PHD theses : Medicine

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Health education program in knowledge, attitude and practice among primary school students towards dental caries in Najran - Saudi Arabia
(AL-Neelain University, 1998) Nahid khalil El Faki Idrees
Abstract Background: Health education program about dental health is one of the reasons behind the declining of dental caries' rates in many industrialized countries. Other reasons include consumption of fluoridated toothpastes, effective and accessible oral health services. Objectives: The aim of the present study was to assess the effect of health education program in knowledge, attitudes and practice towards dental caries among school children during the period from 2013- 2016. Material & Methods: School-based interventional study design was adopted. A systemic random sample technique was used to obtain sample of 288 students from 3 different public primary schools for girls. The principal method of data collection was a semi structured questionnaire beside clinical examination that guided by DMFT index. Results: The result shows that 209 students out of 288 have dental caries (a rate of 72.57%). DMFT mean of the surveyed subjects was 0.73. Around 16% of the examined students didn't know the causes of dental caries. The study also revealed that 37% of the students get their knowledge about oral issues from their parents. 90% of students with dental problems have positive family history. After conducting the health education program the students' knowledge was significantly (p< 0.01) improved about fluoridated toothpastes, hygiene practices and the importance of visiting dentists was significantly (p< 0.01) increased. Conclusion: Poor oral hygiene practices, lack of parental guidance, hereditary factor together with lack of appropriate dental knowledge and frequent exposure to cariogenic foods are the main risk factors for dental decay among the surveyed students. Recommendation: Extra emphasis on dental health education programs in cooperation between education and medical authorities should be considered and implemented in Najran area. Key words: Dental caries, health education, school children, DMFT index. XI 12 ملخص الدراسة: خلفیة الدراسة: یعد التثقیف الصحي عن صحة الفم و الأسنان أحد الأسباب وراء انخفاض معدلات انتشار تسوس الأسنان لدى أطفال في الدول الصناعیة. أما الأسباب الأخرى فتشمل على سبیل المثال استخدام معاجین الأسنان التي تحتوى على مادة الفلور و سھولة التعامل و استخدام خدمات صحة الفم و الأسنان بالإضافة إلى تطور برامج التثقیف الصحي المدرسي مما زاد من مفھوم صحة الفم. ھدف الدراسة: أجریت ھذه الدراسة التطبیقیة في المدارس الابتدائیة للبنات بمدینة نجران بالمملكة العربیة السعودیة بھدف تقییم مدى تأثیر برنامج التوعیة والتثقیف الصحي في رفع مستوى المعرفة و السلوكیات والممارسات الصحیة لصحة الفم. وذلك في الفترة من 2013 وحتى 2016 م. منھج الدراسة: تعد ھذه الدراسة دراسة تطبیقیة و فیھا تم اختیار 288 طالبة عن طریق العینة العشوائیة –العدلیة- المتعددة المراحل من ثلاثة مدارس. كما تم جمع البیانات عن طریق إستبانة تحتوي على عدد من الأسئلة شبھ مفتوحة و مغلقة بالإضافة لاستمارة للكشف الطبي للفم DMFT و الأسنان للطالبات. وقد تم الكشف على الطالبات بواسطة مؤشر معروف یسمى (تكسر وفقدان الأسنان ووجود حشوة الأسنان) ومن ثم تم جمع البیانات على مرحلتین قبل وبعد إعطاء برنامج التوعیة والتثقیف الصحي حول صحة الفم وتسوس الأسنان. النتائج: قبل إعطاء برنامج التوعیة الصحیة وجد أن نسبة انتشار تسوس الأسنان بلغ %72.57 ومتوسط انتشار المؤشر بمعدل 0.73 وقد تبین أن 16 % من الطلبات لا یعرفن سبب تسوس الأسنان. وحوالي 70 % من الطالبات لا یعرفن أھمیة إضافة الفلور فى معجون الأسنان بالإضافة الى 37 % منھن یتحصلن على معلوماتھن من الوالدین. كما اتضح أن ھنالك علاقة عكسیة بین انتشار تسوس الأسنان لدى الطالبات و مستوى تعلیم الوالدین. بالإضافة إلى أن 90 % من الطالبات اللاتي تعانین من التسوس لدیھن تسوس وسط العائلة. وبعد إعطاء البرنامج ارتفعت نسبة وعى ومعرفة الطالبات من ذي قبل وبالمقارنة الإحصائیة وجدنا احتمال وارتفعت معرفة الطالبات عن الفلور المضاف .(p< ذلك كبیر ونسبة الاحتمال بلغت ( 0.01 بالمقارنة من ذي قبل. وانخفضت نسبة (p< = لمعجون الأسنان بنسبة احتمال بلغت ( 0.01 .( إلى ( 0.7 DMFT مؤشر الخلاصة و التوصیات: واستنتجنا أن معدل انتشارت سوس الأسنان وسط الطالبات منتشر جدا ولھ علاقة وراثیة وسط الأسر. ومعرفة الطالبات بأسباب التسوس منخفضة جدا ومرتبطة بمعرفة الوالدین غیر المتعلمین. وعلیھ ننصح بإدخال برنامج الصحة المدرسیة فى المدارس للتوعیة بأھمیة الصحة وصحة الفم بالخصوص لرفع مستوى وعى الطلاب والأسر. (DMFT) الكلمات الأساسیة: تسوس الأسنان، تثقیف صحي، طالبات المدارس، مؤشر
Mechanisms on childhood overweight and obesity at high altitude
(AL-Neelain University, 2005) Humeda Suekit Humeda
Abstract Objectives: The present study with its three parts, was undertaken to: (a) Describe the body composition and determine the prevalence of overweight and obesity in high altitude children‟s population and compare them their counterparts at low altitude, (b) Determine the possible mechanisms by which high altitude influences childhood body composition and the prevalence of overweight and obesity, (c) Explore the possible role of administration of antioxidants during pregnancy at high altitude in preventing late childhood overweight and obesity. Materials and methods: The first part was a cross-sectional prospective study of 145 Saudi children born and living permanently at high altitude (3100m) and 154 Saudi children born and living permanently at relatively low altitude (500m). For each child selected information regarding birth weight and breast feeding were taken from his or her file. Anthropometric measurements were then performed. Body mass index was calculated using the equation BMI=(Weight (kg)/Height (m2). Fat mass and fat free mass percentages were derived from triceps skinfold measurement. Resting pulse rate (beats/min), blood pressure, haemoglobin concentration and haematocrit value were measured. Physical activity level was determined using the short form of international physical activity questionnaire (IPAQ-SF). The second part was also a cross-sectional prospective study which included 25 healthy pregnant women and their healthy newborns from high altitude and equal numbers from low altitude. Measurements of maternal haemoglobin concentration, haematocrit value and blood pressure were made at the end of gestation. Foetal haemoglobin concentration and haematocrit value were determined immediately after delivery. Determination of the newborn's body shape and
Neuroprotective Potential of L-NAME as Anti-Oxidant and Anti-Inflammatory in Cerebral Injury Induced By Transient Focal Ischemia Reperfusion in Rats
(AL-Neelain University, 2005) Hiba Ahmed Alsheekh Awooda
