PHD theses : Medicine
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Item Heart Rate Variability and Asthma Control Test(ALNEELAIN UNIVERSITY, 2008) Mohamed Faisal Mohamed LutfiABSTRACT 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. XIVItem Association Between Gastroesophageal Reflux Disease and Atrial Arrhythmias IRAQ-FALLUJAH-2010-2012(Alneelain University, 2012) Faisal Khalaf Shaihan AL-AssafIntroduction 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.Item Thyroid function during normal pregnancy and preeclampsia(Alneelain University, 2018) Enaam Taj Elssir Elhaj YassinBaclground There is a need to establish trimester-specific reference ranges for T3, T4 and TSH in different communities. Neither Sudan nor other African countries had established trimester-specific reference ranges for TSH, flee T3 (FT3) and fiee T4 (FT4) in healthy pregnant women. Also changes in thyroid fiinction/antibodies profiles in preeclamptic patients are controversial and were never investigated before in Sudan. ;A_i21§ 0 To establish trimester-specific reference ranges for healthy pregnant Sudanese women. 0 To compare thyroid function/antibodies of patients with preeclarnpsia to healthy pregnant women. Sub|'ects and Methods First study In a longitudinal study, 63 women with singleton pregnancy were followed since early pregnancy until the third trimester in Saad Abu- Alela Hospital, Khartoum, Sudan, during the period January—October 2014. An equal number of age and parity matched non-pregnant women were enrolled as a control group. Basic clinical and obstetrics data were gathered using questionnaires. TSH, FT3 and FT4 were measured using TOSOH. Second study Thyroid hormones (T3, T4 and TSH) and antibodies (anti-TPO and anti- TG) of 55 apparently healthy pregnant women (HC) were compared with patients with mild (MP) and severe (SP) preeclampsia (n=55 for each group). Women with blood pressure 2 140/90 after 20 weeks of gestation, but not before, and 2 300 mg of protein/24-hour urine were defined as preeclarnptic. Diastolic blood pressures < 110 or 2110 mmHg were used to define mild and severe preeclampsia. Patients suffering from diseases or using drug that may affect thyroid, renal or hepatic functions were excluded in all studied subjects. Results First study Median (5-95 centile) of TSH, FT3 and FT4 were 1.164 (0.079—2.177) IU/ml, 4.639 (3.843— 6.562) pmol/1, 16.86 (13.02—31.48) pmol/l in the first trimester; 1.364 (0.540—2.521) IU/ml, 4.347 (3.425—5.447) pmol/1, 13.51 (11.04—3 1 .07) pmol/l in the second trimester, 1.445 (0.588—2.460) IU/ml, 4.132 (3.176—5.164) pmol/l, 12.87 (9.807—23.78) pmol/l in the third trimester, respectively. While TSH increased throughout trimesters, FT3 and FT4 were significantly higher in the first trimester compared to the second and third trimester. TSH, FT3 and FT4 levels were significantly lower in the pregnant compared with non-pregnant women (P < 0.001). Second study TSH of SP (l.5(1.0—1.9) mIU//ml) and MP (l.3(0.9 -2.1) m1U//ml) were lower compared to HC (2.3(1.9—2.6) mIU//ml, P < 0.001). T3 of SP (2.1(l .9—2.6) pg/ml) and MP (2.0(l .4—2.4) pg/ml) were higher compared to HC (0.7(0.5—1.3) pg/ml, P < 0.001). SP had increased anti-TPO (10.5(7.3—l3.4) IU/ml) while MP had decreased anti-TG (1 1.1(8.2—-13.2) IU/ml) compared to HC (8.3(6.4—10.1) and 11.4(8.5——13.8) IU/ml respectively, P 5 0.002). Linear regression confirms association between levels of thyroid hormones and preeclampsia (P < 0.01) but not a.nti-TPO, anti-TG antibodies, parity, gestational age, BMI or hemoglobin levels (P > 0.05). Conclusions First study The present study is the first to establish trimester-specific reference ranges of TSH, free T3 and fiee T4 in Sudanese women with nonnal pregnancy. Our results demonstrated that pregnancy is likely to suppress TSH, FT3 and FT4 levels in healthy women. Second study Sudanese patient with preeclampsia tend to have higher levels of FT3, FT4, TSH and anti-TPO antibodies and lower level of anti-TG antibodies, irrespective of parity, gestational age, BMI and hemoglobin levels.Item Epidemiology of Blindness in Sudan 2019(Neelain University, 2019) Mohanad Kamaleldin Mahmoud IbrahimAbstract Introduction: Blindness is a visual acuity of less than 3/60 or a corresponding visual field loss to less than 10 degrees in the better eye with the best possible correction. There are 39 million blind people globally, almost 90% of them are living in low income settings and the number of affected people is increasing. Blindness is a serious public health problem that contributes to severe physical limitation, affects the productivity and has psychological and social impacts. The objective of this research was to study the epidemiology of blindness in Sudan aiming to reveal information for prevention and control. Research Methods: This was an outreached based cross- sectional study conducted among 858 participants on four different regions in Sudan; Khartoum, Kassala, Nyala and Aldamazin in the period between August 2018 and March 2019.The questionnaire was composed of 43 close-ended questions on socio-demographic data, causes and risk factors of blindness. Cluster sampling was used to draw the sample proportional to size at each setting, systemic random sampling was used to select participants. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0.0, Univariate analysis for all determinants, bivariate analysis by cross tabulation of risk factors and causes, multiple linear regression analysis of variables were done. Results: The prevalence of blindness was 14%; the uppermost affected region was in Nyala (35%). The majority of blinds were females (59%) and the highest age group affected was of 60 years and above (80%). The principle type of blindness was irreversible with glaucoma as a predominant cause (42%) followed by cataract (32%) and diabetic retinopathy (8%). Body mass index was inversely associated with blindness (64% below 30). Family history of blindness (P-value= 0.001); predictor of first degree relationship in a multi-linear regression (P-value= 0.001) and family history of eye disease; mainly glaucoma (P-value= 0.016) were significant associated factors with blindness, with a significant difference towards first degree relationship (P-value= 0.011).The mean income among the blind participants was 1991 Sudanese Pounds and 70% were unemployed. Across the socioeconomic risk factors the prime was low educational level (P-value= 0.000). Conclusion: The prevalence of blindness in Sudan is high. The majority of affected participants were females of older age groups. Glaucoma was the major cause of blindness flowed by cataract. Family history of blindness and family history of glaucoma among first degree relatives were significant associated risk factors for blindness. Low socioeconomic status and low educational level were strong associated factors while obesity was statistically inversely associated with blindness. Recommendations: It is highly recommended to initiate educational programs that strengthen on irreversible causes of blindness; mainly glaucoma. Massive screening programs for causes of irreversible blindness are advisable to be conducted. It is suggested to expand the diagnostic and interventional healthcare services of ophthalmology to meet the needs and it is preferable to take actions to improve the socioeconomic status and educational level. مستخلص الأطروحة المقدمة: العمى هو قوة نظر أقل من 3/60 أو فقدانللمجال البصري إلى أقل من 10 درجات في العين الأفضل مع أفضل تصحيح ممكن. يبلغ عدد المكفوفين في العالم حوالي 39 مليون أعمي, كما أن حوالي 90% منهم يعيشون بالدول الفقيرة وأعدادهم متزايدة. العمى هو مشكلة تهدد الصحة العامة للمجتمع و تسهم في تقليل النشاط الجسديكماتؤثر على الإنتاجية ولها تأثيرات نفسية واجتماعية. كان الهدف من هذا البحث هو دراسة وبائيات العمى في السودان بهدف الكشف عن معلومات للوقاية والسيطرة عليها. منهجية البحث: كانت هذه دراسة مقطعية بالمخيمات الخارجية للعيون و أجريت في 858 مشاركاَ في أربع مناطق مختلفة في السودان وهي الخرطوم ، كسلا ، نيالا والدمازين في الفترة ما بين أغسطس 2018 ومارس 2019. كان الاستبيان مكوناَ من 43 سؤالًا عن البيانات الاجتماعية والديموغرافية وأسباب وعوامل خطر العمى. تم استخدام الطريقة العنقودية لرسم العينة بما يتناسب مع الحجم في كل مخيمعلاجي ثم تم استخدام أخذ العينات العشوائية النظامية لتحديد المشاركين. وقد تم تحليل البيانات باستخدام الحزمة الإحصائية للنسخة 21.0.0 للعلوم الاجتماعية ، وتحليل أحادي المتغير لجميع المحددات ، وتحليل ثنائي المتغير عن طريق جدولة متقاطعة لعوامل الخطر وتحليل الانحدار الخطي المتعدد للمتغيرات. النتائج: كان معدل انتشار العمى 14 ٪. كانتنيالا أكثر المناطق تأئراَ (35٪). غالبية المكفوفين من الإناث (59 ٪) وكانت أعلى الفئات العمرية المتأثرة من 60 سنة وما فوق (80 ٪). كان النوع الأساسي من العمى اللذي لا علاج له ونتيجة للجلوكوما كسبب سائد (42 ٪) تليها إعتام عدسة العين (32 ٪) واعتلال الشبكية السكري (8 ٪). ارتبط مؤشر كتلة الجسم عكسيا مع العمى (64 ٪ أقل من 30). تاريخ عائلي للعمى (P=0.001) ؛ مع تنبؤ لعلاقة الدرجة الأولى في انحدار متعدد الخطي (قيمة P = 0.001) وتاريخ عائلي لمرض العين وبالأخص الجلوكوما (P = 0.016) أهم العوامل المرتبطة بالعمى ، مع وجود اختلاف كبير نحو العلاقة من الدرجة الأولى (P-value = 0.011). وكان متوسط الدخل بين المشاركين المكفوفين 1991 جنيه سوداني و 70٪ عاطلين عن العمل. عبر عوامل الخطر الاجتماعية والاقتصادية ، كان السبب الأساسي هو المستوي التعليمي المنخفض (P = 0.000). الخلاصة:معدل انتشار العمى في السودان مرتفع. كانت غالبية المصابين من الإناث من الفئات العمرية الأكبر سناَ. كانت الجلوكوما السبب الرئيسي للعمى يليها عتامة عدسة العين (الماء الأبيض). كان تاريخ عائلي للعمى وتاريخ عائلي للجلوكوما بين أقارب الدرجة الأولى عوامل الخطر مرتبطة بالعمى. كان الوضع الاجتماعي