Altababa medical volunteer group mission to Almanagil hospital, Sudan: new ideas for long-term partnership, success factors and guidelines for other groups

Sudanese medical volunteers have a long history of working in districts with poor health-care infrastructure. Altababa medical volunteer group [AMVG] was established by Sudanese physicians working in Saudi Arabia who desired to contribute to improving clinical services and training in their country of origin. This paper documents steps in the planning and evaluation of AMVG's first mission to Almanagil hospital in Sudan in 2013. Over a 3-day period the visiting team of 4 physicians performed 25 laparoscopic surgical and obstetric/gynaecological procedures and 36 echocardiogram tests-all with hands-on training-presented 11 lectures and consulted with 137 patients. A total of 247 trainees and patients completed a 22-item evaluation survey. The first mission was highly rated by both trainees [health-care providers] and patients. The results provided a road map for volunteers to accomplish cost-effective goals in small hospitals with modest facilities

clinicopathologic study of Ki-67 proliferation index in colorectal carcinoma

To investigate Ki-67 immunoexpressions in colorectal cancer and analyze possible correlations with variable clinicopathological prognostic factors. A cross-sectional study of tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined at the Histopathology Laboratory of Rezgary Teaching Hospital in Erbil, Iraq between January 2010 and July 2011. Ki-67 labeling index is calculated immunohistochemically using the monoclonal antibody MIB-1, and the standard streptavidin-biotin immunoperoxidase method. The clinicopathologic and prognostic features were statistically analyzed. Over-expression of Ki-67 proliferation protein was found in 31 [62%] cases. Statistical analyses revealed a significant relation between Ki-67 proliferation index and histologic type [p=0.005] and tumor grade [p=0.018]; but no significant relation was calculated with the other clinicopathological parameters such as age, gender, tumor's size, site, depth, stage, nodal status, and vascular invasion [p>0.05]. Ki-67 immune overexpression is a frequent finding in our colorectal cancer cases; but it is not enough to monitor Ki-67 proliferation index alone for prognosis in colorectal cancer

Factors associated with progression of diabetic retinopathy, a multi-centric study in Kuwait

Diabetic retinopathy [DR] is a progressive sight threatening diabetic complication. The prognosis seems to be related to largely modifiable risk factors. The aim of the study was to identify factors that could be associated with progression of DR. among adult diabetic patients attending primary health care centers in Kuwait. The current study is a part of a larger multi-centric one that included 704 diabetic patients. A nested case-control study was used whereas all patients with proliferative diabetic retinopathy [PDR] [case group, n = 33] were compared with all other diabetic patients with non-proliferative diabetic retinopathy [NPDR] [control group, n = 183] to determine the associated factors with cases. A pre-designed questionnaire included socio-demographic, clinical data, laboratory investigations, in addition to health care characteristics and personal practice. Basically univariate analyses were followed by multiple logistic regression analysis. Out of 704 diabetic patients participated in the study 216 were diagnosed as having DR with an overall 30.7% prevalence rate. Among 216 patients with DR, 33 were diagnosed as PDR [4.7%] and 183 were diagnosed as NPDR [26.0%]. Of the personal factors examined, nationality was the only significant determinant of PDR [OR = 0.8, 95% CI: 0.71 - 0.9]. Among clinical factors, patients with type 2 - insulin treated diabetes were more prone to have PDR as compared to type 1 [OR = 1.2, 95% CI: 1.1 - 1.4]. Duration of diabetes > 20 years was a significant predictor of PDR [OR = 1.3, 95% CI: 1.1 - 1.5]. Also, poor hyperglycemia and hypertension were significantly modifiable risk factors [OR = 1.2, 95% CI: 1.1 - 1.3] and [OR = 1.2, 95% CI: 1.1 - 1.4] respectively. Ex-smoking was significantly associated with PDR [OR = 8.3, 95% CI: 3.3 - 23.8]. Hyperglycemia and hypertension are the strongest modifiable risk factor for PDR. Patients with longer duration of diabetes particularly those with type 2-insulin treated diabetes were more prone for PDR and should be regularly screened for DR

