Severe acute malnutrition is associated with mortality in young infants. Associated risk factors ... more Severe acute malnutrition is associated with mortality in young infants. Associated risk factors and management were not well addressed. The aims of this study were to identify factors associated with severe acute malnutrition in children < 6 months of age and to evaluate the outcome of treatment after feeding them diluted therapeutic formula milk (F-100) along with breast-feeding. This interventional hospital-based study was conducted at 2 major children hospitals in Khartoum during the period between September 2011 and January 2014 among malnourished children less than 6 month of age. Infants' demographic, clinical and anthropometric measurements were recorded and then received routine medications and breastfeeding and/or 130ml/kg/day diluted F100 formula for 5 consecutive days and weight gain was recorded. All recruited infants (N=83) received diluted F-100 with breast milk. They had a mean±SD age of 3.8±5.8 months. The male to female a ratio was 1.3. The majority was from poor socioeconomic background and most mothers were below 40 years of age. Only 36 (43.3%) were exclusively breastfed and 37 (44.6%) of infants fed on food other than milk. Following feeding for 5 days, 76 out of 83 (91.6%) malnourished under the age of 6 months infants were discharged with adequate weight gain, 5 (6%) prematurely left the hospital and thus the study, 2 (2.4%) were defaulters and there was no deaths. Infants <6 months of age with severe acute malnutrition were mostly from poor backgrounds and developed malnutrition despite breast-feeding. Diluted F-100 formula was beneficial in treatment along with breastfeeding.
Cervical lymphadenopathy (CLA) is a common childhood problem in clinical practice which poses dia... more Cervical lymphadenopathy (CLA) is a common childhood problem in clinical practice which poses diagnostic difficulties to pediatricians. The aims of this study were to determine the causes of CLA in Sudanese children and to evaluate the value of routine laboratory tests in determining the etiology. Demographic and clinical data were prospectively collected from eighty children with palpable cervical nodes. Children were then subjected to complete blood count, ESR, Mantoux test, aspiration cytology of a lymph node and serological tests for HIV agglutination test, ELISA for Epstein–Barr virus and toxoplasma gondii. The age ranged 1-13 years with a mean of 5.8 ±3.1SD years with no gender difference. Specific etiologies of CLA were determined in 62.5% of patients. Ninety five percent of the causes were due to non-specific reactive hyperplasia of lymph nodes (NSRH) (37.5%), toxoplasmosis (27.5%),
Journal of clinical and diagnostic research : JCDR, 2016
Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mort... more Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mortality. The rationale of this study was to test the trend of paediatricians to achieve rapid response facing severe pneumonia, the lack of agreed on plan for the management of community acquired pneumonia (CAP) and the few experiences regarding injectable form of β-lactam antimicrobial. This is a prospective case control study, purposive randomized sampling, three patients were excluded since their information was incomplete, 132 patients were randomly divided into groups, one group named control group (penicillin according to the guidelines of WHO 2013), 33 patients; second group treated by β-lactam inhibitors (Augmentin IV) 50 patients; and third group treated by 3(rd) generation cephalosporin (ceftriaxone) 49 patients. The study was conducted at the main tertiary care and paediatrics teaching hospital in Khartoum capital of Sudan. The study was completed within the duration from 2010 t...
There are few publications on anemia following artesunate treatment. To investigate the hemoglobi... more There are few publications on anemia following artesunate treatment. To investigate the hemoglobin in patients with severe Plasmodium falciparum malaria treated with artesunate or quinine. Patients with P. falciparum (in Singa, Sudan) were treated by intravenous artesunate or quinine. Hemoglobin was measured initially, at day 14 and day 28. The mean (SD) of the age was 10.3 (10.9) years. The two groups (61 in each arm) were matched in their basic characteristics. Hypotension, convulsions, severe anemia were the main presentations. There was no significant difference in the mean (SD) hemoglobin level at the initial day, day 14 and at day 28 [11.2 (1.8), 11.3 (1.6), 11.5 (1.8), p = 0.170], respectively, in both groups. The hemoglobin did not change significantly from the baseline in any of the group separately. There was no difference in hemoglobin concentration in patients with severe malaria after treatment with either artesunate or quinine.
