Antithrombotic Therapy in Patients with Prosthetic Heart Valves

Patients with mechanical valve prostheses require a lifelong anticoagulant treatment. The combined use of Warfarin and low-dose aspirin appears to reduce the risk of valve thrombosis and systemic embolism at a low risk of bleeding. The management of women with prosthetic heart valves during pregnancy poses a particular challenge, as there are no available controlled clinical trials to provide guidelines for effective antithrombotic therapy. Oral anticoagulants, such as Warfarin, cause foetal embryopathy; unfractionated heparin and low-molecular-weight heparin have been reported to be ineffective in preventing thromboembolic complications. This article discusses the available data and the most recent guidelines in the antithrombotic management of patients with prosthetic valves, and antithrombotic therapy in various clinical situations such as pregnant women with prosthetic heart valves, and patients with prosthetic heart valves undergoing noncardiac surgery

Correlating Annual Piche Evaporation over Sudan and South Sudan to Latitudes, Longitudes and Altitudes

Piche evaporation in mm/day for Sudan and South Sudan  for the period 1961- 1990 was obtained as normal data for 42 stations, and analyzed for correlations between  evaporation on the one hand and latitudes, longitudes and elevations on the other hand. Excel statistical package was used for analysis. Data was analyzed for the whole of Sudan and South Sudan. For the 42 stations, evaporation increased on average with increase in latitudes at a rate of about 0.67 mm/degree showing a highly significant linear correlation (P= 4.95E-07). When the 5 Red Sea stations were removed, analysis for the 37 stations resulted in higher significance (P = 4.61E-14), and evaporation increased at a rate of about 0.98 mm/degree latitude. When 5 South Sudan stations were removed, the increase in evaporation per degree latitude for the 32 stations was 0.96 mm/degree, almost similar to that for the 37 stations. Analysis for longitudes using 42 stations showed week or no significant correlation with evaporation, but demonstrated three clear localized patterns two of which showed a strong correlation between evaporation and longitudes; a South Sudan almost flat trend, a western Sudan moderate slope trend where evaporation decreased at about 0.52 mm/ degree longitude east and a general steep slope trend where evaporation decreased at a rate of about 1.1 mm/ degree longitude. Using 32 stations for Sudan, longitudes showed once again the two different evaporation patterns; the western Sudan trend with almost the same slope and the general steep slope trend with also similar slope. Altitudes on the other hand showed no clear correlation to evaporation when all the 42 stations were considered. When the South Sudan and Red Sea stations were removed, the remaining 32 stations showed significant (P= 0.01) correlation with evaporation which declined at a rate of about 0.01 mm/meter above sea level.Key Words: Piche evaporation, Latitude, Longitude, Altitude, Suda

Syncope: Evaluation and management

Syncope is a sudden transient loss of consciousness and postural tone with spontaneous recovery. Loss of consciousness results from a reduction of blood flow to the reticular activating system located in the brain stem. Syncope is an important clinical problem which accounts for 1% of hospital admissions and 3% of emergency department visits with a reported mortality and major morbidity rate of over 7% [1]. It is often disabling, may cause injury and may be the only warning sign before sudden cardiac death. The prognosis of patients with syncope varies greatly with the underlying etiology. Libyan Journal of Medicine Vol. 3 (3) 2008: pp. 44-4

Noncovalent complexation of amphotericin-B with Poly(α-glutamic acid).

A noncovalent complex of amphotericin B (AmB) and poly(α-glutamic acid) (PGA) was prepared to develop a safe and stable formulation for the treatment of leishmaniasis. The loading of AmB in the complex was in the range of ∼20-50%. AmB was in a highly aggregated state with an aggregation ratio often above 2.0. This complex (AmB-PGA) was shown to be stable and to have reduced toxicity to human red blood cells and KB cells compared to the parent compound; cell viability was not affected at an AmB concentration as high as 50 and 200 μg/mL respectively. This AmB-PGA complex retained AmB activity against intracellular Leishmania major amastigotes in the differentiated THP-1 cells with an EC50 of 0.07 ± 0.03-0.08 ± 0.01 μg/mL, which is similar to Fungizone (EC50 of 0.06 ± 0.01 μg/mL). The in vitro antileishmanial activity of the complex against Leishmania donovani was retained after storage at 37 °C for 7 days in the form of a solution (EC50 of 0.27 ± 0.03 to 0.35 ± 0.04 μg/mL) and for 30 days as a solid (EC50 of 0.41 ± 0.07 to 0.63 ± 0.25 μg/mL). These encouraging results indicate that the AmB-PGA complex has the potential for further development

Negative exercise stress test Does it mean anything?