Factors affecting the occurrence of hydrothorax in Egyptian patients with decompensated liver disease

It is well known that in cirrhotic patients, a large volume of ascetic fluid is generally well tolerated due to the capacitance of the peritoneal cavity. On the other hand, even modest volumes of pleural fluid can cause significant respiratory symptoms, including dyspnea and chest pain. Therefore, although infrequent, hepatic hydrothorax may represent a major clinical problem in the management of patients with portal hypertension. This work search for factors affecting the occurrence of hepatic hydrothorax in Egyptian patients with decompensated liver disease A total of 40 patients selected from Al Azhar University Hospitals with decompensated liver disease and ascites were included in this study divided into two groups 20 patients have ascites without pleural effusion were selected to be included in the study as a group [I], another a 20 patients have ascites with pleural effusion were selected also, to be included in the study as a group [II].All patients were subjected to the following:-Careful history taking, Careful clinical examination, laboratory investigations, including, complete urine and stool analysis, complete blood picture and, Liver function tests, Renal function tests, ascitic fluid and pleural fluid analysis for, physical, chemical, Cytological examinations. Abdominal Ultrasonography, Chest X ray, Results showed that the mean of BMI and ascitic fluid LDH are higher in patients with pleural effusion than in patients without pleural effusion. In contrast, the mean of alkaline phosphatase, ascitic fluid glucose and ascitic fluid RBCs are lower in patients with pleural effusion than in patients without pleural effusion but these findings are not enough to explain the occurrence of hepatic hydrothorax in those patients and these factors still obscure so more studies are needed to detect these factors

Immunoexpression of p53 and p21 [WAF1/CIP1] proteins in colorectal cancer: correlation with clinicopathological parameters

Both p53 and p21 [WAF1/CIP1] proteins belong to the cell cycle-regulating family of proteins, and the loss of their activity seems to be one of the most important regulatory mechanisms of carcinogenesis in colorectal cancer. The aim of this study was to evaluate the tumor suppressor genes p53 and p21 [WAF1/CIP1] expressions in colorectal cancer and assessment the relationship between p2 [WAF1/CIP1] and p53 immunoreactivity with special emphasis on the prognostic significance of their expression with variable clinicopathologic parameters. Tissue sections from 50 formalin-fixed and paraffin-embedded tumor specimens were examined. The standard streptavidin-biotin immunoperoxidase method was used for immunostaining of p53 protein and p2[WAF1/CIP1] protein.The extent of positive p53 and p21 [WAF1/CIP1] staining was graded semiquantitatively. The clinicopathologic and prognostic features were statistically analyzed. Over-expression of p53 and p2l [WAF1/CIP1] were found in 27 cases [54%] and 22 cases [44%] respectively. Statistical analyses revealed a highly significant correlation between p21 [WAF1/CIP1] and p53 immunopositivity [p=0.003]; but no significant correlation could be calculated between p53 or p21 [WAF1/CIP1] proteins expression with the Clinicopathological parameters such as [age, sex, tumor size, gender, TNM staging, and vascular invasion] except there was significant statistical correlation of p53 expression with tumor type [p<0.05]. Our investigation results suggest that p53 and p2l [WAF1/CIP1] immunoexpression are common findings in colorectal cancer and the induction of p21 [WAF1/CIP1] occur in a p53-dependent or independent pathways

