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Background Tumor immune infiltrate has been explored in oral squamous cell carcinoma (OSCC), but studies on simultaneous characterization of multiple immune cell subtypes separately in stromal and intraepithelial tumor compartments are limited. Objectives We aimed to investigate the immune cell infiltrate in OSCC by using immunohistochemistry (IHC) for a panel of inflammatory cells in stromal and epithelial tumor compartments for a better characterization of the tumors. Methods Thirty-six OSCC lesions and nine normal oral mucosa (NOM) samples from patients attending Khartoum Dental Teaching Hospital, Sudan were investigated for presence of tumor infiltrating lymphocytes, tumor-associated macrophages, tumor-associated neutrophils, and PD-L1 positive cells in the inflammatory infiltrate by single and double IHC. Digital quantitative analysis (Aperio Technologies Inc.) was performed separately for stromal and epithelial compartments. Results OSCC cases displayed a higher inflammatory infiltrate in the associated stroma, but not in the epithelial compartment when compared to NOM. The immunosuppressive type of inflammatory infiltrate, that is, T regulatory cells (FoxP3+ cells) was identified to be significantly higher in the epithelial compartment of tumors with advanced clinical state. An immunoscore developed by combining intraepithelial FoxP3+ and CD4+ cells was found significantly higher in lesions from elderly patients, localized at toombak dipping-related sites, poorly differentiated OSCCs, or with loco-regional lymph node spreading. Conclusions Despite heavy immune cell infiltration in tumor-associated stroma, the majority of OSCCs in this cohort displayed a low intraepithelial immune infiltration. An immunoscore based on combined CD4 and FoxP3 intraepithelial expression may serve as an indicator of advanced tumor progression and should be further investigated for its use as potential prognostic biomarker in OSCC. publishedVersion

The clinical efficacy of remote dielectric sensing (ReDS) monitoring is not well known. Digital databases were searched to identify relevant articles. Pooled unadjusted odds ratio (OR) for dichotomous outcomes were calculated using a random-effects model. Findings were reported as a point estimate with its 95% confidence interval (CI). A total of 985 patients across seven studies were included in the meta-analysis. Patients with heart failure monitored with ReDS had significantly lower odds of hospital readmission compared with non-ReDS patients (OR = 0.40; 95% CI 0.29–0.56; z = 5.43 p = 0.000, I2 = 0%). Subgroup analysis based on the duration of follow-up showed a lower odd of readmission within 30 days (OR = 0.36; 95% CI 0.18–0.71; z = 2.93; p = 0.003; I2 5.7%), as well as between 1 and 3 months (OR = 0.42; 95% CI 0.29–0.61; z = 4.54; p = 0.000; I2 = 0.0%). ReDS effect of lower readmissions of HF was observed irrespective of the duration of follow-up (

Hospital-based data in Oman reveal that ischaemic heart disease and cerebrovascular diseases alone account for 30% of hospital deaths in the age group 15 years and above. Very few community-based data are available on the subject, hence a multicentre cardiovascular screening study was undertaken during the pre-Haj medical examination in May 1991, in which 1749 Omanis were screened. Blood pressure levels, body-mass index, serum cholesterol and sugar were recorded and analysed. The results of this study indicate that major risk factors for cardiovascular diseases are prevalent in the community, hence further epidemiological studies should be undertaken, and strategies formulated for the prevention and control of cardiovascular diseases before they emerge as a public health problem in Oman

Introduction: Arab Americans are significantly affected by depression with prevalence as high as 50%. Our study assesses whether unique causes of depression such as stress, acculturation, and heritage identity play a role in the high prevalence of depression in Arab Americans. Methods: We surveyed 142 self-identified Arab Americans using a convenience model. Participants answered questions about their level of perceived stress, everyday discrimination, and acculturative stress. They also answered questions regarding their level of acculturation and heritage identity. Finally, participants answered questions regarding their depressive symptoms. A score of 16+ on the depression scale was used as the cut-off for depression. Results: The prevalence of depression in our sample was 60%. In our logistic regression model adjusted for age, sex, BMI and education, we found that perceived stress (OR = 1.21, 95% CI 1.10, 1.33, p 0.05). Conclusions: Our study shows that perceived stress and acculturative stress increase the odds of depression in Arab Americans and therefore may play a role in the high prevalence of depression in this population. We hope our findings inform clinicians on the important underlying causes that may be causing depression in their Arab American patients.

