Ankle Brachial Index in Children with Steroid-Resistant Nephrotic Syndrome

Objectives: This study aimed to assess the ankle brachial index (ABI) as a predictor of peripheral arterial diseases (PAD) in children with steroid-resistant nephrotic syndrome (NS). Methods: Twenty children (11 males and 9 females) attending the Pediatric Nephrology Outpatient Clinic of El-Minia University Hospital, Egypt, were enrolled in this study. Their age ranged between 5 and 15 years with a mean of 10.75 ± 3.31 years. They had proteinuria and were dependent on steroid therapy. Twenty healthy age- and sex-matched children served as a control group. All patients and controls underwent a thorough history-taking and clinical examination. All subjects in the study underwent laboratory investigations, including a urine analysis (24-hour test for protein in urine, and levels of serum urea and creatinine, triglycerides, and cholesterol). A renal biopsy was done to diagnose the children’s histopathological type of NS. A Doppler study was done to determine patients’ ABI. Results: ABI was significantly higher in the patient group than in the control group (P <0.0001). There was a negative correlation between ABI and duration of treatment (r value = 0.77 and P <0.001). Conclusion: ABI is simple non-invasive manoeuvre that can reliably assess arterial stiffness as an early predictor of atherosclerosis in nephrotic patients with long duration of both illness and steroid therapy

BEHAVIOUR OF HIGH STRENGTH CONCRETE COMPOSITE SLABS WITH DIFFERENT END ANCHORAGES

This study is performed to investigate experimentally the behaviour of steel deck composite slabs with different end anchorages. End anchorage as a type of shear connection for composite slabs plays an important role to prevent relative slip between concrete and steel deck. The presented composite slab specimens are made of high strength concrete and loaded at a specific shear span. Objectives of this study is to evaluate experimentally load carrying capacity, end slip, mode of failure, shear bond capacity, and the end anchorage contribution to the whole composite slab behaviour. Research also presents a comparison between the experimental results and the theoretical results derived according to m-k and partial shear connection methods included in these standards (BS 5950-4:1994, CSSBI S3-2003, and EC4 EN 1994-1-1:2004)

Inappropriate use of antibiotics in the treatment of pharyngo-tonsilitis in children in Khartoum, Sudan

Background: Pharyngo-tonsillitis represents a major public health problem all over the world. Recent studies in Sudan have revealed alarming results reporting antibiotics over prescription in the management of acute tonsillitis.Objectives: The aim of this study was to estimate the prevalence of Group A Beta hemolytic streptococci and document the appropriateness of using antibiotics in the treatment of acute tonsillo-pharyngitis in Jaafar Ibn Auf Pediatrics Hospital.Materials and Methods: A cross sectional hospital based study was conducted in the period January to August 2012 in Jaafar Ibn Auf Hospital, the largest tertiary pediatrics hospital in Sudan. The sample size was 100 including children aged 2-17 years and got antibiotics treatment for their current sore throat. A pharyngeal swab was collected at presentation from tonsils and posterior pharynx. Gram staining was done first, and then Group A Beta hemolytic streptococci were isolated and identified in the laboratory by their growth characteristics. All children included in the study were assessed clinically and subjected to a structural questionnaire. Data were analyzed by SPSS version 19.Results: The estimated prevalence of Group A Beta hemolytic streptococci tonsillitis and/or pharyngitis was 22%, nevertheless the proportion of antibiotic prescription was 100%.Conclusion: Most children were treated inappropriately regarding the need for using antibiotics, the type of antibiotics used and the duration of management. As many studies suggested that increased using of antibiotics may be due to uncertainty of diagnosis, requesting scoring system or rapid diagnostic test can contribute to the reduction of the rate of antibiotics prescription.Keyword: Pharyngo-tonsillitis, inappropriate, children, antibiotics, Suda

Evaluation of the learning environment and the perceived weakness of the curriculum: student perspective

Background: Educational environment has been shown to have influence on learning outcome and affects student achievement, satisfaction, and success. The study was conducted to assess medical students’ perception of their learning environment and to explore areas of weakness within the educational environment.Methods: A mixed method of study, was performed using non-probability sampling at the Faculty of Medicine, Gezira University (FMUG), Sudan. An updated Arabic Dundee Ready Education Environment Measure (DREEM) was developed and administered to 854 students during the academic year 2016-2017.Results: Seventy five percent of students completed the inventory (638/854) and Sixty four percent (546/854) responded to the open-ended question providing comments and suggestions. The overall reliability coefficient alpha in this study was 0.914. The global score for this study was found positive (122/200). Students were most satisfied with the learning aspects, academic environment, and academic self-perception. However, they were unsatisfied with their teaching and social atmosphere (inadequate social support for stressed students, substandard teaching, overemphasised factual learning, unpleasant accommodation). The qualitative content analysis was performed and emerged with four themes: the physical environment, a number of students, pedagogical approaches and faculty-student communication.Conclusions: The study suggested the overall students’ perceptions of the educational environment in the FMUG were on the positive side. However, certain specific elements of the learning environment and educational programme need to be critically investigated and remedied. The updated Arabic DREAM can be used reliably in the context of medical education in Arabic speaking countries

