Determination of pesticide residues in rooibos (Aspalathus linearis) teas in South Africa.

An efficient gas chromatography-mass spectrometry approach was used in this study to quantify 13 pesticide residues in rooibos teas purchased from registered retail outlets in South Africa between November 2019 and April 2020. A QuEChERS (Quick, easy, cheap, effective, rugged, and safe) procedure was used to extract pesticides using 7.5 mg of graphitized carbon black (GCB), 50 mg of primary secondary amine (PSA), and 150 mg of anhydrous MgSO4. In order to compensate for the matrix effect, matrix matched calibration curves ranging from 10 µg/kg-500 µg/kg were applied for accurate quantification. For validation purposes, accuracy tests were conducted using a blank tea sample spiked with pesticide standards at two different concentrations (10 and 100 µg/kg). Most of the analytes were recovered within acceptable recovery ranges (72-106%), with a relative standard deviation of less than 20%. The limits of quantification were low, all falling below 10 µg/kg which meets the maximum residue limits (MRLs). The validated method was used to analyze 100 tea samples, and among the pesticides analyzed, deltamethrin and lambda-cyhalothrin were detected in only one samples at a concentration (92.11 and 66.41 µg/kg, respectively) below the MRLs stipulated by the European Union. The level of pesticides that are commonly used in tea should be checked often.

Fermented and malted millet products in Africa: Expedition from traditional/ethnic foods to industrial value-added products.

With the prevalent food insecurity in Africa, there is a growing need to utilize the available crops to develop nutritious, affordable and palatable food for the populace. Millet is critical in this role, relative to its abundance in the continent and good nutritional composition. For ages, fermentation and malting have been traditionally used to transform millet into variety of produce. A paradigm shift has however occurred over the years, giving birth to new commercially available products. This review thus appraises and gives an overview of traditional and modern fermented and malted products. Although, millet has been diversified to several products, its major food uses are still restrained to traditional consumers and largely remains underutilized. Considering the potential embedded in this grain, it is important to explore this crop through the application of appropriate modern fermentation and malting technologies. This will ensure the availability of ready to eat (RTE) and ready to use (RTU) food products and to a large extent address the incessant food security challenges plaguing Africa.

Review on microbial degradation of aflatoxins.

Aflatoxin (AF) contamination presents one of the most insidious challenges to combat, in food safety. Its adulteration of agricultural commodities presents an important safety concern as evident in the incidences of its health implication and economic losses reported widely. Due to the overarching challenges presented by the contamination of AFs in foods and feeds, there is an urgent need to evolve cost-effective and competent strategies to combat this menace. In our review, we tried to appraise the cost-effective methods for decontamination of AFs. We identified the missing links in adopting microbial degradation as a palliative to decontamination of AFs and its commercialization in food and feed industries. Cogent areas of further research were also highlighted in the review paper.

Presentation pattern and management of effusive-constrictive pericarditis in Ibadan.

BACKGROUND: Effusive-constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease. METHODS: We conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa. RESULTS: The diagnosis of effusive-constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy. CONCLUSION: Effusive-constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

A large pericardial cyst presenting with severe chest pain: a case report and review of literature.

Primary cysts of the pericardium are uncommon, benign developmental anomaly. Most are asymptomatic and a common incidental finding on routine chest radiograph. We report a case of large pericardial cyst presenting with severe excruciating chest pain in a Nigerian man. To the best of our knowledge, no such report has emanated from the country.

Superior vena cava obstruction: diagnosis, management and outcome.

OBJECTIVE: To document our experience with superior vena cava obstruction in a black African population. DESIGN: A retrospective study of clinical data collected from cancer registry, patients case noted, cardiothoracic surgical unit's and operating records between June 1975 and May 1999. SETTING: University College Hospital, Ibadan, Nigeria which hosts a major cancer centre in the West African sub-region and also serves community clinics. PATIENTS: All patients with superior vena cava (SVC) obstruction referred for evaluation and treatment. MAIN OUTCOME MEASURES: Patients who had clinical features related to SVC obstruction and full investigation including tissue diagnosis were collated. Methods of treatment of acute episodes, definitive treatment and outcome of SVC obstruction were studied. RESULTS: One hundred and twenty nine consecutive patients with SVC obstruction were treated. There were 100 males and 29 females. Mean age was 36 +/- 15 years. The annual incidence increased from 2.3 patients per year during the first 12 years to 8.4 patients per year during the second 12 years. The most common symptoms were swelling of face, arms and chest-wall (87.6%) with associated venous congestion over these areas. Majority of the patients (73.8%) presented within 1 to 12 months of onsets of symptoms. Patients with benign diseases had longer duration of symptoms before presentation (mean 3 months) than those with malignant disease (mean 6 months). Majority of the patients (82.2%) had malignancy as the underlying cause of the SVC obstruction and 47.2% of the malignancy was bronchogenic carcinoma. Symptomatic relief and outcome was best in benign disease (7 out of 8 patients, 87.5%). Lymphomas had better outcome than bronchogenic carcinoma among the patients with malignant diseases. CONCLUSION: Patients with SVC obstruction should be carefully evaluated before treatment. This will enhance application of specific therapy.

