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ItemFrequency of Alloimmunization against Red Cell Antigens in pregnant Women Attending Saad Abu Al-Ela Maternity Hospital, 2019.(University of Khartoum, 2022)Abstract Background: Maternal red cell alloimmunization during pregnancy may lead to Haemolytic Diseases of the Foetus and Newborns (HDFN). More than 50 antigens are capable of eliciting an immune response and potentially harming the foetus. D antigen of the Rhesus system is the most common sensitizing antigen during pregnancy in Rh D Negative mothers leading to severe HDFN. Antibodies against the Other Rh system antigens(C,c,E,e), kell (K,k), Duffy and MNS antigens can also cause HDFN. Unlike the developed countries, the application of antenatal screening and identification for alloantibodies is not routine in Sudan. This study aimed to estimate the prevalence of alloimmunization among pregnant women, the frequencies of specific alloantibodies and the frequencies of Rhesus and K antigens. Methods: A prospective cross-sectional study was carried out over three months. The study was done on 127 pregnant women attending Saad Abu Elela maternity hospital. All pregnant women fulfilling the criteria of selection and who accepted to participate in the study were enrolled using a non-probability sampling technique.. Detailed obstetric history was documented. An EDTA blood sample was collected for ABO, Rhesus, and K typing using gel cards and antibody screening with further identification for positive tests using a cell panel. Any pregnant woman known to have an autoimmune disease was excluded. Results: Blood group O is the most common followed by A (50%, 33%) respectively. Rh D antigen 89%. e(100%), c(97%), C(30%), E(11%), K(9%).The prevalence of alloimmunization is 1.6%. 2/127 had a positive screening test, one of unidentified specificity in a multigravida(Gravida 9) with bad obstetric history and the other is Anti D in gravida 2, which could be due to passive alloimmunization. The rate of alloimmunisation among the rhesus D negative group is 7.1% (1/14), and 0.9%(1/113) among the rhesus positive group. There is no significant difference in alloimmunization between Rhesus D positive and negative groups. The Fisher Exact test statistic value is 0.0866. Conclusions: C and E antigens of the Rhesus system are of low frequency 30%, 11% when compared to studies in Arabs. c and e antigens are among the highest reported frequencies. Dccee is the most common Rhesus phenotype(49%). The frequency of alloimmunization is(1.6%), which is comparable to the worldwide frequencies. (2/127) were tested positive in screening. One antibody is Anti-D, which could be a passive antibody acquired after anti-D immunoprophylaxis. The other antibody is unidentified in a woman with a bad obstetric history. There is no significant association between alloimmunization and Rh D status. Recommendations: Antenatal screening based on risk factors stratification may be helpful at present. Testing for the husband’s Rhesus status in the case of Rh D-negative mothers will help limit unnecessary immunoprophylaxis. Extended