P53 expression in endometrial hyperplasia and endometrial carcinoma

Mutations of the P53 tumor suppressor gene and alterations in its protein expression often occur in a variety of human malignant tumors, including endometrial carcinoma, but the practical implications of this phenomenon are yet to be fully exploited. This study was designed to evaluate P53 protein expression in normal, hyperplastic and malignant endometrium by immunohistochemical study and to correlate P53 expression in endometrial carcinoma with other clinic-pathological prognostic parameters [age, histologic type, tumor grade, cervical and myometrial invasion, and tumor stage]. The studied samples included 100 formalin fixed, paraffin embedded endometrial tissue specimens which were divided to the following diagnostic categories: - Proliferative endometrium [n=10]; secretory endometrium [n=10]; simple hyperplasia [n=10]; complex hyperplasia without atypia [n=20]; atypical complex hyperplasia [n=10] and endometrial carcinoma [n=40]. .None of the normal endometrium, simple hyperplasia and complex hyperplasia without atypia showed P53 immunostaining, while 20% of atypical complex hyperplasia and 32.5% of endometrial carcinoma showed immunoreactivity for P53. In endometrial carcinoma, significant correlation was observed between P53 expression and age at diagnosis, histological grade,FIGO stage, myometrial invasion and cervical invasion; but not with the histological type. The results indicated the validity and simplicity of the application of immunohistochemistry in determining the status of P53 overexpresion which is strongly associated with endometrial carcinoma aggressiveness and high malignant potential

challenge of risk stratification in acute myeloid leukemia with normal karyotype

Cytogenetic aberrations have long been recognized as the most important prognostic variable in acute myeloid leukemia [AML] and are now a major stratification tool for post-remission therapy. Cytogenetics-based stratification improves survival. Patients with AML and normal cytogenetics, the largest single subgroup, have had a very heterogeneous outcome with standard chemotherapy in multiple clinical trials. Hence it is difficult to recommend a [one size fits all] kind of treatment for this heterogeneous population of AML patients. New emerging data from preclinical, retrospective, and large, randomized controlled studies indicate that in addition to cytogenetic abnormalities, many other molecular aberrations are operative in the response to treatment as well as in the risk of relapse. Such molecular markers are being tested for developing targeted therapies and may help in improved stratification of patients in the selection of post-remission therapy. Emerging evidence reveals that at the submicroscopic level, AML with normal cytogenetics may carry poor prognostic genetic lesions or [molecular signatures] as is the case with FLT3 mutations and overexpression of BAALC, ERG or MN1, or may have aberrations that predict better risk as is the case with isolated NPM1 or CEBPA mutations. Later studies have tried to explore the interaction of various prognostically important genes in this group of AML patients. The utility of the evolving data for bedside management of such patients is expected to improve with the wider application of modern tools, using the proposed clinical outcome models, and probably by development of a risk-scoring system based on the relative risk associated with each molecular aberration. The goals include identifying those patients most likely to benefit from upfront allogeneic HSCT and sparing good-prognosis patients from unnecessary transplant-related morbidity. The following is an outline of the most common molecular changes, their impact on the outcome of AML patients with normal cytogenetics and challenges in their wide scale application in risk stratification

Synthesis of new bioactive benzothiophene derivatives

Synthesis of new Schiff bases [II] of expected biological activity by reacting 5-nitrobenzo [b] thiophene-2-carboxyaldehyde [I] with different amines and hydrazine hydrate is described. Cyclocondensation of the resulted Schiff bases with thioglycolic acid affords thiazolidin-4-one derivatives [III]. Schiff bases with ortho OH, NH2 or SH substituent in the N-aryl ring, when treated with lead tetra- acetate and/or N-bromosuccinimide, give the cyclization products [IV]. Also when the carboxyaldehyde [I] condensed with different hydrazines, the corresponding hydrazones [V] were obtained. The synthesized compounds showed significant anti-microbial activities

Bioremediation of some aromatic compounds by Corynebacterium sp.