والاقتصادي المنخفض والمستوى التعليمي المنخفض عوامل مرتبطة قوية في حين أن السمنة كانت مرتبطة عكسياَ مع العمي من الناحية الإحصائية. التوصيات: يوصى بشدة ببدء برامج تعليمية تعزز أسباب العمى التي لا علاج لهاوبالأخص الجلوكوما. يفضل إجراء برامج فحص شامل لأسباب العمى الذي لا علاج لها كمايوصيبتوسيع رقعة خدمات الرعاية الصحية التشخيصية والعلاجية لطب العيون لتلبية الاحتياجات ، ويوصي بإتخاذ إجراءات لتحسين الحالة الاجتماعية والاقتصادية والمستوى التعليمي.Item Studies on immunohcmatological Factors as predisposing to recurrent miscarriage in Sudanese women(Al-Neelain University, 2012) Jevara Mohammed Khalifa ElsanhoryRecurrent 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.Item Effect of Gum Arabic (Acacia senegal) on oxidative stress parameters and Liver Functions of Normal and Streptozocin Treated Rat(Sprague-Dawely)(Neelain University, 2018) Mohammed Babiker AbdelraoufAbstract Background: Gum Arabic has strong anti-oxidant properties which may help in reducing the oxidative damage and the complications of diabetes mellitus. Diabetes mellitus is metabolic disorder, which is a major source of illness all over the world and its incidence is expected to increase by 5.4% in 2025. It has been shown that patients with diabetes mellitus have increased oxidative stress and impaired antioxidant defense systems, which appears to contribute to the initiation and progression of diabetes-associated complications. Objectives: The aim of this study was to investigate the effect of long term administration of Gum Arabic on the liver function and hepatic tissue oxidative stress of normal and diabetic Sprague-Dawley Rat. The investigated liver function blood tests were total proteins, albumin, direct and total bilirubin, Alanine transaminase (ALT), Aspartate transaminase (AST) and Alkaline phosphatase (ALP). The measured hepatic oxidative stress parameters were the reduced glutathione (GSH), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), SOD mRNA expression and GLC mRNA expression. Materials and methods: This study followed a randomized controlled preclinical experimental research design and the duration of laboratory experiment was 12 weeks.Sixty male Sprague-Dawley rats with age of 10 to 12 weeks. All rats were obtained from the animal house of King Khalid University. The rats were fed standard rat chow and housed in equal light/dark cycle (twelve hours each) with free access to water or water containing GA 10%w/v. This study involved six groups of Sprague-Dawley rats. Each group was composed of ten rats. Four groups were rendered diabetic by Streptozotocin treatment (single intra peritoneal injection with 65mg/ Kg in 0.1M citrate buffer with pH of 4.5) and two groups were considered as a control groups; the first group (injected with citrate buffer only) and the second group ( injected with citrate buffer and a daily dose of one liter of 10% gum Arabic solution). The four diabetic groups were as follows; Group one was considered as diabetic untreated group,group two rats were treated with insulin (single daily dose of 16 IU/ Kg), group three rats were treated with gum Arabic (daily dose of one liter of 10% gum Arabic solution) and group four rats were treated with a combined therapy of insulin and gum Arabic (16 IU/ Kg single daily dose of insulin for each rat and one liter of 10% gum Arabic solution for all the members of the group). . Results: The random blood glucose concentration of the control group (non diabetic was 73.3±18.3 mg/dl whereas that of diabetic group was 406±48.6 mg/dl. Treatment of diabetic rats with insulin,gum arabic and gum arabic with insulin lowered the blood glucose to 129.4±63.3 mg/dl, 347±29.7 mg/dl and 98.7±17.7mg/dl respectively.The comparison of the mean glucose concentrations in the all groups showed that there was significant variation between control group (control) and all the groups except treated group with insulin and gum Arabic dose. it is evident that the insulin and gum arabic dose was effective in the control of blood sugar of diabetic rats.The total proteins concentration of the diabetic group (5.4± 0.55 g\dl) was significantly decreased compared to the control group (6.3± 0.5g/dl). The total proteins concentration of the gum Arabic treated diabetic rats (5.8± 0.19 g\dl) was significantly more than that of the diabetc rats (5.4± 0.55 g\dl) and significantly less than that of the control group (6.3±0.5g/dl). The total proteins of insulin and the dual dose were (6.5± 0.35 g\dl) and (6.5± 0.24 g\dl) respectively. However, they were insignificantly increased when compared to their values of the control group. The results showed the effectivness of the insuln and the dual dose in controling of the blood total proteins and the ineffectivness of the gum Arabic alone.The albumin concentration in the control and