Clinical Characteristics and Current Medical Practice in a Group of Sudanese Patients with Epilepsy: A Cross Sectional Hospital Based-Study

Introduction: The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospitals will positively add to the welfare of patients with epilepsy. The objectives of this study were to assess the current medical practice in epilepsy work up and to study the selection of AEDs as per ILAE guidelines. Methods: This was a cross sectional-retrospective hospital based study, conducted between April and September 2016 in Omdurman Teaching Hospital, Khartoum, Sudan. Patients aged 18 years old and above were enrolled. Epilepsy was defined as having at least two non-provoked seizures in the least 6 months in a patient who was assessed by clinical review and electroencephalogram (EEG). Epilepsy was classified as generalized, focal or unclassified. Medications refer to all internationally licensed antiepileptic medications (AEDs) in 2016. Results: One hundred adult Sudanese patients were enrolled for this study. The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. In generalized epilepsy, the MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. In focal epilepsy, the CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. The AEDs used were as follows: Carbamazepine (CBZ) 48%, Na valproate (VP) 33%, Lamotrigine (LMT) 2%, Levetricetan (LVT) 1%, CBZ + VP 14% and CBZ + Oxcarbazepine (OXC) 2%. Conclusion: The current medical practice in Omdurman teaching hospital should be modified to match the international league against epilepsy (ILAE) guidelines in workup, management, AEDs selection and classification of epilepsy.

Immigrants and the utilization of hospital emergency departments

BACKGROUND：Immigrants with language barriers are at high risk of having poor access to health care services. However, several studies have indicated that immigrants tend to use emergency departments （EDs） as their primary source of care at the expense of primary care. This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care. The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants＇ satisfaction with ED care. METHODS：Studies about immigrants＇ utilization of EDs in Australia and worldwide were reviewed.RESULTS：There are conflicting results in the literature about the pattern of ED care use among immigrants. Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization. Overall, immigrants use ED care heavily, make inappropriate visits to EDs, have a longer length of stay in EDs, and are less satisfied with ED care as compared to host populations.CONCLUSION：Immigrants might use ED care differently from host populations due to language and cultural barriers. There is sparse Australian literature regarding immigrants＇ access to health care including ED care. To ensure equity, further research is needed to inform policy when planning health care provision to immigrants.

Language affects length of stay in emergency departments in Queensland public hospitals

BACKGROUND:A long length of stay(LOS) in the emergency department(ED) associated with overcrowding has been found to adversely affect the quality of ED care.The objective of this study is to determine whether patients who speak a language other than English at home have a longer LOS in EDs compared to those whose speak only English at home.METHODS:A secondary data analysis of a Queensland state-wide hospital EDs dataset(Emergency Department Information System) was conducted for the period,1 January 2008 to 31 December 2010.RESULTS:The interpreter requirement was the highest among Vietnamese speakers(23.1%)followed by Chinese(19.8%) and Arabic speakers(18.7%).There were significant differences in the distributions of the departure statuses among the language groups(Chi-squared=3236.88,P<0.001).Compared with English speakers,the Beta coefficient for the LOS in the EDs measured in minutes was among Vietnamese,26.3(95%Cl:22.1-30.5);Arabic,10.3(95%Cl:7.3-13.2);Spanish,9.4(95%CI:7.1-11.7);Chinese,8.6(95%Cl:2.6-14.6);Hindi,4.0(95%Cl:2.2-5.7);Italian,3.5(95%Cl:1.6-5.4);and German,2.7(95%Cl:1.0-4.4).The final regression model explained 17%of the variability in LOS.CONCLUSION:There is a close relationship between the language spoken at home and the LOS at EDs,indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.

Ultrastructural Study of Limb Bud Development in Green Turtles Chelonia mydas

Morphological changes during the embryonic development of limbs of the green turtle,Chelonia mydas,were studied during the entire period of incubation,using transmission and scanning electron microscopy(TEM and SEM). Limb buds were first observed at Stage 2. At that stage,the tip was covered with an apical ectodermal ridge(AER) which began to regress at Stage 6. Associated with AER was the presence of the mesenchymal cells which,consequently,differentiated into muscles,cartilage and bones. The gross features of the skeletal development appeared as a condensation of the cartilaginous structures in the proximal distal region of the limbs. The primordial digits were gradually enclosed by hard keratinized webbed skin. The increase in rate of ossification and skin pigmentation was correlated with the growth of the limbs. The development of the limbs was closely related to the transitional appearance of mucus secretion from the epidermis.