Faculty of Medicine and Surgery
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Item Effect of Gum Arabic (Acacia Senegal) supplementation on visceral adiposity index (VAI) and blood pressure in patients with type 2 diabetes mellitus as indicators of cardiovascular disease (CVD): a randomized and placebo-controlled clinical trial(Lipids in Health and Disease, 2018) Babiker, Rasha; Elmusharaf, Khalifa; Keogh, Michael B.; Saeed, Amal M.Background: There is a strong association between cardiometabolic risk and adipose tissue dysfunction with great consequences on type 2 diabetic patients. Visceral Adiposity Index (VAI) is an indirect clinical marker of adipose tissue dysfunction. Gum Arabic (GA) is a safe dietary fiber, an exudate of Acacia Senegal. Gum Arabic had shown lipid lowering effect in both humans and animals. The aim of this trial was to determine the effect of GA supplementation on anthropometric obesity marker, Visceral Adiposity Index (VAI) and blood pressure in patients with type 2 diabetes mellitus. Methods: This randomized, double blinded, placebo controlled trial recruited a total of 91 type 2 diabetic patients (73 females, 18 males), age (mean ±SD) 50.09±9.3 years on hypoglycemic agents and were randomly assigned into two groups, either to consume 30 g of GA or 5 g of placebo daily for 3 months. Anthropometric obesity markers were measured and indices were calculated. Blood pressure was measured and high density lipoprotein (HDL) and triglycerides (TG) were determined in fasting blood samples at the start and end of the study period. Results: After intervention, Gum Arabic decreased BMI and VAI significantly (P < 0.05) in GA group by 2 and 23.7% respectively. Body adiposity index significantly decreased by 3.9% in GA group while there were no significant changes in waist circumference or waist-to-hip ratio (WHR). Systolic blood pressure significantly decreased by 7.6% in GA group and by 2.7% in placebo group from baseline with no significant changes in diastolic blood pressure in the two groups. Conclusion: Gum Arabic consumption at a dose of 30 g/d for 3 months may play an effective role in preventing weight gain and modulating adipose tissue dysfunction in type 2 diabetic patients, although no effect has been shown in waist-to-hip ratioItem Effects of gum Arabic ingestion on body mass index and body fat percentage in healthy adult females: two-arm randomized, placebo controlled, double-blind trial(Nutrition Journal, 2012) Babiker,Rasha; Merghani,Tarig H; Elmusharaf,Khalifa; Badi,Rehab M; Lang,Florian; Saeed,Amal MBackground: Gum Arabic (acacia Senegal) is a complex polysaccharide indigestible to both humans and animals. It has been considered as a safe dietary fiber by the United States, Food and Drug Administration (FDA) since the 1970s. Although its effects were extensively studied in animals, there is paucity of data regarding its quantified use in humans. This study was conducted to determine effects of regular Gum Arabic (GA) ingestion on body mass index and body fat percentage among healthy adult females. Methods: A two-arm randomized, placebo controlled, double-blind trial was conducted in the Department of Physiology at the Khartoum University. A total of 120 healthy females completed the study. They were divided to two groups: A test group of 60 volunteers receiving GA (30 gm /day) for 6 weeks and a placebo group of 60 volunteers receiving pectin (1 gm/day) for the same period of time. Weight and height were measured before and after intervention using standardized height and weight scales. Skin fold thickness was measured using Harpenden Skin fold caliper. Fat percentage was calculated using Jackson and Pollock 7 caliper method and Siri equation. Results: Pre and post analysis among the study group showed significant reduction in BMI by 0.32 (95% CI: 0.17 to 0.47; P<0.0001) and body fat percentage by 2.18% (95% CI: 1.54 to 2.83; P<0.0001) following regular intake of 30 gm /day Gum Arabic for six weeks. Side effects caused by GA ingestion were experienced only in the first week. They included unfavorable viscous sensation in the mouth, early morning nausea, mild diarrhea and bloating abdomen. Conclusions: GA ingestion causes significant reduction in BMI and body fat percentage among healthy adult females. The effect could be exploited in the treatment of