Sudan Journal of Medical Sciences (SJMS)

Editorial – Commitment Toward Accreditation of Medical Schools During Natural Disasters and War in Sudan

MohamedAhmed Ibnouf, Khalid Sirelkhatim, Nasir Elhaboob Arabi, Mohamed Ibnouf — Fri, 29 Mar 2024 00:00:00 +0000

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

Effect of Uncontrolled Type-II Diabetes Mellitus and Its Duration on Nerve Conduction Parameters in Adult Sudanese Patients in Khartoum State

Kamal Awad, Ahmed Abdalgadir, Asim Osman, Mohammed Saeed, Makawi Osman — Fri, 29 Mar 2024 00:00:00 +0000

Background: Peripheral neuropathy is a serious complication of diabetes, which has socioeconomic consequences as well as a reduced quality of life. Early neuropathic process recognition and management could alter its course and considerably reduce the associated morbidity and mortality. This study determines the effect of long-term glycemic control on diabetic peripheral neuropathy in people with type 2 diabetes (T2DM).

Methods: A hospital-based study was carried out at the National Centre of Neurosciences and Ibrahim Malik Hospital in Khartoum. All individuals who were older than 18 years and have had T2DM for less than 10 years were recruited. Using accepted techniques, the BMI, HbA1c level, and nerve conduction studies (NCS) were measured. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25.0 software. P-value ≤ 0.05 was considered significant.

Results: Of the 95 patients with T2DM, 52 were male patients. Our findings showed that as the duration of diabetes increased, the sensory velocity reduced from 64.07 ± 3.22 to 54.00 ± 5.34 and the motor nerve from 63.39 ± 2.38 to 53.87 ± 2.08 (P = 0.05, P = 0.003, respectively). Additionally, with increased duration of diabetes, a significant decrease was seen in both motor nerve amplitude from 8.79 ± 3.11 to 6.94 ± 1.84 (P = 0.05) and sensory nerve amplitude from 25.71 ± 5.70 to 19.51 ± 6.51 (P = 0.003). Also, all parameters of NCS (velocity and amplitude) decreased when Hb A1c was >6 – sensory velocity from 63.96 ± 2.36 to 55.49 ± 2.43 (P = 0.03) and motor velocity from 63.00 ± 2.59 to 51.44 ± 1.66 (P = 0.02). And sensory amplitude decreased from 26.91 ± 1.26 to 20.85 ± 2.1 (P = 0.05), while motor amplitude decreased from 6.88 ± 3.55 to 6.61 ± 3.29 (P = 0.05). Additionally, there is a substantial (P = 0.05) correlation between sensory and motor amplitudes and the BMI.

Conclusion: High BMI and poorly controlled (high HbA1c) long-term diabetes had a negative impact on all nerve conduction study parameters.

Integrated Whole Exome and Transcriptome Sequencing in Cholesterol Metabolism in Melanoma: Systematic Review

Fri, 29 Mar 2024 00:00:00 +0000

Background: Melanoma is a highly malignant form of skin cancer that exhibits remarkable metabolic adaptability. Melanoma cells exhibit the capacity to adapt to specific conditions of the tumor microenvironment through the utilization of diverse energy sources, thereby facilitating the growth and advancement of the tumor. One of the notable characteristics of metabolic reprogramming is the heightened rate of lipid synthesis. This review was conducted to illustrate how the integration of whole exom and transcriptome sequencing will enhance the detection of the effect of cholesterol metabolism in melanoma.

Methods: The Cochrane database, Embase, PubMed, SCOPUS, Google Scholar, Ovid, and other databases were thoroughly searched for works addressing integrated whole exome and transcriptome sequencing in cholesterol metabolism in melanoma. Skin malignancy, melanoma progression, transcriptome sequencing, whole exome sequencing, transcriptome sequencing by RNA sequencing, and integrated transcriptome and whole exome sequencing were the key phrases employed. This article underwent a phased search for pertinent literature using a staged literature search methodology. Each section’s relevant papers were identified and summarized independently. The results have been condensed and narratively given in the pertinent sections of this thorough assessment.

