Pattern and Management of Obstructive Jaundice in Wad Medani Teaching Hospital, March 2014 -2015

Abstract:                                                     Obstructive jaundice is not uncommon in this area certainly with what is reported in the literature, malignant jaundice is more common than choledocholithiasis. The pre-operative management followed the international guidelines; most of the surgery done to the malignant jaundice was palliative because of the late presentation. Endoscopic service in management of obstructive jaundice is important and shall be utelized after completion of the new GIT Centre-Wad Medani Hospital. This study was a prospective cross sectional descriptive study, conducted in Wad Medani hospital - Gezira state – Sudan from March 2014 to March 2015. Wad Medani Teaching Hospital is a tertiary hospital with 600 beds serving all Gezira state and nearby states  Material and Method: 124 patients admitted to hospital with symptoms and signs of obstructive jaundice including; yellow coloration of the sclera, dark urine,pale stools, itching, with or without the association of vomiting, abdominal pain, abdominal mass and weight loss. Diagnosis was confirmed by history, examination and biochemical and radiological investigations.The data was analyzed by computer using SSPS. Results: 52(41.9%) were males and72 (51.8%) were females, with male to female ratio of 1:1.3. The cases of obstructive jaundice were found to be distributed among their age groups from 18-40yr (15.3%),41-60yr(31.5%) , 60yr and above (53.2%). Definitive diagnosis after completion of investigations results showed that cases due to common bile duct (CBD) stone and carcinoma of the head of pancrease were 55 (44.4%) and 52 (41.9%) respectively. The relation between the diagnosis and sex results showed CBD stone in females was 37(51.4%) where as in males  carcinoma of the head of pancrease was 25(48.11%), ERCP was used in 67(54%) patients both for diagnostic and therapeutic indications. The operative intervention was also studied for all patients with obstructive jaundice and the results showed that 48(38.7%) patients underwent surgical intervention with 7(5.6%) CBD exploration and 41(33.1%) by pass surgical operation. Conclusion: ERCP has a promising role in the study area in managing patients with obstructive jaundice. The family physicians   have an important role to play in early detection and referral of patients with obstructive jaundice to hospitals to avoid delayed presentation and minimize the harmful effects of hyper bilirubinemia on the   liver so the step should start with how to detect the case and after that what to do for the case before referral to nearby hospital

Preparation and Investigation of Flexural Strength and Impact Strength for Nano Hybrid Composite Materials of the Tri- Polymeric Blend used in Structural Applications

Current work is aimed to preparation the nanocomposites laminatesof low density and good durability to use in structural applications. So, in thispaper, the preparation and compare of some mechanical properties of twogroups of tri-polymer blends composites consisting of ((93% unsaturatedpolyester resin (UP)+(5%PMMA) (Poly methyl methacrylate)+2%NR(Natural Rubber)) as the matrix materials. Added the reinforce materials(silica (SiO2) and zirconia (ZrO2) nanoparticles) individually, with differentvolume fraction of (0, 0.5, 1, 1.5%) to the ternary polymer blends accordingto the following formula:- [((100-X) (93%UP)+2%NR+5%PMMA): (X%SiO2or X% ZrO2)] The first group is composed of matrix material reinforced withzirconia (ZrO2) nanoparticles with average diameter of nanoparticles(56.88nm) and the second group is composed of matrix material reinforcedwith silica (SiO2) nanoparticles with average diameter of nanoparticles(24.59nm). Then used as a matrix material for the preparation of hybridlaminar composites materials, reinforcement with one and two layers ofwoven carbon fibers The research included the study of the influence ofvolume fraction of nanoparticles on some of mechanical and physicalproperties like flexural strength, flexural modulus impact strength, and impactfracture toughness, in addition to test infrared spectroscopy (FTIR) and all ofthese tests were carried out at laboratory temperature. Search results haveshown that the values of (flexural modulus and impact strength and fracturetoughness) increases with the increase of the nanoparticles ratios in polymerblend nano composite of prepared samples. While flexural strength valuedecreases with the increase in the volume fraction of nanoparticles in polymerblend nano composite. The fracture energy of the of hybrid laminarcomposites is higher than those containing only the nanoparticles powders.Morphology test by scanning electron microscope indicates that a goodadhesion or interfacial interactions between the Nano powders particles,carbon fibers and components of ternary polymer blend. Which results inhigher the carbon fibers efficiency factor, and hence higher mechanicalstrength. So, the hybrid laminar nano composites, which appear high flexuralmodulus and impact strength and fracture toughness, can be foreseen toprovide valuable contribution to high performance structural applications

Structural and magnetic properties of co-nd substituted znfe2o4 ferrites synthesized by co-precipitation technique

