[ changing pattern of hospital admission to medical wards; burden of non-communicable diseases at a hospital in a developing country]

Objectives: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan

Methods: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization's International Classification of Diseases [ICD] coding system

Results: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56-65-year-old age group [19.4%] and the majority of patients were admitted for one week or less [86.4%]. Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases [19.7%], followed by diseases of the circulatory [16.4%], digestive [16.4%] and genito-urinary [13.8%] systems. The most common diseases were cardiovascular disease [16.4%], malaria [11.3%], gastritis/peptic ulcer disease [9.8%], urinary tract infections [7.2%] and diabetes mellitus [6.9%]. The mortality rate was 4.7%

Conclusion: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital

Prevalence of and predictive factors for nonalcoholic fatty liver disease in Sudanese individuals with type 2 diabetes: is metabolic syndrome the culprit?

Non-alcoholic fatty liver disease [NAFLD] is a common global chronic liver condition. The prevalence of NAFLD among individuals with type 2 diabetes is estimated to be as high as 75%. The aim of this study was to determine the prevalence of NAFLD among individuals with type 2 diabetes in Sudan. This was a cross-sectional hospital-based study, which was carried out at the Jabir Abu-Elizz diabetic centre in Khartoum; 167 outpatients with type 2 diabetes were enrolled. NAFLD was diagnosed based on ultrasound, following exclusion of significant alcohol intake and secondary causes of liver diseases. NAFLD was defined as hepatic steatosis in the absence of alcohol intake, medication, previous liver disease and negative results for the serological test for hepatitis B and C. Logistic regression analysis was used to determine independent risk factors for the development of NAFLD in individuals with type 2 diabetes. The number of female subjects was 89 [53.3%], and most subjects [145, 86.8%] were between the ages of 40 and 70 years. The overall prevalence of fatty liver among individuals with type 2 diabetes was found to be 50.3%. Age, duration of diabetes, hypertension and HbAlc levels appeared to have no impact on the prevalence of NAFLD. The possible predictors of NAFLD were overweight, obesity, central obesity, high triglyceride level and low high-density lipoprotein cholesterol [HDL-c] level. A higher prevalence of NAFLD was observed in individuals with three components of the metabolic syndrome. NAFLD was observed in half of the diabetic population, and its occurrence correlates positively with metabolic syndrome risk factors

Non alcoholic fatty liver disease [NAFLD] in a Sudanese population: What is the prevalence and risk factors?

Non alcoholic fatty liver disease [NAFLD] is a common clinical condition associated with obesity and considered as possible precursor of more serious disease like Non alcoholic steatohepatitis [NASH], cirrhosis and hepatocellular carcinoma. There is very little research work carried concerning NAFLD in African countries in relation to prevalence and risk factors. Therefore, the aim of this study is to determine the prevalence of NAFLD and risk factors among asymptomatic co-patients accompanying patients admitted to gastroenterology wards at the National Centre for GI and Liver Diseases, Ibn Sina Hospital [Khartoum, Sudan]. Subjects with liver disease, excess alcohol intake [the intake of more than 21 units of alcohol per week for men and 14 units for women per week] and pregnancy were excluded from this study. The age, sex, body mass index [BMI], history and duration of diabetes and hypertension were recorded. Ultrasound was offered followed by clinical examination and blood sample was taken for assessment of liver function from each subject [total number of participants was 100]. NAFLD was diagnosed in 20 patients, giving prevalence of 20%. There was no statistical significance between the two sexes. The mean age of subjects with NAFLD was 53 years old and without NAFLD was 40 years [p < 0.05]. Importantly, the prevalence of NAFLD increased with age and BMI. Due to small number of diabetic individuals and hypertension, these two conditions were not statistically significant when related to NAFLD. The estimated prevalence of NAFLD in our study is 20% and this figure is comparable to the prevalence of NAFLD in Asian countries. Males and females were nearly equally affected and the prevalence of NAFLD increased with age and BMI, malting obesity a main risk factor

Relationship between non-alcoholic fatty liver disease and kidney function: a communication between two organs that needs further exploration

Non-alcoholic fatty liver disease [NAFLD] is now regarded as hepatic component of the metabolic syn-drome. In addition, NAFLD has emerged as a growing public health problem worldwide and an important challenge for health authorities. NAFLD is associated with insulin resistance and hyperlipidaemia and this appears as the potential pathogenic role of NAFLD in the development and progression of chronic kidney disease [CKD]. Interestingly, NAFLD and CKD may share common pathogenic mechanisms like obesity, abdominal obesity, insulin resistance, hyperlipidaemia, hypertension and inflammation. Importantly, the association between NAFLD and CKD is also being shown to be independent of obesity, hypertension, and other potentially confounding features of the metabolic syndrome, and it occurs both in patients without diabetes and in those with diabetes. How the liver communicates with kidney in individuals with NAFLD is not well known and indeed an urgent research is needed to further elucidate the complex and intertwined mechanisms that link NAFLD and CKD. One potential pathway for future exploration may be inflammatory mediators in NAFLD that may lead to deterioration in renal function. In addition, large clinical studies are needed to study the impact of NAFLD on the progression of CKD and in particular during dialysis and transplant and importantly how treatment of NAFLD and weight loss will have reversible potential benefit in improving renal function

