Genetic and Non-Genetic Factors Association with Warfarin Long Term Therapy Stability in Sudan

Anticoagulation with warfarin is characterized by a wide inter-individual variations in dose requirements and INR (International Normalised Ratio) stability, as there are evidences that warfarin response variability is associated with CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) and VKORC1 (Vitamin K epoxide reductase complex1) genetic polymorphisms. Carriers of CYP2C9*2 and VKORC11639G>A variant alleles are at greater risk of unstable anticoagulation therapy. Objectives: This retrospective case control study was directed to analyze the impact of genetic and non-genetic factors on warfarin therapy in Sudanese out-patients who were on long term warfarin therapy. Method: 118 Sudanese outpatients receiving warfarin treatment for at least six months, were interviewed for their non-genetic factors that included age, sex, indication for warfarin therapy, compliance, Vitamin K rich foods intake and concomitant drug therapy, in addition to their blood samples which were taken for DNA extraction and genotyping of CYP2C9*2 and VKORC11639G>A gene polymorphisms to study the genetic factors. INR stability % index was calculated, accordingly patients were classified into 2 groups, stable and unstable groups. Results: The frequencies of VKORC11639G>A alleles in Sudanese out-patients who were on long term warfarin therapy were 70.3% and 29.7% for the VKORC1/G and VKORC1/A alleles respectively. The frequencies of CYP2C9*2 alleles in Sudanese out-patients were 92.4% and 7.6% for CYP2C9*1 and CYP2C9*2 alleles respectively. Variables associated with low INR stability were VKCOR1/AA genotype (p-value = 0.028) and sex (p = 0.017). Variables that showed no association with INR stability were age (p-value = 0.259), compliance (p-value = 0.058). Vitamin K rich foods intake (p- value = 0.743), and mean stable warfarin dose (p-value = 0.439). Conclusion: Polymorphism in warfarin drug target gene VKORC1-11639G>A and sex are important elements of INR stability in Sudanese out- patients on long term warfarin therapy

Medications package inserts’ usefulness to doctors and patients: Sudanese doctors perspective

Background: Written medication information is important for both doctors and patients. In the developing countries, the medication package inserts (PIs) represent the most available and easily accessible source of written medication information. The main objective of the present study was to assess the knowledge, attitude, and practice of Sudanese doctors toward written medication information in the PIs, and its usefulness for both doctors and patients.Methods: Four hundred (n=400) doctors were randomly selected and addressed with an open to answer the questionnaire composed of fifteen questions (n=15).Results: A big majority (95.7%) of the respondents considered the medications’ PIs, which they regularly read (93.2%), as a reliable and useful source of medication information in their prescribing. Only a minority of the respondent doctors (43.6%) used to advise their patients to read the PIs, whereas a majority (62.4%) of respondents believed that patients might find difficulty in understanding written medication information in the PI. The majority (61.3%) of respondent used to rely on pharmacists to provide patients with the needed medication information. The majority of the respondents (82.2%) used to inform their patients about the possible medication side effects. Respondents ranked medications’ dose (79.5%), how to use it (77.3%) and information about side effects (73%) on top of patients’ medication information most needed particulars.Conclusion: Doctors should give more attention to their patients’ medication information specific needs, advice and motivate them to read the PIs before using their medications

Medication package inserts’ usefulness for Sudanese pharmacists and patients: pharmacists’ perspective

Background: Written medication information is important to health care professionals and patients, alike. Medication package inserts (PI) can prove useful sources for written medication information for pharmacist and patients. The main objective of this study was to evaluate the knowledge, attitude, and practice of the Sudanese pharmacists toward PIs.Methods: A total of 120 randomly selected Sudanese community and hospital pharmacists, were addressed with a questionnaire of 14 free to answer closed-ended questions.Results: Results showed clear dominance of the young (96.5%), females (63.3%)pharmacists population, whose majority (90.8%) had their undergraduates studies in Sudan. Majority (79.2%) of respondents was keen to read the PIs, and (75.8%)considered them as reliable written medication information sources and references. Correlation between respondents’ reliability and reading of PIs was significant (**p=0.038). How to use medications (95%) their dose (92.5%), and compliance (67.5%), topped the medication information particulars provided by respondents to patients. Drug-interactions and side-effects (36.7%) were downplayed by the respondents. Only a small minority (21.7%) of respondents used to advise patients to read PIs. Majority (85%) of respondents believed that PIs were difficult for patients to understand. Their texts’ language (68.2%), technical terminology (75%) and font size (10%) were cited as main barriers to understandability.Conclusions: To secure usefulness of PIs, they shall be written in lay terminology of patients’ native language. Pharmacists shall seek independent sources of medication information, advice and motivate patients to read PIs and keep them for ongoing reference

Gum Arabic Processing and Marketing in the Sudan

The objectives of this study are to determine and analysis the present trends in production and exporting channels of Gum Arabic, the present level of processing and marketing of Gum Arabic and the probable return by fully utilizing of Gum Arabic resources. The amount of gum Arabic produces from Sudan has declined from 48.1*103 metric tons in the year 1992 to 25.1*103 metric tons in 2006. That was due to several reasons such as shara drought and low prices paid to farmers. This instability in productivity affects on the shares of Sudan in the world market, which decreased from 50 percent in 1992 to less than 40 percent in 2006. The local processing companies face many problems especially in the high-energy cost, instability of government tax polices and high transportation fees. The local processing company (Dar Savanna Company) has been taken as a case study for describing the steps of processing Gum Arabic0. Some of the data collected from the kibbled gum process were used in the analysis and calculation of the yields of main products and byproducts. The percentage of main product was estimated to be about 86.8% and the byproducts and losses were 2.7% and 11.46% respectively, which are considered as satisfactory percentages. The main recommendation of this study is to pay more attention to this sector through clear government policies and free auction markets. On the other hand, it strongly recommended to export gums as processed gums rather than raw gums and to give farmers a successful prices for their gums

Greater aortic inflammation and calcification in abdominal aortic aneurysmal disease than atherosclerosis: a prospective matched cohort study

Funder: British Heart Foundation; FundRef: http://dx.doi.org/10.13039/501100000274Objective: Using combined positron emission tomography and CT (PET-CT), we measured aortic inflammation and calcification in patients with abdominal aortic aneurysms (AAA), and compared them with matched controls with atherosclerosis. Methods: We prospectively recruited 63 patients (mean age 76.1±6.8 years) with asymptomatic aneurysm disease (mean size 4.33±0.73 cm) and 19 age-and-sex-matched patients with confirmed atherosclerosis but no aneurysm. Inflammation and calcification were assessed using combined 18F-FDG PET-CT and quantified using tissue-to-background ratios (TBRs) and Agatston scores. Results: In patients with AAA, 18F-FDG uptake was higher within the aneurysm than in other regions of the aorta (mean TBRmax2.23±0.46 vs 2.12±0.46, p=0.02). Compared with atherosclerotic control subjects, both aneurysmal and non-aneurysmal aortae showed higher 18F-FDG accumulation (total aorta mean TBRmax2.16±0.51 vs 1.70±0.22, p=0.001; AAA mean TBRmax2.23±0.45 vs 1.68±0.21, p<0.0001). Aneurysms containing intraluminal thrombus demonstrated lower 18F-FDG uptake within their walls than those without (mean TBRmax2.14±0.43 vs 2.43±0.45, p=0.018), with thrombus itself showing low tracer uptake (mean TBRmax thrombus 1.30±0.48 vs aneurysm wall 2.23±0.46, p<0.0001). Calcification in the aneurysmal segment was higher than both non-aneurysmal segments in patients with aneurysm (Agatston 4918 (2901–8008) vs 1017 (139–2226), p<0.0001) and equivalent regions in control patients (442 (304-920) vs 166 (80-374) Agatston units per cm, p=0.0042). Conclusions: The entire aorta is more inflamed in patients with aneurysm than in those with atherosclerosis, perhaps suggesting a generalised inflammatory aortopathy in patients with aneurysm. Calcification was prominent within the aneurysmal sac, with the remainder of the aorta being relatively spared. The presence of intraluminal thrombus, itself metabolically relatively inert, was associated with lower levels of inflammation in the adjacent aneurysmal wall

Utility of Atherosclerosis Imaging in the Evaluation of High-Density Lipoprotein–Raising Therapies

Decreased level of high density-lipoprotein cholesterol (HDL-C) is a rigorous predictor for future cardiovascular events. Much effort is being made to develop HDL-C–raising pharmacotherapies in the attempt to avert the pandemic of atherosclerotic disease. Important properties by which HDL-C–raising compounds are effective involve improvement of cholesterol uptake from macrophages in plaque for transport back to the liver, improvement of endothelial function, and anti-inflammatory effects. Vascular imaging can aid in the determination which HDL-C–raising compounds are effective. Ultrasound and MRI have proved suitable for assessment of structural changes of the vessel wall. Ultrasound can also be used or assessment of endothelial function. 18F-fluordeoxyglucose positron emission tomography has opened up the possibility to assess vessel wall inflammation. In this article we discuss these various imaging techniques and how they can assess efficacy as well as provide pathophysiologic information on the mechanism of action of novel HDL-C–raising drugs

High Structural Stress and Presence of Intraluminal Thrombus Predict Abdominal Aortic Aneurysm 18F-FDG Uptake: Insights From Biomechanics.

