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Cerebrovascular Disorders: Small Vessel Diseases of the Brain
No full textIn this lecture, I will focus on the main types of cerebrovascular disease (CBV) that lead
to vascular cognitive impairment (VCI), which incorporates all causes of vascular
disease. The integrity of the vasculature is essential for the optimal functioning of the
brain. In addition to the cardiovascular system, brain vascular control mechanisms are
vital for the maintenance of the neurovascular milieu, created by nerve terminals,
astrocytic endfeet and the microvasculature. The degree of cerebral grey matter
damage, neuronal death and survival will be dictated by the multiplicity, size and
laterality of the tissue injury or the extent of vascular disease. Anatomical features of
the circulation including the size of vessels and their distribution as well as vascular wall
cellular elements e.g. arterioles versus capillaries are important factors in defining the
pathology and causes of CBV such as large infarcts, haemorrhages, lacunes,
microinfarcts, amyloid and non-amyloid angiopathies, vasculitis, arterial dissection and
aneurysms. The origin and degree of vascular occlusion or injury and whether this
results in ischaemic or haemorrhagic lesions are further factors which define the extent
and severity of damage. Atherothromboembolism attributed to large vessel disease and
subcortical lesions (including the white matter) described by intracranial small vessel
disease (SVD) are considered to be the main causes of cerebral ischaemia. Sporadic
SVDs of the brain account for about 25% of all conditions, which involve transient
ischaemic episodes and strokes. SVD is actually a radiological term but entails tissue
changes affecting arteries, arterioles, capillaries and small veins. It involves lacunar
infarcts and multiple microinfarcts in subcortical structures including the white matter,
basal ganglia, thalamus and the brainstem. Among post-stroke survivors who develop
dementia, particularly vascular dementia (VaD) more than 50% have strong evidence of
SVD. Several inherited forms of SVD have been described in the past decade.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and
leukoencephalopathy (CADASIL) is the most common of these caused by >190 different
mutations in the NOTCH3 gene. It is characterised by lacunar infarcts accompanied by
diffuse white matter changes and severe arteriosclerosis in the general absence of risk
factors for cerebrovascular disease. Recent elucidation of less common hereditary
small vessel diseases include CARASIL, RVCL and COL4-related conditions.
Our work is supported by the Medical Research Council (UK), Alzheimer’s Research
Trust (UK) and Dunhill Medical Trust (UK)
Challenges of Critical Care Medicine in Resource Limited Environment
No full textWHO based epidemiological reports list cardiovascular and cerebrovascular diseases,
cancer, trauma, tuberculosis and other infectious diseases as being mainly responsible
for the major part of the global burden of disease. However, no reliable international
comparative epidemiologic data exist on critical illness syndromes such as acute lung
injury, sepsis syndrome, multiorgan dysfunction or increased intracranial pressure, all of
them being potentially the consequence of these above quoted diseases. Reported data
are unreliable due to several fundamental challenges
Food Microbiology: Food Hygiene & Safety
No full textMicroorganisms are responsible for a wide range of diseases in man in many cases
caused by contaminated water or food. The most important pathogens are Yersinia
enterocolitica, Salmonella, Shigella, Cholera and non-cholera Vibrios and Coliform
bacteria. The lecture will provide information about the relevance of these micro
organisms for food safety. Sources of contamination include water, food, hygienic
circumstances, and person to person contamination. Contaminated water is responsible
for health problems including malaria and dysentery. Water-related diseases are the
leading cause of death in Africa. Foods that are prone to microbiological infection
resulting in food born diseases include milk and milk products, meat and meat products,
maize flour, bread, scones, other wheat products,and vegetables. Examples will be
given in the presentation.