Diabetes and Ramadan: an update on use of glycemic therapies during fasting

The fasting of Ramadan is observed by a large proportion of Muslims with diabetes. Recommendations for the management of diabetes during Ramadan were last published in 2005 by the American Diabetes Association. Several studies in this field have since been published, some addressing the use of new pharmacological agents in managing diabetes during Ramadan. The incritin memetics are potentially safe during Ramadan; the DPP4 inhibitors vildagliptin and sitagliptin provide an effective and safe therapeutic option, administered either alone or in combination with metformin or sulfonylureas. There are no published studies on the use of GLP-1 receptor agonists during Ramadan. Among the sulfonylureas, gliclazide MR [modified release] and glimepride can be safely used during Ramadan, but glibenclamide should be avoided due to the associated risk of hypoglycemia. In selected patients with type 1 and type 2 diabetes, the long-acting insulin analogues glargine and detemir, as well as the premixed insulin analogues, can be used with minimal risk of metabolic derangement or hypoglycemia; the risk is higher in type 1 diabetes. Insulin pumps can potentially empower patients with diabetes and enable safe fasting during the month of Ramadan. Further clinical trials are needed to evaluate the safety and efficacy of new antidiabetic agents and new diabetes-related technologies during Ramadan

kidneys as an emerging target for the treatment of diabetes mellitus: What we know, thought we knew and hope to gain

Glucose filtered by kidneys is reabsorbed into the proximal tubule through the sodium-coupled glucose co-transporter [GLT2] This promotes urinary excretion of glucose and results in lowering of plasma glucose level. Administration of agents [.g. dapagliflozin] hat inhibits SGLT2 transporter have shown to be associated with improvement in hyperglycaemia without clinically persistent electrolytes disturbances or change in osmolarity. This may suggest that administration of dapagliflozin is effective and safe as treatment for hyperglycaemia. Ongoing clinical trials will reveal the potential benefit and safety of SGLT2 inhibitors as part of the therapy of type 2 diabetes

Sex determination by odontometrics in some Egyptian population

Teeth form an excellent material for odontologic, forensic, anthropological and genetic investigation. The purpose of this study was to investigate the accuracy with which sex can be differentiated by odontometric analysis in some Egyptian population. The material consisted of 150 dental casts, 75 males and 75 females, ranging in age from-[15-45] years. The maxillary [Mx] and mandibular [M] canine width and arch were measured by a calliper. The data collected was analysed stastically. The result showed that the male teeth were consistently larger than the female teeth. The mean of: maxillary canine width [MXCW] = sd [Male [m] 8.97 +/- 0.44 Female [F],.8.11 +/- 0.38 MCW[m: 8.06 +/- 0.41 F :6.95 +/- 2], MXCA [m:35.67 +/- 1.27 F: 32.15 +/- 1.67] MCA [m : 27.42 +/- 1.64 F : 25.90 +/- 1.14]. The mandibular canine index [MCI] are found to exhibit sexual dimorphism as there is significant difference between males and females while maxillary canine index [MXCI] has insignificant difference. These findings support the usefulness of canines in gender determination by odontometric analysis. It also shows high significant dimorphic values for some of the other variables investigated

Protective role of ascorbic acid on population of -T- lymphocyte in major salivary glands of rat exposed to cadmium [immuno-histochemical study]

The study was carried out to evaluate the immunohistochemical investigation of the protective role of ascorbic acid on population of T-lymphocyte in major salivary glands of rat exposed to cadmium. Fifteen male rats weighting about 250g, were divided into three groups, 5 animals for each. In group I, the rats were injected with 0.5 ml of physiological saline and used as control. In group II, the animals were injected with cadmium chloride [15mg/kg body weight] for 1.4 and 8 weeks. In group III, the rats were injected with cadmium chloride simultaneously with ascorbic acid for different periods equal to the periods cadmium chloride injection. The results demonstrated that, by using of the anti-CD3 monoclonal antibody, the immunohistochemical finding of group II demonstrated weak positive staining with anti-CD3 antibody and a few number of positive T lymphocyte was situated in the connective tissue storma, as well as, parenchymal tissue of salivary glands. In group III, strong positive reactivity with anti-CD3 antibody in all examined tissue. There was great number of anti-CD3 positive T-lymphocyte scattered in the glandular tissue than that seen in group II. The ascorbic acid demonstrated beneficial effect on the cadmium toxicity exposed salivary gland when both drugs were simultaneously administrated and toxic effect of cadmium on the immune system can be obliterated by a sufficient intake of ascorbic acid. We conclude that immune functional abnormalities can be restored after toxic chemicals exposure by oral usage of ascorbic acid

influence of testosterone administration on the partially extirpated submandibular salivary gland in rat

This study was carried out in order to investigate the effect of testosterone administration on the regenerative power of the extirpated submandibular gland of rats. Thirty two Spargue-Dawley rats weighting about 240 gm were divided into two groups, 16 animals for each. In group 1 about half of right submandibular gland was removed and the animals were injected intraperitoneally at five successive days by testosterone. At different intervals [1,7,15 and 30 days] four rats were sacrified. Morphological and histochemical studies revealed healing of the extirpated area occured as a result of regeneration of secretory part by formation of newly formed serous acini from the old ones at the line of section and from rudimentary ducts in the central area. In the central area, the periductal cells were transformed into acinar cells and later, some of the straited ducts changed further to form granular convoluted tubules. In our study, group II revealed progressive newly formed acini and ducts. Some of these ducts demonstrated apical vacuolization within the first period, which could be considered as earlier sign of transformation into granular convoluted tubules, which appeared in later period in control groups. The lumina of these ducts appeared with eosinophilic products, which might indicate either that lumina carry acinar secretions or producing such material. The acini of group II became larger and its cytoplasm appeared as honeycombed appearance due to fusion of the secretory granules together. The appearance of the mucous cells or acini in group II may arise either from the proliferation of the already found mucous cells or as a result of sexual maturity. The newly formed acini showed strong PAS reaction, which decreased with maturation, denoting increase in the metabolic activity. The study has demonstrated that after testosterone administration the regenerative process of the submandibular gland was accelerated