Ocular disorders among schoolchildren in Khartoum State, Sudan

From December 2005 to June 2007, a total screening of all 1418 government primary schools in Khartoum State, Sudan, was performed to estimate ocular problems among children aged 6-15 years. We screened 671 119 children [56.7% males] for significant refractive error and other eye ailments. Ocular problems were found in 20 321 [3.03%] children. The 3 localities with highest ocular pathology were Karary [26.2%], Ummbada [21.0%] and Jabal Awlia [15.7%]. The overall prevalence of refractive error was 2.19%. Myopia was found in 10 064 [1.50%] children while 4661 [0.70%] were hyperopic. Other ocular problems included vernal keratoconjunctivitis, vitamin A deficiency, microbial conjunctivitis, strabismus and corneal opacity. Only 288 [0.04%] children were diagnosed with active trachoma: 86.5% of these were from Ummbada locality, on the periphery of the State, where transportation facilities are poor and poverty is widespread. Overall, 99% of the eye ailments identified are either treatable or preventable. To reduce these and to achieve the goals of Vision 2020, an effective and efficient school health programme is needed

Factors associated with patient delay in accessing pulmonary tuberculosis care, Gezira State, Sudan, 2009

Analyses of patient delays in seeking treatment for tuberculosis [TB] provide useful evidence for national TB control programmes. The objectives of this study in Gezira State/ Sudan were to estimate the extent of, and factors associated with, pulmonary TB patient delay in accessing care. A cross-sectional phase was conducted to determine the length of delay, followed by a nested case-control phase comparing patients delaying above or below the median time. The mean patient delay was 27.2 days, median 4 days [range 0-365 days]. There were no significant differences between case and control groups in terms of age/ sex, marital status, educational level or smoking status. However, patients living in urban areas, with low income status and who were housewives or unemployed were more likely to delay. Also patients with a history of contact with a TB patient, those who suspected TB and those with a history of chronic obstructive pulmonary disease were more likely to delay

Antibodies against merozoite surface protein 1 and 2 in Sudanese children

Malaria is a serious childhood disease causing high morbidity and mortality despite control measures. Immunological control against malaria was initiated early, and immunity acquired by children in endemic areas, which is age and exposure dependant, differs in different endemic settings. The objective of the study was to determine antibodies against Merozoite surface protein-1 [MSP-I] and Merozoite surface protein-2 [MSP-2], and to determine their relation to the age of Sudanese children. The study was descriptive, cross-sectional, conducted in Khartoum Children Emergency Hospital [KCEH]. 150 children with positive blood films for P. falciparum malaria were classified according to age, and a blood sample was taken from each one, and tested for antibodies against MSP-I and MSP-2. Antibodies to MSP-I and MSP-2 were 46% and 42% respectively. Sero-positivity and sero-negativity for both antigens were 26.6% and 42.7% respectively. Seropositivity to either MSP2 or MSPl antigen alone was present in 18.7% and 12% of patients respectively. High seropositivity [52.9%] was found in the age group 12-15 years of age. MSP-1 and MSP-2 antibodies in Sudanese children according to this study were age dependant, and findings were similar to what had been reported in some African countries

Evaluation of serum fetuin-A: relationship with endothelial dysfunction in hemodialyzed patients

The aim of this study was to evaluate the association between serum fetuin-A concentrations and endothelial dysfunction in hemodialyzed [HD] patients. 85 patients on regular HD [55 males and 30 females] and 30 healthy controls [17 males and 13 females] were studied. We measurd serum fetuin-A by enzyme-linked immunosorbent assay. Assessment of endothelial dysfunction by measuring common carotid artery intima media thickness [CCA-IMT] and intima media thickness-inhomogeneity using high-resolution ultrasound. In addition, C-reactive protein [hsCRP], serum calcium, phosphate, intact parathyroid hormone [iPTH], albumin, total cholesterol, triglycerides, high density lipoprotein cholesterol [HDL-C], low density lipoprotein cholesterol [LDL -C] and fasting blood sugar were performed. Compared with controls, HD patients had a lower levels of serum fetuin - A, higher levels of CRP and 'iPTH, a greater CCA-IMT as well as CCA-IMT-inhomogeneity. Dialysis patients with cardiovascular disease [CVD] had a greater CCA-IMT and IMT-inhomogeneity compared with patients without CVD. IMT-inhomogeneity strongly correlated with IMT. In multiregression analysis, serum fetuin-A correlated with IMT-inhomogeneity but not with IMT, and hsCRP neither correlated with IMT-inhomogeneity nor with IMT. In conclusion, serum fetuin-A concentrations were decreased in HD patients and may be one of the contributing factors for the development of endothelial dysfunction in these patients

Propofol/Remifentanil TIVA provides superior recovery parameters over Propofol / Sevoflurane anesthesia in children