The knowledge, attitude, and practices (KAP) people hold towards a new disease could play a major role in the way they accept measures put in place to curb its spread as Symptoms of COVID-19 are similar to those of other endemic diseases, especially malaria. A cross-sectional KAP/symptomatology online survey was conducted from August –September 2020 across the six geopolitical regions of Nigeria. Data were entered into Google sheets and analyses performed using SPSS version 20. From the 900 respondents, majority 66% were from the North west while 1.2% were from the North east. By sex and age distribution, 69% were males while females were 31%. Age group 15-25 years were more (32.22%) and the least (11%) among respondents were above 65years. Majority of respondents (57.89%), had not experienced symptoms associated with COVID-19 in the past 3 months before this study, however 96.0% of respondents have heard about COVID19 prior the time of survey. Hyperthemia (high fever) 636(70.67%) was accurately recognized by respondents as the most common symptoms. Other highly mentioned symptoms were dry or chesty cough, shortness of breath, catarrh and cough, difficulty in breathing at night, painful breathing, and weakness or tiredness, with significant differences in the responses recorded for the recognition of COVID-19 symptoms across the geopolitical zones (p=0.00). In terms of preventive measures, 771(85.67%) respondents perceive regular hand washing with soap as the major preventive measure for COVID19 infection. This was followed by the usage of face mask 659(73.22%). Also, 794(88.22%) respondents accurately recognized hyperthemia as the most common overlapping symptom between malaria and COVID-19. Other highly mentioned overlapping symptoms were weakness or tiredness 591(65.67%), loss of appetite 504 (56.00%), loss of taste and smell 388(43.11%), and catarrh and cough 313(34.78%). We conclude that awareness of COVID-19 symptoms is fairly high in the country. Awareness strategies should target those with limited access to information on the disease. Keywords: COVID-19, Knowledge, Symptoms, Preventive measures

BackgroundAzadirachta indica,Khaya senegalensis,Anogeissus leiocarpusandTamarindus indicaare important ethnomedicinal plants used for health mitigation since the history of mankind. They are used discretionarily in folkloric medicine on the premise that they are natural products devoid of synthetic preservatives. However, nature endows plants with metabolites for warding off potential attacks from animals and the environment. Some of these metabolites are responsible for toxicity of some plants. Furthermore, drug-induced liver injuries and nephrotoxicity are the leading causes of pharmaceutical attrition of promising drug candidates in clinical trials. Thus, we aimed to evaluate the safety of four ethnomedicinal plants in short-, medium- and long-term usage.MethodsRats dosed once with 5000 mg/kg extracts of each of these plants served as acute study (AS) while rats dosed daily with 2000 mg/kg for 2, 12 and 14 weeks served as sub-acute (SAS), sub-chronic (SCS) and chronic (CS) studies, respectively. Rats administered distilled water served as the negative control (NC).ResultsA. leiocarpusandT. indicasignificantly reduced percentage weight gain in the SCS compared to the NC.A. leiocarpussignificantly (PK. senegalensissignificantly (PPA. indica and T. indicasignificantly (PA. leiocarpusandK. senegalensissignificantly (P+and K+were significantly higher in the SCS and CS studies compared to the NC. The histological lesions seen ranged from cellular degeneration, congestion, fibrosis to necrosis.ConclusionThus, nonlethal, reversible toxic insults occur in short-term usage (AS); while, insidious lethal toxic effects occur in medium-term (SAS) and long-term usage (SCS and CS). The ability of these plant to maintain adequate hematological parameters, bodyweight and absence of mortality may explain free usage of preparations made from these plants in folkloric medicine.

The promotion of enhanced gas recovery (EGR) and CO2 storage is still shrouded in contention and is not well accepted, due to the excessive in situ CO2 mixing with the nascent natural gas. This adulterates the recovered CH4 and thus results in a high sweetening process cost thereby making the technique impractical. This has not only limited the field application of EGR in actual projects to a few trails but renders it uneconomical. This study aims to present, experimentally, alternating N2 injection as a potential technique for EGR and CO2 storage in sandstone rock cores. A laboratory core flooding experiment was carried out to simulate a detailed process of unsteady-state methane (CH4) displacement using Bandera grey core plug. This was carried out at 40 °C, 1500 psig, and 0.4 ml/min injection rate by alternative injection of N2 and CO2 in succession designed to suit the application based on optimum operating conditions. The results show that both CO2 storage capacity and CH4 recovery improved significantly when gas alternating gas (GAG) injection was considered. The best results were observed at lower N2 cushion volumes (1 and 2 PV). Therefore, the GAG injection method with N2 as cushion gas can potentially increase both CO2 storage and CH4 recovery of the gas reservoir. This technique if employed will assert the current position and provide vital information for further researches aimed at promoting environmental sustainability and economic viability of the EGR and CO2 sequestration processes.

OBJECTIVES: To present a new method to assess the cervical lymph nodes status in head and neck cancer patients. METHODS: Twenty-five oral and maxillofacial cancer patients underwent preoperative CT imaging. The cervical lymph node features on CT scan were examined. Each parameter was given a score, and the total scores in each case was calculated and referred to as metastatic score (MS). Then, patients underwent neck dissection, and all dissected lymph nodes were sent for histopathology. RESULTS: All cases with MS ≥ 6 were histopathologically positive, and all cases with MS ≤ 3 were histopathologically negative. All cases of nodal sizes > 3 cm were histopathologically positive, 82% of cases of nodal sizes between 2.1 and 3 cm were histopathologically positive, 40% of cases of nodal sizes between 1 and 2 cm were histopathologically positive, and all cases of lymph nodes sizes

