Sudan Journal of Medical Sciences <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" rel="noopener"></a>&nbsp;and&nbsp;<a title="" href="" target="_blank" rel="noopener"></a></p> Omdurman Islamic University en-US Sudan Journal of Medical Sciences 1858-5051 <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> War in Sudan: The Impact on Maternal and Perinatal Health <p>No Abstract</p> Ahmed A. Hassan Ishag Adam Nazik Elmalaika Husain Copyright (c) 2023 2023-10-04 2023-10-04 18 3 268–271 268–271 Coronavirus Disease Knowledge and Attitudes of Nursing Students: A Cross-Sectional Study in Saudi Arabia <p><strong>Background</strong>: The prevalence of coronavirus disease is increasing rapidly all over the world therefore, this study aimed to understand the&nbsp; knowledge and attitudes among the nursing students about the coronavirus disease.</p> <p><strong>Methods</strong>: The design of our study was cross- sectional in the period from January to March, 2020. A survey was conducted by Survey Monkey, the questionnaire link had been shared&nbsp; with the students, according to the inclusion criteria (nursing students in the third and fourth year), the questionnaire included two parts:&nbsp; (i) demographic characteristics of the students and (ii) knowledge and attitudes regarding the coronavirus disease. The number of&nbsp; participants in the study, who completed the questionnaire, was 350.</p> <p><strong>Results</strong>: The findings revealed that the average score for their&nbsp; knowledge is good, (13/17 points) reaching 79%. Total 77% students showed a negative attitude about the coronavirus disease and 79.7%&nbsp; students used the website of Ministry of Health for medical information.</p> <p><strong>Conclusion</strong>: This study showed that nursing students had a&nbsp; good knowledge about the coronavirus disease and a negative attitude. The Ministry of Health website was instrumental in imparting&nbsp; knowledge to the students about coronavirus.&nbsp; </p> Ahmed Abdalla Jarelnape Copyright (c) 2023 2023-10-04 2023-10-04 18 3 272–283 272–283 Computer-Based Clinical Examination (CCE) in Surgery: Would It Complement or Replace the OSCE in the Post-COVID-19 Era? <p><strong>Objectives</strong>: Surgical clinical assessment of medical students is confronted by many challenges particularly the increasing numbers of&nbsp; students with limited resources, and pandemics. The search for new tools of assessment continues.</p> <p><strong>Our objectives were</strong>: (1) To develop a computer-based clinical exam (CCE) and identify its characteristics (2) To assess its acceptability of&nbsp; the students.</p> <p><strong>Method</strong>: The study was conducted at the Surgical Department, Alzaiem Alazhari University (AAU) between February and August, 2017.&nbsp; We used the modular objectoriented dynamic learning environment (MOODLE) program as a platform to upload and deliver the exam.&nbsp; The exam consisted of 45 questions (stations). Each consisted of a clinical scenario accompanied by a photograph (of a patient or&nbsp; investigation) or short video followed by multiple choice questions (MCQs). A questionnaire was designed to get the students’ feedback. We analyzed the questionnaire and scores obtained by the students and compared them to their performance in other tools of the&nbsp; surgical exam, using SPSS statistical program.</p> <p><strong>Results</strong>: The study included 188 final year medical students. There was a highly significant correlation of the CCE scores of each student&nbsp; with their final result (r= 0.67), and with other tools of the surgery exam particularly the objective structured clinical examination (OSCE).&nbsp; Students’ acceptability was high.</p> <p><strong>Conclusion</strong>: The CCE is valid and practicable. It saves time and is popular with the students and tutors.&nbsp; It complements the OSCE in the assessment of clinical competency and allows wide coverage of the curriculum. It is expected to gain importance and popularity in the post-COVID-19 era.