Effect of defatted Lagenaria siceraria (Molina) Standley seed flour as a fat replacer on physicochemical, technological, and sensory properties of beef patty.

Defatted Lagenaria siceraria seed flour (DLSSF) was obtained from defatted seed cake, dried, and ground through a sieve of 500 µm and characterized. A 2 × 4 factorial design (two flour hydration rates and four fat substitution rates) was used to produce a low-fat beef patty by replacing fat with DLSSF. Beef kidney fat was used to formulate the control sample. Chemical, physical, technological, sensory, and nutritional characteristics of low-fat beef patties manufactured were evaluated. DLSSF contains mainly protein. As fat replacers, DLSSF induces a significant increase in the pH of the raw and cooked patty, the moisture and protein contents, the cooking yield, the cohesion, chewiness, springiness, and lightness of the cooked beef patty with fat substitution rate. There is a decrease in fat content, total calories, water retention capacity, hardness, and redness of the cooked patty with a fat substitution rate. From the sensory analysis, the substitution of fat improves the acceptability of samples. Based on the overall parameters analyzed, DLSSF containing 60% water can be used to produce low-fat beef patty by replacing fat at 100%. From these results, hydrated DLSSF could be an effective method to solve the problems of noncommunicable diseases related to animal fat consumption.

Diagnostic performance of central and generalized adiposity in detecting risk of diabetes mellitus in adolescents.

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing in all age groups, including the adolescent globally. Objective: This study examined the association of adiposity with the risk of T2DM in adolescents aged 11 to 19 years. Methods: This study comprised 403 adolescent boys (202) and girls (201). Participants were assessed in three indices of body fat and fasting blood glucose (FBG). Multivariate regression models assessing the associations of the independent variables with risk of T2DM were conducted. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive capacities of the body fat proxies to detect risk of T2DM. Results: The prevalence of glucose abnormalities was 13.6% and 1.8% for pre-diabetes and diabetes respectively. Among the body fat indices in boys, WHtR was the only independent predictor (ß =0.599, p<0.001) of T2DM risk. Both the WHtR and WC had significant (p<0.001) Areas under curve (AUC), with WHtR as the best body fat indicator for identifying risk of T2DM in boys. The independent variables had no discriminatory capacities to detect T2DM risk in girls. Conclusions: This study has demonstrated that central fat is more important than total fat in detecting risk of T2DM in Nigerian adolescent boys.

Antimicrobial resistance in neonates with suspected sepsis.

SETTING: Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. OBJECTIVE: To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU). DESIGN: This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records. RESULTS: Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated (n = 40; 78%), followed by coagulase negative staphylococcus (n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (n = 170, 96%) improved, although 7 (4%) left against medical advice. CONCLUSION: Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.

LIEU: Hôpital Universitaire Nobel Medical College, Biratnagar, Népal. OBJECTIF: Déterminer le profil de résistance antimicrobienne et les résultats au moment de la sortie d'hôpital chez des nouveau-nés avec suspicion de sepsis dans une unité néonatale de soins intensifs tertiaires (NICU). MÉTHODE: Cette étude de cohorte hospitalière a été réalisée pour suivre les patients de janvier à décembre 2019. Tous les cas identifiés de suspicion de sepsis ont été inclus à partir des dossiers hospitaliers. RÉSULTATS: Une suspicion de sepsis a été observée chez 177 (88%) des 200 cas admis en NICU ; 52 (29%) étaient positifs par culture. Pseudomonas était le micro-organisme prédominant (n = 40 ; 78%), suivi des staphylocoques à coagulase négative (n = 12, 23%). Neuf (17%) des 52 isolats étaient résistants aux groupes d'antibiotiques « dont l'utilisation est essentielle ¼ et « à utiliser sélectivement ¼, avec certaines résistances aux antibiotiques « de réserve ¼ comme l'imipénème et le linézolide. L'état de la plupart des cas traités (n=170, 96%) s'est amélioré, mais sept (4%) nouveau-nés sont sortis contre avis médical. CONCLUSION: La plupart des pathogènes étaient résistants aux antibiotiques des groupes OMS « dont l'utilisation est essentielle ¼ et « à utiliser sélectivement ¼, et quelques résistances ont été observées à certains « antibiotiques de réserve ¼. La plupart des sepsis ont été causés par des bacilles à Gram négatif. L'amélioration des délais d'exécution des tests de sensibilité aux antibiotiques à l'aide de tests au point de service et un meilleur rendement des résultats positifs par culture sont nécessaires pour renforcer la prise en charge du sepsis néonatal.

