Assessing the effectiveness of greater occipital nerve block in chronic migraine: a systematic review and meta-analysis.

BACKGROUND & AIMS: Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. METHODS: A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. RESULTS: Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. CONCLUSION: The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management.

The critical pharmaceutical situation in Sudan 2023: A humanitarian catastrophe of civil war.

The situation in Sudan have deteriorated since the ongoing war outbreak in April 2023. This article sheds light on the pharmacological status in Sudan in terms of shortage of supply, rising demands, and regulatory issues. The ongoing civil war has acutely impacted the dilapidated pharmaceutical status of Sudan, patients have suffered from the paucity of medical services forcing an out-of-control rise in underreported morbidity and mortality. To mitigate this uprising issue, an increase in stakeholder communication is crucial to deal with this national threat and establish a system for reporting the shortage.

Dissipation pattern and dietary risk assessment of chlorfenapyr and methomyl in corn under Egyptian field conditions.

Corn is the second most widely farmed grain for human consumption. Low corn productivity due to damage caused by pests has led to using pesticides to control pest infestations. However, the uncontrolled application of pesticides on corn harms both environmental and human health. Accordingly, field experiments followed good agricultural practices to investigate the dissipation pattern and terminal residues of chlorfenapyr and methomyl in corn and compare the values with established safety limits. Gas chromatography-tandem mass spectrometer coupled with the quick, easy, cheap, effective, rugged, and safe technique was used to analyze residues of chlorfenapyr and methomyl in corn. The average recoveries varied from 94% to 105%, with relative standard deviations (RSDs) of 8%-13% for chlorfenapyr and from 99% to 111%, with RSDs of 10-16% for methomyl. Chlorfenapyr and methomyl residues degraded in corn following a first-order kinetic model, with an estimated half-life (t1/2) of 3.9 and 2.8 days, respectively, and significant degradation (91.4%-98.1.5%, respectively) after 14 days. Although the maximum residue limits of chlorfenapyr and methomyl for corn are yet to be formulated in Egypt, the long-term dietary risk for those pesticides was acceptable, with arisk quotient < 100%, according to the national assessments. These findings are required to guide the correct and safe application of these insecticides in Egypt.

Peri-levator Betamethasone Versus Triamcinolone Injection in Management of Thyroid Eye Disease-related Upper Eyelid Retraction Without Proptosis.

PURPOSE: To compare the efficacy of peri-levator injection of both betamethasone and triamcinolone in the management of thyroid eye disease-related upper eyelid retraction without proptosis. METHODS: This prospective, double-blind, randomized clinical trial was conducted at Assiut University Hospital, Upper Egypt in the period between December 2021 and October 2023. The study included 47 patients (56 eyes) and was divided into 2 groups. In group A, 1 ml betamethasone was injected into the peri-levator area, while in group B, 1 ml triamcinolone was injected. The injection was repeated every month for up to 5 injections if there was an improvement in margin reflex distance 1 (MRD1). The injection was stopped if MRD1 reached the normal value or if 2 successive injections caused no improvement in MRD1. The postinjection outcome was divided into: 1) effective if MRD1 reached the normal ≤4.5 mm; 2) partially effective if MRD1 was improved but did not reach the normal; and 3) ineffective if there was no improvement in MRD1. The follow up ranged from 6 to 20 months. RESULTS: In group A, the injection was effective in 26 eyes (92.9%) and partially effective in 2 eyes (7.1%). In group B, the injection was effective in 17 eyes (60.7%), partially effective in 6 eyes (21.4%), and ineffective in 5 eyes (17.9%). The mean number of injections was significantly lower in group A than in group B: 1.61 ± 0.50 versus 2.36 ± 1.16. CONCLUSIONS: This study results suggest that betamethasone is more effective with a smaller number of injections than triamcinolone in the management of thyroid eye disease-related upper eyelid retraction.

Decline pattern and dietary risk assessment of spinetoram in grapes under Egyptian field conditions.