Under-reporting, inadequate investigation of outbreaks and inadequate diagnostic
facilities suggest that there are substantially more food borne disease outbreaks than
those recorded. This is a matter of high economic impact on a country. The lecture will
address ways to improve the situation, how to recognize safe food, what are the
essential conditions for a food control system, aspects of a Policy Framework, important
aspects of a Surveillance Programme and food Safety Information and Communication
aspects will all be discussed during the presentation
How to Plan, Design, and Conduct Epidemiological Studies
No full textThis presentation will describe how to do population-based studies from the first
planning to the final writing of the scientific paper in a neuroepidemiological study. To
perform population based studies requires a lot of planning. Before the study can start,
the researcher needs to decide the research question, and hypothesis being tested. The
next phase is to decide on the population to be studied, how to select participants, and
the methods to be used in the examinations. When this is decided, the researcher has to
calculate a budget and apply for grants. An ethical application also has to be written. If
these details work out, staff has to be hired, and trained. Inter-rater reliability studies
have to be done. Then come the art of contacting and invite participants. During the
study period, quality controls need to be done. There are also a number of things which
can go wrong during the study period. After the study come data entry, data cleaning
and quality controls of data. In a neuroepidemiological study, diagnoses of diseases may
be done based on collected data. Finally, it is time to analyse the data, and write the
scientific pa
Limb-Girdle Muscular Dystrophy (LGMD): Diagnosis in An Arab Country
No full textLimb-girdle Muscular Dystrophies (LGMD) are heterogeneous inherited muscle disorders
characterized by progressive weakness and muscle wasting. They show a wide spectrum of
clinical courses, varying from very mild to severe. It is a genetically heterogeneous group of
diseases with dominant (LGMD1) and recessive (LGMD2) inheritance. To date, at least 31 loci
have been identified. The different subtypes can be distinguished by immunohistochemical
analysis in a muscle biopsy specimen in order to guide and abbreviate the molecular genetic
investigations. There is a geographical difference in their incidence.
LGMD2 are prevalent in Arabic countries because of the high rates of consanguinity. Many
genes were identified in these countries, especially in Maghreb. LGMD type 2C, or δ-
sarcoglycanopathy, is the most frequent in North African populations as a result of the founder
c.525delT mutation in the Sarcoglycan gene. It was firstly described in Tunisia, in 1977, by Ben
Hmida in a large consanguineous Tunisian family with Duchenne like phenotype affecting both
girls and boys. It is characterized by a childhood onset of progressive muscular dystrophy. The
mean age of onset is between 5 and 6 years, and half of these patients lose ambulation by age
12 years. Calf hypertrophy and lumbar lordosis are common. Diagnosis confirmation is based on
muscle biopsy and molecular study. The scarcities of specialized centers and difficulties that can
prevent patients from benefitting from immunohistochemical analysis complicate their
diagnosis, management, and genetic counseling. We therefore propose, in our context, that
screening for c.525delT could be the first test for AR-LGMD, with a good cost/benefit ratio in
public health strategies, until access to immunohistochemical analysis will be generalized. This
might be useful not only for management of patients, genetic counseling, and prenatal diagnosis
in families but also for novel therapeutic approaches and future clinical trials
Podoconiosis
No full textPodoconiosis is a non-infectious geochemical disease that results in swelling of the
lower legs. It is caused by long term exposure of bare feet to red clay soil derived from
volcanic rock. In southern Ethiopia, where much of our research has been conducted,
and north-western Cameroon, it affects 5-8% of the population and is more common
than HIV, TB or malaria. Podoconiosis imposes immense economic burdens (the
estimated cost to Ethiopia's economy is $208 million per year) and severe social stigma.
Very little research on disease aetiology or pathogenesis has been done, yet such
research is needed for rational deployment of limited resources towards prevention,
treatment and ultimately eradication of the disease. There is convincing evidence that an
area of the genome commonly involved in human responses to infectious and
environmental challenges plays a major role in susceptibility to podoconiosis. In this talk
I will discuss the work we have undertaken to identify the genetic variation that
predisposes to podoconiosis and how this work could have impact on the lives of people
affected by the condition. For example, establishing the importance of genetic
susceptibility has justified the use of a family history tool in determining which children
should be offered shoes for prevention of disease, when shoes are a scarce resource
Tuberculosis: basics, burden, impact, challenges, innovations, Integration a Human Rights based perspective to TB Control & the post-2015 Strategy
No full textGovernment commitment, diagnosis through microscopy, standardized and supervised
treatment, uninterrupted drug supply, and regular monitoring, which together constitute
DOTS— a strategy which was developed by the International Union Against
Tuberculosis and Lung Diseases and supported by the & recommended by the WHO as
a tuberculosis control strategy—remains essential for controlling tuberculosis. DOTS
have helped make remarkable progress in global control of the disease over the past
decade. The gain is evident: nearly 21 million patients have been cured of tuberculosis.