High antibiotic resistance and mortality with Acinetobacter species in a tertiary hospital, Nepal.

SETTING: Nepal Mediciti Hospital, Bhainsepati, Lalitpur, Nepal. OBJECTIVES: To determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with Acinetobacter isolates between September 2018 and September 2019. DESIGN: This was a hospital laboratory-based, cross-sectional study. RESULTS: Acinetobacter spp. (n = 364) were more common in respiratory (n = 172, 47.3%) and invasive samples such as blood, body fluids (n = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (n = 110, 30.2%) and XDR (MDR plus carbapenem) (n = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (n = 319). Infected patients were more likely to be aged >40 years (n = 196, 61.4%) or inpatients (n = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (n = 59, 18.5%). CONCLUSION: A significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases.

CONTEXTE: Hôpital de Mediciti, Bhainsepati, Lalitpur, Népal. OBJECTIFS: Déterminer les profils de résistance antimicrobienne, le nombre et la proportion de cas multirésistants (MDR) et ultrarésistants (XDR) parmi tous les patients chez qui des isolats d'Acinetobacter ont été identifiés de septembre 2018 à septembre 2019. MÉTHODE: Il s'agissait d'une étude transversale réalisée dans un laboratoire hospitalier. RÉSULTATS: Acinetobacter spp. (n=364) étaient plus fréquentes dans les échantillons respiratoires (n=172, 47,3%) et invasifs comme le sang et les fluides corporels (n=95, 26,1%). La sensibilité aux antibiotiques de la classification AWaRe (« dont l'accessibilité est essentielle ¼, « à utiliser sélectivement ¼, « de réserve ¼) (tigécycline, polymyxine B, colistine) restait élevée. Les isolats MDR (résistance à au moins trois classes d'agents antimicrobiens) (n=110, 30,2%) et XDR (MDR plus carbapénème) (n=87, 23,9%) étaient plus fréquents dans le groupe des « antibiotiques à utiliser sélectivement ¼ ; ils ont été observés chez respectivement 99 (31,0%) et 78 (24,5%) patients (n=319). Les patients infectés étaient plus susceptibles d'être âgés > 40 ans (n=196, 61,4%) ou hospitalisés (n=191, 59,9%). Un résultat défavorable a été observé chez 76 (23,8%) patients, dont des décès (n=59, 18,5%). CONCLUSION: Une proportion significative d'isolats MDR et XDR a été observée ; près de un patient sur cinq est décédé. Des mesures concrètes de prévention et de contrôle des infections à l'hôpital (notamment pour les procédures invasives et respiratoires) et de surveillance de routine sont nécessaires pour réduire les infections et diminuer le taux de mortalité. La tigécycline, la polymyxine B et la colistine doivent être utilisées avec prudence, uniquement en cas de MDR et XDR.

Pseudomonas aeruginosa in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance.

OBJECTIVE: To determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to ⩾3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to ⩾3, susceptible to ⩽2 groups of antibiotics) drug-resistant strains of Pseudomonas aeruginosa. METHODS: This was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility. RESULTS: P. aeruginosa (n = 447) were most frequently isolated in respiratory (n = 203, 45.4%) and urinary samples (n = 120, 26.8%). AWaRe Access antibiotics showed 25-30% resistance, Watch antibiotics 30-55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (n = 229, 63.2%) or inpatients (n = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (n = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years. CONCLUSION: Antibiotic resistance in P. aeruginosa occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade.

