anemia

Introduction: Despite advances in the management of sickle cell disease (SCD), gaps still exist in the knowledge of healthcare professionals (HCPs) about the disease. The objective of this study was to assess the knowledge of HCPs about SCD. Methods: This is a cross-sectional study involving 465 HCPs (physicians and nurses) who responded to the DFConhecimento instrument questionnaire. Performance was tested in terms of average score and proportion of correct response for each questionnaire item topic. Results: The average score for respondents was 4.6 ± 1.9 out of a total of 13 points. Proportions of professionals who responded well were greater than 58% in three topics (Neonatal screening program, Sickle cell conditions, and Sickle cell anemia genotype). In the other topics, rates of good response ranged from 11.6% to 46.0%. There was a statistical association between best performance and medical title: physicians were more knowledgeable than nurses (OR = 6.26; 95% CI: 2.69-14.56). Conclusion: This study highlighted that knowledge of SCD among HCPs is very inadequate. This lack of sufficient information on SCD from HCPs indicates the need to develop continuing education programs.

Aim: Secondary hyperparathyroidism (SHPT) is an often underestimated cause of anemia in hemodialysis (HD) patients. The aim of this study was to assess the effect of pharmacological correction of SHPT on anemia and erythropoiesis-stimulating agents (ESAs) need. Methods: For the purpose of this retrospective pre-post observational study, we selected 55 HD patients, receiving HD at one single center, in the period from January 2005 to December 2020. The follow-up (F-U) lasted 12 months. The selection criteria were parathormone (PTH) levels > 300 pg/ mL, and hemoglobin (Hb) levels < 11 g/dL, despite treatment with ESAs. Parametric and non-parametric tests were used when appropriate. In the light of exploratory nature of the study, the limited sample size and in consideration of the pre-post-design, no further adjustment for potential confounders is performed. Results: The hemoglobin levels throughout the study were correlated to serum PTH (r = -.257, p < 0.01). At the end of the F-U, in the 40 patients whose PTH levels decreased ≥ 30% (responders group) Hb levels increased from 10.3 ± 0.5 g/dL to 12.2 ± 1.1 g/dL (p < 0.001), and ESAs doses decreased from 141 ± 101 IU/kg/b.w./week to 94 ± 76 IU/kg/b.w./week (p < 0.05). On the contrary, in the non-responders group Hb levels did not change 10.3 ± 0.5 gr/dL at baseline and 10.1 ± 1.1 gr/dL at F-U (P = NS), and the mean doses of ESAs increased from 144 ± 75 IU/kg/b.w./week to 218 ± 145 IU/kg/b.w./week (P = NS). Conclusion: Adequate control of SHPT is associated with concomitant improvement of anemia and decrease in ESAs need. Future endeavors are required to confirm these preliminary results. 

Background: The survival of people living with HIV (PLWHIVs) is increased and Health systems will have to deal with the early-aging-associated medical conditions.Objective: The objective of this study is to compare the clinical and biological profiles of PLWHIVs aged 50 and over and those aged less than 50 years.Material and methods: This study conducted at Kinshasa University Teaching Hospital (KUTH) covers 6 years. The clinical and biological characteristics of PLWHIVs aged 50 and over were compared with those under 50. Statistical analysis used the means ± SD, the calculation of frequencies, Student’s t-test and Chi-square.Results: PLWHIVs aged 50 or over represented 35.1%. Their average age was 58.0 ± 4.8 years. Women predominate among those under 50 and men among those 50 and over. Married people were more numerous (54% among those under 50). There were more unemployed (50% of PLHIV under 50). Patients 50 years and older were significantly classified as WHO stage 4 with a high frequency of history of tuberculosis, genital herpes, high blood pressure, smoking, vomiting, hepatomegaly, moderate elevation of diastolic blood pressure (DBP) and sytolic blood pressure (SBP), tuberculosis and anemia.Those under 50 had a significantly increased frequency of shingles, hepatitis B-hepatitis C, headaches and more survivals. The mean of Hb, HDL-C, and CD4s+ were significantly lower in patients 50 years and older, and urea, LDL-c, and ALAT levels were significantly higher. Conclusion: The average age was higher from 50 years old. These PLWHIVs were more frequently in WHO stage 4 with more common TB and anemia. Their Hb, HDL-C, and CD4s+ levels were lower while their urea, LDL-C and ALAT levels were significantly elevated.