Results: DNA-based analysis has proven to be ineffective in identifying numerous mutations that have an impact on splicing or gene expression. RNA-Sequencing, when combined with suitable bioinformatics, offers a reliable method for detecting supplementary mutations that aid in the genetic diagnosis of geno-dermatoses. Therefore, clinical RNA-Sequencing expands the scope of molecular diagnostics for rare genodermatoses, and it has the potential to serve as a dependable initial diagnostic method for expanding mutation databases in individuals with inheritable skin conditions.

Conclusion: The integration of patient-specific tumor RNA-sequencing and tumor DNA whole-exome sequencing (WES) would potentially enhance mutation detection capabilities compared to relying solely on DNA-WES.

Anatomical Variations of the Nose and Paranasal Sinuses in Sudan

Fri, 29 Mar 2024 00:00:00 +0000

Background: To study the anatomical variations of the nose and paranasal sinuses using Computed Tomography (CT) in Sudan during 2020–2022.

Methods: This is a descriptive cross-sectional study conducted in the radiological departments of Sudanese hospitals between 2020 June and 2022 June. The total number of patients was 111 of both sexes.

Results: In this study, CT of 111 patients was analyzed. The patients were aged 18–80 years (mean age: 33 years) and comprised of 52.3% females and 47.7% males. The most common anatomical variants in the study group were pneumatization in sphenoid sinus-sellar type (71.2%), attachment of uncinate process into lamina papyrecea (69%), Keros type II (63.1%), deviated nasal septum (42.3%), concha bullosa (37.8%), and Onodi cells (20%). The opacity of the sinus was seen in about half (49.5%) of the CT, with more common sinus involvement being maxillary sinus (35.1%) followed by frontal sinus (8.1%) and ethmoid sinus (6.3%). There was no opacity in the sphenoid sinus in this study.

Conclusion: The most common anatomical variants in the study group were pneumatization in the sphenoid sinus-sellar type. The opacity of paranasal sinuses was more common in the maxillary sinuses.

Benefit of Finnish Score As a Risk Assessment Tool for Predicting Type II DM Among Sudanese Population in North Sudan

Fri, 29 Mar 2024 00:00:00 +0000

Background: Diabetes mellitus is a major noncommunicable disease worldwide, and its prevalence is rapidly increasing. The Finish score helps in the prediction of the risk of future diabetes development, as well as in the identification of undiagnosed diabetes. The current study was conducted to identify people at risk of developing type II diabetes mellitus in River Nile State, Sudan.

Methods: This cross-sectional community-based study was conducted in River Nile state between 2019 October and 2020 March. Data were collected using a questionnaire that included the Finnish Diabetes Risk Score variables from 400 participants after an informed consent. Chi-square test was used to test the associations, with the P-value considered significant when <0.05.

Results: The majority of participants (257 [64.3%]) were <45 years old, and 229 (57.3%) were male. The risk of type II diabetes mellitus was found to be low in 187 (46.8%) people and high in 213 (53.2%). Moreover, 128 (32%) had a body mass index (BMI) between 25 and 30 kg/m2, while 46 (11.5%) had >30 kg/m2. A waist circumference of <94 cm was found in 147 (36.8%) males, while only 63 females (15.8%) had a waist circumference of <80 cm. Age, gender, BMI, daily activity, history of hypertension, history of hyperglycemia, and family history of diabetes were all significantly associated with the risk of developing diabetes mellitus (P < 0.001).

Conclusion: The Finnish Diabetes Risk Score was found to be useful in facilitating wider access to the risk of type II diabetes among the study population. More than half of the study population were at risk of developing diabetes mellitus.

Epidemiological Analysis of Tongue Lesions in a Tertiary Health Facility in Tanzania

Karpal Singh Sohal, Boniphace Kalyanyama, Uchenna Okechi — Fri, 29 Mar 2024 00:00:00 +0000

Background: The tongue is susceptible to a multitude of conditions that can be of developmental, neoplastic, or inflammatory nature, whose occurrence varies globally by age, sex, and ethnicity. The objective of the present study was to determine the incidence of tongue lesions among cases managed in a tertiary hospital in Tanzania.

