Masters theses : Medicine

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    Hypoiaemia in children with sickle cell anaemia in Khartoum state
    (ALNEELAIN UNIVERSITY, 2004-07) Yassin Hag Mohammed Hamid
    ABSTRACT Sickle cell disease is often complicated acutely or chronically by hypoxaemia. This is a descriptive cross-sectional hospital based study aimed to determine the frequency and possible associated factors of hypoxemia in patients with sickle cell anaemia in their steady state and crises. it was conducted in the sickle cell anaemia referral clinic in KCEH and paediatric wards in most of Khartoum state hospitals in the period from the 15' of April to the 30"‘ of June 2004. The total number of children enrolled in the study was 149 children with sickle cell anaemia aged 0 - £16 yrs, 100 of them in their steady state while 49 were in crises and 80(53.7%) were males while 69(46.3%) were females . Oxygen saturation (SpO2) was measured for all children by pulse oximeter and haematological investigations were also done. The overall frequency of hypoxaemia (SpO2 s 90%) was found to be 37.6% and the mean SpO2 was 92.3% 1 6.0. The frequency of hypoxaemia in patients with steady state was 39% while in those with crises was 34.6% and there was no significant difference between the two groups (p = 0.373). There was no significant correlation between hypoxaemia and gender of patient but hypoxaemia was found to be more frequent in older age groups (p = 0.001) and in those with low weight centile (p= 0.028) but not with height (p = 0.864). Hypoxaemia was found to be associated with history of recurrent chest infection (p = 0.009) but not with history of blood transfusion or recurrent painful episodes. In patients with crises hypoxaemia was found to be correlated with breathlessness as a presenting symptoms (p =0.002) and there was a significant correlation with the type of crises (p = 0.031). Hypoxaemia was found to be correlated with low Hb (p = 0.000), low PCV (p = 0.005) and HbF (p = 0.001) but there was no correlation with retics count (p = 0.310)
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    VariationoftheamountoftheAmnioticFluidamongSudanesepregnantwomenof34-40gestationalage (fromOctober2016ToFebruary2017)
    (Al-Neelain University, 2017) MohamedAbdelmagidMaryoudElbashir
    Abstract The amniotic fluid is secretedmany times per day and has a volume of1500cc,whichmaybepathologicallyincreasedabove2000cc(polyhydramnios)ordecreasedbelow500 cc(oligohydramnios). Thisstudyaimedtomeasuretheamnioticfluidindex(AFI)duringpregnancy specifically at the third trimester, as an indicator of the amniotic fluidvolume and its significant importance in saving the fetal life and during thenormal pregnancy. The study was done at many hospitals in Khartoum state by high qualitysonographic machine to enable estimating the fetal gestational age in correlationwith the amniotic fluidindex, in a sample size of seventy cases, their agesranged between 20–29years,mostofthemweremultigravida. Theresultscomparedwiththegestationalagemeasuredbydifferentbiometrics (BPD, FL & HL), and showed that most of the cases have AFI withinthe normalrange (5–24 cc), also it didnot show any difference from thepreviousstudies.
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    TheEffect of Premature Presbyopia on Binocular Functions
    (Al-Neelain University, 2019-06) Salma Makki Magzob Makki
    Abstract Purposeindividualapproachespresbyopiamayexhibitocularsymptomsastheycontendwithvisualdemandsofnearwork,coupledwithnaturalage-relatedchangesinaccommodationandvengeanceof35-40yearswithsymptomsofasthenopiaandnohistoryofusingcorrectionwereevaluated. Aim: Toassesstheeffectofprematurepresbyopiapatentinbinocularvision Toassesstheeffectofbinocularvisionontheprematurepresbyopiapatent MaterialsandMethods: Inthisstudy153subjectsbetween35-40yearsold,weresubjectshassymptomsofsoreness,tiredeyes,headachewithnearworkregularlyperformed2-3hoursusingamplitudeofaccommodation(AC)andnearpointofconvergent(N.C.P)aremeasuredwithRoyalAirForce(R.A.F). Conclusion: Thevastmajoritiesofpatientsareorthophoricatdistanceandareorthophoricorhavealowdegreeofexosphericatnearage. Thereisslidedecreasingexospheric,andincreasingexosphericatnear. ThestudyfoundaconsiderableprevalenceofbinocularvisionanomalieswithconvergenceweaknessSephorabeginatpredominateanomaly. Recommendation: Increaseawarenessofpeopletoavoidtheprolongednearwork. Increaseawarenessofpeopletoavoidexcessiveuseofdigitaldeviceslikesmartphonesforlongtime. Routineocularexaminableforgeneralpopulationsespeciallythosewithsystemicdisease ―diabetesandhypertension‖. Theremightbeaneedtohavesimilarstudyinotherpartsofthecitytomakecomparisonandfindanysimilarityordifferenceswiththisstudy. Financialsupportandsponsorshipnil. Conflictsofinterest:therearenoconflictsofinterests. Increasesizeofthesamples. Addressingprimaryhealthcarecenterstotakecareofeyehealthandcare.
