Serum Levels of Selenium, Zinc, Copper and Magnesium in Asthmatic Patients: a Case Control Study.

Background: Free radicals have harmful effects on cells and tissues and are thought to be responsible for the pathogenesis of many diseases including bronchial asthma. Selenium (Se), Zinc (Zn), copper (Cu), and magnesium (Mg) are trace elements required for the antioxidant enzymes and hence the optimal functions of the immune system. Changes in the levels of these elements may lead to a reduction in antioxidant activities in asthma. Objective: This study was conducted to determine serum levels of the trace elements Se, Zn, Cu, and Mg in asthmatic patients in order to evaluate the associations of these nutrients with asthma in adults Subjects and Methods: Serum Se, Zn, Cu, and Mg concentrations were measured in 100 asthmatic adult patients and 170 healthy control subjects matched for age and sex. The patients were recruited from asthma casualties, referred clinics and wards of Elshaab and Omdurman Teaching Hospital, Khartoum Sudan. Socio- demographic data and clinical history of all subjects were collected in questionnaires. Results: Serum Se and Cu levels were found to be significantly decreased in asthmatic patients compared to controls. Mean serum Se and Cu for patients were 65.8 5.5Ig/l (mean SD) and 0.711 0.37g/l respectively while that for controls were 78.2 7.5 Ig/l and 0.939 0.322g/l respectively (P value was < 0.001). On the other hand the mean serum Zn level was significantly higher in patients compared to controls (1.2 0.51g/l and 0.94 0.254g/l respectively) (P value wa

Obesity and cardiovascular disease risk factors among adult Sudanese

Subjects and methods: In this study, the effect of obesity on the development of dyslipidemia, hypertension and glucose intolerance among Sudanese adults attending weight reduction programs was investigated. According to the BMI (Body mass index), 98 overweight/obese and 60 normal weight adults were included. Anthropometric measures were taken, lipid profile and C – reactive protein (CRP) were determined using commercial kits.Results: Obesity related dyslipidemia seems to affect overweight/obese males more than females. On the other hand, overweight /obesity among females, not like males, was found to be associated with high blood pressure probably due inflammation, as determined by CRP level.Conclusion and recommendation: Obesity related dyslipidemia is more prominent among males while obesity related hypertension is a phenomenon among females probably due to release of CRP. We recommend a more detailed study of inflammatory cytokines, in relation to obesity, that mayreflect the mass and/or activity of the adipose tissue.Key words: overweight, dyslipedemia, CVD

Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature

Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007, 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie’s disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration, and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycron® 2/0 polyester fiber).Results: After a mean follow-up period of 18 months, successful results with respect to penile straightening, normal erection, penetration and sensation, confirmed both subjectively and objectively, were achieved in all patients. Post-operative penile shortening of less than 1.5 cmwas present in 50% of the cases, but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100% (35/43 very satisfied and 8/43 satisfied).Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful outcomes are: clear identification of the line of maximum curvature, adequate pre-operative evaluation, counseling of the patient to setappropriate expectations, and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle, which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea, which may prevent postoperative erectile dysfunction, is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity

Prospective evaluation of the impact of post-cesarean section uterine scarification in the perinatal diagnosis of placenta accreta spectrum

