Feed balances for ruminant livestock: gridded estimates for data-constrained regions.

Demand for animal-source foods and livestock feed are forecast to increase across sub-Saharan Africa. In this context, there is a need to estimate the availability of livestock feed to support decision-making at local, sub-national and national levels. In this study, we assess feed balances for ruminant livestock in Ethiopia and Burkina Faso. Feed availability was estimated using remotely sensed products and detailed feed composition data. Feed requirements were estimated for maintenance, growth, lactation, gestation and locomotion using a data-intensive model. Biomass available as animal feed was estimated to be 8.6 tonnes of DM per hectare in the Ethiopian highlands and midlands, 3.2 tonnes DM per hectare in the Ethiopian lowlands, 2.9 tonnes DM per hectare in Burkina Faso's Sudanian agro-ecological zone and 1.0 tonne DM per hectare in the Sahel. The energy requirements of lactating cows were estimated to be 62.1 Megajoules (MJs) per animal per day in the Ethiopian highlands and midlands, 62.7 MJ in the Ethiopian lowlands, 88.5 MJ in Burkina Faso's Sudanian agro-ecological zone and 53.1 MJ per animal per day in the Sahel. Feed scarcity hotspots are most prominently located in the Ethiopian highlands and the Sahelian agro-ecological zone of Burkina Faso. Demand-side policy and investment initiatives can address hotspots by influencing herd sizes, nutritional requirements and herd mobility. Supply-side policy and investment initiatives can secure existing feed resources, develop new sources of feed and incentivise trade in feed resources. Improving feed balances will be of value to decision-makers with the aims of optimising livestock productivity, minimising exposure to climatic shocks and minimising greenhouse gas emission intensity.

Review: Role of herbivores in sustainable agriculture in Sub-Saharan Africa.

The role of herbivorous livestock in supporting the sustainability of the farming systems in which they are found is complex and sometimes conflicting. In Sub-Saharan Africa (SSA), the integration of livestock into farming systems is important for sustainable agriculture as the recycling of nutrients for crop production through returns of animal manure is a central element of the dominant mixed crop-livestock systems. Sustainable agriculture has been widely advocated as the main practical pathway to address the challenge of meeting the food needs of the rapidly growing population in SSA while safeguarding the needs of future generations. The objective of this paper is to review the state of knowledge of the role of herbivores in sustainable intensification of key farming systems in SSA. The pathways to sustainable agriculture in SSA include intensification of production and livelihood diversification. Sustainable agricultural practices in SSA have focused on intensification practices which aim to increase the output : input ratio through increasing use of inputs, introduction of new inputs or use of existing inputs in a new way. Intensification of livestock production can occur through increased and improved fodder availability, genetic production gains, improved crop residue use and better nutrient recycling of manure. Livestock deliver many 'goods' in smallholder farming systems in SSA including improving food and nutrition security, increased recycling of organic matter and nutrients and the associated soil fertility amendments, adding value to crop residues by turning them into nutrient-rich foods, income generation and animal traction. Narratives on livestock 'bads' or negative environmental consequences have been largely shaped by the production conditions in the Global North but livestock production in SSA is a different story. In SSA, livestock are an integral component of mixed farming systems and they play key roles in supporting the livelihoods of much of the rural population. None-the-less, the environmental consequences of livestock production on the continent cannot be ignored. To enhance agricultural sustainability in SSA, the challenge is to optimize livestock's role in the farming systems by maximizing livestock 'goods' while minimizing the 'bads'. This can be through better integration of livestock into the farming systems, efficient nutrient management systems, and provision of necessary policy and institutional support.

Emerging feed markets for ruminant production in urban and peri-urban areas of Northern Ghana.

