxynivalenol (DON) [12,13]. Several studies have investigated these toxic substances due to their global economic impacts and toxic effects in humans and animals [14].

Mycotoxins can cause several deleterious health effects, mainly due to their anabolic, estrogenic, carcinogenic, mutagenic and teratogenic properties [15]. There are approximately two dozen known FUM; however, FB1, FB2 and FB3 stand out for their toxic effects in humans and animals [16,17]. FB1 is the most toxic and abundant of them all, representing about 70% of the total concentration of FUM in naturally contaminated food and raw materials, followed by FB2 and FB3 [18]. In horses, FUM cause hemorrhagic‐liquefactive brain lesions (equine leuko encephalomalacia) [19], while in swine they trigger pulmonary edema [20]. In humans, these toxins are associated with eso phageal cancer [21,22].

AFBs (AFB1, AFB2, AFG1 and AFG2) are currently the most important mycotoxins [23] for inducing a drop in animal performance, in addition to their carcinogenic, teratogenic, hepatotoxic and immunosuppressive risk [24,25]. As a result, AFB1 was classified in class 1 of human carcinogens by International Agency for Research on Cancer (IARC) [26]. ZEN and its biotransformation products are well known for their impact on reproduction parameters, especially in sows [27,28]. Growing animals may show flaws in reproductive parameters and decreased semen quality [29]. DON is associated with digestive problems, causing vomiting, refusal to eat and lesions in the gastrointestinal tract, as well as interference with zootechnical parameters [30,31].

Due to their negative impacts, monitoring of these toxic substances must be continuous. There are several sensitive, specific and reliable analytical methods used in the detection of mycotoxins in feed and food, such as Liquid Chromatography coupled to mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assays (ELISA) [32,33]. Currently, optical methods, such as Near Infrared Spectroscopy (NIR) [34,35], have made great headway for being agile and non-destructive technologies [34]. In view of the above, the present investigation aimed to assess the prevalence and average of mycotoxins in Brazilian corn through NIR prediction along 2019.

Materials and Methods

Three thousand and sixty-nine corn samples from ten states of Brazil were predicted throughout 2019. The spectra originated from routine samples predicted through the Olimpo platform, a web service of Pegasus Science Lt da [36], connected to different NIR equipment located in various Brazilian laboratories and industries. The samples were previously ground in a sampler miller with a sieve size of 1mm, homogenized and then read on the NIR equipment.

Subsequently, the corn samples were predicted for the presence and concentration of FUM (B1 and B2), AFB1, DON and ZEN. These assessments resulted in 6,134 predictions of FUM (B1 and B2), 3,069 of AFB1, 3,029 of DON and 2,971 of ZEN, amounting to 15,203 analyses. The LOQ (in μg kg-1) for FB1, FB2, AFB1, DON and ZEN were 200, 200, 5, 350 and 30, respectively. The statistical evaluations were carried out by applying descriptive statistics (mean, range and prevalence) using the Stat graphics® Centurion XV software (Statgraphics Centurion 15.2.11, Manugistics Inc., Rockville, MD).

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Iris Publishers- Open access Journal of Nutrition & Food Science | Prospects and Challenges of Postharvest Losses of Potato (Solanum Tuberosum L.) in Ethiopia

 



authored by Abebe Chindi Degebasa*

Abstract

Potato is known as a semi-perishable commodity and storage of both seed and ware potatoes which is problematic for most producers and consumers. The losses could be occurred during harvesting, sorting, cleaning, handling and packing, transportation, storage, distribution or marketing and processing. In Ethiopia most of the potato produced is mainly consumed as boiled, salad and stew preparations. Use of alternative recipes like french fries, crisps, flakes, flours, starches, pre-peeled potatoes and various snack food items has not developed well. Thus, the study was conducted to evaluate improved seed and ware potato storage, local farmers’ practices such as; storing under bed, storing in pit and extended harvesting for resource poor potato growers in central highlands of Ethiopia. The experimental design was complete randomized design (CRD) with three replications using two improved potato varieties. Improved ware potato storage diffused light store (DLS) were demonstrate to farmers through farmers field school (FFS) and farmers research group (FRG) participatory research approaches. FFS and FRG were organized from four districts and regular assessments were done for 105 days of storage period. From this study non-significant storage losses were observed. However, for the qualitative data, there were significant difference between the improved and the farmer’s/local storage practices in terms of taste, color change, sprouting and pest infestation.