Methods: This study analyzed histological results of patients with tongue lesions diagnosed between 2016 and 2021. Data on the age and sex of the patients and histological diagnosis were collected. Data analysis was done using Statistical Package for the Social Sciences version 27.

Results: A total of 190 samples of tongue lesions were studied and 18 different histological diagnoses were observed. Generally, a majority (84.2%) of the biopsied tongue lesions were malignant. The most common (74.7%) lesions diagnosed were squamous cell carcinoma followed by hemangioma (5.3%). A significant association was noted between the nature of the lesions and the age group and sex of the patients.

Conclusion: This analysis depicts that tongue lesions are frequently encountered in patients managed in tertiary health facilities in Tanzania. A majority of these lesions are malignant tumors. The sex and age of the patients are determining factors for the occurrence of tongue lesions.

The Role of Vitamin D in COVID-19 Survival and Prevention: A Meta-analysis

Shamina Begum, Hyder Osman Mirghani — Fri, 29 Mar 2024 00:00:00 +0000

Background: COVID-19 is still ongoing with frequently discovered new strains, although vaccines are highly effective for prevention. Literature on vitamin D supplementation in COVID-19 prevention and its effect on survival is scarce. This meta-analysis assessed the role of vitamin D supplementation in COVID-19 prevention and survival.

Methods: Four databases (Web of Science, SCOPUS, PubMed, MEDLINE, and the first 100 articles of Google Scholar) were searched for articles published up to September 2023. The keywords used were COVID-19, mortality, vitamin D supplementation, calcitriol, cholecalciferol, Calcifediol, survival, death, and prevention. Six hundred and seven studies were retrieved, and four hundred and three remained after duplication removal; of them eighty-three full texts were screened, and of them, only sixteen (prospective, randomized controlled trials, and retrospective studies) were included in the final meta-analysis.

Results: Sixteen observational studies including 5905,109 patients and 186,500 events were included. Vitamin D supplementation reduced mortality among patients with COVID-19 patients, odd ratio, 2.31, 95% CI, 1.49–3.58; in addition, supplementation was effective in COVID-19 prevention, odd ratio, 1.92, 95% CI, 1.01–3.64.

Conclusion: Vitamin D supplementation prevented COVID-19 and increased survival among patients admitted with moderate/severe COVID-19.

Perception of Doctors at Elobied Teaching Hospital Toward Antibiotics Resistance As a Health Threat

Fri, 29 Mar 2024 00:00:00 +0000

Background: Resistance to antibiotics has increased dramatically over the past few years and has now reached a level that places future patients in real danger. Several factors contribute to this problem, some of them are health workers related and others are community related. This study aimed to assess the awareness of doctors in Elobeid hospital, North Kordofan state, Sudan about the problem, its causes, and its possible preventive measures.

Methods: This descriptive, questionnaire-based study was conducted in Elobeid teaching hospital between 2020, February 27 and March 13. The study involved 50 doctors in the internal medicine department.

Results: Out of the 50 doctors involved, 49 (98%) agreed that antibiotics resistance is a big progressive health threat in Sudan; 86% of the participants think that selfmedication is the leading cause of antibiotic resistance; and 98% believe that providing good quality culture and sensitivity service in hospitals and health centers is the most effective preventive measure. Regarding education about antibiotics as a part of academic activities in the unit during the last year, 36% of the participants received zero sessions, 68% received 1–5 sessions, and 12% received more than 5 sessions. The assessment of doctor’s adherence to the Sudan Standard Treatment Guideline revealed that 28/50 participants (56%) did not see it or hear about it, 17/50 participants (34%) know it but don’t comply, and only 5/50 participants (10%) know it and comply with it.

Conclusion: Participants show a good awareness about the significance of antibiotics resistance as a health threat, a good awareness about the main causes and the possible preventive measures, a low to moderate frequency of education on antibiotics, and a very poor adherence to the Sudan Standard Treatment Guidelines.

Knowledge, Attitude, and Practice Regarding COVID-19 Skin Manifestations among Doctors Working at Khartoum Dermatology and Venereology Teaching Hospital, 2021

Naaila Kabashe, Suad Hassan Hamid El Hassan, Assad Ali Rezigalla — Fri, 29 Mar 2024 00:00:00 +0000

Background: COVID-19 is a global pandemic caused by SARS_COV2. The symptoms of covid-19 include: fever, dyspnea, fatigue, a recent loss of smell and taste, sore throat, cough, and cutaneous lesions. In addition, some skin manifestations were reported to be associated with COVID-19.

Methods: The study design is a descriptive cross-sectional hospital-based study. The study aimed to evaluate the level of knowledge and practice about skin manifestations of COVID-19 among doctors working at Khartoum dermatology and venereology teaching hospital. A self-administrated questionnaire was used for data collection after an informed consent was taken.

Results: Among 140 doctors working in the dermatology and venereology teaching hospital, 75.7% of the doctors had knowledge that COVID-19 can present with skin manifestations. The study results showed that about half of the participants have poor knowledge about COVID-19 skin manifestations while 25% have no knowledge, and that 35 (25%) doctors have good knowledge. From a total of 140 doctors; 46.4% reported that when patients present with COVID-19 skin lesions, they will isolate them in separate rooms and call the epidemiology center, whereas, 61 doctors (43.6%) did not know if they have a protocol for COVID-19 suspected cases. This study reported a significant association between job category and level of knowledge toward COVID-19 skin manifestations measured by Chi-square test, the P-value was 0.003 (significant at 0.05), and the same significant association was found between the year of rotation and knowledge.

Conclusion: Half of the doctors covered by this study had poor knowledge about COVID-19 skin manifestations, and therefore, educating doctors in dermatology hospitals about skin manifestations of COVID-19 is recommended, besides clear and precise guidelines and protocols for diagnosis and management.

The Impact of an Educational Training Program on Basic Life Support and First Aid to Manage Risk Among Mechanical Engineering Students at Sudan University

Fri, 29 Mar 2024 00:00:00 +0000

Background: Mechanical engineering students spend several hours in primitive workshops and laboratories for training as part of their academic curriculum; they are exposed to various types of hazards such as machines, flammable materials, and other dangers. These machines are one of the causes of amputation, crushing, and broken bones among these students. This study aims to explore how training in first aid (FA) and basic life support (BLS) helps mechanical engineering students at Sudan University of Sciences and Technology manage risks in such situations.

Methods: The current study had a quasi-experimental design, and 100 students were chosen through stratified systematic random sampling. Data were gathered via questionnaire and observational checklist, whose content validity and reliability were confirmed (r = 0.87 and r = 0.82, respectively). Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0 for descriptive and inferential statistics. The program was delivered through a series of 13 lectures conducted over a total of 65 hr.

Results: All tests had a maximum mean knowledge score of 50 points. At the pretest, students’ overall knowledge of FA and BLS was low (13.82), however, it improved to 49.87 and 48.77 at posttest one and posttest two, respectively, after the intervention. Statistically significant differences were seen between pre- and posttest one (P = 0.000) and between pre- and post-late (P = 0.000). In the pretest, the total proportion of the students’ practices related to FA and BLS was low (12.87%). However, when the program was implemented, the total percentage of practices increased in posttest one (95.65%) and posttest two (95.21%). This indicates the effectiveness of training programs.

Conclusion: Students lacked knowledge and practice in FA and BLS before the intervention. The training helped enhance their skills. FA and BLS programs should be included in university curricula to help students manage risks in workshops and laboratories.

Nursing Students’ Perception Toward Team-based Learning at Nile University, Sudan

Fri, 29 Mar 2024 00:00:00 +0000

Background: Team-based learning (TBL) is a student-centered approach which has been used in health professions education and has demonstrated effectiveness in promoting students’ learning, engagement, and application of knowledge. This study aimed to assess undergraduate nursing students’ perception about TBL as an instructional strategy at Nile University.

