Editorial – University Staff and Student Protection from COVID-19: Strategic Measures for Teaching and Learning in Resource-limited Setting

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Isolation and Identification of Bacterial Species from the Human Gallbladders Bile of Sudanese Patients

Background: Gallbladder infections are one of the most important problems that affect Sudanese patients.Objectives: To isolate bacterial species from infected human gallbladder's bile in Sudanese patients admitted for cholecystectomy due to calcoulus or acalcoulus cholecystitis.Materials and Methods: A total of 100 bile specimens from 100 patients (88 females and 12 males), were examined in this study. Bile specimens were collected from three different operating theatres including IbnSena Hospital, Sudan Private Clinic and Omdurman Teaching Hospital.Results: Six bacterial species were recognized in bile specimens, four of them are gramnegative and two are gram- positive species. In the present study, bacteria were isolated from 40 specimens out of the 100 bile specimens cultured with an overall incidence of 40%. It was noted that all positive bacterial bile cultures correlated with the presence of gallstones except three Salmonellae which were isolated from bile of acalculus gallbladders. The most prevalent bacteria isolated were E.coli which was isolated from 24 specimens out of the 100 bile specimens. On the other hand, Staphylococcus aureus and Pseudomonas spp. were less frequently isolated from bile specimens showing frequencies of 4 (4%) for each.Conclusion: The finding of this study indicated that Escherichia coli were the most prevalent bacteria which isolated from human bile. As well as, the study revealed that certain bacterial species such as Salmonellae possess characters which allow them to cause cholecystitis without need to gallstones formation.Key words: Gallbladder Bile, Bacterial isolates, Bile specimens, Cholecystectomy; Bacterial cholecystitis, Acalculus gallbladders

Factors influencing immunisation coverage among children under five years of age in Khartoum State, Sudan

Background This article explores the hypothesis that predisposing and enabling factors of households influence the vaccination status of the children under the age of five in Khartoum State, Sudan. Method The study was a cross-sectional survey among a representative sample of 410 male and female children under five years of age from households with varying socio-economic status and mothers with varying levels of education, from both urban and rural localities in the state. Results The correct vaccination coverage rate for children was found to be high. Children in urban and rural areas differed substantially in their correct vaccination rates and their receipt of each vaccine separately. Walking or travelling time to the place of vaccination was found to be longer in rural areas when compared with urban areas. The vaccination rate increased with an increase in the age of the children and the education level of the mother. Children of older mothers were more likely to have had the correct vaccinations. The mothers\' knowledge of and attitudes to vaccination showed a strong relationship with the vaccination status of their children. When the coverage rate for each vaccine was taken separately, the economic level of the households significantly affected only the BCG vaccine coverage. Most vaccinations occurred in public outlet agencies. Conclusion The large differences found in vaccination coverage by place of residence and level of mother\'s education suggest that much greater efforts are required by the government if better rates of correct vaccination are to be achieved in rural areas. South African Family Practice Vol. 49 (8) 2007: pp. 1

Efficacy of Semi-Rigid Ureteroscopy and Holmium:YAG Laser Lithotripsy in the Treatment of Ureteric Calculi, a Retrospective Study

Background: Urolithiasis is a common worldwide health problem. Many endosurgical treatments became available for urinary calculi.Objectives: To find out the success clearance and complication rates of ureteric stone treatment using semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy as a day case procedure.Methods: In the period from April 2011 to October 2013, a total of 64 patients who were treated by laser lithotripsy were reviewed retrospectively using Fedail Hospital data. Diagnosis was radiologically confirmed. Semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy was conducted as a day case surgery. Operative details, clearance of stone fragments, failure and complications were analysed. Cases were followed clinically and radiologically after one week and one month.Results: The studied cases were 47 males and 17 females with average age of 47.3 years and ASA I in 52(81.3%). Those who had left ureteric stones were 28(43.8%) patients, only one patient had bilateral stones and 60(93.8%) patients had single stones. The largest stone diameter was 1.9cm. 68.8% had distal ureteric stones, 14.1% had mid third stones, and 17.2% had upper third stones. Most cases 96.9% were operated under spinal anaesthesia with mean operation time 61.2 minutes. Seven patients needed VUJ balloon dilatation to get access to the ureter.20 watt Holmium:YAG laser fibres were used for stone disintegration. 92.2% of cases had uncomplicated clearance, 3.1% minor complications and 4.7% failure of the procedure.100% clearance was confirmed during follow up. Conclusion: Semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy is a safe treatment for ureteric calculi and can be conducted as a day case with high success rate and very low morbidity.Key words: ureteric stone, Semi-rigid ureteroscopy, Holmium:YAG laser lithotripsy

Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0cm and <12.5cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6–59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4–15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered

Immunization knowledge and practice among Malaysian parents: a questionnaire development and pilot-testing

BACKGROUND: Parents are the main decision makers for their children vaccinations. This fact makes parents’ immunization knowledge and practices as predictor factors for immunization uptake and timeliness. The aim of this pilot study was to develop a reliable and valid instrument in Malaysian language to measure immunization knowledge and practice (KP) of Malaysian parents. METHODS: A cross-sectional prospective pilot survey was conducted among 88 Malaysian parents who attended public health facilities that provide vaccinations. Translated immunization KP questionnaires (Bahasa Melayu version) were used. Descriptive statistics were applied, face and content validity were assessed, and internal consistency, test-retest reliability, and construct validity were determined. RESULTS: The mean ± standard deviation (SD) of the knowledge scores was 7.36 ± 2.29 and for practice scores was 7.13 ± 2.20. Good internal consistency was found for knowledge and practice items (Cronbach’s alpha = 0.757 and 0.743 respectively); the test-retest reliability value was 0.740 (p = 0.014). A panel of three specialist pharmacists who are experts in this field judged the face and content validity of the final questionnaire. Parents with up-to-date immunized children had significantly better knowledge and practice scores than parents who did not (p < 0.001 and p = 0.001 respectively), suggesting a good construct validity. A significant difference was found in knowledge and practice scores among parents’ age (p = 0.006 and p = 0.029 respectively) and place of living (p = 0.037 and p = 0.043). The parents’ knowledge level was positively associated with their practice toward immunization (Spearman’s rank correlation coefficient 0.310, p = 0.003). CONCLUSIONS: The pilot study concluded that the Bahasa Melayu version of the immunization KP questionnaire has good reliability and validity for measuring the knowledge and practices of Malaysian parents and therefore this version can be used in future research

The impact of inversions across 33,924 families with rare disease from a national genome sequencing project

Detection of structural variants (SVs) is currently biased toward those that alter copy number. The relative contribution of inversions toward genetic disease is unclear. In this study, we analyzed genome sequencing data for 33,924 families with rare disease from the 100,000 Genomes Project. From a database hosting >500 million SVs, we focused on 351 genes where haploinsufficiency is a confirmed disease mechanism and identified 47 ultra-rare rearrangements that included an inversion (24 bp to 36.4 Mb, 20/47 de novo). Validation utilized a number of orthogonal approaches, including retrospective exome analysis. RNA-seq data supported the respective diagnoses for six participants. Phenotypic blending was apparent in four probands. Diagnostic odysseys were a common theme (>50 years for one individual), and targeted analysis for the specific gene had already been performed for 30% of these individuals but with no findings. We provide formal confirmation of a European founder origin for an intragenic MSH2 inversion. For two individuals with complex SVs involving the MECP2 mutational hotspot, ambiguous SV structures were resolved using long-read sequencing, influencing clinical interpretation. A de novo inversion of HOXD11-13 was uncovered in a family with Kantaputra-type mesomelic dysplasia. Lastly, a complex translocation disrupting APC and involving nine rearranged segments confirmed a clinical diagnosis for three family members and resolved a conundrum for a sibling with a single polyp. Overall, inversions play a small but notable role in rare disease, likely explaining the etiology in around 1/750 families across heterogeneous clinical cohorts

Latrogenic major bile duct injuries injury

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