Regulated rewriting in formal language theory

Thesis (MSc (Mathematical Sciences))--University of Stellenbosch, 2008.Context-free grammars are well-studied and well-behaved in terms of decidability, but many real-world problems cannot be described with context-free grammars. Grammars with regulated rewriting are grammars with mechanisms to regulate the applications of rules, so that certain derivations are avoided. Thus, with context-free rules and regulated rewriting mechanisms, one can often generate languages that are not context-free. In this thesis we study grammars with regulated rewriting mechanisms. We consider problems in which context-free grammars are insufficient and in which more descriptive grammars are required. We compare bag context grammars with other well-known classes of grammars with regulated rewriting mechanisms. We also discuss the relation between bag context grammars and recognizing devices such as counter automata and Petri net automata. We show that regular bag context grammars can generate any recursively enumerable language. We reformulate the pumping lemma for random permitting context languages with context-free rules, as introduced by Ewert and Van der Walt, by using the concept of a string homomorphism. We conclude the thesis with decidability and complexity properties of grammars with regulated rewriting

Usefulness of atropine in patients with chronotropic incompetence and poor exercise capacity during treadmill stress testing

AbstractBackgroundAtropine, an anticholinergic agent, has been shown to increase heart rate and enhance the sensitivity of dobutamine stress echocardiography in the detection of CAD in patients with chronotropic incompetence; however, the addition of atropine to exercise stress testing EST, in these types of patients has not been well studied previously.ObjectiveInvestigating the usefulness and accuracy of atropine in decreasing the number of inconclusive results of EST in patients with chronotropic incompetence and poor exercise capacity.MethodsThirty patients (16 males and 14 females with the age range of 40:73years with mean of 55±8) out of 180 patients who preformed EST were chosen as having chronotropic incompetence or poor exercise capacity by Borg scale. Atropine was administered during the exercise phase in doses of 0.5mg per minute until test conclusion or the maximum dose of 2mg was reached. All patients were subjected to stress myocardial perfusion imaging SMPI to confirm accuracy.ResultsConclusive test results were achieved in 29 patients (97%). Heart rate and blood pressure were markedly increased with statically highly significant difference (P value <0.001), patients on b-blocker treatment had lower maximum heart rate compared to other patients with significant difference. Twenty-three (79%) patients had negative test results and six (21%) patients had positive test results, and if compared to SMPT results, EST was considered better positive than negative test, with higher specificity than sensitivity and accuracy.ConclusionsAtropine injection during EST significantly reduced the inconclusive test results in patients with chronotropic incompetence and poor exercise capacity

The implementation of social accountability in medical schools in Eastern Mediterranean region:A scoping review

Objectives: Social Accountability is a relatively new approach in medical education, Information about its implementation is scarce in the Eastern Mediterranean Region. The objective of this scoping review was to investigate the patterns and trends in reporting the social accountability (SA) of medical schools in the Eastern Mediterranean region (EMR). Methods: Using the Arksey and O'Malley approach, we conducted literature searches between 1995 and 2022 in the following databases: Scopus, Web of Sciences, CINAHL, PubMed, and Google Scholar using the search terms social accountability, medical school, faculty of medicine, Eastern Mediterranean Region, EMRO region. Using qualitative theme analysis, the extracted, coded, and analyzed data were reported. Results: The screening of various databases revealed 164 articles, 26 articles were finally included in the review. The 26 included articles originated from only seven out of the 22 EMR countries: Iran, Sudan, Kingdom of Saudi Arabia (KSA), United Arab Emirates, Egypt, Morocco, and Pakistan. The articles included were categorized under six themes: defining the SA and compliance with SA values and concepts, accreditation, educational program, perceptions of faculty and students, admission of students, and measurement of social accountability. Conclusions: The publications related to SA from the EM regions countries revealed similarities with other parts of the world in that the SA concept is not effectively translated into real day-to-day activities in medical schools. More work is needed from leaders in education and health systems to examine SA enablers and improve the uptake of the concept.</p

Usefulness of atropine in patients with chronotropic incompetence and poor exercise capacity during treadmill stress testing

AbstractBackgroundAtropine, an anticholinergic agent, has been shown to increase heart rate and enhance the sensitivity of dobutamine stress echocardiography in the detection of CAD in patients with chronotropic incompetence; however, the addition of atropine to exercise stress testing EST, in these types of patients has not been well studied previously.ObjectiveInvestigating the usefulness and accuracy of atropine in decreasing the number of inconclusive results of EST in patients with chronotropic incompetence and poor exercise capacity.MethodsThirty patients (16 males and 14 females with the age range of 40:73years with mean of 55±8) out of 180 patients who preformed EST were chosen as having chronotropic incompetence or poor exercise capacity by Borg scale. Atropine was administered during the exercise phase in doses of 0.5mg per minute until test conclusion or the maximum dose of 2mg was reached. All patients were subjected to stress myocardial perfusion imaging SMPI to confirm accuracy.ResultsConclusive test results were achieved in 29 patients (97%). Heart rate and blood pressure were markedly increased with statically highly significant difference (P value <0.001), patients on b-blocker treatment had lower maximum heart rate compared to other patients with significant difference. Twenty-three (79%) patients had negative test results and six (21%) patients had positive test results, and if compared to SMPT results, EST was considered better positive than negative test, with higher specificity than sensitivity and accuracy.ConclusionsAtropine injection during EST significantly reduced the inconclusive test results in patients with chronotropic incompetence and poor exercise capacity