The patterns of clinical presentations of cerebellar syndromes among adult Sudanese patients

Cerebellar syndromes are one of the commonest neurological diseases.Objectives: To study the patterns of clinical presentations of cerebellar syndromes and to identify the possible causes.Methods: This is a prospective hospital based, cross-sectional study. One hundred adult Sudanese patients with cerebellar syndromes were included in the study during the period from January 2006– January 2007.Results: The most common age group affected was 18 – 25 years. Male to female ratio was 1.5: 1 unsteadiness on walking was the most common symptom (83%). Gait-ataxia was the most common sign (83%). Cerebrovascular disease was the most common aetiology (25%).Conclusion: Cerebellar syndromes are not rare in Sudan. However, they were diagnosed more commonly at the central regions of the country probably because of more awareness of patients and better facilitiesfor diagnosis. The age of onset, the male predominance, the presentation and clinical findings were not different from reported literature. This also goes for the common causes apart from alcohol which is a strikingly rare as a cause in this study and could be accounted for the implementation of Elshariya (Islamic laws) Laws in Sudan.Keywords: ataxia, dysmetria, disdiadochokenesis, decomposition, nystagmus, dysarthria

Evaluation of efficient vehicular ad hoc networks based on a maximum distance routing algorithm

Traffic management at road intersections is a complex requirement that has been an important topic of research and discussion. Solutions have been primarily focused on using vehicular ad hoc networks (VANETs). Key issues in VANETs are high mobility, restriction of road setup, frequent topology variations, failed network links, and timely communication of data, which make the routing of packets to a particular destination problematic. To address these issues, a new dependable routing algorithm is proposed, which utilizes a wireless communication system between vehicles in urban vehicular networks. This routing is position-based, known as the maximum distance on-demand routing algorithm (MDORA). It aims to find an optimal route on a hop-by-hop basis based on the maximum distance toward the destination from the sender and sufficient communication lifetime, which guarantee the completion of the data transmission process. Moreover, communication overhead is minimized by finding the next hop and forwarding the packet directly to it without the need to discover the whole route first. A comparison is performed between MDORA and ad hoc on-demand distance vector (AODV) protocol in terms of throughput, packet delivery ratio, delay, and communication overhead. The outcome of the proposed algorithm is better than that of AODV

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Effect of sildenafil citrate on retinal functions: Preliminary report on Humphrey visual field analysis

Objective: To assess the effect of sildenafil citrate treatment on visual field analysis (VFA) in patients using sildenafil citrate for erectile dysfunction. Materials and Methods: In this prospective study on 18 male volunteers with erectile dysfunction, bilateral VFA was performed using the Humphrey 30-2 central standard threshold test. White-on-white (W/W) and blue-on-yellow (B/Y) protocols were used prior to treatment ( baseline VFA) and after treatment (repeat VFA) with sildenafil citrate. W/W and B/Y baseline VFA and repeat VFA mean deviations (MD) were compared. Results: The baseline MD for W/W and B/Y protocols were -1.34 +/- 1.8 and -2.59 +/- 2.1 dB, respectively, whereas the mean repeat MD for W/W and B/Y protocols were -1.79 +/- 2.21 and -2.83 +/- 3.31 dB, respectively. There was no statistically significant difference between W/W and B/Y baseline and repeat VFA with respect to MD (p > 0.05). Conclusion: Sildenafil citrate causes no significant changes in Humphrey VFA in patients with erectile dysfunction. Copyright (C) 2004 S. Karger AG, Basel

Efficient and Stable Routing Algorithm Based on User Mobility and Node Density in Urban Vehicular Network

Vehicular ad hoc networks (VANETs) are considered an emerging technology in the industrial and educational fields. This technology is essential in the deployment of the intelligent transportation system, which is targeted to improve safety and efficiency of traffic. The implementation of VANETs can be effectively executed by transmitting data among vehicles with the use of multiple hops. However, the intrinsic characteristics of VANETs, such as its dynamic network topology and intermittent connectivity, limit data delivery. One particular challenge of this network is the possibility that the contributing node may only remain in the network for a limited time. Hence, to prevent data loss from that node, the information must reach the destination node via multi-hop routing techniques. An appropriate, efficient, and stable routing algorithm must be developed for various VANET applications to address the issues of dynamic topology and intermittent connectivity. Therefore, this paper proposes a novel routing algorithm called efficient and stable routing algorithm based on user mobility and node density (ESRA-MD). The proposed algorithm can adapt to significant changes that may occur in the urban vehicular environment. This algorithm works by selecting an optimal route on the basis of hop count and link duration for delivering data from source to destination, thereby satisfying various quality of service considerations. The validity of the proposed algorithm is investigated by its comparison with ARP-QD protocol, which works on the mechanism of optimal route finding in VANETs in urban environments. Simulation results reveal that the proposed ESRA-MD algorithm shows remarkable improvement in terms of delivery ratio, delivery delay, and communication overhead