Sudan Journal of Medical Sciences

Editorial - Resilience in Chaos: Sudanese Actors Shock Absorber in Catastrophes

Mohamed Elsheikh — 2024-09-30

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

Thiopurine S-methyl Transferase (TPMT) Enzyme Level in Healthy Sudanese Population

Rayan Khalid — 2024-09-30

Background: Thiopurine drugs have limited use due to their toxicity, related to the enzyme thiopurine S-methyl transferase (TPMT) activity, which varies between individuals. This is the first study in Sudan, which aimed to assess the TPMT phenotypic status of healthy Sudanese volunteers.
Methods: A total of 177 healthy volunteers from Sudan were included in the study. TPMT enzymatic activities were measured using the ELISA serum protocol. We used SPSS to analyze the data and determined enzyme level categories and normal range with Z scores and quartile tests. The Sudan Medical Specialization Board (SMSB) Ethical Committee approved the study.
Results: There were 117 males and 60 females among the volunteers, with ages ranging from 16 to 70 years and a mean age ± SD of 28.0 ±1 0.2, median = 24. Most candidates were from the Afro-Asiatic linguistic group (64.5%), followed by Nilo-Saharan (18.6%) and Niger-Kordofanian (16.9%). The TPMT enzyme level ranged between 0.17 and 9.5 ng/ml, with a mean of 2.26 ± 0.75 ng/ml. The quartile classification included very low enzyme (<0.76 ng/ml) seen in 4 candidates (2.3%), intermediate low (0.76-1.4 ng/ml) seen in 34 (19.2%), the normal range (1.5 – 3.75 ng/ml) seen in 119 (67.2%), and high enzyme activity (>3.76 ng/ml) seen in 20 (11.3%). No significant correlations between age, sex, and ethnic groups were recorded.
Conclusion: The normal TPMT enzyme activity is between 1.5 and 3.76 ng/ml. A higher prevalence of TPMT deficiency was recorded and compared with international studies. Pretreatment screening using serum ELISA test for TPMT enzyme activity should be used to predict the risk of toxicity.

Functional Outcome After Total Hip Replacement using Ceramic-on-Ceramic among young adults patients

Mahgoub H. A. Fadlalla — 2024-09-30

Background: Total hip arthroplasty (THA) by using ceramic-on-ceramic (CoC) implants has emerged as a promising solution to mitigate wear debris-related complications, such as osteolysis, specifically in younger patients. This study aims to investigate the functional outcomes after total hip replacement by CoC in patients less than 30 years old, conducted within the hospitals of Khartoum, Sudan.
Methods: A descriptive, cross-sectional, hospital-based study was carried out across the major healthcare institutions in Khartoum state from October 2021 to April 2022. A cohort of 32 patients, all aged 30 or below, who underwent total hip replacement were included. Thorough data analysis was conducted using advanced statistical techniques.
Results: The average age of included patients was 25.69 ± 2.7 years, among them, males had a slight predominance (56.3%) with a male-to-female ratio of 1.3:1. Most patients had a secondary school level of education (37.5%), while workers constituted the largest group (34.4%). The included patients were followed-up for more than six months. The mean visual analog scale (VAS) score was 7.91 ± 0.893. Additionally, the mean modified Harris hip score was 83.03 ± 4.9 (range: 72–91), highlighting the enhanced hip function achieved through the procedure. The majority of patients (65.6%) reported good functional outcomes, followed by 28.1% who attained fair outcomes and 25.8% who reported excellent outcomes.
Conclusion: The study demonstrates that CoC THA yields optimal functional outcomes among patients aged 30 years and below. The procedure exhibits remarkable potential to improve hip function and alleviate pain in this specific patient population. These findings highlight the efficacy and viability of CoC implants in younger patients, contributing to the advancement of hip arthroplasty techniques.