A series of Zn1-xCoxNdyFe2-yO4 spinel ferrites (x=0,0-0.5, y=0.00-0.10) was synthesized using the co-precipitation method sintered at 1000oC. Synthesized Ferrites were characterized by x-ray diffraction (XRD), scanning electron microscopy (SEM) and vibrating sample magnetometery (VSM). The diffraction patterns show the formation of the spinel phase along with some traces of second phase Nd2O3. The lattice constant decreases with increasing Co-Nd ions because of the solubility of Nd3+ into the spinel lattice. SEM shows the decrease of the grain size with the increase of Co-Nd contents due to the fact that the second phase inhibits the growth of grain. VSM results show increasing trends of remanence and saturation magnetization due to the strengthening of the A-B sublattice interactions. The coercivity shows an increasing behaviour with the increase of co-substitutent contents

A Systematic Review on Cardiovascular Stent and Stenting Failure: Coherent Taxonomy, Performance Measures, Motivations, Open Challenges and Recommendations

Cardiovascular stenting is a mature topic but it is still being developed in the research community because of its importance. To provide worthy information about cardiovascular stenting environments and to give support to the researchers, attention must be given to understand the obtainable choices and gaps in this research field. This work aims to examine and examine the literature of each work related to the placement of cardiovascular stents, the failure of the stents and the models of stent designs to provide a good understanding through the investigation of articles published in various contextual aspects, such as motivations, open-challenges and recommendations to improve the field of stent placement. A systematic review is carried-out to map and examine the articles related to cardiovascular stents, the failure of the stents and the models of stent designs through a coherent-taxonomy used in three well-known scientific databases: ScienceDirect, IEEE Explore, and Web of Science. These databases involve literature that highlight arterial stenting. Based-on our inclusion and exception, a total of 90 articles composed the final set that offer various classes and sub-classes. The first class includes the development studies with (42/90) of experimental, computational and combined experimental and computational studies related to stent models performance and stent failure, the second class discussed studies that have been performed on stent design with (32/90), the third class is focused on the framework studies with (10/90), and the fourth class includes problems of stenting long-term with (6/90). The performance of stent designs, which is a research area that requires periodic controls, tools and procedures that could provide a stent design with good mechanical performance, reduce restenosis in the stent and increase fatigue resistance and durability. There have been numerous studies on stent performance that could promise good results in this field. The fields of research in stent designs vary, but all fields are fundamental equally. The expectation of this work could help to emphasize present research chances and, therefore, expand and make further research fields

Relationship between antimicrobial prescribing and antimicrobial resistance among UTI patients at Buraidah Central Hospital, Saudi Arabia

Most of the decisions regarding diagnosis and treatment are based on laboratory test results. Urinary tract infections (UTIs) are among the most common infections in humans. The changing antimicrobial sensitivity in UTI requires appropriate antibiotics. Antimicrobial resistance is an emerging problem in the Kingdom of Saudi Arabia where the complete reversal of antimicrobial resistance is difficult due to irrational use of antibiotics. Objectives: This study aimed to determine the most common bacterial agents causing UTI in different seasons among patients who were admitted to Buraidah Central Hospital (BCH), Saudi Arabia. The study also evaluated the link between prescribing and resistance toward antimicrobials. Materials and Methods: A 6-month retrospective study was conducted among adult patients who were admitted to the inpatient department at BCH. A total of 379 files were collected from microbiological laboratory for inpatients. Results: Most UTI-causing bacteria prevailed in the same season. Of 15 bacterial strains, 12 were significantly correlated with 20 (of a total of 40) antibiotics that were used. Most bacteria were gram-negative. Gram-negative bacilli including Escherichia coli, Klebsiella spp., and Pseudomonadaceae and gram-positive Enterococcus faecalis were most frequently causing UTIs. Conclusion: Overall prevalence of antibiotic resistance was negative in bacterial isolates. However, the relationship between antimicrobial prescribing and antimicrobial resistance was significantly negative among UTI patients in BCH, Saudi Arabia

Medical education across three colleges of medicine: perspectives of medical students

AimThis study aimed to explore and evaluate various components of the medical education process (lectures, labs, small-group discussions, clinical rotations, and undergraduate research) in three colleges of medicine in Jordan. MethodsThis cross-sectional questionnaire-based study included 849 undergraduate students from three main medical colleges in Jordan. Statically valid responses were considered for 684 students. The participants were from Jordan University of Science and Technology, Yarmouk University, and the University of Jordan. ResultsThe distribution of students according to their admission status was 276 (40%) regular, 266 (38.9%) parallel, and 142 (20.8%) international programs. Personal interest and self-initiation were the major motives for studying medicine in 66.1%. Regarding the frequency of attending classes, University of Jordan students reported the highest rate of regular classes' attendance (93%). The study also reported that lecture notes and textbooks were the main sources of learning for medical students. The study also reported superior academic performance of students in the regular program compared to students in the parallel and international programs. Participants of the study criticized the medical curricula in the three colleges mentioned above because of the lack of active research programs. Most of the students (40%–56%) also complained that the lectures within the modules were not well-integrated, and they felt that the academic environment was moderate (48–59%). In addition, most students in the clinical phase complained of overcrowding in hospital wards during clinical rotation. ConclusionsBased on students' feedback, multiple aspects of the medical education process require substantial reform to meet the expectations of medical students in Jordan.This study was supported by the Deanship of Research at JUST (2015/513). Dr. Ayman Mustafa is currently at leave from JUST. Open access funding provided by the Qatar National Library

