Post-discharge surveillance of wound infections by telephone calls method in a Sudanese teaching hospital

Surveillance of wound infections has been shown to be a powerful preventive tool, and feedback to the clinical staff reduces wound infection rates. The main objectives of this study were to identify the applicability of telephone calls as a method of post-discharge wound infection surveillance, and to identify patients and procedures characteristics associated with loss for follow-up after hospital discharge. This was a prospective cohort study conducted in Khartoum Teaching Hospital, Sudan. Patients, aged >18 years admitted for elective clean and clean-contaminated surgery during March 1[st] to 31[st] October 2010 were recruited. 1-month surveillance of wound infections was conducted with telephone interviews. Overall 3656 patients were operated on. Of them 1769 [48.4%] were eligible [mean age 37.8+14 years; females, n=1472 [83.3%]]. The performed surgical interventions were 1814. Of these 1277 [70.4%] were clean-contaminated and 537 [29.6%] were clean. Patients who successfully completed the follow-up were 1387 [78.4%], while 368 [20.8%] were lost, and 14 [0.8%] died. The percentage of male patients [85.3%] who successfully completed the follow-up was significantly higher than females [77.8%]; [P=0.002]. Wound infection was detected in 15 [0.8%] cases during hospital stay and 110 [6.2%] others after hospital discharge. The majority of wound infections in the current study appeared in post-discharge period; this emphasis the need for establishment of surveillance program in the hospital. Surveillance of wound infections using telephone calls is applicable in this setting and can be used as an alternative method to clinic-based diagnosis of wound infections

Pharmaceutical representatives' beliefs and practices about their professional practice: a study in Sudan

Pharmaceutical representatives are an important promotional tool for pharmaceutical companies. This cross-sectional, exploratory study aimed to determine pharmaceutical representatives' beliefs and practices about their professional practice in Sudan. A random sample of 160 pharmaceutical representatives were interviewed using a pretested questionnaire. The majority were male [84.4%] and had received training in professional sales skills [86.3%] and about the products being promoted [82.5%]. Only 65.6% agreed that they provided full and balanced information about products. Not providing balanced information was attributed by 23.1% to doctors' lack of time. However, 28.1% confessed they sometimes felt like hiding unfavourable information, 21.9% were sometimes or always inclined to give untrue information to make sales and 66.9% considered free gifts as ethically acceptable. More attention is needed to dissemination of ethical codes of conduct and training about the ethics of drug promotion for pharmaceutical representatives in Sudan

Influence of milk and some Sudanese meals on the dissolution of ciprofloxacin tablets

For a drug to be effective, it must be released from the dosage form, fully dissolved in the gastro-intestinal fluids, be stable as solution in the gastrointestinal fluids, pass through the gastrointestinal barriers into the mesenteric circulation without being metabolized, pass through the liver into the systemic circulation unchanged and reach its site of action. Food is one of the factors which interfere with these processes. The effect of Sudanese meals will be different due to their high contents of fats, proteins and fibers. This study aimed to determine the influence of milk and some Sudanese meals [Foul - Vicia faba -, "Gorrassah with damaa" and "Kissraa with sharmoot"' on the dissolution of ciprofloxacin HCI tablets and hence bioavailability. The influence of milk and the mentioned Sudanese meals on the dissolution of ciprofloxacin was studied using paddle dissolution apparatus. The dissolution of the drug was measured in the presence of each meal individually using U.V.- visible spectrophotometer. The samples were taken with 5 minutes intervals up to 30 minutes. The results obtained were compared to the results of the dissolution of this drug in simulated gastric fluid in fast state [0.1 N HCl]. The study revealed that the dissolution of ciprofloxacin in Sudanese meals is lower than its dissolution in milk- whose reduction of dissolution of ciprofloxacin was mentioned in a lot of studies world-wide. The order of the influence of Sudanese meals, used in the study, was foul followed by kissraa then gorrasah which showed that the influence was directly proportional to the viscosity of the meal. Using two different volumes of foul, the study revealed that influence of meals on the dissolution of ciprofloxacin was significant even small amounts were used

[IL-10 levels determination in Syrian patients with newly diagnosed lymphoma and their relation with disease progression]

