How the Global Burden of Animal Diseases links to the Global Burden of Crop Loss: a food systems perspective.

Food systems comprise interconnected webs of processes that together transform inputs (land, labour, water, nutrients and genetics, to mention just a few) into outputs such as nutrition and revenue for human societies. Perfect systems do not exist; rather, global food systems operate in the presence of hazards, biotic and abiotic alike, and under the constraint of limited resources to mitigate these hazards. There are, therefore, inefficiencies in these systems, which lead to losses in terms of monetary, nutritional, health and environmental values and create additional negative externalities in the health, social and environmental spaces. Health hazards in the food system do not respect arbitrary distinctions between the crop and livestock sectors, which are highly interconnected. These linkages exist where one sector provides inputs to another or through substitution effects where supply in one sector influences demand in another. The One Health approach advocates investigating the intersectoral hazards in a highly interdisciplinary manner. This article provides a conceptual framework for integrating the methodologies developed by the Global Burden of Crop Loss and Global Burden of Animal Diseases initiatives to generate burden estimates for hazards in food systems that better account for interconnectivity and foster an improved understanding of food systems that is aligned with the interdisciplinary nature of the One Health approach. A case study related to maize and poultry sector linkages in the wider context of public and environmental health is presented.

Les systèmes alimentaires sont des réseaux de processus interconnectés qui concourent à transformer des intrants (terre, main-d'oeuvre, eau, nutriments et génétique, pour n'en mentionner que quelques-uns) en extrants tels que des aliments et des revenus pour les sociétés humaines. Il n'existe pas de système parfait ; les systèmes alimentaires mondiaux sont exposés en permanence à des dangers de nature tant biotique qu'abiotique et contraints par les ressources limitées consacrées à l'atténuation de ces dangers. Les problèmes d'efficacité sont donc inéluctables ; ils entraînent des pertes de valeur tant monétaire que nutritionnelle, sanitaire et environnementale, et génèrent de nouvelles externalités négatives dans le domaine de la santé ainsi que dans l'espace social et dans l'environnement. Les dangers sanitaires présents dans le système alimentaire ignorent les distinctions arbitraires entre les secteurs agricole et d'élevage, lesquels sont fortement interconnectés. Ces liens se manifestent lorsqu'un secteur fournit des intrants à l'autre et, par l'effet de substitutions, lorsque l'offre dans un secteur influence la demande dans l'autre. L'approche " Une seule santé " préconise d'adopter une méthode fondée sur l'interdisciplinarité pour enquêter sur les dangers intersectoriels. Les auteurs décrivent le cadre conceptuel de l'intégration des méthodes des initiatives " Fardeau mondial des pertes agricoles " et " Impact mondial des maladies animales " dans le but de produire des estimations de la charge induite par les dangers des systèmes alimentaires qui prennent davantage en compte leur inter-connectivité et donnent lieu à une meilleure compréhension des systèmes alimentaires, en cohérence avec le caractère interdisciplinaire de l'approche " Une seule santé ". Est également présentée une étude de cas portant sur les liens entre la culture du maïs et l'élevage de volailles dans le contexte plus large de la santé publique et environnementale.

Los sistemas alimentarios comprenden redes interconectadas de procesos que, conjuntamente, transforman insumos (tierra, mano de obra, agua, nutrientes y genética, por mencionar solo algunos) en productos como alimentos e ingresos para las sociedades humanas. No existen sistemas perfectos; más bien, los sistemas alimentarios mundiales funcionan en un entorno de peligros, tanto bióticos como abióticos, y con las restricciones impuestas por los limitados recursos disponibles para mitigarlos. En estos sistemas se observan, por tanto, ineficiencias, que provocan pérdidas en términos monetarios, nutricionales, sanitarios y ambientales y que crean externalidades negativas adicionales en los ámbitos sanitario, social y ambiental. Los peligros para la salud en los sistemas alimentarios no atienden a distinciones arbitrarias entre los sectores agrícola y ganadero, que están muy interconectados. Estos vínculos surgen cuando un sector proporciona insumos a otro o a través de efectos de sustitución en los que la oferta de un sector influye en la demanda de otro. El enfoque de "Una sola salud" aboga por investigar los peligros intersectoriales de manera eminentemente interdisciplinaria. En este artículo se ofrece un marco teórico para la integración de las metodologías desarrolladas por las iniciativas dedicadas al impacto global de las pérdidas de cosechas y al impacto global de las enfermedades animales a fin de obtener estimaciones de los peligros en los sistemas alimentarios que tengan más en cuenta la interconexión y fomenten una mejor comprensión de los sistemas alimentarios acorde con el carácter interdisciplinario del enfoque de "Una sola salud". En este sentido, se presenta un estudio de caso relacionado con los vínculos entre los sectores del maíz y las aves de corral en el contexto más amplio de la salud pública y ambiental.

Urinary retention and intravesical hemorrhage following urethral collagen injections in women using warfarin.

Two women on warfarin anticoagulation experienced urinary retention following urethral collagen bulk injections. Both women developed implant site hematomas, with urinary retention and intravesical hemorrhage. One woman was supratherapeutic and the other was therapeutic on warfarin therapy. Both women required transfusion and prolonged catheterization.

Is it worth doing barium enemas on patients with unexplained iron deficiency anaemia?

The incidence on double contrast barium enema (DCBE) of carcinomas and polyps > 1 cm in size was compared in 92 patients with iron deficiency anaemia and a group of randomly obtained non-anaemic controls. In the anaemic group there were eight carcinomas and four polyps, and in the control group two carcinomas and no polyps. The incidence of neoplasms in the anaemic group (13.0%) was significantly greater than in the control group (1.6%). The incidence of neoplasms in iron-deficient males was 19% compared with 9% in females. The presence of bowel symptoms or weight loss were not found to be significant. This study confirms the value of DCBE in investigating patients with unexplained iron deficiency anaemia even in the absence of bowel symptoms.

The effect of oestradiol implants on regional and total bone mass: a three-year longitudinal study.

OBJECTIVE: Although there is evidence from cross-sectional studies that percutaneous oestrogen administration protects against menopausal bone loss, few longitudinal data are available. We have examined the effect of 3 years' treatment with percutaneous oestradiol on total body calcium, spinal trabecular bone mineral density and radial bone mineral content in post-menopausal women. DESIGN AND PATIENTS: Twenty-nine post-menopausal women, aged 37-55 years, who had undergone hysterectomy and had experienced the onset of menopausal symptoms within the previous 2 years, were studied before and for 3 years during hormone replacement with oestradiol implants, given at approximately 6-monthly intervals. MEASUREMENTS: Total body calcium was measured by prompt gamma neutron activation analysis, spinal trabecular bone mineral density by quantitative computed tomography and radial bone mineral content by single-photon absorptiometry. RESULTS: There was a significant increase in the mean total body calcium, spinal trabecular bone mineral density and radial bone mineral content over the 3 years of the study. The mean (+/- SEM) percentage change per annum was +2.4% (+/- 0.8) for total body calcium (P < 0.01), +3.3% (+/- 0.6) for spinal trabecular bone mineral density (P < 0.001) and +1.2% (+/- 0.6) for radial bone mineral content (P < 0.05). CONCLUSIONS: Percutaneous oestradiol replacement therapy prevents menopausal bone loss and is associated with a sustained and significant increase in total body calcium, spinal trabecular bone mineral density and radial bone mineral content over a 3-year treatment period. Oestradiol implants thus have skeletal effects comparable to those of oral or transdermal oestrogens.

Case report: pericolic abscess secondary to torsion of an appendix epiploica.

Torsion of the appendices epiploicae is a rare condition which may present with acute abdominal pain and mimic appendicitis. Untreated, peritonitis or intestinal obstruction may result. We present a case in which torsion of an appendix epiploica led to the development of a pericolic abscess communicating between the colon and lesser sac. To our knowledge these radiological findings have not been described previously.

Is the appendix where you think it is--and if not does it matter?

For over 100 years the recognized surface marking for the appendix has been McBurney's point (the junction of the lateral and middle thirds of a line joining the umbilicus with the right anterior superior iliac spine (ASIS)). In order to test its validity, the relationship between McBurney's point and the appendix was determined on 275 double contrast barium enemas (DCBE). A wide spread of distribution of the site of the appendix base was seen. Only 35% of appendix bases were found to lie within 5 cm of McBurney's point, and 15% were more than 10 cm distant. Seventy-five per cent of appendix bases were below and medial to a line joining the umbilicus with the right ASIS. These findings are in agreement with world-wide studies conducted by the World Organisation of Gastroenterology which showed that less than half of all patients with appendicitis have tenderness maximal over McBurney's point. A record was also made in 93 cases of the position of the appendix in relation to the caecum. The importance of these results in the diagnosis and management of patients with suspected appendicitis is discussed.

Aspiration of high-density barium contrast medium causing acute pulmonary inflammation--report of two fatal cases in elderly women with disordered swallowing.

Two cases are reported in which accidental inhalation of barium contrast medium occurred owing to disordered swallowing in elderly women. In each case there was a pulmonary inflammatory reaction followed within a few hours by death. Experimental and clinical reports of barium inhalation are reviewed and the hazard of aspiration of high density barium preparations in elderly and debilitated patients with dysphagia is emphasised. It is concluded that particular care should be taken in the radiological examination of such patients, and a suggested method for performing a contrast swallow in those who are liable to aspirate is described.

Annual oration 1989: bring out your barium.

A critical review of the use of barium examinations of the gastrointestinal tract compared with endoscopy provides evidence of a valid role for barium studies in contemporary radiology. It is concluded that there is no clinical, scientific, or economic justification for the wholesale replacement of barium radiology by endoscopy.

