Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study / 한국역학회지

OBJECTIVES@#The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan.@*METHODS@#This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test.@*RESULTS@#A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection.@*CONCLUSIONS@#Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients' adherence to treatment, and to reduce contact with MDR-TB patients.

Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study / 한국역학회지

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.

Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study / 한국역학회지

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan.METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test.RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection.CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients' adherence to treatment, and to reduce contact with MDR-TB patients.

Particle associated polycyclic aromatic hydrocarbons in the atmospheric environment of urban and suburban residential area

Ten polycyclic aromatic hydrocarbons associated with suspended particulate matter in the ambient air were collected at two sampling sites: urban and suburban residential areas of Yokohama, Japan from 1999 to 2005. The concentrations of target compounds were determined using gas chromatography-mass spectrometry. The total concentrations were higher in urban residential area than suburban residential area. They ranged from 0.31 to 6.16 ng/m3 with a mean of 2.07 ng/m3 and 0.33 to 2.87 ng/m3 with a mean of 1.02 ng/m3 in the urban and suburban residential areas, respectively. The predominant compounds determined both in the urban and suburban residential areas were benzo[b]fluoranthene, benzo[ghi]perylene, indeno[1,2,3-cd]pyrene and benzo[e]pyrene. The concentrations of 5- and 6-ring polycyclic aromatic hydrocarbons were higher in the urban than the suburban residential area, accounting for 77.3% and 72.1% of total polycyclic aromatic hydrocarbons, respectively. Source identification was performed by principal component analysis. Two principal components were identified for each study area and these accounted for 95.9% and 83.3% of total variance, respectively. The results revealed that stationary source and vehicle emissions were the major pollution sources in the studied areas. The impact of emission regulations for automobiles in large Japanese cities, which were enacted during 2002 and 2003, was also studied. Based on the average total concentration, emission reduction was 47.8% and 18.6% in urban residential and suburban residential areas, respectively

Evaluation of diagnostic accuracy of different biomarkers for prostate cancer

Serum total prostate specific antigen [PSA], free fraction of total prostate specific antigen percent [fPSA%] and prostate specific antigen density [PSAD] have all been considered as valuable non-invasive tumor markers for prostate cancer. This study was carried out to evaluate and compare the performances of serum total PSA, fPSA% and PSAD in terms of their sensitivity, specificity and overall diagnostic accuracy for prostate cancer. Fifty [50] DRE [digital rectal examination]-positive patients admitted in Rajshahi Medical College Hospital [RMCH], Bangladesh during January, 2006 to January, 2008 were included. Estimation of serum total PSA and fPSA% were done by ELISA [Enzyme linked immunosorbent assay] using commercially available kits. Data pertaining to volume of prostate as determined by transabdominal ultrasonography were used to calculate PSAD and histology of the surgically resected prostatic tissue was done for laboratory confirmation of prostate cancer for all patients. Diagnostic sensitivity, specificity and accuracy of serum total PSA, fPSA% and PSAD were calculated using standard formulae against histopathological diagnosis. Prostate cancer was revealed in 41 of 50 patients by histopathological examination with mean age of 71.2 +/- 10.1 years. There were 9 cases detected as Nodular Hyperplasia of Prostate [NHP] with prostate-specific biomarkers mostly within their normal range. The sensitivity, specificity and overall diagnostic accuracy for prostate cancer of serum total PSA [at cut off value of >10 ng/ml] were 80.48%, 88.90% and 82.00%, for serum fPSA [at cut off value of <25%], were 92.68%, 77.80% and 90.00% and for PSAD [at a cut off value of > 0.15 ng/ ml/cm[3]], were found to be 90.00%, 88.90% and 90.00% respectively. Histologically, 27 [65.85%], 13 [31.71%] and 01 [2.44%] cases were labeled as poorly differenntiated, moderately differentiated and well differentiated carcinoma respectively and overwhelming majority had excellent correlation with all prostate-specific biomarkers. These results reinforce that different prostate-specific biomarkers have good diagnostic prediction with free PSA percent and PSAD have slightly better diagnostic accuracy over serum total PSA for prostate cancer

Detection of ESBL producing nosocomial gram negative bacteria from a tertiary care hospital in Bangladesh

