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Background: Resistance to antibiotics has increased dramatically over the past few years and has now reached a level that places future patients in real danger. Several factors contribute to this problem, some of them are health workers related and others are community related. This study aimed to assess the awareness of doctors in Elobeid hospital, North Kordofan state, Sudan about the problem, its causes, and its possible preventive measures. Methods: This descriptive, questionnaire-based study was conducted in Elobeid teaching hospital between 2020, February 27 and March 13. The study involved 50 doctors in the internal medicine department. Results: Out of the 50 doctors involved, 49 (98%) agreed that antibiotics resistance is a big progressive health threat in Sudan; 86% of the participants think that selfmedication is the leading cause of antibiotic resistance; and 98% believe that providing good quality culture and sensitivity service in hospitals and health centers is the most effective preventive measure. Regarding education about antibiotics as a part of academic activities in the unit during the last year, 36% of the participants received zero sessions, 68% received 15 sessions, and 12% received more than 5 sessions. The assessment of doctor's adherence to the Sudan Standard Treatment Guideline revealed that 28/50 participants (56%) did not see it or hear about it, 17/50 participants (34%) know it but don't comply, and only 5/50 participants (10%) know it and comply with it. Conclusion: Participants show a good awareness about the significance of antibiotics resistance as a health threat, a good awareness about the main causes and the possible preventive measures, a low to moderate frequency of education on antibiotics, and a very poor adherence to the Sudan Standard Treatment Guidelines.
Subject(s)
Anti-Bacterial AgentsABSTRACT
Hip firearm injuries are rare injuries that could lead to serious complications, such as posttraumatic hip arthritis and coloarticular fistula. We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture, concomitant with a colon injury treated on an emergency basis by a diverting colostomy; acetabular fractures were treated conservatively by traction. After the patient recovered from the abdominal injury, he was presented with bilateral hip pain and limited motion; plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type ⅢA. Reconstruction of the hips was performed using the same technique: impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty (THA) 6 months apart. The patient presented with loosening of the left THA acetabular cup 3 years later, which was revised; then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula, which was confirmed using CT with contrast material. A temporary colostomy and fistula excision were performed, and a cement spacer was applied to the hip. After clearing the infection, a final revision THA for the left hip was performed. Treating post-firearm hip arthritis by THA is challenging, especially in the situation of neglected cases with the presence of an acetabular defect. Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation, which could present later. Working with a multidisciplinary team is paramount.
Subject(s)
Male , Humans , Adult , Arthroplasty, Replacement, Hip , Firearms , Wounds, Gunshot/surgery , Acetabulum/injuries , Hip Fractures/surgery , Arthritis/surgery , Spinal Fractures/surgery , Reoperation , Fistula/surgery , Treatment Outcome , Follow-Up Studies , Prosthesis Failure , Retrospective StudiesABSTRACT
Introduction. In Mali, information related to COVID-19 is regularly shared by the coordination board against COVID-19 through daily official press releases and situation reports. The goal of this study was to analyze data related to the tested samples; and the confirmed, contacts, recovered and dead cases in order to take lessons for the future. Population and methods. Data from the first 100 days after the detection of the first cases in Mali were collected and recorded on an Excel file before they got analyzed using SPSS 25.0 software. Analyses were descriptive and correlational. Results. We included 14938 tested samples, 2260 confirmed cases, 12864 contact cases, 1502 recovered cases and 117 deaths were reported during the first 100 days of the epidemic. There was a positive correlation between the number of confirmed cases; and the number of tested samples, the number of recovered cases and the number of deaths. These results suggest that the number of confirmed cases increase with the number of tested samples. Conclusion. These results call for more testing and encourage the identification, location and follow-up of COVID-19 cases. They can also be used to support the improvement of data quality and the response to COVID-19. As a result, they can contribute to improve population health
Subject(s)
Humans , Male , Female , Data Collection , Mortality , Consumer Health Information , COVID-19ABSTRACT
Objective@#To investigate the effect of aqua therapy resistance exercise on arm volume, pain, and shoulder range of movements in post-mastectomy lymphedema. @*Methods@#This was a single-blind randomized controlled trial. Fifty eligible breast cancer survivors (median, 10 years after surgery) with lymphedema (median, 21% inter-limb difference) were assigned randomly to group A (n=25) or control group B (n=25). The study group underwent 60 minutes of aqua therapy exercise comprising of warm-up for 10 minutes, 40 minutes of strengthening exercises, and 10 minutes of cooling down, three times a week for 8 weeks. The control group underwent 60 minutes of land-based exercise three times a week for 8 weeks. Arm volume calculated by measuring the arm circumference, shoulder flexion, and abduction range of motion (ROM), and pain using a visual analog scale (VAS) were assessed at baseline and after 8 weeks of treatment. @*Results@#There was a statistically significant difference in limb volume, shoulder flexion and abduction ROM, and VAS scores in favor of the study group (p<0.001) after 8 weeks of intervention. The mean±standard deviation for limb volume, shoulder flexion, abduction, and pain score were 2,108.71±200.97 mL, 169.68°±4.54°, 150.44°±3.92°, and 3.16±1.1 in the study group and 2,256.41±186.94 mL, 147.36°±5.32°, 131.32°±4.38°, and 5.68±0.94 in the control group, respectively. @*Conclusion@#Adding aqua therapy resistance exercise to routine physical therapy might be more effective in decreasing the limb volume and pain intensity and improving ROM of the shoulder in postmastectomy lymphedema.
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Background@#Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. @*Methods@#Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block.In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. @*Results@#There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. @*Conclusions@#The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following nonrecurrent inguinal herniorrhaphy.
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Objective@#To investigate the effect of aqua therapy resistance exercise on arm volume, pain, and shoulder range of movements in post-mastectomy lymphedema. @*Methods@#This was a single-blind randomized controlled trial. Fifty eligible breast cancer survivors (median, 10 years after surgery) with lymphedema (median, 21% inter-limb difference) were assigned randomly to group A (n=25) or control group B (n=25). The study group underwent 60 minutes of aqua therapy exercise comprising of warm-up for 10 minutes, 40 minutes of strengthening exercises, and 10 minutes of cooling down, three times a week for 8 weeks. The control group underwent 60 minutes of land-based exercise three times a week for 8 weeks. Arm volume calculated by measuring the arm circumference, shoulder flexion, and abduction range of motion (ROM), and pain using a visual analog scale (VAS) were assessed at baseline and after 8 weeks of treatment. @*Results@#There was a statistically significant difference in limb volume, shoulder flexion and abduction ROM, and VAS scores in favor of the study group (p<0.001) after 8 weeks of intervention. The mean±standard deviation for limb volume, shoulder flexion, abduction, and pain score were 2,108.71±200.97 mL, 169.68°±4.54°, 150.44°±3.92°, and 3.16±1.1 in the study group and 2,256.41±186.94 mL, 147.36°±5.32°, 131.32°±4.38°, and 5.68±0.94 in the control group, respectively. @*Conclusion@#Adding aqua therapy resistance exercise to routine physical therapy might be more effective in decreasing the limb volume and pain intensity and improving ROM of the shoulder in postmastectomy lymphedema.
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Background@#Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. @*Methods@#Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block.In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. @*Results@#There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. @*Conclusions@#The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following nonrecurrent inguinal herniorrhaphy.