A literature-based review was made to assess available information on bovine hemoparasites related to their epidemiology, distribution, and economic importance in Ethiopia. Babesiosis, anaplasmosis, cowdriosis, theileriosis, and trypanosomosis are the major hemo-parasitic disease of bovine in Ethiopia. Their adverse effects on the health of the animals can decrease production and productivity. Hemoparasites generally cause fever, anemia, jaundice, anorexia, weight loss, milk drop, malaise, swelling of lymph nodes, dyspnoea, diarrhea, nervous disorders, and death by affecting blood vessels and/or lymphatic system of the animal. Reports from different parts of the country displayed there is a high distribution of bovine hemoparastic disease throughout the country. Anaplasmosis, Babesiosis (redwater), Ehlichiosis (Heartwater), Theileriosis, and Trypanosomosis are the major hemoparasitic diseases with heavy economic losses. Their mode of transmission was by arthropod vectors ticks and flies. Applying effective vector control and using vaccines drugs are the two most important control methods for hemoparasites diseases. Also having knowledge of parasite life cycles, their biological vector, and the immune response of bovines to vectors and parasites were also used in the successful application of control strategies. Creating awareness of the mode of transmission, method of control, and prevention of hemoparastic disease of bovine to livestock owners were warranted to decrease the effect of the disease.

Background: Iron deficiency anemia is common during pregnancy since the overall iron requirement is greater than non-pregnant women and is associated with adverse outcomes. Iron deficiency (ID) is a state of insufficient iron to maintain normal physiological functions of tissues and leads to anemia.Objectives: To assess factors associated with the utilization of Iron with Folic acid supplement Among Pregnant Women Attending Antenatal care at Government Health Facilities and Family Guidance Clinic in Hawassa City, South Ethiopia.Methods: Institutional-based cross-sectional study design was conducted among 412 health providers who are working at public health institutes in Hawassa city from March to April 2015. Pretested Self-administered questionnaires were used to collect the data. The data was entered into Epi-data and analysed by SPSS version 26.0. Bivariate and multivariate regression analysis was used to see the significant association between the outcome and independent variables. Odds ratios and 95% CI will be computed to measure the strength of the association, p - value of ˂ 0.05 will be considered a statistically significant.Results: A total of 412 pregnant women who came to attend ANC at least for the second time were interviewed in seven health facilities. Our study showed that 333 (81%, 95% CI: 77.2 - 84.8) pregnant women reported taking IFA supplements and high compliance was 37.7% (95% CI: 32.5 - 42.9). In multivariable analysis, side effects and low acceptance of the supplement were significantly associated with compliance to IFA supplementation (p < 0.05).Conclusion: There is a relatively better level of compliance towards IFA supplementation compared to other national data. Pregnant women should be counseled regarding how to manage the side effects of IFA supplements during ANC. Further research has to be done on the acceptability of the supplements.

Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure.Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF.Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance. Purposes: This work aims to study the prognostic value of Global the left ventricle’s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF. Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians.Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%).63% of patients have impaired GLS (< 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study. Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF.

Background: Leiomyomas beyond the uterus are defined by benign smooth muscle cell tumors outside of the uterus. Intravenous leiomyomatosis is a rare type of uterine leiomyoma and is characterized by the formation and growth of benign leiomyoma tissue within the vascular wall. Herein, we present a case of Intravenous leiomyomatosis successfully treated by surgical removal and a review of actual medical recommendations.Case presentation: A 49 - year-old woman, maghrébin, G3 P2, no family history of uterine myomas mentioned, having systemic arterial hypertension, presented to our department with hypogastric pain and abnormal uterine bleeding in the prior five months resulting in anemia which required iron supplementation. On physical examination the vital signs were normal. A palpable mass in the hypogastrium was noted. The rest of the exam was unremarkable. Pelvic ultrasound showed a huge uterus with multiple heterogeneous leiomyomas, including at least one intracavity. Computed tomography scans and magnetic resonance imaging were not done initially due to the unaffordability of the patient. The initial diagnosis was leiomyoma. The decision to perform a total abdominal hysterectomy and bilateral salpingo-oophorectomy was taken. The abdomen was opened by a midline vertical incision. During surgery, multiple subserosal, intramural and submucosal fibroids ranging from 2 cm × 3 cm to 10 cm × 10 cm were seen. On pathological examination, the uterus measured 19 cm in the largest diameter and weighed 1.3 kg. The cut section showed white nodular myometrial masses. Microscopically, intravascular growth of benign smooth muscle cells is found within venous channels lined by endothelium. The diagnosis of Intravenous leiomyomatosis of the uterus without malignant transformation was retained. The patient was monitored for 14 months and subsequent computed tomography did not reveal any evidence of tumor recurrence. The follow-up will be performed annually till the age of menopause.Conclusion: Intravenous leiomyomatosis is a benign, rare and potentially lethal pathology. It especially affects premenopausal women with a history of uterine myoma, whether operated on or not. They require close and prolonged follow-up because of the high risk of recurrence.

