ObjectivesWe aimed to stratify the possible risk factors for diabetic cardiac autonomic neuropathy (CAN).MethodsWe did a meta-analysis of risk factors of CAN. We did a web-based search for literature in MEDLINE/PubMed, Scopus database and CENTRAL database up to August 2015. We included clinical trials or cohort studies that provide data about relationship between CAN and variables of interest. Our risk factors of interest were age, sex, duration of diabetes, body mass index (BMI), systolic blood pressure (sBP) and diastolic blood pressure (dBP), glycated haemoglobin (HbA1c), high-density lipoprotein and low-density lipoprotein (HDL and LDL), triglycerides, retinopathy and nephropathy. We generated Forest plots, χ2 test and I2 as tests for heterogeneity, risk ratio (RR), mean difference (MD), CIs and p values by ReVMan V.5.3 software.ResultsWe found a total of 882 related items. We excluded 873 studies from the title and abstract and 4 studies after review of full reports. Four studies were included. Our meta-analysis showed significant association between CAN and age (MD=4.94 (3.46 to 6.42)), duration of diabetes (MD=4.51 (2.51 to 6.52)), HbA1c (MD=0.48 (0.28 to 0.67)), BMI (MD=0.55 (0.08 to 1.01)), serum triglycerides (MD=0.09 (0.01 to 0.17)), proliferative retinopathy (RR=3.69 (1.20 to 11.34)), microalbuminuria (RR=2.47 (1.43 to 4.29)), hypertension (RR=4.18 (2.52 to 6.91)) and sBP (MD=4.10 (2.20 to 6.00)). We neither discovered the absence of significant association between the development of CAN and male sex (RR=1.57 (0.45 to 5.39)), dBP (MD=0.89 (−0.36 to 2.14)), cholesterol level (MD=1.19 (−0.99 to 3.36)), LDL (MD=0.12 (−0.15 to 0.39)), nor HDL level (MD=−0.28 (−0.58 to 0.03)).ConclusionsAge, duration of diabetes, HbA1c, BMI, serum triglycerides, proliferative retinopathy, microalbuminuria, hypertension and sBP are directly related to the risk of development of diabetic CAN.

There was no relationship between serum levels of AEDs and their side effects.

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Background. Brain dysfunction may be the most important and least studied problem afflicting the aging SCD population. 25% of neurologically intact pediatric SCD patients have NP dysfunction and silent CNS infarction. In children, age is associated with progressive decline in NP scores suggesting adults are at risk for progressive brain injury and NP decline. Objective. To determine the extent of NP impairment, the prevalence of MRI abnormalities, and their relationship in neurologically asymptomatic adult SCD patients compared to national norms and matched controls. Methods. Patients (21–55 yrs) with HbSS, normal neurologic exams and no history of stroke or abnormal neuroimaging, were recruited from 11 centers and screened for mental status and depression. The patient to control ratio goal was 3:1. After consenting, participants completed NP tests that assessed verbal and nonverbal intelligence, academic achievement, executive functioning, processing speed (PS), attention, and memory. Tests included the Wechsler Adult Intelligence Scale (WAIS-III), the Wechsler Memory Scales (WMS-III), the Woodcock-Johnson Tests of Achievement (WJ III), the Test of Everyday Attention (TEA), and others. Participants underwent standardized brain MRI read for atrophy and lesions. Volumetric analysis (vMRI) quantitated white and grey matter. Results. This is a report of 138 of the 150 planned SCD subjects and 37 controls: 62% female, 21–29 yrs, with mean hemoglobin (Hb) 8.2g/dl. 32% and 39% of patients scored one standard deviation (below 86) on the WAIS-III Performance IQ (PIQ) and PS index (PSI) scores compared to 16% in national norms. 26% and 22% of patients scored below 86 on the WMS-III visual immediate and immediate memory scales compared to 16% in national norms. Controlling for age, gender, and education, patients and controls differed significantly on the WAIS-III PSI Score, −14.1 (95% CI of −19.2 to −9.0) and the WJ-III including reading, math and following directions. Subtests of attention and flexibility of thought of the TEA significantly decreased with age in patients but not controls. In 82 patients with MRIs, 63% had an abnormal MRI or NP dysfunction, 38% had atrophy and/or ischemic lesions, and 18% had ischemic lesions only. Low PIQ and PSI were significantly associated with ischemic lesions. In vMRI, adjusting for age and gender, hippocampal volume in patients was 541.1 μL < controls (95% CI of 212.0, 870.3) and CSF volume in patients was 16 mL > controls (95% CI of 1.7, 31.5). These dfferences were significant. Patient Hb was a significant independent predictor of verbal IQ, PIQ, PSI, math, and executive function (Pearson r = .20 –.28). Conclusion. NP dysfunction and/or undetected brain injury affect the majority of neurologically intact adults with SCD, especially in areas of executive functioning, reading and math fluency. Patients with lower Hb have lower IQ scores. Ischemic lesions, alone, do not account for the extent of the NP impairment observed. Hb, age, and hippocampal volume were predictive of NP dysfunction, suggesting a link between reduced oxygenation, neuronal loss, and cognitive impairment. This supports the importance of a transfusion trial to improve NP function.

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Background: Epilepsy is a common disease with economic impact in form of frequent clinical visits, investigations and management. Objective: To estimate the direct and part of the indirect costs of epilepsy. Design and methods: The study was performed on a case series of medically treated Sudanese patients with epilepsy in a charity clinic. Data on clinical characteristics, utilization of medical services, and costs were collected from 38 patients using a standardized pre-tested format. The patients' approval was obtained as necessary. Results: Direct medical care costs was (2,395 Sudanese Pounds "SDG", 417 American Dollars "USD") per year per patient, of which antiepileptic drugs was the major component (1,587 SDG, 276 USD). Other costs are medical consultations and hospitalization charges (SDG 148, 26 USD), investigations cost (146 SDG, 25 USD), and cost of travel to clinics (514 SDG, 90 USD). Nonmedical direct cost -in form of traditional healers' visits were reported by 13.5% of the patients and estimated to be (1,422 SDG, 251 USD) per patient per year. The indirect cost was estimated for co-patients transportation, which is reported by patients who resides outside the state, making 7.9% of patients, and estimated to be (1,773 SDG, 308USD) per co-patient per year. The overall mean annual cost for epilepsy per patient in our clinic was approximately (2,724 SDG, 474 USD). Conclusion:The economic burden on epilepsy patients is heavy, and the contributors to the cost in Sudan have many similar features and some noteworthy differences with that of other countries.

Cerebrovascular Accident (CVAs) represents a major cause of death and disability among women. Age, hypertension, diabetes mellitus, hyperlpidemia, obesity and heart disease are known predisposing factors for the development of stroke. To describe clinical presentation of (CVAs) and to identify risk factors among adult Sudanese female.: This prospective cross sectional hospital based study it was done in (ETH) ELshaab Teaching hospital, in the period between

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