Neuropsychological Changes in Children with Sickle Cell Disease and Their Correlation to the Imaging Studies

Background:Early detection of neuropsychological changes in children with sickle cell disease (SCD) is essential to improve their quality of life. Aim of the Work: To assess neurological and psychological disorders in children with sickle cell disease (SCD) using multimodal approach through clinical, laboratory, neuroimaging and neurophysiological studies in a trial to detect etiological risk factors.Study Design: Cross-sectional study.Placeand Duration of Study: Sample: Department of Pediatric (Hematology Unit) and Department of Neurology, Tanta University Hospital Egypt, between April 2016 and April 2018.Methodology:This study was conducted on 50 children (27 male and 23 female; age range 2-18 years) with SCD and 25 healthy children matched age and sex. All subjects were subjected to full history taking, neurologic examination using pediatric neurological sheet, laboratory investigations, neuroimaging including: CT and /or MRI, MRA and/or CT angiography, also MR, EEG and Stanford-Binet Intelligence scales-Fifth Edition. Results:Most of patients presented with headache 66%, cognitive decline 48%, seizures 28%, and visual affection 24%. Less common presentations were, ischemic and hemorrhagic stroke 6%and 4% respectively. SCD children showed many abnormalities on neurological examination and on different modalities of MR imaging on the brain with positive correlation (X2=7.641, p-value <0.001*, r=0.248) with many risk factors. Prophylactic blood transfusion in SCD patients with abnormal TCD had a role in reducing the incidence of stroke. Conclusion: Children with SCD were presented with variable neuropsychological disturbance that correlated with the brain imaging.

Study of Knowledge, Attitudes and Practices among Sanitary Workers Regarding Medical Waste Management in Khartoum Locality Teaching Hospitals, 2019

Health care waste is considered as a risk or dangerous to public health and the environment. The exposure of patients, staff, waste handlers, visitors and the community to medical waste is due to bad management practices in hospitals and health care centers. This cross sectional descriptive study was carried out in in Khartoum Locality Teaching Hospitals with the aim to assess knowledge, attitudes and practices among the health sanitary workers towards medical waste management. Total 210 respondents were participated in the study; the study uses questionnaires, interviews and observations as tools for data collection. The collected data were analyzed by Software Package for Social Sciences (SPSS) and the result was presented in text, figures and tables. The study revealed that 42.4% of the respondents have excellent knowledge about hazardous waste. Nearly half, 45.2% of the respondents have excellent and very good knowledge concerning waste transmitting diseases. 95.2%, 82.9%, 66.2%, 22.8% and 53.8% have favorable attitudes towards wearing gloves, wearing an apron, wearing masks, wearing boots, wearing gloves during the work respectively. 83.3% wash their hands after the work, but only 33.3% use soap. This study showed that females were significantly more knowledgeable, having favorable attitude, and better practices towards medical waste than males. The Study recommended that the Occupational Health Department in State Ministry of Health should apply programs to encourage the health workers to use the personal protective equipment..

Airway inflammatory biomarker: could it tailor the right medications for the right asthmatic patient?

Asthma is a heterogeneous disease, in which asthmatic patients present with different clinical phenotypes, variable endotypes, and different response to asthma medicines. Thus, we are faced with an asthma paradox; asthma is diagnosed subjectively by clinical history and treated with biologically active drugs. To solve this paradox, we need objective airway biomarkers to tailor the proper medications to the proper patient. Biomarkers should have one or more of the following characteristics: 1] could differentiate poor symptoms perceivers from over-perceivers, 2] could predict disease activity and hence disease outcome, 3] could clarify asthma phenotype responders from non-responders, and finally 4] could characterize different clinical asthma phenotypes. Therefore, we have conducted a review of literature trying to apply those four parameters to different airway inflammatory biomarkers. We found that FeNO fulfilled the four proposed clinical parameters of airway inflammatory biomarkers whereas; serum periostin was the single best systemic biomarker of airway luminal and tissue eosinophilia in severe uncontrolled TH2 asthma phenotype. Thus, this may be considered a trial towards tailoring the proper medication to the proper patient. However, application of biomarkers in clinical practice requires easier and cheaper techniques together with standardized methods for sample collection and analysis