Interleukin 10 is an immune regulatory and immunomodulating cytokine, in this study serum IL-10 levels were measured in 44 Syrian patients with newly diagnosed lymphoma [Hodgkin's disease, non Hodgkin's lymphoma] to determine the significance of pre-treatment IL-10 levels. In our attempting to further elucidate the immunological state of lymphoma patients, serum interferon gamma [IFN-GAMMA] [the immune stimulating cytokine] levels were determined. Pre treatment serum IL-10 were measured and patients were followed-up for at least one year, at the end of the study, the significance of basal serum IL-10 levels, and its independence from other prognostic factors were determined. Pre treatment serum IFN-GAMMA were calibrated, and the correlation between IL-10 levels and IFN-GAMMA levels was examined. Serum IL-10 were significantly higher in patients compared with healthy controls [p=0.002], basal IL-10 values were found significantly higher in non responders compared with responders in retrospective analysis [univariate analysis] p=0.008 in both Hodgkin's disease patients [p=0.013], non Hodgkin's lymphoma patients [p=0.004]. Moreover this prognostic value was found to be independent from other prognostic factors, tumour stage [p=0.13], clinical symptoms [p=0.49], [multivariate analysis MANOVA test]. The correlation between IL-10 and IFN-GAMMA in pre treatment lymphoma patients was [r=0.54], and it was stronger in Hodgkin's patients [r=0.93], than non Hodgkin's lymphoma patients group [r=0.53]. the results of the current study show that measurement of pre treatment serum IL-10 levels is of independent prognostic utility in patients with Hodgkin's disease, and some non Hodgkin's lymphoma types

Hepatocellular integrity during sevoflurane anesthesia with induced hypotension

The effect of sevoflurane anesthesia with or without induced hypotension on hepatocellular integrity was studied. Forty adult consented patients scheduled for various urological procedures were allocated randomly to either NTG group [nitroglycerin-induced hypotension] or a control group of twenty patients each. Anesthesia was induced and maintained by fentanyl, sevoflurane and vecuronium in both groups. In NTG group, nitro-glycerin infusion was adjusted to maintain mean arterial pressure [MAP] of 50-65 mm Hg. Specific and sensitive hepatic biomarkers; alpha [alpha] and pi [pi] glutathione S-transferases [GST] and hyaluronic acid [HA], also traditional liver enzymes; aspartate [AST] and alanine [ALT] aminotransferases were measured at: TO [pre-induction], T1, T2, T3 [15, 30 and 60 minutes after MAP stabilization respectively] and T4 [24 hours after anesthesia end]. Plasma alpha-GST significantly increased at T3 in control group [p < 0.05] and in NTG group [p < 0.01] compared to T0 in same group. In NTG group, hyaluronic acid con-centrations was significantly increased at T1, T2 [p < 0.05] and T3 [p < 0.01] from T0. Compared to control group, alpha- GST and HA concentrations showed significant increases in NTG group at T3 with p < 0.05 then returned back to normal range at T4. But, pi-GST, AST and ALT showed no significant changes throughout the study in both groups

Types of haemoglobin in patients attending Khartoum Teaching Hospital - Sudan

Abnormal haemoglobins lead to significant morbidity and mortality. This is a prospective study, evaluating types of haemoglobin and haematological parameters in blood samples of 631 Sudanese patients. Participants were patients who attended different departments in Khartoum Teaching Hospital in the period from March 2005 through July 2005. Electrophoresis was used to determine the type of haemoglobin. 585 cases have normal haemoglobin [Hb A]. Mean red cell indices were: Hbl 1.5 g/dl, PCV 34.9%, MCV 85.4 fl, MCH 32.1pg, MCHC 33.2 g/dl, RDW 37 fl and WBC 7013 /cm3. 46 [7.3%] patients had abnormal Hb. The frequency of Hb types were AA: 92.7%, AS: 4.9%, SS: 0.8%, AC: 0.5% and AF: 0.5%.The presence of abnormal haemoglobin such as haemoglobin S is not unexpected because we live in the centre of an affected area. The study showed low haematological parameters due to various causes including poor nutrition as well as infections and haemolytic processes

Knowledge of tuberculosis: a survey among tuberculosis patients in Omdurman, Sudan

A cross-sectional study was conducted in different health settings in Greater Omdurman Province with the objective of measuring the patients' knowledge about tuberculosis and its treatment. One thousand tuberculosis patients were randomly selected. Results revealed general unawareness with the disease and its treatment among the interviewees. Only 36.2% of them had satisfactory knowledge about tuberculosis and its treatment. The level of this knowledge was inversely proportional with respondent's age. Males [38.7%] were more knowledgeable than females [31.4%]. The level of satisfactory knowledge increased with increasing educational level. Respondents treated at health facilities implementing the ational Tuberculosis Programme guidelines [34.5%] were more knowledgeable compared to those treated at general hospitals and private clinics where there is no commitment to the uidelines [23.1%]. Increasing coverage of programme implementation to include general hospitals and private sector, the designing of special health educational programmes and interventions directed toward tuberculosis patients to increase their general awareness about the disease and its treatment were recommended

