Diabetic Septic Foot in Omdurman Teaching Hospital

Objective: To audit the management of diabetic septic foot [DSF] lesions in Omdurman Teaching Hospital, usingWagner classification. Patients and methods: This is a retrospective study on 208 patients with DSF admitted to Omdurman Teaching Hospital, Sudan between June 2006 and May 2007. Data were analyzed manually Results: The male to female ratio was 2:1. The mean age± SD was 56 ± 12.35 year. 16.8% patients were grade 1. 33 (15.9%) patients were grade 2. grades 3, 4, 5 patients were 66 (37 %), 38 (18.3%) and 36 (17.3%) respectively. Major lower limb amputation and mortality were 19.2%, and 6.7% respectively.Conclusion: Preventive measures for patients at risk are highly needed as well early presentation isencouraged when ulcer develops in diabetic foot to avoid subsequent complications.Key words: Diabetes Mellitus, Diabetic septic foot, amputatio

Audit of laparoscopic cholecystectomy Omdurman teaching hospital

Objectives: To review and audit our experience in laparoscopic cholecystectomy [LC] at Omdurman Teaching Hospital, Sudan. Methods: A prospective study for patients who underwent laparoscopic cholecystectomy in the period, from January 2006 to October 2007. Demographic data, indications for surgery, rate of conversion to open cholecystectomy, morbidity, and mortality rates were noted. Results: A total of 114 patients underwent LC in 21 months, They were female 100 patients and 14 males, age range from 25 to70 years, mean age 44 years. Indications for surgery were biliary colic 65.8%, fatty dyspepsia 37.7%, and acute cholecystitis 3.5%. The range of operative time was 25-90 minutes. Conversion rate was (7.9%). The reasons for conversions were bleeding, extensive dense adhesions, severe inflammation. Conclusion: Our findings were consistent with the literature, demonstrating that LC is a safe minimal invasive technique Keywords: Laparoscopic, cholecystectomy, minimal invasive surgery, surgical audit, Sudan.Sudan Journal of Medical Sciences Vol. 3 (1) 2008: pp. 21-2

Bioconversion process of rice straw by thermotolerant cellulolytic Streptomyces viridiochromogenes under solid-state fermentation conditions for bioethanol production

Enzymatic hydrolysis of the cellulose fraction of rice straw to glucose using solid-state fermentation for bioethanol production is a focus of current attention. A total of 10 actinomycetes isolates were isolated from soils and decayed rice straw. All these isolates were purified and screened for their cellulolytic activity; one strain was selected for further study and identified as Streptomyces viridiochromogenes. Optimization of fermentation conditions showed highest cellulolytic enzymes production on the 5th day at pH 6.5 and at 40°C. The production of enzymes reached its maximal value at 4.0 g of rice straw/250 ml flask. Avicelase and total cellulase productivity were highly increased by the addition of NH4Cl as Nsource, while maximum activity of CMCase was recorded by the addition of peptone as N-source to the fermentation medium. The influence of various physico-chemical factors on enzyme activity was also investigated. The half life time of avicelase, total cellulase and CMCase at 60°C was 39.4, 50.0 and 78.58 min, respectively. A maximum of ethanol production 1.428±0.074% (v/v) by Saccharomyces cereviseae using dilute acid pretreated rice straw hydrolysate with initial soluble sugar 2.340±0.072%  was recorded after 2 days of fermentation.Key words: Bioethanol, cellulolytic enzymes, rice straw, solid-state fermentation, Streptomycesviridiochromogenes

Molecular epidemiology of antibiotic-associated diarrhoea due to Clostridium difficile and clostridium perfringens in Ain Shams University Hospitals

Background: As we are living in the era of antibiotic overuse, antibiotic associated diarrhea (AAD) is considered now a distinct health problem with a need for more attention. Aim of the Study: was to perform a highly specific detection and definition of pathogenic Clostridium perfringens and Clostridium difficile related AAD in children compared to adults and geriatircs. Patients and Methods: One hundred and fifty patients diagnosed for AAD were included in this study (50 children, 50 adults and 50 geriatric patients). All of them were subjected to full medical history including complete therapeutic history of antibiotics and collection of stool sample during the attack for detection of Clostridium perfringenes enterotoxin (CPEnt) and Clostridium difficile cytotoxin by (EIA) kit. PCR detection of Clostridium perfringenes cpe gene (Coding gene for CPEnt) was performed as well. Results: Results showed that prevalence of Clostridium difficile cytotoxin was 24% while Clostridium perfringenes enterotoxin was 12% as detected by EIA in faecal specimens as a whole. Detection of cpe gene by PCR was positive in 16% of all cases. Children (OR: 4.2, 95% CI: 1.3-14.8, P_0.01) and geriatric patients (OR: 3.4, 95% CI: 1.2-13.5, P_0.02) were significantly more prone to Clostridium difficile AAD compared to adults. Also, childhood was a significant risk for Clostridium perfringens AAD (OR: 2.1, 95% CI: 0.54-7.4, P_0.04). In Conclusion: children and geriatric patients are more vulnerable to develop AAD with antibiotic abuse compared to adults. Abbreviations: AAD=Antibiotic associated diarrhea, CI=Confidence interval, ELISA=Enzyme-linked immunosorbent assay, OR=Odd ratio, PCR=Polymerase chain reaction. Keywords: Antibiotic-associated diarrhea, children, Clostridium perfringens, Clostridium difficile. Egypt. J. Hum. Genet Vol. 8 (2) 2007: pp. 121-13

