Synthesis, Biological activity and Mass Spectral Fragmentation Patterns of some New Fused Phthalazine-1,4-dione Derivatives

1,2,4-Triazino[1,2-b]phthalazine-6,11-dione (3) and 1,2,4-triazino[1,2-b]phthalazine-5,10-dione (4) were prepared via the reaction of 2-aminothiocarbonylphthalazine-1,4-dione with ethyl chloropropionate and ethyl chloroacetate.Acetylation of 4 with Ac2O gave the corresponding monoacetylderivative (5), while the acetylation of 4 with Ac2O in the presence of AcONa gave the corresponding diacetyl derivative (6). Treatment of 4 with bromine in AcOH and aromatic aldehydes afforded the corresponding 3-substituted-1,2,4-triazino[1,2-b]phthalazine-5,10-diones (7 and 8). The electron impact mass spectra of both of the above series of compounds have also been recorded and theirfragmentation pattern is discussed

Adherence to Anti-seizure Drugs and Associated Factors among Children with Epilepsy in central Sudan

Background: Epilepsies are the most common neurological disorder in children worldwide. They result in disability or even death. Adherence to anti-seizure drugs (ASDs) is challenging for children with epilepsies. Methods: This cross-sectional descriptive study was conducted on 67 children with epilepsies age between (2-16 years of age) on follow up visits at neurology refer clinic at Wad Medani Pediatric Teaching Hospital; Central Sudan from February to July. 2022. Adherence to ASDs was measured using Morisky’s Medication Adherence Scale eight – items (MMAS-8) translated to the local language. Descriptive analysis was conducted to calculate frequencies and percentages for categorical data, chi-square test for associated factors with adherence. A P-value of < 0.05 was considered statistically significant.  Results: Gender analysis showed that 36 (53.7%) of patients were males. Forty-eight (71.6%) had good adherence to their medications. Thirty-three (49.3%) had 1-12 seizures/year. Thirty-nine (58.2%) of participants had generalized seizures while 22 (32.8%) had focal seizures. Sixty-six (95.5%) of study patients on poly therapy had good adherences. Adherence was not found to be associated with sex, age, parental education, employment status, ASDs, duration of epilepsy, type of epilepsy, seizures frequency or monotherapy versus poly therapy (p value > 0.05)

Evaluation of Side Effects of Anti-Seizure Drugs Among Sudanese Children with Epilepsy in Wad Medani Pediatric Teaching Hospital

Abstract: Background: Treatment of epilepsy with anti-seizure drugs (ASDs) for 2-5 years is important to control epileptic seizures.  Side effects of ASDs are well recognised and affect treatment outcomes if ASDs are severe. Methods: A cross-sectional descriptive hospital-based study was conducted on 67 children with epilepsy on follow-up visits at a neurology referral clinic in Wad Medani Pediatric Teaching Hospital, Central Sudan, from February 2022 to July 2022.  Side effects of ASDs were measured using the Pediatric Epilepsy Side Effects Scale (PESQs).  Data were entered into the Statistical Package of Social Sciences (SPSS) version 20, and descriptive analysis was done to calculate frequencies and percentages and chi-square test for association.  The P-value of < 0.05 was considered statistically significant. Results: Gender assessment showed that 36 (53.7%) of study patients were male.  43(64.2%) of participants had low severity of side effects, 14(20.9%) had low–moderate severity, and 8(11.9%) had no side effects. Significant associations were found between age and cognitive side effects (P-value .008); epilepsy type and cognitive side effects (P-value .026); seizure frequency and behavioural side effects (P-value .018); Type of ASD and behavioural side effects (P-value .000) and; type of ASD and neurological side effects (P-value .004)

Effect of different treatments on germination of Romi red grape seeds

Germination of seeds required a stratification period either at cold (5 ± 1 °C) or warm (18 ± 1 °C) conditions. Besides, production of normal seedlings (seedlings with plumule) needed stratification of at least 60 d. Cold stratification treatments increased pronouncedly the percentages of seed germination and normal seedlings when seeds were first subjected to warm stratification conditions. Soaking the seeds in IAA, IBA or Ethrel at different concentrations before sowing failed completely to produce normal seedlings. Conversely, the best results with respect to germination i;ercentage and normal seedlings were obtained with GA-, especially at 5000 ppm, followed by thiourea and kinetin. Applying GA3 to seeds immediately before stratification was more effective than adding it after stratification.Der Einfluß verschiedener Behandlungsbedingungen auf die Samenkeimung bei der Rebsorte Romi redDie Samen der Rebsorte Romi red keimten nur nach Stratifikation, entweder unter Kälte- oder unter Wärmebedingungen (5 ± 1 °C bzw. 18 ± 1 °C). Normale Sämlinge, d. h. solche mit Plumula, entwickelten sich nur bei einer Stratifikationsdauer von mindestens 60 d. Durch Kaltstratifikation wurde der Anteil keimender Samen und normaler Sämlinge bedeutend erhöht, wenn die Samen zuvor warmstratifiziert worden waren. Das Einweichen der Samen vor der Aussaat in unterschiedlichen Konzentrationen von IAA, IBA oder Ethrel förderte die Bildung normaler Sämlinge in keiner Weise. Umgekehrt wurden im Hinblick auf die Samenkeimung und die Bildung normaler Sämlinge die besten Ergebnisse mit GA3, vor allem in der Konzentration von 5000 ppm erzielt; auch Thioharnstoff und Kinetin zeigten einen positiven Einfluß. GA3-Behandlung der Samen unmittelbar vor der Stratifikation war wirksamer als danach

