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)

Vegetation and Species Diversity in the Northern Sector of Eastern Desert, Egypt

The study aims to assess the vegetation and plant diversity in relation to edaphic factors at three sites (Cairo- Suez, Ain Sokhnia-Makattam desert roads and Wadi Hagul) in northern sector of Eastern Desert. The results revealed that northern sector of Eastern Desert (The Galalah Desert) harbors had 95 species (36 annuals, two biennial and 57 perennials) with high taxonomic diversity (species/genera = 1.17 and genera/families = 3.12). The largest families were Asteraceae comprising 22 species, followed by Poaceae, 11 species, Brassicaceae and Chenopodiaceae, 7 species each, Fabaceae 6 species, Zygophyllaceae, 5 species. Zilla spinosa and Zygophyllum coccineum had a wide ecological range of distribution (P = 63.3% and 61.7%, respectively). On the other hand, Zygophyllum simplex, Matthiola longipetala and Senecio glaucus showed the highest presence estimates among annuals (P = 38.3%, 31.7% and 30%, respectively). Species richness, Shannon-Weiner H and Simpson indices measurements indicated that group D and B are the most diverse group followed by group A and C in the present study. The main dominant species include Haloxylon salicornicum, Launaea nudicaulis, Zilla spinosa and Zygophyllum coccineum. Soil physical properties in addition to soil salinity and human activities are the main driving factors controlling the distribution of wild plants in the northern sector of Eastern Desert

Optimization of industrial production of rifamycin B by Amycolatopsis mediterranei. I. The role of colony morphology and nitrogen sources in productivity

A systematic approach to process optimization for production of rifamycin B was applied to a strain of Amycolatopsis mediterranei. Examination of the growth revealed 6 different morphologically distinct colonies on Bennett's agar medium. Rifamycin B production in shake flasks by the six different colony types ranged between 0.5 and 1.2 g/l. There was a clear correlation between the colony morphology and rifamycin B productivity. The highest yield of rifamycin B (1.03-1.2 g/l) was obtained by using the orange-red colored colonies, rosette shaped, devoid of hollow center and 2-3 mm in diameter. Variability in colony morphology, however, remained and the appropriate colonies had to be picked up for preparing the inoculum of each experiment. Addition of yeast extract to the fermentation medium at different times increased rifamycin B production. The highest antibiotic production was obtained upon the addition of 0.1% yeast extract after 2 days of incubation, where the yield increased from 1.15 to 1.95 g/l (70%). The use of 1.8% KNO3 in the fermentation medium, instead of 0.96% (NH4)2SO4, markedly increased rifamycin B production from 1.15 to 2.92 g/l (154%). It was also observed, upon microscopical examination, that KNO3 decreased branching and fragmentation of the mycelia in the fermentation medium. Keywords: Rifamycin B; fermentation; biotechnology; Amycolatopsis mediterranei; strain selection. African Journal of Biotechnology Vol.3(5) 2004: 266-27

Optimization of industrial production of rifamycin B by Amycolatopsis mediterranei. II. The role of gene amplification and physiological factors in productivity in shake flasks

Amplification of gene expression of the most productive colony type of Amycolatopsis mediterranei strain N1 under stress of chloramphenicol, resulted in isolation of a variant NCH with productivity of 2.56 g/l compared to 1.15 g/l by the parent strain N1 (2.2 fold increase). This amplified variant has a further advantage of reduced variation in colony morphology with predominance of the most productive colony type. Using variant NCH, modification of the fermentation medium F1 by the addition of 0.1% yeast extract or the use of 1.8% KNO3 resulted in 3.8 and 5.8-fold increase in productivity, respectively, compared to strain N1. When the F1 medium was replaced by a new medium F2 containing soytone, instead of the particulate constituents (peanut meal and soybean meal) the yield by variant NCH reached 7.85 g/l (6.8-fold increase). Modification of the F2 medium by addition of glycerol or the replacement of glucose by glucose syrup decreased rifamycin B production. Changing the concentration of soytone increased the yield only slightly while replacing it with peptone or tryptone or the addition of 1 % corn steep liquor failed to increase the yield. On the other hand, the addition of 0.1 % yeast extract, or the replacement of 0.6% (NH4)2SO4 by 1.2% KNO3 or 0.4% NH4NO3, to F2 medium led to 8.2, 10.2 and 10.4-fold increase in productivity, respectively, compared to productivity of strain N1 in F1 medium. The change in the concentrations of either MgSO4 or CaCO3, the use of different types of antifoams and the use of higher concentrations of sodium diethyl barbiturate did not significantly influence the yield. These collective optimization attempts thus resulted in a 10.4-fold increase in productivity, from 1.15 to 11.99 g/l. Key words: Rifamycin B, fermentation, biotechnology, Amycolatopsis mediterranei, optimization, gene amplification, physiological factors. African Journal of Biotechnology Vol.3(5) 2004: 273-28

Optimization of industrial production of rifamycin B by Amycolatopsis mediterranei. III. Production in fed-batch mode in shake flasks