Abstract: Background: Stroke is a major cause of death and disability globally. The function of nitric oxide (NO) in cerebral ischemia/reperfusion (I/R) has been intensively investigated; however, the exact role of NO inhibition in cerebral ischemia remains controversial. Aim: This study explored the possible neuroprotective effect of nonselective Nitric Oxide Synthase (NOS) inhibitor N-Nitro-L-Arginine-Methylester (L-NAME) in rat’s transient cerebral I/R. Materials and Methods: 30 adult male Wistar rats (150-250g) were divided into three groups 10 rats in each: First group was sham-operated and served as a control. I/R group of rats infused with 0.9% normal saline intraperitoneally 15 minutes prior to 30 minutes of left common carotid artery occlusion, followed by reperfusion for 24-hour, and a test group infused with L-NAME (15 mg/kg per weight) intraperitoneally 15 minutes prior to similar I/R periods. Neurobehavioral assessments were evaluated, Western blotting was used to estimated Nuclear factor kappa B (NF-қB) and quantitative -Enzymewas measured by α) -α (TNF-Tumor necrosis factormeasurement of nitrite and nitrate), and NO metabolites ( )ELISA(linked immuno sorbent assay malondialdehyde (MDA), and total antioxidant capacity (TAC) were measured colorimetrically in both plasma and affected cerebral hemisphere. Results: The L-NAME group showed a significant improvement in neurological deficit (M±SD = 15.07±0.584) compared to both I/R and control groups (12.798±0.689, 17.50±0.707, respectively P <0.001). In I/R rats NF-қB was significantly increased (129.2±1.7 RGB unit/mg protein) compared to the control group (53±1.03RGB unit/mg protein) and L-NAME pretreatment resulted in a significant decrease in NF-қB (44.4±1.3RGB unit/mg protein, P <0.001) compared to I/R group. The serum level of TNF-α was significantly increased in I/R group (734.8±108.9 pg/ml) compared to the control group (37.18±10.183 pg/ml), while L-NAME administration resulted in a significant decrease in serum TNF- α (64.36±11.053, P <0.001) compared to the I/R group. The brain tissue of TNF-α in the I/R group (110.4±6.2pg/mg protein) was significantly increased compared to the control group (4.9±0.8 pg/mg protein), L-NAME administration resulted in a significant decrease in tissue level of TNF-α (21.60±2.289, P <0.001) in compared to the control and I/R groups. Serum level of MDA and NO were significantly increased in I/R group (14.88±1.14 nmol/mL, 42.03±4.558 μmol/L respectively) compared to the control group (5.43±0.44 nmol/mL, 17.84±0.701 μmol/L respectively, P <0.001), while L-NAME administration resulted in a significant decrease in serum MDA and NO (7.18±0.135 nmol/mL, 18.44±0.513μmol/L respectively) compared to the I/R group. The serum level of TAC in the I/R group (1.21±0.169 mM/L) was significantly lower compared to the control group (2.52±0.062 mM/L), L-NAME pretreatment resulted in significant higher serum level of TAC (2.53±0.067 mM/L, P <0.001) compared to rats treated with normal saline. Regarding brain tissue levels of MDA and NO, the I/R group demonstrated a significant increase in the tissue level of both MDA and NO (8.56±0.658, 8.88±0.572 nmol/mg protein) compared to the control group (3.24±0.226, 3.48±0.228 nmol/mg protein, P <0.001). The L-NAME group showed a significant decrease in tissue level of MDA and NO (3.18±0.155, 4.47±0.392 nmol/mg protein, P <0.001) compared to the I/R group. The brain TAC level of the I/R group (0.0186±0.00373 mmol/mg protein) was significantly decreased compared to the control group (0.070±0.0085 mmol/mg protein, P < 0.001) On the contrary, administration of L-NAME prior to ischemia resulted in significant increase of brain TAC level (0.0747±0.00563 mmol/mg protein, P < 0.001) compared to rats subjected to saline infusion. NAME -These data demonstrated that L :nclusionsCoand Discussion significantly improve neurological deficit and L-NAME showed a potential ’sinflammatory effect in a rat-oxidant and anti-antiis through it tionneuroprotecmodel of transient focal cerebral ischemia reperfusion. الخلفيه: السكتة الدماغية هي سبب رئيسي للوفاة والعجز البدني عالميا. وقد تم التحقيق بشكل مكثف في دور أكسيد النيتريك (NO) في الفاقه الدمويه و اعاده ضخ الدم للدماغ, وبالرغم من ذلك فان الدور الفعلي لتثبيط NO في نقص الترويه الدماغي لايزال مثيرا للجدل. الأهداف: استنادا إلى هذه الملاحظات فان الغرض الرئيسي من الدراسه الحاليه هو استكشاف التاثير الوقائي المحتمل للاعصاب الناتج عن المثبط للانزيم المصنع لاكسيد النيتريك N-Nitro-L-Arginine-Methylester (L-NAME) خلال الفاقه الدمويه المؤقته للمخ و اعاده ضخ الدم في الفئران. المواد والطرق: اجريت هذه الدراسه علي 30 فئرا ذكرا بالغا من فصيله ويستار(تتراوح اوزانهم بين 150– 250جم) وتم تقسيمهم الي ثلاثه مجموعات تجريبيه 10 فئران في كل مجموعه. المجموعة الاولى (المجموعة المراقبة): وقد اجريت لهم عمليه خادعه. المجموعة الثانيه: قد خضعوا الى 30 دقيقه من نقص التروية الدماغية بواسطه انسداد الشريان السباتي الأيسر المشترك وتلاها اعاده لضخ الدم لمدة 24 ساعة, وقبل اجراء العمليه بخمسه عشر دقيقه تم حقنهم بمحلول ملحي بتركيز 0.9٪ داخل البرتونيوم. المجموعة الثالثه: تم حقنهم بماده L-NAMEداخل البرتونيوم خمسه عشر دقيقه قبل ان يخضعوا لنقص تروية دماغي عابر لمدة 30 دقيقة واعاده لضخ الدم لمدة 24 ساعة. وقد أجريت التجارب على السلوك العصبي قبل وفي أوقات مختلفة خلال الدراسة التجريبية في كل المجموعات. وفي نهاية الفترة التجريبية قتلت كل الفئران وقد أزيل المخ بسرعة وتم التقييم الكمي للموادالتاليه: Nuclear factor kappaβ (NF-қβ) باستخدام طريقه western blotting وقياس Tumor necrosis factor-α (TNF-α) بواسطه الانزيم اميونو ايسي وتم قياس اكسيد النتريك (النتريت والنترات)، و إجمالي القدرة المضادة للأكسدة Total antioxidant capacity(TAC) وقياس Malondialdehyde(MDA) عن طريق القياس اللوني في كل من من البلازما ونصف الكرة المخية المتأثرة. النتائج: تم التعبير عن النتائج بواسطه (الوسيط ± الانحراف المعياري), بعد حقن L-NAME لوحظ تحسن كبير في العجز العصبي والاعاقه الجسديه (15.07±0.584) بالمقارنة مع المجموعتين الاولي والثانيه (0 12.798±0.689, 17.50±0.707على التوالي P <0.001). فيما يتعلق بمستوى NF-қβ الذي قيس في نصف الكرة المخية المتأثرة, فقد لوحظ زياده ذات دلاله احصائيه وثيقه في المجموعه الثانيه (129.2±1.7 RGB unit/mg protein) مقارنة مع المجموعة المراقبة (53±1.03RGB unit/mg protein) وعلاوة على ذلك, فان المعالجه بواسطه L-NAME قبل نقص التروية
Seroepidemiologic Study of Brucellosis in Febrile Patients in Khartoum State
(Al Neelain University, 2008) Adam Ahmed Adam Mustafa
Biucellosis is a zoonotic disease caused by bacteria of the genus Brucella. Humans are infected mostly due to animal contact especially through consumption of unpasteurized milk or its raw products from infected animals. Consumption and handling of other raw products of animals also constitute an important mode of transmission. Human brucellosis is a debilitating disease which is commonly misdiagnosed for other infectious and non-infectious febrile diseases. The objective of this study was to provide baseline data on human brucellosis among febrile patients in Khartoum State. The diagnosis of brucellosis case in this study depended on a clinical manifestation which was fever for at least two weeks coupled with serum antibody titre of 1:160 or more to Brucella melitensis or Brucella abortus by using Standard Tube agglutinatonTest technique. The prevalence of human brucellosis was 8.9% among febrile patients in Khartoum State. Sixty three (70.8%) of the brucellosis patients were males, and 26 (29.2%) were females. Males constituted a significantly high number of patients than females. The males to females ratio was 2.4:l. ~ Fifty four (60.7%) of the brucellosis patients had signiﬁcant titres to Brucella melitensis with a mean serum titre of 1:373. Twenty three (25.8%) patients had signiﬁcant titres to Brucella abortus with a mean serum titre of 1:327. Twelve (13.5 %) of the patients had significant titres to both Brucella melitensis and Bruqella abortus with mean serum titres of 1:332 and 1:321 respectively. Risk factors for Human brucellosis include animal contact, particularly among people of certain occupations such as herdsmen, milkmen and those involved in meat industry. In addition, males were more exposed to infection than females, while both males and females at their mid-forties were more susceptible to infection than other age groups. High index of clinical suspicion of human brucellosis is needed for early diagnosis and management of the disease. More studies on the biology and epidemiology of Brucella species are important so as to reach a rational strategy for diagnosis, treatment and prevention of the infection.
