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Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects’ blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity.

Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects’ blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity.

Fuzzy logic systems with approximation capabilities provide effective control for nonlinear and uncertain systems. Due to the characteristics of photovoltaic (PV) and the PWM method, a grid-connected PV system is a considerably nonlinear system with unpredictable parameters. In this study, a new adaptive interval type-2 fuzzy approximation-based controller (AIT2FAC) was developed to control a three-phase grid-connected PV system. The proposed controller can be implemented without any prior knowledge of the system mathematical model. In the presence of both parametric and modeling uncertainty, the developed controller can achieve the control objectives. The proposed controller utilizes the principle of input-output feedback linearization and the approximation capability of fuzzy systems to the control inverter current components to track prescribed reference values. The proposed AIT2FAC controller is capable of handling system uncertainties due to the interval type-2 fuzzy logic system capability to cope with a high level of uncertainty. Lyapunov analysis is used to determine the closed-loop system stability and the updating laws of the proposed controller parameters. The effectiveness of the designed controller to achieve the required tracking is validated for different operating cases, including system disturbances, modelling, and parameter uncertainties. For evaluation, the proposed type-2 fuzzy controller is compared to a type-1 fuzzy controller in terms of some performance measures. The comparison results demonstrate that the proposed type-2 fuzzy controller has better tracking performance than the type-1 fuzzy controller in terms of the settling time, the maximum overshoot, the integral absolute error (IAE) and the integral time of absolute error (ITAE).

In recent years, the penetration of renewable power generations into the electrical grid has substantially increased. Continuous deployment of power electronic-based distributed generations and the reduction of traditional synchronous machines with their essential dynamics in modern power networks are very critical in this change. The use of power electronic inverters leads to the dissociation of sources and loads and lowering the power system inertia. Under power imbalance, this drop causes an elevated rate of change in frequency and frequency divergences, which has a notable impact on the system’s frequency stability. As a result, enhanced control techniques for grid-tied electronic converters are required to secure the power system’s stability and support. The virtual-synchronous generator (VSG) control is used to mimic the dynamics of a rotating synchronous generator and improve the power system’s stability. In this article, the problems of such low-inertia power systems, as well as the VSG technologies, are explored. This research also looks at different control orders and strategies for virtual-synchronous generators (VSG). In addition, the utilization of energy storage and critical matters in VSG and further research recommendations are explained.

Background Neonatal admission hypothermia (HT) is a frequently encountered problem in neonatal intensive care units (NICUs) and it has been linked to a higher risk of mortality and morbidity. However, there is a disparity in data in the existing literature regarding the prevalence and outcomes associated with HT in very low birth weight (VLBW) infants. This review aimed to provide further summary and analyses of the association between HT and adverse clinical outcomes in VLBW infants. Methods In July 2020, we conducted this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic database search was conducted in MEDLINE (PubMed), Google Scholar, ScienceDirect, World Health Organization Virtual Health Library, Cochrane Library databases, and System for Information on Grey Literature in Europe (SIGLE). We included studies that assessed the prevalence of HT and/or the association between HT and any adverse outcomes in VLBW infants. We calculated the pooled prevalence and Odds Ratio (OR) estimates with the corresponding 95% Confidence Interval (CI) using the Comprehensive meta-analysis software version 3.3 (Biostat, Engle-wood, NJ, USA; http://www.Meta-Analysis.com). Results Eighteen studies that fulfilled the eligibility criteria were meta-analyzed. The pooled prevalence of HT among VLBW infants was 48.3% (95% CI, 42.0–54.7%). HT in VLBW infants was significantly associated with mortality (OR = 1.89; 1.72–2.09), intra-ventricular hemorrhage (OR = 1.86; 1.09–3.14), bronchopulmonary dysplasia (OR = 1.28; 1.16–1.40), neonatal sepsis (OR = 1.47; 1.09–2.49), and retinopathy of prematurity (OR = 1.45; 1.28–1.72). Conclusion Neonatal HT rate is high in VLBW infants and it is a risk factor for mortality and morbidity in VLBW infants. This review provides a comprehensive view of the prevalence and outcomes of HT in VLBW infants.