The World Health Organisation (WHO) defines anemia as a global public health problem. It is a medical condition in which the number of red blood cells or the hemoglobin concentration within them is below the physiological range. We present a case of a 40-year-old woman with Abnormal Uterine Bleeding (AUB) accompanied by malaise, weakness, and tachycardia. The patient reported heavy menstrual bleeding for the past 14 days. Speculum examination revealed that the bleeding was from the uterus. There were no pathological findings during a gynecological and transvaginal ultrasound examination. A complete blood count performed at the time of her arrival showed a low hemoglobin level of 24 g/L, a low hematocrit level of 7,4%, a mean corpuscular volume of 98,7 fL and a number of red blood cells 0,75 x 1012/L. Due to the severity of the anemia, she was given 6 units of red blood cell transfusion, 2 fresh frozen plasmas and tranexamic acid accompanied with calcium carbonate. The curettage was performed. The pathohistological finding was endometrium in proliferation. Afterward, the hemoglobin level increased to 90 g/L. Their past medical history revealed that she abused alcohol. On an abdominal CT scan, Alcohol-Related Liver Disease (ARLD) was confirmed. We should keep in mind that coagulopathy could be the underlying cause of abnormal uterine bleeding and that anemia must be analyzed for successful treatment. A multidisciplinary approach to anemia caused by AUB is required in cases of severe anemia.

Introduction: Cardiovascular diseases are the leading cause of death in the world, headed by coronary artery disease, which is secondary to atherosclerosis. The latter recognizes classic risk factors such as diabetes, high blood pressure, tobacco, and dyslipidemia and other less classic factors such as chronic inflammation of rheumatoid arthritis. Many studies have highlighted the correlation between this chronic inflammation and clinical coronary disease but very few have focused on the anatomical correlation. Objective: To describe the correlation between the chronic biological inflammation of rheumatoid arthritis and anatomical coronary lesions on angiography. Method: This observational, retrospective, single-center study, including over 10 years, of patients with rheumatoid arthritis, confirmed the EULAR 2010 criteria and presented with coronary artery disease requiring coronary angiography. Patients with missing data or in whom coronary angiography was not done were excluded (n = 14). We divided then the patients according to the existence or not of chronic inflammation to study the impact of the latter on the existence (Stenosis < 50% vs. stenosis ≥ 50%), the extent (single vs. multivessel disease), and the severity of the coronary lesions (syntax score < 32 vs. ≥ 32). Results: 202 patients (49♂/153♀) aged between 30-75 years with a history of rheumatoid arthritis have had a coronary event requiring coronary angiography, were included; The mean ejection fraction at baseline was 57.3% +/- 5.8 (37 vs.-65%). 75% of them were ≥ 65 years old. 55% were diabetics, 61% with hypertension, 38% with dyslipidemia, and 19% were smokers. Chronic inflammation was diagnosed in 70% of them on non-specific parameters (ESR, CRP, fibrinogen, anemia, and rheumatoid factor). All patients had coronary angiography, which made it possible to identify the coronary lesions according to their existence (Stenosis < 50%: 51 patients vs. stenosis ≥ 50%: 151 patients), the extent (single: 86 patients vs. multivessel disease: 116 patients) and the severity of the coronary lesions (syntax score < 32: 142 patients vs. ≥ 32: 60 patients). Chronic inflammation of rheumatoid arthritis was correlated in bivariate and multivariate analysis (after excluding the impact of other risk factors) with the existence and extent of coronary lesions (p < 0.05) but not with their severity (p > 0.05). Discussion: The two limitations of this work are the monocentric nature of the study and the absence of specific inflammatory parameters such as anti-CCP antibodies. Strengths are anatomical correlations and multivariate analysis. Chronic inflammation apart from any influence of the various risk factors predisposes to the existence and extent of coronary lesions (p < 0.05). The severity of coronary lesions assessed by Syntax Score was not correlated with chronic inflammation, although other studies suggest that this inflammation is the cause of complex lesions.Interpretation: Rheumatoid arthritis is associated with an increase in cardiac morbidity and mortality. Atheromatous lesions are more frequent in those patients than the existence of classic cardiovascular risk factors would suggest. Several explanations could account for this risk: the inflammatory syndrome and its impact on the cardiovascular risk factors and the vessel and the deleterious effect of the treatments. This requires stricter screening and management of risk factors in rheumatoid arthritis.

