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Objective: The present study was aimed to compare best-corrected vision and central macular thickness for macular edema in diabetes (DME) after utilizing laser, Avastin, and Lucentis. Methods: A retrospective randomized cross-sectional study was conducted at Alfaisal Eye Center, Khartoum. Best-corrected vision and central macular thickness (CMT) were assessed by Snellen's chart and Heidelberg optical coherence tomography OCT, respectively. Results: In this study, a total of 252 records of DME-treated patients with laser applications, Avastin, and Lucentis were enrolled, their mean age was 57 ± 5.22 yrs. A significant enhancement in best-corrected vision and CMT of studied groups with laser applications, Avastin, and Lucentis was obtained (P= 0.000) with no differences between treated groups (p= 0.445 and 0,479), respectively. Non-significant differences in variable measurements related to gender or age (p = 0.117, 0.781), respectively. CMT of females (260 ± 48 μm) was thinner than males (306 ± 74 μm) after treatment (P = 0.000). Conclusion: laser applications, Avastin, and Lucentis improved best-corrected vision and reduced central macular thickness significantly with no clear differences between studied groups. Age or gender have a non-significant impact on dependent variables. Females gained thinner results compared to males after treatment.

Purpose: To see the effect of Ranibizumab at 1-monthly and 2-monthly intervals on visual acuity and central macula thickness among patients with diabetic macular edema, neovascular age-related macular degeneration and diabetic retinopathy. Study Design: Retrospective review of clinical record. Place and Duration of Study: The present study was conducted at four eye centers (Al-Shami Eye Center, Sudan Eye Center, Makkah Eye Complex and Nor-Aloyon Eye Hospital) located at Khartoum state of Sudan from January 2021 and June 2021. Methods: A total of 109 records of patients with diabetic retinopathy, age related macular degeneration and macular edema were included. They were categorized into 4 groups; group A (wet age-related macular edema (WAMD, n = 16)), group B (macular edema (ME, n = 32)), group C (proliferative diabetic retinopathy (PDR, n = 31)), and group D (non-proliferative diabetic retinopathy and macular edema (NPDR + ME, n = 30)). All participants underwent full ophthalmic examination before the injection, at one month and two months after the injection. Means, standard deviations and frequencies were calculated. ANOVA was used to find any significant difference between the study groups and the impact of treatment. Results: Mean age of patients was 57.73 ± 10.44 years. There was significant improvement in terms of mean visual acuity from baseline to third follow up in all study groups, (F (1, 105) = 14.94, P < 0.001), with no significant differences in this improvement between the study groups, F (1.83, 5.48) =14.6, P = 0.19. Conclusion: Use of Lucentis has demonstrated a statistically significant reduction in CMT and improvement in BCVA. However, none of the patients showed a complete resolution of edema at the end of last follow up.

Background: Organophosphate (OP) compounds are agrochemical agents that have been frequently misused for deliberate self-harm in the world; the majority of the three million pesticides related poisonings worldwide are due to OP compounds. Early identification followed by effective management in the initial stages increases the rate of survival among patients with (OP) poisoning. Aim of the study: to assess nurses' performance (knowledge, practice and attitude) for patient with acute organophosphate poisoning. Research Design: A descriptive exploratory design was utilized. Method: A convenience sample of all available nurses (50 nurses) working in four units surgical ICU, Emergency unit, poisoning ICU, and poisoning unit in Tanta university hospital. Tools three tools used in the current study: self-administrated questionnaire, observational checklist, and nurses' attitude Likert scale. Results: 70% of studied nurses had unsatisfactory level of knowledge and 54% had incompetent practice regarding care of patient with acute organophosphate poisoning. 84% of nurses have negative attitude regarding care of patient with acute organophosphate poisoning. Conclusion: based on the results of the current study there was statistically significant correlation between the nurses' knowledge, practice and attitude regarding care of patients with acute organophosphate poisoning Recommendation: Designing teaching program for nurses to improve nurses' knowledge, practice and attitude for care of patient with acute organophosphate poisoning. Developing simplified and comprehensive booklet including basic information about organophosphate poisoning.