Feed shortage in urban and peri-urban areas has triggered the emergence of feed markets in Northern Ghana. These markets were surveyed at three locations (Tamale, Bolgatanga, and Wa markets) to determine types and prices of feedstuffs sold across seasons; early dry (November-January), late dry (February-April), early wet (May-July), and main wet (August-October). Semi-structured questionnaire was used for data collection. Three samples of each feed type in the markets were bought from three different sellers per market in each season. The samples were oven dried to constant weight and price/kg DM of each feed determined. The total respondents were 169. Out of this number, 41% were feed sellers, 46% buyers, and 13% retailers. The feedstuffs found were crop residues (groundnut haulm and cowpea haulm), agro-industrial by-products (bran of maize, rice, and sorghum), fresh grasses (Rotteboellia cochinchinensis), and local browses (Ficus sp. and Pterocarpus erinaceous). Prices of feeds differed (P < 0.05) among markets and were higher in Bolgatanga than Tamale and Wa markets. Prices of cereal bran were not different (P > 0.05) in all seasons but that of crop residues were higher (P < 05) in early to late dry season than the wet season. Majority (90%) of respondents opined that the feed market will expand due to increasing number of livestock population in the peri-urban areas.

Assessment of lifetime performance of small ruminants under different feeding systems.

Evaluation of lifetime productivity of individual animals in response to various interventions allows assessment of long-term investment opportunities for farmers. In order to gain a better understanding of promising feed interventions for improvement of small ruminant production in Southwestern Nigeria, a dynamic modelling approach was used to explore the effect of different feeding strategies on the lifetime productivity of West African Dwarf (WAD) goats. Modifications were made to the current version of Livestock Simulator developed for cattle production to simulate goat production systems particularly for WAD goats. Effects of changes in input parameters (quality of feed and potential adult weight) confirmed the sensitivity of the modelled weight development and reproductive performance. The values of simulated model outputs corresponded well with observed values for most of the variables, except for the pre-weaning mortality rate in the cut-and-carry system where a wide discrepancy between simulated (2.1%) and observed (23%) data was found. The scenario analysis showed that simulated goats in the free grazing system attained sexual maturity and kidded much later than those in the grazing with supplementation and the cut-and-carry systems. The simulated results suggested that goats require supplementation with protein and energy sources, in order to promote lifetime productivity, early sexual maturity and higher birth weight. In terms of economic returns based on feed cost alone, the moderately intense system produced the most profit. We therefore conclude that grazing with adequate supplementation using farm-generated feed resources offers an opportunity for improving smallholder goat production systems in West Africa.

Approach to the diagnosis and management of retained rectal foreign bodies: clinical update.

Retained rectal foreign body is not an uncommon condition, but reliable epidemiological data are not available. The diagnosis and management can present a significant challenge due to delayed presentation and the reluctance of the patients to provide details of the incident. The aim of the clinical evaluation is to identify the type, number, size, shape and location of the foreign body. Removal of retained rectal foreign bodies requires experience, with particular attention to different methods of extracting various objects. Most retained rectal foreign bodies can be successfully extracted transanally under appropriate anaesthesia and only a small proportion, mostly cases of perforation, overt peritonitis, pelvic sepsis or for failure of transanal extraction, will require open surgery or laparoscopy. It is mandatory to perform a proctosigmoidoscopy after anorectal foreign body removal to exclude bowel injury and ensure that the patient has not inserted more than one foreign body. Patients with mucosal abrasion, tears and oedema are to be admitted for a period of observation.

Supplementation with groundnut haulms for sheep fattening in the West African Sahel.

Groundnut haulms along with cowpea hay are major crop residues used for animal fattening in the West African Sahel. In traditional sheep fattening, feeds are always provided ad-hoc and in an unregulated fashion, which is rather wasteful. As a preliminary study to establish the optimal feeding levels of groundnut haulms for profitable sheep fattening, a feeding trial was conducted for 70 days with four levels of groundnut haulms (0, 150, 300 and 450 g/day) and a basal diet of bush hay. The effects of supplementation with groundnut haulms on feed intake, water consumption, live weight changes and economic return were determined. Twenty-four Peuhl Oudah rams with average initial weight of 28.6 kg (SD = 1.4) were randomly allocated to four treatments defined by the four levels of groundnut haulms in the diet. Faeces and urine were collected in weeks 5 and 9 of the trial. Digestible organic matter intake (g/(kg LW)0.75) and nitrogen intake (g/day) increased linearly with the level of groundnut haulms offered. Sheep that were fed only bush hay lost 18.4 g/day, while those that were offered 150, 300 and 450 g of groundnut haulms gained 1.4, 19.3 and 40.2 g/day, respectively. The gross return ranged from 1883 to 4946 FCFA per ram. Net benefit, after removing the feed and veterinary costs from the gross return, ranged from 368 to 1400 FCFA per ram.

Esophagogastric cancers secondary to a breast primary tumor do not require resection.

BACKGROUND: Breast cancer metastasis to the gastrointestinal tract (GIT) is rare. When it does occur, the upper GIT is more frequently involved, and lobular infiltrating carcinoma apparently has a greater apparent predilection for the GIT than the ductal type does. This study reviewed the clinicopathological features of esophagogastric secondary tumors from breast cancer. PATIENTS AND METHODS: Patients with breast cancer metastases to the upper GIT referred to us for treatment of either esophageal or gastric cancers between November 1997 and November 2004 were identified from our database. The medical records of these patients were then reviewed for clinicopathological data and outcome. RESULTS: Nine patients with mean age of 71 (range: 57-90) years had median time of 6.5 (2.8-32.8) years between primary breast cancer diagnosis and upper GI metastasis. The sites of metastatic lesions included the lower esophagus (2 patients), gastroesophageal junction (1 patient), gastric body (3 patients), and pylorus (3 patients). Histological typing indicated 7 cases of the lobular form and 2 cases of ductal carcinoma. All but one biopsy specimen were estrogen receptor and CK7 positive. Treatment included hormonal therapy and stent in 3 patients, hormonal therapy alone in 1 patient, chemotherapy alone in 1 patient, chemotherapy and gastrojejunostomy in 1 patient, dilatation and stent in 1 patient, and palliative care only in 2 patients. The median survival following treatment of these metastases was 20 (range: 2.1-96.6) months. CONCLUSIONS: The onset of nonspecific GIT symptoms in patients with a history of breast carcinoma should prompt the clinician to rule out the possibility of upper GIT metastasis even many years after the original breast cancer. The use of systemic therapy for breast cancer may result in longer survival.

Gallstone ileus: diagnosis and management.

BACKGROUND: Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. It accounts for 1%-4% of mechanical bowel obstruction and is associated with high morbidity and mortality. We present our experience of gallstone ileus and discuss current opinion as reported in the literature. PATIENTS AND METHODS: A retrospective review was performed of medical records of patients in our institution coded for gallstone ileus by the International Classification of Diseases (ICD K-563) coding system between January 1998 and December 2005. RESULTS: There were 22 patients with mean age of 77 (58-92) years and a female to male ratio of 4.5:1. Most patients presented with abdominal pain and vomiting, with a median duration of symptoms of 3 (1-28) days. Preoperative diagnosis was made in 77% from a combination of plain x-ray, ultrasonography, and computed tomography (CT) scans; 86.4% of the patients belonged to ASA class of 3 or 4. Twenty patients underwent enterolithotomy alone, and two had one-stage procedure. The mean size of impacted stones was 3.6 (2.5-4.5) cm, with location in the terminal ileum in 17 and jejunum in 5 patients. There were 5 perioperative deaths and an episode of cholangitis occurring in one patient 18 months after enterolithotomy alone. CONCLUSIONS: Gallstone ileus is a difficult clinical entity to diagnose. Unreserved use of imaging techniques can improve diagnostic accuracy and speed of therapeutic decision making. Management of gallstone ileus must be individualized. The one-stage procedure should be offered only to highly selected patients with good cardiorespiratory reserve and with absolute indications for biliary surgery at the time of presentation.

The role of staging laparoscopy in oesophagogastric cancers.