Phenol [Ph], bromobezene[BrB], salicylate [Sal],benzoate [Ben] and gallic Acid [GaA] were tested as sole carbon sources for the growth of the isolated soil strain Corynebacterium sp.. It was found that the isolated strain degraded phenol, gallic acid, benzoate, salicalate and bromobenzene. The optimum carbon concentrations were [0.5-1 g/l] of the aromatic compounds enhanced the growth. On the other hand, the concentration of carbon sources at 5-10 g/l inhibited the growth. The concentration of yeast extract [2 g/l] was effective for the degradation of aromatic compounds. Catechol 1-2 dioxygenase was found in the cells grown on media containing phenol or bromobenzene while protocatechouic 3-4dioxygenase was found in cells grown on media containing salicylate [Sal],benzoate [Ben] and gallic acid as sole carbon sources which means that ortho cleavage pathway may be present in C orynebacterium sp.

Use of thallium-201 sepct to differentiate recurrent glioma from radiation necrosis

Recurrent glioma in patients who are symptomatic after high dose of radiotherapy is difficult to differentiate from radiation necrosis by conventional imaging techniques [CT] scan and MR imaging. Thailuim-201 SPECT is useful in prediction the viable tumour cells in patients with glioma. To clarify the usefuillness of TL-201 SPECT in differentiating the tumour recurrence from radiation necrosis and to evaluate the relationship between tumour perfusion and early TL-201 uptake. Thirty-six patients [age ranged from 16 to 65 years old 26 males and 10 females] deteriorated clinically after high dose of radiation therapy. CT scan or MR imaging performed in all patients, but failed to differentiate between the recurrence of tumour and radiation necrosis 111 MBQ of Thallium-201 were injected and first minute perfusion, early [15 minutes post injection] and late [3 hours post injection] SPECT images were acquired. The results were assessed by both visual [semi quantitative] and Quantitative evaluation. We found a sensitivity, specificity and accuracy of 97.2% 93.2 and 94.4% respectively for visual evaluation. And for the quantitative evaluation the sensitivity, specificity and accuracy were 100%, 94.4% and 97.2% respective. The mean Thallium-201index [T1] and retention index [R1] for recurrent gliomas were 2.6 and 2.0 for both early and delayed Scans respectively: while in radiation necrosis the indices were [1.1 +/- SD 0.1] in early scans and [1.1 +/- SD0] for delayed scans. Two patients in our study had a contradictory results; one had a recurrent glioma with TL-201 index [T1] 1.8 and retention index [R1] 13% [false negative] while the other patient diagnosed pathologically as radiation necrosis and had a T1 and R1 of 2.7 and 18,5% respectively [false positive]. The mean retention indices for both recurrence and radiation necrosis in our study were 21% and 8.7% respectively. Also we found a poor correlation between perfusion and early TL-201 uptake in the study group [rho= 0.41]. The quantitative 201 TL SPECT is a useful noninvasive tool for differentiating recurrent glioma from post radiation necrosis

distal fascicle of the anterior inferior tibio-fibular ligament in correlation with talar impingement

Up till now, the anterior inferior tibiofibular ligament [AITFL] is described in the anatomic tradition as one entity. The present investigation confirmed the presence of what was recently termed [a distal fascicle] of the ligament, which appeared as a separate band found in all [thirteen] the examined cadavers. It took the shape of a parallelogram that lied below and parallel to the rest of the AITFL. A pad of fat separated this fascicle from the rest of the ligament that masked its easy differentiation for a long time. In extreme dorsiflexion of the ankle, the lower border of the fascicle became tight and touched the dome of talus. Also, the clinical study showed audible popping and friction between the thickened fascicle and the opposite hyaline cartilage on talus. This indicated a ligamentous talar impingement with chronic pain on the anterolateral aspect of the ankle in 5 out of 9 patients with soft tissue talar impingement syndrome related to the anterolateral compartment of the ankle. Arthroscopic resection of the distal fascicle gave excellent results with complete relief of pain in all 5 patients suffering of this lesion. Arthroscopic removal of this fascicle along with treatment of other offending pathological lesions gave excellent results in 8 out of 9 patients after an average follow up of 13 months. It was concluded that the anatomy of this distal fascicle has to be included in literature. Furthermore, its pathologic role in talar impingement should be appreciated, yet not overemphasized by clinicians and those dealing with sport injuries, especially when exostoses are absent in radiographs

Candidoses systemiques enreamination: quelle incidence?

