Sudan Journal of Medical Sciences (SJMS)

Editorial – Resilience and Progress: The Sudan Journal of Medical Sciences in the Face of Adversity

Ahmed Mohamedani — 2024-06-28

This is an Editorial and does not have an abstract. Please download the PDF or view the article in HTML.

The Role of Surgical Androgen Deprivation in the Treatment of Patients With Urine Retention Due to Prostate Cancer

Adil Ibrahim — 2024-06-28

Background: Surgical androgen deprivation (SAD) and temporary urethral catheterization remain the most suitable therapy for locally advanced prostate cancer (PC). This study aimed to assess the suitable interval duration for voiding trial without a catheter (TWOC) after SAD and to correlate the Gleason score, prostate volume, and PSA level with the free-catheter voiding success.

Methods: A total of 62 patients with urine retention due to PC were included in this study. PSA, pelvic ultrasound, and Gleason score were done prior to SAD as baseline measurements and repeated four weeks after surgery. Initial two-week voiding TWOC was done for all patients and repeated after two weeks for patients who failed the initial voiding TWOC.

Results: The results showed that 34 (54.8%) patients had Gleason score >7, 21 (33.9%) had a score of 7, and 7 (11.3%) had a score <7. Following SAD, the mean prostate size reduction was seen in 36 (58%) patients, whereas PSA ranged between 0.87 and 38 ng/ml with a mean reduction level of 10.9 ng/ml. All patients with Gleason ≤7 could void free one month after SAD. Five patients with Gleason >7 failed to void free and needed TURP tunneling. In summary, 39 (62%) were void-free after two weeks, 18 (29%) after one month, and the remaining 5 (8.1) required tunneling TURP.

Conclusion: The initial TWOC should start two weeks after SAD and followed by a second voiding TWOC two weeks later. Those who fail the second voiding TWOC usually have high Gleason scores, and tunneling TURP may be the best option to treat such patients.

Bibliometrics Analysis and Thematic Mapping of Global Literature on Human Papillomavirus (HPV)

Meisam Dastani — 2024-06-28

Background: Since human papillomavirus (HPV) infection is known as one of the main causes of cervical cancer, medical researchers pay significant attention to this issue2. The current study applies the bibliometric method to identify the trends and advancements of research on HPV worldwide.

Methods: This descriptive study was conducted using a bibliometric approach. All HPV-related scientific publications in the Web of Science database until 2022, August 30 were included in the statistical population. The Bibliometrix package of the R programming language was used to analyze the data.

Results: In the field of HPV, a total of 45,657 scientific publications were retrieved, the majority of which were articles. The countries with the highest publications were the USA (45,954 document), China (9977), and UK (6652). The words “Infection,” “Cancer,” and “Women” are the most important keywords of scientific publications on HPV. “Cancer,” “infection,” and “women” are the more developed and essential in HPV subject area. “Protein,” “gene-expression,” and “human-keratinocytes” are in this quadrant. “DNA,” “squamous-cell carcinoma,” and “head” keywords are basic themes in the HPV subject area. “Human-papillomavirus vaccination,” “knowledge,” and “attitude” are in this quadrant.

Conclusion: The study suggests the need to enhance the focus on global and public health aspects within HPV research to encourage greater participation from various countries in international research endeavors.

Threads of Vulnerability: A Cross-sectional Study on Factors Associated with Suicide and Self-harm in Pakistan

Shaib Muhammad — 2024-06-28

Background: Globally, over a million people commit suicide every year. Although suicide rates are more in high-income countries, many countries do not report suicide cases regularly to the World Health Organization (WHO). Therefore, this study aimed to determine the factors associated with suicide and self-harm in Pakistan.

Method: This cross-sectional study was conducted at Peoples Medical College Hospital (PMCH) in Shaheed Benazirabad, Sindh, Pakistan, from July to December 2019. A total of 131 cases of suicide/self-harm were included using a convenience sampling technique. Data were collected on a predesigned questionnaire consisting of 14 close-ended questions. A chi-square test was used to determine the association between different categorical variables.

Results: The majority of the subjects were males (53.4%), young adults aged between 16 and 30 years (69.5%), single (51.9%), and uneducated (57.3%). More than half (51.9%) of the subjects who attempted suicide or self-harm were unemployed. There was a significant association between education level (c² =13.149, P = 0.001) and age groups (c² = 15.554, P = 0.001) with health outcomes (suicide or self-harm) only. Moreover, gender (c² = 20.776, P = 0.004), marital status (c² = 69.047, P < 0.001), level of education (c² = 63.144, P < 0.001), age groups (c² = 69.848, P < 0.001), and employment status (c² = 28.677, P = 0.012) were also associated with the reasons of suicide and self-harm.