&nbsp;&nbsp; </p> Gamal E.H.A El Shallaly Mudather M. Bafadni Hozifa M.A. Abdelmaged Maysa H.A. Hamza Copyright (c) 2023 2023-10-04 2023-10-04 18 3 291–304 291–304 Wilson’s Disease and Autoimmune Hepatitis Coexistence: A Cause of Diagnostic Delay <p>This case report describes a 27-year-old housewife who presented with a progressive and insidious onset of abdominal distension, loss of&nbsp; appetite, and fatigue which started 3 months before her presentation. The physical assessment showed moderate ascites and small&nbsp; liver size, and no other peripheral evidence of chronic liver disease was observed. A diagnosis of liver cirrhosis and was confirmed by&nbsp; investigations and imaging, where ascites responded well to therapy with diuretics. Investigations for the cause of cirrhosis was&nbsp; established through the diagnosis of autoimmune hepatitis, and she was started on steroids and azathioprine with partial improvement&nbsp; in liver biochemistry. She presented 8 months later with neuropsychiatric symptoms in the form of slurred speech and difficulty walking.&nbsp; Accordingly, Wilson’s disease was suspected to be the cause and further investigations confirmed this. A chelating agent, D penicillamine, was added to her immunosuppressive treatment. Nine months later she showed slow improvement in her neurological symptoms and&nbsp; was referred for assessment for liver transplantation. Wilson’s disease, although rare, should be suspected in patients with&nbsp; decompensated liver disease. The dominance of clinical and epidemiological features of autoimmune hepatitis as a common causative&nbsp; pathology for chronic liver disease in young and middle-aged ladies may hide the presence of other serious different pathologies such as&nbsp; Wilson’s disease.&nbsp; </p> Mohammed G. Mudawi Barakat M.D. Salma Elhadi M. Awooda Copyright (c) 2023 2023-10-04 2023-10-04 18 3 305–310 305–310 Validation of the Arabic Version of Medication Regimen Complexity Index Among Older Patients - Validation of the “MRCI-Arabic” <p>The medication regimen complexity index is widely used in clinical practice and many studies, to assess the complexity of medication&nbsp; regimens. The goal of this study is to validate the medication regimen complexity index-Arabic (MRCI-Arabic) version among older&nbsp; patients.</p> <p><strong>Methods</strong>: This methodologic study was conducted in older patients (≥ 65 years old) who were native Arabic speakers at a&nbsp; community pharmacy located in Istanbul, Turkey. After the translation and cultural adaptation process finished, medication regimens of&nbsp; 30 patients were evaluated for test-retest reliability three weeks apart by the rater who was a native Arabic speaker. The inter-rater&nbsp; correlation was calculated in study population (n =100). The link between the number of medications and the score of medication&nbsp; regimen complexity was used to assess convergent validity. The difference in the score of pharmaceutical regimen complexity in&nbsp; stratified age groups was used to examine discriminant validity.</p> <p><strong>Results</strong>: The inter-rater and test-retest reliability of the MRCI-Arabic total&nbsp; scale and its subsection were extremely high (Spearman’s rho ranged from 0.996 to 1; p &lt;0.001). There was a strong and positive&nbsp; correlation between the total MRCI-Arabic score and the number of medications (r = 0.830; p &lt; 0.001), the number of chronic diseases (r =&nbsp; 0.641; p &lt; 0.001).</p> <p><strong>Conclusion</strong>: The Arabic validation of the MRCI is a validated tool that can be used by native Arabic-speaking&nbsp; healthcare professionals to determine the complexity of their patients’ medication regimens.&nbsp; </p> Nilay Aksoy Nur Ozturk Betul Okuyan Mesut Sancar Copyright (c) 2023 2023-10-04 2023-10-04 18 3 311–324 311–324 Assessment of Knowledge and Attitude of Health Workers About Dengue Fever at Al-Hodeidah Governorate <p>Dengue fever (DF) is a viral disease transmitted by mosquitoes and is emerging as a serious global health problem. However, there is still&nbsp; a lack of knowledge regarding the disease. The aim of the study: To assess the knowledge and attitude of health workers about dengue&nbsp; fever in Al-Hodeidah governorate.</p> <p><strong>Subjects and methods</strong>: Descriptive research design was used in the study with convenient sampling.&nbsp; The current study included 337 participants.</p> <p><strong>Results</strong>: The study revealed that 53% of health workers had a fair knowledge level about&nbsp; dengue fever and 78.65% of them had a positive attitude about dengue fever.</p> <p><strong>Conclusion</strong>: The study concluded that about half of health&nbsp; workers had fair knowledge about dengue fever. While about three-quarters of them had a positive attitude about dengue fever.&nbsp;&nbsp;</p> <p><strong>Recommendations</strong>: According to the current study, educational programs for nurses and midwives on dengue fever management and&nbsp; prevention should be organized.&nbsp;&nbsp; </p> Mohammed M. Al-Jabri Adel M Al Jawfi Copyright (c) 2023 2023-10-04 2023-10-04 18 3 Measuring Nurses’ Satisfaction in Primary Health Care Centers at Khartoum, Sudan <p><strong>Background</strong>: The primary healthcare sector has experienced significant growth globally, and the nursing workforce has also expanded in&nbsp; recent decades in response to health system reforms. This study aims to assess job satisfaction among primary healthcare nurses in&nbsp; Khartoum, Sudan.</p> <p><strong>Methods</strong>: This descriptive cross-sectional study was conducted in 10 primary healthcare centers on 50 nurses who&nbsp; were selected using simple random sampling. Data were collected using an online questionnaire and it was analyzed using SPSS.</p> <p><strong>Results</strong>:&nbsp; The findings of this study indicate that the job satisfaction level among nurses working at primary healthcare centers in&nbsp; Khartoum was high (4.4/5). Most nurses reported high satisfaction with all items including protocols, salary, environment, and relationships. The study also found a significant correlation between nurses’ sex and experience with their level of job satisfaction.&nbsp; Female nurses reported significantly higher job satisfaction (4.4/5) compared to male nurses (3.6/5), (p-value = 0.04). Additionally, nurses&nbsp; with fewer years of experience reported significantly higher job satisfaction compared to those with more years of experience (p-value =&nbsp; 0.03).</p> <p><strong>Conclusion</strong>: The study concludes that nurses working at primary healthcare centers in Khartoum have high job satisfaction,&nbsp; particularly regarding the working environment, salary, relationships, and availability of guidelines. Female nurses and those with less&nbsp;&nbsp; experience have significantly higher job satisfaction.</p> Yahya Hussein Ahmed Abdalla Copyright (c) 2023 2023-10-04 2023-10-04 18 3 358–369 358–369 Out-of-Wedlock Pregnancy Among Single Mothers in Khartoum, Sudan: Sociodemographic Characteristics, Causes, and Consequences <p><strong>Background</strong>: Out-of-wedlock childbearing is a global phenomenon that has lifelong consequences on the lives of both mothers and their&nbsp; children. The aim of this study is to identify the sociodemographic characteristics, causes, and consequences of outof-wedlock&nbsp; pregnancy among single mothers in Khartoum, Sudan.</p> <p><strong>Methods</strong>: This descriptive, cross-sectional study was conducted at the Mygoma Orphanage Center (MOC) and Shamaa Rehabilitation&nbsp; Center (SRC) using convenience sampling among 200 participants. A validated questionnaire with 25 items was used to collect data. The&nbsp; data were entered into Epi-Data Manager and analyzed using the SPSS.</p> <p><strong>Results</strong>: The study found that most of the single mothers in Khartoum who gave birth out of wedlock were young and had just&nbsp; completed their university education. Most of them discovered their pregnancy during the second or third trimester, and nearly half of&nbsp; them did not receive any antenatal care. The majority of the children born to these mothers were preterm and had a low birth weight.&nbsp; Additionally, many mothers reported experiencing social stigma and rejection from their families due to their out-of-wedlock pregnancy.&nbsp; The study also highlighted loneliness, stress, and romantic relations as the main causes of out-of-wedlock pregnancy among single&nbsp; mothers in Khartoum, Sudan.</p> <p><strong>Conclusion</strong>: The study provides useful insights into the sociodemographic characteristics, causes, and&nbsp; consequences of out-of-wedlock pregnancy among single mothers in Khartoum, Sudan. Social stigma and lack of support were identified as significant barriers to the reintegration of single mothers and their children into society. Future research should focus on investigating&nbsp; the long-term effects of outof-wedlock pregnancy on mothers and their children.&nbsp;&nbsp; </p> Amal Abdelgadir Ali Mohamed Elshafee Ahmed Apaker Babiker Sohair mohmoud Godat Salma Mohammed Gomaa Doalbet Aida A.F. Ahmed Maha Hamed Mohamed Ali Abdalkhaliq Ahmed Obadi Amna Mohammed Ali Mustafa Amani Awad Elkarim Taha Amira Elnour Eltayeb Elbashir Ragaa Gasim Ahmed Fahad A. Alghamdi Waled A.M. Ahmed Copyright (c) 2023 2023-10-04 2023-10-04 18 3 377–390 377–390 Factors Associated with Access to the Saudi Primary Healthcare in Light of Vision 2030 <p>Objective: Primary healthcare is a comprehensive approach to ensuring universal<br>access to essential healthcare services. The Ministry of Health in Saudi Arabia has<br>developed health-related objectives to enhance the accessibility of healthcare services<br>and refining its policies. However, certain obstacles may impede the delivery and<br>accessibility of healthcare, particularly to primary healthcare centers. The current study<br>explored the variables associated with the accessibility of primary healthcare services<br>in the context of Saudi Vision 2030. In particular, the research focused on examining<br>the organizational and doctor-patient communication factors that are linked to primary<br>healthcare accessibility.<br>Methodology: In this cross-sectional study, an electronic questionnaire is used to<br>collect data from patients visiting the primary healthcare facilities located within the<br>second health cluster in Riyadh, Saudi Arabia.<br>Results: The findings indicate that the organizational factors that have the greatest<br>influence on primary healthcare accessibility are the proximity of the primary healthcare<br>centers, the rapid and convenient nature of the registration and payment procedures,<br>the cleanliness, design, and clarity of the facility, and the availability of up-to-date<br>technologies and equipment. As for the factors affecting access to primary healthcare<br>in doctor-patient communication, the most notable factors include the provision of<br>respectful treatment by the doctor toward patients, attentive listening to patients’<br>concerns and questions, and clear explanation of treatment plans and outcomes.<br>Conclusion: The findings of this study demonstrated the effect of several factors<br>on primary healthcare accessibility, which will benefit the policymakers in healthcare<br>planning in Saudi Arabia to improve the quality and accessibility to primary healthcare<br>centers.</p> Ahmed Nasser Al-luhaym Salah Alshagrawi Copyright (c) 2023 2023-10-04 2023-10-04 18 3 391–401 391–401 CD20 Negative Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type with Rapidly Progressing Skin Lesions <p>A 95-year-old man came with violaceous nodular skin lesions of the left shin. The lesions were not painful or pruritic but progressed&nbsp; rapidly over the 3 months. Fever, night sweats, weight loss, and other systemic symptoms were absent. Shave biopsy of the lesion&nbsp; revealed the cells negative for CD20 but positive for <em>BCL2, BCL6, FOX-P1, and CD10</em>. PET/CT showed high uptake in the left leg and a&nbsp; sizeable hypermetabolic lymph node in the left pelvis. The patient was started on rituximab treatment as a single agent. This report&nbsp;&nbsp; highlights some of the diagnostic and treatment difficulties in CD20 negative lymphomas and the importance of a multidisciplinary&nbsp; approach in those cases. </p> Dalya M.M. Abdelmaged Carol A. Avila Abubaker A. MohamedSharif Isra Bdraldein Salih Mohammed Copyright (c) 2023 2023-10-04 2023-10-04 18 3 284–290 284–290 Customized Preliminary Impression: A Novel Impression Technique for Severely Resorbed Edentulous Ridges <p>Patients with long-term edentulism and/or ill-fitting (poorly fitted) dentures are more likely to experience severe mandibular alveolar&nbsp; ridge resorption. Some of these patients have genial tubercles that rise over the mandibular residual ridge in the anterior region and&nbsp; protrude into the floor of the mouth. Typically, the most prominent portions of the resorbed mandibular edentulous ridge are in contact&nbsp; with the lingual flanges of the mandibular stock impression trays (i.e., genial tubercles and internal oblique lines). In these situations, it is&nbsp; advised that a preliminary custom impression tray be created to pour an initial impression, allowing for the fabrication of individual custom trays. In general, dental practice for the fabrication of the complete denture, the stock trays are used for making the preliminary&nbsp; impression and the custom trays for the final impression. The present article portrays an innovative and efficient clinical technique&nbsp; involving the fabrication of a customized preliminary impression tray for preliminary impression making particularly in unconventional&nbsp; situations, that is, pronounced mandibular alveolar ridge resorption.