May Measurement Month 2017: an analysis of blood pressure screening in Sudan-Northern Africa and Middle East

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Sudan has the second highest prevalence of hypertension in North Africa. One in four people with a non-communicable disease has hypertension. May Measurement Month (MMM) is a global initiative, aimed at raising awareness of high BP to act as a temporary solution to the lack of screening programs worldwide. The MMM screening survey provided an opportunity to correlate between unique risk factors and BP levels among Sudanese population. Such an approach allows for directing efforts towards setting the appropriate preventive measures as opposed to disease treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted at 100 sites distributed in four states: Khartoum, Gezira, Blue Nile, and Kassala. Overall, a total of 44 413 participants were enrolled in the survey. After imputation, 7332 out of 44 118 participants with an available mean of the second and third readings had hypertension (16.6%). A total of 6956 (15.9%) participants were found to have hypertension of the 43 742 who were not receiving treatment. Among participants who were on treatment, 155 out of 374 (41.3%) had uncontrolled BP. After adjusting for age and sex, systolic and diastolic BP's were significantly higher in those receiving antihypertensive treatment, with a previous history of stroke and with elevated body mass index. Systolic BP was significantly higher in people with diabetes and with previous myocardial infarction. Smoking was associated with increased diastolic BP and decreased systolic BP. Alcohol intake as well as BP measurement on left vs. right arm had no association with BP reading. The MMM17 was the largest BP screening campaign ever held in the country. A considerable percentage of detected hypertensives were not on treatment with a significant proportion of uncontrolled hypertension among those on treatment. These results suggest that opportunistic screening can identify significant numbers with raised BP

Molecular identification of different Theileria and Babesia species infecting sheep in Sudan

The epidemiological aspects of sheep piroplasmosis in Sudan are poorly studied, and further investigations using sensitive and precise techniques are required. In this study, the Reverse Line Blot (RLB) hybridization assay was used to detect and simultaneously differentiate between Theileria and Babesia species. DNA was extracted from blood collected on filter paper (n=219) from apparently healthy sheep from six different geographical localities in Sudan. Results indicated that Theileria ovis (88.6%), T. separata (20.1%), T. lestoquardi (16.4%) and T. annulata (16.4%) DNA could be detected in the blood samples. Single and mixed Theileria infections were detected in 74 (33.8%) and 124 (56.6%) respectively and T. ovis being the most prevalent species in the country. T. ovis and T. separata were reported for the first time in sheep in Sudan.University of Elimam Elmahadi, Ministry of High Education and Scientific Research, Sudanhttp://www.bioone.org/loi/copaam2016Veterinary Tropical Disease

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Evaluate the efficacy of Simvastatin and Fluvastatin in patients with hypercholesterolemia and their effect on liver functions

The study was aimed to evaluate Simvastatin and Fluvastatin effects on patients with hypercholesterolemia. For 6 months, 141 patients administered Simvastatin (GpA), 100 administered Fluvastatin (GpB) and 100 fluctuated between them (GpC). Post treatment, in GpA, Triglycerides, total Bilirubin (T.BIL), Cholesterol and Low Density Lipoprotein (LDL) were significantly reduced. Alkaline Phosphatase (ALP) and Alanine Aminotransferase (ALT) elevated reduced in females and elevated in males. T.BIL reduced in both males and females. In GpB, Glutamyltransferase elevated and Cholesterol and LDL reduced. Albumin elevated in females and reduced in males and the opposite in Triglycerides. Significant difference between age groups in Albumin, Globulin, and ALT was found. In GpC, Asprtate Aminotransferase (AST) elevated and ALT, Cholesterol, Triglycerides and LDL reduced in all patients. Albumin and ALT elevated in males and reduced in females. Significant difference between age groups in Albumin, T.BIL and AST was found. Fluvastatin or simvastatin had variable effects on lipid parameters in patients with hypercholesterolemia and associated with mild effect on liver. Simvastatin was more effective to reach antihypercholesterolemic goal. Effects were related to gender, age and continuation on the same medication. Patients lab data periodic monitoring during therapy is useful to reach antihypercholesterolemic goal and observe any serious liver parameters elevation. [Med-Science 2017; 6(4.000): 724-728