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    Neurogenetics Spectrum of Sq related spinal muscular atrophies (lower motor neuron syndromes) in Sudanese and Saudi populations; a multicentre clinical and Molecular Study.
    (ALNEELAIN UNIVERSITY, 2010-10) Ali Alsanousi
    Abstract Background Spinal muscular atrophy is one of the most common autosomal recessive neurogcnetics disorders in East Africa and Middle East countries, also considered as a leading genetic killer under the age of two years, with high carriers‘ frequency exceeds 1:50 in Europe. The most common presentation is proximal muscle weakness as a consequence of anterior hom cells degeneration. A mutation in the telomeric copy of the survival motor neuron gene (SMNI) considered as main underlying causative factor. Most carriers of SMA have one chromosome 5 with a normal SMNI gene and one with a deleted SMNIcopy. Although no large-scale population-based study has been established in the region; a previous estimation has indicated that incidence of SMA is much higher in Arab population compared with other ethnic groups, partly because of high prevalence of tribal and consanguineous marriages. Objectives General objective The project has been designed to introduce the molecular medicine advanced technology to improve the accuracy in the diagnosis of lower motor neuron disorders presented in a form of SMA as translational reseach for our cun'ent knoweledge of the pathogenic chromosomal region (5ql3). The specific objectives were: '2' To Introduce the SMA Molecular diagnostics and the carrier detection methods in Sudan. '1' To review the role of SMNI and other candidate genes (NAIPs genes in susceptibility to SMA in Middle East countries and Arab ethnic groups). To establish a method could help detection of other possible mutations in SMA nondeleted patients (~5% of SMA Patients). '3' To explore the possibility of increasing the sensitivity of the diagnostic molecular technology for 5qSMA cases from 95 to~99%. '2' To correlate the genotype (SMNI and SMN2 copy number) with the phenotype and carrier status in diagnosed patients within special type of SMA families. ¢ 0.0 Material and methods Materials bower Motor neurone/5qSMA diagnosis retrospective study included 259 of DNA samples each sample extracted from clinically symptomatic patient during the year 2005 and 2006. Material for SMA carrier analysis study included Total number of 2000 healthy volunteers. Material for SMNI-Exon7 nondeleted patients’ analysis study Included 80 patients showed SMA clinical phenotype. Material for Sq SMA families without SMNI common deletion Included Ten (10) families (36 individuals) for SMA patients didn't show SMNI-exon7 deletion. Methods DNA extraction fi'om peripheral blood using QIAGEN (QIAamp DNA Blood Midi Kit) has been used for all samples included in this project; an altemative rapid extraction method l.raCode paper has been used for heterozygousity carriers testing. Amplification ofSMNI exon7 and 8 PCR performed in l2.5 ul total volumes containing l00 ng of DNA; the PCR products then digested with Dral and Ddel enzyme to visualize and identify the SMNI copy. Multiplex-PCR has been used as quantitative-PCR to determine the presence of single SMNlcopy (gene dosage scan) and stndardized as SMA carriers’ detection method as we used it also to detennine SMNI/2 copies and NAIF deletions in SMA family study. SMNI Long-Range PCR (LR-PCR) Selective amplification of SMNI gene by LR-PCR method was initiated to detect the single nucleotide mutation possibilities on SqSMA eases without SMNI common deletions. Fluorescenct~Based PCR SSCA (Single Strand Conformational Analysis) has been established as pre- sequencing methods to determine SMNI-exons with possible mutation. Sequencing has been performed using a dye terminator cycle sequencing kit (Perkin Elmer, Wanington, UK) and an automatic Sequencer (Applied Biosystem 373) for specific SMNI exons purified from the LR-PCR product. Outcomes and Results patients presented with lower motor neuron pheotype showed SMNl—Exon7 deletion therefore had a oonfinnation of Sq SMA diagnosis were (8l.08%). SMNI gene was absent or interrupted in 97 out of 137 (70.8%) of SMA types l patients, although SMA type II patients showed deletion in (93.1%) i.e. 8| out of 87; while (9l.4%) i.e. 32 out of 35 type-lll patients showed the same deletion mutation. The initial controls of the healthy carriers screening study included [87 normal individuals showed carrier frequency of 5%, i.e. one carrier in each 20 persons compared to one in 50-80 in other parts of the world. Therefore we expanded the healthy volunteers number to include i869 subjects. Only 43 i.e. (2.3%) individuals showed single copy of SMNIthis make the carrier frequency one in 34. 