Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Breast conservation treatment at Groote Schuur Hospital : treatment outcome

Includes bibliographical references (leaves 56-62)

Comparison of continuous dynamics probing with the standard penetration test for highly weathered limestone of eastern Sudan

Insitu soil tests in general have the advantage of allowing measurements under the field environmental conditions with minimum amount of soil disturbance due to sampling. A comparison of continuous dynamic probing with the SPT has been made for a case study of highly weathered limestone in Eastern Sudan. The correlation of Modified Light Dynamic Penetrometer, DPLmod with the Standard Penetration Test, SPT is obtained in terms of penetration resistance. Two types of correlation are obtained using statistical analysis: DPN300 vs. SPTN300 and DPN100 vs. SPTN300. The analysis results have indicated a general trend line of linear correlation without intercept. The obtained correlations were compared to some previous similar correlations. This comparison indicated that this study produced correlations that have the same trend line as that for the previous studies. The correlations of this research are found to be better than the similar correlations collected from the literature review as reflected by the correlation coefficient, which is ranging from 0.85 to 0.92 for the current research correlations and from 0.31 to 0.89 for the previous correlations. This comparison supports the idea of this research and is considered as a successful step for producing correlations for this simple method. The relationship between input energy and theoretical energy for both continuous dynamic probing and standard penetration test as well as the relationship between input energies for both types of tests was produced. It is found that the Engineering News Record (ENR) formula is the most suitable to represent the SPT theoretical energy, whereas for the dynamic probing theoretical energy the formula after Gates (1957) is the best one. This study has verified high degree of consistency between the two tests

Comparison of continuous dynamic probing with the standard penetration test for highly weathered limestone of Eastern Sudan

Insitu soil tests in general have the advantage of allowing measurements under the field environmental conditions with minimum amount of soil disturbance due to sampling. A comparison of continuous dynamic probing with the SPT has been made for a study case of highly weathered limestone in Eastern Sudan. The correlation between the two test results is obtained in terms of penetration resistance and compared with the previous studies results. This reflected that the correlations of this study have the same trend line as that for the correlations of previous studies. The correlation coefficient for the current study, which ranges from 0.85 to 0.92, is better than that for the correlations obtained from literature review, which falls in the range of 0.31 to 0.89. This is considered to be a successful step to establish reliable correlations for this simple method. The relationship between input energy and theoretical energy for both continuous dynamic probing and standard penetration test as well as the relationship between input energies for both types of tests was produced. This study has verified high degree of consistency between the two tests

Immunohistochemistry defined subtypes of breast cancer in 678 Sudanese and Eritrean women; hospitals based case series

Abstract Background Breast cancer is the most common malignancy accounting for 25% of all cancers in females. In Africa, breast cancer prevalence and mortality are steadily increasing. Knowledge of hormone receptors and human epidermal growth factor receptor-2 (HER-2) expressions are vital for breast cancer management plans and decision making. There is wide regional variation in the proportion of these biomarkers, especially in African countries. Hormone receptors positivity in indigenous African and African American women is considered to be low and triple negative breast cancer is a dominant phenotype. There is paucity of data regarding hormone receptors (ER and PR) and HER2 expressions in North-eastern Africa (Eritrea and Sudan). The purpose of this study was to evaluate the expression of ER, PR and HER2 in Eritrean and Sudanese case series and correlate these biomarkers with the clinicopathological profile. Method Clinicopathologic data of patients were collected from clinical records. Immunohistochemistry biomarkers (ER, PR, and HER2) were assessed in consecutive female patients who had been diagnosed with invasive breast cancer from 2011 to 2015 in Gezira University Pathology Laboratory, the Sudan and National Health laboratory, Asmara, Eritrea. Results There were 678 cases involved in this study. The mean age was 48.8 years with ±0.53 standard error of the mean. Two-thirds of the case were ≤50 years. Invasive ductal carcinoma, no special type was the most dominant histologic type (86%) in both study groups. The majority of cases (70%) had tumour stage pT2 and pT3 and about 50% had lymph node involvement. Less than 5% of the cases had well-differentiated tumours. The ER, PR and HER2 positive rates were 45%, 32%, and 29%, respectively. The proportion of luminal-A like, luminal-B like, HER2 enriched and TNBC were 37%, 13%, 16% and 34%, respectively. Fisher extract analysis showed age (p = .015), tumour size (p = .041), and histologic grade (p = .000) were significantly associated with intrinsic subtypes. Furthermore, Logistic regression analysis stratified by origin, age, tumour size, lymph-node metastasis and grade indicated that younger women age (≤50 years) and grade III tumours were more likely to be diagnosed with ER negative breast cancer. Conclusion Most of Sudanese and Eritrean women were diagnosed at younger age and with unfavourable prognostic clinicopathologic prognostic markers. TNBC is more frequent in this cohort study; patients with grade III tumours and young age are more likely to be hormone receptors negative. Therefore, routine determination of hormone receptors is warranted for appropriate targeted therapy