BACKGROUND: Abdominal aortic aneurysm (AAA) wall inflammation and mechanical structural stress may influence AAA expansion and lead to rupture. We hypothesized a positive correlation between structural stress and fluorine-18-labeled 2-deoxy-2-fluoro-d-glucose (18F-FDG) positron emission tomography-defined inflammation. We also explored the influence of computed tomography-derived aneurysm morphology and composition, including intraluminal thrombus, on both variables. METHODS AND RESULTS: Twenty-one patients (19 males) with AAAs below surgical threshold (AAA size was 4.10±0.54 cm) underwent 18F-FDG positron emission tomography and contrast-enhanced computed tomography imaging. Structural stresses were calculated using finite element analysis. The relationship between maximum aneurysm 18F-FDG standardized uptake value within aortic wall and wall structural stress, patient clinical characteristics, aneurysm morphology, and compositions was explored using a hierarchical linear mixed-effects model. On univariate analysis, local aneurysm diameter, thrombus burden, extent of calcification, and structural stress were all associated with 18F-FDG uptake (P<0.05). AAA structural stress correlated with 18F-FDG maximum standardized uptake value (slope estimate, 0.552; P<0.0001). Multivariate linear mixed-effects analysis revealed an important interaction between structural stress and intraluminal thrombus in relation to maximum standardized uptake value (fixed effect coefficient, 1.68 [SE, 0.10]; P<0.0001). Compared with other factors, structural stress was the best predictor of inflammation (receiver-operating characteristic curve area under the curve =0.59), with higher accuracy seen in regions with high thrombus burden (area under the curve =0.80). Regions with both high thrombus burden and high structural stress had higher 18F-FDG maximum standardized uptake value compared with regions with high thrombus burdens but low stress (median [interquartile range], 1.93 [1.60-2.14] versus 1.14 [0.90-1.53]; P<0.0001). CONCLUSIONS: Increased aortic wall inflammation, demonstrated by 18F-FDG positron emission tomography, was observed in AAA regions with thick intraluminal thrombus subjected to high mechanical stress, suggesting a potential mechanistic link underlying aneurysm inflammation.This study was supported by the British Heart Foundation Cambridge Centre of Excellence (RE/13/6/30180), Heart Research UK (RG2638/14/16), EPSRC Centre for Mathematical and Statistical Analysis of Multimodal Clinical Imaging (EP/N014588/1), and the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. Dr Tarkin is supported by a Wellcome Trust research training fellowship (104492/Z/14/Z). Dr Rudd is part-supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, the Wellcome Trust, and Higher Education Funding Council for England (HEFCE). Dr Newby is supported by the British Heart Foundation (CH/09/002) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA)

Weeds distribution and abundance in irrigated fields of White Nile State

Field survey was conducted during the summer season of 2011- 2012 to determine the weed flora and weed dominance at the irrigated sites of White Nile State. The State was divided into six irrigated sites from which a total of thirty- five fields were selected and ten quadrates (1m2) from each field were taken randomly. In each quadrate individual weed species were recorded. Field frequency, uniformity and mean field density were also determined for each weed. Fifty five weed species belonging to twenty- four families (three monocotyledonous and twenty- one dicotyledonous) were recorded. Brachiaria eruciformis, Brachiaria reptans, Thunbergia annua and Ipomoea cordofana were the most dominant weed species in most fields. The highest Abundance Index were recorded by Ipomoea cordofana at El Salam and El Dawium counties (208.16 and 116.35), Brachiaria eruciformis at Um Remta and El Gebalen counties (158.80 and 79.23), Brachiaria reptans at Kosti (116.54) and Momordica balsamina at Gezira Aba county (90.06). Brachiaria eruciformis showed the highest MFD and Uniformity at El Salam and Um Remta Counties (19.11 and 80.00), respectively, and highest frequency value was recorded by Ipomoea cordofana (142.86) at El Salam County. The AI which used as weed survey method is to evaluate the weed management strategies and the change of weed species in weed communities through years.International Journal of Environment Vol.4(4) 2015: 45-61</p

Some Geological and Geote chnical Properties of Lateritic Soils from Muglad Basin Located in the South-Western Part of Sudan

Some Geological and Geote chnical Properties of Lateritic Soils from Muglad Basin Located in the South-Western Part of SudanThe soil name "laterite" was coined by Buchanan (1807) in India, from a Latin word "later" meaning brick (Raychaudhuri, 1980). Lateritic soils are highly weathered and altered residual soils formed by the insitu weathering and/or decomposition of rocks in the tropical and sub-tropical regions with hot, humid climatic conditions. Laterites are rich in iron oxides, aluminum oxides and low silicates but may contain appreciable amounts of kaolinite and due to the presence of iron oxides; lateritic soils are red in colour (Amu and Adetuberu, 2010). The process of weathering produces a wide variety in the thickness, grade, chemistry and ore mineralogy of the resulting soils. Lateritic soils are widely used as fill materials for various construction works in most tropical countries. These soils are weathered under conditions of high temperatures and humidity with well-defined alternating wet and dry seasons resulting in poor engineering properties such as high plasticity, poor workability, low strength, high permeability, tendency to retain moisture and high natural moisture content Maigien (1966); Gidigasu (1976); Charman (1988). Considerable studies have been carried out on the engineering geological properties of the soil by various researchers (Akpokodje, 1986; Alabo and Pandy, 1987; Arumala and Akpokodje, 1987; Leton and Omotosho, 2004 and Omotosho and Eze-Uzomaka, 2008)