Blood Pressure Values in Apparently Healthy Sudanese Population

Introduction: Blood pressure is one of the most often measured clinical parameters, and assessment of blood pressure has a considerable impact on diagnostic decisions. Objectives: To establish blood pressure normal reference values in Sudanese. Methods: A cross-sectional study was conducted from September 2016 to November 2018. Eight hundred eighty-eight healthy adult Sudanese between the ages of 18 and 60 (203 men and 685 women) were randomly selected from the states of Khartoum, Northern, Gezira, Red Sea, and North Darfur. Clinical, anthropometric, and blood pressure measurement data were collected. Results: The mean for all volunteers was 113.93 ± 9.917 mmHg, systolic blood pressure (SBP) and 75.29 ± 6.79 mmHg, diastolic blood pressure (DBP). SBP in men was 118.6 + 7.642 mmHg compared to 112.53 + 9.121 mmHg in women, while DBP in men was 77.51 + 5.984 mmHg compared to 74.63 + 6.844 mmHg in women. Beside the gender variations, blood pressure values also showed geographical variability. There was a positive connection between blood pressures (SBP and DBP), BMI, and age. (P < 0.05) was used for significance. Conclusion: Blood pressure of Sudanese was found to be within the normal international range with gender and geographical variability. It showed positive correlation with age and BMI.

Vitamin D status among Kashmiri tribal population: A cross-sectional community-based study

Background & objectives: Vitamin D deficiency (VDD) is prevalent across all age groups in general population of India but studies among tribal populations are scanty. This study aimed to evaluate the prevalence of VDD in the indigenous tribal population of the Kashmir valley and examine associated risk factors. Methods: In this cross-sectional investigation, a total of 1732 apparently healthy tribal participants (n=786 males and n=946 females) were sampled from five districts of Kashmir valley by using probability proportional to size method. Serum 25-hydroxy vitamin D (25(OH)D) levels were classified as per the Endocrine Society (ES) recommendations: deficiency (<20 ng/ml), insufficiency (20-30 ng/ml) and sufficiency (>30 ng/ml). The serum 25(OH)D levels were assessed in relation to various demographic characteristics such as age, sex, education, smoking, sun exposure, body mass index and physical activity. Results: The mean age of the male participants was 43.79±18.47 yr with a mean body mass index (BMI) of 20.50±7.53 kg/m2, while the mean age of female participants was 35.47±14.92 yr with mean BMI of 22.24±4.73 kg/m2. As per the ES guidelines 1143 of 1732 (66%) subjects had VDD, 254 (14.71%) had insufficient and 334 (19.3%) had sufficient serum 25(OH)D levels. VDD was equally prevalent in male and female participants. Serum 25(OH)D levels correlated positively with serum calcium, phosphorous and negatively with serum alkaline phosphatase. Gender, sun exposure, altitude, physical activity and BMI did not seem to contribute significantly to VDD risk. Interpretation & conclusions: VD deficiency is highly prevalent among Kashmiri tribals, although the magnitude seems to be lower as compared to the general population. These preliminary data are likely to pave way for further studies analyzing the impact of vitamin D supplementation with analysis of functional outcomes

Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

High Burden of Antibiotic Resistant Bacteria Isolated from Tracheal Culture in a Tertiary Care Institute

Introduction: Multidrug resistant bacteria is causing a veryserious problem in the proper treatment and management ofsick patients in ICU’s. Study aimed to find out antimicrobialsusceptibility pattern of bacterial isolates from trachealculture.Material and methods: This study was carried over a periodof 6 months from July to December 2017 in the departmentof microbiology. Total of 470 tracheal aspirates were studied.Each specimen was streaked on 5% sheep blood agar andMacConkey agar. After isolation and identification, sensitivityof selected organisms against different antibiotics was studiedResults: Out of 470 tracheal aspirates, 328 samples showedsingle bacterial growth, 76 were sterile; contaminants weregrown in 58 samples and in remaining 8 samples yeast weregrown. The incidence of positivity in our study was 83.8%,with gram negative bacteria outnumbering the gram positiveones. Of the 328 samples which showed bacterial growth,Acinetobacter spp 159(40.3) was the most common organismfollowed by Klebsiella pneumoniae 72(18.2), Pseudomonasspp 46(11.6), Escherichia coli 27(6.8), Staphylococcus aureus13(3.2), Klebsiella oxytoca 5(1.26), Enterococcus spp 3(0.76),Proteus spp, Citrobacter spp, Providencia stuartii 1(0.25)each. Also XDR (extensively drug resistant) bacteria wereisolated at a high frequency (67%) with Acinetobacter spp.being the most common 128(56.6)) followed by Klebsiellaspp. 39(17.2) Pseudomonas spp. 38(16.8), and E.coli 12(5.3).Conclusion: Gram negative were main organisms responsiblefor lower respiratory tract infections in hospitalized patientsand the majority of the isolates belong to XDR and MDRcategory.

An analysis of adverse events and human error associated with the imaging of patients at a major trauma centre in South Africa

Background. There is growing realisation that human error contributes significantly to morbidity and mortality in modern healthcare. A number of taxonomies and classification systems have been developed in an attempt to categorise errors and quantify their impact.Objectives. To record and identify adverse events and errors as they impacted on acute trauma patients undergoing a computed tomography (CT) scan, and then quantify the effect this had on the individual patients. It is hoped that these data will provide evidence to develop error prevention programmes designed to reduce the incidence of human error.Methods. The trauma database was interrogated for the period December 2012 - April 2017. All patients aged >18 years who underwent a CT scan for blunt trauma were included. All recorded morbidity for these patients was reviewed.Results. During the period under review, a total of 1 566 patients required a CT scan at our institution following blunt trauma. Of these, 192 (12.3%, 134 male and 58 female) experienced an error related to the process of undergoing a CT scan. Of 755 patients who underwent a CT scan with intravenous contrast, detailed results were available for 312, and of these 46 (14.7%) had an acute deterioration in renal function. According to Chang's taxonomy, physical harm occurred as follows: grade I n=6, grade II n=62, grade III n=45, grade IV n=11, grade V n=27, grade VI n=21, grade VII n=15, grade VIII n=3 and grade IX n=2. Adverse events were performing an unnecessary scan (n=24), omitting an indicated scan (n=23), performing the scan incorrectly (n=8), scanning the wrong body part (n=7), equipment failure (n=18), omitting treatment following the scan (n=6), incorrect interpretation of the scan (n=65), deterioration during the scan (n=6) and others (n=35). The setting for the error was the ward (n=19), the radiology suite (n=126), the emergency department (n=45) and the operating theatre (n=2). The staff responsible for the adverse events were medical (n=155), nursing (n=4) and radiology staff (n=15). There were 67 errors of commission and 125 errors of omission. The primary cause was a planning problem in 78 cases and an execution problem in 114.Conclusions. Errors and adverse events related to obtaining a CT scan following blunt polytrauma are not uncommon and may impact significantly on the patient. Communication is essential to eliminate errors related to performing the wrong type of scan. The commonest errors relate to misinterpretation of the scan

The impact of 6-month micronutrient supplementation on viral, immunological, and mental health profile of a cohort of highly active antiretroviral therapy-naive HIV-positive patients in Northern Nigeria

Background: HIV is a chronic disease with inflammatory reactions involving numerous elements of the immune system, resulting in an increased risk for other physical and psychiatric morbidities. Micronutrients, some of which possess anti-inflammatory properties, may help prevent the development of psychological disorders such as anxiety and depression in people living with HIV disease. Objectives: This study examined the profile of viral load, CD4 cell count, C-reactive protein, anxiety, and depression among highly active antiretroviral therapy (HAART)-naive HIV-positive patients receiving micronutrient supplementation over a 6-month period. Materials and Methods: A total of ninety HAART-naïve HIV-infected patients completed the Hospital Anxiety Depression Scale. Their blood samples were taken for serum viral load, CD4 cell count, and C-reactive protein at baseline. They all received a micronutrient supplement for 6 months, and 68 participants who remained in treatment at 6 months were reassessed with the same parameters. Results: After 6 months of micronutrient supplementation, the participants were found to have statistically significantly lower mean scores on the anxiety (t-test = 2.970,P = 0.003) and depression (t-test = 3.843,P = 0.001) subscales. They also had statistically significantly lower median CD4 cell count (P = 0.00) and C-reactive protein serum measures (P = 0.04). The median viral load decreased although the difference was not statistically significant. Conclusion: Micronutrient supplementation may reduce inflammatory reactions, anxiety, and depression in HAART-naive HIV-infected persons

