Hematologic, hepatic, and renal function changes in hospitalized patients with Middle East respiratory syndrome coronavirus

Background There are no longitudinal data on the changes in hematologic, hepatic, and renal function findings in patients with Middle East respiratory syndrome coronavirus (MERS‐CoV) infection. Methods This is a retrospective cohort study of 16 MERS‐CoV patients, to describe the hematological, hepatic, and renal findings of patients with MERS‐CoV. Results During the 21 days of observation, there was no significant change in the hepatic panel or creatinine tests. There was a significant increase in the mean ± SD of the white blood cell count from 8.3 ± 4.6 to 14.53 ± 7 (P value = 0.001) and an increase in mean ± SD of the absolute neutrophil count from 6.33 ± 4.2 to 12 ± 5.5 (P value = 0.015). Leukocytosis was observed in 31% (5/16) of the patients on day 1 and in 80% (4/5) on day 21. Transient leukopenia developed in 6% (1/16) of the patients on day 1 and in 13% (1/8) on day 8. None of the patients had neutropenia. Lymphopenia was a prominent feature with a rate of 44% (7/16) of the patients on day 1 and 60% (3/5) on day 21. Lymphocytosis was not a feature of MERS‐CoV infection. Thrombocytopenia developed in 31% (5/16) of the patients on day 1 and 40% (2/5) on day 21. Thrombocytosis was not a prominent feature and was observed in 6% (1/16) of the patients on day 1 and 17% (1/6) on day 9. Conclusions Patients with MERS‐CoV infection showed variable hematologic parameters over time. Lymphocytosis and neutropenia were not features of MERS‐CoV infection

Tracking Water Quality from Source to Home: A showed Case of El Gorashi Locality, Gezira State, Sudan

Water quality is recognized one of the greatest challenges to human life because water may become unsafe at any point between collection and consumption.  This study was conducted in Elgorashi locality, Gezira State Sudan to investigate water sources physically and biologically. A number of 70 water samples were taken from various sources which include; irrigation canals, Haffir, Haffir Exit Basin (HEB), Slow Sand Filters (SSF), Clean Water Basin (CLB), homes taps and homes storage containers. The samples were collected from Elgorashi city, Galoka, Geneda, Maatoug and Hillat Babiker villages.  The results were compared to WHO risk category. Statistical results revealed that physically, 86% of water sources were suitable for human consumption. Biological analysis showed 73% of water sources were polluted with bacteria. It has been found that (19/70) 27.14% of all water sources were safe, (28/70) 40% at low-risk, (14/70) 20% at intermediate risk and (9/70) 12.86% were at high risk. A long the water supply network, the main water sources of irrigation canals and Haffirs were unsafe. At home level, 70% of taps water were classified under low risk category and 55% of storage containers showed high risk sources. These results indicate leakage at the water distribution network. The study recommends immediate disinfection intervention at all sources to protect community from illness associated with poor water quality. جودة الماء تعتبر من اهم التحديات لصحة الانسان  لان الماء قد يتعرض للتلوث في اي موقع  بين المصدر والمستهلك.  في هذا البحث تم اختبار نوعية الماء الطبيعية والبيولوجية في مدينة القرشي – ولاية الجزيرة في السودان.  تم  جمع 70 عينة ماء من مصادر  مختلفة شملت  قنوات الري والحفائر واحواض تجميع ماء الحفير واحواض تنقية الماء وحنفيات المنازل وادوات حفظ الماء المنزلية. تم جمع العينات من مدينة القرشي وابوقوتة وقرية جنيدا ومعتوق وحلة بابكر. تمت مقارنة النتائج مع مقاييس منظمة الصحة العالمية. اظهرت  نتائج التحليل الطبيعى ان 86% من المصادر تحتوي على ماء صالح لاستخدام الانسان. التحليل البكتيرى للماء اظهر ان 73% من المصادر ملوثة بالبكتريا. وجد ان نسبة 27.14% من  جملة المصادر تحتوي على ماء نظيف و 40% من المصادر تحتوي على ماء ذو خطورة منخفضة و 20% من المصادر تحتوى على ماء ذو خطورة متوسطة و12.86% من المصادر مياهها عالية الخطورة. على طول شبكة توزيع الماء تعتبر قنوات الري والحفائر مصادر ذات  ماء غير امن. 70% من حنفيات المنازل تحتوي على ماء ذو خطورة منخفضة و 55% من اواني حقظ الماء المنزلية تعتبر مياهها عالية الخطورة. دلت النتائج على وجود كسورات في خطوط توزيع الماء واوصت الدراسة على تطهير كل المصادر لحماية المجتمع من الامراض المرتبطة بالماء. &nbsp

