Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience

Introduction: The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying. Methods: We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations. Results: The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures. Conclusion: Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients. Care is, therefore, needed to screen CAPD patients for these complications in order to timely address and manage problems. Keywords: Peritoneal Dialysis; Non-infectious Complications; Sudan; Herni

May Measurement Month 2017: an analysis of blood pressure screening in Sudan-Northern Africa and Middle East

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Sudan has the second highest prevalence of hypertension in North Africa. One in four people with a non-communicable disease has hypertension. May Measurement Month (MMM) is a global initiative, aimed at raising awareness of high BP to act as a temporary solution to the lack of screening programs worldwide. The MMM screening survey provided an opportunity to correlate between unique risk factors and BP levels among Sudanese population. Such an approach allows for directing efforts towards setting the appropriate preventive measures as opposed to disease treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted at 100 sites distributed in four states: Khartoum, Gezira, Blue Nile, and Kassala. Overall, a total of 44 413 participants were enrolled in the survey. After imputation, 7332 out of 44 118 participants with an available mean of the second and third readings had hypertension (16.6%). A total of 6956 (15.9%) participants were found to have hypertension of the 43 742 who were not receiving treatment. Among participants who were on treatment, 155 out of 374 (41.3%) had uncontrolled BP. After adjusting for age and sex, systolic and diastolic BP's were significantly higher in those receiving antihypertensive treatment, with a previous history of stroke and with elevated body mass index. Systolic BP was significantly higher in people with diabetes and with previous myocardial infarction. Smoking was associated with increased diastolic BP and decreased systolic BP. Alcohol intake as well as BP measurement on left vs. right arm had no association with BP reading. The MMM17 was the largest BP screening campaign ever held in the country. A considerable percentage of detected hypertensives were not on treatment with a significant proportion of uncontrolled hypertension among those on treatment. These results suggest that opportunistic screening can identify significant numbers with raised BP

Medical students' perceptions of complementary and alternative medicine therapies: A pre- and post-exposure survey in Majmaah University, Saudi Arabia

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health  and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and  innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia.Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item  self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or  alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities.Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies.Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation. Key words: Medical students; Complementary and Alternative Medicine; CAM course; CAM therapies; pre-post design study; Saudi Arabia

Use of the analysis of the volatile faecal metabolome in screening for colorectal cancer

Diagnosis of colorectal cancer is an invasive and expensive colonoscopy, which is usually carried out after a positive screening test. Unfortunately, existing screening tests lack specificity and sensitivity, hence many unnecessary colonoscopies are performed. Here we report on a potential new screening test for colorectal cancer based on the analysis of volatile organic compounds (VOCs) in the headspace of faecal samples. Faecal samples were obtained from subjects who had a positive faecal occult blood sample (FOBT). Subjects subsequently had colonoscopies performed to classify them into low risk (non-cancer) and high risk (colorectal cancer) groups. Volatile organic compounds were analysed by selected ion flow tube mass spectrometry (SIFT-MS) and then data were analysed using both univariate and multivariate statistical methods. Ions most likely from hydrogen sulphide, dimethyl sulphide and dimethyl disulphide are statistically significantly higher in samples from high risk rather than low risk subjects. Results using multivariate methods show that the test gives a correct classification of 75% with 78% specificity and 72% sensitivity on FOBT positive samples, offering a potentially effective alternative to FOBT

Preconditioning Shields Against Vascular Events in Surgery (SAVES), a multicentre feasibility trial of preconditioning against adverse events in major vascular surgery: study protocol for a randomised control trial.

Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff

MEDICAL STUDENTS' PERCEPTIONS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES: A PRE- AND POST-EXPOSURE SURVEY IN MAJMAAH UNIVERSITY, SAUDI ARABIA

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia. Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities. Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies. Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation

Social Inequality as Global Challenge

Доступ до книги на сайті видавництва (copyright) https://www.riverpublishers.com/book_details.php?book_id=922У цій книзі обговорюються чинники нерівності, закладеної в наші соціальні, економічні та політичні системи. Соціальна нерівність особливо проявляється в секторах послуг у відмінності в доступі до охорони здоров’я, освіти, соціального захисту, системи житла, догляду за дітьми, догляду за літніми тощо. соціальним статусом певної групи, мовою, релігією, звичаями та нормами є ще одна поширена проблема. Ця книга намагається представити точну картину цих проблем на прикладах з різних країн. Здебільшого, коли ми говоримо про нерівність, акцент робиться на економічній нерівності; однак зберігається значна нерівність, особливо дискримінація за статтю, віком, походженням, етнічною приналежністю, інвалідністю, сексуальною орієнтацією, класом та релігією. Щоб покласти край цій ситуації, необхідно провести соціальні, економічні та політичні реформи. Поки маргіналізовані групи не отримають повноваження, проблему нерівності неможливо вирішити чи навіть мінімізувати. На основі різних тематичних досліджень ця книга заохочує нас переосмислити розвиток суспільства через призму зростаючої нерівності та диспропорції. У книзі представлені нові ідеї для оцінки прогресу соціального розвитку. Книга висвітлює сучасні проблеми соціальної нерівності. У сукупності ця збірка відредагованих статей дає комплексне розуміння питання «чому суспільство нерівне»? Ця книга націлена на тих зацікавлених сторін, які хочуть змінити та побудувати нерозділене, соціально інклюзивне суспільство або внести свій внесок у них, а також для тих, хто хоче зробити свій внесок у розширення прав і можливостей суспільства у ХХІ столітті.В этой книге обсуждаются факторы, лежащие в основе неравенства, присущего нашим социальным, экономическим и политическим системам. Социальное неравенство особенно заметно в секторах услуг - в различиях в доступе к здравоохранению, образованию, социальной защите, жилищным системам, уходу за детьми, уходу за престарелыми и т. д. Другой широко распространенной проблемой является социальный статус конкретных групп, их язык, религия, обычаи и нормы. В этой книге делается попытка представить точную картину этих проблем на примерах из разных стран. На основе различных тематических исследований эта книга побуждает нас переосмыслить социальное развитие через призму растущего неравенства и неравенства. В книге представлены новые идеи для оценки прогресса в социальном развитии. В книге освещаются современные проблемы социального неравенства. В совокупности этот сборник отредактированных статей дает комплексное понимание вопроса «почему общество неравно»? Эта книга адресована тем заинтересованным сторонам, которые хотят внести свой вклад в изменения и построить неразделенное, социально инклюзивное общество, а также тем, кто хочет внести свой вклад в расширение прав и возможностей общества в XXI веке.This book discusses the factors behind the inequalities embedded within our social, economic and political systems. Social inequalities are especially seen in the service sectors â  in the differences of access to healthcare, education, social protection, housing systems, childcare, elderly care etc. Cultural inequality, which segregates people from the mainstream based on recognition problems with a specific groups' social status, language, religion, customs and norms, is another widespread issue. This book tries to present an accurate picture of these issues with cases studies from various countries. Mostly, when we talk about inequality, the focus is on economic inequality; however, much inequality persists, especially discrimination due to gender, age, origin, ethnicity, disability, sexual orientation, class, and religion. To end this situation there is a need for social, economic, and political reform. Until or unless the marginalized groups are empowered, the inequality issue cannot be solved or even minimized. On the basis of various case studies, this book encourages us to rethink societal development through the lens of growing inequalities and disparities. The book presents new insights for evaluating the progress on social development. The book highlights the current challenges of social inequality. In combination this collection of edited papers gives an integrated understanding of the question of “why is society unequal”? This book is aimed at those stakeholders, who want to make or contribute to change and build an undivided, socially inclusive society, and to those who want to contribute to empowering society in the Twenty-First century

Re: Bladder Cancer in Renal Allograft Recipients: Risk Factors and Outcomes

Malignancy is the second most important cause of death after cardiovascular disease in kidney transplant recipients (KTR) with a functioning allograft due to load of immunosuppression and oncologic viral infections. The authors have reviewed the Irish National Cancer Registry and National Renal Transplant registry to find the incidence and types of de novo developing bladder cancers in KTR who were transplanted between 1994 and 2012 in Ireland. A total of 15 patients representing 0.48% of the KTR were found to have a 2.5 fold increased risk of bladder malignancy compared with the general population in Ireland. Tumors were diagnosed in a younger population, at a more advanced stage, with a worse 1-year overall survival. Besides, immunosuppression preexisting genitourinary diseases, toxic nephropathies, and cyclophosphamide exposure and BK-induced nephropathy have been identified as extra risk factors. However, different ethnical populations might have distinct risk factors, such as exposure to Chinese herbs and, arsenic found in underground water sources as if found in Chinese population. Identifying patients with preexisting risk factors in the population and careful posttransplant monitoring with a low threshold for cystoscopy may improve outcomes in KTR

Survey and on-farm trials in private beef cattle finishing feedlots in the Khartoom area

In IDL-663