Aorto-femoral bypass in the HIV infected patient.

We describe a 49-year old male Nigerian with HIV infection who presented in our institution with aorto-iliac arterial occlusive disease and progressive severe ischaemic changes of the lower extremity. His preoperative CD4 count was 43 cells / microlitre. He underwent a successful intra-peritoneal aorto-femoral bypass. This report illustrates that vascular reconstruction in an HIV infected patient can be successfully performed with minimal morbidity despite a high risk factor for major infection. The histological finding was in keeping with an accelerated atherosclerosis resulting from HIV infection.

Congenital diaphragmatic eventration in a Nigerian child.

BACKGROUND: Diaphragmatic eventration is a rare cause of respiratory distress and failure to thrive in children. METHOD/RESULT: A report of a case of diaphragmatic eventration in a four-month-old child is presented with a review of the relevant literature. CONCLUSION: Clinicians should be aware of this diagnosis and avoid misdiagnosing the condition as a diaphragmatic hernia.

Presentation of primary mediastinal masses in Ibadan.

OBJECTIVES: To determine clinical features, anatomic location and histological types of primary mediastinal masses diagnosed and treated in a black African population. DESIGN: A retrospective study of clinical data collected from patients case notes, the cardiothoracic unit's and pathology records between June 1975 and May 1999. SETTING: University College Hospital, Ibadan, Nigeria which hosts a major cancer center in the West African sub-region, and serves community clinics. PATIENTS: All patients with primary mediastinal masses referred for evaluation and treatment. MAIN OUTCOME MEASURES: Excluded metastatic, oesophageal and vascular-lesions. All patients had radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinum into anterosuperior, middle and posterior section was used. RESULTS: One hundred and five consecutive patients were evaluated and treated. The mean age was 34.0 +/- 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) were symptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomatic patients had malignant disease while 44 (54.3%) had benign disease. Forty five patients (43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence of symptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference in incidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%) had benign disease while 29.2% of patients with malignancy were asymptomatic. This difference in incidence was statistically significant (p=0.0039). The frequency of mediastinal masses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients (22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymus glands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonest types of primary mediastinal masses treated. CONCLUSION: Majority of our patients with mediastinal masses (whether benign or malignant) are symptomatic and the absence of symptoms is more associated with benign disease. Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the most frequent primary mediastinal mass.

The place of clinical features and standard chest radiography in evaluation of mediastinal masses.

One hundred and five primary mediastinal masses were seen between 1975 and 1998, at the Cardiothoracic surgical Unit of the University College Hospital Ibadan. These were studied to establish the importance of clinical features and plain chest radiography in preoperative evaluation of these masses. The sources of information were unit's record, cancer registry and the patients case note. The age range of the 75 male patients was 3 to 80 years (mean 35.2 +/- 22.1 year) and for the 30 female patients was 2.5 to 70 years (mean 30.9 +/- 18.6 years). Anterosuperior mediastinal masses were the most common (63.8%) followed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1%). Endocrine tumours (mainly goiters) constituted 17.1% of the masses. On the whole, 45 (42.9%) of the mediastinal tumours were malignant and 60 (57.1%) were benign. Eighty one patients (77.1%) were symptomatic at presentation, 24 patients (22.9%) were asymptomatic. Malignancy was more associated with symptoms in this series (82.2%) and benign lesion were more frequently (70.8%) asymptomatic. Cervical lymphadenopathy (78.6%), was more frequent in patients with malignant lesion. Tracheal deviation (60.3%) and neurological signs (78.9%) were more frequent in benign disease. Superior vena cava syndrome was more frequently associated with primary malignant mediastinal tumours. All masses (100%) were visualized on plain chest x-ray. On the basis of clinical features and chest x-ray, majority of patients (76.2%) with primary mediastinal masses had exploratory thoracotomy, sternotomy or biopsy of their mediastinal mass.

Traumatic vertebral artery pseudoaneurysm: a case report.

A case of traumatic vertebral artery pseudoaneurysm in a 16-year-old Nigerian male following a stab wound is described. Successful surgical treatment by proximal Subclavian artery control and excision of the lesion was achieved. The value of Doppler ultrasonography in the diagnosis is highlighted. This case illustrates and re-emphasises that this rare lesion should be considered in patients with neck mass following penetrating posteriorly located neck injuries.