A Survey: To Govern, Protect, and Detect Security Principles on Internet of Medical Things (IoMT)

The integration of medical equipment into the Internet of Things (IoT) led to the introduction of Internet of Medical Things (IoMT). Variation of IoT devices have been equipped in medical facilities. These devices provided convenience to healthcare provider since they can continuously monitor their patients in real-time, while allowing them to have greater physical flexibility and mobility. However, users of healthcare services (such as patients and medical staff) often are less concerned about security issues associated with IoT. These alleviate existing problems and jeopardize the lives of their patients by making them susceptible to attacks. Furthermore, IoMT applications have direct access to healthcare services because it handles sensitive patient information. Therefore, it is extremely important to preserve and establish the security and privacy of IoMT. This further justifies the need to investigate and address the related issues. Despite existing literature on security and privacy mechanisms, the domain still requires more attention. Therefore, this paper aims to discuss the security and privacy principles, as well as challenges associated with IoMT. Besides, a comprehensive analysis of privacy and security solutions for IoMT is also presented. In addition, we introduced a novel taxonomy of IoMT security and privacy based on cyber security principles such as “govern,” “protect,” and “detect”. In conclusion, this paper provides a discussion on existing challenges and future direction for researchers

Impacts of Agricultural Practices on Insecticide Resistance in the Malaria Vector Anopheles arabiensis in Khartoum State, Sudan.

BACKGROUND Agricultural pesticides may play a profound role in selection of resistance in field populations of mosquito vectors. The objective of this study is to investigate possible links between agricultural pesticide use and development of resistance to insecticides by the major malaria vector Anopheles arabiensis in northern Sudan. METHODOLOGY/PRINCIPAL FINDINGS Entomological surveys were conducted during two agricultural seasons in six urban and peri-urban sites in Khartoum state. Agro-sociological data were collected from 240 farmers subjected to semi-structured questionnaires based on knowledge attitude and practice (KAP) surveys. Susceptibility status of An. arabiensis (n=6000) was assessed in all sites and during each season using WHO bioassay tests to DDT, deltamethrin, permethrin, Malathion and bendiocarb. KAP analysis revealed that pesticide application was common practice among both urban and peri-urban farmers, with organophosphates and carbamates most commonly used. Selection for resistance is likely to be greater in peri-urban sites where farmers apply pesticide more frequently and are less likely to dispose of surpluses correctly. Though variable among insecticides and seasons, broad-spectrum mortality was slightly, but significantly higher in urban than peri-urban sites and most marked for bendiocarb, to which susceptibility was lowest. Anopheles arabiensis from all sites showed evidence of resistance or suspected resistance, especially pyrethroids. However, low-moderate frequencies of the L1014F kdr allele in all sites, which was very strongly associated with DDT, permethrin and deltamethrin survivorship (OR=6.14-14.67) suggests that resistance could increase rapidly. CONCLUSIONS Ubiquitous multiple-resistance coupled with presence of a clear mechanism for DDT and pyrethroids (kdr L1014F) in populations of An. arabiensis from Khartoum-Sudan suggests careful insecticide management is essential to prolong efficacy. Our findings are consistent with agricultural insecticide use as a source of selection for resistance and argue for coordination between the integrated vector control program and the Ministry of Agriculture to permit successful implementation of rational resistance management strategies