diabetic groups were (4.1± 0.26 g\dl) and (2.4± 0.31 g\dl) respectively. The mean concnetrations of the albumin of the insulin, gum Arabic and insulin with gum arabic treated were (3.1± 0.28 g\dl), (3.1± 0.41 g\dl) and (3.96± 0.65 g\dl) respectively. There was significant variation between the mean albumin values in all the study groups and its mean value in the contol group except the insulin with gum arabic treated group which reflected the effectiveness of the insulin and gum Arabic combined dose in normlizing the blood albumin. With regard to the liver enzymes, the mean activities of AST, ALT and ALP, ALT in the control group were (68.4± 13.8U/l), (30± 3.8U/l) and (150± 30.1U/l), respectively, whereas their mean activities in the blood of the diabetic rats were (185.5±33.9U/l), (56.7±6.1U/l) and (880.3±157.4 U/l) resepectively. The mean activities of the three enzymes in the blood of the diabetic rats were significantly increased compared to their mean activities in the control rats. The mean activities of AST in the blood of the insulin, gum Arabic and the combination of insulin and gum Arabic treated rats were (78.7± 15.2 U\l), (174.4± 25.4 U\l) and (74.5± 12.7 U\l). However, the mean activities of ALT in the blood the insulin, gum Arabic and insulin with gum Arabic were (37.8± 1.9 U\l), (39.9± 9.2 U\l) and (35.6± 3.4 U\l) respectively, in comparison to the mean value of (174.4± 25.4 U\l) in the control group.The results of the ALP activities in the different groups were similar to the pattern of the ALT activities results since all the treatment regimes failed to normalize the blood ALP activities. The activities of the blood ALP of the different treated groups with insulin, gum Arabic and insulin with gum Arabic were (458± 89.7 U\l), (594± 119 U\l) and (350.4± 39.6 U\l) respectively, compared to a mean value (150± 30.1U/l) in the control group. The results of ALT and ALP showed the ineffectiveness of the three treatments. The total bilirubin (TB) mean concentration in the blood of the control rats was (0.358± 0.016 mg\dl) compared to (0.592± 0.09 mg\dl) in the blood of the diabetic rats. However, the variation between the previously mentioned two means was significantly different. The blood TB mean values of the insulin treated, gum arabic treated and insulin with gum Arabic treated groups were (0.275± 0.073 mg\dl), (0.297± 0.062 mg\dl) and (0.26± 0.042 mg\dl) respectively. There were insignificant variations between all the treated rats and the control group which showed that the three treatements were able to normalize the blood total bilirubin.The blood direct bilirubin (DB) concentration of the control group was (0.15± 0.034 mg/dl) whereas that of diabetic group was (0.193± 0.14 mg/dl). There was insignificant variation between the mean values of direct bilirubin in the control and diabetic groups. i.e. the diabetes did not significantly affected the direct bilirubin concnetration. Treatment of diabetic rats with insulin and insulin with gum Arabic insignificantly, lowered the blood direct bilirubin to (0.079± 0.032 mg/dl) and (0.067± 0.023 mg/dl) respectively, whereas the gum Arabic dose alone significantly increased the direct bilirubin to (0.236± 0.038 mg/dl). The increase in the direct bilirubin may be refferred to the competetion between the bilirubin and gum arabic for the binding of albumin.The reduced glutathione (GSH) mean concentration in the liver tissue of the control group was (0.0727± 0.005 nmol/100g) whereas that of diabetic group was (0.0169± 0.003 nmol/100g). There was significant variation between the mean concnetration of GSH in the liver tissues of the control and diabetic groups. i.e. the diabetes significantly decreased the concnetration of GSH. Treatment of diabetic rats with insulin, gum Arabic and insulin with gum Arabic significantly, lowered the liver tissues GSH to (0.043± 0.008 nmol/100g), (0.0457± 0.007 nmol/100g) and (0.0605± 0.011 nmol/100g) respectively. The three treatments did not succeed in increasing the GSH concnetration to its normal concnetration in the liver tissues of the control group except the insulin with gum Arabic dose.The Malondaialdehyde (MDA) mean concentration in the liver tissue of the control group was (41.1 ± 2.14 nmol/100g) whereas that of diabetic group was (92.38± 8.07 nmol/100g). There was significant variation between the mean concnetration of MDA in the liver tissues of the control and diabetic groups. i.e. the diabetes significantly inecreased the concnetration of MDA which is considered as an oxidant factor. Treatment of diabetic rats with insulin, gum Arabic and insulin with gum Arabic lowered the MDA in the liver tissues to (57.67± 5 nmol/100g), (57.49± 7.44 nmol/100g) and (44.23± 3.607 nmol/100g) respectively. The ANOVA test showed that there was