5 Ali Alsanousi-October/2010 ____ _ SMNI-Exon7 nondeleted SMA came study: included 80 patients classified into three classes. 5% of them showed SMN]-Exon8 deletions. Class] patients (SMNI-Exon7 nondeleted independent patients) results showed 21.05% of those patients showed deletion mutation of NAIP gene Exons.Class2 (SMN1 -Exon7 Nondeleted patient investigated in correlation with their family SMN genetic profile) showed deletion mutation in NAIP in 6.25%. Class 3 (included patients wit11 Exon7- SMN2 deletion) showed NAIP gene mutation in 50% of patients included from this group. Futher molecular analysis of the SMA families investigated for SMN!/SMN2 copies number using gene dosage scan analysis showed (100%) patients in this group were SMNI- Exon7 nondeleted. Gene dosage scan classified class 2 into further 3 classes; i.e. patients showed single copy of SMN! and single copy of SMN2 (IT/1C) represented 10% of this group. Patients showed 2 copies of SMN] and no copy of SMN2 (2T/0C) represented 30% of this group. While the majority of this group (60%) showed 2 copies of SMN] and one copy of SMN2 (2T/1C). We have established in this study a newly invented method using the Long range PCR to determine SMN! by amplification of 13 Kb of the SMN! genes i.e. (ex0n2a to exon8).The selective amplification of SMN! successfully performed using LR-PCR as substituting method for SMNI gene cloning from cDNA. Using 10% of class 2 patients (i.e. patients form showed single copy of SMNI in gene dosage scan).SMNl has been visualized then purified for specific Exon SSCA/SSCP which is optimized using I5 samples with known gene dosage scan profile. Two samples (13.3%) showed abnormal migration curve in SSCP therefore selected for optimimtion of the sequence analysis study. Both abnomially migrating SMN-Exon6 samples showed a normal or nonmuatated sequence. ln conclusions The project presented both the SMA diagnostic method together with a method for carriers testing with the highest sensitivity and specificity; then could be considered a comer stone to stop the spread of this fatal diabling disease. Homozygous deletion of Sll/flVI-exons7 was found in 93.1 to 91% while SMNI-exon8 deletion detected in 87% of patients included therefore could present a confimiatory diagnosis for SMA with high confidence. Healthy volunteers’ carriers study revealed relatively higher carrier frequency in comparison with other ethnics (2.34% i.e. one in 34). SMA families study gave an evidence of a possible underlying genetics mechanism related to S1vflV gene conversion and Sq 13 region rearrangements indicated by the gene dose scan analysis and NAIP gene deletions in SMA nondeleted patients. Ali Alsnnnusi-October/2010 6 Ali Alsanousi-October/2010
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    Etiology of Community Acquired Pneumonia in Sudanese patients in KTH and ATH
    (ALNEELAIN UNIVERSITY, 2003-02) Afrah Yousif Adam Haroon
    Abstract This is a prospective study which was conducted in Khartoum teaching hospital, Alshaab teaching hospital and Alakademia charity hospital to determine the etiology of community acquired pneumonia in adult patients who required hospitalization and the antibiotics sensitivity ofthe isolated pathogen. lO4 patients were diagnosed as having community acquired pneumonia CAP during the period between July 2000- December 2002. The microbiological diagnosis was based on the results of sputum culture. In 47 patients (45.2%) the causative pathogen was isolated. Streptococcus pneumonae was isolated in 25 patients (24.8%), and it proved so tar as the most common organism responsible for CAP among patients in the study group which is similar when compared with that in western countries. Six patients (5.8%) proved to have tuberculosis as cause otiCAP. Most ofthe isolated Strept pneumonae was found to be sensitive to penicillin. Resistance to penicillin was detected in one patient who is originally from Chad. Most ofthe isolates were sensitive to cephalosporin and Quinolones.