Impact of mitral clip implantation on left atrial appendage velocity

Background: Previous studies have demonstrated the feasibility of mitral clip to improve safety and achieve similar clinical outcomes compared to surgical mitral valve repair in high risk surgical patients with severe mitralregurgitation. Transesophageal echocardiogram (TEE) plays an integral role in planning of a successful procedure. Leftatrial appendage (LAA) velocity serves as a marker of LAA function. However, there is no data about the impact ofmitral clip procedure on the LAA function and velocity. We sought to assess the impact of mitral clip procedure on pre and post-procedure LAA velocity as assessed by intra-procedural TEE. Methods: We evaluated a total of 29 patients with severe mitral regurgitation who were poor surgical candidates for mitral valve surgery and thus underwent mitral clip procedure between July 2015 to December 2016. Baseline demographics and intra-procedure TEE data was obtained and patients were followed for 30-days clinical outcomes. Mitral regurgitation (MR) severity was graded as (1=mild, 2=moderate, 3=moderate-severe, 4=severe). Results: Among the 29 patients, 70% were females and the mean age at the time ofprocedure was 78.5 years. The mean Society of Thoracic Surgeons mortality risk score was 8.3%. 18 (62%) patients had pre-existing atrial fibrillation or flutter with mean CHA2DS2-VASc score of 5.5. All patients had pre-existing grade 4 MR which was reduced to grade 1 in 20/29 and grade 2 in 5/29 patients after the procedure. There was a significant decrease in LAA velocity after the procedure (39.1± 17.8 cm/sec vs 27.11 ± 11.9 cm/sec, p = 0.001). In 4 patients, the post-procedure LAA velocity was higher compared to the pre-procedure LAA velocity and they had residual grade 3 MR which was eccentric in nature. There were a total of 2 non-cardiac related deaths at 30 days with no cases of post-procedure stroke. At 30-days, NYHA class improved from III/IV to I/II (p\u3c0.05). Conclusion: Mitral clipimplantation was associated with significant decrease in the post-procedure LAA velocity which may in turn serve as a marker of procedural success as demonstrated by more pronounced improvement in MR grade and improved NYHA class at 30-days follow-up. Larger studies with longer follow-up are needed to assess the long-term clinical impact ofchange in LAA velocity over time

Arbuscular mycorrhizal fungi as an effective approach to enhance the growth and metabolism of soybean plants under thallium (TI) toxicity

Abstract: Thallium (TI) is a toxic metal that can trigger harmful impacts on growth and metabolism of plants. Utilizing arbuscular mycorrhizal fungi (AMF) proves to be an effective strategy for alleviating heavy metal toxicity in plants. To this end, AMF were applied to mitigate TI toxic effects on the growth, primary and secondary metabolism of soybean plants. Here, TI stress inhibited the growth and photosynthetic parameters of soybean plants. It also increased the oxidative damage as demonstrated by increased levels of oxidative markers, (MDA and lipoxygenase (LOX) activity). However, AMF could mitigate the reduction in growth and photosynthesis induced by TI, as well as the induction of oxidative damage. To overcome TI toxicity, AMF increased the levels and metabolism of osmolytes such as proline in soybean plants. This was in line with the increased activities of key enzymes that involved in proline biosynthesis (e.g., P5CS (pyrroline-5-carboxylate synthetase), P5CR (pyr-roline-5-carboxylate reductase) and OAT (ornithine aminotransferase) under the AMF and/or TI treatments. Furthermore, soybean plants could benefit from the synergism between AMF and TI to enhance the contents of individual (e.g., spermine and spermidine) and total polyamines as well as their metabolic enzymes (e.g., arginine decarboxylase and ornithine decarboxylase). Overall, the combined application of AMF emerges as a viable approach for alleviating TI toxicity in soybean plants

The Interaction Effect of Laser Irradiation and 6-Benzylaminopurine Improves the Chemical Composition and Biological Activities of Linseed (Linum usitatissimum) Sprouts

Even though laser light (LL) and 6-benzylaminopurine (BAP) priming are well-known as promising strategies for increasing the growth and nutritional value of several plants, no previous studies have investigated their synergistic effect. Herein, we investigated the effects of laser light, 6-benzylaminopurine (BAP) priming, and combined LL-BAP treatment on the nutritional value, chemical composition, and the biological activity of Linum usitatissimum sprouts. The fresh weight, leaf pigments, primary and secondary metabolites, enzymes, and antimicrobial activities were determined. A substantial enhancement was observed in the growth characteristics and leaf pigments of laser-irradiated and BAP-primed sprouts. Furthermore, the combined treatments improved the accumulation of minerals, vitamins, and amino acids, and also enhanced the N-metabolism more than LL or BAP alone. Furthermore, the combined priming boosted the antioxidant capacity by increasing the contents of fatty acids, phenols, and flavonoids. Antimicrobial activity and the highest increase in bioactive compounds were recorded in linseed sprouts simultaneously treated with LL and BAP. This work suggests that priming L. usitatissimum sprouts with laser light and BAP is a promising approach that can improve the nutritional value and health-promoting impacts of L. usitatissimum sprouts

Correction: Antimalarial drug resistance molecular markers of Plasmodium falciparum isolates from Sudan during 2015-2017.

[This corrects the article DOI: 10.1371/journal.pone.0235401.]