Airway Management in ICU Settings

Maintenance of patent airway, adequate ventilation, and pulmonary gas exchange is very important in critically ill patients. Airway management in intensive care patients differs significantly from routine surgical procedures in the operating room. The airway competence in intensive care unit (ICU) should be coping with the rapidly evolving advances in airway management. Therefore, efforts should be focused on the three pillars of airway master: airway providers as intensivists or critical care physicians, equipment, and operational plans. Not all institutions can afford all airway equipment in the market; however, they should make sure that critical care providers have a full access to the available tools and they are comfortable using it. Educational sessions and refresher courses should be tailored to meet the competence level of the ICU providers and equipment availability. Operational plan includes developing institutional airway protocols and implementing difficult airway guidelines. The protocols should consider different staffing models of ICU and make sure all the time at least one member of the team with the highest experience in airway should be always available. The aim of writing this chapter is to enable the intensivist to optimize their use of airway equipment and managing high‐risk patients in ICU

SUCCESSFUL TWO PREGNANCIES IN ACHONDROPLASIC MOTHER, A CASE REPORT

The word achondroplasia is derived from Greek and means "without cartilage formation," although individuals with achondroplasia do have cartilage. In genetics, dominance describes the effects of the different versions of a particular gene on the phenotype of an organism. Many animals (including humans) and plants have two copies of each gene in their genome, one inherited from each parent

Knowledge, attitude and practice of hepatitis (B) among healthcare workers in relation to their vaccination status in Khartoum, Sudan, 2015: a cross-sectional study

Background: Hepatitis B is a serious chronic infection of the liver and caused by hepatitis B virus. It is an endemic disease in Sudan. Healthcare workers are occupationally more prone to acquire the disease. Evaluation of their knowledge, attitude and practice and their vaccination status, are very important in the control of the disease. The aim of this study was to assess the knowledge, attitude, and practiceof healthcare workers towards hepatitis B and their vaccination status. Materials and Methods: In total, 372 healthcare workers were enrolled in the study, which was conducted at 10 public hospitals in Khartoum state during July-August 2015. After taking written informed consent from the Khartoum State Research Department, self-administrated questionnaires were distributed to the healthcareworkers. The KAP score was the sum of the three categories, which is 32 points, and the mean was then obtained. Results: The study revealed that the respondents’ mean scores of knowledge, attitude, and practice (KAP) were 18.4, 2.14 and 2.49, respectively. The study also showed that doctors have the highest KAP score in comparison with other occupations. Doctors are the least occupational category that uses gloves when dealing with patient’s blood. The KAP score was found higher among vaccinated healthcare workers 27.4% in comparison to unvaccinated ones, That yield to a significant the association between KAP score and vac-cination status (p-value0.007).Conclusions: This study concluded that, there is a positive association between the level of vaccination among Health care workers and their Knowledge, attitude and practice of hepatitis B virus. Further studies would be recommended on larger population

Safety of Transcatheter Aortic Valve Replacement in Patients with Aortic Aneurysm: A Propensity-Matched Analysis

Introduction There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA. Methods We queried the National Inpatient Sample database (2012–2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that \u3e 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA. Results From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28–1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0–7.0) versus 3 days (IQR 2.0–6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73–1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81–1.69), p = 0.40], aortic dissection [OR 2.38 (0.41–13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18–1.16), p = 0.09], vascular complications [OR 0.80 (0.34–1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81–1.57), p = 0.42], blood transfusion [OR 1.20 (0.84–1.70), p = 0.26], and stroke [OR 0.58 (0.24–1.39), p = 0.25] were similar in those with and without AA. Conclusions Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA. Key Summary Points Patients with a diagnosis aortic aneurysm (thoracic or abdominal) undergoing transcatheter aortic valve replacement (TAVR) have same risk of periprocedural complications as those without a diagnosis of aortic aneurysms (AA). Patients with a diagnosis of aortic aneurysm had a longer length of hospital stay. Further studies are needed to determine how specific features of aortic aneurysm such as size, shape, thrombus burden, or calcifications affect the safety of TAVR

Diagnostic Accuracy of the Leishmania OligoC-TesT and NASBA-Oligochromatography for Diagnosis of Leishmaniasis in Sudan

