Health ramifications and recovery avenues for Sudan's April 2023 armed conflict: A review

Background: Sudan's history is marred by ongoing sociopolitical challenges, with deep cultural divisions fueling numerous wars. A new conflict erupted on April 15, 2023, pushing the country closer to a full-scale civil war. This war has severely crippled Sudan's already fragile healthcare system, rendering 70% of hospitals in combat zones nonoperational, causing 12,000 deaths, thousands of injuries, and leaving 11 million in dire need of healthcare. More than seven million people are displaced, half of which are children, and are facing severe health challenges, especially vulnerable groups. Heath situation is threatening with unchecked spread of outbreaks of communicable diseases that were previously controlled and marked failure in meeting the health demands of patients with noncommunicable diseases, reproductive and child health issues, and people with serious conditions that require adequate follow-up. Moreover, the projections threaten with more catastrophic consequences including famine, environmental destruction, and further displacement of people. This review article highlights the urgency of the situation and explores potential solutions to enrich global understanding of crisis management. Methods: To comprehensively assess the impact of the crisis and propose a way forward, we drew data by exploring search engines and databases such as Google, Humanitarian Agencies Websites, Google Scholer, and PubMed along with some relevant reports. The search terms included are "Sudan's war", "impact of war on healthcare systems", and "Sudan's armed conflicts". Results: More than 19 publications on the impact of the war on health in addition to periodic reports from international organizations and governmental authorities were reviewed. Conclusion: Although all publications point to the gravity of the situation and the need for prompt response, this crisis offers a unique opportunity to rebuild Sudan's struggling healthcare system with the principles of social accountability. Through domestic and international collaboration, this sector can become a model for similar nations, meeting the needs of its people and promoting sustainable development.

Association of protein tyrosine phosphatase non-receptor type 22 gene functional variant C1858T, HLA-DQ/DR genotypes and autoantibodies with susceptibility to type-1 diabetes mellitus in Kuwaiti Arabs

The incidence of type-1 Diabetes Mellitus [T1DM] has increased steadily in Kuwait during recent years and it is now considered amongst the high-incidence countries. An interaction between susceptibility genes, immune system mediators and environmental factors predispose susceptible individuals to T1DM. We have determined the prevalence of protein tyrosine phosphatase non-receptor type 22 [PTPN22] gene functional variant [C1858T; R620W, rs2476601], HLA-DQ and DR alleles and three autoantibodies in Kuwaiti children with T1DM to evaluate their impact on genetic predisposition of the disease. This study included 253 Kuwaiti children with T1DM and 214 ethnically matched controls. The genotypes of PTPN22 gene functional variant C1858T [R620W; rs2476601] were detected by PCR-RFLP method and confirmed by DNA sequencing. HLA-DQ and DR alleles were determined by sequence-specific PCR.Three autoantibodies were detected in the T1DM patients using radio-immunoassays. A significant association was detected between the variant genotype of the PTPN22 gene [C1858T, rs2476601] and T1DM in Kuwaiti Arabs. HLA-DQ2 and DQ8 alleles showed a strong association with T1DM. In T1DM patients which carried the variant TT-genotype of the PTPN22 gene, 93% had at least one DQ2 allele and 60% carried either a DQ2 or a DQ8 allele. Amongst the DR alleles, the DR3-DRB5, DR3-3, DR3-4 and DR4-4 showed a strong association with T1DM. Majority of T1DM patients who carried homozygous variant [TT] genotype of the PTPN22 gene had either DR3-DRB5 or DRB3-DRB4 genotypes. In T1DM patients who co-inherited the high risk HLA DQ, DR alleles with the variant genotype of PTPN22 gene, the majority were positive for three autoantibodies. Our data demonstrate that the variant T-allele of the PTPN22 gene along with HLA-DQ2 and DQ8 alleles constitute significant determinants of genetic predisposition of T1DM in Kuwaiti children

Factors Affecting the Surgical Outcome of Primary Exotropia in Children.

Objective: The objective of current study to evaluate the outcome results of the surgical correction and as well as the effects of some factors on the outcome and surgical response of primary exotropia. Study Design: Retrospective Clinical Study. Place and Duration of Study: Hamad Medical Corporation –Tertiary Hospital in Qatar, study done over six months. Methods: Medical records of patients who underwent surgical correction of primary exotropia procedures between the years 2008 and 2013 were retrospectively reviewed. Patients less than 15 years of age were included in the study and the following data were collected: onset age of squint, age at surgery, type of exotropia, visual acuity, presence of amblyopia, anisometropia, refractive error (spherical equivalent), preoperative deviation, AV pattern, stereopsis, type of surgery and analysis using descriptive statistics, unpaired t- and chi-square statistical tests. Results: Of 74 patients we studied, 30 Male (40.5%), 44 Female (59.5%), 46 patients (62.2%) had successful surgical outcome, and 28 patients (37.8%) had unsuccessful outcome (all under correction). The response to surgery correlated mainly to with the preoperative angle. A higher response resulted from larger preoperative deviation and it this was better with lateral plus medial rectus muscle recessions than with bilateral lateral rectus recession. Conclusions: Preoperative deviation was the most important factor in determining better response to surgical correction of primary exotropia, and accurate measurement of the angle of deviation can improve the outcome and response to surgery.

Hypertrophic cardiomyopathy in the Saudi Arabian population: clinical and echocardiographic characteristics and outcome analysis

Current published literature on hypertrophic cardiomyopathy [HCM] comes primarily from Western populations. There is no published data on clinical and echocardiographic characteristics and long-term outcome of HCM in an Arab population. We conducted a retrospective analysis of all patients 16 years or older diagnosed with HCM at our institution. Detailed clinical and echocardiographic data were collected and outcome was analyzed. A total of 69 patients were identified as having HCM. The mean age was 42 +/- 16 years with 71% male patients. All patients were Saudi citizens with Arab ancestry. Details about family history and presenting symptoms were available for 44 and 48 patients consecutively. Nine [18%] patients were asymptomatic and were diagnosed based on abnormal cardiac auscultation. The commonest presenting symptoms were dyspnea with or without chest pain and palpitations occurring in 40 [81%] patients. Only four [9%] of 44 patients had a family history of HCM and /or sudden cardiac death [SCD]. The most common ECG abnormality was left ventricular hypertrophy [LVH] present in 60 [86%] patients. The commonest septal hypertrophy morphology was mid-septal [catenoid] in 30 [43%] followed by neutral in 23 [33%], basal septal [sigmoid] in 3 [4%] and apical in 6 [8%] patients. Twenty [28%] patients had evidence of resting left ventricular cavity gradient of >/= 30mmHg. Eleven [16%] patients had evidence of biventricular hypertrophy. Left ventricular ejection fraction was normal in 65 [94%] patients. Over a median [25-75 percentile] follow-up of 7 years [4.5-10], only three patients died, all of non-cardiac causes. There were no cases of SCD during the follow-up period. Six patients required an implantable cardioverter-defibrillator [ICD]; five for primary prevention and one for secondary prevention. Only one patient progressed to end stage dilated cardiomyopathy. The natural history of hypertrophic cardiomyopathy in the Saudi population appears to be benign with catenoid morphology being the most common septal hypertrophy pattern. Risk of SCD appears to be quite low in this population

Outcome of occlusion treatment for strabismic amblyopia in children below 12 years old age

The aim of our study was to determine the related clinical factors affecting the outcome of occlusion treatment for Strabismic Amblyopia in Qatari children. This is a retrospective descriptive study. The study included 38 Qatari children with strabismic amblyopia who were treated with occlusion therapy. The survey was conducted among the Qatari children below 12 years of age during a 10 year period from 1 992-2002. During this study period, 23 girls and 15 boys were treated for strabismic amblyopia. A total of 38 Qatari children were treated during the 10 year period. Of these children, 39.5% were males and 60.5% females. After the treatment, it is found that their final visual acuity improved. 73.7% achieved 6/9 or more and 26.3% achieved less than 6/9. The initial visual acuity, the presence of anisometropia and compliance were found to be related to the outcome of amblyopia treatment. The age at the start of treatment was found unrelated to the outcome. It was further discovered that most vision loss from amblyopia can be reversed with the correct intervention. The results of the present study indicated that the main factors affecting the treatment of strabismic amblyopia are initial visual acuity, presence of anisometropia and compliance

Iris depigmentation: an unusual complication of intralesional corticosteroid injection for capillary hemangioma

Intralesional injection of corticosteroids has been used successfully in the treatment of adenexal hemangiomas, with advantages of easy administration, rapid action, repeatability, efficacy and safety. We report a case of an eight-month-old female infant who underwent intralesional corticosteroid injection for capillary hemangioma that had resulted in amblyopia of her left eye from ptosis. Two weeks after the injection, the hemangioma showed some regression but at that point iris depigmentation of the affected eye was noted. The iris depigmentation remained unchanged during her follow-up visit with significant regression of the hemangioma, associated ptosis and astigmatism