Pancytopenia due to hemophagocytic lymphohistiocytosis in a patient with acute brucellosis

A Bangladeshi male patient with a culture positive Brucellosis had severe pancytopenia and fever. Patient was found to have Hemophagocytosis. He had uneventful recovery after treatment of Brucellosis. Discussion of the case and its treatment is presented

study of incidence of adverse drug reactions among tuberculosis patients, Omdurman, Sudan

A cross sectional study was conducted in Omdurman 'Alkobra' Province with the objective of identifying the occurrence of side effects among tuberculosis [TB] patients, treated with first line anti-TB drugs. Nine hundred forty one patients were selected randomly. Of the interviewees, about 71.2% reported the occurrence of one or more adverse drug effects. The occurrence of dizziness [33.3%], nausea [26.5%], joint pain [23.4%]. burning sensation [15.0%]. and numbness in hands/feet [16.0%] were observed. Certain groups of respondents complained from these effects more than others, e.g. females [78.7%], and alcoholics [75.0%]; [71.8%] of respondents had other disease/s together with TB. and those who used other medication/s with anti-TB drugs [73.7%]. The principal factor responsible for the increased incidence- of these effects seems to be the observed over-doses of anti TB drugs. A set of recommendations was proposed including revision of prescriptions to correct or modify doses, continuous training of health care providers especially in counseling the TB patients about adverse drug reactions, and teaching them to recognize these effects and education of the public to recognize the anti-TB drugs' adverse effects are needed

Malignant peripheral neuroepithelioma "peripheral neuroblastoma" a case report

Peripheral neuroepithelioma is a rate malignant tumour of primitive peripheral non autonomic nervous system. The tumour can occur at any age involving soft tissue mainly of lower extremities. Other sites of occurrence are the shoulder-thoracic region and the head and neck. It is a very aggressive tumour with early metastasis mainly to the lung. Herewith we report a case of 16 years old female who was presented with soft mass of labia majora of 3 years duration which has been rapidly enlarging in the last 6 months. The mass was excised and followed by administration of chemotherapy and radiotherapy. The patient developed secondaries in the lung 3 months after excision, with pleural effusion, but no local recurrence. However, eight months after the diagnosis and in January 2005, the patient died from the tumour

Calcium status in Sudanese cancer patients attending the institute of nuclear medicine, molecular biology and oncology

The aim of this study was to study the incidence of hypercalcaemia together with the related biochemical parameters and anthropometric measurements in Sudanese cancer patients attending the Institute of Nuclear Medicine, Molecular Biology and Oncology [INMO], Gezira State, Sudan. The study was a prospective study performed on 100 cancer patients [age ranging between 4- 70 years]. The study period was from 15/4/2003 to 1/9/2003. Another 100 persons [age and sex matched] were used as control group. The biochemical parameters measured in this study were serum calcium, serum inorganic phosphorus and serum albumin. Calcium, inorganic phosphorus and albumin were measured by Spectrophotometery. Anthropometrics measurements determined were weight and height. A questionnaire was filled in order to obtain information regarding: age, sex, residence, tribe and information about education, occupation, marital status and past medical history. Type of cancer, date of diagnosis, stage of cancer, treatment, and present complaints were recorded. Hypercalcaemia was detected in ten of the patients [10%]. This is similar to the internationally published rates. The types of cancers associated with hypercalcaemia were cancer of the breast [20%], skin [20%], prostate [10%], bladder [10%], rectum [10%], unknown primary [10%] and hematological malignancies [20%].Mean serum calcium [9.48 +/- 1.07 mg/dL] and inorganic phosphorus [4.45 +/- 1.01 mg/dL] were higher in the cancer patients than the control group [9.03 +/- 0.56, 4.13 +/- 0.72 mg/dL respectively]. However, the difference is statistically not significant. Serum albumin concentration was similar in the patients and control groups [4.97 +/- 0.63 and 4.93 +/- 0.41 g/dL respectively]. The differences of weight and height were not significantly different in the two groups. It is concluded that the calcium, phosphorus and albumin levels among Sudanese individuals were similar to the internationally published levels. Hypercalcaemia is not a rare condition among cancer patients and should be checked whenever there is a symptom because it can lead to many serious complications

Impact of the national protocol for malaria treatment on prescribing patterns in Gezira state, Sudan

