Hirschisprung’s disease: Factors Affecting the Outcome at The National Ribat University Hospital, Khartoum, Sudan, 2007 to 2011

Background: Hirschsprung's disease (HSD) remains the most frequent cause of child intestinal obstruction.Objectives: to evaluate the effect of different factors at the final outcome, postoperative complications and the hospital stay of children with HSD.Methodology: It is a retro-prospective analytical observational hospital based study, involving all the cases presented initially to the Paediatric Surgery Centre at the National Ribat University Hospital and confirmed to be a case of HSD. The data were collected using a questionnaire and analyzed by the software SPSS version 17.Results: Sixty four patients were involved in this study with male to female ratio of 5:1. The mean age at the first time of presentation was 9 days and the bulk of the patients seen from the center of Sudan. The emergency presentation accounted for 21.9% of the cases with the delayed passage ofmeconium and constipation as the main presenting symptoms. Complications occur mainly at day 13 post operatively with colostomy prolapse as the commonest type of complications. The age of the patients at the time of Pull Through Procedure (PTP) was ranging between 7 to 72 months and the mean body weight found to be 11.94 kg. Complicationsfollowing PTP occur in 18.8% of the cases, with wound infection accounting for 15.6% of the cases. The total duration of hospital stay post operatively after reversal of colostomy was found to range between 6 and 60 days with a mean of 8.77 days and SD of ± 6.657.Conclusion: The average hospital frequency of HSD in our study is  compared to that encountered in European countries and Northern  American countries. Early diagnosis and treatment is essential for better outcome. Emergency presentation, age and the weight at Pull Through Operation and at the time of closure of colostomy, significantly affect the outcome and prolong the hospital stay.Key words: Hirschsprung's Disease, colostomy, Pull Through Operation

Mutagenic and antimutagenic potentials of fruit juices of five medicinal plants in Allium cepa L.: Possible influence of DPPH free radical scavengers

Mutagenic and antimutagenic activities of freeze dried fruit juices (FDFJ) of Morinda elliptica Ridl. (Rubiaceae), Morinda citrifolia L. (Rubiaceae), Averrhoa bilimbi L. (Oxalidaceae), Phyllantus acidus (L.) Skeels (Phyllantaceae) and Myristica fragrans Houtt. (Myristicaceae) in Allium cepa L was evaluated. Testing the mutagenic activity, onions were suspended in solution of different concentrations of FDFJ alone in tap water for 48 h. Thereafter, root tips were prepared and observed for dividing cells and chromosomal aberrations using a light microscope. Antimutagenicity screening was similar to the mutagenic evaluation, except that the solution of FDFJ was combined with 0.1% cylophosphamide-CP. Free radicals (2,2-diphenyl-1-picrylhyrazyl) scavenging activity of the FDFJ was tested using butylated hydroxylanisole (BHA) and butylated hydroxytoluene (BHT) as the standards and their phenolic contents were evaluated by comparing with gallic acid equivalents (GAE). The free radicals scavenging power of M. fragrans at 1 mg/ml was almost similar to that of BHA and BHT and its phenolic content was 21 ± 6.0 mg GAE/g, the highest among the tested juices. A. cepa cell division was inhibited in a dose-dependent manner by the FDFJ of M. fragrans, while the induced chromosomal aberrations were non dose dependent. The cytotoxicity and chromosomal aberrations of CP were suppressed throughout the tested concentrations of M. fragrans, unlike the effects of other four juices. These results suggest that the observed activities of FDFJ of M. fragrans may be due to the quantity and quality of phenolic compounds with antioxidant activity, suggesting its use in preventing the DNAdamaging effects of mutagens.Key words: Allium cepa, antimutagenicity, antioxidants, cyclophosphamide, mutagenicity

Identifying the barriers affecting quality in maintenance within Libyan manufacturing organisations (public sector)

