Sudan Journal of Medical Sciences

Editorial - Malaria Vaccine for Children in Sudan: Commencing Midst the Gloom of War

2025-01-21T05:37:13+00:00

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Cystic Kidney Diseases in Sudanese Children: Pattern, Clinical Presentation, and Outcome

2025-01-21T05:40:18+00:00

Background: Cystic kidney disease (CKD) can directly lead to chronic kidney disease in children. This study aims to determine the types, clinical presentation, and outcome of CKD in Sudanese children.
Methods: This retrospective records-based study from January 2005 to December 2017 was conducted at Soba University Hospital, including patients with renal diseases coming from different parts of Sudan.
Results: A total of 105 cases of CKD were identified out of 3050 medical records reviewed in this study, resulting in a prevalence of 3.4% among all pediatric admissions to the renal unit. Male represents 57.1%, and the mean age at presentation was 36.5 ± 4.5 months. The most frequent clinical presentation was a palpable abdominal mass followed by urinary tract infection and incidental presentation. About 15.2% presented with chronic renal failure, and neonatal presentations were reported in 6.6%. The most prevalent type was polycystic kidney disease (PCKD; 40.9%), followed by multicystic dysplastic kidney (MCDK; 36.2%). Autosomal dominant polycystic kidney disease (ADPCKD) and MCDK were present mainly in age groups <1 year old, compared to the cyst of the medulla related to age groups 5–9 and 10–14 years. The clinical outcome showed the absence of symptoms and normal renal function in 59% of the patients during follow-up notes. In comparison, 29.5% developed chronic kidney disease, of whom 11.4% were stage-five and required dialysis, while 8.6% required kidney transplantation, and death was reported in 11.4%. There was a significant statistical association between the type of disease and consanguinity (P = 0.018) and the age of presentation (P = 0.012).
Conclusion: Five types of CKD were reported, with the predominance of polycystic kidney disease. Males and <1 year olds were more affected among children. Early detection and renal replacement therapy can improve the outcome in such cases.

Factors Associated with Poor Asthma Control among Sudanese Patients Attending Atbara Teaching Hospital in Sudan

2025-01-21T07:04:07+00:00

Objective: To identify factors associated with poor bronchial asthma control in patients attending Atbara Teaching Hospital, Sudan, in 2020.
Methods: This was an analytical, descriptive, cross-sectional hospital-based study conducted at the Atbara Teaching Hospital in River Nile State, Sudan, between February and June 2020. All patients diagnosed with bronchial asthma who were attending any hospital department were included.
Results: In total, 292 patients were enrolled, 51.4% were aged 18–45 years and 51.4% were female. The most frequent complaints were an audible wheeze and shortness of breath (approximately 93%), and 49% had been diagnosed with asthma >10 years previously. Of the patients, 42% were admitted 1 to 3 times and 47.3% were admitted to the intensive care unit (ICU). Hospital admission was associated with improper inhaler use (P = 0.003), the presence of triggers at home or work (P = 0.003), and passive smoking (P = 0.016). ICU admission was associated with female sex (P = 0.039) and the presence of triggers at home or work (P = 0.026).
Conclusion: Asthma is a major problem in Atbara City. Improper inhaler use, the presence of triggers at home or work, and passive smoking were significantly associated with hospital admission. Female sex and the presence of triggers at home or work were significantly associated with ICU admission.

Development of Asthma Mouse Model By Dermal Sensitization

2025-01-21T07:12:45+00:00

Background: Urbanization is often associated with the increased asthma prevalence in recent times. Asthma prevalence in Khartoum, Sudan has risen to 18.2% among children aged 13–14 years. Extensive research has been done on the prevalence and triggering factors of asthma, however, no experimental research using animal models has been done. Thus, this study aims to develop asthma phenotype in mice with TDI sensitization.
Methods: This study was a controlled experimental study in which 24 BALB/Lac mice were equally divided into control (G1) and treatment (G2) groups. G1 was treated with 25μL of 0.3% TDI in acetone olive oil (AOO) applied on the same days. Autopsy and samples (blood, bronchoalveolar lavage fluid [BALF], and lung tissue) collection were performed on day 12. Results were analyzed using t-test on the SPSS.
Results: A statistically significant increase in neutrophils and eosinophils was observed in the blood of TDI-sensitized mice (G2) with a reduction in lymphocytes. In the TDI group, a significant increase was seen in the BALF, neutrophils, lymphocytes, and basophils; the increase in eosinophils and monocytes was nonsignificant. Besides, lung-related histopathological changes in the TDI group were hyperemia, leukocytic infiltration, thickening of bronchoalveolar walls, and damage of respiratory epithelium.
Conclusion: TDI-sensitized mice showed a significant increase in granulocyte count, especially neutrophils and eosinophils, both in the blood and BALF with inflammatory and allergic lung tissue changes. These changes confirmed the allergic responses and the development of asthma phenotype.