Objectives To analyse the clinical and histopathological features of oral leukoplakia (OL) in the Sudan, and to identify the risk factors associated with dysplastic and malignant changes. Methods Records of 117 cases with the diagnosis of OL at the Department of Oral Pathology in the period from 2010 to 2017 were reviewed. Results Of the 117 cases included in this study, 30 cases (25.6%) showed carcinoma in the initial diagnostic biopsy. The mean age at diagnosis was 59.8 years with a male/female ratio of 3.3:1. The lip (48.7%) and the gingiva (31.6%) were the predominantly affected sites. Multivariate regression analysis revealed that females were associated with 3.36-fold [95% confidence interval (CI), 1.36-10.76; P = 0.012] higher risk of malignant transformation compared with males. Verrucous leukoplakia was associated with 3.38-fold (95% CI, 1.12-10.19; P = 0.031) higher risk of malignant transformation compared with homogeneous leukoplakia. Exclusive Toombak dipping was the significant risk factor for the presence of dysplasia in OL (odds ratio, 9.35; 95% CI, 1.28-67.99; P = 0.027). Conclusions Clinical and histopathological features of OL were analysed and correlated. Toombak dipping was the significant risk factor for dysplastic changes, while female gender and verrucous leukoplakia were the factors associated with malignant transformation.

Introduction Sigmoid volvulus in pregnancy is a rare cause of intestinal obstruction with high maternal and fetal morbidity and mortality if not diagnosed and managed early. Case presentation A 29-year-old female (Chagga by tribe) presented with clinical features of intestinal obstruction 24 weeks into her second pregnancy. She had symptoms for one week. An emergency laparotomy was performed whereby gangrenous sigmoid volvulus was found; thus, it was resected and Hartmann’s colostomy was raised. Unfortunately, she experienced intrauterine fetal death post-operatively. She was discharged clinically stable. Conclusion Early diagnosis and management can prevent adverse effects such as bowel ischemia and preterm labor. Because classic clinical and radiological features may not be evident, high degree of suspicion is warranted.

Intussusception is a common pediatric emergency, although a prolapsed intussusception is a rare entity, often misdiagnosed as a rectal prolapse. We report a 10-month-old female baby who presented with a three week history of a mass protruding per anus and vomiting, and a 2 week history of bloody diarrhoea. A clinical diagnosis of a prolapsed intussusception was made and no imaging studies were ordered to avoid a delay in management. The patient underwent an emergency laparotomy, where a dual reduction was done and the bowels were found to be ischemic hence a right hemicolectomy was performed with end-to-end ileo-transverse anastomosis. Unfortunately, 2 weeks post laparotomy, the patient presented with a high output enterocutaneous fistula. Another emergency laparotomy was performed, with findings of intestinal adhesions and an anastomotic leak. Adhesiolysis was done along with re-freshening of the ileo-transverse anastomosis. Intussusceptions presenting in the form of a prolapse through the anus is a rare condition indicating a serious sign and is often mistaken for a rectal prolapse. A digital rectal examination can help differentiate the two from each other. Surgery is the mainstay treatment for a prolapse intussusception, and should not be delayed.

Introduction The relative safety and efficacy of polymer-free (PF) versus polymer-coated (PC) drug-eluting stents (DES) in patients with angina or acute coronary syndrome (ACS) undergoing percutaneous coronary intervention has received limited study. Method Digital databases were queried to identify relevant studies. Major adverse cardiovascular events (MACE) and secondary outcomes were compared using a random effect model to calculate unadjusted odds ratios (OR). Results A total of 28 studies consisting of 23,198 patients were included in the final analysis. On pooled analysis, there was no significant difference in the odds of MACE (OR 0.98, 95% CI 0.91-1.08) and major bleeding (OR 0.87, 95% CI 0.61-1.24) between patients undergoing PF-DES versus PC-DES. Similarly, the odds of myocardial infarction, stroke, stent thrombosis, cardiovascular mortality and need for target vessel revascularization was similar between the two groups. PF-DES was favored due to significantly lower odds of non-cardiac death (OR 0.78, 95% CI 0.68-89) and all-cause mortality (OR 0.87, 95% CI 0.80-0.95), but had a higher need for target lesion revascularization (OR 1.2, 95% CI 1.02-1.42). A subgroup analysis based on follow up duration, clinical presentation, presence of diabetes and class of eluting drugs mirrored the net estimates for all outcomes with a few exceptions. A sensitivity and meta-regression analysis showed no influence of single-study and duration of antiplatelet therapy on pooled outcomes. Conclusion In patients presenting with angina or ACS, PF-DES might be favored due to lower all-cause mortality and equal risk of ischemic adverse cardiovascular and major bleeding events compared with PC-DES.

