PHD theses : Medicine
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Item Mechanisms on childhood overweight and obesity at high altitude(Al-Neelain University, 2015) Humeda Suekit HumedaAbstract 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 2 determined immediately after delivery. Determination of the newborn's body shape and body composition were made from anthropometric measurements. Placental weight was determined immediately after its delivery. Placentae were then examined histologically. The third part was performed on pregnant Wistar rats which were distributed into three groups: Vitamin E treated group (injected intraperitoneally with vitamin E) on alternating days throughout pregnancy, vehicle treated group (injected intraperitoneally with olive oil) also on alternating days throughout pregnancy and control group (receive nothing). For each rat in the three groups haemoglobin concentration and haematocrit value were measured. After sacrification of each rat in the three groups number of pups and birth weight were determined. Haemoglobin concentration and haematocrit value were measured. Placental oxidants and antioxidants were measured in placental tissues. Placentae were then examined histologically. Results: The percentage of fat and the overall prevalence of overweight and obesity among children aged 10-15 years were significantly greater among highlanders than among lowlanders (P<0.01 and < 0.004 respectively), while the percentage of fat free mass showed an opposite trend (P<0.01). The average birth weight of highland children was found to be significantly greater than their respectives at lowland (P<0.01). Highland children reported lower level of physical activity than lowland ones. Birth weight was found to be positively and significantly associated with the percentage of fat free mass and negatively and significantly with the percentage of fat mass and the prevalence of overweight and obesity. Physical activity level was found to be inversely and significantly related to overweight and obesity in boys at both altitudes but there was no clear trend for girls at either altitude. 3 Compared with their respectives from lowland, highland pregnant women and their placentae showed haematological and histological changes suggestive of maternal and placental hypoxia respectively. There was no haematological evidence suggesting that the high altitude foetuses experienced a greater degree of hypoxia in utero than did the low altitude foetuses. Compared with lowland newborns, highland newborns were significantly lighter, fatter and had greater head circumference: birth weight ratio and abdominal circumference and significantly lesser chest and lower limbs circumferences and fat free mass. These differences in body physique between high and lowland newborns appeared to be mainly secondary to placental hypoxia resulting from maternal hypoxia which in turn was caused by high altitude hypoxia. Administration of Vitamin E to pregnant rats at high altitude reduced maternal hypoxia which resulted in a decrease in placental oxidative stress and placental hypoxia leading to significant increase in the number of newly born pups and insignificant increase in the total and individual birth weights of the newborn pups. Conclusion: Highland children of Southwestern Saudi Arabia were found to be significantly fatter, significantly less leaner and have significantly higher prevalence of overweight and obesity when compared with their respectives at lowland. These differences in body physique were attributed to the low birth weight, caused by placental hypoxia, and low physical activity level among highland children compared to lowland children. Administration of vitamin E to pregnant rats at high altitude decreased maternal and placental hypoxia and ultimately caused significant increase in the number of newborn pups and insignificant increase in the total and individual birth weight of newborn pups. These results call for controlled trial study to investigate the effect of vitamin E on birth weight in pregnant women at high altitude. 