Adherence of Healthcare Professionals to Evidence-based Clinical Practice Guidelines in the Management of Hemodialysis Patients, Khartoum State, Sudan

Introduction: Hemodialysis (HD) is a complex procedure with many specifications and requires adherence to a set of particular clinical practice guidelines. These guidelines had already been established by globally acclaimed renal authorities and their implementation was shown to correlate with patients’ morbidity and mortality. This study was conducted to evaluate the adherence of healthcare professionals to the evidence-based clinical practice patterns in Khartoum State HD units.Methods: A cross-sectional study was conducted in Khartoum State HD units during the period from September 2010 to January of 2011. Data was collected from the healthcare professionals using a specially designed checklist. The checklist included the evidence-based clinical practice guidelines for the HD vascular access, HD adequacy, anemia of chronic kidney disease (CKD), nutrition, cardiovascular risk assessment, and hepatitis B and C virus infection control. Implementation of these guidelines was evaluated, and further graded using a Likert-type scale.Results: Four randomly selected HD units were included in the study. The rate of implementation of the HD vascular access guidelines was 54.8%, adequacy guidelines 57%, anemia of CKD 68.8%, nutrition 58.4%, cardiovascular risk assessment 57%, and hepatitis B and C infection control guidelines was 79.2%. Overall, the four HD units assessed showed moderate deviations from the practice guidelines of anemia of CKD and hepatitis B and C infection control. Extreme deviations from the clinical practice guidelines were seen in HD vascular access practices, adequacy assessments, nutrition and cardiovascular risk assessment.Conclusion: Hemodialysis services in Khartoum State are in need of great improvements regarding adherence to protocols and the standards of care.Key words: Clinical practice guidelines; Hemodialysis; Suda

A UV-Spectrophotmetric Chemometric Method for the Simultaneous Determination of Sulfadoxine and Pyrimethamine in Tablets

In the present study, a simple, inexpensive, precise and accurate uv-spectrophotometric method based on chemometrics, has been developed for the simultaneous determination of sulfadoxine and pyrimethamine in tablet formulation. The % recoveries obtained were 99.7% ± 0.9 and 101.5% ± 0.8 for sulfadoxine and pyrimethamine, respectively. The developed method has been compared to USP-HPLC method with regard to accuracy and precision. The calculated F-ratio and the (t) statistics indicate that there is no significant difference at 5% level with regard to precision and accuracy between the proposed and the USP methods. Moreover, the developed method is simple, cost-effective, and less time-consuming. Accordingly, it can be used advantageously in routine quality control of sulfadoxine and pyrimethamine in tablet formulation

Effects of Acute or Chronic Ethanol Exposure during Adolescence on Behavioral Inhibition and Efficiency in a Modified Water Maze Task

Ethanol is well known to adversely affect frontal executive functioning, which continues to develop throughout adolescence and into young adulthood. This is also a developmental window in which ethanol is misused by a significant number of adolescents. We examined the effects of acute and chronic ethanol exposure during adolescence on behavioral inhibition and efficiency using a modified water maze task. During acquisition, rats were trained to find a stable visible platform onto which they could escape. During the test phase, the stable platform was converted to a visible floating platform (providing no escape) and a new hidden platform was added in the opposite quadrant. The hidden platform was the only means of escape during the test phase. In experiment 1, adolescent animals received ethanol (1.0g/kg) 30min before each session during the test phase. In experiment 2, adolescent animals received chronic intermittent ethanol (5.0g/kg) for 16 days (PND30 To PND46) prior to any training in the maze. At PND72, training was initiated in the same modified water maze task. Results from experiment 1 indicated that acute ethanol promoted behavioral disinhibition and inefficiency. Experiment 2 showed that chronic intermittent ethanol during adolescence appeared to have no lasting effect on behavioral disinhibition or new spatial learning during adulthood. However, chronic ethanol did promote behavioral inefficiency. In summary, results indicate that ethanol-induced promotion of perseverative behavior may contribute to the many adverse behavioral sequelae of alcohol intoxication in adolescents and young adults. Moreover, the long-term effect of adolescent chronic ethanol exposure on behavioral efficiency is similar to that observed after chronic exposure in humans

Diagnosis of acquired generalized lipodystrophy in a single patient with T-cell lymphoma and no exposure to Metreleptin

Abstract Background Metreleptin, a recombinant methionyl -human -leptin, was approved to treat patients with generalized lipodystrophy (GL) in February 2014. However, leptin therapy has been associated with the development of lymphoma. We present a unique case of a patient with prior history of T cell lymphoma in remission, who was diagnosed with Acquired Generalized Lipodystrophy (AGL) during the following year after a clinical remission of her lymphoma without receiving leptin therapy. Case presentation A 33-year-old woman with a diagnosis of stage IV subcutaneous panniculitis like T-cell lymphoma in 2011, underwent chemotherapy. Shortly after completion therapy, she had a relapse and required more chemotherapy with complete response, followed by allogenic stem cell transplant on June 28, 2012. Since that time, she has been on observation with no evidence of disease recurrence. Subsequent to the treatment, she was found to have high triglycerides, loss of fat tissue from her entire body and diagnosis of diabetes. Constellation of these findings led to the diagnosis of AGL in 2013. Her leptin level was low at 3.4 ng/mL (182 pmol/mL). She is currently not receiving any treatment with Metreleptin for her AGL. Conclusions Causal association between exogenous leptin therapy and T-cell lymphoma still remains unclear. We hereby present a case of a young woman who was diagnosed with AGL after going into remission from T-cell lymphoma and who has never been treated with Metreleptin. Steroid therapy and chemotherapy might have masked the diagnosis of AGL in this patient. We believe that patients can develop these 2 conditions independent of each other.https://deepblue.lib.umich.edu/bitstream/2027.42/148289/1/40842_2019_Article_76.pd

Сравнение показателей соотношений тромбоциты / лимфоциты и нейтрофилы / лимфоциты в качестве предикторов исхода COVID-19

Clinical presentation is an undependable prognostic indicator of COVID-19 (COronaVIrus Disease 2019). So, a more objective predictor is needed to precisely evaluate and classify the prognosis. Immune dysregulation to lymphocytes, mainly T-lymphocytes, have been noticed between COVID-19 patients. The aim. This study was planned to determine the role of platelet-to-lymphocyte count ratio and neutrophil-to-lymphocyte ratio in assessment of COVID-19 prognosis. Methods. 70 hospitalized patients with confirmed COVID-19 were included in this study. All included patients underwent a consistent clinical, radiological and blood examination. Laboratory analysis was made by means of a commercially accessible kit. Blood cells ratios were computed by dividing their absolute counts. Results. Non-significant association was found between laboratory data and COVID-19 clinical severity. A significant association between CT classification and platelet-to-lymphocyte count ratio (higher value in L type; p = 0.001) was detected. Platelet-to-lymphocyte count ratio was significantly higher among intubated cases. However, Non-significant association was found between neutrophil-to-lymphocyte ratio and need of endotracheal intubation. Conclusion. Routine blood values are abnormal in patients with COVID-19. Platelet-to-lymphocyte count ratio ratios could be used as more meaningful biomarker than other values in predicting the prognosis of COVID-19. LMR helpful in COVID-19 severity.Клиническая картина является ненадежным показателем прогноза исхода новой коронавирусной инфекции (НКИ), поэтому для точной оценки и классификации прогноза необходим более объективный прогнозирующий фактор. У пациентов, перенесших НКИ, отмечается нарушение регуляции иммунного ответа со стороны лимфоцитов, в основном Т-лимфоцитов. Целью исследования явилось определение роли показателей соотношений тромбоциты / лимфоциты и нейтрофилы / лимфоциты при оценке прогноза COVID-19. Материалы и методы. В исследование были включены госпитализированные пациенты (n = 70) с подтвержденным COVID-19 (COronaVIrus Disease 2019). У всех пациентов проводились последовательное клиническое и рентгенологическое обследование и анализ крови. Лабораторные анализы выполнялись с помощью коммерческого набора. Соотношения показателей клеток крови рассчитывались путем деления их абсолютного количества. Результаты. Обнаружена незначимая связь между лабораторными показателями и степенью тяжести COVID-19. Выявлена значимая связь между степенью поражения легких по данным компьютерной томографии и показателем соотношения тромбоциты / лимфоциты (более высокое значение для L-типа; p = 0,001). У интубированных пациентов соотношение показателя тромбоциты / лимфоциты было значимо выше. Однако обнаружена незначимая связь между показателем соотношения нейтрофилы / лимфоциты и необходимостью интубации трахеи. Заключение. У пациентов с COVID-19 наблюдаются отклонения показателей рутинных анализов крови. Показатель соотношения тромбоциты / лимфоциты может служить биомаркером при прогнозировании течения COVID-19, а показатель соотношения лимфоциты / моноциты полезен при прогнозировании степени тяжести COVID-19

Using Voice Technologies to Support Disabled People

In recent years, significant strides have been made in speech and speaker recognition systems, owing to the rapid evolution of data processing capabilities. Utilizing a speech recognition system facilitates straightforward and efficient interaction, especially for individuals with disabilities. This article introduces an automatic speech recognition (ASR) system designed for seamless adaptation across diverse platforms. The model is meticulously described, emphasizing clarity and detail to ensure reproducibility for researchers advancing in this field. The model’s architecture encompasses four stages: data acquisition, preprocessing, feature extraction, and pattern recognition. Comprehensive insights into the system’s functionality are provided in the Experiments and Results section. In this study, an ASR system is introduced as a valuable addition to the advancement of educational platforms, enhancing accessibility for individuals with visual disabilities. While the achieved recognition accuracy levels are promising, they may not match those of certain commercial systems. Nevertheless, the proposed model offers a cost-effective solution with low computational requirements. It seamlessly integrates with various platforms, facilitates straightforward modifications for developers, and can be tailored to the specific needs of individual users. Additionally, the system allows for the effortless inclusion of new words in its database through a single recording process

Cosmological dynamics of exponential gravity

We present a detailed investigation of the cosmological dynamics based on $\exp (-R/{\Lambda})$ gravity. We apply the dynamical system approach to both the vacuum and matter cases and obtain exact solutions and their stability in the finite and asymptotic regimes. The results show that cosmic histories exist which admit a double de-Sitter phase which could be useful for describing the early and the late-time accelerating universe.Comment: 17 pages LaTeX, 3 figure