significant MDA variation between all the treated groups and the control group except the insulin with gum Arabic group. The insulin and gum Arabic dose normalized the live tissue of MDA whereas the other treaments did not.Concerning the SOD activity, it was decreased in the diabetic group to (50.2± 3.9 U\l) from (94± 9.03 U\l) in the control group and the difference between the two means was signficant. Thus the diabetes can be considered as oxidative stress inducing factor. The mean activities of SOD in the insulin, gum Arabic and insulin with gum Arabic treated diabetic rats were (65.4± 2.41 U\l), (49.47± 4.9 U\l) and (81.7± 13.49 U\l) respectively. The more SOD normalizing treatement was the insulin and insulin with gum Arabic since there was insignificant variation between the mean SOD activity in it and the control group.The mean catalase (CAT) activity in the control group was (41.59± 0.68 U\l) while it was (24.59± 7.6 U\l) in the diabetic rats. The difference of the CAT two means was significantly variable which indicated that the diabetes was a CAT lowering factor.i.e oxidative stress inducing. The mean activities of CAT in the insulin, gum Arabic and insulin with gum Arabic treated diabetic rats were (34± 1.46 U\l), (32.96± 1.58 U\l) and (38.7± 2.18 U\l) respectively. The variations between the mean activities of the liver CAT of all the treatement groups and the control group were significant except the insulin with gum Arabic treated group. The insulin with gum Arabic treatment was more effective in normalizing the CAT than the other treatments.The results of the SOD mRNA expression and GLC mRNA expression were comparable to the results of the SOD activity which means that the effect of diabetes, insulin, gum Arabic and the insulin with gum Arabic was through increasing the transcription rate. Conclusion: Four conclusions were derived from this study; firstly, the gum Arabic can be considered as antioxidant therapy. And it can be useful in delaying the diabetes complications. Secondly, the gum Arabic isn’t useful in minimizing the blood concentration of glucose. [Not to be considered as glucose lowering agent alone].Thirdly, the dual dose of insulin and gum Arabic is efficient in reducing the concentration of the blood glucose than the insulin in the diabetic rats. Finally, the combined insulin and gum Arabic is more efficient as an antioxidant therapy for the diabetic rats than the insulin or gum Arabic alone. الخلاصه الخلفيه يحتوي الصمغ العربي على خصائص قوية مضادة للأكسدة والتي قد تساعد في الحد من الأضرار التأكسدية ومضاعفات مرض السكري. داء السكري هو اضطراب استقلابي ، وهو مصدر رئيسي للامراض في جميع أنحاء العالم ، ومن المتوقع أن يزيد معدل حدوثه بنسبة 5.4 ٪ في عام 2025. وقد تبين أن المرضى الذين يعانون من مرض السكري يعانون من زياده الإجهاد التأكسدي وضعف مضادات الأكسدة ، التي يبدو أنها تسهم في بدء وتطور المضاعفات المرتبطة بالسكري.. الأهداف: الهدف من هذه الدراسة هو دراسة تأثير إعطاء الصمغ العربي على المدى الطويل على وظائف الكبد وضغط الأكسدة الكبدي لجرذ Sprague-Dawley العادي والمصاب بداء السكري. لفحص وظائف الكبد قمنا بقياس البروتينات الكاملة ، والألبومين ، والبيليروبين المباشر والكامل ، (ALT ، AST و (ALP في الدم. ولقياس الإجهاد المؤكسد علي الكبد قمنا بقياس الجلوتاثيون (GSH ، ,MDA CAT SOD) SOD mRNA expression وGLC mRNA expression في انسجه الكبد. المواد والطرق: اتبعت هذه الدراسة تصميم بحث تجريبي عشوائي قبل السريري. ما مجموعه ستون من ذكور فئران Sprague- Dawley عمرهم مابين 10 إلى 12 أسبوعا. تم الحصول على جميع الفئران من بيت الحيوان بجامعة الملك خالد. كانت الفئران تتغذى على طعام الفئران القياسي وتؤوي في دورة متساوية من الضوء و الظلام (اثنتي عشرة ساعة لكل منها) مع إمكانية الوصول إلى الماء أو الماء المحتوي على 10٪من الصمغ العربي. اشتملت هذه الدراسة على ست مجموعات من جرذان Sprague-Dawley. كل مجموعة تتكون من عشرة فئران. أربع مجموعات مصابة بداء السكري عن طريق العلاج بالستربتوزين (حقنة واحدة داخل الغشاء البريتوني تحتوي علي 65 مغ / كغ ذائبه في محلول مقاوم لتغير الاس الهيدروجيني(البفر). واعتبرت مجموعتان كمجموعة تحكم. المجموعة الأولى (المحقونة بالبفر) والمجموعة الثانية (محقونه بالبفر وتشرب جرعة يومية من محلول الصمغ العربي بنسبة 10٪). وكانت مجموعات السكر الأربعة على النحو التالي ؛ المجموعة الأولى مجموعة مريضه سكري غير معالجه ، المجموعه الثانيه مريضه بداء السكري وتعالج بالانسولين فقط (جرعة واحدة يومياً من 17 وحدة دولية / كغ) ، المجموعه الثالثه مريضه بداء السكري وتعالج بالصمغ العربي يومياً (10٪ من محلول الصمغ العربي في ماء الشرب). المجموعه الرابعه مريضه بداء السكري وتعالج بعلاج مشترك من الانسولين والصمغ العربي (17 وحده دوليه/كغ يومية من الأنسولين لكل فأر و10٪ من محلول الصمغ العربي في ماء الشرب لجميع أعضاء المجموعة). النتائج: تركيز الجلوكوز في فحص الدم العشوائي لمجموعة التحكم (غير المصاب بالسكري 73.3 ± 18.3 ملغم / ديسيلتر) بينما كانت المجموعة المصابة بالسكري 406 ± 48.6 ملغم / ديسيلتر ، وعلاج الجرذان المصابة بالسكري مع الأنسولين والصمغ العربي والصمغ العربي مع الأنسولين خفض مستوى الجلوكوز في الدم إلى 129.4 ± 63.3 mg / dl و 347 ± 29.7 مجم / ديسيلتر و 98.7 ± 17.7mg / dl على التوالي.