Seroepidemiologic Study of Brucellosis in Febrile Patients in Khartoum State
(Neelain University, 2008) Adam Ahmed Adam Mustafa
Abstract Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella. Humans are infected mostly due to animal contact especially through consumption of unpasteurized milk or its raw products from infected animals. Consumption and handling of other raw products’ of animals also constitute an important mode of transmission. Human brucellosis is a debilitating disease which is commonly misdiagnosed for other infectious and non-infectious febrile diseases. The objective of this study was to provide baseline data on human brucellosis among febrile patients in Khartoum State. The diagnosis of brucellosis case in this study depended on a clinical manifestation which was fever for at least two weeks coupled with serum antibody titre of 1:160 or more to Brucella melitensis or Brucella abortus by using Standard Tube agglutinatonTest technique. The prevalence of human brucellosis was 8.9% among febrile patients in Khartoum State. Sixty three (70.8%) of the brucellosis patients were males, and 26 (29.2%) were females. Males constituted a signiﬁcantly high number of patients than females. The males to females ratio was 2.4: 1. Fifty four (60.7%) of the brucellosis patients had significant titres to Brucella melitensis with a mean serum titre of 1:373. Twenty three (25.8%) patients had significant titres to Brucella abortus with a mean serum titre of 1:327. Twelve (13.5 %) of the patients had significant titres to both Brucella melitensis and Brucella abortus with mean serum titres of 1:332 and 1:321 respectively. Risk factors for Human brucellosis include animal contact, particularly among people of certain occupations such as herdsmcn, milkmen and those involved in meat industry. In addition, males were more exposed to infection than females, while both males and females at their mid-forties were more susceptible to infection than other age groups. High index of clinical suspicion of human brucellosis is needed for early diagnosis and management of the disease. More studies on the biology and epidemiology of Brucella species are important so as to reach a rational strategy for diagnosis, treatment and prevention of the infection.
Heart Rate Variability and Asthma Control Test
(ALNEELAIN UNIVERSITY, 2008) Mohamed Faisal Mohamed Lutﬁ
ABSTRACT Background HRV is widely accepted to have prognostic signiﬁcance in patients with cardiovascular diseases especially after acute myocardial infarction. However, recently. interest has grown in relating some pathologies with abnormal autonomic activity based on HRV studies. Although asthmatics are known to have enhanced cholinergic activity, little I-[RV studies were done on asthma patients. Moreover, the results of these studies are not reproducible, probably due to inter-individual differences of autonomic balance in test group or inadequately designed methods. Objectives l. To develop an effective spirometric score that can faithfully reﬂect ventilatory functions of the lungs and efﬁciently discriminating asthmatics from non- asthmatics 2. To detect reliability and validity of Asthma Control Test (ACT) and National Asthma Education and Prevention Program (NAEPP) in the classiﬁcation of studied asthmatic patients based on above-mentioned spirometric score. 3. To correlate asthma control (using ACT and NAEPP) and ventilatory function with parameters of autonomic balance. 4. To detect the pattem of autonomic balance in asthmatics using a parameter known to be inﬂuenced by sympathetic and parasympathetic e.g. airways narrowing indicated by spirometry, blood pressure and blood glucose concentration. Methods The study involved 56 apparently healthy subjects and gender and an age matched group of 100 asthma patients classiﬁed into subgroups according to asthma severity using ACT and NAEPP classiﬁcations. Blood pressure, anthropometric. spirometric, HRV measurements together with drug therapy, blood level of glucose, hemoglobin and electrolytes were assessed for every subject. All spirometric measurements were condensed into one representative score (discrimination analysis score (DAS)) using discrimination analysis. Sensitivity and speciﬁty of DAS were tested using conditional ratios and Receiver Operating Characteristic (ROC) curve. Screening of studied variables for signiﬁcant correlations and mean differences among different groups with adjustment for possible confounding factors was perfonned using appropriate statistical techniques. Results Spirometry: Correlations between all spirometric measurements and DAS were highly signiﬁcant (P = 0.000 for all correlations). DAS when compared with F EVl% (at the most accurate cutoff equal to 80%) as a predictive measurement for presence of asthma, is proved to be more sensitive (8l.00% for DAS and 71.00% for FEVl%). speciﬁc (94.14% for DAS and 92.86% for FEV1%) and accurate (86.54% for DAS and 78.85% for FEV1%). For further veriﬁcation, accuracy of DAS was compared with the remaining of spirometric measurements using ROC curves. DAS is proved to be the most sensitive measure in diagnosing asthma (area under the curve = 0.933, P = 2.77E-l9 and 95% conﬁdence interval 0.897 - 0.971). Of asymptomatic asthma patients, 34.0 % were labeled poorly controlled and 41.5% were labeled uncontrolled. ACT score was higher while NAEPP class was lower in symptoms free compared with symptomatic asthmatic patients (P = 0.000 and 0.005 respectively). DAS correlate signiﬁcantly, but moderately, with ACT score and NAEPP class (P = 0.000 for both, CC = 0.38 and -0.49 respectively). Heart Rate Variability: Sympathetic tone (LF Nonn) of mild asthmatics was signiﬁcantly lower while parasympathetic tone (HF Nonn) was signiﬁcantly higher compared with apparently healthy subjects (P = 0.016 and 0.017 respectively). This was also true when mild asthmatics are