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Dengue is a debilitating disease that poses a perpetual threat to human health and increases the global economic burden every year. Despite advances in medical sciences, dengue virus (DENV) infects approximately 200 million people every year. To date, no effective antiviral is valiable to treat DENV in individuals despite great efforts in accomplishing these goals. Numerous approaches have been used in the search for dengue antiviral like screening of combinatorial compounds against DENV enzymes and structure-based computational discovery. In recent years, investigators have turned their focus into medicinal plants, trying to identify compounds that can be used as dengue antiviral. Nature represents a great reservoir of potential substances that can be explored with the aim of discovering new drugs that can be either used directly as pharmaceuticals or can provide drug leads, which can be scrutinized further for the development of new anti-dengue natural product. Many previous investigations have dealt with numerous plant extracts or bioactive principles for their antiviral property as they normally considered being safer when compared to synthetic drugs. Andrographis paniculata belongs to family Acanthaceae and is generally known as 'king of bitters'. Diverse bioactive compounds from this plant such as diterpenes, flavonoids, xanthones, noriridoides and other miscellaneous compounds have exhibited their potential as therapeutics for various chronic as well as infectious diseases. This review is based on literature review on scientific journals, books and electronic sources, which highlights the pathogenesis of DENV and describe an assortment of bioactive principles that have been possessing antiviral potential, which include dengue and discuss the therapeutic efficacy and mechanism of action of Andrographis paniculata. However, a detailed and more comprehensive clinical trial on mammalian tissues and organs is needed in future studies.
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Dengue is a debilitating disease that poses a perpetual threat to human health and increases the global economic burden every year. Despite advances in medical sciences, dengue virus (DENV) infects approximately 200 million people every year. To date, no effective antiviral is valiable to treat DENV in individuals despite great efforts in accomplishing these goals. Numerous approaches have been used in the search for dengue antiviral like screening of combinatorial compounds against DENV enzymes and structure-based computational discovery. In recent years, investigators have turned their focus into medicinal plants, trying to identify compounds that can be used as dengue antiviral. Nature represents a great reservoir of potential substances that can be explored with the aim of discovering new drugs that can be either used directly as pharmaceuticals or can provide drug leads, which can be scrutinized further for the development of new anti-dengue natural product. Many previous investigations have dealt with numerous plant extracts or bioactive principles for their antiviral property as they normally considered being safer when compared to synthetic drugs. Andrographis paniculata belongs to family Acanthaceae and is generally known as 'king of bitters'. Diverse bioactive compounds from this plant such as diterpenes, flavonoids, xanthones, noriridoides and other miscellaneous compounds have exhibited their potential as therapeutics for various chronic as well as infectious diseases. This review is based on literature review on scientific journals, books and electronic sources, which highlights the pathogenesis of DENV and describe an assortment of bioactive principles that have been possessing antiviral potential, which include dengue and discuss the therapeutic efficacy and mechanism of action of Andrographis paniculata. However, a detailed and more comprehensive clinical trial on mammalian tissues and organs is needed in future studies.
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Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.
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Introduction: The increasing prevalence of ureteric stone is a matter of concern in this era and it may be linked to improvedquality of life. Medical expulsive therapy, including alpha-blockers, steroids, and calcium channel blockers, has been extensivelystudied for improving the rate of stone passage in patients who do not require immediate urologic intervention.Aim: The aim of this study is to compare the efficacy of tamsulosin and tadalafil in expulsive treatment for distal ureteralstones.Materials and Methods: This was a prospective comparative study included 120 adult patients (>18 years of age) presentingwith distal ureteric stones were randomized into 60 patients with tamsulosin 0.4 mg once daily (Group A) or 60 patients withtadalafil 10 mg once daily (Group B) treatment. Therapy was given for a maximum of 4 weeks.Results: About 85% of study patients had a size between 5 mm and 7 mm and 18 patients had size between 8 mm and 10 mm.There was no statistical difference noted in the pain duration and analgesic usage of both groups. In Group A, 67% of patientshad expulsion of stones; in Group B, 63% of patients had expulsion of stones. About 90% of patients in 40 cases of expelledstones are in <5 days in Group A and 89% of patients 38 cases of expelled stones are in <5 days in Group B. There was nostatistical difference noted between both groups.Conclusion: Tamsulosin and tadalafil have shown similar expulsion rate. Both of them simultaneously provides better paincontrol and significantly lower the needs for analgesia.
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Background: Preterm labor classically defined as delivery before completed 37 gestational weeks. Urocortin a biomarker that have raised recent research interest is a 40-amino acid neuropeptide related to the corticotrophin-releasing factor molecular family. Interestingly urocortin is produced by gestational tissue such as amnion and chorion predictability of preterm labor by biomarker assay could enhance management levels particularly in cases of preterm labor that are considered a frequent clinical scenario in obstetric practice. Aim of the study was to assess and evaluate the serum levels of urocortin predictability capacity in cases that develop preterm labor.Methods: The current research clinical trial was conducted in a prospective way there was two research groups 60 study subjects had threatened preterm labor and 60 normal research study subjects that delivered at term. Comparative analysis was performed for urocortin assay conducted in both research groups in correlation to gathered clinical data obtained from both research groups.Results: Receiver operating characteristic curve (ROC) between preterm and term delivery research groups as regards plasma urocortin level (pg/ml) as a predictor of pre term delivery showing that a cut-off point level >101.3 pg/ml in which statistical sensitivity=88.33%, statistical specificity=75%, positive predictive value=77.9, negative predictive value=86.5.Conclusions: This research finding reveal that maternal serum urocortin is an effective biomarker in predictability of preterm labor; however future research studies should be multicentric in fashion putting in consideration the racial and ethnic differences besides the impact of BMI on maternal serum urocortin indices.
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Aims: This study is done to identify factors affecting under five mortality in Dar Alsalam area, Khartoum.Study Design:This is a community based cross-sectional study.Place and Duration of Study:The study was carried out in block 25 in Dar Alsalam area in Khartoum State during March-April 2012.Methodology: A total of 240 women in reproductive age who had an experienceof child death were interviewed. The data was collected by semi-final medical students using structured questionnaire. Two stage cluster sampling was used to select the households. Data was summarized using descriptive statistics and logistic regression analysis was carried out to identify factors associated with under-five mortality.Results: Age of 156 (65%) of the deceased children was less than one year, while the age of 84 (35%) was between one and five years. The age of (25%) of the motherat the time of their child birth was below 18 years. The majority of the mothers (70.8%) were illiterate, 74.2% were working and 80% were married. Of the children 51.7 were males and for 74.2% of them the birth interval was less than 2 years. Only 16.7% were breast fed for more than two years while the rest (83.3%) were breast fed up to 2years. Only 34.2% of the deceased children had completed their vaccination, and 68.3% had been admitted to hospital more than once before death.Half of the families have piped water in their houses, in 75.8% of the houses there are pit latrines andin68.3% there is electricity supply. Logistic regression analysis identified incomplete vaccination, not employed mothers and having no latrines in the house as the factors related to the death of children between 1-5 years than those below one year.Conclusion: Under-five mortality in low socioeconomic areas is associated with Low family income, mother’s illiteracy, early marriage and absence of latrines in the houses.
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This study aimed to investigate relationship of the HCV genome structure and treatment with Pegylated Interferonα/Ribavirin (peg-IFNα/RBV) Egyptian patient. Mutations in two sites of HCV genome; the internal ribosome entry site(IRES) and the interferon sensitivity determining region (ISDR) of HCV genotype 4a were studied in details including DNAsequences and mutations detection in response to treatment. Ninety patients, responders and non-responders, to treatmentwith peg-IFN α /RBV were included in this study. IRES and ISDR regions were amplified by RT-PCR using specific designedprimers, and amplified regions were sequenced. The data obtained were aligned with published sequences in GenBank usingBLAST program. Results of this study have revealed that there are different mutations in the studied sequences in both ISDRand IRES regions. The predicted amino acids sequences in the ISDR region showed significant differences ranging from oneup to more than eight mutations in the HCV Genome sequences. Although there was a significant difference betweensequences of HCV RNA isolated from responders and non-responders, these data were not able to give an absolute answerwhether response to interferon therapy is directly/relates to the structure of the HCV genome
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Abstract@#The consequence of post-operative infection can be devastating despite its rare incidence. Common organisms causing post-operative infection are normal flora of the skin: Staphylococcus aureus and Staphylococcus epidermidis. Early diagnosis followed by arthroscopic debridement and antibiotic therapy with graft retention remains the main aim of treatment. However, there are certain cases where the infection persists despite early intervention. Vancomycin-loaded bone cement bullet inserted into bone tunnel can provide a high local concentration of vancomycin with bactericidal effect and low systemic complications to treat deep-seated infection.
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Abstract@#Medial meniscus root tear (MMRT) is uncommon and is often associated with osteoarthritis during presentation. Whether it is a cause or effect, it is still debatable at this point of time. However, when a combination of injuries occurs in a middle age group patient, a careful examination before offering a treatment is advised. We herein report a case of a middle-aged gentleman suffering from both arthritis and MMRT.
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Background: in orthopedic procedures more blood is lost from raw bone and muscle surface than from identifiable blood vessels. Moderate hypotensive anesthesia was found to significantly decrease the average blood loss by nearly 40%, reduce the need for transfusion by 45% and shorten the average operating time by nearly 10%. Objective: The aim of the current study was to compare magnesium sulphate and dexmedetomidine with nitroglycerin as regard hypotensive effect as primary outcome, volume of blood loss, blood substitution and pattern of recovery as secondary outcome during lumbar spine surgery. Patients and Methods: This prospective, controlled, comperative, randomized, double blind study included a total of ninty patients aged 21-50 years of both sex, ASA I-II scheduled for elective lumber spine surgery, attending at Department of Orthopedic, AL-Azher university Hospital in Assuit as single center study. Patients have received either dexmedetomidine, magnesium sulfate or nitroglycerine. Results: There were highly significant difference (P <0.000) with duration of surgery between different study groups with duration of surgery shortest in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. There were highly significant differences between different study groups with fluid maintenance with higher volume in nitroglycerine group then magnesium sulfate group and then dexmedetomidine group. There were highly significant differences (P <0.000) with systolic blood pressure between study groups at A1 and hypotensive agent discontinuation with lowest systolic blood pressure in dexmedetomidine group followed by magnesium sulfate group and then nitroglycerine group. Conclusion: nitroglycerine, magnesium sulfate and dexmedetomidine could induce hypotension, but dexmedetomidine showed more favorable hemodynamic profile as regard blood pressure and heart rate
Subject(s)
Antihypertensive Agents , Dexmedetomidine , Magnesium Sulfate , NitroglycerinABSTRACT
Background: Corneal blindness resulting from various medical condition affects millions worldwide. The rapid developing field of tissue engineering offers the potential to develop a tissue-engineered cornea that adheres very closely to the native cornea for transplantation. The design of a scaffold with mechanical properties and transparency similar to that of natural cornea is vital for the regeneration of corneal tissues. Hence, there is a need to investigate this relatively inexpensive but an improved scaffold to assist in human corneal stem cells delivery. Aim and Study Design: The present study aimed at to prepare and investigate the properties of poly vinyl alcohol (PVA)/chitosan blended scaffold by further cross-linking with 1-Ethyl-3-(3-dimethyl amino propyl)-carbodiimide (EDC), 2 N-Hydroxysuccinimide (NHS) as potential in vitro carrier for human limbal epithelial cells delivery. Results: After the viscosity measurement, the PVA/Chitosan scaffold was observed by Fourier transform infrared spectroscopy (FT-IR). The water absorbency of PVA/Chitosan was increased 361% by swelling. Compression testing demonstrated that by increasing the amount of chitosan, the strength of the scaffold could be increased to 16 × 10−1 Mega Pascal Pressure Unit (MPa). Our degradation results revealed by mass loss shows that scaffold degraded gradually implies slow degradation but shown enhanced the biomechanical properties. In vitro 3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay showed good cell proliferation and growth in the scaffold. Besides the above, the present study aimed at exploring the effects if any observed with PVA/chitosan and other cross linkers on cell morphology and phenotype using H&E staining. Our MTT assay results and the cells observed on these membranes confirmed that the safer and improved method of preparation of membrane could increase the cells adhesion and growth on the substrata. Conclusion: Hence, we strongly believe the use of this improved PVA/chitosan polymer scaffold has potential to cut down the disadvantages of human amniotic membrane (HAM) for corneal epithelium in ocular surface surgery in future after successful experimentation with clinical trials.