This research is concerned with understanding a quality management system and itsinteraction with maintenance management activities within the organisation. Theinteraction between maintenance and quality, can lead to their integration withproduction. The second output of production is maintenance, whose output is increasedproduction capacity. Both the production process and the quality of the maintenancework, which, in turn, affects equipment condition, affect the quality of final product.The thesis aims to identify the barriers and difficulties affecting quality in maintenance,within Libyan (public sector) manufacturing organisations. The specific objectives arederived to provide focus for the research activities, in order to fulfil the specific aim ofthe research in a structured and scientific manner.In order to achieve the thesis objectives, an empirically-based systems analysis of twocase study organisations in the Libyan public manufacturing sector was carried out.Substantial field work was carried out using predominantly a qualitative approach.Qualitative data was collected by semi structured interview (from different levels ofmanagement and supervisors) to explore the quality management phenomena, and toprovide a more holistic understanding through triangulation techniques of required andsuitable data.This study has contributed to existing knowledge through getting an in-depthunderstanding of quality and maintenance issues. A specific definition of "quality inmaintenance" was developed, common barriers of quality systems and the key factors ofimproving maintenance were summarised. Furthermore, by using the framework infigure 2.8 the enablers and inhibitors of quality in maintenance were demonstrated.This study is the first one that identified the unique barriers affecting quality inmaintenance within the Libyan manufacturing organisations. These barriers are dividedinto three main kinds: the technical, economic barriers, managerial, organisationalbarriers, and cultural environmental barriers. The key findings of the research indicatethat the case study organisations do not actively promote quality in the maintenancearea that takes into consideration the influence of organisational, social, economic andpolitical factors (change culture) on the quality of operations and performance inside theorganisations

A twin study of cilioretinal arteries, tilted discs and situs inversus

PURPOSE: To establish the prevalence and heritability of cilioretinal arteries (CRAs), tilted discs (TDs) and situs inversus (SI). METHODS: Fundus photos from the Twins UK Adult Twin registry twin database were analyzed: 1812 individuals, 526 complete monozygotic (MZ) twin pairs and 336 complete dizygotic (DZ) pairs. Images were assessed non-stereoscopically on a computer screen by the same ophthalmologist for presence of CRAs, TDs or SI. Prevalence figures, probandwise concordances and heritabilities were calculated. RESULTS: Prevalence of a CRA in subjects’ right eyes was 28.6% (26.5–30.8). Prevalence of subjects with a CRA in at least one eye was 45.0% (42.6–47.5), with a TD in at least one eye was 1.2% (0.8–1.9), and with SI at least one eye was 0.5% (0.3–1.0). There was no association between birth weight and presence of CRA. Concordance for CRA in at least one eye (MZ twins) was 60% (95% CI 55–64), and (DZ) was 45% (95% CI 39–51). Heritability for CRAs in at least one eye was 49.4% (95% CI 38.1–59.7) and for both eyes was 32.9% (95% CI 10.4–53.3). We were unable to calculate meaningful heritabilities or concordances for TDs and situs SI, due to insufficient numbers. CONCLUSIONS: The presence of CRAs appears to be moderately heritable, with greater variance explained by individual environmental factors or even stochastic events. They were not associated with low birth weight. Future genetic research and studies of birth/lifecourse cohorts may offer further insights into the etiology of congenital papillovascular abnormalities

Stochastic analysis of a deterministic and seasonally forced SEI model for improved disease spread simulation

The geographic distribution of different viruses has developed widely, giving rise to an escalating number of cases during the past two decades. The deterministic Susceptible, Exposed, Infectious (SEI) models can demonstrate the spatio-temporal dynamics of the diseases and have been used extensively in modern mathematical and mechano-biological simulations. This article presents a functional technique to model the stochastic effects and seasonal forcing in a reliable manner by satisfying the Lipschitz criteria. We have emphasized that the graphical portrayal can prove to be a powerful tool to demonstrate the stability analysis of the deterministic as well as the stochastic modeling. Emphasis is made on the dynamical effects of the force of infection. Such analysis based on the parametric sweep can prove to be helpful in predicting the disease spread in urban as well as rural areas and should be of interest to mathematical biosciences researchers

Retinal thickness measurements in sickle cell patients with HbSS and HbSC genotype

OBJECTIVE: Temporal macula thinning has been reported in sickle cell patients, but it remains unclear if there is a difference between HbSS and HbSC genotypes. We aimed to quantitatively compare macular thickness between eyes with HbSS and HbSC genotype. DESIGN: Retrospective descriptive study. METHODS: Consecutive patients seen over a 5.5-year period in the Ophthalmology Department at St Thomas’ Hospital, London, were identified. Macular optical coherence tomography images were retrospectively analyzed. The retinal thickness in all 9 subfields of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid was compared between HbSS and HbSC eyes. Right eyes and left eyes were analyzed independently, as well as averaged measurements from both eyes. Comparison was made between the 2 genotypes, adjusting for age and sex, and for multiple testing. Scans were excluded in cases of poor fixation or ocular comorbidity affecting retinal thickness. RESULTS: 132 HbSC and 120 HbSS patients were identified. Scans from 166 right and 153 left eyes were included (with approximately equal numbers of HbSS and HbSC genotypes). Mean retinal thickness was lower in HbSS eyes compared with HbSC eyes in all subfields of the ETDRS grid, but in most subfields the difference was <10 microns. Differences reached statistical significance for outer superior, inferior, and temporal subfields and the inner temporal subfield (p < 0.05). CONCLUSION: Although the HbSC genotype is more strongly associated with proliferative retinopathy, HbSS patients had on average more macular thinning