Carbonic anhydrases (CAs and EC 4.2.1.1) are the Zn2+ containing enzymes which catalyze the reversible hydration of CO2 to carbonate and proton. If they are not functioning properly, it would lead towards many diseases including tumor. Synthesis of hydrazide-sulfonamide hybrids (19-36) was carried out by the reaction of aryl (10-11) and acyl (12-13) hydrazides with substituted sulfonyl chloride (14-18). Final product formation was confirmed by FT-IR, NMR, and EI-MS. Density functional theory (DFT) calculations were performed on all the synthesized compounds to get the ground-state geometries and compute NMR properties. NMR computations were in excellent agreement with the experimental NMR data. All the synthesized hydrazide-sulfonamide hybrids were in vitro evaluated against CA II, CA IX, and CA XII isozymes for their carbonic anhydrase inhibition activities. Among the entire series, only compounds 22, 32, and 36 were highly selective inhibitors of hCA IX and did not inhibit hCA XII. To investigate the binding affinity of these compounds, molecular docking studies of compounds 32 and 36 were carried out against both hCA IX and hCA XII. By using BioSolveIT’s SeeSAR software, further studies to provide visual clues to binding affinity indicate that the structural elements that are responsible for this were also studied. The binding of these compounds with hCA IX was highly favorable (as expected) and in agreement with the experimental data.

Three-phase grid-connected photovoltaic (PV) systems are most dominant in power system distribution applications. The LC filters are commonly employed in the PV grid-connected inverters. This paper presents a new adaptive fuzzy control for an inverter connected to the grid through an LC filter. The proposed controller exploits the concept of input-output feedback linearization and the approximation capability of fuzzy systems. The control objective is to control the inverter current components to prescribed reference values. The closed-loop system stability and the updating laws of the controller parameters are determined via Lyapunov analysis. Finally, the proposed controller is simulated, and results are presented to validate the effectiveness of the designed controller under different system disturbance and parameter uncertainties.

Three-phase inverters are widely used in grid-connected renewable energy systems. This paper presents a new control methodology for grid-connected inverters using an adaptive fuzzy control (AFC) technique. The implementation of the proposed controller does not need prior knowledge of the system mathematical model. The capabilities of the fuzzy system in approximating the nonlinear functions of the grid-connected inverter system are exploited to design the controller. The proposed controller is capable to achieve the control objectives in the presence of both parametric and modelling uncertainties. The control objectives are to regulate the grid power factor and the dc output voltage of the photovoltaic systems. The closed-loop system stability and the updating laws of the controller parameters are determined via Lyapunov analysis. The proposed controller is simulated under different system disturbances, parameters, and modelling uncertainties to validate the effectiveness of the designed controller. For evaluation, the proposed controller is compared with conventional proportional-integral (PI) controller and Takagi–Sugeno–Kang-type probabilistic fuzzy neural network controller (TSKPFNN). The results demonstrated that the proposed AFC showed better performance in terms of response and reduced fluctuations compared to conventional PI controllers and TSKPFNN controllers.