PV cell/module/characteristic array accuracy is mainly influenced by their circuit elements, based on established circuit characteristics, under varied radiation and temperature operating conditions. As a result, this study provides a modified accessible Honey Badger algorithm (HBA) to identify the trustworthy parameters of diode models for various PV cells and modules. This approach relies on modifying the 2D chaotic Henon map settings to improve HBA’s searching ability. A series of experiments are done utilizing the RTC France cell and SLP080 solar module datasets for the single and double-diode models to validate the performance of the presented technique. It is also compared to other state-of-the-art methods. Furthermore, a variety of statistical and non-parametric tests are used. The findings reveal that the suggested method outperforms competing strategies regarding accuracy, consistency, and convergence rate. Moreover, the primary outcomes clarify the superiority of the proposed modified optimizer in determining accurate parameters that provide a high matching between the estimated and the measured datasets.

Background: Crowding can be defined as the impaired recognition of closely spaced objects. Changing colour and lighting enhance visual comfort and perceptual troubles that influence impaired vision reading. Objective: The current study was aimed to investigate the impact of changing the flanker distance and unflanked targets with colours on central crowding reading for subjects with their distant best correction (BCVA) equal to or greater than 6/6. Methodology: Six native English speakers (age: 18–38) who participated in a cross-section intervention study were asked to identify the orientation of the letter E (flanked or unflanked) in different directions around the central target in different colours (red, green, blue and black) on a white background. Results: Different colours affect central crowding (p 0.05). Conclusion: Central reading crowding is visual crowding. Different colours affect central crowding. However, the central crowding reading in red was not affected by changes in flankers.

BACKGROUND: Sheard and Percival assumed that symptoms from latent strabismus can be avoided if the relevant fusional vergence is adequate to support the heterophoria. AIM: The aim of the study was to determine the sensitivity and specificity of Sheard’s and Percival’s criterion for the diagnosis of heterophoria. METHODS: A cross-sectional hospital-based study was performed at Al-Neelain Eye Hospital Khartoum, Sudan from February to October 2019. Heterophoria was measured using Maddox Wing and fusional vergence using a prism bar. Thereafter, Sheard’s and Percival’s criteria were used for the diagnosis of heterophoria. RESULTS: A total of 230 participants (age = 15–30 years; mean age = 19.34 ± 3.325 years) were recruited for this study. The Sheard’s criteria showed a high sensitivity of 87.2% and a low specificity of 8.0% for the diagnosing of exophoria, with positive and negative predictive values of 65.5% and 26%, respectively. The criteria showed a relatively low sensitivity of 77.8% and a specificity of 9.0% in the diagnosis of esophoria, with a positive and negative predictive values of 56% and 20%, respectively. Percival criteria showed high sensitivity 84.2% and low specificity 9.1% in diagnosing esophoria, with a positive and negative predictive value of 61.5% and 25%, respectively. On the other hand, the criteria showed low sensitivity 67.4% and specificity 13.8% in diagnosing exophoria, with positive and negative predictive value 61.9% and 17%, respectively. CONCLUSION: Sheard’s and Percival’s criteria are useful in diagnosing binocular vision problems. Sheard’s criteria are accurate in diagnosing near exophoria and Percival’s criteria are more accurate in diagnosing near esophoria. Therefore, these criteria provide good clues and predictions for the diagnosis of binocular vision problems.

