Total posterior leg open wound management with free anterolateral thigh flap: case and literature review.

Soft tissue coverage of the exposed Achilles tendon is a unique reconstructive challenge. In this report, we describe the management of a large posterior leg wound with exposed Achilles tendon using a free anterolateral thigh (ALT) flap. A careful review of alternative reconstructive options is included, along with their respective advantages and disadvantages. A 32-year-old white man suffered a fulminant right lower extremity soft tissue infection requiring extensive debridement of the entire posterior surface of the right leg. The resulting large soft tissue defect included exposure of the Achilles tendon. Reconstruction of the defect was achieved with an ALT flap and split-thickness skin graft for coverage of the Achilles tendon and gastrocnemius muscle, respectively. The patient was able to ambulate independently within 2 months of the procedure

Knowledge of ICU nurses regarding the ongoing nursing assessment of ICU patients in Khartoum city, 2020

Background: An ongoing nursing assessment is the most significant point in the nursing process to be executed in the beginning of every shift which can be accomplished by using different approaches. It needs to be conducted accurately to guide professional nurses’ decision-making ability to further provide holistic nursing care to patients in the intensive care units (ICUs). This study was aimed to assess the ICU nurses’ knowledge regarding ongoing nursing assessment of ICU patients.Methods: This descriptive cross-sectional hospital-based study was conducted in Khartoum city, and included 86 out of the 135 participants working in the critical care units of the main governmental hospitals in Khartoum city. Data were collected using a structured self-administered questionnaire after being tested for validity and then analyzed using mean, standard deviation, and correlation. Data were then presented as frequencies and percentages.Results: The study participants were aged between 20 and 40 years with a female to male ratio of 3:1, and varied levels of experience. Overall, 71.7% of the studied participants scored good on the standardized knowledge classification tool used, with few areas of knowledge gap, impacted by increased experience. Moreover, 36% of the participants used the ABCDE approach for ongoing nursing assessment, followed by the head-to-toe assessment approach (21%).Conclusion: The nurses’ knowledge regarding ongoing nursing assessment was good with a few areas of weakness raising the need for continuous educational and training programs

Knowledge of ICU Nurses Regarding the Ongoing Nursing Assessment of ICU Patients in Khartoum City, 2020

Background: An ongoing nursing assessment is the most significant point in the nursing process to be executed in the beginning of every shift which can be accomplished by using different approaches. It needs to be conducted accurately to guide professional nurses’ decision-making ability to further provide holistic nursing care to patients in the intensive care units (ICUs). This study was aimed to assess the ICU nurses’ knowledge regarding ongoing nursing assessment of ICU patients. Methods: This descriptive cross-sectional hospital-based study was conducted in Khartoum city, and included 86 out of the 135 participants working in the critical care units of the main governmental hospitals in Khartoum city. Data were collected using a structured self-administered questionnaire after being tested for validity and then analyzed using mean, standard deviation, and correlation. Data were then presented as frequencies and percentages. Results: The study participants were aged between 20 and 40 years with a female to male ratio of 3:1, and varied levels of experience. Overall, 71.7% of the studied participants scored good on the standardized knowledge classification tool used, with few areas of knowledge gap, impacted by increased experience. Moreover, 36% of the participants used the ABCDE approach for ongoing nursing assessment, followed by the head-to-toe assessment approach (21%). Conclusion: The nurses’ knowledge regarding ongoing nursing assessment was good with a few areas of weakness raising the need for continuous educational and training programs

Comparison Between Hyaluronic Acid and Chlorhexidine in the Treatment of Orthodontically Induced Gingival Enlargement.

Abstract Aim: The study aimed to assess and compare the effectiveness of chlorhexidine and hyaluronic acid when used as an adjuvant to professional mechanical plaque removal (PMPR) in the treatment of orthodontically induced gingival enlargement. Methods: The study conducted was a randomized controlled clinical trial involving 45 patients. The patients will be categorized into 3 groups; control group receiving conventional PMPR, study 1 group receiving PMPR and chlorhexidine (CHX), and study 2 group receiving PMPR and hyaluronic acid (HA). Probing depth (PD), Gingival overgrowth index (GOI), gingival bleeding index (GBI), and plaque index (PI), will be recorded at baseline, 1 month, 2 months, and 4 months’ post therapy. A bivariate analysis was conducted to evaluate the parameters in function of the three study groups, and to evaluate the changes in PD and GBI between baseline, month 1, month 2 and month 4 in the three study groups. Results: A significant reduction in probing depth and gingival bleeding was observed in the three groups (p 0.05). The change in PD, PI, GBI and GOI was more in Group 1 and Group 2 than in the control group. Hyaluronic acid demonstrated the same effect of chlorhexidine. Conclusion: HA is just as effective as CHX in treating gingival enlargement. Based on the acceptance of HA by patients generally and the negative effects of CHX, HA may be a potential alternative to CHX

Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials

Background: Cryptogenic strokes can be attributed to paradoxical emboli through patent foramen ovale (PFO). However, the effectiveness of PFO closure in preventing recurrent stroke is uncertain and the results of previous randomized clinical trials (RCTs) have been inconclusive. Hence, this study pro- vides an updated meta-analysis of all RCTs comparing PFO closure with medical therapy for secondary prevention of cryptogenic stroke. Methods: All RCTs were identified by a comprehensive literature search of PubMed, Embase, the Cochrane Collaboration Central Register of Controlled Trials, Scopus, and Clinicaltrials.gov. The primary outcome was recurrent ischemic stroke and secondary outcomes were transient ischemic at- tack (TIA), all-cause mortality, new-onset atrial fibrillation (AF), serious adverse events, and major bleeding. Results: Five RCTs with 3440 participants were included in the present study (1829 patients under- went PFO closure and 1611 were treated medically). Pooled analysis showed a statistically significant reduction in the rate of recurrent stroke with PFO closure in comparison to medical therapy (OR 0.41; 95% CI 0.19–0.90; p = 0.03). However, there were no statistically significant reductions of recurrent TIAs (OR 0.77; 95% CI 0.51–1.14; p = 0.19) or all-cause mortality (OR 0.76; 95% CI 0.35–1.65; p = 0.48). The risk of developing new-onset AF was increased significantly with PFO closure (OR 4.74; 95% CI 2.33–9.61; p < 0.0001), but no significant differences in terms of serious adverse events or major bleeding between both groups. Conclusions: Patent foramen ovale closure in adults with recent cryptogenic stroke was associated with a lower rate of recurrent strokes in comparison with medical therapy alone.

Status of greenhouses in Khartoum and Gezira States, Sudan

   Greenhouse technology facilitates the cultivation of most horticultural crops in any region of the world, provided that the greenhouse is properly designed and equipped to control environmental conditions. The objective of this study was to investigate the characteristics of greenhouses in Khartoum and Gezira States, Sudan, and show their drawbacks and disadvantages.  A survey was carried out using a questionnaire and interviews with greenhouse owners in Khartoum and Gezira States. Khartoum and Gezira States have about 68 greenhouse projects, 33 of them were selected for the study. The data were collected during 2013 and were analyzed using statistical package for social sciences (SPSS) computer program. Results showed that 69.7% of greenhouses were privately owned and the vast majority of greenhouses were used to produce vegetable crops or seedlings. Results indicated that most of the greenhouses designs are not suited to the hot arid tropics of the Sudan. More than half of greenhouses had the arched system, most of them were covered by polyethylene, 69.7% of greenhouses were constructed in a single span, 72.7% had a single door, 76.3% of greenhouses had a height between 2.5 m to 3 m and 42.6% of them were 40 m long. Accordingly, an ideal greenhouse design is needed in which all the drawbacks and shortcomings are corrected to suit the arid conditions of central Sudan

Current status of tomato greenhouse production in Khartoum and Gezira States, Sudan.

Tomato production under protected cultivation has increased consistently in recent decades in the Sudan. The objective of this study was to investigate the current situation of tomato cultural practices in existing greenhouses in Khartoum and Gezira States. A survey was carried out using a questionnaire and interviews with greenhouse owners in Khartoum and Gezira States. Khartoum and Gezira States have about 68 greenhouse projects, 33 of them were selected for the study. Data were collected during 2013 and analyzed using statistical package for social sciences (SPSS). Results indicated that a large number of introduced tomato cultivars were used for production and most of greenhouse farmers (48.5%) sow tomato seeds in mid-February. The majority of farmers (63.6%) grow tomato in high plant density (30cm). More than half of greenhouses (75.8 %) had no specific fertilizer programs. Most of the greenhouse farmers (90.9 %) prune weekly. All greenhouse farmers used pesticides for pest control. Our observations indicated that most of the growers failed to produce summer tomato. Accordingly, further research in tomato greenhouse production is needed

Clinical and echocardiographic features of children with rheumatic heart disease and their serum cytokine profile