Clinical, genetic, and functional characterization of the glycine receptor β-subunit A455P variant in a family affected by hyperekplexia syndrome

Hyperekplexia is a rare neurological disorder characterized by exaggerated startle response affecting newborns with the hallmark characteristics of hypertonia, apnea, and noise or touch-induced non-epileptic seizures. The genetic causes of the disease can vary and several associated genes and mutations have been reported to affect glycine receptors (GlyRs); however, the mechanistic links between GlyRs and hyperekplexia are not yet understood. Here, we describe a patient with hyperekplexia from a consanguineous family. Extensive genetic screening using exome sequencing coupled with autozygome analysis and iterative filtering supplemented by in silico prediction identified that the patient carries the homozygous missense mutation A455P in GLRB, which encodes the GlyR β-subunit. To unravel the physiological and molecular effects of A455P on GlyRs, we used electrophysiology in a heterologous system as well as immunocytochemistry, confocal microscopy, and cellular biochemistry. We found a reduction in glycine-evoked currents in N2A cells expressing the mutation compared to wild type cells. Western blot analysis also revealed a reduced amount of GlyR β protein both in cell lysates and isolated membrane fractions. In line with the above observations, co-immunoprecipitation assays suggested that the GlyR α1-subunit retained co-assembly with βA455P to form membrane-bound heteromeric receptors. Finally, structural modelling showed that the A455P mutation affected the interaction between the GlyR β-subunit transmembrane domain 4 and the other helices of the subunit. Taken together, our study identifies and validates a novel loss-of-function mutation in GlyRs whose pathogenicity is likely to cause hyperekplexia in affected individuals

Unveiling the therapeutic potential of exogenous β-hydroxybutyrate for chronic colitis in rats: novel insights on autophagy, apoptosis, and pyroptosis

Ulcerative colitis (UC) is a chronic relapsing inflammatory disease of the colorectal area that demonstrates a dramatically increasing incidence worldwide. This study provides novel insights into the capacity of the exogenous β-hydroxybutyrate and ketogenic diet (KD) consumption to alleviate dextran sodium sulfate (DSS)-induced UC in rats. Remarkably, both interventions attenuated disease activity and colon weight-to-length ratio, and improved macro and microstructures of the damaged colon. Importantly, both β-hydroxybutyrate and KD curbed the DSS-induced aberrant NLRP3 inflammasome activation as observed in mRNA and protein expression analysis. Additionally, inhibition of the NLRP3/NGSDMD-mediated pyroptosis was detected in response to both regimens. In parallel, these modalities attenuated caspase-1 and its associated consequences of IL-1β and IL-18 overproduction. They also mitigated apoptosis as indicated by the inactivation of caspase-3. The anti-inflammatory effects of BHB and KD were confirmed by the reported decline in the levels of inflammatory markers including MPO, NFκB, IL-6, and TNF-α. Moreover, these interventions exhibited antioxidative properties by reducing ROS production and improving antioxidative enzymes. Their effectiveness in mitigating UC was also evident in the renovation of normal intestinal epithelial barrier function, as shown by correcting the discrepancies in the levels of tight junction proteins ZO-1, OCLN, and CLDN5. Furthermore, their effects on the intestinal microbiota homeostasis were investigated. In terms of autophagy, exogenous β-hydroxybutyrate upregulated BECN-1 and downregulated p62, which may account for its superiority over KD in attenuating colonic damage. In conclusion, this study provides experimental evidence supporting the potential therapeutic use of β-hydroxybutyrate or β-hydroxybutyrate-boosting regimens in UC

Single Spin Asymmetry ANA_N in Polarized Proton-Proton Elastic Scattering at s=200\sqrt{s}=200 GeV

We report a high precision measurement of the transverse single spin asymmetry $A_N$ at the center of mass energy $\sqrt{s}=200$ GeV in elastic proton-proton scattering by the STAR experiment at RHIC. The $A_N$ was measured in the four-momentum transfer squared $t$ range $0.003 \leqslant |t| \leqslant 0.035$ \GeVcSq, the region of a significant interference between the electromagnetic and hadronic scattering amplitudes. The measured values of $A_N$ and its $t$-dependence are consistent with a vanishing hadronic spin-flip amplitude, thus providing strong constraints on the ratio of the single spin-flip to the non-flip amplitudes. Since the hadronic amplitude is dominated by the Pomeron amplitude at this $\sqrt{s}$, we conclude that this measurement addresses the question about the presence of a hadronic spin flip due to the Pomeron exchange in polarized proton-proton elastic scattering.Comment: 12 pages, 6 figure