Sudan Journal of Medical Sciences
https://www.ajol.info/index.php/sjms
<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="http://www.sudjms.net/" href="http://www.sudjms.net/" target="_blank" rel="noopener">http://www.sudjms.net/</a> and <a title="https://www.knepublishing.com/index.php/SJMS" href="https://www.knepublishing.com/index.php/SJMS" target="_blank" rel="noopener">https://www.knepublishing.com/index.php/SJMS</a></p>Omdurman Islamic Universityen-USSudan Journal of Medical Sciences1858-5051<p>Copyright for articles published in this journal is retained by the journal.</p><p>This content is freely available and published under a Creative Commons Attribution License.</p>Association of <i>Helicobacter pylori</i> infection with endothelial dysfunction in metabolic syndrome
https://www.ajol.info/index.php/sjms/article/view/261939
<p><strong>Background:</strong> Metabolic risk factors play a critical role in metabolic syndrome (MetS), and endothelial dysfunction is important in its development. On the other hand, <em>Helicobacter pylori</em> (<em>H. pylori</em>) infection has an essential role in MetS. The goal of present study was to evaluate the effect of <em>H. pylori</em> infection on endothelial dysfunction in MetS patients.</p> <p><strong>Methods:</strong> Based on the International Diabetes Federation (IDF) criteria, 80 MetS patients (59 females and 21 males, mean age: 48.94 ± 10.00 years) were selected. Plasma samples were assayed for <em>H. pylori</em> IgG using the ELISA method. Endothelial function was also evaluated by measuring plasma concentrations of endothelin-1 (ET- 1), E-selectin, and intracellular adhesion molecule (ICAM-1) using ELISA method. Also, NO<sub>2</sub> <sup>−</sup> and NO<sub>3</sub> <sup>−</sup> concentrations were measured by Griess method.</p> <p><strong>Results:</strong> Fifty patients (62.5%) had <em>H. pylori</em> infection. Plasma concentrations of ET-1, NO<sub>2</sub><sup>−</sup>, and NO<sub>3</sub><sup>−</sup> were significantly higher in MetS patients with positive <em>H. pylori</em> infection than in MetS patients with negative <em>H. pylori</em> infection (ET-1: 2.92 ± 2.33 vs 1.9 ± 1.4 pg/ml; <em>P</em> = 0.037; NO<sub>2</sub> −−:19.46 ± 7/11 vs 15.46 ± 4.56 μM; <em>P</em> = 0.003; NO<sub>3</sub> <sup>−</sup>: 20.8 ± 10.53 vs 16.85 ± 6.03 μM, <em>P</em> = 0.036). However, plasma concentrations of ICAM-1 and E-selectin did not show any significant difference in the two groups.</p> <p><strong>Conclusion:</strong> The results showed a relationship between <em>H. pylori</em> infection and endothelial dysfunction. <em>Helicobacter pylori</em> infection can lead to atherosclerosis by causing chronic inflammation and affecting the factors contributing to the MetS.</p>Yousef RasmiMohammad-Hassan Khadem-AnsariNeda ValizadehFariba ValipourMohadeseh NematiFariba KhosravifarMahdieh Nemati
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2024-01-082024-01-08184418–427418–427Substance abuse and its association with adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia
https://www.ajol.info/index.php/sjms/article/view/261940
<p><strong>Background:</strong> Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs.</p> <p><strong>Methods:</strong> The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables.</p> <p><strong>Results:</strong> In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47–56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46– 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42–187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8–5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084–0.355].</p> <p><strong>Conclusion:</strong> Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.</p>Teshome SosengoEyassu Mathewos
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2024-01-082024-01-08184428–443428–443Assessment of vitamin D level and its relation to glycemic control among patients with type 2 diabetes mellitus in Khartoum State
https://www.ajol.info/index.php/sjms/article/view/261941
<p><strong>Background:</strong> Type II diabetes is a chronic hyperglycemic disorder. Vitamin D appears to be associated with chronic disease prevention and modulation of immunity. This study was designed to associate vitamin D levels with glycemic control among type 2 diabetes mellitus in Khartoum state.</p> <p><strong>Methods:</strong> This was a prospective case-control study conducted between June and November 2021 in Khartoum, Sudan. In total, 80 individuals were included in the study, of which 40 had type 2 diabetes mellitus, while the other 40 were normal, apparently healthy individuals. Vitamin D was measured by ELISA.</p> <p><strong>Results:</strong> SPSS was used for statistical analysis. Results showed that 20% of the case group (patients with diabetes mellitus) had suboptimal vitamin D levels, whereas 80% had vitamin D deficiency. Vitamin D levels were significantly decreased among the case group when compared to the control group (P-value = 0.00). The glycated hemoglobin was negatively correlated with vitamin D level (<em>P</em>-value = 0.017, <em>R</em> = –0.376).</p> <p><strong>Conclusion:</strong> In this study, a significant decrease in vitamin D was seen among people with type 2 DM. There was a weak negative correlation between hemoglobin A1C and vitamin D levels, and no significant difference in Vitamin D levels among gender and different types of treatment.</p>Ola Abdoalnasir Abdoalrasol AbdallahHafsa Ahmed Elrheima Ahmed
