Classification and management of epilepsy and epileptic syndromes in a cohort of 202 school children- a 2 year follow up study- Sudan.

BACKGROUND: In this paper, seizure types, and epilepsy syndromes are elucidated as per ILAE (2010) classification. A brief outline of the antiepileptic drug regimens used and the outcome of seizure control in a two -year period is presented. The applicability of the ILAE classification in resource limited countries has been revisited. METHODS: This is a descriptive prospective study, in which 202 patients were enrolled. The Cohort group was seen and evaluated by a pediatric neurologist at the Pediatric neurology Outpatients Department (OPD). Epilepsy was classified using the International League Against Epilepsy (ILAE) classification (2005-2009) report. All patients had an Electroencephalogram (EEG) at the start of the study, and this was repeated as deemed appropriate. Brain imaging (MRI) was done to patients when indicated. Treatment decisions were made by pediatric neurologists. Outcomes were categorized into four groups: fully recovered, well controlled, partially controlled and uncontrolled. RESULTS: The mean age is 10.5 + 2.7 years. Male to female ratio was 1.7: 1. Thirty five (17.3%) patients had generalized onset seizures, 46(22.8%) had focal onset seizures, 104(51.5%) had a specific epilepsy syndrome, and 17(8.4%) patients were unclassified. 170 (84.2%) patients were on mono-therapy on their initial visit, 30(14.8%) were on two Antiepileptic Drugs (AEDs) while two (1.0%) patients were on poly-therapy. After 2 years; 155(76.7%) patients were on mono-therapy, 36(17.8%) on two AEDs while ten were (4.0%) on polytherapy. One eighty (88.2%) patients were controlled. Fifteen (7.4%) of them were off medication after being seizure free for 2 years. Twenty (9.8%) have partial control, while two (1.0%) patients were uncontrolled. Patients with focal epilepsy, those on polytherapy and those with abnormal imaging had poor prognosis. CONCLUSIONS: The ILAE classification can be used in resource limited countries. Childhood epilepsies have a good prognosis provided they are well classified and treated.

Prevalence of epilepsy in 74,949 school children in Khartoum State, Sudan.

BACKGROUND: Data on childhood epilepsy in Sudan are scarce and the only published study on its prevalence was published in 1983. This study aimed to determine the current prevalence of epilepsy in school children in Khartoum State. METHODS: This is an analytical population-based, cross-sectional study conducted in Khartoum State, Sudan. The study included students in the basic (primary) schools aged 6-14 years. Simple random sampling was used to draw a cluster of four of the seven localities comprising Khartoum State. The sample frame consisted of 1609 public schools (808,624 pupils) and 787 private schools (194,613 pupils), a total of 2396 schools (1,003,237 pupils). A sample size of 75 940 pupils was estimated and 250 schools were drawn from a sample frame of 2396 schools using a stratified random sampling technique. Consent was obtained from the headmaster/head teacher of the selected schools who arranged a meeting with the tutor/teacher responsible for each class. The study team asked whether any of the pupils was ever noticed or known to have had any kind of seizures, and a confidential letter was sent to the parents of each identified pupil. The letter included an explanation of the aims of the study, information on the research group and the kind of help the research group could offer; contact numbers and email addresses were made available if they wished to participate in this study. Those who consented to participate were then given an appointment at the Epilepsy Outpatient Department, Gaafar Ibnauf Children's Hospital, Khartoum where they were evaluated by the paediatric neurologist. RESULTS: Altogether, 74,949 pupils were enrolled for the study, 398 of whom were identified initially as having seizures and 332 of whom (83.4%) were identified by a paediatric neurologist. Of the 332, 303 (91.3%) proved to have epileptic seizures, 250 (82.5%) were known to have epilepsy, and 53 (17.5%) were newly diagnosed during the survey. The male to female ratio was 1.5:1. The total prevalence of epilepsy in Khartoum State was estimated to be 4/1000. The highest prevalence was in Jabal Awliya Locality (4.87/1000) and the lowest was in Khartoum Locality (3.35/1000). Twenty-nine (8.7%) patients proved to have non-epileptic seizures. The majority (15, 51.6%) had psychogenic non-epileptic seizures, and four (13.6%) had syncope. The majority (171, 56.43%) of patients had generalised epilepsy, 109 (35.97%) had focal epilepsy, and 23 (7.6%) had unclassified epilepsy. CONCLUSION: The prevalence of epilepsy in school children in Khartoum State (4/1000) is higher than that reported previously from Khartoum Province in 1983 (0.9/1000).

Research: Prevalence of neural tube defects Khartoum, Sudan August 2014-July 2015.

BACKGROUND: Neural tube defects (NTDs) are birth defects that results from failure of the neural tube to develop properly during early pregnancy. METHODS: We studied the prevalence of neural tube defects in newborns admitted to the NICU in Soba University and Omdurman Maternity hospitals, during the period 1st August 2014 to 31st July 2015. A cross-sectional hospital based study, involved all newborns with any type of neural tube defect admitted to the NICU in the study area during the study period. Data was collected using a questionnaire reviewing the medical, social history and clinical examination. RESULTS: Out of the 36,785 delivered newborns during the study period, the prevalence of NTDs was 2.8:1000. Females were 56 (54.4%) predominated males 47 (45.6%). History of neural tube defects was found in 11 (10.7%) of the affected newborns siblings. Sixty-eight (66%) of the studied mothers received folic acid during pregnancy with the current child, of those who received folic acid 66 (97.1%) started folic acid after conception, 36 (54.5%) in the first trimester and 39 (57.4%) had no regular intake of the folic acid. The types of NTDs include myelomeningocele 49 (47.6%), anencephaly 18 (17.5%), encephalocele 14 (13.6%), myelomeningocele and hydrocephalus 11 (10.7%) and meningocele 8 (7.8%). CONCLUSION: The prevalence of neural tube defects is 2.8:1000. Myelomeningocele is the commonest encountered NTD. The use of preconception folic acid needs to be advocated.