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    The Effect of gum Arabic ingestion on the hormones and the metabolic markers in patients with polycystic ovary syndrome
    (ALNEELAIN UNIVERSITY, 2016) Reem Ibrahim Mohamed
    Abstract Background Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of reproductive age. associated with multiple metabolic abnormalities, pathogenesis remain unclear but increased Gonadotrophin releasing hormone pulsitility. altered gut microbiome and oxidation stress play a major role. Gum Arabic (GA), edible, dried, gummy exudates from Acacia Senegal tree, is known for its prebiotic and antioxidant properties. Objective The main objective was to assess the changes in hormonal and metabolic profile in PCOS patients afier gum Arabic ingestion. Method Fifteen PCOS patients aged 20-40 years were recruited. All recruited patients met the inclusion criteria The patients received 30 g/day of GA dissolved in 250 ml water for 8 weeks. Follicular stimulating hormone(FSH), luteinizing hormone(LH), total testosterone(TT) fasting insulin, cholesterol and HBAW were measured before and after GA intake. Ethical approval from the National Medicines and Poisons Board was obtained. Results The study clarified that there is asignificant decrease in theluteinizing hormone level and the FSH/ LH ratio and the cholesterol pre and post intervention (P values 0.001, 0.0l3and 0.007) respectively. Follicular stimulating hormone slightly reduced post intervention with no significant difference (P value 0.414). No change in the testosterone, insulin nor HBAIC levels. Conclusion The study demonstrated that Gum Arabic ingestion for 8 weeks in PCOS patients decreases the luteinizing hormone and LH/FSH ratio and improve the metabolic profile by decreasing the cholesterol level.
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    Factors Associated with Poor Asthma Control Among Adult Patients Attending Three Tertiary Hospitals in Khartoum State, Sudan 2018
    (AL-Neelain University, 2018) Khalid Ahmed Albasher Ahmed
    Introduction: Asthma constitutes a significant public health problem and its burden in terms of prevalence, morbidity, mortality and economic impact, is high in both developed and developing countries. Research Objectives: The aim was to study the factors associated with poor asthma control among adult patients attending three tertiary hospitals in Khartoum state, 2018 and to determine the level of asthma control among asthma patients Methods: This was a descriptive, cross sectional hospital based study 374 asthmatic from three main Tertiary hospitals; namely Omdurman, Ibrahim Malik and Bahri hospitals to represent the three main localities in Khartoum State, between March 2018 to June 2018. Data were collected by using standardized questionnaire and the Asthma control test (ACT) was used to determine the level of control and the data was processed and analyzed by the Statistical Package for Social Sciences program (SPSS) version 20. Results: The mean age of the subjects was 40.1 years (115.7) and the sex distribution was almost equal, with 198 (52.9%) females. According to ACT score (84.2%) was uncontrolled asthma. Factors associated with poor asthma control included; residence [OR=1.89 (1.04-3.58)], time to reach facility [OR=2.36 (1.11-5.01)], longer asthma duration [0R=2.91(1.47-5.76)], family history of asthma [OR=0.39 (0.21-072)], history of ICU admission or ventilation [0R=4.07 (1.42-11.62)], Adherence to follow up [0R=7.44(1.91-29.00)] and inhaler technique (0R=0.26 (0.14-0.47]. Conclusion: The majority of asthma patients seen at the outpatient's clinics in the three tertiary hospitals in Khartoum have poor asthma control. An integrated approach to improve the management of asthma should be considered. Recommendations: Inhaled corticosteroids are good quality outcomes in asthma management, and achieving better control, efforts should be made to avail affordable and quality assured asthma medications should be increased Asthma knowledge, patients understanding and the important role of preventer medications in controlling asthma. Asthma standardized case management should be adopted by the ministry of health with emphasis on asthma capacity building and training for the working health personnel. Conflict of Interest: No Conflict of Interest Key Words: Asthma Asthma patients Poor asthma control Factors associated Asthma control.