4 Meanwhile pregnant women at high altitude are advised to take diet rich in vitamin E throughout pregnancy to improve birth weight and thereby reduce late childhood overweight and obesity. Also physical activity should be encouraged as strategy directed towards weight reduction in overweight and obese children as well as prevention of overweight and obesity in Saudi high and lowland children.Item Low Laser Therapy, VEGF- acceleratetooth Movement: duringOrthodontic Treatment:Radiographical,Histological andImmuno - histochemical study(Al-Neelain University, 2016) Mona Abdl-Hadi JassimAL SafiAbstract Background Orthodontic tooth movement is dependent on efficient remodeling of periodontal ligament and the alveolar bone, linkedwith several biological and mechanical responses of the tissues surrounding the teeth. A periodontal ligament placed under compressionwill result in bone resorption whereas a periodontal ligament under tension results in bone formation. In the primary stage of the application of orthodontic forces, an acute inflammation occurs in periodontium, and several proinflammatory cytokines are produced,the main molecules, namely,vascular endothelial growth factor(VEGF). Materials and Methods Low-level laser therapy (LLLT) is increasingly used in medicine and dentistry. It has been suggested that LLLT may be beneficial in the management of many different orthodontic conditions. LLLT effect on bone healing is a fundamental principle that may improve tooth movement.Vascular endothelial growth factor (VEGF)is oneof proliferation markers of osteoclasts and osteoblasts.Thebiomarkers of bone resorption such as macrophage colony stimulating factor andbiomarkers of bone formation such ascollagen I and alkaline phosphataseenzymehad been used in present study. Study design The present study was carried out to evaluate the effect of exogenous vascular endothelial growth factor(VEGF) and LLLT on orthodontic tooth movement rate and bone remodeling in experimental animals III (rabbits) by studying the casesclinically, radiographically, histologically and immunehistochemical investigation for Collagen typeI,macrophage colony stimulating factor(M-CSF) andalkaline phosphatase (ALP). The study group of total sixty healthy male New- Zealand white rabbits (22-24) weeks of age received orthodontic appliancein the mandibular central incisors (MCIs), the teeth were moved distally for 21 days using pushing coil spring that apply a constant total amount of light continuous orthodontic force of about100gm (50gm for each tooth). The study group n=60were divided randomly into two main groups, control group n= (15) and experimental group n= (45), after activation of pushing coil spring they have beensubdivided as follows: A. Controlling group consist of (15) rabbits treated with orthodontic appliance only. B. Experimental group-1 consists of (15) rabbits treated with LLLT (wavelength of 800 nm). C. Experimental group-2 consists of(15) rabbits treated with 0.1µm VEGF. D. Experimentalgroup-3 consists of (15) rabbits treated with LLLT plus 0.1µm VEGF (Combination). Application days for the above experimental groups (B, C and D)were at days (0,7th ,14th , 18th) of the total experimental period . Five rabbits for each study groups were sacrificed at the end of each period (1 st week,2 nd week,3 rd week)with inhalation anesthesia. IV Objectives Clinical andradiographical assessment methods were performed first, followed by histopathological examinations for the amount of bone formation and resorption at the compression and tension sides of the coronal level, and then with immunohistochemical based assessment for tooth movement by stimulating PDL remodeling and increasing collagen I, macrophage colony-stimulating factor (M-CSF) and alkaline phosphatase (ALP). Results In present study, Mean value, Standard Deviation, Standard Error, (95%) Confidence interval for population Mean values, two Extreme values (min. and max.) were used. The clinical findings showed after 3 week: the mean ± SD values of separation were increased and the highest one was (1.95 ±0.11), in combination group, (1.78 ±0.03 mm) in laser, (1.23±0.01 mm) in VEGF, and the lowest one was (0.92±0.01 mm) in control P<0.000 HS(high significant difference). The increase in distance (mm) between MCIs compered to control group were, (1.01 