Methods: A descriptive cross-sectional study was carried out among undergraduate nursing students at Nile University in Sudan. A structured questionnaire was filled out by 43 students out of 48 total students in cardiothoracic module, where 5 students refused to participate. Data were analyzed by descriptive and inferential statistics using the SPSS version 16.

Results: The findings showed that nursing students had high level of agreement with TBL in all domains of study, the higher score was noted in learning and engagement and motivation (86.80% and 87.44%, respectively). They demonstrated high positive perception on the usage of TBL in nursing education, P-value = 0.00.

Conclusion: The study concluded that nursing students have a positive perception about TBL method and that it improved students’ learning behaviors; the more effect was in students’ learning and communication skills in speaking English and transferring knowledge to others.

Prevalence of Leishmania donovani Infection in Humans and Dogs in Gadarif State, Sudan: A Diagnostic Comparison

Fri, 29 Mar 2024 00:00:00 +0000

Background: Leishmania donovani is a protozoan parasite that causes visceral leishmaniasis, a potentially fatal disease in humans and dogs. The epidemiology and transmission dynamics of L. donovani in Sudan are poorly understood. We aim to determine the prevalence and characterization of L. donovani in human hospital cases and domestic dogs using different diagnostic methods in two localities in Gadarif State, Sudan.

Methods: A cross-sectional study was conducted from October 2019 to April 2020. Whole blood samples and lymph node aspirates were collected from 69 human and 32 dog participants for parasitological, immunological, and molecular tests.

Results: No parasites were detected in blood samples from either humans or dogs. Lymph node microscopy revealed 71.01% positivity in humans and 9.4% in dogs. The IT Leish test showed 82.6% positivity in humans and 43.75% in dogs. PCR confirmed L. donovani infection in all six selected samples (three from humans and three from dogs).

Conclusion: The study confirmed the presence of L. donovani in both human and dog populations in the study area, suggesting that dogs may act as reservoirs or hosts for the parasite. The IT Leish kit test was the most sensitive and specific method, while microscopy of blood and lymph node smears was the least sensitive method. Further studies are needed to elucidate the role of dogs in the transmission cycle of L. donovani and the risk factors associated with human infection.

Health Ramifications and Recovery Avenues for Sudan’s April 2023 Armed Conflict: A Review

Tahra Al Sadig Al Mahdi, A. H. Fahal, Abdelmuniem S. El Mardi — Fri, 29 Mar 2024 00:00:00 +0000

Background: Sudan’s history is marred by ongoing sociopolitical challenges, with deep cultural divisions fueling numerous wars. A new conflict erupted on April 15, 2023, pushing the country closer to a full-scale civil war. This war has severely crippled Sudan’s already fragile healthcare system, rendering 70% of hospitals in combat zones nonoperational, causing 12,000 deaths, thousands of injuries, and leaving 11 million in dire need of healthcare. More than seven million people are displaced, half of which are children, and are facing severe health challenges, especially vulnerable groups. Heath situation is threatening with unchecked spread of outbreaks of communicable diseases that were previously controlled and marked failure in meeting the health demands of patients with noncommunicable diseases, reproductive and child health issues, and people with serious conditions that require adequate follow-up. Moreover, the projections threaten with more catastrophic consequences including famine, environmental destruction, and further displacement of people. This review article highlights the urgency of the situation and explores potential solutions to enrich global understanding of crisis management.

Methods: To comprehensively assess the impact of the crisis and propose a way forward, we drew data by exploring search engines and databases such as Google, Humanitarian Agencies Websites, Google Scholer, and PubMed along with some relevant reports. The search terms included are “Sudan’s war”, “impact of war on healthcare systems”, and “Sudan’s armed conflicts”.

Results: More than 19 publications on the impact of the war on health in addition to periodic reports from international organizations and governmental authorities were reviewed.

Conclusion: Although all publications point to the gravity of the situation and the need for prompt response, this crisis offers a unique opportunity to rebuild Sudan’s struggling healthcare system with the principles of social accountability. Through domestic and international collaboration, this sector can become a model for similar nations, meeting the needs of its people and promoting sustainable development.