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Symphorema polyandrum belongs to the Lamiaceae family and is locally known as Badichang or mahasindhu. In this study, we performed Soxhlet extraction to prepare methanolic and hydromethanolic extracts, followed by quantification of their total phenolic content and total flavonoid content. Qualitative analysis of both the extracts was conducted to determine the presence of different phytochemicals. In addition, we aimed to identify the important phytochemical constituents in the methanolic extracts of S. polyandrum (SPM) using ultra-performance liquid chromatography hyphenated with high-resolution mass spectrometry (UPLC-ESI-QTOF-MS E ). Furthermore, this study investigated the antioxidant, anticancer and anti-inflammatory properties of SPM and its safety profile in the normal fibroblast cell line L929. A colony proliferation assay and a Griess assay were performed to evaluate the effects of SPM on colony formation and nitric oxide (NO) production. A total of 13 important phytochemicals were identified and reported. The methanolic extract of SPM demonstrated significant antioxidant activity. SPM also showed substantial antiproliferative activity on MDA-MB-231 triple-negative breast cancer cells, with an IC 50 value of 45.53 ± 1.63 µg/ml, and also reduced the survival of these cancer cells by promoting nuclear fragmentation and condensation without causing harm to normal cells. SPM inhibits the colony formation and reduces the nitric oxide (NO) production. The anti-inflammatory potential of SPM was assessed utilizing the murine alveolar macrophages (J774.A.1) as an in vitro model, and SPM effectively lowered the levels of proinflammatory cytokines such as TNF-α and IL-6. These findings emphasized the antiproliferative potential of SPM to cancer cells, along with its anti-inflammatory, and antioxidant capabilities, indicating the therapeutic efficacy of this medicinal plant., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© King Abdulaziz City for Science and Technology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: To investigate the impact of a pre-emptive apnoea triggered oxygen response on oxygen saturation (SpO 2 ) targeting following central apnoea in preterm infants., Design: Interventional crossover study of a 12-hour period of automated oxygen control with an apnoea response (AR) module, nested within a crossover study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking 12-hour periods of manual control., Setting: Neonatal intensive care unit PATIENTS: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median (IQR) birth gestation 27 (26-28) weeks, postnatal age 17 (12-23) days., Intervention: Automated oxygen titration with an automated control algorithm modified to include an AR module. Alterations to inspired oxygen concentration (FiO 2 ) were actuated by a motorised blender. Desired SpO 2 range was 90-94%. Apnoea detection was by capsule pneumography., Main Outcome Measures: Duration, magnitude and area under the curve (AUC) of SpO 2 deviations following apnoea; frequency and duration of apnoeic events. Comparisons between periods of manual, automated and automated control with AR module., Results: In 60 studies in 35 infants, inclusion of the AR module significantly reduced AUC for SpO 2 deviations below baseline compared with both automated and manual control (manual: 87.1%±107.6% s, automated: 84.6%±102.8% s, AR module: 79.4%±102.7% s). However, there was a coincident increase in SpO 2 overshoot (AUC (SpO 2 >SpO 2(onset) ); manual: 44.3±99.9% s, automated: 54.7%±103.4% s, AR module: 65.7%±126.2% s)., Conclusion: Automated control with a pre-emptive apnoea-triggered FiO 2 boost resulted in a modest reduction in post-apnoea hypoxaemia, but was followed by a greater SpO 2 overshoot., Trial Registration Number: ACTRN12616000300471., Competing Interests: Competing interests: The University of Tasmania and Royal Hobart Hospital have jointly lodged a patent application concerning automated control of inspired oxygen concentration in the newborn infant. TJG and PAD are named inventors. The authors have no other conflicts of interest relevant to this article to disclose., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Declaration of Competing Interest No specific funding support was utilized to host this symposium. The authors have no conflicts of interest to disclose.

Importance: The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified., Objective: To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age., Design, Setting, and Participants: Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022., Interventions: Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment., Main Outcomes and Measures: The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years., Results: Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90])., Conclusions and Relevance: In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life., Trial Registration: anzctr.org.au Identifier: ACTRN12611000916943.