OBJECTIF: Déterminer les profils de résistance antimicrobienne et la prévalence des souches de Pseudomonas aeruginosa multirésistantes (MDR, c.-à-d., résistantes à ⩾3 classes d'agents antimicrobiens) et ultrarésistantes (XDR, c.-à-d., résistantes à ⩾3, susceptibles à ⩽2 familles d'antibiotiques). MÉTHODES: Il s'agissait d'une étude transversale réalisée à l'Hôpital Mediciti, Lalitpur, Népal, à l'aide de méthodes microbiologiques standards avec test de diffusion sur disque de Kirby Bauer pour identifier la sensibilité aux antimicrobiens. RÉSULTATS: P. aeruginosa (n = 447) a été le plus souvent isolé d'échantillons respiratoires (n = 203, 45,4%) et urinaires (n = 120, 26,8%). Le groupe des « antibiotiques dont l'accessibilité est essentielle ¼ selon la classification AWaRe, a été associé à une résistance de 25­30% contre 30-55% pour ceux du groupe « antibiotiques à utiliser sélectivement ¼. La sensibilité aux « antibiotiques de réserve ¼ restait élevée, mais 32,8% des isolats étaient résistants à l'aztréonam. Dans l'ensemble, 190 (42,5%) isolats étaient MDR et 99 (22,1%) XDR (premier rapport népalais) sur la base d'échantillons principalement non respiratoires. La majorité des patients infectés étaient âgés de >40 ans (n = 229 ; 63,2%) ou hospitalisés (n = 181, 50,0%). Une issue défavorable a été rapportée chez 36 patients (15,2%), dont des décès (n = 25 ; 10,5%). Notre vaste étude a montré l'absence d'amélioration sur huit études antérieures qui couvrent 10 années. CONCLUSION: Une résistance de P. aeruginosa aux 19 antibiotiques de la classification AWaRe testés a été observée. Ces souches résistantes font encourir un risque significatif aux patients vulnérables, avec un taux de mortalité élevé. Un contrôle et une surveillance durable et satisfaisante des antibiotiques sont nécessaires au Népal, puisque le taux de résistance antimicrobienne a augmenté au cours des 10 dernières années.

Stroke in Sierra Leonean Africans:Perspectives from a Private Health Facility.

BACKGROUND: Several stroke studies in West Africans have demonstrated a high proportion of haemorrhagic stroke and poor outcomes. This may be due to the socioeconomic status of patients and inadequate clinical care. Outcomes may well be different if more informed patients treated in better facilities are studied. OBJECTIVE: To study the pattern of stroke and stroke outcomes in African patients attending a private hospital in Sierra Leone METHODS: 150 consecutive African stroke patients admitted to a private hospital in Sierra Leone were studied. Demographic details, risk factors, clinical features including blood pressure were recorded. CT scans, ECG, serum cholesterol, and blood sugar were done. Patients were reviewed at day 30 and Rankin scores allocated. Two sample independent t-test was used to compare means, and chi square to compare variables. RESULTS: Hypertension was the most common risk factor present in 77.6% of patients prior to admission with diabetes in 29.5%. Other risk factors include previous stroke (11.7%), smoking (6.3%), hypercholesterolemia (23.4%), high alcohol intake (28.8%) and lack of exercise according to self-evaluation (87.5%). 76.3% of patients had ischaemic and 18.2% haemorrhagic stroke. 41% of patients aged 50 years or less had haemorrhagic stroke and 9.3% of patients had atrial fibrillation. In-patient mortality was 10.6%. CONCLUSION: Stroke types and outcomes are different from those generally reported from the sub-region. This may well be due to the population studied, and the level of care provided by a private facility. Socio-economic factors, literacy and clinical care are likely determinants of stroke types and outcomes in African patients. . More detailed studies to confirm the effects of socioeconomic factors on stroke pattern and outcomes in Africa are needed.

Introduction of Ebola virus into a remote border district of Sierra Leone, 2014: use of field epidemiology and RNA sequencing to describe chains of transmission.

