Pattern and Management of Obstructive Jaundice in Wad Medani Teaching Hospital, March 2014 -2015

Abstract:                                                     Obstructive jaundice is not uncommon in this area certainly with what is reported in the literature, malignant jaundice is more common than choledocholithiasis. The pre-operative management followed the international guidelines; most of the surgery done to the malignant jaundice was palliative because of the late presentation. Endoscopic service in management of obstructive jaundice is important and shall be utelized after completion of the new GIT Centre-Wad Medani Hospital. This study was a prospective cross sectional descriptive study, conducted in Wad Medani hospital - Gezira state – Sudan from March 2014 to March 2015. Wad Medani Teaching Hospital is a tertiary hospital with 600 beds serving all Gezira state and nearby states  Material and Method: 124 patients admitted to hospital with symptoms and signs of obstructive jaundice including; yellow coloration of the sclera, dark urine,pale stools, itching, with or without the association of vomiting, abdominal pain, abdominal mass and weight loss. Diagnosis was confirmed by history, examination and biochemical and radiological investigations.The data was analyzed by computer using SSPS. Results: 52(41.9%) were males and72 (51.8%) were females, with male to female ratio of 1:1.3. The cases of obstructive jaundice were found to be distributed among their age groups from 18-40yr (15.3%),41-60yr(31.5%) , 60yr and above (53.2%). Definitive diagnosis after completion of investigations results showed that cases due to common bile duct (CBD) stone and carcinoma of the head of pancrease were 55 (44.4%) and 52 (41.9%) respectively. The relation between the diagnosis and sex results showed CBD stone in females was 37(51.4%) where as in males  carcinoma of the head of pancrease was 25(48.11%), ERCP was used in 67(54%) patients both for diagnostic and therapeutic indications. The operative intervention was also studied for all patients with obstructive jaundice and the results showed that 48(38.7%) patients underwent surgical intervention with 7(5.6%) CBD exploration and 41(33.1%) by pass surgical operation. Conclusion: ERCP has a promising role in the study area in managing patients with obstructive jaundice. The family physicians   have an important role to play in early detection and referral of patients with obstructive jaundice to hospitals to avoid delayed presentation and minimize the harmful effects of hyper bilirubinemia on the   liver so the step should start with how to detect the case and after that what to do for the case before referral to nearby hospital

Prophylactic use of carvedilol to prevent ventricular dysfunction in patients with cancer treated with doxorubicin

Objective: Deterioration in ventricular function is often observed in patients treated with anthracyclines for cancer. There is a paucity of evidence on interventions that might provide cardio-protection. We investigated whether prophylactic use of carvedilol can prevent doxorubicin-induced cardiotoxicity and whether any observed effect is dose related. Methods: A prospective, randomized, double-blind study in patients treated with doxorubicin, comparing placebo (n = 38) with different doses of carvedilol [6.25 mg/day (n = 41), 12.5 mg/day (n = 38) or 25 mg/day (n = 37)]. The primary endpoint was the measured change in left ventricular ejection fraction (LVEF) from baseline to 6 months. Results: LVEF decreased from 62 ± 5% at baseline to 58 ± 7% at 6-months (p = 0.002) in patients assigned to placebo but no statistically significant changes were observed in any of the 3 carvedilol groups. At 6 months, only one of 116 patients (1%) assigned to carvedilol had an LVEF < 50% compared to four of the 38 assigned to placebo (11%), (p = 0.013). No significant differences were noted between carvedilol and placebo in terms of the development of diastolic dysfunction, clinically overt heart failure or death. Conclusions: Carvedilol might prevent deterioration in LVEF in cancer patients treated with doxorubicin. This effect may not be dose related within the studied range

Dihydrophenazine:a multifunctional new weapon that kills multidrug-resistant Acinetobacter baumannii and restores carbapenem and oxidative stress susceptibilities

AimsThe current work aims to fully characterize a new antimicrobial agent against Acinetobacter baumannii, which continues to represent a growing threat to healthcare settings worldwide. With minimal treatment options due to the extensive spread of resistance to almost all the available antimicrobials, the hunt for new antimicrobial agents is a high priority. Methods and resultsAn Egyptian soil-derived bacterium strain NHM-077B proved to be a promising source for a new antimicrobial agent. Bioguided fractionation of the culture supernatants of NHM-077B followed by chemical structure elucidation identified the active antimicrobial agent as 1-hydroxy phenazine. Chemical synthesis yielded more derivatives, including dihydrophenazine (DHP), which proved to be the most potent against A. baumannii, yet it exhibited a safe cytotoxicity profile against human skin fibroblasts. Proteomics analysis of the cells treated with DHP revealed multiple proteins with altered expression that could be correlated to the observed phenotypes and potential mechanism of the antimicrobial action of DHP. DHP is a multi-pronged agent that affects membrane integrity, increases susceptibility to oxidative stress, interferes with amino acids/protein synthesis, and modulates virulence-related proteins. Interestingly, DHP in sub-inhibitory concentrations resensitizes the highly virulent carbapenem-resistant A. baumannii strain AB5075 to carbapenems providing great hope in regaining some of the benefits of this important class of antibiotics. ConclusionsThis work underscores the potential of DHP as a promising new agent with multifunctional roles as both a classical and non-conventional antimicrobial agent that is urgently needed.<br/

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Interrelationships between Yield and it Components in some Roselle (Hibiscus Sabdariffa L.) Genotypes