Rhesus and K phenotyping of females of reproductive age who need blood transfusion is recommended to avoid sensitization by E, C and K antigens. Large-scale studies are required in order to study the applicability of the developed countries' guidelines here in Sudan. المستخلص الخلفية : قد يؤدي التمنيع الخيفي لخلايا الدم الحمراء للأم أثناء الحمل إلى الإصابة بأمراض انحلال الدم للجنين وحديثي الولادة. أكثر من 50 من المستضدات قادرة على إثارة الاستجابة المناعية وإلحاق الضرر بالجنين. مستضد D لنظام Rhesus هو مستضد التحسس الأكثر شيوعًا أثناء الحمل لدى الأمهات السلبيات Rh D مما يؤدي إلى HDFN شديد. الأجسام المضادة ضد مستضدات عوامل النظام الريسي الأخرى(E,C,e,c) ، ال kell ، ال Duffyو MNS يمكن أن تسبب أيضا HDFN . على عكس البلدان المتقدمة ، فإن تطبيق الفحص والتعرف قبل الولادة للأجسام المضادة ليست روتينية في هذا البلد. أجريت هذه الدراسة لتقدير انتشار التمنيع الخيفي بين السيدات الحوامل ، وترددات الأجسام المضادة المحددة وترددات مستضدات Rhesus و K لتحديد ما إذا كان هذا الفحص ضروريًا. منهجية البحث: أجريت دراسة مقطعية مستقبلية على مدى ثلاثة أشهر. أجريت الدراسة على 127 سيدة حامل يترددن على مستشفى سعد أبو العيلة للولادة. تم تسجيل جميع السيدات الحوامل اللواتي استوفين معايير الاختيار وقبلن المشاركة في الدراسة باستخدام تقنية أخذ العينات غير الاحتمالية. تم توثيق تاريخ الولادة والحمل التفصيلي و جمع عينة دم في وعاء EDTA لفحص فصائل الدم ABO و Rhesus و K باستخدام بطاقات من الGel وفحص الأجسام المضادة مع تحديد إضافي للاختبارات الإيجابية باستخدام بطاقات Coombs و خلايا دم خاصة. تم استبعاد أي سيدة حامل معروفة بأنها مصابة بأمراض المناعة الذاتية. النتائج : فصيلة الدم O هي الأكثر شيوعًا تليها A (50٪ ، 33٪) على التوالي. مستضد Rh D 89٪. هـ (100٪) ، ج (97٪) ، C (30٪) ، E (11٪) ، ك (9٪) انتشار التمنيع الخيفي 1.6٪. 2/127 كان لديه اختبار فحص إيجابي ، وهو اختبار خاص غير معروف في multigravida (Gravida 9) مع تاريخ توليدي سيئ والآخر هو Anti D في gravida 2 ، والذي يمكن أن يكون بسبب التمنيع الخيفي السلبي. معدل التمنيع الخيفي بين المجموعة السالبة ريسوس D 7.1٪ (1/14) و 0.9٪ (1/113) بين المجموعة الموجبة الريسوسية ، ولا يوجد فرق معنوي في التمنيع الخيفي بين المجموعتين الموجبة والسالبة. القيمة الإحصائية للاختبار الدقيق فيشر هي 0.0866. الاستنتاجات: المستضدات C و E لنظام الريسوس ذات تردد منخفض 30٪ ، 11٪ مقارنة بالدراسات عند العرب. المستضدات c و e هي من بين أعلى الترددات المبلغ عنها. Dccee هو النمط الظاهري Rhesus الأكثر شيوعًا (49٪) ، وتواتر التلقيح الخيفي (alloimmunisation) هو (1.6٪) وهو مشابه للترددات العالمية. تم العثور على (2/127) محصنًا خيفيًا ، أحد الأجسام المضادة هو Anti D ، أحد الأجسام المضادة هو Anti-D ، والذي يمكن أن يكون جسمًا مضادًا سلبيًا مكتسبًا بعد الوقاية المناعية المضادة لـ D.. الجسم المضاد الآخر غير معروف في امرأة ذات تاريخ توليد سيئ. لا توجد علاقة ذات دلالة إحصائية بين التمنيع الخيفي وحالةRhD التوصيات: قد يكون الفحص قبل الولادة المستند إلى تصنيف عوامل الخطر مفيدًا في الوقت الحالي. سيساعد اختبار حالة الريسس للزوج في حالة الأمهات السلبيات من عامل ريسس د في الحد من الوقاية المناعية غير الضرورية. يُنصح بإجراء التنميط الظاهري لفصيلة Rhesus و K للإناث في سن الإنجاب اللاتي يحتجن إلى نقل دم لتجنب التحسس بواسطة مستضدات E و C و K. مطلوب دراسات على نطاق واسع من أجل دراسة إمكانية تطبيق المبادئ التوجيهية للبلدان المتقدمة هنا في السودان.