أظهرت المقارنة بين متوسطات تركيز الجلوكوز في جميع المجموعات وجود اختلاف معنوي بين مجموعة التحكم وجميع المجموعات ما عدا المجموعة المعالجة بالأنسولين وجرعة الصمغ العربي. من الواضح أن جرعة الأنسولين والصمغ العربي كانت فعالة في التحكم في سكر الدم لدى الجرذان المصابة بداء السكري. انخفض تركيز البروتينات الكلي للمجموعة المصابه بداء السكري (5.4 ± 0.55 غم / ديسلتر) بشكل ملحوظ مقارنة بمجموعة التحكم (6.3 ± 0.5). غ / دل). كان تركيز البروتين الكلي للجرذان المصابة بداء السكري المعامل بالصمغ العربي (5.8 ± 0.19 غم / دل) أعلى بشكل ملحوظ من ذكور الجرذان المصابة بداء السكري (5.4 ± 0.55 غم / ديسلتر) وأقل بكثير من مجموعة التحكم (6.3 ± 0.5 جرام). / دل). البروتين الكلي في الدم في المجموعه المعالجه بلأنسولين والجرعة المزدوجة (6.5 ± 0.35 غم / ديسيلتر) و (6.5 ± 0.24 غم / دل) على التوالي.ازدادت بشكل غير معنوي عند مقارنتها بقيم المجموعة الضابطة. أوضحت النتائج فاعلية الإنسولين والجرعة المزدوجة في التحكم في البروتين الكلي للدم وعدم فاعلية الصمغ العربي وحده. تركيز الألبومين في مجموعه التحكم والمجموعه المصابه بداء السكري (4.1 ± 0.26 غ / دل) و (2.4 ±). 0.31 غم / دل) على التوالي. متوسطات الألبومين في مجموعه الأنسولين ، الصمغ العربي والأنسولين مع الصمغ العربي (3.1 ± 0.28 غم / ديسيلتر) ، (3.1 ± 0.41 غم / دل) و (3.96 ± 0.65 غم / دل) على التوالي. كان هناك اختلاف معنوي بين قيم الألبومين المتوسطة في جميع مجموعات الدراسة وقيمتها المتوسطة في مجموعة التحكم فيما عدا الأنسولين مع مجموعة الصمغ العربي التي عكست فعالية الأنسولين والصمغ العربي مجتمعتين في تحديد مستوى الالبيومين في الدم. فيما يتعلق بإنزيمات الكبد ، كان متوسط النشاطات لل AST و ALT و ALP و ALT في مجموعة التحكم (68.4 ± 13.8U / l) و (30 ± 3.8U / l) و (150 ± 30.1U / l) ، على التوالي، في حين كانت أنشطتهم في دم الجرذان المصابة بداء السكري (185.5 ± 33.9U / l) و (56.7 ± 6.1U / l) و (880.3 ± 157.4 U / l) علي التوالي. وزادت بشكل ملحوظ أنشطة الأنزيمات الثلاثة في دم الجرذان المصابة بداء السكري مقارنة مع أنشطتها في الجرذان بمجموعه التحكم. كانت متوسطات أنشطة AST في الدم في المجموعه المعاجه بالأنسولين ، والصمغ العربي ، والمجموعه المعالجه بالأنسولين والصمغ العربي (78.7 ± 15.2 U \ l) ، (174.4 ± 25.4 U \ l) و (74.5 ± 12.7 U \ l ) علي التوالي. متوسط أنشطة الإنزيم ALT في الدم للمجموعه المعالجه بالأنسولين والصمغ العربي والأنسولين مع الصمغ العربي (37.8 ± 1.9 U \ l) و (39.9 ± 9.2 U \ l) و (35.6 ± 3.4 U \ l) على التوالي ، مقارنة بمتوسط قيمة في مجموعه التحكم (174.4 ± 25.4 U \ l) . كانت نتائج نشاط ALP في المجموعات المختلفة مشابهة لنمط نتائج أنشطة ALT لأن كل المعالجات فشلت في ضبط نشاط ALP في الدم. كان نشاط ALP في الدم للمجموعات المختلفة المعالجة بالأنسولين والصمغ العربي والأنسولين مع الصمغ العربي (458 ± 89.7 U \ l) و (594 ± 119 U \ l) و (350.4 ± 39.6 U \ l) على التوالي ، مقارنة بقيمها المتوسطة (150 ± 30.1U / لتر) في المجموعة الضابطة. أظهرت نتائج ALT و ALP عدم فعالية المعاملات الثلاثة. تركيز البيليروبين الكلي (TB) في دم فئران التحكم (0.358 ± 0.016 mg \ dl) مقارنة بـ (0.592 ± 0.09 mg \ dl) في دم الجرذان المصابة بداء السكري. ومع ذلك ، كان الاختلاف معنوي بين المجموعتين المذكورتين. قيم البليروبين الكلي في المجموعات المعالجه بالأنسولين ، والصمغ العربي ,والأنسولين مع الصمغ العربي(0.275 ± 0.073 mg \ dl) ، (0.297 ± 0.062 mg \ dl) و (0.26 ± 0.042 mg \ dl) على التوالي. كانت هناك اختلافات طفيفة بين جميع الفئران المعالجة ومجموعة التحكم التي أظهرت أن المعالجات الثلاثة كانت قادرة على ضبط البيليروبين الكلي في الدم. كان تركيز البيليروبين المباشر للدم (DB) للمجموعة الضابطة (0.15 ± 0.034 مجم / ديسيلتر) بينما في المجموعة المصابه بداء السكري كان (0.193 ± 0.14 ملغ / دل). كان هناك اختلاف طفيف بين القيم المتوسطة للبيليروبين المباشر في مجموعه السيطرة ومجموعات السكري. أي أن مرض السكري لم يؤثر تأثيراً معنوياً على تركيز البيليروبين المباشرة. علاج الجرذان المصابة بالسكري بالأنسولين والأنسولين مع الصمغ العربي لم تؤثر بشكل معنوي ، في خفض البيليروبين المباشر فيالدم (0.079 ± 0.032 ملغ / ديسيلتر) و (0.067 ± 0.023 ملغ / ديسيلتر) على التوالي. في حين أن جرعة الصمغ العربي وحدها زادت بشكل كبير البيليروبين المباشر إلى (0.236 ± 0.038 ملغ / ديسيلتر). يمكن ان نعزي الزيادة في البيليروبين المباشر إلى المنافسة بين البيليروبين والصمغ العربي للارتباط بالألبومين. كان متوسط تركيز الجلوتاثيون (GSH) في أنسجة الكبد للمجموعة الضابطة (0.0727 ± 0.005 nmol / 100g) )بينما كان تركيز المجموعة السكرية (0.0169 ± 0.003 nmol / 100g).) كان هناك اختلاف معنوي بين متوسط تركيز GSH في أنسجة الكبد للمجموعة الضابطة والسكرية. أي أن داء السكري أدى إلى انخفاض كبير في GSH. علاج الجرذان المصابة بالسكري بالأنسولين والصمغ العربي والأنسولين مع الصمغ العربي ادي بشكل ملحوظ في خفض GSH في أنسجة الكبد إلى (0.043 ± 0.008 نانومول / 100 جم) ، (0.0457 ± 0.007 nmol / 100g) و (0.0605 ± 0.011 nmol / 100g) على التوالي. لم تنجح المعالجات الثلاثة في ضبط GSH إلى مستواه الطبيعي في أنسجة الكبد للمجموعة الضابطة باستثناء الأنسولين مع جرعة الصمغ العربي. تركيز ال MDA في أنسجة الكبد للمجموعة الضابطة (41.1 ± 2.14 nmol / 100g) في حين أن المجموعة المصابة بداء السكري كانت (92.38 ± 8.07 nmol / 100g). كان هناك اختلاف معنوي بين متوسط MDA في أنسجة الكبد للمجموعة الضابطة والسكرية. أي أن داء السكري أدى إلى زيادة ملحوظة في MDA الذي يعتبر عامل مؤكسد. علاج الجرذان المصابة بالسكري مع الأنسولين ، الصمغ العربي والأنسولين مع الصمغ العربي خفضت MDA في أنسجة الكبد إلى (57.67 ± 5 nmol / 100g) ، (57.49 ± 7.44 nmol / 100g) و (44.23 ± 3.607 nmol / 100g) على التوالي. أظهر اختبار ANOVA أن هناك اختلافًا معنويا في MDA بين جميع المجموعات المعالجة ومجموعة التحكم فيما عدا الأنسولين مع مجموعة الصمغ العربي. قامت مجموعه الأنسولين و الصمغ العربي بضبط مستوي الـ MDA في حين أن العلاجات الأخرى لم تكن كذلك. فيما يتعلق بنشاط SOD ، انخفض في المجموعة المصابة بالسكري إلى (50.2 ± 3.9 U \ l) من (94 ± 9.03) في المجموعة الضابطة وكان الفرق بين المجموعتين معنوي. وبالتالي يمكن اعتبار مرض السكري كعامل مؤثر على الإجهاد التأكسدي. كان متوسط نشاط مجموعه الأنسولين والصمغ العربي ,والأنسولين مع الصمغ العربي في المجموعات المصابه بمرض السكري (65.4 ± 2.41 وحدة \ l) و (49.47 ± 4.9 U \ l) و (81.7 ± 13.49 U \ l) على التوالي. كان علاج الأكثر ملاءمة هو الأنسولين مع الصمغ العربي حيث كان هناك اختلاف طفيف بين النشاط للـ SOD في المجموعة الضابطة. نشاط الكاتلاز (CAT) في المجموعة الضابطة (41.59 ± 0.68 U \ l) بينما كان (24.59 ± 7.6 U \ l) في الجرذان المصابة بداء السكري. كان الفرق بين المجموعتين معنويا مما يشير إلى أن مرض السكري هو عامل مهم في خفض CAT ةزياده الإجهاد التاكسدي. متوسط نشاط الكاتاليز في الجموعات المصابه بمرض السكري المعالجه بالأنسولين والصمغ العربي والأنسولين مع الصمغ العربي (34 ± 1.46 U \ l) و (32.96 ± 1.58 U \ l) و (38.7 ± 2.18 U \ l) على التوالي. كانت الاختلافات بين القيم المتوسطة لل CAT لجميع مجموعات العلاج ومجموعة التحكم كبيرة باستثناء مجموعة الأنسولين مع الصمغ العربي. كان الأنسولين مع علاج الصمغ العربي أكثر فعالية في ضبط نشاط CAT أكثر من العلاجات الأخرى. كانت نتائج تعبير الحمض الرايبوزي لل SOD و GLC مرتفعه مقارنة مع نتائج نشاط SOD مما يعني أن تأثير السكري والأنسولين والصمغ العربي والأنسولين مع الصمغ العربي كان من خلال زيادة معدل النسخ الجيني لل SOD. الخلاصه: تم استخلاص أربعة استنتاجات من هذه الدراسة. أولاً ، يمكن اعتبار الصمغ العربي كعلاج مضاد للأكسدة. ويمكن أن يكون مفيدا في تأخير مضاعفات مرض السكري. ثانيا ، الصمغ العربي ليس مفيدا في تقليل تركيز الجلوكوز في الدم. [لا يعتبر بمثابة عامل خفض الجلوكوز وحده]. ثالثًا ، الجرعة المزدوجة من الأنسولين والصمغ العربي فعالة في تقليل تركيز الجلوكوز في الدم من الأنسولين لوحده في الجرذان المصابة بداء السكري. وأخيرًا ، يعتبر الأنسولين والصمغ العربي المختلط أكثر فاعلية كمضاد للأكسدة للجرذان المصابة بداء السكري من الأنسولين أو الصمغ العربي وحدهما.Item Effectiveness of a New Checklist-Based Intervention on Promoting Rational Prescribing of Artemisinin-Based Combination Therapy for Treating Uncomplicated Malaria at Primary Health Care Facilities - Gazira State, Sudan.(Neelain University, 2018) Abeer Abuzeid Atta ElmannanAbstract Background: The World Health Organization (WHO) recommends Artemisinin-based Combination Therapies (ACTs) as first-line treatment for uncomplicated malaria. Sudan revised its malaria treatment policy accordingly in 2004. However, after more than a decade since the switching from antimalarial monotherapies to the current ACTs, the irrational prescribing of antimalarials remains a challenge. This study objectively aimed to evaluate the effectiveness of a new checklist-based intervention on promoting rational prescribing of ACTs among patients with uncomplicated malaria in primary health care facilities in Gezira State. Methods: This was a cluster randomized controlled trial (cRCT) with repeated cross-sectional design. A total of 40 primary health care facilities, and 2400 patients were recruited (1200 patients before the intervention and 1200 after the intervention). Facilities were randomized into intervention and control groups. Assessments were made for 30 patients in each healthcare facility at the pre-intervention phase (baseline), and later at the post-intervention phase for all healthcare facilities in the sample. The malaria treatment-checklist intervention was a multifaceted intervention which combined two approaches; educational and managerial. The primary outcome measure was the proportion of patients who were managed according to the recommended ACT guidelines. Descriptive statistics were used to describe the key drug use indicators measured in each arm. Chi-square test was used to detect if there were any significant differences between the intervention and control health care facilities. Post-intervention analysis was done at the cluster level using aggregate summary data. In order to estimate the magnitude of the intervention, effect sizes were calculated in the form of relative risk for improvement with their corresponding 95% confidence intervals. Results: At the base line, only 26.80% patients were adequately