Common ORL Surgical Emergencies in Sudanese Children

Background: Otorhinolaryngology (ORL) emergencies in children age group are of specific concern because they may become life threatening conditionsObjective: To obtain baseline data on the most common Otorhinolaryngology (ORL) surgical emergencies in Sudanese children in Gezira State, Sudan.Methods: This is a retrospectiveanalytic hospital based study of all children who presented with ORL surgical emergencies at the department of Ear, Nose and Throat (ENT), Wad-Medani Teaching Hospital, Gezira State, Sudan, during the period from 1st. of January 2009 to 31st. ofDecember 2010.Results: The total number of children who presented to the ENT department was 5568(31%) of the total frequency of all patients. The total number of children admissions was (54.6%) of all patients’ admissions. Emergency Surgical intervention indicated for children constituted (63.9%) of all emergency operations. Most cases (66%) occurred between the ages of six weeks to five years, with a male to female ratio of 1.15:1.0. Foreign body impaction emergencies were the most common presentation (83%) requiring surgical intervention. The sites of impaction were; the bronchus(31.45 %), the pharynx and oesophagus (22.77%), the ear (20.46%) and nose (7.26%).Conclusions: Children have always constituted a significant proportion of patients attending the general otolaryngology service. Upper aero-digestive tract foreign bodies are the most common indication for urgent surgical intervention. These emergencies are potentially life-threatening procedures with a high running cost and requiring very skilful staff and appropriate equipments. Public health education is essential in order to prevent these avoidable accidents.Key words: Otorhinolaryngology (ORL), Surgical, Emergency, Children, Foreign body (FB)

Pattern of Head and neck malignancies in Central Sudan-(study of 314 cases)

Objective: The objective of this work is to study the patterns of head and neck malignancies (HNM) in central Sudan and to compare it with international published series. Methods: This is a retrospective study conducted at the Institute of Nuclear Medicine, Molecular Biology and Oncology (INMO)-University of Gezira; Wadmedani, Sudan. The data were collected through reviewing of patients records over 6 years. Parameters analyzed were age, sex, topography and tumor histology. Results: The total number of patients records reviewed was 314. Age distribution ranged from 11 to 90 years with mean age of 48.79 and median age of 50 years. The male to female ratio was 1.7:1. The most common affected sites in order of frequency were nasopharynx (41.1%), hypopharnx (20.4%), larynx (11.2%), oral cavity (10.5%), salivary glands (4.8%), lips (4.5%), tongue (4.1%) and paranasal sinuses (3.5%). The most common histological types were squamous cell carcinoma (90.77%) followed by salivary gland tumors and lymphomas. Conclusion: HNM are common in Sudan, affecting all age groups with predominance in males. Nasopharynx is the commonest site. Further studies for identification of possible risk factors are recommended. Population-based cancer registry is recommended to reflect on the epidemiology of cancer in Sudan. Keywords: Nasopharynx, oropharyngeal, squamous, carcinomas, epidemiology, snuffed tobacco.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 105-10

Solar Energy powered active Greenhouse for the cultivation of Fresh Food during winter in Trans Himalayan Cold Arid Region, India

The Trans-Himalayan Cold arid high altitude region of Ladakh have hostile climatic conditions particularly lowtemperature (-20°C to -45°C). The region shares international borders with two countries viz. China and Pakistanand hence large numbers of Army personnel are deployed in the region due to their strategic importance. Production of fresh food locally is difficult due to low atmospheric temperatures. The region remains cut off from the external world during the winter period for almost 6-8 months due to the closure of roads, which causes an acute shortage of fresh food. Some supply from other regions through the air is carried out but available only to a limited population and costly also, hence beyond the pocket of the common’s man. The inhabitants hence mostly have to survive on packaged food containing food preservatives and harmful chemicals, which are the causes of many diseases. In addition, the unavailability of fresh food causes nutritional deficiency in the inhabitants of the region. Production of fresh food locally seems possible and realistic in closed structures, only if the temperature is maintained. The objective of this study is to prove fresh food production by maintaining suitable temperatures in structures during peak winter using solar energy. Solar energy is available in plenty in the region and stood at 4 th position in India in terms of irradiation. A variety of fresh foods were produced by maintaining temperature in the coldest and largest existing structure using commercially available heating units successively from 2016-2019 during the winter period. The heating units were supplied energy from a Solar PV-based system. An average of 1500kgs-1800kgs of a variety of fresh vegetables were produced and supplied for the first time in the region during the peak winter period of 2016 to 2019. The survival percentage of 92.5% to 100% is found in a structure with an area of 3600 2 feet.Fresh foods were produced and supplied to the user by maintaining minimum survival temperature using solar energy as a source with commercially available heating technology in the largest and coldest existing structure

