Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Chronic hepatitis C treatment: a systematic review

Background: Chronic hepatitis C [CHC] infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Thus, there is a compelling need to develop and introduce new therapeutics with a direct-acting antiviral effect in order to target various stages of the HCV lifecycle for HCV eradication without concomitant interferon

Study Objective: to provide treatment recommendations for chronic HCV for specialists and generalists based on published evidence

Methods: A literature search of Web of Science, Scopus, Embase, Agricola, Cochrane Library, Cinahl Plus, Google Scholar, and Oaister was conducted from 1990 to 2016, records were filtered according to the Inclusion criteria and 27 hits were yielded

Results: Hepatitis C virus genotype 1 is more difficult to cure than genotype 2 or genotype 3. Patients with HCV genotype 1 should receive treatment with sofosbuvir + pegylated interferon + ribavirin because of the shorter duration of therapy and high rates of SVR [89%-90%]. Simeprevir + pegylated interferon + ribavirin is an alternative for patients with HCV genotype 1 [SVR, 79%-86%]. Patients with HCV genotypes 2 and 3 should receive therapy with sofosbuvir + ribavirin alone [SVR for genotype 2, 12 weeks' duration: 82%-93%; SVR for genotype 3, 24 weeks' duration, 80%-95%]. Patients with HIV-HCV coinfection and patients with compensated cirrhosis [ie, cirrhosis but preserved synthetic liver function] should receive the same treatment as HCV-monoinfected patients

Conclusion: A growing body of evidence suggests that recently developed HCV combined treatment modalities have transformed chronic HCV into a routinely curable disease being relatively available and well tolerated,which can potentially reduce the need for liver transplantation and reduce HCV-related mortality. Treatment protocol for genotype1 is based on a combined regimen of Pegylated interferons with ribavirin and sofosbuvir or simeprevir while Sofosbuvir with ribavirin alone should be used to treat patients infected with HCV genotypes 2 and 3. Patients coinfected with human immunodefiency virus and HCV genotype 1 should be treated for HCV with pegylated interferons, ribavirin, and sofosbuvir by a physician with experience in treating this particular group of patients and familiar with potential drug interactions

Treatment of iron deficiency anaemia in patients with inflammatory bowel disease

In spite of the fact that anemia is the most widely recognized systemic sign of inflammatory bowel disease [IBD], among the expansive range of extraintestinal malady complexities experienced in IBD, including joint inflammation and osteopathy, it has for the most part gotten little thought. In any case, as far as recurrence, as well as to its potential impact on hospitalization rates and on the personal satisfaction and work, sickliness is, in fact, a huge and expensive intricacy of IBD

Frailty is multifactorial in nature, the most predominant etiological structures being iron deficiency anemia [IDA] and anemia of a chronic disease. In a condition related to irritation, for example, IBD, the assurance of iron status utilizing normal biochemical parameters alone is insufficient. A more exact evaluation might be achieved utilizing new iron lists including reticulocyte hemoglobin content, the rate of hypochromic red cells or zinc protoporphyrin. While oral iron supplementation has generally been a backbone of IDA treatment, it has likewise been connected to a broad gastrointestinal reactions and conceivable infection compounding. Be that as it may, numerous doctors are as yet hesitant to administer iron intravenously, in spite of the wide accessibility of an assortment of new IV arrangements with enhanced safety profiles, and in spite of the proposals of worldwide master rules. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD

Epidermoid Cyst of Ovary: A Rare Entity.

Rare instances of epidermoid cyst of ovary have been reported in literature with incidence of <1% among all the ovarian tumors. It often mimics mature cystic teratoma of the ovary and needs extensive sampling and careful microscopic examination to rule out the presence of adnexal structures and other tissues. Most of the cases in literature were reported as an incidental finding, but large epidermoid cyst of the ovary is seen as a rare entity. We present one such quizzical case of a large epidermoid cyst of ovary occurring in a 44-year-old female presenting with multiple fibroids of uterus.

Hepcidin TH1-5 Induces Apoptosis and Activate Caspase-9 in MCF-7 Cells.