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    epidemioligcal pattern of road traffic accident in khartoum state sudan .2015
    (Al-Neelain University, 2015) Ameen mohmmed ahmed mohmmed Al ashram
    Abstract Background: Worldwide, the number of people killed in road traffic crashes each year is estimated at almost l.2 million, while the number injured could be as high as 50 million. Every tenth bed in a hospital is occupied by an accident victim. The average cost of road traffic accident in developing countries is estimated at 65 billion dollars; the global annual cost of road traffic accident is almost 230 billion dollars. Objectives: The study aimed to study the epidemiological pattem of road traffic accident in Khartoum State . Methodology: A descriptive cross sectional hospital based of road traffic accident. It was carried out in Khartoum State in the period of 10"‘ of April to l 1"‘ of May, 20l5. Data was collected by using a questionnaire that consisted of personal identification data, and accident characteristics that were obtained from patient or (close relatives, other available persons who were present at the time of incidence). This study included (200) victims of road traffic accidents whom were attendant to three hospitals (Khanoum, Barry and Omdurman). Results: The proportion of road traffic accident cases was 7.6% from the total patients whom admitted to emergency departments of selected three hospitals. Nearly one third (35%) ofthe study population belong to the age group of 25-44 years. The accident rates were 5.4 times higher in males than in females. It was found in people having secondary level of education (29.5%) followed by primary education (25%) and illiterates (14%). The present occupation it was found that 32% were students, 31.5% were skilled workers as their occupation. The highest number of RTAs took place on Thursday (27.5%) followed by Tuesday (21.5%). Maximum number of accidents occurred in between day hours of 06.0] pm-12.00 midnight. 7l% were admitted to the hospital within less than 30 minutes. Majorities (52%) ofthe victims were using Motorized 4 Wheelers. The distribution of RTAs according to the type of road user’s victims indicates that pedestrians were the highest proportion (38.5%) followed by passengers (25%), drivers (22.5%), and motorcyclists (7.5%). Run over pedestrians were the most type of accidents (43%) shown followed by fall down (23.5%) and sideway (8.5%). The majority of incidents occurred due to road condition of crossing road (30%). Most of injuries site were
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    Emiological pattern if road traffic accdient in kharto
    (Al-Neelain University, 2015) Ameen mohmmed ahmed mohmmed Al ashram
    Abstract Background: Worldwide, the number of people killed in road traffic crashes each year is estimated at almost l.2 million, while the number injured could be as high as 50 million. Every tenth bed in a hospital is occupied by an accident victim. The average cost of road traffic accident in developing countries is estimated at 65 billion dollars; the global annual cost of road traffic accident is almost 230 billion dollars. Objectives: The study aimed to study the epidemiological pattem of road traffic accident in Khartoum State . Methodology: A descriptive cross sectional hospital based of road traffic accident. It was carried out in Khartoum State in the period of 10"‘ of April to l 1"‘ of May, 20l5. Data was collected by using a questionnaire that consisted of personal identification data, and accident characteristics that were obtained from patient or (close relatives, other available persons who were present at the time of incidence). This study included (200) victims of road traffic accidents whom were attendant to three hospitals (Khanoum, Barry and Omdurman). Results: The proportion of road traffic accident cases was 7.6% from the total patients whom admitted to emergency departments of selected three hospitals. Nearly one third (35%) ofthe study population belong to the age group of 25-44 years. The accident rates were 5.4 times higher in males than in females. It was found in people having secondary level of education (29.5%) followed by primary education (25%) and illiterates (14%). The present occupation it was found that 32% were students, 31.5% were skilled workers as their occupation. The highest number of RTAs took place on Thursday (27.5%) followed by Tuesday (21.5%). Maximum number of accidents occurred in between day hours of 06.0] pm-12.00 midnight. 7l% were admitted to the hospital within less than 30 minutes. Majorities (52%) ofthe victims were using Motorized 4 Wheelers. The distribution of RTAs according to the type of road user’s victims indicates that pedestrians were the highest proportion (38.5%) followed by passengers (25%), drivers (22.5%), and motorcyclists (7.5%). Run over pedestrians were the most type of accidents (43%) shown followed by fall down (23.5%) and sideway (8.5%). The majority of incidents occurred due to road condition of crossing road (30%). Most of injuries site were