Acute Perforated Peptic Ulcer at El Obeid Hospital, Western Sudan

Background: The pattern of peptic ulcer disease and its complications has changed during the last two to three decades.Objectives: To state the frequency of acute peptic ulcer perforations and outcomes of their management at El Obeid Hospital, Western Sudan.Materials and Methods: This is an audit of patients with acute perforated peptic ulcer admitted to the emergency wards of the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan during the period from January 2006 to December 2012.Results: There were 53 patients, 94.3% were males. The age ranged between 18 and 77 years. Most of the patients reported late and 45.3% during Ramadan and Shawal. All patients had emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy. The postoperative mortality was 7.6%.Conclusions: Perforated peptic ulcer in this community was mainly  duodenal. Emergency peritoneal lavage and simple closure with omental patch followed by anti-ulcer therapy resulted in excellent outcomes. Old age, shock, peritonitis and septicaemia were the major risk factors formortality.Key words: Perforated duodenal and gastric ulcers

Sleep-wake sensitive mechanisms of adenosine release in the basal forebrain of rodents : an in vitro study

Adenosine acting in the basal forebrain is a key mediator of sleep homeostasis. Extracellular adenosine concentrations increase during wakefulness, especially during prolonged wakefulness and lead to increased sleep pressure and subsequent rebound sleep. The release of endogenous adenosine during the sleep-wake cycle has mainly been studied in vivo with microdialysis techniques. The biochemical changes that accompany sleep-wake status may be preserved in vitro. We have therefore used adenosine-sensitive biosensors in slices of the basal forebrain (BFB) to study both depolarization-evoked adenosine release and the steady state adenosine tone in rats, mice and hamsters. Adenosine release was evoked by high K+, AMPA, NMDA and mGlu receptor agonists, but not by other transmitters associated with wakefulness such as orexin, histamine or neurotensin. Evoked and basal adenosine release in the BFB in vitro exhibited three key features: the magnitude of each varied systematically with the diurnal time at which the animal was sacrificed; sleep deprivation prior to sacrifice greatly increased both evoked adenosine release and the basal tone; and the enhancement of evoked adenosine release and basal tone resulting from sleep deprivation was reversed by the inducible nitric oxide synthase (iNOS) inhibitor, 1400 W. These data indicate that characteristics of adenosine release recorded in the BFB in vitro reflect those that have been linked in vivo to the homeostatic control of sleep. Our results provide methodologically independent support for a key role for induction of iNOS as a trigger for enhanced adenosine release following sleep deprivation and suggest that this induction may constitute a biochemical memory of this state

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Landslide susceptibility mapping at VAZ watershed (Iran) using an artificial neural network model: a comparison between multilayer perceptron (MLP) and radial basic function (RBF) algorithms

Landslide susceptibility and hazard assessments are the most important steps in landslide risk mapping. The main objective of this study was to investigate and compare the results of two artificial neural network (ANN) algorithms, i.e., multilayer perceptron (MLP) and radial basic function (RBF) for spatial prediction of landslide susceptibility in Vaz Watershed, Iran. At first, landslide locations were identified by aerial photographs and field surveys, and a total of 136 landside locations were constructed from various sources. Then the landslide inventory map was randomly split into a training dataset 70 % (95 landslide locations) for training the ANN model and the remaining 30 % (41 landslides locations) was used for validation purpose. Nine landslide conditioning factors such as slope, slope aspect, altitude, land use, lithology, distance from rivers, distance from roads, distance from faults, and rainfall were constructed in geographical information system. In this study, both MLP and RBF algorithms were used in artificial neural network model. The results showed that MLP with Broyden–Fletcher–Goldfarb–Shanno learning algorithm is more efficient than RBF in landslide susceptibility mapping for the study area. Finally the landslide susceptibility maps were validated using the validation data (i.e., 30 % landslide location data that was not used during the model construction) using area under the curve (AUC) method. The success rate curve showed that the area under the curve for RBF and MLP was 0.9085 (90.85 %) and 0.9193 (91.93 %) accuracy, respectively. Similarly, the validation result showed that the area under the curve for MLP and RBF models were 0.881 (88.1 %) and 0.8724 (87.24 %), respectively. The results of this study showed that landslide susceptibility mapping in the Vaz Watershed of Iran using the ANN approach is viable and can be used for land use planning

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Quantifying and evaluating the impacts of cooperation in transboundary river basins on the Water-Energy-Food nexus: The Blue Nile Basin

Efficient utilization of the limited Water, Energy, and Food (WEF) resources in stressed transboundary river basins requires understanding their interlinkages in different transboundary cooperation conditions. The Blue Nile Basin, a transboundary river basin between Ethiopia and Sudan, is used to illustrate the impacts of cooperation between riparian countries on the Water-Energy-Food nexus (WEF nexus). These impacts are quantified and evaluated using a daily model that simulates hydrological processes, irrigation water requirements, and water allocation to hydro-energy generation and irrigation water supply. Satellite-based rainfall data are evaluated and applied as a boundary condition to model the hydrological processes. The model is used to determine changes in the long-term economic gain (i.e. after infrastructure development plans are implemented and in steady operation) for each of Sudan and Ethiopia independently, and for the Blue Nile Basin from WEF in 120 scenarios. Those scenarios result from combinations of three cooperation states: unilateral action, coordination, and collaboration; and infrastructure development settings including the Grand Ethiopian Renaissance Dam and planned irrigation schemes in Sudan. The results show that the economic gain of the Blue Nile Basin from WEF increases with raising the cooperation level between Ethiopia and Sudan to collaboration. However, the economic gain of each riparian country does not necessarily follow the same pattern as the economic gain of the basin

Filling Africa’s largest hydropower dam should consider engineering realities

The Grand Ethiopian Renaissance Dam (GERD) on the Nile River will double Ethiopia’s electricity generation and reduce the Nile flow to Sudan and Egypt during reservoir filling. We argue that multi-country negotiations over the initial filling and long-term operation of the GERD reservoir should not overlook key dam engineering features

Cooperative filling approaches for the Grand Ethiopian Renaissance Dam

Strategies forfilling the Grand Ethiopian Renaissance Dam and implications for downstream water resources are analyzed using a river basin planning model with a wide range of historical hydrological conditions and increasing coordination between the co-riparian countries. The analysisfinds that risks to water diversions in Sudan can be largely managed through adaptations of Sudanese reservoir operations. The risks to Egyptian users and energy generation can be minimized through combinations of sufficient agreed annual releases from the Grand Ethiopian Renaissance Dam, a drought management policy for the High Aswan Dam, and a basin-wide cooperative agreement that protects the elevation of Lake Nasser