AIMS: Selection of patients for treatment of oesophagogastric cancers rests on accurate staging. Laparoscopy has become a safe and effective staging tool in upper gastrointestinal cancers because of its ability to detect small peritoneal and liver metastases missed by imaging techniques. The aim of this study was to evaluate the role of staging laparoscopy (SL) in determining resectability of oesophagogastric cancers. METHODS: A review of 511 patients with oesophagogastric cancers referred to our centre during a 7-year period was performed. Four hundred and sixteen of them assessed to have resectable tumours after preoperative staging with CT and/or ultrasound underwent SL. The main outcome measure was the number of patients in whom laparoscopy changed treatment decision. RESULTS: Staging laparoscopy changed treatment decision in 84 cases (20.2%): locally advanced disease in 17, extensive lymph node disease in four and distant metastases (liver and peritoneum) in 63 cases. The sensitivity of laparoscopy for resectability was 88%. Eighty-one percent of patients who had combined CT scan and EUS were resectable at surgery compared with 65% of those who had CT scan alone (statistically significant with P-value<0.05). Of those patients deemed resectable by SL 8.1% were found to be unresectable at laparotomy, 16 with locally advanced disease and 11 with metastases. CONCLUSION: Staging laparoscopy avoided unnecessary laparotomy in 20.2% of our patients and was most useful in adenocarcinoma, distal oesophageal, GOJ and gastric cancers and probably not necessary in lesions of the upper two-third of the oesophagus.

Pattern and prognostic factors in patients with malignant ascites: a retrospective study.

BACKGROUND: Malignant ascites is a manifestation of end stage events in a variety of cancers and associated with a poor prognosis. We evaluated the pattern of cancers causing malignant ascites and factors affecting survival. PATIENTS AND METHODS: Patients coded with the International Classification of Diseases-9 coding system for malignant ascites over a 2-year period were reviewed. The clinicopathological data and patients' survival were compared among cancer groups. RESULTS: There were 209 patients (140 females and 69 males), median age being 67 (30-98) years. The commonest cancer was ovarian followed by gastrointestinal (GI) cancers. Fifty-eight per cent of the patients had symptoms related to the ascites. Liver metastases were significantly commoner in the GI cancers (P = 0.0001). Fifty-four per cent of our patients presented with ascites at the initial diagnosis of their cancer. Paracentesis was given to 112, diuretics to 70 and chemotherapy to 103 patients. The median survival following diagnosis of ascites was 5.7 months. Ovarian cancer favoured longer survival while low serum albumin, low serum protein and liver metastases adversely affected survival. The independent prognostic factors for survival were cancer type, liver metastases and serum albumin. CONCLUSION: The identified independent prognostic factors should be used to select patients for multimodality therapy for adequate palliation.

A survey of patient satisfaction and use of the Internet for health information.

To survey patients/carers' use of the Internet and other sources for health information, to determine how useful health information over the Internet was to patients/carers and to assess the potential use of validated health information on the Internet by our patients. A multidisciplinary questionnaire survey of the use of the Internet for health information was performed. The study population consisted of patients and accompanying adults 18 years and older who attended outpatient clinics at Nottingham City Hospital for a period of two weeks in July 2005. The questionnaire captured information on demographics, frequency of use of the Internet, sources of health information, satisfaction rating of health information obtained on the Internet and their interest in using trustworthy health information Internet site if made available. Of the 800 questionnaires sent out, 663 responded (83%). Sixty three percent of patients had access to the Internet. 42% of the participants had used the Internet to access health information prior to this survey. 7.5% of the participants who have no access to the Internet, have had someone else look up health information on the Internet on their behalf. 95% of the respondents who had used the Internet for health information rated such information between average to excellent. 82% of those with Internet access and 21% of those with no Internet access would be interested in using trustworthy health information on the internet. Nearly half of our population of secondary care patients have used the internet to access health information and most are interested in using validated health information. Delivery of validated health information via the internet should be a priority for health care providers.

Male breast cancer: a review of clinical management.