Intradermal administration of Rabies Vaccine at an affordable cost: Experience from tertiary care hospital in Jammu

Background: Rabies continue to be a major public health challenge in India. It can certainly be prevented by timely and appropriate administration of WHO recommended pre and post exposure prophylaxis. Intradermal regimen is running successfully and beneficial both in monetary as well as non-monetary terms. Aim& Objective:To evaluate the reduction in direct cost incurred with the use of intradermal regimen as compared to intramuscular regimen. Settings and Design: The present cross-sectional study was conducted in Government Medical College Jammu, a tertiary care centre. Methods and Material: A total of 17535 patients attending Anti Rabies Section of GMC Jammu were studied from Jan 2015 to September 2017.The patients belonging to Category II and III received 0.1 ml 2 site ID purified vero cell culture vaccine (PVCCV) on days 0, 3, 7 and 28 (2-2-2-0-2) and Rabies Immunoglobulin (RIG)(Category III only). Cost borne per patient receiving intradermal regimen was calculated and compared with cost borne in case Intramuscular regimen would have been used. Statistical analysis: Results were presented in descriptive manner using percentages and proportions. Conclusions: Intradermal regimen reduces the direct cost as compared to intramuscular regimen.

Radionuclide Esophageal Transit Scintigraphy in Primary Hypothyroidism

BACKGROUND/AIMS: Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in patients of primary hypothyroidism using the technique of radionuclide esophageal transit scintigraphy. METHODS: Thirty-one patients of primary hypothyroidism and 15 euthyroid healthy controls were evaluated for esophageal transit time using 15–20 MBq of Technetium-99m sulfur colloid diluted in 10–15 mL of drinking water. Time activity curve was generated for each study and esophageal transit time was calculated as time taken for clearance of 90% radioactive bolus from the region of interest encompassing the esophagus. Esophageal transit time of more than 10 seconds was considered as prolonged. RESULTS: Patients of primary hypothyroidism had a significantly increased mean esophageal transit time of 19.35 ± 20.02 seconds in comparison to the mean time of 8.25 ± 1.71 seconds in healthy controls (P < 0.05). Esophageal transit time improved and in some patients even normalized after treatment with thyroxine. A positive correlation (r = 0.39, P < 0.05) albeit weak existed between the serum thyroid stimulating hormone and the observed esophageal transit time. CONCLUSIONS: A significant number of patients with primary hypothyroidism may have subclinical esophageal dysmotility with prolonged esophageal transit time which can be reversible by thyroxine treatment. Prolonged esophageal transit time in primary hypothyroidism may correlate with serum thyroid stimulating hormone levels.

Maternal Overt Hypothyroidism and Neurobehavioral Outcome of Neonates: A Cohort Study from an Iodine-deficient Area of Northern India.

Objective: To study the relation between maternal overt hypothyroidism and neurodevelopmental outcome of neonates in iodine-deficient region of Northern India (Kashmir Valley). Design: Prospective cohort study. Setting: Endocrinology department of a tertiary-care hospital. Participants: 82 hypothyroid pregnant women were enrolled and followed up till delivery. The neonates born to this group represented the case neonates. 51 euthyroid healthy pregnant women were selected as control group. The neonates born to these mothers served as controls. Main outcome measures: Early neonatal behavioral assessment at 3-4 weeks of age. Results: The mean TSH and free T4 in neonates of mothers with well controlled hypothyroidism was significantly different from those born to mothers with poorly controlled hypothyroidism and controls in 1st trimester, but the difference was statistically insignificant for 2nd and 3rd trimester values. Conclusion: Overt maternal hypothyroidism in iodine-deficient area constitutes a risk factor for an abnormal neurobehavioral development of affected child.

feasibility and safety of laparoscopic liver resections

Objective: To assess the feasibility and safety of laparoscopic liver resections

Methods: A prospective study of laparoscopic liver resections was undertaken in San_camillo hospital, Rome Italy, Anam hospital, Seoul South Korea and Assiut University Hospitals. in the period from July, 2012 till, Augest 2014 in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of colorectal and noncolorectal origin, the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were led. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation

Results: From July 2012 to Augest 2014 undertaken in San_camillo hospital, Rome Italy, hospital, Seoul South Korea and Assiut University Hospitals. 80 liver resections were included. Median follow up was 19 months ranging from 6 to 24 months. There were hepatocellular carcinoma [HCC; n=32], colorectal carcinoma liver metastasis [CRCLM; n=19] metastatic neuroendocrine tumor [NET;n=1], non-CRCLM [n=6], intrahepatic cholangiocarcinoma [n=4], lymphomas [n=1] and uncertain preoperative diagnosis [n=1] mostly pseudo inflammatory tumour, Mean tumor size was 3.6 cm. There were three conversions to laparotomy [3. 75%]. There were anatomical liver resection [n=31]. Four major hepatectomies [5%] were performed [3 segments or more], including 1 right hepatectomy and 3 left hepatectomies, 2 of them with caudate lobectomy. Mean blood loss was 129.50 mL. Mean surgical time was 115.36 minutes. There were no deaths. Complications occurred in 4 cases [5%]. two cirrhotic patients developed postoperative ascites. No port-site metastases were observed in patients with malignant disease

Conclusion: Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate. For liver resections, unlike other areas of abdominal surgery, the laparoscopic approach has not been widely developed. The reasons are presumed technical difficulties and the intraoperative hazards of bleeding and gas embolism. Another concern is the potential risk of tumor seeding in patients with malignant disease, who constitute the majority of candidates for liver resections. However, technologic refinements in laparoscopic instruments, experience in laparoscopic and hepatic surgery, and the application of the principles of oncologic surgery have led some groups, to explore the place of laparoscopic liver resections. Initial laparoscopic procedures on the liver included staging of tumors to select patients for open resection [Rahusen F, et al 1999] and treatment of nonparasitic cysts by unroofing. [Morino M,et al 1994] More recently, there have been advancement of laparoscopic liver resections up to living donor hepatectomy for liver transplantation. [Quirino Lai, et al 2012] We initiated a prospective evaluation of laparoscopic liver resections in selected patients, and we report the results in our first 80 patients]

Anthelmintic, antimicrobial, antioxidant and cytotoxic activity of Caltha palustris var. alba Kashmir, India / 中国天然药物

The methanolic extract obtained from the root portion of Caltha palustris var. alba was evaluated for its anthelmintic efficacy against gastrointestinal nematodes of sheep under both in vitro and in vivo conditions using worm motility inhibition (WMI) assay and fecal egg count reduction (FECR) assay, respectively. The extract was subjected to antimicrobial activity using agar-well diffusion method against different bacterial strains. In addition the extract was evaluated for cytotoxic and antioxidant activity against cultured THP-1(Leukemia), A-549 (Lung), HCT-15 (Colon), Cervix (HeLa) and PC-3(Prostrate) cell lines by SRB and DPPH radical scavenging assays. The extract used resulted in mean %WMI of 94.44%, as observed when the worms were put in lukewarm buffer for 30 min after exposure to different treatments. The mean mortality index of the sample was 0.95. The lethal concentration (LC50) was 0.11 mg·mL(-1). Cell lines were exposed to concentration of 100 μg·mL(-1) of extract for 48 h, which reduced the viability of these cell lines. The same plant extract also showed 55.58% DPPH radical scavenging activity.

Predatory potential of Platynectes sp. (Coleoptera:Dytiscidae) on Aedes albopictus, the vector of dengue/ chikungunya in Kerala, India

Unused and discarded latex collection containers (LCCs) are the major breeding habitats of Aedes albopictus in the rubber plantations of Kerala, India. Platynectes sp. (Family: Dytiscidae) was observed to invade these habitats during the monsoon season and voraciously devour the larval instars of this major vector species of arbo-viral diseases. Field observations showed a reduction of 70.91% (p = 0.0017) and 100% in Aedes larval density, on the first and four days post release of eight beetles per LCC respectively. In laboratory, a beetle was found to devour 17.75 + 5.0 late larval instars of Ae. albopictus per day. Our findings indicate Platynectes sp. could be a potential bio-control agent against Ae. albopictus, the vector of chikungunya/dengue fevers, in rubber plantations.

