Seasonal variation and hypertensive disorders of pregnancy in eastern Sudan

The aim of this study was to investigate the seasonal variation and hypertensive disorders of pregnancy in eastern Sudan, in the period between January 2008 and December 2010. The medical files of women attending at Kassala hospital, eastern Sudan with hypertension, with or without proteinuria were retrospectively retrieved. The data of patients with hypertensive disorders of pregnancy were compared with a similar number of controls that were normotensive and non-proteinuric. During the study period, there were 9,578 deliveries; 153 patients had hypertensive disorders of pregnancy, yielding an incidence rate of 1.6%. Of all cases and controls (306), there were 183 (59.8%) deliveries in winter, 84 (27.5%) in summer and 39 (12.7%) in autumn. The highest rate of pre-eclampsia was in winter (1.1%) (CI = 1.1-2.7, OR = 1.7, p = 0.004) and the lowest rate was in autumn (0.2%) (CI = 0.4-1.8, OR = 0.8, p = 0.758.). Our study revealed significant association between the incidence of hypertensive disorders of pregnancy and the winter season (103 (67.3%) vs 80 (52.3%), p = 0.001). Thus, more attention in the winter season might reduce the morbidity and mortality of hypertensive disorders of pregnancy.

Vegetation limits the impact of a warm climate on boreal wildfires

Strategic introduction of less flammable broadleaf vegetation into landscapes was suggested as a management strategy for decreasing the risk of boreal wildfires projected under climatic change. However, the realization and strength of this offsetting effect in an actual environment remain to be demonstrated. Here we combined paleoecological data, global climate models and wildfire modelling to assess regional fire frequency (RegFF, i.e. the number of fires through time) in boreal forests as it relates to tree species composition and climate over millennial time-scales. Lacustrine charcoals from northern landscapes of eastern boreal Canada indicate that RegFF during the mid-Holocene (6000-3000 yr ago) was significantly higher than pre-industrial RegFF (AD c. 1750). In southern landscapes, RegFF was not significantly higher than the pre-industrial RegFF in spite of the declining drought severity. The modelling experiment indicates that the high fire risk brought about by a warmer and drier climate in the south during the mid-Holocene was offset by a higher broadleaf component. Our data highlight an important function for broadleaf vegetation in determining boreal RegFF in a warmer climate. We estimate that its feedback may be large enough to offset the projected climate change impacts on drought conditions.

Bond durability of self-etch adhesive to ethanol-based chlorhexidine pretreated dentin after storage in artificial saliva and under intrapulpal pressure simulation

OBJECTIVE

To evaluate the bond strength durability of a single-step self-etch adhesive to dentin pretreated with either ethanol-based chlorhexidine (ECHX) or water-based chlorhexidine (WCHX) after storage in artificial saliva and under intrapulpal pressure simulation (IPPS).

METHODS

The occlusal enamel of 30 freshly extracted premolars was trimmed to expose midcoronal dentin. Roots were sectioned to expose the pulp chamber. Specimens were distributed over three groups (n=10) according to the dentin pretreatment used. In the first group, Adper Easy One (3M ESPE) was applied to the dentin surfaces according to the manufacturer's instructions (control group). In the second group, dentin was pretreated before bonding with 1 mL of 2% CHX diacetate dissolved in 100% ethanol (ECHX). The third group received the same pretreatment; however, CHX was dissolved in distilled water (WCHX). Pretreatment and bonding were carried out while the specimens were subjected to IPPS. Resin composite (Valux Plus, 3MESPE) buildups were made. After curing, specimens were stored in artificial saliva and under IPPS at 37°C in a specially constructed incubator (n=5/group) either for 24 hours or six months prior to testing. Thereafter, bonded specimens were sectioned into sticks with a cross section of 0.9 ± 0.01 mm(2) and subjected to microtensile bond strength (μTBS) testing (n=25/subgroup) using a universal testing machine. Data were statistically analyzed using two-way analysis of variance (ANOVA) with repeated measures, one-way ANOVA , and Bonferroni post hoc tests (p≤0.05). Failure modes were determined using a scanning electron microscope.

