Adverse drug reactions of Intermittent chemotherapy compared to daily regimen in Sudanese patients with pulmonary Tuberculosis

The World Health Organization [WHO] declared Tuberculosis a global health emergency in 1993 as it remains a major cause of mortality in developing countries. The World Health Organization's Directly Observed Treatment Short course [DOTs] strategy achieve 87% success rate in the areas where it is implemented, usually with five drugs, lasts for 6months. Till 1998 Sudan was classified as one of the slowly moving countries in implementation of the DOTS strategy and making no progress against tuberculosis. A prospective comparative, randomized clinical trial, hospital based study carried out at Kosti Teaching Hospital using directly observed treatment short course [DOTS], to assess the adverse drug reactions of intermittent chemotherapy compared to the currently adopted short course therapy. Patients with smear positive new cases of tuberculosis were enrolled and randomized in to two groups, intermittent treatment group [A] and daily regimen group [B] .The raw data were introduced into SPSS program, the data comparison was carried out by Pearson Chi square and pair independent sample student T-test. The level of significance [P<0.05]. A total of 275 were studied, significant initial [pre-interventional] elevated means of aspartate aminotransferase [AST] was detected in the two groups and significantly in the intermittent regimen after two and four months, but the decrease was significant only after two months in the daily group. Liver injury following antituberculous treatment was minimal and the adverse drug reactions were tolerable concerning the majority of the patients completing the course of the treatment

History of TB in the Sudan

Medical history in Sudan is far from being complete. There are no reliable records. Attempt to write on the projects and development of history of TB in the Sudan is a difficult task. To study and trace the progress of TB in Sudan during the last century through their historical development. A retrospective study. Data were collected from the annual reports of the Sudan Medical Services. Libraries and a number of previous studies were consulted. The route of entry of TB in the Sudan is mainly from the North. The South was virgin from TB up to 1930s. Northern Sudanese tribes have a high susceptibility and incidence of TB during 1925-1932 [3.7/1000]. The south and the Nuba Mountains were almost free from infection or disease. The infectivity rate was highest in North 4.3% while Khartoum showed 3%. In the South, Rumbek district, no TB cases were reported before the age of puberty up to 1930. Prevalence of tuberculosis in 1959/1960 was 26.0% and the detection rate was only 30%. Northern Sudanese contracted tuberculosis while serving in the Egyptian army and cities. The Southern and Western tribes who were almost free from TB infection became highly susceptible to both infection and disease. The infectivity rate remains static during the last 50 years

Anaemia in pregnant and non pregnant Yemeni females in Sana'a area

To determine the prevalence and predictors of anaemia among Yemeni females in Sana'a area and impact of anaemia on labour and outcome. Prospective community based randomized multicenter analytical and comparative study. AlSabein Hospital, AlHamzy MCH Center, Al-Olefi MCH Center, Yemeni Family Care Center, Al-Roudah Health Center and Omer Ibn AbdulAziz MCH Center from 1999-200l. 1800 pregnant Yemeni females were included in this study, 800 from Sana'a city reflecting the urban group, 500 were taken from Al-Roudah town reflecting the urban group and 500 during delivery. Also 300 non pregnant Yemeni females were screened for the presence of anaemia. A questionnaire was designed for all pregnant women. Heamogram, blood film, serum iron level, TIBC and serum ferritin level [by ELISA] were done for all the pregnant females. Heamogram as screening test was done for the non pregnant group. Chi square test was used to assess the relationship between categorical variables. The prevalence of anaemia in pregnant Yemeni females was 16.2%. The prevalence of anaemia in non pregnant Yemeni females was 8.3%. The prevalence of anaemia during delivery was 19.2%. The most common cause of anaemia was iron deficiency anaemia [84.5%]. Pregnancy was found to be a definite risk factor for anaemia. Several risk factors were found to be conductive to anaemia in particular chewing qat and inadequate general health education. There was no statistically increased risk of complications in antepartum, intrapartum or postpartum periods

Anatomical study of rectus abdominis muscle and its clinical application

To study the neurovascular anatomy of the rectus abdominis muscle with reference to their relation to tendinous intersections of the muscle. Eight human cadavers were injected with latex/lead oxide mixture into the superior epigastric artery and external iliac artery. The vascular architecture of the superior and deep inferior epigastric arteries was studied together with the nerve supply of rectus abdominis muscle. The superior epigastric supplied the upper part of rectus muscle. It pierced the rectus muscle between the first and second tendinous intersections. The inferior epigastric artery had 3 patterns of branching; Type I the artery ascended as a single stem parallel to the muscle fibers [in 37.5% of cases]; Type II the vessel divided into 2 branches of different size after giving a perimuscular branch to the lower portion of rectus [in 50% of cases]; The medial branch was short and small to supply the lower medial portion of rectus while the lateral branch was longer with larger diameter. It ran parallel to the muscle fibers to a level above the umbilicus. Type III the deep inferior epigastric artery divided into 3 branches [in 12.5% of cases], the lower one was the smallest. The other 2 branches were of the same caliber, the medial one was short never reach the umbilicus supplying the lower medial portion of the muscle, and the lateral one was longer, ran parallel to the muscle fibers to a level above the umbilicus. The rectus muscle was innervated by lower thoracic spinal nerves in a segmental manner. The muscular perforators arranged in a vertical row from the posterior rectus sheath to the deep surface of rectus. The point of their perforation to the muscle corresponded approximately to the vascular axis which situated at the junction of lateral 1/3 and medial 2/3 of rectus. The perforators of the anterior rectus sheath to skin arranged also in a vertical row lateral to mid line of rectus above the umbilicus and medial to mid line below the umbilicus. Both the superior and deep inferior epigastric arteries supplied the rectus abdominis. The inferior epigastric artery was more reliable than the superior epigastric artery, as it was easily accessible and easily separated from the muscle with minimal damage. It can be used for free tissue transplantation to perineum, genital area and the abdominal wall. A strip of anterior rectus sheath, should be preserved between the intersections to prevent rupture of the vulnerable rectus abdominis and its vessels due to presence of substantial connective tissue within the muscle between the tendinous intersections. During obtaining muscle flaps, denervation of the remaining muscle occurred if more than medial half of the muscle was taken with the flap, due to vertical arrangement of segmental nerve supply of the rectus at the junction of lateral 1/3 with the medial 2/3

