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"></a> and <a title="" href="" target="_blank"></a></p> en-US <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> (Editor-in-Chief) (Dr. Aamir Yassin) Thu, 01 Jul 2021 15:18:05 +0000 OJS 60 Editorial: Diagnosis of COVID-19 in Countries with Limited Health Resources – Blood Markers versus rRT–PCR <p>No Abstract.</p> Imad Fadl-Elmula, Rayan Khalid Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Mapping the Reproductive Health Communication Landscape: A State-of-the-art Review <p><strong>Background:</strong> Reproductive health communication encompasses family planning, maternal, neonatal and child health, and sexual and&nbsp; reproductive health communications for adolescents and youth as fundamental elements for intervention. The objective of this study was to summarize, examine, and identify gaps in the theoretical, methodological, empirical, and measurement literature on reproductive health communication as it relates to Ethiopia.</p> <p><strong>Methods</strong>: A systematic search was conducted using electronic databases such as the Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO), and Google Scholar to locate theoretic, psychometric, and empirical literature on reproductive health communication.</p> <p><strong>Results:</strong> Local literature identified by the databases were mainly based on crosssectional designs, had small sample size and lacked essential psychometric protocols. Results showed that most studies replicatively focused on spousal communication centering&nbsp; reproductive choices and decisions. A common strategy was to use student populations as data sources limiting the generalizability of findings.</p> <p><strong>Conclusion</strong>: The need for more diverse designs and areas of investigation using better instrumentation is indicated.</p> <p><br><strong>Keywords</strong>: communication, reproductive, family planning, child, spouse, health</p> Amanuel Gebru Woldearegay Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Assessment of Disease Activity and Complications in Patients of Pulmonary Tuberculosis by High Resolution Computed Tomography <p><strong>Background:</strong> Tuberculosis (TB) is a global health problem and the second most common infectious cause of death. High-resolution&nbsp; computed tomography (HRCT) is far more superior to chest radiography as well as conventional CT for analyzing the pulmonary parenchyma. This study aimed to evaluate the role of HRCT in pulmonary tuberculosis (PTB) with respect to disease activity and&nbsp; complication after anti-tubercular therapy (ATT).</p> <p><strong>Methods:</strong> This prospective observational study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College &amp; Research Centre (TMMC&amp;RC) for a period of 1.5 years. A total of 50 cases of newly diagnosed TB were included in the study and a standard six-month ATT was given to the patients. Pulmonary involvement was evaluated by HRCT (128 slice multi-detector PHILIPS INGENUITY CT scanner), twice for each patient (first scan after diagnosis and second after treatment completion). The acquired HRCT images were reconstructed on a highresolution lung algorithm and parenchymal, bronchial, and extra parenchymal findings were recorded systematically.</p> <p><strong>Results:</strong> Out of the 50 patients, 5 died within two months of the initiation of treatment and four were lost to follow-up. Thus, post&nbsp; treatment follow-up sample size was reduced to 41 patients. Ill-defined nodules (96%), tree-in-bud pattern (74%), consolidation (86%),<br>cavitary lesions (98%), and ground glass opacities (58%) were the main imaging features of active cases of TB on HRCT. Resolution to thin-walled cavitary lesions (36.5%), bronchiectasis (41.5%), and fibrotic (parenchymal) bands (66%) were common complications or sequelae which were observed after completion of treatment.</p> <p><strong>Conclusion</strong>: HRCT thorax is a sensitive modality for evaluation of parenchymal and airway manifestations in cases of PTB and can aid in differentiation of active disease from healed disease. It allows early identification of post-treatment complications and sequelae in patients of PTB.</p> <p><strong>Keywords</strong>: HRCT, lung, tuberculosis, pulmonary, complications</p> Ashwani Jain, Ankur Malhotra, Deepti Arora, Mazher Maqusood, Sunil Kumar Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Knowledge and Practice Regarding Coronavirus Disease Prevention (COVID-19) Among Internally Displaced Persons in Camps in Central Darfur Region, Sudan <p><strong>Background</strong>: The lacking healthcare system services in conflict areas and the emergence of infection with a pandemic of coronavirus&nbsp; disease may exacerbate the humanitarian crisis among the camp residents in the central Dafur region of Sudan. Adequate knowledge and practices are vital to prevent coronavirus disease 2019 (COVID-19). Therefore, this study aimed to investigate the knowledge and practice<br>regarding COVID-19 among internally displaced persons in Sudan.