This study aims to describe etiological agents, demographic details of patients, seasonality and underlying conditions among patients hospitalized due to viral severe acute respiratory infection (SARI) in Yemen. We carried out a retrospective descriptive analysis of data from January 2014 to December 2015. Nasopharyngeal swabs were taken from each patient for laboratory testing. A total of 1346 diagnostic specimens were tested, of which 733 (54%) were positive for influenza viruses. Influenza A(H3) and A(H1N1) pdm09 predominated. Respiratory syncytial virus (RSV) was reported predominantly among children (41%). Males (61%) were more affected than females. The median age was 1 year (range 0.5-94.0). The median length of hospitalization was 6 days. Chronic cardiovascular disease was the most commonly reported underlying condition, but 67% had no documented underlying disease. Respiratory viruses, particularly RSV, adenovirus and influenza, were commonly associated with hospitalization for SARI.خصائص العلاج بالمستشفيات المرتبط بالإلتهابات التنفسية الحادة الوخيمة في اليمن، 2014-2015.أحمد علي قايد ثابت، عبد الحكيم الكحلاني، أحمد فرح شادوول، علي المحاقري، مريم بن يحيى، عبده حمود صالح، لينا الأديمي، واثق خان، مامونور مالك.توضح هذه الدراسة العوامل السببية، والتفاصيل السكانية للمرضى، والموسمية، والحالات الأساسية لدى المرضى المدخَلن إلى المستشفيات بسبب التهابات فيروسية تنفسية حادة وخيمة في اليمن. فقد أجرينا تحليلاً وصفياً استعادياً للبيانات المتعلقة بالأمراض التنفسية الحادة الوخيمة من يناير/كانون الثاني 2014 إلى ديسمبر/كانون الأول. أُخذت مسحات أنفية بلعومية من كل مريض من أجل الفحص المختبري. وتم فحص ما مجموعه 1346 عينة تشخيصية، كان منها 733 (%54) عينة إيجابية لفيروسات الإنفلونزا، تتصدرها الإنفلونزا A(H3N2) (5%) و (3%). A(H1N1)dpdm09 ولقد أبلغ أن الفيروس المخلوي التنفي هو الغالب لدى الأطفال (%41). وكان الذكور (% 16 ) أكثر إصابة من الإناث. وكان متوسط العمر سنة واحدة (يراوح ما بن 0.5 و 9.4 ). وكان متوسط مدة الاستشفاء 6 أيام. وكانت الأمراض القلبية الوعائية المزمنة أكثر الحالات المذكورة شيوعاً؛ ولم يكن لدى % 67 منهم أمراض دفينة موثقة. وكانت الفيروسات التنفسية – لاسيَّما الفيروس المخلوي التنفي والفيروسة الغدَّائية وفيروس الإنفلونزا – مرافقة عادة مع دخول المستشفى بسبب مرض تنفي حاد وخيم.Yémen : caractéristiques des cas d’hospitalisation associés aux infections respiratoires aiguës sévères, 2014-2015.Cette étude présente les agents étiologiques, les données démographiques des patients, la saisonnalité et les pathologies sous-jacentes chez des patients hospitalisés en raison d’infections respiratoires aiguës sévères (IRAS) au Yémen. Nous avons réalisé une analyse descriptive rétrospective des données portant sur les IRAS et couvrant la période de janvier 2014 à décembre 2015. Des sécrétions rhinopharyngées ont été prélevées par écouvillonnage pour chaque patient afin d’être testées en laboratoire. Un total de 1 346 échantillons diagnostiques ont été testés, parmi lesquels 733 (54 %) se sont avérés positifs aux virus de la grippe. Les virus de la grippe A(H3N2) (5 %) et A(H1N1)pdm09 (3 %) étaient prédominants. Le virus respiratoire syncytial (VRS) a été observé principalement chez les enfants (41 %). Les sujets de sexe masculin étaient plus touchés (61 %) que les sujets de sexe féminin. L’âge médian était d'un an (intervalle : 0,5-94). La durée médiane d’hospitalisation était de 6 jours. Les maladies cardio-vasculaires chroniques constituaient la pathologie la plus fréquemment rapportée ; 67 % ne présentaient aucune pathologie sous-jacente établie. Les cas d’hospitalisation étaient généralement associés à des virus respiratoires, en particulier au VRS, documentée. Les d'hospitalisation étaient généralement.

Modeling and simulation are important parts in analysis and design of electrical circuits. Nowadays, with the revolution in energy and penetration of renewable energy resources to the power grid, the power converters play vital role in power systems. The mathematical models of these converters are nonlinear due to switching behavior. In this paper, we consider controller design for boost converters. The DC-DC boost converter is modeled using small signal analysis where the duty cycle and the voltage are the control and output variables respectively. A controller for the linearized model of the boost converter is designed to achieve constant DC output voltage irrespective of load variation. The transfer function of the converter is derived and employed to design a PI controller using the root locus technique. The quality of the designed controller is tested in the MATLAB/SIMULINK environment. Simulation results of the closed-loop system are obtained for source and load disturbances. To validate the proposed control methodology, the designed controller is tested on the actual nonlinear converter using SIMULINK. The simulation results show accepted performance of the converter in the presence of disturbance.

After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

Five major disasters in Pakistan affected close to 8 million people from 2005 to 2009. The 2008-09 humanitarian crisis in Khyber Pakhtunkhwa and the Federally Administered Tribal Areas (FATA) of Pakistan resulted in 2.76 million internally displaced persons (IDPs), of whom 88% were off-camp IDPs hosted by the local population. The service delivery challenges posed by the IDPs, their sparse geographical distribution and phased displacement were managed through a successful health response strategy, which focused on 13 major interventions supplemented by a set of standard guidelines for field implementation. This study evaluates the process and results attained by this coordinated health cluster strategy that has guided the mobilization and implementation of a colossal humanitarian response to an unprecedented crisis in Pakistan's history.