Controlling Formal Fibers of Countably Many Principal Prime Ideals

Let $T$ be a complete local (Noetherian) ring. For each $i \in \mathbb{N}$, let $C_i$ be a nonempty countable set of nonmaximal pairwise incomparable prime ideals of $T$, and suppose that if $i \neq j$, then either $C_i = C_j$ or no element of $C_i$ is contained in an element of $C_j$. We provide necessary and sufficient conditions for $T$ to be the completion of a local integral domain $A$ satisfying the condition that, for all $i \in \mathbb{N}$, there is a nonzero prime element $p_i$ of $A$, such that $C_i$ is exactly the set of maximal elements of the formal fiber of $A$ at $p_iA$. We then prove related results where the domain $A$ is required to be countable and/or excellent.Comment: 29 page

Childhood Steroid Sensitive Nephrotic Syndrome: Characteristics and Predictors of Relapses; A study at a Single Center in Khartoum

Background: Childhood steroid-sensitive nephrotic syndrome (SSNS) usually has a favorable outcome in spite of its relapsing course. The objective of the authors was to study the demographic and clinical characteristics, outcome and risk factors for relapses in children with SSNS at a single center in Khartoum, Sudan. Material and Methods: In this cross-sectional, facility-based study, the authors retrospectively reviewed all the records of children with SSNS, followed at the Pediatric Renal Unit, Soba University Hospital, Khartoum between 2001 and 2014. SSRNS was defined as the remission of proteinuria within 4–6 weeks of corticosteroids. Relapse is therecurrence of proteinuria after remission; frequent if ≥ 2 within initial six months or ≥ 4 within one year, and steroid dependence if 2 during therapy or within 14 days after stopping it. Results: 330 children (males 220; 66.7%) with SSNS were studied with a mean age of 5.2 ± 3.5 years of whom 42.4% aged 1–5 years. At the presentation, hypertension was detected in 31.8% and hematuria in 19.1%. Serum cholesterol was elevated in all patients (mean 347.34 ± 117.87 mg/dl) and serum creatinine in 7.27% (mean 1.4 ± 0.35 mg/dl). Renal histology showed mesangioproliferative glomerulonephritis (MesPGN) in 57.5%, minimal change disease (MCD) in 35.5%, and focal segmental glomerulosclerosis (FSGS) and IgM nephropathy in 3.5% each. During the course of the illness, 10.3% achieved long-term remission, 89.7% relapsed— of whom 52.3% had frequent relapsing/steroid-dependent (FR/SD) course and 37.7% had infrequent relapses. Risk of frequent relapses were age of onset and low/moderate socioeconomic status (P = 0.015 and 0.019, respectively). Infectionswere recorded in 71.8%, but not significantly associated with the risk of frequent relapses (P > 0.05). Conclusions: The majority children with SSNS at this single center in Khartoum had a relapsing course with the majority being FR or SD. Predictors of frequent relapses were young age at onset and low socioeconomic status

Risk Score, Causes, and Clinical Impact of Failure of Transradial Approach for Percutaneous Coronary Interventions

