Health-Related Quality of Life in Sudanese Children with Nephrotic Syndrome: A Comparative Cross-Sectional Study.

Background: Nephrotic syndrome (NS) is an essential chronic disease in children that has a major impact on a child's health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL of Sudanese children with NS and clinical parameters that can influence their HRQoL. Methods: This study was a descriptive cross-sectional of children with NS conducted in Khartoum state hospitals. A standardized PedsQLTM 4.0 Scale Score evaluated the HRQoL of the participants. Patients' socio-demographics, clinical data, and disease complications were collected using a data collection sheet. This study assessed the HRQoL of children with NS and compared it with apparent age and sex-matched to three groups (healthy children, children with chronic diseases, and kidney-transplanted children). Results: 80 children with NS were recruited from April to August 2021. Children over eight years old represented (63.8%) of the study subjects. The total mean HRQoL scores of nephrotic children were significantly lower than those of healthy children (78.46 ± 24.01) (p = 0.001) and those with other chronic diseases (78.45 ± 24.01) (p= 0.006); however, it was not significantly different from those with kidney transplantation. Socio-demographics did not significantly affect the total mean HRQoL scores of children with NS. Clinical parameters such as the duration of illness, "less than one year" (p= 0.006), and the minimum change nephropathy histopathology (p= 0.035) significantly lowered the total mean HRQoL scores of NS children. Regression analysis further confirmed that edema, proteinuria, and hospital admission had a high impact on the total mean HRQoL. Conclusion: The total mean HRQoL scores of children with NS were low and significantly lower than healthy children. Parameters such as the patient's socio-demographics and phenotype of NS had no significant effect on the total mean HRQoL scores of children with NS. However, other clinical parameters significantly lowered their total mean HRQoL scores.

Epilepsy classification (ILAE Classification 2017) in resource-limited countries: A cross-sectional study on epilepsy in pediatric patients from Sudan

Background: The objective of this study is to utilize the ILAE 2017 to classify epilepsy patients and determine its applicability in Sudan. Methods: This study is a prospective, descriptive, cross-sectional research conducted in two pediatric epilepsy clinics in Khartoum State, Sudan. Results: In this cross-sectional study, 350 pediatric patients with epilepsy were included, with a mean age of 8.4 ± 4.7 years and a mean illness duration of 4.71 ± 3.91 years. The ILAE classification was applied, showing that 71.11% of patients had generalized onset seizures, 27.7% had focal onset seizures, and only 1.1% had unknown onset seizures. Among patients with focal onset seizures, 56.4% had intact awareness, while 43.6% had impaired levels of awareness. The majority of patients who had generalized onset seizures experienced motor onset seizures, with tonicclonic seizures being the most common (44.2%). Nearly all patients with unknown onset seizures experienced tonic-clonic convulsions. These findings provide insights into the prevalence and types of seizures among pediatric epilepsy patients in Sudan and can guide clinicians in developing appropriate treatment plans. Conclusion: This study highlights the importance of utilizing the latest ILAE classification 2017 in epilepsy classification and its potential utilization in resource limited areas like Sudan.

Molar incisor hypomineralization, prevalence, pattern and distribution in Sudanese children.

BACKGROUND: Molar incisor hypomineralization (MIH) has serious impact on oral health-related quality of life for a child, due to its effects on tooth structure, aesthetics and behavior of the child. The current study was designed to determine the prevalence, pattern and distribution of MIH in school children in Sudan. METHODS: This was a descriptive cross-sectional study involving 568 children, aged 8-11 years from schools in Khartoum State. Following the collection of their socio-demographic data, the children were examined for hypomineralization on the 12 MIH-index teeth, the pattern and distribution of the MIH. The data collected was analyzed to obtain descriptive statistics. The results related to the socio-demography and other dental-related factors were tested using chi-square test and Spearman Rank Correlation, with the significant level set at p < 0.05. RESULTS: The prevalence of MIH in the study population was 20.1%. The majority of the participants had both permanent first molars (PFMs) and permanent incisors affected (12.5%). However, in 7.6% of the cases only molars were affected. Even though more maxillary teeth were affected when compared to the mandibular teeth, there was no statistical significant difference between the occurrence of hypomineralization on mandibular and maxillary molars (p = 0.22). Maxillary incisors were significantly more affected by MIH when related to the mandibular ones (p = 0.00). Demarcated opacities were the commonest pattern of MIH defects (69.9%) in the experimental group. CONCLUSION: The prevalence of MIH in Sudanese children was 20.1%. In both dental arches, the permanent molars and incisors were frequently affected, with the demarcated opacity type of MIH being the most common form of defect.

