Evaluation of Punica granatum peel against diabetic wound infection

Foot infections are a common and serious problem in diabetic patients. To investigate the antibacterial activity of some medicinal plants used by traditional healers for diabetic wounds and to examine in-vivo wound healing activity of active extracts. An experimental study in which fifteen plant extracts subjected to preliminary antibacterial screening against six standard organisms [Bacillus subtilis, Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa and Staphylococcus aureus] using cup-plate agar diffusion method and the result was compared with activity of commonly used antibiotics. The minimum inhibitory concentration [MIC] was determined for active extracts using agar plate dilution method. The two extracts was screened against 180 clinical isolates obtained from diabetic wound infection. In this study the wound healing effect of methanolic extracts of Punicagranatum peels was tested on open skin wound model on Swiss Wistar Albino rats. Fourteen extracts [93.3%] exhibited inhibitory activity against one or more of the six organisms. The MICs of the methanolic and aqueous extracts of Punica granatum were very low against all organisms. 180 clinical isolates were obtained from diabetic wound infection, the results of identification showed that 30 were Escherichia coli, 15 Klebsiella pneumoniae, 45 Proteus spp, 15 Pseudomonas aeruginosa, 60 Staphylococcus aureus and 15 Staphylococcus epidermidis. The methanolic extract of Punica granatum peels had inhibitory effect against 99.4% of the isolates at concentration l00mg/ml. The aqueous extract has inhibitory effect against 91.7% of the isolates. Results were obtained by measuring the wound healing percentage. In the first group, healing was completed in 15 days. In the second group and third group, 13 days were required for the completion of healing. The results of this study indicated that the methanolic extract of Punica granatum had high antibacterial activity and have wound healing activity

Bone disease in upper Egyptian transfusion dependent pediatric B-thalassemia major

Thalassemia and the blood transfusion complications associated with it predispose children to poor bone health. This study was conducted to determine the prevalence of bone-related abnormalities within this population. Forty two transfusion-dependent beta thalassemic subjects 5-19 years old in Assiut, Egypt, participated in this cross-sectional study. Medical history by interview and review of medical records, physical examinations including anthropometric measures and puberty assessment, and bone densitometry using DEXA and height adjustment were performed. The incidence of underweight and short stature was 73.8% and 69%, respectively, which were indicators of malnutrition among thalassemic subjects in this study. Low bone density [BMD Z-scores < -2] was detected in the lumbar spine and femoral region in 54.7% and 95.2% of subjects, respectively. But after height adjustment they became 11.9% and 64.3%, respectively. Forty-seven percent of patients had a history of fractures and the cumulative risk for which increased almost with age. Seventy-eight percent of patients reported bone pain, whilst back/hip pain was present in 69% of thalassemic children and adolescents. Genu valgus deformity and scoliosis were seen in 40.5% and 11.9% of patients. High incidence of low bone density and deficit in other aspects of bone health among thalassemia patients makes routine bone health assessment necessary for this vulnerable group. Considering influencing factors, dietary counseling and preventive supplementation therapy for this high risk group of children and adolescents may be necessary, although this should be assessed by intervention studies

Pattern of presentation of coronary artery disease in hypertensive patients

Hypertension is a major risk factor for coronary artery disease [CAD] and left ventricular hypertrophy [LVH]. Hypertensives have a threefold increase in cardiac death [due to either CAD or to cardiac failure]. In Sudan hypertension complications were increasing in incidence and prevalence. Evaluating chest pain in hypertensive patients presents challenges because of left ventricular hypertrophy as a cause of chest pain besides CAD. There are limited data on different aspects of hypertension complications. To assess the CAD as a cause of chest pain, to see the pattern and severity of CAD and to find the correlation between ECG, ECHO and coronary angiography findings in hypertensive patients 135 known hypertensive patients presented with chest pain were assessed through ECG, ECHO and coronary angiography. The participants' ages ranged between 39 and 90 years, with mean age of 59 years .73.3% of them were found to have CAD. The left anterior descending [LAD] artery was the most involved one. Left main [LM] artery was the least involved. Electrocardiography [ECG] showed that LVH is found in more than 50%of patients with CAD. BMI was>25 in 41.5%. Percutaneous coronary intervention [PCI] was recommended in [31.4%], coronary artery bypass graft [CABG] in[21.6%]. 33% and 25% of these consecutively have hypertension for 10 years or more. CAD is the main cause of chest pain in hypertensives. Aging, body mass index, duration and magnitude of hypertension and LVH have strong and frequent association with CAD

BDN programmes and the effect of medical students' interventions to promote child health in Sudan

Basic development needs [BDN] is an approach to community development that aims at improving quality of life through the full involvement and self-management of communities, supported by intersectoral collaboration. The objective of this study was to assess the effects of BDN implementation in an area of Sudan on aspects of a programme implemented by students from the Faculty of Medicine, University of Gezira. The study revealed that the joint implementation of BDN programmes and students' interventions brought about marked improvement of family and community practices as well as greater reduction in the incidence of all assessed major childhood illnesses [diarrhoea, cough and fever] than when the students' programme was implemented alone. BDN implementation also facilitated the retrieval of good quality community-based data

Protein content study revealed presence of isoform 2 of beta-tropomyosin in primary breast cancer tissues from Sudanese patients

This study was designed to compare antigen content of normal and cancerous breast tissues of Sudanese patients. 50 tissue samples- normal and cancerous - from 25 Sudanese patients with primary breast cancer were analyzed for their protein content using 2D PAGE and for protein identification using LC/MS and nr. fasta data base search. Beta-Tropomyosin spot was found in all the cancerous tissues and absent from all the normal tissues of the same patients. The protein is isoform 2 with 257 amino acids. Primary breast cancer tissues from Sudanese patients are characterized by the presence of isoform 2 of beta-tropomyosin, which is not detected in the normal tissues

