The sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Introduction: Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. Objective: This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis.Methods: The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation (signs and symptoms) and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous.Results: Clinical diagnosis was made correctly in 807 (93.2%) of the patients. White blood cells count ranged from 3.70 to 45.30 /mm3 (mean 17.5353 /mm3). It wa

Why do people prefer traditional bonesetters in Sudan?

Background: In Sudan as in other developing nations, traditional bonesetters play a significant role in primary fracture care. There is widespread belief in our society that TBS are better at fracture treatment than orthodox practitioners. Significant numbers of patients with fractures present first to the traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in Sudan. Objectives: A prospective study designed to determine the reasons of why a considerable number of people prefer to go to the traditional bonesetters in Sudan.Patients and methods: This prospective two stages study was carried out in two different stages, 1st stage in 2006 targeted general population, and the 2nd stage in the period from May 2009 to September 2009 targeted traditional bonesetters and their patients. In the 1st stage of the study we distributed a predesigned questionnaire to general population, while in the 2nd stage of the study we visited different traditional bonesetter in order to interview them and their visitors and completing the early prepared Performa. We excluded the too elderly patients and children who have nodecisions to choose TBS.Results: In the 1st stage of study the participants were 199 of them, 192 participants responded well to the questionnaire. The reasons why they went to traditional bonesetters were; in 71 participants (37%) was their beliefs, in 27 (14.06%) was due to the low cost, and in 27 (14.06%) was due to fear of plaster. In the 2nd stage of the study 276 participants fulfilled the criteria of the research. The reason why they went to traditional bonesetters; in 63 candidates (22.8%) was their beliefs (P value < 0.003), in 53 (19.2%) was low cost (P value < 0.05), and in 46 (16.7%) was due to fear of cast or amputation. Study included sixteen traditional bonesetters, of them 14 were males and 2 were females. One of them has a bachelor graduation from faculty of sciences. 11 (68.8%) traditional bonesetters accepted the idea of regular training under medical supervision.Conclusion: Despite an adequate number of physicians practising in the region, traditional bonesetters continue to be consulted. Study showed that a belief is the most leading cause of consulting traditional bonesetters, other causes including fear of plaster or amputation and less cost. We recommend that the efficacy of their treatments have to be further assessed.Keywords: Traditional bonesetter (TBS); Beliefs, medical services

Spontaneous Achilles tendon rupture in alkaptonuria

Spontaneous Achilles tendon ruptures are uncommon. We present a 46-year-old man with spontaneous Achilles tendon rupture due to ochronosis. To our knowledge, this has not been previously reported in Sudan literature. The tendon of the reported patient healed well after debridement and primary repairs

Pyocolpos with imperforate hymen during early childhood presented with urine retention and bouts of intestinal obstruction

An imperforate hymen is not a rare condition in female newborns, but is often ignored in a genital examination by doctors. We report an unusual case of a 2 years old Sudanese girl with an imperforate hymen and pyocolpos presented with urine retention and intermittent bouts of intestinalobstruction. To our knowledge, this is a first case of female child with  pyocolpos to be documented in Sudan literature. Keywords: Hydrocolpos, urinary ascites, hymenotomy

Article Neurotransmitters – A biochemical view

The neurotransmission at most if not all synapses is chemical and is of great biochemical, physiological and pharmacological importance. Neurons communicate with each other at synapses by a process called synaptic transmission in which the release of small quantities of chemicalmessengers, called neurotransmitters that alter the electrical activity of neurons after they interact with receptors on post-synaptic cell surfaces. This review gives a biochemical view on the nature of neurotransmitters and presents the biochemical chart and the medical relevance of the mostimportant neurotransmitters. Keywords: Neurotransmitter, Synaptic vesicles, Acetylcholine (ACh), g-Aminobutyrate (GABA), Myasthenia Gravis (MG), Parkinson's disease, Opioid peptides

Colorectal cancer during pregnancy in a Sudanese female

We report a new case of uncommon but not rare condition of colorectal cancer during pregnancy in 33 years old Sudanese female at her 16th weeks of gestation presented with bloody diarrhea and intermittent left side abdominal pain. Initially she was diagnosed as a case of dysentery which was treated by antibiotics. Condition was diagnosed by colonoscopy and histopathology as colonic cancer, located in the sigmoid colon 50 cm from anal verge. A review of literature found that 276 cases of colon cancer associated with pregnancy have been reported. Pregnancy affects the clinical presentation, evaluation, therapy, and prognosis of colon cancer. Patients usually present with misdiagnosed symptoms. Diagnostic delays often lead to the tragic demise of a young woman from a potentially curable disease and of an otherwise viable fetus. This delay in diagnosis is a major contributing factor to the poor prognosis associated with this disease. Synchronous colon cancer during pregnancy presents a diagnostic and therapeutic challenge for clinicians because there are no generally accepted guidelines regarding diagnosis or treatment. This article reviews this uncommon condition with a focus on the features of colon cancer inpregnancy to facilitate earlier diagnosis, to modify investigations, to optimize the therapy, and to improve the maternal and fetal outcomes.Keywords: Colorectal cancer; Pregnancy; CEA, FOLFO

