Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect.

OBJECTIVES: (a) To compare levels of pro- and anti-inflammatory mediators in saliva and gingival crevicular fluid (GCF) in children with and without congenital heart defects (CHD cases and controls) and to test whether a systemic component exists in CHD cases by controlling for gingivitis and plaque scores. (b) To correlate the levels of pro- and anti-inflammatory mediators in GCF and saliva with plaque bacterial composition among CHD cases and controls. MATERIALS AND METHODS: Whole un-stimulated saliva and GCF samples were collected (60 CHD cases, 60 controls [Sudan]) and were analysed for levels of prostaglandin E2 (PGE2), interleukin-1ß (IL-1ß), tumour necrosis factor-α (TNF-α), interleukin-1ra (IL-1ra) and interleukin-10 (IL-10) levels. These levels were correlated with the previously reported levels of four red complex bacteria. RESULTS: Significantly elevated levels of PGE2 and IL-1ß in GCF and IL-1ß and TNF-α in saliva were detected among CHD cases compared with controls. General linear model (GLM) analyses revealed that PGE2 and IL-1ß levels remained significantly higher in GCF and saliva samples, respectively, among CHD cases after controlling for gingivitis and plaque score, whereas TNF-α and IL-10 levels were significantly lower in their GCF samples. Additionally, IL-1ß level was significantly positively correlated to the counts of the four red complex species in their GCF. CONCLUSION: In addition to higher levels of some pro-inflammatory mediators in saliva and GCF corresponding to more gingivitis in CHD cases, also a systemic inflammatory component exists and is reflected in these two oral fluids.

Presence of plaque, gingivitis and caries in Sudanese children with congenital heart defects.

OBJECTIVES: The objective of this study is to assess the presence of plaque, gingivitis, and caries in a group of Sudanese children with congenital heart defects CHDs (cases) and compare them to children without CHDs (controls). MATERIALS AND METHODS: This analytical cross-sectional study included cases (N = 111, with a mean age of 7.2 ± 3.0 years) and controls (N = 182, with a mean age of 7.2 ± 2.8 years) from Khartoum, Sudan. Examinations were done by two calibrated dentists using plaque index, gingival index, and WHO (World Health Organization) caries diagnostic criteria (dmft/DMFT index: decayed, missing, and filled teeth). RESULTS: Children with CHDs (cases) had statistically significantly higher mean number of sites with plaque and gingivitis than children without CHDs (controls), although almost all children experienced plaque. Cases also experienced significantly higher mean dmft/DMFT than controls (age group 1, 3-7 years: 3.7 vs 2.3 and age group 2, 8-12 years: 1.3 vs 0.6). The Significant Caries Indices in cases (age groups 1 and 2) were also significantly higher than among controls (SiC 8.2 vs 5.9 and 1.8 vs 0.8, respectively). Fillings were totally lacking among cases and scarce among controls. CONCLUSIONS: The findings clearly showed that this group of Sudanese children with CHDs was more severely affected with gingivitis and caries than the control group without CHDs. These results are cause for concern in children at risk of developing systemic infections and serious complications related to poor oral health. CLINICAL RELEVANCE: These findings provide important baseline data for planning appropriate dental preventive strategies for Sudanese children with CHDs.

I want to see the other doctor: a tribute to the pioneer and icon of paediatrics and medical education in Africa and the Middle East.

In this article, I will try to shine a light on the life and contribution to child health of the Late Professor Hafiz Elshazali, who passed away in December 2020, through my eyes. He is my father but more than that he was my mentor and role model.

Paediatric dilated cardiomyopathy in Khartoum state, Sudan: a prospective study.

Background: Dilated cardiomyopathy (DCM) is a disease of the heart muscle that affects ventricular function; it is a debilitating disease that can lead to heart failure and death in children. There is a lack of good epidemiological data about paediatric DCM in Sudan or in sub-Saharan Africa. Objective: To study the incidence, causes and outcome of DCM among children in Sudan. Methods: A prospective cross-sectional study that was conducted in three paediatric hospitals in Khartoum state, Sudan over the period of 6 months. Results: During the study period, 55 children were seen with the diagnosis of DCM; The female: male ratio was 1.9:1. The incidence of DCM in Khartoum state was found to be 1.4 cases per 100 000 children per year, 10 children (18 %) were diagnosed in the first year of their life. Twenty-seven children (49 %) showed evidence of failure to thrive, being below the fifth percentile for weight. The most common cause of DCM was found to be postviral in 27 children (49%), followed by Idiopathic in 25 children (45%). The most common presentation was the shortness of breath in 53 children (97%), on echocardiography 26 children (47 %) showed evidence of severe left ventricular impairment and 23 children (42%) showed moderate ventricular impairment. Regarding the outcome, 8 children (15%) recovered, the condition of 11 children (20%) remained static and there were 36 deaths (65%). Conclusion: The incidence of DCM in Sudanese children was found to high with a higher mortality compared with middle-income and high-income countries; Improvement in the entire health system is needed to tackle this condition.

Progress, challenges and partnerships of teaching medical professionalism in medical schools in Sudan: the success story of Sudan Medical Council.

This paper highlights the historical perspective of medical education in Sudan and the context within which initiatives for teaching medical professionalism were implemented. It reflects upon the present-day situation of teaching professionalism in Sudan and identifies the challenges of teaching professionalism in the medical schools in the country. The cultural and social adaptation and professional implementation challenges within a poorly resourced health system will be discussed. The successful experience of the Sudan Medical Council in conducting the accreditation for medical schools and in commencing and maintaining partnerships with major concerned partners is shared.

The relationship between birth weight and congenital heart disease at Ahmed Gasim Cardiac Centre, Bahri, Sudan.

Low birth weight is a known comorbidity of congenital heart disease (CHD). This study examines the relationship between CHD and birth weight of singletons, while attempting to remove factors that influence birth weight, and assesses the impact of CHD on growth in later life. The main objective is to study the relationship between birthweight and CHD. This is a cross-sectional study of 141 samples, covering all patients who were referred to the Paediatric Echocardiography Lab at Ahmed Gasim Cardiac Centre between September and October 2016. Infants with genetic syndromes or other major extracardiac abnormalities were excluded. The findings of this study clearly demonstrate that infants with CHD are more likely to be of low birth weight than the general Sudanese population, by a factor of 2.6. Of the sample, 31.9% were born with low or very low birthweight. The mean birth weight of the cases was 2.59 kg, which is 17.3% and 542.4 g less than the national average. CHD that cause a decrement in birth weight in a descending order of severity were atrial septal defect (-721 g/23%), patent ductus arteriosus (-669 g/21%), ventricular septal defect (-610 g/19%), pulmonary stenosis (-548 g/13%) and tetralogy of Fallot (248 g/8%). Pre/postnatal growth impairment is a common feature among children with CHD. No statistically significant relationship was found between the degree of birth weight/weight to age decrement and the specific type of hemodynamic disturbance. Our results are comparable to other studies that have been undertaken. However, Sudanese patients display larger birthweight deficits than other populations.