However, global statistics suggest that DOTS alone is not sufficient to achieve the 2015
tuberculosis-related Millennium Development Goals (MDG) and the Stop TB Partnership
targets.
Two other 2015 global targets for reductions in disease burden (prevalence and mortality
rates) and two additional indicators fit within the MDG framework. In addition, 2015
targets for the response needed to address the specific challenges of multidrug-resistant
TB (MDR-TB) and the TB/HIV co-epidemic were set within the Global Plan to Stop TB
2011–2015.
Tuberculosis, a disease of poverty, is a measurable indicator of equitable development
Inclusion of TB in the MDGs has contributed to making progress in global TB control
Union/WHO TB strategy has helped cure 51 million patients and save 20 million lives
2015 MDG target of halting and beginning to reverse TB incidence has been achieved.
Compared to 1990, TB mortality has been reduced by 41% and will be halved in 2015
R&D is now finally resulting in new tools and scientific breakthroughs. However, TB
incidence decline is too slow to realize the vision of a TB free world. Every year, still 1.4
million people die of TB and 8.7 million suffer from.
However, TB incidence decline is too slow to realize the vision of a TB free world Every
year, still 1.4 million people die of TB and 8.7 million suffer from it
Ambitious targets and expanded efforts required post-2015 to accelerate progress: Goal:
―Zero TB deaths‖ besides ―TB elimination as a public health problem‖ Target 2025:
―Halve TB mortality and prevalence rates compared with 2015
The Impact of the Advanced Life Support in Obstetrics (ALSO) on Sudan: The Impact of ALSO on our Performance
No full textFirst developed in 1991 under the ownership of the American Academy of Family Physician. ALSO important in Provision of Emergency Obstetric Care. In Feb 2004 the1st ALSO Provider course held at Continuous Professional Development Centre (CPD), University of Khartoum followed by a further 19 courses 9 at CPD - Soba University Hospital, U of K, 3 at CPD – Ministry of Health and 1 each in Dongola, Madani, ElObeid, Kosti, Sennar, Hasahisa & Kassala Then 4 instructors’ courses were held,480 completed the providers’ course.
This is an observational cross-sectional study conducted in Sudan to evaluate the impact of ALSO on the performance of instructors.
Almost all instructors (96%) were committed to continue in their involvement in the ALSO The majority (76%) are using the ALSO pneumonics in their practice Most instructors reported an increase in motivation (64%), confidence (73%) and ability (95%) in tackling obstetrical emergencies. The involvement of the instructors in ALSO improved their knowledge (49%), and markedly improved their skills (73%) andattitude (78%)
Conclusion:The ALSO course should be a mandatory component of the postgraduate training curriculum
Medical education and professionalism in medical practice
No full textProfessionalism is considered to be the zenith of professional training in Medicine encompassing the basic principles that underpins the professional practice of any medical graduate. It encompasses certain professional traits that are essential for clinical practice including: ethics and ethical practice, communication skills, teamwork and interaction, accountability and continuing professional development, it is the basis of the medical profession contract with society. It was central to all major review documents and position papers that influenced change in medical education in the ninetie
Intermittent chemotherapy compared to the daily regimen in Sudanese patients with pulmonary Tuberculosis
No full textStudy objective
A prospective comparative, randomized clinical trial, hospital based study, carried out at Kosti teaching hospital using directly observed treatment short course (DOTS), to evaluate the efficacy of intermittent chemotherapy compared to the currently adopted daily short course therapy.
Methodology
A total of 275 smear positive new cases of Tuberculosis were enrolled and randomized in to two groups 2006-2008, intermittent group (A) and daily short course regimen group (B) . The raw data were introduced into SPSS program, data comparison was carried out by Pearson Chi square and pair independent sample student T-test. The level of significant (P<0.05).
Results
By the end of the fourth, fifth and the sixth month, was no patient with positive sputum in the two groups. By the end of the second month, significant decrease in the means of ESR at 6 month compared to the initial results (P<0.05).
Conclusion
The twice weekly 6 month intermittent is effective as the daily regimen, complete conversion in the two groups occurred after the end of third month. No relapse case detected in the two groups and death rate was comparable in the two regimens