Introduction: Echocardiographic (echo) screening has unmasked a high prevalence of subclinical rheumatic heart disease (RHD) in many countries, and it can be used as a surveillance tool to control the disease. Methods: School children of 10 to 15 years of age were selected in two areas of Sudan, Khartoum, the capital, and Niyala in western Sudan. Echo screening using a hand-held echo (HHE) was conducted in Khartoum using a three-view protocol, and in Niyala, a one-view protocol, both modified from the World Heart Federation protocol. Suspected cases were referred for standard echo study. Training of health personnel was conducted and health education sessions were delivered to the public. Results: In Khartoum, a total of 3 000 school children were screened; seven cases were positive for RHD using HHE and one case was confirmed by standard echocardiography. The prevalence of RHD using echocardiography was 0.3 per 1 000 children. In Niyala, a total of 1 515 school children were screened. Using HHE, 59 cases were positive for RHD; 44 had definite and 15 borderline disease. Out of 34 who underwent standard echocardiography, 29 (85.2%) were found to have RHD; 22 had definite and seven borderline disease. The prevalence using echocardiography was 19 per 1 000 children. A total of 779 health workers were trained in South Darfur and 50 000 posters and pamphlets were distributed. Conclusion: Using echocardiography, there was a significant disparity in RHD prevalence between the two communities in Sudan. Efforts to control RHD should be directed to this area, and other rural communities should be investigated.
Surgical site infections are the second most common cause of hospital acquired infections. The objectives of this study were to quantify the rate of wound infection and to identify risk factors associated for its prevalence among patients admitted for elective surgery in Khartoum Teaching Hospital in Sudan. A prospective study was conducted. All patients, aged >18 years admitted during March 1st 2010 to 31th october 2010 were recruited. baseline data was collected before the patient was operated. Patients were followed up to one month for detection of wound infection using bedside and post-discharge surveillance. A total of 1387 patients were included with a mean age of 35±14 years and 1138(82%) were females. More than three quarters were healthy (79.3%) and 1367 (98.6%) patients were operated on conventionally. The total number of the performed surgical procedures was 1426. The rate of wound infection was found to be 9%. The majority of the infected wounds 120 (96%) were superficial and only 5 (4%) were deep incisional. Univariate analysis revealed that five variables were significantly associated with the prevalence of wound infection; namely patient's body mass index (P=0.041), comorbidity (P=0.006), presence of diabetes (P=0.010), ASA score (P<0.0001) and laparoscopic surgical technique (P=0.007). Multivariate logistic analysis showed that ASA score 2 and ASA score > 3, [adjusted OR 1.9 (1.2-3.0), P =0.006 and adjusted OR 3.6 (2.0-6.7); P<0.001 respectively], laparoscopic surgical technique [adjusted OR 5.5 (2-14.8); P=0.001] were mostly significantly associated with the prevalence of wound infection. The rate of wound infection was high with patient's physical status being strong predictor of infection.
Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751; of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m 2 OR 2.1, 95% CI (1.1 -4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions' parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription's parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.
Background Acute gastroenteritis (AGE) remains a significant cause of diarrhea that affects children worldwide. It is usually caused by viral agents, including rotavirus (RV), norovirus (NoV), adenovirus (AdV), astrovirus (AstV), and sapovirus (SaV), and the disease severity varies accordingly. Here, we report the association of clinical severity among AGE‐infected pediatrics caused by a single viral pathogen, coinfection (viral–viral), mixed infection (viral–bacterial), and AGE‐negative samples. Methods A total of 901 pediatric patients were admitted with AGE to the Pediatric Emergency Center of Hamad Medical Corporation in Qatar from June 2016 to June 2018. The age of the subjects ranged between 3 months and 14 years (median of 16 months). Virus antigens detection was performed by using Film Array Gastrointestinal (GI) Panel kit. AGE severity was assessed using the Vesikari Clinical Severity Scoring System. Multivariable multinomial logistic regression was used to model the five AGE viral agents' likelihood in relation to severity versus co‐infection, mixed infection, and AGE‐negative samples. Results AGE was most common in pediatrics aged 1–3 years (median age = 1.25 years) and more frequent in males than females, with a ratio of 1:0.8. About 19.2% of the infections were caused by NoV, followed by RV (18.2%), AdV (6.5%), SaV (2.3%), and AstV (1.8%). The majority of viral agents were detected higher in mixed infection (32.1%) than coinfection (4.9%). Based on the Vesikari score system, severe clinical illness was recorded among pediatrics infected with RV (82.2%) and NoV (75.7%). Further on multivariable analysis, compared to testing negative, the odds of detecting RV was three times significantly higher in children with severe symptoms relative to those with moderate (adjusted‐odds ratio [a‐OR] = 3.10; 95% confidence interval [CI] = 1.82–5.28). Similar results were observed when considering RV relative to co‐infection and mixed infection (a‐OR = 2.59; 95% CI = 1.23–5.48 and a‐OR = 2.06; 1.28–3.30, respectively). About one‐third of the study sample were Qatari children with AGE (33%), whereas 35% and 32% were pediatrics from the Middle East and North Africa region, excluding Qatari and nonregions. Conclusion This study underlines the association of disease severity among AGE‐infected pediatrics in Qatar. The overall Vesikari median score was significantly high, followed by more frequent hospitalization among RV‐infected pediatrics compared to others. There was no reduction in the disease severity among RV‐infected regardless of the vaccine dose.
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