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.

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.

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.

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.

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.

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.

Deregulation of miR-34a and Its Chaperon Hsp70 in Hepatitis C virus-Induced Liver Cirrhosis and Hepatocellular Carcinoma Patients

Background: MicroRNA deregulation may occur during hepatocellular carcinoma (HCC) genesis and progression stages. MicroRNA-34a (miR-34a) functions as a tumor suppressor and is down-regulated or silenced in a variety of human cancers, while heat shock proteins (Hsps) play important roles in assisting protein folding and preventing both protein aggregation and transport across membranes. The present study aimed to evaluating serum expression of miR-34a and its target Hsp70 for early detection of HCC in patients with liver cirrhosis (LC), focusing on correlations with clinicopathological features. Methods: A total of 180 patients were included: 120 with HCC on top of LC (60 with either early or late HCC) and 60 patients with HCV-related LC. In addition, 60 healthy individuals were considered as controls. Real-time polymerase chain reactions were performed for expression profiling of serum miR-34a and Hsp70 and for allelic discrimination of the promotor variant (rs2763979, C/T). In addition, in silico analysis was carried out. Results: All participants were heterozygote for the promotor polymorphism. miR-34a serum levels were significantly under-expressed in LC and especially HCC patients as compared to controls. Associations with a high Child-Turcotte- Pugh (CTP) score, advanced cancer stage, and number of masses were noted. In contrast the target Hsp70 was significantly overexpressed in cancer patients but not in LC group and inversely correlated with miR-34a levels. Conclusion: Utility of circulating miRNAs as biomarkers for early detection of HCC was raised. Future large-scale studies are warranted to confirm the current findings.

Gas-Phase Thermal Tautomerization of Imidazole-Acetic Acid: Theoretical and Computational Investigations.

The gas-phase thermal tautomerization reaction between imidazole-4-acetic (I) and imidazole-5-acetic (II) acids was monitored using the traditional hybrid functional (B3LYP) and the long-range corrected functionals (CAM-B3LYP and ωB97XD) with 6-311++G** and aug-cc-pvdz basis sets. The roles of the long-range and dispersion corrections on their geometrical parameters, thermodynamic functions, kinetics, dipole moments, Highest Occupied Molecular Orbital-Lowest Unoccupied Molecular Orbital (HOMO-LUMO) energy gaps and total hyperpolarizability were investigated. All tested levels of theory predicted the preference of I over II by 0.750-0.877 kcal/mol. The origin of predilection of I is assigned to the H-bonding interaction (nN8→σ*O14-H15). This interaction stabilized I by 15.07 kcal/mol. The gas-phase interconversion between the two tautomers assumed a 1,2-proton shift mechanism, with two transition states (TS), TS1 and TS2, having energy barriers of 47.67-49.92 and 49.55-52.69 kcal/mol, respectively, and an sp³-type intermediate. A water-assisted 1,3-proton shift route brought the barrier height down to less than 20 kcal/mol in gas-phase and less than 12 kcal/mol in solution. The relatively high values of total hyperpolarizability of I compared to II were interpreted and discussed.

The Effect of AIDS Peer Health Education on Knowledge, Attitudes, and Practices of Secondary School Students in Khartoum, Sudan.

BACKGROUND: Peer education seeks to enroll students in persuasive communication programs aiming at AIDS prevention. Providing information about AIDS prevention methods can lead to behavioral change and also a potential reduction in unsafe sexual behavior, particularly among young people. OBJECTIVE: This study aims to assess the role of peer education interventions in improving awareness, attitudes, and practices of secondary school students and peer educators towards AIDS. METHODS: This is a pre-and post-study. The study was conducted among 400 students who were randomly selected from 10 gender-balanced schools. They received the information from trained peer educators. 200 peers carried out the intervention (20 peers from each school), which was conducted in phases. The intervention required coordinating with official concerned stakeholders, preparing teaching aids, and four days of training workshops for the peer educators. The data was analyzed using the Statistical Package for Social Science program (SPSS). A paired sample t-test was obtained and utilized to interpret the changes observed in pre- and post-intervention knowledge, attitude, and practice. RESULTS: The study showed that the intervention program improved participants' knowledge from 75.5% to 83.2%. This improvement was with specific regard to the following: the causative agent of AIDs (p = 0.017), which improved from 77.7% to 81.5%; the spread of HIV through mosquitos (p = 0.001), which showed an increase from 12.7% to 23.8%; the program focused on the concept of the HIV carrier (p = 0.001), and also on the AIDS risk when having multiple sex partners, (p = 0.001), showing an increase of 47.5% to 83.5%. Following the knowledge test, the attitudes of students significantly increased from 70% to 83% with regards to youth vulnerability to HIV (p = 0.001), while scored dropped from 15.7% to 8.5% concerning the topic of HIV voluntary testing (p = 0.001). The practices of students changed from 70% to 83% when prompted about shaking the hands of an HIV infected person and also from 84.8% to 87.7% about sharing food with an HIV infected person (p > 0.05). CONCLUSION: The study concluded that school peer education is an effective approach to inform students of unsafe sexual behavior with regards to HIV/AIDS. It is clear that peer education enables significant improvements to be made with regards to the knowledge, attitudes, and practices of the students.