RESULTS

After 24 hours of storage, control and WCHX groups revealed significantly higher μTBS than the ECHX group. After six-month storage in artificial saliva and IPPS, only the WCHX group maintained its μTBS value. The predominant mode of failure was the mixed type, except for the ECHX group, which was mostly adhesive.

CONCLUSION

Pretreatment of the dentin with ECHX had a negative effect on bonding of the tested single-step self-etch adhesive; however, WCHX showed bond stability under IPPS.

Problems leading to conversion in laparoscopic cholecystectomy

In prospective study, the various reasons for conversion in laparoscopic cholecystectomy were shown and recommended various measures to decrease the incidence of conversion and associated complications with this procedure. Fifty cases of conversion in laparoscopic cholecystectomy were studied in Dhaka Medical College Hospital & Bangabandhu Sheikh Mujib Medical University from July 2002 to July 2004. The commonest cause of conversion was dense pericholecystic adhesion or unclear anatomy (24%). Next common cause was accidental injury to surrounding structures (18%) and uncontrolled bleeding (14%) and thick fibrosed gall bladder (14%). Other causes were gall bladder wall perforation (6%), carcinoma gall bladder (6%) and choledocholithiasis (6%), anatomic variation (4%), equipment failure (4%), cholecystoduodenal fistula (2%) and choledochal cyst (2%). Proper case selection, good laparoscopic skill and adequate experience of the surgeon are the prerequisites for safe laparoscopic cholecystectomy and thereby reducing conversion rate.

Association of positive thyroid auto antibodies with thyroid carcinoma

The association between thyroid autoimmunity and thyroid cancer was carried out in a series of solitary thyroid nodules submitted to fine-needle aspiration cytology and subsequent histopathology. US guided FNACs were obtained from 295 unselected consecutive patients with single thyroid nodules and positive (98) or negative (197) serum anti-thyroid antibody. Cytological results were classified in three classes of increased risk of malignancy: low risk (class II); indeterminate risk (class III); and suspect or malignant (class IV). A higher prevalence of class III (29.6%, p<0.05) and class IV (17.34%, p<0.05) and lower prevalence of class II (52.06%, p<0.01) were found in ATA+ nodules respectively. By multivariate logistic regression analysis ATA+ conferred a significant risk (odds ratio: 1.97 & 95% confidence interval: 0.97-3.97) for class IV cytology independently for age and sex. In 53 patients where thyroidectomy was carried out, thyroid cancer was found in (86.66%) patients with class IV nodules, in (19.4%) of class III nodules (all ATA-) and in none of 7 class II nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (13.2%) of ATA+, when compared with ATA- nodules (8.1%, p>0.01), but the significance of this finding is limited by the low number of class II nodules operated on. The presence of ATA+ confers an increased risk of suspicious or malignant cytology in solitary thyroid nodules.

High incidence of obstetric complications in Kassala Hospital, Eastern Sudan

Medical files of women delivered at Kassala Hospital, Eastern Sudan in the period of January-December 2009 were reviewed retrospectively. Out of 4,689 delivered women, 14.7% were teenagers, 67.1% had no antenatal care and 12.6% were grandmultiparous. Obstetric complications included: pre-term birth (2.6%); pre-eclampsia/eclampsia (4.2%); haemorrhage (2.9%); malpresentation (5.5%); obstructed labour (1.9%) and ruptured uterus (0.6%). Caesarean delivery rate was 31.1%. While 89.4% of the newborn babies were taken home, 6% were admitted to the nursery, 4.4% were stillbirths, and 0.2% immediate neonatal deaths. There were 26 maternal deaths (550 per 100,000 live births), mainly due to septicaemia (38.4%), haemorrhage (19.2%), embolism (15.3%) and malaria (11.5%). Thus, there is a high frequency of maternal morbidities and mortality which needs improvement in obstetric care. It is important to make visits from a tertiary hospital to the region to collect statistics and discuss management of the problems they reveal, with the local staff.