compared with severe asthma patients (P = 0.020 and 0.015 respectively). ACT state of asthmatics correlate signiﬁcantly, but weakly, with LF Norm (CC = 0.292, P = 0.003) and HF NOHTL (CC = 0.309, P = 0.002). Blood Pressure and Blood Glucose Concentration: ln contrast to systolic and mean arterial blood pressures, diastolic blood pressure was signiﬁcantly higher in asthmatics compared with non-asthmatics (P = 0.002). Blood pressures correlate positively with sympathetic and negatively with parasympathetic activity in non- asthmatics (P < 0.05 for all). However, these correlations are lost in asthmatics. Blood glucose concentrations in asthmatic patients were signiﬁcantly higher as compared with healthy subjects (P = 0.000). Blood glucose concentrations correlate positively with parasympathetic and negatively with sympathetic in non-asthmatics (P < 0.05 for all). Nevertheless, these correlations are lost in asthmatic patients. Conclusions DAS is more sensitive, speciﬁc and accurate compared with other spirometric measurements, but like other indicators it fails to reach 100% sensitivity and speciﬁty on asthma diagnosis. Presence or absence of symptoms did not correlate with asthma control which draws attention to asthma classiﬁcation criteria. The autonomic balance of mild asthma (showing high parasympathetic and low sympathetic activities) is different compared to the severe form of the disease (which showed normal parasympathetic and sympathetic activities). Autonomic balance might inﬂuence symptomatology but not ventilatory function Many signs of functional impairment (control of blood pressure and blood glucose concentrations) of the autonomic nervous system are noted in asthmatic patients. XIV
Spoligotyping patterns and drug resistant of Mycobacterium tuberculosis in Sudan
(Al-Neelain University, 2009) Ghada Suliman Sharaf-Eldin
ABSTRACT . Sudan has a high burden of tuberculosis with an estimated 93,000 new cases each year. The purpose of this study was to investigate the genotypic patterns of M. tuberculosis strains circulating in Sudan and to assess their susceptibly to anti-tuberculosis drugs. Isolates from 237 smear positive tuberculosis patients were collected from different geographic regions of the country. Spoligotyping was performed by the Kamerbeek method and results were compared with the international SpolDB4 database (Institut Pasteur, Guadeloupe). Results revealed 28 clusters ranging in size from 12 to 57 isolates. Seventy unique (unclustered) strains were observed, representing 30% of the strains examined. The most frequently observed spoligotype patterns belonged to the CAS family which represented 115 (48.5%) of isolates studied. T1, H3, U and Beijing strains were found in 12 (5.1%), 11 (4.6%), 7 (3%) and 6 (2.5%) patients respectively. Strains belonging to the Beijing family were found mainly in Western Sudan. Resistance to isoniazid, rifampicin, ethambutol and streptomycin was observed in 18.1, 22.4, 22.2 and 32% of strains respectively. Twenty patients (8.4%) had MDR-TB of which 10 were new cases. Seventeen patients with rifampicin resistant tuberculosis were infected with CAS1-DELHI strains matching SIT 25 of the SpolDB4 database and 3 were of the SIT 1 Beijing family. 15 loci MIRU-VNTR typing subdivided the 17 CAS strains into one cluster of 5, two clusters of 2 and 8 individual MIRU types. Similarly the 3 Beijing spoligotypes were differentiated into a cluster of 2 and a single strain. x The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigation in Sudan. However, caution must be used when interpreting clustered spoligotype patterns in this region. xi مستخلص يقدر عدد الحال ت الجديدة من المصابين بمرض السل الرئوي كل عام بحوالي 93 ألف حالة. تهدف هذه الدراسة إلى إجراء اختبارا ت تنمط نوعي على عينا ت من سلل ت الجراثيم الدقيقة المنتشرة في السودان ، إضافة إلى عمل تقييم قابلية استجابتها لعقاقير المضادة لحال ت السل الرئوي . تم عزل اللطاخا ت الموجبة لعدد 237 مريض من مرضى السل الرئوي الذين تم جمع عيناتهم من مناطق جغرافية مختلفة من القطر . حيث تم إجراء عمليا ت التنميط النوعي بواسطة طريقة كامربيك وتم إجراء مقارنة مع قواعد بيانا ت ذا ت معايير دولية تمثلت في معهد باستير قوادالوبي . أظهر ت النتائج أن إجمالي المجموعا ت المفحوصة بلغ 28 مجموعة تفاوتت أحجام العزل لها بين 12 إلى 57 . ولوحظ أن هناك 70 نوعاً من النواع الفريدة من تلك السلل ت غير المنضوية تحت عوائل مجموعة محددة وأن ما نسبته 30 %من تلك السلل ت قد أجريت عليه الختبارا ت . وقد لوحظ أن أكثر النماذج التي أجريت عليها اختبارا ت التنميط النوعي تعود لعوائل موطنها الصلي أواسط قارة آسيا ، وقد أجريت عليها دراسا ت عزل قد بلغت في مجملها 115 دراسة ـ أي ما نسبته 48 ، %فيما وجد أن عدد ونسبة المر ضى المصابين بالسل الرئوي من سلل ت توسكاني 1 ، هارليم 3 ،يورال وبيجينغ قد بلغت 12 ) بنسبة 1.5 ، (%11 ) بنسبة 6.4 ، (%7) بنسبة 3 (%و 6) بنسبة 5.2 (%على التوالي. وتتواجد السلل ت التي تنتمي إلى عائلة بيجينغ بصفة رئيسية في غرب السودان. حيث لوحظ أن نسبة تواجد مقاومة العزل ، للريفامبيسين ، إثامبيوتول والستريبتومايسين في بعض العوائل بلغت 1.18، 4.22 ، 2.22 وبنسبة إجمالية 32 %على التوالي . عشرون من مرضى السل الرئوي وجد أن لديهم خاصية مقاومة عقاقير متعددة للمرض وبما نسبته (4.8 (%سجلت عشرة حال ت منهم كحال ت جديدة. أثبت المسح أن سبعة عشر مريضاً ممن يتناولون مضاد الريفامبيسين للسل الرئوي مصابون بالمرض الذي ينحدر من عوائل يعود موطنها الصلي لواسط قارة آسيا – دلهي حيث يتطابق ذلك مع 25 منهم 4 شملهم الفحص بواسطة قواعد البيانا ت SpolDB و 3 من النواع الشائعة ST من عائلة بيجينغ حيث جاء التقسيم الفرعي لـ 17 سللة تحت سللة رئيسية واحدة من أصل 5 ، سللتان من أصل إثنين و 8 من السلل ت الفردية أصبح تحت فرع العوائل المستجيبة لنواع الـميرو MIRU . وعلى ذا ت المنوال انفصل التنميط النوعي لسللة بيجينغ إلى سللتين وسللة فردية واحدة .إن استخدام التنميط الجزئي للسللة يوفر طرق فعالة من تلك الطرق التي يستهل بها تصنيف العوائل السللية وليس الدمج فحسب، بل حتى في طرق الرقابة التقليدية للمسوحا ت المنتشرة في السودان . وفي ذا ت الصدد ؛ يجب أخذ الحيطة عند عمل التحاليل التفسيرية لنماذج التنميط لعوائل المجموعا ت في هذه المنطقة.