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2024-01-082024-01-08184444–452444–452Perception, practice, and attitude toward prostate-specific antigen test among Sudanese urologists
https://www.ajol.info/index.php/sjms/article/view/261942
<p><strong>Background:</strong> The introduction of prostate-specific antigen (PSA) has revolutionized the diagnosis of prostate cancer (PC). However, there is a wide variation in the daily practice of PSA testing with ongoing efforts to increase its sensitivity. This study aims to evaluate the attitude of Sudanese urologists toward the PSA test in their daily practice.</p> <p><strong>Methods:</strong> An online questionnaire was formed and sent to the academic group of Sudanese urologists; it was left for two months with weekly reminders. The group contains 135 members. Data were then collected and analyzed.</p> <p><strong>Results:</strong> Of the 135 members, 83 (61.5%) responded to the questionnaire, all were males, with 43% of them being consultants, and 37% having an experience between 5 and 10 years. Most participants (85%) use the test according to international guidelines, the majority (60%) counsel patients before the test, with 72% finding the test more than 50% reliable. In addition, >33% face problems when requesting PSA with >29% of them finding it unreliable. Moreover, in >13%, the test is unavailable. Nearly all participants (95%) think that there is a need for national guidelines to regulate the use of PSA tests.</p> <p><strong>Conclusion:</strong> For the diversity of practice toward the PSA test and the unavailability of adjunct methods that increase its sensitivity, there is a need for national guidelines to regulate the use of the test in the context of other clinical factors.</p>Mosab A.A AlzubierRaed Abdullah AlasmiEltahir Ahmed Eltahir
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2024-01-082024-01-08184453–464453–464Implementing accreditation standards in academic medical programs is necessary to trust higher education: the experience of two academic programs at Qassim University, Kingdom of Saudi Arabia
https://www.ajol.info/index.php/sjms/article/view/261943
<p><strong>Background:</strong> Quality assurance (QA) is becoming more critical in higher education (HE) worldwide. Quality in HE can be managed by QA, quality improvement, and quality control. This systematic review demonstrates the benefits of QA and academic accreditation in HE by examining the National Commission for Academic Accreditation and Assessment (NCAAA) accreditation standards and two accredited academic programs at Qassim University (QU) in the Kingdom of Saudi Arabia (KSA).</p> <p><strong>Methods:</strong> Elton B. Stephens Company (EBSCO) e-library was used to collect and retrieve literature from December 2022 to January 2023. Only English-language full-text papers were reviewed and cited.</p> <p><strong>Results:</strong> To assure medical education quality and encourage healthcare workforce confidence, medical educational institutions must be overseen by a QA system, such as a formal accreditation system. The World Federation of Medical Education set “Trilogy” global standards for quality improvement in medical education. The ambitious “Vision 2030” of KSA invests a large percentage of its Gross Domestic Product in education to address the significant challenges of educational quality management. The sole statutory organization in KSA that evaluates and accredits all public and private HE institutions and programs is the National Commission for Academic Accreditation and Assessment (NCAAA). The NCAAA’s accreditation standards are generally acknowledged as good practice in HE worldwide and have been adapted to KSA higher education’s special circumstances. NCAAA has recently granted accreditation to two academic programs offered by the College of Applied Medical Sciences, QU.</p> <p><strong>Conclusion:</strong> Accreditation promotes “added value” under the win-win-win “WWW” paradigm, where stakeholders win first, then the program, and finally the community.</p>Abdelmarouf Hassan Mohieldein
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2024-01-082024-01-08184465–477465–477Primary school teachers’ perspectives on ADHD in Alkadrow, Khartoum, Sudan
