Iris Publishers- Open access Journal of Anaesthesia & Surgery | Review of Visceral Surgery Activities in A Field Hospital in Juba: Epidemiological, Diagnostic and Therapeutic Aspects

 

Authored by Abdessamad El Kaoukabi*

Introduction

As part of the South-South cooperation, King Mohammed VI gave his high instructions for the deployment of a multi-specialty field hospital in Juba with a capacity of 30 beds expandable to 60, with a staff of 20 specialist doctors and 18 nurses. Visceral surgery was provided by a single general surgeon. We wanted to take stock of more than 3 months of visceral surgery activity. Thus, the purpose of this study was to describe the epidemiological aspects, diagnosis of visceral affections and report the results of the management.

Materials and Methods

This was a descriptive retrospective study over a period of more than 3 months from January 15 to April 25, 2017. Included were all patients operated on for a visceral pathology in the operating theater of the Juba Field Hospital. The operating theater of the JFH is equipped with 2 rooms for surgical procedures, including one reserved for minor surgery such as circumcisions, incisions and drainages of abscess, uterine curettage for incomplete abortions, lipomas and cyst resections under local anesthesia. The patients had been operated on by a general surgeon. The sources of the data were the registers of operative protocols and hospitalizations. The variables studied were sociodemographic, diagnostic and therapeutic outcomes.

Results

Epidemiology

During the study period, 519 patients were operated in the operating theater of the JFH including 202 (38.92%) for a visceral pathology. The average age of patients was 38.75 years with extremes of 12 and 86 years. There were 156 males (77.22%) and 46 females (22, 77%). The sex ratio is 3.39. Scheduled surgery and emergencies concerned 190 (94.05%) and 12 (5.94%) patients, respectively.

The first two pathologies in order of frequency were hernias and proctologic pathologies (Table1). Surgical emergencies involved 12 patients (5.94%) including 6 appendicitis (2.97%) and 6 cholecystitis (2.97%). The inguinal hernias (Figure 1) accounted for 80.70% (n = 92) of the hernias and 45.54% of the operated diseases. The femoral hernias (Figure 2) were 2 (0.99%). The epigastric (Figure 3) and incisional hernias were 19 (9.40%) and 1 (0.49%), respectively and there were 12 (5.94%) uncomplicated vesicular lithiasis. Only one patient was treated for hydatid liver disease (0.49%).

Therapeutic results

We recorded 20 cases of complications, a morbidity of 9.90%. Surgical site infections were 14 or 6.93% of all surgical procedures and 70% of complications. Other complications were: scrotal hematoma 03 cases (1.48%), parietal hematoma 02 cases (0.99%). A single stercoral fistula was recorded (0.45%).

Discussion

Visceral surgery accounted for 38.92% of the operations of the JFH operating theater and involved more young males. Emergencies accounted for 11.88% of visceral surgery activities. The young age of the population has been found in several studies concerning visceral surgery [1-7]. Groin hernia is a surgical pathology whose frequency makes it one of the first acts of general surgery [8]. Even if its prevalence and incidence are not known, hernia occupies first place visceral pathologies In Africa [9]. This high rate of hernia surgery can be explained by the strong presence of farmers in this rural area. Sani R. and al in Niger also found a predominance of hernia surgery in a study conducted in several area hospitals [7]. Inguinal hernias accounted for 45.54% of pathologies. This rate was well above the 15.3% found in Dakar [10]. Acute appendicitis seems rare with 2.97% of visceral surgery activities. Patients are seen at an early stage which explains the absence of complications contrary to what has been observed by other authors in Africa [1,3,7] where patients are seen at the stage of complication which explains the high percentage of appendicular peritonitis (15,26%). In western countries, acute appendicitis accounts for 7 to 14% of UCA [11]. A study conducted in the same hospital in 2016 found a rate of 10% [12]. The rate of surgical site infections was 6.93%. This rate varies from 2.5% to 30.90% in Africa according to countries and years [13] for all surgical procedures. It was 7.3% in Parakou in northern Benin in 2011 [14]. The mortality rate was 00% compared to 6.25% found in Niger [7].

Conclusion

The visceral surgery at the JFH (Juba field hospital) are dominated by hernia surgery and proctologic surgery. The absence of traumatic abdominal surgery was mainly due to the site of the hospital in central Juba far from unstable areas.

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Iris Publishers- Open access Journal of Anaesthesia & Surgery | Regional Anesthesia Device Against the “Dead Ends” in the Emergency Unit Peripheral Locoregional Anesthesia in front of “ Therapeutic Impasse” in the Emergency Operating Room

 

Authored by Nabil Jbili*

Introduction

The regional anesthesia is experiencing a big boom in the daily practice of intensive care anesthetists. The major interest of peripheral nerve blocks in emergencies lies in the absence of general repercussion [1], facilitating perioperative [2] with a better predictor of patient satisfaction and a major economic impact [3-4]. This technique can be an interesting alternative to general anesthesia and anesthesia perimedullary (APM) as part of the emergency, when they would be at risk [1,5,6] Within our training about 35% of surgical emergencies are performed under local anesthesia with approximately 90% of emergency concerning the members are performed under regional anesthesia device. We report through this study the experience of anesthesia pole and reanimation- emergencies involving the provision of ALR in the operating room when the emergency AG and / or epidural ALR can be dangerous.

