Detection of typhoid carriers by duodenal fluid culture in a tertiary care hospital, Karachi: a cross-sectional study

Published in August 2021.

In Vitro Digestibility of Lamtoro Leaves (Leucaena Leucocephala) In Poultry With Gizzard Fluid And Duodenum

Protein source feed is the feed that has the biggest share in the nutritional needs of livestock. Lamtoro or Leucaena leucocephala is one of the leaf flours that can be used as an alternative feed ingredient for poultry in the tropics. With its abundant availability and does not compete for its needs with humans and has no selling value so that it can minimize consumption costs for poultry. This study aims to determine the effect of fluid from the digestive tract of chickens on the in vitro digestibility measurement of lamtoro leaves. The study used a completely randomized design (CRD) with a unidirectional pattern with 4 treatments and 3 replications. The treatments consisted of P0 = control, P1 = gizzard fluid, P2 = duodenal fluid and P3 = a mixture of gizzard and duodenal fluid. The results of this study show the average Dry Matter Digestibility Coefficient (%) for the treatment P0, P1, P2 and P3 respectively; 19.276, 29.089, 20.515 and 28.737. Organic Matter Digestibility Coefficient ; 27.702, 36.313, 24.795 and 35.649. Dissolved Protein Digestibility Coefficient ; 39.777, 53.288, 21.145 and 48.737. The results of the statistical test that the administration of lamtoro leaves showed a significant difference (P<0.05) on the digestibility coefficient of dry matter, organic matter and dissolved protein. The conclusion is that the use of gizzard liquid is more effective in increasing the in vitro digestibility of lamtoro leaves.

Early Detection of Pancreatic Cancer: Role of Biomarkers in Pancreatic Fluid Samples

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths worldwide. Most patients with PDAC present with symptomatic, surgically unresectable disease. Therefore, the establishment of strategies for the early detection is urgently needed. Molecular biomarkers might be useful in various phases of a strategy to identify high-risk individuals in the general population and to detect high-risk lesions during intense surveillance programs combined with imaging modalities. However, the low sensitivity and specificity of biomarkers currently available for PDAC, such as carbohydrate 19-9 (CA19-9), contribute to the late diagnosis of this deadly disease. Although almost all classes of biomarker assays have been studied, most of them are used in the context of symptomatic diseases. Compared to other body fluids, pancreatic juice and duodenal fluid are better sources of DNA, RNA, proteins, and exosomes derived from neoplastic cells and have the potential to increase the sensitivity/specificity of these biomarkers. The number of studies using duodenal fluid with or without secretin stimulation for DNA/protein marker tests have been increasing because of the less-invasiveness in comparison to pancreatic juice collection by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Genomic analyses have been very well-studied, and based on PDAC progression model, mutations detected in pancreatic juice/duodenal fluid seem to indicate the presence of microscopic precursors and high-grade dysplasia/invasive cancer. In addition to known proteins overexpressed both in precursors and PDACs, such as CEA and S100P, comprehensive proteomic analysis of pancreatic juice from patients with PDAC identified many proteins which were not previously described. A novel technique to isolate exosomes from pancreatic juice was recently invented and identification of exosomal microRNA’s 21 and 155 could be biomarkers for diagnosis of PDAC. Since many studies have explored biomarkers in fluid samples containing pancreatic juice and reported excellent diagnostic accuracy, we need to discuss how these biomarker assays can be validated and utilized in the strategy of early detection of PDAC.

Exploring the Effect of Esomeprazole on Gastric and Duodenal Fluid Volumes and Absorption of Ritonavir

Proton-pump inhibitors (PPIs), frequently prescribed to lower gastric acid secretion, often exert an effect on the absorption of co-medicated drug products. A previous study showed decreased plasma levels of the lipophilic drug ritonavir after co-administration with the PPI Nexium (40 mg esomeprazole), even though duodenal concentrations were not affected. The present study explored if a PPI-induced decrease in gastrointestinal (GI) fluid volume might contribute to the reduced absorption of ritonavir. In an exploratory cross-over study, five volunteers were given a Norvir tablet (100 mg ritonavir) orally, once without PPI pre-treatment and once after a three-day pre-treatment with the PPI esomeprazole. Blood samples were collected for eight hours to assess ritonavir absorption and magnetic resonance imaging (MRI) was used to determine the gastric and duodenal fluid volumes during the first three hours after administration of the tablet. The results confirmed that PPI intake reduced ritonavir plasma concentrations by 40%. The gastric residual volume and gastric fluid volume decreased by 41% and 44% respectively, while the duodenal fluid volume was reduced by 33%. These data suggest that the PPI esomeprazole lowers the available fluid volume for dissolution, which may limit the amount of ritonavir that can be absorbed. Although additional factors may play a role, the effect of PPI intake on the GI fluid volume should be considered when simulating the absorption of poorly soluble drugs like ritonavir in real-life conditions.

