Risk factors of Gestational Diabetes Mellitus Among Saudi Women

Abstract:Objective: The aim of this study was to identify the main risk factors of Gestational Diabetes Mellitus among Saudi women. Methodology: This is a case control laboratory-based study conducted in Wadi Al Dawasir City in Saudi Arabia.600 pregnant women as follows; 300 screened pregnant women as the study group and 300 non screened pregnant women as the control group.Selection Criteria for the screened group: Should be booked at 28 weeks or before that, not known to be diabetic before pregnancy or diagnosed as cases of GDM before 24 weeks. Selection Criteria for the non-screened group: They were not diagnosed before pregnancy as cases of DM or diagnosed during pregnancy as cases of GDM.Screening for GDM: Screening for GDM was a routine using loading dose glucose (LDG) or glucose challenge test (GCT) between 24-28 weeks gestation according to the hospitals protocol. The pregnant women were classified into high risk or low risk according to the following characteristics  Results: Risk factors in the screened mothers with positive LDG result was: family history was identified in 56.1% (23/41) of mothers and it was absent in 43.8% (18/41). The next main risk factor among the mothers with positive LDG results was a history of baby weight 4 kg or more and was found in 9.76% (4/41) followed by history of intrauterine fetal death that was detected in 7.32% (3/41). Only one mother 2.44% (1/41) had past history of gestational diabetes mellitus similar to mothers with history of babies with congenital malformation that was detected in 2.44% (1/41) also. Family history was the main risk factor among mothers with positive LDG results as it was found in 56.1%. Within the 20 mothers with significant oral glucose tolerance test (OGTT) results, 80% (16/20) had risk factors and 20% (4/20) had no risk factors. Conclusion: Identifying of risk factors is important for screening for GDM but even women with low risk and no risk factors should be screened for GDM

Association Between Lipid Profile and Glyceamic Control in Sudanese Children with Type 1 Diabetes Mellitus at Gezira State, Sudan