effect of sand storms on acute asthma in Riyadh, Saudi Arabia

Major sand storms are frequent in the Middle East. This study aims to investigate the role of air particulate matter [PM] level in acute asthma in children in Riyadh, Saudi Arabia. An aerosol spectrometer was used to evaluate PM < 10microm in diameter [PM 10] and PM < 2.5 microm in diameter [PM 2.5] concentrations in the air every 30 minutes throughout February and March 2012 in Riyadh. Data on children 2-12 years of age presenting to the emergency department of a major children's hospital with acute asthma during the same period were collected including their acute asthma severity score. The median with interquartile range [IQR] levels of PM 10 and PM 2.5 were 454 microg/m[3] [309, 864] and 108 microg/m[3] [72,192] respectively. There was no correlation between the average daily PM 10 levels and the average number of children presenting with acute asthma per day [r = -0.14, P = 0.45], their daily asthma score [r = 0.014, P = 0.94], or admission rate [r= -0.08, P = 0.65]. This was also true for average daily PM 2.5 levels. In addition, there was no difference in these variables between days with PM 10 >1000 microg/m[3], representing major sand storms, plus the following 5 days and other days with PM 10 < 1000 microg/m[3]. Sand storms, even major ones, had no significant impact on acute asthma exacerbations in children in Riyadh, Saudi Arabia. The very high levels of PM, however, deserve further studying especially of their long-term effects

effectiveness of a program for developing leadership skill for preparatory schools students

Objective: The study seeks checking out the effectiveness of the proposed program for developing skill of leadership after being applied on students of preparatory stage

Method: It uses the experimental method by applying activities of a program for leadership skill

Sample: It consists of 20 [Male/ Female] students in preparatory schools, aged [13-15] year olds, divided equally into the control and the experimental groups, selected from Future Experimental Languages School, in Zaytoun district, Cairo governorate

Tools: IQ Pictured Test [1974] by Ahmed ZakiSaieh, The Socio-economic and Cultural Level Form, by Abdel Aziz El-Shakhs, Scale of Leadership Skill, by researcher, and Program of Developing Leadership Skill, by researcher

Results: The study checked hypotheses and extracted results which most important are: There are no significant statistical differences between average scores of males and females of the experimental groups regarding the post-application of the proposed program; while there are significant statistical differences between the two groups, the control and the experimental post-application of the proposed program, in favor of the experimental group

High Prevalence of Multidrug Resistant Tuberculosis in Djibouti: a Retrospective Study

Introduction:The Republic of Djibouti is an African country that exhibits one of the highest incidence rate of tuberculosis in the world. The aim of this study was to evaluate the prevalence of multidrug resistant tuberculosis among new cases. Methodology: We studied retrospectively every tuberculosis case diagnosed over a 12month period in patients hospitalized at the French military Hospital of Bouffard. During this period; 1;274 samples from 675 patients were tested. Results: We isolated 266 mycobacteria corresponding to 180 cases of tuberculosis. Thirty three were fully susceptible and 57 met the tuberculosis criteria; with 46 primary resistance. No extensively drug resistant tuberculosis was found. Conclusion: Our results highlight a major concern about the situation in this part of the world

Myelo-Enhancement by Astragalus Membranaceus in Male Albino Rats with Chemotherapy Myelo-Suppression. Histological and Immunohistochemical Study

BACKGROUND AND OBJECTIVES: Myelo-suppression is the most common toxicity encountered in the oncology clinic today. This study was planned to investigate the possible protective and therapeutic role of the traditional Chinese Medicinal Herb; Astragalus Membranaceus (AM), on chemotherapy-induced myelosuppression. METHODS AND RESULTS: This study was carried out on thirty six adult male albino rats. They were divided into: Group I Control Group (n=6) received a vehicle of phosphate buffered saline (PBS) solution. Group II (n=12) were injected I.P. with cyclophosphamide (CY) for 3 days (gIIa n =6) and continued for one more week to receive AM orally (gIIb n=6). Group III (n=6) received CY I.P. together with AM orally for 3 days. Group IV (n=12) received AM orally for one week (gIVa n=6) and continued for extra three days receiving CY I.P. with AM orally (gIVb n=6). Blood samples were analysed for Total Leucocytic Count and Lymphocytic Count. Counting of CD34 +ve cells in bone marrow was performed by flowcytometry. Bone marrow sections were subjected to H&E stain as well as immunohistochemical staining for anti- CD20 antibody. The mean area % of cellular bone marrow regions occupied by developing haemopoietic cells, mean area of fat cells and mean number of CD20 immunopositive B lymphocytes in the bone marrow were measured by histomorphometric studies and statistically compared. AM proved to have a myelo-protective and myelo-therapeutic capacity, evidenced at both laboratory and morphological levels. CONCLUSIONS: The greatest myelo-potentiating effect of AM was achieved when supplied before and together with CY therapy.