obesity.Item Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan(2015) Banaga,Amin S. I; Mohammed,Elaf B; Siddig,Rania M; Salama,Diana E; Elbashir,Sara B; Khojali,Mohamed O; Babiker,Rasha A; Elmusharaf,Khalifa; Homeida,Mamoun MBackground: End stage renal failure (ESRF) has become a major health problem in Sub Saharan Africa (SSA). There were limited data about causes of ESRF in the Sudan. Methods: This is a cross sectional hospital based descriptive study. The subjects of the study are ESRF adults’ patients on regular haemodialysis treatment in 15 haemdoialysis centres in Khartoum State—Sudan. Clinical and epidemio- logical data were obtained from 1583 patients. The medical files of each patient were reviewed to identify the cause of ESRF. Concerning the causes of ESRF, diabetes was diagnosed based on the past medical history and result of the glucose tolerance test, hypertension was diagnosed based on past history of hypertension based on blood pressure of more than 140/90 mmHg, glomerulonephritis was diagnosed based on results of previous kidney biopsies and on clinical grounds, polycystic kidney disease and obstructive uropathy were diagnosed based on abdominal ultrasound and other imaging modalities, sickle cell anaemia was diagnosed based on the result of haemoglobin electrophoresis, systemic lupus erythematosus was diagnosed based on the clinical criteria in addition to lab results of auto antibod- ies, and analgesic nephropathy was diagnosed based on past medical history of chronic analgesic drugs usage with no other identifiable risk factors. We included all ESRF patients on regular haemodialysis treatment. We excluded ESRF patients less than 18 years old. Results: The results showed that the mean age of ESRF Patients was 49 ± 15.8 (years) and 63.4 % were male and 76.3 % were unemployed. The mean duration of haemodialysis is 4.38 ± 4.24 (years). The most common cause of ESRF in our patients was hypertension (34.6 %) followed by chronic glomerulonephritis (17.6 %), diabetes mellitus (12.8 %), obstructive uropathy (9.6 %), autosomal dominant poly cystic kidney disease (ADPKD) (4.7 %), chronic pyelonephritis (4.6 %), analgesic nephropathy (3.5 %). However in (10.7 %) no cause was found. In patient aged less than 40 years old the leading cause of ESRF was glomerulonephritis (29.3 %) followed by hypertension (25 %). In patient aged between 40 to 60 years old the leading cause of ESRF was hypertension (38.5 %) followed by diabetes mellitus (14 %). In patient aged older than 60 years the leading cause of ESRF was hypertension (38.4 %) followed by diabetes mellitus (23.3 %). Conclusions: ESRF in Sudan affects the economically productive age group; unemployment rate among ESRF patients is high. The study showed that hypertension is a leading cause of ESRF in Sudan followed by chronic glomer- ulonephritis. Hypertension and diabetes mellitus are the leading causes of ESRF among patients over 40 years old.Item Metabolic effects of Gum Arabic (Acacia Senegal) in patients with Type 2 Diabetes Mellitus (T2DM): Randomized, placebo controlled double blind trial(2017) Babiker,Rasha; Elmusharaf,Khalifa; Keogh,Michael B; Banaga,Amin S. I; Saeed,Amal MBackground: Gum Arabic (GA) is a water-soluble dietary fiber, indigestible to both humans and animals. While GA currently does not have any therapeutic potential, it has nutritional value and some effects on metabolism of glucose and lipids. Thus, the aim of this study is to assess the effect of GA on serum level of glucose, lipids, and the BMI in type 2 diabetic patients. Methods: A double-blind randomized placebo-controlled trial took place at Academy Charity Teaching Hospital (ACTH) in Sudan between August 2014 to February 2015. The trial was conducted in type 2 diabetic patients who were on regular oral hypoglycemic drugs and had HbA1C ≥ 6.5%. Patients excluded from the study included those on insulin, any patient with a metabolic or gastrointestinal disease, and any patient with history of drug addiction and alcoholism. Other patients excluded were patients who had previous allergic reactions to GA in addition to patients who were pregnant or planned for conception within 6 months. 120 patients were invited to participate in this trial. 