Breast cancer is the most commonly diagnosed and leading cause of cancer deaths among women globally. In continuation of our investigation into the cytotoxicity of the antimicrobial peptide, Hepcidin TH1-5 on human breast adenocarcinoma cell line (MCF-7), we further affirm the apoptosis-inducing effect of the cysteine-rich peptide in the present study. Annexin V-fluorescein isothiocyanate and propidium iodide (annexin V-FITC/PI) apoptosis assay was performed after treatment of the cells. In the determination of caspase activity and pathway of apoptosis, luminescent assay was also performed where caspase-3/7, caspase-8 and caspase-9 were evaluated. Results of annexin V-FITC/PI staining showed proportion of early apoptotic cell were 73.67 ± 4.93%, 61.00 ± 5.57% and 44.33 ± 2.52% at 24, 48 and 72 hours respectively, while late apoptotic cell were 6.33 ± 1.53%, 23 ± 3.56% and 34 ± 3.51% within the same time interval. Based on the data from the luminescence test, Hepcidin TH1-5 activated caspases-3/7 and -9 which suggests that the apoptosis induced was due to the peptide treatment. Hepcidin TH1-5 induced apoptosis in MCF-7 via the activation of caspase-9 of the intrinsic pathway. These results support our previous findings of the cytotoxicity of Hepcidin TH1-5 and indicate that the peptide may be a potential agent for breast cancer therapy.

Correlation between Anthropometric Measures, Lipid Profile and Serum Adiponectin and Steatosis in Nondiabetic Nonalcoholic Fatty Liver Disease.

Aims: To assess the relation between the grade of steatosis and anthropometric measures, lipid profile and serum adiponectin in non-diabetic patients with nonalcoholic fatty liver. Study Design: Cross sectional study. Place and Duration of Study: Department of Tropical Medicine and Gastroenterology, Qena faculty of medicine, South Valley University. Methodology: Fifty patients with US evidence suggestive of fatty liver disease and normal fasting and post-prandial serum glucose were included. No past or current history of alcohol consumption. Blood samples were taken to detect liver function tests, fasting lipogram, complete blood count and serum adiponectin. Body mass index (BMI) and waist circumferences (WC) were measured for all patients. Liver biopsy was done to detect the presence and the degree of steatosis. Results: The mean age of patients was 40+/-12 years. Patients with steatosis showed significantly higher value for BMI and WC than those without (P value =0.000). Cholesterol, triglyceride and Low density lipoprotein-cholesterol (LDL-C) also were significantly higher in patients with steatosis (P value =0.00). High density lipoprotein-cholesterol (HDL-C) and serum adiponectin were significantly lower in patients with steatosis (P value =0.00). Patients with severe steatosis showed significantly higher values for BMI and WC, cholesterol, triglyceride, LDL-C and lower values for HDL-C and adiponectin (P value = 0.05) than those with mild or moderate steatosis. Positive correlations were detected between the age, BMI and WC, cholesterol, triglyceride, LDL-C and the grade of steatosis and negative correlations with HDL-C and adiponectin. Conclusion: Anthropometric measures, lipogram and serum adiponectin are associated with progression of steatosis in nondiabetic patients with NAFLD. So their detection is important for evaluation and management.

Determination of baseline Widal titre in healthy individuals in Karbala city, South of Iraq

Objective: To determine the cutoff of antibodies directed against Salmonella enterica subspecies enterica serotype typhi, paratyphi A, and paratyphi B in normal population in Karbala city, south Iraq

Methods: Widal test was performed for 90 serially diluted serum samples collected from apparently healthy volunteers. A commercial Widal test kit was used. Agglutination results were observed within 1 minute

Results: In the current study, 23.33%, 22.22%, 6.6%, 4.4%, 38.88% and 5.55% of individuals had antibody titre >/=1:20 for S. enterica subspecies enterica serotype typhi O, H, S. enterica serotype paratyphi AO, AH, S. enterica serotype paratyphi BO and BH, respectively

Conclusion: Based on these results, antibody titres of 1:160 for O and H, 1:40 for AO, 1:80 for AH and BH and 1:320 for BO antigens were considered as baseline titre in Karbala

Molecular detection of HPV genotype-16 in a group of patients with grade 1 invasive papillary thyroid carcinoma

Background: Thyroid cancers are neoplasms originating from follicular thyroid cells thought to be related to a number of environmental and genetic predisposing factors. HPV is one among their associated infective agent