Extended spectrum beta-lactamases [ESBLs] represent a major group of lactamases currently being identified in large number worldwide mostly produced by gram-negative bacteria. The present study was done to see the frequency of ESBLs in gram-negative bacterial isolates causing nosocomial wound infections from a tertiary care hospital in Bangladesh. A total of 125 wound swabs were collected from surgical site infections and burn cases, admitted in Rajshahi Medical College Hospital [RMCH], during January to June, 2008. Swabs were cultured for aerobic bacteria and antimicrobial susceptibility testing was carried out using the Kirby-Bauer agar diffusion method. Gram-negative isolates were tested for ESBLs on Mueller Hinton agar by both modified double disc and phenotypic confirmatory methods. Culture yielded 71 [56.8%] bacterial growths with 60 [84.51%] gram-negative and 11 [15.49%] gram-positive bacteria [Staph aureus]. Gram-negative isolates included 23 [32.39%] E. coli, 19 [26.76%] Klebsiella spp., 16 [22.54%] Pseudomonas spp., and 02 [2.82%] Proteus spp. The number of ESBL producing bacteria in modified double disc and phenotypic confirmatory methods were 28 [46.67%] and 25 [41.66%] respectively. Highest rate of ESBLs was observed in Klebsiella spp. [57.89%] followed by Proteus spp. [50.0%], E. coli [47.83%] and Pseudomonas spp. [31.25%], which showed significantly increasing resistance to 3rd generation cephalosporins, aminoglycoside, quinolone and trimethoprim-sulfamethoxazole. Significant number of nosocomial wound infections is caused by ESBL bacteria; those are not detected by routine antimicrobial susceptibility testing. It is recommended that clinical microbiology laboratory should take urgent measure for ESBLs detection as routine to enhance hospital infection control programme

Congenital visceral leishmaniasis

Visceral leishmaniasis [kala-azar] is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sand fly Phlebotomus argentipes. Only a few cases of congenital transmission have been reported. We are reporting a 15 days old baby with congenital visceral leishmaniasis and then the literature is reviewed

Colorectal cancer during pregnancy in a Sudanese female

We report a new case of uncommon but not rare condition of colorectal cancer during pregnancy in 33 years old Sudanese female at her 16th weeks of gestation presented with bloody diarrhea and intermittent left side abdominal pain. Initially she was diagnosed as a case of dysentery which was treated by antibiotics. Condition was diagnosed by colonoscopy and histopathology as colonic cancer, located in the sigmoid colon 50 cm from anal verge. A review of literature found that 276 cases of colon cancer associated with pregnancy have been reported. Pregnancy affects the clinical presentation, evaluation, therapy, and prognosis of colon cancer. Patients usually present with misdiagnosed symptoms. Diagnostic delays often lead to the tragic demise of a young woman from a potentially curable disease and of an otherwise viable fetus. This delay in diagnosis is a major contributing factor to the poor prognosis associated with this disease. Synchronous colon cancer during pregnancy presents a diagnostic and therapeutic challenge for clinicians because there are no generally accepted guideline regarding diagnosis or treatment. This article reviews this uncommon condition with a focus on the features of colon cancer in pregnancy to facilitate earlier diagnosis, to modify investigations, to optimize the therapy, and to improve the maternal and fetal outcomes

Mercury[II] cystine complex as antineoplastic agent

Antineoplastic activity of mercury[II] cystine complex was studied against ehrlich ascites carcinoma [EAC] cells in Swiss Albino mice. Cell growth inhibition, increase of life span, haematological parameters, alkaline phosphatase activity of tumour bearing mice inoculated with EAC cells were studied with the test compound. It was found that this compound significantly inhibited the tumour cell growth, enhanced life span of the tumour bearing mice at dose 6 mg/kg i.p. Such treatment also restored the altered haematological parameters and serum alkaline phosphatase activity very closely towards normal. The compound can be considered as a potent antineoplastic agent

variation in the circulus arteriosus: a case report

This article described a variation detected in the cerebral arteries. In general the right arteries were found larger than the left. The left vertebral artery was found very small. Both anterior cerebral arteries originated from the right internal carotid and there was a small connecting branch from the left internal carotid to the left anterior cerebral artery

Epidemiology of Kawasaki disease in Qatar [an Arabian gulf country]

Case records were reviewed retrospectively of 49 patients admitted between January 1992 and December 2002 to evaluate the epidemiologic pattern of Kawasaki disease [KD] in Qatar. Ages ranged from three months to nine years with a median of 28 months and a male/female ratio of 2.3:1. During the eleven years, the annual incidence varied from 2.5/100,000 to 20/100,000 and appears to be increasing. Most cases occurred in the cooler season [January-May] affecting predominantly males and children under five years of age with no apparent predilection for any section of the ethnically varied population