Spoligotyping patterns and drug resistant of Mycobacterium tuberculosis in Sudan
(Al Neelain University, 2009) Ghada Suliman Sharaf-Eldin
. Sudan has a high burden of tuberculosis with an estimated 93,000 new cases each year. The purpose of this study was to investigate the genotypic patterns of M. tuberculosis strains circulating in Sudan and to assess their susceptibly to anti-tuberculosis drugs. Isolates from 237 smear positive tuberculosis patients were collected from different geographic regions of the country. Spoligotyping was performed by the Kamerbeek method and results were compared with the international SpolDB4 database (Institut Pasteur, Guadeloupe). Results revealed 28 clusters ranging in size from 12 to 57 isolates. Seventy unique (unclustered) strains were observed, representing 30% of the strains examined. The most frequently observed spoligotype patterns belonged to the CAS family which represented 115 (48.5%) of isolates studied. T1, H3, U and Beijing strains were found in 12 (5.1%), 11 (4.6%), 7 (3%) and 6 (2.5%) patients respectively. Strains belonging to the Beijing family were found mainly in Western Sudan. Resistance to isoniazid, rifampicin, ethambutol and streptomycin was observed in 18.1, 22.4, 22.2 and 32% of strains respectively. Twenty patients (8.4%) had MDR-TB of which 10 were new cases. Seventeen patients with rifampicin resistant tuberculosis were infected with CAS1-DELHI strains matching SIT 25 of the SpolDB4 database and 3 were of the SIT 1 Beijing family. 15 loci MIRU-VNTR typing subdivided the 17 CAS strains into one cluster of 5, two clusters of 2 and 8 individual MIRU types. Similarly the 3 Beijing spoligotypes were differentiated into a cluster of 2 and a single strain. x The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigation in Sudan. However, caution must be used when interpreting clustered spoligotype patterns in this region
Determination of Antiphospholipid antibodies and Thrombophilia in women with Recurrent Miscarriage
(Al Neelain University, 2011) Tagwa Yousif Elsayed Yousif
Recurrent miscarriage is a_critical problem in which many factors play a crucial role such as antiphospholipid antibodies (APA) and anticardiolipin antibodies (ACA). This study was a case control study, was conducted from Febraury-2008 to February - 2011 in Khartoum State; it determined the haemostatic abnormalities and the frequency of the primary and secondary antiphospholipid syndrome in women with history of recurrent miscarriage (RM). A total of 100 women with three or more consecutive recurrent miscarriage as case group and 100 non complicated pregnant women as control group were enrolled in this study and were interviewed through clinically structured questionnaire to assess the risk factors for RM and an informed consent were obtained from them. Patient and control groups were screened for the presence of antinuclear antibodies (ANA), anti-double stranded DNA (anti- dsDNA), antiphospholipid antibodies (APA IgM/IgG), and anticardiolipin antibodies (ACA/IgG) by using Enzyme linked Immuno-Sorbent assay (ELISA). The platelets were counted using Sysmex KXN-21. Activated Partial thromboplastin time (APTT), Prothrombin time (PT) and Thrombin Time (TT) were measured using coagulometer biobas 10. Women positive for APA were repeated the measuring of APA level after 6 as conﬁrmatory test. All tests were analyzed using Statistical Packages of Social Sciences Version 17 (SPSS program). Results showed that the frequencies for both APA and ACA were 20%, ANA and Anti- dsDNA were 12%, thrombocytopenia was 8%, LA was 20% , 5% had prolonged PT, where as the remaining patient and control groups had normal results. There were a signiﬁcant correlation between Age and the presence of APA (P=0.03), ACA (IgG) (P=0.04), ANA and Anti-dsDNA (P=0.0l3), LA (P=0.033) and thrombocytopenia (P=0.02), whereas PT had not inﬂuenced by age. The data concluded_ that the frequencies of APA, ACA, ANA, Anti-dsDNA, LA and thrombocytopenia in women with RM obtained in this study were in agreement to the frequencies for these parameters obtained in previous studies and their presence were signiﬁcantly associated with recurrent miscarriage. The current study recommends measuring of APA, ACA, Anti-dsDNA-antibodies, APTT and PT in all women with 3 or more consecutive pregnancy loss.
The Effectiveness of Nursing Counseling Intervention on The Social Adaptation Among HIVIAIDS Patients In Khartoum Teaching Hospital 2006-2011
(Neelain University, 2011) Saadia Abdalla Gesm Elseed
Abstract This study aims to assess the Effectiveness ofnursing Counseling lntervention on the social adaptation among HIV/AIDS patients in voluntary Counseling Test Center (VCT) at Khartoum Teaching Hospital. The method of the study is interventional programs consist of 24 sessions applied in. intervention group compare with non intervention group. Tools for data collection which involve Self Esteem Scale, Self concept scale, hospital anxiety and depression, social desirability, social function sheet, assessment sheet for patients satisfaction during counseling sessions and assessment sheet to assess the program. Participants are HlV/AIDS patients at VCT Center in KTH. lnclusion criteria are adult HIV /AIDS patients, receiving antiviral and willing to participate. Exclusion criteria are HIV/AIDS patients not receiving antiviral, refused to participate and children. The sample size is 200 HIV/AIDS patients (200 intervention and200 non interventions). Ethical considerations are involved in application; for permission from the Hospital Authority to conduct the study was obtained and verbal informed consent ofparticipants whom are given code numbers \vas attained. The research results are disseminated to the Voluntary Counseling Test Centers, to help HIV/AlDS patient to achieve social adaptation and live positively. The present study reveals that results in non intervention group which received standard nursing care in self esteem scale, which measures attitude towards myself varies between 60-70% in disagree and strongly disagree, this is indication to low self-esteem (table 4-l).However after the implementation of the program in intervention group self-esteem of patients results varies between 70-75% in agree and strongly agree this indicates that the implementation of the program is very effective in enhancing patients self-esteem (table 4 -8). ' Also, the study shows that the results of self concept scales which measure physical self- moral, ethical-self, personal, family and social in non intervention group various between 75-85% in strongly disagree (table 4-2), in spite of experimental group these results between 75-85% in agrees and strongly agree an indication the increase in self-concept (table 4-9). The study reveals that in the assessment of the program and patient satisfaction (tables 4-6/4-7) there is low satisfaction in non intervention group, compare with high satisfaction and responses(tables 4-l3/4-14) in intervention group during counseling sessions. Results of the study indicate marked improvement in patient's communication, interaction, span of attention, socialization and social perfomtance. This is supported by Roy Adaptation theory and Orenr Selfcare theory. Then this study proves the effectiveness ofthe constructed nursing counseling program on the social adaptation of the chronically HIV/AIDS patient's (through a planned therapeutic program) as well as the influence of the nursing role throughout the processes of treating the chronically HIV/AIDS patients. On the light of these study findings, it is recommended that nursing counseling program should be implemented early to patients and their families, nursing counseling program should include self- care, coping strategies, problem solving, communication, decision making and assertiveness skills. A counseling nursing program should be, established to qualify personnel to conduct counseling sessions for the HIV/AIDS patients.
