Restoration of Kidney Function after Prolonged (Four Months)Anuria Due to Bilateral Renal Artery Occlusion

Introduction: Atherosclerotic renal artery stenosis (RAS) is usually one manifestation of wide spread atherosclerotic disease and its presence has a grave impact on prognosis. RAS is a progressive condition that can remain asymptomatic for a long time, only to present later with accelerated hypertension or renal insufficiency. The first approach to the management of atherosclerotic RAS consists of medical therapy to control blood pressure and other atherosclerotic risk factors. However, surgical or percutaneous revascularization can be of substantial benefit in selected patient groups. Case Report: A 37 year old man who was a heavy smoker and known to have hypertension for the previous five years presented with acute anterior myocardial infarction (MI). His serum creatinine was 8.5 mg/dl and he needed a session of acute peritoneal dialysis to relieve severe pulmonary edema. Subsequent investigations revealed the presence of bilateral total occlusion of the renal arteries resulting in severe renal impairment and dialysis dependency. He underwent two unsuccessful attempts at angioplasty. Surgical revascularization of both renal arteries was eventually carried out after four months of anuria, and was immediately followed by dramatic improvement of his kidney function. The patient, however, continued to receive antihypertensive medication for adequate blood pressure control. Conclusion: This case reflects the ability of the kidney to adapt to chronic ischemia, and underscores the importance of considering renal revascularization in all patients with renal artery occlusion, even after long periods of kidney non-functioning. Key words: renal artery occlusion, renaovascular disease, renal revascularization, ischemic nephropath

Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan

Introduction: New onset post transplant diabetes mellitus (PTDM) is a common complication of kidney transplantation with a negative impact on patient and graft survival. Non-white ethnicity is a well known risk factor for PTDM. Methods: This is a retrospective study of 221 Sudanese patients who received live donor kidney transplantation in Ahmed Gasim kidney transplant center between December 2001 and December 2007, focusing on the incidence, clinical course and prognosis of PTDM during the first post transplant year, and relating this to calcineurin inhibitor use. Results: The 12 months cumulative incidence of PTDM in our transplant population was 17.6% and all cases required treatment with insulin. 53.8% of PTDM cases were transient with a median duration of 76 days; by 12 months post transplant only 6.2% of patients were receiving insulin. The 12 months cumulative incidence of PTDM was higher in the tacrolimus compared to cyclosporine groups (25.4% versus 6.6%; OR 4.8, 95% CI: 1.9-12.1; P=0.00). During the follow up period 57.6% of PTDM patients in the tacrolimus group were able to discontinue insulin compared to 33.3% of PTDM patients in the cyclosporine groups (OR 2.7, 95% CI: 0.4-17; P=0.3). By 12 months post transplant, the proportion of patients receiving insulin was not significantly different between the two groups (8.0% versus 4.0%; OR 2.1, 95% CI 0.5-8.4; P = 0.2). Conclusion: The incidence of PTDM in our transplant population is not different from that reported in published randomized controlled trials and similarly, in the majority of cases PTDM was transient. Key words: Post transplant diabetes mellitus, kidney transplantation, tacrolimus, cyclosporine, calcineurin inhibito

An Optimized Hybrid Fuzzy-Fuzzy Controller for PWM-driven Variable Speed Drives

This paper discusses the performance and the impact of disturbances onto a proposed hybrid fuzzy-fuzzy controller (HFFC) system to attain speed control of a variable speed induction motor (IM) drive. Notably, to design a scalar controller, the two features of field-oriented control (FOC), i.e., the frequency and current, are employed. Specifically, the features of fuzzy frequency and fuzzy current amplitude controls are exploited for the control of an induction motor in a closed-loop current amplitude input model; hence, with the combination of both controllers to form a hybrid controller. With respect to finding the rule base of a fuzzy controller, a genetic algorithm is employed to resolve the problem of an optimization that diminishes an objective function, i.e., the Integrated Absolute Error (IAE) criterion. Furthermore, the principle of HFFC, for the purpose of overcoming the shortcoming of the FOC technique is established during the acceleration-deceleration stages to regulate the speed of the rotor using the fuzzy frequency controller. On the other hand, during the steady-state stage, the fuzzy stator current magnitude controller is engaged. A simulation is conducted via MATLAB/Simulink to observe the performance of the controller. Thus, from a series of simulations and experimental tests, the controller shows to perform consistently well and possesses insensitive behavior towards the parameter deviations in the system, as well as robust to load and noise disturbances

Effect of Alkali Refining on Removal of Aflatoxins in Groundnut Oil and Quality Evaluation