The difference in the developmental impact of planning decisions from one city to another is an important matter for study and investigation, as planning differs in terms of quality and quantity from one city to another. Each planning decision has a positive impact on one sector of the city and negatively on other sectors, which makes the maximum utilization of the available resources not practically easy, Maximum utilization of resources needs controlling indicators to strike a balance between the various development sectors in the city. The research assumes the reason for this difference is the existence of a dynamic internal system for each city that works on its own to balance some indicators within the city until it is in a mature position. This system depends on multiple factors (social - economic - urban - ...) And because the factors are unique to each city, therefore, the planning decision has different returns from one city to another due to the difference affecting it, and it is important to understand the internal system of the city’s work to be a tool to support the planning decisions with its results for the continuity of development and reaching maturity. When tracking the factors of city growth, we find that they are many, intertwined and variable, so the factors of growth of the city from the Middle Ages differ from the eras of the Renaissance and the Industrial Revolution, and therefore it is difficult to consider one of the factors as important than the other, so to determine the importance of each factor, the research resorted to extracting features and indicators of maturity through the experiences of International cities. And the setting of weights for the features and indicators by means of recurring statistics in each experiment, establishing a reciprocal relationship between the features and indicators, and extracting the relative importance of each indicator. The research concluded with the most important results, the most important of which are that social indicators are the leaders in the urban maturity process, and the morphological indicators have a strong influence on the internal system of city growth and its reaching urban maturity. يعد اختلاف المردود التنموى للقرارات التخطيطية من مدينة لأخرى أمرا هاما للدراسة والاستقصاء، حيث أن القرار التخطيطى تختلف فى مردوده کما ونوعا من مدينة لأخرى، فلکل قرار تخطيطى تداعيات إيجابية على أحد قطاعات المدينة وسلبية على قطاعات أخرى ما يجعل من تحقيق الاستفادة القصوى من الموارد المتاحة ليس باليسير عمليا، فتحتاج الاستفادة من الوفورات إلى مؤشرات ضابطة لاحداث اتزان بين القطاعات التنموية المختلفة بالمدينة. ويفترض البحث السبب فى هذا الاختلاف الى وجود نظام ديناميکى داخلى لکل مدينة يعمل ذاتيا على اتزان بعض المؤشرات داخل المدينة حتى تکون فى وضعية ناضجة، يعتمد هذا النظام على عوامل متعددة (اجتماعية – اقتصادية – عمرانية-..)، ولأن العوامل صفة فريدة لکل مدينة فالتالى فإن القرار التخطيطى مردوده مختلف من مدينة لأخرى نتيجة لإختلاف المؤثر فيه، ومن المهم فهم النظام الداخلى لعمل المدينة ليکون أداة لتدعيم القرارات التخطيطية بنتائجه لإستمرارية التنمية والوصول للنضج. وعند تتبع عوامل نمو المدينة نجدها کثيرة ومتداخلة ومتغيرة، فتختلف عوامل نمو المدينة من العصور الوسطى عن عصور النهضة والثورة الصناعية، وبالثالى فإنه من الصعب اعتبار أحد العوامل ذا أهمية عن الاخر، فلتحديد أهمية کل عامل لجأ البحث إلى استخلاص سمات ومؤشرات النضج من خلال تجارب مدن عالمية، ووضع الاوزان الخاصة بالسمات والمؤشرات عن طريق الاحصاء التکرارى فى کل تجربة، ووضع علاقة تبادلية بين السمات والمؤشرات واستخلاص الاهمية النسبية لکل مؤشر. وقد خلص البحث لنتائج أهمها أن المؤشرات الاجتماعية هى القائدة فى عملية نضج المدن، کما أن المؤشرات المورفولوجية شديدة التأثير على النظام الداخلى لنمو المدينة ووصولها للنضج العمرانى.

Background: Displaced intra-articular calcaneus fractures are still now a controversial topic among orthopedic surgeons. There is no single treatment option to manage all different fractures. Objective: The aim of this study was the assessment and evaluation of providing and maintaining stable fixation by the use of a T-shaped plate for displaced intra-articular calcaneal fractures. Patients and Methods: A randomized controlled study was conducted on18 patients were conducted between the ages of 18 to 50 years in the Orthopedic and Traumatology Department of Zagazig University Hospital from August 2020 to April 2021 including 6 months follow-up periods, all patients with closed D.I.A.C.F with no morbidity. T plates were the method of fixation for all patients. Results:Mean A.O.F.A.S. hindfoot scale result was 86.61, 88.8% of patients their results were satisfying (excellent and good), and 11.1% of patients their results were unsatisfying (fair). Complications were seen in 27.7% (wound complication, subtalar arthritis, symptomatic hardware, and delayed union). Conclusion: T-shaped plates can provide stable support and rigid fixation as they maintain proper reduction and alignment to displaced intra-articular calcaneus fractures.

BACKGROUND: Reading can be described as a complex cognitive process of decrypting signs to create meaning. Eventually, it is a way of language achievement, communication, and sharing of information and ideas. Changing lighting and color are known to improve visual comfort and the perceptual difficulties that affect reading for those with poor vision. AIM: The main objectives of the current study were to investigate the effect of changing the wavelengths and color with different levels of positional noise on reading performance with non-word for subjects with best-corrected distant visual acuity (BCVA) equal or better than 6/6. METHODOLOGY: In a cross-section interventional study, 20 English speakers were asked to read non-words presented in a printed format. The stimuli were black print words in a horizontal arrangement on a matte white card. They were degraded using positional noise produced by random vertical displacements of the letter position below or above the horizontal line on three levels. RESULTS: Introducing positional noise affected real and non-words recognition differently. The detrimental effects of positional noise with non-words on reading rate were not influenced by changes in wavelengths and color. The long-wavelength reading rate resulted in the lowest performance compared with other wavelengths with all levels of noise. CONCLUSION: Reading performance is affected by changes in the levels of positional noise. However, the reading rate is not affected by changes in wavelength and color with non-words. The long-wavelength reading rate resulted in the lowest performance compared with other wavelengths and color with all levels of noise.