The UN Secretary-General constituted a high-level panel on system-wide coherence in 2005 within the areas of development, humanitarian assistance and the environment. The panel adopted "Delivering as One" as a slogan for its coherence initiative. Pakistan was among eight pilot countries implementing this reform initiative. Five joint programmes were developed, on health and population; agriculture, rural development and poverty reduction; disaster risk management; education; and environment. Fourteen UN agencies supported the health and population joint programme and participatd aripe in its implementation. Although confronted by many challenges, the positive results of the joint programmes confirmed the advantage of Delivering as One over the past scenarios of fragmentation, duplication and incoherent government and UN strategic operations. The paper shares the accomplishments of the health and population sector including its ability to harness the power of intersectoral collaboration and prospectively concentrate human and financial resources around the strategic national priorities.

Of the 10 million annual deaths of children below five years of age four million are neonates. Pakistans neonatal mortality rate of 54/1000 live births which accounts for 57% of the under-five mortality the contraceptive prevalence rate stagnating at 30% the meagre number of deliveries assisted by skilled birth attendants (39%) and the low coverage of cost-effective child survival interventions hamper the achievement of Millennium Development Goals (MDGs) 4 and 5. The Government launched the national maternal neonatal and child health programme in 2007 to promote access to evidence-based cost-effective interventions; strengthen district health system capacities; empower communities; expand the community midwives cadre; and promote utilization of essential services. This paper reviews the implementation of the programme and the likelihood of attaining the MDG4 and 5 targets by 2015 and provides strategic directions for scaling-up programme implementation.

Of the 10 million annual deaths of children below five years of age, four million are neonates. Pakistan's neonatal mortality rate of 54/1000 live births, which accounts for 57% of the under-five mortality, the contraceptive prevalence rate stagnating at 30%, the meagre number of deliveries assisted by skilled birth attendants (39%) and the low coverage of cost-effective child survival interventions hamper the achievement of Millennium Development Goals (MDGs) 4 and 5. The Government launched the national maternal, neonatal and child health programme in 2007 to promote access to evidence-based cost-effective interventions; strengthen district health system capacities; empower communities; expand the community midwives' cadre; and promote utilization of essential services. This paper reviews the implementation of the programme and the likelihood of attaining the MDG4 and 5 targets by 2015, and provides strategic directions for scaling-up programme implementation.

The UN Secretary-General constituted a high-level panel on system-wide coherence in 2005 within the areas of development, humanitarian assistance and the environment. The panel adopted "Delivering as One" as a slogan for its coherence initiative. Pakistan was among eight pilot countries implementing this reform initiative. Five joint programmes were developed, on health and population; agriculture, rural development and poverty reduction; disaster risk management; education; and environment. Fourteen UN agencies supported the health and population joint programme and participatd aripe in its implementation. Although confronted by many challenges, the positive results of the joint programmes confirmed the advantage of Delivering as One over the past scenarios of fragmentation, duplication and incoherent government and UN strategic operations. The paper shares the accomplishments of the health and population sector including its ability to harness the power of intersectoral collaboration and prospectively concentrate human and financial resources around the strategic national priorities.

Background The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences. Methods This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression. Results Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety. Conclusion The relationship between women's post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.

OBJECTIVES: To determine the extent to which families follow referral and follow-up recommendations given in accordance with the Integrated Management of Childhood Illnesses (IMCI) strategy and the factors that influence families' responses to such recommendations. METHODS: Children aged 2 months-5 years who presented to an IMCI-trained health worker in Massalamia Health Area, Sudan, were recruited. Children with an IMCI classification that indicated the need for referral or follow-up were traced to determine whether the family complied with the referral or follow-up recommendation. Caretakers were interviewed to find out why they had or had not complied. Focus group discussions were held with health workers, caretakers, and community members. FINDINGS: Overall, 5745 children were enrolled. Of these, 162 (3%) were considered to be in need of urgent referral: 53 (33%) attended a hospital on the day of the referral, with a further 37 (23%) visiting the hospital later than the day of referral. About half of families cited cost as the reason for not visiting a hospital. A total of 1197 (21%) children were classified as needing follow-up. Compliance with a follow-up recommendation was 44% (529 children). Almost 165 (90%) of caretakers who were aware of and did not comply with follow-up, said they had not done so because the child was better. Compliance increased with the caretaker's level of education, if drugs were provided during the first visit, and if the follow-up period was short (2 or 5 days). CONCLUSION: In Massalamia--a resource-constrained environment in which IMCI implementation was well received by the community--only about half of children judged to be in need of urgent referral were taken for that care within 24 hours. Most children in need of follow-up received their first treatment dose in the health facility. This aspect of IMCI was commented upon favourably by caretakers, and it may encourage them to return for follow-up. Rates of return might also improve if return visits for children currently asked to return after 14 or 30 days were scheduled earlier.