Despite its low sensitivity and specificity (67% and 72%, respectively), exercise testing has remained one of the most widely used noninvasive tests to determine the prognosis in patients with suspected or established coronary disease.As a screening test for coronary artery disease, the exercise stress test is useful in that it is relatively simple and inexpensive. It has been considered particularly helpful in patients with chest pain syndromes who have moderate probability for coronary artery disease, and in whom the resting electrocardiogram (ECG) is normal. The following case presentation and discussion will question the predictive value of a negative stress testing in patients with moderate probability for coronary artery disease

Initial Experience with Awake Craniotomy In Sudan

Resection of brain tumours carries a great risk of functional impairment, especially if the tumour is located in the anterior temporal or frontal lobes, near motor, language, or memory areas of the brain. Awake craniotomy has been proposed aiming for maximum resection with minimum impairment of neurological function. The technique should provide adequate sedation, analgesia, respiratory and haemodynamic stability with an awake and cooperative patient for neurological testing. Airway management during a wake craniotomy is a crucial part of the anaesthetic technique, but it remains the subject of debate. In this case, who was the first patient operated upon as awake craniotomy in Sudan; awake craniotomy has been adopted as his cardiac function made surgery under general anaethesia a potential risk. The patient\'s tolerance to the procedure, haemodynamic stability, the incidence of airway obstruction and intraoperative and postoperative neurological status were assessed. The candidate well tolerated the procedure, with haemodynamic stability and a patent airway throughout the procedure. Convenient resection of the tumor was achieved and uneventful post-operative recovery with no neurological deficits was reported. Keywords: awake craniotomy, propofol, fentanyl.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 171-17

Seroprevalence of cytomegalovirus Antibodies among pregnant women and it’s correlation with spontaneous abortion in Khartoum state

Background: Cytomegalovirus is a common virus that infects most people at some time during their lives. It becomes dormant for a while and may reactivate later. In pregnant women, intrauterine infection may be  associated with congenital abnormalities, intrauterine growth retardation and intrauterine death of the fetus as well as late sequelae such as  developmental delay, blindness and congenital deafness.Objectives: The aim of this study was to determine the seroprevalence of CMV infection among women presenting with spontaneous abortion to major hospitals in Khartoum State and to find out the correlation between CMV infection and spontaneous abortion in the group under study.Methodology: In this study a total of 180 spontaneously aborted females, and 80 normally delivered females (control) were included. Three mls of venous blood were collected from each subject under study in a plain  container allowed to clot and after clot retraction centrifuged at 4000rpm. The sera were then separated and stored at -20c0 in a deep freezer. The stored sera were tested for CMV IgG and IgM antibodies using Enzyme Linked Immunosorbent Assay (BIOTECH –ENGLAND).Results: In the case group, 176 (97.8%) women were positive for Anti-CMV IgG and 69 (38.3%) for Anti-CMV IgM. The CMV antibodies significantly co related with increasing age (P-value = -0.0185), the number of abortion (P-value = -0.0177) and congenital malformation in children (P value= 0.037).Conclusion: Seroprevalence of CMV antibodies was found to be 97.8% and 38.3% for IgG & IgM respectively. There was significant association  between CMV infection and frequency of abortion, age and congenital  malformation in children.Key words: CMV, seroprevalnce, pregnancy, spontaneous abortion, Suda

Impact of anthropogenic activities and natural inputs on oceanographic characteristics of water and geochemistry of surface sediments in different sites along the Egyptian Red Sea Coast

The surface sediments and sea water interactions were studied in five different sites along the Egyptian Red Sea coast. There are commutative and correlative relations between these constituents, therefore, any alterations occur in the sediments and sea water will be directly reflected on the marine environment. Sixty-five sediment samples were collected and also the oceanographic characteristics of surface sea water such as salinity, pH and total dissolved salts (TDS) were measured in situ for the same five localities (El-Hamrawein Harbour, Sharm el Bahari, Abu Dabab, Qola'an and Shalatein). The oceanographic properties of sea water show high salinity (42.55 and 42.59 psu) and total dissolved salts values (31.77 and 31.73 mg/L-1) in both Qola'an and Shalatein, also Abu Dabab and Qala'an areas shows high pH values (8.00 and 8.04) due to the presence of dense sea grass cover. The sediment types generally changes from sand to slightly gravelly sand or muddy sand, also the surface sediments are mainly medium sand, moderately to poorly sorted. Geochemically, the factor controlling the carbonate content of studies sediments includes material supply of biogenic and terrigenous components. Therefore, sediments of El-Hamrawein, Sharm el-Bahari, Abu Dabab and Shalatein areas are terrigenous sediments, while sediments of Qola'an area south Marsa Alam are highly carbonates. In general, organic matter (4.82%) is higher in the sediments relative to adjacent areas due to high contributions of terrestrial materials by wadis and anthropogenic factors.Key words: Grain size, geochemistry, oceanographic, sediments, seawater, Red Sea, Egypt