Materials and Methods

This is a prospective study conducted in the operating room for emergencies Military Hospital Moulay Ismail in Meknes on a oneyear period extending from January 2016 to January 2017. Were included patients admitted for surgical emergencies and members with serious violations of cardiorespiratory and metabolic functions and for whom general anesthesia or spinal perished were deemed at risk where ALR device would be a good alternative. Exclusion criteria were patient refusal, allergy to local anesthetics, severe coagulation abnormalities. Peripheral nerve blocks were performed under standard monitoring, post-interventional surveillance room or neurostimulation or ultrasound guidance using local anesthetics like lidocaine 1% and 0.25% bupivacaine. The effectiveness of the block was assessed prior to admission of the patient to the operating room, in case of failure or insufficient block additional block was conducted Were assessed hemodynamics, respiratory, neurological, analgesia and patient satisfaction in per and postoperative.

Results

Our study includes 30 patients, including 18 men and 12 women with a sex ratio of 1.5 M / F, mean age 72.5 years (63-82). The evaluation of our patients pre anesthetic has classified all ASA III and IV (Table 1) with 4 presented difficult intubation criteria and 7 ventilation criteria difficult mask. 20 blocks were made to the lower limbs and 10 graduate members. The ultrasonographic guidance was conducted in sixteen cases and fourteen neurostimulation (Table 2). Local anesthetics used were 1% lidocaine and bupivacaine 0.25%, the volumes used ranged from 20 to 40ml.

The number of requested specialized medical opinion in all our patients were limited to 4. The transthoracic echocardiography was not sought in any of our patients and the time interval between hospital admission and surgery was reduced by half in comparison with IV or ASA III patients who were operated on under general anesthesia or spinal anesthesia during the same period. The monitoring was standard in all cases, interventions were conducted without repercussion on the previous state of patients. Intraoperatively, changes in the FC were 6% (3-10%), blood pressure was 5% (2-8%) with respect to the intake values, the filling was provided by the saline with volumes ranging from 250 to 500cc and no patient needed vasoactive agents. No cases of respiratory distress, confusion or agitation in intraoperative or postoperative had been noted and none of our patients had need to stay in the intensive care unit after surgery.

In post-operative, all patients had a good quality of analgesia 6.5 (3-10) hours. At the rising of sensory block, VAS pain was estimated at 1 and calmed by paracetamol 1g infusion. After the 8th time, our patients had a mean VAS between 2 and 3, under control by paracetamol infusion and nefopam, only 2 patients required morphine iv 5mg and 5mg sc. The next day, our patients had a VAS pain˂3 and benefit of analgesia alone or paracetamol associated with codeine. Approximately 40% of patients expressed their discomfort with the realization of the block, but postoperative they were satisfied with the quality of algesia and no vomiting nausea. The anesthetic team was satisfied with fewer interventions in the operating room and even the bathroom SSPI. The stay in recovery room averaged 30 minutes, allowing patients to quickly join their relatives with less stress monitoring devices and a number of great satisfactions. The incidents were noticed a feeling of discomfort when performing in 12 patients, a vagal malaise and arrhythmia in three patients, and associated additives were further block in 02 patients and a supplement sedation in 02 case.

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Iris Publishers- Open access Journal of Otolaryngology and Rhinology | Pick up an oar - or swab - and row

 

Authored by Miriam I Redleaf*

Opinion

On the morning of Thursday March 26, 2020 one of us, a facial plastics surgeon at the University of Illinois Department of Otolaryngology/Head and Neck Surgery, noted that COVID-19 nasopharyngeal swabs in the US were showing a very high false negative rate. She suggested this may be due to obtaining specimens from the septum and anterior portions of the turbinates, rather than the nasopharynx. In the afternoon, our department formed a swab education team, and another of us, our head neurotologist at the University of Illinois, was assigned as lead. As the two doctors were gathering information, we were approached on Friday, March 27th to also plan how we might help University Health Services accommodate the increase of COVID-19 related employee visits.

Therefore, during the week of March 30th through April 3rd, 2020 the two otolaryngology subspecialists demonstrated nasopharyngeal swabbing to 12 sessions of healthcare workersspeaking and answering questions to 10-20 people at a time. At the end of the week we made an educational video [1] which we posted on our health systems’ internet. The educational efforts were greatly appreciated by the hospital staff-in each of the 12 sessions, several nurses or doctors spoke up and stated that they were surprised how deep the nasopharynx was.