Helicobacter pylori infection and the onset of type 1 diabetes mellitus in Sudanese children.

Type 1 diabetes mellitus (T1DM) is a chronic T cell mediated autoimmune disease that results in destruction of pancreatic islet cells. Helicobacter pylori (HP) was recently thought to be a triggering factor for T1DM. This is a prospective case control study at Gaafar Ibnauf Children's Hospital and three other diabetic clinics in Khartoum, during the period January-September 2012. Ninety newly diagnosed T1DM children and a similar number of a control group were compared. Assessment of HP specific serum immunoglobulin was performed using Eliza test. There were 40(44.4%) female and 50(55.6%) male diabetic children. Diabetic children tested positive for HP constituted 56/90 (62.2%) compared to 59/90 (65.6%) from the control group. Diabetic children aged 11-18 years represented 46 (51%), 32/46 (57%) of them were seropositive for HP. A similar number of the same age in control group 30/46 (50.8%) were seropositive. Of 41newly diagnosed diabetic children (44.4%) of newly who complained of symptoms, 30 (53.6%) were seropositive for HP compared to 34 (37.7%) among the healthy children, out of whom 24 (40.7%) tested positive for HP. Diabetic children with moderate anemia were 35 (45.5%) compared to 54 (60.0%) in the control group. Seropositive children for HP in the 2 groups were, respectively, 20(40.8%) and 38(64.4%). Those with a poor family background were 28 (56%), 20 (40.0%) tested positive for HP, compared to 38 (64.4%), of whom 20 (64.5%) were seropositive in the controls. In conclusion, HP infection does not seem to play a role in triggering T1DM in children.

Oxygen therapy in neonatal intensive care units in Khartoum State.

Oxygen is a drug that is essential in the treatment and prevention of neonatal hypoxia. The goal of oxygen therapy is to deliver sufficient oxygen to tissues while minimizing oxygen toxicity and oxidative stress. Improvement in monitoring technology of oxygen therapy has helped to improve clinicians' ability to appropriately apply and deliver oxygen. The objectives of this prospective observational descriptive hospital based study were: to evaluate the practice of oxygen therapy in the neonatal intensive care units (NICUs) in Khartoum State, to identify guidelines of oxygen therapy in NICUs, to determine the mode of oxygen delivery to the neonates, and to assess the practice of long term follow up of patients who used oxygen. During the period January - June 2014, 139 neonates were included. Oxygen was delivered to the neonates in the study depending on the clinical assessment. Saturation was not measured at the time of oxygen administration in 119 (85.6%) neonates. Oxygen was delivered by central device in 135 neonates (97.1%). The majority of the staff did not know the practice of long-term follow up. Hundred and sixteen (83.5%) of the nursing staff knew that oxygen has complications but the majority didn't know the nature of the complications and what causes them. The study showed that there is lack of guidelines of oxygen therapy in the NICUs and lack of monitoring procedures, which is important to be highlighted to overcome the complications and to improve the practice of oxygen therapy.

The prevalence and risk factors of retinopathy of prematurity among preterm babies admitted to Soba Neonatal Intensive Care Unit.

This is a prospective hospital based study conducted in Soba University Hospital (SUH), Neonatal Intensive Care Unit (NICU) between January 2012 and January 2013, to determine the prevalence and risk factors of retinopathy of prematurity (ROP) among preterm babies admitted to Soba NICU and to assess the outcome of those babies. Ninety-two neonates with gestational age less than 34 weeks at birth were included in the study. Thirty-three of them were males and 59 were females. All of them were admitted to the NICU due to prematurity. Data was collected in a structured questionnaire. Thirty-four infants (37%) developed ROP in one or both eyes; 12 (35.3%) of them developed stage 3 and underwent laser therapy, 2 of them had aggressive posterior form, which was treated with Evastin injection. Seven (20.3%) neonates diagnosed as stage 2, and 13 (37.7%) had stage 1. Statistically, there were significant relationships between ROP and gestational age, birth weight (BW), oxygen therapy, sepsis, and blood transfusion (p=0.000). No significant relationship was found between the occurrence of ROP and sex of the baby, respiratory distress syndrome (RDS), hyperbilirubineamia, intraventricular haemorrage (IVH) and necrotizing enterocolitis (NEC), p >0.000 in all of them. The prevalence of ROP in this study was 37%. Low BW, low gestational age, oxygen therapy, and blood transfusion were all significant risk factors for ROP. ROP should be highlighted in Sudan, and screening program should be recommended for all premature babies.

Meckel-Gruber syndrome: A rare and lethal anomaly.

Meckel-Gruber syndrome is a rare and lethal autosomal recessive disorder characterized by occipital encephalocele, postaxial polydactyly and bilateral dysplastic cystic kidneys. It can be associated with many other conditions. Antenatal ultrasound examination establishes the diagnosis by identifying at least two of the major features described. We describe a female baby who had the typical triad of Meckel-Gruber syndrome and died shortly after birth.

Successful separation of craniopagus conjoined twins.

Craniopagus conjoined twins represent a rare phenom- enon of congenital malformation/ dysmorphism. The clinical pathology of this complex entity is reviewed and placed in perspective. Confusion surrounds the severity of craniopagus conjoined twins especially in relation to the difficulty of separation and subsequent outcome. Successful separation of craniopagus twins remains a rarity, however modern neurosurgical tech- niques have created opportunities for successful sepa- ration and brought hope for a normal survival of these children who in the past were often left as historical footnotes or put on display as oddities of nature. We report on a craniopagus conjoined twins from Sudan who had been successfully separated.