Acute abdomen 10 years after surgery for duodenal ulcer disease

A 55 years old male was admitted in the surgical unit of Dhaka Medical College & Hospital with the complaints of pain and discomfort in the upper abdomen for 1 day and hiccough and vomiting for several episodes for same duration. He had history of abdominal operation 10 years back for his peptic ulcer disease probably due to pyloric stenosis. On examination a linear scar mark was present along the upper midline region & visible peristalsis was seen on the left hypochondriac region. A palpable diffuse lump was present in the left hypochondriac region which was intraperitoneal seemed to be distended gut and the peristaltic wave moved from left to right. Endoscopy of upper GIT Showed loops of small intestine (evidenced by valvulae conneventes) protruded through a stoma suggestive of jejunogastric intussusception. Laparotomy revealed a portion of adherent small gut already become gangrenous so the whole portion of the intussuscepted gut was resected. After that revision and take-down of the anastomosis was done with vicryl stitches. The post operative period was uneventful. The patient underwent regular follow up.

Hearts from DCD donors display acceptable biventricular function after heart transplantation in pigs

Cardiac transplantation is in decline, in contrast to other solid organs where the number of solid organ transplants from donors after circulatory death (DCD) is increasing. Hearts from DCD donors are not currently utilized due to concerns that they may suffer irreversible cardiac injury with resultant poor graft function. Using a large animal model, we tested the hypothesis that hearts from DCD donors would be suitable for transplantation. Donor pigs were subjected to hypoxic cardiac arrest (DCD) followed by 15 min of warm ischemia and resuscitation on cardiopulmonary bypass, or brainstem death (BSD) via intracerebral balloon inflation. Cardiac function was assessed through load-independent measures and magnetic resonance imaging and spectroscopy. After resuscitation, DCD hearts had near normal contractility, although stroke volume was reduced, comparable to BSD hearts. DCD hearts had a significant decline in phosphocreatine and increase in inorganic phosphate during the hypoxic period, with a return to baseline levels after reperfusion. After transplantation, cardiac function was comparable between BSD and DCD groups. Therefore, in a large animal model, the DCD heart maintains viability and recovers function similar to that of the BSD heart and may be suitable for clinical transplantation. Further study is warranted on optimal reperfusion strategies.

Polymorphisms of the SLC11A1 gene and resistance to bovine tuberculosis in African Zebu cattle

Bovine tuberculosis (BTB) is a considerable health threat to livestock keepers and general communities in many developing countries. Information on genetic resistance or susceptibility because of polymorphisms of candidate genes could be used in making selection decisions for breeding disease tolerant/resistant animals. Here, we investigated associations between polymorphisms at the solute carrier family 11 (proton-coupled divalent metal ion transporters), member 1 gene (SLC11A1, previously known as natural resistant associated macrophage protein 1, NRAMP1), with BTB phenotypes in Chadian cattle. Phenotypes were (i) single intradermal comparative cervical tuberculin test (SICCT) outcome, (ii) presence of gross visible lung lesions, (iii) a bacteriological culture test outcome and (iv) a predicted true BTB infection status using a Bayesian model. All traits were recorded as binary (presence or absence) traits. A total of 211 cattle were genotyped for a microsatellite within the SLC11A1 candidate gene. Standard linear and threshold-liability models regressing BTB traits on copy number of SLC11A1 alleles revealed statistically significant effects of SLC11A1 alleles (P < 0.001) on most BTB traits. Polymorphisms (alleles 211, 215 and 217) are significantly related to lower incidence of BTB traits in Chadian cattle. This is the first study to report the association of SLC11A1 gene polymorphisms with BTB traits in Chadian or any other African cattle breeds.