The aim of this study is to determine the true incidence of SC in our ICU. For that every patient without neutropenia hospitalised more than 24 hours was included in this prospective study. For every patient, peripheric samples, hemaocultures, and serologic dosage were systematically realized at J1, J4, J7 and once a week, as well as every time there used to be clinical presemptions. The diagnosis of SC was concluded if 2 hemocultures were positive or one positive with the isolation of candida in a peripheric site, or in case of seroconversion with the isolation of candida in a peripheric or central site. The time limit for SC to arise was 20 +/- 5 days. All patients with SC were artificially ventilated and under a large spectrum of antibiotic treatment for a documented bacterial infection. Only 6 patients benefited from an antifongic treatment, the others did not becaue the diagnosis was late [aftter death]. Mortality was of 53.8%

range of morphological variation of the middle meatus of the nose in cases without clinical sinusitis

Twenty cadaveric head regions were sagitally sectioned and examined for the anatomy of the middle meatus region. Serial coronal CT section [1-3 mm] of fifty persons were done. Twenty five of tehm belong to patients suffering from chronic sinusitis, and the other twenty five of sinusitis-free persons. Selected measures were applied on both cadaveric speciments and coronal CT scans. The results of the present study showed a wide range of anatomical cariations in this region, even in the sinusitis-free. Certain anatomical structures showed marked discrepancy in frequency of variations or its dimensions in patient suffering from chronic sinusitis in relation to sinusitis-free persons. The most important variation in the middle turbinate was the concha bullosa which was present in 28% of sinusitis-free bit it was found in 52% of sinusitis patients. Also, the curvature of the middle turbinate was abnormal in 20% sinusitis patient while no cases of abnormal curvature were recorded in sinusitis-free persons. The distance between the middle turbinate and the bulla ethmoidalis was wider in sinusitis-free persons as it was of mean value 1.9 mm than in sinusitis patients which was of mean value 1.7 mm. As regards the uncinate process, it showed abnormal deflections in 28% of sinusitis-free persons and in 60% of sinusitis patients. Concerning the hiatus semilunaris and the infundibulum, it was found that in sinusitis-free persons the hiatus semilunaris was more wide as it was of mean value 2.7 mm while in sinusitis patients the mean width was 1.4 mm. The infundibulum depth was more shallow in sinusitis-free persons as its mean depth was 5.6 mm, while in sinusitis patients, the mean depth was 6.6 mm. Concerning the bulla ethmoidalis size, it was larger in sinusitis patients as it was of mean value 17 x 7 mm while in sinusitis-free persons, it was of mean value 14 x 6 mm. Haller's cells were detected in 28% of sinusitis-free persons and in 60% of sinusitis patients. As regards the maxillary sinus ostium, it was found that its transverse diameter was of mean value 6 mm in sinusitis-free persons while it was 3.5 mm in patients of sinusitis. Scanning of the anatomical variations and measures in cadavers and sinusitis-free persons could act as an accurate Egyptian guide serving surgical procedures. The higher incidence of variations in certain parts and discrepancy in dimensions of other parts between the sinusitis and non-sinusitis cases may support the theory that emphasizes the role of anatomical variations in the aetiology of chronic sinusitis and consequently may help to settle the controversy around this point

Flavonoids of urtica urens L and biological evaluation

Six flavonol glycosides; namely, quercetin 3-O-galactoside, patuletin 3-O-rutinoside, isorhamnetin, patuletin 3-O-glucoside, kaempferol-7-O-rutinoside together with the rare flavonol patuletin were isolated from the methanolic extract 70% of the aerial parts of Urtica urens L. They were identified using spectroscopic techniques. The aglycon patuletin which represents the major compound was tested for its antimicrobial properties as well as anti-inflammatory, analgesic and ulcerogenic effects