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) constitute important public health problems in developing countries. Children with ARF and RHD seen at Children’s Hospital-Sudan from May 2008-2009 were examined clinically and by echocardiography. Blood cytokines (interleukin 10 (IL10), Tumor necrosis factor alpha (TNF- alpha) and interferon gamma (IFN-gamma) were done. Thirty six children were enrolled; 63% had established RHD, and 37% ARF. Mitral regurgitation (MR) was the most common lesion (94%).Ninety five percent of the valve lesions were severe. The serum interleukin IL10 level ranged between 3-6 pg/ml. TNF alpha levels were 9- 100 pg/ml in 12 patients (40%), 101-1000 pg/ml in 10 patients (33%) , more than 1000 in 8 patients (26%). The level of IFN gamma ranged between 2-7 pg/m in all patients except 2 (84 and 135 pg/ml). RHD is manifested with severe valvular lesions and a high TNF alpha indicating and ongoing inflammation.Pan African Medical Journal 2012; 13:3

Expression of E-cadherin, N-cadherin, and Cytokeratin 18 and 19 in Placentas of Women with Severe Preeclampsia

BACKGROUND: Although the exact mechanism leading to preeclampsia is not fully understood, abnormal trophoblast invasion contributes to its pathogenesis. Keratins and cadherin are known to play roles in the regulation of trophoblast proliferation. However, studies describing the association between keratins, cadherin, and preeclampsia are limited. AIM: The current study was conducted to investigate the association of these proteins with severe preeclampsia in Sudanese women. METHODS: A case–control study was conducted at Madani Maternity Hospital, Sudan. The cases included women with severe preeclampsia (n = 56) and healthy pregnant women as controls (n = 56). The assessment of keratin and cadherin was performed using immunohistochemical staining. RESULTS: There was no significant difference between the two groups in their mean age or parity. We found no significant differences in the expression of the markers E-cadherin, N-cadherin, or cytokeratin 18 and 19 in the placentas from individuals with preeclampsia versus controls. The number of placentas with severe preeclampsia versus controls expressing the E-cadherin, N-cadherin, cytokeratin 18, and cytokeratin 19 markers was 46 (82.1%) versus 46 (82.1%) (p = 0.988), 54 (96.4%) versus 48 (85.7%) (p = 0.121), 4 (7.1%) versus 0 (0%) (p = 0.126), and 11 (19.6%) versus 11 (19.6%) (p = 0.532), respectively. There was also no significant difference in the intensity of staining of these four markers (Ecadherin, N-cadherin, and cytokeratin 18 and 19) between severe preeclampsia and control placentas. CONCLUSION: Together, these results indicate that in this setting, the expression of E-cadherin, N-cadherin, CK18, and CK19 is not associated with severe preeclampsia

Sensitivity and Specificity of Gold Chromatography Immuno-Assays IgM/IgG Antibody Test for COVID-19: Review of the current literature

Abstract: Background: The World Health Organization recommends molecular tests (PCR) to the diagnosis of COVID-19, which detect the (SARS-CoV2) virus RNA. However, these tests are expensive and give a high negative result. There were urgent medical and public health needs for early diagnosis and treatment to minimize the spread of COVID-19. This review aimed to summarize known to date information about the latest research progress of the sensitivity and specificity of rapid combined IgM/IgG antibody test to diagnose the pandemic novel coronavirus. Methods: The literature search was conducted using PubMed, Google Scholar, Science Direct, supplemented by (Web of Science electronic databases), with the search term (COVID19 or COVID-19, novel coronavirus, SARS CoV-2 or SARS CoV2, Rapid antibody test, IgM/IgG, sensitivity, specificity). Results: The review included eight clinical studies for a total of 782 patients with COVID-19 and 631 healthy control. The sensitivity and specificity of Gold Chromatography Immuno-Assays (GCIAs) IgM/IgG rapid test vary greatly among published studies. The IgM/IgG sensitivity ranged from 73.9 to 89.3% in 6/8 (75%) studies and the IgM/IgG specificity ranged from 88.9 to 100% in the eight (100%) reviewed studies. The pooled data revealed that the average of sensitivity and specificity was 70% and 94.5%, respectively. They agreed on its simplicity, fastness, and fewer requirements. Conclusion: The GCIAs IgM/IgG rapid tests are simply fast and safe. Besides their short turnaround time, no specific equipment or skilled technicians’ requirements, they can serve as a rapid diagnostic test of RT-PCR-negative symptomatic patients and screening of SARS CoV-2 carriers. It cannot take the place of PCR, but the huge lab diagnosis pressure can be greatly relieved and more research is needed to detect its reliability in limited-resource settings.  Keywords: COVID-19, Rapid Test, IgM/IgG, Sensitivity, Specificity, Limited-resource