Objective: To determine the frequency of HPV genotype-16 in infection in a group of iraqi patients with papillary thyroidcell carcinoma

Patients and Methods: A total number of 64 patients with different thyroid lesions were collected during 2008-2013. 30 have thyroid cancers, 22 benign thyroid tumors while 12 healthy thyroid tissues were used as control group. In situ hybridization [ISH] was used to localize high risk HPV- genotype 16 in these tissues

Results: Among malignant thyroid tumors 53.3% patients had HPV-16 while 27.3% HPV-16 positivity was detected in benign thyroid tumor group. None of healthy thyroid tissues revealed ISH reactions. There was 38.5% female had HPV-16, while there was 28% male had HPV-16. No significant statistical associations were noticed between the presence of HPV-16 and the age of those patients

Conclusion: Human papilloma virus genotype 16 could share a role in pathogenesis of this group of patients with thyroid cancers

Prescribing rationality in Khartoum state, Sudan: an update

Rational prescribing is one of the essential components of good medical practice targeted to provide successful and relatively safe drug therapies. The present study was carried to assess the rationality of the current prescribing practices in Khartoum State. A descriptive, observational, 1-time study was carried out in Khartoum State hospitals and community pharmacies, to evaluate the five main prescribing indicators adopted by the WHO. Data were collected using the WHO prescribing indicator form. The total number of prescriptions collected and analyzed was 7377 prescriptions, 67% from Khartoum city, 22.5% from Khartoum North city and 10.5% from Omdurman city. The total number of drugs prescribed was 20,482, the average number of drugs per prescription: 2.776 drugs, percentage of generics: 37.3%, percentage of antibiotics: 54.3%, percentage of injections: 38.6% and the percentage of drugs on the essential drug list [EDL] was 72.8%. The number of encounters included in this study is sufficiently large compared to other previously reported studies allowing us to consider the results obtained as an acceptable representative of the total population to describe the overall prescribing pattern. Except for the value obtained for the percentage drugs on the EDL, the values of the other four indicators are indicative of prescribing irrationality in the study population. The observed irrational prescribing behavior necessitates the development of certain policies as well as practical and effective implementation mechanisms to promote rational prescribing. We, therefore, recommend the conduction of one or more of three interventions namely, administrative, managerial and/or educational addressing the prescribers population

Cryotherapy of 2 weeks versus 3 weeks interval for Common warts

Cryotherapy with liquid nitrogen is a widely used method for treatment of common warts by dermatologists. Traditionally, when treating warts, liquid nitrogen is applied at intervals of 3 weeks. This study was designed to compare the efficacy, and time to clearance of 2-week and 3-week interval cryotherapy of patients attending the department of dermatology and venereology at Rizgary Teaching Hospital in Erbil City. In This comparative study 80 immunocompetant patients, age range 10-55 years with common warts on the hands and/or feet were enrolled from November 2008 through May 2009. Patients were randomized to receive cryotherapy at interval of either 2 or 3 weeks. All patients allocated to have liquid nitrogen applied with a cryo-spray technique. Cure rates were evaluated in both groups after 3 months and after 6 treatments. 72 patients completed the study. The mean times for clearance of all warts in both groups were 9 weeks in every 2-week treatment group and 14 weeks in every 3-week treatment group. The mean numbers of treatment sessions required to achieve clearance were similar in each group [4.5 and 4.7 treatment sessions] for 2- and 3- week interval groups respectively. Cure rates at 3 months were 64% in the 2-week interval treatment group and 45% in the 3-week group. After 6 treatment sessions cure rates were similar for both groups; 65% and 60% for 2- and 3- week interval groups respectively. Morbidity was slightly greater in the 2-week interval treatment group. Cryotherapy of common warts is effective and the percentage of cure is related to the number of treatments received, and independent from the period between treatments

Lung diffusing capacity for carbon monoxide [DLco-SB]: the influence of cigarette smoking