Rapid technological developments in the field of production and quality control influenced the nature and requirements of quantitative production, which led to the emergence of various industrial products, as the development of the concept of markets to turn from local markets to markets is high competition where each productive enterprise tries to impose its dominance on the market by obtaining the largest percentages of sales possible, which made these institutions seek to find competitive advantages for their products through competition in quality, price or services, which led to the emergence of methodologies regulating the process Design and production to get the highest possible quality at the lowest cost, and one of the methodologies that achieved a remarkable distinction in this framework is the methodology Of Six-Sigma, a set of mechanisms applied to each element or stage of design and production to reach or approach the point (zero) defects, which made it important to research the mechanism of application of this methodology in the institutions concerned with the production of metal furniture to improve the quality of products. Statement of the problem:There is a lack of application of standard specifications during the production stages, which limits the level of quality required compared to some competitors. - Many industrial enterprises specialized in the production of metal furniture use traditional methods such as random research and virtual inspection of the product and the lack of proper testing, which leads to increased missing persons and the owners and rejects of the product and thus increase the total cost. - Changes and deviations from the appropriate specifications of the user of the metal furniture product, which negatively affects the reputation of the product in the market. Objective: The research aims to improve the quality of metal furniture products (administrative furniture) using the methodology Sigma Six by addressing the phased treatment of defects and problems and adjusting specifications and avoiding defects resulting during production and trying to prevent mistakes during design and industry. Methodology: Research follows the introspection approach. Results :The researcher concluded that when applying the Six Sigma methodology in the institutions producing metal furniture administrative will lead to:Arrange production processes and avoid overproduction by manufacturing by supply order according to the needs and desire of the customer, while reducing the production of the half-factory in addition to following the performance of equipment and production lines and the speed of repair of malfunctions. Reducing inventory without demand and avoiding excess inventory in addition to proper storage to minimize defects.Reducing the percentage of defects, errors, missing and fatigue from the product in the industrial institutions specialized in the metal furniture product to the least possible.Improving product quality and approaching zero defect ratios, in addition to reducing waste ratios to as little as possible, which increases its competitiveness in the global markets. Not to allow the existence of a process based on the standards of acceptance or rejection of discretion, but, it must contain visual specifications that help to judge correctly, the design process is based on marketing research or technical specifications by the client, and the operations are based on orders and follow-up supposing from the production and quality departments of the factory. Industrial enterprises are aware of the importance of six Sigma methodology applied to the field of administrative metal furniture. Recognizing that the characteristics of the furniture product are the responsibility of everyone in the industrial enterprises producing it.

Background: Type 2 diabetes mellitus (DM) is the most common cause of end- stage renal disease. Albuminuria is the foremost commonly utilized marker to anticipate onset of diabetic nephropathy (DN) without sufficient affectability and specificity to identify early DN. Aim: This study aimed to evaluate plasma α-Klotho as a new biomarker for chronic diabetic nephropathy. Methods: This cross sectional study included 125 Egyptian subjects attending the out Patients Clinic of the Department of Internal Medicine, 10Th of Ramadan city Health Insurance Hospital and divided into:-control group, patient with diabetic mellitus, patients with Diabetic nephropathy and patient with diabetic nephropathy and other complications. Patients were subjected to measurement of plasma α- Klotho, FBS, HbAIC, serum creatinine, serum urea, serum uric acid, k, Na, serum phosphorus, Albumin: Creatinine Ratio, GFR, Chol, TG, LDL HDL, AST, ALT, T.BIL, D.BIL ALB, TP, GLB and A/G ratio. Results: Results showed that plasma a-klotho was significantly correlated with hemoglobin A1C, potassium, GFR, Albumin, TP and GLB. Meanwhile, plasma a- klotho was negatively correlated with duration of DM, CR, Urea, UR.A, Na, phosphorus, ACR, Chol, TG, LDL, AST, ALT, T.BIL, and D.BIL. However, there were no significant correlations between plasma α -klotho and FBS, HDL and A/G ratio. At cut-off level ≥2.6, plasma α -klotho had 95% sensitivity and 81% specificity for diagnosing diabetic nephropathy. Conclusion: α-klotho may be the chronic diabetic nephropathy markers for predicting renal injury in patients with type 2 diabetes.