Anticoagulation for cerebral venous thrombosis with subarachnoid hemorrhage: a case report

To report the success of anticoagulation [AC] treatment in a case of cerebral venous thrombosis [CVT] with subarachnoid hemorrhage [SAH] in view of the limited evidence seen in the literature supporting such a treatment option. A 38-year-old lady with CVT and SAH presented 12 h after the onset of symptoms. AC with low-molecular-weight heparin was started 4 days later, when the repeated brain CT showed regression of the SAH. Heparin was changed to warfarin, and she was asymptomatic over a 12-month follow-up period. In a limited number of small studies, AC has been found to be beneficial for cases of CVT with hemorrhagic complications. The proper time to start AC in such cases was not clearly defined, and a delay of 4-33 days was observed after the onset of symptoms. In cases of spontaneous intracranial hemorrhage [ICH] in general, active bleeding is usually confined to the first 6 h, and chances of hematoma enlargement are higher in the first 24 h. On the other hand, it has been advised to rule out a coincidental vascular malformation and to radiologically confirm regression [or at least non-progression] of the ICH before starting AC. AC for cases of CVT may remain beneficial in the presence of SAH. The time to start AC for CVT with hemorrhagic complications is unclear; however, AC was successful when given 4 days after the onset of symptoms in our case. It may be wise to repeat CT after at least 24 h from the onset of symptoms [to confirm regression or at least non-progression of the ICH] before starting AC. It may also be prudent to perform magnetic resonance angiography, or digital subtraction angiography to rule out a coincidental intracranial aneurysm before AC

Pre/post-testing in evaluation of students' gain of content knowledge from a blood and lymph course

There is an increased interest in programme evaluation, especially the definition of goals and the measurement of educational outcomes. To evaluate the student gain of content knowledge in one of phase II modules [blood and lymph] as an institutional self evaluation process. This descriptive study assessed the students' gain of content knowledge of the blood and lymph course via pre- and post-testing. A sample of 214 second-year pre-clinical medical students comprising 114 males and 119 females of the Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman, Sudan participated in the study. Data were analyzed using SPPS, version 15. The t-test [unpaired] was used for the difference of means. Pearson's correlation coefficient was used and P < 0.05 was considered as statistically significant. The mean post-test score [7.99/12, SD = 2.17] was significantly higher [P < 0.0001] than the mean pre-test score [4.64/12, SD = 1.69]. The average normalized gain [gain score] is 0.83. There is no statistically significant difference in the pre-and post-test scores between male and female students [P=values: 0.838 and 0.328]. The curriculum content of the blood and lymph course is effective in increasing students' knowledge about the haemopoietic system. Gender difference of students or instructors does not affect students' gain. We believe that other institutions should consider the use of pre- and post-test as a useful direct method of programme evaluation

Major lower limb amputation in diabetics

Lower limb amputation is one of the most feared complication of diabetes mellitus. It is associated with a high mortality rate and a considerable loss of walking ability and independence among survivors. This study was set to review the indications and outcome of major lower extremity amputation [LEA]. This is a prospective hospital based study conducted in Khartoum Teaching Hospital and Jabir Abu El Iz Diabetic Centre [JADC] during the period of July 2002 to January 2003. Consecutive seventy diabetic patients who underwent major LEA during the study period were included. Their age ranged between 35-92 years with a mean age of 61 years +/- 12. The male to female ratio was 1.5:1. Ninety six percent [96%] had Type 2 diabetes mellitus. Fifty two patients [74%] had transtibial amputation and 18 [25%] had transfemoral amputation. The indications for major LEA were intractable sepsis in [80%], foot gangrene [44%] and extensive tissue loss [18%]. The most frequently encountered post-operative complication was wound infection in 11 patients [15.7%] followed by ischaemia of the stump in 6 patients [8.7%]. The rate of postoperative complications was significantly higher in patients who underwent transfemoral amputation. Transtibial is the main type of major lower extremity amputation. The most common indication of major LEA is intractable sepsis, followed by gangrene of the foot then various combinations of sepsis, gangrene and extensive tissue loss. Transfemoral amputation is associated with higher rates of complications, re-operation, delayed healing and mortality