ItemT cell responses in patients with Pulmonary tuberculosis: Identification of point in time for boosting the immune effector functions.(University of Khartoum., 2017)Abstract Background: Tuberculosis is a major health problem and has been declared as an urgent priority for control. Th1 immune response is curative whereas Th2 and a mixed type of immune response are the causes of immunopathology. The point in time to boost the immune system against mycobacterial tuberculosis is very crucial for proper take. It was hypothesized that reduction of mycobacerial tuberculosis load will modulate the T cells immune function and then the immune status will be suitable for boosting. Objectives: The objectives of this study were to characterize the immune responses restoration in the peripheral blood mononuclear cells in patients with PTB during treatment in view to identify early possible point in time for boosting the immune effector functions. Materials and Methods: This was a longitudinal study. Patients and healthy controls were recruited from Abu-Anga Chest hospital after they have signed a written consent. Then 5 mls of venous blood were collected from the patients in EDTA tubes one day before starting the anti-Tb treatment, at day 15 and day 30 of treatment and once from the controls. The blood samples were processed for immune cells phenotyping CD3, CD4+, CD8+, Treg cells, CD20 and intracellular cytokines measurements IL10, IL17, and IFN-γ, IFN-α and TGF β by EPICS XL Beckman Coulter, Miami, USA flowcytometry the same day of collection. Specific monoclonal antibody kits (Immuno step S.L, Spain) were used for detection of CD markers and cytokines. Data were analyzed using SPSS package, version 19 program. A p value of < 0.05 was considered statistically significant. viii Results: Fifty-six newly (9% females) diagnosed as PTB patients and 54 (males) apparently healthy controls were recruited to participate in this study. The mean age of patients was 33.5 ± 12.8 years and that of the controls was 32.7± 7.5 years. IFN-γ showed higher mean level at day 0 (138.0± 490 pg) and decreased level at day 15 (56.1±20.7 pg) and day 30 (80.1±11.9 pg) p= 0.001 & 0.01 respectively. The difference is statistically significant when compared with its level in the controls (11.1±3.5 pg), p <0.001. IL 10 showed higher level at day 0 (3.0±5.9 pg). It was reduced significantly (1.6±2.0 pg) at day 15 (p=0.038) and increased (2.6±3.2 pg) at day 30 compared with day 15 (p=0.39). The IL 10 levels were significantly higher compared with the control IL 10 level (0.7±1.2 pg) level (p <0.05). IL 17 mean level showed inverse relationship with IL 10 and proportional relationship with IFN-γ. It showed steady increase from day 0 (42.9±26.9 pg), day 15 (45.5±17.8 pg) and day 30 (61.6±13.8 pg) compared with the controls (0.4±0.8 pg). TGFβ as well as IFN-α did not show any difference in patients but their mean levels were significantly different from the controls (p <05). CD20 mean counts were 231±73 cells/µl, 243± 87 cells/µl, 268±102 cells/µl, 140±93 cells/µl for the controls and at day 0, 15 and 30 respectively (p= 0.047). CD4+, CD8+ cells counts increased from day 0 (341±124 cells/µl, 430±78 cells/µl) up to day 15 (430±108 cells/µl, 424±176 cells/µl) respectively and remained unchanged (430±212 cells/µl, 397±137 cells/µl). The controls showed higher level of CD4+ (559± 234 cells/µl), and a comparable level of CD8+ (343± 178 cells/µl). T regulatory cells levels were 304±83 cells/µl at day 0, 346±133 cells/µl at day 15 and 369±216 cells/µl at day 30. These levels were significantly different from the controls (41±43 cells/µl) p=0.002. The pattern of the dynamics of the immune cells was in favor of restoration of the immune response to Th1 at day 15. ix Conclusion: The immune response is shifted from immunopathology response towards curative modality at day 15 and thereafter. This could be helpful in selecting a point in time immediately after day 15 of chemotherapy for boosting the ongoing curative immune response. This finding can be taken further to develop immuno-chemotherapeutic modality of treatment.
ItemKnowledge , Attitude and Practice of Dentists in Public Dental Clinics of Khartoum State in The Management of Medical Emergencies.(University of Khartoum., 2019)Abstract: Background: Medical emergencies situations are increasing in dental clinics due to increasing number of elderly and immunocompromised patients who are seeking dental care .This category of patients are more susceptible to have a medical emergency in the dental clinic.In addition to that dental care is considered stressful situation for a lot of patients making them also susceptible to have an emergency situation .Unfortunately this can end with serious medical complications or even death . Dentists should have enough knowledge about managements of medical emergencies . Dental clinics should be prepared with medical emergency drugs and equipments. Objective: The present study aims to assess Knowledge, attitude and practice of dentists in management of ME in public dental Clinics in Khartoum State,toassess availability of medical emergency drugs and equipments in Khartoum Public Dental Clinics , and frequencies of ME in these clinics . Subjects and methods: 132 dentists were targeted , 118 of them participated in the present study with 90.1% response rate . A questionnaire was personally delivered to the participants to assess their knowledgeregarding MEand ED and equipments ,frequencies of ME at public Dental Clinics in Khartoum State and medical emergency training status of participants. Results: Results of the present study showed that 47.9% of the participants have high knowledge ,47.1% have medium knowledge and 5% have low knowledge .60.5% of participants received a training in ME managements. Normal saline was the most available ED(49%) while atropine was the least available ED(0.8%).Hypotension was the most frequent ME(73%) while foreign body aspiration was the least frequent ME(2.5%).Regarding ME equipmentssphygmomanometerwas the most available equipment(10%).Most of participants were familiar with use of sphygmomanometer(96%) . Normal saline was the most familiar drug for the participants (84%) , while atropine was the least known drug. Regarding ME practice skills 86.6% and 60% of participants can introduce IM and IV injections respectively , 47% can insert cannula ,42% can perform CPR and 73% had bleeding control skills .Most of participants were confident to manage post operative bleeding (84.9%), whileforeign body aspiration was the least know ME for the participants (30%) . Conclusion: Regarding ME knowledge, participants were distributed within three levels :high knowledge(47.9%) , medium knowledge (47.1%) and low knowledge(5%) .Regarding ME drugs and equipmentsavailability , surveyed clinics showed great shortage of these materials .
ItemThe Role of Immunohistochemistry in the Workup of Malignant Neoplasm of Unknown Primary Origin at Khartoum Oncology Hosp ital 2012-2017 .– Khartoum : University of Khartoum, 2019. - 78 P. : illus., 28 cm., MS.C.(University of Khartoum., 2019)Abstract Background: Carcinoma of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic tumours with no identified primary tumour at presentation. At each diagnostic step, the assessment of tissue-specific genes through immunohistochemistry (IHC) substantially helps in tumour classification. IHC is a reliable, inexpensive, and available resource. New markers continue to emerge, which, allow rapid and accurate identification of the primary site in an increasing number of cases. Objective: The study aimed to explore the role of available immunohistochemical markers in the diagnosis and classification of malignant neoplasms of unknown primary origin. Design: This was a retrospective, cross-sectional, and institution-based study. Methods: The study included patients diagnosed histologically as carcinoma of unknown primary (CUP) referred to the Histopathology and Immunohistochemistry Department, Medical Laboratory, Khartoum Oncology Hospital in the period from January 2012 to December 2017. Cases with incomplete data or slides were excluded. Hematoxylin and Eosin (H&E), and immune stained slides used in the workup were collected from the laboratory archives then reviewed under a light microscope (Olympus CX41, Japan) by the researcher and the supervising pathologist and classified CUP into the main histologic types. The clinical information of the patients was obtained from the request forms in the records of the laboratory. The collected data were analyzed by SPSS and Excel analytical system. The P-value calculated and 0.05 