Bronchiectasis consequent upon prolonged foreign body retention.

OBJECTIVE: To review our experience with bronchiectasis complicating prolonged endobronchial retention of foreign bodies (FB) among patients with a history of aspiration of FB seen between 1975 and 1998. DESIGN: A retrospective review of clinical data of consecutive patients with a history of aspiration of FB treated during the time of study. SETTING: The Cardiothoracic Unit of the University College Hospital, Ibadan, directly serves a population of about 40 to 60 million in the South Western Nigeria and the community clinics. SUBJECTS: All patients with a history of FB aspiration (or suggestive of FB aspiration) from whom patients with prolonged FB retention were selected. MAIN OUTCOME MEASURES: Patients with a relevant history or chronic respiratory symptoms had their clinical examination findings, plain chest radiographic (or/and bronchographic) findings, treatment modalities and outcome studied. RESULTS: Sixteen patients among 203 patients who had tracheobronchial foreign bodies removed had this complication. The mean age at presentation was 13.0 +/- 17.3 years. Twelve patients (75%) retained inorganic materials and in four patients (25%) it was organic. The period of retention ranged between 4.8 to 108 months (mean 17.0 +/- 22.6 months). Main presenting symptoms were: productive cough, 16 patients; pyrexia, seven patients; combination of chest pain, fever and copious sputum, five patients. In none of the patients was the history of aspiration of FB definitely elicited before commencement of treatment. Symptoms were worst among patients who retained inorganic materials. All of the patients had bronchoscopy but retrieval of FB by this means was successful in one patient (6.3%). Six patients (37.5%) had thoracotomy and bronchotomy; nine patients had bronchotomy and lung resection [seven (77.8%) lobectomies, one (11.1%) pneumonectomy and one (11.1%) segmentectomy] as the definitive treatment. The one patient who had brochoscopic retrieval subsequently had lobectomy to control symptoms of bronchiectasis. Five out of six (83.3%) who had bronchotomy had persistent symptoms of bronchiectasis. All the nine (56.3%) who had lung resection remained asymptomatic at follow up. There was one mortality (6.3%) in the series--a 75 year old who died from poorly controlled Diabetes mellitus. CONCLUSION: Prevention of aspiration of FB is better than cure. In every medically treated child with persistent cough with or without a history of aspirated FB, the possibility of retained FB should be borne in mind.

Diaphragmatic injuries.

This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment among patients with diaphragmatic injuries. One hundred and sixteen patients with diaphragmatic injuries were treated. This was 6.5% of 1,778 chest trauma patients. Eighty-four of these patients (6.8%) were among 1230 patients who had blunt chest injury and the remaining 32 patients (5.8%) were among 548 patients who had penetrating chest injury. The commonest mechanisms of injury were motor vehicle accidents (48.8%) for blunt and gunshot wounds (56.3%) for penetrating diaphragmatic injuries. The left diaphragm was most commonly involved (86.9% for blunt, 59.4% for penetration), 12.5% of the patients with penetrating chest injury had bilateral diaphragmatic injuries. There were no bilateral diaphragmatic injuries amongst the patients with blunt chest injury. Chest radiographs gave a highly positive yield in the diagnosis of blunt diaphragmatic hernias (67.9%) while nonspecific chest radiological findings (59.4%) were more common among those with penetrating injuries. In 57 patients (49.1%) out of 116, preoperative diagnosis of diaphragmatic hernia was certain. In the remaining 59 patients (50.9%), diagnosis was intraoperative (40 patients), or at postmortem (19 patients). Surgery was emergent in 69 patients (71.1%), semi emergent in 21 patients (21.6%) and elective in 7 patients (7.2%). Surgical approaches were mainly thoracotomy (57 patients), laparotomy (17 patients), laparotomy and thoracotomy (20 patients). In seventy seven patients (79.4%) the diaphragmatic injuries were left sided and in 20 patients (20.6%), the diaphragmatic injuries were right sided. There were 19 preoperative and 21 postoperative deaths. The overall mortality was 34.5%. Associated abdominal and thoracic injuries were the commonest causes of mortality among the patients with diaphragmatic injuries in this study. We conclude that diaphragmatic injury should be suspected in all thoracoabdominal trauma. Lack of specific signs and symptoms is common and a high index of suspicion is required. Routine chest radiograph remains the best screening test for diaphragmatic rupture. Diaphragmatic injury may be a predictor of severity of injury in blunt trauma patient. Surgical approach should be individualized.

Trans-oral irrigation for the management of cervical esophagogastric anastomotic leak.

Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical oesophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CES) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 +/- 15.7 year). Anastomotic leaks were diagnosed between 3rd to 10th postoperative day (mean 7.1 +/- 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 +/- 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 +/- 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilation. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.

Anterior mediastinotomy--a diagnostic tool.

This is a review of our experience with anterior mediastinotomy (AM) in the diagnosis and evaluation of diseases of the mediastinum and lung. Thirty consecutive patients who had AM between 1984 and 1999 were retrospectively studied. The mean age of patients was 28 +/- 6.5 years. There were 22 males to 8 females. Sixteen patients had superior vena cava (SVC) obstruction (12 patients with lung cancer, 4 with primary mediastinal tumours), 4 patients had radiological evidence of mediastinal contiguity of upper lobe tumours and 10 patients had primary mediastinal tumours. AM was 1st procedure in 10 patients and 2nd procedure in 20 patients after failed or inconclusive result from FNAB, scalene node/cervical lymph node biopsy or bronchoscopy. Eighteen right-sided and 12 left-sided AMs were performed. Satisfactory histological diagnoses were achieved in all patients. Complications were easily controlled bleeding (4 patients) and life-threatening haemorrhage in 2 patients. Three patients had delayed wound healing and 4 had inadvertent pleural entries. There was no mortality temporarily related to the procedure. We conclude that AM is valuable as a surgical technique for obtaining tissue for histological purposes in diseases of the mediastinum and the lung when tissue specimens from less invasive procedures are unsatisfactory.

Transhiatal esophagectomy in children with corrosive esophageal stricture.

Ten children with corrosive esophageal strictures were referred for esophageal replacement. The children whose ages ranged between 2 and 6 years (mean 4.1 +/- 1.4 years) had transhiatal esophagectomy (THE) and immediate posterior mediastinal transposition of their isoperistaltic stomach and cervical esophagogastrostomy. No patient had a gastric drainage procedure. All patients had nasogastric tube and a cervical perianastomotic drain until full oral intake resumed. Anastomotic leakages were managed by trans-oral irrigation (TOI) and postoperative feeding was through jejunostomy. Postoperative elective mechanical ventilation was for between 24 and 60 hours. Pleural entries were the commonest complication and they occurred in 6 patients (60%), unilateral in 2 patients, bilateral in 4 patients. Cervical anastomotic leaks and strictures occurred in 2 patients (20%) and 3 patients (30%), respectively, and the 2 patients (20%) who had anastomotic leaks and stricture had associated hoarseness. Though the incidence of complications was high, these responded well to appropriate treatment. There was no mortality in the series. THE and esophageal replacement with isoperistaltic stomach in the posterior mediastinum is a safe and useful procedure in the management of corrosive esophageal stricture in children.

Postoperative closed chest drainage without an underwater seal: a preliminary report.

The Aldon's urobag (e.g. simpla S4) which consists of a 2 litre plastic bag with a flutter valve and a drainage tube has been used in 29 consecutive cases as a postoperative pleural drainage system. The age range of patients was between 2 months and 74 years (mean 26.7 years). Indications for pleural drainage included lobectomy (3 cases), decortication (2 cases), lung biopsy (2 cases). Blalock-Taussig shunt (5 cases), patent ductus arteriosus patent ductus arteriosus (PDA) ligation (1 case), closed mitral valvotomy (1 case), oesophageal surgery (13 cases) and chest wall resection (2 cases). The period of pleural drainage ranged from 1 to 8 days (mean 3.75 days). The only operative death was not related to drainage system. No complications were attributable to the drainage system. This alternative chest drainage was found to enhance early ambulation, increase the efficiency of patient nursing and reduced the cost of consumables.

Closed chest drainage without an underwater seal.

Six hundred and eighty-five patients requiring pleural drainage were referred to and managed by the Cardiothoracic Unit of the University College Hospital, Ibadan between June 1985 and September 1992. Two hundred patients, in which Aldon's urobag (e.g. Simpla S4 type) was used for pleural drainage were studied. The indications for pleural drainage were pyothorax or pyopneumothorax (106 patients), malignant pleural effusion (53 patients), tuberculous effusions (23 patients) and chest trauma (18 patients). In seven of these patients, the Aldon's urobag was used for out-patient care pleural drainage. Some of the reasons for discontinuing its use were major tracheobronchial injuries (2 patients), clotted haemothorax (5 patients), chronic empyema thoracis (10 patients) and loculated malignant pleural effusions. The few easily surmountable complications encountered were obstruction of the tube by blood clot and fibrinous coagulate, stoma necrosis and periosteal reaction. The advantages observed from the use of Aldon's urobag for pleural drainage were reduction in cost of pleural drainage, availability of this drainage system and its use for out-patient care when indicated.