In early October 2014, 7 months after the 2014-2015 Ebola epidemic in West Africa began, a cluster of reported deaths in Koinadugu, a remote district of Sierra Leone, was the first evidence of Ebola virus disease (Ebola) in the district. Prior to this event, geographic isolation was thought to have prevented the introduction of Ebola to this area. We describe our initial investigation of this cluster of deaths and subsequent public health actions after Ebola was confirmed, and present challenges to our investigation and methods of overcoming them. We present a transmission tree and results of whole genome sequencing of selected isolates to identify the source of infection in Koinadugu and demonstrate transmission between its villages. Koinadugu's experience highlights the danger of assuming that remote location and geographic isolation can prevent the spread of Ebola, but also demonstrates how deployment of rapid field response teams can help limit spread once Ebola is detected.

Management of malaria in children with fever in rural Sierra Leone in relation to the 2014-2015 Ebola outbreak.

Setting: Sixty-eight primary health facilities, Koinadugu District, rural Sierra Leone. Objectives: Sierra Leone, a country with one of the highest burdens of malaria, was severely affected by the 2014-2015 Ebola virus disease outbreak. In under-five children, we compared trends in the completeness of malaria reports sent to the district office during the pre-Ebola, Ebola and post-Ebola periods, including the number of children with reported fever, malaria diagnostic testing performed and treatment for malaria initiated with artemisinin-based combination therapy (ACT). Design: A cross-sectional study. Results: Of 1904 expected malaria reports, 1289 (68%) were received. Completeness of reporting was 61% pre-Ebola, increased to 88% during the outbreak and dropped to 44% post-Ebola (P = 0.003). Total malaria testing (n = 105 558) exceeded the number of fever cases (n = 105 320). Pre-Ebola, 75% (n = 43 245) of all reported fever cases received malaria treatment, dropping to 34% (n = 50 453) during the Ebola outbreak. Of 36 804 confirmed malaria cases during Ebola, 17 438 (47%) were treated, significantly fewer than in the pre-Ebola period (96%, P < 0.001). Of the fever cases, 95% in both the pre- and post-Ebola periods received ACT, a rate that increased to 99% during the Ebola outbreak. Conclusion: Pre-existing gaps in malaria reporting worsened after the Ebola outbreak. Reassuringly, malaria testing matched fever cases, although only half of all confirmed cases received treatment during the outbreak, possibly explained by outbreak-related operational difficulties. These findings could be useful to guide health systems strengthening and recovery.

Contexte : Soixante-huit structures de soins de santé primaires, dans le district de Koinadugu, dans la Sierra Leone rurale.Objectifs : La Sierra Leone, un des pays les plus frappés par le paludisme, a été gravement affecté par la flambée épidémique d'Ebola en 2014­2015. Parmi les enfants âgés de <5 ans, nous avons comparé, dans les périodes avant, pendant et après Ebola, les tendances de l'exhaustivité des rapports relatifs au paludisme envoyés au bureau du district, le nombre d'enfants fébriles chez qui le test de diagnostic du paludisme a été réalisé et la prise en charge du paludisme par un traitement combiné à base d'artémisinine (TCA).Schéma : Etude transversale.Résultats : Sur 1904 rapports de paludisme attendus, 1289 (68%) ont été reçus. La complétude des rapports a été de 61% avant Ebola, a augmenté à 88% pendant Ebola et est tombée à 44% après Ebola (P = 0,003). Le nombre total de tests de paludisme (n = 105 558) a dépassé le nombre de cas de fièvre (n = 105 320). Avant Ebola, 75% de tous les cas de fièvre rapportés (n = 43 245) ont reçu un traitement du paludisme, nombre qui est tombé à 34% pendant Ebola (n = 50 453). Sur 36 804 cas de paludisme confirmés pendant Ebola, 17 438 (47%) ont été traités, significativement moins qu'avant Ebola (96% ; P < 0,001). Parmi les cas de fièvre, 95% ont reçu du TCA avant et après Ebola et jusqu'à 99% pendant Ebola.Conclusion : Les lacunes préexistantes en matière de rapports relatifs au paludisme se sont aggravées après Ebola. Il est rassurant de voir que les tests du paludisme sont restés parallèles aux cas de fièvre mais seulement la moitié de tous les cas confirmés a reçu un traitement pendant Ebola, ce qui peut être expliqué par des problèmes opérationnels liés à la flambée épidémique. Ces résultats pourraient être utiles pour guider le renforcement et la récupération des systèmes de santé.