Ventricular dysfunction may be found in 40% of newborns with CDH, and is not only a predictor of disease severity, but also mortality and need for ECMO. We conducted this study to assess the utility of serial echocardiography in management of newborns with CDH and their survival outcomes. This is a retrospective study, wherein the demographic, clinical and echocardiographic data from our local CDH registry and hospital clinical database were analyzed to study the correlation of timed echocardiographic findings with mortality and other outcomes. Fourty-two newborns with CDH were admitted during the study period (M/F:19/23), with median gestation of 38 weeks (IQR:36-39) and birth weight of 2.83 kg (IQR 2.45-3.17). Thirty-one were left-sided, seven right, one central, and three bilateral hernias. Twelve infants (28%) died in early infancy. Three infants were excluded from analysis due to either palliation at birth or significant cardiac anomaly. A total of 137 echos from 39 infants were analyzed. Seventy percent of newborns who died and had an echo within the first 72 h, were noted to have suffered from moderate to severe PH. Birth weight < 2.8 kg, RVSP > 45.5 in the first 72 h and postoperative VIS > 23.5 and RSS > 4.3 were good predictors of mortality. Markers of elevated pulmonary pressures and cardiac function were useful in guiding therapy. Serial timed functional echocardiography (f-Echo) monitoring allows targeted therapy of patients with CDH. Birth weight, initial severity of pulmonary hypertension and postoperative RSS and VIS may be useful in predicting mortality., (© 2022. The Author(s).)

Rheumatic heart disease (RHD), a preventable complication of group A beta-haemolytic streptococcal infection, is highly prevalent in Sudan. Echocardiographic (echo) screening has an established role in disease surveillance. This study aims to measure the echo prevalence of RHD using handheld echo (HHE) in West and North Darfur and Kassala states and initiate control programs. School children 10-18 years of age were selected from the three states and HHE screening was performed by trained paediatric residents supervised by cardiologists using a pre-tested protocol. Health worker training and public awareness sessions were carried out. The study was conducted between November 2020 and December 2021. In West Darfur, 1,547 children were screened, echo prevalence was found to be 17.4/1,000, and 22% had moderate to severe disease. In North Darfur, 800 children were screened and echo prevalence was 16.2/1,000, 23% had moderate to severe disease while in Kasala 2,225 children were screened and the prevalence was 3.1/1,000 and all cases were mild. One hundred and fifty-eight health workers were trained and 20,150 people benefited from health education sessions. The prevalence of RHD in Darfur is 5 times more than in Kassala. This may reflect socioeconomic and genetic differences between the two regions. RHD control in Darfur needs to be consolidated, and echo surveillance is an important tool for early detection and the institution of secondary prophylaxis., Competing Interests: The authors declare that they have no competing interests., (Copyright © Sudanese Association of Pediatricians.)

Objective: To evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency., Design: Interventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each)., Setting: Neonatal intensive care unit., Participants: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26-28) and postnatal age 17 (12-23) days., Intervention: Automated oxygen titration with the VDL1.1 algorithm, with the incoming SpO 2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO 2 ) adjustments actuated by a motorised blender. The desired SpO 2 range was 90%-94%, with bedside clinicians able to make corrective manual FiO 2 adjustments at all times., Main Outcome Measures: Target range (TR) time (SpO 2 90%-94% or 90%-100% if in air), periods of SpO 2 deviation, number of manual FiO 2 adjustments and oxygen requirement were compared between automated and manual control periods., Results: In 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51-64)% vs automated 81 (72-85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO 2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25-32)% and automated 26 (24-32)%, p=0.13)., Conclusion: The VDL1.1 algorithm was safe and effective in SpO 2 targeting in preterm infants on non-invasive respiratory support., Trial Registration Number: ACTRN12616000300471., Competing Interests: Competing interests: The University of Tasmania and Tasmanian Health Service have jointly lodged a patent application concerning automated control of inspired oxygen concentration in the newborn infant, and have entered into a licensing agreement with SLE Limited allowing use of the VDL1.1 algorithm (as OxyGenie) in SLE respiratory support devices., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Rheumatic heart disease (RHD) is a completely preventable, life-threatening complication of group A streptococcal pharyngitis and the commonest cause of acquired heart disease in children and young adults in low- and middle-income countries. Conventional control measures are faced with many obstacles including the difficulty of early diagnosis of bacterial pharyngitis and acute rheumatic fever (ARF) leading to late presentation with established RHD which is not curable. Recent evidence confirmed the role of echocardiography screening of asymptomatic children in the early detection of 'latent' RHD. Benzathine penicillin prophylaxis was shown to be effective in halting the progression of latent RHD. There is enough evidence to warrant the implementation of control strategies that use lower thresholds for the diagnosis of group A streptococcal infection and ARF and we believe that it is high time to introduce an echocardiography screen-to-treat policy in endemic areas., Competing Interests: The authors declare that they have no competing interests., (Copyright © Sudanese Association of Pediatricians.)