Background: Type 2 diabetes mellitus (DM) is the most common cause of end- stage renal disease. Albuminuria is the foremost commonly utilized marker to anticipate onset of diabetic nephropathy (DN) without sufficient affectability and specificity to identify early DN. Aim: This study aimed to evaluate Plasma cyclophilin A (CypA) as a new biomarker for early DN. Methods: This cross sectional study included 125 Egyptian subjects attending the out Patients Clinic of the Department of Internal Medicine, 10Th of Ramadan city Health Insurance Hospital and divided into-:control group, patient with diabetic mellitus, patients with Diabetic nephropathy and patient with diabetic nephropathy and other complications. Patients were subjected to measurement of plasma cyclophyline A, FBS, HbAIC, serum creatinine, serum urea, serum uric acid, k, Na, serum phosphorus, Albumin:Creatinine Ratio, GFR, Chol, TG, LDL HDL, AST, ALT, T.BIL, D.BIL ALB, TP, GLB and A/G ratio. Results: Results showed that Cyclophilin A was significantly correlated with duration of DM, CR, Urea, UR.A, Na, phosphorus, ACR, Chol, TG, LDL, AST, ALT, T.BIL, D.BIL. Meanwhile, Cyclophilin A was negatively correlated with HA1C, K, GFR, HDL, ALB, TP, GLB and A/G ratio. At cut-off level ≥84.14, cyclophilin A had 91% sensitivity and 62% specificity for diagnosing diabetic nephropathy. Conclusion: CypA can be used as an early marker for DN as we found early significant high levels of urinary CypA in diabetic patients with stage 2 DN even before the appearance of albuminuria.

Background Newborn infants have an increased sensitivity to pain and are more reactive to pain than older children and adults. Nurses play a crucial role in assessing pain, implementing and evaluating interventions to minimize neonatal pain using available resources especially nonpharmacologic techniques. Aim of the study to develop and apply an educational program on pediatric nurses regarding selected nonpharmacologic techniques to relieve pain in neonates. Research design A pre/post quasi-experimental research design was utilized in the present study. The study was carried out at Minia University for Obstetric and Pediatric and General Hospitals at neonatal care units. A convenient sample of 41 nurses was included in this study. Educational program for nurses was done through using the following data collection tools 1) Pre-designed questionnaire sheet, 2) Observation checklists sheet and 3) Educational and training program. Results It was revealed that there was an obvious increase in the total mean scores of knowledge and practice in post and follow up program phase compared with pretest phase, with a very highly significant difference (p Conclusion The education program had a significant impact on pediatric nurses' knowledge and practices regarding selected nonpharmacologic techniques to relieve pain in neonates. Recommendations A continuous training and educational program should be planned and offered on regular basis for nurses regarding nonpharmacologic techniques to relieve pain in neonates.

Corona virus pandemic 2019 (COVID-19) lockdown has a negative psychological impact on Egyptian mothers of children with autism. As a result of social distancing, both mothers and Autism Spectrum Disorder (ASD) were not supported by face to face by care and not able to participate in external care and staying at home. Aim: The study was aimed to evaluate the effect of instructional guidelines on mothers’ anxiety regarding behavioral changes among children with autism during corona virus disease. Subjects and method: in this study quasi-experimental research design was used on a convenient sample composed of 130 mothers having children with autism residing at Sohag Governorate, Egypt. Five tools were used in this study: A self-administered questionnaire, the Adaptive Behaviour Assessment System, The ASD Behaviour Inventory, The Short Sensor and Beck Anxiety Inventory (BAI). The link of the survey using the questionnaire, the scale, and the instructional guidelines were sent to the participants' mothers through Facebook and Whats App groups. Results: The study showed an increase in repetitive and restricted behaviors among more than one-third of the participants. Mothers' anxiety level was severe before the implementation of the guideline and became low after guidelines implementation. Conclusion: The instructional guidelines were effective in reducing mothers’ anxiety regarding behavioral changes among children with autism during coronavirus pandemic outbreaks. Recommendations: Educational programs about the meanings of behavioral changes of their children, COVID -19 and its preventive measures should be taught to all mothers and psychological support is essential for them.