In our study, we aimed to show that alternative iron salts containing different additives are safe to use in patients who have type 1 hypersensitivity reactions to iron drugs and need iron replacement therapy.Materials and methods: Between January 2022 and June 2022, patients who had previously developed type 1 hypersensitivity reactions with iron preparations and needed iron replacement were included in the study. The study was designed retrospectively. Skin tests were first performed on patients to demonstrate a type 1 hypersensitivity reaction. If skin tests were negative and there was no history of life-threatening anaphylaxis, oral provocation tests were continued. If the absence of variability in symptoms and perimeter values, the drug allergy test was considered negative. Results: Twenty-two patients were included in the study. Twenty-one of the patients were female and one was male. Iron deficiency anemia was found in nine patients, and low iron stores in thirteen patients without anemia were found. Type 1 hypersensitivity reaction developed with Iron 3 Carboxymaltose in 7 patients, Iron 2 Sulfate in 5 patients, Iron 2 Glycine in 4 patients, Iron 3 Hydroxy Polymaltose in 4 patients, Iron 2 Fumarate in 1 patient and Iron 3 Hydroxide Sucrose in 1 patient. Allergy tests with all alternative iron drugs containing additional additives were negative.Conclusion: If patients with allergic reactions cannot be referred to allergy clinics, we think that oral iron salts with different additives can be used after the first dose is given in the hospital under general anaphylaxis precautions. We show that oral iron salts containing different additives can be safely used.

Hereditary spherocytosis is a common inherited type of hemolytic anemia that results from abnormal morphology of erythrocytes. It has a high occurrence in North Americans and northern Europeans with a prevalence of 1/2000. There is a wide range in age and symptoms at presentation with some individuals being asymptomatic and others having severe diseases requiring blood transfusions. Based on the severity of symptoms, management may vary from simple observation to frequent blood transfusions, cholecystectomy for gallstones, and splenectomy. Timely diagnosis may be critical to minimize complications. Diagnostic tests have been available with varying degrees of accuracy. However new diagnostic tests with greater specificity and sensitivity are now available for more accurate diagnosis of Hereditary Spherocytosis in individuals of all ages including newborns. Illustrative cases are presented that show the variability in presentation, symptoms, complications, and care. Information is presented updating diagnostic testing that allows earlier diagnosis of children with hereditary spherocytosis. Additionally, the hematologic findings suspicious and consistent for this diagnosis are presented, serving as a guide when testing should be initiated.

Systemic sclerosis sine scleroderma is a rare subset of systemic sclerosis with isolated organ involvement. Scleroderma renal crisis is a severe manifestation of systemic sclerosis characterized by malignant hypertension, oligo/anuric renal failure, and thrombotic microangiopathy. We present a case of a 55-year-old male with uncontrolled hypertension who presented with hematospermia and was found to have acute renal failure, microangiopathic hemolytic anemia, concerning thrombotic microangiopathy. Empiric management for thrombotic thrombocytopenic purpura (TTP) with plasma exchange and corticosteroids yielded a paradoxical response, ultimately leading to the diagnosis of systemic sclerosis sine scleroderma presenting as scleroderma renal crisis (SRC) after serological confirmation. Given the morbidity and mortality associated with scleroderma renal crisis, it should be increasingly considered as a differential for thrombotic microangiopathy even without outward manifestations of systemic sclerosis. Additionally, the empiric management of TTP can include the use of corticosteroids which can exacerbate SRC, an early clinical clue in the diagnosis of this disease.