This study aimed to evaluate the applicability of remifentanil-based anesthesia in comparison to sevoflurane-based anesthesia in 60 children assigned to undergo lower abdominal extra-intestinal surgical procedures, Patients were randomly allocated into two equal groups: Propofol/Remifentanil [PR group] or Propofol/Sevoflurane [PS group]. All patients were premedicated using oral midazolam with a maximum dose of 15mg, ondansteron [100 microg/kg] and dexamethasone [0.25-0.5 mg/kg]. In PR Group, anesthesia was induced with propofol 3 mg/kg followed by remifentanil 1 microg/kg; during surgica procedure further injections of remifentanil 0.5 microg/kg were given depending on whether the patient moved or showed signs of awakening in response to skin incision or during the procedure. In PS group; anesthesia was induced with a sleep dose of propofol [3-5 mg/kg] and was continued with 2%-8% sevoflurane and 66% nitrous oxide in oxygen. The minimum sevoflurane concentration used was 2% and was increased up to 8% if the patient moved during skin incision or the procedure. During anesthesia, patients were non-invasively monitored and the times of the start of anesthesia, of the start of the procedure and the time of the end of the procedure and the occurrence of movement during the procedure were noted. During recovery, children were left undisturbed, being called every minute until they first opened their eyes. Anesthetic recovery and distress behavior were assessed using recovery and distress scoring systems. The times at which children first opened their eyes, interacted spontaneously, drank, ate and were ready for discharge from the recovery ward and the hospital were recorded. Incidence of adverse events; hypotension, bradycardia and postoperative nausea and vomiting were monitored throughout the study period. Time till the start of anesthesia was significantly shorter, while time till start of the surgical procedure was non-significantly shorter in PR group compared to that recorded in PS group. Eleven patients; 7 in PS and 4 in PR groups showed minor movement during procedure with a non-significant difference between both groups. All patients were hemodynamically sable throughout the duration of surgery till skin closure and in PACU with a non-significant difference between both groups. Patients included in PR group showed superior emergence off anesttiesia compared to PS group in the form of significantly shorter time to respire spontaneously, to eye opening and to verbalization. Moreover, patients received remifentanil showed significantly shorter time till drinking and eating with significantly shorter PACU and hospital stay in comparison to PS group. Number of patients required rescue analgesia despite increased in both groups, did not show a significant difference. Moreover, mean DS was non-significantly higher in PR group compared to PS group. The incidence of adverse events did not reach the significance level. It can conclude that remifentanil is appropriate for opioid-based anesthesia for children for its provided shorter anesthesia times, hemodynamic stability and rapid recovery characteristics however, attention must be paid for prophylactic antiemesis and proper postoperative analgesia

Anesthesia for laparoscopic cholecystectomy in cirrhotic patients: a comparison of sevoflurane versus isoflurane

This study aimed to compare the effect of anesthesia using isoflurane [ISO] or sevoflurane [SEVO] in conjunction with nitrous oxide on postoperative liver function tests in 30 cirrhotic patients [Child-Pugh Grade A] assigned to undergo laparoscopic cholecystectomy [LC]. Anesthesia was maintained with either sevoflurane [SEVO group] or isoflurane [ISO group] with nitrous oxide 3 L/min in oxygen 3 L/min. Non-invasive intraoperative monitoring included heart rate [HR], systolic and diastolic blood pressure [SBP and DBF] estimated before induction of anesthesia [T[1]], 5 min. after insufflation [T[2]], 5-min after tilting in reverse Trendlenburg position [T[3]] and after exsufflation of CO2 [T[4]]. Venous blood samples were taken for estimation of serum levels of aspartate [AST] and alanine [ALT] aminotransferases, total bilirubin [TB] and alkaline phosphatase [AP] before and I, 3, and 7 days after surgery. Another venous blood samples were taken at time of induction of anesthesia, at, 2-hrs and 24-hrs after the end of surgery for estimation of serum levels of a-glutathione S-transferase [GST]. The formation of the lidocaine metabolite monoethylglycinexylidide [MEGX Test] was estimated preoperatively and immediately postoperative. All patients developed significantly higher HR, SBP and DBF at T[2] and T[3] compared to at T[1] with a significantly higher measures at T[3] compared to at T[2], but measures recorded at T[4] were significantly lower compared to that recorded at T[2] and T[3] in both groups with a significantly lower blood pressure in ISO group and non-significantly lower blood pressure measures in SEVO group compared to measures recorded at T[1]. Postoperative serum AST and ALT levels were significantly higher compared to preoperative levels in both groups reaching a peak at 3-days PO and declined on the 7[th] PO day with significantly higher levels in ISO group compared to SEVO group at 3-day and 7-day PO. Serum GST levels estimated at and 2-hrs after end of surgery were significantly higher in both groups compared to levels estimated at time of induction of anesthesia with significantly higher levels at 2-hrs compared to levels estimated at end of surgery in both groups, but was significantly higher in ISO group compared to SEVO group. Postoperative serum MEGX levels were significantly lower in both groups compared to levels estimated at time of induction of anesthesia with a nonsignificant difference between both ISO and SEVO group. It could be concluded that LC in cirrhotic patients performed under sevoflurane anesthesia supplemented by NO[2] is a feasible safe procedure with less postoperative impairment of liver function tests in comparison to isoflurane anesthesia and serum GST and MEGX are useful early biomarkerfor liver dysfunction that precede enzymes alteration in cirrhotic patients undergoing LC

Laparoscopic cholecystectomy in cirrhotic patients: is it safe?