The leishmaniases are a group of vector-borne diseases caused by protozoan parasites of the genus Leishmania. The parasites are transmitted by phlebotomine sand flies and can cause, depending on the infecting species, three clinical manifestations of leishmaniasis: visceral leishmaniasis (VL), post kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL) including the mucocutaneous form. VL, PKDL as well as CL are endemic in several parts of Sudan, and VL especially represents a major health problem in this country. Molecular tests such as the polymerase chain reaction (PCR) or nucleic acid sequence based assay (NASBA) are powerful techniques for accurate detection of the parasite in clinical specimens, but broad use is hampered by their complexity and lack of standardisation. Recently, the Leishmania OligoC-TesT and NASBA-Oligochromatography were developed as simplified and standardised PCR and NASBA formats. In this study, both tests were phase II evaluated for diagnosis of VL, PKDL and CL in Sudan

Number Recognition in the Saudi License Plates using Classification and Clustering Methods

This study is conducted for the purpose of recognizing numbers printed on the license plates images. The size of different patterns in the Saudi license plates is 20: the Arabic and English numbers. It is hard to classify all the numbers due to the similarity between specific numbers. This paper will propose to use a clustering technique called X-Means in order to regroup the numbers that have the same characteristics. Later develop a specific classification technique for each cluster. The experimentation of the proposed approach is applied on our constructed dataset gave us some limitation in classification. The results are improved by constructing a reference image for each class selected using a specific criteria from the training dataset. Moreover, the experimental results ensure better recognition accuracy by using the proposed methods rather than classifying the same dataset using other classical classifier in the state-of-art

Undergraduate medical research perspective among medical students in university of Khartoum: a cross-sectional study from Sudan

Background: Research is one of the crucial factors in the advancement of health. Undergraduate medical research training is a cornerstone in medical students’ education. This study aimed to evaluate the knowledge and attitude of medical students toward medical research. Methods: This cross-sectional analytical study included 200 medical students in their fifth and sixth years at the Faculty of Medicine, University of Khartoum. Data was collected using a self-administered questionnaire, assessing students’ knowledge and attitudes toward medical research, which were scored out of 100. Data were analyzed using the SPSS software. Results: Of the 200 students, 69% were females and 31% males; 81% of them held a Sudanese secondary school diploma and reported future clinical career choice. Their mean academic score was 16 out of 32  6.6 points. Students’ mean knowledge score was 36 out of 100, which was considered low. Their mean attitude score toward medical research was 48.2 out of 100, which was considered moderate.   Conclusions: This study concluded that the knowledge of fifth- and sixth-year medical students about medical research was low. However, moderately positive attitude was reported among them. It is recommended that students’ engagement in active research ought to be started early in their medical school. Additionally, more engaging and interactive methods of teaching research are endorsed to be implemented. Keywords: attitude; knowledge; medical research; medical students; University of Khartou

Role of small ruminants in the epidemiology of foot-and-mouth disease in Sudan

Anti-3ABC activity was studied, using the Priocheck ELISA, in 1195 sheep and goats sera from four different states in Sudan; South and North Kordfan, Blue Nile and Kassala. Positive sera were screened by serum neutralization test (SNT) for serotype specific antibodies against known active FMD infections in the country; “O”, “A” and “SAT2”. Results were compared with those of 119 cattle sera; tested simultaneously. Regardless of the locality and the test system used, much lower activity was detected in sheep and goats than in cattle. Almost in every case, sero-prevalence of serotype specific antibodies in sheep and goats followed the same order that in cattle. Excluding the Blue Nile State, sero-prevalence of anti-3ABC antibodies in small ruminants (n=870) was 14.1% (C. I. 11.79%-16.41%) whereas that in cattle (n=89) was 53.9% (43.54%-64.26%). Unlike cattle, around 20% of small ruminants Priocheck positive sera failed to react in combined SNT while, concurrently, strong positive Priocheck reactors represented only 8.61% (n=1195). Apart from the Blue Nile state, sero-prevalence of serotype specific antibodies in small ruminants, in any instance, did not exceed 11%. Results were in agreement with the field observation in Sudan describing no clinical FMD in small ruminants. Infection of FMD in sheep and goats seemed largely secondary to that in cattle i.e. transmission within small ruminants’ herds was likely less significant than transmission from cattle. Sero-prevalence’s in goats, which generally reared more close to cattle, surpassed that in sheep (generally more susceptible), only, in Kassala state, where little grazing of cattle was practiced indicating also the insignificance of transmission within small ruminants herds. Diminished role of small ruminants in the epidemiology of FMD in Sudan is conceivable. Where higher FMD activity was detected, in the Blue Nile state, sero-prevalenc of anti-3ABC antibodies mounted to 37.8% (C. I. 32.53%-43.07%) in small ruminants (n=325) and to 83.3% (C. I. 69.95%- 96.65%) in cattle (n=30). Sero-prevalence’s of the mostly predominant type “O” reached 64% and 24% in cattle and small ruminants respectively. The no very good match between Priocheck ELISA and combined SNT positive reactors in small ruminants was likewise observed previously in wild life, in East Africa, when sero-prevalence estimates in the two test systems were low. Sheep, in Blue Nile and South Kordfan states where more multi-serotype conditions prevailed, showed statistically significantly different proportions (p= 0.0036) of such reactors. Likely, mild exposure (limited virus multiplication) to different serotypes resulted in boosting immune response to NSP but not to SP

