Evaluation of Metabolic Syndrome in Primary Health Care

Background: Metabolic syndrome includes atherogenic dyslipidemia, obesity, hypertension, hyperglycemia, andinsulin resistance. This complex of metabolic abnormalities is a risk factor for DM2, stroke, adverse cardiacevents, and hepatic necrosis. In the last few years, studies showed a significant high prevalence of this syndromeamong Saudi males. Central visceral adiposity is thought to be the primary trigger of most pathogenic eventsinvolved in the advent of the syndrome. Objectives: In this paper, our aim is to discuss metabolic syndrome, itsdefinitions, pathophysiology, diagnosis, screening, and the management done for such patients in general withspecial focus to primary healthcare. Methodology: PubMed database was used for articles selection. Conclusion:The syndrome is linked with significant impacts on the patient health; as a result, the health care providers shallbe alarmed on how to screen, diagnose and manage such disease. Prevention of childhood obesity is criticalthrough screening and early diagnosis to save major burden and prevent future complications. Thus, nowadays,the new trend is towards incorporating screening of this syndrome in primary health care centers.

Experimental murine model of intra-abdominal infections caused by some non-albicans Candida species

Background: Even though intra-abdominal candidiasis (IAC) has been increasingly recognized, with associated high morbidity and mortality rates, its pathogenesis remains poorly understood. This model aims to study the pathogenicity and invivo susceptibility of non-albicans Candida species associated with IAC in human in order to predict the frequency of infections, outcome of clinical disease and response to antifungal therapy. Methodology: Both immunosuppressed and immunocompetent female CD-1 mice were challenged intraperitoneally with 5 x 108 CFU/ml inoculum of five non-albicans Candida strains; Candida glabrata, Candida parapsilosis, Candida lipolytica, Candida tropicalis and Candida guilliermondii. Mice were closely observed for symptoms. Treated groups received voriconazole (40 mg/kg/day) or micafungin (10 mg/kg/day) 24 hours after infection depending on invitro susceptibility results. Survival rate, mean survival time and fungal tissue burdens were recorded for all groups. Results: All infected groups developed hepatosplenomegaly, peritonitis and multiple abscesses on intra-abdominal organs and mesenteries. C. glabrata and C. lipolytica represented the most and the least virulent strains respectively in terms of survival rate, mean survival time and fungal burden in both immunosuppressed and immunocompetent models. Following treatment, all immunocompetent animals survived the entire duration of experiments (0% mortality rate), while mortality rate was relatively high (20-60%) in immunosuppressed mice. Treatment failed to eradicate the infection in immunosuppressed mice despite significant decrease of the fungal burden and increase mean survival time. Conclusion: This study reports an increasing pathogenicity of non-albicans Candida species, with persistent infection among immunosuppressed animals

Cure of post Kala-azar dermal leishmaniasis with paromomycin/sodium stibogluconate combination: a proof of concept.

Background: Post kala-azar dermal leishmaniasis (PKDL) is a recognized dermatologic complication of successfully treated visceral leishmaniasis (VL). PKDL lesions are suspected to be important reservoirs for VL transmission in Sudan. Prolonged treatment schedules, feeling of general well-being and the social stigmata of PKDL prevent most patients seeking treatment. The mainstay of treatment is cardiotoxic sodium stibogluconate (SSG) for 60-120 days. Recently, liposomal amphotericin B (Ambisome®) and immunochemotherapy gave promising results. Ambisome® is expensive and difficult to prepare under field conditions. Paromomycin/SSG combination has been shown to be safe, efficacious and can save time in VL treatment. This study aims to prove that Paromomycin/SSG combination can cure and reduce PKDL treatment duration. Methods: We are reporting nine cases of patients with PKDL lesions of ≥6 months duration who were diagnosed by clinical signs, histopathological/immunohistochemical and PCR. Results: Patients’ mean age was 11.7 ± 4.3 years. A third of the patients (3/9; 33.3%) who failed previous SSG treatment of 2-3 months duration responded completely to 40 days of paromomycin/SSG combination. The majority of patients (5/9; 55.6%) responded completely to 30 days of the combination. One patient (1/9; 11.1%) relapsed following 30 days paromomycin/SSG combination. Conclusion: It was concluded that paromomycin/SSG combination for 30 days is time-saving, safe and efficacious for PKDL treatment.

Hepatoprotective Effect of Momordica charantia Extract against CCl4 Induced Liver Damage in Rats.

Aim: The study was aimed to evaluate Momordica charantia leaves extract for hepatoprotective effect against carbon tetrachloride (CCl4) induced hepatotoxicity in rats. Methodology: A total of twenty five male rats were randomly divided into five groups of five rats each. The extract was administered orally for fifteen days at 200 and 400 mg/g body weight. Results: The results obtained showed that, treatment with the extract significantly (P<0.05) restored liver weight to near normal. The result showed a significant (P<0.05) increase in Heamoglobin (Hb) and Packed Cell Volume (PCV) compared to toxin control group. Also treatment with the extract caused a significant (P<0.05) decrease in the activities of Alanine Transaminase (ALT), Aspartate Transaminase (AST), Alkaline Phosphatise (ALP) and the level of total bilirubin: and a significant (P<0.05) increase in total protein level compared to control group. Similarly, the extract caused a significant (P<0.05) decrease in the level of reduced Glutathione (GSH) and Malondialdehyde (MDA) and a significant (P<0.05) elevation in the activities of Superoxide Dismutase (SOD) and Catalase (CAT) compared to toxin control group. Conclusion: This study found that, administration of aqueous leaves extract of M. charantia ameliorated hepatotoxicity induced experimentally by CCl4.

Surgical management of colonic volvulus during same hospital admission

To study the local patient profile, diagnostic methods, and treatment outcome in patients with large bowel volvulus to recommend a management plan. A retrospective study of patients record with a final diagnosis of large bowel volvulus treated at King Saud Medical Complex, Riyadh, Saudi Arabia between January 2000 and December 2007 were performed for patient demography, clinical presentations, co-morbidity, diagnostic methods, anatomical types, management, and outcome. Forty-two patients with large bowel volvulus were reviewed. They represented 8.5% of all intestinal obstructions treated. Most had sigmoid volvulus [83%], were less than 60 years of age, and were male. Recognized risk factors were present in 12 [29%] patients. Diagnosis was suspected on plain abdominal x-ray in 28 patients [69%], although the characteristic signs of omega and coffee bean were seen in only 16 patients. Eight patients required emergency surgery. Endoscopic decompression was successful in 34 patients, followed by a definitive surgery in 24 patients. Seven patients refused surgery; 3 of them were readmitted with recurrence and were operated. Three patients were unfit for surgery. There were 3 deaths. Large bowel volvulus is uncommon in this area. Abdominal distension with pain, constipation, and characteristic gas pattern in plain x-ray can help diagnose most cases. Decompression can be achieved in most patients with sigmoid volvulus, followed by surgery during the same hospital admission. Transverse colon and cecal volvulus usually need emergency surgery

Management options in civilian anorectal injuries

This study aims to analyze our experience in the management of anorectal injuries with a particular reference to the use of rectal wall repair, diverting colostomy, distal rectal washout andpresacral drainage. The management of 26 patients with anorectal injuries treated at Riyadh Central Hospital, over an 8 year period [1997-2004] was reviewed. There were 15 patients with extraperitoneal injuries. Transrectal repair was possible in 12 patients, diverting colostomy was carried out in 7 patients, distal washout in 4, and none had formal presacral drainage. There were 8 patients with intraperitoneal injury. All were repaired through laparotomy, only 4 patients had diverting colostomy None were treated by either distal washout or presacral drainage. Three patients had an anal sphincter injury treated by sphincter repair and diverting colostomy and perineal drainage. There -was no mortality related to anorectal injuries in our study. We conclude that most anorectal injuries in our civilian practice are due to low velocity firearm injury or non firearm injury which produced less devastating injuries. Intraperitoneal rectal injury can be managed by rectal wall repair and that diverting loop colostomy should be performed only if there is gross peritoneal contamination. Extraperitoneal injury can be repaired if accessible, colostomy is indicated for high grade injury and if rectal wall repair is not possible. Most civilian rectal injuries can be managed without routine use of distal rectal washout and presacral drainage

Customers Satisfaction with Health Services Provided by Emergency Departments of Federal Teaching Hospitals Khartoum; 2005

The Federal Ministry of Health is trying continuously to provide the best health care through improving service quality and efficiency as expected by those who benefit from these services and to ensure their satisfaction. This study attempts to assess customers' satisfaction both (patients and co-patients); who attend the Emergency Departments of federal teaching hospitals. It also attempts to illicit their opinions and suggestions for improving the quality of these services in order to meet their expectations and achieve their satisfaction. A total of 210 patients and co patients from the Emergency Departments of the three teaching hospitals Khartoum; Khartoum north and Omdurman were selected randomly. Data was collected using a pre-coded and a pre-tested questionnaire. The results revealed high levels of satisfaction with the Emergency Department staff performance and attitude especially with the doctors' performance. Low levels of satisfaction were noticed with other aspects of health services like cleanliness; toilets; food services; the emergency general wards and lastly the Cost of some services

Role of circulating fosciola antigens and IgG4 isotype in assessment of cure from fascioliasis

Sixty-eight individuals were included in this study; 30 of them were presented with Fasciola infection, 20 were infected with other parasites [infected control group] and 18 individuals were parasite- free [normal control group]. For all groups, stool analysis by modified formol-ether technique and Kato thick smears for egg counts and the circulating Fasciola antigens [CFAgs] and anti-Fasciola IgG4 isotype were estimated by ELISA technique. Complete blood count, liver functions tests and abdominal ultrasonography were performed for all Fasciola-infected patients. Patients with fascioliasis received a myrrh-derived drug [mirazid] in a dose of 10 mg/kg b. Wt., one hour before breakfast for six consecutive days. Re-measuring of the above parameters was performed one and three months after therapy. The detection of CFAgs was found to be a useful marker for the assessment of core. No cross-reaction was observed between Fasciola and other parasites using CFAg [100% specificity]. The level of these antigens was positively correlated with the signs of cure, parasitologically, clinically or ultrasonographically. The detection of IgG4 isotype was found to be a more sensitive and accurate immunodiagnostic tool for fascioliasis, but it was not a useful marker for the assessment of cure. Mirazid drug possesses a high therapeutic efficacy [100% cure rate] on fascioliasis without remarkable side effects