managed according to the nationally recommended ACT guidelines. Although, this proportion has increased substantially following the intervention, however, there was no evidence of significant differences between the intervention and control groups (ES= 1.001; 95% CI: 0.560-1.783, p = 0.793). In addition, only 22% of health care providers were found to be ACT knowledgeable. Conclusion: Correcting ACT prescribing malpractices is too complex. The situation is more challenging in outpatient settings. The malaria-treatment checklist did not lead to statistically significant improvement in ACT prescribing practices. In addition, the level of knowledge about ACT among prescribers and dispensers was found to be critically low. Lack of effect of the checklist-based intervention is thought to be primarily related to extrinsic challenges in outpatient setting that were difficult to control rather than genuine ineffectiveness. Recommendations: Collaborative efforts of multiple stakeholders are required to strengthen policies relating to ACT prescribing and dispensing. A Qualitative investigation into reasons why health care providers are reluctant to use ACT guidelines is needed. Quality control systems for day-to-day monitoring should be institutionalized. Considering the complexity of malaria treatment practices in outpatient health care settings, further research is needed to identify optimal, cost-effective interventions that could lead to rational prescribing and dispensing of ACT in Sudan. ملخص الدراسة مقدمة: توصي منظمة الصحة العالمية (WHO) بالعلاجات المركبة القائمة على مادة الأرتيميسينين (ACTs) كخط علاج أول للملاريا غير المعقدة. قام السودان بمراجعة سياسته لمعالجة الملاريا وفقا لذلك في عام 2004. ومع ذلك ، بعد أكثر من عقد من الزمن منذ التحول إلى الـ ACT الحالية ، لا يزال وصف الأدوية المضادة للملاريا غير العقلاني يشكل تحديا. تهدف هذه الدراسة بشكل موضوعي إلى تقييم فعالية تدخل بحثى جديد عبارة عن استخدام قائمة التطبيب المتميز لمريض الملاريا على المستوى الأول للمرضى الذين يعانون من الملاريا غير المعقدة في مرافق الرعاية الصحية الأولية في ولاية الجزيرة. نوع الدراسة: تجريبية عنقودية ضابطة (cRCT) مع دراسة مقطعية متكررة. تم تعيين ما مجموعه 40 مرفق من مرافق الرعاية الصحية الأولية ، و 2400 مريض (1200 مريض قبل التدخل و1200 مريض بعد التدخل) تم اختيارهم بصورة عشوائية و من ثم أجريت تقييمات ل 30 مريضا في كل مرفق في مرحلة ما قبل التدخل (خط الأساس) ، وبعد ذلك في مرحلة ما بعد التدخل لجميع مرافق الرعاية الصحية في العينة. كانت قائمة التطبيب المتميز لمريض الملاريا على المستوى الأول عبارة عن تدخل متعدد الوجوه يجمع بين ناحيتين تعليمية وإدارية. كان قياس النتيجة الأولية هو نسبة المرضى الذين تم علاجهم وفقًا لإرشادات ACT الموصى بها. تم استخدام الإحصاء الوصفي لوصف المؤشرات الرئيسية لاستخدام الدواء المقاسة في كل ذراع. تم استخدام اختبار مربع كاي لاكتشاف ما إذا كانت هناك فروق ذات دلالة إحصائية. تم إجراء تحليل ما بعد التدخل على مستوى الكتلة باستخدام بيانات الملخص الإجمالية ،كما تم ايضا حساب مقدار التأثير مع فواصل الثقة بنسبة 95٪. النتائج: في مرحلة ما قبل التدخل (خط الأساس) بلغ عدد مرضى الملاريا الذين تم علاجهم على نحو كاف وفقا لإرشادات ACT الموصى بها 26.80 % فقط. على الرغم من أن هذه النسبة قد زادت بشكل كبير بعد التدخل ، ومع ذلك ، لم يكن هناك أي دليل على وجود فروق ذات دلالة إحصائية بين ذراعى الدراسة (ES = 1.001 ؛ p = 0.793). بالإضافة إلى ذلك ، بلغ عدد مقدمي الرعاية الصحية الذين على دراية بإرشادات ACT 22 ٪ فقط. الخلاصة: إن تصحيح الممارسات الخاطئة لوصف وعلاج ACT معقد للغاية. الوضع أكثر صعوبة في مرافق الرعاية الصحية الاولية. لم يؤدِ استخدام قائمة التطبيب المتميز لمريض الملاريا على المستوى الأول إلى تحسن كبير إحصائيًا في ممارسات وصف الـ ACT. بالإضافة إلى ذلك ، اتضح ان مستوى المعرفة حول ACT بين مقدمي الرعاية الصحية منخفض للغاية. يُعتقد أن عدم وجود تأثير للتدخل فى هذه الدراسة يرتبط في المقام الأول بالتحديات الخارجية التي يصعب التحكم فيها فضلا عن عدم وجود فعالية حقيقية. التوصيات: تعاون كل الجهات ذات الصلة لتعزيز السياسات المتعلقة بوصف وصرف ACT. هناك حاجة إلى اجراء دراسة نوعية حول الأسباب التي تجعل مقدمي الرعاية الصحية مترددين في استخدام إرشادات ACT. كما يجب إضفاء طابع مؤسسي على أنظمة ضبط الجودة فى مرافق الرعاية الصحية الاولية. وبالنظر إلى مدى تعقيد ممارسات علاج الملاريا في مرافق الرعاية الصحية الاولية ، هناك حاجة إلى إجراء المزيد من البحوث لتحديد التدخلات المثلى و الفعالة من حيث التكلفة والتي يمكن أن تؤدي إلى تحسين اساليب وصف ACT في السودان.Item Seroepidemiologic Study of Brucellosis in Febrile Patients in Khartoum State(Al Neelain University, 2008) Adam Ahmed Adam MustafaBiucellosis 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.Item 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 ElseedAbstract 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.Item Knowledge, Attitude and Practice of Women in Reproductive age (15 - 49 years) towards Breast Cancer(Neelain University, 2013) Insaf Hassan Ahmed MohammedAbstract 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.