https://www.ajol.info/index.php/sjms/article/view/261945
<p><strong>Background:</strong> Attention deficit hyperactivity disorder, which is a prevalent neurodevelopmental condition, commonly manifests during early childhood and has the potential to adversely affect an individual’s social, academic, and occupational performance in multiple settings. Students with ADHD may struggle with attention, focus, listening, and completing schoolwork. Additionally, they may exhibit restless or disruptive behavior in class and may have learning disabilities that affect their academic performance. The aim of this study was to explore the perspectives of primary school teachers on ADHD in Alkadrow, Khartoum, Sudan.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study was conducted in Alkadrow-Bahri locality, Sudan, over a period of three to six months in 2022. The study population included primary school teachers who had taught for at least one year and encountered at least one student with ADHD. A convenience sampling technique was used to select a minimum of 59 participants, and data were collected using a self-administered questionnaire with closed-ended questions. SPSS version 23 was used to analyze the data, including descriptive statistics and inferential statistics such as chi-square tests and logistic regression analysis.</p> <p><strong>Results:</strong> The study had 59 participants, with the majority being female and in the age group of 41–45 years. The participants were mostly married and had obtained psychology courses, with a bachelor’s degree being the most common level of education. Many participants had over 20 years of teaching experience. Regarding the attitude toward attention deficit hyperactivity, most participants strongly agreed that they did have a negative/positive attitude toward it, and a majority agreed or were neutral toward ADHD. However, in the case of attention deficit hyperactivity, a significant percentage of participants disagreed or strongly disagreed with the statement.</p> <p><strong>Conclusion:</strong> The study found that most participants had a negative attitude toward student referrals for medical care and believed that most symptoms of ADHD can be lowered by aging. Additionally, more than half strongly disagreed that punishment has a positive effect on ADHD.</p>Zeinab Taha Ali OmerAya Hassan Abu AlhassanManal Mohammed Hassan AhmedAida Ahmed Fadlala AhmedSuaad Ahmed Suliman OmerSalma Mohammed GomaaSameer AlqubatiAhmed Abdalla JarelnabeMohamed Abdalla Eltahir HassanAmal Abdelgadir Ali MohamedMudathir Mohamedahmed EltayebAmna Mohammed IdrisWaled AM Ahmed
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2024-01-082024-01-08184478–487478–487 Epilepsy classification (ILAE Classification 2017) in resource-limited countries: A cross-sectional study on epilepsy in pediatric patients from Sudan
https://www.ajol.info/index.php/sjms/article/view/261971
<p><strong>Background:</strong> The objective of this study is to utilize the ILAE 2017 to classify epilepsy patients and determine its applicability in Sudan.</p> <p><strong>Methods:</strong> This study is a prospective, descriptive, cross-sectional research conducted in two pediatric epilepsy clinics in Khartoum State, Sudan.</p> <p><strong>Results:</strong> In this cross-sectional study, 350 pediatric patients with epilepsy were included, with a mean age of 8.4 ± 4.7 years and a mean illness duration of 4.71 ± 3.91 years. The ILAE classification was applied, showing that 71.11% of patients had generalized onset seizures, 27.7% had focal onset seizures, and only 1.1% had unknown onset seizures. Among patients with focal onset seizures, 56.4% had intact awareness, while 43.6% had impaired levels of awareness. The majority of patients who had generalized onset seizures experienced motor onset seizures, with tonic-clonic seizures being the most common (44.2%). Nearly all patients with unknown onset seizures experienced tonic-clonic convulsions. These findings provide insights into the prevalence and types of seizures among pediatric epilepsy patients in Sudan and can guide clinicians in developing appropriate treatment plans.</p> <p><strong>Conclusion:</strong> This study highlights the importance of utilizing the latest ILAE classification 2017 in epilepsy classification and its potential utilization in resource-limited areas like Sudan.</p>Hajatmena A M AlkhedirAbubaker A MohamedSharifIsra Bdraldein Salih MohammedInaam N Mohamed
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2024-01-082024-01-08184488–497488–497Clinical and demographic patterns of pulmonary tuberculosis in patients with diabetes mellitus: impact of diabetes mellitus on patient
https://www.ajol.info/index.php/sjms/article/view/261990