Synthesis and spectral characterization of CoxMg1-xAl2O4 as new nano-coloring agent of ceramic pigment

New nano-blue ceramic pigments of Co(x)Mg(1-x)Al(2)O(4) (0< or =x< or =0.1) have been prepared by co-precipitate-combustion as a hybrid method using urea as a fuel at 500 degrees C in open furnace in air atmosphere. The structure of pigment is assigned based on TGA/DTA/DrTGA analyses, X-ray diffraction (XRD) and transmission electron microscopy (TEM). Also, electronic spectra, infrared (IR) and diffuse reflectance spectroscopy (DRS) using CIE L*a*b* parameter measurement techniques were used. The results revealed that the nano-particle size of pigments were obtained in the range 30-38 nm as well as the varying colors and particle size as a result of different calcinations temperatures within the range of 500-1200 degrees C for 2h.

Prevalence and etiology of nosocomial diarrhoea in children < 5 years in Tikrit teaching hospital

A cross-sectional hospital-based study was carried out at Tikrit teaching hospital, Iraq, from October 2004 to September 2005, to identify the prevalence and etiology of nosocomial infectious diarrhoea among children under 5 years of age. Of 259 children admitted to the paediatric ward for reasons other than diarrhoea and hospitalized for more than 3 days, clinical and laboratory analysis of stool samples showed nosocomial diarrhoea in 84 children (32.4%). The most common causative agents were enteropathogenic Escherichia coli (25.9%), Clostridium difficile (21.0%) and rotavirus (18.5%). Single infectious agents caused 63.1% of the cases, while mixed infections were detected in 16.7%; in 20.2% of children the cause remained unknown.

Patient with bilateral breast enlargement and hypospadias

A 20 year old man was admitted in the surgical unit of Dhaka Medical College Hospital on August 2007 presented with Hypospadias & underdeveloped penis from childhood, gradual enlargement of both breasts for the last 10 years, absence of axillary and pubic hair from puberty & painful swelling of both testes for the last 3 years. The patient was regarded as a female upto the age of 10 years. He has got no voice change since puberty. On examination he had average body built, there was bilateral gynaecomastia, hypospadias, rudimentary penis & absence of pubic and axillary hair. His testosterone level, serum prolactin level, serum progesterone level, serum estradiol level was done. Cytology on buccal smear done and ultrasonography revealed no ovary and uterus. Ultimately patient was diagnosed as a case of androgen insensitivity syndrome (AIS). The case is reported for clinical awareness & to share our experience.

Synthesis and characterization of new nano-particles as blue ceramic pigment

The synthesis of a new nano-blue ceramic pigment CoxMg1-xAl2O4 (0 < or = x < or = 0.1) using the combination between co-precipitation and combustion synthesis (CS) method. The structure of pigments is assigned based on thermogravimetric and differential thermogravimetric analysis (TG-DTGA), X-ray diffractions (XRD), and UV-vis spectroscopy. Also, diffuse reflectance spectroscopy (DRS) using CIE L*a*b* parameter measurement method, infrared spectroscopy (IR) and transmission electron microscopy (TEM) is used. The result revealed that the nano-size particle pigment was obtained in range 24-35 nm by using 3-methyl-pyrozole-5-one (3MP5O) as a fuel at 400 degrees C in open furnace. Also, results show the varying colors and particles' size as a result of different calcination temperatures from 500 to 1200 degrees C for 2h.

Incendies et peuplements à Pinus mugo Turra dans les Alpes occidentales (Val de Suse, Italie) durant la transition Tardiglaciaire–Holocène : une zone refuge évidente

In western Italian Alps, small distinct populations of Pinus mugo Turra raise some questions concerning its ecological status and dynamics in the occidental Alps. This note present new palaeobotanical data based on cone imprints of Pinus mugo, identified in travertine systems located in the Val di Susa and dated back to the Late Dryas (11506+/-66 BP) and the Early Holocene (10145+/-225 et 9475+/-670 BP). Heliophilous species and charcoal fragments were also identified, testifying to the oldness of wildfires in this region. The data support the hypothesis that this zone was a refuge area of this pine during the last glaciation. Here we discuss about the postglacial dynamics of the Pinus mugo in the occidental Alps.

