The prevalence and associated factors for primary headache disorders in adolescents in eastern Sudan: a community-based cross-sectional study.

Background: Headache disorder is the second-highest cause of disability worldwide; however, data are scarce on headache among adolescents, especially in Africa. There has yet to be published data on headache among adolescents in Sudan, the third-largest country in Africa. This study aimed to assess the prevalence of primary headache disorders and associated factors among adolescents (10-19 years) in eastern Sudan. Methods: A community-based cross-sectional study was conducted in the city of Gadarif in eastern Sudan. Questionnaires were used to gather the adolescents' sociodemographic characteristics. Headache diagnostic questions were based on the beta version of the International Classification of Headache Disorders-III (ICHD-3). Multivariate analysis was conducted to assess the associated factors for primary headache disorders, and the results were expressed as risk ratios (RRs) and 95.0% confidence interval (CI). Results: Of the 401 enrolled adolescents, 186 (46.4%) and 215 (53.6%) were male and female, respectively. The median (IQR) age was 14.0 (12.1-16.2) years. Eighty-one (20.2%) of the 401 adolescents reported experiencing primary headache disorders, including migraine with aura in 16 (4.0%), migraine without aura in 33 (8.2%), tension-type in 14 (3.5%), and undifferentiated headache in 18 (4.5%) adolescents. The prevalence of primary headache disorders was significantly higher in females than in males [55/215 (67.9%) vs. 26/186 (32.1%), p = 0.004]. In the multivariate analysis, increased age (RR = 1.09, 95.0 CI = 1.02-1.16) and being female (RR = 1.75, 95.0 CI = 1.14-2.67) were associated with increased RR of primary headache disorders. Parents' education level and occupation, smoking/snuff use, and body mass index were not associated with primary headache disorders. Conclusion: One-fifth of the adolescents in eastern Sudan reported experiencing primary headache disorders, which was more common in females and with increased age.

Second Trimester Spontaneous Fundal Rupture of Unscarred Bicornuate Uterus in Primipara: A Case Report and Literature Review; Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia.

Background: Primary rupture of an unscarred uterus is rare. Spontaneous rupture of an unscarred bicornuate uterus is a life-threatening obstetric emergency with high morbidity and mortality in the mother and fetus; however, it most commonly occurs in the first trimester of pregnancy. Case: A 20-year-old primigravid woman at 22 weeks of gestation, with no prior surgery, presented with severe abdominal pain, anemia, and hemodynamic instability. With a preoperative diagnosis of uterine rupture, she was transfused with three units of cross-matched whole blood and underwent emergency laparotomy. Intraoperative findings showed a ruptured bicornuate uterus and a dead fetus in the abdomen with huge hemoperitoneum. Postoperative recovery was smooth, and the patient was discharged after being counselled on family planning and subsequent pregnancy. Conclusion: A bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid women at any stage of pregnancy. Each obstetrician should have a high index of suspicion for a rare condition like ruptured bicornuate uterus, especially for a pregnant woman presenting with acute abdominal pain and hemodynamic instability. Early ultrasonography plays a key role in the evaluation, follow-up, and management of these patients.

Identifying novel therapeutic inhibitors to target FMS-like tyrosine kinase-3 (FLT3) against acute myeloid leukemia: a molecular docking, molecular dynamics, and DFT study.

