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]

Relation between severity of bronchial asthma and body composition parameters in obese asthmatic children

Background: Obesity and asthma in children are both increasing concomitantly with serious effects on health and quality of life. Obesity worsens the severity of asthma symptoms. Both, asthma and obesity have serious health consequences and significant financial costs. Assessment of body composition is important in understanding the relationship between obesity and asthma

Aim: This study was designed to evaluate body composition parameters in both obese and non-obeseasthmatic children and their effect on severity of asthma symptoms

Methods: A cross-sectional case-control study included 90 children divided into 3 equal groups including both males and females with an age range of [7-12] years; 30 non-obese asthmatics, 30 obese asthmatics from children attending allergy clinic at Abu-El Rish Pediatric Hospital, and 30 healthy controls. Complete history, clinical examination, anthropometric measurements; including: height, weight and body mass index, and body composition parameters including: fat mass, fat free mass, fat %, total body water, impedance and basal metabolic rate were taken

Results: Prevalence of both asthma and obesity was more among males with a male to female ratio-2: 1. Non-obese asthmatics were classified into 76.7% mild and 23.3% moderate cases. The obese asthmatics were classified into 30% mild, 60% moderate and 10% severe cases. The obese asthmatic group showed highly statistically significant differences compared to the non-obese asthmatic group: P< 0.005 regarding: weight, BMI, FM, FFM, IMP, TBW, BMR and in Fat% P< 0.05. The obese asthmatic group showed statistically significant differences compared to the control regarding weight, BMI, FM, FFM, IMP, TBW, BMR with [P< 0.005] and in the Fat% with [P<0.05]

Conclusion: Obesity aggravates the severity of asthma and body composition plays an important role as well

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

Evaluating medicines prices, availability, affordability and price components in Sudan

The aim of this study to measure medicines prices, their availability, affordability and price structure carried out in different sectors in Sudan. Methods: A field study was undertaken in the public and private sector in Sudan from March 2012 to April 2013 using a standardized methodology developed by the [World Health Organization] and [health action international]. Results: Based on median price ratio [MPR], the central medical store was procuring lowest priced generics [LPGs] at 1.2 times their international reference price [IRP], while they were selling generics at 2.34 times the IRP. The revolving drug fund was procuring LPGs at 1.55 times IRP, and selling generics at 5.13 times the IRP. In public pharmacies, the median MPR for LPG medicines was 2.99 and 8.03 for originator brands [OBs]. In private retail pharmacies, the median MPR is 3.84 for LPGs and 19.37 for OBs. Generic medicines were the predominant products in public and private pharmacy sectors [39.5% and 56.6% respectively], while for OBs were 1.8% in public sector pharmacies and 9.3% for private pharmacy sector. The affordability of LPGs in the public sector was good for half of conditions, with standard treatment costing a days' wage or less for 53.3% of treatments. In the private sector, the affordability of LPGs was similar to the public sector. The government worker would have to work 2.5 days to pay for 1-month of treatment with OB Glibenclamide for diabetes when purchased from private pharmacies, for LPG Glibenclamide he has to pay about half-a day's salary to buy the medicines from public and private sectors. In Sudan, the availability of the surveyed medicines was low in all sectors as both OBs [<10%], and 40-50% as generics depending on the sector. LPGs have been accepted in the country as they are more available than OBs. In both the private and public sectors, considerable price differences were seen between OBs and LPGs. Medicines are often unaffordable for ordinary citizens

Seroprevalenc of HIV/AIDS among pregnant Sudanese women

The prevalence of HIV/AIDS in the Sudan is 1.6-6.0%. With the advent of peace, the disease is expected to be on the rise. The objective of the study is to assess the prevalence of HIV/AIDS in pregnant Sudanese women so as to prevent Mother-to-Child Transmission. In a pilot study conducted at antenatal clinics in 5 Sudanese Teaching Hospitals, five teams were trained in the basic skills of counseling, diagnosis and management of HIV/AIDS. Rapid Test [Uni-gold HIV-1/HIV-2], Serodia HIV-1/2, and Western blot [INNP-LIA HIV-1/2 SCORE] tests were used. The prevalence of HIV/AIDS was found to be 0.8%. This pilot study led to establishment of seven Antenatal clinics for prevention of mother_to-child transmission in different parts of the country. Qualified teams composed of an Obstetrician, Paediatrician, pharmacist, Social worker, Health visitor, midwife, Laboratory Technician and a counselor provided counseling, testing and management for pregnant women and children of HIVpositive mothers. 57793 pregnant women attended antenatal clinics during the period August 2007-August 2008. Out of these 25941 [44.9%] were counseled; however only 5959 [23.0%] accepted to be tested for HIV. 39 positive cases were found, making the prevalence rate of 0.65%. Patients were managed and the babies were given antiretroviral treatment. Breast feeding was advised. Although the prevalence of HIV/AIDS is about 1.6-6% in the country, it is still low in pregnant women. A great effort should be done on Voluntary Counseling and Testing [VCT]; and effective preventive measures should be taken

role of serum transferrin receptors in the assessment of body iron stores and iron - deficient erythropoiesis in children

The present work studied the role of serum transferrin receptors in the differentiation between iron deficiency anemia and anemia of chronic disorders based on the presence or absence of iron stores. The study included 40 children, in the age range of 5-15 years. They were divided into 3 groups: control group of 10 healthy children, iron deficiency group of 15 patients, and 15 patients with anemia of chronic disease. The following laboratory tests were done for both cases and controls: complete blood picture, serum iron, total iron binding capacity [TIBC], serum ferritin and serum transferrin receptors. Percent transferrin saturation and serum transferrin receptor-ferritin index [sTfR- F index] were calculated. Hemoglobin concentration, red blood cell [RBC] indices and serum iron behaved similarly in patients with iron deficiency anemia [IDA] and those with anemia of chronic diseases [ACD]. Total iron binding capacity was significantly increased in IDA and decreased in ACD. The percent transferrin saturation decreased in IDA patients to less than 16%, it was significantly higher in ACD than IDA patients. Serum ferritin was significantly higher in ACD than in IDA group. The serum transferrin receptor [sTfR] was found to be significantly higher in IDA than in patients with ACD. The serum transferrin receptor [sTfR] was the best discriminatory power of all parameters used in the study for distinguishing between IDA and ACD

Peritonitis: comparison of three scoring systems

Two hundred patients were included in this trial. They had data of diffuse peritonitis proved surgically. Information specific to peritonitis and variables necessary for the calculation of APACHE II, MPI and PIAII scores were recorded. The three scoring systems were compared as regards the discriminatory ability, sharpness and reliability. It was found that APACHE II score is more superior than both MPI and PIA II as it produces reliable predications and can define more precisely the risk groups. Additional antibiotic trial was performed using APACHE II score to look for the impact on wound sepsis, augmenting which proved to be the best, followed by unasyn and lastly zinnat

Effect of acupuncture on blood pressure: role of opioid peptides

The effect of electroacupuncture on experimentally norepinephrine induced hypertension was studied on albino rats. In normotensive rats no significant change was observed in blood pressure with acupuncture insertion. The effect on experimentally induced hypertensive rats was contrary. As while insertion of needle at St.36 point resulted in a significant decrease in blood pressure, needle inserted at Go. 26 point resulted in a significant increase in blood pressure. Naloxone administration before acupuncture failed to inhibit its effects on blood pressure, indicating that acupuncture mediates its effects via opioid receptors other than mu receptors

Time factor in the effect of reperfusion of the ischemic cardiac muscle on the changes in T wave voltage and area, serum creatine phosphokinase and infarct size

The aim of this work was to detect the best time of reperfusion of the ischemic myocardium in rats. Reperfusion started 30 minutes to 180 minutes after induction of ischemia T wave voltage and area SCPK and infarction size [% of left ventricle] were the parameters studied. It was found that although the T wave voltage and area increased significantly after induction of ischemia, yet, they were not indicators of the duration of ischemia SCPK increased significantly in all groups and the infarct size showed no relation to the duration of ischemia Finally, It was clear that myocardial ischemia for the interval between 30 minutes up to 180 minutes cannot be recovered by reperfusion as evidence by persistence of high values of T- wave voltage and area after 30 minutes of reperfusion and the failure of recovery of high SCPK and the infarct size