Pattern of liver diseases in Sudanese children

No Abstract

Pattern and clinical presentation of constipation in children in Sudan

Background: Constipation represents a common problem in children. The worldwide prevalence of functional constipation in children varies from 0.7% to 29.6%. The aim of this study is to identify common causes of childhood constipation, clinical profiles of functional constipation.Methods: all children less than 16years old who suffered from constipation and attended Gaafar Ibnaouf specialized children hospital and gastroenterology private clinic of one pediatric gastroenterologist between June 2011 and May 2012 were included in this study. Patients wereconsidered having functional constipation if there were no objective evidences of pathological condition, and the rest were termed as organic constipation.Results: a total of 150 children suffered from constipation were seen. (81males), the age was divided into three groups, the majority 96 (64 %) aged between 1-5years, and the least were 12 (8%) aged less than 1year.133 children (88.7%) had functional constipation, while the remaining 17 children (11.3%) had an associated organic disorders, among them 12 children (8%) had Hirschsprung’s disease, 2children (1.3%) had hypothyroidism, 2 children (1.3%) had celiac disease,and 1child (0.7%) had cerebral palsy. The main clinical characteristic of functional constipation were faecal impaction presented in 59.4% of patients, straining in 43%, withholding behavior in 32.3%, soiling in 16.5%, abdominal pain in12% of patients.Conclusions: Functional constipation is the most common cause of constipation in Sudanese children.Keywords: functional constipation, hypothyroidism, Hirschsprung

Original Article Gum Arabic in treatment of functional constipation in children in Sudan

Background: Constipation represents a common problem in children. The worldwide prevalence of functional constipation in children varies from 0.7% to 29.6%.Objective: The aim of this study is to assess the response to Gum Arabic in addition to laxative in management of functional constipation.Methods: All children less than 16 years old who suffered from constipation and attended Gaafar Ibnaouf Specialized Children Hospital and  gastroenterology private clinic of one pediatric gastroenterologist between June 2011 and May 2012 were included in this study. Patients were considered having functional constipation according to Rome III criteria. They were divided randomly into two similar groups. Children in the first group were treated with laxative (lactulose), and those in the second group were treated with Gum Arabic in addition to laxative (lactulose), children in both groups were educated about the process of developing constipation, defecation process and approach to toilet training. All children were seen after 1month and 3 months after treatment, they were rated as successfully treated when they had .3 bowel movements per week, soft stool, no soiling or abdominal pain in the last 3weeks of treatment.Results: A total of 150 children suffered from constipation were seen. (81males), the age was divided into three groups, the majority 96 (64 %) aged between 1-5years, and the least were 12 (8%) aged less than 1year. 133 children (88.7%) had functional constipation, while the remaining 17 children (11.3%) had an associated organic disorders, among them 12 children (8%) had Hirschsprungfs disease, 2 children (1.3%) had hypothyroidism, 2 children (1.3%) had celiac disease, and 1child (0.7%) had cerebral palsy. The main clinical characteristic of functional constipation were faecal impaction presented in 59.4% of patients, straining in 43%, withholding behavior in 32.3%, soiling in 16.5%, abdominal pain in12% of patients. In those who were treated with Gum Arabic, 41/63 (65%) showed improvement at 1st month of treatment and 59/63 (93.6%) at 3rd month of treatment, while those who were treated with laxative alone showed that 34/60(56.66%) improved at 1month of treatment and 48/60 (80%) at 3rd month, with p value <0.025Conclusions: Functional constipation is the most cause of constipation in Sudanese children. Gum Arabic achieved better results than laxative alone in treatment of functional constipation.Keywords: Hirschsprungfs disease, hypothyroidism, faecal impaction

Liver Biopsy: Is it Safe in Children?

Introduction: The blind liver biopsy technique has been widely used in Sudan as the availability of the ultra sound machines and the committed Pediatrics Radiologist were not always at hands. Liver biopsy is an essential tool in the diagnosis of liver diseases and subsequently, initiating the appropriate treatment.Objective: The aim of the study was to observe the safety of blind liver biopsy in our children. Methods: One hundred fifty consecutive liver biopsies in hospitalized children were evaluated retrospectively. Using a standard percussion technique biopsy sites were chosen and through intercostals space blind liver biopsies were performed by TruCut biopsy needle. The study was conducted at Gafaar Ibn Oaf Specialized Children Hospital ,Khartoum Sudan, over the last five years, between January 2005-January 2010 .Results: The first biopsy sample was considered macroscopically adequate in 94.8% of cases. A definitive histological diagnosis was possible in 99.1% of cases. seventy children were more than 5 years of age and of these 8 (11.4%) complained of pain at the biopsy site, external hemorrhage from the biopsy site was seen in 1 (0.6%) case but no sign of internal hemorrhage was detected during the 24 hours follow up period. No child died following the procedure.Conclusions: Blind liver biopsy in the studied hospitalized children was found to be a safe procedure.Key words: Menghini, intercostal, percutaneous, Cholestatic jaundice, hepatomegaly

Analytic and Harmonic Univalent Functions

Studies on analytic univalent functions became the focus of intense researchwith theBieberbachconjectureposed in 1916 concerning the size of the moduli of the Taylor coefficients of these functions. In efforts towards its resolution, the conjecture inspired the development of several ingeniously different mathematical techniques with powerful influence. These techniques include Lowner’s parametric representation method, the area method,Grunsky inequalities, and methods of variations.Despite the fact that the conjecture was affirmatively settled by de Branges in 1985, complex function theory continued to remain a highly active relevant area of research

Erratum to “Regularity theory for time-fractional advection-diffusion-reaction equations” [Comput. Math. Appl. 79 (2020) 947–961] (Computers and Mathematics with Applications (2020) 79(4) (947–961), (S0898122119304055), (10.1016/j.camwa.2019.08.008))

In this note, we correct the statement of Theorem 12 from the paper in the title above (McLean et al., 2020) and fill some gaps in the proof

Application of the Health Belief Model -Based Educational Intervention on Hand Hygiene Performance of Intensive Care Units' Nurses

Background: Practicing hand hygiene is a simple yet effective way to prevent infections. Cleaning hands can prevent the spread of germs, including those resistant to antibiotics and are becoming difficult, if not impossible, to treat. On average, healthcare providers clean their hands less than half of the times they should.Aim of the study: This study aimed to apply the health belief model based educational intervention on hand hygiene performance among nurses working in adults and pediatric intensive care units.Materials and methods: A quasi experimental research design was used in this study. The study was conducted at pediatric and adult intensive care unit; at Tanta University Hospital. All available nurses 262who are working in the previously mentioned settings as the following: 118 nurses working in pediatric intensive care unit nurse and 144nurse working in adult intensive care unit. Tools of the study: Four tools were used to collect the data Tool I: Nurses' knowledge regarding Hand Hygiene Structured Questionnaire: it consisted of two parts: Part1: Socio demographic data of the nurses Part II: Nurses' Knowledge Regarding Hand Hygiene Performance. Tool II: Assessment of Nurses Barriers of Hand Hygiene Performance Questionnaire, Tool III: Hand Hygiene Perception Survey and Tool IV: Hand Hygiene Performance Observational Checklist. Result; the mean score of total hand hygiene performance using soap and water of nurses working in pediatric ICUs were 8. 85±1.02 and 10.10±1.84, while among adult ICUs nurses were 8.37±1.75and10.20±0.80 pre and post the educational intervention respectively. There was a significant difference of both groups in the; five Health Belief Model Construct in addition to nurses’ identified barriers of hand hygiene pre and post the intervention.Conclusion and recommendations: Total hand hygiene performance level and HBM construct regarding hand hygiene performance were higher among nurses working in pediatric and adult ICUs nurses post than pre application of the HBM educational intervention. Also, higher mean scores of the barriers of hand hygiene performance among all nurses in both ICUs pre compared to post intervention. Periodic and refreshment educational intervention related to hand hygiene is recommended for adult and pediatric ICUs nurses to improve their hand hygiene performance and further study for barriers in other ICUs is recommended. Keywords: Health Belief Model -Based Educational intervention, Hand Hygiene Performanc

Estimation of serum gonadotrophins in relation to anti-Müllerian hormone in polycystic ovary syndrome patients attended infertility centers in khartoum state Dec.2017 –Mar. 2017 A

يعتبر تكيس المبايض مرض متباين يحدث لأسباب غير واضحة وهو أهم الأسباب لعدم انتظام عمليه التبييض والدورة الشهرية وزيادة الهرمونات الذكرية عند النساء .تكيس المبايض يؤدي الى عدم تصنيع كل الهرمونات التي تحتاجها البويضة للنضوج الكامل حيث تبدأ الحويصلات في النمو وتعزز بالسوائل لكن عملية التبييض لا تحدث وتبقي كأكياس. الهدف من هذه الدراسة قياس الهرمونات المحفزة للمبايض ومعرفه مدي علاقتها مع مضاد هرمون ميلر في حالة مرض تكيس المبايض. هذه الدراسة أجريت في مركزين للخصوبة والعقم في ولاية الخرطوم مركز جامعه الخرطوم للخصوبة والعقم(مستشفي سعد أبو العلا) ومركز السر أبو الحسن للخصوبة والعقم خلال الفترة من ديسمبر 2017الي مارس 2018. تضمنت الدراسة تسع وتسعون مريضة بتكيس المبايض وثلاثون نساء سليمات كضابط للدراسة أعمارهم تتراوح بين أقل من 22سنة إلى أكثر من 32 سنة قيس تركيز الهرمونات المحفزة للمبايض(الهرمون المحفز للحويصلة,الهرمون المنشط للجسم الأصفر) ومضاد هرمون ميلر لهن. القيم المصلية للهرمون المحفز للحويصلة في النساء السليمات كان أعلى ( 9.19± 0.66 ( من مريضات التكيس)6.46 ±0.20 (لكن نسبة الهرمون المنشط للجسم الأصفر(9.21نانوجرام/مل) و مضاد هرمون ميلر( 8.7نانوجرام/مل) تركيزهما اعلي عند المريضات بالتكيس. النسبة بين الهرمون المحفز للحويصلة والهرمون المنشط للجسم الأصفر في الحالات الطبيعية أعلي (1.49نانوجرام/مل) من المريضات بالتكيس(0.98نانوجرام/مل).بينما مريضات التكيس أعلى(1.48 نانوجرام/مل )في النسبة بين الهرمون المنشط للجسم الأصفر والهرمون المحفز للحويصلة بالنسبة للحالات السليمة (0.88 نانوجرام/مل). الهرمون المنشط للحويصلة له علاقة كبيرة (0.316) وموجبة ( اقل من0.01 ) مع الهرمون المنشط للجسم الأصفر للمريضات وأيضا مع النسبة بين الهرمون المنشط للحويصلة والهرمون المنشط للجسم الأصفر للسليمات.أعلى ارتباط يوجد بين الهرمون المنشط للجسم الأصفر والنسبة بين الهرمون المنشط للجسم الأصفر والهرمون المنشط للحويصلة المريضات متبوعا بعلاقة سلبية بين نسبة الهرمون المنشط للحويصلة والهرمون المنشط للجسم الأصفر ونسبة الهرمون المنشط للجسم الأصفر والهرمون المنشط للحويصلة للمريضات. علاوة على ذلك توجد علاقة سالبة (اقل من05 .0 ) بشكل كبير(0.246)بين مضاد هرمون ميلر و النسبة بين الهرمون المنشط للحويصلة والهرمون المنشط للجسم الأصفر للمريضات . ولا يوجد اختلاف بين نسبة الهرمونات الثلاث في مختلف الفئات العمرية. ولا توجد اختلاف بين تراكيز الهرمونات بالنسبة لمختلف المناطق الجغرافية في السودان

