Association Between Hemoglobin A1C and the Severity of Acute Ischemic Stroke in Sudanese Patients in Omdurman Military Hospital

Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects’ blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (<7 HbA1C) and poor glycemic control (PGC) (>7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity

Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience

<p>Abstract</p> <p>Background</p> <p>The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences.</p> <p>Methods</p> <p>This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression.</p> <p>Results</p> <p>Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety.</p> <p>Conclusion</p> <p>The relationship between women's post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.</p

Adaptive Fuzzy Approximation Control of PV Grid-Connected Inverters

Three-phase inverters are widely used in grid-connected renewable energy systems. This paper presents a new control methodology for grid-connected inverters using an adaptive fuzzy control (AFC) technique. The implementation of the proposed controller does not need prior knowledge of the system mathematical model. The capabilities of the fuzzy system in approximating the nonlinear functions of the grid-connected inverter system are exploited to design the controller. The proposed controller is capable to achieve the control objectives in the presence of both parametric and modelling uncertainties. The control objectives are to regulate the grid power factor and the dc output voltage of the photovoltaic systems. The closed-loop system stability and the updating laws of the controller parameters are determined via Lyapunov analysis. The proposed controller is simulated under different system disturbances, parameters, and modelling uncertainties to validate the effectiveness of the designed controller. For evaluation, the proposed controller is compared with conventional proportional-integral (PI) controller and Takagi–Sugeno–Kang-type probabilistic fuzzy neural network controller (TSKPFNN). The results demonstrated that the proposed AFC showed better performance in terms of response and reduced fluctuations compared to conventional PI controllers and TSKPFNN controllers

Adaptive Fuzzy Approximation Control of PV Grid-Connected Inverters

Three-phase inverters are widely used in grid-connected renewable energy systems. This paper presents a new control methodology for grid-connected inverters using an adaptive fuzzy control (AFC) technique. The implementation of the proposed controller does not need prior knowledge of the system mathematical model. The capabilities of the fuzzy system in approximating the nonlinear functions of the grid-connected inverter system are exploited to design the controller. The proposed controller is capable to achieve the control objectives in the presence of both parametric and modelling uncertainties. The control objectives are to regulate the grid power factor and the dc output voltage of the photovoltaic systems. The closed-loop system stability and the updating laws of the controller parameters are determined via Lyapunov analysis. The proposed controller is simulated under different system disturbances, parameters, and modelling uncertainties to validate the effectiveness of the designed controller. For evaluation, the proposed controller is compared with conventional proportional-integral (PI) controller and Takagi–Sugeno–Kang-type probabilistic fuzzy neural network controller (TSKPFNN). The results demonstrated that the proposed AFC showed better performance in terms of response and reduced fluctuations compared to conventional PI controllers and TSKPFNN controllers

A Comprehensive Review on a Virtual-Synchronous Generator: Topologies, Control Orders and Techniques, Energy Storages, and Applications

In recent years, the penetration of renewable power generations into the electrical grid has substantially increased. Continuous deployment of power electronic-based distributed generations and the reduction of traditional synchronous machines with their essential dynamics in modern power networks are very critical in this change. The use of power electronic inverters leads to the dissociation of sources and loads and lowering the power system inertia. Under power imbalance, this drop causes an elevated rate of change in frequency and frequency divergences, which has a notable impact on the system&rsquo;s frequency stability. As a result, enhanced control techniques for grid-tied electronic converters are required to secure the power system&rsquo;s stability and support. The virtual-synchronous generator (VSG) control is used to mimic the dynamics of a rotating synchronous generator and improve the power system&rsquo;s stability. In this article, the problems of such low-inertia power systems, as well as the VSG technologies, are explored. This research also looks at different control orders and strategies for virtual-synchronous generators (VSG). In addition, the utilization of energy storage and critical matters in VSG and further research recommendations are explained

A Comprehensive Review on a Virtual-Synchronous Generator: Topologies, Control Orders and Techniques, Energy Storages, and Applications

In recent years, the penetration of renewable power generations into the electrical grid has substantially increased. Continuous deployment of power electronic-based distributed generations and the reduction of traditional synchronous machines with their essential dynamics in modern power networks are very critical in this change. The use of power electronic inverters leads to the dissociation of sources and loads and lowering the power system inertia. Under power imbalance, this drop causes an elevated rate of change in frequency and frequency divergences, which has a notable impact on the system’s frequency stability. As a result, enhanced control techniques for grid-tied electronic converters are required to secure the power system’s stability and support. The virtual-synchronous generator (VSG) control is used to mimic the dynamics of a rotating synchronous generator and improve the power system’s stability. In this article, the problems of such low-inertia power systems, as well as the VSG technologies, are explored. This research also looks at different control orders and strategies for virtual-synchronous generators (VSG). In addition, the utilization of energy storage and critical matters in VSG and further research recommendations are explained

Integrated Management of Childhood Illnesses strategy: compliance with referral and follow-up recommendations in Gezira State, Sudan.

OBJECTIVES: To determine the extent to which families follow referral and follow-up recommendations given in accordance with the Integrated Management of Childhood Illnesses (IMCI) strategy and the factors that influence families' responses to such recommendations. METHODS: Children aged 2 months-5 years who presented to an IMCI-trained health worker in Massalamia Health Area, Sudan, were recruited. Children with an IMCI classification that indicated the need for referral or follow-up were traced to determine whether the family complied with the referral or follow-up recommendation. Caretakers were interviewed to find out why they had or had not complied. Focus group discussions were held with health workers, caretakers, and community members. FINDINGS: Overall, 5745 children were enrolled. Of these, 162 (3%) were considered to be in need of urgent referral: 53 (33%) attended a hospital on the day of the referral, with a further 37 (23%) visiting the hospital later than the day of referral. About half of families cited cost as the reason for not visiting a hospital. A total of 1197 (21%) children were classified as needing follow-up. Compliance with a follow-up recommendation was 44% (529 children). Almost 165 (90%) of caretakers who were aware of and did not comply with follow-up, said they had not done so because the child was better. Compliance increased with the caretaker's level of education, if drugs were provided during the first visit, and if the follow-up period was short (2 or 5 days). CONCLUSION: In Massalamia--a resource-constrained environment in which IMCI implementation was well received by the community--only about half of children judged to be in need of urgent referral were taken for that care within 24 hours. Most children in need of follow-up received their first treatment dose in the health facility. This aspect of IMCI was commented upon favourably by caretakers, and it may encourage them to return for follow-up. Rates of return might also improve if return visits for children currently asked to return after 14 or 30 days were scheduled earlier

Association Between Hemoglobin A1C and the Severity of Acute Ischemic Stroke in Sudanese Patients in Omdurman Military Hospital

Abstract Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects' blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) ( 7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5 ± 9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9 ± 1.3 (P=0.000), when compared to GGC subgroups 5.1 ± 0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke ( > 18.8 NIHSS) versus (33.3%) that of the GGC ( > 10.4NIHSS).The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity