Treatment outcomes of distal tibia fractures among adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: The treatment of distal tibia fractures remains challenging since they are prone to higher rates of complications. Treatment options are expanding and although their indications, advantages and disadvantages have been discussed in literature, controversy still exists over the clinical efficacy and cost-effectiveness of each option. This has led to different orthopaedic surgeons employing different operative treatment options based on their experience, preference and patient characteristics.Objective: This study sought to describe the patients’ characteristics and treatment of distal tibia fractures at MTRH and compare the outcome results of the various treatment options.Design: A prospective observational study design was used. Adult patients with distal tibia fractures admitted during the study period were included through consecutive sampling.Methods: A total of 76 patients were followed up. Data including injury aetiology, fracture types and classification, treatment and complications were collected. Functional outcome was assessed using Olerud and Molander Ankle Score (OMAS) at 6 months after treatment. Data was collected between October 2015 and March 2017 using a structured questionnaire and analyzed using STATA version 13 at 95% confidence level. Chi square test was used to determine the significance of associations between categorical variables.Results: The median age was 40.0 (30.0, 52.0) years, with a male-to-female ratio of 1.7:1. Most common causes of injury were RTA in 37 patients and falls in 29 patients. There were 48 closed and 28 open injuries. According to Arbeitsgemeinschaftfür Osteosynthesefragen (AO)/ Orthopaedic Trauma Association (OTA) classification, there were 40 (52.6%) type A, 28 (36.8%) type B and 8 (10.6%) type C fractures. Twenty-five (32.9%) patients were treated non-operatively, 28 (36.8%) patients underwent internal fixation with plating and 23 (30.3%) patients were treated using external fixation method. Non-operative treatment was mostly used for closed injuries (80%) whereas majority of open fractures (82%) were treated operatively (P=0.033). Complications occurred in 48 (57.8%) patients, including 30 (62.5%) wound infections, 21 (43.7%) malunions and 3 (6%) chronic osteomyelitis. Infections were significantly higher among external fixation treated patients (P=0.002). At final follow up the functional outcome using OMAS was excellent in 11(14.5%) patients, good in 28 (36.8%), fair in 17 (22.4%) and poor in 20 (26.3%) patients. OMAS scores were significantly high in patients treated with plating and low in patients with comminuted fractures, complications and open injuries (P<0.001).Conclusion: Distal tibia fractures mostly occurred in young males. Road traffic accidents and falls were the commonest causes. Treatment by plate fixation resulted in significantly higher functional outcome scores and lower rate of complications compared to non-operative treatment.Recommendation: Distal tibia fractures should be treated operatively by plate fixation to improve treatment outcomes.Keywords: Distal tibia fracture, OMAS, Treatment outcom

Evaluation of drug-resistant Enterobacteriaceae in retail poultry and beef

There has been increasing concern on the emergence of multidrug-resistant foodborne pathogens from foods of animal origin, including poultry. The current study aimed to evaluate antibiotic-resistant Enterobacteriaceae from raw retail chicken/turkey parts (thigh, wings, breast, and ground) and beef meat (ground and chunks) in Middle Tennessee. Resistance of the collected Enterobacteriaceae to a panel of antibiotics was determined by the Kirby-Bauer disk diffusion test. Retail meats were also assayed for the presence of Salmonella spp. and Escherichia coli O157:H7. Two hundred thirty-seven samples representing 95.2% of the total of 249 samples tested were positive for Enterobacteriaceae. The level of contamination with Enterobacteriaceae in raw meats ranged from 3.26 log10 cfu/g to 4.94 log10 cfu/g with significant differences in counts among meat types (P \u3c 0.05). Contamination was significantly greater (P \u3c 0.05) in ground beef, beef chucks, ground chicken, chicken breast, and turkey wings (4.92, 4.58, 4.94, 4.75, 4.13 log10 cfu/g, respectively) than ground turkey and chicken wings (3.26 and 3.26 log10 cfu/g, respectively). Klebsiella oxytoca, Serratia spp., E. coli, and Haffnia alvei were most prevalent contaminants at 27.4, 14.3, 12.1, and 11.4%, respectively. Resistance of the Enterobacteriaceae to antimicrobials was most frequent with erythromycin, penicillin, and ampicillin at 100, 89, and 65.8%, respectively. Few (2.7%) of the Enterobacteriaceae were resistant to chloramphenicol. Salmonella spp., E. coli O157:H7, Morganella morganii, Yersinia enterocolitica, and Vibrio parahemolyticus exhibited multiple drug resistance. This investigation demonstrates that raw poultry and beef are potential reservoirs of antibiotic-resistant Enterobacteriaceae

Treatment and Outcome of Ankle Fractures at the Moi Teaching and Referral Hospital

Background: Ankle fractures are common and protocols for their  management are generally well established. Despite this, a significant  proportion of the patients get unfavourable outcomes after being managed for this injury. This study looked at the treatment options offered and their outcome at our unit.Methodology: A prospective study was conducted to examine ankle fracture patients presenting at our unit from 1st November 2009 to 30th April 2011. All patients were followed up was for 6 months where clinical and  radiological evaluations recorded to determine outcome. Results: The mean age of patients was 47years with the ratio of female to male being 1.5:1. An infection rate of 10% in patients treated by ORIF and 33.3% in open fractures was documented. At 6 months follow up, there was a higher rate of complications in the unstable fractures treated   non-operatively (92.3%) compared to unstable fractures treated surgically (37.7%) (p<0.001).Conclusion: The rate of infection after surgical  management was high and measures are required to mitigate this. The unstable ankle fractures  treated non-operatively have a high rate of complications and should be managed operatively.Key Words: Ankle fractures, Treatment outcome, Developing countr

Prevalence and Antimicrobial Resistance of Pathogenic Bacteria in Chicken and Guinea Fowl

This study was conducted to compare the presence and antimicrobial susceptibility of Campylobacter, Salmonella spp., and other enteric bacteria between chickens and guinea fowls. Birds were reared on enclosed concrete floor housing covered with pine wood shavings litter material. Chicken (n = 40) and guinea fowl (n = 40) carcasses, drinking water (10 mL; n = 40), and litter (10 g; n = 40) were aseptically collected randomly from a poultry farm and analyzed within 1 h of collection. Individual pens served as experimental units and were replicated twice. Campylobacter spp., Salmonella spp., and other enterobactericeae were isolated and identified using standard selective media and biochemical tests. Isolates were tested for sensitivity to tetracycline, ampicillin, streptomycin, kanamycin, nalidixic acid, gentamicin, erythromycin, ciprofloxacin, cefoxitin, and colistin using the Kirby-Bauer disk diffusion test. Campylobacter spp. and Salmonella spp. were isolated from 28 and 35% of whole carcass rinses of chickens and from 18 and 23% of whole carcass rinses of guinea fowl, respectively. Although only Salmonella spp. were recovered from drinking water, both Salmonella and Campylobacter spp. were recovered from litter material. Campylobacter upsaliensis was recovered only in the guinea fowl, whereas Klebsiella oxytoca and Enterobacter sakazakii were recovered only in chickens. Although no antibiotic resistance was determined in Campylobacter upsaliensis, most Campylobacter, Salmonella, and Escherichia coli isolates from both chickens and guinea fowl were resistant to antibiotics such as ampicillin, kanamycin, erythromycin, and nalidixic acid

Probiotics and Antimicrobial Effect of Lactiplantibacillus plantarum, Saccharomyces cerevisiae, and Bifidobacterium longum against Common Foodborne Pathogens in Poultry

The probiotic potential and antimicrobial activity of Lactiplantibacillus plantarum, Saccharomyces cerevisiae, and Bifidobacterium longum were investigated against Escherichia coli O157:H7, Salmonella typhimurium and Listeria monocytogenes. Selected strains were subjected to different acid levels (pH 2.5–6.0) and bile concentrations (1.0–3.0%). Strains were also evaluated for their antimicrobial activity by agar spot test. The potential probiotic strains tolerated pH 3.5 and above without statistically significant growth reduction. However, at pH 2.5, a significant (p \u3c 0.05) growth reduction occurred after 1 h for L. plantarum (4.32 log CFU/mL) and B. longum (5.71 log CFU/mL). S. cerevisiae maintained steady cell counts for the entire treatment period without a statistically significant (p \u3e 0.05) reduction (0.39 log CFU/mL). The results indicate at 3% bile concertation, 1.86 log CFU/mL reduction was observed for L. plantarum, while S. cerevisiae, and B. longum growth increased by 0.06 and 0.37 log CFU/mL, respectively. L. plantarum and B. longum demonstrated antimicrobial activity against E. coli O157:H7, S. typhimurium and L. monocytogenes. However, S. cerevisiae did not display any inhibition to any of the pathogens. The results indicate that L. plantarum and B. longum present probiotic potential for controlling E. coli O157:H7, S. and L. monocytogenes in poultry

A comparative analysis of microbial profile of Guinea fowl and chicken using metagenomic approach

Probiotics are live microbial feed supplements that promote growth and health to the host by minimizing non-essential and pathogenic microorganisms in the host’s gastrointestinal tract (GIT). The campaign to minimize excessive use of antibiotics in poultry production has necessitated development of probiotics with broad application in multiple poultry species. Design of such probiotics requires understanding of the diversity or similarity in microbial profiles among avian species of economic importance. Therefore, the objective of this research was to establish and compare the microbial profiles of the GIT of Guinea fowl and chicken and to establish the microbial diversity or similarity between the two avian species. A metagenomic approach consisting of the amplification and sequence analysis of the hypervariable regions V1-V9 of the 16S rRNA gene was used to identify the GIT microbes. Collectively, we detected more than 150 microbial families. The total number of microbial species detected in the chicken GIT was higher than that found in the Guinea Fowl GIT. Our studies also revealed phylogenetic diversity among the microbial species found in chicken and guinea fowl. The phylum Firmicutes was most abundant in both avian species whereas Phylum Actinobacteria was most abundant in chickens than Guinea fowls. The diversity of the microbial profiles found in broiler chickens and Guinea fowls suggest that the design of effective avian probiotics would require species specificity

Prevalence of Multidrug-Resistant Foodborne Pathogens and Indicator Bacteria from Edible Offal and Muscle Meats in Nashville, Tennessee

This study investigated the prevalence of antimicrobial-resistant bacteria in retail edible offal and muscle meats in Nashville, Tennessee. A total of 348 retail meats (160 edible offal and 188 muscle) were analyzed for Salmonella enterica serovar, Campylobacter, Escherichia coli, E. coli O157:H7, and enterococci. Bacteria was identified using biochemical and PCR methods. Salmonella enterica serovar (4.4% and 4.3%), Campylobacter (1.9% and 1.1%), E. coli (79.4% and 89.4%), and enterococci (88.1% and 95.7%) was detected in offal and muscle meats, respectively. Chicken liver (9.7%) was most frequently contaminated with Salmonella enterica serovar, followed by ground chicken (6.9%) and chicken wings (4.2%). No Salmonella enterica serovar was detected in beef liver, beef tripe, and ground beef. The prevalence of Campylobacter was 6.9%, 2.3%, and 1.4% in beef liver, ground beef, and ground chicken, respectively. None of the meats were positive for E. coli O157:H7. Resistance of isolates was significantly (p \u3c 0.05) highest in erythromycin (98.3%; 99.1%), followed by tetracycline (94%; 98.3%), vancomycin (88.8%; 92.2%) as compared to chloramphenicol (43.1%; 53.9%), amoxicillin/clavulanic (43.5%; 45.7%), and ciprofloxacin (45.7%; 55.7%) in offal and muscle meats, respectively. Imipenem showed the lowest resistance (0%; 0.9%). A total of 41 multidrug-resistant patterns were displayed. Edible offal could be a source of antibiotic-resistant bacteria

Pheochromocytoma in pregnancy: Case report

This is a case presentation of a 32 year old woman with pheochromocytoma diagnosed at 27 weeks of gestation, she was managed till term, induced and had assisted vaginal delivery. The pheochromocytoma was surgically re-sected successfully at six weeks postpartum