mm in combination group, 0.82 mm in laser group and 0.31mm in VEGF group)respectively. The radiographic measurement results of the distance that remained between MCIs at the end of experiment were matched with the results of the clinical measurement at the same period, with statistically no significant difference (P > 0.05) between the two measurements of each group. The highest mean values of the Mandibular suture width at three points that measured through radiographs at the end of the experiment were in V combination group, (0.492±0.04mm), and in laser(0.455±0.01mm), while VEGF records a low value (0.242 ±0.02mm) and control is the lowest one (0.215±0.01mm). With P<0.01 for the combination group at three periods intervals. Width of PDL of right and left mesial side highest in combination group,theright and left distal side highest in laser group.Mesial Side: Cutoff Point (0.25) at (right); Cutoff Point (0.24) at (left).Distal side:Cutoff Point (0.22) at (right); Cutoff Point (0.22) at (left). Histologicalreports for numbers of osteoblast, osteoclast and blood vessels revealed the followings: 1. Statistics evaluation for the mean difference in the number of osteoblast and osteoclast cells revealed a mean and standard deviation (M ± SD) with a high value in combination group (5.50±0.84; 2.50±0.55, P<0.01; P0<05, respectively).Followed by laser group (4.67±0.82; 1.83±0.75, P<0.01 highly significant differences (HS); P<0.05 respectively). 2. Analysis for blood vessel count, show a high value in it's mean in combination group, followed by VEGF group (4.00 ±0.89; 3.67±0.52, P<0.05; P<0.01, respectively), then laser group (3.33±1.03) P<0.05.Lastly control group (1.83 ±0.41) P<0.001(HS). Highly significant difference between control group and the experimental ones.Cutoff Point (5) for osteoblast; Cutoff Point (2) for osteoclast; Cutoff Point (2) for blood vessels. Immunohistochemical assessment for positive expression of collagen I, M-CSF and ALP showed that experimental groups, specifically VI combination group, recorded high significant differences in comparison to control group and as follow: 1. Collagen I, the results showed that combination group recorded high expression of collagen I (36.8± 1.14; 33.3 ± 1.17; 14.7 ± 0.42, respectively) for different three periods P<0.001. 2. Macrophage colony stimulating factor(M-CSF), the results showed that combination group recorded high expression of M-CSF for three periods (9.8±0.60; 9.2±0.48; 8.0± 0.26, respectively)P<0.001. 3. Alkaline phosphatase (ALP), the results showedthat combination group recorded high expression of ALP for 2 periods (1 stand 3 rd weeks) (9.0±0.37; 7.5± 0.43, respectively)P<0.001, While the 2 nd week showedhigh expression of ALP by laser group,M ± SD (19.0± 1.13).P<0.001. Conclusion From the present experimental study, it is concluded that the exogenous application of VEGF and LLLtherapy can accelerate the rate and percentage of orthodonticalveolar bone formation. VII المستخلص تعتمد حركة الاسنان التقویمیة على كفاءة إعادة ھیكلة الرابط اللثوي وعظم الفك ،متلازمة مع عدة استجابات بیولوجیة ومیكانیكیة من قبل انسجة ما حول الاسنان. ان الرابط اللثوي الذي یتعرض للضغط ینتج عنھ تاكل العظم ،بینما الذي یتعرض للشد ینتج عنھ تشكیل العظم. في المرحلة الأولیة لاستخدام القوة التقویمیة یحدث التھاب حاد لا انسجة ما حول الاسنان مع انتاج عدة انزیمات (سایتوكینات) اھمھا VEGF)عامل النمو الخاص بالاوعیة الدمویة) الذي یعتبر مؤشر لتكاثر ونمو الخلایا المھدمة والبناءة للعظم ) ، وھذه دراسة نسیجیة مناعیة باستخدام المؤشرات التالیة : ( Collagen 1 , M-CSF and ALP ) المواد والطرائق : العلاج باللیزر ذو المستوى المنخفض (LLLT ( یستخدم الان بازدیاد في المجال الطبي وطب الاسنان ویعتقد ان لھ فائدة في ادارة مختلف حالات التقویم ولھ تأثیر في إلتئآم العظم وتعتبر مھمة في تحسین حركة الاسنان . ان الغرض من ھذه الدراسة ھو تقییم استخدام المادة الخارجیة VEGF وباللیزر ذو المستوى المنخفض على معدل حركة الاسنان التقویمیة وإعادة ھیكلة العظم من خلال دراسة سریریھ شعاعیھ بیولوجیة نسیجیة و نسیجیة مناعیة (ALP and CSF-M, I Collagen .( مخطط الدراسة : لقد تمت ھذه الدراسة باستخدام ستین ارنبا نیوزلندیا أبیض من فئة الذكوربین عمر (24-22 ( اسبوع وقسمت الى أربعة مجامیع عشوائیة (خمسة عشر أرنبا لكل مجموعة): 1 .مجموعة السیطرة 2 .مجموعة تجریبیة باستخدام LLLT بطول موجي nm 800 VEGF 0.1µm باستخدام تجریبیة مجموعة. 3 4 .مجموعة تجریبیة باستخدام VEGFو LLLT لقد تلقت المجامیع الاربعة اجھزه تقویم الاسنان للقواطع الامامیة السفلیة ، وحركت الاسنان باتجاه الخلف ولمده 21 یوم ،باستخدام الحلزون الفاتح والذي یعطي قوة تقویمیة ثابتة ومستمرة وبمقدار 100 غم (50 غم لكل سن). VIII التجارب تمت في الأیام( 18,14,7,0 (وتم الذبح في الاسابیع (3,2,1(وبعدل خمسة ارانب لكل مدة (بعد تخدیرھا). الغرض من الدراسة : التقییم السریري والشعاعي ثم التقییم النسیجي لفحص كمیھ العظم المتكون والمتاكل في مناطق الضغط والشد للمستوى القمي للعینات ( level Coronal، (كما تم التقییم النسیجي المناعي Collagen 1, M-CSF,ALP النتائج : اظھرت النتائج السریریة بوجود فرق معنوي في النسب المئویة لحركة الاسنان بین المجامیع التجریبیة ومجموعة السیطرة وسجلت مجموعة ال (Combination (أعلى القیم وكانت 95.1( (11.0 ، ±أما مجموعة اللیزر فكانت (mm 03.0 ±78.1 ، (في حین كانت قیم مجموعة .السیطرة لمجموعة) 0.92±0.01 mm) كانت القیم وأقل ، VEGF(1.23±0.01 mm) التقییم الشعاعي والسریري حسب جدول ( t-Student (یظھر عدم وجود فروق إحصائیة بین القرائتین ، وسجلت المجموعة ج (Combination ( أعلى القیم بمعدل (933.1 (وكانت قیم P< 0.05 ولخط الإلتئآم للفك الأسفل أوسع عرض تم تسجیلھ على ثلاثة نقاط أخذت علیھ ، وكان لمجموعة تلیھا) ، 0.492±0.04mm) القیم أعلى) Combination) واخیرا) ، 0.242 ±0.02mm) النمو عامل مجموعة ثم، لمجموعةاللیزر)0.455±0.01mm) مجموعة السیطرة التي كانت أقل القیم (01mm.0±215.0.( عرض النسیج اللثوي للجانبین الایمن والایسر لخط وسط الفك السفلي كانت الاعلى في مجموعــة ال (combination ( بالنســـــبة للجھــة الأنســـــیة ( القریبــة من خط وســط الفك) Mesial Side: Cutoff Point (0.25) at (right); Cutoff Point (0.24) at (left) في حین بالنسبة للجھة الوحشیة (البعیدة عن خط الوسط) كانت النتائج الأعلى لمجموعة (laser ( التقییمDistal side: Cutoff Point (0.22) at (right); Cutoff Point (0.22) at (left). النسیجي كان كالآتي : 1 -معدل الفرق لخلایا العظم البناءة والھدامة كان كالآتي : IX على)5.50±0.84; 2.50±0.55( Combination) ج للمجموعة كان الأعلى P<0.01; P0<05.التوالي P<0.01 s .التوالي على 4.67±0.82; 1.83±0.75 اللیزر مجموعة تلیھا .إحصائي فرق أعلى) HS); P<0.05 2 -التحلیل الإحصائي لعدد الأوعیــة الدمویــة أظھر بأن أعلى قیمة كانت للمجموعة ج ثم، 3.67±0.52P<0.05; P<0.01 النمو عامل مجموعة تلیھا ، 4.00 ±0.89 .(3.33±1.03P<0.001(HS اللیزر مجموعة التقییم النسیجي المناعي : التقییم النسیجي المناعي للخلایا المناعیة المختلفة (ALP and CSF-M, I collagen (أظھر بأن المجامیع التجریبیة وبشكل خاص المجموعة (ج) قد سجلت أعلى القیم مقارنة بمجموعة السیطرة وكما یلي : بالنسبة للكولاجین (I collagen ( فقد سجلت المجموعة (ج) القیم التالیة للأسابیع الثلاثة P<0.000. التوالي على)36.8± 1.14; 33.3 ± 1.17; 14.7 ± 0.42) وبالنسبة لل (CSF-M (كذلك سجلت المجموعة (ج) أعلى القیم للأسابیع الثلاثة P<0.000.التوالي على) 9.8±0.60; 9.2±0.48; 8.0± 0.26) أما بالنسبة لل (ALP(فقد كانت النتائج أعلى للمجموعة (ج) في الأسبوعین الأول والثالث(43.0± 5.7; 37.0±0.9 (على التوالي ، في حین سجلت مجموعة اللیزر أعلى P<0.000 .(19.0± 1.13) التجارب من الثاني الأسبوع في النتائج الملخص من ھذه الدراسة التجریبیة نستنتج ان استخدام المادة الخارجیة VEGF و العلاج باللیزر ذو المستوى المنخفض یؤدیان الى زیادة معدل النسب المئویة لحركة الاسنان التقویمیة بتحفیز اعادة ھیكلیة الرابط اللثوي و زیاده تكوین العظم الفكي. عملیة ھدم وبناء العظم ودینامیكیة التغذیة الدمویة لھذه العملیة.Item Immune Mediated Atherosclerotic Vascular Disease; Case-Control Study Among Sudanese Patients(Al-Neelain University, 2012) Mohammed Kamel Naief ShubairAbstract 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.Item Evaluation of The Quality of Health Information System at Locality level(Al-Neelain University, 2015) Wiam Bushra Mohamed MustafaABSTRACT Introduction: Health information system (HIS) is a system that integrates data collection, processing, reporting and use of the information necessary for improving health services. It’s actually a crucial determinant for health planners to implement and distribute health services. The objective: to investigate the quality of health information system at locality level in Khartoum State 2012. The methodology: The study was a descriptive cross sectional study; it was limited to three randomly selected localities namely, Khartoum, Omdurman and Sharg Elneel. It was characterized by using two stages cluster sample; the sample size of health centers was 93 health centers. The health centers represented three categories namely: governmental health centers (42), non-governmental organizations centers (46) and five private centers. Direct Interviews were conducted with (93) medical directors and (93) statistical technicians at the health centers through pre-tested standardized questionnaire. Indepth interviews were carried out with the mangers and statistical technicians at the health team, locality and State Ministry of Health levels. A standard checklist was used to review the quality of statistical monthly reports and the available resources of the statistical units at the health centers. The data were analyzed using SPSS version 11, and chi-square test was used. P value < 0.05 was considered significant. x Results: The study revealed that, the statistical monthly reports of the year 2010 were not up to the required standard of accuracy. The percentage of statisticians using tally tables at the governmental centers was (21.4%) while at nongovernmental organizations centers, it was (37%) and (40%) at the private centers. This study showed that there was an evident inaccuracy of the information of the statistical monthly report of the year 2010, regarding the diseases reported in outpatient clinic of the health centers. Result of the completeness of the reports showed, at the non-governmental organizations centers and Private centers, a higher percentage of completeness revealed, than the governmental centers, especially in important items like immunization and antenatal care services. The statistical monthly reports were sent regularly in due time. (71%) of the medical directors used health information in the report, this was mainly confined to know disease pattern in the community. Feedback on the monthly statistical reports from the health teams to the medical directors did not exceed a percentage of (28%). All the statisticians at the governmental centers (100%) received the basic statistical training course before recruitment, while at the non-governmental organizations centers the percentage was (97.8%) and (60%) at the private centers. (47.2%) of the statisticians at different types of health centers did not receive in service training directed to HIS. At the governmental, non-governmental organizations centers and private centers there were marked shortages in the available resources, mainly computers (7.5%), photocopies (3.2%), Printers (2.1%) and cars (7.5%). No shortages in box files (96%) and cupboards (89.2%), at the three types of health centers. xi Results from interviews showed that, the directors at SMOH, localities and health teams, did not receive any technical training in HIS. No regular feedback between the different administrative levels. They were facing many problems like lack of supporting facilities and fund. Absent of regulations and guidelines of Health information system at the locality level. Conclusion: Health information system was inadequately functioning at the locality level in Khartoum State. There were many loopholes and negative aspects that need to be managed, mainly the inaccuracy of the statistical monthly report. The use of information was poorly practiced at all levels. There were problems reflected in the capacities, of human resources and inadequate resources. Recommendations: capacity building for the personnel involved in the system, to set clear guidlines for the health information system. It is crucial to reinforce, the feedback and use of information at all levels through measures and directions from top level decision makers, improve the working conditions and avail budget for health information system. xii Abstract Arabic مقدمة: نظام المعلومات الصحية ھو آلية جمع ومعالجة وتحليل البيانات ونقل المعلومات التي يحتاج إليھا جميع المستويات التى تقدم الخدمات الصحية لالستفادة منھا بواسطة متخذى القرار لوضع االخطط التى تساعد فى تطويرھذه الخدمات الصحية. االھداف: تقييم جودة نظام المعلومات الصحية على مستوى المحلية بوالية الخرطوم في العام ٢٠١٢م. منھجية البحث: تتميز ھذه دراسة بانھا وصفية بأسلوب العينة العنقودية من مرحلتين ولقد كان حجم العينة بالنسبة للمراكز الصحية ھو ٩٣ مركز صحي ينقسم إلى ٤٢ مركز صحي حكومي، ٤٦ مركز صحي منظمات و ٥ مراكز صحية خاصة حسب التوزيع النسبي. أجريت معاينات مع ٩٣ مدير طبي و٩٣ إحصائي بالمراكز الصحية عن طريق استبيانات مخصصه لذلك. كما أجريت المقابالت الشخصية مع مدراء الرعاية الصحية األولية واإلحصائيين على مستوى الفرق الصحية والمحلية ورئاسة وزارة الصحة الوالئيه. كما تمت مراجعة التقارير االحصائية ومالحظة الموارد المتوفرة لوحدات اإلحصاء بالمراكز الصحية عن طريق قائمة ضبط . النتѧѧائج: التقѧѧارير الشѧѧھرية للعѧѧام ٢٠١٠ لѧѧم تكѧѧن بالمسѧѧتوى المطلѧѧوب مѧѧن الدقѧѧة، وقѧѧد وجѧѧد ان نسѧѧبة االحصائيين الذين يستعملون نظام الحزمѧة للتصѧنيف فѧى المراكѧز الحكوميѧة ال تتجѧاوز (٢١٫٤ (%بينمѧا ترتفع النسبة فى مراكز المنظمات الى (٣٧ (%والمراكز الخاصѧة الѧى (٤٠ .