The present study was investigated the effect of alkali refining on the removal of aflatoxins (AFs) in groundnut oil. Groundnut oil samples were collected from different expellers in Medani and Khartoum cities in Sudan. The samples were investigated for their fungal growth using potato dextrose agar (PDA) media and quantitation of the toxins was accomplished by the thin layer chromatography (TLC) technique. The results show that most of the oil samples were affected by A. flavus and other fungi as well as contaminated with AFs. The findings show that the alkali refining processes of the groundnut oil slightly effect on the removal of AFs in groundnut oil. In addition, there was significant difference in the physicochemical properties of the groundnut oil after treatment via alkali refining, these include the moisture content, peroxide value, acid value as well as the free fatty acids. On the other hand, there were no significant changes in the refractive index before and after alkali refining

Effect of Groundnut Pod Condition on the Microbial Content and Aflatoxin Contamination in the Groundnut Seeds

The present study was investigated the effect of groundnut pod condition on the microbial content and aflatoxin contamination in the groundnut seeds in Sudan, which collected from irrigated area (Gezira) and rain-fed area (Al-fao and Kordofan). The samples were investigated for their fungal growth using potato dextrose agar (PDA) media and for their aflatoxin contamination using thin layer chromatography (TLC) technique. High percentage of the groundnut seeds were found unshelled sound intact (53.33-63.00%), while the low percentage was unshelled shrink/damaged (10.33-19.34%). The infection by A. flavus and aflatoxins contamination were found to be high in the split samples either shelled or unshelled which collected from Gezira area (56.67%), whereas, the low percentage was (10.00%) in the unshelled shrink/damaged samples which collected from Kordofan area. Microbial content showed that the sound intact seeds either shelled or unshelled were free from A. flavus and aflatoxins, while the split and shrink/damaged samples either shelled or unshelled were infected by A. flavus and contaminated by aflatoxins. Moreover, High percentage of fungs infection other than A. flavus were obtained (40.00-43.33%) in split and shrink/damaged shelled samples, however, low percentage were obtained (10.00%) in intact samples either shelled or unshelled which collected from Gezira are

Impact of the underlying cause and co-morbid conditions on the outcome of hepatic encephalopathy

Background: Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of acute and chronic liver diseases. This study aimed at identifying liver diseases and co-morbidity conditions associated with hepatic encephalopathy (HE) and their impact on patient`s mortality (the outcome).Methods: A hospital-based, prospective study enrolled 76 patients admitted with HE conducted at Ibn Sina specialized gastroenterology hospital, Sudan, from January 2010 to May 2011. Personal data, clinical presentation, underlying liver disease, precipitants, co-morbid conditions and the outcome of HE were obtained from the inpatients’ hospital records.Results: A total of 76 patients were included, 62 males (81.5%) and 14 females (18.5%) aged between 13 and 84 years old. Hepatitis B virus (HBV) was the most common cause of the liver disease (36.8%), followed by HCV (11.8%). Clinically, 53 patients (69%) had impaired level of consciousness. Infection was the most common risk factor for HE (54%) followed by electrolyte disturbance (42%). Overall mortality within one to three weeks following the admission was (50%). The higher percentage of mortality was seen inpatients with late stage autoimmune hepatitis, followed by HCC and in co-morbid conditions like renal impairment (58.8%).Conclusion: HE is associated with a high mortality despite proper management in specialized hospitals. The mortality tends to increase in the presence of comorbid condition.

Effect of combination of Nigella sativa and Bee’s honey on lung function, respiratory muscle power, and asthma control in patients with persistent asthma

Background: Persistent asthma is a serious global medical problem, usually controlled by long term use of inhaled corticosteroids (ICS). However, ICS are expensive particularly in the developing countries and despite their use, a proportion of patients still suffer from uncontrolled symptoms and may progress into intractable airflow limitation. Nigella sativa and Bee’s honey are relatively cheap and safe natural products with anti- inflammatory and anti-allergic properties; they are used traditionally in treatment of so many diseases.Methods: In this study, we investigated the adjuvant effect of combination of Nigella Sativa and Bee’s honey on lung function, respiratory muscle power and asthma control in patients with persistent asthma. An oral dose of Nigella sativa (2 mg once daily), and bee’s honey (7.5 ml twice a day) were given to patients with uncontrolled persistent asthma (n=30, 14 females and 16 males with mean age of 43.91±5.8) for three months duration. Lung function tests (FEV1, FVC and PEFR) and respiratory muscle power indicators (MEP, MIP) were measured initially as baseline records and monthly for 3 months. The baseline score for asthma control test (ACT) was calculated for all patients and repeated after three months.Results: There was statistically significant improvement in lung function and respiratory muscle power. The need for asthma relieving β2 agonists was remarkably decreased and a significant improvement in asthma control test score in both asthma groups was observed.Conclusions: Combination of Nigella sativa and Bee's Honey as an adjuvant therapy with ICS decreases asthma severity grade and hence the need for both asthma controlling and relieving drugs and improves patient’s quality of life