The quality of life among Sudanese children with epilepsy and their care givers.

In the past few years, there has been a progressive increase in appreciation of the importance of quality of life (QOL) especially among patients with epilepsy. This issue had not been addressed in Sudanese children with epilepsy. We here aim to assess the quality of life in Sudanese children with epilepsy and their family care giver. This study was conducted in 2011 at the Epilepsy and Neurodisablity Out-patient Clinic at Saad Abualila University Hospital, Sudan. The study included 100 Children with epilepsy, and their care givers, whose age was between 6-18 years and had seizure for more than one year. The questionnaire used contains 27 questions; it was divided into four sections: impact of epilepsy and treatment, impact on the child development, impact on parents and impact on the family. For each question there were two dimensions: the frequency of the problem and the concerns that it causes. The total score ranges from 0 to 54. A combined total scale scores were calculated. The commonest concern regarding epilepsy was that the child may injure oneself, followed by that the child may stop breathing or develop brain damage or even die. The commonest concern regarding treatment was that medication may cause reduced alertness. The relevant mean scores in frequency and concern were 5.77 and 5.83 out of 10 respectively. In the child development domain, the commonest concern was that the child may become more moody and the related mean scores in frequency and concern were 9.36 and 9.32 out of 18. The commonest concern to parent was decreased ability for self care with relevant mean scores in frequency and concern of 3.14 and 3.16 out of 10. The commonest concern to the family was that the child needs to be more closely watched than other children. The mean scores here in frequency and concern were 5.37 and 5.44 out of 14. The group with epilepsy and associated co morbidities, longer seizure and treatment duration had consistently higher mean scores which were proved to significantly lower their QOL. There is a significant decline in the quality of life among Sudanese children with epilepsy and their family care giver. Psychosocial consultation, family support programs and health education for parent, teachers and publics about different aspects of epilepsy need to be addressed through mass media.

Occlusal characteristics of primary dentition in sudanese children in khartoum state / Características oclusais da dentição decídua em crianças Sudanesas do Estado de Khartoum

Background: Occlusal relationships in the primary dentition play an important role in the consequential final occlusion in permanent dentition. Therefore, good knowledge of occlusal relationships in children is essential for dental practitioners. Design: A descriptive, cross-sectional study done in randomly selected kindergartens in Khartoum State to determine the occlusal characteristics of primary dentition in a group of Sudanese children. Objective: To determine the occlusal characteristics feature of primary dentition in a group of Sudanese children. Methods: A sample of 381 children age 3-5 years old, randomly selected from kindergartens in Khartoum Stat. Clinical examination was done to all children fulfil the inclusion criteria in the teacher office and in natural day light. Prevalence of different types of terminal plane, types of primary canine relationship and spacing of the primary dentition were assessed. Results: Flush terminal plane was the most prevalent type of terminal plane (72.2%). Class I canine relationship was the most common type of primary canine relationships (95%). In the upper arch primate space and physiological spaces were present in 90.3% and 82.4% of the children, respectively. Nevertheless, the lower arch showed primate spaces in 70.1% and physiological spaces in 74.8% of the children. Conclusion: Large number of the examined children had flush terminal plane and spacing primary dentition that forecasts development of normal occlusion in their permanent dentition

Introdução: As relações oclusais na dentição decídua desempenham um papel importante na oclusão final, na dentição permanente. Portanto, um bom conhecimento das relações oclusais em crianças é essencial para os cirurgiões-dentistas. Foi realizado um estudo descritivo , transversal, em creches selecionadas aleatoriamente no estado de Khartoum (Sudão) para determinar as características oclusais de dentição decídua em um grupo de crianças sudanesas. Objetivo: Determinar as características oclusais de dentição decídua em um grupo de crianças sudanesas. Métodos: Uma amostra de 381 crianças com idade entre 3 e 5 anos foram selecionados aleatoriamente a partir creches no estado de Khartoum. O exame clínico foi feito em todas as crianças cumpriram os critérios de inclusão, na sala dos professores sob luz natural do dia. Foram avaliadas a prevalência dos diferentes tipos de plano terminal, tipos de relação canina e espaçamento da dentição decídua. Resultados: O plano terminal em topo foi o tipo mais prevalente de plano terminal (72,2%) . A relação canina de Classe I foi o tipo mais comum de relacionamentos nos caninos decíduos (95 %). Os espaços primatas e fisiológicas nos arcos superiores estavam presentes em 90,3% e 82,4 % das crianças , respectivamente. No entanto, os arcos inferiores mostraram espaços primatas em 70,1% e espaços fisiológicos em 74,8% das crianças. Conclusão: Grande número de crianças examinadas tinham plano terminal em topo e espaçamento dentição decídua, o que pode predizer um desenvolvimento da oclusão normal na sua dentição permanente.

Pattern and outcome of renal diseases in hospitalized children in Khartoum State, Sudan.

In developing countries, renal diseases in children constitute important causes of morbidity and mortality. In Sudan, data about patterns and outcome of these disorders is generally scanty. We conducted this study to provide basic renal data that may be utilized by researchers and health planners in a resource poor setting. A retrospective record review of all pediatric patients, followed in four teaching hospitals in Khartoum State over a five-year period (January 2000-June 2004), was achieved. In 150 hospitalized children a total of 200 renal diagnoses were recorded. Urinary tract infection (UTI), occurring with other underlying renal morbidities or isolated, was the commonest renal diagnosis (20%). The second common renal disorders were nephrotic syndrome (NS) and urolithiasis/stones accounting for 16% and 15.5% of cases, respectively. Acute glomerulonephritis (AGN) and congenital anomalies were relatively less common (12% and 10.5%, respectively). Other less frequently detected diseases were acute renal failure (ARF) in 6%, chronic renal failure (CRF) in 4%, hereditary nephropathies in 3.5% and renal tumors in 2.5%. There was a significant correlation between the pattern of renal diseases and age of patients (P =0.001) but not their gender or social class (P = 0.211 and 0.34, respectively). On follow up, 99 out of 150 patients (66%) recovered their normal renal function, 6/150 (4%) remained with persistent proteinuria, 30/150 (20%) progressed to CRF, 10/150 (6.7%) died, and 5/150 (3.3%) were referred to radiotherapy department for further management. Our data reflects geographical variations of patterns of renal diseases in Sudanese children as in other countries. Many of these diseases are preventable or potentially curable. Therefore, improvement of pediatric renal services and training of health workers would help in early detection and treatment of these conditions leading to reduction in their morbidity and mortality.

Acute phase reactants in Sudanese children with severe protein-energy malnutrition.