Meanwhile, two experienced administrators worked through the logistics of creating a high-turnover COVID testing site for our employees. By April 1st, they had found open clinical space and cleaned it and converted it. By April 2nd they had arranged an orientation session in the morning-complete with phone registration, patient lists, fit testing, one receptionist, two medical assistants, two medical student volunteers, one manager, and two security officers to safely route the patient traffic. Our first employee testing began in the afternoon with a limited schedule. On Friday, April 3rd, we had our first full schedule morning clinic with 2 ENT doctors performing the swabs. The second week of swabbing processed 43, 44, 62, 84, and 53 patients in 2-3 hours each morning. The University Health Services and the University employees have repeatedly expressed their thanks for the services and their satisfaction with how efficient and painless the entire process was.

We have thought about what features of this experience have made it so successful. One was that all the organizers were willing to perform tasks which they knew well how to do, but were “beneath them.” Otolaryngology subspecialists were immediately willing to demonstrate the lowly nasal swab over and over to groups of other healthcare professionals. Otolaryngologists who normally interpret specialized tests and perform complex operations pitched in-two at a time-every morning to swab dozens of fellow employees in a few hours. Administrators who no longer work “in the trenches” put aside their business analyses and revenue investigations and assembled a functioning clinic in two days. Everybody just picked up an oar-or nasopharyngeal swab-and rowed.

Another feature we uncovered is that, the joy of a light work day, and avoiding work altogether is a myth. Everyone working in the testing clinic-stated that they greatly enjoyed working full tilt without any down time. They never had to wait and they were never bored. Finally, despite the lowly task, everyone felt extreme satisfaction that they were doing something helpful-a task that was really needed.

The major early lessons from this experience are rather inspiring. First is that healthcare workers truly want to help others. Second is that many of the administrative procedures which hobble healthcare delivery in fact turn out to be dispensable. And third is that otolaryngologists love to work, and want to work hard and efficiently. In this age of increasing paperwork and computer clicks, COVID has shown that it is possible to get back to basics-healthcare. 

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Iris Publishers- Open access Journal of Otolaryngology and Rhinology | We & CORONA, where to?!

 

Authored by Majid Mohammed Mahmood*

Opinion

As a novel virus, Coronavirus or SARS-Covid-19 as agreed to be called yet is expected to keep freely replicates comparing to other, known viruses for the fact that there were and still no previous exposure by the immune system to its antigens. The matter would be attributed to immune response gene that controls cellular& humoral specific immune responses.

As well known, historically many morbidity causatives agents had destroyed communities when they were not recognized (immunologically) yet, but they had gotten less & less chances to replicate and transmit once they’re gradually identified by the immune system in term of successive generations. This was for the host (the human, here) and his natural capabilities and diverse interventions. But for the virus, on other hand, it’s going to be less exhausting as time gone and this would be the ultimate trend of parasites of successful parasitism, since their host’s depletion or even further exhaustion would be against their favorites for reasons behind their persistence & continuation.

In respect to viruses, this matter of course is partially correlating to natural selection (postulate). Besides the fact that the graded recognition of the immune system to Coronavirus antigens throughout repeated exposure to a limit of copies of the virus (less than minimum infective dose) is undoubtedly considered as a typical, natural way to gain acquired immunity though that weak it would firstly be but it’d take accumulative& co-strengthen attitude on time ahead. Forgetting not what the lessen replicating chances and less availability of ready hosts due to candidate usable vaccines & successful vaccination.

All that is happening, steps wisely, & the virus might remain (eventually) included in human accompanied viruses’ list & revealed as mutations, tracked by the immune system, manifested through the resultant memory cells & serum level of protective antibodies that could providing us escape opportunities from infections were potentially been caused by. Likewise, more copies of the virus do not cause diseases, such as that caused by the day the immune system was of recent dealing with the virus, but rather its morbidity is transient that we do not feel or with slight symptoms that we don’t pay attention to.

Same virus’ vaccines could be transferred someday to describable vaccines’ list, which scheduled to be administered to certain community categories might include elderly, immune compromised & others (the vulnerable, who were feared about, from infection’s consequences &complications for their noncompetent immune systems, after a definite or indefinite reason). Bearing in mind that there is a fearsome of acquiring the virus (which stay dormant) during summer season in countries of hot climate, which reactivates during winter.

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Iris Publishers- Open access Journal of Current Trends in Civil & Structural Engineering | Development of the Trenchless Installations for Underground Structures in Highway Systems

 

Authored by Carl M. Duan*,

Characteristics of HSLA Steel

There are many underground structures, such as culverts, tunnels and vehicle undercrossing in transportation systems throughout the world. These structures are used to convey water, wildlife, fish, pedestrians and vehicles. Their roles are just as important as surface structures, such as bridges. Cut-and-cover, immersing and trenchless installations are the three major methods to construct underground structures. For an installation of buried structure, the specific method should be chosen based on the factors such as geotechnical properties in subgrade, environment impact, cost and the degree of disturbance to the highway traffic above it. Currently, it is becoming more popular to use trenchless installations including tunneling methods for new structures and trenchless replacement method for existing structures. Comparing to cut-and-cover method, trenchless installations provide much less impact to the roadway traffic and the environment.