Conclusion: Our study concluded that mostly single, unemployed males with low literacy and with marital and family issues are determined as factors associated with a high risk of self-harm and suicide.

Penile Injury: Four Years’ Experience of a Single Surgeon in a Limited Resources Setting

Mosab Alzubier — 2024-06-28

Background: Penile injuries (PIs) are uncommon, with the management of severe cases being difficult. This study aims to examine the causes of PIs and present experience for their management using the limited facilities available in a hospital with low-resource settings.

Methods: The management of PIs in a limited-resource hospital in eastern Sudan was recorded over four years. Records of 32 cases of emergency penile surgical conditions between January 2016 and March 2020 were retrospectively reviewed, and 17 cases of significant PI were included in the study and divided into pediatric and adult groups with further subdivision of each group according to the nature of the injury.

Results: Seventeen patients with PIs were treated during the study period. The pediatric group (n = 4) were victims of traditional circumcision; two of them presented with glans penis (GP) amputation, one with gangrenous GP, and one with mild GP injury. The patients in the adult group were divided into three subgroups; the first group had penile fractures (n = 8), the second group had degloving PIs (n = 2), and the third group had penile amputation injuries (n = 3). Management included various surgical techniques tailored to the individual patients. The outcome of the intervention was presented on a case-by-case basis.

Conclusion: Severe PIs should be managed using a case-by-case approach. To enhance the effectiveness of surgical interventions, the field of reconstructive penile surgery must be established and developed. Community orientation and work safety measures should be implemented to avoid PIs that may result from traditional circumcision and machinery trauma.

Effects of Cognitive and Emotional Impairment Management Bundle among Patients with Coronary Artery Disease: A Randomized Control Double-blinded Trial

Sarika M L — 2024-06-28

Background: Cardiovascular diseases are the major non-communicable disease causing increased mortality and morbidity worldwide. Among cardiovascular diseases, coronary artery disease is one of the life-threatening diseases. The majority of patients, after the acute event of coronary artery disease, suffer from mental stress, depression, and cognitive impairments. Therefore, this study mainly focuses on the effect of the Cognitive and Emotional Impairment Management Bundle (CEIMB) among patients with coronary artery disease.

Methods: This randomized, controlled, double-blinded trial was conducted in a tertiary care center among patients with coronary artery disease. The samples were recruited from the coronary intensive care unit through purposive sampling technique. After the sample selection, they were allotted to control (n₁ = 55) and intervention (n₂= 56) groups through block randomization. The intervention was provided through three sessions. The study was registered under the Clinical Trial registry of the country. The statistical analysis was done using the SPSS ver. 25. The analysis was done by mean, standard deviation, frequency, percentage, and two-way repeated measures ANOVA.

Results: The mean age of the participants in the control group was 56.6 ± 6.1 years, and in the experimental group was 57.6 ± 6.4 years. The majority of the participants (39.3%) in the intervention group had severe depression, moderate levels of stress (30.4%), and medication adherence (96.4%). In the experimental group, depression, stress, medication adherence, and cognition had a statistically significant difference at different periods (<0.05).

Conclusion: The impaired mental status and cognitive level of the patients after the cardiac event negatively influences the patient's prognosis, contributing to readmission and premature death.

Timing of Umbilical Cord Clamping in Preterm Neonates: A Randomized Controlled Trial

Fatma Zaghloul Mahmoud — 2024-06-28

Background: The optimal timing for clamping the umbilical cord remains controversial. This study aimed to assess the optimal timing of umbilical cord clamping and its effect on preterm neonates.

Methods: The study was a randomized controlled trial with the registration number: NCT06000800. It was conducted at Kasr Al Ainy Maternity Hospital, Cairo University Hospital, where a total of 80 pregnant women were randomly pooled and randomly divided into four groups with each group comprising 20 pregnant women. Umbilical cord clamping was performed in the first group immediately (5 sec after birth), after 30 sec in the second group, after 60 sec in the third group, and after 90 sec in the fourth group. After birth, clinical and laboratory parameters were assessed and recorded at the 1^st, 6^th, 12^th, 24^th, and 48^th hours for all preterm neonates.

Results: Delayed cord clamping at 90 sec was linked to improved preterm neonatal outcomes including heart rate at the 1^st and the 6^th hours; respiratory rate at the 12^th hour; oxygen saturation at the 1^st hour; hemoglobin, hematocrit, and blood glucose levels at the 6^th, 12^th, 24^th, and 48^th hours; but also linked to increase in bilirubin levels at the 12^th, 24^th, and 48^thhours (P < 0.001). There was no statistically significant difference concerning APGAR score; respiratory rate at the 12^thhour, temperature at the 1^st, 6^th, 12^th, 24^th, and 48^th hours; hemoglobin, hematocrit, and blood glucose at the 1^st hour; and bilirubin at the 1^st, 6^th, and 12^th hours in all groups (5, 30, 60, and 90 sec) (P > 0.05).

Conclusion: Better levels of blood glucose and hemoglobin were seen in preterm neonates whose cord clamping was delayed. Further studies should be carried out to determine the optimal timing of umbilical cord clamping with larger samples, for extended delay of clamping for more than 90 sec, and with recording of parameters for an extended period of follow-up even past the neonatal period.

Evaluation of Age-Friendliness in Primary Health Care Centers in Sulaimani Governorate, Iraq

Zana Faris Muhammed — 2024-06-28

Background: The aging of the global population has increased the demand for primary care of older adult’s health disorders. As the first point of contact for healthcare, primary care services should be accessible and adaptable to the needs of older people. This study aims to assess the age-friendliness of healthcare services at the primary healthcare centers (PHCCs) in Sulaimani Governorate, Iraq.

Methods: This cross-sectional descriptive study included all 87 PHCCs in Sulaimani governorate (61 centers in Sulaimani city, 16 in Raparin Administration, and 10 in Garmyan Administration). In each of these health facilities, data were collected regarding the physical, architectural, and clinical age-friendliness of these centers. A modified age-friendly PHCCs toolkit was used as a tool for assessing the PHCCs, and then a scoring system was utilized to estimate the overall friendliness of the PHCCs.

Results: The Sulaimani governorate selected 13 out of 87 PHCCs (14.9%) to be age-friendly; all of them were in Sulaimani city. However, this study found that only 3 out of 87 (3.4%) centers were in the range of the WHO age-friendly recommendations with a score of >75%, while 64 (73.6%) centers were partially age-friendly with a score of 50–74% and 20 (23%) centers were not age-friendly with a score <50%.

Conclusion: Only 3.4% of PHCCs in Sulaimani Governorate were age-friendly, and most of the centers were partially age-friendly. Geriatric doctors and geriatric nurses were not recruited, and geriatric training programs for medical staff were not satisfactory.

The Spectrum of Pediatric Skin Diseases: A Prospective Study in Sudan

Mahasin Nsraldein Abass — 2024-06-28

Background: In line with the World Health Organization's (WHO) campaign to improve community dermatology services, research on the spectrum of pediatric skin diseases is crucial for both patients and policymakers. Identifying the spectrum of pediatric skin conditions among children visiting the Khartoum Dermatological Hospital's outpatient dermatology clinic was the goal of this study.

Methods: Over six months, a prospective cross-sectional study including children (0–18 years old) was undertaken. Once the pertinent medical history and examinations were gathered, dermatologists made the diagnosis. Skin conditions were divided into several categories. The analysis of the data was done with the SPSS version 23.

Results: A total of 320 children, with a male-to-female ratio of 1.1:1, were enrolled. Ten categories with 38 different skin diseases were established after diagnosis. Infections in 152 (47.5%), eczematous disorders in 89 (27.8%), and appendageal disorders in 19 (5.93%) children were the most prevalent conditions by group. Impetigo (37.5%), scabies (10.9%), and seborrheic dermatitis (10.6%) were the most frequently seen diseases. These illnesses most commonly afflicted the areas of the limbs (30%), face (20%), and scalp (18.7%). Papules in 148 (46%) and scales in 74 (23%) children were the most prevalent primary and secondary efflorescence, respectively. A clinical diagnosis was made in the majority (266 [83.1%]) of the cases.

Conclusion: The most frequently observed group was infection. This demonstrates how crucial it is to maintain good personal and family hygiene, minimize overcrowded spaces, and promoting public health.

Nurses’ Awareness and Practice Toward Pain Assessment and Management as Fifth Vital Sign in Sudan: A Cross-sectional Study

Mohammed Abdelmalik — 2024-06-28

Background: Pain is globally prevalent, affecting quality of life and driving most people to seek medical care. Nurses are essential for pain assessment and treatment. Adequate nursing awareness, attitudes, and skills are vital for optimal management. This study investigates nurses’ awareness and practice toward pain assessment and management as the fifth vital sign in Sudan.

Methods: This study was a cross-sectional, hospital-based study. Convenience sampling was performed to collect information from nurses working at four government hospitals using a self-administered questionnaire 24 November 2020 and 18 April 2021. The study utilized descriptive and inferential statistics for data analysis.

Results: A total of 393 registered nurses participated in this study. Most (66.7%) were women, 46.6% were aged 20–25 years, and 69.2% had a bachelor degree. More than half of the nurses had low awareness of pain assessment (51.7%) and management practices (53.7%). A weak positive correlation was observed between awareness and practice (r = 0.280, P = 0.000). Women nurses showed a higher awareness (204.80, P = 0.048). Nurses with a high level of education showed higher awareness (249.32, P = 0.031) and higher practice (272.00, P = 0.029). Nurses working in the critical care unit performed significantly better than others (234.61, P = 0.001).

Conclusion: There is a low level of awareness regarding pain assessment and management practices. This study suggests the need for more research and training programs, especially for nurses with low educational levels.

Public Perception toward Nursing Profession in Selective Arabic Communities

Yahya Hussein Ahmed Abdalla — 2024-06-28

Background: The development of the nursing profession depends significantly on how communities perceive it. This study aims to identify the views and attitudes of Arabic communities, specifically those in Sudan, Yemen, and Egypt, toward the nursing profession.

Methods: A descriptive comparative study was used to identify the perception of Arabic communities (Sudan, Yemen, and Egypt) toward the nursing profession. The study was conducted in three Arabic countries (Sudan, Yemen, and Egypt) using an online approach by sending the link of questions to the targeted population using emails, WhatsApp, and social media. There were 529 participants from the three Arabic countries. The study was analyzed by SPSS software using descriptive and inferential statistics.

Results: A majority (75.6%) of the participants were aged <40 years, with most (82.9%) being between 21 and 30 years of age. There was a generally positive perception toward the nursing profession among these communities: 97.6% of Sudanese, 94.9% of Yemenis, and 96.1% Egyptian. There was a borderline statistical significance between the Sudanese and Egyptians' age and their perception toward their profession. Gender is the only factor influencing the perception in Sudan and Egypt, and while women have a higher positive perception in Egypt, men have a higher positive perception in Sudan.

Conclusion: Overall, the perception of Sudanese, Yemeni, and Egyptian communities toward the nursing profession is acceptable. The only influencing factor on the level of perception was Egyptian females who have high positive perception toward the nursing profession and Sudanese males who have high positive perception toward nursing profession We recommend further research to assess the perception toward nursing from different sociocultural backgrounds and on a larger sample size.

The Markov Chains to Predict Malaria Incidence and Death in Gazira State, Sudan From 2001 to 2021

Badawi Osman Mohammed Fadlelkarim — 2024-06-28

Background: Malaria is considered the most deadly and difficult parasitic disease in the world. This study aims to use Markov chains to predict the probability patterns of stability or change in malaria incidence and deaths.

Methods: Markov chains were used to analyze the data on malaria incidence and deaths through the Windows Quantitative Systems for Business (WINQSB) program. Data was obtained from the Ministry of Health, Gazira State, Health Information Centre, Sudan. The data is a time series, from 2001 to 2021 per year, according to three cases of decrease, stability, and increase. A transitional matrix is built for the three cases.

Results: The results revealed that the probability that malaria incidence and deaths will reach a stable state in one year and in the long run; the probability of transitioning to an increased state was 0.66 of malaria incidence; and the probability of moving to a decreased state was 0.52 of malaria deaths.

Conclusion: The results show that the malaria incidence will increase and malaria deaths will decrease in the short and long run from 2022 to 2030 in Gazira State. It is necessary to reinforce means and resources for case management and to investigate the determinants of the situation. Thus, strategies are urgently needed to arrest the unacceptably high incidence and death rates.

Keywords: Markov Chain, Predicting, Malaria Incidence, Malaria Death, Gazira State.

Beyond Menace: Unveiling the Landscape of Predatory Journals in Sudan’s Pediatric Academic Community

Mohammed Abdulrahman Abdulhafeez Alhassan — 2024-06-28

This is a Short Communication and does not have an abstract. Please download the PDF or view the article in HTML.