ObjectivesTo study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI).BackgroundTRA-PCI failure has been reported in 5% to 10% of cases.MethodsTRA-PCI failure was categorized as primary (clinical reasons) or crossover failure. Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed.ResultsFrom January to June 2010, TRA-PCI was attempted in 1,609 (97.3%) consecutive patients, whereas 45 (2.7%) had primary TRA-PCI failure. Crossover TRA-PCI failure occurred in 30 (1.8%) patients. Causes of primary TRA-PCI failure included chronic radial artery occlusion (11%), previous coronary artery bypass graft (27%), and cardiogenic shock (20%). Causes for crossover TRA-PCI failure included: inadequate puncture in 17 patients (57%); radial artery spasm in 5 (17%); radial loop in 4 (13%); subclavian tortuosity in 2 (7%); and inadequate guide catheter support in 2 (7%) patients. Female sex (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.95 to 5.26, p < 0.0001), previous coronary artery bypass graft (OR: 6.1; 95% CI: 3.63 to 10.05, p < 0.0001), and cardiogenic shock (OR: 11.2; 95% CI: 2.78 to 41.2, p = 0.0011) were independent predictors of TRA-PCI failure. Risk score values from 0 to 7 predicted a TRA-PCI failure rate from 2% to 80%.ConclusionsIn a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure

Nutritional and hematological status of Sudanese women of childbearing age with steady-state sickle cell anemia

We sought to investigate the nutritional and hematological status of Sudanese women of childbearing age with sickle cell anemia (SCA). Anthropometry and hematology were used to assess nutritional status and health and disease conditions, respectively. Women with steady-state (HbSS, n = 39; age = 19.0±2.7) and without (HbAA, n = 36; age, 19.8±2.7) SCA were recruited during a routine visit to the Hematology Clinic, Ibn-Auf Teaching Hospital, Khartoum, Sudan. The two groups of women lived in similar environmental conditions and ate similar diets three times a day. However, despite taking regular meals, the women with sickle anemia were thinner and lighter ( 0.050). The low anthropometric (height, weight, and body mass index) and abnormal hematological values in the women with SCA in steady-state reflect sustained nutritional insults inflected by the disease and poverty. Tailored nutritional counseling/advice must be an integral part of managing patients with SCA. Such advice is particularly vital for women of childbearing age because of the adverse effects of prepregnancy nutritional deficiency on outcomes

Female genital mutilation of a karyotypic male presenting as a female with delayed puberty

BACKGROUND: Female genital mutilation (FGM) is commonly practiced mainly in a belt reaching from East to West Africa north of the equator. The practice is known across socio-economic classes and among different ethnic, religious, and cultural groups. Few studies have been appropriately designed to measure the health effects of FGM. However, the outcome of FGM on intersex individuals has never been discussed before. CASE PRESENTATION: The patient first presented as a female with delayed puberty. Hormonal analysis revealed a normal serum prolactin level of 215 Mu/L, a low FSH of 0.5 Mu/L, and a low LH of 1.1 Mu/L. Type IV FGM (Pharaonic circumcision) had been performed during childhood. Chromosomal analysis showed a 46, XY karyotype and ultrasonography verified a soft tissue structure in the position of the prostate. CONCLUSION: FGM pose a threat to the diagnosis and management of children with abnormal genital development in the Sudan and similar societies

Discovery of novel natural products as dual MNK/PIM inhibitors for acute myeloid leukemia treatment: Pharmacophore modeling, molecular docking, and molecular dynamics studies

MNK-2 and PIM-2 kinases play an indispensable role in cell proliferation signaling pathways linked to tyrosine kinase inhibitors resistance. In this study, pharmacophore modeling studies have been conducted on the co-crystalized ligands of MNK-2 and PIM-2 enzyme crystal structures to determine the essential features required for the identification of potential dual inhibitors. The obtained pharmacophore features were then screened against a library of 270,540 natural products from the ZINC database. The matched natural molecules were docked into the binding sites of MNK-2 and PIM-2 enzymes. The compounds with high docking scores with the two enzymes were further subjected to MM-GBSA calculations and ADME prediction. This led to the identification of compound 1 (ZINC000085569211), compound 2 (ZINC000085569178), and compound 3 (ZINC000085569190), with better docking scores compared to the reference co-crystallized ligands of MNK-2 and PIM-2. Moreover, compounds 1‒3 displayed better MM-GBSA binding free energies compared to the reference ligands. Finally, molecular dynamics (MD) study was used to assess the interaction stability of the compounds with MNK-2. To this end, compounds 1 and 3 bound strongly to the target during the whole period of MD simulation. The findings of the current study may further help the researchers in the discovery of novel molecules against MNK-2 and PIM-2

Adverse pregnancy outcomes in sickle cell trait: a prospective cohort study evaluating clinical and haematological parameters in postpartum mothers and newborns

Background: Sickle cell trait (SCT) is a congenital condition caused by the inheritance of a single allele of the abnormal haemoglobin beta gene, HbS. Carriers of SCT are generally asymptomatic, and they do not manifest the clinical and haematological abnormalities of sickle cell anaemia (SCA). However, there is evidence that they display some symptoms in stressful situations. Pregnancy is a stressful physiological event, and it is not clear if SCT adversely affects pregnancy outcomes, particularly in those from developing countries where people regularly suffer from nutritional insufficiency. Objective: This study aims to investigate pregnancy outcomes in Sudanese women with SCT. Subjects and methods: Pregnant women with (HbAS, n=34) and without (HbAA, n=60) SCT were recruited during their first trimester at El Obeid Hospital, Kordofan, Western Sudan. Following appropriate ethical approval and informed consent from the participants, detailed anthropometric, clinical, haematological, obstetric, and birth outcome data were registered. In addition, blood samples were collected at enrolment and at delivery. Results: At enrolment in the first trimester, the SCT group did not manifest SCA symptoms, and there was no difference in the haematological parameters between the SCT and control groups. However, at delivery, the women with SCT, compared with the control group, had lower levels of hemoglobin (Hb, p=0.000), packed cell volume (PCV, p=0.000), mean corpuscular haemoglobin (MCH, p=0.002) and neutrophil counts (p=0.045) and higher mean corpuscular volume (MCV, p=0.000) and platelet counts (p=0.000). Similarly, at delivery, the babies of SCT women had lower birth weight (p=0.000), lower Hb (p=0.045), PCV (p=0.000), MCH (p=0.000), and higher neutrophil (p=0.004) and platelet counts (p=0.000) than the babies of the healthy control group. Additionally, there were more miscarriages, stillbirths, and admissions to the Special Care Baby Unit (SCBU) in the SCT group. Conclusions: The study revealed that SCT is associated with adverse pregnancy outcomes, including maternal and neonatal anaemia, low birth weight, and increased risk of stillbirth, miscarriage, and admission to SCBU. Therefore, pregnant women with SCT should be given appropriate pre-conceptual advice and multidisciplinary antenatal and postnatal care

Coexistence of HBsAg/Anti-HBs and HBeAg/Anti-HBe in Sudanese Patients with Chronic Hepatitis B Virus Infection: A Cross-Sectional Study

Background: Seroconversion of hepatitis B surface antigen (HBsAg) to hepatitis B surface antibody (anti-HBs) is a recognized goal of HBV therapy. This dynamic transition responsible for the coexistence of HBsAg and anti-HBs is rarely detected in clinical cases. However, with vaccination and the use of various antiviral drugs, as well as the development of new medical technologies, recognizing the coexistence of HBsAg and anti-HBs has become more common. In addition, mutations in viral genomes, immune status, and human genetic factors may also contribute to such coexistence. The current study was designed to determine the prevalence of the coexistence of HBsAg and anti-HBs and HBeAg and anti-HBe in CHB patients in Sudan. Methods and Results: This was a descriptive cross-sectional study conducted in Khartoum state from November 2018 to January 2019. The study included 70 HBV-infected patients who were positive for HBsAg for more than six months. Blood samples were tested for HBsAg/Anti-HBs and HBeAg/Anti-HBe using Commercial ELISA Kits (Foresight, United Kingdom) and (PRECHEK, USA). Demographic data were collected using a structured questionnaire, and any antiviral agent and laboratory results were also recorded for each participant. The current study showed that one case (1.4%) was reactive for the coexistence of HBsAg/HBsAb and two cases (2.8%) for the coexistence of HBeAg/HBeAb. There was no statistical difference between the coexistence of HBsAg/HBsAb and HBeAg/HBeAb with age, gender, residence, and treatment status. Conclusion: Our study indicates that the frequencies of the coexistence of HBsAg/HBsAb and HBeAg/HBeAb among Sudanese patients with chronic HBV infection were low compared to previous studies in a different population