Importance: The benefits of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome are uncertain., Objective: To examine the effect of selective application of MIST at a low fraction of inspired oxygen threshold on survival without bronchopulmonary dysplasia (BPD)., Design, Setting, and Participants: Randomized clinical trial including 485 preterm infants with a gestational age of 25 to 28 weeks who were supported with continuous positive airway pressure (CPAP) and required a fraction of inspired oxygen of 0.30 or greater within 6 hours of birth. The trial was conducted at 33 tertiary-level neonatal intensive care units around the world, with blinding of the clinicians and outcome assessors. Enrollment took place between December 16, 2011, and March 26, 2020; follow-up was completed on December 2, 2020., Interventions: Infants were randomized to the MIST group (n = 241) and received exogenous surfactant (200 mg/kg of poractant alfa) via a thin catheter or to the control group (n = 244) and received a sham (control) treatment; CPAP was continued thereafter in both groups unless specified intubation criteria were met., Main Outcomes and Measures: The primary outcome was the composite of death or physiological BPD assessed at 36 weeks' postmenstrual age. The components of the primary outcome (death prior to 36 weeks' postmenstrual age and BPD at 36 weeks' postmenstrual age) also were considered separately., Results: Among the 485 infants randomized (median gestational age, 27.3 weeks; 241 [49.7%] female), all completed follow-up. Death or BPD occurred in 105 infants (43.6%) in the MIST group and 121 (49.6%) in the control group (risk difference [RD], -6.3% [95% CI, -14.2% to 1.6%]; relative risk [RR], 0.87 [95% CI, 0.74 to 1.03]; P = .10). Incidence of death before 36 weeks' postmenstrual age did not differ significantly between groups (24 [10.0%] in MIST vs 19 [7.8%] in control; RD, 2.1% [95% CI, -3.6% to 7.8%]; RR, 1.27 [95% CI, 0.63 to 2.57]; P = .51), but incidence of BPD in survivors to 36 weeks' postmenstrual age was lower in the MIST group (81/217 [37.3%] vs 102/225 [45.3%] in the control group; RD, -7.8% [95% CI, -14.9% to -0.7%]; RR, 0.83 [95% CI, 0.70 to 0.98]; P = .03). Serious adverse events occurred in 10.3% of infants in the MIST group and 11.1% in the control group., Conclusions and Relevance: Among preterm infants with respiratory distress syndrome supported with CPAP, minimally invasive surfactant therapy compared with sham (control) treatment did not significantly reduce the incidence of the composite outcome of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age. However, given the statistical uncertainty reflected in the 95% CI, a clinically important effect cannot be excluded., Trial Registration: anzctr.org.au Identifier: ACTRN12611000916943.

Background: Most preterm infants born at 29-32 weeks gestation now avoid intubation in early life, and thus lack the usual conduit through which exogenous surfactant is given if needed., Objective: The aim of this work was to examine whether a technique of minimally invasive surfactant therapy used selectively at 29-32 weeks gestation would improve outcomes., Methods: We studied the impact of selective administration of surfactant (poractant alfa 100-200 mg/kg) by thin catheter in infants with respiratory distress syndrome on continuous positive airway pressure (CPAP). The threshold for consideration of treatment was CPAP ≥7 cm H2O and FiO2 ≥0.35 prior to 24 h of life. In-hospital outcomes were compared before and after introducing minimally invasive surfactant therapy (epochs 1 and 2, respectively)., Results: During epoch 2, of 266 infants commencing CPAP, 51 (19%) reached the treatment threshold. Thirty-seven infants received surfactant via thin catheter, and CPAP failure was avoided in 34 of these (92%). For the overall cohort of infants at 29-32 weeks gestation, after the introduction of minimally invasive surfactant therapy, there were reductions in CPAP failure (epoch 1: 14%, epoch 2: 7.2%) and average days of intubation, with equivalent surfactant use and days of respiratory support (intubation + CPAP). Pneumothorax was substantially reduced (from 8.0 to 2.4%). These findings were mirrored within the subgroups reaching the severity threshold in each epoch. The incidence of bronchopulmonary dysplasia was low in both epochs., Conclusions: Selective use of minimally invasive surfactant therapy at 29-32 weeks gestation permits a primary CPAP strategy to be pursued with a high rate of success, and a low risk of pneumothorax., (© 2017 S. Karger AG, Basel.)

Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts., (Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.)

Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults in developing countries. It results from throat infection with group A beta hemolytic streptococcus that proceeds to acute rheumatic fever (ARF). We report a 13 years old girl from Darfur presenting with recurrent acute rheumatic fever for 4 years that led to affection of all her heart valves with severe mitral and tricuspid regurgitation together with moderate pulmonary and mild aortic valve regurgitation. There was an associated atrial septal defect (Lutembacher syndrome variant). The disease was severe and led to cardiogenic shock and death while awaiting surgery. The case highlights the impact of RHD on young people and the need to implement control programs for RHD in Sudan.