Sudan Journal of Medical Sciences 2021-02-08T14:53:02+00:00 Editor-in-Chief Open Journal Systems <p>Sudan JMS is a joint project of continuous medical education program at Faculty of Medicine - Omdurman Islamic University, The National Centre for Gastroenterology and Liver Diseases, Ibn Sina Hospital and Omdurman teaching Hospital (Sudan). Sudan JMS is published every three months. High-quality papers written in English or Arabic language dealing with aspects of medical sciences are welcomed. Sudan JMS publishes original articles, case reports, Letter to the Editor, commentaries and peer reviews.</p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a> and <a title="" href="" target="_blank"></a></p> Effects of nurse’s work environment and practice on patient’s safety 2021-02-08T07:00:16+00:00 Montaha Mohammed Ibrahim Hammad Ali Fadlalmola <p><strong>Background:</strong> When a patient with an acute medical illness is admitted to a hospital, their safety is a prime concern for healthcare professionals. Ongoing nursing assessment is a type of nursing assessment that commences at the beginning of every shift. and **is completed on every patient. This information is used to develop a plan of care. The aim of this study is to assess the application of ongoing nursing assessment approaches in intensive care units.<br><strong>Methods:</strong> This cross-sectional hospital-based study included a total of 135 nurses, of which 23 (17%) were from Khartoum hospital, 62 (46%) from Alshaab hospital, 15 (11%) from Soba University Hospital, and 35 (26%) from National Center for Neurological Science.<br><strong>Results:</strong> The ongoing nursing assessment approaches were available in most intensive care units of the study area with the domination of ABCDE approach. Factors that can impact the thoroughness of the ongoing nursing assessment performance suggested by the studied participants were nurses’ knowledge and competency, followed by insufficient time and resources to carry out the assessment.<br><strong>Conclusions:</strong> Most participants did not complete the assessment suggesting a poor performance. The knowledge base of the participants was not reflected in their practice with a wide difference between them.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Prevalence of post-partum depression among Sudanese women using Edinburgh Postnatal Depression Scale (EPDS) in two major delivery hospitals in Khartoum State 2021-02-08T07:08:55+00:00 Maram Osman Elawad Mabyoue <p><strong>Background:</strong> Postpartum depression is a mood disorder that can affect women after childbirth; it can occur at any time during the first year after delivery. Mothers experience depressive symptoms that may make it difficult for them to complete daily care activities. The aim of this study was to find out the prevalence of postpartum depression among Sudanese women as well as determining the association between postpartum depression (PPD), socio-demographic, and obstetric characteristics.<br><strong>Method:</strong> In this cross-sectional study, 129 women selected through convenient sampling technique were interviewed; the participants were recruited from the postnatal and child welfare clinics at the Saad Abueleella and the Dream International<br>Hospitals. To assess any possible depression, information was collected at six weeks postpartum using a structured questionnaire in addition to a screening tool.<br><strong>Results:</strong> At a cutoff score of ≥12, the prevalence of PPD was found to be 10.9% (Confidence Interval 6.5–17.3%); while 79.1% of mothers revealed no signs of PPD and scored &lt;9 points, 10.1% scored 9–11, indicating a need for extra visits. Interestingly, 59.7% of the respondents were aged between 25 and 35 years, 76% were university graduates, 64.3% housewives, 20.9% had obstetric complications, 3.1% reported a history of PPD, and almost 97.7% breastfed their babies. Moreover, PPD was found to be associated with occupational status (p = 0.01) and a previous history of PPD (p =<br>0.01).<br><strong>Conclusion:</strong> The prevalence of postpartum depression was 10.9% among the studied sample. Interventions to address its risk factors should be implemented, physicians and health personnel should be qualified on screening and referring depressed mothers<br>for further clinical assessment.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Tele screening, triaging of dental patients, and reopening of dental services during SAR-CoV2 pandemic 2021-02-08T07:17:19+00:00 Elhadi M. Awooda Reem E. Siddig <p><strong>Background:</strong> The nature of dental profession requires a dentist to be in a close proximity to the patient’s mouth to perform various operative treatments including procedures such as generating aerosols. As such, dentistry is considered as one of the riskiest profession for the cross-transmission of SARS-CoV2. Although the prevalence and incidence of SARS-CoV2 continue to increase worldwide; the dental services and treatment of non-emergency cases have resumed in many countries including Sudan. Moreover, the use of smartphone technology in communication with patients can play an important role in controlling the spread of SARS-CoV2. Therefore, the aim of this short review was to draw a summary on using smartphone technology for<br>telescreening dental patients prior to their visit to the clinics and to set guidelines and rules for dental treatment during SARS-CoV2 pandemic.<br><strong>Methods:</strong> For the purpose of this study, telescreening is referred as a virtual contact between patients and healthcare personnel used to provide health services during the highly contiguous SARS-CoV2 pandemic. Using a smartphone, dental patients can be screened and questioned about their medical history and particularly for SARS-CoV2 (for symptoms such as fever, headache, coughing, breath shortness, loss of smell or taste). They should also be asked about their travel history to epidemic area, visiting hospital or coming in contact with a confirmed SARS-CoV2 patient during the last 14 days. On arrival to a dental clinic, the patient’s temperature should be measured, instruction for wearing masks, hand hygiene, and keeping distances from others inside the waiting zone.<br><strong>Conclusion:</strong> Telescreening and triaging will minimize the time of patients’ exposure to dental clinic environments, hence decreasing the risk of getting SARS-CoV2 infection for both patients and dental healthcare workers.</p> 2021-02-08T00:00:00+00:00 Copyright (c) The controversy on the role of ACE2 receptor in COVID-19 infection: the protective shift toward the ACE2 axis 2021-02-08T07:23:20+00:00 Saray I.Y. Ahmed <p><strong>Background:</strong> Angiotensin-converting enzyme 2 (ACE2) is recognized as the main cellular receptor for the new coronavirus, SARS-CoV-2, that facilitates its entry into the host target cell, leading to the fatal viral infection, coronavirus disease 2019 (COVID-19). Thus, it is considered as a main therapeutic target in the SARS-CoV-2 infection. The dual role of ACE2 as a gate for SARS-CoV-2 virus and as a part of<br>lung and multi-organ protection has built a scientific debate that affects the choice of treatments used against COVID-19 patient. ACE2 inhibitors like anti-ACE2 antibodies were first introduced as therapeutic solutions that, theoretically, would decrease the availability of target molecules for SARS-CoV-2 by downregulating ACE2 expression. However, animal studies showed that ACE2 upregulation acts as a counterbalance to the hypertensive pro-inflammatory angiotensin I-converting enzyme (ACE) in the renin–angiotensin system (RAS) and results in a protective role against acute lung injury – a fatal consequence of the disease. The current study tests the effect of ACE2-activating treatments against the outcome of genetic variations in the population that have ACE2-upregulatory effects.<br><strong>Conclusion:</strong> Despite its role as a receptor for the SARS-CoV-2 virus, experimental studies and the genetic polymorphisms in populations that have ACE2 upregulation revealed a protective role against COVID-19 infection.</p> 2021-02-08T00:00:00+00:00 Copyright (c) The importance of theory to inform practice — theorizing the current trends of clinical teaching: a narrative review 2021-02-08T07:29:42+00:00 Ahmad AbdulAzeem Abdullah Omer <p>Clinical teaching lies at the heart of physicians’ training; however, it is often opportunistic, haphazard, and lacks a theoretical foundation. Medical education is a profession that requires robust scientific methods and an evidence-based approach driven by accountability and patient safety concerns in the healthcare provision nowadays. Learning theories are increasingly applied in the realm of medicine with implications to the quality of teaching and learning in the clinical environment and the professional growth of medical graduates. These theories elucidate the basic tenets ambient to the intricate process of learning and answer some basic questions of how people learn. Educational theories provide a myriad of benefits to the teaching and learning approaches in the clinical environment. It arms teachers with a repertoire of educational tools and sets out principles to justify their use and predict the conditions under which they may likely work. It enables clinicians to design their teaching based on well-developed objectives and robust methods for their evaluation. As such, learners’ capacity to achieve clinical competence is enhanced and their identity formation and other essential attributes of clinical expertise are potentiated. However, it has been reported that learning theories are neither well-articulated in clinical teaching nor educators and clinicians are formally trained on their application in the clinical context. Continuous professional development and faculty training about learning theories are essential to lift their capability to teach effectively in the clinical environment. This article revisited the main learning theories and discusses their application to enhance teaching and learning in the clinical context.</p> 2021-02-08T00:00:00+00:00 Copyright (c) IL1 𝛽 exon5 3954 C/T Polymorphism: a potential genetic risk factor of heart diseases’ predisposition in Sudanese patients 2021-02-08T07:52:24+00:00 Manal A. Fadl Sahar S. Noor Algalil <p><strong>Background:</strong> IL-1β was known to cause an inflammation in heart tissue leading to progressive loss of contractile tissues. The aim of this study was to evaluate “for the first time” the relationship between IL-1β polymorphism (rs1143634) and the risk of heart diseases (HDs) in Sudanese patients.<br><strong>Methods:</strong> Fifty patients with HD and 65 healthy controls were enrolled in this crosssectional study. The IL-1β (rs1143634) polymorphism was detected by PCR-RFLP using TaqI restriction enzyme.<br><strong>Results:</strong> About 82% of the HD cases were aged &gt;40 years. No gender difference was reported between the two groups (<em>P</em> = 0.28). 24% of the cases had a previous history of heart attack. Family history of HD was associated with a six-fold increased risk of HD.<br>The analysis provides evidence that the mutant genotype (CT + TT) of the IL1β polymorphism is significantly associated with HD, with up to four-fold increased risk of the disease (<em>P</em> = 0.015, OR = 3.8). The mutant allele T was significantly higher in HD patients as compared to the controls (P = 0.023). The frequency of the CT genotype among patient who have family history, previous attack of HD, hypertension, and diabetes was 79%, 33%, 81%, and 90% respectively.<br><strong>Conclusion:</strong> The IL1β (rs1143634) polymorphism was associated with the increased risk of HD in our samples. The carriage of the mutant allele among those who have family history of HD, previous attack, hypertension, and diabetes might be a predictive factor for the onset of clinical manifestation of HD in Sudanese patients.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Prevalence and risk factors of depression among adult Type 2 diabetic patients at Al-Jemaih Diabetic Center, Dongola, Northern State, Sudan, 2019 2021-02-08T08:01:06+00:00 Mohamed Osman Abdelaziz Mohamed Ali Alzain Mohammed Abdalmageed Abdalkhaleg <p><strong>Background:</strong> Type 2 diabetes and depression are common diseases with bidirectional associations. Depression in diabetics leads to poor adherence to diet and medication, poor glycemic control, reduced quality of life, and increased diabetes-related healthcare expenditure. This study aimed at evaluating diabetic patients with depression to improve the quality of care delivered.<br><strong>Materials and Methods:</strong> An institution-based cross-sectional study was conducted among adult type 2 diabetics at Al-Jemaih Diabetic Center, Dongola, in July– December 2019A standardized pretested questionnaire was used to collect data, and the depression subscale of the Patient Health Questionnaire was used to diagnose depression. Chi-square test and logistic regression were used to analyze the data using the Statistical Package for Social Sciences version 25.0.<br><strong>Results:</strong> Out of the 407 participants, 282 (69.3%) were females, and more than half were aged between 40 and 59 years. The prevalence of depression among type 2 diabetic patients was 35.6%, ranging from mild (24.3%) to moderate (7.4%), moderately severe (2.2%), and severe depression (1.7%). The risk factors associated with depression in type 2 diabetes were: combining antidiabetic therapy, long duration of diabetes, family history of psychiatric illness, diabetes-related complications, poor glycemic control, and lack of regular exercise.<br><strong>Conclusion:</strong> More than a third of type 2 diabetics have depression. Screening diabetic patients for depression, establishing a psychiatric unit at the diabetic center, and community-based studies are recommended.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Thorax gunshot and sharp cutting tool injuries: for 5 months Nyala experiences 2021-02-08T10:41:08+00:00 Hüseyin Fatih Sezer Hakan Dayanir <p><strong>Background:</strong> The two most common causes of penetrating thoracic trauma are firearm injuries and injuries by sharpened cutting tool. Penetrating thoracic injuries are risk factors for high mortality and morbidity, so they need to be diagnosed correctly and timely in order to perform an effective intervention. In this study, patients with penetrating thoracic trauma were treated through surgical intervention accompanying minimal morbidity–mortality compared to literature, even though they were admitted relatively late.<br><strong>Methods:</strong> In this retrospective study, 29 gunshot and stab wounds penetrating thoracic trauma patients were admitted to the emergency department of Nyala Sudan Turkey Education and Research Hospital between April and September 2018.<br><strong>Results:</strong> Of the 29 patients, 7 (24.13%) were gunshot injuries and 22 (75.86%) were injured with a sharp cutting tool. While 13 of the cases (44.82%) were admitted on the day the incident took place, 5 of them (17.24%) were post-traumatic first day of the admission, 9 of them (31.03%) were post-traumatic day 2, whereas 1 of them (3.44%) was post-traumatic the third day of admission. Finally, 14 patients (48.28%)<br>were followed-up conservatively without tube thoracostomy, while 15 patients (51.72%) underwent tube thoracostomy in follow-up. No patient was operated for penetrant trauma. Mortality was not seen.<br><strong>Conclusion:</strong> Patients with penetrating thoracic trauma were treated by surgical interventions accompanying minimal morbidity–mortality even though they were admitted relatively late to healthcare facilities.</p> 2021-02-08T00:00:00+00:00 Copyright (c) The cross-talk relationship between metformin and gut microbiota 2021-02-08T08:28:48+00:00 Hyder O. Mirghani <p><strong>Background:</strong> Metformin is the first-line oral therapy for type 2 diabetes mellitus. However, its mode of action is poorly defined. There is an increasing awareness regarding the cross talk of gut microbiota and metformin. The current review aimed to assess the bidirectional relationship between metformin and gut microbiota.<br><strong>Methods:</strong> Electronic search was conducted in Pub Med and the first 100 articles in Google Scholar published until November 2019. However, only randomized controlled trials on humans published in the English language were included. The terms “gut microbiota,” “gut flora ”and “ metformin” were as keywords to perform the search. Although 124 articles were retrieved, only six met the inclusion criteria of the study.<br><strong>Results:</strong> Of the six full texts of randomized controlled trials included in the study, two-thirds were published in Europe, one in the USA, and one in China. Six hundred thirty five patients were included and the duration of the studies ranged from seven days to six months. The studies concluded that microbiota modulates some metformin actions on plasma glucose; while metformin enhances the abundance of microbiota<br>that positively affect insulin resistance and plasma glucose.<br><strong>Conclusion:</strong> The current review showed that microbiota dysbiosis may mediate metformin antidiabetic effects. Whereas metformin shifted the gut microbiota toward the beneficial species ameliorating insulin resistance. The present study might provide insights into a novel therapeutic approach to treat type 2 diabetes mellitus.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Enhancing the knowledge of cervical cancer screening among female nursing students: an interventional educational program 2021-02-08T08:35:57+00:00 Hayam Fathey A. Eittah Khalid Abdullah S. Aljohani Mohammed Saeed E. Aljohani <p><strong>Background:</strong> Cervical cancer is a growing health risk facing women worldwide with the human papillomavirus (HPV) as the primary underlying cause. Pap smear is a simple screening test that can detect early changes in cervical cells, which might develop into cancer cells. Raising awareness of cervical cancer prevention has a significant impact on decreasing the burden of the disease. The aim of the study is to assess female nursing students’ knowledge on early detection and screening of cervical cancer, and to determine the effectiveness of an educational program.<br><strong>Methods:</strong> A quasi-experimental research design (one group for pre- and post-tests) was utilized with a convenience sample of 130 female nursing students in one of the nursing colleges in Saudi Arabia. The study’s educational intervention included information about anatomy of genital tract and the importance of regular check-ups. The pre- and post-tests were applied to identify changes after intervention measures.<br><strong>Results:</strong> The mean age of the participants were 21.32 years (SD: 1.34). The findings revealed a significant improvement of post-test students’ knowledge in all items related to risk factors, signs and symptoms, occurrence, identification of HPV as causative agent, vaccination against HPV, and finally Pap smear for early detection and screening of cervical cancer.<br><strong>Conclusion:</strong> The study results support implementing educational intervention to improve nursing students’ knowledge and awareness about cervical cancer prevention. Furthermore, it is imperative that cervical cancer awareness education modules should be developed and integrated within the nursing curriculum. Further studies with large sample size are recommended to increase generalization of the<br>results.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Errors and near-miss errors encountered by nursing students in clinical settings in governmental universities, Khartoum State (2018) 2021-02-08T10:51:31+00:00 Sahar Ahmed Mohamed Toum Samah Abdalla Montahaa Mohammed <p><strong>Background:</strong> Identifying and analyzing the occurrence and sort of student clinical errors which will allow for early detection of problems and offer chance for system evaluation and improvement. This study intended to explain the types of errors along with near-miss errors encountered by nursing students in clinical settings.