The trenchless installation method can be used to install a utility line with a small cross-sectional size of 4 inches in diameter for hundreds of feet long as well as a large facility with a width of 51 feet for 5.6 miles, as in the case of Chongming Tunnel across Yangtze River in Shanghai. Trenchless technology (TT) consists of a wide range of methods, materials, and equipment for installing new or rehabilitating existing underground structures. Frequently used tunneling methods include Pipe Jacking for pipes or concrete boxes, Horizontal Direct Drilling (HDD) for pipes, Auger Boring using steel casing (SC), Pipe Ramming using SC, Micro-tunneling, Tunneling by Tunneling Boring Machin (TBM) and so on. On the other hand, Cured-In-Place-Pipe (CIPP) is an effective method to replace existing pipes in place, and Slipling is used to rehabilitate existing pipes. Major trenchless installation methods, size limits and approximate maximum lengths are summarized in Table 1.

Table 1:Major Trenchless Installation Methods

Installation

Proper geotechnical investigation of site, planning, design, and selection of compatible construction methods, materials, and equipment are very important for the successful installations of the underground structures in highway systems. One concern in trenchless installations is the road surface settlement when a hole underneath is created and a gap between the pipe and the adjacent soil exists. This is typical when a tunneling structure has a relatively shallow earth cover above it. An assessment to the roadway surface settlement during planning is needed to see if the amount of roadway subsidence is acceptable. Some tunneling methods can make this subsidence decreased during installation. For example, tunneling by TBM can reduce this concern by using a self-adjustable tunnel liner system such as rib and lagging liner system. The significant benefit of the rib and lag liner is the ability of the jacked casing to expand the tunnel liner after it exits the jacking shield against the adjacent soil to reduce potential for roadway subsidence. Structural analysis needs to be performed to check the integrity of the tunneling structures during construction under loadings such as horizontal jacking force, earth pressure, distributed live load from trucks and so on. Currently, there is a lack of unified methods to conduct this analysis. In addition, standard specifications for tunneling installations are another important document for the owners to adopt a specific method of installation.

Design for Service Life

If a tunneling structure is used as a permanent structure, it shall be designed for its service life. Currently, the structures in the U.S. highway system are designed using LRFD methodology. There is a large discrepancy in determining the appropriate soil or rock pressures applied to the tunneling structures. Improved methods in soil-structure interaction analysis should be developed for the safety, durability and the cost of the project. In the past, most of the buried structures in highway systems are not designed for seismic loading. But underground structures without seismic design in many countries suffered damages in the past earthquakes. For important utility lines and for large size tunneling structures, i.e., when the span is over 20 feet, seismic design is needed. AASHTO Technical Manual for Design and Construction of Road Tunnels has covered seismic design only for the tunnels used for traffic. Most of the methods used in seismic design are based on structural analysis using software. Experimental model tests and corresponding structural analysis are needed to validate those methods. Practical seismic design criteria using performance-based design methodology need to be established [1-3].

Development in the Future

With future forecast of traffic density higher and higher, trenchless installations, with least impact to traffic, will be used more frequently. The innovated trenchless installations have been developed in recent years to meet the project needs. The trenchless technology, design and installation specifications should be improved to keep up with the trend.

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Iris Publishers- Open access Journal of Archives in Neurology & Neuroscience | Antitumor Activity of Novel Azoles on Ehrlich Ascites Carcinoma Cells in Mice

 

Authored by Fawiza Zakaria ELAblack*

Abstract

Background: Azoles has been used traditionally for many centuries. Some impressive therapeutic qualities have been discovered.

Aim: Our study aims to investigate in vivo antitumor, and antioxidant activities of Ethanolic Azoles. Also, to study the side effects of Azoles on different organs (Liver/ Kidney).

Materials & Methods: We assessed the effect of Azoles on life span prolongation and on the levels of malondialdehyde (MDA), nitric oxide (NO), Catalase, glutathione peroxidase (GPx), Caspase-3, and Cytochrome c. Also, our study estimated their effect on Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Protein (T.P), Albumin (Alb), bilirubin, urea and creatinine.

