Inappropriate use of antibiotics in the treatment of pharyngo-tonsilitis in children in Khartoum, Sudan

Pharyngo-tonsillitis represents a major public health problem all over the world. Recent studies in Sudan have revealed alarming results reporting antibiotics over prescription in the management of acute tonsillitis. The aim of this study was to estimate the prevalence of Group A Beta hemolytic streptococci and document the appropriateness of using antibiotics in the treatment of acute tonsillo-pharyngitis in Jaafar Ibn Auf Pediatrics Hospital. A cross sectional hospital based study was conducted in the period January to August 2012 in Jaafar Ibn Auf Hospital, the largest tertiary pediatrics hospital in Sudan. The sample size was 100 including children aged 2-17 years and got antibiotics treatment for their current sore throat. A pharyngeal swab was collected at presentation from tonsils and posterior pharynx. Gram staining was done first, and then Group A Beta hemolytic streptococci were isolated and identified in the laboratory by their growth characteristics. All children included in the study were assessed clinically and subjected to a structural questionnaire. Data were analyzed by SPSS version 19. The estimated prevalence of Group A Beta hemolytic streptococci tonsillitis and/or pharyngitis was 22%, nevertheless the proportion of antibiotic prescription was 100%. Most children were treated inappropriately regarding the need for using antibiotics, the type of antibiotics used and the duration of management. As many studies suggested that increased using of antibiotics may be due to uncertainty of diagnosis, requesting scoring system or rapid diagnostic test can contribute to the reduction of the rate of antibiotics prescription

Anaerobic digestion of Nssc pulping effluent

Two UASB reactors R-I and R-II, each of 10liters capacity, made up of acryl material were operated parallel and continuously for a period of 220 days, using actual effluent of the NSSC pulp and paper mill, at mesophilic temperature and neutral pH. The main objective was to investigate the treatability performance of the reactors at varying OLR and HRT in terms of TOC and lignin removal. The reactor R-I was used by conventional procedure, whereas, for the reactor R-II methanol and activated carbon was added to supplement its efficiency. Corresponding to an optimum OLR of 4.5kg/m[3]-day and HRT of 18hrs, the reactor R-II gives 69% TOC and 60% lignin removal. But, in the reactor R-I at same operating conditions, only 56% TOC and 51% lignin removal was noticed. However, the biogas yield in the reactor R-I was noticed relatively more than in the R-II. The biogas yield observed was 0.28m[3]/kg-COD[rem] and 0.18m[3]/kg-COD[rem] in the reactor R-I and R-II, respectively, with 56-58% methane content in both the reactors. The average VFAs concentration observed in the reactor R-I and R-II is 360mg/L and 230mg/L, respectively. The results of this study suggest that the use of methanol and activated carbon to enhance the treatability efficiency of the UASB reactor is a viable option for the treatment of NSSC pulping effluent

Epistaxis management

Epistaxis is common and has been reported to occur in up to 60 percent of the general population. The affected person usually does not seek medical attention, particularly if the bleeding is minor or self-limited. In rare cases, however, massive nasal bleeding can lead to death. The nose has an abundant blood supply. The arterial supply to the nose comes from carotid arteries. Nasal bleeding usually responds to first-aid measures. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated appropriately. There is no unanimity amongst Otorhinolaryngologists in terms of the sequence of different treatment methods in Epistaxis patients. We aimed in this study to examine our existing practice in terms of management of epistaxis, and to try to come up with suggestions of sequential treatment steps. This is a retrospective study conducted from November 2004 to January 2005 in the Otolaryngology Department in Midway Maritime Hospital. The study group consisted of 100 case notes requested. The demographic data of the patients were collected and the history of epistaxis in each patient. The study showed the peak of incidence of epistaxis [66%] was in adults [51 - 91 years old]. No sex predilection. It was mostly spontaneous. 60% of the patients presented for the first time. 63% of the patients have co-morbid conditions. 60% of the patients needed hospital admission. The patients were treated with different measures. We concluded that the cases of epistaxis caused by trauma in our series is far less than expected. Co-morbidity plays a major role in the causation of epistaxis according to this study. We recommend the use of chemical cautery, merocele or both as the first line of local treatment of epistaxis. If it does not work, Rapid Rhino with or without anterior packing should be considered. If this does not work, then sphenopalatine artery ligation is the next step

Evaluation of fine needle aspiration cytology [FNAC] in diagnosis of head and neck swellings in Bab Elsheria Hospital

FNAC is believed to be of great benefit as an alternative diagnostic approach to lesions in Head and Neck region. This study aims at evaluating the results of FNAC undertaken in Otorhinolaryngology, Head and Neck Surgery Department, Bab Elsheria Hospital in relation to the International big series. This is a retrospective study of 42 cases with FNACs performed between September 2004 and April 2006. All patients had both FNAC and Histology done. Patients were classified into 3 groups according to the site of their swellings: [parotid, thyroid and others]. The origin of the swellings in this series was 48% from the parotid gland, 19% from the thyroid gland and 33% from other sites. The first FNAC was only diagnostic in 21 patients [50%]. While the 2nd FNAC was diagnostic in 8 patients out of 15 [53.3%]. The majority of swellings with positive findings on FNAC in 29 patients had matched the histology results [68.9%]. So, the chances of getting diagnosis were about 50% in either first or second FNAC. The FNAC sensitivity was 69% and its specificity was 80%, which lags behind the International big series. We need to improve our FNAC results to be compared with the results of International big series

Safety and efficacy of Esmolol as add on therapy in acute unstable angina

The present study examined the hemodynamic and anti-ischemic effects of esmolol in 20 patients with unstable angina. Two patients required a termination of infusion at the titration period because of hypotension, but they recovered hemodynamic stability within 30 minutes of termination of the infusion. During esmolol infusion, two patients of those receiving intravenous nitroglycerin required a downward adjustment of nitroglycerin infusion rate to maintain systolic blood pressure >90 mm hg. These results suggested that esmolol safely and effectively lowered both arterial pressure and heart rate in patients with acute ischemia