(%كمѧا اوضѧحت الدراسѧة مستوى ملحوظ من عدم دقѧة المعلومѧات الصѧحية بѧالتقرير االحصѧائى الشѧھرى للعѧام ٢٠١٠ فيمѧا يتعلѧق باالمراض الموجودة بسجل العيادة الخارجية بالمراكز الصحية. بالنسبة الكتمال التقѧارير نجѧد ان مراكѧز المنظمات والمراكز الخاصة اظھرت معدالت اعلى من المراكز الحكومية خاصة فѧى المحتويѧات الھامѧة مثل التطعيم ورعاية الحوامل. يتم ارسال التقارير االحصائية بصورة منتظمة وفى وقѧت محѧدد. (٧١ (% مѧن المѧدراء الطبيѧين اسѧتخدموا المعلومѧات الصѧحية الموجѧودة بالتقѧارير، لمعرفѧة تѧردد االمѧراض فѧى المجتمع. كانت نسبة التغذيѧة الراجعѧة عѧن التقѧارير االحصѧائية الشѧھرية مѧن المحليѧات للمراكѧز الصѧحية .(%٢٨) xiii (١٠٠ (%مѧن االحصѧائيين بѧالمراكز الحكوميѧة تلقѧوا التѧدريب االحصѧائى االساسѧى قبѧل التعيين.وكانѧت نسبة الذين تلقوا ھذا التدريب بمراكز المنظمات (٩٧٫٨ (%والمراكز الخاصѧة (٦٠) .(%٤٧٫٢ (%مѧن االحصائيين بالمراكز الصحية لم يتلقوا تدريبا مباشرا على نظام المعلومѧات الصѧحية اثنѧاء فتѧرة الخدمѧة. ً ملحوظѧا فѧي المѧوارد المتاحѧة فѧي كѧل مѧن المراكѧز الحكوميѧة ومراكѧز المنظمѧات ً اظھرت الدراسة نقصا والمراكز الخاصѧة. ھѧذا الѧنقص تمثѧل فѧي الكمبيѧوترات (٧٫٥ (%وآالت التصѧوير (٣٫٢ (%والطابعѧات (٢٫١ (%والعربѧات (٧٫٥ .(%لѧم يكѧن ھنѧاك نقѧص فѧي فѧايالت الحفѧظ (٩٦ (%والѧدواليب (٨٩٫٢ (% بالمراكز الصحية الثالث. أظھرت نتائج المقابالت الشخصية التي تمت مع المدراء في كل من وزارة الصحة الوالئية، المحليات والفرق الصحية، ان ھذه الفئات لم تتلقى أى تدريب فني عن نظام المعلومات الصحية. ھذا باإلضافة إلى عدم وجود معينات للعمل والنقص في االعتمادات المالية. كما ان سياسة نظام المعلومات الصحية غير داعمة ألداء وألنشطة النظام على مستوى المحليات. خلصت الدراسة: إلى أن نظام المعلومات الصحية ال يسير بالصورة المطلوبة على مستوى المحليات بوالية الخرطوم. ھنالك العديد من السلبيات مثل عدم الدقة واكتمال المعلومات واالستفادة من المعلومات وعدم وجود نظام للتغذية الراجعة. ھذا باالضافة الى ضعف اإلمكانيات المادية ووسائل االتصال، ولعل الجانب اإليجابي الوحيد ھو االنتظام في إرسال التقارير الشھرية في المواعيد المحددة. التوصيات: العمل على بناء القدرات للعامليين، تقوية سياسة نظام المعلومات الصحية. ال بد من االھتمام بالتغذية الراجعة واستخدام المعلومات وذلك بوضع الضوابط والتوجيھات الضابطة لكل المستويات، تحسين ببيئة العمل وتوفير الميزانية لنظام المعلومات الصحية.Item Evaluation of Health Information System at National and State level – Khartoum - Sudan 2014(Al-Neelain University, 2015) Amel Elamin Mohammed ElnourAbstract Introduction The health information system is recognized as the central nervous system of the health sector and the major informant to support evidence based decision and action and to preserve population health. Therefore the information system has to be regularly evaluated to grantee the development of the effective integrated system. The last comprehensive assessment was conducted in 2007 using the metrics network tools, identified the gaps and deficiencies and targeted them in strategic plans, so it was high time to check progress by this assessment Objectives The main objective of the study was to investigate health information system components at national and state levels by evaluation of inputs, determination of processes ,assessment of outputs and the identification of challenges facing HIS at all levels. Methods: A cross sectional institutional based study was conducted at health information research and evidence (HIRE) that replaced the national health information Centre (NHIC); 19 federal information units and 18 health information units in the 18 states of the Sudan Quantitative data were collected by using close and open structure questionnaire for statisticians; Computerized HMN questionnaire for assessing indicators and data management and standard checklist for equipment and infrastructure. Qualitative data were also collected by in-depth