&nbsp;</p> Arpit Sikri Jyotsana Sikri Tarun Kalra Ritika Sharda Natasha Bathla Sahil Thakur Copyright (c) 2023 2023-10-04 2023-10-04 18 3 325–337 325–337 Pagophagia-Induced Hyponatremia: An Unusual Case <p>Hyponatremia occurs when the serum sodium level is below 135 mmol/L. The symptoms include nausea, vomiting, confusion, headache,&nbsp; cardiorespiratory symptoms, profound somnolence or coma, and seizures are observed. Iron deficiency anemia can also cause&nbsp; pagophagia, a Pica subspecies. Although it has been emphasized that electrolyte disturbance may develop due to pagophagia, only a dearth of cases was reported. A 59-year-old male patient was brought to the emergency department with complaints of incoherent&nbsp; speech that started at night, disorientated movements (such as fluttering and climbing), insomnia, restlessness, and confusion. In 2017,&nbsp; he experienced hyponatremia due to pagophagia and a salt-free diet. At the index episode of hyponatremia, he experienced confusion,&nbsp; drowsiness, and sleepiness. It was learned that the patient enjoyed these symptoms.For this purpose, the patient made a habit of eating&nbsp; a completely salt-free diet and consumed plenty of water. Although pagophagia is considered to cause hyponatremia because it causes excessive water intake, there are not enough cases reported. It is to be noted that people develop habits or addiction to things they like.&nbsp; </p> Aydanur Akbaba Mustafa Bogan Ceren Karakeçili Fatma Boğan Hasan Sultanoglu Copyright (c) 2023 2023-10-04 2023-10-04 18 3 370–376 370–376 Consolidating Medical Education in Sudan During War <p><strong>Background</strong>: Providing quality medical education in Sudan faces challenges due to armed conflicts. This short communication explores&nbsp; practical solutions for ensuring the continuity of medical education during the conflict in the Sudanese context.</p> <p><strong>Methods</strong>: A comprehensive literature review covered relevant articles published from 1915 to 2023. Four major databases (PubMed,&nbsp; Scopus, Web of Science, and Google Scholar) were searched using keywords related to medical education, war, armed conflict, and&nbsp; affected countries. Data synthesis identified common themes, challenges, and trends and suggested solutions for medical education in&nbsp; conflict zones. Case studies from Ukraine, Liberia, and Iraq were included for a comprehensive understanding.</p> <p><strong>Results</strong>: Collaborative alliances among medical schools facilitate resource sharing and support. Engaging the Sudanese diaspora through&nbsp; virtual collaborations, mentorship programs, and faculty exchanges enhance educational experiences. Stable regions as educational hubs ensure uninterrupted academic progress for students from conflict-affected areas. Online and remote education, including asynchronous&nbsp; learning and social media platforms, overcome access barriers and fosters knowledge sharing. Ambulatory teaching&nbsp; provides practical experience and adaptability. Prioritizing faculty well-being and professional development through training and support&nbsp; is crucial. Emphasizing resilience and adaptability in student education prepare them for healthcare delivery in resource-limited&nbsp; settings. Research and innovation contribute to evidence-based strategies. International collaboration and support offer opportunities&nbsp; for knowledge exchange and infrastructure improvement.</p> <p><strong>Conclusion</strong>: Implementing collaborative strategies and innovative approaches&nbsp; helps Sudanese medical schools overcome challenges during armed conflicts and maintain quality medical education. These solutions&nbsp; empower students and faculty, enhance resilience, and contribute to improving healthcare systems in post-war Sudan.</p> Mohamed H. Taha Nazik E. Husain Wail Nuri Osman Mukhtar Mohamed Elhassan Abdalla Copyright (c) 2023 2023-10-04 2023-10-04 18 3 402–412 402–412