Acta Dermatovenerologica Alpina Panonica Et Adriatica, Sep 1, 2012
INTRODUCTION: Staphylococcus aureus is known as a common pathogen in atopic dermatitis. A methici... more INTRODUCTION: Staphylococcus aureus is known as a common pathogen in atopic dermatitis. A methicillin-resistant S. aureus strain with reduced susceptibility to vancomycin (VISA/VRSA) is increasing worldwide. The aims of this study were to evaluate the antibiotic-susceptibility pattern of S. aureus isolated from children with atopic dermatitis and to identify the occurrence of resistance to glycopeptide antibiotics.METHODS: Swabs were collected from atopic dermatitis skin lesions of 80 children being treated at dermatology clinics whose ages ranged from 6 months to 15 years in the period from March 2009 to February 2010. Isolates were studied with an antibiogram for an antibiotic-susceptibility test. The selected antibiotics were the usually administered antimicrobials at dermatological clinics in Buraydah (Qassim, Saudi Arabia). Results were determined as minimal inhibitory concentration (MIC) using the Vitek system.RESULTS: Thirty S. aureus isolates showed resistance to streptomycin (100%), benzylpenicillin and ampicillin (96.7%), and oxacillin (90%). S. aureus resistance to trimethoprim/sulfamethoxazole, tigecycline, and vancomycin was 63.3%, 83.3%, and 53.3%, respectively. Resistance to linezolid was less, at 5.7%.CONCLUSIONS: Strains of MRSA with decreasing susceptibility to vancomycin were documented in the Qassim region of Saudi Arabia. Other studies will be required on VISA/VRSA strains concerning phenotypic and genotypic characterization.
Estimating malaria parasite count is needed for estimating the severity of the disease and during... more Estimating malaria parasite count is needed for estimating the severity of the disease and during the follow-up. This study was conducted to determine the malaria parasite density among children using actual white blood cell (WBC) and the assumed WBC counts (8.0 × 10(9)/l). A cross-sectional study was conducted at New Halfa Hospital, Sudan. WBC count and count of asexual malaria parasite were performed on blood films. One hundred and three children were enrolled. The mean (SD) WBCs was 6.2 (2.9) cells × 10(9)/l. The geometric mean (SD) of the parasite count using the assumed WBCs (8.0 × 10(9)/l cells/μl) was significantly higher than that estimated using the actual WBC count [7345.76 (31 038.56) vs. 5965 (28 061.57) rings/μl, p = 0.042]. Malaria parasitemia based on assumed (8.0 × 10(9)/) WBCs is higher than parasitemia based on actual WBCs.
Blood culture is necessary for appropriate management of clinically severe pneumonia in children ... more Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.
Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infec... more Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infection is not sought as a cause in low-resources settings. The virus among children with cervical lymphadenopathy was not studied before in this country. The aims of this study were to estimate the prevalence of primary EBV infection and to describe clinical characteristics of children presenting with cervical lymphadenopathy. A cross-sectional study was conducted among children presented with cervical lymphadenopathy to Khartoum Children Emergency Hospital during the period from February 2009 to January 2010. Eighty-two children were randomly selected. Demographic and clinical data were recorded. Routine laboratory values were determined and children&amp;amp;#39;s sera were analysed for anti- viral capsid antigens IgM Epstein-Barr virus ELISA tests. Mean and SD were calculated. Regression analysis was to identify association between demographic, clinical and laboratory variables and IgM seropositivity of EBV. Epstein-Barr virus infection was diagnosed in 13 (15.9%) children with cervical adenopathy (n=82). The average age of these children was 7.5 (SD±3.3) years. The male to female ratio was 1.6. The most frequent symptoms were fever, loss of appetite and cough. The anterior cervical group of lymph nodes was most commonly implicated. All affected patients had mobile lymph nodes and the majority, 12 (92.3%), of patient had firm nodes. The lymph node number ranged from 2-6 nodes; with a mean of 3.5 nodes and average size of 3.6 cm. Splenomegaly and pharyngo-tonsillitis were found in 30.8% and 23.1% of patients respectively and leukocytosis was noted in 3 (23.1%). The odds of IgM seropositivity decreased with age ≤ 9 years (OR 0.15, 95% CI 0.03-0.78, p=0.023). EBV infection is not an uncommon cause of childhood cervical lymphadenopathy. The commonest symptoms are fever, loss of appetite and cough. Anterior cervical nodes are the most affected. Younger children (age ≤ 9 years) are less likely to be sero-positive.