A comparative assessment of heavy metal accumulation in soft parts and byssus of mussels from subarctic, temperate, subtropical and tropical marine environments

Existing data on metal concentrations in mussels from subarctic, temperate, subtropical and tropical waters were analyzed using multivariate statistics in order to assess regional variations in metal contamination. Potential errors were reduced by only analyzing data from surveys that employed the same protocols, analytical methodologies and analysts. Factor analysis demonstrated that mussels inhabiting extremely contaminated areas (e.g. from Japanese and Swedish metallurgy sources) could be separated from mussels from other contaminated areas, and that metals such as Cd, Pb, Cu and Zn could be used to identify heavily contaminated samples while Co, Fe, Cr and Ni concentrations were good markers for exposure to inputs from different industrial sources. Furthermore byssus, like soft tissue, selectively and sensitively reflects variations of certain metal concentrations in ambient waters and thus serves as a reliable biomonitor for these contaminants in a variety of coastal and estuarine areas.

Chronic elevation of parathyroid hormone in mice reduces expression of sclerostin by osteocytes: a novel mechanism for hormonal control of osteoblastogenesis

Both chronic excess of PTH, as in hyperparathyroidism, and intermittent elevation of PTH (by daily injections) increase the number of osteoblasts; albeit, the former is associated with bone catabolism and the later with bone anabolism. Intermittent PTH increases osteoblast number by attenuating osteoblast apoptosis, an effect that requires the transcription factor Runx2. However, chronic elevation of PTH does not affect osteoblast apoptosis because it stimulates the proteasomal degradation of Runx2. Here, we studied the effects of PTH on Sost, a Runx2 target gene expressed in osteocytes (former osteoblasts embedded in the bone matrix), which antagonizes the pro-osteoblastogenic actions of bone morphogenetic proteins and Wnts. We report that continuous infusion of PTH to mice for 4 d decreased Sost mRNA expression in vertebral bone by 80-90%. This effect was accompanied by a comparable reduction of sclerostin, the product of Sost, in osteocytes, as determined by quantitative immunoblot analysis of bone extracts and by immunostaining. In contrast, a single injection of PTH caused a transient 50% reduction in Sost mRNA at 2 h, but four daily injections had no effect on Sost mRNA or sclerostin. PTH strongly decreased Sost expression in osteocytes formed in primary cultures of neonatal murine calvaria cells as well as in osteocytic MLO-A5 cells, demonstrating a direct effect of PTH on this cell type. These results, together with evidence that sclerostin antagonizes bone morphogenetic proteins and Wnts, strongly suggest that suppression of Sost by PTH represents a novel mechanism for hormonal control of osteoblastogenesis mediated by osteocytes.

Tumour T-lymphocyte subset infiltration and tumour recurrence following curative resection for colorectal cancer

AIM

The relationship of tumour T-lymphocytic subset infiltration and recurrence in patients undergoing potentially curative resection for colorectal cancer has not been clearly defined.

METHODS

Tumour sections from patients who had undergone potentially curative resection for colorectal cancer were stained and counted for CD4+ and CD8+ T-lymphocytes.

RESULTS

Twenty-three patients developed recurrence during the follow-up period. Patients were grouped according to whether or not they developed recurrence. The groups were similar in age, sex, site of tumour, Dukes stage and the numbers of patients receiving adjuvant therapy. The total percentage volume of labelled CD4+ T-lymphocytes in the tumour was significantly lower in the patients who recurred (p<0.05).