The result revealed that storing potato on the ground under beds exposes the tubers for rapid sprouting, color and taste changes within few days. Especially in Haramaya district the tubers stored in the ground pits, according to the farmers practice, have rotten and excessively sprouted almost totally unlike the ones put in improved structures. On the other hand, extended harvesting has exposed the tubers for pest infestation. Even though, it is possible to use potato for ware through extended harvesting for some months, the losses due to pest infestation was extremely high. Thus, extended harvesting and other farmers’ practices are not effective for handling ware potato for long-term storage. It seems that the introduced improved seed and ware potato storage were the only effective option for potato grower farmers in central highlands where the temperature and relative humidity are suitable using locally constructed storage structure. Therefore, it was with great enthusiasm that the participated farmers highly interested with this improved practice and accepted to use the improved seed and ware potato storage structures for prolonged time and exploits the potential of this crop for food and nutrition security.

Keywords: Postharvest; Farmers field school; Farmer research Group; Ware potato storage

Introduction

Potato (Solanum tuberosum L.) ranked as the third most important food crop following rice and wheat and is consumed by over a billion people throughout the world [1,2]. Potato serves as a food and income security source and provides important nutrients. Potato has a high content of carbohydrates, significant amounts of quality protein, and substantial amounts of vitamins, especially vitamin C [3]. Potato production is expanding strongly in many developing countries accounting for more than half of the global harvest [4]. In Ethiopia, root and tuber crops are the third largest national food commodity, after maize and wheat, in terms of production [5,6]. Potato promises higher calorie per unit area production potential than any grain and can be produced, stored, and consumed without major technological inputs. Recent trends indicate that potato production in densely populated developing nations is on the rise [7]. According to [1] half of the total production occurs in developing countries that makes potato the third most important food crop globally [8,9] suggested that the high yield potential of potato per hectare of arable land, good nutritive value, and cooking versatility have resulted in a threefold per capita potato consumption in the developing world, from 6 kg capita_1 year_1 in 1969 to 18 kg capita_1 year_1 in 2009. The crop’s short cropping cycle allows it to serve as a hunger-breaking crop, and makes it suitable for intercropping and double cropping, especially in cereal-based production systems in Africa and Asia [10,11].

However, production of potato tuber is constrained by pre-harvest factors and postharvest losses, which in turn limit the volumes of good quality, produce reaching consumers [12] reported that potato is a source of food and cash income, playing an important role in the rural livelihood system of the densely populated highlands of sub-Saharan Africa. Ethiopia is one of the major potato producing countries in Africa as 70% of its arable lands in the highlands are suitable for potato production [13]. Potato being cultivated for more than 150 years in Ethiopia, it grows dominantly in the Northern Central and Eastern highlands of the country [12] and the recent reports of [14] stated that its production area has reached about 0.3 million ha producing more than 3.66 million tons in both Meher and Belg seasons.

According to [15], in 2017, potato yielded up to 20 tons/ha worldwide on average, whereas maize, rice and wheat had an average yield of 5.7 tons/ha, 4.7 tons/ha and 3.5 tons/ha, respectively. Potato is one of the most productive food crops, producing more dry matter (food) per hectare than cereals or any other cultivated plant. As such, it can significantly contribute to food and nutrition security. A hectare of potatoes provides up to four times the calories of a grain crop and up to 85% of the plant is edible human food, compared to around 50% in cereals. Potato produces more food per liter of freshwater used through irrigation than cereals and thus is more sustainable to mitigate the effects of climate change. Over the past 20 years, potato production has significantly increased in developing countries in Asia, Africa and Latin America by 89, 14.5, and 4 million tons, respectively. In Africa, the potato production and harvested areas more than doubled over the last 20 years. Average potato consumption in East Africa has grown by approximately 300% over the past two decades, yet yields are low. The major bottlenecks to higher potato yield and reliable supplies in Africa are limited or no access of farmers to high quality seed tubers of improved varieties, poor crop husbandry practices (e.g. disease and soil fertility management), and poor post-harvest management [16]. A promising alternative to traditional clonal propagation of tetraploid potatoes is the production of hybrid true potato seeds: planting 10 hectares, for instance, takes just 200 grams of easily transported true seeds, compared with 25 tons of perishable seed-tubers. It was introduced in Africa at the end of the 17th century by Christian missionaries through the formation of small plantations. Soon after, potatoes quickly became part of the feeding habits of both rural and urban populations. As in Europe, potato production could contribute in the fight against food insecurity in the sub-Saharan African countries [17].