Increasing pattern of antibiotic resistance in neisseria gonorrhoeae

To explore the fact of increasing pattern of resistance to commonly used antibiotics by Neisseria gonorrhoeae detected simultaneously in gram-stained smears and cultures of urethral and/or prostatic secretions. Retrospective study to detect N. gonorrhoeae from the submitted urethral and/or prostatic secretions and their antibiogram. One hundred thirty three male patients of suspected gonorrhoea attending the Skin and V.D. outpatient's department of Rajshahi Medical College Hospital [RMCH], Bangladesh from January to November 2001. The study was conducted at the Department of Microbiology of Rajshahi Medical College as a part of its diagnostic service delivery to the patients of RMCH. Urethral and/or prostatic secretions were collected from the suspected cases of gonorrhoea. Gram-stained smears for microscopical detection of gram-negative diplococci and culture on Chocolate agar media were done for all samples. Antimicrobial susceptibility testing by standard disc diffusion method was performed using antibiotics commonly prescribed for the treatment of gonorrhoea. Significant number of cases was found to be positive for N. gonorrhoeae in both urethral and prostatic secretions. As tools for detecting N. gonorrhoeae both Microscopical examination and Culture were equally comparable. Ciprofloxacin and Gentamicin showed around 11.60% resistant cases while Penicillin and Amoxycillin were found to be least efficacious drugs. Cephalexin, Doxycycline and Tetracycline were equivocal in sensitivity. This study reinforces the microscopy of gram-stained smears as a good tool for rapid diagnosis of N gonorrhoeae. It also explores the fact of increasing pattern of antibiotic resistance by N. gonorrhoeae to commonly prescribing drugs

Leishmaniasis: Biological understanding and beyond

An attempt has been made to briefly review the literature regarding current molecular understanding of host parasite relationship in Leishmaniasis. Sequencing of genomes for both human and important microbes including Leishmania major are in progress. The genetic information from both human and parasite have led towards molecular understanding of the interaction between parasite virulence factors and the host response factors. Gene codes for natural resistance associated macrophage protein 1 [NRAMP1], which controls the susceptibility to Leishmania donovani, Salmonella typhimurium and Mycobacterium bovis has been cloned in both mice and human. Research into the host genetics of Leishmaniasis has revealed the fundamental immunological mechanisms determining outcome of infection. It has been shown very conclusively that Tumour Necrosis Factor Alpha [TNF a] MHC and T helper cells [Th] all are associated to determine the susceptibility or resistance to leishmanial infection. Biological insights regarding parasite virulence genes identified as part of the leishmania genome project may be specifically targeted for vaccines or designing drugs for new treatments

Splenic lymphoma and schistosomiasis

This is a report of a 42-year old Egyptian with splenic lymphoma associated with in-testinal schistosomiasis. This association is rare and should be looked for in the evaluation of patients

Post operative sepsis due to antibiotic failure in gangrenous or perforated appendicitis

Seventy-two adult patients with peritonitis, caused by gangrenous or perforated appendicitis, received 80 mg of gentamicin and 500 mg of metronidazole, 8 hourly for 5 days. Postoperative wound infection occurred in 16 [22%] of these patients. Changing the antibiotic therapy, after the culture result became available did not influence the clinical outcome. Deep seated infections occurred in 3 patients, 2 of whom had pelvic and one retrocaecal abscess. Escherichia coli was the commonest organism isolated in 9 patients in 6 of whom it was resistant to gentamicin. No signs or symptoms of nephrotoxicity or ototoxicity developed during use of gentamicin. Although the combination of gentamicin and metronidazole is safe in the prevention and treatment of wound infection, the failure rate in appendicectomy for perforated or gangrenous appendicitis is unacceptably high. This data shows that a reconsideration of the antibiotic policy in patients with perforated and gangrenous appendicitis is indicated

Upper gastrointestinal fibreoptic endoscopy in Khartoum teaching hospital [Sudan]: a retrospective study of 5000 cases

The results of 5000 upper gastrointestinal endoscopic examinations carried out in Khartoum Teaching Hospital in the period 1980-1986 are presented. 44% of those endoscoped were normal. Duodenal ulcer was the commonest abnormality detected and occurred in 23% of cases. Although the finding of a gastric ulcer was rare [0.9%], 50% of those detected were malignant. Oesophageal varices were diagnosed in 10% of patients. Endoscopy is a safe and easy procedure and can be used in the study of the pattern of upper gastrointestinal disease in a large country like Sudan