Renal cell carcinoma and acquired cystic disease of the kidneys in a patient on long term haemodialysis

A 65-year-old male Sudanese with end stage disease renal failure [ESRD] on regular haemodialysis [HD] for 5 years developed a painful swelling of his left kidney, which increased in size over a short period of time. He is anaemic and has acquired cystic disease of his native kidneys. Surgical removal and histology proved renal cell carcinoma [RCC]. This is the first case to be reported from Sudan, in a series of 350 haemodialysis patients over the last 14 years

screening for diabetic nephropathy in diabetes clinic in Khartoum- Sudan

Diabetes mellitus and its complications is one of the major health problems. This study is about the screening for one of these complications -diabetic nephropathy- in our clinical practice in Khartoum Sudan. The main objective is to determine whether the clinical practice in the diabetes clinics in Khartoum- Sudan is following the recommended guidelines for the screening for diabetic nephropathy. Prospective cross- sectional study. Populations: during the period from Jan-March 2008, 98 diabetic patients with type 1 or type 2 were randomly selected from patients attending the outpatient diabetes clinic in Omdurman Teaching Hospital. Methodology: ninety eight adult type1 and 2 diabetic patients were studied using simple, direct, standardized questionnaire, previous records were seen and a urine sample for each patient was examined for proteinuria. 6.1% of the total number of patients had urine examination on regular bases, 75.5% rarely had urine examination, while 18.4% had their urine never been examined before in the diabetes clinics. None of patients was diagnosed as having diabetic nephropathy or seen by a nephrologist. Only 7.1% of the total patients were using ACE inhibitors or ARB agents and these were prescribed for indications other than diabetic nephropathy. Testing urine of our patients we found that 18.4% had macroalbuminuria, 40.8% microalbuminuria, while40.8% had negative results. The majority of the patients with either type of albuminuria were in the age group 51-65 years and most of them had type 2 diabetes. A large number of our patients had evidence of diabetic nephropathy. However, none of them had been screened before for that. Despite the small number of patients, this study raises a serious alarm regarding the clinical practice in our diabetes clinics in Khartoum Sudan and it strongly recommends urgent intervention by the authorities to implement the international guidelines of screening and management of these patients

Incidence of ventricular arrhythmias, brady-arrhythmias and sudden cardiac death in Sudanese patients with acute myocardial infarction

Ventricular arrhythmias [VAS], including ventricular tachycardia [VT], ventricular fibrillation [VF] and Brady-arrhythmias, are life-threatening complications of acute myocardial infarction [MI]. To study the incidence of ventricular arrhythmias, brady-arrhythmias and Sudden Cardiac Death [SCD] in Sudanese patients with acute MI. This is a prospective cross sectional, hospital based study, conducted at Elshaab Teaching Hospital Khartoum Sudan. One Hundred Sudanese patients with acute MI were enrolled in the study in the period between August 2006 and December 2006. A questionnaire was constructed in sections to address the different aspect of the study group. ECG Monitor was used to confirm the complication in every patient. Of the study group forty seven [47%] patients were 55-65 years old, twenty eight [28%] were more than 65 years old and twenty five [25%] were less than 55 years old. Sixty nine [69%] were males. Twenty patients [20%] developed complications [ventricular arrhythmias [VAS], Brady-arrhythmias and SCD]. The incidence of ventricular arrhythmias, brady-arrhythmias and sudden cardiac death following acute myocardial infarction were significantly high in Sudanese patients. The increased incidence is even in all age groups. DM, smoking and past history of IHD are the commonest associated risk factors. Thrombolysis is under used and had no significant impact

[ role of television touristic programs in touristic acculturation for university students]

Research problem can be formed in the following main inquiry: what is the role of television touristic programs in touristic acculturation for university students? It aims at identifying objectives of television touristic programs in touristic acculturation of universities students and role played by television touristic programs in touristic acculturation field. This study is considered from descriptive studies depending on survey methodology by its two parts the analytic and field. The analytic study sample included a comprehensive survey for all touristic programs presented in the following channels: the first, the second, the third Egyptian satellite, international Nile channels and that through one year [2006], the field study was conducted on regular random sample of Egyptian universities' students of theoretical and practical faculties, the study used the following tools: questionnaire of analyzing content of touristic programs in T.V. and questionnaire from the universities' students. The study concluded that the most important touristic programs objectives is touristic acculturation and the most touristic programs in all television channels take less than 5 minutes. There are statistical significant differences on touristic acculturation questionnaire in favor of males. There are statistical significant differences on those exposed and not exposed to touristic materials in favor of those exposed to touristic programs in television and that on touristic acculturation scale