100 patients gave consent and were randomized to GA and placebo groups. The GA group was given 30 g of Acacia Senegal and the placebo group was given 5 g of placebo daily for 3 months. The outcomes assessed were primarily the effect of GA on glucose levels in addition to the effects on levels of lipids and BMI in type 2 diabetic patients. Results: The GA group showed significant reduction in fasting plasma glucose (FPG) and HbA1c (P<0.05) within the GA group. Moreover, GA supplementation improved lipid profiles; decreased LDL-Cholesterol by 5.95%, total Cholesterol by 8.28% and triglyceride by 10.95% from baseline levels. HDL-Cholesterol showed significant increase by 19.89% within GA group (P<0.05), BMI was decreased significantly by 2.06% (95% CI: −0.98; −0.16), P<0.05). Conclusions: Gum Arabic is a dietary supplement for improving nutrition of type 2 diabetic patients; it has demonstrated a good effect on improving their poor glycemic control. It has also shown improvement in the levels of the lipids and the BMI. Further studies are needed in obese and pre-diabetic patients to evaluate GA therapeutic potentials.Item Prevalence and Presentation of Tuberculosis among Hemodialysis Patients in Khartoum, Sudan(Saudi Journal of Kidney Diseases and Transplantation, 2016) Banaga,Amin S. I; Siddiq,Nihad K; Alsayed,Randa T; Babiker,Rasha; Elmusharaf,KhalifaABSTRACT. Tuberculosis (TB) is a major health problem in the developing countries. There are limited data about the prevalence of TB patients on maintenance hemodialysis (HD) in Sudan. The aim of this study is to identify the prevalence and presentation of TB among Sudanese maintenance HD patients. This is a hospital-based descriptive study. The participants of the study are all HD patients distributed in 13 HD centers in Khartoum and Khartoum North Provinces in Sudan. All patients attended the HD centers from November 1, 2014 to February 1, 2015, were interviewed by a questionnaire focused on personal and clinical data. Those who were diagnosed as having active TB were studied regarding their clinical presentation, presence of comorbidities, site of TB, and methods used on diagnosis. The total number of HD patients during the study period was 1328 patients. We found 19 patients who already diagnosed and treated for TB infec- tion. The prevalence rate of TB among HD patients is 1.4%. The mean age of patient was 44.53 ±8.69 years, 89.5% of them were males. The majority of them have comorbidities: 31.6%% have hypertension and 21.1% have diabetes. Extrapulmonary TB was the major presentation (57.9%) mainly tuberculous lymphadenitis (26.3%). The pulmonary presentation was found to be 42.1%. The diagnosis of TB was supported by microbiological evidence of alcohol acid-fast Bacilli pre- sent in sputum smear (21%), histological diagnosis (31.6%), polymerase chain reaction (21%), and imaging in (26.3%). Patients on maintenance HD are at an increased risk of TB and diagnosis of TB among HD patients need a high index of suspicion. There is a great need for establishing a screening scheme for TB among HD patients and further epidemiological studies are needed to fully evaluate this problem.Item Why Did Sudanese End Stage Renal Failure Patients Refuse Renal Transplantation?(Open Journal of Nephrology, 2015) Banaga,Amin S; Mohammed,Elaf B; Siddig,Rania M; Salama,Diana E; Elbashir,Sara B; Khojali,Mohamed O; Babiker,Rasha A; Elmusharaf,Khalifa; Homeida,Mamoun MRenal transplantation remains the most effective treatment of End Stage Renal Failure (ESRF). In this cross sectional study we explore the reasons behind refusal of renal transplantation among adults’ Sudanese haemodialysis patients. The subjects of the study are ESRF adults’ patients on regular haemodialysis treatment in 15 haemdoialysis centres in Khartoum/Sudan. All patients who are on regular haemodialysis were interviewed by questionnaire to explore the reasons of refusal of renal transplantation. A total of 1583 ESRF adults’ patients on regular haemodialysis have been participated in the study, 381 (24.1%) patients refused kidney transplantation. The mean age of patients refusing kidney transplantation was (58.5 + 15.1 years); 77.4% of them were ≥50 years old, 59.2% were males and 88.1% were unemployed, patients older than 50 years old and unemployed are tend to refuse renal transplantation (P < 0.001). The main reason of refusal was that the patients refuse to accept kidney from living donors (34.8%). 