Introduction. Instruments used for student evaluation need a follow up revision of their validity... more Introduction. Instruments used for student evaluation need a follow up revision of their validity and reliability. Reliability is concerned with the ability of an instrument to measure performance of student in a consistent way. Clinical pediatric examination involves multiple instruments including written MCQs, simulated history stations, simulated physical examination stations, OSCE video and photo stations in addition to live clinical settings and continuous assessment activities. This research aims at the evaluation of the internal consistency of these instruments used in the process of student evaluation during his pediatric clinical course. Methods. This study is involving the score data of 173 students at their final year of medical education during their pediatric course in the educational years 2013, 2014. They were in the form of 6 student batches: batch 1: 33 male students, batch 2: 32 male students, batch 3: 22 male students, batch 4: 22 male students, batch 5: 31 female...
To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, ... more To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, and to evaluate needle aspiration treatment. Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration. The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis (p>0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes (p=0.001). Most (91.3%) had axillary...
Glucose is the main source of energy for organ function in neonates. There are few published rece... more Glucose is the main source of energy for organ function in neonates. There are few published recent data on neonatal glucose levels during cesarean delivery. A case (cesarean delivery) -control (vaginal delivery) study was conducted at Khartoum Hospital Sudan to compare blood glucose levels of term newborns born after elective cesarean delivery with those born vaginally. Cord blood glucose levels at delivery were significantly lower in women who had a cesarean delivery compared with those who delivered vaginally (99.8 ± 20.6 vs. 106.8 ± 11.1 mg/dl, P=0.026), but there was no significant difference (97.8 ± 16.7 vs. 102.1 ± 9.6, P=0.110) in newborn glucose levels at 2 hours after delivery between the groups. In linear regression, cesarean delivery (-6.475 mg/dl, P=0.013) and maternal blood glucose levels at the time of delivery (+0.619 mg, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) were significantly associated with mean cord glucose levels. This study shows that cord blood glucose levels are significantly lower in cesarean-delivered neonates than vaginally-delivered neonates. In addition, cord blood glucose levels are significantly associated with cesarean delivery and maternal blood glucose levels at delivery. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2011479878124993.
In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Ro... more In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Rotavirus A is well known as the leading cause of diarrhea in young children worldwide. It was estimated to account for 41% of hospitalized cases of acute gastroenteritis among children in Sub-Saharan Africa. This study aimed to determine the prevalence and the common clinical presentations of rotavirus A infection among Sudanese children with gastroenteritis seeking management in hospitals. Methods: 755 Sudanese children less than 5 years of age suffering from acute gastroenteritis in hospital settings were included. The positive stool specimens for rotavirus A was used for extract Ribonucleic acid (RNA) and the RNA product was loaded on formaldehyde agarose gel and visualized under UV illumination. Results: Of the 755 children, 430(57%) were males while 325(43%) were female. The age of children ranged from 1 to 60 months. There were 631 (84%) children who were less than 24 months of age. Out of the 755 stool samples, 121(16%) were positive for rotavirus. Of the 121 infected children with rotavirus, 79(65.3%) were male and 42(34.7%) were female and the highest infection rate was seen among 91(75.2%) of children up to 12 months of age. Children of illiterate parents were more infected with rotavirus than children of educated parents. Severe dehydration present among 70% of infected children with rotavirus. Conclusion: Since this study is hospital-based, the 16% prevalence rate may not reflect the true prevalence among Sudanese children, thus a community-based surveillance is needed.