Effectiveness of day-case surgery in urology: single surgeon experience

To evaluate the feasibility and cost effectiveness of day-case and short stay surgery in urology. Retrospective. Urology Unit, Ibn Al Nafees hospital. A retrospective study of 300 patients operated upon at Ibn Al Nafees Hospital as day-case and short stay surgery between January 2003 and December 2005. The majority of these patients had intermediate or minor procedures, but few had major procedures. Two hundred andrological procedures, for impotence 96, infertility 76 and 28 vasectomy reversal were done as day surgery together with all the minor urological procedures; most of these patients went home few hours after surgery. Twenty major [47%] procedures needed to stay a little longer especially in open kidney surgery. Day-case and short stay surgery in urology is feasible, and cost effective especially in private setting. In this study, most patients left the hospital few hours after the surgery

Effect of the organophosphate [curacron] on activity of acetylcholinesterase in different parts of rat brain [in vivo studies]

Curacron profenofos is 0-[4-Bromo-2 chlorophenyl]-O-ethyi-S-propyl phosphorothioate. Its chemical formula C11H15BrCIO3PS. It is a broad-spectrum organophosphorous insecticide for control of pests in cotton growing areas. Inhibition of acetyi and pseudocholinesterase by this compound results in signs and symptoms of toxicity signs and symptoms [cholinergic syndrome]: bradycardia, respiratory-circulatory arrest, vomiting and diam'iea in a variety of animals including man. In this work experiments were carried out in vivo to study its effect on the activity of AChE enzyme obtained from whole and five different parts of rat brain, namely basal ganglia, frontal cortex, medulla oblongata, pons, and cerebellum. This work was carried out by 2 experiments: Exp. A: Depending on the dose of intraperitoneal infusion of curacon. Exp. B: Depending on the time course post infusion of a constant dose of curacron 100 mg/kg BW [dose causing 50% inhibition] in vivo. The results showed that the inhibition occurred in all brain parts, but it was highly marked in the enzyme obtained from the cerebellum [the part responsible for balance and coordination of movements]. The results also indicated that the inhibition of AChE produced by i.p. injection with curacon was dose and time dependent

Effect of two different levels of intra-abdominal pressure on hemodynamics during short pediatric laparoscopic procedures

Objective: the purpose of this study was to compare the adverse hemodynamic effects that occur during diagnostic laparoscopic procedures in children by using two different levels of intra-abdominal pressure [6 mmHg and 12 mmHg]

Study Design: a randomized controlled study, was conducted during the period from June 2004 till January 2006, on twenty children [4-12 years] scheduled to undergo laparoscopy for diagnosis of non-palpable unilateral or bilateral testis

Setting: department of Anesthesiology and Pediatric Surgery, Assiut University Hospital, Assiut, Egypt

Subjects: twenty male children [ASA I-II] scheduled for diagnostic laparoscopic surgery under general anesthesia were included in the present work

Interventions: children were classified into two groups [according to the intraabdominal pressure, IAP], group I [n=10] with IAP 6mmHg, and group II [n=10] with IAP 12 mmHg. Noninvasive hemodynarnic changes [including HR, MAP, SVI, CI, EF, and SpO2] were measured in both groups, in the supine position, at three time points: before insufflation, ten min after insufflations [before starting surgery], and ten min after deflation of the abdomen

Results: HR and MAP increased significantly [P<0.05] after insufflation, Then HR and MAP decrease significantly [P<0.05] and returned to near the base line values, after deflation in both groups. CI increased significantly [P<0.05] after insufflation from a base line value 3.70 +/- 0.14 to 4.11 +/- 0.34 in group I, but decreased significantly from a base line value of 3.73 +/- 0.21 to 3.67 +/- 0.31 in group II. Then after deflation, the mean value of CI decreased significantly [P<0.05] to 3.71 +/- 0.26 in-group I and increased significantly [P<0.05] to 3.74 +/- 0.17 in-group II. The effects on SVI were nearly similar to that on CI, while EF and SpO2 were insignificantly affected

Conclusions: this study concluded that low-pressure CO2 pneumoperitoneum [with IAPs not exceeding 6 mmHg] for diagnostic laparoscopic surgery in children has adequate safe, if not luxurious, surgical visualization and exposure