Optimization of the fermentation process using the gene amplified variant of Amycolatopsis mediterranei, NCH, in the fermentation medium F2 was carried out by the application of fed-batch regime. The addition of 12% glucose alone at day 4 or simultaneously with 0.1% yeast extract at day 2 led to an increase in the yield of rifamycin B by 46% and 57%, respectively. The application of fed-batch regime together with replacing (NH4)2SO4 with the better yielding inorganic nitrogen sources NH4NO3 or KNO3 (F2m1 and F2m2 media, respectively) increased the production of rifamycin B. The use of F2m1 medium alone or with an additional 12% glucose added at day 4 increased the yield by 53% and 120%, respectively. However, further addition of 0.1% yeast extract led to an increase in the yield by only 63%. The addition of 3% soytone or 0.05% NH4NO3 to F2m1 at day 3 increased the yield by 72% and 61%, respectively, compared to productivity in F2 medium. The use of F2m2 medium increased the yield by 50%. The addition of 12% glucose at day 4 or of 0.1% yeast extract at day 2 to F2m2 medium led to an increase in the yield by 119 and 55%, respectively, compared to F2 medium. However, when both 12% glucose and 0.1% yeast extract were added at similar scheduled times only 64% increase in the yield occurred. By applying the three most effective optimization regimes determined using variant NCH with F2m2 medium on a standard rifamycin B producing strain, Nocardia mediterranei ATCC 21789, a similar pattern of increase in the antibiotic yield was observed. Thus, the use of F2m2 instead of F2 medium either alone or with an additional 12% glucose added at day 4 increased the yield by 36 and 75%, respectively, whereas the addition of 0.1% yeast extract to F2 medium increased the yield by 15%. In conclusion, the application of fed-batch technique with the optimum modifications of the medium constituents increased rifamycin B production by variant NCH to a maximum of 17.17 g/l compared to a yield of 5.3 g/l by the tested standard strain under the same conditions. The increase in rifamycin B production using the standard strain confirms the usefulness of the tested medium modifications in the improvement of rifamycin B production and its possible application in fermentations using other rifamycin B producer strains and also shows the superiority of variant NCH as a producer, when compared to the standard strain. Key words: Rifamycin B, fermentation, biotechnology, Amycolatopsis mediterranei, optimization, fed-batch and physiological factors. African Journal of Biotechnology Vol.3(8) 2004: 387-39

Fecal incontinence after single-stage Soave’s pull-through: abdominal versus transanal endorectal pull-through

Purpose To compare the postoperative fecal continence and bowel functions between patients who underwent a single stage - Soave’s endorectal pull through operations whether via the classic abdominal endorectal pull through approach (TAPT) or trans-anal endorectal pull through approach (TERPT).Patients and Methods This retrospective study was performed on 50 HD consecutive patients who had undergone surgery during a period of 5 years from January 2002 to January 2007. They were two equal groups; group I (n=25) including patients who underwent TAPT; group II (n=25) including patients who underwent TERPT. Demographic, clinical data, preoperative investigations, operative records, postoperative outcome were studied. Post operative fecal continence score rate (FCSR) was assessed in children over the age of 4 years. Moreover, those with poor FCSR were further investigated by magnetic resonance imaging (MRI). Electromyography (EMG) and anorecatal manometery (AM) were also used in follow-up.Results Twenty six patients (52%) had an excellent FCSR and eighteen patients (36%) showed good FCSR. However, 5 patients (10%) had a fair FCSR and only 1 patient (2%) suffered of a poor FCSR. There was no statistical significant difference between the two groups in neither anal manometry nor EMG. MRI did not show any abnormalities on pelvic floor and anal muscle complex on those patients who had fair or poor FCSR.Conclusion The incidence of fecal incontinence is very low after Soave’s pull-through operations whether TAPT or TERPT approaches with no statistical significant difference.Keywords: fecal continence, Hirschsprung’s disease, Soave’s operation, transanal endorectal pull-throug

Optimization of industrial production of rifamycin B by Amycolatopsis mediterranei. IV. Production in the fermentor

Optimization of the physical and physiological parameters of the fermentation process using the gene amplified variant of Amycolatopsis mediterranei (NCH) was carried out. Optimization of the physical parameters by controlling the pH at 6.5 for 3 days then at 7 thereafter and by adjustment of aeration at 1 vvm for 3 days then controlling the dissolved oxygen (DO) at 30% saturation increased the yield from 9.77 to 11.96 (22%) and 13.39 g/l (37%), respectively. Replacing 12% glucose in the fermentation medium (F2m1) with 5% glucose syrup (F2m3 medium) resulted in a drop of the yield from 9.77 to 7.5 g/l, while further addition of another 5% glucose syrup at day 4 increased the yield from 7.5 to 13.81 g/l (84%); with a further increase in the yield to 14.25 g/l (90%) upon controlling DO. Whereas, the combined addition of 0.1% yeast extract at day 2 to F2m3 medium along with the addition 5% glucose syrup at day 4 increased the yield from 7.5 to 15.35 g/l (105%); with a further increase in the yield to 16.3 g/l (117%) upon controlling DO. The fed-batch addition of both 3% soytone at day 3 and 5% of glucose syrup at day 4 to F2m3 medium increased the yield from 7.5 to 16.2 g/l (116%) and by extending the fermentation period to 10 days the yield reached 17.9 g/l (139%). Upon applying all optimum physical and physiological conditions in the fermentor the yield increased from 7.5 to 17.43 g/l in 8 days (132%) and by extending the fermentation period to 10 days the yield reached 19.4 g/l (159%). Further process optimization by examination and analysis of the kinetics of the process would most certainly further increase the yield and quantitatively define the process to a level that could be tested on a pilot scale. Key Words: Rifamycin B, fermentor, biotechnology, Amycolatopsis mediterranei, optimization, fed-batch and process development African Journal of Biotechnology Vol.3(9) 2004: 432-44