Global burden of human brucellosis : a systematic review of disease frequency

BACKGROUND: This report presents a systematic review of scientific literature published between 1990-2010 relating to the frequency of human brucellosis, commissioned by WHO. The objectives were to identify high quality disease incidence data to complement existing knowledge of the global disease burden and, ultimately, to contribute towards the calculation of a Disability-Adjusted Life Years (DALY) estimate for brucellosis.METHODS/PRINCIPAL FINDINGS: Thirty three databases were searched, identifying 2,385 articles relating to human brucellosis. Based on strict screening criteria, 60 studies were selected for quality assessment, of which only 29 were of sufficient quality for data analysis. Data were only available from 15 countries in the regions of Northern Africa and Middle East, Western Europe, Central and South America, Sub-Saharan Africa, and Central Asia. Half of the studies presented incidence data, six of which were longitudinal prospective studies, and half presented seroprevalence data which were converted to incidence rates. Brucellosis incidence varied widely between, and within, countries. Although study biases cannot be ruled out, demographic, occupational, and socioeconomic factors likely play a role. Aggregated data at national or regional levels do not capture these complexities of disease dynamics and, consequently, at-risk populations or areas may be overlooked. In many brucellosis-endemic countries, health systems are weak and passively-acquired official data underestimate the true disease burden.CONCLUSIONS: High quality research is essential for an accurate assessment of disease burden, particularly in Eastern Europe, the Asia-Pacific, Central and South America and Africa where data are lacking. Providing formal epidemiological and statistical training to researchers is essential for improving study quality. An integrated approach to disease surveillance involving both human health and veterinary services would allow a better understand of disease dynamics at the animal-human interface, as well as a more cost-effective utilisation of resources

A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial

<p>Abstract</p> <p>Background</p> <p>Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.</p> <p>Methods and design</p> <p>This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34°C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes.</p> <p>Discussion</p> <p>Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is frequently not applied in practice. If this trial is positive, our results will have broad implications by showing that a knowledge translation strategy shared across a collaborative network of hospitals can increase the number of patients that receive this lifesaving intervention in a timely manner.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Trial Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00683683">NCT00683683</a></p

Gastrointestinal nematode infections in German sheep

The objective of the present study was to determine the prevalence and variation of natural gastrointestinal nematode (GIN) infections in lambs according to birth type, gender and breed based on individual faecal egg counts (FEC) from various regions in Germany. A total of 3,924 lambs (3 to 15 months old) with different genetic backgrounds (Merinoland, German Blackhead Mutton, Rhoen, Texel and Merino long-wool) were individually sampled during the grazing period between 2006 and 2008. Furthermore, pooled faecal samples from each of the farms were cultured in order to differentiate the third-stage larvae of the nematode spp. Sixty-three percent of the lambs were infected with GIN. The infections were mostly low to moderate and involved several nematode species. The Trichostrongylus spp. was the predominant species based on the percentage of larvae in faecal cultures. Only 11.4% of the lambs were free of Eimeria oocysts. Tapeworm eggs were encountered in 13.2% of all samples. The prevalence of GIN infections varied significantly (P < 0.001) among farms. A significantly higher FEC (P < 0.05) was observed in multiple-born lambs when compared with singletons. Moreover, male lambs were more susceptible to infection than females (P < 0.001). No significant differences (P > 0.05) were observed between breeds regarding FEC. Inter-individual variations were higher than inter-breed differences, which may indicate the possibility of selection within these breeds for parasites resistance as described in earlier studies

Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status

Background: Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. Methods: Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive model was developed in a retrospective cohort (n = 32; September 2006 September 2011, 48.5 ± 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011 July 2013, 5 ± 1.8 months of follow-up). Results: FNP was present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p &lt; 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity = 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic &#8805; 0.89. Conclusions: A spectral analysis-based model reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest.the CNIC is supported by the Spanish Ministry of Economy and Competitiveness and the Pro-CNIC Foundation.Filgueiras-Rama, D.; Calvo Saiz, CJ.; Salvador-Montañés, Ó.; Cádenas, R.; Ruiz-Cantador, J.; Armada, E.; Rey, JR.... (2015). Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status. International Journal of Cardiology. 186:250-258. doi:10.1016/j.ijcard.2015.03.074S25025818