Results: Azoles showed great increase in life span. Also, they showed a significant decrease in malondialdehyde and nitric oxide and an increase in catalase, glutathione peroxidase, caspase-3 activities, and cytochrome c concentration. Hence, it may be possible that Azoles decrease lipid peroxidation level due to their antioxidant effect and enhance apoptosis process. Azoles showed no side effects on liver and kidney. Also, they showed a significant protection for both liver and kidney histopathologically

Keywords: Antitumor activity; Erlich ascites carcinoma; Novel azoles; Triazole derivatives; Benzimidazole; Swiss albino mice

Introduction

Benzimidazole being an isostere of purine based nucleic acid and an important scaffold in various biologically active molecules is widely explored for development of anticancer agents [1]. The versatility of new generation benzimidazole would represent a fruitful pharmacophore for further development of better medicinal agents [2]. Thus, benzimidazole-derived moieties’ introduction to the drug design may enhance the biological activities. As, triazoles are safe for most patients; their use in medically complex cases can be complicated further by dose-limiting toxicities and pharmacokinetic drug-drug interactions Cancer is a severe metabolic syndrome and is one of the leading causes of death regardless of developments in the tools of disease diagnosis, treatment and prevention measures [3,4]. Cancer development and progression, programmed cell death (apoptosis) and the genes regulating this process involved in tissue and organ homeostasis and loss of the apoptotic process is often associated with tumour expansion, Alterations in the expression of proteins involved in intracellular apoptotic pathways are a potential cause of neoplastic expansion, so the earliest and most specific tumour markers are usually detectable at the intracellular level [5]. When exposure the cells to the external damage stimuli, they activate the regulation of expression of P53 and Bcl-2 genes. P53 tumor suppressor protein acts as a protector of genomic activity by inducing either cell cycle arrest (at G1 and/or G2 phase) or apoptosis. Bc1-2 gene is an anti-apoptotic protein, participate in the p53 apoptotic pathway and the equilibrium between those positively and negatively regula-tory proteins is essential for the susceptibility to apoptosis. A high level of Bcl-2 expression prevents cells from apoptosis caused by cytotoxic factors or cellular stress [6]. Ehrlich ascites carcinoma (EAC) considered as an experimental tumor modeling. EAC is referred to as an undifferentiayrd carcinoma and is originally hyper diploid, has high transplantable capability, no-regresion, rapid proliferation, shorter life span, 100% malignanc, and resembles human tumors which are the most sensitive to chemotherapy due to they are undifferentiated and have a rapid growth rate [7] Development and identification of compounds capable of killing transformed or cancer cells, without being toxic, is of utmost importance, and has gained the increasing interest of scientists worldwide [8]. The major side effect associated with various anticancer or anti-proliferative agents is cytotoxicity towards normal cells due to lack of selectivity for the abnormal cells. Therefore, search on anticancer agent has been in continuum since many years [9]. Cisplatin is one of the most compelling chemotherapy drugs that are widely used for cancer. It was the first FDA-approved platinum compound for cancer treatment in 1978 [10]. Common side effects for using Cisplatin include bone marrow suppression, hearing problems, kidney problems, and vomiting. Other serious side effects include numbness, trouble walking, allergic reactions, electrolyte problems, and heart disease. Use during pregnancy is known to harm the baby [11]. However, the severe side effects and resistance by the cancer cells confine their clinical application widely. To curb increasing resistance and the unbearable cost of treatment, it is a necessity to design potential alternatives [12]. Benzimidazole derivatives have demonstrated as potential new therapeutics for the treatment of cancer in vitro and in vivo [13]. The present study was carried out to investigate the anti-tumor activity of newly synthesised azoles in comparison with cisplatin against Ehrlich ascites carcinoma in Swiss albino mice.

Materials and Methods

Experimental animals

Studies were carried out using a total of 75 male Swiss albino mice weighting 22- 25 g obtained from Animal House of National Research Center, Giza, Egypt. The experimental animals were housed 15 per cage in a room with 65% humidity, 12:12 h light: dark cycle at ambient temperature of 20 ± 1 _C. Standard diet, commercial feed pellets and tap water were freely available (Figure 1).

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Iris Publishers- Open access Journal of Archives of Animal Husbandry & Dairy Science | Histamine in Some Fish Products

 

Authored by Shaltout FA* 

Abstract

Histamine compounds are members of a group of compounds known as biogenic amines normally produced by decarboxylation of free amino acids and are present in a variety of foods. In the present study a total of 90 random samples of salted and smoked fish products represented by fesiekh, salted sardine, and smoked herring (30 of each) were collected from different fish markets in Middle Delta area, Egypt and examined for the presence of histamine by ELISA. The results recorded that the histamine mean values in examined fish samples were20.76 ± 0.54, 15.49 ± 0.31 and 9.82 ± 0.26mg/kg, unaccepted samples were53.3%, 36.7% and 30%for fesiekh, sardine and smoked herring, respectively.

