Sudan Journal of Medical Sciences

A Rare Condition in the Differential Diagnosis of Arthritis, Preiser’s Disease: A Case Report and Review of the Literature

2025-03-28T06:41:56+00:00

Chronic wrist pain is a common clinical condition that negatively affects daily activities. Many diseases are involved in the etiology of chronic wrist pain. Identification of specific causes of pain increases treatment success and prevents disability. Detailed evaluation and necessary imaging methods for differential diagnosis of multiple clinical entities with similar history and examination findings are essential for accurate diagnosis and treatment success. Avascular necrosis is a progressive disorder resulting in partial or complete death of bone tissue cells due to impaired blood circulation of the bone, usually caused by nontraumatic or idiopathic etiology. Preiser’s disease, avascular necrosis of the carpal scaphoid, is a rare disorder generally occurring on the dominant side and in women. This case report presents an uncommon disease that should be considered in the differential diagnosis while searching for the etiologic cause of chronic wrist pain.

Limitations in Vitamin D Reference Values: Assessment of Vitamin D Levels and Their Relation to Glycemic Control in Sudanese Patients with Type 2 Diabetes Mellitus

2025-03-28T06:41:57+00:00

Experiences of Newly Graduated Nurses at Al-Baha Hospitals

2025-03-28T06:41:58+00:00

Background: The transition of nurses from education to practice is associated with many difficulties and opportunities, making this period critical to the nursing profession. This study assesses the experiences of newly graduated nurses (NGNs) in Al-Baha, Saudi Arabia.

Methods: The researchers conducted a cross-sectional study to assess NGNs’ experience. Using a convenience sampling method, they selected 101 nurses from Al-Baha Hospitals. Data were collected using an online survey from a previous study, which was analyzed using SPSS and descriptive and inferential methods.

Results: The study findings showed that most NGNs were between 20 and 29 years old, with a balanced gender distribution and a significant number of single individuals. Most have less than a year of work experience, primarily at King Fahad Hospital. While the majority are Saudi nationals, they work in various hospital units. Although they feel confident communicating with physicians and delegating tasks, they struggle to prioritize and organize patient care needs. They report predominantly positive experiences and satisfaction, particularly about having flexible shift options, weekends off, and constructive feedback.

Conclusion: The study indicated that most NGNs in Al-Baha Hospitals were satisfied with their jobs and had positive experiences. However, the 20–29-year-old Saudi nationals had better experiences and job satisfaction.

Glaucoma Awareness and Associated Factors in an Eye Hospital in Khartoum, Sudan

2025-03-28T06:41:58+00:00

Background: Glaucoma is one of the leading causes of irreversible blindness worldwide and its early detection and management can reduce the prevalence of visual impairment. The present study aims to assess the level of awareness about glaucoma in patients and co-patients attending an eye hospital in Khartoum State, Sudan.

Methods: A cross-sectional study was conducted from June to December 2021 on a convenience sample of 220 participants aged 18 to 71. Data were collected using a standardized research tool, summarized numerically (mean, standard deviation, median) and graphically (frequency tables) through SPSS 23, and their reliability was measured through Cronbach’s Alpha tests before generating the scores of knowledge and awareness. A logistic regression analysis assessed the factors associated with glaucoma awareness.

Results: Glaucoma awareness was low (9.1%), despite its presence in 3.2% of the study population, highlighting a significant knowledge gap. Awareness of glaucoma was strongly associated with the knowledge that glaucoma is the leading cause of blindness (P = 0.004) and patients with glaucoma (P = 0.02). Despite their contribution to the model prediction based on eight explanatory variables, education level and area of residence were not statistically significant (P < 0.05).

Conclusion: This study showed that awareness about glaucoma was low among the Sudanese population. Therefore, it appeals to health authorities and eye care professionals, in partnership with their communities, to promote information about glaucoma to prevent blindness and improve the quality of life of those affected.

Impact of Inappropriate Empirical Antibiotics Therapy on Clinical Outcomes in Adult Patients with Sepsis and Septic Shock at Wad Medani Teaching Hospital, Sudan

2025-03-28T06:41:57+00:00

Background: Inappropriate empirical antimicrobial therapy for sepsis or septic shock patients is independently linked to higher mortality rates. This study aims to evaluate the impact of inappropriate empirical antibiotic therapy on mortality and length of Intensive Care Unit (ICU) stay in adult patients with sepsis and septic shock.

Methods: A cross-sectional, retrospective study was conducted in the ICU of Wad Medani Teaching Hospital, Sudan, from January 1^st, 2018 to May 31^st, 2020.

Results: Out of the 101 patients analyzed, 95 (94.06%) received more than one antibiotic (2.772 ± 1), and 78 (77.2%) received inappropriate empirical antibiotics. In total, 17 antimicrobial drugs were used, of which metronidazole was used the most used in 70 patients (69.3%). Aspiration pneumonia was identified as the predominant source of infection in 33 (32.7%) patients. The ICU mortality rate was 77 patients (76.2%), which is significantly associated with inappropriate antibiotics used (P-value: 0.00), with a relative risk of 3.12 (CI 95% 1.66–5.84). Additionally, there was a significant difference in survival depending on the appropriate use of antimicrobials (P-value: 0.00) and Sequential Organ Failure Assessment (SOFA) score (P-value: 0.00).

Conclusion: Inappropriate empirical antibiotic use in sepsis or septic shock patients was associated with a higher risk of patient death and more extended hospital stays. This study revealed a significant percentage of inappropriate antibiotic use. These results highlight the significance of creating evidence-based empirical antibiotic protocols for treating sepsis and septic shock and educating healthcare staff on the urgent treatment of these patients and the application of sepsis bundles.

Childhood Mortality in Saudi Arabia: Analysis of 50 Years (1973–2022)

2025-03-28T06:41:56+00:00

Background: Infant mortality rate (IMR) refers to the likelihood that a newborn will not survive to their first birthday; it is expressed per 1000 live births. Globally, the IMR represents a considerable proportion of under-five mortality. This study aimed to investigate and compare IMR trends and patterns in Saudi Arabia by decade and sex over 50 years.

Methods: Data on the IMR in Saudi Arabia from 1973 to 2022 were extracted from the UNICEF database. The mean mortality rates every 10 years were calculated and then compared over decades between males and females using a chi-square test. A two-sided P-value <0.05 was deemed statistically significant.

Results: The IMR was highest in 1973 (102.9 per 1000 live births; 107.3 males vs 98.1 females) and lowest in 2022 (5.4 per 1000 live births; 5.6 males vs 5.3 females). The statistical analysis results revealed a significant decline in the mean IMR from 1973 to 2022 (P < 0.01), with no difference between male and female IMR in any of the five decades.

Conclusion: Saudi Arabia’s success in reaching the SDG for infant mortality reflects decades of improvements in healthcare, driven by the Vision 2030 framework. This effort has continuously decreased infant and under-five mortality rates due to improved medical services, including enhanced access to maternal and child healthcare, advanced neonatal care, and comprehensive immunization programs.

Eight in Ten Multimorbid Patients Experience High Treatment Burden: A Cross-sectional Survey in an Outpatient Setting

2025-03-28T06:41:58+00:00

Background: Multimorbidity is linked with poor patient outcomes, polypharmacy, and treatment burden. Treatment burden is the workload needed by patients to manage their multiple chronic conditions. We aimed to assess treatment burden and its predictors in patients with multimorbidity at the internal medicine clinic of the Omdurman Teaching Hospital.

Methods: This was a descriptive, cross-sectional study. Patients were eligible for inclusion if they were aged ≥55 years and had ≥2 self-reported chronic conditions. Treatment burden was measured through the Multimorbidity Treatment Burden Questionnaire (MTBQ). Multivariable logistic regression was used to predict the factors associated with a high treatment burden. SPSS V.26 was used for statistical analysis.

Results: A total of 256 participants were recruited (the median age was 64 years, and 39.1% were men). About 47% of participants had more than three chronic conditions, with hypertension (89.5%) and diabetes (82.0%) being the most common. Eighty-one percent of the participants had a high treatment burden with a median score of 40.4 (28.8–51.9). Arranging appointments (83.7%), seeing several health professionals (83.5%), and collecting prescription medicines (83.2%) were perceived as difficult tasks. Aspects related to treatment (collection of, taking, and paying for medicines) were the most difficult as perceived by participants. Low education (OR = 10.46; CI 3.01–36.39; P = 0.000), living outside Khartoum (OR = 4.24; CI 1.22–14.73; P = 0.023), having more chronic conditions (OR = 1.75; CI 1.03-2.97; P = 0.038), and taking more regular medications (OR = 1.32; CI 1.09–1.61; P = 0.004) were independently associated with high treatment burden.

Conclusion: A high treatment burden was common and was primarily incurred by difficulties in interacting with many healthcare providers and obtaining prescribed medicines. More attention should be given to assessing and supporting patients with multimorbidity to reduce the burden through organized and integrated healthcare services.

Medical Students’ Perceptions of Online Learning During COVID-19 Pandemic in Ibn Sina University

2025-03-28T06:41:57+00:00

Background: The COVID-19 lockdown of Sudanese universities in March 2020 affected education at all colleges, notably medical students. Therefore, this study aimed to investigate final-year medical students’ perceptions and satisfaction with using mobile phones and Telegram at Ibn Sina University. Fortunately, these students were familiar with using mobile phones and Telegram as technological teaching and learning tools with some lecturers before the spread of COVID-19.

Methods: This evaluation-based design study was conducted from March to June 2020. A diagnostic test and a questionnaire were used to collect data. The diagnostic test consisted of five multiple choice questions (MCQs) on Control Infection Measures. The questionnaire consisted of three sections: (i) demographic characteristics of the students; (ii) students’ learning experience; and (iii) mobile learning design. A population of 135 students was targeted and a convenience sample of 40 medical students in their final fifth year voluntarily participated in this study. The questionnaire data were analyzed using SPSS, while the diagnostic test data were analyzed by comparing pass rates per item.

Results: The findings of the diagnostic test revealed that 94% of the students learned about what infections are, where they come from, and how to prevent them; 66% learned about standard precautions; 56% understood how to break the chain of infection; and 53% succeeded in recognizing diseases that are transmitted by infection, thus, they were aware about the epidemic process of an infectious disease. Students enhanced their knowledge of personal hygiene and built personal skills, experiences, and practices for reducing infection. The questionnaire findings revealed that the students showed positive perceptions, strong satisfaction, and positive learning experiences with a percentage score ranging from 67.5% to 95% indicating that they “agree” and “strongly agree,” respectively. Moreover, 75% of the students were able to get advice from their instructors whenever they needed and had the opportunity to study, gain knowledge, and interact with their peers successfully. Additionally, 82.5% of the students preferred asynchronous learning and teaching.

Conclusion: Mobile phones and the Telegram App have been accepted well by the students as indicated by the results of the present study and may be used more for academic activities. It is recommended that these tools can broadly be adopted in medical education due to their positive potential during this research.

Determinants of Job Satisfaction and Retention Among Medical Laboratory Professionals in Somalia

2025-03-28T06:41:57+00:00

Background: Job satisfaction among laboratory professionals is critical to healthcare quality and workforce retention in Somalia. Understanding job satisfaction factors is crucial for implementing targeted interventions to improve healthcare services. This study aimed to determine the factors influencing job satisfaction and retention among medical laboratory technologists in Somalia.

Methods: A descriptive cross-sectional study involving laboratory professionals in Mogadishu was conducted between October 2023 and March 2024. Structured questionnaires were used to gather the data. We used descriptive and logistic regression, such as binary and multivariate logistic regression, to identify the factors affecting job satisfaction. P-values <0.05 were considered significant.

Results: This study revealed a range of job satisfaction levels, with 43.3% of respondents dissatisfied and 56.7% satisfied. Significant factors influencing job satisfaction included gender (AOR = 2.054, 95% CI: 1.095–3.855, P = 0.025), education level (AOR = 3.086, 95% CI: 0.607–15.699, P = 0.036), years of experience (AOR = 5.894, 95% CI: 1.618–21.475, P = 0.001), facility level (AOR = 0.692, 95% CI: 0.364– 1.316, P = 0.041), professional development (AOR = 2.374, 95% CI: 1.467–3.842, P = 0.003), management appreciation (AOR = 1.699, 95% CI: 1.011–2.855, P = 0.045), and vacation time (AOR = 1.972, 95% CI: 1.165–3.192, P = 0.011).

Conclusion: This study’s results underscore the need for targeted interventions to address job dissatisfaction among laboratory professionals in Somalia. Recommendations include implementing gender-sensitive policies to promote equality, enhancing professional development programs to foster career growth, and improving management recognition and support to create a more conducive work environment and boost job satisfaction.

Assessment of Tacrolimus Adherence in Kidney Transplant Patients at Ahmed Gasim Hospital, Khartoum, Sudan (2022–2023)

2025-03-28T06:41:57+00:00

Background: Adherence to the immunosuppressant agents is essential for reducing graft rejection. Several tools have been investigated to determine the adherence level of different medications, and the simplified medication adherence questionnaire (SMAQ) is considered one such tool, especially for tacrolimus. This study assesses adherence levels toward tacrolimus use in kidney transplant patients (KTPs).

Methods: This descriptive cross-sectional study was conducted at the Clinic of Nephrology, Ahmed-Gasim Hospital, Sudan, where a total of 166 KTPs responded to the questionnaire in the follow-up clinic, and those participants were treated with the immunosuppressant agent (tacrolimus). Statistical analysis was performed using the Statistical Package of Social Sciences (SPSS, version 27.0).

Results: Out of the 166 responders, 157 (94.6%) exerted a high level of adherence, and 9 (5.4%) were nonadherent. Among different factors related to the low adherence level, forgetfulness (n = 22; 13.3%) was a significant factor. Patient’s age (years), time since transplant (months), and the number of co-medications represented significant differences between the nonadherents and adherents (49.80 ± [10.592] vs 36.22 ± [11.434] P < 0.05), (9.80 ± [5.263] vs 4.27 ± [2.910] P < 0.05) ( 9(5.4%) vs 157 [94.6%] P < 0.05), respectively.

Conclusion: The adherence level of the studied participants was high. The nonadherence level was strongly associated with the patient’s age, time since transplants, daily dose, and number of co-medications administered.

Sudan Medical Specialization Board Amidst Challenges

2025-03-28T06:41:56+00:00

Established in 1995, the Sudan Medical Specialization Board (SMSB) has long served as the cornerstone for postgraduate professional medical education in Sudan. However, the 2023 conflict presented unprecedented challenges to SMSB’s operations, disrupting training, examinations, and administrative functions. This editorial highlights the Board’s historical evolution, the strategies adopted to maintain operations during the conflict, and its forward-looking vision for recovery and resilience in post-conflict Sudan.

Predictor of Spontaneous Rupture of Malarial Spleen: A Systematic Review and Meta-analysis

2025-03-28T06:41:57+00:00

Background: Spontaneous pathological rupture of the malarial spleen (SPRMS) is a rare but serious complication that has no known predictor in the medical literature. This study aims to report a systematic review of the search for a predictor for SPRMS and the recent changes in the management trends and outcomes of this problem.

Methods: A systematic review of 122 cases from January of 2000 through March of 2024 was conducted and linear regression was computed to search for predicting factors for SPRMS.

Results: Plasmodium vivax (P. vivax) was the most common cause of SPRMS among local citizens, while Plasmodium falciparum (P. Falciparum) was predominant among infected travelers. Fifty patients underwent splenectomy. Despite being a confounding factor in logistic regression, blood pressure could be the sole predictor of SPRMS.

Conclusion: Recent management trends have shown a tendency toward conservative treatment to preserve splenic immunological functions. To our knowledge, this is the first report on a predicting factor for SPRMS. This is important for early diagnosis and health management, as securing patient safety is a cornerstone of clinical governance in emergency settings.

Prevalence of Dental Anomalies in Adult Orthodontic Patients with Oral Radiological Point: A Systematic Review

2025-03-28T06:41:56+00:00

Background: Dental rosy anomalies, although not a disease, can impact a person’s quality of life. This study investigates irregularities in the teeth, the degree of opening of the edge of the upper and lower teeth, and pink dental anomalies in the studied population.

Methods: The study reviewed 61 articles with keywords “dental anomalies,” “orthodontics,” “dental problems,” and “internal diseases” in the Web of Science, PsycInfo, PubMed, and Scopus and published between January 2010 and September 2024.

Results: Dental abnormalities noticeably affect the appearance of teeth. In dental anomalies, deviations are the origin of dental tissue, and can occur in tooth enamel, dentin, or cementum of dental tissues.

Conclusion: Abnormalities can be drastic changes or minor deviations. They have various causes. Some abnormalities are caused by intrinsic factors such as heredity, metabolic disorder, or genetic mutation. Other external causes include physical or chemical trauma, biological agents, nutritional deficiencies, stress, habits, or adverse environmental conditions. True anodontia is the congenital absence of teeth, including the teeth, baby teeth, or both. Congenital loss of milk teeth prevents permanent replacement.