So far, different attempts have been made to come up with an appropriate agronomic and pre-harvest management to increase potato tuber productivity in Ethiopia [18-20]. The major constraint of potato production in Ethiopia includes poor quality seed, poor agronomic practices, poor pre and post-harvest handling, marketing and transportation systems. The percentage losses of potato due to post harvest handling are estimated to be 20-25% [21]. Potato production is seasonal, and it lack proper storage methods such as cold storage. In agriculture sector, a lot of emphasis has been put on research and development of agriculture production and fewer resources in post-harvest development. Potato is a bulky and fleshy crop with a short storage life therefore needs careful handling, packaging and storage. In Ethiopia, post-harvest losses of horticultural crops may be estimated for about 15 to 70% at various stages [18]. Potato is known as a semi-perishable commodity and storage of both seed and ware potatoes which is problematic for most farmers, as storage losses can reach 50% and sometimes higher [22]. Lack of proper storage systems are among the main factors contributing to the low yield of potato in the region, which is the case at the country level also [23]. Furthermore, market price of the product and marketing systems are also problematic [24]. According to [25] unavailability of proper potato seed storage forces the farmer to sell immediately during harvest with low price, whereas availability of proper storage facilities allow farmers to sell their potato tuber as a seed during planting or in the later season with higher price compared to the immediate sell.

Farmers stored potato either for seed or ware using various traditional storage mechanisms. These traditional storage facilities do not allow the growers and consumers to store potato not more than three and half months without deterioration [24]. However, farmer requires good storage either to use tubers of their own harvest as a seed source to postpone sales to get better market price and for household consumption in the later season. Hence, improving food security requires a comprehensive approach towards post-harvest managements using new strategies and/or technologies to ensure the higher value of post-harvest produces. Therefore, the major post-harvest losses of potato and its strategy to mitigate the problem were described.

Major potato post-harvest losses

In the absence of storage technologies for seed and ware potatoes, farmers keep potato harvest in the field for extended period in Ethiopia. This practice exposes the tubers for insect attack which reduces tuber yield and quality significantly. A study on extended harvesting period in Alemaya revealed that yield of marketable tubers was reduced by 60% when tubers were harvested at 210 days after planting as compared to a harvest at 120 days [26]. Similarly, [27] reported significant yield reductions (70-100%) when harvesting was delayed from about 125 days to 230 days after planting. Estimates of the production losses in developing countries are hard to judge; but some estimate the losses of potatoes, sweet potatoes, plantain, tomatoes, bananas and citrus to be very high. About 30-50% of the total produce (1.3 million tons) is lost after harvest. Globally, horticultural crops postharvest losses have been reported at 19% for the USA at an estimated annual loss of $18 billion [28]. Higher losses have been reported for African countries ranging between 15%-30% of the harvested product [29].

Post-harvest losses are mainly caused by different physical, environmental and biological factors which include mechanical injuries, extreme temperatures and pathogens [30]. According to [31], the causal factors enhance post-harvest losses through changes in the chemical composition and physical properties of the tuber in the process of respiration, loss of moisture from the tuber, sprouting, and spread of diseases. In the light of the little information generated on the major factors of post-harvest losses in Ethiopia, some of the principles in post-harvest management and the basic environmental and physiological causes of post-harvest loss are discussed as below.

Physical, biochemical and physiological losses

Physical losses include the various responses of tuber to excessive or insufficient heat, cold, or humidity. Proper storage is required to allow ventilation and heat exchange to maintain proper temperature level, to reduce the air and gas exchange (oxygen, carbon dioxide, and ethylene) and to minimize water loss. Losses caused by mechanical injury are usually overlooked. Physical injury is a loss by itself, and it can result in secondary physiological and pathological losses. Mechanical injury can occur at hilling, harvesting, and handling operations such as grading, transporting and marketing. Among tubers from the same cultivar, the degree of damage is influenced by the dry matter content and turgidity of the tubers [32]. High dry matter content causes higher braising. Good level of care is needed during harvesting and handling operations to minimize damage caused on tubers. The damaged tuber always has a shorter post-harvest life than the undamaged tubers [32].

Respiration

Potato tubers respires using sugars converted from starch. Therefore, respiration reduces the starch content of the tuber. During respiration, the tubers use oxygen from the air and produces water, and carbon dioxide and heat. The most important effect of tuber respiration is the production of heat and its subsequent effect on storage temperatures and the action required to control it [32]. If the respiratory heat is not removed, the temperature of the potatoes rises by 0.25 °C per 24 hours. The rate of respiration is dependent on the temperature and is minimum at about 5 °C. Tubers that are stored at relatively higher temperature lose their moisture after some time and become unfit for consumption or for prolonged storage as seed for the coming season planting. The problem was observed in seed potatoes stored in diffused light store (DLS) at Shashemene area. Fresh weight of tubers is considerably reduced in storage both due to respiration and water loss. It was observed that mean tuber weight loss as high as 23% was recorded when potatoes were stored in naturally ventilated storage for 120 days (Table 1). The tubers were dry due to excessive moisture loss and they were not suitable for planting after 6 months. This was due to relatively higher temperatures and dry air that enhances respiration and consequently desiccates the stored tuber.

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