Wait-and-see policy versus cholecystectomy after endoscopic sphincterotomy for bile-duct stones in high-risk patients with co-existing gallbladder stones: a prospective randomised trial

Endoscopic sphincterotomy [ES] is one of the most important advances in the treatment of common bile duct [CBD] stones. However, the use of ES to remove CBD stones in high-risk patients without cholecystectomy is still debatable. The aim of this study was to compare the efficacy of a wait-and-see policy versus cholecystectomy after ES for CBD stones in high-risk patients with co-existing cholelithiasis. A total of 162 patients after undergoing ES with the clearance of CBD stones were randomised after informed consent to cholecystectomy or conservative management of their gallbladder stones. The results indicated that cholecystectomy after ES for CBD stones significantly reduced the biliary complications in high-risk patients. Every patient who has both CBD stones and gallstones with significant co-morbid illnesses, after clearance of CBD stones by ES, should undergo early cholecystectomy

Clinico-radiological profi le of strokes in Kashmir valley, North-West India: A study from a university hospital

Background: Globally, ischemic stroke outnumber hemorrhagic strokes. However, it was observed that hemorrhagic stroke is more common in Kashmir valley. The present study was conducted to substantiate this notion, and to identify the possible risk factors. Methods: This prospective study was conducted on 6,906 patients with fi rst ever stroke admitted to S. M. H. S. Hospital, an associated teaching hospital of the Government Medical College, Kashmir, from January 1996 to June 2009. Other than clinical history, examination and routine biochemistry, cranial CT scan (non-contrast) was performed in all the cases within three days of the stroke onset. MRI brain, CSF analysis, screening for cardiovascular disorders, prothrombotic states and collagen profi le were performed wherever deemed necessary. Results: There was predilection of stroke among the males and rural population. Eighty three percent of patients developed fi rst-ever stroke in sixth and seventh decade. Fifty four percent of cases had a Glasgow coma score of >10 on admission. Intracerebral hemorrhage was observed in 64.7% patients with male preponderance. Putamen (53.5%) was the most common, site of hemorrhage, followed by thalamus (29.7%). Hypertension, smoking and multiple risk factors were observed in 92.3%, 70.3% and 67.9% cases respectively. Poor antihypertensive medication compliance was observed in 55.9% cases. Conclusions: Intracerebral hemorrhage was the commonest stroke-type observed in Kashmir accounting for close to two third of strokes with male preponderance.

Emergence of Culex Quinquefasciatus Say Larvae (Diptera: Culicidae) Resistance to Some Organophosphate Insecticides in Khartoum State; Sudan

Abstract:tbackground:Chemicals are used for rapid control of large area; although misuse of those insecticide leads to resistance; resurgence of pests and finally replacement of insecticide which is unaffordable in developing Country.Objectives:This study aimed to determine the susceptibility status of Culex quinquefasciatus larvae to four organophosphate insecticides; Temephos; Fenthion; Fenitrothion and Chlorpyrifos.Material et methods.Following WHO standard protocols; larval susceptibility tests were carried out in 3 localities;namely Khartoum; Omdurman and Khartoum North. Mortality rates and lethal concentration (LC 50 and LC 95) were calculated for four types of organophosphate insecticides: includes; Temephos; Fenthion; Fenitrithion and Chlorpyrifos.results: Susceptibility of Culex quinquefasciatus; prevalent in the three greater localities of Khartoum State was determined against four organophosphates (Temephos; Fenitrothion; Fenthion and Chlorpyrifos) were confirmed resistant (mortality below 80). Studies were carried out on late 3rd or early 4th instar larvae of these species using standard WHO technique. Based on concentration mortality data LC 50 and LC 95 values were calculated. LC 50 values as observed for the above four insecticides in the three greater localities Khartoum North ; Khartoum and Omdurman for Fenitrothion were 0.8097; 0.0398 and 0.0432?g per litre ; for Temephos 0.47; 3.85 and 12.82 ?g per litre and for Fenthion .15; 0.11 and 0.91 ?g per litreand finally for Chlorpyrifos 0.31; 0.39 and 13.76 ?g per litre respectively.Conclusion: The study concluded that;Cx. quinquefasciatus larvae in Khartoum State create a resistance to the tested larvicides(Fenthion;Temephos; Fenitrothion and Chlorpyrifos).recommendations:Use of non-chemical control methods in addition to using insecticide mixture is important tactics to manage insecticides resistance

Dermatitis Herpetiformis (DH) in Association with H. pylori Infection: Description of a Case Report.