MELD score: utility and comparison with King\u27s College criteria in non-acetaminophen acute liver failure.

Objective: To compare Model for End-stage Liver Disease Score (MELD Score, MS) and King’s College Hospital (KCH) criteria for finding correlation of mortality in non-acetaminophen induced acute liver failure (NAI-ALF). Study Design: An analytical cross-sectional study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2005 to 2007. Methodology: The study included patients with NAI-ALF. KCH criteria were labelled as good and bad prognosis groups. MELD score were calculated by using the MELD calculator. ROC was plotted and sensitivity analysis was done. ETA was used to see correlation between MELD and KCH. Results: Ninety-one patients with mean age of 32.5 + 16.3 years were studied; 49 were males (54%). Out of these, 57 patients died (63%); two leading causes of non-acetaminophen induced acute liver failure (NAI-ALF) were hepatitis hepatitis B virus (HBV) (n = 30, 33%) followed by hepatitis E virus in (n = 23, 25.3%). According to King\u27s College Hospital (KCH) criteria, 50 patients (88%) who died had bad prognosis and 24 patients (70.6%) who survived had good prognosis. The ROC determined MELD score of 32 was the best predictor of mortality with sensitivity and specificity of 79% and 71%, respectively and positive predictive value (PPV) and negative predictive values (NPV) of 82% and 67% respectively. There was significant association between mortality and bad prognosis according to KCH criteria (p \u3c 0.001). Overall mean MELD score (MMS) was 35.35 + 8.64. MMS on admission was 38 + 7.32 in patients who died and 30.7 + 8.77 in those who survived (p = \u3c 0.001). MMS correlated equally with KCH criteria (ETA = 0.52). Conclusion: The admission MELD score has an excellent utility and correlates equally with KCH criteria for mortality in NAI- ALF

Comparative computational study of mechanical behavior in self-expanding femoropopliteal stents

The use of the stent to treat peripheral artery disease (PAD) is increased and the proportion of failures also increases. The femoropopliteal artery (FPA) experiences a high deformation ratio compared to the cardiovascular artery due to limp flexion and daily activities that could lead to stent failure, as well as increasing the number of observed mortality and morbidity. In the present work, two of the common PAD stent design models represented as STENT I and STENT II were analyzed by using of finite element method (FEM) to simulate the most mechanical loading modes that could occur in FPA, such as axial tension and compression, torsion, three-point bending and radial compression to give a good understanding of deformation that affected stent inside the in-vivo. The gradual force load was used to simulate all modes, the force values are 0.25 N, 0.5 N, 1.5 N, 2.5 N, 3.5 N and 5.5 N until the stent models obtain the yield-point. The comparison of stent models (STENT I, STENT II) was performed in terms of graphs of total deformation, force-stress and stress-strain for all test modes. The similarity ratio of the total deformation in axial tension and the compression mode for STENT I and STENT II was 17% and that may indicate that STENT I obtained a high deformation value instead of STENT II, while, the torsion similarity ratio was 86% which could show a good agreement in this mode, as well as the similarity ratio, was 78% of the total three-point bending deformation and the value of the similarity ratio in the radial compression mode was 23%. Still unclear what is the clinical mode of mechanical deformation that is more important than others with changing the length of the lesion and stent diameter, and the fatigue life test provides a better understanding of the mechanical tests that must be sought