Sero-epidemiology of foot-and-mouth disease in Sudan

The prevalence of antibodies against the three active infections of foot-and-mouth disease (FMD) in Sudan; “O”, “A” and “SAT2”, was studied in more than 1500 cattle sera, collected from 7 states in 2013, using a screening format of serum neutralization test (SNT). Prevalence’s detected were 60.16% ±2.25, 30.04%±2.19 and 12.31% ±1.59 for type “O”, “A” and “SAT2” respectively. The result indicated intense circulation and wide distribution of type “O” in the country as opposed to a likely significant introduction of type “SAT2” and “A”. The geographical distribution of FMD infections was defined as penetrating along the Nile basin,  particularly, for “O” and “A” viruses and more favorable at Eastern and Western Sudan. Still more favorable conditions are to be expected North of Khartoum and in Darfur in the far West. Type “O” was intensely  disseminated along the Nile basin and distribution decreased away from there. The Blue Nile state, at the South Eastern corner of the country, was an important route of entry of the three FMD viruses. Evidently, more risk factors were associated with intense traffic and movements of livestock related to national trade along and from the Nile basin than with movement of livestock associated with nomadic pastoralists in the East and West of the country. Nonetheless, movement of nomadic pastoralists in the East was associated with the potential risk of introduction of type “A” through the extended Eastern border of the country from Wad El Helew in Kassala to Aljabalein in the White Nilestate.Keywords: Foot-and-mouth disease; Sudan; epidemiology; Serum  neutralization test; type “O”, “A” and “SAT2” viruses  Séroépidémiologie de la fièvre aphteuse au SoudanLa prévalence des anticorps contre les trois infections actives de fièvre aphteuse au Soudan, à savoir «O», «A» et «SAT2», a été étudié dans plus de 1500 sérums de bovins, prélevés dans 7 États en 2013, selon un mode de dépistage du test de neutralisation du sérum (SNT). Les taux de prévalence détectés étaient de 60,16% ± 2,25, 30,04% ± 2,19 et 12,31% ± 1,59, respectivement pour les types «O», «A» et «SAT2». Le résultat est une indication d’une circulation importante et d’une large distribution du type «O» dans le pays, par opposition à une introduction probablement significative de «SAT2» et «A». En ce qui concerne la répartition géographique des infections à fièvre aphteuse, il a été déterminé que son inclusion se faisait le long du bassin du Nil, en particulier pour les virus «O» et «A», les conditions étant plus propices à l’est et au sud-ouest du Soudan. Des conditions encore plus propices sont à prévoir au nord de Khartoum et au Darfour dans l’extrême-ouest. Le type «O» a été intensément disséminé le long du bassin du Nil et sa distribution a diminué à partir de cette région. L’État du Nil bleu, au sud-est du pays, a été une voie importante d’entrée des trois virus de la fièvre aphteuse. De toute évidence, un plus grand nombre de facteurs de risque ont été associés à une circulation intense et à des mouvements de bétail résultant du commerce national le long et à partir du bassin du Nil, plutôt qu’avec des mouvements de bétail appartenant aux pasteurs nomades à l’Est et à l’Ouest du pays. Néanmoins, le mouvement des pasteurs nomades à l’Est a été associé au risque potentiel d’introduction du type «A» à travers la longue frontière orientale du pays, qui s’étend de Wad El Helew à Kassala jusqu’à Aljabalein dans l’État du Nil Blanc.Mots-clés : fièvre aphteuse, Soudan, épidémiologie, test de neutralisation de sérum; virus des types “O”, “A” et “SAT2