Role of P Wave Duration and Tissue Doppler Imaging as Predictive Indicators for Paroxysmal Atrial Fibrillation in Hypertensive Patients

Background: Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the heart. AF accounts for one-third of rhythm disorder hospitalizations. AF increases profoundly the risk of stroke, heart failure, and death. This study used P-wave and transthoracic echocardiography with tissue Doppler imaging (TDI) to determine paroxysmal AF predictors in hypertensive individuals. Methods: This case control study was performed on 100 hypertensive adult patients. They were classified into two equal group: Group I included hypertensive patients diagnosed to have paroxysmal AF. Group II (control group) included hypertensive patients with normal sinus rhythm. All subjects were subjected to electrocardiographic and conventional and tissue Doppler Imaging measurements. Results: Pmax had significantly increased in PAF patients compared to sinus rhythm patients. PAL, PAR, PAI, LR, LI and IR had significantly increased in PAF patients compared to sinus rhythm patients. In Multivariate logistic regression analysis, Pmax, PAL, PAI, PAR, LR, LI and IR were found to be independent predictors for PAF. Therefore, Pmax, PAL PAI, PAR, LR, LI and IR were found to be significant predictors for PAF. Best cut-off values for Pmax, PAL, PAI, PAR, LR, LI and IR were: (118, 81, 61, 49.9, 34, 20 and 16 ms) with sensitivity (76, 96, 96, 88, 82, 86 and 77.5 ), specificity (84, 100, 98, 92, 78, 82 and 76) and the AUC of (0.850, 0.979, 0.987, 0.961, 0.836, 0.891 and 0.798) respectively. Conclusions: Electrocardiographic P-wave analysis and echocardiographic TDI may identify hypertension patients at risk for paroxysmal AF, since the combination of Pmax and TDI may help in predicting the development of AF in hypertensive individuals.

Selection and characterization of novel zinc-tolerant Trichoderma strains obtained by protoplast fusion

Aim: To develop new Trichoderma strains, capable of removing toxic heavy metal ions from polluted environments, via protoplast fusion.Methodology: Trichoderma parental strains (T. viride and T. koningii) along with their ten fusants (Tk+Tv 1, Tk+Tv 2, Tk+Tv 3, Tk+Tv 4, Tk+Tv 5, Tk+Tv 6, Tk+Tv 7, Tk+Tv 8, Tk+Tv 9 and Tk+Tv 10) were obtained from the Department of Plant Pathology, Junagadh Agricultural University, Junagadh. The strains obtained by protoplast fusion were examined for their ability to remove toxic heavy metal ions, especially zinc ion. Fourier-transform infrared spectroscopy (FTIR) was conducted to detect the zinc uptake mechanism of Trichoderma parental and their fusant strains. Results: FTIR results demonstrated the Zn ion uptake capacity of fusant strains was found to be higher than that of the parental strains (12.8 to 10.7 mg g-1 on a dry weight basis at 1300 ppm). The highest Zn ion mobility observed was 62.1 mg. kg-1 and the highest Zn ion mobility observed per strain was 12.4% in Tk+Tv 3, followed by 11.86 % in Tk + Tv 7, 11.84% in Tk + Tv 9 and 11.28% in Tk + Tv 10. Parental and fusant strains Tk + Tv 3, Tk + Tv 8 and Tk + Tv 10 confirmed the involvement of different functional groups for different concentrations of zinc during adsorption by the fungus. Interpretation: FTIR results identified greater metal removal capacity in the fusant strains, particularly for soil Zn ion. Zinc tolerance was higher in the fusant strains than in the parental strains. Thus, protoplast fusion is an effective and feasible method for constructing new strains that can be used for bioremediation of contaminated environments.

Molecular characterization of phosphate solubilizing fungi Aspergillus niger and its correlation to sustainable agriculture

Aim: The present study aimed to investigate the phosphate solubilization potential of agriculturally important fungi, i.e., Aspergillus sp. isolated from the rhizosphere of healthy plants in Abha city, Saudi Arabia.Methodology: Sixteen Aspergillus sp. isolated and tested for phosphate solubilization potential were identified by 5.8S-ITS region sequencing and characterized by 11 ISSR-PCR markers. Finally, the highest phosphate solubilization potential isolates were used in field experiments on cucumber and tomato plants. Results: All Aspergillus niger isolates showed 96–100% similarity to A. niger strains available at GenBank database, Isolate ASAB-5 was most efficient at solubilizing phosphate on Pikovskaya’s medium, with a solubilization index of 2.67, and 235.22 mg l-1 of solubilized phosphate. ISSR-PCR markers revealed is total 142 bands in all isolates, with about 32.3% showing monomorphism and 67.6% polymorphism. Based on genetic similarity and intraspecies variability, the Aspergillus isolates were grouped into two different clusters with about 67.9% genetic similarity. The results of field experiments showed no significant difference between seeds treated with culture filtrate or conidial suspension of ASAB-5; however, both differed remarkably from untreated seeds. Interpretation: The current study confirms the existence of several useful phosphate solubilizing fungi in plants, which may serve as potential biological fertilizers. They are safer than chemical fertilizers and increase the bioavailability of soil phosphates for plants