Prevalence of Thyroid Dysfunction and Antithyroid Antibodies in North India

2025-01-22T12:36:08+00:00

Background: Thyroid hormones control metabolism and growth functions. Incidence of thyroid dysfunction – hypothyroidism, hyperthyroidism, and autoimmune disorders are on the rise. There are minimal data reports regarding thyroid disorders prevalence in North India. The present study aims to report their prevalence in the general population.
Methods: The current retrospective study was conducted at a tertiary care institute for five years. Archives of thyroid function tests (Free T3 [FT3], Free T4 [FT4], and Thyroid-stimulating Hormone [TSH]) and antithyroid antibodies (Antithyroid Peroxidase and Anti-thyroglobulin) were screened. Duplicate/repeated test entries and follow-ups were excluded. For data analysis, the study population was grouped into hypothyroid (low FT3, low FT4, and high TSH), hyperthyroid (high FT3, high FT4, and low TSH), and others – including all other biochemical patterns. Statistical analysis was done using the IBM-SPSS software, version 20.
Results: Out of the initially screened 16,884 patients, a total of 12,775 meeting inclusion criteria were included in the study. The overall prevalence of thyroid dysfunction was 24% (3133/12,775). Hypothyroidism was most prevalent, constituting 51% (1603/3133), followed by hyperthyroidism in 26% (819/3133). The majority affected were females – 68% (2136/3133), commonly occurring in the 18–35 years of age range. The prevalence of antithyroid antibodies was 34% (1073/3133), anti-TPO constituted 77.6% (833/1073), and anti-thyroglobulin antibodies 22.4% (270/1073).
Conclusion: The prevalence of thyroid disorders is high in North India. Females in reproductive age group of 18–35 years are commonly affected. Study aids in early recognition of vulnerable populations for timely treatment of thyroid disorders.

Short Telomere Length in Plasma of Sudanese Patients with Hepatocellular Carcinoma and Chronic Liver Diseases

2025-01-21T05:40:18+00:00

Background: Telomeres, a protective sequence of DNA at the end of chromosomes, are essential for the maintenance of chromosomal integrity and stability. With each cell division, telomeres are shortened until a critical length is reached. Several cancers have been linked to shortened telomere length (TL). The current cross-sectional study aims to investigate the TL in the plasma of Sudanese patients with hepatocellular carcinoma (HCC) and chronic liver diseases (CLD).
Methods: Blood samples were obtained from 113 patients with HCC and CLD as well as from 50 healthy controls. The assessment of TL in blood samples was carried out using the relative quantitative PCR method.
Results: Patients with HCC had significantly shorter TL than healthy controls (0.66 vs 0.89; P < 0.01), whereas insignificant shorter TL was detected in HCC patients as compared to those with CLD. A significant decrease in telomeres copy numbers was observed in HCC patients when compared to those with CLD (P < 0.01).
Conclusion: The results of the present study demonstrate that TL is shorter in patients with HCC and CLD compared to healthy controls.

Comparing General versus Spinal Anesthesia for Cesarean Section in a Severely Pre-eclamptic Parturients

2025-01-21T05:40:20+00:00

Background: Preeclampsia poses a high challenge during anesthesia. Both spinal anesthesia (SA) and general anesthesia (GA) are commonly used for the operative management of severe preeclampsia. The study aimed to assess feto-maternal outcomes among severely preeclamptic parturients scheduled for emergency cesarean section (C/S) delivery under GA or SA.
Methods: A total of 80 parturients were enrolled into two equal groups, one group received SA and the other GA. Vital parameters were recorded before starting and during the procedure. The Chi-square test was used for analysis. A P-value of ≤0.05 was considered significant.
Results: Both groups were similar in age, weight, parity, gestational age, and duration of surgery. An intraoperative need for vasopressors was higher in anesthesia (P-value 0.013). Significant intraoperative decreases in blood pressure were observed in SA. The rate of intensive care unit (ICU) admission was higher in GA (11 vs 4 patients, P-value 0.0463).
Conclusion: Assuming no contraindication, SA is the first choice for cesarean section delivery in a severely preeclamptic parturient.