Effect of Corn Particle Size on the Particle Size of Intestinal Digesta or Feces and Nutrient Digestibility of Corn–Soybean Meal Diets for Growing Pigs

This study was conducted to evaluate the effect of corn particle size on the particle size of intestinal digesta or feces and nutrient digestibility of corn–soybean meal diets. Twenty-four growing barrows (initial BW: 21.9 ± 1.62 kg) were randomly divided into 4 groups of 6 pigs. A T-cannula was surgically placed in the anterior duodenum (about 50 cm from pylorus) of pigs in Groups 1 and 2 or in the distal ileum of pigs in Groups 3 and 4. Corn used to formulate diets had mean particle size (MPS) of 365 µm (Corn 1) or 682 µm (Corn 2), resulting in diets with MPS of 390 µm (Diet 1) or 511 μm (Diet 2). Diet 1 or 2 were randomly assigned within pig Groups 1 or 2 and 3 or 4. The digestive enzyme activities of duodenal fluid, particle size of intestinal digesta and feces, as well as nutrient digestibility, were determined for each pig as the experiment unit. The MPS of duodenal digesta (181 vs. 287 µm, p < 0.01), ileal digesta (253 vs. 331 µm, p < 0.01), and feces (195 vs. 293 µm, p < 0.01) was significantly reduced for pigs fed Diet 1 vs. Diet 2, respectively. Compared with Diet 2, Diet 1 significantly reduced the proportion of particles above 0.5 mm, but significantly increased the proportion of particles between 0.072 and 0.5 mm (p < 0.01) in digesta and feces (p < 0.01). Diet 1 significantly increased solubles percentage (<0.072 mm) in duodenal digesta (p < 0.05) but did not affect solubles percentage in ileal digesta and feces. The MPS of diet did not affect the activities of amylase, trypsin, and chymotrypsin in the duodenal fluid and the apparent total tract digestibility (ATTD) of dry matter, gross energy, crude protein, ether extract, neutral detergent fiber (NDF) and acid detergent fiber (ADF) in pigs offered Diet 1 compared to Diet 2. The in vitro digestible energy (IVDE) (3706 vs. 3641 kcal/kg; p = 0.03) was greater for Corn 1 vs. Corn 2. However, no significant difference was observed in IVDE (3574 vs. 3561 kcal/kg; p = 0.47) for Diet 1 vs. Diet 2. In conclusion, the particle size of digesta and feces was dependent on the dietary particle size. However, the digestive enzyme activities of duodenal fluid and ATTD of energy and nutrients were not affected by reducing dietary MPS from 511 to 390 µm.

Alterations of the bile microbiome in primary sclerosing cholangitis

BackgroundPatients with primary sclerosing cholangitis (PSC) display an altered colonic microbiome compared with healthy controls. However, little is known on the bile duct microbiome and its interplay with bile acid metabolism in PSC.MethodsPatients with PSC (n=43) and controls without sclerosing cholangitis (n=22) requiring endoscopic retrograde cholangiography were included prospectively. Leading indications in controls were sporadic choledocholithiasis and papillary adenoma. A total of 260 biospecimens were collected from the oral cavity, duodenal fluid and mucosa and ductal bile. Microbiomes of the upper alimentary tract and ductal bile were profiled by sequencing the 16S-rRNA-encoding gene (V1–V2). Bile fluid bile acid composition was measured by high-performance liquid chromatography mass spectrometry and validated in an external cohort (n=20).ResultsThe bile fluid harboured a diverse microbiome that was distinct from the oral cavity, the duodenal fluid and duodenal mucosa communities. The upper alimentary tract microbiome differed between PSC patients and controls. However, the strongest differences between PSC patients and controls were observed in the ductal bile fluid, including reduced biodiversity (Shannon entropy, p=0.0127) and increase of pathogen Enterococcus faecalis (FDR=4.18×10−5) in PSC. Enterococcus abundance in ductal bile was strongly correlated with concentration of the noxious secondary bile acid taurolithocholic acid (r=0.60, p=0.0021).ConclusionPSC is characterised by an altered microbiome of the upper alimentary tract and bile ducts. Biliary dysbiosis is linked with increased concentrations of the proinflammatory and potentially cancerogenic agent taurolithocholic acid.

Method Performance of Bicarbonate and Electrolytes by Use of Duodenal Fluid for Assessment of Exocrine Pancreatic Function

Background Evaluation of exocrine pancreatic insufficiency is challenging for both clinicians and laboratories. Indirect pancreatic function tests such as serum trypsinogen, fecal elastase, and fecal fat measurements are moderately sensitive for diagnosis of advanced chronic pancreatitis but show reduced sensitivity and specificity for diagnosis of early disease. An alternative is the endoscopic pancreatic function test, which uses duodenal secretions after administration of IV secretin. Samples are collected at various times via the endoscopic tube and then analyzed for bicarbonate, sodium, potassium, and chloride. Methods Precision, linearity, method comparison, and stability studies were performed on the Beckman Coulter AU5822 chemistry analyzer with duodenal fluid. Comparison with the Vitros 4600 dry slide chemistry instrument was used to interrogate differences between methods. Results All assays produced a CV &lt;2% without any measurable effects from the endoscopy fluid matrix and showed acceptable imprecision near the limit of detection (CV &lt; 5%). All analytes showed linear dilution across the analytical measuring range. All the calculated error biases from dilutions were within 50% of the CLIA-allowable error for serum for each of the respective analytes. The calculated slopes ranged from 0.841 to 1.274 when compared to the Vitros 4600. Stability studies demonstrated that sodium, potassium, chloride, and bicarbonate remained stable after storage at −20 °C and after multiple freeze–thaw cycles. The percent change for all analytes was &lt;5% mmol/L. Conclusions The AU5800 series demonstrated adequate performance for the analysis of bicarbonate in duodenal fluid and therefore can be used for assessment of exocrine pancreatic function. However, notable discrepancies were observed for sodium, potassium, and chloride between the AU5800 series and the Vitros 4600.