Late diagnosis of 5-alpha-reductase type 2 deficiency in an adolescent girl with primary amenorrhoea

Deficiency of the 5-alpha-reductase enzyme has been found to affect male sexual development. We report an 18-year-old patient who was referred to an endocrinology clinic in Jizan, Saudi Arabia, in April 2014 with primary amenorrhoea, virilisation and a lack of secondary sex characteristics. As female external genitalia were present at birth, she had been raised as a female. Magnetic resonance imaging revealed no uterine or ovarian tissue in the pelvis and the presence of a scrotal sac. She was diagnosed with 5-alpha-reductase type 2 deficiency, a 46,XY disorder of sexual development. Typically, affected males have pseudovaginal perineoscrotal hypospadias and ambiguous genitalia at birth. Individuals who have been raised as female manifest characteristics of virilisation at puberty, including deepening of the vocal tone, phallus enlargement, scrotal hyperpigmentation and increased muscle mass

unusual case of bezoar from Sudan

Pica is an abnormal eating behavior in which patients persistently eat non-food materials, which can lead to health consequences. A man presented complaining of several months of back pain and constipation without vomiting, abdominal pain, or distension. He experienced increasing social isolation and emotional lability over 5 years. Radiological findings confirmed the diagnosis, noting multiple radiopaque foreign bodies. Several types of pica are described based on the substance consumed. Bezoars may develop in the gastrointestinal tract as a result of these ingestions. Lithobezoars are rare types of bezoars, more common in males and psychiatric patients. An important clue to the diagnosis of lithobezoars is severe constipation, recurrent abdominal or back pain, and painful defecation. The diagnosis might not be made for years if such symptoms are not related to careful history, abdominal examination, or radiological findings

Bedside teaching at the cinderella status. options for promotion

Recently, there are increasing published reports that there is a decline in bedside skills of medical students and young doctors. The decline is thought to be due to decline in bedside teaching in medical schools. The aim of this paper is to study the reasons of decline in bedside teaching, and to suggest some remedies for this decline. This study discusses reasons of decline in clinical teaching itemized under 4 subheadings: teaching methods and curricular factors, teachers' factors, students' factors, and patients' factors. We suggest some strategies to improve the status of bedside teaching, including curricular change to better introduce students to properly approach patients clinically, use of community health settings, and outpatient departments as teaching sites and use of clinical skill centers, simulated patient and multimedia programs to enhance clinical skills of students. The situation of bedside teaching is somewhat inadequate, but in adopting innovative solutions, there are hopes for betterment

Deficiencies in physical examination of the cardiovascular system among medical students

The aim of this study was to assess the patterns of errors committed by medical students [on the clinical phase of their study] at a medical school on performing examination of the cardiovascular system. The author used a study battery in which performance errors were classified into four patterns: errors of technique, omission, detection and interpretation. The patterns and frequencies of errors reported in this study included: 13 errors of technique, 4 errors of omission, 5 errors of detection and 11 errors of interpretation. The medical students have deficiencies in their bedside skills of cardiovascular examination. The author suggested some solutions to improve and maintain these skills

Response of Sudanese doctors to domestic violence

The aim of this study was to assess the awareness, and response of the Sudanese doctors to domestic violence. The study was carried out among the doctors of the Police University Hospital, Khartoum, Sudan. Self-administered questionnaires were distributed to all doctors who were attendants at the hospital, one morning in July 2002. The information required from the surveyed doctors included their familiarity, and views on domestic violence as a health problem, number of cases of abuse encountered, barriers to diagnose or screen cases, their views on intervention beyond physical treatment and if they had been taught or trained in domestic violence. Out of 142 doctors who received the questionnaires, 102 returned it giving a response rate of 71.8%. The respondent's ages ranged from 25-54 years; 53 were female [51.9%]; and 32 [31.3%] had experience of more than 10 years. Forty-three doctors [42.1%] had a fair knowledge of the concept of domestic violence, 28 [27.4%] viewed it as a worthwhile health problem and 21 [20.5%] reported encountering 1-2 cases in the last year. Barriers to screen cases included a lack of knowledge and training, insufficient time at clinics and fear of problems with perpetrators. The female gender and long professional experience had positive correlations with a better knowledge regarding violence and the desire to intervene beyond physical treatment [P<0.005]. Our study indicated clearly the missing role of the medial profession in recognition and helping the victims of domestic violence. The authors discussed several suggestions to promote the role of doctors in addressing this problem