Abstract Sixteen genotypes of Roselle (Hibiscus sabdariffa L.) were evaluated for two seasons to estimate phenotypic and genotypic correlations, path analysis and selection indices. They study was conducted at Shambat Demonstration Farm in a randomized complete block design with three replications. Data were collected on thirteen plant attributes. Number of capsules/branch, 1000-seed weight, fruit yield /plant, seed yield/plant and calyx yield /unit area exhibited significant positive genotypic correlations with calyx yield/plant in the second season. On the other hand, the plant height, number of fruiting branches/plant, fruit weight, mean calyx weight/capsule, seed yield/plant and calyx yield/unit area showed significant negative genotypic correlations with calyx yield per plant in the first season. At the phenotypic level, calyx yield per plant had positive and significant association with number of capsules/main stem, number of capsules/branch, fruit yield/plant and seed yield/plant in both seasons. The yield components showed different patterns of association with each other. The path analysis indicated that fruit weight had the highest direct effect (0.46) on calyx yield/plant, while fruit yield had the lowest one (-0.19). The selection index based on number of fruiting branches/plant alone produced the highest expected genetic advance (1.66|) and the highest relative efficiency (40.39), followed by number of capsules/main stem and fruit weight. On the other hand, fruit yield/plant produced the lowest expected genetic advance (0.41) and lowest relative efficiency (9.98). Consequently, number of fruiting branches/plant, number of capsules/main stem and fruit weight can be used as selection criteria for the improvement of calyx yield/plant in Roselle

Influence of Plant Spacing and Weeds on Growth and Yield of Peanut (Arachis hypogaea L) in Rain-fed of Sudan

Abstract A field experiment was conducted for two consecutive seasons to assess the impact of four plant spacing (10, 20, 30 and 40 cm) and three weeding levels (no weeding, weeding once (at two weeks from sowing) and weeding twice (at two weeks and at four weeks) on growth and yield of peanut (groundnut) in rain-fed under Kordofan (Sudan) conditions. A randomized complete block design in four replications was used. The results showed that plant spacing of 10 cm gave 40% more yield than that at 40 cm and was the best for maximizing yield under rain-fed conditions. The growth and yield attributes of groundnut were significantly reduced when the crop was left un weeded. Weeding twice had the highest number of pods per plant, 100-Kernel weight, pods yield per plant and final pod yield (t/h). Weeds reduced pod yield by about 40%. The field was dominated by Cenchrus biflours L

Variability in Some Roselle (Hibiscus sabdariffa L.) Genotypes for Yield and its Attributes

Abstract Sixteen genotypes of Roselle (Hibiscus sabdariffa) were evaluated at Shambat (Sudan) for two consecutive seasons to assess genetic variability and heritability of different characters. Field experiment was conducted at Shambat Demonstration Farm in a randomized comp lete block design with three replications. Data were collected on thirteen plant attributes. Analysis of variance indicated significant differences among the sixteen genotypes for most of the characters studied. In general, the morphological characters had larger environ mental variances than their respective genotypic ones. The highest genotypic coefficient of variation was exh ibited by the seed yield/plant in both seasons. The highest genetic advance, 46.63 % in the first season and 170.13 % in the second season were obtained both for caly x yield/unit area. High values of heritability estimates (&gt; 0.70) were recorded for days to 50 % flowering over the two seasons. On the other hand, the yield co mponents showed low heritability estimates (&lt; 0.50) except for fru it weight in the second season

Path Coefficient and Selection Indices in Sixteen Guar (Cyamopsis Tetragonoloba L.) Genotypes Under Rain-fed

Abstract Set of sixteen guar genotypes was evaluated under rain-fed conditions at Kazgeil, Northren Kordofan State, Sudan in 1998/99 season, using a four x four triple partially balanced lattice design. Data recorded at were used for partitioning the genotypic correlations between seed yield and five of its components into direct and indirect effects. Moreover, different selection indices were constructed using different combinations of these characters. The path analysis showed that number of pods/plant had the highest positive direct effect (2.653) on seed yield/plant followed by number of seeds per pod. On the other hand number of fruiting nodes/main stem exerted the highest negative direct effect (-1.383) on seed yield/plant. The selection index involving single trait viz.1000 seed weight gave the minimum expected genetic advance (0.6) and relative efficiency (83.33%). However, the index involving all the six traits exhibited the highest expected genetic advance (2.03) and the maximum relative efficiency (281.94%).The two trait selection index of number of pods/plant and 1000-seed weight scored the relative efficiency of 138.89% which is equal to the relative efficiency of the individual trait index of number of reproductive branches/plant

New Sudanese Reference Chart of Fetal Biometry and Weight Using Ultrasonography

Abstract Background: Many centers in Sudan use the reference data for fetal biometry. The recently published population-based reference either overestimated or underestimated the weight of the fetuses. Objective: To establish a national reference for fetal biometry, and weight by gestational age for singleton fetuses in Sudan. Methods: Data were collected on all singleton live births documented in the data collection sheet done at Saudi Hospital from 2015 to 2016 (n = 225). Gestational age estimation was based on the last menstrual period and fetal ultrasound thereafter. Fetal biometry and weight and other 6 fetal weight formulae were assessed. Reference data for fetal growth by gestational age were created. Results: New charts and reference equations are reported in Sudanese population for fetal biparietal diameter, head circumference, abdominal circumference and femur length and fetal weight. Conclusion: We advocate that these reference charts and equations for fetal biometry and weight might be valuable in the clinical use for appropriate ethnic Sudanese