In this work we present a fast and label-free technique for biomolecules detection. The approach has been proved to be powerful to investigate small DNA mutation. Surface enhanced Raman spectroscopy (SERS) is an outstanding technique for DNA analyses by providing a specific fingerprint of chemical structure with a high sensitivity in a very short acquisition time. Homogeneous decoration of Silicon nanowires (SiNWs) by silver nanoparticles (Ag-NPs) was carried out using pulsed laser deposition (PLD) technique. SiNWs have been synthesized via metal-assisted chemical etching (MACE) method. We investigate in this work the effect of the Ag-NPs nanodecoration conditions through the variation of the laser ablation pulses number (NLAP). Thus, the Ag-NPs decorated SiNWs were used as sensors to detect organic and biomolecules by means of Surface Enhanced Raman Spectroscopy (SERS). By varying the NLAP, we were able to identify the optimal combination of Ag-NPs' size and surface coverage that yields the highest SERS signal. SEM images revealed well-ordered SiNWs (~2.4 μm-long and 30–60 nm diam.) with their uniform decoration by Ag-NP. High resolution-TEM analyses confirmed the effective decoration of the SiNWs by Ag-NPs of which average size is found to increase linearly from ~20 to 50 nm when the NLAP is increased from 500 to 10,000. The Ag-NPs/SiNWs matrix shows significantly higher (150 fold) Raman signal compared to their Ag-NPs-decorated-flat‑silicon counterparts. We found that SERS efficiency is sensitive to the nanoparticles size and reaches its maximum of (1.6 × 106) for the Ag-NPs having the optimal diameter of ~40 nm (obtained at NLP = 5000). The developed sensor proved to be highly sensitive to detect upto pico-molar concentrations of R6G. These Ag-NPs/SiNWs probes were demonstrated to have outstanding potential for label free detection of DNA samples with high sensitivity and reproducibility. It was found that the developed nanohybrid sensor is able to differentiate DNAs with very small genetic sequence difference.

Acute acalculous cholecystitis remains an elusive clinical diagnosis possibly due to complex clinical setting in which this entity develops, lack of large prospective controlled trials that evaluate various diagnostic modalities, thus dependence on a small database for clinical decision making. Concealed gallbladder perforation is rare. Herein, we report an 82-year-old female who presented with a right upper quadrant pain and features of local peritonitis. Abdominal ultrasound was suggestive of cholecystitis while computed tomography (CT) scan reported a perforated gallbladder with pericholecystic fluid collection. The patient underwent successful cholecystectomy; and intra-operatively, similar findings as those reported on imaging were seen. Unfortunately, she succumbed shortly post-operatively due to pulmonary embolism. Our report highlights the importance CT scan in patients with vague abdominal symptoms followed by sudden resolution. It also reminds the importance of considering the diagnosis of concealed gallbladder perforation as a differential in patients with peritonitis, as it may be missed by routine radiological investigations.

Visine eye drops are a commonly used topical drug for irritation of the eye. The active component in Visine eye drops is tetrahydrozoline. Tetrahydrozoline is an imidazoline derivative found in several ophthalmic and nasal decongestants. Exposure is common in young children, who unintentionally ingest it, but cases have been rising in the adult population. The main systemic effects are bradycardia and hypotension due to activation of the central alpha-adrenergic receptors. In this case report, a 76-year-old man presents with bradycardia after 24 hours following ingestion of 120 mL of 0.05% tetrahydrozoline (eight bottles of Visine eye drops) in a suicide attempt. His initial ECG demonstrated complete heart block and QT prolongation. Subsequent ECGs showed unremitting first-degree atrioventricular block and QT prolongation. Here, we are presenting the first case of complete heart block following tetrahydrozoline consumption.

Surgeons in resource-limited settings have adapted to overcome the challenges of the limitations of resources using different available methods and inventions from the local environment. We report four cases of oesophageal cancer palliatively treated with improvised gastrostomy feeding tubes by using 24Fr urinary catheters, to optimize their nutritional status to withstand chemotherapy/radiotherapy. Two patients managed to begin chemo and radiotherapy, but only one out of the four survived. The aim of this report is to appraise the methods used by surgeons to overcome the challenges they face in clinical practice.

Introduction The safety of renin–angiotensin–aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic. Methods Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR). Results A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99–1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93–0.99; p 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97–1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes. Conclusions COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-021-00462-w.

Background: Oral squamous cell carcinoma (OSCC) is increasing at an alarming rate particularly in low-income countries. This urges for research into noninvasive, user-friendly diagnostic tools that can be used in limited-resource settings. This study aims to test and validate the feasibility of e-nose technology for detecting OSCC in the limited-resource settings of the Sudanese population. Methods: Two e-nose devices (Aeonose™, eNose Company, Zutphen, The Netherlands) were used to collect breath samples from OSCC (n = 49) and control (n = 35) patients. Patients were divided into a training group for building an artificial neural network (ANN) model and a blinded control group for model validation. The Statistical Package for the Social Sciences (SPSS) software was used for the analysis of baseline characteristics and regression. Aethena proprietary software was used for data analysis using artificial neural networks based on patterns of volatile organic compounds. Results: A diagnostic accuracy of 81% was observed, with 88% sensitivity and 71% specificity. Conclusions: This study demonstrates that e-nose is an efficient tool for OSCC detection in limited-resource settings, where it offers a valuable cost-effective strategy to tackle the burden posed by OSCC. publishedVersion

Introduction: Isolated native coarctation of the aorta (CoA) affects 1 in every 1800 infants born in the United States each year. Currently there are three primary treatment options: balloon angioplasty (BA), stent, and surgical repair. Since the approval of stent therapy for CoA in the 1990s, there has been a debate on which of the three treatment modalities is superior. Data has often been limited due to the lack of short and intermediate follow-up. The purpose of our study is …