Around 30% of acute myeloid leukemia (AML) patients have triggering mutations in Feline McDonough Sarcoma (FMS)-like tyrosine kinase 3 (FLT3), which has been suggested as a possible therapeutic candidate for AML therapy. Many tyrosine kinase inhibitors are available and have a wide variety of applications in the treatment of cancer by inhibiting subsequent steps of cell proliferation. Therefore, our study aims to identify effective antileukemic agents against FLT3 gene. Initially, well-known antileukemic drug candidates have been chosen to generate a structure-based pharmacophore model to assist the virtual screening of 217,77,093 compounds from the Zinc database. The final hits compounds were retrieved and evaluated by docking against the target protein, where the top four compounds have been selected for the analysis of ADMET. Based on the density functional theory (DFT), the geometry optimization, frontier molecular orbital (FMO), HOMO-LUMO, and global reactivity descriptor values have been evaluated that confirming a satisfactory profile and reactivity order for the selected candidates. In comparison to control compounds, the docking results revealed that the four compounds had substantial binding energies (-11.1 to -11.5 kcal/mol) with FLT3. The physicochemical and ADMET (adsorption, distribution, metabolism, excretion, toxicity) prediction results corresponded to the bioactive and safe candidates. Molecular dynamics (MD) confirmed the better binding affinity and stability compared to gilteritinib as a potential FLT3 inhibitor. In this study, a computational approach has been performed that found a better docking and dynamics score against target proteins, indicating potent and safe antileukemic agents, furthermore in-vivo and in-vitro investigations are recommended.Communicated by Ramaswamy H. Sarma.

The association between parity and hypertension: a cross-sectional, community-based study.

Background: The available data on the association between parity and hypertension are inconclusive. This study was conducted to investigate the prevalence of hypertension and its association with parity among adult Sudanese women. Methods: A multi-stage sampling survey was conducted in four villages in the River Nile State in Sudan between July and September 2022. The World Health Organization's three-level stepwise questionnaire was used to gather the participants' sociodemographic characteristics (age, sex, marital status, parity, educational level, occupation, obstetric history, family history of hypertension, weight and height). Regression analyses were performed. Results: A total of 408 women were recruited. The median [measured in terms of interquartile range (IQR)] age was 45.0 years (33.0-55.7 years). A linear regression analysis revealed a significant association between parity and diastolic blood pressure (coefficient, 0.60; P = 0.011). The prevalence of hypertension (55.9%) increased with parity and ranged from 43.7% to 74.9%. In the multivariate analyses, increasing age (adjusted odds ratio [AOR], 1.03; 95% confidence interval [CI], 1.02-1.05), increasing parity (AOR, 1.09; 95% CI, 1.01-1.19), family history of hypertension (AOR, 1.79; 95% CI, 1.15-2.77), and increasing body mass index (AOR, 1.09; 95% CI, 1.05-1.13) were associated with hypertension. In women of ages ≥ 50 years, increasing parity was significantly associated with hypertension (AOR, 1.15; 95% CI, 1.2-1.29). Para > 5 (AOR, 2.73; 95% CI, 1.11-6.73) was associated with hypertension. Conclusion: A high prevalence of hypertension was found among Sudanese women, and that parity at 5 or more is linked to hypertension.

Organoboron Complexes as Thermally Activated Delayed Fluorescence (TADF) Materials for Organic Light-Emitting Diodes (OLEDs): A Computational Study.

We report on organoboron complexes characterized by very small energy gaps (ΔEST) between their singlet and triplet states, which allow for highly efficient harvesting of triplet excitons into singlet states for working as thermally activated delayed fluorescence (TADF) devices. Energy gaps ranging between 0.01 and 0.06 eV with dihedral angles of ca. 90° were registered. The spin-orbit couplings between the lowest excited S1 and T1 states yielded reversed intersystem crossing rate constants (KRISC) of an average of 105 s-1. This setup accomplished radiative decay rates of ca. 106 s-1, indicating highly potent electroluminescent devices, and hence, being suitable for application as organic light-emitting diodes.

Association between serum 25-hydroxyvitamin D concentrations and hypertension among adults in North Sudan: a community-based cross-sectional study.

BACKGROUND: Globally, hypertension represents a major public health problem. The association between 25-hydroxyvitamin D (25[OH]D) levels and hypertension remains unclear. The current study aimed to investigate the association between serum 25(OH)D levels and hypertension among adults in Sudan. METHODS: A community-based cross-sectional study was conducted among adults in North Sudan. Sociodemographic and clinical data were collected using a questionnaire and face-to-face interviews. Serum 25(OH)D was measured using an enzyme-linked immunosorbent assay. Multivariate logistic regression and multiple linear regression analyses were performed. RESULTS: Of the total of 391 participants, 202 (51.7%) were females. The median (interquartile range [IQR]) of participants' ages was 45(32-55) years. Of the total, 219(56.0%) had hypertension. The median (IQR) of serum25(OH)D was 13.3(9.9-19.7) ng/mL, and 295 (75.4%) participants had vitamin D deficiency (< 20 ng/mL). In multivariable logistic regression, the adjusted odds ratio (AOR) for age = 1.05, 95% confidence interval (CI)1.03‒1.061, the AOR for being female = 2.02, 95% CI, 1.12‒3.66, and body mass index was AOR = 1.09, 95% CI, 1.05‒1.14, all of which were significantly associated with hypertension. However, serum 25(OH)D levels were not associated with hypertension (AOR = 1.01, 95% CI 0.99‒1.05, P = 0.317). In multiple linear regression, while systolic blood pressure was negatively associated with 25(OH)D (coefficient = - 0.28, P = 0.017), there was no significant association between serum 25(OH)D level and diastolic blood pressure (coefficient = - 0.10, P = 0.272) or mean blood pressure (coefficient =-0.03, P = 0.686). CONCLUSION: The current study revealed a negative association between vitamin D and systolic blood pressure. The mechanism of such an association needs further study.

Association between Helicobacter pylori seropositivity and hypertension among adults in Northern Sudan: a community-based case-control study.

OBJECTIVE: The association between Helicobacter pylori and hypertension is unclear. Herein, we aimed to investigate the association between H. pylori and hypertension among adults in Sudan. METHODS: We conducted a community-based case-control study (175 participants in each arm) in the Wad Hamid district in northern Sudan. Cases comprised adults with hypertension and controls were non-hypertensive adults. We assessed participants' data using a questionnaire. We also conducted rapid H. pylori antibody tests and binary and linear regression analyses. RESULTS: Multivariable logistic regression revealed age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.03-1.07), female sex (AOR 5.50, 95% CI 2.36-12.80), and body mass index (AOR 1.12, 95% CI 1.07-1.17) were significantly associated with hypertension. Moreover, compared with controls, a significantly higher number of patients with hypertension were positive for H. pylori (82/175, 46.9% vs. 46/175, 26.3%). H. pylori seropositivity was associated with systolic blood pressure (coefficient 3.811), diastolic blood pressure (coefficient 3.492), mean blood pressure (coefficient 3.599), and hypertension (AOR 3.15, 95% CI 1.82-5.46). CONCLUSION: Our study revealed a significant positive association between H. pylori seropositivity and hypertension. This finding supports literature recommending the eradication of H. pylori to prevent hypertension and its complications.

Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter Retrospective Study.

BACKGROUND: Management of macroscopic local recurrence (MLR) after radical prostatectomy is a challenging situation with no standardized approach. OBJECTIVE: The objective of our study was to assess the efficacy and safety of functional image-guided salvage radiotherapy (SRT) in patients with MLR in the prostate bed. DESIGN, SETTING, AND PARTICIPANTS: In this international multicenter retrospective study across 16 European centers, eligible patients were initially treated by radical prostatectomy (RP) with or without pelvic lymph node dissection for localized or locally advanced adenocarcinoma of the prostate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Prostate-specific antigen (PSA) measured 4 wk after RP was <0.1 ng/ml. All patients presented a biochemical relapse after RP defined by an increase in PSA level of ≥0.2 ng/ml on two successive measures. Only patients with an MLR lesion in the prostatectomy bed visualized on functional imaging (multiparametric magnetic resonance imaging, positron emission tomography/computed tomography [PET/CT] choline, or PET/CT prostate-specific membrane antigen) were eligible. Patients with lymph node, bone, or visceral dissemination at restaging imaging (CT and/or bone scintigraphy and/or magnetic resonance imaging and/or PET) were excluded. Dose escalation was defined as a dose of >66 Gy prescribed to the prostate bed or to MLR. Toxicities were classified using the Common Terminology Criteria for Adverse Events scale, version 4.03. The primary endpoint was progression-free survival (PFS). Secondary outcomes were metastasis-free survival (MPFS), biochemical progression-free survival, and overall survival. Genitourinary (GU) and gastrointestinal (GI) toxicities were analyzed. RESULTS AND LIMITATIONS: Between January 2000 and December 2019, 310 patients received at least one dose escalation on MLR and 25 patients did not receive any dose escalation. The median PSA level before SRT was 0.63 ng/ml (interquartile range [IQR], 0.27-1.7). The median follow-up was 54 mo (IQR, 50-56). Five-year PFS and MPFS were 70% (95% confidence interval [CI]: [64; 75]) and 84% (95% CI: [78; 88]), respectively. Grade ≥2 GU and GI late toxicities were observed in 43 (12%) and 11 (3%) patients, respectively. When the prescribed dose on the MLR lesion was ≥72 Gy, an improvement in 5-yr PFS was found for patients received at least one dose escalation (73% [95% CI: 65-79]) vs 60% [95% CI: 48; 70]; p = 0.03). CONCLUSIONS: In this contemporary study integrating functional imaging data, we found potential efficacy of SRT with dose escalation ≥72 Gy for patients with MLR in the prostate bed and with an acceptable toxicity profile. Prospective data exploring this MLR dose escalation strategy are awaited. PATIENT SUMMARY: In this report, we looked at the outcomes from salvage radiotherapy for prostate cancer and macroscopic relapse in a large European population. We found that outcomes varied with prostate-specific antigen at relapse, Gleason score, and dose escalation. We found potential efficacy of salvage radiotherapy with dose escalation for macroscopic relapse in the prostate bed, with an acceptable toxicity profile.

Hydroaminoalkylation of alkenes using transition metals complexes grafted on silica SBA15 as catalysts.

The gas-phase hydroaminoalkylation reaction of propene catalyzed by group 4 (M = Ti, Zr and Hf) metal amido complexes [(≡Si-O-)(M(-NMe2)3] was investigated by using PBE0-D3/SVP//TZVP level of theory. The geometrical analysis traced the formation of the metallaaziridines and the azametallacyclopentanes as key intermediates in these reactions. The metallaaziridines were simulated through the activation of α-C-H bonds of the amido groups; while the azametallacyclopentanes were configured by slotting the propene double bond onto the M - C bonds of the metallaaziridines. The latter reaction was considered the rate-determining step. Thermochemical calculations showed that the order of catalytic activity is: Ti ≥ Zr > Hf; while the preference of the azametallacyclopentanes is: Hf > Zr ≥ Ti.

Computational Identification of Druggable Bioactive Compounds from Catharanthus roseus and Avicennia marina against Colorectal Cancer by Targeting Thymidylate Synthase.

Colorectal cancer (CRC) is the second most common cause of death worldwide, affecting approximately 1.9 million individuals in 2020. Therapeutics of the disease are not yet available and discovering a novel anticancer drug candidate against the disease is an urgent need. Thymidylate synthase (TS) is an important enzyme and prime precursor for DNA biosynthesis that catalyzes the methylation of deoxyuridine monophosphate (dUMP) to deoxythymidine monophosphate (dTMP) that has emerged as a novel drug target against the disease. Elevated expression of TS in proliferating cells promotes oncogenesis as well as CRC. Therefore, this study aimed to identify potential natural anticancer agents that can inhibit the activity of the TS protein, subsequently blocking the progression of colorectal cancer. Initially, molecular docking was implied on 63 natural compounds identified from Catharanthus roseus and Avicennia marina to evaluate their binding affinity to the desired protein. Subsequently, molecular dynamics (MD) simulation, ADME (Absorption, Distribution, Metabolism, and Excretion), toxicity, and quantum chemical-based DFT (density-functional theory) approaches were applied to evaluate the efficacy of the selected compounds. Molecular docking analysis initially identified four compounds (PubChem CID: 5281349, CID: 102004710, CID: 11969465, CID: 198912) that have better binding affinity to the target protein. The ADME and toxicity properties indicated good pharmacokinetics (PK) and toxicity ability of the selected compounds. Additionally, the quantum chemical calculation of the selected molecules found low chemical reactivity indicating the bioactivity of the drug candidate. The global descriptor and HOMO-LUMO energy gap values indicated a satisfactory and remarkable profile of the selected molecules. Furthermore, MD simulations of the compounds identified better binding stability of the compounds to the desired protein. To sum up, the phytoconstituents from two plants showed better anticancer activity against TS protein that can be further developed as an anti-CRC drug.

Zn2+-Schiff's Base Complex as an "On-Off-On" Molecular Switch and a Fluorescence Probe for Cu2+ and Ag+ Ions.

The present study presents a thorough theoretical analysis of the electronic structure and conformational preference of Schiff's base ligand N,N-bis(2-hydroxybenzilidene)-2,4,6-trimethyl benzene-1,3-diamine (H2L) and its metal complexes with Zn2+, Cu2+ and Ag+ ions. This study aims to investigate the behavior of H2L and the binuclear Zn2+ complex (1) as fluorescent probes for the detection of metal ions (Zn2+, Cu2+ and Ag+) using density functional theory (DFT) and time-dependent density functional theory (TDDFT). The six conformers of the H2L ligand were optimized using the B3LYP/6-311 + + G** level of theory, while the L-2-metal complexes were optimized by applying the B3LYP functional with the LANL2DZ/6-311 + + G** mixed basis set. The gas-phase and solvated Enol-cis isomer (E-cis) was found to be the most stable species. The absorption spectra of the E-cis isomer and its metal complexes were simulated using B3LYP, CAM-B3LYP, M06-2X and ωB97X functionals with a 6-311 + + G** basis set for C, O, N and H atoms and a LANL2DZ basis set for the metal ions (Zn2+, Cu2+ and Ag+). The computational results of the B3LYP functional were in excellent agreement with the experimental results. Hence, it was adopted for performing the emission calculations. The results indicated that metal complex (1) can act as a fluorescent chemosensor for the detection of Ag+ and Cu2+ ions through the mechanism of intermolecular charge transfer (ICT) and as a molecular switch "On-Off-On" via the replacement of Cu2+ by Ag+ ions, as proved experimentally.

Challenges, constraints and failures that are related to the posterior sagittal anorectoplasty approach to anorectal malformations in a low-resource context: An experience from a sudanese tertiary referral centre.

BACKGROUND: Anorectal malformations (ARMs) in the sub-Saharan Africa are a common cause of neonatal referral for intestinal obstruction, and the posterior sagittal anorectoplasty (PSARP) approach is rapidly spreading. The small number of paediatric surgeons and the low-resource context limit children's access to care and constrain the quality of results. A retrospective, observational study has been done on a consecutive series of ARM cases admitted to a Sudanese tertiary paediatric surgical centre within the framework of a partnership between Italian and Sudanese academic institutions addressed to review and upgrade the standard of care of major congenital anomalies. MATERIALS AND METHODS: The authors collected 94 ARM cases in a 3 years' period. Conditions on referral, operative procedures, post-operative course and follow-up were recorded and examined. Their correlations with complications and outcome were analysed. RESULTS: The male/female ratio was 47/47. Eighty patients presented with an untreated ARM; 66 had a divided stoma and 14 had already a PSARP procedure, followed by a poor outcome or sequelae. In 25% of the cases, colostomy required re-doing. In 57 cases, a staged PSARP (primary or re-do) was done. Surgical-site infections occurred in nine patients. Some patients were lost to follow-up after preliminary colostomy. Post-operative dilatation programme suffered from the lack of systematic follow-up, and colostomy closure was possible in 46% of the cases due to problems in travelling and accessing hospital care. Anal stenosis was frequently observed among unfollowed patients. CONCLUSION: Despite PSARP's widespread adoption in Africa, the risk of complications and failures is high. Primary management is often inappropriate, and a high rate of colostomy-related complications is observed. Poverty and lack of transportation reduce attendance to follow-up, hampering the final results. Investments in healthcare facilities and retention of trained health providers are needed to improve the standard of care.

Effects of dietary supplementation with different concentration of molasses on growth performance, blood metabolites and rumen fermentation indices of Nubian goats.

BACKGROUND: Molasses is a potential energy supplement; extensively used to improve growth performance, milk and meat characteristics in goats at relatively low concentrations of 5-40% of the diet. Few data are available concerning feeding molasses to goat kids; therefore, the current study aimed to investigate the effects of dietary supplementation with higher concentrations of molasses on growth performance, blood metabolites and rumen fermentation indices. Twenty male Nubian goat kids (4-6 months old; 9-10 kg BW) were randomly assigned to 4 groups receiving different concentration of molasses: 0% (M-0), 30% (M-30), 40% (M-40) and 45% (M-45) for 5 weeks. Feed (DFI) and water intake (DWI) were measured daily, while the blood and rumen liquor samples were collected weekly. RESULTS: The DFI increased and feed conversion ratio (FCR) decreased in all molasses-supplemented groups (P ≤ 0.05), whereas DWI increased in M-30 and decreased in M-45 (P ≤ 0.05). The final BW and average daily gain (ADG) increased (P < 0.0001) in groups M-30 and M-40 compared to the control and M-45. Blood pH was significantly influenced by dietary molasses concentration (MC) and the duration of molasses supplementation (MD), where it decreased in groups M-30 and M-45 compared to the control and M-40 (P < 0.05). The MC had no significant effect on blood Hb, HCT, TLC, albumin, [K+], AST, ALT and total protozoa count (TPC), as well as ruminal-[Na+], [K+], strong ion difference concentration ([SID3]) and [NH3]; however, only [NH3] was significantly affected by MD and the interaction between MC and MD (MC × MD). Serum TP, globulins, [Na+] and [Cl-] increased (P ≤ 0.05) in all supplemented groups, while A/G ratio and [SID3] decreased (P ≤ 0.05). Ruminal pH decreased (P < 0.0001) in M-40 and M-45 compared to the control and M-30. However, [VFAs] increased (P < 0.04) in M-30 and M-40 compared to the control and M-45, while osmolality increased (P ≤ 0.05) in M-30 compared to the other groups. CONCLUSIONS: Dietary supplementation with molasses at a concentration of 30% for 3 weeks improved growth performance, protein metabolism and rumen fermentation without compromising animal health, immunity, and electrolytes and acid-base homeostasis.

Knowledge, attitudes and practices among people in Saudi Arabia regarding COVID-19: A cross-sectional study.

Background: The general population's compliance with preventive measures and legislation is mainly influenced by their knowledge level, attitude, and practices. This study assessed the knowledge, attitude, and practices of public residents towards corona virus disease-2019 preventive measures in Saudi Arabia. Design and Methods: This is a cross-sectional study; it used a validated cross-sectional online survey that received responses from 13 Saudi administrative regions. Results: There were 1513 participants who completed the study (55% females; 77.7%, university education). Knowledge level, attitude, and practices towards corona virus disease-2019 were 81.3%, 86.6%, and 81.9%, respectively. The knowledge subscales showed that 1496 (98.9%) participants knew the system targeted by the virus, 96.2% and 97.3% knew the causative agent and symptoms, 783 (52.2%) participants knew the transmission modes, and 696 (46.0%) participants knew about the complications. The attitude subscales included 1465 (96.5%) participants who had dealt with an infected person, 1451 (95.9%) participants who isolated in a health facility, 1195 (97.0%) participants who knew about hand washing, and 1387 (91.7%) participants who thought the virus spread through home delivery. The practice subscales included 1505 (99.5%) participants who properly disposed of gloves and tissues and 1347 (89.0%) participants who reported safe practices when coughing or sneezing. Conclusions: This study showed satisfactory knowledge, attitude, and practice towards corona virus disease-2019 in Saudi Arabia. The educational level is a dominant influencing factor for knowledge, attitude, and practice.

Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership.

BACKGROUND: An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation. METHODS: The state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described. RESULTS: Main surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain. CONCLUSIONS: The key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.

Prevalence and associated factors of hypertension among adults in Gadarif in eastern Sudan: a community-based study.

BACKGROUND: Hypertension is becoming an increasingly common health issue worldwide, especially in countries in Sub-Saharan Africa. Hypertension is the leading risk factor for premature death and disability worldwide, and it is the leading risk factor for mortality from cardiovascular diseases worldwide. The data on hypertension in Sudan that has been published is limited. We conducted this study to assess the prevalence of hypertension and its associated risk factors. METHODS: A multistage sampling survey was conducted in Gadarif, Eastern Sudan, from January to May 2018 to investigate the prevalence of hypertension and associated factors in adults in Eastern Sudan. The World Health Organization (WHO) three-level stepwise approach questionnaire was used to gather sociodemographic characteristics (age, sex, height, weight marital status, education level, smoking habit, alcohol consumption habit, and family history of hypertension). Hypertension was defined as the presence of an average blood pressure of ≥140/90 mmHg or the reported use of anti-hypertensive medications for high blood pressure. RESULTS: A total of 600 participants (mean age: 44.9 years) were enrolled in this study. Four hundred twenty-two (70.3%) participants were women, and 196 (32.7%) participants were obese. Of the 600 enrolled participants, 245 (40.8%) individuals had hypertension, 44 (7.3%) had been previously diagnosed with hypertension, and 201 (33.5%) were newly diagnosed with hypertension. A logistic regression analysis showed no significant associations across the education level, marital status, overweight and hypertension factors. However, an older age (adjusted OR = 3.20, 95% CI = 2.28-4.51, P < 0.001) and obesity (adjusted OR = 2.41, 95% CI = 1.57-3.69, P < 0.001) were associated with the presence of hypertension. CONCLUSION: There is a high rate of hypertension in Eastern Sudan, especially among older and obese individuals. Preventive measures, such as dietary measures, should be implemented.

Prevalence and predictors of occult hepatitis C virus infection among Egyptian patients who achieved sustained virologic response to sofosbuvir/daclatasvir therapy: a multi-center study.

BACKGROUND: Occult hepatitis C virus (HCV) infection (OCI) is characterized by the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA or antibodies in the serum. In this study, we tried to evaluate the prevalence and possible predictors of OCI in patients who achieved sustained virologic response (SVR) post sofosbuvir/daclatasvir (SOF/DCV) therapy. PATIENTS AND METHODS: A cross-sectional multicenter study was designed to enroll 1,280 HCV-infected patients who received SOF (400 mg) plus DCV (60 mg) once daily ± ribavirin regimen for 12 weeks and achieved SVR 12 weeks post treatment. They were randomly recruited from three dedicated Egyptian centers for management of HCV. Real-time PCR was performed to detect HCV-RNA in serum and PBMCs and to evaluate the different risk factors pertaining to the existence of OCI. RESULTS: HCV-RNA was detected in PBMCs of 50 (3.9%) of them. All OCI cases exhibited significant fibrosis score and raised pre-treatment alanine aminotransferase (ALT) levels. Logistic regression analysis comparing OCI with non-OCI revealed that high pre-treatment viral load, raised ALT, advanced fibrosis score, prolonged prothrombin time, low albumin, Child B score, antiviral experienced patients, and raised bilirubin are the most significant predictor for the possibility of OCI presence with Odds Ratio as 7.03, 5.13, 4.4, 2.68, 2.52, 1.9, 1.5, and 1.2, respectively. CONCLUSION: In spite of its remote possibility, OCI post SOF/DCV therapy may be present in some cases, and this may entail a re-auditing for the definition of SVR by dual testing in both serum and PBMCs.

Assessment of patient safety measures in governmental hospitals in Al-Baha, Saudi Arabia.

BACKGROUND/OBJECTIVE: There is a need for patient safety in healthcare settings, WHO recommended an intergradation of patient safety in the curriculum of health specialties. This study aimed to assess the application patient safety measures at governmental hospitals in Al-Baha region. METHODS: This is a descriptive cross-sectional study. It was conducted at Al-Baha governmental hospitals, 2017-2018. The data was collected using a pretested, modified and validated questionnaire, a convenience sampling technique was used among 115 health care providers (doctors and nurses). The collected data was analyzed using SPSS version 22. RESULTS: The study showed that most of participants have previous training on patient safety and about 81.7% of them had heard about global aims of patient safety. The level of application of patient safety at Al-Baha governmental hospitals was 106 (92.2%) as very often. The findings showed that there are no significant influencing factors on application of patient safety. CONCLUSION: The application of patient safety in Al-Baha governmental hospitals was very high. There are no significant influencing factors for the application status of patient safety measures in Al-Baha governmental hospitals.

Reference intervals of thyroid hormones in Khartoum, Sudan.

OBJECTIVES: This study aimed to establish the reference intervals (RIs) of thyroid function test among the adult Sudanese population in Khartoum, Sudan. A multi-stage survey stratified sampling method was used. Total triiodothyronine (TT3), total thyroxine (TT4) level and thyroid stimulating hormone (TSH) levels were measured using radioimmunoassay gamma counter (Riostad, Germany) to determine the reference intervals. RESULT: A total of 390 adults aged 20-75 years (male: 40.5%, female: 59.5%) were recruited. The median (95% intervals) serum TSH, TT4 and TT3 levels were 1.2 (0.50-3.1) mIU/L, 103.0 (63.0-159.0) nmol/L and 1.4 (0.8-2.7) nmol/L respectively. Compared with males; females had significantly lower TSH level and significantly higher TT4 level, but there was no significant difference when the TT3 level was assessed. While there was no significant difference in the level of TSH and T3 in the age group, T4 levels have shown a progressive increase with age. In summary the RIs for TSH, TT4 and TT3 in this setting were different from the levels provided by the manufacturers. A significant different was observed in TSH and FT4 when considering gender issue. The RIs were not different in the different age groups except for FT4.

Extended Use of Full-Thickness Skin Grafts, Employing Variable Donor Sites.

BACKGROUND: Full-thickness skin graft (FTSG) is a very versatile tool regularly used in small sizes. With the established knowledge of the graft take through the margins as well as wound bed, we extended the use of the FTSG for reconstruction of large-sized defects with satisfactory results. METHODS: We presented our experience in wound reconstruction using FTSG in 28 patients. We selected cases with graft size equal to or more than 130 cm2. Seven patients had chronic but healthy granulating wounds and 21 patients had fresh raw areas. Sizes of FTSG used varied between 130 to 452 cm2 of outstretched skin at donor sites. We used subgluteal skin crease in most of cases, though groin, upper medial thigh and medial arm aspects were also used. RESULTS: There was no difference in graft take between fresh and chronic wound sites. Almost complete graft take was the rule in all cases apart from mild epidermal skin peeling in four cases and small spots of graft necrosis in three cases. Primary wound healing at donor sites was the rule with scar hypertrophy in six cases necessitating scar conservative care for few months. CONCLUSION: Use of FTSG for reconstructing raw areas in acute and chronic wounds has to be safely reconsidered regardless of wound size. It's still a sound and reliable tool which can decrease the necessity of complex flap coverage. Subgluteal skin crease is relatively a new donor site to be considered for large grafts with primary direct closure.