Community-acquired pneumonia (CAP) is as a major cause for childhood morbidity and mortality worl... more Community-acquired pneumonia (CAP) is as a major cause for childhood morbidity and mortality worldwide. This study was conducted to investigate the adherence and response of the WHO guidelines for treatment of severe pneumonia. A cross-sectional study was conducted in the period of June 2009 to July 2010 at Khartoum Hospital, Sudan. Children admitted and treated for severe pneumonia were enrolled. Only 39 (18.8%) out of 208 enrolled children received prescriptions that were adherent to the WHO guidelines of treatment of severe pneumonia. In logistic regression none of the investigated variable (age, gender, and clinical presentations) was associated with the adherence to the WHO guidelines. There was no significant difference in the response between adherent and non-adherent prescriptions. There was no association between the demographic, clinical data, treatment-adherence to the guidelines and the patients' response. There is a poor (18.8%) adherence to the WHO guidelines of th...
To determine the seroprevalence of Toxoplasma gondii (T. gondii) in children with reactive hyperp... more To determine the seroprevalence of Toxoplasma gondii (T. gondii) in children with reactive hyperplasia of the cervical lymph nodes. This cross-sectional prospective study was conducted in Khartoum Children Emergency Hospital, Khartoum, Sudan between January 2010 and April 2011. Eighty children with cervical lymphadenopathy were selected using random sampling. Their lymph nodes were aspirated for cytology, and a blood sample was collected from all patients for routine laboratory analysis and T. gondii IgG and IgM antibodies. Among 80 children with cervical lymphadenopathy, 60 (75%) had non-specific reactive hyperplasia. The seroprevalence of T. gondii among children with cervical lymphadenopathy was 27.5% (n=22), and the seropositivity of acute T. gondii among those with reactive hyperplasia was 36.7% (n=22/60). Lymph nodes in the T. gondii positive group were mobile and warm…
Journal of clinical and diagnostic research : JCDR, 2013
Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening conditi... more Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening condition, it may become infected with microorganisms, especially in children. The aim of this study was to determine bacterial colonisation in children with atopic dermatitis. A total of 80 children were randomly included in this study. Two swabs were taken from each child, one from the eczematous skin lesion and the other from apparently healthy skin, as a control. Bacteria were isolated and identified on the basis of the colonial morphology, gram staining and the Vitek System. The mean age of children in this study was 1.4 years, with no gender difference (p=0.98) (n=80). A total of 240 bacterial colonies were grown from atopic dermatitis lesions in contrast to 193 colonies from non-lesional skin. Gram-positive cocci were found in 78 (97.5%) lesions and in 77 (96.2%) non-lesional skin. Staphylococci species were significantly detected in the lesions than in the non-lesional skin. Ent. Faecal...
Background: In spite of the World Health Organization recommendations for the treatment of malari... more Background: In spite of the World Health Organization recommendations for the treatment of malaria, febrile patients are still infrequently tested and erroneously treated for malaria. This study aimed to investigate the adherence to malaria national protocol for the management of malaria among under five years old children. Methods: A cross sectional hospital-based study was conducted during the period from September through December 2013 among febrile children below the age of five years attending the outpatient department of Omdurman Children Hospital, Sudan. Demographic, clinical and laboratory data [blood film, rapid diagnostic test (RDTs), haemoglobin, WBCs and chest X ray] and anti-malarials and/or antibiotics prescription were recorded. Results: A total of 749 febrile children were enrolled. The mean (SD) age was 37.51 (41.6) months. Less than a half, (327, 43.7%) of children were investigated for malaria using microscopy (271, 82.9%), RDT (4, 1.2%) or both (52, 15.9%). Malaria was not investigated for more than a half, (422, 56.3%) however investigations targeting other causes of fever were requested for them. Malaria was positive in 72 (22%) of the 327 investigated children. Five (1.6%) out of 255 with negative malaria tests were treated by an anti-malarials. Quinine was the most frequently prescribed anti-malarials (65, 72.2%) then artemisinin-based combination therapy (ACT) (2, 27.8%). The majority of the 749 children (655, 87.4%) were prescribed an antibiotic. Conclusion: There is a poor adherence to malaria management protocol in Sudan among physicians treating children below five years of age. There was a high rate of antibiotic prescription needs.