Introduction: Diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Objectives This study aimed to assess the metabolic control of type 1 diabetes mellitus (T1DM) in Sudanese children. Methods: One hundred and seventy four children with type 1 diabetes mellitus were enrolled in this study; 56 healthy non-diabetic children served as a control group. Glycosylated hemoglobin (HbA1c), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C) were measured, very low density lipoprotein-cholesterol (VLDL), and LDL-C/HDL-C ratio were calculated. Results: HbA1c,TC, LDL-C LDL-C/HDL-C ratio and TG were significantly higher among diabetic group compared to non-diabetic group (P<0.001 and P<0.05 for TG).In the diabetic group, there was a positive significant correlation of: HbA1c with TC, TG, HDL- C, LDL-C, VLDL and LDL/HDL ratio; TC with TG, HDL- C, LDL-C, VLDL and LDL/HDL; TG with LDL- C, VLDL and LDL/HDL ratio; HDL-C with LDL-C;LDL-C with VLDL and LDL/ HDL;VLDL-C with LDL/HDL ratio. A significant negative correlation was observed between HDL- C and LDL/HDL ratio. Diabetic group with poor metabolic control (HbA1c level >8).had significantly higher levels of TC and LDL-C (P<0.001),TG and VLDL (P<0.01), HDL-C and LDL-C/ HDL-C ratio (P<0.05) compared with diabetic group with good metabolic control (HbA1c <8%). Conclusion: 85.63% of diabetic patients were found to have poor metabolic control (HbA1c level >8). يوصف مرض السكري بأنه من المسببات المرضية المتعددة التي تتميز بفرط  سكر الدم المزمن واضطراب في التمثيل الغذائي ( اضطرابات من الكربوهيدرات والدهون واستقلاب البروتين) الناتج عن نقص في إفراز الأنسولين، عمل الانسولين أو كليهما.هدفت هذه الدراسة لاستخدام التقييم الكيموحيوي لمعرفة مدي التحكم لضبط السكر عند مرضي السكري النوع الاول. إشتملت هذه الدراسه علي 174طفل مصابين مرض السكري و56 أصحاء من نفس العمر.تضمنت هذه الدراسة  القياسات الكيموحيويه الأتيه: خضاب الدم المسكر، الكوليستيرول ، ثلاثي أسيل الجليسرول و الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة وعاليه الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة. وجد أن تركيز كل من خضاب الدم المسكر، الكوليستيرول ، الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة الكثافة ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة وثلاثي أسيل الجليسرول يرتفع إرتفاعا ذا معني عند مجموعة مرضي السكري.مستوي خضاب الدم المسكر يرتبط إرتباطا موجبا ذا معني مع كل من الكوليستيرول ، ثلاثي أسيل الجليسرول والبروتينات الشحميه عالية ومنخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة، الكوليستيرول مع كل من ثلاثي أسيل الجليسرول والبروتينات الشحميه عالية و منخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة ، يرتبط ثلاثي أسيل الجليسرول مع كل من البروتينات الشحميه منخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة . كما أن  مستوي البروتينات الشحميه عالية الكثافة يرتبط إرتباطا ذا معني مع نسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة.طبقا لتقسيم مجموعة الدارسين لمرض السكري العالميه الأمريكيه أظهرت هذه الدراسه أن نسبة (85.63)  من المرضي يبلغ معدل خضاب الدم المسكر عندهم أكثر من  8% (ضبط غير مقبول) بينما  (%14.37) يبلغ معدل خضاب الدم المسكر عندهم أقل من  8% (ضبط مقبول).  وجدت هذه الدراسة ان مرضي السكري والذين لديهم ضبط غير مقبول لخضاب الدم المسكر ترتفع عندهم مستويات الكوليستيرول ، ثلاثي أسيل الجليسرول و الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة وعاليه الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة ارتفاعا ذا معني مقارنة مرضي السكري والذين لديهم ضبط مقبول لخضاب الدم المسكر

Doctor-Patient Communication A Requisite for Better Medication History Taking: Insight from Sudan

Despite the awareness of doctors about the significance of obtaining a comprehensive medication history for patients, they often neglect this in their practice, resulting in an incomplete patient medication list. The study aimed to investigate the role of communication skills as a crucial part of optimal pharmacotherapy. An observational, cross-sectional study was carried out at internal medicine department in a tertiary hospital, Wad Medani, Sudan.  The research instrument was a form involved a checklist rating a doctor’s performance during the medical encounters. Among 94 medical doctors, 51% were males and 6.15 (SE) was the average years of experience. About 13% of participants received under-graduation training in communication skills, while 21% had it after post-graduation. Concerning communication skills evaluation, 61% of specialists, 29% of registrars, and 7% of house officers reported an excellent performance. Gender and doctors’ ranking in a medical team had a significant role in communication skills (P-value <0.05) with an overall adjusted R2 of 0.339. Specialists were the most knowledgeable and skillful in obtaining structured medication history; 67% reported an excellent performance. Communication skills had a remarkable impact in getting patient medication history (P-value: <0.05) with an overall adjusted R2 of 0. 763.The study concluded that; gender and doctors’ ranking in the medical team were the main predictors for doctors to be a good communicator. Communication skills have a significant role in medication history taking. There was a gap in knowledge and training in communication skills among internal medicine doctors specifically, “house officers.” This gap negatively contributed to obtaining a comprehensive patient medication history

Perceptions and Expectations of Medical Students towards the Quality of Educational Services offered at A Sudanese University: How Far is the Gap?