<p><strong>Background:</strong> Tuberculosis (TB) is a communicable infectious disease and one of the leading causes of death. Until the coronavirus pandemic, tuberculosis was the leading cause of death from a single infectious agent, more than HIV/AIDS. Due to urbanization and rapid social and economic development, there is a rapidly increasing diabetes mellitus (DM) epidemic and India has the second largest number of DM patients in the world. There are around 74.2 million DM cases and 40.1 million people with impaired glucose tolerance. Tuberculosis is more common in low- and middle-income countries. The increasing trend of the two diseases poses a major challenge for the tuberculosis control program.</p> <p><strong>Methods:</strong> The main goal of this research was to investigate clinical and demographic patterns of pulmonary tuberculosis in patients with DM. It is a prospective, observational, in-hospital study. We studied 165 PTB patients associated with DM who were at least scanty/1+ positive on smear or had Mycobacterium TB sputum CBNAAT detected.</p> <p><strong>Results:</strong> Of the 165 patients, 127 PTB-DM patients were male and 38 were female. The most common symptom was cough, which occurred in 164 (99.4%) patients. Fever was the second most common symptom in 152 (92.1%) patients and anorexia was the third most common symptom, occurring in 119 (72.1%) patients.</p> <p><strong>Conclusion:</strong> The majority of patients were from IPD 88 (54%), suggesting that PTB–DM cases have a more severe and complicated presentation. Male patients are affected more frequently than female patients. People in the age group 31–60 years often suffer from PTB–DM. Cough, fever, and anorexia are the most common symptoms, while chest pain and breathlessness are more common in the older age group. The history of PTB in DM patients is also of concern as the present study shows that there is a possible association with relapse or reactivation of PTB as well as drug resistance of PTB.</p>Yagnang K. VyasA. T. Leuva
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2024-01-082024-01-08184498–509498–509Application of R.E.N.A.L nephrometry score in planning type of surgery and predicting complications in RCC patients in Gezira Hospital
https://www.ajol.info/index.php/sjms/article/view/261991
<p><strong>Background:</strong> Adult renal cell carcinomas account for 80–85% of all renal tumors, making them the most common primary renal tumors. As a method for categorizing renal masses by anatomical characteristics, R.E.N.A.L score is suggested to study the effect on surgical approach in addition to perioperative outcomes and complications.</p> <p><strong>Methods:</strong> A cross-sectional prospective hospital-based study enrolled 48 RCC patients in GHRDS in the period between September 2020 and September 2021. Data regarding demographics, histological subtypes, surgical approach, intraoperative and postoperative complications were collected. Based on R.E.N.A.L score, the complexity of renal tumors is grouped into low, moderate, and high.</p> <p><strong>Results:</strong> The study sample size was 48. Twenty-five participants (52.1%) were men with a mean age of 51 years. Most cases had clear cell RCC 22 (45.8%) and papillary RCC 19 (39.6%). Thirty-nine (81.5%) patients underwent radical nephrectomy (flank incision [extraperitoneal] in 32 [82.1%] and midline incision [transperitoneal] in 7 [17.3%]), and 9 (18.5%) patients underwent partial nephrectomy. One-third of the patients 15 (31.2%) had intraoperative complications and 7 (14.6%) had postoperative complications. All intraoperative and most postoperative complications were associated with radical nephrectomy (P = 0.001). According to complexity, 21 (43.8%) patients had moderate complexity, 15 (31.2%) high complexity, and 12 (25%) low complexity.</p> <p><strong>Conclusion:</strong> Most RCC patients had moderate complexity and were subjected to radical nephrectomy. High complexities were linked to the decision of radical nephrectomy, and intraoperative and postoperative complications. More prospective research with large sample size and multi-centered studies is essential to ensure the generalizability of study findings.</p>Muzafr Shakir Ali YousifAhmed Shakir Ali YousifMarwa Gamal AbdelmagidYassin Mohammed OsmanSami Mahjoub Taha
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2024-01-082024-01-08184510–524510–524Idiopathic intracranial hypertension with transcribriform plate intranasal meningocele without cerebrospinal fluid Rhinorrhea: A case report
https://www.ajol.info/index.php/sjms/article/view/261999