or less was the cut off value. Results: 141 cases of metastatic carcinoma with complete slides and records were examined histopathologically and immunohistochemically. These represent (3.2%) of all cases present in the lab for IHC during the study period. The age group (60-69) years have the highest percentage (20.13%) of the study population, with slightly male predominance (51.77%). For the site of VII presentation, the study showed that lymph nodes represent (41.84%) followed by the liver (12.77%), spine (3.55%), and lungs (2.13%). Histologically, the most common subtype was adenocarcinoma (75.89%), followed by undifferentiated neoplasm (14.18%), squamous cell carcinoma (7.09%), and carcinoma with neuroendocrine differentiation (2.84%). Using IHC by the available immunomarkers, the primary site was known in (49.6%) of the study cases, in (17.7%) able to give a differential diagnosis and in (32.6%) the origin remains unknown. The common immune stains used include Epithelial markers (Pan CK, CK20, CK7, CK5\6, and EMA), Lymphocytic markers (LCA, CD3 and CD20), S100 for sarcoma, HMB45 and Melan-A as Melanocytic markers. Synaptophysin and chromogranin for neuroendocrine tumours. The organ-specific markers used include PAS, CDX2, TTF-1, Thyroglobulin, and HepPar-1. Conclusions: The study concluded that CUP cases during the study period are 141 (3.2%) of 4436 cases presented for IHC and by the available immune markers 70 cases (49.6%) were diagnosed. The common histological types of CUP in descending order were adenocarcinoma, undifferentiated neoplasm, squamous cell carcinoma and carcinoma with neuroendocrine differentiation. The most common presenting sites are lymph node, liver, spine and lungs. Recommendation: From this study, it is recommended that IHC should be used in the right histological and clinical context. Use the immune markers in panels rather than individually. Availability of the immune markers and introduction of the new markers is an important part of the diagnosis and management of CUP patients.
ItemIntelligence Quotient Level and Prevalence of Dental Fluorosis among 6-16 years old Children in Tow Sudanese Suburban Communities with Optimal and above Optimal Natural Fluoride in drinking Water, 2020.(University of Khartoum., 2020)ABSTRACT Background: Dental fluorosis is one of the common dental problems. It occurs when fluoride interacts with mineralizing tissues, causing hypomineralization or subsurface porosity leading to tooth discoloration or chipping that cause functional and psychological dissatisfaction. Objective: To investigate the association between prevalence of dental fluorosis and Intelligence Quotient (IQ) level in two areas, one with optimal fluoride level in its natural drinking water (Wad Albakheet), and the other with above optimal Fluoride level in drinking water)Abu Groon). Methodology: A cross sectional, comparative, community based study conducted at Abu Groon village (Shargelneel locality) and Wad Albakheet (Karrary locality), Khartoum State, Sudan. From July to October 2019. Data was collected through examination and Intelligence Quotient test according to Raven’s Progressive Matrix after informed consent. Independent t test and Chi square test was used to compare mean IQ scores in high and low fluoridated areas. Pearson’s correlation and multivariate linear regression were used to appraise the issue of all the study variables on IQ. And data was analyzed using SPSS version 23 and excel version 16. 6 Results: The prevalence of dental fluorosis in Abu Groon was 96.8% while in Wad Albakheet It was56.3%. No statistically significant difference in prevalence based on gender in Abu Groon, but in Wad Albakheet it’s more among female (58.1%) compared to(55.1%) among male. The severity was more in older age group. The mean intelligence quotient of children with DF was 22.9 while the Intelligence Quotient of those free of DF was 31.2. The overall female Intelligence Quotient was higher than male’s IQ. Older children showed better results in Intelligence Quotient test when compared to younger one. The high fluorosis prevalence and severity of DF associated with the increased Fluoride concentration in drinking Water. Conclusion: Findings of this study suggest that the overall Intelligence Quotient(IQ) of the children exposed to high fluoride levels in drinking water and hence suffering from dental fluorosis was low when compared to the (IQ) of the Children from low fluoride in drinking Water and the difference was statistically significant (p=0.001).