Imbalance between free radical propagation and some antioxidants in patients with cataract

The relation of oxidative stress to the occurrence of cataract remains to be undetermined and must be clarified. So, the aim of this work was to study the effect of O2-free radical and some antioxidants in the pathogenesis of senile and diabetic cataract. This work was carried on 30 patients and 10 healthy subjects as control. They were 23 males and 17 females. Their ages ranged from 50 to 64 years. Patients were classified into senile cataract, diabetic without cataract and diabetic cataract groups. Each group included 10 patients. The results of this work showed that, in patients with senile cataract, were non-significant increase of fasting serum glucose [FSG] and serum total bilirubin [serum T. bilirubin] compared with the control group. Serum lipid peroxide [S. LP] and serum ceruloplasmin [S. Cp] were. significantly increased [P<0.05] while plasma superoxide dismutase [SOD] and serum uric acid were significantly decreased [P<0.05] compared with the control group. Moreover, diabetic patients with and without cataract showed a significant increase of FSG, S. total bilirubin. S. LP, S. Cp, and S. uric acid [P<0.05] while plasma SOD was significantly decreased [P<0.05] compared with the control group. Comparative study of the diabetic cataract versus senile cataract and diabetic without cataract, our results showed a significant increase of FSG, S. LP, S. total bilirubin and S. Cp, while there was significant decrease of plasma SOD in diabetic cataract compared with both senile cataract and diabetic without cataract [P1<0.05 and P2<0.05], respectively. S. uric acid was significantly increased in diabetic cataract compared with senile cataract group [P1<0.05] while it was non-significantly increased compared with diabetic without cataract group. Also, aqueous humor study of diabetic cataract group versus senile cataract group showed that LP and uric acid were significantly increased [P<0.05] while SOD was significantly decreased [P<0.05]. Correlation study revealed that, age was significantly and positively correlated with LP, but negatively correlated with SOD both in serum and aqueous in all patient groups. FSG was significantly and directly correlated with serum and aqueous LP, uric acid, S. total bilirubin, and S. Cp in diabetics with and without cataract. Moreover, serum and aqueous LP was significantly and inversely correlated with serum and aqueous SOD in all patient groups, while, it was positively correlated with S. total bilirubin, and S. Cp in diabetics with and without cataract. We could conclude that the imbalance between generation of O2-free radical and plasma SOD may have an etiological implication in the occurrence of cataract

Diabetic autonomic neuropathy

The diabetic autonomic neuropathy is a poorly studied subject in our medical literature. This study is aimed at investigating the presence of diabetic autonomic neuropathy in a group of Sudanese diabetic patients and its relationship to factors like glycemic control, duration of diabetes and presence of peripheral neuropathy. During one year we examined 120 diabetic patients and an age-matched control group of 42 by applying a battery of 5 cardiovascular autonomic tests, beside a full history and clinical examination. The patients were also tested for glycemic control and presence of peripheral neuropathy. Diabetic autonomic neuropathy was diagnosed in 48 patients [40%] of a mean age of 48.411 + 12.50 years, type 1/2 diabetes was 10/38, mean duration of diabetes 16.2 + 7.3 years, 41 with poor glycemic control [81%] and peripheral neuropathy was present in 32 patients [66%]. We found a significant association between diabetic autonomic neuropathy and prolonged duration of diabetes [P<0.001], poor glycemic control [0.01>P>0.001] and presence of peripheral neuropathy [0.02>P>0.01]. Diabetic autonomic neuropathy [both asymptomatic and symptomatic] is a common problem among our diabetic patients. It is significantly associated with prolonged duration, poor control of diabetes and presence of peripheral neuropathy. We need to augment the awareness of diabetes care providers to the occurrence, and peculiar features and tests of this syndrome

Could hepatitis C virus affect the pancreatic functions?