The patterns of clinical presentations of cerebellar syndromes among adult Sudanese patients

Cerebellar syndromes are one of the commonest neurological diseases.Objectives: To study the patterns of clinical presentations of cerebellar syndromes and to identify the possible causes.Methods: This is a prospective hospital based, cross-sectional study. One hundred adult Sudanese patients with cerebellar syndromes were included in the study during the period from January 2006– January 2007.Results: The most common age group affected was 18 – 25 years. Male to female ratio was 1.5: 1 unsteadiness on walking was the most common symptom (83%). Gait-ataxia was the most common sign (83%). Cerebrovascular disease was the most common aetiology (25%).Conclusion: Cerebellar syndromes are not rare in Sudan. However, they were diagnosed more commonly at the central regions of the country probably because of more awareness of patients and better facilitiesfor diagnosis. The age of onset, the male predominance, the presentation and clinical findings were not different from reported literature. This also goes for the common causes apart from alcohol which is a strikingly rare as a cause in this study and could be accounted for the implementation of Elshariya (Islamic laws) Laws in Sudan.Keywords: ataxia, dysmetria, disdiadochokenesis, decomposition, nystagmus, dysarthria

Derivative spectrophotometric analysis of benzophenone (as an impurity) in phenytoin

Three simple and rapid spectrophotometric methods were developed for detection and trace determination of benzophenone (the main impurity) in phenytoin bulk powder and pharmaceutical formulations. The first method, zero-crossing first derivative spectrophotometry, depends on measuring the first derivative trough values at 257.6 nm for benzophenone. The second method, zero-crossing third derivative spectrophotometry, depends on measuring the third derivative peak values at 263.2 nm. The third method, ratio first derivative spectrophotometry, depends on measuring the peak amplitudes of the first derivative of the ratio spectra (the spectra of benzophenone divided by the spectrum of 5.0 μg/mL phenytoin solution) at 272 nm. The calibration graphs were linear over the range of 1-10 μg/mL. The detection limits of the first and the third derivative methods were found to be 0.04 μg/mL and 0.11 μg/mL and the quantitation limits were 0.13 μg/mL and 0.34 μg/mL, respectively, while for the ratio derivative method, the detection limit was 0.06 μg/mL and the quantitation limit was 0.18 μg/mL. The proposed methods were applied successfully to the assay of the studied drug in phenytoin bulk powder and certain pharmaceutical preparations. The results were statistically compared to those obtained using a polarographic method and were found to be in good agreement

Molecular identification of adenoviruses associated with respiratory infection in Egypt from 2003 to 2010.

BACKGROUND: Human adenoviruses of species B, C, and E (HAdV-B, -C, -E) are frequent causative agents of acute respiratory infections worldwide. As part of a surveillance program aimed at identifying the etiology of influenza-like illness (ILI) in Egypt, we characterized 105 adenovirus isolates from clinical samples collected between 2003 and 2010. METHODS: Identification of the isolates as HAdV was accomplished by an immunofluorescence assay (IFA) and confirmed by a set of species and type specific polymerase chain reactions (PCR). RESULTS: Of the 105 isolates, 42% were identified as belonging to HAdV-B, 60% as HAdV-C, and 1% as HAdV-E. We identified a total of six co-infections by PCR, of which five were HAdV-B/HAdV-C co-infections, and one was a co-infection of two HAdV-C types: HAdV-5/HAdV-6. Molecular typing by PCR enabled the identification of eight genotypes of human adenoviruses; HAdV-3 (n = 22), HAdV-7 (n = 14), HAdV-11 (n = 8), HAdV-1 (n = 22), HAdV-2 (20), HAdV-5 (n = 15), HAdV-6 (n = 3) and HAdV-4 (n = 1). The most abundant species in the characterized collection of isolates was HAdV-C, which is concordant with existing data for worldwide epidemiology of HAdV respiratory infections. CONCLUSIONS: We identified three species, HAdV-B, -C and -E, among patients with ILI over the course of 7 years in Egypt, with at least eight diverse types circulating