Purpose: To compare the corneal endothelial cells morphology and central corneal thickness (CCT) before and after phacoemulsification in Sudanese population. Place and Duration of Study: Al-Neelain eye hospital, Khartoum, Sudan, from January 2018 to May 2018. Study Design: Observational longitudinal study. Methods: One hundred and forty eyes of 140 patients with immature senile cataract were selected by convenient sampling. The age ranged from 40 to 85 years. The patients underwent complete ocular examination including morphology of corneal endothelial cells and CCT using computerized non-contact specular microscope. Inclusion criteria for the study was eyes with normal corneal endothelial cells and cell density more than 1000 cells/mm2. We excluded patients with ocular or systemic diseases, previous history of intraocular surgery, refractive surgery or trauma as well as contact lenses wear. The patients underwent phacoemulsification by a single surgeon. The examination parameters were repeated one month after surgery. Descriptive and comparative statistical analyses were performed using SPSS for Windows Version 21.0. Results: There was significant reduction in mean endothelial cells density after phacoemulsification compared to baseline with p < 0.001. There was also significant post-operative reduction in mean endothelial cells number as compared to baseline (P value < 0.001). Mean endothelial cells hexagonality was reduced after surgery with P value of 0.003. No significant difference was found between mean coefficient variation of endothelial cells size before and after phacoemulsification (P = 0.55). Central corneal thickness showed significant increase post-operatively, P = 0.003. Conclusion: Phacoemulsification causes significant damage to corneal endothelium cells, including decrease in corneal endothelial cell density, hexagonality and cell number. Key Words: Corneal endothelium, Endothelial cell density, Central corneal thickness, Phacoemulsification.

Purpose: To see the effect of binocular vision problems on childhood academic performance and to record the teacher's perspectives about childhood eye care in Khartoum State of Sudan. Place and Duration of Study: A descriptive cross-sectional study done among the school going children in the Khartoum State of Sudan during the year 2018. Study Design: Descriptive cross sectional study. Material and Methods: Three hundred and forty (340) primary school children’s were recruited for study by convenient sampling technique during the academic year 2018. After relevant history, ocular examination was performed. It included visual acuity measurement, assessment of refractive errors and binocular function tests. Academic performance of the children was recorded from academic records of the children. Finally, the qualitative data was derived from teachers’ perspectives about childhood eye care. Results: Mean age of the participants was 11.96 ± 1.63 years. The findings revealed that (78.6%) of children achieved poor academic performances with decompensated exophoria at near. 52.7% children with poor academic performances had weak positive fusion reserve at near P = 0.04. 37.2% of the poor performers had convergence insufficiency. Fort eight percent of females with ocular complaints achieved poor academic performances P = 0.034. With regard to teacher's perspectives about childhood eye care, 98.8%believed that the vision problems had effect on the academic record of the children. Seventy percent of the teachers reported that the students did not undergo eye examinations before joining school. Conclusion: Convergence Insufficiency and weak positive fusional reserve at near has a significant effect on academic performances.

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primipara women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

Background: Calculation of medication dosages can be the challenging for nursing students. Nurse educators are able to design and develop effective methods that consider the cognitive structures and how the mind processes information to teach pediatric medication content to nursing students. The aim of the study was to compare between two teaching strategies for pediatric drug dosage calculation among under graduating nursing students Research design: A quasi-experimental study research design. Sample: Ninety nursing students in the third academic year who were studying pediatric nursing course who divided into two groups: low fidelity simulation (group I, or the study group) and traditional classroom (group II, or the comparison group). Setting: In the faculty of nursing in the South Valley University conducted this study. The tool of data collection: This study used one tool consisted of two parts: part 1 socio-demographic questionnaire and part 2: pre-dosage calculation test and post-dosage calculation test. Results: Increase mean score of knowledge among nursing students who included in the low-fidelity simulation experience (Group I) (6.69 ± 3.08; 12.71 ± 2.74) pre and posttest respectively as well as increase mean score of knowledge of nursing students who included in the traditional classroom experience (Group II) (3.20 ± 1.75; 11.58 ± 2.02) pre and posttest respectively, there was highly statistical significant p < 0.000. Illustrate that more increase the mean score of performance among nursing students who included in the low-fidelity simulation experience (Group I) than another group 2.58 ± 2.08; 12.73 ± 2.67) pre and posttest respectively. Conclusion: Lack of knowledge of basic math principles before intervention with different teaching strategies but after intervention with different teaching strategies increase the score of knowledge among nursing students who included in the low-fidelity simulation experience (Group I) equals as the score of knowledge who included in the traditional classroom experience (Group II). While increase mean score of performing of nursing students who included in the low-fidelity simulation experience (Group I) better than who included in the traditional classroom experience (Group II) posttest. Recommendations: Replicate the study with a larger sample size of students within each demographic group. Conduct a longitudinal study to measure retention of skills. Research could be conducted to see if the actual rates of dosage calculation errors are decreased in the clinical setting.

