Fine Needle Aspiration Cytology for Suspected Tuberculous Lymphadenitis: A Feasible Solution for a Diagnostic Dilemma in Sudan

Background: Tuberculosis is a common health problem in Sudan. Tuberculous lymphadenitis is one of the most frequent causes of lymphadenopathy. In most of these cases sputum as well as other diagnostic routine tests are negative.Objective: To evaluate the usefulness of fine needle aspiration cytology (FNAC) as a diagnostic tool for tuberculous lymphadenitis and to describe the cytomorphology of the smears.Material and Methods: This is a prospective hospital-based study conducted in Khartoum during the period from February 2011 to January 2012. Eighty five patients with a clinical suspicion of tuberculous lymphadenopathy were included. Direct smears were prepared and stained with Diff Quick (DQ) and Ziehl-Neelsen (ZN) stains.Results: of the 85 patients, 52 (61.2%) were females with 1.5:1 female to male ratio. The mean age was 31.6 years (range 2 - 70 years). The most frequent site involved was the cervical lymph node group,58 (68.2%) cases. Seventy five (88.3%) smears showed necrotizing granulomatous lymphadenitis (with or without detected epithelioid cells), and 10 (11.7%) smears were non necrotizing granulomatous lymphadenitis, only epithelioid and inflammatory cells detected. Positive smears for acid fast bacilli (AFB) by ZN stain were observed in 40 (47%) cases.Conclusion: FNAC is a simple and inexpensive method for diagnosis of tuberculous lymphadenitis, and can obviate the need for surgical excision. Combination of FNAC with ZN stain is valuable and recommended as first line diagnostic modality in suspected cases.Keywords: Fine Needle Aspiration Cytology, Tuberculous lymphadenitis, Acid fast bacilli

The digital simulation of attacking structures in accordance to the standard lps 1175 set by the loss prevention certification board (LPCB)

Protecting critical parts of UK infrastructure resources from criminal or terrorist attack in the UK is an industrial sector which is rapidly expanding. In 2016 the UK Security sector grew by 17% and in the last five years, its turnover has doubled to £12.2 billion. There are 13 sectors of Critical National Infrastructure (CNI) that are included in the security sector, where there is a high regard for the protection of the assets within CNI. The National Infrastructure Delivery Plan, outlines details of £483 billion of investment in over 600 infrastructure projects and programmes in all sectors and spread across the UK, up to 2020-21 and beyond.The development and successful certification of Loss Prevention Certification Board (LPCB) products, demonstrates their ability to resist physical attack for guaranteed periods of time. LPCB state that the failure rate on products submitted to them for testing is 95%, the development and testing of these new products has historically been undertaken using an iterative ‘by eye’ approach. Although this has clearly developed suitable products, the iterative approach of fabricate, test, improve, retest is inefficient and can be improved upon using digital techniques.The aim of this thesis is to develop a new method in which to design and test new security products, so that the probability of new products passing an LPCB attack test is greatly increased through two key methods; The assimilation and interpretation of historic test data and the finite element analysis of proposed structures. This, in turn, leads to more highly engineered products that are quicker and more economical to design and develop.A novel database that contains unique data related to the physical testing of the LPCB rated products has been proposed, created and implemented. This has shown that a saving of £10,000 could have benefitted the company on a single product with its implementation and an overall saving of £30,000 spread over a year with multiple product test regimes. This reduction in time and money spent testing individual products multiple times could also mean that the Company can have an increased capacity for the development of new products in a year. Equally a new digital workflow which is validated against a bespoke physical testing regime has been developed and implemented, which when combined with the database has led to reduced product development and increased efficiencies of product design.This proposed methodology within the sector is unique and has generated interest from companies such as the Loss Prevention Certification Board. LPCB which is part of BRE Global, is commissioned by the BRE Trust, and wish to see the methodology rolled out across the sector

Auditing the use of percutaneous pinning as a technique of fixation of unstable humeral supracondylar fractures in Sudanese children.

Background:Supracondylar fractures of the humerus in children are commonly treated with closed reduction and percutaneous pin fixation. There has been controversy regarding the optimal pin configuration inthe management of supracondylar humeral fractures in children.Objectives: To evaluate the effectiveness of closed percutaneous pinning (P.C.P.) as a treatment modality of supracondylar fractures of humerus in Sudanese children.Patients and methods: Hospital based prospective study conducted in Khartoum teaching hospital during the period from July 2006 to March 2007. It included all children less than 14 years of age, with closed type III supracondylar humeral fracture, extension variant, who treated by closedreduction and percutaneous cross pinning.Results: 34 patients were included in the study. Their age ranged between 4 -12 years, with mean ± SD of 7.68 ± 2.34 years. Twenty-four (70.6%) fractures were fixed with crossed pins whereas ten (29.4%) fractures with two lateral pins. The two lateral pins fixation was found to be significantlyassociated with loss of reduction (p=0.004).Conclusion: PCP is safe and effective with good functional outcome in treatment of unstable supracondylar fractures. The best wires configuration is that which gives ability to extend elbow with much stability