A fixed-dose 24-hour regimen of artesunate plus sulfamethoxypyrazine-pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan

BACKGROUND: Artemisinin-based combination therapy is increasingly being adopted as first-line antimalarial therapy. The choice of appropriate therapy depends on efficacy, cost, side effects, and simplicity of administration. METHODS: the efficacy of fixed co-formulated (f) artesunate-sulfamethoxypyrazine-pyrimethamine (AS+SMP f) administered at time intervals of 12 hours for a 24-hour therapy was compared with the efficacy of the same drug given as a loose combination (AS+SMP l) with a dose interval of 24 hours for 3 days for the treatment of uncomplicated Plasmodium falciparum malaria in eastern Sudan. RESULTS: seventy-three patients (39 and 34 in the fixed and the loose regimen of AS+SMP respectively) completed the 28-days of follow-up. On day 3; all patients in both groups were a parasitaemic but one patient in the fixed group of AS+SMP f was still febrile. Polymerase chain reaction genotyping adjusted cure rates on day 28 were 92.3% and 97.1% (P > 0.05) for the fixed and loose combination of AS+SMP respectively. Three (4.1%) patients (one in the fixed and two patients in the loose group of AS+SMP) in the study suffered drug-related adverse effects. Gametocytaemia was not detected during follow-up in any of the patients. CONCLUSION: both regimens of AS+SMP were effective and safe for the treatment of uncomplicated P. falciparum malaria in eastern Sudan. Due to its simplicity, the fixed dose one-day treatment regimen may improve compliance and therefore may be the preferred choice

An Investigation of the Swelling Kinetics of Bentonite Systems Using Particle Size Analysis

Particles size distribution (PSD) is introduced as a tool for analysis of bentonite aggregation and swelling kinetics. Raw Ca-bentonite was purified using a combined wet sieving and sedimentation processes, followed by thermochemical treatment with Na 2 CO 3 to increase its swelling capacity. The detailed analysis of the PSD shows a strong correlation between the PSD and the swelling process. For the chemically treated raw bentonite, PSD revealed two different peaks representing unswelled and swelled particles along with some aggregates. The swelling is shown to be a kinetically controlled process that depends on time, temperature, and bentonite chemical composition. At the beginning of the chemical treatment, the effect of aggregates was more dominant; therefore, the viscosity did not increase much with particle size. However, the combined chemical and thermal treatment has enhanced the Na-activation process and boosted bentonite swelling. The rheological measurements have shown enhancement in the viscosity and confirmed the PSD findings. The same optimal treatment conditions are obtained from both rheological measurements and PSD analysis. A model is developed based on classical reaction rate kinetics and used to describe the conversion from unswelled to swelled particles. The PSD has a strong correlation with the physical properties of the suspension such as the viscosity. The swelling rate fits a second order model with a rate constant, k, in the range 0.002 to 0.124 h 1 and an activation energy, E, of 87 kJ/mol. PSD analysis together with the developed kinetic model are powerful tools for studying the swelling kinetics of bentonites.Scopu

Investigation of Filter Cake Evolution in Carbonate Formation Using Polymer-Based Drilling Fluid

Drilling fluid and filtrates invasion often alter the near-wellbore flow properties during overbalanced drilling. The utilization of polymeric gels to prevent drilling fluid loss reduces the risk of formation damage caused by this alteration. In this study, the internal and external filter cake evolution by polyacrylamide (PAM) cross-linked with polyethylenimine (PEI) was investigated. The analysis conducted in this study showed that the cross-linked polymer activates and forms a mature gel inside the formation’s pores. Gel also formed a dense uniform structure on the rock’s surface, preventing further fluid loss. A high sealing pressure of up to 1000 psi was achieved, allowing drilling to continue without the need for additional casing string to prevent lost circulation. Moreover, the PAM/PEI formula showed less invasion of filtrate and evolution of a thin shallow internal filter cake that penetrated less than half of the filter disk thickness. In comparison to the full invasion and particle depositions that occurred with the water-based mud (WBM), the PAM/PEI formula is expected to reduce the impact of lost circulation materials (LCMs) on formation damage.The authors thank the Qatar National Research Fund (a member of the Qatar Foundation) for funding this study. This paper was made possible by an NPRP Grant No. NPRP10-0125-170240. Open Access fees paid for in whole or in part by the University of Oklahoma Libraries.Ye