CONCLUSIONS

The results of the present pilot study suggest that a reduction in tumour T-lymphocyte infiltration, in particular CD4+ T-lymphocyte infiltration, is associated with recurrence in patients following potentially curative resection for colorectal cancer.

Preuve de l'indigénat de Populus alba L. dans le Bassin méditerranéen occidental

Around the western Mediterranean Basin, the ecological status of Populus alba, whether indigenous or introduced, is controversial. This note presents new palaeobotanical data based on analyses of leaf imprints from a travertine formation located in southern France. This travertine presents two levels with Populus alba imprints. The oldest level is dated back by 14C to the Early Holocene, i.e., 8890 +/- 70 BP. This demonstrates that Populus alba is an autochthonous species of the southern-France vegetation, removing speculations reporting that its distribution area was greatly influenced by Roman civilization. Finally, we discuss this new data in regard to other Pleistocene and Holocene deposits circum the Mediterranean Basin and in Europe, where this species was identified.

Endometrial cancer metastasis presenting as a grossly swollen toe

Metastasis to the peripheral skeleton, especially in the face of low stage disease, is rare. This report describes the case of a 77-year-old lady with stage IC disease who underwent curative total abdominal hysterectomy and bilateral salpingo-oopherectomy 2 years prior to presenting with a painless gigantism of her fourth toe. A histologic diagnosis of dedifferentiated endometrial metastasis with sarcomatous differentiation was made following amputation of the toe. Osseous metastasis to bone is discussed in the context of endometrial carcinoma and the literature reviewed. This paper reports the first case of endometrial carcinoma metastasis presenting as gross swelling of a toe.

Antioxidant requirements for bovine oocytes varies during in vitro maturation, fertilization and development

Antioxidants may be beneficial additives to synthetic culture media because these well defined media lack serum or other macromolecules that serve as reactive oxygen species scavengers. In this study, three separate experiments were performed to determine the effects of antioxidants on the development of oocytes to the morula and blastocyst stage when added during in vitro maturation (IVM) of bovine oocytes, during in vitro fertilization (IVF), and during embryo culture for the first 72 h of the development period. Bovine oocytes were matured, fertilized (under 20% O(2)), and embryos were cultured (under 7% O(2)) in defined conditioned medium in vitro with or without supplementation with the antioxidant cysteine, N-acetyl-L-cysteine (NAC), catalase and superoxide dismutase (SOD). Significant improvements in the proportion of oocytes undergoing morula and blastocyst development (33.3% versus 20.3%, P<0.05) were achieved when cysteine (0.6 mM) was added to the maturation medium as compared to control medium without antioxidant supplementation. However, the addition of NAC (0.6mM), catalase (5 or 127 U/ml) or SOD (10 or 1000 U/ml) to the maturation medium did not improve the proportion of oocytes undergoing morula and blastocyst development. During the IVF period, addition of antioxidants (cysteine or NAC 0.6mM, catalase 127U/ml, SOD 100U/ml) significantly reduced the subsequent rate of bovine embryo development to the morula and blastocyst stage (P<0.05). In a defined medium for embryo culture (7% O(2)), the addition of cysteine improved the development of bovine embryos while NAC, catalase and SOD had no positive effect on embryonic development. Our study showed that medium supplementation with cysteine during IVM and in vitro culture (IVC) improved the rate of bovine embryo development, in contrast to extracellular antioxidants like catalase and SOD that caused no improvement.

Invasive pulmonary aspergillosis complicating chronic obstructive pulmonary disease in an immunocompetent patient

Immunocompromised individuals are susceptible to pulmonary aspergillus infection, but invasive aspergillus infection is extremely rare in the presence of normal immunity. We report a case of invasive aspergillosis in an immunocompetent 63-year-old male with chronic obstructive pulmonary disease (COPD). Patients with COPD may be at risk for developing pulmonary aspergillus infection, which should be considered as a diagnostic possibility in patients with unresolving pulmonary infection.