Pattern of irritable bowel syndrome and its impact on quality of life in primary health care center attendees, Suez governorate, Egypt

Introduction: Irritable bowel syndrome (IBS) is one of the most common disorders diagnosed by gastroenterologists and a common cause of general practice visits. Although this disease is not life threatening, patients with IBS seem to be seriously affected in their everyday life. The study was designed to explore the pattern of IBS in clinical practice and the impact on the quality of life. Methods: This is a case control descriptive study. 117 individuals were included in this study. Rome II criteria were used for the diagnosis of IBS. Impact of IBS on patient's quality of life was determined by irritable bowel syndrome quality of life (IBS-QOL) questionnaire. Results: Prevalence of IBS among the study sample was 34.2%. 10% were IBS-Diarrhea, 37.5% were IBS-Constipation and 52.5% were alternators. There is statistical insignificant relationship between IBS (+) and age while it was a significant relation regarding gender (more common among women 80%). There is statistical significance relationship between IBS (+) on one hand and marital status and occupational status on the other hand. Patients with IBS had statistically significant lower scores for all IBS- QOL domains compared with the control group. Conclusion: IBS is a prevalent disorder that affects females more than males and it has significant impacts on work, lifestyle and social well-being.Key words: Irritable bowel syndrome, quality of life, Roma I

Enzymatic Preparation of Low-Phenylalanine Formula Derived from Skim Milk Hydrolysate for Phenyl ketonuric Patients

Background: Phenylketonuria (PKU) is one of the most common inborn errors of amino acids metabolism. WHO guidelines introduced in 1979 and revised 1988 for breast-feeding infants with PKU included a formula containing low amounts of phenylalanine as a part of dietary prescription. Mental retardation can be prevented if PKU is diagnosed in the 1st three weeks of life and diet therapy started straightaway throughout life and especially in the hyper phenylalaninemic mothers before conception and during pregnancy. Aim of the Work: The aim of the present study was to synthesize a lowphenylalanine formula suitable to be taken by PKU children, adolescents and the hyperphenylalaninemic mothers. Materials and Method: This formula should be of high biological value, taken safely by those patients and to be of low cost. The formula was prepared from skim milk hydrolysate using two proteolytic enzymes. The first was the immobilized purified papain enzyme and the second was the modified protease XXIII prepared from Aspergillus oryzae. The skim milk hydrolysate was adsorbed on barium sulphate or activated carbon for removing phenylalanine. They were applied separately for the purpose of debittering and nutritional value comparison. Results: This skim milk hydrolysate had been supplemented with the amino acids tryptophan, tyrosine, methionine and valine. Beside the comprehensive amino acids analysis (Especially for the free amino acids), this formula was then analyzed for protein, fat, lactose and ash contents as well as microbiological and biological testing on mice. Hyperphenylalaninemia was induced in BALB/c mice model then changes in blood phenylalanine level and weight were scored during the periods of mutagenesis as well as the treatment period compared with the control group. Conclusion: The amino acids analysis showed that phenylalanine was 0.71gm/100 gram protein in the skim milk hydrolysate compared to 3.26gm amino acid/100 gram protein in the skim milk. The level of free phenylalanine decreased from 6.34% (In the skim milk) to 0% after adsorption to barium sulphate and compared to 3.41% after adsorption to activated carbon. The formula adsorbed on barium sulphate, although it is more preserving to the nutritional composition; yet, it is less effective in the debittering effect than that adsorbed on activated carbon. This formula, in addition to being of high nutrional value, it is not expensive since it is obtained from skim milk hydrolysate. From the present study, it could be concluded that: The synthesized low-phenylalanine formula was effective in supplying most of the needed dietary intakes for conditions of hyperphenylalaninemia. The use of the immobilized purified Papain and modified protease XXIII from Aspergillus oryzae in enzymatic hydrolysis of skim milk has been proved to be effective in hydrolysis and emulsification. Keywords: Phenylketonuria, skim milk. Egypt. J. Hum. Genet Vol. 9 (1) 2008: pp. 51-7