Background: 800 women die and 2.6 million stillbirths occur worldwide related to pregnancy complications. Racial/ethnic disparities in pregnancy-related mortality have continued to be significantly higher among black than whites due to various factors. We sought to investigate complications among pregnant women of different race/ethnicity.Methods: Cross-sectional observational study of 2030 obstetric cases randomly selected for the period January 1 to December 31, 2021. Data was collected from the hard copy and electronic inpatients’ records. Analysis was performed using SPSS version 23. Descriptive statistics analyzed the pregnancy complication frequencies, standard deviations, range, minimum and maximum values. Maternal characteristics were analyzed using an independent samples t-test. Maternal characteristics were evaluated using the two samples t-test. The odds ratios and confidence intervals were calculated as measures of association between ethnicity/race and pregnancy complications using a binary logistic regression model. Confidence interval was set at 95% and p < 0.05 (2-tailed) was considered statistically significant.Results: 76.25% of Chinese and 67.86% of Zambians were affected by one or more complications. The mean ± standard deviation for MGH [age (26.69 ± 7.33), gravidity (3.35 ± 2.08), and parity (2.07 ± 1.68)] and for 2nd affiliated hospital was [age (30.04 ± 4.29), gravidity (2.19 ± 1.38) and parity (0.45 ± 0.55)]. Prevalence of top five pregnancy complications in the Chinese group was gestational diabetes mellitus at 18.41%, hypothyroidism at 15.91%, oligohydramnios at 14.39%, premature rupture of membranes at 12.17%, and anemia at 5.73%. The prevalence of the top five pregnancy complications in the Zambian group was preeclampsia at 13.80%, PIH at 12.74%, PROM at 12.45%, eclampsia at 7.53%, and placenta abruption at 7.43%. Statistical significance findings were noted as follows: Oligohydramnios [OR 0.02, CI (0.01 - 0.05), p = 0.000], placenta praevia [OR 0.08, CI (0.01 - 0.61), p = 0.015], preeclampsia [OR 13.10, CI (7.22 - 23.78), p = 0.000], placenta abruptio [OR 79.73, CI (11.07 - 574.38), p = 0.000], PIH [OR 11.95, CI (6.57 - 21.73), p = 0.005], eclampsia [OR 162.90, CI (10.08 - 2631, p = 0.000), PPROM [OR 0.03, CI (0.00 - 0.45), p = 0.012], GDM [OR 0.11, CI (0.07 - 0.17), p = 0.000], hypothyroidism [OR 0.01(0.00-0.03), p = 0.000], anemia [OR 0.18, CI (0.92-0.34), p = 0.000], ICP [OR 0.03, CI (0.00 - 0.48), p = 0.013], syphilis [OR 7.17, CI (2.14 - 24.02), p = 0.001], UTI [OR 22.55, CI (3.04 - 17.26), p = 0.002], HBV [OR 0.05, CI (0.00 - 0.86), p = 0.039] and GBS [OR 0.06, CI (0.00 - 1.11), p = 0.059].Conclusion: Highest odds for obstetrical and infection-related pregnancy complications were associated with Zambian cases. The highest odds for medical complications were associated with Chinese cases.

Although intussusception occurs in children and adults with celiac disease, it is a relatively uncommon symptom. Even more rare is the occurrence of intussusception as the presenting symptom of the disease. In the two cases we report here, transient intussusception, occurring at three years of age, was the first and only physical sign of celiac disease, and lead to a timely diagnosis by immunoserology and histology, followed by implementation of a gluten-free diet before sequelae such as significant anemia or Failure to Thrive (FTT) developed. In both cases, neither immunoserological nor physical signs of disease were present at the follow-up examination after 6 months on a gluten-free diet. In addition, genetic screening of the patients’ families revealed HLA-DQ2 positivity in two cases, leading to the additional diagnosis of celiac disease in the pregnant mother of one of the patients.