Risk factors for peritoneal dialysis catheter failure in children

Background Peritoneal dialysis catheter (PDC) failure still remains a common clinical problem in pediatric patients despite advancements in catheter placement and dialysis techniques. Our aim was to determine the risk factors that may lead to PDC failure, especially those factors that could be potentially modified to minimize PDC failures.Patients and methods This study was designed as a retrospective chart review of 31 patients less than 12 years of age who had end-stage renal disease (ESRD) on whom a total of 54 operative PDC placements were carried out at the tertiary Children’s Hospital, King Fahad Medical City, Riyadh, Saudi Arabia, from January 2007 to December 2010. The data included patient demographics and perioperative and operative variables.Results Fifty-four PDCs were inserted in 31 pediatric patients with ESRD, of whom 17 (55%) were boys and 14 (45%) were girls. Young age showed a statistically significant effect on PDC failure [1.8 (± 5) vs. 5 (± 7.8), P = 0.007], whereas weight did not (P = 0.085). Five types of PDCs were used, which showed significant association with PDC failure (P =0.009). Supraumbilical paramedian abdominal entry incisions were used in 49 (90.7%) patients without peritoneal leakage in any case. Nonsimultaneous omentectomy and upward PDC exit site orientation showed significant association with PDC failure (Pr0.001). The causes of PDC failure included idiopathic peritonitis in 13 (56.5%), PDC occlusion by omentum in five (21.7%), PDC malposition in four (17.4%) patients, and PDC leakage in one (4.4%) patient. Peritonitis showed a high statistical significance in PDC failure with P value of less than 0.001. The serum albumin level at the time of PDC insertion was not statistically significant in terms of PDC failure (P = 0.40) but had a high association with idiopathic peritonitis.Conclusion Our study provides some recommendations to minimize PDC failures that include improvement of patients’ nutritional status, use of a swan-neck double-cuffed catheter, paramedian abdominal entry incision, simultaneous omentectomy, downward orientation of exit site, and use of an up-to-date technique by a dedicated team for proper use of PDC. However, prospective studies possibly on a multicentric basis are necessary to standardize the best PDC insertion and maintenance techniques to minimize PDC failures and improve the quality of life for children with ESRD. Keywords: end-stage renal disease, pediatric patients, peritoneal dialysis, tenckhoff cathete

Development and Evaluation of Orally Disintegrating Tablets of Montelukast Sodium by Direct Compression Method

Purpose: To design an orally disintegrating montelukast sodium tablet (ODT) that disintegrates in the oral cavity leaving an easy-to-swallow residue especially for pediatric and elderly patients who have difficulty swallowing tablets.Methods: Two different formulations of montelukast sodium (5 mg) orally disintegrating tablets were designed and manufactured by direct compression method, using microcrystalline (Avicel PH-102), mannitol, sodium bicarbonate, crospovidone and magnesium stearate as key excipients, and with cherry flavor and aspartame as flavor and sweetener, respectively. These formulations were then evaluated using pharmacopoeial and non-pharmacopoeial physical and chemical tests. Dissolution and assay tests were performed using USP apparatus II and ultraviolet (UV) spectrophotometry, respectively. Formulations with better results were further subjected for optimization study using central composite design method.Results: The results of prototype formulation batch (Trial-02) and the finest optimization formulation batch (FOB-01) reflected the successful development of new formulation of orally disintegrating montelukast sodium 5 mg tablet by direct compression technique. The value of similarity factor (f2 > 50), indicating that both formulations have similar drug release profiles. The formulations were further evaluated for three and six months under accelerated conditions to ascertain their stability.Conclusion: The results obtained demonstrate the suitability of the formulation as an ODT for convenient delivery of montelukast sodium for asthmatic patients. However, clinical studies are required to confirm this.Keywords: Orally disintegrating tablets, Asthma, Disintegration, Dissolution, Montelukast sodiu

Antibacterial activity of whole plant extract of Marrubium vulgare

The antibacterial activity of the methanolic extract of Marrubium vulgare whole plant was tested by disc diffusion method. Zones of Inhibition produced by methanolic extract in a dose of 50, 100, 200, 400 and600 mg/ml against selected strains was measured and compared with those of standard discs of antibiotic ciprofloxacin (10 ìg/ml)

Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations

BACKGROUND: A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety. METHODS: Hospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews. RESULTS: Ten participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient's journey was a major safety concern. DISCUSSION: The complexity of EP systems' adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety.Peer reviewe

Misidentification of methicillinresistant Staphylococcus aureus (MRSA) in hospitals in Tripoli, Libya

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial (hospital-acquired) pathogen of exceptional concern. It is responsible for life-threatening infections in both the hospital and the community. Aims: To determine the frequency of MRSA misidentification in hospitals in Tripoli, Libya using current testing methods. Methods: One hundred and seventy S. aureus isolates previously identified as MRSA were obtained from three hospitals in Tripoli. All isolates were reidentified by culturing on mannitol salt agar, API 20 Staph System and retested for resistance to methicillin using the cefoxitin disk diffusion susceptibility test and PBP2a. D-tests and vancomycin E-tests (Van-E-tests) were also performed for vancomycin-resistant isolates. Results: Of the 170 isolates examined, 86 (51%) were confirmed as MRSA (i.e. 49% were misidentified as MRSA). Fifteen (17%) of the confirmed MRSA strains exhibited inducible clindamycin resistance. Of the 86 confirmed MRSA isolates, 13 (15%) were resistant to mupirocin, 53 (62%) were resistant to ciprofloxacin, 41 (48%) were resistant to trimethoprim-sulfamethoxazole, and none were resistant to linezolid. Although discdiffusion testing indicated that 23 (27%) of the isolates were resistant to vancomycin, none of the isolates were vancomycin-resistant by Van-E-test. Conclusions: Misidentification of nosocomial S. aureus as MRSA is a serious problem in Libyan hospitals. There is an urgent need for the proper training of microbiology laboratory technicians in standard antimicrobial susceptibility procedures and the implementation of quality control programs in microbiology laboratories of Libyan hospitals.Keywords: MRSA misidentification; clindamycin resistance; E-test; vancomycin resistanc