Serum Magnesium Level among Acute Myocardial Infarction Patients and Its Correlation with Intra-hospital Complications: A Cross-sectional Single-center Study among Sudanese Patients

2025-01-21T05:40:18+00:00

Background: Patients with acute myocardial infarction (AMI) frequently have hypomagnesemia, although magnesium (Mg) has proven cardioprotective characteristics. Cardiovascular fatality has been linked to low serum Mg levels; however, the exact mechanism is unknown and results are inconsistent. This study aims to measure the level of serum Mg among patients diagnosed with AMI.
Methods: One hundred AMI patients who came to the Wad Madani Heart Center were included in a cross-sectional research study. Demographic data, clinical data (presenting compliance, medical history, and medication history), laboratory examination, electrocardiography (ECG) findings, and echocardiography findings were collected. Serum Mg was measured for all participants, and hypomagnesemia was considered as a serum Mg level <1.6 mg/dl. Version 21.0 of SPSS was used to analyze the data.
Results: The mean age of 100 patients was 60 ± 2 years, with 55 (or 55%) being female and 45 (or 45%) being male. Chest pain (n = 92; 92%) was the major presenting complaint. Moreover, the most prevalent heart disease determinants among patients were diabetes mellitus (n = 50; 50%) and hypertension (n = 50; 50%). The mean of Mg was 2.5 mg/dl, and hypomagnesemia was found in 10 (10%) patients and significantly associated with arrhythmia, namely supraventricular tachycardia, (P-value = 0.01). Patients with normal or low Mg levels (98%) were more likely to be discharged in stable condition, whereas all fatalities were among patients with elevated Mg levels (2%).
Conclusion: The frequency of hypomagnesemia among AMI patients was 10%. In addition, hypomagnesemia was significantly associated with arrhythmias (mainly supraventricular tachycardia).

Analysis of the Curriculum of the Faculty of Medicine, University of Kordofan, Sudan: Using Harden’s 10 Questions Framework 2022

2025-01-22T12:35:43+00:00

Background: Curriculum analysis involves unpacking the curriculum into its component parts and evaluating how these parts fit together. The aim of this study is to analyze the curriculum of the Faculty of Medicine, University of Kordofan (FM-UK), Sudan, using Harden’s 10 questions of curriculum development framework.
Methods: This is a mixed qualitative and quantitative descriptive purposive study. The qualitative descriptive study is based on documents analysis. All necessary documents of the college were reviewed. Intensive interviews were performed with the leading administration personnel in the College, Regional Ministry of Health, Teaching Hospital and Community Leaders. Focus Group Discussions were conducted separately for representatives of the students and representatives of the nonacademic staff. Thematic analysis was then used to categorize the findings. This quantitative study used a self-administered questionnaire for fifth-year students’ perceptions of the educational environment including Likert scale and open-ended questions. The quantitative data were analyzed using SPSS.
Results: The curriculum is built to meet the needs of the local community. The objectives are clear, and the content is adequate. The educational strategies, teaching methods, student assessment, and study organization need to be updated. There are deficiencies in the learning environment, delivery of the curriculum, and how it is communicated.
Conclusion: Harden’s 10 questions are all addressed by the curriculum of the FM-UK. There is a need for establishment of the school in this community and the curriculum supports the mission and objectives. There are areas identified for improvement.

The Association Between Human Cytomegalovirus and Salivary Gland Cancer: An Analytical Study and Literature Review

2025-01-21T05:40:19+00:00

Background: Human cytomegalovirus (HCMV) is a widespread human pathogen that triggers varying clinical symptoms depending on the host’s age and immune status. It appears that HCMV infection plays a role in the development of numerous types of cancer. This study aimed to identify the presence of HCMV in different kinds of malignant salivary gland tumors in Sudanese patients.
Methods: Eighty-four formalin-fixed paraffin-embedded tissues (FFPE) from Sudanese patients previously diagnosed with salivary gland cancer (SGC) between 2014 and 2022 were selected. All cases include normal salivary gland tissue. Immunohistochemical staining for CMV was performed using monoclonal antibodies to detect the presence of the virus among the studied group.
Results: CMV was detected in only 1 out of 84 SGC cases; an adenoid cystic carcinoma. All adjacent normal salivary gland tissues were negative for the virus.
Conclusion: The absence of CMV in the studied cases suggests that the virus was not involved in developing these malignancies.

Dysmenorrhea: Predisposing Factors, Effects on Activities and Health-seeking Behavior among University Students in Ibadan, Nigeria

2025-01-21T05:40:20+00:00

Background: Dysmenorrhea, a common gynecologic complaint among adolescent and young women is of public health importance because of its impact on their regular activities. This study aimed to determine the predisposing factors of dysmenorrhea, its effects, and health-seeking behavior among University students.
Methods: This analytic cross-sectional study was conducted among 319 students selected through multistage random sampling technique from major halls of residence in the University of Ibadan, Nigeria. Information on respondents’ demographic characteristics, effect of dysmenorrhea on their daily activities, and their health-seeking behavior was collected using a self-administered questionnaire. Data were analyzed using SPSS version 22.0 with level of statistical significance set at P < 0.05.
Results: The mean age of the respondents was 20.8 ± 1.91 years, and the prevalence of dysmenorrhea was 82.1%. The commonest symptom among those experiencing dysmenorrhea was low mood (51.9%). The length of cycle was the only factor associated with the presence of dysmenorrhea (P = 0.041). Ninety-two (35.1%) respondents sought medical attention. Severity and duration of pain, duration and heaviness of flow, and previous treatment for sexually transmitted infection were associated with their health-seeking behavior (P < 0.05). Class absenteeism, limitation to extracurricular activities, and restriction in relationship with others had significant impact on the students with moderate and severe dysmenorrhea (P < 0.05).
Conclusion: Despite the high prevalence of dysmenorrhea, less than half of the students sought medical attention even though it affected their class attendance, extracurricular activities, and relationship with others.

Adapted Guidelines for Malaria Case Management in Sudan

2025-01-21T07:49:24+00:00

Background: Malaria is a major public health hazard in Sudan. The latest update to the malaria diagnosis and treatment protocol in Sudan was in 2017, after which multiple developments in the global guidelines for malaria case management have taken place. Sudan’s Federal Ministry of Health (FMOH) has updated its malaria case management policy to guide healthcare workers in making informed decisions about malaria diagnosis, treatment, and prevention.
Methods: The National Malaria Control Program (NMCP) selected a multidisciplinary Technical Advisory Committee (TAC) balanced to bring together diverse expertise. The committee convened with the NMCP writing team to propose, discuss, and approve updates to the malaria case management protocol. Protocol updates were prioritized based on the guidelines’ efficacy, safety, and cost-effectiveness.
Results: The management guidelines for severe malaria were updated so that parenteral artesunate is the first-line treatment, with parenteral quinine reserved as second-line therapy. Other updates include the adoption of oral artemetherlumefantrine (AL) as the first-line treatment for uncomplicated malaria in the first trimester of pregnancy. The 2023 protocol upheld the 2017 treatment guidelines for uncomplicated malaria in other groups, including children, adults, and pregnant women in their second and third trimesters, with AL as the first-line treatment and dihydroartemisinin-piperaquine (DHAP) as the second-line treatment.
Conclusion: Key changes in the 2023 protocol include updates to the treatment guidelines for severe malaria in all patient groups and uncomplicated malaria in the first trimester of pregnancy. Future adjustments to the malaria protocol will take place in accordance with changes in the local context of Sudan as well as global malaria guidelines.

Meningiomatosis Restricted to the Left Cerebral Hemisphere Presenting with Frontal Lobe Seizure: A Short Communication

2025-01-21T05:40:20+00:00

Seizures are a common clinical feature of benign intracranial brain tumors such as meningioma. Although seizures are cortical phenomena that typically originate from lesions affecting cortical neurons, meningiomas, which arise from the meningeal lining, can still induce seizures due to their proximity to the cerebral cortex. However, the relationship between multiple meningiomas and frontal lobe seizures remains underexplored. We present the case of a 42-year-old woman without neurofibromatosis who experienced global headaches and nocturnal motor seizure involving the right hemi body, associated with loss of consciousness. The motor fits frequently occur at night. Brain magnetic resonance image (MRI) and electroencephalograph (EEG) show multiple meningioma and left frontal epileptogenic focus, respectively. The patient was managed conservatively with anticonvulsant.