Hydrogen-Bonding Organocatalysis Enabled Photocatalytic Intramolecular [2+2]-Cycloaddition Reaction

The combination of organocatalytic activation and photocatalysis for enabling the intramolecular [2+2]‐cycloaddition of enone‐ene substrates bearing one Lewis base binding site is reported. While in a variety of solvents a poor conversion or no reaction takes place in the absence of a hydrogen bonding catalyst, the corresponding ring‐fused cyclobutane products could be built in moderate to good yields using a synergistic dual iridium‐urea co‐catalytic system. Control and mechanistic studies supported the postulated interaction between the organocatalyst and the substrate, which proved essential for an efficient energy transfer from the photosensitizer

Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial

<p>Abstract</p> <p>Background</p> <p>As the worldwide dietary pattern becomes more westernized, the metabolic syndrome is reaching epidemic proportions. Lifestyle modifications including diet and exercise are recommended as first-line intervention for treating metabolic syndrome. Previously, we reported that a modified Mediterranean-style, low glycemic load diet with soy protein and phytosterols had a more favorable impact than the American Heart Association Step 1 diet on cardiovascular disease (CVD) risk factors. Subsequently, we screened for phytochemicals with a history of safe use that were capable of increasing insulin sensitivity through modulation of protein kinases, and identified hops <it>rho </it>iso-alpha acid and acacia proanthocyanidins. The objective of this study was to investigate whether enhancement of a modified Mediterranean-style, low glycemic load diet (MED) with specific phytochemicals (soy protein, phytosterols, <it>rho </it>iso-alpha acids and proanthocyanidins; PED) could improve cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia.</p> <p>Methods</p> <p>Forty-nine subjects with metabolic syndrome and hypercholesterolemia, aged 25–80, entered a randomized, 2-arm, 12-week intervention trial; 23 randomized to the MED arm; 26 to the PED arm. Forty-four subjects completed at least 8 weeks [MED (<it>n </it>= 19); PED (<it>n </it>= 25)]. All subjects were instructed to follow the same aerobic exercise program. Three-day diet diaries and 7-day exercise diaries were assessed at each visit. Fasting blood samples were collected at baseline, 8 and 12 weeks for analysis.</p> <p>Results</p> <p>Both arms experienced equal weight loss (MED: -5.7 kg; PED: -5.9 kg). However, at 12 weeks, the PED arm experienced greater reductions (<it>P </it>< 0.05) in cholesterol, non-HDL cholesterol, triglycerides (TG), cholesterol/HDL and TG/HDL compared with the MED arm. Only the PED arm experienced increased HDL (<it>P </it>< 0.05) and decreased TG/HDL (<it>P </it>< 0.01), and continued reduction in apo B/apo A-I from 8 to 12 weeks. Furthermore, 43% of PED subjects vs. only 22% of MED subjects had net resolution of metabolic syndrome. The Framingham 10-year CVD risk score decreased by 5.6% in the PED arm (<it>P </it>< 0.01) and 2.9% in the MED arm (<it>P </it>< 0.05).</p> <p>Conclusion</p> <p>These results demonstrate that specific phytochemical supplementation increased the effectiveness of the modified Mediterranean-style low glycemic load dietary program on variables associated with metabolic syndrome and CVD.</p

Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe