Mycobacterium ulcerans disease in the middle belt of Ghana: An eight-year review from six endemic districts

AbstractBackgroundMycobacterium ulcerans (MU) produces mycolactone toxin when infected with a plasmid. Toxin is cytotoxic and immunosuppressive, causing extensive destruction of tissues, leading to large ulcers on exposed parts of the body. Spontaneous healing by secondary intention leads to contractures, subluxation of joints, disuse atrophy, distal lymphedema and other complications. The disease is endemic in some communities within the middle belt of Ghana.ObjectiveTo document the clinical and epidemiological features of MU disease in the middle belt of Ghana and the outcome of treatment.Patients and methodsPatients with lesions suspected to MU disease were screened by community workers. Lesions were confirmed by any of the following: direct smear examination, culture, polymerase chain reaction (PCR), or histopathology.Patients were treated with rifampicin (10mg/kg orally) and streptomycin (15mg/kg IM) combination for eight weeks. Patients selected for surgical treatment included cases where medical treatment had failed, cases where medical treatment is contraindicated, cases presenting late with complications and recurrent cases.Results258 patients were seen in the Ahafo Ano, Amansie Central, Amansie West, Asunafo, Asutifi, and Upper Denkyira districts of Ghana between 2005 and 2012. Their ages ranged from 1year 3months to 98years, with a mean age of 29.8 (SD 20.4).The clinical forms of MU disease seen were: papule (0.5%), nodule (1.5%), chronic osteomyelitis (1.5%), contracture (1.5%), edematous lesion (3%), and ulcer (92%). Uncommon complications include subluxation of knee joint, salivary gland fistula and Marjolin’s ulcer.The lesions were distributed as follows: head and neck (6.8%), upper limb (20.3%), trunk (1.7%), and lower limb (71.2%).ConclusionMU disease in the middle belt of Ghana can be controlled by early case detection and adequate curative treatment

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mycobacterium ulcerans disease in the Middle Belt of Ghana: An 8-year review from six endemic districts

Background: Mycobacterium ulcerans (MU) produces mycolactone toxin when infected Aims and objectives: The aim is to document the clinical and epidemiological features of Mycobacterium ulcerans disease in the Middle Belt of Ghana, and the outcome of treatment. Patients and Methods: Patients with lesions suspected to be MU disease were screened by community workers. Lesions were confirmed by any of the following: direct smear examination, culture, polymerase chain reaction (PCR), or histopathology. Patients were treated with rifampicin (10 mg/kg orally) and streptomycin (15 mg/kg im) combination for 8 weeks. Patients selected for surgical treatment included cases where medical treatment had failed, cases presenting late with complications, and recurrent cases. Results: 258 patients were seen in the Ahafo Ano, Amansie Central, Amansie West, Asunafo, Asutifi, and Upper Denkyira districts of Ghana between 2005 and 2012. Their ages ranged from 1 year 3 months to 98 years, with a mean age of 29.8 (SD 20.4). The clinical forms of MU disease seen were: papule (0.74%), nodule (1.48%), chronic osteomyelitis (1.48%), contracture (1.48%), oedematous lesion (2.69%), and ulcer (91.85%). Uncommon complications include subluxation of knee joint, salivary gland fistula and Marjolin's ulcer. The lesions were distributed as follows: head and neck (6.2%), upper limb (23.1%), trunk (1.5%), and lower limb (69.2%). Conclusion: The use of antibiotics for MU disease has controlled most lesions; however, rare complications requiring reconstructive surgery are emerging

Management of complications of Mycobacterium ulcerans disease: A three-year review

Background: Infection with Mycobacterium ulcerans (MU) causes extensive destruction of tissues with the formation of large ulcers on exposed parts of the body. Healing leads to extensive scarring and other complications which may impair function. Objective: To document the complications of MU disease and the reconstructive surgery performed to correct them. Study design: Prospective from January 2010 to December 2012. Setting: Ahafo Ano, Amansie West, Asunafo, and Upper Denkyira districts of Ghana. Methods: Patients with unhealed lesions after completing 8 weeks of rifampicin and streptomycin treatment, and patients with complications of MU disease were selected and prepared for surgical treatment. Results: 61 patients were treated successfully with rifampicin and streptomycin without complications. 65 patients presented with complications; they comprised 34 males and 31 females. Their ages ranged from 1 year 3 months to 80 years with mean age of 29.7 (S.D. 20.1). The types of lesions seen were ulcers (54), contractures (7), chronic osteomyelitis (one), subluxation of knee joint (one), salivary gland fistula (one) and Marjolin's ulcer (one). The lesions were distributed as follows: 69.2% on the lower, and 23.1% on the upper limbs, 6.2% on the head and neck and 1.5% on the trunk. Wound excision with or without skin grafting was done in 84.6% of patients, surgery for contractures in10.8%, and sequestrectomy, exploration and ligation of fistula, groin dissection and above knee amputation in 4.6%. Conclusion[/TAG:2]: Whilst ulcers, the commonest MU lesions, are being controlled with antibiotics, rare complications of the disease are also emerging

Quality Characteristics of Native Starch from Selected Improved Varieties of Sweetpotato (Ipomoea batatas)

Sweetpotato (Ipomoea batatas L.) is a starchy root crop with a wide range of diversity in physical and compositional characteristics. Links between starch properties and processing characteristics are known to have an impact in utilization. Starches were extracted from six (6) improved varieties of sweetpotato harvested at 3, 4 and 5 months after planting. Starch granule morphologies were characterized at 4 months using Light Microscopy, and starch pasting properties were determined at all harvest times by Rapid Visco Analyzer. Granular shapes were generally heterogeneous and approximate size distributions varied from 2 to 15m to 8  to 40m. peak viscosity ranged from 4077 to 5260 centipoise, pasting temperature ranged from 77.95 to 82.45oC, setback ratio ranged from 1.25 to 1.61 and stability ratio ranged from 0.52 to 0.73. Starches with smaller granules had relatively low peak viscosities and high  stability or resistance to breakdown while those with larger granule size ranges had lower setback ratio, indicating less retrogradation and better long-term cold paste stability. The influence of both variety and harvest maturity on all RVA pasting properties were  significant at p<0.001. Small starch granule size varieties harvested at 4 and 5 months had the lowest peak viscosities and highest  setback ratio; larger granule size varieties harvested at 4 months had the highest peak viscosities and lowest setback ratio. These  results are relevant in understanding the processing and utilization quality of the varieties studied, and also in identifying potential niche applications for sweetpotato starch as food ingredients or in other applications. Keywords: Starch quality, RVA pasting properties, Harvest maturity, Granule morphology, Ipomoea batatas.  Caractéristiques De La Qualité De L'amidon Locale À Partir De Variétés Améliorées De Patate Douce (Ipomoea batatas)La patate douce (Ipomoea batatas L.) est une culture racinaire fétide avec une large diversité de caractéristiques physiques et de  composition. Les liens entre les propriétés de l'amidon et les caractéristiques de formation sont connus pour avoir une incidence sur l'utilisation. Les amidons ont été extraits de six (6) variétés améliorées de patates douces récoltées à 3, 4 et 5 mois après la  cultivation. Les morphologies des granulés d'amidon ont été caractérisées à 4 mois à l'aide d'une Microscopie légère, et les propriétés de collage d'amidon ont été déterminées à toutes les heures de récolte par la machine'Rapid Visco Analyzer'. Les formes granulaires étaient généralement hétérogènes et les distributions approximatives des tailles variaient entre 2 et 15 μm à 8 à 40m. La viscosité maximale variait de 4077 à 5260 centipois- es, la température de collage variait de 77,95 à 82,45°C, le rapport de retrait variait de 1,25 à 1,61 et le rapport de stabilité variait de 0,52 à 0,73. Les amidons avec des granulés plus petits avaient des viscosités de  pointe relativement faibles et une stabilité élevée ou une résistance à la panne tandis que ceux avec des gammes de granulométrie  plus grandes avaient un rapport de retrait inférieur, ce qui indique une rétrogradation moins élevée et une meilleure stabilité à la pâte froid à long terme. L'influence de la variété et de la maturité des récoltes sur toutes les propriétés de collage de RVA était significative à p <0,001. Les petites variétés de gran- ules d'amidon récoltées à 4 et 5 mois présentaient les viscosités maximales les plus faibles et le taux de retrait le plus élevé; Les grandes variétés granulométriques récoltées à 4 mois avaient les viscosités maximales les plus élevées et le rapport de retrait le plus bas. Ces résultats sont pertinents pour comprendre la transformation et la qualité d'utilisation des variétés étudiées, et aussi pour identifier les applications de marché potentiel pour l'amidon de la patate douce comme  ingrédients alimentaires ou dans d'autres applications. Mots-clés: la qualité de l'amidon, propriétés de collage de RVA, maturité de la récolte, morphologie des granulés, Ipomoea batatas

Cowpea striga problems and research in Nigeria

Brief mention of research into the infestation of cowpeas by Striga gesnerioides conducted by staff of the Botany Department of the University of Nigeria at Nsukka is followed by more extensive discussion of work on this host-parasite relationship conducted at the Institute of Agricultural Research at Samaru. Investigations at the Institute have covered the following aspects: symptoms of infection and the extent of yield losses in Nigeria, screening for resistance under field conditions, the development of pot culture techniques, the effect of inoculum density on the number of emergent S. gesnerioides plants, the effects of the frequency of watering, the effect of the extent of lateral distribution in inoculum, the progress of infection with time, the effect of soil N content in the incidence of infection, the effect of N fertilizer application indices for measuring infection, screening cowpea lines for resistance and the inheritance of resistance. Proposed future work on the cowpea-S. gesnerioides relationship is noted

Public exposure to natural radioactivity and radon exhalation rate in construction materials used within Greater Accra Region of Ghana

The natural radioactivity of 238U, 232Th, 40K, radiological hazards and 222Rn exhalation rate in building materials used within Greater Accra Region of Ghana, have been measured using Gamma spectrometry and CR-39. The results obtained are as follows 238U (2.6–47.1 Bq/kg), 232Th (3.6–43.0 Bq/kg), 40K (62.8–1222.2 Bq/kg), radium equivalent (32.7–174.3 Bq/kg), internal hazard index (0.04–0.51), external hazard index (0.04–0.23), activity concentration index (0.10–0.63 mSv/y) absorbed dose rate (9.5–76.3 nGy/h), outdoor effective doses (11.6–93.6 μSv/y), indoor effective doses (46.5–374.1 μSv/y,) and excess lifetime cancer risk (0.04 × 10−3–0.33 × 10−3). 222Rn exhalation rate (3.1 × 10−5–11.4 × 10−5 Bq/m2 h), 222Rn activity (17.4–42.6 Bq/m3), effective radium (0.19–0.64 Bq/kg). Positive correlation was found between 238U and 222Rn. The results were discussed in terms of limits to the accepted natural radioactivity levels and compared with similar studies reported in other countries. The gneiss rocks recorded excess lifetime cancer risk values of (0.32 × 10−3 and 0.33 × 10−3) greater than the world value of 0.29 × 10−3 proposed by UNSCEAR, 2000. With exception gneiss rocks from Shai hills which recorded high value of cancer risk as compare to the world average value, all the studied building materials do not pose any radiological effects to the people of Greater Accra Region when used for construction. Keywords: HPGe, CR-39, 222Rn, NORMS, Construction material