Objective: Standardized ultrasound imaging and pathology protocols have recently been developed for the perinatal diagnosis of placenta accreta spectrum (PAS) disorders. The aim of this study was to evaluate prospectively the effectiveness of these standardized protocols in the prenatal diagnosis and postnatal examination of women presenting with a low-lying placenta or placenta previa and a history of multiple Cesarean deliveries (CDs). Methods: This was a prospective cohort study of 84 consecutive women with a history of two or more prior CDs presenting with a singleton pregnancy and low-lying placenta/placenta previa at 32–37 weeks' gestation, who were referred for perinatal care and management between 15 January 2019 and 15 December 2020. All women were investigated using the standardized description of ultrasound signs of PAS proposed by the European Working Group on abnormally invasive placenta. In all cases, the ultrasound features were compared with intraoperative and histopathological findings. Areas of abnormal placental attachment were identified during the immediate postoperative gross examination and sampled for histological examination. The data of a subgroup of 32 women diagnosed antenatally as non-PAS who had complete placental separation at birth were compared with those of 39 cases diagnosed antenatally as having PAS disorder that was confirmed by histopathology at delivery. Results: Of the 84 women included in the study, 42 (50.0%) were diagnosed prenatally as PAS and the remaining 42 (50.0%) as non-PAS on ultrasound examination. Intraoperatively, 66 (78.6%) women presented with a large or extended area of dehiscence and 52 (61.9%) with a dense tangled bed of vessels or multiple vessels running laterally and craniocaudally in the uterine serosa. A loss of clear zone was recorded on grayscale ultrasound imaging in all 84 cases, while there was no case with bladder-wall interruption or with a focal exophytic mass. Myometrial thinning (< 1 mm) in at least one area of the anterior uterine wall was found in 41 (97.6%) of the 42 cases diagnosed as non-PAS on ultrasound and 37 (88.1%) of the 42 diagnosed antenatally as PAS. Histological samples were available for all 48 hysterectomy specimens with abnormal placental attachment and for the three cases managed conservatively with focal myometrial resection and uterine reconstruction. Villous tissue was found directly attached to the superficial myometrium (placenta creta) in six of these cases and both creta villous tissue and deeply implanted villous tissue within the uterine wall (placenta increta) were found in the remaining 45 cases. There was no evidence of percreta placentation on histology in any of the PAS cases. Comparison of the main antenatal ultrasound signs and perioperative macroscopic findings between the two subgroups correctly diagnosed antenatally (32 non-PAS and 39 PAS) showed no significant difference with respect to the distribution of myometrial thinning and the presence of a placental bulge on ultrasound and of anterior uterine wall dehiscence intraoperatively. Compared with the non-PAS subgroup, the PAS subgroup showed significantly higher placental lacunae grade (P < 0.001) and more often hypervascularity of the uterovesical/subplacental area (P < 0.001), presence of bridging vessels (P = 0.027) and presence of lacunae feeder vessels (P < 0.001) on ultrasound examination, and increased vascularization of the anterior uterine wall intraoperatively (P < 0.001). Conclusions: Remodeling of the lower uterine segment following CD scarring leads to structural abnormalities of the uterine contour on both ultrasound examination and intraoperatively, independently of the presence of accreta villous tissue on microscopic examination. These anatomical changes are often reported as diagnostic of placenta percreta, including cases with no histological evidence of PAS. Guided histological examination could improve the overall diagnosis of PAS and is essential to obtain evidence-based epidemiologic data. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Binding to CSA receptor is associated with asymptomatic and mild malaria: a preliminary study using P.falciparum field isolates from Sudan

Malaria imposes great socio-economic burden on humanity, and afflicts approximately 90 countries and territories in the tropical and subtropical regions, almost one half of them are in Africa, South of Sahara. Sequestration of parasitized erythrocytes within the small vessels of vital organs is a key event in the pathogenesis of malaria and responsible of virulence of Plasmodium falciparum parasite. To find out whether the ability of infected red blood cells (IRBCs) to adhere to a specific receptor is a risk factor for developing severe clinical manifestation of the disease, in-vitro cytoadhesion and inhibition experiments were performed on field isolates obtained from five symptomatic and five asymptomatic patients inhabiting Gazira State, Central Sudan. The results showed significant lower levels (

Assessment of ultrasound features of placenta accreta spectrum in women at high risk: association with outcome and interobserver concordance

OBJECTIVES: The aims of this study were to evaluate the prenatal ultrasound features associated with operative complications and to assess the interobserver agreement in a cohort with detailed intraoperative and histopathologic data. METHODS: We conducted a retrospective, multicentre cohort study of 102 patients at high-risk of placenta accreta spectrum (PAS) between January 2019 and May 2022. De-identified ultrasound images were reviewed retrospectively and independently by two experienced operators blinded to clinical details, intra-operative features, outcome, and the histopathologic findings. The diagnosis of PAS was confirmed by the failure of detachment of one or more placental cotyledon from the uterine wall at delivery and the absence of decidua with distortion of the utero-placental interface by fibrinoid deposition on histologic examination of the accreta areas obtained by guided-sampling of partial myometrial resection or hysterectomy specimens. Antenatal categorisation was low or high probability of the likelihood of PAS at birth. Interobserver agreement was assessed using kappa statistic. Primary outcome was major operative morbidity (blood loss of ≥2000 ml, unintentional injury to the viscera, admission to intensive care unit or death). RESULTS: There were 66 cases with, and 36 cases without evidence PAS at birth. When blinded to other clinical details, the examiners agreed on the low or high probability of PAS in 87/102 cases (73.5%) on ultrasound features. The kappa statistic is 0.47 (95% CI: 0.28 - 0.66) showing moderate agreement. Morbidity was twice as common with a diagnosis of PAS. Concordant assessment of high probability of PAS was associated with the highest morbidity (66.6%) and a high (97.6%) chance of histopathological confirmation. CONCLUSIONS: The probability of histopathological confirmation is exceedingly high with concordant prenatal assessment suggestive of PAS. The interoperator agreement for preoperative assessment for histopathological confirmation of PAS is only moderate. Morbidity is linked to both histopathological diagnosis and antenatal assessment concordant of PAS. This article is protected by copyright. All rights reserved

A new methodologic approach for clinico-pathologic correlations in invasive placenta previa accreta

BACKGROUND: The development of new management strategies for women presenting with placenta accreta spectrum requires quality epidemiology data which have so far been limited by the high variability in clinical and histopathologic data confirming the diagnosis at birth. OBJECTIVE: To evaluate the role of a new methodologic approach for the correlation of clinical and pathological data for women with a history of prior cesarean delivery diagnosed prenatally with placenta previa accreta. STUDY DESIGN: A modified pathologic technique for gross examination of hysterectomy specimens with placenta in-situ consisting of intra-operative examination, immediate post-operative examination and guided histologic sampling was used prospectively in a cohort of 24 patients with singleton pregnancies complicated by placenta low-lying/placenta previa accreta. The maternal characteristics, detailed ultrasound findings, surgical outcomes and histopathologic examination were compared with those of a group of 24 patients with similar clinical characteristics where a standard pathologic examination method was used. RESULTS: The median reporting time for obtaining the complete histopathology results including the microscopic examination was significantly shorter (7 vs 15 days; P<0.001) and the median number of samples taken for histologic examination significantly lower (4 vs 14 samples; P<0.001) in the study group than in the controls. The number of histologic slides showing villous invasion was significantly higher (2 vs 1 slides; P=0.002) and the ratio of the number of samples taken to the numbers of slides confirming villous invasion was significantly lower (2 vs 9; P<0.001) in the study group than in the controls. In all cases of the study group, intra-operative examination identified a dense tangled bed of vessels or multiple vessels running laterally and cranio-caudally in the uterine serosa above the placental insertion which were no longer visible during immediate gross post-operative examination of the hysterectomy specimens. Immediate post-operative dissection enables the differential diagnosis between focal and large increta areas, and between abnormally adherent placenta and invasive placenta accreta. CONCLUSIONS: Valuable clinical information on the serosal vascularity, uterine dehiscence and extension of the accreta area is added with the description of the macroscopic examination during the surgical procedure and immediate dissection of the specimen. This methodological approach is cost-effective and increases the quality of the histologic sampling. It thus provides more accurate correlations with the clinical data and more accurate epidemiologic data collection. Perinatal pathologists should be part of multidisciplinary teams involved the management placenta accreta spectrum disorders

Laplacians with point interactions -- expected and unexpected spectral properties

We study the one-dimensional Laplace operator with point interactions on the real line identified with two copies of the half-line $[0,\infty)$. All possible boundary conditions that define generators of $C_0$-semigroups on $L^2\big([0,\infty)\big)\oplus L^2\big([0,\infty)\big)$ are characterized. Here, the Cayley transform of the boundary conditions plays an important role and using an explicit representation of the Green's functions, it allows us to study invariance properties of semigroups