Sequestered Plasmodium falciparum parasites in human infections: different genotype distribution in placental and the peripheral circulation
(Al Neelain University, 2011-09) Elamin Abdulkareem Elamin
Introduction: In regions highly endemic for malaria, the prevalence of placental malaria ranges from 30% to 60% and has been associated with increased risk of adverse infant outcomes, particularly in primigravidae The study was conducted on mothers after delivery to detect hidden Plasmodium falciparum parasite, merozoite surface protein (mspl) & (msp 2) by PCR technique.75 pregnant women were enrolled in the study; the mean age of them was 26.30 i 7.02. Sml of venous blood were collected from the mothers after delivery. Materials and methods: Approximately, Sml of venous and placental blood were obtained from 75 mothers aﬁer delivery, attended Omdurman Matemity Hospital, which is one of the largest matemity hospitals in the capital Khartoum. The mean age of the mothers was 26.3i7.02.The study was conducted during the pen'od January to May 2009. Genomic DNA was extracted from peripheral and placental blood samples using modiﬁed phenol chlorofonn technique. The msp-1 allele (MAD20,) and msp-2 allele A1, A2, Bl and B2, P. falciparum primers were used for PCR. The PCR product was analyzed on 1.5% Agarose gel and visualized by gel documentation system after ethidium bromide staining. Results: The results revealed that the overall malaria detection rate in peripheral blood and placental blood using ICT was 10.7%. With the PCR (msp-l alleles) the detection rate of malaria in peripheral blood was found to be 9.3%, while in placental blood the same technique showed a detection rate of 10.7%. For PCR (msp-2 alleles), the detection rate of malaria in peripheral blood was 12%, while in placental blood the same technique showed detection rate of 2 1 .3% malaria. p The detection rate of the different combination of the positive and negative results in peripheral and placental blood by using msp-1 alleles revealed that the highest rate (84%) was reported among the peripheral negative & placental negative group while the lowest rate (4%) was reported among the peripheral positive and placental positive. The detection rate of the different combination of the positive and negative results in peripheral and placental blood by using msp-2 alleles revealed that the highest rate (72%) was reported among the peripheral negative & placental negative group while the lowest rate (5.3%) was reported among the peripheral positive and placental positive . When msp-1 and msp-2 alleles used in combined way for the detection of malaria parasite in peripheral and placental blood, they revealed that they were identical in 66.7% of examined samples, discordant in 10.7% of the samples, positive in peripheral blood and not in placental blood in 8% of the samples and positive in placental blood not in peripheral blood in 14.7% of the samples. Out of the 53 cases with no previous history of malaria when using the ICT, 14 were found negative for malaria and out of the 5 positive cases with previous history of malaria, 3 were found positive. For the msp-1 used in peripheral blood, out of 52 cases with no previous history of malaria, 16 were found positive for malaria and out of the 6 cases with previous history of malaria, 1 ease was found positive for malaria. For the msp-1 used in placental blood, out of the 51 cases with no previous history of malaria, 16 were found positive for malaria and out of the 7 cases with previous history of malaria, l case was found positive for malaria. For the msp-2 used in peripheral blood, out of 51 cases with no previous history of malaria, 15 were found positive for malaria and out of the 7 cases with previous history of malaria, 2 cases were found positive for malaria. For the msp-2 used in placental blood, out of 46 cases of no previous history of malaria, 13 were found positive for malaria and out of the ll cases with previous history of malaria, 4 cases were found positive for malaria. When using the msp-1 for peripheral blood, the result showed that the mean body weight among the negatives was 3.187 and it was 3.1833 among the positives. When using the msp-1 for placental blood the result showed that the mean body weight among the negatives was 3.1967 and it was 3.1000 among the positives. When using the msp-2 for peripheral blood the result showed that the mean body weight among the negatives was 3.1705 and it was 3.3286 among the positives. When using the msp-2 for placental blood the result showed that the mean body weight among the negative was 3.1786 and it was 3.1889 among the positives. Conclusion: In the vast majority of cases, some sequestered genotypes remain hidden, undetected in the peripheral circulation, indicating that analysis of peripheral parasites generates a partial picture of a P. falciparum infection. The cord blood must be collected from the umbilical cord to detected placental P. falciparum infection particularly in primigravidae
Studies on immunohcmatological Factors as predisposing to recurrent miscarriage in Sudanese women
(Al-Neelain University, 2012) Jevara Mohammed Khalifa Elsanhory
Recurrent miscarriage is a critical problem in which many factors play a crucial role such as antiphospholipid antibodies (APA) and anticardiolipin antibodies (ACA). This study was a case control study, conducted in Khartoum State; it determined the haemostatic abnormalities and the frequency of ABO and Rh blood group in women with history of recurrent miscarriage (RM). A total of 200 women with three or more consecutive recurrent miscarriage asvcase group and 200 non complicated pregnant women as control group were enrolled in this study and were interviewed through clinically structured questionnaire to assess the risk factors for RM and an informed consent were obtained from them. All samples were tested for ABO, Rh (D) and anti—cardiolipin ( |gM, |gG), anti- phospholipids ( lgM, lgG), protein C and protein S deficiency ,complement 3 and 4 and Prothrombin time (PT) and activated partial thromboplastin time (AP"l'l'), complement receptor 1 ,2. All tests were analyzed using Statistical Packages of Social Sciences Version 17 (SPSS program). Results showed that, the 0 group was most common frequently occurred (55% ) , followed by group A (26%) group B was found ( 14% ) and least common was group AB (5%) .The frequency of the Rh (D) was most common frequently occurred (95%). The frequency of anti- cardiolipin |gM was (5.5%), while anti—cardiolipin IgG was highest common frequently (6.5%), the frequency of anti-phospholipids lgM was (10%), while antl-phospholipids lgG was (6.5%), The levels of C3 (17.5%) and C4 levels (18.5%) were found to be lower in women with recurrent miscarriage, We propose that the decreased levels of sCD21 (1.5%) and sCD35 (29.5%) , An increased frequency of protein S deficiency (13%) compared to protein C deficiency (2%) in the case group. The data concluded that the ABO and Rh blood group system, Proteln C and protein S deficiency, low levels of C3 and C4, the presence of anticardiolipin antibodies (|gM/|gG) and the presence of the antiphospholipid antibodies were significantly associated the immune- pathogenesis of recurrent miscarriage. The current study recommends measuring of APA, ACA, Protein C, S, level of C3 and C4, and ABO and Rh blood group in all women with 3 or more consecutive recurrent miscarriage.
Association Between Gastroesophageal Reﬂux Disease and Atrial Arrhythmias IRAQ-FALLUJAH-2010-2012
(Alneelain University, 2012) Faisal Khalaf Shaihan AL-Assaf
Introduction Gastroesophageal reﬂux represents the retrograde ﬂow of gastric contents into the esophagus. It occurs even in healthy individuals and is regarded as "physiological" as long as it does not induce esophageal mucosal abnormalities or symptoms. Whenever Gastro-oesophageal reﬂux provokes symptoms or complications it is called gastro-oesophageal reﬂux disease (GERD). In the last decade, there has been renewed interest_in the functional relationship between the gastrointestinal tract " the oesophagus in particular" and the cardiovascular system, there is clinical evidence showing the role of the oesophagus in triggering cardiac dysrhythrnias. As there are cases of atrial arrhythmias with obscure reasons in spite of all sophisticated diagnostic tests, so this research may contributes in detecting one of these reasons. Objective the association between gastroesophageal reﬂux disease (GERD) and cardiac dysrhythmias still conjectural in spite of studies that had been conducted. By this study I try to explore this relationship and to test the efficacy of proton pump inhibitors on GERD related arrhythmias. Methods Gastroscopy and 24 hrs ECG Holter monitoring performed for 120 patients (67 males and 53 females, The age of study sample ranged between a minimum of 16 years to a maximum of 70 years old. The mean age was 34 + / - ll years) who complained of symptoms of (GERD) with frequency score for symptoms of GERD of 8 and more aﬁer excluded all the n'sk factors that can inﬂuenced the heart rate. A second 24 hrs Holter study two month followed treatment "as outpatients" by proton pump inhibitors (PPI), and a third Holter study one month after hold of treatment had been perfonned. Results An impressive reduction in frequency count of atrial arrhythmias were noticed in 68.1% of studied subjects, furthennore, signiﬁcant recurrence of sinus tachycardia observed in 75% of patients, one month aﬂer discontinuing treatment. Conclusion Atrial arrhythmias can be triggered by GERD, PPI had a signiﬁcant inﬂuence on amelioration of the GERD related atrial arrhythmias.