Knowledge, Attitudes, and Practices of Prescribing Doctors Towards Direct Oral Anticoagulants: First Cross-sectional Study from Sudan

Toga K. Mohamed — 2024-09-30

Background: During recent years, the prescription rates of direct oral anticoagulants (DOACs) have increased rapidly worldwide. Little is known about situation of DOACs in Sudan. Therefore, this study was conducted to assess prescribing doctors’ knowledge, attitude, and practice level regarding DOACs.
Methods: A cross-sectional, hospital-based study was conducted at three large hospitals in Khartoum, Sudan. The doctors were recruited from a wide range of disciplines such as cardiology, surgery, and nephrology. A four-section questionnaire consisting of questions on demographics, knowledge, attitude, and practice was designed and administered.
Results: A total of 100 doctors responded over a period of four months, 52% of them were found to correlate with a low level of knowledge. Moreover, 56% and 81% of the doctors demonstrated inappropriate attitude and practice levels, respectively. With regard to switching protocols between DOACs and warfarin, the majority of the doctors did not have sufficient information when converting from rivaroxaban to warfarin and vice versa.
Conclusion: The overall knowledge, attitudes, and practices of prescribing doctors regarding the use of the DOACs were found to be inadequate and insufficient for maintaining high therapeutic outcomes in patients necessitating anticoagulants agents. A well-structured educational program about DOACs is urgently needed.

Prevalence of Erectile Dysfunction among Sudanese Patients at Gezira Hospital for Renal Disease and Surgery

Hassan Mahgob Hassan Khalifa — 2024-09-30

Background: Erectile dysfunction (ED) is a disorder that makes it hard or impossible to keep or get an erection that is good enough for sexual activity. ED can be caused by physical, mental, or combined factors, and it is usually associated with a long-term health issue.
Methods: The study is a prospective and cross-sectional research conducted in a hospital setting. It took place from December 2019 to December 2022 at Gezira Hospital for Renal Disease and Surgery. The study sample consisted of 246 patients.
Results: The most frequently affected age groups were 30–40 years and 50–60 years, accounting for 26% and 25.2% of the sample, respectively, while the least affected age groups were >20 years and >70 years, representing 1.2% and 3.7% of the sample, respectively. The most common symptoms reported by the patients were ED alone (74%) and ED with penile curvature (22%). The most prevalent causes were psychogenic, Peyronie’s disease, and venogenic, affecting 54.1%, 24.4%, and 16.3% of patients, respectively. The most frequent comorbidities associated with ED were diabetes mellitus (DM) and hypertension, occurring in 12.2% and 4.1% of the patients, respectively. There was a statistically significant correlation between age and etiology (P-value = 0.00), age and symptom (P-value = 0.012), and symptom and cause (P-value = 0.000).
Conclusion: The age group of 30–40 years was the most affected by ED, and ED alone was the most frequent symptom. Psychological factors were the main cause of ED, and DM was the most common comorbidity associated with ED.

The Relationship of University Students’ Academic Achievement with Emotional Intelligence and Self-esteem: A Descriptive Correlation Study Design at Jouf University, Saudi Arabia 2023

Shahenda Salih — 2024-09-30

Background: Understanding the factors that influence academic achievement among university students is crucial for educational institutions. This study aims to clarify the possible relationship between students’ academic achievement, emotional intelligence, and self-esteem. The findings from this research may provide valuable insights for educators and policymakers in developing strategies to enhance students’ academic performance and well-being.
Methods: A descriptive-correlational study design was used. Participants were a total of 412 university students belonging to the selected 13 medical, scientific, and literary faculties of Jouf University, Saudi Arabia. The sample was determined randomly from different faculties. A multipart assessment tool was used to focus on assessing demographic information in terms of college, years of education, gender, parents’ educational level, marital status, and birth order. Students’ academic performance was based on their selfreported responses, as the grade point average is measured out of five. In contrast, emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire- Short Form and the Rosenberg Self-Esteem Scale used to calculate students’ self-esteem.
Results: The study found a strong positive correlation between grade point average, emotional intelligence, and self-esteem with parental educational level and academic year. Emotional intelligence and self-esteem were significantly influencing grade point average. Gender and academic year also had slight positive effects.
Conclusion: There is a significant positive correlation between academic achievement, emotional intelligence, and self-esteem. Variables like fathers, mothers, academic year, gender, and self-esteem positively impacted grade point average.