17.6% of patients de- cline kidney transplantation because of financial reason, 18.1% of patients refused to do trans- plantation because of fear of transplant surgery, 15.7% of patients believe that kidney transplan- tation is against their religious values, 11.9% of patients refused transplantation because they don’t have enough knowledge on renal transplantation, only 0.5% of patients refuse transplanta- tion because of side effect of immunosuppressive drugs. In conclusion, in this study we found that elderly and unemployed ESRF patients tend to refuse renal transplantation, the most important reason behind refusal of renal transplantation is refusal of accepting kidney donation from living related donors. This reflects the need for development of cadaveric donors program in the Sudan. ESRF patients need education and counseling on renal transplantation.Item Evaluation of the toxic influence of vitamin E (dl-alpha-tocopheryl acetate) and treatment with aqueous extracts of cinnamon or anise on lipid profile and liver functions of female wistar rats(International Journal of Medicine, 2017) Ibrahim ,Sabah A. E; Sabahelkhier,Murwan KThe toxic effects of vitamin E and its treatment with aqueous extracts of Cinnamon or anise on lipid profile and liver functions of female wistar rats were examined for six weeks during September 2016 at labs in al-Neelain University. 18 rats were divided into six groups: 1. negative control group (sunflower oil), 2. Positive control group and rest groups given (1500 mg/Kg/BW/day of Vitamin E). After two hours, the four treated groups received a low dose (2.13g/Kg) and a high dose (3.20g/Kg) 20g/Kg from Cinnamon aqueous extract (CAE) and Anise aqueous extract (AAE). At the end rats were sacrificed then serum and liver tissues were analyzed. Vitamin E toxic dose had caused a significant increase in serum Triglycerides (TG), Alanine amino transferase (ALT) levels, while it decreased the levels of High- density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC) and Aspartate amino transferase (AST). All treatments decreased TG and ALT levels. CAE low dose significantly increased TC, LDL and HDL levels. CAE high dose caused a significant decrease in AST, TC, and LDL. Both doses of AAE, caused significant increases on AST levels, and only anise low dose caused a signif- icant decrease on TC and LDL levels. Vitamin E toxic dose caused severe fatty change in liver histology, which was near normal in both doses of CAE with a small necrosis in a low dose. Only AAE low dose normalized the liver. To conclude Vitamin E oral administration with a dose of (1500 mg/Kg) induced liver injury with an elevation in ALT and TG levels, which was significantly ameliorated by both treatments. Cinnamon was better than anise in ameliorating the toxicity. Cinnamon high dose was better than Cinnamon low dose; in contrast anise low dose was better than Anise high dose.Item Accuracy of Fetal Foot Length Measurement in Estimation of Gestational Age and Fetal Weight in the Third Trimester of Pregnancy(Journal of Health Research and Reviews, 2018) Ebraheem,Mohamed; Malik,Bushra Abdel; Ali,Qurashi M; Gameraddin,Moawia; Gareeballah,AwadiaBackground: Fetal foot length (FFL) is a biometric parameter that has been established for estimating the gestational age (GA). Accurate knowledge of fetal weight (FW) and GA assist Clinicians in the evaluation of fetal growth and predict neonatal outcomes. Aims: This study aims to predict the estimated FW and GA using the FFL in 26–40 weeks’ gestation on antenatal ultrasound. Materials and Methods: In a retrospective study, we investigated the fetal measurements of FFL, femoral length (FL), and estimated FW in 100 pregnant women at 26–16 weeks’ gestation who attended routine antenatal care. The fetal measurements were examined about the foot length. Results: The foot length was not a significance parameter to determine fetal gender (P = 0.6). There was no correlation of FFL with maternal socioeconomic status, parity, fetal gender, and maternal body mass index, P = 0.26, 0.84, 0.67, and 0.26, respectively. The FFL, FL, and estimated FW were strongly and linearly correlated with GA. The combination of FL, foot length, and estimated FW provide an accurate estimation of GA with minimum (standard error [SE] = 1.75). The combination of FL and foot length provide an accurate prediction of FW with SE of 320.52. The foot length and FL revealed similar values of SEs in estimated FW (R2 = 0.85) for each. Conclusions: The