Therapeutic outcomes evaluation of adjuvant hyperbaric oxygen therapy for non-healing diabetic foot ulcers among sudanese patients.

BACKGROUND AND AIMS: Diabetic foot ulcers (DFUs) are common complications of diabetes that frequently lead to amputation and disability. Despite some promising results in using hyperbaric oxygen therapy (HBOT) for DFUs treatment, its efficacy is still debatable. The aim of this study was to evaluate the therapeutic outcomes of adjuvant HBOT in non-healing DFUs treatment. METHODS: A descriptive, retrospective, hospital-based study was conducted at Al-Mo'alem Medical City-Khartoum, Sudan from August to December 2018. Medical records of Type 2 diabetic patients, treated with HBOT plus standard wound care for DFUs, were included in the study. Data were analyzed by simple descriptive statistics and logistic regression. P ≤ 0.05 was considered statistically significant. RESULTS: The study results showed that 51.7% of patients had Wagner grade-3 ulcers and 28.3% had complete loss of protective sensation. Almost 61% of patients achieved complete ulcer healing while 16.7% underwent amputation. Twenty percent of patients treated with HBOT experienced ear barotraumas as adverse effects. Protective sensation (OR = 6.00, 95% CI = 1.79-20.16, p = 0.004) and more sessions of HBOT (OR = 17.35, 95% CI = 4.51-66.73, p = 0.000) were positive predictors of complete ulcer healing. Loss of protective sensation (OR = 0.17, 95% CI = 0.05-0.63, p = 0.007) was an indicator of amputation. CONCLUSIONS: Treatment with adjuvant HBOT enhanced ulcer healing and reduced amputation rate in patients with non-healing DFUs. HBOT could be considered a relatively safe intervention.

Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan.

BACKGROUND: Cefepime is essentially used for life-threatening infections. Although overutilisation of antibiotics is strongly discouraged around the world, they are still overused in developing countries including Sudan. OBJECTIVES: This study aims to evaluate the rational use of cefepime at Khartoum North Teaching Hospital-Sudan. METHODS: A retrospective cross-sectional, hospital-based study was conducted in the internal medicine ward at Khartoum North Teaching Hospital from August/2018 to April/2019. The study covered medical records of adult patients receiving cefepime during the study period. Patient's data were analysed using simple descriptive statistics (frequency and percentage) and inferential statistics (logistic regression) to describe the relationship between dependent and independent variables. P ≤ .05 was considered statistically significant. RESULTS: Out of 90 patients, only 16.7% of patients were tested for antibiotic sensitivity. Cefepime was prescribed to 50% and 23.3% of patients for the treatment of UTIs/post-dialysis and sepsis, respectively. Although the majority of patients (72.2%) received cefepime with appropriate indication, only 21.1% and 15.6% received the drug with appropriate dose and duration, respectively. Cefepime had been prescribed appropriately in a correct dose, duration, and indications for only 7.8% of patients. The vast majority of patients tested for kidney functions had elevated creatinine levels (96.1%); however, cefepime dose had been adjusted for only 4.1% of them. CONCLUSION: This study highlighted the irrational use of cefepime regarding inappropriate dose, duration, and inadequate antibiotic sensitivity tests. A lack of attention to dosage adjustment in patients with renal impairment had been observed. Positive clinical outcome was significantly associated with antibiotic sensitivity test.

Antigens shared by Leishmania species and Trypanosoma cruzi: immunological comparison of the acidic ribosomal P0 proteins.

Patients with visceral leishmaniasis produce high levels of immunoglobulin, but the specificities of antibodies produced are not well characterized. In an effort to identify leishmania antigens that are specific to Leishmania species or are cross-reactive with other parasitic protozoa, we have cloned and characterized full-length genomic and cDNA clones encoding a Leishmania chagasi acidic ribosomal antigen, LcP0, recognized during human infections. The protein is homologous to the Trypanosoma cruzi and human ribosomal proteins TcP0 and HuP0, respectively. Unlike most higher eukaryotes, but similar to TcP0, LcP0 has a C-terminal heptapeptide sequence resembling those of the archaebacterial acidic (P-like) proteins. The highly charged C-terminal acidic domain of LcP0 contains a serine residue typically found in most eukaryotes but lacking in all T. cruzi P proteins we have characterized thus far. L. chagasi-infected individuals as well as those with T. cruzi infections have antibodies cross-reactive with recombinant LcP0 and TcP0 as well as HuP0. However, the properties of anti-P0 antibodies in T. cruzi and L. chagasi infection sera are quite different. Through the use of synthetic peptides, we showed that while T. cruzi infection anti-TcP0 antibodies are exclusively directed against the C-terminal domain of TcP0, L. chagasi infection sera contain antibodies reactive with epitopes other than the C-terminal sequence of LcP0. Thus, anti-LcP0 antibodies in L. chagasi infection sera represent the first characterized deviation from the restricted immunodominant C-terminal epitope involved in the generation of anti-P0 antibodies following infection or autoimmune diseases.

Chloroquine-resistant Plasmodium falciparum in eastern Sudan.

In vivo testing of the sensitivity of Plasmodium falciparum to chloroquine was carried out in 61 falciparum malaria patients with acute symptoms, in Eastern Sudan. In 26 patients (42%), P. falciparum was resistant to chloroquine. Nine patients (15%) had RI resistance, seven (11%) had RII resistance while ten (16%) had RIII resistance. The persistance of parasitaemia and symptoms were highly correlated in patients with RIII responses. In 21 patients in vitro testing of chloroquine sensitivity was carried out simultaneously with the in vivo testing using the World Health Organization microtest. In vivo and in vitro testing were also highly correlated. Isolates from 12 patients with proven in vivo resistance, grew in vitro in the presence of chloroquine concentrations above 0.8 X 10(-6) mol/l blood. Resistant strains have either been spread by refugees across the borders from Ethiopia or have developed indigenously. Mounting drug pressure, mass movement of non-immune refugees and loss of immunity among local inhabitants, due to the drought, are in favour of development of an indigenous focus. Epidemics with intense transmission caused by heavy rains following the drought could have greatly enhanced the emergence and spread of resistant strains.

Haemogregarina sp. (Apicomplexa: Adeleorina) from the gecko Tarentola annularis in the Sudan: fine structure and life-cycle trials.

The ubiquitous gecko Tarentola annularis in the area around Khartoum, Sudan, was found to be infected with Haemogregarina sp., with merogonic stages in its pulmonary endothelial cells and gamonts in its erythrocytes. The fine structure of Haemogregarina meronts, merozoites and gamonts revealed great conformity with the micromorphology of similar stages of other apicomplexan parasites. The unsuccessful transmission of Haemogregarina gamonts to the mosquitoes Aedes aegypti, Culex quinquefasciatus and Anopheles stephensi is also reported.