Psychological status of children with type 1 diabetes in Kuwait

Childhood diabetes puts an enormous burden on both the child and his family and may put them at increased risk for psychological problems. The purpose of the study was to assess the psychological reactions to type 1 diabetes in children and the effect of glycemic control on them. A specially designed questionnaire was used to collect demographic data. The children behavioral check list and the Arabic childhood depression inventory were used to assess depression, anxiety and other behavioral disorders. Social workers and research assistants interviewed the patients in the outpatients of the 5 hospitals. Controls were interviewed at school. A total of 215 diabetic and 221 age and sex matched healthy subjects were enrolled in the study. Measure depression, and other behavioral disorders in diabetic patients. Mild depression was reported in 63% of the diabetic subjects, 3-fold higher than in the control group [p < 0.05]. Medium and high anxiety scores were significantly more frequent in diabetic children [p <0.001, and p < 0.01 respectively] Attention, concentration problems, hyperactivity and aggressive behavior were significantly more frequent in the diabetic children compared to matched controls. There was a significant association between poor glycemic control and depression; p < 0.001. hyperactivity [p = 0.001], poor attention [p - 0.007], and aggression [p = 0.03]. Children with diabetes are at increased risk of depression and behavioral problems. Regular psychological assessment along with medical treatment must be addressed to optimize control

Successful transfer from insulin to oral sulfonylurea in a 3-year-old girl with a mutation in the KCNJ11 gene

Neonatal diabetes mellitus is considered a rare disease that is diagnosed in the first six months of life, and can be either transient or permanent. Recent advances in molecular genetics have shown that activating mutations in KCNJ11 [the gene that encodes for the Kir6.2 subunit of the K[ATP] potassium channel of the pancreatic beta-cell] is a common cause of permanent neonatal diabetes mellitus. Patients with mutations in this gene may respond to oral sulfonyureas. We describe a 3-year-old girl with permanent neonatal diabetes mellitus with a mutation in the KCNJ11 gene [R201H], who was successfully transferred from subcutaneous insulin to oral glibenclamide, with a marked improvement in glycemic control. This is the first successful switch from insulin to oral sulfonylurea in a patient with R201H mutation, in the Arabian Gulf

Antimicrobial susceptibility of thermophilic Campylo-bacter spp. isolated from environmental samples.

Environmental samples were subjected to determine frequency of occurrence of pathogenic campylobacters in the environment. The antimicrobial susceptibility of the isolates was tested to evaluate the level of antibiotic sensitive campylobacters in the environment of investigation. In all, 70 Campylobacter isolates were obtained from water and domestic animal faeces samples using Kapadnis-Baseri device and antimicrobial susceptibility of them was determined by disc diffusion test and E- test. The results indicated that all the isolates of Campylobacter were sensitive to ciprofloxacin and resistant to cefotaxime, cephalexin and ampicillin. Lowest MIC values were observed for ciprofloxacin and gentamicin (2 microg/mL) and highest MIC values for ampicillin and chloramphinicol (256 microg/mL). In general, pathogenic Campylobacter spp. were prevalent in large numbers in the environment, however, they were sensitive to ciprofloxacin.

Desmoid fibromatosis; Problems in diagnosis and management: reappraisal

Twenty-nine patients with desmoid tumors were identified. Estrogen receptor assays were studied by the immunocytochemical method using monoclonal antibodies to human ER and highly sensitive streptavidin immunoperoxidase kit in ten patients. The clinical follow up was available for all patients with a range of 1-9 years. The duration of the follow up was less than one year from the time of resection in three patients. All lesions were treated initially with a surgical excision. Those patients who received adjuvant radiotherapy were treated with cobalt-60 units or a 4 MeV linear accelerator to 5-6 Gy. One patient received brachytherapy at the tumor site to 6 Gy. Another patient was treated with tamoxifen and non-steroidal anti-inflammatory drugs after surgical resection. Pathology reports were reviewed in an attempt to evaluate the effect of histologic margins on subsequent tumor recurrences

Utilization of health services by the primary health care centres-registered elderly people in Burraidah city, Saudi Arabia

To assess the pattern of and factors associated with geriatrics' utilisation of health services. Design: A cross-sectional, study involving a random sample of 266 elderly subjects registered in the primary health care centres in Burraidah city, Saudi Arabia. Setting: The primary health care centres in Qassim Region, Saudi Arabia. Data was collected from PHC centres-registered elderly subjects at their homes. Information including utilisation of primary health centres, hospital admissions and duration of hospital stay were recorded. The response rate was 96.7%. Twenty% of the sample had not used any health services facility during the previous year. Two-thirds of subjects made visits to the primary health care centres, majority of them having made 6 visits or less. Significant factors positively associated with those visits were female, advancing age, and having a family. Three-quarters of the sample did not have hospital admissions. Significant factors positively associated with admissions were diabetes mellitus, hypertension, paralysis, advanced age, and living with a family. Conclusions: Geriatric health services utilisation by the study sample is affected by family ties and the high prevalence of chronic diseases. Subjects living alone or crippled by immobility may not be able to utilise available health services properly. Community based geriatrics services can help this vulnerable group