Spinetoram is one of the most extensively used insecticides globally and is a new spinosyn-based insecticide registered for direct treatment of Egyptian grapes. This work established and validated a developed method for determining spinetoram in grape berries and leaves using the QuEChERS coupled LC-MS/MS technique. The average recoveries ranged between 98.52-101.19% and 100.53-104.93%, with RSDs of 2.74-6.21% and 2.79-7.26% for grape berries and leaves, respectively. Spinetoram residues degraded in grape berries and leaves through a first-order kinetic, with an estimated half-life (t1/2) of 4.3 and 2.8 days in grape berries and leaves, respectively, and significant degradation (91.4-97.5%, respectively) after 14 days. Besides, the terminal residues of spinetoram detected in grape berries and leaves samples ranged between 0.017-0.077 mg‧kg-1 and 0.79-0.023 mg·kg-1, respectively, when applied two to three times at a single recommended rate, while it was varied between 0.026-0.44mg‧kg-1 and 0.79-0.023mg‧kg-1 when applied two to three times at a double recommended rate, respectively. A dietary risk assessment was conducted using scientific data from field trials, acceptable daily intake (ADI), and food consumption. It was determined that no noteworthy health hazards were connected to eating grape berries and leaves that had been treated with spinetoram since the risk quotients (RQs) were ≤ 0.4.

The educational value of ward rounds as a learning and teaching opportunity for house officers, medical officers, and registrars in Sudanese hospitals: a multi-center cross-sectional study.

BACKGROUND: Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors' perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals. METHOD: A cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors' perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions. RESULTS: A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment. CONCLUSION: Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Novel Corrosion Inhibitor for Carbon Steel in Acidic Solutions Based on α-Aminophosphonate (Chemical, Electrochemical, and Quantum Studies).

α-aminophosphonate (α-AP) is used as a novel corrosion inhibitor for carbon steel. The aggressive media applied in this study are HCl and H2SO4 acid solutions. The findings indicate that the morphology of the α-AP compound is cubic, with particles ranging in size from 17 to 23 µm. FT-IR, 1HNMR, 31PNMR, and 13CNMR analysis confirmed the synthesis of the α-AP molecule. It has been discovered that the compound α-AP plays an important role in inhibiting the corrosion of carbon steel in both HCl and H2SO4 acids. This was identifiably inferred from the fact that the addition of α-AP compound decreased the corrosion rate. It is important to report that the maximum inhibition efficiency (92.4% for HCl and 95.7% for H2SO4) was obtained at 180 ppm. The primary factor affecting the rate at which steel specimens corrode in acidic electrolytes is the tendency of α-AP compounds to adsorb on the surface of steel through their heteroatoms (O, N, and P). This was verified by SEM/EDX results. The adsorption actually occurs through physical and chemical mechanisms via different active centers which are matched with the calculated quantum parameters. In addition, the adsorption of α-AP follows the Langmuir isotherm.

Clinical characteristics, complications, and predictors of outcome of hospitalized adult Sudanese patients with COVID-19 and malaria coinfection in Sudan: A multicenter retrospective cross-sectional study.

Malaria and coronavirus disease 2019 (COVID-19) share several characteristics that could lead to cross-infection, particularly in malaria-endemic areas. Early COVID-19 symptoms might be misdiagnosed for malaria in clinical settings. Also, both diseases can cause fatal complications. So, laboratory testing for both diseases was recommended by the World Health Organization. To study the clinical characteristics and outcomes of Adult Sudanese patients with COVID-19 and malaria coinfection. This retrospective cross-sectional study was conducted from January 2021 to October 2021 in Wad Medani. Total coverage of all Sudanese patients above 18 years old with a confirmed diagnosis of coinfection with COVID-19 and malaria was included, and data were collected using a data collection sheet. Data were analyzed using R software version 4.0.2. Data were described and presented as mean, standard deviation, and number (percentage). To find associated factors with in-hospital outcome, χ2 test, fisher exact test, and independent t test or Wilcoxon rank-sum test were used. In this study, 156 participants were diagnosed with COVID-19 and malaria coinfection. Most of them were between 60 and 70 years (30.8%), the majority were males (59%). Shortness of breath (76.3%) and acute respiratory distress syndrome (35.3%) were the most common symptom and complications among coinfected patients, respectively. Ground glass opacity (n = 47/49, 95.9%) is the most common result for computed tomography scan. Atrial fibrillation was the most common abnormal electrocardiogram finding (n = 6/62, 9.7%). Overall mortality among all participants was (63/156, 40.4%). High mortality rate was found among the coinfected patients. More attention is needed towards fighting COVID-19 and malaria coinfection. There may be a link between malaria and COVID-19.

Unusual neurological presentation of second stage African trypanosomiasis in a young boy: a case report.

BACKGROUND: In South Sudan, sleeping sickness is a frequent condition caused by human African trypanosomiasis. There are two stages that are well-known. When the CNS is affected, especially with Trypanosoma gambiense infection, the early hemolymphatic stage and the late encephalitic stage have been observed, including mental, motor, and sensory symptoms. In this case, second-stage African trypanosomiasis manifested itself in an atypical neurological manner. CASE PRESENTATION: A 16-year-old boy from South Sudan referred to Sudan National Centre for Neurological Sciences, Khartoum, Sudan suffering from non-convulsive status epilepticus, mental deterioration and behavioral changes for the last nine months. He was conscious but disorientated. Low hemoglobin concentration, elevated ESR, enlarged spleen and positive card agglutination test for trypanosomiasis was found in this patient. Electro-encephalogram (EEG) found an on-going generalized seizure activity. The patient showed improvement after management with carbamazepine and tonic. CONCLUSION: Our case highlights that late second stage African trypanosomiasis with neurological complications such as non-convulsive status epilepticus should be suspected in any patient who developed progressive cognitive decline and behavioral changes following long standing history of African Trypanosomiasis and routine Electro-encephalogram EEG is the best tool to diagnose non convulsive status epilepticus.

Facile Synthesis of 5-Aryl-N-(pyrazin-2-yl)thiophene-2-carboxamides via Suzuki Cross-Coupling Reactions, Their Electronic and Nonlinear Optical Properties through DFT Calculations.

Synthesis of 5-aryl-N-(pyrazin-2-yl)thiophene-2-carboxamides (4a-4n) by a Suzuki cross-coupling reaction of 5-bromo-N-(pyrazin-2-yl)thiophene-2-carboxamide (3) with various aryl/heteroaryl boronic acids/pinacol esters was observed in this article. The intermediate compound 3 was prepared by condensation of pyrazin-2-amine (1) with 5-bromothiophene-2-carboxylic acid (2) mediated by TiCl4. The target pyrazine analogs (4a-4n) were confirmed by NMR and mass spectrometry. In DFT calculation of target molecules, several reactivity parameters like FMOs (EHOMO, ELUMO), HOMO-LUMO energy gap, electron affinity (A), ionization energy (I), electrophilicity index (ω), chemical softness (σ) and chemical hardness (η) were considered and discussed. Effect of various substituents was observed on values of the HOMO-LUMO energy gap and hyperpolarizability. The p-electronic delocalization extended over pyrazine, benzene and thiophene was examined in studying the NLO behavior. The chemical shifts of 1H NMR of all the synthesized compounds 4a-4n were calculated and compared with the experimental values.

Dissipation behavior, residue distribution, and exposure risk assessment of tebufenpyrad and milbemectin acaricides in strawberries under open field conditions.

Strawberries are a favorite fruit for most people, but the residues of pesticides on strawberries might be risky to human health. Tebufenpyrad and milbemectin are broad-spectrum acaricides with insecticide properties authorized for use on strawberries in Egypt. As a result, it is crucial to investigate their residues in the final product to ensure customers' safety. Consequently, field trials were conducted following the Good Agricultural Practices (GAPs) to study the dissipation rate and terminal residues of tebufenpyrad and milbemectin on strawberries. Tebufenpyrad and milbemectin residues in strawberries declined due to first-order decay process, showing significant degradation (88.5% and 94.7%, respectively) after 14 days. Risk assessment study was carried out by comparing the national estimated daily intake (NEDI) to the acceptable daily intake (ADI). The results demonstrated that the dietary risk posed by the residues of tebufenpyrad and milbemectin in strawberry fruits was acceptable for consumers. It is envisaged that the current study's findings would support the safe application of tebufenpyrad and milbemectin to strawberries and perhaps other crops in Egypt and other countries with similar climatic conditions.

Dual therapy of cancer using optimal control supported by swarm intelligence.

BACKGROUND: The scientific revolution in the treatment of many illnesses has been significantly aided by stem cells. This paper presents an optimal control on a mathematical model of chemotherapy and stem cell therapy for cancer treatment. OBJECTIVE: To develop effective hybrid techniques that combine the optimal control theory (OCT) with the evolutionary algorithm and multi-objective swarm algorithm. The developed technique is aimed to reduce the number of cancerous cells while utilizing the minimum necessary chemotherapy medications and minimizing toxicity to protect patients' health. METHODS: Two hybrid techniques are proposed in this paper. Both techniques combined OCT with the evolutionary algorithm and multi-objective swarm algorithm which included MOEA/D, MOPSO, SPEA II and PESA II. This study evaluates the performance of two hybrid techniques in terms of reducing cancer cells and drug concentrations, as well as computational time consumption. RESULTS: In both techniques, MOEA/D emerges as the most effective algorithm due to its superior capability in minimizing tumour size and cancer drug concentration. CONCLUSION: This study highlights the importance of integrating OCT and evolutionary algorithms as a robust approach for optimizing cancer chemotherapy treatment.

Pharmacological evaluation and binding behavior of 4,4'-diamino-2,2'-stilbene disulfonic acid with metal ions using spectroscopic techniques.

Industrial and human activities contribute significantly to the environmental contamination of heavy metal ions (HMIs), which have detrimental effects on aquatic life, plants, and animals, causing major toxicological problems. The commercially available 4,4'-diamino-2,2'-stilbenedisulfonic acid (DSD) has been playing a vital role in the detection of heavy metal ions and has significantly inhibited a variety of cancer cells in numerous field of modern science. The current investigation aimed to ensure the detection of heavy metals ions from the environment and fluorescence imaging of DSD in the treatment of cancer cells. Fluorescence and UV-Visible spectroscopic analysis was performed to sense the selective behavior of the probe DSD with several heavy metal ions, including Fe2+, K1+, Co2+, Ni2+, Zn2+, Cd2+, Pb2+, Mn2+, Sn2+, and Cr3+. Furthermore, DSD was subjected to examine enzyme inhibition such as anti-Alzheimer, anti-inflammatory, antioxidant, anticancer, and antimicrobial activities in search of multifaceted drugs. Test compounds have demonstrated dose-dependent responses in the in-vitro enzyme inhibition assays for acetylcholinesterase (AChE), butyrylcholinesterase (BChE), cyclooxygenase (COX), and lipoxygenase (LOX), as well as antioxidant [DPPH = 2,2-diphenyl-1-picrylhydrazyl and ABTS = 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid]. The DSD were shown to be more effective than the conventional medication galantamine in inhibiting acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), with an IC50 value of 12.18 and 20.87 µM, which is equivalent to the standard drug. The results obtained has revealed that DSD has the potential to become an effective sensor for the detection of Sn2+ ions over competing metal ions due to the inhibition of photo-induced electron transfer pathway (PET). The MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide tetrazolium) test, demonstrated that DSD had strong anticancer effects against the brain cancer cell line NIH/3T3, HeLa and MCF-7 with an IC50 value of 32.59, 15.31 and 96.46 µM respectively. The antimicrobial testing has shown that DSD outperforms the standard drug cefixime against Candida albicans and Pseudomonas aeruginosa, respectively. This study makes a substantial contribution to the ongoing search for efficient treatments for breast cancer.

Polyrhodanine-based nanomaterials for biomedical applications: A review.

Rhodanine is a heterocyclic organic compound that has been investigated for its potential biomedical applications, particularly in drug discovery. Rhodanine derivatives have been examined as the medication options for numerous illnesses, including cancer, inflammation, and infectious diseases. Some rhodanine derivatives have also shown promising activity against drug-resistant strains of bacteria and viruses. One of these derivatives is polyrhodanine (PR), a conducting polymer that has gained attention for its biomedical properties. This review article summarises the latest advancements in creating biomaterials based on PR for biosensing, antimicrobial treatments, and anticancer therapies. The distinctive characteristics of PR, such as biocompatibility, biodegradability, and good conductivity, render it an attractive candidate for these applications. The article also explores obstacles and potential future paths for advancing biomaterials made with PR, including synthesis modifications, characterisation techniques, and in vivo evaluation of biocompatibility and efficacy. Overall, as an emerging research topic, this review emphasises the potential of PR as a promising biomaterial for various biomedical applications and provides insights into the contemporary state of research and prospective directions for investigation.

Sulfoxaflor residues and exposure risk assessment in grape under Egyptian field conditions.

Grapes are among the most popular fruits globally, and insecticides are commonly used on grape farms. Sulfoxaflor, a novel sulfoximine insecticide that works against various insect pests, is extensively used in Egypt. Our field trials assessed the dynamics and final residues of sulfoxaflor in grapes and grape leaves grown in Egyptian environments with different application rates, including worst-case scenarios. A QuEChERS-based method with LC-MS/MS was used to analyze residues of sulfoxaflor in grapes and grape leaves. The limit of quantification (LOQ) was validated at 0.01 mg‧kg-1. Sulfoxaflor residues are degraded in grapes and grape leaves according to a first-order kinetic model, with an estimated half-life (t1/2) of 7.04 and 7.7 days, respectively, and considerable degradation (74.68 and 72.16%, respectively) after 14 days. The final residues in grapes and grape leaves were below the Codex or EU maximum residue limit (MRL) (2 mg‧kg-1) after 3 days of the recommended and high application rates. The findings showed that grapes and leaves treated with sulfoxaflor at the recommended rate are safe for humans 3 days after two or three consecutive treatments with intervals of 14 days. The current study should pave the way for implementing safe and appropriate sulfoxaflor use in grapes and grape leaves in Egypt.

Cutaneous Larva Migrans (CLM) may not be easy to diagnose: a case report and narrative review.

BACKGROUND: Cutaneous Larva Migrans (CLM) is one of the most common zoonotic dermatoses in subtropical and tropical regions and some European countries. It is caused by different types of hookworm, such as Ancylostoma braziliense, Ancylostoma caninum, and Uncinaria stenocephala. It is usually easy to diagnose, but the atypical presentation may occasionally mimic other dermatoses. CASE REPORT: A 32-year-old man presented with an extensive eczematous rash that developed during a recent vacation in Thailand. He didn't respond to antihistamines and systemic steroids. Finally, he was diagnosed with an atypical presentation of CLM and treated successfully with anthelminthic therapy. CONCLUSION: The report of an atypical presentation of CLM is crucial to increase awareness among healthcare workers, helping in early diagnosis and reducing potential psychological distress that patients may face.

Safety and efficacy of extended thrombophilia screening directed venous thromboembolic events (VTE) prophylaxis in live liver donors: do we really need extended thrombophilia screening routinely?

Background and aims: The study aimed to determine the prevalence of hereditary thrombophilia, and stratify its severity among live liver donors in Pakistan. Also, the authors evaluated the safety and efficacy of thrombophilia profile testing directed venous thromboembolic events (VTE) prophylaxis while balancing bleeding risk and the need for routine thrombophilia testing before live liver donation among living donor candidates. Materials and methods: Protein S (PS), protein C (PC), anti-thrombin (AT) III, and anti-phospholipid antibody panel (APLA) levels were measured in 567 potential donor candidates. Donors were divided into normal, borderline and high-risk groups based on Caprini score. The safety endpoints were VTE occurrence, bleeding complications or mortality. Results: Among 567 donors, 21 (3.7%) were deficient in protein C, and 14 (2.5%) were deficient in anti-thrombin-III. IgM and IgG. Anti-phospholipids antibodies were positive in 2/567 (0.4%) and 2/567 (0.4%), respectively. IgM and IgG lupus anticoagulant antibodies were positive in 3/567 (0.5%) and 3/567 (0.5%), respectively. VTE events, bleeding complications and postoperative living donors liver transplantation-related complications were comparable among the three donor groups (P>0.05). One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE. The mean length of ICU and total hospital stay were comparable. No donor mortality was observed in all donor groups. Conclusions: Due to thrombophilia testing directed VTE prophylaxis, VTE events were comparable in normal, borderline and high-risk thrombophilia donor groups, but more evaluations are required to determine the lower safe levels for various thrombophilia parameters including PC, PS and AT-III before surgery among living donor candidates.

Fifteen Years' Experience of Thoracoscopic Sympathetic Chain Interruption for Palmar Hyperhidrosis in Children and Adolescents: Evaluation of Different Techniques.

Background: Thoracoscopic sympathetic chain interruption is a definitive and effective therapy for severe primary palmar hyperhidrosis (PPH). Well-known methods include sympathectomy, sympathotomy, and clipping, but the occurrence of compensatory sweating offsets these methods. This study aims to report our experience with thoracoscopic sympathetic chain interruption in a large group of patients of age <18 years with PPH, focusing on surgical outcomes, complication rates, and patient satisfaction. Patients and Methods: This retrospective study included patients who underwent thoracoscopic sympathectomy, sympathotomy, or clipping for severe PPH between April 2008 and March 2023 at the Pediatric Surgery Department, Al-Azhar University Hospitals. Demographic and clinical data, operative steps, postoperative outcomes, complications, and patient satisfaction were reviewed from the patients' medical records. Results: During the 15-year study period, 420 children with PPH underwent bilateral thoracoscopic sympathetic chain interruption by either sympathectomy, sympathotomy, or clipping, with a sex ratio of 60% being females. The mean ages were 12 ± 3.48, 13 ± 2.45, and 13 ± 2.45 years, respectively. Sympathectomy was performed in 190 patients (45.2%), sympathotomy in 170 patients (40.5%), and clipping in 60 patients (14.3%). All patients had completed follow-up, with mean periods of ∼43 ± 5 months, 45 ± 3 months, and 42 ± 6 months, respectively. Complete palmar dryness was achieved in 405 patients (overall 96.4%) (97.8% after sympathectomy, 97.05% after sympathotomy, and 90% after clipping), whereas 2.1%, 2.9%, and 10% of patients experienced symptom recurrence, respectively, denoting significant statistical differences. Overall, 94 patients (22.4%) experienced compensatory sweating. Eventually, 409 patients (97.4%) were satisfied with the outcome, whereas 11 patients (2.6%) reported dissatisfaction, yet no significant differences found. Conclusion: The presented three modalities of thoracoscopic sympathetic chain interruption for PPH in children and adolescents are safe and effective, with overall very high postoperative satisfaction, despite a relatively high rate of compensatory sweating in sympathectomy group. Other major complications in this age population were scanty.

Traditional uvulectomy; practice and belief among Sudanese children in Khartoum hospitals: A multi-center cross-sectional study.

BACKGROUND: Traditional healing practices are common in Sub-Saharan Africa. Traditional uvulectomy (TU) is the removal of the uvula with a sharp curved knife and is often practised in children under five years old. This practice is believed to have a therapeutic effect on children suffering from sore throat, vomiting or difficulty breastfeeding. OBJECTIVES: This study aimed to describe the practice of traditional uvulectomy and Sudanese mothers' perception of it. METHODS: A cross-sectional study was conducted in seven teaching hospitals across Khartoum State. We interviewed 385 mothers of children who presented to pediatric units using a semi-structured questionnaire. The study period spanned from July 2022-February 2023. RESULTS: A total of 385 mothers of children under five participated in this study. 33 % of mothers believed in the practice of traditional uvulectomy, yet only 17.9 % of children under five years had undergone TU. Reasons for performing TU included persistent cough (36.9 %), vomiting (33 %), difficulty in breastfeeding (22.6 %) and TU being a family tradition (25.7 %). Factors significantly associated with these practices were the mother's age, her level of education and the family's regional origin. Mothers reported that no major complications to the children were perceived as a result of the TU procedure. CONCLUSION: The practice of TU is prevalent among children who present to hospitals seeking medical advice. More than one-third of mothers had misconceptions regarding the uvula. Health education campaigns targeting females of childbearing age, and health practitioners at primary health centres and hospitals must raise awareness related to this practice.