Tako-Tsubo Cardiomyopathy in a Patient with Advanced Colorectal Adenocarcinoma

Transient left ventricular dysfunction syndrome (TLVDS), or Tako-Tsubo cardiomyopathy (TC), is a clinical entity in which patients present with features of acute coronary syndrome, electrocardiogram abnormalities, and transient left ventricular (apical or mid-ventricular) dysfunction. Patients usually recover from this condition four to six weeks after the event. The etiology or triggering factors of TC remains unknown. Various triggering factors have been associated with this syndrome, with one of the most recent being malignancies. In this case report we present a postmenopausal female with underlying advanced malignancy who presented with TC. This is consistent with a recent hypothesis that in addition to currently known triggering factors, malignancies might well trigger TC in the context of a stressor or paraneoplastic phenomenon

Epidemiology of antibiotic resistance in culture-positive hospitalized patients in selected hospitals in Khartoum, Sudan

Objective: To study the prevelence of antibiotic resistance and the prevalent bacterial isolates in hospitalized patients in Khartoum hospitals. Materials & Methods: A cross-sectional prevalence study was carried out during the period of April–November 2015 in Khartoum; 226 bacterial cultures were included. Identification of isolates using standard biochemical tests and antibiotic susceptibilities were determined using disc diffusion method. Results were interpreted according to the standards of the British society of antimicrobial chemotherapy. Results: Eight bacterial species were isolated: Staphylococcus aureus, Enterococcus faecalis, Streptococcus spp., Klebsiella pneumoniae, Pseudomonas spp., Escherichia coli, Proteus spp., and Acinetobacter spp. S. aureus was the most prevalent, the majority of which were resistant to methicillin/oxacillin (MRSA). Cultures in our study were mainly from urine (36.7%), blood samples (37.2%), and wound cultures (19%). More than 90% of the tested isolates were resistant to cefuroxime; 54% and 73.8% of Gram-positive and Gram-negative isolates, respectively, were resistant to ceftazidime. Furthermore, there was a high meropenem resistance among Gram-negative isolates tested. Multi-resistant Acinetobacter spp. as well as vancomycin-resistant S. aureus was isolated. Gram-negative isolates showed good susceptibilities to aminoglycosides as well as ciprofloxacin. However, the high resistance rate to these antibiotics was observed in Gram-positive isolates in these hospitals. Conclusion: Methicillin-resistant S. aureus was the most prevalent organism. Gramnegative isolates showed good susceptibilities to aminoglycosides and ciprofloxacin. There were high resistance rates to cefuroxime, ceftazidime, and meropenem. Five vancomycin-resistant S. aureus were identified

Association of NOS3 gene polymorphisms with essential hypertension in Sudanese patients: a case control study

Abstract Background Essential hypertension (EH) is influenced by various environmental and genetic factors. Nitric oxide is important for the functional integrity of the vascular endothelium and is produced in endothelial cells by the enzyme endothelial nitric oxide synthase (eNOS). EH has a strong genetic component, and the NOS3 gene, which encodes eNOS, represents an interesting candidate for contribution to the phenotype. The most clinically relevant polymorphisms in the NOS3 gene are rs1799983 in exon 7 (encoding Glu298Asp), a variable number tandem repeat (VNTR) in intron 4, and rs2070744 (T-786C) in the promoter region. This study aims to investigate the association between these three polymorphisms in the NOS3 gene and EH in Sudanese patients. Methods Hypertensive patients (n = 157) > 18 years of age with established hypertension from various hospitals in Khartoum, and controls (n = 85) > 18 years of age and with blood pressure measurements 1% of the Sudanese population under study. Conclusion The results of this study indicated that the rs2070744 polymorphism in NOS3 may be a genetic susceptibility factor for EH in the Sudanese population. The c allele of intron 4 VNTR is not rare in the Sudanese population

Case report: Insulin desensitization as the only option for managing insulin allergy in a Sudanese patient

IntroductionAllergic reactions to insulin have become very rare with the introduction of human insulin. Anaphylaxis is a life-threatening condition that results from immediate IgE-mediated hypersensitivity. Desensitization to human insulin was reported to control immediate hypersensitivity reactions to insulin. Here, we describe the history and challenges of managing our patient and the development of an insulin desensitization protocol in a resource-limited setup.Case SummaryA 42-year-old Sudanese woman with poorly controlled type 2 diabetes on maximum antidiabetic medications required insulin therapy to achieve reasonable glycemic control. She developed progressive and severe immediate hypersensitivity reactions to insulin, including anaphylaxis. Serum sample analysis demonstrated insulin-specific IgE antibodies. The patient's poor glycemic control and the need for breast surgery indicated insulin desensitization. A 4-day desensitization protocol was delivered in an ICU bed for close observation. Following successful desensitization and 24-h observation, our patient was discharged on pre-meal human insulin, which was tolerated well to the current dateConclusionsAlthough insulin allergy is rare, once encountered, it is very challenging in patients who have no other treatment options available. Different protocols for insulin desensitization are described in the literature; the agreed protocol was implemented successfully in our patient despite the limited resources

Epidemiology of Antibiotic Resistance in Culture-positive Hospitalized Patients in Selected Hospitals in Khartoum, Sudan

Objective: To study the prevelence of antibiotic resistance and the prevalent bacterial isolates in hospitalized patients in Khartoum hospitals. Materials & Methods: A cross-sectional prevalence study was carried out during the period of April–November 2015 in Khartoum; 226 bacterial cultures were included. Identification of isolates using standard biochemical tests and antibiotic susceptibilities were determined using disc diffusion method. Results were interpreted according to the standards of the British society of antimicrobial chemotherapy. Results: Eight bacterial species were isolated: Staphylococcus aureus, Enterococcusfaecalis, Streptococcus spp., Klebsiella pneumoniae, Pseudomonas spp., Escherichia coli, Proteus spp., and Acinetobacter spp. S. aureus was the most prevalent, the majority of which were resistant to methicillin/oxacillin (MRSA). Cultures in our study were mainly from urine (36.7%), blood samples (37.2%), and wound cultures (19%). More than 90% of the tested isolates were resistant to cefuroxime; 54% and 73.8% ofGram-positive and Gram-negative isolates, respectively, were resistant to ceftazidime. Furthermore, there was a high meropenem resistance among Gram-negative isolates tested. Multi-resistant Acinetobacter spp. as well as vancomycin-resistant S. aureus was isolated. Gram-negative isolates showed good susceptibilities to aminoglycosides as well as ciprofloxacin. However, the high resistance rate to these antibiotics was observed in Gram-positive isolates in these hospitals. Conclusion: Methicillin-resistant S. aureus was the most prevalent organism. Gramnegative isolates showed good susceptibilities to aminoglycosides and ciprofloxacin. There were high resistance rates to cefuroxime, ceftazidime, and meropenem. Five vancomycin-resistant S. aureus were identified

Irrational use of antibiotics with representation of antimicrobial resistance patterns in Sudan: a narrative review

Increasing bacterial resistance to antibiotics is a growing menace, mainly caused by the rapid genetic modification of bacterial strains and new alternations in behavior favoring their survival. There is no doubt that the irrational use of antibiotics is one of the factors contributing to the rise of this problem, whether that be in hospitals or at a community level. Although the extent of this influence is yet to be learned, it is definite that this is of great impact on the endemic disease patterns in developing areas specifically and on an expanding global issue generally

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially