The 'Alala (Corvus hawaiiensis) is the most endangered corvid in the world, and intensive efforts are being made to reintroduce it to its former native range in Hawaii. We diagnosed Toxoplasma gondii infection in five free-ranging 'Alala. One 'Alala, recaptured from the wild because it was underweight and depressed, was treated with diclazuril (10 mg/kg) orally for 10 days. Antibodies were measured before and after treatment by the modified agglutination test (MAT) using whole T. gondii tachyzoites fixed in formalin and mercaptoethanol. The MAT titer decreased four-fold from an initial titer of 1:1,600 with remarkable improvement in physical condition. Lesions of toxoplasmosis also were seen in two partially scavenged carcasses and in a third fresh intact carcass. Toxoplasma gondii was confirmed immunohistochemically by using anti-T. gondii specific serum. The organism was also cultured by bioassay in mice from tissues of one of these birds and the brain of a fifth 'Alala that did not exhibit lesions. The life cycle of the parasite was experimentally completed in cats. This is the first record of toxoplasmosis in 'Alala, and the parasite appears to pose a significant threat and management challenge to reintroduction programs for 'Alala in Hawaii.
Toxoplasma gondii was found in endemic Hawaiian birds, including 2 nene geese (Nesochen sandvicensis), 1 red-footed booby (Sula sula), and an introduced bird, the Erckels francolin (Francolinus erckelii). All 4 birds died of disseminated toxoplasmosis; the parasite was found in sections of many organs, and the diagnosis was confirmed by immunohistochemical staining with anti-T. gondii-specific polyclonal antibodies. This is the first report of toxoplasmosis in these species of birds.
SummaryPercutaneous endoscopic gastrostomy (PEG) is now the technique of choice for patients requiring long-term enteral feeding. It is a good method for feeding patients with neurological dysphagia and can safely be kept in situ for long periods. PEG feeding requires a multidisciplinary approach, involving doctors, nurses pharmacists, speech therapists, dieticians and carers. The insertion of a PEG, which requires two operators and two endoscopy nurses, is described in full. Feeding can commence after a few hours. Various types of feed and feed-ing patterns are described and their relative merits discussed. Although psychological problems may occur following PEG insertion, the procedure is usually well accepted by patients.Keywords: percutaneous endoscopic gastrostomy, feeding, stroke Patients who are malnourished on admission to hospital have longer hospital stays, experience more complications and are at a greater risk of dying than well-nourished patients with a similar illness.",2 Enteral nutrition with fine bore nasogastric tubes has been the mainstay until now, but they are often poorly tolerated and extubation is common.3 Percutaneous endoscopic gastrostomy (PEG) is now the technique of choice for longer term administration, replacing surgical gastrostomy. Any patient likely to require enteral feeding for more than four weeks should be considered for PEG.PEG under local anaesthetic was first described in 1980 for obtaining access to the stomach in patients requiring long-term tube feeding.4 Since its first description, PEG has become one of the more favoured techniques of feeding elderly and frail people with persistent swallowing difficulties due to neurological or oropharyngeal disorders. PEG feeding is well tolerated by patients and has a low morbidity (6-16%) and mortality (0-1 %).5Who should have a PEG?We feel that feeding with PEG is a good method for feeding patients with neurological dysphagia. If the patient is being considered for nasogastric or peripheral line feeding, PEG feeding may well be less invasive and more comfortable. Many doctors feel reluctant to use PEG seeing it as keeping severely disabled patients alive when this may not be in their best interests. We feel the decision to be active should come first and then the appropriate method chosen. Peripheral line feeding and nasogastric feeding have their places but the comfort of a PEG over these methods is striking.We recently audited our use of PEG feeding in patients with dysphagia after stroke. Seventy-five consecutive patients (39 males) with swallowing difficulties after stroke were included. We offered PEG feeding at the end of 7-10 days unless a speech therapy assessment showed return of swallowing to be imminent. Patients remained nil by mouth and received intravenous fluids or peripheral feeding until the insertion of the PEG. The results of this audit showed that those who had difficulty swallowing after 10 days took a surprisingly long time to recover swallowing (median 69 days, range 19-405). The PEG tube could be kept in ...
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