Immune Mediated Atherosclerotic Vascular Disease; Case-Control Study Among Sudanese Patients
(Al-Neelain University, 2012) Mohammed Kamel Naief Shubair
Abstract Atherosclerosis is an inflammatory disease, with similar chronic inflammatory conditions found in Coronary Heart Disease (CHD). The current study is aiming at determination or assessment of immune mediated responses in patients with atherosclerotic lesions with a specific focus on the T cell and the role of Proinflammatory and anti-inflammatory cytokines namely IL-1β, TNF-α and IL-Ra. The study was a case-control study; that was conducted at Medical Research Center of Al-Neelain University. Following informed consent samples were collected at hospitals from Khartoum State and the study done during in 2010-2012. The study involved 81 control healthy and three test groups: 100 patients of atherosclerotic CHD, 35 stroke patients and 35 diabetes mellitus and hypertension patients. The study has investigated the levels of cytokines IL-1β and TNF-α using ELISA. In addition to that polymorphisms of genes of IL-1β, TNF-α and IL- 1Ra were detected using PCR. Atherosclerotic CHD is associated with low level IL-1β. However, the level of IL-1β in atherosclerotic patients with CHD was significantly higher compared with the control group in those less than 40 years old. It was also noted that there is significant association between higher levels of IL-1β and patients with stroke, DM and HTN. In contrast to patients with atherosclerotic CHD, there is significant association between higher levels TNF-α of and patients with stroke, DM and HTN. IL-1β genotypes among studied groups showed no significant association between allele frequencies of IL-1β and atherosclerotic CHD, stroke, DM and HTN. Similarly, there was no significant association between allele frequencies of IL-1Ra and atherosclerotic CHD, stroke, DM and HTN. In contrast to patients with atherosclerotic CHD and HTN, there was significant association between allele frequencies of TNF-α and patients with Stroke and DM. In the study a window was opened on inflammatory diseases in the Sudan. However, it was concluded that: There is a need for more clinical studies to determine the interest of cytokines, and to compare it with other cytokines present in cardiovascular patients. This is cytokines found in various with inflammatory diseases, and even now we need to clarify and interpret studies of cytokines associated with inflammation, and show allelic frequency for the immediate immune responses of coronary atherosclerosis in patients with heart disease and stroke. V الملخص: تصلب الشرايين هو مرض التهابي، إن نفس الظروف المماثلة للالتهابات المزمنة وجدت في مرض القلب التاجي (CHD ،(فالدراسة الحالية تهدف إلى تحديد أو تقييم ردود الاستجابة المناعية المتوسطة لدى مرضى تصلب الشرايين، مع التركيز بصفة خاصة على الخلايا التائية ودور السيتوكينات الموالية للالتهابات والمضادة لها وهما 1β-IL ،α-TNF و Ra-IL . وكان منهج الدراسة هو حالة التحكم والمراقبة. وأجريت الدراسة في مركز البحوث الطبية في جامعة آل النيلين. وبعد الموافقة المطلع عليها تم جمع العينات من المستشفيات بولاية الخرطوم وأنجزت الدراسة في الفترة 2010-2012 .وشملت الدراسة مجموعة الأصحاء وهم 81 ومجموعات الاختبار الثلاثة وهم 100 من المرضى الذين يعانون من تصلب الشرايين التاجية ، 35 مريضاً يعانون السكتة الدماغية و 35 مريضا يعانون من داء السكري أو ارتفاع ضغط الدم. وقد شملت هذه الدراسة اختبار مستويات السيتوكينات 1β-IL و α-TNF باستخدام تقنية ELISA . بالإضافة إلى الأشكال المتعددة للجينات لكل من 1β-IL ، α-TNF و 1Ra-IL ،وقد تم الكشف عنها باستخدام تقنية .PCR يرتبط مع تصلب الشرايين التاجية مستوى منخفض من 1β-IL .ومع ذلك، كان هناك ارتفاع ملحوظ في مستوى 1β-IL في مرضى تصلب الشرايين التاجية دون40 سنة مقارنة مع مجموعة التحكم (الأصحاء). كما لوحظ أنه هناك ارتباط كبير بين مستويات أعلى من 1β-IL في مرضى ضغط الدم، السكري والسكتة الدماغية، على عكس الذي وجد في مرضى تصلب الشرايين التاجية. وهناك دلالة وارتباط بين مستويات α-TNF العالية والمرضى الذين يعانون من السكتة الدماغية، السكري وضغط الدم. وأظهرت مورثات 1β-IL بين المجموعات المدروسة، فلقد شوهد أنه لا يوجد ارتباط كبير بين التكرات للأليل 1β-IL في مرضى الشرايين ، السكتة الدماغية ، ضغط الدم والسكري. ونفس الشيء لم يكن هناك ارتباط كبير بين التكرارات للأليل 1Ra-IL في تصلب الشرايين ، السكتة الدماغية وضغط الدم والسكري. وعلى العكس في المرضى الذين يعانون من أمراض الشرايين وضغط الدم، كان هناك ارتباط ودلالة مهمة بين التكرارات للأليل α-TNF في مرضى السكتة الدماغية و السكري. في دراستنا تم فتح نافذة على الامراض الالتهابية في السودان. ومع ذلك، تم التوصل إلى أنه: هناك حاجة لمزيد من الدراسات السريرية لتحديد الفائدة من السيتوكينات، ومقارنتها بسيتوكينات اخرى موجوده في مرضى أوعية القلب. هذه الستوكينات موجودة في أمراض مختلفة، وحتى الآن نحن بحاجة إلى دراسات توضح وتفسر السيتوكينات المرتبطة والمفرزة مع الالتهابات، واظهار التكرار الأليلي عن الاستجابات المناعية الفورية لتصلب الشرايين التاجية عند مرضى القلب والسكتة الدماغية.
Production, Expression and Characterization of Single Chain Fragment Variable (scFv) Against Breast Carcinoma Cell Line (MCF-7) p
(Neelain University, 2013) ELHAM OMER MAHGOUB
Abstract: Background: Recombinant antibody cloning and phage display technologies proved very efﬁcient in producing and isolating single-chain antibodies (scFv), especially against antigen of interest, which is MCF-7 breast cancer cell line. Aim: The main objectives of this study are to construct single chain variable fragment (scFv) towards MCF-7 breast cancer cells and to characterize scFv antibodies that interacts with MCF-7 breast cancer cells line. Materials and Methods: Therefore, phage display technologies were used to produce single- chain antibodies (scFv) against (MCF-7) breast carcinoma cell line. The starting material was the mouse B cell hybridoma line C3A8, which generates a monoclonal antibody against breast cancer cells (MCF-7). The integrated cloning, screening, and phage display system allowed to obtain a scFv sequences derived from the hybridoma C3A8 cell line. The extended primer set can incorporate the entire mouse VH and V1, sequences collected in the Kabat database. The best candidate scFv sequences, based on preliminary enzyme-linked immunosorbent assay (ELISA) screening data were sub-cloned into HB2l51 host strain. The expressed product was characterized by westem blot and indirect ELISA. The scFv gene was then cloned into nova-blue host strain for cloning purposes and then into origami DE host strain for further characterization. The puriﬁed single-chain antibody expressed in origami DE3 was puriﬁed using Immobilized Metal Afﬁnity Chromatography (IMAC). The puriﬁed scFv protein was characterized using westem blot, ﬂow Cytometery and immunoﬂuorescence tests. Bioinformatics tools was also used and databases such as BLAST (alignment search tool), GenBank, PDB (protein databank), KABAT numbering, SWISS- MODEL and Insight II to gain speciﬁc functional insights into scFv anti-MCF-7. VH and VL chains models were evaluated using Verify3D, ERRAT and Ramchandran plot methods of evaluation. Results: A 32-kDa band was observed on the blotting membrane when scFv antibody probed with an anti-his tag monoclonal antibody. In addition, scFv protein was characterized and showed speciﬁc binding toward MCF-7 cells line. A band of 68kD was appeared in nitrocellose membrane when westem blot test was used. Further, immuno-ﬂuorescence test clearly proved that the scFv recognized the MCF-7 antigen epitopes, which is localized in MCF-7 nuclear. Moreover, 53% of the cells numbers were bound to scFv protein as measured by ﬂow cytometery analysis. Finally, the predicted stmctures of heavy and light chains were connected with peptide linker to build the full scFv protein structure. The predicted structures of heavy and light chains were found to be acceptable according to the structure evaluation methods and were used to predict conformational and sequential epitopes. Discussion and Conclusions: Herein the recombinant antibody technology is a rapid and eﬁective approach to the development of the next generation of cancer diagnosis and therapy antibodies.