Application of the Health Belief Model -Based Educational Intervention on Hand Hygiene Performance of Intensive Care Units' Nurses

Background: Practicing hand hygiene is a simple yet effective way to prevent infections. Cleaning hands can prevent the spread of germs, including those resistant to antibiotics and are becoming difficult, if not impossible, to treat. On average, healthcare providers clean their hands less than half of the times they should.Aim of the study: This study aimed to apply the health belief model based educational intervention on hand hygiene performance among nurses working in adults and pediatric intensive care units.Materials and methods: A quasi experimental research design was used in this study. The study was conducted at pediatric and adult intensive care unit; at Tanta University Hospital. All available nurses 262who are working in the previously mentioned settings as the following: 118 nurses working in pediatric intensive care unit nurse and 144nurse working in adult intensive care unit. Tools of the study: Four tools were used to collect the data Tool I: Nurses' knowledge regarding Hand Hygiene Structured Questionnaire: it consisted of two parts: Part1: Socio demographic data of the nurses Part II: Nurses' Knowledge Regarding Hand Hygiene Performance. Tool II: Assessment of Nurses Barriers of Hand Hygiene Performance Questionnaire, Tool III: Hand Hygiene Perception Survey and Tool IV: Hand Hygiene Performance Observational Checklist. Result; the mean score of total hand hygiene performance using soap and water of nurses working in pediatric ICUs were 8. 85±1.02 and 10.10±1.84, while among adult ICUs nurses were 8.37±1.75and10.20±0.80 pre and post the educational intervention respectively. There was a significant difference of both groups in the; five Health Belief Model Construct in addition to nurses’ identified barriers of hand hygiene pre and post the intervention.Conclusion and recommendations: Total hand hygiene performance level and HBM construct regarding hand hygiene performance were higher among nurses working in pediatric and adult ICUs nurses post than pre application of the HBM educational intervention. Also, higher mean scores of the barriers of hand hygiene performance among all nurses in both ICUs pre compared to post intervention. Periodic and refreshment educational intervention related to hand hygiene is recommended for adult and pediatric ICUs nurses to improve their hand hygiene performance and further study for barriers in other ICUs is recommended. Keywords: Health Belief Model -Based Educational intervention, Hand Hygiene Performanc

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

Effect of Protocol of Care on Clinical Outcomes of Patients with Chest Tube Post Cardiothoracic Surgery

Cardiothoracic surgery is a surgical specialty, which deals with the diagnosis and management of surgical conditions of the heart, lungs and esophagus (1) .Chest tube (CT) is an invasive procedure which inserted post cardiothoracic surgery to facilitate lung expansion and allowing  the drainage of fluids from the chest cavity. Aim: this study aimed to evaluate the effect of protocol of care on clinical outcomes of patients with chest tube post cardiothoracic surgery. Materials and method a quasi-experimental research design was conducted at Cardiothoracic Surgery Department at Tanta University hospital. A purposive sample of 80 adult patients with chest tube based on statistical power analysis were selected and divided into two equal group 40 patients in each group as follows: Group 1: (Study group): consist of 40 adult patients were received protocol of care implemented by the researcher. Group 2: (Control group): consists of 40 adult patients who were received routine nursing care by hospital nursing staff. Three Tools were used to collect the data .Tool (I) Biosocio-demographic characteristics. Tool (II) Chest tube assessment, Tool (III) Pain assessment. Results:- The mean duration of ICU stay in control group (6.77) was higher than in the study group (4.97) days, more than half (52.6%)of the patients in the control group at the 7th day of the study had elevated body temperature comparing to none  in the study group, nearly two third (62.5%) of patients has  a positive culture swab in the control group at the  7th day of the study group ,compared to about  third(35%) of patients in the study group. More than half of patients (52.5%) in the control group had a severe pain during removal of chest tube compared to small percentage (5.0%) in the study group. Conclusions and recommendations:-Protocol of nursing care which was composed of deep breathing and coughing   exercises, sterile technique during chest tube dressing, and cold application, are recommended for all cardiothoracic surgical patients with chest tube. Keywords: Protocol of Care, Clinical Outcomes, Cardiothorathic Surger