Tubular Reconstruction with Bovine Pericardium Xenografts to Treat Native Aortic Infections.

BACKGROUND: The treatment of aortic infections is complex, and the material of reconstruction remains discussed. Several alternatives were suggested in the literature. The current consensus is the use of biological material. The aim of this study was to evaluate the short-term results of bovine pericardium xenografts. METHODS: Between November 2016 and June 2019, we included consecutively all the patients presenting with native aortic infections in which arterial reconstruction was carried out with tubular bovine pericardium grafts sutured longitudinally. We collected the preoperative, peroperative, and postoperative clinical, radiological, biological, and bacteriological characteristics. The recurrence of infection, the graft failures, and the morbimortality were analyzed. RESULTS: Twelve patients including three women were treated. Their mean age was 68.4 ± 9 years. They presented 2 thoracic, 4 thoracoabdominal, 4 abdominal, and 2 aortoiliac aneurysms. The diagnosis was made using angio-CT in all the cases and was confirmed by positron emission tomography (PET) scan in 7 cases and blood cultures in 9 cases. Peroperative cultures were positive in 11 cases. Antibiotics were given in 9 patients before operation for a median duration of 9 (3-19) days and in all the patients postoperatively for a median duration of 42 (1-540) days. The median follow-up was 355 (98-839) days. Six medical complications occurred, including 2 (16.6%) leading to death in the immediate postoperative period. No reoperation was needed. The PET scan returned positive in 1/10 cases (10%) during the follow-up. The diameter of the grafts was preserved, without any defect observed on the angio-CT. CONCLUSIONS: Short-term results showed a mechanical resistance to infection of the bovine pericardium. This biological material offers a promising alternative with multiple advantages including availability, simplicity of preparation, and adaptability to the various locations of the aortic infection.

Intralesional bleomycin injection vs microneedling-assisted topical bleomycin spraying in treatment of plantar warts.

BACKGROUND: Warts, or verrucae, are benign epithelial profilerations of skin and mucosa caused by infection with HPV and poses a challenge to treat. OBJECTIVE: To compare between single and microneedling-assisted multipuncture techniques of intralesional application in treatment of plantar warts. METHODS: The study included 60 Patients who were divided into two groups (A&B). Each group consisted of (30) patients. Group (A) subjects received intralesional bleomycin with a single injection using syringe needle. For Group (B) subjects, we combined microneedling with topical spraying of bleomycin (MN + Bleo) and followed by occlusion for 2 hours. RESULTS: The results revealed complete clearance of warts in 21 patients in group (A) (70%) whom were treated by intralesional (IL) bleomycin vs 25 patients (83.3%) in group (B) whom were treated by spraying of bleomycin following microneedling. Side effects other than pain, erythema, and transient induration were relatively infrequent, and no nail changes or Raynaud's phenomenon was observed in both groups. CONCLUSION: We established a good safety and efficacy profile for bleomycin in plantar wart treatment and we demonstrated that microneedling followed by bleomycin spraying had a higher clearance and proved less painful as opposed to bleomycin injection.

"Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan.

Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: "shopping around" for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be "hiding," requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.

Preparation, quality control and biodistribution assessment of ¹5³Sm-BPAMD as a novel agent for bone pain palliation therapy.

OBJECTIVE: Various phosphonate ligands labeled with ß(-)-emitting radionuclides have shown good efficacy for bone pain palliation. In this study, a new agent for bone pain palliation has been developed. METHODS: ¹5³Sm-(4-{[(bis(phosphonomethyl))carbamoyl]methyl}-7,10-bis(carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl) acetic acid (¹5³Sm-BPAMD) complex was prepared using BPAMD ligand and ¹5³SmCl3. The effect of various parameters on the labeling yield of ¹5³Sm-BPAMD including ligand concentration, pH, temperature and reaction time were studied. Radiochemical purity of the radiolabeled complex was checked by instant thin layer chromatography (ITLC). Stability studies of the complex in the final preparation and in the presence of human serum were performed up to 48 h. Partition coefficient and hydroxyapatite (HA) binding of the complex were investigated and biodistribution studies (SPECT imaging and scarification) were performed after injection of the complex to Syrian mice up to 48 h post-injection. The biodistribution of the complex was compared with the biodistribution of the ¹5³Sm cation in the same type mice. RESULTS: ¹5³Sm-BPAMD was prepared in high radiochemical purity >98% and specific activity of 267 GBq/mmol at the optimal conditions. The complex demonstrated significant stability at room temperature and in human serum at least for 48 h. HA binding assay demonstrated that at the amount of more than 5 mg, approximately, all radiolabeled complex was bound to HA. At the pH 7.4, LogP o/w was -1.86 ± 0.02. Both SPECT and scarification showed major accumulation of the labeled compound in the bone tissue. CONCLUSION: The results show that ¹5³Sm-BPAMD has interesting characteristics as an agent for bone pain palliation; however, further biological studies in other mammals are still needed.

Puerperal sepsis in a rural hospital in Sudan.

BACKGROUND: Increasingly, women in rural areas in Sudan reported to hospital with puerperal infections. AIMS: This study was design to identify the common pathogens causing puerperal infections and their susceptibility to current antibiotics. SUBJECTS AND METHODS: We prospectively studied 170 women from January, 2011 through January 2012 attended Hussein Mustafa Hospital for Obstetrics and Gynecology at Gadarif State, Sudan. We included patients if they met the criteria proposed by the WHO for definition of maternal sepsis. Blood was collected on existing infection guidelines for clean practice and equipments. RESULTS: Out of the 170 samples, 124 (72.9%) were pathogen-positive samples. Out the 124 positive cases, aerobes were the predominant isolates 77 (62.1 %%) which included Staph.aureus 49 (39.5%), Staph. epidemics 7 (5.6%) and Listeria monocytogenes 21 (16.9%). The anaerobes isolates were Clostridium perfringens 34 (27.4 %) and Entrobactor cloacae 13 (10.5%). Standard biochemical test were for bacterial isolation. Higher rate of infections followed vaginal delivery compared to Cesarean section 121 (97.6%), 3 (2.5%) respectively. All strains of Staph were sensitive to Vancomycin, Gentamicin and Ceftriaxone. C. perfringens were sensitive to Ceftriaxone, Penicillins, Vancomycin and Metronidazole, while E. cloacae were sensitive to Gentamicin and Ceftriaxone. CONCLUSION: Despite the limited resources in the developing countries, treatment based on cultures remains the only solution to reduce maternal morbidity and mortality rates following puerperal infections.

Effect of narrowband ultraviolet B phototherapy on serum folic acid levels in patients with psoriasis.

Narrowband ultraviolet B phototherapy (NB-UVB) is a widely used modality in the treatment of psoriasis and is generally accepted as safe in pregnancy. Previous studies have described photodegradation of serum folate after exposure to UVA radiation but the effect of UVB is not known. We studied the effect of NB-UVB phototherapy on serum folic acid levels in patients with psoriasis and the relationship between changes in serum folate levels and the total cumulative dose of NB-UVB. Included in the study were 30 psoriatic patients between 13 and 55 years of age. Serum folate levels were measured at baseline, and after exposure to 18 and 36 sessions of NB-UVB irradiation. There were significant decreases in mean serum folate levels after NB-UVB exposure. After exposure to 18 and 36 sessions the decreases were 19% and 27%, respectively. After 18 sessions, the mean serum folate level had decreased in 18 patients (60%) from 8.64 ng/ml at baseline to 7.02 ng/ml (mean NB-UVB cumulative dose 40.02 J/cm(2); P = 0.019). After 36 sessions, the mean serum folate levels had decreased in 22 patients (73%) to 6.32 ng/ml (mean NB-UVB cumulative dose 118.16 J/cm(2); P = 0.002). The present study showed that high cumulative NB-UVB doses can induce folate photodegradation and decrease serum folate levels in patients with psoriasis and that this effect is directly related to the total cumulative dose of NB-UVB.