A cross-sectional study to assess the impact of the national protocol for malaria treatment was conducted in a town in Gezira state, central Sudan, in 2001. Most of the 165 doctors and medical assistants interviewed [80.0%] had not been trained in the protocol and many [57.5%] were still using their own protocols. Analysis of 410 prescriptions showed chloroquine was the most common antimalarial drug used [69.5% of prescriptions]. Compared with a study before implementation of the protocol, more prescriptions met the protocol st and ards for correct chloroquine dose, whereas regimens for administration of intravenous quinine were still inadequate. The study showed a lack of continuous supervision, training and follow-up in the protocol guidelines and negative attitudes of hospital specialists towards the protocol

influence of reconstitution vehicles on the stability of ampicillin oral powders

The effect of different reconstitution vehicles on the stability of ampicillin oral powders was studied. Distilled water, tap water and well water were used for powder reconstitution. The suspensions were stored at 350C that representing the average room temperature in Sudan. The stability of the drug in suspension was tested daily over a period of seven days. The drug contents in the samples were determined using the cup- plate agar diffusion technique and chemical spectrophotometric method. The obtained results, represented the means of 10-20 determinations. The study revealed a higher degradation extent in the ampicillin oral powders reconstituted with water obtained from wells, followed by tap water when compared with the slower rate of degradation in the oral antibiotic that reconstituted with distilled water. In an attempt to decrease the destabilizing effect of the reconstitution vehicles on the daily used oral antibiotic powders, the authors suggested to use such formulae in a single-dose sachet form to be used instantly after reconstitution

In-home drug storage and utilization habits: a Sudanese study

Community drug-use habits were studied in 469 household units in different areas of Sudan. About 97.7% of the investigated families had at least one drug product stored at home. The study revealed a high rate of self-medication [46.9%], repeated use of unfinished stored drugs [55.0%], a high rate of drug exchange among families [59.3%] and poor compliance [71.2%]. In Sudan there is still a great need to educate and to motivate the general public regarding the principles of rational drug use in order to safeguard health and avoid economic losses

Antimalarials prescribing patterns in Gezira state: precepts and practices

A longitudinal pharmacoepidemiological study on prescribing patterns of antimalarials was conducted in Gezira State, Sudan. Different core drug prescribing indicators were identified, measured and correlated. Chloroquine and quinine were the most frequently prescribed antimalaria drugs but in 44.7% of cases, the dosage was inappropriate and did not conform to standard regimens. Due to variable and unmonitored patterns of drug resistance, most medical practitioners in Sudan tend to follow their own protocols to treat severe cases of malaria rather than conforming to standard regimens. We attribute the emergence of a high rate of resistance to malaria chemotherapy to such practices. We recommend interventions to ensure rational prescribing, and call for the formulation of a national antimalarial drugs policy

Prevalence of chlamydial infection among pregnant women in Bahrain

A pilot study to assess the prevalence of Chlamydial Infection among pregnant women routinely attending the antenatal clinics in Salmaniya Medical and Health Centres, was carried out during 1992. The sera of one hundred women attending the antenatal clinic were randomly screened for the presence of Chlamydia antibodies' by the enzyme immuno assay technique. The results showed that 44% of women had antibodies to Chlamydia trachomatis indicating high prevalence of chlamydial disease in the community

Male urethritis in Bahrain: the increasing incidence of resistant gonorrhea

Bahrain has a relatively low incidence of male urethritis; about one-half of these cases are due to N.gonorrhoeae. Despite the overall low frequency of sexually transmitted disease in Bahrain, N. gonorrhoeae isolates are often highly resistant. One-fourth of recent strains were resistant to penicillin, and 65% of the remaining isolates showed evidence of a chromosomally mediated diminished sensitivity to penicillin. Resistance to tetracycline is not yet common, but emerging chromosomal resistance and potentially poor compliance make tetracyclines inferior agents for gonorrhea therapy. We recommend ceftriaxone as primary therapy for N.gonorrhoeae in Bahrain; spectinomycin would be a reasonable second choice

In-vitro activity of imipenem to pseudomonas and other gram negative bacteria

The agar dilution technique was used to determine the minimum inhibitory concentration [MIC] of imipenem to clinical isolates from hospital and community acquired infections. From 160 strains of pseudomonas tested, 76% were sensitive to 6 Ug/ml or less, of which 66% had MIC of 4Ug/ml. There was 10% resistance as defined by growth at higher than 8 Ug/ml. Most escherichia coli strains [90%] were sensitive to 2 Ug/ml or less, while 13% of klebsiella strains showed resistance to 8 Ug/ml. The overall resistance in all strains was 9%