The association between Hepatitis C virus [HCV] and diabetes mellitus remains undetermined and must be defined. So, the aim of this work was to study serum insulin, C-peptide and amylase concentrations in patients with chronic hepatitis C virus [CHCV] infection in a trial to search for any pathogenic impact of HCV on both the endocrine and exocrine functions of the pancreatic gland. This work was carried on 75 patients and 20 healthy subjects as controls. All our patients and controls were males and their ages ranged from 40 to 64 years. Patients were classified into diabetic, CHCV and diabetic with CHCV groups. Each group included 25 males. The results of this work showed a significant increase of S.glucose in diabetics, with and without CHCV [p < 0.001] while liver enzymes [AST and ALT] were significantly increased in CHCV with and without DM [p < 0.001] compared with the control group. Additionally, diabetic group showed a significant increase of S.insulin and C-peptide [p < 0.05] while CHCV group showed a significant increase of S. amylase [p < 0.001] compared with the control group. Diabetics with CHCV showed a significant decrease of both serum insulin and C-peptide [p < 0.05] but a significant increase of S. amylase [p < 0.001] compared with the control group. Comparative study of diabetic with CHCV group versus diabetic group and CHCV group, the data showed a significant decrease of S. insulin and C-peptide [p[1] < 0.001 and p[2] < 0.05], respectively while S.amylase was significantly increase comparing it with DM group. [p[1] < 0.001] but non-significant change did not occur when compared with CHCV group [p[2] > 0.05]. We could conclude that; both the exocrine and endocrine parts of the pancreas may be an extrahepatic target of HCV. The disturbances of both insulin and C-peptide associated with CHCV could explain a direct link between HCV and occurrence of diabetes mellitus. So, we recommend to assay S. glucose, insulin and C - peptide levels in every patients with CHCV to predict the incidence of diabetes mellitus

Gastroparesis diabeticorum: a clinical study in sudanese patients

Gastroparesis diabeticorum is a distressing and little mentioned gastrointestinal complication among our diabetic patients. The objective of this study was to confirm the occurrence of this syndrome and to identify its clinical features and impact on glycemic control of diabetes mellitus. The authors set a special clinic in Medani, Sudan, to receive the diabetic patients complaining of chronic [more than two weeks] symptoms related to the upper gastrointestinal tract. The criteria of diagnosis of gastroparesis diabeticorum were: symptoms [nausea, vomiting, epigastric discomfort and feeling of fullness for long periods after meals] in patients with diabetic autonomic neuropathy, and confirmatory findings of gastric stasis in the barium studies. The similar conditions were excluded. Fasting blood glucose was measured to assess the glycemic control of diabetes. Eight patients were identified, of a wide range of age group [27 - 64 years], longstanding diabetes [8 - 26 years] and poor glycemic control [fasting blood glucose > 8 mmol / L in 7 out of 8 patients]. More than one diabetic complication was recorded in each patient. We established the occurrence of gastroparesis diabeticorum as one of the manifestations of diabetic autonomic neuropathy among our patients. It should be thought of as one of the etiological factors of the upper gastroenteropathies, like peptic ulcer and giardiasis, in Sudanese diabetic patients

Serum iron, ferritin and transferrin in patients with ischemic heart disease

To shed more light on the relationship between ischemic heart disease and iron, serum iron parameters [iron, ferritin and transferring] were estimated in fifty ischemic heart patients [15 stable angina-15 crescendo angina and 20 acute Myocardial Infarction. MI]. Their ages ranged 43-58 years- Ten healthy subjects, matched with patients for age and sex, sevred as control group. Echocardiographic studies [ejection fraction [EF] and end systolic volume [ESV] together with peak serum creatine phosphokinase [CPK] were done for each case of infarction to correlate these variables with the corresponding serum iron parameters. compared to controls, ischemic heart patients had highly significant increase of serum iron [103.5 +/- 25.6 vs 79.6 +/- 19.2, p<0.01] and serum ferritin [94.7 +/- 54.2 vs 44.4 +/- 11.0. p<0.01] whereas they showed insignificant increase of serum transferrin [273.8 +/- 83.8 vs 244.1 +/- 56.4, p<0.05]]. Subgroup analysis showed that there was statistically significant increase in serum iron and ferritin but not transferrin in patients with stable and unstable angina while in cases with acute MI, there was significant increase in all serum iron parameters. correlation studies showed that serum iron and ferritin but not transferrin were strongly correlated with peak CPK. EF and ESV. Patients with acute MI who had complicated in-hospital course showed significant higher value of serum iron. ferritin. transferrin, CPK and ESV but they had a significant lower EF than non-complicated cases. In conclusion, serum iron and ferritin were significantly higher in ischemic heart patients while serum transferrin was significantly higher only in patients with acute MI In the infarction group, the higher the serum iron and ferritin, the larger is the size of infarction, the worser is the in-hospital course and the more impaired is the systolic function. Thus, the present study might give a new meaning for the emerging role of iron in ischemic heart disease