Ne uroprotective Potential of L-NAME asAntidant and -OxiAnti-Inflammatory in Cerebral Injury Induced By Transient Focal Ischemia Reperfusion in Rats
(2013) Hiba Ahmed Alsheekh Awooda
Energy Expenditure in Obese Type II Diabetic Patients and Its Relation to Plasma TNFα Level
(2013) Azza Osman AlawadYousif
Knowledge, Attitude and Practice of Women in Reproductive age (15 - 49 years) towards Breast Cancer
(Neelain University, 2013) Insaf Hassan Ahmed Mohammed
Abstract Background: Breast cancer is the most common malignancy in women and accounts for more than 30% of all cancers in women in Sudan and is estimated as 17.2% of all types of cancers in 2007 and 17.9% in 2008. In addition the mortality rate is high and most of patients are detected at late stages of the disease due to the lack of awareness and absence of screening programs. Objectives: The overall objective was to study the level of knowledge, attitude and practices of women in reproductive age (l5- 49 years) towards breast cancer in order to generate information necessary for formulation of evidence-based prevention program. Material and methods: A community-based descriptive cross sectional study conducted from April 2012 to April 2013 at Muraba l5. Abused locality. Omdurman State. The estimated sample size mounted to three hundred and ﬁfty three participants. By simple. random sample clusters were selected and all elements in the cluster were used (single-stage cluster sampling). A standardized administered questionnaire was developed, pre-tested and used to generate information on personal-demographic characteristics, general knowledge, attitude and practice about breast cancer and breast self -examination. A modiﬁed scale (V. poor- V. good) and ﬁve point Likert type scale was used. In addition four questions were discussed in four focus groups discussion. Each group consists often participants. Data were analyzed using SPSS version 16. Results: The mean age of the respondents was 32.1487 (SD =l0.46) years. The results showed that the vast majority (91.8%) of participants had heard about breast cancer from TV source. In addition most (81.3%) of interviewed women their knowledge about risk factors and signs and symptoms of breast cancer were poor. 86.1% of the interviewed women did not know how to perform BSE. 56.3% were worried, anxious and aﬁaid of being diagnosed with cancer. Only 18.4% of the interviewed women stated that they practiced BSE. Moreover, (45.2%) of them had poor knowledge about BSE and its technique which was statistically signiﬁcant with the level of education (p- value= 0.047) and family history (p-value = 0.018). Conclusion: Most of the interviewed women had heard about breast cancer from TV. Source and their knowledge about risk factors, signs, abnormal signs, knowledge and technique of BSE were poor. In addition they had negative attitude towards treatment and BSE.
Health Education Program for Non-Insulin Dependent Diabetes Mellitus Patients in Khartoum State (Locality – Gabir Abu Aleez Center and Bahri Center )
(AL-Neelain University, 2013) Hammad Ali Hassan
Abstract Diabetes mellitus, is one of the top of five chronic conditions affecting the population, it is not a health problem that can be cured. The, client with diabetes mellitus must learn, to master a regimen of monitoring and treatment that involves a great deal of patient participation, (Rifaie, 1996). Objectives:  To develop and implement an educational program for non-insulin dependent diabetes mellitus patients.  To evaluate the impact of the educational program on the above mentioned patients knowledge, attitude and prevention of patient practices. Methods: This study is a case-control interventional study that was conducted in Bahry center in Khartoum. 150 diabetic patients were included in the study. They were divided into two equal groups: The studied group: Included 75 patients, their mean age was 45.2 ± 18.7 years, they were 45 males (60 %) and 30 females (40%). The control group: Included 75 patients, their mean age was 45.2 ± 18.7 years, they were 43 males (60 %) and 32 females (40%). Tools: Tool: - I Structured interview questionnaire sheet Tool: - II. Physical assessment sheet Results: The results of the current study showed that there was no significant difference between the studied group and controls regarding sex distribution, age, weight, systolic and diastolic BP, educational level and occupation, (P>0.05). The results of the current study regarding control of diabetes , distribution of obesity and frequency of exercise among the studied group and controls before the program, showed that there was no significant difference between both groups regarding the control of diabetes, level of obesity, frequency of practicing exercise. Conclusion: In conclusion, the present study demonstrates that educational program for non insulin dependent diabetic (NIDDM) patients promotes patients education of daily urine self monitoring and weight reduction through flexible dieting, sample teaching methods and daily home exerc
Seroepidemiological study of alloimmunization and antinuclear antibody in Sudanese patients with homozygous sickle cell disease receiving frequent transfusion therapy.
(Neelain University, 2013) Mohammed Yousif Abbas Mohammed
Abstract Transfusion of red blood cells is a major therapeutic option for anemia in homozygous sickle cell disease (SCD), it is limited by the development of alloantibodies to erythrocytes. On the other hand, the coexistence of SCD and autoimmune diseases which is characterized by the production of antibodies to the nuclear materials lead to increased suffering of the patients since they share numbers of clinical features which may lead to delay or miss diagnosis of the underline disease. Since description of the ﬁrst case of SCD in Sudan at I926, there was and still increasing research activities in this ﬁeld. Unfoitunately, no studies published in open literature to determine the frequency and alloimmunization and the coexistence of autoimmune diseases in SCD, as far as we know. The objectives ofthis study were to determine the frequency of alloimmunization in frequent transfusion and the frequencies of anti nuclear antibodies (ANA) and the anti double stranded DNA (anti- dsDNA) in SCD patients receiving frequent transfusion therapy in Sudan. This study was conducted at Albuluk Pediatric Teaching Hospital and Omdurman Pediatric Hospital between August 20ll and April 2012. Questionnaires were used to collect demographic and clinical data include sex, age. tribe, number and indication for transfusion, transfusion reaction, and malarial attack . Blood samples were collected from hundred (n=l00) SCD (HbSS) patients of age between 6 month - l7 years, both males (57%) and females (43%) who had received at least 2 transfusions with units of ABO and D matched RBCs. lmmunohematological and immunological investigations were done on patient samples, and the frequencies of alloimmunization , ANA and anti-dsDNA were determined. The mean number ofblood‘s units transfused per patient was 6.73 (SD,4.46l). The patients were transfused with a total of 673 (maximum, 20; minimum,2) units of blood. Fifty ﬁve percent ofthe patients had been transfused from non relative donors, while 45% from relative donors. (4%) ofthe patients were developed alloantibodies, all antibodies belong to the Rhesus and Kell system. The alloimmunization appears to be affected by the number of transfusion episodes (P= 0.002), and not affected by patients sex (P= 0.578). Blood group O appears to be predominant on other ABO blood group antigens (46%), and the percentage of Rhesus antigens: D+, d, C, c, E and e in the total sample was 96%, 4%, 33%, 67%, 13% and 100%, respectively. ANA was found in (17.3%) of patients compared to (0.7%) of control group (P= 0.0l3), the females showed dominance in positivity, (3.l%) of the patients were positive to anti-dsDNA. None of the control were positive for antibodies to dsDNA. The females are at four times higher risk for developing of ANA than males (Odd Ratio = 3.871 (Cl 95% l.244 — 12.048), P=0.0l5)