AIMS: Male breast cancer incidence is 1% of all breast cancers and is increasing. We aim to present an overview of male breast cancer with particular emphasis on clinical management. METHODS: Studies were identified by an online search of literature in the MEDLINE database till June 2006 followed by an extensive review of bibliographies. RESULTS: Increased risk factors include genetic predisposition as in BRCA2 families; testicular dysfunction due to chromosomal abnormality such as Klinefelter's syndrome or environmental factors such as chronic heat exposure and radiation. Clinical assessment with biopsy is the hallmark of diagnosis. Earlier presentations are becoming commoner but there are wide geographical differences. Surgical treatment involves simple or modified radical mastectomy along with surgical assessment of the axilla, either via sentinel node biopsy in clinically node-negative disease or axillary sampling/clearance in node-positive disease. Reconstructions for restoring body image have been recently reported. Indications for adjuvant therapies are similar to that in women. For metastatic disease, tamoxifen is still the mainstay for oestrogen receptor positive disease. For oestrogen receptor negative disease, doxorubicin based chemotherapy regimens are used. In addition, the oft neglected psychological aspects of men having a "cancer of women" are increasingly being recognised. CONCLUSIONS: There is, thus, need for further increasing awareness among men to reduce stigma associated with presentation of symptoms related to breast. This should be in addition to stressing to clinicians the ways of earlier detection and tailor-made "gender oriented" treatment of breast cancer in men.

A review of gastrointestinal foreign bodies.

Gastrointestinal tract (GIT) foreign bodies represent a significant clinical problem in the Emergency Department, causing a high degree of financial burden, morbidity and mortality. A large variety of foreign bodies are accidentally ingested or inserted into the GIT in different age groups. This a retrospective review of 38 patients who presented to the Emergency Department with GIT foreign bodies between January 2001 and December 2004. Computer database and case note search of patients' personal data, nature of the foreign objects and mode of entry to the GIT were recorded. There were 30 males and eight females (M : F ratio of 3.75:1) with an age range of 10 months to 87 years (median age 25.5 years). Foreign body ingestion/insertion was accidental in 14 patients, deliberate in 11, for anal erotism in 11 and as a result of assault in two cases. The median time before presentation was 12 h, and the mean length of hospital stay was 1.7 days. Treatment was conservative in 15 patients; five patients had gastroscopic retrieval; 15 patients underwent examination under anaesthetic, retrieval and proctosigmoidoscopy and three patients underwent laparotomy for impacted foreign bodies. GIT foreign body ingestion or insertion is common; however, majority of cases can be successfully managed conservatively.

Portal vein thrombosis complicating appendicitis.

Appendicitis is still the most common acute surgical abdomen all over the world and its complications may be grave. We report an adult case of acute appendicitis complicated by Portal Vein Thrombosis (PVT) and ascending portomesenteric phlebitis treated successfully with antibiotics and anticoagulation with no residual morbidity. Review of published works on the subject matter is also presented.

A review of gall bladder carcinoma in Ibadan.

Twenty cases of histologically proven carcinoma of the gall bladder (GB) seen in the University College Hospital, Ibadan, Nigeria between 1983 and 1997 were reviewed. There were seven males and thirteen females, thus giving a sex ratio of 1:2. The majority of the cancers occurred between the fourth and seventh decade of life. The pre-operative diagnosis has improved and about 70% of the ten patients with adequate clinical information had definitive surgical treatment. The advent of new imaging techniques at this hospital, consisting of ultasound (US) and computerized axial tomography(CT) has made pre-operative diagnosis possible. This is in contrast to the situation noted twenty years earlier in a similar study. Surgical intervention can now be timed and planned appropriately in the majority of cases although late presentation is still a problem. With earlier presentation, prompt diagnosis and appropriately planned surgery, a better survival figure is anticipated at this institution.

Spontaneous rupture of incisional hernia--a case report.

A case of spontaneous rupture of an incisional hernia is hereby presented. Though very rare in adults, it is a potentially fatal but preventable clinical condition.