interviews by informants from federal and state directors and managers of health information and planning. Results: The findings of the study revealed that HIS plans and strategic were developed, and partially implemented. The reviewed HIS policy was formulated but not indorsed. There was no representative national coordination committee. The majority of state HIS units had adequate number of trained information technicians and statisticians while only about half of the federal units had them. v Health Statistical Technicians Training Centre (HISTTC) stopped functioning in 2013 while still needed. Continuous, refreshing and ICD-10 training programs were not adequate, supervision visits and feedback mechanism were not regularly conducted. Generally indicators witnessed considerable improvement. Usage of computers for data analysis was good, but using information and indicators by decision maker was limited. Data management witnessed a little progress. A repository, a warehouse and DHIS-2 servers were installed and prepared to function. Reporting from PHC and private sector facilities was limited and the coverage of births and deaths was deficient and data quality assurance was not regularly conducted at all levels. Generally NHIS suffered from fragmentation and lack of integration especially with vertical programs but DHIS-2 that started implementation in 2013, gave a great push towards integration by installing servers, distributing computers to most of localities and training of trainers to train information workers at locality, state and national. Conclusion: The study concluded that there was no representative national coordination committee, no legal regulations to assure perfect functioning of the system and the reviewed policy was not indorsed. Lack of data capacity on information sciences, data analysis and use, lack of training health statistical technicians and training programs for data provides and users was deficient. Data quality assurance was not regular conducted and needs improving by using proper mechanism. Recommendation: - Finalization and indorsing of the representative national coordination committee, enactment of legal regulations covering fundamental principles of information and statistics and the endorsement of the reviewed policy. - Strengthening capacity building focusing on information sciences, data analysis and use, functioning and upgrading Health Statistical Technicians Training Centre and developing needed training programs targeting all data providers and users in coordination with health training institutions. - Advocacy among decision-makers and other stakeholders to use the information and indicators that are disseminated through Sudan health observatory. - Supporting the implementation and functioning of DHIS-2to provide platform for integration HIS data management aspects and data production and dissemination and use.Item Cytogenetic and Molecular Cytogenetics (FISH) Study amang Sudanes Patients with Constitutional Chromosomal Changes and Microdeletion Syndromes(Al-Neelain University, 2016) Safa Mohamed Hamid MohamedABSTRACT Objectives: To evaluate the chromosomal changes in Sudanese patients with suspected chromosomal abnormality referred for cytogenetic analysis. Material and Methods: A total of 1500 patients referred during 2009 and 2013 for cytogenetic to Cytogenetic Unit at Al Neelian medical research center, faculty of medicine, Al Neelian University, Sudan. The patients had various presentation including mental retardation, multiple congenital malformations, dysmorphic feature, primary and secondary amenorrhea, ambiguous genitaliaو and recurrent miscarriage. Conventional Cytogenetic analyses performed in peripheral blood samples that cultured in RPMI 1640 medium for three days. microdeletion not detected by conventional light microscopy were submitted to the fluorescence In situ hybridization (FISH) technique, FISH technique was done according to modification of Pinkle, The clonality criteria and the karyotype descriptions were according to the international system for Human Cytogenetic Nomenclature recommendations (ISCN). 