ObjectivesAutoimmune bullous diseases vary in their clinico-epidemiological features and burden across populations. Data about these diseases was lacking in Sudan. We aimed to describe the epidemiological profile and to estimate the burden of autoimmune bullous diseases in Sudan.MethodsThis was a retrospective cross-sectional study conducted at Khartoum Dermatological and Venereal Diseases Teaching Hospital. We used routinely collected health care data, and included all patients with an autoimmune bullous disease who presented to the hospital between 2001 and 2016.ResultsOut of the 4736 patients who were admitted to the hospital during the study period, 923 (19.5%) had an autoimmune bullous disease. The average rate of patients at the hospital was 57.7 per year representing 1.3 per 100,000 population per year. After exclusion of patients where the final diagnosis was missing, 585 were included in the further analysis. Pemphigus vulgaris was the most common disease (50.9%), followed by bullous pemphigoid (28.2%), linear IgA disease/chronic bullous disease of childhood (8.4%), and pemphigus foliaceous (8.2%). Pemphigoid gestationis and IgA pemphigus constituted 1.4% and 1.2% of the cohort, respectively. Paraneoplastic pemphigus, mucous membrane pemphigoid, lichen planus pemphigoidis, bullous systemic lupus erythematosus, and dermatitis herpetiformis were rare. None of the patients had epidermolysis bullosa acquisita.ConclusionsThe clinico-epidemiological characteristics vary among the types of autoimmune bullous diseases. Females were more predominant in most of them. Sudanese patients tended in general to present at a younger age than other populations. The pool of Sudanese patients with autoimmune bullous diseases is large which requires investigation for the local risk factors and presents a field for future trials.

This paper presents the development of an artificial neural network (ANN) Gas Path Diagnostics (GPD) technique applied to pipeline compression system for fault detection and quantification. The work detailed the various degradation mechanisms and the effect of such degradations on the performance of natural gas compressors. The data used in demonstrating the ANN diagnostics is so derived using an advanced thermodynamic performance simulation model of integrated pipeline and compressor systems, which has embedded empirical compressor map data and pipeline resistance model. Implantation of faults within the model is in such a way to account for faults degradations caused by fouling, erosion and corrosion, of various degrees of severities, to obtain wide range of corresponding simulated “true” measurements. In order to account for uncertainties normally encountered in field measurements, Gaussian noise distribution was combined with simulated true measurements, which depends on the instrument’s tolerances. Furthermore, since judicious measurements selection are crucial in ensuring flawless GPD predictions, a sensitivity and correlation analysis of the available measurements revealed that discharge temperature, rotational speed and torque are the most effective measurements for the diagnostics with acceptable degrees of accuracies. The measurements observability technique is a novel approach in pipeline compressor diagnostics. Analytical case studies of the developed method show that, a selected ANN architecture can detect and quantify faults related to degradation in efficiency and flow capacities in the presence of instrument error, varied operational and environmental conditions.

Background. Improving patient satisfaction and quality of life is of great importance when considering the different prosthetic treatment options for patients with severely resorbed residual alveolar ridges. We aimed to evaluate and compare patients’ satisfaction when changing from fixed, removable, and/or conventional implant prostheses to basal implant-supported prostheses. Methods. Sixty patients with a history of fixed, removable, and/or conventional implant prostheses who received basal implant-supported prostheses (BCS®, IHDE Implant System) were included in this study. Direct interviews were conducted using a four-section questionnaire that covered sociodemographic data, clinical examination, information on previous prostheses, and new implant information. The obtained data were statistically analysed using a Wilcoxon signed-rank test and chi-squared test. Results. Patients were predominantly female, partially edentulous, and aged between 40 and 59 years. Patients’ general satisfaction with basal implants was very high (7.7 out of 8). Patients’ satisfaction with comfort, mastication, speech, and aesthetics significantly improved with the new basal implants. Males aged between 40 and 59 years and patients who had previously used both fixed and removable prostheses were generally the most satisfied. Although some patients had complaints, they still had high satisfaction and would choose the same treatment modality again. Conclusions. Basal implant-supported prostheses have a positive impact on oral health and highly increase patients’ satisfaction.

1. Ahmad M. Suleiman, MD* 2. Sangeeta Krishna, MD* 3. Benjamin Katholi, MD* 4. Kate Eshleman, PsychD* 1. *Pediatric Institute, Cleveland Clinic Children’s Hospital, Cleveland, OH This month, many people use Valentine’s Day as an opportunity to celebrate loving relationships. As seen in some of this month’s Index of Suspicion cases, though, sometimes health problems result from imperfect relationships. As pediatricians, we have the privilege of working for the best possible outcomes for children and their families. Philip R. Fischer, MD Associate Editor, Index of Suspicion A 12-year-old previously healthy girl is admitted to the hospital from an orthopedic surgeon’s office due to concern for osteomyelitis 2 weeks after an injury while playing soccer. She began having foot pain and erythema after her foot was stepped on during a soccer match. A radiograph of the foot taken on the day of injury was negative for fracture. During the 10-day period after the injury, she describes decreased ability to bear weight and progression of erythema and tenderness over her dorsomedial right foot. She and her mother also report consistent fevers at home, with the highest recorded at 103°F (39.4°C). A sports medicine physician saw her on the tenth day after her injury. The complete blood cell count and C-reactive protein level at his office were normal. She was started on clindamycin for a presumptive diagnosis of cellulitis, and she was referred to orthopedics for further evaluation. She was seen by orthopedics 2 days later and was sent for admission to the hospital due to worsening erythema and inability to bear weight. She had taken 4 doses of clindamycin by the time of admission with no apparent improvement in symptoms. Her mother has pictures showing the progression of erythema along the foot …