Background: Umbilical Cord Milking (UCM) is a safe and likely technique for both the mothers and their neonates which improve the neonatal outcomes. The aim of the study was to assess the effects of umbilical cord milking on premature neonates' and mothers' outcomes.Methods: Design: Quasi-experimental research design was utilized. Setting: Emergency and Labor Unit of Women's Health University Hospital and Neonatal Intensive Care Unit (NICU) in Assiut University Children Hospital were the setting which the study was implemented. Subjects: It included 80 mothers and their premature neonates. The subjects were divided randomly into two groups (40 premature neonates who were received the UCM as a study group and 40 premature neonates as a control group who received the Immediate Cord Clamping [ICC]). Tool: One structured interview questionnaire was designed especially for this study. It included two parts: Personal and clinical data of the studied mothers and premature neonates.Results: The Hemoglobin (Hb) level significantly increased in the study group when compared to the control group within 6 hours of birth (12.11 vs. 10.61) and at 36-48 hours after UCM (12.27 vs. 11.32). Also, UCM had significantly improved the need for blood transfusion, death rate, and length of hospital stay among premature neonates in the study group.Conclusions and recommendations: UCM improved preterm neonates' outcomes as increasing Hb level, less need for blood transfusion, and decline incidence of death, lowers length of hospital stay. Recommendations: Increasing awareness of neonatology, pediatric, and obstetric nurses about benefits and technique of UCM through health education program.

Background: Understanding the clinical profile of keratoconus is important in the diagnosis and management of the disease. Aim: This study aimed to investigate the clinical characteristics of keratoconus patients in Sudan with respect to age and gender. Materials and Methods: Clinical records of keratoconus patients were retrospectively reviewed in a period between April and June 2015. Records were collected from Makkah Eye Complex, Alwaledain Eye Charity Hospital and Sudan Eye Center, Khartoum City. Parameters investigated included patient's demography, keratometric readings, visual acuity, and manifest refraction. Classification of keratoconus was based on Amsler-Krumeich grading system. Results: A total of 208 patients' record was found diagnosed with keratoconus. The mean age of subjects was 21.43 ± 8.91 years. Around 78% of subjects were found with bilateral keratoconus. Analysis showed that keratoconus is more common in males (55.8%) than in females (44.2%) and manifest in young age (late teenage and early 20s). Age was not correlated with disease severity (P > 0.05). No significant difference was found between both genders in term of age, visual acuities, and severity of keratoconus (P > 0.05). Conclusion: Clinical profile of Sudanese keratoconus patients looks similar to that reported earlier worldwide.

Background: Uncorrected refractive errors continue to remain a public health problem in the different population groups. Among children, it has a considerable impact on learning and academic achievement, especially in under-served communities. Optical correction of refractive errors in children is indicated when the refractive errors are sufficiently large to cause amblyopia or impairing the child's ability to function normally. Objective: The study aimed to investigate the distribution pattern of refractive errors and related visual impairment due to amblyopia in children. Materials and Methods: The recorded data of 183 children examined at optical center during the period (2007-2011) were reviewed and analyzed to show refractive status. The examination included visual acuity measurements, cover test, and noncycloplegic refraction (retinoscopy and/or autorefraction). The best-corrected visual acuity was noted. Results: The age range of children was 5-15 years, of whom 72 (39.3%) were males and 111 (60.7%) females. There was no significant difference in the correction of the two eyes and no gender associations. In this study, 97 (53.0%) were myopic, 17 (9.3%) hypermetropic, 42 (22.9%) pure astigmatic, and 27 (14.8%) normal. An adequate improvement of vision after correction in each eye reached 1.0 (6/6) achieved in 123 (67.2%) children ( P Conclusions: Significant refractive errors revealed among children aged 5-15 years. Therefore, there is a need to have eye examination in school-age children at least at the commencement of school so as to early tackle disabilities due to amblyopia in children.