Curative effect of bone marrow transplantation on irradiated liver and plasma proteins

The histopathological examination of mice liver exposed to whole body gamma irradiation [6 Gy] followed by bone marrow transplantation [BMT], showed a moderate degree of recovery after 20 days. Parallel electrophoretic analysis of plasma proteins revealed significant increase only in alpha and gamma-globulins. Accordingly, it could be assumed that BMT ameliorated partially the liver histopathology and the level of certain plasma proteins after 20 days, so it could be considered as a convenient therapy following whole body gamma- irradiation

inferior approach for hip arthroscopy

This work describes a new inferior approach for hip arthroscopy. Five newlyborn and five adult cadavers were tried upon. Penetration was carried out just lateral to the ischial tuberosity in the direction of the anterior superior iliac spine. So, the manipulation was easy to perform being guided by two points on the same bone, i.e. two fixed landmarks whatever the position is. All trials were successful without using guides or screens. The joint was reached at a shallow distance from the skin. The capsule was pierced in the most dependent part, and that procedure enabled the removal of loose bodies during arthroscopy. In addition, a complete visualization of the joint could be possible. By dissection the present portal proved to be very safe. In conclusion, this new approach seems to be the most easy, safe and useful portal for hip joint up till now. This will encourage the practice of hip arthroscopy and instrumentation

Ultrastructure of the ectopic eosinophilopoeitic foci in the liver and small intestine of schistosomiasis mansoni infected hamsters

Extramedullary Eosinophilopoiesis in murine schistosomiasis mansoni is thought to occur only in those tissues having a heamopoietic potential. So, the aim of this work is thought to be to investigate this belief in hamster model, by the histological examination of an organ that lacks this potential; as the small intestine. Ecotopic eosinophilic foci in different stages of maturation was seen in both the liver as well as the gut wall [ilium]. The ultrastructural features of cell population in these foci, were nearly identical in both organs. Three stages of cell maturation could be identified, resembling those described in the bone marrow. Several mitotic figures was seen, not only in the early stages but also of the adult eosinophils. The latter was more encountered in the intestine than in the liver. From the findings of this study it can be assumed that, ectopic eosinophil granulocytopoiesis can occur in any infected tissue under the effect of suitable stimuli; that means a haemoietic potential is not a must in having extramedullary eosinophilopoiesis

Premaxilla in man: a developmental and anthropological study

The premaxilla in man, whether exists as a separate bone or not, constitutes a "Problematic status". The incisive suture is currently described on the palate of children, while its facial representation is still unknown. Various anthropological and phylogenetic views appeared and based on the various degrees of development of both maxilla and premaxilla. The present study aims at finding a true anatomical data concerning the boundaries of premaxilla in man to compare it with its homologue in other mammals, and to correlate these fmdings with the precedent views. Serially-cut histological sections, at different planes, in human foetuses [4, 5 and 6 months] were examined. Dissection and maceration were applied on 3 other foetuses, 3 newlyborns and 8 children. Sixty macerated skulls of adult man, as well as of various mammals, were inspected for the presence of an incisive suture. The results obtained revealed a prenatal existence of premaxilla in man, on the contrary to what was claimed by Wood et aI [1967]. Also, it revealed a complete prenatal presence of an incisive suture, on palatal endonasal and facial aspects. Soon after birth, the sutural line disappeared completely on the facial aspect, and partly on endonasal one. On palatal aspect, it gradually and invariably disappeared in children and adult skulls. A nasal process of premaxilla in man was newly delineated, and constitutes the homologue of that present in mammals. In both gorilla and man, the so-called incisive process of maxilla [which overlaps premaxilla from infront] was not observed. In consequence, certain anthropological and phylogenetic views were discussed. Prognathism, duplicated narial margin etc... claimed to exist in negros and the so-called inferior human races, seemed to be in relation to the developmental and age changes The prenatal detection of the incisive suture may pave the way for a better understanding of the pathogenesis of the cleft palate