Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era.

The use of the wide-awake local anesthesia no tourniquet, a tumescent local anesthetic technique in recent years, emerged as a powerful tool primarily in hand surgery. It has been adopted in many low- and middle-income countries where it was applied to an increasingly broad group of procedures. We report the case of an older patient with an arm liposarcoma for which surgery under general or regional anesthesia was deemed unsafe, but was successfully managed with a curative right shoulder disarticulation using tumescent local anesthesia.

Potential Influence of Regulation of the Food Value Chain on Prevalence and Patterns of Antimicrobial Resistance: the Case of Tilapia (Oreochromis niloticus).

The current study was designed to evaluate the potential impact of the level of regulation on the prevalence and patterns of antimicrobial agent resistance in bacteria isolated from fish. The study sites included two large lakes and both semiregulated and unregulated fish value chains. A total of 328 bacterial isolates belonging to 11 genera were evaluated for antimicrobial susceptibility testing using the disk diffusion method. The bacterial species were tested against 12 different antibiotics (trimethoprim-sulfamethoxazole, tetracycline, ampicillin, cefotaxime, chloramphenicol, nalidixic acid, amoxicillin, meropenem, ciprofloxacin, nitrofurantoin, cefuroxime, and kanamycin). Data analysis was done to assess the heterogeneity in proportion of resistant bacterial species within and between the two value chains using a random-effects model proposed by DerSimonian and Laird (Control Clin Trials 7:177-188, 1986). Statistical heterogeneity within and between groups was estimated using the Cochran chi-square test and the Cochrane I2 index. The overall proportion of bacterial species resistant to antimicrobial agents in semiregulated and unregulated value chains ranged from 0.00 to 0.88 and 0.09 to 0.95, respectively. Shigella spp. had the highest proportion of bacteria that were resistant to most of the antimicrobial agents used. The bacterial species were highly resistant to ampicillin and amoxicillin, and the highest multidrug resistance capacity was observed in Shigella spp. (18.3%, n = 328), Vibrio spp. (18.3%), and Listeria monocytogenes (12.2%). We observed strong heterogeneity within and between the two value chains regarding proportion of resistant bacterial species. Sun-dried fish in both value chains had significantly high proportions of resistant bacterial species. Comparing the two value chains, the unregulated value chain had a significantly higher proportion of bacterial species that were resistant. In order to mitigate the risk of transmitting antimicrobial-resistant bacteria to consumers along the fish value chain, good manufacturing practices coupled with identification and management of possible sources of contamination are recommended for fish and potentially other foods distributed along the less regulated value chains. IMPORTANCE In order to mitigate the risk of transmitting antimicrobial-resistant bacteria to consumers along the fish value chain, good manufacturing practices coupled with identification and management of possible sources of contamination are recommended for fish and potentially other foods distributed along the less regulated value chains.

Development and Sensory Evaluation of Omega-3-Rich Nile Perch Fish Oil-Fortified Yogurt.

Nile perch (Lates niloticus) is a major fish species in East Africa and its processing produces sufficient amounts of by-products containing significant amounts of long-chain polyunsaturated fatty acids (PUFAs). Due to the health benefits associated with PUFAs, they can be incorporated into commonly consumed foods such as yoghurt. This study is aimed at developing an omega-3-rich functional yoghurt and evaluating its quality and acceptability. Omega-3-rich fish oils were obtained from Nile perch fat pads in the presence and absence of a commercial food grade enzyme Alcalase. Recovery of omega-3-rich fish oil was done by centrifugation at 1000 × g at room temperature. The peroxide value (PV), anisidine value (AV), total oxidation (TOTOX), and free fatty acids (FFA) were some of the quality parameters investigated. Natural yoghurt (150 ml) was prepared and spiked with 3.5 g of omega-3-rich Nile perch oil. To mask the fishy flavor and taste, four different flavors were used and sensory evaluation of the yoghurt samples was performed. The liberation of Nile perch fish oil in the absence of Alcalase gave better yield (60.7% wet weight), while the use of Alcalase gave lower yields (48.3% wet weight). Assessment of the quality of the extracted fish oils showed that all parameters were within the required limits. Sensory characterization by a panel of students showed that passion and strawberry flavors were the most liked with mean values of 4.65 and 4.625, respectively. This study revealed that substantial amounts of omega-3-rich fish oil can be extracted from Nile perch fish pads in the absence of exogenous enzymes. Fortification of yoghurt with omega-3-rich Nile perch fish oils is an approach towards increasing omega-3 intake within the Kenyan population and globally.

Microbiological Safety of Fresh Tilapia ( Oreochromis niloticus) from Kenyan Fresh Water Fish Value Chains.

This study evaluated the microbiological safety of fresh Nile tilapia ( Oreochromis niloticus) from Kenyan fresh water fish value chains. One hundred seventy-six fish samples were analyzed. The microbial counts of hygiene indicators, total viable aerobic count (TVC), total coliforms, and fecal coliforms isolated by using culture techniques were enumerated, and microbial pathogens present in the fish samples were identified and characterized by using molecular methods. The diversity of bacterial isolates was determined by using the Shannon-Weaver diversity index. The mean of TVC in the samples was 4.44 log CFU/g. A comparison with the European Commission and International Commission on Microbiological Specifications for Foods standards showed two fish samples had counts above the 5.00 log CFU/g limit for TVC, and all the fish samples had total coliform and fecal coliform counts above 2.00 and 1.00 log CFU/g, respectively. Pathogenic strains, including Shiga toxin-producing and enteropathogenic Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Klebsiella pneumoniae, and Salmonella enterica, were identified in the fish samples. The diversity of 1,608 bacterial isolates was higher in semiregulated chains than unregulated chains. The diversity was also high at the retail stage of the fish value chain. In conclusion, fresh Nile tilapia samples were above some of the set food safety standards and may be a source of foodborne pathogens. Further microbial risk assessment for detected pathogens is recommended to further support public health protection, taking into account growth, inactivation through cooking, processing, survival, and consumption.