Marco de referencia: Sesenta y ocho establecimientos de salud del distrito rural de Koinadugu en Sierra Leona.Objetivos: Sierra Leona es uno de los países con más alta carga de morbilidad por paludismo y sufrió una grave epidemia de enfermedad por el virus del Ébola en el 2014 y el 2015. Se compararon las tendencias en el carácter integral de los informes sobre el paludismo de los niños <5 años de edad enviados a la oficina distrital, antes, durante y después del brote; se analizaron las cifras de los informes con el número de casos de fiebre en los cuales se practicaron las pruebas diagnósticas de paludismo y de tratamientos combinados a base de artemisinina (TCA).Método: Une estudio transversal.Resultados: De las 1904 notificaciones de paludismo previstas, se recibieron 1289 (68%). La exhaustividad de los informes durante el período antes del brote del Ébola fue de 61%, aumentó a 88% durante el brote y disminuyó a 44% después del mismo (P = 0,003). El total de las pruebas diagnósticas de paludismo practicadas (n = 105 558) excedió el número disminuido de casos (n = 105 320). Durante el período anterior al brote, el 75% de todos los casos notificados de fiebre (n = 43 245) recibió tratamiento antipalúdico y esta cifra disminuyó al 34% durante el brote (n = 50 453). De los 36 804 casos confirmados de paludismo durante el brote, 17 438 (47%) recibieron tratamiento, lo cual representa una proporción significativamente inferior a la del período antes del brote (96%; P < 0,001). Del reducido número de casos, el 95% recibió TCA antes y después del brote y esta proporción alcanzó el 99% durante el brote epidémico.Conclusión: Las deficiencias prexistentes en la notificación del paludismo se agravaron después del brote epidémico del Ébola. Un dato alentador es que el número de pruebas diagnósticas realizadas fue equiparable al número reducido de casos notificados de paludismo, pero solo la mitad de todos los casos confirmados recibieron tratamiento durante el brote del Ébola, probablemente por causa de dificultades operativas relacionadas la epidemia. Estos resultados pueden ser útiles a fin de orientar el fortalecimiento y la reactivación de los sistemas de salud.

Preliminary Studies of the Performance of Quinoa (Chenopodium quinoa Willd.) Genotypes under Irrigated and Rainfed Conditions of Central Malawi.

The goal of sustainable intensification of agriculture in Malawi has led to the evaluation of innovative, regionally novel or under-utilized crop species. Quinoa (Chenopodium quinoa Willd.) has the potential to provide a drought tolerant, nutritious alternative to maize. We evaluated 11 diverse varieties of quinoa for their yield and agronomic performance at two locations, Bunda and Bembeke, in Malawi. The varieties originated from Ecuador, Chile and Bolivia in South America; the United States and Canada in North America; and, Denmark in Europe, and were chosen based on their variation in morphological and agronomic traits, and their potential for adaptation to the climate of Malawi. Plant height, panicle length, days to maturity, harvest index, and seed yield were recorded for each variety under irrigation at Bunda and Bembeke, and under rainfed conditions at Bunda. Plant height was significantly influenced by both genotype and environment. There were also significant differences between the two locations for panicle length whereas genotype and genotype × environment (G × E) interaction were not significantly different. Differences were found for genotype and G × E interaction for harvest index. Notably, differences for genotype, environment and G × E were found for grain yield. Seed yield was higher at Bunda (237-3019 kg/ha) than Bembeke (62-692 kg/ha) under irrigated conditions. The highest yielding genotype at Bunda was Titicaca (3019 kg/ha) whereas Multi-Hued was the highest (692 kg/ha) at Bembeke. Strong positive correlations between seed yield and (1) plant height (r = 0.74), (2) days to maturity (r = 0.76), and (3) biomass (r = 0.87) were found under irrigated conditions. The rainfed evaluations at Bunda revealed significant differences in seed yield, plant biomass, and seed size among the genotypes. The highest yielding genotype was Black Seeded (2050 kg/ha) followed by Multi-Hued (1603 kg/ha) and Bio-Bio (1446 kg/ha). Ecuadorian (257 kg/ha) was the lowest yielding genotype. In general the seed yields of the genotypes were lower under rainfed conditions than under irrigated conditions at Bunda. The results also highlight the need to continue evaluating a diverse number of cultivars to select for genotypes adapted to specific agro-ecological areas and across seasons in Malawi.

Effect of Soaking and Roasting on the Physicochemical and Pasting Properties of Soybean Flour.

The effects of soaking and roasting on the physicochemical and pasting properties of soybean flour were evaluated. Soybean seeds were soaked overnight in tap water for 0-72 h, hand dehulled, dried, and part of the sample was roasted. Roasted and unroasted soy beans were milled into flour and analyzed. The results showed that the total carbohydrates (22.8-27.9 g/100 g), the ash content (3.5-3.6 g/100 g), and the total polyphenols (0.29-0.51 g/100g) did not significantly change during both the soaking and roasting processes. However, the total proteins (35.8-46.0 g/100 g) and lipid contents (21.4-29.5 g/100 g) were significantly (p < 0.05) affected only by soaking, with a decrease in total protein and an increase in lipid contents. Phytate content (0.22-0.26 g/100 g) decreased significantly (p < 0.05) only with roasting. The tannins (0.01-0.30 g/100 g) and soluble proteins (4.0-29.0 g/100 g) significantly (p < 0.05) diminished with both treatments. There was a significant increase in the least gelation concentration (20-30 g/100 mL), a decrease in the swelling power (1.3-2.0 mL/mL), and consequently, reduction in the viscosity (range peak viscosity 18-210 cP) of the flour slurry after soaking and roasting. All these qualities-needed for producing nutritious flour for infants-highlighted the efficiency of these endogenous technologies.

Evaluation of some selected blood parameters and histopathology of liver and kidney of rats fed protein-substituted mucuna flour and derived protein rich product.

This comparative study reports the nutritional and toxicological characteristics of Mucuna pruriens flour and a protein-rich product developed from it. The protein-rich mucuna product (PRMP) was obtained by the three steps procedure: protein solubilization, heat-coagulation and sieving. Three weeks rats (n=6 per group) were fed for 28 days on standard protein-substituted rat feed with mucuna flour or PRMP. The experimental design was a factorial design with three mucuna accessions (Velvet, Black and White) and two treatments (flour and PRMP). The protein content ranged 27.2-31.5 g/100 g for flour and 58.8-61.1% for PRMP. Processing flour into PRMP led to a significant (p<0.05) reduction of tannins (50%), total polyphenols (50%) and trypsin inhibitors (94%). The rats fed PMRP diets witnessed weight gain similar to casein, while those fed mucuna flour lost weight. The levels of total cholesterol, HDL-cholesterol and LDL-cholesterol observed in animals groups fed mucuna flour and PRMP were significantly lower (p<0.05) than the control group. In addition lymphocytes, granulocytes, red blood cells, hemoglobin and hematocrit of rats fed mucuna flour were significantly (p<0.05) lower than values in other rats groups. Kidneys glomerular sclerosis and high creatinine levels were observed in group fed mucuna flour. PRMP then represents a good alternative of using mucuna proteins for human nutrition.

The effect of oral decontamination with clindamycin palmitate on the incidence of bacteremia after esophageal dilation: a prospective trial.

BACKGROUND: Antibiotic prophylaxis to prevent bacterial endocarditis is recommended in high-risk patients undergoing esophageal dilation, a high-risk procedure. Some studies suggest that the oropharynx is the source of bacteremia. A topical antibiotic mouthwash, which reduces bacterial colonization of the oral flora, might decrease bacteremia rates and would be an attractive alternative to systemic administration of antibiotics. METHODS: Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to either pre-procedure clindamycin mouthwash or no treatment. Subjects were stratified by type of dilator used. Blood cultures were obtained immediately after the first esophageal dilation and 5 minutes after the last dilation. RESULTS: Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the treatment arm and 2 in the no-treatment arm. The identified organisms were Streptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2), and Actinomyces odontolyticus (1). Patients with bacteremia reported greater subjective difficulty with dysphagia (p = 0.01) irrespective of stricture diameter, procurement of biopsies, or dilator type. CONCLUSIONS: The percentage of cases with bacteremia for all dilations performed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previously cited. All organisms in this study were oral commensals. There appears to be no effect of a clindamycin mouthwash on reducing bacteremia after esophageal dilation.