Surgical Outcome of Three-Dimensional Correction of Adolescent Idiopathic Scoliosis

Background: Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated "S" or "C" shape; the bones of the spine are also slightly twisted or rotated. To prevent further curve progression and obtain a balanced spine, surgery remains the mainstay of treatment for idiopathic scoliosis (IS). Objective: This study aimed to discuss three dimensional surgical techniques used for correction of adolescent idiopathic scoliosis, evaluating their feasibility, efficacy and safety. Patients and methods: This study was conducted in Mansoura University Hospital and Alexandria University Hospitals between September 2018 and April 2021. 3D surgical correction was performed for 91 patients complaining of idiopathic scoliosis, and not responding to conservative measures and not associated with neurological affection. Results: According to Lenke classification, there were 56 patients (61.5%) with type 1 curve type , 9 patients (9.9%) with type 2, 7 patients (7.7%) with type 3, 7 patients (7.7%) with type 5 and 12 patients (13.2%) with type 6. Mean preoperative height was 1.60 m while mean postoperative height was 1.66 m. with significant increase in height postoperatively (p < 0.001). Mean percentage height gain was 3.91%. Conclusion: We do believe that the posterior only approach 3D correction is an effective method in management of AIS concerning correction of Cobb angle, shoulder balance and spinopelvic parameters and recommend it as the best way nowadays to treat this disease

Surgical Outcome of Three-Dimensional Correction of Adolescent Idiopathic Scoliosis

Background: Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated "S" or "C" shape; the bones of the spine are also slightly twisted or rotated. To prevent further curve progression and obtain a balanced spine, surgery remains the mainstay of treatment for idiopathic scoliosis (IS). Objective: This study aimed to discuss three dimensional surgical techniques used for correction of adolescent idiopathic scoliosis, evaluating their feasibility, efficacy and safety. Patients and methods: This study was conducted in Mansoura University Hospital and Alexandria University Hospitals between September 2018 and April 2021. 3D surgical correction was performed for 91 patients complaining of idiopathic scoliosis, and not responding to conservative measures and not associated with neurological affection. Results: According to Lenke classification, there were 56 patients (61.5%) with type 1 curve type , 9 patients (9.9%) with type 2, 7 patients (7.7%) with type 3, 7 patients (7.7%) with type 5 and 12 patients (13.2%) with type 6. Mean preoperative height was 1.60 m while mean postoperative height was 1.66 m. with significant increase in height postoperatively (p < 0.001). Mean percentage height gain was 3.91%. Conclusion: We do believe that the posterior only approach 3D correction is an effective method in management of AIS concerning correction of Cobb angle, shoulder balance and spinopelvic parameters and recommend it as the best way nowadays to treat this disease

New Mononuclear and Binuclear Cu(II), Co(II), Ni(II), and Zn(II) Thiosemicarbazone Complexes with Potential Biological Activity: Antimicrobial and Molecular Docking Study

Herein, we report the synthesis of eight new mononuclear and binuclear Co2+, Ni2+, Cu2+, and Zn2+ methoxy thiosemicarbazone (MTSC) complexes aiming at obtaining thiosemicarbazone complex with potent biological activity. The structure of the MTSC ligand and its metal complexes was fully characterized by elemental analysis, spectroscopic techniques (NMR, FTIR, UV-Vis), molar conductivity, thermogravimetric analysis (TG), and thermal differential analysis (DrTGA). The spectral and analytical data revealed that the obtained thiosemicarbazone-metal complexes have octahedral geometry around the metal center, except for the Zn2+-thiosemicarbazone complexes, which showed a tetrahedral geometry. The antibacterial and antifungal activities of the MTSC ligand and its (Co2+, Ni2+, Cu2+, and Zn2+) metal complexes were also investigated. Interestingly, the antibacterial activity of MTSC- metal complexes against examined bacteria was higher than that of the MTSC alone, which indicates that metal complexation improved the antibacterial activity of the parent ligand. Among different metal complexes, the MTSC- mono- and binuclear Cu2+ complexes showed significant antibacterial activity against Bacillus subtilis and Proteus vulgaris, better than that of the standard gentamycin drug. The in silico molecular docking study has revealed that the MTSC ligand could be a potential inhibitor for the oxidoreductase protein.Taif UniversityPeer Reviewe

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

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