Keywords: ELISA; Histamine compounds; Salted; Smoked fish

Introduction

Fish is very important source of protein especially in Egypt. Fish and fish products are one of the most important food stuffs as they are one of the cheapest sources of animal protein. Fish are enriched with essential minerals, vitamins, and unsaturated fatty acids [1]. Histamine is known as a biogenic amine which is low molecular weight and possesses biological activity [2]. The levels of histamine have been suggested as rapid fish spoilage indicators [2,3]. Gramnegative histamine producing bacteria are more common in fish. A wide range of Gram-negative bacteria can produce histamine in fish, but the major types are mesophilic enteric and marine bacteria. Morganella morganii, Morganella psychrotolerans, Photobacterium damselae, Photobacterium phosphoreum, Raoultella planticola, Hafnia alvei were reported as histamine formers. In the case of fermented sea food, Staphylococcus spp. and Tetragenococcus spp [4]. These types of bacteria naturally present on the gills, external surfaces and in the gut of live saltwater fish with no harm to the fish. Up on death, the defense mechanism of the fish no longer inhibits bacterial growth in the muscle tissue and histamine forming bacteria may start to grow resulting in the formation of biogenic amines [5].scombroid poisoning is a form of toxicity caused by the ingestion of spoiled dark-flesh fishes, mainly of the scombroid family. The clinical picture is secondary to histamine toxicity, manifest ed as flushing, headache, palpitations, and abdominal cramps [6]. Inadequate cooling following harvest promotes bacterial histamine production and can result in outbreaks of scombroid poisoning [7] which results from the ingestion of histamine-contaminated fish of the scombroid fish including tuna, mackerel, and non-scombroid fish include sardine, herring and anchovy [8].The symptoms of scombroid poisoning appear within a few minutes after eating fish of Scombridae family and related species. The first symptoms are cutaneous, with flush, pruritus, and erythema of the face and trunk having an urticarial appearance, together with faintness. Gastrointestinal symptoms include nausea, vomiting, abdominal cramps and occasionally diarrhea [9].

This work aimed to determine histamine residue in salted and smoked fish collected from different fish markets in Gharbia governorate, Egypt by using ELIZA technique to asses quality of fish.

Materials and Methods

Collection of Samples

Collection of Samples

Determination of Histamine By ELISA

Sample Preparation and Acylation

i. Pipette 25 μL of standards, 25 μL of controls, 25 μL of plasma samples, 10 μL of fish samples, or 50 μL of supernatant from the release test* into the respective wells of the Reaction Plate.

ii. 25 μL of Acylation Buffer were added to all wells.

iii. 25 μL of Acylation Reagent were added to all wells.

iv. Incubated for 45 min at RT (20-25°C) on a shaker (approx. 600 rpm).

v. 200 μL of distilled water were added to all wells.

vi. Incubated for 15 min. at RT (20-25°C) on a shaker (approx. 600 rpm).

vii. 25 μL of the prepared standards, controls, and samples were taken for the Histamine ELISA.

*For the release test the Histamine Release supplementary kit (available for purchase separately, cat. no. BA E-1100) must be used.

Histamine ELISA

i. 25 μL of the acylated standards, controls, and samples were pipetted into the appropriate wells of the Histamine Microtiter Strips.

ii. 100 μL of the Histamine Antiserum were pipetted into all wells and cover plate with adhesive foil.

iii. Incubated for 3 hours at RT (20-25°C) on a shaker (approx. 600 rpm).

Alternatively: shake the Histamine Micro titer Strips briefly by hand and incubate for 15-20 hours at 2-8°C.

i. The foil was removed. The contents of the wells were discarded or aspirated, and each well was washed 4 times thoroughly with 300 μL Wash Buffer. Blotted dry by tapping the inverted plate on absorbent material.

ii. 100 μL of the Enzyme Conjugate was pipetted into all wells.

iii. Incubated for 30 min at RT (20-25°C) on a shaker (approx. 600 rpm).

iv. The contents of well were discarded or aspirated, and each well was washed 4 times thoroughly with 300 μL Wash Buffer. Blotted dry by tapping the inverted plate on absorbent material.

v. 100 μL of the Substrate were pipetted into all wells and incubate for 20-30 min at RT (20-25°C) on a shaker (approx. 600 rpm). Avoid exposure to direct sunlight.

vi. 100 μL of the Stop Solution were pitted to each well and shake the microtiter plate to ensure a homogeneous distribution of the solution. The absorbance of the solution in the wells was read within 10 minutes, using a microplate reader set to 450 nm with a reference wavelength between 620 nm and 650 nm.

Statistical Analysis

Analysis of Variance (ANOVA) test was applied for statistical evaluation of the obtained results of each detected residue in the examined samples of salted and smoked fish products according to Feldman et al., (2003).

Results

It is evident from the results recorded in Table 1 that the Histamine values in examined fish samples were varied from2.9- 36.1mg/kg with an average of 20.76 ± 0.54 for Fesiekh;2.2-29.8mg/ kg with an average of 15.49 ± 0.31for sardine and1.4-21.7mg/kg with an average of 9.82 ± 0.26 for smoked herring. The differences between the examined samples of different fish species were high significant (P<0.01). Table 2 revealed that46.7%.73.3% and 70%of the examined samples of Fesiekh, sardine and smoked herring were accepted, however, 53.3%, 36.7% and 30% of such samples were unaccepted, respectively.