FFL is linearly correlated with GA, FW, and FL. It is an accurate parameter to assess the GA and reliable for predicting the estimated FW. This is useful for assessing fetal growth and skeletal dysplasia.Item Reference Values (RV), MNS and MTS for Morphological Characteristics of Normal and Abnormal Human Spermatozoon Describing Teratozoospermic Index (TZI) & Sperm Deformity Index (SDI) in Sudanese Infertile Couples Using CASA System(Article in International Journal of Morphology, 2019) Alarabi,Tarig; Ali,Qurashi; Abdalla,Asim; Mutwakil,HeithamA scientific determination of fertilization ability of the sperm can be made by motility, viability and morphological examinations that are called as potential fertility criteria. Some previous studies documented only the total morphological defect rates without including the morphologic subjects. As it is recorded in many studies, the success of IUI, ICSI and IVF depends mainly on the quality of the collected semen. 1) Determine and classify the common morphological defects and rates of sperms. 2) Analyze the effect of age on the sperm abnormalities and to assess the impact of environment on changing normal sperm characteristics. 3) Determine the common types of semen abnormalities (Asthenoterato-zoospermia, Asthenozoospermia, Azoopyospermia, Azoospermia, Hypospermia, Oligoasthenoteratozoospermia, Oligoasthenozoopyospermia, Oligoasthenozoospermia and Teratozoospermia). 4) Determine the range of teratozoospermic index (TZI) and sperm deformity index (SDI). A prospective case series study for 566 men of infertile couples who were requesting semen analysis was applied to those came to the ULTRALAB laboratory center main campus and ULTRALAB branch of the Sudan Assisted Reproduction Center (SARC), Khartoum, Sudan. Data collection was done for 20 months from April 1st, 2010 to December 31st, 2011. analysis of semen samples was done using Computer Assisted Semen Analysis (CASA). 1) The study demonstrates that there are differences in normality and abnormality of sperm morphology parameters of sperm between Sudanese population and other studies including WHO standards. 2) SDI and TZI were higher in overall semen as well as in abnormal semen samples. 3) Common semen abnormalities were oligoasthenoteratozoospermia, asthenoteratozoospermia and asthenozoospermia. There are differences in sperm morphology of both normal and abnormal parameters between Sudanese population and other studies including WHO standards.Item Case report of a novel homozygous splice site mutation in PLA2G6 gene causing infantile neuroaxonal dystrophy in a Sudanese family(BMC Medical Genetics, 2018) Elsayed,Liena E. O; Mohammed,Inaam N; Hamed,Ahlam A. A; Elseed,Maha A; Salih,Mustafa A. M; Yahia,Ashraf; Siddig,Rayan A; Amin,Mutaz; Koko,Mahmoud; Elbashir,Mustafa I; Ibrahim,Muntaser E; Brice,Alexis; Ahmed,Ammar E; Stevanin,GiovanniBackground: Infantile neuroaxonal dystrophy (INAD) is a rare hereditary neurological disorder caused by mutations in PLA2G6. The disease commonly affects children below 3 years of age and presents with delay in motor skills, optic atrophy and progressive spastic tetraparesis. Studies of INAD in Africa are extremely rare, and genetic studies from Sub Saharan Africa are almost non-existent. Case presentation: Two Sudanese siblings presented, at ages 18 and 24 months, with regression in both motor milestones and speech development and hyper-reflexia. Brain MRI showed bilateral and symmetrical T2/FLAIR hyperintense signal changes in periventricular areas and basal ganglia and mild cerebellar atrophy. Whole exome sequencing with confirmatory Sanger sequencing were performed for the two patients and healthy family members. A novel variant (NM_003560.2 c.1427 + 2 T > C) acting on a splice donor site and predicted to lead to skipping of exon 10 was found in PLA2G6. It was found in a homozygous state in the two patients and homozygous reference or heterozygous in five healthy family members. Conclusion: This variant has one very strong (loss of function mutation) and three supporting evidences for its pathogenicity (segregation with the disease, multiple computational evidence and specific patients’ phenotype). Therefore this variant can be currently annotated as “pathogenic”. This is the first study to report mutations in PLA2G6 gene in patients from Sudan.
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