Background: Students are the primary customers of high education service, and are becoming more aware of their consumer rights and of gaps between their expectations of service delivery and the reality of services.Objective: of this study was to investigate medical students’ perceptions and expectations of educational services quality at X University in Sudan.Methods: One hundred ninety six registered medical students in the academic year 2013- 2014, were enrolled; sample was collected through convenience sample technique. The study was conducted by the use of Modified SERVQUAL questionnaire. SPSS version 20 was used for data analysis.Results: There was a negative mean score for quality gap in all dimensions of service quality. Students perceived tangibles as quality indicators of the service quality at university, and expect universities to have modern-looking equipment, so that staff can provide efficient service to them. There was a strong student concern about teaching staff promises regarding timetables and exam schedules to be fulfilled on time, which indicated the area of most concern amongst the respondents (gap score – 1.94). A clear communication problem regarding service delivery was inferred, as students perception towards solving their problems was very low (gap score -1.91).Conclusion: students’ perceptions of services delivered by X University falls below their expectations; that indicates student’s dissatisfaction. This large gap constitutes a great challenge to the administrators and educational policy makers, who are recommended to consider students feedback as a quality indicator in the quality assurance process.Keywords: medical student, quality education, Sudan

Modelling and control of standing up and sitting down manoeuver

Exoskeleton Robot is one of the most significant examples of human-oriented robotic devices. Nevertheless, the main challenge remains the complexity of their mechanical design and human-robot interfaces. This paper is an outcome of a research to model and to simulate the support of mobility of an elderly people using exoskeleton. Exoskeleton is developed in order to complement the corporal deficiencies of an elderly person in standing up and sitting down. When the natural joint torques is integrated with the exoskeleton's torque the result is in an overall torque that is comparable to that of a physically normal person. This work focuses on standing-up and sitting-down movements. Appropriate simulation models are formulated and their performances examined against measured data. The results with PID control show that at different speed of standing up and sitting down, the joint torques can be compromised. This is done within allowable limits

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

MR fluoroscopy in vascular and cardiac interventions (review)

Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image–guided surgeries that offer improved patient management and cost effectiveness

Oral cancer knowledge, attitudes, and practices among dentists in Khartoum State, Sudan

The dental professions hold an important responsibility in the control of oral cancer and the early diagnosis highly depends on their knowledge. The present study was developed to assess the knowledge, attitude, and practice of dentists in Khartoum State regarding oral cancer prevention and early detection. An administered questionnaire was structured and sent to all licensed 130 dentists working in public dental clinics in Khartoum State. Responses to the questionnaire were analyzed using descriptive and analytical statistics. Although the majority of the dentists were knowledgeable about the major risk factors of oral cancer, more than half of the dentists reported they do not carry out any special examination to detect oral cancer in age 40 and above in asymptomatic patients. Dentists indicated their lack of training as the main barrier for conducting a comprehensive oral cancer examination. Interestingly, the vast majority of the dentists express their interest to have further oral cancer educational and training sessions. The findings of the present study suggested strongly that educational and training interventions are necessary to enhance preventive measures which may lead to reduce mortality and morbidity from oral cancer

Recurrent SARS-CoV-2 mutations in immunodeficient patients

Long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in immunodeficient patients are an important source of variation for the virus but are understudied. Many case studies have been published which describe one or a small number of long-term infected individuals but no study has combined these sequences into a cohesive dataset. This work aims to rectify this and study the genomics of this patient group through a combination of literature searches as well as identifying new case series directly from the COVID-19 Genomics UK (COG-UK) dataset. The spike gene receptor-binding domain and N-terminal domain (NTD) were identified as mutation hotspots. Numerous mutations associated with variants of concern were observed to emerge recurrently. Additionally a mutation in the envelope gene, T30I was determined to be the second most frequent recurrently occurring mutation arising in persistent infections. A high proportion of recurrent mutations in immunodeficient individuals are associated with ACE2 affinity, immune escape, or viral packaging optimisation.There is an apparent selective pressure for mutations that aid cell–cell transmission within the host or persistence which are often different from mutations that aid inter-host transmission, although the fact that multiple recurrent de novo mutations are considered defining for variants of concern strongly indicates that this potential source of novel variants should not be discounted

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112