Impact of the national protocol for malaria treatment on prescribing patterns in Gezira state, Sudan

A cross-sectional study to assess the impact of the national protocol for malaria treatment was conducted in a town in Gezira state, central Sudan, in 2001. Most of the 165 doctors and medical assistants interviewed [80.0%] had not been trained in the protocol and many [57.5%] were still using their own protocols. Analysis of 410 prescriptions showed chloroquine was the most common antimalarial drug used [69.5% of prescriptions]. Compared with a study before implementation of the protocol, more prescriptions met the protocol st and ards for correct chloroquine dose, whereas regimens for administration of intravenous quinine were still inadequate. The study showed a lack of continuous supervision, training and follow-up in the protocol guidelines and negative attitudes of hospital specialists towards the protocol

diabetic foot: a significant decrease in Major lower limb amputation rate

Diabetic foot is a major surgical challenge that carries a 30% to 40% risk of major limb amputation in Khartoum, The multidisciplinary approach adopted in developed countries in the management of this condition can hardly be established in developing countries. However a stringent protocol of management may improve in these results. A total of 300 patients with diabetic foot were studied prospectively, a consecutive 150 were treated by the 2nd author in specialized diabetic center [Group A] and a similar group of 150 patients treated by 6 general surgical units in a public hospital [Group B] were compared. Foot lesions were classified as: life threatening, limb threatening or non-limb threatening according to two main risk factors: major limb ischaemia and evidence of major sepsis. Thirty patients in group A [20%] and 59 in group B [39%] had major limb amputation [p < 0.001].In group A all 4 patients with life threatening infection, 24 out of 86 patients from the limb threatening group [28%] and 2 out of 60 patients from the non-limb threatening group ended with major limb amputation. In group B, 7 out of 12 patients from life threatening group, 27 out of 27 patients from the limb threatening and 25 out of 111 patients from non-limb threatening group ended in major limb amputation. There were 3 deaths in group A [2%] and 10 in group B [6.7%] all from life threatening group. There is underestimation in diagnosis of the degree of risk in both life and limb threatening infection in group B. A significant decrease in both morbidity and mortality rates were achieved in group A by right diagnosis of the degree of risk of the wound sepsis and by adopting aggressive surgical debridement with antibiotics cover and close follow up

Blood pressure control and target organ complications among hypertensive patients in southern Saudi Arabia

Blood pressure [BP] control and target organ complications [TOC] among 203 hypertensive patients attending a hospital clinic in Abha, Saudi Arabia were studied. Optimal BP control was defined as BP < 140/90 and was achieved in 99 [48.8%] patients. Diuretics and calcium channel blockers were associated with the best rates of BP control while adverse drug reactions were associated with the poorest rates. TOC were classified according to World Health Organization criteria; 62% of patients had no TOC. Retinopathy, renal impairment and left ventricular hypertrophy were the most common stage II complications. Cerebrovascular accidents and ischaemic heart disease were the most common stage III complications

Hemagglutination and hemolysis by Escherichia coli isolated from cases of mastitis

A total of 64 isolates of Escherichia coli secured from cases of intramammary infections were tested for their ability to hemagglutinate bovine erythrocytes; of these, 37 [58%] were hemagglutination positive. Only 2 of 12 fecal Escherichia coli isolates [17%] obtained from healthy controls were hemagglutination positive. This significant association of hemagglutinating Escherichia and intramammary infections indicates the likelihood that hemagglutination is a marker of virulence. Only 16% [3 of 19] of Proteus species and 13% [1 of 19] of Klebsiella pneumoniae mastitis isolates were hemagglutination positive. There was a significant correlation [P< 0.025] between hemolysin production and hemagglutination; 67% [16 of 24] of the isolates that produced hemolysin also hemagglutinated bovine erythrocytes. There was no significant correlation between hemagglutination and motility, as there was a trend for flagellated organisms to be non hemagglutinators

Efficacy of lactoferrin on some mastitogenic bacteria

Organisms isolated from subclinical cases of mastitis, staphylococcus aureus; Escherichia coli, pseudomonas aeruginosa, proteus vulgaris and klebsiella pneumoniae were examined for their susceptibility to lacto ferrin. Using a disc assay, minimum inhibitory concentrations of apo-lactoferrin ranging from 0.1 to 0.8 mg/ml among the strains, while saturated lactoferrin did not alter the grwth of the tested bacteria

Isolation of listeria monocytogenes from farm bulk milk cans

One hundred raw milk samples collected from bulk milk cans belonged to 15 dairy farms at Giza Governorate. They represented 10 buffalo farms and 5 cow farms. They were examined bacteriologically for the detection and isolation of Listeria monocytogenes. All samples from buffalo milk [65 samples] were negative while, 8 out of 35 cow milk samples were positive for the presence of Listeria monocytogenes. All isolated strains were pathogenic to mice and killed them within 4 days following inoculation

Preoperative fasting state in patients undergoing elective surgery

Preoperative fasting and glycaemia states were studied in 77 patients undergoing elective surgery after 12:00 hours at Khartoum Teaching Hospital. Thirty one patients [40%] took their last oral feed before 16:00 hours the day before surgery and 14 patients [19%] were fasting for more than 18 hours. In six patients [7.8%] the preoperative blood sugar at the time of induction of general anaesthesia was less than 3 mmol/L and in one patient it was 1.6 mmol/L. Patients scheduled for elective surgery in the afternoon may be prone to latent hypoglycaemia and should therefore be encouraged to have their evening meal the day before surgery