<p>Idiopathic intracranial hypertension (IIH) is a rare disorder of unclear pathogenesis occurring commonly in obese women of childbearing age and characterized by increased intracranial pressure in the absence of intracranial space-occupying lesion or cerebrospinal fluid outflow obstruction. We report a rare case of a middle-aged obese female with intractable headache referred to the department of radiology for neuroimaging on account of suspected dural sinus thrombosis and brain Magnetic Resonance Imaging (MRI) which revealed signs of IIH with asymptomatic transcribriform plate intranasal meningocele with a view to underscore the quiddity of IIH in middleaged obese females and also emphasize the need for radiologists to diligently review previous patient’s images where available for possible finding that could contribute to a suspected diagnosis.</p>Khalid Mohamed AbdallaAwajimijan Nathaniel MbabaHamza Mustapha Ahmed
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2024-01-082024-01-08184552–560552–560Molecular pathogenesis and treatment strategies of Chronic Myeloid Leukemia (CML)
https://www.ajol.info/index.php/sjms/article/view/261995
<p>Chronic Myeloid Leukemia (CML) is a myeloproliferative disease diagnosed in bone marrow, arising from a chromosomal translocation between chromosomes 9 and 22, resulting in the formation of fusion oncogene <em>BCR–ABL</em>. The product of this fusion oncogene is a new oncoprotein bcr–abl which possesses abnormal tyrosine kinase activity. In response to this, abnormal signaling pathway activation occurs, leading to cell transformation. <em>BCR–ABL</em> oncogene could be targeted by tyrosine kinase inhibitors (TKIs) to delay or inhibit the disease progression. Imatinib is the first drug designed against CML but resistance to this has led to the development of the second- and third generations of inhibitors that are active against many types of <em>BCR–ABL</em> gene mutations. However, somehow, due to disease progression, TKIs do not remain as effective. There are three well-characterized phases of CML: The chronic phase (CP), the accelerated phase, and the terminal stage which is the blast crisis (BC) stage. In the CP of CML, mature granulocytes and myeloid precursors become aggregated majorly in the bone marrow and peripheral blood. The accelerated phase is marked by increased disease severity and an increase in progenitor/precursor cell number. In the BC stage, undifferentiated blast cells grow in number. Many patients with CML are diagnosed during the CP of the disease, so the survival rate of CML is high. However, 20% of CML patients proceed to advanced stages that result in drug resistance, intolerance, and mortality. So, for proper CML treatment, drugs are needed to target multiple BCR– ABL mutations, delay or stop disease progression, and overcome resistance caused by <em>BCR–ABL</em> independent mechanisms, especially during advanced phases of CML. Moreover, drugs could be developed to eradicate the stem cells of CML. These targets could be achieved by understanding mechanisms of disease progression, disease relapse, and drug resistance by utilizing high throughput molecular genetics, cell biology and immunology techniques.</p>Rabia KhalidSana Riasat
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2024-01-082024-01-08184525–538525–538An updated review on rheumatoid arthritis (RA): Epidemiology, pathophysiology, diagnosis, and the current approaches for its treatment
https://www.ajol.info/index.php/sjms/article/view/261997
<p>Rheumatoid arthritis (RA) is a systemic self-inflicted inflammatory disease that primarily affects middle-aged women. Globally, 1% of people live with RA. This review aims to provide updated information on the different aspects of RA, including its epidemiology, pathophysiology, diagnosis, treatment, and management. A web-based literature search was conducted through various databases, including PubMed, Google Scholar, and Science Direct, to identify the most relevant studies. Epidemiological studies have suggested that the prevalence and occurrence of RA have remained inconsistent across geographical areas in different periods. Many factors such as age, gender, inheritances, and environmental exposure can contribute to the severity of the disease. The acute form of RA usually presents with pain, and if left untreated, it can result in joint deformities and influence a patient’s quality of life (QoL). RA diagnosis is usually based on the manifestation of pain with inflammation. Currently, many therapeutic strategies are available for the cure of RA. The management of daily routine activities is required with treatment to curtail the damage, avoid future deformities, and ultimately minimize the aching trouble of the patient.</p>Kanwal AshiqSana AshiqAisha MobasharFarah AbidAnam YasmeenNaureen ShehzadiMuhammad Tanveer KhanKhalid Hussain
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2024-01-082024-01-08184539–551539–551Confronting challenges and proposed solutions for the Sudan immunization program amid ongoing armed conflict
https://www.ajol.info/index.php/sjms/article/view/261938
<p>No abstract</p>Muaath A. MohammedIbrahim A. AliNazik Elmalaika Husain
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2024-01-082024-01-08184413–417413–417