Severe acute malnutrition is associated with mortality in young infants. Associated risk factors ... more Severe acute malnutrition is associated with mortality in young infants. Associated risk factors and management were not well addressed. The aims of this study were to identify factors associated with severe acute malnutrition in children < 6 months of age and to evaluate the outcome of treatment after feeding them diluted therapeutic formula milk (F-100) along with breast-feeding. This interventional hospital-based study was conducted at 2 major children hospitals in Khartoum during the period between September 2011 and January 2014 among malnourished children less than 6 month of age. Infants' demographic, clinical and anthropometric measurements were recorded and then received routine medications and breastfeeding and/or 130ml/kg/day diluted F100 formula for 5 consecutive days and weight gain was recorded. All recruited infants (N=83) received diluted F-100 with breast milk. They had a mean±SD age of 3.8±5.8 months. The male to female a ratio was 1.3. The majority was from poor socioeconomic background and most mothers were below 40 years of age. Only 36 (43.3%) were exclusively breastfed and 37 (44.6%) of infants fed on food other than milk. Following feeding for 5 days, 76 out of 83 (91.6%) malnourished under the age of 6 months infants were discharged with adequate weight gain, 5 (6%) prematurely left the hospital and thus the study, 2 (2.4%) were defaulters and there was no deaths. Infants <6 months of age with severe acute malnutrition were mostly from poor backgrounds and developed malnutrition despite breast-feeding. Diluted F-100 formula was beneficial in treatment along with breastfeeding.
Cervical lymphadenopathy (CLA) is a common childhood problem in clinical practice which poses dia... more Cervical lymphadenopathy (CLA) is a common childhood problem in clinical practice which poses diagnostic difficulties to pediatricians. The aims of this study were to determine the causes of CLA in Sudanese children and to evaluate the value of routine laboratory tests in determining the etiology. Demographic and clinical data were prospectively collected from eighty children with palpable cervical nodes. Children were then subjected to complete blood count, ESR, Mantoux test, aspiration cytology of a lymph node and serological tests for HIV agglutination test, ELISA for Epstein–Barr virus and toxoplasma gondii. The age ranged 1-13 years with a mean of 5.8 ±3.1SD years with no gender difference. Specific etiologies of CLA were determined in 62.5% of patients. Ninety five percent of the causes were due to non-specific reactive hyperplasia of lymph nodes (NSRH) (37.5%), toxoplasmosis (27.5%),
Journal of clinical and diagnostic research : JCDR, 2016
Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mort... more Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mortality. The rationale of this study was to test the trend of paediatricians to achieve rapid response facing severe pneumonia, the lack of agreed on plan for the management of community acquired pneumonia (CAP) and the few experiences regarding injectable form of β-lactam antimicrobial. This is a prospective case control study, purposive randomized sampling, three patients were excluded since their information was incomplete, 132 patients were randomly divided into groups, one group named control group (penicillin according to the guidelines of WHO 2013), 33 patients; second group treated by β-lactam inhibitors (Augmentin IV) 50 patients; and third group treated by 3(rd) generation cephalosporin (ceftriaxone) 49 patients. The study was conducted at the main tertiary care and paediatrics teaching hospital in Khartoum capital of Sudan. The study was completed within the duration from 2010 t...
There are few publications on anemia following artesunate treatment. To investigate the hemoglobi... more There are few publications on anemia following artesunate treatment. To investigate the hemoglobin in patients with severe Plasmodium falciparum malaria treated with artesunate or quinine. Patients with P. falciparum (in Singa, Sudan) were treated by intravenous artesunate or quinine. Hemoglobin was measured initially, at day 14 and day 28. The mean (SD) of the age was 10.3 (10.9) years. The two groups (61 in each arm) were matched in their basic characteristics. Hypotension, convulsions, severe anemia were the main presentations. There was no significant difference in the mean (SD) hemoglobin level at the initial day, day 14 and at day 28 [11.2 (1.8), 11.3 (1.6), 11.5 (1.8), p = 0.170], respectively, in both groups. The hemoglobin did not change significantly from the baseline in any of the group separately. There was no difference in hemoglobin concentration in patients with severe malaria after treatment with either artesunate or quinine.