Fifteen patients [9 females and 6 males] with cirrhotic liver, all Child A, were subjected to laparoscopic cholecystectomy over an 18 months period. The mean age was 43.6 years. Chronic calcular cholecystitis and its manifestations were the main indication in all but three cases of acute cholecystitis. Problems in obtained superior retraction of the liver were encountered and solved along the course of the study either by the introduction of an additional port just below and to the left or the xiphisternum to allow superior retraction of the fundus of the gallbladder or by retraction of the liver by a blunt instrument through the lateral port. In seven cases, difficulty in hemostasis was encountered. In four cases [26.6%] of these, hemostasis was achieved by packing while in the remaining three cases [20%] conversion to open cholecystectomy was necessary due to uncontrollable bleeding. The mean operation time was 72.7 minutes with 12 [80%] patients discharged within 24 hours, the remainder being discharged on the seventh postoperative day. No operative or postoperative mortality was reported. In conclusion, laparoscopic cholecystectomy is at least as safe as open cholecystectomy in cirrhotic patients and may thus carry the hope for cirrhotic patients to be operated upon with a reasonably good outcome provided that problems related to secure hemostasis are properly dealt with

Endoscopic therapy versus surgery in dealing with acute persistent bleeding peptic ulcers: a pilot study

By comparing the therapeutic endoscopy group to the medical group, a statistically significant difference between the 2 groups was found, favoring the former group in the following parameters: Mean number of days of hospital stay, which was 9.38 +/- 4.7 in endoscopic therapy group versus 21.89 +/- 8.2 in the surgical group [p <0.001], hospital cost, which was 11023 +/- 5382.9 US$ in the former group vs. 46610 +/- 2859.9 US$ in the latter group [p <0.001], and the mean number of transfused blood units required in the endoscopic therapy group was 5.2 +/- 2.7 whereas in the surgical group it was 10.94 +/- 4.78 [p <0.001]. The percentage of failure in the therapeutic endoscopy group was statistically insignificant [3 out of 26, 11.5%, p >0.05] as compared with the surgical group, and there were no mortalities in the former group. So, endoscopic therapy in the form of heater probe or bicap probe is efficient, safe and superior to the surgical management regarding the following parameters: Days of hospital stay, hospital charges, and units of transfused blood. However, in certain circumstances, when this treatment modality fails, surgical management is the essential treatment modality available

Arthroscopic assisted percutaneous screw fixation of certain tibial plateau fractures

Eighteen patients with tibial plateau fractures were accurately reduced and percutaneously fixed by cancellous screw under arthroscopic control. In six patients bone graft was used. The depression of the articular surface was managed by elevation of subchondral plate through a small window. The post-operative rehabilitation program consisted of early mobilization [on the second postoperative day] and non-weight bearing for at least six weeks. The low complications rate [8%] due to restricted arthrotomy and good early results obtained [80.88%] would seem to justify the use of this technically demanding procedure in carefully selected fractures

Comparative evaluation of combined endoscopic variceal ligation together with low volume sclerotherapy versus sclerotherapy or band ligation alone for bleeding esophageal varices

The subjects of this study were forty six patients presenting with upper GI bleeding due to esophageal varices with unstable vital signs or blood transfusion of >/ 2 units. These patients were randomly assigned to intravariceal sclerotherapy [5% ethanolamine oleate], variceal ligation or combined endoscopic variceal ligation and low volume endoscopic sclerotherapy after resuscitation. Patients had therapy at initial endoscopy and then had weekly sessions until obliteration then follow-up at three months interval. The number of sessions, rebleeding, complications, and treatment failure were reported. Control of active bleeding was accomplished by sclerotherapy in 15 of 17 [88.2%], by ligation in 12 of 15 [80%], and by combined modality in 12 of 14 [85.7%]. Recurrent bleeding was insignificantly lower in both ligation and comibned modality groups. The number of sessions needed for variceal obliteration were significantly lower in both ligation and combined modality groups [4.2 +/- 0.5 and 3.2 +/- 0.6 vs. 6.2 +/- 0.7, P <0.05]. Moreover, the complication rate was significantly higher in the sclerotherapy group. It was also concluded that combination endoscopic variceal ligation together with low volume sclerotherapy results in rapid eradication of esophageal varices with low incidence of complications

Entrapment of musculocutaneous nerve in the upper arm

Nine cases with musculocutaneous nerve entrapment were presented in which the nerve was affected while passing through the substance of coracobrachialis muscle. They were examined clinically, radiologically and electrom-yographically together with laboratory tests to exclude other simulatory factors. All cases were given intensive physiotherapy for the coracobrachialis and the biceps with occasional anti-inflammatory drugs. Great improvement has been achieved except for two cases that received local corticosteroid injection at the coracobrachialis muscle with compete recovery

Closed avulsion of the flexor digitorum profundus tendon of the ring finger

Seven patients had closed avulsion of the profundus tendon. Five of them were treated surgically by tendon grafting and the other two patients were treated conservatively. The results of non operative means were better