The Effect of Sudan's April 2023 War on Medical Education and Prospects for Recovery

Tahra Al Sadig Al Mahdi — 2024-09-30

Background: Sudan’s historical narrative is marked by enduring sociopolitical challenges and deep cultural divisions that have sparked numerous conflicts. A recent escalation in hostilities on 2023, April 15 has dangerously pushed the nation to the brink of a full-scale civil war with potential regional ramifications. The resultant humanitarian crisis involves over 9000 fatalities, 12,000 injuries, and the displacement of six million people, now grappling with dire conditions in their new settlements. The ongoing conflict in Sudan has had a profound impact on the nation’s already challenged medical education (ME) sector, resulting in the complete destruction of buildings and infrastructure, widespread looting in conflict zones, and a nationwide disruption of educational activities. This review sheds light on the urgent and still unfolding crisis in ME and explores potential solutions to enhance global understanding of crisis management.
Methods: The review utilizes the crisis management framework and draws insights from diverse sources such as literature, student-led webinars, and discussions with Sudanese ME experts. We have examined pre-existing challenges, analyzed the war’s impact on ME, and proposed a path forward.
Results: Despite the profound devastation, this crisis offers a unique opportunity to revamp Sudan’s struggling ME system, introducing a community-centric and socially accountable approach.
Conclusion: Through collaborative efforts, Sudan’s ME system has the potential to serve as a model for similar nations, effectively addressing the needs of its populace and fostering sustainable development.

Calculating the Notional Learning Hours (NLH) for Final-year Medical Students in a Clinical Surgery Clerkship Course

Gamal E.H.A. Shallaly — 2024-09-30

Background: The main objective of this study is to design a method to calculate the notional learning hours (NLH) of final year medical students doing a surgical clerkship course. Secondary objectives include derivation of the Oman Qualification Framework (OQF) credits and setting a benchmark of NLH in clinical courses.
Methods: This is an observational cross-sectional study which uses a quantitative way to estimate students’ NLH. A questionnaire was designed and filled by final year medical students at the end of their surgical rotation. Ethical clearance was obtained. The data were uploaded and analyzed using SPSS 25. The NLH was then calculated and mapped on the OQF template.
Results:Ninety-seven students participated in the study. Students spent an average of 1.20 (0.99) hours/day to study their clinical sessions and 2.86 (1.4)/day to study for their theory sessions. The mean weekend hours of study on Friday and Saturday were 3.1 hours (2.6), and 3.2 hours (2.5), respectively. The average preparation for the end rotation and the final MD exams were 9.7 (3.3) and 10.4 (3.6) hours, respectively. We calculated the NLH of our students by adding the above data to the contact teaching hours from our course timetable. We compared our results with worldwide medical schools.
Conclusion: The NLH of our surgical clerkship students was calculated and subsequently the OQF credits were derived. This suggested method is evidence-based and could be used as a guide by other clinical clerkship courses.

Pharmacotherapy Practices and Clinical Outcomes of Pre-eclampsia/Eclampsia: An Observational Study

Shumaila Sarwar — 2024-09-30

Background: This study observes fetal, pregnancy, and maternal outcomes with different regimens of Magnesium sulphate (MgSO4), used for prophylaxis and treatment of convulsions in eclampsia.
Methods: In this observational study, the current prescribing practice and management outcomes of pre-eclampsia/eclampsia were observed in three tertiary care hospitals in Lahore, Pakistan. Data were collected by using data collection form, containing information related to patient demographics, history, laboratory findings, drug administration record, and therapeutic outcomes for pregnancy, fetus, and mother.
Results: Of the 50 patients studied, most (74%) were of eclampsia. The mean age of the patients was 25.7 (+5.05) years with the majority (36%) in the age range 21–25 years. Forty-one patients received MgSO4, of which most received the Pritchard regimen (n = 35), whereas only 5 patients were managed with Zuspan regimen. Liner logistic analysis revealed better fetal outcomes (OR 0.217, CI –0.283 – 1.543) and pregnancy outcomes (OR 0.186, CI –0.164 – 0.635) with Zuspan regimen as compared to Pritchard. Whereas, both regimens showed no difference in maternal outcomes (OR 0.044, CI –0.129 – 0.170).
Conclusion: Zuspan regimen proved to be better in morbidity and mortality associated with eclampsia. Additionally, national as well as institutional guidelines should be developed, implemented, properly monitored, and evaluated for management of preeclampsia/ eclampsia. Mandatory in-service training and expertise should be provided for health professionals at all levels of the healthcare system, especially those working in gynecological setup.

The Effect of Disease-modifying Antirheumatic Drugs (DMARDs) on the Expression and Methylation Status of the FOXO1 gene in Newly Diagnosed Patients with Rheumatoid Arthritis

Shirin Assar — 2024-09-30

Background: The expression of forkhead box O (FOXO) was found to be connected with developing rheumatoid arthritis (RA), an inflammatory autoimmune disorder. The current study is intended to assess the expression and methylation status of the FOXO1 gene in individuals with recently diagnosed RA, before and after the administration of customary disease-modifying antirheumatic drugs (DMARDs).
Methods: Twenty participants were investigated in this study. The assessment of the FOXO1 gene expression in peripheral blood was done by real-time PCR, and the status of FOXO1 promoter methylation was ascertained via quantitative methylation-specific PCR (Q-MSP) before and after the administration of DMARDs for six months.
Results: Following DMARDs treatment, the study discovered a decrease in FOXO1 gene expression. However, the decline did not meet the criteria for statistically meaningful (P = 0.087). The expression of the FOXO1 gene was positively correlated with RA disease activity pre- and post-treatment with DMARDs (P = 0.009, r = 0.567 and P = 0.001, r = 0.656, respectively). Moreover, the study showed no alterations in the amount of DNA methylation of the FOXO1 promoter in newly diagnosed RA patients who had not yet received DMARDs, as compared to DMARDs-treated RA patients.
Conclusion: Altogether, this study suggests that DMARDs treatment may reduce FOXO1 gene expression, potentially helping to alleviate the pro-inflammatory effects associated with this gene.

Teledentistry in the Time of Conflict in Sudan

Reem Esam Siddig — 2024-09-30

Background: The War in Sudan between the Sudanese armed forces and rapid support forces has left undeniable impacts on the healthcare system which is already compromised by decades of neglect. Hospitals were bombed or occupied by conflict parties. Healthcare providers were killed or assaulted, citizens were forced to displace, and access to healthcare was impaired in many cities. Teledentistry is a modern and promising way to provide dental consultations. It is an easy, safe, and affordable solution for both patients and dental personnel in times like war. This short communication aims to urge the need to implement teledentistry to facilitate access to dental services during the current conflict in Sudan.
Methods: This article discusses teledentistry, which according to the American Teledentistry Association (ADA) is the use of electronic information, imaging, and communication technologies, such as audio, video, and data communications for oral care delivery, diagnosis, consultation, treatment, and education. The healthcare system in Sudan is currently facing many challenges such as a lack of healthcare providers, economic crisis, inability to access dental health centers, and political instability. The application of teledentistry will facilitate access to oral healthcare and provide optimum solutions during the current conflict in Sudan.
Conclusion: Implementation of teledentistry during military conflicts is a golden solution for both patients and dental care providers as it is a time-saving, cost-effective, safe, and quick way to access oral healthcare services.

In Their Own Words: Narratives of Sudanese Pediatricians Displaced By Conflict

Mohammed Alhassan — 2024-09-30

Background: This study examines the profound personal and professional impact of the armed conflict in Sudan since April 2023 on pediatricians, particularly focusing on their displacement from Khartoum and the resultant challenges in providing essential health services to children in conflict-affected areas.
Methods: Utilizing a mixed-methods approach, this study targeted displaced pediatricians from Khartoum identified via purposive sampling. Data were collected through a semi-structured questionnaire, featuring both quantitative items and an open-ended question for qualitative insights, administered electronically. The analysis combined descriptive statistics and thematic analysis with ethical oversight provided by the IRB of Prince Sattam Bin Abdulaziz University.
Results: In a study of 42 displaced pediatricians from Sudan, 66.67% were female and the majority were aged between 30 and 45 years. Despite facing adversities due to armed conflict, these pediatricians displayed remarkable resilience and continued to provide pediatric care under challenging conditions. Key themes emerged from their narratives, including professional commitment amid scarcity, emotional turmoil coupled with spiritual reflection, and relentless pursuit of providing care. Safety concerns primarily drove displacement, with 95.24% citing this as a reason. While 61.90% of the respondents relocated within Sudan, 38.10% moved abroad, reflecting the profound personal and professional impact of the conflict.
Conclusion: The armed conflict in Sudan has severely disrupted the pediatric healthcare system, leading to widespread displacement of pediatricians and jeopardizing child healthcare. The study highlights the resilience of healthcare professionals amidst adversity, their struggle to maintain care delivery, and the critical need for support and strategic planning to restore healthcare services in conflictaffected areas.