Acta Dermatovenerologica Alpina Panonica Et Adriatica, Sep 1, 2012
INTRODUCTION: Staphylococcus aureus is known as a common pathogen in atopic dermatitis. A methici... more INTRODUCTION: Staphylococcus aureus is known as a common pathogen in atopic dermatitis. A methicillin-resistant S. aureus strain with reduced susceptibility to vancomycin (VISA/VRSA) is increasing worldwide. The aims of this study were to evaluate the antibiotic-susceptibility pattern of S. aureus isolated from children with atopic dermatitis and to identify the occurrence of resistance to glycopeptide antibiotics.METHODS: Swabs were collected from atopic dermatitis skin lesions of 80 children being treated at dermatology clinics whose ages ranged from 6 months to 15 years in the period from March 2009 to February 2010. Isolates were studied with an antibiogram for an antibiotic-susceptibility test. The selected antibiotics were the usually administered antimicrobials at dermatological clinics in Buraydah (Qassim, Saudi Arabia). Results were determined as minimal inhibitory concentration (MIC) using the Vitek system.RESULTS: Thirty S. aureus isolates showed resistance to streptomycin (100%), benzylpenicillin and ampicillin (96.7%), and oxacillin (90%). S. aureus resistance to trimethoprim/sulfamethoxazole, tigecycline, and vancomycin was 63.3%, 83.3%, and 53.3%, respectively. Resistance to linezolid was less, at 5.7%.CONCLUSIONS: Strains of MRSA with decreasing susceptibility to vancomycin were documented in the Qassim region of Saudi Arabia. Other studies will be required on VISA/VRSA strains concerning phenotypic and genotypic characterization.
Estimating malaria parasite count is needed for estimating the severity of the disease and during... more Estimating malaria parasite count is needed for estimating the severity of the disease and during the follow-up. This study was conducted to determine the malaria parasite density among children using actual white blood cell (WBC) and the assumed WBC counts (8.0 × 10(9)/l). A cross-sectional study was conducted at New Halfa Hospital, Sudan. WBC count and count of asexual malaria parasite were performed on blood films. One hundred and three children were enrolled. The mean (SD) WBCs was 6.2 (2.9) cells × 10(9)/l. The geometric mean (SD) of the parasite count using the assumed WBCs (8.0 × 10(9)/l cells/μl) was significantly higher than that estimated using the actual WBC count [7345.76 (31 038.56) vs. 5965 (28 061.57) rings/μl, p = 0.042]. Malaria parasitemia based on assumed (8.0 × 10(9)/) WBCs is higher than parasitemia based on actual WBCs.
Blood culture is necessary for appropriate management of clinically severe pneumonia in children ... more Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.
Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infec... more Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infection is not sought as a cause in low-resources settings. The virus among children with cervical lymphadenopathy was not studied before in this country. The aims of this study were to estimate the prevalence of primary EBV infection and to describe clinical characteristics of children presenting with cervical lymphadenopathy. A cross-sectional study was conducted among children presented with cervical lymphadenopathy to Khartoum Children Emergency Hospital during the period from February 2009 to January 2010. Eighty-two children were randomly selected. Demographic and clinical data were recorded. Routine laboratory values were determined and children&amp;amp;#39;s sera were analysed for anti- viral capsid antigens IgM Epstein-Barr virus ELISA tests. Mean and SD were calculated. Regression analysis was to identify association between demographic, clinical and laboratory variables and IgM seropositivity of EBV. Epstein-Barr virus infection was diagnosed in 13 (15.9%) children with cervical adenopathy (n=82). The average age of these children was 7.5 (SD±3.3) years. The male to female ratio was 1.6. The most frequent symptoms were fever, loss of appetite and cough. The anterior cervical group of lymph nodes was most commonly implicated. All affected patients had mobile lymph nodes and the majority, 12 (92.3%), of patient had firm nodes. The lymph node number ranged from 2-6 nodes; with a mean of 3.5 nodes and average size of 3.6 cm. Splenomegaly and pharyngo-tonsillitis were found in 30.8% and 23.1% of patients respectively and leukocytosis was noted in 3 (23.1%). The odds of IgM seropositivity decreased with age ≤ 9 years (OR 0.15, 95% CI 0.03-0.78, p=0.023). EBV infection is not an uncommon cause of childhood cervical lymphadenopathy. The commonest symptoms are fever, loss of appetite and cough. Anterior cervical nodes are the most affected. Younger children (age ≤ 9 years) are less likely to be sero-positive.
Introduction. Instruments used for student evaluation need a follow up revision of their validity... more Introduction. Instruments used for student evaluation need a follow up revision of their validity and reliability. Reliability is concerned with the ability of an instrument to measure performance of student in a consistent way. Clinical pediatric examination involves multiple instruments including written MCQs, simulated history stations, simulated physical examination stations, OSCE video and photo stations in addition to live clinical settings and continuous assessment activities. This research aims at the evaluation of the internal consistency of these instruments used in the process of student evaluation during his pediatric clinical course. Methods. This study is involving the score data of 173 students at their final year of medical education during their pediatric course in the educational years 2013, 2014. They were in the form of 6 student batches: batch 1: 33 male students, batch 2: 32 male students, batch 3: 22 male students, batch 4: 22 male students, batch 5: 31 female...
To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, ... more To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, and to evaluate needle aspiration treatment. Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration. The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis (p>0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes (p=0.001). Most (91.3%) had axillary...
Glucose is the main source of energy for organ function in neonates. There are few published rece... more Glucose is the main source of energy for organ function in neonates. There are few published recent data on neonatal glucose levels during cesarean delivery. A case (cesarean delivery) -control (vaginal delivery) study was conducted at Khartoum Hospital Sudan to compare blood glucose levels of term newborns born after elective cesarean delivery with those born vaginally. Cord blood glucose levels at delivery were significantly lower in women who had a cesarean delivery compared with those who delivered vaginally (99.8 ± 20.6 vs. 106.8 ± 11.1 mg/dl, P=0.026), but there was no significant difference (97.8 ± 16.7 vs. 102.1 ± 9.6, P=0.110) in newborn glucose levels at 2 hours after delivery between the groups. In linear regression, cesarean delivery (-6.475 mg/dl, P=0.013) and maternal blood glucose levels at the time of delivery (+0.619 mg, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) were significantly associated with mean cord glucose levels. This study shows that cord blood glucose levels are significantly lower in cesarean-delivered neonates than vaginally-delivered neonates. In addition, cord blood glucose levels are significantly associated with cesarean delivery and maternal blood glucose levels at delivery. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2011479878124993.
In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Ro... more In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Rotavirus A is well known as the leading cause of diarrhea in young children worldwide. It was estimated to account for 41% of hospitalized cases of acute gastroenteritis among children in Sub-Saharan Africa. This study aimed to determine the prevalence and the common clinical presentations of rotavirus A infection among Sudanese children with gastroenteritis seeking management in hospitals. Methods: 755 Sudanese children less than 5 years of age suffering from acute gastroenteritis in hospital settings were included. The positive stool specimens for rotavirus A was used for extract Ribonucleic acid (RNA) and the RNA product was loaded on formaldehyde agarose gel and visualized under UV illumination. Results: Of the 755 children, 430(57%) were males while 325(43%) were female. The age of children ranged from 1 to 60 months. There were 631 (84%) children who were less than 24 months of age. Out of the 755 stool samples, 121(16%) were positive for rotavirus. Of the 121 infected children with rotavirus, 79(65.3%) were male and 42(34.7%) were female and the highest infection rate was seen among 91(75.2%) of children up to 12 months of age. Children of illiterate parents were more infected with rotavirus than children of educated parents. Severe dehydration present among 70% of infected children with rotavirus. Conclusion: Since this study is hospital-based, the 16% prevalence rate may not reflect the true prevalence among Sudanese children, thus a community-based surveillance is needed.
Community-acquired pneumonia (CAP) is as a major cause for childhood morbidity and mortality worl... more Community-acquired pneumonia (CAP) is as a major cause for childhood morbidity and mortality worldwide. This study was conducted to investigate the adherence and response of the WHO guidelines for treatment of severe pneumonia. A cross-sectional study was conducted in the period of June 2009 to July 2010 at Khartoum Hospital, Sudan. Children admitted and treated for severe pneumonia were enrolled. Only 39 (18.8%) out of 208 enrolled children received prescriptions that were adherent to the WHO guidelines of treatment of severe pneumonia. In logistic regression none of the investigated variable (age, gender, and clinical presentations) was associated with the adherence to the WHO guidelines. There was no significant difference in the response between adherent and non-adherent prescriptions. There was no association between the demographic, clinical data, treatment-adherence to the guidelines and the patients' response. There is a poor (18.8%) adherence to the WHO guidelines of th...
To determine the seroprevalence of Toxoplasma gondii (T. gondii) in children with reactive hyperp... more To determine the seroprevalence of Toxoplasma gondii (T. gondii) in children with reactive hyperplasia of the cervical lymph nodes. This cross-sectional prospective study was conducted in Khartoum Children Emergency Hospital, Khartoum, Sudan between January 2010 and April 2011. Eighty children with cervical lymphadenopathy were selected using random sampling. Their lymph nodes were aspirated for cytology, and a blood sample was collected from all patients for routine laboratory analysis and T. gondii IgG and IgM antibodies. Among 80 children with cervical lymphadenopathy, 60 (75%) had non-specific reactive hyperplasia. The seroprevalence of T. gondii among children with cervical lymphadenopathy was 27.5% (n=22), and the seropositivity of acute T. gondii among those with reactive hyperplasia was 36.7% (n=22/60). Lymph nodes in the T. gondii positive group were mobile and warm…
Journal of clinical and diagnostic research : JCDR, 2013
Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening conditi... more Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening condition, it may become infected with microorganisms, especially in children. The aim of this study was to determine bacterial colonisation in children with atopic dermatitis. A total of 80 children were randomly included in this study. Two swabs were taken from each child, one from the eczematous skin lesion and the other from apparently healthy skin, as a control. Bacteria were isolated and identified on the basis of the colonial morphology, gram staining and the Vitek System. The mean age of children in this study was 1.4 years, with no gender difference (p=0.98) (n=80). A total of 240 bacterial colonies were grown from atopic dermatitis lesions in contrast to 193 colonies from non-lesional skin. Gram-positive cocci were found in 78 (97.5%) lesions and in 77 (96.2%) non-lesional skin. Staphylococci species were significantly detected in the lesions than in the non-lesional skin. Ent. Faecal...
Background: In spite of the World Health Organization recommendations for the treatment of malari... more Background: In spite of the World Health Organization recommendations for the treatment of malaria, febrile patients are still infrequently tested and erroneously treated for malaria. This study aimed to investigate the adherence to malaria national protocol for the management of malaria among under five years old children. Methods: A cross sectional hospital-based study was conducted during the period from September through December 2013 among febrile children below the age of five years attending the outpatient department of Omdurman Children Hospital, Sudan. Demographic, clinical and laboratory data [blood film, rapid diagnostic test (RDTs), haemoglobin, WBCs and chest X ray] and anti-malarials and/or antibiotics prescription were recorded. Results: A total of 749 febrile children were enrolled. The mean (SD) age was 37.51 (41.6) months. Less than a half, (327, 43.7%) of children were investigated for malaria using microscopy (271, 82.9%), RDT (4, 1.2%) or both (52, 15.9%). Malaria was not investigated for more than a half, (422, 56.3%) however investigations targeting other causes of fever were requested for them. Malaria was positive in 72 (22%) of the 327 investigated children. Five (1.6%) out of 255 with negative malaria tests were treated by an anti-malarials. Quinine was the most frequently prescribed anti-malarials (65, 72.2%) then artemisinin-based combination therapy (ACT) (2, 27.8%). The majority of the 749 children (655, 87.4%) were prescribed an antibiotic. Conclusion: There is a poor adherence to malaria management protocol in Sudan among physicians treating children below five years of age. There was a high rate of antibiotic prescription needs.
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