The role of transabdominal ultrasound in the preoperative evaluation of patients with benign prostatic hypertrophy.

We evaluated 59 consecutive patients for obstructive voiding symptoms with physical examination, excretory urography, urethrocystoscopy, post-voiding residual volumes, uroflowmetry and transabdominal ultrasound of the prostate. Of the patients 53 underwent transurethral resection of the prostate and 6 underwent open prostatectomy. Followup uroflowmetry was done 4 weeks postoperatively. The best predictor of the actual prostatic weight was transabdominal ultrasound (r equals 0.975), and with digital rectal examination and urethrocystoscopy there was a tendency to overestimate small and underestimate large glands. Symptoms such as nocturia do not allow any conclusions about the size of the prostate. The correlation between post-void residual and specimen weight also is poor and only patients in retention (Foley catheter) have a significantly larger prostate. Preoperative uroflowmetry provides limited information about the prostatic size but, although the difference between the preoperative and postoperative flow rate index is highly significant (p less than 0.001, mean difference test), the correlation between specimen weight, and the difference between preoperative and postoperative flow rate index is not significant. We recommend transabdominal sonography of the prostate, a simple and noninvasive procedure, as a useful adjunct in the preoperative evaluation of patients with benign prostatic hypertrophy. In addition to the fact that only this method provides reliable and reproducible estimations of the weight of the prostate, further information, such as measurement of the post-void residual volume, can be obtained without additional costs or loss of time.

New method for the dynamic assessment of anorectal function in constipation.

A new dynamic technique for the investigation of anorectal function has been developed. This involves radiological visualization of the rectum during voiding of a semisolid radio-opaque contrast medium, and simultaneous measurement of the intrarectal pressure and electrical activity of the external anal sphincter. The method has been used to study patients (n = 16) with profound difficulty passing formed stool. It has demonstrated an abnormal increase in the activity of the puborectalis and superficial and sphincter muscles during voiding in these patients, compared with normal subjects (n = 6). The inability to void was associated with failure to widen the anorectal angle on straining.

The barium enema appearances in solitary rectal ulcer syndrome.

Solitary rectal ulcer syndrome is a benign condition of unknown aetiology, usually found in young adults. The main clinical complaint is of rectal bleeding, often with change in bowel habit. The radiological findings in 17 patients with histologically proven solitary rectal ulcer syndrome, seen at the General Infirmary at Leeds over an 8-year period, are presented. Ulceration, polypoid lesion, stricture, granularity or a normal rectal mucosa may all be found on barium enema. The histological findings and pathogenesis of the condition are discussed.

Abdominal actinomycosis: a report of three cases.

Abdominal actinomycosis is a rare condition which is difficult to diagnose because of its close resemblance to other, more common conditions. The clinical and radiological features of three cases are described and illustrated. The diagnosis is suggested by the rapid development of a fixed mass with fistulae.

Do plain films of the chest and abdomen have a role in the diagnosis of acute pancreatitis?

Radiographs taken on the day of admission on 52 patients with acute pancreatitis have been compared with similar radiographs of 30 patients with acute cholecystitis and 22 patients with perforated duodenal ulcer. Two radiologists, who were unaware of the clinical features, looked specifically for the presence of 30 radiological signs. The only abdominal signs seen more frequently in acute pancreatitis were fluid levels in the stomach and duodenum, usually associated with dilatation. Duodenal abnormalities were seen in 42% of patients with acute pancreatitis and 21% of the controls (P less than 0.05) while gastric dilatation with a fluid level was seen in 29% of cases of acute pancreatitis compared with 12% of controls (P less than 0.05). Seventy per cent of the patients with severe acute pancreatitis had an abnormal chest radiograph on admission compared with 18% of those with mild disease. Left pleural effusion was the most common abnormality in severe pancreatitis (43%) and was seen significantly more often than in mild pancreatitis (P less than 0.01) and the control group (P less than 0.05). Therefore, consideration of the admission chest radiograph may help at an early stage to distinguish patients with severe pancreatitis from those with mild disease.

A comparison of barium sulphate preparations used for the double contrast barium meal.

Radiologists' opinions of the properties of six barium suspensions with their recommended gas-producing agents designed for upper gastrointestinal use were assessed, using a linear analogue scale. Five radiologists independently assessed mucosal coating of stomach and duodenum, areae gastricae, gaseous distension and bubble formation in a total of 258 patient examinations. Preparation 1 (EZHD) was judged to give best overall results, coating stomach and duodenum particularly well. Preparation 2 (X-Opaque) gave good distension and also coated mucosa fairly well, as did preparations 3 and 4 (Medebar XAC and Field 2C). The latter two preparations produced good distension at the expense of bubble formation. Preparations 5 and 6 (Micropaque DC and Baritop G) were judged, by comparison, to have performed poorly as regards mucosal coating. None of the preparations delineated areae gastricae well, even in the presence of good, bubble-free gastric distension.