Respiratory syncytial virus infection in the first three years of life: evaluation of new diagnostic test

Nasopharyngeal aspirates were collected from 270 infants and young children less than 3 years suffering from acute lower respiratory tract infections. Respiratory syncytial virus [RSV] infection was established as an etiologic agent in 118 patients out of 270 [43.7%] using different virologic diagnostic tests. The ages of our cases ranged from 15 days to 3 years, more than 70% of RSV infections occurred in winter season. Acute bronchiolitis was the most common clinical diagnosis in cases with RSV infection and represented 61% of all cases, followed by bronchopneumonia and croup. Directigen RSV was assessed for rapid diagnosis of respiratory syncytial virus as compared to virus isolation and indirect immuno fluorescent [IF]. Directigen RSV showed a sensitivity and specificity of 94.9% and 100% respectively. So it was concluded that Directigen RSV is a rapid and sensitive test for diagnosis of RSV. This test has the advantages of rapidity and simplicity as it is completed within minutes without the need of equipments and can be done by personnel with little experiences in viral diagnosis

Herpes simplex virus type 2: comparison of diagnostic modalities

61 cases diagnosed clinically as Herpes genitalis were investigated. 40 males and 21 females with ulcerative or vesicular eruptions on external genitalia were studied for detecting Herpes simplex virus type 2 [HSV-2] infection, either through antigen detection, virus isolation or serological methods. 29 cases [47.5%] were positive by virus isolation, 27 cases [44.2%] were positive by the direct antigen test while 6 cases [9.8%] were positive for IgM and 33 [54%] were positive for IgG. From the results obtained, it seems that the direct antigen detection is the most simple and highly specific laboratory technique for detecting recent and previous infections with HSV-2

In utero correction of pulmonary hypoplasia in congenital diaphragmatic hernia: an animal model

A model of congenital diaphragmatic hernia was created in fetal rabbits by excising a section of diaphragm at 25 days gestation. Animals were sacrificed at 27 and 30 days gastation, then morphological and histological examinations were made for the feti and the lungs. There was a decrease in the lung growth and alveolar development. The changes were most marked in the homo-lateral lungs, but changes were also seen in the contralateral lungs as in human patients with diaphragmatic hernia. In a group of fetal animals with surgically created diaphragmatic hernia, the trachea was occluded by ligation at 27 days and the lungs were examined at 30 days. In the treated group, there was alveolar hyperplasia, with lung per body weight percentage increasing to compensate the change caused by the diaphragmatic hernia. These results indicate that it is possible to reverse the pulmonary hypoplasia in utero. This would improve survival and allow elective and easier repair of the diaphragmatic hernia after birth

Some factors affecting the compressive strength of the gypsum-bonded investment

Gypsum-bonded investments have been widely used in dentistry for reproducing precious and semi precious cast restorations. Meanwhile, the casting of high fusing non-precious alloys such as nickel- chromium and cobalt-chromium alloys is usually performed with phosphate-bonded investments. However, some gypsum-bonded investments are used for casting nickel-chromium alloys with a relatively low fusing temperature. The main disadvantage of the phosphate- bonded investments is the reaction with the molten alloys during casting resulted in reaction products that are difficult to remove and take much effort in the finishing of the cast restorations. A sample size of 105 gypsum-bonded investment blocks [5 cm diameter and 5 cm in length] was employed in this study. The first 6 groups were mixed mechanically under vacuum while the last one was mixed by hand. After mixing, the molds were filled with the different investment mixes using the vibrator for 5 seconds, then the surface of each mold was covered by a flat smooth glass slide in order to standardize the length of each sample as well as to assure that, the base and the top surface are parallel to each others. Results revealed that, the compressive strength values decreased with the increases of burnout temperature at different treatments. Furthermore, vacuum mixing increase the compressive strength value when compared to hand mixing. Samples obtained by proper mixing under vacuum with low W/P ratio provided the maximum compressive strength values at 900 degree F. burnout temperature. On the other hand, the maximum strength values were obtained at 1100 degree F. burnout temperature when samples were prepared with paper water/ power ratio and short mixing time under vacuum. Vacuum performed before, during and after mixing resulted in the maximum compressive strength values at 1350 degree F. High W/P ratio reduced the compressive strength of the gypsum-bonded investment at various burnout temperatures