Chemosensetizing and cardioprotective effects of resveratrol in doxorubicin- treated animals.

BACKGROUND: Doxorubicin (DOX), an anthracycline antibiotic is one of the most effective anticancer drug used in the treatment of variety of cancers .Its use is limited by its cardiotoxicity. The present study was designed to assess the role of a natural product resveratrol (RSVL) on sensitization of mammary carcinoma (Ehrlich ascites carcinoma) to the action of DOX and at the same time its protective effect against DOX-induced cardiotoxicity in rats. METHODS: Ehrlich ascites carcinoma bearing mice were used in this study. Percent survival of tumor bearing mice was used for determination of the Cytotoxic activity of DOX in presence and absence of RSVL. Uptake and cell cycle effect of DOX in tumor cells in the presence of RSVL was also determined. Histopatholgical examination of heart tissues after DOX and/or RSVL therapy was also investigated. RESULTS: DOX at a dose level of 15 mg/kg increased the mean survival time of tumor bearing mice to 21 days compared with 15 days for non tumor-bearing control mice. Administration of RSVL at a dose level of 10 mg/kg simultaneously with DOX increased the mean survival time to 30 days with 70% survival of the tumor-bearing animals. RSVL increased the intracellular level of DOX and there was a strong correlation between the high cellular level of DOX and its cytotoxic activity. Moreover, RSVL treatment showed 4.8 fold inhibition in proliferation index of cells treated with DOX. Histopathological analysis of rat heart tissue after a single dose of DOX (20 mg/kg) showed myocytolysis with congestion of blood vessels, cytoplasmic vacuolization and fragmentation. Concomitant treatment with RSVL, fragmentation of the muscle fiber revealed normal muscle fiber. CONCLUSION: This study suggests that RSVL could increase the cytotoxic activity of DOX and at the same time protect against its cardiotoxicity.

Diagnostic accuracy of the Leishmania OligoC-TesT and NASBA-Oligochromatography for diagnosis of leishmaniasis in Sudan.

BACKGROUND: The Leishmania OligoC-TesT and NASBA-Oligochromatography (OC) were recently developed for simplified and standardised molecular detection of Leishmania parasites in clinical specimens. We here present the phase II evaluation of both tests for diagnosis of visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and post kala-azar dermal leishmaniasis (PKDL) in Sudan. METHODOLOGY: The diagnostic accuracy of the tests was evaluated on 90 confirmed and 90 suspected VL cases, 7 confirmed and 8 suspected CL cases, 2 confirmed PKDL cases and 50 healthy endemic controls from Gedarif state and Khartoum state in Sudan. PRINCIPAL FINDINGS: The OligoC-TesT as well as the NASBA-OC showed a sensitivity of 96.8% (95% CI: 83.8%-99.4%) on lymph node aspirates and of 96.2% (95% CI: 89.4%-98.7%) on blood from the confirmed VL cases. The sensitivity on bone marrow was 96.9% (95% CI: 89.3%-99.1%) and 95.3% (95% CI: 87.1%-98.4%) for the OligoC-TesT and NASBA-OC, respectively. All confirmed CL and PKDL cases were positive with both tests. On the suspected VL cases, we observed a positive OligoC-TesT and NASBA-OC result in 37.1% (95% CI: 23.2%-53.7%) and 34.3% (95% CI: 20.8%-50.9%) on lymph, in 72.7% (95% CI: 55.8%-84.9%) and 63.6% (95% CI: 46.6%-77.8%) on bone marrow and in 76.9% (95% CI: 49.7%-91.8%) and 69.2% (95% CI: 42.4%-87.3%) on blood. Seven out of 8 CL suspected cases were positive with both tests. The specificity on the healthy endemic controls was 90% (95% CI: 78.6%-95.7%) for the OligoC-TesT and 100% (95% CI: 92.9%-100.0%) for the NASBA-OC test. CONCLUSIONS: Both tests showed high sensitivity on lymph, blood and tissue scrapings for diagnosis of VL, CL and PKDL in Sudan, but the specificity for clinical VL was significantly higher with NASBA-OC.

Craving for ice and iron-deficiency anemia: a case series from Oman.

Pagophagia, or the practice of consuming ice, is a particular expression of the more general phenomenon of pica. Pagophagia is a complex behavioral phenomenon arising from the interplay of biochemical, hematological, psychological, and cultural factors. This compulsive dietary aberration is observed in many children and pregnant women worldwide. The authors report 3 cases of severe iron deficiency anemia with a serum ferritin level of 2-3 ng/mL, in which the patients were consuming 2 trays and many bags of ice per day. Following treatment with iron therapy, pagophagia spontaneously resolved within 2 weeks. It is a commonly missed problem. Pediatricians should be alert to this phenomena and its association with iron-deficiency anemia.