Immune cytopenias occur when the body produces antibodies that target specific hematopoietic cells, inducing extravascular antibody-mediated phagocytosis by monocyte-macrophages in the spleen and/or liver through activation of Fcγ Receptors (FcγRs). Immune cytopenias include Immune Thrombocytopenia (ITP), Autoimmune Hemolytic Anemia (AIHA), Hemolytic Transfusion Reactions (HTR), Hemolytic Disease of the Fetus and Newborn (HDFN), and Autoimmune Neutropenia (AIN). Thus, novel therapeutics that inhibit phagocytosis would be useful, especially for short-term use while other therapies are being evaluated. In our earlier studies, we successfully identified two small-molecule drugs able to inhibit in vitro phagocytosis with a low IC50 concentration and negligible toxicity. These drugs, known as KB-151 and KB-208, have the potential to be utilized as lead compounds for further studies, once their mechanism of action is more clearly understood. In this regard, we have developed preliminary results that suggest that these small molecules may bind to the Fc receptors on monocyte macrophages and block the subsequent attachment of antibody-opsonized red blood cells to prevent phagocytosis.

Introduction: In the present study we evaluated and compared RBC parameters, iron status, and ferritin for discriminating between patients with iron deficiency anemia and anemia of chronic disease. Anemia that accompanies infection, inflammation, and cancer, is commonly termed anemia of chronic disease (ACD). Methods: We compared the ability of serum ferritin concentration, using the microplate immunoenzymometric assay method with other, more traditional indicators of iron status like total iron binding capacity [TIBC], mean corpuscular volume [MCV], percent transferrin saturation [%TS], RBC distribution width [RDW], and serum iron concentration [SIC]. The ferritin concentration was determined in 80 serum samples selected from men and women above the age of 18 years. The patients were assigned to IDA and ACD groups based on serum ferritin concentration.Observation: By studying the ROC Curve for various red cell parameters for the diagnosis of IDA and ACD, we found that diagnostic accuracy of various indicators was as follows TIBC>TS%>MCV>MCH>SI>MCHC for anemia of chronic diseases, and TIBC>MCH>MCV>MCHC>TS%>SI for iron deficiency anemia. When both the value of AUCs (Area under Curve) of ROC were compared it is apparent that TIBC, TS%, MCV, and MCH are important discriminating factors between IDA and ACD. Conclusion: Conventional laboratory parameters play an important role in distinguishing overt causes of IDA and ACD. MCV, MCH, and TIBC were found to be (p -value < .05) significantly discriminated against IDA and ACD. Serum ferritin is an important diagnostic tool with reasonable accuracy for the detection and differentiation of iron deficiency anemia and anemia of chronic disease.

Background: Stroke occurs in 11% of patients with SCA before 20 years of age. In Northwestern Tanzania, the prevalence of stroke among children living with SCA under the age 15 years is 16.9%, of which might be attributed to the absence of routine screening for the risk of stroke by using Transcranial Doppler Ultrasound (TCD). Screening with TCD allows preventive measures such as chronic blood transfusion to be done which has led to the reduction of stroke by 92%.Methods: This was a prospective analytical cross sectional study which enrolled 267 SCA children aged 2 to 16 years attending Bugando Medical Centre Pediatric Sickle Cell Clinic from July 2019 to June 2020. Assessment of factors associated with elevated TCD included a clinical history of stroke in sibling, death in sibling, temperature, oxygen saturation in room air, blood pressure, hemoglobin level and total white blood cell count. TCD was done by accessing transtemporal window and recording the highest time average mean of maximum velocity (TAMMV) of major vessels mainly, middle cerebral artery (MCA) and distal internal carotid artery (dICA).Results: The median age of enrolled was 6.6 (IQR: 4-9) years. The prevalence of elevated TCD (> 170 cm/s)was found to be 21% (56/267). By multivariate logistic regression, low oxygen saturation in room air, p - value = 0.037, OR 1.08 [95% CI 1.00-1.17] and low hemoglobin level, p - value = 0.001, OR 1.76 [95% CI 1.26-2.45] were statistically significantly associated with elevated TCD among children living with SCA.Conclusion: The high prevalence of elevated TCD velocity, with low hemoglobin and low oxygen saturation in room air as associated factors under multivariate logistic regression, warrants routine TCD screening for children with SCA aged 2 to 16 years.