<br><strong>Methods:</strong> This descriptive cross-sectional study was conducted at five recognized governmental universities in Khartoum State and included 470 nursing students in their fourth year (2017–2018)who met the selection criteria of the study. A full-converge sampling method was used and data were first collected by the researcher using published self-administered survey and then analyzed.<br><strong>Results:</strong> Initially, the study included 519 nursing students but only 470 of them responded(at a rate of 90.5%).The responses showed that while one-third of them, that is, 162(34.5%) students, had never encountered an error, 99(21.1%), 79 (16.8%), 71 (15.1%), 46(9.8%), and 13(2.8%) of them encountered errors with respect to needle stick, medical administration, omission of treatment, and wrong treatment, respectively.<br>Regarding the near-miss errors encountered by the respondents, almost half, that is, 202(43%)of them had never encountered a near-miss errors, while 112(23.8%), 106(22.6%), 18(3.8%),17(3.6%), and 15(3.2%) of them encountered near-miss errors with respect to medication administration, omission of treatment, wrong patient, providing wrong treatment and others such as improper bedrail used, did not follow sterile<br>precautions respectively.<br><strong>Conclusion:</strong> This study concluded that errors and near-miss errors exist and that awareness on clinical errors and near-misses nEed to be raised and strategies be developed for error management.</p> 2021-02-08T00:00:00+00:00 Copyright (c) Treatment of acute bronchiolitis in a resource-limited setting in Port Sudan City: a simple effective regimen 2021-02-08T10:57:46+00:00 Suhair Abdelrahim Osman Hassan <p><strong>Background:</strong> Bronchiolitis is an acute lower respiratory viral infection, caused by the Respiratory Syncytial Virus (RSV) in 60–85% of cases and other respiratory viruses in remaining ones. It is the leading cause of hospitalization for infants and toddlers during the winter and early spring months. At the moment, there is no consensus on its treatment worldwide. The prevalence is increasing in port Sudan eastern Sudan, while we have no admission policy or a unified management protocol. Therefore, the aim of this study is: (1) to formulate an admission policy and a new simple management protocol; (2) to determine the factor(s) that increased the prevalence in port Sudan as a secondary objective; and (3) to compare the outcome in the study (119 infants) and historical (135 infants) groups concerning the hospitalization length and death rate as<br>a primary objectives.<br><strong>Method:</strong> This is a hospital-based, controlled clinical trial (CCT) study, demographic data were collected by a questionnaire, and data were analyzed manually. Severity criteria for acute bronchiolitis are defined. A management guideline was defined and applied to bronchiolitis cases (119 case) with intention to treat, from October to April each year (2013–2015). All infants aged between 1 and 23 months with only acute bronchiolitis were included, while cases with bronchiolitis and associated dysmorphic features, heart disease, tracheo-oesophageal fistula, other respiratory diseases, other morbidities, infants below one month or above two years were excluded from this study. The outcome was compared to a group of matched infants with bronchiolitis (135 cases) who received antibiotics, B2 agonist, and steroids, between October and<br>April of years 2011–2012.<br><strong>Results:</strong> While several new lifestyle factors increased the prevalence, the new guidelines decreased the admission rate (9.6 vs 5.7 mo), is simple and effective, less expensive, and the duration of hospitalization also reduced (p = 0.04).</p> 2021-02-08T00:00:00+00:00 Copyright (c) Diagnosis of viral diseases in Sudan: coronaviruses unveil the concealed venues 2021-02-08T14:45:46+00:00 Wadie M.Y. Elmadhoun Nadir Abuzeid Shahinaz Bedri M.H. Ahmed <p>Establishing the diagnosis of viral diseases often needs sophisticated settings, equipment, expertise, and strict laboratory methods. In Sudan, as in most developing countries, viral diseases are mostly diagnosed by clinical presentation. As most viral infections are self-limiting and there is no specific treatment for most of them, laboratory diagnosis has not been a focus for improvement, particularly in public sector until the current pandemic of COVID-19. During this pandemic, the vital need for well-equipped clinical virology laboratories is urged. The aim of this work is to highlight the various diagnostic methods and to describe the current situation of clinical virology diagnostics in Sudan.</p> 2021-02-08T00:00:00+00:00 Copyright (c)