Incidence of stool guaiac conversion following extracorporeal shock wave lithotripsy.

OBJECTIVES: To study, in a prospective fashion, acute traumatic effects on the gastrointestinal tract of patients treated by extracorporeal shock wave lithotripsy (ESWL). METHODS: Stool samples from each of 54 patients were tested before and after ESWL for conversion to hemoccult positive. A minimum of one negative pre-ESWL stool guaiac test was required for inclusion into the study. A minimum of two stool guaiac tests were done after ESWL to verify negativity. Patients who converted to a positive hemoccult test after ESWL were then evaluated by colonoscopy for the source of bleeding. RESULTS: Fifty patients completed the study. A single patient (2.0%) converted to a positive post-ESWL hemoccult test and was evaluated with colonoscopy. This patient was found to have two benign adenomatous polyps in the sigmoid and descending colon after treatment for a left renal pelvis calculus. An additional patient with a slightly positive post-ESWL conversion refused further evaluation. The overall post-ESWL conversion rate to guaiac positive, therefore, was less than 4% (2 of 51 patients). CONCLUSIONS: There is no evidence of significant trauma or detectable bleeding in the normal gastrointestinal tract caused by ESWL as measured by postprocedure stool guaiac testing. Guaiac testing of the stool after ESWL may unmask pre-existing gastrointestinal disease. Therefore a positive guaiac test after ESWL warrants further evaluation. This study reaffirms that ESWL is a safe, minimally invasive technique for the treatment of urolithiasis, without significant adverse side effects on the gastrointestinal tract.

Acute pancreatitis associated with continuous infusion cytarabine therapy: a case report.

BACKGROUND: While acute pancreatitis is a recognized complication of numerous drugs, cytarabine's role in causing this complication is controversial. Approximately 15 cases have been reported to the Food and Drug Administration linking cytarabine with pancreas-related toxicities. Previous case reports have been complicated by comorbid illnesses and the coadministration of other drugs associated with acute pancreatitis. METHODS: This report describes the clinical course of a patient with acute myelogenous leukemia (AML) who developed recurrent pancreatitis associated with cytarabine therapy. RESULTS: A male age 36 years with French-American-British M5B acute myelogenous leukemia received induction cytarabine (200 mg/m2/day) by continuous infusion for 7 days, and subsequently developed acute pancreatitis. The patient was rechallenged with intermittent, bolus, high dose cytarabine (HDAC) (3 g/m2bid administered over 3 hours) during the following intensification treatment, but did not develop clinical acute pancreatitis. Retreatment with continuous infusion cytarabine at a later time resulted in recurrence of acute pancreatitis. CONCLUSIONS: This case illustrates that cytarabine treatment may cause acute pancreatitis, and that this toxicity may be schedule dependent. In those with known sensitivity to cytarabine, altering the administration technique may avoid this complication.

Recurrent abdominal pain from abdominal adhesions in an endurance triathlete.

Abdominal adhesions have been described as developing postoperatively and as developing "spontaneously" in patients over 60 yr old. To our knowledge, abdominal adhesions have not been described as an etiology of recurrent abdominal pain in young endurance athletes, without prior history of abdominal surgery. We present a 28-yr-old endurance triathlete with recurrent abdominal pain in which multiple diagnostic imaging studies were unable to diagnose the etiology. Diagnostic laparoscopy revealed adhesions between the ascending colon and the anterior abdominal wall. Laparoscopic adhesiolysis was performed successfully and the athlete resumed his training several weeks post-laparoscopy without symptoms. One year later, the athlete remains pain free.