The impact of gender on difficulty of classical open cholecystectomy

Background: Cholecystectomy demands attention, and expectation of abnormal anatomy in the veins, arteries or ducts. Prediction of difficult cholecystectomy does not only helpin patient counseling but also helps the surgeon to prepare better for the technical difficulties that may be encountered1-3.The aim: To find out whether there is impact of gender on the difficulty of surgery during open cholecystectomy.Patients and methods: This is a prospective hospital based study. Patients who presented to Ibn Sina Hospital for open cholecystectomy during the period from April 2011 to April 2012 were included in this study. Special emphasis was put on gender, the operative time, difficulty of surgeryand complications of open cholecystectomy. A pre-tested questionnaire was filled during interview of patients and operating surgeons.Results: A total 327 operations were included in the study. Of them there were 34(64.2%) males and 99(36.1%) females presented early i.e. after the first diagnosis was made. The mean operative time was 44.6 min for males and 43.57 min for females. Difficult surgery was described in 6(11.3%) of male and 23(8.4%) females.Conclusion: There was no significant statistical difference in the operative time, difficulty of operation and complication rate between males and females.Key words: Open cholecystectomy, difficulty, gender

Rare coding SNP in DZIP1 gene associated with late-onset sporadic Parkinson's disease

We present the first application of the hypothesis-rich mathematical theory to genome-wide association data. The Hamza et al. late-onset sporadic Parkinson's disease genome-wide association study dataset was analyzed. We found a rare, coding, non-synonymous SNP variant in the gene DZIP1 that confers increased susceptibility to Parkinson's disease. The association of DZIP1 with Parkinson's disease is consistent with a Parkinson's disease stem-cell ageing theory.Comment: 14 page

Definition of strategies for the reduction of operational inefficiencies in a stroke unit

Stroke disease is the second common cause of death in the world and is then of particular concern to policy-makers. Additionally, it is a meaningful problem leaving a high number of people with severe disabilities, placing a heavy burden on society and incurring prolonged length of stay. In this respect, it is necessary to develop analytic models providing information on care system behavior in order to detect potential operational inefficiencies along the stroke patient journey and subsequently design improvement strategies. However, modeling stroke care is highly complex due to the multiple clinical outcomes and different pathways. Therefore, this paper presents an integrated approach between Discrete-event Simulation (DES) and Markov models so that integrated planning of healthcare services relating to stroke care and the evaluation of potential improvement scenarios can be facilitated, made more logically robust and easy to understand. First, a stroke care system from Colombia was characterized by identifying the exogenous and endogenous variables of the process. Afterward, an input analysis was conducted to define the probability distributions of the aforementioned variables. Then, both DES and Markov models were designed and validated to provide deeper analysis of the entire patient journey. Finally, the possible adoption of thrombolytic treatment on patients with stroke disease was assessed based on the proposed approaches within this paper. The results evidenced that the length of stay (LOS) decreased by 12,89% and the mortality ratio was diminished by 21,52%. Evaluation of treatment cost per patient is also carried out

Compound double ileoileal and ileocecocolic intussusception caused by lipoma of the ileum in an adult patient: A case report

<p>Abstract</p> <p>Introduction</p> <p>The initial diagnosis of intussusception in adults very often can be missed and cause delayed treatment and possible serious complications. We report the case of an adult patient with complicated double ileoileal and ileocecocolic intussusception.</p> <p>Case presentation</p> <p>A 46-year-old Caucasian man was transferred from the gastroenterology service to the abdominal surgery service with severe abdominal pain, nausea, and vomiting. An abdominal ultrasound, barium enema, and abdominal computed tomography scan revealed an intraluminal obstruction of his ascending colon. Plain abdominal X-rays showed diffuse air-fluid levels in his small intestine. A double ileoileal and ileocecocolic intussusception was found during an emergent laparotomy. A right hemicolectomy, including resection of a long segment of his ileum, was performed. The postoperative period was complicated by acute renal failure, shock liver, and pulmonary thromboembolism. Our patient was discharged from the hospital after 30 days. An anatomical pathology examination revealed a lipoma of his ileum.</p> <p>Conclusions</p> <p>Intussusception in adults requires early surgical resection regardless of the nature of the initial cause. Delayed treatment can cause very serious complications.</p