</p> <p><strong>Methods:</strong> In this cross-sectional study, data were collected through an online survey using a self-administered questionnaire. Convenience sampling method was used for the internally displaced persons in two camps of Zalingei town, central Darfur region, Sudan.</p> <p><strong>Results:</strong> In total, 143 participants responded; 75 (52.4%) of them were female, while 68 (47.6%) were male; 49 (34.3%) were between the age of 50 and 60 years; 78 (54.5%) were formally uneducated; 126 (88.1%) did not have a chronic disease; and 56 (39.2%) knew about COVID-19 from their relatives and friends. The overall mean of participants’ knowledge toward COVID-19 was 3.68 (SD ± 0.60(, denoting good with a rate of 73.6% and that of the practice was 2.65 (SD ±1.08), denoting moderate with a rate of 53%. A positive correlation was seen between knowledge and practice (r = 0.700, p &lt; 0.000). Statistically significant differences were observed between the mean score of knowledge and practice with age, education, and information sources (p &lt; 0.0001). While graduates showed a higher knowledge (116.29, p = 0.000), secondary respondents showed a higher practice (115.04, p = 0.000) than others.</p> <p><strong>Conclusion</strong>: This study suggests educational intervention and awareness programs for uneducated and older people.</p> <p><strong>Keywords:</strong> Darfur, camp residents, knowledge, practical measures, COVID-19</p> Mohammed Abdelkrim, Adam Abdelmalik, Abdalbasit Adam Mariod, Mohamed Adam Beraima, Hammad Ali Fadlalmola, Eltagi Elsadeg Sulliman Rahama, Huda Khalafallah Masaad, Mohammed Ibrahim Osman Ahmed, Ibrahim Abbakr Ibrahim Abbakr, Eyas Gaffar Abdelraheem Osman, Ibrahim Musa Ibrahim Hassan Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Rare Presentation of Wilson Disease in an 11-year-old Sudanese Girl <p>Background: Wilson disease is an inherited disorder in which excessive amount of<br>copper accumulates in various tissues of the body. Clinical features related to copper<br>deposition in the liver may appear in the first and second decades followed by<br>neurologic and psychiatric thereafter; however, many patients have a combination<br>of these symptoms.<br>Case: We report a case of 11 year-old girl, admitted to Wad Medani Pediatric<br>Teaching Hospital with generalized body swellings for four days. Initial investigations<br>showed proteinuria and hypoalbuminemia, thought to be due to nephrotic syndrome.<br>Days later, patient developed jaundice and neuropsychiatric manifestations. A slit<br>lamb examination confirmed the presence of Kayser–Fleischer ring (KF ring) and<br>she scored high in the scoring system for the diagnosis of Wilson disease. Dpenicillamine<br>treatment therapy was started and unfortunately the patient’s clinical<br>condition deteriorated gradually, and eventually went into deep coma and died. Wilson<br>disease mainly affects the liver, but the initial presentation was completely compatible<br>with nephrotic syndrome.<br>Conclusion: Diagnosis of Wilson disease should be suspected in a child presenting<br>with generalized body swellings even in the absence of clinical evidence of hepatic<br>and/or neuropsychiatric involvements.<br>Keywords: Wilson disease, nephrotic syndrome, case report, pediatrics, Sudan</p> Mumen Abdalazim Dafallah, Elsanosi Habour, Esraa Ahmed Ragab, Zahraa Mamoun Shouk, Fawzeia Hamad, Fawzeia Hamad, Musaab Ahmed, Mohamed H. Ahmed Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Research Article The Polymorphisms of Epidermal Growth Factor-driven Signaling and Cancer Pathogenesis <p><strong>Background:</strong> Epidermal growth factor (EGF) is a stimulating protein for cell proliferation and differentiation. An amplification of its signaling pathway has been frequently reported in numerous malignant tumors. Specific polymorphisms of the genes encoding proteins involved in this cellular pathway may constitute risk factors for carcinogenesis. The aim of this study was to identify the most relevant&nbsp; polymorphisms of EGF and their signaling pathways and their relation to carcinogenesis.<br><strong>Methods:</strong> The study included 40 full-text articles published between January 2010 and May 2020, extracted from PubMed, Scopus, Web of Science, and Science Direct databases in May 2020, using the following keywords: EGF OR epidermal growth factor AND polymorphism AND cancer OR neoplasia OR tumor.<br><strong>Results:</strong> We identified relevant polymorphisms of the EGF signaling pathway that were involved in the development and progression of hepatocellular carcinoma, esophageal cancer, gastric cancer, colorectal cancer, glioma, lung cancer, breast cancer, cervical cancer, and head and neck cancer. Rs4444903 variants have been widely studied and the association with numerous tumors has been confirmed by multiple studies. Other frequently investigated polymorphisms are –191C/A and –216G&gt;T.<br><strong>Conclusion</strong>: The polymorphisms of EGF signaling pathway have been widely studied in connection to various malignancies. Some&nbsp; predisposing variants are common in different forms of cancer. These polymorphisms might be general risk factors for carcinogenesis.</p> <p><strong>Keywords</strong>: epidermal growth factor, cancer, polymorphism, signaling pathway</p> Monica Dugăeșescu, Florentina Mușat, Octavian Andronic Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Prevalence of Social Anxiety Disorder among Medical Students from Six Medical Schools in Khartoum State <p><strong>Background</strong>: Social anxiety disorder (social phobia) is a type of anxiety disorder which is characterized by significant anxiety and&nbsp; discomfort about being embarrassed, humiliated, rejected, or looked down on in social interactions. Although it affects about 30% of adults worldwide at some point in their lives, lifetime social anxiety disorder affects only about 4% of the world population. People with this disorder experience extreme fear of social interactions (e.g., public speaking and meeting new people). This anxiety affects daily functions and lasts at least six months. They may also experience strong physical symptoms like rapid heart rate, nausea, vomiting, and full-blown attacks. Social phobia can be treated by a combination of psychotherapy and medical treatment (e.g., anti-anxiety, antidepressants, and beta-blockers).<br><strong>Methods:</strong> This study was conducted using the Arabic SPIN and a group of questions to assess the associated factors, complications, and sociodemographic determinate of social anxiety disorder and included a total of 375 medical students from different universities and educational years.<br><strong>Results:</strong> The overall prevalence of social anxiety disorder among our participants was 61.3%, of which 19.2% had mild, 21.6% moderate, 10.9% severe, and 9.6% had very severe SAD. There was a significant difference regarding self-esteem, academic achievement, and drug addiction between students with social phobia and students with no social phobia.<br><strong>Conclusion:</strong> Social phobia is quite prevalent among Sudanese medical students, particularly the severe form of the disorder with no significant gender differences. It seems to affect self-esteem and academic achievement and can be associated with drug addiction.</p> <p><strong>Keywords:</strong> social phobia, prevalence, medical students, Sudanese </p> Hazeem Abeljaleel Suleiman, Sara Ahmed Elamin, Abdalaziz Awad Alobeid, Wegdan Elshame Altaib Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 The Relationship between Serum Vitamin D Level and Psychosomatic Symptoms in Females in Mosul City <p><strong>Background</strong>: A widespread severe deficiency of vitamin D (vit D) exists in Iraq, especially among women of reproductive age. Depression or anxiety is related to deficiency of vit D. These patients may present with psychosomatic symptoms which are symptoms with no sufficient organic cause in the body but from psychological causality. The study aimed to investigate the serum level of vit D in females with psychosomatic symptoms residing in Mosul City, Iraq and explore the effect of vitamin D3 (vit D3) supplements for treating psychosomatic symptoms.<br><strong>Methods:</strong> A total of 73 female patients aged 15–45 years presented with several symptoms. All patients underwent physical examination and psychiatric interviews. Patients with minimal to mild depression were selected. All included patients underwent investigation of first serum vit D level. The supplementation with vitamin D3 was started. The second serum vit D level was investigated at first post-improvement visit.<br><strong>Results</strong>: In the improved group, the post-supplementation serum vit D level was higher than that before the supplementation (p = 0.00). In addition, the vit D serum difference before and after its supplementation was greater in the improved group than the nonimproved one (p = 0.00). Patients not only experienced improvement in their mood swings, but also recovered from other recorded symptoms such as headache, fatigue, tiredness, and joint pain.<br><strong>Conclusion</strong>: This study revealed a noticeable association concerning serum levels of 25-OH D and mild depression in addition to&nbsp; psychosomatic symptoms in females living in Mosul City. Supplementation with suitable loading vit D3 dosages improved these symptoms showing a probable causal relationship.</p> <p><strong>Keywords</strong>: psychosomatic symptom, vit D, depression, vit D3 supplementation</p> Janan A. Alrefaee, Ban K. Rushdi, Ghada K. Adeeb Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Assessment of Knowledge, Qualification, Experience, and Medication Dispensing Practices in South Karachi, Pakistan <p><strong>Background</strong>: Drug stores in Pakistan are run by dispensers with varied knowledge, qualification, and experience. The current study was sought to explore the knowledge, qualification, experience, and dispensing practices among dispensers working in drugstores in South Karachi, Pakistan.<br><strong>Methods:</strong> A cross-sectional survey was carried out using a structured questionnaire. Data were collected from medical stores in South&nbsp; Karachi which were then categorized, coded, and analyzed using SPSS version 23. Relationship among different study variables with pharmacist’s availability and personal experience was assessed using statistical non-parametric Chi-square test. A total of 385 samples obtained using a simple random sampling method were included in the study. However, only 210 responses on questionnaire were complete which were then selected for study analysis between October and December 2018.<br><strong>Results:</strong> Of the 210 surveyed drugstores, 9% of their staff had studied only till primary school, 5.7% till the eighth grade, 25.2% up to&nbsp; secondary school level, 26.7% till higher secondary school level, 15.7% had non-professional education, and 8.1% were professional&nbsp; graduate. Only 9% of them had a degree in Pharm. D or B. Pharm, while 0.5% had a post-graduation qualification. Furthermore, 44.8% of pharmacies had a valid pharmacy license but the pharmacist was physically absent in 91% of the drugstores. Majority of pharmacies did not maintain appropriate temperature (refrigerator and/or room temperature). Majority of dispensers did not review prescription&nbsp; particulars before dispensing medications and also dispensed medications on older prescriptions as well as without prescription.<br><strong>Conclusion</strong>: In conclusion, the overall knowledge and practices of dispensers working in drugstores was poor. However, the presence of pharmacist was associated with good dispensing practices to a certain extent.</p> <p><strong>Keywords:</strong> community pharmacy, good dispensing practice, pharmacist, prescription review</p> Nauman Haider Siddiqui, Abdullah Dayo, Mudassar Iqbal Arain, Muhammad Ali Ghoto, Saira Shahnaz, Ramesha Anwar, Jibran Khan Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017 <p><strong>Background</strong>: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017.<br><strong>Methods:</strong> This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases&nbsp; registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment.<br><strong>Results</strong>: A total of 710 TB cases of which 53.4% were men, 22.1% children (&lt;15 years), and 36.2% extrapulmonary TB (EPTB) were&nbsp; registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome.<br><strong>Conclusion:</strong> The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.</p> <p><strong>Keywords:</strong> refugees, Sudan, treatment outcome, tuberculosis</p> Tsegay Legesse, Mohammed Hussein Elduma, Nagi Masoud Awad, Mousab Siddig Elhag, Israa Abushama, Hamdan Mustafa, Kabashi Hashim, assan Mahmoed, Yassen Mohamed, Ahmed E. Dafalla, Fathia Alwan, Desta Kassa Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Association between Inflammatory Cytokines and Liver Functions in Rheumatoid Arthritis Patients <p><strong>Background</strong>: Rheumatoid arthritis (RA) is associated with abnormal liver tests, and the medications used for RA are often hepatotoxic.&nbsp; Therefore, this study aimed to investigate an association between pro-inflammatory and anti-inflammatory cytokines and liver function tests in RA patients.</p> <p><strong>Methods:</strong> In this descriptive cross-sectional study, 88 RA patients were included, 84 of them were women and 4 men, aged 21–81 years. Serum interleukin-10 (IL-10), interleukin-17 (IL-17), Osteopontin (OPN) were measured and liver function tests were conducted.</p> <p><strong>Results:</strong> The frequency of RA was higher among adults aged &gt;41 years (72 [81.8%]) than young adults aged ≤41 years (16 [18.2%]). RA was more common in women (84 [95.5%]) than in men (4 [4.5%]) – approximately 21:1-fold. Young adults had higher abnormal IL-10 than adult RA patients (OR = 3.72, p-value 0.044). Abnormal IL-17 (OR = 5.67, p-value 0.034) was found to be increased in young-adult RA patients. No association was observed between age and OPN and between the duration of disease and IL-10, IL-17, and OPN. Similarly, no association was noted between the types of treatment and IL-10, IL-17, and OPN, nor between IL-10, IL-17, OPN and liver parameters (AST, ALT,<br>ALP, ALB, TP, and GGT).</p> <p><strong>Conclusion</strong>: Pro-inflammatory and anti-inflammatory cytokines are not associated with abnormal liver functions, as has been&nbsp; demonstrated in RA patients.</p> <p><strong>Keywords:</strong> rheumatoid arthritis, interleukin, liver function tests, cytokines</p> Mohamed Abdelrhman Eltahir, Kawthar Abdelgaleil Mohammedsalih, Elhaj Noureldien Mohamed, Faisal Makki Babekir, Amar Mohamed Ismail Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Feelings, Stress, and Coping of Nurses Amidst COVID-19 Outbreak in Saudi Arabia <p><strong>Background:</strong> A year after the COVID-19 pandemic spread around the world, the pandemic is still affecting healthcare systems with an increasing number of infected healthcare workers. Such a unique situation may often result in emotional turmoil, anxiety, depression, and fear, which could lead to resignation and burnout. The study intended to assess the feelings of nurses toward the COVID-19 outbreak; ascertain the factors that cause stress; and determine their coping strategies and factors contributing to coping.<br><strong>Methods:</strong> A descriptive cross-sectional design was utilized to recruit 313 nurses working in the Ministry of Health (Saudi Arabia) hospitals that accommodate COVID-19 patients. The study instrument was adapted and modified from the ”MERS-CoV Staff Questionnaire” and the Brief COPE.<br><strong>Results:</strong> The results showed that female, married, those with a bachelor’s degree, and aged 25–34 years had higher significant coping strategies. On the other hand, Filipino nurses assigned in the Outpatient Department and COVID-19 Isolation Ward had more negative feelings and encountered several factors causing stress but were coping in a better way than others.<br><strong>Conclusion:</strong> Nurses’ commitment to their profession appears to be an intrinsic motivation to continue caring for COVID-19 patients&nbsp; despite the risk of infection. Comfort with religion, spiritual beliefs, and the presence of a support system were the coping strategies used by nurses to ameliorate the stress and negative feelings during the COVID-19 outbreak.</p> <p><strong>Keywords:</strong> COVID-19, Saudi Arabia, nurses, feelings, factors causing stress, coping strategies</p> Maria Jocelyn B. Natividad, Khalid A. Aljohani, Mark Y. Roque, Helen M. Gamboa Copyright (c) Thu, 01 Jul 2021 00:00:00 +0000 Workplace Violence Against Doctors in Khartoum State, Sudan, 2020 <p><strong>Background:</strong> Workplace violence against healthcare workers and especially doctors are now clearly taken as a rapidly rising health&nbsp; problem in Sudan with great political and legal concerns. The current study was aimed at exploring the prevalence of verbal and physical workplace violence, the major factors associated with it, and its consequences reported by medical staff in Khartoum, Sudan government hospitals in 2020.</p> <p><br><strong>Methods:</strong> This cross-sectional study utilized self-administered questionnaires to collect data on aspects of workplace violence against doctors working in the government hospitals of Khartoum, Sudan. A nine-item self-reported workplace violence scale was used. An online survey of self-reported work-related violence exposure during the preceding 12 months was sent to conveniently selected doctors. In total, 387 doctors completed the questionnaire in 2020. Data were analyzed using the SPSS version 26.</p> <p><strong>Results</strong>: One hundred and ninety five (50%) respondents reported they were victims of violence in the previous 12 months; 92% of them experienced nonphysical violence; while female doctors were more likely to experience this type of violence (67%), younger respondents &lt;30 years of age were more likely to encounter violent episodes. Results show an association between exposure to physical violence and working at an emergency department. The assailants were mostly males in the age group of 19–35 years (70.2%), most of them were under no influence (60.8%).</p> <p><strong>Conclusion:</strong> Approximately one in every two doctors had experienced some degree of violence, either physical or nonphysical or both, and it was negatively reflected on their psychological status as well as their work performance.</p> <p><strong>Keywords:</strong> violence, workplace, doctors, physical, nonphysical</p> Muna Mohamed Elamin, Salih Boushra Hamza, Khabab Abbasher, Khalid Elsir Idris, Yassin Abdelrahim Abdallah, Khadija Ala Abdalmaqsud Muhmmed, Tibyan Hassan Mustafa Alkabashi, Radi Tofaha Alhusseini, Sidieg Elias Sidieg Mohammed, Ahmed Alsayed Mohammed Mustafa Copyright (c)