The pre-dietary rehabilitation levels of acute phase proteins (APP) namely, alpha-1-antitrypsin (AAT), orosomucoid (ORO), haptoglobin (HAP), fibrinogen (FIB) and C-reactive protein (CRP) in the plasma of Sudanese children with severe protein energy malnutrition (PEM) were compared with those of normal controls, and with the levels after dietary rehabilitation. Eighty one children were included in the study; 49 with severe PEM (23 with marasmus, 17 with marasmic-kwashiorkor and 9 with kwashiorkor), 13 with tuberculosis (TB) and 19 healthy children as controls. The study showed a high incidence of infections, especially acute respiratory infection (ARI), diarrhoeal diseases and intestinal parasites in the malnourished children. The mean plasma level of albumin was significantly lower in the malnourished children compared to controls (P<0.001), with kwashiorkor children showing the lowest mean level. This hypoalbuminaemia was significantly associated with the presence of ARI and intestinal parasites. The mean plasma levels of the APP, except FIB, were significantly higher in malnourished children than in controls, with higher levels associated with ARI and the presence of fever. Malnourished children with TB had significantly higher mean levels of the APP (AAT, HAP, FIB, CRP) compared to those without TB. The mean levels of HAP and AAT were significantly lower in the presence of diarrhoea, suggesting their loss in the stool. The mean levels of the APP after two weeks dietary rehabilitation and antimicrobial treatment showed a significant drop in only two of the APP, namely CRP, ORO, while FIB showed a significant rise.

Infection and immunoglobulin levels in Sudanese children with severe protein-energy malnutrition.

A hospital-based case control study was carried out to determine the pattern of infections and immunoblobulin levels in Sudanese children with severe protein energy malnutrition (PEM). The pre-dietary rehabilitation levels of the three major immunoglobulins (IgG, IgA and IgM) were compared with those of normal controls, and with the levels after dietary rehabilitation. Eighty one children were included in the study: 49 with severe PEM (23 with marasmus, 17 with marasmic - kwashiorkor and 9 with kwashiorkor), 13 with tuberculosis and 19 healthy children as controls. The study showed high incidence of infections, especially pneumonia and gastrointestinal infections in the malnourished children. Of special concern was the high incidence of urinary tract infection: 13 (26.5%) had significant pyuria and 9 of them had positive urine cultures, mainly Escherichia coli. Eight of the malnourished children also had pulmonary TB, and the ESR and Mantoux tests were not helpful in the diagnosis. The Mantoux test was negative in 88.8% of the malnourished group compared to 62.5% in those malnourished with TB. The malnourished groups had significantly higher plasma levels of the 3 immunoglobulins. While the maramic group attained significantly higher levels of IgG and IgA compared to the marasmic -kwashiorkor and kwashiorkor groups, the 3 groups of PEM showed a uniformly higher level of the IgM. After 2 weeks of rehabilitation, the levels of the 3 immunoglobulins showed no significant changes, except for the IgA which significantly decreased in all malnourished and the oedematous groups, and the IgM which increased significantly in the oedematous group.

She wants it done.

OBJECTIVE: To compare ear piercing practices and complications arising therefrom in British and Sudanese children and to seek possible ethnic, cultural and environmental differences. SETTINGS: Maelor General Hospital, Wrexham, UK and Wad Medani Children Hospital, Wad Medani, Sudan. METHODS: Parents of a hundred British children and an equal number of Sudanese parents were requested to fill a questionnaire on ear piercing. All children were examined for possible local or systemic complications. RESULTS: All parents answered the questionnaire. Eighty-eight (88%) of the British children were girls while all Sudanese children (100%) were girls. Eighty (80%) of the British children had had their ears pierced before they were 6 years old while 90% of Sudanese children had had their ears pierced below that age. The procedure was performed in both groups by non-medical staff. Local inflammation and allergic contact reactions were the commonest complications in both groups. Keloids were only encountered in the Sudanese children. A case of tetanus was encountered in the Sudanese group. CONCLUSION AND RECOMMENDATIONS: Ear piercing in both communities is performed at a very early age. This procedure is not without complications and the medical profession should advise safety in this practice. Earrings selected should be of non-allergenic material. Regular application of an antiseptic to the site should be encouraged. The community should be made aware of the hazards and complications of ear piercing. With the awareness of these complications and guided with a set of rules, people may continue the practice (she may have it done). Health authorities in Sudan should formulate guidelines that will ensure hygienic measures and reduce complications.