Background: Grand multiparty is common obstetrical problem, in Sudan large families is desirable for cultural and religious backgrounds and higher incidence of grandmultipra is expected, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity need to delivered by primary cesarean section.Objective: The main objective was to determine impact of primary cesarean section on grand multiparous, it is indications and complications.Methodology: It was a descriptive prospective cross-sectional hospital-based study conducted at Omdurman Maternity Hospital during period October 2016 to March 2017.An interview questionnaire was used for data collection. Demographic and clinical data concerning personal history, parity, indications of primary cesarean section, type of Cs, maternal complication and neonatal complications were recorded. Also, multiparous less than five delivery, previous lower segment caesarean section, known medical disorders except anemia and twin pregnancy were excluded.Results: During the study period total of 113 grand multipara included, incidence of primary cesarean section in grand multipara was 10%. Indication in our study 22.1% due to malpresentation, fetl distress 15% and prolonged first stage 13.4%, prolonged second stage 12.4% and antepartum haemorrhage 11.5%.  Postpartum haemorrhage developed in 9.7%, hysterectomy 1.8%, uterine tear 5.4% bladder injury fetal laceration 3.6%, spinal anesthesia headache 7%, post-partum pyrexia 5.3%, sepsis 4.4%, urinary tract infections were 2.7%.Conclusion: The finding in this study showed 10% incidence of primary cesarean section in grandmultipra. The most indications of primary cesarean section in grandmultipra malpresentation, fetal distress, prolonged first and second stage of labour. Most CS were emergency. 

Despite decades of global and country commitments towards eradicating malaria, malaria remains the most hazardous parasitic disease and the most common cause of fever for humans, especially in tropical countries. Plasmodium falciparum causes 90% of malaria cases. Coma [Cerebral Malaria (CM)], acidosis, hypoglycemia, severe anemia, renal dysfunction, and pulmonary edema are the most common complications of malaria caused by Plasmodium falciparum and the most common cause of death related to malaria. People from less prevalent malaria areas are at high risk of developing these complications. A 16-year-old male from a low malaria transmission area was diagnosed with CM. Prior to developing CM, he was treated with Coartem. CM is a medical emergency and one of the forms of severe malaria. CM has high mortality and morbidity rates. Yet, international health-related agencies, funders, and policy-makers are unfamiliar with it. The continuous occurrence of CM validates the considerable need for global investment in malaria control and elimination programs. Early administration of Artesunate to all patients suspected of having severe malaria would reduce global malaria-related mortality and morbidity. Simple tests, such as the determination of malaria parasitic density either with thin or thick blood smears, may influence the proper management of all severe malaria cases. However, in clinical practice, the determination of malaria parasitic density is not routinely done. Further commitments are needed to ensure routine determination of malaria parasitic density for all suspected severe malaria cases. Moreover, further commitments are needed to guarantee the proper management of CM because it is a major cause of reversible encephalopathy in tropical countries.

Introduction: Factor VII (FVII) deficiency, a rare bleeding disorder, can manifest as an autosomal recessive congenital or an acquired coagulopathy. Acquired FVII deficiency, although infrequently reported, presents unique challenges in understanding its mechanisms and identifying underlying causes. Case presentation: We present a case of acquired FVII deficiency discovered in a 23-year-old female patient with no apparent underlying disease. The patient exhibited spontaneous ecchymosis and gingival hemorrhage, along with low FVII activity and isolated prolongation of prothrombin time. Extensive laboratory investigations excluded liver dysfunction, familial deficiency, vitamin K deficiency, and inhibitory antibodies. Prompt treatment with Fresh Frozen Plasma (FFP) and bypassing agents resulted in a favorable response and resolution of hematomas. Conclusion: Acquired FVII deficiency was identified with bleeding symptoms in association with prolonged prothrombin time and a low level of FVII activity. In literature, this deficiency has been associated with various conditions such as sepsis, aplastic anemia, stem cell transplantation, and neoplasms, although approximately 14% of cases remain idiopathic. Clinical outcomes remain generally poor, with limited complete remissions reported.