Dermatitis herpetiformis (DH) is an autoimmune blistering disorder associated with a gluten-sensitive enteropathy (GSE), and is generally accepted as a cutaneous manifestation of celiac disease and is characterized by grouped excoriations; erythematous, urticarial plaques; and papules with vesicles. We reported an interesting case of adult DH occurred in a 30 year old Sudanese young adult with chronic inflammatory bowel disease, presented with typical string of pearls in the face, trunk and extremities for 2 months duration. The case is diagnosed and confirmed as DH where histopathologically shows a sub-epidermal bulla with microabscess formation, sigmoidoscopy and H. pylori ELISA test were positive IgA. Our case had an adult onset of presentation. Clinical features and histopathology are typical. It is associated of H. Pylori, although poorly responding to triple therapy (Doxycyclin 100 mg bid for 8 days, Cefixime 400 mg for 5 days and Rabeprazole as proton pump inhibitor (PPI) 20 mg for 28 days), but focusing as possible antigen was of paramount concern as possible causative antigen; as in this case all serological specific tests for Coeliac disease were negative. The case was considered to be the second case of DH with CIBD due to H. Pylori been reported in Sudan.

Profile of Acute Renal Failure in Children in Kashmir.

We report on the etiology and the short term outcome (3 month) of children with acute renal failure (ARF) at a tertiary care centre in north India. Acute tubular necrosis was the commonest cause of ARF (33%) especially in children <5 years of age; while in children >10 years, glomerulonephritis was the commonest cause. The overall mortality rate was 20%.The outcome at 3 months showed normal renal function in 72 patients and CKD in 5 patients. Three patients were lost to follow-up.

Posterior fossa extradural haematoma following thrombolysis therapy for acute myocardial infarction

Intracranial haemorrhage [ICH] is one of the dreaded complications following thrombolytic therapy for acute myocardial infarction [AMI].3,6,17,24,28,29 Haemorrhage can occur in varied locations but predominantly it is intraparenchymal.[8] Trauma is the commonest cause of extradural haematoma [EDH] but in rare instances it can occur spontaneously due to vascular malformation of dura[11,23], infections of air sinuses or middle ear[4,5,7,14], coagulopathies[10,13,18] or tumours.[16] Thrombolysis for AMI leading to EDH has not been reported until date to the best of our knowledge. We here report a patient who developed posterior fossa EDH after thrombolysis. Early CT scan and high degree of suspicion enabled the patient to have good outcome

Susceptibility of Culex Quinquefasciatus say (Diptera: Culicidae) in Khartoum Locality (Sudan) to Malathion; Temephos; Lambdacyhalothrin and Permethrin Insecticides

Abstract:background et objectives:Mosquito control is becoming increasingly difficult because of the developmentof resistance in vectors to conventional insecticides. The resistance in vectors warrants development of newer insecticides for mosquito control besides use of other counter-measures. This study aimed to determine the susceptibility of adult and larvae of Cx.quinquefasciatus mosquitoes (Diptera: Culicidae) to malathion; temephos; lambdacyhalothrin and permethrin insecticides in Khartoum locality.Material et methods:Susceptibility of Culex quinquefasciatus mosquitoes to malathion; lambdacyhalothrin and permethrin; and of the larvae to temephos in Khartoum locality was carried out; following WHO standard susceptibility tests. One to three days old female mosquitoes; which were reared from field collected immature stages; were exposed to discriminating dosages of the insecticides; for respective exposure periods. Then knockdown time and 24-hours mortality were recorded. For larvae which were exposed to a series of temephos concentrations; and LC 50 and LC 90 values were calculated.results:The study revealed that;Culex quinquefasciatus is predominant in Khartoum locality. Evidence of resistance was revealed to malathion and the two pyrethroids against Culex quinquefasciatus. The average KDT 50 values consider high and indicated resistance. But larvae stages were found to be susceptible to temephos.Interpretation et conclusion:Resistance of the field population of Cx. quinquefasciatus in Khartoum was revealed to malathion; lambdacyhalothrin and permethrin. On the other hand; the same population of Cx. quinquefasciatus is still sensitive to temephos. Therefore; the vector control unit should consider introducing rotation of insecticidesas a management strategy to increase the duration of the usage of the current insecticides. Furthermore; a rationalized use of insecticides coupled with regular monitoring of insecticide resistance is recommended to mitigate the rapid emergence of insecticide resistance