This study aims to experimentally investigate the potential of solubility trapping mechanism in increasing CO2 storage during EGR by CO2 injection and sequestration in conventional natural gas reservoirs. A laboratory core flooding process was carried out to simulate EGR on a sandstone core at 0, 5, 10 wt% NaCl formation water salinity at 1300 psig, 50 °C and 0.3 ml/min injection rate. The results show that CO2 storage capacity was improved significantly when solubility trapping was considered. Lower connate water salinities (0 and 5 wt%) showed higher CO2 solubility from IFT measurements. With 10% connate water salinity, the highest accumulation of the CO2 in the reservoir was realised with about 63% of the total CO2 injected stored; an indication of improved storage capacity. Therefore, solubility trapping can potentially increase the CO2 storage capacity of the gas reservoir by serving as a secondary trapping mechanism in addition to the primary structural and stratigraphic trapping and improving CH4 recovery.

Background: Instrumental vaginal deliveries are witnessing a steady decline despite its usefulness in improving obstetric outcomes in resource‑limited settings. This decline in instrumental deliveries is enhanced by dearth of information on good outcomes thereby making its use unpopular among younger generations of obstetricians. The study was aimed at determining the rate of instrumental deliveries and associated outcomes in Jos University Teaching Hospital (JUTH). Materials and Methods: This study was a 10‑year retrospective hospital‑based study carried out between January 2007 and December 2016 in JUTH which compared the use of vacuum extractors and forceps to effect vaginal deliveries and the delivery outcomes encountered following such deliveries. Results: Of the 16,614 deliveries during the study period, 71 were instrumental vaginal deliveries with an incidence of 0.4% for the study period. Vacuum accounted for 97.2% of the deliveries and forceps 2.8%. Prolonged second stage was the indication for instrumental delivery in 85.9% of parturients and there were no significant differences in Apgar scores between babies that had instrumental deliveries and those that did not. Age and parity were not significantly associated with instrumental deliveries. The instrumental delivery rates were, however, significantly lower than earlier reports from this center, and that globally recommended. Conclusion: Instrumental vaginal deliveries are fast declining in JUTH and the few instrumental deliveries carried out showed a faster decline in forceps deliveries. Efforts have to be made to revive the art of instrumental vaginal delivery in the center to save it from extinction. Keywords: Complications; forceps; instrumental vaginal delivery; North Central Nigeria; outcomes; trends; vacuum delivery

River Chanchaga is the major source of drinking water in Minna, Nigeria. This river has been a medium to an increasing pollution loads from contaminated runoff from different land uses degrading aquatic ecosystem and water quality in the river.This paper investigates the threat of anthropogenic influence on river environment and aquatic ecosystem distortion of River Chanchaga, Minna, Nigeria. Field work which include interview and observation methods were used to collect data on effect of anthropogenic and eutrophication along the study area. A total of Two Hundred and Fifty (250) people accounting for 0.5% of the total population were interviewed, making it eight per each community in thirty settlements along the study area. Physical observation of deforestation around sample sites spatially distributed along River Chanchaga depicted in Figure 2 was carried out to study mining activities, farming practice, crop types, and fallow duration to generate the mean and percentages of different anthropogenic activities along the study area. The findings revealed that deforestation is links to high demand for fire wood, lumbering, irrigation farming bank-side mining for sand and gold as depicted in Plat 1 and 2. Eutrophication at the upper course of river is links to high inflow of agricultural wastes and seasonal nature of the river from site A to C evident from Table 4 and constant flow from site C to K as a result of released water from Tagwai Dam that keeps (site C, the confluence of River Chanchaga and River Numui) middle and lower courses of River Chanchaga with sustainable moving water. The result further indicated that continue increase of pollution has a direct relationship to an increasing level of human activities like deforestation, mining activities and agricultural practices along the study area. The result also shows that there is decline in fallow duration as indicated in Table 1 and increase environmental related issues such as soil erosion, water floor (depth) reduction and distortion of river morphology of the study area. It is therefore recommended that the identified anthropogenic activities that lead to pollution and eutrophication such as river-side deforestation, irrigation farming, mining and other related environmental problems should be regulated and discourages to avoid further increase of pollution and distortion of river environment of the study area.