Most tests of lung function used in the evaluation and follow-up of the pulmonary effect of smoking reflect airway function alone such as standard spirometry. Whereas, the best established test that reflect alveolar function is the single-breath carbon monoxide diffusing capacity [DLco-SB] especially when this is expressed per liter of alveolar volume [DLco/VA]. Accordingly, to study the effect of smoking on both airway and alveolar functions, it is necessary to use DLco/VA test in addition to standards spirometry. The present study was designed to evaluate the effect of cigarette smoking on lung diffusion, to correlate the effect of cigarette smoking and smoking cessation on lung diffusion and to find out whether the effect of cigarette smoking on lung diffusion is reversible. The effect of cigarette smoking on spirometric indicators of ventilator function [FVC, FEV1%, PEFR] and on lung diffusing capacity for carbon monoxide [DLco-SB/VA] was evaluated on two occasions 6 months apart in 94 middle-aged, asymptomatic, male subjects, 56 smokers and 38 nonsmokers. All subjects were within the normal predicted spirometric and lung diffusion values [80-120%]. The values of FVC, FEV1, FEV,/FVC% and PEFR averaged more than 94% in never smokers [n=38, mean age 43.57 years], 85% predicted in smokers [n=56, mean age 42.54 years]. However, the mean rate of decrease in spirometric and lung diffusion values [DLco/VA] between smoker and non-smokers were significant [p<0.05] fourteen subjects [14] who initially were smokers became sustained ex-smokers within six months of the first measurement, however, comparing the mean values of thse parameters between the two groups reveals statistically significant greater than those of current smokers and approached the values of those who had never smoked. In ex-smokers the mean values of DLco/VA rose, averaging 90% predicted at the first assessment byt 97% predicted six months later. The values of FVC, FEV1, FEV1/FVC%, PEFR and Lung diffusing capacity for carbon monoxide [DLco/Va] were lower in smokers than in never smokers. Ex-smokrs had spirometric and lung diffusion values similar to those of never smokers even when spirometric values and DLco/Va were known to have been reduced while they were smoking

Evaluation of the sensation of hearing false mobile sounds [phantom ring tone; ringxiety] in individuals

The annoying feeling of mistakenly thinking that you can hear your mobile phone ringing. This audio illusion is familiar and unnerving sensation is so widespread and now it has an official name: ringxiety. This study was conducted to determine whether [Ringxiety] is common among Iraqi people and its correlation with age, sex, education, mobile type, and mobile using time. Two hundred adult persons of either sex with a mean age of 20 +/- 3 years were asked to answer a questioner with 14 questions. The results of this study revealed that 73% of the individual involved experienced the phenomenon of ringxiety from time to time, in addition to 4% who experienced frequent ringxiety. Significant correlations were found between this sign and using mobile for more than 30 minutes per day and also a significant correlation was found between mobile addicts and ringxiety [P value<0.05]. 42% of studied subjects experienced mobile vibration mistakenly feeling, which occurs always with ringxiety but not the reverse. This sign was only correlated with the high mobile using time. No association was found between ringxiety and age, education, type of ring tone, or short messages [SMS] using. This study has proved that ringxiety is common among mobile users and could be one of the effects of radio waves or just a malfunction of the brain due to the life heavy duties. Ringxiety might cause discomfort or loss of concentration during car driving or using dangerous machine

Detection of vertebral fractures versus bone mineral density in early ankylosing spondylitis

To determine bone mineral density [BMD] in patients with mild ankylosing spondylitis [AS], to establish the prevalence of vertebral fractures and fracture risk in these patients, and to determine the relationship between BMD and vertebral fractures. Twenty patients were compared with five healthy subjects were included in the study as a control group. Bone mineral density [BMD] was evaluated at the lumbar spine, forearm and femoral neck by dual X-ray absorptiometry [DXA] and A clinical index of disease activity [BASDAI; Bath Ankylosing Spondylitis Activity Index] was also evaluated and plain radiographs of the thoracic and lumbar spine were obtained in all subjects. In patients with AS, BMD was reduced in both the lumbar spine T score -1.0700 +/- 1.9572] and femoral neck [T score -1.3850 +/- 1.2999] and forearm [T score-.9150 +/- 7969] There was no correlation between BMD of the lumbar spine, forearm or femoral neck and duration of disease in patients with AS. four of 20 [20%] patients with AS had a vertebral fracture. Patients with AS with fractures were not significantly older [mean age 34.0 +/- 2.120P=0.301], but had significantly longer disease duration [7.4500 +/- 1.1459, P<0.05] than patients without fractures. No significant correlation between indices of disease activity [ESR and BASDAI] and vertebral fractures in patients with AS. No significant correlation was observed between BMD of the lumbar spine, forearm or femoral neck and vertebral fractures in patients with AS. In addition, there was no significant difference in the lumbar spine, forearm or femoral neck BMD in AS patients with fractures compared with those without. Osteopenia of spine, forearm and femur and vertebral fractures are a feature of mild AS. However, there was no correlation between BMD and vertebral fractures in these patients. AS patients with mild disease had a higher risk of fractures compared with the normal population and this increased with the duration of disease

Surgical correction of relapsed club foot

Thirty eight relapsed club feet in 28 children previously treated by soft tissue release were corrected by further surgical procedures. Nineteen feet with relapse of all the three elements of the deformity, treated by extensive posteromedial release with limited plantar release and correction of the talonavicular subluxation or dislocation. Eight feet with relapse of the forefoot adduction were treated by medial release and limited plantar release with correction of talonavicular subluxation. Six feet with recurrent cavovarus deformity were treated by radical medial and radical plantar release with reduction of talonavicular subluxation. The reduction of talonavicular dislocation or subluxation was maintained by thin K-wire. Five feet had relapse of varus heel were treated by open or closed calcaneal wedge osteotomy. The average age of the patients at the final surgical treatment was 2 years and 4 months. The average follow up was 5 years and 8 months. Assessment was made up on strict clinical criteria and the functional results were 76% satisfactory [7 feet were excellent and 22 feet were good], 24% were poor [9 feet]. The satisfactory results decrease with the increasing age at which the final operation was done. The best result obtained in children who underwent final correction when they were two years old or younger. Talonavicular subluxation or dislocation was present in every case. In the majority of patients, feet and ankle motion was limited but relatively free of pain and able to fit into normal shoes

Surgical management of neglected club feet between two and twelve years of age

The result of surgical treatment for neglected cases of congenital talipes equino varus deformity in 76 children [114 feet] who were followed for two to ten years were evaluated. They were divided into three groups according to their age and the type of treatment used. Group I consisted of thirty six children [48 feet], their age ranged between two to five years and were treated by extensive postero medial soft tissue release with fixation of the talo navicular joint by Kirschner wire in some cases. Group II consisted of 22 children [34 feet], their age ranged between five to ten years and were treated by combined extensive postero medial soft tissue release with excision of lateral segment of bone including the calcaneo cuboid joint. Group III consisted of 18 children [32 feet], their age ranged between ten and twelve years and were treated by triple arthrodesis. Group I had 84%, group II had 76% and group III had 72% excellent or good long term result. In group I and II 90% of the patients or their parents were satisfied with both the appearance and function of club foot

Recurrent anterior shoulder dislocation result of putti platt operation

A review of twenty three cases of the Putti Platt procedure for recurrent anterior shoulder dislocation is presented. Their age ranged from 16 to 44 years averaged 19 years. A follow up of 3 to 10 years, averaged 5.5 years, revealed only two recurrences, one of them for only one time and no serious complications. The clinical results were excellent in 18 cases [78.2 percent], satisfactory in 4 cases [17.4 percent] and bad in one case [4.4 percent]. The restriction of outward rotation of less than 10 degrees could be observed in eighteen cases and of 10°-20° in five cases. Only three cases had pain. Putti Platt repair permitted good function without significant disability in most case

Assessment of the surgical treatment of the lumbar intervertebral disc

One hundred and sixty two patients with sciatic pain who had primary excision of a lumbar disc by interlaminar approach over a period of nine years [1987-1995] were studied. Of these, one hundred and forty eight patients were available for comprehensive review. The duration of follow-up ranged from two years to eight years. Patients in the age group 30-49 years were most prone to develop sciatica. At operation L5-S1 level was involved in 51% of cases. There were five negative explorations and six patients needed re-exploration. The functional outcome was good in 85% of the patients, fair in 9% of the patients and poor in 6% of the patients according to Stauffer and Coventry Criteria. Critical analysis of these results were comparable to other reviews where wide laminectomy approach was used