2009 recommendations Results: Of the 1500 patients investigated, 330 (22%) patients showed abnormal karyotypes and 1170 (78%) showed normal karyotypic findings. Out of the 330 patients with abnormal karyotypes, 310 (94%) patients showed numerical abnormalities whereas 20 (6%) patients revealed structural abnormalities. The most common karyotypic abnormalities were Down's syndrome seen in 230 (74.1%) patients. Abnormalities, of sex chromosome seen in 69 (20.9%) of all patients of which 52 showed karyotype consistent with turner's syndrome (16.7%), Nine patients 2.6% consistent with Klinefelter’s syndrome, 3 patients 0.9% consistent with XXX, developmental of sexual diseases seen in 5 patients (1.6%). 8 patients (2.4%), consistent with Edwards's syndromes. Patau's syndromes were observed in two patients (0.6%). Abnormalities of Other chromosome were seen in seven patients (1.6%). Structure abnormalities found in 20 patients,(79.2%) of them present with menatal retardation, deletion consistent in 3 patients (15%) inversion consistent in 2 patients (10%) translocation consistent in 11 patients (55%), fragile X consistent in 3 patients (15%), Derivative in one patient (5%). FISH technique was done for 17 cases that suspected of micro deletion syndrome of which, 9 patients, (52.9%) showed abnormality consistent with diagnosis of DiGeorge syndrome in 3 patients, Angelman syndrome in 2 patients, and Prader-Willi Syndrome in the remaining 4 patients. Conclusions: The present study, the first ever in Sudan, showed high incidence of chromosomal abnormalities (22%). This justifies the needs for cytogenetic analysis in patients with clinical suspicions. Cytogenetic tests are complicated, time consuming and expensive. Most laboratories can handle only a limited number of specimens and thus physician should request the cytogenetic test in cases with justified indication. The frequency of microdeletion detected (52.9%) in cases with normal initial karyotype justify the use of FISH analysis as complimentary test in microdeletion suspicious cases. Moreover, a multi-disciplinary strategy is needed to aid in clinical management and counseling. المستخـلص الاهداف: هدفت هذة الدراسة لتقييم القصور الصبغى فى المرضى السودانين المشتبهين باختلال فى الصبغيات والكشف عن معدل التكرار في هذه الحالات ومقارنة نتائج الدراسة بالدراسات السابقة المشابهه. المواد وطرق البحث: تم احالة 1500 مريض تراوحت أعمارهم من يوم واحد الى 50 سنة وذلك فى الفترة من 2009-2013 الى قسم الوراثه الخلوية بمركز النيلين للابحاث الطبية لاجراء فحص الصبغيات للاشتباه فى اصابتهم بخلل فى الصبغيات حيث تعددت الاعراض والشكوى لتشمل التشوهات الخلقية والاجهاض المتكرر وانقطاع الطمس الاولى والثانوى وتدنى مستوى الذكاءوتشوة الاعضاء الجنسية الخارجية والعقم. تم اجراء فحض الصبغيات وفقا للطرق القياسيه المرجعية للتحليل الصبغى لتشمل تزريع كرويات الدم البيضاء لمدة ثلاث ايام ثم استخدمت تقنيه التهجين في محله لتشخيص حالات الاصابه بمتلازمات النزع الجزيى للصبغيات‘ كما تم وصف اختلال الصبغيات بناء على موجهات النظام العالمى لوصف خلل الصبغيات البشرية النتائج: أظهرت النتائج وجود خلل فى الصبغيات لدى 330 مريض بينما كانت الصبغيات طبيعة فى 1170 مريض. فى 310 من المرضى كان نوع الخلل الصبغى عددى أما فى 20 حاله فقد كان الخلل الصبغى بنيوي. أظهرت النتائج ان الغالبية العظمى من الخلل الصبغى العددى كان متلازمة داون (74.1 %) تلى ذلك خلل الصبغبات الجنسية (22.1%) مثل متلازمة التيرنر (16,71%) ومتلازمة كلاينفلتر(2.9%) وحالات الخنثى (1.6%) ومتلازمة ثلاثية X (9.%) ووجدت متلازمه ادوارد في 2,4% ومتلازمة بتاو (0,6%) كانت حالات الخلل الصبغى البنيوي نزعية (15 %) وخلل الصبغبات النقلية 55% ومتلازمه اكس الهشة 15% ثم خلل الصبغبات القلبية 10% والمشتقة (5%)وقد وجدت حالات الاصابه بمتلازمات النزع الجزيئى للصبغيات في (52.9%) من الحالات المشتبه باصابتهم بهذه المتلازمات باستخدام بتقنية التهجين في محله. الخاتمة: اظهرت هذة الدراسة (الاولى من نوعها فى السودان) ارتفاع فى نسب الخلل الصبغى (22%) مما يؤكد أهمية الفحص والحوجة الماسة لة. فحص الصبغيات معقد يستغرق كثيرا من الوقت والجهد والمال حيث أن معظم المختبرات تستطيع التعامل مع عدد محدود من فحص الصبغيات ولهذا يجدر بالاطباء تحويل الحالات المبررة لاجراء فحص الصبغيات. التنوع والاختلاف في نتائج التحليل الصبغي للمرضى في هذه الدراسة يوضح الحوجة إلى طرق التحليل المتقدمة التي تسهل التشخيص الصحيح للمرضى السودانيين المصابون بتغيرات النمطية الصبغية. هنالك أيضاً حوجة لتخطيط محكم من الجهات ذات الصلة للمساعدة في التشخيص والعلاح السريري والتوعية.