Leishmaniasis in Yemen is still not fully investigated nor well studied. Recently, outbreaks of cutaneous leishmaniasis (CL) in western highland were declared. However, there are no reports concerning the disease and the circulating species in the region. The aim of this study was to determine the prevalence of cutaneous leishmaniasis in Utmah district located in Western Highlands in Yemen. A cross-sectional survey was carried out at those highlands. For the survey, 1165 participants were subjected to Leishmanin Skin Test (LST) accompanied with direct interviews and physical examination. The overall prevalence of cutaneous leishmaniasis in the district was 18.5% and the cutaneous leishmaniasis (CL) was more frequent in the escarpments with a prevalence of 37%, including 5.5% for active lesion and 31.5% for scar of healed lesions. Children under the age of 16 years old comprised most of the CL cases (76.3%). The escarpments of western highlands in Yemen were hyperendemic areas for CL and the infection was more prevalent in children.

Highlights • Choledochal cyst is a rare malformation of the common bile duct causing jaundice in the pediatric group. • Diagnosis can easily be made using abdominal ultrasonography, hence a high degree of suspicion is needed among clinicians. • Surgery, open or laparoscopic, remains the core management depending upon the availability of the resources and expertise., Introduction Choledochal cyst is a rare common bile duct malformation that usually presents in the pediatric group with abdominal pain, distension, and jaundice. The pathophysiology remains unclear for the cause, and surgery aims to restore biliary enteric drainage. Case presentation We present a six-year-old female who presented with gradual abdominal distention associated with jaundice. Abdominal ultrasound was suggestive of choledochal cyst, and CT-scan confirmed the diagnosis. She was operated on successfully and fared well. Conclusion Choledochal cysts are a rare entity of common bile duct malformations and should be considered as a differential diagnosis in the pediatric age group. Diagnosis can be easily made by non-invasive and in-expensive radiologic modalities like ultrasonography in resource-limited settings.

The choice of the flow velocity in EGR thus becomes important since higher injection rates could lead to premature mixing of the fluids and lower injection rates generally provide longer resident times for the fluids in contact and indirectly increases the mixing of the gases. Additionally, the medium peclet numbers mostly indicate the best injection rates that translate to a smoother displacement with a lower dispersion coefficient during the EGR process. Therefore, N2 Injection into natural gas reservoirs offers the potential to higher recovery efficiency with less mixing compared to conventional CO2 injection. The atmospheric air contained 79% of N2, making it readily available than CO2 with 400 ppm air composition. More so, N2 requires less compression ratio, which is why a lower amount of it was required to initiate much pressure in the CH4 reservoir during displacement. These made the use of N2 more economically feasible and friendly for the EGR process. A laboratory core flooding experiment was carried out to simulate the effect of injection velocity on CH4 recovery and dispersion coefficient. This was done at 40 ◦C, 1500 psig, and 0.2–1.0 ml/min injection rates. The results showed that a medium peclet number could be used to predict the best injection rate that translates to a smoother displacement with a lower dispersion coefficient during the EGR process. CH4 recovery and efficiency were highest at lower injection velocities experienced in both core samples. This could be attributed to insignificance nascent mixing observed as seen on their recorded low longitudinal dispersion coefficient results. Consequence, the experimental runs at high injection rates (0.6–1.0 ml/min) present a different scenario with lower recovery and efficiency due to their high interstitial velocities as the N2 plumes transverses into the core sample during CH4 displacement. Overall, the least methane production and efficiency were noticed in the Bandera core sample as a result of the heterogeneity effect due to the presence of higher clay contents in Bandera than Berea gray. When the capillary forces within the narrower pores in Bandera core sample were overcome, the clay particles occupied those pores thereby sealing some of the flow paths within the pore matrix. This reduces the flow channels, significantly, through which the injected N2 will flow to displace the residual CH4.

Objective: The aim of this study was to evaluate preoperative anemia in patients undergoing oral and maxillofacial surgery under general anesthesia. Material and methods: A prospective cross sectional hospital-based study was carried at Khartoum Teaching Dental Hospital. Five hundred and twenty three patients were included in the study, 324were males and 199 were females. Patients’ age was ranging from 6 months to 84 years. Children formed 34.6% of the patients. Cleft lip and palate constituted the largest number of the patients (173). There were 70 oral cancer patients, 126 trauma patients and 154 patients with benign lesions. Anemia was defined according to the WHO criteria as hemoglobin concentration (Hb) less than 13 g/dl for males, less than 12 g/dl for females while Children were diagnosed based on their age. Variables related to hemoglobin level, age, gender and related diseases were analyzed. Test of significance (P< 0.05) was applied using SPSS version 20. Results: Preoperative investigations revealed a high prevalence of anemia in patients constituting 48.2% for men, 45% for females and 47% for children. Severe anemia was found in 4.5% of children and 1.4% of males. The mean hemoglobin level for males was 12.8 ± 2.1 g/dl, for females was 12.1± 4 . 1 and for children was11.4±1.6. One way analysis of variance revealed a significant difference in the mean of hemoglobin between patients with different diseases (P-value=0.001). Conclusion: The findings of this study indicated that anemia is a common finding among patients undergoing oral and maxillofacial surgery and most of the time it was discovered during the preoperative investigation for surgery preparation.