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Iris Publishers- Open access Journal of Archives of Animal Husbandry & Dairy Science | Antimicrobial Use for The Food Production Animals: Needs & Harms

 

Authored by Mohamed Ali Alhosani*

Opinion

Since centuries, the human is depending on the farm animals as a source of food, commerce, transport, and others, a thing that develop the caring practice of the humans toward the animals to keep them safe and healthy. And with the progress of the time and existing of the alternate sources, the purpose of having the farm animals is changed to be either for fun or wealth. And for those who have the interest to use the farm animals as commercial source, they are facing several challenges to maintain the health and life quality of the animals. therefore, many of the animal owners are biased to use the antimicrobial drugs as a quick and affordable tool to promote the growth and protect the animals from microbial infections. And this evidenced by several documents reported that most of the antimicrobial drugs administrated for food-producing animals are used as growth promoter, prophylaxis and metaphylaxis [1].

As good as using the antimicrobial as protecting agents, it can harm the animal and human health when it abused. Overdosing of these drugs is enhancing the microorganisms to protect themselves through several mechanisms such as acquiring and expressing resistant genes against the administrated antimicrobial drugs, and possible other antimicrobial drugs as well, and sharing these genes with other bacteria [2]. The resistant microorganisms and especially resistant bacteria could be considered as “contagion” if it grows in a poor environment that rich by facilitating factors such as poor housing, weak infection control management, limited cleaning and disinfecting of the environment [3]. Moreover, most of the bacteria can be transmitted within and between animals, humans, and environment as well as the resistant genes, and most of the antimicrobial drugs classes are common between the human and animals, a thing that reflect the high risk of abusing these drugs on the human health. There are several evidences showed that the antimicrobial resistance of some pathogens such as Salmonella spp. and Escherichia coli (E. coli) which isolated from humans are contributed to antimicrobial drugs used in animals.

common foodborne bacteria that primarily cause gastroenteritis, bacteremia, and focal infection in human [4]. This bacterium is hosted by several animals such as poultry, pigs, and cattle; and in pets, including cats, dogs, birds, and reptiles such as turtles [5]. It has been shown that the isolated antimicrobial resistant Salmonella from meat and poultry products are due to the contamination with the feces of the carrier animals [6]. In addition, some of the isolated NTS from human showed antimicrobial resistance against the third generation cephalosporins antibiotics, which can be contributed to the mass using of this antibiotic as a therapy or prophylaxis in animals and poultries [7].

Another example is using colistin antibiotic as a growth promoter. Colistin is an antimicrobial drug used since decades to treat both human and animal. And this drug has been approved by several countries to be used as growth promoter, a thing that led most of the animal breeders to use it to improve their animal fatten with ignorance of the side effect or negative impacts of this drug. And as consequence, antimicrobial resistance against colistin showed by E. coli which is isolated from livestock [8-9]. Moreover, mobile colistin-resistance gene (MCR-1) was identified in E. coli which isolated from food producing animals in several countries [10-11]. On the other hand, for the human colistin is considered as one of the last-resort antibiotics to treat infections caused by multidrugresistant Gram-negative bacteria such as Enterobacteriaceae and Pseudomonas aeruginosa in human [12].

In conclusion, using antimicrobial drugs for food producing animals is a double-edged sword, as good as it is a health protector and growth promoter, as bad as it can develop several negative impacts on animals, humans, and environment.

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Iris Publishers- Open access Journal of Otolaryngology and Rhinology | Dizziness in A Patient with Airway Compromise and TMD: A Case Report

 

Authored by Charles Blum*

Introduction

Evidence is emerging to support the theory that airway oxygenation, which is often associated with obstructive sleep apnea (OSA), is an important condition to include in a differential diagnosis. OSA is a condition that sometimes presents as a symptom of a more complex condition (e.g., cardiovascular, diabetes, cancer, inflammatory diseases, gastroesophageal reflux disorder, etc.) [1-10] without an apparent direct relationship to any airway compromise. One feature of OSA is the jaw-head position-hypoxia relationship that is associated with a persistent forward head posture [11-14] causing chronic skeletal pains that do not resolve with conventional therapies. As a means to sustain optimal airway space with OSA the head tends to move forward and while this improves oxygenation it adversely affects the cervical spine and body posture. Literature suggests there is a relationship between head posture and temporomandibular joint dysfunction (TMD) issues [15-20].

Case History

A 38-year-old patient presented for care at this office in November 2016 with an array of symptoms (autoimmune disorders, dizziness, obstructive sleep apnea-OSA, etc.). The onset of his condition reportedly began eight years ago following a surfing accident (fell on left shoulder) and removal of his wisdom teeth. After these events, he began experiencing syncope, brain fog, dizziness, and movement/vertigo, all of which worsen when sitting on soft seats or when hunching over or with his head tilted up or down. He noted that his condition was aggravated with computer work and when his head was in a forward posture. Brain fog prevented him from being able to concentrate at work, and he found his condition debilitating, relentless, and life-altering. He was primarily diagnosed with apnea (OSA), vestibular dysfunction, vascular headaches/migraines, and cervico/thoracic enthesopathy.

At eight years old, the patient reports that he fell off of a cliff and landed on his head. At age 10, he fell onto a skill saw blade and needed multiple stitches to the back of his head. The patient had an automobile accident at 14 years old, which resulted in head trauma and a fractured C7 spinous process. He had his adenoid and tonsils removed at the age of 21. Compounding his presentation, the patient had migraines and sleep disorders which were diagnosed as a form of sleep apnea in 2008. He has had a history of anemia with a low red blood cell count complicating his hypoxic condition. Of note he was temporarily disabled for 2 months in 2008 and during that time received chiropractic care over the course of a month. The patient reported that chiropractic helped him somewhat but did not affect the dizziness or brain fog. He was also on disability for 1 month in February 2017 due to his condition.

A 2010 ECG study showed probable left ventricular hypertrophy of heart, and ejection fraction at 67% of normal. EEG testing at that time showed some brief high voltage bursts of alpha activity followed by some decrease in the background activity. A recent MRI of the brain and head was described as normal. He was recently diagnosed with scleroderma but was not receiving care for that condition at the time of his presentation at this office. Since early 2012 he was using a continuous positive airway pressure (CPAP) machine for sleep and as a means to treat his OSA [21]. nose and throat specialist, allergy-immunologist, sleep specialist, internist, rheumatologist), cranial osteopaths, acupuncturists, physical therapists, and massage therapists. He has spent thousands of dollars on care and had been on short-term disability for the past year. For three years prior to beginning care at this office he had been unable to perform physical exercise. With regards to the other care he received, he reported that he felt somewhat better, though only temporarily, with upper cervical chiropractic treatment.

Methods/Interventions

The patient’s examination findings revealed reduced cervical rotation, and pain with lateral cervical flexion localizing to the occiput /C1 and C5 through C7. Lumbar vertebral flexion was limited with pain localizing to the L5 region. Sacro Occipital technique (SOT) cervical compaction test was positive for lumbopelvic involvement. Cervical stairstep was positive at the Occiput /C1 and C5-7 spinal levels. Forward head posture was noted with sensitivity on palpation at the right temporal bone styloid process (can be related to L5 [22,23] and the right 1st costotransverse junction. Body sway analysis noted both anterior/posterior and lateral sway patterns. He had sleep disorders/apnea with inability to reach deep sleep, stage 3-4, associated with frequent limb movements at the time he should enter deep sleep treated with a dental appliance and CPAP.

Treatment focused on SOT and SOT cranial chiropractic interventions, nasal balloon methods for craniofacial sinus expansion, and supplementation with B12/methylated folic acid (to facilitate red blood cell oxygen uptake) [24]. SOT interventions focused on releasing right psoas and bilateral piriformis muscles’ greater trochanteric attachments. The patient was treated for SB+ pattern, which relates to increased lumbosacral dural meningeal tensions [25]. His cervical spine was treated with cervical stairstep mobilization and adjusting. Osseous adjusting was applied to the thoracic and lumbar vertebra along with an anterior diaphragm pseudo-hiatal hernia release. Common cranial patterns included sphenobasilar right side-bending and vertical strain lesions [26]. Intraoral adjusting focused on releasing his right zygoma that was restricted in external rotation and bilaterally external pterygoid muscle release. The left sphenoidal greater wing was also corrected from an external rotation positioning. Initial use of nasal balloons focused on insertion into the lower right and middle left turbinates, followed with upper and middle turbinate releases [27] on alternate days.

Results

The patient was treated from November 15, 2016 through March 24, 2017. By early 2017 his eight-year bout with dizziness was reduced and he could function in most activities of daily living. By March 2017 he only noted mild neck pain (50% reduction) with significantly reduced tension and swelling. His lower back pain would only present on occasion and described by the patient to be 80% improved. Since he was using the CPAP and an oral dental appliance, he noted an improvement in his oxygenation characterized by a pulse oximeter reading of 98%, and a normal Epworth Sleepiness Scale scoring [28]. Initial pre-treatment (November 2016) Roland-Morris disability index scales [29] were scored at 28% for low back pain and disability and with a followup approximately six months later showing a minimal change or reduction to 24%, a reduction of 4%. His neck pain disability index scales [30] were initially measured at 52%, with follow-up testing (April 2017) showing a reduction of his neck disability index of 36%, a reduction of 16%. Beck’s motor testing [31-34] was normal for TMJ dysfunction and positive for his neck at the initial office visit and reported as normal after 2nd office visit.

The patient reported that the chiropractic care he received at this office, which consisted of sacro occipital technique (SOT) along with SOT extra cranial/intra oral and nasal balloons gave him at least 50% improvement of his symptoms, which had been unresponsive for eight years, along with giving him the ability to return to work. After approximately five months of care the patient has been able to maintain his improvements and continues to feel increasingly capable of doing his activities of daily living without restrictions. He still self-limits, particularly regarding heavy strenuous work, though for the first time in years he has been able to do rock climbing and other limited sports activities.

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