Background: The gene order for the Rubella virus (RV)40S RNA is 5' -p150-p90-C-E2-E1-3' and the complete nucleotide sequence of RV has been determined for three strains. The RV core is surrounded by a host-derived lipid bilayer containing 5-6nm long spikes composed of the E2 and E1 glycoproteins Objective(s): Molecular detection of Rubella virus glycoprotein after serum screening of 240 women attending Federal Medical Centre Lokoja (FMC) via IgG and IgM ELISA. Method: Cross-sectional study was carried out in Obstetrics and Gynecology clinic at FMC Lokoja. Serology for anti RV-IgG and IgM was done for 240 blood samples after serum separation. Polymerase Chain Reaction (PCR) was done for rubella cDNA via RUB 2 & 7 and RUB 8 & 11 specific primers and this was sequenced using dye terminator cycle sequencing. Result: 231(96.25%) of 240 and 4(1.7%) of 231 subjects were positive to Rubella IgG and IgM respectively after assay. PCR band result had 320bp on 1kb DNA plus ladder of 0.9μg/lane and live blast of the 320 length sequence result revealed a Rubella membrane glycoprotein E1 (Rubella_E1). All subjects that had blood transfusion were positive to Rub-IgG (p=0.566) while 3(1.6%) of 168(88.9%) respondents with no blood transfusion were IgM positive (P= 0.537). 61(32.6%) of 67(35.8%) respondent who reported history of rash were positive to Rub-IgG (p=0.057) and of 30(22.7%) that has had a miscarriage, 29(22.0%) was positive to Rub-IgG (p=0.731) Conclusion: Rubella virus membrane glycoprotein E1, an important structural type 1 membrane protein in the entire pathogenesis of rubella virus has been confirmed in this locality.

The aim of the study – to investigate the effectiveness of innovative teaching methods implementing to train qualified pharmacy professionals. The main body. For conducting the study the modern information and communication technologies were used, namely: Internet sites, blog technology, audio and video resources, Skype program, multimedia presentations, trainings, role plays and computer-based testing. The use of innovative educational technologies in the National University of Pharmacy provides great opportunities to improve the learning process effectiveness. Information and multimedia educational programs facilitate not only high-quality digestion of theoretical material, but also computers skills improving. Innovations in the content of education should be supplemented and implemented through the mastery of innovative methods. One of the methods, which is appropriate to be used within future pharmacists training is case-method. Using this method in the form of a case-by-case, case exercise and case situation during Clinical Pharmacology, Pharmacognosy, Pharmaceutical Chemistry and Pharmaceutical and Industrial Drugs Technology classes during autumn semester of 2016 led to the increase of indicators of qualitative students’ achievement of average statistical group by 20-25%. Conclusion. The use of innovative teaching methods in the educational process carries a great potential, because it accelerates the mastery of knowledge and makes this process interesting and dynamic. The use of interactive method (case method) as to core subjects showed improving of qualitative students’ achievement compared to using traditional methods.

Entrepreneurs all over seek ways of introducing their products to international markets, but international business environments pose a lot of opportunities and threats to foreign entrants. The cultural, political and technological environment has a lot to do in entrepreneurial success in global markets. The study examined the effect of social media on international business venturing. The general objective of the study is to critically determine the extent to which social media have contributed to the international venturing of entrepreneurs in Nigeria. The study concludes that since technological products provide ample benefits for international entrepreneurs, organizations should endeavour to provide indispensable technologies that support international transactions.

Oral verrucous carcinoma is a clinico-pathological variant of OSCC. The most frequent affected sites intraoral are the mucosa of the buccal area and alveolus, also the gingiva. It’s a locally aggressive tumor. Generally it is related to tobacco use specially the chewed and snuffed types, hence it named “snuff dipper's cancer’’, the recurrence is high due to the dysplastic cells around the tumor. This is a case of Sudanese male diagnosed with verrucous carcinoma in the Oral and Maxillofacial Clinic.

Suckling time to aid gland evacuation of oxytocin and ethyl acetate fraction of Hibiscus sabdariffa l. seed was evaluated in lactating rats. The 12 lactating rats were allocated at random to 2 treatment groups to determine the rate of suckling with the aid of oxytocin and ethyl acetate fraction H i b i s c u s s a b d a r i f f a l . The 2 treatments were 6 different suckling times of 3-96 minutes arranged in geometric progression. Each of the suckling time in the 2 treatments was applied with the aid of subcutaneous injection of 0.1 iu oxytocin immediately prior to suckling and 50mg/kg ethyl acetate fraction Hibiscus sabdariffa l. respectively. Treatments were carried out on days 3, 6, 9, 12, 15 and 18 of lactation. The amount of milk sucked by the litters in the various suckling times showed that, the oxytocin enabled the pups to remove the milk more rapidly than the ethyl acetate fraction of Hibiscus sabdariffa l. Oxytocin a lactogenic hormone causes myoepithelial contraction for milk letdown through ejection reflex during lactation, while ethyl acetate fraction of Hibiscus sabdariffa l. has a relaxing effect.